{"text_format":"1","workbook":"xlsx","n_sheets":20,"sheets":["Instructions","CPT & HCPCS Lookup Tool","NDC Lookup Tool","NDCDropFormulas","Average Table - NDC","Average Table","HCPCS Pivot","Average Table - HCPCS","Sheet6 (hcpcs)","HCPCSPayer&Plan","HCPCSPayer&Code&Desc","HCPCSCombo","HCPCS Table","CPT Pivot","Average Table - CPT","Sheet6 (cpt)","CPTPayer&Codes&Desc","CPT Table","CPTPayer&Plans","CPTCombo"],"not_rendered":{"charts":0,"images":3,"macros":1,"external_links":11,"defined_names":56,"comments":0,"pivot_tables":3},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"Instructions","index":0,"n_rows":0,"n_cols":0,"rows_kept":0,"cut":false,"hidden":false,"merged":[]}

{"sheet":"CPT & HCPCS Lookup Tool","index":1,"n_rows":36,"n_cols":10,"rows_kept":36,"cut":false,"hidden":false,"merged":[]}
[]
[null,null,null,null,null,"BMC Outpatient CPT & HCPCS Lookup Tool"]
[]
[]
[]
[null,null,null,null,"CPT",null,null,null,null,"HCPCS"]
[]
[]
[null,null,null,"Insurance Carrier",null,null,"Select the Insurance Carrier from the dropdown list",null,"Insurance Carrier"]
[null,null,null,"Insurance Plan",null,null,"Select the Insurance Plan from the dropdown list. ",null,"Insurance Plan"]
[null,null,null,"Bill Code",null,null,"Select the Bill Code from the dropdown list",null,"Bill Code"]
[null,null,null,null,{"$f":"CONCATENATE(INDEX(CPTCombo!L4:L22,CPTCombo!K4),\" - \",INDEX(CPTCombo!N4:N11,CPTCombo!M4),\" - \",INDEX(CPTCombo!P4:P3564,CPTCombo!O4))","v":"Select Insurance Carrier - Select Insurance Plan - Select CPT Code"},null,null,null,null,{"$f":"CONCATENATE(INDEX(HCPCSCombo!L4:L22,HCPCSCombo!K4),\" - \",INDEX(HCPCSCombo!N4:N11,HCPCSCombo!M4),\" - \",INDEX(HCPCSCombo!P4:P327,HCPCSCombo!O4))","v":"Select Insurance Carrier - Select Insurance Plan - Select HCPCS Code"}]
[null,null,null,"CPT Code",{"$f":"IFERROR(VLOOKUP(E$12,'Average Table'!$C:$N,5,0),\"-\")","v":"-"},null,null,null,"HCPCS Code",{"$f":"IFERROR(VLOOKUP(J$12,'Average Table'!$C:$N,5,0),\"-\")","v":"-"}]
[null,null,null,"CPT Code Description",{"$f":"IFERROR(VLOOKUP(E$12,'Average Table'!$C:$N,6,0),\"-\")","v":"-"},null,null,null,"HCPCS Code Description",{"$f":"IFERROR(VLOOKUP(J$12,'Average Table'!$C:$N,6,0),\"-\")","v":"-"}]
[null,null,null,"Average Total Charges",{"$f":"IFERROR(VLOOKUP(E$12,'Average Table'!$C:$N,8,0),0)","v":0},null,null,null,"Average Total Charges",{"$f":"IFERROR(VLOOKUP(J$12,'Average Table'!$C:$N,8,0),0)","v":0}]
[null,null,null,"Your Payer Specific Rate",{"$f":"IFERROR(VLOOKUP(E$12,'Average Table'!$C:$N,9,0),0)","v":0},null,null,null,"Your Payer Specific Rate",{"$f":"IFERROR(VLOOKUP(J$12,'Average Table'!$C:$N,9,0),0)","v":0}]
[null,null,null,"Minimum Negotiated Rate",{"$f":"IFERROR(VLOOKUP(E$12,'Average Table'!$C:$N,10,0),0)","v":0},null,null,null,"Minimum Negotiated Rate",{"$f":"IFERROR(VLOOKUP(J$12,'Average Table'!$C:$N,10,0),0)","v":0}]
[null,null,null,"Maximum Negotiated Rate",{"$f":"IFERROR(VLOOKUP(E$12,'Average Table'!$C:$N,11,0),0)","v":0},null,null,null,"Maximum Negotiated Rate",{"$f":"IFERROR(VLOOKUP(J$12,'Average Table'!$C:$N,11,0),0)","v":0}]
[null,null,null,"Uninsured Rate",{"$f":"IFERROR(VLOOKUP(E$12,'Average Table'!$C:$N,12,0),0)","v":0},null,null,null,"Uninsured Rate",{"$f":"IFERROR(VLOOKUP(J$12,'Average Table'!$C:$N,12,0),0)","v":0}]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,"*Rates are based on the blended range."]

{"sheet":"NDC Lookup Tool","index":2,"n_rows":17,"n_cols":5,"rows_kept":17,"cut":false,"hidden":false,"merged":[]}
[]
[]
[]
[null,null,"BMC Outpatient NDC Lookup Tool"]
[]
[]
[]
[]
[null,"NDC",null,null,"Select from the drowdown list or start typing in your NDC in the box to the left"]
[]
[]
[null,"NDC Description",{"$f":"IFERROR(VLOOKUP($C$9,NDC_Average[[Bill Code]:[Self-Pay Charge]],2,0),\"-\")","v":"-"}]
[null,"Average Total Charges",{"$f":"IFERROR(VLOOKUP($C$9,NDC_Average[[Bill Code]:[Self-Pay Charge]],3,0),0)","v":0}]
[null,"Your Payer Specific Rate",{"$f":"IFERROR(VLOOKUP($C$9,NDC_Average[[Bill Code]:[Self-Pay Charge]],4,0),0)","v":0}]
[null,"Minimum Negotiated Rate",{"$f":"IFERROR(VLOOKUP($C$9,NDC_Average[[Bill Code]:[Self-Pay Charge]],5,0),0)","v":0}]
[null,"Maximum Negotiated Rate",{"$f":"IFERROR(VLOOKUP($C$9,NDC_Average[[Bill Code]:[Self-Pay Charge]],6,0),0)","v":0}]
[null,"Uninsured Rate",{"$f":"IFERROR(VLOOKUP($C$9,NDC_Average[[Bill Code]:[Self-Pay Charge]],7,0),0)","v":0}]

{"sheet":"NDCDropFormulas","index":3,"n_rows":3716,"n_cols":11,"rows_kept":3716,"cut":false,"hidden":true,"merged":[]}
[]
[null,null,null,null,null,"Helper Col 1","Helper Col 2","Helper Col 3"]
[null,null,null,null,"Select NDC",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3,1),\"\"))","v":1},{"$f":"IF(F3=1,COUNTIF($F$3:F3,1),\"\")","v":1},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3),$G$3:$G$3716,0)),\"\")","v":"Select NDC"}]
[null,null,null,null,"00002323560",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E4,1),\"\"))","v":1},{"$f":"IF(F4=1,COUNTIF($F$3:F4,1),\"\")","v":2},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G4),$G$3:$G$3716,0)),\"\")","v":"00002323560"},null,null,"This is the raw data for the NDC dropdown list. "]
[null,null,null,null,"00002324033",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E5,1),\"\"))","v":1},{"$f":"IF(F5=1,COUNTIF($F$3:F5,1),\"\")","v":3},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G5),$G$3:$G$3716,0)),\"\")","v":"00002324033"},null,null,"If need to update this list, new codes need to be added both the the Average table, and then here"]
[null,null,null,null,"00002416502",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E6,1),\"\"))","v":1},{"$f":"IF(F6=1,COUNTIF($F$3:F6,1),\"\")","v":4},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G6),$G$3:$G$3716,0)),\"\")","v":"00002416502"},null,null,"PLUS - the formuals will need to be updated in order to include the additional rows"]
[null,null,null,null,"00002446430",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E7,1),\"\"))","v":1},{"$f":"IF(F7=1,COUNTIF($F$3:F7,1),\"\")","v":5},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G7),$G$3:$G$3716,0)),\"\")","v":"00002446430"}]
[null,null,null,null,"00002475977",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E8,1),\"\"))","v":1},{"$f":"IF(F8=1,COUNTIF($F$3:F8,1),\"\")","v":6},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G8),$G$3:$G$3716,0)),\"\")","v":"00002475977"},null,null,"Name manager - Define Name for the Drop down list. That is used in the combo box on the userform page"]
[null,null,null,null,"00002512101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E9,1),\"\"))","v":1},{"$f":"IF(F9=1,COUNTIF($F$3:F9,1),\"\")","v":7},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G9),$G$3:$G$3716,0)),\"\")","v":"00002512101"},null,null,"Based on Col H"]
[null,null,null,null,"00002512152",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E10,1),\"\"))","v":1},{"$f":"IF(F10=1,COUNTIF($F$3:F10,1),\"\")","v":8},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G10),$G$3:$G$3716,0)),\"\")","v":"00002512152"},null,null,"NDCDropFormulas is the name"]
[null,null,null,null,"00002512301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E11,1),\"\"))","v":1},{"$f":"IF(F11=1,COUNTIF($F$3:F11,1),\"\")","v":9},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G11),$G$3:$G$3716,0)),\"\")","v":"00002512301"}]
[null,null,null,null,"00002512330",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E12,1),\"\"))","v":1},{"$f":"IF(F12=1,COUNTIF($F$3:F12,1),\"\")","v":10},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G12),$G$3:$G$3716,0)),\"\")","v":"00002512330"}]
[null,null,null,null,"00002733511",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E13,1),\"\"))","v":1},{"$f":"IF(F13=1,COUNTIF($F$3:F13,1),\"\")","v":11},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G13),$G$3:$G$3716,0)),\"\")","v":"00002733511"}]
[null,null,null,null,"00002734901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E14,1),\"\"))","v":1},{"$f":"IF(F14=1,COUNTIF($F$3:F14,1),\"\")","v":12},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G14),$G$3:$G$3716,0)),\"\")","v":"00002734901"}]
[null,null,null,null,"00003089321",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E15,1),\"\"))","v":1},{"$f":"IF(F15=1,COUNTIF($F$3:F15,1),\"\")","v":13},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G15),$G$3:$G$3716,0)),\"\")","v":"00003089321"}]
[null,null,null,null,"00003089331",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E16,1),\"\"))","v":1},{"$f":"IF(F16=1,COUNTIF($F$3:F16,1),\"\")","v":14},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G16),$G$3:$G$3716,0)),\"\")","v":"00003089331"}]
[null,null,null,null,"00003089421",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E17,1),\"\"))","v":1},{"$f":"IF(F17=1,COUNTIF($F$3:F17,1),\"\")","v":15},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G17),$G$3:$G$3716,0)),\"\")","v":"00003089421"}]
[null,null,null,null,"00003089431",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E18,1),\"\"))","v":1},{"$f":"IF(F18=1,COUNTIF($F$3:F18,1),\"\")","v":16},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G18),$G$3:$G$3716,0)),\"\")","v":"00003089431"}]
[null,null,null,null,"00003161112",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E19,1),\"\"))","v":1},{"$f":"IF(F19=1,COUNTIF($F$3:F19,1),\"\")","v":17},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G19),$G$3:$G$3716,0)),\"\")","v":"00003161112"}]
[null,null,null,null,"00003256016",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E20,1),\"\"))","v":1},{"$f":"IF(F20=1,COUNTIF($F$3:F20,1),\"\")","v":18},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G20),$G$3:$G$3716,0)),\"\")","v":"00003256016"}]
[null,null,null,null,"00003257016",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E21,1),\"\"))","v":1},{"$f":"IF(F21=1,COUNTIF($F$3:F21,1),\"\")","v":19},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G21),$G$3:$G$3716,0)),\"\")","v":"00003257016"}]
[null,null,null,null,"00003362212",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E22,1),\"\"))","v":1},{"$f":"IF(F22=1,COUNTIF($F$3:F22,1),\"\")","v":20},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G22),$G$3:$G$3716,0)),\"\")","v":"00003362212"}]
[null,null,null,null,"00003362412",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E23,1),\"\"))","v":1},{"$f":"IF(F23=1,COUNTIF($F$3:F23,1),\"\")","v":21},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G23),$G$3:$G$3716,0)),\"\")","v":"00003362412"}]
[null,null,null,null,"00003363112",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E24,1),\"\"))","v":1},{"$f":"IF(F24=1,COUNTIF($F$3:F24,1),\"\")","v":22},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G24),$G$3:$G$3716,0)),\"\")","v":"00003363112"}]
[null,null,null,null,"00004003822",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E25,1),\"\"))","v":1},{"$f":"IF(F25=1,COUNTIF($F$3:F25,1),\"\")","v":23},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G25),$G$3:$G$3716,0)),\"\")","v":"00004003822"}]
[null,null,null,null,"00004003909",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E26,1),\"\"))","v":1},{"$f":"IF(F26=1,COUNTIF($F$3:F26,1),\"\")","v":24},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G26),$G$3:$G$3716,0)),\"\")","v":"00004003909"}]
[null,null,null,null,"00004024451",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E27,1),\"\"))","v":1},{"$f":"IF(F27=1,COUNTIF($F$3:F27,1),\"\")","v":25},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G27),$G$3:$G$3716,0)),\"\")","v":"00004024451"}]
[null,null,null,null,"00004029809",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E28,1),\"\"))","v":1},{"$f":"IF(F28=1,COUNTIF($F$3:F28,1),\"\")","v":26},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G28),$G$3:$G$3716,0)),\"\")","v":"00004029809"}]
[null,null,null,null,"00004038039",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E29,1),\"\"))","v":1},{"$f":"IF(F29=1,COUNTIF($F$3:F29,1),\"\")","v":27},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G29),$G$3:$G$3716,0)),\"\")","v":"00004038039"}]
[null,null,null,null,"00004080085",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E30,1),\"\"))","v":1},{"$f":"IF(F30=1,COUNTIF($F$3:F30,1),\"\")","v":28},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G30),$G$3:$G$3716,0)),\"\")","v":"00004080085"}]
[null,null,null,null,"00004080185",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E31,1),\"\"))","v":1},{"$f":"IF(F31=1,COUNTIF($F$3:F31,1),\"\")","v":29},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G31),$G$3:$G$3716,0)),\"\")","v":"00004080185"}]
[null,null,null,null,"00004080285",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E32,1),\"\"))","v":1},{"$f":"IF(F32=1,COUNTIF($F$3:F32,1),\"\")","v":30},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G32),$G$3:$G$3716,0)),\"\")","v":"00004080285"}]
[null,null,null,null,"00004082009",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E33,1),\"\"))","v":1},{"$f":"IF(F33=1,COUNTIF($F$3:F33,1),\"\")","v":31},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G33),$G$3:$G$3716,0)),\"\")","v":"00004082009"}]
[null,null,null,null,"00004082205",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E34,1),\"\"))","v":1},{"$f":"IF(F34=1,COUNTIF($F$3:F34,1),\"\")","v":32},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G34),$G$3:$G$3716,0)),\"\")","v":"00004082205"}]
[null,null,null,null,"00006003220",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E35,1),\"\"))","v":1},{"$f":"IF(F35=1,COUNTIF($F$3:F35,1),\"\")","v":33},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G35),$G$3:$G$3716,0)),\"\")","v":"00006003220"}]
[null,null,null,null,"00006022761",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E36,1),\"\"))","v":1},{"$f":"IF(F36=1,COUNTIF($F$3:F36,1),\"\")","v":34},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G36),$G$3:$G$3716,0)),\"\")","v":"00006022761"}]
[null,null,null,null,"00006047361",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E37,1),\"\"))","v":1},{"$f":"IF(F37=1,COUNTIF($F$3:F37,1),\"\")","v":35},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G37),$G$3:$G$3716,0)),\"\")","v":"00006047361"}]
[null,null,null,null,"00006047761",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E38,1),\"\"))","v":1},{"$f":"IF(F38=1,COUNTIF($F$3:F38,1),\"\")","v":36},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G38),$G$3:$G$3716,0)),\"\")","v":"00006047761"}]
[null,null,null,null,"00006057143",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E39,1),\"\"))","v":1},{"$f":"IF(F39=1,COUNTIF($F$3:F39,1),\"\")","v":37},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G39),$G$3:$G$3716,0)),\"\")","v":"00006057143"}]
[null,null,null,null,"00006057362",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E40,1),\"\"))","v":1},{"$f":"IF(F40=1,COUNTIF($F$3:F40,1),\"\")","v":38},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G40),$G$3:$G$3716,0)),\"\")","v":"00006057362"}]
[null,null,null,null,"00006071131",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E41,1),\"\"))","v":1},{"$f":"IF(F41=1,COUNTIF($F$3:F41,1),\"\")","v":39},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G41),$G$3:$G$3716,0)),\"\")","v":"00006071131"}]
[null,null,null,null,"00006095154",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E42,1),\"\"))","v":1},{"$f":"IF(F42=1,COUNTIF($F$3:F42,1),\"\")","v":40},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G42),$G$3:$G$3716,0)),\"\")","v":"00006095154"}]
[null,null,null,null,"00006095231",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E43,1),\"\"))","v":1},{"$f":"IF(F43=1,COUNTIF($F$3:F43,1),\"\")","v":41},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G43),$G$3:$G$3716,0)),\"\")","v":"00006095231"}]
[null,null,null,null,"00006306901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E44,1),\"\"))","v":1},{"$f":"IF(F44=1,COUNTIF($F$3:F44,1),\"\")","v":42},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G44),$G$3:$G$3716,0)),\"\")","v":"00006306901"}]
[null,null,null,null,"00006307402",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E45,1),\"\"))","v":1},{"$f":"IF(F45=1,COUNTIF($F$3:F45,1),\"\")","v":43},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G45),$G$3:$G$3716,0)),\"\")","v":"00006307402"}]
[null,null,null,null,"00006360361",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E46,1),\"\"))","v":1},{"$f":"IF(F46=1,COUNTIF($F$3:F46,1),\"\")","v":44},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G46),$G$3:$G$3716,0)),\"\")","v":"00006360361"}]
[null,null,null,null,"00006404541",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E47,1),\"\"))","v":1},{"$f":"IF(F47=1,COUNTIF($F$3:F47,1),\"\")","v":45},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G47),$G$3:$G$3716,0)),\"\")","v":"00006404541"}]
[null,null,null,null,"00006417100",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E48,1),\"\"))","v":1},{"$f":"IF(F48=1,COUNTIF($F$3:F48,1),\"\")","v":46},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G48),$G$3:$G$3716,0)),\"\")","v":"00006417100"}]
[null,null,null,null,"00006417101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E49,1),\"\"))","v":1},{"$f":"IF(F49=1,COUNTIF($F$3:F49,1),\"\")","v":47},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G49),$G$3:$G$3716,0)),\"\")","v":"00006417101"}]
[null,null,null,null,"00006498100",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E50,1),\"\"))","v":1},{"$f":"IF(F50=1,COUNTIF($F$3:F50,1),\"\")","v":48},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G50),$G$3:$G$3716,0)),\"\")","v":"00006498100"}]
[null,null,null,null,"00006498101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E51,1),\"\"))","v":1},{"$f":"IF(F51=1,COUNTIF($F$3:F51,1),\"\")","v":49},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G51),$G$3:$G$3716,0)),\"\")","v":"00006498101"}]
[null,null,null,null,"00009003101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E52,1),\"\"))","v":1},{"$f":"IF(F52=1,COUNTIF($F$3:F52,1),\"\")","v":50},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G52),$G$3:$G$3716,0)),\"\")","v":"00009003101"}]
[null,null,null,null,"00009023301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E53,1),\"\"))","v":1},{"$f":"IF(F53=1,COUNTIF($F$3:F53,1),\"\")","v":51},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G53),$G$3:$G$3716,0)),\"\")","v":"00009023301"}]
[null,null,null,null,"00009023303",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E54,1),\"\"))","v":1},{"$f":"IF(F54=1,COUNTIF($F$3:F54,1),\"\")","v":52},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G54),$G$3:$G$3716,0)),\"\")","v":"00009023303"}]
[null,null,null,null,"00009454101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E55,1),\"\"))","v":1},{"$f":"IF(F55=1,COUNTIF($F$3:F55,1),\"\")","v":53},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G55),$G$3:$G$3716,0)),\"\")","v":"00009454101"}]
[null,null,null,null,"00009454401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E56,1),\"\"))","v":1},{"$f":"IF(F56=1,COUNTIF($F$3:F56,1),\"\")","v":54},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G56),$G$3:$G$3716,0)),\"\")","v":"00009454401"}]
[null,null,null,null,"00009470913",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E57,1),\"\"))","v":1},{"$f":"IF(F57=1,COUNTIF($F$3:F57,1),\"\")","v":55},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G57),$G$3:$G$3716,0)),\"\")","v":"00009470913"}]
[null,null,null,null,"00009513502",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E58,1),\"\"))","v":1},{"$f":"IF(F58=1,COUNTIF($F$3:F58,1),\"\")","v":56},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G58),$G$3:$G$3716,0)),\"\")","v":"00009513502"}]
[null,null,null,null,"00009513503",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E59,1),\"\"))","v":1},{"$f":"IF(F59=1,COUNTIF($F$3:F59,1),\"\")","v":57},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G59),$G$3:$G$3716,0)),\"\")","v":"00009513503"}]
[null,null,null,null,"00009513601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E60,1),\"\"))","v":1},{"$f":"IF(F60=1,COUNTIF($F$3:F60,1),\"\")","v":58},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G60),$G$3:$G$3716,0)),\"\")","v":"00009513601"}]
[null,null,null,null,"00009519001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E61,1),\"\"))","v":1},{"$f":"IF(F61=1,COUNTIF($F$3:F61,1),\"\")","v":59},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G61),$G$3:$G$3716,0)),\"\")","v":"00009519001"}]
[null,null,null,null,"00009519004",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E62,1),\"\"))","v":1},{"$f":"IF(F62=1,COUNTIF($F$3:F62,1),\"\")","v":60},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G62),$G$3:$G$3716,0)),\"\")","v":"00009519004"}]
[null,null,null,null,"00009519101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E63,1),\"\"))","v":1},{"$f":"IF(F63=1,COUNTIF($F$3:F63,1),\"\")","v":61},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G63),$G$3:$G$3716,0)),\"\")","v":"00009519101"}]
[null,null,null,null,"00009519104",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E64,1),\"\"))","v":1},{"$f":"IF(F64=1,COUNTIF($F$3:F64,1),\"\")","v":62},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G64),$G$3:$G$3716,0)),\"\")","v":"00009519104"}]
[null,null,null,null,"00013530117",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E65,1),\"\"))","v":1},{"$f":"IF(F65=1,COUNTIF($F$3:F65,1),\"\")","v":63},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G65),$G$3:$G$3716,0)),\"\")","v":"00013530117"}]
[null,null,null,null,"00015303020",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E66,1),\"\"))","v":1},{"$f":"IF(F66=1,COUNTIF($F$3:F66,1),\"\")","v":64},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G66),$G$3:$G$3716,0)),\"\")","v":"00015303020"}]
[null,null,null,null,"00015303120",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E67,1),\"\"))","v":1},{"$f":"IF(F67=1,COUNTIF($F$3:F67,1),\"\")","v":65},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G67),$G$3:$G$3716,0)),\"\")","v":"00015303120"}]
[null,null,null,null,"00015303220",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E68,1),\"\"))","v":1},{"$f":"IF(F68=1,COUNTIF($F$3:F68,1),\"\")","v":66},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G68),$G$3:$G$3716,0)),\"\")","v":"00015303220"}]
[null,null,null,null,"00016031660",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E69,1),\"\"))","v":1},{"$f":"IF(F69=1,COUNTIF($F$3:F69,1),\"\")","v":67},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G69),$G$3:$G$3716,0)),\"\")","v":"00016031660"}]
[null,null,null,null,"00023024004",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E70,1),\"\"))","v":1},{"$f":"IF(F70=1,COUNTIF($F$3:F70,1),\"\")","v":68},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G70),$G$3:$G$3716,0)),\"\")","v":"00023024004"}]
[null,null,null,null,"00023031204",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E71,1),\"\"))","v":1},{"$f":"IF(F71=1,COUNTIF($F$3:F71,1),\"\")","v":69},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G71),$G$3:$G$3716,0)),\"\")","v":"00023031204"}]
[null,null,null,null,"00023066704",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E72,1),\"\"))","v":1},{"$f":"IF(F72=1,COUNTIF($F$3:F72,1),\"\")","v":70},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G72),$G$3:$G$3716,0)),\"\")","v":"00023066704"}]
[null,null,null,null,"00023320503",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E73,1),\"\"))","v":1},{"$f":"IF(F73=1,COUNTIF($F$3:F73,1),\"\")","v":71},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G73),$G$3:$G$3716,0)),\"\")","v":"00023320503"}]
[null,null,null,null,"00023455430",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E74,1),\"\"))","v":1},{"$f":"IF(F74=1,COUNTIF($F$3:F74,1),\"\")","v":72},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G74),$G$3:$G$3716,0)),\"\")","v":"00023455430"}]
[null,null,null,null,"00023585318",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E75,1),\"\"))","v":1},{"$f":"IF(F75=1,COUNTIF($F$3:F75,1),\"\")","v":73},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G75),$G$3:$G$3716,0)),\"\")","v":"00023585318"}]
[null,null,null,null,"00023590204",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E76,1),\"\"))","v":1},{"$f":"IF(F76=1,COUNTIF($F$3:F76,1),\"\")","v":74},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G76),$G$3:$G$3716,0)),\"\")","v":"00023590204"}]
[null,null,null,null,"00023916330",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E77,1),\"\"))","v":1},{"$f":"IF(F77=1,COUNTIF($F$3:F77,1),\"\")","v":75},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G77),$G$3:$G$3716,0)),\"\")","v":"00023916330"}]
[null,null,null,null,"00023917705",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E78,1),\"\"))","v":1},{"$f":"IF(F78=1,COUNTIF($F$3:F78,1),\"\")","v":76},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G78),$G$3:$G$3716,0)),\"\")","v":"00023917705"}]
[null,null,null,null,"00023920515",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E79,1),\"\"))","v":1},{"$f":"IF(F79=1,COUNTIF($F$3:F79,1),\"\")","v":77},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G79),$G$3:$G$3716,0)),\"\")","v":"00023920515"}]
[null,null,null,null,"00024134803",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E80,1),\"\"))","v":1},{"$f":"IF(F80=1,COUNTIF($F$3:F80,1),\"\")","v":78},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G80),$G$3:$G$3716,0)),\"\")","v":"00024134803"}]
[null,null,null,null,"00024135202",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E81,1),\"\"))","v":1},{"$f":"IF(F81=1,COUNTIF($F$3:F81,1),\"\")","v":79},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G81),$G$3:$G$3716,0)),\"\")","v":"00024135202"}]
[null,null,null,null,"00024135301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E82,1),\"\"))","v":1},{"$f":"IF(F82=1,COUNTIF($F$3:F82,1),\"\")","v":80},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G82),$G$3:$G$3716,0)),\"\")","v":"00024135301"}]
[null,null,null,null,"00024159601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E83,1),\"\"))","v":1},{"$f":"IF(F83=1,COUNTIF($F$3:F83,1),\"\")","v":81},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G83),$G$3:$G$3716,0)),\"\")","v":"00024159601"}]
[null,null,null,null,"00025145160",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E84,1),\"\"))","v":1},{"$f":"IF(F84=1,COUNTIF($F$3:F84,1),\"\")","v":82},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G84),$G$3:$G$3716,0)),\"\")","v":"00025145160"}]
[null,null,null,null,"00025152034",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E85,1),\"\"))","v":1},{"$f":"IF(F85=1,COUNTIF($F$3:F85,1),\"\")","v":83},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G85),$G$3:$G$3716,0)),\"\")","v":"00025152034"}]
[null,null,null,null,"00025152534",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E86,1),\"\"))","v":1},{"$f":"IF(F86=1,COUNTIF($F$3:F86,1),\"\")","v":84},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G86),$G$3:$G$3716,0)),\"\")","v":"00025152534"}]
[null,null,null,null,"00025273231",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E87,1),\"\"))","v":1},{"$f":"IF(F87=1,COUNTIF($F$3:F87,1),\"\")","v":85},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G87),$G$3:$G$3716,0)),\"\")","v":"00025273231"}]
[null,null,null,null,"00025274231",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E88,1),\"\"))","v":1},{"$f":"IF(F88=1,COUNTIF($F$3:F88,1),\"\")","v":86},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G88),$G$3:$G$3716,0)),\"\")","v":"00025274231"}]
[null,null,null,null,"00032120607",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E89,1),\"\"))","v":1},{"$f":"IF(F89=1,COUNTIF($F$3:F89,1),\"\")","v":87},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G89),$G$3:$G$3716,0)),\"\")","v":"00032120607"}]
[null,null,null,null,"00032122401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E90,1),\"\"))","v":1},{"$f":"IF(F90=1,COUNTIF($F$3:F90,1),\"\")","v":88},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G90),$G$3:$G$3716,0)),\"\")","v":"00032122401"}]
[null,null,null,null,"00032170801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E91,1),\"\"))","v":1},{"$f":"IF(F91=1,COUNTIF($F$3:F91,1),\"\")","v":89},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G91),$G$3:$G$3716,0)),\"\")","v":"00032170801"}]
[null,null,null,null,"00037043001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E92,1),\"\"))","v":1},{"$f":"IF(F92=1,COUNTIF($F$3:F92,1),\"\")","v":90},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G92),$G$3:$G$3716,0)),\"\")","v":"00037043001"}]
[null,null,null,null,"00037043101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E93,1),\"\"))","v":1},{"$f":"IF(F93=1,COUNTIF($F$3:F93,1),\"\")","v":91},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G93),$G$3:$G$3716,0)),\"\")","v":"00037043101"}]
[null,null,null,null,"00037044267",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E94,1),\"\"))","v":1},{"$f":"IF(F94=1,COUNTIF($F$3:F94,1),\"\")","v":92},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G94),$G$3:$G$3716,0)),\"\")","v":"00037044267"}]
[null,null,null,null,"00037682210",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E95,1),\"\"))","v":1},{"$f":"IF(F95=1,COUNTIF($F$3:F95,1),\"\")","v":93},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G95),$G$3:$G$3716,0)),\"\")","v":"00037682210"}]
[null,null,null,null,"00046087221",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E96,1),\"\"))","v":1},{"$f":"IF(F96=1,COUNTIF($F$3:F96,1),\"\")","v":94},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G96),$G$3:$G$3716,0)),\"\")","v":"00046087221"}]
[null,null,null,null,"00046106505",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E97,1),\"\"))","v":1},{"$f":"IF(F97=1,COUNTIF($F$3:F97,1),\"\")","v":95},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G97),$G$3:$G$3716,0)),\"\")","v":"00046106505"}]
[null,null,null,null,"00046110081",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E98,1),\"\"))","v":1},{"$f":"IF(F98=1,COUNTIF($F$3:F98,1),\"\")","v":96},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G98),$G$3:$G$3716,0)),\"\")","v":"00046110081"}]
[null,null,null,null,"00046110281",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E99,1),\"\"))","v":1},{"$f":"IF(F99=1,COUNTIF($F$3:F99,1),\"\")","v":97},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G99),$G$3:$G$3716,0)),\"\")","v":"00046110281"}]
[null,null,null,null,"00046110481",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E100,1),\"\"))","v":1},{"$f":"IF(F100=1,COUNTIF($F$3:F100,1),\"\")","v":98},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G100),$G$3:$G$3716,0)),\"\")","v":"00046110481"}]
[null,null,null,null,"00049318030",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E101,1),\"\"))","v":1},{"$f":"IF(F101=1,COUNTIF($F$3:F101,1),\"\")","v":99},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G101),$G$3:$G$3716,0)),\"\")","v":"00049318030"}]
[null,null,null,null,"00049396041",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E102,1),\"\"))","v":1},{"$f":"IF(F102=1,COUNTIF($F$3:F102,1),\"\")","v":100},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G102),$G$3:$G$3716,0)),\"\")","v":"00049396041"}]
[null,null,null,null,"00049490030",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E103,1),\"\"))","v":1},{"$f":"IF(F103=1,COUNTIF($F$3:F103,1),\"\")","v":101},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G103),$G$3:$G$3716,0)),\"\")","v":"00049490030"}]
[null,null,null,null,"00049491030",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E104,1),\"\"))","v":1},{"$f":"IF(F104=1,COUNTIF($F$3:F104,1),\"\")","v":102},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G104),$G$3:$G$3716,0)),\"\")","v":"00049491030"}]
[null,null,null,null,"00049491041",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E105,1),\"\"))","v":1},{"$f":"IF(F105=1,COUNTIF($F$3:F105,1),\"\")","v":103},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G105),$G$3:$G$3716,0)),\"\")","v":"00049491041"}]
[null,null,null,null,"00053623202",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E106,1),\"\"))","v":1},{"$f":"IF(F106=1,COUNTIF($F$3:F106,1),\"\")","v":104},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G106),$G$3:$G$3716,0)),\"\")","v":"00053623202"}]
[null,null,null,null,"00054000725",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E107,1),\"\"))","v":1},{"$f":"IF(F107=1,COUNTIF($F$3:F107,1),\"\")","v":105},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G107),$G$3:$G$3716,0)),\"\")","v":"00054000725"}]
[null,null,null,null,"00054001121",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E108,1),\"\"))","v":1},{"$f":"IF(F108=1,COUNTIF($F$3:F108,1),\"\")","v":106},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G108),$G$3:$G$3716,0)),\"\")","v":"00054001121"}]
[null,null,null,null,"00054002025",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E109,1),\"\"))","v":1},{"$f":"IF(F109=1,COUNTIF($F$3:F109,1),\"\")","v":107},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G109),$G$3:$G$3716,0)),\"\")","v":"00054002025"}]
[null,null,null,null,"00054002125",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E110,1),\"\"))","v":1},{"$f":"IF(F110=1,COUNTIF($F$3:F110,1),\"\")","v":108},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G110),$G$3:$G$3716,0)),\"\")","v":"00054002125"}]
[null,null,null,null,"00054002821",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E111,1),\"\"))","v":1},{"$f":"IF(F111=1,COUNTIF($F$3:F111,1),\"\")","v":109},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G111),$G$3:$G$3716,0)),\"\")","v":"00054002821"}]
[null,null,null,null,"00054007928",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E112,1),\"\"))","v":1},{"$f":"IF(F112=1,COUNTIF($F$3:F112,1),\"\")","v":110},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G112),$G$3:$G$3716,0)),\"\")","v":"00054007928"}]
[null,null,null,null,"00054008826",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E113,1),\"\"))","v":1},{"$f":"IF(F113=1,COUNTIF($F$3:F113,1),\"\")","v":111},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G113),$G$3:$G$3716,0)),\"\")","v":"00054008826"}]
[null,null,null,null,"00054009720",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E114,1),\"\"))","v":1},{"$f":"IF(F114=1,COUNTIF($F$3:F114,1),\"\")","v":112},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G114),$G$3:$G$3716,0)),\"\")","v":"00054009720"}]
[null,null,null,null,"00054009820",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E115,1),\"\"))","v":1},{"$f":"IF(F115=1,COUNTIF($F$3:F115,1),\"\")","v":113},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G115),$G$3:$G$3716,0)),\"\")","v":"00054009820"}]
[null,null,null,null,"00054010625",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E116,1),\"\"))","v":1},{"$f":"IF(F116=1,COUNTIF($F$3:F116,1),\"\")","v":114},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G116),$G$3:$G$3716,0)),\"\")","v":"00054010625"}]
[null,null,null,null,"00054010820",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E117,1),\"\"))","v":1},{"$f":"IF(F117=1,COUNTIF($F$3:F117,1),\"\")","v":115},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G117),$G$3:$G$3716,0)),\"\")","v":"00054010820"}]
[null,null,null,null,"00054011625",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E118,1),\"\"))","v":1},{"$f":"IF(F118=1,COUNTIF($F$3:F118,1),\"\")","v":116},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G118),$G$3:$G$3716,0)),\"\")","v":"00054011625"}]
[null,null,null,null,"00054011825",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E119,1),\"\"))","v":1},{"$f":"IF(F119=1,COUNTIF($F$3:F119,1),\"\")","v":117},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G119),$G$3:$G$3716,0)),\"\")","v":"00054011825"}]
[null,null,null,null,"00054011925",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E120,1),\"\"))","v":1},{"$f":"IF(F120=1,COUNTIF($F$3:F120,1),\"\")","v":118},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G120),$G$3:$G$3716,0)),\"\")","v":"00054011925"}]
[null,null,null,null,"00054014125",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E121,1),\"\"))","v":1},{"$f":"IF(F121=1,COUNTIF($F$3:F121,1),\"\")","v":119},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G121),$G$3:$G$3716,0)),\"\")","v":"00054014125"}]
[null,null,null,null,"00054022125",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E122,1),\"\"))","v":1},{"$f":"IF(F122=1,COUNTIF($F$3:F122,1),\"\")","v":120},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G122),$G$3:$G$3716,0)),\"\")","v":"00054022125"}]
[null,null,null,null,"00054024324",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E123,1),\"\"))","v":1},{"$f":"IF(F123=1,COUNTIF($F$3:F123,1),\"\")","v":121},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G123),$G$3:$G$3716,0)),\"\")","v":"00054024324"}]
[null,null,null,null,"00054024424",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E124,1),\"\"))","v":1},{"$f":"IF(F124=1,COUNTIF($F$3:F124,1),\"\")","v":122},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G124),$G$3:$G$3716,0)),\"\")","v":"00054024424"}]
[null,null,null,null,"00054024425",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E125,1),\"\"))","v":1},{"$f":"IF(F125=1,COUNTIF($F$3:F125,1),\"\")","v":123},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G125),$G$3:$G$3716,0)),\"\")","v":"00054024425"}]
[null,null,null,null,"00054031950",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E126,1),\"\"))","v":1},{"$f":"IF(F126=1,COUNTIF($F$3:F126,1),\"\")","v":124},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G126),$G$3:$G$3716,0)),\"\")","v":"00054031950"}]
[null,null,null,null,"00054034462",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E127,1),\"\"))","v":1},{"$f":"IF(F127=1,COUNTIF($F$3:F127,1),\"\")","v":125},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G127),$G$3:$G$3716,0)),\"\")","v":"00054034462"}]
[null,null,null,null,"00054038663",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E128,1),\"\"))","v":1},{"$f":"IF(F128=1,COUNTIF($F$3:F128,1),\"\")","v":126},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G128),$G$3:$G$3716,0)),\"\")","v":"00054038663"}]
[null,null,null,null,"00054041525",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E129,1),\"\"))","v":1},{"$f":"IF(F129=1,COUNTIF($F$3:F129,1),\"\")","v":127},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G129),$G$3:$G$3716,0)),\"\")","v":"00054041525"}]
[null,null,null,null,"00054045058",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E130,1),\"\"))","v":1},{"$f":"IF(F130=1,COUNTIF($F$3:F130,1),\"\")","v":128},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G130),$G$3:$G$3716,0)),\"\")","v":"00054045058"}]
[null,null,null,null,"00054070920",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E131,1),\"\"))","v":1},{"$f":"IF(F131=1,COUNTIF($F$3:F131,1),\"\")","v":129},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G131),$G$3:$G$3716,0)),\"\")","v":"00054070920"}]
[null,null,null,null,"00054311763",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E132,1),\"\"))","v":1},{"$f":"IF(F132=1,COUNTIF($F$3:F132,1),\"\")","v":130},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G132),$G$3:$G$3716,0)),\"\")","v":"00054311763"}]
[null,null,null,null,"00054318544",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E133,1),\"\"))","v":1},{"$f":"IF(F133=1,COUNTIF($F$3:F133,1),\"\")","v":131},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G133),$G$3:$G$3716,0)),\"\")","v":"00054318544"}]
[null,null,null,null,"00054344625",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E134,1),\"\"))","v":1},{"$f":"IF(F134=1,COUNTIF($F$3:F134,1),\"\")","v":132},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G134),$G$3:$G$3716,0)),\"\")","v":"00054344625"}]
[null,null,null,null,"00054353201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E135,1),\"\"))","v":1},{"$f":"IF(F135=1,COUNTIF($F$3:F135,1),\"\")","v":133},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G135),$G$3:$G$3716,0)),\"\")","v":"00054353201"}]
[null,null,null,null,"00054353244",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E136,1),\"\"))","v":1},{"$f":"IF(F136=1,COUNTIF($F$3:F136,1),\"\")","v":134},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G136),$G$3:$G$3716,0)),\"\")","v":"00054353244"}]
[null,null,null,null,"00054354258",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E137,1),\"\"))","v":1},{"$f":"IF(F137=1,COUNTIF($F$3:F137,1),\"\")","v":135},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G137),$G$3:$G$3716,0)),\"\")","v":"00054354258"}]
[null,null,null,null,"00054356699",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E138,1),\"\"))","v":1},{"$f":"IF(F138=1,COUNTIF($F$3:F138,1),\"\")","v":136},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G138),$G$3:$G$3716,0)),\"\")","v":"00054356699"}]
[null,null,null,null,"00054363063",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E139,1),\"\"))","v":1},{"$f":"IF(F139=1,COUNTIF($F$3:F139,1),\"\")","v":137},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G139),$G$3:$G$3716,0)),\"\")","v":"00054363063"}]
[null,null,null,null,"00054429725",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E140,1),\"\"))","v":1},{"$f":"IF(F140=1,COUNTIF($F$3:F140,1),\"\")","v":138},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G140),$G$3:$G$3716,0)),\"\")","v":"00054429725"}]
[null,null,null,null,"00054458111",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E141,1),\"\"))","v":1},{"$f":"IF(F141=1,COUNTIF($F$3:F141,1),\"\")","v":139},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G141),$G$3:$G$3716,0)),\"\")","v":"00054458111"}]
[null,null,null,null,"00054472125",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E142,1),\"\"))","v":1},{"$f":"IF(F142=1,COUNTIF($F$3:F142,1),\"\")","v":140},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G142),$G$3:$G$3716,0)),\"\")","v":"00054472125"}]
[null,null,null,null,"00054812025",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E143,1),\"\"))","v":1},{"$f":"IF(F143=1,COUNTIF($F$3:F143,1),\"\")","v":141},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G143),$G$3:$G$3716,0)),\"\")","v":"00054812025"}]
[null,null,null,null,"00054814622",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E144,1),\"\"))","v":1},{"$f":"IF(F144=1,COUNTIF($F$3:F144,1),\"\")","v":142},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G144),$G$3:$G$3716,0)),\"\")","v":"00054814622"}]
[null,null,null,null,"00054829725",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E145,1),\"\"))","v":1},{"$f":"IF(F145=1,COUNTIF($F$3:F145,1),\"\")","v":143},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G145),$G$3:$G$3716,0)),\"\")","v":"00054829725"}]
[null,null,null,null,"00054829925",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E146,1),\"\"))","v":1},{"$f":"IF(F146=1,COUNTIF($F$3:F146,1),\"\")","v":144},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G146),$G$3:$G$3716,0)),\"\")","v":"00054829925"}]
[null,null,null,null,"00054852625",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E147,1),\"\"))","v":1},{"$f":"IF(F147=1,COUNTIF($F$3:F147,1),\"\")","v":145},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G147),$G$3:$G$3716,0)),\"\")","v":"00054852625"}]
[null,null,null,null,"00054852725",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E148,1),\"\"))","v":1},{"$f":"IF(F148=1,COUNTIF($F$3:F148,1),\"\")","v":146},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G148),$G$3:$G$3716,0)),\"\")","v":"00054852725"}]
[null,null,null,null,"00054852825",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E149,1),\"\"))","v":1},{"$f":"IF(F149=1,COUNTIF($F$3:F149,1),\"\")","v":147},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G149),$G$3:$G$3716,0)),\"\")","v":"00054852825"}]
[null,null,null,null,"00054855324",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E150,1),\"\"))","v":1},{"$f":"IF(F150=1,COUNTIF($F$3:F150,1),\"\")","v":148},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G150),$G$3:$G$3716,0)),\"\")","v":"00054855324"}]
[null,null,null,null,"00054859511",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E151,1),\"\"))","v":1},{"$f":"IF(F151=1,COUNTIF($F$3:F151,1),\"\")","v":149},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G151),$G$3:$G$3716,0)),\"\")","v":"00054859511"}]
[null,null,null,null,"00054860325",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E152,1),\"\"))","v":1},{"$f":"IF(F152=1,COUNTIF($F$3:F152,1),\"\")","v":150},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G152),$G$3:$G$3716,0)),\"\")","v":"00054860325"}]
[null,null,null,null,"00054860425",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E153,1),\"\"))","v":1},{"$f":"IF(F153=1,COUNTIF($F$3:F153,1),\"\")","v":151},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G153),$G$3:$G$3716,0)),\"\")","v":"00054860425"}]
[null,null,null,null,"00054885925",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E154,1),\"\"))","v":1},{"$f":"IF(F154=1,COUNTIF($F$3:F154,1),\"\")","v":152},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G154),$G$3:$G$3716,0)),\"\")","v":"00054885925"}]
[null,null,null,null,"00056016901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E155,1),\"\"))","v":1},{"$f":"IF(F155=1,COUNTIF($F$3:F155,1),\"\")","v":153},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G155),$G$3:$G$3716,0)),\"\")","v":"00056016901"}]
[null,null,null,null,"00056016975",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E156,1),\"\"))","v":1},{"$f":"IF(F156=1,COUNTIF($F$3:F156,1),\"\")","v":154},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G156),$G$3:$G$3716,0)),\"\")","v":"00056016975"}]
[null,null,null,null,"00056017001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E157,1),\"\"))","v":1},{"$f":"IF(F157=1,COUNTIF($F$3:F157,1),\"\")","v":155},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G157),$G$3:$G$3716,0)),\"\")","v":"00056017001"}]
[null,null,null,null,"00056017201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E158,1),\"\"))","v":1},{"$f":"IF(F158=1,COUNTIF($F$3:F158,1),\"\")","v":156},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G158),$G$3:$G$3716,0)),\"\")","v":"00056017201"}]
[null,null,null,null,"00056017275",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E159,1),\"\"))","v":1},{"$f":"IF(F159=1,COUNTIF($F$3:F159,1),\"\")","v":157},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G159),$G$3:$G$3716,0)),\"\")","v":"00056017275"}]
[null,null,null,null,"00056017301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E160,1),\"\"))","v":1},{"$f":"IF(F160=1,COUNTIF($F$3:F160,1),\"\")","v":158},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G160),$G$3:$G$3716,0)),\"\")","v":"00056017301"}]
[null,null,null,null,"00056017601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E161,1),\"\"))","v":1},{"$f":"IF(F161=1,COUNTIF($F$3:F161,1),\"\")","v":159},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G161),$G$3:$G$3716,0)),\"\")","v":"00056017601"}]
[null,null,null,null,"00056017675",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E162,1),\"\"))","v":1},{"$f":"IF(F162=1,COUNTIF($F$3:F162,1),\"\")","v":160},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G162),$G$3:$G$3716,0)),\"\")","v":"00056017675"}]
[null,null,null,null,"00056018801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E163,1),\"\"))","v":1},{"$f":"IF(F163=1,COUNTIF($F$3:F163,1),\"\")","v":161},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G163),$G$3:$G$3716,0)),\"\")","v":"00056018801"}]
[null,null,null,null,"00056047030",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E164,1),\"\"))","v":1},{"$f":"IF(F164=1,COUNTIF($F$3:F164,1),\"\")","v":162},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G164),$G$3:$G$3716,0)),\"\")","v":"00056047030"}]
[null,null,null,null,"00056047492",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E165,1),\"\"))","v":1},{"$f":"IF(F165=1,COUNTIF($F$3:F165,1),\"\")","v":163},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G165),$G$3:$G$3716,0)),\"\")","v":"00056047492"}]
[null,null,null,null,"00056051030",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E166,1),\"\"))","v":1},{"$f":"IF(F166=1,COUNTIF($F$3:F166,1),\"\")","v":164},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G166),$G$3:$G$3716,0)),\"\")","v":"00056051030"}]
[null,null,null,null,"00056051168",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E167,1),\"\"))","v":1},{"$f":"IF(F167=1,COUNTIF($F$3:F167,1),\"\")","v":165},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G167),$G$3:$G$3716,0)),\"\")","v":"00056051168"}]
[null,null,null,null,"00064501030",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E168,1),\"\"))","v":1},{"$f":"IF(F168=1,COUNTIF($F$3:F168,1),\"\")","v":166},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G168),$G$3:$G$3716,0)),\"\")","v":"00064501030"}]
[null,null,null,null,"00065024610",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E169,1),\"\"))","v":1},{"$f":"IF(F169=1,COUNTIF($F$3:F169,1),\"\")","v":167},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G169),$G$3:$G$3716,0)),\"\")","v":"00065024610"}]
[null,null,null,null,"00065030355",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E170,1),\"\"))","v":1},{"$f":"IF(F170=1,COUNTIF($F$3:F170,1),\"\")","v":168},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G170),$G$3:$G$3716,0)),\"\")","v":"00065030355"}]
[null,null,null,null,"00065039515",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E171,1),\"\"))","v":1},{"$f":"IF(F171=1,COUNTIF($F$3:F171,1),\"\")","v":169},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G171),$G$3:$G$3716,0)),\"\")","v":"00065039515"}]
[null,null,null,null,"00065063827",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E172,1),\"\"))","v":1},{"$f":"IF(F172=1,COUNTIF($F$3:F172,1),\"\")","v":170},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G172),$G$3:$G$3716,0)),\"\")","v":"00065063827"}]
[null,null,null,null,"00065064435",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E173,1),\"\"))","v":1},{"$f":"IF(F173=1,COUNTIF($F$3:F173,1),\"\")","v":171},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G173),$G$3:$G$3716,0)),\"\")","v":"00065064435"}]
[null,null,null,null,"00065064515",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E174,1),\"\"))","v":1},{"$f":"IF(F174=1,COUNTIF($F$3:F174,1),\"\")","v":172},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G174),$G$3:$G$3716,0)),\"\")","v":"00065064515"}]
[null,null,null,null,"00065064835",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E175,1),\"\"))","v":1},{"$f":"IF(F175=1,COUNTIF($F$3:F175,1),\"\")","v":173},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G175),$G$3:$G$3716,0)),\"\")","v":"00065064835"}]
[null,null,null,null,"00065074114",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E176,1),\"\"))","v":1},{"$f":"IF(F176=1,COUNTIF($F$3:F176,1),\"\")","v":174},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G176),$G$3:$G$3716,0)),\"\")","v":"00065074114"}]
[null,null,null,null,"00065401303",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E177,1),\"\"))","v":1},{"$f":"IF(F177=1,COUNTIF($F$3:F177,1),\"\")","v":175},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G177),$G$3:$G$3716,0)),\"\")","v":"00065401303"}]
[null,null,null,null,"00067434601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E178,1),\"\"))","v":1},{"$f":"IF(F178=1,COUNTIF($F$3:F178,1),\"\")","v":176},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G178),$G$3:$G$3716,0)),\"\")","v":"00067434601"}]
[null,null,null,null,"00067512414",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E179,1),\"\"))","v":1},{"$f":"IF(F179=1,COUNTIF($F$3:F179,1),\"\")","v":177},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G179),$G$3:$G$3716,0)),\"\")","v":"00067512414"}]
[null,null,null,null,"00067512514",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E180,1),\"\"))","v":1},{"$f":"IF(F180=1,COUNTIF($F$3:F180,1),\"\")","v":178},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G180),$G$3:$G$3716,0)),\"\")","v":"00067512514"}]
[null,null,null,null,"00067512614",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E181,1),\"\"))","v":1},{"$f":"IF(F181=1,COUNTIF($F$3:F181,1),\"\")","v":179},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G181),$G$3:$G$3716,0)),\"\")","v":"00067512614"}]
[null,null,null,null,"00068059701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E182,1),\"\"))","v":1},{"$f":"IF(F182=1,COUNTIF($F$3:F182,1),\"\")","v":180},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G182),$G$3:$G$3716,0)),\"\")","v":"00068059701"}]
[null,null,null,null,"00069009402",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E183,1),\"\"))","v":1},{"$f":"IF(F183=1,COUNTIF($F$3:F183,1),\"\")","v":181},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G183),$G$3:$G$3716,0)),\"\")","v":"00069009402"}]
[null,null,null,null,"00069011201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E184,1),\"\"))","v":1},{"$f":"IF(F184=1,COUNTIF($F$3:F184,1),\"\")","v":182},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G184),$G$3:$G$3716,0)),\"\")","v":"00069011201"}]
[null,null,null,null,"00069012201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E185,1),\"\"))","v":1},{"$f":"IF(F185=1,COUNTIF($F$3:F185,1),\"\")","v":183},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G185),$G$3:$G$3716,0)),\"\")","v":"00069012201"}]
[null,null,null,null,"00069030801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E186,1),\"\"))","v":1},{"$f":"IF(F186=1,COUNTIF($F$3:F186,1),\"\")","v":184},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G186),$G$3:$G$3716,0)),\"\")","v":"00069030801"}]
[null,null,null,null,"00069046856",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E187,1),\"\"))","v":1},{"$f":"IF(F187=1,COUNTIF($F$3:F187,1),\"\")","v":185},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G187),$G$3:$G$3716,0)),\"\")","v":"00069046856"}]
[null,null,null,null,"00069046956",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E188,1),\"\"))","v":1},{"$f":"IF(F188=1,COUNTIF($F$3:F188,1),\"\")","v":186},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G188),$G$3:$G$3716,0)),\"\")","v":"00069046956"}]
[null,null,null,null,"00069306030",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E189,1),\"\"))","v":1},{"$f":"IF(F189=1,COUNTIF($F$3:F189,1),\"\")","v":187},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G189),$G$3:$G$3716,0)),\"\")","v":"00069306030"}]
[null,null,null,null,"00069406189",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E190,1),\"\"))","v":1},{"$f":"IF(F190=1,COUNTIF($F$3:F190,1),\"\")","v":188},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G190),$G$3:$G$3716,0)),\"\")","v":"00069406189"}]
[null,null,null,null,"00069421030",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E191,1),\"\"))","v":1},{"$f":"IF(F191=1,COUNTIF($F$3:F191,1),\"\")","v":189},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G191),$G$3:$G$3716,0)),\"\")","v":"00069421030"}]
[null,null,null,null,"00069422030",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E192,1),\"\"))","v":1},{"$f":"IF(F192=1,COUNTIF($F$3:F192,1),\"\")","v":190},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G192),$G$3:$G$3716,0)),\"\")","v":"00069422030"}]
[null,null,null,null,"00069580043",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E193,1),\"\"))","v":1},{"$f":"IF(F193=1,COUNTIF($F$3:F193,1),\"\")","v":191},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G193),$G$3:$G$3716,0)),\"\")","v":"00069580043"}]
[null,null,null,null,"00069580060",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E194,1),\"\"))","v":1},{"$f":"IF(F194=1,COUNTIF($F$3:F194,1),\"\")","v":192},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G194),$G$3:$G$3716,0)),\"\")","v":"00069580060"}]
[null,null,null,null,"00071000740",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E195,1),\"\"))","v":1},{"$f":"IF(F195=1,COUNTIF($F$3:F195,1),\"\")","v":193},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G195),$G$3:$G$3716,0)),\"\")","v":"00071000740"}]
[null,null,null,null,"00071036924",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E196,1),\"\"))","v":1},{"$f":"IF(F196=1,COUNTIF($F$3:F196,1),\"\")","v":194},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G196),$G$3:$G$3716,0)),\"\")","v":"00071036924"}]
[null,null,null,null,"00071036940",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E197,1),\"\"))","v":1},{"$f":"IF(F197=1,COUNTIF($F$3:F197,1),\"\")","v":195},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G197),$G$3:$G$3716,0)),\"\")","v":"00071036940"}]
[null,null,null,null,"00071041813",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E198,1),\"\"))","v":1},{"$f":"IF(F198=1,COUNTIF($F$3:F198,1),\"\")","v":196},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G198),$G$3:$G$3716,0)),\"\")","v":"00071041813"}]
[null,null,null,null,"00071041924",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E199,1),\"\"))","v":1},{"$f":"IF(F199=1,COUNTIF($F$3:F199,1),\"\")","v":197},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G199),$G$3:$G$3716,0)),\"\")","v":"00071041924"}]
[null,null,null,null,"00071101268",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E200,1),\"\"))","v":1},{"$f":"IF(F200=1,COUNTIF($F$3:F200,1),\"\")","v":198},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G200),$G$3:$G$3716,0)),\"\")","v":"00071101268"}]
[null,null,null,null,"00071101541",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E201,1),\"\"))","v":1},{"$f":"IF(F201=1,COUNTIF($F$3:F201,1),\"\")","v":199},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G201),$G$3:$G$3716,0)),\"\")","v":"00071101541"}]
[null,null,null,null,"00071101641",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E202,1),\"\"))","v":1},{"$f":"IF(F202=1,COUNTIF($F$3:F202,1),\"\")","v":200},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G202),$G$3:$G$3716,0)),\"\")","v":"00071101641"}]
[null,null,null,null,"00071101668",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E203,1),\"\"))","v":1},{"$f":"IF(F203=1,COUNTIF($F$3:F203,1),\"\")","v":201},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G203),$G$3:$G$3716,0)),\"\")","v":"00071101668"}]
[null,null,null,null,"00071101768",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E204,1),\"\"))","v":1},{"$f":"IF(F204=1,COUNTIF($F$3:F204,1),\"\")","v":202},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G204),$G$3:$G$3716,0)),\"\")","v":"00071101768"}]
[null,null,null,null,"00071374066",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E205,1),\"\"))","v":1},{"$f":"IF(F205=1,COUNTIF($F$3:F205,1),\"\")","v":203},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G205),$G$3:$G$3716,0)),\"\")","v":"00071374066"}]
[null,null,null,null,"00074052260",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E206,1),\"\"))","v":1},{"$f":"IF(F206=1,COUNTIF($F$3:F206,1),\"\")","v":204},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G206),$G$3:$G$3716,0)),\"\")","v":"00074052260"}]
[null,null,null,null,"00074262528",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E207,1),\"\"))","v":1},{"$f":"IF(F207=1,COUNTIF($F$3:F207,1),\"\")","v":205},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G207),$G$3:$G$3716,0)),\"\")","v":"00074262528"}]
[null,null,null,null,"00074307490",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E208,1),\"\"))","v":1},{"$f":"IF(F208=1,COUNTIF($F$3:F208,1),\"\")","v":206},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G208),$G$3:$G$3716,0)),\"\")","v":"00074307490"}]
[null,null,null,null,"00074308090",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E209,1),\"\"))","v":1},{"$f":"IF(F209=1,COUNTIF($F$3:F209,1),\"\")","v":207},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G209),$G$3:$G$3716,0)),\"\")","v":"00074308090"}]
[null,null,null,null,"00074333330",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E210,1),\"\"))","v":1},{"$f":"IF(F210=1,COUNTIF($F$3:F210,1),\"\")","v":208},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G210),$G$3:$G$3716,0)),\"\")","v":"00074333330"}]
[null,null,null,null,"00074382611",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E211,1),\"\"))","v":1},{"$f":"IF(F211=1,COUNTIF($F$3:F211,1),\"\")","v":209},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G211),$G$3:$G$3716,0)),\"\")","v":"00074382611"}]
[null,null,null,null,"00074449201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E212,1),\"\"))","v":1},{"$f":"IF(F212=1,COUNTIF($F$3:F212,1),\"\")","v":210},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G212),$G$3:$G$3716,0)),\"\")","v":"00074449201"}]
[null,null,null,null,"00074455211",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E213,1),\"\"))","v":1},{"$f":"IF(F213=1,COUNTIF($F$3:F213,1),\"\")","v":211},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G213),$G$3:$G$3716,0)),\"\")","v":"00074455211"}]
[null,null,null,null,"00074518211",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E214,1),\"\"))","v":1},{"$f":"IF(F214=1,COUNTIF($F$3:F214,1),\"\")","v":212},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G214),$G$3:$G$3716,0)),\"\")","v":"00074518211"}]
[null,null,null,null,"00074518290",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E215,1),\"\"))","v":1},{"$f":"IF(F215=1,COUNTIF($F$3:F215,1),\"\")","v":213},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G215),$G$3:$G$3716,0)),\"\")","v":"00074518290"}]
[null,null,null,null,"00074611411",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E216,1),\"\"))","v":1},{"$f":"IF(F216=1,COUNTIF($F$3:F216,1),\"\")","v":214},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G216),$G$3:$G$3716,0)),\"\")","v":"00074611411"}]
[null,null,null,null,"00074611413",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E217,1),\"\"))","v":1},{"$f":"IF(F217=1,COUNTIF($F$3:F217,1),\"\")","v":215},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G217),$G$3:$G$3716,0)),\"\")","v":"00074611413"}]
[null,null,null,null,"00074621213",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E218,1),\"\"))","v":1},{"$f":"IF(F218=1,COUNTIF($F$3:F218,1),\"\")","v":216},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G218),$G$3:$G$3716,0)),\"\")","v":"00074621213"}]
[null,null,null,null,"00074621413",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E219,1),\"\"))","v":1},{"$f":"IF(F219=1,COUNTIF($F$3:F219,1),\"\")","v":217},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G219),$G$3:$G$3716,0)),\"\")","v":"00074621413"}]
[null,null,null,null,"00074621513",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E220,1),\"\"))","v":1},{"$f":"IF(F220=1,COUNTIF($F$3:F220,1),\"\")","v":218},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G220),$G$3:$G$3716,0)),\"\")","v":"00074621513"}]
[null,null,null,null,"00074659490",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E221,1),\"\"))","v":1},{"$f":"IF(F221=1,COUNTIF($F$3:F221,1),\"\")","v":219},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G221),$G$3:$G$3716,0)),\"\")","v":"00074659490"}]
[null,null,null,null,"00074662490",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E222,1),\"\"))","v":1},{"$f":"IF(F222=1,COUNTIF($F$3:F222,1),\"\")","v":220},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G222),$G$3:$G$3716,0)),\"\")","v":"00074662490"}]
[null,null,null,null,"00074679922",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E223,1),\"\"))","v":1},{"$f":"IF(F223=1,COUNTIF($F$3:F223,1),\"\")","v":221},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G223),$G$3:$G$3716,0)),\"\")","v":"00074679922"}]
[null,null,null,null,"00074706811",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E224,1),\"\"))","v":1},{"$f":"IF(F224=1,COUNTIF($F$3:F224,1),\"\")","v":222},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G224),$G$3:$G$3716,0)),\"\")","v":"00074706811"}]
[null,null,null,null,"00074706911",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E225,1),\"\"))","v":1},{"$f":"IF(F225=1,COUNTIF($F$3:F225,1),\"\")","v":223},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G225),$G$3:$G$3716,0)),\"\")","v":"00074706911"}]
[null,null,null,null,"00074712611",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E226,1),\"\"))","v":1},{"$f":"IF(F226=1,COUNTIF($F$3:F226,1),\"\")","v":224},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G226),$G$3:$G$3716,0)),\"\")","v":"00074712611"}]
[null,null,null,null,"00074714811",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E227,1),\"\"))","v":1},{"$f":"IF(F227=1,COUNTIF($F$3:F227,1),\"\")","v":225},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G227),$G$3:$G$3716,0)),\"\")","v":"00074714811"}]
[null,null,null,null,"00074929690",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E228,1),\"\"))","v":1},{"$f":"IF(F228=1,COUNTIF($F$3:F228,1),\"\")","v":226},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G228),$G$3:$G$3716,0)),\"\")","v":"00074929690"}]
[null,null,null,null,"00075770060",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E229,1),\"\"))","v":1},{"$f":"IF(F229=1,COUNTIF($F$3:F229,1),\"\")","v":227},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G229),$G$3:$G$3716,0)),\"\")","v":"00075770060"}]
[null,null,null,null,"00078024915",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E230,1),\"\"))","v":1},{"$f":"IF(F230=1,COUNTIF($F$3:F230,1),\"\")","v":228},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G230),$G$3:$G$3716,0)),\"\")","v":"00078024915"}]
[null,null,null,null,"00078032705",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E231,1),\"\"))","v":1},{"$f":"IF(F231=1,COUNTIF($F$3:F231,1),\"\")","v":229},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G231),$G$3:$G$3716,0)),\"\")","v":"00078032705"}]
[null,null,null,null,"00078033705",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E232,1),\"\"))","v":1},{"$f":"IF(F232=1,COUNTIF($F$3:F232,1),\"\")","v":230},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G232),$G$3:$G$3716,0)),\"\")","v":"00078033705"}]
[null,null,null,null,"00078035752",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E233,1),\"\"))","v":1},{"$f":"IF(F233=1,COUNTIF($F$3:F233,1),\"\")","v":231},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G233),$G$3:$G$3716,0)),\"\")","v":"00078035752"}]
[null,null,null,null,"00078035834",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E234,1),\"\"))","v":1},{"$f":"IF(F234=1,COUNTIF($F$3:F234,1),\"\")","v":232},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G234),$G$3:$G$3716,0)),\"\")","v":"00078035834"}]
[null,null,null,null,"00078040134",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E235,1),\"\"))","v":1},{"$f":"IF(F235=1,COUNTIF($F$3:F235,1),\"\")","v":233},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G235),$G$3:$G$3716,0)),\"\")","v":"00078040134"}]
[null,null,null,null,"00078042315",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E236,1),\"\"))","v":1},{"$f":"IF(F236=1,COUNTIF($F$3:F236,1),\"\")","v":234},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G236),$G$3:$G$3716,0)),\"\")","v":"00078042315"}]
[null,null,null,null,"00078045605",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E237,1),\"\"))","v":1},{"$f":"IF(F237=1,COUNTIF($F$3:F237,1),\"\")","v":235},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G237),$G$3:$G$3716,0)),\"\")","v":"00078045605"}]
[null,null,null,null,"00078051005",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E238,1),\"\"))","v":1},{"$f":"IF(F238=1,COUNTIF($F$3:F238,1),\"\")","v":236},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G238),$G$3:$G$3716,0)),\"\")","v":"00078051005"}]
[null,null,null,null,"00078051105",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E239,1),\"\"))","v":1},{"$f":"IF(F239=1,COUNTIF($F$3:F239,1),\"\")","v":237},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G239),$G$3:$G$3716,0)),\"\")","v":"00078051105"}]
[null,null,null,null,"00078051205",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E240,1),\"\"))","v":1},{"$f":"IF(F240=1,COUNTIF($F$3:F240,1),\"\")","v":238},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G240),$G$3:$G$3716,0)),\"\")","v":"00078051205"}]
[null,null,null,null,"00078056845",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E241,1),\"\"))","v":1},{"$f":"IF(F241=1,COUNTIF($F$3:F241,1),\"\")","v":239},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G241),$G$3:$G$3716,0)),\"\")","v":"00078056845"}]
[null,null,null,null,"00078065920",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E242,1),\"\"))","v":1},{"$f":"IF(F242=1,COUNTIF($F$3:F242,1),\"\")","v":240},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G242),$G$3:$G$3716,0)),\"\")","v":"00078065920"}]
[null,null,null,null,"00078069620",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E243,1),\"\"))","v":1},{"$f":"IF(F243=1,COUNTIF($F$3:F243,1),\"\")","v":241},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G243),$G$3:$G$3716,0)),\"\")","v":"00078069620"}]
[null,null,null,null,"00078077720",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E244,1),\"\"))","v":1},{"$f":"IF(F244=1,COUNTIF($F$3:F244,1),\"\")","v":242},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G244),$G$3:$G$3716,0)),\"\")","v":"00078077720"}]
[null,null,null,null,"00078084619",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E245,1),\"\"))","v":1},{"$f":"IF(F245=1,COUNTIF($F$3:F245,1),\"\")","v":243},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G245),$G$3:$G$3716,0)),\"\")","v":"00078084619"}]
[null,null,null,null,"00078095819",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E246,1),\"\"))","v":1},{"$f":"IF(F246=1,COUNTIF($F$3:F246,1),\"\")","v":244},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G246),$G$3:$G$3716,0)),\"\")","v":"00078095819"}]
[null,null,null,null,"00085113204",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E247,1),\"\"))","v":1},{"$f":"IF(F247=1,COUNTIF($F$3:F247,1),\"\")","v":245},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G247),$G$3:$G$3716,0)),\"\")","v":"00085113204"}]
[null,null,null,null,"00085171802",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E248,1),\"\"))","v":1},{"$f":"IF(F248=1,COUNTIF($F$3:F248,1),\"\")","v":246},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G248),$G$3:$G$3716,0)),\"\")","v":"00085171802"}]
[null,null,null,null,"00085173305",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E249,1),\"\"))","v":1},{"$f":"IF(F249=1,COUNTIF($F$3:F249,1),\"\")","v":247},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G249),$G$3:$G$3716,0)),\"\")","v":"00085173305"}]
[null,null,null,null,"00085222201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E250,1),\"\"))","v":1},{"$f":"IF(F250=1,COUNTIF($F$3:F250,1),\"\")","v":248},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G250),$G$3:$G$3716,0)),\"\")","v":"00085222201"}]
[null,null,null,null,"00085331504",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E251,1),\"\"))","v":1},{"$f":"IF(F251=1,COUNTIF($F$3:F251,1),\"\")","v":249},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G251),$G$3:$G$3716,0)),\"\")","v":"00085331504"}]
[null,null,null,null,"00085331535",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E252,1),\"\"))","v":1},{"$f":"IF(F252=1,COUNTIF($F$3:F252,1),\"\")","v":250},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G252),$G$3:$G$3716,0)),\"\")","v":"00085331535"}]
[null,null,null,null,"00085433301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E253,1),\"\"))","v":1},{"$f":"IF(F253=1,COUNTIF($F$3:F253,1),\"\")","v":251},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G253),$G$3:$G$3716,0)),\"\")","v":"00085433301"}]
[null,null,null,null,"00085433401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E254,1),\"\"))","v":1},{"$f":"IF(F254=1,COUNTIF($F$3:F254,1),\"\")","v":252},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G254),$G$3:$G$3716,0)),\"\")","v":"00085433401"}]
[null,null,null,null,"00087040201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E255,1),\"\"))","v":1},{"$f":"IF(F255=1,COUNTIF($F$3:F255,1),\"\")","v":253},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G255),$G$3:$G$3716,0)),\"\")","v":"00087040201"}]
[null,null,null,null,"00087040203",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E256,1),\"\"))","v":1},{"$f":"IF(F256=1,COUNTIF($F$3:F256,1),\"\")","v":254},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G256),$G$3:$G$3716,0)),\"\")","v":"00087040203"}]
[null,null,null,null,"00087040501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E257,1),\"\"))","v":1},{"$f":"IF(F257=1,COUNTIF($F$3:F257,1),\"\")","v":255},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G257),$G$3:$G$3716,0)),\"\")","v":"00087040501"}]
[null,null,null,null,"00087040589",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E258,1),\"\"))","v":1},{"$f":"IF(F258=1,COUNTIF($F$3:F258,1),\"\")","v":256},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G258),$G$3:$G$3716,0)),\"\")","v":"00087040589"}]
[null,null,null,null,"00087277235",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E259,1),\"\"))","v":1},{"$f":"IF(F259=1,COUNTIF($F$3:F259,1),\"\")","v":257},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G259),$G$3:$G$3716,0)),\"\")","v":"00087277235"}]
[null,null,null,null,"00087663341",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E260,1),\"\"))","v":1},{"$f":"IF(F260=1,COUNTIF($F$3:F260,1),\"\")","v":258},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G260),$G$3:$G$3716,0)),\"\")","v":"00087663341"}]
[null,null,null,null,"00087667117",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E261,1),\"\"))","v":1},{"$f":"IF(F261=1,COUNTIF($F$3:F261,1),\"\")","v":259},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G261),$G$3:$G$3716,0)),\"\")","v":"00087667117"}]
[null,null,null,null,"00087667217",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E262,1),\"\"))","v":1},{"$f":"IF(F262=1,COUNTIF($F$3:F262,1),\"\")","v":260},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G262),$G$3:$G$3716,0)),\"\")","v":"00087667217"}]
[null,null,null,null,"00087667317",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E263,1),\"\"))","v":1},{"$f":"IF(F263=1,COUNTIF($F$3:F263,1),\"\")","v":261},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G263),$G$3:$G$3716,0)),\"\")","v":"00087667317"}]
[null,null,null,null,"00087667417",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E264,1),\"\"))","v":1},{"$f":"IF(F264=1,COUNTIF($F$3:F264,1),\"\")","v":262},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G264),$G$3:$G$3716,0)),\"\")","v":"00087667417"}]
[null,null,null,null,"00088057641",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E265,1),\"\"))","v":1},{"$f":"IF(F265=1,COUNTIF($F$3:F265,1),\"\")","v":263},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G265),$G$3:$G$3716,0)),\"\")","v":"00088057641"}]
[null,null,null,null,"00091415060",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E266,1),\"\"))","v":1},{"$f":"IF(F266=1,COUNTIF($F$3:F266,1),\"\")","v":264},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G266),$G$3:$G$3716,0)),\"\")","v":"00091415060"}]
[null,null,null,null,"00093001006",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E267,1),\"\"))","v":1},{"$f":"IF(F267=1,COUNTIF($F$3:F267,1),\"\")","v":265},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G267),$G$3:$G$3716,0)),\"\")","v":"00093001006"}]
[null,null,null,null,"00093005401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E268,1),\"\"))","v":1},{"$f":"IF(F268=1,COUNTIF($F$3:F268,1),\"\")","v":266},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G268),$G$3:$G$3716,0)),\"\")","v":"00093005401"}]
[null,null,null,null,"00093005405",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E269,1),\"\"))","v":1},{"$f":"IF(F269=1,COUNTIF($F$3:F269,1),\"\")","v":267},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G269),$G$3:$G$3716,0)),\"\")","v":"00093005405"}]
[null,null,null,null,"00093017456",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E270,1),\"\"))","v":1},{"$f":"IF(F270=1,COUNTIF($F$3:F270,1),\"\")","v":268},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G270),$G$3:$G$3716,0)),\"\")","v":"00093017456"}]
[null,null,null,null,"00093019901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E271,1),\"\"))","v":1},{"$f":"IF(F271=1,COUNTIF($F$3:F271,1),\"\")","v":269},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G271),$G$3:$G$3716,0)),\"\")","v":"00093019901"}]
[null,null,null,null,"00093026215",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E272,1),\"\"))","v":1},{"$f":"IF(F272=1,COUNTIF($F$3:F272,1),\"\")","v":270},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G272),$G$3:$G$3716,0)),\"\")","v":"00093026215"}]
[null,null,null,null,"00093026292",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E273,1),\"\"))","v":1},{"$f":"IF(F273=1,COUNTIF($F$3:F273,1),\"\")","v":271},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G273),$G$3:$G$3716,0)),\"\")","v":"00093026292"}]
[null,null,null,null,"00093026415",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E274,1),\"\"))","v":1},{"$f":"IF(F274=1,COUNTIF($F$3:F274,1),\"\")","v":272},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G274),$G$3:$G$3716,0)),\"\")","v":"00093026415"}]
[null,null,null,null,"00093026492",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E275,1),\"\"))","v":1},{"$f":"IF(F275=1,COUNTIF($F$3:F275,1),\"\")","v":273},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G275),$G$3:$G$3716,0)),\"\")","v":"00093026492"}]
[null,null,null,null,"00093031101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E276,1),\"\"))","v":1},{"$f":"IF(F276=1,COUNTIF($F$3:F276,1),\"\")","v":274},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G276),$G$3:$G$3716,0)),\"\")","v":"00093031101"}]
[null,null,null,null,"00093031801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E277,1),\"\"))","v":1},{"$f":"IF(F277=1,COUNTIF($F$3:F277,1),\"\")","v":275},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G277),$G$3:$G$3716,0)),\"\")","v":"00093031801"}]
[null,null,null,null,"00093031805",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E278,1),\"\"))","v":1},{"$f":"IF(F278=1,COUNTIF($F$3:F278,1),\"\")","v":276},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G278),$G$3:$G$3716,0)),\"\")","v":"00093031805"}]
[null,null,null,null,"00093031901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E279,1),\"\"))","v":1},{"$f":"IF(F279=1,COUNTIF($F$3:F279,1),\"\")","v":277},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G279),$G$3:$G$3716,0)),\"\")","v":"00093031901"}]
[null,null,null,null,"00093046301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E280,1),\"\"))","v":1},{"$f":"IF(F280=1,COUNTIF($F$3:F280,1),\"\")","v":278},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G280),$G$3:$G$3716,0)),\"\")","v":"00093046301"}]
[null,null,null,null,"00093066116",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E281,1),\"\"))","v":1},{"$f":"IF(F281=1,COUNTIF($F$3:F281,1),\"\")","v":279},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G281),$G$3:$G$3716,0)),\"\")","v":"00093066116"}]
[null,null,null,null,"00093068801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E282,1),\"\"))","v":1},{"$f":"IF(F282=1,COUNTIF($F$3:F282,1),\"\")","v":280},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G282),$G$3:$G$3716,0)),\"\")","v":"00093068801"}]
[null,null,null,null,"00093075201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E283,1),\"\"))","v":1},{"$f":"IF(F283=1,COUNTIF($F$3:F283,1),\"\")","v":281},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G283),$G$3:$G$3716,0)),\"\")","v":"00093075201"}]
[null,null,null,null,"00093075210",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E284,1),\"\"))","v":1},{"$f":"IF(F284=1,COUNTIF($F$3:F284,1),\"\")","v":282},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G284),$G$3:$G$3716,0)),\"\")","v":"00093075210"}]
[null,null,null,null,"00093075301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E285,1),\"\"))","v":1},{"$f":"IF(F285=1,COUNTIF($F$3:F285,1),\"\")","v":283},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G285),$G$3:$G$3716,0)),\"\")","v":"00093075301"}]
[null,null,null,null,"00093075601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E286,1),\"\"))","v":1},{"$f":"IF(F286=1,COUNTIF($F$3:F286,1),\"\")","v":284},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G286),$G$3:$G$3716,0)),\"\")","v":"00093075601"}]
[null,null,null,null,"00093078701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E287,1),\"\"))","v":1},{"$f":"IF(F287=1,COUNTIF($F$3:F287,1),\"\")","v":285},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G287),$G$3:$G$3716,0)),\"\")","v":"00093078701"}]
[null,null,null,null,"00093081001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E288,1),\"\"))","v":1},{"$f":"IF(F288=1,COUNTIF($F$3:F288,1),\"\")","v":286},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G288),$G$3:$G$3716,0)),\"\")","v":"00093081001"}]
[null,null,null,null,"00093081101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E289,1),\"\"))","v":1},{"$f":"IF(F289=1,COUNTIF($F$3:F289,1),\"\")","v":287},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G289),$G$3:$G$3716,0)),\"\")","v":"00093081101"}]
[null,null,null,null,"00093098301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E290,1),\"\"))","v":1},{"$f":"IF(F290=1,COUNTIF($F$3:F290,1),\"\")","v":288},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G290),$G$3:$G$3716,0)),\"\")","v":"00093098301"}]
[null,null,null,null,"00093101042",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E291,1),\"\"))","v":1},{"$f":"IF(F291=1,COUNTIF($F$3:F291,1),\"\")","v":289},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G291),$G$3:$G$3716,0)),\"\")","v":"00093101042"}]
[null,null,null,null,"00093102406",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E292,1),\"\"))","v":1},{"$f":"IF(F292=1,COUNTIF($F$3:F292,1),\"\")","v":290},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G292),$G$3:$G$3716,0)),\"\")","v":"00093102406"}]
[null,null,null,null,"00093103993",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E293,1),\"\"))","v":1},{"$f":"IF(F293=1,COUNTIF($F$3:F293,1),\"\")","v":291},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G293),$G$3:$G$3716,0)),\"\")","v":"00093103993"}]
[null,null,null,null,"00093106001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E294,1),\"\"))","v":1},{"$f":"IF(F294=1,COUNTIF($F$3:F294,1),\"\")","v":292},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G294),$G$3:$G$3716,0)),\"\")","v":"00093106001"}]
[null,null,null,null,"00093106101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E295,1),\"\"))","v":1},{"$f":"IF(F295=1,COUNTIF($F$3:F295,1),\"\")","v":293},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G295),$G$3:$G$3716,0)),\"\")","v":"00093106101"}]
[null,null,null,null,"00093107853",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E296,1),\"\"))","v":1},{"$f":"IF(F296=1,COUNTIF($F$3:F296,1),\"\")","v":294},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G296),$G$3:$G$3716,0)),\"\")","v":"00093107853"}]
[null,null,null,null,"00093117201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E297,1),\"\"))","v":1},{"$f":"IF(F297=1,COUNTIF($F$3:F297,1),\"\")","v":295},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G297),$G$3:$G$3716,0)),\"\")","v":"00093117201"}]
[null,null,null,null,"00093117401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E298,1),\"\"))","v":1},{"$f":"IF(F298=1,COUNTIF($F$3:F298,1),\"\")","v":296},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G298),$G$3:$G$3716,0)),\"\")","v":"00093117401"}]
[null,null,null,null,"00093117701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E299,1),\"\"))","v":1},{"$f":"IF(F299=1,COUNTIF($F$3:F299,1),\"\")","v":297},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G299),$G$3:$G$3716,0)),\"\")","v":"00093117701"}]
[null,null,null,null,"00093172301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E300,1),\"\"))","v":1},{"$f":"IF(F300=1,COUNTIF($F$3:F300,1),\"\")","v":298},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G300),$G$3:$G$3716,0)),\"\")","v":"00093172301"}]
[null,null,null,null,"00093202631",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E301,1),\"\"))","v":1},{"$f":"IF(F301=1,COUNTIF($F$3:F301,1),\"\")","v":299},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G301),$G$3:$G$3716,0)),\"\")","v":"00093202631"}]
[null,null,null,null,"00093202723",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E302,1),\"\"))","v":1},{"$f":"IF(F302=1,COUNTIF($F$3:F302,1),\"\")","v":300},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G302),$G$3:$G$3716,0)),\"\")","v":"00093202723"}]
[null,null,null,null,"00093206406",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E303,1),\"\"))","v":1},{"$f":"IF(F303=1,COUNTIF($F$3:F303,1),\"\")","v":301},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G303),$G$3:$G$3716,0)),\"\")","v":"00093206406"}]
[null,null,null,null,"00093221001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E304,1),\"\"))","v":1},{"$f":"IF(F304=1,COUNTIF($F$3:F304,1),\"\")","v":302},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G304),$G$3:$G$3716,0)),\"\")","v":"00093221001"}]
[null,null,null,null,"00093227434",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E305,1),\"\"))","v":1},{"$f":"IF(F305=1,COUNTIF($F$3:F305,1),\"\")","v":303},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G305),$G$3:$G$3716,0)),\"\")","v":"00093227434"}]
[null,null,null,null,"00093292901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E306,1),\"\"))","v":1},{"$f":"IF(F306=1,COUNTIF($F$3:F306,1),\"\")","v":304},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G306),$G$3:$G$3716,0)),\"\")","v":"00093292901"}]
[null,null,null,null,"00093293101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E307,1),\"\"))","v":1},{"$f":"IF(F307=1,COUNTIF($F$3:F307,1),\"\")","v":305},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G307),$G$3:$G$3716,0)),\"\")","v":"00093293101"}]
[null,null,null,null,"00093300256",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E308,1),\"\"))","v":1},{"$f":"IF(F308=1,COUNTIF($F$3:F308,1),\"\")","v":306},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G308),$G$3:$G$3716,0)),\"\")","v":"00093300256"}]
[null,null,null,null,"00093304006",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E309,1),\"\"))","v":1},{"$f":"IF(F309=1,COUNTIF($F$3:F309,1),\"\")","v":307},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G309),$G$3:$G$3716,0)),\"\")","v":"00093304006"}]
[null,null,null,null,"00093310701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E310,1),\"\"))","v":1},{"$f":"IF(F310=1,COUNTIF($F$3:F310,1),\"\")","v":308},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G310),$G$3:$G$3716,0)),\"\")","v":"00093310701"}]
[null,null,null,null,"00093310793",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E311,1),\"\"))","v":1},{"$f":"IF(F311=1,COUNTIF($F$3:F311,1),\"\")","v":309},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G311),$G$3:$G$3716,0)),\"\")","v":"00093310793"}]
[null,null,null,null,"00093310953",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E312,1),\"\"))","v":1},{"$f":"IF(F312=1,COUNTIF($F$3:F312,1),\"\")","v":310},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G312),$G$3:$G$3716,0)),\"\")","v":"00093310953"}]
[null,null,null,null,"00093312301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E313,1),\"\"))","v":1},{"$f":"IF(F313=1,COUNTIF($F$3:F313,1),\"\")","v":311},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G313),$G$3:$G$3716,0)),\"\")","v":"00093312301"}]
[null,null,null,null,"00093312501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E314,1),\"\"))","v":1},{"$f":"IF(F314=1,COUNTIF($F$3:F314,1),\"\")","v":312},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G314),$G$3:$G$3716,0)),\"\")","v":"00093312501"}]
[null,null,null,null,"00093312701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E315,1),\"\"))","v":1},{"$f":"IF(F315=1,COUNTIF($F$3:F315,1),\"\")","v":313},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G315),$G$3:$G$3716,0)),\"\")","v":"00093312701"}]
[null,null,null,null,"00093312901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E316,1),\"\"))","v":1},{"$f":"IF(F316=1,COUNTIF($F$3:F316,1),\"\")","v":314},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G316),$G$3:$G$3716,0)),\"\")","v":"00093312901"}]
[null,null,null,null,"00093314501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E317,1),\"\"))","v":1},{"$f":"IF(F317=1,COUNTIF($F$3:F317,1),\"\")","v":315},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G317),$G$3:$G$3716,0)),\"\")","v":"00093314501"}]
[null,null,null,null,"00093314701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E318,1),\"\"))","v":1},{"$f":"IF(F318=1,COUNTIF($F$3:F318,1),\"\")","v":316},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G318),$G$3:$G$3716,0)),\"\")","v":"00093314701"}]
[null,null,null,null,"00093317431",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E319,1),\"\"))","v":1},{"$f":"IF(F319=1,COUNTIF($F$3:F319,1),\"\")","v":317},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G319),$G$3:$G$3716,0)),\"\")","v":"00093317431"}]
[null,null,null,null,"00093319653",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E320,1),\"\"))","v":1},{"$f":"IF(F320=1,COUNTIF($F$3:F320,1),\"\")","v":318},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G320),$G$3:$G$3716,0)),\"\")","v":"00093319653"}]
[null,null,null,null,"00093365940",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E321,1),\"\"))","v":1},{"$f":"IF(F321=1,COUNTIF($F$3:F321,1),\"\")","v":319},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G321),$G$3:$G$3716,0)),\"\")","v":"00093365940"}]
[null,null,null,null,"00093412773",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E322,1),\"\"))","v":1},{"$f":"IF(F322=1,COUNTIF($F$3:F322,1),\"\")","v":320},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G322),$G$3:$G$3716,0)),\"\")","v":"00093412773"}]
[null,null,null,null,"00093412774",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E323,1),\"\"))","v":1},{"$f":"IF(F323=1,COUNTIF($F$3:F323,1),\"\")","v":321},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G323),$G$3:$G$3716,0)),\"\")","v":"00093412774"}]
[null,null,null,null,"00093415080",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E324,1),\"\"))","v":1},{"$f":"IF(F324=1,COUNTIF($F$3:F324,1),\"\")","v":322},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G324),$G$3:$G$3716,0)),\"\")","v":"00093415080"}]
[null,null,null,null,"00093415573",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E325,1),\"\"))","v":1},{"$f":"IF(F325=1,COUNTIF($F$3:F325,1),\"\")","v":323},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G325),$G$3:$G$3716,0)),\"\")","v":"00093415573"}]
[null,null,null,null,"00093415580",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E326,1),\"\"))","v":1},{"$f":"IF(F326=1,COUNTIF($F$3:F326,1),\"\")","v":324},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G326),$G$3:$G$3716,0)),\"\")","v":"00093415580"}]
[null,null,null,null,"00093417573",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E327,1),\"\"))","v":1},{"$f":"IF(F327=1,COUNTIF($F$3:F327,1),\"\")","v":325},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G327),$G$3:$G$3716,0)),\"\")","v":"00093417573"}]
[null,null,null,null,"00093417574",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E328,1),\"\"))","v":1},{"$f":"IF(F328=1,COUNTIF($F$3:F328,1),\"\")","v":326},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G328),$G$3:$G$3716,0)),\"\")","v":"00093417574"}]
[null,null,null,null,"00093417773",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E329,1),\"\"))","v":1},{"$f":"IF(F329=1,COUNTIF($F$3:F329,1),\"\")","v":327},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G329),$G$3:$G$3716,0)),\"\")","v":"00093417773"}]
[null,null,null,null,"00093423701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E330,1),\"\"))","v":1},{"$f":"IF(F330=1,COUNTIF($F$3:F330,1),\"\")","v":328},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G330),$G$3:$G$3716,0)),\"\")","v":"00093423701"}]
[null,null,null,null,"00093503056",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E331,1),\"\"))","v":1},{"$f":"IF(F331=1,COUNTIF($F$3:F331,1),\"\")","v":329},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G331),$G$3:$G$3716,0)),\"\")","v":"00093503056"}]
[null,null,null,null,"00093503156",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E332,1),\"\"))","v":1},{"$f":"IF(F332=1,COUNTIF($F$3:F332,1),\"\")","v":330},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G332),$G$3:$G$3716,0)),\"\")","v":"00093503156"}]
[null,null,null,null,"00093506101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E333,1),\"\"))","v":1},{"$f":"IF(F333=1,COUNTIF($F$3:F333,1),\"\")","v":331},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G333),$G$3:$G$3716,0)),\"\")","v":"00093506101"}]
[null,null,null,null,"00093511298",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E334,1),\"\"))","v":1},{"$f":"IF(F334=1,COUNTIF($F$3:F334,1),\"\")","v":332},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G334),$G$3:$G$3716,0)),\"\")","v":"00093511298"}]
[null,null,null,null,"00093511798",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E335,1),\"\"))","v":1},{"$f":"IF(F335=1,COUNTIF($F$3:F335,1),\"\")","v":333},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G335),$G$3:$G$3716,0)),\"\")","v":"00093511798"}]
[null,null,null,null,"00093511898",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E336,1),\"\"))","v":1},{"$f":"IF(F336=1,COUNTIF($F$3:F336,1),\"\")","v":334},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G336),$G$3:$G$3716,0)),\"\")","v":"00093511898"}]
[null,null,null,null,"00093520601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E337,1),\"\"))","v":1},{"$f":"IF(F337=1,COUNTIF($F$3:F337,1),\"\")","v":335},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G337),$G$3:$G$3716,0)),\"\")","v":"00093520601"}]
[null,null,null,null,"00093525601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E338,1),\"\"))","v":1},{"$f":"IF(F338=1,COUNTIF($F$3:F338,1),\"\")","v":336},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G338),$G$3:$G$3716,0)),\"\")","v":"00093525601"}]
[null,null,null,null,"00093529056",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E339,1),\"\"))","v":1},{"$f":"IF(F339=1,COUNTIF($F$3:F339,1),\"\")","v":337},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G339),$G$3:$G$3716,0)),\"\")","v":"00093529056"}]
[null,null,null,null,"00093541495",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E340,1),\"\"))","v":1},{"$f":"IF(F340=1,COUNTIF($F$3:F340,1),\"\")","v":338},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G340),$G$3:$G$3716,0)),\"\")","v":"00093541495"}]
[null,null,null,null,"00093541595",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E341,1),\"\"))","v":1},{"$f":"IF(F341=1,COUNTIF($F$3:F341,1),\"\")","v":339},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G341),$G$3:$G$3716,0)),\"\")","v":"00093541595"}]
[null,null,null,null,"00093552606",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E342,1),\"\"))","v":1},{"$f":"IF(F342=1,COUNTIF($F$3:F342,1),\"\")","v":340},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G342),$G$3:$G$3716,0)),\"\")","v":"00093552606"}]
[null,null,null,null,"00093552856",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E343,1),\"\"))","v":1},{"$f":"IF(F343=1,COUNTIF($F$3:F343,1),\"\")","v":341},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G343),$G$3:$G$3716,0)),\"\")","v":"00093552856"}]
[null,null,null,null,"00093577001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E344,1),\"\"))","v":1},{"$f":"IF(F344=1,COUNTIF($F$3:F344,1),\"\")","v":342},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G344),$G$3:$G$3716,0)),\"\")","v":"00093577001"}]
[null,null,null,null,"00093577056",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E345,1),\"\"))","v":1},{"$f":"IF(F345=1,COUNTIF($F$3:F345,1),\"\")","v":343},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G345),$G$3:$G$3716,0)),\"\")","v":"00093577056"}]
[null,null,null,null,"00093578656",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E346,1),\"\"))","v":1},{"$f":"IF(F346=1,COUNTIF($F$3:F346,1),\"\")","v":344},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G346),$G$3:$G$3716,0)),\"\")","v":"00093578656"}]
[null,null,null,null,"00093613832",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E347,1),\"\"))","v":1},{"$f":"IF(F347=1,COUNTIF($F$3:F347,1),\"\")","v":345},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G347),$G$3:$G$3716,0)),\"\")","v":"00093613832"}]
[null,null,null,null,"00093710212",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E348,1),\"\"))","v":1},{"$f":"IF(F348=1,COUNTIF($F$3:F348,1),\"\")","v":346},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G348),$G$3:$G$3716,0)),\"\")","v":"00093710212"}]
[null,null,null,null,"00093711306",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E349,1),\"\"))","v":1},{"$f":"IF(F349=1,COUNTIF($F$3:F349,1),\"\")","v":347},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G349),$G$3:$G$3716,0)),\"\")","v":"00093711306"}]
[null,null,null,null,"00093714656",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E350,1),\"\"))","v":1},{"$f":"IF(F350=1,COUNTIF($F$3:F350,1),\"\")","v":348},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G350),$G$3:$G$3716,0)),\"\")","v":"00093714656"}]
[null,null,null,null,"00093714756",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E351,1),\"\"))","v":1},{"$f":"IF(F351=1,COUNTIF($F$3:F351,1),\"\")","v":349},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G351),$G$3:$G$3716,0)),\"\")","v":"00093714756"}]
[null,null,null,null,"00093714823",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E352,1),\"\"))","v":1},{"$f":"IF(F352=1,COUNTIF($F$3:F352,1),\"\")","v":350},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G352),$G$3:$G$3716,0)),\"\")","v":"00093714823"}]
[null,null,null,null,"00093720198",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E353,1),\"\"))","v":1},{"$f":"IF(F353=1,COUNTIF($F$3:F353,1),\"\")","v":351},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G353),$G$3:$G$3716,0)),\"\")","v":"00093720198"}]
[null,null,null,null,"00093720656",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E354,1),\"\"))","v":1},{"$f":"IF(F354=1,COUNTIF($F$3:F354,1),\"\")","v":352},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G354),$G$3:$G$3716,0)),\"\")","v":"00093720656"}]
[null,null,null,null,"00093725401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E355,1),\"\"))","v":1},{"$f":"IF(F355=1,COUNTIF($F$3:F355,1),\"\")","v":353},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G355),$G$3:$G$3716,0)),\"\")","v":"00093725401"}]
[null,null,null,null,"00093725501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E356,1),\"\"))","v":1},{"$f":"IF(F356=1,COUNTIF($F$3:F356,1),\"\")","v":354},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G356),$G$3:$G$3716,0)),\"\")","v":"00093725501"}]
[null,null,null,null,"00093729501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E357,1),\"\"))","v":1},{"$f":"IF(F357=1,COUNTIF($F$3:F357,1),\"\")","v":355},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G357),$G$3:$G$3716,0)),\"\")","v":"00093729501"}]
[null,null,null,null,"00093731601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E358,1),\"\"))","v":1},{"$f":"IF(F358=1,COUNTIF($F$3:F358,1),\"\")","v":356},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G358),$G$3:$G$3716,0)),\"\")","v":"00093731601"}]
[null,null,null,null,"00093733506",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E359,1),\"\"))","v":1},{"$f":"IF(F359=1,COUNTIF($F$3:F359,1),\"\")","v":357},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G359),$G$3:$G$3716,0)),\"\")","v":"00093733506"}]
[null,null,null,null,"00093733606",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E360,1),\"\"))","v":1},{"$f":"IF(F360=1,COUNTIF($F$3:F360,1),\"\")","v":358},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G360),$G$3:$G$3716,0)),\"\")","v":"00093733606"}]
[null,null,null,null,"00093735156",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E361,1),\"\"))","v":1},{"$f":"IF(F361=1,COUNTIF($F$3:F361,1),\"\")","v":359},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G361),$G$3:$G$3716,0)),\"\")","v":"00093735156"}]
[null,null,null,null,"00093735598",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E362,1),\"\"))","v":1},{"$f":"IF(F362=1,COUNTIF($F$3:F362,1),\"\")","v":360},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G362),$G$3:$G$3716,0)),\"\")","v":"00093735598"}]
[null,null,null,null,"00093736498",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E363,1),\"\"))","v":1},{"$f":"IF(F363=1,COUNTIF($F$3:F363,1),\"\")","v":361},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G363),$G$3:$G$3716,0)),\"\")","v":"00093736498"}]
[null,null,null,null,"00093736510",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E364,1),\"\"))","v":1},{"$f":"IF(F364=1,COUNTIF($F$3:F364,1),\"\")","v":362},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G364),$G$3:$G$3716,0)),\"\")","v":"00093736510"}]
[null,null,null,null,"00093738001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E365,1),\"\"))","v":1},{"$f":"IF(F365=1,COUNTIF($F$3:F365,1),\"\")","v":363},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G365),$G$3:$G$3716,0)),\"\")","v":"00093738001"}]
[null,null,null,null,"00093738101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E366,1),\"\"))","v":1},{"$f":"IF(F366=1,COUNTIF($F$3:F366,1),\"\")","v":364},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G366),$G$3:$G$3716,0)),\"\")","v":"00093738101"}]
[null,null,null,null,"00093738456",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E367,1),\"\"))","v":1},{"$f":"IF(F367=1,COUNTIF($F$3:F367,1),\"\")","v":365},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G367),$G$3:$G$3716,0)),\"\")","v":"00093738456"}]
[null,null,null,null,"00093738556",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E368,1),\"\"))","v":1},{"$f":"IF(F368=1,COUNTIF($F$3:F368,1),\"\")","v":366},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G368),$G$3:$G$3716,0)),\"\")","v":"00093738556"}]
[null,null,null,null,"00093743901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E369,1),\"\"))","v":1},{"$f":"IF(F369=1,COUNTIF($F$3:F369,1),\"\")","v":367},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G369),$G$3:$G$3716,0)),\"\")","v":"00093743901"}]
[null,null,null,null,"00093744001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E370,1),\"\"))","v":1},{"$f":"IF(F370=1,COUNTIF($F$3:F370,1),\"\")","v":368},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G370),$G$3:$G$3716,0)),\"\")","v":"00093744001"}]
[null,null,null,null,"00093746598",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E371,1),\"\"))","v":1},{"$f":"IF(F371=1,COUNTIF($F$3:F371,1),\"\")","v":369},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G371),$G$3:$G$3716,0)),\"\")","v":"00093746598"}]
[null,null,null,null,"00093761843",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E372,1),\"\"))","v":1},{"$f":"IF(F372=1,COUNTIF($F$3:F372,1),\"\")","v":370},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G372),$G$3:$G$3716,0)),\"\")","v":"00093761843"}]
[null,null,null,null,"00093762056",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E373,1),\"\"))","v":1},{"$f":"IF(F373=1,COUNTIF($F$3:F373,1),\"\")","v":371},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G373),$G$3:$G$3716,0)),\"\")","v":"00093762056"}]
[null,null,null,null,"00093777201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E374,1),\"\"))","v":1},{"$f":"IF(F374=1,COUNTIF($F$3:F374,1),\"\")","v":372},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G374),$G$3:$G$3716,0)),\"\")","v":"00093777201"}]
[null,null,null,null,"00093811856",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E375,1),\"\"))","v":1},{"$f":"IF(F375=1,COUNTIF($F$3:F375,1),\"\")","v":373},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G375),$G$3:$G$3716,0)),\"\")","v":"00093811856"}]
[null,null,null,null,"00093812193",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E376,1),\"\"))","v":1},{"$f":"IF(F376=1,COUNTIF($F$3:F376,1),\"\")","v":374},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G376),$G$3:$G$3716,0)),\"\")","v":"00093812193"}]
[null,null,null,null,"00093812201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E377,1),\"\"))","v":1},{"$f":"IF(F377=1,COUNTIF($F$3:F377,1),\"\")","v":375},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G377),$G$3:$G$3716,0)),\"\")","v":"00093812201"}]
[null,null,null,null,"00093812293",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E378,1),\"\"))","v":1},{"$f":"IF(F378=1,COUNTIF($F$3:F378,1),\"\")","v":376},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G378),$G$3:$G$3716,0)),\"\")","v":"00093812293"}]
[null,null,null,null,"00093816201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E379,1),\"\"))","v":1},{"$f":"IF(F379=1,COUNTIF($F$3:F379,1),\"\")","v":377},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G379),$G$3:$G$3716,0)),\"\")","v":"00093816201"}]
[null,null,null,null,"00093834301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E380,1),\"\"))","v":1},{"$f":"IF(F380=1,COUNTIF($F$3:F380,1),\"\")","v":378},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G380),$G$3:$G$3716,0)),\"\")","v":"00093834301"}]
[null,null,null,null,"00093834401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E381,1),\"\"))","v":1},{"$f":"IF(F381=1,COUNTIF($F$3:F381,1),\"\")","v":379},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G381),$G$3:$G$3716,0)),\"\")","v":"00093834401"}]
[null,null,null,null,"00093834493",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E382,1),\"\"))","v":1},{"$f":"IF(F382=1,COUNTIF($F$3:F382,1),\"\")","v":380},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G382),$G$3:$G$3716,0)),\"\")","v":"00093834493"}]
[null,null,null,null,"00093873901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E383,1),\"\"))","v":1},{"$f":"IF(F383=1,COUNTIF($F$3:F383,1),\"\")","v":381},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G383),$G$3:$G$3716,0)),\"\")","v":"00093873901"}]
[null,null,null,null,"00093874001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E384,1),\"\"))","v":1},{"$f":"IF(F384=1,COUNTIF($F$3:F384,1),\"\")","v":382},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G384),$G$3:$G$3716,0)),\"\")","v":"00093874001"}]
[null,null,null,null,"00093874101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E385,1),\"\"))","v":1},{"$f":"IF(F385=1,COUNTIF($F$3:F385,1),\"\")","v":383},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G385),$G$3:$G$3716,0)),\"\")","v":"00093874101"}]
[null,null,null,null,"00093894005",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E386,1),\"\"))","v":1},{"$f":"IF(F386=1,COUNTIF($F$3:F386,1),\"\")","v":384},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G386),$G$3:$G$3716,0)),\"\")","v":"00093894005"}]
[null,null,null,null,"00093894301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E387,1),\"\"))","v":1},{"$f":"IF(F387=1,COUNTIF($F$3:F387,1),\"\")","v":385},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G387),$G$3:$G$3716,0)),\"\")","v":"00093894301"}]
[null,null,null,null,"00093960412",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E388,1),\"\"))","v":1},{"$f":"IF(F388=1,COUNTIF($F$3:F388,1),\"\")","v":386},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G388),$G$3:$G$3716,0)),\"\")","v":"00093960412"}]
[null,null,null,null,"00093961212",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E389,1),\"\"))","v":1},{"$f":"IF(F389=1,COUNTIF($F$3:F389,1),\"\")","v":387},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G389),$G$3:$G$3716,0)),\"\")","v":"00093961212"}]
[null,null,null,null,"00113034403",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E390,1),\"\"))","v":1},{"$f":"IF(F390=1,COUNTIF($F$3:F390,1),\"\")","v":388},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G390),$G$3:$G$3716,0)),\"\")","v":"00113034403"}]
[null,null,null,null,"00115147446",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E391,1),\"\"))","v":1},{"$f":"IF(F391=1,COUNTIF($F$3:F391,1),\"\")","v":389},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G391),$G$3:$G$3716,0)),\"\")","v":"00115147446"}]
[null,null,null,null,"00115165901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E392,1),\"\"))","v":1},{"$f":"IF(F392=1,COUNTIF($F$3:F392,1),\"\")","v":390},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G392),$G$3:$G$3716,0)),\"\")","v":"00115165901"}]
[null,null,null,null,"00115166001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E393,1),\"\"))","v":1},{"$f":"IF(F393=1,COUNTIF($F$3:F393,1),\"\")","v":391},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G393),$G$3:$G$3716,0)),\"\")","v":"00115166001"}]
[null,null,null,null,"00115169701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E394,1),\"\"))","v":1},{"$f":"IF(F394=1,COUNTIF($F$3:F394,1),\"\")","v":392},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G394),$G$3:$G$3716,0)),\"\")","v":"00115169701"}]
[null,null,null,null,"00115262201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E395,1),\"\"))","v":1},{"$f":"IF(F395=1,COUNTIF($F$3:F395,1),\"\")","v":393},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G395),$G$3:$G$3716,0)),\"\")","v":"00115262201"}]
[null,null,null,null,"00115351101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E396,1),\"\"))","v":1},{"$f":"IF(F396=1,COUNTIF($F$3:F396,1),\"\")","v":394},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G396),$G$3:$G$3716,0)),\"\")","v":"00115351101"}]
[null,null,null,null,"00115421101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E397,1),\"\"))","v":1},{"$f":"IF(F397=1,COUNTIF($F$3:F397,1),\"\")","v":395},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G397),$G$3:$G$3716,0)),\"\")","v":"00115421101"}]
[null,null,null,null,"00115441101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E398,1),\"\"))","v":1},{"$f":"IF(F398=1,COUNTIF($F$3:F398,1),\"\")","v":396},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G398),$G$3:$G$3716,0)),\"\")","v":"00115441101"}]
[null,null,null,null,"00115443301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E399,1),\"\"))","v":1},{"$f":"IF(F399=1,COUNTIF($F$3:F399,1),\"\")","v":397},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G399),$G$3:$G$3716,0)),\"\")","v":"00115443301"}]
[null,null,null,null,"00115592201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E400,1),\"\"))","v":1},{"$f":"IF(F400=1,COUNTIF($F$3:F400,1),\"\")","v":398},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G400),$G$3:$G$3716,0)),\"\")","v":"00115592201"}]
[null,null,null,null,"00115703301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E401,1),\"\"))","v":1},{"$f":"IF(F401=1,COUNTIF($F$3:F401,1),\"\")","v":399},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G401),$G$3:$G$3716,0)),\"\")","v":"00115703301"}]
[null,null,null,null,"00116106103",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E402,1),\"\"))","v":1},{"$f":"IF(F402=1,COUNTIF($F$3:F402,1),\"\")","v":400},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G402),$G$3:$G$3716,0)),\"\")","v":"00116106103"}]
[null,null,null,null,"00116200115",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E403,1),\"\"))","v":1},{"$f":"IF(F403=1,COUNTIF($F$3:F403,1),\"\")","v":401},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G403),$G$3:$G$3716,0)),\"\")","v":"00116200115"}]
[null,null,null,null,"00116200116",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E404,1),\"\"))","v":1},{"$f":"IF(F404=1,COUNTIF($F$3:F404,1),\"\")","v":402},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G404),$G$3:$G$3716,0)),\"\")","v":"00116200116"}]
[null,null,null,null,"00116200189",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E405,1),\"\"))","v":1},{"$f":"IF(F405=1,COUNTIF($F$3:F405,1),\"\")","v":403},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G405),$G$3:$G$3716,0)),\"\")","v":"00116200189"}]
[null,null,null,null,"00121043130",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E406,1),\"\"))","v":1},{"$f":"IF(F406=1,COUNTIF($F$3:F406,1),\"\")","v":404},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G406),$G$3:$G$3716,0)),\"\")","v":"00121043130"}]
[null,null,null,null,"00121053005",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E407,1),\"\"))","v":1},{"$f":"IF(F407=1,COUNTIF($F$3:F407,1),\"\")","v":405},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G407),$G$3:$G$3716,0)),\"\")","v":"00121053005"}]
[null,null,null,null,"00121054410",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E408,1),\"\"))","v":1},{"$f":"IF(F408=1,COUNTIF($F$3:F408,1),\"\")","v":406},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G408),$G$3:$G$3716,0)),\"\")","v":"00121054410"}]
[null,null,null,null,"00121058101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E409,1),\"\"))","v":1},{"$f":"IF(F409=1,COUNTIF($F$3:F409,1),\"\")","v":407},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G409),$G$3:$G$3716,0)),\"\")","v":"00121058101"}]
[null,null,null,null,"00121058104",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E410,1),\"\"))","v":1},{"$f":"IF(F410=1,COUNTIF($F$3:F410,1),\"\")","v":408},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G410),$G$3:$G$3716,0)),\"\")","v":"00121058104"}]
[null,null,null,null,"00121058105",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E411,1),\"\"))","v":1},{"$f":"IF(F411=1,COUNTIF($F$3:F411,1),\"\")","v":409},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G411),$G$3:$G$3716,0)),\"\")","v":"00121058105"}]
[null,null,null,null,"00121063810",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E412,1),\"\"))","v":1},{"$f":"IF(F412=1,COUNTIF($F$3:F412,1),\"\")","v":410},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G412),$G$3:$G$3716,0)),\"\")","v":"00121063810"}]
[null,null,null,null,"00121064616",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E413,1),\"\"))","v":1},{"$f":"IF(F413=1,COUNTIF($F$3:F413,1),\"\")","v":411},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G413),$G$3:$G$3716,0)),\"\")","v":"00121064616"}]
[null,null,null,null,"00121065416",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E414,1),\"\"))","v":1},{"$f":"IF(F414=1,COUNTIF($F$3:F414,1),\"\")","v":412},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G414),$G$3:$G$3716,0)),\"\")","v":"00121065416"}]
[null,null,null,null,"00121074710",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E415,1),\"\"))","v":1},{"$f":"IF(F415=1,COUNTIF($F$3:F415,1),\"\")","v":413},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G415),$G$3:$G$3716,0)),\"\")","v":"00121074710"}]
[null,null,null,null,"00121076616",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E416,1),\"\"))","v":1},{"$f":"IF(F416=1,COUNTIF($F$3:F416,1),\"\")","v":414},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G416),$G$3:$G$3716,0)),\"\")","v":"00121076616"}]
[null,null,null,null,"00121082601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E417,1),\"\"))","v":1},{"$f":"IF(F417=1,COUNTIF($F$3:F417,1),\"\")","v":415},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G417),$G$3:$G$3716,0)),\"\")","v":"00121082601"}]
[null,null,null,null,"00121086805",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E418,1),\"\"))","v":1},{"$f":"IF(F418=1,COUNTIF($F$3:F418,1),\"\")","v":416},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G418),$G$3:$G$3716,0)),\"\")","v":"00121086805"}]
[null,null,null,null,"00121127600",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E419,1),\"\"))","v":1},{"$f":"IF(F419=1,COUNTIF($F$3:F419,1),\"\")","v":417},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G419),$G$3:$G$3716,0)),\"\")","v":"00121127600"}]
[null,null,null,null,"00121127610",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E420,1),\"\"))","v":1},{"$f":"IF(F420=1,COUNTIF($F$3:F420,1),\"\")","v":418},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G420),$G$3:$G$3716,0)),\"\")","v":"00121127610"}]
[null,null,null,null,"00121146515",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E421,1),\"\"))","v":1},{"$f":"IF(F421=1,COUNTIF($F$3:F421,1),\"\")","v":419},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G421),$G$3:$G$3716,0)),\"\")","v":"00121146515"}]
[null,null,null,null,"00121146530",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E422,1),\"\"))","v":1},{"$f":"IF(F422=1,COUNTIF($F$3:F422,1),\"\")","v":420},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G422),$G$3:$G$3716,0)),\"\")","v":"00121146530"}]
[null,null,null,null,"00121148810",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E423,1),\"\"))","v":1},{"$f":"IF(F423=1,COUNTIF($F$3:F423,1),\"\")","v":421},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G423),$G$3:$G$3716,0)),\"\")","v":"00121148810"}]
[null,null,null,null,"00121168015",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E424,1),\"\"))","v":1},{"$f":"IF(F424=1,COUNTIF($F$3:F424,1),\"\")","v":422},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G424),$G$3:$G$3716,0)),\"\")","v":"00121168015"}]
[null,null,null,null,"00121174410",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E425,1),\"\"))","v":1},{"$f":"IF(F425=1,COUNTIF($F$3:F425,1),\"\")","v":423},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G425),$G$3:$G$3716,0)),\"\")","v":"00121174410"}]
[null,null,null,null,"00121182810",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E426,1),\"\"))","v":1},{"$f":"IF(F426=1,COUNTIF($F$3:F426,1),\"\")","v":424},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G426),$G$3:$G$3716,0)),\"\")","v":"00121182810"}]
[null,null,null,null,"00121472215",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E427,1),\"\"))","v":1},{"$f":"IF(F427=1,COUNTIF($F$3:F427,1),\"\")","v":425},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G427),$G$3:$G$3716,0)),\"\")","v":"00121472215"}]
[null,null,null,null,"00121477610",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E428,1),\"\"))","v":1},{"$f":"IF(F428=1,COUNTIF($F$3:F428,1),\"\")","v":426},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G428),$G$3:$G$3716,0)),\"\")","v":"00121477610"}]
[null,null,null,null,"00121482015",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E429,1),\"\"))","v":1},{"$f":"IF(F429=1,COUNTIF($F$3:F429,1),\"\")","v":427},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G429),$G$3:$G$3716,0)),\"\")","v":"00121482015"}]
[null,null,null,null,"00131247760",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E430,1),\"\"))","v":1},{"$f":"IF(F430=1,COUNTIF($F$3:F430,1),\"\")","v":428},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G430),$G$3:$G$3716,0)),\"\")","v":"00131247760"}]
[null,null,null,null,"00131247835",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E431,1),\"\"))","v":1},{"$f":"IF(F431=1,COUNTIF($F$3:F431,1),\"\")","v":429},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G431),$G$3:$G$3716,0)),\"\")","v":"00131247835"}]
[null,null,null,null,"00131247860",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E432,1),\"\"))","v":1},{"$f":"IF(F432=1,COUNTIF($F$3:F432,1),\"\")","v":430},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G432),$G$3:$G$3716,0)),\"\")","v":"00131247860"}]
[null,null,null,null,"00132007950",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E433,1),\"\"))","v":1},{"$f":"IF(F433=1,COUNTIF($F$3:F433,1),\"\")","v":431},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G433),$G$3:$G$3716,0)),\"\")","v":"00132007950"}]
[null,null,null,null,"00132020220",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E434,1),\"\"))","v":1},{"$f":"IF(F434=1,COUNTIF($F$3:F434,1),\"\")","v":432},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G434),$G$3:$G$3716,0)),\"\")","v":"00132020220"}]
[null,null,null,null,"00132030140",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E435,1),\"\"))","v":1},{"$f":"IF(F435=1,COUNTIF($F$3:F435,1),\"\")","v":433},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G435),$G$3:$G$3716,0)),\"\")","v":"00132030140"}]
[null,null,null,null,"00135014502",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E436,1),\"\"))","v":1},{"$f":"IF(F436=1,COUNTIF($F$3:F436,1),\"\")","v":434},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G436),$G$3:$G$3716,0)),\"\")","v":"00135014502"}]
[null,null,null,null,"00135019502",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E437,1),\"\"))","v":1},{"$f":"IF(F437=1,COUNTIF($F$3:F437,1),\"\")","v":435},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G437),$G$3:$G$3716,0)),\"\")","v":"00135019502"}]
[null,null,null,null,"00143117101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E438,1),\"\"))","v":1},{"$f":"IF(F438=1,COUNTIF($F$3:F438,1),\"\")","v":436},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G438),$G$3:$G$3716,0)),\"\")","v":"00143117101"}]
[null,null,null,null,"00143129201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E439,1),\"\"))","v":1},{"$f":"IF(F439=1,COUNTIF($F$3:F439,1),\"\")","v":437},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G439),$G$3:$G$3716,0)),\"\")","v":"00143129201"}]
[null,null,null,null,"00143148001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E440,1),\"\"))","v":1},{"$f":"IF(F440=1,COUNTIF($F$3:F440,1),\"\")","v":438},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G440),$G$3:$G$3716,0)),\"\")","v":"00143148001"}]
[null,null,null,null,"00143176301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E441,1),\"\"))","v":1},{"$f":"IF(F441=1,COUNTIF($F$3:F441,1),\"\")","v":439},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G441),$G$3:$G$3716,0)),\"\")","v":"00143176301"}]
[null,null,null,null,"00143176401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E442,1),\"\"))","v":1},{"$f":"IF(F442=1,COUNTIF($F$3:F442,1),\"\")","v":440},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G442),$G$3:$G$3716,0)),\"\")","v":"00143176401"}]
[null,null,null,null,"00143176901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E443,1),\"\"))","v":1},{"$f":"IF(F443=1,COUNTIF($F$3:F443,1),\"\")","v":441},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G443),$G$3:$G$3716,0)),\"\")","v":"00143176901"}]
[null,null,null,null,"00143177101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E444,1),\"\"))","v":1},{"$f":"IF(F444=1,COUNTIF($F$3:F444,1),\"\")","v":442},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G444),$G$3:$G$3716,0)),\"\")","v":"00143177101"}]
[null,null,null,null,"00143177110",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E445,1),\"\"))","v":1},{"$f":"IF(F445=1,COUNTIF($F$3:F445,1),\"\")","v":443},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G445),$G$3:$G$3716,0)),\"\")","v":"00143177110"}]
[null,null,null,null,"00143177201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E446,1),\"\"))","v":1},{"$f":"IF(F446=1,COUNTIF($F$3:F446,1),\"\")","v":444},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G446),$G$3:$G$3716,0)),\"\")","v":"00143177201"}]
[null,null,null,null,"00143177301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E447,1),\"\"))","v":1},{"$f":"IF(F447=1,COUNTIF($F$3:F447,1),\"\")","v":445},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G447),$G$3:$G$3716,0)),\"\")","v":"00143177301"}]
[null,null,null,null,"00143178701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E448,1),\"\"))","v":1},{"$f":"IF(F448=1,COUNTIF($F$3:F448,1),\"\")","v":446},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G448),$G$3:$G$3716,0)),\"\")","v":"00143178701"}]
[null,null,null,null,"00143211250",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E449,1),\"\"))","v":1},{"$f":"IF(F449=1,COUNTIF($F$3:F449,1),\"\")","v":447},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G449),$G$3:$G$3716,0)),\"\")","v":"00143211250"}]
[null,null,null,null,"00143212522",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E450,1),\"\"))","v":1},{"$f":"IF(F450=1,COUNTIF($F$3:F450,1),\"\")","v":448},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G450),$G$3:$G$3716,0)),\"\")","v":"00143212522"}]
[null,null,null,null,"00143226001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E451,1),\"\"))","v":1},{"$f":"IF(F451=1,COUNTIF($F$3:F451,1),\"\")","v":449},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G451),$G$3:$G$3716,0)),\"\")","v":"00143226001"}]
[null,null,null,null,"00143318801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E452,1),\"\"))","v":1},{"$f":"IF(F452=1,COUNTIF($F$3:F452,1),\"\")","v":450},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G452),$G$3:$G$3716,0)),\"\")","v":"00143318801"}]
[null,null,null,null,"00143953301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E453,1),\"\"))","v":1},{"$f":"IF(F453=1,COUNTIF($F$3:F453,1),\"\")","v":451},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G453),$G$3:$G$3716,0)),\"\")","v":"00143953301"}]
[null,null,null,null,"00143958109",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E454,1),\"\"))","v":1},{"$f":"IF(F454=1,COUNTIF($F$3:F454,1),\"\")","v":452},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G454),$G$3:$G$3716,0)),\"\")","v":"00143958109"}]
[null,null,null,null,"00143963301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E455,1),\"\"))","v":1},{"$f":"IF(F455=1,COUNTIF($F$3:F455,1),\"\")","v":453},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G455),$G$3:$G$3716,0)),\"\")","v":"00143963301"}]
[null,null,null,null,"00143963310",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E456,1),\"\"))","v":1},{"$f":"IF(F456=1,COUNTIF($F$3:F456,1),\"\")","v":454},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G456),$G$3:$G$3716,0)),\"\")","v":"00143963310"}]
[null,null,null,null,"00143971710",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E457,1),\"\"))","v":1},{"$f":"IF(F457=1,COUNTIF($F$3:F457,1),\"\")","v":455},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G457),$G$3:$G$3716,0)),\"\")","v":"00143971710"}]
[null,null,null,null,"00143985316",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E458,1),\"\"))","v":1},{"$f":"IF(F458=1,COUNTIF($F$3:F458,1),\"\")","v":456},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G458),$G$3:$G$3716,0)),\"\")","v":"00143985316"}]
[null,null,null,null,"00143988815",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E459,1),\"\"))","v":1},{"$f":"IF(F459=1,COUNTIF($F$3:F459,1),\"\")","v":457},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G459),$G$3:$G$3716,0)),\"\")","v":"00143988815"}]
[null,null,null,null,"00143988915",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E460,1),\"\"))","v":1},{"$f":"IF(F460=1,COUNTIF($F$3:F460,1),\"\")","v":458},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G460),$G$3:$G$3716,0)),\"\")","v":"00143988915"}]
[null,null,null,null,"00143989701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E461,1),\"\"))","v":1},{"$f":"IF(F461=1,COUNTIF($F$3:F461,1),\"\")","v":459},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G461),$G$3:$G$3716,0)),\"\")","v":"00143989701"}]
[null,null,null,null,"00143989801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E462,1),\"\"))","v":1},{"$f":"IF(F462=1,COUNTIF($F$3:F462,1),\"\")","v":460},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G462),$G$3:$G$3716,0)),\"\")","v":"00143989801"}]
[null,null,null,null,"00143994850",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E463,1),\"\"))","v":1},{"$f":"IF(F463=1,COUNTIF($F$3:F463,1),\"\")","v":461},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G463),$G$3:$G$3716,0)),\"\")","v":"00143994850"}]
[null,null,null,null,"00143998150",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E464,1),\"\"))","v":1},{"$f":"IF(F464=1,COUNTIF($F$3:F464,1),\"\")","v":462},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G464),$G$3:$G$3716,0)),\"\")","v":"00143998150"}]
[null,null,null,null,"00143998201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E465,1),\"\"))","v":1},{"$f":"IF(F465=1,COUNTIF($F$3:F465,1),\"\")","v":463},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G465),$G$3:$G$3716,0)),\"\")","v":"00143998201"}]
[null,null,null,null,"00143998250",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E466,1),\"\"))","v":1},{"$f":"IF(F466=1,COUNTIF($F$3:F466,1),\"\")","v":464},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G466),$G$3:$G$3716,0)),\"\")","v":"00143998250"}]
[null,null,null,null,"00168000315",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E467,1),\"\"))","v":1},{"$f":"IF(F467=1,COUNTIF($F$3:F467,1),\"\")","v":465},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G467),$G$3:$G$3716,0)),\"\")","v":"00168000315"}]
[null,null,null,null,"00168000415",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E468,1),\"\"))","v":1},{"$f":"IF(F468=1,COUNTIF($F$3:F468,1),\"\")","v":466},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G468),$G$3:$G$3716,0)),\"\")","v":"00168000415"}]
[null,null,null,null,"00168000480",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E469,1),\"\"))","v":1},{"$f":"IF(F469=1,COUNTIF($F$3:F469,1),\"\")","v":467},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G469),$G$3:$G$3716,0)),\"\")","v":"00168000480"}]
[null,null,null,null,"00168000615",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E470,1),\"\"))","v":1},{"$f":"IF(F470=1,COUNTIF($F$3:F470,1),\"\")","v":468},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G470),$G$3:$G$3716,0)),\"\")","v":"00168000615"}]
[null,null,null,null,"00168000616",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E471,1),\"\"))","v":1},{"$f":"IF(F471=1,COUNTIF($F$3:F471,1),\"\")","v":469},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G471),$G$3:$G$3716,0)),\"\")","v":"00168000616"}]
[null,null,null,null,"00168000680",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E472,1),\"\"))","v":1},{"$f":"IF(F472=1,COUNTIF($F$3:F472,1),\"\")","v":470},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G472),$G$3:$G$3716,0)),\"\")","v":"00168000680"}]
[null,null,null,null,"00168000715",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E473,1),\"\"))","v":1},{"$f":"IF(F473=1,COUNTIF($F$3:F473,1),\"\")","v":471},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G473),$G$3:$G$3716,0)),\"\")","v":"00168000715"}]
[null,null,null,null,"00168001235",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E474,1),\"\"))","v":1},{"$f":"IF(F474=1,COUNTIF($F$3:F474,1),\"\")","v":472},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G474),$G$3:$G$3716,0)),\"\")","v":"00168001235"}]
[null,null,null,null,"00168001431",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E475,1),\"\"))","v":1},{"$f":"IF(F475=1,COUNTIF($F$3:F475,1),\"\")","v":473},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G475),$G$3:$G$3716,0)),\"\")","v":"00168001431"}]
[null,null,null,null,"00168003501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E476,1),\"\"))","v":1},{"$f":"IF(F476=1,COUNTIF($F$3:F476,1),\"\")","v":474},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G476),$G$3:$G$3716,0)),\"\")","v":"00168003501"}]
[null,null,null,null,"00168006015",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E477,1),\"\"))","v":1},{"$f":"IF(F477=1,COUNTIF($F$3:F477,1),\"\")","v":475},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G477),$G$3:$G$3716,0)),\"\")","v":"00168006015"}]
[null,null,null,null,"00168006060",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E478,1),\"\"))","v":1},{"$f":"IF(F478=1,COUNTIF($F$3:F478,1),\"\")","v":476},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G478),$G$3:$G$3716,0)),\"\")","v":"00168006060"}]
[null,null,null,null,"00168006231",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E479,1),\"\"))","v":1},{"$f":"IF(F479=1,COUNTIF($F$3:F479,1),\"\")","v":477},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G479),$G$3:$G$3716,0)),\"\")","v":"00168006231"}]
[null,null,null,null,"00168006415",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E480,1),\"\"))","v":1},{"$f":"IF(F480=1,COUNTIF($F$3:F480,1),\"\")","v":478},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G480),$G$3:$G$3716,0)),\"\")","v":"00168006415"}]
[null,null,null,null,"00168006460",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E481,1),\"\"))","v":1},{"$f":"IF(F481=1,COUNTIF($F$3:F481,1),\"\")","v":479},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G481),$G$3:$G$3716,0)),\"\")","v":"00168006460"}]
[null,null,null,null,"00168008031",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E482,1),\"\"))","v":1},{"$f":"IF(F482=1,COUNTIF($F$3:F482,1),\"\")","v":480},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G482),$G$3:$G$3716,0)),\"\")","v":"00168008031"}]
[null,null,null,null,"00168009930",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E483,1),\"\"))","v":1},{"$f":"IF(F483=1,COUNTIF($F$3:F483,1),\"\")","v":481},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G483),$G$3:$G$3716,0)),\"\")","v":"00168009930"}]
[null,null,null,null,"00168014630",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E484,1),\"\"))","v":1},{"$f":"IF(F484=1,COUNTIF($F$3:F484,1),\"\")","v":482},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G484),$G$3:$G$3716,0)),\"\")","v":"00168014630"}]
[null,null,null,null,"00168016330",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E485,1),\"\"))","v":1},{"$f":"IF(F485=1,COUNTIF($F$3:F485,1),\"\")","v":483},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G485),$G$3:$G$3716,0)),\"\")","v":"00168016330"}]
[null,null,null,null,"00168020230",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E486,1),\"\"))","v":1},{"$f":"IF(F486=1,COUNTIF($F$3:F486,1),\"\")","v":484},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G486),$G$3:$G$3716,0)),\"\")","v":"00168020230"}]
[null,null,null,null,"00168027545",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E487,1),\"\"))","v":1},{"$f":"IF(F487=1,COUNTIF($F$3:F487,1),\"\")","v":485},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G487),$G$3:$G$3716,0)),\"\")","v":"00168027545"}]
[null,null,null,null,"00168027740",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E488,1),\"\"))","v":1},{"$f":"IF(F488=1,COUNTIF($F$3:F488,1),\"\")","v":486},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G488),$G$3:$G$3716,0)),\"\")","v":"00168027740"}]
[null,null,null,null,"00172208310",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E489,1),\"\"))","v":1},{"$f":"IF(F489=1,COUNTIF($F$3:F489,1),\"\")","v":487},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G489),$G$3:$G$3716,0)),\"\")","v":"00172208310"}]
[null,null,null,null,"00172208380",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E490,1),\"\"))","v":1},{"$f":"IF(F490=1,COUNTIF($F$3:F490,1),\"\")","v":488},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G490),$G$3:$G$3716,0)),\"\")","v":"00172208380"}]
[null,null,null,null,"00172240710",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E491,1),\"\"))","v":1},{"$f":"IF(F491=1,COUNTIF($F$3:F491,1),\"\")","v":489},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G491),$G$3:$G$3716,0)),\"\")","v":"00172240710"}]
[null,null,null,null,"00172290710",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E492,1),\"\"))","v":1},{"$f":"IF(F492=1,COUNTIF($F$3:F492,1),\"\")","v":490},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G492),$G$3:$G$3716,0)),\"\")","v":"00172290710"}]
[null,null,null,null,"00172364910",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E493,1),\"\"))","v":1},{"$f":"IF(F493=1,COUNTIF($F$3:F493,1),\"\")","v":491},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G493),$G$3:$G$3716,0)),\"\")","v":"00172364910"}]
[null,null,null,null,"00172364960",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E494,1),\"\"))","v":1},{"$f":"IF(F494=1,COUNTIF($F$3:F494,1),\"\")","v":492},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G494),$G$3:$G$3716,0)),\"\")","v":"00172364960"}]
[null,null,null,null,"00172375810",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E495,1),\"\"))","v":1},{"$f":"IF(F495=1,COUNTIF($F$3:F495,1),\"\")","v":493},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G495),$G$3:$G$3716,0)),\"\")","v":"00172375810"}]
[null,null,null,null,"00172375960",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E496,1),\"\"))","v":1},{"$f":"IF(F496=1,COUNTIF($F$3:F496,1),\"\")","v":494},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G496),$G$3:$G$3716,0)),\"\")","v":"00172375960"}]
[null,null,null,null,"00172375970",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E497,1),\"\"))","v":1},{"$f":"IF(F497=1,COUNTIF($F$3:F497,1),\"\")","v":495},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G497),$G$3:$G$3716,0)),\"\")","v":"00172375970"}]
[null,null,null,null,"00172376010",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E498,1),\"\"))","v":1},{"$f":"IF(F498=1,COUNTIF($F$3:F498,1),\"\")","v":496},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G498),$G$3:$G$3716,0)),\"\")","v":"00172376010"}]
[null,null,null,null,"00172376070",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E499,1),\"\"))","v":1},{"$f":"IF(F499=1,COUNTIF($F$3:F499,1),\"\")","v":497},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G499),$G$3:$G$3716,0)),\"\")","v":"00172376070"}]
[null,null,null,null,"00172392660",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E500,1),\"\"))","v":1},{"$f":"IF(F500=1,COUNTIF($F$3:F500,1),\"\")","v":498},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G500),$G$3:$G$3716,0)),\"\")","v":"00172392660"}]
[null,null,null,null,"00172392760",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E501,1),\"\"))","v":1},{"$f":"IF(F501=1,COUNTIF($F$3:F501,1),\"\")","v":499},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G501),$G$3:$G$3716,0)),\"\")","v":"00172392760"}]
[null,null,null,null,"00172409660",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E502,1),\"\"))","v":1},{"$f":"IF(F502=1,COUNTIF($F$3:F502,1),\"\")","v":500},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G502),$G$3:$G$3716,0)),\"\")","v":"00172409660"}]
[null,null,null,null,"00172409760",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E503,1),\"\"))","v":1},{"$f":"IF(F503=1,COUNTIF($F$3:F503,1),\"\")","v":501},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G503),$G$3:$G$3716,0)),\"\")","v":"00172409760"}]
[null,null,null,null,"00172428010",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E504,1),\"\"))","v":1},{"$f":"IF(F504=1,COUNTIF($F$3:F504,1),\"\")","v":502},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G504),$G$3:$G$3716,0)),\"\")","v":"00172428010"}]
[null,null,null,null,"00172428510",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E505,1),\"\"))","v":1},{"$f":"IF(F505=1,COUNTIF($F$3:F505,1),\"\")","v":503},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G505),$G$3:$G$3716,0)),\"\")","v":"00172428510"}]
[null,null,null,null,"00172428610",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E506,1),\"\"))","v":1},{"$f":"IF(F506=1,COUNTIF($F$3:F506,1),\"\")","v":504},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G506),$G$3:$G$3716,0)),\"\")","v":"00172428610"}]
[null,null,null,null,"00172436560",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E507,1),\"\"))","v":1},{"$f":"IF(F507=1,COUNTIF($F$3:F507,1),\"\")","v":505},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G507),$G$3:$G$3716,0)),\"\")","v":"00172436560"}]
[null,null,null,null,"00172436570",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E508,1),\"\"))","v":1},{"$f":"IF(F508=1,COUNTIF($F$3:F508,1),\"\")","v":506},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G508),$G$3:$G$3716,0)),\"\")","v":"00172436570"}]
[null,null,null,null,"00172436660",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E509,1),\"\"))","v":1},{"$f":"IF(F509=1,COUNTIF($F$3:F509,1),\"\")","v":507},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G509),$G$3:$G$3716,0)),\"\")","v":"00172436660"}]
[null,null,null,null,"00172480560",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E510,1),\"\"))","v":1},{"$f":"IF(F510=1,COUNTIF($F$3:F510,1),\"\")","v":508},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G510),$G$3:$G$3716,0)),\"\")","v":"00172480560"}]
[null,null,null,null,"00172496058",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E511,1),\"\"))","v":1},{"$f":"IF(F511=1,COUNTIF($F$3:F511,1),\"\")","v":509},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G511),$G$3:$G$3716,0)),\"\")","v":"00172496058"}]
[null,null,null,null,"00172524160",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E512,1),\"\"))","v":1},{"$f":"IF(F512=1,COUNTIF($F$3:F512,1),\"\")","v":510},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G512),$G$3:$G$3716,0)),\"\")","v":"00172524160"}]
[null,null,null,null,"00172531360",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E513,1),\"\"))","v":1},{"$f":"IF(F513=1,COUNTIF($F$3:F513,1),\"\")","v":511},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G513),$G$3:$G$3716,0)),\"\")","v":"00172531360"}]
[null,null,null,null,"00172541046",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E514,1),\"\"))","v":1},{"$f":"IF(F514=1,COUNTIF($F$3:F514,1),\"\")","v":512},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G514),$G$3:$G$3716,0)),\"\")","v":"00172541046"}]
[null,null,null,null,"00172541146",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E515,1),\"\"))","v":1},{"$f":"IF(F515=1,COUNTIF($F$3:F515,1),\"\")","v":513},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G515),$G$3:$G$3716,0)),\"\")","v":"00172541146"}]
[null,null,null,null,"00172541160",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E516,1),\"\"))","v":1},{"$f":"IF(F516=1,COUNTIF($F$3:F516,1),\"\")","v":514},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G516),$G$3:$G$3716,0)),\"\")","v":"00172541160"}]
[null,null,null,null,"00172541346",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E517,1),\"\"))","v":1},{"$f":"IF(F517=1,COUNTIF($F$3:F517,1),\"\")","v":515},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G517),$G$3:$G$3716,0)),\"\")","v":"00172541346"}]
[null,null,null,null,"00172541360",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E518,1),\"\"))","v":1},{"$f":"IF(F518=1,COUNTIF($F$3:F518,1),\"\")","v":516},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G518),$G$3:$G$3716,0)),\"\")","v":"00172541360"}]
[null,null,null,null,"00172572860",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E519,1),\"\"))","v":1},{"$f":"IF(F519=1,COUNTIF($F$3:F519,1),\"\")","v":517},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G519),$G$3:$G$3716,0)),\"\")","v":"00172572860"}]
[null,null,null,null,"00172572870",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E520,1),\"\"))","v":1},{"$f":"IF(F520=1,COUNTIF($F$3:F520,1),\"\")","v":518},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G520),$G$3:$G$3716,0)),\"\")","v":"00172572870"}]
[null,null,null,null,"00172572880",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E521,1),\"\"))","v":1},{"$f":"IF(F521=1,COUNTIF($F$3:F521,1),\"\")","v":519},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G521),$G$3:$G$3716,0)),\"\")","v":"00172572880"}]
[null,null,null,null,"00173052000",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E522,1),\"\"))","v":1},{"$f":"IF(F522=1,COUNTIF($F$3:F522,1),\"\")","v":520},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G522),$G$3:$G$3716,0)),\"\")","v":"00173052000"}]
[null,null,null,null,"00173052600",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E523,1),\"\"))","v":1},{"$f":"IF(F523=1,COUNTIF($F$3:F523,1),\"\")","v":521},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G523),$G$3:$G$3716,0)),\"\")","v":"00173052600"}]
[null,null,null,null,"00173052700",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E524,1),\"\"))","v":1},{"$f":"IF(F524=1,COUNTIF($F$3:F524,1),\"\")","v":522},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G524),$G$3:$G$3716,0)),\"\")","v":"00173052700"}]
[null,null,null,null,"00173054700",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E525,1),\"\"))","v":1},{"$f":"IF(F525=1,COUNTIF($F$3:F525,1),\"\")","v":523},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G525),$G$3:$G$3716,0)),\"\")","v":"00173054700"}]
[null,null,null,null,"00173064255",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E526,1),\"\"))","v":1},{"$f":"IF(F526=1,COUNTIF($F$3:F526,1),\"\")","v":524},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G526),$G$3:$G$3716,0)),\"\")","v":"00173064255"}]
[null,null,null,null,"00173068220",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E527,1),\"\"))","v":1},{"$f":"IF(F527=1,COUNTIF($F$3:F527,1),\"\")","v":525},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G527),$G$3:$G$3716,0)),\"\")","v":"00173068220"}]
[null,null,null,null,"00173068224",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E528,1),\"\"))","v":1},{"$f":"IF(F528=1,COUNTIF($F$3:F528,1),\"\")","v":526},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G528),$G$3:$G$3716,0)),\"\")","v":"00173068224"}]
[null,null,null,null,"00173071820",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E529,1),\"\"))","v":1},{"$f":"IF(F529=1,COUNTIF($F$3:F529,1),\"\")","v":527},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G529),$G$3:$G$3716,0)),\"\")","v":"00173071820"}]
[null,null,null,null,"00173071920",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E530,1),\"\"))","v":1},{"$f":"IF(F530=1,COUNTIF($F$3:F530,1),\"\")","v":528},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G530),$G$3:$G$3716,0)),\"\")","v":"00173071920"}]
[null,null,null,null,"00173072020",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E531,1),\"\"))","v":1},{"$f":"IF(F531=1,COUNTIF($F$3:F531,1),\"\")","v":529},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G531),$G$3:$G$3716,0)),\"\")","v":"00173072020"}]
[null,null,null,null,"00173073500",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E532,1),\"\"))","v":1},{"$f":"IF(F532=1,COUNTIF($F$3:F532,1),\"\")","v":530},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G532),$G$3:$G$3716,0)),\"\")","v":"00173073500"}]
[null,null,null,null,"00173088025",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E533,1),\"\"))","v":1},{"$f":"IF(F533=1,COUNTIF($F$3:F533,1),\"\")","v":531},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G533),$G$3:$G$3716,0)),\"\")","v":"00173088025"}]
[null,null,null,null,"00182055489",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E534,1),\"\"))","v":1},{"$f":"IF(F534=1,COUNTIF($F$3:F534,1),\"\")","v":532},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G534),$G$3:$G$3716,0)),\"\")","v":"00182055489"}]
[null,null,null,null,"00182090589",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E535,1),\"\"))","v":1},{"$f":"IF(F535=1,COUNTIF($F$3:F535,1),\"\")","v":533},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G535),$G$3:$G$3716,0)),\"\")","v":"00182090589"}]
[null,null,null,null,"00185011801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E536,1),\"\"))","v":1},{"$f":"IF(F536=1,COUNTIF($F$3:F536,1),\"\")","v":534},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G536),$G$3:$G$3716,0)),\"\")","v":"00185011801"}]
[null,null,null,null,"00185012201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E537,1),\"\"))","v":1},{"$f":"IF(F537=1,COUNTIF($F$3:F537,1),\"\")","v":535},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G537),$G$3:$G$3716,0)),\"\")","v":"00185012201"}]
[null,null,null,null,"00185012901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E538,1),\"\"))","v":1},{"$f":"IF(F538=1,COUNTIF($F$3:F538,1),\"\")","v":536},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G538),$G$3:$G$3716,0)),\"\")","v":"00185012901"}]
[null,null,null,null,"00185012905",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E539,1),\"\"))","v":1},{"$f":"IF(F539=1,COUNTIF($F$3:F539,1),\"\")","v":537},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G539),$G$3:$G$3716,0)),\"\")","v":"00185012905"}]
[null,null,null,null,"00185020501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E540,1),\"\"))","v":1},{"$f":"IF(F540=1,COUNTIF($F$3:F540,1),\"\")","v":538},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G540),$G$3:$G$3716,0)),\"\")","v":"00185020501"}]
[null,null,null,null,"00185021001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E541,1),\"\"))","v":1},{"$f":"IF(F541=1,COUNTIF($F$3:F541,1),\"\")","v":539},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G541),$G$3:$G$3716,0)),\"\")","v":"00185021001"}]
[null,null,null,null,"00185022360",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E542,1),\"\"))","v":1},{"$f":"IF(F542=1,COUNTIF($F$3:F542,1),\"\")","v":540},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G542),$G$3:$G$3716,0)),\"\")","v":"00185022360"}]
[null,null,null,null,"00185041060",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E543,1),\"\"))","v":1},{"$f":"IF(F543=1,COUNTIF($F$3:F543,1),\"\")","v":541},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G543),$G$3:$G$3716,0)),\"\")","v":"00185041060"}]
[null,null,null,null,"00185041552",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E544,1),\"\"))","v":1},{"$f":"IF(F544=1,COUNTIF($F$3:F544,1),\"\")","v":542},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G544),$G$3:$G$3716,0)),\"\")","v":"00185041552"}]
[null,null,null,null,"00185055030",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E545,1),\"\"))","v":1},{"$f":"IF(F545=1,COUNTIF($F$3:F545,1),\"\")","v":543},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G545),$G$3:$G$3716,0)),\"\")","v":"00185055030"}]
[null,null,null,null,"00185075701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E546,1),\"\"))","v":1},{"$f":"IF(F546=1,COUNTIF($F$3:F546,1),\"\")","v":544},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G546),$G$3:$G$3716,0)),\"\")","v":"00185075701"}]
[null,null,null,null,"00185434601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E547,1),\"\"))","v":1},{"$f":"IF(F547=1,COUNTIF($F$3:F547,1),\"\")","v":545},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G547),$G$3:$G$3716,0)),\"\")","v":"00185434601"}]
[null,null,null,null,"00186000431",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E548,1),\"\"))","v":1},{"$f":"IF(F548=1,COUNTIF($F$3:F548,1),\"\")","v":546},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G548),$G$3:$G$3716,0)),\"\")","v":"00186000431"}]
[null,null,null,null,"00186001631",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E549,1),\"\"))","v":1},{"$f":"IF(F549=1,COUNTIF($F$3:F549,1),\"\")","v":547},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G549),$G$3:$G$3716,0)),\"\")","v":"00186001631"}]
[null,null,null,null,"00186077660",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E550,1),\"\"))","v":1},{"$f":"IF(F550=1,COUNTIF($F$3:F550,1),\"\")","v":548},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G550),$G$3:$G$3716,0)),\"\")","v":"00186077660"}]
[null,null,null,null,"00186077739",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E551,1),\"\"))","v":1},{"$f":"IF(F551=1,COUNTIF($F$3:F551,1),\"\")","v":549},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G551),$G$3:$G$3716,0)),\"\")","v":"00186077739"}]
[null,null,null,null,"00186077760",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E552,1),\"\"))","v":1},{"$f":"IF(F552=1,COUNTIF($F$3:F552,1),\"\")","v":550},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G552),$G$3:$G$3716,0)),\"\")","v":"00186077760"}]
[null,null,null,null,"00187065820",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E553,1),\"\"))","v":1},{"$f":"IF(F553=1,COUNTIF($F$3:F553,1),\"\")","v":551},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G553),$G$3:$G$3716,0)),\"\")","v":"00187065820"}]
[null,null,null,null,"00187065920",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E554,1),\"\"))","v":1},{"$f":"IF(F554=1,COUNTIF($F$3:F554,1),\"\")","v":552},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G554),$G$3:$G$3716,0)),\"\")","v":"00187065920"}]
[null,null,null,null,"00187079530",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E555,1),\"\"))","v":1},{"$f":"IF(F555=1,COUNTIF($F$3:F555,1),\"\")","v":553},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G555),$G$3:$G$3716,0)),\"\")","v":"00187079530"}]
[null,null,null,null,"00187093801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E556,1),\"\"))","v":1},{"$f":"IF(F556=1,COUNTIF($F$3:F556,1),\"\")","v":554},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G556),$G$3:$G$3716,0)),\"\")","v":"00187093801"}]
[null,null,null,null,"00187170405",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E557,1),\"\"))","v":1},{"$f":"IF(F557=1,COUNTIF($F$3:F557,1),\"\")","v":555},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G557),$G$3:$G$3716,0)),\"\")","v":"00187170405"}]
[null,null,null,null,"00187301220",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E558,1),\"\"))","v":1},{"$f":"IF(F558=1,COUNTIF($F$3:F558,1),\"\")","v":556},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G558),$G$3:$G$3716,0)),\"\")","v":"00187301220"}]
[null,null,null,null,"00187355410",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E559,1),\"\"))","v":1},{"$f":"IF(F559=1,COUNTIF($F$3:F559,1),\"\")","v":557},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G559),$G$3:$G$3716,0)),\"\")","v":"00187355410"}]
[null,null,null,null,"00187355510",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E560,1),\"\"))","v":1},{"$f":"IF(F560=1,COUNTIF($F$3:F560,1),\"\")","v":558},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G560),$G$3:$G$3716,0)),\"\")","v":"00187355510"}]
[null,null,null,null,"00187526802",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E561,1),\"\"))","v":1},{"$f":"IF(F561=1,COUNTIF($F$3:F561,1),\"\")","v":559},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G561),$G$3:$G$3716,0)),\"\")","v":"00187526802"}]
[null,null,null,null,"00212282374",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E562,1),\"\"))","v":1},{"$f":"IF(F562=1,COUNTIF($F$3:F562,1),\"\")","v":560},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G562),$G$3:$G$3716,0)),\"\")","v":"00212282374"}]
[null,null,null,null,"00223172101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E563,1),\"\"))","v":1},{"$f":"IF(F563=1,COUNTIF($F$3:F563,1),\"\")","v":561},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G563),$G$3:$G$3716,0)),\"\")","v":"00223172101"}]
[null,null,null,null,"00223176001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E564,1),\"\"))","v":1},{"$f":"IF(F564=1,COUNTIF($F$3:F564,1),\"\")","v":562},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G564),$G$3:$G$3716,0)),\"\")","v":"00223176001"}]
[null,null,null,null,"00224185200",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E565,1),\"\"))","v":1},{"$f":"IF(F565=1,COUNTIF($F$3:F565,1),\"\")","v":563},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G565),$G$3:$G$3716,0)),\"\")","v":"00224185200"}]
[null,null,null,null,"00224185281",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E566,1),\"\"))","v":1},{"$f":"IF(F566=1,COUNTIF($F$3:F566,1),\"\")","v":564},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G566),$G$3:$G$3716,0)),\"\")","v":"00224185281"}]
[null,null,null,null,"00225052547",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E567,1),\"\"))","v":1},{"$f":"IF(F567=1,COUNTIF($F$3:F567,1),\"\")","v":565},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G567),$G$3:$G$3716,0)),\"\")","v":"00225052547"}]
[null,null,null,null,"00225052848",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E568,1),\"\"))","v":1},{"$f":"IF(F568=1,COUNTIF($F$3:F568,1),\"\")","v":566},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G568),$G$3:$G$3716,0)),\"\")","v":"00225052848"}]
[null,null,null,null,"00225081047",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E569,1),\"\"))","v":1},{"$f":"IF(F569=1,COUNTIF($F$3:F569,1),\"\")","v":567},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G569),$G$3:$G$3716,0)),\"\")","v":"00225081047"}]
[null,null,null,null,"00228206710",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E570,1),\"\"))","v":1},{"$f":"IF(F570=1,COUNTIF($F$3:F570,1),\"\")","v":568},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G570),$G$3:$G$3716,0)),\"\")","v":"00228206710"}]
[null,null,null,null,"00228206910",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E571,1),\"\"))","v":1},{"$f":"IF(F571=1,COUNTIF($F$3:F571,1),\"\")","v":569},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G571),$G$3:$G$3716,0)),\"\")","v":"00228206910"}]
[null,null,null,null,"00228212750",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E572,1),\"\"))","v":1},{"$f":"IF(F572=1,COUNTIF($F$3:F572,1),\"\")","v":570},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G572),$G$3:$G$3716,0)),\"\")","v":"00228212750"}]
[null,null,null,null,"00228212810",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E573,1),\"\"))","v":1},{"$f":"IF(F573=1,COUNTIF($F$3:F573,1),\"\")","v":571},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G573),$G$3:$G$3716,0)),\"\")","v":"00228212810"}]
[null,null,null,null,"00228212910",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E574,1),\"\"))","v":1},{"$f":"IF(F574=1,COUNTIF($F$3:F574,1),\"\")","v":572},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G574),$G$3:$G$3716,0)),\"\")","v":"00228212910"}]
[null,null,null,null,"00228234810",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E575,1),\"\"))","v":1},{"$f":"IF(F575=1,COUNTIF($F$3:F575,1),\"\")","v":573},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G575),$G$3:$G$3716,0)),\"\")","v":"00228234810"}]
[null,null,null,null,"00228249710",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E576,1),\"\"))","v":1},{"$f":"IF(F576=1,COUNTIF($F$3:F576,1),\"\")","v":574},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G576),$G$3:$G$3716,0)),\"\")","v":"00228249710"}]
[null,null,null,null,"00228253910",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E577,1),\"\"))","v":1},{"$f":"IF(F577=1,COUNTIF($F$3:F577,1),\"\")","v":575},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G577),$G$3:$G$3716,0)),\"\")","v":"00228253910"}]
[null,null,null,null,"00228262011",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E578,1),\"\"))","v":1},{"$f":"IF(F578=1,COUNTIF($F$3:F578,1),\"\")","v":576},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G578),$G$3:$G$3716,0)),\"\")","v":"00228262011"}]
[null,null,null,null,"00228267211",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E579,1),\"\"))","v":1},{"$f":"IF(F579=1,COUNTIF($F$3:F579,1),\"\")","v":577},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G579),$G$3:$G$3716,0)),\"\")","v":"00228267211"}]
[null,null,null,null,"00228277811",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E580,1),\"\"))","v":1},{"$f":"IF(F580=1,COUNTIF($F$3:F580,1),\"\")","v":578},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G580),$G$3:$G$3716,0)),\"\")","v":"00228277811"}]
[null,null,null,null,"00228277911",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E581,1),\"\"))","v":1},{"$f":"IF(F581=1,COUNTIF($F$3:F581,1),\"\")","v":579},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G581),$G$3:$G$3716,0)),\"\")","v":"00228277911"}]
[null,null,null,null,"00228278111",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E582,1),\"\"))","v":1},{"$f":"IF(F582=1,COUNTIF($F$3:F582,1),\"\")","v":580},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G582),$G$3:$G$3716,0)),\"\")","v":"00228278111"}]
[null,null,null,null,"00228299611",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E583,1),\"\"))","v":1},{"$f":"IF(F583=1,COUNTIF($F$3:F583,1),\"\")","v":581},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G583),$G$3:$G$3716,0)),\"\")","v":"00228299611"}]
[null,null,null,null,"00228300411",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E584,1),\"\"))","v":1},{"$f":"IF(F584=1,COUNTIF($F$3:F584,1),\"\")","v":582},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G584),$G$3:$G$3716,0)),\"\")","v":"00228300411"}]
[null,null,null,null,"00230066704",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E585,1),\"\"))","v":1},{"$f":"IF(F585=1,COUNTIF($F$3:F585,1),\"\")","v":583},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G585),$G$3:$G$3716,0)),\"\")","v":"00230066704"}]
[null,null,null,null,"00245003660",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E586,1),\"\"))","v":1},{"$f":"IF(F586=1,COUNTIF($F$3:F586,1),\"\")","v":584},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G586),$G$3:$G$3716,0)),\"\")","v":"00245003660"}]
[null,null,null,null,"00245003689",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E587,1),\"\"))","v":1},{"$f":"IF(F587=1,COUNTIF($F$3:F587,1),\"\")","v":585},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G587),$G$3:$G$3716,0)),\"\")","v":"00245003689"}]
[null,null,null,null,"00245004089",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E588,1),\"\"))","v":1},{"$f":"IF(F588=1,COUNTIF($F$3:F588,1),\"\")","v":586},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G588),$G$3:$G$3716,0)),\"\")","v":"00245004089"}]
[null,null,null,null,"00245008511",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E589,1),\"\"))","v":1},{"$f":"IF(F589=1,COUNTIF($F$3:F589,1),\"\")","v":587},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G589),$G$3:$G$3716,0)),\"\")","v":"00245008511"}]
[null,null,null,null,"00245018001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E590,1),\"\"))","v":1},{"$f":"IF(F590=1,COUNTIF($F$3:F590,1),\"\")","v":588},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G590),$G$3:$G$3716,0)),\"\")","v":"00245018001"}]
[null,null,null,null,"00245018101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E591,1),\"\"))","v":1},{"$f":"IF(F591=1,COUNTIF($F$3:F591,1),\"\")","v":589},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G591),$G$3:$G$3716,0)),\"\")","v":"00245018101"}]
[null,null,null,null,"00245018201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E592,1),\"\"))","v":1},{"$f":"IF(F592=1,COUNTIF($F$3:F592,1),\"\")","v":590},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G592),$G$3:$G$3716,0)),\"\")","v":"00245018201"}]
[null,null,null,null,"00245021111",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E593,1),\"\"))","v":1},{"$f":"IF(F593=1,COUNTIF($F$3:F593,1),\"\")","v":591},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G593),$G$3:$G$3716,0)),\"\")","v":"00245021111"}]
[null,null,null,null,"00254100752",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E594,1),\"\"))","v":1},{"$f":"IF(F594=1,COUNTIF($F$3:F594,1),\"\")","v":592},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G594),$G$3:$G$3716,0)),\"\")","v":"00254100752"}]
[null,null,null,null,"00254200811",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E595,1),\"\"))","v":1},{"$f":"IF(F595=1,COUNTIF($F$3:F595,1),\"\")","v":593},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G595),$G$3:$G$3716,0)),\"\")","v":"00254200811"}]
[null,null,null,null,"00264180032",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E596,1),\"\"))","v":1},{"$f":"IF(F596=1,COUNTIF($F$3:F596,1),\"\")","v":594},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G596),$G$3:$G$3716,0)),\"\")","v":"00264180032"}]
[null,null,null,null,"00264320055",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E597,1),\"\"))","v":1},{"$f":"IF(F597=1,COUNTIF($F$3:F597,1),\"\")","v":595},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G597),$G$3:$G$3716,0)),\"\")","v":"00264320055"}]
[null,null,null,null,"00264446000",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E598,1),\"\"))","v":1},{"$f":"IF(F598=1,COUNTIF($F$3:F598,1),\"\")","v":596},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G598),$G$3:$G$3716,0)),\"\")","v":"00264446000"}]
[null,null,null,null,"00264751000",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E599,1),\"\"))","v":1},{"$f":"IF(F599=1,COUNTIF($F$3:F599,1),\"\")","v":597},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G599),$G$3:$G$3716,0)),\"\")","v":"00264751000"}]
[null,null,null,null,"00264751010",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E600,1),\"\"))","v":1},{"$f":"IF(F600=1,COUNTIF($F$3:F600,1),\"\")","v":598},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G600),$G$3:$G$3716,0)),\"\")","v":"00264751010"}]
[null,null,null,null,"00264751020",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E601,1),\"\"))","v":1},{"$f":"IF(F601=1,COUNTIF($F$3:F601,1),\"\")","v":599},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G601),$G$3:$G$3716,0)),\"\")","v":"00264751020"}]
[null,null,null,null,"00264752020",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E602,1),\"\"))","v":1},{"$f":"IF(F602=1,COUNTIF($F$3:F602,1),\"\")","v":600},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G602),$G$3:$G$3716,0)),\"\")","v":"00264752020"}]
[null,null,null,null,"00264757810",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E603,1),\"\"))","v":1},{"$f":"IF(F603=1,COUNTIF($F$3:F603,1),\"\")","v":601},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G603),$G$3:$G$3716,0)),\"\")","v":"00264757810"}]
[null,null,null,null,"00264780010",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E604,1),\"\"))","v":1},{"$f":"IF(F604=1,COUNTIF($F$3:F604,1),\"\")","v":602},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G604),$G$3:$G$3716,0)),\"\")","v":"00264780010"}]
[null,null,null,null,"00264780020",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E605,1),\"\"))","v":1},{"$f":"IF(F605=1,COUNTIF($F$3:F605,1),\"\")","v":603},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G605),$G$3:$G$3716,0)),\"\")","v":"00264780020"}]
[null,null,null,null,"00281032630",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E606,1),\"\"))","v":1},{"$f":"IF(F606=1,COUNTIF($F$3:F606,1),\"\")","v":604},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G606),$G$3:$G$3716,0)),\"\")","v":"00281032630"}]
[null,null,null,null,"00295122395",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E607,1),\"\"))","v":1},{"$f":"IF(F607=1,COUNTIF($F$3:F607,1),\"\")","v":605},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G607),$G$3:$G$3716,0)),\"\")","v":"00295122395"}]
[null,null,null,null,"00316018601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E608,1),\"\"))","v":1},{"$f":"IF(F608=1,COUNTIF($F$3:F608,1),\"\")","v":606},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G608),$G$3:$G$3716,0)),\"\")","v":"00316018601"}]
[null,null,null,null,"00338001304",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E609,1),\"\"))","v":1},{"$f":"IF(F609=1,COUNTIF($F$3:F609,1),\"\")","v":607},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G609),$G$3:$G$3716,0)),\"\")","v":"00338001304"}]
[null,null,null,null,"00338001306",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E610,1),\"\"))","v":1},{"$f":"IF(F610=1,COUNTIF($F$3:F610,1),\"\")","v":608},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G610),$G$3:$G$3716,0)),\"\")","v":"00338001306"}]
[null,null,null,null,"00338001701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E611,1),\"\"))","v":1},{"$f":"IF(F611=1,COUNTIF($F$3:F611,1),\"\")","v":609},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G611),$G$3:$G$3716,0)),\"\")","v":"00338001701"}]
[null,null,null,null,"00338001702",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E612,1),\"\"))","v":1},{"$f":"IF(F612=1,COUNTIF($F$3:F612,1),\"\")","v":610},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G612),$G$3:$G$3716,0)),\"\")","v":"00338001702"}]
[null,null,null,null,"00338001703",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E613,1),\"\"))","v":1},{"$f":"IF(F613=1,COUNTIF($F$3:F613,1),\"\")","v":611},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G613),$G$3:$G$3716,0)),\"\")","v":"00338001703"}]
[null,null,null,null,"00338001704",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E614,1),\"\"))","v":1},{"$f":"IF(F614=1,COUNTIF($F$3:F614,1),\"\")","v":612},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G614),$G$3:$G$3716,0)),\"\")","v":"00338001704"}]
[null,null,null,null,"00338001731",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E615,1),\"\"))","v":1},{"$f":"IF(F615=1,COUNTIF($F$3:F615,1),\"\")","v":613},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G615),$G$3:$G$3716,0)),\"\")","v":"00338001731"}]
[null,null,null,null,"00338001738",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E616,1),\"\"))","v":1},{"$f":"IF(F616=1,COUNTIF($F$3:F616,1),\"\")","v":614},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G616),$G$3:$G$3716,0)),\"\")","v":"00338001738"}]
[null,null,null,null,"00338001741",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E617,1),\"\"))","v":1},{"$f":"IF(F617=1,COUNTIF($F$3:F617,1),\"\")","v":615},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G617),$G$3:$G$3716,0)),\"\")","v":"00338001741"}]
[null,null,null,null,"00338002303",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E618,1),\"\"))","v":1},{"$f":"IF(F618=1,COUNTIF($F$3:F618,1),\"\")","v":616},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G618),$G$3:$G$3716,0)),\"\")","v":"00338002303"}]
[null,null,null,null,"00338004303",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E619,1),\"\"))","v":1},{"$f":"IF(F619=1,COUNTIF($F$3:F619,1),\"\")","v":617},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G619),$G$3:$G$3716,0)),\"\")","v":"00338004303"}]
[null,null,null,null,"00338004304",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E620,1),\"\"))","v":1},{"$f":"IF(F620=1,COUNTIF($F$3:F620,1),\"\")","v":618},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G620),$G$3:$G$3716,0)),\"\")","v":"00338004304"}]
[null,null,null,null,"00338004901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E621,1),\"\"))","v":1},{"$f":"IF(F621=1,COUNTIF($F$3:F621,1),\"\")","v":619},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G621),$G$3:$G$3716,0)),\"\")","v":"00338004901"}]
[null,null,null,null,"00338004902",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E622,1),\"\"))","v":1},{"$f":"IF(F622=1,COUNTIF($F$3:F622,1),\"\")","v":620},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G622),$G$3:$G$3716,0)),\"\")","v":"00338004902"}]
[null,null,null,null,"00338004903",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E623,1),\"\"))","v":1},{"$f":"IF(F623=1,COUNTIF($F$3:F623,1),\"\")","v":621},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G623),$G$3:$G$3716,0)),\"\")","v":"00338004903"}]
[null,null,null,null,"00338004904",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E624,1),\"\"))","v":1},{"$f":"IF(F624=1,COUNTIF($F$3:F624,1),\"\")","v":622},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G624),$G$3:$G$3716,0)),\"\")","v":"00338004904"}]
[null,null,null,null,"00338004931",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E625,1),\"\"))","v":1},{"$f":"IF(F625=1,COUNTIF($F$3:F625,1),\"\")","v":623},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G625),$G$3:$G$3716,0)),\"\")","v":"00338004931"}]
[null,null,null,null,"00338004938",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E626,1),\"\"))","v":1},{"$f":"IF(F626=1,COUNTIF($F$3:F626,1),\"\")","v":624},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G626),$G$3:$G$3716,0)),\"\")","v":"00338004938"}]
[null,null,null,null,"00338004941",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E627,1),\"\"))","v":1},{"$f":"IF(F627=1,COUNTIF($F$3:F627,1),\"\")","v":625},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G627),$G$3:$G$3716,0)),\"\")","v":"00338004941"}]
[null,null,null,null,"00338004948",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E628,1),\"\"))","v":1},{"$f":"IF(F628=1,COUNTIF($F$3:F628,1),\"\")","v":626},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G628),$G$3:$G$3716,0)),\"\")","v":"00338004948"}]
[null,null,null,null,"00338005403",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E629,1),\"\"))","v":1},{"$f":"IF(F629=1,COUNTIF($F$3:F629,1),\"\")","v":627},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G629),$G$3:$G$3716,0)),\"\")","v":"00338005403"}]
[null,null,null,null,"00338007304",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E630,1),\"\"))","v":1},{"$f":"IF(F630=1,COUNTIF($F$3:F630,1),\"\")","v":628},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G630),$G$3:$G$3716,0)),\"\")","v":"00338007304"}]
[null,null,null,null,"00338008504",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E631,1),\"\"))","v":1},{"$f":"IF(F631=1,COUNTIF($F$3:F631,1),\"\")","v":629},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G631),$G$3:$G$3716,0)),\"\")","v":"00338008504"}]
[null,null,null,null,"00338008903",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E632,1),\"\"))","v":1},{"$f":"IF(F632=1,COUNTIF($F$3:F632,1),\"\")","v":630},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G632),$G$3:$G$3716,0)),\"\")","v":"00338008903"}]
[null,null,null,null,"00338008904",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E633,1),\"\"))","v":1},{"$f":"IF(F633=1,COUNTIF($F$3:F633,1),\"\")","v":631},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G633),$G$3:$G$3716,0)),\"\")","v":"00338008904"}]
[null,null,null,null,"00338012503",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E634,1),\"\"))","v":1},{"$f":"IF(F634=1,COUNTIF($F$3:F634,1),\"\")","v":632},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G634),$G$3:$G$3716,0)),\"\")","v":"00338012503"}]
[null,null,null,null,"00338012504",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E635,1),\"\"))","v":1},{"$f":"IF(F635=1,COUNTIF($F$3:F635,1),\"\")","v":633},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G635),$G$3:$G$3716,0)),\"\")","v":"00338012504"}]
[null,null,null,null,"00338020601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E636,1),\"\"))","v":1},{"$f":"IF(F636=1,COUNTIF($F$3:F636,1),\"\")","v":634},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G636),$G$3:$G$3716,0)),\"\")","v":"00338020601"}]
[null,null,null,null,"00338020604",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E637,1),\"\"))","v":1},{"$f":"IF(F637=1,COUNTIF($F$3:F637,1),\"\")","v":635},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G637),$G$3:$G$3716,0)),\"\")","v":"00338020604"}]
[null,null,null,null,"00338021001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E638,1),\"\"))","v":1},{"$f":"IF(F638=1,COUNTIF($F$3:F638,1),\"\")","v":636},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G638),$G$3:$G$3716,0)),\"\")","v":"00338021001"}]
[null,null,null,null,"00338021401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E639,1),\"\"))","v":1},{"$f":"IF(F639=1,COUNTIF($F$3:F639,1),\"\")","v":637},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G639),$G$3:$G$3716,0)),\"\")","v":"00338021401"}]
[null,null,null,null,"00338021404",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E640,1),\"\"))","v":1},{"$f":"IF(F640=1,COUNTIF($F$3:F640,1),\"\")","v":638},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G640),$G$3:$G$3716,0)),\"\")","v":"00338021404"}]
[null,null,null,null,"00338022103",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E641,1),\"\"))","v":1},{"$f":"IF(F641=1,COUNTIF($F$3:F641,1),\"\")","v":639},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G641),$G$3:$G$3716,0)),\"\")","v":"00338022103"}]
[null,null,null,null,"00338022104",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E642,1),\"\"))","v":1},{"$f":"IF(F642=1,COUNTIF($F$3:F642,1),\"\")","v":640},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G642),$G$3:$G$3716,0)),\"\")","v":"00338022104"}]
[null,null,null,null,"00338035703",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E643,1),\"\"))","v":1},{"$f":"IF(F643=1,COUNTIF($F$3:F643,1),\"\")","v":641},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G643),$G$3:$G$3716,0)),\"\")","v":"00338035703"}]
[null,null,null,null,"00338051141",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E644,1),\"\"))","v":1},{"$f":"IF(F644=1,COUNTIF($F$3:F644,1),\"\")","v":642},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G644),$G$3:$G$3716,0)),\"\")","v":"00338051141"}]
[null,null,null,null,"00338051902",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E645,1),\"\"))","v":1},{"$f":"IF(F645=1,COUNTIF($F$3:F645,1),\"\")","v":643},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G645),$G$3:$G$3716,0)),\"\")","v":"00338051902"}]
[null,null,null,null,"00338051909",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E646,1),\"\"))","v":1},{"$f":"IF(F646=1,COUNTIF($F$3:F646,1),\"\")","v":644},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G646),$G$3:$G$3716,0)),\"\")","v":"00338051909"}]
[null,null,null,null,"00338055311",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E647,1),\"\"))","v":1},{"$f":"IF(F647=1,COUNTIF($F$3:F647,1),\"\")","v":645},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G647),$G$3:$G$3716,0)),\"\")","v":"00338055311"}]
[null,null,null,null,"00338055318",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E648,1),\"\"))","v":1},{"$f":"IF(F648=1,COUNTIF($F$3:F648,1),\"\")","v":646},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G648),$G$3:$G$3716,0)),\"\")","v":"00338055318"}]
[null,null,null,null,"00338071906",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E649,1),\"\"))","v":1},{"$f":"IF(F649=1,COUNTIF($F$3:F649,1),\"\")","v":647},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G649),$G$3:$G$3716,0)),\"\")","v":"00338071906"}]
[null,null,null,null,"00338111504",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E650,1),\"\"))","v":1},{"$f":"IF(F650=1,COUNTIF($F$3:F650,1),\"\")","v":648},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G650),$G$3:$G$3716,0)),\"\")","v":"00338111504"}]
[null,null,null,null,"00338112304",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E651,1),\"\"))","v":1},{"$f":"IF(F651=1,COUNTIF($F$3:F651,1),\"\")","v":649},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G651),$G$3:$G$3716,0)),\"\")","v":"00338112304"}]
[null,null,null,null,"00338114503",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E652,1),\"\"))","v":1},{"$f":"IF(F652=1,COUNTIF($F$3:F652,1),\"\")","v":650},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G652),$G$3:$G$3716,0)),\"\")","v":"00338114503"}]
[null,null,null,null,"00338114703",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E653,1),\"\"))","v":1},{"$f":"IF(F653=1,COUNTIF($F$3:F653,1),\"\")","v":651},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G653),$G$3:$G$3716,0)),\"\")","v":"00338114703"}]
[null,null,null,null,"00338630404",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E654,1),\"\"))","v":1},{"$f":"IF(F654=1,COUNTIF($F$3:F654,1),\"\")","v":652},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G654),$G$3:$G$3716,0)),\"\")","v":"00338630404"}]
[null,null,null,null,"00338634602",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E655,1),\"\"))","v":1},{"$f":"IF(F655=1,COUNTIF($F$3:F655,1),\"\")","v":653},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G655),$G$3:$G$3716,0)),\"\")","v":"00338634602"}]
[null,null,null,null,"00338915930",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E656,1),\"\"))","v":1},{"$f":"IF(F656=1,COUNTIF($F$3:F656,1),\"\")","v":654},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G656),$G$3:$G$3716,0)),\"\")","v":"00338915930"}]
[null,null,null,null,"00362904902",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E657,1),\"\"))","v":1},{"$f":"IF(F657=1,COUNTIF($F$3:F657,1),\"\")","v":655},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G657),$G$3:$G$3716,0)),\"\")","v":"00362904902"}]
[null,null,null,null,"00378003001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E658,1),\"\"))","v":1},{"$f":"IF(F658=1,COUNTIF($F$3:F658,1),\"\")","v":656},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G658),$G$3:$G$3716,0)),\"\")","v":"00378003001"}]
[null,null,null,null,"00378003201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E659,1),\"\"))","v":1},{"$f":"IF(F659=1,COUNTIF($F$3:F659,1),\"\")","v":657},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G659),$G$3:$G$3716,0)),\"\")","v":"00378003201"}]
[null,null,null,null,"00378007801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E660,1),\"\"))","v":1},{"$f":"IF(F660=1,COUNTIF($F$3:F660,1),\"\")","v":658},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G660),$G$3:$G$3716,0)),\"\")","v":"00378007801"}]
[null,null,null,null,"00378008701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E661,1),\"\"))","v":1},{"$f":"IF(F661=1,COUNTIF($F$3:F661,1),\"\")","v":659},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G661),$G$3:$G$3716,0)),\"\")","v":"00378008701"}]
[null,null,null,null,"00378013701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E662,1),\"\"))","v":1},{"$f":"IF(F662=1,COUNTIF($F$3:F662,1),\"\")","v":660},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G662),$G$3:$G$3716,0)),\"\")","v":"00378013701"}]
[null,null,null,null,"00378013710",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E663,1),\"\"))","v":1},{"$f":"IF(F663=1,COUNTIF($F$3:F663,1),\"\")","v":661},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G663),$G$3:$G$3716,0)),\"\")","v":"00378013710"}]
[null,null,null,null,"00378015001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E664,1),\"\"))","v":1},{"$f":"IF(F664=1,COUNTIF($F$3:F664,1),\"\")","v":662},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G664),$G$3:$G$3716,0)),\"\")","v":"00378015001"}]
[null,null,null,null,"00378015601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E665,1),\"\"))","v":1},{"$f":"IF(F665=1,COUNTIF($F$3:F665,1),\"\")","v":663},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G665),$G$3:$G$3716,0)),\"\")","v":"00378015601"}]
[null,null,null,null,"00378018101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E666,1),\"\"))","v":1},{"$f":"IF(F666=1,COUNTIF($F$3:F666,1),\"\")","v":664},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G666),$G$3:$G$3716,0)),\"\")","v":"00378018101"}]
[null,null,null,null,"00378018301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E667,1),\"\"))","v":1},{"$f":"IF(F667=1,COUNTIF($F$3:F667,1),\"\")","v":665},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G667),$G$3:$G$3716,0)),\"\")","v":"00378018301"}]
[null,null,null,null,"00378020801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E668,1),\"\"))","v":1},{"$f":"IF(F668=1,COUNTIF($F$3:F668,1),\"\")","v":666},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G668),$G$3:$G$3716,0)),\"\")","v":"00378020801"}]
[null,null,null,null,"00378021601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E669,1),\"\"))","v":1},{"$f":"IF(F669=1,COUNTIF($F$3:F669,1),\"\")","v":667},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G669),$G$3:$G$3716,0)),\"\")","v":"00378021601"}]
[null,null,null,null,"00378035701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E670,1),\"\"))","v":1},{"$f":"IF(F670=1,COUNTIF($F$3:F670,1),\"\")","v":668},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G670),$G$3:$G$3716,0)),\"\")","v":"00378035701"}]
[null,null,null,null,"00378041501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E671,1),\"\"))","v":1},{"$f":"IF(F671=1,COUNTIF($F$3:F671,1),\"\")","v":669},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G671),$G$3:$G$3716,0)),\"\")","v":"00378041501"}]
[null,null,null,null,"00378042101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E672,1),\"\"))","v":1},{"$f":"IF(F672=1,COUNTIF($F$3:F672,1),\"\")","v":670},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G672),$G$3:$G$3716,0)),\"\")","v":"00378042101"}]
[null,null,null,null,"00378047701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E673,1),\"\"))","v":1},{"$f":"IF(F673=1,COUNTIF($F$3:F673,1),\"\")","v":671},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G673),$G$3:$G$3716,0)),\"\")","v":"00378047701"}]
[null,null,null,null,"00378048101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E674,1),\"\"))","v":1},{"$f":"IF(F674=1,COUNTIF($F$3:F674,1),\"\")","v":672},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G674),$G$3:$G$3716,0)),\"\")","v":"00378048101"}]
[null,null,null,null,"00378049401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E675,1),\"\"))","v":1},{"$f":"IF(F675=1,COUNTIF($F$3:F675,1),\"\")","v":673},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G675),$G$3:$G$3716,0)),\"\")","v":"00378049401"}]
[null,null,null,null,"00378057205",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E676,1),\"\"))","v":1},{"$f":"IF(F676=1,COUNTIF($F$3:F676,1),\"\")","v":674},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G676),$G$3:$G$3716,0)),\"\")","v":"00378057205"}]
[null,null,null,null,"00378061801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E677,1),\"\"))","v":1},{"$f":"IF(F677=1,COUNTIF($F$3:F677,1),\"\")","v":675},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G677),$G$3:$G$3716,0)),\"\")","v":"00378061801"}]
[null,null,null,null,"00378087116",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E678,1),\"\"))","v":1},{"$f":"IF(F678=1,COUNTIF($F$3:F678,1),\"\")","v":676},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G678),$G$3:$G$3716,0)),\"\")","v":"00378087116"}]
[null,null,null,null,"00378087199",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E679,1),\"\"))","v":1},{"$f":"IF(F679=1,COUNTIF($F$3:F679,1),\"\")","v":677},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G679),$G$3:$G$3716,0)),\"\")","v":"00378087199"}]
[null,null,null,null,"00378087216",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E680,1),\"\"))","v":1},{"$f":"IF(F680=1,COUNTIF($F$3:F680,1),\"\")","v":678},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G680),$G$3:$G$3716,0)),\"\")","v":"00378087216"}]
[null,null,null,null,"00378087316",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E681,1),\"\"))","v":1},{"$f":"IF(F681=1,COUNTIF($F$3:F681,1),\"\")","v":679},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G681),$G$3:$G$3716,0)),\"\")","v":"00378087316"}]
[null,null,null,null,"00378100101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E682,1),\"\"))","v":1},{"$f":"IF(F682=1,COUNTIF($F$3:F682,1),\"\")","v":680},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G682),$G$3:$G$3716,0)),\"\")","v":"00378100101"}]
[null,null,null,null,"00378103077",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E683,1),\"\"))","v":1},{"$f":"IF(F683=1,COUNTIF($F$3:F683,1),\"\")","v":681},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G683),$G$3:$G$3716,0)),\"\")","v":"00378103077"}]
[null,null,null,null,"00378103093",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E684,1),\"\"))","v":1},{"$f":"IF(F684=1,COUNTIF($F$3:F684,1),\"\")","v":682},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G684),$G$3:$G$3716,0)),\"\")","v":"00378103093"}]
[null,null,null,null,"00378104901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E685,1),\"\"))","v":1},{"$f":"IF(F685=1,COUNTIF($F$3:F685,1),\"\")","v":683},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G685),$G$3:$G$3716,0)),\"\")","v":"00378104901"}]
[null,null,null,null,"00378110101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E686,1),\"\"))","v":1},{"$f":"IF(F686=1,COUNTIF($F$3:F686,1),\"\")","v":684},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G686),$G$3:$G$3716,0)),\"\")","v":"00378110101"}]
[null,null,null,null,"00378116001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E687,1),\"\"))","v":1},{"$f":"IF(F687=1,COUNTIF($F$3:F687,1),\"\")","v":685},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G687),$G$3:$G$3716,0)),\"\")","v":"00378116001"}]
[null,null,null,null,"00378143077",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E688,1),\"\"))","v":1},{"$f":"IF(F688=1,COUNTIF($F$3:F688,1),\"\")","v":686},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G688),$G$3:$G$3716,0)),\"\")","v":"00378143077"}]
[null,null,null,null,"00378173001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E689,1),\"\"))","v":1},{"$f":"IF(F689=1,COUNTIF($F$3:F689,1),\"\")","v":687},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G689),$G$3:$G$3716,0)),\"\")","v":"00378173001"}]
[null,null,null,null,"00378180001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E690,1),\"\"))","v":1},{"$f":"IF(F690=1,COUNTIF($F$3:F690,1),\"\")","v":688},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G690),$G$3:$G$3716,0)),\"\")","v":"00378180001"}]
[null,null,null,null,"00378180077",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E691,1),\"\"))","v":1},{"$f":"IF(F691=1,COUNTIF($F$3:F691,1),\"\")","v":689},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G691),$G$3:$G$3716,0)),\"\")","v":"00378180077"}]
[null,null,null,null,"00378180501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E692,1),\"\"))","v":1},{"$f":"IF(F692=1,COUNTIF($F$3:F692,1),\"\")","v":690},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G692),$G$3:$G$3716,0)),\"\")","v":"00378180501"}]
[null,null,null,null,"00378180577",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E693,1),\"\"))","v":1},{"$f":"IF(F693=1,COUNTIF($F$3:F693,1),\"\")","v":691},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G693),$G$3:$G$3716,0)),\"\")","v":"00378180577"}]
[null,null,null,null,"00378180701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E694,1),\"\"))","v":1},{"$f":"IF(F694=1,COUNTIF($F$3:F694,1),\"\")","v":692},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G694),$G$3:$G$3716,0)),\"\")","v":"00378180701"}]
[null,null,null,null,"00378180977",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E695,1),\"\"))","v":1},{"$f":"IF(F695=1,COUNTIF($F$3:F695,1),\"\")","v":693},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G695),$G$3:$G$3716,0)),\"\")","v":"00378180977"}]
[null,null,null,null,"00378181101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E696,1),\"\"))","v":1},{"$f":"IF(F696=1,COUNTIF($F$3:F696,1),\"\")","v":694},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G696),$G$3:$G$3716,0)),\"\")","v":"00378181101"}]
[null,null,null,null,"00378181301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E697,1),\"\"))","v":1},{"$f":"IF(F697=1,COUNTIF($F$3:F697,1),\"\")","v":695},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G697),$G$3:$G$3716,0)),\"\")","v":"00378181301"}]
[null,null,null,null,"00378181501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E698,1),\"\"))","v":1},{"$f":"IF(F698=1,COUNTIF($F$3:F698,1),\"\")","v":696},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G698),$G$3:$G$3716,0)),\"\")","v":"00378181501"}]
[null,null,null,null,"00378181701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E699,1),\"\"))","v":1},{"$f":"IF(F699=1,COUNTIF($F$3:F699,1),\"\")","v":697},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G699),$G$3:$G$3716,0)),\"\")","v":"00378181701"}]
[null,null,null,null,"00378181901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E700,1),\"\"))","v":1},{"$f":"IF(F700=1,COUNTIF($F$3:F700,1),\"\")","v":698},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G700),$G$3:$G$3716,0)),\"\")","v":"00378181901"}]
[null,null,null,null,"00378193093",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E701,1),\"\"))","v":1},{"$f":"IF(F701=1,COUNTIF($F$3:F701,1),\"\")","v":699},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G701),$G$3:$G$3716,0)),\"\")","v":"00378193093"}]
[null,null,null,null,"00378207410",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E702,1),\"\"))","v":1},{"$f":"IF(F702=1,COUNTIF($F$3:F702,1),\"\")","v":700},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G702),$G$3:$G$3716,0)),\"\")","v":"00378207410"}]
[null,null,null,null,"00378210001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E703,1),\"\"))","v":1},{"$f":"IF(F703=1,COUNTIF($F$3:F703,1),\"\")","v":701},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G703),$G$3:$G$3716,0)),\"\")","v":"00378210001"}]
[null,null,null,null,"00378212205",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E704,1),\"\"))","v":1},{"$f":"IF(F704=1,COUNTIF($F$3:F704,1),\"\")","v":702},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G704),$G$3:$G$3716,0)),\"\")","v":"00378212205"}]
[null,null,null,null,"00378212277",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E705,1),\"\"))","v":1},{"$f":"IF(F705=1,COUNTIF($F$3:F705,1),\"\")","v":703},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G705),$G$3:$G$3716,0)),\"\")","v":"00378212277"}]
[null,null,null,null,"00378218001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E706,1),\"\"))","v":1},{"$f":"IF(F706=1,COUNTIF($F$3:F706,1),\"\")","v":704},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G706),$G$3:$G$3716,0)),\"\")","v":"00378218001"}]
[null,null,null,null,"00378240501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E707,1),\"\"))","v":1},{"$f":"IF(F707=1,COUNTIF($F$3:F707,1),\"\")","v":705},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G707),$G$3:$G$3716,0)),\"\")","v":"00378240501"}]
[null,null,null,null,"00378253701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E708,1),\"\"))","v":1},{"$f":"IF(F708=1,COUNTIF($F$3:F708,1),\"\")","v":706},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G708),$G$3:$G$3716,0)),\"\")","v":"00378253701"}]
[null,null,null,null,"00378300501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E709,1),\"\"))","v":1},{"$f":"IF(F709=1,COUNTIF($F$3:F709,1),\"\")","v":707},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G709),$G$3:$G$3716,0)),\"\")","v":"00378300501"}]
[null,null,null,null,"00378301701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E710,1),\"\"))","v":1},{"$f":"IF(F710=1,COUNTIF($F$3:F710,1),\"\")","v":708},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G710),$G$3:$G$3716,0)),\"\")","v":"00378301701"}]
[null,null,null,null,"00378312501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E711,1),\"\"))","v":1},{"$f":"IF(F711=1,COUNTIF($F$3:F711,1),\"\")","v":709},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G711),$G$3:$G$3716,0)),\"\")","v":"00378312501"}]
[null,null,null,null,"00378328691",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E712,1),\"\"))","v":1},{"$f":"IF(F712=1,COUNTIF($F$3:F712,1),\"\")","v":710},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G712),$G$3:$G$3716,0)),\"\")","v":"00378328691"}]
[null,null,null,null,"00378335016",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E713,1),\"\"))","v":1},{"$f":"IF(F713=1,COUNTIF($F$3:F713,1),\"\")","v":711},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G713),$G$3:$G$3716,0)),\"\")","v":"00378335016"}]
[null,null,null,null,"00378335099",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E714,1),\"\"))","v":1},{"$f":"IF(F714=1,COUNTIF($F$3:F714,1),\"\")","v":712},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G714),$G$3:$G$3716,0)),\"\")","v":"00378335099"}]
[null,null,null,null,"00378340493",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E715,1),\"\"))","v":1},{"$f":"IF(F715=1,COUNTIF($F$3:F715,1),\"\")","v":713},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G715),$G$3:$G$3716,0)),\"\")","v":"00378340493"}]
[null,null,null,null,"00378362777",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E716,1),\"\"))","v":1},{"$f":"IF(F716=1,COUNTIF($F$3:F716,1),\"\")","v":714},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G716),$G$3:$G$3716,0)),\"\")","v":"00378362777"}]
[null,null,null,null,"00378362793",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E717,1),\"\"))","v":1},{"$f":"IF(F717=1,COUNTIF($F$3:F717,1),\"\")","v":715},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G717),$G$3:$G$3716,0)),\"\")","v":"00378362793"}]
[null,null,null,null,"00378395077",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E718,1),\"\"))","v":1},{"$f":"IF(F718=1,COUNTIF($F$3:F718,1),\"\")","v":716},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G718),$G$3:$G$3716,0)),\"\")","v":"00378395077"}]
[null,null,null,null,"00378395277",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E719,1),\"\"))","v":1},{"$f":"IF(F719=1,COUNTIF($F$3:F719,1),\"\")","v":717},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G719),$G$3:$G$3716,0)),\"\")","v":"00378395277"}]
[null,null,null,null,"00378410591",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E720,1),\"\"))","v":1},{"$f":"IF(F720=1,COUNTIF($F$3:F720,1),\"\")","v":718},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G720),$G$3:$G$3716,0)),\"\")","v":"00378410591"}]
[null,null,null,null,"00378427677",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E721,1),\"\"))","v":1},{"$f":"IF(F721=1,COUNTIF($F$3:F721,1),\"\")","v":719},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G721),$G$3:$G$3716,0)),\"\")","v":"00378427677"}]
[null,null,null,null,"00378427693",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E722,1),\"\"))","v":1},{"$f":"IF(F722=1,COUNTIF($F$3:F722,1),\"\")","v":720},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G722),$G$3:$G$3716,0)),\"\")","v":"00378427693"}]
[null,null,null,null,"00378510093",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E723,1),\"\"))","v":1},{"$f":"IF(F723=1,COUNTIF($F$3:F723,1),\"\")","v":721},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G723),$G$3:$G$3716,0)),\"\")","v":"00378510093"}]
[null,null,null,null,"00378518593",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E724,1),\"\"))","v":1},{"$f":"IF(F724=1,COUNTIF($F$3:F724,1),\"\")","v":722},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G724),$G$3:$G$3716,0)),\"\")","v":"00378518593"}]
[null,null,null,null,"00378581377",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E725,1),\"\"))","v":1},{"$f":"IF(F725=1,COUNTIF($F$3:F725,1),\"\")","v":723},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G725),$G$3:$G$3716,0)),\"\")","v":"00378581377"}]
[null,null,null,null,"00378617201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E726,1),\"\"))","v":1},{"$f":"IF(F726=1,COUNTIF($F$3:F726,1),\"\")","v":724},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G726),$G$3:$G$3716,0)),\"\")","v":"00378617201"}]
[null,null,null,null,"00378617301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E727,1),\"\"))","v":1},{"$f":"IF(F727=1,COUNTIF($F$3:F727,1),\"\")","v":725},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G727),$G$3:$G$3716,0)),\"\")","v":"00378617301"}]
[null,null,null,null,"00378623301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E728,1),\"\"))","v":1},{"$f":"IF(F728=1,COUNTIF($F$3:F728,1),\"\")","v":726},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G728),$G$3:$G$3716,0)),\"\")","v":"00378623301"}]
[null,null,null,null,"00378647097",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E729,1),\"\"))","v":1},{"$f":"IF(F729=1,COUNTIF($F$3:F729,1),\"\")","v":727},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G729),$G$3:$G$3716,0)),\"\")","v":"00378647097"}]
[null,null,null,null,"00378660501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E730,1),\"\"))","v":1},{"$f":"IF(F730=1,COUNTIF($F$3:F730,1),\"\")","v":728},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G730),$G$3:$G$3716,0)),\"\")","v":"00378660501"}]
[null,null,null,null,"00378668910",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E731,1),\"\"))","v":1},{"$f":"IF(F731=1,COUNTIF($F$3:F731,1),\"\")","v":729},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G731),$G$3:$G$3716,0)),\"\")","v":"00378668910"}]
[null,null,null,null,"00378668977",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E732,1),\"\"))","v":1},{"$f":"IF(F732=1,COUNTIF($F$3:F732,1),\"\")","v":730},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G732),$G$3:$G$3716,0)),\"\")","v":"00378668977"}]
[null,null,null,null,"00378672501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E733,1),\"\"))","v":1},{"$f":"IF(F733=1,COUNTIF($F$3:F733,1),\"\")","v":731},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G733),$G$3:$G$3716,0)),\"\")","v":"00378672501"}]
[null,null,null,null,"00378698232",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E734,1),\"\"))","v":1},{"$f":"IF(F734=1,COUNTIF($F$3:F734,1),\"\")","v":732},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G734),$G$3:$G$3716,0)),\"\")","v":"00378698232"}]
[null,null,null,null,"00378698288",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E735,1),\"\"))","v":1},{"$f":"IF(F735=1,COUNTIF($F$3:F735,1),\"\")","v":733},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G735),$G$3:$G$3716,0)),\"\")","v":"00378698288"}]
[null,null,null,null,"00378700293",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E736,1),\"\"))","v":1},{"$f":"IF(F736=1,COUNTIF($F$3:F736,1),\"\")","v":734},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G736),$G$3:$G$3716,0)),\"\")","v":"00378700293"}]
[null,null,null,null,"00378702501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E737,1),\"\"))","v":1},{"$f":"IF(F737=1,COUNTIF($F$3:F737,1),\"\")","v":735},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G737),$G$3:$G$3716,0)),\"\")","v":"00378702501"}]
[null,null,null,null,"00378710077",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E738,1),\"\"))","v":1},{"$f":"IF(F738=1,COUNTIF($F$3:F738,1),\"\")","v":736},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G738),$G$3:$G$3716,0)),\"\")","v":"00378710077"}]
[null,null,null,null,"00378710177",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E739,1),\"\"))","v":1},{"$f":"IF(F739=1,COUNTIF($F$3:F739,1),\"\")","v":737},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G739),$G$3:$G$3716,0)),\"\")","v":"00378710177"}]
[null,null,null,null,"00378715501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E740,1),\"\"))","v":1},{"$f":"IF(F740=1,COUNTIF($F$3:F740,1),\"\")","v":738},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G740),$G$3:$G$3716,0)),\"\")","v":"00378715501"}]
[null,null,null,null,"00378905593",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E741,1),\"\"))","v":1},{"$f":"IF(F741=1,COUNTIF($F$3:F741,1),\"\")","v":739},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G741),$G$3:$G$3716,0)),\"\")","v":"00378905593"}]
[null,null,null,null,"00378910293",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E742,1),\"\"))","v":1},{"$f":"IF(F742=1,COUNTIF($F$3:F742,1),\"\")","v":740},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G742),$G$3:$G$3716,0)),\"\")","v":"00378910293"}]
[null,null,null,null,"00378911216",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E743,1),\"\"))","v":1},{"$f":"IF(F743=1,COUNTIF($F$3:F743,1),\"\")","v":741},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G743),$G$3:$G$3716,0)),\"\")","v":"00378911216"}]
[null,null,null,null,"00378911693",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E744,1),\"\"))","v":1},{"$f":"IF(F744=1,COUNTIF($F$3:F744,1),\"\")","v":742},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G744),$G$3:$G$3716,0)),\"\")","v":"00378911693"}]
[null,null,null,null,"00378911916",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E745,1),\"\"))","v":1},{"$f":"IF(F745=1,COUNTIF($F$3:F745,1),\"\")","v":743},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G745),$G$3:$G$3716,0)),\"\")","v":"00378911916"}]
[null,null,null,null,"00378911998",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E746,1),\"\"))","v":1},{"$f":"IF(F746=1,COUNTIF($F$3:F746,1),\"\")","v":744},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G746),$G$3:$G$3716,0)),\"\")","v":"00378911998"}]
[null,null,null,null,"00378912198",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E747,1),\"\"))","v":1},{"$f":"IF(F747=1,COUNTIF($F$3:F747,1),\"\")","v":745},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G747),$G$3:$G$3716,0)),\"\")","v":"00378912198"}]
[null,null,null,null,"00378912398",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E748,1),\"\"))","v":1},{"$f":"IF(F748=1,COUNTIF($F$3:F748,1),\"\")","v":746},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G748),$G$3:$G$3716,0)),\"\")","v":"00378912398"}]
[null,null,null,null,"00378929091",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E749,1),\"\"))","v":1},{"$f":"IF(F749=1,COUNTIF($F$3:F749,1),\"\")","v":747},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G749),$G$3:$G$3716,0)),\"\")","v":"00378929091"}]
[null,null,null,null,"00395004912",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E750,1),\"\"))","v":1},{"$f":"IF(F750=1,COUNTIF($F$3:F750,1),\"\")","v":748},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G750),$G$3:$G$3716,0)),\"\")","v":"00395004912"}]
[null,null,null,null,"00395009016",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E751,1),\"\"))","v":1},{"$f":"IF(F751=1,COUNTIF($F$3:F751,1),\"\")","v":749},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G751),$G$3:$G$3716,0)),\"\")","v":"00395009016"}]
[null,null,null,null,"00395009416",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E752,1),\"\"))","v":1},{"$f":"IF(F752=1,COUNTIF($F$3:F752,1),\"\")","v":750},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G752),$G$3:$G$3716,0)),\"\")","v":"00395009416"}]
[null,null,null,null,"00395041396",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E753,1),\"\"))","v":1},{"$f":"IF(F753=1,COUNTIF($F$3:F753,1),\"\")","v":751},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G753),$G$3:$G$3716,0)),\"\")","v":"00395041396"}]
[null,null,null,null,"00395266116",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E754,1),\"\"))","v":1},{"$f":"IF(F754=1,COUNTIF($F$3:F754,1),\"\")","v":752},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G754),$G$3:$G$3716,0)),\"\")","v":"00395266116"}]
[null,null,null,null,"00395266216",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E755,1),\"\"))","v":1},{"$f":"IF(F755=1,COUNTIF($F$3:F755,1),\"\")","v":753},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G755),$G$3:$G$3716,0)),\"\")","v":"00395266216"}]
[null,null,null,null,"00395392085",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E756,1),\"\"))","v":1},{"$f":"IF(F756=1,COUNTIF($F$3:F756,1),\"\")","v":754},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G756),$G$3:$G$3716,0)),\"\")","v":"00395392085"}]
[null,null,null,null,"00404651205",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E757,1),\"\"))","v":1},{"$f":"IF(F757=1,COUNTIF($F$3:F757,1),\"\")","v":755},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G757),$G$3:$G$3716,0)),\"\")","v":"00404651205"}]
[null,null,null,null,"00404673005",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E758,1),\"\"))","v":1},{"$f":"IF(F758=1,COUNTIF($F$3:F758,1),\"\")","v":756},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G758),$G$3:$G$3716,0)),\"\")","v":"00404673005"}]
[null,null,null,null,"00406048462",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E759,1),\"\"))","v":1},{"$f":"IF(F759=1,COUNTIF($F$3:F759,1),\"\")","v":757},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G759),$G$3:$G$3716,0)),\"\")","v":"00406048462"}]
[null,null,null,null,"00406051223",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E760,1),\"\"))","v":1},{"$f":"IF(F760=1,COUNTIF($F$3:F760,1),\"\")","v":758},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G760),$G$3:$G$3716,0)),\"\")","v":"00406051223"}]
[null,null,null,null,"00406051262",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E761,1),\"\"))","v":1},{"$f":"IF(F761=1,COUNTIF($F$3:F761,1),\"\")","v":759},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G761),$G$3:$G$3716,0)),\"\")","v":"00406051262"}]
[null,null,null,null,"00406052704",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E762,1),\"\"))","v":1},{"$f":"IF(F762=1,COUNTIF($F$3:F762,1),\"\")","v":760},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G762),$G$3:$G$3716,0)),\"\")","v":"00406052704"}]
[null,null,null,null,"00406055223",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E763,1),\"\"))","v":1},{"$f":"IF(F763=1,COUNTIF($F$3:F763,1),\"\")","v":761},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G763),$G$3:$G$3716,0)),\"\")","v":"00406055223"}]
[null,null,null,null,"00406055262",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E764,1),\"\"))","v":1},{"$f":"IF(F764=1,COUNTIF($F$3:F764,1),\"\")","v":762},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G764),$G$3:$G$3716,0)),\"\")","v":"00406055262"}]
[null,null,null,null,"00406114201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E765,1),\"\"))","v":1},{"$f":"IF(F765=1,COUNTIF($F$3:F765,1),\"\")","v":763},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G765),$G$3:$G$3716,0)),\"\")","v":"00406114201"}]
[null,null,null,null,"00406324401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E766,1),\"\"))","v":1},{"$f":"IF(F766=1,COUNTIF($F$3:F766,1),\"\")","v":764},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G766),$G$3:$G$3716,0)),\"\")","v":"00406324401"}]
[null,null,null,null,"00406324552",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E767,1),\"\"))","v":1},{"$f":"IF(F767=1,COUNTIF($F$3:F767,1),\"\")","v":765},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G767),$G$3:$G$3716,0)),\"\")","v":"00406324552"}]
[null,null,null,null,"00406575523",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E768,1),\"\"))","v":1},{"$f":"IF(F768=1,COUNTIF($F$3:F768,1),\"\")","v":766},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G768),$G$3:$G$3716,0)),\"\")","v":"00406575523"}]
[null,null,null,null,"00406575562",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E769,1),\"\"))","v":1},{"$f":"IF(F769=1,COUNTIF($F$3:F769,1),\"\")","v":767},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G769),$G$3:$G$3716,0)),\"\")","v":"00406575562"}]
[null,null,null,null,"00406831523",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E770,1),\"\"))","v":1},{"$f":"IF(F770=1,COUNTIF($F$3:F770,1),\"\")","v":768},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G770),$G$3:$G$3716,0)),\"\")","v":"00406831523"}]
[null,null,null,null,"00406831562",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E771,1),\"\"))","v":1},{"$f":"IF(F771=1,COUNTIF($F$3:F771,1),\"\")","v":769},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G771),$G$3:$G$3716,0)),\"\")","v":"00406831562"}]
[null,null,null,null,"00406833062",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E772,1),\"\"))","v":1},{"$f":"IF(F772=1,COUNTIF($F$3:F772,1),\"\")","v":770},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G772),$G$3:$G$3716,0)),\"\")","v":"00406833062"}]
[null,null,null,null,"00406838023",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E773,1),\"\"))","v":1},{"$f":"IF(F773=1,COUNTIF($F$3:F773,1),\"\")","v":771},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G773),$G$3:$G$3716,0)),\"\")","v":"00406838023"}]
[null,null,null,null,"00406838062",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E774,1),\"\"))","v":1},{"$f":"IF(F774=1,COUNTIF($F$3:F774,1),\"\")","v":772},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G774),$G$3:$G$3716,0)),\"\")","v":"00406838062"}]
[null,null,null,null,"00406839062",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E775,1),\"\"))","v":1},{"$f":"IF(F775=1,COUNTIF($F$3:F775,1),\"\")","v":773},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G775),$G$3:$G$3716,0)),\"\")","v":"00406839062"}]
[null,null,null,null,"00406853062",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E776,1),\"\"))","v":1},{"$f":"IF(F776=1,COUNTIF($F$3:F776,1),\"\")","v":774},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G776),$G$3:$G$3716,0)),\"\")","v":"00406853062"}]
[null,null,null,null,"00406895801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E777,1),\"\"))","v":1},{"$f":"IF(F777=1,COUNTIF($F$3:F777,1),\"\")","v":775},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G777),$G$3:$G$3716,0)),\"\")","v":"00406895801"}]
[null,null,null,null,"00406900076",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E778,1),\"\"))","v":1},{"$f":"IF(F778=1,COUNTIF($F$3:F778,1),\"\")","v":776},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G778),$G$3:$G$3716,0)),\"\")","v":"00406900076"}]
[null,null,null,null,"00406901276",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E779,1),\"\"))","v":1},{"$f":"IF(F779=1,COUNTIF($F$3:F779,1),\"\")","v":777},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G779),$G$3:$G$3716,0)),\"\")","v":"00406901276"}]
[null,null,null,null,"00406905076",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E780,1),\"\"))","v":1},{"$f":"IF(F780=1,COUNTIF($F$3:F780,1),\"\")","v":778},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G780),$G$3:$G$3716,0)),\"\")","v":"00406905076"}]
[null,null,null,null,"00406917576",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E781,1),\"\"))","v":1},{"$f":"IF(F781=1,COUNTIF($F$3:F781,1),\"\")","v":779},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G781),$G$3:$G$3716,0)),\"\")","v":"00406917576"}]
[null,null,null,null,"00409163110",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E782,1),\"\"))","v":1},{"$f":"IF(F782=1,COUNTIF($F$3:F782,1),\"\")","v":780},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G782),$G$3:$G$3716,0)),\"\")","v":"00409163110"}]
[null,null,null,null,"00409163201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E783,1),\"\"))","v":1},{"$f":"IF(F783=1,COUNTIF($F$3:F783,1),\"\")","v":781},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G783),$G$3:$G$3716,0)),\"\")","v":"00409163201"}]
[null,null,null,null,"00409233934",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E784,1),\"\"))","v":1},{"$f":"IF(F784=1,COUNTIF($F$3:F784,1),\"\")","v":782},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G784),$G$3:$G$3716,0)),\"\")","v":"00409233934"}]
[null,null,null,null,"00409371410",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E785,1),\"\"))","v":1},{"$f":"IF(F785=1,COUNTIF($F$3:F785,1),\"\")","v":783},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G785),$G$3:$G$3716,0)),\"\")","v":"00409371410"}]
[null,null,null,null,"00409490034",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E786,1),\"\"))","v":1},{"$f":"IF(F786=1,COUNTIF($F$3:F786,1),\"\")","v":784},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G786),$G$3:$G$3716,0)),\"\")","v":"00409490034"}]
[null,null,null,null,"00409490234",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E787,1),\"\"))","v":1},{"$f":"IF(F787=1,COUNTIF($F$3:F787,1),\"\")","v":785},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G787),$G$3:$G$3716,0)),\"\")","v":"00409490234"}]
[null,null,null,null,"00409492811",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E788,1),\"\"))","v":1},{"$f":"IF(F788=1,COUNTIF($F$3:F788,1),\"\")","v":786},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G788),$G$3:$G$3716,0)),\"\")","v":"00409492811"}]
[null,null,null,null,"00409492834",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E789,1),\"\"))","v":1},{"$f":"IF(F789=1,COUNTIF($F$3:F789,1),\"\")","v":787},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G789),$G$3:$G$3716,0)),\"\")","v":"00409492834"}]
[null,null,null,null,"00409553424",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E790,1),\"\"))","v":1},{"$f":"IF(F790=1,COUNTIF($F$3:F790,1),\"\")","v":788},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G790),$G$3:$G$3716,0)),\"\")","v":"00409553424"}]
[null,null,null,null,"00409553434",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E791,1),\"\"))","v":1},{"$f":"IF(F791=1,COUNTIF($F$3:F791,1),\"\")","v":789},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G791),$G$3:$G$3716,0)),\"\")","v":"00409553434"}]
[null,null,null,null,"00409663734",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E792,1),\"\"))","v":1},{"$f":"IF(F792=1,COUNTIF($F$3:F792,1),\"\")","v":790},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G792),$G$3:$G$3716,0)),\"\")","v":"00409663734"}]
[null,null,null,null,"00409664802",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E793,1),\"\"))","v":1},{"$f":"IF(F793=1,COUNTIF($F$3:F793,1),\"\")","v":791},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G793),$G$3:$G$3716,0)),\"\")","v":"00409664802"}]
[null,null,null,null,"00409729501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E794,1),\"\"))","v":1},{"$f":"IF(F794=1,COUNTIF($F$3:F794,1),\"\")","v":792},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G794),$G$3:$G$3716,0)),\"\")","v":"00409729501"}]
[null,null,null,null,"00409751716",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E795,1),\"\"))","v":1},{"$f":"IF(F795=1,COUNTIF($F$3:F795,1),\"\")","v":793},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G795),$G$3:$G$3716,0)),\"\")","v":"00409751716"}]
[null,null,null,null,"00409751766",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E796,1),\"\"))","v":1},{"$f":"IF(F796=1,COUNTIF($F$3:F796,1),\"\")","v":794},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G796),$G$3:$G$3716,0)),\"\")","v":"00409751766"}]
[null,null,null,null,"00409767003",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E797,1),\"\"))","v":1},{"$f":"IF(F797=1,COUNTIF($F$3:F797,1),\"\")","v":795},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G797),$G$3:$G$3716,0)),\"\")","v":"00409767003"}]
[null,null,null,null,"00409767009",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E798,1),\"\"))","v":1},{"$f":"IF(F798=1,COUNTIF($F$3:F798,1),\"\")","v":796},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G798),$G$3:$G$3716,0)),\"\")","v":"00409767009"}]
[null,null,null,null,"00409771503",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E799,1),\"\"))","v":1},{"$f":"IF(F799=1,COUNTIF($F$3:F799,1),\"\")","v":797},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G799),$G$3:$G$3716,0)),\"\")","v":"00409771503"}]
[null,null,null,null,"00409771513",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E800,1),\"\"))","v":1},{"$f":"IF(F800=1,COUNTIF($F$3:F800,1),\"\")","v":798},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G800),$G$3:$G$3716,0)),\"\")","v":"00409771513"}]
[null,null,null,null,"00409792203",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E801,1),\"\"))","v":1},{"$f":"IF(F801=1,COUNTIF($F$3:F801,1),\"\")","v":799},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G801),$G$3:$G$3716,0)),\"\")","v":"00409792203"}]
[null,null,null,null,"00409792209",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E802,1),\"\"))","v":1},{"$f":"IF(F802=1,COUNTIF($F$3:F802,1),\"\")","v":800},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G802),$G$3:$G$3716,0)),\"\")","v":"00409792209"}]
[null,null,null,null,"00409792230",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E803,1),\"\"))","v":1},{"$f":"IF(F803=1,COUNTIF($F$3:F803,1),\"\")","v":801},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G803),$G$3:$G$3716,0)),\"\")","v":"00409792230"}]
[null,null,null,null,"00409792248",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E804,1),\"\"))","v":1},{"$f":"IF(F804=1,COUNTIF($F$3:F804,1),\"\")","v":802},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G804),$G$3:$G$3716,0)),\"\")","v":"00409792248"}]
[null,null,null,null,"00409792253",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E805,1),\"\"))","v":1},{"$f":"IF(F805=1,COUNTIF($F$3:F805,1),\"\")","v":803},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G805),$G$3:$G$3716,0)),\"\")","v":"00409792253"}]
[null,null,null,null,"00409792306",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E806,1),\"\"))","v":1},{"$f":"IF(F806=1,COUNTIF($F$3:F806,1),\"\")","v":804},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G806),$G$3:$G$3716,0)),\"\")","v":"00409792306"}]
[null,null,null,null,"00409792311",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E807,1),\"\"))","v":1},{"$f":"IF(F807=1,COUNTIF($F$3:F807,1),\"\")","v":805},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G807),$G$3:$G$3716,0)),\"\")","v":"00409792311"}]
[null,null,null,null,"00409792609",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E808,1),\"\"))","v":1},{"$f":"IF(F808=1,COUNTIF($F$3:F808,1),\"\")","v":806},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G808),$G$3:$G$3716,0)),\"\")","v":"00409792609"}]
[null,null,null,null,"00409793009",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E809,1),\"\"))","v":1},{"$f":"IF(F809=1,COUNTIF($F$3:F809,1),\"\")","v":807},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G809),$G$3:$G$3716,0)),\"\")","v":"00409793009"}]
[null,null,null,null,"00409793519",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E810,1),\"\"))","v":1},{"$f":"IF(F810=1,COUNTIF($F$3:F810,1),\"\")","v":808},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G810),$G$3:$G$3716,0)),\"\")","v":"00409793519"}]
[null,null,null,null,"00409798303",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E811,1),\"\"))","v":1},{"$f":"IF(F811=1,COUNTIF($F$3:F811,1),\"\")","v":809},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G811),$G$3:$G$3716,0)),\"\")","v":"00409798303"}]
[null,null,null,null,"00409798353",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E812,1),\"\"))","v":1},{"$f":"IF(F812=1,COUNTIF($F$3:F812,1),\"\")","v":810},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G812),$G$3:$G$3716,0)),\"\")","v":"00409798353"}]
[null,null,null,null,"00409798406",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E813,1),\"\"))","v":1},{"$f":"IF(F813=1,COUNTIF($F$3:F813,1),\"\")","v":811},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G813),$G$3:$G$3716,0)),\"\")","v":"00409798406"}]
[null,null,null,null,"00409798411",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E814,1),\"\"))","v":1},{"$f":"IF(F814=1,COUNTIF($F$3:F814,1),\"\")","v":812},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G814),$G$3:$G$3716,0)),\"\")","v":"00409798411"}]
[null,null,null,null,"00409798503",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E815,1),\"\"))","v":1},{"$f":"IF(F815=1,COUNTIF($F$3:F815,1),\"\")","v":813},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G815),$G$3:$G$3716,0)),\"\")","v":"00409798503"}]
[null,null,null,null,"00409798509",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E816,1),\"\"))","v":1},{"$f":"IF(F816=1,COUNTIF($F$3:F816,1),\"\")","v":814},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G816),$G$3:$G$3716,0)),\"\")","v":"00409798509"}]
[null,null,null,null,"00456045801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E817,1),\"\"))","v":1},{"$f":"IF(F817=1,COUNTIF($F$3:F817,1),\"\")","v":815},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G817),$G$3:$G$3716,0)),\"\")","v":"00456045801"}]
[null,null,null,null,"00456045901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E818,1),\"\"))","v":1},{"$f":"IF(F818=1,COUNTIF($F$3:F818,1),\"\")","v":816},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G818),$G$3:$G$3716,0)),\"\")","v":"00456045901"}]
[null,null,null,null,"00456320563",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E819,1),\"\"))","v":1},{"$f":"IF(F819=1,COUNTIF($F$3:F819,1),\"\")","v":817},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G819),$G$3:$G$3716,0)),\"\")","v":"00456320563"}]
[null,null,null,null,"00456333001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E820,1),\"\"))","v":1},{"$f":"IF(F820=1,COUNTIF($F$3:F820,1),\"\")","v":818},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G820),$G$3:$G$3716,0)),\"\")","v":"00456333001"}]
[null,null,null,null,"00456430001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E821,1),\"\"))","v":1},{"$f":"IF(F821=1,COUNTIF($F$3:F821,1),\"\")","v":819},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G821),$G$3:$G$3716,0)),\"\")","v":"00456430001"}]
[null,null,null,null,"00456430008",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E822,1),\"\"))","v":1},{"$f":"IF(F822=1,COUNTIF($F$3:F822,1),\"\")","v":820},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G822),$G$3:$G$3716,0)),\"\")","v":"00456430008"}]
[null,null,null,null,"00469052014",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E823,1),\"\"))","v":1},{"$f":"IF(F823=1,COUNTIF($F$3:F823,1),\"\")","v":821},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G823),$G$3:$G$3716,0)),\"\")","v":"00469052014"}]
[null,null,null,null,"00472017934",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E824,1),\"\"))","v":1},{"$f":"IF(F824=1,COUNTIF($F$3:F824,1),\"\")","v":822},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G824),$G$3:$G$3716,0)),\"\")","v":"00472017934"}]
[null,null,null,null,"00472022041",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E825,1),\"\"))","v":1},{"$f":"IF(F825=1,COUNTIF($F$3:F825,1),\"\")","v":823},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G825),$G$3:$G$3716,0)),\"\")","v":"00472022041"}]
[null,null,null,null,"00472024260",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E826,1),\"\"))","v":1},{"$f":"IF(F826=1,COUNTIF($F$3:F826,1),\"\")","v":824},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G826),$G$3:$G$3716,0)),\"\")","v":"00472024260"}]
[null,null,null,null,"00472032126",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E827,1),\"\"))","v":1},{"$f":"IF(F827=1,COUNTIF($F$3:F827,1),\"\")","v":825},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G827),$G$3:$G$3716,0)),\"\")","v":"00472032126"}]
[null,null,null,null,"00472033956",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E828,1),\"\"))","v":1},{"$f":"IF(F828=1,COUNTIF($F$3:F828,1),\"\")","v":826},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G828),$G$3:$G$3716,0)),\"\")","v":"00472033956"}]
[null,null,null,null,"00472073514",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E829,1),\"\"))","v":1},{"$f":"IF(F829=1,COUNTIF($F$3:F829,1),\"\")","v":827},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G829),$G$3:$G$3716,0)),\"\")","v":"00472073514"}]
[null,null,null,null,"00472082516",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E830,1),\"\"))","v":1},{"$f":"IF(F830=1,COUNTIF($F$3:F830,1),\"\")","v":828},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G830),$G$3:$G$3716,0)),\"\")","v":"00472082516"}]
[null,null,null,null,"00472125594",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E831,1),\"\"))","v":1},{"$f":"IF(F831=1,COUNTIF($F$3:F831,1),\"\")","v":829},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G831),$G$3:$G$3716,0)),\"\")","v":"00472125594"}]
[null,null,null,null,"00472173803",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E832,1),\"\"))","v":1},{"$f":"IF(F832=1,COUNTIF($F$3:F832,1),\"\")","v":830},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G832),$G$3:$G$3716,0)),\"\")","v":"00472173803"}]
[null,null,null,null,"00472524267",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E833,1),\"\"))","v":1},{"$f":"IF(F833=1,COUNTIF($F$3:F833,1),\"\")","v":831},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G833),$G$3:$G$3716,0)),\"\")","v":"00472524267"}]
[null,null,null,null,"00472524269",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E834,1),\"\"))","v":1},{"$f":"IF(F834=1,COUNTIF($F$3:F834,1),\"\")","v":832},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G834),$G$3:$G$3716,0)),\"\")","v":"00472524269"}]
[null,null,null,null,"00486111101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E835,1),\"\"))","v":1},{"$f":"IF(F835=1,COUNTIF($F$3:F835,1),\"\")","v":833},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G835),$G$3:$G$3716,0)),\"\")","v":"00486111101"}]
[null,null,null,null,"00486112501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E836,1),\"\"))","v":1},{"$f":"IF(F836=1,COUNTIF($F$3:F836,1),\"\")","v":834},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G836),$G$3:$G$3716,0)),\"\")","v":"00486112501"}]
[null,null,null,null,"00487590199",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E837,1),\"\"))","v":1},{"$f":"IF(F837=1,COUNTIF($F$3:F837,1),\"\")","v":835},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G837),$G$3:$G$3716,0)),\"\")","v":"00487590199"}]
[null,null,null,null,"00496088205",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E838,1),\"\"))","v":1},{"$f":"IF(F838=1,COUNTIF($F$3:F838,1),\"\")","v":836},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G838),$G$3:$G$3716,0)),\"\")","v":"00496088205"}]
[null,null,null,null,"00496088207",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E839,1),\"\"))","v":1},{"$f":"IF(F839=1,COUNTIF($F$3:F839,1),\"\")","v":837},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G839),$G$3:$G$3716,0)),\"\")","v":"00496088207"}]
[null,null,null,null,"00521238400",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E840,1),\"\"))","v":1},{"$f":"IF(F840=1,COUNTIF($F$3:F840,1),\"\")","v":838},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G840),$G$3:$G$3716,0)),\"\")","v":"00521238400"}]
[null,null,null,null,"00527105001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E841,1),\"\"))","v":1},{"$f":"IF(F841=1,COUNTIF($F$3:F841,1),\"\")","v":839},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G841),$G$3:$G$3716,0)),\"\")","v":"00527105001"}]
[null,null,null,null,"00527130101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E842,1),\"\"))","v":1},{"$f":"IF(F842=1,COUNTIF($F$3:F842,1),\"\")","v":840},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G842),$G$3:$G$3716,0)),\"\")","v":"00527130101"}]
[null,null,null,null,"00527131101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E843,1),\"\"))","v":1},{"$f":"IF(F843=1,COUNTIF($F$3:F843,1),\"\")","v":841},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G843),$G$3:$G$3716,0)),\"\")","v":"00527131101"}]
[null,null,null,null,"00527131301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E844,1),\"\"))","v":1},{"$f":"IF(F844=1,COUNTIF($F$3:F844,1),\"\")","v":842},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G844),$G$3:$G$3716,0)),\"\")","v":"00527131301"}]
[null,null,null,null,"00527131801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E845,1),\"\"))","v":1},{"$f":"IF(F845=1,COUNTIF($F$3:F845,1),\"\")","v":843},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G845),$G$3:$G$3716,0)),\"\")","v":"00527131801"}]
[null,null,null,null,"00527132601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E846,1),\"\"))","v":1},{"$f":"IF(F846=1,COUNTIF($F$3:F846,1),\"\")","v":844},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G846),$G$3:$G$3716,0)),\"\")","v":"00527132601"}]
[null,null,null,null,"00527134101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E847,1),\"\"))","v":1},{"$f":"IF(F847=1,COUNTIF($F$3:F847,1),\"\")","v":845},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G847),$G$3:$G$3716,0)),\"\")","v":"00527134101"}]
[null,null,null,null,"00527136801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E848,1),\"\"))","v":1},{"$f":"IF(F848=1,COUNTIF($F$3:F848,1),\"\")","v":846},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G848),$G$3:$G$3716,0)),\"\")","v":"00527136801"}]
[null,null,null,null,"00527141310",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E849,1),\"\"))","v":1},{"$f":"IF(F849=1,COUNTIF($F$3:F849,1),\"\")","v":847},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G849),$G$3:$G$3716,0)),\"\")","v":"00527141310"}]
[null,null,null,null,"00527179001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E850,1),\"\"))","v":1},{"$f":"IF(F850=1,COUNTIF($F$3:F850,1),\"\")","v":848},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G850),$G$3:$G$3716,0)),\"\")","v":"00527179001"}]
[null,null,null,null,"00527193206",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E851,1),\"\"))","v":1},{"$f":"IF(F851=1,COUNTIF($F$3:F851,1),\"\")","v":849},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G851),$G$3:$G$3716,0)),\"\")","v":"00527193206"}]
[null,null,null,null,"00527410737",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E852,1),\"\"))","v":1},{"$f":"IF(F852=1,COUNTIF($F$3:F852,1),\"\")","v":850},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G852),$G$3:$G$3716,0)),\"\")","v":"00527410737"}]
[null,null,null,null,"00527530164",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E853,1),\"\"))","v":1},{"$f":"IF(F853=1,COUNTIF($F$3:F853,1),\"\")","v":851},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G853),$G$3:$G$3716,0)),\"\")","v":"00527530164"}]
[null,null,null,null,"00536002583",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E854,1),\"\"))","v":1},{"$f":"IF(F854=1,COUNTIF($F$3:F854,1),\"\")","v":852},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G854),$G$3:$G$3716,0)),\"\")","v":"00536002583"}]
[null,null,null,null,"00536009185",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E855,1),\"\"))","v":1},{"$f":"IF(F855=1,COUNTIF($F$3:F855,1),\"\")","v":853},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G855),$G$3:$G$3716,0)),\"\")","v":"00536009185"}]
[null,null,null,null,"00536012285",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E856,1),\"\"))","v":1},{"$f":"IF(F856=1,COUNTIF($F$3:F856,1),\"\")","v":854},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G856),$G$3:$G$3716,0)),\"\")","v":"00536012285"}]
[null,null,null,null,"00536016097",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E857,1),\"\"))","v":1},{"$f":"IF(F857=1,COUNTIF($F$3:F857,1),\"\")","v":855},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G857),$G$3:$G$3716,0)),\"\")","v":"00536016097"}]
[null,null,null,null,"00536071080",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E858,1),\"\"))","v":1},{"$f":"IF(F858=1,COUNTIF($F$3:F858,1),\"\")","v":856},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G858),$G$3:$G$3716,0)),\"\")","v":"00536071080"}]
[null,null,null,null,"00536102410",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E859,1),\"\"))","v":1},{"$f":"IF(F859=1,COUNTIF($F$3:F859,1),\"\")","v":857},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G859),$G$3:$G$3716,0)),\"\")","v":"00536102410"}]
[null,null,null,null,"00536104815",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E860,1),\"\"))","v":1},{"$f":"IF(F860=1,COUNTIF($F$3:F860,1),\"\")","v":858},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G860),$G$3:$G$3716,0)),\"\")","v":"00536104815"}]
[null,null,null,null,"00536105305",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E861,1),\"\"))","v":1},{"$f":"IF(F861=1,COUNTIF($F$3:F861,1),\"\")","v":859},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G861),$G$3:$G$3716,0)),\"\")","v":"00536105305"}]
[null,null,null,null,"00536105429",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E862,1),\"\"))","v":1},{"$f":"IF(F862=1,COUNTIF($F$3:F862,1),\"\")","v":860},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G862),$G$3:$G$3716,0)),\"\")","v":"00536105429"}]
[null,null,null,null,"00536105556",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E863,1),\"\"))","v":1},{"$f":"IF(F863=1,COUNTIF($F$3:F863,1),\"\")","v":861},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G863),$G$3:$G$3716,0)),\"\")","v":"00536105556"}]
[null,null,null,null,"00536105656",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E864,1),\"\"))","v":1},{"$f":"IF(F864=1,COUNTIF($F$3:F864,1),\"\")","v":862},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G864),$G$3:$G$3716,0)),\"\")","v":"00536105656"}]
[null,null,null,null,"00536106210",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E865,1),\"\"))","v":1},{"$f":"IF(F865=1,COUNTIF($F$3:F865,1),\"\")","v":863},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G865),$G$3:$G$3716,0)),\"\")","v":"00536106210"}]
[null,null,null,null,"00536108494",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E866,1),\"\"))","v":1},{"$f":"IF(F866=1,COUNTIF($F$3:F866,1),\"\")","v":864},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G866),$G$3:$G$3716,0)),\"\")","v":"00536108494"}]
[null,null,null,null,"00536108691",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E867,1),\"\"))","v":1},{"$f":"IF(F867=1,COUNTIF($F$3:F867,1),\"\")","v":865},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G867),$G$3:$G$3716,0)),\"\")","v":"00536108691"}]
[null,null,null,null,"00536110688",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E868,1),\"\"))","v":1},{"$f":"IF(F868=1,COUNTIF($F$3:F868,1),\"\")","v":866},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G868),$G$3:$G$3716,0)),\"\")","v":"00536110688"}]
[null,null,null,null,"00536111825",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E869,1),\"\"))","v":1},{"$f":"IF(F869=1,COUNTIF($F$3:F869,1),\"\")","v":867},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G869),$G$3:$G$3716,0)),\"\")","v":"00536111825"}]
[null,null,null,null,"00536120610",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E870,1),\"\"))","v":1},{"$f":"IF(F870=1,COUNTIF($F$3:F870,1),\"\")","v":868},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G870),$G$3:$G$3716,0)),\"\")","v":"00536120610"}]
[null,null,null,null,"00536123441",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E871,1),\"\"))","v":1},{"$f":"IF(F871=1,COUNTIF($F$3:F871,1),\"\")","v":869},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G871),$G$3:$G$3716,0)),\"\")","v":"00536123441"}]
[null,null,null,null,"00536123927",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E872,1),\"\"))","v":1},{"$f":"IF(F872=1,COUNTIF($F$3:F872,1),\"\")","v":870},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G872),$G$3:$G$3716,0)),\"\")","v":"00536123927"}]
[null,null,null,null,"00536123981",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E873,1),\"\"))","v":1},{"$f":"IF(F873=1,COUNTIF($F$3:F873,1),\"\")","v":871},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G873),$G$3:$G$3716,0)),\"\")","v":"00536123981"}]
[null,null,null,null,"00536126812",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E874,1),\"\"))","v":1},{"$f":"IF(F874=1,COUNTIF($F$3:F874,1),\"\")","v":872},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G874),$G$3:$G$3716,0)),\"\")","v":"00536126812"}]
[null,null,null,null,"00536128636",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E875,1),\"\"))","v":1},{"$f":"IF(F875=1,COUNTIF($F$3:F875,1),\"\")","v":873},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G875),$G$3:$G$3716,0)),\"\")","v":"00536128636"}]
[null,null,null,null,"00536135501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E876,1),\"\"))","v":1},{"$f":"IF(F876=1,COUNTIF($F$3:F876,1),\"\")","v":874},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G876),$G$3:$G$3716,0)),\"\")","v":"00536135501"}]
[null,null,null,null,"00536194583",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E877,1),\"\"))","v":1},{"$f":"IF(F877=1,COUNTIF($F$3:F877,1),\"\")","v":875},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G877),$G$3:$G$3716,0)),\"\")","v":"00536194583"}]
[null,null,null,null,"00536199553",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E878,1),\"\"))","v":1},{"$f":"IF(F878=1,COUNTIF($F$3:F878,1),\"\")","v":876},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G878),$G$3:$G$3716,0)),\"\")","v":"00536199553"}]
[null,null,null,null,"00536242558",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E879,1),\"\"))","v":1},{"$f":"IF(F879=1,COUNTIF($F$3:F879,1),\"\")","v":877},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G879),$G$3:$G$3716,0)),\"\")","v":"00536242558"}]
[null,null,null,null,"00536252525",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E880,1),\"\"))","v":1},{"$f":"IF(F880=1,COUNTIF($F$3:F880,1),\"\")","v":878},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G880),$G$3:$G$3716,0)),\"\")","v":"00536252525"}]
[null,null,null,null,"00536277085",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E881,1),\"\"))","v":1},{"$f":"IF(F881=1,COUNTIF($F$3:F881,1),\"\")","v":879},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G881),$G$3:$G$3716,0)),\"\")","v":"00536277085"}]
[null,null,null,null,"00536331310",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E882,1),\"\"))","v":1},{"$f":"IF(F882=1,COUNTIF($F$3:F882,1),\"\")","v":880},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G882),$G$3:$G$3716,0)),\"\")","v":"00536331310"}]
[null,null,null,null,"00536333401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E883,1),\"\"))","v":1},{"$f":"IF(F883=1,COUNTIF($F$3:F883,1),\"\")","v":881},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G883),$G$3:$G$3716,0)),\"\")","v":"00536333401"}]
[null,null,null,null,"00536338101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E884,1),\"\"))","v":1},{"$f":"IF(F884=1,COUNTIF($F$3:F884,1),\"\")","v":882},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G884),$G$3:$G$3716,0)),\"\")","v":"00536338101"}]
[null,null,null,null,"00536338601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E885,1),\"\"))","v":1},{"$f":"IF(F885=1,COUNTIF($F$3:F885,1),\"\")","v":883},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G885),$G$3:$G$3716,0)),\"\")","v":"00536338601"}]
[null,null,null,null,"00536352141",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E886,1),\"\"))","v":1},{"$f":"IF(F886=1,COUNTIF($F$3:F886,1),\"\")","v":884},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G886),$G$3:$G$3716,0)),\"\")","v":"00536352141"}]
[null,null,null,null,"00536354201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E887,1),\"\"))","v":1},{"$f":"IF(F887=1,COUNTIF($F$3:F887,1),\"\")","v":885},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G887),$G$3:$G$3716,0)),\"\")","v":"00536354201"}]
[null,null,null,null,"00536398501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E888,1),\"\"))","v":1},{"$f":"IF(F888=1,COUNTIF($F$3:F888,1),\"\")","v":886},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G888),$G$3:$G$3716,0)),\"\")","v":"00536398501"}]
[null,null,null,null,"00536407601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E889,1),\"\"))","v":1},{"$f":"IF(F889=1,COUNTIF($F$3:F889,1),\"\")","v":887},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G889),$G$3:$G$3716,0)),\"\")","v":"00536407601"}]
[null,null,null,null,"00536440601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E890,1),\"\"))","v":1},{"$f":"IF(F890=1,COUNTIF($F$3:F890,1),\"\")","v":888},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G890),$G$3:$G$3716,0)),\"\")","v":"00536440601"}]
[null,null,null,null,"00536440801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E891,1),\"\"))","v":1},{"$f":"IF(F891=1,COUNTIF($F$3:F891,1),\"\")","v":889},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G891),$G$3:$G$3716,0)),\"\")","v":"00536440801"}]
[null,null,null,null,"00536454410",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E892,1),\"\"))","v":1},{"$f":"IF(F892=1,COUNTIF($F$3:F892,1),\"\")","v":890},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G892),$G$3:$G$3716,0)),\"\")","v":"00536454410"}]
[null,null,null,null,"00536570028",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E893,1),\"\"))","v":1},{"$f":"IF(F893=1,COUNTIF($F$3:F893,1),\"\")","v":891},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G893),$G$3:$G$3716,0)),\"\")","v":"00536570028"}]
[null,null,null,null,"00536570098",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E894,1),\"\"))","v":1},{"$f":"IF(F894=1,COUNTIF($F$3:F894,1),\"\")","v":892},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G894),$G$3:$G$3716,0)),\"\")","v":"00536570098"}]
[null,null,null,null,"00536589453",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E895,1),\"\"))","v":1},{"$f":"IF(F895=1,COUNTIF($F$3:F895,1),\"\")","v":893},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G895),$G$3:$G$3716,0)),\"\")","v":"00536589453"}]
[null,null,null,null,"00536589488",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E896,1),\"\"))","v":1},{"$f":"IF(F896=1,COUNTIF($F$3:F896,1),\"\")","v":894},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G896),$G$3:$G$3716,0)),\"\")","v":"00536589488"}]
[null,null,null,null,"00536589588",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E897,1),\"\"))","v":1},{"$f":"IF(F897=1,COUNTIF($F$3:F897,1),\"\")","v":895},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G897),$G$3:$G$3716,0)),\"\")","v":"00536589588"}]
[null,null,null,null,"00536589688",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E898,1),\"\"))","v":1},{"$f":"IF(F898=1,COUNTIF($F$3:F898,1),\"\")","v":896},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G898),$G$3:$G$3716,0)),\"\")","v":"00536589688"}]
[null,null,null,null,"00536741551",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E899,1),\"\"))","v":1},{"$f":"IF(F899=1,COUNTIF($F$3:F899,1),\"\")","v":897},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G899),$G$3:$G$3716,0)),\"\")","v":"00536741551"}]
[null,null,null,null,"00536845080",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E900,1),\"\"))","v":1},{"$f":"IF(F900=1,COUNTIF($F$3:F900,1),\"\")","v":898},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G900),$G$3:$G$3716,0)),\"\")","v":"00536845080"}]
[null,null,null,null,"00555006602",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E901,1),\"\"))","v":1},{"$f":"IF(F901=1,COUNTIF($F$3:F901,1),\"\")","v":899},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G901),$G$3:$G$3716,0)),\"\")","v":"00555006602"}]
[null,null,null,null,"00555007101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E902,1),\"\"))","v":1},{"$f":"IF(F902=1,COUNTIF($F$3:F902,1),\"\")","v":900},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G902),$G$3:$G$3716,0)),\"\")","v":"00555007101"}]
[null,null,null,null,"00555007102",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E903,1),\"\"))","v":1},{"$f":"IF(F903=1,COUNTIF($F$3:F903,1),\"\")","v":901},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G903),$G$3:$G$3716,0)),\"\")","v":"00555007102"}]
[null,null,null,null,"00555013809",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E904,1),\"\"))","v":1},{"$f":"IF(F904=1,COUNTIF($F$3:F904,1),\"\")","v":902},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G904),$G$3:$G$3716,0)),\"\")","v":"00555013809"}]
[null,null,null,null,"00555015802",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E905,1),\"\"))","v":1},{"$f":"IF(F905=1,COUNTIF($F$3:F905,1),\"\")","v":903},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G905),$G$3:$G$3716,0)),\"\")","v":"00555015802"}]
[null,null,null,null,"00555015902",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E906,1),\"\"))","v":1},{"$f":"IF(F906=1,COUNTIF($F$3:F906,1),\"\")","v":904},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G906),$G$3:$G$3716,0)),\"\")","v":"00555015902"}]
[null,null,null,null,"00555048402",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E907,1),\"\"))","v":1},{"$f":"IF(F907=1,COUNTIF($F$3:F907,1),\"\")","v":905},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G907),$G$3:$G$3716,0)),\"\")","v":"00555048402"}]
[null,null,null,null,"00555061214",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E908,1),\"\"))","v":1},{"$f":"IF(F908=1,COUNTIF($F$3:F908,1),\"\")","v":906},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G908),$G$3:$G$3716,0)),\"\")","v":"00555061214"}]
[null,null,null,null,"00555061414",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E909,1),\"\"))","v":1},{"$f":"IF(F909=1,COUNTIF($F$3:F909,1),\"\")","v":907},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G909),$G$3:$G$3716,0)),\"\")","v":"00555061414"}]
[null,null,null,null,"00555061514",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E910,1),\"\"))","v":1},{"$f":"IF(F910=1,COUNTIF($F$3:F910,1),\"\")","v":908},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G910),$G$3:$G$3716,0)),\"\")","v":"00555061514"}]
[null,null,null,null,"00555061762",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E911,1),\"\"))","v":1},{"$f":"IF(F911=1,COUNTIF($F$3:F911,1),\"\")","v":909},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G911),$G$3:$G$3716,0)),\"\")","v":"00555061762"}]
[null,null,null,null,"00555063402",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E912,1),\"\"))","v":1},{"$f":"IF(F912=1,COUNTIF($F$3:F912,1),\"\")","v":910},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G912),$G$3:$G$3716,0)),\"\")","v":"00555063402"}]
[null,null,null,null,"00555077902",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E913,1),\"\"))","v":1},{"$f":"IF(F913=1,COUNTIF($F$3:F913,1),\"\")","v":911},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G913),$G$3:$G$3716,0)),\"\")","v":"00555077902"}]
[null,null,null,null,"00555080802",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E914,1),\"\"))","v":1},{"$f":"IF(F914=1,COUNTIF($F$3:F914,1),\"\")","v":912},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G914),$G$3:$G$3716,0)),\"\")","v":"00555080802"}]
[null,null,null,null,"00555088602",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E915,1),\"\"))","v":1},{"$f":"IF(F915=1,COUNTIF($F$3:F915,1),\"\")","v":913},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G915),$G$3:$G$3716,0)),\"\")","v":"00555088602"}]
[null,null,null,null,"00555090201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E916,1),\"\"))","v":1},{"$f":"IF(F916=1,COUNTIF($F$3:F916,1),\"\")","v":914},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G916),$G$3:$G$3716,0)),\"\")","v":"00555090201"}]
[null,null,null,null,"00555095202",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E917,1),\"\"))","v":1},{"$f":"IF(F917=1,COUNTIF($F$3:F917,1),\"\")","v":915},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G917),$G$3:$G$3716,0)),\"\")","v":"00555095202"}]
[null,null,null,null,"00555098037",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E918,1),\"\"))","v":1},{"$f":"IF(F918=1,COUNTIF($F$3:F918,1),\"\")","v":916},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G918),$G$3:$G$3716,0)),\"\")","v":"00555098037"}]
[null,null,null,null,"00555099702",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E919,1),\"\"))","v":1},{"$f":"IF(F919=1,COUNTIF($F$3:F919,1),\"\")","v":917},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G919),$G$3:$G$3716,0)),\"\")","v":"00555099702"}]
[null,null,null,null,"00555100916",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E920,1),\"\"))","v":1},{"$f":"IF(F920=1,COUNTIF($F$3:F920,1),\"\")","v":918},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G920),$G$3:$G$3716,0)),\"\")","v":"00555100916"}]
[null,null,null,null,"00555101016",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E921,1),\"\"))","v":1},{"$f":"IF(F921=1,COUNTIF($F$3:F921,1),\"\")","v":919},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G921),$G$3:$G$3716,0)),\"\")","v":"00555101016"}]
[null,null,null,null,"00574006915",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E922,1),\"\"))","v":1},{"$f":"IF(F922=1,COUNTIF($F$3:F922,1),\"\")","v":920},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G922),$G$3:$G$3716,0)),\"\")","v":"00574006915"}]
[null,null,null,null,"00574010601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E923,1),\"\"))","v":1},{"$f":"IF(F923=1,COUNTIF($F$3:F923,1),\"\")","v":921},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G923),$G$3:$G$3716,0)),\"\")","v":"00574010601"}]
[null,null,null,null,"00574010777",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E924,1),\"\"))","v":1},{"$f":"IF(F924=1,COUNTIF($F$3:F924,1),\"\")","v":922},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G924),$G$3:$G$3716,0)),\"\")","v":"00574010777"}]
[null,null,null,null,"00574012074",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E925,1),\"\"))","v":1},{"$f":"IF(F925=1,COUNTIF($F$3:F925,1),\"\")","v":923},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G925),$G$3:$G$3716,0)),\"\")","v":"00574012074"}]
[null,null,null,null,"00574012076",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E926,1),\"\"))","v":1},{"$f":"IF(F926=1,COUNTIF($F$3:F926,1),\"\")","v":924},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G926),$G$3:$G$3716,0)),\"\")","v":"00574012076"}]
[null,null,null,null,"00574012104",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E927,1),\"\"))","v":1},{"$f":"IF(F927=1,COUNTIF($F$3:F927,1),\"\")","v":925},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G927),$G$3:$G$3716,0)),\"\")","v":"00574012104"}]
[null,null,null,null,"00574012108",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E928,1),\"\"))","v":1},{"$f":"IF(F928=1,COUNTIF($F$3:F928,1),\"\")","v":926},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G928),$G$3:$G$3716,0)),\"\")","v":"00574012108"}]
[null,null,null,null,"00574012174",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E929,1),\"\"))","v":1},{"$f":"IF(F929=1,COUNTIF($F$3:F929,1),\"\")","v":927},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G929),$G$3:$G$3716,0)),\"\")","v":"00574012174"}]
[null,null,null,null,"00574012901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E930,1),\"\"))","v":1},{"$f":"IF(F930=1,COUNTIF($F$3:F930,1),\"\")","v":928},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G930),$G$3:$G$3716,0)),\"\")","v":"00574012901"}]
[null,null,null,null,"00574014704",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E931,1),\"\"))","v":1},{"$f":"IF(F931=1,COUNTIF($F$3:F931,1),\"\")","v":929},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G931),$G$3:$G$3716,0)),\"\")","v":"00574014704"}]
[null,null,null,null,"00574015004",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E932,1),\"\"))","v":1},{"$f":"IF(F932=1,COUNTIF($F$3:F932,1),\"\")","v":930},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G932),$G$3:$G$3716,0)),\"\")","v":"00574015004"}]
[null,null,null,null,"00574022201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E933,1),\"\"))","v":1},{"$f":"IF(F933=1,COUNTIF($F$3:F933,1),\"\")","v":931},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G933),$G$3:$G$3716,0)),\"\")","v":"00574022201"}]
[null,null,null,null,"00574025001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E934,1),\"\"))","v":1},{"$f":"IF(F934=1,COUNTIF($F$3:F934,1),\"\")","v":932},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G934),$G$3:$G$3716,0)),\"\")","v":"00574025001"}]
[null,null,null,null,"00574029201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E935,1),\"\"))","v":1},{"$f":"IF(F935=1,COUNTIF($F$3:F935,1),\"\")","v":933},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G935),$G$3:$G$3716,0)),\"\")","v":"00574029201"}]
[null,null,null,null,"00574030216",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E936,1),\"\"))","v":1},{"$f":"IF(F936=1,COUNTIF($F$3:F936,1),\"\")","v":934},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G936),$G$3:$G$3716,0)),\"\")","v":"00574030216"}]
[null,null,null,null,"00574030416",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E937,1),\"\"))","v":1},{"$f":"IF(F937=1,COUNTIF($F$3:F937,1),\"\")","v":935},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G937),$G$3:$G$3716,0)),\"\")","v":"00574030416"}]
[null,null,null,null,"00574041207",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E938,1),\"\"))","v":1},{"$f":"IF(F938=1,COUNTIF($F$3:F938,1),\"\")","v":936},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G938),$G$3:$G$3716,0)),\"\")","v":"00574041207"}]
[null,null,null,null,"00574050811",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E939,1),\"\"))","v":1},{"$f":"IF(F939=1,COUNTIF($F$3:F939,1),\"\")","v":937},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G939),$G$3:$G$3716,0)),\"\")","v":"00574050811"}]
[null,null,null,null,"00574052174",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E940,1),\"\"))","v":1},{"$f":"IF(F940=1,COUNTIF($F$3:F940,1),\"\")","v":938},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G940),$G$3:$G$3716,0)),\"\")","v":"00574052174"}]
[null,null,null,null,"00574200802",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E941,1),\"\"))","v":1},{"$f":"IF(F941=1,COUNTIF($F$3:F941,1),\"\")","v":939},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G941),$G$3:$G$3716,0)),\"\")","v":"00574200802"}]
[null,null,null,null,"00574200815",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E942,1),\"\"))","v":1},{"$f":"IF(F942=1,COUNTIF($F$3:F942,1),\"\")","v":940},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G942),$G$3:$G$3716,0)),\"\")","v":"00574200815"}]
[null,null,null,null,"00574402135",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E943,1),\"\"))","v":1},{"$f":"IF(F943=1,COUNTIF($F$3:F943,1),\"\")","v":941},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G943),$G$3:$G$3716,0)),\"\")","v":"00574402135"}]
[null,null,null,null,"00574402411",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E944,1),\"\"))","v":1},{"$f":"IF(F944=1,COUNTIF($F$3:F944,1),\"\")","v":942},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G944),$G$3:$G$3716,0)),\"\")","v":"00574402411"}]
[null,null,null,null,"00574414435",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E945,1),\"\"))","v":1},{"$f":"IF(F945=1,COUNTIF($F$3:F945,1),\"\")","v":943},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G945),$G$3:$G$3716,0)),\"\")","v":"00574414435"}]
[null,null,null,null,"00574416035",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E946,1),\"\"))","v":1},{"$f":"IF(F946=1,COUNTIF($F$3:F946,1),\"\")","v":944},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G946),$G$3:$G$3716,0)),\"\")","v":"00574416035"}]
[null,null,null,null,"00574703412",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E947,1),\"\"))","v":1},{"$f":"IF(F947=1,COUNTIF($F$3:F947,1),\"\")","v":945},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G947),$G$3:$G$3716,0)),\"\")","v":"00574703412"}]
[null,null,null,null,"00574703612",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E948,1),\"\"))","v":1},{"$f":"IF(F948=1,COUNTIF($F$3:F948,1),\"\")","v":946},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G948),$G$3:$G$3716,0)),\"\")","v":"00574703612"}]
[null,null,null,null,"00574705012",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E949,1),\"\"))","v":1},{"$f":"IF(F949=1,COUNTIF($F$3:F949,1),\"\")","v":947},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G949),$G$3:$G$3716,0)),\"\")","v":"00574705012"}]
[null,null,null,null,"00574709012",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E950,1),\"\"))","v":1},{"$f":"IF(F950=1,COUNTIF($F$3:F950,1),\"\")","v":948},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G950),$G$3:$G$3716,0)),\"\")","v":"00574709012"}]
[null,null,null,null,"00574722612",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E951,1),\"\"))","v":1},{"$f":"IF(F951=1,COUNTIF($F$3:F951,1),\"\")","v":949},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G951),$G$3:$G$3716,0)),\"\")","v":"00574722612"}]
[null,null,null,null,"00574723412",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E952,1),\"\"))","v":1},{"$f":"IF(F952=1,COUNTIF($F$3:F952,1),\"\")","v":950},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G952),$G$3:$G$3716,0)),\"\")","v":"00574723412"}]
[null,null,null,null,"00575620030",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E953,1),\"\"))","v":1},{"$f":"IF(F953=1,COUNTIF($F$3:F953,1),\"\")","v":951},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G953),$G$3:$G$3716,0)),\"\")","v":"00575620030"}]
[null,null,null,null,"00591024201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E954,1),\"\"))","v":1},{"$f":"IF(F954=1,COUNTIF($F$3:F954,1),\"\")","v":952},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G954),$G$3:$G$3716,0)),\"\")","v":"00591024201"}]
[null,null,null,null,"00591037101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E955,1),\"\"))","v":1},{"$f":"IF(F955=1,COUNTIF($F$3:F955,1),\"\")","v":953},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G955),$G$3:$G$3716,0)),\"\")","v":"00591037101"}]
[null,null,null,null,"00591040701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E956,1),\"\"))","v":1},{"$f":"IF(F956=1,COUNTIF($F$3:F956,1),\"\")","v":954},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G956),$G$3:$G$3716,0)),\"\")","v":"00591040701"}]
[null,null,null,null,"00591044401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E957,1),\"\"))","v":1},{"$f":"IF(F957=1,COUNTIF($F$3:F957,1),\"\")","v":955},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G957),$G$3:$G$3716,0)),\"\")","v":"00591044401"}]
[null,null,null,null,"00591048701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E958,1),\"\"))","v":1},{"$f":"IF(F958=1,COUNTIF($F$3:F958,1),\"\")","v":956},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G958),$G$3:$G$3716,0)),\"\")","v":"00591048701"}]
[null,null,null,null,"00591058201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E959,1),\"\"))","v":1},{"$f":"IF(F959=1,COUNTIF($F$3:F959,1),\"\")","v":957},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G959),$G$3:$G$3716,0)),\"\")","v":"00591058201"}]
[null,null,null,null,"00591065801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E960,1),\"\"))","v":1},{"$f":"IF(F960=1,COUNTIF($F$3:F960,1),\"\")","v":958},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G960),$G$3:$G$3716,0)),\"\")","v":"00591065801"}]
[null,null,null,null,"00591078001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E961,1),\"\"))","v":1},{"$f":"IF(F961=1,COUNTIF($F$3:F961,1),\"\")","v":959},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G961),$G$3:$G$3716,0)),\"\")","v":"00591078001"}]
[null,null,null,null,"00591078005",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E962,1),\"\"))","v":1},{"$f":"IF(F962=1,COUNTIF($F$3:F962,1),\"\")","v":960},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G962),$G$3:$G$3716,0)),\"\")","v":"00591078005"}]
[null,null,null,null,"00591079601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E963,1),\"\"))","v":1},{"$f":"IF(F963=1,COUNTIF($F$3:F963,1),\"\")","v":961},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G963),$G$3:$G$3716,0)),\"\")","v":"00591079601"}]
[null,null,null,null,"00591081046",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E964,1),\"\"))","v":1},{"$f":"IF(F964=1,COUNTIF($F$3:F964,1),\"\")","v":962},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G964),$G$3:$G$3716,0)),\"\")","v":"00591081046"}]
[null,null,null,null,"00591081055",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E965,1),\"\"))","v":1},{"$f":"IF(F965=1,COUNTIF($F$3:F965,1),\"\")","v":963},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G965),$G$3:$G$3716,0)),\"\")","v":"00591081055"}]
[null,null,null,null,"00591081083",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E966,1),\"\"))","v":1},{"$f":"IF(F966=1,COUNTIF($F$3:F966,1),\"\")","v":964},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G966),$G$3:$G$3716,0)),\"\")","v":"00591081083"}]
[null,null,null,null,"00591084401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E967,1),\"\"))","v":1},{"$f":"IF(F967=1,COUNTIF($F$3:F967,1),\"\")","v":965},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G967),$G$3:$G$3716,0)),\"\")","v":"00591084401"}]
[null,null,null,null,"00591084501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E968,1),\"\"))","v":1},{"$f":"IF(F968=1,COUNTIF($F$3:F968,1),\"\")","v":966},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G968),$G$3:$G$3716,0)),\"\")","v":"00591084501"}]
[null,null,null,null,"00591216139",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E969,1),\"\"))","v":1},{"$f":"IF(F969=1,COUNTIF($F$3:F969,1),\"\")","v":967},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G969),$G$3:$G$3716,0)),\"\")","v":"00591216139"}]
[null,null,null,null,"00591246401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E970,1),\"\"))","v":1},{"$f":"IF(F970=1,COUNTIF($F$3:F970,1),\"\")","v":968},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G970),$G$3:$G$3716,0)),\"\")","v":"00591246401"}]
[null,null,null,null,"00591256201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E971,1),\"\"))","v":1},{"$f":"IF(F971=1,COUNTIF($F$3:F971,1),\"\")","v":969},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G971),$G$3:$G$3716,0)),\"\")","v":"00591256201"}]
[null,null,null,null,"00591257920",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E972,1),\"\"))","v":1},{"$f":"IF(F972=1,COUNTIF($F$3:F972,1),\"\")","v":970},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G972),$G$3:$G$3716,0)),\"\")","v":"00591257920"}]
[null,null,null,null,"00591299239",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E973,1),\"\"))","v":1},{"$f":"IF(F973=1,COUNTIF($F$3:F973,1),\"\")","v":971},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G973),$G$3:$G$3716,0)),\"\")","v":"00591299239"}]
[null,null,null,null,"00591301230",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E974,1),\"\"))","v":1},{"$f":"IF(F974=1,COUNTIF($F$3:F974,1),\"\")","v":972},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G974),$G$3:$G$3716,0)),\"\")","v":"00591301230"}]
[null,null,null,null,"00591319872",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E975,1),\"\"))","v":1},{"$f":"IF(F975=1,COUNTIF($F$3:F975,1),\"\")","v":973},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G975),$G$3:$G$3716,0)),\"\")","v":"00591319872"}]
[null,null,null,null,"00591320519",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E976,1),\"\"))","v":1},{"$f":"IF(F976=1,COUNTIF($F$3:F976,1),\"\")","v":974},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G976),$G$3:$G$3716,0)),\"\")","v":"00591320519"}]
[null,null,null,null,"00591321254",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E977,1),\"\"))","v":1},{"$f":"IF(F977=1,COUNTIF($F$3:F977,1),\"\")","v":975},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G977),$G$3:$G$3716,0)),\"\")","v":"00591321254"}]
[null,null,null,null,"00591321272",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E978,1),\"\"))","v":1},{"$f":"IF(F978=1,COUNTIF($F$3:F978,1),\"\")","v":976},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G978),$G$3:$G$3716,0)),\"\")","v":"00591321272"}]
[null,null,null,null,"00591321372",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E979,1),\"\"))","v":1},{"$f":"IF(F979=1,COUNTIF($F$3:F979,1),\"\")","v":977},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G979),$G$3:$G$3716,0)),\"\")","v":"00591321372"}]
[null,null,null,null,"00591321472",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E980,1),\"\"))","v":1},{"$f":"IF(F980=1,COUNTIF($F$3:F980,1),\"\")","v":978},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G980),$G$3:$G$3716,0)),\"\")","v":"00591321472"}]
[null,null,null,null,"00591327230",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E981,1),\"\"))","v":1},{"$f":"IF(F981=1,COUNTIF($F$3:F981,1),\"\")","v":979},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G981),$G$3:$G$3716,0)),\"\")","v":"00591327230"}]
[null,null,null,null,"00591352511",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E982,1),\"\"))","v":1},{"$f":"IF(F982=1,COUNTIF($F$3:F982,1),\"\")","v":980},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G982),$G$3:$G$3716,0)),\"\")","v":"00591352511"}]
[null,null,null,null,"00591354060",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E983,1),\"\"))","v":1},{"$f":"IF(F983=1,COUNTIF($F$3:F983,1),\"\")","v":981},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G983),$G$3:$G$3716,0)),\"\")","v":"00591354060"}]
[null,null,null,null,"00591367001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E984,1),\"\"))","v":1},{"$f":"IF(F984=1,COUNTIF($F$3:F984,1),\"\")","v":982},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G984),$G$3:$G$3716,0)),\"\")","v":"00591367001"}]
[null,null,null,null,"00591377719",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E985,1),\"\"))","v":1},{"$f":"IF(F985=1,COUNTIF($F$3:F985,1),\"\")","v":983},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G985),$G$3:$G$3716,0)),\"\")","v":"00591377719"}]
[null,null,null,null,"00591387044",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E986,1),\"\"))","v":1},{"$f":"IF(F986=1,COUNTIF($F$3:F986,1),\"\")","v":984},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G986),$G$3:$G$3716,0)),\"\")","v":"00591387044"}]
[null,null,null,null,"00591387045",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E987,1),\"\"))","v":1},{"$f":"IF(F987=1,COUNTIF($F$3:F987,1),\"\")","v":985},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G987),$G$3:$G$3716,0)),\"\")","v":"00591387045"}]
[null,null,null,null,"00591401201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E988,1),\"\"))","v":1},{"$f":"IF(F988=1,COUNTIF($F$3:F988,1),\"\")","v":986},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G988),$G$3:$G$3716,0)),\"\")","v":"00591401201"}]
[null,null,null,null,"00591533501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E989,1),\"\"))","v":1},{"$f":"IF(F989=1,COUNTIF($F$3:F989,1),\"\")","v":987},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G989),$G$3:$G$3716,0)),\"\")","v":"00591533501"}]
[null,null,null,null,"00591534701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E990,1),\"\"))","v":1},{"$f":"IF(F990=1,COUNTIF($F$3:F990,1),\"\")","v":988},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G990),$G$3:$G$3716,0)),\"\")","v":"00591534701"}]
[null,null,null,null,"00591543801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E991,1),\"\"))","v":1},{"$f":"IF(F991=1,COUNTIF($F$3:F991,1),\"\")","v":989},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G991),$G$3:$G$3716,0)),\"\")","v":"00591543801"}]
[null,null,null,null,"00591554405",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E992,1),\"\"))","v":1},{"$f":"IF(F992=1,COUNTIF($F$3:F992,1),\"\")","v":990},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G992),$G$3:$G$3716,0)),\"\")","v":"00591554405"}]
[null,null,null,null,"00591555701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E993,1),\"\"))","v":1},{"$f":"IF(F993=1,COUNTIF($F$3:F993,1),\"\")","v":991},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G993),$G$3:$G$3716,0)),\"\")","v":"00591555701"}]
[null,null,null,null,"00591564201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E994,1),\"\"))","v":1},{"$f":"IF(F994=1,COUNTIF($F$3:F994,1),\"\")","v":992},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G994),$G$3:$G$3716,0)),\"\")","v":"00591564201"}]
[null,null,null,null,"00591564301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E995,1),\"\"))","v":1},{"$f":"IF(F995=1,COUNTIF($F$3:F995,1),\"\")","v":993},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G995),$G$3:$G$3716,0)),\"\")","v":"00591564301"}]
[null,null,null,null,"00591570801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E996,1),\"\"))","v":1},{"$f":"IF(F996=1,COUNTIF($F$3:F996,1),\"\")","v":994},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G996),$G$3:$G$3716,0)),\"\")","v":"00591570801"}]
[null,null,null,null,"00591571401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E997,1),\"\"))","v":1},{"$f":"IF(F997=1,COUNTIF($F$3:F997,1),\"\")","v":995},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G997),$G$3:$G$3716,0)),\"\")","v":"00591571401"}]
[null,null,null,null,"00591578601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E998,1),\"\"))","v":1},{"$f":"IF(F998=1,COUNTIF($F$3:F998,1),\"\")","v":996},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G998),$G$3:$G$3716,0)),\"\")","v":"00591578601"}]
[null,null,null,null,"00597000160",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E999,1),\"\"))","v":1},{"$f":"IF(F999=1,COUNTIF($F$3:F999,1),\"\")","v":997},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G999),$G$3:$G$3716,0)),\"\")","v":"00597000160"}]
[null,null,null,null,"00597000302",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1000,1),\"\"))","v":1},{"$f":"IF(F1000=1,COUNTIF($F$3:F1000,1),\"\")","v":998},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1000),$G$3:$G$3716,0)),\"\")","v":"00597000302"}]
[null,null,null,null,"00597004660",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1001,1),\"\"))","v":1},{"$f":"IF(F1001=1,COUNTIF($F$3:F1001,1),\"\")","v":999},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1001),$G$3:$G$3716,0)),\"\")","v":"00597004660"}]
[null,null,null,null,"00597004724",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1002,1),\"\"))","v":1},{"$f":"IF(F1002=1,COUNTIF($F$3:F1002,1),\"\")","v":1000},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1002),$G$3:$G$3716,0)),\"\")","v":"00597004724"}]
[null,null,null,null,"00597007575",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1003,1),\"\"))","v":1},{"$f":"IF(F1003=1,COUNTIF($F$3:F1003,1),\"\")","v":1001},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1003),$G$3:$G$3716,0)),\"\")","v":"00597007575"}]
[null,null,null,null,"00597008717",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1004,1),\"\"))","v":1},{"$f":"IF(F1004=1,COUNTIF($F$3:F1004,1),\"\")","v":1002},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1004),$G$3:$G$3716,0)),\"\")","v":"00597008717"}]
[null,null,null,null,"00597014030",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1005,1),\"\"))","v":1},{"$f":"IF(F1005=1,COUNTIF($F$3:F1005,1),\"\")","v":1003},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1005),$G$3:$G$3716,0)),\"\")","v":"00597014030"}]
[null,null,null,null,"00597014061",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1006,1),\"\"))","v":1},{"$f":"IF(F1006=1,COUNTIF($F$3:F1006,1),\"\")","v":1004},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1006),$G$3:$G$3716,0)),\"\")","v":"00597014061"}]
[null,null,null,null,"00597035556",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1007,1),\"\"))","v":1},{"$f":"IF(F1007=1,COUNTIF($F$3:F1007,1),\"\")","v":1005},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1007),$G$3:$G$3716,0)),\"\")","v":"00597035556"}]
[null,null,null,null,"00597036082",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1008,1),\"\"))","v":1},{"$f":"IF(F1008=1,COUNTIF($F$3:F1008,1),\"\")","v":1006},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1008),$G$3:$G$3716,0)),\"\")","v":"00597036082"}]
[null,null,null,null,"00603016932",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1009,1),\"\"))","v":1},{"$f":"IF(F1009=1,COUNTIF($F$3:F1009,1),\"\")","v":1007},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1009),$G$3:$G$3716,0)),\"\")","v":"00603016932"}]
[null,null,null,null,"00603017932",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1010,1),\"\"))","v":1},{"$f":"IF(F1010=1,COUNTIF($F$3:F1010,1),\"\")","v":1008},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1010),$G$3:$G$3716,0)),\"\")","v":"00603017932"}]
[null,null,null,null,"00603020922",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1011,1),\"\"))","v":1},{"$f":"IF(F1011=1,COUNTIF($F$3:F1011,1),\"\")","v":1009},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1011),$G$3:$G$3716,0)),\"\")","v":"00603020922"}]
[null,null,null,null,"00603064888",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1012,1),\"\"))","v":1},{"$f":"IF(F1012=1,COUNTIF($F$3:F1012,1),\"\")","v":1010},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1012),$G$3:$G$3716,0)),\"\")","v":"00603064888"}]
[null,null,null,null,"00603064988",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1013,1),\"\"))","v":1},{"$f":"IF(F1013=1,COUNTIF($F$3:F1013,1),\"\")","v":1011},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1013),$G$3:$G$3716,0)),\"\")","v":"00603064988"}]
[null,null,null,null,"00603083958",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1014,1),\"\"))","v":1},{"$f":"IF(F1014=1,COUNTIF($F$3:F1014,1),\"\")","v":1012},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1014),$G$3:$G$3716,0)),\"\")","v":"00603083958"}]
[null,null,null,null,"00603148149",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1015,1),\"\"))","v":1},{"$f":"IF(F1015=1,COUNTIF($F$3:F1015,1),\"\")","v":1013},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1015),$G$3:$G$3716,0)),\"\")","v":"00603148149"}]
[null,null,null,null,"00603150858",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1016,1),\"\"))","v":1},{"$f":"IF(F1016=1,COUNTIF($F$3:F1016,1),\"\")","v":1014},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1016),$G$3:$G$3716,0)),\"\")","v":"00603150858"}]
[null,null,null,null,"00603153258",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1017,1),\"\"))","v":1},{"$f":"IF(F1017=1,COUNTIF($F$3:F1017,1),\"\")","v":1015},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1017),$G$3:$G$3716,0)),\"\")","v":"00603153258"}]
[null,null,null,null,"00603153458",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1018,1),\"\"))","v":1},{"$f":"IF(F1018=1,COUNTIF($F$3:F1018,1),\"\")","v":1016},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1018),$G$3:$G$3716,0)),\"\")","v":"00603153458"}]
[null,null,null,null,"00603154215",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1019,1),\"\"))","v":1},{"$f":"IF(F1019=1,COUNTIF($F$3:F1019,1),\"\")","v":1017},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1019),$G$3:$G$3716,0)),\"\")","v":"00603154215"}]
[null,null,null,null,"00603154258",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1020,1),\"\"))","v":1},{"$f":"IF(F1020=1,COUNTIF($F$3:F1020,1),\"\")","v":1018},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1020),$G$3:$G$3716,0)),\"\")","v":"00603154258"}]
[null,null,null,null,"00603188010",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1021,1),\"\"))","v":1},{"$f":"IF(F1021=1,COUNTIF($F$3:F1021,1),\"\")","v":1019},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1021),$G$3:$G$3716,0)),\"\")","v":"00603188010"}]
[null,null,null,null,"00603188016",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1022,1),\"\"))","v":1},{"$f":"IF(F1022=1,COUNTIF($F$3:F1022,1),\"\")","v":1020},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1022),$G$3:$G$3716,0)),\"\")","v":"00603188016"}]
[null,null,null,null,"00603221221",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1023,1),\"\"))","v":1},{"$f":"IF(F1023=1,COUNTIF($F$3:F1023,1),\"\")","v":1021},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1023),$G$3:$G$3716,0)),\"\")","v":"00603221221"}]
[null,null,null,null,"00603243421",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1024,1),\"\"))","v":1},{"$f":"IF(F1024=1,COUNTIF($F$3:F1024,1),\"\")","v":1022},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1024),$G$3:$G$3716,0)),\"\")","v":"00603243421"}]
[null,null,null,null,"00603243821",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1025,1),\"\"))","v":1},{"$f":"IF(F1025=1,COUNTIF($F$3:F1025,1),\"\")","v":1023},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1025),$G$3:$G$3716,0)),\"\")","v":"00603243821"}]
[null,null,null,null,"00603254421",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1026,1),\"\"))","v":1},{"$f":"IF(F1026=1,COUNTIF($F$3:F1026,1),\"\")","v":1024},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1026),$G$3:$G$3716,0)),\"\")","v":"00603254421"}]
[null,null,null,null,"00603258221",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1027,1),\"\"))","v":1},{"$f":"IF(F1027=1,COUNTIF($F$3:F1027,1),\"\")","v":1025},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1027),$G$3:$G$3716,0)),\"\")","v":"00603258221"}]
[null,null,null,null,"00603358121",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1028,1),\"\"))","v":1},{"$f":"IF(F1028=1,COUNTIF($F$3:F1028,1),\"\")","v":1026},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1028),$G$3:$G$3716,0)),\"\")","v":"00603358121"}]
[null,null,null,null,"00603358221",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1029,1),\"\"))","v":1},{"$f":"IF(F1029=1,COUNTIF($F$3:F1029,1),\"\")","v":1027},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1029),$G$3:$G$3716,0)),\"\")","v":"00603358221"}]
[null,null,null,null,"00603358321",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1030,1),\"\"))","v":1},{"$f":"IF(F1030=1,COUNTIF($F$3:F1030,1),\"\")","v":1028},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1030),$G$3:$G$3716,0)),\"\")","v":"00603358321"}]
[null,null,null,null,"00603385621",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1031,1),\"\"))","v":1},{"$f":"IF(F1031=1,COUNTIF($F$3:F1031,1),\"\")","v":1029},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1031),$G$3:$G$3716,0)),\"\")","v":"00603385621"}]
[null,null,null,null,"00603385632",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1032,1),\"\"))","v":1},{"$f":"IF(F1032=1,COUNTIF($F$3:F1032,1),\"\")","v":1030},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1032),$G$3:$G$3716,0)),\"\")","v":"00603385632"}]
[null,null,null,null,"00603390021",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1033,1),\"\"))","v":1},{"$f":"IF(F1033=1,COUNTIF($F$3:F1033,1),\"\")","v":1031},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1033),$G$3:$G$3716,0)),\"\")","v":"00603390021"}]
[null,null,null,null,"00603411021",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1034,1),\"\"))","v":1},{"$f":"IF(F1034=1,COUNTIF($F$3:F1034,1),\"\")","v":1032},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1034),$G$3:$G$3716,0)),\"\")","v":"00603411021"}]
[null,null,null,null,"00603411121",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1035,1),\"\"))","v":1},{"$f":"IF(F1035=1,COUNTIF($F$3:F1035,1),\"\")","v":1033},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1035),$G$3:$G$3716,0)),\"\")","v":"00603411121"}]
[null,null,null,null,"00603422402",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1036,1),\"\"))","v":1},{"$f":"IF(F1036=1,COUNTIF($F$3:F1036,1),\"\")","v":1034},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1036),$G$3:$G$3716,0)),\"\")","v":"00603422402"}]
[null,null,null,null,"00603422532",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1037,1),\"\"))","v":1},{"$f":"IF(F1037=1,COUNTIF($F$3:F1037,1),\"\")","v":1035},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1037),$G$3:$G$3716,0)),\"\")","v":"00603422532"}]
[null,null,null,null,"00603448621",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1038,1),\"\"))","v":1},{"$f":"IF(F1038=1,COUNTIF($F$3:F1038,1),\"\")","v":1036},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1038),$G$3:$G$3716,0)),\"\")","v":"00603448621"}]
[null,null,null,null,"00603465302",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1039,1),\"\"))","v":1},{"$f":"IF(F1039=1,COUNTIF($F$3:F1039,1),\"\")","v":1037},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1039),$G$3:$G$3716,0)),\"\")","v":"00603465302"}]
[null,null,null,null,"00603465316",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1040,1),\"\"))","v":1},{"$f":"IF(F1040=1,COUNTIF($F$3:F1040,1),\"\")","v":1038},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1040),$G$3:$G$3716,0)),\"\")","v":"00603465316"}]
[null,null,null,null,"00603516521",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1041,1),\"\"))","v":1},{"$f":"IF(F1041=1,COUNTIF($F$3:F1041,1),\"\")","v":1039},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1041),$G$3:$G$3716,0)),\"\")","v":"00603516521"}]
[null,null,null,null,"00603516721",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1042,1),\"\"))","v":1},{"$f":"IF(F1042=1,COUNTIF($F$3:F1042,1),\"\")","v":1040},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1042),$G$3:$G$3716,0)),\"\")","v":"00603516721"}]
[null,null,null,null,"00603516821",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1043,1),\"\"))","v":1},{"$f":"IF(F1043=1,COUNTIF($F$3:F1043,1),\"\")","v":1041},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1043),$G$3:$G$3716,0)),\"\")","v":"00603516821"}]
[null,null,null,null,"00603578121",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1044,1),\"\"))","v":1},{"$f":"IF(F1044=1,COUNTIF($F$3:F1044,1),\"\")","v":1042},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1044),$G$3:$G$3716,0)),\"\")","v":"00603578121"}]
[null,null,null,null,"00603752101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1045,1),\"\"))","v":1},{"$f":"IF(F1045=1,COUNTIF($F$3:F1045,1),\"\")","v":1043},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1045),$G$3:$G$3716,0)),\"\")","v":"00603752101"}]
[null,null,null,null,"00603752117",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1046,1),\"\"))","v":1},{"$f":"IF(F1046=1,COUNTIF($F$3:F1046,1),\"\")","v":1044},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1046),$G$3:$G$3716,0)),\"\")","v":"00603752117"}]
[null,null,null,null,"00603781878",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1047,1),\"\"))","v":1},{"$f":"IF(F1047=1,COUNTIF($F$3:F1047,1),\"\")","v":1045},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1047),$G$3:$G$3716,0)),\"\")","v":"00603781878"}]
[null,null,null,null,"00603786190",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1048,1),\"\"))","v":1},{"$f":"IF(F1048=1,COUNTIF($F$3:F1048,1),\"\")","v":1046},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1048),$G$3:$G$3716,0)),\"\")","v":"00603786190"}]
[null,null,null,null,"00603786274",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1049,1),\"\"))","v":1},{"$f":"IF(F1049=1,COUNTIF($F$3:F1049,1),\"\")","v":1047},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1049),$G$3:$G$3716,0)),\"\")","v":"00603786274"}]
[null,null,null,null,"00703291401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1050,1),\"\"))","v":1},{"$f":"IF(F1050=1,COUNTIF($F$3:F1050,1),\"\")","v":1048},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1050),$G$3:$G$3716,0)),\"\")","v":"00703291401"}]
[null,null,null,null,"00713010106",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1051,1),\"\"))","v":1},{"$f":"IF(F1051=1,COUNTIF($F$3:F1051,1),\"\")","v":1049},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1051),$G$3:$G$3716,0)),\"\")","v":"00713010106"}]
[null,null,null,null,"00713010151",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1052,1),\"\"))","v":1},{"$f":"IF(F1052=1,COUNTIF($F$3:F1052,1),\"\")","v":1050},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1052),$G$3:$G$3716,0)),\"\")","v":"00713010151"}]
[null,null,null,null,"00713010225",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1053,1),\"\"))","v":1},{"$f":"IF(F1053=1,COUNTIF($F$3:F1053,1),\"\")","v":1051},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1053),$G$3:$G$3716,0)),\"\")","v":"00713010225"}]
[null,null,null,null,"00713010901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1054,1),\"\"))","v":1},{"$f":"IF(F1054=1,COUNTIF($F$3:F1054,1),\"\")","v":1052},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1054),$G$3:$G$3716,0)),\"\")","v":"00713010901"}]
[null,null,null,null,"00713010906",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1055,1),\"\"))","v":1},{"$f":"IF(F1055=1,COUNTIF($F$3:F1055,1),\"\")","v":1053},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1055),$G$3:$G$3716,0)),\"\")","v":"00713010906"}]
[null,null,null,null,"00713010908",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1056,1),\"\"))","v":1},{"$f":"IF(F1056=1,COUNTIF($F$3:F1056,1),\"\")","v":1054},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1056),$G$3:$G$3716,0)),\"\")","v":"00713010908"}]
[null,null,null,null,"00713013506",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1057,1),\"\"))","v":1},{"$f":"IF(F1057=1,COUNTIF($F$3:F1057,1),\"\")","v":1055},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1057),$G$3:$G$3716,0)),\"\")","v":"00713013506"}]
[null,null,null,null,"00713013512",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1058,1),\"\"))","v":1},{"$f":"IF(F1058=1,COUNTIF($F$3:F1058,1),\"\")","v":1056},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1058),$G$3:$G$3716,0)),\"\")","v":"00713013512"}]
[null,null,null,null,"00713016406",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1059,1),\"\"))","v":1},{"$f":"IF(F1059=1,COUNTIF($F$3:F1059,1),\"\")","v":1057},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1059),$G$3:$G$3716,0)),\"\")","v":"00713016406"}]
[null,null,null,null,"00713016412",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1060,1),\"\"))","v":1},{"$f":"IF(F1060=1,COUNTIF($F$3:F1060,1),\"\")","v":1058},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1060),$G$3:$G$3716,0)),\"\")","v":"00713016412"}]
[null,null,null,null,"00713016512",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1061,1),\"\"))","v":1},{"$f":"IF(F1061=1,COUNTIF($F$3:F1061,1),\"\")","v":1059},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1061),$G$3:$G$3716,0)),\"\")","v":"00713016512"}]
[null,null,null,null,"00713019757",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1062,1),\"\"))","v":1},{"$f":"IF(F1062=1,COUNTIF($F$3:F1062,1),\"\")","v":1060},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1062),$G$3:$G$3716,0)),\"\")","v":"00713019757"}]
[null,null,null,null,"00713022415",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1063,1),\"\"))","v":1},{"$f":"IF(F1063=1,COUNTIF($F$3:F1063,1),\"\")","v":1061},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1063),$G$3:$G$3716,0)),\"\")","v":"00713022415"}]
[null,null,null,null,"00713022460",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1064,1),\"\"))","v":1},{"$f":"IF(F1064=1,COUNTIF($F$3:F1064,1),\"\")","v":1062},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1064),$G$3:$G$3716,0)),\"\")","v":"00713022460"}]
[null,null,null,null,"00713025237",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1065,1),\"\"))","v":1},{"$f":"IF(F1065=1,COUNTIF($F$3:F1065,1),\"\")","v":1063},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1065),$G$3:$G$3716,0)),\"\")","v":"00713025237"}]
[null,null,null,null,"00713026831",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1066,1),\"\"))","v":1},{"$f":"IF(F1066=1,COUNTIF($F$3:F1066,1),\"\")","v":1064},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1066),$G$3:$G$3716,0)),\"\")","v":"00713026831"}]
[null,null,null,null,"00713032415",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1067,1),\"\"))","v":1},{"$f":"IF(F1067=1,COUNTIF($F$3:F1067,1),\"\")","v":1065},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1067),$G$3:$G$3716,0)),\"\")","v":"00713032415"}]
[null,null,null,null,"00713032460",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1068,1),\"\"))","v":1},{"$f":"IF(F1068=1,COUNTIF($F$3:F1068,1),\"\")","v":1066},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1068),$G$3:$G$3716,0)),\"\")","v":"00713032460"}]
[null,null,null,null,"00713050306",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1069,1),\"\"))","v":1},{"$f":"IF(F1069=1,COUNTIF($F$3:F1069,1),\"\")","v":1067},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1069),$G$3:$G$3716,0)),\"\")","v":"00713050306"}]
[null,null,null,null,"00713063737",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1070,1),\"\"))","v":1},{"$f":"IF(F1070=1,COUNTIF($F$3:F1070,1),\"\")","v":1068},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1070),$G$3:$G$3716,0)),\"\")","v":"00713063737"}]
[null,null,null,null,"00713068315",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1071,1),\"\"))","v":1},{"$f":"IF(F1071=1,COUNTIF($F$3:F1071,1),\"\")","v":1069},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1071),$G$3:$G$3716,0)),\"\")","v":"00713068315"}]
[null,null,null,null,"00713070915",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1072,1),\"\"))","v":1},{"$f":"IF(F1072=1,COUNTIF($F$3:F1072,1),\"\")","v":1070},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1072),$G$3:$G$3716,0)),\"\")","v":"00713070915"}]
[null,null,null,null,"00713525601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1073,1),\"\"))","v":1},{"$f":"IF(F1073=1,COUNTIF($F$3:F1073,1),\"\")","v":1071},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1073),$G$3:$G$3716,0)),\"\")","v":"00713525601"}]
[null,null,null,null,"00731040106",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1074,1),\"\"))","v":1},{"$f":"IF(F1074=1,COUNTIF($F$3:F1074,1),\"\")","v":1072},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1074),$G$3:$G$3716,0)),\"\")","v":"00731040106"}]
[null,null,null,null,"00781106101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1075,1),\"\"))","v":1},{"$f":"IF(F1075=1,COUNTIF($F$3:F1075,1),\"\")","v":1073},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1075),$G$3:$G$3716,0)),\"\")","v":"00781106101"}]
[null,null,null,null,"00781106401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1076,1),\"\"))","v":1},{"$f":"IF(F1076=1,COUNTIF($F$3:F1076,1),\"\")","v":1074},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1076),$G$3:$G$3716,0)),\"\")","v":"00781106401"}]
[null,null,null,null,"00781107101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1077,1),\"\"))","v":1},{"$f":"IF(F1077=1,COUNTIF($F$3:F1077,1),\"\")","v":1075},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1077),$G$3:$G$3716,0)),\"\")","v":"00781107101"}]
[null,null,null,null,"00781107801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1078,1),\"\"))","v":1},{"$f":"IF(F1078=1,COUNTIF($F$3:F1078,1),\"\")","v":1076},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1078),$G$3:$G$3716,0)),\"\")","v":"00781107801"}]
[null,null,null,null,"00781107810",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1079,1),\"\"))","v":1},{"$f":"IF(F1079=1,COUNTIF($F$3:F1079,1),\"\")","v":1077},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1079),$G$3:$G$3716,0)),\"\")","v":"00781107810"}]
[null,null,null,null,"00781118201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1080,1),\"\"))","v":1},{"$f":"IF(F1080=1,COUNTIF($F$3:F1080,1),\"\")","v":1078},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1080),$G$3:$G$3716,0)),\"\")","v":"00781118201"}]
[null,null,null,null,"00781118301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1081,1),\"\"))","v":1},{"$f":"IF(F1081=1,COUNTIF($F$3:F1081,1),\"\")","v":1079},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1081),$G$3:$G$3716,0)),\"\")","v":"00781118301"}]
[null,null,null,null,"00781120501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1082,1),\"\"))","v":1},{"$f":"IF(F1082=1,COUNTIF($F$3:F1082,1),\"\")","v":1080},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1082),$G$3:$G$3716,0)),\"\")","v":"00781120501"}]
[null,null,null,null,"00781139113",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1083,1),\"\"))","v":1},{"$f":"IF(F1083=1,COUNTIF($F$3:F1083,1),\"\")","v":1081},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1083),$G$3:$G$3716,0)),\"\")","v":"00781139113"}]
[null,null,null,null,"00781139313",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1084,1),\"\"))","v":1},{"$f":"IF(F1084=1,COUNTIF($F$3:F1084,1),\"\")","v":1082},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1084),$G$3:$G$3716,0)),\"\")","v":"00781139313"}]
[null,null,null,null,"00781145210",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1085,1),\"\"))","v":1},{"$f":"IF(F1085=1,COUNTIF($F$3:F1085,1),\"\")","v":1083},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1085),$G$3:$G$3716,0)),\"\")","v":"00781145210"}]
[null,null,null,null,"00781145301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1086,1),\"\"))","v":1},{"$f":"IF(F1086=1,COUNTIF($F$3:F1086,1),\"\")","v":1084},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1086),$G$3:$G$3716,0)),\"\")","v":"00781145301"}]
[null,null,null,null,"00781148601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1087,1),\"\"))","v":1},{"$f":"IF(F1087=1,COUNTIF($F$3:F1087,1),\"\")","v":1085},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1087),$G$3:$G$3716,0)),\"\")","v":"00781148601"}]
[null,null,null,null,"00781149731",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1088,1),\"\"))","v":1},{"$f":"IF(F1088=1,COUNTIF($F$3:F1088,1),\"\")","v":1086},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1088),$G$3:$G$3716,0)),\"\")","v":"00781149731"}]
[null,null,null,null,"00781150601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1089,1),\"\"))","v":1},{"$f":"IF(F1089=1,COUNTIF($F$3:F1089,1),\"\")","v":1087},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1089),$G$3:$G$3716,0)),\"\")","v":"00781150601"}]
[null,null,null,null,"00781155601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1090,1),\"\"))","v":1},{"$f":"IF(F1090=1,COUNTIF($F$3:F1090,1),\"\")","v":1088},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1090),$G$3:$G$3716,0)),\"\")","v":"00781155601"}]
[null,null,null,null,"00781155613",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1091,1),\"\"))","v":1},{"$f":"IF(F1091=1,COUNTIF($F$3:F1091,1),\"\")","v":1089},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1091),$G$3:$G$3716,0)),\"\")","v":"00781155613"}]
[null,null,null,null,"00781165501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1092,1),\"\"))","v":1},{"$f":"IF(F1092=1,COUNTIF($F$3:F1092,1),\"\")","v":1090},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1092),$G$3:$G$3716,0)),\"\")","v":"00781165501"}]
[null,null,null,null,"00781187431",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1093,1),\"\"))","v":1},{"$f":"IF(F1093=1,COUNTIF($F$3:F1093,1),\"\")","v":1091},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1093),$G$3:$G$3716,0)),\"\")","v":"00781187431"}]
[null,null,null,null,"00781194339",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1094,1),\"\"))","v":1},{"$f":"IF(F1094=1,COUNTIF($F$3:F1094,1),\"\")","v":1092},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1094),$G$3:$G$3716,0)),\"\")","v":"00781194339"}]
[null,null,null,null,"00781196160",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1095,1),\"\"))","v":1},{"$f":"IF(F1095=1,COUNTIF($F$3:F1095,1),\"\")","v":1093},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1095),$G$3:$G$3716,0)),\"\")","v":"00781196160"}]
[null,null,null,null,"00781196260",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1096,1),\"\"))","v":1},{"$f":"IF(F1096=1,COUNTIF($F$3:F1096,1),\"\")","v":1094},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1096),$G$3:$G$3716,0)),\"\")","v":"00781196260"}]
[null,null,null,null,"00781196601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1097,1),\"\"))","v":1},{"$f":"IF(F1097=1,COUNTIF($F$3:F1097,1),\"\")","v":1095},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1097),$G$3:$G$3716,0)),\"\")","v":"00781196601"}]
[null,null,null,null,"00781197301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1098,1),\"\"))","v":1},{"$f":"IF(F1098=1,COUNTIF($F$3:F1098,1),\"\")","v":1096},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1098),$G$3:$G$3716,0)),\"\")","v":"00781197301"}]
[null,null,null,null,"00781202001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1099,1),\"\"))","v":1},{"$f":"IF(F1099=1,COUNTIF($F$3:F1099,1),\"\")","v":1097},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1099),$G$3:$G$3716,0)),\"\")","v":"00781202001"}]
[null,null,null,null,"00781204801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1100,1),\"\"))","v":1},{"$f":"IF(F1100=1,COUNTIF($F$3:F1100,1),\"\")","v":1098},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1100),$G$3:$G$3716,0)),\"\")","v":"00781204801"}]
[null,null,null,null,"00781207601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1101,1),\"\"))","v":1},{"$f":"IF(F1101=1,COUNTIF($F$3:F1101,1),\"\")","v":1099},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1101),$G$3:$G$3716,0)),\"\")","v":"00781207601"}]
[null,null,null,null,"00781214801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1102,1),\"\"))","v":1},{"$f":"IF(F1102=1,COUNTIF($F$3:F1102,1),\"\")","v":1100},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1102),$G$3:$G$3716,0)),\"\")","v":"00781214801"}]
[null,null,null,null,"00781261460",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1103,1),\"\"))","v":1},{"$f":"IF(F1103=1,COUNTIF($F$3:F1103,1),\"\")","v":1101},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1103),$G$3:$G$3716,0)),\"\")","v":"00781261460"}]
[null,null,null,null,"00781281001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1104,1),\"\"))","v":1},{"$f":"IF(F1104=1,COUNTIF($F$3:F1104,1),\"\")","v":1102},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1104),$G$3:$G$3716,0)),\"\")","v":"00781281001"}]
[null,null,null,null,"00781504301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1105,1),\"\"))","v":1},{"$f":"IF(F1105=1,COUNTIF($F$3:F1105,1),\"\")","v":1103},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1105),$G$3:$G$3716,0)),\"\")","v":"00781504301"}]
[null,null,null,null,"00781518692",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1106,1),\"\"))","v":1},{"$f":"IF(F1106=1,COUNTIF($F$3:F1106,1),\"\")","v":1104},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1106),$G$3:$G$3716,0)),\"\")","v":"00781518692"}]
[null,null,null,null,"00781518992",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1107,1),\"\"))","v":1},{"$f":"IF(F1107=1,COUNTIF($F$3:F1107,1),\"\")","v":1105},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1107),$G$3:$G$3716,0)),\"\")","v":"00781518992"}]
[null,null,null,null,"00781524892",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1108,1),\"\"))","v":1},{"$f":"IF(F1108=1,COUNTIF($F$3:F1108,1),\"\")","v":1106},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1108),$G$3:$G$3716,0)),\"\")","v":"00781524892"}]
[null,null,null,null,"00781524992",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1109,1),\"\"))","v":1},{"$f":"IF(F1109=1,COUNTIF($F$3:F1109,1),\"\")","v":1107},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1109),$G$3:$G$3716,0)),\"\")","v":"00781524992"}]
[null,null,null,null,"00781543820",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1110,1),\"\"))","v":1},{"$f":"IF(F1110=1,COUNTIF($F$3:F1110,1),\"\")","v":1108},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1110),$G$3:$G$3716,0)),\"\")","v":"00781543820"}]
[null,null,null,null,"00781543920",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1111,1),\"\"))","v":1},{"$f":"IF(F1111=1,COUNTIF($F$3:F1111,1),\"\")","v":1109},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1111),$G$3:$G$3716,0)),\"\")","v":"00781543920"}]
[null,null,null,null,"00781566731",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1112,1),\"\"))","v":1},{"$f":"IF(F1112=1,COUNTIF($F$3:F1112,1),\"\")","v":1110},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1112),$G$3:$G$3716,0)),\"\")","v":"00781566731"}]
[null,null,null,null,"00781569031",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1113,1),\"\"))","v":1},{"$f":"IF(F1113=1,COUNTIF($F$3:F1113,1),\"\")","v":1111},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1113),$G$3:$G$3716,0)),\"\")","v":"00781569031"}]
[null,null,null,null,"00781569092",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1114,1),\"\"))","v":1},{"$f":"IF(F1114=1,COUNTIF($F$3:F1114,1),\"\")","v":1112},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1114),$G$3:$G$3716,0)),\"\")","v":"00781569092"}]
[null,null,null,null,"00781574801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1115,1),\"\"))","v":1},{"$f":"IF(F1115=1,COUNTIF($F$3:F1115,1),\"\")","v":1113},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1115),$G$3:$G$3716,0)),\"\")","v":"00781574801"}]
[null,null,null,null,"00781577631",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1116,1),\"\"))","v":1},{"$f":"IF(F1116=1,COUNTIF($F$3:F1116,1),\"\")","v":1114},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1116),$G$3:$G$3716,0)),\"\")","v":"00781577631"}]
[null,null,null,null,"00781593631",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1117,1),\"\"))","v":1},{"$f":"IF(F1117=1,COUNTIF($F$3:F1117,1),\"\")","v":1115},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1117),$G$3:$G$3716,0)),\"\")","v":"00781593631"}]
[null,null,null,null,"00781602252",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1118,1),\"\"))","v":1},{"$f":"IF(F1118=1,COUNTIF($F$3:F1118,1),\"\")","v":1116},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1118),$G$3:$G$3716,0)),\"\")","v":"00781602252"}]
[null,null,null,null,"00781602352",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1119,1),\"\"))","v":1},{"$f":"IF(F1119=1,COUNTIF($F$3:F1119,1),\"\")","v":1117},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1119),$G$3:$G$3716,0)),\"\")","v":"00781602352"}]
[null,null,null,null,"00781603955",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1120,1),\"\"))","v":1},{"$f":"IF(F1120=1,COUNTIF($F$3:F1120,1),\"\")","v":1118},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1120),$G$3:$G$3716,0)),\"\")","v":"00781603955"}]
[null,null,null,null,"00781604146",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1121,1),\"\"))","v":1},{"$f":"IF(F1121=1,COUNTIF($F$3:F1121,1),\"\")","v":1119},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1121),$G$3:$G$3716,0)),\"\")","v":"00781604146"}]
[null,null,null,null,"00781613954",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1122,1),\"\"))","v":1},{"$f":"IF(F1122=1,COUNTIF($F$3:F1122,1),\"\")","v":1120},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1122),$G$3:$G$3716,0)),\"\")","v":"00781613954"}]
[null,null,null,null,"00781616846",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1123,1),\"\"))","v":1},{"$f":"IF(F1123=1,COUNTIF($F$3:F1123,1),\"\")","v":1121},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1123),$G$3:$G$3716,0)),\"\")","v":"00781616846"}]
[null,null,null,null,"00781616952",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1124,1),\"\"))","v":1},{"$f":"IF(F1124=1,COUNTIF($F$3:F1124,1),\"\")","v":1122},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1124),$G$3:$G$3716,0)),\"\")","v":"00781616952"}]
[null,null,null,null,"00781713358",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1125,1),\"\"))","v":1},{"$f":"IF(F1125=1,COUNTIF($F$3:F1125,1),\"\")","v":1123},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1125),$G$3:$G$3716,0)),\"\")","v":"00781713358"}]
[null,null,null,null,"00781724055",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1126,1),\"\"))","v":1},{"$f":"IF(F1126=1,COUNTIF($F$3:F1126,1),\"\")","v":1124},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1126),$G$3:$G$3716,0)),\"\")","v":"00781724055"}]
[null,null,null,null,"00810073088",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1127,1),\"\"))","v":1},{"$f":"IF(F1127=1,COUNTIF($F$3:F1127,1),\"\")","v":1125},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1127),$G$3:$G$3716,0)),\"\")","v":"00810073088"}]
[null,null,null,null,"00832003889",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1128,1),\"\"))","v":1},{"$f":"IF(F1128=1,COUNTIF($F$3:F1128,1),\"\")","v":1126},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1128),$G$3:$G$3716,0)),\"\")","v":"00832003889"}]
[null,null,null,null,"00832046515",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1129,1),\"\"))","v":1},{"$f":"IF(F1129=1,COUNTIF($F$3:F1129,1),\"\")","v":1127},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1129),$G$3:$G$3716,0)),\"\")","v":"00832046515"}]
[null,null,null,null,"00832051200",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1130,1),\"\"))","v":1},{"$f":"IF(F1130=1,COUNTIF($F$3:F1130,1),\"\")","v":1128},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1130),$G$3:$G$3716,0)),\"\")","v":"00832051200"}]
[null,null,null,null,"00832101500",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1131,1),\"\"))","v":1},{"$f":"IF(F1131=1,COUNTIF($F$3:F1131,1),\"\")","v":1129},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1131),$G$3:$G$3716,0)),\"\")","v":"00832101500"}]
[null,null,null,null,"00832111260",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1132,1),\"\"))","v":1},{"$f":"IF(F1132=1,COUNTIF($F$3:F1132,1),\"\")","v":1130},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1132),$G$3:$G$3716,0)),\"\")","v":"00832111260"}]
[null,null,null,null,"00832121101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1133,1),\"\"))","v":1},{"$f":"IF(F1133=1,COUNTIF($F$3:F1133,1),\"\")","v":1131},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1133),$G$3:$G$3716,0)),\"\")","v":"00832121101"}]
[null,null,null,null,"00832121289",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1134,1),\"\"))","v":1},{"$f":"IF(F1134=1,COUNTIF($F$3:F1134,1),\"\")","v":1132},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1134),$G$3:$G$3716,0)),\"\")","v":"00832121289"}]
[null,null,null,null,"00832121301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1135,1),\"\"))","v":1},{"$f":"IF(F1135=1,COUNTIF($F$3:F1135,1),\"\")","v":1133},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1135),$G$3:$G$3716,0)),\"\")","v":"00832121301"}]
[null,null,null,null,"00832121389",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1136,1),\"\"))","v":1},{"$f":"IF(F1136=1,COUNTIF($F$3:F1136,1),\"\")","v":1134},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1136),$G$3:$G$3716,0)),\"\")","v":"00832121389"}]
[null,null,null,null,"00832121989",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1137,1),\"\"))","v":1},{"$f":"IF(F1137=1,COUNTIF($F$3:F1137,1),\"\")","v":1135},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1137),$G$3:$G$3716,0)),\"\")","v":"00832121989"}]
[null,null,null,null,"00832712211",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1138,1),\"\"))","v":1},{"$f":"IF(F1138=1,COUNTIF($F$3:F1138,1),\"\")","v":1136},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1138),$G$3:$G$3716,0)),\"\")","v":"00832712211"}]
[null,null,null,null,"00832712401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1139,1),\"\"))","v":1},{"$f":"IF(F1139=1,COUNTIF($F$3:F1139,1),\"\")","v":1137},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1139),$G$3:$G$3716,0)),\"\")","v":"00832712401"}]
[null,null,null,null,"00832712489",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1140,1),\"\"))","v":1},{"$f":"IF(F1140=1,COUNTIF($F$3:F1140,1),\"\")","v":1138},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1140),$G$3:$G$3716,0)),\"\")","v":"00832712489"}]
[null,null,null,null,"00904000414",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1141,1),\"\"))","v":1},{"$f":"IF(F1141=1,COUNTIF($F$3:F1141,1),\"\")","v":1139},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1141),$G$3:$G$3716,0)),\"\")","v":"00904000414"}]
[null,null,null,null,"00904001261",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1142,1),\"\"))","v":1},{"$f":"IF(F1142=1,COUNTIF($F$3:F1142,1),\"\")","v":1140},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1142),$G$3:$G$3716,0)),\"\")","v":"00904001261"}]
[null,null,null,null,"00904020261",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1143,1),\"\"))","v":1},{"$f":"IF(F1143=1,COUNTIF($F$3:F1143,1),\"\")","v":1141},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1143),$G$3:$G$3716,0)),\"\")","v":"00904020261"}]
[null,null,null,null,"00904027460",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1144,1),\"\"))","v":1},{"$f":"IF(F1144=1,COUNTIF($F$3:F1144,1),\"\")","v":1142},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1144),$G$3:$G$3716,0)),\"\")","v":"00904027460"}]
[null,null,null,null,"00904041161",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1145,1),\"\"))","v":1},{"$f":"IF(F1145=1,COUNTIF($F$3:F1145,1),\"\")","v":1143},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1145),$G$3:$G$3716,0)),\"\")","v":"00904041161"}]
[null,null,null,null,"00904052260",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1146,1),\"\"))","v":1},{"$f":"IF(F1146=1,COUNTIF($F$3:F1146,1),\"\")","v":1144},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1146),$G$3:$G$3716,0)),\"\")","v":"00904052260"}]
[null,null,null,null,"00904052360",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1147,1),\"\"))","v":1},{"$f":"IF(F1147=1,COUNTIF($F$3:F1147,1),\"\")","v":1145},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1147),$G$3:$G$3716,0)),\"\")","v":"00904052360"}]
[null,null,null,null,"00904052361",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1148,1),\"\"))","v":1},{"$f":"IF(F1148=1,COUNTIF($F$3:F1148,1),\"\")","v":1146},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1148),$G$3:$G$3716,0)),\"\")","v":"00904052361"}]
[null,null,null,null,"00904052372",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1149,1),\"\"))","v":1},{"$f":"IF(F1149=1,COUNTIF($F$3:F1149,1),\"\")","v":1147},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1149),$G$3:$G$3716,0)),\"\")","v":"00904052372"}]
[null,null,null,null,"00904053061",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1150,1),\"\"))","v":1},{"$f":"IF(F1150=1,COUNTIF($F$3:F1150,1),\"\")","v":1148},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1150),$G$3:$G$3716,0)),\"\")","v":"00904053061"}]
[null,null,null,null,"00904053660",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1151,1),\"\"))","v":1},{"$f":"IF(F1151=1,COUNTIF($F$3:F1151,1),\"\")","v":1149},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1151),$G$3:$G$3716,0)),\"\")","v":"00904053660"}]
[null,null,null,null,"00904053913",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1152,1),\"\"))","v":1},{"$f":"IF(F1152=1,COUNTIF($F$3:F1152,1),\"\")","v":1150},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1152),$G$3:$G$3716,0)),\"\")","v":"00904053913"}]
[null,null,null,null,"00904053961",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1153,1),\"\"))","v":1},{"$f":"IF(F1153=1,COUNTIF($F$3:F1153,1),\"\")","v":1151},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1153),$G$3:$G$3716,0)),\"\")","v":"00904053961"}]
[null,null,null,null,"00904054460",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1154,1),\"\"))","v":1},{"$f":"IF(F1154=1,COUNTIF($F$3:F1154,1),\"\")","v":1152},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1154),$G$3:$G$3716,0)),\"\")","v":"00904054460"}]
[null,null,null,null,"00904108661",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1155,1),\"\"))","v":1},{"$f":"IF(F1155=1,COUNTIF($F$3:F1155,1),\"\")","v":1153},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1155),$G$3:$G$3716,0)),\"\")","v":"00904108661"}]
[null,null,null,null,"00904108861",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1156,1),\"\"))","v":1},{"$f":"IF(F1156=1,COUNTIF($F$3:F1156,1),\"\")","v":1154},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1156),$G$3:$G$3716,0)),\"\")","v":"00904108861"}]
[null,null,null,null,"00904125061",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1157,1),\"\"))","v":1},{"$f":"IF(F1157=1,COUNTIF($F$3:F1157,1),\"\")","v":1155},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1157),$G$3:$G$3716,0)),\"\")","v":"00904125061"}]
[null,null,null,null,"00904125161",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1158,1),\"\"))","v":1},{"$f":"IF(F1158=1,COUNTIF($F$3:F1158,1),\"\")","v":1156},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1158),$G$3:$G$3716,0)),\"\")","v":"00904125161"}]
[null,null,null,null,"00904145361",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1159,1),\"\"))","v":1},{"$f":"IF(F1159=1,COUNTIF($F$3:F1159,1),\"\")","v":1157},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1159),$G$3:$G$3716,0)),\"\")","v":"00904145361"}]
[null,null,null,null,"00904188260",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1160,1),\"\"))","v":1},{"$f":"IF(F1160=1,COUNTIF($F$3:F1160,1),\"\")","v":1158},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1160),$G$3:$G$3716,0)),\"\")","v":"00904188260"}]
[null,null,null,null,"00904188261",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1161,1),\"\"))","v":1},{"$f":"IF(F1161=1,COUNTIF($F$3:F1161,1),\"\")","v":1159},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1161),$G$3:$G$3716,0)),\"\")","v":"00904188261"}]
[null,null,null,null,"00904188361",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1162,1),\"\"))","v":1},{"$f":"IF(F1162=1,COUNTIF($F$3:F1162,1),\"\")","v":1160},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1162),$G$3:$G$3716,0)),\"\")","v":"00904188361"}]
[null,null,null,null,"00904198520",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1163,1),\"\"))","v":1},{"$f":"IF(F1163=1,COUNTIF($F$3:F1163,1),\"\")","v":1161},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1163),$G$3:$G$3716,0)),\"\")","v":"00904198520"}]
[null,null,null,null,"00904201360",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1164,1),\"\"))","v":1},{"$f":"IF(F1164=1,COUNTIF($F$3:F1164,1),\"\")","v":1162},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1164),$G$3:$G$3716,0)),\"\")","v":"00904201360"}]
[null,null,null,null,"00904208560",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1165,1),\"\"))","v":1},{"$f":"IF(F1165=1,COUNTIF($F$3:F1165,1),\"\")","v":1163},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1165),$G$3:$G$3716,0)),\"\")","v":"00904208560"}]
[null,null,null,null,"00904213761",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1166,1),\"\"))","v":1},{"$f":"IF(F1166=1,COUNTIF($F$3:F1166,1),\"\")","v":1164},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1166),$G$3:$G$3716,0)),\"\")","v":"00904213761"}]
[null,null,null,null,"00904215461",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1167,1),\"\"))","v":1},{"$f":"IF(F1167=1,COUNTIF($F$3:F1167,1),\"\")","v":1165},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1167),$G$3:$G$3716,0)),\"\")","v":"00904215461"}]
[null,null,null,null,"00904253321",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1168,1),\"\"))","v":1},{"$f":"IF(F1168=1,COUNTIF($F$3:F1168,1),\"\")","v":1166},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1168),$G$3:$G$3716,0)),\"\")","v":"00904253321"}]
[null,null,null,null,"00904262160",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1169,1),\"\"))","v":1},{"$f":"IF(F1169=1,COUNTIF($F$3:F1169,1),\"\")","v":1167},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1169),$G$3:$G$3716,0)),\"\")","v":"00904262160"}]
[null,null,null,null,"00904266617",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1170,1),\"\"))","v":1},{"$f":"IF(F1170=1,COUNTIF($F$3:F1170,1),\"\")","v":1168},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1170),$G$3:$G$3716,0)),\"\")","v":"00904266617"}]
[null,null,null,null,"00904272561",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1171,1),\"\"))","v":1},{"$f":"IF(F1171=1,COUNTIF($F$3:F1171,1),\"\")","v":1169},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1171),$G$3:$G$3716,0)),\"\")","v":"00904272561"}]
[null,null,null,null,"00904282161",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1172,1),\"\"))","v":1},{"$f":"IF(F1172=1,COUNTIF($F$3:F1172,1),\"\")","v":1170},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1172),$G$3:$G$3716,0)),\"\")","v":"00904282161"}]
[null,null,null,null,"00904292061",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1173,1),\"\"))","v":1},{"$f":"IF(F1173=1,COUNTIF($F$3:F1173,1),\"\")","v":1171},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1173),$G$3:$G$3716,0)),\"\")","v":"00904292061"}]
[null,null,null,null,"00904292461",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1174,1),\"\"))","v":1},{"$f":"IF(F1174=1,COUNTIF($F$3:F1174,1),\"\")","v":1172},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1174),$G$3:$G$3716,0)),\"\")","v":"00904292461"}]
[null,null,null,null,"00904320713",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1175,1),\"\"))","v":1},{"$f":"IF(F1175=1,COUNTIF($F$3:F1175,1),\"\")","v":1173},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1175),$G$3:$G$3716,0)),\"\")","v":"00904320713"}]
[null,null,null,null,"00904322035",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1176,1),\"\"))","v":1},{"$f":"IF(F1176=1,COUNTIF($F$3:F1176,1),\"\")","v":1174},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1176),$G$3:$G$3716,0)),\"\")","v":"00904322035"}]
[null,null,null,null,"00904357161",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1177,1),\"\"))","v":1},{"$f":"IF(F1177=1,COUNTIF($F$3:F1177,1),\"\")","v":1175},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1177),$G$3:$G$3716,0)),\"\")","v":"00904357161"}]
[null,null,null,null,"00904385461",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1178,1),\"\"))","v":1},{"$f":"IF(F1178=1,COUNTIF($F$3:F1178,1),\"\")","v":1176},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1178),$G$3:$G$3716,0)),\"\")","v":"00904385461"}]
[null,null,null,null,"00904386575",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1179,1),\"\"))","v":1},{"$f":"IF(F1179=1,COUNTIF($F$3:F1179,1),\"\")","v":1177},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1179),$G$3:$G$3716,0)),\"\")","v":"00904386575"}]
[null,null,null,null,"00904399061",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1180,1),\"\"))","v":1},{"$f":"IF(F1180=1,COUNTIF($F$3:F1180,1),\"\")","v":1178},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1180),$G$3:$G$3716,0)),\"\")","v":"00904399061"}]
[null,null,null,null,"00904404073",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1181,1),\"\"))","v":1},{"$f":"IF(F1181=1,COUNTIF($F$3:F1181,1),\"\")","v":1179},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1181),$G$3:$G$3716,0)),\"\")","v":"00904404073"}]
[null,null,null,null,"00904420260",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1182,1),\"\"))","v":1},{"$f":"IF(F1182=1,COUNTIF($F$3:F1182,1),\"\")","v":1180},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1182),$G$3:$G$3716,0)),\"\")","v":"00904420260"}]
[null,null,null,null,"00904501735",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1183,1),\"\"))","v":1},{"$f":"IF(F1183=1,COUNTIF($F$3:F1183,1),\"\")","v":1181},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1183),$G$3:$G$3716,0)),\"\")","v":"00904501735"}]
[null,null,null,null,"00904504561",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1184,1),\"\"))","v":1},{"$f":"IF(F1184=1,COUNTIF($F$3:F1184,1),\"\")","v":1182},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1184),$G$3:$G$3716,0)),\"\")","v":"00904504561"}]
[null,null,null,null,"00904504661",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1185,1),\"\"))","v":1},{"$f":"IF(F1185=1,COUNTIF($F$3:F1185,1),\"\")","v":1183},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1185),$G$3:$G$3716,0)),\"\")","v":"00904504661"}]
[null,null,null,null,"00904505359",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1186,1),\"\"))","v":1},{"$f":"IF(F1186=1,COUNTIF($F$3:F1186,1),\"\")","v":1184},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1186),$G$3:$G$3716,0)),\"\")","v":"00904505359"}]
[null,null,null,null,"00904505360",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1187,1),\"\"))","v":1},{"$f":"IF(F1187=1,COUNTIF($F$3:F1187,1),\"\")","v":1185},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1187),$G$3:$G$3716,0)),\"\")","v":"00904505360"}]
[null,null,null,null,"00904506860",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1188,1),\"\"))","v":1},{"$f":"IF(F1188=1,COUNTIF($F$3:F1188,1),\"\")","v":1186},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1188),$G$3:$G$3716,0)),\"\")","v":"00904506860"}]
[null,null,null,null,"00904512559",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1189,1),\"\"))","v":1},{"$f":"IF(F1189=1,COUNTIF($F$3:F1189,1),\"\")","v":1187},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1189),$G$3:$G$3716,0)),\"\")","v":"00904512559"}]
[null,null,null,null,"00904516561",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1190,1),\"\"))","v":1},{"$f":"IF(F1190=1,COUNTIF($F$3:F1190,1),\"\")","v":1188},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1190),$G$3:$G$3716,0)),\"\")","v":"00904516561"}]
[null,null,null,null,"00904516580",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1191,1),\"\"))","v":1},{"$f":"IF(F1191=1,COUNTIF($F$3:F1191,1),\"\")","v":1189},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1191),$G$3:$G$3716,0)),\"\")","v":"00904516580"}]
[null,null,null,null,"00904518252",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1192,1),\"\"))","v":1},{"$f":"IF(F1192=1,COUNTIF($F$3:F1192,1),\"\")","v":1190},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1192),$G$3:$G$3716,0)),\"\")","v":"00904518252"}]
[null,null,null,null,"00904518261",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1193,1),\"\"))","v":1},{"$f":"IF(F1193=1,COUNTIF($F$3:F1193,1),\"\")","v":1191},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1193),$G$3:$G$3716,0)),\"\")","v":"00904518261"}]
[null,null,null,null,"00904528261",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1194,1),\"\"))","v":1},{"$f":"IF(F1194=1,COUNTIF($F$3:F1194,1),\"\")","v":1192},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1194),$G$3:$G$3716,0)),\"\")","v":"00904528261"}]
[null,null,null,null,"00904530920",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1195,1),\"\"))","v":1},{"$f":"IF(F1195=1,COUNTIF($F$3:F1195,1),\"\")","v":1193},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1195),$G$3:$G$3716,0)),\"\")","v":"00904530920"}]
[null,null,null,null,"00904533260",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1196,1),\"\"))","v":1},{"$f":"IF(F1196=1,COUNTIF($F$3:F1196,1),\"\")","v":1194},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1196),$G$3:$G$3716,0)),\"\")","v":"00904533260"}]
[null,null,null,null,"00904539261",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1197,1),\"\"))","v":1},{"$f":"IF(F1197=1,COUNTIF($F$3:F1197,1),\"\")","v":1195},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1197),$G$3:$G$3716,0)),\"\")","v":"00904539261"}]
[null,null,null,null,"00904539561",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1198,1),\"\"))","v":1},{"$f":"IF(F1198=1,COUNTIF($F$3:F1198,1),\"\")","v":1196},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1198),$G$3:$G$3716,0)),\"\")","v":"00904539561"}]
[null,null,null,null,"00904541501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1199,1),\"\"))","v":1},{"$f":"IF(F1199=1,COUNTIF($F$3:F1199,1),\"\")","v":1197},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1199),$G$3:$G$3716,0)),\"\")","v":"00904541501"}]
[null,null,null,null,"00904546061",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1200,1),\"\"))","v":1},{"$f":"IF(F1200=1,COUNTIF($F$3:F1200,1),\"\")","v":1198},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1200),$G$3:$G$3716,0)),\"\")","v":"00904546061"}]
[null,null,null,null,"00904549213",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1201,1),\"\"))","v":1},{"$f":"IF(F1201=1,COUNTIF($F$3:F1201,1),\"\")","v":1199},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1201),$G$3:$G$3716,0)),\"\")","v":"00904549213"}]
[null,null,null,null,"00904549261",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1202,1),\"\"))","v":1},{"$f":"IF(F1202=1,COUNTIF($F$3:F1202,1),\"\")","v":1200},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1202),$G$3:$G$3716,0)),\"\")","v":"00904549261"}]
[null,null,null,null,"00904549546",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1203,1),\"\"))","v":1},{"$f":"IF(F1203=1,COUNTIF($F$3:F1203,1),\"\")","v":1201},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1203),$G$3:$G$3716,0)),\"\")","v":"00904549546"}]
[null,null,null,null,"00904549646",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1204,1),\"\"))","v":1},{"$f":"IF(F1204=1,COUNTIF($F$3:F1204,1),\"\")","v":1202},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1204),$G$3:$G$3716,0)),\"\")","v":"00904549646"}]
[null,null,null,null,"00904549746",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1205,1),\"\"))","v":1},{"$f":"IF(F1205=1,COUNTIF($F$3:F1205,1),\"\")","v":1203},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1205),$G$3:$G$3716,0)),\"\")","v":"00904549746"}]
[null,null,null,null,"00904550261",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1206,1),\"\"))","v":1},{"$f":"IF(F1206=1,COUNTIF($F$3:F1206,1),\"\")","v":1204},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1206),$G$3:$G$3716,0)),\"\")","v":"00904550261"}]
[null,null,null,null,"00904552361",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1207,1),\"\"))","v":1},{"$f":"IF(F1207=1,COUNTIF($F$3:F1207,1),\"\")","v":1205},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1207),$G$3:$G$3716,0)),\"\")","v":"00904552361"}]
[null,null,null,null,"00904552461",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1208,1),\"\"))","v":1},{"$f":"IF(F1208=1,COUNTIF($F$3:F1208,1),\"\")","v":1206},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1208),$G$3:$G$3716,0)),\"\")","v":"00904552461"}]
[null,null,null,null,"00904555361",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1209,1),\"\"))","v":1},{"$f":"IF(F1209=1,COUNTIF($F$3:F1209,1),\"\")","v":1207},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1209),$G$3:$G$3716,0)),\"\")","v":"00904555361"}]
[null,null,null,null,"00904561061",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1210,1),\"\"))","v":1},{"$f":"IF(F1210=1,COUNTIF($F$3:F1210,1),\"\")","v":1208},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1210),$G$3:$G$3716,0)),\"\")","v":"00904561061"}]
[null,null,null,null,"00904563161",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1211,1),\"\"))","v":1},{"$f":"IF(F1211=1,COUNTIF($F$3:F1211,1),\"\")","v":1209},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1211),$G$3:$G$3716,0)),\"\")","v":"00904563161"}]
[null,null,null,null,"00904563261",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1212,1),\"\"))","v":1},{"$f":"IF(F1212=1,COUNTIF($F$3:F1212,1),\"\")","v":1210},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1212),$G$3:$G$3716,0)),\"\")","v":"00904563261"}]
[null,null,null,null,"00904563361",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1213,1),\"\"))","v":1},{"$f":"IF(F1213=1,COUNTIF($F$3:F1213,1),\"\")","v":1211},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1213),$G$3:$G$3716,0)),\"\")","v":"00904563361"}]
[null,null,null,null,"00904565661",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1214,1),\"\"))","v":1},{"$f":"IF(F1214=1,COUNTIF($F$3:F1214,1),\"\")","v":1212},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1214),$G$3:$G$3716,0)),\"\")","v":"00904565661"}]
[null,null,null,null,"00904565761",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1215,1),\"\"))","v":1},{"$f":"IF(F1215=1,COUNTIF($F$3:F1215,1),\"\")","v":1213},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1215),$G$3:$G$3716,0)),\"\")","v":"00904565761"}]
[null,null,null,null,"00904565861",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1216,1),\"\"))","v":1},{"$f":"IF(F1216=1,COUNTIF($F$3:F1216,1),\"\")","v":1214},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1216),$G$3:$G$3716,0)),\"\")","v":"00904565861"}]
[null,null,null,null,"00904567761",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1217,1),\"\"))","v":1},{"$f":"IF(F1217=1,COUNTIF($F$3:F1217,1),\"\")","v":1215},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1217),$G$3:$G$3716,0)),\"\")","v":"00904567761"}]
[null,null,null,null,"00904571135",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1218,1),\"\"))","v":1},{"$f":"IF(F1218=1,COUNTIF($F$3:F1218,1),\"\")","v":1216},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1218),$G$3:$G$3716,0)),\"\")","v":"00904571135"}]
[null,null,null,null,"00904572114",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1219,1),\"\"))","v":1},{"$f":"IF(F1219=1,COUNTIF($F$3:F1219,1),\"\")","v":1217},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1219),$G$3:$G$3716,0)),\"\")","v":"00904572114"}]
[null,null,null,null,"00904573451",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1220,1),\"\"))","v":1},{"$f":"IF(F1220=1,COUNTIF($F$3:F1220,1),\"\")","v":1218},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1220),$G$3:$G$3716,0)),\"\")","v":"00904573451"}]
[null,null,null,null,"00904578051",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1221,1),\"\"))","v":1},{"$f":"IF(F1221=1,COUNTIF($F$3:F1221,1),\"\")","v":1219},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1221),$G$3:$G$3716,0)),\"\")","v":"00904578051"}]
[null,null,null,null,"00904578461",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1222,1),\"\"))","v":1},{"$f":"IF(F1222=1,COUNTIF($F$3:F1222,1),\"\")","v":1220},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1222),$G$3:$G$3716,0)),\"\")","v":"00904578461"}]
[null,null,null,null,"00904578561",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1223,1),\"\"))","v":1},{"$f":"IF(F1223=1,COUNTIF($F$3:F1223,1),\"\")","v":1221},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1223),$G$3:$G$3716,0)),\"\")","v":"00904578561"}]
[null,null,null,null,"00904579061",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1224,1),\"\"))","v":1},{"$f":"IF(F1224=1,COUNTIF($F$3:F1224,1),\"\")","v":1222},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1224),$G$3:$G$3716,0)),\"\")","v":"00904579061"}]
[null,null,null,null,"00904579661",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1225,1),\"\"))","v":1},{"$f":"IF(F1225=1,COUNTIF($F$3:F1225,1),\"\")","v":1223},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1225),$G$3:$G$3716,0)),\"\")","v":"00904579661"}]
[null,null,null,null,"00904579761",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1226,1),\"\"))","v":1},{"$f":"IF(F1226=1,COUNTIF($F$3:F1226,1),\"\")","v":1224},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1226),$G$3:$G$3716,0)),\"\")","v":"00904579761"}]
[null,null,null,null,"00904579861",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1227,1),\"\"))","v":1},{"$f":"IF(F1227=1,COUNTIF($F$3:F1227,1),\"\")","v":1225},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1227),$G$3:$G$3716,0)),\"\")","v":"00904579861"}]
[null,null,null,null,"00904580061",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1228,1),\"\"))","v":1},{"$f":"IF(F1228=1,COUNTIF($F$3:F1228,1),\"\")","v":1226},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1228),$G$3:$G$3716,0)),\"\")","v":"00904580061"}]
[null,null,null,null,"00904580161",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1229,1),\"\"))","v":1},{"$f":"IF(F1229=1,COUNTIF($F$3:F1229,1),\"\")","v":1227},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1229),$G$3:$G$3716,0)),\"\")","v":"00904580161"}]
[null,null,null,null,"00904580261",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1230,1),\"\"))","v":1},{"$f":"IF(F1230=1,COUNTIF($F$3:F1230,1),\"\")","v":1228},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1230),$G$3:$G$3716,0)),\"\")","v":"00904580261"}]
[null,null,null,null,"00904580861",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1231,1),\"\"))","v":1},{"$f":"IF(F1231=1,COUNTIF($F$3:F1231,1),\"\")","v":1229},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1231),$G$3:$G$3716,0)),\"\")","v":"00904580861"}]
[null,null,null,null,"00904580961",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1232,1),\"\"))","v":1},{"$f":"IF(F1232=1,COUNTIF($F$3:F1232,1),\"\")","v":1230},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1232),$G$3:$G$3716,0)),\"\")","v":"00904580961"}]
[null,null,null,null,"00904581161",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1233,1),\"\"))","v":1},{"$f":"IF(F1233=1,COUNTIF($F$3:F1233,1),\"\")","v":1231},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1233),$G$3:$G$3716,0)),\"\")","v":"00904581161"}]
[null,null,null,null,"00904582360",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1234,1),\"\"))","v":1},{"$f":"IF(F1234=1,COUNTIF($F$3:F1234,1),\"\")","v":1232},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1234),$G$3:$G$3716,0)),\"\")","v":"00904582360"}]
[null,null,null,null,"00904582460",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1235,1),\"\"))","v":1},{"$f":"IF(F1235=1,COUNTIF($F$3:F1235,1),\"\")","v":1233},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1235),$G$3:$G$3716,0)),\"\")","v":"00904582460"}]
[null,null,null,null,"00904582461",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1236,1),\"\"))","v":1},{"$f":"IF(F1236=1,COUNTIF($F$3:F1236,1),\"\")","v":1234},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1236),$G$3:$G$3716,0)),\"\")","v":"00904582461"}]
[null,null,null,null,"00904582489",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1237,1),\"\"))","v":1},{"$f":"IF(F1237=1,COUNTIF($F$3:F1237,1),\"\")","v":1235},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1237),$G$3:$G$3716,0)),\"\")","v":"00904582489"}]
[null,null,null,null,"00904585461",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1238,1),\"\"))","v":1},{"$f":"IF(F1238=1,COUNTIF($F$3:F1238,1),\"\")","v":1236},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1238),$G$3:$G$3716,0)),\"\")","v":"00904585461"}]
[null,null,null,null,"00904585561",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1239,1),\"\"))","v":1},{"$f":"IF(F1239=1,COUNTIF($F$3:F1239,1),\"\")","v":1237},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1239),$G$3:$G$3716,0)),\"\")","v":"00904585561"}]
[null,null,null,null,"00904585861",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1240,1),\"\"))","v":1},{"$f":"IF(F1240=1,COUNTIF($F$3:F1240,1),\"\")","v":1238},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1240),$G$3:$G$3716,0)),\"\")","v":"00904585861"}]
[null,null,null,null,"00904585961",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1241,1),\"\"))","v":1},{"$f":"IF(F1241=1,COUNTIF($F$3:F1241,1),\"\")","v":1239},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1241),$G$3:$G$3716,0)),\"\")","v":"00904585961"}]
[null,null,null,null,"00904586061",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1242,1),\"\"))","v":1},{"$f":"IF(F1242=1,COUNTIF($F$3:F1242,1),\"\")","v":1240},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1242),$G$3:$G$3716,0)),\"\")","v":"00904586061"}]
[null,null,null,null,"00904588061",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1243,1),\"\"))","v":1},{"$f":"IF(F1243=1,COUNTIF($F$3:F1243,1),\"\")","v":1241},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1243),$G$3:$G$3716,0)),\"\")","v":"00904588061"}]
[null,null,null,null,"00904588761",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1244,1),\"\"))","v":1},{"$f":"IF(F1244=1,COUNTIF($F$3:F1244,1),\"\")","v":1242},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1244),$G$3:$G$3716,0)),\"\")","v":"00904588761"}]
[null,null,null,null,"00904588961",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1245,1),\"\"))","v":1},{"$f":"IF(F1245=1,COUNTIF($F$3:F1245,1),\"\")","v":1243},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1245),$G$3:$G$3716,0)),\"\")","v":"00904588961"}]
[null,null,null,null,"00904589430",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1246,1),\"\"))","v":1},{"$f":"IF(F1246=1,COUNTIF($F$3:F1246,1),\"\")","v":1244},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1246),$G$3:$G$3716,0)),\"\")","v":"00904589430"}]
[null,null,null,null,"00904590460",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1247,1),\"\"))","v":1},{"$f":"IF(F1247=1,COUNTIF($F$3:F1247,1),\"\")","v":1245},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1247),$G$3:$G$3716,0)),\"\")","v":"00904590460"}]
[null,null,null,null,"00904592161",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1248,1),\"\"))","v":1},{"$f":"IF(F1248=1,COUNTIF($F$3:F1248,1),\"\")","v":1246},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1248),$G$3:$G$3716,0)),\"\")","v":"00904592161"}]
[null,null,null,null,"00904592261",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1249,1),\"\"))","v":1},{"$f":"IF(F1249=1,COUNTIF($F$3:F1249,1),\"\")","v":1247},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1249),$G$3:$G$3716,0)),\"\")","v":"00904592261"}]
[null,null,null,null,"00904592461",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1250,1),\"\"))","v":1},{"$f":"IF(F1250=1,COUNTIF($F$3:F1250,1),\"\")","v":1248},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1250),$G$3:$G$3716,0)),\"\")","v":"00904592461"}]
[null,null,null,null,"00904592961",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1251,1),\"\"))","v":1},{"$f":"IF(F1251=1,COUNTIF($F$3:F1251,1),\"\")","v":1249},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1251),$G$3:$G$3716,0)),\"\")","v":"00904592961"}]
[null,null,null,null,"00904593061",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1252,1),\"\"))","v":1},{"$f":"IF(F1252=1,COUNTIF($F$3:F1252,1),\"\")","v":1250},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1252),$G$3:$G$3716,0)),\"\")","v":"00904593061"}]
[null,null,null,null,"00904595161",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1253,1),\"\"))","v":1},{"$f":"IF(F1253=1,COUNTIF($F$3:F1253,1),\"\")","v":1251},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1253),$G$3:$G$3716,0)),\"\")","v":"00904595161"}]
[null,null,null,null,"00904595961",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1254,1),\"\"))","v":1},{"$f":"IF(F1254=1,COUNTIF($F$3:F1254,1),\"\")","v":1252},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1254),$G$3:$G$3716,0)),\"\")","v":"00904595961"}]
[null,null,null,null,"00904597561",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1255,1),\"\"))","v":1},{"$f":"IF(F1255=1,COUNTIF($F$3:F1255,1),\"\")","v":1253},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1255),$G$3:$G$3716,0)),\"\")","v":"00904597561"}]
[null,null,null,null,"00904597661",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1256,1),\"\"))","v":1},{"$f":"IF(F1256=1,COUNTIF($F$3:F1256,1),\"\")","v":1254},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1256),$G$3:$G$3716,0)),\"\")","v":"00904597661"}]
[null,null,null,null,"00904598061",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1257,1),\"\"))","v":1},{"$f":"IF(F1257=1,COUNTIF($F$3:F1257,1),\"\")","v":1255},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1257),$G$3:$G$3716,0)),\"\")","v":"00904598061"}]
[null,null,null,null,"00904598161",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1258,1),\"\"))","v":1},{"$f":"IF(F1258=1,COUNTIF($F$3:F1258,1),\"\")","v":1256},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1258),$G$3:$G$3716,0)),\"\")","v":"00904598161"}]
[null,null,null,null,"00904598426",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1259,1),\"\"))","v":1},{"$f":"IF(F1259=1,COUNTIF($F$3:F1259,1),\"\")","v":1257},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1259),$G$3:$G$3716,0)),\"\")","v":"00904598426"}]
[null,null,null,null,"00904599061",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1260,1),\"\"))","v":1},{"$f":"IF(F1260=1,COUNTIF($F$3:F1260,1),\"\")","v":1258},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1260),$G$3:$G$3716,0)),\"\")","v":"00904599061"}]
[null,null,null,null,"00904599161",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1261,1),\"\"))","v":1},{"$f":"IF(F1261=1,COUNTIF($F$3:F1261,1),\"\")","v":1259},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1261),$G$3:$G$3716,0)),\"\")","v":"00904599161"}]
[null,null,null,null,"00904599261",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1262,1),\"\"))","v":1},{"$f":"IF(F1262=1,COUNTIF($F$3:F1262,1),\"\")","v":1260},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1262),$G$3:$G$3716,0)),\"\")","v":"00904599261"}]
[null,null,null,null,"00904600761",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1263,1),\"\"))","v":1},{"$f":"IF(F1263=1,COUNTIF($F$3:F1263,1),\"\")","v":1261},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1263),$G$3:$G$3716,0)),\"\")","v":"00904600761"}]
[null,null,null,null,"00904600861",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1264,1),\"\"))","v":1},{"$f":"IF(F1264=1,COUNTIF($F$3:F1264,1),\"\")","v":1262},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1264),$G$3:$G$3716,0)),\"\")","v":"00904600861"}]
[null,null,null,null,"00904600961",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1265,1),\"\"))","v":1},{"$f":"IF(F1265=1,COUNTIF($F$3:F1265,1),\"\")","v":1263},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1265),$G$3:$G$3716,0)),\"\")","v":"00904600961"}]
[null,null,null,null,"00904601946",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1266,1),\"\"))","v":1},{"$f":"IF(F1266=1,COUNTIF($F$3:F1266,1),\"\")","v":1264},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1266),$G$3:$G$3716,0)),\"\")","v":"00904601946"}]
[null,null,null,null,"00904605161",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1267,1),\"\"))","v":1},{"$f":"IF(F1267=1,COUNTIF($F$3:F1267,1),\"\")","v":1265},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1267),$G$3:$G$3716,0)),\"\")","v":"00904605161"}]
[null,null,null,null,"00904605261",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1268,1),\"\"))","v":1},{"$f":"IF(F1268=1,COUNTIF($F$3:F1268,1),\"\")","v":1266},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1268),$G$3:$G$3716,0)),\"\")","v":"00904605261"}]
[null,null,null,null,"00904606050",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1269,1),\"\"))","v":1},{"$f":"IF(F1269=1,COUNTIF($F$3:F1269,1),\"\")","v":1267},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1269),$G$3:$G$3716,0)),\"\")","v":"00904606050"}]
[null,null,null,null,"00904606961",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1270,1),\"\"))","v":1},{"$f":"IF(F1270=1,COUNTIF($F$3:F1270,1),\"\")","v":1268},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1270),$G$3:$G$3716,0)),\"\")","v":"00904606961"}]
[null,null,null,null,"00904607461",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1271,1),\"\"))","v":1},{"$f":"IF(F1271=1,COUNTIF($F$3:F1271,1),\"\")","v":1269},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1271),$G$3:$G$3716,0)),\"\")","v":"00904607461"}]
[null,null,null,null,"00904607961",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1272,1),\"\"))","v":1},{"$f":"IF(F1272=1,COUNTIF($F$3:F1272,1),\"\")","v":1270},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1272),$G$3:$G$3716,0)),\"\")","v":"00904607961"}]
[null,null,null,null,"00904608261",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1273,1),\"\"))","v":1},{"$f":"IF(F1273=1,COUNTIF($F$3:F1273,1),\"\")","v":1271},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1273),$G$3:$G$3716,0)),\"\")","v":"00904608261"}]
[null,null,null,null,"00904608561",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1274,1),\"\"))","v":1},{"$f":"IF(F1274=1,COUNTIF($F$3:F1274,1),\"\")","v":1272},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1274),$G$3:$G$3716,0)),\"\")","v":"00904608561"}]
[null,null,null,null,"00904608661",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1275,1),\"\"))","v":1},{"$f":"IF(F1275=1,COUNTIF($F$3:F1275,1),\"\")","v":1273},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1275),$G$3:$G$3716,0)),\"\")","v":"00904608661"}]
[null,null,null,null,"00904610161",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1276,1),\"\"))","v":1},{"$f":"IF(F1276=1,COUNTIF($F$3:F1276,1),\"\")","v":1274},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1276),$G$3:$G$3716,0)),\"\")","v":"00904610161"}]
[null,null,null,null,"00904610261",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1277,1),\"\"))","v":1},{"$f":"IF(F1277=1,COUNTIF($F$3:F1277,1),\"\")","v":1275},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1277),$G$3:$G$3716,0)),\"\")","v":"00904610261"}]
[null,null,null,null,"00904610361",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1278,1),\"\"))","v":1},{"$f":"IF(F1278=1,COUNTIF($F$3:F1278,1),\"\")","v":1276},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1278),$G$3:$G$3716,0)),\"\")","v":"00904610361"}]
[null,null,null,null,"00904612161",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1279,1),\"\"))","v":1},{"$f":"IF(F1279=1,COUNTIF($F$3:F1279,1),\"\")","v":1277},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1279),$G$3:$G$3716,0)),\"\")","v":"00904612161"}]
[null,null,null,null,"00904612361",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1280,1),\"\"))","v":1},{"$f":"IF(F1280=1,COUNTIF($F$3:F1280,1),\"\")","v":1278},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1280),$G$3:$G$3716,0)),\"\")","v":"00904612361"}]
[null,null,null,null,"00904612661",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1281,1),\"\"))","v":1},{"$f":"IF(F1281=1,COUNTIF($F$3:F1281,1),\"\")","v":1279},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1281),$G$3:$G$3716,0)),\"\")","v":"00904612661"}]
[null,null,null,null,"00904612861",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1282,1),\"\"))","v":1},{"$f":"IF(F1282=1,COUNTIF($F$3:F1282,1),\"\")","v":1280},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1282),$G$3:$G$3716,0)),\"\")","v":"00904612861"}]
[null,null,null,null,"00904612961",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1283,1),\"\"))","v":1},{"$f":"IF(F1283=1,COUNTIF($F$3:F1283,1),\"\")","v":1281},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1283),$G$3:$G$3716,0)),\"\")","v":"00904612961"}]
[null,null,null,null,"00904617261",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1284,1),\"\"))","v":1},{"$f":"IF(F1284=1,COUNTIF($F$3:F1284,1),\"\")","v":1282},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1284),$G$3:$G$3716,0)),\"\")","v":"00904617261"}]
[null,null,null,null,"00904618061",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1285,1),\"\"))","v":1},{"$f":"IF(F1285=1,COUNTIF($F$3:F1285,1),\"\")","v":1283},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1285),$G$3:$G$3716,0)),\"\")","v":"00904618061"}]
[null,null,null,null,"00904618761",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1286,1),\"\"))","v":1},{"$f":"IF(F1286=1,COUNTIF($F$3:F1286,1),\"\")","v":1284},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1286),$G$3:$G$3716,0)),\"\")","v":"00904618761"}]
[null,null,null,null,"00904619546",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1287,1),\"\"))","v":1},{"$f":"IF(F1287=1,COUNTIF($F$3:F1287,1),\"\")","v":1285},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1287),$G$3:$G$3716,0)),\"\")","v":"00904619546"}]
[null,null,null,null,"00904622161",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1288,1),\"\"))","v":1},{"$f":"IF(F1288=1,COUNTIF($F$3:F1288,1),\"\")","v":1286},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1288),$G$3:$G$3716,0)),\"\")","v":"00904622161"}]
[null,null,null,null,"00904623761",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1289,1),\"\"))","v":1},{"$f":"IF(F1289=1,COUNTIF($F$3:F1289,1),\"\")","v":1287},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1289),$G$3:$G$3716,0)),\"\")","v":"00904623761"}]
[null,null,null,null,"00904623861",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1290,1),\"\"))","v":1},{"$f":"IF(F1290=1,COUNTIF($F$3:F1290,1),\"\")","v":1288},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1290),$G$3:$G$3716,0)),\"\")","v":"00904623861"}]
[null,null,null,null,"00904624261",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1291,1),\"\"))","v":1},{"$f":"IF(F1291=1,COUNTIF($F$3:F1291,1),\"\")","v":1289},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1291),$G$3:$G$3716,0)),\"\")","v":"00904624261"}]
[null,null,null,null,"00904624761",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1292,1),\"\"))","v":1},{"$f":"IF(F1292=1,COUNTIF($F$3:F1292,1),\"\")","v":1290},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1292),$G$3:$G$3716,0)),\"\")","v":"00904624761"}]
[null,null,null,null,"00904624961",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1293,1),\"\"))","v":1},{"$f":"IF(F1293=1,COUNTIF($F$3:F1293,1),\"\")","v":1291},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1293),$G$3:$G$3716,0)),\"\")","v":"00904624961"}]
[null,null,null,null,"00904625061",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1294,1),\"\"))","v":1},{"$f":"IF(F1294=1,COUNTIF($F$3:F1294,1),\"\")","v":1292},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1294),$G$3:$G$3716,0)),\"\")","v":"00904625061"}]
[null,null,null,null,"00904625161",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1295,1),\"\"))","v":1},{"$f":"IF(F1295=1,COUNTIF($F$3:F1295,1),\"\")","v":1293},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1295),$G$3:$G$3716,0)),\"\")","v":"00904625161"}]
[null,null,null,null,"00904625549",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1296,1),\"\"))","v":1},{"$f":"IF(F1296=1,COUNTIF($F$3:F1296,1),\"\")","v":1294},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1296),$G$3:$G$3716,0)),\"\")","v":"00904625549"}]
[null,null,null,null,"00904626661",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1297,1),\"\"))","v":1},{"$f":"IF(F1297=1,COUNTIF($F$3:F1297,1),\"\")","v":1295},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1297),$G$3:$G$3716,0)),\"\")","v":"00904626661"}]
[null,null,null,null,"00904628461",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1298,1),\"\"))","v":1},{"$f":"IF(F1298=1,COUNTIF($F$3:F1298,1),\"\")","v":1296},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1298),$G$3:$G$3716,0)),\"\")","v":"00904628461"}]
[null,null,null,null,"00904628561",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1299,1),\"\"))","v":1},{"$f":"IF(F1299=1,COUNTIF($F$3:F1299,1),\"\")","v":1297},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1299),$G$3:$G$3716,0)),\"\")","v":"00904628561"}]
[null,null,null,null,"00904628889",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1300,1),\"\"))","v":1},{"$f":"IF(F1300=1,COUNTIF($F$3:F1300,1),\"\")","v":1298},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1300),$G$3:$G$3716,0)),\"\")","v":"00904628889"}]
[null,null,null,null,"00904629061",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1301,1),\"\"))","v":1},{"$f":"IF(F1301=1,COUNTIF($F$3:F1301,1),\"\")","v":1299},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1301),$G$3:$G$3716,0)),\"\")","v":"00904629061"}]
[null,null,null,null,"00904629161",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1302,1),\"\"))","v":1},{"$f":"IF(F1302=1,COUNTIF($F$3:F1302,1),\"\")","v":1300},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1302),$G$3:$G$3716,0)),\"\")","v":"00904629161"}]
[null,null,null,null,"00904629261",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1303,1),\"\"))","v":1},{"$f":"IF(F1303=1,COUNTIF($F$3:F1303,1),\"\")","v":1301},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1303),$G$3:$G$3716,0)),\"\")","v":"00904629261"}]
[null,null,null,null,"00904629304",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1304,1),\"\"))","v":1},{"$f":"IF(F1304=1,COUNTIF($F$3:F1304,1),\"\")","v":1302},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1304),$G$3:$G$3716,0)),\"\")","v":"00904629304"}]
[null,null,null,null,"00904629461",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1305,1),\"\"))","v":1},{"$f":"IF(F1305=1,COUNTIF($F$3:F1305,1),\"\")","v":1303},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1305),$G$3:$G$3716,0)),\"\")","v":"00904629461"}]
[null,null,null,null,"00904630161",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1306,1),\"\"))","v":1},{"$f":"IF(F1306=1,COUNTIF($F$3:F1306,1),\"\")","v":1304},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1306),$G$3:$G$3716,0)),\"\")","v":"00904630161"}]
[null,null,null,null,"00904630261",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1307,1),\"\"))","v":1},{"$f":"IF(F1307=1,COUNTIF($F$3:F1307,1),\"\")","v":1305},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1307),$G$3:$G$3716,0)),\"\")","v":"00904630261"}]
[null,null,null,null,"00904630521",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1308,1),\"\"))","v":1},{"$f":"IF(F1308=1,COUNTIF($F$3:F1308,1),\"\")","v":1306},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1308),$G$3:$G$3716,0)),\"\")","v":"00904630521"}]
[null,null,null,null,"00904632261",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1309,1),\"\"))","v":1},{"$f":"IF(F1309=1,COUNTIF($F$3:F1309,1),\"\")","v":1307},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1309),$G$3:$G$3716,0)),\"\")","v":"00904632261"}]
[null,null,null,null,"00904632361",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1310,1),\"\"))","v":1},{"$f":"IF(F1310=1,COUNTIF($F$3:F1310,1),\"\")","v":1308},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1310),$G$3:$G$3716,0)),\"\")","v":"00904632361"}]
[null,null,null,null,"00904632461",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1311,1),\"\"))","v":1},{"$f":"IF(F1311=1,COUNTIF($F$3:F1311,1),\"\")","v":1309},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1311),$G$3:$G$3716,0)),\"\")","v":"00904632461"}]
[null,null,null,null,"00904632661",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1312,1),\"\"))","v":1},{"$f":"IF(F1312=1,COUNTIF($F$3:F1312,1),\"\")","v":1310},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1312),$G$3:$G$3716,0)),\"\")","v":"00904632661"}]
[null,null,null,null,"00904633860",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1313,1),\"\"))","v":1},{"$f":"IF(F1313=1,COUNTIF($F$3:F1313,1),\"\")","v":1311},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1313),$G$3:$G$3716,0)),\"\")","v":"00904633860"}]
[null,null,null,null,"00904634061",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1314,1),\"\"))","v":1},{"$f":"IF(F1314=1,COUNTIF($F$3:F1314,1),\"\")","v":1312},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1314),$G$3:$G$3716,0)),\"\")","v":"00904634061"}]
[null,null,null,null,"00904634161",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1315,1),\"\"))","v":1},{"$f":"IF(F1315=1,COUNTIF($F$3:F1315,1),\"\")","v":1313},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1315),$G$3:$G$3716,0)),\"\")","v":"00904634161"}]
[null,null,null,null,"00904635161",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1316,1),\"\"))","v":1},{"$f":"IF(F1316=1,COUNTIF($F$3:F1316,1),\"\")","v":1314},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1316),$G$3:$G$3716,0)),\"\")","v":"00904635161"}]
[null,null,null,null,"00904635261",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1317,1),\"\"))","v":1},{"$f":"IF(F1317=1,COUNTIF($F$3:F1317,1),\"\")","v":1315},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1317),$G$3:$G$3716,0)),\"\")","v":"00904635261"}]
[null,null,null,null,"00904635361",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1318,1),\"\"))","v":1},{"$f":"IF(F1318=1,COUNTIF($F$3:F1318,1),\"\")","v":1316},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1318),$G$3:$G$3716,0)),\"\")","v":"00904635361"}]
[null,null,null,null,"00904635961",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1319,1),\"\"))","v":1},{"$f":"IF(F1319=1,COUNTIF($F$3:F1319,1),\"\")","v":1317},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1319),$G$3:$G$3716,0)),\"\")","v":"00904635961"}]
[null,null,null,null,"00904636061",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1320,1),\"\"))","v":1},{"$f":"IF(F1320=1,COUNTIF($F$3:F1320,1),\"\")","v":1318},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1320),$G$3:$G$3716,0)),\"\")","v":"00904636061"}]
[null,null,null,null,"00904636461",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1321,1),\"\"))","v":1},{"$f":"IF(F1321=1,COUNTIF($F$3:F1321,1),\"\")","v":1319},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1321),$G$3:$G$3716,0)),\"\")","v":"00904636461"}]
[null,null,null,null,"00904636561",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1322,1),\"\"))","v":1},{"$f":"IF(F1322=1,COUNTIF($F$3:F1322,1),\"\")","v":1320},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1322),$G$3:$G$3716,0)),\"\")","v":"00904636561"}]
[null,null,null,null,"00904636961",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1323,1),\"\"))","v":1},{"$f":"IF(F1323=1,COUNTIF($F$3:F1323,1),\"\")","v":1321},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1323),$G$3:$G$3716,0)),\"\")","v":"00904636961"}]
[null,null,null,null,"00904637061",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1324,1),\"\"))","v":1},{"$f":"IF(F1324=1,COUNTIF($F$3:F1324,1),\"\")","v":1322},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1324),$G$3:$G$3716,0)),\"\")","v":"00904637061"}]
[null,null,null,null,"00904637361",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1325,1),\"\"))","v":1},{"$f":"IF(F1325=1,COUNTIF($F$3:F1325,1),\"\")","v":1323},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1325),$G$3:$G$3716,0)),\"\")","v":"00904637361"}]
[null,null,null,null,"00904637661",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1326,1),\"\"))","v":1},{"$f":"IF(F1326=1,COUNTIF($F$3:F1326,1),\"\")","v":1324},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1326),$G$3:$G$3716,0)),\"\")","v":"00904637661"}]
[null,null,null,null,"00904637761",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1327,1),\"\"))","v":1},{"$f":"IF(F1327=1,COUNTIF($F$3:F1327,1),\"\")","v":1325},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1327),$G$3:$G$3716,0)),\"\")","v":"00904637761"}]
[null,null,null,null,"00904639061",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1328,1),\"\"))","v":1},{"$f":"IF(F1328=1,COUNTIF($F$3:F1328,1),\"\")","v":1326},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1328),$G$3:$G$3716,0)),\"\")","v":"00904639061"}]
[null,null,null,null,"00904640161",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1329,1),\"\"))","v":1},{"$f":"IF(F1329=1,COUNTIF($F$3:F1329,1),\"\")","v":1327},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1329),$G$3:$G$3716,0)),\"\")","v":"00904640161"}]
[null,null,null,null,"00904640506",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1330,1),\"\"))","v":1},{"$f":"IF(F1330=1,COUNTIF($F$3:F1330,1),\"\")","v":1328},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1330),$G$3:$G$3716,0)),\"\")","v":"00904640506"}]
[null,null,null,null,"00904640561",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1331,1),\"\"))","v":1},{"$f":"IF(F1331=1,COUNTIF($F$3:F1331,1),\"\")","v":1329},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1331),$G$3:$G$3716,0)),\"\")","v":"00904640561"}]
[null,null,null,null,"00904640761",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1332,1),\"\"))","v":1},{"$f":"IF(F1332=1,COUNTIF($F$3:F1332,1),\"\")","v":1330},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1332),$G$3:$G$3716,0)),\"\")","v":"00904640761"}]
[null,null,null,null,"00904640861",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1333,1),\"\"))","v":1},{"$f":"IF(F1333=1,COUNTIF($F$3:F1333,1),\"\")","v":1331},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1333),$G$3:$G$3716,0)),\"\")","v":"00904640861"}]
[null,null,null,null,"00904640961",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1334,1),\"\"))","v":1},{"$f":"IF(F1334=1,COUNTIF($F$3:F1334,1),\"\")","v":1332},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1334),$G$3:$G$3716,0)),\"\")","v":"00904640961"}]
[null,null,null,null,"00904641292",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1335,1),\"\"))","v":1},{"$f":"IF(F1335=1,COUNTIF($F$3:F1335,1),\"\")","v":1333},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1335),$G$3:$G$3716,0)),\"\")","v":"00904641292"}]
[null,null,null,null,"00904642281",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1336,1),\"\"))","v":1},{"$f":"IF(F1336=1,COUNTIF($F$3:F1336,1),\"\")","v":1334},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1336),$G$3:$G$3716,0)),\"\")","v":"00904642281"}]
[null,null,null,null,"00904642286",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1337,1),\"\"))","v":1},{"$f":"IF(F1337=1,COUNTIF($F$3:F1337,1),\"\")","v":1335},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1337),$G$3:$G$3716,0)),\"\")","v":"00904642286"}]
[null,null,null,null,"00904642304",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1338,1),\"\"))","v":1},{"$f":"IF(F1338=1,COUNTIF($F$3:F1338,1),\"\")","v":1336},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1338),$G$3:$G$3716,0)),\"\")","v":"00904642304"}]
[null,null,null,null,"00904643480",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1339,1),\"\"))","v":1},{"$f":"IF(F1339=1,COUNTIF($F$3:F1339,1),\"\")","v":1337},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1339),$G$3:$G$3716,0)),\"\")","v":"00904643480"}]
[null,null,null,null,"00904643761",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1340,1),\"\"))","v":1},{"$f":"IF(F1340=1,COUNTIF($F$3:F1340,1),\"\")","v":1338},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1340),$G$3:$G$3716,0)),\"\")","v":"00904643761"}]
[null,null,null,null,"00904644061",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1341,1),\"\"))","v":1},{"$f":"IF(F1341=1,COUNTIF($F$3:F1341,1),\"\")","v":1339},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1341),$G$3:$G$3716,0)),\"\")","v":"00904644061"}]
[null,null,null,null,"00904644161",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1342,1),\"\"))","v":1},{"$f":"IF(F1342=1,COUNTIF($F$3:F1342,1),\"\")","v":1340},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1342),$G$3:$G$3716,0)),\"\")","v":"00904644161"}]
[null,null,null,null,"00904644261",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1343,1),\"\"))","v":1},{"$f":"IF(F1343=1,COUNTIF($F$3:F1343,1),\"\")","v":1341},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1343),$G$3:$G$3716,0)),\"\")","v":"00904644261"}]
[null,null,null,null,"00904644461",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1344,1),\"\"))","v":1},{"$f":"IF(F1344=1,COUNTIF($F$3:F1344,1),\"\")","v":1342},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1344),$G$3:$G$3716,0)),\"\")","v":"00904644461"}]
[null,null,null,null,"00904644961",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1345,1),\"\"))","v":1},{"$f":"IF(F1345=1,COUNTIF($F$3:F1345,1),\"\")","v":1343},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1345),$G$3:$G$3716,0)),\"\")","v":"00904644961"}]
[null,null,null,null,"00904645061",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1346,1),\"\"))","v":1},{"$f":"IF(F1346=1,COUNTIF($F$3:F1346,1),\"\")","v":1344},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1346),$G$3:$G$3716,0)),\"\")","v":"00904645061"}]
[null,null,null,null,"00904645204",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1347,1),\"\"))","v":1},{"$f":"IF(F1347=1,COUNTIF($F$3:F1347,1),\"\")","v":1345},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1347),$G$3:$G$3716,0)),\"\")","v":"00904645204"}]
[null,null,null,null,"00904645261",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1348,1),\"\"))","v":1},{"$f":"IF(F1348=1,COUNTIF($F$3:F1348,1),\"\")","v":1346},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1348),$G$3:$G$3716,0)),\"\")","v":"00904645261"}]
[null,null,null,null,"00904645361",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1349,1),\"\"))","v":1},{"$f":"IF(F1349=1,COUNTIF($F$3:F1349,1),\"\")","v":1347},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1349),$G$3:$G$3716,0)),\"\")","v":"00904645361"}]
[null,null,null,null,"00904645561",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1350,1),\"\"))","v":1},{"$f":"IF(F1350=1,COUNTIF($F$3:F1350,1),\"\")","v":1348},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1350),$G$3:$G$3716,0)),\"\")","v":"00904645561"}]
[null,null,null,null,"00904645760",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1351,1),\"\"))","v":1},{"$f":"IF(F1351=1,COUNTIF($F$3:F1351,1),\"\")","v":1349},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1351),$G$3:$G$3716,0)),\"\")","v":"00904645760"}]
[null,null,null,null,"00904645780",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1352,1),\"\"))","v":1},{"$f":"IF(F1352=1,COUNTIF($F$3:F1352,1),\"\")","v":1350},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1352),$G$3:$G$3716,0)),\"\")","v":"00904645780"}]
[null,null,null,null,"00904646961",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1353,1),\"\"))","v":1},{"$f":"IF(F1353=1,COUNTIF($F$3:F1353,1),\"\")","v":1351},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1353),$G$3:$G$3716,0)),\"\")","v":"00904646961"}]
[null,null,null,null,"00904647104",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1354,1),\"\"))","v":1},{"$f":"IF(F1354=1,COUNTIF($F$3:F1354,1),\"\")","v":1352},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1354),$G$3:$G$3716,0)),\"\")","v":"00904647104"}]
[null,null,null,null,"00904647461",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1355,1),\"\"))","v":1},{"$f":"IF(F1355=1,COUNTIF($F$3:F1355,1),\"\")","v":1353},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1355),$G$3:$G$3716,0)),\"\")","v":"00904647461"}]
[null,null,null,null,"00904647561",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1356,1),\"\"))","v":1},{"$f":"IF(F1356=1,COUNTIF($F$3:F1356,1),\"\")","v":1354},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1356),$G$3:$G$3716,0)),\"\")","v":"00904647561"}]
[null,null,null,null,"00904647661",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1357,1),\"\"))","v":1},{"$f":"IF(F1357=1,COUNTIF($F$3:F1357,1),\"\")","v":1355},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1357),$G$3:$G$3716,0)),\"\")","v":"00904647661"}]
[null,null,null,null,"00904647861",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1358,1),\"\"))","v":1},{"$f":"IF(F1358=1,COUNTIF($F$3:F1358,1),\"\")","v":1356},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1358),$G$3:$G$3716,0)),\"\")","v":"00904647861"}]
[null,null,null,null,"00904648561",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1359,1),\"\"))","v":1},{"$f":"IF(F1359=1,COUNTIF($F$3:F1359,1),\"\")","v":1357},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1359),$G$3:$G$3716,0)),\"\")","v":"00904648561"}]
[null,null,null,null,"00904648661",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1360,1),\"\"))","v":1},{"$f":"IF(F1360=1,COUNTIF($F$3:F1360,1),\"\")","v":1358},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1360),$G$3:$G$3716,0)),\"\")","v":"00904648661"}]
[null,null,null,null,"00904648838",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1361,1),\"\"))","v":1},{"$f":"IF(F1361=1,COUNTIF($F$3:F1361,1),\"\")","v":1359},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1361),$G$3:$G$3716,0)),\"\")","v":"00904648838"}]
[null,null,null,null,"00904649235",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1362,1),\"\"))","v":1},{"$f":"IF(F1362=1,COUNTIF($F$3:F1362,1),\"\")","v":1360},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1362),$G$3:$G$3716,0)),\"\")","v":"00904649235"}]
[null,null,null,null,"00904650061",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1363,1),\"\"))","v":1},{"$f":"IF(F1363=1,COUNTIF($F$3:F1363,1),\"\")","v":1361},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1363),$G$3:$G$3716,0)),\"\")","v":"00904650061"}]
[null,null,null,null,"00904650161",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1364,1),\"\"))","v":1},{"$f":"IF(F1364=1,COUNTIF($F$3:F1364,1),\"\")","v":1362},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1364),$G$3:$G$3716,0)),\"\")","v":"00904650161"}]
[null,null,null,null,"00904650261",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1365,1),\"\"))","v":1},{"$f":"IF(F1365=1,COUNTIF($F$3:F1365,1),\"\")","v":1363},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1365),$G$3:$G$3716,0)),\"\")","v":"00904650261"}]
[null,null,null,null,"00904650361",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1366,1),\"\"))","v":1},{"$f":"IF(F1366=1,COUNTIF($F$3:F1366,1),\"\")","v":1364},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1366),$G$3:$G$3716,0)),\"\")","v":"00904650361"}]
[null,null,null,null,"00904650561",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1367,1),\"\"))","v":1},{"$f":"IF(F1367=1,COUNTIF($F$3:F1367,1),\"\")","v":1365},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1367),$G$3:$G$3716,0)),\"\")","v":"00904650561"}]
[null,null,null,null,"00904650861",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1368,1),\"\"))","v":1},{"$f":"IF(F1368=1,COUNTIF($F$3:F1368,1),\"\")","v":1366},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1368),$G$3:$G$3716,0)),\"\")","v":"00904650861"}]
[null,null,null,null,"00904651161",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1369,1),\"\"))","v":1},{"$f":"IF(F1369=1,COUNTIF($F$3:F1369,1),\"\")","v":1367},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1369),$G$3:$G$3716,0)),\"\")","v":"00904651161"}]
[null,null,null,null,"00904651961",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1370,1),\"\"))","v":1},{"$f":"IF(F1370=1,COUNTIF($F$3:F1370,1),\"\")","v":1368},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1370),$G$3:$G$3716,0)),\"\")","v":"00904651961"}]
[null,null,null,null,"00904652261",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1371,1),\"\"))","v":1},{"$f":"IF(F1371=1,COUNTIF($F$3:F1371,1),\"\")","v":1369},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1371),$G$3:$G$3716,0)),\"\")","v":"00904652261"}]
[null,null,null,null,"00904652306",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1372,1),\"\"))","v":1},{"$f":"IF(F1372=1,COUNTIF($F$3:F1372,1),\"\")","v":1370},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1372),$G$3:$G$3716,0)),\"\")","v":"00904652306"}]
[null,null,null,null,"00904652961",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1373,1),\"\"))","v":1},{"$f":"IF(F1373=1,COUNTIF($F$3:F1373,1),\"\")","v":1371},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1373),$G$3:$G$3716,0)),\"\")","v":"00904652961"}]
[null,null,null,null,"00904653806",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1374,1),\"\"))","v":1},{"$f":"IF(F1374=1,COUNTIF($F$3:F1374,1),\"\")","v":1372},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1374),$G$3:$G$3716,0)),\"\")","v":"00904653806"}]
[null,null,null,null,"00904654061",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1375,1),\"\"))","v":1},{"$f":"IF(F1375=1,COUNTIF($F$3:F1375,1),\"\")","v":1373},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1375),$G$3:$G$3716,0)),\"\")","v":"00904654061"}]
[null,null,null,null,"00904654661",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1376,1),\"\"))","v":1},{"$f":"IF(F1376=1,COUNTIF($F$3:F1376,1),\"\")","v":1374},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1376),$G$3:$G$3716,0)),\"\")","v":"00904654661"}]
[null,null,null,null,"00904655304",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1377,1),\"\"))","v":1},{"$f":"IF(F1377=1,COUNTIF($F$3:F1377,1),\"\")","v":1375},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1377),$G$3:$G$3716,0)),\"\")","v":"00904655304"}]
[null,null,null,null,"00904655461",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1378,1),\"\"))","v":1},{"$f":"IF(F1378=1,COUNTIF($F$3:F1378,1),\"\")","v":1376},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1378),$G$3:$G$3716,0)),\"\")","v":"00904655461"}]
[null,null,null,null,"00904655561",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1379,1),\"\"))","v":1},{"$f":"IF(F1379=1,COUNTIF($F$3:F1379,1),\"\")","v":1377},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1379),$G$3:$G$3716,0)),\"\")","v":"00904655561"}]
[null,null,null,null,"00904655661",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1380,1),\"\"))","v":1},{"$f":"IF(F1380=1,COUNTIF($F$3:F1380,1),\"\")","v":1378},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1380),$G$3:$G$3716,0)),\"\")","v":"00904655661"}]
[null,null,null,null,"00904655761",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1381,1),\"\"))","v":1},{"$f":"IF(F1381=1,COUNTIF($F$3:F1381,1),\"\")","v":1379},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1381),$G$3:$G$3716,0)),\"\")","v":"00904655761"}]
[null,null,null,null,"00904655861",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1382,1),\"\"))","v":1},{"$f":"IF(F1382=1,COUNTIF($F$3:F1382,1),\"\")","v":1380},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1382),$G$3:$G$3716,0)),\"\")","v":"00904655861"}]
[null,null,null,null,"00904655961",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1383,1),\"\"))","v":1},{"$f":"IF(F1383=1,COUNTIF($F$3:F1383,1),\"\")","v":1381},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1383),$G$3:$G$3716,0)),\"\")","v":"00904655961"}]
[null,null,null,null,"00904656061",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1384,1),\"\"))","v":1},{"$f":"IF(F1384=1,COUNTIF($F$3:F1384,1),\"\")","v":1382},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1384),$G$3:$G$3716,0)),\"\")","v":"00904656061"}]
[null,null,null,null,"00904656460",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1385,1),\"\"))","v":1},{"$f":"IF(F1385=1,COUNTIF($F$3:F1385,1),\"\")","v":1383},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1385),$G$3:$G$3716,0)),\"\")","v":"00904656460"}]
[null,null,null,null,"00904656461",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1386,1),\"\"))","v":1},{"$f":"IF(F1386=1,COUNTIF($F$3:F1386,1),\"\")","v":1384},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1386),$G$3:$G$3716,0)),\"\")","v":"00904656461"}]
[null,null,null,null,"00904656561",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1387,1),\"\"))","v":1},{"$f":"IF(F1387=1,COUNTIF($F$3:F1387,1),\"\")","v":1385},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1387),$G$3:$G$3716,0)),\"\")","v":"00904656561"}]
[null,null,null,null,"00904656861",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1388,1),\"\"))","v":1},{"$f":"IF(F1388=1,COUNTIF($F$3:F1388,1),\"\")","v":1386},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1388),$G$3:$G$3716,0)),\"\")","v":"00904656861"}]
[null,null,null,null,"00904657006",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1389,1),\"\"))","v":1},{"$f":"IF(F1389=1,COUNTIF($F$3:F1389,1),\"\")","v":1387},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1389),$G$3:$G$3716,0)),\"\")","v":"00904657006"}]
[null,null,null,null,"00904657161",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1390,1),\"\"))","v":1},{"$f":"IF(F1390=1,COUNTIF($F$3:F1390,1),\"\")","v":1388},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1390),$G$3:$G$3716,0)),\"\")","v":"00904657161"}]
[null,null,null,null,"00904657261",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1391,1),\"\"))","v":1},{"$f":"IF(F1391=1,COUNTIF($F$3:F1391,1),\"\")","v":1389},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1391),$G$3:$G$3716,0)),\"\")","v":"00904657261"}]
[null,null,null,null,"00904657561",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1392,1),\"\"))","v":1},{"$f":"IF(F1392=1,COUNTIF($F$3:F1392,1),\"\")","v":1390},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1392),$G$3:$G$3716,0)),\"\")","v":"00904657561"}]
[null,null,null,null,"00904658261",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1393,1),\"\"))","v":1},{"$f":"IF(F1393=1,COUNTIF($F$3:F1393,1),\"\")","v":1391},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1393),$G$3:$G$3716,0)),\"\")","v":"00904658261"}]
[null,null,null,null,"00904658561",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1394,1),\"\"))","v":1},{"$f":"IF(F1394=1,COUNTIF($F$3:F1394,1),\"\")","v":1392},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1394),$G$3:$G$3716,0)),\"\")","v":"00904658561"}]
[null,null,null,null,"00904659161",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1395,1),\"\"))","v":1},{"$f":"IF(F1395=1,COUNTIF($F$3:F1395,1),\"\")","v":1393},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1395),$G$3:$G$3716,0)),\"\")","v":"00904659161"}]
[null,null,null,null,"00904659204",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1396,1),\"\"))","v":1},{"$f":"IF(F1396=1,COUNTIF($F$3:F1396,1),\"\")","v":1394},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1396),$G$3:$G$3716,0)),\"\")","v":"00904659204"}]
[null,null,null,null,"00904659461",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1397,1),\"\"))","v":1},{"$f":"IF(F1397=1,COUNTIF($F$3:F1397,1),\"\")","v":1395},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1397),$G$3:$G$3716,0)),\"\")","v":"00904659461"}]
[null,null,null,null,"00904659604",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1398,1),\"\"))","v":1},{"$f":"IF(F1398=1,COUNTIF($F$3:F1398,1),\"\")","v":1396},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1398),$G$3:$G$3716,0)),\"\")","v":"00904659604"}]
[null,null,null,null,"00904660961",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1399,1),\"\"))","v":1},{"$f":"IF(F1399=1,COUNTIF($F$3:F1399,1),\"\")","v":1397},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1399),$G$3:$G$3716,0)),\"\")","v":"00904660961"}]
[null,null,null,null,"00904661561",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1400,1),\"\"))","v":1},{"$f":"IF(F1400=1,COUNTIF($F$3:F1400,1),\"\")","v":1398},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1400),$G$3:$G$3716,0)),\"\")","v":"00904661561"}]
[null,null,null,null,"00904661761",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1401,1),\"\"))","v":1},{"$f":"IF(F1401=1,COUNTIF($F$3:F1401,1),\"\")","v":1399},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1401),$G$3:$G$3716,0)),\"\")","v":"00904661761"}]
[null,null,null,null,"00904662061",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1402,1),\"\"))","v":1},{"$f":"IF(F1402=1,COUNTIF($F$3:F1402,1),\"\")","v":1400},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1402),$G$3:$G$3716,0)),\"\")","v":"00904662061"}]
[null,null,null,null,"00904662735",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1403,1),\"\"))","v":1},{"$f":"IF(F1403=1,COUNTIF($F$3:F1403,1),\"\")","v":1401},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1403),$G$3:$G$3716,0)),\"\")","v":"00904662735"}]
[null,null,null,null,"00904663661",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1404,1),\"\"))","v":1},{"$f":"IF(F1404=1,COUNTIF($F$3:F1404,1),\"\")","v":1402},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1404),$G$3:$G$3716,0)),\"\")","v":"00904663661"}]
[null,null,null,null,"00904663761",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1405,1),\"\"))","v":1},{"$f":"IF(F1405=1,COUNTIF($F$3:F1405,1),\"\")","v":1403},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1405),$G$3:$G$3716,0)),\"\")","v":"00904663761"}]
[null,null,null,null,"00904663861",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1406,1),\"\"))","v":1},{"$f":"IF(F1406=1,COUNTIF($F$3:F1406,1),\"\")","v":1404},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1406),$G$3:$G$3716,0)),\"\")","v":"00904663861"}]
[null,null,null,null,"00904664061",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1407,1),\"\"))","v":1},{"$f":"IF(F1407=1,COUNTIF($F$3:F1407,1),\"\")","v":1405},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1407),$G$3:$G$3716,0)),\"\")","v":"00904664061"}]
[null,null,null,null,"00904666361",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1408,1),\"\"))","v":1},{"$f":"IF(F1408=1,COUNTIF($F$3:F1408,1),\"\")","v":1406},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1408),$G$3:$G$3716,0)),\"\")","v":"00904666361"}]
[null,null,null,null,"00904666561",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1409,1),\"\"))","v":1},{"$f":"IF(F1409=1,COUNTIF($F$3:F1409,1),\"\")","v":1407},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1409),$G$3:$G$3716,0)),\"\")","v":"00904666561"}]
[null,null,null,null,"00904666661",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1410,1),\"\"))","v":1},{"$f":"IF(F1410=1,COUNTIF($F$3:F1410,1),\"\")","v":1408},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1410),$G$3:$G$3716,0)),\"\")","v":"00904666661"}]
[null,null,null,null,"00904666761",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1411,1),\"\"))","v":1},{"$f":"IF(F1411=1,COUNTIF($F$3:F1411,1),\"\")","v":1409},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1411),$G$3:$G$3716,0)),\"\")","v":"00904666761"}]
[null,null,null,null,"00904667104",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1412,1),\"\"))","v":1},{"$f":"IF(F1412=1,COUNTIF($F$3:F1412,1),\"\")","v":1410},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1412),$G$3:$G$3716,0)),\"\")","v":"00904667104"}]
[null,null,null,null,"00904670310",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1413,1),\"\"))","v":1},{"$f":"IF(F1413=1,COUNTIF($F$3:F1413,1),\"\")","v":1411},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1413),$G$3:$G$3716,0)),\"\")","v":"00904670310"}]
[null,null,null,null,"00904670706",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1414,1),\"\"))","v":1},{"$f":"IF(F1414=1,COUNTIF($F$3:F1414,1),\"\")","v":1412},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1414),$G$3:$G$3716,0)),\"\")","v":"00904670706"}]
[null,null,null,null,"00904672580",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1415,1),\"\"))","v":1},{"$f":"IF(F1415=1,COUNTIF($F$3:F1415,1),\"\")","v":1413},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1415),$G$3:$G$3716,0)),\"\")","v":"00904672580"}]
[null,null,null,null,"00904674759",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1416,1),\"\"))","v":1},{"$f":"IF(F1416=1,COUNTIF($F$3:F1416,1),\"\")","v":1414},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1416),$G$3:$G$3716,0)),\"\")","v":"00904674759"}]
[null,null,null,null,"00904674860",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1417,1),\"\"))","v":1},{"$f":"IF(F1417=1,COUNTIF($F$3:F1417,1),\"\")","v":1415},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1417),$G$3:$G$3716,0)),\"\")","v":"00904674860"}]
[null,null,null,null,"00904676130",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1418,1),\"\"))","v":1},{"$f":"IF(F1418=1,COUNTIF($F$3:F1418,1),\"\")","v":1416},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1418),$G$3:$G$3716,0)),\"\")","v":"00904676130"}]
[null,null,null,null,"00904676605",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1419,1),\"\"))","v":1},{"$f":"IF(F1419=1,COUNTIF($F$3:F1419,1),\"\")","v":1417},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1419),$G$3:$G$3716,0)),\"\")","v":"00904676605"}]
[null,null,null,null,"00904677361",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1420,1),\"\"))","v":1},{"$f":"IF(F1420=1,COUNTIF($F$3:F1420,1),\"\")","v":1418},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1420),$G$3:$G$3716,0)),\"\")","v":"00904677361"}]
[null,null,null,null,"00904677861",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1421,1),\"\"))","v":1},{"$f":"IF(F1421=1,COUNTIF($F$3:F1421,1),\"\")","v":1419},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1421),$G$3:$G$3716,0)),\"\")","v":"00904677861"}]
[null,null,null,null,"00904678370",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1422,1),\"\"))","v":1},{"$f":"IF(F1422=1,COUNTIF($F$3:F1422,1),\"\")","v":1420},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1422),$G$3:$G$3716,0)),\"\")","v":"00904678370"}]
[null,null,null,null,"00904678861",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1423,1),\"\"))","v":1},{"$f":"IF(F1423=1,COUNTIF($F$3:F1423,1),\"\")","v":1421},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1423),$G$3:$G$3716,0)),\"\")","v":"00904678861"}]
[null,null,null,null,"00904679480",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1424,1),\"\"))","v":1},{"$f":"IF(F1424=1,COUNTIF($F$3:F1424,1),\"\")","v":1422},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1424),$G$3:$G$3716,0)),\"\")","v":"00904679480"}]
[null,null,null,null,"00904679489",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1425,1),\"\"))","v":1},{"$f":"IF(F1425=1,COUNTIF($F$3:F1425,1),\"\")","v":1423},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1425),$G$3:$G$3716,0)),\"\")","v":"00904679489"}]
[null,null,null,null,"00904679761",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1426,1),\"\"))","v":1},{"$f":"IF(F1426=1,COUNTIF($F$3:F1426,1),\"\")","v":1424},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1426),$G$3:$G$3716,0)),\"\")","v":"00904679761"}]
[null,null,null,null,"00904679861",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1427,1),\"\"))","v":1},{"$f":"IF(F1427=1,COUNTIF($F$3:F1427,1),\"\")","v":1425},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1427),$G$3:$G$3716,0)),\"\")","v":"00904679861"}]
[null,null,null,null,"00904679961",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1428,1),\"\"))","v":1},{"$f":"IF(F1428=1,COUNTIF($F$3:F1428,1),\"\")","v":1426},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1428),$G$3:$G$3716,0)),\"\")","v":"00904679961"}]
[null,null,null,null,"00904683006",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1429,1),\"\"))","v":1},{"$f":"IF(F1429=1,COUNTIF($F$3:F1429,1),\"\")","v":1427},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1429),$G$3:$G$3716,0)),\"\")","v":"00904683006"}]
[null,null,null,null,"00904685261",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1430,1),\"\"))","v":1},{"$f":"IF(F1430=1,COUNTIF($F$3:F1430,1),\"\")","v":1428},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1430),$G$3:$G$3716,0)),\"\")","v":"00904685261"}]
[null,null,null,null,"00904686061",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1431,1),\"\"))","v":1},{"$f":"IF(F1431=1,COUNTIF($F$3:F1431,1),\"\")","v":1429},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1431),$G$3:$G$3716,0)),\"\")","v":"00904686061"}]
[null,null,null,null,"00904686861",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1432,1),\"\"))","v":1},{"$f":"IF(F1432=1,COUNTIF($F$3:F1432,1),\"\")","v":1430},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1432),$G$3:$G$3716,0)),\"\")","v":"00904686861"}]
[null,null,null,null,"00904690204",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1433,1),\"\"))","v":1},{"$f":"IF(F1433=1,COUNTIF($F$3:F1433,1),\"\")","v":1431},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1433),$G$3:$G$3716,0)),\"\")","v":"00904690204"}]
[null,null,null,null,"00904690706",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1434,1),\"\"))","v":1},{"$f":"IF(F1434=1,COUNTIF($F$3:F1434,1),\"\")","v":1432},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1434),$G$3:$G$3716,0)),\"\")","v":"00904690706"}]
[null,null,null,null,"00904691661",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1435,1),\"\"))","v":1},{"$f":"IF(F1435=1,COUNTIF($F$3:F1435,1),\"\")","v":1433},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1435),$G$3:$G$3716,0)),\"\")","v":"00904691661"}]
[null,null,null,null,"00904692561",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1436,1),\"\"))","v":1},{"$f":"IF(F1436=1,COUNTIF($F$3:F1436,1),\"\")","v":1434},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1436),$G$3:$G$3716,0)),\"\")","v":"00904692561"}]
[null,null,null,null,"00904692661",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1437,1),\"\"))","v":1},{"$f":"IF(F1437=1,COUNTIF($F$3:F1437,1),\"\")","v":1435},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1437),$G$3:$G$3716,0)),\"\")","v":"00904692661"}]
[null,null,null,null,"00904693186",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1438,1),\"\"))","v":1},{"$f":"IF(F1438=1,COUNTIF($F$3:F1438,1),\"\")","v":1436},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1438),$G$3:$G$3716,0)),\"\")","v":"00904693186"}]
[null,null,null,null,"00904695361",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1439,1),\"\"))","v":1},{"$f":"IF(F1439=1,COUNTIF($F$3:F1439,1),\"\")","v":1437},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1439),$G$3:$G$3716,0)),\"\")","v":"00904695361"}]
[null,null,null,null,"00904695461",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1440,1),\"\"))","v":1},{"$f":"IF(F1440=1,COUNTIF($F$3:F1440,1),\"\")","v":1438},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1440),$G$3:$G$3716,0)),\"\")","v":"00904695461"}]
[null,null,null,null,"00904697261",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1441,1),\"\"))","v":1},{"$f":"IF(F1441=1,COUNTIF($F$3:F1441,1),\"\")","v":1439},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1441),$G$3:$G$3716,0)),\"\")","v":"00904697261"}]
[null,null,null,null,"00904699361",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1442,1),\"\"))","v":1},{"$f":"IF(F1442=1,COUNTIF($F$3:F1442,1),\"\")","v":1440},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1442),$G$3:$G$3716,0)),\"\")","v":"00904699361"}]
[null,null,null,null,"00904699880",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1443,1),\"\"))","v":1},{"$f":"IF(F1443=1,COUNTIF($F$3:F1443,1),\"\")","v":1441},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1443),$G$3:$G$3716,0)),\"\")","v":"00904699880"}]
[null,null,null,null,"00904700761",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1444,1),\"\"))","v":1},{"$f":"IF(F1444=1,COUNTIF($F$3:F1444,1),\"\")","v":1442},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1444),$G$3:$G$3716,0)),\"\")","v":"00904700761"}]
[null,null,null,null,"00904703588",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1445,1),\"\"))","v":1},{"$f":"IF(F1445=1,COUNTIF($F$3:F1445,1),\"\")","v":1443},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1445),$G$3:$G$3716,0)),\"\")","v":"00904703588"}]
[null,null,null,null,"00904703604",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1446,1),\"\"))","v":1},{"$f":"IF(F1446=1,COUNTIF($F$3:F1446,1),\"\")","v":1444},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1446),$G$3:$G$3716,0)),\"\")","v":"00904703604"}]
[null,null,null,null,"00904704304",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1447,1),\"\"))","v":1},{"$f":"IF(F1447=1,COUNTIF($F$3:F1447,1),\"\")","v":1445},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1447),$G$3:$G$3716,0)),\"\")","v":"00904704304"}]
[null,null,null,null,"00904704361",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1448,1),\"\"))","v":1},{"$f":"IF(F1448=1,COUNTIF($F$3:F1448,1),\"\")","v":1446},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1448),$G$3:$G$3716,0)),\"\")","v":"00904704361"}]
[null,null,null,null,"00904704461",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1449,1),\"\"))","v":1},{"$f":"IF(F1449=1,COUNTIF($F$3:F1449,1),\"\")","v":1447},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1449),$G$3:$G$3716,0)),\"\")","v":"00904704461"}]
[null,null,null,null,"00904704761",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1450,1),\"\"))","v":1},{"$f":"IF(F1450=1,COUNTIF($F$3:F1450,1),\"\")","v":1448},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1450),$G$3:$G$3716,0)),\"\")","v":"00904704761"}]
[null,null,null,null,"00904704861",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1451,1),\"\"))","v":1},{"$f":"IF(F1451=1,COUNTIF($F$3:F1451,1),\"\")","v":1449},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1451),$G$3:$G$3716,0)),\"\")","v":"00904704861"}]
[null,null,null,null,"00904705361",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1452,1),\"\"))","v":1},{"$f":"IF(F1452=1,COUNTIF($F$3:F1452,1),\"\")","v":1450},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1452),$G$3:$G$3716,0)),\"\")","v":"00904705361"}]
[null,null,null,null,"00904706188",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1453,1),\"\"))","v":1},{"$f":"IF(F1453=1,COUNTIF($F$3:F1453,1),\"\")","v":1451},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1453),$G$3:$G$3716,0)),\"\")","v":"00904706188"}]
[null,null,null,null,"00904708061",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1454,1),\"\"))","v":1},{"$f":"IF(F1454=1,COUNTIF($F$3:F1454,1),\"\")","v":1452},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1454),$G$3:$G$3716,0)),\"\")","v":"00904708061"}]
[null,null,null,null,"00904708106",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1455,1),\"\"))","v":1},{"$f":"IF(F1455=1,COUNTIF($F$3:F1455,1),\"\")","v":1453},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1455),$G$3:$G$3716,0)),\"\")","v":"00904708106"}]
[null,null,null,null,"00904708161",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1456,1),\"\"))","v":1},{"$f":"IF(F1456=1,COUNTIF($F$3:F1456,1),\"\")","v":1454},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1456),$G$3:$G$3716,0)),\"\")","v":"00904708161"}]
[null,null,null,null,"00904708204",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1457,1),\"\"))","v":1},{"$f":"IF(F1457=1,COUNTIF($F$3:F1457,1),\"\")","v":1455},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1457),$G$3:$G$3716,0)),\"\")","v":"00904708204"}]
[null,null,null,null,"00904710561",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1458,1),\"\"))","v":1},{"$f":"IF(F1458=1,COUNTIF($F$3:F1458,1),\"\")","v":1456},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1458),$G$3:$G$3716,0)),\"\")","v":"00904710561"}]
[null,null,null,null,"00904711561",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1459,1),\"\"))","v":1},{"$f":"IF(F1459=1,COUNTIF($F$3:F1459,1),\"\")","v":1457},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1459),$G$3:$G$3716,0)),\"\")","v":"00904711561"}]
[null,null,null,null,"00904714260",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1460,1),\"\"))","v":1},{"$f":"IF(F1460=1,COUNTIF($F$3:F1460,1),\"\")","v":1458},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1460),$G$3:$G$3716,0)),\"\")","v":"00904714260"}]
[null,null,null,null,"00904715661",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1461,1),\"\"))","v":1},{"$f":"IF(F1461=1,COUNTIF($F$3:F1461,1),\"\")","v":1459},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1461),$G$3:$G$3716,0)),\"\")","v":"00904715661"}]
[null,null,null,null,"00904716261",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1462,1),\"\"))","v":1},{"$f":"IF(F1462=1,COUNTIF($F$3:F1462,1),\"\")","v":1460},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1462),$G$3:$G$3716,0)),\"\")","v":"00904716261"}]
[null,null,null,null,"00904759160",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1463,1),\"\"))","v":1},{"$f":"IF(F1463=1,COUNTIF($F$3:F1463,1),\"\")","v":1461},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1463),$G$3:$G$3716,0)),\"\")","v":"00904759160"}]
[null,null,null,null,"00904759161",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1464,1),\"\"))","v":1},{"$f":"IF(F1464=1,COUNTIF($F$3:F1464,1),\"\")","v":1462},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1464),$G$3:$G$3716,0)),\"\")","v":"00904759161"}]
[null,null,null,null,"00904759180",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1465,1),\"\"))","v":1},{"$f":"IF(F1465=1,COUNTIF($F$3:F1465,1),\"\")","v":1463},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1465),$G$3:$G$3716,0)),\"\")","v":"00904759180"}]
[null,null,null,null,"00904762331",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1466,1),\"\"))","v":1},{"$f":"IF(F1466=1,COUNTIF($F$3:F1466,1),\"\")","v":1464},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1466),$G$3:$G$3716,0)),\"\")","v":"00904762331"}]
[null,null,null,null,"00904768822",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1467,1),\"\"))","v":1},{"$f":"IF(F1467=1,COUNTIF($F$3:F1467,1),\"\")","v":1465},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1467),$G$3:$G$3716,0)),\"\")","v":"00904768822"}]
[null,null,null,null,"00904770480",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1468,1),\"\"))","v":1},{"$f":"IF(F1468=1,COUNTIF($F$3:F1468,1),\"\")","v":1466},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1468),$G$3:$G$3716,0)),\"\")","v":"00904770480"}]
[null,null,null,null,"00904780961",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1469,1),\"\"))","v":1},{"$f":"IF(F1469=1,COUNTIF($F$3:F1469,1),\"\")","v":1467},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1469),$G$3:$G$3716,0)),\"\")","v":"00904780961"}]
[null,null,null,null,"00904782231",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1470,1),\"\"))","v":1},{"$f":"IF(F1470=1,COUNTIF($F$3:F1470,1),\"\")","v":1468},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1470),$G$3:$G$3716,0)),\"\")","v":"00904782231"}]
[null,null,null,null,"00904782236",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1471,1),\"\"))","v":1},{"$f":"IF(F1471=1,COUNTIF($F$3:F1471,1),\"\")","v":1469},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1471),$G$3:$G$3716,0)),\"\")","v":"00904782236"}]
[null,null,null,null,"00904791259",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1472,1),\"\"))","v":1},{"$f":"IF(F1472=1,COUNTIF($F$3:F1472,1),\"\")","v":1470},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1472),$G$3:$G$3716,0)),\"\")","v":"00904791259"}]
[null,null,null,null,"00904791461",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1473,1),\"\"))","v":1},{"$f":"IF(F1473=1,COUNTIF($F$3:F1473,1),\"\")","v":1471},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1473),$G$3:$G$3716,0)),\"\")","v":"00904791461"}]
[null,null,null,null,"00904791580",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1474,1),\"\"))","v":1},{"$f":"IF(F1474=1,COUNTIF($F$3:F1474,1),\"\")","v":1472},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1474),$G$3:$G$3716,0)),\"\")","v":"00904791580"}]
[null,null,null,null,"00904792761",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1475,1),\"\"))","v":1},{"$f":"IF(F1475=1,COUNTIF($F$3:F1475,1),\"\")","v":1473},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1475),$G$3:$G$3716,0)),\"\")","v":"00904792761"}]
[null,null,null,null,"00955105027",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1476,1),\"\"))","v":1},{"$f":"IF(F1476=1,COUNTIF($F$3:F1476,1),\"\")","v":1474},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1476),$G$3:$G$3716,0)),\"\")","v":"00955105027"}]
[null,null,null,null,"00955173730",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1477,1),\"\"))","v":1},{"$f":"IF(F1477=1,COUNTIF($F$3:F1477,1),\"\")","v":1475},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1477),$G$3:$G$3716,0)),\"\")","v":"00955173730"}]
[null,null,null,null,"00990793519",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1478,1),\"\"))","v":1},{"$f":"IF(F1478=1,COUNTIF($F$3:F1478,1),\"\")","v":1476},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1478),$G$3:$G$3716,0)),\"\")","v":"00990793519"}]
[null,null,null,null,"00998020415",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1479,1),\"\"))","v":1},{"$f":"IF(F1479=1,COUNTIF($F$3:F1479,1),\"\")","v":1477},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1479),$G$3:$G$3716,0)),\"\")","v":"00998020415"}]
[null,null,null,null,"00998020615",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1480,1),\"\"))","v":1},{"$f":"IF(F1480=1,COUNTIF($F$3:F1480,1),\"\")","v":1478},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1480),$G$3:$G$3716,0)),\"\")","v":"00998020615"}]
[null,null,null,null,"01490003904",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1481,1),\"\"))","v":1},{"$f":"IF(F1481=1,COUNTIF($F$3:F1481,1),\"\")","v":1479},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1481),$G$3:$G$3716,0)),\"\")","v":"01490003904"}]
[null,null,null,null,"01490003908",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1482,1),\"\"))","v":1},{"$f":"IF(F1482=1,COUNTIF($F$3:F1482,1),\"\")","v":1480},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1482),$G$3:$G$3716,0)),\"\")","v":"01490003908"}]
[null,null,null,null,"01490085602",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1483,1),\"\"))","v":1},{"$f":"IF(F1483=1,COUNTIF($F$3:F1483,1),\"\")","v":1481},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1483),$G$3:$G$3716,0)),\"\")","v":"01490085602"}]
[null,null,null,null,"01870074631",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1484,1),\"\"))","v":1},{"$f":"IF(F1484=1,COUNTIF($F$3:F1484,1),\"\")","v":1482},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1484),$G$3:$G$3716,0)),\"\")","v":"01870074631"}]
[null,null,null,null,"01870074633",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1485,1),\"\"))","v":1},{"$f":"IF(F1485=1,COUNTIF($F$3:F1485,1),\"\")","v":1483},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1485),$G$3:$G$3716,0)),\"\")","v":"01870074633"}]
[null,null,null,null,"05047450858",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1486,1),\"\"))","v":1},{"$f":"IF(F1486=1,COUNTIF($F$3:F1486,1),\"\")","v":1484},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1486),$G$3:$G$3716,0)),\"\")","v":"05047450858"}]
[null,null,null,null,"05074250501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1487,1),\"\"))","v":1},{"$f":"IF(F1487=1,COUNTIF($F$3:F1487,1),\"\")","v":1485},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1487),$G$3:$G$3716,0)),\"\")","v":"05074250501"}]
[null,null,null,null,"05664119850",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1488,1),\"\"))","v":1},{"$f":"IF(F1488=1,COUNTIF($F$3:F1488,1),\"\")","v":1486},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1488),$G$3:$G$3716,0)),\"\")","v":"05664119850"}]
[null,null,null,null,"08065183055",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1489,1),\"\"))","v":1},{"$f":"IF(F1489=1,COUNTIF($F$3:F1489,1),\"\")","v":1487},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1489),$G$3:$G$3716,0)),\"\")","v":"08065183055"}]
[null,null,null,null,"08065183135",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1490,1),\"\"))","v":1},{"$f":"IF(F1490=1,COUNTIF($F$3:F1490,1),\"\")","v":1488},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1490),$G$3:$G$3716,0)),\"\")","v":"08065183135"}]
[null,null,null,null,"08065183150",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1491,1),\"\"))","v":1},{"$f":"IF(F1491=1,COUNTIF($F$3:F1491,1),\"\")","v":1489},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1491),$G$3:$G$3716,0)),\"\")","v":"08065183150"}]
[null,null,null,null,"08290309628",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1492,1),\"\"))","v":1},{"$f":"IF(F1492=1,COUNTIF($F$3:F1492,1),\"\")","v":1490},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1492),$G$3:$G$3716,0)),\"\")","v":"08290309628"}]
[null,null,null,null,"10006070034",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1493,1),\"\"))","v":1},{"$f":"IF(F1493=1,COUNTIF($F$3:F1493,1),\"\")","v":1491},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1493),$G$3:$G$3716,0)),\"\")","v":"10006070034"}]
[null,null,null,null,"10006073038",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1494,1),\"\"))","v":1},{"$f":"IF(F1494=1,COUNTIF($F$3:F1494,1),\"\")","v":1492},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1494),$G$3:$G$3716,0)),\"\")","v":"10006073038"}]
[null,null,null,null,"10019005561",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1495,1),\"\"))","v":1},{"$f":"IF(F1495=1,COUNTIF($F$3:F1495,1),\"\")","v":1493},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1495),$G$3:$G$3716,0)),\"\")","v":"10019005561"}]
[null,null,null,null,"10019007587",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1496,1),\"\"))","v":1},{"$f":"IF(F1496=1,COUNTIF($F$3:F1496,1),\"\")","v":1494},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1496),$G$3:$G$3716,0)),\"\")","v":"10019007587"}]
[null,null,null,null,"10019055303",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1497,1),\"\"))","v":1},{"$f":"IF(F1497=1,COUNTIF($F$3:F1497,1),\"\")","v":1495},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1497),$G$3:$G$3716,0)),\"\")","v":"10019055303"}]
[null,null,null,null,"10019055390",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1498,1),\"\"))","v":1},{"$f":"IF(F1498=1,COUNTIF($F$3:F1498,1),\"\")","v":1496},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1498),$G$3:$G$3716,0)),\"\")","v":"10019055390"}]
[null,null,null,null,"10119002003",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1499,1),\"\"))","v":1},{"$f":"IF(F1499=1,COUNTIF($F$3:F1499,1),\"\")","v":1497},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1499),$G$3:$G$3716,0)),\"\")","v":"10119002003"}]
[null,null,null,null,"10122032501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1500,1),\"\"))","v":1},{"$f":"IF(F1500=1,COUNTIF($F$3:F1500,1),\"\")","v":1498},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1500),$G$3:$G$3716,0)),\"\")","v":"10122032501"}]
[null,null,null,null,"10122032510",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1501,1),\"\"))","v":1},{"$f":"IF(F1501=1,COUNTIF($F$3:F1501,1),\"\")","v":1499},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1501),$G$3:$G$3716,0)),\"\")","v":"10122032510"}]
[null,null,null,null,"10122051001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1502,1),\"\"))","v":1},{"$f":"IF(F1502=1,COUNTIF($F$3:F1502,1),\"\")","v":1500},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1502),$G$3:$G$3716,0)),\"\")","v":"10122051001"}]
[null,null,null,null,"10122051003",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1503,1),\"\"))","v":1},{"$f":"IF(F1503=1,COUNTIF($F$3:F1503,1),\"\")","v":1501},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1503),$G$3:$G$3716,0)),\"\")","v":"10122051003"}]
[null,null,null,null,"10122061001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1504,1),\"\"))","v":1},{"$f":"IF(F1504=1,COUNTIF($F$3:F1504,1),\"\")","v":1502},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1504),$G$3:$G$3716,0)),\"\")","v":"10122061001"}]
[null,null,null,null,"10147075004",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1505,1),\"\"))","v":1},{"$f":"IF(F1505=1,COUNTIF($F$3:F1505,1),\"\")","v":1503},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1505),$G$3:$G$3716,0)),\"\")","v":"10147075004"}]
[null,null,null,null,"10147088106",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1506,1),\"\"))","v":1},{"$f":"IF(F1506=1,COUNTIF($F$3:F1506,1),\"\")","v":1504},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1506),$G$3:$G$3716,0)),\"\")","v":"10147088106"}]
[null,null,null,null,"10147170003",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1507,1),\"\"))","v":1},{"$f":"IF(F1507=1,COUNTIF($F$3:F1507,1),\"\")","v":1505},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1507),$G$3:$G$3716,0)),\"\")","v":"10147170003"}]
[null,null,null,null,"10370083109",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1508,1),\"\"))","v":1},{"$f":"IF(F1508=1,COUNTIF($F$3:F1508,1),\"\")","v":1506},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1508),$G$3:$G$3716,0)),\"\")","v":"10370083109"}]
[null,null,null,null,"10702001101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1509,1),\"\"))","v":1},{"$f":"IF(F1509=1,COUNTIF($F$3:F1509,1),\"\")","v":1507},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1509),$G$3:$G$3716,0)),\"\")","v":"10702001101"}]
[null,null,null,null,"10702006501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1510,1),\"\"))","v":1},{"$f":"IF(F1510=1,COUNTIF($F$3:F1510,1),\"\")","v":1508},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1510),$G$3:$G$3716,0)),\"\")","v":"10702006501"}]
[null,null,null,null,"10702010001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1511,1),\"\"))","v":1},{"$f":"IF(F1511=1,COUNTIF($F$3:F1511,1),\"\")","v":1509},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1511),$G$3:$G$3716,0)),\"\")","v":"10702010001"}]
[null,null,null,null,"10939079411",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1512,1),\"\"))","v":1},{"$f":"IF(F1512=1,COUNTIF($F$3:F1512,1),\"\")","v":1510},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1512),$G$3:$G$3716,0)),\"\")","v":"10939079411"}]
[null,null,null,null,"11086003010",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1513,1),\"\"))","v":1},{"$f":"IF(F1513=1,COUNTIF($F$3:F1513,1),\"\")","v":1511},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1513),$G$3:$G$3716,0)),\"\")","v":"11086003010"}]
[null,null,null,null,"11523723403",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1514,1),\"\"))","v":1},{"$f":"IF(F1514=1,COUNTIF($F$3:F1514,1),\"\")","v":1512},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1514),$G$3:$G$3716,0)),\"\")","v":"11523723403"}]
[null,null,null,null,"11534016501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1515,1),\"\"))","v":1},{"$f":"IF(F1515=1,COUNTIF($F$3:F1515,1),\"\")","v":1513},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1515),$G$3:$G$3716,0)),\"\")","v":"11534016501"}]
[null,null,null,null,"11704037001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1516,1),\"\"))","v":1},{"$f":"IF(F1516=1,COUNTIF($F$3:F1516,1),\"\")","v":1514},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1516),$G$3:$G$3716,0)),\"\")","v":"11704037001"}]
[null,null,null,null,"11788000101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1517,1),\"\"))","v":1},{"$f":"IF(F1517=1,COUNTIF($F$3:F1517,1),\"\")","v":1515},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1517),$G$3:$G$3716,0)),\"\")","v":"11788000101"}]
[null,null,null,null,"11788001001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1518,1),\"\"))","v":1},{"$f":"IF(F1518=1,COUNTIF($F$3:F1518,1),\"\")","v":1516},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1518),$G$3:$G$3716,0)),\"\")","v":"11788001001"}]
[null,null,null,null,"11845009151",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1519,1),\"\"))","v":1},{"$f":"IF(F1519=1,COUNTIF($F$3:F1519,1),\"\")","v":1517},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1519),$G$3:$G$3716,0)),\"\")","v":"11845009151"}]
[null,null,null,null,"11845050501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1520,1),\"\"))","v":1},{"$f":"IF(F1520=1,COUNTIF($F$3:F1520,1),\"\")","v":1518},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1520),$G$3:$G$3716,0)),\"\")","v":"11845050501"}]
[null,null,null,null,"11845071401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1521,1),\"\"))","v":1},{"$f":"IF(F1521=1,COUNTIF($F$3:F1521,1),\"\")","v":1519},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1521),$G$3:$G$3716,0)),\"\")","v":"11845071401"}]
[null,null,null,null,"11980017405",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1522,1),\"\"))","v":1},{"$f":"IF(F1522=1,COUNTIF($F$3:F1522,1),\"\")","v":1520},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1522),$G$3:$G$3716,0)),\"\")","v":"11980017405"}]
[null,null,null,null,"12870000101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1523,1),\"\"))","v":1},{"$f":"IF(F1523=1,COUNTIF($F$3:F1523,1),\"\")","v":1521},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1523),$G$3:$G$3716,0)),\"\")","v":"12870000101"}]
[null,null,null,null,"12870000102",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1524,1),\"\"))","v":1},{"$f":"IF(F1524=1,COUNTIF($F$3:F1524,1),\"\")","v":1522},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1524),$G$3:$G$3716,0)),\"\")","v":"12870000102"}]
[null,null,null,null,"13273021003",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1525,1),\"\"))","v":1},{"$f":"IF(F1525=1,COUNTIF($F$3:F1525,1),\"\")","v":1523},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1525),$G$3:$G$3716,0)),\"\")","v":"13273021003"}]
[null,null,null,null,"13310015307",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1526,1),\"\"))","v":1},{"$f":"IF(F1526=1,COUNTIF($F$3:F1526,1),\"\")","v":1524},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1526),$G$3:$G$3716,0)),\"\")","v":"13310015307"}]
[null,null,null,null,"13668004501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1527,1),\"\"))","v":1},{"$f":"IF(F1527=1,COUNTIF($F$3:F1527,1),\"\")","v":1525},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1527),$G$3:$G$3716,0)),\"\")","v":"13668004501"}]
[null,null,null,null,"13668008030",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1528,1),\"\"))","v":1},{"$f":"IF(F1528=1,COUNTIF($F$3:F1528,1),\"\")","v":1526},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1528),$G$3:$G$3716,0)),\"\")","v":"13668008030"}]
[null,null,null,null,"13668009190",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1529,1),\"\"))","v":1},{"$f":"IF(F1529=1,COUNTIF($F$3:F1529,1),\"\")","v":1527},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1529),$G$3:$G$3716,0)),\"\")","v":"13668009190"}]
[null,null,null,null,"13668009490",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1530,1),\"\"))","v":1},{"$f":"IF(F1530=1,COUNTIF($F$3:F1530,1),\"\")","v":1528},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1530),$G$3:$G$3716,0)),\"\")","v":"13668009490"}]
[null,null,null,null,"13668013301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1531,1),\"\"))","v":1},{"$f":"IF(F1531=1,COUNTIF($F$3:F1531,1),\"\")","v":1529},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1531),$G$3:$G$3716,0)),\"\")","v":"13668013301"}]
[null,null,null,null,"13668045301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1532,1),\"\"))","v":1},{"$f":"IF(F1532=1,COUNTIF($F$3:F1532,1),\"\")","v":1530},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1532),$G$3:$G$3716,0)),\"\")","v":"13668045301"}]
[null,null,null,null,"13668048450",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1533,1),\"\"))","v":1},{"$f":"IF(F1533=1,COUNTIF($F$3:F1533,1),\"\")","v":1531},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1533),$G$3:$G$3716,0)),\"\")","v":"13668048450"}]
[null,null,null,null,"13668060601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1534,1),\"\"))","v":1},{"$f":"IF(F1534=1,COUNTIF($F$3:F1534,1),\"\")","v":1532},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1534),$G$3:$G$3716,0)),\"\")","v":"13668060601"}]
[null,null,null,null,"13811052501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1535,1),\"\"))","v":1},{"$f":"IF(F1535=1,COUNTIF($F$3:F1535,1),\"\")","v":1533},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1535),$G$3:$G$3716,0)),\"\")","v":"13811052501"}]
[null,null,null,null,"13845120202",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1536,1),\"\"))","v":1},{"$f":"IF(F1536=1,COUNTIF($F$3:F1536,1),\"\")","v":1534},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1536),$G$3:$G$3716,0)),\"\")","v":"13845120202"}]
[null,null,null,null,"13925050530",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1537,1),\"\"))","v":1},{"$f":"IF(F1537=1,COUNTIF($F$3:F1537,1),\"\")","v":1535},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1537),$G$3:$G$3716,0)),\"\")","v":"13925050530"}]
[null,null,null,null,"14428000888",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1538,1),\"\"))","v":1},{"$f":"IF(F1538=1,COUNTIF($F$3:F1538,1),\"\")","v":1536},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1538),$G$3:$G$3716,0)),\"\")","v":"14428000888"}]
[null,null,null,null,"15584010101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1539,1),\"\"))","v":1},{"$f":"IF(F1539=1,COUNTIF($F$3:F1539,1),\"\")","v":1537},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1539),$G$3:$G$3716,0)),\"\")","v":"15584010101"}]
[null,null,null,null,"16252051401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1540,1),\"\"))","v":1},{"$f":"IF(F1540=1,COUNTIF($F$3:F1540,1),\"\")","v":1538},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1540),$G$3:$G$3716,0)),\"\")","v":"16252051401"}]
[null,null,null,null,"16500007909",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1541,1),\"\"))","v":1},{"$f":"IF(F1541=1,COUNTIF($F$3:F1541,1),\"\")","v":1539},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1541),$G$3:$G$3716,0)),\"\")","v":"16500007909"}]
[null,null,null,null,"16571016010",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1542,1),\"\"))","v":1},{"$f":"IF(F1542=1,COUNTIF($F$3:F1542,1),\"\")","v":1540},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1542),$G$3:$G$3716,0)),\"\")","v":"16571016010"}]
[null,null,null,null,"16571016110",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1543,1),\"\"))","v":1},{"$f":"IF(F1543=1,COUNTIF($F$3:F1543,1),\"\")","v":1541},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1543),$G$3:$G$3716,0)),\"\")","v":"16571016110"}]
[null,null,null,null,"16571033016",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1544,1),\"\"))","v":1},{"$f":"IF(F1544=1,COUNTIF($F$3:F1544,1),\"\")","v":1542},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1544),$G$3:$G$3716,0)),\"\")","v":"16571033016"}]
[null,null,null,null,"16571066101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1545,1),\"\"))","v":1},{"$f":"IF(F1545=1,COUNTIF($F$3:F1545,1),\"\")","v":1543},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1545),$G$3:$G$3716,0)),\"\")","v":"16571066101"}]
[null,null,null,null,"16729000101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1546,1),\"\"))","v":1},{"$f":"IF(F1546=1,COUNTIF($F$3:F1546,1),\"\")","v":1544},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1546),$G$3:$G$3716,0)),\"\")","v":"16729000101"}]
[null,null,null,null,"16729003001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1547,1),\"\"))","v":1},{"$f":"IF(F1547=1,COUNTIF($F$3:F1547,1),\"\")","v":1545},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1547),$G$3:$G$3716,0)),\"\")","v":"16729003001"}]
[null,null,null,null,"16729003410",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1548,1),\"\"))","v":1},{"$f":"IF(F1548=1,COUNTIF($F$3:F1548,1),\"\")","v":1546},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1548),$G$3:$G$3716,0)),\"\")","v":"16729003410"}]
[null,null,null,null,"16729009015",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1549,1),\"\"))","v":1},{"$f":"IF(F1549=1,COUNTIF($F$3:F1549,1),\"\")","v":1547},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1549),$G$3:$G$3716,0)),\"\")","v":"16729009015"}]
[null,null,null,null,"16729013600",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1550,1),\"\"))","v":1},{"$f":"IF(F1550=1,COUNTIF($F$3:F1550,1),\"\")","v":1548},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1550),$G$3:$G$3716,0)),\"\")","v":"16729013600"}]
[null,null,null,null,"16729017101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1551,1),\"\"))","v":1},{"$f":"IF(F1551=1,COUNTIF($F$3:F1551,1),\"\")","v":1549},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1551),$G$3:$G$3716,0)),\"\")","v":"16729017101"}]
[null,null,null,null,"16729018301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1552,1),\"\"))","v":1},{"$f":"IF(F1552=1,COUNTIF($F$3:F1552,1),\"\")","v":1550},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1552),$G$3:$G$3716,0)),\"\")","v":"16729018301"}]
[null,null,null,null,"16729020001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1553,1),\"\"))","v":1},{"$f":"IF(F1553=1,COUNTIF($F$3:F1553,1),\"\")","v":1551},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1553),$G$3:$G$3716,0)),\"\")","v":"16729020001"}]
[null,null,null,null,"16729021615",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1554,1),\"\"))","v":1},{"$f":"IF(F1554=1,COUNTIF($F$3:F1554,1),\"\")","v":1552},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1554),$G$3:$G$3716,0)),\"\")","v":"16729021615"}]
[null,null,null,null,"16729022516",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1555,1),\"\"))","v":1},{"$f":"IF(F1555=1,COUNTIF($F$3:F1555,1),\"\")","v":1553},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1555),$G$3:$G$3716,0)),\"\")","v":"16729022516"}]
[null,null,null,null,"17238061015",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1556,1),\"\"))","v":1},{"$f":"IF(F1556=1,COUNTIF($F$3:F1556,1),\"\")","v":1554},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1556),$G$3:$G$3716,0)),\"\")","v":"17238061015"}]
[null,null,null,null,"17238090011",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1557,1),\"\"))","v":1},{"$f":"IF(F1557=1,COUNTIF($F$3:F1557,1),\"\")","v":1555},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1557),$G$3:$G$3716,0)),\"\")","v":"17238090011"}]
[null,null,null,null,"17478006235",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1558,1),\"\"))","v":1},{"$f":"IF(F1558=1,COUNTIF($F$3:F1558,1),\"\")","v":1556},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1558),$G$3:$G$3716,0)),\"\")","v":"17478006235"}]
[null,null,null,null,"17478006412",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1559,1),\"\"))","v":1},{"$f":"IF(F1559=1,COUNTIF($F$3:F1559,1),\"\")","v":1557},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1559),$G$3:$G$3716,0)),\"\")","v":"17478006412"}]
[null,null,null,null,"17478007031",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1560,1),\"\"))","v":1},{"$f":"IF(F1560=1,COUNTIF($F$3:F1560,1),\"\")","v":1558},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1560),$G$3:$G$3716,0)),\"\")","v":"17478007031"}]
[null,null,null,null,"17478009702",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1561,1),\"\"))","v":1},{"$f":"IF(F1561=1,COUNTIF($F$3:F1561,1),\"\")","v":1559},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1561),$G$3:$G$3716,0)),\"\")","v":"17478009702"}]
[null,null,null,null,"17478010002",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1562,1),\"\"))","v":1},{"$f":"IF(F1562=1,COUNTIF($F$3:F1562,1),\"\")","v":1560},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1562),$G$3:$G$3716,0)),\"\")","v":"17478010002"}]
[null,null,null,null,"17478010012",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1563,1),\"\"))","v":1},{"$f":"IF(F1563=1,COUNTIF($F$3:F1563,1),\"\")","v":1561},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1563),$G$3:$G$3716,0)),\"\")","v":"17478010012"}]
[null,null,null,null,"17478010112",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1564,1),\"\"))","v":1},{"$f":"IF(F1564=1,COUNTIF($F$3:F1564,1),\"\")","v":1562},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1564),$G$3:$G$3716,0)),\"\")","v":"17478010112"}]
[null,null,null,null,"17478010212",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1565,1),\"\"))","v":1},{"$f":"IF(F1565=1,COUNTIF($F$3:F1565,1),\"\")","v":1563},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1565),$G$3:$G$3716,0)),\"\")","v":"17478010212"}]
[null,null,null,null,"17478015142",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1566,1),\"\"))","v":1},{"$f":"IF(F1566=1,COUNTIF($F$3:F1566,1),\"\")","v":1564},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1566),$G$3:$G$3716,0)),\"\")","v":"17478015142"}]
[null,null,null,null,"17478020020",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1567,1),\"\"))","v":1},{"$f":"IF(F1567=1,COUNTIF($F$3:F1567,1),\"\")","v":1565},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1567),$G$3:$G$3716,0)),\"\")","v":"17478020020"}]
[null,null,null,null,"17478020115",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1568,1),\"\"))","v":1},{"$f":"IF(F1568=1,COUNTIF($F$3:F1568,1),\"\")","v":1566},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1568),$G$3:$G$3716,0)),\"\")","v":"17478020115"}]
[null,null,null,null,"17478020510",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1569,1),\"\"))","v":1},{"$f":"IF(F1569=1,COUNTIF($F$3:F1569,1),\"\")","v":1567},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1569),$G$3:$G$3716,0)),\"\")","v":"17478020510"}]
[null,null,null,null,"17478020810",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1570,1),\"\"))","v":1},{"$f":"IF(F1570=1,COUNTIF($F$3:F1570,1),\"\")","v":1568},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1570),$G$3:$G$3716,0)),\"\")","v":"17478020810"}]
[null,null,null,null,"17478021410",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1571,1),\"\"))","v":1},{"$f":"IF(F1571=1,COUNTIF($F$3:F1571,1),\"\")","v":1569},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1571),$G$3:$G$3716,0)),\"\")","v":"17478021410"}]
[null,null,null,null,"17478021505",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1572,1),\"\"))","v":1},{"$f":"IF(F1572=1,COUNTIF($F$3:F1572,1),\"\")","v":1570},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1572),$G$3:$G$3716,0)),\"\")","v":"17478021505"}]
[null,null,null,null,"17478023835",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1573,1),\"\"))","v":1},{"$f":"IF(F1573=1,COUNTIF($F$3:F1573,1),\"\")","v":1571},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1573),$G$3:$G$3716,0)),\"\")","v":"17478023835"}]
[null,null,null,null,"17478026312",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1574,1),\"\"))","v":1},{"$f":"IF(F1574=1,COUNTIF($F$3:F1574,1),\"\")","v":1572},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1574),$G$3:$G$3716,0)),\"\")","v":"17478026312"}]
[null,null,null,null,"17478028310",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1575,1),\"\"))","v":1},{"$f":"IF(F1575=1,COUNTIF($F$3:F1575,1),\"\")","v":1573},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1575),$G$3:$G$3716,0)),\"\")","v":"17478028310"}]
[null,null,null,null,"17478028435",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1576,1),\"\"))","v":1},{"$f":"IF(F1576=1,COUNTIF($F$3:F1576,1),\"\")","v":1574},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1576),$G$3:$G$3716,0)),\"\")","v":"17478028435"}]
[null,null,null,null,"17478028810",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1577,1),\"\"))","v":1},{"$f":"IF(F1577=1,COUNTIF($F$3:F1577,1),\"\")","v":1575},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1577),$G$3:$G$3716,0)),\"\")","v":"17478028810"}]
[null,null,null,null,"17478028811",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1578,1),\"\"))","v":1},{"$f":"IF(F1578=1,COUNTIF($F$3:F1578,1),\"\")","v":1576},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1578),$G$3:$G$3716,0)),\"\")","v":"17478028811"}]
[null,null,null,null,"17478029010",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1579,1),\"\"))","v":1},{"$f":"IF(F1579=1,COUNTIF($F$3:F1579,1),\"\")","v":1577},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1579),$G$3:$G$3716,0)),\"\")","v":"17478029010"}]
[null,null,null,null,"17478040401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1580,1),\"\"))","v":1},{"$f":"IF(F1580=1,COUNTIF($F$3:F1580,1),\"\")","v":1578},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1580),$G$3:$G$3716,0)),\"\")","v":"17478040401"}]
[null,null,null,null,"17478060510",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1581,1),\"\"))","v":1},{"$f":"IF(F1581=1,COUNTIF($F$3:F1581,1),\"\")","v":1579},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1581),$G$3:$G$3716,0)),\"\")","v":"17478060510"}]
[null,null,null,null,"17478062312",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1582,1),\"\"))","v":1},{"$f":"IF(F1582=1,COUNTIF($F$3:F1582,1),\"\")","v":1580},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1582),$G$3:$G$3716,0)),\"\")","v":"17478062312"}]
[null,null,null,null,"17478062512",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1583,1),\"\"))","v":1},{"$f":"IF(F1583=1,COUNTIF($F$3:F1583,1),\"\")","v":1581},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1583),$G$3:$G$3716,0)),\"\")","v":"17478062512"}]
[null,null,null,null,"17478070311",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1584,1),\"\"))","v":1},{"$f":"IF(F1584=1,COUNTIF($F$3:F1584,1),\"\")","v":1582},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1584),$G$3:$G$3716,0)),\"\")","v":"17478070311"}]
[null,null,null,null,"17478071110",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1585,1),\"\"))","v":1},{"$f":"IF(F1585=1,COUNTIF($F$3:F1585,1),\"\")","v":1583},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1585),$G$3:$G$3716,0)),\"\")","v":"17478071110"}]
[null,null,null,null,"17478071130",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1586,1),\"\"))","v":1},{"$f":"IF(F1586=1,COUNTIF($F$3:F1586,1),\"\")","v":1584},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1586),$G$3:$G$3716,0)),\"\")","v":"17478071130"}]
[null,null,null,null,"17478071310",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1587,1),\"\"))","v":1},{"$f":"IF(F1587=1,COUNTIF($F$3:F1587,1),\"\")","v":1585},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1587),$G$3:$G$3716,0)),\"\")","v":"17478071310"}]
[null,null,null,null,"17478071610",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1588,1),\"\"))","v":1},{"$f":"IF(F1588=1,COUNTIF($F$3:F1588,1),\"\")","v":1586},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1588),$G$3:$G$3716,0)),\"\")","v":"17478071610"}]
[null,null,null,null,"17478071710",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1589,1),\"\"))","v":1},{"$f":"IF(F1589=1,COUNTIF($F$3:F1589,1),\"\")","v":1587},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1589),$G$3:$G$3716,0)),\"\")","v":"17478071710"}]
[null,null,null,null,"17478074202",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1590,1),\"\"))","v":1},{"$f":"IF(F1590=1,COUNTIF($F$3:F1590,1),\"\")","v":1588},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1590),$G$3:$G$3716,0)),\"\")","v":"17478074202"}]
[null,null,null,null,"17478076610",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1591,1),\"\"))","v":1},{"$f":"IF(F1591=1,COUNTIF($F$3:F1591,1),\"\")","v":1589},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1591),$G$3:$G$3716,0)),\"\")","v":"17478076610"}]
[null,null,null,null,"17478079201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1592,1),\"\"))","v":1},{"$f":"IF(F1592=1,COUNTIF($F$3:F1592,1),\"\")","v":1590},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1592),$G$3:$G$3716,0)),\"\")","v":"17478079201"}]
[null,null,null,null,"17478079225",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1593,1),\"\"))","v":1},{"$f":"IF(F1593=1,COUNTIF($F$3:F1593,1),\"\")","v":1591},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1593),$G$3:$G$3716,0)),\"\")","v":"17478079225"}]
[null,null,null,null,"20555000100",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1594,1),\"\"))","v":1},{"$f":"IF(F1594=1,COUNTIF($F$3:F1594,1),\"\")","v":1592},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1594),$G$3:$G$3716,0)),\"\")","v":"20555000100"}]
[null,null,null,null,"20555001900",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1595,1),\"\"))","v":1},{"$f":"IF(F1595=1,COUNTIF($F$3:F1595,1),\"\")","v":1593},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1595),$G$3:$G$3716,0)),\"\")","v":"20555001900"}]
[null,null,null,null,"20555004000",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1596,1),\"\"))","v":1},{"$f":"IF(F1596=1,COUNTIF($F$3:F1596,1),\"\")","v":1594},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1596),$G$3:$G$3716,0)),\"\")","v":"20555004000"}]
[null,null,null,null,"21292000431",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1597,1),\"\"))","v":1},{"$f":"IF(F1597=1,COUNTIF($F$3:F1597,1),\"\")","v":1595},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1597),$G$3:$G$3716,0)),\"\")","v":"21292000431"}]
[null,null,null,null,"21922002107",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1598,1),\"\"))","v":1},{"$f":"IF(F1598=1,COUNTIF($F$3:F1598,1),\"\")","v":1596},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1598),$G$3:$G$3716,0)),\"\")","v":"21922002107"}]
[null,null,null,null,"23155000301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1599,1),\"\"))","v":1},{"$f":"IF(F1599=1,COUNTIF($F$3:F1599,1),\"\")","v":1597},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1599),$G$3:$G$3716,0)),\"\")","v":"23155000301"}]
[null,null,null,null,"23155002401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1600,1),\"\"))","v":1},{"$f":"IF(F1600=1,COUNTIF($F$3:F1600,1),\"\")","v":1598},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1600),$G$3:$G$3716,0)),\"\")","v":"23155002401"}]
[null,null,null,null,"23155002601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1601,1),\"\"))","v":1},{"$f":"IF(F1601=1,COUNTIF($F$3:F1601,1),\"\")","v":1599},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1601),$G$3:$G$3716,0)),\"\")","v":"23155002601"}]
[null,null,null,null,"23155003801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1602,1),\"\"))","v":1},{"$f":"IF(F1602=1,COUNTIF($F$3:F1602,1),\"\")","v":1600},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1602),$G$3:$G$3716,0)),\"\")","v":"23155003801"}]
[null,null,null,null,"23155004403",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1603,1),\"\"))","v":1},{"$f":"IF(F1603=1,COUNTIF($F$3:F1603,1),\"\")","v":1601},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1603),$G$3:$G$3716,0)),\"\")","v":"23155004403"}]
[null,null,null,null,"23155005101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1604,1),\"\"))","v":1},{"$f":"IF(F1604=1,COUNTIF($F$3:F1604,1),\"\")","v":1602},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1604),$G$3:$G$3716,0)),\"\")","v":"23155005101"}]
[null,null,null,null,"23155005801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1605,1),\"\"))","v":1},{"$f":"IF(F1605=1,COUNTIF($F$3:F1605,1),\"\")","v":1603},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1605),$G$3:$G$3716,0)),\"\")","v":"23155005801"}]
[null,null,null,null,"23155007001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1606,1),\"\"))","v":1},{"$f":"IF(F1606=1,COUNTIF($F$3:F1606,1),\"\")","v":1604},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1606),$G$3:$G$3716,0)),\"\")","v":"23155007001"}]
[null,null,null,null,"23155007101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1607,1),\"\"))","v":1},{"$f":"IF(F1607=1,COUNTIF($F$3:F1607,1),\"\")","v":1605},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1607),$G$3:$G$3716,0)),\"\")","v":"23155007101"}]
[null,null,null,null,"23155010800",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1608,1),\"\"))","v":1},{"$f":"IF(F1608=1,COUNTIF($F$3:F1608,1),\"\")","v":1606},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1608),$G$3:$G$3716,0)),\"\")","v":"23155010800"}]
[null,null,null,null,"23155010811",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1609,1),\"\"))","v":1},{"$f":"IF(F1609=1,COUNTIF($F$3:F1609,1),\"\")","v":1607},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1609),$G$3:$G$3716,0)),\"\")","v":"23155010811"}]
[null,null,null,null,"23155010830",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1610,1),\"\"))","v":1},{"$f":"IF(F1610=1,COUNTIF($F$3:F1610,1),\"\")","v":1608},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1610),$G$3:$G$3716,0)),\"\")","v":"23155010830"}]
[null,null,null,null,"23155011001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1611,1),\"\"))","v":1},{"$f":"IF(F1611=1,COUNTIF($F$3:F1611,1),\"\")","v":1609},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1611),$G$3:$G$3716,0)),\"\")","v":"23155011001"}]
[null,null,null,null,"23155011801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1612,1),\"\"))","v":1},{"$f":"IF(F1612=1,COUNTIF($F$3:F1612,1),\"\")","v":1610},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1612),$G$3:$G$3716,0)),\"\")","v":"23155011801"}]
[null,null,null,null,"23155022701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1613,1),\"\"))","v":1},{"$f":"IF(F1613=1,COUNTIF($F$3:F1613,1),\"\")","v":1611},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1613),$G$3:$G$3716,0)),\"\")","v":"23155022701"}]
[null,null,null,null,"23155028801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1614,1),\"\"))","v":1},{"$f":"IF(F1614=1,COUNTIF($F$3:F1614,1),\"\")","v":1612},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1614),$G$3:$G$3716,0)),\"\")","v":"23155028801"}]
[null,null,null,null,"23155048901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1615,1),\"\"))","v":1},{"$f":"IF(F1615=1,COUNTIF($F$3:F1615,1),\"\")","v":1613},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1615),$G$3:$G$3716,0)),\"\")","v":"23155048901"}]
[null,null,null,null,"23155051211",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1616,1),\"\"))","v":1},{"$f":"IF(F1616=1,COUNTIF($F$3:F1616,1),\"\")","v":1614},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1616),$G$3:$G$3716,0)),\"\")","v":"23155051211"}]
[null,null,null,null,"23155051230",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1617,1),\"\"))","v":1},{"$f":"IF(F1617=1,COUNTIF($F$3:F1617,1),\"\")","v":1615},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1617),$G$3:$G$3716,0)),\"\")","v":"23155051230"}]
[null,null,null,null,"23155057901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1618,1),\"\"))","v":1},{"$f":"IF(F1618=1,COUNTIF($F$3:F1618,1),\"\")","v":1616},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1618),$G$3:$G$3716,0)),\"\")","v":"23155057901"}]
[null,null,null,null,"23155058001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1619,1),\"\"))","v":1},{"$f":"IF(F1619=1,COUNTIF($F$3:F1619,1),\"\")","v":1617},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1619),$G$3:$G$3716,0)),\"\")","v":"23155058001"}]
[null,null,null,null,"23155066201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1620,1),\"\"))","v":1},{"$f":"IF(F1620=1,COUNTIF($F$3:F1620,1),\"\")","v":1618},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1620),$G$3:$G$3716,0)),\"\")","v":"23155066201"}]
[null,null,null,null,"23900001252",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1621,1),\"\"))","v":1},{"$f":"IF(F1621=1,COUNTIF($F$3:F1621,1),\"\")","v":1619},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1621),$G$3:$G$3716,0)),\"\")","v":"23900001252"}]
[null,null,null,null,"24208029005",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1622,1),\"\"))","v":1},{"$f":"IF(F1622=1,COUNTIF($F$3:F1622,1),\"\")","v":1620},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1622),$G$3:$G$3716,0)),\"\")","v":"24208029005"}]
[null,null,null,null,"24208029525",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1623,1),\"\"))","v":1},{"$f":"IF(F1623=1,COUNTIF($F$3:F1623,1),\"\")","v":1621},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1623),$G$3:$G$3716,0)),\"\")","v":"24208029525"}]
[null,null,null,null,"24208031510",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1624,1),\"\"))","v":1},{"$f":"IF(F1624=1,COUNTIF($F$3:F1624,1),\"\")","v":1622},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1624),$G$3:$G$3716,0)),\"\")","v":"24208031510"}]
[null,null,null,null,"24208034205",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1625,1),\"\"))","v":1},{"$f":"IF(F1625=1,COUNTIF($F$3:F1625,1),\"\")","v":1623},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1625),$G$3:$G$3716,0)),\"\")","v":"24208034205"}]
[null,null,null,null,"24208041005",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1626,1),\"\"))","v":1},{"$f":"IF(F1626=1,COUNTIF($F$3:F1626,1),\"\")","v":1624},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1626),$G$3:$G$3716,0)),\"\")","v":"24208041005"}]
[null,null,null,null,"24208048510",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1627,1),\"\"))","v":1},{"$f":"IF(F1627=1,COUNTIF($F$3:F1627,1),\"\")","v":1625},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1627),$G$3:$G$3716,0)),\"\")","v":"24208048510"}]
[null,null,null,null,"24208048610",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1628,1),\"\"))","v":1},{"$f":"IF(F1628=1,COUNTIF($F$3:F1628,1),\"\")","v":1626},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1628),$G$3:$G$3716,0)),\"\")","v":"24208048610"}]
[null,null,null,null,"24208050505",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1629,1),\"\"))","v":1},{"$f":"IF(F1629=1,COUNTIF($F$3:F1629,1),\"\")","v":1627},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1629),$G$3:$G$3716,0)),\"\")","v":"24208050505"}]
[null,null,null,null,"24208058559",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1630,1),\"\"))","v":1},{"$f":"IF(F1630=1,COUNTIF($F$3:F1630,1),\"\")","v":1628},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1630),$G$3:$G$3716,0)),\"\")","v":"24208058559"}]
[null,null,null,null,"24208063562",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1631,1),\"\"))","v":1},{"$f":"IF(F1631=1,COUNTIF($F$3:F1631,1),\"\")","v":1629},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1631),$G$3:$G$3716,0)),\"\")","v":"24208063562"}]
[null,null,null,null,"24208072002",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1632,1),\"\"))","v":1},{"$f":"IF(F1632=1,COUNTIF($F$3:F1632,1),\"\")","v":1630},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1632),$G$3:$G$3716,0)),\"\")","v":"24208072002"}]
[null,null,null,null,"24208073006",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1633,1),\"\"))","v":1},{"$f":"IF(F1633=1,COUNTIF($F$3:F1633,1),\"\")","v":1631},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1633),$G$3:$G$3716,0)),\"\")","v":"24208073006"}]
[null,null,null,null,"24208073501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1634,1),\"\"))","v":1},{"$f":"IF(F1634=1,COUNTIF($F$3:F1634,1),\"\")","v":1632},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1634),$G$3:$G$3716,0)),\"\")","v":"24208073501"}]
[null,null,null,null,"24208078555",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1635,1),\"\"))","v":1},{"$f":"IF(F1635=1,COUNTIF($F$3:F1635,1),\"\")","v":1633},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1635),$G$3:$G$3716,0)),\"\")","v":"24208078555"}]
[null,null,null,null,"24208079535",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1636,1),\"\"))","v":1},{"$f":"IF(F1636=1,COUNTIF($F$3:F1636,1),\"\")","v":1634},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1636),$G$3:$G$3716,0)),\"\")","v":"24208079535"}]
[null,null,null,null,"24208082555",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1637,1),\"\"))","v":1},{"$f":"IF(F1637=1,COUNTIF($F$3:F1637,1),\"\")","v":1635},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1637),$G$3:$G$3716,0)),\"\")","v":"24208082555"}]
[null,null,null,null,"24208091019",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1638,1),\"\"))","v":1},{"$f":"IF(F1638=1,COUNTIF($F$3:F1638,1),\"\")","v":1636},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1638),$G$3:$G$3716,0)),\"\")","v":"24208091019"}]
[null,null,null,null,"24208091055",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1639,1),\"\"))","v":1},{"$f":"IF(F1639=1,COUNTIF($F$3:F1639,1),\"\")","v":1637},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1639),$G$3:$G$3716,0)),\"\")","v":"24208091055"}]
[null,null,null,null,"24208092064",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1640,1),\"\"))","v":1},{"$f":"IF(F1640=1,COUNTIF($F$3:F1640,1),\"\")","v":1638},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1640),$G$3:$G$3716,0)),\"\")","v":"24208092064"}]
[null,null,null,null,"24338010213",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1641,1),\"\"))","v":1},{"$f":"IF(F1641=1,COUNTIF($F$3:F1641,1),\"\")","v":1639},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1641),$G$3:$G$3716,0)),\"\")","v":"24338010213"}]
[null,null,null,null,"24338012613",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1642,1),\"\"))","v":1},{"$f":"IF(F1642=1,COUNTIF($F$3:F1642,1),\"\")","v":1640},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1642),$G$3:$G$3716,0)),\"\")","v":"24338012613"}]
[null,null,null,null,"24338013213",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1643,1),\"\"))","v":1},{"$f":"IF(F1643=1,COUNTIF($F$3:F1643,1),\"\")","v":1641},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1643),$G$3:$G$3716,0)),\"\")","v":"24338013213"}]
[null,null,null,null,"24338013402",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1644,1),\"\"))","v":1},{"$f":"IF(F1644=1,COUNTIF($F$3:F1644,1),\"\")","v":1642},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1644),$G$3:$G$3716,0)),\"\")","v":"24338013402"}]
[null,null,null,null,"24338023005",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1645,1),\"\"))","v":1},{"$f":"IF(F1645=1,COUNTIF($F$3:F1645,1),\"\")","v":1643},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1645),$G$3:$G$3716,0)),\"\")","v":"24338023005"}]
[null,null,null,null,"24357030030",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1646,1),\"\"))","v":1},{"$f":"IF(F1646=1,COUNTIF($F$3:F1646,1),\"\")","v":1644},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1646),$G$3:$G$3716,0)),\"\")","v":"24357030030"}]
[null,null,null,null,"24357070105",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1647,1),\"\"))","v":1},{"$f":"IF(F1647=1,COUNTIF($F$3:F1647,1),\"\")","v":1645},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1647),$G$3:$G$3716,0)),\"\")","v":"24357070105"}]
[null,null,null,null,"24357070107",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1648,1),\"\"))","v":1},{"$f":"IF(F1648=1,COUNTIF($F$3:F1648,1),\"\")","v":1646},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1648),$G$3:$G$3716,0)),\"\")","v":"24357070107"}]
[null,null,null,null,"24385041396",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1649,1),\"\"))","v":1},{"$f":"IF(F1649=1,COUNTIF($F$3:F1649,1),\"\")","v":1647},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1649),$G$3:$G$3716,0)),\"\")","v":"24385041396"}]
[null,null,null,null,"24486060110",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1650,1),\"\"))","v":1},{"$f":"IF(F1650=1,COUNTIF($F$3:F1650,1),\"\")","v":1648},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1650),$G$3:$G$3716,0)),\"\")","v":"24486060110"}]
[null,null,null,null,"24979001101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1651,1),\"\"))","v":1},{"$f":"IF(F1651=1,COUNTIF($F$3:F1651,1),\"\")","v":1649},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1651),$G$3:$G$3716,0)),\"\")","v":"24979001101"}]
[null,null,null,null,"24987024256",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1652,1),\"\"))","v":1},{"$f":"IF(F1652=1,COUNTIF($F$3:F1652,1),\"\")","v":1650},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1652),$G$3:$G$3716,0)),\"\")","v":"24987024256"}]
[null,null,null,null,"24987024956",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1653,1),\"\"))","v":1},{"$f":"IF(F1653=1,COUNTIF($F$3:F1653,1),\"\")","v":1651},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1653),$G$3:$G$3716,0)),\"\")","v":"24987024956"}]
[null,null,null,null,"25010020515",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1654,1),\"\"))","v":1},{"$f":"IF(F1654=1,COUNTIF($F$3:F1654,1),\"\")","v":1652},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1654),$G$3:$G$3716,0)),\"\")","v":"25010020515"}]
[null,null,null,null,"25010021027",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1655,1),\"\"))","v":1},{"$f":"IF(F1655=1,COUNTIF($F$3:F1655,1),\"\")","v":1653},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1655),$G$3:$G$3716,0)),\"\")","v":"25010021027"}]
[null,null,null,null,"25010040515",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1656,1),\"\"))","v":1},{"$f":"IF(F1656=1,COUNTIF($F$3:F1656,1),\"\")","v":1654},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1656),$G$3:$G$3716,0)),\"\")","v":"25010040515"}]
[null,null,null,null,"25021030884",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1657,1),\"\"))","v":1},{"$f":"IF(F1657=1,COUNTIF($F$3:F1657,1),\"\")","v":1655},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1657),$G$3:$G$3716,0)),\"\")","v":"25021030884"}]
[null,null,null,null,"25021065710",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1658,1),\"\"))","v":1},{"$f":"IF(F1658=1,COUNTIF($F$3:F1658,1),\"\")","v":1656},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1658),$G$3:$G$3716,0)),\"\")","v":"25021065710"}]
[null,null,null,null,"25021067377",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1659,1),\"\"))","v":1},{"$f":"IF(F1659=1,COUNTIF($F$3:F1659,1),\"\")","v":1657},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1659),$G$3:$G$3716,0)),\"\")","v":"25021067377"}]
[null,null,null,null,"25357002301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1660,1),\"\"))","v":1},{"$f":"IF(F1660=1,COUNTIF($F$3:F1660,1),\"\")","v":1658},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1660),$G$3:$G$3716,0)),\"\")","v":"25357002301"}]
[null,null,null,null,"27241006203",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1661,1),\"\"))","v":1},{"$f":"IF(F1661=1,COUNTIF($F$3:F1661,1),\"\")","v":1659},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1661),$G$3:$G$3716,0)),\"\")","v":"27241006203"}]
[null,null,null,null,"27241006303",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1662,1),\"\"))","v":1},{"$f":"IF(F1662=1,COUNTIF($F$3:F1662,1),\"\")","v":1660},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1662),$G$3:$G$3716,0)),\"\")","v":"27241006303"}]
[null,null,null,null,"27241013909",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1663,1),\"\"))","v":1},{"$f":"IF(F1663=1,COUNTIF($F$3:F1663,1),\"\")","v":1661},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1663),$G$3:$G$3716,0)),\"\")","v":"27241013909"}]
[null,null,null,null,"27241016001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1664,1),\"\"))","v":1},{"$f":"IF(F1664=1,COUNTIF($F$3:F1664,1),\"\")","v":1662},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1664),$G$3:$G$3716,0)),\"\")","v":"27241016001"}]
[null,null,null,null,"27241016101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1665,1),\"\"))","v":1},{"$f":"IF(F1665=1,COUNTIF($F$3:F1665,1),\"\")","v":1663},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1665),$G$3:$G$3716,0)),\"\")","v":"27241016101"}]
[null,null,null,null,"27434001017",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1666,1),\"\"))","v":1},{"$f":"IF(F1666=1,COUNTIF($F$3:F1666,1),\"\")","v":1664},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1666),$G$3:$G$3716,0)),\"\")","v":"27434001017"}]
[null,null,null,null,"27437005057",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1667,1),\"\"))","v":1},{"$f":"IF(F1667=1,COUNTIF($F$3:F1667,1),\"\")","v":1665},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1667),$G$3:$G$3716,0)),\"\")","v":"27437005057"}]
[null,null,null,null,"27437010601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1668,1),\"\"))","v":1},{"$f":"IF(F1668=1,COUNTIF($F$3:F1668,1),\"\")","v":1666},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1668),$G$3:$G$3716,0)),\"\")","v":"27437010601"}]
[null,null,null,null,"29033000301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1669,1),\"\"))","v":1},{"$f":"IF(F1669=1,COUNTIF($F$3:F1669,1),\"\")","v":1667},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1669),$G$3:$G$3716,0)),\"\")","v":"29033000301"}]
[null,null,null,null,"29033000412",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1670,1),\"\"))","v":1},{"$f":"IF(F1670=1,COUNTIF($F$3:F1670,1),\"\")","v":1668},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1670),$G$3:$G$3716,0)),\"\")","v":"29033000412"}]
[null,null,null,null,"29033001912",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1671,1),\"\"))","v":1},{"$f":"IF(F1671=1,COUNTIF($F$3:F1671,1),\"\")","v":1669},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1671),$G$3:$G$3716,0)),\"\")","v":"29033001912"}]
[null,null,null,null,"29300016810",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1672,1),\"\"))","v":1},{"$f":"IF(F1672=1,COUNTIF($F$3:F1672,1),\"\")","v":1670},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1672),$G$3:$G$3716,0)),\"\")","v":"29300016810"}]
[null,null,null,null,"29300016815",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1673,1),\"\"))","v":1},{"$f":"IF(F1673=1,COUNTIF($F$3:F1673,1),\"\")","v":1671},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1673),$G$3:$G$3716,0)),\"\")","v":"29300016815"}]
[null,null,null,null,"29300022701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1674,1),\"\"))","v":1},{"$f":"IF(F1674=1,COUNTIF($F$3:F1674,1),\"\")","v":1672},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1674),$G$3:$G$3716,0)),\"\")","v":"29300022701"}]
[null,null,null,null,"29300022705",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1675,1),\"\"))","v":1},{"$f":"IF(F1675=1,COUNTIF($F$3:F1675,1),\"\")","v":1673},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1675),$G$3:$G$3716,0)),\"\")","v":"29300022705"}]
[null,null,null,null,"30698006701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1676,1),\"\"))","v":1},{"$f":"IF(F1676=1,COUNTIF($F$3:F1676,1),\"\")","v":1674},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1676),$G$3:$G$3716,0)),\"\")","v":"30698006701"}]
[null,null,null,null,"30768003268",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1677,1),\"\"))","v":1},{"$f":"IF(F1677=1,COUNTIF($F$3:F1677,1),\"\")","v":1675},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1677),$G$3:$G$3716,0)),\"\")","v":"30768003268"}]
[null,null,null,null,"30768025570",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1678,1),\"\"))","v":1},{"$f":"IF(F1678=1,COUNTIF($F$3:F1678,1),\"\")","v":1676},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1678),$G$3:$G$3716,0)),\"\")","v":"30768025570"}]
[null,null,null,null,"31604001224",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1679,1),\"\"))","v":1},{"$f":"IF(F1679=1,COUNTIF($F$3:F1679,1),\"\")","v":1677},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1679),$G$3:$G$3716,0)),\"\")","v":"31604001224"}]
[null,null,null,null,"31604002850",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1680,1),\"\"))","v":1},{"$f":"IF(F1680=1,COUNTIF($F$3:F1680,1),\"\")","v":1678},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1680),$G$3:$G$3716,0)),\"\")","v":"31604002850"}]
[null,null,null,null,"31722026790",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1681,1),\"\"))","v":1},{"$f":"IF(F1681=1,COUNTIF($F$3:F1681,1),\"\")","v":1679},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1681),$G$3:$G$3716,0)),\"\")","v":"31722026790"}]
[null,null,null,null,"31722028060",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1682,1),\"\"))","v":1},{"$f":"IF(F1682=1,COUNTIF($F$3:F1682,1),\"\")","v":1680},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1682),$G$3:$G$3716,0)),\"\")","v":"31722028060"}]
[null,null,null,null,"31722028160",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1683,1),\"\"))","v":1},{"$f":"IF(F1683=1,COUNTIF($F$3:F1683,1),\"\")","v":1681},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1683),$G$3:$G$3716,0)),\"\")","v":"31722028160"}]
[null,null,null,null,"31722033001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1684,1),\"\"))","v":1},{"$f":"IF(F1684=1,COUNTIF($F$3:F1684,1),\"\")","v":1682},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1684),$G$3:$G$3716,0)),\"\")","v":"31722033001"}]
[null,null,null,null,"31722033201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1685,1),\"\"))","v":1},{"$f":"IF(F1685=1,COUNTIF($F$3:F1685,1),\"\")","v":1683},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1685),$G$3:$G$3716,0)),\"\")","v":"31722033201"}]
[null,null,null,null,"31722050660",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1686,1),\"\"))","v":1},{"$f":"IF(F1686=1,COUNTIF($F$3:F1686,1),\"\")","v":1684},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1686),$G$3:$G$3716,0)),\"\")","v":"31722050660"}]
[null,null,null,null,"31722051560",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1687,1),\"\"))","v":1},{"$f":"IF(F1687=1,COUNTIF($F$3:F1687,1),\"\")","v":1685},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1687),$G$3:$G$3716,0)),\"\")","v":"31722051560"}]
[null,null,null,null,"31722052590",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1688,1),\"\"))","v":1},{"$f":"IF(F1688=1,COUNTIF($F$3:F1688,1),\"\")","v":1686},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1688),$G$3:$G$3716,0)),\"\")","v":"31722052590"}]
[null,null,null,null,"31722053001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1689,1),\"\"))","v":1},{"$f":"IF(F1689=1,COUNTIF($F$3:F1689,1),\"\")","v":1687},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1689),$G$3:$G$3716,0)),\"\")","v":"31722053001"}]
[null,null,null,null,"31722053101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1690,1),\"\"))","v":1},{"$f":"IF(F1690=1,COUNTIF($F$3:F1690,1),\"\")","v":1688},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1690),$G$3:$G$3716,0)),\"\")","v":"31722053101"}]
[null,null,null,null,"31722053201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1691,1),\"\"))","v":1},{"$f":"IF(F1691=1,COUNTIF($F$3:F1691,1),\"\")","v":1689},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1691),$G$3:$G$3716,0)),\"\")","v":"31722053201"}]
[null,null,null,null,"31722053712",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1692,1),\"\"))","v":1},{"$f":"IF(F1692=1,COUNTIF($F$3:F1692,1),\"\")","v":1690},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1692),$G$3:$G$3716,0)),\"\")","v":"31722053712"}]
[null,null,null,null,"31722062905",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1693,1),\"\"))","v":1},{"$f":"IF(F1693=1,COUNTIF($F$3:F1693,1),\"\")","v":1691},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1693),$G$3:$G$3716,0)),\"\")","v":"31722062905"}]
[null,null,null,null,"31722062921",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1694,1),\"\"))","v":1},{"$f":"IF(F1694=1,COUNTIF($F$3:F1694,1),\"\")","v":1692},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1694),$G$3:$G$3716,0)),\"\")","v":"31722062921"}]
[null,null,null,null,"31722063031",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1695,1),\"\"))","v":1},{"$f":"IF(F1695=1,COUNTIF($F$3:F1695,1),\"\")","v":1693},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1695),$G$3:$G$3716,0)),\"\")","v":"31722063031"}]
[null,null,null,null,"31722063231",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1696,1),\"\"))","v":1},{"$f":"IF(F1696=1,COUNTIF($F$3:F1696,1),\"\")","v":1694},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1696),$G$3:$G$3716,0)),\"\")","v":"31722063231"}]
[null,null,null,null,"31722070090",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1697,1),\"\"))","v":1},{"$f":"IF(F1697=1,COUNTIF($F$3:F1697,1),\"\")","v":1695},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1697),$G$3:$G$3716,0)),\"\")","v":"31722070090"}]
[null,null,null,null,"31722073090",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1698,1),\"\"))","v":1},{"$f":"IF(F1698=1,COUNTIF($F$3:F1698,1),\"\")","v":1696},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1698),$G$3:$G$3716,0)),\"\")","v":"31722073090"}]
[null,null,null,null,"31722082730",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1699,1),\"\"))","v":1},{"$f":"IF(F1699=1,COUNTIF($F$3:F1699,1),\"\")","v":1697},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1699),$G$3:$G$3716,0)),\"\")","v":"31722082730"}]
[null,null,null,null,"31722083260",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1700,1),\"\"))","v":1},{"$f":"IF(F1700=1,COUNTIF($F$3:F1700,1),\"\")","v":1698},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1700),$G$3:$G$3716,0)),\"\")","v":"31722083260"}]
[null,null,null,null,"31722083330",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1701,1),\"\"))","v":1},{"$f":"IF(F1701=1,COUNTIF($F$3:F1701,1),\"\")","v":1699},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1701),$G$3:$G$3716,0)),\"\")","v":"31722083330"}]
[null,null,null,null,"33342002507",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1702,1),\"\"))","v":1},{"$f":"IF(F1702=1,COUNTIF($F$3:F1702,1),\"\")","v":1700},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1702),$G$3:$G$3716,0)),\"\")","v":"33342002507"}]
[null,null,null,null,"33342009607",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1703,1),\"\"))","v":1},{"$f":"IF(F1703=1,COUNTIF($F$3:F1703,1),\"\")","v":1701},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1703),$G$3:$G$3716,0)),\"\")","v":"33342009607"}]
[null,null,null,null,"33342033315",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1704,1),\"\"))","v":1},{"$f":"IF(F1704=1,COUNTIF($F$3:F1704,1),\"\")","v":1702},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1704),$G$3:$G$3716,0)),\"\")","v":"33342033315"}]
[null,null,null,null,"33342033380",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1705,1),\"\"))","v":1},{"$f":"IF(F1705=1,COUNTIF($F$3:F1705,1),\"\")","v":1703},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1705),$G$3:$G$3716,0)),\"\")","v":"33342033380"}]
[null,null,null,null,"33342046206",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1706,1),\"\"))","v":1},{"$f":"IF(F1706=1,COUNTIF($F$3:F1706,1),\"\")","v":1704},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1706),$G$3:$G$3716,0)),\"\")","v":"33342046206"}]
[null,null,null,null,"33342046266",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1707,1),\"\"))","v":1},{"$f":"IF(F1707=1,COUNTIF($F$3:F1707,1),\"\")","v":1705},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1707),$G$3:$G$3716,0)),\"\")","v":"33342046266"}]
[null,null,null,null,"35573043302",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1708,1),\"\"))","v":1},{"$f":"IF(F1708=1,COUNTIF($F$3:F1708,1),\"\")","v":1706},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1708),$G$3:$G$3716,0)),\"\")","v":"35573043302"}]
[null,null,null,null,"35573043330",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1709,1),\"\"))","v":1},{"$f":"IF(F1709=1,COUNTIF($F$3:F1709,1),\"\")","v":1707},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1709),$G$3:$G$3716,0)),\"\")","v":"35573043330"}]
[null,null,null,null,"37000002304",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1710,1),\"\"))","v":1},{"$f":"IF(F1710=1,COUNTIF($F$3:F1710,1),\"\")","v":1708},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1710),$G$3:$G$3716,0)),\"\")","v":"37000002304"}]
[null,null,null,null,"37000002410",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1711,1),\"\"))","v":1},{"$f":"IF(F1711=1,COUNTIF($F$3:F1711,1),\"\")","v":1709},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1711),$G$3:$G$3716,0)),\"\")","v":"37000002410"}]
[null,null,null,null,"37000025445",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1712,1),\"\"))","v":1},{"$f":"IF(F1712=1,COUNTIF($F$3:F1712,1),\"\")","v":1710},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1712),$G$3:$G$3716,0)),\"\")","v":"37000025445"}]
[null,null,null,null,"37205006411",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1713,1),\"\"))","v":1},{"$f":"IF(F1713=1,COUNTIF($F$3:F1713,1),\"\")","v":1711},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1713),$G$3:$G$3716,0)),\"\")","v":"37205006411"}]
[null,null,null,null,"37205011278",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1714,1),\"\"))","v":1},{"$f":"IF(F1714=1,COUNTIF($F$3:F1714,1),\"\")","v":1712},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1714),$G$3:$G$3716,0)),\"\")","v":"37205011278"}]
[null,null,null,null,"37205034665",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1715,1),\"\"))","v":1},{"$f":"IF(F1715=1,COUNTIF($F$3:F1715,1),\"\")","v":1713},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1715),$G$3:$G$3716,0)),\"\")","v":"37205034665"}]
[null,null,null,null,"37205035874",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1716,1),\"\"))","v":1},{"$f":"IF(F1716=1,COUNTIF($F$3:F1716,1),\"\")","v":1714},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1716),$G$3:$G$3716,0)),\"\")","v":"37205035874"}]
[null,null,null,null,"37205036174",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1717,1),\"\"))","v":1},{"$f":"IF(F1717=1,COUNTIF($F$3:F1717,1),\"\")","v":1715},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1717),$G$3:$G$3716,0)),\"\")","v":"37205036174"}]
[null,null,null,null,"37205061272",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1718,1),\"\"))","v":1},{"$f":"IF(F1718=1,COUNTIF($F$3:F1718,1),\"\")","v":1716},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1718),$G$3:$G$3716,0)),\"\")","v":"37205061272"}]
[null,null,null,null,"37864000033",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1719,1),\"\"))","v":1},{"$f":"IF(F1719=1,COUNTIF($F$3:F1719,1),\"\")","v":1717},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1719),$G$3:$G$3716,0)),\"\")","v":"37864000033"}]
[null,null,null,null,"37864008289",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1720,1),\"\"))","v":1},{"$f":"IF(F1720=1,COUNTIF($F$3:F1720,1),\"\")","v":1718},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1720),$G$3:$G$3716,0)),\"\")","v":"37864008289"}]
[null,null,null,null,"37864076099",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1721,1),\"\"))","v":1},{"$f":"IF(F1721=1,COUNTIF($F$3:F1721,1),\"\")","v":1719},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1721),$G$3:$G$3716,0)),\"\")","v":"37864076099"}]
[null,null,null,null,"37864078599",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1722,1),\"\"))","v":1},{"$f":"IF(F1722=1,COUNTIF($F$3:F1722,1),\"\")","v":1720},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1722),$G$3:$G$3716,0)),\"\")","v":"37864078599"}]
[null,null,null,null,"37864082699",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1723,1),\"\"))","v":1},{"$f":"IF(F1723=1,COUNTIF($F$3:F1723,1),\"\")","v":1721},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1723),$G$3:$G$3716,0)),\"\")","v":"37864082699"}]
[null,null,null,null,"37864082799",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1724,1),\"\"))","v":1},{"$f":"IF(F1724=1,COUNTIF($F$3:F1724,1),\"\")","v":1722},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1724),$G$3:$G$3716,0)),\"\")","v":"37864082799"}]
[null,null,null,null,"37864086001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1725,1),\"\"))","v":1},{"$f":"IF(F1725=1,COUNTIF($F$3:F1725,1),\"\")","v":1723},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1725),$G$3:$G$3716,0)),\"\")","v":"37864086001"}]
[null,null,null,null,"37864090901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1726,1),\"\"))","v":1},{"$f":"IF(F1726=1,COUNTIF($F$3:F1726,1),\"\")","v":1724},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1726),$G$3:$G$3716,0)),\"\")","v":"37864090901"}]
[null,null,null,null,"38396054208",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1727,1),\"\"))","v":1},{"$f":"IF(F1727=1,COUNTIF($F$3:F1727,1),\"\")","v":1725},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1727),$G$3:$G$3716,0)),\"\")","v":"38396054208"}]
[null,null,null,null,"38396090208",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1728,1),\"\"))","v":1},{"$f":"IF(F1728=1,COUNTIF($F$3:F1728,1),\"\")","v":1726},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1728),$G$3:$G$3716,0)),\"\")","v":"38396090208"}]
[null,null,null,null,"38779073106",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1729,1),\"\"))","v":1},{"$f":"IF(F1729=1,COUNTIF($F$3:F1729,1),\"\")","v":1727},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1729),$G$3:$G$3716,0)),\"\")","v":"38779073106"}]
[null,null,null,null,"38779088408",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1730,1),\"\"))","v":1},{"$f":"IF(F1730=1,COUNTIF($F$3:F1730,1),\"\")","v":1728},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1730),$G$3:$G$3716,0)),\"\")","v":"38779088408"}]
[null,null,null,null,"38779251008",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1731,1),\"\"))","v":1},{"$f":"IF(F1731=1,COUNTIF($F$3:F1731,1),\"\")","v":1729},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1731),$G$3:$G$3716,0)),\"\")","v":"38779251008"}]
[null,null,null,null,"39328005750",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1732,1),\"\"))","v":1},{"$f":"IF(F1732=1,COUNTIF($F$3:F1732,1),\"\")","v":1730},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1732),$G$3:$G$3716,0)),\"\")","v":"39328005750"}]
[null,null,null,null,"39328010710",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1733,1),\"\"))","v":1},{"$f":"IF(F1733=1,COUNTIF($F$3:F1733,1),\"\")","v":1731},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1733),$G$3:$G$3716,0)),\"\")","v":"39328010710"}]
[null,null,null,null,"39328035760",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1734,1),\"\"))","v":1},{"$f":"IF(F1734=1,COUNTIF($F$3:F1734,1),\"\")","v":1732},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1734),$G$3:$G$3716,0)),\"\")","v":"39328035760"}]
[null,null,null,null,"39822016605",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1735,1),\"\"))","v":1},{"$f":"IF(F1735=1,COUNTIF($F$3:F1735,1),\"\")","v":1733},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1735),$G$3:$G$3716,0)),\"\")","v":"39822016605"}]
[null,null,null,null,"39822017001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1736,1),\"\"))","v":1},{"$f":"IF(F1736=1,COUNTIF($F$3:F1736,1),\"\")","v":1734},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1736),$G$3:$G$3716,0)),\"\")","v":"39822017001"}]
[null,null,null,null,"39822017002",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1737,1),\"\"))","v":1},{"$f":"IF(F1737=1,COUNTIF($F$3:F1737,1),\"\")","v":1735},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1737),$G$3:$G$3716,0)),\"\")","v":"39822017002"}]
[null,null,null,null,"39822027801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1738,1),\"\"))","v":1},{"$f":"IF(F1738=1,COUNTIF($F$3:F1738,1),\"\")","v":1736},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1738),$G$3:$G$3716,0)),\"\")","v":"39822027801"}]
[null,null,null,null,"39822301501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1739,1),\"\"))","v":1},{"$f":"IF(F1739=1,COUNTIF($F$3:F1739,1),\"\")","v":1737},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1739),$G$3:$G$3716,0)),\"\")","v":"39822301501"}]
[null,null,null,null,"40085084296",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1740,1),\"\"))","v":1},{"$f":"IF(F1740=1,COUNTIF($F$3:F1740,1),\"\")","v":1738},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1740),$G$3:$G$3716,0)),\"\")","v":"40085084296"}]
[null,null,null,null,"40565012251",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1741,1),\"\"))","v":1},{"$f":"IF(F1741=1,COUNTIF($F$3:F1741,1),\"\")","v":1739},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1741),$G$3:$G$3716,0)),\"\")","v":"40565012251"}]
[null,null,null,null,"40565012253",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1742,1),\"\"))","v":1},{"$f":"IF(F1742=1,COUNTIF($F$3:F1742,1),\"\")","v":1740},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1742),$G$3:$G$3716,0)),\"\")","v":"40565012253"}]
[null,null,null,null,"40985021245",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1743,1),\"\"))","v":1},{"$f":"IF(F1743=1,COUNTIF($F$3:F1743,1),\"\")","v":1741},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1743),$G$3:$G$3716,0)),\"\")","v":"40985021245"}]
[null,null,null,null,"40985022368",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1744,1),\"\"))","v":1},{"$f":"IF(F1744=1,COUNTIF($F$3:F1744,1),\"\")","v":1742},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1744),$G$3:$G$3716,0)),\"\")","v":"40985022368"}]
[null,null,null,null,"41100080676",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1745,1),\"\"))","v":1},{"$f":"IF(F1745=1,COUNTIF($F$3:F1745,1),\"\")","v":1743},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1745),$G$3:$G$3716,0)),\"\")","v":"41100080676"}]
[null,null,null,null,"41100081122",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1746,1),\"\"))","v":1},{"$f":"IF(F1746=1,COUNTIF($F$3:F1746,1),\"\")","v":1744},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1746),$G$3:$G$3716,0)),\"\")","v":"41100081122"}]
[null,null,null,null,"41100081123",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1747,1),\"\"))","v":1},{"$f":"IF(F1747=1,COUNTIF($F$3:F1747,1),\"\")","v":1745},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1747),$G$3:$G$3716,0)),\"\")","v":"41100081123"}]
[null,null,null,null,"41100082076",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1748,1),\"\"))","v":1},{"$f":"IF(F1748=1,COUNTIF($F$3:F1748,1),\"\")","v":1746},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1748),$G$3:$G$3716,0)),\"\")","v":"41100082076"}]
[null,null,null,null,"41167000879",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1749,1),\"\"))","v":1},{"$f":"IF(F1749=1,COUNTIF($F$3:F1749,1),\"\")","v":1747},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1749),$G$3:$G$3716,0)),\"\")","v":"41167000879"}]
[null,null,null,null,"41616048583",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1750,1),\"\"))","v":1},{"$f":"IF(F1750=1,COUNTIF($F$3:F1750,1),\"\")","v":1748},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1750),$G$3:$G$3716,0)),\"\")","v":"41616048583"}]
[null,null,null,null,"41616093144",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1751,1),\"\"))","v":1},{"$f":"IF(F1751=1,COUNTIF($F$3:F1751,1),\"\")","v":1749},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1751),$G$3:$G$3716,0)),\"\")","v":"41616093144"}]
[null,null,null,null,"42002030001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1752,1),\"\"))","v":1},{"$f":"IF(F1752=1,COUNTIF($F$3:F1752,1),\"\")","v":1750},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1752),$G$3:$G$3716,0)),\"\")","v":"42002030001"}]
[null,null,null,null,"42023010501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1753,1),\"\"))","v":1},{"$f":"IF(F1753=1,COUNTIF($F$3:F1753,1),\"\")","v":1751},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1753),$G$3:$G$3716,0)),\"\")","v":"42023010501"}]
[null,null,null,null,"42023012306",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1754,1),\"\"))","v":1},{"$f":"IF(F1754=1,COUNTIF($F$3:F1754,1),\"\")","v":1752},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1754),$G$3:$G$3716,0)),\"\")","v":"42023012306"}]
[null,null,null,null,"42023012401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1755,1),\"\"))","v":1},{"$f":"IF(F1755=1,COUNTIF($F$3:F1755,1),\"\")","v":1753},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1755),$G$3:$G$3716,0)),\"\")","v":"42023012401"}]
[null,null,null,null,"42023015701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1756,1),\"\"))","v":1},{"$f":"IF(F1756=1,COUNTIF($F$3:F1756,1),\"\")","v":1754},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1756),$G$3:$G$3716,0)),\"\")","v":"42023015701"}]
[null,null,null,null,"42023017204",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1757,1),\"\"))","v":1},{"$f":"IF(F1757=1,COUNTIF($F$3:F1757,1),\"\")","v":1755},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1757),$G$3:$G$3716,0)),\"\")","v":"42023017204"}]
[null,null,null,null,"42023020101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1758,1),\"\"))","v":1},{"$f":"IF(F1758=1,COUNTIF($F$3:F1758,1),\"\")","v":1756},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1758),$G$3:$G$3716,0)),\"\")","v":"42023020101"}]
[null,null,null,null,"42037010478",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1759,1),\"\"))","v":1},{"$f":"IF(F1759=1,COUNTIF($F$3:F1759,1),\"\")","v":1757},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1759),$G$3:$G$3716,0)),\"\")","v":"42037010478"}]
[null,null,null,null,"42211010243",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1760,1),\"\"))","v":1},{"$f":"IF(F1760=1,COUNTIF($F$3:F1760,1),\"\")","v":1758},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1760),$G$3:$G$3716,0)),\"\")","v":"42211010243"}]
[null,null,null,null,"42291014018",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1761,1),\"\"))","v":1},{"$f":"IF(F1761=1,COUNTIF($F$3:F1761,1),\"\")","v":1759},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1761),$G$3:$G$3716,0)),\"\")","v":"42291014018"}]
[null,null,null,null,"42292000101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1762,1),\"\"))","v":1},{"$f":"IF(F1762=1,COUNTIF($F$3:F1762,1),\"\")","v":1760},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1762),$G$3:$G$3716,0)),\"\")","v":"42292000101"}]
[null,null,null,null,"42292000120",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1763,1),\"\"))","v":1},{"$f":"IF(F1763=1,COUNTIF($F$3:F1763,1),\"\")","v":1761},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1763),$G$3:$G$3716,0)),\"\")","v":"42292000120"}]
[null,null,null,null,"42292000201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1764,1),\"\"))","v":1},{"$f":"IF(F1764=1,COUNTIF($F$3:F1764,1),\"\")","v":1762},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1764),$G$3:$G$3716,0)),\"\")","v":"42292000201"}]
[null,null,null,null,"42292000801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1765,1),\"\"))","v":1},{"$f":"IF(F1765=1,COUNTIF($F$3:F1765,1),\"\")","v":1763},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1765),$G$3:$G$3716,0)),\"\")","v":"42292000801"}]
[null,null,null,null,"42292003901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1766,1),\"\"))","v":1},{"$f":"IF(F1766=1,COUNTIF($F$3:F1766,1),\"\")","v":1764},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1766),$G$3:$G$3716,0)),\"\")","v":"42292003901"}]
[null,null,null,null,"42292005401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1767,1),\"\"))","v":1},{"$f":"IF(F1767=1,COUNTIF($F$3:F1767,1),\"\")","v":1765},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1767),$G$3:$G$3716,0)),\"\")","v":"42292005401"}]
[null,null,null,null,"42367054032",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1768,1),\"\"))","v":1},{"$f":"IF(F1768=1,COUNTIF($F$3:F1768,1),\"\")","v":1766},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1768),$G$3:$G$3716,0)),\"\")","v":"42367054032"}]
[null,null,null,null,"42385095330",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1769,1),\"\"))","v":1},{"$f":"IF(F1769=1,COUNTIF($F$3:F1769,1),\"\")","v":1767},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1769),$G$3:$G$3716,0)),\"\")","v":"42385095330"}]
[null,null,null,null,"42702010305",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1770,1),\"\"))","v":1},{"$f":"IF(F1770=1,COUNTIF($F$3:F1770,1),\"\")","v":1768},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1770),$G$3:$G$3716,0)),\"\")","v":"42702010305"}]
[null,null,null,null,"42799011901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1771,1),\"\"))","v":1},{"$f":"IF(F1771=1,COUNTIF($F$3:F1771,1),\"\")","v":1769},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1771),$G$3:$G$3716,0)),\"\")","v":"42799011901"}]
[null,null,null,null,"42799040501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1772,1),\"\"))","v":1},{"$f":"IF(F1772=1,COUNTIF($F$3:F1772,1),\"\")","v":1770},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1772),$G$3:$G$3716,0)),\"\")","v":"42799040501"}]
[null,null,null,null,"42799080601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1773,1),\"\"))","v":1},{"$f":"IF(F1773=1,COUNTIF($F$3:F1773,1),\"\")","v":1771},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1773),$G$3:$G$3716,0)),\"\")","v":"42799080601"}]
[null,null,null,null,"42806001101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1774,1),\"\"))","v":1},{"$f":"IF(F1774=1,COUNTIF($F$3:F1774,1),\"\")","v":1772},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1774),$G$3:$G$3716,0)),\"\")","v":"42806001101"}]
[null,null,null,null,"42806050301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1775,1),\"\"))","v":1},{"$f":"IF(F1775=1,COUNTIF($F$3:F1775,1),\"\")","v":1773},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1775),$G$3:$G$3716,0)),\"\")","v":"42806050301"}]
[null,null,null,null,"42806071401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1776,1),\"\"))","v":1},{"$f":"IF(F1776=1,COUNTIF($F$3:F1776,1),\"\")","v":1774},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1776),$G$3:$G$3716,0)),\"\")","v":"42806071401"}]
[null,null,null,null,"42858000110",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1777,1),\"\"))","v":1},{"$f":"IF(F1777=1,COUNTIF($F$3:F1777,1),\"\")","v":1775},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1777),$G$3:$G$3716,0)),\"\")","v":"42858000110"}]
[null,null,null,null,"42858023401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1778,1),\"\"))","v":1},{"$f":"IF(F1778=1,COUNTIF($F$3:F1778,1),\"\")","v":1776},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1778),$G$3:$G$3716,0)),\"\")","v":"42858023401"}]
[null,null,null,null,"42858030101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1779,1),\"\"))","v":1},{"$f":"IF(F1779=1,COUNTIF($F$3:F1779,1),\"\")","v":1777},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1779),$G$3:$G$3716,0)),\"\")","v":"42858030101"}]
[null,null,null,null,"42858030125",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1780,1),\"\"))","v":1},{"$f":"IF(F1780=1,COUNTIF($F$3:F1780,1),\"\")","v":1778},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1780),$G$3:$G$3716,0)),\"\")","v":"42858030125"}]
[null,null,null,null,"42858030225",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1781,1),\"\"))","v":1},{"$f":"IF(F1781=1,COUNTIF($F$3:F1781,1),\"\")","v":1779},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1781),$G$3:$G$3716,0)),\"\")","v":"42858030225"}]
[null,null,null,null,"42858030416",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1782,1),\"\"))","v":1},{"$f":"IF(F1782=1,COUNTIF($F$3:F1782,1),\"\")","v":1780},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1782),$G$3:$G$3716,0)),\"\")","v":"42858030416"}]
[null,null,null,null,"43199001101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1783,1),\"\"))","v":1},{"$f":"IF(F1783=1,COUNTIF($F$3:F1783,1),\"\")","v":1781},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1783),$G$3:$G$3716,0)),\"\")","v":"43199001101"}]
[null,null,null,null,"43199002112",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1784,1),\"\"))","v":1},{"$f":"IF(F1784=1,COUNTIF($F$3:F1784,1),\"\")","v":1782},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1784),$G$3:$G$3716,0)),\"\")","v":"43199002112"}]
[null,null,null,null,"43386009019",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1785,1),\"\"))","v":1},{"$f":"IF(F1785=1,COUNTIF($F$3:F1785,1),\"\")","v":1783},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1785),$G$3:$G$3716,0)),\"\")","v":"43386009019"}]
[null,null,null,null,"43386014001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1786,1),\"\"))","v":1},{"$f":"IF(F1786=1,COUNTIF($F$3:F1786,1),\"\")","v":1784},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1786),$G$3:$G$3716,0)),\"\")","v":"43386014001"}]
[null,null,null,null,"43386016006",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1787,1),\"\"))","v":1},{"$f":"IF(F1787=1,COUNTIF($F$3:F1787,1),\"\")","v":1785},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1787),$G$3:$G$3716,0)),\"\")","v":"43386016006"}]
[null,null,null,null,"43386031208",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1788,1),\"\"))","v":1},{"$f":"IF(F1788=1,COUNTIF($F$3:F1788,1),\"\")","v":1786},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1788),$G$3:$G$3716,0)),\"\")","v":"43386031208"}]
[null,null,null,null,"43386040512",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1789,1),\"\"))","v":1},{"$f":"IF(F1789=1,COUNTIF($F$3:F1789,1),\"\")","v":1787},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1789),$G$3:$G$3716,0)),\"\")","v":"43386040512"}]
[null,null,null,null,"43386043201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1790,1),\"\"))","v":1},{"$f":"IF(F1790=1,COUNTIF($F$3:F1790,1),\"\")","v":1788},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1790),$G$3:$G$3716,0)),\"\")","v":"43386043201"}]
[null,null,null,null,"43386044024",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1791,1),\"\"))","v":1},{"$f":"IF(F1791=1,COUNTIF($F$3:F1791,1),\"\")","v":1789},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1791),$G$3:$G$3716,0)),\"\")","v":"43386044024"}]
[null,null,null,null,"43386051087",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1792,1),\"\"))","v":1},{"$f":"IF(F1792=1,COUNTIF($F$3:F1792,1),\"\")","v":1790},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1792),$G$3:$G$3716,0)),\"\")","v":"43386051087"}]
[null,null,null,null,"43386062230",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1793,1),\"\"))","v":1},{"$f":"IF(F1793=1,COUNTIF($F$3:F1793,1),\"\")","v":1791},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1793),$G$3:$G$3716,0)),\"\")","v":"43386062230"}]
[null,null,null,null,"43386092047",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1794,1),\"\"))","v":1},{"$f":"IF(F1794=1,COUNTIF($F$3:F1794,1),\"\")","v":1792},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1794),$G$3:$G$3716,0)),\"\")","v":"43386092047"}]
[null,null,null,null,"43478090288",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1795,1),\"\"))","v":1},{"$f":"IF(F1795=1,COUNTIF($F$3:F1795,1),\"\")","v":1793},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1795),$G$3:$G$3716,0)),\"\")","v":"43478090288"}]
[null,null,null,null,"43547026810",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1796,1),\"\"))","v":1},{"$f":"IF(F1796=1,COUNTIF($F$3:F1796,1),\"\")","v":1794},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1796),$G$3:$G$3716,0)),\"\")","v":"43547026810"}]
[null,null,null,null,"43547027010",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1797,1),\"\"))","v":1},{"$f":"IF(F1797=1,COUNTIF($F$3:F1797,1),\"\")","v":1795},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1797),$G$3:$G$3716,0)),\"\")","v":"43547027010"}]
[null,null,null,null,"43547027110",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1798,1),\"\"))","v":1},{"$f":"IF(F1798=1,COUNTIF($F$3:F1798,1),\"\")","v":1796},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1798),$G$3:$G$3716,0)),\"\")","v":"43547027110"}]
[null,null,null,null,"43547035410",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1799,1),\"\"))","v":1},{"$f":"IF(F1799=1,COUNTIF($F$3:F1799,1),\"\")","v":1797},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1799),$G$3:$G$3716,0)),\"\")","v":"43547035410"}]
[null,null,null,null,"43547036809",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1800,1),\"\"))","v":1},{"$f":"IF(F1800=1,COUNTIF($F$3:F1800,1),\"\")","v":1798},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1800),$G$3:$G$3716,0)),\"\")","v":"43547036809"}]
[null,null,null,null,"43547040710",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1801,1),\"\"))","v":1},{"$f":"IF(F1801=1,COUNTIF($F$3:F1801,1),\"\")","v":1799},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1801),$G$3:$G$3716,0)),\"\")","v":"43547040710"}]
[null,null,null,null,"43547040810",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1802,1),\"\"))","v":1},{"$f":"IF(F1802=1,COUNTIF($F$3:F1802,1),\"\")","v":1800},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1802),$G$3:$G$3716,0)),\"\")","v":"43547040810"}]
[null,null,null,null,"43598016430",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1803,1),\"\"))","v":1},{"$f":"IF(F1803=1,COUNTIF($F$3:F1803,1),\"\")","v":1801},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1803),$G$3:$G$3716,0)),\"\")","v":"43598016430"}]
[null,null,null,null,"43598020451",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1804,1),\"\"))","v":1},{"$f":"IF(F1804=1,COUNTIF($F$3:F1804,1),\"\")","v":1802},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1804),$G$3:$G$3716,0)),\"\")","v":"43598020451"}]
[null,null,null,null,"43598021025",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1805,1),\"\"))","v":1},{"$f":"IF(F1805=1,COUNTIF($F$3:F1805,1),\"\")","v":1803},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1805),$G$3:$G$3716,0)),\"\")","v":"43598021025"}]
[null,null,null,null,"43598021040",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1806,1),\"\"))","v":1},{"$f":"IF(F1806=1,COUNTIF($F$3:F1806,1),\"\")","v":1804},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1806),$G$3:$G$3716,0)),\"\")","v":"43598021040"}]
[null,null,null,null,"43598021350",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1807,1),\"\"))","v":1},{"$f":"IF(F1807=1,COUNTIF($F$3:F1807,1),\"\")","v":1805},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1807),$G$3:$G$3716,0)),\"\")","v":"43598021350"}]
[null,null,null,null,"43598021830",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1808,1),\"\"))","v":1},{"$f":"IF(F1808=1,COUNTIF($F$3:F1808,1),\"\")","v":1806},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1808),$G$3:$G$3716,0)),\"\")","v":"43598021830"}]
[null,null,null,null,"43598022040",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1809,1),\"\"))","v":1},{"$f":"IF(F1809=1,COUNTIF($F$3:F1809,1),\"\")","v":1807},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1809),$G$3:$G$3716,0)),\"\")","v":"43598022040"}]
[null,null,null,null,"43598022114",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1810,1),\"\"))","v":1},{"$f":"IF(F1810=1,COUNTIF($F$3:F1810,1),\"\")","v":1808},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1810),$G$3:$G$3716,0)),\"\")","v":"43598022114"}]
[null,null,null,null,"43598043635",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1811,1),\"\"))","v":1},{"$f":"IF(F1811=1,COUNTIF($F$3:F1811,1),\"\")","v":1809},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1811),$G$3:$G$3716,0)),\"\")","v":"43598043635"}]
[null,null,null,null,"43598044670",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1812,1),\"\"))","v":1},{"$f":"IF(F1812=1,COUNTIF($F$3:F1812,1),\"\")","v":1810},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1812),$G$3:$G$3716,0)),\"\")","v":"43598044670"}]
[null,null,null,null,"43598044671",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1813,1),\"\"))","v":1},{"$f":"IF(F1813=1,COUNTIF($F$3:F1813,1),\"\")","v":1811},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1813),$G$3:$G$3716,0)),\"\")","v":"43598044671"}]
[null,null,null,null,"43598044770",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1814,1),\"\"))","v":1},{"$f":"IF(F1814=1,COUNTIF($F$3:F1814,1),\"\")","v":1812},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1814),$G$3:$G$3716,0)),\"\")","v":"43598044770"}]
[null,null,null,null,"43598044774",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1815,1),\"\"))","v":1},{"$f":"IF(F1815=1,COUNTIF($F$3:F1815,1),\"\")","v":1813},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1815),$G$3:$G$3716,0)),\"\")","v":"43598044774"}]
[null,null,null,null,"43598044871",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1816,1),\"\"))","v":1},{"$f":"IF(F1816=1,COUNTIF($F$3:F1816,1),\"\")","v":1814},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1816),$G$3:$G$3716,0)),\"\")","v":"43598044871"}]
[null,null,null,null,"43598044874",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1817,1),\"\"))","v":1},{"$f":"IF(F1817=1,COUNTIF($F$3:F1817,1),\"\")","v":1815},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1817),$G$3:$G$3716,0)),\"\")","v":"43598044874"}]
[null,null,null,null,"43598048627",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1818,1),\"\"))","v":1},{"$f":"IF(F1818=1,COUNTIF($F$3:F1818,1),\"\")","v":1816},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1818),$G$3:$G$3716,0)),\"\")","v":"43598048627"}]
[null,null,null,null,"43598055530",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1819,1),\"\"))","v":1},{"$f":"IF(F1819=1,COUNTIF($F$3:F1819,1),\"\")","v":1817},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1819),$G$3:$G$3716,0)),\"\")","v":"43598055530"}]
[null,null,null,null,"43598056178",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1820,1),\"\"))","v":1},{"$f":"IF(F1820=1,COUNTIF($F$3:F1820,1),\"\")","v":1818},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1820),$G$3:$G$3716,0)),\"\")","v":"43598056178"}]
[null,null,null,null,"43598056179",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1821,1),\"\"))","v":1},{"$f":"IF(F1821=1,COUNTIF($F$3:F1821,1),\"\")","v":1819},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1821),$G$3:$G$3716,0)),\"\")","v":"43598056179"}]
[null,null,null,null,"43598072101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1822,1),\"\"))","v":1},{"$f":"IF(F1822=1,COUNTIF($F$3:F1822,1),\"\")","v":1820},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1822),$G$3:$G$3716,0)),\"\")","v":"43598072101"}]
[null,null,null,null,"43825060641",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1823,1),\"\"))","v":1},{"$f":"IF(F1823=1,COUNTIF($F$3:F1823,1),\"\")","v":1821},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1823),$G$3:$G$3716,0)),\"\")","v":"43825060641"}]
[null,null,null,null,"43900097647",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1824,1),\"\"))","v":1},{"$f":"IF(F1824=1,COUNTIF($F$3:F1824,1),\"\")","v":1822},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1824),$G$3:$G$3716,0)),\"\")","v":"43900097647"}]
[null,null,null,null,"45802000402",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1825,1),\"\"))","v":1},{"$f":"IF(F1825=1,COUNTIF($F$3:F1825,1),\"\")","v":1823},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1825),$G$3:$G$3716,0)),\"\")","v":"45802000402"}]
[null,null,null,null,"45802000403",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1826,1),\"\"))","v":1},{"$f":"IF(F1826=1,COUNTIF($F$3:F1826,1),\"\")","v":1824},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1826),$G$3:$G$3716,0)),\"\")","v":"45802000403"}]
[null,null,null,null,"45802001402",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1827,1),\"\"))","v":1},{"$f":"IF(F1827=1,COUNTIF($F$3:F1827,1),\"\")","v":1825},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1827),$G$3:$G$3716,0)),\"\")","v":"45802001402"}]
[null,null,null,null,"45802004064",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1828,1),\"\"))","v":1},{"$f":"IF(F1828=1,COUNTIF($F$3:F1828,1),\"\")","v":1826},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1828),$G$3:$G$3716,0)),\"\")","v":"45802004064"}]
[null,null,null,null,"45802004835",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1829,1),\"\"))","v":1},{"$f":"IF(F1829=1,COUNTIF($F$3:F1829,1),\"\")","v":1827},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1829),$G$3:$G$3716,0)),\"\")","v":"45802004835"}]
[null,null,null,null,"45802005635",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1830,1),\"\"))","v":1},{"$f":"IF(F1830=1,COUNTIF($F$3:F1830,1),\"\")","v":1828},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1830),$G$3:$G$3716,0)),\"\")","v":"45802005635"}]
[null,null,null,null,"45802005911",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1831,1),\"\"))","v":1},{"$f":"IF(F1831=1,COUNTIF($F$3:F1831,1),\"\")","v":1829},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1831),$G$3:$G$3716,0)),\"\")","v":"45802005911"}]
[null,null,null,null,"45802006001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1832,1),\"\"))","v":1},{"$f":"IF(F1832=1,COUNTIF($F$3:F1832,1),\"\")","v":1830},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1832),$G$3:$G$3716,0)),\"\")","v":"45802006001"}]
[null,null,null,null,"45802006101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1833,1),\"\"))","v":1},{"$f":"IF(F1833=1,COUNTIF($F$3:F1833,1),\"\")","v":1831},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1833),$G$3:$G$3716,0)),\"\")","v":"45802006101"}]
[null,null,null,null,"45802006435",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1834,1),\"\"))","v":1},{"$f":"IF(F1834=1,COUNTIF($F$3:F1834,1),\"\")","v":1832},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1834),$G$3:$G$3716,0)),\"\")","v":"45802006435"}]
[null,null,null,null,"45802008801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1835,1),\"\"))","v":1},{"$f":"IF(F1835=1,COUNTIF($F$3:F1835,1),\"\")","v":1833},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1835),$G$3:$G$3716,0)),\"\")","v":"45802008801"}]
[null,null,null,null,"45802009851",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1836,1),\"\"))","v":1},{"$f":"IF(F1836=1,COUNTIF($F$3:F1836,1),\"\")","v":1834},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1836),$G$3:$G$3716,0)),\"\")","v":"45802009851"}]
[null,null,null,null,"45802011222",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1837,1),\"\"))","v":1},{"$f":"IF(F1837=1,COUNTIF($F$3:F1837,1),\"\")","v":1835},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1837),$G$3:$G$3716,0)),\"\")","v":"45802011222"}]
[null,null,null,null,"45802014301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1838,1),\"\"))","v":1},{"$f":"IF(F1838=1,COUNTIF($F$3:F1838,1),\"\")","v":1836},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1838),$G$3:$G$3716,0)),\"\")","v":"45802014301"}]
[null,null,null,null,"45802020305",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1839,1),\"\"))","v":1},{"$f":"IF(F1839=1,COUNTIF($F$3:F1839,1),\"\")","v":1837},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1839),$G$3:$G$3716,0)),\"\")","v":"45802020305"}]
[null,null,null,null,"45802020326",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1840,1),\"\"))","v":1},{"$f":"IF(F1840=1,COUNTIF($F$3:F1840,1),\"\")","v":1838},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1840),$G$3:$G$3716,0)),\"\")","v":"45802020326"}]
[null,null,null,null,"45802020365",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1841,1),\"\"))","v":1},{"$f":"IF(F1841=1,COUNTIF($F$3:F1841,1),\"\")","v":1839},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1841),$G$3:$G$3716,0)),\"\")","v":"45802020365"}]
[null,null,null,null,"45802026937",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1842,1),\"\"))","v":1},{"$f":"IF(F1842=1,COUNTIF($F$3:F1842,1),\"\")","v":1840},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1842),$G$3:$G$3716,0)),\"\")","v":"45802026937"}]
[null,null,null,null,"45802034405",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1843,1),\"\"))","v":1},{"$f":"IF(F1843=1,COUNTIF($F$3:F1843,1),\"\")","v":1841},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1843),$G$3:$G$3716,0)),\"\")","v":"45802034405"}]
[null,null,null,null,"45802042235",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1844,1),\"\"))","v":1},{"$f":"IF(F1844=1,COUNTIF($F$3:F1844,1),\"\")","v":1842},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1844),$G$3:$G$3716,0)),\"\")","v":"45802042235"}]
[null,null,null,null,"45802043411",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1845,1),\"\"))","v":1},{"$f":"IF(F1845=1,COUNTIF($F$3:F1845,1),\"\")","v":1843},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1845),$G$3:$G$3716,0)),\"\")","v":"45802043411"}]
[null,null,null,null,"45802043803",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1846,1),\"\"))","v":1},{"$f":"IF(F1846=1,COUNTIF($F$3:F1846,1),\"\")","v":1844},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1846),$G$3:$G$3716,0)),\"\")","v":"45802043803"}]
[null,null,null,null,"45802046564",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1847,1),\"\"))","v":1},{"$f":"IF(F1847=1,COUNTIF($F$3:F1847,1),\"\")","v":1845},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1847),$G$3:$G$3716,0)),\"\")","v":"45802046564"}]
[null,null,null,null,"45802052555",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1848,1),\"\"))","v":1},{"$f":"IF(F1848=1,COUNTIF($F$3:F1848,1),\"\")","v":1846},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1848),$G$3:$G$3716,0)),\"\")","v":"45802052555"}]
[null,null,null,null,"45802058084",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1849,1),\"\"))","v":1},{"$f":"IF(F1849=1,COUNTIF($F$3:F1849,1),\"\")","v":1847},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1849),$G$3:$G$3716,0)),\"\")","v":"45802058084"}]
[null,null,null,null,"45802065087",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1850,1),\"\"))","v":1},{"$f":"IF(F1850=1,COUNTIF($F$3:F1850,1),\"\")","v":1848},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1850),$G$3:$G$3716,0)),\"\")","v":"45802065087"}]
[null,null,null,null,"45802073000",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1851,1),\"\"))","v":1},{"$f":"IF(F1851=1,COUNTIF($F$3:F1851,1),\"\")","v":1849},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1851),$G$3:$G$3716,0)),\"\")","v":"45802073000"}]
[null,null,null,null,"45802073030",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1852,1),\"\"))","v":1},{"$f":"IF(F1852=1,COUNTIF($F$3:F1852,1),\"\")","v":1850},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1852),$G$3:$G$3716,0)),\"\")","v":"45802073030"}]
[null,null,null,null,"45802073200",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1853,1),\"\"))","v":1},{"$f":"IF(F1853=1,COUNTIF($F$3:F1853,1),\"\")","v":1851},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1853),$G$3:$G$3716,0)),\"\")","v":"45802073200"}]
[null,null,null,null,"45802073230",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1854,1),\"\"))","v":1},{"$f":"IF(F1854=1,COUNTIF($F$3:F1854,1),\"\")","v":1852},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1854),$G$3:$G$3716,0)),\"\")","v":"45802073230"}]
[null,null,null,null,"45802086801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1855,1),\"\"))","v":1},{"$f":"IF(F1855=1,COUNTIF($F$3:F1855,1),\"\")","v":1853},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1855),$G$3:$G$3716,0)),\"\")","v":"45802086801"}]
[null,null,null,null,"45802089710",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1856,1),\"\"))","v":1},{"$f":"IF(F1856=1,COUNTIF($F$3:F1856,1),\"\")","v":1854},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1856),$G$3:$G$3716,0)),\"\")","v":"45802089710"}]
[null,null,null,null,"45963034102",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1857,1),\"\"))","v":1},{"$f":"IF(F1857=1,COUNTIF($F$3:F1857,1),\"\")","v":1855},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1857),$G$3:$G$3716,0)),\"\")","v":"45963034102"}]
[null,null,null,null,"45963034202",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1858,1),\"\"))","v":1},{"$f":"IF(F1858=1,COUNTIF($F$3:F1858,1),\"\")","v":1856},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1858),$G$3:$G$3716,0)),\"\")","v":"45963034202"}]
[null,null,null,null,"45963034302",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1859,1),\"\"))","v":1},{"$f":"IF(F1859=1,COUNTIF($F$3:F1859,1),\"\")","v":1857},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1859),$G$3:$G$3716,0)),\"\")","v":"45963034302"}]
[null,null,null,null,"45963046110",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1860,1),\"\"))","v":1},{"$f":"IF(F1860=1,COUNTIF($F$3:F1860,1),\"\")","v":1858},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1860),$G$3:$G$3716,0)),\"\")","v":"45963046110"}]
[null,null,null,null,"46122017608",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1861,1),\"\"))","v":1},{"$f":"IF(F1861=1,COUNTIF($F$3:F1861,1),\"\")","v":1859},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1861),$G$3:$G$3716,0)),\"\")","v":"46122017608"}]
[null,null,null,null,"46122057578",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1862,1),\"\"))","v":1},{"$f":"IF(F1862=1,COUNTIF($F$3:F1862,1),\"\")","v":1860},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1862),$G$3:$G$3716,0)),\"\")","v":"46122057578"}]
[null,null,null,null,"46287000660",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1863,1),\"\"))","v":1},{"$f":"IF(F1863=1,COUNTIF($F$3:F1863,1),\"\")","v":1861},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1863),$G$3:$G$3716,0)),\"\")","v":"46287000660"}]
[null,null,null,null,"46287050704",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1864,1),\"\"))","v":1},{"$f":"IF(F1864=1,COUNTIF($F$3:F1864,1),\"\")","v":1862},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1864),$G$3:$G$3716,0)),\"\")","v":"46287050704"}]
[null,null,null,null,"47335006186",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1865,1),\"\"))","v":1},{"$f":"IF(F1865=1,COUNTIF($F$3:F1865,1),\"\")","v":1863},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1865),$G$3:$G$3716,0)),\"\")","v":"47335006186"}]
[null,null,null,null,"47335053981",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1866,1),\"\"))","v":1},{"$f":"IF(F1866=1,COUNTIF($F$3:F1866,1),\"\")","v":1864},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1866),$G$3:$G$3716,0)),\"\")","v":"47335053981"}]
[null,null,null,null,"47335073686",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1867,1),\"\"))","v":1},{"$f":"IF(F1867=1,COUNTIF($F$3:F1867,1),\"\")","v":1865},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1867),$G$3:$G$3716,0)),\"\")","v":"47335073686"}]
[null,null,null,null,"47335073786",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1868,1),\"\"))","v":1},{"$f":"IF(F1868=1,COUNTIF($F$3:F1868,1),\"\")","v":1866},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1868),$G$3:$G$3716,0)),\"\")","v":"47335073786"}]
[null,null,null,null,"47335090288",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1869,1),\"\"))","v":1},{"$f":"IF(F1869=1,COUNTIF($F$3:F1869,1),\"\")","v":1867},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1869),$G$3:$G$3716,0)),\"\")","v":"47335090288"}]
[null,null,null,null,"47335090488",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1870,1),\"\"))","v":1},{"$f":"IF(F1870=1,COUNTIF($F$3:F1870,1),\"\")","v":1868},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1870),$G$3:$G$3716,0)),\"\")","v":"47335090488"}]
[null,null,null,null,"47335093140",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1871,1),\"\"))","v":1},{"$f":"IF(F1871=1,COUNTIF($F$3:F1871,1),\"\")","v":1869},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1871),$G$3:$G$3716,0)),\"\")","v":"47335093140"}]
[null,null,null,null,"47682047915",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1872,1),\"\"))","v":1},{"$f":"IF(F1872=1,COUNTIF($F$3:F1872,1),\"\")","v":1870},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1872),$G$3:$G$3716,0)),\"\")","v":"47682047915"}]
[null,null,null,null,"47781030301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1873,1),\"\"))","v":1},{"$f":"IF(F1873=1,COUNTIF($F$3:F1873,1),\"\")","v":1871},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1873),$G$3:$G$3716,0)),\"\")","v":"47781030301"}]
[null,null,null,null,"47781033201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1874,1),\"\"))","v":1},{"$f":"IF(F1874=1,COUNTIF($F$3:F1874,1),\"\")","v":1872},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1874),$G$3:$G$3716,0)),\"\")","v":"47781033201"}]
[null,null,null,null,"47781033331",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1875,1),\"\"))","v":1},{"$f":"IF(F1875=1,COUNTIF($F$3:F1875,1),\"\")","v":1873},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1875),$G$3:$G$3716,0)),\"\")","v":"47781033331"}]
[null,null,null,null,"47781033431",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1876,1),\"\"))","v":1},{"$f":"IF(F1876=1,COUNTIF($F$3:F1876,1),\"\")","v":1874},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1876),$G$3:$G$3716,0)),\"\")","v":"47781033431"}]
[null,null,null,null,"47781038426",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1877,1),\"\"))","v":1},{"$f":"IF(F1877=1,COUNTIF($F$3:F1877,1),\"\")","v":1875},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1877),$G$3:$G$3716,0)),\"\")","v":"47781038426"}]
[null,null,null,null,"47781046813",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1878,1),\"\"))","v":1},{"$f":"IF(F1878=1,COUNTIF($F$3:F1878,1),\"\")","v":1876},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1878),$G$3:$G$3716,0)),\"\")","v":"47781046813"}]
[null,null,null,null,"47781047013",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1879,1),\"\"))","v":1},{"$f":"IF(F1879=1,COUNTIF($F$3:F1879,1),\"\")","v":1877},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1879),$G$3:$G$3716,0)),\"\")","v":"47781047013"}]
[null,null,null,null,"47781049701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1880,1),\"\"))","v":1},{"$f":"IF(F1880=1,COUNTIF($F$3:F1880,1),\"\")","v":1878},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1880),$G$3:$G$3716,0)),\"\")","v":"47781049701"}]
[null,null,null,null,"47781056926",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1881,1),\"\"))","v":1},{"$f":"IF(F1881=1,COUNTIF($F$3:F1881,1),\"\")","v":1879},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1881),$G$3:$G$3716,0)),\"\")","v":"47781056926"}]
[null,null,null,null,"47781060730",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1882,1),\"\"))","v":1},{"$f":"IF(F1882=1,COUNTIF($F$3:F1882,1),\"\")","v":1880},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1882),$G$3:$G$3716,0)),\"\")","v":"47781060730"}]
[null,null,null,null,"47781064726",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1883,1),\"\"))","v":1},{"$f":"IF(F1883=1,COUNTIF($F$3:F1883,1),\"\")","v":1881},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1883),$G$3:$G$3716,0)),\"\")","v":"47781064726"}]
[null,null,null,null,"48433010401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1884,1),\"\"))","v":1},{"$f":"IF(F1884=1,COUNTIF($F$3:F1884,1),\"\")","v":1882},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1884),$G$3:$G$3716,0)),\"\")","v":"48433010401"}]
[null,null,null,null,"48433010801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1885,1),\"\"))","v":1},{"$f":"IF(F1885=1,COUNTIF($F$3:F1885,1),\"\")","v":1883},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1885),$G$3:$G$3716,0)),\"\")","v":"48433010801"}]
[null,null,null,null,"48433011101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1886,1),\"\"))","v":1},{"$f":"IF(F1886=1,COUNTIF($F$3:F1886,1),\"\")","v":1884},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1886),$G$3:$G$3716,0)),\"\")","v":"48433011101"}]
[null,null,null,null,"48433020230",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1887,1),\"\"))","v":1},{"$f":"IF(F1887=1,COUNTIF($F$3:F1887,1),\"\")","v":1885},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1887),$G$3:$G$3716,0)),\"\")","v":"48433020230"}]
[null,null,null,null,"49281051105",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1888,1),\"\"))","v":1},{"$f":"IF(F1888=1,COUNTIF($F$3:F1888,1),\"\")","v":1886},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1888),$G$3:$G$3716,0)),\"\")","v":"49281051105"}]
[null,null,null,null,"49411005030",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1889,1),\"\"))","v":1},{"$f":"IF(F1889=1,COUNTIF($F$3:F1889,1),\"\")","v":1887},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1889),$G$3:$G$3716,0)),\"\")","v":"49411005030"}]
[null,null,null,null,"49483060701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1890,1),\"\"))","v":1},{"$f":"IF(F1890=1,COUNTIF($F$3:F1890,1),\"\")","v":1888},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1890),$G$3:$G$3716,0)),\"\")","v":"49483060701"}]
[null,null,null,null,"49702020218",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1891,1),\"\"))","v":1},{"$f":"IF(F1891=1,COUNTIF($F$3:F1891,1),\"\")","v":1889},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1891),$G$3:$G$3716,0)),\"\")","v":"49702020218"}]
[null,null,null,null,"49702020229",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1892,1),\"\"))","v":1},{"$f":"IF(F1892=1,COUNTIF($F$3:F1892,1),\"\")","v":1890},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1892),$G$3:$G$3716,0)),\"\")","v":"49702020229"}]
[null,null,null,null,"49702020613",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1893,1),\"\"))","v":1},{"$f":"IF(F1893=1,COUNTIF($F$3:F1893,1),\"\")","v":1891},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1893),$G$3:$G$3716,0)),\"\")","v":"49702020613"}]
[null,null,null,null,"49702020718",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1894,1),\"\"))","v":1},{"$f":"IF(F1894=1,COUNTIF($F$3:F1894,1),\"\")","v":1892},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1894),$G$3:$G$3716,0)),\"\")","v":"49702020718"}]
[null,null,null,null,"49702021718",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1895,1),\"\"))","v":1},{"$f":"IF(F1895=1,COUNTIF($F$3:F1895,1),\"\")","v":1893},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1895),$G$3:$G$3716,0)),\"\")","v":"49702021718"}]
[null,null,null,null,"49702022144",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1896,1),\"\"))","v":1},{"$f":"IF(F1896=1,COUNTIF($F$3:F1896,1),\"\")","v":1894},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1896),$G$3:$G$3716,0)),\"\")","v":"49702022144"}]
[null,null,null,null,"49702022318",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1897,1),\"\"))","v":1},{"$f":"IF(F1897=1,COUNTIF($F$3:F1897,1),\"\")","v":1895},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1897),$G$3:$G$3716,0)),\"\")","v":"49702022318"}]
[null,null,null,null,"49702022418",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1898,1),\"\"))","v":1},{"$f":"IF(F1898=1,COUNTIF($F$3:F1898,1),\"\")","v":1896},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1898),$G$3:$G$3716,0)),\"\")","v":"49702022418"}]
[null,null,null,null,"49702022813",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1899,1),\"\"))","v":1},{"$f":"IF(F1899=1,COUNTIF($F$3:F1899,1),\"\")","v":1897},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1899),$G$3:$G$3716,0)),\"\")","v":"49702022813"}]
[null,null,null,null,"49702023113",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1900,1),\"\"))","v":1},{"$f":"IF(F1900=1,COUNTIF($F$3:F1900,1),\"\")","v":1898},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1900),$G$3:$G$3716,0)),\"\")","v":"49702023113"}]
[null,null,null,null,"49702024015",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1901,1),\"\"))","v":1},{"$f":"IF(F1901=1,COUNTIF($F$3:F1901,1),\"\")","v":1899},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1901),$G$3:$G$3716,0)),\"\")","v":"49702024015"}]
[null,null,null,null,"49702025315",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1902,1),\"\"))","v":1},{"$f":"IF(F1902=1,COUNTIF($F$3:F1902,1),\"\")","v":1900},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1902),$G$3:$G$3716,0)),\"\")","v":"49702025315"}]
[null,null,null,null,"49708064490",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1903,1),\"\"))","v":1},{"$f":"IF(F1903=1,COUNTIF($F$3:F1903,1),\"\")","v":1901},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1903),$G$3:$G$3716,0)),\"\")","v":"49708064490"}]
[null,null,null,null,"49781008499",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1904,1),\"\"))","v":1},{"$f":"IF(F1904=1,COUNTIF($F$3:F1904,1),\"\")","v":1902},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1904),$G$3:$G$3716,0)),\"\")","v":"49781008499"}]
[null,null,null,null,"49884000910",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1905,1),\"\"))","v":1},{"$f":"IF(F1905=1,COUNTIF($F$3:F1905,1),\"\")","v":1903},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1905),$G$3:$G$3716,0)),\"\")","v":"49884000910"}]
[null,null,null,null,"49884002901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1906,1),\"\"))","v":1},{"$f":"IF(F1906=1,COUNTIF($F$3:F1906,1),\"\")","v":1904},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1906),$G$3:$G$3716,0)),\"\")","v":"49884002901"}]
[null,null,null,null,"49884003501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1907,1),\"\"))","v":1},{"$f":"IF(F1907=1,COUNTIF($F$3:F1907,1),\"\")","v":1905},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1907),$G$3:$G$3716,0)),\"\")","v":"49884003501"}]
[null,null,null,null,"49884005401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1908,1),\"\"))","v":1},{"$f":"IF(F1908=1,COUNTIF($F$3:F1908,1),\"\")","v":1906},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1908),$G$3:$G$3716,0)),\"\")","v":"49884005401"}]
[null,null,null,null,"49884022811",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1909,1),\"\"))","v":1},{"$f":"IF(F1909=1,COUNTIF($F$3:F1909,1),\"\")","v":1907},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1909),$G$3:$G$3716,0)),\"\")","v":"49884022811"}]
[null,null,null,null,"49884023183",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1910,1),\"\"))","v":1},{"$f":"IF(F1910=1,COUNTIF($F$3:F1910,1),\"\")","v":1908},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1910),$G$3:$G$3716,0)),\"\")","v":"49884023183"}]
[null,null,null,null,"49884025901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1911,1),\"\"))","v":1},{"$f":"IF(F1911=1,COUNTIF($F$3:F1911,1),\"\")","v":1909},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1911),$G$3:$G$3716,0)),\"\")","v":"49884025901"}]
[null,null,null,null,"49884040501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1912,1),\"\"))","v":1},{"$f":"IF(F1912=1,COUNTIF($F$3:F1912,1),\"\")","v":1910},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1912),$G$3:$G$3716,0)),\"\")","v":"49884040501"}]
[null,null,null,null,"49884046663",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1913,1),\"\"))","v":1},{"$f":"IF(F1913=1,COUNTIF($F$3:F1913,1),\"\")","v":1911},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1913),$G$3:$G$3716,0)),\"\")","v":"49884046663"}]
[null,null,null,null,"49884046665",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1914,1),\"\"))","v":1},{"$f":"IF(F1914=1,COUNTIF($F$3:F1914,1),\"\")","v":1912},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1914),$G$3:$G$3716,0)),\"\")","v":"49884046665"}]
[null,null,null,null,"49884050101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1915,1),\"\"))","v":1},{"$f":"IF(F1915=1,COUNTIF($F$3:F1915,1),\"\")","v":1913},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1915),$G$3:$G$3716,0)),\"\")","v":"49884050101"}]
[null,null,null,null,"49884064001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1916,1),\"\"))","v":1},{"$f":"IF(F1916=1,COUNTIF($F$3:F1916,1),\"\")","v":1914},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1916),$G$3:$G$3716,0)),\"\")","v":"49884064001"}]
[null,null,null,null,"49884064101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1917,1),\"\"))","v":1},{"$f":"IF(F1917=1,COUNTIF($F$3:F1917,1),\"\")","v":1915},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1917),$G$3:$G$3716,0)),\"\")","v":"49884064101"}]
[null,null,null,null,"49884072401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1918,1),\"\"))","v":1},{"$f":"IF(F1918=1,COUNTIF($F$3:F1918,1),\"\")","v":1916},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1918),$G$3:$G$3716,0)),\"\")","v":"49884072401"}]
[null,null,null,null,"49884082911",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1919,1),\"\"))","v":1},{"$f":"IF(F1919=1,COUNTIF($F$3:F1919,1),\"\")","v":1917},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1919),$G$3:$G$3716,0)),\"\")","v":"49884082911"}]
[null,null,null,null,"49884098401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1920,1),\"\"))","v":1},{"$f":"IF(F1920=1,COUNTIF($F$3:F1920,1),\"\")","v":1918},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1920),$G$3:$G$3716,0)),\"\")","v":"49884098401"}]
[null,null,null,null,"49938010130",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1921,1),\"\"))","v":1},{"$f":"IF(F1921=1,COUNTIF($F$3:F1921,1),\"\")","v":1919},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1921),$G$3:$G$3716,0)),\"\")","v":"49938010130"}]
[null,null,null,null,"49938010230",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1922,1),\"\"))","v":1},{"$f":"IF(F1922=1,COUNTIF($F$3:F1922,1),\"\")","v":1920},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1922),$G$3:$G$3716,0)),\"\")","v":"49938010230"}]
[null,null,null,null,"50024043100",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1923,1),\"\"))","v":1},{"$f":"IF(F1923=1,COUNTIF($F$3:F1923,1),\"\")","v":1921},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1923),$G$3:$G$3716,0)),\"\")","v":"50024043100"}]
[null,null,null,null,"50102091101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1924,1),\"\"))","v":1},{"$f":"IF(F1924=1,COUNTIF($F$3:F1924,1),\"\")","v":1922},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1924),$G$3:$G$3716,0)),\"\")","v":"50102091101"}]
[null,null,null,null,"50111033301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1925,1),\"\"))","v":1},{"$f":"IF(F1925=1,COUNTIF($F$3:F1925,1),\"\")","v":1923},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1925),$G$3:$G$3716,0)),\"\")","v":"50111033301"}]
[null,null,null,null,"50111033302",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1926,1),\"\"))","v":1},{"$f":"IF(F1926=1,COUNTIF($F$3:F1926,1),\"\")","v":1924},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1926),$G$3:$G$3716,0)),\"\")","v":"50111033302"}]
[null,null,null,null,"50111033402",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1927,1),\"\"))","v":1},{"$f":"IF(F1927=1,COUNTIF($F$3:F1927,1),\"\")","v":1925},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1927),$G$3:$G$3716,0)),\"\")","v":"50111033402"}]
[null,null,null,null,"50111043301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1928,1),\"\"))","v":1},{"$f":"IF(F1928=1,COUNTIF($F$3:F1928,1),\"\")","v":1926},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1928),$G$3:$G$3716,0)),\"\")","v":"50111043301"}]
[null,null,null,null,"50111043302",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1929,1),\"\"))","v":1},{"$f":"IF(F1929=1,COUNTIF($F$3:F1929,1),\"\")","v":1927},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1929),$G$3:$G$3716,0)),\"\")","v":"50111043302"}]
[null,null,null,null,"50111043402",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1930,1),\"\"))","v":1},{"$f":"IF(F1930=1,COUNTIF($F$3:F1930,1),\"\")","v":1928},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1930),$G$3:$G$3716,0)),\"\")","v":"50111043402"}]
[null,null,null,null,"50111046701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1931,1),\"\"))","v":1},{"$f":"IF(F1931=1,COUNTIF($F$3:F1931,1),\"\")","v":1929},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1931),$G$3:$G$3716,0)),\"\")","v":"50111046701"}]
[null,null,null,null,"50111056001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1932,1),\"\"))","v":1},{"$f":"IF(F1932=1,COUNTIF($F$3:F1932,1),\"\")","v":1930},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1932),$G$3:$G$3716,0)),\"\")","v":"50111056001"}]
[null,null,null,null,"50111056101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1933,1),\"\"))","v":1},{"$f":"IF(F1933=1,COUNTIF($F$3:F1933,1),\"\")","v":1931},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1933),$G$3:$G$3716,0)),\"\")","v":"50111056101"}]
[null,null,null,null,"50111064701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1934,1),\"\"))","v":1},{"$f":"IF(F1934=1,COUNTIF($F$3:F1934,1),\"\")","v":1932},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1934),$G$3:$G$3716,0)),\"\")","v":"50111064701"}]
[null,null,null,null,"50111064702",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1935,1),\"\"))","v":1},{"$f":"IF(F1935=1,COUNTIF($F$3:F1935,1),\"\")","v":1933},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1935),$G$3:$G$3716,0)),\"\")","v":"50111064702"}]
[null,null,null,null,"50111091601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1936,1),\"\"))","v":1},{"$f":"IF(F1936=1,COUNTIF($F$3:F1936,1),\"\")","v":1934},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1936),$G$3:$G$3716,0)),\"\")","v":"50111091601"}]
[null,null,null,null,"50111091701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1937,1),\"\"))","v":1},{"$f":"IF(F1937=1,COUNTIF($F$3:F1937,1),\"\")","v":1935},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1937),$G$3:$G$3716,0)),\"\")","v":"50111091701"}]
[null,null,null,null,"50111099001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1938,1),\"\"))","v":1},{"$f":"IF(F1938=1,COUNTIF($F$3:F1938,1),\"\")","v":1936},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1938),$G$3:$G$3716,0)),\"\")","v":"50111099001"}]
[null,null,null,null,"50268006115",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1939,1),\"\"))","v":1},{"$f":"IF(F1939=1,COUNTIF($F$3:F1939,1),\"\")","v":1937},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1939),$G$3:$G$3716,0)),\"\")","v":"50268006115"}]
[null,null,null,null,"50268006911",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1940,1),\"\"))","v":1},{"$f":"IF(F1940=1,COUNTIF($F$3:F1940,1),\"\")","v":1938},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1940),$G$3:$G$3716,0)),\"\")","v":"50268006911"}]
[null,null,null,null,"50268007111",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1941,1),\"\"))","v":1},{"$f":"IF(F1941=1,COUNTIF($F$3:F1941,1),\"\")","v":1939},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1941),$G$3:$G$3716,0)),\"\")","v":"50268007111"}]
[null,null,null,null,"50268008115",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1942,1),\"\"))","v":1},{"$f":"IF(F1942=1,COUNTIF($F$3:F1942,1),\"\")","v":1940},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1942),$G$3:$G$3716,0)),\"\")","v":"50268008115"}]
[null,null,null,null,"50268008411",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1943,1),\"\"))","v":1},{"$f":"IF(F1943=1,COUNTIF($F$3:F1943,1),\"\")","v":1941},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1943),$G$3:$G$3716,0)),\"\")","v":"50268008411"}]
[null,null,null,null,"50268009315",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1944,1),\"\"))","v":1},{"$f":"IF(F1944=1,COUNTIF($F$3:F1944,1),\"\")","v":1942},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1944),$G$3:$G$3716,0)),\"\")","v":"50268009315"}]
[null,null,null,null,"50268009815",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1945,1),\"\"))","v":1},{"$f":"IF(F1945=1,COUNTIF($F$3:F1945,1),\"\")","v":1943},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1945),$G$3:$G$3716,0)),\"\")","v":"50268009815"}]
[null,null,null,null,"50268010211",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1946,1),\"\"))","v":1},{"$f":"IF(F1946=1,COUNTIF($F$3:F1946,1),\"\")","v":1944},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1946),$G$3:$G$3716,0)),\"\")","v":"50268010211"}]
[null,null,null,null,"50268010213",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1947,1),\"\"))","v":1},{"$f":"IF(F1947=1,COUNTIF($F$3:F1947,1),\"\")","v":1945},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1947),$G$3:$G$3716,0)),\"\")","v":"50268010213"}]
[null,null,null,null,"50268010311",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1948,1),\"\"))","v":1},{"$f":"IF(F1948=1,COUNTIF($F$3:F1948,1),\"\")","v":1946},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1948),$G$3:$G$3716,0)),\"\")","v":"50268010311"}]
[null,null,null,null,"50268010315",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1949,1),\"\"))","v":1},{"$f":"IF(F1949=1,COUNTIF($F$3:F1949,1),\"\")","v":1947},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1949),$G$3:$G$3716,0)),\"\")","v":"50268010315"}]
[null,null,null,null,"50268015115",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1950,1),\"\"))","v":1},{"$f":"IF(F1950=1,COUNTIF($F$3:F1950,1),\"\")","v":1948},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1950),$G$3:$G$3716,0)),\"\")","v":"50268015115"}]
[null,null,null,null,"50268017611",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1951,1),\"\"))","v":1},{"$f":"IF(F1951=1,COUNTIF($F$3:F1951,1),\"\")","v":1949},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1951),$G$3:$G$3716,0)),\"\")","v":"50268017611"}]
[null,null,null,null,"50268017615",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1952,1),\"\"))","v":1},{"$f":"IF(F1952=1,COUNTIF($F$3:F1952,1),\"\")","v":1950},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1952),$G$3:$G$3716,0)),\"\")","v":"50268017615"}]
[null,null,null,null,"50268017715",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1953,1),\"\"))","v":1},{"$f":"IF(F1953=1,COUNTIF($F$3:F1953,1),\"\")","v":1951},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1953),$G$3:$G$3716,0)),\"\")","v":"50268017715"}]
[null,null,null,null,"50268027915",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1954,1),\"\"))","v":1},{"$f":"IF(F1954=1,COUNTIF($F$3:F1954,1),\"\")","v":1952},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1954),$G$3:$G$3716,0)),\"\")","v":"50268027915"}]
[null,null,null,null,"50268030315",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1955,1),\"\"))","v":1},{"$f":"IF(F1955=1,COUNTIF($F$3:F1955,1),\"\")","v":1953},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1955),$G$3:$G$3716,0)),\"\")","v":"50268030315"}]
[null,null,null,null,"50268030611",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1956,1),\"\"))","v":1},{"$f":"IF(F1956=1,COUNTIF($F$3:F1956,1),\"\")","v":1954},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1956),$G$3:$G$3716,0)),\"\")","v":"50268030611"}]
[null,null,null,null,"50268030613",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1957,1),\"\"))","v":1},{"$f":"IF(F1957=1,COUNTIF($F$3:F1957,1),\"\")","v":1955},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1957),$G$3:$G$3716,0)),\"\")","v":"50268030613"}]
[null,null,null,null,"50268031311",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1958,1),\"\"))","v":1},{"$f":"IF(F1958=1,COUNTIF($F$3:F1958,1),\"\")","v":1956},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1958),$G$3:$G$3716,0)),\"\")","v":"50268031311"}]
[null,null,null,null,"50268032111",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1959,1),\"\"))","v":1},{"$f":"IF(F1959=1,COUNTIF($F$3:F1959,1),\"\")","v":1957},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1959),$G$3:$G$3716,0)),\"\")","v":"50268032111"}]
[null,null,null,null,"50268032311",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1960,1),\"\"))","v":1},{"$f":"IF(F1960=1,COUNTIF($F$3:F1960,1),\"\")","v":1958},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1960),$G$3:$G$3716,0)),\"\")","v":"50268032311"}]
[null,null,null,null,"50268032315",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1961,1),\"\"))","v":1},{"$f":"IF(F1961=1,COUNTIF($F$3:F1961,1),\"\")","v":1959},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1961),$G$3:$G$3716,0)),\"\")","v":"50268032315"}]
[null,null,null,null,"50268034511",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1962,1),\"\"))","v":1},{"$f":"IF(F1962=1,COUNTIF($F$3:F1962,1),\"\")","v":1960},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1962),$G$3:$G$3716,0)),\"\")","v":"50268034511"}]
[null,null,null,null,"50268034811",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1963,1),\"\"))","v":1},{"$f":"IF(F1963=1,COUNTIF($F$3:F1963,1),\"\")","v":1961},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1963),$G$3:$G$3716,0)),\"\")","v":"50268034811"}]
[null,null,null,null,"50268034911",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1964,1),\"\"))","v":1},{"$f":"IF(F1964=1,COUNTIF($F$3:F1964,1),\"\")","v":1962},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1964),$G$3:$G$3716,0)),\"\")","v":"50268034911"}]
[null,null,null,null,"50268041211",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1965,1),\"\"))","v":1},{"$f":"IF(F1965=1,COUNTIF($F$3:F1965,1),\"\")","v":1963},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1965),$G$3:$G$3716,0)),\"\")","v":"50268041211"}]
[null,null,null,null,"50268046711",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1966,1),\"\"))","v":1},{"$f":"IF(F1966=1,COUNTIF($F$3:F1966,1),\"\")","v":1964},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1966),$G$3:$G$3716,0)),\"\")","v":"50268046711"}]
[null,null,null,null,"50268046715",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1967,1),\"\"))","v":1},{"$f":"IF(F1967=1,COUNTIF($F$3:F1967,1),\"\")","v":1965},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1967),$G$3:$G$3716,0)),\"\")","v":"50268046715"}]
[null,null,null,null,"50268046811",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1968,1),\"\"))","v":1},{"$f":"IF(F1968=1,COUNTIF($F$3:F1968,1),\"\")","v":1966},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1968),$G$3:$G$3716,0)),\"\")","v":"50268046811"}]
[null,null,null,null,"50268046815",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1969,1),\"\"))","v":1},{"$f":"IF(F1969=1,COUNTIF($F$3:F1969,1),\"\")","v":1967},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1969),$G$3:$G$3716,0)),\"\")","v":"50268046815"}]
[null,null,null,null,"50268051611",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1970,1),\"\"))","v":1},{"$f":"IF(F1970=1,COUNTIF($F$3:F1970,1),\"\")","v":1968},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1970),$G$3:$G$3716,0)),\"\")","v":"50268051611"}]
[null,null,null,null,"50268051711",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1971,1),\"\"))","v":1},{"$f":"IF(F1971=1,COUNTIF($F$3:F1971,1),\"\")","v":1969},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1971),$G$3:$G$3716,0)),\"\")","v":"50268051711"}]
[null,null,null,null,"50268052215",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1972,1),\"\"))","v":1},{"$f":"IF(F1972=1,COUNTIF($F$3:F1972,1),\"\")","v":1970},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1972),$G$3:$G$3716,0)),\"\")","v":"50268052215"}]
[null,null,null,null,"50268052311",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1973,1),\"\"))","v":1},{"$f":"IF(F1973=1,COUNTIF($F$3:F1973,1),\"\")","v":1971},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1973),$G$3:$G$3716,0)),\"\")","v":"50268052311"}]
[null,null,null,null,"50268052315",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1974,1),\"\"))","v":1},{"$f":"IF(F1974=1,COUNTIF($F$3:F1974,1),\"\")","v":1972},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1974),$G$3:$G$3716,0)),\"\")","v":"50268052315"}]
[null,null,null,null,"50268052411",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1975,1),\"\"))","v":1},{"$f":"IF(F1975=1,COUNTIF($F$3:F1975,1),\"\")","v":1973},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1975),$G$3:$G$3716,0)),\"\")","v":"50268052411"}]
[null,null,null,null,"50268052415",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1976,1),\"\"))","v":1},{"$f":"IF(F1976=1,COUNTIF($F$3:F1976,1),\"\")","v":1974},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1976),$G$3:$G$3716,0)),\"\")","v":"50268052415"}]
[null,null,null,null,"50268053711",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1977,1),\"\"))","v":1},{"$f":"IF(F1977=1,COUNTIF($F$3:F1977,1),\"\")","v":1975},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1977),$G$3:$G$3716,0)),\"\")","v":"50268053711"}]
[null,null,null,null,"50268053715",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1978,1),\"\"))","v":1},{"$f":"IF(F1978=1,COUNTIF($F$3:F1978,1),\"\")","v":1976},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1978),$G$3:$G$3716,0)),\"\")","v":"50268053715"}]
[null,null,null,null,"50268053911",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1979,1),\"\"))","v":1},{"$f":"IF(F1979=1,COUNTIF($F$3:F1979,1),\"\")","v":1977},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1979),$G$3:$G$3716,0)),\"\")","v":"50268053911"}]
[null,null,null,null,"50268056111",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1980,1),\"\"))","v":1},{"$f":"IF(F1980=1,COUNTIF($F$3:F1980,1),\"\")","v":1978},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1980),$G$3:$G$3716,0)),\"\")","v":"50268056111"}]
[null,null,null,null,"50268056115",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1981,1),\"\"))","v":1},{"$f":"IF(F1981=1,COUNTIF($F$3:F1981,1),\"\")","v":1979},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1981),$G$3:$G$3716,0)),\"\")","v":"50268056115"}]
[null,null,null,null,"50268056311",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1982,1),\"\"))","v":1},{"$f":"IF(F1982=1,COUNTIF($F$3:F1982,1),\"\")","v":1980},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1982),$G$3:$G$3716,0)),\"\")","v":"50268056311"}]
[null,null,null,null,"50268056315",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1983,1),\"\"))","v":1},{"$f":"IF(F1983=1,COUNTIF($F$3:F1983,1),\"\")","v":1981},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1983),$G$3:$G$3716,0)),\"\")","v":"50268056315"}]
[null,null,null,null,"50268056411",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1984,1),\"\"))","v":1},{"$f":"IF(F1984=1,COUNTIF($F$3:F1984,1),\"\")","v":1982},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1984),$G$3:$G$3716,0)),\"\")","v":"50268056411"}]
[null,null,null,null,"50268056415",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1985,1),\"\"))","v":1},{"$f":"IF(F1985=1,COUNTIF($F$3:F1985,1),\"\")","v":1983},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1985),$G$3:$G$3716,0)),\"\")","v":"50268056415"}]
[null,null,null,null,"50268056911",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1986,1),\"\"))","v":1},{"$f":"IF(F1986=1,COUNTIF($F$3:F1986,1),\"\")","v":1984},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1986),$G$3:$G$3716,0)),\"\")","v":"50268056911"}]
[null,null,null,null,"50268057011",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1987,1),\"\"))","v":1},{"$f":"IF(F1987=1,COUNTIF($F$3:F1987,1),\"\")","v":1985},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1987),$G$3:$G$3716,0)),\"\")","v":"50268057011"}]
[null,null,null,null,"50268057311",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1988,1),\"\"))","v":1},{"$f":"IF(F1988=1,COUNTIF($F$3:F1988,1),\"\")","v":1986},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1988),$G$3:$G$3716,0)),\"\")","v":"50268057311"}]
[null,null,null,null,"50268057315",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1989,1),\"\"))","v":1},{"$f":"IF(F1989=1,COUNTIF($F$3:F1989,1),\"\")","v":1987},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1989),$G$3:$G$3716,0)),\"\")","v":"50268057315"}]
[null,null,null,null,"50268059411",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1990,1),\"\"))","v":1},{"$f":"IF(F1990=1,COUNTIF($F$3:F1990,1),\"\")","v":1988},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1990),$G$3:$G$3716,0)),\"\")","v":"50268059411"}]
[null,null,null,null,"50268059415",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1991,1),\"\"))","v":1},{"$f":"IF(F1991=1,COUNTIF($F$3:F1991,1),\"\")","v":1989},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1991),$G$3:$G$3716,0)),\"\")","v":"50268059415"}]
[null,null,null,null,"50268060311",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1992,1),\"\"))","v":1},{"$f":"IF(F1992=1,COUNTIF($F$3:F1992,1),\"\")","v":1990},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1992),$G$3:$G$3716,0)),\"\")","v":"50268060311"}]
[null,null,null,null,"50268060315",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1993,1),\"\"))","v":1},{"$f":"IF(F1993=1,COUNTIF($F$3:F1993,1),\"\")","v":1991},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1993),$G$3:$G$3716,0)),\"\")","v":"50268060315"}]
[null,null,null,null,"50268062715",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1994,1),\"\"))","v":1},{"$f":"IF(F1994=1,COUNTIF($F$3:F1994,1),\"\")","v":1992},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1994),$G$3:$G$3716,0)),\"\")","v":"50268062715"}]
[null,null,null,null,"50268063011",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1995,1),\"\"))","v":1},{"$f":"IF(F1995=1,COUNTIF($F$3:F1995,1),\"\")","v":1993},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1995),$G$3:$G$3716,0)),\"\")","v":"50268063011"}]
[null,null,null,null,"50268063211",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1996,1),\"\"))","v":1},{"$f":"IF(F1996=1,COUNTIF($F$3:F1996,1),\"\")","v":1994},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1996),$G$3:$G$3716,0)),\"\")","v":"50268063211"}]
[null,null,null,null,"50268064415",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1997,1),\"\"))","v":1},{"$f":"IF(F1997=1,COUNTIF($F$3:F1997,1),\"\")","v":1995},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1997),$G$3:$G$3716,0)),\"\")","v":"50268064415"}]
[null,null,null,null,"50268071015",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1998,1),\"\"))","v":1},{"$f":"IF(F1998=1,COUNTIF($F$3:F1998,1),\"\")","v":1996},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1998),$G$3:$G$3716,0)),\"\")","v":"50268071015"}]
[null,null,null,null,"50268071115",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E1999,1),\"\"))","v":1},{"$f":"IF(F1999=1,COUNTIF($F$3:F1999,1),\"\")","v":1997},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G1999),$G$3:$G$3716,0)),\"\")","v":"50268071115"}]
[null,null,null,null,"50268071711",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2000,1),\"\"))","v":1},{"$f":"IF(F2000=1,COUNTIF($F$3:F2000,1),\"\")","v":1998},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2000),$G$3:$G$3716,0)),\"\")","v":"50268071711"}]
[null,null,null,null,"50268072011",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2001,1),\"\"))","v":1},{"$f":"IF(F2001=1,COUNTIF($F$3:F2001,1),\"\")","v":1999},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2001),$G$3:$G$3716,0)),\"\")","v":"50268072011"}]
[null,null,null,null,"50268072811",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2002,1),\"\"))","v":1},{"$f":"IF(F2002=1,COUNTIF($F$3:F2002,1),\"\")","v":2000},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2002),$G$3:$G$3716,0)),\"\")","v":"50268072811"}]
[null,null,null,null,"50268073211",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2003,1),\"\"))","v":1},{"$f":"IF(F2003=1,COUNTIF($F$3:F2003,1),\"\")","v":2001},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2003),$G$3:$G$3716,0)),\"\")","v":"50268073211"}]
[null,null,null,null,"50268075011",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2004,1),\"\"))","v":1},{"$f":"IF(F2004=1,COUNTIF($F$3:F2004,1),\"\")","v":2002},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2004),$G$3:$G$3716,0)),\"\")","v":"50268075011"}]
[null,null,null,null,"50268075015",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2005,1),\"\"))","v":1},{"$f":"IF(F2005=1,COUNTIF($F$3:F2005,1),\"\")","v":2003},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2005),$G$3:$G$3716,0)),\"\")","v":"50268075015"}]
[null,null,null,null,"50268075211",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2006,1),\"\"))","v":1},{"$f":"IF(F2006=1,COUNTIF($F$3:F2006,1),\"\")","v":2004},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2006),$G$3:$G$3716,0)),\"\")","v":"50268075211"}]
[null,null,null,null,"50268075215",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2007,1),\"\"))","v":1},{"$f":"IF(F2007=1,COUNTIF($F$3:F2007,1),\"\")","v":2005},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2007),$G$3:$G$3716,0)),\"\")","v":"50268075215"}]
[null,null,null,null,"50268075511",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2008,1),\"\"))","v":1},{"$f":"IF(F2008=1,COUNTIF($F$3:F2008,1),\"\")","v":2006},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2008),$G$3:$G$3716,0)),\"\")","v":"50268075511"}]
[null,null,null,null,"50268075611",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2009,1),\"\"))","v":1},{"$f":"IF(F2009=1,COUNTIF($F$3:F2009,1),\"\")","v":2007},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2009),$G$3:$G$3716,0)),\"\")","v":"50268075611"}]
[null,null,null,null,"50268075915",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2010,1),\"\"))","v":1},{"$f":"IF(F2010=1,COUNTIF($F$3:F2010,1),\"\")","v":2008},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2010),$G$3:$G$3716,0)),\"\")","v":"50268075915"}]
[null,null,null,null,"50268076411",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2011,1),\"\"))","v":1},{"$f":"IF(F2011=1,COUNTIF($F$3:F2011,1),\"\")","v":2009},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2011),$G$3:$G$3716,0)),\"\")","v":"50268076411"}]
[null,null,null,null,"50268078711",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2012,1),\"\"))","v":1},{"$f":"IF(F2012=1,COUNTIF($F$3:F2012,1),\"\")","v":2010},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2012),$G$3:$G$3716,0)),\"\")","v":"50268078711"}]
[null,null,null,null,"50268078712",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2013,1),\"\"))","v":1},{"$f":"IF(F2013=1,COUNTIF($F$3:F2013,1),\"\")","v":2011},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2013),$G$3:$G$3716,0)),\"\")","v":"50268078712"}]
[null,null,null,null,"50268078911",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2014,1),\"\"))","v":1},{"$f":"IF(F2014=1,COUNTIF($F$3:F2014,1),\"\")","v":2012},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2014),$G$3:$G$3716,0)),\"\")","v":"50268078911"}]
[null,null,null,null,"50268078915",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2015,1),\"\"))","v":1},{"$f":"IF(F2015=1,COUNTIF($F$3:F2015,1),\"\")","v":2013},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2015),$G$3:$G$3716,0)),\"\")","v":"50268078915"}]
[null,null,null,null,"50268079611",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2016,1),\"\"))","v":1},{"$f":"IF(F2016=1,COUNTIF($F$3:F2016,1),\"\")","v":2014},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2016),$G$3:$G$3716,0)),\"\")","v":"50268079611"}]
[null,null,null,null,"50268079615",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2017,1),\"\"))","v":1},{"$f":"IF(F2017=1,COUNTIF($F$3:F2017,1),\"\")","v":2015},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2017),$G$3:$G$3716,0)),\"\")","v":"50268079615"}]
[null,null,null,null,"50268079911",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2018,1),\"\"))","v":1},{"$f":"IF(F2018=1,COUNTIF($F$3:F2018,1),\"\")","v":2016},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2018),$G$3:$G$3716,0)),\"\")","v":"50268079911"}]
[null,null,null,null,"50268080011",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2019,1),\"\"))","v":1},{"$f":"IF(F2019=1,COUNTIF($F$3:F2019,1),\"\")","v":2017},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2019),$G$3:$G$3716,0)),\"\")","v":"50268080011"}]
[null,null,null,null,"50268081611",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2020,1),\"\"))","v":1},{"$f":"IF(F2020=1,COUNTIF($F$3:F2020,1),\"\")","v":2018},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2020),$G$3:$G$3716,0)),\"\")","v":"50268081611"}]
[null,null,null,null,"50268081615",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2021,1),\"\"))","v":1},{"$f":"IF(F2021=1,COUNTIF($F$3:F2021,1),\"\")","v":2019},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2021),$G$3:$G$3716,0)),\"\")","v":"50268081615"}]
[null,null,null,null,"50268085411",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2022,1),\"\"))","v":1},{"$f":"IF(F2022=1,COUNTIF($F$3:F2022,1),\"\")","v":2020},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2022),$G$3:$G$3716,0)),\"\")","v":"50268085411"}]
[null,null,null,null,"50268085815",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2023,1),\"\"))","v":1},{"$f":"IF(F2023=1,COUNTIF($F$3:F2023,1),\"\")","v":2021},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2023),$G$3:$G$3716,0)),\"\")","v":"50268085815"}]
[null,null,null,null,"50323000602",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2024,1),\"\"))","v":1},{"$f":"IF(F2024=1,COUNTIF($F$3:F2024,1),\"\")","v":2022},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2024),$G$3:$G$3716,0)),\"\")","v":"50323000602"}]
[null,null,null,null,"50323000603",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2025,1),\"\"))","v":1},{"$f":"IF(F2025=1,COUNTIF($F$3:F2025,1),\"\")","v":2023},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2025),$G$3:$G$3716,0)),\"\")","v":"50323000603"}]
[null,null,null,null,"50323000604",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2026,1),\"\"))","v":1},{"$f":"IF(F2026=1,COUNTIF($F$3:F2026,1),\"\")","v":2024},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2026),$G$3:$G$3716,0)),\"\")","v":"50323000604"}]
[null,null,null,null,"50383006212",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2027,1),\"\"))","v":1},{"$f":"IF(F2027=1,COUNTIF($F$3:F2027,1),\"\")","v":2025},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2027),$G$3:$G$3716,0)),\"\")","v":"50383006212"}]
[null,null,null,null,"50383006310",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2028,1),\"\"))","v":1},{"$f":"IF(F2028=1,COUNTIF($F$3:F2028,1),\"\")","v":2026},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2028),$G$3:$G$3716,0)),\"\")","v":"50383006310"}]
[null,null,null,null,"50383016716",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2029,1),\"\"))","v":1},{"$f":"IF(F2029=1,COUNTIF($F$3:F2029,1),\"\")","v":2027},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2029),$G$3:$G$3716,0)),\"\")","v":"50383016716"}]
[null,null,null,null,"50383017290",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2030,1),\"\"))","v":1},{"$f":"IF(F2030=1,COUNTIF($F$3:F2030,1),\"\")","v":2028},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2030),$G$3:$G$3716,0)),\"\")","v":"50383017290"}]
[null,null,null,null,"50383023210",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2031,1),\"\"))","v":1},{"$f":"IF(F2031=1,COUNTIF($F$3:F2031,1),\"\")","v":2029},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2031),$G$3:$G$3716,0)),\"\")","v":"50383023210"}]
[null,null,null,null,"50383023310",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2032,1),\"\"))","v":1},{"$f":"IF(F2032=1,COUNTIF($F$3:F2032,1),\"\")","v":2030},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2032),$G$3:$G$3716,0)),\"\")","v":"50383023310"}]
[null,null,null,null,"50383026730",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2033,1),\"\"))","v":1},{"$f":"IF(F2033=1,COUNTIF($F$3:F2033,1),\"\")","v":2031},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2033),$G$3:$G$3716,0)),\"\")","v":"50383026730"}]
[null,null,null,null,"50383061804",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2034,1),\"\"))","v":1},{"$f":"IF(F2034=1,COUNTIF($F$3:F2034,1),\"\")","v":2032},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2034),$G$3:$G$3716,0)),\"\")","v":"50383061804"}]
[null,null,null,null,"50383061805",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2035,1),\"\"))","v":1},{"$f":"IF(F2035=1,COUNTIF($F$3:F2035,1),\"\")","v":2033},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2035),$G$3:$G$3716,0)),\"\")","v":"50383061805"}]
[null,null,null,null,"50383061811",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2036,1),\"\"))","v":1},{"$f":"IF(F2036=1,COUNTIF($F$3:F2036,1),\"\")","v":2034},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2036),$G$3:$G$3716,0)),\"\")","v":"50383061811"}]
[null,null,null,null,"50383070530",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2037,1),\"\"))","v":1},{"$f":"IF(F2037=1,COUNTIF($F$3:F2037,1),\"\")","v":2035},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2037),$G$3:$G$3716,0)),\"\")","v":"50383070530"}]
[null,null,null,null,"50383072015",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2038,1),\"\"))","v":1},{"$f":"IF(F2038=1,COUNTIF($F$3:F2038,1),\"\")","v":2036},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2038),$G$3:$G$3716,0)),\"\")","v":"50383072015"}]
[null,null,null,null,"50383072016",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2039,1),\"\"))","v":1},{"$f":"IF(F2039=1,COUNTIF($F$3:F2039,1),\"\")","v":2037},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2039),$G$3:$G$3716,0)),\"\")","v":"50383072016"}]
[null,null,null,null,"50383074016",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2040,1),\"\"))","v":1},{"$f":"IF(F2040=1,COUNTIF($F$3:F2040,1),\"\")","v":2038},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2040),$G$3:$G$3716,0)),\"\")","v":"50383074016"}]
[null,null,null,null,"50383077110",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2041,1),\"\"))","v":1},{"$f":"IF(F2041=1,COUNTIF($F$3:F2041,1),\"\")","v":2039},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2041),$G$3:$G$3716,0)),\"\")","v":"50383077110"}]
[null,null,null,null,"50383077116",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2042,1),\"\"))","v":1},{"$f":"IF(F2042=1,COUNTIF($F$3:F2042,1),\"\")","v":2040},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2042),$G$3:$G$3716,0)),\"\")","v":"50383077116"}]
[null,null,null,null,"50383078105",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2043,1),\"\"))","v":1},{"$f":"IF(F2043=1,COUNTIF($F$3:F2043,1),\"\")","v":2041},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2043),$G$3:$G$3716,0)),\"\")","v":"50383078105"}]
[null,null,null,null,"50383078130",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2044,1),\"\"))","v":1},{"$f":"IF(F2044=1,COUNTIF($F$3:F2044,1),\"\")","v":2042},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2044),$G$3:$G$3716,0)),\"\")","v":"50383078130"}]
[null,null,null,null,"50383078608",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2045,1),\"\"))","v":1},{"$f":"IF(F2045=1,COUNTIF($F$3:F2045,1),\"\")","v":2043},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2045),$G$3:$G$3716,0)),\"\")","v":"50383078608"}]
[null,null,null,null,"50383082316",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2046,1),\"\"))","v":1},{"$f":"IF(F2046=1,COUNTIF($F$3:F2046,1),\"\")","v":2044},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2046),$G$3:$G$3716,0)),\"\")","v":"50383082316"}]
[null,null,null,null,"50383082416",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2047,1),\"\"))","v":1},{"$f":"IF(F2047=1,COUNTIF($F$3:F2047,1),\"\")","v":2045},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2047),$G$3:$G$3716,0)),\"\")","v":"50383082416"}]
[null,null,null,null,"50383091750",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2048,1),\"\"))","v":1},{"$f":"IF(F2048=1,COUNTIF($F$3:F2048,1),\"\")","v":2046},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2048),$G$3:$G$3716,0)),\"\")","v":"50383091750"}]
[null,null,null,null,"50419045201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2049,1),\"\"))","v":1},{"$f":"IF(F2049=1,COUNTIF($F$3:F2049,1),\"\")","v":2047},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2049),$G$3:$G$3716,0)),\"\")","v":"50419045201"}]
[null,null,null,null,"50419045304",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2050,1),\"\"))","v":1},{"$f":"IF(F2050=1,COUNTIF($F$3:F2050,1),\"\")","v":2048},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2050),$G$3:$G$3716,0)),\"\")","v":"50419045304"}]
[null,null,null,null,"50419074701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2051,1),\"\"))","v":1},{"$f":"IF(F2051=1,COUNTIF($F$3:F2051,1),\"\")","v":2049},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2051),$G$3:$G$3716,0)),\"\")","v":"50419074701"}]
[null,null,null,null,"50419077701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2052,1),\"\"))","v":1},{"$f":"IF(F2052=1,COUNTIF($F$3:F2052,1),\"\")","v":2050},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2052),$G$3:$G$3716,0)),\"\")","v":"50419077701"}]
[null,null,null,null,"50428322435",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2053,1),\"\"))","v":1},{"$f":"IF(F2053=1,COUNTIF($F$3:F2053,1),\"\")","v":2051},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2053),$G$3:$G$3716,0)),\"\")","v":"50428322435"}]
[null,null,null,null,"50458009005",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2054,1),\"\"))","v":1},{"$f":"IF(F2054=1,COUNTIF($F$3:F2054,1),\"\")","v":2052},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2054),$G$3:$G$3716,0)),\"\")","v":"50458009005"}]
[null,null,null,null,"50458009205",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2055,1),\"\"))","v":1},{"$f":"IF(F2055=1,COUNTIF($F$3:F2055,1),\"\")","v":2053},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2055),$G$3:$G$3716,0)),\"\")","v":"50458009205"}]
[null,null,null,null,"50458009305",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2056,1),\"\"))","v":1},{"$f":"IF(F2056=1,COUNTIF($F$3:F2056,1),\"\")","v":2054},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2056),$G$3:$G$3716,0)),\"\")","v":"50458009305"}]
[null,null,null,null,"50458057760",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2057,1),\"\"))","v":1},{"$f":"IF(F2057=1,COUNTIF($F$3:F2057,1),\"\")","v":2055},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2057),$G$3:$G$3716,0)),\"\")","v":"50458057760"}]
[null,null,null,null,"50458057810",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2058,1),\"\"))","v":1},{"$f":"IF(F2058=1,COUNTIF($F$3:F2058,1),\"\")","v":2056},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2058),$G$3:$G$3716,0)),\"\")","v":"50458057810"}]
[null,null,null,null,"50458057830",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2059,1),\"\"))","v":1},{"$f":"IF(F2059=1,COUNTIF($F$3:F2059,1),\"\")","v":2057},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2059),$G$3:$G$3716,0)),\"\")","v":"50458057830"}]
[null,null,null,null,"50458057910",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2060,1),\"\"))","v":1},{"$f":"IF(F2060=1,COUNTIF($F$3:F2060,1),\"\")","v":2058},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2060),$G$3:$G$3716,0)),\"\")","v":"50458057910"}]
[null,null,null,null,"50458057930",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2061,1),\"\"))","v":1},{"$f":"IF(F2061=1,COUNTIF($F$3:F2061,1),\"\")","v":2059},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2061),$G$3:$G$3716,0)),\"\")","v":"50458057930"}]
[null,null,null,null,"50458057990",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2062,1),\"\"))","v":1},{"$f":"IF(F2062=1,COUNTIF($F$3:F2062,1),\"\")","v":2060},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2062),$G$3:$G$3716,0)),\"\")","v":"50458057990"}]
[null,null,null,null,"50458058030",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2063,1),\"\"))","v":1},{"$f":"IF(F2063=1,COUNTIF($F$3:F2063,1),\"\")","v":2061},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2063),$G$3:$G$3716,0)),\"\")","v":"50458058030"}]
[null,null,null,null,"50458063965",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2064,1),\"\"))","v":1},{"$f":"IF(F2064=1,COUNTIF($F$3:F2064,1),\"\")","v":2062},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2064),$G$3:$G$3716,0)),\"\")","v":"50458063965"}]
[null,null,null,null,"50458064165",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2065,1),\"\"))","v":1},{"$f":"IF(F2065=1,COUNTIF($F$3:F2065,1),\"\")","v":2063},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2065),$G$3:$G$3716,0)),\"\")","v":"50458064165"}]
[null,null,null,null,"50458064265",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2066,1),\"\"))","v":1},{"$f":"IF(F2066=1,COUNTIF($F$3:F2066,1),\"\")","v":2064},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2066),$G$3:$G$3716,0)),\"\")","v":"50458064265"}]
[null,null,null,null,"50458064565",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2067,1),\"\"))","v":1},{"$f":"IF(F2067=1,COUNTIF($F$3:F2067,1),\"\")","v":2065},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2067),$G$3:$G$3716,0)),\"\")","v":"50458064565"}]
[null,null,null,null,"50458064765",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2068,1),\"\"))","v":1},{"$f":"IF(F2068=1,COUNTIF($F$3:F2068,1),\"\")","v":2066},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2068),$G$3:$G$3716,0)),\"\")","v":"50458064765"}]
[null,null,null,null,"50474047066",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2069,1),\"\"))","v":1},{"$f":"IF(F2069=1,COUNTIF($F$3:F2069,1),\"\")","v":2067},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2069),$G$3:$G$3716,0)),\"\")","v":"50474047066"}]
[null,null,null,null,"50474059440",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2070,1),\"\"))","v":1},{"$f":"IF(F2070=1,COUNTIF($F$3:F2070,1),\"\")","v":2068},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2070),$G$3:$G$3716,0)),\"\")","v":"50474059440"}]
[null,null,null,null,"50474059540",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2071,1),\"\"))","v":1},{"$f":"IF(F2071=1,COUNTIF($F$3:F2071,1),\"\")","v":2069},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2071),$G$3:$G$3716,0)),\"\")","v":"50474059540"}]
[null,null,null,null,"50484001030",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2072,1),\"\"))","v":1},{"$f":"IF(F2072=1,COUNTIF($F$3:F2072,1),\"\")","v":2070},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2072),$G$3:$G$3716,0)),\"\")","v":"50484001030"}]
[null,null,null,null,"50580029605",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2073,1),\"\"))","v":1},{"$f":"IF(F2073=1,COUNTIF($F$3:F2073,1),\"\")","v":2071},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2073),$G$3:$G$3716,0)),\"\")","v":"50580029605"}]
[null,null,null,null,"50580029665",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2074,1),\"\"))","v":1},{"$f":"IF(F2074=1,COUNTIF($F$3:F2074,1),\"\")","v":2072},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2074),$G$3:$G$3716,0)),\"\")","v":"50580029665"}]
[null,null,null,null,"50580050110",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2075,1),\"\"))","v":1},{"$f":"IF(F2075=1,COUNTIF($F$3:F2075,1),\"\")","v":2073},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2075),$G$3:$G$3716,0)),\"\")","v":"50580050110"}]
[null,null,null,null,"50580050130",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2076,1),\"\"))","v":1},{"$f":"IF(F2076=1,COUNTIF($F$3:F2076,1),\"\")","v":2074},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2076),$G$3:$G$3716,0)),\"\")","v":"50580050130"}]
[null,null,null,null,"50580050180",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2077,1),\"\"))","v":1},{"$f":"IF(F2077=1,COUNTIF($F$3:F2077,1),\"\")","v":2075},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2077),$G$3:$G$3716,0)),\"\")","v":"50580050180"}]
[null,null,null,null,"50580060002",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2078,1),\"\"))","v":1},{"$f":"IF(F2078=1,COUNTIF($F$3:F2078,1),\"\")","v":2076},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2078),$G$3:$G$3716,0)),\"\")","v":"50580060002"}]
[null,null,null,null,"50580060110",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2079,1),\"\"))","v":1},{"$f":"IF(F2079=1,COUNTIF($F$3:F2079,1),\"\")","v":2077},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2079),$G$3:$G$3716,0)),\"\")","v":"50580060110"}]
[null,null,null,null,"50580061205",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2080,1),\"\"))","v":1},{"$f":"IF(F2080=1,COUNTIF($F$3:F2080,1),\"\")","v":2078},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2080),$G$3:$G$3716,0)),\"\")","v":"50580061205"}]
[null,null,null,null,"50580061265",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2081,1),\"\"))","v":1},{"$f":"IF(F2081=1,COUNTIF($F$3:F2081,1),\"\")","v":2079},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2081),$G$3:$G$3716,0)),\"\")","v":"50580061265"}]
[null,null,null,null,"50742023301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2082,1),\"\"))","v":1},{"$f":"IF(F2082=1,COUNTIF($F$3:F2082,1),\"\")","v":2080},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2082),$G$3:$G$3716,0)),\"\")","v":"50742023301"}]
[null,null,null,null,"50742050510",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2083,1),\"\"))","v":1},{"$f":"IF(F2083=1,COUNTIF($F$3:F2083,1),\"\")","v":2081},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2083),$G$3:$G$3716,0)),\"\")","v":"50742050510"}]
[null,null,null,null,"50742051530",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2084,1),\"\"))","v":1},{"$f":"IF(F2084=1,COUNTIF($F$3:F2084,1),\"\")","v":2082},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2084),$G$3:$G$3716,0)),\"\")","v":"50742051530"}]
[null,null,null,null,"51079002320",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2085,1),\"\"))","v":1},{"$f":"IF(F2085=1,COUNTIF($F$3:F2085,1),\"\")","v":2083},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2085),$G$3:$G$3716,0)),\"\")","v":"51079002320"}]
[null,null,null,null,"51079002401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2086,1),\"\"))","v":1},{"$f":"IF(F2086=1,COUNTIF($F$3:F2086,1),\"\")","v":2084},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2086),$G$3:$G$3716,0)),\"\")","v":"51079002401"}]
[null,null,null,null,"51079002420",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2087,1),\"\"))","v":1},{"$f":"IF(F2087=1,COUNTIF($F$3:F2087,1),\"\")","v":2085},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2087),$G$3:$G$3716,0)),\"\")","v":"51079002420"}]
[null,null,null,null,"51079002720",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2088,1),\"\"))","v":1},{"$f":"IF(F2088=1,COUNTIF($F$3:F2088,1),\"\")","v":2086},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2088),$G$3:$G$3716,0)),\"\")","v":"51079002720"}]
[null,null,null,null,"51079005101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2089,1),\"\"))","v":1},{"$f":"IF(F2089=1,COUNTIF($F$3:F2089,1),\"\")","v":2087},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2089),$G$3:$G$3716,0)),\"\")","v":"51079005101"}]
[null,null,null,null,"51079005120",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2090,1),\"\"))","v":1},{"$f":"IF(F2090=1,COUNTIF($F$3:F2090,1),\"\")","v":2088},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2090),$G$3:$G$3716,0)),\"\")","v":"51079005120"}]
[null,null,null,null,"51079006720",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2091,1),\"\"))","v":1},{"$f":"IF(F2091=1,COUNTIF($F$3:F2091,1),\"\")","v":2089},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2091),$G$3:$G$3716,0)),\"\")","v":"51079006720"}]
[null,null,null,null,"51079007201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2092,1),\"\"))","v":1},{"$f":"IF(F2092=1,COUNTIF($F$3:F2092,1),\"\")","v":2090},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2092),$G$3:$G$3716,0)),\"\")","v":"51079007201"}]
[null,null,null,null,"51079007301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2093,1),\"\"))","v":1},{"$f":"IF(F2093=1,COUNTIF($F$3:F2093,1),\"\")","v":2091},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2093),$G$3:$G$3716,0)),\"\")","v":"51079007301"}]
[null,null,null,null,"51079007320",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2094,1),\"\"))","v":1},{"$f":"IF(F2094=1,COUNTIF($F$3:F2094,1),\"\")","v":2092},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2094),$G$3:$G$3716,0)),\"\")","v":"51079007320"}]
[null,null,null,null,"51079007401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2095,1),\"\"))","v":1},{"$f":"IF(F2095=1,COUNTIF($F$3:F2095,1),\"\")","v":2093},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2095),$G$3:$G$3716,0)),\"\")","v":"51079007401"}]
[null,null,null,null,"51079007420",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2096,1),\"\"))","v":1},{"$f":"IF(F2096=1,COUNTIF($F$3:F2096,1),\"\")","v":2094},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2096),$G$3:$G$3716,0)),\"\")","v":"51079007420"}]
[null,null,null,null,"51079007501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2097,1),\"\"))","v":1},{"$f":"IF(F2097=1,COUNTIF($F$3:F2097,1),\"\")","v":2095},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2097),$G$3:$G$3716,0)),\"\")","v":"51079007501"}]
[null,null,null,null,"51079007520",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2098,1),\"\"))","v":1},{"$f":"IF(F2098=1,COUNTIF($F$3:F2098,1),\"\")","v":2096},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2098),$G$3:$G$3716,0)),\"\")","v":"51079007520"}]
[null,null,null,null,"51079007601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2099,1),\"\"))","v":1},{"$f":"IF(F2099=1,COUNTIF($F$3:F2099,1),\"\")","v":2097},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2099),$G$3:$G$3716,0)),\"\")","v":"51079007601"}]
[null,null,null,null,"51079007620",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2100,1),\"\"))","v":1},{"$f":"IF(F2100=1,COUNTIF($F$3:F2100,1),\"\")","v":2098},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2100),$G$3:$G$3716,0)),\"\")","v":"51079007620"}]
[null,null,null,null,"51079008601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2101,1),\"\"))","v":1},{"$f":"IF(F2101=1,COUNTIF($F$3:F2101,1),\"\")","v":2099},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2101),$G$3:$G$3716,0)),\"\")","v":"51079008601"}]
[null,null,null,null,"51079008620",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2102,1),\"\"))","v":1},{"$f":"IF(F2102=1,COUNTIF($F$3:F2102,1),\"\")","v":2100},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2102),$G$3:$G$3716,0)),\"\")","v":"51079008620"}]
[null,null,null,null,"51079010301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2103,1),\"\"))","v":1},{"$f":"IF(F2103=1,COUNTIF($F$3:F2103,1),\"\")","v":2101},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2103),$G$3:$G$3716,0)),\"\")","v":"51079010301"}]
[null,null,null,null,"51079010320",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2104,1),\"\"))","v":1},{"$f":"IF(F2104=1,COUNTIF($F$3:F2104,1),\"\")","v":2102},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2104),$G$3:$G$3716,0)),\"\")","v":"51079010320"}]
[null,null,null,null,"51079010420",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2105,1),\"\"))","v":1},{"$f":"IF(F2105=1,COUNTIF($F$3:F2105,1),\"\")","v":2103},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2105),$G$3:$G$3716,0)),\"\")","v":"51079010420"}]
[null,null,null,null,"51079010501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2106,1),\"\"))","v":1},{"$f":"IF(F2106=1,COUNTIF($F$3:F2106,1),\"\")","v":2104},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2106),$G$3:$G$3716,0)),\"\")","v":"51079010501"}]
[null,null,null,null,"51079010520",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2107,1),\"\"))","v":1},{"$f":"IF(F2107=1,COUNTIF($F$3:F2107,1),\"\")","v":2105},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2107),$G$3:$G$3716,0)),\"\")","v":"51079010520"}]
[null,null,null,null,"51079011901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2108,1),\"\"))","v":1},{"$f":"IF(F2108=1,COUNTIF($F$3:F2108,1),\"\")","v":2106},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2108),$G$3:$G$3716,0)),\"\")","v":"51079011901"}]
[null,null,null,null,"51079011920",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2109,1),\"\"))","v":1},{"$f":"IF(F2109=1,COUNTIF($F$3:F2109,1),\"\")","v":2107},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2109),$G$3:$G$3716,0)),\"\")","v":"51079011920"}]
[null,null,null,null,"51079012220",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2110,1),\"\"))","v":1},{"$f":"IF(F2110=1,COUNTIF($F$3:F2110,1),\"\")","v":2108},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2110),$G$3:$G$3716,0)),\"\")","v":"51079012220"}]
[null,null,null,null,"51079012820",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2111,1),\"\"))","v":1},{"$f":"IF(F2111=1,COUNTIF($F$3:F2111,1),\"\")","v":2109},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2111),$G$3:$G$3716,0)),\"\")","v":"51079012820"}]
[null,null,null,null,"51079013101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2112,1),\"\"))","v":1},{"$f":"IF(F2112=1,COUNTIF($F$3:F2112,1),\"\")","v":2110},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2112),$G$3:$G$3716,0)),\"\")","v":"51079013101"}]
[null,null,null,null,"51079013120",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2113,1),\"\"))","v":1},{"$f":"IF(F2113=1,COUNTIF($F$3:F2113,1),\"\")","v":2111},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2113),$G$3:$G$3716,0)),\"\")","v":"51079013120"}]
[null,null,null,null,"51079013301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2114,1),\"\"))","v":1},{"$f":"IF(F2114=1,COUNTIF($F$3:F2114,1),\"\")","v":2112},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2114),$G$3:$G$3716,0)),\"\")","v":"51079013301"}]
[null,null,null,null,"51079013320",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2115,1),\"\"))","v":1},{"$f":"IF(F2115=1,COUNTIF($F$3:F2115,1),\"\")","v":2113},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2115),$G$3:$G$3716,0)),\"\")","v":"51079013320"}]
[null,null,null,null,"51079014120",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2116,1),\"\"))","v":1},{"$f":"IF(F2116=1,COUNTIF($F$3:F2116,1),\"\")","v":2114},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2116),$G$3:$G$3716,0)),\"\")","v":"51079014120"}]
[null,null,null,null,"51079016120",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2117,1),\"\"))","v":1},{"$f":"IF(F2117=1,COUNTIF($F$3:F2117,1),\"\")","v":2115},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2117),$G$3:$G$3716,0)),\"\")","v":"51079016120"}]
[null,null,null,null,"51079016501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2118,1),\"\"))","v":1},{"$f":"IF(F2118=1,COUNTIF($F$3:F2118,1),\"\")","v":2116},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2118),$G$3:$G$3716,0)),\"\")","v":"51079016501"}]
[null,null,null,null,"51079017220",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2119,1),\"\"))","v":1},{"$f":"IF(F2119=1,COUNTIF($F$3:F2119,1),\"\")","v":2117},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2119),$G$3:$G$3716,0)),\"\")","v":"51079017220"}]
[null,null,null,null,"51079018120",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2120,1),\"\"))","v":1},{"$f":"IF(F2120=1,COUNTIF($F$3:F2120,1),\"\")","v":2118},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2120),$G$3:$G$3716,0)),\"\")","v":"51079018120"}]
[null,null,null,null,"51079019020",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2121,1),\"\"))","v":1},{"$f":"IF(F2121=1,COUNTIF($F$3:F2121,1),\"\")","v":2119},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2121),$G$3:$G$3716,0)),\"\")","v":"51079019020"}]
[null,null,null,null,"51079019120",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2122,1),\"\"))","v":1},{"$f":"IF(F2122=1,COUNTIF($F$3:F2122,1),\"\")","v":2120},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2122),$G$3:$G$3716,0)),\"\")","v":"51079019120"}]
[null,null,null,null,"51079019701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2123,1),\"\"))","v":1},{"$f":"IF(F2123=1,COUNTIF($F$3:F2123,1),\"\")","v":2121},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2123),$G$3:$G$3716,0)),\"\")","v":"51079019701"}]
[null,null,null,null,"51079019920",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2124,1),\"\"))","v":1},{"$f":"IF(F2124=1,COUNTIF($F$3:F2124,1),\"\")","v":2122},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2124),$G$3:$G$3716,0)),\"\")","v":"51079019920"}]
[null,null,null,null,"51079020120",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2125,1),\"\"))","v":1},{"$f":"IF(F2125=1,COUNTIF($F$3:F2125,1),\"\")","v":2123},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2125),$G$3:$G$3716,0)),\"\")","v":"51079020120"}]
[null,null,null,null,"51079020501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2126,1),\"\"))","v":1},{"$f":"IF(F2126=1,COUNTIF($F$3:F2126,1),\"\")","v":2124},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2126),$G$3:$G$3716,0)),\"\")","v":"51079020501"}]
[null,null,null,null,"51079020520",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2127,1),\"\"))","v":1},{"$f":"IF(F2127=1,COUNTIF($F$3:F2127,1),\"\")","v":2125},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2127),$G$3:$G$3716,0)),\"\")","v":"51079020520"}]
[null,null,null,null,"51079020620",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2128,1),\"\"))","v":1},{"$f":"IF(F2128=1,COUNTIF($F$3:F2128,1),\"\")","v":2126},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2128),$G$3:$G$3716,0)),\"\")","v":"51079020620"}]
[null,null,null,null,"51079020801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2129,1),\"\"))","v":1},{"$f":"IF(F2129=1,COUNTIF($F$3:F2129,1),\"\")","v":2127},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2129),$G$3:$G$3716,0)),\"\")","v":"51079020801"}]
[null,null,null,null,"51079020901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2130,1),\"\"))","v":1},{"$f":"IF(F2130=1,COUNTIF($F$3:F2130,1),\"\")","v":2128},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2130),$G$3:$G$3716,0)),\"\")","v":"51079020901"}]
[null,null,null,null,"51079020920",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2131,1),\"\"))","v":1},{"$f":"IF(F2131=1,COUNTIF($F$3:F2131,1),\"\")","v":2129},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2131),$G$3:$G$3716,0)),\"\")","v":"51079020920"}]
[null,null,null,null,"51079021101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2132,1),\"\"))","v":1},{"$f":"IF(F2132=1,COUNTIF($F$3:F2132,1),\"\")","v":2130},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2132),$G$3:$G$3716,0)),\"\")","v":"51079021101"}]
[null,null,null,null,"51079022301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2133,1),\"\"))","v":1},{"$f":"IF(F2133=1,COUNTIF($F$3:F2133,1),\"\")","v":2131},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2133),$G$3:$G$3716,0)),\"\")","v":"51079022301"}]
[null,null,null,null,"51079022320",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2134,1),\"\"))","v":1},{"$f":"IF(F2134=1,COUNTIF($F$3:F2134,1),\"\")","v":2132},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2134),$G$3:$G$3716,0)),\"\")","v":"51079022320"}]
[null,null,null,null,"51079024601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2135,1),\"\"))","v":1},{"$f":"IF(F2135=1,COUNTIF($F$3:F2135,1),\"\")","v":2133},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2135),$G$3:$G$3716,0)),\"\")","v":"51079024601"}]
[null,null,null,null,"51079025520",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2136,1),\"\"))","v":1},{"$f":"IF(F2136=1,COUNTIF($F$3:F2136,1),\"\")","v":2134},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2136),$G$3:$G$3716,0)),\"\")","v":"51079025520"}]
[null,null,null,null,"51079027301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2137,1),\"\"))","v":1},{"$f":"IF(F2137=1,COUNTIF($F$3:F2137,1),\"\")","v":2135},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2137),$G$3:$G$3716,0)),\"\")","v":"51079027301"}]
[null,null,null,null,"51079027303",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2138,1),\"\"))","v":1},{"$f":"IF(F2138=1,COUNTIF($F$3:F2138,1),\"\")","v":2136},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2138),$G$3:$G$3716,0)),\"\")","v":"51079027303"}]
[null,null,null,null,"51079027820",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2139,1),\"\"))","v":1},{"$f":"IF(F2139=1,COUNTIF($F$3:F2139,1),\"\")","v":2137},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2139),$G$3:$G$3716,0)),\"\")","v":"51079027820"}]
[null,null,null,null,"51079028320",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2140,1),\"\"))","v":1},{"$f":"IF(F2140=1,COUNTIF($F$3:F2140,1),\"\")","v":2138},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2140),$G$3:$G$3716,0)),\"\")","v":"51079028320"}]
[null,null,null,null,"51079028401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2141,1),\"\"))","v":1},{"$f":"IF(F2141=1,COUNTIF($F$3:F2141,1),\"\")","v":2139},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2141),$G$3:$G$3716,0)),\"\")","v":"51079028401"}]
[null,null,null,null,"51079028420",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2142,1),\"\"))","v":1},{"$f":"IF(F2142=1,COUNTIF($F$3:F2142,1),\"\")","v":2140},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2142),$G$3:$G$3716,0)),\"\")","v":"51079028420"}]
[null,null,null,null,"51079028501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2143,1),\"\"))","v":1},{"$f":"IF(F2143=1,COUNTIF($F$3:F2143,1),\"\")","v":2141},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2143),$G$3:$G$3716,0)),\"\")","v":"51079028501"}]
[null,null,null,null,"51079028520",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2144,1),\"\"))","v":1},{"$f":"IF(F2144=1,COUNTIF($F$3:F2144,1),\"\")","v":2142},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2144),$G$3:$G$3716,0)),\"\")","v":"51079028520"}]
[null,null,null,null,"51079028601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2145,1),\"\"))","v":1},{"$f":"IF(F2145=1,COUNTIF($F$3:F2145,1),\"\")","v":2143},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2145),$G$3:$G$3716,0)),\"\")","v":"51079028601"}]
[null,null,null,null,"51079028620",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2146,1),\"\"))","v":1},{"$f":"IF(F2146=1,COUNTIF($F$3:F2146,1),\"\")","v":2144},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2146),$G$3:$G$3716,0)),\"\")","v":"51079028620"}]
[null,null,null,null,"51079029401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2147,1),\"\"))","v":1},{"$f":"IF(F2147=1,COUNTIF($F$3:F2147,1),\"\")","v":2145},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2147),$G$3:$G$3716,0)),\"\")","v":"51079029401"}]
[null,null,null,null,"51079029420",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2148,1),\"\"))","v":1},{"$f":"IF(F2148=1,COUNTIF($F$3:F2148,1),\"\")","v":2146},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2148),$G$3:$G$3716,0)),\"\")","v":"51079029420"}]
[null,null,null,null,"51079029808",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2149,1),\"\"))","v":1},{"$f":"IF(F2149=1,COUNTIF($F$3:F2149,1),\"\")","v":2147},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2149),$G$3:$G$3716,0)),\"\")","v":"51079029808"}]
[null,null,null,null,"51079029901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2150,1),\"\"))","v":1},{"$f":"IF(F2150=1,COUNTIF($F$3:F2150,1),\"\")","v":2148},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2150),$G$3:$G$3716,0)),\"\")","v":"51079029901"}]
[null,null,null,null,"51079029920",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2151,1),\"\"))","v":1},{"$f":"IF(F2151=1,COUNTIF($F$3:F2151,1),\"\")","v":2149},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2151),$G$3:$G$3716,0)),\"\")","v":"51079029920"}]
[null,null,null,null,"51079030001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2152,1),\"\"))","v":1},{"$f":"IF(F2152=1,COUNTIF($F$3:F2152,1),\"\")","v":2150},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2152),$G$3:$G$3716,0)),\"\")","v":"51079030001"}]
[null,null,null,null,"51079030120",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2153,1),\"\"))","v":1},{"$f":"IF(F2153=1,COUNTIF($F$3:F2153,1),\"\")","v":2151},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2153),$G$3:$G$3716,0)),\"\")","v":"51079030120"}]
[null,null,null,null,"51079032101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2154,1),\"\"))","v":1},{"$f":"IF(F2154=1,COUNTIF($F$3:F2154,1),\"\")","v":2152},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2154),$G$3:$G$3716,0)),\"\")","v":"51079032101"}]
[null,null,null,null,"51079037420",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2155,1),\"\"))","v":1},{"$f":"IF(F2155=1,COUNTIF($F$3:F2155,1),\"\")","v":2153},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2155),$G$3:$G$3716,0)),\"\")","v":"51079037420"}]
[null,null,null,null,"51079037520",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2156,1),\"\"))","v":1},{"$f":"IF(F2156=1,COUNTIF($F$3:F2156,1),\"\")","v":2154},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2156),$G$3:$G$3716,0)),\"\")","v":"51079037520"}]
[null,null,null,null,"51079038501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2157,1),\"\"))","v":1},{"$f":"IF(F2157=1,COUNTIF($F$3:F2157,1),\"\")","v":2155},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2157),$G$3:$G$3716,0)),\"\")","v":"51079038501"}]
[null,null,null,null,"51079038520",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2158,1),\"\"))","v":1},{"$f":"IF(F2158=1,COUNTIF($F$3:F2158,1),\"\")","v":2156},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2158),$G$3:$G$3716,0)),\"\")","v":"51079038520"}]
[null,null,null,null,"51079038601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2159,1),\"\"))","v":1},{"$f":"IF(F2159=1,COUNTIF($F$3:F2159,1),\"\")","v":2157},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2159),$G$3:$G$3716,0)),\"\")","v":"51079038601"}]
[null,null,null,null,"51079038620",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2160,1),\"\"))","v":1},{"$f":"IF(F2160=1,COUNTIF($F$3:F2160,1),\"\")","v":2158},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2160),$G$3:$G$3716,0)),\"\")","v":"51079038620"}]
[null,null,null,null,"51079038701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2161,1),\"\"))","v":1},{"$f":"IF(F2161=1,COUNTIF($F$3:F2161,1),\"\")","v":2159},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2161),$G$3:$G$3716,0)),\"\")","v":"51079038701"}]
[null,null,null,null,"51079038720",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2162,1),\"\"))","v":1},{"$f":"IF(F2162=1,COUNTIF($F$3:F2162,1),\"\")","v":2160},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2162),$G$3:$G$3716,0)),\"\")","v":"51079038720"}]
[null,null,null,null,"51079039201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2163,1),\"\"))","v":1},{"$f":"IF(F2163=1,COUNTIF($F$3:F2163,1),\"\")","v":2161},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2163),$G$3:$G$3716,0)),\"\")","v":"51079039201"}]
[null,null,null,null,"51079039820",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2164,1),\"\"))","v":1},{"$f":"IF(F2164=1,COUNTIF($F$3:F2164,1),\"\")","v":2162},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2164),$G$3:$G$3716,0)),\"\")","v":"51079039820"}]
[null,null,null,null,"51079040001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2165,1),\"\"))","v":1},{"$f":"IF(F2165=1,COUNTIF($F$3:F2165,1),\"\")","v":2163},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2165),$G$3:$G$3716,0)),\"\")","v":"51079040001"}]
[null,null,null,null,"51079040020",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2166,1),\"\"))","v":1},{"$f":"IF(F2166=1,COUNTIF($F$3:F2166,1),\"\")","v":2164},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2166),$G$3:$G$3716,0)),\"\")","v":"51079040020"}]
[null,null,null,null,"51079041701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2167,1),\"\"))","v":1},{"$f":"IF(F2167=1,COUNTIF($F$3:F2167,1),\"\")","v":2165},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2167),$G$3:$G$3716,0)),\"\")","v":"51079041701"}]
[null,null,null,null,"51079041720",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2168,1),\"\"))","v":1},{"$f":"IF(F2168=1,COUNTIF($F$3:F2168,1),\"\")","v":2166},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2168),$G$3:$G$3716,0)),\"\")","v":"51079041720"}]
[null,null,null,null,"51079043601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2169,1),\"\"))","v":1},{"$f":"IF(F2169=1,COUNTIF($F$3:F2169,1),\"\")","v":2167},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2169),$G$3:$G$3716,0)),\"\")","v":"51079043601"}]
[null,null,null,null,"51079043620",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2170,1),\"\"))","v":1},{"$f":"IF(F2170=1,COUNTIF($F$3:F2170,1),\"\")","v":2168},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2170),$G$3:$G$3716,0)),\"\")","v":"51079043620"}]
[null,null,null,null,"51079043720",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2171,1),\"\"))","v":1},{"$f":"IF(F2171=1,COUNTIF($F$3:F2171,1),\"\")","v":2169},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2171),$G$3:$G$3716,0)),\"\")","v":"51079043720"}]
[null,null,null,null,"51079043801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2172,1),\"\"))","v":1},{"$f":"IF(F2172=1,COUNTIF($F$3:F2172,1),\"\")","v":2170},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2172),$G$3:$G$3716,0)),\"\")","v":"51079043801"}]
[null,null,null,null,"51079043820",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2173,1),\"\"))","v":1},{"$f":"IF(F2173=1,COUNTIF($F$3:F2173,1),\"\")","v":2171},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2173),$G$3:$G$3716,0)),\"\")","v":"51079043820"}]
[null,null,null,null,"51079044001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2174,1),\"\"))","v":1},{"$f":"IF(F2174=1,COUNTIF($F$3:F2174,1),\"\")","v":2172},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2174),$G$3:$G$3716,0)),\"\")","v":"51079044001"}]
[null,null,null,null,"51079044020",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2175,1),\"\"))","v":1},{"$f":"IF(F2175=1,COUNTIF($F$3:F2175,1),\"\")","v":2173},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2175),$G$3:$G$3716,0)),\"\")","v":"51079044020"}]
[null,null,null,null,"51079044120",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2176,1),\"\"))","v":1},{"$f":"IF(F2176=1,COUNTIF($F$3:F2176,1),\"\")","v":2174},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2176),$G$3:$G$3716,0)),\"\")","v":"51079044120"}]
[null,null,null,null,"51079044220",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2177,1),\"\"))","v":1},{"$f":"IF(F2177=1,COUNTIF($F$3:F2177,1),\"\")","v":2175},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2177),$G$3:$G$3716,0)),\"\")","v":"51079044220"}]
[null,null,null,null,"51079044320",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2178,1),\"\"))","v":1},{"$f":"IF(F2178=1,COUNTIF($F$3:F2178,1),\"\")","v":2176},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2178),$G$3:$G$3716,0)),\"\")","v":"51079044320"}]
[null,null,null,null,"51079044401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2179,1),\"\"))","v":1},{"$f":"IF(F2179=1,COUNTIF($F$3:F2179,1),\"\")","v":2177},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2179),$G$3:$G$3716,0)),\"\")","v":"51079044401"}]
[null,null,null,null,"51079044420",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2180,1),\"\"))","v":1},{"$f":"IF(F2180=1,COUNTIF($F$3:F2180,1),\"\")","v":2178},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2180),$G$3:$G$3716,0)),\"\")","v":"51079044420"}]
[null,null,null,null,"51079044520",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2181,1),\"\"))","v":1},{"$f":"IF(F2181=1,COUNTIF($F$3:F2181,1),\"\")","v":2179},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2181),$G$3:$G$3716,0)),\"\")","v":"51079044520"}]
[null,null,null,null,"51079045001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2182,1),\"\"))","v":1},{"$f":"IF(F2182=1,COUNTIF($F$3:F2182,1),\"\")","v":2180},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2182),$G$3:$G$3716,0)),\"\")","v":"51079045001"}]
[null,null,null,null,"51079045101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2183,1),\"\"))","v":1},{"$f":"IF(F2183=1,COUNTIF($F$3:F2183,1),\"\")","v":2181},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2183),$G$3:$G$3716,0)),\"\")","v":"51079045101"}]
[null,null,null,null,"51079045120",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2184,1),\"\"))","v":1},{"$f":"IF(F2184=1,COUNTIF($F$3:F2184,1),\"\")","v":2182},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2184),$G$3:$G$3716,0)),\"\")","v":"51079045120"}]
[null,null,null,null,"51079045401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2185,1),\"\"))","v":1},{"$f":"IF(F2185=1,COUNTIF($F$3:F2185,1),\"\")","v":2183},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2185),$G$3:$G$3716,0)),\"\")","v":"51079045401"}]
[null,null,null,null,"51079045420",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2186,1),\"\"))","v":1},{"$f":"IF(F2186=1,COUNTIF($F$3:F2186,1),\"\")","v":2184},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2186),$G$3:$G$3716,0)),\"\")","v":"51079045420"}]
[null,null,null,null,"51079045501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2187,1),\"\"))","v":1},{"$f":"IF(F2187=1,COUNTIF($F$3:F2187,1),\"\")","v":2185},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2187),$G$3:$G$3716,0)),\"\")","v":"51079045501"}]
[null,null,null,null,"51079045520",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2188,1),\"\"))","v":1},{"$f":"IF(F2188=1,COUNTIF($F$3:F2188,1),\"\")","v":2186},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2188),$G$3:$G$3716,0)),\"\")","v":"51079045520"}]
[null,null,null,null,"51079045601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2189,1),\"\"))","v":1},{"$f":"IF(F2189=1,COUNTIF($F$3:F2189,1),\"\")","v":2187},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2189),$G$3:$G$3716,0)),\"\")","v":"51079045601"}]
[null,null,null,null,"51079045620",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2190,1),\"\"))","v":1},{"$f":"IF(F2190=1,COUNTIF($F$3:F2190,1),\"\")","v":2188},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2190),$G$3:$G$3716,0)),\"\")","v":"51079045620"}]
[null,null,null,null,"51079046201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2191,1),\"\"))","v":1},{"$f":"IF(F2191=1,COUNTIF($F$3:F2191,1),\"\")","v":2189},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2191),$G$3:$G$3716,0)),\"\")","v":"51079046201"}]
[null,null,null,null,"51079047508",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2192,1),\"\"))","v":1},{"$f":"IF(F2192=1,COUNTIF($F$3:F2192,1),\"\")","v":2190},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2192),$G$3:$G$3716,0)),\"\")","v":"51079047508"}]
[null,null,null,null,"51079048501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2193,1),\"\"))","v":1},{"$f":"IF(F2193=1,COUNTIF($F$3:F2193,1),\"\")","v":2191},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2193),$G$3:$G$3716,0)),\"\")","v":"51079048501"}]
[null,null,null,null,"51079048520",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2194,1),\"\"))","v":1},{"$f":"IF(F2194=1,COUNTIF($F$3:F2194,1),\"\")","v":2192},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2194),$G$3:$G$3716,0)),\"\")","v":"51079048520"}]
[null,null,null,null,"51079048601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2195,1),\"\"))","v":1},{"$f":"IF(F2195=1,COUNTIF($F$3:F2195,1),\"\")","v":2193},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2195),$G$3:$G$3716,0)),\"\")","v":"51079048601"}]
[null,null,null,null,"51079048620",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2196,1),\"\"))","v":1},{"$f":"IF(F2196=1,COUNTIF($F$3:F2196,1),\"\")","v":2194},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2196),$G$3:$G$3716,0)),\"\")","v":"51079048620"}]
[null,null,null,null,"51079048720",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2197,1),\"\"))","v":1},{"$f":"IF(F2197=1,COUNTIF($F$3:F2197,1),\"\")","v":2195},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2197),$G$3:$G$3716,0)),\"\")","v":"51079048720"}]
[null,null,null,null,"51079048820",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2198,1),\"\"))","v":1},{"$f":"IF(F2198=1,COUNTIF($F$3:F2198,1),\"\")","v":2196},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2198),$G$3:$G$3716,0)),\"\")","v":"51079048820"}]
[null,null,null,null,"51079049801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2199,1),\"\"))","v":1},{"$f":"IF(F2199=1,COUNTIF($F$3:F2199,1),\"\")","v":2197},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2199),$G$3:$G$3716,0)),\"\")","v":"51079049801"}]
[null,null,null,null,"51079049820",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2200,1),\"\"))","v":1},{"$f":"IF(F2200=1,COUNTIF($F$3:F2200,1),\"\")","v":2198},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2200),$G$3:$G$3716,0)),\"\")","v":"51079049820"}]
[null,null,null,null,"51079049901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2201,1),\"\"))","v":1},{"$f":"IF(F2201=1,COUNTIF($F$3:F2201,1),\"\")","v":2199},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2201),$G$3:$G$3716,0)),\"\")","v":"51079049901"}]
[null,null,null,null,"51079052020",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2202,1),\"\"))","v":1},{"$f":"IF(F2202=1,COUNTIF($F$3:F2202,1),\"\")","v":2200},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2202),$G$3:$G$3716,0)),\"\")","v":"51079052020"}]
[null,null,null,null,"51079052701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2203,1),\"\"))","v":1},{"$f":"IF(F2203=1,COUNTIF($F$3:F2203,1),\"\")","v":2201},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2203),$G$3:$G$3716,0)),\"\")","v":"51079052701"}]
[null,null,null,null,"51079052720",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2204,1),\"\"))","v":1},{"$f":"IF(F2204=1,COUNTIF($F$3:F2204,1),\"\")","v":2202},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2204),$G$3:$G$3716,0)),\"\")","v":"51079052720"}]
[null,null,null,null,"51079053820",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2205,1),\"\"))","v":1},{"$f":"IF(F2205=1,COUNTIF($F$3:F2205,1),\"\")","v":2203},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2205),$G$3:$G$3716,0)),\"\")","v":"51079053820"}]
[null,null,null,null,"51079055701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2206,1),\"\"))","v":1},{"$f":"IF(F2206=1,COUNTIF($F$3:F2206,1),\"\")","v":2204},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2206),$G$3:$G$3716,0)),\"\")","v":"51079055701"}]
[null,null,null,null,"51079055720",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2207,1),\"\"))","v":1},{"$f":"IF(F2207=1,COUNTIF($F$3:F2207,1),\"\")","v":2205},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2207),$G$3:$G$3716,0)),\"\")","v":"51079055720"}]
[null,null,null,null,"51079056520",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2208,1),\"\"))","v":1},{"$f":"IF(F2208=1,COUNTIF($F$3:F2208,1),\"\")","v":2206},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2208),$G$3:$G$3716,0)),\"\")","v":"51079056520"}]
[null,null,null,null,"51079056620",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2209,1),\"\"))","v":1},{"$f":"IF(F2209=1,COUNTIF($F$3:F2209,1),\"\")","v":2207},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2209),$G$3:$G$3716,0)),\"\")","v":"51079056620"}]
[null,null,null,null,"51079056720",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2210,1),\"\"))","v":1},{"$f":"IF(F2210=1,COUNTIF($F$3:F2210,1),\"\")","v":2208},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2210),$G$3:$G$3716,0)),\"\")","v":"51079056720"}]
[null,null,null,null,"51079057220",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2211,1),\"\"))","v":1},{"$f":"IF(F2211=1,COUNTIF($F$3:F2211,1),\"\")","v":2209},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2211),$G$3:$G$3716,0)),\"\")","v":"51079057220"}]
[null,null,null,null,"51079057420",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2212,1),\"\"))","v":1},{"$f":"IF(F2212=1,COUNTIF($F$3:F2212,1),\"\")","v":2210},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2212),$G$3:$G$3716,0)),\"\")","v":"51079057420"}]
[null,null,null,null,"51079058001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2213,1),\"\"))","v":1},{"$f":"IF(F2213=1,COUNTIF($F$3:F2213,1),\"\")","v":2211},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2213),$G$3:$G$3716,0)),\"\")","v":"51079058001"}]
[null,null,null,null,"51079058020",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2214,1),\"\"))","v":1},{"$f":"IF(F2214=1,COUNTIF($F$3:F2214,1),\"\")","v":2212},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2214),$G$3:$G$3716,0)),\"\")","v":"51079058020"}]
[null,null,null,null,"51079058106",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2215,1),\"\"))","v":1},{"$f":"IF(F2215=1,COUNTIF($F$3:F2215,1),\"\")","v":2213},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2215),$G$3:$G$3716,0)),\"\")","v":"51079058106"}]
[null,null,null,null,"51079058201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2216,1),\"\"))","v":1},{"$f":"IF(F2216=1,COUNTIF($F$3:F2216,1),\"\")","v":2214},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2216),$G$3:$G$3716,0)),\"\")","v":"51079058201"}]
[null,null,null,null,"51079058205",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2217,1),\"\"))","v":1},{"$f":"IF(F2217=1,COUNTIF($F$3:F2217,1),\"\")","v":2215},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2217),$G$3:$G$3716,0)),\"\")","v":"51079058205"}]
[null,null,null,null,"51079058801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2218,1),\"\"))","v":1},{"$f":"IF(F2218=1,COUNTIF($F$3:F2218,1),\"\")","v":2216},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2218),$G$3:$G$3716,0)),\"\")","v":"51079058801"}]
[null,null,null,null,"51079063001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2219,1),\"\"))","v":1},{"$f":"IF(F2219=1,COUNTIF($F$3:F2219,1),\"\")","v":2217},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2219),$G$3:$G$3716,0)),\"\")","v":"51079063001"}]
[null,null,null,null,"51079063020",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2220,1),\"\"))","v":1},{"$f":"IF(F2220=1,COUNTIF($F$3:F2220,1),\"\")","v":2218},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2220),$G$3:$G$3716,0)),\"\")","v":"51079063020"}]
[null,null,null,null,"51079063101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2221,1),\"\"))","v":1},{"$f":"IF(F2221=1,COUNTIF($F$3:F2221,1),\"\")","v":2219},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2221),$G$3:$G$3716,0)),\"\")","v":"51079063101"}]
[null,null,null,null,"51079063120",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2222,1),\"\"))","v":1},{"$f":"IF(F2222=1,COUNTIF($F$3:F2222,1),\"\")","v":2220},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2222),$G$3:$G$3716,0)),\"\")","v":"51079063120"}]
[null,null,null,null,"51079063201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2223,1),\"\"))","v":1},{"$f":"IF(F2223=1,COUNTIF($F$3:F2223,1),\"\")","v":2221},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2223),$G$3:$G$3716,0)),\"\")","v":"51079063201"}]
[null,null,null,null,"51079063220",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2224,1),\"\"))","v":1},{"$f":"IF(F2224=1,COUNTIF($F$3:F2224,1),\"\")","v":2222},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2224),$G$3:$G$3716,0)),\"\")","v":"51079063220"}]
[null,null,null,null,"51079064401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2225,1),\"\"))","v":1},{"$f":"IF(F2225=1,COUNTIF($F$3:F2225,1),\"\")","v":2223},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2225),$G$3:$G$3716,0)),\"\")","v":"51079064401"}]
[null,null,null,null,"51079064420",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2226,1),\"\"))","v":1},{"$f":"IF(F2226=1,COUNTIF($F$3:F2226,1),\"\")","v":2224},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2226),$G$3:$G$3716,0)),\"\")","v":"51079064420"}]
[null,null,null,null,"51079066701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2227,1),\"\"))","v":1},{"$f":"IF(F2227=1,COUNTIF($F$3:F2227,1),\"\")","v":2225},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2227),$G$3:$G$3716,0)),\"\")","v":"51079066701"}]
[null,null,null,null,"51079066720",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2228,1),\"\"))","v":1},{"$f":"IF(F2228=1,COUNTIF($F$3:F2228,1),\"\")","v":2226},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2228),$G$3:$G$3716,0)),\"\")","v":"51079066720"}]
[null,null,null,null,"51079068401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2229,1),\"\"))","v":1},{"$f":"IF(F2229=1,COUNTIF($F$3:F2229,1),\"\")","v":2227},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2229),$G$3:$G$3716,0)),\"\")","v":"51079068401"}]
[null,null,null,null,"51079068420",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2230,1),\"\"))","v":1},{"$f":"IF(F2230=1,COUNTIF($F$3:F2230,1),\"\")","v":2228},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2230),$G$3:$G$3716,0)),\"\")","v":"51079068420"}]
[null,null,null,null,"51079068520",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2231,1),\"\"))","v":1},{"$f":"IF(F2231=1,COUNTIF($F$3:F2231,1),\"\")","v":2229},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2231),$G$3:$G$3716,0)),\"\")","v":"51079068520"}]
[null,null,null,null,"51079068620",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2232,1),\"\"))","v":1},{"$f":"IF(F2232=1,COUNTIF($F$3:F2232,1),\"\")","v":2230},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2232),$G$3:$G$3716,0)),\"\")","v":"51079068620"}]
[null,null,null,null,"51079069001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2233,1),\"\"))","v":1},{"$f":"IF(F2233=1,COUNTIF($F$3:F2233,1),\"\")","v":2231},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2233),$G$3:$G$3716,0)),\"\")","v":"51079069001"}]
[null,null,null,null,"51079069020",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2234,1),\"\"))","v":1},{"$f":"IF(F2234=1,COUNTIF($F$3:F2234,1),\"\")","v":2232},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2234),$G$3:$G$3716,0)),\"\")","v":"51079069020"}]
[null,null,null,null,"51079072601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2235,1),\"\"))","v":1},{"$f":"IF(F2235=1,COUNTIF($F$3:F2235,1),\"\")","v":2233},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2235),$G$3:$G$3716,0)),\"\")","v":"51079072601"}]
[null,null,null,null,"51079072801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2236,1),\"\"))","v":1},{"$f":"IF(F2236=1,COUNTIF($F$3:F2236,1),\"\")","v":2234},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2236),$G$3:$G$3716,0)),\"\")","v":"51079072801"}]
[null,null,null,null,"51079073301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2237,1),\"\"))","v":1},{"$f":"IF(F2237=1,COUNTIF($F$3:F2237,1),\"\")","v":2235},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2237),$G$3:$G$3716,0)),\"\")","v":"51079073301"}]
[null,null,null,null,"51079073320",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2238,1),\"\"))","v":1},{"$f":"IF(F2238=1,COUNTIF($F$3:F2238,1),\"\")","v":2236},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2238),$G$3:$G$3716,0)),\"\")","v":"51079073320"}]
[null,null,null,null,"51079073501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2239,1),\"\"))","v":1},{"$f":"IF(F2239=1,COUNTIF($F$3:F2239,1),\"\")","v":2237},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2239),$G$3:$G$3716,0)),\"\")","v":"51079073501"}]
[null,null,null,null,"51079073520",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2240,1),\"\"))","v":1},{"$f":"IF(F2240=1,COUNTIF($F$3:F2240,1),\"\")","v":2238},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2240),$G$3:$G$3716,0)),\"\")","v":"51079073520"}]
[null,null,null,null,"51079074501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2241,1),\"\"))","v":1},{"$f":"IF(F2241=1,COUNTIF($F$3:F2241,1),\"\")","v":2239},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2241),$G$3:$G$3716,0)),\"\")","v":"51079074501"}]
[null,null,null,null,"51079074520",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2242,1),\"\"))","v":1},{"$f":"IF(F2242=1,COUNTIF($F$3:F2242,1),\"\")","v":2240},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2242),$G$3:$G$3716,0)),\"\")","v":"51079074520"}]
[null,null,null,null,"51079074601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2243,1),\"\"))","v":1},{"$f":"IF(F2243=1,COUNTIF($F$3:F2243,1),\"\")","v":2241},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2243),$G$3:$G$3716,0)),\"\")","v":"51079074601"}]
[null,null,null,null,"51079074620",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2244,1),\"\"))","v":1},{"$f":"IF(F2244=1,COUNTIF($F$3:F2244,1),\"\")","v":2242},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2244),$G$3:$G$3716,0)),\"\")","v":"51079074620"}]
[null,null,null,null,"51079075320",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2245,1),\"\"))","v":1},{"$f":"IF(F2245=1,COUNTIF($F$3:F2245,1),\"\")","v":2243},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2245),$G$3:$G$3716,0)),\"\")","v":"51079075320"}]
[null,null,null,null,"51079075901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2246,1),\"\"))","v":1},{"$f":"IF(F2246=1,COUNTIF($F$3:F2246,1),\"\")","v":2244},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2246),$G$3:$G$3716,0)),\"\")","v":"51079075901"}]
[null,null,null,null,"51079075920",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2247,1),\"\"))","v":1},{"$f":"IF(F2247=1,COUNTIF($F$3:F2247,1),\"\")","v":2245},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2247),$G$3:$G$3716,0)),\"\")","v":"51079075920"}]
[null,null,null,null,"51079076601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2248,1),\"\"))","v":1},{"$f":"IF(F2248=1,COUNTIF($F$3:F2248,1),\"\")","v":2246},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2248),$G$3:$G$3716,0)),\"\")","v":"51079076601"}]
[null,null,null,null,"51079077401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2249,1),\"\"))","v":1},{"$f":"IF(F2249=1,COUNTIF($F$3:F2249,1),\"\")","v":2247},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2249),$G$3:$G$3716,0)),\"\")","v":"51079077401"}]
[null,null,null,null,"51079077420",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2250,1),\"\"))","v":1},{"$f":"IF(F2250=1,COUNTIF($F$3:F2250,1),\"\")","v":2248},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2250),$G$3:$G$3716,0)),\"\")","v":"51079077420"}]
[null,null,null,null,"51079079020",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2251,1),\"\"))","v":1},{"$f":"IF(F2251=1,COUNTIF($F$3:F2251,1),\"\")","v":2249},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2251),$G$3:$G$3716,0)),\"\")","v":"51079079020"}]
[null,null,null,null,"51079079601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2252,1),\"\"))","v":1},{"$f":"IF(F2252=1,COUNTIF($F$3:F2252,1),\"\")","v":2250},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2252),$G$3:$G$3716,0)),\"\")","v":"51079079601"}]
[null,null,null,null,"51079079620",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2253,1),\"\"))","v":1},{"$f":"IF(F2253=1,COUNTIF($F$3:F2253,1),\"\")","v":2251},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2253),$G$3:$G$3716,0)),\"\")","v":"51079079620"}]
[null,null,null,null,"51079080120",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2254,1),\"\"))","v":1},{"$f":"IF(F2254=1,COUNTIF($F$3:F2254,1),\"\")","v":2252},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2254),$G$3:$G$3716,0)),\"\")","v":"51079080120"}]
[null,null,null,null,"51079081001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2255,1),\"\"))","v":1},{"$f":"IF(F2255=1,COUNTIF($F$3:F2255,1),\"\")","v":2253},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2255),$G$3:$G$3716,0)),\"\")","v":"51079081001"}]
[null,null,null,null,"51079081020",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2256,1),\"\"))","v":1},{"$f":"IF(F2256=1,COUNTIF($F$3:F2256,1),\"\")","v":2254},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2256),$G$3:$G$3716,0)),\"\")","v":"51079081020"}]
[null,null,null,null,"51079081101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2257,1),\"\"))","v":1},{"$f":"IF(F2257=1,COUNTIF($F$3:F2257,1),\"\")","v":2255},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2257),$G$3:$G$3716,0)),\"\")","v":"51079081101"}]
[null,null,null,null,"51079081120",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2258,1),\"\"))","v":1},{"$f":"IF(F2258=1,COUNTIF($F$3:F2258,1),\"\")","v":2256},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2258),$G$3:$G$3716,0)),\"\")","v":"51079081120"}]
[null,null,null,null,"51079081301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2259,1),\"\"))","v":1},{"$f":"IF(F2259=1,COUNTIF($F$3:F2259,1),\"\")","v":2257},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2259),$G$3:$G$3716,0)),\"\")","v":"51079081301"}]
[null,null,null,null,"51079081320",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2260,1),\"\"))","v":1},{"$f":"IF(F2260=1,COUNTIF($F$3:F2260,1),\"\")","v":2258},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2260),$G$3:$G$3716,0)),\"\")","v":"51079081320"}]
[null,null,null,null,"51079082001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2261,1),\"\"))","v":1},{"$f":"IF(F2261=1,COUNTIF($F$3:F2261,1),\"\")","v":2259},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2261),$G$3:$G$3716,0)),\"\")","v":"51079082001"}]
[null,null,null,null,"51079082101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2262,1),\"\"))","v":1},{"$f":"IF(F2262=1,COUNTIF($F$3:F2262,1),\"\")","v":2260},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2262),$G$3:$G$3716,0)),\"\")","v":"51079082101"}]
[null,null,null,null,"51079086301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2263,1),\"\"))","v":1},{"$f":"IF(F2263=1,COUNTIF($F$3:F2263,1),\"\")","v":2261},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2263),$G$3:$G$3716,0)),\"\")","v":"51079086301"}]
[null,null,null,null,"51079086320",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2264,1),\"\"))","v":1},{"$f":"IF(F2264=1,COUNTIF($F$3:F2264,1),\"\")","v":2262},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2264),$G$3:$G$3716,0)),\"\")","v":"51079086320"}]
[null,null,null,null,"51079086401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2265,1),\"\"))","v":1},{"$f":"IF(F2265=1,COUNTIF($F$3:F2265,1),\"\")","v":2263},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2265),$G$3:$G$3716,0)),\"\")","v":"51079086401"}]
[null,null,null,null,"51079086420",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2266,1),\"\"))","v":1},{"$f":"IF(F2266=1,COUNTIF($F$3:F2266,1),\"\")","v":2264},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2266),$G$3:$G$3716,0)),\"\")","v":"51079086420"}]
[null,null,null,null,"51079086820",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2267,1),\"\"))","v":1},{"$f":"IF(F2267=1,COUNTIF($F$3:F2267,1),\"\")","v":2265},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2267),$G$3:$G$3716,0)),\"\")","v":"51079086820"}]
[null,null,null,null,"51079086920",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2268,1),\"\"))","v":1},{"$f":"IF(F2268=1,COUNTIF($F$3:F2268,1),\"\")","v":2266},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2268),$G$3:$G$3716,0)),\"\")","v":"51079086920"}]
[null,null,null,null,"51079087001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2269,1),\"\"))","v":1},{"$f":"IF(F2269=1,COUNTIF($F$3:F2269,1),\"\")","v":2267},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2269),$G$3:$G$3716,0)),\"\")","v":"51079087001"}]
[null,null,null,null,"51079087020",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2270,1),\"\"))","v":1},{"$f":"IF(F2270=1,COUNTIF($F$3:F2270,1),\"\")","v":2268},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2270),$G$3:$G$3716,0)),\"\")","v":"51079087020"}]
[null,null,null,null,"51079087120",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2271,1),\"\"))","v":1},{"$f":"IF(F2271=1,COUNTIF($F$3:F2271,1),\"\")","v":2269},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2271),$G$3:$G$3716,0)),\"\")","v":"51079087120"}]
[null,null,null,null,"51079088120",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2272,1),\"\"))","v":1},{"$f":"IF(F2272=1,COUNTIF($F$3:F2272,1),\"\")","v":2270},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2272),$G$3:$G$3716,0)),\"\")","v":"51079088120"}]
[null,null,null,null,"51079088201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2273,1),\"\"))","v":1},{"$f":"IF(F2273=1,COUNTIF($F$3:F2273,1),\"\")","v":2271},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2273),$G$3:$G$3716,0)),\"\")","v":"51079088201"}]
[null,null,null,null,"51079088220",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2274,1),\"\"))","v":1},{"$f":"IF(F2274=1,COUNTIF($F$3:F2274,1),\"\")","v":2272},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2274),$G$3:$G$3716,0)),\"\")","v":"51079088220"}]
[null,null,null,null,"51079088301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2275,1),\"\"))","v":1},{"$f":"IF(F2275=1,COUNTIF($F$3:F2275,1),\"\")","v":2273},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2275),$G$3:$G$3716,0)),\"\")","v":"51079088301"}]
[null,null,null,null,"51079088320",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2276,1),\"\"))","v":1},{"$f":"IF(F2276=1,COUNTIF($F$3:F2276,1),\"\")","v":2274},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2276),$G$3:$G$3716,0)),\"\")","v":"51079088320"}]
[null,null,null,null,"51079088401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2277,1),\"\"))","v":1},{"$f":"IF(F2277=1,COUNTIF($F$3:F2277,1),\"\")","v":2275},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2277),$G$3:$G$3716,0)),\"\")","v":"51079088401"}]
[null,null,null,null,"51079088420",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2278,1),\"\"))","v":1},{"$f":"IF(F2278=1,COUNTIF($F$3:F2278,1),\"\")","v":2276},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2278),$G$3:$G$3716,0)),\"\")","v":"51079088420"}]
[null,null,null,null,"51079088801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2279,1),\"\"))","v":1},{"$f":"IF(F2279=1,COUNTIF($F$3:F2279,1),\"\")","v":2277},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2279),$G$3:$G$3716,0)),\"\")","v":"51079088801"}]
[null,null,null,null,"51079088820",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2280,1),\"\"))","v":1},{"$f":"IF(F2280=1,COUNTIF($F$3:F2280,1),\"\")","v":2278},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2280),$G$3:$G$3716,0)),\"\")","v":"51079088820"}]
[null,null,null,null,"51079089401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2281,1),\"\"))","v":1},{"$f":"IF(F2281=1,COUNTIF($F$3:F2281,1),\"\")","v":2279},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2281),$G$3:$G$3716,0)),\"\")","v":"51079089401"}]
[null,null,null,null,"51079089601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2282,1),\"\"))","v":1},{"$f":"IF(F2282=1,COUNTIF($F$3:F2282,1),\"\")","v":2280},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2282),$G$3:$G$3716,0)),\"\")","v":"51079089601"}]
[null,null,null,null,"51079089708",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2283,1),\"\"))","v":1},{"$f":"IF(F2283=1,COUNTIF($F$3:F2283,1),\"\")","v":2281},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2283),$G$3:$G$3716,0)),\"\")","v":"51079089708"}]
[null,null,null,null,"51079089901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2284,1),\"\"))","v":1},{"$f":"IF(F2284=1,COUNTIF($F$3:F2284,1),\"\")","v":2282},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2284),$G$3:$G$3716,0)),\"\")","v":"51079089901"}]
[null,null,null,null,"51079089920",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2285,1),\"\"))","v":1},{"$f":"IF(F2285=1,COUNTIF($F$3:F2285,1),\"\")","v":2283},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2285),$G$3:$G$3716,0)),\"\")","v":"51079089920"}]
[null,null,null,null,"51079090501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2286,1),\"\"))","v":1},{"$f":"IF(F2286=1,COUNTIF($F$3:F2286,1),\"\")","v":2284},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2286),$G$3:$G$3716,0)),\"\")","v":"51079090501"}]
[null,null,null,null,"51079090520",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2287,1),\"\"))","v":1},{"$f":"IF(F2287=1,COUNTIF($F$3:F2287,1),\"\")","v":2285},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2287),$G$3:$G$3716,0)),\"\")","v":"51079090520"}]
[null,null,null,null,"51079092101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2288,1),\"\"))","v":1},{"$f":"IF(F2288=1,COUNTIF($F$3:F2288,1),\"\")","v":2286},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2288),$G$3:$G$3716,0)),\"\")","v":"51079092101"}]
[null,null,null,null,"51079092120",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2289,1),\"\"))","v":1},{"$f":"IF(F2289=1,COUNTIF($F$3:F2289,1),\"\")","v":2287},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2289),$G$3:$G$3716,0)),\"\")","v":"51079092120"}]
[null,null,null,null,"51079092201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2290,1),\"\"))","v":1},{"$f":"IF(F2290=1,COUNTIF($F$3:F2290,1),\"\")","v":2288},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2290),$G$3:$G$3716,0)),\"\")","v":"51079092201"}]
[null,null,null,null,"51079092220",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2291,1),\"\"))","v":1},{"$f":"IF(F2291=1,COUNTIF($F$3:F2291,1),\"\")","v":2289},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2291),$G$3:$G$3716,0)),\"\")","v":"51079092220"}]
[null,null,null,null,"51079092420",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2292,1),\"\"))","v":1},{"$f":"IF(F2292=1,COUNTIF($F$3:F2292,1),\"\")","v":2290},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2292),$G$3:$G$3716,0)),\"\")","v":"51079092420"}]
[null,null,null,null,"51079092520",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2293,1),\"\"))","v":1},{"$f":"IF(F2293=1,COUNTIF($F$3:F2293,1),\"\")","v":2291},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2293),$G$3:$G$3716,0)),\"\")","v":"51079092520"}]
[null,null,null,null,"51079092601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2294,1),\"\"))","v":1},{"$f":"IF(F2294=1,COUNTIF($F$3:F2294,1),\"\")","v":2292},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2294),$G$3:$G$3716,0)),\"\")","v":"51079092601"}]
[null,null,null,null,"51079092620",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2295,1),\"\"))","v":1},{"$f":"IF(F2295=1,COUNTIF($F$3:F2295,1),\"\")","v":2293},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2295),$G$3:$G$3716,0)),\"\")","v":"51079092620"}]
[null,null,null,null,"51079092901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2296,1),\"\"))","v":1},{"$f":"IF(F2296=1,COUNTIF($F$3:F2296,1),\"\")","v":2294},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2296),$G$3:$G$3716,0)),\"\")","v":"51079092901"}]
[null,null,null,null,"51079092920",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2297,1),\"\"))","v":1},{"$f":"IF(F2297=1,COUNTIF($F$3:F2297,1),\"\")","v":2295},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2297),$G$3:$G$3716,0)),\"\")","v":"51079092920"}]
[null,null,null,null,"51079093001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2298,1),\"\"))","v":1},{"$f":"IF(F2298=1,COUNTIF($F$3:F2298,1),\"\")","v":2296},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2298),$G$3:$G$3716,0)),\"\")","v":"51079093001"}]
[null,null,null,null,"51079093020",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2299,1),\"\"))","v":1},{"$f":"IF(F2299=1,COUNTIF($F$3:F2299,1),\"\")","v":2297},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2299),$G$3:$G$3716,0)),\"\")","v":"51079093020"}]
[null,null,null,null,"51079093101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2300,1),\"\"))","v":1},{"$f":"IF(F2300=1,COUNTIF($F$3:F2300,1),\"\")","v":2298},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2300),$G$3:$G$3716,0)),\"\")","v":"51079093101"}]
[null,null,null,null,"51079093120",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2301,1),\"\"))","v":1},{"$f":"IF(F2301=1,COUNTIF($F$3:F2301,1),\"\")","v":2299},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2301),$G$3:$G$3716,0)),\"\")","v":"51079093120"}]
[null,null,null,null,"51079093501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2302,1),\"\"))","v":1},{"$f":"IF(F2302=1,COUNTIF($F$3:F2302,1),\"\")","v":2300},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2302),$G$3:$G$3716,0)),\"\")","v":"51079093501"}]
[null,null,null,null,"51079093601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2303,1),\"\"))","v":1},{"$f":"IF(F2303=1,COUNTIF($F$3:F2303,1),\"\")","v":2301},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2303),$G$3:$G$3716,0)),\"\")","v":"51079093601"}]
[null,null,null,null,"51079093801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2304,1),\"\"))","v":1},{"$f":"IF(F2304=1,COUNTIF($F$3:F2304,1),\"\")","v":2302},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2304),$G$3:$G$3716,0)),\"\")","v":"51079093801"}]
[null,null,null,null,"51079094301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2305,1),\"\"))","v":1},{"$f":"IF(F2305=1,COUNTIF($F$3:F2305,1),\"\")","v":2303},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2305),$G$3:$G$3716,0)),\"\")","v":"51079094301"}]
[null,null,null,null,"51079094320",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2306,1),\"\"))","v":1},{"$f":"IF(F2306=1,COUNTIF($F$3:F2306,1),\"\")","v":2304},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2306),$G$3:$G$3716,0)),\"\")","v":"51079094320"}]
[null,null,null,null,"51079094401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2307,1),\"\"))","v":1},{"$f":"IF(F2307=1,COUNTIF($F$3:F2307,1),\"\")","v":2305},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2307),$G$3:$G$3716,0)),\"\")","v":"51079094401"}]
[null,null,null,null,"51079094420",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2308,1),\"\"))","v":1},{"$f":"IF(F2308=1,COUNTIF($F$3:F2308,1),\"\")","v":2306},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2308),$G$3:$G$3716,0)),\"\")","v":"51079094420"}]
[null,null,null,null,"51079095201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2309,1),\"\"))","v":1},{"$f":"IF(F2309=1,COUNTIF($F$3:F2309,1),\"\")","v":2307},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2309),$G$3:$G$3716,0)),\"\")","v":"51079095201"}]
[null,null,null,null,"51079095220",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2310,1),\"\"))","v":1},{"$f":"IF(F2310=1,COUNTIF($F$3:F2310,1),\"\")","v":2308},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2310),$G$3:$G$3716,0)),\"\")","v":"51079095220"}]
[null,null,null,null,"51079095820",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2311,1),\"\"))","v":1},{"$f":"IF(F2311=1,COUNTIF($F$3:F2311,1),\"\")","v":2309},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2311),$G$3:$G$3716,0)),\"\")","v":"51079095820"}]
[null,null,null,null,"51079095920",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2312,1),\"\"))","v":1},{"$f":"IF(F2312=1,COUNTIF($F$3:F2312,1),\"\")","v":2310},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2312),$G$3:$G$3716,0)),\"\")","v":"51079095920"}]
[null,null,null,null,"51079096601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2313,1),\"\"))","v":1},{"$f":"IF(F2313=1,COUNTIF($F$3:F2313,1),\"\")","v":2311},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2313),$G$3:$G$3716,0)),\"\")","v":"51079096601"}]
[null,null,null,null,"51079096620",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2314,1),\"\"))","v":1},{"$f":"IF(F2314=1,COUNTIF($F$3:F2314,1),\"\")","v":2312},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2314),$G$3:$G$3716,0)),\"\")","v":"51079096620"}]
[null,null,null,null,"51079097801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2315,1),\"\"))","v":1},{"$f":"IF(F2315=1,COUNTIF($F$3:F2315,1),\"\")","v":2313},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2315),$G$3:$G$3716,0)),\"\")","v":"51079097801"}]
[null,null,null,null,"51079098001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2316,1),\"\"))","v":1},{"$f":"IF(F2316=1,COUNTIF($F$3:F2316,1),\"\")","v":2314},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2316),$G$3:$G$3716,0)),\"\")","v":"51079098001"}]
[null,null,null,null,"51079098101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2317,1),\"\"))","v":1},{"$f":"IF(F2317=1,COUNTIF($F$3:F2317,1),\"\")","v":2315},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2317),$G$3:$G$3716,0)),\"\")","v":"51079098101"}]
[null,null,null,null,"51079098120",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2318,1),\"\"))","v":1},{"$f":"IF(F2318=1,COUNTIF($F$3:F2318,1),\"\")","v":2316},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2318),$G$3:$G$3716,0)),\"\")","v":"51079098120"}]
[null,null,null,null,"51079098301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2319,1),\"\"))","v":1},{"$f":"IF(F2319=1,COUNTIF($F$3:F2319,1),\"\")","v":2317},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2319),$G$3:$G$3716,0)),\"\")","v":"51079098301"}]
[null,null,null,null,"51079098320",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2320,1),\"\"))","v":1},{"$f":"IF(F2320=1,COUNTIF($F$3:F2320,1),\"\")","v":2318},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2320),$G$3:$G$3716,0)),\"\")","v":"51079098320"}]
[null,null,null,null,"51079098501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2321,1),\"\"))","v":1},{"$f":"IF(F2321=1,COUNTIF($F$3:F2321,1),\"\")","v":2319},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2321),$G$3:$G$3716,0)),\"\")","v":"51079098501"}]
[null,null,null,null,"51079098520",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2322,1),\"\"))","v":1},{"$f":"IF(F2322=1,COUNTIF($F$3:F2322,1),\"\")","v":2320},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2322),$G$3:$G$3716,0)),\"\")","v":"51079098520"}]
[null,null,null,null,"51079098601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2323,1),\"\"))","v":1},{"$f":"IF(F2323=1,COUNTIF($F$3:F2323,1),\"\")","v":2321},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2323),$G$3:$G$3716,0)),\"\")","v":"51079098601"}]
[null,null,null,null,"51079098620",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2324,1),\"\"))","v":1},{"$f":"IF(F2324=1,COUNTIF($F$3:F2324,1),\"\")","v":2322},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2324),$G$3:$G$3716,0)),\"\")","v":"51079098620"}]
[null,null,null,null,"51079099101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2325,1),\"\"))","v":1},{"$f":"IF(F2325=1,COUNTIF($F$3:F2325,1),\"\")","v":2323},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2325),$G$3:$G$3716,0)),\"\")","v":"51079099101"}]
[null,null,null,null,"51079099120",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2326,1),\"\"))","v":1},{"$f":"IF(F2326=1,COUNTIF($F$3:F2326,1),\"\")","v":2324},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2326),$G$3:$G$3716,0)),\"\")","v":"51079099120"}]
[null,null,null,null,"51079099130",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2327,1),\"\"))","v":1},{"$f":"IF(F2327=1,COUNTIF($F$3:F2327,1),\"\")","v":2325},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2327),$G$3:$G$3716,0)),\"\")","v":"51079099130"}]
[null,null,null,null,"51224020630",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2328,1),\"\"))","v":1},{"$f":"IF(F2328=1,COUNTIF($F$3:F2328,1),\"\")","v":2326},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2328),$G$3:$G$3716,0)),\"\")","v":"51224020630"}]
[null,null,null,null,"51224022230",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2329,1),\"\"))","v":1},{"$f":"IF(F2329=1,COUNTIF($F$3:F2329,1),\"\")","v":2327},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2329),$G$3:$G$3716,0)),\"\")","v":"51224022230"}]
[null,null,null,null,"51285094288",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2330,1),\"\"))","v":1},{"$f":"IF(F2330=1,COUNTIF($F$3:F2330,1),\"\")","v":2328},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2330),$G$3:$G$3716,0)),\"\")","v":"51285094288"}]
[null,null,null,null,"51293061501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2331,1),\"\"))","v":1},{"$f":"IF(F2331=1,COUNTIF($F$3:F2331,1),\"\")","v":2329},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2331),$G$3:$G$3716,0)),\"\")","v":"51293061501"}]
[null,null,null,null,"51293080301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2332,1),\"\"))","v":1},{"$f":"IF(F2332=1,COUNTIF($F$3:F2332,1),\"\")","v":2330},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2332),$G$3:$G$3716,0)),\"\")","v":"51293080301"}]
[null,null,null,null,"51293080401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2333,1),\"\"))","v":1},{"$f":"IF(F2333=1,COUNTIF($F$3:F2333,1),\"\")","v":2331},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2333),$G$3:$G$3716,0)),\"\")","v":"51293080401"}]
[null,null,null,null,"51293084610",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2334,1),\"\"))","v":1},{"$f":"IF(F2334=1,COUNTIF($F$3:F2334,1),\"\")","v":2332},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2334),$G$3:$G$3716,0)),\"\")","v":"51293084610"}]
[null,null,null,null,"51525043101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2335,1),\"\"))","v":1},{"$f":"IF(F2335=1,COUNTIF($F$3:F2335,1),\"\")","v":2333},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2335),$G$3:$G$3716,0)),\"\")","v":"51525043101"}]
[null,null,null,null,"51525044208",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2336,1),\"\"))","v":1},{"$f":"IF(F2336=1,COUNTIF($F$3:F2336,1),\"\")","v":2334},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2336),$G$3:$G$3716,0)),\"\")","v":"51525044208"}]
[null,null,null,null,"51552102606",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2337,1),\"\"))","v":1},{"$f":"IF(F2337=1,COUNTIF($F$3:F2337,1),\"\")","v":2335},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2337),$G$3:$G$3716,0)),\"\")","v":"51552102606"}]
[null,null,null,null,"51645085101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2338,1),\"\"))","v":1},{"$f":"IF(F2338=1,COUNTIF($F$3:F2338,1),\"\")","v":2336},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2338),$G$3:$G$3716,0)),\"\")","v":"51645085101"}]
[null,null,null,null,"51645085110",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2339,1),\"\"))","v":1},{"$f":"IF(F2339=1,COUNTIF($F$3:F2339,1),\"\")","v":2337},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2339),$G$3:$G$3716,0)),\"\")","v":"51645085110"}]
[null,null,null,null,"51645086001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2340,1),\"\"))","v":1},{"$f":"IF(F2340=1,COUNTIF($F$3:F2340,1),\"\")","v":2338},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2340),$G$3:$G$3716,0)),\"\")","v":"51645086001"}]
[null,null,null,null,"51645099101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2341,1),\"\"))","v":1},{"$f":"IF(F2341=1,COUNTIF($F$3:F2341,1),\"\")","v":2339},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2341),$G$3:$G$3716,0)),\"\")","v":"51645099101"}]
[null,null,null,null,"51672125301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2342,1),\"\"))","v":1},{"$f":"IF(F2342=1,COUNTIF($F$3:F2342,1),\"\")","v":2340},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2342),$G$3:$G$3716,0)),\"\")","v":"51672125301"}]
[null,null,null,null,"51672125303",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2343,1),\"\"))","v":1},{"$f":"IF(F2343=1,COUNTIF($F$3:F2343,1),\"\")","v":2341},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2343),$G$3:$G$3716,0)),\"\")","v":"51672125303"}]
[null,null,null,null,"51672125802",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2344,1),\"\"))","v":1},{"$f":"IF(F2344=1,COUNTIF($F$3:F2344,1),\"\")","v":2342},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2344),$G$3:$G$3716,0)),\"\")","v":"51672125802"}]
[null,null,null,null,"51672126401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2345,1),\"\"))","v":1},{"$f":"IF(F2345=1,COUNTIF($F$3:F2345,1),\"\")","v":2343},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2345),$G$3:$G$3716,0)),\"\")","v":"51672126401"}]
[null,null,null,null,"51672126403",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2346,1),\"\"))","v":1},{"$f":"IF(F2346=1,COUNTIF($F$3:F2346,1),\"\")","v":2344},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2346),$G$3:$G$3716,0)),\"\")","v":"51672126403"}]
[null,null,null,null,"51672127501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2347,1),\"\"))","v":1},{"$f":"IF(F2347=1,COUNTIF($F$3:F2347,1),\"\")","v":2345},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2347),$G$3:$G$3716,0)),\"\")","v":"51672127501"}]
[null,null,null,null,"51672128001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2348,1),\"\"))","v":1},{"$f":"IF(F2348=1,COUNTIF($F$3:F2348,1),\"\")","v":2346},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2348),$G$3:$G$3716,0)),\"\")","v":"51672128001"}]
[null,null,null,null,"51672128401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2349,1),\"\"))","v":1},{"$f":"IF(F2349=1,COUNTIF($F$3:F2349,1),\"\")","v":2347},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2349),$G$3:$G$3716,0)),\"\")","v":"51672128401"}]
[null,null,null,null,"51672128408",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2350,1),\"\"))","v":1},{"$f":"IF(F2350=1,COUNTIF($F$3:F2350,1),\"\")","v":2348},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2350),$G$3:$G$3716,0)),\"\")","v":"51672128408"}]
[null,null,null,null,"51672128902",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2351,1),\"\"))","v":1},{"$f":"IF(F2351=1,COUNTIF($F$3:F2351,1),\"\")","v":2349},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2351),$G$3:$G$3716,0)),\"\")","v":"51672128902"}]
[null,null,null,null,"51672129802",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2352,1),\"\"))","v":1},{"$f":"IF(F2352=1,COUNTIF($F$3:F2352,1),\"\")","v":2350},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2352),$G$3:$G$3716,0)),\"\")","v":"51672129802"}]
[null,null,null,null,"51672131200",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2353,1),\"\"))","v":1},{"$f":"IF(F2353=1,COUNTIF($F$3:F2353,1),\"\")","v":2351},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2353),$G$3:$G$3716,0)),\"\")","v":"51672131200"}]
[null,null,null,null,"51672138603",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2354,1),\"\"))","v":1},{"$f":"IF(F2354=1,COUNTIF($F$3:F2354,1),\"\")","v":2352},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2354),$G$3:$G$3716,0)),\"\")","v":"51672138603"}]
[null,null,null,null,"51672200201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2355,1),\"\"))","v":1},{"$f":"IF(F2355=1,COUNTIF($F$3:F2355,1),\"\")","v":2353},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2355),$G$3:$G$3716,0)),\"\")","v":"51672200201"}]
[null,null,null,null,"51672200306",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2356,1),\"\"))","v":1},{"$f":"IF(F2356=1,COUNTIF($F$3:F2356,1),\"\")","v":2354},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2356),$G$3:$G$3716,0)),\"\")","v":"51672200306"}]
[null,null,null,null,"51672201002",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2357,1),\"\"))","v":1},{"$f":"IF(F2357=1,COUNTIF($F$3:F2357,1),\"\")","v":2355},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2357),$G$3:$G$3716,0)),\"\")","v":"51672201002"}]
[null,null,null,null,"51672203506",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2358,1),\"\"))","v":1},{"$f":"IF(F2358=1,COUNTIF($F$3:F2358,1),\"\")","v":2356},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2358),$G$3:$G$3716,0)),\"\")","v":"51672203506"}]
[null,null,null,null,"51672211502",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2359,1),\"\"))","v":1},{"$f":"IF(F2359=1,COUNTIF($F$3:F2359,1),\"\")","v":2357},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2359),$G$3:$G$3716,0)),\"\")","v":"51672211502"}]
[null,null,null,null,"51672400201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2360,1),\"\"))","v":1},{"$f":"IF(F2360=1,COUNTIF($F$3:F2360,1),\"\")","v":2358},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2360),$G$3:$G$3716,0)),\"\")","v":"51672400201"}]
[null,null,null,null,"51672401106",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2361,1),\"\"))","v":1},{"$f":"IF(F2361=1,COUNTIF($F$3:F2361,1),\"\")","v":2359},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2361),$G$3:$G$3716,0)),\"\")","v":"51672401106"}]
[null,null,null,null,"51672401206",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2362,1),\"\"))","v":1},{"$f":"IF(F2362=1,COUNTIF($F$3:F2362,1),\"\")","v":2360},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2362),$G$3:$G$3716,0)),\"\")","v":"51672401206"}]
[null,null,null,null,"51672402301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2363,1),\"\"))","v":1},{"$f":"IF(F2363=1,COUNTIF($F$3:F2363,1),\"\")","v":2361},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2363),$G$3:$G$3716,0)),\"\")","v":"51672402301"}]
[null,null,null,null,"51672402606",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2364,1),\"\"))","v":1},{"$f":"IF(F2364=1,COUNTIF($F$3:F2364,1),\"\")","v":2362},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2364),$G$3:$G$3716,0)),\"\")","v":"51672402606"}]
[null,null,null,null,"51672404201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2365,1),\"\"))","v":1},{"$f":"IF(F2365=1,COUNTIF($F$3:F2365,1),\"\")","v":2363},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2365),$G$3:$G$3716,0)),\"\")","v":"51672404201"}]
[null,null,null,null,"51672404709",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2366,1),\"\"))","v":1},{"$f":"IF(F2366=1,COUNTIF($F$3:F2366,1),\"\")","v":2364},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2366),$G$3:$G$3716,0)),\"\")","v":"51672404709"}]
[null,null,null,null,"51672406901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2367,1),\"\"))","v":1},{"$f":"IF(F2367=1,COUNTIF($F$3:F2367,1),\"\")","v":2365},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2367),$G$3:$G$3716,0)),\"\")","v":"51672406901"}]
[null,null,null,null,"51672411606",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2368,1),\"\"))","v":1},{"$f":"IF(F2368=1,COUNTIF($F$3:F2368,1),\"\")","v":2366},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2368),$G$3:$G$3716,0)),\"\")","v":"51672411606"}]
[null,null,null,null,"51672411704",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2369,1),\"\"))","v":1},{"$f":"IF(F2369=1,COUNTIF($F$3:F2369,1),\"\")","v":2367},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2369),$G$3:$G$3716,0)),\"\")","v":"51672411704"}]
[null,null,null,null,"51672412401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2370,1),\"\"))","v":1},{"$f":"IF(F2370=1,COUNTIF($F$3:F2370,1),\"\")","v":2368},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2370),$G$3:$G$3716,0)),\"\")","v":"51672412401"}]
[null,null,null,null,"51672413001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2371,1),\"\"))","v":1},{"$f":"IF(F2371=1,COUNTIF($F$3:F2371,1),\"\")","v":2369},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2371),$G$3:$G$3716,0)),\"\")","v":"51672413001"}]
[null,null,null,null,"51672413101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2372,1),\"\"))","v":1},{"$f":"IF(F2372=1,COUNTIF($F$3:F2372,1),\"\")","v":2370},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2372),$G$3:$G$3716,0)),\"\")","v":"51672413101"}]
[null,null,null,null,"51672414601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2373,1),\"\"))","v":1},{"$f":"IF(F2373=1,COUNTIF($F$3:F2373,1),\"\")","v":2371},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2373),$G$3:$G$3716,0)),\"\")","v":"51672414601"}]
[null,null,null,null,"51672670800",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2374,1),\"\"))","v":1},{"$f":"IF(F2374=1,COUNTIF($F$3:F2374,1),\"\")","v":2372},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2374),$G$3:$G$3716,0)),\"\")","v":"51672670800"}]
[null,null,null,null,"51862018015",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2375,1),\"\"))","v":1},{"$f":"IF(F2375=1,COUNTIF($F$3:F2375,1),\"\")","v":2373},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2375),$G$3:$G$3716,0)),\"\")","v":"51862018015"}]
[null,null,null,null,"51927120200",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2376,1),\"\"))","v":1},{"$f":"IF(F2376=1,COUNTIF($F$3:F2376,1),\"\")","v":2374},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2376),$G$3:$G$3716,0)),\"\")","v":"51927120200"}]
[null,null,null,null,"51991020311",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2377,1),\"\"))","v":1},{"$f":"IF(F2377=1,COUNTIF($F$3:F2377,1),\"\")","v":2375},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2377),$G$3:$G$3716,0)),\"\")","v":"51991020311"}]
[null,null,null,null,"51991029301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2378,1),\"\"))","v":1},{"$f":"IF(F2378=1,COUNTIF($F$3:F2378,1),\"\")","v":2376},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2378),$G$3:$G$3716,0)),\"\")","v":"51991029301"}]
[null,null,null,null,"51991033106",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2379,1),\"\"))","v":1},{"$f":"IF(F2379=1,COUNTIF($F$3:F2379,1),\"\")","v":2377},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2379),$G$3:$G$3716,0)),\"\")","v":"51991033106"}]
[null,null,null,null,"51991070501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2380,1),\"\"))","v":1},{"$f":"IF(F2380=1,COUNTIF($F$3:F2380,1),\"\")","v":2378},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2380),$G$3:$G$3716,0)),\"\")","v":"51991070501"}]
[null,null,null,null,"51991075933",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2381,1),\"\"))","v":1},{"$f":"IF(F2381=1,COUNTIF($F$3:F2381,1),\"\")","v":2379},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2381),$G$3:$G$3716,0)),\"\")","v":"51991075933"}]
[null,null,null,null,"51991079306",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2382,1),\"\"))","v":1},{"$f":"IF(F2382=1,COUNTIF($F$3:F2382,1),\"\")","v":2380},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2382),$G$3:$G$3716,0)),\"\")","v":"51991079306"}]
[null,null,null,null,"51991081701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2383,1),\"\"))","v":1},{"$f":"IF(F2383=1,COUNTIF($F$3:F2383,1),\"\")","v":2381},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2383),$G$3:$G$3716,0)),\"\")","v":"51991081701"}]
[null,null,null,null,"51991081801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2384,1),\"\"))","v":1},{"$f":"IF(F2384=1,COUNTIF($F$3:F2384,1),\"\")","v":2382},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2384),$G$3:$G$3716,0)),\"\")","v":"51991081801"}]
[null,null,null,null,"51991082001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2385,1),\"\"))","v":1},{"$f":"IF(F2385=1,COUNTIF($F$3:F2385,1),\"\")","v":2383},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2385),$G$3:$G$3716,0)),\"\")","v":"51991082001"}]
[null,null,null,null,"51991090001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2386,1),\"\"))","v":1},{"$f":"IF(F2386=1,COUNTIF($F$3:F2386,1),\"\")","v":2384},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2386),$G$3:$G$3716,0)),\"\")","v":"51991090001"}]
[null,null,null,null,"52015008001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2387,1),\"\"))","v":1},{"$f":"IF(F2387=1,COUNTIF($F$3:F2387,1),\"\")","v":2385},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2387),$G$3:$G$3716,0)),\"\")","v":"52015008001"}]
[null,null,null,null,"52054033010",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2388,1),\"\"))","v":1},{"$f":"IF(F2388=1,COUNTIF($F$3:F2388,1),\"\")","v":2386},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2388),$G$3:$G$3716,0)),\"\")","v":"52054033010"}]
[null,null,null,null,"52054055022",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2389,1),\"\"))","v":1},{"$f":"IF(F2389=1,COUNTIF($F$3:F2389,1),\"\")","v":2387},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2389),$G$3:$G$3716,0)),\"\")","v":"52054055022"}]
[null,null,null,null,"52054055028",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2390,1),\"\"))","v":1},{"$f":"IF(F2390=1,COUNTIF($F$3:F2390,1),\"\")","v":2388},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2390),$G$3:$G$3716,0)),\"\")","v":"52054055028"}]
[null,null,null,null,"52244010010",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2391,1),\"\"))","v":1},{"$f":"IF(F2391=1,COUNTIF($F$3:F2391,1),\"\")","v":2389},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2391),$G$3:$G$3716,0)),\"\")","v":"52244010010"}]
[null,null,null,null,"52268010001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2392,1),\"\"))","v":1},{"$f":"IF(F2392=1,COUNTIF($F$3:F2392,1),\"\")","v":2390},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2392),$G$3:$G$3716,0)),\"\")","v":"52268010001"}]
[null,null,null,null,"52376002102",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2393,1),\"\"))","v":1},{"$f":"IF(F2393=1,COUNTIF($F$3:F2393,1),\"\")","v":2391},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2393),$G$3:$G$3716,0)),\"\")","v":"52376002102"}]
[null,null,null,null,"52380127204",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2394,1),\"\"))","v":1},{"$f":"IF(F2394=1,COUNTIF($F$3:F2394,1),\"\")","v":2392},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2394),$G$3:$G$3716,0)),\"\")","v":"52380127204"}]
[null,null,null,null,"52544023854",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2395,1),\"\"))","v":1},{"$f":"IF(F2395=1,COUNTIF($F$3:F2395,1),\"\")","v":2393},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2395),$G$3:$G$3716,0)),\"\")","v":"52544023854"}]
[null,null,null,null,"52544046960",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2396,1),\"\"))","v":1},{"$f":"IF(F2396=1,COUNTIF($F$3:F2396,1),\"\")","v":2394},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2396),$G$3:$G$3716,0)),\"\")","v":"52544046960"}]
[null,null,null,null,"52565001480",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2397,1),\"\"))","v":1},{"$f":"IF(F2397=1,COUNTIF($F$3:F2397,1),\"\")","v":2395},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2397),$G$3:$G$3716,0)),\"\")","v":"52565001480"}]
[null,null,null,null,"52565002060",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2398,1),\"\"))","v":1},{"$f":"IF(F2398=1,COUNTIF($F$3:F2398,1),\"\")","v":2396},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2398),$G$3:$G$3716,0)),\"\")","v":"52565002060"}]
[null,null,null,null,"52817018210",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2399,1),\"\"))","v":1},{"$f":"IF(F2399=1,COUNTIF($F$3:F2399,1),\"\")","v":2397},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2399),$G$3:$G$3716,0)),\"\")","v":"52817018210"}]
[null,null,null,null,"52817021010",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2400,1),\"\"))","v":1},{"$f":"IF(F2400=1,COUNTIF($F$3:F2400,1),\"\")","v":2398},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2400),$G$3:$G$3716,0)),\"\")","v":"52817021010"}]
[null,null,null,null,"52817034130",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2401,1),\"\"))","v":1},{"$f":"IF(F2401=1,COUNTIF($F$3:F2401,1),\"\")","v":2399},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2401),$G$3:$G$3716,0)),\"\")","v":"52817034130"}]
[null,null,null,null,"52817036010",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2402,1),\"\"))","v":1},{"$f":"IF(F2402=1,COUNTIF($F$3:F2402,1),\"\")","v":2400},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2402),$G$3:$G$3716,0)),\"\")","v":"52817036010"}]
[null,null,null,null,"52817036110",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2403,1),\"\"))","v":1},{"$f":"IF(F2403=1,COUNTIF($F$3:F2403,1),\"\")","v":2401},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2403),$G$3:$G$3716,0)),\"\")","v":"52817036110"}]
[null,null,null,null,"52817036410",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2404,1),\"\"))","v":1},{"$f":"IF(F2404=1,COUNTIF($F$3:F2404,1),\"\")","v":2402},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2404),$G$3:$G$3716,0)),\"\")","v":"52817036410"}]
[null,null,null,null,"53014053107",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2405,1),\"\"))","v":1},{"$f":"IF(F2405=1,COUNTIF($F$3:F2405,1),\"\")","v":2403},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2405),$G$3:$G$3716,0)),\"\")","v":"53014053107"}]
[null,null,null,null,"53276101002",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2406,1),\"\"))","v":1},{"$f":"IF(F2406=1,COUNTIF($F$3:F2406,1),\"\")","v":2404},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2406),$G$3:$G$3716,0)),\"\")","v":"53276101002"}]
[null,null,null,null,"53436008430",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2407,1),\"\"))","v":1},{"$f":"IF(F2407=1,COUNTIF($F$3:F2407,1),\"\")","v":2405},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2407),$G$3:$G$3716,0)),\"\")","v":"53436008430"}]
[null,null,null,null,"53489012002",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2408,1),\"\"))","v":1},{"$f":"IF(F2408=1,COUNTIF($F$3:F2408,1),\"\")","v":2406},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2408),$G$3:$G$3716,0)),\"\")","v":"53489012002"}]
[null,null,null,null,"53489012005",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2409,1),\"\"))","v":1},{"$f":"IF(F2409=1,COUNTIF($F$3:F2409,1),\"\")","v":2407},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2409),$G$3:$G$3716,0)),\"\")","v":"53489012005"}]
[null,null,null,null,"53489014501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2410,1),\"\"))","v":1},{"$f":"IF(F2410=1,COUNTIF($F$3:F2410,1),\"\")","v":2408},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2410),$G$3:$G$3716,0)),\"\")","v":"53489014501"}]
[null,null,null,null,"53489014601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2411,1),\"\"))","v":1},{"$f":"IF(F2411=1,COUNTIF($F$3:F2411,1),\"\")","v":2409},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2411),$G$3:$G$3716,0)),\"\")","v":"53489014601"}]
[null,null,null,null,"53489021501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2412,1),\"\"))","v":1},{"$f":"IF(F2412=1,COUNTIF($F$3:F2412,1),\"\")","v":2410},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2412),$G$3:$G$3716,0)),\"\")","v":"53489021501"}]
[null,null,null,null,"53489033001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2413,1),\"\"))","v":1},{"$f":"IF(F2413=1,COUNTIF($F$3:F2413,1),\"\")","v":2411},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2413),$G$3:$G$3716,0)),\"\")","v":"53489033001"}]
[null,null,null,null,"53489033101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2414,1),\"\"))","v":1},{"$f":"IF(F2414=1,COUNTIF($F$3:F2414,1),\"\")","v":2412},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2414),$G$3:$G$3716,0)),\"\")","v":"53489033101"}]
[null,null,null,null,"53489036801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2415,1),\"\"))","v":1},{"$f":"IF(F2415=1,COUNTIF($F$3:F2415,1),\"\")","v":2413},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2415),$G$3:$G$3716,0)),\"\")","v":"53489036801"}]
[null,null,null,null,"53489036901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2416,1),\"\"))","v":1},{"$f":"IF(F2416=1,COUNTIF($F$3:F2416,1),\"\")","v":2414},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2416),$G$3:$G$3716,0)),\"\")","v":"53489036901"}]
[null,null,null,null,"53489037001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2417,1),\"\"))","v":1},{"$f":"IF(F2417=1,COUNTIF($F$3:F2417,1),\"\")","v":2415},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2417),$G$3:$G$3716,0)),\"\")","v":"53489037001"}]
[null,null,null,null,"53489038601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2418,1),\"\"))","v":1},{"$f":"IF(F2418=1,COUNTIF($F$3:F2418,1),\"\")","v":2416},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2418),$G$3:$G$3716,0)),\"\")","v":"53489038601"}]
[null,null,null,null,"53489047801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2419,1),\"\"))","v":1},{"$f":"IF(F2419=1,COUNTIF($F$3:F2419,1),\"\")","v":2417},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2419),$G$3:$G$3716,0)),\"\")","v":"53489047801"}]
[null,null,null,null,"53746027101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2420,1),\"\"))","v":1},{"$f":"IF(F2420=1,COUNTIF($F$3:F2420,1),\"\")","v":2418},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2420),$G$3:$G$3716,0)),\"\")","v":"53746027101"}]
[null,null,null,null,"53746046601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2421,1),\"\"))","v":1},{"$f":"IF(F2421=1,COUNTIF($F$3:F2421,1),\"\")","v":2419},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2421),$G$3:$G$3716,0)),\"\")","v":"53746046601"}]
[null,null,null,null,"53746054401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2422,1),\"\"))","v":1},{"$f":"IF(F2422=1,COUNTIF($F$3:F2422,1),\"\")","v":2420},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2422),$G$3:$G$3716,0)),\"\")","v":"53746054401"}]
[null,null,null,null,"54092017212",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2423,1),\"\"))","v":1},{"$f":"IF(F2423=1,COUNTIF($F$3:F2423,1),\"\")","v":2421},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2423),$G$3:$G$3716,0)),\"\")","v":"54092017212"}]
[null,null,null,null,"54092018981",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2424,1),\"\"))","v":1},{"$f":"IF(F2424=1,COUNTIF($F$3:F2424,1),\"\")","v":2422},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2424),$G$3:$G$3716,0)),\"\")","v":"54092018981"}]
[null,null,null,null,"54162000002",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2425,1),\"\"))","v":1},{"$f":"IF(F2425=1,COUNTIF($F$3:F2425,1),\"\")","v":2423},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2425),$G$3:$G$3716,0)),\"\")","v":"54162000002"}]
[null,null,null,null,"54162010002",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2426,1),\"\"))","v":1},{"$f":"IF(F2426=1,COUNTIF($F$3:F2426,1),\"\")","v":2424},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2426),$G$3:$G$3716,0)),\"\")","v":"54162010002"}]
[null,null,null,null,"54162017505",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2427,1),\"\"))","v":1},{"$f":"IF(F2427=1,COUNTIF($F$3:F2427,1),\"\")","v":2425},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2427),$G$3:$G$3716,0)),\"\")","v":"54162017505"}]
[null,null,null,null,"54162055002",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2428,1),\"\"))","v":1},{"$f":"IF(F2428=1,COUNTIF($F$3:F2428,1),\"\")","v":2426},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2428),$G$3:$G$3716,0)),\"\")","v":"54162055002"}]
[null,null,null,null,"54162055007",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2429,1),\"\"))","v":1},{"$f":"IF(F2429=1,COUNTIF($F$3:F2429,1),\"\")","v":2427},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2429),$G$3:$G$3716,0)),\"\")","v":"54162055007"}]
[null,null,null,null,"54162055009",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2430,1),\"\"))","v":1},{"$f":"IF(F2430=1,COUNTIF($F$3:F2430,1),\"\")","v":2428},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2430),$G$3:$G$3716,0)),\"\")","v":"54162055009"}]
[null,null,null,null,"54162055501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2431,1),\"\"))","v":1},{"$f":"IF(F2431=1,COUNTIF($F$3:F2431,1),\"\")","v":2429},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2431),$G$3:$G$3716,0)),\"\")","v":"54162055501"}]
[null,null,null,null,"54162060002",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2432,1),\"\"))","v":1},{"$f":"IF(F2432=1,COUNTIF($F$3:F2432,1),\"\")","v":2430},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2432),$G$3:$G$3716,0)),\"\")","v":"54162060002"}]
[null,null,null,null,"54295030815",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2433,1),\"\"))","v":1},{"$f":"IF(F2433=1,COUNTIF($F$3:F2433,1),\"\")","v":2431},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2433),$G$3:$G$3716,0)),\"\")","v":"54295030815"}]
[null,null,null,null,"54482014407",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2434,1),\"\"))","v":1},{"$f":"IF(F2434=1,COUNTIF($F$3:F2434,1),\"\")","v":2432},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2434),$G$3:$G$3716,0)),\"\")","v":"54482014407"}]
[null,null,null,null,"54505005522",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2435,1),\"\"))","v":1},{"$f":"IF(F2435=1,COUNTIF($F$3:F2435,1),\"\")","v":2433},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2435),$G$3:$G$3716,0)),\"\")","v":"54505005522"}]
[null,null,null,null,"54505033210",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2436,1),\"\"))","v":1},{"$f":"IF(F2436=1,COUNTIF($F$3:F2436,1),\"\")","v":2434},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2436),$G$3:$G$3716,0)),\"\")","v":"54505033210"}]
[null,null,null,null,"54569519100",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2437,1),\"\"))","v":1},{"$f":"IF(F2437=1,COUNTIF($F$3:F2437,1),\"\")","v":2435},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2437),$G$3:$G$3716,0)),\"\")","v":"54569519100"}]
[null,null,null,null,"54569635200",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2438,1),\"\"))","v":1},{"$f":"IF(F2438=1,COUNTIF($F$3:F2438,1),\"\")","v":2436},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2438),$G$3:$G$3716,0)),\"\")","v":"54569635200"}]
[null,null,null,null,"54629007101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2439,1),\"\"))","v":1},{"$f":"IF(F2439=1,COUNTIF($F$3:F2439,1),\"\")","v":2437},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2439),$G$3:$G$3716,0)),\"\")","v":"54629007101"}]
[null,null,null,null,"54629068301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2440,1),\"\"))","v":1},{"$f":"IF(F2440=1,COUNTIF($F$3:F2440,1),\"\")","v":2438},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2440),$G$3:$G$3716,0)),\"\")","v":"54629068301"}]
[null,null,null,null,"54758000628",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2441,1),\"\"))","v":1},{"$f":"IF(F2441=1,COUNTIF($F$3:F2441,1),\"\")","v":2439},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2441),$G$3:$G$3716,0)),\"\")","v":"54758000628"}]
[null,null,null,null,"54799050401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2442,1),\"\"))","v":1},{"$f":"IF(F2442=1,COUNTIF($F$3:F2442,1),\"\")","v":2440},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2442),$G$3:$G$3716,0)),\"\")","v":"54799050401"}]
[null,null,null,null,"54799050721",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2443,1),\"\"))","v":1},{"$f":"IF(F2443=1,COUNTIF($F$3:F2443,1),\"\")","v":2441},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2443),$G$3:$G$3716,0)),\"\")","v":"54799050721"}]
[null,null,null,null,"54838000530",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2444,1),\"\"))","v":1},{"$f":"IF(F2444=1,COUNTIF($F$3:F2444,1),\"\")","v":2442},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2444),$G$3:$G$3716,0)),\"\")","v":"54838000530"}]
[null,null,null,null,"54838000650",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2445,1),\"\"))","v":1},{"$f":"IF(F2445=1,COUNTIF($F$3:F2445,1),\"\")","v":2443},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2445),$G$3:$G$3716,0)),\"\")","v":"54838000650"}]
[null,null,null,null,"54838001070",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2446,1),\"\"))","v":1},{"$f":"IF(F2446=1,COUNTIF($F$3:F2446,1),\"\")","v":2444},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2446),$G$3:$G$3716,0)),\"\")","v":"54838001070"}]
[null,null,null,null,"54838001150",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2447,1),\"\"))","v":1},{"$f":"IF(F2447=1,COUNTIF($F$3:F2447,1),\"\")","v":2445},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2447),$G$3:$G$3716,0)),\"\")","v":"54838001150"}]
[null,null,null,null,"54838050140",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2448,1),\"\"))","v":1},{"$f":"IF(F2448=1,COUNTIF($F$3:F2448,1),\"\")","v":2446},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2448),$G$3:$G$3716,0)),\"\")","v":"54838050140"}]
[null,null,null,null,"54868560000",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2449,1),\"\"))","v":1},{"$f":"IF(F2449=1,COUNTIF($F$3:F2449,1),\"\")","v":2447},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2449),$G$3:$G$3716,0)),\"\")","v":"54868560000"}]
[null,null,null,null,"54879000100",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2450,1),\"\"))","v":1},{"$f":"IF(F2450=1,COUNTIF($F$3:F2450,1),\"\")","v":2448},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2450),$G$3:$G$3716,0)),\"\")","v":"54879000100"}]
[null,null,null,null,"55111012190",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2451,1),\"\"))","v":1},{"$f":"IF(F2451=1,COUNTIF($F$3:F2451,1),\"\")","v":2449},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2451),$G$3:$G$3716,0)),\"\")","v":"55111012190"}]
[null,null,null,null,"55111012705",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2452,1),\"\"))","v":1},{"$f":"IF(F2452=1,COUNTIF($F$3:F2452,1),\"\")","v":2450},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2452),$G$3:$G$3716,0)),\"\")","v":"55111012705"}]
[null,null,null,null,"55111016630",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2453,1),\"\"))","v":1},{"$f":"IF(F2453=1,COUNTIF($F$3:F2453,1),\"\")","v":2451},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2453),$G$3:$G$3716,0)),\"\")","v":"55111016630"}]
[null,null,null,null,"55111025660",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2454,1),\"\"))","v":1},{"$f":"IF(F2454=1,COUNTIF($F$3:F2454,1),\"\")","v":2452},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2454),$G$3:$G$3716,0)),\"\")","v":"55111025660"}]
[null,null,null,null,"55111027950",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2455,1),\"\"))","v":1},{"$f":"IF(F2455=1,COUNTIF($F$3:F2455,1),\"\")","v":2453},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2455),$G$3:$G$3716,0)),\"\")","v":"55111027950"}]
[null,null,null,null,"55111028130",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2456,1),\"\"))","v":1},{"$f":"IF(F2456=1,COUNTIF($F$3:F2456,1),\"\")","v":2454},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2456),$G$3:$G$3716,0)),\"\")","v":"55111028130"}]
[null,null,null,null,"55111029109",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2457,1),\"\"))","v":1},{"$f":"IF(F2457=1,COUNTIF($F$3:F2457,1),\"\")","v":2455},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2457),$G$3:$G$3716,0)),\"\")","v":"55111029109"}]
[null,null,null,null,"55111068301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2458,1),\"\"))","v":1},{"$f":"IF(F2458=1,COUNTIF($F$3:F2458,1),\"\")","v":2456},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2458),$G$3:$G$3716,0)),\"\")","v":"55111068301"}]
[null,null,null,null,"55111078927",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2459,1),\"\"))","v":1},{"$f":"IF(F2459=1,COUNTIF($F$3:F2459,1),\"\")","v":2457},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2459),$G$3:$G$3716,0)),\"\")","v":"55111078927"}]
[null,null,null,null,"55111078948",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2460,1),\"\"))","v":1},{"$f":"IF(F2460=1,COUNTIF($F$3:F2460,1),\"\")","v":2458},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2460),$G$3:$G$3716,0)),\"\")","v":"55111078948"}]
[null,null,null,null,"55150012215",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2461,1),\"\"))","v":1},{"$f":"IF(F2461=1,COUNTIF($F$3:F2461,1),\"\")","v":2459},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2461),$G$3:$G$3716,0)),\"\")","v":"55150012215"}]
[null,null,null,null,"55150023501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2462,1),\"\"))","v":1},{"$f":"IF(F2462=1,COUNTIF($F$3:F2462,1),\"\")","v":2460},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2462),$G$3:$G$3716,0)),\"\")","v":"55150023501"}]
[null,null,null,null,"55154358107",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2463,1),\"\"))","v":1},{"$f":"IF(F2463=1,COUNTIF($F$3:F2463,1),\"\")","v":2461},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2463),$G$3:$G$3716,0)),\"\")","v":"55154358107"}]
[null,null,null,null,"55390003710",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2464,1),\"\"))","v":1},{"$f":"IF(F2464=1,COUNTIF($F$3:F2464,1),\"\")","v":2462},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2464),$G$3:$G$3716,0)),\"\")","v":"55390003710"}]
[null,null,null,null,"56151161051",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2465,1),\"\"))","v":1},{"$f":"IF(F2465=1,COUNTIF($F$3:F2465,1),\"\")","v":2463},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2465),$G$3:$G$3716,0)),\"\")","v":"56151161051"}]
[null,null,null,null,"56151161151",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2466,1),\"\"))","v":1},{"$f":"IF(F2466=1,COUNTIF($F$3:F2466,1),\"\")","v":2464},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2466),$G$3:$G$3716,0)),\"\")","v":"56151161151"}]
[null,null,null,null,"56184010105",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2467,1),\"\"))","v":1},{"$f":"IF(F2467=1,COUNTIF($F$3:F2467,1),\"\")","v":2465},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2467),$G$3:$G$3716,0)),\"\")","v":"56184010105"}]
[null,null,null,null,"56184012041",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2468,1),\"\"))","v":1},{"$f":"IF(F2468=1,COUNTIF($F$3:F2468,1),\"\")","v":2466},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2468),$G$3:$G$3716,0)),\"\")","v":"56184012041"}]
[null,null,null,null,"57237001401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2469,1),\"\"))","v":1},{"$f":"IF(F2469=1,COUNTIF($F$3:F2469,1),\"\")","v":2467},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2469),$G$3:$G$3716,0)),\"\")","v":"57237001401"}]
[null,null,null,null,"57237004390",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2470,1),\"\"))","v":1},{"$f":"IF(F2470=1,COUNTIF($F$3:F2470,1),\"\")","v":2468},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2470),$G$3:$G$3716,0)),\"\")","v":"57237004390"}]
[null,null,null,null,"57237011001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2471,1),\"\"))","v":1},{"$f":"IF(F2471=1,COUNTIF($F$3:F2471,1),\"\")","v":2469},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2471),$G$3:$G$3716,0)),\"\")","v":"57237011001"}]
[null,null,null,null,"57237014935",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2472,1),\"\"))","v":1},{"$f":"IF(F2472=1,COUNTIF($F$3:F2472,1),\"\")","v":2470},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2472),$G$3:$G$3716,0)),\"\")","v":"57237014935"}]
[null,null,null,null,"57237015035",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2473,1),\"\"))","v":1},{"$f":"IF(F2473=1,COUNTIF($F$3:F2473,1),\"\")","v":2471},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2473),$G$3:$G$3716,0)),\"\")","v":"57237015035"}]
[null,null,null,null,"57237017301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2474,1),\"\"))","v":1},{"$f":"IF(F2474=1,COUNTIF($F$3:F2474,1),\"\")","v":2472},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2474),$G$3:$G$3716,0)),\"\")","v":"57237017301"}]
[null,null,null,null,"57237017401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2475,1),\"\"))","v":1},{"$f":"IF(F2475=1,COUNTIF($F$3:F2475,1),\"\")","v":2473},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2475),$G$3:$G$3716,0)),\"\")","v":"57237017401"}]
[null,null,null,null,"57237021230",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2476,1),\"\"))","v":1},{"$f":"IF(F2476=1,COUNTIF($F$3:F2476,1),\"\")","v":2474},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2476),$G$3:$G$3716,0)),\"\")","v":"57237021230"}]
[null,null,null,null,"57664013565",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2477,1),\"\"))","v":1},{"$f":"IF(F2477=1,COUNTIF($F$3:F2477,1),\"\")","v":2475},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2477),$G$3:$G$3716,0)),\"\")","v":"57664013565"}]
[null,null,null,null,"57664039288",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2478,1),\"\"))","v":1},{"$f":"IF(F2478=1,COUNTIF($F$3:F2478,1),\"\")","v":2476},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2478),$G$3:$G$3716,0)),\"\")","v":"57664039288"}]
[null,null,null,null,"57664039488",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2479,1),\"\"))","v":1},{"$f":"IF(F2479=1,COUNTIF($F$3:F2479,1),\"\")","v":2477},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2479),$G$3:$G$3716,0)),\"\")","v":"57664039488"}]
[null,null,null,null,"57664039753",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2480,1),\"\"))","v":1},{"$f":"IF(F2480=1,COUNTIF($F$3:F2480,1),\"\")","v":2478},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2480),$G$3:$G$3716,0)),\"\")","v":"57664039753"}]
[null,null,null,null,"57664043551",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2481,1),\"\"))","v":1},{"$f":"IF(F2481=1,COUNTIF($F$3:F2481,1),\"\")","v":2479},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2481),$G$3:$G$3716,0)),\"\")","v":"57664043551"}]
[null,null,null,null,"57664047752",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2482,1),\"\"))","v":1},{"$f":"IF(F2482=1,COUNTIF($F$3:F2482,1),\"\")","v":2480},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2482),$G$3:$G$3716,0)),\"\")","v":"57664047752"}]
[null,null,null,null,"57664050289",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2483,1),\"\"))","v":1},{"$f":"IF(F2483=1,COUNTIF($F$3:F2483,1),\"\")","v":2481},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2483),$G$3:$G$3716,0)),\"\")","v":"57664050289"}]
[null,null,null,null,"57664056918",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2484,1),\"\"))","v":1},{"$f":"IF(F2484=1,COUNTIF($F$3:F2484,1),\"\")","v":2482},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2484),$G$3:$G$3716,0)),\"\")","v":"57664056918"}]
[null,null,null,null,"57664076188",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2485,1),\"\"))","v":1},{"$f":"IF(F2485=1,COUNTIF($F$3:F2485,1),\"\")","v":2483},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2485),$G$3:$G$3716,0)),\"\")","v":"57664076188"}]
[null,null,null,null,"57770005500",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2486,1),\"\"))","v":1},{"$f":"IF(F2486=1,COUNTIF($F$3:F2486,1),\"\")","v":2484},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2486),$G$3:$G$3716,0)),\"\")","v":"57770005500"}]
[null,null,null,null,"57896040316",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2487,1),\"\"))","v":1},{"$f":"IF(F2487=1,COUNTIF($F$3:F2487,1),\"\")","v":2485},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2487),$G$3:$G$3716,0)),\"\")","v":"57896040316"}]
[null,null,null,null,"57896045101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2488,1),\"\"))","v":1},{"$f":"IF(F2488=1,COUNTIF($F$3:F2488,1),\"\")","v":2486},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2488),$G$3:$G$3716,0)),\"\")","v":"57896045101"}]
[null,null,null,null,"57896045401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2489,1),\"\"))","v":1},{"$f":"IF(F2489=1,COUNTIF($F$3:F2489,1),\"\")","v":2487},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2489),$G$3:$G$3716,0)),\"\")","v":"57896045401"}]
[null,null,null,null,"57896057501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2490,1),\"\"))","v":1},{"$f":"IF(F2490=1,COUNTIF($F$3:F2490,1),\"\")","v":2488},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2490),$G$3:$G$3716,0)),\"\")","v":"57896057501"}]
[null,null,null,null,"57896062912",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2491,1),\"\"))","v":1},{"$f":"IF(F2491=1,COUNTIF($F$3:F2491,1),\"\")","v":2489},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2491),$G$3:$G$3716,0)),\"\")","v":"57896062912"}]
[null,null,null,null,"57896074201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2492,1),\"\"))","v":1},{"$f":"IF(F2492=1,COUNTIF($F$3:F2492,1),\"\")","v":2490},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2492),$G$3:$G$3716,0)),\"\")","v":"57896074201"}]
[null,null,null,null,"57896084216",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2493,1),\"\"))","v":1},{"$f":"IF(F2493=1,COUNTIF($F$3:F2493,1),\"\")","v":2491},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2493),$G$3:$G$3716,0)),\"\")","v":"57896084216"}]
[null,null,null,null,"57896090101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2494,1),\"\"))","v":1},{"$f":"IF(F2494=1,COUNTIF($F$3:F2494,1),\"\")","v":2492},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2494),$G$3:$G$3716,0)),\"\")","v":"57896090101"}]
[null,null,null,null,"57896098101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2495,1),\"\"))","v":1},{"$f":"IF(F2495=1,COUNTIF($F$3:F2495,1),\"\")","v":2493},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2495),$G$3:$G$3716,0)),\"\")","v":"57896098101"}]
[null,null,null,null,"57896098112",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2496,1),\"\"))","v":1},{"$f":"IF(F2496=1,COUNTIF($F$3:F2496,1),\"\")","v":2494},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2496),$G$3:$G$3716,0)),\"\")","v":"57896098112"}]
[null,null,null,null,"58160081201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2497,1),\"\"))","v":1},{"$f":"IF(F2497=1,COUNTIF($F$3:F2497,1),\"\")","v":2495},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2497),$G$3:$G$3716,0)),\"\")","v":"58160081201"}]
[null,null,null,null,"58160081211",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2498,1),\"\"))","v":1},{"$f":"IF(F2498=1,COUNTIF($F$3:F2498,1),\"\")","v":2496},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2498),$G$3:$G$3716,0)),\"\")","v":"58160081211"}]
[null,null,null,null,"58468013001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2499,1),\"\"))","v":1},{"$f":"IF(F2499=1,COUNTIF($F$3:F2499,1),\"\")","v":2497},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2499),$G$3:$G$3716,0)),\"\")","v":"58468013001"}]
[null,null,null,null,"58526000540",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2500,1),\"\"))","v":1},{"$f":"IF(F2500=1,COUNTIF($F$3:F2500,1),\"\")","v":2498},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2500),$G$3:$G$3716,0)),\"\")","v":"58526000540"}]
[null,null,null,null,"58526000541",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2501,1),\"\"))","v":1},{"$f":"IF(F2501=1,COUNTIF($F$3:F2501,1),\"\")","v":2499},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2501),$G$3:$G$3716,0)),\"\")","v":"58526000541"}]
[null,null,null,null,"58657061110",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2502,1),\"\"))","v":1},{"$f":"IF(F2502=1,COUNTIF($F$3:F2502,1),\"\")","v":2500},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2502),$G$3:$G$3716,0)),\"\")","v":"58657061110"}]
[null,null,null,null,"58914001516",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2503,1),\"\"))","v":1},{"$f":"IF(F2503=1,COUNTIF($F$3:F2503,1),\"\")","v":2501},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2503),$G$3:$G$3716,0)),\"\")","v":"58914001516"}]
[null,null,null,null,"58914011210",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2504,1),\"\"))","v":1},{"$f":"IF(F2504=1,COUNTIF($F$3:F2504,1),\"\")","v":2502},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2504),$G$3:$G$3716,0)),\"\")","v":"58914011210"}]
[null,null,null,null,"58914017110",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2505,1),\"\"))","v":1},{"$f":"IF(F2505=1,COUNTIF($F$3:F2505,1),\"\")","v":2503},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2505),$G$3:$G$3716,0)),\"\")","v":"58914017110"}]
[null,null,null,null,"58914021460",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2506,1),\"\"))","v":1},{"$f":"IF(F2506=1,COUNTIF($F$3:F2506,1),\"\")","v":2504},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2506),$G$3:$G$3716,0)),\"\")","v":"58914021460"}]
[null,null,null,null,"58914050101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2507,1),\"\"))","v":1},{"$f":"IF(F2507=1,COUNTIF($F$3:F2507,1),\"\")","v":2505},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2507),$G$3:$G$3716,0)),\"\")","v":"58914050101"}]
[null,null,null,null,"58914050156",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2508,1),\"\"))","v":1},{"$f":"IF(F2508=1,COUNTIF($F$3:F2508,1),\"\")","v":2506},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2508),$G$3:$G$3716,0)),\"\")","v":"58914050156"}]
[null,null,null,null,"58914060120",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2509,1),\"\"))","v":1},{"$f":"IF(F2509=1,COUNTIF($F$3:F2509,1),\"\")","v":2507},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2509),$G$3:$G$3716,0)),\"\")","v":"58914060120"}]
[null,null,null,null,"58980041501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2510,1),\"\"))","v":1},{"$f":"IF(F2510=1,COUNTIF($F$3:F2510,1),\"\")","v":2508},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2510),$G$3:$G$3716,0)),\"\")","v":"58980041501"}]
[null,null,null,null,"58980062510",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2511,1),\"\"))","v":1},{"$f":"IF(F2511=1,COUNTIF($F$3:F2511,1),\"\")","v":2509},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2511),$G$3:$G$3716,0)),\"\")","v":"58980062510"}]
[null,null,null,null,"59011045101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2512,1),\"\"))","v":1},{"$f":"IF(F2512=1,COUNTIF($F$3:F2512,1),\"\")","v":2510},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2512),$G$3:$G$3716,0)),\"\")","v":"59011045101"}]
[null,null,null,null,"59011045201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2513,1),\"\"))","v":1},{"$f":"IF(F2513=1,COUNTIF($F$3:F2513,1),\"\")","v":2511},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2513),$G$3:$G$3716,0)),\"\")","v":"59011045201"}]
[null,null,null,null,"59148000613",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2514,1),\"\"))","v":1},{"$f":"IF(F2514=1,COUNTIF($F$3:F2514,1),\"\")","v":2512},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2514),$G$3:$G$3716,0)),\"\")","v":"59148000613"}]
[null,null,null,null,"59148000713",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2515,1),\"\"))","v":1},{"$f":"IF(F2515=1,COUNTIF($F$3:F2515,1),\"\")","v":2513},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2515),$G$3:$G$3716,0)),\"\")","v":"59148000713"}]
[null,null,null,null,"59148000835",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2516,1),\"\"))","v":1},{"$f":"IF(F2516=1,COUNTIF($F$3:F2516,1),\"\")","v":2514},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2516),$G$3:$G$3716,0)),\"\")","v":"59148000835"}]
[null,null,null,null,"59212056210",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2517,1),\"\"))","v":1},{"$f":"IF(F2517=1,COUNTIF($F$3:F2517,1),\"\")","v":2515},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2517),$G$3:$G$3716,0)),\"\")","v":"59212056210"}]
[null,null,null,null,"59212068010",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2518,1),\"\"))","v":1},{"$f":"IF(F2518=1,COUNTIF($F$3:F2518,1),\"\")","v":2516},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2518),$G$3:$G$3716,0)),\"\")","v":"59212068010"}]
[null,null,null,null,"59212068110",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2519,1),\"\"))","v":1},{"$f":"IF(F2519=1,COUNTIF($F$3:F2519,1),\"\")","v":2517},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2519),$G$3:$G$3716,0)),\"\")","v":"59212068110"}]
[null,null,null,null,"59310030240",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2520,1),\"\"))","v":1},{"$f":"IF(F2520=1,COUNTIF($F$3:F2520,1),\"\")","v":2518},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2520),$G$3:$G$3716,0)),\"\")","v":"59310030240"}]
[null,null,null,null,"59310030480",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2521,1),\"\"))","v":1},{"$f":"IF(F2521=1,COUNTIF($F$3:F2521,1),\"\")","v":2519},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2521),$G$3:$G$3716,0)),\"\")","v":"59310030480"}]
[null,null,null,null,"59310057922",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2522,1),\"\"))","v":1},{"$f":"IF(F2522=1,COUNTIF($F$3:F2522,1),\"\")","v":2520},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2522),$G$3:$G$3716,0)),\"\")","v":"59310057922"}]
[null,null,null,null,"59390018213",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2523,1),\"\"))","v":1},{"$f":"IF(F2523=1,COUNTIF($F$3:F2523,1),\"\")","v":2521},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2523),$G$3:$G$3716,0)),\"\")","v":"59390018213"}]
[null,null,null,null,"59390018950",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2524,1),\"\"))","v":1},{"$f":"IF(F2524=1,COUNTIF($F$3:F2524,1),\"\")","v":2522},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2524),$G$3:$G$3716,0)),\"\")","v":"59390018950"}]
[null,null,null,null,"59390019050",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2525,1),\"\"))","v":1},{"$f":"IF(F2525=1,COUNTIF($F$3:F2525,1),\"\")","v":2523},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2525),$G$3:$G$3716,0)),\"\")","v":"59390019050"}]
[null,null,null,null,"59584013801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2526,1),\"\"))","v":1},{"$f":"IF(F2526=1,COUNTIF($F$3:F2526,1),\"\")","v":2524},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2526),$G$3:$G$3716,0)),\"\")","v":"59584013801"}]
[null,null,null,null,"59651017301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2527,1),\"\"))","v":1},{"$f":"IF(F2527=1,COUNTIF($F$3:F2527,1),\"\")","v":2525},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2527),$G$3:$G$3716,0)),\"\")","v":"59651017301"}]
[null,null,null,null,"59676027801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2528,1),\"\"))","v":1},{"$f":"IF(F2528=1,COUNTIF($F$3:F2528,1),\"\")","v":2526},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2528),$G$3:$G$3716,0)),\"\")","v":"59676027801"}]
[null,null,null,null,"59676056201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2529,1),\"\"))","v":1},{"$f":"IF(F2529=1,COUNTIF($F$3:F2529,1),\"\")","v":2527},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2529),$G$3:$G$3716,0)),\"\")","v":"59676056201"}]
[null,null,null,null,"59676056630",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2530,1),\"\"))","v":1},{"$f":"IF(F2530=1,COUNTIF($F$3:F2530,1),\"\")","v":2528},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2530),$G$3:$G$3716,0)),\"\")","v":"59676056630"}]
[null,null,null,null,"59676057001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2531,1),\"\"))","v":1},{"$f":"IF(F2531=1,COUNTIF($F$3:F2531,1),\"\")","v":2529},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2531),$G$3:$G$3716,0)),\"\")","v":"59676057001"}]
[null,null,null,null,"59676057101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2532,1),\"\"))","v":1},{"$f":"IF(F2532=1,COUNTIF($F$3:F2532,1),\"\")","v":2530},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2532),$G$3:$G$3716,0)),\"\")","v":"59676057101"}]
[null,null,null,null,"59676057530",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2533,1),\"\"))","v":1},{"$f":"IF(F2533=1,COUNTIF($F$3:F2533,1),\"\")","v":2531},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2533),$G$3:$G$3716,0)),\"\")","v":"59676057530"}]
[null,null,null,null,"59676070101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2534,1),\"\"))","v":1},{"$f":"IF(F2534=1,COUNTIF($F$3:F2534,1),\"\")","v":2532},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2534),$G$3:$G$3716,0)),\"\")","v":"59676070101"}]
[null,null,null,null,"59746024501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2535,1),\"\"))","v":1},{"$f":"IF(F2535=1,COUNTIF($F$3:F2535,1),\"\")","v":2533},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2535),$G$3:$G$3716,0)),\"\")","v":"59746024501"}]
[null,null,null,null,"59746032530",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2536,1),\"\"))","v":1},{"$f":"IF(F2536=1,COUNTIF($F$3:F2536,1),\"\")","v":2534},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2536),$G$3:$G$3716,0)),\"\")","v":"59746032530"}]
[null,null,null,null,"59762001601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2537,1),\"\"))","v":1},{"$f":"IF(F2537=1,COUNTIF($F$3:F2537,1),\"\")","v":2535},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2537),$G$3:$G$3716,0)),\"\")","v":"59762001601"}]
[null,null,null,null,"59762007401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2538,1),\"\"))","v":1},{"$f":"IF(F2538=1,COUNTIF($F$3:F2538,1),\"\")","v":2536},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2538),$G$3:$G$3716,0)),\"\")","v":"59762007401"}]
[null,null,null,null,"59762014001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2539,1),\"\"))","v":1},{"$f":"IF(F2539=1,COUNTIF($F$3:F2539,1),\"\")","v":2537},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2539),$G$3:$G$3716,0)),\"\")","v":"59762014001"}]
[null,null,null,null,"59762015501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2540,1),\"\"))","v":1},{"$f":"IF(F2540=1,COUNTIF($F$3:F2540,1),\"\")","v":2538},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2540),$G$3:$G$3716,0)),\"\")","v":"59762015501"}]
[null,null,null,null,"59762015802",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2541,1),\"\"))","v":1},{"$f":"IF(F2541=1,COUNTIF($F$3:F2541,1),\"\")","v":2539},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2541),$G$3:$G$3716,0)),\"\")","v":"59762015802"}]
[null,null,null,null,"59762018101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2542,1),\"\"))","v":1},{"$f":"IF(F2542=1,COUNTIF($F$3:F2542,1),\"\")","v":2540},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2542),$G$3:$G$3716,0)),\"\")","v":"59762018101"}]
[null,null,null,null,"59762024603",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2543,1),\"\"))","v":1},{"$f":"IF(F2543=1,COUNTIF($F$3:F2543,1),\"\")","v":2541},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2543),$G$3:$G$3716,0)),\"\")","v":"59762024603"}]
[null,null,null,null,"59762092501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2544,1),\"\"))","v":1},{"$f":"IF(F2544=1,COUNTIF($F$3:F2544,1),\"\")","v":2542},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2544),$G$3:$G$3716,0)),\"\")","v":"59762092501"}]
[null,null,null,null,"59762106101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2545,1),\"\"))","v":1},{"$f":"IF(F2545=1,COUNTIF($F$3:F2545,1),\"\")","v":2543},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2545),$G$3:$G$3716,0)),\"\")","v":"59762106101"}]
[null,null,null,null,"59762130702",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2546,1),\"\"))","v":1},{"$f":"IF(F2546=1,COUNTIF($F$3:F2546,1),\"\")","v":2544},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2546),$G$3:$G$3716,0)),\"\")","v":"59762130702"}]
[null,null,null,null,"59762130801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2547,1),\"\"))","v":1},{"$f":"IF(F2547=1,COUNTIF($F$3:F2547,1),\"\")","v":2545},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2547),$G$3:$G$3716,0)),\"\")","v":"59762130801"}]
[null,null,null,null,"59762135001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2548,1),\"\"))","v":1},{"$f":"IF(F2548=1,COUNTIF($F$3:F2548,1),\"\")","v":2546},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2548),$G$3:$G$3716,0)),\"\")","v":"59762135001"}]
[null,null,null,null,"59762153001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2549,1),\"\"))","v":1},{"$f":"IF(F2549=1,COUNTIF($F$3:F2549,1),\"\")","v":2547},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2549),$G$3:$G$3716,0)),\"\")","v":"59762153001"}]
[null,null,null,null,"59762153002",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2550,1),\"\"))","v":1},{"$f":"IF(F2550=1,COUNTIF($F$3:F2550,1),\"\")","v":2548},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2550),$G$3:$G$3716,0)),\"\")","v":"59762153002"}]
[null,null,null,null,"59762153003",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2551,1),\"\"))","v":1},{"$f":"IF(F2551=1,COUNTIF($F$3:F2551,1),\"\")","v":2549},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2551),$G$3:$G$3716,0)),\"\")","v":"59762153003"}]
[null,null,null,null,"59762153005",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2552,1),\"\"))","v":1},{"$f":"IF(F2552=1,COUNTIF($F$3:F2552,1),\"\")","v":2550},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2552),$G$3:$G$3716,0)),\"\")","v":"59762153005"}]
[null,null,null,null,"59762153401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2553,1),\"\"))","v":1},{"$f":"IF(F2553=1,COUNTIF($F$3:F2553,1),\"\")","v":2551},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2553),$G$3:$G$3716,0)),\"\")","v":"59762153401"}]
[null,null,null,null,"59762153701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2554,1),\"\"))","v":1},{"$f":"IF(F2554=1,COUNTIF($F$3:F2554,1),\"\")","v":2552},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2554),$G$3:$G$3716,0)),\"\")","v":"59762153701"}]
[null,null,null,null,"59762171001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2555,1),\"\"))","v":1},{"$f":"IF(F2555=1,COUNTIF($F$3:F2555,1),\"\")","v":2553},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2555),$G$3:$G$3716,0)),\"\")","v":"59762171001"}]
[null,null,null,null,"59762171003",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2556,1),\"\"))","v":1},{"$f":"IF(F2556=1,COUNTIF($F$3:F2556,1),\"\")","v":2554},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2556),$G$3:$G$3716,0)),\"\")","v":"59762171003"}]
[null,null,null,null,"59762306002",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2557,1),\"\"))","v":1},{"$f":"IF(F2557=1,COUNTIF($F$3:F2557,1),\"\")","v":2555},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2557),$G$3:$G$3716,0)),\"\")","v":"59762306002"}]
[null,null,null,null,"59762306003",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2558,1),\"\"))","v":1},{"$f":"IF(F2558=1,COUNTIF($F$3:F2558,1),\"\")","v":2556},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2558),$G$3:$G$3716,0)),\"\")","v":"59762306003"}]
[null,null,null,null,"59762308001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2559,1),\"\"))","v":1},{"$f":"IF(F2559=1,COUNTIF($F$3:F2559,1),\"\")","v":2557},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2559),$G$3:$G$3716,0)),\"\")","v":"59762308001"}]
[null,null,null,null,"59762314001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2560,1),\"\"))","v":1},{"$f":"IF(F2560=1,COUNTIF($F$3:F2560,1),\"\")","v":2558},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2560),$G$3:$G$3716,0)),\"\")","v":"59762314001"}]
[null,null,null,null,"59762332801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2561,1),\"\"))","v":1},{"$f":"IF(F2561=1,COUNTIF($F$3:F2561,1),\"\")","v":2559},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2561),$G$3:$G$3716,0)),\"\")","v":"59762332801"}]
[null,null,null,null,"59762371704",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2562,1),\"\"))","v":1},{"$f":"IF(F2562=1,COUNTIF($F$3:F2562,1),\"\")","v":2560},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2562),$G$3:$G$3716,0)),\"\")","v":"59762371704"}]
[null,null,null,null,"59762371709",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2563,1),\"\"))","v":1},{"$f":"IF(F2563=1,COUNTIF($F$3:F2563,1),\"\")","v":2561},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2563),$G$3:$G$3716,0)),\"\")","v":"59762371709"}]
[null,null,null,null,"59762371809",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2564,1),\"\"))","v":1},{"$f":"IF(F2564=1,COUNTIF($F$3:F2564,1),\"\")","v":2562},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2564),$G$3:$G$3716,0)),\"\")","v":"59762371809"}]
[null,null,null,null,"59762372001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2565,1),\"\"))","v":1},{"$f":"IF(F2565=1,COUNTIF($F$3:F2565,1),\"\")","v":2563},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2565),$G$3:$G$3716,0)),\"\")","v":"59762372001"}]
[null,null,null,null,"59762374001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2566,1),\"\"))","v":1},{"$f":"IF(F2566=1,COUNTIF($F$3:F2566,1),\"\")","v":2564},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2566),$G$3:$G$3716,0)),\"\")","v":"59762374001"}]
[null,null,null,null,"59762374202",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2567,1),\"\"))","v":1},{"$f":"IF(F2567=1,COUNTIF($F$3:F2567,1),\"\")","v":2565},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2567),$G$3:$G$3716,0)),\"\")","v":"59762374202"}]
[null,null,null,null,"59762374301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2568,1),\"\"))","v":1},{"$f":"IF(F2568=1,COUNTIF($F$3:F2568,1),\"\")","v":2566},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2568),$G$3:$G$3716,0)),\"\")","v":"59762374301"}]
[null,null,null,null,"59762490003",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2569,1),\"\"))","v":1},{"$f":"IF(F2569=1,COUNTIF($F$3:F2569,1),\"\")","v":2567},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2569),$G$3:$G$3716,0)),\"\")","v":"59762490003"}]
[null,null,null,null,"59762490004",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2570,1),\"\"))","v":1},{"$f":"IF(F2570=1,COUNTIF($F$3:F2570,1),\"\")","v":2568},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2570),$G$3:$G$3716,0)),\"\")","v":"59762490004"}]
[null,null,null,null,"59762491001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2571,1),\"\"))","v":1},{"$f":"IF(F2571=1,COUNTIF($F$3:F2571,1),\"\")","v":2569},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2571),$G$3:$G$3716,0)),\"\")","v":"59762491001"}]
[null,null,null,null,"59762491003",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2572,1),\"\"))","v":1},{"$f":"IF(F2572=1,COUNTIF($F$3:F2572,1),\"\")","v":2570},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2572),$G$3:$G$3716,0)),\"\")","v":"59762491003"}]
[null,null,null,null,"59762494001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2573,1),\"\"))","v":1},{"$f":"IF(F2573=1,COUNTIF($F$3:F2573,1),\"\")","v":2571},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2573),$G$3:$G$3716,0)),\"\")","v":"59762494001"}]
[null,null,null,null,"59762500001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2574,1),\"\"))","v":1},{"$f":"IF(F2574=1,COUNTIF($F$3:F2574,1),\"\")","v":2572},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2574),$G$3:$G$3716,0)),\"\")","v":"59762500001"}]
[null,null,null,null,"59762500005",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2575,1),\"\"))","v":1},{"$f":"IF(F2575=1,COUNTIF($F$3:F2575,1),\"\")","v":2573},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2575),$G$3:$G$3716,0)),\"\")","v":"59762500005"}]
[null,null,null,null,"59762500701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2576,1),\"\"))","v":1},{"$f":"IF(F2576=1,COUNTIF($F$3:F2576,1),\"\")","v":2574},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2576),$G$3:$G$3716,0)),\"\")","v":"59762500701"}]
[null,null,null,null,"59762500801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2577,1),\"\"))","v":1},{"$f":"IF(F2577=1,COUNTIF($F$3:F2577,1),\"\")","v":2575},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2577),$G$3:$G$3716,0)),\"\")","v":"59762500801"}]
[null,null,null,null,"59762500802",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2578,1),\"\"))","v":1},{"$f":"IF(F2578=1,COUNTIF($F$3:F2578,1),\"\")","v":2576},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2578),$G$3:$G$3716,0)),\"\")","v":"59762500802"}]
[null,null,null,null,"59762500901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2579,1),\"\"))","v":1},{"$f":"IF(F2579=1,COUNTIF($F$3:F2579,1),\"\")","v":2577},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2579),$G$3:$G$3716,0)),\"\")","v":"59762500901"}]
[null,null,null,null,"59762501201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2580,1),\"\"))","v":1},{"$f":"IF(F2580=1,COUNTIF($F$3:F2580,1),\"\")","v":2578},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2580),$G$3:$G$3716,0)),\"\")","v":"59762501201"}]
[null,null,null,null,"59762502701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2581,1),\"\"))","v":1},{"$f":"IF(F2581=1,COUNTIF($F$3:F2581,1),\"\")","v":2579},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2581),$G$3:$G$3716,0)),\"\")","v":"59762502701"}]
[null,null,null,null,"59762502901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2582,1),\"\"))","v":1},{"$f":"IF(F2582=1,COUNTIF($F$3:F2582,1),\"\")","v":2580},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2582),$G$3:$G$3716,0)),\"\")","v":"59762502901"}]
[null,null,null,null,"59762503001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2583,1),\"\"))","v":1},{"$f":"IF(F2583=1,COUNTIF($F$3:F2583,1),\"\")","v":2581},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2583),$G$3:$G$3716,0)),\"\")","v":"59762503001"}]
[null,null,null,null,"59762503201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2584,1),\"\"))","v":1},{"$f":"IF(F2584=1,COUNTIF($F$3:F2584,1),\"\")","v":2582},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2584),$G$3:$G$3716,0)),\"\")","v":"59762503201"}]
[null,null,null,null,"59762503301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2585,1),\"\"))","v":1},{"$f":"IF(F2585=1,COUNTIF($F$3:F2585,1),\"\")","v":2583},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2585),$G$3:$G$3716,0)),\"\")","v":"59762503301"}]
[null,null,null,null,"59762669008",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2586,1),\"\"))","v":1},{"$f":"IF(F2586=1,COUNTIF($F$3:F2586,1),\"\")","v":2584},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2586),$G$3:$G$3716,0)),\"\")","v":"59762669008"}]
[null,null,null,null,"59762669108",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2587,1),\"\"))","v":1},{"$f":"IF(F2587=1,COUNTIF($F$3:F2587,1),\"\")","v":2585},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2587),$G$3:$G$3716,0)),\"\")","v":"59762669108"}]
[null,null,null,null,"59762669203",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2588,1),\"\"))","v":1},{"$f":"IF(F2588=1,COUNTIF($F$3:F2588,1),\"\")","v":2586},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2588),$G$3:$G$3716,0)),\"\")","v":"59762669203"}]
[null,null,null,null,"60258000601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2589,1),\"\"))","v":1},{"$f":"IF(F2589=1,COUNTIF($F$3:F2589,1),\"\")","v":2587},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2589),$G$3:$G$3716,0)),\"\")","v":"60258000601"}]
[null,null,null,null,"60258000615",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2590,1),\"\"))","v":1},{"$f":"IF(F2590=1,COUNTIF($F$3:F2590,1),\"\")","v":2588},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2590),$G$3:$G$3716,0)),\"\")","v":"60258000615"}]
[null,null,null,null,"60432006575",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2591,1),\"\"))","v":1},{"$f":"IF(F2591=1,COUNTIF($F$3:F2591,1),\"\")","v":2589},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2591),$G$3:$G$3716,0)),\"\")","v":"60432006575"}]
[null,null,null,null,"60432009216",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2592,1),\"\"))","v":1},{"$f":"IF(F2592=1,COUNTIF($F$3:F2592,1),\"\")","v":2590},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2592),$G$3:$G$3716,0)),\"\")","v":"60432009216"}]
[null,null,null,null,"60432013108",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2593,1),\"\"))","v":1},{"$f":"IF(F2593=1,COUNTIF($F$3:F2593,1),\"\")","v":2591},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2593),$G$3:$G$3716,0)),\"\")","v":"60432013108"}]
[null,null,null,null,"60432053716",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2594,1),\"\"))","v":1},{"$f":"IF(F2594=1,COUNTIF($F$3:F2594,1),\"\")","v":2592},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2594),$G$3:$G$3716,0)),\"\")","v":"60432053716"}]
[null,null,null,null,"60432053760",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2595,1),\"\"))","v":1},{"$f":"IF(F2595=1,COUNTIF($F$3:F2595,1),\"\")","v":2593},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2595),$G$3:$G$3716,0)),\"\")","v":"60432053760"}]
[null,null,null,null,"60505008000",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2596,1),\"\"))","v":1},{"$f":"IF(F2596=1,COUNTIF($F$3:F2596,1),\"\")","v":2594},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2596),$G$3:$G$3716,0)),\"\")","v":"60505008000"}]
[null,null,null,null,"60505011200",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2597,1),\"\"))","v":1},{"$f":"IF(F2597=1,COUNTIF($F$3:F2597,1),\"\")","v":2595},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2597),$G$3:$G$3716,0)),\"\")","v":"60505011200"}]
[null,null,null,null,"60505011300",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2598,1),\"\"))","v":1},{"$f":"IF(F2598=1,COUNTIF($F$3:F2598,1),\"\")","v":2596},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2598),$G$3:$G$3716,0)),\"\")","v":"60505011300"}]
[null,null,null,null,"60505011400",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2599,1),\"\"))","v":1},{"$f":"IF(F2599=1,COUNTIF($F$3:F2599,1),\"\")","v":2597},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2599),$G$3:$G$3716,0)),\"\")","v":"60505011400"}]
[null,null,null,null,"60505011401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2600,1),\"\"))","v":1},{"$f":"IF(F2600=1,COUNTIF($F$3:F2600,1),\"\")","v":2598},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2600),$G$3:$G$3716,0)),\"\")","v":"60505011401"}]
[null,null,null,null,"60505016909",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2601,1),\"\"))","v":1},{"$f":"IF(F2601=1,COUNTIF($F$3:F2601,1),\"\")","v":2599},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2601),$G$3:$G$3716,0)),\"\")","v":"60505016909"}]
[null,null,null,null,"60505025701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2602,1),\"\"))","v":1},{"$f":"IF(F2602=1,COUNTIF($F$3:F2602,1),\"\")","v":2600},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2602),$G$3:$G$3716,0)),\"\")","v":"60505025701"}]
[null,null,null,null,"60505036301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2603,1),\"\"))","v":1},{"$f":"IF(F2603=1,COUNTIF($F$3:F2603,1),\"\")","v":2601},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2603),$G$3:$G$3716,0)),\"\")","v":"60505036301"}]
[null,null,null,null,"60505081500",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2604,1),\"\"))","v":1},{"$f":"IF(F2604=1,COUNTIF($F$3:F2604,1),\"\")","v":2602},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2604),$G$3:$G$3716,0)),\"\")","v":"60505081500"}]
[null,null,null,null,"60505082306",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2605,1),\"\"))","v":1},{"$f":"IF(F2605=1,COUNTIF($F$3:F2605,1),\"\")","v":2603},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2605),$G$3:$G$3716,0)),\"\")","v":"60505082306"}]
[null,null,null,null,"60505251903",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2606,1),\"\"))","v":1},{"$f":"IF(F2606=1,COUNTIF($F$3:F2606,1),\"\")","v":2604},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2606),$G$3:$G$3716,0)),\"\")","v":"60505251903"}]
[null,null,null,null,"60505252101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2607,1),\"\"))","v":1},{"$f":"IF(F2607=1,COUNTIF($F$3:F2607,1),\"\")","v":2605},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2607),$G$3:$G$3716,0)),\"\")","v":"60505252101"}]
[null,null,null,null,"60505252603",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2608,1),\"\"))","v":1},{"$f":"IF(F2608=1,COUNTIF($F$3:F2608,1),\"\")","v":2606},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2608),$G$3:$G$3716,0)),\"\")","v":"60505252603"}]
[null,null,null,null,"60505252806",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2609,1),\"\"))","v":1},{"$f":"IF(F2609=1,COUNTIF($F$3:F2609,1),\"\")","v":2607},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2609),$G$3:$G$3716,0)),\"\")","v":"60505252806"}]
[null,null,null,null,"60505257507",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2610,1),\"\"))","v":1},{"$f":"IF(F2610=1,COUNTIF($F$3:F2610,1),\"\")","v":2608},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2610),$G$3:$G$3716,0)),\"\")","v":"60505257507"}]
[null,null,null,null,"60505257909",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2611,1),\"\"))","v":1},{"$f":"IF(F2611=1,COUNTIF($F$3:F2611,1),\"\")","v":2609},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2611),$G$3:$G$3716,0)),\"\")","v":"60505257909"}]
[null,null,null,null,"60505258008",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2612,1),\"\"))","v":1},{"$f":"IF(F2612=1,COUNTIF($F$3:F2612,1),\"\")","v":2610},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2612),$G$3:$G$3716,0)),\"\")","v":"60505258008"}]
[null,null,null,null,"60505258009",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2613,1),\"\"))","v":1},{"$f":"IF(F2613=1,COUNTIF($F$3:F2613,1),\"\")","v":2611},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2613),$G$3:$G$3716,0)),\"\")","v":"60505258009"}]
[null,null,null,null,"60505264203",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2614,1),\"\"))","v":1},{"$f":"IF(F2614=1,COUNTIF($F$3:F2614,1),\"\")","v":2612},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2614),$G$3:$G$3716,0)),\"\")","v":"60505264203"}]
[null,null,null,null,"60505265300",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2615,1),\"\"))","v":1},{"$f":"IF(F2615=1,COUNTIF($F$3:F2615,1),\"\")","v":2613},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2615),$G$3:$G$3716,0)),\"\")","v":"60505265300"}]
[null,null,null,null,"60505267109",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2616,1),\"\"))","v":1},{"$f":"IF(F2616=1,COUNTIF($F$3:F2616,1),\"\")","v":2614},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2616),$G$3:$G$3716,0)),\"\")","v":"60505267109"}]
[null,null,null,null,"60505267403",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2617,1),\"\"))","v":1},{"$f":"IF(F2617=1,COUNTIF($F$3:F2617,1),\"\")","v":2615},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2617),$G$3:$G$3716,0)),\"\")","v":"60505267403"}]
[null,null,null,null,"60505307503",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2618,1),\"\"))","v":1},{"$f":"IF(F2618=1,COUNTIF($F$3:F2618,1),\"\")","v":2616},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2618),$G$3:$G$3716,0)),\"\")","v":"60505307503"}]
[null,null,null,null,"60505311100",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2619,1),\"\"))","v":1},{"$f":"IF(F2619=1,COUNTIF($F$3:F2619,1),\"\")","v":2617},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2619),$G$3:$G$3716,0)),\"\")","v":"60505311100"}]
[null,null,null,null,"60505313301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2620,1),\"\"))","v":1},{"$f":"IF(F2620=1,COUNTIF($F$3:F2620,1),\"\")","v":2618},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2620),$G$3:$G$3716,0)),\"\")","v":"60505313301"}]
[null,null,null,null,"60505316009",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2621,1),\"\"))","v":1},{"$f":"IF(F2621=1,COUNTIF($F$3:F2621,1),\"\")","v":2619},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2621),$G$3:$G$3716,0)),\"\")","v":"60505316009"}]
[null,null,null,null,"60505324603",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2622,1),\"\"))","v":1},{"$f":"IF(F2622=1,COUNTIF($F$3:F2622,1),\"\")","v":2620},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2622),$G$3:$G$3716,0)),\"\")","v":"60505324603"}]
[null,null,null,null,"60505325106",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2623,1),\"\"))","v":1},{"$f":"IF(F2623=1,COUNTIF($F$3:F2623,1),\"\")","v":2621},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2623),$G$3:$G$3716,0)),\"\")","v":"60505325106"}]
[null,null,null,null,"60505327500",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2624,1),\"\"))","v":1},{"$f":"IF(F2624=1,COUNTIF($F$3:F2624,1),\"\")","v":2622},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2624),$G$3:$G$3716,0)),\"\")","v":"60505327500"}]
[null,null,null,null,"60505327700",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2625,1),\"\"))","v":1},{"$f":"IF(F2625=1,COUNTIF($F$3:F2625,1),\"\")","v":2623},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2625),$G$3:$G$3716,0)),\"\")","v":"60505327700"}]
[null,null,null,null,"60505327800",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2626,1),\"\"))","v":1},{"$f":"IF(F2626=1,COUNTIF($F$3:F2626,1),\"\")","v":2624},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2626),$G$3:$G$3716,0)),\"\")","v":"60505327800"}]
[null,null,null,null,"60505340409",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2627,1),\"\"))","v":1},{"$f":"IF(F2627=1,COUNTIF($F$3:F2627,1),\"\")","v":2625},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2627),$G$3:$G$3716,0)),\"\")","v":"60505340409"}]
[null,null,null,null,"60505436203",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2628,1),\"\"))","v":1},{"$f":"IF(F2628=1,COUNTIF($F$3:F2628,1),\"\")","v":2626},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2628),$G$3:$G$3716,0)),\"\")","v":"60505436203"}]
[null,null,null,null,"60505464203",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2629,1),\"\"))","v":1},{"$f":"IF(F2629=1,COUNTIF($F$3:F2629,1),\"\")","v":2627},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2629),$G$3:$G$3716,0)),\"\")","v":"60505464203"}]
[null,null,null,null,"60505464303",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2630,1),\"\"))","v":1},{"$f":"IF(F2630=1,COUNTIF($F$3:F2630,1),\"\")","v":2628},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2630),$G$3:$G$3716,0)),\"\")","v":"60505464303"}]
[null,null,null,null,"60505476606",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2631,1),\"\"))","v":1},{"$f":"IF(F2631=1,COUNTIF($F$3:F2631,1),\"\")","v":2629},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2631),$G$3:$G$3716,0)),\"\")","v":"60505476606"}]
[null,null,null,null,"60505700302",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2632,1),\"\"))","v":1},{"$f":"IF(F2632=1,COUNTIF($F$3:F2632,1),\"\")","v":2630},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2632),$G$3:$G$3716,0)),\"\")","v":"60505700302"}]
[null,null,null,null,"60505700600",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2633,1),\"\"))","v":1},{"$f":"IF(F2633=1,COUNTIF($F$3:F2633,1),\"\")","v":2631},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2633),$G$3:$G$3716,0)),\"\")","v":"60505700600"}]
[null,null,null,null,"60505700602",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2634,1),\"\"))","v":1},{"$f":"IF(F2634=1,COUNTIF($F$3:F2634,1),\"\")","v":2632},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2634),$G$3:$G$3716,0)),\"\")","v":"60505700602"}]
[null,null,null,null,"60505700700",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2635,1),\"\"))","v":1},{"$f":"IF(F2635=1,COUNTIF($F$3:F2635,1),\"\")","v":2633},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2635),$G$3:$G$3716,0)),\"\")","v":"60505700700"}]
[null,null,null,null,"60505700702",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2636,1),\"\"))","v":1},{"$f":"IF(F2636=1,COUNTIF($F$3:F2636,1),\"\")","v":2634},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2636),$G$3:$G$3716,0)),\"\")","v":"60505700702"}]
[null,null,null,null,"60505700902",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2637,1),\"\"))","v":1},{"$f":"IF(F2637=1,COUNTIF($F$3:F2637,1),\"\")","v":2635},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2637),$G$3:$G$3716,0)),\"\")","v":"60505700902"}]
[null,null,null,null,"60505708202",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2638,1),\"\"))","v":1},{"$f":"IF(F2638=1,COUNTIF($F$3:F2638,1),\"\")","v":2636},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2638),$G$3:$G$3716,0)),\"\")","v":"60505708202"}]
[null,null,null,null,"60569044202",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2639,1),\"\"))","v":1},{"$f":"IF(F2639=1,COUNTIF($F$3:F2639,1),\"\")","v":2637},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2639),$G$3:$G$3716,0)),\"\")","v":"60569044202"}]
[null,null,null,null,"60687010011",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2640,1),\"\"))","v":1},{"$f":"IF(F2640=1,COUNTIF($F$3:F2640,1),\"\")","v":2638},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2640),$G$3:$G$3716,0)),\"\")","v":"60687010011"}]
[null,null,null,null,"60687011211",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2641,1),\"\"))","v":1},{"$f":"IF(F2641=1,COUNTIF($F$3:F2641,1),\"\")","v":2639},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2641),$G$3:$G$3716,0)),\"\")","v":"60687011211"}]
[null,null,null,null,"60687011501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2642,1),\"\"))","v":1},{"$f":"IF(F2642=1,COUNTIF($F$3:F2642,1),\"\")","v":2640},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2642),$G$3:$G$3716,0)),\"\")","v":"60687011501"}]
[null,null,null,null,"60687011511",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2643,1),\"\"))","v":1},{"$f":"IF(F2643=1,COUNTIF($F$3:F2643,1),\"\")","v":2641},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2643),$G$3:$G$3716,0)),\"\")","v":"60687011511"}]
[null,null,null,null,"60687012125",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2644,1),\"\"))","v":1},{"$f":"IF(F2644=1,COUNTIF($F$3:F2644,1),\"\")","v":2642},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2644),$G$3:$G$3716,0)),\"\")","v":"60687012125"}]
[null,null,null,null,"60687012401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2645,1),\"\"))","v":1},{"$f":"IF(F2645=1,COUNTIF($F$3:F2645,1),\"\")","v":2643},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2645),$G$3:$G$3716,0)),\"\")","v":"60687012401"}]
[null,null,null,null,"60687012411",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2646,1),\"\"))","v":1},{"$f":"IF(F2646=1,COUNTIF($F$3:F2646,1),\"\")","v":2644},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2646),$G$3:$G$3716,0)),\"\")","v":"60687012411"}]
[null,null,null,null,"60687012511",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2647,1),\"\"))","v":1},{"$f":"IF(F2647=1,COUNTIF($F$3:F2647,1),\"\")","v":2645},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2647),$G$3:$G$3716,0)),\"\")","v":"60687012511"}]
[null,null,null,null,"60687012911",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2648,1),\"\"))","v":1},{"$f":"IF(F2648=1,COUNTIF($F$3:F2648,1),\"\")","v":2646},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2648),$G$3:$G$3716,0)),\"\")","v":"60687012911"}]
[null,null,null,null,"60687013601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2649,1),\"\"))","v":1},{"$f":"IF(F2649=1,COUNTIF($F$3:F2649,1),\"\")","v":2647},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2649),$G$3:$G$3716,0)),\"\")","v":"60687013601"}]
[null,null,null,null,"60687013611",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2650,1),\"\"))","v":1},{"$f":"IF(F2650=1,COUNTIF($F$3:F2650,1),\"\")","v":2648},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2650),$G$3:$G$3716,0)),\"\")","v":"60687013611"}]
[null,null,null,null,"60687015211",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2651,1),\"\"))","v":1},{"$f":"IF(F2651=1,COUNTIF($F$3:F2651,1),\"\")","v":2649},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2651),$G$3:$G$3716,0)),\"\")","v":"60687015211"}]
[null,null,null,null,"60687015801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2652,1),\"\"))","v":1},{"$f":"IF(F2652=1,COUNTIF($F$3:F2652,1),\"\")","v":2650},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2652),$G$3:$G$3716,0)),\"\")","v":"60687015801"}]
[null,null,null,null,"60687016311",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2653,1),\"\"))","v":1},{"$f":"IF(F2653=1,COUNTIF($F$3:F2653,1),\"\")","v":2651},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2653),$G$3:$G$3716,0)),\"\")","v":"60687016311"}]
[null,null,null,null,"60687017811",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2654,1),\"\"))","v":1},{"$f":"IF(F2654=1,COUNTIF($F$3:F2654,1),\"\")","v":2652},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2654),$G$3:$G$3716,0)),\"\")","v":"60687017811"}]
[null,null,null,null,"60687018811",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2655,1),\"\"))","v":1},{"$f":"IF(F2655=1,COUNTIF($F$3:F2655,1),\"\")","v":2653},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2655),$G$3:$G$3716,0)),\"\")","v":"60687018811"}]
[null,null,null,null,"60687020601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2656,1),\"\"))","v":1},{"$f":"IF(F2656=1,COUNTIF($F$3:F2656,1),\"\")","v":2654},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2656),$G$3:$G$3716,0)),\"\")","v":"60687020601"}]
[null,null,null,null,"60687021111",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2657,1),\"\"))","v":1},{"$f":"IF(F2657=1,COUNTIF($F$3:F2657,1),\"\")","v":2655},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2657),$G$3:$G$3716,0)),\"\")","v":"60687021111"}]
[null,null,null,null,"60687021401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2658,1),\"\"))","v":1},{"$f":"IF(F2658=1,COUNTIF($F$3:F2658,1),\"\")","v":2656},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2658),$G$3:$G$3716,0)),\"\")","v":"60687021401"}]
[null,null,null,null,"60687021411",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2659,1),\"\"))","v":1},{"$f":"IF(F2659=1,COUNTIF($F$3:F2659,1),\"\")","v":2657},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2659),$G$3:$G$3716,0)),\"\")","v":"60687021411"}]
[null,null,null,null,"60687022711",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2660,1),\"\"))","v":1},{"$f":"IF(F2660=1,COUNTIF($F$3:F2660,1),\"\")","v":2658},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2660),$G$3:$G$3716,0)),\"\")","v":"60687022711"}]
[null,null,null,null,"60687022911",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2661,1),\"\"))","v":1},{"$f":"IF(F2661=1,COUNTIF($F$3:F2661,1),\"\")","v":2659},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2661),$G$3:$G$3716,0)),\"\")","v":"60687022911"}]
[null,null,null,null,"60687024195",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2662,1),\"\"))","v":1},{"$f":"IF(F2662=1,COUNTIF($F$3:F2662,1),\"\")","v":2660},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2662),$G$3:$G$3716,0)),\"\")","v":"60687024195"}]
[null,null,null,null,"60687024211",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2663,1),\"\"))","v":1},{"$f":"IF(F2663=1,COUNTIF($F$3:F2663,1),\"\")","v":2661},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2663),$G$3:$G$3716,0)),\"\")","v":"60687024211"}]
[null,null,null,null,"60687025311",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2664,1),\"\"))","v":1},{"$f":"IF(F2664=1,COUNTIF($F$3:F2664,1),\"\")","v":2662},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2664),$G$3:$G$3716,0)),\"\")","v":"60687025311"}]
[null,null,null,null,"60687026311",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2665,1),\"\"))","v":1},{"$f":"IF(F2665=1,COUNTIF($F$3:F2665,1),\"\")","v":2663},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2665),$G$3:$G$3716,0)),\"\")","v":"60687026311"}]
[null,null,null,null,"60687026611",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2666,1),\"\"))","v":1},{"$f":"IF(F2666=1,COUNTIF($F$3:F2666,1),\"\")","v":2664},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2666),$G$3:$G$3716,0)),\"\")","v":"60687026611"}]
[null,null,null,null,"60687028111",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2667,1),\"\"))","v":1},{"$f":"IF(F2667=1,COUNTIF($F$3:F2667,1),\"\")","v":2665},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2667),$G$3:$G$3716,0)),\"\")","v":"60687028111"}]
[null,null,null,null,"60687030311",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2668,1),\"\"))","v":1},{"$f":"IF(F2668=1,COUNTIF($F$3:F2668,1),\"\")","v":2666},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2668),$G$3:$G$3716,0)),\"\")","v":"60687030311"}]
[null,null,null,null,"60687030411",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2669,1),\"\"))","v":1},{"$f":"IF(F2669=1,COUNTIF($F$3:F2669,1),\"\")","v":2667},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2669),$G$3:$G$3716,0)),\"\")","v":"60687030411"}]
[null,null,null,null,"60687030611",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2670,1),\"\"))","v":1},{"$f":"IF(F2670=1,COUNTIF($F$3:F2670,1),\"\")","v":2668},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2670),$G$3:$G$3716,0)),\"\")","v":"60687030611"}]
[null,null,null,null,"60687032833",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2671,1),\"\"))","v":1},{"$f":"IF(F2671=1,COUNTIF($F$3:F2671,1),\"\")","v":2669},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2671),$G$3:$G$3716,0)),\"\")","v":"60687032833"}]
[null,null,null,null,"60687033011",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2672,1),\"\"))","v":1},{"$f":"IF(F2672=1,COUNTIF($F$3:F2672,1),\"\")","v":2670},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2672),$G$3:$G$3716,0)),\"\")","v":"60687033011"}]
[null,null,null,null,"60687033021",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2673,1),\"\"))","v":1},{"$f":"IF(F2673=1,COUNTIF($F$3:F2673,1),\"\")","v":2671},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2673),$G$3:$G$3716,0)),\"\")","v":"60687033021"}]
[null,null,null,null,"60687033311",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2674,1),\"\"))","v":1},{"$f":"IF(F2674=1,COUNTIF($F$3:F2674,1),\"\")","v":2672},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2674),$G$3:$G$3716,0)),\"\")","v":"60687033311"}]
[null,null,null,null,"60687033611",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2675,1),\"\"))","v":1},{"$f":"IF(F2675=1,COUNTIF($F$3:F2675,1),\"\")","v":2673},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2675),$G$3:$G$3716,0)),\"\")","v":"60687033611"}]
[null,null,null,null,"60687034001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2676,1),\"\"))","v":1},{"$f":"IF(F2676=1,COUNTIF($F$3:F2676,1),\"\")","v":2674},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2676),$G$3:$G$3716,0)),\"\")","v":"60687034001"}]
[null,null,null,null,"60687034011",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2677,1),\"\"))","v":1},{"$f":"IF(F2677=1,COUNTIF($F$3:F2677,1),\"\")","v":2675},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2677),$G$3:$G$3716,0)),\"\")","v":"60687034011"}]
[null,null,null,null,"60687034511",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2678,1),\"\"))","v":1},{"$f":"IF(F2678=1,COUNTIF($F$3:F2678,1),\"\")","v":2676},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2678),$G$3:$G$3716,0)),\"\")","v":"60687034511"}]
[null,null,null,null,"60687034601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2679,1),\"\"))","v":1},{"$f":"IF(F2679=1,COUNTIF($F$3:F2679,1),\"\")","v":2677},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2679),$G$3:$G$3716,0)),\"\")","v":"60687034601"}]
[null,null,null,null,"60687034611",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2680,1),\"\"))","v":1},{"$f":"IF(F2680=1,COUNTIF($F$3:F2680,1),\"\")","v":2678},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2680),$G$3:$G$3716,0)),\"\")","v":"60687034611"}]
[null,null,null,null,"60687035511",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2681,1),\"\"))","v":1},{"$f":"IF(F2681=1,COUNTIF($F$3:F2681,1),\"\")","v":2679},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2681),$G$3:$G$3716,0)),\"\")","v":"60687035511"}]
[null,null,null,null,"60687036211",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2682,1),\"\"))","v":1},{"$f":"IF(F2682=1,COUNTIF($F$3:F2682,1),\"\")","v":2680},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2682),$G$3:$G$3716,0)),\"\")","v":"60687036211"}]
[null,null,null,null,"60687036711",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2683,1),\"\"))","v":1},{"$f":"IF(F2683=1,COUNTIF($F$3:F2683,1),\"\")","v":2681},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2683),$G$3:$G$3716,0)),\"\")","v":"60687036711"}]
[null,null,null,null,"60687037011",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2684,1),\"\"))","v":1},{"$f":"IF(F2684=1,COUNTIF($F$3:F2684,1),\"\")","v":2682},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2684),$G$3:$G$3716,0)),\"\")","v":"60687037011"}]
[null,null,null,null,"60687037311",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2685,1),\"\"))","v":1},{"$f":"IF(F2685=1,COUNTIF($F$3:F2685,1),\"\")","v":2683},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2685),$G$3:$G$3716,0)),\"\")","v":"60687037311"}]
[null,null,null,null,"60687038001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2686,1),\"\"))","v":1},{"$f":"IF(F2686=1,COUNTIF($F$3:F2686,1),\"\")","v":2684},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2686),$G$3:$G$3716,0)),\"\")","v":"60687038001"}]
[null,null,null,null,"60687038011",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2687,1),\"\"))","v":1},{"$f":"IF(F2687=1,COUNTIF($F$3:F2687,1),\"\")","v":2685},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2687),$G$3:$G$3716,0)),\"\")","v":"60687038011"}]
[null,null,null,null,"60687038495",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2688,1),\"\"))","v":1},{"$f":"IF(F2688=1,COUNTIF($F$3:F2688,1),\"\")","v":2686},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2688),$G$3:$G$3716,0)),\"\")","v":"60687038495"}]
[null,null,null,null,"60687038911",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2689,1),\"\"))","v":1},{"$f":"IF(F2689=1,COUNTIF($F$3:F2689,1),\"\")","v":2687},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2689),$G$3:$G$3716,0)),\"\")","v":"60687038911"}]
[null,null,null,null,"60687039011",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2690,1),\"\"))","v":1},{"$f":"IF(F2690=1,COUNTIF($F$3:F2690,1),\"\")","v":2688},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2690),$G$3:$G$3716,0)),\"\")","v":"60687039011"}]
[null,null,null,null,"60687039101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2691,1),\"\"))","v":1},{"$f":"IF(F2691=1,COUNTIF($F$3:F2691,1),\"\")","v":2689},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2691),$G$3:$G$3716,0)),\"\")","v":"60687039101"}]
[null,null,null,null,"60687040211",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2692,1),\"\"))","v":1},{"$f":"IF(F2692=1,COUNTIF($F$3:F2692,1),\"\")","v":2690},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2692),$G$3:$G$3716,0)),\"\")","v":"60687040211"}]
[null,null,null,null,"60687041311",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2693,1),\"\"))","v":1},{"$f":"IF(F2693=1,COUNTIF($F$3:F2693,1),\"\")","v":2691},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2693),$G$3:$G$3716,0)),\"\")","v":"60687041311"}]
[null,null,null,null,"60687041501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2694,1),\"\"))","v":1},{"$f":"IF(F2694=1,COUNTIF($F$3:F2694,1),\"\")","v":2692},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2694),$G$3:$G$3716,0)),\"\")","v":"60687041501"}]
[null,null,null,null,"60687042411",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2695,1),\"\"))","v":1},{"$f":"IF(F2695=1,COUNTIF($F$3:F2695,1),\"\")","v":2693},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2695),$G$3:$G$3716,0)),\"\")","v":"60687042411"}]
[null,null,null,null,"60687043701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2696,1),\"\"))","v":1},{"$f":"IF(F2696=1,COUNTIF($F$3:F2696,1),\"\")","v":2694},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2696),$G$3:$G$3716,0)),\"\")","v":"60687043701"}]
[null,null,null,null,"60687044411",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2697,1),\"\"))","v":1},{"$f":"IF(F2697=1,COUNTIF($F$3:F2697,1),\"\")","v":2695},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2697),$G$3:$G$3716,0)),\"\")","v":"60687044411"}]
[null,null,null,null,"60687044711",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2698,1),\"\"))","v":1},{"$f":"IF(F2698=1,COUNTIF($F$3:F2698,1),\"\")","v":2696},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2698),$G$3:$G$3716,0)),\"\")","v":"60687044711"}]
[null,null,null,null,"60687046111",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2699,1),\"\"))","v":1},{"$f":"IF(F2699=1,COUNTIF($F$3:F2699,1),\"\")","v":2697},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2699),$G$3:$G$3716,0)),\"\")","v":"60687046111"}]
[null,null,null,null,"60687047501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2700,1),\"\"))","v":1},{"$f":"IF(F2700=1,COUNTIF($F$3:F2700,1),\"\")","v":2698},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2700),$G$3:$G$3716,0)),\"\")","v":"60687047501"}]
[null,null,null,null,"60687047511",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2701,1),\"\"))","v":1},{"$f":"IF(F2701=1,COUNTIF($F$3:F2701,1),\"\")","v":2699},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2701),$G$3:$G$3716,0)),\"\")","v":"60687047511"}]
[null,null,null,null,"60687047611",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2702,1),\"\"))","v":1},{"$f":"IF(F2702=1,COUNTIF($F$3:F2702,1),\"\")","v":2700},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2702),$G$3:$G$3716,0)),\"\")","v":"60687047611"}]
[null,null,null,null,"60687048801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2703,1),\"\"))","v":1},{"$f":"IF(F2703=1,COUNTIF($F$3:F2703,1),\"\")","v":2701},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2703),$G$3:$G$3716,0)),\"\")","v":"60687048801"}]
[null,null,null,null,"60687048811",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2704,1),\"\"))","v":1},{"$f":"IF(F2704=1,COUNTIF($F$3:F2704,1),\"\")","v":2702},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2704),$G$3:$G$3716,0)),\"\")","v":"60687048811"}]
[null,null,null,null,"60687049301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2705,1),\"\"))","v":1},{"$f":"IF(F2705=1,COUNTIF($F$3:F2705,1),\"\")","v":2703},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2705),$G$3:$G$3716,0)),\"\")","v":"60687049301"}]
[null,null,null,null,"60687050011",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2706,1),\"\"))","v":1},{"$f":"IF(F2706=1,COUNTIF($F$3:F2706,1),\"\")","v":2704},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2706),$G$3:$G$3716,0)),\"\")","v":"60687050011"}]
[null,null,null,null,"60687050201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2707,1),\"\"))","v":1},{"$f":"IF(F2707=1,COUNTIF($F$3:F2707,1),\"\")","v":2705},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2707),$G$3:$G$3716,0)),\"\")","v":"60687050201"}]
[null,null,null,null,"60687050211",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2708,1),\"\"))","v":1},{"$f":"IF(F2708=1,COUNTIF($F$3:F2708,1),\"\")","v":2706},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2708),$G$3:$G$3716,0)),\"\")","v":"60687050211"}]
[null,null,null,null,"60687050611",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2709,1),\"\"))","v":1},{"$f":"IF(F2709=1,COUNTIF($F$3:F2709,1),\"\")","v":2707},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2709),$G$3:$G$3716,0)),\"\")","v":"60687050611"}]
[null,null,null,null,"60687050811",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2710,1),\"\"))","v":1},{"$f":"IF(F2710=1,COUNTIF($F$3:F2710,1),\"\")","v":2708},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2710),$G$3:$G$3716,0)),\"\")","v":"60687050811"}]
[null,null,null,null,"60687053111",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2711,1),\"\"))","v":1},{"$f":"IF(F2711=1,COUNTIF($F$3:F2711,1),\"\")","v":2709},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2711),$G$3:$G$3716,0)),\"\")","v":"60687053111"}]
[null,null,null,null,"60687054911",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2712,1),\"\"))","v":1},{"$f":"IF(F2712=1,COUNTIF($F$3:F2712,1),\"\")","v":2710},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2712),$G$3:$G$3716,0)),\"\")","v":"60687054911"}]
[null,null,null,null,"60687054921",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2713,1),\"\"))","v":1},{"$f":"IF(F2713=1,COUNTIF($F$3:F2713,1),\"\")","v":2711},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2713),$G$3:$G$3716,0)),\"\")","v":"60687054921"}]
[null,null,null,null,"60687055011",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2714,1),\"\"))","v":1},{"$f":"IF(F2714=1,COUNTIF($F$3:F2714,1),\"\")","v":2712},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2714),$G$3:$G$3716,0)),\"\")","v":"60687055011"}]
[null,null,null,null,"60687055211",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2715,1),\"\"))","v":1},{"$f":"IF(F2715=1,COUNTIF($F$3:F2715,1),\"\")","v":2713},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2715),$G$3:$G$3716,0)),\"\")","v":"60687055211"}]
[null,null,null,null,"60687055501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2716,1),\"\"))","v":1},{"$f":"IF(F2716=1,COUNTIF($F$3:F2716,1),\"\")","v":2714},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2716),$G$3:$G$3716,0)),\"\")","v":"60687055501"}]
[null,null,null,null,"60687055511",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2717,1),\"\"))","v":1},{"$f":"IF(F2717=1,COUNTIF($F$3:F2717,1),\"\")","v":2715},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2717),$G$3:$G$3716,0)),\"\")","v":"60687055511"}]
[null,null,null,null,"60687056811",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2718,1),\"\"))","v":1},{"$f":"IF(F2718=1,COUNTIF($F$3:F2718,1),\"\")","v":2716},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2718),$G$3:$G$3716,0)),\"\")","v":"60687056811"}]
[null,null,null,null,"60687057511",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2719,1),\"\"))","v":1},{"$f":"IF(F2719=1,COUNTIF($F$3:F2719,1),\"\")","v":2717},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2719),$G$3:$G$3716,0)),\"\")","v":"60687057511"}]
[null,null,null,null,"60687058601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2720,1),\"\"))","v":1},{"$f":"IF(F2720=1,COUNTIF($F$3:F2720,1),\"\")","v":2718},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2720),$G$3:$G$3716,0)),\"\")","v":"60687058601"}]
[null,null,null,null,"60687058611",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2721,1),\"\"))","v":1},{"$f":"IF(F2721=1,COUNTIF($F$3:F2721,1),\"\")","v":2719},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2721),$G$3:$G$3716,0)),\"\")","v":"60687058611"}]
[null,null,null,null,"60687058711",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2722,1),\"\"))","v":1},{"$f":"IF(F2722=1,COUNTIF($F$3:F2722,1),\"\")","v":2720},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2722),$G$3:$G$3716,0)),\"\")","v":"60687058711"}]
[null,null,null,null,"60687058811",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2723,1),\"\"))","v":1},{"$f":"IF(F2723=1,COUNTIF($F$3:F2723,1),\"\")","v":2721},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2723),$G$3:$G$3716,0)),\"\")","v":"60687058811"}]
[null,null,null,null,"60758011905",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2724,1),\"\"))","v":1},{"$f":"IF(F2724=1,COUNTIF($F$3:F2724,1),\"\")","v":2722},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2724),$G$3:$G$3716,0)),\"\")","v":"60758011905"}]
[null,null,null,null,"60758011915",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2725,1),\"\"))","v":1},{"$f":"IF(F2725=1,COUNTIF($F$3:F2725,1),\"\")","v":2723},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2725),$G$3:$G$3716,0)),\"\")","v":"60758011915"}]
[null,null,null,null,"60758077305",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2726,1),\"\"))","v":1},{"$f":"IF(F2726=1,COUNTIF($F$3:F2726,1),\"\")","v":2724},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2726),$G$3:$G$3716,0)),\"\")","v":"60758077305"}]
[null,null,null,null,"60758080105",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2727,1),\"\"))","v":1},{"$f":"IF(F2727=1,COUNTIF($F$3:F2727,1),\"\")","v":2725},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2727),$G$3:$G$3716,0)),\"\")","v":"60758080105"}]
[null,null,null,null,"60758080110",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2728,1),\"\"))","v":1},{"$f":"IF(F2728=1,COUNTIF($F$3:F2728,1),\"\")","v":2726},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2728),$G$3:$G$3716,0)),\"\")","v":"60758080110"}]
[null,null,null,null,"60758080205",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2729,1),\"\"))","v":1},{"$f":"IF(F2729=1,COUNTIF($F$3:F2729,1),\"\")","v":2727},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2729),$G$3:$G$3716,0)),\"\")","v":"60758080205"}]
[null,null,null,null,"60758088005",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2730,1),\"\"))","v":1},{"$f":"IF(F2730=1,COUNTIF($F$3:F2730,1),\"\")","v":2728},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2730),$G$3:$G$3716,0)),\"\")","v":"60758088005"}]
[null,null,null,null,"60793021505",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2731,1),\"\"))","v":1},{"$f":"IF(F2731=1,COUNTIF($F$3:F2731,1),\"\")","v":2729},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2731),$G$3:$G$3716,0)),\"\")","v":"60793021505"}]
[null,null,null,null,"60793085401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2732,1),\"\"))","v":1},{"$f":"IF(F2732=1,COUNTIF($F$3:F2732,1),\"\")","v":2730},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2732),$G$3:$G$3716,0)),\"\")","v":"60793085401"}]
[null,null,null,null,"60793085501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2733,1),\"\"))","v":1},{"$f":"IF(F2733=1,COUNTIF($F$3:F2733,1),\"\")","v":2731},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2733),$G$3:$G$3716,0)),\"\")","v":"60793085501"}]
[null,null,null,null,"61269022041",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2734,1),\"\"))","v":1},{"$f":"IF(F2734=1,COUNTIF($F$3:F2734,1),\"\")","v":2732},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2734),$G$3:$G$3716,0)),\"\")","v":"61269022041"}]
[null,null,null,null,"61314001505",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2735,1),\"\"))","v":1},{"$f":"IF(F2735=1,COUNTIF($F$3:F2735,1),\"\")","v":2733},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2735),$G$3:$G$3716,0)),\"\")","v":"61314001505"}]
[null,null,null,null,"61314001601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2736,1),\"\"))","v":1},{"$f":"IF(F2736=1,COUNTIF($F$3:F2736,1),\"\")","v":2734},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2736),$G$3:$G$3716,0)),\"\")","v":"61314001601"}]
[null,null,null,null,"61314001910",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2737,1),\"\"))","v":1},{"$f":"IF(F2737=1,COUNTIF($F$3:F2737,1),\"\")","v":2735},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2737),$G$3:$G$3716,0)),\"\")","v":"61314001910"}]
[null,null,null,null,"61314004475",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2738,1),\"\"))","v":1},{"$f":"IF(F2738=1,COUNTIF($F$3:F2738,1),\"\")","v":2736},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2738),$G$3:$G$3716,0)),\"\")","v":"61314004475"}]
[null,null,null,null,"61314014405",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2739,1),\"\"))","v":1},{"$f":"IF(F2739=1,COUNTIF($F$3:F2739,1),\"\")","v":2737},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2739),$G$3:$G$3716,0)),\"\")","v":"61314014405"}]
[null,null,null,null,"61314020315",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2740,1),\"\"))","v":1},{"$f":"IF(F2740=1,COUNTIF($F$3:F2740,1),\"\")","v":2738},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2740),$G$3:$G$3716,0)),\"\")","v":"61314020315"}]
[null,null,null,null,"61314020415",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2741,1),\"\"))","v":1},{"$f":"IF(F2741=1,COUNTIF($F$3:F2741,1),\"\")","v":2739},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2741),$G$3:$G$3716,0)),\"\")","v":"61314020415"}]
[null,null,null,null,"61314020615",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2742,1),\"\"))","v":1},{"$f":"IF(F2742=1,COUNTIF($F$3:F2742,1),\"\")","v":2740},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2742),$G$3:$G$3716,0)),\"\")","v":"61314020615"}]
[null,null,null,null,"61314022605",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2743,1),\"\"))","v":1},{"$f":"IF(F2743=1,COUNTIF($F$3:F2743,1),\"\")","v":2741},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2743),$G$3:$G$3716,0)),\"\")","v":"61314022605"}]
[null,null,null,null,"61314022705",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2744,1),\"\"))","v":1},{"$f":"IF(F2744=1,COUNTIF($F$3:F2744,1),\"\")","v":2742},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2744),$G$3:$G$3716,0)),\"\")","v":"61314022705"}]
[null,null,null,null,"61314022710",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2745,1),\"\"))","v":1},{"$f":"IF(F2745=1,COUNTIF($F$3:F2745,1),\"\")","v":2743},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2745),$G$3:$G$3716,0)),\"\")","v":"61314022710"}]
[null,null,null,null,"61314029405",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2746,1),\"\"))","v":1},{"$f":"IF(F2746=1,COUNTIF($F$3:F2746,1),\"\")","v":2744},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2746),$G$3:$G$3716,0)),\"\")","v":"61314029405"}]
[null,null,null,null,"61314030301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2747,1),\"\"))","v":1},{"$f":"IF(F2747=1,COUNTIF($F$3:F2747,1),\"\")","v":2745},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2747),$G$3:$G$3716,0)),\"\")","v":"61314030301"}]
[null,null,null,null,"61314035401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2748,1),\"\"))","v":1},{"$f":"IF(F2748=1,COUNTIF($F$3:F2748,1),\"\")","v":2746},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2748),$G$3:$G$3716,0)),\"\")","v":"61314035401"}]
[null,null,null,null,"61314035501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2749,1),\"\"))","v":1},{"$f":"IF(F2749=1,COUNTIF($F$3:F2749,1),\"\")","v":2747},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2749),$G$3:$G$3716,0)),\"\")","v":"61314035501"}]
[null,null,null,null,"61314035502",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2750,1),\"\"))","v":1},{"$f":"IF(F2750=1,COUNTIF($F$3:F2750,1),\"\")","v":2748},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2750),$G$3:$G$3716,0)),\"\")","v":"61314035502"}]
[null,null,null,null,"61314039603",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2751,1),\"\"))","v":1},{"$f":"IF(F2751=1,COUNTIF($F$3:F2751,1),\"\")","v":2749},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2751),$G$3:$G$3716,0)),\"\")","v":"61314039603"}]
[null,null,null,null,"61314054701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2752,1),\"\"))","v":1},{"$f":"IF(F2752=1,COUNTIF($F$3:F2752,1),\"\")","v":2750},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2752),$G$3:$G$3716,0)),\"\")","v":"61314054701"}]
[null,null,null,null,"61314062810",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2753,1),\"\"))","v":1},{"$f":"IF(F2753=1,COUNTIF($F$3:F2753,1),\"\")","v":2751},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2753),$G$3:$G$3716,0)),\"\")","v":"61314062810"}]
[null,null,null,null,"61314063136",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2754,1),\"\"))","v":1},{"$f":"IF(F2754=1,COUNTIF($F$3:F2754,1),\"\")","v":2752},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2754),$G$3:$G$3716,0)),\"\")","v":"61314063136"}]
[null,null,null,null,"61314063305",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2755,1),\"\"))","v":1},{"$f":"IF(F2755=1,COUNTIF($F$3:F2755,1),\"\")","v":2753},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2755),$G$3:$G$3716,0)),\"\")","v":"61314063305"}]
[null,null,null,null,"61314063705",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2756,1),\"\"))","v":1},{"$f":"IF(F2756=1,COUNTIF($F$3:F2756,1),\"\")","v":2754},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2756),$G$3:$G$3716,0)),\"\")","v":"61314063705"}]
[null,null,null,null,"61314063715",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2757,1),\"\"))","v":1},{"$f":"IF(F2757=1,COUNTIF($F$3:F2757,1),\"\")","v":2755},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2757),$G$3:$G$3716,0)),\"\")","v":"61314063715"}]
[null,null,null,null,"61314064305",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2758,1),\"\"))","v":1},{"$f":"IF(F2758=1,COUNTIF($F$3:F2758,1),\"\")","v":2756},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2758),$G$3:$G$3716,0)),\"\")","v":"61314064305"}]
[null,null,null,null,"61314064511",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2759,1),\"\"))","v":1},{"$f":"IF(F2759=1,COUNTIF($F$3:F2759,1),\"\")","v":2757},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2759),$G$3:$G$3716,0)),\"\")","v":"61314064511"}]
[null,null,null,null,"61314066505",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2760,1),\"\"))","v":1},{"$f":"IF(F2760=1,COUNTIF($F$3:F2760,1),\"\")","v":2758},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2760),$G$3:$G$3716,0)),\"\")","v":"61314066505"}]
[null,null,null,null,"61442045101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2761,1),\"\"))","v":1},{"$f":"IF(F2761=1,COUNTIF($F$3:F2761,1),\"\")","v":2759},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2761),$G$3:$G$3716,0)),\"\")","v":"61442045101"}]
[null,null,null,null,"61570013125",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2762,1),\"\"))","v":1},{"$f":"IF(F2762=1,COUNTIF($F$3:F2762,1),\"\")","v":2760},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2762),$G$3:$G$3716,0)),\"\")","v":"61570013125"}]
[null,null,null,null,"61570013140",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2763,1),\"\"))","v":1},{"$f":"IF(F2763=1,COUNTIF($F$3:F2763,1),\"\")","v":2761},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2763),$G$3:$G$3716,0)),\"\")","v":"61570013140"}]
[null,null,null,null,"61570013150",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2764,1),\"\"))","v":1},{"$f":"IF(F2764=1,COUNTIF($F$3:F2764,1),\"\")","v":2762},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2764),$G$3:$G$3716,0)),\"\")","v":"61570013150"}]
[null,null,null,null,"61703042153",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2765,1),\"\"))","v":1},{"$f":"IF(F2765=1,COUNTIF($F$3:F2765,1),\"\")","v":2763},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2765),$G$3:$G$3716,0)),\"\")","v":"61703042153"}]
[null,null,null,null,"61748001101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2766,1),\"\"))","v":1},{"$f":"IF(F2766=1,COUNTIF($F$3:F2766,1),\"\")","v":2764},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2766),$G$3:$G$3716,0)),\"\")","v":"61748001101"}]
[null,null,null,null,"61748001201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2767,1),\"\"))","v":1},{"$f":"IF(F2767=1,COUNTIF($F$3:F2767,1),\"\")","v":2765},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2767),$G$3:$G$3716,0)),\"\")","v":"61748001201"}]
[null,null,null,null,"61748001211",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2768,1),\"\"))","v":1},{"$f":"IF(F2768=1,COUNTIF($F$3:F2768,1),\"\")","v":2766},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2768),$G$3:$G$3716,0)),\"\")","v":"61748001211"}]
[null,null,null,null,"61748001530",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2769,1),\"\"))","v":1},{"$f":"IF(F2769=1,COUNTIF($F$3:F2769,1),\"\")","v":2767},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2769),$G$3:$G$3716,0)),\"\")","v":"61748001530"}]
[null,null,null,null,"61748001801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2770,1),\"\"))","v":1},{"$f":"IF(F2770=1,COUNTIF($F$3:F2770,1),\"\")","v":2768},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2770),$G$3:$G$3716,0)),\"\")","v":"61748001801"}]
[null,null,null,null,"61748001830",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2771,1),\"\"))","v":1},{"$f":"IF(F2771=1,COUNTIF($F$3:F2771,1),\"\")","v":2769},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2771),$G$3:$G$3716,0)),\"\")","v":"61748001830"}]
[null,null,null,null,"61748002501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2772,1),\"\"))","v":1},{"$f":"IF(F2772=1,COUNTIF($F$3:F2772,1),\"\")","v":2770},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2772),$G$3:$G$3716,0)),\"\")","v":"61748002501"}]
[null,null,null,null,"61748004501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2773,1),\"\"))","v":1},{"$f":"IF(F2773=1,COUNTIF($F$3:F2773,1),\"\")","v":2771},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2773),$G$3:$G$3716,0)),\"\")","v":"61748004501"}]
[null,null,null,null,"61748009201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2774,1),\"\"))","v":1},{"$f":"IF(F2774=1,COUNTIF($F$3:F2774,1),\"\")","v":2772},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2774),$G$3:$G$3716,0)),\"\")","v":"61748009201"}]
[null,null,null,null,"61787044202",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2775,1),\"\"))","v":1},{"$f":"IF(F2775=1,COUNTIF($F$3:F2775,1),\"\")","v":2773},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2775),$G$3:$G$3716,0)),\"\")","v":"61787044202"}]
[null,null,null,null,"61924018802",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2776,1),\"\"))","v":1},{"$f":"IF(F2776=1,COUNTIF($F$3:F2776,1),\"\")","v":2774},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2776),$G$3:$G$3716,0)),\"\")","v":"61924018802"}]
[null,null,null,null,"61924018808",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2777,1),\"\"))","v":1},{"$f":"IF(F2777=1,COUNTIF($F$3:F2777,1),\"\")","v":2775},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2777),$G$3:$G$3716,0)),\"\")","v":"61924018808"}]
[null,null,null,null,"61958040101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2778,1),\"\"))","v":1},{"$f":"IF(F2778=1,COUNTIF($F$3:F2778,1),\"\")","v":2776},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2778),$G$3:$G$3716,0)),\"\")","v":"61958040101"}]
[null,null,null,null,"61958040401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2779,1),\"\"))","v":1},{"$f":"IF(F2779=1,COUNTIF($F$3:F2779,1),\"\")","v":2777},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2779),$G$3:$G$3716,0)),\"\")","v":"61958040401"}]
[null,null,null,null,"61958040501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2780,1),\"\"))","v":1},{"$f":"IF(F2780=1,COUNTIF($F$3:F2780,1),\"\")","v":2778},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2780),$G$3:$G$3716,0)),\"\")","v":"61958040501"}]
[null,null,null,null,"61958040601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2781,1),\"\"))","v":1},{"$f":"IF(F2781=1,COUNTIF($F$3:F2781,1),\"\")","v":2779},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2781),$G$3:$G$3716,0)),\"\")","v":"61958040601"}]
[null,null,null,null,"61958050101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2782,1),\"\"))","v":1},{"$f":"IF(F2782=1,COUNTIF($F$3:F2782,1),\"\")","v":2780},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2782),$G$3:$G$3716,0)),\"\")","v":"61958050101"}]
[null,null,null,null,"61958060101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2783,1),\"\"))","v":1},{"$f":"IF(F2783=1,COUNTIF($F$3:F2783,1),\"\")","v":2781},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2783),$G$3:$G$3716,0)),\"\")","v":"61958060101"}]
[null,null,null,null,"61958070101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2784,1),\"\"))","v":1},{"$f":"IF(F2784=1,COUNTIF($F$3:F2784,1),\"\")","v":2782},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2784),$G$3:$G$3716,0)),\"\")","v":"61958070101"}]
[null,null,null,null,"61958080101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2785,1),\"\"))","v":1},{"$f":"IF(F2785=1,COUNTIF($F$3:F2785,1),\"\")","v":2783},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2785),$G$3:$G$3716,0)),\"\")","v":"61958080101"}]
[null,null,null,null,"61958080201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2786,1),\"\"))","v":1},{"$f":"IF(F2786=1,COUNTIF($F$3:F2786,1),\"\")","v":2784},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2786),$G$3:$G$3716,0)),\"\")","v":"61958080201"}]
[null,null,null,null,"61958100301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2787,1),\"\"))","v":1},{"$f":"IF(F2787=1,COUNTIF($F$3:F2787,1),\"\")","v":2785},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2787),$G$3:$G$3716,0)),\"\")","v":"61958100301"}]
[null,null,null,null,"61958110101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2788,1),\"\"))","v":1},{"$f":"IF(F2788=1,COUNTIF($F$3:F2788,1),\"\")","v":2786},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2788),$G$3:$G$3716,0)),\"\")","v":"61958110101"}]
[null,null,null,null,"61958120101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2789,1),\"\"))","v":1},{"$f":"IF(F2789=1,COUNTIF($F$3:F2789,1),\"\")","v":2787},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2789),$G$3:$G$3716,0)),\"\")","v":"61958120101"}]
[null,null,null,null,"61958180101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2790,1),\"\"))","v":1},{"$f":"IF(F2790=1,COUNTIF($F$3:F2790,1),\"\")","v":2788},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2790),$G$3:$G$3716,0)),\"\")","v":"61958180101"}]
[null,null,null,null,"61958190101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2791,1),\"\"))","v":1},{"$f":"IF(F2791=1,COUNTIF($F$3:F2791,1),\"\")","v":2789},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2791),$G$3:$G$3716,0)),\"\")","v":"61958190101"}]
[null,null,null,null,"61958200201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2792,1),\"\"))","v":1},{"$f":"IF(F2792=1,COUNTIF($F$3:F2792,1),\"\")","v":2790},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2792),$G$3:$G$3716,0)),\"\")","v":"61958200201"}]
[null,null,null,null,"61958210101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2793,1),\"\"))","v":1},{"$f":"IF(F2793=1,COUNTIF($F$3:F2793,1),\"\")","v":2791},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2793),$G$3:$G$3716,0)),\"\")","v":"61958210101"}]
[null,null,null,null,"61958220101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2794,1),\"\"))","v":1},{"$f":"IF(F2794=1,COUNTIF($F$3:F2794,1),\"\")","v":2792},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2794),$G$3:$G$3716,0)),\"\")","v":"61958220101"}]
[null,null,null,null,"61958240101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2795,1),\"\"))","v":1},{"$f":"IF(F2795=1,COUNTIF($F$3:F2795,1),\"\")","v":2793},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2795),$G$3:$G$3716,0)),\"\")","v":"61958240101"}]
[null,null,null,null,"61958250101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2796,1),\"\"))","v":1},{"$f":"IF(F2796=1,COUNTIF($F$3:F2796,1),\"\")","v":2794},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2796),$G$3:$G$3716,0)),\"\")","v":"61958250101"}]
[null,null,null,null,"61958290101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2797,1),\"\"))","v":1},{"$f":"IF(F2797=1,COUNTIF($F$3:F2797,1),\"\")","v":2795},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2797),$G$3:$G$3716,0)),\"\")","v":"61958290101"}]
[null,null,null,null,"62037083001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2798,1),\"\"))","v":1},{"$f":"IF(F2798=1,COUNTIF($F$3:F2798,1),\"\")","v":2796},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2798),$G$3:$G$3716,0)),\"\")","v":"62037083001"}]
[null,null,null,null,"62037083101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2799,1),\"\"))","v":1},{"$f":"IF(F2799=1,COUNTIF($F$3:F2799,1),\"\")","v":2797},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2799),$G$3:$G$3716,0)),\"\")","v":"62037083101"}]
[null,null,null,null,"62037083201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2800,1),\"\"))","v":1},{"$f":"IF(F2800=1,COUNTIF($F$3:F2800,1),\"\")","v":2798},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2800),$G$3:$G$3716,0)),\"\")","v":"62037083201"}]
[null,null,null,null,"62144551005",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2801,1),\"\"))","v":1},{"$f":"IF(F2801=1,COUNTIF($F$3:F2801,1),\"\")","v":2799},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2801),$G$3:$G$3716,0)),\"\")","v":"62144551005"}]
[null,null,null,null,"62175010701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2802,1),\"\"))","v":1},{"$f":"IF(F2802=1,COUNTIF($F$3:F2802,1),\"\")","v":2800},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2802),$G$3:$G$3716,0)),\"\")","v":"62175010701"}]
[null,null,null,null,"62175011937",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2803,1),\"\"))","v":1},{"$f":"IF(F2803=1,COUNTIF($F$3:F2803,1),\"\")","v":2801},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2803),$G$3:$G$3716,0)),\"\")","v":"62175011937"}]
[null,null,null,null,"62175020546",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2804,1),\"\"))","v":1},{"$f":"IF(F2804=1,COUNTIF($F$3:F2804,1),\"\")","v":2802},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2804),$G$3:$G$3716,0)),\"\")","v":"62175020546"}]
[null,null,null,null,"62175021032",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2805,1),\"\"))","v":1},{"$f":"IF(F2805=1,COUNTIF($F$3:F2805,1),\"\")","v":2803},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2805),$G$3:$G$3716,0)),\"\")","v":"62175021032"}]
[null,null,null,null,"62175061743",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2806,1),\"\"))","v":1},{"$f":"IF(F2806=1,COUNTIF($F$3:F2806,1),\"\")","v":2804},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2806),$G$3:$G$3716,0)),\"\")","v":"62175061743"}]
[null,null,null,null,"62327044404",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2807,1),\"\"))","v":1},{"$f":"IF(F2807=1,COUNTIF($F$3:F2807,1),\"\")","v":2805},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2807),$G$3:$G$3716,0)),\"\")","v":"62327044404"}]
[null,null,null,null,"62327044444",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2808,1),\"\"))","v":1},{"$f":"IF(F2808=1,COUNTIF($F$3:F2808,1),\"\")","v":2806},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2808),$G$3:$G$3716,0)),\"\")","v":"62327044444"}]
[null,null,null,null,"62332009930",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2809,1),\"\"))","v":1},{"$f":"IF(F2809=1,COUNTIF($F$3:F2809,1),\"\")","v":2807},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2809),$G$3:$G$3716,0)),\"\")","v":"62332009930"}]
[null,null,null,null,"62332010530",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2810,1),\"\"))","v":1},{"$f":"IF(F2810=1,COUNTIF($F$3:F2810,1),\"\")","v":2808},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2810),$G$3:$G$3716,0)),\"\")","v":"62332010530"}]
[null,null,null,null,"62332012390",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2811,1),\"\"))","v":1},{"$f":"IF(F2811=1,COUNTIF($F$3:F2811,1),\"\")","v":2809},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2811),$G$3:$G$3716,0)),\"\")","v":"62332012390"}]
[null,null,null,null,"62332038530",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2812,1),\"\"))","v":1},{"$f":"IF(F2812=1,COUNTIF($F$3:F2812,1),\"\")","v":2810},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2812),$G$3:$G$3716,0)),\"\")","v":"62332038530"}]
[null,null,null,null,"62559013807",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2813,1),\"\"))","v":1},{"$f":"IF(F2813=1,COUNTIF($F$3:F2813,1),\"\")","v":2811},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2813),$G$3:$G$3716,0)),\"\")","v":"62559013807"}]
[null,null,null,null,"62559015304",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2814,1),\"\"))","v":1},{"$f":"IF(F2814=1,COUNTIF($F$3:F2814,1),\"\")","v":2812},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2814),$G$3:$G$3716,0)),\"\")","v":"62559015304"}]
[null,null,null,null,"62559015901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2815,1),\"\"))","v":1},{"$f":"IF(F2815=1,COUNTIF($F$3:F2815,1),\"\")","v":2813},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2815),$G$3:$G$3716,0)),\"\")","v":"62559015901"}]
[null,null,null,null,"62559021052",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2816,1),\"\"))","v":1},{"$f":"IF(F2816=1,COUNTIF($F$3:F2816,1),\"\")","v":2814},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2816),$G$3:$G$3716,0)),\"\")","v":"62559021052"}]
[null,null,null,null,"62559024101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2817,1),\"\"))","v":1},{"$f":"IF(F2817=1,COUNTIF($F$3:F2817,1),\"\")","v":2815},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2817),$G$3:$G$3716,0)),\"\")","v":"62559024101"}]
[null,null,null,null,"62559063001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2818,1),\"\"))","v":1},{"$f":"IF(F2818=1,COUNTIF($F$3:F2818,1),\"\")","v":2816},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2818),$G$3:$G$3716,0)),\"\")","v":"62559063001"}]
[null,null,null,null,"62584014301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2819,1),\"\"))","v":1},{"$f":"IF(F2819=1,COUNTIF($F$3:F2819,1),\"\")","v":2817},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2819),$G$3:$G$3716,0)),\"\")","v":"62584014301"}]
[null,null,null,null,"62584026501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2820,1),\"\"))","v":1},{"$f":"IF(F2820=1,COUNTIF($F$3:F2820,1),\"\")","v":2818},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2820),$G$3:$G$3716,0)),\"\")","v":"62584026501"}]
[null,null,null,null,"62584026511",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2821,1),\"\"))","v":1},{"$f":"IF(F2821=1,COUNTIF($F$3:F2821,1),\"\")","v":2819},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2821),$G$3:$G$3716,0)),\"\")","v":"62584026511"}]
[null,null,null,null,"62584026601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2822,1),\"\"))","v":1},{"$f":"IF(F2822=1,COUNTIF($F$3:F2822,1),\"\")","v":2820},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2822),$G$3:$G$3716,0)),\"\")","v":"62584026601"}]
[null,null,null,null,"62584026611",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2823,1),\"\"))","v":1},{"$f":"IF(F2823=1,COUNTIF($F$3:F2823,1),\"\")","v":2821},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2823),$G$3:$G$3716,0)),\"\")","v":"62584026611"}]
[null,null,null,null,"62584033901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2824,1),\"\"))","v":1},{"$f":"IF(F2824=1,COUNTIF($F$3:F2824,1),\"\")","v":2822},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2824),$G$3:$G$3716,0)),\"\")","v":"62584033901"}]
[null,null,null,null,"62584046701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2825,1),\"\"))","v":1},{"$f":"IF(F2825=1,COUNTIF($F$3:F2825,1),\"\")","v":2823},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2825),$G$3:$G$3716,0)),\"\")","v":"62584046701"}]
[null,null,null,null,"62584046711",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2826,1),\"\"))","v":1},{"$f":"IF(F2826=1,COUNTIF($F$3:F2826,1),\"\")","v":2824},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2826),$G$3:$G$3716,0)),\"\")","v":"62584046711"}]
[null,null,null,null,"62584055911",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2827,1),\"\"))","v":1},{"$f":"IF(F2827=1,COUNTIF($F$3:F2827,1),\"\")","v":2825},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2827),$G$3:$G$3716,0)),\"\")","v":"62584055911"}]
[null,null,null,null,"62584065701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2828,1),\"\"))","v":1},{"$f":"IF(F2828=1,COUNTIF($F$3:F2828,1),\"\")","v":2826},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2828),$G$3:$G$3716,0)),\"\")","v":"62584065701"}]
[null,null,null,null,"62584071301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2829,1),\"\"))","v":1},{"$f":"IF(F2829=1,COUNTIF($F$3:F2829,1),\"\")","v":2827},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2829),$G$3:$G$3716,0)),\"\")","v":"62584071301"}]
[null,null,null,null,"62584073301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2830,1),\"\"))","v":1},{"$f":"IF(F2830=1,COUNTIF($F$3:F2830,1),\"\")","v":2828},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2830),$G$3:$G$3716,0)),\"\")","v":"62584073301"}]
[null,null,null,null,"62584073401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2831,1),\"\"))","v":1},{"$f":"IF(F2831=1,COUNTIF($F$3:F2831,1),\"\")","v":2829},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2831),$G$3:$G$3716,0)),\"\")","v":"62584073401"}]
[null,null,null,null,"62584074701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2832,1),\"\"))","v":1},{"$f":"IF(F2832=1,COUNTIF($F$3:F2832,1),\"\")","v":2830},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2832),$G$3:$G$3716,0)),\"\")","v":"62584074701"}]
[null,null,null,null,"62584074801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2833,1),\"\"))","v":1},{"$f":"IF(F2833=1,COUNTIF($F$3:F2833,1),\"\")","v":2831},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2833),$G$3:$G$3716,0)),\"\")","v":"62584074801"}]
[null,null,null,null,"62584081201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2834,1),\"\"))","v":1},{"$f":"IF(F2834=1,COUNTIF($F$3:F2834,1),\"\")","v":2832},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2834),$G$3:$G$3716,0)),\"\")","v":"62584081201"}]
[null,null,null,null,"62584081301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2835,1),\"\"))","v":1},{"$f":"IF(F2835=1,COUNTIF($F$3:F2835,1),\"\")","v":2833},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2835),$G$3:$G$3716,0)),\"\")","v":"62584081301"}]
[null,null,null,null,"62584089701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2836,1),\"\"))","v":1},{"$f":"IF(F2836=1,COUNTIF($F$3:F2836,1),\"\")","v":2834},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2836),$G$3:$G$3716,0)),\"\")","v":"62584089701"}]
[null,null,null,null,"62584089711",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2837,1),\"\"))","v":1},{"$f":"IF(F2837=1,COUNTIF($F$3:F2837,1),\"\")","v":2835},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2837),$G$3:$G$3716,0)),\"\")","v":"62584089711"}]
[null,null,null,null,"62584097601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2838,1),\"\"))","v":1},{"$f":"IF(F2838=1,COUNTIF($F$3:F2838,1),\"\")","v":2836},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2838),$G$3:$G$3716,0)),\"\")","v":"62584097601"}]
[null,null,null,null,"62584097701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2839,1),\"\"))","v":1},{"$f":"IF(F2839=1,COUNTIF($F$3:F2839,1),\"\")","v":2837},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2839),$G$3:$G$3716,0)),\"\")","v":"62584097701"}]
[null,null,null,null,"62584098801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2840,1),\"\"))","v":1},{"$f":"IF(F2840=1,COUNTIF($F$3:F2840,1),\"\")","v":2838},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2840),$G$3:$G$3716,0)),\"\")","v":"62584098801"}]
[null,null,null,null,"62584099001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2841,1),\"\"))","v":1},{"$f":"IF(F2841=1,COUNTIF($F$3:F2841,1),\"\")","v":2839},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2841),$G$3:$G$3716,0)),\"\")","v":"62584099001"}]
[null,null,null,null,"62584099411",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2842,1),\"\"))","v":1},{"$f":"IF(F2842=1,COUNTIF($F$3:F2842,1),\"\")","v":2840},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2842),$G$3:$G$3716,0)),\"\")","v":"62584099411"}]
[null,null,null,null,"62756016088",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2843,1),\"\"))","v":1},{"$f":"IF(F2843=1,COUNTIF($F$3:F2843,1),\"\")","v":2841},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2843),$G$3:$G$3716,0)),\"\")","v":"62756016088"}]
[null,null,null,null,"62756018388",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2844,1),\"\"))","v":1},{"$f":"IF(F2844=1,COUNTIF($F$3:F2844,1),\"\")","v":2842},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2844),$G$3:$G$3716,0)),\"\")","v":"62756018388"}]
[null,null,null,null,"62756018488",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2845,1),\"\"))","v":1},{"$f":"IF(F2845=1,COUNTIF($F$3:F2845,1),\"\")","v":2843},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2845),$G$3:$G$3716,0)),\"\")","v":"62756018488"}]
[null,null,null,null,"62756020083",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2846,1),\"\"))","v":1},{"$f":"IF(F2846=1,COUNTIF($F$3:F2846,1),\"\")","v":2844},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2846),$G$3:$G$3716,0)),\"\")","v":"62756020083"}]
[null,null,null,null,"62756022483",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2847,1),\"\"))","v":1},{"$f":"IF(F2847=1,COUNTIF($F$3:F2847,1),\"\")","v":2845},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2847),$G$3:$G$3716,0)),\"\")","v":"62756022483"}]
[null,null,null,null,"62756026002",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2848,1),\"\"))","v":1},{"$f":"IF(F2848=1,COUNTIF($F$3:F2848,1),\"\")","v":2846},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2848),$G$3:$G$3716,0)),\"\")","v":"62756026002"}]
[null,null,null,null,"62756045788",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2849,1),\"\"))","v":1},{"$f":"IF(F2849=1,COUNTIF($F$3:F2849,1),\"\")","v":2847},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2849),$G$3:$G$3716,0)),\"\")","v":"62756045788"}]
[null,null,null,null,"62756051788",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2850,1),\"\"))","v":1},{"$f":"IF(F2850=1,COUNTIF($F$3:F2850,1),\"\")","v":2848},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2850),$G$3:$G$3716,0)),\"\")","v":"62756051788"}]
[null,null,null,null,"62756051888",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2851,1),\"\"))","v":1},{"$f":"IF(F2851=1,COUNTIF($F$3:F2851,1),\"\")","v":2849},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2851),$G$3:$G$3716,0)),\"\")","v":"62756051888"}]
[null,null,null,null,"62756052069",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2852,1),\"\"))","v":1},{"$f":"IF(F2852=1,COUNTIF($F$3:F2852,1),\"\")","v":2850},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2852),$G$3:$G$3716,0)),\"\")","v":"62756052069"}]
[null,null,null,null,"62756070786",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2853,1),\"\"))","v":1},{"$f":"IF(F2853=1,COUNTIF($F$3:F2853,1),\"\")","v":2851},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2853),$G$3:$G$3716,0)),\"\")","v":"62756070786"}]
[null,null,null,null,"62756071186",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2854,1),\"\"))","v":1},{"$f":"IF(F2854=1,COUNTIF($F$3:F2854,1),\"\")","v":2852},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2854),$G$3:$G$3716,0)),\"\")","v":"62756071186"}]
[null,null,null,null,"62756071286",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2855,1),\"\"))","v":1},{"$f":"IF(F2855=1,COUNTIF($F$3:F2855,1),\"\")","v":2853},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2855),$G$3:$G$3716,0)),\"\")","v":"62756071286"}]
[null,null,null,null,"62756071860",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2856,1),\"\"))","v":1},{"$f":"IF(F2856=1,COUNTIF($F$3:F2856,1),\"\")","v":2854},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2856),$G$3:$G$3716,0)),\"\")","v":"62756071860"}]
[null,null,null,null,"62756079688",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2857,1),\"\"))","v":1},{"$f":"IF(F2857=1,COUNTIF($F$3:F2857,1),\"\")","v":2855},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2857),$G$3:$G$3716,0)),\"\")","v":"62756079688"}]
[null,null,null,null,"62756079788",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2858,1),\"\"))","v":1},{"$f":"IF(F2858=1,COUNTIF($F$3:F2858,1),\"\")","v":2856},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2858),$G$3:$G$3716,0)),\"\")","v":"62756079788"}]
[null,null,null,null,"62856027230",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2859,1),\"\"))","v":1},{"$f":"IF(F2859=1,COUNTIF($F$3:F2859,1),\"\")","v":2857},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2859),$G$3:$G$3716,0)),\"\")","v":"62856027230"}]
[null,null,null,null,"62856027630",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2860,1),\"\"))","v":1},{"$f":"IF(F2860=1,COUNTIF($F$3:F2860,1),\"\")","v":2858},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2860),$G$3:$G$3716,0)),\"\")","v":"62856027630"}]
[null,null,null,null,"62856028030",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2861,1),\"\"))","v":1},{"$f":"IF(F2861=1,COUNTIF($F$3:F2861,1),\"\")","v":2859},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2861),$G$3:$G$3716,0)),\"\")","v":"62856028030"}]
[null,null,null,null,"62856058252",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2862,1),\"\"))","v":1},{"$f":"IF(F2862=1,COUNTIF($F$3:F2862,1),\"\")","v":2860},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2862),$G$3:$G$3716,0)),\"\")","v":"62856058252"}]
[null,null,null,null,"62856058352",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2863,1),\"\"))","v":1},{"$f":"IF(F2863=1,COUNTIF($F$3:F2863,1),\"\")","v":2861},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2863),$G$3:$G$3716,0)),\"\")","v":"62856058352"}]
[null,null,null,null,"62856068010",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2864,1),\"\"))","v":1},{"$f":"IF(F2864=1,COUNTIF($F$3:F2864,1),\"\")","v":2862},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2864),$G$3:$G$3716,0)),\"\")","v":"62856068010"}]
[null,null,null,null,"62856068110",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2865,1),\"\"))","v":1},{"$f":"IF(F2865=1,COUNTIF($F$3:F2865,1),\"\")","v":2863},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2865),$G$3:$G$3716,0)),\"\")","v":"62856068110"}]
[null,null,null,null,"63010001030",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2866,1),\"\"))","v":1},{"$f":"IF(F2866=1,COUNTIF($F$3:F2866,1),\"\")","v":2864},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2866),$G$3:$G$3716,0)),\"\")","v":"63010001030"}]
[null,null,null,null,"63010002770",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2867,1),\"\"))","v":1},{"$f":"IF(F2867=1,COUNTIF($F$3:F2867,1),\"\")","v":2865},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2867),$G$3:$G$3716,0)),\"\")","v":"63010002770"}]
[null,null,null,null,"63044048409",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2868,1),\"\"))","v":1},{"$f":"IF(F2868=1,COUNTIF($F$3:F2868,1),\"\")","v":2866},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2868),$G$3:$G$3716,0)),\"\")","v":"63044048409"}]
[null,null,null,null,"63044062201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2869,1),\"\"))","v":1},{"$f":"IF(F2869=1,COUNTIF($F$3:F2869,1),\"\")","v":2867},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2869),$G$3:$G$3716,0)),\"\")","v":"63044062201"}]
[null,null,null,null,"63256020005",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2870,1),\"\"))","v":1},{"$f":"IF(F2870=1,COUNTIF($F$3:F2870,1),\"\")","v":2868},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2870),$G$3:$G$3716,0)),\"\")","v":"63256020005"}]
[null,null,null,null,"63304029601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2871,1),\"\"))","v":1},{"$f":"IF(F2871=1,COUNTIF($F$3:F2871,1),\"\")","v":2869},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2871),$G$3:$G$3716,0)),\"\")","v":"63304029601"}]
[null,null,null,null,"63304057901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2872,1),\"\"))","v":1},{"$f":"IF(F2872=1,COUNTIF($F$3:F2872,1),\"\")","v":2870},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2872),$G$3:$G$3716,0)),\"\")","v":"63304057901"}]
[null,null,null,null,"63304058360",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2873,1),\"\"))","v":1},{"$f":"IF(F2873=1,COUNTIF($F$3:F2873,1),\"\")","v":2871},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2873),$G$3:$G$3716,0)),\"\")","v":"63304058360"}]
[null,null,null,null,"63304082990",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2874,1),\"\"))","v":1},{"$f":"IF(F2874=1,COUNTIF($F$3:F2874,1),\"\")","v":2872},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2874),$G$3:$G$3716,0)),\"\")","v":"63304082990"}]
[null,null,null,null,"63304083090",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2875,1),\"\"))","v":1},{"$f":"IF(F2875=1,COUNTIF($F$3:F2875,1),\"\")","v":2873},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2875),$G$3:$G$3716,0)),\"\")","v":"63304083090"}]
[null,null,null,null,"63323008861",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2876,1),\"\"))","v":1},{"$f":"IF(F2876=1,COUNTIF($F$3:F2876,1),\"\")","v":2874},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2876),$G$3:$G$3716,0)),\"\")","v":"63323008861"}]
[null,null,null,null,"63323008863",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2877,1),\"\"))","v":1},{"$f":"IF(F2877=1,COUNTIF($F$3:F2877,1),\"\")","v":2875},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2877),$G$3:$G$3716,0)),\"\")","v":"63323008863"}]
[null,null,null,null,"63323011310",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2878,1),\"\"))","v":1},{"$f":"IF(F2878=1,COUNTIF($F$3:F2878,1),\"\")","v":2876},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2878),$G$3:$G$3716,0)),\"\")","v":"63323011310"}]
[null,null,null,null,"63323013011",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2879,1),\"\"))","v":1},{"$f":"IF(F2879=1,COUNTIF($F$3:F2879,1),\"\")","v":2877},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2879),$G$3:$G$3716,0)),\"\")","v":"63323013011"}]
[null,null,null,null,"63323018730",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2880,1),\"\"))","v":1},{"$f":"IF(F2880=1,COUNTIF($F$3:F2880,1),\"\")","v":2878},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2880),$G$3:$G$3716,0)),\"\")","v":"63323018730"}]
[null,null,null,null,"63323020500",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2881,1),\"\"))","v":1},{"$f":"IF(F2881=1,COUNTIF($F$3:F2881,1),\"\")","v":2879},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2881),$G$3:$G$3716,0)),\"\")","v":"63323020500"}]
[null,null,null,null,"63323020550",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2882,1),\"\"))","v":1},{"$f":"IF(F2882=1,COUNTIF($F$3:F2882,1),\"\")","v":2880},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2882),$G$3:$G$3716,0)),\"\")","v":"63323020550"}]
[null,null,null,null,"63323025410",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2883,1),\"\"))","v":1},{"$f":"IF(F2883=1,COUNTIF($F$3:F2883,1),\"\")","v":2881},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2883),$G$3:$G$3716,0)),\"\")","v":"63323025410"}]
[null,null,null,null,"63323032110",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2884,1),\"\"))","v":1},{"$f":"IF(F2884=1,COUNTIF($F$3:F2884,1),\"\")","v":2882},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2884),$G$3:$G$3716,0)),\"\")","v":"63323032110"}]
[null,null,null,null,"63323032710",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2885,1),\"\"))","v":1},{"$f":"IF(F2885=1,COUNTIF($F$3:F2885,1),\"\")","v":2883},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2885),$G$3:$G$3716,0)),\"\")","v":"63323032710"}]
[null,null,null,null,"63323032930",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2886,1),\"\"))","v":1},{"$f":"IF(F2886=1,COUNTIF($F$3:F2886,1),\"\")","v":2884},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2886),$G$3:$G$3716,0)),\"\")","v":"63323032930"}]
[null,null,null,null,"63323032931",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2887,1),\"\"))","v":1},{"$f":"IF(F2887=1,COUNTIF($F$3:F2887,1),\"\")","v":2885},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2887),$G$3:$G$3716,0)),\"\")","v":"63323032931"}]
[null,null,null,null,"63323035120",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2888,1),\"\"))","v":1},{"$f":"IF(F2888=1,COUNTIF($F$3:F2888,1),\"\")","v":2886},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2888),$G$3:$G$3716,0)),\"\")","v":"63323035120"}]
[null,null,null,null,"63323036711",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2889,1),\"\"))","v":1},{"$f":"IF(F2889=1,COUNTIF($F$3:F2889,1),\"\")","v":2887},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2889),$G$3:$G$3716,0)),\"\")","v":"63323036711"}]
[null,null,null,null,"63323040120",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2890,1),\"\"))","v":1},{"$f":"IF(F2890=1,COUNTIF($F$3:F2890,1),\"\")","v":2888},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2890),$G$3:$G$3716,0)),\"\")","v":"63323040120"}]
[null,null,null,null,"63323040220",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2891,1),\"\"))","v":1},{"$f":"IF(F2891=1,COUNTIF($F$3:F2891,1),\"\")","v":2889},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2891),$G$3:$G$3716,0)),\"\")","v":"63323040220"}]
[null,null,null,null,"63323064810",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2892,1),\"\"))","v":1},{"$f":"IF(F2892=1,COUNTIF($F$3:F2892,1),\"\")","v":2890},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2892),$G$3:$G$3716,0)),\"\")","v":"63323064810"}]
[null,null,null,null,"63323064907",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2893,1),\"\"))","v":1},{"$f":"IF(F2893=1,COUNTIF($F$3:F2893,1),\"\")","v":2891},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2893),$G$3:$G$3716,0)),\"\")","v":"63323064907"}]
[null,null,null,null,"63323065903",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2894,1),\"\"))","v":1},{"$f":"IF(F2894=1,COUNTIF($F$3:F2894,1),\"\")","v":2892},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2894),$G$3:$G$3716,0)),\"\")","v":"63323065903"}]
[null,null,null,null,"63323072303",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2895,1),\"\"))","v":1},{"$f":"IF(F2895=1,COUNTIF($F$3:F2895,1),\"\")","v":2893},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2895),$G$3:$G$3716,0)),\"\")","v":"63323072303"}]
[null,null,null,null,"63323072401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2896,1),\"\"))","v":1},{"$f":"IF(F2896=1,COUNTIF($F$3:F2896,1),\"\")","v":2894},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2896),$G$3:$G$3716,0)),\"\")","v":"63323072401"}]
[null,null,null,null,"63323072405",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2897,1),\"\"))","v":1},{"$f":"IF(F2897=1,COUNTIF($F$3:F2897,1),\"\")","v":2895},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2897),$G$3:$G$3716,0)),\"\")","v":"63323072405"}]
[null,null,null,null,"63323078110",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2898,1),\"\"))","v":1},{"$f":"IF(F2898=1,COUNTIF($F$3:F2898,1),\"\")","v":2896},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2898),$G$3:$G$3716,0)),\"\")","v":"63323078110"}]
[null,null,null,null,"63323082003",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2899,1),\"\"))","v":1},{"$f":"IF(F2899=1,COUNTIF($F$3:F2899,1),\"\")","v":2897},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2899),$G$3:$G$3716,0)),\"\")","v":"63323082003"}]
[null,null,null,null,"63323082050",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2900,1),\"\"))","v":1},{"$f":"IF(F2900=1,COUNTIF($F$3:F2900,1),\"\")","v":2898},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2900),$G$3:$G$3716,0)),\"\")","v":"63323082050"}]
[null,null,null,null,"63402030430",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2901,1),\"\"))","v":1},{"$f":"IF(F2901=1,COUNTIF($F$3:F2901,1),\"\")","v":2899},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2901),$G$3:$G$3716,0)),\"\")","v":"63402030430"}]
[null,null,null,null,"63402030630",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2902,1),\"\"))","v":1},{"$f":"IF(F2902=1,COUNTIF($F$3:F2902,1),\"\")","v":2900},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2902),$G$3:$G$3716,0)),\"\")","v":"63402030630"}]
[null,null,null,null,"63459010130",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2903,1),\"\"))","v":1},{"$f":"IF(F2903=1,COUNTIF($F$3:F2903,1),\"\")","v":2901},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2903),$G$3:$G$3716,0)),\"\")","v":"63459010130"}]
[null,null,null,null,"63481068706",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2904,1),\"\"))","v":1},{"$f":"IF(F2904=1,COUNTIF($F$3:F2904,1),\"\")","v":2902},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2904),$G$3:$G$3716,0)),\"\")","v":"63481068706"}]
[null,null,null,null,"63653117103",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2905,1),\"\"))","v":1},{"$f":"IF(F2905=1,COUNTIF($F$3:F2905,1),\"\")","v":2903},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2905),$G$3:$G$3716,0)),\"\")","v":"63653117103"}]
[null,null,null,null,"63739001410",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2906,1),\"\"))","v":1},{"$f":"IF(F2906=1,COUNTIF($F$3:F2906,1),\"\")","v":2904},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2906),$G$3:$G$3716,0)),\"\")","v":"63739001410"}]
[null,null,null,null,"63739001510",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2907,1),\"\"))","v":1},{"$f":"IF(F2907=1,COUNTIF($F$3:F2907,1),\"\")","v":2905},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2907),$G$3:$G$3716,0)),\"\")","v":"63739001510"}]
[null,null,null,null,"63739001710",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2908,1),\"\"))","v":1},{"$f":"IF(F2908=1,COUNTIF($F$3:F2908,1),\"\")","v":2906},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2908),$G$3:$G$3716,0)),\"\")","v":"63739001710"}]
[null,null,null,null,"63739004610",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2909,1),\"\"))","v":1},{"$f":"IF(F2909=1,COUNTIF($F$3:F2909,1),\"\")","v":2907},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2909),$G$3:$G$3716,0)),\"\")","v":"63739004610"}]
[null,null,null,null,"63739004710",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2910,1),\"\"))","v":1},{"$f":"IF(F2910=1,COUNTIF($F$3:F2910,1),\"\")","v":2908},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2910),$G$3:$G$3716,0)),\"\")","v":"63739004710"}]
[null,null,null,null,"63739005007",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2911,1),\"\"))","v":1},{"$f":"IF(F2911=1,COUNTIF($F$3:F2911,1),\"\")","v":2909},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2911),$G$3:$G$3716,0)),\"\")","v":"63739005007"}]
[null,null,null,null,"63739005110",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2912,1),\"\"))","v":1},{"$f":"IF(F2912=1,COUNTIF($F$3:F2912,1),\"\")","v":2910},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2912),$G$3:$G$3716,0)),\"\")","v":"63739005110"}]
[null,null,null,null,"63739007910",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2913,1),\"\"))","v":1},{"$f":"IF(F2913=1,COUNTIF($F$3:F2913,1),\"\")","v":2911},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2913),$G$3:$G$3716,0)),\"\")","v":"63739007910"}]
[null,null,null,null,"63739008010",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2914,1),\"\"))","v":1},{"$f":"IF(F2914=1,COUNTIF($F$3:F2914,1),\"\")","v":2912},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2914),$G$3:$G$3716,0)),\"\")","v":"63739008010"}]
[null,null,null,null,"63739008610",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2915,1),\"\"))","v":1},{"$f":"IF(F2915=1,COUNTIF($F$3:F2915,1),\"\")","v":2913},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2915),$G$3:$G$3716,0)),\"\")","v":"63739008610"}]
[null,null,null,null,"63739011910",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2916,1),\"\"))","v":1},{"$f":"IF(F2916=1,COUNTIF($F$3:F2916,1),\"\")","v":2914},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2916),$G$3:$G$3716,0)),\"\")","v":"63739011910"}]
[null,null,null,null,"63739012610",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2917,1),\"\"))","v":1},{"$f":"IF(F2917=1,COUNTIF($F$3:F2917,1),\"\")","v":2915},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2917),$G$3:$G$3716,0)),\"\")","v":"63739012610"}]
[null,null,null,null,"63739012710",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2918,1),\"\"))","v":1},{"$f":"IF(F2918=1,COUNTIF($F$3:F2918,1),\"\")","v":2916},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2918),$G$3:$G$3716,0)),\"\")","v":"63739012710"}]
[null,null,null,null,"63739012810",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2919,1),\"\"))","v":1},{"$f":"IF(F2919=1,COUNTIF($F$3:F2919,1),\"\")","v":2917},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2919),$G$3:$G$3716,0)),\"\")","v":"63739012810"}]
[null,null,null,null,"63739016510",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2920,1),\"\"))","v":1},{"$f":"IF(F2920=1,COUNTIF($F$3:F2920,1),\"\")","v":2918},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2920),$G$3:$G$3716,0)),\"\")","v":"63739016510"}]
[null,null,null,null,"63739016710",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2921,1),\"\"))","v":1},{"$f":"IF(F2921=1,COUNTIF($F$3:F2921,1),\"\")","v":2919},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2921),$G$3:$G$3716,0)),\"\")","v":"63739016710"}]
[null,null,null,null,"63739017210",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2922,1),\"\"))","v":1},{"$f":"IF(F2922=1,COUNTIF($F$3:F2922,1),\"\")","v":2920},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2922),$G$3:$G$3716,0)),\"\")","v":"63739017210"}]
[null,null,null,null,"63739020010",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2923,1),\"\"))","v":1},{"$f":"IF(F2923=1,COUNTIF($F$3:F2923,1),\"\")","v":2921},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2923),$G$3:$G$3716,0)),\"\")","v":"63739020010"}]
[null,null,null,null,"63739020110",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2924,1),\"\"))","v":1},{"$f":"IF(F2924=1,COUNTIF($F$3:F2924,1),\"\")","v":2922},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2924),$G$3:$G$3716,0)),\"\")","v":"63739020110"}]
[null,null,null,null,"63739021210",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2925,1),\"\"))","v":1},{"$f":"IF(F2925=1,COUNTIF($F$3:F2925,1),\"\")","v":2923},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2925),$G$3:$G$3716,0)),\"\")","v":"63739021210"}]
[null,null,null,null,"63739022510",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2926,1),\"\"))","v":1},{"$f":"IF(F2926=1,COUNTIF($F$3:F2926,1),\"\")","v":2924},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2926),$G$3:$G$3716,0)),\"\")","v":"63739022510"}]
[null,null,null,null,"63739022810",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2927,1),\"\"))","v":1},{"$f":"IF(F2927=1,COUNTIF($F$3:F2927,1),\"\")","v":2925},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2927),$G$3:$G$3716,0)),\"\")","v":"63739022810"}]
[null,null,null,null,"63739023610",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2928,1),\"\"))","v":1},{"$f":"IF(F2928=1,COUNTIF($F$3:F2928,1),\"\")","v":2926},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2928),$G$3:$G$3716,0)),\"\")","v":"63739023610"}]
[null,null,null,null,"63739025110",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2929,1),\"\"))","v":1},{"$f":"IF(F2929=1,COUNTIF($F$3:F2929,1),\"\")","v":2927},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2929),$G$3:$G$3716,0)),\"\")","v":"63739025110"}]
[null,null,null,null,"63739026310",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2930,1),\"\"))","v":1},{"$f":"IF(F2930=1,COUNTIF($F$3:F2930,1),\"\")","v":2928},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2930),$G$3:$G$3716,0)),\"\")","v":"63739026310"}]
[null,null,null,null,"63739026410",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2931,1),\"\"))","v":1},{"$f":"IF(F2931=1,COUNTIF($F$3:F2931,1),\"\")","v":2929},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2931),$G$3:$G$3716,0)),\"\")","v":"63739026410"}]
[null,null,null,null,"63739026910",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2932,1),\"\"))","v":1},{"$f":"IF(F2932=1,COUNTIF($F$3:F2932,1),\"\")","v":2930},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2932),$G$3:$G$3716,0)),\"\")","v":"63739026910"}]
[null,null,null,null,"63739027201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2933,1),\"\"))","v":1},{"$f":"IF(F2933=1,COUNTIF($F$3:F2933,1),\"\")","v":2931},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2933),$G$3:$G$3716,0)),\"\")","v":"63739027201"}]
[null,null,null,null,"63739027510",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2934,1),\"\"))","v":1},{"$f":"IF(F2934=1,COUNTIF($F$3:F2934,1),\"\")","v":2932},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2934),$G$3:$G$3716,0)),\"\")","v":"63739027510"}]
[null,null,null,null,"63739028310",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2935,1),\"\"))","v":1},{"$f":"IF(F2935=1,COUNTIF($F$3:F2935,1),\"\")","v":2933},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2935),$G$3:$G$3716,0)),\"\")","v":"63739028310"}]
[null,null,null,null,"63739028510",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2936,1),\"\"))","v":1},{"$f":"IF(F2936=1,COUNTIF($F$3:F2936,1),\"\")","v":2934},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2936),$G$3:$G$3716,0)),\"\")","v":"63739028510"}]
[null,null,null,null,"63739029310",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2937,1),\"\"))","v":1},{"$f":"IF(F2937=1,COUNTIF($F$3:F2937,1),\"\")","v":2935},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2937),$G$3:$G$3716,0)),\"\")","v":"63739029310"}]
[null,null,null,null,"63739035010",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2938,1),\"\"))","v":1},{"$f":"IF(F2938=1,COUNTIF($F$3:F2938,1),\"\")","v":2936},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2938),$G$3:$G$3716,0)),\"\")","v":"63739035010"}]
[null,null,null,null,"63739035410",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2939,1),\"\"))","v":1},{"$f":"IF(F2939=1,COUNTIF($F$3:F2939,1),\"\")","v":2937},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2939),$G$3:$G$3716,0)),\"\")","v":"63739035410"}]
[null,null,null,null,"63739035510",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2940,1),\"\"))","v":1},{"$f":"IF(F2940=1,COUNTIF($F$3:F2940,1),\"\")","v":2938},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2940),$G$3:$G$3716,0)),\"\")","v":"63739035510"}]
[null,null,null,null,"63739036710",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2941,1),\"\"))","v":1},{"$f":"IF(F2941=1,COUNTIF($F$3:F2941,1),\"\")","v":2939},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2941),$G$3:$G$3716,0)),\"\")","v":"63739036710"}]
[null,null,null,null,"63739037510",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2942,1),\"\"))","v":1},{"$f":"IF(F2942=1,COUNTIF($F$3:F2942,1),\"\")","v":2940},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2942),$G$3:$G$3716,0)),\"\")","v":"63739037510"}]
[null,null,null,null,"63739038710",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2943,1),\"\"))","v":1},{"$f":"IF(F2943=1,COUNTIF($F$3:F2943,1),\"\")","v":2941},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2943),$G$3:$G$3716,0)),\"\")","v":"63739038710"}]
[null,null,null,null,"63739041110",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2944,1),\"\"))","v":1},{"$f":"IF(F2944=1,COUNTIF($F$3:F2944,1),\"\")","v":2942},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2944),$G$3:$G$3716,0)),\"\")","v":"63739041110"}]
[null,null,null,null,"63739043401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2945,1),\"\"))","v":1},{"$f":"IF(F2945=1,COUNTIF($F$3:F2945,1),\"\")","v":2943},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2945),$G$3:$G$3716,0)),\"\")","v":"63739043401"}]
[null,null,null,null,"63739044001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2946,1),\"\"))","v":1},{"$f":"IF(F2946=1,COUNTIF($F$3:F2946,1),\"\")","v":2944},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2946),$G$3:$G$3716,0)),\"\")","v":"63739044001"}]
[null,null,null,null,"63739044310",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2947,1),\"\"))","v":1},{"$f":"IF(F2947=1,COUNTIF($F$3:F2947,1),\"\")","v":2945},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2947),$G$3:$G$3716,0)),\"\")","v":"63739044310"}]
[null,null,null,null,"63739044710",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2948,1),\"\"))","v":1},{"$f":"IF(F2948=1,COUNTIF($F$3:F2948,1),\"\")","v":2946},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2948),$G$3:$G$3716,0)),\"\")","v":"63739044710"}]
[null,null,null,null,"63739045410",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2949,1),\"\"))","v":1},{"$f":"IF(F2949=1,COUNTIF($F$3:F2949,1),\"\")","v":2947},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2949),$G$3:$G$3716,0)),\"\")","v":"63739045410"}]
[null,null,null,null,"63739047810",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2950,1),\"\"))","v":1},{"$f":"IF(F2950=1,COUNTIF($F$3:F2950,1),\"\")","v":2948},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2950),$G$3:$G$3716,0)),\"\")","v":"63739047810"}]
[null,null,null,null,"63739047910",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2951,1),\"\"))","v":1},{"$f":"IF(F2951=1,COUNTIF($F$3:F2951,1),\"\")","v":2949},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2951),$G$3:$G$3716,0)),\"\")","v":"63739047910"}]
[null,null,null,null,"63739048210",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2952,1),\"\"))","v":1},{"$f":"IF(F2952=1,COUNTIF($F$3:F2952,1),\"\")","v":2950},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2952),$G$3:$G$3716,0)),\"\")","v":"63739048210"}]
[null,null,null,null,"63739048410",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2953,1),\"\"))","v":1},{"$f":"IF(F2953=1,COUNTIF($F$3:F2953,1),\"\")","v":2951},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2953),$G$3:$G$3716,0)),\"\")","v":"63739048410"}]
[null,null,null,null,"63739048610",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2954,1),\"\"))","v":1},{"$f":"IF(F2954=1,COUNTIF($F$3:F2954,1),\"\")","v":2952},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2954),$G$3:$G$3716,0)),\"\")","v":"63739048610"}]
[null,null,null,null,"63739049910",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2955,1),\"\"))","v":1},{"$f":"IF(F2955=1,COUNTIF($F$3:F2955,1),\"\")","v":2953},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2955),$G$3:$G$3716,0)),\"\")","v":"63739049910"}]
[null,null,null,null,"63739050110",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2956,1),\"\"))","v":1},{"$f":"IF(F2956=1,COUNTIF($F$3:F2956,1),\"\")","v":2954},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2956),$G$3:$G$3716,0)),\"\")","v":"63739050110"}]
[null,null,null,null,"63739051610",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2957,1),\"\"))","v":1},{"$f":"IF(F2957=1,COUNTIF($F$3:F2957,1),\"\")","v":2955},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2957),$G$3:$G$3716,0)),\"\")","v":"63739051610"}]
[null,null,null,null,"63739052201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2958,1),\"\"))","v":1},{"$f":"IF(F2958=1,COUNTIF($F$3:F2958,1),\"\")","v":2956},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2958),$G$3:$G$3716,0)),\"\")","v":"63739052201"}]
[null,null,null,null,"63739052210",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2959,1),\"\"))","v":1},{"$f":"IF(F2959=1,COUNTIF($F$3:F2959,1),\"\")","v":2957},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2959),$G$3:$G$3716,0)),\"\")","v":"63739052210"}]
[null,null,null,null,"63739052510",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2960,1),\"\"))","v":1},{"$f":"IF(F2960=1,COUNTIF($F$3:F2960,1),\"\")","v":2958},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2960),$G$3:$G$3716,0)),\"\")","v":"63739052510"}]
[null,null,null,null,"63739053110",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2961,1),\"\"))","v":1},{"$f":"IF(F2961=1,COUNTIF($F$3:F2961,1),\"\")","v":2959},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2961),$G$3:$G$3716,0)),\"\")","v":"63739053110"}]
[null,null,null,null,"63739053710",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2962,1),\"\"))","v":1},{"$f":"IF(F2962=1,COUNTIF($F$3:F2962,1),\"\")","v":2960},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2962),$G$3:$G$3716,0)),\"\")","v":"63739053710"}]
[null,null,null,null,"63739054110",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2963,1),\"\"))","v":1},{"$f":"IF(F2963=1,COUNTIF($F$3:F2963,1),\"\")","v":2961},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2963),$G$3:$G$3716,0)),\"\")","v":"63739054110"}]
[null,null,null,null,"63739054210",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2964,1),\"\"))","v":1},{"$f":"IF(F2964=1,COUNTIF($F$3:F2964,1),\"\")","v":2962},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2964),$G$3:$G$3716,0)),\"\")","v":"63739054210"}]
[null,null,null,null,"63739054410",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2965,1),\"\"))","v":1},{"$f":"IF(F2965=1,COUNTIF($F$3:F2965,1),\"\")","v":2963},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2965),$G$3:$G$3716,0)),\"\")","v":"63739054410"}]
[null,null,null,null,"63739054833",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2966,1),\"\"))","v":1},{"$f":"IF(F2966=1,COUNTIF($F$3:F2966,1),\"\")","v":2964},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2966),$G$3:$G$3716,0)),\"\")","v":"63739054833"}]
[null,null,null,null,"63739056710",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2967,1),\"\"))","v":1},{"$f":"IF(F2967=1,COUNTIF($F$3:F2967,1),\"\")","v":2965},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2967),$G$3:$G$3716,0)),\"\")","v":"63739056710"}]
[null,null,null,null,"63739056910",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2968,1),\"\"))","v":1},{"$f":"IF(F2968=1,COUNTIF($F$3:F2968,1),\"\")","v":2966},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2968),$G$3:$G$3716,0)),\"\")","v":"63739056910"}]
[null,null,null,null,"63739057210",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2969,1),\"\"))","v":1},{"$f":"IF(F2969=1,COUNTIF($F$3:F2969,1),\"\")","v":2967},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2969),$G$3:$G$3716,0)),\"\")","v":"63739057210"}]
[null,null,null,null,"63739057310",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2970,1),\"\"))","v":1},{"$f":"IF(F2970=1,COUNTIF($F$3:F2970,1),\"\")","v":2968},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2970),$G$3:$G$3716,0)),\"\")","v":"63739057310"}]
[null,null,null,null,"63739059110",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2971,1),\"\"))","v":1},{"$f":"IF(F2971=1,COUNTIF($F$3:F2971,1),\"\")","v":2969},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2971),$G$3:$G$3716,0)),\"\")","v":"63739059110"}]
[null,null,null,null,"63739064510",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2972,1),\"\"))","v":1},{"$f":"IF(F2972=1,COUNTIF($F$3:F2972,1),\"\")","v":2970},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2972),$G$3:$G$3716,0)),\"\")","v":"63739064510"}]
[null,null,null,null,"63739064610",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2973,1),\"\"))","v":1},{"$f":"IF(F2973=1,COUNTIF($F$3:F2973,1),\"\")","v":2971},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2973),$G$3:$G$3716,0)),\"\")","v":"63739064610"}]
[null,null,null,null,"63739066510",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2974,1),\"\"))","v":1},{"$f":"IF(F2974=1,COUNTIF($F$3:F2974,1),\"\")","v":2972},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2974),$G$3:$G$3716,0)),\"\")","v":"63739066510"}]
[null,null,null,null,"63739067110",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2975,1),\"\"))","v":1},{"$f":"IF(F2975=1,COUNTIF($F$3:F2975,1),\"\")","v":2973},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2975),$G$3:$G$3716,0)),\"\")","v":"63739067110"}]
[null,null,null,null,"63739068410",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2976,1),\"\"))","v":1},{"$f":"IF(F2976=1,COUNTIF($F$3:F2976,1),\"\")","v":2974},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2976),$G$3:$G$3716,0)),\"\")","v":"63739068410"}]
[null,null,null,null,"63739068910",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2977,1),\"\"))","v":1},{"$f":"IF(F2977=1,COUNTIF($F$3:F2977,1),\"\")","v":2975},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2977),$G$3:$G$3716,0)),\"\")","v":"63739068910"}]
[null,null,null,null,"63739070610",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2978,1),\"\"))","v":1},{"$f":"IF(F2978=1,COUNTIF($F$3:F2978,1),\"\")","v":2976},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2978),$G$3:$G$3716,0)),\"\")","v":"63739070610"}]
[null,null,null,null,"63739071410",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2979,1),\"\"))","v":1},{"$f":"IF(F2979=1,COUNTIF($F$3:F2979,1),\"\")","v":2977},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2979),$G$3:$G$3716,0)),\"\")","v":"63739071410"}]
[null,null,null,null,"63739079110",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2980,1),\"\"))","v":1},{"$f":"IF(F2980=1,COUNTIF($F$3:F2980,1),\"\")","v":2978},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2980),$G$3:$G$3716,0)),\"\")","v":"63739079110"}]
[null,null,null,null,"63739079733",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2981,1),\"\"))","v":1},{"$f":"IF(F2981=1,COUNTIF($F$3:F2981,1),\"\")","v":2979},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2981),$G$3:$G$3716,0)),\"\")","v":"63739079733"}]
[null,null,null,null,"63739089910",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2982,1),\"\"))","v":1},{"$f":"IF(F2982=1,COUNTIF($F$3:F2982,1),\"\")","v":2980},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2982),$G$3:$G$3716,0)),\"\")","v":"63739089910"}]
[null,null,null,null,"63739094310",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2983,1),\"\"))","v":1},{"$f":"IF(F2983=1,COUNTIF($F$3:F2983,1),\"\")","v":2981},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2983),$G$3:$G$3716,0)),\"\")","v":"63739094310"}]
[null,null,null,null,"63739098410",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2984,1),\"\"))","v":1},{"$f":"IF(F2984=1,COUNTIF($F$3:F2984,1),\"\")","v":2982},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2984),$G$3:$G$3716,0)),\"\")","v":"63739098410"}]
[null,null,null,null,"63739098832",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2985,1),\"\"))","v":1},{"$f":"IF(F2985=1,COUNTIF($F$3:F2985,1),\"\")","v":2983},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2985),$G$3:$G$3716,0)),\"\")","v":"63739098832"}]
[null,null,null,null,"63807010001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2986,1),\"\"))","v":1},{"$f":"IF(F2986=1,COUNTIF($F$3:F2986,1),\"\")","v":2984},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2986),$G$3:$G$3716,0)),\"\")","v":"63807010001"}]
[null,null,null,null,"63807010035",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2987,1),\"\"))","v":1},{"$f":"IF(F2987=1,COUNTIF($F$3:F2987,1),\"\")","v":2985},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2987),$G$3:$G$3716,0)),\"\")","v":"63807010035"}]
[null,null,null,null,"63807010055",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2988,1),\"\"))","v":1},{"$f":"IF(F2988=1,COUNTIF($F$3:F2988,1),\"\")","v":2986},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2988),$G$3:$G$3716,0)),\"\")","v":"63807010055"}]
[null,null,null,null,"63824071016",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2989,1),\"\"))","v":1},{"$f":"IF(F2989=1,COUNTIF($F$3:F2989,1),\"\")","v":2987},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2989),$G$3:$G$3716,0)),\"\")","v":"63824071016"}]
[null,null,null,null,"64253090030",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2990,1),\"\"))","v":1},{"$f":"IF(F2990=1,COUNTIF($F$3:F2990,1),\"\")","v":2988},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2990),$G$3:$G$3716,0)),\"\")","v":"64253090030"}]
[null,null,null,null,"64376012801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2991,1),\"\"))","v":1},{"$f":"IF(F2991=1,COUNTIF($F$3:F2991,1),\"\")","v":2989},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2991),$G$3:$G$3716,0)),\"\")","v":"64376012801"}]
[null,null,null,null,"64376012923",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2992,1),\"\"))","v":1},{"$f":"IF(F2992=1,COUNTIF($F$3:F2992,1),\"\")","v":2990},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2992),$G$3:$G$3716,0)),\"\")","v":"64376012923"}]
[null,null,null,null,"64376013612",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2993,1),\"\"))","v":1},{"$f":"IF(F2993=1,COUNTIF($F$3:F2993,1),\"\")","v":2991},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2993),$G$3:$G$3716,0)),\"\")","v":"64376013612"}]
[null,null,null,null,"64376013712",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2994,1),\"\"))","v":1},{"$f":"IF(F2994=1,COUNTIF($F$3:F2994,1),\"\")","v":2992},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2994),$G$3:$G$3716,0)),\"\")","v":"64376013712"}]
[null,null,null,null,"64380073706",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2995,1),\"\"))","v":1},{"$f":"IF(F2995=1,COUNTIF($F$3:F2995,1),\"\")","v":2993},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2995),$G$3:$G$3716,0)),\"\")","v":"64380073706"}]
[null,null,null,null,"64679042202",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2996,1),\"\"))","v":1},{"$f":"IF(F2996=1,COUNTIF($F$3:F2996,1),\"\")","v":2994},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2996),$G$3:$G$3716,0)),\"\")","v":"64679042202"}]
[null,null,null,null,"64679043402",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2997,1),\"\"))","v":1},{"$f":"IF(F2997=1,COUNTIF($F$3:F2997,1),\"\")","v":2995},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2997),$G$3:$G$3716,0)),\"\")","v":"64679043402"}]
[null,null,null,null,"64679073402",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2998,1),\"\"))","v":1},{"$f":"IF(F2998=1,COUNTIF($F$3:F2998,1),\"\")","v":2996},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2998),$G$3:$G$3716,0)),\"\")","v":"64679073402"}]
[null,null,null,null,"64679073602",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E2999,1),\"\"))","v":1},{"$f":"IF(F2999=1,COUNTIF($F$3:F2999,1),\"\")","v":2997},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G2999),$G$3:$G$3716,0)),\"\")","v":"64679073602"}]
[null,null,null,null,"64679078102",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3000,1),\"\"))","v":1},{"$f":"IF(F3000=1,COUNTIF($F$3:F3000,1),\"\")","v":2998},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3000),$G$3:$G$3716,0)),\"\")","v":"64679078102"}]
[null,null,null,null,"64679093603",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3001,1),\"\"))","v":1},{"$f":"IF(F3001=1,COUNTIF($F$3:F3001,1),\"\")","v":2999},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3001),$G$3:$G$3716,0)),\"\")","v":"64679093603"}]
[null,null,null,null,"64720013910",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3002,1),\"\"))","v":1},{"$f":"IF(F3002=1,COUNTIF($F$3:F3002,1),\"\")","v":3000},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3002),$G$3:$G$3716,0)),\"\")","v":"64720013910"}]
[null,null,null,null,"64764011901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3003,1),\"\"))","v":1},{"$f":"IF(F3003=1,COUNTIF($F$3:F3003,1),\"\")","v":3001},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3003),$G$3:$G$3716,0)),\"\")","v":"64764011901"}]
[null,null,null,null,"64764011907",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3004,1),\"\"))","v":1},{"$f":"IF(F3004=1,COUNTIF($F$3:F3004,1),\"\")","v":3002},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3004),$G$3:$G$3716,0)),\"\")","v":"64764011907"}]
[null,null,null,null,"64764015105",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3005,1),\"\"))","v":1},{"$f":"IF(F3005=1,COUNTIF($F$3:F3005,1),\"\")","v":3003},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3005),$G$3:$G$3716,0)),\"\")","v":"64764015105"}]
[null,null,null,null,"64764024060",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3006,1),\"\"))","v":1},{"$f":"IF(F3006=1,COUNTIF($F$3:F3006,1),\"\")","v":3004},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3006),$G$3:$G$3716,0)),\"\")","v":"64764024060"}]
[null,null,null,null,"64764054411",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3007,1),\"\"))","v":1},{"$f":"IF(F3007=1,COUNTIF($F$3:F3007,1),\"\")","v":3005},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3007),$G$3:$G$3716,0)),\"\")","v":"64764054411"}]
[null,null,null,null,"64875000103",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3008,1),\"\"))","v":1},{"$f":"IF(F3008=1,COUNTIF($F$3:F3008,1),\"\")","v":3006},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3008),$G$3:$G$3716,0)),\"\")","v":"64875000103"}]
[null,null,null,null,"64980010401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3009,1),\"\"))","v":1},{"$f":"IF(F3009=1,COUNTIF($F$3:F3009,1),\"\")","v":3007},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3009),$G$3:$G$3716,0)),\"\")","v":"64980010401"}]
[null,null,null,null,"64980013501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3010,1),\"\"))","v":1},{"$f":"IF(F3010=1,COUNTIF($F$3:F3010,1),\"\")","v":3008},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3010),$G$3:$G$3716,0)),\"\")","v":"64980013501"}]
[null,null,null,null,"64980014612",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3011,1),\"\"))","v":1},{"$f":"IF(F3011=1,COUNTIF($F$3:F3011,1),\"\")","v":3009},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3011),$G$3:$G$3716,0)),\"\")","v":"64980014612"}]
[null,null,null,null,"64980014698",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3012,1),\"\"))","v":1},{"$f":"IF(F3012=1,COUNTIF($F$3:F3012,1),\"\")","v":3010},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3012),$G$3:$G$3716,0)),\"\")","v":"64980014698"}]
[null,null,null,null,"64980015101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3013,1),\"\"))","v":1},{"$f":"IF(F3013=1,COUNTIF($F$3:F3013,1),\"\")","v":3011},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3013),$G$3:$G$3716,0)),\"\")","v":"64980015101"}]
[null,null,null,null,"64980015701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3014,1),\"\"))","v":1},{"$f":"IF(F3014=1,COUNTIF($F$3:F3014,1),\"\")","v":3012},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3014),$G$3:$G$3716,0)),\"\")","v":"64980015701"}]
[null,null,null,null,"64980016001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3015,1),\"\"))","v":1},{"$f":"IF(F3015=1,COUNTIF($F$3:F3015,1),\"\")","v":3013},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3015),$G$3:$G$3716,0)),\"\")","v":"64980016001"}]
[null,null,null,null,"64980016201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3016,1),\"\"))","v":1},{"$f":"IF(F3016=1,COUNTIF($F$3:F3016,1),\"\")","v":3014},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3016),$G$3:$G$3716,0)),\"\")","v":"64980016201"}]
[null,null,null,null,"64980017802",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3017,1),\"\"))","v":1},{"$f":"IF(F3017=1,COUNTIF($F$3:F3017,1),\"\")","v":3015},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3017),$G$3:$G$3716,0)),\"\")","v":"64980017802"}]
[null,null,null,null,"64980017901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3018,1),\"\"))","v":1},{"$f":"IF(F3018=1,COUNTIF($F$3:F3018,1),\"\")","v":3016},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3018),$G$3:$G$3716,0)),\"\")","v":"64980017901"}]
[null,null,null,null,"64980017903",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3019,1),\"\"))","v":1},{"$f":"IF(F3019=1,COUNTIF($F$3:F3019,1),\"\")","v":3017},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3019),$G$3:$G$3716,0)),\"\")","v":"64980017903"}]
[null,null,null,null,"64980018001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3020,1),\"\"))","v":1},{"$f":"IF(F3020=1,COUNTIF($F$3:F3020,1),\"\")","v":3018},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3020),$G$3:$G$3716,0)),\"\")","v":"64980018001"}]
[null,null,null,null,"64980018210",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3021,1),\"\"))","v":1},{"$f":"IF(F3021=1,COUNTIF($F$3:F3021,1),\"\")","v":3019},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3021),$G$3:$G$3716,0)),\"\")","v":"64980018210"}]
[null,null,null,null,"64980023601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3022,1),\"\"))","v":1},{"$f":"IF(F3022=1,COUNTIF($F$3:F3022,1),\"\")","v":3020},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3022),$G$3:$G$3716,0)),\"\")","v":"64980023601"}]
[null,null,null,null,"64980029410",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3023,1),\"\"))","v":1},{"$f":"IF(F3023=1,COUNTIF($F$3:F3023,1),\"\")","v":3021},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3023),$G$3:$G$3716,0)),\"\")","v":"64980029410"}]
[null,null,null,null,"64980033990",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3024,1),\"\"))","v":1},{"$f":"IF(F3024=1,COUNTIF($F$3:F3024,1),\"\")","v":3022},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3024),$G$3:$G$3716,0)),\"\")","v":"64980033990"}]
[null,null,null,null,"64980040603",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3025,1),\"\"))","v":1},{"$f":"IF(F3025=1,COUNTIF($F$3:F3025,1),\"\")","v":3023},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3025),$G$3:$G$3716,0)),\"\")","v":"64980040603"}]
[null,null,null,null,"64980050448",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3026,1),\"\"))","v":1},{"$f":"IF(F3026=1,COUNTIF($F$3:F3026,1),\"\")","v":3024},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3026),$G$3:$G$3716,0)),\"\")","v":"64980050448"}]
[null,null,null,null,"64980051401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3027,1),\"\"))","v":1},{"$f":"IF(F3027=1,COUNTIF($F$3:F3027,1),\"\")","v":3025},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3027),$G$3:$G$3716,0)),\"\")","v":"64980051401"}]
[null,null,null,null,"64980051505",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3028,1),\"\"))","v":1},{"$f":"IF(F3028=1,COUNTIF($F$3:F3028,1),\"\")","v":3026},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3028),$G$3:$G$3716,0)),\"\")","v":"64980051505"}]
[null,null,null,null,"64980052621",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3029,1),\"\"))","v":1},{"$f":"IF(F3029=1,COUNTIF($F$3:F3029,1),\"\")","v":3027},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3029),$G$3:$G$3716,0)),\"\")","v":"64980052621"}]
[null,null,null,null,"65162005827",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3030,1),\"\"))","v":1},{"$f":"IF(F3030=1,COUNTIF($F$3:F3030,1),\"\")","v":3028},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3030),$G$3:$G$3716,0)),\"\")","v":"65162005827"}]
[null,null,null,null,"65162027110",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3031,1),\"\"))","v":1},{"$f":"IF(F3031=1,COUNTIF($F$3:F3031,1),\"\")","v":3029},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3031),$G$3:$G$3716,0)),\"\")","v":"65162027110"}]
[null,null,null,null,"65162035109",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3032,1),\"\"))","v":1},{"$f":"IF(F3032=1,COUNTIF($F$3:F3032,1),\"\")","v":3030},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3032),$G$3:$G$3716,0)),\"\")","v":"65162035109"}]
[null,null,null,null,"65162044210",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3033,1),\"\"))","v":1},{"$f":"IF(F3033=1,COUNTIF($F$3:F3033,1),\"\")","v":3031},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3033),$G$3:$G$3716,0)),\"\")","v":"65162044210"}]
[null,null,null,null,"65162051210",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3034,1),\"\"))","v":1},{"$f":"IF(F3034=1,COUNTIF($F$3:F3034,1),\"\")","v":3032},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3034),$G$3:$G$3716,0)),\"\")","v":"65162051210"}]
[null,null,null,null,"65162054510",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3035,1),\"\"))","v":1},{"$f":"IF(F3035=1,COUNTIF($F$3:F3035,1),\"\")","v":3033},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3035),$G$3:$G$3716,0)),\"\")","v":"65162054510"}]
[null,null,null,null,"65162055410",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3036,1),\"\"))","v":1},{"$f":"IF(F3036=1,COUNTIF($F$3:F3036,1),\"\")","v":3034},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3036),$G$3:$G$3716,0)),\"\")","v":"65162055410"}]
[null,null,null,null,"65162059606",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3037,1),\"\"))","v":1},{"$f":"IF(F3037=1,COUNTIF($F$3:F3037,1),\"\")","v":3035},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3037),$G$3:$G$3716,0)),\"\")","v":"65162059606"}]
[null,null,null,null,"65162064978",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3038,1),\"\"))","v":1},{"$f":"IF(F3038=1,COUNTIF($F$3:F3038,1),\"\")","v":3036},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3038),$G$3:$G$3716,0)),\"\")","v":"65162064978"}]
[null,null,null,null,"65162068688",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3039,1),\"\"))","v":1},{"$f":"IF(F3039=1,COUNTIF($F$3:F3039,1),\"\")","v":3037},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3039),$G$3:$G$3716,0)),\"\")","v":"65162068688"}]
[null,null,null,null,"65162068988",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3040,1),\"\"))","v":1},{"$f":"IF(F3040=1,COUNTIF($F$3:F3040,1),\"\")","v":3038},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3040),$G$3:$G$3716,0)),\"\")","v":"65162068988"}]
[null,null,null,null,"65162069305",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3041,1),\"\"))","v":1},{"$f":"IF(F3041=1,COUNTIF($F$3:F3041,1),\"\")","v":3039},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3041),$G$3:$G$3716,0)),\"\")","v":"65162069305"}]
[null,null,null,null,"65162073403",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3042,1),\"\"))","v":1},{"$f":"IF(F3042=1,COUNTIF($F$3:F3042,1),\"\")","v":3040},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3042),$G$3:$G$3716,0)),\"\")","v":"65162073403"}]
[null,null,null,null,"65162073503",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3043,1),\"\"))","v":1},{"$f":"IF(F3043=1,COUNTIF($F$3:F3043,1),\"\")","v":3041},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3043),$G$3:$G$3716,0)),\"\")","v":"65162073503"}]
[null,null,null,null,"65162075710",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3044,1),\"\"))","v":1},{"$f":"IF(F3044=1,COUNTIF($F$3:F3044,1),\"\")","v":3042},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3044),$G$3:$G$3716,0)),\"\")","v":"65162075710"}]
[null,null,null,null,"65162089603",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3045,1),\"\"))","v":1},{"$f":"IF(F3045=1,COUNTIF($F$3:F3045,1),\"\")","v":3043},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3045),$G$3:$G$3716,0)),\"\")","v":"65162089603"}]
[null,null,null,null,"65162089703",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3046,1),\"\"))","v":1},{"$f":"IF(F3046=1,COUNTIF($F$3:F3046,1),\"\")","v":3044},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3046),$G$3:$G$3716,0)),\"\")","v":"65162089703"}]
[null,null,null,null,"65162089803",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3047,1),\"\"))","v":1},{"$f":"IF(F3047=1,COUNTIF($F$3:F3047,1),\"\")","v":3045},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3047),$G$3:$G$3716,0)),\"\")","v":"65162089803"}]
[null,null,null,null,"65197000101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3048,1),\"\"))","v":1},{"$f":"IF(F3048=1,COUNTIF($F$3:F3048,1),\"\")","v":3046},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3048),$G$3:$G$3716,0)),\"\")","v":"65197000101"}]
[null,null,null,null,"65197000201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3049,1),\"\"))","v":1},{"$f":"IF(F3049=1,COUNTIF($F$3:F3049,1),\"\")","v":3047},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3049),$G$3:$G$3716,0)),\"\")","v":"65197000201"}]
[null,null,null,null,"65197000301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3050,1),\"\"))","v":1},{"$f":"IF(F3050=1,COUNTIF($F$3:F3050,1),\"\")","v":3048},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3050),$G$3:$G$3716,0)),\"\")","v":"65197000301"}]
[null,null,null,null,"65628020605",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3051,1),\"\"))","v":1},{"$f":"IF(F3051=1,COUNTIF($F$3:F3051,1),\"\")","v":3049},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3051),$G$3:$G$3716,0)),\"\")","v":"65628020605"}]
[null,null,null,null,"65649030302",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3052,1),\"\"))","v":1},{"$f":"IF(F3052=1,COUNTIF($F$3:F3052,1),\"\")","v":3050},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3052),$G$3:$G$3716,0)),\"\")","v":"65649030302"}]
[null,null,null,null,"65649030303",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3053,1),\"\"))","v":1},{"$f":"IF(F3053=1,COUNTIF($F$3:F3053,1),\"\")","v":3051},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3053),$G$3:$G$3716,0)),\"\")","v":"65649030303"}]
[null,null,null,null,"65649031112",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3054,1),\"\"))","v":1},{"$f":"IF(F3054=1,COUNTIF($F$3:F3054,1),\"\")","v":3052},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3054),$G$3:$G$3716,0)),\"\")","v":"65649031112"}]
[null,null,null,null,"65862000901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3055,1),\"\"))","v":1},{"$f":"IF(F3055=1,COUNTIF($F$3:F3055,1),\"\")","v":3053},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3055),$G$3:$G$3716,0)),\"\")","v":"65862000901"}]
[null,null,null,null,"65862001230",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3056,1),\"\"))","v":1},{"$f":"IF(F3056=1,COUNTIF($F$3:F3056,1),\"\")","v":3054},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3056),$G$3:$G$3716,0)),\"\")","v":"65862001230"}]
[null,null,null,null,"65862001330",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3057,1),\"\"))","v":1},{"$f":"IF(F3057=1,COUNTIF($F$3:F3057,1),\"\")","v":3055},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3057),$G$3:$G$3716,0)),\"\")","v":"65862001330"}]
[null,null,null,null,"65862002901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3058,1),\"\"))","v":1},{"$f":"IF(F3058=1,COUNTIF($F$3:F3058,1),\"\")","v":3056},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3058),$G$3:$G$3716,0)),\"\")","v":"65862002901"}]
[null,null,null,null,"65862004824",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3059,1),\"\"))","v":1},{"$f":"IF(F3059=1,COUNTIF($F$3:F3059,1),\"\")","v":3057},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3059),$G$3:$G$3716,0)),\"\")","v":"65862004824"}]
[null,null,null,null,"65862006201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3060,1),\"\"))","v":1},{"$f":"IF(F3060=1,COUNTIF($F$3:F3060,1),\"\")","v":3058},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3060),$G$3:$G$3716,0)),\"\")","v":"65862006201"}]
[null,null,null,null,"65862007360",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3061,1),\"\"))","v":1},{"$f":"IF(F3061=1,COUNTIF($F$3:F3061,1),\"\")","v":3059},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3061),$G$3:$G$3716,0)),\"\")","v":"65862007360"}]
[null,null,null,null,"65862008301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3062,1),\"\"))","v":1},{"$f":"IF(F3062=1,COUNTIF($F$3:F3062,1),\"\")","v":3060},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3062),$G$3:$G$3716,0)),\"\")","v":"65862008301"}]
[null,null,null,null,"65862009520",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3063,1),\"\"))","v":1},{"$f":"IF(F3063=1,COUNTIF($F$3:F3063,1),\"\")","v":3061},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3063),$G$3:$G$3716,0)),\"\")","v":"65862009520"}]
[null,null,null,null,"65862009620",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3064,1),\"\"))","v":1},{"$f":"IF(F3064=1,COUNTIF($F$3:F3064,1),\"\")","v":3062},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3064),$G$3:$G$3716,0)),\"\")","v":"65862009620"}]
[null,null,null,null,"65862010701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3065,1),\"\"))","v":1},{"$f":"IF(F3065=1,COUNTIF($F$3:F3065,1),\"\")","v":3063},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3065),$G$3:$G$3716,0)),\"\")","v":"65862010701"}]
[null,null,null,null,"65862014636",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3066,1),\"\"))","v":1},{"$f":"IF(F3066=1,COUNTIF($F$3:F3066,1),\"\")","v":3064},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3066),$G$3:$G$3716,0)),\"\")","v":"65862014636"}]
[null,null,null,null,"65862020190",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3067,1),\"\"))","v":1},{"$f":"IF(F3067=1,COUNTIF($F$3:F3067,1),\"\")","v":3065},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3067),$G$3:$G$3716,0)),\"\")","v":"65862020190"}]
[null,null,null,null,"65862020299",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3068,1),\"\"))","v":1},{"$f":"IF(F3068=1,COUNTIF($F$3:F3068,1),\"\")","v":3066},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3068),$G$3:$G$3716,0)),\"\")","v":"65862020299"}]
[null,null,null,null,"65862031030",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3069,1),\"\"))","v":1},{"$f":"IF(F3069=1,COUNTIF($F$3:F3069,1),\"\")","v":3067},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3069),$G$3:$G$3716,0)),\"\")","v":"65862031030"}]
[null,null,null,null,"65862042130",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3070,1),\"\"))","v":1},{"$f":"IF(F3070=1,COUNTIF($F$3:F3070,1),\"\")","v":3068},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3070),$G$3:$G$3716,0)),\"\")","v":"65862042130"}]
[null,null,null,null,"65862049647",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3071,1),\"\"))","v":1},{"$f":"IF(F3071=1,COUNTIF($F$3:F3071,1),\"\")","v":3069},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3071),$G$3:$G$3716,0)),\"\")","v":"65862049647"}]
[null,null,null,null,"65862049730",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3072,1),\"\"))","v":1},{"$f":"IF(F3072=1,COUNTIF($F$3:F3072,1),\"\")","v":3070},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3072),$G$3:$G$3716,0)),\"\")","v":"65862049730"}]
[null,null,null,null,"65862052830",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3073,1),\"\"))","v":1},{"$f":"IF(F3073=1,COUNTIF($F$3:F3073,1),\"\")","v":3071},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3073),$G$3:$G$3716,0)),\"\")","v":"65862052830"}]
[null,null,null,null,"65862053350",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3074,1),\"\"))","v":1},{"$f":"IF(F3074=1,COUNTIF($F$3:F3074,1),\"\")","v":3072},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3074),$G$3:$G$3716,0)),\"\")","v":"65862053350"}]
[null,null,null,null,"65862053450",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3075,1),\"\"))","v":1},{"$f":"IF(F3075=1,COUNTIF($F$3:F3075,1),\"\")","v":3073},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3075),$G$3:$G$3716,0)),\"\")","v":"65862053450"}]
[null,null,null,null,"65862053513",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3076,1),\"\"))","v":1},{"$f":"IF(F3076=1,COUNTIF($F$3:F3076,1),\"\")","v":3074},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3076),$G$3:$G$3716,0)),\"\")","v":"65862053513"}]
[null,null,null,null,"65862059401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3077,1),\"\"))","v":1},{"$f":"IF(F3077=1,COUNTIF($F$3:F3077,1),\"\")","v":3075},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3077),$G$3:$G$3716,0)),\"\")","v":"65862059401"}]
[null,null,null,null,"65862059601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3078,1),\"\"))","v":1},{"$f":"IF(F3078=1,COUNTIF($F$3:F3078,1),\"\")","v":3076},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3078),$G$3:$G$3716,0)),\"\")","v":"65862059601"}]
[null,null,null,null,"65862060330",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3079,1),\"\"))","v":1},{"$f":"IF(F3079=1,COUNTIF($F$3:F3079,1),\"\")","v":3077},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3079),$G$3:$G$3716,0)),\"\")","v":"65862060330"}]
[null,null,null,null,"65862064163",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3080,1),\"\"))","v":1},{"$f":"IF(F3080=1,COUNTIF($F$3:F3080,1),\"\")","v":3078},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3080),$G$3:$G$3716,0)),\"\")","v":"65862064163"}]
[null,null,null,null,"65862064860",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3081,1),\"\"))","v":1},{"$f":"IF(F3081=1,COUNTIF($F$3:F3081,1),\"\")","v":3079},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3081),$G$3:$G$3716,0)),\"\")","v":"65862064860"}]
[null,null,null,null,"65862067701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3082,1),\"\"))","v":1},{"$f":"IF(F3082=1,COUNTIF($F$3:F3082,1),\"\")","v":3080},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3082),$G$3:$G$3716,0)),\"\")","v":"65862067701"}]
[null,null,null,null,"65862067801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3083,1),\"\"))","v":1},{"$f":"IF(F3083=1,COUNTIF($F$3:F3083,1),\"\")","v":3081},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3083),$G$3:$G$3716,0)),\"\")","v":"65862067801"}]
[null,null,null,null,"65862071330",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3084,1),\"\"))","v":1},{"$f":"IF(F3084=1,COUNTIF($F$3:F3084,1),\"\")","v":3082},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3084),$G$3:$G$3716,0)),\"\")","v":"65862071330"}]
[null,null,null,null,"65862075150",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3085,1),\"\"))","v":1},{"$f":"IF(F3085=1,COUNTIF($F$3:F3085,1),\"\")","v":3083},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3085),$G$3:$G$3716,0)),\"\")","v":"65862075150"}]
[null,null,null,null,"65862083030",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3086,1),\"\"))","v":1},{"$f":"IF(F3086=1,COUNTIF($F$3:F3086,1),\"\")","v":3084},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3086),$G$3:$G$3716,0)),\"\")","v":"65862083030"}]
[null,null,null,null,"65862084003",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3087,1),\"\"))","v":1},{"$f":"IF(F3087=1,COUNTIF($F$3:F3087,1),\"\")","v":3085},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3087),$G$3:$G$3716,0)),\"\")","v":"65862084003"}]
[null,null,null,null,"65862093008",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3088,1),\"\"))","v":1},{"$f":"IF(F3088=1,COUNTIF($F$3:F3088,1),\"\")","v":3086},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3088),$G$3:$G$3716,0)),\"\")","v":"65862093008"}]
[null,null,null,null,"66215010106",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3089,1),\"\"))","v":1},{"$f":"IF(F3089=1,COUNTIF($F$3:F3089,1),\"\")","v":3087},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3089),$G$3:$G$3716,0)),\"\")","v":"66215010106"}]
[null,null,null,null,"66215010206",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3090,1),\"\"))","v":1},{"$f":"IF(F3090=1,COUNTIF($F$3:F3090,1),\"\")","v":3088},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3090),$G$3:$G$3716,0)),\"\")","v":"66215010206"}]
[null,null,null,null,"66490065020",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3091,1),\"\"))","v":1},{"$f":"IF(F3091=1,COUNTIF($F$3:F3091,1),\"\")","v":3089},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3091),$G$3:$G$3716,0)),\"\")","v":"66490065020"}]
[null,null,null,null,"66553000201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3092,1),\"\"))","v":1},{"$f":"IF(F3092=1,COUNTIF($F$3:F3092,1),\"\")","v":3090},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3092),$G$3:$G$3716,0)),\"\")","v":"66553000201"}]
[null,null,null,null,"66553000401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3093,1),\"\"))","v":1},{"$f":"IF(F3093=1,COUNTIF($F$3:F3093,1),\"\")","v":3091},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3093),$G$3:$G$3716,0)),\"\")","v":"66553000401"}]
[null,null,null,null,"66553000801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3094,1),\"\"))","v":1},{"$f":"IF(F3094=1,COUNTIF($F$3:F3094,1),\"\")","v":3092},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3094),$G$3:$G$3716,0)),\"\")","v":"66553000801"}]
[null,null,null,null,"66582041428",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3095,1),\"\"))","v":1},{"$f":"IF(F3095=1,COUNTIF($F$3:F3095,1),\"\")","v":3093},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3095),$G$3:$G$3716,0)),\"\")","v":"66582041428"}]
[null,null,null,null,"66647600342",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3096,1),\"\"))","v":1},{"$f":"IF(F3096=1,COUNTIF($F$3:F3096,1),\"\")","v":3094},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3096),$G$3:$G$3716,0)),\"\")","v":"66647600342"}]
[null,null,null,null,"66647601242",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3097,1),\"\"))","v":1},{"$f":"IF(F3097=1,COUNTIF($F$3:F3097,1),\"\")","v":3095},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3097),$G$3:$G$3716,0)),\"\")","v":"66647601242"}]
[null,null,null,null,"66685100100",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3098,1),\"\"))","v":1},{"$f":"IF(F3098=1,COUNTIF($F$3:F3098,1),\"\")","v":3096},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3098),$G$3:$G$3716,0)),\"\")","v":"66685100100"}]
[null,null,null,null,"66685100101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3099,1),\"\"))","v":1},{"$f":"IF(F3099=1,COUNTIF($F$3:F3099,1),\"\")","v":3097},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3099),$G$3:$G$3716,0)),\"\")","v":"66685100101"}]
[null,null,null,null,"66685100200",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3100,1),\"\"))","v":1},{"$f":"IF(F3100=1,COUNTIF($F$3:F3100,1),\"\")","v":3098},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3100),$G$3:$G$3716,0)),\"\")","v":"66685100200"}]
[null,null,null,null,"66685101100",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3101,1),\"\"))","v":1},{"$f":"IF(F3101=1,COUNTIF($F$3:F3101,1),\"\")","v":3099},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3101),$G$3:$G$3716,0)),\"\")","v":"66685101100"}]
[null,null,null,null,"66685101200",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3102,1),\"\"))","v":1},{"$f":"IF(F3102=1,COUNTIF($F$3:F3102,1),\"\")","v":3100},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3102),$G$3:$G$3716,0)),\"\")","v":"66685101200"}]
[null,null,null,null,"66689000802",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3103,1),\"\"))","v":1},{"$f":"IF(F3103=1,COUNTIF($F$3:F3103,1),\"\")","v":3101},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3103),$G$3:$G$3716,0)),\"\")","v":"66689000802"}]
[null,null,null,null,"66689003601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3104,1),\"\"))","v":1},{"$f":"IF(F3104=1,COUNTIF($F$3:F3104,1),\"\")","v":3102},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3104),$G$3:$G$3716,0)),\"\")","v":"66689003601"}]
[null,null,null,null,"66689003650",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3105,1),\"\"))","v":1},{"$f":"IF(F3105=1,COUNTIF($F$3:F3105,1),\"\")","v":3103},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3105),$G$3:$G$3716,0)),\"\")","v":"66689003650"}]
[null,null,null,null,"66689003701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3106,1),\"\"))","v":1},{"$f":"IF(F3106=1,COUNTIF($F$3:F3106,1),\"\")","v":3104},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3106),$G$3:$G$3716,0)),\"\")","v":"66689003701"}]
[null,null,null,null,"66689004701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3107,1),\"\"))","v":1},{"$f":"IF(F3107=1,COUNTIF($F$3:F3107,1),\"\")","v":3105},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3107),$G$3:$G$3716,0)),\"\")","v":"66689004701"}]
[null,null,null,null,"66689020108",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3108,1),\"\"))","v":1},{"$f":"IF(F3108=1,COUNTIF($F$3:F3108,1),\"\")","v":3106},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3108),$G$3:$G$3716,0)),\"\")","v":"66689020108"}]
[null,null,null,null,"66689020204",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3109,1),\"\"))","v":1},{"$f":"IF(F3109=1,COUNTIF($F$3:F3109,1),\"\")","v":3107},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3109),$G$3:$G$3716,0)),\"\")","v":"66689020204"}]
[null,null,null,null,"66689020304",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3110,1),\"\"))","v":1},{"$f":"IF(F3110=1,COUNTIF($F$3:F3110,1),\"\")","v":3108},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3110),$G$3:$G$3716,0)),\"\")","v":"66689020304"}]
[null,null,null,null,"66689020308",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3111,1),\"\"))","v":1},{"$f":"IF(F3111=1,COUNTIF($F$3:F3111,1),\"\")","v":3109},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3111),$G$3:$G$3716,0)),\"\")","v":"66689020308"}]
[null,null,null,null,"66689069404",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3112,1),\"\"))","v":1},{"$f":"IF(F3112=1,COUNTIF($F$3:F3112,1),\"\")","v":3110},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3112),$G$3:$G$3716,0)),\"\")","v":"66689069404"}]
[null,null,null,null,"66758019006",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3113,1),\"\"))","v":1},{"$f":"IF(F3113=1,COUNTIF($F$3:F3113,1),\"\")","v":3111},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3113),$G$3:$G$3716,0)),\"\")","v":"66758019006"}]
[null,null,null,null,"66758019013",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3114,1),\"\"))","v":1},{"$f":"IF(F3114=1,COUNTIF($F$3:F3114,1),\"\")","v":3112},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3114),$G$3:$G$3716,0)),\"\")","v":"66758019013"}]
[null,null,null,null,"66758020854",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3115,1),\"\"))","v":1},{"$f":"IF(F3115=1,COUNTIF($F$3:F3115,1),\"\")","v":3113},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3115),$G$3:$G$3716,0)),\"\")","v":"66758020854"}]
[null,null,null,null,"66758020858",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3116,1),\"\"))","v":1},{"$f":"IF(F3116=1,COUNTIF($F$3:F3116,1),\"\")","v":3114},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3116),$G$3:$G$3716,0)),\"\")","v":"66758020858"}]
[null,null,null,null,"66993001968",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3117,1),\"\"))","v":1},{"$f":"IF(F3117=1,COUNTIF($F$3:F3117,1),\"\")","v":3115},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3117),$G$3:$G$3716,0)),\"\")","v":"66993001968"}]
[null,null,null,null,"66993005430",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3118,1),\"\"))","v":1},{"$f":"IF(F3118=1,COUNTIF($F$3:F3118,1),\"\")","v":3116},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3118),$G$3:$G$3716,0)),\"\")","v":"66993005430"}]
[null,null,null,null,"66993005702",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3119,1),\"\"))","v":1},{"$f":"IF(F3119=1,COUNTIF($F$3:F3119,1),\"\")","v":3117},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3119),$G$3:$G$3716,0)),\"\")","v":"66993005702"}]
[null,null,null,null,"66993006205",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3120,1),\"\"))","v":1},{"$f":"IF(F3120=1,COUNTIF($F$3:F3120,1),\"\")","v":3118},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3120),$G$3:$G$3716,0)),\"\")","v":"66993006205"}]
[null,null,null,null,"66993006851",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3121,1),\"\"))","v":1},{"$f":"IF(F3121=1,COUNTIF($F$3:F3121,1),\"\")","v":3119},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3121),$G$3:$G$3716,0)),\"\")","v":"66993006851"}]
[null,null,null,null,"66993016502",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3122,1),\"\"))","v":1},{"$f":"IF(F3122=1,COUNTIF($F$3:F3122,1),\"\")","v":3120},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3122),$G$3:$G$3716,0)),\"\")","v":"66993016502"}]
[null,null,null,null,"66993021019",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3123,1),\"\"))","v":1},{"$f":"IF(F3123=1,COUNTIF($F$3:F3123,1),\"\")","v":3121},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3123),$G$3:$G$3716,0)),\"\")","v":"66993021019"}]
[null,null,null,null,"66993040932",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3124,1),\"\"))","v":1},{"$f":"IF(F3124=1,COUNTIF($F$3:F3124,1),\"\")","v":3122},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3124),$G$3:$G$3716,0)),\"\")","v":"66993040932"}]
[null,null,null,null,"66993066130",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3125,1),\"\"))","v":1},{"$f":"IF(F3125=1,COUNTIF($F$3:F3125,1),\"\")","v":3123},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3125),$G$3:$G$3716,0)),\"\")","v":"66993066130"}]
[null,null,null,null,"67253020320",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3126,1),\"\"))","v":1},{"$f":"IF(F3126=1,COUNTIF($F$3:F3126,1),\"\")","v":3124},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3126),$G$3:$G$3716,0)),\"\")","v":"67253020320"}]
[null,null,null,null,"67253039115",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3127,1),\"\"))","v":1},{"$f":"IF(F3127=1,COUNTIF($F$3:F3127,1),\"\")","v":3125},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3127),$G$3:$G$3716,0)),\"\")","v":"67253039115"}]
[null,null,null,null,"67253070006",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3128,1),\"\"))","v":1},{"$f":"IF(F3128=1,COUNTIF($F$3:F3128,1),\"\")","v":3126},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3128),$G$3:$G$3716,0)),\"\")","v":"67253070006"}]
[null,null,null,null,"67253090010",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3129,1),\"\"))","v":1},{"$f":"IF(F3129=1,COUNTIF($F$3:F3129,1),\"\")","v":3127},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3129),$G$3:$G$3716,0)),\"\")","v":"67253090010"}]
[null,null,null,null,"67386031321",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3130,1),\"\"))","v":1},{"$f":"IF(F3130=1,COUNTIF($F$3:F3130,1),\"\")","v":3128},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3130),$G$3:$G$3716,0)),\"\")","v":"67386031321"}]
[null,null,null,null,"67386031401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3131,1),\"\"))","v":1},{"$f":"IF(F3131=1,COUNTIF($F$3:F3131,1),\"\")","v":3129},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3131),$G$3:$G$3716,0)),\"\")","v":"67386031401"}]
[null,null,null,null,"67386082019",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3132,1),\"\"))","v":1},{"$f":"IF(F3132=1,COUNTIF($F$3:F3132,1),\"\")","v":3130},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3132),$G$3:$G$3716,0)),\"\")","v":"67386082019"}]
[null,null,null,null,"67386082219",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3133,1),\"\"))","v":1},{"$f":"IF(F3133=1,COUNTIF($F$3:F3133,1),\"\")","v":3131},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3133),$G$3:$G$3716,0)),\"\")","v":"67386082219"}]
[null,null,null,null,"67457019803",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3134,1),\"\"))","v":1},{"$f":"IF(F3134=1,COUNTIF($F$3:F3134,1),\"\")","v":3132},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3134),$G$3:$G$3716,0)),\"\")","v":"67457019803"}]
[null,null,null,null,"67457043700",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3135,1),\"\"))","v":1},{"$f":"IF(F3135=1,COUNTIF($F$3:F3135,1),\"\")","v":3133},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3135),$G$3:$G$3716,0)),\"\")","v":"67457043700"}]
[null,null,null,null,"67457043800",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3136,1),\"\"))","v":1},{"$f":"IF(F3136=1,COUNTIF($F$3:F3136,1),\"\")","v":3134},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3136),$G$3:$G$3716,0)),\"\")","v":"67457043800"}]
[null,null,null,null,"67457043810",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3137,1),\"\"))","v":1},{"$f":"IF(F3137=1,COUNTIF($F$3:F3137,1),\"\")","v":3135},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3137),$G$3:$G$3716,0)),\"\")","v":"67457043810"}]
[null,null,null,null,"67457065725",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3138,1),\"\"))","v":1},{"$f":"IF(F3138=1,COUNTIF($F$3:F3138,1),\"\")","v":3136},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3138),$G$3:$G$3716,0)),\"\")","v":"67457065725"}]
[null,null,null,null,"67546011114",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3139,1),\"\"))","v":1},{"$f":"IF(F3139=1,COUNTIF($F$3:F3139,1),\"\")","v":3137},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3139),$G$3:$G$3716,0)),\"\")","v":"67546011114"}]
[null,null,null,null,"67877010501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3140,1),\"\"))","v":1},{"$f":"IF(F3140=1,COUNTIF($F$3:F3140,1),\"\")","v":3138},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3140),$G$3:$G$3716,0)),\"\")","v":"67877010501"}]
[null,null,null,null,"67877011601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3141,1),\"\"))","v":1},{"$f":"IF(F3141=1,COUNTIF($F$3:F3141,1),\"\")","v":3139},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3141),$G$3:$G$3716,0)),\"\")","v":"67877011601"}]
[null,null,null,null,"67877012425",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3142,1),\"\"))","v":1},{"$f":"IF(F3142=1,COUNTIF($F$3:F3142,1),\"\")","v":3140},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3142),$G$3:$G$3716,0)),\"\")","v":"67877012425"}]
[null,null,null,null,"67877012440",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3143,1),\"\"))","v":1},{"$f":"IF(F3143=1,COUNTIF($F$3:F3143,1),\"\")","v":3141},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3143),$G$3:$G$3716,0)),\"\")","v":"67877012440"}]
[null,null,null,null,"67877019805",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3144,1),\"\"))","v":1},{"$f":"IF(F3144=1,COUNTIF($F$3:F3144,1),\"\")","v":3142},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3144),$G$3:$G$3716,0)),\"\")","v":"67877019805"}]
[null,null,null,null,"67877021901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3145,1),\"\"))","v":1},{"$f":"IF(F3145=1,COUNTIF($F$3:F3145,1),\"\")","v":3143},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3145),$G$3:$G$3716,0)),\"\")","v":"67877021901"}]
[null,null,null,null,"67877022305",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3146,1),\"\"))","v":1},{"$f":"IF(F3146=1,COUNTIF($F$3:F3146,1),\"\")","v":3144},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3146),$G$3:$G$3716,0)),\"\")","v":"67877022305"}]
[null,null,null,null,"67877022401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3147,1),\"\"))","v":1},{"$f":"IF(F3147=1,COUNTIF($F$3:F3147,1),\"\")","v":3145},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3147),$G$3:$G$3716,0)),\"\")","v":"67877022401"}]
[null,null,null,null,"67877024201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3148,1),\"\"))","v":1},{"$f":"IF(F3148=1,COUNTIF($F$3:F3148,1),\"\")","v":3146},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3148),$G$3:$G$3716,0)),\"\")","v":"67877024201"}]
[null,null,null,null,"67877025001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3149,1),\"\"))","v":1},{"$f":"IF(F3149=1,COUNTIF($F$3:F3149,1),\"\")","v":3147},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3149),$G$3:$G$3716,0)),\"\")","v":"67877025001"}]
[null,null,null,null,"67877025115",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3150,1),\"\"))","v":1},{"$f":"IF(F3150=1,COUNTIF($F$3:F3150,1),\"\")","v":3148},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3150),$G$3:$G$3716,0)),\"\")","v":"67877025115"}]
[null,null,null,null,"67877025180",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3151,1),\"\"))","v":1},{"$f":"IF(F3151=1,COUNTIF($F$3:F3151,1),\"\")","v":3149},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3151),$G$3:$G$3716,0)),\"\")","v":"67877025180"}]
[null,null,null,null,"67877026490",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3152,1),\"\"))","v":1},{"$f":"IF(F3152=1,COUNTIF($F$3:F3152,1),\"\")","v":3150},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3152),$G$3:$G$3716,0)),\"\")","v":"67877026490"}]
[null,null,null,null,"67877028660",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3153,1),\"\"))","v":1},{"$f":"IF(F3153=1,COUNTIF($F$3:F3153,1),\"\")","v":3151},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3153),$G$3:$G$3716,0)),\"\")","v":"67877028660"}]
[null,null,null,null,"67877032001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3154,1),\"\"))","v":1},{"$f":"IF(F3154=1,COUNTIF($F$3:F3154,1),\"\")","v":3152},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3154),$G$3:$G$3716,0)),\"\")","v":"67877032001"}]
[null,null,null,null,"67877032101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3155,1),\"\"))","v":1},{"$f":"IF(F3155=1,COUNTIF($F$3:F3155,1),\"\")","v":3153},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3155),$G$3:$G$3716,0)),\"\")","v":"67877032101"}]
[null,null,null,null,"67877041984",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3156,1),\"\"))","v":1},{"$f":"IF(F3156=1,COUNTIF($F$3:F3156,1),\"\")","v":3154},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3156),$G$3:$G$3716,0)),\"\")","v":"67877041984"}]
[null,null,null,null,"67877054568",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3157,1),\"\"))","v":1},{"$f":"IF(F3157=1,COUNTIF($F$3:F3157,1),\"\")","v":3155},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3157),$G$3:$G$3716,0)),\"\")","v":"67877054568"}]
[null,null,null,null,"67877057301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3158,1),\"\"))","v":1},{"$f":"IF(F3158=1,COUNTIF($F$3:F3158,1),\"\")","v":3156},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3158),$G$3:$G$3716,0)),\"\")","v":"67877057301"}]
[null,null,null,null,"68001015900",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3159,1),\"\"))","v":1},{"$f":"IF(F3159=1,COUNTIF($F$3:F3159,1),\"\")","v":3157},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3159),$G$3:$G$3716,0)),\"\")","v":"68001015900"}]
[null,null,null,null,"68001033500",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3160,1),\"\"))","v":1},{"$f":"IF(F3160=1,COUNTIF($F$3:F3160,1),\"\")","v":3158},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3160),$G$3:$G$3716,0)),\"\")","v":"68001033500"}]
[null,null,null,null,"68001043592",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3161,1),\"\"))","v":1},{"$f":"IF(F3161=1,COUNTIF($F$3:F3161,1),\"\")","v":3159},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3161),$G$3:$G$3716,0)),\"\")","v":"68001043592"}]
[null,null,null,null,"68001043594",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3162,1),\"\"))","v":1},{"$f":"IF(F3162=1,COUNTIF($F$3:F3162,1),\"\")","v":3160},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3162),$G$3:$G$3716,0)),\"\")","v":"68001043594"}]
[null,null,null,null,"68001043816",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3163,1),\"\"))","v":1},{"$f":"IF(F3163=1,COUNTIF($F$3:F3163,1),\"\")","v":3161},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3163),$G$3:$G$3716,0)),\"\")","v":"68001043816"}]
[null,null,null,null,"68001043896",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3164,1),\"\"))","v":1},{"$f":"IF(F3164=1,COUNTIF($F$3:F3164,1),\"\")","v":3162},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3164),$G$3:$G$3716,0)),\"\")","v":"68001043896"}]
[null,null,null,null,"68001047300",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3165,1),\"\"))","v":1},{"$f":"IF(F3165=1,COUNTIF($F$3:F3165,1),\"\")","v":3163},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3165),$G$3:$G$3716,0)),\"\")","v":"68001047300"}]
[null,null,null,null,"68001047547",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3166,1),\"\"))","v":1},{"$f":"IF(F3166=1,COUNTIF($F$3:F3166,1),\"\")","v":3164},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3166),$G$3:$G$3716,0)),\"\")","v":"68001047547"}]
[null,null,null,null,"68084001601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3167,1),\"\"))","v":1},{"$f":"IF(F3167=1,COUNTIF($F$3:F3167,1),\"\")","v":3165},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3167),$G$3:$G$3716,0)),\"\")","v":"68084001601"}]
[null,null,null,null,"68084001901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3168,1),\"\"))","v":1},{"$f":"IF(F3168=1,COUNTIF($F$3:F3168,1),\"\")","v":3166},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3168),$G$3:$G$3716,0)),\"\")","v":"68084001901"}]
[null,null,null,null,"68084001911",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3169,1),\"\"))","v":1},{"$f":"IF(F3169=1,COUNTIF($F$3:F3169,1),\"\")","v":3167},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3169),$G$3:$G$3716,0)),\"\")","v":"68084001911"}]
[null,null,null,null,"68084002711",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3170,1),\"\"))","v":1},{"$f":"IF(F3170=1,COUNTIF($F$3:F3170,1),\"\")","v":3168},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3170),$G$3:$G$3716,0)),\"\")","v":"68084002711"}]
[null,null,null,null,"68084002801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3171,1),\"\"))","v":1},{"$f":"IF(F3171=1,COUNTIF($F$3:F3171,1),\"\")","v":3169},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3171),$G$3:$G$3716,0)),\"\")","v":"68084002801"}]
[null,null,null,null,"68084003101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3172,1),\"\"))","v":1},{"$f":"IF(F3172=1,COUNTIF($F$3:F3172,1),\"\")","v":3170},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3172),$G$3:$G$3716,0)),\"\")","v":"68084003101"}]
[null,null,null,null,"68084003201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3173,1),\"\"))","v":1},{"$f":"IF(F3173=1,COUNTIF($F$3:F3173,1),\"\")","v":3171},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3173),$G$3:$G$3716,0)),\"\")","v":"68084003201"}]
[null,null,null,null,"68084004101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3174,1),\"\"))","v":1},{"$f":"IF(F3174=1,COUNTIF($F$3:F3174,1),\"\")","v":3172},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3174),$G$3:$G$3716,0)),\"\")","v":"68084004101"}]
[null,null,null,null,"68084004111",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3175,1),\"\"))","v":1},{"$f":"IF(F3175=1,COUNTIF($F$3:F3175,1),\"\")","v":3173},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3175),$G$3:$G$3716,0)),\"\")","v":"68084004111"}]
[null,null,null,null,"68084004501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3176,1),\"\"))","v":1},{"$f":"IF(F3176=1,COUNTIF($F$3:F3176,1),\"\")","v":3174},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3176),$G$3:$G$3716,0)),\"\")","v":"68084004501"}]
[null,null,null,null,"68084005411",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3177,1),\"\"))","v":1},{"$f":"IF(F3177=1,COUNTIF($F$3:F3177,1),\"\")","v":3175},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3177),$G$3:$G$3716,0)),\"\")","v":"68084005411"}]
[null,null,null,null,"68084006001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3178,1),\"\"))","v":1},{"$f":"IF(F3178=1,COUNTIF($F$3:F3178,1),\"\")","v":3176},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3178),$G$3:$G$3716,0)),\"\")","v":"68084006001"}]
[null,null,null,null,"68084006101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3179,1),\"\"))","v":1},{"$f":"IF(F3179=1,COUNTIF($F$3:F3179,1),\"\")","v":3177},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3179),$G$3:$G$3716,0)),\"\")","v":"68084006101"}]
[null,null,null,null,"68084006501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3180,1),\"\"))","v":1},{"$f":"IF(F3180=1,COUNTIF($F$3:F3180,1),\"\")","v":3178},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3180),$G$3:$G$3716,0)),\"\")","v":"68084006501"}]
[null,null,null,null,"68084006901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3181,1),\"\"))","v":1},{"$f":"IF(F3181=1,COUNTIF($F$3:F3181,1),\"\")","v":3179},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3181),$G$3:$G$3716,0)),\"\")","v":"68084006901"}]
[null,null,null,null,"68084007101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3182,1),\"\"))","v":1},{"$f":"IF(F3182=1,COUNTIF($F$3:F3182,1),\"\")","v":3180},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3182),$G$3:$G$3716,0)),\"\")","v":"68084007101"}]
[null,null,null,null,"68084007421",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3183,1),\"\"))","v":1},{"$f":"IF(F3183=1,COUNTIF($F$3:F3183,1),\"\")","v":3181},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3183),$G$3:$G$3716,0)),\"\")","v":"68084007421"}]
[null,null,null,null,"68084008211",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3184,1),\"\"))","v":1},{"$f":"IF(F3184=1,COUNTIF($F$3:F3184,1),\"\")","v":3182},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3184),$G$3:$G$3716,0)),\"\")","v":"68084008211"}]
[null,null,null,null,"68084008601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3185,1),\"\"))","v":1},{"$f":"IF(F3185=1,COUNTIF($F$3:F3185,1),\"\")","v":3183},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3185),$G$3:$G$3716,0)),\"\")","v":"68084008601"}]
[null,null,null,null,"68084008901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3186,1),\"\"))","v":1},{"$f":"IF(F3186=1,COUNTIF($F$3:F3186,1),\"\")","v":3184},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3186),$G$3:$G$3716,0)),\"\")","v":"68084008901"}]
[null,null,null,null,"68084009101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3187,1),\"\"))","v":1},{"$f":"IF(F3187=1,COUNTIF($F$3:F3187,1),\"\")","v":3185},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3187),$G$3:$G$3716,0)),\"\")","v":"68084009101"}]
[null,null,null,null,"68084009701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3188,1),\"\"))","v":1},{"$f":"IF(F3188=1,COUNTIF($F$3:F3188,1),\"\")","v":3186},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3188),$G$3:$G$3716,0)),\"\")","v":"68084009701"}]
[null,null,null,null,"68084009711",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3189,1),\"\"))","v":1},{"$f":"IF(F3189=1,COUNTIF($F$3:F3189,1),\"\")","v":3187},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3189),$G$3:$G$3716,0)),\"\")","v":"68084009711"}]
[null,null,null,null,"68084009811",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3190,1),\"\"))","v":1},{"$f":"IF(F3190=1,COUNTIF($F$3:F3190,1),\"\")","v":3188},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3190),$G$3:$G$3716,0)),\"\")","v":"68084009811"}]
[null,null,null,null,"68084009911",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3191,1),\"\"))","v":1},{"$f":"IF(F3191=1,COUNTIF($F$3:F3191,1),\"\")","v":3189},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3191),$G$3:$G$3716,0)),\"\")","v":"68084009911"}]
[null,null,null,null,"68084010311",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3192,1),\"\"))","v":1},{"$f":"IF(F3192=1,COUNTIF($F$3:F3192,1),\"\")","v":3190},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3192),$G$3:$G$3716,0)),\"\")","v":"68084010311"}]
[null,null,null,null,"68084011211",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3193,1),\"\"))","v":1},{"$f":"IF(F3193=1,COUNTIF($F$3:F3193,1),\"\")","v":3191},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3193),$G$3:$G$3716,0)),\"\")","v":"68084011211"}]
[null,null,null,null,"68084011901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3194,1),\"\"))","v":1},{"$f":"IF(F3194=1,COUNTIF($F$3:F3194,1),\"\")","v":3192},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3194),$G$3:$G$3716,0)),\"\")","v":"68084011901"}]
[null,null,null,null,"68084012511",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3195,1),\"\"))","v":1},{"$f":"IF(F3195=1,COUNTIF($F$3:F3195,1),\"\")","v":3193},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3195),$G$3:$G$3716,0)),\"\")","v":"68084012511"}]
[null,null,null,null,"68084017965",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3196,1),\"\"))","v":1},{"$f":"IF(F3196=1,COUNTIF($F$3:F3196,1),\"\")","v":3194},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3196),$G$3:$G$3716,0)),\"\")","v":"68084017965"}]
[null,null,null,null,"68084018101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3197,1),\"\"))","v":1},{"$f":"IF(F3197=1,COUNTIF($F$3:F3197,1),\"\")","v":3195},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3197),$G$3:$G$3716,0)),\"\")","v":"68084018101"}]
[null,null,null,null,"68084018111",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3198,1),\"\"))","v":1},{"$f":"IF(F3198=1,COUNTIF($F$3:F3198,1),\"\")","v":3196},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3198),$G$3:$G$3716,0)),\"\")","v":"68084018111"}]
[null,null,null,null,"68084018201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3199,1),\"\"))","v":1},{"$f":"IF(F3199=1,COUNTIF($F$3:F3199,1),\"\")","v":3197},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3199),$G$3:$G$3716,0)),\"\")","v":"68084018201"}]
[null,null,null,null,"68084018211",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3200,1),\"\"))","v":1},{"$f":"IF(F3200=1,COUNTIF($F$3:F3200,1),\"\")","v":3198},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3200),$G$3:$G$3716,0)),\"\")","v":"68084018211"}]
[null,null,null,null,"68084018501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3201,1),\"\"))","v":1},{"$f":"IF(F3201=1,COUNTIF($F$3:F3201,1),\"\")","v":3199},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3201),$G$3:$G$3716,0)),\"\")","v":"68084018501"}]
[null,null,null,null,"68084018511",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3202,1),\"\"))","v":1},{"$f":"IF(F3202=1,COUNTIF($F$3:F3202,1),\"\")","v":3200},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3202),$G$3:$G$3716,0)),\"\")","v":"68084018511"}]
[null,null,null,null,"68084019611",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3203,1),\"\"))","v":1},{"$f":"IF(F3203=1,COUNTIF($F$3:F3203,1),\"\")","v":3201},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3203),$G$3:$G$3716,0)),\"\")","v":"68084019611"}]
[null,null,null,null,"68084019811",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3204,1),\"\"))","v":1},{"$f":"IF(F3204=1,COUNTIF($F$3:F3204,1),\"\")","v":3202},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3204),$G$3:$G$3716,0)),\"\")","v":"68084019811"}]
[null,null,null,null,"68084020211",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3205,1),\"\"))","v":1},{"$f":"IF(F3205=1,COUNTIF($F$3:F3205,1),\"\")","v":3203},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3205),$G$3:$G$3716,0)),\"\")","v":"68084020211"}]
[null,null,null,null,"68084020311",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3206,1),\"\"))","v":1},{"$f":"IF(F3206=1,COUNTIF($F$3:F3206,1),\"\")","v":3204},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3206),$G$3:$G$3716,0)),\"\")","v":"68084020311"}]
[null,null,null,null,"68084020601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3207,1),\"\"))","v":1},{"$f":"IF(F3207=1,COUNTIF($F$3:F3207,1),\"\")","v":3205},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3207),$G$3:$G$3716,0)),\"\")","v":"68084020601"}]
[null,null,null,null,"68084020701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3208,1),\"\"))","v":1},{"$f":"IF(F3208=1,COUNTIF($F$3:F3208,1),\"\")","v":3206},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3208),$G$3:$G$3716,0)),\"\")","v":"68084020701"}]
[null,null,null,null,"68084020711",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3209,1),\"\"))","v":1},{"$f":"IF(F3209=1,COUNTIF($F$3:F3209,1),\"\")","v":3207},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3209),$G$3:$G$3716,0)),\"\")","v":"68084020711"}]
[null,null,null,null,"68084020801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3210,1),\"\"))","v":1},{"$f":"IF(F3210=1,COUNTIF($F$3:F3210,1),\"\")","v":3208},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3210),$G$3:$G$3716,0)),\"\")","v":"68084020801"}]
[null,null,null,null,"68084021411",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3211,1),\"\"))","v":1},{"$f":"IF(F3211=1,COUNTIF($F$3:F3211,1),\"\")","v":3209},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3211),$G$3:$G$3716,0)),\"\")","v":"68084021411"}]
[null,null,null,null,"68084023001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3212,1),\"\"))","v":1},{"$f":"IF(F3212=1,COUNTIF($F$3:F3212,1),\"\")","v":3210},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3212),$G$3:$G$3716,0)),\"\")","v":"68084023001"}]
[null,null,null,null,"68084023011",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3213,1),\"\"))","v":1},{"$f":"IF(F3213=1,COUNTIF($F$3:F3213,1),\"\")","v":3211},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3213),$G$3:$G$3716,0)),\"\")","v":"68084023011"}]
[null,null,null,null,"68084024001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3214,1),\"\"))","v":1},{"$f":"IF(F3214=1,COUNTIF($F$3:F3214,1),\"\")","v":3212},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3214),$G$3:$G$3716,0)),\"\")","v":"68084024001"}]
[null,null,null,null,"68084024011",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3215,1),\"\"))","v":1},{"$f":"IF(F3215=1,COUNTIF($F$3:F3215,1),\"\")","v":3213},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3215),$G$3:$G$3716,0)),\"\")","v":"68084024011"}]
[null,null,null,null,"68084024311",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3216,1),\"\"))","v":1},{"$f":"IF(F3216=1,COUNTIF($F$3:F3216,1),\"\")","v":3214},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3216),$G$3:$G$3716,0)),\"\")","v":"68084024311"}]
[null,null,null,null,"68084024411",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3217,1),\"\"))","v":1},{"$f":"IF(F3217=1,COUNTIF($F$3:F3217,1),\"\")","v":3215},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3217),$G$3:$G$3716,0)),\"\")","v":"68084024411"}]
[null,null,null,null,"68084024801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3218,1),\"\"))","v":1},{"$f":"IF(F3218=1,COUNTIF($F$3:F3218,1),\"\")","v":3216},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3218),$G$3:$G$3716,0)),\"\")","v":"68084024801"}]
[null,null,null,null,"68084024811",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3219,1),\"\"))","v":1},{"$f":"IF(F3219=1,COUNTIF($F$3:F3219,1),\"\")","v":3217},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3219),$G$3:$G$3716,0)),\"\")","v":"68084024811"}]
[null,null,null,null,"68084025301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3220,1),\"\"))","v":1},{"$f":"IF(F3220=1,COUNTIF($F$3:F3220,1),\"\")","v":3218},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3220),$G$3:$G$3716,0)),\"\")","v":"68084025301"}]
[null,null,null,null,"68084025311",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3221,1),\"\"))","v":1},{"$f":"IF(F3221=1,COUNTIF($F$3:F3221,1),\"\")","v":3219},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3221),$G$3:$G$3716,0)),\"\")","v":"68084025311"}]
[null,null,null,null,"68084025401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3222,1),\"\"))","v":1},{"$f":"IF(F3222=1,COUNTIF($F$3:F3222,1),\"\")","v":3220},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3222),$G$3:$G$3716,0)),\"\")","v":"68084025401"}]
[null,null,null,null,"68084025411",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3223,1),\"\"))","v":1},{"$f":"IF(F3223=1,COUNTIF($F$3:F3223,1),\"\")","v":3221},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3223),$G$3:$G$3716,0)),\"\")","v":"68084025411"}]
[null,null,null,null,"68084025901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3224,1),\"\"))","v":1},{"$f":"IF(F3224=1,COUNTIF($F$3:F3224,1),\"\")","v":3222},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3224),$G$3:$G$3716,0)),\"\")","v":"68084025901"}]
[null,null,null,null,"68084025911",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3225,1),\"\"))","v":1},{"$f":"IF(F3225=1,COUNTIF($F$3:F3225,1),\"\")","v":3223},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3225),$G$3:$G$3716,0)),\"\")","v":"68084025911"}]
[null,null,null,null,"68084026201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3226,1),\"\"))","v":1},{"$f":"IF(F3226=1,COUNTIF($F$3:F3226,1),\"\")","v":3224},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3226),$G$3:$G$3716,0)),\"\")","v":"68084026201"}]
[null,null,null,null,"68084026901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3227,1),\"\"))","v":1},{"$f":"IF(F3227=1,COUNTIF($F$3:F3227,1),\"\")","v":3225},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3227),$G$3:$G$3716,0)),\"\")","v":"68084026901"}]
[null,null,null,null,"68084026911",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3228,1),\"\"))","v":1},{"$f":"IF(F3228=1,COUNTIF($F$3:F3228,1),\"\")","v":3226},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3228),$G$3:$G$3716,0)),\"\")","v":"68084026911"}]
[null,null,null,null,"68084027511",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3229,1),\"\"))","v":1},{"$f":"IF(F3229=1,COUNTIF($F$3:F3229,1),\"\")","v":3227},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3229),$G$3:$G$3716,0)),\"\")","v":"68084027511"}]
[null,null,null,null,"68084027801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3230,1),\"\"))","v":1},{"$f":"IF(F3230=1,COUNTIF($F$3:F3230,1),\"\")","v":3228},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3230),$G$3:$G$3716,0)),\"\")","v":"68084027801"}]
[null,null,null,null,"68084027811",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3231,1),\"\"))","v":1},{"$f":"IF(F3231=1,COUNTIF($F$3:F3231,1),\"\")","v":3229},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3231),$G$3:$G$3716,0)),\"\")","v":"68084027811"}]
[null,null,null,null,"68084028001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3232,1),\"\"))","v":1},{"$f":"IF(F3232=1,COUNTIF($F$3:F3232,1),\"\")","v":3230},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3232),$G$3:$G$3716,0)),\"\")","v":"68084028001"}]
[null,null,null,null,"68084028101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3233,1),\"\"))","v":1},{"$f":"IF(F3233=1,COUNTIF($F$3:F3233,1),\"\")","v":3231},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3233),$G$3:$G$3716,0)),\"\")","v":"68084028101"}]
[null,null,null,null,"68084028201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3234,1),\"\"))","v":1},{"$f":"IF(F3234=1,COUNTIF($F$3:F3234,1),\"\")","v":3232},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3234),$G$3:$G$3716,0)),\"\")","v":"68084028201"}]
[null,null,null,null,"68084028401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3235,1),\"\"))","v":1},{"$f":"IF(F3235=1,COUNTIF($F$3:F3235,1),\"\")","v":3233},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3235),$G$3:$G$3716,0)),\"\")","v":"68084028401"}]
[null,null,null,null,"68084028411",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3236,1),\"\"))","v":1},{"$f":"IF(F3236=1,COUNTIF($F$3:F3236,1),\"\")","v":3234},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3236),$G$3:$G$3716,0)),\"\")","v":"68084028411"}]
[null,null,null,null,"68084028811",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3237,1),\"\"))","v":1},{"$f":"IF(F3237=1,COUNTIF($F$3:F3237,1),\"\")","v":3235},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3237),$G$3:$G$3716,0)),\"\")","v":"68084028811"}]
[null,null,null,null,"68084029111",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3238,1),\"\"))","v":1},{"$f":"IF(F3238=1,COUNTIF($F$3:F3238,1),\"\")","v":3236},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3238),$G$3:$G$3716,0)),\"\")","v":"68084029111"}]
[null,null,null,null,"68084029201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3239,1),\"\"))","v":1},{"$f":"IF(F3239=1,COUNTIF($F$3:F3239,1),\"\")","v":3237},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3239),$G$3:$G$3716,0)),\"\")","v":"68084029201"}]
[null,null,null,null,"68084029301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3240,1),\"\"))","v":1},{"$f":"IF(F3240=1,COUNTIF($F$3:F3240,1),\"\")","v":3238},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3240),$G$3:$G$3716,0)),\"\")","v":"68084029301"}]
[null,null,null,null,"68084031011",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3241,1),\"\"))","v":1},{"$f":"IF(F3241=1,COUNTIF($F$3:F3241,1),\"\")","v":3239},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3241),$G$3:$G$3716,0)),\"\")","v":"68084031011"}]
[null,null,null,null,"68084031301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3242,1),\"\"))","v":1},{"$f":"IF(F3242=1,COUNTIF($F$3:F3242,1),\"\")","v":3240},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3242),$G$3:$G$3716,0)),\"\")","v":"68084031301"}]
[null,null,null,null,"68084031311",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3243,1),\"\"))","v":1},{"$f":"IF(F3243=1,COUNTIF($F$3:F3243,1),\"\")","v":3241},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3243),$G$3:$G$3716,0)),\"\")","v":"68084031311"}]
[null,null,null,null,"68084031401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3244,1),\"\"))","v":1},{"$f":"IF(F3244=1,COUNTIF($F$3:F3244,1),\"\")","v":3242},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3244),$G$3:$G$3716,0)),\"\")","v":"68084031401"}]
[null,null,null,null,"68084031501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3245,1),\"\"))","v":1},{"$f":"IF(F3245=1,COUNTIF($F$3:F3245,1),\"\")","v":3243},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3245),$G$3:$G$3716,0)),\"\")","v":"68084031501"}]
[null,null,null,null,"68084031711",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3246,1),\"\"))","v":1},{"$f":"IF(F3246=1,COUNTIF($F$3:F3246,1),\"\")","v":3244},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3246),$G$3:$G$3716,0)),\"\")","v":"68084031711"}]
[null,null,null,null,"68084031801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3247,1),\"\"))","v":1},{"$f":"IF(F3247=1,COUNTIF($F$3:F3247,1),\"\")","v":3245},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3247),$G$3:$G$3716,0)),\"\")","v":"68084031801"}]
[null,null,null,null,"68084032811",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3248,1),\"\"))","v":1},{"$f":"IF(F3248=1,COUNTIF($F$3:F3248,1),\"\")","v":3246},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3248),$G$3:$G$3716,0)),\"\")","v":"68084032811"}]
[null,null,null,null,"68084032821",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3249,1),\"\"))","v":1},{"$f":"IF(F3249=1,COUNTIF($F$3:F3249,1),\"\")","v":3247},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3249),$G$3:$G$3716,0)),\"\")","v":"68084032821"}]
[null,null,null,null,"68084033511",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3250,1),\"\"))","v":1},{"$f":"IF(F3250=1,COUNTIF($F$3:F3250,1),\"\")","v":3248},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3250),$G$3:$G$3716,0)),\"\")","v":"68084033511"}]
[null,null,null,null,"68084033521",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3251,1),\"\"))","v":1},{"$f":"IF(F3251=1,COUNTIF($F$3:F3251,1),\"\")","v":3249},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3251),$G$3:$G$3716,0)),\"\")","v":"68084033521"}]
[null,null,null,null,"68084033996",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3252,1),\"\"))","v":1},{"$f":"IF(F3252=1,COUNTIF($F$3:F3252,1),\"\")","v":3250},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3252),$G$3:$G$3716,0)),\"\")","v":"68084033996"}]
[null,null,null,null,"68084034211",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3253,1),\"\"))","v":1},{"$f":"IF(F3253=1,COUNTIF($F$3:F3253,1),\"\")","v":3251},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3253),$G$3:$G$3716,0)),\"\")","v":"68084034211"}]
[null,null,null,null,"68084034411",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3254,1),\"\"))","v":1},{"$f":"IF(F3254=1,COUNTIF($F$3:F3254,1),\"\")","v":3252},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3254),$G$3:$G$3716,0)),\"\")","v":"68084034411"}]
[null,null,null,null,"68084035501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3255,1),\"\"))","v":1},{"$f":"IF(F3255=1,COUNTIF($F$3:F3255,1),\"\")","v":3253},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3255),$G$3:$G$3716,0)),\"\")","v":"68084035501"}]
[null,null,null,null,"68084035811",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3256,1),\"\"))","v":1},{"$f":"IF(F3256=1,COUNTIF($F$3:F3256,1),\"\")","v":3254},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3256),$G$3:$G$3716,0)),\"\")","v":"68084035811"}]
[null,null,null,null,"68084036011",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3257,1),\"\"))","v":1},{"$f":"IF(F3257=1,COUNTIF($F$3:F3257,1),\"\")","v":3255},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3257),$G$3:$G$3716,0)),\"\")","v":"68084036011"}]
[null,null,null,null,"68084036101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3258,1),\"\"))","v":1},{"$f":"IF(F3258=1,COUNTIF($F$3:F3258,1),\"\")","v":3256},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3258),$G$3:$G$3716,0)),\"\")","v":"68084036101"}]
[null,null,null,null,"68084037101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3259,1),\"\"))","v":1},{"$f":"IF(F3259=1,COUNTIF($F$3:F3259,1),\"\")","v":3257},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3259),$G$3:$G$3716,0)),\"\")","v":"68084037101"}]
[null,null,null,null,"68084037211",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3260,1),\"\"))","v":1},{"$f":"IF(F3260=1,COUNTIF($F$3:F3260,1),\"\")","v":3258},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3260),$G$3:$G$3716,0)),\"\")","v":"68084037211"}]
[null,null,null,null,"68084038101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3261,1),\"\"))","v":1},{"$f":"IF(F3261=1,COUNTIF($F$3:F3261,1),\"\")","v":3259},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3261),$G$3:$G$3716,0)),\"\")","v":"68084038101"}]
[null,null,null,null,"68084038111",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3262,1),\"\"))","v":1},{"$f":"IF(F3262=1,COUNTIF($F$3:F3262,1),\"\")","v":3260},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3262),$G$3:$G$3716,0)),\"\")","v":"68084038111"}]
[null,null,null,null,"68084038801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3263,1),\"\"))","v":1},{"$f":"IF(F3263=1,COUNTIF($F$3:F3263,1),\"\")","v":3261},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3263),$G$3:$G$3716,0)),\"\")","v":"68084038801"}]
[null,null,null,null,"68084039701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3264,1),\"\"))","v":1},{"$f":"IF(F3264=1,COUNTIF($F$3:F3264,1),\"\")","v":3262},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3264),$G$3:$G$3716,0)),\"\")","v":"68084039701"}]
[null,null,null,null,"68084039901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3265,1),\"\"))","v":1},{"$f":"IF(F3265=1,COUNTIF($F$3:F3265,1),\"\")","v":3263},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3265),$G$3:$G$3716,0)),\"\")","v":"68084039901"}]
[null,null,null,null,"68084040011",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3266,1),\"\"))","v":1},{"$f":"IF(F3266=1,COUNTIF($F$3:F3266,1),\"\")","v":3264},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3266),$G$3:$G$3716,0)),\"\")","v":"68084040011"}]
[null,null,null,null,"68084040111",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3267,1),\"\"))","v":1},{"$f":"IF(F3267=1,COUNTIF($F$3:F3267,1),\"\")","v":3265},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3267),$G$3:$G$3716,0)),\"\")","v":"68084040111"}]
[null,null,null,null,"68084040711",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3268,1),\"\"))","v":1},{"$f":"IF(F3268=1,COUNTIF($F$3:F3268,1),\"\")","v":3266},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3268),$G$3:$G$3716,0)),\"\")","v":"68084040711"}]
[null,null,null,null,"68084040811",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3269,1),\"\"))","v":1},{"$f":"IF(F3269=1,COUNTIF($F$3:F3269,1),\"\")","v":3267},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3269),$G$3:$G$3716,0)),\"\")","v":"68084040811"}]
[null,null,null,null,"68084040911",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3270,1),\"\"))","v":1},{"$f":"IF(F3270=1,COUNTIF($F$3:F3270,1),\"\")","v":3268},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3270),$G$3:$G$3716,0)),\"\")","v":"68084040911"}]
[null,null,null,null,"68084041511",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3271,1),\"\"))","v":1},{"$f":"IF(F3271=1,COUNTIF($F$3:F3271,1),\"\")","v":3269},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3271),$G$3:$G$3716,0)),\"\")","v":"68084041511"}]
[null,null,null,null,"68084042301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3272,1),\"\"))","v":1},{"$f":"IF(F3272=1,COUNTIF($F$3:F3272,1),\"\")","v":3270},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3272),$G$3:$G$3716,0)),\"\")","v":"68084042301"}]
[null,null,null,null,"68084042311",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3273,1),\"\"))","v":1},{"$f":"IF(F3273=1,COUNTIF($F$3:F3273,1),\"\")","v":3271},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3273),$G$3:$G$3716,0)),\"\")","v":"68084042311"}]
[null,null,null,null,"68084043098",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3274,1),\"\"))","v":1},{"$f":"IF(F3274=1,COUNTIF($F$3:F3274,1),\"\")","v":3272},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3274),$G$3:$G$3716,0)),\"\")","v":"68084043098"}]
[null,null,null,null,"68084043099",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3275,1),\"\"))","v":1},{"$f":"IF(F3275=1,COUNTIF($F$3:F3275,1),\"\")","v":3273},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3275),$G$3:$G$3716,0)),\"\")","v":"68084043099"}]
[null,null,null,null,"68084044001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3276,1),\"\"))","v":1},{"$f":"IF(F3276=1,COUNTIF($F$3:F3276,1),\"\")","v":3274},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3276),$G$3:$G$3716,0)),\"\")","v":"68084044001"}]
[null,null,null,null,"68084044011",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3277,1),\"\"))","v":1},{"$f":"IF(F3277=1,COUNTIF($F$3:F3277,1),\"\")","v":3275},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3277),$G$3:$G$3716,0)),\"\")","v":"68084044011"}]
[null,null,null,null,"68084044701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3278,1),\"\"))","v":1},{"$f":"IF(F3278=1,COUNTIF($F$3:F3278,1),\"\")","v":3276},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3278),$G$3:$G$3716,0)),\"\")","v":"68084044701"}]
[null,null,null,null,"68084046911",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3279,1),\"\"))","v":1},{"$f":"IF(F3279=1,COUNTIF($F$3:F3279,1),\"\")","v":3277},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3279),$G$3:$G$3716,0)),\"\")","v":"68084046911"}]
[null,null,null,null,"68084047211",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3280,1),\"\"))","v":1},{"$f":"IF(F3280=1,COUNTIF($F$3:F3280,1),\"\")","v":3278},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3280),$G$3:$G$3716,0)),\"\")","v":"68084047211"}]
[null,null,null,null,"68084047901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3281,1),\"\"))","v":1},{"$f":"IF(F3281=1,COUNTIF($F$3:F3281,1),\"\")","v":3279},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3281),$G$3:$G$3716,0)),\"\")","v":"68084047901"}]
[null,null,null,null,"68084047911",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3282,1),\"\"))","v":1},{"$f":"IF(F3282=1,COUNTIF($F$3:F3282,1),\"\")","v":3280},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3282),$G$3:$G$3716,0)),\"\")","v":"68084047911"}]
[null,null,null,null,"68084048001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3283,1),\"\"))","v":1},{"$f":"IF(F3283=1,COUNTIF($F$3:F3283,1),\"\")","v":3281},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3283),$G$3:$G$3716,0)),\"\")","v":"68084048001"}]
[null,null,null,null,"68084048011",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3284,1),\"\"))","v":1},{"$f":"IF(F3284=1,COUNTIF($F$3:F3284,1),\"\")","v":3282},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3284),$G$3:$G$3716,0)),\"\")","v":"68084048011"}]
[null,null,null,null,"68084048101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3285,1),\"\"))","v":1},{"$f":"IF(F3285=1,COUNTIF($F$3:F3285,1),\"\")","v":3283},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3285),$G$3:$G$3716,0)),\"\")","v":"68084048101"}]
[null,null,null,null,"68084048511",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3286,1),\"\"))","v":1},{"$f":"IF(F3286=1,COUNTIF($F$3:F3286,1),\"\")","v":3284},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3286),$G$3:$G$3716,0)),\"\")","v":"68084048511"}]
[null,null,null,null,"68084049411",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3287,1),\"\"))","v":1},{"$f":"IF(F3287=1,COUNTIF($F$3:F3287,1),\"\")","v":3285},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3287),$G$3:$G$3716,0)),\"\")","v":"68084049411"}]
[null,null,null,null,"68084050501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3288,1),\"\"))","v":1},{"$f":"IF(F3288=1,COUNTIF($F$3:F3288,1),\"\")","v":3286},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3288),$G$3:$G$3716,0)),\"\")","v":"68084050501"}]
[null,null,null,null,"68084051101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3289,1),\"\"))","v":1},{"$f":"IF(F3289=1,COUNTIF($F$3:F3289,1),\"\")","v":3287},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3289),$G$3:$G$3716,0)),\"\")","v":"68084051101"}]
[null,null,null,null,"68084051111",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3290,1),\"\"))","v":1},{"$f":"IF(F3290=1,COUNTIF($F$3:F3290,1),\"\")","v":3288},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3290),$G$3:$G$3716,0)),\"\")","v":"68084051111"}]
[null,null,null,null,"68084051211",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3291,1),\"\"))","v":1},{"$f":"IF(F3291=1,COUNTIF($F$3:F3291,1),\"\")","v":3289},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3291),$G$3:$G$3716,0)),\"\")","v":"68084051211"}]
[null,null,null,null,"68084051301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3292,1),\"\"))","v":1},{"$f":"IF(F3292=1,COUNTIF($F$3:F3292,1),\"\")","v":3290},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3292),$G$3:$G$3716,0)),\"\")","v":"68084051301"}]
[null,null,null,null,"68084053211",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3293,1),\"\"))","v":1},{"$f":"IF(F3293=1,COUNTIF($F$3:F3293,1),\"\")","v":3291},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3293),$G$3:$G$3716,0)),\"\")","v":"68084053211"}]
[null,null,null,null,"68084053601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3294,1),\"\"))","v":1},{"$f":"IF(F3294=1,COUNTIF($F$3:F3294,1),\"\")","v":3292},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3294),$G$3:$G$3716,0)),\"\")","v":"68084053601"}]
[null,null,null,null,"68084053611",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3295,1),\"\"))","v":1},{"$f":"IF(F3295=1,COUNTIF($F$3:F3295,1),\"\")","v":3293},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3295),$G$3:$G$3716,0)),\"\")","v":"68084053611"}]
[null,null,null,null,"68084053911",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3296,1),\"\"))","v":1},{"$f":"IF(F3296=1,COUNTIF($F$3:F3296,1),\"\")","v":3294},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3296),$G$3:$G$3716,0)),\"\")","v":"68084053911"}]
[null,null,null,null,"68084056111",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3297,1),\"\"))","v":1},{"$f":"IF(F3297=1,COUNTIF($F$3:F3297,1),\"\")","v":3295},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3297),$G$3:$G$3716,0)),\"\")","v":"68084056111"}]
[null,null,null,null,"68084056211",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3298,1),\"\"))","v":1},{"$f":"IF(F3298=1,COUNTIF($F$3:F3298,1),\"\")","v":3296},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3298),$G$3:$G$3716,0)),\"\")","v":"68084056211"}]
[null,null,null,null,"68084056301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3299,1),\"\"))","v":1},{"$f":"IF(F3299=1,COUNTIF($F$3:F3299,1),\"\")","v":3297},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3299),$G$3:$G$3716,0)),\"\")","v":"68084056301"}]
[null,null,null,null,"68084059025",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3300,1),\"\"))","v":1},{"$f":"IF(F3300=1,COUNTIF($F$3:F3300,1),\"\")","v":3298},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3300),$G$3:$G$3716,0)),\"\")","v":"68084059025"}]
[null,null,null,null,"68084059095",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3301,1),\"\"))","v":1},{"$f":"IF(F3301=1,COUNTIF($F$3:F3301,1),\"\")","v":3299},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3301),$G$3:$G$3716,0)),\"\")","v":"68084059095"}]
[null,null,null,null,"68084059201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3302,1),\"\"))","v":1},{"$f":"IF(F3302=1,COUNTIF($F$3:F3302,1),\"\")","v":3300},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3302),$G$3:$G$3716,0)),\"\")","v":"68084059201"}]
[null,null,null,null,"68084059211",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3303,1),\"\"))","v":1},{"$f":"IF(F3303=1,COUNTIF($F$3:F3303,1),\"\")","v":3301},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3303),$G$3:$G$3716,0)),\"\")","v":"68084059211"}]
[null,null,null,null,"68084059701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3304,1),\"\"))","v":1},{"$f":"IF(F3304=1,COUNTIF($F$3:F3304,1),\"\")","v":3302},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3304),$G$3:$G$3716,0)),\"\")","v":"68084059701"}]
[null,null,null,null,"68084059711",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3305,1),\"\"))","v":1},{"$f":"IF(F3305=1,COUNTIF($F$3:F3305,1),\"\")","v":3303},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3305),$G$3:$G$3716,0)),\"\")","v":"68084059711"}]
[null,null,null,null,"68084059811",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3306,1),\"\"))","v":1},{"$f":"IF(F3306=1,COUNTIF($F$3:F3306,1),\"\")","v":3304},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3306),$G$3:$G$3716,0)),\"\")","v":"68084059811"}]
[null,null,null,null,"68084060901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3307,1),\"\"))","v":1},{"$f":"IF(F3307=1,COUNTIF($F$3:F3307,1),\"\")","v":3305},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3307),$G$3:$G$3716,0)),\"\")","v":"68084060901"}]
[null,null,null,null,"68084061901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3308,1),\"\"))","v":1},{"$f":"IF(F3308=1,COUNTIF($F$3:F3308,1),\"\")","v":3306},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3308),$G$3:$G$3716,0)),\"\")","v":"68084061901"}]
[null,null,null,null,"68084062001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3309,1),\"\"))","v":1},{"$f":"IF(F3309=1,COUNTIF($F$3:F3309,1),\"\")","v":3307},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3309),$G$3:$G$3716,0)),\"\")","v":"68084062001"}]
[null,null,null,null,"68084062221",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3310,1),\"\"))","v":1},{"$f":"IF(F3310=1,COUNTIF($F$3:F3310,1),\"\")","v":3308},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3310),$G$3:$G$3716,0)),\"\")","v":"68084062221"}]
[null,null,null,null,"68084065411",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3311,1),\"\"))","v":1},{"$f":"IF(F3311=1,COUNTIF($F$3:F3311,1),\"\")","v":3309},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3311),$G$3:$G$3716,0)),\"\")","v":"68084065411"}]
[null,null,null,null,"68084065611",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3312,1),\"\"))","v":1},{"$f":"IF(F3312=1,COUNTIF($F$3:F3312,1),\"\")","v":3310},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3312),$G$3:$G$3716,0)),\"\")","v":"68084065611"}]
[null,null,null,null,"68084065901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3313,1),\"\"))","v":1},{"$f":"IF(F3313=1,COUNTIF($F$3:F3313,1),\"\")","v":3311},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3313),$G$3:$G$3716,0)),\"\")","v":"68084065901"}]
[null,null,null,null,"68084065911",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3314,1),\"\"))","v":1},{"$f":"IF(F3314=1,COUNTIF($F$3:F3314,1),\"\")","v":3312},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3314),$G$3:$G$3716,0)),\"\")","v":"68084065911"}]
[null,null,null,null,"68084066601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3315,1),\"\"))","v":1},{"$f":"IF(F3315=1,COUNTIF($F$3:F3315,1),\"\")","v":3313},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3315),$G$3:$G$3716,0)),\"\")","v":"68084066601"}]
[null,null,null,null,"68084066611",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3316,1),\"\"))","v":1},{"$f":"IF(F3316=1,COUNTIF($F$3:F3316,1),\"\")","v":3314},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3316),$G$3:$G$3716,0)),\"\")","v":"68084066611"}]
[null,null,null,null,"68084067511",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3317,1),\"\"))","v":1},{"$f":"IF(F3317=1,COUNTIF($F$3:F3317,1),\"\")","v":3315},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3317),$G$3:$G$3716,0)),\"\")","v":"68084067511"}]
[null,null,null,null,"68084067521",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3318,1),\"\"))","v":1},{"$f":"IF(F3318=1,COUNTIF($F$3:F3318,1),\"\")","v":3316},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3318),$G$3:$G$3716,0)),\"\")","v":"68084067521"}]
[null,null,null,null,"68084067611",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3319,1),\"\"))","v":1},{"$f":"IF(F3319=1,COUNTIF($F$3:F3319,1),\"\")","v":3317},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3319),$G$3:$G$3716,0)),\"\")","v":"68084067611"}]
[null,null,null,null,"68084068311",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3320,1),\"\"))","v":1},{"$f":"IF(F3320=1,COUNTIF($F$3:F3320,1),\"\")","v":3318},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3320),$G$3:$G$3716,0)),\"\")","v":"68084068311"}]
[null,null,null,null,"68084069711",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3321,1),\"\"))","v":1},{"$f":"IF(F3321=1,COUNTIF($F$3:F3321,1),\"\")","v":3319},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3321),$G$3:$G$3716,0)),\"\")","v":"68084069711"}]
[null,null,null,null,"68084069811",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3322,1),\"\"))","v":1},{"$f":"IF(F3322=1,COUNTIF($F$3:F3322,1),\"\")","v":3320},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3322),$G$3:$G$3716,0)),\"\")","v":"68084069811"}]
[null,null,null,null,"68084070301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3323,1),\"\"))","v":1},{"$f":"IF(F3323=1,COUNTIF($F$3:F3323,1),\"\")","v":3321},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3323),$G$3:$G$3716,0)),\"\")","v":"68084070301"}]
[null,null,null,null,"68084070311",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3324,1),\"\"))","v":1},{"$f":"IF(F3324=1,COUNTIF($F$3:F3324,1),\"\")","v":3322},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3324),$G$3:$G$3716,0)),\"\")","v":"68084070311"}]
[null,null,null,null,"68084070825",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3325,1),\"\"))","v":1},{"$f":"IF(F3325=1,COUNTIF($F$3:F3325,1),\"\")","v":3323},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3325),$G$3:$G$3716,0)),\"\")","v":"68084070825"}]
[null,null,null,null,"68084070895",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3326,1),\"\"))","v":1},{"$f":"IF(F3326=1,COUNTIF($F$3:F3326,1),\"\")","v":3324},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3326),$G$3:$G$3716,0)),\"\")","v":"68084070895"}]
[null,null,null,null,"68084072301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3327,1),\"\"))","v":1},{"$f":"IF(F3327=1,COUNTIF($F$3:F3327,1),\"\")","v":3325},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3327),$G$3:$G$3716,0)),\"\")","v":"68084072301"}]
[null,null,null,null,"68084072311",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3328,1),\"\"))","v":1},{"$f":"IF(F3328=1,COUNTIF($F$3:F3328,1),\"\")","v":3326},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3328),$G$3:$G$3716,0)),\"\")","v":"68084072311"}]
[null,null,null,null,"68084072911",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3329,1),\"\"))","v":1},{"$f":"IF(F3329=1,COUNTIF($F$3:F3329,1),\"\")","v":3327},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3329),$G$3:$G$3716,0)),\"\")","v":"68084072911"}]
[null,null,null,null,"68084073501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3330,1),\"\"))","v":1},{"$f":"IF(F3330=1,COUNTIF($F$3:F3330,1),\"\")","v":3328},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3330),$G$3:$G$3716,0)),\"\")","v":"68084073501"}]
[null,null,null,null,"68084074211",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3331,1),\"\"))","v":1},{"$f":"IF(F3331=1,COUNTIF($F$3:F3331,1),\"\")","v":3329},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3331),$G$3:$G$3716,0)),\"\")","v":"68084074211"}]
[null,null,null,null,"68084075411",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3332,1),\"\"))","v":1},{"$f":"IF(F3332=1,COUNTIF($F$3:F3332,1),\"\")","v":3330},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3332),$G$3:$G$3716,0)),\"\")","v":"68084075411"}]
[null,null,null,null,"68084076211",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3333,1),\"\"))","v":1},{"$f":"IF(F3333=1,COUNTIF($F$3:F3333,1),\"\")","v":3331},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3333),$G$3:$G$3716,0)),\"\")","v":"68084076211"}]
[null,null,null,null,"68084077201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3334,1),\"\"))","v":1},{"$f":"IF(F3334=1,COUNTIF($F$3:F3334,1),\"\")","v":3332},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3334),$G$3:$G$3716,0)),\"\")","v":"68084077201"}]
[null,null,null,null,"68084077211",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3335,1),\"\"))","v":1},{"$f":"IF(F3335=1,COUNTIF($F$3:F3335,1),\"\")","v":3333},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3335),$G$3:$G$3716,0)),\"\")","v":"68084077211"}]
[null,null,null,null,"68084077401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3336,1),\"\"))","v":1},{"$f":"IF(F3336=1,COUNTIF($F$3:F3336,1),\"\")","v":3334},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3336),$G$3:$G$3716,0)),\"\")","v":"68084077401"}]
[null,null,null,null,"68084077411",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3337,1),\"\"))","v":1},{"$f":"IF(F3337=1,COUNTIF($F$3:F3337,1),\"\")","v":3335},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3337),$G$3:$G$3716,0)),\"\")","v":"68084077411"}]
[null,null,null,null,"68084077525",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3338,1),\"\"))","v":1},{"$f":"IF(F3338=1,COUNTIF($F$3:F3338,1),\"\")","v":3336},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3338),$G$3:$G$3716,0)),\"\")","v":"68084077525"}]
[null,null,null,null,"68084077595",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3339,1),\"\"))","v":1},{"$f":"IF(F3339=1,COUNTIF($F$3:F3339,1),\"\")","v":3337},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3339),$G$3:$G$3716,0)),\"\")","v":"68084077595"}]
[null,null,null,null,"68084077611",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3340,1),\"\"))","v":1},{"$f":"IF(F3340=1,COUNTIF($F$3:F3340,1),\"\")","v":3338},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3340),$G$3:$G$3716,0)),\"\")","v":"68084077611"}]
[null,null,null,null,"68084078211",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3341,1),\"\"))","v":1},{"$f":"IF(F3341=1,COUNTIF($F$3:F3341,1),\"\")","v":3339},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3341),$G$3:$G$3716,0)),\"\")","v":"68084078211"}]
[null,null,null,null,"68084078301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3342,1),\"\"))","v":1},{"$f":"IF(F3342=1,COUNTIF($F$3:F3342,1),\"\")","v":3340},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3342),$G$3:$G$3716,0)),\"\")","v":"68084078301"}]
[null,null,null,null,"68084078311",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3343,1),\"\"))","v":1},{"$f":"IF(F3343=1,COUNTIF($F$3:F3343,1),\"\")","v":3341},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3343),$G$3:$G$3716,0)),\"\")","v":"68084078311"}]
[null,null,null,null,"68084080811",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3344,1),\"\"))","v":1},{"$f":"IF(F3344=1,COUNTIF($F$3:F3344,1),\"\")","v":3342},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3344),$G$3:$G$3716,0)),\"\")","v":"68084080811"}]
[null,null,null,null,"68084082725",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3345,1),\"\"))","v":1},{"$f":"IF(F3345=1,COUNTIF($F$3:F3345,1),\"\")","v":3343},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3345),$G$3:$G$3716,0)),\"\")","v":"68084082725"}]
[null,null,null,null,"68084082795",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3346,1),\"\"))","v":1},{"$f":"IF(F3346=1,COUNTIF($F$3:F3346,1),\"\")","v":3344},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3346),$G$3:$G$3716,0)),\"\")","v":"68084082795"}]
[null,null,null,null,"68084084401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3347,1),\"\"))","v":1},{"$f":"IF(F3347=1,COUNTIF($F$3:F3347,1),\"\")","v":3345},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3347),$G$3:$G$3716,0)),\"\")","v":"68084084401"}]
[null,null,null,null,"68084084411",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3348,1),\"\"))","v":1},{"$f":"IF(F3348=1,COUNTIF($F$3:F3348,1),\"\")","v":3346},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3348),$G$3:$G$3716,0)),\"\")","v":"68084084411"}]
[null,null,null,null,"68084084695",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3349,1),\"\"))","v":1},{"$f":"IF(F3349=1,COUNTIF($F$3:F3349,1),\"\")","v":3347},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3349),$G$3:$G$3716,0)),\"\")","v":"68084084695"}]
[null,null,null,null,"68084085311",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3350,1),\"\"))","v":1},{"$f":"IF(F3350=1,COUNTIF($F$3:F3350,1),\"\")","v":3348},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3350),$G$3:$G$3716,0)),\"\")","v":"68084085311"}]
[null,null,null,null,"68084085511",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3351,1),\"\"))","v":1},{"$f":"IF(F3351=1,COUNTIF($F$3:F3351,1),\"\")","v":3349},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3351),$G$3:$G$3716,0)),\"\")","v":"68084085511"}]
[null,null,null,null,"68084087501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3352,1),\"\"))","v":1},{"$f":"IF(F3352=1,COUNTIF($F$3:F3352,1),\"\")","v":3350},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3352),$G$3:$G$3716,0)),\"\")","v":"68084087501"}]
[null,null,null,null,"68084091695",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3353,1),\"\"))","v":1},{"$f":"IF(F3353=1,COUNTIF($F$3:F3353,1),\"\")","v":3351},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3353),$G$3:$G$3716,0)),\"\")","v":"68084091695"}]
[null,null,null,null,"68084094733",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3354,1),\"\"))","v":1},{"$f":"IF(F3354=1,COUNTIF($F$3:F3354,1),\"\")","v":3352},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3354),$G$3:$G$3716,0)),\"\")","v":"68084094733"}]
[null,null,null,null,"68084094895",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3355,1),\"\"))","v":1},{"$f":"IF(F3355=1,COUNTIF($F$3:F3355,1),\"\")","v":3353},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3355),$G$3:$G$3716,0)),\"\")","v":"68084094895"}]
[null,null,null,null,"68084096595",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3356,1),\"\"))","v":1},{"$f":"IF(F3356=1,COUNTIF($F$3:F3356,1),\"\")","v":3354},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3356),$G$3:$G$3716,0)),\"\")","v":"68084096595"}]
[null,null,null,null,"68084096901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3357,1),\"\"))","v":1},{"$f":"IF(F3357=1,COUNTIF($F$3:F3357,1),\"\")","v":3355},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3357),$G$3:$G$3716,0)),\"\")","v":"68084096901"}]
[null,null,null,null,"68084096911",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3358,1),\"\"))","v":1},{"$f":"IF(F3358=1,COUNTIF($F$3:F3358,1),\"\")","v":3356},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3358),$G$3:$G$3716,0)),\"\")","v":"68084096911"}]
[null,null,null,null,"68084097611",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3359,1),\"\"))","v":1},{"$f":"IF(F3359=1,COUNTIF($F$3:F3359,1),\"\")","v":3357},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3359),$G$3:$G$3716,0)),\"\")","v":"68084097611"}]
[null,null,null,null,"68084098833",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3360,1),\"\"))","v":1},{"$f":"IF(F3360=1,COUNTIF($F$3:F3360,1),\"\")","v":3358},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3360),$G$3:$G$3716,0)),\"\")","v":"68084098833"}]
[null,null,null,null,"68094000261",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3361,1),\"\"))","v":1},{"$f":"IF(F3361=1,COUNTIF($F$3:F3361,1),\"\")","v":3359},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3361),$G$3:$G$3716,0)),\"\")","v":"68094000261"}]
[null,null,null,null,"68094002861",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3362,1),\"\"))","v":1},{"$f":"IF(F3362=1,COUNTIF($F$3:F3362,1),\"\")","v":3360},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3362),$G$3:$G$3716,0)),\"\")","v":"68094002861"}]
[null,null,null,null,"68094017159",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3363,1),\"\"))","v":1},{"$f":"IF(F3363=1,COUNTIF($F$3:F3363,1),\"\")","v":3361},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3363),$G$3:$G$3716,0)),\"\")","v":"68094017159"}]
[null,null,null,null,"68094017161",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3364,1),\"\"))","v":1},{"$f":"IF(F3364=1,COUNTIF($F$3:F3364,1),\"\")","v":3362},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3364),$G$3:$G$3716,0)),\"\")","v":"68094017161"}]
[null,null,null,null,"68094050359",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3365,1),\"\"))","v":1},{"$f":"IF(F3365=1,COUNTIF($F$3:F3365,1),\"\")","v":3363},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3365),$G$3:$G$3716,0)),\"\")","v":"68094050359"}]
[null,null,null,null,"68094050361",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3366,1),\"\"))","v":1},{"$f":"IF(F3366=1,COUNTIF($F$3:F3366,1),\"\")","v":3364},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3366),$G$3:$G$3716,0)),\"\")","v":"68094050361"}]
[null,null,null,null,"68094059959",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3367,1),\"\"))","v":1},{"$f":"IF(F3367=1,COUNTIF($F$3:F3367,1),\"\")","v":3365},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3367),$G$3:$G$3716,0)),\"\")","v":"68094059959"}]
[null,null,null,null,"68094085362",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3368,1),\"\"))","v":1},{"$f":"IF(F3368=1,COUNTIF($F$3:F3368,1),\"\")","v":3366},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3368),$G$3:$G$3716,0)),\"\")","v":"68094085362"}]
[null,null,null,null,"68134020116",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3369,1),\"\"))","v":1},{"$f":"IF(F3369=1,COUNTIF($F$3:F3369,1),\"\")","v":3367},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3369),$G$3:$G$3716,0)),\"\")","v":"68134020116"}]
[null,null,null,null,"68176000010",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3370,1),\"\"))","v":1},{"$f":"IF(F3370=1,COUNTIF($F$3:F3370,1),\"\")","v":3368},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3370),$G$3:$G$3716,0)),\"\")","v":"68176000010"}]
[null,null,null,null,"68180012301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3371,1),\"\"))","v":1},{"$f":"IF(F3371=1,COUNTIF($F$3:F3371,1),\"\")","v":3369},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3371),$G$3:$G$3716,0)),\"\")","v":"68180012301"}]
[null,null,null,null,"68180012401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3372,1),\"\"))","v":1},{"$f":"IF(F3372=1,COUNTIF($F$3:F3372,1),\"\")","v":3370},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3372),$G$3:$G$3716,0)),\"\")","v":"68180012401"}]
[null,null,null,null,"68180015001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3373,1),\"\"))","v":1},{"$f":"IF(F3373=1,COUNTIF($F$3:F3373,1),\"\")","v":3371},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3373),$G$3:$G$3716,0)),\"\")","v":"68180015001"}]
[null,null,null,null,"68180015601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3374,1),\"\"))","v":1},{"$f":"IF(F3374=1,COUNTIF($F$3:F3374,1),\"\")","v":3372},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3374),$G$3:$G$3716,0)),\"\")","v":"68180015601"}]
[null,null,null,null,"68180015901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3375,1),\"\"))","v":1},{"$f":"IF(F3375=1,COUNTIF($F$3:F3375,1),\"\")","v":3373},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3375),$G$3:$G$3716,0)),\"\")","v":"68180015901"}]
[null,null,null,null,"68180018008",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3376,1),\"\"))","v":1},{"$f":"IF(F3376=1,COUNTIF($F$3:F3376,1),\"\")","v":3374},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3376),$G$3:$G$3716,0)),\"\")","v":"68180018008"}]
[null,null,null,null,"68180018202",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3377,1),\"\"))","v":1},{"$f":"IF(F3377=1,COUNTIF($F$3:F3377,1),\"\")","v":3375},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3377),$G$3:$G$3716,0)),\"\")","v":"68180018202"}]
[null,null,null,null,"68180020203",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3378,1),\"\"))","v":1},{"$f":"IF(F3378=1,COUNTIF($F$3:F3378,1),\"\")","v":3376},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3378),$G$3:$G$3716,0)),\"\")","v":"68180020203"}]
[null,null,null,null,"68180024101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3379,1),\"\"))","v":1},{"$f":"IF(F3379=1,COUNTIF($F$3:F3379,1),\"\")","v":3377},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3379),$G$3:$G$3716,0)),\"\")","v":"68180024101"}]
[null,null,null,null,"68180028501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3380,1),\"\"))","v":1},{"$f":"IF(F3380=1,COUNTIF($F$3:F3380,1),\"\")","v":3378},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3380),$G$3:$G$3716,0)),\"\")","v":"68180028501"}]
[null,null,null,null,"68180028806",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3381,1),\"\"))","v":1},{"$f":"IF(F3381=1,COUNTIF($F$3:F3381,1),\"\")","v":3379},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3381),$G$3:$G$3716,0)),\"\")","v":"68180028806"}]
[null,null,null,null,"68180035209",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3382,1),\"\"))","v":1},{"$f":"IF(F3382=1,COUNTIF($F$3:F3382,1),\"\")","v":3380},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3382),$G$3:$G$3716,0)),\"\")","v":"68180035209"}]
[null,null,null,null,"68180035306",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3383,1),\"\"))","v":1},{"$f":"IF(F3383=1,COUNTIF($F$3:F3383,1),\"\")","v":3381},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3383),$G$3:$G$3716,0)),\"\")","v":"68180035306"}]
[null,null,null,null,"68180035309",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3384,1),\"\"))","v":1},{"$f":"IF(F3384=1,COUNTIF($F$3:F3384,1),\"\")","v":3382},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3384),$G$3:$G$3716,0)),\"\")","v":"68180035309"}]
[null,null,null,null,"68180036209",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3385,1),\"\"))","v":1},{"$f":"IF(F3385=1,COUNTIF($F$3:F3385,1),\"\")","v":3383},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3385),$G$3:$G$3716,0)),\"\")","v":"68180036209"}]
[null,null,null,null,"68180036309",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3386,1),\"\"))","v":1},{"$f":"IF(F3386=1,COUNTIF($F$3:F3386,1),\"\")","v":3384},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3386),$G$3:$G$3716,0)),\"\")","v":"68180036309"}]
[null,null,null,null,"68180040101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3387,1),\"\"))","v":1},{"$f":"IF(F3387=1,COUNTIF($F$3:F3387,1),\"\")","v":3385},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3387),$G$3:$G$3716,0)),\"\")","v":"68180040101"}]
[null,null,null,null,"68180040201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3388,1),\"\"))","v":1},{"$f":"IF(F3388=1,COUNTIF($F$3:F3388,1),\"\")","v":3386},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3388),$G$3:$G$3716,0)),\"\")","v":"68180040201"}]
[null,null,null,null,"68180040301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3389,1),\"\"))","v":1},{"$f":"IF(F3389=1,COUNTIF($F$3:F3389,1),\"\")","v":3387},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3389),$G$3:$G$3716,0)),\"\")","v":"68180040301"}]
[null,null,null,null,"68180040401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3390,1),\"\"))","v":1},{"$f":"IF(F3390=1,COUNTIF($F$3:F3390,1),\"\")","v":3388},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3390),$G$3:$G$3716,0)),\"\")","v":"68180040401"}]
[null,null,null,null,"68180047801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3391,1),\"\"))","v":1},{"$f":"IF(F3391=1,COUNTIF($F$3:F3391,1),\"\")","v":3389},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3391),$G$3:$G$3716,0)),\"\")","v":"68180047801"}]
[null,null,null,null,"68180048001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3392,1),\"\"))","v":1},{"$f":"IF(F3392=1,COUNTIF($F$3:F3392,1),\"\")","v":3390},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3392),$G$3:$G$3716,0)),\"\")","v":"68180048001"}]
[null,null,null,null,"68180051301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3393,1),\"\"))","v":1},{"$f":"IF(F3393=1,COUNTIF($F$3:F3393,1),\"\")","v":3391},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3393),$G$3:$G$3716,0)),\"\")","v":"68180051301"}]
[null,null,null,null,"68180051401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3394,1),\"\"))","v":1},{"$f":"IF(F3394=1,COUNTIF($F$3:F3394,1),\"\")","v":3392},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3394),$G$3:$G$3716,0)),\"\")","v":"68180051401"}]
[null,null,null,null,"68180051501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3395,1),\"\"))","v":1},{"$f":"IF(F3395=1,COUNTIF($F$3:F3395,1),\"\")","v":3393},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3395),$G$3:$G$3716,0)),\"\")","v":"68180051501"}]
[null,null,null,null,"68180051503",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3396,1),\"\"))","v":1},{"$f":"IF(F3396=1,COUNTIF($F$3:F3396,1),\"\")","v":3394},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3396),$G$3:$G$3716,0)),\"\")","v":"68180051503"}]
[null,null,null,null,"68180056006",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3397,1),\"\"))","v":1},{"$f":"IF(F3397=1,COUNTIF($F$3:F3397,1),\"\")","v":3395},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3397),$G$3:$G$3716,0)),\"\")","v":"68180056006"}]
[null,null,null,null,"68180065806",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3398,1),\"\"))","v":1},{"$f":"IF(F3398=1,COUNTIF($F$3:F3398,1),\"\")","v":3396},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3398),$G$3:$G$3716,0)),\"\")","v":"68180065806"}]
[null,null,null,null,"68180096509",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3399,1),\"\"))","v":1},{"$f":"IF(F3399=1,COUNTIF($F$3:F3399,1),\"\")","v":3397},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3399),$G$3:$G$3716,0)),\"\")","v":"68180096509"}]
[null,null,null,null,"68180098001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3400,1),\"\"))","v":1},{"$f":"IF(F3400=1,COUNTIF($F$3:F3400,1),\"\")","v":3398},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3400),$G$3:$G$3716,0)),\"\")","v":"68180098001"}]
[null,null,null,null,"68220014315",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3401,1),\"\"))","v":1},{"$f":"IF(F3401=1,COUNTIF($F$3:F3401,1),\"\")","v":3399},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3401),$G$3:$G$3716,0)),\"\")","v":"68220014315"}]
[null,null,null,null,"68308040547",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3402,1),\"\"))","v":1},{"$f":"IF(F3402=1,COUNTIF($F$3:F3402,1),\"\")","v":3400},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3402),$G$3:$G$3716,0)),\"\")","v":"68308040547"}]
[null,null,null,null,"68308050547",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3403,1),\"\"))","v":1},{"$f":"IF(F3403=1,COUNTIF($F$3:F3403,1),\"\")","v":3401},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3403),$G$3:$G$3716,0)),\"\")","v":"68308050547"}]
[null,null,null,null,"68382000514",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3404,1),\"\"))","v":1},{"$f":"IF(F3404=1,COUNTIF($F$3:F3404,1),\"\")","v":3402},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3404),$G$3:$G$3716,0)),\"\")","v":"68382000514"}]
[null,null,null,null,"68382000601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3405,1),\"\"))","v":1},{"$f":"IF(F3405=1,COUNTIF($F$3:F3405,1),\"\")","v":3403},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3405),$G$3:$G$3716,0)),\"\")","v":"68382000601"}]
[null,null,null,null,"68382000801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3406,1),\"\"))","v":1},{"$f":"IF(F3406=1,COUNTIF($F$3:F3406,1),\"\")","v":3404},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3406),$G$3:$G$3716,0)),\"\")","v":"68382000801"}]
[null,null,null,null,"68382002805",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3407,1),\"\"))","v":1},{"$f":"IF(F3407=1,COUNTIF($F$3:F3407,1),\"\")","v":3405},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3407),$G$3:$G$3716,0)),\"\")","v":"68382002805"}]
[null,null,null,null,"68382002901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3408,1),\"\"))","v":1},{"$f":"IF(F3408=1,COUNTIF($F$3:F3408,1),\"\")","v":3406},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3408),$G$3:$G$3716,0)),\"\")","v":"68382002901"}]
[null,null,null,null,"68382007116",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3409,1),\"\"))","v":1},{"$f":"IF(F3409=1,COUNTIF($F$3:F3409,1),\"\")","v":3407},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3409),$G$3:$G$3716,0)),\"\")","v":"68382007116"}]
[null,null,null,null,"68382007901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3410,1),\"\"))","v":1},{"$f":"IF(F3410=1,COUNTIF($F$3:F3410,1),\"\")","v":3408},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3410),$G$3:$G$3716,0)),\"\")","v":"68382007901"}]
[null,null,null,null,"68382009301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3411,1),\"\"))","v":1},{"$f":"IF(F3411=1,COUNTIF($F$3:F3411,1),\"\")","v":3409},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3411),$G$3:$G$3716,0)),\"\")","v":"68382009301"}]
[null,null,null,null,"68382009601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3412,1),\"\"))","v":1},{"$f":"IF(F3412=1,COUNTIF($F$3:F3412,1),\"\")","v":3410},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3412),$G$3:$G$3716,0)),\"\")","v":"68382009601"}]
[null,null,null,null,"68382013814",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3413,1),\"\"))","v":1},{"$f":"IF(F3413=1,COUNTIF($F$3:F3413,1),\"\")","v":3411},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3413),$G$3:$G$3716,0)),\"\")","v":"68382013814"}]
[null,null,null,null,"68382014014",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3414,1),\"\"))","v":1},{"$f":"IF(F3414=1,COUNTIF($F$3:F3414,1),\"\")","v":3412},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3414),$G$3:$G$3716,0)),\"\")","v":"68382014014"}]
[null,null,null,null,"68382014114",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3415,1),\"\"))","v":1},{"$f":"IF(F3415=1,COUNTIF($F$3:F3415,1),\"\")","v":3413},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3415),$G$3:$G$3716,0)),\"\")","v":"68382014114"}]
[null,null,null,null,"68382019716",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3416,1),\"\"))","v":1},{"$f":"IF(F3416=1,COUNTIF($F$3:F3416,1),\"\")","v":3414},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3416),$G$3:$G$3716,0)),\"\")","v":"68382019716"}]
[null,null,null,null,"68382020016",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3417,1),\"\"))","v":1},{"$f":"IF(F3417=1,COUNTIF($F$3:F3417,1),\"\")","v":3415},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3417),$G$3:$G$3716,0)),\"\")","v":"68382020016"}]
[null,null,null,null,"68382022714",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3418,1),\"\"))","v":1},{"$f":"IF(F3418=1,COUNTIF($F$3:F3418,1),\"\")","v":3416},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3418),$G$3:$G$3716,0)),\"\")","v":"68382022714"}]
[null,null,null,null,"68382026012",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3419,1),\"\"))","v":1},{"$f":"IF(F3419=1,COUNTIF($F$3:F3419,1),\"\")","v":3417},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3419),$G$3:$G$3716,0)),\"\")","v":"68382026012"}]
[null,null,null,null,"68382026101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3420,1),\"\"))","v":1},{"$f":"IF(F3420=1,COUNTIF($F$3:F3420,1),\"\")","v":3418},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3420),$G$3:$G$3716,0)),\"\")","v":"68382026101"}]
[null,null,null,null,"68382031130",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3421,1),\"\"))","v":1},{"$f":"IF(F3421=1,COUNTIF($F$3:F3421,1),\"\")","v":3419},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3421),$G$3:$G$3716,0)),\"\")","v":"68382031130"}]
[null,null,null,null,"68382031818",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3422,1),\"\"))","v":1},{"$f":"IF(F3422=1,COUNTIF($F$3:F3422,1),\"\")","v":3420},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3422),$G$3:$G$3716,0)),\"\")","v":"68382031818"}]
[null,null,null,null,"68382044405",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3423,1),\"\"))","v":1},{"$f":"IF(F3423=1,COUNTIF($F$3:F3423,1),\"\")","v":3421},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3423),$G$3:$G$3716,0)),\"\")","v":"68382044405"}]
[null,null,null,null,"68382052960",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3424,1),\"\"))","v":1},{"$f":"IF(F3424=1,COUNTIF($F$3:F3424,1),\"\")","v":3422},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3424),$G$3:$G$3716,0)),\"\")","v":"68382052960"}]
[null,null,null,null,"68382056928",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3425,1),\"\"))","v":1},{"$f":"IF(F3425=1,COUNTIF($F$3:F3425,1),\"\")","v":3423},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3425),$G$3:$G$3716,0)),\"\")","v":"68382056928"}]
[null,null,null,null,"68382059616",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3426,1),\"\"))","v":1},{"$f":"IF(F3426=1,COUNTIF($F$3:F3426,1),\"\")","v":3424},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3426),$G$3:$G$3716,0)),\"\")","v":"68382059616"}]
[null,null,null,null,"68382065101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3427,1),\"\"))","v":1},{"$f":"IF(F3427=1,COUNTIF($F$3:F3427,1),\"\")","v":3425},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3427),$G$3:$G$3716,0)),\"\")","v":"68382065101"}]
[null,null,null,null,"68382066101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3428,1),\"\"))","v":1},{"$f":"IF(F3428=1,COUNTIF($F$3:F3428,1),\"\")","v":3426},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3428),$G$3:$G$3716,0)),\"\")","v":"68382066101"}]
[null,null,null,null,"68382077230",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3429,1),\"\"))","v":1},{"$f":"IF(F3429=1,COUNTIF($F$3:F3429,1),\"\")","v":3427},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3429),$G$3:$G$3716,0)),\"\")","v":"68382077230"}]
[null,null,null,null,"68382080001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3430,1),\"\"))","v":1},{"$f":"IF(F3430=1,COUNTIF($F$3:F3430,1),\"\")","v":3428},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3430),$G$3:$G$3716,0)),\"\")","v":"68382080001"}]
[null,null,null,null,"68382089906",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3431,1),\"\"))","v":1},{"$f":"IF(F3431=1,COUNTIF($F$3:F3431,1),\"\")","v":3429},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3431),$G$3:$G$3716,0)),\"\")","v":"68382089906"}]
[null,null,null,null,"68455010690",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3432,1),\"\"))","v":1},{"$f":"IF(F3432=1,COUNTIF($F$3:F3432,1),\"\")","v":3430},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3432),$G$3:$G$3716,0)),\"\")","v":"68455010690"}]
[null,null,null,null,"68462010130",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3433,1),\"\"))","v":1},{"$f":"IF(F3433=1,COUNTIF($F$3:F3433,1),\"\")","v":3431},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3433),$G$3:$G$3716,0)),\"\")","v":"68462010130"}]
[null,null,null,null,"68462010230",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3434,1),\"\"))","v":1},{"$f":"IF(F3434=1,COUNTIF($F$3:F3434,1),\"\")","v":3432},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3434),$G$3:$G$3716,0)),\"\")","v":"68462010230"}]
[null,null,null,null,"68462010860",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3435,1),\"\"))","v":1},{"$f":"IF(F3435=1,COUNTIF($F$3:F3435,1),\"\")","v":3433},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3435),$G$3:$G$3716,0)),\"\")","v":"68462010860"}]
[null,null,null,null,"68462012801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3436,1),\"\"))","v":1},{"$f":"IF(F3436=1,COUNTIF($F$3:F3436,1),\"\")","v":3434},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3436),$G$3:$G$3716,0)),\"\")","v":"68462012801"}]
[null,null,null,null,"68462016301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3437,1),\"\"))","v":1},{"$f":"IF(F3437=1,COUNTIF($F$3:F3437,1),\"\")","v":3435},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3437),$G$3:$G$3716,0)),\"\")","v":"68462016301"}]
[null,null,null,null,"68462019690",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3438,1),\"\"))","v":1},{"$f":"IF(F3438=1,COUNTIF($F$3:F3438,1),\"\")","v":3436},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3438),$G$3:$G$3716,0)),\"\")","v":"68462019690"}]
[null,null,null,null,"68462022801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3439,1),\"\"))","v":1},{"$f":"IF(F3439=1,COUNTIF($F$3:F3439,1),\"\")","v":3437},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3439),$G$3:$G$3716,0)),\"\")","v":"68462022801"}]
[null,null,null,null,"68462022901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3440,1),\"\"))","v":1},{"$f":"IF(F3440=1,COUNTIF($F$3:F3440,1),\"\")","v":3438},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3440),$G$3:$G$3716,0)),\"\")","v":"68462022901"}]
[null,null,null,null,"68462023501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3441,1),\"\"))","v":1},{"$f":"IF(F3441=1,COUNTIF($F$3:F3441,1),\"\")","v":3439},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3441),$G$3:$G$3716,0)),\"\")","v":"68462023501"}]
[null,null,null,null,"68462033190",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3442,1),\"\"))","v":1},{"$f":"IF(F3442=1,COUNTIF($F$3:F3442,1),\"\")","v":3440},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3442),$G$3:$G$3716,0)),\"\")","v":"68462033190"}]
[null,null,null,null,"68462033490",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3443,1),\"\"))","v":1},{"$f":"IF(F3443=1,COUNTIF($F$3:F3443,1),\"\")","v":3441},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3443),$G$3:$G$3716,0)),\"\")","v":"68462033490"}]
[null,null,null,null,"68462035801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3444,1),\"\"))","v":1},{"$f":"IF(F3444=1,COUNTIF($F$3:F3444,1),\"\")","v":3442},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3444),$G$3:$G$3716,0)),\"\")","v":"68462035801"}]
[null,null,null,null,"68462036001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3445,1),\"\"))","v":1},{"$f":"IF(F3445=1,COUNTIF($F$3:F3445,1),\"\")","v":3443},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3445),$G$3:$G$3716,0)),\"\")","v":"68462036001"}]
[null,null,null,null,"68462036101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3446,1),\"\"))","v":1},{"$f":"IF(F3446=1,COUNTIF($F$3:F3446,1),\"\")","v":3444},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3446),$G$3:$G$3716,0)),\"\")","v":"68462036101"}]
[null,null,null,null,"68462039230",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3447,1),\"\"))","v":1},{"$f":"IF(F3447=1,COUNTIF($F$3:F3447,1),\"\")","v":3445},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3447),$G$3:$G$3716,0)),\"\")","v":"68462039230"}]
[null,null,null,null,"68462039290",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3448,1),\"\"))","v":1},{"$f":"IF(F3448=1,COUNTIF($F$3:F3448,1),\"\")","v":3446},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3448),$G$3:$G$3716,0)),\"\")","v":"68462039290"}]
[null,null,null,null,"68462040444",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3449,1),\"\"))","v":1},{"$f":"IF(F3449=1,COUNTIF($F$3:F3449,1),\"\")","v":3447},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3449),$G$3:$G$3716,0)),\"\")","v":"68462040444"}]
[null,null,null,null,"68462040601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3450,1),\"\"))","v":1},{"$f":"IF(F3450=1,COUNTIF($F$3:F3450,1),\"\")","v":3448},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3450),$G$3:$G$3716,0)),\"\")","v":"68462040601"}]
[null,null,null,null,"68462043518",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3451,1),\"\"))","v":1},{"$f":"IF(F3451=1,COUNTIF($F$3:F3451,1),\"\")","v":3449},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3451),$G$3:$G$3716,0)),\"\")","v":"68462043518"}]
[null,null,null,null,"68462063925",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3452,1),\"\"))","v":1},{"$f":"IF(F3452=1,COUNTIF($F$3:F3452,1),\"\")","v":3450},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3452),$G$3:$G$3716,0)),\"\")","v":"68462063925"}]
[null,null,null,null,"68462063945",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3453,1),\"\"))","v":1},{"$f":"IF(F3453=1,COUNTIF($F$3:F3453,1),\"\")","v":3451},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3453),$G$3:$G$3716,0)),\"\")","v":"68462063945"}]
[null,null,null,null,"68516360702",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3454,1),\"\"))","v":1},{"$f":"IF(F3454=1,COUNTIF($F$3:F3454,1),\"\")","v":3452},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3454),$G$3:$G$3716,0)),\"\")","v":"68516360702"}]
[null,null,null,null,"68516360902",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3455,1),\"\"))","v":1},{"$f":"IF(F3455=1,COUNTIF($F$3:F3455,1),\"\")","v":3453},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3455),$G$3:$G$3716,0)),\"\")","v":"68516360902"}]
[null,null,null,null,"68585000612",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3456,1),\"\"))","v":1},{"$f":"IF(F3456=1,COUNTIF($F$3:F3456,1),\"\")","v":3454},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3456),$G$3:$G$3716,0)),\"\")","v":"68585000612"}]
[null,null,null,null,"68585000641",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3457,1),\"\"))","v":1},{"$f":"IF(F3457=1,COUNTIF($F$3:F3457,1),\"\")","v":3455},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3457),$G$3:$G$3716,0)),\"\")","v":"68585000641"}]
[null,null,null,null,"68585000698",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3458,1),\"\"))","v":1},{"$f":"IF(F3458=1,COUNTIF($F$3:F3458,1),\"\")","v":3456},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3458),$G$3:$G$3716,0)),\"\")","v":"68585000698"}]
[null,null,null,null,"68682010910",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3459,1),\"\"))","v":1},{"$f":"IF(F3459=1,COUNTIF($F$3:F3459,1),\"\")","v":3457},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3459),$G$3:$G$3716,0)),\"\")","v":"68682010910"}]
[null,null,null,null,"68682045570",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3460,1),\"\"))","v":1},{"$f":"IF(F3460=1,COUNTIF($F$3:F3460,1),\"\")","v":3458},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3460),$G$3:$G$3716,0)),\"\")","v":"68682045570"}]
[null,null,null,null,"68682065020",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3461,1),\"\"))","v":1},{"$f":"IF(F3461=1,COUNTIF($F$3:F3461,1),\"\")","v":3459},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3461),$G$3:$G$3716,0)),\"\")","v":"68682065020"}]
[null,null,null,null,"68682065220",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3462,1),\"\"))","v":1},{"$f":"IF(F3462=1,COUNTIF($F$3:F3462,1),\"\")","v":3460},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3462),$G$3:$G$3716,0)),\"\")","v":"68682065220"}]
[null,null,null,null,"68682065520",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3463,1),\"\"))","v":1},{"$f":"IF(F3463=1,COUNTIF($F$3:F3463,1),\"\")","v":3461},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3463),$G$3:$G$3716,0)),\"\")","v":"68682065520"}]
[null,null,null,null,"68682092005",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3464,1),\"\"))","v":1},{"$f":"IF(F3464=1,COUNTIF($F$3:F3464,1),\"\")","v":3462},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3464),$G$3:$G$3716,0)),\"\")","v":"68682092005"}]
[null,null,null,null,"68682099398",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3465,1),\"\"))","v":1},{"$f":"IF(F3465=1,COUNTIF($F$3:F3465,1),\"\")","v":3463},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3465),$G$3:$G$3716,0)),\"\")","v":"68682099398"}]
[null,null,null,null,"68803061210",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3466,1),\"\"))","v":1},{"$f":"IF(F3466=1,COUNTIF($F$3:F3466,1),\"\")","v":3464},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3466),$G$3:$G$3716,0)),\"\")","v":"68803061210"}]
[null,null,null,null,"68803067205",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3467,1),\"\"))","v":1},{"$f":"IF(F3467=1,COUNTIF($F$3:F3467,1),\"\")","v":3465},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3467),$G$3:$G$3716,0)),\"\")","v":"68803067205"}]
[null,null,null,null,"68803072225",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3468,1),\"\"))","v":1},{"$f":"IF(F3468=1,COUNTIF($F$3:F3468,1),\"\")","v":3466},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3468),$G$3:$G$3716,0)),\"\")","v":"68803072225"}]
[null,null,null,null,"68850001202",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3469,1),\"\"))","v":1},{"$f":"IF(F3469=1,COUNTIF($F$3:F3469,1),\"\")","v":3467},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3469),$G$3:$G$3716,0)),\"\")","v":"68850001202"}]
[null,null,null,null,"68968449201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3470,1),\"\"))","v":1},{"$f":"IF(F3470=1,COUNTIF($F$3:F3470,1),\"\")","v":3468},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3470),$G$3:$G$3716,0)),\"\")","v":"68968449201"}]
[null,null,null,null,"69097012705",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3471,1),\"\"))","v":1},{"$f":"IF(F3471=1,COUNTIF($F$3:F3471,1),\"\")","v":3469},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3471),$G$3:$G$3716,0)),\"\")","v":"69097012705"}]
[null,null,null,null,"69097014260",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3472,1),\"\"))","v":1},{"$f":"IF(F3472=1,COUNTIF($F$3:F3472,1),\"\")","v":3470},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3472),$G$3:$G$3716,0)),\"\")","v":"69097014260"}]
[null,null,null,null,"69097021002",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3473,1),\"\"))","v":1},{"$f":"IF(F3473=1,COUNTIF($F$3:F3473,1),\"\")","v":3471},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3473),$G$3:$G$3716,0)),\"\")","v":"69097021002"}]
[null,null,null,null,"69097023772",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3474,1),\"\"))","v":1},{"$f":"IF(F3474=1,COUNTIF($F$3:F3474,1),\"\")","v":3472},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3474),$G$3:$G$3716,0)),\"\")","v":"69097023772"}]
[null,null,null,null,"69097042602",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3475,1),\"\"))","v":1},{"$f":"IF(F3475=1,COUNTIF($F$3:F3475,1),\"\")","v":3473},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3475),$G$3:$G$3716,0)),\"\")","v":"69097042602"}]
[null,null,null,null,"69097064202",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3476,1),\"\"))","v":1},{"$f":"IF(F3476=1,COUNTIF($F$3:F3476,1),\"\")","v":3474},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3476),$G$3:$G$3716,0)),\"\")","v":"69097064202"}]
[null,null,null,null,"69097084607",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3477,1),\"\"))","v":1},{"$f":"IF(F3477=1,COUNTIF($F$3:F3477,1),\"\")","v":3475},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3477),$G$3:$G$3716,0)),\"\")","v":"69097084607"}]
[null,null,null,null,"69097094505",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3478,1),\"\"))","v":1},{"$f":"IF(F3478=1,COUNTIF($F$3:F3478,1),\"\")","v":3476},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3478),$G$3:$G$3716,0)),\"\")","v":"69097094505"}]
[null,null,null,null,"69097096507",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3479,1),\"\"))","v":1},{"$f":"IF(F3479=1,COUNTIF($F$3:F3479,1),\"\")","v":3477},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3479),$G$3:$G$3716,0)),\"\")","v":"69097096507"}]
[null,null,null,null,"69238110005",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3480,1),\"\"))","v":1},{"$f":"IF(F3480=1,COUNTIF($F$3:F3480,1),\"\")","v":3478},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3480),$G$3:$G$3716,0)),\"\")","v":"69238110005"}]
[null,null,null,null,"69238115403",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3481,1),\"\"))","v":1},{"$f":"IF(F3481=1,COUNTIF($F$3:F3481,1),\"\")","v":3479},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3481),$G$3:$G$3716,0)),\"\")","v":"69238115403"}]
[null,null,null,null,"69238131009",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3482,1),\"\"))","v":1},{"$f":"IF(F3482=1,COUNTIF($F$3:F3482,1),\"\")","v":3480},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3482),$G$3:$G$3716,0)),\"\")","v":"69238131009"}]
[null,null,null,null,"69238131309",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3483,1),\"\"))","v":1},{"$f":"IF(F3483=1,COUNTIF($F$3:F3483,1),\"\")","v":3481},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3483),$G$3:$G$3716,0)),\"\")","v":"69238131309"}]
[null,null,null,null,"69238148401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3484,1),\"\"))","v":1},{"$f":"IF(F3484=1,COUNTIF($F$3:F3484,1),\"\")","v":3482},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3484),$G$3:$G$3716,0)),\"\")","v":"69238148401"}]
[null,null,null,null,"69238148901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3485,1),\"\"))","v":1},{"$f":"IF(F3485=1,COUNTIF($F$3:F3485,1),\"\")","v":3483},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3485),$G$3:$G$3716,0)),\"\")","v":"69238148901"}]
[null,null,null,null,"69238149001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3486,1),\"\"))","v":1},{"$f":"IF(F3486=1,COUNTIF($F$3:F3486,1),\"\")","v":3484},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3486),$G$3:$G$3716,0)),\"\")","v":"69238149001"}]
[null,null,null,null,"69238152301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3487,1),\"\"))","v":1},{"$f":"IF(F3487=1,COUNTIF($F$3:F3487,1),\"\")","v":3485},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3487),$G$3:$G$3716,0)),\"\")","v":"69238152301"}]
[null,null,null,null,"69238154401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3488,1),\"\"))","v":1},{"$f":"IF(F3488=1,COUNTIF($F$3:F3488,1),\"\")","v":3486},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3488),$G$3:$G$3716,0)),\"\")","v":"69238154401"}]
[null,null,null,null,"69238160502",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3489,1),\"\"))","v":1},{"$f":"IF(F3489=1,COUNTIF($F$3:F3489,1),\"\")","v":3487},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3489),$G$3:$G$3716,0)),\"\")","v":"69238160502"}]
[null,null,null,null,"69238183301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3490,1),\"\"))","v":1},{"$f":"IF(F3490=1,COUNTIF($F$3:F3490,1),\"\")","v":3488},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3490),$G$3:$G$3716,0)),\"\")","v":"69238183301"}]
[null,null,null,null,"69315021101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3491,1),\"\"))","v":1},{"$f":"IF(F3491=1,COUNTIF($F$3:F3491,1),\"\")","v":3489},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3491),$G$3:$G$3716,0)),\"\")","v":"69315021101"}]
[null,null,null,null,"69315070150",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3492,1),\"\"))","v":1},{"$f":"IF(F3492=1,COUNTIF($F$3:F3492,1),\"\")","v":3490},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3492),$G$3:$G$3716,0)),\"\")","v":"69315070150"}]
[null,null,null,null,"69315090501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3493,1),\"\"))","v":1},{"$f":"IF(F3493=1,COUNTIF($F$3:F3493,1),\"\")","v":3491},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3493),$G$3:$G$3716,0)),\"\")","v":"69315090501"}]
[null,null,null,null,"69339014801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3494,1),\"\"))","v":1},{"$f":"IF(F3494=1,COUNTIF($F$3:F3494,1),\"\")","v":3492},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3494),$G$3:$G$3716,0)),\"\")","v":"69339014801"}]
[null,null,null,null,"69339014817",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3495,1),\"\"))","v":1},{"$f":"IF(F3495=1,COUNTIF($F$3:F3495,1),\"\")","v":3493},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3495),$G$3:$G$3716,0)),\"\")","v":"69339014817"}]
[null,null,null,null,"69367016504",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3496,1),\"\"))","v":1},{"$f":"IF(F3496=1,COUNTIF($F$3:F3496,1),\"\")","v":3494},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3496),$G$3:$G$3716,0)),\"\")","v":"69367016504"}]
[null,null,null,null,"69367022001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3497,1),\"\"))","v":1},{"$f":"IF(F3497=1,COUNTIF($F$3:F3497,1),\"\")","v":3495},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3497),$G$3:$G$3716,0)),\"\")","v":"69367022001"}]
[null,null,null,null,"69374052930",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3498,1),\"\"))","v":1},{"$f":"IF(F3498=1,COUNTIF($F$3:F3498,1),\"\")","v":3496},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3498),$G$3:$G$3716,0)),\"\")","v":"69374052930"}]
[null,null,null,null,"69374055930",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3499,1),\"\"))","v":1},{"$f":"IF(F3499=1,COUNTIF($F$3:F3499,1),\"\")","v":3497},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3499),$G$3:$G$3716,0)),\"\")","v":"69374055930"}]
[null,null,null,null,"69374090105",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3500,1),\"\"))","v":1},{"$f":"IF(F3500=1,COUNTIF($F$3:F3500,1),\"\")","v":3498},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3500),$G$3:$G$3716,0)),\"\")","v":"69374090105"}]
[null,null,null,null,"69374092405",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3501,1),\"\"))","v":1},{"$f":"IF(F3501=1,COUNTIF($F$3:F3501,1),\"\")","v":3499},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3501),$G$3:$G$3716,0)),\"\")","v":"69374092405"}]
[null,null,null,null,"69374094604",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3502,1),\"\"))","v":1},{"$f":"IF(F3502=1,COUNTIF($F$3:F3502,1),\"\")","v":3500},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3502),$G$3:$G$3716,0)),\"\")","v":"69374094604"}]
[null,null,null,null,"69374098330",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3503,1),\"\"))","v":1},{"$f":"IF(F3503=1,COUNTIF($F$3:F3503,1),\"\")","v":3501},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3503),$G$3:$G$3716,0)),\"\")","v":"69374098330"}]
[null,null,null,null,"69452011420",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3504,1),\"\"))","v":1},{"$f":"IF(F3504=1,COUNTIF($F$3:F3504,1),\"\")","v":3502},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3504),$G$3:$G$3716,0)),\"\")","v":"69452011420"}]
[null,null,null,null,"69452015020",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3505,1),\"\"))","v":1},{"$f":"IF(F3505=1,COUNTIF($F$3:F3505,1),\"\")","v":3503},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3505),$G$3:$G$3716,0)),\"\")","v":"69452015020"}]
[null,null,null,null,"69452015120",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3506,1),\"\"))","v":1},{"$f":"IF(F3506=1,COUNTIF($F$3:F3506,1),\"\")","v":3504},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3506),$G$3:$G$3716,0)),\"\")","v":"69452015120"}]
[null,null,null,null,"69452020907",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3507,1),\"\"))","v":1},{"$f":"IF(F3507=1,COUNTIF($F$3:F3507,1),\"\")","v":3505},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3507),$G$3:$G$3716,0)),\"\")","v":"69452020907"}]
[null,null,null,null,"69543021712",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3508,1),\"\"))","v":1},{"$f":"IF(F3508=1,COUNTIF($F$3:F3508,1),\"\")","v":3506},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3508),$G$3:$G$3716,0)),\"\")","v":"69543021712"}]
[null,null,null,null,"69543026010",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3509,1),\"\"))","v":1},{"$f":"IF(F3509=1,COUNTIF($F$3:F3509,1),\"\")","v":3507},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3509),$G$3:$G$3716,0)),\"\")","v":"69543026010"}]
[null,null,null,null,"69543026810",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3510,1),\"\"))","v":1},{"$f":"IF(F3510=1,COUNTIF($F$3:F3510,1),\"\")","v":3508},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3510),$G$3:$G$3716,0)),\"\")","v":"69543026810"}]
[null,null,null,null,"69547035302",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3511,1),\"\"))","v":1},{"$f":"IF(F3511=1,COUNTIF($F$3:F3511,1),\"\")","v":3509},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3511),$G$3:$G$3716,0)),\"\")","v":"69547035302"}]
[null,null,null,null,"69618000815",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3512,1),\"\"))","v":1},{"$f":"IF(F3512=1,COUNTIF($F$3:F3512,1),\"\")","v":3510},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3512),$G$3:$G$3716,0)),\"\")","v":"69618000815"}]
[null,null,null,null,"69618000858",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3513,1),\"\"))","v":1},{"$f":"IF(F3513=1,COUNTIF($F$3:F3513,1),\"\")","v":3511},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3513),$G$3:$G$3716,0)),\"\")","v":"69618000858"}]
[null,null,null,null,"69618003301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3514,1),\"\"))","v":1},{"$f":"IF(F3514=1,COUNTIF($F$3:F3514,1),\"\")","v":3512},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3514),$G$3:$G$3716,0)),\"\")","v":"69618003301"}]
[null,null,null,null,"69918050105",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3515,1),\"\"))","v":1},{"$f":"IF(F3515=1,COUNTIF($F$3:F3515,1),\"\")","v":3513},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3515),$G$3:$G$3716,0)),\"\")","v":"69918050105"}]
[null,null,null,null,"70000011701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3516,1),\"\"))","v":1},{"$f":"IF(F3516=1,COUNTIF($F$3:F3516,1),\"\")","v":3514},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3516),$G$3:$G$3716,0)),\"\")","v":"70000011701"}]
[null,null,null,null,"70000012100",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3517,1),\"\"))","v":1},{"$f":"IF(F3517=1,COUNTIF($F$3:F3517,1),\"\")","v":3515},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3517),$G$3:$G$3716,0)),\"\")","v":"70000012100"}]
[null,null,null,null,"70000012101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3518,1),\"\"))","v":1},{"$f":"IF(F3518=1,COUNTIF($F$3:F3518,1),\"\")","v":3516},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3518),$G$3:$G$3716,0)),\"\")","v":"70000012101"}]
[null,null,null,null,"70000012401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3519,1),\"\"))","v":1},{"$f":"IF(F3519=1,COUNTIF($F$3:F3519,1),\"\")","v":3517},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3519),$G$3:$G$3716,0)),\"\")","v":"70000012401"}]
[null,null,null,null,"70000017365",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3520,1),\"\"))","v":1},{"$f":"IF(F3520=1,COUNTIF($F$3:F3520,1),\"\")","v":3518},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3520),$G$3:$G$3716,0)),\"\")","v":"70000017365"}]
[null,null,null,null,"70000017802",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3521,1),\"\"))","v":1},{"$f":"IF(F3521=1,COUNTIF($F$3:F3521,1),\"\")","v":3519},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3521),$G$3:$G$3716,0)),\"\")","v":"70000017802"}]
[null,null,null,null,"70000041501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3522,1),\"\"))","v":1},{"$f":"IF(F3522=1,COUNTIF($F$3:F3522,1),\"\")","v":3520},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3522),$G$3:$G$3716,0)),\"\")","v":"70000041501"}]
[null,null,null,null,"70000041701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3523,1),\"\"))","v":1},{"$f":"IF(F3523=1,COUNTIF($F$3:F3523,1),\"\")","v":3521},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3523),$G$3:$G$3716,0)),\"\")","v":"70000041701"}]
[null,null,null,null,"70000043401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3524,1),\"\"))","v":1},{"$f":"IF(F3524=1,COUNTIF($F$3:F3524,1),\"\")","v":3522},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3524),$G$3:$G$3716,0)),\"\")","v":"70000043401"}]
[null,null,null,null,"70000044701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3525,1),\"\"))","v":1},{"$f":"IF(F3525=1,COUNTIF($F$3:F3525,1),\"\")","v":3523},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3525),$G$3:$G$3716,0)),\"\")","v":"70000044701"}]
[null,null,null,null,"70000044702",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3526,1),\"\"))","v":1},{"$f":"IF(F3526=1,COUNTIF($F$3:F3526,1),\"\")","v":3524},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3526),$G$3:$G$3716,0)),\"\")","v":"70000044702"}]
[null,null,null,null,"70000049601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3527,1),\"\"))","v":1},{"$f":"IF(F3527=1,COUNTIF($F$3:F3527,1),\"\")","v":3525},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3527),$G$3:$G$3716,0)),\"\")","v":"70000049601"}]
[null,null,null,null,"70000054601",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3528,1),\"\"))","v":1},{"$f":"IF(F3528=1,COUNTIF($F$3:F3528,1),\"\")","v":3526},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3528),$G$3:$G$3716,0)),\"\")","v":"70000054601"}]
[null,null,null,null,"70003030020",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3529,1),\"\"))","v":1},{"$f":"IF(F3529=1,COUNTIF($F$3:F3529,1),\"\")","v":3527},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3529),$G$3:$G$3716,0)),\"\")","v":"70003030020"}]
[null,null,null,null,"70010006301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3530,1),\"\"))","v":1},{"$f":"IF(F3530=1,COUNTIF($F$3:F3530,1),\"\")","v":3528},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3530),$G$3:$G$3716,0)),\"\")","v":"70010006301"}]
[null,null,null,null,"70030051063",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3531,1),\"\"))","v":1},{"$f":"IF(F3531=1,COUNTIF($F$3:F3531,1),\"\")","v":3529},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3531),$G$3:$G$3716,0)),\"\")","v":"70030051063"}]
[null,null,null,null,"70030051066",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3532,1),\"\"))","v":1},{"$f":"IF(F3532=1,COUNTIF($F$3:F3532,1),\"\")","v":3530},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3532),$G$3:$G$3716,0)),\"\")","v":"70030051066"}]
[null,null,null,null,"70074067397",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3533,1),\"\"))","v":1},{"$f":"IF(F3533=1,COUNTIF($F$3:F3533,1),\"\")","v":3531},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3533),$G$3:$G$3716,0)),\"\")","v":"70074067397"}]
[null,null,null,null,"70074067398",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3534,1),\"\"))","v":1},{"$f":"IF(F3534=1,COUNTIF($F$3:F3534,1),\"\")","v":3532},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3534),$G$3:$G$3716,0)),\"\")","v":"70074067398"}]
[null,null,null,null,"70436005106",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3535,1),\"\"))","v":1},{"$f":"IF(F3535=1,COUNTIF($F$3:F3535,1),\"\")","v":3533},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3535),$G$3:$G$3716,0)),\"\")","v":"70436005106"}]
[null,null,null,null,"70436009205",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3536,1),\"\"))","v":1},{"$f":"IF(F3536=1,COUNTIF($F$3:F3536,1),\"\")","v":3534},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3536),$G$3:$G$3716,0)),\"\")","v":"70436009205"}]
[null,null,null,null,"70710100802",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3537,1),\"\"))","v":1},{"$f":"IF(F3537=1,COUNTIF($F$3:F3537,1),\"\")","v":3535},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3537),$G$3:$G$3716,0)),\"\")","v":"70710100802"}]
[null,null,null,null,"70710100902",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3538,1),\"\"))","v":1},{"$f":"IF(F3538=1,COUNTIF($F$3:F3538,1),\"\")","v":3536},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3538),$G$3:$G$3716,0)),\"\")","v":"70710100902"}]
[null,null,null,null,"70710101002",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3539,1),\"\"))","v":1},{"$f":"IF(F3539=1,COUNTIF($F$3:F3539,1),\"\")","v":3537},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3539),$G$3:$G$3716,0)),\"\")","v":"70710101002"}]
[null,null,null,null,"70710102108",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3540,1),\"\"))","v":1},{"$f":"IF(F3540=1,COUNTIF($F$3:F3540,1),\"\")","v":3538},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3540),$G$3:$G$3716,0)),\"\")","v":"70710102108"}]
[null,null,null,null,"70710145701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3541,1),\"\"))","v":1},{"$f":"IF(F3541=1,COUNTIF($F$3:F3541,1),\"\")","v":3539},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3541),$G$3:$G$3716,0)),\"\")","v":"70710145701"}]
[null,null,null,null,"70756072111",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3542,1),\"\"))","v":1},{"$f":"IF(F3542=1,COUNTIF($F$3:F3542,1),\"\")","v":3540},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3542),$G$3:$G$3716,0)),\"\")","v":"70756072111"}]
[null,null,null,null,"70860010310",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3543,1),\"\"))","v":1},{"$f":"IF(F3543=1,COUNTIF($F$3:F3543,1),\"\")","v":3541},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3543),$G$3:$G$3716,0)),\"\")","v":"70860010310"}]
[null,null,null,null,"70860045110",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3544,1),\"\"))","v":1},{"$f":"IF(F3544=1,COUNTIF($F$3:F3544,1),\"\")","v":3542},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3544),$G$3:$G$3716,0)),\"\")","v":"70860045110"}]
[null,null,null,null,"70954001610",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3545,1),\"\"))","v":1},{"$f":"IF(F3545=1,COUNTIF($F$3:F3545,1),\"\")","v":3543},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3545),$G$3:$G$3716,0)),\"\")","v":"70954001610"}]
[null,null,null,null,"70954014810",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3546,1),\"\"))","v":1},{"$f":"IF(F3546=1,COUNTIF($F$3:F3546,1),\"\")","v":3544},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3546),$G$3:$G$3716,0)),\"\")","v":"70954014810"}]
[null,null,null,null,"70954015110",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3547,1),\"\"))","v":1},{"$f":"IF(F3547=1,COUNTIF($F$3:F3547,1),\"\")","v":3545},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3547),$G$3:$G$3716,0)),\"\")","v":"70954015110"}]
[null,null,null,null,"71019037404",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3548,1),\"\"))","v":1},{"$f":"IF(F3548=1,COUNTIF($F$3:F3548,1),\"\")","v":3546},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3548),$G$3:$G$3716,0)),\"\")","v":"71019037404"}]
[null,null,null,null,"71321080230",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3549,1),\"\"))","v":1},{"$f":"IF(F3549=1,COUNTIF($F$3:F3549,1),\"\")","v":3547},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3549),$G$3:$G$3716,0)),\"\")","v":"71321080230"}]
[null,null,null,null,"71399862701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3550,1),\"\"))","v":1},{"$f":"IF(F3550=1,COUNTIF($F$3:F3550,1),\"\")","v":3548},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3550),$G$3:$G$3716,0)),\"\")","v":"71399862701"}]
[null,null,null,null,"71546001010",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3551,1),\"\"))","v":1},{"$f":"IF(F3551=1,COUNTIF($F$3:F3551,1),\"\")","v":3549},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3551),$G$3:$G$3716,0)),\"\")","v":"71546001010"}]
[null,null,null,null,"71546001205",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3552,1),\"\"))","v":1},{"$f":"IF(F3552=1,COUNTIF($F$3:F3552,1),\"\")","v":3550},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3552),$G$3:$G$3716,0)),\"\")","v":"71546001205"}]
[null,null,null,null,"71546009005",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3553,1),\"\"))","v":1},{"$f":"IF(F3553=1,COUNTIF($F$3:F3553,1),\"\")","v":3551},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3553),$G$3:$G$3716,0)),\"\")","v":"71546009005"}]
[null,null,null,null,"71546010052",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3554,1),\"\"))","v":1},{"$f":"IF(F3554=1,COUNTIF($F$3:F3554,1),\"\")","v":3552},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3554),$G$3:$G$3716,0)),\"\")","v":"71546010052"}]
[null,null,null,null,"72140000022",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3555,1),\"\"))","v":1},{"$f":"IF(F3555=1,COUNTIF($F$3:F3555,1),\"\")","v":3553},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3555),$G$3:$G$3716,0)),\"\")","v":"72140000022"}]
[null,null,null,null,"72205005108",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3556,1),\"\"))","v":1},{"$f":"IF(F3556=1,COUNTIF($F$3:F3556,1),\"\")","v":3554},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3556),$G$3:$G$3716,0)),\"\")","v":"72205005108"}]
[null,null,null,null,"72508000407",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3557,1),\"\"))","v":1},{"$f":"IF(F3557=1,COUNTIF($F$3:F3557,1),\"\")","v":3555},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3557),$G$3:$G$3716,0)),\"\")","v":"72508000407"}]
[null,null,null,null,"72508020407",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3558,1),\"\"))","v":1},{"$f":"IF(F3558=1,COUNTIF($F$3:F3558,1),\"\")","v":3556},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3558),$G$3:$G$3716,0)),\"\")","v":"72508020407"}]
[null,null,null,null,"72627250503",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3559,1),\"\"))","v":1},{"$f":"IF(F3559=1,COUNTIF($F$3:F3559,1),\"\")","v":3557},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3559),$G$3:$G$3716,0)),\"\")","v":"72627250503"}]
[null,null,null,null,"73657002001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3560,1),\"\"))","v":1},{"$f":"IF(F3560=1,COUNTIF($F$3:F3560,1),\"\")","v":3558},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3560),$G$3:$G$3716,0)),\"\")","v":"73657002001"}]
[null,null,null,null,"75826011510",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3561,1),\"\"))","v":1},{"$f":"IF(F3561=1,COUNTIF($F$3:F3561,1),\"\")","v":3559},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3561),$G$3:$G$3716,0)),\"\")","v":"75826011510"}]
[null,null,null,null,"75834017001",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3562,1),\"\"))","v":1},{"$f":"IF(F3562=1,COUNTIF($F$3:F3562,1),\"\")","v":3560},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3562),$G$3:$G$3716,0)),\"\")","v":"75834017001"}]
[null,null,null,null,"76045073701",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3563,1),\"\"))","v":1},{"$f":"IF(F3563=1,COUNTIF($F$3:F3563,1),\"\")","v":3561},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3563),$G$3:$G$3716,0)),\"\")","v":"76045073701"}]
[null,null,null,null,"76329301105",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3564,1),\"\"))","v":1},{"$f":"IF(F3564=1,COUNTIF($F$3:F3564,1),\"\")","v":3562},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3564),$G$3:$G$3716,0)),\"\")","v":"76329301105"}]
[null,null,null,null,"76329301205",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3565,1),\"\"))","v":1},{"$f":"IF(F3565=1,COUNTIF($F$3:F3565,1),\"\")","v":3563},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3565),$G$3:$G$3716,0)),\"\")","v":"76329301205"}]
[null,null,null,null,"76329330201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3566,1),\"\"))","v":1},{"$f":"IF(F3566=1,COUNTIF($F$3:F3566,1),\"\")","v":3564},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3566),$G$3:$G$3716,0)),\"\")","v":"76329330201"}]
[null,null,null,null,"76329330401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3567,1),\"\"))","v":1},{"$f":"IF(F3567=1,COUNTIF($F$3:F3567,1),\"\")","v":3565},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3567),$G$3:$G$3716,0)),\"\")","v":"76329330401"}]
[null,null,null,null,"76385010401",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3568,1),\"\"))","v":1},{"$f":"IF(F3568=1,COUNTIF($F$3:F3568,1),\"\")","v":3566},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3568),$G$3:$G$3716,0)),\"\")","v":"76385010401"}]
[null,null,null,null,"76388063525",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3569,1),\"\"))","v":1},{"$f":"IF(F3569=1,COUNTIF($F$3:F3569,1),\"\")","v":3567},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3569),$G$3:$G$3716,0)),\"\")","v":"76388063525"}]
[null,null,null,null,"77333051610",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3570,1),\"\"))","v":1},{"$f":"IF(F3570=1,COUNTIF($F$3:F3570,1),\"\")","v":3568},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3570),$G$3:$G$3716,0)),\"\")","v":"77333051610"}]
[null,null,null,null,"77333083110",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3571,1),\"\"))","v":1},{"$f":"IF(F3571=1,COUNTIF($F$3:F3571,1),\"\")","v":3569},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3571),$G$3:$G$3716,0)),\"\")","v":"77333083110"}]
[null,null,null,null,"77333083125",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3572,1),\"\"))","v":1},{"$f":"IF(F3572=1,COUNTIF($F$3:F3572,1),\"\")","v":3570},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3572),$G$3:$G$3716,0)),\"\")","v":"77333083125"}]
[null,null,null,null,"77333093410",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3573,1),\"\"))","v":1},{"$f":"IF(F3573=1,COUNTIF($F$3:F3573,1),\"\")","v":3571},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3573),$G$3:$G$3716,0)),\"\")","v":"77333093410"}]
[null,null,null,null,"77333098310",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3574,1),\"\"))","v":1},{"$f":"IF(F3574=1,COUNTIF($F$3:F3574,1),\"\")","v":3572},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3574),$G$3:$G$3716,0)),\"\")","v":"77333098310"}]
[null,null,null,null,"77333098325",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3575,1),\"\"))","v":1},{"$f":"IF(F3575=1,COUNTIF($F$3:F3575,1),\"\")","v":3573},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3575),$G$3:$G$3716,0)),\"\")","v":"77333098325"}]
[null,null,null,null,"78112073623",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3576,1),\"\"))","v":1},{"$f":"IF(F3576=1,COUNTIF($F$3:F3576,1),\"\")","v":3574},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3576),$G$3:$G$3716,0)),\"\")","v":"78112073623"}]
[null,null,null,null,"78112073632",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3577,1),\"\"))","v":1},{"$f":"IF(F3577=1,COUNTIF($F$3:F3577,1),\"\")","v":3575},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3577),$G$3:$G$3716,0)),\"\")","v":"78112073632"}]
[null,null,null,null,"78206011101",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3578,1),\"\"))","v":1},{"$f":"IF(F3578=1,COUNTIF($F$3:F3578,1),\"\")","v":3576},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3578),$G$3:$G$3716,0)),\"\")","v":"78206011101"}]
[null,null,null,null,"78206011201",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3579,1),\"\"))","v":1},{"$f":"IF(F3579=1,COUNTIF($F$3:F3579,1),\"\")","v":3577},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3579),$G$3:$G$3716,0)),\"\")","v":"78206011201"}]
[null,null,null,null,"78206011301",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3580,1),\"\"))","v":1},{"$f":"IF(F3580=1,COUNTIF($F$3:F3580,1),\"\")","v":3578},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3580),$G$3:$G$3716,0)),\"\")","v":"78206011301"}]
[null,null,null,null,"79854007723",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3581,1),\"\"))","v":1},{"$f":"IF(F3581=1,COUNTIF($F$3:F3581,1),\"\")","v":3579},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3581),$G$3:$G$3716,0)),\"\")","v":"79854007723"}]
[null,null,null,null,"79854030035",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3582,1),\"\"))","v":1},{"$f":"IF(F3582=1,COUNTIF($F$3:F3582,1),\"\")","v":3580},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3582),$G$3:$G$3716,0)),\"\")","v":"79854030035"}]
[null,null,null,null,"79854050021",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3583,1),\"\"))","v":1},{"$f":"IF(F3583=1,COUNTIF($F$3:F3583,1),\"\")","v":3581},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3583),$G$3:$G$3716,0)),\"\")","v":"79854050021"}]
[null,null,null,null,"80681007100",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3584,1),\"\"))","v":1},{"$f":"IF(F3584=1,COUNTIF($F$3:F3584,1),\"\")","v":3582},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3584),$G$3:$G$3716,0)),\"\")","v":"80681007100"}]
[null,null,null,null,"80681016000",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3585,1),\"\"))","v":1},{"$f":"IF(F3585=1,COUNTIF($F$3:F3585,1),\"\")","v":3583},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3585),$G$3:$G$3716,0)),\"\")","v":"80681016000"}]
[null,null,null,null,"80681016900",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3586,1),\"\"))","v":1},{"$f":"IF(F3586=1,COUNTIF($F$3:F3586,1),\"\")","v":3584},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3586),$G$3:$G$3716,0)),\"\")","v":"80681016900"}]
[null,null,null,null,"81421002002",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3587,1),\"\"))","v":1},{"$f":"IF(F3587=1,COUNTIF($F$3:F3587,1),\"\")","v":3585},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3587),$G$3:$G$3716,0)),\"\")","v":"81421002002"}]
[null,null,null,null,"81421002102",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3588,1),\"\"))","v":1},{"$f":"IF(F3588=1,COUNTIF($F$3:F3588,1),\"\")","v":3586},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3588),$G$3:$G$3716,0)),\"\")","v":"81421002102"}]
[null,null,null,null,"81421002105",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3589,1),\"\"))","v":1},{"$f":"IF(F3589=1,COUNTIF($F$3:F3589,1),\"\")","v":3587},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3589),$G$3:$G$3716,0)),\"\")","v":"81421002105"}]
[null,null,null,null,"85446036991",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3590,1),\"\"))","v":1},{"$f":"IF(F3590=1,COUNTIF($F$3:F3590,1),\"\")","v":3588},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3590),$G$3:$G$3716,0)),\"\")","v":"85446036991"}]
[null,null,null,null,"87701041285",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3591,1),\"\"))","v":1},{"$f":"IF(F3591=1,COUNTIF($F$3:F3591,1),\"\")","v":3589},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3591),$G$3:$G$3716,0)),\"\")","v":"87701041285"}]
[null,null,null,null,"96295012528",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3592,1),\"\"))","v":1},{"$f":"IF(F3592=1,COUNTIF($F$3:F3592,1),\"\")","v":3590},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3592),$G$3:$G$3716,0)),\"\")","v":"96295012528"}]
[null,null,null,null,"96295013836",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3593,1),\"\"))","v":1},{"$f":"IF(F3593=1,COUNTIF($F$3:F3593,1),\"\")","v":3591},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3593),$G$3:$G$3716,0)),\"\")","v":"96295013836"}]
[null,null,null,null,"98515000103",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3594,1),\"\"))","v":1},{"$f":"IF(F3594=1,COUNTIF($F$3:F3594,1),\"\")","v":3592},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3594),$G$3:$G$3716,0)),\"\")","v":"98515000103"}]
[null,null,null,null,"99400899664",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3595,1),\"\"))","v":1},{"$f":"IF(F3595=1,COUNTIF($F$3:F3595,1),\"\")","v":3593},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3595),$G$3:$G$3716,0)),\"\")","v":"99400899664"}]
[null,null,null,null,"99400899665",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3596,1),\"\"))","v":1},{"$f":"IF(F3596=1,COUNTIF($F$3:F3596,1),\"\")","v":3594},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3596),$G$3:$G$3716,0)),\"\")","v":"99400899665"}]
[null,null,null,null,"99940801136",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3597,1),\"\"))","v":1},{"$f":"IF(F3597=1,COUNTIF($F$3:F3597,1),\"\")","v":3595},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3597),$G$3:$G$3716,0)),\"\")","v":"99940801136"}]
[null,null,null,null,"99940840536",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3598,1),\"\"))","v":1},{"$f":"IF(F3598=1,COUNTIF($F$3:F3598,1),\"\")","v":3596},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3598),$G$3:$G$3716,0)),\"\")","v":"99940840536"}]
[null,null,null,null,"99990998823",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3599,1),\"\"))","v":1},{"$f":"IF(F3599=1,COUNTIF($F$3:F3599,1),\"\")","v":3597},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3599),$G$3:$G$3716,0)),\"\")","v":"99990998823"}]
[null,null,null,null,"99990998824",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3600,1),\"\"))","v":1},{"$f":"IF(F3600=1,COUNTIF($F$3:F3600,1),\"\")","v":3598},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3600),$G$3:$G$3716,0)),\"\")","v":"99990998824"}]
[null,null,null,null,"99990999140",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3601,1),\"\"))","v":1},{"$f":"IF(F3601=1,COUNTIF($F$3:F3601,1),\"\")","v":3599},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3601),$G$3:$G$3716,0)),\"\")","v":"99990999140"}]
[null,null,null,null,"99994080107",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3602,1),\"\"))","v":1},{"$f":"IF(F3602=1,COUNTIF($F$3:F3602,1),\"\")","v":3600},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3602),$G$3:$G$3716,0)),\"\")","v":"99994080107"}]
[null,null,null,null,"99994080113",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3603,1),\"\"))","v":1},{"$f":"IF(F3603=1,COUNTIF($F$3:F3603,1),\"\")","v":3601},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3603),$G$3:$G$3716,0)),\"\")","v":"99994080113"}]
[null,null,null,null,"99994080119",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3604,1),\"\"))","v":1},{"$f":"IF(F3604=1,COUNTIF($F$3:F3604,1),\"\")","v":3602},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3604),$G$3:$G$3716,0)),\"\")","v":"99994080119"}]
[null,null,null,null,"99994080149",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3605,1),\"\"))","v":1},{"$f":"IF(F3605=1,COUNTIF($F$3:F3605,1),\"\")","v":3603},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3605),$G$3:$G$3716,0)),\"\")","v":"99994080149"}]
[null,null,null,null,"99994080155",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3606,1),\"\"))","v":1},{"$f":"IF(F3606=1,COUNTIF($F$3:F3606,1),\"\")","v":3604},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3606),$G$3:$G$3716,0)),\"\")","v":"99994080155"}]
[null,null,null,null,"99999102460",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3607,1),\"\"))","v":1},{"$f":"IF(F3607=1,COUNTIF($F$3:F3607,1),\"\")","v":3605},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3607),$G$3:$G$3716,0)),\"\")","v":"99999102460"}]
[null,null,null,null,"99999125642",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3608,1),\"\"))","v":1},{"$f":"IF(F3608=1,COUNTIF($F$3:F3608,1),\"\")","v":3606},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3608),$G$3:$G$3716,0)),\"\")","v":"99999125642"}]
[null,null,null,null,"99999128932",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3609,1),\"\"))","v":1},{"$f":"IF(F3609=1,COUNTIF($F$3:F3609,1),\"\")","v":3607},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3609),$G$3:$G$3716,0)),\"\")","v":"99999128932"}]
[null,null,null,null,"99999164620",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3610,1),\"\"))","v":1},{"$f":"IF(F3610=1,COUNTIF($F$3:F3610,1),\"\")","v":3608},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3610),$G$3:$G$3716,0)),\"\")","v":"99999164620"}]
[null,null,null,null,"99999190195",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3611,1),\"\"))","v":1},{"$f":"IF(F3611=1,COUNTIF($F$3:F3611,1),\"\")","v":3609},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3611),$G$3:$G$3716,0)),\"\")","v":"99999190195"}]
[null,null,null,null,"99999401010",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3612,1),\"\"))","v":1},{"$f":"IF(F3612=1,COUNTIF($F$3:F3612,1),\"\")","v":3610},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3612),$G$3:$G$3716,0)),\"\")","v":"99999401010"}]
[null,null,null,null,"99999401011",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3613,1),\"\"))","v":1},{"$f":"IF(F3613=1,COUNTIF($F$3:F3613,1),\"\")","v":3611},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3613),$G$3:$G$3716,0)),\"\")","v":"99999401011"}]
[null,null,null,null,"99999408147",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3614,1),\"\"))","v":1},{"$f":"IF(F3614=1,COUNTIF($F$3:F3614,1),\"\")","v":3612},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3614),$G$3:$G$3716,0)),\"\")","v":"99999408147"}]
[null,null,null,null,"99999408410",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3615,1),\"\"))","v":1},{"$f":"IF(F3615=1,COUNTIF($F$3:F3615,1),\"\")","v":3613},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3615),$G$3:$G$3716,0)),\"\")","v":"99999408410"}]
[null,null,null,null,"99999408520",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3616,1),\"\"))","v":1},{"$f":"IF(F3616=1,COUNTIF($F$3:F3616,1),\"\")","v":3614},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3616),$G$3:$G$3716,0)),\"\")","v":"99999408520"}]
[null,null,null,null,"99999408778",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3617,1),\"\"))","v":1},{"$f":"IF(F3617=1,COUNTIF($F$3:F3617,1),\"\")","v":3615},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3617),$G$3:$G$3716,0)),\"\")","v":"99999408778"}]
[null,null,null,null,"99999900155",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3618,1),\"\"))","v":1},{"$f":"IF(F3618=1,COUNTIF($F$3:F3618,1),\"\")","v":3616},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3618),$G$3:$G$3716,0)),\"\")","v":"99999900155"}]
[null,null,null,null,"99999909901",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3619,1),\"\"))","v":1},{"$f":"IF(F3619=1,COUNTIF($F$3:F3619,1),\"\")","v":3617},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3619),$G$3:$G$3716,0)),\"\")","v":"99999909901"}]
[null,null,null,null,"99999910023",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3620,1),\"\"))","v":1},{"$f":"IF(F3620=1,COUNTIF($F$3:F3620,1),\"\")","v":3618},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3620),$G$3:$G$3716,0)),\"\")","v":"99999910023"}]
[null,null,null,null,"99999910810",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3621,1),\"\"))","v":1},{"$f":"IF(F3621=1,COUNTIF($F$3:F3621,1),\"\")","v":3619},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3621),$G$3:$G$3716,0)),\"\")","v":"99999910810"}]
[null,null,null,null,"99999922560",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3622,1),\"\"))","v":1},{"$f":"IF(F3622=1,COUNTIF($F$3:F3622,1),\"\")","v":3620},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3622),$G$3:$G$3716,0)),\"\")","v":"99999922560"}]
[null,null,null,null,"99999936962",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3623,1),\"\"))","v":1},{"$f":"IF(F3623=1,COUNTIF($F$3:F3623,1),\"\")","v":3621},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3623),$G$3:$G$3716,0)),\"\")","v":"99999936962"}]
[null,null,null,null,"99999940802",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3624,1),\"\"))","v":1},{"$f":"IF(F3624=1,COUNTIF($F$3:F3624,1),\"\")","v":3622},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3624),$G$3:$G$3716,0)),\"\")","v":"99999940802"}]
[null,null,null,null,"99999988801",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3625,1),\"\"))","v":1},{"$f":"IF(F3625=1,COUNTIF($F$3:F3625,1),\"\")","v":3623},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3625),$G$3:$G$3716,0)),\"\")","v":"99999988801"}]
[null,null,null,null,"99999988803",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3626,1),\"\"))","v":1},{"$f":"IF(F3626=1,COUNTIF($F$3:F3626,1),\"\")","v":3624},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3626),$G$3:$G$3716,0)),\"\")","v":"99999988803"}]
[null,null,null,null,"99999988869",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3627,1),\"\"))","v":1},{"$f":"IF(F3627=1,COUNTIF($F$3:F3627,1),\"\")","v":3625},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3627),$G$3:$G$3716,0)),\"\")","v":"99999988869"}]
[null,null,null,null,"99999990051",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3628,1),\"\"))","v":1},{"$f":"IF(F3628=1,COUNTIF($F$3:F3628,1),\"\")","v":3626},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3628),$G$3:$G$3716,0)),\"\")","v":"99999990051"}]
[null,null,null,null,"99999990057",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3629,1),\"\"))","v":1},{"$f":"IF(F3629=1,COUNTIF($F$3:F3629,1),\"\")","v":3627},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3629),$G$3:$G$3716,0)),\"\")","v":"99999990057"}]
[null,null,null,null,"99999990059",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3630,1),\"\"))","v":1},{"$f":"IF(F3630=1,COUNTIF($F$3:F3630,1),\"\")","v":3628},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3630),$G$3:$G$3716,0)),\"\")","v":"99999990059"}]
[null,null,null,null,"99999990068",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3631,1),\"\"))","v":1},{"$f":"IF(F3631=1,COUNTIF($F$3:F3631,1),\"\")","v":3629},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3631),$G$3:$G$3716,0)),\"\")","v":"99999990068"}]
[null,null,null,null,"99999990069",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3632,1),\"\"))","v":1},{"$f":"IF(F3632=1,COUNTIF($F$3:F3632,1),\"\")","v":3630},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3632),$G$3:$G$3716,0)),\"\")","v":"99999990069"}]
[null,null,null,null,"99999990071",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3633,1),\"\"))","v":1},{"$f":"IF(F3633=1,COUNTIF($F$3:F3633,1),\"\")","v":3631},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3633),$G$3:$G$3716,0)),\"\")","v":"99999990071"}]
[null,null,null,null,"99999990072",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3634,1),\"\"))","v":1},{"$f":"IF(F3634=1,COUNTIF($F$3:F3634,1),\"\")","v":3632},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3634),$G$3:$G$3716,0)),\"\")","v":"99999990072"}]
[null,null,null,null,"99999990073",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3635,1),\"\"))","v":1},{"$f":"IF(F3635=1,COUNTIF($F$3:F3635,1),\"\")","v":3633},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3635),$G$3:$G$3716,0)),\"\")","v":"99999990073"}]
[null,null,null,null,"99999990074",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3636,1),\"\"))","v":1},{"$f":"IF(F3636=1,COUNTIF($F$3:F3636,1),\"\")","v":3634},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3636),$G$3:$G$3716,0)),\"\")","v":"99999990074"}]
[null,null,null,null,"99999990077",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3637,1),\"\"))","v":1},{"$f":"IF(F3637=1,COUNTIF($F$3:F3637,1),\"\")","v":3635},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3637),$G$3:$G$3716,0)),\"\")","v":"99999990077"}]
[null,null,null,null,"99999990082",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3638,1),\"\"))","v":1},{"$f":"IF(F3638=1,COUNTIF($F$3:F3638,1),\"\")","v":3636},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3638),$G$3:$G$3716,0)),\"\")","v":"99999990082"}]
[null,null,null,null,"99999990083",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3639,1),\"\"))","v":1},{"$f":"IF(F3639=1,COUNTIF($F$3:F3639,1),\"\")","v":3637},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3639),$G$3:$G$3716,0)),\"\")","v":"99999990083"}]
[null,null,null,null,"99999990085",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3640,1),\"\"))","v":1},{"$f":"IF(F3640=1,COUNTIF($F$3:F3640,1),\"\")","v":3638},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3640),$G$3:$G$3716,0)),\"\")","v":"99999990085"}]
[null,null,null,null,"99999990086",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3641,1),\"\"))","v":1},{"$f":"IF(F3641=1,COUNTIF($F$3:F3641,1),\"\")","v":3639},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3641),$G$3:$G$3716,0)),\"\")","v":"99999990086"}]
[null,null,null,null,"99999990087",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3642,1),\"\"))","v":1},{"$f":"IF(F3642=1,COUNTIF($F$3:F3642,1),\"\")","v":3640},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3642),$G$3:$G$3716,0)),\"\")","v":"99999990087"}]
[null,null,null,null,"99999990088",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3643,1),\"\"))","v":1},{"$f":"IF(F3643=1,COUNTIF($F$3:F3643,1),\"\")","v":3641},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3643),$G$3:$G$3716,0)),\"\")","v":"99999990088"}]
[null,null,null,null,"99999990089",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3644,1),\"\"))","v":1},{"$f":"IF(F3644=1,COUNTIF($F$3:F3644,1),\"\")","v":3642},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3644),$G$3:$G$3716,0)),\"\")","v":"99999990089"}]
[null,null,null,null,"99999990096",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3645,1),\"\"))","v":1},{"$f":"IF(F3645=1,COUNTIF($F$3:F3645,1),\"\")","v":3643},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3645),$G$3:$G$3716,0)),\"\")","v":"99999990096"}]
[null,null,null,null,"99999990097",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3646,1),\"\"))","v":1},{"$f":"IF(F3646=1,COUNTIF($F$3:F3646,1),\"\")","v":3644},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3646),$G$3:$G$3716,0)),\"\")","v":"99999990097"}]
[null,null,null,null,"99999990099",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3647,1),\"\"))","v":1},{"$f":"IF(F3647=1,COUNTIF($F$3:F3647,1),\"\")","v":3645},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3647),$G$3:$G$3716,0)),\"\")","v":"99999990099"}]
[null,null,null,null,"99999990258",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3648,1),\"\"))","v":1},{"$f":"IF(F3648=1,COUNTIF($F$3:F3648,1),\"\")","v":3646},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3648),$G$3:$G$3716,0)),\"\")","v":"99999990258"}]
[null,null,null,null,"99999990266",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3649,1),\"\"))","v":1},{"$f":"IF(F3649=1,COUNTIF($F$3:F3649,1),\"\")","v":3647},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3649),$G$3:$G$3716,0)),\"\")","v":"99999990266"}]
[null,null,null,null,"99999990997",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3650,1),\"\"))","v":1},{"$f":"IF(F3650=1,COUNTIF($F$3:F3650,1),\"\")","v":3648},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3650),$G$3:$G$3716,0)),\"\")","v":"99999990997"}]
[null,null,null,null,"99999992032",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3651,1),\"\"))","v":1},{"$f":"IF(F3651=1,COUNTIF($F$3:F3651,1),\"\")","v":3649},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3651),$G$3:$G$3716,0)),\"\")","v":"99999992032"}]
[null,null,null,null,"99999993585",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3652,1),\"\"))","v":1},{"$f":"IF(F3652=1,COUNTIF($F$3:F3652,1),\"\")","v":3650},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3652),$G$3:$G$3716,0)),\"\")","v":"99999993585"}]
[null,null,null,null,"99999996212",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3653,1),\"\"))","v":1},{"$f":"IF(F3653=1,COUNTIF($F$3:F3653,1),\"\")","v":3651},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3653),$G$3:$G$3716,0)),\"\")","v":"99999996212"}]
[null,null,null,null,"99999996930",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3654,1),\"\"))","v":1},{"$f":"IF(F3654=1,COUNTIF($F$3:F3654,1),\"\")","v":3652},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3654),$G$3:$G$3716,0)),\"\")","v":"99999996930"}]
[null,null,null,null,"99999997120",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3655,1),\"\"))","v":1},{"$f":"IF(F3655=1,COUNTIF($F$3:F3655,1),\"\")","v":3653},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3655),$G$3:$G$3716,0)),\"\")","v":"99999997120"}]
[null,null,null,null,"99999999077",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3656,1),\"\"))","v":1},{"$f":"IF(F3656=1,COUNTIF($F$3:F3656,1),\"\")","v":3654},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3656),$G$3:$G$3716,0)),\"\")","v":"99999999077"}]
[null,null,null,null,"99999999131",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3657,1),\"\"))","v":1},{"$f":"IF(F3657=1,COUNTIF($F$3:F3657,1),\"\")","v":3655},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3657),$G$3:$G$3716,0)),\"\")","v":"99999999131"}]
[null,null,null,null,"99999999501",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3658,1),\"\"))","v":1},{"$f":"IF(F3658=1,COUNTIF($F$3:F3658,1),\"\")","v":3656},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3658),$G$3:$G$3716,0)),\"\")","v":"99999999501"}]
[null,null,null,null,"99999999505",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3659,1),\"\"))","v":1},{"$f":"IF(F3659=1,COUNTIF($F$3:F3659,1),\"\")","v":3657},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3659),$G$3:$G$3716,0)),\"\")","v":"99999999505"}]
[null,null,null,null,"99999999507",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3660,1),\"\"))","v":1},{"$f":"IF(F3660=1,COUNTIF($F$3:F3660,1),\"\")","v":3658},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3660),$G$3:$G$3716,0)),\"\")","v":"99999999507"}]
[null,null,null,null,"99999999509",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3661,1),\"\"))","v":1},{"$f":"IF(F3661=1,COUNTIF($F$3:F3661,1),\"\")","v":3659},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3661),$G$3:$G$3716,0)),\"\")","v":"99999999509"}]
[null,null,null,null,"99999999511",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3662,1),\"\"))","v":1},{"$f":"IF(F3662=1,COUNTIF($F$3:F3662,1),\"\")","v":3660},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3662),$G$3:$G$3716,0)),\"\")","v":"99999999511"}]
[null,null,null,null,"99999999512",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3663,1),\"\"))","v":1},{"$f":"IF(F3663=1,COUNTIF($F$3:F3663,1),\"\")","v":3661},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3663),$G$3:$G$3716,0)),\"\")","v":"99999999512"}]
[null,null,null,null,"99999999513",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3664,1),\"\"))","v":1},{"$f":"IF(F3664=1,COUNTIF($F$3:F3664,1),\"\")","v":3662},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3664),$G$3:$G$3716,0)),\"\")","v":"99999999513"}]
[null,null,null,null,"99999999514",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3665,1),\"\"))","v":1},{"$f":"IF(F3665=1,COUNTIF($F$3:F3665,1),\"\")","v":3663},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3665),$G$3:$G$3716,0)),\"\")","v":"99999999514"}]
[null,null,null,null,"99999999515",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3666,1),\"\"))","v":1},{"$f":"IF(F3666=1,COUNTIF($F$3:F3666,1),\"\")","v":3664},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3666),$G$3:$G$3716,0)),\"\")","v":"99999999515"}]
[null,null,null,null,"99999999517",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3667,1),\"\"))","v":1},{"$f":"IF(F3667=1,COUNTIF($F$3:F3667,1),\"\")","v":3665},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3667),$G$3:$G$3716,0)),\"\")","v":"99999999517"}]
[null,null,null,null,"99999999518",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3668,1),\"\"))","v":1},{"$f":"IF(F3668=1,COUNTIF($F$3:F3668,1),\"\")","v":3666},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3668),$G$3:$G$3716,0)),\"\")","v":"99999999518"}]
[null,null,null,null,"99999999522",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3669,1),\"\"))","v":1},{"$f":"IF(F3669=1,COUNTIF($F$3:F3669,1),\"\")","v":3667},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3669),$G$3:$G$3716,0)),\"\")","v":"99999999522"}]
[null,null,null,null,"99999999525",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3670,1),\"\"))","v":1},{"$f":"IF(F3670=1,COUNTIF($F$3:F3670,1),\"\")","v":3668},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3670),$G$3:$G$3716,0)),\"\")","v":"99999999525"}]
[null,null,null,null,"99999999527",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3671,1),\"\"))","v":1},{"$f":"IF(F3671=1,COUNTIF($F$3:F3671,1),\"\")","v":3669},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3671),$G$3:$G$3716,0)),\"\")","v":"99999999527"}]
[null,null,null,null,"99999999528",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3672,1),\"\"))","v":1},{"$f":"IF(F3672=1,COUNTIF($F$3:F3672,1),\"\")","v":3670},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3672),$G$3:$G$3716,0)),\"\")","v":"99999999528"}]
[null,null,null,null,"99999999529",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3673,1),\"\"))","v":1},{"$f":"IF(F3673=1,COUNTIF($F$3:F3673,1),\"\")","v":3671},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3673),$G$3:$G$3716,0)),\"\")","v":"99999999529"}]
[null,null,null,null,"99999999530",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3674,1),\"\"))","v":1},{"$f":"IF(F3674=1,COUNTIF($F$3:F3674,1),\"\")","v":3672},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3674),$G$3:$G$3716,0)),\"\")","v":"99999999530"}]
[null,null,null,null,"99999999596",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3675,1),\"\"))","v":1},{"$f":"IF(F3675=1,COUNTIF($F$3:F3675,1),\"\")","v":3673},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3675),$G$3:$G$3716,0)),\"\")","v":"99999999596"}]
[null,null,null,null,"99999999621",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3676,1),\"\"))","v":1},{"$f":"IF(F3676=1,COUNTIF($F$3:F3676,1),\"\")","v":3674},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3676),$G$3:$G$3716,0)),\"\")","v":"99999999621"}]
[null,null,null,null,"99999999631",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3677,1),\"\"))","v":1},{"$f":"IF(F3677=1,COUNTIF($F$3:F3677,1),\"\")","v":3675},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3677),$G$3:$G$3716,0)),\"\")","v":"99999999631"}]
[null,null,null,null,"99999999632",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3678,1),\"\"))","v":1},{"$f":"IF(F3678=1,COUNTIF($F$3:F3678,1),\"\")","v":3676},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3678),$G$3:$G$3716,0)),\"\")","v":"99999999632"}]
[null,null,null,null,"99999999633",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3679,1),\"\"))","v":1},{"$f":"IF(F3679=1,COUNTIF($F$3:F3679,1),\"\")","v":3677},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3679),$G$3:$G$3716,0)),\"\")","v":"99999999633"}]
[null,null,null,null,"99999999634",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3680,1),\"\"))","v":1},{"$f":"IF(F3680=1,COUNTIF($F$3:F3680,1),\"\")","v":3678},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3680),$G$3:$G$3716,0)),\"\")","v":"99999999634"}]
[null,null,null,null,"99999999646",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3681,1),\"\"))","v":1},{"$f":"IF(F3681=1,COUNTIF($F$3:F3681,1),\"\")","v":3679},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3681),$G$3:$G$3716,0)),\"\")","v":"99999999646"}]
[null,null,null,null,"99999999655",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3682,1),\"\"))","v":1},{"$f":"IF(F3682=1,COUNTIF($F$3:F3682,1),\"\")","v":3680},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3682),$G$3:$G$3716,0)),\"\")","v":"99999999655"}]
[null,null,null,null,"99999999681",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3683,1),\"\"))","v":1},{"$f":"IF(F3683=1,COUNTIF($F$3:F3683,1),\"\")","v":3681},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3683),$G$3:$G$3716,0)),\"\")","v":"99999999681"}]
[null,null,null,null,"99999999724",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3684,1),\"\"))","v":1},{"$f":"IF(F3684=1,COUNTIF($F$3:F3684,1),\"\")","v":3682},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3684),$G$3:$G$3716,0)),\"\")","v":"99999999724"}]
[null,null,null,null,"99999999739",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3685,1),\"\"))","v":1},{"$f":"IF(F3685=1,COUNTIF($F$3:F3685,1),\"\")","v":3683},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3685),$G$3:$G$3716,0)),\"\")","v":"99999999739"}]
[null,null,null,null,"99999999740",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3686,1),\"\"))","v":1},{"$f":"IF(F3686=1,COUNTIF($F$3:F3686,1),\"\")","v":3684},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3686),$G$3:$G$3716,0)),\"\")","v":"99999999740"}]
[null,null,null,null,"99999999742",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3687,1),\"\"))","v":1},{"$f":"IF(F3687=1,COUNTIF($F$3:F3687,1),\"\")","v":3685},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3687),$G$3:$G$3716,0)),\"\")","v":"99999999742"}]
[null,null,null,null,"99999999750",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3688,1),\"\"))","v":1},{"$f":"IF(F3688=1,COUNTIF($F$3:F3688,1),\"\")","v":3686},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3688),$G$3:$G$3716,0)),\"\")","v":"99999999750"}]
[null,null,null,null,"99999999751",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3689,1),\"\"))","v":1},{"$f":"IF(F3689=1,COUNTIF($F$3:F3689,1),\"\")","v":3687},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3689),$G$3:$G$3716,0)),\"\")","v":"99999999751"}]
[null,null,null,null,"99999999754",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3690,1),\"\"))","v":1},{"$f":"IF(F3690=1,COUNTIF($F$3:F3690,1),\"\")","v":3688},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3690),$G$3:$G$3716,0)),\"\")","v":"99999999754"}]
[null,null,null,null,"99999999758",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3691,1),\"\"))","v":1},{"$f":"IF(F3691=1,COUNTIF($F$3:F3691,1),\"\")","v":3689},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3691),$G$3:$G$3716,0)),\"\")","v":"99999999758"}]
[null,null,null,null,"99999999759",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3692,1),\"\"))","v":1},{"$f":"IF(F3692=1,COUNTIF($F$3:F3692,1),\"\")","v":3690},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3692),$G$3:$G$3716,0)),\"\")","v":"99999999759"}]
[null,null,null,null,"99999999760",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3693,1),\"\"))","v":1},{"$f":"IF(F3693=1,COUNTIF($F$3:F3693,1),\"\")","v":3691},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3693),$G$3:$G$3716,0)),\"\")","v":"99999999760"}]
[null,null,null,null,"99999999762",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3694,1),\"\"))","v":1},{"$f":"IF(F3694=1,COUNTIF($F$3:F3694,1),\"\")","v":3692},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3694),$G$3:$G$3716,0)),\"\")","v":"99999999762"}]
[null,null,null,null,"99999999810",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3695,1),\"\"))","v":1},{"$f":"IF(F3695=1,COUNTIF($F$3:F3695,1),\"\")","v":3693},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3695),$G$3:$G$3716,0)),\"\")","v":"99999999810"}]
[null,null,null,null,"99999999811",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3696,1),\"\"))","v":1},{"$f":"IF(F3696=1,COUNTIF($F$3:F3696,1),\"\")","v":3694},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3696),$G$3:$G$3716,0)),\"\")","v":"99999999811"}]
[null,null,null,null,"99999999812",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3697,1),\"\"))","v":1},{"$f":"IF(F3697=1,COUNTIF($F$3:F3697,1),\"\")","v":3695},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3697),$G$3:$G$3716,0)),\"\")","v":"99999999812"}]
[null,null,null,null,"99999999813",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3698,1),\"\"))","v":1},{"$f":"IF(F3698=1,COUNTIF($F$3:F3698,1),\"\")","v":3696},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3698),$G$3:$G$3716,0)),\"\")","v":"99999999813"}]
[null,null,null,null,"99999999814",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3699,1),\"\"))","v":1},{"$f":"IF(F3699=1,COUNTIF($F$3:F3699,1),\"\")","v":3697},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3699),$G$3:$G$3716,0)),\"\")","v":"99999999814"}]
[null,null,null,null,"99999999815",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3700,1),\"\"))","v":1},{"$f":"IF(F3700=1,COUNTIF($F$3:F3700,1),\"\")","v":3698},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3700),$G$3:$G$3716,0)),\"\")","v":"99999999815"}]
[null,null,null,null,"99999999816",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3701,1),\"\"))","v":1},{"$f":"IF(F3701=1,COUNTIF($F$3:F3701,1),\"\")","v":3699},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3701),$G$3:$G$3716,0)),\"\")","v":"99999999816"}]
[null,null,null,null,"99999999817",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3702,1),\"\"))","v":1},{"$f":"IF(F3702=1,COUNTIF($F$3:F3702,1),\"\")","v":3700},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3702),$G$3:$G$3716,0)),\"\")","v":"99999999817"}]
[null,null,null,null,"99999999818",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3703,1),\"\"))","v":1},{"$f":"IF(F3703=1,COUNTIF($F$3:F3703,1),\"\")","v":3701},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3703),$G$3:$G$3716,0)),\"\")","v":"99999999818"}]
[null,null,null,null,"99999999850",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3704,1),\"\"))","v":1},{"$f":"IF(F3704=1,COUNTIF($F$3:F3704,1),\"\")","v":3702},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3704),$G$3:$G$3716,0)),\"\")","v":"99999999850"}]
[null,null,null,null,"99999999851",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3705,1),\"\"))","v":1},{"$f":"IF(F3705=1,COUNTIF($F$3:F3705,1),\"\")","v":3703},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3705),$G$3:$G$3716,0)),\"\")","v":"99999999851"}]
[null,null,null,null,"99999999879",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3706,1),\"\"))","v":1},{"$f":"IF(F3706=1,COUNTIF($F$3:F3706,1),\"\")","v":3704},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3706),$G$3:$G$3716,0)),\"\")","v":"99999999879"}]
[null,null,null,null,"99999999880",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3707,1),\"\"))","v":1},{"$f":"IF(F3707=1,COUNTIF($F$3:F3707,1),\"\")","v":3705},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3707),$G$3:$G$3716,0)),\"\")","v":"99999999880"}]
[null,null,null,null,"99999999906",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3708,1),\"\"))","v":1},{"$f":"IF(F3708=1,COUNTIF($F$3:F3708,1),\"\")","v":3706},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3708),$G$3:$G$3716,0)),\"\")","v":"99999999906"}]
[null,null,null,null,"99999999907",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3709,1),\"\"))","v":1},{"$f":"IF(F3709=1,COUNTIF($F$3:F3709,1),\"\")","v":3707},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3709),$G$3:$G$3716,0)),\"\")","v":"99999999907"}]
[null,null,null,null,"99999999925",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3710,1),\"\"))","v":1},{"$f":"IF(F3710=1,COUNTIF($F$3:F3710,1),\"\")","v":3708},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3710),$G$3:$G$3716,0)),\"\")","v":"99999999925"}]
[null,null,null,null,"99999999952",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3711,1),\"\"))","v":1},{"$f":"IF(F3711=1,COUNTIF($F$3:F3711,1),\"\")","v":3709},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3711),$G$3:$G$3716,0)),\"\")","v":"99999999952"}]
[null,null,null,null,"99999999984",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3712,1),\"\"))","v":1},{"$f":"IF(F3712=1,COUNTIF($F$3:F3712,1),\"\")","v":3710},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3712),$G$3:$G$3716,0)),\"\")","v":"99999999984"}]
[null,null,null,null,"99999999985",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3713,1),\"\"))","v":1},{"$f":"IF(F3713=1,COUNTIF($F$3:F3713,1),\"\")","v":3711},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3713),$G$3:$G$3716,0)),\"\")","v":"99999999985"}]
[null,null,null,null,"99999999986",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3714,1),\"\"))","v":1},{"$f":"IF(F3714=1,COUNTIF($F$3:F3714,1),\"\")","v":3712},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3714),$G$3:$G$3716,0)),\"\")","v":"99999999986"}]
[null,null,null,null,"99999999987",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3715,1),\"\"))","v":1},{"$f":"IF(F3715=1,COUNTIF($F$3:F3715,1),\"\")","v":3713},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3715),$G$3:$G$3716,0)),\"\")","v":"99999999987"}]
[null,null,null,null,"99999999988",{"$f":"--ISNUMBER(IFERROR(SEARCH('NDC Lookup Tool'!$C$9,E3716,1),\"\"))","v":1},{"$f":"IF(F3716=1,COUNTIF($F$3:F3716,1),\"\")","v":3714},{"$f":"IFERROR(INDEX($E$3:$E$3716,MATCH(ROWS($G$3:G3716),$G$3:$G$3716,0)),\"\")","v":"99999999988"}]

{"sheet":"Average Table - NDC","index":4,"n_rows":3715,"n_cols":11,"rows_kept":3715,"cut":false,"hidden":true,"merged":[]}
["Payer - Plan - NDC","Payer","Plan","Bill Type","Bill Code","Bill Code Description","Gross Charge Amount","Payer Charge Amount","Minimum Chage Amount","Maximum Charge Amount","Self-Pay Charge"]
["Not Applicable - Not Applicable - 00002323560","Not Applicable","Not Applicable","NDC","00002323560","DULOXETINE 20 MG CAPSULE,DELAYED RELEASE",78.17,78.17,26.06,78.17,19.5425]
["Not Applicable - Not Applicable - 00002324033","Not Applicable","Not Applicable","NDC","00002324033","DULOXETINE 30 MG CAPSULE,DELAYED RELEASE",51.66,51.66,17.22,51.66,12.914999999999999]
["Not Applicable - Not Applicable - 00002416502","Not Applicable","Not Applicable","NDC","00002416502","RALOXIFENE 60 MG TABLET",22.12,22.12,22.12,22.12,5.53]
["Not Applicable - Not Applicable - 00002446430","Not Applicable","Not Applicable","NDC","00002446430","TADALAFIL 20 MG TABLET",460.77,460.77,230.39,460.77,115.1925]
["Not Applicable - Not Applicable - 00002475977","Not Applicable","Not Applicable","NDC","00002475977","PRASUGREL 10 MG TABLET",135.99,135.99,22.67,135.99,33.997500000000002]
["Not Applicable - Not Applicable - 00002512101","Not Applicable","Not Applicable","NDC","00002512101","PRASUGREL 5 MG TABLET",54.36,54.36,54.36,54.36,13.59]
["Not Applicable - Not Applicable - 00002512152","Not Applicable","Not Applicable","NDC","00002512152","PRASUGREL 5 MG TABLET",51.04,51.04,51.04,51.04,12.76]
["Not Applicable - Not Applicable - 00002512301","Not Applicable","Not Applicable","NDC","00002512301","PRASUGREL 10 MG TABLET",326.12,326.12,54.36,326.12,81.53]
["Not Applicable - Not Applicable - 00002512330","Not Applicable","Not Applicable","NDC","00002512330","PRASUGREL 10 MG TABLET",306.24,306.24,51.04,306.24,76.56]
["Not Applicable - Not Applicable - 00002733511","Not Applicable","Not Applicable","NDC","00002733511","SOMATROPIN 5 MG (15 UNIT) SOLUTION FOR INJECTION",661.2,661.2,661.2,661.2,165.3]
["Not Applicable - Not Applicable - 00002734901","Not Applicable","Not Applicable","NDC","00002734901","SOMATROPIN 5 MG (15 UNIT) SOLUTION FOR INJECTION",703.4,703.4,703.4,703.4,175.85]
["Not Applicable - Not Applicable - 00003089321","Not Applicable","Not Applicable","NDC","00003089321","APIXABAN 2.5 MG TABLET",1240.75,1240.75,1240.75,1240.75,310.1875]
["Not Applicable - Not Applicable - 00003089331","Not Applicable","Not Applicable","NDC","00003089331","APIXABAN 2.5 MG TABLET",2068.27,2068.27,2068.27,2068.27,517.0675]
["Not Applicable - Not Applicable - 00003089421","Not Applicable","Not Applicable","NDC","00003089421","APIXABAN 5 MG TABLET",1240.75,1240.75,1240.75,1240.75,310.1875]
["Not Applicable - Not Applicable - 00003089431","Not Applicable","Not Applicable","NDC","00003089431","APIXABAN 5 MG TABLET",2068.27,2068.27,2068.27,2068.27,517.0675]
["Not Applicable - Not Applicable - 00003161112","Not Applicable","Not Applicable","NDC","00003161112","ENTECAVIR 0.5 MG TABLET",308.8,308.8,154.4,308.8,77.2]
["Not Applicable - Not Applicable - 00003256016","Not Applicable","Not Applicable","NDC","00003256016","AZTREONAM 1 GRAM SOLUTION FOR INJECTION",96.9,96.9,96.9,96.9,24.225000000000001]
["Not Applicable - Not Applicable - 00003257016","Not Applicable","Not Applicable","NDC","00003257016","AZTREONAM 2 GRAM SOLUTION FOR INJECTION",193.79,193.79,193.79,193.79,48.447499999999998]
["Not Applicable - Not Applicable - 00003362212","Not Applicable","Not Applicable","NDC","00003362212","ATAZANAVIR 300 MG CAPSULE",220.84,220.84,165.63,220.84,55.21]
["Not Applicable - Not Applicable - 00003362412","Not Applicable","Not Applicable","NDC","00003362412","ATAZANAVIR 150 MG CAPSULE",222.95,222.95,167.21,222.95,55.737499999999997]
["Not Applicable - Not Applicable - 00003363112","Not Applicable","Not Applicable","NDC","00003363112","ATAZANAVIR 200 MG CAPSULE",162.71,162.71,122.03,162.71,40.677500000000002]
["Not Applicable - Not Applicable - 00004003822","Not Applicable","Not Applicable","NDC","00004003822","VALGANCICLOVIR 450 MG TABLET",602.35,602.35,301.18,602.35,150.58750000000001]
["Not Applicable - Not Applicable - 00004003909","Not Applicable","Not Applicable","NDC","00004003909","VALGANCICLOVIR 50 MG/ML ORAL SOLUTION",733.77,733.77,81.53,733.77,183.4425]
["Not Applicable - Not Applicable - 00004024451","Not Applicable","Not Applicable","NDC","00004024451","SAQUINAVIR 500 MG TABLET",66.400000000000006,66.400000000000006,66.400000000000006,66.400000000000006,16.600000000000001]
["Not Applicable - Not Applicable - 00004029809","Not Applicable","Not Applicable","NDC","00004029809","MYCOPHENOLATE 500 MG INTRAVENOUS SOLUTION",370.18,370.18,370.18,370.18,92.545000000000002]
["Not Applicable - Not Applicable - 00004038039","Not Applicable","Not Applicable","NDC","00004038039","ENFUVIRTIDE 90 MG SUBCUTANEOUS KIT",9906.1200000000008,9906.1200000000008,9906.1200000000008,9906.1200000000008,2476.5300000000002]
["Not Applicable - Not Applicable - 00004080085","Not Applicable","Not Applicable","NDC","00004080085","OSELTAMIVIR 75 MG CAPSULE",51.26,51.26,20.51,51.26,12.815]
["Not Applicable - Not Applicable - 00004080185","Not Applicable","Not Applicable","NDC","00004080185","OSELTAMIVIR 45 MG CAPSULE",78.38,78.38,31.36,78.38,19.594999999999999]
["Not Applicable - Not Applicable - 00004080285","Not Applicable","Not Applicable","NDC","00004080285","OSELTAMIVIR 30 MG CAPSULE",117.57,117.57,47.03,117.57,29.392499999999998]
["Not Applicable - Not Applicable - 00004082009","Not Applicable","Not Applicable","NDC","00004082009","OSELTAMIVIR 6 MG/ML ORAL SUSPENSION (PEDI SYRINGE)",428.44,428.44,428.44,428.44,107.11]
["Not Applicable - Not Applicable - 00004082205","Not Applicable","Not Applicable","NDC","00004082205","OSELTAMIVIR 6 MG/ML ORAL SUSPENSION (PEDI SYRINGE)",512.63,512.63,512.63,512.63,128.1575]
["Not Applicable - Not Applicable - 00006003220","Not Applicable","Not Applicable","NDC","00006003220","IVERMECTIN 3 MG TABLET",314.05,314.05,314.05,314.05,78.512500000000003]
["Not Applicable - Not Applicable - 00006022761","Not Applicable","Not Applicable","NDC","00006022761","RALTEGRAVIR 400 MG TABLET",99.15,99.15,99.15,99.15,24.787500000000001]
["Not Applicable - Not Applicable - 00006047361","Not Applicable","Not Applicable","NDC","00006047361","RALTEGRAVIR 25 MG CHEWABLE TABLET",74.349999999999994,74.349999999999994,6.2,74.349999999999994,18.587499999999999]
["Not Applicable - Not Applicable - 00006047761","Not Applicable","Not Applicable","NDC","00006047761","RALTEGRAVIR 100 MG CHEWABLE TABLET",1487.15,1487.15,1487.15,1487.15,371.78750000000002]
["Not Applicable - Not Applicable - 00006057143","Not Applicable","Not Applicable","NDC","00006057143","INDINAVIR 200 MG CAPSULE",21.2,21.2,12.72,21.2,5.3]
["Not Applicable - Not Applicable - 00006057362","Not Applicable","Not Applicable","NDC","00006057362","INDINAVIR 400 MG CAPSULE",21.18,21.18,8.4700000000000006,21.18,5.2949999999999999]
["Not Applicable - Not Applicable - 00006071131","Not Applicable","Not Applicable","NDC","00006071131","MONTELUKAST 4 MG CHEWABLE TABLET",27.63,27.63,22.11,27.63,6.9074999999999998]
["Not Applicable - Not Applicable - 00006095154","Not Applicable","Not Applicable","NDC","00006095154","LOSARTAN 25 MG TABLET",36.97,36.97,9.25,36.97,9.2424999999999997]
["Not Applicable - Not Applicable - 00006095231","Not Applicable","Not Applicable","NDC","00006095231","LOSARTAN 50 MG TABLET",24.6,24.6,6.15,24.6,6.15]
["Not Applicable - Not Applicable - 00006306901","Not Applicable","Not Applicable","NDC","00006306901","DORAVIRINE 100 MG TABLET",173.85,173.85,173.85,173.85,43.462499999999999]
["Not Applicable - Not Applicable - 00006307402","Not Applicable","Not Applicable","NDC","00006307402","ELBASVIR 50 MG-GRAZOPREVIR 100 MG TABLET",891.33,891.33,891.33,891.33,222.83250000000001]
["Not Applicable - Not Applicable - 00006360361","Not Applicable","Not Applicable","NDC","00006360361","RALTEGRAVIR 100 MG POWDER PACKET FOR ORAL SUSPENSION",1487.15,1487.15,1487.15,1487.15,371.78750000000002]
["Not Applicable - Not Applicable - 00006404541","Not Applicable","Not Applicable","NDC","00006404541","H PAPILLOMAVIRUS VAC,QVAL(PF) 20MCG-40MCG-40MCG-20MCG/0.5ML IM SUSP",536.72,536.72,536.72,536.72,134.18]
["Not Applicable - Not Applicable - 00006417100","Not Applicable","Not Applicable","NDC","00006417100","MEASLES,MUMPS,RUBEL,VARICEL LIV(PF)10E3-4.3-3-3.99TCID50/0.5 ML SUBCUT",844.31,844.31,844.31,844.31,211.07749999999999]
["Not Applicable - Not Applicable - 00006417101","Not Applicable","Not Applicable","NDC","00006417101","MEASLES,MUMPS,RUBEL,VARICEL LIV(PF)10E3-4.3-3-3.99TCID50/0.5 ML SUBCUT",877.53,877.53,877.53,877.53,219.38249999999999]
["Not Applicable - Not Applicable - 00006498100","Not Applicable","Not Applicable","NDC","00006498100","HEPATITIS B VIRUS VACCINE RECOMB (PF) 5 MCG/0.5 ML INTRAMUSCULAR SUSP",68.09,68.09,68.09,68.09,17.022500000000001]
["Not Applicable - Not Applicable - 00006498101","Not Applicable","Not Applicable","NDC","00006498101","HEPATITIS B VIRUS VACCINE RECOMB (PF) 5 MCG/0.5 ML INTRAMUSCULAR SUSP",88.29,88.29,88.29,88.29,22.072500000000002]
["Not Applicable - Not Applicable - 00009003101","Not Applicable","Not Applicable","NDC","00009003101","HYDROCORTISONE 10 MG TABLET",11.35,11.35,2.84,11.35,2.8374999999999999]
["Not Applicable - Not Applicable - 00009023301","Not Applicable","Not Applicable","NDC","00009023301","BACITRACIN 50,000 UNIT INTRAMUSCULAR SOLUTION",35.96,35.96,35.96,35.96,8.99]
["Not Applicable - Not Applicable - 00009023303","Not Applicable","Not Applicable","NDC","00009023303","BACITRACIN 50,000 UNIT INTRAMUSCULAR SOLUTION",36.68,36.68,36.68,36.68,9.17]
["Not Applicable - Not Applicable - 00009454101","Not Applicable","Not Applicable","NDC","00009454101","TOLTERODINE 1 MG TABLET",42.92,42.92,21.46,42.92,10.73]
["Not Applicable - Not Applicable - 00009454401","Not Applicable","Not Applicable","NDC","00009454401","TOLTERODINE 2 MG TABLET",22.02,22.02,11.01,22.02,5.5049999999999999]
["Not Applicable - Not Applicable - 00009470913","Not Applicable","Not Applicable","NDC","00009470913","MEDROXYPROGESTERONE 104 MG/0.65 ML SUBCUTANEOUS SYRINGE",177.63,177.63,177.63,177.63,44.407499999999999]
["Not Applicable - Not Applicable - 00009513502","Not Applicable","Not Applicable","NDC","00009513502","LINEZOLID 600 MG TABLET",604.16999999999996,604.16999999999996,604.16999999999996,604.16999999999996,151.04249999999999]
["Not Applicable - Not Applicable - 00009513503","Not Applicable","Not Applicable","NDC","00009513503","LINEZOLID 600 MG TABLET",604.16,604.16,604.16,604.16,151.04]
["Not Applicable - Not Applicable - 00009513601","Not Applicable","Not Applicable","NDC","00009513601","LINEZOLID 100 MG/5 ML ORAL SUSPENSION (PEDIATRIC)",2085.6799999999998,2085.6799999999998,2085.6799999999998,2085.6799999999998,521.41999999999996]
["Not Applicable - Not Applicable - 00009519001","Not Applicable","Not Applicable","NDC","00009519001","TOLTERODINE ER 2 MG CAPSULE,EXTENDED RELEASE 24 HR",81.58,81.58,40.79,81.58,20.395]
["Not Applicable - Not Applicable - 00009519004","Not Applicable","Not Applicable","NDC","00009519004","TOLTERODINE ER 2 MG CAPSULE,EXTENDED RELEASE 24 HR",81.64,81.64,40.82,81.64,20.41]
["Not Applicable - Not Applicable - 00009519101","Not Applicable","Not Applicable","NDC","00009519101","TOLTERODINE ER 4 MG CAPSULE,EXTENDED RELEASE 24 HR",40.54,40.54,20.27,40.54,10.135]
["Not Applicable - Not Applicable - 00009519104","Not Applicable","Not Applicable","NDC","00009519104","TOLTERODINE ER 4 MG CAPSULE,EXTENDED RELEASE 24 HR",41.05,41.05,20.53,41.05,10.262499999999999]
["Not Applicable - Not Applicable - 00013530117","Not Applicable","Not Applicable","NDC","00013530117","RIFABUTIN 150 MG CAPSULE",108.26,108.26,54.13,108.26,27.065000000000001]
["Not Applicable - Not Applicable - 00015303020","Not Applicable","Not Applicable","NDC","00015303020","LOMUSTINE 10 MG CAPSULE",313.44,313.44,31.35,313.44,78.36]
["Not Applicable - Not Applicable - 00015303120","Not Applicable","Not Applicable","NDC","00015303120","LOMUSTINE 40 MG CAPSULE",235.96,235.96,23.6,235.96,58.99]
["Not Applicable - Not Applicable - 00015303220","Not Applicable","Not Applicable","NDC","00015303220","LOMUSTINE 100 MG CAPSULE",179.43,179.43,17.95,179.43,44.857500000000002]
["Not Applicable - Not Applicable - 00016031660","Not Applicable","Not Applicable","NDC","00016031660","SODIUM HYALURONATE 23 MG/ML INTRAOCULAR SYRINGE",398.53,398.53,398.53,398.53,99.632499999999993]
["Not Applicable - Not Applicable - 00023024004","Not Applicable","Not Applicable","NDC","00023024004","WHITE PETROLATUM-MINERAL OIL 57.3 %-42.5 % EYE OINTMENT",25.34,25.34,25.34,25.34,6.335]
["Not Applicable - Not Applicable - 00023031204","Not Applicable","Not Applicable","NDC","00023031204","WHITE PETROLATUM-MINERAL OIL 56.8 %-42.5 % EYE OINTMENT",28.85,28.85,28.85,28.85,7.2125000000000004]
["Not Applicable - Not Applicable - 00023066704","Not Applicable","Not Applicable","NDC","00023066704","WHITE PETROLATUM-MINERAL OIL 56.8 %-43.5 % EYE OINTMENT SUPERORDERABLE",30.48,30.48,30.48,30.48,7.62]
["Not Applicable - Not Applicable - 00023320503","Not Applicable","Not Applicable","NDC","00023320503","BIMATOPROST 0.01 % EYE DROPS",719.49,719.49,719.49,719.49,179.8725]
["Not Applicable - Not Applicable - 00023455430","Not Applicable","Not Applicable","NDC","00023455430","CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE",1.0900000000000001,1.0900000000000001,1.0900000000000001,1.0900000000000001,0.27250000000000002]
["Not Applicable - Not Applicable - 00023585318","Not Applicable","Not Applicable","NDC","00023585318","MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)",25.73,25.73,12.87,25.73,6.4325000000000001]
["Not Applicable - Not Applicable - 00023590204","Not Applicable","Not Applicable","NDC","00023590204","TRIPTORELIN PAMOATE 3.75 MG INTRAMUSCULAR SUSPENSION",2713.97,2713.97,2713.97,2713.97,678.49249999999995]
["Not Applicable - Not Applicable - 00023916330","Not Applicable","Not Applicable","NDC","00023916330","CYCLOSPORINE 0.05 % EYE DROPS IN A DROPPERETTE",1.73,1.73,1.73,1.73,0.4325]
["Not Applicable - Not Applicable - 00023917705","Not Applicable","Not Applicable","NDC","00023917705","BRIMONIDINE 0.15 % EYE DROPS",623.29,623.29,623.29,623.29,155.82249999999999]
["Not Applicable - Not Applicable - 00023920515","Not Applicable","Not Applicable","NDC","00023920515","CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS",26.6,26.6,26.6,26.6,6.65]
["Not Applicable - Not Applicable - 00024134803","Not Applicable","Not Applicable","NDC","00024134803","PHENYLEPHRINE 0.25 % NASAL SPRAY",11.25,11.25,11.25,11.25,2.8125]
["Not Applicable - Not Applicable - 00024135202","Not Applicable","Not Applicable","NDC","00024135202","PHENYLEPHRINE 1 % NASAL SPRAY",12.63,12.63,12.63,12.63,3.1575000000000002]
["Not Applicable - Not Applicable - 00024135301","Not Applicable","Not Applicable","NDC","00024135301","PHENYLEPHRINE 0.5 % NASAL SPRAY",11.25,11.25,11.25,11.25,2.8125]
["Not Applicable - Not Applicable - 00024159601","Not Applicable","Not Applicable","NDC","00024159601","PRIMAQUINE 26.3 MG TABLET",629.86,629.86,629.86,629.86,157.465]
["Not Applicable - Not Applicable - 00025145160","Not Applicable","Not Applicable","NDC","00025145160","MISOPROSTOL 100 MCG TABLET",128.36000000000001,128.36000000000001,3.21,128.36000000000001,32.090000000000003]
["Not Applicable - Not Applicable - 00025152034","Not Applicable","Not Applicable","NDC","00025152034","CELECOXIB 100 MG CAPSULE",56.67,56.67,28.34,56.67,14.1675]
["Not Applicable - Not Applicable - 00025152534","Not Applicable","Not Applicable","NDC","00025152534","CELECOXIB 200 MG CAPSULE",92.95,92.95,23.24,92.95,23.237500000000001]
["Not Applicable - Not Applicable - 00025273231","Not Applicable","Not Applicable","NDC","00025273231","DISOPYRAMIDE PHOSPHATE ER 100 MG CAPSULE,EXTENDED RELEASE",40.81,40.81,13.61,40.81,10.202500000000001]
["Not Applicable - Not Applicable - 00025274231","Not Applicable","Not Applicable","NDC","00025274231","DISOPYRAMIDE PHOSPHATE ER 150 MG CAPSULE,EXTENDED RELEASE",32.159999999999997,32.159999999999997,10.72,32.159999999999997,8.0399999999999991]
["Not Applicable - Not Applicable - 00032120607","Not Applicable","Not Applicable","NDC","00032120607","LIPASE-PROTEASE-AMYLASE 6,000-19,000-30,000 UNIT CAPSULE,DELAYED REL",47.07,47.07,5.89,47.07,11.7675]
["Not Applicable - Not Applicable - 00032122401","Not Applicable","Not Applicable","NDC","00032122401","LIPASE-PROTEASE-AMYLASE 24,000-76,000-120,000 UNIT CAPSULE,DELAYED REL",46.62,46.62,23.31,46.62,11.654999999999999]
["Not Applicable - Not Applicable - 00032170801","Not Applicable","Not Applicable","NDC","00032170801","PROGESTERONE MICRONIZED 100 MG CAPSULE",23.86,23.86,11.93,23.86,5.9649999999999999]
["Not Applicable - Not Applicable - 00037043001","Not Applicable","Not Applicable","NDC","00037043001","FELBAMATE 400 MG TABLET",132,132,44,132,33]
["Not Applicable - Not Applicable - 00037043101","Not Applicable","Not Applicable","NDC","00037043101","FELBAMATE 600 MG TABLET",100.85,100.85,33.619999999999997,100.85,25.212499999999999]
["Not Applicable - Not Applicable - 00037044267","Not Applicable","Not Applicable","NDC","00037044267","FELBAMATE 600 MG/5 ML ORAL SUSPENSION",75.099999999999994,75.099999999999994,56.33,75.099999999999994,18.774999999999999]
["Not Applicable - Not Applicable - 00037682210","Not Applicable","Not Applicable","NDC","00037682210","HYDROCORTISONE 1 %-PRAMOXINE 1 % RECTAL FOAM",520.69000000000005,520.69000000000005,520.69000000000005,520.69000000000005,130.17250000000001]
["Not Applicable - Not Applicable - 00046087221","Not Applicable","Not Applicable","NDC","00046087221","CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM",1339.23,1339.23,1339.23,1339.23,334.8075]
["Not Applicable - Not Applicable - 00046106505","Not Applicable","Not Applicable","NDC","00046106505","ECHOTHIOPHATE IODIDE 0.125 % EYE DROPS",316.57,316.57,316.57,316.57,79.142499999999998]
["Not Applicable - Not Applicable - 00046110081","Not Applicable","Not Applicable","NDC","00046110081","CONJUGATED ESTROGENS 0.3 MG TABLET",85.64,85.64,20.56,85.64,21.41]
["Not Applicable - Not Applicable - 00046110281","Not Applicable","Not Applicable","NDC","00046110281","CONJUGATED ESTROGENS 0.625 MG TABLET",41.11,41.11,9.8699999999999992,41.11,10.2775]
["Not Applicable - Not Applicable - 00046110481","Not Applicable","Not Applicable","NDC","00046110481","CONJUGATED ESTROGENS 1.25 MG TABLET",20.56,20.56,4.9400000000000004,20.56,5.14]
["Not Applicable - Not Applicable - 00049318030","Not Applicable","Not Applicable","NDC","00049318030","VORICONAZOLE 200 MG TABLET",373.23,373.23,373.23,373.23,93.307500000000005]
["Not Applicable - Not Applicable - 00049396041","Not Applicable","Not Applicable","NDC","00049396041","ZIPRASIDONE 20 MG CAPSULE",208.52,208.52,52.13,208.52,52.13]
["Not Applicable - Not Applicable - 00049490030","Not Applicable","Not Applicable","NDC","00049490030","SERTRALINE 50 MG TABLET",81.36,81.36,20.34,81.36,20.34]
["Not Applicable - Not Applicable - 00049491030","Not Applicable","Not Applicable","NDC","00049491030","SERTRALINE 100 MG TABLET",40.68,40.68,10.17,40.68,10.17]
["Not Applicable - Not Applicable - 00049491041","Not Applicable","Not Applicable","NDC","00049491041","SERTRALINE 100 MG TABLET",40.68,40.68,10.17,40.68,10.17]
["Not Applicable - Not Applicable - 00053623202","Not Applicable","Not Applicable","NDC","00053623202","COAGULATION FACTOR IX 500 (+/-) UNIT INTRAVENOUS KIT",1691.99,1691.99,1691.99,1691.99,422.9975]
["Not Applicable - Not Applicable - 00054000725","Not Applicable","Not Applicable","NDC","00054000725","CALCITRIOL 0.25 MCG CAPSULE",6.28,6.28,3.14,6.28,1.57]
["Not Applicable - Not Applicable - 00054001121","Not Applicable","Not Applicable","NDC","00054001121","FLECAINIDE 100 MG TABLET",4.67,4.67,1.56,4.67,1.1675]
["Not Applicable - Not Applicable - 00054002025","Not Applicable","Not Applicable","NDC","00054002025","LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE",1.08,1.08,0.36,1.08,0.27]
["Not Applicable - Not Applicable - 00054002125","Not Applicable","Not Applicable","NDC","00054002125","LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE",1.48,1.48,0.5,1.48,0.37]
["Not Applicable - Not Applicable - 00054002821","Not Applicable","Not Applicable","NDC","00054002821","CILOSTAZOL 50 MG TABLET",2.09,2.09,1.05,2.09,0.52249999999999996]
["Not Applicable - Not Applicable - 00054007928","Not Applicable","Not Applicable","NDC","00054007928","BALSALAZIDE 750 MG CAPSULE",7.5,7.5,7.5,7.5,1.875]
["Not Applicable - Not Applicable - 00054008826","Not Applicable","Not Applicable","NDC","00054008826","CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE",5.66,5.66,1.89,5.66,1.415]
["Not Applicable - Not Applicable - 00054009720","Not Applicable","Not Applicable","NDC","00054009720","OXCARBAZEPINE 150 MG TABLET",3.87,3.87,0.97,3.87,0.96750000000000003]
["Not Applicable - Not Applicable - 00054009820","Not Applicable","Not Applicable","NDC","00054009820","OXCARBAZEPINE 300 MG TABLET",1.9,1.9,0.48,1.9,0.47499999999999998]
["Not Applicable - Not Applicable - 00054010625","Not Applicable","Not Applicable","NDC","00054010625","RAMIPRIL 1.25 MG CAPSULE",8.33,8.33,1.05,8.33,2.0825]
["Not Applicable - Not Applicable - 00054010820","Not Applicable","Not Applicable","NDC","00054010820","RAMIPRIL 5 MG CAPSULE",2.52,2.52,0.32,2.52,0.63]
["Not Applicable - Not Applicable - 00054011625","Not Applicable","Not Applicable","NDC","00054011625","ROPINIROLE 0.25 MG TABLET",14.21,14.21,1.78,14.21,3.5525000000000002]
["Not Applicable - Not Applicable - 00054011825","Not Applicable","Not Applicable","NDC","00054011825","ROPINIROLE 1 MG TABLET",3.56,3.56,0.45,3.56,0.89]
["Not Applicable - Not Applicable - 00054011925","Not Applicable","Not Applicable","NDC","00054011925","ROPINIROLE 2 MG TABLET",1.78,1.78,0.23,1.78,0.44500000000000001]
["Not Applicable - Not Applicable - 00054014125","Not Applicable","Not Applicable","NDC","00054014125","ACARBOSE 50 MG TABLET",1.1399999999999999,1.1399999999999999,0.28999999999999998,1.1399999999999999,0.28499999999999998]
["Not Applicable - Not Applicable - 00054022125","Not Applicable","Not Applicable","NDC","00054022125","QUETIAPINE 100 MG TABLET",4.1500000000000004,4.1500000000000004,1.39,4.1500000000000004,1.0375000000000001]
["Not Applicable - Not Applicable - 00054024324","Not Applicable","Not Applicable","NDC","00054024324","CODEINE SULFATE 15 MG TABLET",8.19,8.19,2.0499999999999998,8.19,2.0474999999999999]
["Not Applicable - Not Applicable - 00054024424","Not Applicable","Not Applicable","NDC","00054024424","CODEINE SULFATE 30 MG TABLET",5.7,5.7,1.43,5.7,1.425]
["Not Applicable - Not Applicable - 00054024425","Not Applicable","Not Applicable","NDC","00054024425","CODEINE SULFATE 30 MG TABLET",3.85,3.85,0.97,3.85,0.96250000000000002]
["Not Applicable - Not Applicable - 00054031950","Not Applicable","Not Applicable","NDC","00054031950","LINEZOLID 100 MG/5 ML ORAL SUSPENSION",974.63,974.63,974.63,974.63,243.6575]
["Not Applicable - Not Applicable - 00054034462","Not Applicable","Not Applicable","NDC","00054034462","MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID",1.44,1.44,1.44,1.44,0.36]
["Not Applicable - Not Applicable - 00054038663","Not Applicable","Not Applicable","NDC","00054038663","HYDROMORPHONE 1 MG/ML ORAL LIQUID",12.54,12.54,3.14,12.54,3.1349999999999998]
["Not Applicable - Not Applicable - 00054041525","Not Applicable","Not Applicable","NDC","00054041525","ETHACRYNIC ACID 25 MG TABLET",213.62,213.62,53.41,213.62,53.405000000000001]
["Not Applicable - Not Applicable - 00054045058","Not Applicable","Not Applicable","NDC","00054045058","NEVIRAPINE 50 MG/5 ML ORAL SUSPENSION",538,538,538,538,134.5]
["Not Applicable - Not Applicable - 00054070920","Not Applicable","Not Applicable","NDC","00054070920","METHADONE 5 MG TABLET",6.12,6.12,1.02,6.12,1.53]
["Not Applicable - Not Applicable - 00054311763","Not Applicable","Not Applicable","NDC","00054311763","CALCIUM CARBONATE 500 MG/5 ML CALCIUM (1,250 MG/5 ML) ORAL SUSPENSION",23.1,23.1,23.1,23.1,5.7750000000000004]
["Not Applicable - Not Applicable - 00054318544","Not Applicable","Not Applicable","NDC","00054318544","DIAZEPAM 5 MG/ML ORAL CONCENTRATE",87.29,87.29,87.29,87.29,21.822500000000002]
["Not Applicable - Not Applicable - 00054344625","Not Applicable","Not Applicable","NDC","00054344625","MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID",1.92,1.92,1.92,1.92,0.48]
["Not Applicable - Not Applicable - 00054353201","Not Applicable","Not Applicable","NDC","00054353201","LORAZEPAM 2 MG/ML ORAL CONCENTRATE",0.93,0.93,0.93,0.93,0.23250000000000001]
["Not Applicable - Not Applicable - 00054353244","Not Applicable","Not Applicable","NDC","00054353244","LORAZEPAM 2 MG/ML ORAL CONCENTRATE",27.82,27.82,27.82,27.82,6.9550000000000001]
["Not Applicable - Not Applicable - 00054354258","Not Applicable","Not Applicable","NDC","00054354258","MEGESTROL 400 MG/10 ML (40 MG/ML) ORAL SUSPENSION",184.17,184.17,184.17,184.17,46.042499999999997]
["Not Applicable - Not Applicable - 00054356699","Not Applicable","Not Applicable","NDC","00054356699","MIDAZOLAM 2 MG/ML SYRUP (PEDIATRIC)",121.15,121.15,121.15,121.15,30.287500000000001]
["Not Applicable - Not Applicable - 00054363063","Not Applicable","Not Applicable","NDC","00054363063","NAPROXEN 125 MG/5 ML ORAL SUSPENSION (PEDIATRIC)",2840.23,2840.23,2840.23,2840.23,710.0575]
["Not Applicable - Not Applicable - 00054429725","Not Applicable","Not Applicable","NDC","00054429725","FUROSEMIDE 20 MG TABLET",0.73,0.73,0.1,0.73,0.1825]
["Not Applicable - Not Applicable - 00054458111","Not Applicable","Not Applicable","NDC","00054458111","MERCAPTOPURINE 50 MG TABLET",21.02,21.02,5.26,21.02,5.2549999999999999]
["Not Applicable - Not Applicable - 00054472125","Not Applicable","Not Applicable","NDC","00054472125","PROPANTHELINE 15 MG TABLET",10.220000000000001,10.220000000000001,5.1100000000000003,10.220000000000001,2.5550000000000002]
["Not Applicable - Not Applicable - 00054812025","Not Applicable","Not Applicable","NDC","00054812025","CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) TABLET",0.39,0.39,0.39,0.39,9.7500000000000003E-2]
["Not Applicable - Not Applicable - 00054814622","Not Applicable","Not Applicable","NDC","00054814622","CLOTRIMAZOLE 10 MG TROCHE",4.26,4.26,4.26,4.26,1.0649999999999999]
["Not Applicable - Not Applicable - 00054829725","Not Applicable","Not Applicable","NDC","00054829725","FUROSEMIDE 20 MG TABLET",2.2400000000000002,2.2400000000000002,0.28000000000000003,2.2400000000000002,0.56000000000000005]
["Not Applicable - Not Applicable - 00054829925","Not Applicable","Not Applicable","NDC","00054829925","FUROSEMIDE 40 MG TABLET",1.26,1.26,0.16,1.26,0.315]
["Not Applicable - Not Applicable - 00054852625","Not Applicable","Not Applicable","NDC","00054852625","LITHIUM CARBONATE 150 MG CAPSULE",1.44,1.44,0.36,1.44,0.36]
["Not Applicable - Not Applicable - 00054852725","Not Applicable","Not Applicable","NDC","00054852725","LITHIUM CARBONATE 300 MG CAPSULE",0.75,0.75,0.19,0.75,0.1875]
["Not Applicable - Not Applicable - 00054852825","Not Applicable","Not Applicable","NDC","00054852825","LITHIUM CARBONATE 300 MG TABLET",1.1599999999999999,1.1599999999999999,0.28999999999999998,1.1599999999999999,0.28999999999999998]
["Not Applicable - Not Applicable - 00054855324","Not Applicable","Not Applicable","NDC","00054855324","METHADONE 5 MG TABLET",8,8,1.34,8,2]
["Not Applicable - Not Applicable - 00054859511","Not Applicable","Not Applicable","NDC","00054859511","MEPERIDINE 50 MG TABLET",7.67,7.67,3.84,7.67,1.9175]
["Not Applicable - Not Applicable - 00054860325","Not Applicable","Not Applicable","NDC","00054860325","MEGESTROL 20 MG TABLET",3.78,3.78,1.89,3.78,0.94499999999999995]
["Not Applicable - Not Applicable - 00054860425","Not Applicable","Not Applicable","NDC","00054860425","MEGESTROL 40 MG TABLET",1.71,1.71,0.86,1.71,0.42749999999999999]
["Not Applicable - Not Applicable - 00054885925","Not Applicable","Not Applicable","NDC","00054885925","TRIAZOLAM 0.25 MG TABLET",15.59,15.59,3.9,15.59,3.8975]
["Not Applicable - Not Applicable - 00056016901","Not Applicable","Not Applicable","NDC","00056016901","WARFARIN 1 MG TABLET",73.260000000000005,73.260000000000005,7.33,73.260000000000005,18.315000000000001]
["Not Applicable - Not Applicable - 00056016975","Not Applicable","Not Applicable","NDC","00056016975","WARFARIN 1 MG TABLET",68.849999999999994,68.849999999999994,6.89,68.849999999999994,17.212499999999999]
["Not Applicable - Not Applicable - 00056017001","Not Applicable","Not Applicable","NDC","00056017001","WARFARIN 2 MG TABLET",38.21,38.21,3.83,38.21,9.5525000000000002]
["Not Applicable - Not Applicable - 00056017201","Not Applicable","Not Applicable","NDC","00056017201","WARFARIN 5 MG TABLET",16.440000000000001,16.440000000000001,1.65,16.440000000000001,4.1100000000000003]
["Not Applicable - Not Applicable - 00056017275","Not Applicable","Not Applicable","NDC","00056017275","WARFARIN 5 MG TABLET",15.46,15.46,1.55,15.46,3.8650000000000002]
["Not Applicable - Not Applicable - 00056017301","Not Applicable","Not Applicable","NDC","00056017301","WARFARIN 7.5 MG TABLET",14.61,14.61,1.47,14.61,3.6524999999999999]
["Not Applicable - Not Applicable - 00056017601","Not Applicable","Not Applicable","NDC","00056017601","WARFARIN 2.5 MG TABLET",31.55,31.55,3.16,31.55,7.8875000000000002]
["Not Applicable - Not Applicable - 00056017675","Not Applicable","Not Applicable","NDC","00056017675","WARFARIN 2.5 MG TABLET",29.65,29.65,2.97,29.65,7.4124999999999996]
["Not Applicable - Not Applicable - 00056018801","Not Applicable","Not Applicable","NDC","00056018801","WARFARIN 3 MG TABLET",26.39,26.39,2.64,26.39,6.5975000000000001]
["Not Applicable - Not Applicable - 00056047030","Not Applicable","Not Applicable","NDC","00056047030","EFAVIRENZ 50 MG CAPSULE",110.42,110.42,36.81,110.42,27.605]
["Not Applicable - Not Applicable - 00056047492","Not Applicable","Not Applicable","NDC","00056047492","EFAVIRENZ 200 MG CAPSULE",147.09,147.09,110.32,147.09,36.772500000000001]
["Not Applicable - Not Applicable - 00056051030","Not Applicable","Not Applicable","NDC","00056051030","EFAVIRENZ 600 MG TABLET",110.32,110.32,110.32,110.32,27.58]
["Not Applicable - Not Applicable - 00056051168","Not Applicable","Not Applicable","NDC","00056051168","CARBIDOPA 25 MG TABLET",24.35,24.35,12.18,24.35,6.0875000000000004]
["Not Applicable - Not Applicable - 00064501030","Not Applicable","Not Applicable","NDC","00064501030","COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT",727.59,727.59,727.59,727.59,181.89750000000001]
["Not Applicable - Not Applicable - 00065024610","Not Applicable","Not Applicable","NDC","00065024610","BETAXOLOL 0.25 % EYE DROPS,SUSPENSION",1048.03,1048.03,1048.03,1048.03,262.00749999999999]
["Not Applicable - Not Applicable - 00065030355","Not Applicable","Not Applicable","NDC","00065030355","ATROPINE 1 % EYE DROPS",163.16999999999999,163.16999999999999,163.16999999999999,163.16999999999999,40.792499999999997]
["Not Applicable - Not Applicable - 00065039515","Not Applicable","Not Applicable","NDC","00065039515","CYCLOPENTOLATE 0.5 % EYE DROPS",265.8,265.8,265.8,265.8,66.45]
["Not Applicable - Not Applicable - 00065063827","Not Applicable","Not Applicable","NDC","00065063827","PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION",316,316,316,316,79]
["Not Applicable - Not Applicable - 00065064435","Not Applicable","Not Applicable","NDC","00065064435","TOBRAMYCIN 0.3 % EYE OINTMENT",633.04,633.04,633.04,633.04,158.26]
["Not Applicable - Not Applicable - 00065064515","Not Applicable","Not Applicable","NDC","00065064515","NATAMYCIN 5 % EYE DROPS,SUSPENSION",1598.47,1598.47,1598.47,1598.47,399.61750000000001]
["Not Applicable - Not Applicable - 00065064835","Not Applicable","Not Applicable","NDC","00065064835","TOBRAMYCIN-DEXAMETHASONE 0.3 %-0.1 % EYE OINTMENT",670.56,670.56,670.56,670.56,167.64]
["Not Applicable - Not Applicable - 00065074114","Not Applicable","Not Applicable","NDC","00065074114","TETRACAINE HCL (PF) 0.5 % EYE DROPS",35.74,35.74,35.74,35.74,8.9350000000000005]
["Not Applicable - Not Applicable - 00065401303","Not Applicable","Not Applicable","NDC","00065401303","MOXIFLOXACIN 0.5 % EYE DROPS",574.30999999999995,574.30999999999995,574.30999999999995,574.30999999999995,143.57749999999999]
["Not Applicable - Not Applicable - 00067434601","Not Applicable","Not Applicable","NDC","00067434601","SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH",66.53,66.53,66.53,66.53,16.6325]
["Not Applicable - Not Applicable - 00067512414","Not Applicable","Not Applicable","NDC","00067512414","NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH",6.32,6.32,6.32,6.32,1.58]
["Not Applicable - Not Applicable - 00067512514","Not Applicable","Not Applicable","NDC","00067512514","NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH",6.32,6.32,6.32,6.32,1.58]
["Not Applicable - Not Applicable - 00067512614","Not Applicable","Not Applicable","NDC","00067512614","NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH",6.32,6.32,6.32,6.32,1.58]
["Not Applicable - Not Applicable - 00068059701","Not Applicable","Not Applicable","NDC","00068059701","RIFAMPIN 600 MG INTRAVENOUS SOLUTION",295.95999999999998,295.95999999999998,295.95999999999998,295.95999999999998,73.989999999999995]
["Not Applicable - Not Applicable - 00069009402","Not Applicable","Not Applicable","NDC","00069009402","VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION",17.77,17.77,17.77,17.77,4.4424999999999999]
["Not Applicable - Not Applicable - 00069011201","Not Applicable","Not Applicable","NDC","00069011201","RIFAMPIN 600 MG INTRAVENOUS SOLUTION",230.92,230.92,230.92,230.92,57.73]
["Not Applicable - Not Applicable - 00069012201","Not Applicable","Not Applicable","NDC","00069012201","BENZONATATE 100 MG CAPSULE",13.06,13.06,6.53,13.06,3.2650000000000001]
["Not Applicable - Not Applicable - 00069030801","Not Applicable","Not Applicable","NDC","00069030801","TRASTUZUMAB-QYYP 150 MG INTRAVENOUS SOLUTION",2969.43,2969.43,2969.43,2969.43,742.35749999999996]
["Not Applicable - Not Applicable - 00069046856","Not Applicable","Not Applicable","NDC","00069046856","VARENICLINE 0.5 MG TABLET",53.95,53.95,26.98,53.95,13.487500000000001]
["Not Applicable - Not Applicable - 00069046956","Not Applicable","Not Applicable","NDC","00069046956","VARENICLINE 1 MG TABLET",26.98,26.98,13.49,26.98,6.7450000000000001]
["Not Applicable - Not Applicable - 00069306030","Not Applicable","Not Applicable","NDC","00069306030","AZITHROMYCIN 250 MG TABLET",11.21,11.21,2.34,11.21,2.8025000000000002]
["Not Applicable - Not Applicable - 00069406189","Not Applicable","Not Applicable","NDC","00069406189","AZITHROMYCIN 250 MG TABLET",55.36,55.36,11.54,55.36,13.84]
["Not Applicable - Not Applicable - 00069421030","Not Applicable","Not Applicable","NDC","00069421030","SILDENAFIL 50 MG TABLET",515.91,515.91,128.97999999999999,515.91,128.97749999999999]
["Not Applicable - Not Applicable - 00069422030","Not Applicable","Not Applicable","NDC","00069422030","SILDENAFIL 100 MG TABLET",257.95999999999998,257.95999999999998,64.489999999999995,257.95999999999998,64.489999999999995]
["Not Applicable - Not Applicable - 00069580043","Not Applicable","Not Applicable","NDC","00069580043","DOFETILIDE 125 MCG CAPSULE",146.21,146.21,36.56,146.21,36.552500000000002]
["Not Applicable - Not Applicable - 00069580060","Not Applicable","Not Applicable","NDC","00069580060","DOFETILIDE 125 MCG CAPSULE",138.5,138.5,34.630000000000003,138.5,34.625]
["Not Applicable - Not Applicable - 00071000740","Not Applicable","Not Applicable","NDC","00071000740","PHENYTOIN 50 MG CHEWABLE TABLET",12.58,12.58,6.29,12.58,3.145]
["Not Applicable - Not Applicable - 00071036924","Not Applicable","Not Applicable","NDC","00071036924","PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE",14.2,14.2,1.42,14.2,3.55]
["Not Applicable - Not Applicable - 00071036940","Not Applicable","Not Applicable","NDC","00071036940","PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE",15.67,15.67,1.57,15.67,3.9175]
["Not Applicable - Not Applicable - 00071041813","Not Applicable","Not Applicable","NDC","00071041813","NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET",4.55,4.55,4.55,4.55,1.1375]
["Not Applicable - Not Applicable - 00071041924","Not Applicable","Not Applicable","NDC","00071041924","NITROGLYCERIN 0.6 MG SUBLINGUAL TABLET",1.4,1.4,1.4,1.4,0.35]
["Not Applicable - Not Applicable - 00071101268","Not Applicable","Not Applicable","NDC","00071101268","PREGABALIN 25 MG CAPSULE",256.17,256.17,85.39,256.17,64.042500000000004]
["Not Applicable - Not Applicable - 00071101541","Not Applicable","Not Applicable","NDC","00071101541","PREGABALIN 100 MG CAPSULE",93.93,93.93,23.49,93.93,23.482500000000002]
["Not Applicable - Not Applicable - 00071101641","Not Applicable","Not Applicable","NDC","00071101641","PREGABALIN 150 MG CAPSULE",62.62,62.62,15.66,62.62,15.654999999999999]
["Not Applicable - Not Applicable - 00071101668","Not Applicable","Not Applicable","NDC","00071101668","PREGABALIN 150 MG CAPSULE",56.93,56.93,14.24,56.93,14.2325]
["Not Applicable - Not Applicable - 00071101768","Not Applicable","Not Applicable","NDC","00071101768","PREGABALIN 200 MG CAPSULE",42.7,42.7,14.24,42.7,10.675000000000001]
["Not Applicable - Not Applicable - 00071374066","Not Applicable","Not Applicable","NDC","00071374066","PHENYTOIN SODIUM EXTENDED 30 MG CAPSULE",40.82,40.82,4.09,40.82,10.205]
["Not Applicable - Not Applicable - 00074052260","Not Applicable","Not Applicable","NDC","00074052260","LOPINAVIR-RITONAVIR 100 MG-25 MG TABLET",56.59,56.59,28.3,56.59,14.147500000000001]
["Not Applicable - Not Applicable - 00074262528","Not Applicable","Not Applicable","NDC","00074262528","GLECAPREVIR 100 MG-PIBRENTASVIR 40 MG TABLET",1616.14,1616.14,1616.14,1616.14,404.03500000000003]
["Not Applicable - Not Applicable - 00074307490","Not Applicable","Not Applicable","NDC","00074307490","NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR",34.26,34.26,17.13,34.26,8.5649999999999995]
["Not Applicable - Not Applicable - 00074308090","Not Applicable","Not Applicable","NDC","00074308090","NIACIN ER 1,000 MG TABLET,EXTENDED RELEASE 24 HR",30.3,30.3,15.15,30.3,7.5750000000000002]
["Not Applicable - Not Applicable - 00074333330","Not Applicable","Not Applicable","NDC","00074333330","RITONAVIR 100 MG TABLET (INPATIENT)",58.78,58.78,29.39,58.78,14.695]
["Not Applicable - Not Applicable - 00074382611","Not Applicable","Not Applicable","NDC","00074382611","DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR",44.81,44.81,11.21,44.81,11.202500000000001]
["Not Applicable - Not Applicable - 00074449201","Not Applicable","Not Applicable","NDC","00074449201","IV VENIPUNCTURE NEEDLE SET",1.78,1.78,1.78,1.78,0.44500000000000001]
["Not Applicable - Not Applicable - 00074455211","Not Applicable","Not Applicable","NDC","00074455211","LEVOTHYROXINE 50 MCG TABLET",18.07,18.07,2.2599999999999998,18.07,4.5175000000000001]
["Not Applicable - Not Applicable - 00074518211","Not Applicable","Not Applicable","NDC","00074518211","LEVOTHYROXINE 75 MCG TABLET",12.05,12.05,1.51,12.05,3.0125000000000002]
["Not Applicable - Not Applicable - 00074518290","Not Applicable","Not Applicable","NDC","00074518290","LEVOTHYROXINE 75 MCG TABLET",12.06,12.06,1.51,12.06,3.0150000000000001]
["Not Applicable - Not Applicable - 00074611411","Not Applicable","Not Applicable","NDC","00074611411","DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE",11.15,11.15,5.58,11.15,2.7875000000000001]
["Not Applicable - Not Applicable - 00074611413","Not Applicable","Not Applicable","NDC","00074611413","DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE",11.23,11.23,5.62,11.23,2.8075000000000001]
["Not Applicable - Not Applicable - 00074621213","Not Applicable","Not Applicable","NDC","00074621213","DIVALPROEX 125 MG TABLET,DELAYED RELEASE",23.55,23.55,5.89,23.55,5.8875000000000002]
["Not Applicable - Not Applicable - 00074621413","Not Applicable","Not Applicable","NDC","00074621413","DIVALPROEX 250 MG TABLET,DELAYED RELEASE",23.13,23.13,5.79,23.13,5.7824999999999998]
["Not Applicable - Not Applicable - 00074621513","Not Applicable","Not Applicable","NDC","00074621513","DIVALPROEX 500 MG TABLET,DELAYED RELEASE",21.33,21.33,5.34,21.33,5.3324999999999996]
["Not Applicable - Not Applicable - 00074659490","Not Applicable","Not Applicable","NDC","00074659490","LEVOTHYROXINE 88 MCG TABLET",10.27,10.27,1.29,10.27,2.5674999999999999]
["Not Applicable - Not Applicable - 00074662490","Not Applicable","Not Applicable","NDC","00074662490","LEVOTHYROXINE 100 MCG TABLET",9.0399999999999991,9.0399999999999991,1.1299999999999999,9.0399999999999991,2.2599999999999998]
["Not Applicable - Not Applicable - 00074679922","Not Applicable","Not Applicable","NDC","00074679922","LOPINAVIR-RITONAVIR 200 MG-50 MG TABLET",113.17,113.17,28.3,113.17,28.2925]
["Not Applicable - Not Applicable - 00074706811","Not Applicable","Not Applicable","NDC","00074706811","LEVOTHYROXINE 125 MCG TABLET",7.23,7.23,0.91,7.23,1.8075000000000001]
["Not Applicable - Not Applicable - 00074706911","Not Applicable","Not Applicable","NDC","00074706911","LEVOTHYROXINE 150 MCG TABLET",4.5199999999999996,4.5199999999999996,0.76,4.5199999999999996,1.1299999999999999]
["Not Applicable - Not Applicable - 00074712611","Not Applicable","Not Applicable","NDC","00074712611","DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR",39.31,39.31,9.83,39.31,9.8275000000000006]
["Not Applicable - Not Applicable - 00074714811","Not Applicable","Not Applicable","NDC","00074714811","LEVOTHYROXINE 200 MCG TABLET",4.5199999999999996,4.5199999999999996,0.56999999999999995,4.5199999999999996,1.1299999999999999]
["Not Applicable - Not Applicable - 00074929690","Not Applicable","Not Applicable","NDC","00074929690","LEVOTHYROXINE 112 MCG TABLET",8.07,8.07,1.01,8.07,2.0175000000000001]
["Not Applicable - Not Applicable - 00075770060","Not Applicable","Not Applicable","NDC","00075770060","RILUZOLE 50 MG TABLET",122.92,122.92,122.92,122.92,30.73]
["Not Applicable - Not Applicable - 00078024915","Not Applicable","Not Applicable","NDC","00078024915","LETROZOLE 2.5 MG TABLET",77.58,77.58,77.58,77.58,19.395]
["Not Applicable - Not Applicable - 00078032705","Not Applicable","Not Applicable","NDC","00078032705","ENTACAPONE 200 MG TABLET",25.73,25.73,25.73,25.73,6.4325000000000001]
["Not Applicable - Not Applicable - 00078033705","Not Applicable","Not Applicable","NDC","00078033705","OXCARBAZEPINE 300 MG TABLET",58.91,58.91,14.73,58.91,14.727499999999999]
["Not Applicable - Not Applicable - 00078035752","Not Applicable","Not Applicable","NDC","00078035752","TRILEPTAL 300 MG/5 ML ORAL SUSPENSION (BRAND)",56.53,56.53,28.27,56.53,14.1325]
["Not Applicable - Not Applicable - 00078035834","Not Applicable","Not Applicable","NDC","00078035834","VALSARTAN 80 MG TABLET",104.15,104.15,13.02,104.15,26.037500000000001]
["Not Applicable - Not Applicable - 00078040134","Not Applicable","Not Applicable","NDC","00078040134","IMATINIB 100 MG TABLET",1926.05,1926.05,1284.03,1926.05,481.51249999999999]
["Not Applicable - Not Applicable - 00078042315","Not Applicable","Not Applicable","NDC","00078042315","VALSARTAN 40 MG TABLET",174.25,174.25,21.79,174.25,43.5625]
["Not Applicable - Not Applicable - 00078045605","Not Applicable","Not Applicable","NDC","00078045605","OXCARBAZEPINE 150 MG TABLET",64.52,64.52,16.13,64.52,16.13]
["Not Applicable - Not Applicable - 00078051005","Not Applicable","Not Applicable","NDC","00078051005","CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR",26.99,26.99,4.5,26.99,6.7474999999999996]
["Not Applicable - Not Applicable - 00078051105","Not Applicable","Not Applicable","NDC","00078051105","CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR",26.93,26.93,4.49,26.93,6.7324999999999999]
["Not Applicable - Not Applicable - 00078051205","Not Applicable","Not Applicable","NDC","00078051205","CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR",26.9,26.9,4.49,26.9,6.7249999999999996]
["Not Applicable - Not Applicable - 00078056845","Not Applicable","Not Applicable","NDC","00078056845","ARTEMETHER-LUMEFANTRINE 20 MG-120 MG TABLET",68.98,68.98,17.25,68.98,17.245000000000001]
["Not Applicable - Not Applicable - 00078065920","Not Applicable","Not Applicable","NDC","00078065920","SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET",32.46,32.46,32.46,32.46,8.1150000000000002]
["Not Applicable - Not Applicable - 00078069620","Not Applicable","Not Applicable","NDC","00078069620","SACUBITRIL 97 MG-VALSARTAN 103 MG TABLET",32.46,32.46,32.46,32.46,8.1150000000000002]
["Not Applicable - Not Applicable - 00078077720","Not Applicable","Not Applicable","NDC","00078077720","SACUBITRIL 49 MG-VALSARTAN 51 MG TABLET",32.46,32.46,32.46,32.46,8.1150000000000002]
["Not Applicable - Not Applicable - 00078084619","Not Applicable","Not Applicable","NDC","00078084619","TISAGENLECLEUCEL 0.2 X10EXP6 TO 2.5X10EXP8 CELL INTRAVENOUS SUSPENSION",1687437.5,1687437.5,1687437.5,1687437.5,421859.375]
["Not Applicable - Not Applicable - 00078095819","Not Applicable","Not Applicable","NDC","00078095819","TISAGENLECLEUCEL 0.6 X 10EXP8 TO 6 X10EXP8 CELL INTRAVENOUS SUSPENSION",1325082.5,1325082.5,1325082.5,1325082.5,331270.625]
["Not Applicable - Not Applicable - 00085113204","Not Applicable","Not Applicable","NDC","00085113204","ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER",105.73,105.73,105.73,105.73,26.432500000000001]
["Not Applicable - Not Applicable - 00085171802","Not Applicable","Not Applicable","NDC","00085171802","POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)",3.47,3.47,1.74,3.47,0.86750000000000005]
["Not Applicable - Not Applicable - 00085173305","Not Applicable","Not Applicable","NDC","00085173305","MOXIFLOXACIN 400 MG TABLET",44.67,44.67,44.67,44.67,11.1675]
["Not Applicable - Not Applicable - 00085222201","Not Applicable","Not Applicable","NDC","00085222201","MOMETASONE 50 MCG/ACTUATION HFA AEROSOL INHALER",591.71,591.71,591.71,591.71,147.92750000000001]
["Not Applicable - Not Applicable - 00085331504","Not Applicable","Not Applicable","NDC","00085331504","NITROGLYCERIN 0.3 MG/HR TRANSDERMAL 24 HOUR PATCH",19.760000000000002,19.760000000000002,19.760000000000002,19.760000000000002,4.9400000000000004]
["Not Applicable - Not Applicable - 00085331535","Not Applicable","Not Applicable","NDC","00085331535","NITROGLYCERIN 0.3 MG/HR TRANSDERMAL 24 HOUR PATCH",18.43,18.43,18.43,18.43,4.6074999999999999]
["Not Applicable - Not Applicable - 00085433301","Not Applicable","Not Applicable","NDC","00085433301","MOMETASONE 100 MCG/ACTUATION HFA AEROSOL INHALER",638.17999999999995,638.17999999999995,638.17999999999995,638.17999999999995,159.54499999999999]
["Not Applicable - Not Applicable - 00085433401","Not Applicable","Not Applicable","NDC","00085433401","MOMETASONE 200 MCG/ACTUATION HFA AEROSOL INHALER",750.29,750.29,750.29,750.29,187.57249999999999]
["Not Applicable - Not Applicable - 00087040201","Not Applicable","Not Applicable","NDC","00087040201","PEDIATRIC MULTIVITAMIN NO.192 250 MCG-50 MG-10 MCG/ML ORAL DROPS",0.64,0.64,0.32,0.64,0.16]
["Not Applicable - Not Applicable - 00087040203","Not Applicable","Not Applicable","NDC","00087040203","PEDIATRIC MULTIVITAMIN NO.192 250 MCG-50 MG-10 MCG/ML ORAL DROPS",0.64,0.64,0.32,0.64,0.16]
["Not Applicable - Not Applicable - 00087040501","Not Applicable","Not Applicable","NDC","00087040501","PEDIATRIC MULTIVITAMIN NO.189-FERROUS SULFATE 11 MG/ML ORAL DROPS",31.98,31.98,31.98,31.98,7.9950000000000001]
["Not Applicable - Not Applicable - 00087040589","Not Applicable","Not Applicable","NDC","00087040589","PEDIATRIC MULTIVITAMIN NO.189-FERROUS SULFATE 11 MG/ML ORAL DROPS",0.64,0.64,0.64,0.64,0.16]
["Not Applicable - Not Applicable - 00087277235","Not Applicable","Not Applicable","NDC","00087277235","IRBESARTAN 150 MG TABLET",20.22,20.22,10.11,20.22,5.0549999999999997]
["Not Applicable - Not Applicable - 00087663341","Not Applicable","Not Applicable","NDC","00087663341","DIDANOSINE 10 MG/ML (FINAL CONC.) ORAL SOLUTION",402.86,402.86,402.86,402.86,100.715]
["Not Applicable - Not Applicable - 00087667117","Not Applicable","Not Applicable","NDC","00087667117","DIDANOSINE 125 MG CAPSULE,DELAYED RELEASE",48.1,48.1,15.04,48.1,12.025]
["Not Applicable - Not Applicable - 00087667217","Not Applicable","Not Applicable","NDC","00087667217","DIDANOSINE 200 MG CAPSULE,DELAYED RELEASE",48.06,48.06,15.02,48.06,12.015000000000001]
["Not Applicable - Not Applicable - 00087667317","Not Applicable","Not Applicable","NDC","00087667317","DIDANOSINE 250 MG CAPSULE,DELAYED RELEASE",49,49,15.31,49,12.25]
["Not Applicable - Not Applicable - 00087667417","Not Applicable","Not Applicable","NDC","00087667417","DIDANOSINE 400 MG CAPSULE,DELAYED RELEASE",47.72,47.72,14.92,47.72,11.93]
["Not Applicable - Not Applicable - 00088057641","Not Applicable","Not Applicable","NDC","00088057641","ISONIAZID-RIFAMP-PYRAZINAMIDE 50 MG-120 MG-300 MG TABLET",78.739999999999995,78.739999999999995,52.5,78.739999999999995,19.684999999999999]
["Not Applicable - Not Applicable - 00091415060","Not Applicable","Not Applicable","NDC","00091415060","ERGOCALCIFEROL (VITAMIN D2) 8,000 UNIT/ML ORAL DROPS (PEDI SYRINGE)",12.29,12.29,3.08,12.29,3.0724999999999998]
["Not Applicable - Not Applicable - 00093001006","Not Applicable","Not Applicable","NDC","00093001006","TOLTERODINE 1 MG TABLET",3.78,3.78,1.89,3.78,0.94499999999999995]
["Not Applicable - Not Applicable - 00093005401","Not Applicable","Not Applicable","NDC","00093005401","BUSPIRONE 10 MG TABLET",0.36,0.36,0.12,0.36,0.09]
["Not Applicable - Not Applicable - 00093005405","Not Applicable","Not Applicable","NDC","00093005405","BUSPIRONE 10 MG TABLET",0.35,0.35,0.12,0.35,8.7499999999999994E-2]
["Not Applicable - Not Applicable - 00093017456","Not Applicable","Not Applicable","NDC","00093017456","LEFLUNOMIDE 20 MG TABLET",2.96,2.96,1.48,2.96,0.74]
["Not Applicable - Not Applicable - 00093019901","Not Applicable","Not Applicable","NDC","00093019901","VENLAFAXINE 25 MG TABLET",3.03,3.03,1.01,3.03,0.75749999999999995]
["Not Applicable - Not Applicable - 00093026215","Not Applicable","Not Applicable","NDC","00093026215","FLUOCINONIDE 0.05 % TOPICAL CREAM",24.89,24.89,24.89,24.89,6.2225000000000001]
["Not Applicable - Not Applicable - 00093026292","Not Applicable","Not Applicable","NDC","00093026292","FLUOCINONIDE 0.05 % TOPICAL CREAM",91.23,91.23,91.23,91.23,22.807500000000001]
["Not Applicable - Not Applicable - 00093026415","Not Applicable","Not Applicable","NDC","00093026415","FLUOCINONIDE 0.05 % TOPICAL OINTMENT",60.11,60.11,60.11,60.11,15.0275]
["Not Applicable - Not Applicable - 00093026492","Not Applicable","Not Applicable","NDC","00093026492","FLUOCINONIDE 0.05 % TOPICAL OINTMENT",240.44,240.44,240.44,240.44,60.11]
["Not Applicable - Not Applicable - 00093031101","Not Applicable","Not Applicable","NDC","00093031101","LOPERAMIDE 2 MG CAPSULE",1.6,1.6,0.8,1.6,0.4]
["Not Applicable - Not Applicable - 00093031801","Not Applicable","Not Applicable","NDC","00093031801","DILTIAZEM 30 MG TABLET",1.33,1.33,0.34,1.33,0.33250000000000002]
["Not Applicable - Not Applicable - 00093031805","Not Applicable","Not Applicable","NDC","00093031805","DILTIAZEM 30 MG TABLET",1.28,1.28,0.32,1.28,0.32]
["Not Applicable - Not Applicable - 00093031901","Not Applicable","Not Applicable","NDC","00093031901","DILTIAZEM 60 MG TABLET",1.56,1.56,0.39,1.56,0.39]
["Not Applicable - Not Applicable - 00093046301","Not Applicable","Not Applicable","NDC","00093046301","LAMOTRIGINE 100 MG TABLET",2.0099999999999998,2.0099999999999998,0.26,2.0099999999999998,0.50249999999999995]
["Not Applicable - Not Applicable - 00093066116","Not Applicable","Not Applicable","NDC","00093066116","ALBUTEROL SULFATE 2 MG/5 ML SYRUP (PEDIATRIC)",132.75,132.75,132.75,132.75,33.1875]
["Not Applicable - Not Applicable - 00093068801","Not Applicable","Not Applicable","NDC","00093068801","LAMOTRIGINE 5 MG CHEWABLE DISPERSIBLE TABLET",102.32,102.32,102.32,102.32,25.58]
["Not Applicable - Not Applicable - 00093075201","Not Applicable","Not Applicable","NDC","00093075201","ATENOLOL 50 MG TABLET",0.23,0.23,0.03,0.23,5.7500000000000002E-2]
["Not Applicable - Not Applicable - 00093075210","Not Applicable","Not Applicable","NDC","00093075210","ATENOLOL 50 MG TABLET",0.2,0.2,0.03,0.2,0.05]
["Not Applicable - Not Applicable - 00093075301","Not Applicable","Not Applicable","NDC","00093075301","ATENOLOL 100 MG TABLET",0.21,0.21,0.03,0.21,5.2499999999999998E-2]
["Not Applicable - Not Applicable - 00093075601","Not Applicable","Not Applicable","NDC","00093075601","PIROXICAM 10 MG CAPSULE",7.47,7.47,3.74,7.47,1.8674999999999999]
["Not Applicable - Not Applicable - 00093078701","Not Applicable","Not Applicable","NDC","00093078701","ATENOLOL 25 MG TABLET",0.46,0.46,0.06,0.46,0.115]
["Not Applicable - Not Applicable - 00093081001","Not Applicable","Not Applicable","NDC","00093081001","NORTRIPTYLINE 10 MG CAPSULE",4.66,4.66,0.47,4.66,1.165]
["Not Applicable - Not Applicable - 00093081101","Not Applicable","Not Applicable","NDC","00093081101","NORTRIPTYLINE 25 MG CAPSULE",2.56,2.56,0.26,2.56,0.64]
["Not Applicable - Not Applicable - 00093098301","Not Applicable","Not Applicable","NDC","00093098301","NYSTATIN 500,000 UNIT TABLET",1.49,1.49,1.49,1.49,0.3725]
["Not Applicable - Not Applicable - 00093101042","Not Applicable","Not Applicable","NDC","00093101042","MUPIROCIN 2 % TOPICAL OINTMENT",106.3,106.3,106.3,106.3,26.574999999999999]
["Not Applicable - Not Applicable - 00093102406","Not Applicable","Not Applicable","NDC","00093102406","NEFAZODONE 100 MG TABLET",13.43,13.43,4.4800000000000004,13.43,3.3574999999999999]
["Not Applicable - Not Applicable - 00093103993","Not Applicable","Not Applicable","NDC","00093103993","GABAPENTIN 300 MG CAPSULE",4.59,4.59,1.1499999999999999,4.59,1.1475]
["Not Applicable - Not Applicable - 00093106001","Not Applicable","Not Applicable","NDC","00093106001","SOTALOL 120 MG TABLET",1.25,1.25,0.83,1.25,0.3125]
["Not Applicable - Not Applicable - 00093106101","Not Applicable","Not Applicable","NDC","00093106101","SOTALOL 80 MG TABLET",1.4,1.4,0.93,1.4,0.35]
["Not Applicable - Not Applicable - 00093107853","Not Applicable","Not Applicable","NDC","00093107853","CEFPROZIL 500 MG TABLET",4.0599999999999996,4.0599999999999996,2.0299999999999998,4.0599999999999996,1.0149999999999999]
["Not Applicable - Not Applicable - 00093117201","Not Applicable","Not Applicable","NDC","00093117201","PENICILLIN V POTASSIUM 250 MG TABLET",0.92,0.92,0.46,0.92,0.23]
["Not Applicable - Not Applicable - 00093117401","Not Applicable","Not Applicable","NDC","00093117401","PENICILLIN V POTASSIUM 500 MG TABLET",1.0900000000000001,1.0900000000000001,0.55000000000000004,1.0900000000000001,0.27250000000000002]
["Not Applicable - Not Applicable - 00093117701","Not Applicable","Not Applicable","NDC","00093117701","NEOMYCIN 500 MG TABLET",5.38,5.38,2.69,5.38,1.345]
["Not Applicable - Not Applicable - 00093172301","Not Applicable","Not Applicable","NDC","00093172301","WARFARIN 7.5 MG TABLET",1.55,1.55,0.16,1.55,0.38750000000000001]
["Not Applicable - Not Applicable - 00093202631","Not Applicable","Not Applicable","NDC","00093202631","AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION",26.2,26.2,22.349999999999998,26.2,6.55]
["Not Applicable - Not Applicable - 00093202723","Not Applicable","Not Applicable","NDC","00093202723","AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION",34.96,34.96,34.96,34.96,8.74]
["Not Applicable - Not Applicable - 00093206406","Not Applicable","Not Applicable","NDC","00093206406","CILOSTAZOL 100 MG TABLET",0.32,0.32,0.16,0.32,0.08]
["Not Applicable - Not Applicable - 00093221001","Not Applicable","Not Applicable","NDC","00093221001","SUCRALFATE 1 GRAM TABLET",1.55,1.55,0.78,1.55,0.38750000000000001]
["Not Applicable - Not Applicable - 00093227434","Not Applicable","Not Applicable","NDC","00093227434","AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET",4.68,4.68,4.68,4.68,1.17]
["Not Applicable - Not Applicable - 00093292901","Not Applicable","Not Applicable","NDC","00093292901","CYPROHEPTADINE 4 MG TABLET",2.95,2.95,2.95,2.95,0.73750000000000004]
["Not Applicable - Not Applicable - 00093293101","Not Applicable","Not Applicable","NDC","00093293101","METHYLDOPA 250 MG TABLET",2.04,2.04,1.02,2.04,0.51]
["Not Applicable - Not Applicable - 00093300256","Not Applicable","Not Applicable","NDC","00093300256","QUININE 324 MG CAPSULE",37.520000000000003,37.520000000000003,18.760000000000002,37.520000000000003,9.3800000000000008]
["Not Applicable - Not Applicable - 00093304006","Not Applicable","Not Applicable","NDC","00093304006","ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE",24.61,24.61,24.61,24.61,6.1524999999999999]
["Not Applicable - Not Applicable - 00093310701","Not Applicable","Not Applicable","NDC","00093310701","AMOXICILLIN 250 MG CAPSULE",0.47,0.47,0.12,0.47,0.11749999999999999]
["Not Applicable - Not Applicable - 00093310793","Not Applicable","Not Applicable","NDC","00093310793","AMOXICILLIN 250 MG CAPSULE",1.7,1.7,0.43,1.7,0.42499999999999999]
["Not Applicable - Not Applicable - 00093310953","Not Applicable","Not Applicable","NDC","00093310953","AMOXICILLIN 500 MG CAPSULE",0.91,0.91,0.23,0.91,0.22750000000000001]
["Not Applicable - Not Applicable - 00093312301","Not Applicable","Not Applicable","NDC","00093312301","DICLOXACILLIN 250 MG CAPSULE",5.52,5.52,1.38,5.52,1.38]
["Not Applicable - Not Applicable - 00093312501","Not Applicable","Not Applicable","NDC","00093312501","DICLOXACILLIN 500 MG CAPSULE",6.32,6.32,1.58,6.32,1.58]
["Not Applicable - Not Applicable - 00093312701","Not Applicable","Not Applicable","NDC","00093312701","DISOPYRAMIDE PHOSPHATE 100 MG CAPSULE",8.65,8.65,4.33,8.65,2.1625000000000001]
["Not Applicable - Not Applicable - 00093312901","Not Applicable","Not Applicable","NDC","00093312901","DISOPYRAMIDE PHOSPHATE 150 MG CAPSULE",7.88,7.88,3.94,7.88,1.97]
["Not Applicable - Not Applicable - 00093314501","Not Applicable","Not Applicable","NDC","00093314501","CEPHALEXIN 250 MG CAPSULE",0.42,0.42,0.21,0.42,0.105]
["Not Applicable - Not Applicable - 00093314701","Not Applicable","Not Applicable","NDC","00093314701","CEPHALEXIN 500 MG CAPSULE",0.56000000000000005,0.56000000000000005,0.14000000000000001,0.56000000000000005,0.14000000000000001]
["Not Applicable - Not Applicable - 00093317431","Not Applicable","Not Applicable","NDC","00093317431","ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER",248.68,248.68,248.68,248.68,62.17]
["Not Applicable - Not Applicable - 00093319653","Not Applicable","Not Applicable","NDC","00093319653","CEFADROXIL 500 MG CAPSULE",3.83,3.83,1.92,3.83,0.95750000000000002]
["Not Applicable - Not Applicable - 00093365940","Not Applicable","Not Applicable","NDC","00093365940","BUPRENORPHINE 20 MCG/HOUR WEEKLY TRANSDERMAL PATCH",466.16,466.16,466.16,466.16,116.54]
["Not Applicable - Not Applicable - 00093412773","Not Applicable","Not Applicable","NDC","00093412773","PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLUTION",20.25,20.25,20.25,20.25,5.0625]
["Not Applicable - Not Applicable - 00093412774","Not Applicable","Not Applicable","NDC","00093412774","PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLUTION",32.69,32.69,32.69,32.69,8.1724999999999994]
["Not Applicable - Not Applicable - 00093415080","Not Applicable","Not Applicable","NDC","00093415080","AMOXICILLIN 125 MG/5 ML ORAL SUSPENSION (PEDIATRIC)",12.79,12.79,12.79,12.79,3.1974999999999998]
["Not Applicable - Not Applicable - 00093415573","Not Applicable","Not Applicable","NDC","00093415573","AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION",3.91,3.91,3.91,3.91,0.97750000000000004]
["Not Applicable - Not Applicable - 00093415580","Not Applicable","Not Applicable","NDC","00093415580","AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION",17.59,17.59,17.59,17.59,4.3975]
["Not Applicable - Not Applicable - 00093417573","Not Applicable","Not Applicable","NDC","00093417573","CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION",27.36,27.36,27.36,27.36,6.84]
["Not Applicable - Not Applicable - 00093417574","Not Applicable","Not Applicable","NDC","00093417574","CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION",34.82,34.82,34.82,34.82,8.7050000000000001]
["Not Applicable - Not Applicable - 00093417773","Not Applicable","Not Applicable","NDC","00093417773","CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION",26.29,26.29,26.29,26.29,6.5724999999999998]
["Not Applicable - Not Applicable - 00093423701","Not Applicable","Not Applicable","NDC","00093423701","NADOLOL 80 MG TABLET",38.22,38.22,4.78,38.22,9.5549999999999997]
["Not Applicable - Not Applicable - 00093503056","Not Applicable","Not Applicable","NDC","00093503056","TIAGABINE 2 MG TABLET",148.53,148.53,18.57,148.53,37.1325]
["Not Applicable - Not Applicable - 00093503156","Not Applicable","Not Applicable","NDC","00093503156","TIAGABINE 4 MG TABLET",74.27,74.27,9.2899999999999991,74.27,18.567499999999999]
["Not Applicable - Not Applicable - 00093506101","Not Applicable","Not Applicable","NDC","00093506101","HYDROXYZINE HCL 25 MG TABLET",0.34,0.34,7.0000000000000007E-2,0.34,8.5000000000000006E-2]
["Not Applicable - Not Applicable - 00093511298","Not Applicable","Not Applicable","NDC","00093511298","DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR",8.25,8.25,2.75,8.25,2.0625]
["Not Applicable - Not Applicable - 00093511798","Not Applicable","Not Applicable","NDC","00093511798","DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR",6.65,6.65,2.2200000000000002,6.65,1.6625000000000001]
["Not Applicable - Not Applicable - 00093511898","Not Applicable","Not Applicable","NDC","00093511898","DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR",7.07,7.07,2.36,7.07,1.7675000000000001]
["Not Applicable - Not Applicable - 00093520601","Not Applicable","Not Applicable","NDC","00093520601","OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR",11.81,11.81,3.94,11.81,2.9525000000000001]
["Not Applicable - Not Applicable - 00093525601","Not Applicable","Not Applicable","NDC","00093525601","CLINDAMYCIN HCL 300 MG CAPSULE",1.53,1.53,0.77,1.53,0.38250000000000001]
["Not Applicable - Not Applicable - 00093529056","Not Applicable","Not Applicable","NDC","00093529056","VORICONAZOLE 200 MG TABLET",1418.09,1418.09,1418.09,1418.09,354.52249999999998]
["Not Applicable - Not Applicable - 00093541495","Not Applicable","Not Applicable","NDC","00093541495","FLUCONAZOLE 10 MG/ML ORAL SUSPENSION",102.71,102.71,102.71,102.71,25.677499999999998]
["Not Applicable - Not Applicable - 00093541595","Not Applicable","Not Applicable","NDC","00093541595","FLUCONAZOLE 40 MG/ML ORAL SUSPENSION",399.79500000000002,399.79500000000002,239.88,399.79500000000002,99.948750000000004]
["Not Applicable - Not Applicable - 00093552606","Not Applicable","Not Applicable","NDC","00093552606","ATAZANAVIR 150 MG CAPSULE",22.55,22.55,16.91,22.55,5.6375000000000002]
["Not Applicable - Not Applicable - 00093552856","Not Applicable","Not Applicable","NDC","00093552856","ATAZANAVIR 300 MG CAPSULE",32.9,32.9,24.68,32.9,8.2249999999999996]
["Not Applicable - Not Applicable - 00093577001","Not Applicable","Not Applicable","NDC","00093577001","OLANZAPINE 10 MG TABLET",3.02,3.02,0.76,3.02,0.755]
["Not Applicable - Not Applicable - 00093577056","Not Applicable","Not Applicable","NDC","00093577056","OLANZAPINE 10 MG TABLET",3.02,3.02,0.76,3.02,0.755]
["Not Applicable - Not Applicable - 00093578656","Not Applicable","Not Applicable","NDC","00093578656","ENTECAVIR 0.5 MG TABLET",230.3,230.3,115.15,230.3,57.575000000000003]
["Not Applicable - Not Applicable - 00093613832","Not Applicable","Not Applicable","NDC","00093613832","DIAZEPAM 5 MG-7.5 MG-10 MG RECTAL KIT",1186.68,1186.68,1186.68,1186.68,296.67]
["Not Applicable - Not Applicable - 00093710212","Not Applicable","Not Applicable","NDC","00093710212","GRISEOFULVIN MICROSIZE 125 MG/5 ML ORAL SUSPENSION",72.19,72.19,18.05,72.19,18.047499999999999]
["Not Applicable - Not Applicable - 00093711306","Not Applicable","Not Applicable","NDC","00093711306","NEFAZODONE 150 MG TABLET",9.4,9.4,3.14,9.4,2.35]
["Not Applicable - Not Applicable - 00093714656","Not Applicable","Not Applicable","NDC","00093714656","AZITHROMYCIN 250 MG TABLET",22.91,22.91,4.78,22.91,5.7275]
["Not Applicable - Not Applicable - 00093714756","Not Applicable","Not Applicable","NDC","00093714756","AZITHROMYCIN 600 MG TABLET",21.45,21.45,4.47,21.45,5.3624999999999998]
["Not Applicable - Not Applicable - 00093714823","Not Applicable","Not Applicable","NDC","00093714823","AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION (PEDIATRIC)",92.94,92.94,92.94,92.94,23.234999999999999]
["Not Applicable - Not Applicable - 00093720198","Not Applicable","Not Applicable","NDC","00093720198","PRAVASTATIN 20 MG TABLET",0.56999999999999995,0.56999999999999995,0.08,0.56999999999999995,0.14249999999999999]
["Not Applicable - Not Applicable - 00093720656","Not Applicable","Not Applicable","NDC","00093720656","MIRTAZAPINE 15 MG TABLET",1.28,1.28,0.22,1.28,0.32]
["Not Applicable - Not Applicable - 00093725401","Not Applicable","Not Applicable","NDC","00093725401","GLIMEPIRIDE 1 MG TABLET",4.24,4.24,0.53,4.24,1.06]
["Not Applicable - Not Applicable - 00093725501","Not Applicable","Not Applicable","NDC","00093725501","GLIMEPIRIDE 2 MG TABLET",3.43,3.43,0.43,3.43,0.85750000000000004]
["Not Applicable - Not Applicable - 00093729501","Not Applicable","Not Applicable","NDC","00093729501","CARVEDILOL 12.5 MG TABLET",0.4,0.4,0.05,0.4,0.1]
["Not Applicable - Not Applicable - 00093731601","Not Applicable","Not Applicable","NDC","00093731601","DESMOPRESSIN 0.1 MG TABLET",11.51,11.51,2.88,11.51,2.8774999999999999]
["Not Applicable - Not Applicable - 00093733506","Not Applicable","Not Applicable","NDC","00093733506","TOPIRAMATE 15 MG SPRINKLE CAPSULE",9.0299999999999994,9.0299999999999994,5.42,9.0299999999999994,2.2574999999999998]
["Not Applicable - Not Applicable - 00093733606","Not Applicable","Not Applicable","NDC","00093733606","TOPIRAMATE 25 MG SPRINKLE CAPSULE",6.63,6.63,3.98,6.63,1.6575]
["Not Applicable - Not Applicable - 00093735156","Not Applicable","Not Applicable","NDC","00093735156","LANSOPRAZOLE 30 MG CAPSULE,DELAYED RELEASE",0.69,0.69,0.69,0.69,0.17249999999999999]
["Not Applicable - Not Applicable - 00093735598","Not Applicable","Not Applicable","NDC","00093735598","FINASTERIDE 5 MG TABLET",1.83,1.83,1.83,1.83,0.45750000000000002]
["Not Applicable - Not Applicable - 00093736498","Not Applicable","Not Applicable","NDC","00093736498","LOSARTAN 25 MG TABLET",0.76,0.76,0.19,0.76,0.19]
["Not Applicable - Not Applicable - 00093736510","Not Applicable","Not Applicable","NDC","00093736510","LOSARTAN 50 MG TABLET",0.59,0.59,0.15,0.59,0.14749999999999999]
["Not Applicable - Not Applicable - 00093738001","Not Applicable","Not Applicable","NDC","00093738001","VENLAFAXINE 37.5 MG TABLET",1.51,1.51,0.51,1.51,0.3775]
["Not Applicable - Not Applicable - 00093738101","Not Applicable","Not Applicable","NDC","00093738101","VENLAFAXINE 50 MG TABLET",1.61,1.61,0.54,1.61,0.40250000000000002]
["Not Applicable - Not Applicable - 00093738456","Not Applicable","Not Applicable","NDC","00093738456","VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR",3.39,3.39,0.85,3.39,0.84750000000000003]
["Not Applicable - Not Applicable - 00093738556","Not Applicable","Not Applicable","NDC","00093738556","VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR",3.07,3.07,1.03,3.07,0.76749999999999996]
["Not Applicable - Not Applicable - 00093743901","Not Applicable","Not Applicable","NDC","00093743901","DIVALPROEX 125 MG TABLET,DELAYED RELEASE",3.7,3.7,0.93,3.7,0.92500000000000004]
["Not Applicable - Not Applicable - 00093744001","Not Applicable","Not Applicable","NDC","00093744001","DIVALPROEX 250 MG TABLET,DELAYED RELEASE",3.16,3.16,0.79,3.16,0.79]
["Not Applicable - Not Applicable - 00093746598","Not Applicable","Not Applicable","NDC","00093746598","IRBESARTAN 150 MG TABLET",2.19,2.19,1.1000000000000001,2.19,0.54749999999999999]
["Not Applicable - Not Applicable - 00093761843","Not Applicable","Not Applicable","NDC","00093761843","DORZOLAMIDE 2 % EYE DROPS",110.52,110.52,110.52,110.52,27.63]
["Not Applicable - Not Applicable - 00093762056","Not Applicable","Not Applicable","NDC","00093762056","LETROZOLE 2.5 MG TABLET",0.35,0.35,0.35,0.35,8.7499999999999994E-2]
["Not Applicable - Not Applicable - 00093777201","Not Applicable","Not Applicable","NDC","00093777201","CLOZAPINE 100 MG TABLET",13.67,13.67,3.42,13.67,3.4175]
["Not Applicable - Not Applicable - 00093811856","Not Applicable","Not Applicable","NDC","00093811856","FAMCICLOVIR 250 MG TABLET",10.67,10.67,5.34,10.67,2.6675]
["Not Applicable - Not Applicable - 00093812193","Not Applicable","Not Applicable","NDC","00093812193","DOXAZOSIN 2 MG TABLET",2.2400000000000002,2.2400000000000002,0.28000000000000003,2.2400000000000002,0.56000000000000005]
["Not Applicable - Not Applicable - 00093812201","Not Applicable","Not Applicable","NDC","00093812201","DOXAZOSIN 4 MG TABLET",5.04,5.04,0.63,5.04,1.26]
["Not Applicable - Not Applicable - 00093812293","Not Applicable","Not Applicable","NDC","00093812293","DOXAZOSIN 4 MG TABLET",1.43,1.43,0.18,1.43,0.35749999999999998]
["Not Applicable - Not Applicable - 00093816201","Not Applicable","Not Applicable","NDC","00093816201","QUETIAPINE 100 MG TABLET",6.83,6.83,2.2799999999999998,6.83,1.7075]
["Not Applicable - Not Applicable - 00093834301","Not Applicable","Not Applicable","NDC","00093834301","GLYBURIDE 2.5 MG TABLET",0.56000000000000005,0.56000000000000005,7.0000000000000007E-2,0.56000000000000005,0.14000000000000001]
["Not Applicable - Not Applicable - 00093834401","Not Applicable","Not Applicable","NDC","00093834401","GLYBURIDE 5 MG TABLET",0.27,0.27,0.04,0.27,6.7500000000000004E-2]
["Not Applicable - Not Applicable - 00093834493","Not Applicable","Not Applicable","NDC","00093834493","GLYBURIDE 5 MG TABLET",2.09,2.09,0.27,2.09,0.52249999999999996]
["Not Applicable - Not Applicable - 00093873901","Not Applicable","Not Applicable","NDC","00093873901","MEXILETINE 150 MG CAPSULE",3.02,3.02,1.81,3.02,0.755]
["Not Applicable - Not Applicable - 00093874001","Not Applicable","Not Applicable","NDC","00093874001","MEXILETINE 200 MG CAPSULE",6.52,6.52,3.92,6.52,1.63]
["Not Applicable - Not Applicable - 00093874101","Not Applicable","Not Applicable","NDC","00093874101","MEXILETINE 250 MG CAPSULE",6.11,6.11,3.67,6.11,1.5275000000000001]
["Not Applicable - Not Applicable - 00093894005","Not Applicable","Not Applicable","NDC","00093894005","ACYCLOVIR 200 MG CAPSULE",1.54,1.54,0.39,1.54,0.38500000000000001]
["Not Applicable - Not Applicable - 00093894301","Not Applicable","Not Applicable","NDC","00093894301","ACYCLOVIR 400 MG TABLET",57.2,57.2,57.2,57.2,14.3]
["Not Applicable - Not Applicable - 00093960412","Not Applicable","Not Applicable","NDC","00093960412","HALOPERIDOL LACTATE 2 MG/ML ORAL CONCENTRATE",1.24,1.24,0.13,1.24,0.31]
["Not Applicable - Not Applicable - 00093961212","Not Applicable","Not Applicable","NDC","00093961212","DOXEPIN 10 MG/ML ORAL CONCENTRATE",2.7,2.7,0.36,2.7,0.67500000000000004]
["Not Applicable - Not Applicable - 00113034403","Not Applicable","Not Applicable","NDC","00113034403","NICOTINE (POLACRILEX) 2 MG BUCCAL LOZENGE",9.81,9.81,4.91,9.81,2.4525000000000001]
["Not Applicable - Not Applicable - 00115147446","Not Applicable","Not Applicable","NDC","00115147446","METRONIDAZOLE 0.75 % TOPICAL GEL",324.85000000000002,324.85000000000002,324.85000000000002,324.85000000000002,81.212500000000006]
["Not Applicable - Not Applicable - 00115165901","Not Applicable","Not Applicable","NDC","00115165901","PROPRANOLOL 10 MG TABLET",2.5099999999999998,2.5099999999999998,0.32,2.5099999999999998,0.62749999999999995]
["Not Applicable - Not Applicable - 00115166001","Not Applicable","Not Applicable","NDC","00115166001","PROPRANOLOL 20 MG TABLET",1.84,1.84,0.23,1.84,0.46]
["Not Applicable - Not Applicable - 00115169701","Not Applicable","Not Applicable","NDC","00115169701","HYDROCORTISONE 10 MG TABLET",2.35,2.35,0.59,2.35,0.58750000000000002]
["Not Applicable - Not Applicable - 00115262201","Not Applicable","Not Applicable","NDC","00115262201","TERBUTALINE 5 MG TABLET",11.28,11.28,5.64,11.28,2.82]
["Not Applicable - Not Applicable - 00115351101","Not Applicable","Not Applicable","NDC","00115351101","PYRIDOSTIGMINE BROMIDE 60 MG TABLET",5.42,5.42,1.36,5.42,1.355]
["Not Applicable - Not Applicable - 00115421101","Not Applicable","Not Applicable","NDC","00115421101","MIDODRINE 2.5 MG TABLET",17.07,17.07,4.2699999999999996,17.07,4.2675000000000001]
["Not Applicable - Not Applicable - 00115441101","Not Applicable","Not Applicable","NDC","00115441101","DANTROLENE 25 MG CAPSULE",10.75,10.75,2.69,10.75,2.6875]
["Not Applicable - Not Applicable - 00115443301","Not Applicable","Not Applicable","NDC","00115443301","DANTROLENE 100 MG CAPSULE",5.44,5.44,1.36,5.44,1.36]
["Not Applicable - Not Applicable - 00115592201","Not Applicable","Not Applicable","NDC","00115592201","PILOCARPINE 5 MG TABLET",2.99,2.99,1.99,2.99,0.74750000000000005]
["Not Applicable - Not Applicable - 00115703301","Not Applicable","Not Applicable","NDC","00115703301","FLUDROCORTISONE 0.1 MG TABLET",3.91,3.91,0.98,3.91,0.97750000000000004]
["Not Applicable - Not Applicable - 00116106103","Not Applicable","Not Applicable","NDC","00116106103","CHLORHEXIDINE GLUCONATE 4 % TOPICAL LIQUID",7.25,7.25,7.25,7.25,1.8125]
["Not Applicable - Not Applicable - 00116200115","Not Applicable","Not Applicable","NDC","00116200115","CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH",0.16,0.16,0.16,0.16,0.04]
["Not Applicable - Not Applicable - 00116200116","Not Applicable","Not Applicable","NDC","00116200116","CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH",0.16,0.16,0.16,0.16,0.04]
["Not Applicable - Not Applicable - 00116200189","Not Applicable","Not Applicable","NDC","00116200189","CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH",0.32,0.32,0.32,0.32,0.08]
["Not Applicable - Not Applicable - 00121043130","Not Applicable","Not Applicable","NDC","00121043130","MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION",3.2,3.2,3.2,3.2,0.8]
["Not Applicable - Not Applicable - 00121053005","Not Applicable","Not Applicable","NDC","00121053005","FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID",9.44,9.44,9.44,9.44,2.36]
["Not Applicable - Not Applicable - 00121054410","Not Applicable","Not Applicable","NDC","00121054410","DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID",1.46,1.46,1.46,1.46,0.36499999999999999]
["Not Applicable - Not Applicable - 00121058101","Not Applicable","Not Applicable","NDC","00121058101","HALOPERIDOL 2 MG/ML ORAL CONCENTRATE (PEDIATRIC)",9.5150000000000006,9.5150000000000006,3.4,9.5150000000000006,2.3787500000000001]
["Not Applicable - Not Applicable - 00121058104","Not Applicable","Not Applicable","NDC","00121058104","HALOPERIDOL LACTATE 2 MG/ML ORAL CONCENTRATE",1.38,1.38,0.14000000000000001,1.38,0.34499999999999997]
["Not Applicable - Not Applicable - 00121058105","Not Applicable","Not Applicable","NDC","00121058105","HALOPERIDOL 2 MG/ML ORAL CONCENTRATE (PEDIATRIC)",7.08,7.08,4.9599999999999991,7.08,1.77]
["Not Applicable - Not Applicable - 00121063810","Not Applicable","Not Applicable","NDC","00121063810","DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML SUPERORDERABLE",1.96,1.96,1.96,1.96,0.49]
["Not Applicable - Not Applicable - 00121064616","Not Applicable","Not Applicable","NDC","00121064616","AMANTADINE HCL 50 MG/5 ML SYRUP (PEDIATRIC)",20.170000000000002,20.170000000000002,20.170000000000002,20.170000000000002,5.0425000000000004]
["Not Applicable - Not Applicable - 00121065416","Not Applicable","Not Applicable","NDC","00121065416","FLUPHENAZINE 2.5 MG/5 ML ORAL ELIXIR (PEDIATRIC)",19.12,19.12,2.39,19.12,4.78]
["Not Applicable - Not Applicable - 00121074710","Not Applicable","Not Applicable","NDC","00121074710","SUCRALFATE 100 MG/ML ORAL SUSPENSION (PEDIATRIC)",17.309999999999999,17.309999999999999,17.309999999999999,17.309999999999999,4.3274999999999997]
["Not Applicable - Not Applicable - 00121076616","Not Applicable","Not Applicable","NDC","00121076616","CALCIUM CARBONATE 500 MG/5 ML CALCIUM (1,250 MG/5 ML) ORAL SUSPENSION",23.53,23.53,23.53,23.53,5.8825000000000003]
["Not Applicable - Not Applicable - 00121082601","Not Applicable","Not Applicable","NDC","00121082601","OXYCODONE 20 MG/ML ORAL CONCENTRATE",3.67,3.67,0.92,3.67,0.91749999999999998]
["Not Applicable - Not Applicable - 00121086805","Not Applicable","Not Applicable","NDC","00121086805","NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION",4.91,4.91,4.91,4.91,1.2275]
["Not Applicable - Not Applicable - 00121127600","Not Applicable","Not Applicable","NDC","00121127600","DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP",5.33,5.33,5.33,5.33,1.3325]
["Not Applicable - Not Applicable - 00121127610","Not Applicable","Not Applicable","NDC","00121127610","DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP",8.2100000000000009,8.2100000000000009,8.2100000000000009,8.2100000000000009,2.0525000000000002]
["Not Applicable - Not Applicable - 00121146515","Not Applicable","Not Applicable","NDC","00121146515","POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID",16.04,16.04,16.04,16.04,4.01]
["Not Applicable - Not Applicable - 00121146530","Not Applicable","Not Applicable","NDC","00121146530","POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID",18.23,18.23,18.23,18.23,4.5575000000000001]
["Not Applicable - Not Applicable - 00121148810","Not Applicable","Not Applicable","NDC","00121148810","GUAIFENESIN 100 MG/5 ML ORAL LIQUID",1.96,1.96,1.96,1.96,0.49]
["Not Applicable - Not Applicable - 00121168015","Not Applicable","Not Applicable","NDC","00121168015","POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID",42.79,42.79,42.79,42.79,10.6975]
["Not Applicable - Not Applicable - 00121174410","Not Applicable","Not Applicable","NDC","00121174410","GUAIFENESIN 100 MG/5 ML ORAL LIQUID",1.85,1.85,1.85,1.85,0.46250000000000002]
["Not Applicable - Not Applicable - 00121182810","Not Applicable","Not Applicable","NDC","00121182810","IBUPROFEN 100 MG/5 ML ORAL SUSPENSION",4.34,4.34,4.34,4.34,1.085]
["Not Applicable - Not Applicable - 00121472215","Not Applicable","Not Applicable","NDC","00121472215","SENNA LEAF EXTRACT 176 MG/5 ML ORAL SYRUP",11.36,11.36,11.36,11.36,2.84]
["Not Applicable - Not Applicable - 00121477610","Not Applicable","Not Applicable","NDC","00121477610","MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION",6.97,6.97,6.97,6.97,1.7424999999999999]
["Not Applicable - Not Applicable - 00121482015","Not Applicable","Not Applicable","NDC","00121482015","THEOPHYLLINE 80 MG/15 ML ORAL ELIXIR",35.549999999999997,35.549999999999997,35.549999999999997,35.549999999999997,8.8874999999999993]
["Not Applicable - Not Applicable - 00131247760","Not Applicable","Not Applicable","NDC","00131247760","LACOSAMIDE 50 MG TABLET",145.22,145.22,36.31,145.22,36.305]
["Not Applicable - Not Applicable - 00131247835","Not Applicable","Not Applicable","NDC","00131247835","LACOSAMIDE 100 MG TABLET",206.38,206.38,25.8,206.38,51.594999999999999]
["Not Applicable - Not Applicable - 00131247860","Not Applicable","Not Applicable","NDC","00131247860","LACOSAMIDE 100 MG TABLET",227.04,227.04,28.38,227.04,56.76]
["Not Applicable - Not Applicable - 00132007950","Not Applicable","Not Applicable","NDC","00132007950","GLYCERIN (ADULT) RECTAL SUPPOSITORY",0.23,0.23,0.23,0.23,5.7500000000000002E-2]
["Not Applicable - Not Applicable - 00132020220","Not Applicable","Not Applicable","NDC","00132020220","SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA",4.93,4.93,4.93,4.93,1.2324999999999999]
["Not Applicable - Not Applicable - 00132030140","Not Applicable","Not Applicable","NDC","00132030140","MINERAL OIL ENEMA",6.62,6.62,6.62,6.62,1.655]
["Not Applicable - Not Applicable - 00135014502","Not Applicable","Not Applicable","NDC","00135014502","NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH",10.68,10.68,10.68,10.68,2.67]
["Not Applicable - Not Applicable - 00135019502","Not Applicable","Not Applicable","NDC","00135019502","NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH",4.82,4.82,4.82,4.82,1.2050000000000001]
["Not Applicable - Not Applicable - 00143117101","Not Applicable","Not Applicable","NDC","00143117101","CAPTOPRIL 12.5 MG TABLET",8.3699999999999992,8.3699999999999992,1.05,8.3699999999999992,2.0924999999999998]
["Not Applicable - Not Applicable - 00143129201","Not Applicable","Not Applicable","NDC","00143129201","METHOCARBAMOL 750 MG TABLET",0.7,0.7,0.35,0.7,0.17499999999999999]
["Not Applicable - Not Applicable - 00143148001","Not Applicable","Not Applicable","NDC","00143148001","PROPYLTHIOURACIL 50 MG TABLET",3.56,3.56,1.78,3.56,0.89]
["Not Applicable - Not Applicable - 00143176301","Not Applicable","Not Applicable","NDC","00143176301","TRIHEXYPHENIDYL 5 MG TABLET",0.55000000000000004,0.55000000000000004,0.22,0.55000000000000004,0.13750000000000001]
["Not Applicable - Not Applicable - 00143176401","Not Applicable","Not Applicable","NDC","00143176401","TRIHEXYPHENIDYL 2 MG TABLET",0.68,0.68,0.27,0.68,0.17]
["Not Applicable - Not Applicable - 00143176901","Not Applicable","Not Applicable","NDC","00143176901","ISOSORBIDE DINITRATE 5 MG TABLET",13.93,13.93,3.49,13.93,3.4824999999999999]
["Not Applicable - Not Applicable - 00143177101","Not Applicable","Not Applicable","NDC","00143177101","ISOSORBIDE DINITRATE 10 MG TABLET",7.66,7.66,0.96,7.66,1.915]
["Not Applicable - Not Applicable - 00143177110","Not Applicable","Not Applicable","NDC","00143177110","ISOSORBIDE DINITRATE 10 MG TABLET",10.65,10.65,1.34,10.65,2.6625000000000001]
["Not Applicable - Not Applicable - 00143177201","Not Applicable","Not Applicable","NDC","00143177201","ISOSORBIDE DINITRATE 20 MG TABLET",4.22,4.22,1.06,4.22,1.0549999999999999]
["Not Applicable - Not Applicable - 00143177301","Not Applicable","Not Applicable","NDC","00143177301","ISOSORBIDE DINITRATE 30 MG TABLET",3.32,3.32,0.83,3.32,0.83]
["Not Applicable - Not Applicable - 00143178701","Not Applicable","Not Applicable","NDC","00143178701","BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET",6.84,6.84,3.42,6.84,1.71]
["Not Applicable - Not Applicable - 00143211250","Not Applicable","Not Applicable","NDC","00143211250","DOXYCYCLINE HYCLATE 100 MG TABLET",3.98,3.98,3.98,3.98,0.995]
["Not Applicable - Not Applicable - 00143212522","Not Applicable","Not Applicable","NDC","00143212522","CHLOROQUINE PHOSPHATE 500 MG TABLET",23.88,23.88,5.97,23.88,5.97]
["Not Applicable - Not Applicable - 00143226001","Not Applicable","Not Applicable","NDC","00143226001","ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR",2.69,2.69,0.9,2.69,0.67249999999999999]
["Not Applicable - Not Applicable - 00143318801","Not Applicable","Not Applicable","NDC","00143318801","LITHIUM CARBONATE 150 MG CAPSULE",1.99,1.99,0.5,1.99,0.4975]
["Not Applicable - Not Applicable - 00143953301","Not Applicable","Not Applicable","NDC","00143953301","ALLOPURINOL 500 MG INTRAVENOUS SOLUTION",12662.71,12662.71,12662.71,12662.71,3165.6774999999998]
["Not Applicable - Not Applicable - 00143958109","Not Applicable","Not Applicable","NDC","00143958109","SERTRALINE 50 MG TABLET",2.14,2.14,0.54,2.14,0.53500000000000003]
["Not Applicable - Not Applicable - 00143963301","Not Applicable","Not Applicable","NDC","00143963301","NICARDIPINE 40 MG/200 ML(0.2 MG/ML) IN SOD CHLOR(ISO) INTRAVENOUS SOLN",235.18,235.18,235.18,235.18,58.795000000000002]
["Not Applicable - Not Applicable - 00143963310","Not Applicable","Not Applicable","NDC","00143963310","NICARDIPINE 40 MG/200 ML(0.2 MG/ML) IN SOD CHLOR(ISO) INTRAVENOUS SOLN",215.29,215.29,215.29,215.29,53.822499999999998]
["Not Applicable - Not Applicable - 00143971710","Not Applicable","Not Applicable","NDC","00143971710","FOLIC ACID 1 MG TABLET",0.08,0.08,0.08,0.08,0.02]
["Not Applicable - Not Applicable - 00143985316","Not Applicable","Not Applicable","NDC","00143985316","AMOXICILLIN 600 MG-POT CLAVULANATE 42.9 MG/5 ML ORAL SUSP PEDI",60.4,60.4,60.4,60.4,15.1]
["Not Applicable - Not Applicable - 00143988815","Not Applicable","Not Applicable","NDC","00143988815","AMOXICILLIN 125 MG/5 ML ORAL SUSPENSION",5.33,5.33,5.33,5.33,1.3325]
["Not Applicable - Not Applicable - 00143988915","Not Applicable","Not Applicable","NDC","00143988915","AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION (PEDIATRIC)",8,8,8,8,2]
["Not Applicable - Not Applicable - 00143989701","Not Applicable","Not Applicable","NDC","00143989701","CEPHALEXIN 500 MG CAPSULE",1.85,1.85,0.47,1.85,0.46250000000000002]
["Not Applicable - Not Applicable - 00143989801","Not Applicable","Not Applicable","NDC","00143989801","CEPHALEXIN 250 MG CAPSULE",1.19,1.19,0.6,1.19,0.29749999999999999]
["Not Applicable - Not Applicable - 00143994850","Not Applicable","Not Applicable","NDC","00143994850","CEFADROXIL 1 GRAM TABLET",21.79,21.79,10.9,21.79,5.4474999999999998]
["Not Applicable - Not Applicable - 00143998150","Not Applicable","Not Applicable","NDC","00143998150","AMOXICILLIN 200 MG-POTASSIUM CLAVULANATE 28.5 MG/5 ML ORAL SUSPENSION",28.6,28.6,28.6,28.6,7.15]
["Not Applicable - Not Applicable - 00143998201","Not Applicable","Not Applicable","NDC","00143998201","AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION",48.32,48.32,48.32,48.32,12.08]
["Not Applicable - Not Applicable - 00143998250","Not Applicable","Not Applicable","NDC","00143998250","AMOXICILLIN 400 MG-POT CLAVULANATE 57 MG/5 ML ORAL SUSP (PEDI)",35.89,35.89,35.89,35.89,8.9725000000000001]
["Not Applicable - Not Applicable - 00168000315","Not Applicable","Not Applicable","NDC","00168000315","TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM",7.63,7.63,7.63,7.63,1.9075]
["Not Applicable - Not Applicable - 00168000415","Not Applicable","Not Applicable","NDC","00168000415","TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM",8.9,8.9,8.9,8.9,2.2250000000000001]
["Not Applicable - Not Applicable - 00168000480","Not Applicable","Not Applicable","NDC","00168000480","TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM",22.17,22.17,22.17,22.17,5.5425000000000004]
["Not Applicable - Not Applicable - 00168000615","Not Applicable","Not Applicable","NDC","00168000615","TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT",9.1199999999999992,9.1199999999999992,9.1199999999999992,9.1199999999999992,2.2799999999999998]
["Not Applicable - Not Applicable - 00168000616","Not Applicable","Not Applicable","NDC","00168000616","TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT",67.680000000000007,67.680000000000007,67.680000000000007,67.680000000000007,16.920000000000002]
["Not Applicable - Not Applicable - 00168000680","Not Applicable","Not Applicable","NDC","00168000680","TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT",22.74,22.74,22.74,22.74,5.6849999999999996]
["Not Applicable - Not Applicable - 00168000715","Not Applicable","Not Applicable","NDC","00168000715","NYSTATIN 100,000 UNIT/GRAM TOPICAL OINTMENT",21.43,21.43,21.43,21.43,5.3574999999999999]
["Not Applicable - Not Applicable - 00168001235","Not Applicable","Not Applicable","NDC","00168001235","NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT",7.04,7.04,7.04,7.04,1.76]
["Not Applicable - Not Applicable - 00168001431","Not Applicable","Not Applicable","NDC","00168001431","HYDROCORTISONE 0.5 % TOPICAL CREAM",7.76,7.76,7.76,7.76,1.94]
["Not Applicable - Not Applicable - 00168003501","Not Applicable","Not Applicable","NDC","00168003501","VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT",6.05,6.05,6.05,6.05,1.5125]
["Not Applicable - Not Applicable - 00168006015","Not Applicable","Not Applicable","NDC","00168006015","FLUOCINOLONE 0.025 % TOPICAL CREAM",121.93,121.93,121.93,121.93,30.482500000000002]
["Not Applicable - Not Applicable - 00168006060","Not Applicable","Not Applicable","NDC","00168006060","FLUOCINOLONE 0.025 % TOPICAL CREAM",365.77,365.77,365.77,365.77,91.442499999999995]
["Not Applicable - Not Applicable - 00168006231","Not Applicable","Not Applicable","NDC","00168006231","ZINC OXIDE 20 % TOPICAL OINTMENT",6.35,6.35,6.35,6.35,1.5874999999999999]
["Not Applicable - Not Applicable - 00168006415","Not Applicable","Not Applicable","NDC","00168006415","FLUOCINOLONE 0.025 % TOPICAL OINTMENT",34.590000000000003,34.590000000000003,34.590000000000003,34.590000000000003,8.6475000000000009]
["Not Applicable - Not Applicable - 00168006460","Not Applicable","Not Applicable","NDC","00168006460","FLUOCINOLONE 0.025 % TOPICAL OINTMENT",179.05,179.05,179.05,179.05,44.762500000000003]
["Not Applicable - Not Applicable - 00168008031","Not Applicable","Not Applicable","NDC","00168008031","HYDROCORTISONE 2.5 % TOPICAL CREAM",8.85,8.85,8.85,8.85,2.2124999999999999]
["Not Applicable - Not Applicable - 00168009930","Not Applicable","Not Applicable","NDC","00168009930","KETOCONAZOLE 2 % TOPICAL CREAM",66.510000000000005,66.510000000000005,66.510000000000005,66.510000000000005,16.627500000000001]
["Not Applicable - Not Applicable - 00168014630","Not Applicable","Not Applicable","NDC","00168014630","HYDROCORTISONE 2.5 % TOPICAL OINTMENT",8.06,8.06,8.06,8.06,2.0150000000000001]
["Not Applicable - Not Applicable - 00168016330","Not Applicable","Not Applicable","NDC","00168016330","CLOBETASOL 0.05 % TOPICAL CREAM",80.260000000000005,80.260000000000005,80.260000000000005,80.260000000000005,20.065000000000001]
["Not Applicable - Not Applicable - 00168020230","Not Applicable","Not Applicable","NDC","00168020230","CLINDAMYCIN 1 % TOPICAL GEL",38.159999999999997,38.159999999999997,38.159999999999997,38.159999999999997,9.5399999999999991]
["Not Applicable - Not Applicable - 00168027545","Not Applicable","Not Applicable","NDC","00168027545","METRONIDAZOLE 0.75 % TOPICAL GEL",592.29999999999995,592.29999999999995,592.29999999999995,592.29999999999995,148.07499999999999]
["Not Applicable - Not Applicable - 00168027740","Not Applicable","Not Applicable","NDC","00168027740","CLINDAMYCIN 2 % VAGINAL CREAM",205.34,205.34,205.34,205.34,51.335000000000001]
["Not Applicable - Not Applicable - 00172208310","Not Applicable","Not Applicable","NDC","00172208310","HYDROCHLOROTHIAZIDE 25 MG TABLET",0.31,0.31,0.31,0.31,7.7499999999999999E-2]
["Not Applicable - Not Applicable - 00172208380","Not Applicable","Not Applicable","NDC","00172208380","HYDROCHLOROTHIAZIDE 25 MG TABLET",0.14000000000000001,0.14000000000000001,0.14000000000000001,0.14000000000000001,3.5000000000000003E-2]
["Not Applicable - Not Applicable - 00172240710","Not Applicable","Not Applicable","NDC","00172240710","TETRACYCLINE 500 MG CAPSULE",0.26,0.26,0.13,0.26,6.5000000000000002E-2]
["Not Applicable - Not Applicable - 00172290710","Not Applicable","Not Applicable","NDC","00172290710","FUROSEMIDE 40 MG TABLET",0.55000000000000004,0.55000000000000004,7.0000000000000007E-2,0.55000000000000004,0.13750000000000001]
["Not Applicable - Not Applicable - 00172364910","Not Applicable","Not Applicable","NDC","00172364910","GLIPIZIDE 5 MG TABLET",0.91,0.91,0.23,0.91,0.22750000000000001]
["Not Applicable - Not Applicable - 00172364960","Not Applicable","Not Applicable","NDC","00172364960","GLIPIZIDE 5 MG TABLET",0.63,0.63,0.16,0.63,0.1575]
["Not Applicable - Not Applicable - 00172375810","Not Applicable","Not Applicable","NDC","00172375810","LISINOPRIL 5 MG TABLET",2.88,2.88,0.36,2.88,0.72]
["Not Applicable - Not Applicable - 00172375960","Not Applicable","Not Applicable","NDC","00172375960","LISINOPRIL 10 MG TABLET",1.28,1.28,0.16,1.28,0.32]
["Not Applicable - Not Applicable - 00172375970","Not Applicable","Not Applicable","NDC","00172375970","LISINOPRIL 10 MG TABLET",1.26,1.26,0.16,1.26,0.315]
["Not Applicable - Not Applicable - 00172376010","Not Applicable","Not Applicable","NDC","00172376010","LISINOPRIL 20 MG TABLET",0.81,0.81,0.11,0.81,0.20250000000000001]
["Not Applicable - Not Applicable - 00172376070","Not Applicable","Not Applicable","NDC","00172376070","LISINOPRIL 20 MG TABLET",0.47,0.47,0.06,0.47,0.11749999999999999]
["Not Applicable - Not Applicable - 00172392660","Not Applicable","Not Applicable","NDC","00172392660","DIAZEPAM 5 MG TABLET",0.23,0.23,0.03,0.23,5.7500000000000002E-2]
["Not Applicable - Not Applicable - 00172392760","Not Applicable","Not Applicable","NDC","00172392760","DIAZEPAM 10 MG TABLET",0.62,0.62,7.0000000000000007E-2,0.62,0.155]
["Not Applicable - Not Applicable - 00172409660","Not Applicable","Not Applicable","NDC","00172409660","BACLOFEN 10 MG TABLET",2.8,2.8,0.35,2.8,0.7]
["Not Applicable - Not Applicable - 00172409760","Not Applicable","Not Applicable","NDC","00172409760","BACLOFEN 20 MG TABLET",2.29,2.29,0.28999999999999998,2.29,0.57250000000000001]
["Not Applicable - Not Applicable - 00172428010","Not Applicable","Not Applicable","NDC","00172428010","VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE",1.32,1.32,0.66,1.32,0.33]
["Not Applicable - Not Applicable - 00172428510","Not Applicable","Not Applicable","NDC","00172428510","VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE",5.16,5.16,2.58,5.16,1.29]
["Not Applicable - Not Applicable - 00172428610","Not Applicable","Not Applicable","NDC","00172428610","VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE",1.76,1.76,0.88,1.76,0.44]
["Not Applicable - Not Applicable - 00172436560","Not Applicable","Not Applicable","NDC","00172436560","LABETALOL 200 MG TABLET",5.09,5.09,1.28,5.09,1.2725]
["Not Applicable - Not Applicable - 00172436570","Not Applicable","Not Applicable","NDC","00172436570","LABETALOL 200 MG TABLET",5.01,5.01,1.26,5.01,1.2524999999999999]
["Not Applicable - Not Applicable - 00172436660","Not Applicable","Not Applicable","NDC","00172436660","LABETALOL 300 MG TABLET",3.68,3.68,0.92,3.68,0.92]
["Not Applicable - Not Applicable - 00172480560","Not Applicable","Not Applicable","NDC","00172480560","OXAZEPAM 15 MG CAPSULE",5.76,5.76,1.92,5.76,1.44]
["Not Applicable - Not Applicable - 00172496058","Not Applicable","Not Applicable","NDC","00172496058","FLUTAMIDE 125 MG CAPSULE",24.88,24.88,12.44,24.88,6.22]
["Not Applicable - Not Applicable - 00172524160","Not Applicable","Not Applicable","NDC","00172524160","ANAGRELIDE 0.5 MG CAPSULE",3.83,3.83,1.92,3.83,0.95750000000000002]
["Not Applicable - Not Applicable - 00172531360","Not Applicable","Not Applicable","NDC","00172531360","CIPROFLOXACIN 750 MG TABLET",8.0299999999999994,8.0299999999999994,2.68,8.0299999999999994,2.0074999999999998]
["Not Applicable - Not Applicable - 00172541046","Not Applicable","Not Applicable","NDC","00172541046","FLUCONAZOLE 50 MG TABLET",13.85,13.85,6.93,13.85,3.4624999999999999]
["Not Applicable - Not Applicable - 00172541146","Not Applicable","Not Applicable","NDC","00172541146","FLUCONAZOLE 100 MG TABLET",63.84,63.84,3.99,63.84,15.96]
["Not Applicable - Not Applicable - 00172541160","Not Applicable","Not Applicable","NDC","00172541160","FLUCONAZOLE 100 MG TABLET",90.84,90.84,5.68,90.84,22.71]
["Not Applicable - Not Applicable - 00172541346","Not Applicable","Not Applicable","NDC","00172541346","FLUCONAZOLE 200 MG TABLET",53.35,53.35,3.34,53.35,13.3375]
["Not Applicable - Not Applicable - 00172541360","Not Applicable","Not Applicable","NDC","00172541360","FLUCONAZOLE 200 MG TABLET",115.28,115.28,7.21,115.28,28.82]
["Not Applicable - Not Applicable - 00172572860","Not Applicable","Not Applicable","NDC","00172572860","FAMOTIDINE 20 MG TABLET",0.36,0.36,0.09,0.36,0.09]
["Not Applicable - Not Applicable - 00172572870","Not Applicable","Not Applicable","NDC","00172572870","FAMOTIDINE 20 MG TABLET",0.34,0.34,0.09,0.34,8.5000000000000006E-2]
["Not Applicable - Not Applicable - 00172572880","Not Applicable","Not Applicable","NDC","00172572880","FAMOTIDINE 20 MG TABLET",0.35,0.35,0.09,0.35,8.7499999999999994E-2]
["Not Applicable - Not Applicable - 00173052000","Not Applicable","Not Applicable","NDC","00173052000","SALMETEROL 50 MCG/DOSE BLISTER POWDER FOR INHALATION",810.49,810.49,810.49,810.49,202.6225]
["Not Applicable - Not Applicable - 00173052600","Not Applicable","Not Applicable","NDC","00173052600","LAMOTRIGINE 5 MG CHEWABLE DISPERSIBLE TABLET",4430.33,4430.33,4430.33,4430.33,1107.5825]
["Not Applicable - Not Applicable - 00173052700","Not Applicable","Not Applicable","NDC","00173052700","LAMOTRIGINE 25 MG CHEWABLE DISPERSIBLE TABLET",4756.09,4756.09,4756.09,4756.09,1189.0225]
["Not Applicable - Not Applicable - 00173054700","Not Applicable","Not Applicable","NDC","00173054700","ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION",109.9,109.9,109.9,109.9,27.475000000000001]
["Not Applicable - Not Applicable - 00173064255","Not Applicable","Not Applicable","NDC","00173064255","LAMOTRIGINE 100 MG TABLET",104.6,104.6,13.08,104.6,26.15]
["Not Applicable - Not Applicable - 00173068220","Not Applicable","Not Applicable","NDC","00173068220","ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER",248.68,248.68,248.68,248.68,62.17]
["Not Applicable - Not Applicable - 00173068224","Not Applicable","Not Applicable","NDC","00173068224","ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER",74.61,74.61,74.61,74.61,18.6525]
["Not Applicable - Not Applicable - 00173071820","Not Applicable","Not Applicable","NDC","00173071820","FLUTICASONE PROPIONATE 44 MCG/ACTUATION HFA AEROSOL INHALER",658.28,658.28,658.28,658.28,164.57]
["Not Applicable - Not Applicable - 00173071920","Not Applicable","Not Applicable","NDC","00173071920","FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER",881.29,881.29,881.29,881.29,220.32249999999999]
["Not Applicable - Not Applicable - 00173072020","Not Applicable","Not Applicable","NDC","00173072020","FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER",1368.85,1368.85,1368.85,1368.85,342.21249999999998]
["Not Applicable - Not Applicable - 00173073500","Not Applicable","Not Applicable","NDC","00173073500","SUMATRIPTAN 25 MG TABLET",421.5,421.5,105.38,421.5,105.375]
["Not Applicable - Not Applicable - 00173088025","Not Applicable","Not Applicable","NDC","00173088025","THIOGUANINE 40 MG TABLET",35.68,35.68,35.68,35.68,8.92]
["Not Applicable - Not Applicable - 00182055489","Not Applicable","Not Applicable","NDC","00182055489","HYDRALAZINE 25 MG TABLET",2.57,2.57,0.35,2.57,0.64249999999999996]
["Not Applicable - Not Applicable - 00182090589","Not Applicable","Not Applicable","NDC","00182090589","HYDRALAZINE 10 MG TABLET",5.2,5.2,0.7,5.2,1.3]
["Not Applicable - Not Applicable - 00185011801","Not Applicable","Not Applicable","NDC","00185011801","LABETALOL 300 MG TABLET",3.43,3.43,0.86,3.43,0.85750000000000004]
["Not Applicable - Not Applicable - 00185012201","Not Applicable","Not Applicable","NDC","00185012201","NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE",4.88,4.88,4.88,4.88,1.22]
["Not Applicable - Not Applicable - 00185012901","Not Applicable","Not Applicable","NDC","00185012901","BUMETANIDE 1 MG TABLET",2.86,2.86,0.72,2.86,0.71499999999999997]
["Not Applicable - Not Applicable - 00185012905","Not Applicable","Not Applicable","NDC","00185012905","BUMETANIDE 1 MG TABLET",3.01,3.01,0.76,3.01,0.75249999999999995]
["Not Applicable - Not Applicable - 00185020501","Not Applicable","Not Applicable","NDC","00185020501","METHIMAZOLE 5 MG TABLET",2.58,2.58,0.65,2.58,0.64500000000000002]
["Not Applicable - Not Applicable - 00185021001","Not Applicable","Not Applicable","NDC","00185021001","METHIMAZOLE 10 MG TABLET",2.27,2.27,0.56999999999999995,2.27,0.5675]
["Not Applicable - Not Applicable - 00185022360","Not Applicable","Not Applicable","NDC","00185022360","CILOSTAZOL 100 MG TABLET",3.15,3.15,1.58,3.15,0.78749999999999998]
["Not Applicable - Not Applicable - 00185041060","Not Applicable","Not Applicable","NDC","00185041060","BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE",4.49,4.49,2.25,4.49,1.1225000000000001]
["Not Applicable - Not Applicable - 00185041552","Not Applicable","Not Applicable","NDC","00185041552","BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE",1.99,1.99,1,1.99,0.4975]
["Not Applicable - Not Applicable - 00185055030","Not Applicable","Not Applicable","NDC","00185055030","ITRACONAZOLE 100 MG CAPSULE",98.87,98.87,32.96,98.87,24.717500000000001]
["Not Applicable - Not Applicable - 00185075701","Not Applicable","Not Applicable","NDC","00185075701","SULFADIAZINE 500 MG TABLET",31.32,31.32,20.88,31.32,7.83]
["Not Applicable - Not Applicable - 00185434601","Not Applicable","Not Applicable","NDC","00185434601","QUINIDINE SULFATE 200 MG TABLET",1.26,1.26,0.63,1.26,0.315]
["Not Applicable - Not Applicable - 00186000431","Not Applicable","Not Applicable","NDC","00186000431","CANDESARTAN 4 MG TABLET",94.33,94.33,11.8,94.33,23.5825]
["Not Applicable - Not Applicable - 00186001631","Not Applicable","Not Applicable","NDC","00186001631","CANDESARTAN 16 MG TABLET",23.59,23.59,2.95,23.59,5.8975]
["Not Applicable - Not Applicable - 00186077660","Not Applicable","Not Applicable","NDC","00186077660","TICAGRELOR 60 MG TABLET",34.06,34.06,22.71,34.06,8.5150000000000006]
["Not Applicable - Not Applicable - 00186077739","Not Applicable","Not Applicable","NDC","00186077739","TICAGRELOR 90 MG TABLET",22.7,22.7,22.7,22.7,5.6749999999999998]
["Not Applicable - Not Applicable - 00186077760","Not Applicable","Not Applicable","NDC","00186077760","TICAGRELOR 90 MG TABLET",22.71,22.71,22.71,22.71,5.6775000000000002]
["Not Applicable - Not Applicable - 00187065820","Not Applicable","Not Applicable","NDC","00187065820","DIAZEPAM 5 MG-7.5 MG-10 MG RECTAL KIT",1162.7,1162.7,1162.7,1162.7,290.67500000000001]
["Not Applicable - Not Applicable - 00187065920","Not Applicable","Not Applicable","NDC","00187065920","DIAZEPAM 12.5 MG-15 MG-17.5 MG-20 MG RECTAL KIT",1162.7,1162.7,1162.7,1162.7,290.67500000000001]
["Not Applicable - Not Applicable - 00187079530","Not Applicable","Not Applicable","NDC","00187079530","DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR",262.24,262.24,87.42,262.24,65.56]
["Not Applicable - Not Applicable - 00187093801","Not Applicable","Not Applicable","NDC","00187093801","TOLCAPONE 100 MG TABLET",790.85,790.85,395.43,790.85,197.71250000000001]
["Not Applicable - Not Applicable - 00187170405","Not Applicable","Not Applicable","NDC","00187170405","PHYTONADIONE (VITAMIN K1) 5 MG TABLET",389.57,389.57,97.4,389.57,97.392499999999998]
["Not Applicable - Not Applicable - 00187301220","Not Applicable","Not Applicable","NDC","00187301220","PYRIDOSTIGMINE BROMIDE 60 MG/5 ML SYRUP (PEDIATRIC)",4552.03,4552.03,4552.03,4552.03,1138.0074999999999]
["Not Applicable - Not Applicable - 00187355410","Not Applicable","Not Applicable","NDC","00187355410","FLUCYTOSINE 250 MG CAPSULE",1091.96,1091.96,545.98,1091.96,272.99]
["Not Applicable - Not Applicable - 00187355510","Not Applicable","Not Applicable","NDC","00187355510","FLUCYTOSINE 500 MG CAPSULE",992.03,992.03,496.02,992.03,248.00749999999999]
["Not Applicable - Not Applicable - 00187526802","Not Applicable","Not Applicable","NDC","00187526802","VITAMIN B COMPLEX AND VITAMIN C NO.20-FOLIC ACID 1 MG CAPSULE",19.32,19.32,19.32,19.32,4.83]
["Not Applicable - Not Applicable - 00212282374","Not Applicable","Not Applicable","NDC","00212282374","GUAR GUM ORAL PACKET",1.44,1.44,1.44,1.44,0.36]
["Not Applicable - Not Applicable - 00223172101","Not Applicable","Not Applicable","NDC","00223172101","SODIUM BICARBONATE 650 MG TABLET",0.22,0.22,0.22,0.22,5.5E-2]
["Not Applicable - Not Applicable - 00223176001","Not Applicable","Not Applicable","NDC","00223176001","SODIUM CHLORIDE 1 GRAM TABLET",0.5,0.5,0.25,0.5,0.125]
["Not Applicable - Not Applicable - 00224185200","Not Applicable","Not Applicable","NDC","00224185200","PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET",1.51,1.51,1.51,1.51,0.3775]
["Not Applicable - Not Applicable - 00224185281","Not Applicable","Not Applicable","NDC","00224185281","PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET",1.91,1.91,1.91,1.91,0.47749999999999998]
["Not Applicable - Not Applicable - 00225052547","Not Applicable","Not Applicable","NDC","00225052547","SODIUM CHLORIDE-ALOE VERA NASAL GEL",9.4700000000000006,9.4700000000000006,9.4700000000000006,9.4700000000000006,2.3675000000000002]
["Not Applicable - Not Applicable - 00225052848","Not Applicable","Not Applicable","NDC","00225052848","SODIUM CHLORIDE-ALOE VERA NASAL SPRAY",17.12,17.12,17.12,17.12,4.28]
["Not Applicable - Not Applicable - 00225081047","Not Applicable","Not Applicable","NDC","00225081047","PHENYLEPHRINE 1 % NASAL SPRAY",13.91,13.91,13.91,13.91,3.4775]
["Not Applicable - Not Applicable - 00228206710","Not Applicable","Not Applicable","NDC","00228206710","OXAZEPAM 10 MG CAPSULE",9.5500000000000007,9.5500000000000007,3.19,9.5500000000000007,2.3875000000000002]
["Not Applicable - Not Applicable - 00228206910","Not Applicable","Not Applicable","NDC","00228206910","OXAZEPAM 15 MG CAPSULE",8.0399999999999991,8.0399999999999991,2.68,8.0399999999999991,2.0099999999999998]
["Not Applicable - Not Applicable - 00228212750","Not Applicable","Not Applicable","NDC","00228212750","CLONIDINE HCL 0.1 MG TABLET",0.21,0.21,7.0000000000000007E-2,0.21,5.2499999999999998E-2]
["Not Applicable - Not Applicable - 00228212810","Not Applicable","Not Applicable","NDC","00228212810","CLONIDINE HCL 0.2 MG TABLET",0.13,0.13,0.05,0.13,3.2500000000000001E-2]
["Not Applicable - Not Applicable - 00228212910","Not Applicable","Not Applicable","NDC","00228212910","CLONIDINE HCL 0.3 MG TABLET",0.11,0.11,0.04,0.11,2.75E-2]
["Not Applicable - Not Applicable - 00228234810","Not Applicable","Not Applicable","NDC","00228234810","PROPYLTHIOURACIL 50 MG TABLET",3.22,3.22,1.61,3.22,0.80500000000000005]
["Not Applicable - Not Applicable - 00228249710","Not Applicable","Not Applicable","NDC","00228249710","NIFEDIPINE 10 MG CAPSULE",5.51,5.51,2.76,5.51,1.3774999999999999]
["Not Applicable - Not Applicable - 00228253910","Not Applicable","Not Applicable","NDC","00228253910","CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET",1.48,1.48,0.37,1.48,0.37]
["Not Applicable - Not Applicable - 00228262011","Not Applicable","Not Applicable","NDC","00228262011","ISOSORBIDE MONONITRATE 20 MG TABLET",0.56000000000000005,0.56000000000000005,0.28000000000000003,0.56000000000000005,0.14000000000000001]
["Not Applicable - Not Applicable - 00228267211","Not Applicable","Not Applicable","NDC","00228267211","SPIRONOLACTONE 50 MG TABLET",2.8,2.8,0.7,2.8,0.7]
["Not Applicable - Not Applicable - 00228277811","Not Applicable","Not Applicable","NDC","00228277811","PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE",2.5099999999999998,2.5099999999999998,0.94,2.5099999999999998,0.62749999999999995]
["Not Applicable - Not Applicable - 00228277911","Not Applicable","Not Applicable","NDC","00228277911","PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE",1.92,1.92,0.72,1.92,0.48]
["Not Applicable - Not Applicable - 00228278111","Not Applicable","Not Applicable","NDC","00228278111","PROPRANOLOL ER 160 MG CAPSULE,24 HR,EXTENDED RELEASE",1.76,1.76,0.88,1.76,0.44]
["Not Applicable - Not Applicable - 00228299611","Not Applicable","Not Applicable","NDC","00228299611","TAMSULOSIN 0.4 MG CAPSULE",3.32,3.32,1.66,3.32,0.83]
["Not Applicable - Not Applicable - 00228300411","Not Applicable","Not Applicable","NDC","00228300411","CLONAZEPAM 1 MG TABLET",0.28000000000000003,0.28000000000000003,0.04,0.28000000000000003,7.0000000000000007E-2]
["Not Applicable - Not Applicable - 00230066704","Not Applicable","Not Applicable","NDC","00230066704","WHITE PETROLATUM-MINERAL OIL 56.8 %-43.5 % EYE OINTMENT SUPERORDERABLE",30.48,30.48,30.48,30.48,7.62]
["Not Applicable - Not Applicable - 00245003660","Not Applicable","Not Applicable","NDC","00245003660","CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET",6.8,6.8,6.8,6.8,1.7]
["Not Applicable - Not Applicable - 00245003689","Not Applicable","Not Applicable","NDC","00245003689","CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET",7.29,7.29,7.29,7.29,1.8225]
["Not Applicable - Not Applicable - 00245004089","Not Applicable","Not Applicable","NDC","00245004089","POTASSIUM CHLORIDE ER 8 MEQ TABLET,EXTENDED RELEASE",1.75,1.75,1.75,1.75,0.4375]
["Not Applicable - Not Applicable - 00245008511","Not Applicable","Not Applicable","NDC","00245008511","PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE",12.75,12.75,4.78,12.75,3.1875]
["Not Applicable - Not Applicable - 00245018001","Not Applicable","Not Applicable","NDC","00245018001","DIVALPROEX 125 MG TABLET,DELAYED RELEASE",2.72,2.72,0.68,2.72,0.68]
["Not Applicable - Not Applicable - 00245018101","Not Applicable","Not Applicable","NDC","00245018101","DIVALPROEX 250 MG TABLET,DELAYED RELEASE",2.65,2.65,0.67,2.65,0.66249999999999998]
["Not Applicable - Not Applicable - 00245018201","Not Applicable","Not Applicable","NDC","00245018201","DIVALPROEX 500 MG TABLET,DELAYED RELEASE",2.4500000000000002,2.4500000000000002,0.62,2.4500000000000002,0.61250000000000004]
["Not Applicable - Not Applicable - 00245021111","Not Applicable","Not Applicable","NDC","00245021111","MIDODRINE 2.5 MG TABLET",6.93,6.93,1.74,6.93,1.7324999999999999]
["Not Applicable - Not Applicable - 00254100752","Not Applicable","Not Applicable","NDC","00254100752","ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER",248.68,248.68,248.68,248.68,62.17]
["Not Applicable - Not Applicable - 00254200811","Not Applicable","Not Applicable","NDC","00254200811","COLCHICINE 0.6 MG TABLET",32.81,32.81,16.41,32.81,8.2025000000000006]
["Not Applicable - Not Applicable - 00264180032","Not Applicable","Not Applicable","NDC","00264180032","INV SODIUM CHLORIDE 0.9 % IV SOLP",7.82,7.82,7.82,7.82,1.9550000000000001]
["Not Applicable - Not Applicable - 00264320055","Not Applicable","Not Applicable","NDC","00264320055","AMINO ACIDS",226.65,226.65,226.65,226.65,56.662500000000001]
["Not Applicable - Not Applicable - 00264446000","Not Applicable","Not Applicable","NDC","00264446000","INTRALIPID",131.44999999999999,131.44999999999999,131.44999999999999,131.44999999999999,32.862499999999997]
["Not Applicable - Not Applicable - 00264751000","Not Applicable","Not Applicable","NDC","00264751000","DEXTROSE 5 % IN WATER (D5W) IV NON-PVC",14.21,14.21,14.21,14.21,3.5525000000000002]
["Not Applicable - Not Applicable - 00264751010","Not Applicable","Not Applicable","NDC","00264751010","DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION",12.44,12.44,12.44,12.44,3.11]
["Not Applicable - Not Applicable - 00264751020","Not Applicable","Not Applicable","NDC","00264751020","DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION",9.77,9.77,9.77,9.77,2.4424999999999999]
["Not Applicable - Not Applicable - 00264752020","Not Applicable","Not Applicable","NDC","00264752020","DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS BOLUS",7.11,7.11,7.11,7.11,1.7775000000000001]
["Not Applicable - Not Applicable - 00264757810","Not Applicable","Not Applicable","NDC","00264757810","MANNITOL 20 % INTRAVENOUS SOLUTION",115.46,115.46,115.46,115.46,28.864999999999998]
["Not Applicable - Not Applicable - 00264780010","Not Applicable","Not Applicable","NDC","00264780010","SODIUM CHLORIDE 0.9 % IV NON-PVC",10.66,10.66,10.66,10.66,2.665]
["Not Applicable - Not Applicable - 00264780020","Not Applicable","Not Applicable","NDC","00264780020","SODIUM CHLORIDE 0.9 % IV NON-PVC",8,8,8,8,2]
["Not Applicable - Not Applicable - 00281032630","Not Applicable","Not Applicable","NDC","00281032630","NITROGLYCERIN 2 % TRANSDERMAL OINTMENT",112.97,112.97,112.97,112.97,28.2425]
["Not Applicable - Not Applicable - 00295122395","Not Applicable","Not Applicable","NDC","00295122395","BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT",6.72,6.72,6.72,6.72,1.68]
["Not Applicable - Not Applicable - 00316018601","Not Applicable","Not Applicable","NDC","00316018601","HYDROCORTISONE 1 % TOPICAL CREAM",8.98,8.98,8.98,8.98,2.2450000000000001]
["Not Applicable - Not Applicable - 00338001304","Not Applicable","Not Applicable","NDC","00338001304","TPN ONLY WATER FOR INJECTION, STERILE INTRAVENOUS SOL",21.32,21.32,21.32,21.32,5.33]
["Not Applicable - Not Applicable - 00338001306","Not Applicable","Not Applicable","NDC","00338001306","TPN ONLY WATER FOR INJECTION, STERILE INTRAVENOUS SOL",21.32,21.32,21.32,21.32,5.33]
["Not Applicable - Not Applicable - 00338001701","Not Applicable","Not Applicable","NDC","00338001701","DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION",23.45,23.45,23.45,23.45,5.8624999999999998]
["Not Applicable - Not Applicable - 00338001702","Not Applicable","Not Applicable","NDC","00338001702","DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION",8,8,8,8,2]
["Not Applicable - Not Applicable - 00338001703","Not Applicable","Not Applicable","NDC","00338001703","DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION",8.89,8.89,8.89,8.89,2.2225000000000001]
["Not Applicable - Not Applicable - 00338001704","Not Applicable","Not Applicable","NDC","00338001704","INV DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION",10.66,10.66,10.66,10.66,2.665]
["Not Applicable - Not Applicable - 00338001731","Not Applicable","Not Applicable","NDC","00338001731","INV DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION",6.22,6.22,6.22,6.22,1.5549999999999999]
["Not Applicable - Not Applicable - 00338001738","Not Applicable","Not Applicable","NDC","00338001738","INV DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION",6.4,6.4,6.4,6.4,1.6]
["Not Applicable - Not Applicable - 00338001741","Not Applicable","Not Applicable","NDC","00338001741","DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION",6.22,6.22,6.22,6.22,1.5549999999999999]
["Not Applicable - Not Applicable - 00338002303","Not Applicable","Not Applicable","NDC","00338002303","DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS BOLUS",12.44,12.44,12.44,12.44,3.11]
["Not Applicable - Not Applicable - 00338004303","Not Applicable","Not Applicable","NDC","00338004303","SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION",8.89,8.89,8.89,8.89,2.2225000000000001]
["Not Applicable - Not Applicable - 00338004304","Not Applicable","Not Applicable","NDC","00338004304","SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION",10.66,10.66,10.66,10.66,2.665]
["Not Applicable - Not Applicable - 00338004901","Not Applicable","Not Applicable","NDC","00338004901","INV SODIUM CHLORIDE 0.9 % IV SOLP",23.45,23.45,23.45,23.45,5.8624999999999998]
["Not Applicable - Not Applicable - 00338004902","Not Applicable","Not Applicable","NDC","00338004902","SODIUM CHLORIDE 0.9 % IV SOLP",7.11,7.11,7.11,7.11,1.7775000000000001]
["Not Applicable - Not Applicable - 00338004903","Not Applicable","Not Applicable","NDC","00338004903","AMNIOINFUSION - SODIUM CHLORIDE 0.9% BOLUS",8.89,8.89,8.89,8.89,2.2225000000000001]
["Not Applicable - Not Applicable - 00338004904","Not Applicable","Not Applicable","NDC","00338004904","AMNIOINFUSION - SODIUM CHLORIDE 0.9% BOLUS",7.11,7.11,7.11,7.11,1.7775000000000001]
["Not Applicable - Not Applicable - 00338004931","Not Applicable","Not Applicable","NDC","00338004931","INV SODIUM CHLORIDE 0.9 % IV SOLP",6.22,6.22,6.22,6.22,1.5549999999999999]
["Not Applicable - Not Applicable - 00338004938","Not Applicable","Not Applicable","NDC","00338004938","SODIUM CHLORIDE 0.9 % IV SOLP",6.4,6.4,6.4,6.4,1.6]
["Not Applicable - Not Applicable - 00338004941","Not Applicable","Not Applicable","NDC","00338004941","INV SODIUM CHLORIDE 0.9 % IV SOLP",6.22,6.22,6.22,6.22,1.5549999999999999]
["Not Applicable - Not Applicable - 00338004948","Not Applicable","Not Applicable","NDC","00338004948","AMNIOINFUSION - SODIUM CHLORIDE 0.9% BOLUS",6.4,6.4,6.4,6.4,1.6]
["Not Applicable - Not Applicable - 00338005403","Not Applicable","Not Applicable","NDC","00338005403","SODIUM CHLORIDE 3% INTRAVENOUS BOLUS SOLUTION",12.44,12.44,12.44,12.44,3.11]
["Not Applicable - Not Applicable - 00338007304","Not Applicable","Not Applicable","NDC","00338007304","DEXTROSE 2.5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION",21.32,21.32,21.32,21.32,5.33]
["Not Applicable - Not Applicable - 00338008504","Not Applicable","Not Applicable","NDC","00338008504","DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION",10.66,10.66,10.66,10.66,2.665]
["Not Applicable - Not Applicable - 00338008903","Not Applicable","Not Applicable","NDC","00338008903","DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION",15.99,15.99,15.99,15.99,3.9975000000000001]
["Not Applicable - Not Applicable - 00338008904","Not Applicable","Not Applicable","NDC","00338008904","DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION",10.66,10.66,10.66,10.66,2.665]
["Not Applicable - Not Applicable - 00338012503","Not Applicable","Not Applicable","NDC","00338012503","DEXTROSE 5 % AND LACTATED RINGERS INTRAVENOUS SOLUTION",19.54,19.54,19.54,19.54,4.8849999999999998]
["Not Applicable - Not Applicable - 00338012504","Not Applicable","Not Applicable","NDC","00338012504","DEXTROSE 5 % AND LACTATED RINGERS INTRAVENOUS SOLUTION",10.66,10.66,10.66,10.66,2.665]
["Not Applicable - Not Applicable - 00338020601","Not Applicable","Not Applicable","NDC","00338020601","AMINO ACIDS 8 %-DEXTROSE 14 %-ELECTROLYTES INTRAVENOUS SOLUTION",390.78,390.78,390.78,390.78,97.694999999999993]
["Not Applicable - Not Applicable - 00338020604","Not Applicable","Not Applicable","NDC","00338020604","AMINO ACIDS 8 %-DEXTROSE 14 %-ELECTROLYTES INTRAVENOUS SOLUTION",277.10000000000002,277.10000000000002,277.10000000000002,277.10000000000002,69.275000000000006]
["Not Applicable - Not Applicable - 00338021001","Not Applicable","Not Applicable","NDC","00338021001","AMINO ACIDS 8 %-DEXTROSE 10 %-ELECTROLYTES INTRAVENOUS SOLUTION",216.71,216.71,216.71,216.71,54.177500000000002]
["Not Applicable - Not Applicable - 00338021401","Not Applicable","Not Applicable","NDC","00338021401","AMINO ACIDS 8 %-DEXTROSE 10 %-ELECTROLYTES INTRAVENOUS SOLUTION",369.46,369.46,369.46,369.46,92.364999999999995]
["Not Applicable - Not Applicable - 00338021404","Not Applicable","Not Applicable","NDC","00338021404","AMINO ACIDS 8 %-DEXTROSE 10 %-ELECTROLYTES INTRAVENOUS SOLUTION",255.78,255.78,255.78,255.78,63.945]
["Not Applicable - Not Applicable - 00338022103","Not Applicable","Not Applicable","NDC","00338022103","ELECTROLYTE-A INTRAVENOUS SOLUTION",15.99,15.99,15.99,15.99,3.9975000000000001]
["Not Applicable - Not Applicable - 00338022104","Not Applicable","Not Applicable","NDC","00338022104","ELECTROLYTE-A IV BOLUS",17.77,17.77,17.77,17.77,4.4424999999999999]
["Not Applicable - Not Applicable - 00338035703","Not Applicable","Not Applicable","NDC","00338035703","MANNITOL 20 % INTRAVENOUS SOLUTION",122.57,122.57,122.57,122.57,30.642499999999998]
["Not Applicable - Not Applicable - 00338051141","Not Applicable","Not Applicable","NDC","00338051141","GENTAMICIN IV SYRINGE 2 MG/ML",9.42,9.42,9.42,9.42,2.355]
["Not Applicable - Not Applicable - 00338051902","Not Applicable","Not Applicable","NDC","00338051902","FAT EMULSION 20 % INTRAVENOUS FOR CLINIMIX",123.45,123.45,123.45,123.45,30.862500000000001]
["Not Applicable - Not Applicable - 00338051909","Not Applicable","Not Applicable","NDC","00338051909","FAT EMULSION 20 % INTRAVENOUS",50.63,50.63,50.63,50.63,12.657500000000001]
["Not Applicable - Not Applicable - 00338055311","Not Applicable","Not Applicable","NDC","00338055311","SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK",11.02,11.02,11.02,11.02,2.7549999999999999]
["Not Applicable - Not Applicable - 00338055318","Not Applicable","Not Applicable","NDC","00338055318","SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK",11.02,11.02,11.02,11.02,2.7549999999999999]
["Not Applicable - Not Applicable - 00338071906","Not Applicable","Not Applicable","NDC","00338071906","DEXTROSE",56.84,56.84,56.84,56.84,14.21]
["Not Applicable - Not Applicable - 00338111504","Not Applicable","Not Applicable","NDC","00338111504","AMINO ACIDS 4.25 % WITH LYTES AND CALCIUM IN D10W INTRAVENOUS SOLUTION",206.05,206.05,206.05,206.05,51.512500000000003]
["Not Applicable - Not Applicable - 00338112304","Not Applicable","Not Applicable","NDC","00338112304","AMINO ACIDS 5 %-DEXTROSE 15 %-ELECTROLYTES INTRAVENOUS SOLUTION",227.36,227.36,227.36,227.36,56.84]
["Not Applicable - Not Applicable - 00338114503","Not Applicable","Not Applicable","NDC","00338114503","AMINO ACIDS 4.25 % WITH LYTES AND CALCIUM IN D10W INTRAVENOUS SOLUTION",120.79,120.79,120.79,120.79,30.197500000000002]
["Not Applicable - Not Applicable - 00338114703","Not Applicable","Not Applicable","NDC","00338114703","AMINO ACIDS 5 %-DEXTROSE 15 %-ELECTROLYTES INTRAVENOUS SOLUTION",135,135,135,135,33.75]
["Not Applicable - Not Applicable - 00338630404","Not Applicable","Not Applicable","NDC","00338630404","SODIUM CHLORIDE 0.9 % IV NON-PVC",10.66,10.66,10.66,10.66,2.665]
["Not Applicable - Not Applicable - 00338634602","Not Applicable","Not Applicable","NDC","00338634602","INV DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION",15.1,15.1,15.1,15.1,3.7749999999999999]
["Not Applicable - Not Applicable - 00338915930","Not Applicable","Not Applicable","NDC","00338915930","SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK",11.73,11.73,11.73,11.73,2.9325000000000001]
["Not Applicable - Not Applicable - 00362904902","Not Applicable","Not Applicable","NDC","00362904902","ARTICAINE 4 %-EPINEPHRINE BITARTRATE 1:100,000 INJECTION CARTRIDGE",3.63,3.63,3.63,3.63,0.90749999999999997]
["Not Applicable - Not Applicable - 00378003001","Not Applicable","Not Applicable","NDC","00378003001","CLORAZEPATE DIPOTASSIUM 3.75 MG TABLET",10.210000000000001,10.210000000000001,2.56,10.210000000000001,2.5525000000000002]
["Not Applicable - Not Applicable - 00378003201","Not Applicable","Not Applicable","NDC","00378003201","METOPROLOL TARTRATE 50 MG TABLET",0.33,0.33,0.05,0.33,8.2500000000000004E-2]
["Not Applicable - Not Applicable - 00378007801","Not Applicable","Not Applicable","NDC","00378007801","CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET",1.74,1.74,0.44,1.74,0.435]
["Not Applicable - Not Applicable - 00378008701","Not Applicable","Not Applicable","NDC","00378008701","MAPROTILINE 50 MG TABLET",14.71,14.71,2.46,14.71,3.6775000000000002]
["Not Applicable - Not Applicable - 00378013701","Not Applicable","Not Applicable","NDC","00378013701","ALLOPURINOL 100 MG TABLET",0.6,0.6,0.1,0.6,0.15]
["Not Applicable - Not Applicable - 00378013710","Not Applicable","Not Applicable","NDC","00378013710","ALLOPURINOL 100 MG TABLET",0.6,0.6,0.1,0.6,0.15]
["Not Applicable - Not Applicable - 00378015001","Not Applicable","Not Applicable","NDC","00378015001","CHLOROTHIAZIDE 250 MG TABLET",3.31,3.31,1.66,3.31,0.82750000000000001]
["Not Applicable - Not Applicable - 00378015601","Not Applicable","Not Applicable","NDC","00378015601","PROBENECID 500 MG TABLET",6.61,6.61,1.66,6.61,1.6525000000000001]
["Not Applicable - Not Applicable - 00378018101","Not Applicable","Not Applicable","NDC","00378018101","ALLOPURINOL 300 MG TABLET",25.23,25.23,25.23,25.23,6.3075000000000001]
["Not Applicable - Not Applicable - 00378018301","Not Applicable","Not Applicable","NDC","00378018301","PROPRANOLOL 20 MG TABLET",4.74,4.74,0.6,4.74,1.1850000000000001]
["Not Applicable - Not Applicable - 00378020801","Not Applicable","Not Applicable","NDC","00378020801","FUROSEMIDE 20 MG TABLET",0.67,0.67,0.09,0.67,0.16750000000000001]
["Not Applicable - Not Applicable - 00378021601","Not Applicable","Not Applicable","NDC","00378021601","FUROSEMIDE 40 MG TABLET",0.35,0.35,0.05,0.35,8.7499999999999994E-2]
["Not Applicable - Not Applicable - 00378035701","Not Applicable","Not Applicable","NDC","00378035701","PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE",2.2799999999999998,2.2799999999999998,2.2799999999999998,2.2799999999999998,0.56999999999999995]
["Not Applicable - Not Applicable - 00378041501","Not Applicable","Not Applicable","NDC","00378041501","DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET",4.6399999999999997,4.6399999999999997,2.3199999999999998,4.6399999999999997,1.1599999999999999]
["Not Applicable - Not Applicable - 00378042101","Not Applicable","Not Applicable","NDC","00378042101","METHYLDOPA 500 MG TABLET",1.2,1.2,0.6,1.2,0.3]
["Not Applicable - Not Applicable - 00378047701","Not Applicable","Not Applicable","NDC","00378047701","DIAZEPAM 10 MG TABLET",0.16,0.16,0.02,0.16,0.04]
["Not Applicable - Not Applicable - 00378048101","Not Applicable","Not Applicable","NDC","00378048101","NIFEDIPINE ER 60 MG TABLET,EXTENDED RELEASE 24 HR",5.4,5.4,1.8,5.4,1.35]
["Not Applicable - Not Applicable - 00378049401","Not Applicable","Not Applicable","NDC","00378049401","NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR",5.59,5.59,1.87,5.59,1.3975]
["Not Applicable - Not Applicable - 00378057205","Not Applicable","Not Applicable","NDC","00378057205","ALBUTEROL SULFATE 4 MG TABLET",16.7,16.7,8.35,16.7,4.1749999999999998]
["Not Applicable - Not Applicable - 00378061801","Not Applicable","Not Applicable","NDC","00378061801","THIORIDAZINE 100 MG TABLET",2.4700000000000002,2.4700000000000002,0.25,2.4700000000000002,0.61750000000000005]
["Not Applicable - Not Applicable - 00378087116","Not Applicable","Not Applicable","NDC","00378087116","CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH",94.14,94.14,94.14,94.14,23.535]
["Not Applicable - Not Applicable - 00378087199","Not Applicable","Not Applicable","NDC","00378087199","CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH",87.84,87.84,87.84,87.84,21.96]
["Not Applicable - Not Applicable - 00378087216","Not Applicable","Not Applicable","NDC","00378087216","CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH",158.49,158.49,158.49,158.49,39.622500000000002]
["Not Applicable - Not Applicable - 00378087316","Not Applicable","Not Applicable","NDC","00378087316","CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH",219.87,219.87,219.87,219.87,54.967500000000001]
["Not Applicable - Not Applicable - 00378100101","Not Applicable","Not Applicable","NDC","00378100101","THIOTHIXENE 1 MG CAPSULE",14.18,14.18,2.84,14.18,3.5449999999999999]
["Not Applicable - Not Applicable - 00378103077","Not Applicable","Not Applicable","NDC","00378103077","EPLERENONE 25 MG TABLET",9.2799999999999994,9.2799999999999994,4.6399999999999997,9.2799999999999994,2.3199999999999998]
["Not Applicable - Not Applicable - 00378103093","Not Applicable","Not Applicable","NDC","00378103093","EPLERENONE 25 MG TABLET",9.2799999999999994,9.2799999999999994,4.6399999999999997,9.2799999999999994,2.3199999999999998]
["Not Applicable - Not Applicable - 00378104901","Not Applicable","Not Applicable","NDC","00378104901","DOXEPIN 10 MG CAPSULE",6.99,6.99,1.4,6.99,1.7475000000000001]
["Not Applicable - Not Applicable - 00378110101","Not Applicable","Not Applicable","NDC","00378110101","PRAZOSIN 1 MG CAPSULE",8.02,8.02,1.61,8.02,2.0049999999999999]
["Not Applicable - Not Applicable - 00378116001","Not Applicable","Not Applicable","NDC","00378116001","GUANFACINE 1 MG TABLET",1.67,1.67,0.84,1.67,0.41749999999999998]
["Not Applicable - Not Applicable - 00378143077","Not Applicable","Not Applicable","NDC","00378143077","NICARDIPINE 30 MG CAPSULE",17.34,17.34,8.67,17.34,4.335]
["Not Applicable - Not Applicable - 00378173001","Not Applicable","Not Applicable","NDC","00378173001","URSODIOL 300 MG CAPSULE",13.97,13.97,13.97,13.97,3.4925000000000002]
["Not Applicable - Not Applicable - 00378180001","Not Applicable","Not Applicable","NDC","00378180001","LEVOTHYROXINE 25 MCG TABLET",10.35,10.35,1.3,10.35,2.5874999999999999]
["Not Applicable - Not Applicable - 00378180077","Not Applicable","Not Applicable","NDC","00378180077","LEVOTHYROXINE 25 MCG TABLET",9.67,9.67,1.21,9.67,2.4175]
["Not Applicable - Not Applicable - 00378180501","Not Applicable","Not Applicable","NDC","00378180501","LEVOTHYROXINE 75 MCG TABLET",4.33,4.33,0.55000000000000004,4.33,1.0825]
["Not Applicable - Not Applicable - 00378180577","Not Applicable","Not Applicable","NDC","00378180577","LEVOTHYROXINE 75 MCG TABLET",4.04,4.04,0.51,4.04,1.01]
["Not Applicable - Not Applicable - 00378180701","Not Applicable","Not Applicable","NDC","00378180701","LEVOTHYROXINE 88 MCG TABLET",3.76,3.76,0.47,3.76,0.94]
["Not Applicable - Not Applicable - 00378180977","Not Applicable","Not Applicable","NDC","00378180977","LEVOTHYROXINE 100 MCG TABLET",3.11,3.11,0.39,3.11,0.77749999999999997]
["Not Applicable - Not Applicable - 00378181101","Not Applicable","Not Applicable","NDC","00378181101","LEVOTHYROXINE 112 MCG TABLET",3.44,3.44,0.43,3.44,0.86]
["Not Applicable - Not Applicable - 00378181301","Not Applicable","Not Applicable","NDC","00378181301","LEVOTHYROXINE 125 MCG TABLET",3.13,3.13,0.4,3.13,0.78249999999999997]
["Not Applicable - Not Applicable - 00378181501","Not Applicable","Not Applicable","NDC","00378181501","LEVOTHYROXINE 150 MCG TABLET",2.0099999999999998,2.0099999999999998,0.34,2.0099999999999998,0.50249999999999995]
["Not Applicable - Not Applicable - 00378181701","Not Applicable","Not Applicable","NDC","00378181701","LEVOTHYROXINE 175 MCG TABLET",2.73,2.73,0.35,2.73,0.6825]
["Not Applicable - Not Applicable - 00378181901","Not Applicable","Not Applicable","NDC","00378181901","LEVOTHYROXINE 200 MCG TABLET",2.4,2.4,0.3,2.4,0.6]
["Not Applicable - Not Applicable - 00378193093","Not Applicable","Not Applicable","NDC","00378193093","EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET",2.56,2.56,2.56,2.56,0.64]
["Not Applicable - Not Applicable - 00378207410","Not Applicable","Not Applicable","NDC","00378207410","LISINOPRIL 10 MG TABLET",0.3,0.3,0.04,0.3,7.4999999999999997E-2]
["Not Applicable - Not Applicable - 00378210001","Not Applicable","Not Applicable","NDC","00378210001","LOPERAMIDE 2 MG CAPSULE",2.2000000000000002,2.2000000000000002,1.1000000000000001,2.2000000000000002,0.55000000000000004]
["Not Applicable - Not Applicable - 00378212205","Not Applicable","Not Applicable","NDC","00378212205","ATORVASTATIN 80 MG TABLET",1.87,1.87,1.87,1.87,0.46750000000000003]
["Not Applicable - Not Applicable - 00378212277","Not Applicable","Not Applicable","NDC","00378212277","ATORVASTATIN 80 MG TABLET",1.87,1.87,1.87,1.87,0.46750000000000003]
["Not Applicable - Not Applicable - 00378218001","Not Applicable","Not Applicable","NDC","00378218001","VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE",12.81,12.81,6.41,12.81,3.2025000000000001]
["Not Applicable - Not Applicable - 00378240501","Not Applicable","Not Applicable","NDC","00378240501","TRIFLUOPERAZINE 5 MG TABLET",3.77,3.77,0.76,3.77,0.9425]
["Not Applicable - Not Applicable - 00378253701","Not Applicable","Not Applicable","NDC","00378253701","TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG CAPSULE",1.2,1.2,1.2,1.2,0.3]
["Not Applicable - Not Applicable - 00378300501","Not Applicable","Not Applicable","NDC","00378300501","THIOTHIXENE 5 MG CAPSULE",5.69,5.69,2.2799999999999998,5.69,1.4225000000000001]
["Not Applicable - Not Applicable - 00378301701","Not Applicable","Not Applicable","NDC","00378301701","CAPTOPRIL 50 MG TABLET",10.3,10.3,1.29,10.3,2.5750000000000002]
["Not Applicable - Not Applicable - 00378312501","Not Applicable","Not Applicable","NDC","00378312501","DOXEPIN 25 MG CAPSULE",10.81,10.81,1.81,10.81,2.7025000000000001]
["Not Applicable - Not Applicable - 00378328691","Not Applicable","Not Applicable","NDC","00378328691","ETIDRONATE DISODIUM 200 MG TABLET",16.41,16.41,8.2100000000000009,16.41,4.1025]
["Not Applicable - Not Applicable - 00378335016","Not Applicable","Not Applicable","NDC","00378335016","ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH",65.959999999999994,65.959999999999994,65.959999999999994,65.959999999999994,16.489999999999998]
["Not Applicable - Not Applicable - 00378335099","Not Applicable","Not Applicable","NDC","00378335099","ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH",44.83,44.83,44.83,44.83,11.2075]
["Not Applicable - Not Applicable - 00378340493","Not Applicable","Not Applicable","NDC","00378340493","TOLTERODINE ER 4 MG CAPSULE,EXTENDED RELEASE 24 HR",28.52,28.52,14.26,28.52,7.13]
["Not Applicable - Not Applicable - 00378362777","Not Applicable","Not Applicable","NDC","00378362777","CLOPIDOGREL 75 MG TABLET",4.75,4.75,0.6,4.75,1.1875]
["Not Applicable - Not Applicable - 00378362793","Not Applicable","Not Applicable","NDC","00378362793","CLOPIDOGREL 75 MG TABLET",15.24,15.24,1.91,15.24,3.81]
["Not Applicable - Not Applicable - 00378395077","Not Applicable","Not Applicable","NDC","00378395077","ATORVASTATIN 10 MG TABLET",5.63,5.63,0.71,5.63,1.4075]
["Not Applicable - Not Applicable - 00378395277","Not Applicable","Not Applicable","NDC","00378395277","ATORVASTATIN 40 MG TABLET",2,2,0.5,2,0.5]
["Not Applicable - Not Applicable - 00378410591","Not Applicable","Not Applicable","NDC","00378410591","ABACAVIR 300 MG TABLET",33.57,33.57,16.79,33.57,8.3925000000000001]
["Not Applicable - Not Applicable - 00378427677","Not Applicable","Not Applicable","NDC","00378427677","VALACYCLOVIR 1 GRAM TABLET",8.59,8.59,2.15,8.59,2.1475]
["Not Applicable - Not Applicable - 00378427693","Not Applicable","Not Applicable","NDC","00378427693","VALACYCLOVIR 1 GRAM TABLET",8.19,8.19,2.0499999999999998,8.19,2.0474999999999999]
["Not Applicable - Not Applicable - 00378510093","Not Applicable","Not Applicable","NDC","00378510093","ITRACONAZOLE 100 MG CAPSULE",51.61,51.61,17.21,51.61,12.9025]
["Not Applicable - Not Applicable - 00378518593","Not Applicable","Not Applicable","NDC","00378518593","PRASUGREL 5 MG TABLET",3.32,3.32,3.32,3.32,0.83]
["Not Applicable - Not Applicable - 00378581377","Not Applicable","Not Applicable","NDC","00378581377","VALSARTAN 80 MG TABLET",4.42,4.42,0.56000000000000005,4.42,1.105]
["Not Applicable - Not Applicable - 00378617201","Not Applicable","Not Applicable","NDC","00378617201","METOLAZONE 2.5 MG TABLET",21.53,21.53,5.39,21.53,5.3825000000000003]
["Not Applicable - Not Applicable - 00378617301","Not Applicable","Not Applicable","NDC","00378617301","METOLAZONE 5 MG TABLET",12.24,12.24,3.06,12.24,3.06]
["Not Applicable - Not Applicable - 00378623301","Not Applicable","Not Applicable","NDC","00378623301","CITALOPRAM 40 MG TABLET",0.34,0.34,0.09,0.34,8.5000000000000006E-2]
["Not Applicable - Not Applicable - 00378647097","Not Applicable","Not Applicable","NDC","00378647097","SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH",20.94,20.94,20.94,20.94,5.2350000000000003]
["Not Applicable - Not Applicable - 00378660501","Not Applicable","Not Applicable","NDC","00378660501","OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR",18.07,18.07,6.03,18.07,4.5175000000000001]
["Not Applicable - Not Applicable - 00378668910","Not Applicable","Not Applicable","NDC","00378668910","PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE",0.67,0.67,0.34,0.67,0.16750000000000001]
["Not Applicable - Not Applicable - 00378668977","Not Applicable","Not Applicable","NDC","00378668977","PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE",0.75,0.75,0.38,0.75,0.1875]
["Not Applicable - Not Applicable - 00378672501","Not Applicable","Not Applicable","NDC","00378672501","ZONISAMIDE 25 MG CAPSULE",5.01,5.01,0.63,5.01,1.2524999999999999]
["Not Applicable - Not Applicable - 00378698232","Not Applicable","Not Applicable","NDC","00378698232","LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET",32.06,32.06,32.06,32.06,8.0150000000000006]
["Not Applicable - Not Applicable - 00378698288","Not Applicable","Not Applicable","NDC","00378698288","LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET",26.37,26.37,26.37,26.37,6.5925000000000002]
["Not Applicable - Not Applicable - 00378700293","Not Applicable","Not Applicable","NDC","00378700293","PAROXETINE 20 MG TABLET",0.93,0.93,0.24,0.93,0.23250000000000001]
["Not Applicable - Not Applicable - 00378702501","Not Applicable","Not Applicable","NDC","00378702501","LOXAPINE SUCCINATE 25 MG CAPSULE",9.48,9.48,4.74,9.48,2.37]
["Not Applicable - Not Applicable - 00378710077","Not Applicable","Not Applicable","NDC","00378710077","FENOFIBRATE 54 MG TABLET",5.98,5.98,2.02,5.98,1.4950000000000001]
["Not Applicable - Not Applicable - 00378710177","Not Applicable","Not Applicable","NDC","00378710177","FENOFIBRATE 160 MG TABLET",6.05,6.05,2.0499999999999998,6.05,1.5125]
["Not Applicable - Not Applicable - 00378715501","Not Applicable","Not Applicable","NDC","00378715501","BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE",44.25,44.25,14.75,44.25,11.0625]
["Not Applicable - Not Applicable - 00378905593","Not Applicable","Not Applicable","NDC","00378905593","LIDOCAINE 5 % TOPICAL PATCH",39.99,39.99,13.33,39.99,9.9975000000000005]
["Not Applicable - Not Applicable - 00378910293","Not Applicable","Not Applicable","NDC","00378910293","NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH",1.61,1.61,1.61,1.61,0.40250000000000002]
["Not Applicable - Not Applicable - 00378911216","Not Applicable","Not Applicable","NDC","00378911216","NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH",2.9,2.9,2.9,2.9,0.72499999999999998]
["Not Applicable - Not Applicable - 00378911693","Not Applicable","Not Applicable","NDC","00378911693","NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH",2.66,2.66,2.66,2.66,0.66500000000000004]
["Not Applicable - Not Applicable - 00378911916","Not Applicable","Not Applicable","NDC","00378911916","FENTANYL 12 MCG/HR TRANSDERMAL PATCH",57.7,57.7,57.7,57.7,14.425000000000001]
["Not Applicable - Not Applicable - 00378911998","Not Applicable","Not Applicable","NDC","00378911998","FENTANYL 12 MCG/HR TRANSDERMAL PATCH",53.85,53.85,53.85,53.85,13.4625]
["Not Applicable - Not Applicable - 00378912198","Not Applicable","Not Applicable","NDC","00378912198","FENTANYL 25 MCG/HR TRANSDERMAL PATCH",23.64,23.64,23.64,23.64,5.91]
["Not Applicable - Not Applicable - 00378912398","Not Applicable","Not Applicable","NDC","00378912398","FENTANYL 75 MCG/HR TRANSDERMAL PATCH",132.74,132.74,66.37,132.74,33.185000000000002]
["Not Applicable - Not Applicable - 00378929091","Not Applicable","Not Applicable","NDC","00378929091","SELEGILINE 5 MG TABLET",10.53,10.53,10.53,10.53,2.6324999999999998]
["Not Applicable - Not Applicable - 00395004912","Not Applicable","Not Applicable","NDC","00395004912","ALUM, AMMONIUM (BULK) POWDER",48.32,48.32,48.32,48.32,12.08]
["Not Applicable - Not Applicable - 00395009016","Not Applicable","Not Applicable","NDC","00395009016","COMPOUNDING VEHICLE SYRUP NO.23",47.05,47.05,47.05,47.05,11.762499999999999]
["Not Applicable - Not Applicable - 00395009416","Not Applicable","Not Applicable","NDC","00395009416","ORA-SWEET SUGAR FREE ORAL LIQUID",47.05,47.05,47.05,47.05,11.762499999999999]
["Not Applicable - Not Applicable - 00395041396","Not Applicable","Not Applicable","NDC","00395041396","CALAMINE 8 %-ZINC OXIDE 8 % LOTION",12.15,12.15,12.15,12.15,3.0375000000000001]
["Not Applicable - Not Applicable - 00395266116","Not Applicable","Not Applicable","NDC","00395266116","SIMPLE SYRUP",40.33,40.33,40.33,40.33,10.0825]
["Not Applicable - Not Applicable - 00395266216","Not Applicable","Not Applicable","NDC","00395266216","CHERRY FLAVOR (BULK) ORAL SYRUP",38.65,38.65,38.65,38.65,9.6624999999999996]
["Not Applicable - Not Applicable - 00395392085","Not Applicable","Not Applicable","NDC","00395392085","SUCROSE 83% SYRUP",1.82,1.82,1.82,1.82,0.45500000000000002]
["Not Applicable - Not Applicable - 00404651205","Not Applicable","Not Applicable","NDC","00404651205","LIDOCAINE 2 %-EPINEPHRINE BITARTRATE 1:100,000 INJECTION CARTRIDGE",0.57999999999999996,0.57999999999999996,0.57999999999999996,0.57999999999999996,0.14499999999999999]
["Not Applicable - Not Applicable - 00404673005","Not Applicable","Not Applicable","NDC","00404673005","MEPIVACAINE 30 MG/ML (3 %) INJECTION DENTAL CARTRIDGE",0.98,0.98,0.98,0.98,0.245]
["Not Applicable - Not Applicable - 00406048462","Not Applicable","Not Applicable","NDC","00406048462","ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET",0.59,0.59,0.3,0.59,0.14749999999999999]
["Not Applicable - Not Applicable - 00406051223","Not Applicable","Not Applicable","NDC","00406051223","OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET",2.92,2.92,1.46,2.92,0.73]
["Not Applicable - Not Applicable - 00406051262","Not Applicable","Not Applicable","NDC","00406051262","OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET",1.87,1.87,0.94,1.87,0.46750000000000003]
["Not Applicable - Not Applicable - 00406052704","Not Applicable","Not Applicable","NDC","00406052704","METHADONE 10 MG/ML ORAL CONCENTRATE",5.94,5.94,5.94,5.94,1.4850000000000001]
["Not Applicable - Not Applicable - 00406055223","Not Applicable","Not Applicable","NDC","00406055223","OXYCODONE 5 MG TABLET",6.4,6.4,1.6,6.4,1.6]
["Not Applicable - Not Applicable - 00406055262","Not Applicable","Not Applicable","NDC","00406055262","OXYCODONE 5 MG TABLET",3.64,3.64,0.91,3.64,0.91]
["Not Applicable - Not Applicable - 00406114201","Not Applicable","Not Applicable","NDC","00406114201","METHYLPHENIDATE 5 MG TABLET",2.5299999999999998,2.5299999999999998,0.64,2.5299999999999998,0.63249999999999995]
["Not Applicable - Not Applicable - 00406324401","Not Applicable","Not Applicable","NDC","00406324401","HYDROMORPHONE 4 MG TABLET",0.49,0.49,7.0000000000000007E-2,0.49,0.1225]
["Not Applicable - Not Applicable - 00406324552","Not Applicable","Not Applicable","NDC","00406324552","HYDROMORPHONE (BULK) 100 % POWDER",415.01,415.01,415.01,415.01,103.7525]
["Not Applicable - Not Applicable - 00406575523","Not Applicable","Not Applicable","NDC","00406575523","METHADONE 5 MG TABLET",6.19,6.19,1.04,6.19,1.5475000000000001]
["Not Applicable - Not Applicable - 00406575562","Not Applicable","Not Applicable","NDC","00406575562","METHADONE 5 MG TABLET",6.23,6.23,1.04,6.23,1.5575000000000001]
["Not Applicable - Not Applicable - 00406831523","Not Applicable","Not Applicable","NDC","00406831523","MORPHINE ER 15 MG TABLET,EXTENDED RELEASE",19.899999999999999,19.899999999999999,2.99,19.899999999999999,4.9749999999999996]
["Not Applicable - Not Applicable - 00406831562","Not Applicable","Not Applicable","NDC","00406831562","MORPHINE ER 15 MG TABLET,EXTENDED RELEASE",10.35,10.35,1.56,10.35,2.5874999999999999]
["Not Applicable - Not Applicable - 00406833062","Not Applicable","Not Applicable","NDC","00406833062","MORPHINE ER 30 MG TABLET,EXTENDED RELEASE",9.85,9.85,1.48,9.85,2.4624999999999999]
["Not Applicable - Not Applicable - 00406838023","Not Applicable","Not Applicable","NDC","00406838023","MORPHINE ER 60 MG TABLET,EXTENDED RELEASE",36.71,36.71,5.51,36.71,9.1775000000000002]
["Not Applicable - Not Applicable - 00406838062","Not Applicable","Not Applicable","NDC","00406838062","MORPHINE ER 60 MG TABLET,EXTENDED RELEASE",22.78,22.78,3.42,22.78,5.6950000000000003]
["Not Applicable - Not Applicable - 00406839062","Not Applicable","Not Applicable","NDC","00406839062","MORPHINE ER 100 MG TABLET,EXTENDED RELEASE",8.92,8.92,1.34,8.92,2.23]
["Not Applicable - Not Applicable - 00406853062","Not Applicable","Not Applicable","NDC","00406853062","OXYCODONE 30 MG TABLET",3.24,3.24,0.54,3.24,0.81]
["Not Applicable - Not Applicable - 00406895801","Not Applicable","Not Applicable","NDC","00406895801","DEXTROAMPHETAMINE 5 MG TABLET",5.51,5.51,2.76,5.51,1.3774999999999999]
["Not Applicable - Not Applicable - 00406900076","Not Applicable","Not Applicable","NDC","00406900076","FENTANYL 100 MCG/HR TRANSDERMAL PATCH",83.29,83.29,41.65,83.29,20.822500000000002]
["Not Applicable - Not Applicable - 00406901276","Not Applicable","Not Applicable","NDC","00406901276","FENTANYL 12 MCG/HR TRANSDERMAL PATCH",27.08,27.08,27.08,27.08,6.77]
["Not Applicable - Not Applicable - 00406905076","Not Applicable","Not Applicable","NDC","00406905076","FENTANYL 50 MCG/HR TRANSDERMAL PATCH",18.34,18.34,18.34,18.34,4.585]
["Not Applicable - Not Applicable - 00406917576","Not Applicable","Not Applicable","NDC","00406917576","FENTANYL 75 MCG/HR TRANSDERMAL PATCH",30.3,30.3,15.15,30.3,7.5750000000000002]
["Not Applicable - Not Applicable - 00409163110","Not Applicable","Not Applicable","NDC","00409163110","CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE",23.45,23.45,23.45,23.45,5.8624999999999998]
["Not Applicable - Not Applicable - 00409163201","Not Applicable","Not Applicable","NDC","00409163201","VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION",16.41,16.41,16.41,16.41,4.1025]
["Not Applicable - Not Applicable - 00409233934","Not Applicable","Not Applicable","NDC","00409233934","LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE",23.38,23.38,23.38,23.38,5.8449999999999998]
["Not Applicable - Not Applicable - 00409371410","Not Applicable","Not Applicable","NDC","00409371410","*DESENSITIZATION* NAFCILLIN 2G SOLN",31.66,31.66,31.66,31.66,7.915]
["Not Applicable - Not Applicable - 00409490034","Not Applicable","Not Applicable","NDC","00409490034","SODIUM BICARBONATE 10 MEQ/10 ML (8.4 %) INTRAVENOUS SYRINGE",42.99,42.99,42.99,42.99,10.7475]
["Not Applicable - Not Applicable - 00409490234","Not Applicable","Not Applicable","NDC","00409490234","DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE",31.09,31.09,31.09,31.09,7.7725]
["Not Applicable - Not Applicable - 00409492811","Not Applicable","Not Applicable","NDC","00409492811","CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE",34.29,34.29,34.29,34.29,8.5724999999999998]
["Not Applicable - Not Applicable - 00409492834","Not Applicable","Not Applicable","NDC","00409492834","CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE",30.38,30.38,30.38,30.38,7.5949999999999998]
["Not Applicable - Not Applicable - 00409553424","Not Applicable","Not Applicable","NDC","00409553424","SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) INTRAVENOUS SYRINGE",40.33,40.33,40.33,40.33,10.0825]
["Not Applicable - Not Applicable - 00409553434","Not Applicable","Not Applicable","NDC","00409553434","SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) INTRAVENOUS SYRINGE",32.4,32.4,32.4,32.4,8.1]
["Not Applicable - Not Applicable - 00409663734","Not Applicable","Not Applicable","NDC","00409663734","SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE",33.04,33.04,33.04,33.04,8.26]
["Not Applicable - Not Applicable - 00409664802","Not Applicable","Not Applicable","NDC","00409664802","DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION",10.130000000000001,10.130000000000001,10.130000000000001,10.130000000000001,2.5325000000000002]
["Not Applicable - Not Applicable - 00409729501","Not Applicable","Not Applicable","NDC","00409729501","POTASSIUM PHOSPHATE",45.89,45.89,45.89,45.89,11.4725]
["Not Applicable - Not Applicable - 00409751716","Not Applicable","Not Applicable","NDC","00409751716","DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE",30.38,30.38,30.38,30.38,7.5949999999999998]
["Not Applicable - Not Applicable - 00409751766","Not Applicable","Not Applicable","NDC","00409751766","DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE",32.69,32.69,32.69,32.69,8.1724999999999994]
["Not Applicable - Not Applicable - 00409767003","Not Applicable","Not Applicable","NDC","00409767003","ELECTROLYTE-R (PH 7.4) INTRAVENOUS SOLUTION",10.66,10.66,10.66,10.66,2.665]
["Not Applicable - Not Applicable - 00409767009","Not Applicable","Not Applicable","NDC","00409767009","ELECTROLYTE-R (PH 7.4) INTRAVENOUS SOLUTION",10.66,10.66,10.66,10.66,2.665]
["Not Applicable - Not Applicable - 00409771503","Not Applicable","Not Applicable","NDC","00409771503","MANNITOL 20 % INTRAVENOUS SOLUTION",37.31,37.31,37.31,37.31,9.3275000000000006]
["Not Applicable - Not Applicable - 00409771513","Not Applicable","Not Applicable","NDC","00409771513","MANNITOL 20 % INTRAVENOUS SOLUTION",67.5,67.5,67.5,67.5,16.875]
["Not Applicable - Not Applicable - 00409792203","Not Applicable","Not Applicable","NDC","00409792203","INV DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION",12.44,12.44,12.44,12.44,3.11]
["Not Applicable - Not Applicable - 00409792209","Not Applicable","Not Applicable","NDC","00409792209","DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION",10.66,10.66,10.66,10.66,2.665]
["Not Applicable - Not Applicable - 00409792230","Not Applicable","Not Applicable","NDC","00409792230","DEXTROSE 5 % IN WATER (D5W) IV NON-PVC",5.33,5.33,5.33,5.33,1.3325]
["Not Applicable - Not Applicable - 00409792248","Not Applicable","Not Applicable","NDC","00409792248","DEXTROSE 5 % IN WATER (D5W) IV NON-PVC",14.21,14.21,14.21,14.21,3.5525000000000002]
["Not Applicable - Not Applicable - 00409792253","Not Applicable","Not Applicable","NDC","00409792253","INV DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION",10.66,10.66,10.66,10.66,2.665]
["Not Applicable - Not Applicable - 00409792306","Not Applicable","Not Applicable","NDC","00409792306","DEXTROSE 5 % IN WATER (D5W) IV NON-PVC",10.48,10.48,10.48,10.48,2.62]
["Not Applicable - Not Applicable - 00409792311","Not Applicable","Not Applicable","NDC","00409792311","DEXTROSE 5 % IN WATER (D5W) IV NON-PVC",10.31,10.31,10.31,10.31,2.5775000000000001]
["Not Applicable - Not Applicable - 00409792609","Not Applicable","Not Applicable","NDC","00409792609","DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION",10.66,10.66,10.66,10.66,2.665]
["Not Applicable - Not Applicable - 00409793009","Not Applicable","Not Applicable","NDC","00409793009","DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS BOLUS",10.66,10.66,10.66,10.66,2.665]
["Not Applicable - Not Applicable - 00409793519","Not Applicable","Not Applicable","NDC","00409793519","DEXTROSE 20 % IN WATER (D20W) INTRAVENOUS SOLUTION",14.21,14.21,14.21,14.21,3.5525000000000002]
["Not Applicable - Not Applicable - 00409798303","Not Applicable","Not Applicable","NDC","00409798303","INV SODIUM CHLORIDE 0.9 % IV SOLP",10.66,10.66,10.66,10.66,2.665]
["Not Applicable - Not Applicable - 00409798353","Not Applicable","Not Applicable","NDC","00409798353","SODIUM CHLORIDE 0.9 % IV SOLP",10.66,10.66,10.66,10.66,2.665]
["Not Applicable - Not Applicable - 00409798406","Not Applicable","Not Applicable","NDC","00409798406","SODIUM CHLORIDE 0.9 % IV NON-PVC",18.12,18.12,18.12,18.12,4.53]
["Not Applicable - Not Applicable - 00409798411","Not Applicable","Not Applicable","NDC","00409798411","SODIUM CHLORIDE 0.9 % IV NON-PVC",18.48,18.48,18.48,18.48,4.62]
["Not Applicable - Not Applicable - 00409798503","Not Applicable","Not Applicable","NDC","00409798503","SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION",10.66,10.66,10.66,10.66,2.665]
["Not Applicable - Not Applicable - 00409798509","Not Applicable","Not Applicable","NDC","00409798509","SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION",10.66,10.66,10.66,10.66,2.665]
["Not Applicable - Not Applicable - 00456045801","Not Applicable","Not Applicable","NDC","00456045801","THYROID (PORK) 30 MG TABLET",11.03,11.03,2.76,11.03,2.7574999999999998]
["Not Applicable - Not Applicable - 00456045901","Not Applicable","Not Applicable","NDC","00456045901","THYROID (PORK) 60 MG TABLET",6.13,6.13,1.54,6.13,1.5325]
["Not Applicable - Not Applicable - 00456320563","Not Applicable","Not Applicable","NDC","00456320563","MEMANTINE 5 MG TABLET",49.14,49.14,24.57,49.14,12.285]
["Not Applicable - Not Applicable - 00456333001","Not Applicable","Not Applicable","NDC","00456333001","ACAMPROSATE 333 MG TABLET,DELAYED RELEASE",10.41,10.41,5.21,10.41,2.6025]
["Not Applicable - Not Applicable - 00456430001","Not Applicable","Not Applicable","NDC","00456430001","FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET",308.04000000000002,308.04000000000002,308.04000000000002,308.04000000000002,77.010000000000005]
["Not Applicable - Not Applicable - 00456430008","Not Applicable","Not Applicable","NDC","00456430008","FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET",324.24,324.24,324.24,324.24,81.06]
["Not Applicable - Not Applicable - 00469052014","Not Applicable","Not Applicable","NDC","00469052014","ISAVUCONAZONIUM SULFATE 186 MG CAPSULE",631.86,631.86,631.86,631.86,157.965]
["Not Applicable - Not Applicable - 00472017934","Not Applicable","Not Applicable","NDC","00472017934","NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT",9.4499999999999993,9.4499999999999993,9.4499999999999993,9.4499999999999993,2.3624999999999998]
["Not Applicable - Not Applicable - 00472022041","Not Applicable","Not Applicable","NDC","00472022041","CLOTRIMAZOLE 1 % VAGINAL CREAM",19.190000000000001,19.190000000000001,19.190000000000001,19.190000000000001,4.7975000000000003]
["Not Applicable - Not Applicable - 00472024260","Not Applicable","Not Applicable","NDC","00472024260","PERMETHRIN 5 % TOPICAL CREAM",328.26,328.26,328.26,328.26,82.064999999999998]
["Not Applicable - Not Applicable - 00472032126","Not Applicable","Not Applicable","NDC","00472032126","HYDROCORTISONE 1 % TOPICAL CREAM",14.94,14.94,14.94,14.94,3.7349999999999999]
["Not Applicable - Not Applicable - 00472033956","Not Applicable","Not Applicable","NDC","00472033956","HYDROCORTISONE 1 % TOPICAL CREAM",6.57,6.57,6.57,6.57,1.6425000000000001]
["Not Applicable - Not Applicable - 00472073514","Not Applicable","Not Applicable","NDC","00472073514","MICONAZOLE NITRATE 2 % TOPICAL CREAM",4.93,4.93,4.93,4.93,1.2324999999999999]
["Not Applicable - Not Applicable - 00472082516","Not Applicable","Not Applicable","NDC","00472082516","ALBUTEROL SULFATE 2 MG/5 ML ORAL SYRUP",70.58,70.58,70.58,70.58,17.645]
["Not Applicable - Not Applicable - 00472125594","Not Applicable","Not Applicable","NDC","00472125594","IBUPROFEN 100 MG/5 ML ORAL SUSPENSION",13,13,13,13,3.25]
["Not Applicable - Not Applicable - 00472173803","Not Applicable","Not Applicable","NDC","00472173803","MICONAZOLE NITRATE 200 MG VAGINAL SUPPOSITORY",39.72,39.72,39.72,39.72,9.93]
["Not Applicable - Not Applicable - 00472524267","Not Applicable","Not Applicable","NDC","00472524267","PERMETHRIN 1 % TOPICAL LIQUID",23.27,23.27,23.27,23.27,5.8174999999999999]
["Not Applicable - Not Applicable - 00472524269","Not Applicable","Not Applicable","NDC","00472524269","PERMETHRIN 1 % TOPICAL LIQUID",18.03,18.03,18.03,18.03,4.5075000000000003]
["Not Applicable - Not Applicable - 00486111101","Not Applicable","Not Applicable","NDC","00486111101","POTASSIUM PHOSPHATE, MONOBASIC 500 MG SOLUBLE TABLET",3.22,3.22,1.61,3.22,0.80500000000000005]
["Not Applicable - Not Applicable - 00486112501","Not Applicable","Not Applicable","NDC","00486112501","SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET",4.5,4.5,2.25,4.5,1.125]
["Not Applicable - Not Applicable - 00487590199","Not Applicable","Not Applicable","NDC","00487590199","RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION",4.3899999999999997,4.3899999999999997,4.3899999999999997,4.3899999999999997,1.0974999999999999]
["Not Applicable - Not Applicable - 00496088205","Not Applicable","Not Applicable","NDC","00496088205","LIDOCAINE 4 % TOPICAL CREAM",29.31,29.31,29.31,29.31,7.3274999999999997]
["Not Applicable - Not Applicable - 00496088207","Not Applicable","Not Applicable","NDC","00496088207","LIDOCAINE-TRANSPARENT DRESSING 4 % TOPICAL KIT",31.32,31.32,31.32,31.32,7.83]
["Not Applicable - Not Applicable - 00521238400","Not Applicable","Not Applicable","NDC","00521238400","WHITE PETROLATUM TOPICAL JELLY",9.33,9.33,9.33,9.33,2.3325]
["Not Applicable - Not Applicable - 00527105001","Not Applicable","Not Applicable","NDC","00527105001","ACETAZOLAMIDE 250 MG TABLET",6.24,6.24,1.56,6.24,1.56]
["Not Applicable - Not Applicable - 00527130101","Not Applicable","Not Applicable","NDC","00527130101","PRIMIDONE 50 MG TABLET",2.1,2.1,0.42,2.1,0.52500000000000002]
["Not Applicable - Not Applicable - 00527131101","Not Applicable","Not Applicable","NDC","00527131101","TERBUTALINE 5 MG TABLET",14.4,14.4,7.2,14.4,3.6]
["Not Applicable - Not Applicable - 00527131301","Not Applicable","Not Applicable","NDC","00527131301","PILOCARPINE 5 MG TABLET",1.8,1.8,1.2,1.8,0.45]
["Not Applicable - Not Applicable - 00527131801","Not Applicable","Not Applicable","NDC","00527131801","TERBUTALINE 2.5 MG TABLET",25.02,25.02,12.51,25.02,6.2549999999999999]
["Not Applicable - Not Applicable - 00527132601","Not Applicable","Not Applicable","NDC","00527132601","URSODIOL 300 MG CAPSULE",4.1500000000000004,4.1500000000000004,4.1500000000000004,4.1500000000000004,1.0375000000000001]
["Not Applicable - Not Applicable - 00527134101","Not Applicable","Not Applicable","NDC","00527134101","LEVOTHYROXINE 25 MCG TABLET",10.26,10.26,1.29,10.26,2.5649999999999999]
["Not Applicable - Not Applicable - 00527136801","Not Applicable","Not Applicable","NDC","00527136801","DANAZOL 100 MG CAPSULE",25.25,25.25,6.32,25.25,6.3125]
["Not Applicable - Not Applicable - 00527141310","Not Applicable","Not Applicable","NDC","00527141310","HYDROCHLOROTHIAZIDE 25 MG TABLET",7.0000000000000007E-2,7.0000000000000007E-2,7.0000000000000007E-2,7.0000000000000007E-2,1.7500000000000002E-2]
["Not Applicable - Not Applicable - 00527179001","Not Applicable","Not Applicable","NDC","00527179001","FLUPHENAZINE 5 MG TABLET",18.29,18.29,1.83,18.29,4.5724999999999998]
["Not Applicable - Not Applicable - 00527193206","Not Applicable","Not Applicable","NDC","00527193206","CLARITHROMYCIN 500 MG TABLET",2.3199999999999998,2.3199999999999998,1.1599999999999999,2.3199999999999998,0.57999999999999996]
["Not Applicable - Not Applicable - 00527410737","Not Applicable","Not Applicable","NDC","00527410737","MEXILETINE 150 MG CAPSULE",2.82,2.82,1.69,2.82,0.70499999999999996]
["Not Applicable - Not Applicable - 00527530164","Not Applicable","Not Applicable","NDC","00527530164","CLOBAZAM 2.5 MG/ML ORAL SUSPENSION",185.02,185.02,185.02,185.02,46.255000000000003]
["Not Applicable - Not Applicable - 00536002583","Not Applicable","Not Applicable","NDC","00536002583","ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP",0.54,0.54,0.27,0.54,0.13500000000000001]
["Not Applicable - Not Applicable - 00536009185","Not Applicable","Not Applicable","NDC","00536009185","ALUMINUM HYDROXIDE GEL 320 MG/5 ML ORAL SUSPENSION",0.35,0.35,0.12,0.35,8.7499999999999994E-2]
["Not Applicable - Not Applicable - 00536012285","Not Applicable","Not Applicable","NDC","00536012285","ACETAMINOPHEN 160 MG/5 ML ORAL ELIXIR",11.77,11.77,11.77,11.77,2.9424999999999999]
["Not Applicable - Not Applicable - 00536016097","Not Applicable","Not Applicable","NDC","00536016097","ASCORBIC ACID (VITAMIN C) 500 MG/5 ML ORAL SYRUP",1.76,1.76,0.3,1.76,0.44]
["Not Applicable - Not Applicable - 00536071080","Not Applicable","Not Applicable","NDC","00536071080","FERROUS SULFATE 15 MG IRON (75 MG)/ML ORAL DROPS",7.64,7.64,7.64,7.64,1.91]
["Not Applicable - Not Applicable - 00536102410","Not Applicable","Not Applicable","NDC","00536102410","CALCIUM CARBONATE 260 MG CALCIUM (648 MG) TABLET",0.03,0.03,0.03,0.03,7.4999999999999997E-3]
["Not Applicable - Not Applicable - 00536104815","Not Applicable","Not Applicable","NDC","00536104815","CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET",0.06,0.06,0.03,0.06,1.4999999999999999E-2]
["Not Applicable - Not Applicable - 00536105305","Not Applicable","Not Applicable","NDC","00536105305","ASPIRIN 325 MG TABLET",0.05,0.05,0.03,0.05,1.2500000000000001E-2]
["Not Applicable - Not Applicable - 00536105429","Not Applicable","Not Applicable","NDC","00536105429","ASPIRIN 325 MG TABLET",7.0000000000000007E-2,7.0000000000000007E-2,0.04,7.0000000000000007E-2,1.7500000000000002E-2]
["Not Applicable - Not Applicable - 00536105556","Not Applicable","Not Applicable","NDC","00536105556","BENZOYL PEROXIDE 5 % TOPICAL GEL",6.65,6.65,6.65,6.65,1.6625000000000001]
["Not Applicable - Not Applicable - 00536105656","Not Applicable","Not Applicable","NDC","00536105656","BENZOYL PEROXIDE 10 % TOPICAL GEL",9.06,9.06,9.06,9.06,2.2650000000000001]
["Not Applicable - Not Applicable - 00536106210","Not Applicable","Not Applicable","NDC","00536106210","DOCUSATE SODIUM 100 MG CAPSULE",0.04,0.04,0.04,0.04,0.01]
["Not Applicable - Not Applicable - 00536108494","Not Applicable","Not Applicable","NDC","00536108494","POLYVINYL ALCOHOL 1.4 % EYE DROPS",5.23,5.23,5.23,5.23,1.3075000000000001]
["Not Applicable - Not Applicable - 00536108691","Not Applicable","Not Applicable","NDC","00536108691","WHITE PETROLATUM-MINERAL OIL 83 %-15 % EYE OINTMENT",9.74,9.74,9.74,9.74,2.4350000000000001]
["Not Applicable - Not Applicable - 00536110688","Not Applicable","Not Applicable","NDC","00536110688","NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH",7.86,7.86,7.86,7.86,1.9650000000000001]
["Not Applicable - Not Applicable - 00536111825","Not Applicable","Not Applicable","NDC","00536111825","CAPSAICIN 0.075 % TOPICAL CREAM",11.55,11.55,11.55,11.55,2.8875000000000002]
["Not Applicable - Not Applicable - 00536120610","Not Applicable","Not Applicable","NDC","00536120610","CALCIUM CARBONATE 260 MG CALCIUM (648 MG) TABLET",0.03,0.03,0.03,0.03,7.4999999999999997E-3]
["Not Applicable - Not Applicable - 00536123441","Not Applicable","Not Applicable","NDC","00536123441","ASPIRIN 81 MG TABLET,DELAYED RELEASE",0.28999999999999998,0.28999999999999998,0.04,0.28999999999999998,7.2499999999999995E-2]
["Not Applicable - Not Applicable - 00536123927","Not Applicable","Not Applicable","NDC","00536123927","NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE",3,3,1.5,3,0.75]
["Not Applicable - Not Applicable - 00536123981","Not Applicable","Not Applicable","NDC","00536123981","NICOTINE (POLACRILEX) 2 MG BUCCAL LOZENGE SUPERORDERABLE",2.02,2.02,1.01,2.02,0.505]
["Not Applicable - Not Applicable - 00536126812","Not Applicable","Not Applicable","NDC","00536126812","CAMPHOR-MENTHOL 0.5 %-0.5 % LOTION",12.62,12.62,12.62,12.62,3.1549999999999998]
["Not Applicable - Not Applicable - 00536128636","Not Applicable","Not Applicable","NDC","00536128636","BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION",5.9,5.9,5.9,5.9,1.4750000000000001]
["Not Applicable - Not Applicable - 00536135501","Not Applicable","Not Applicable","NDC","00536135501","BISACODYL 10 MG RECTAL SUPPOSITORY",0.28999999999999998,0.28999999999999998,0.15,0.28999999999999998,7.2499999999999995E-2]
["Not Applicable - Not Applicable - 00536194583","Not Applicable","Not Applicable","NDC","00536194583","ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP",0.43,0.43,0.22,0.43,0.1075]
["Not Applicable - Not Applicable - 00536199553","Not Applicable","Not Applicable","NDC","00536199553","SELENIUM SULFIDE 1 % SHAMPOO",8.09,8.09,8.09,8.09,2.0225]
["Not Applicable - Not Applicable - 00536242558","Not Applicable","Not Applicable","NDC","00536242558","PHENOL 1.4 % MUCOSAL AEROSOL SPRAY",10.69,10.69,10.69,10.69,2.6724999999999999]
["Not Applicable - Not Applicable - 00536252525","Not Applicable","Not Applicable","NDC","00536252525","CAPSAICIN 0.025 % TOPICAL CREAM",10.02,10.02,10.02,10.02,2.5049999999999999]
["Not Applicable - Not Applicable - 00536277085","Not Applicable","Not Applicable","NDC","00536277085","CALCIUM GLUBIONATE 115 MG/5 ML (1.8 GRAM/5 ML) ORAL SYRUP",45.37,45.37,45.37,45.37,11.342499999999999]
["Not Applicable - Not Applicable - 00536331310","Not Applicable","Not Applicable","NDC","00536331310","ASPIRIN 325 MG TABLET,DELAYED RELEASE",0.08,0.08,0.01,0.08,0.02]
["Not Applicable - Not Applicable - 00536333401","Not Applicable","Not Applicable","NDC","00536333401","CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET",0.05,0.05,0.02,0.05,1.2500000000000001E-2]
["Not Applicable - Not Applicable - 00536338101","Not Applicable","Not Applicable","NDC","00536338101","BISACODYL 5 MG TABLET,DELAYED RELEASE",0.23,0.23,0.12,0.23,5.7500000000000002E-2]
["Not Applicable - Not Applicable - 00536338601","Not Applicable","Not Applicable","NDC","00536338601","NICOTINE (POLACRILEX) 2 MG GUM",2.3199999999999998,2.3199999999999998,1.1599999999999999,2.3199999999999998,0.57999999999999996]
["Not Applicable - Not Applicable - 00536352141","Not Applicable","Not Applicable","NDC","00536352141","MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET",0.12,0.12,0.06,0.12,0.03]
["Not Applicable - Not Applicable - 00536354201","Not Applicable","Not Applicable","NDC","00536354201","CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET",0.43,0.43,0.05,0.43,0.1075]
["Not Applicable - Not Applicable - 00536398501","Not Applicable","Not Applicable","NDC","00536398501","MECLIZINE 12.5 MG TABLET",0.43,0.43,0.11,0.43,0.1075]
["Not Applicable - Not Applicable - 00536407601","Not Applicable","Not Applicable","NDC","00536407601","NIACIN 100 MG TABLET",0.32,0.32,7.0000000000000007E-2,0.32,0.08]
["Not Applicable - Not Applicable - 00536440601","Not Applicable","Not Applicable","NDC","00536440601","PYRIDOXINE (VITAMIN B6) 25 MG TABLET",0.2,0.2,0.05,0.2,0.05]
["Not Applicable - Not Applicable - 00536440801","Not Applicable","Not Applicable","NDC","00536440801","PYRIDOXINE (VITAMIN B6) 50 MG TABLET",0.12,0.12,0.03,0.12,0.03]
["Not Applicable - Not Applicable - 00536454410","Not Applicable","Not Applicable","NDC","00536454410","SODIUM BICARBONATE 650 MG TABLET",0.06,0.06,0.06,0.06,1.4999999999999999E-2]
["Not Applicable - Not Applicable - 00536570028","Not Applicable","Not Applicable","NDC","00536570028","ZINC OXIDE 20 % TOPICAL OINTMENT",8.1,8.1,8.1,8.1,2.0249999999999999]
["Not Applicable - Not Applicable - 00536570098","Not Applicable","Not Applicable","NDC","00536570098","ZINC OXIDE 20 % TOPICAL OINTMENT",17.75,17.75,17.75,17.75,4.4375]
["Not Applicable - Not Applicable - 00536589453","Not Applicable","Not Applicable","NDC","00536589453","NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH",5.29,5.29,5.29,5.29,1.3225]
["Not Applicable - Not Applicable - 00536589488","Not Applicable","Not Applicable","NDC","00536589488","NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH",4.24,4.24,4.24,4.24,1.06]
["Not Applicable - Not Applicable - 00536589588","Not Applicable","Not Applicable","NDC","00536589588","NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH",4.24,4.24,4.24,4.24,1.06]
["Not Applicable - Not Applicable - 00536589688","Not Applicable","Not Applicable","NDC","00536589688","NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH",4.24,4.24,4.24,4.24,1.06]
["Not Applicable - Not Applicable - 00536741551","Not Applicable","Not Applicable","NDC","00536741551","SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA",2.37,2.37,2.37,2.37,0.59250000000000003]
["Not Applicable - Not Applicable - 00536845080","Not Applicable","Not Applicable","NDC","00536845080","PEDIATRIC MULTIVITAMIN NO.20 1,500 UNIT-35 MG-400 UNIT/ML ORAL DROPS",11.02,11.02,11.02,11.02,2.7549999999999999]
["Not Applicable - Not Applicable - 00555006602","Not Applicable","Not Applicable","NDC","00555006602","ISONIAZID 100 MG TABLET",0.7,0.7,0.24,0.7,0.17499999999999999]
["Not Applicable - Not Applicable - 00555007101","Not Applicable","Not Applicable","NDC","00555007101","ISONIAZID 300 MG TABLET",0.8,0.8,0.27,0.8,0.2]
["Not Applicable - Not Applicable - 00555007102","Not Applicable","Not Applicable","NDC","00555007102","ISONIAZID 300 MG TABLET",0.55000000000000004,0.55000000000000004,0.19,0.55000000000000004,0.13750000000000001]
["Not Applicable - Not Applicable - 00555013809","Not Applicable","Not Applicable","NDC","00555013809","GALANTAMINE 4 MG TABLET",21.63,21.63,7.21,21.63,5.4074999999999998]
["Not Applicable - Not Applicable - 00555015802","Not Applicable","Not Applicable","NDC","00555015802","CHLORDIAZEPOXIDE 5 MG CAPSULE",1.34,1.34,0.27,1.34,0.33500000000000002]
["Not Applicable - Not Applicable - 00555015902","Not Applicable","Not Applicable","NDC","00555015902","CHLORDIAZEPOXIDE 25 MG CAPSULE",0.24,0.24,0.05,0.24,0.06]
["Not Applicable - Not Applicable - 00555048402","Not Applicable","Not Applicable","NDC","00555048402","LEUCOVORIN CALCIUM 5 MG TABLET",19.899999999999999,19.899999999999999,3.98,19.899999999999999,4.9749999999999996]
["Not Applicable - Not Applicable - 00555061214","Not Applicable","Not Applicable","NDC","00555061214","PRAMIPEXOLE 0.25 MG TABLET",4.1399999999999997,4.1399999999999997,0.35,4.1399999999999997,1.0349999999999999]
["Not Applicable - Not Applicable - 00555061414","Not Applicable","Not Applicable","NDC","00555061414","PRAMIPEXOLE 1 MG TABLET",1.04,1.04,0.09,1.04,0.26]
["Not Applicable - Not Applicable - 00555061514","Not Applicable","Not Applicable","NDC","00555061514","PRAMIPEXOLE 1.5 MG TABLET",0.69,0.69,0.06,0.69,0.17249999999999999]
["Not Applicable - Not Applicable - 00555061762","Not Applicable","Not Applicable","NDC","00555061762","PRAMIPEXOLE 0.125 MG TABLET",8.2799999999999994,8.2799999999999994,0.69,8.2799999999999994,2.0699999999999998]
["Not Applicable - Not Applicable - 00555063402","Not Applicable","Not Applicable","NDC","00555063402","DANAZOL 100 MG CAPSULE",9.35,9.35,2.34,9.35,2.3374999999999999]
["Not Applicable - Not Applicable - 00555077902","Not Applicable","Not Applicable","NDC","00555077902","MEDROXYPROGESTERONE 10 MG TABLET",0.46,0.46,0.23,0.46,0.115]
["Not Applicable - Not Applicable - 00555080802","Not Applicable","Not Applicable","NDC","00555080802","TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE",25.43,25.43,25.43,25.43,6.3574999999999999]
["Not Applicable - Not Applicable - 00555088602","Not Applicable","Not Applicable","NDC","00555088602","ESTRADIOL 1 MG TABLET",0.88,0.88,0.22,0.88,0.22]
["Not Applicable - Not Applicable - 00555090201","Not Applicable","Not Applicable","NDC","00555090201","NALTREXONE 50 MG TABLET",30.3,30.3,5.05,30.3,7.5750000000000002]
["Not Applicable - Not Applicable - 00555095202","Not Applicable","Not Applicable","NDC","00555095202","DEXTROAMPHETAMINE 5 MG TABLET",9.9499999999999993,9.9499999999999993,4.9800000000000004,9.9499999999999993,2.4874999999999998]
["Not Applicable - Not Applicable - 00555098037","Not Applicable","Not Applicable","NDC","00555098037","NIMODIPINE 30 MG CAPSULE",49.56,49.56,24.78,49.56,12.39]
["Not Applicable - Not Applicable - 00555099702","Not Applicable","Not Applicable","NDC","00555099702","FLUDROCORTISONE 0.1 MG TABLET",2.85,2.85,0.72,2.85,0.71250000000000002]
["Not Applicable - Not Applicable - 00555100916","Not Applicable","Not Applicable","NDC","00555100916","CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH",79.47,79.47,79.47,79.47,19.8675]
["Not Applicable - Not Applicable - 00555101016","Not Applicable","Not Applicable","NDC","00555101016","CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH",132.97,132.97,132.97,132.97,33.2425]
["Not Applicable - Not Applicable - 00574006915","Not Applicable","Not Applicable","NDC","00574006915","GLUCOSE GEL 40 % ORAL GEL",9.1999999999999993,9.1999999999999993,9.1999999999999993,9.1999999999999993,2.2999999999999998]
["Not Applicable - Not Applicable - 00574010601","Not Applicable","Not Applicable","NDC","00574010601","BROMOCRIPTINE 2.5 MG TABLET",3.13,3.13,3.13,3.13,0.78249999999999997]
["Not Applicable - Not Applicable - 00574010777","Not Applicable","Not Applicable","NDC","00574010777","CLOTRIMAZOLE 10 MG TROCHE",1.86,1.86,1.86,1.86,0.46500000000000002]
["Not Applicable - Not Applicable - 00574012074","Not Applicable","Not Applicable","NDC","00574012074","ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSPENSION",42.63,42.63,42.63,42.63,10.657500000000001]
["Not Applicable - Not Applicable - 00574012076","Not Applicable","Not Applicable","NDC","00574012076","ACTIVATED CHARCOAL-SORBITOL 50 GRAM/240 ML ORAL SUSPENSION",60.54,60.54,60.54,60.54,15.135]
["Not Applicable - Not Applicable - 00574012104","Not Applicable","Not Applicable","NDC","00574012104","ACTIVATED CHARCOAL 25 GRAM/120 ML ORAL SUSPENSION",44.34,44.34,44.34,44.34,11.085000000000001]
["Not Applicable - Not Applicable - 00574012108","Not Applicable","Not Applicable","NDC","00574012108","ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION",62.24,62.24,62.24,62.24,15.56]
["Not Applicable - Not Applicable - 00574012174","Not Applicable","Not Applicable","NDC","00574012174","ACTIVATED CHARCOAL 25 GRAM/120 ML ORAL SUSPENSION",42.63,42.63,42.63,42.63,10.657500000000001]
["Not Applicable - Not Applicable - 00574012901","Not Applicable","Not Applicable","NDC","00574012901","CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION",63.59,63.59,63.59,63.59,15.897500000000001]
["Not Applicable - Not Applicable - 00574014704","Not Applicable","Not Applicable","NDC","00574014704","FAMOTIDINE 40 MG/5 ML ORAL SUSPENSION (PEDIATRIC)",517.96,517.96,517.96,517.96,129.49]
["Not Applicable - Not Applicable - 00574015004","Not Applicable","Not Applicable","NDC","00574015004","MIDAZOLAM 2 MG/ML ORAL SYRUP",141.27000000000001,141.27000000000001,141.27000000000001,141.27000000000001,35.317500000000003]
["Not Applicable - Not Applicable - 00574022201","Not Applicable","Not Applicable","NDC","00574022201","LIOTHYRONINE 25 MCG TABLET",8.1,8.1,0.54,8.1,2.0249999999999999]
["Not Applicable - Not Applicable - 00574025001","Not Applicable","Not Applicable","NDC","00574025001","HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET",4.84,4.84,2.42,4.84,1.21]
["Not Applicable - Not Applicable - 00574029201","Not Applicable","Not Applicable","NDC","00574029201","AMILORIDE 5 MG TABLET",1.31,1.31,0.66,1.31,0.32750000000000001]
["Not Applicable - Not Applicable - 00574030216","Not Applicable","Not Applicable","NDC","00574030216","ORA-SWEET SUGAR FREE ORAL LIQUID",47.05,47.05,47.05,47.05,11.762499999999999]
["Not Applicable - Not Applicable - 00574030416","Not Applicable","Not Applicable","NDC","00574030416","COMPOUNDING VEHICLE SYRUP NO.23",47.05,47.05,47.05,47.05,11.762499999999999]
["Not Applicable - Not Applicable - 00574041207","Not Applicable","Not Applicable","NDC","00574041207","POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET",149.51,149.51,149.51,149.51,37.377499999999998]
["Not Applicable - Not Applicable - 00574050811","Not Applicable","Not Applicable","NDC","00574050811","FERROUS GLUCONATE 324 MG (38 MG IRON) TABLET",0.25,0.25,0.25,0.25,6.25E-2]
["Not Applicable - Not Applicable - 00574052174","Not Applicable","Not Applicable","NDC","00574052174","ACTIVATED CHARCOAL 25 GRAM/120 ML ORAL SUSPENSION",42.63,42.63,42.63,42.63,10.657500000000001]
["Not Applicable - Not Applicable - 00574200802","Not Applicable","Not Applicable","NDC","00574200802","NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER",40.08,40.08,40.08,40.08,10.02]
["Not Applicable - Not Applicable - 00574200815","Not Applicable","Not Applicable","NDC","00574200815","NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER",11.09,11.09,11.09,11.09,2.7725]
["Not Applicable - Not Applicable - 00574402135","Not Applicable","Not Applicable","NDC","00574402135","BACITRACIN-POLYMYXIN B 500 UNIT-10,000 UNIT/GRAM EYE OINTMENT",30.09,30.09,30.09,30.09,7.5225]
["Not Applicable - Not Applicable - 00574402411","Not Applicable","Not Applicable","NDC","00574402411","ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT",25.75,25.75,25.75,25.75,6.4375]
["Not Applicable - Not Applicable - 00574414435","Not Applicable","Not Applicable","NDC","00574414435","NEOMYCIN-BACITRACIN-POLY-HC 3.5 MG-400-10,000 UNIT/G-1 % EYE OINTMENT",127.76,127.76,127.76,127.76,31.94]
["Not Applicable - Not Applicable - 00574416035","Not Applicable","Not Applicable","NDC","00574416035","NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT",55.75,55.75,55.75,55.75,13.9375]
["Not Applicable - Not Applicable - 00574703412","Not Applicable","Not Applicable","NDC","00574703412","ASPIRIN 300 MG RECTAL SUPPOSITORY",6.82,6.82,3.41,6.82,1.7050000000000001]
["Not Applicable - Not Applicable - 00574703612","Not Applicable","Not Applicable","NDC","00574703612","ASPIRIN 600 MG RECTAL SUPPOSITORY",5.53,5.53,2.77,5.53,1.3825000000000001]
["Not Applicable - Not Applicable - 00574705012","Not Applicable","Not Applicable","NDC","00574705012","BISACODYL 10 MG RECTAL SUPPOSITORY",1.04,1.04,0.52,1.04,0.26]
["Not Applicable - Not Applicable - 00574709012","Not Applicable","Not Applicable","NDC","00574709012","HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY",10.98,10.98,5.49,10.98,2.7450000000000001]
["Not Applicable - Not Applicable - 00574722612","Not Applicable","Not Applicable","NDC","00574722612","PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY",22.24,22.24,22.24,22.24,5.56]
["Not Applicable - Not Applicable - 00574723412","Not Applicable","Not Applicable","NDC","00574723412","PROMETHAZINE 25 MG RECTAL SUPPOSITORY",23.09,23.09,5.78,23.09,5.7725]
["Not Applicable - Not Applicable - 00575620030","Not Applicable","Not Applicable","NDC","00575620030","DIAZOXIDE 50 MG/ML ORAL SUSPENSION (PEDIATRIC)",1084.6199999999999,1084.6199999999999,1084.6199999999999,1084.6199999999999,271.15499999999997]
["Not Applicable - Not Applicable - 00591024201","Not Applicable","Not Applicable","NDC","00591024201","LORAZEPAM 2 MG TABLET",0.26,0.26,7.0000000000000007E-2,0.26,6.5000000000000002E-2]
["Not Applicable - Not Applicable - 00591037101","Not Applicable","Not Applicable","NDC","00591037101","LOXAPINE SUCCINATE 25 MG CAPSULE",3.67,3.67,1.84,3.67,0.91749999999999998]
["Not Applicable - Not Applicable - 00591040701","Not Applicable","Not Applicable","NDC","00591040701","LISINOPRIL 10 MG TABLET",0.28999999999999998,0.28999999999999998,0.04,0.28999999999999998,7.2499999999999995E-2]
["Not Applicable - Not Applicable - 00591044401","Not Applicable","Not Applicable","NDC","00591044401","GUANFACINE 1 MG TABLET",1.2,1.2,0.6,1.2,0.3]
["Not Applicable - Not Applicable - 00591048701","Not Applicable","Not Applicable","NDC","00591048701","ESTRADIOL 1 MG TABLET",2.19,2.19,0.55000000000000004,2.19,0.54749999999999999]
["Not Applicable - Not Applicable - 00591058201","Not Applicable","Not Applicable","NDC","00591058201","PROPAFENONE 150 MG TABLET",2.56,2.56,1.28,2.56,0.64]
["Not Applicable - Not Applicable - 00591065801","Not Applicable","Not Applicable","NDC","00591065801","BUSPIRONE 10 MG TABLET",0.7,0.7,0.24,0.7,0.17499999999999999]
["Not Applicable - Not Applicable - 00591078001","Not Applicable","Not Applicable","NDC","00591078001","SUCRALFATE 1 GRAM TABLET",2.31,2.31,1.1599999999999999,2.31,0.57750000000000001]
["Not Applicable - Not Applicable - 00591078005","Not Applicable","Not Applicable","NDC","00591078005","SUCRALFATE 1 GRAM TABLET",1.55,1.55,0.78,1.55,0.38750000000000001]
["Not Applicable - Not Applicable - 00591079601","Not Applicable","Not Applicable","NDC","00591079601","SULFASALAZINE 500 MG TABLET",1.24,1.24,0.62,1.24,0.31]
["Not Applicable - Not Applicable - 00591081046","Not Applicable","Not Applicable","NDC","00591081046","SILVER SULFADIAZINE 1 % TOPICAL CREAM",125.05,125.05,125.05,125.05,31.262499999999999]
["Not Applicable - Not Applicable - 00591081055","Not Applicable","Not Applicable","NDC","00591081055","SILVER SULFADIAZINE 1 % TOPICAL CREAM",48.5,48.5,48.5,48.5,12.125]
["Not Applicable - Not Applicable - 00591081083","Not Applicable","Not Applicable","NDC","00591081083","SILVER SULFADIAZINE 1 % TOPICAL CREAM",24.87,24.87,24.87,24.87,6.2175000000000002]
["Not Applicable - Not Applicable - 00591084401","Not Applicable","Not Applicable","NDC","00591084401","GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR",0.89,0.89,0.45,0.89,0.2225]
["Not Applicable - Not Applicable - 00591084501","Not Applicable","Not Applicable","NDC","00591084501","GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR",1.9,1.9,0.95,1.9,0.47499999999999998]
["Not Applicable - Not Applicable - 00591216139","Not Applicable","Not Applicable","NDC","00591216139","PROMETHAZINE 25 MG RECTAL SUPPOSITORY",69.260000000000005,69.260000000000005,17.32,69.260000000000005,17.315000000000001]
["Not Applicable - Not Applicable - 00591246401","Not Applicable","Not Applicable","NDC","00591246401","DESMOPRESSIN 0.1 MG TABLET",5.62,5.62,1.41,5.62,1.405]
["Not Applicable - Not Applicable - 00591256201","Not Applicable","Not Applicable","NDC","00591256201","COLCHICINE 0.6 MG TABLET",4.0999999999999996,4.0999999999999996,2.0499999999999998,4.0999999999999996,1.0249999999999999]
["Not Applicable - Not Applicable - 00591257920","Not Applicable","Not Applicable","NDC","00591257920","VALGANCICLOVIR 50 MG/ML ORAL SOLUTION",467.63,467.63,51.96,467.63,116.9075]
["Not Applicable - Not Applicable - 00591299239","Not Applicable","Not Applicable","NDC","00591299239","PROMETHAZINE 25 MG RECTAL SUPPOSITORY",47.65,47.65,11.92,47.65,11.9125]
["Not Applicable - Not Applicable - 00591301230","Not Applicable","Not Applicable","NDC","00591301230","LIDOCAINE HCL 2 % MUCOSAL JELLY",23.88,23.88,23.88,23.88,5.97]
["Not Applicable - Not Applicable - 00591319872","Not Applicable","Not Applicable","NDC","00591319872","FENTANYL 25 MCG/HR TRANSDERMAL PATCH",33.44,33.44,33.44,33.44,8.36]
["Not Applicable - Not Applicable - 00591320519","Not Applicable","Not Applicable","NDC","00591320519","PIOGLITAZONE 15 MG TABLET",2.71,2.71,0.91,2.71,0.67749999999999999]
["Not Applicable - Not Applicable - 00591321254","Not Applicable","Not Applicable","NDC","00591321254","FENTANYL 50 MCG/HR TRANSDERMAL PATCH",45,45,45,45,11.25]
["Not Applicable - Not Applicable - 00591321272","Not Applicable","Not Applicable","NDC","00591321272","FENTANYL 50 MCG/HR TRANSDERMAL PATCH",59.4,59.4,59.4,59.4,14.85]
["Not Applicable - Not Applicable - 00591321372","Not Applicable","Not Applicable","NDC","00591321372","FENTANYL 75 MCG/HR TRANSDERMAL PATCH",187.76,187.76,93.88,187.76,46.94]
["Not Applicable - Not Applicable - 00591321472","Not Applicable","Not Applicable","NDC","00591321472","FENTANYL 100 MCG/HR TRANSDERMAL PATCH",258.45999999999998,258.45999999999998,129.22999999999999,258.45999999999998,64.614999999999995]
["Not Applicable - Not Applicable - 00591327230","Not Applicable","Not Applicable","NDC","00591327230","FAMCICLOVIR 250 MG TABLET",10.34,10.34,5.17,10.34,2.585]
["Not Applicable - Not Applicable - 00591352511","Not Applicable","Not Applicable","NDC","00591352511","LIDOCAINE 5 % TOPICAL PATCH",31.92,31.92,10.64,31.92,7.98]
["Not Applicable - Not Applicable - 00591354060","Not Applicable","Not Applicable","NDC","00591354060","BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE",1.65,1.65,0.83,1.65,0.41249999999999998]
["Not Applicable - Not Applicable - 00591367001","Not Applicable","Not Applicable","NDC","00591367001","NABUMETONE 500 MG TABLET",1.08,1.08,0.54,1.08,0.27]
["Not Applicable - Not Applicable - 00591377719","Not Applicable","Not Applicable","NDC","00591377719","ATORVASTATIN 80 MG TABLET",1.2,1.2,1.2,1.2,0.3]
["Not Applicable - Not Applicable - 00591387044","Not Applicable","Not Applicable","NDC","00591387044","MEMANTINE 5 MG TABLET",2.19,2.19,1.1000000000000001,2.19,0.54749999999999999]
["Not Applicable - Not Applicable - 00591387045","Not Applicable","Not Applicable","NDC","00591387045","MEMANTINE 5 MG TABLET",2.97,2.97,1.49,2.97,0.74250000000000005]
["Not Applicable - Not Applicable - 00591401201","Not Applicable","Not Applicable","NDC","00591401201","VALPROIC ACID 250 MG CAPSULE",0.98,0.98,0.49,0.98,0.245]
["Not Applicable - Not Applicable - 00591533501","Not Applicable","Not Applicable","NDC","00591533501","TRIHEXYPHENIDYL 2 MG TABLET",0.4,0.4,0.16,0.4,0.1]
["Not Applicable - Not Applicable - 00591534701","Not Applicable","Not Applicable","NDC","00591534701","PROBENECID 500 MG TABLET",3.48,3.48,0.87,3.48,0.87]
["Not Applicable - Not Applicable - 00591543801","Not Applicable","Not Applicable","NDC","00591543801","QUINIDINE SULFATE 200 MG TABLET",1.21,1.21,0.61,1.21,0.30249999999999999]
["Not Applicable - Not Applicable - 00591554405","Not Applicable","Not Applicable","NDC","00591554405","ALLOPURINOL 300 MG TABLET",589.72,589.72,589.72,589.72,147.43]
["Not Applicable - Not Applicable - 00591555701","Not Applicable","Not Applicable","NDC","00591555701","PROPRANOLOL 80 MG TABLET",2.0099999999999998,2.0099999999999998,0.26,2.0099999999999998,0.50249999999999995]
["Not Applicable - Not Applicable - 00591564201","Not Applicable","Not Applicable","NDC","00591564201","MINOXIDIL 2.5 MG TABLET",1.64,1.64,0.41,1.64,0.41]
["Not Applicable - Not Applicable - 00591564301","Not Applicable","Not Applicable","NDC","00591564301","MINOXIDIL 10 MG TABLET",0.75,0.75,0.19,0.75,0.1875]
["Not Applicable - Not Applicable - 00591570801","Not Applicable","Not Applicable","NDC","00591570801","CLINDAMYCIN HCL 150 MG CAPSULE",1.44,1.44,0.48,1.44,0.36]
["Not Applicable - Not Applicable - 00591571401","Not Applicable","Not Applicable","NDC","00591571401","AMOXAPINE 50 MG TABLET",8.35,8.35,1.05,8.35,2.0874999999999999]
["Not Applicable - Not Applicable - 00591578601","Not Applicable","Not Applicable","NDC","00591578601","NORTRIPTYLINE 10 MG CAPSULE",3.98,3.98,0.4,3.98,0.995]
["Not Applicable - Not Applicable - 00597000160","Not Applicable","Not Applicable","NDC","00597000160","ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE",31.37,31.37,31.37,31.37,7.8425000000000002]
["Not Applicable - Not Applicable - 00597000302","Not Applicable","Not Applicable","NDC","00597000302","TIPRANAVIR 250 MG CAPSULE",101.9,101.9,101.9,101.9,25.475000000000001]
["Not Applicable - Not Applicable - 00597004660","Not Applicable","Not Applicable","NDC","00597004660","NEVIRAPINE 200 MG TABLET",50.4,50.4,50.4,50.4,12.6]
["Not Applicable - Not Applicable - 00597004724","Not Applicable","Not Applicable","NDC","00597004724","NEVIRAPINE 50 MG/5 ML ORAL SUSPENSION",654.79999999999995,654.79999999999995,654.79999999999995,654.79999999999995,163.69999999999999]
["Not Applicable - Not Applicable - 00597007575","Not Applicable","Not Applicable","NDC","00597007575","TIOTROPIUM BROMIDE 18 MCG CAPSULE WITH INHALATION DEVICE",159.41,159.41,159.41,159.41,39.852499999999999]
["Not Applicable - Not Applicable - 00597008717","Not Applicable","Not Applicable","NDC","00597008717","IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER",1372.69,1372.69,1372.69,1372.69,343.17250000000001]
["Not Applicable - Not Applicable - 00597014030","Not Applicable","Not Applicable","NDC","00597014030","LINAGLIPTIN 5 MG TABLET",48.28,48.28,48.28,48.28,12.07]
["Not Applicable - Not Applicable - 00597014061","Not Applicable","Not Applicable","NDC","00597014061","LINAGLIPTIN 5 MG TABLET",48.28,48.28,48.28,48.28,12.07]
["Not Applicable - Not Applicable - 00597035556","Not Applicable","Not Applicable","NDC","00597035556","DABIGATRAN ETEXILATE 75 MG CAPSULE",47.43,47.43,23.72,47.43,11.8575]
["Not Applicable - Not Applicable - 00597036082","Not Applicable","Not Applicable","NDC","00597036082","DABIGATRAN ETEXILATE 150 MG CAPSULE",23.72,23.72,11.86,23.72,5.93]
["Not Applicable - Not Applicable - 00603016932","Not Applicable","Not Applicable","NDC","00603016932","ASPIRIN 325 MG TABLET,DELAYED RELEASE",0.08,0.08,0.01,0.08,0.02]
["Not Applicable - Not Applicable - 00603017932","Not Applicable","Not Applicable","NDC","00603017932","FERROUS SULFATE 325 MG (65 MG IRON) TABLET",0.03,0.03,0.03,0.03,7.4999999999999997E-3]
["Not Applicable - Not Applicable - 00603020922","Not Applicable","Not Applicable","NDC","00603020922","MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET",0.1,0.1,0.05,0.1,2.5000000000000001E-2]
["Not Applicable - Not Applicable - 00603064888","Not Applicable","Not Applicable","NDC","00603064888","CAPSAICIN 0.025 % TOPICAL CREAM",10.24,10.24,10.24,10.24,2.56]
["Not Applicable - Not Applicable - 00603064988","Not Applicable","Not Applicable","NDC","00603064988","CAPSAICIN 0.075 % TOPICAL CREAM",15.56,15.56,15.56,15.56,3.89]
["Not Applicable - Not Applicable - 00603083958","Not Applicable","Not Applicable","NDC","00603083958","ACETAMINOPHEN 160 MG/5 ML ORAL LIQUID",11.77,11.77,11.77,11.77,2.9424999999999999]
["Not Applicable - Not Applicable - 00603148149","Not Applicable","Not Applicable","NDC","00603148149","NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION",33.9,33.9,33.9,33.9,8.4749999999999996]
["Not Applicable - Not Applicable - 00603150858","Not Applicable","Not Applicable","NDC","00603150858","PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR",236.93,236.93,236.93,236.93,59.232500000000002]
["Not Applicable - Not Applicable - 00603153258","Not Applicable","Not Applicable","NDC","00603153258","POTASSIUM CHLORIDE 10 % ORAL LIQUID (PEDIATRIC)",149.55000000000001,149.55000000000001,149.55000000000001,149.55000000000001,37.387500000000003]
["Not Applicable - Not Applicable - 00603153458","Not Applicable","Not Applicable","NDC","00603153458","POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID",149.55000000000001,149.55000000000001,149.55000000000001,149.55000000000001,37.387500000000003]
["Not Applicable - Not Applicable - 00603154215","Not Applicable","Not Applicable","NDC","00603154215","POTASSIUM CHLORIDE 10 % ORAL LIQUID (PEDIATRIC)",16.899999999999999,16.899999999999999,16.899999999999999,16.899999999999999,4.2249999999999996]
["Not Applicable - Not Applicable - 00603154258","Not Applicable","Not Applicable","NDC","00603154258","POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID",532.66999999999996,532.66999999999996,532.66999999999996,532.66999999999996,133.16749999999999]
["Not Applicable - Not Applicable - 00603188010","Not Applicable","Not Applicable","NDC","00603188010","LIDOCAINE 5 % TOPICAL PATCH",79.81,79.81,26.61,79.81,19.952500000000001]
["Not Applicable - Not Applicable - 00603188016","Not Applicable","Not Applicable","NDC","00603188016","LIDOCAINE 5 % TOPICAL PATCH",74.47,74.47,24.83,74.47,18.6175]
["Not Applicable - Not Applicable - 00603221221","Not Applicable","Not Applicable","NDC","00603221221","AMITRIPTYLINE 10 MG TABLET",4.7699999999999996,4.7699999999999996,0.48,4.7699999999999996,1.1924999999999999]
["Not Applicable - Not Applicable - 00603243421","Not Applicable","Not Applicable","NDC","00603243421","BENZTROPINE 1 MG TABLET",0.78,0.78,0.2,0.78,0.19500000000000001]
["Not Applicable - Not Applicable - 00603243821","Not Applicable","Not Applicable","NDC","00603243821","BENZTROPINE 1 MG TABLET",0.56000000000000005,0.56000000000000005,0.14000000000000001,0.56000000000000005,0.14000000000000001]
["Not Applicable - Not Applicable - 00603254421","Not Applicable","Not Applicable","NDC","00603254421","BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET",7.45,7.45,3.73,7.45,1.8625]
["Not Applicable - Not Applicable - 00603258221","Not Applicable","Not Applicable","NDC","00603258221","CARISOPRODOL 350 MG TABLET",0.23,0.23,0.23,0.23,5.7500000000000002E-2]
["Not Applicable - Not Applicable - 00603358121","Not Applicable","Not Applicable","NDC","00603358121","FELODIPINE ER 2.5 MG TABLET,EXTENDED RELEASE 24 HR",4.8099999999999996,4.8099999999999996,1.21,4.8099999999999996,1.2024999999999999]
["Not Applicable - Not Applicable - 00603358221","Not Applicable","Not Applicable","NDC","00603358221","FELODIPINE ER 5 MG TABLET,EXTENDED RELEASE 24 HR",2.19,2.19,0.55000000000000004,2.19,0.54749999999999999]
["Not Applicable - Not Applicable - 00603358321","Not Applicable","Not Applicable","NDC","00603358321","FELODIPINE ER 10 MG TABLET,EXTENDED RELEASE 24 HR",1.21,1.21,0.31,1.21,0.30249999999999999]
["Not Applicable - Not Applicable - 00603385621","Not Applicable","Not Applicable","NDC","00603385621","HYDROCHLOROTHIAZIDE 25 MG TABLET",0.12,0.12,0.12,0.12,0.03]
["Not Applicable - Not Applicable - 00603385632","Not Applicable","Not Applicable","NDC","00603385632","HYDROCHLOROTHIAZIDE 25 MG TABLET",0.13,0.13,0.13,0.13,3.2500000000000001E-2]
["Not Applicable - Not Applicable - 00603390021","Not Applicable","Not Applicable","NDC","00603390021","HYDROCORTISONE 10 MG TABLET",3.26,3.26,0.82,3.26,0.81499999999999995]
["Not Applicable - Not Applicable - 00603411021","Not Applicable","Not Applicable","NDC","00603411021","ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR",1.43,1.43,0.48,1.43,0.35749999999999998]
["Not Applicable - Not Applicable - 00603411121","Not Applicable","Not Applicable","NDC","00603411121","ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR",1.07,1.07,0.36,1.07,0.26750000000000002]
["Not Applicable - Not Applicable - 00603422402","Not Applicable","Not Applicable","NDC","00603422402","LOSARTAN 25 MG TABLET",0.67,0.67,0.17,0.67,0.16750000000000001]
["Not Applicable - Not Applicable - 00603422532","Not Applicable","Not Applicable","NDC","00603422532","LOSARTAN 50 MG TABLET",0.27,0.27,7.0000000000000007E-2,0.27,6.7500000000000004E-2]
["Not Applicable - Not Applicable - 00603448621","Not Applicable","Not Applicable","NDC","00603448621","METHOCARBAMOL 750 MG TABLET",0.5,0.5,0.25,0.5,0.125]
["Not Applicable - Not Applicable - 00603465302","Not Applicable","Not Applicable","NDC","00603465302","MONTELUKAST 4 MG CHEWABLE TABLET",5.39,5.39,4.3099999999999996,5.39,1.3474999999999999]
["Not Applicable - Not Applicable - 00603465316","Not Applicable","Not Applicable","NDC","00603465316","MONTELUKAST 4 MG CHEWABLE TABLET",2.57,2.57,2.0499999999999998,2.57,0.64249999999999996]
["Not Applicable - Not Applicable - 00603516521","Not Applicable","Not Applicable","NDC","00603516521","PHENOBARBITAL 16.2 MG TABLET",8.66,8.66,2.89,8.66,2.165]
["Not Applicable - Not Applicable - 00603516721","Not Applicable","Not Applicable","NDC","00603516721","PHENOBARBITAL 64.8 MG TABLET",3.42,3.42,0.56999999999999995,3.42,0.85499999999999998]
["Not Applicable - Not Applicable - 00603516821","Not Applicable","Not Applicable","NDC","00603516821","PHENOBARBITAL 97.2 MG TABLET",3.22,3.22,1.08,3.22,0.80500000000000005]
["Not Applicable - Not Applicable - 00603578121","Not Applicable","Not Applicable","NDC","00603578121","SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET",0.41,0.41,0.21,0.41,0.10249999999999999]
["Not Applicable - Not Applicable - 00603752101","Not Applicable","Not Applicable","NDC","00603752101","NORETHINDRONE 1 MG-ETHINYL ESTRADIOL 35 MCG TABLET",70.63,70.63,70.63,70.63,17.657499999999999]
["Not Applicable - Not Applicable - 00603752117","Not Applicable","Not Applicable","NDC","00603752117","NORETHINDRONE 1 MG-ETHINYL ESTRADIOL 35 MCG TABLET",37.51,37.51,37.51,37.51,9.3774999999999995]
["Not Applicable - Not Applicable - 00603781878","Not Applicable","Not Applicable","NDC","00603781878","NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM",93.26,93.26,93.26,93.26,23.315000000000001]
["Not Applicable - Not Applicable - 00603786190","Not Applicable","Not Applicable","NDC","00603786190","TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM",28.42,28.42,28.42,28.42,7.1050000000000004]
["Not Applicable - Not Applicable - 00603786274","Not Applicable","Not Applicable","NDC","00603786274","TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM",15.3,15.3,15.3,15.3,3.8250000000000002]
["Not Applicable - Not Applicable - 00703291401","Not Applicable","Not Applicable","NDC","00703291401","VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION",22.39,22.39,22.39,22.39,5.5975000000000001]
["Not Applicable - Not Applicable - 00713010106","Not Applicable","Not Applicable","NDC","00713010106","GLYCERIN (ADULT) RECTAL SUPPOSITORY",2.2999999999999998,2.2999999999999998,2.2999999999999998,2.2999999999999998,0.57499999999999996]
["Not Applicable - Not Applicable - 00713010151","Not Applicable","Not Applicable","NDC","00713010151","GLYCERIN (ADULT) RECTAL SUPPOSITORY",0.18,0.18,0.18,0.18,4.4999999999999998E-2]
["Not Applicable - Not Applicable - 00713010225","Not Applicable","Not Applicable","NDC","00713010225","GLYCERIN (CHILD) RECTAL SUPPOSITORY",0.67,0.67,0.67,0.67,0.16750000000000001]
["Not Applicable - Not Applicable - 00713010901","Not Applicable","Not Applicable","NDC","00713010901","BISACODYL 10 MG RECTAL SUPPOSITORY",0.24,0.24,0.12,0.24,0.06]
["Not Applicable - Not Applicable - 00713010906","Not Applicable","Not Applicable","NDC","00713010906","BISACODYL 10 MG RECTAL SUPPOSITORY",0.37,0.37,0.19,0.37,9.2499999999999999E-2]
["Not Applicable - Not Applicable - 00713010908","Not Applicable","Not Applicable","NDC","00713010908","BISACODYL 10 MG RECTAL SUPPOSITORY",0.55000000000000004,0.55000000000000004,0.28000000000000003,0.55000000000000004,0.13750000000000001]
["Not Applicable - Not Applicable - 00713013506","Not Applicable","Not Applicable","NDC","00713013506","PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY",30.96,30.96,30.96,30.96,7.74]
["Not Applicable - Not Applicable - 00713013512","Not Applicable","Not Applicable","NDC","00713013512","PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY",28.89,28.89,28.89,28.89,7.2225000000000001]
["Not Applicable - Not Applicable - 00713016406","Not Applicable","Not Applicable","NDC","00713016406","ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY",3.73,3.73,0.35,3.73,0.9325]
["Not Applicable - Not Applicable - 00713016412","Not Applicable","Not Applicable","NDC","00713016412","ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY",2.76,2.76,0.26,2.76,0.69]
["Not Applicable - Not Applicable - 00713016512","Not Applicable","Not Applicable","NDC","00713016512","ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY",1.34,1.34,0.13,1.34,0.33500000000000002]
["Not Applicable - Not Applicable - 00713019757","Not Applicable","Not Applicable","NDC","00713019757","MICONAZOLE NITRATE 100 MG VAGINAL SUPPOSITORY",2.64,2.64,1.32,2.64,0.66]
["Not Applicable - Not Applicable - 00713022415","Not Applicable","Not Applicable","NDC","00713022415","FLUOCINOLONE 0.025 % TOPICAL OINTMENT",93.79,93.79,93.79,93.79,23.447500000000002]
["Not Applicable - Not Applicable - 00713022460","Not Applicable","Not Applicable","NDC","00713022460","FLUOCINOLONE 0.025 % TOPICAL OINTMENT",280.3,280.3,280.3,280.3,70.075000000000003]
["Not Applicable - Not Applicable - 00713025237","Not Applicable","Not Applicable","NDC","00713025237","MICONAZOLE NITRATE 2 % VAGINAL CREAM",10.08,10.08,10.08,10.08,2.52]
["Not Applicable - Not Applicable - 00713026831","Not Applicable","Not Applicable","NDC","00713026831","NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT",5.05,5.05,5.05,5.05,1.2625]
["Not Applicable - Not Applicable - 00713032415","Not Applicable","Not Applicable","NDC","00713032415","FLUOCINOLONE 0.025 % TOPICAL CREAM",82.81,82.81,82.81,82.81,20.702500000000001]
["Not Applicable - Not Applicable - 00713032460","Not Applicable","Not Applicable","NDC","00713032460","FLUOCINOLONE 0.025 % TOPICAL CREAM",328.47,328.47,328.47,328.47,82.117500000000007]
["Not Applicable - Not Applicable - 00713050306","Not Applicable","Not Applicable","NDC","00713050306","HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY",81.709999999999994,81.709999999999994,40.86,81.709999999999994,20.427499999999998]
["Not Applicable - Not Applicable - 00713063737","Not Applicable","Not Applicable","NDC","00713063737","METRONIDAZOLE 0.75 % TOPICAL GEL",324.85000000000002,324.85000000000002,324.85000000000002,324.85000000000002,81.212500000000006]
["Not Applicable - Not Applicable - 00713068315","Not Applicable","Not Applicable","NDC","00713068315","GENTAMICIN 0.1 % TOPICAL CREAM",49.24,49.24,49.24,49.24,12.31]
["Not Applicable - Not Applicable - 00713070915","Not Applicable","Not Applicable","NDC","00713070915","FLUOCINOLONE 0.025 % TOPICAL CREAM",96.99,96.99,96.99,96.99,24.247499999999999]
["Not Applicable - Not Applicable - 00713525601","Not Applicable","Not Applicable","NDC","00713525601","CLINDAMYCIN HCL 300 MG CAPSULE",1.87,1.87,0.94,1.87,0.46750000000000003]
["Not Applicable - Not Applicable - 00731040106","Not Applicable","Not Applicable","NDC","00731040106","ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE",0.47,0.47,0.47,0.47,0.11749999999999999]
["Not Applicable - Not Applicable - 00781106101","Not Applicable","Not Applicable","NDC","00781106101","ALPRAZOLAM 0.25 MG TABLET",0.63,0.63,0.08,0.63,0.1575]
["Not Applicable - Not Applicable - 00781106401","Not Applicable","Not Applicable","NDC","00781106401","BUPROPION HCL 100 MG TABLET",3.42,3.42,1.71,3.42,0.85499999999999998]
["Not Applicable - Not Applicable - 00781107101","Not Applicable","Not Applicable","NDC","00781107101","METHAZOLAMIDE 50 MG TABLET",27.22,27.22,13.61,27.22,6.8049999999999997]
["Not Applicable - Not Applicable - 00781107801","Not Applicable","Not Applicable","NDC","00781107801","ATENOLOL 25 MG TABLET",0.33,0.33,0.05,0.33,8.2500000000000004E-2]
["Not Applicable - Not Applicable - 00781107810","Not Applicable","Not Applicable","NDC","00781107810","ATENOLOL 25 MG TABLET",0.74,0.74,0.1,0.74,0.185]
["Not Applicable - Not Applicable - 00781118201","Not Applicable","Not Applicable","NDC","00781118201","NADOLOL 40 MG TABLET",57.02,57.02,7.13,57.02,14.255000000000001]
["Not Applicable - Not Applicable - 00781118301","Not Applicable","Not Applicable","NDC","00781118301","NADOLOL 80 MG TABLET",39.17,39.17,4.9000000000000004,39.17,9.7925000000000004]
["Not Applicable - Not Applicable - 00781120501","Not Applicable","Not Applicable","NDC","00781120501","PENICILLIN V POTASSIUM 250 MG TABLET",4.88,4.88,2.44,4.88,1.22]
["Not Applicable - Not Applicable - 00781139113","Not Applicable","Not Applicable","NDC","00781139113","HALOPERIDOL 0.5 MG TABLET",4.4800000000000004,4.4800000000000004,0.45,4.4800000000000004,1.1200000000000001]
["Not Applicable - Not Applicable - 00781139313","Not Applicable","Not Applicable","NDC","00781139313","HALOPERIDOL 2 MG TABLET",2.76,2.76,0.28000000000000003,2.76,0.69]
["Not Applicable - Not Applicable - 00781145210","Not Applicable","Not Applicable","NDC","00781145210","GLIPIZIDE 5 MG TABLET",0.4,0.4,0.1,0.4,0.1]
["Not Applicable - Not Applicable - 00781145301","Not Applicable","Not Applicable","NDC","00781145301","GLIPIZIDE 10 MG TABLET",0.68,0.68,0.17,0.68,0.17]
["Not Applicable - Not Applicable - 00781148601","Not Applicable","Not Applicable","NDC","00781148601","AMITRIPTYLINE 10 MG TABLET",4.16,4.16,0.42,4.16,1.04]
["Not Applicable - Not Applicable - 00781149731","Not Applicable","Not Applicable","NDC","00781149731","AZITHROMYCIN 600 MG TABLET",62.9,62.9,13.11,62.9,15.725]
["Not Applicable - Not Applicable - 00781150601","Not Applicable","Not Applicable","NDC","00781150601","ATENOLOL 50 MG TABLET",0.17,0.17,0.03,0.17,4.2500000000000003E-2]
["Not Applicable - Not Applicable - 00781155601","Not Applicable","Not Applicable","NDC","00781155601","ISOSORBIDE DINITRATE 10 MG TABLET",7.14,7.14,0.9,7.14,1.7849999999999999]
["Not Applicable - Not Applicable - 00781155613","Not Applicable","Not Applicable","NDC","00781155613","ISOSORBIDE DINITRATE 10 MG TABLET",8.09,8.09,1.02,8.09,2.0225]
["Not Applicable - Not Applicable - 00781165501","Not Applicable","Not Applicable","NDC","00781165501","PENICILLIN V POTASSIUM 500 MG TABLET",3.1,3.1,1.55,3.1,0.77500000000000002]
["Not Applicable - Not Applicable - 00781187431","Not Applicable","Not Applicable","NDC","00781187431","AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET",4.16,4.16,4.16,4.16,1.04]
["Not Applicable - Not Applicable - 00781194339","Not Applicable","Not Applicable","NDC","00781194339","AMOXICILLIN-POTASSIUM CLAVULANATE 1,000 MG-62.5 MG TABLET,EXT.REL 12HR",26.19,26.19,13.1,26.19,6.5475000000000003]
["Not Applicable - Not Applicable - 00781196160","Not Applicable","Not Applicable","NDC","00781196160","CLARITHROMYCIN 250 MG TABLET",2.06,2.06,1.03,2.06,0.51500000000000001]
["Not Applicable - Not Applicable - 00781196260","Not Applicable","Not Applicable","NDC","00781196260","CLARITHROMYCIN 500 MG TABLET",1.5,1.5,0.75,1.5,0.375]
["Not Applicable - Not Applicable - 00781196601","Not Applicable","Not Applicable","NDC","00781196601","FUROSEMIDE 40 MG TABLET",0.2,0.2,0.03,0.2,0.05]
["Not Applicable - Not Applicable - 00781197301","Not Applicable","Not Applicable","NDC","00781197301","DESIPRAMINE 50 MG TABLET",12.87,12.87,3.22,12.87,3.2174999999999998]
["Not Applicable - Not Applicable - 00781202001","Not Applicable","Not Applicable","NDC","00781202001","AMOXICILLIN 250 MG CAPSULE",0.47,0.47,0.12,0.47,0.11749999999999999]
["Not Applicable - Not Applicable - 00781204801","Not Applicable","Not Applicable","NDC","00781204801","AMANTADINE HCL 100 MG CAPSULE",7.56,7.56,3.78,7.56,1.89]
["Not Applicable - Not Applicable - 00781207601","Not Applicable","Not Applicable","NDC","00781207601","TAMSULOSIN 0.4 MG CAPSULE",3.32,3.32,1.66,3.32,0.83]
["Not Applicable - Not Applicable - 00781214801","Not Applicable","Not Applicable","NDC","00781214801","LANSOPRAZOLE 30 MG CAPSULE,DELAYED RELEASE",7.18,7.18,7.18,7.18,1.7949999999999999]
["Not Applicable - Not Applicable - 00781261460","Not Applicable","Not Applicable","NDC","00781261460","RIVASTIGMINE 1.5 MG CAPSULE",48.25,48.25,12.07,48.25,12.0625]
["Not Applicable - Not Applicable - 00781281001","Not Applicable","Not Applicable","NDC","00781281001","OXAZEPAM 15 MG CAPSULE",1.37,1.37,0.46,1.37,0.34250000000000003]
["Not Applicable - Not Applicable - 00781504301","Not Applicable","Not Applicable","NDC","00781504301","CEFPROZIL 250 MG TABLET",14.9,14.9,7.45,14.9,3.7250000000000001]
["Not Applicable - Not Applicable - 00781518692","Not Applicable","Not Applicable","NDC","00781518692","LEVOTHYROXINE 125 MCG TABLET",1.75,1.75,0.22,1.75,0.4375]
["Not Applicable - Not Applicable - 00781518992","Not Applicable","Not Applicable","NDC","00781518992","LEVOTHYROXINE 200 MCG TABLET",1.34,1.34,0.17,1.34,0.33500000000000002]
["Not Applicable - Not Applicable - 00781524892","Not Applicable","Not Applicable","NDC","00781524892","PRAMIPEXOLE 0.125 MG TABLET",7.12,7.12,0.6,7.12,1.78]
["Not Applicable - Not Applicable - 00781524992","Not Applicable","Not Applicable","NDC","00781524992","PRAMIPEXOLE 0.25 MG TABLET",3.56,3.56,0.3,3.56,0.89]
["Not Applicable - Not Applicable - 00781543820","Not Applicable","Not Applicable","NDC","00781543820","CEFPODOXIME 100 MG TABLET",29.93,29.93,7.49,29.93,7.4824999999999999]
["Not Applicable - Not Applicable - 00781543920","Not Applicable","Not Applicable","NDC","00781543920","CEFPODOXIME 200 MG TABLET",20.12,20.12,5.03,20.12,5.03]
["Not Applicable - Not Applicable - 00781566731","Not Applicable","Not Applicable","NDC","00781566731","VORICONAZOLE 50 MG TABLET",40.659999999999997,40.659999999999997,40.659999999999997,40.659999999999997,10.164999999999999]
["Not Applicable - Not Applicable - 00781569031","Not Applicable","Not Applicable","NDC","00781569031","EZETIMIBE 10 MG TABLET",0.97,0.97,0.97,0.97,0.24249999999999999]
["Not Applicable - Not Applicable - 00781569092","Not Applicable","Not Applicable","NDC","00781569092","EZETIMIBE 10 MG TABLET",0.97,0.97,0.97,0.97,0.24249999999999999]
["Not Applicable - Not Applicable - 00781574801","Not Applicable","Not Applicable","NDC","00781574801","METHYLPHENIDATE 5 MG TABLET",6.97,6.97,1.75,6.97,1.7424999999999999]
["Not Applicable - Not Applicable - 00781577631","Not Applicable","Not Applicable","NDC","00781577631","AZITHROMYCIN 250 MG TABLET",23.95,23.95,4.99,23.95,5.9874999999999998]
["Not Applicable - Not Applicable - 00781593631","Not Applicable","Not Applicable","NDC","00781593631","CANDESARTAN 4 MG TABLET",69.150000000000006,69.150000000000006,8.65,69.150000000000006,17.287500000000001]
["Not Applicable - Not Applicable - 00781602252","Not Applicable","Not Applicable","NDC","00781602252","CLARITHROMYCIN 125 MG/5 ML ORAL SUSPENSION",122.21,122.21,122.21,122.21,30.552499999999998]
["Not Applicable - Not Applicable - 00781602352","Not Applicable","Not Applicable","NDC","00781602352","CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION",216.71,216.71,216.71,216.71,54.177500000000002]
["Not Applicable - Not Applicable - 00781603955","Not Applicable","Not Applicable","NDC","00781603955","AMOXICILLIN 125 MG/5 ML ORAL SUSPENSION",12.26,12.26,12.26,12.26,3.0649999999999999]
["Not Applicable - Not Applicable - 00781604146","Not Applicable","Not Applicable","NDC","00781604146","AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION",9.24,9.24,9.24,9.24,2.31]
["Not Applicable - Not Applicable - 00781613954","Not Applicable","Not Applicable","NDC","00781613954","AMOXICILLIN 600 MG-POTASSIUM CLAVULANATE 42.9 MG/5 ML ORAL SUSPENSION",33.75,33.75,33.75,33.75,8.4375]
["Not Applicable - Not Applicable - 00781616846","Not Applicable","Not Applicable","NDC","00781616846","CEFPODOXIME 50 MG/5 ML ORAL SUSPENSION",217.06,217.06,217.06,217.06,54.265000000000001]
["Not Applicable - Not Applicable - 00781616952","Not Applicable","Not Applicable","NDC","00781616952","CEFPODOXIME 100 MG/5 ML ORAL SUSPENSION",100.075,100.075,91.734999999999999,100.075,25.018750000000001]
["Not Applicable - Not Applicable - 00781713358","Not Applicable","Not Applicable","NDC","00781713358","ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH",65.959999999999994,65.959999999999994,65.959999999999994,65.959999999999994,16.489999999999998]
["Not Applicable - Not Applicable - 00781724055","Not Applicable","Not Applicable","NDC","00781724055","FENTANYL 12 MCG/HR TRANSDERMAL PATCH",37.85,37.85,37.85,37.85,9.4625000000000004]
["Not Applicable - Not Applicable - 00810073088","Not Applicable","Not Applicable","NDC","00810073088","NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT",14.63,14.63,14.63,14.63,3.6575000000000002]
["Not Applicable - Not Applicable - 00832003889","Not Applicable","Not Applicable","NDC","00832003889","OXYBUTYNIN CHLORIDE 5 MG TABLET",4.6900000000000004,4.6900000000000004,1.18,4.6900000000000004,1.1725000000000001]
["Not Applicable - Not Applicable - 00832046515","Not Applicable","Not Applicable","NDC","00832046515","NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER",36.19,36.19,36.19,36.19,9.0474999999999994]
["Not Applicable - Not Applicable - 00832051200","Not Applicable","Not Applicable","NDC","00832051200","BETHANECHOL CHLORIDE 25 MG TABLET",2.21,2.21,0.23,2.21,0.55249999999999999]
["Not Applicable - Not Applicable - 00832101500","Not Applicable","Not Applicable","NDC","00832101500","AMANTADINE HCL 100 MG CAPSULE",3.59,3.59,1.8,3.59,0.89749999999999996]
["Not Applicable - Not Applicable - 00832111260","Not Applicable","Not Applicable","NDC","00832111260","MEMANTINE 5 MG TABLET",1.22,1.22,0.61,1.22,0.30499999999999999]
["Not Applicable - Not Applicable - 00832121101","Not Applicable","Not Applicable","NDC","00832121101","WARFARIN 1 MG TABLET",4.66,4.66,0.47,4.66,1.165]
["Not Applicable - Not Applicable - 00832121289","Not Applicable","Not Applicable","NDC","00832121289","WARFARIN 2 MG TABLET",6.75,6.75,0.68,6.75,1.6875]
["Not Applicable - Not Applicable - 00832121301","Not Applicable","Not Applicable","NDC","00832121301","WARFARIN 2.5 MG TABLET",1.87,1.87,0.19,1.87,0.46750000000000003]
["Not Applicable - Not Applicable - 00832121389","Not Applicable","Not Applicable","NDC","00832121389","WARFARIN 2.5 MG TABLET",5.55,5.55,0.56000000000000005,5.55,1.3875]
["Not Applicable - Not Applicable - 00832121989","Not Applicable","Not Applicable","NDC","00832121989","WARFARIN 10 MG TABLET",2.17,2.17,0.22,2.17,0.54249999999999998]
["Not Applicable - Not Applicable - 00832712211","Not Applicable","Not Applicable","NDC","00832712211","DIVALPROEX 125 MG TABLET,DELAYED RELEASE",1.2,1.2,0.3,1.2,0.3]
["Not Applicable - Not Applicable - 00832712401","Not Applicable","Not Applicable","NDC","00832712401","DIVALPROEX 500 MG TABLET,DELAYED RELEASE",0.45,0.45,0.12,0.45,0.1125]
["Not Applicable - Not Applicable - 00832712489","Not Applicable","Not Applicable","NDC","00832712489","DIVALPROEX 500 MG TABLET,DELAYED RELEASE",1.04,1.04,0.26,1.04,0.26]
["Not Applicable - Not Applicable - 00904000414","Not Applicable","Not Applicable","NDC","00904000414","ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP",0.64,0.64,0.32,0.64,0.16]
["Not Applicable - Not Applicable - 00904001261","Not Applicable","Not Applicable","NDC","00904001261","CHLORPHENIRAMINE 4 MG TABLET",0.1,0.1,0.1,0.1,2.5000000000000001E-2]
["Not Applicable - Not Applicable - 00904020261","Not Applicable","Not Applicable","NDC","00904020261","AMITRIPTYLINE 50 MG TABLET",4.88,4.88,0.49,4.88,1.22]
["Not Applicable - Not Applicable - 00904027460","Not Applicable","Not Applicable","NDC","00904027460","VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) CAPSULE",0.17,0.17,0.17,0.17,4.2500000000000003E-2]
["Not Applicable - Not Applicable - 00904041161","Not Applicable","Not Applicable","NDC","00904041161","PROPRANOLOL 10 MG TABLET",7.62,7.62,0.96,7.62,1.905]
["Not Applicable - Not Applicable - 00904052260","Not Applicable","Not Applicable","NDC","00904052260","ASCORBIC ACID (VITAMIN C) 250 MG TABLET",0.28000000000000003,0.28000000000000003,0.05,0.28000000000000003,7.0000000000000007E-2]
["Not Applicable - Not Applicable - 00904052360","Not Applicable","Not Applicable","NDC","00904052360","ASCORBIC ACID (VITAMIN C) 500 MG TABLET",0.19,0.19,0.04,0.19,4.7500000000000001E-2]
["Not Applicable - Not Applicable - 00904052361","Not Applicable","Not Applicable","NDC","00904052361","ASCORBIC ACID (VITAMIN C) 500 MG TABLET",0.28999999999999998,0.28999999999999998,0.05,0.28999999999999998,7.2499999999999995E-2]
["Not Applicable - Not Applicable - 00904052372","Not Applicable","Not Applicable","NDC","00904052372","ASCORBIC ACID (VITAMIN C) 500 MG TABLET",0.18,0.18,0.03,0.18,4.4999999999999998E-2]
["Not Applicable - Not Applicable - 00904053061","Not Applicable","Not Applicable","NDC","00904053061","MULTIVITAMIN WITH FOLIC ACID 400 MCG TABLET",0.09,0.09,0.09,0.09,2.2499999999999999E-2]
["Not Applicable - Not Applicable - 00904053660","Not Applicable","Not Applicable","NDC","00904053660","PEDIATRIC MULTIVITAMIN-IRON CHEWABLE TABLET",0.08,0.08,0.08,0.08,0.02]
["Not Applicable - Not Applicable - 00904053913","Not Applicable","Not Applicable","NDC","00904053913","MULTIVITAMIN WITH FOLIC ACID 400 MCG TABLET",0.09,0.09,0.09,0.09,2.2499999999999999E-2]
["Not Applicable - Not Applicable - 00904053961","Not Applicable","Not Applicable","NDC","00904053961","MULTIVITAMIN WITH FOLIC ACID 400 MCG TABLET",0.12,0.12,0.12,0.12,0.03]
["Not Applicable - Not Applicable - 00904054460","Not Applicable","Not Applicable","NDC","00904054460","THIAMINE HCL (VITAMIN B1) 100 MG TABLET",0.06,0.06,0.06,0.06,1.4999999999999999E-2]
["Not Applicable - Not Applicable - 00904108661","Not Applicable","Not Applicable","NDC","00904108661","DIPYRIDAMOLE 25 MG TABLET",2.4500000000000002,2.4500000000000002,0.82,2.4500000000000002,0.61250000000000004]
["Not Applicable - Not Applicable - 00904108861","Not Applicable","Not Applicable","NDC","00904108861","DIPYRIDAMOLE 75 MG TABLET",1.64,1.64,0.55000000000000004,1.64,0.41]
["Not Applicable - Not Applicable - 00904125061","Not Applicable","Not Applicable","NDC","00904125061","SALSALATE 500 MG TABLET",2.46,2.46,1.23,2.46,0.61499999999999999]
["Not Applicable - Not Applicable - 00904125161","Not Applicable","Not Applicable","NDC","00904125161","SALSALATE 750 MG TABLET",2.14,2.14,1.07,2.14,0.53500000000000003]
["Not Applicable - Not Applicable - 00904145361","Not Applicable","Not Applicable","NDC","00904145361","METRONIDAZOLE 250 MG TABLET",1.82,1.82,0.91,1.82,0.45500000000000002]
["Not Applicable - Not Applicable - 00904188260","Not Applicable","Not Applicable","NDC","00904188260","CALCIUM CARBONATE 250 MG-VITAMIN D3 3.125 MCG (125 UNIT) TABLET",0.08,0.08,0.04,0.08,0.02]
["Not Applicable - Not Applicable - 00904188261","Not Applicable","Not Applicable","NDC","00904188261","CALCIUM CARBONATE 250 MG-VITAMIN D3 3.125 MCG (125 UNIT) TABLET",0.23,0.23,0.12,0.23,5.7500000000000002E-2]
["Not Applicable - Not Applicable - 00904188361","Not Applicable","Not Applicable","NDC","00904188361","CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) TABLET",0.1,0.1,0.1,0.1,2.5000000000000001E-2]
["Not Applicable - Not Applicable - 00904198520","Not Applicable","Not Applicable","NDC","00904198520","ACETAMINOPHEN 160 MG/5 ML ORAL LIQUID",3.78,3.78,3.78,3.78,0.94499999999999995]
["Not Applicable - Not Applicable - 00904201360","Not Applicable","Not Applicable","NDC","00904201360","ASPIRIN 325 MG TABLET,DELAYED RELEASE",0.08,0.08,0.01,0.08,0.02]
["Not Applicable - Not Applicable - 00904208560","Not Applicable","Not Applicable","NDC","00904208560","VITAMIN A 10,000 UNIT CAPSULE",0.12,0.12,0.06,0.12,0.03]
["Not Applicable - Not Applicable - 00904213761","Not Applicable","Not Applicable","NDC","00904213761","FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET",0.09,0.09,0.09,0.09,2.2499999999999999E-2]
["Not Applicable - Not Applicable - 00904215461","Not Applicable","Not Applicable","NDC","00904215461","ISOSORBIDE DINITRATE 20 MG TABLET",6.18,6.18,1.55,6.18,1.5449999999999999]
["Not Applicable - Not Applicable - 00904253321","Not Applicable","Not Applicable","NDC","00904253321","CALAMINE 8 %-ZINC OXIDE 8 % LOTION",4.41,4.41,4.41,4.41,1.1025]
["Not Applicable - Not Applicable - 00904262160","Not Applicable","Not Applicable","NDC","00904262160","PEDIATRIC MULTIVITAMIN CHEWABLE TABLET",0.09,0.09,0.09,0.09,2.2499999999999999E-2]
["Not Applicable - Not Applicable - 00904266617","Not Applicable","Not Applicable","NDC","00904266617","GLYCERIN (CHILD) RECTAL SUPPOSITORY",0.2,0.2,0.2,0.2,0.05]
["Not Applicable - Not Applicable - 00904272561","Not Applicable","Not Applicable","NDC","00904272561","SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET",1.24,1.24,0.62,1.24,0.31]
["Not Applicable - Not Applicable - 00904282161","Not Applicable","Not Applicable","NDC","00904282161","OXYBUTYNIN CHLORIDE 5 MG TABLET",2.12,2.12,0.53,2.12,0.53]
["Not Applicable - Not Applicable - 00904292061","Not Applicable","Not Applicable","NDC","00904292061","VERAPAMIL 80 MG TABLET",0.38,0.38,0.26,0.38,9.5000000000000001E-2]
["Not Applicable - Not Applicable - 00904292461","Not Applicable","Not Applicable","NDC","00904292461","VERAPAMIL 120 MG TABLET",0.27,0.27,0.09,0.27,6.7500000000000004E-2]
["Not Applicable - Not Applicable - 00904320713","Not Applicable","Not Applicable","NDC","00904320713","CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET",0.1,0.1,0.01,0.1,2.5000000000000001E-2]
["Not Applicable - Not Applicable - 00904322035","Not Applicable","Not Applicable","NDC","00904322035","CARBAMIDE PEROXIDE 6.5 % EAR DROPS",4.05,4.05,4.05,4.05,1.0125]
["Not Applicable - Not Applicable - 00904357161","Not Applicable","Not Applicable","NDC","00904357161","MEGESTROL 40 MG TABLET",0.62,0.62,0.31,0.62,0.155]
["Not Applicable - Not Applicable - 00904385461","Not Applicable","Not Applicable","NDC","00904385461","CARBAMAZEPINE 100 MG CHEWABLE TABLET",2.67,2.67,1.34,2.67,0.66749999999999998]
["Not Applicable - Not Applicable - 00904386575","Not Applicable","Not Applicable","NDC","00904386575","SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL",2.04,2.04,2.04,2.04,0.51]
["Not Applicable - Not Applicable - 00904399061","Not Applicable","Not Applicable","NDC","00904399061","TRAZODONE 50 MG TABLET",2.66,2.66,0.34,2.66,0.66500000000000004]
["Not Applicable - Not Applicable - 00904404073","Not Applicable","Not Applicable","NDC","00904404073","ASPIRIN 81 MG CHEWABLE TABLET",0.23,0.23,0.06,0.23,5.7500000000000002E-2]
["Not Applicable - Not Applicable - 00904420260","Not Applicable","Not Applicable","NDC","00904420260","NIACINAMIDE 500 MG TABLET",0.09,0.09,0.02,0.09,2.2499999999999999E-2]
["Not Applicable - Not Applicable - 00904501735","Not Applicable","Not Applicable","NDC","00904501735","POLYVINYL ALCOHOL 1.4 % EYE DROPS",5.92,5.92,5.92,5.92,1.48]
["Not Applicable - Not Applicable - 00904504561","Not Applicable","Not Applicable","NDC","00904504561","CAPTOPRIL 12.5 MG TABLET",18.73,18.73,2.35,18.73,4.6825000000000001]
["Not Applicable - Not Applicable - 00904504661","Not Applicable","Not Applicable","NDC","00904504661","CAPTOPRIL 25 MG TABLET",9.93,9.93,1.25,9.93,2.4824999999999999]
["Not Applicable - Not Applicable - 00904505359","Not Applicable","Not Applicable","NDC","00904505359","PSEUDOEPHEDRINE 30 MG TABLET",0.13,0.13,7.0000000000000007E-2,0.13,3.2500000000000001E-2]
["Not Applicable - Not Applicable - 00904505360","Not Applicable","Not Applicable","NDC","00904505360","PSEUDOEPHEDRINE 30 MG TABLET",0.15,0.15,0.08,0.15,3.7499999999999999E-2]
["Not Applicable - Not Applicable - 00904506860","Not Applicable","Not Applicable","NDC","00904506860","SIMETHICONE 80 MG CHEWABLE TABLET",0.13,0.13,7.0000000000000007E-2,0.13,3.2500000000000001E-2]
["Not Applicable - Not Applicable - 00904512559","Not Applicable","Not Applicable","NDC","00904512559","PSEUDOEPHEDRINE 60 MG TABLET",0.1,0.1,0.05,0.1,2.5000000000000001E-2]
["Not Applicable - Not Applicable - 00904516561","Not Applicable","Not Applicable","NDC","00904516561","SENNOSIDES 8.6 MG TABLET",0.25,0.25,0.13,0.25,6.25E-2]
["Not Applicable - Not Applicable - 00904516580","Not Applicable","Not Applicable","NDC","00904516580","SENNOSIDES 8.6 MG TABLET",7.0000000000000007E-2,7.0000000000000007E-2,0.04,7.0000000000000007E-2,1.7500000000000002E-2]
["Not Applicable - Not Applicable - 00904518252","Not Applicable","Not Applicable","NDC","00904518252","MELATONIN 3 MG TABLET",0.61,0.61,0.21,0.61,0.1525]
["Not Applicable - Not Applicable - 00904518261","Not Applicable","Not Applicable","NDC","00904518261","MELATONIN 3 MG TABLET",1.23,1.23,0.41,1.23,0.3075]
["Not Applicable - Not Applicable - 00904528261","Not Applicable","Not Applicable","NDC","00904528261","RIFAMPIN 300 MG CAPSULE",7.34,7.34,3.67,7.34,1.835]
["Not Applicable - Not Applicable - 00904530920","Not Applicable","Not Applicable","NDC","00904530920","IBUPROFEN 100 MG/5 ML ORAL SUSPENSION",15.78,15.78,15.78,15.78,3.9449999999999998]
["Not Applicable - Not Applicable - 00904533260","Not Applicable","Not Applicable","NDC","00904533260","ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE",0.08,0.08,0.08,0.08,0.02]
["Not Applicable - Not Applicable - 00904539261","Not Applicable","Not Applicable","NDC","00904539261","ATENOLOL 25 MG TABLET",0.79,0.79,0.1,0.79,0.19750000000000001]
["Not Applicable - Not Applicable - 00904539561","Not Applicable","Not Applicable","NDC","00904539561","POLYSACCHARIDE IRON COMPLEX 150 MG IRON CAPSULE",0.31,0.31,0.31,0.31,7.7499999999999999E-2]
["Not Applicable - Not Applicable - 00904541501","Not Applicable","Not Applicable","NDC","00904541501","MICONAZOLE NITRATE 200 MG-2 % (9 GRAM) VAGINAL KIT",19.37,19.37,19.37,19.37,4.8425000000000002]
["Not Applicable - Not Applicable - 00904546061","Not Applicable","Not Applicable","NDC","00904546061","CALCIUM CARBONATE 500 MG-VITAMIN D3 5 MCG (200 UNIT) TABLET",0.26,0.26,0.13,0.26,6.5000000000000002E-2]
["Not Applicable - Not Applicable - 00904549213","Not Applicable","Not Applicable","NDC","00904549213","MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET",0.09,0.09,0.09,0.09,2.2499999999999999E-2]
["Not Applicable - Not Applicable - 00904549261","Not Applicable","Not Applicable","NDC","00904549261","MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET",0.13,0.13,0.13,0.13,3.2500000000000001E-2]
["Not Applicable - Not Applicable - 00904549546","Not Applicable","Not Applicable","NDC","00904549546","NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH",1.37,1.37,1.37,1.37,0.34250000000000003]
["Not Applicable - Not Applicable - 00904549646","Not Applicable","Not Applicable","NDC","00904549646","NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH",1.6,1.6,1.6,1.6,0.4]
["Not Applicable - Not Applicable - 00904549746","Not Applicable","Not Applicable","NDC","00904549746","NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH",2.14,2.14,2.14,2.14,0.53500000000000003]
["Not Applicable - Not Applicable - 00904550261","Not Applicable","Not Applicable","NDC","00904550261","ENALAPRIL MALEATE 5 MG TABLET",5.04,5.04,1.26,5.04,1.26]
["Not Applicable - Not Applicable - 00904552361","Not Applicable","Not Applicable","NDC","00904552361","DOXAZOSIN 2 MG TABLET",8.0500000000000007,8.0500000000000007,1.01,8.0500000000000007,2.0125000000000002]
["Not Applicable - Not Applicable - 00904552461","Not Applicable","Not Applicable","NDC","00904552461","DOXAZOSIN 4 MG TABLET",3.49,3.49,0.44,3.49,0.87250000000000005]
["Not Applicable - Not Applicable - 00904555361","Not Applicable","Not Applicable","NDC","00904555361","FAMOTIDINE 20 MG TABLET",0.46,0.46,0.12,0.46,0.115]
["Not Applicable - Not Applicable - 00904561061","Not Applicable","Not Applicable","NDC","00904561061","ENALAPRIL MALEATE 10 MG TABLET",2.35,2.35,0.59,2.35,0.58750000000000002]
["Not Applicable - Not Applicable - 00904563161","Not Applicable","Not Applicable","NDC","00904563161","GABAPENTIN 100 MG CAPSULE",0.87,0.87,0.22,0.87,0.2175]
["Not Applicable - Not Applicable - 00904563261","Not Applicable","Not Applicable","NDC","00904563261","GABAPENTIN 300 MG CAPSULE",0.42,0.42,0.11,0.42,0.105]
["Not Applicable - Not Applicable - 00904563361","Not Applicable","Not Applicable","NDC","00904563361","GABAPENTIN 400 MG CAPSULE",0.45,0.45,0.12,0.45,0.1125]
["Not Applicable - Not Applicable - 00904565661","Not Applicable","Not Applicable","NDC","00904565661","CLONIDINE HCL 0.1 MG TABLET",0.46,0.46,0.16,0.46,0.115]
["Not Applicable - Not Applicable - 00904565761","Not Applicable","Not Applicable","NDC","00904565761","CLONIDINE HCL 0.2 MG TABLET",0.32,0.32,0.11,0.32,0.08]
["Not Applicable - Not Applicable - 00904565861","Not Applicable","Not Applicable","NDC","00904565861","CLONIDINE HCL 0.3 MG TABLET",0.24,0.24,0.08,0.24,0.06]
["Not Applicable - Not Applicable - 00904567761","Not Applicable","Not Applicable","NDC","00904567761","PAROXETINE 20 MG TABLET",1.1399999999999999,1.1399999999999999,0.28999999999999998,1.1399999999999999,0.28499999999999998]
["Not Applicable - Not Applicable - 00904571135","Not Applicable","Not Applicable","NDC","00904571135","OXYMETAZOLINE 0.05 % NASAL SPRAY",2.5099999999999998,2.5099999999999998,2.5099999999999998,2.5099999999999998,0.62749999999999995]
["Not Applicable - Not Applicable - 00904572114","Not Applicable","Not Applicable","NDC","00904572114","ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP",0.64,0.64,0.32,0.64,0.16]
["Not Applicable - Not Applicable - 00904573451","Not Applicable","Not Applicable","NDC","00904573451","NICOTINE (POLACRILEX) 2 MG GUM",1.56,1.56,0.78,1.56,0.39]
["Not Applicable - Not Applicable - 00904578051","Not Applicable","Not Applicable","NDC","00904578051","FAMOTIDINE 20 MG TABLET",0.74,0.74,0.19,0.74,0.185]
["Not Applicable - Not Applicable - 00904578461","Not Applicable","Not Applicable","NDC","00904578461","FLUOXETINE 10 MG CAPSULE",0.87,0.87,0.22,0.87,0.2175]
["Not Applicable - Not Applicable - 00904578561","Not Applicable","Not Applicable","NDC","00904578561","FLUOXETINE 20 MG CAPSULE",0.45,0.45,0.12,0.45,0.1125]
["Not Applicable - Not Applicable - 00904579061","Not Applicable","Not Applicable","NDC","00904579061","ACYCLOVIR 400 MG TABLET",79.58,79.58,79.58,79.58,19.895]
["Not Applicable - Not Applicable - 00904579661","Not Applicable","Not Applicable","NDC","00904579661","FUROSEMIDE 20 MG TABLET",0.47,0.47,0.06,0.47,0.11749999999999999]
["Not Applicable - Not Applicable - 00904579761","Not Applicable","Not Applicable","NDC","00904579761","FUROSEMIDE 40 MG TABLET",0.27,0.27,0.04,0.27,6.7500000000000004E-2]
["Not Applicable - Not Applicable - 00904579861","Not Applicable","Not Applicable","NDC","00904579861","FUROSEMIDE 80 MG TABLET",0.41,0.41,0.06,0.41,0.10249999999999999]
["Not Applicable - Not Applicable - 00904580061","Not Applicable","Not Applicable","NDC","00904580061","SIMVASTATIN 10 MG TABLET",1.4,1.4,0.35,1.4,0.35]
["Not Applicable - Not Applicable - 00904580161","Not Applicable","Not Applicable","NDC","00904580161","SIMVASTATIN 20 MG TABLET",0.86,0.86,0.22,0.86,0.215]
["Not Applicable - Not Applicable - 00904580261","Not Applicable","Not Applicable","NDC","00904580261","SIMVASTATIN 40 MG TABLET",0.35,0.35,0.09,0.35,8.7499999999999994E-2]
["Not Applicable - Not Applicable - 00904580861","Not Applicable","Not Applicable","NDC","00904580861","LISINOPRIL 10 MG TABLET",0.81,0.81,0.11,0.81,0.20250000000000001]
["Not Applicable - Not Applicable - 00904580961","Not Applicable","Not Applicable","NDC","00904580961","LISINOPRIL 20 MG TABLET",0.5,0.5,7.0000000000000007E-2,0.5,0.125]
["Not Applicable - Not Applicable - 00904581161","Not Applicable","Not Applicable","NDC","00904581161","LISINOPRIL 5 MG TABLET",1.26,1.26,0.16,1.26,0.315]
["Not Applicable - Not Applicable - 00904582360","Not Applicable","Not Applicable","NDC","00904582360","CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET",0.09,0.09,0.04,0.09,2.2499999999999999E-2]
["Not Applicable - Not Applicable - 00904582460","Not Applicable","Not Applicable","NDC","00904582460","CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET",0.06,0.06,0.03,0.06,1.4999999999999999E-2]
["Not Applicable - Not Applicable - 00904582461","Not Applicable","Not Applicable","NDC","00904582461","CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET",0.13,0.13,0.05,0.13,3.2500000000000001E-2]
["Not Applicable - Not Applicable - 00904582489","Not Applicable","Not Applicable","NDC","00904582489","CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET",0.06,0.06,0.03,0.06,1.4999999999999999E-2]
["Not Applicable - Not Applicable - 00904585461","Not Applicable","Not Applicable","NDC","00904585461","IBUPROFEN 600 MG TABLET",0.38,0.38,0.1,0.38,9.5000000000000001E-2]
["Not Applicable - Not Applicable - 00904585561","Not Applicable","Not Applicable","NDC","00904585561","IBUPROFEN 800 MG TABLET",0.21,0.21,0.06,0.21,5.2499999999999998E-2]
["Not Applicable - Not Applicable - 00904585861","Not Applicable","Not Applicable","NDC","00904585861","ALPRAZOLAM 0.25 MG TABLET",1.2,1.2,0.15,1.2,0.3]
["Not Applicable - Not Applicable - 00904585961","Not Applicable","Not Applicable","NDC","00904585961","ALPRAZOLAM 0.5 MG TABLET",0.6,0.6,0.08,0.6,0.15]
["Not Applicable - Not Applicable - 00904586061","Not Applicable","Not Applicable","NDC","00904586061","ALPRAZOLAM 1 MG TABLET",0.35,0.35,0.05,0.35,8.7499999999999994E-2]
["Not Applicable - Not Applicable - 00904588061","Not Applicable","Not Applicable","NDC","00904588061","DIAZEPAM 5 MG TABLET",0.74,0.74,0.08,0.74,0.185]
["Not Applicable - Not Applicable - 00904588761","Not Applicable","Not Applicable","NDC","00904588761","THEOPHYLLINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR",5.2,5.2,1.74,5.2,1.3]
["Not Applicable - Not Applicable - 00904588961","Not Applicable","Not Applicable","NDC","00904588961","THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR",1.96,1.96,0.66,1.96,0.49]
["Not Applicable - Not Applicable - 00904589430","Not Applicable","Not Applicable","NDC","00904589430","SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION",5.76,5.76,5.76,5.76,1.44]
["Not Applicable - Not Applicable - 00904590460","Not Applicable","Not Applicable","NDC","00904590460","BENZONATATE 100 MG CAPSULE",1.66,1.66,0.83,1.66,0.41499999999999998]
["Not Applicable - Not Applicable - 00904592161","Not Applicable","Not Applicable","NDC","00904592161","DIGOXIN 0.125 MG TABLET",8.94,8.94,4.47,8.94,2.2349999999999999]
["Not Applicable - Not Applicable - 00904592261","Not Applicable","Not Applicable","NDC","00904592261","DIGOXIN 0.25 MG TABLET",324.7,324.7,324.7,324.7,81.174999999999997]
["Not Applicable - Not Applicable - 00904592461","Not Applicable","Not Applicable","NDC","00904592461","HALOPERIDOL 2 MG TABLET",13.7,13.7,1.37,13.7,3.4249999999999998]
["Not Applicable - Not Applicable - 00904592961","Not Applicable","Not Applicable","NDC","00904592961","LABETALOL 200 MG TABLET",2.56,2.56,0.64,2.56,0.64]
["Not Applicable - Not Applicable - 00904593061","Not Applicable","Not Applicable","NDC","00904593061","LABETALOL 300 MG TABLET",3.81,3.81,0.96,3.81,0.95250000000000001]
["Not Applicable - Not Applicable - 00904595161","Not Applicable","Not Applicable","NDC","00904595161","SPIRONOLACTONE 25 MG TABLET",1.51,1.51,0.38,1.51,0.3775]
["Not Applicable - Not Applicable - 00904595961","Not Applicable","Not Applicable","NDC","00904595961","CLINDAMYCIN HCL 150 MG CAPSULE",3.29,3.29,1.1000000000000001,3.29,0.82250000000000001]
["Not Applicable - Not Applicable - 00904597561","Not Applicable","Not Applicable","NDC","00904597561","RISPERIDONE 1 MG TABLET",5.19,5.19,0.65,5.19,1.2975000000000001]
["Not Applicable - Not Applicable - 00904597661","Not Applicable","Not Applicable","NDC","00904597661","RISPERIDONE 2 MG TABLET",2.95,2.95,0.37,2.95,0.73750000000000004]
["Not Applicable - Not Applicable - 00904598061","Not Applicable","Not Applicable","NDC","00904598061","LORAZEPAM 0.5 MG TABLET",0.8,0.8,0.2,0.8,0.2]
["Not Applicable - Not Applicable - 00904598161","Not Applicable","Not Applicable","NDC","00904598161","LORAZEPAM 1 MG TABLET",0.47,0.47,0.12,0.47,0.11749999999999999]
["Not Applicable - Not Applicable - 00904598426","Not Applicable","Not Applicable","NDC","00904598426","AMMONIUM LACTATE 12 % LOTION",10.44,10.44,10.44,10.44,2.61]
["Not Applicable - Not Applicable - 00904599061","Not Applicable","Not Applicable","NDC","00904599061","DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR",27.17,27.17,6.8,27.17,6.7925000000000004]
["Not Applicable - Not Applicable - 00904599161","Not Applicable","Not Applicable","NDC","00904599161","AMLODIPINE 2.5 MG TABLET",1.98,1.98,0.5,1.98,0.495]
["Not Applicable - Not Applicable - 00904599261","Not Applicable","Not Applicable","NDC","00904599261","AMLODIPINE 5 MG TABLET",0.56999999999999995,0.56999999999999995,0.15,0.56999999999999995,0.14249999999999999]
["Not Applicable - Not Applicable - 00904600761","Not Applicable","Not Applicable","NDC","00904600761","LORAZEPAM 0.5 MG TABLET",0.7,0.7,0.18,0.7,0.17499999999999999]
["Not Applicable - Not Applicable - 00904600861","Not Applicable","Not Applicable","NDC","00904600861","LORAZEPAM 1 MG TABLET",0.56999999999999995,0.56999999999999995,0.15,0.56999999999999995,0.14249999999999999]
["Not Applicable - Not Applicable - 00904600961","Not Applicable","Not Applicable","NDC","00904600961","LORAZEPAM 2 MG TABLET",0.24,0.24,0.06,0.24,0.06]
["Not Applicable - Not Applicable - 00904601946","Not Applicable","Not Applicable","NDC","00904601946","BICALUTAMIDE 50 MG TABLET",0.96,0.96,0.96,0.96,0.24]
["Not Applicable - Not Applicable - 00904605161","Not Applicable","Not Applicable","NDC","00904605161","LEVETIRACETAM 250 MG TABLET",2.1800000000000002,2.1800000000000002,0.55000000000000004,2.1800000000000002,0.54500000000000004]
["Not Applicable - Not Applicable - 00904605261","Not Applicable","Not Applicable","NDC","00904605261","LEVETIRACETAM 500 MG TABLET",1.39,1.39,0.35,1.39,0.34749999999999998]
["Not Applicable - Not Applicable - 00904606050","Not Applicable","Not Applicable","NDC","00904606050","FERROUS SULFATE 15 MG IRON (75 MG)/ML ORAL DROPS",9.77,9.77,9.77,9.77,2.4424999999999999]
["Not Applicable - Not Applicable - 00904606961","Not Applicable","Not Applicable","NDC","00904606961","NAPROXEN 250 MG TABLET",0.47,0.47,0.24,0.47,0.11749999999999999]
["Not Applicable - Not Applicable - 00904607461","Not Applicable","Not Applicable","NDC","00904607461","LORATADINE 10 MG TABLET",0.85,0.85,0.43,0.85,0.21249999999999999]
["Not Applicable - Not Applicable - 00904607961","Not Applicable","Not Applicable","NDC","00904607961","GABAPENTIN 300 MG CAPSULE",0.57999999999999996,0.57999999999999996,0.15,0.57999999999999996,0.14499999999999999]
["Not Applicable - Not Applicable - 00904608261","Not Applicable","Not Applicable","NDC","00904608261","ZOLPIDEM 5 MG TABLET",0.28000000000000003,0.28000000000000003,7.0000000000000007E-2,0.28000000000000003,7.0000000000000007E-2]
["Not Applicable - Not Applicable - 00904608561","Not Applicable","Not Applicable","NDC","00904608561","CITALOPRAM 20 MG TABLET",0.32,0.32,0.08,0.32,0.08]
["Not Applicable - Not Applicable - 00904608661","Not Applicable","Not Applicable","NDC","00904608661","CITALOPRAM 40 MG TABLET",0.22,0.22,0.06,0.22,5.5E-2]
["Not Applicable - Not Applicable - 00904610161","Not Applicable","Not Applicable","NDC","00904610161","CLONAZEPAM 0.5 MG TABLET",0.74,0.74,0.1,0.74,0.185]
["Not Applicable - Not Applicable - 00904610261","Not Applicable","Not Applicable","NDC","00904610261","CLONAZEPAM 1 MG TABLET",0.43,0.43,0.06,0.43,0.1075]
["Not Applicable - Not Applicable - 00904610361","Not Applicable","Not Applicable","NDC","00904610361","CLONAZEPAM 2 MG TABLET",0.27,0.27,0.04,0.27,6.7500000000000004E-2]
["Not Applicable - Not Applicable - 00904612161","Not Applicable","Not Applicable","NDC","00904612161","ACYCLOVIR 400 MG TABLET",143.88,143.88,143.88,143.88,35.97]
["Not Applicable - Not Applicable - 00904612361","Not Applicable","Not Applicable","NDC","00904612361","GLIPIZIDE 10 MG TABLET",0.57999999999999996,0.57999999999999996,0.15,0.57999999999999996,0.14499999999999999]
["Not Applicable - Not Applicable - 00904612661","Not Applicable","Not Applicable","NDC","00904612661","TERAZOSIN 1 MG CAPSULE",1.83,1.83,0.37,1.83,0.45750000000000002]
["Not Applicable - Not Applicable - 00904612861","Not Applicable","Not Applicable","NDC","00904612861","TERAZOSIN 5 MG CAPSULE",0.38,0.38,0.08,0.38,9.5000000000000001E-2]
["Not Applicable - Not Applicable - 00904612961","Not Applicable","Not Applicable","NDC","00904612961","BUPROPION HCL 100 MG TABLET",2.2200000000000002,2.2200000000000002,1.1100000000000001,2.2200000000000002,0.55500000000000005]
["Not Applicable - Not Applicable - 00904617261","Not Applicable","Not Applicable","NDC","00904617261","CARBAMAZEPINE 200 MG TABLET",2.98,2.98,0.75,2.98,0.745]
["Not Applicable - Not Applicable - 00904618061","Not Applicable","Not Applicable","NDC","00904618061","DEMECLOCYCLINE 150 MG TABLET",25.09,25.09,12.55,25.09,6.2725]
["Not Applicable - Not Applicable - 00904618761","Not Applicable","Not Applicable","NDC","00904618761","PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE",6.08,6.08,0.61,6.08,1.52]
["Not Applicable - Not Applicable - 00904619546","Not Applicable","Not Applicable","NDC","00904619546","ANASTROZOLE 1 MG TABLET",0.53,0.53,0.53,0.53,0.13250000000000001]
["Not Applicable - Not Applicable - 00904622161","Not Applicable","Not Applicable","NDC","00904622161","URSODIOL 300 MG CAPSULE",13.7,13.7,13.7,13.7,3.4249999999999998]
["Not Applicable - Not Applicable - 00904623761","Not Applicable","Not Applicable","NDC","00904623761","CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET",1.1100000000000001,1.1100000000000001,0.28000000000000003,1.1100000000000001,0.27750000000000002]
["Not Applicable - Not Applicable - 00904623861","Not Applicable","Not Applicable","NDC","00904623861","CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET",0.66,0.66,0.33,0.66,0.16500000000000001]
["Not Applicable - Not Applicable - 00904624261","Not Applicable","Not Applicable","NDC","00904624261","DONEPEZIL 5 MG TABLET",0.97,0.97,0.49,0.97,0.24249999999999999]
["Not Applicable - Not Applicable - 00904624761","Not Applicable","Not Applicable","NDC","00904624761","VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR",3.54,3.54,1.18,3.54,0.88500000000000001]
["Not Applicable - Not Applicable - 00904624961","Not Applicable","Not Applicable","NDC","00904624961","LEVOFLOXACIN 250 MG TABLET",3.24,3.24,0.81,3.24,0.81]
["Not Applicable - Not Applicable - 00904625061","Not Applicable","Not Applicable","NDC","00904625061","LEVOFLOXACIN 500 MG TABLET",2.19,2.19,0.55000000000000004,2.19,0.54749999999999999]
["Not Applicable - Not Applicable - 00904625161","Not Applicable","Not Applicable","NDC","00904625161","LEVOFLOXACIN 750 MG TABLET",2.56,2.56,0.64,2.56,0.64]
["Not Applicable - Not Applicable - 00904625549","Not Applicable","Not Applicable","NDC","00904625549","BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES",0.26,0.26,0.26,0.26,6.5000000000000002E-2]
["Not Applicable - Not Applicable - 00904626661","Not Applicable","Not Applicable","NDC","00904626661","ALLOPURINOL 100 MG TABLET",0.7,0.7,0.12,0.7,0.17499999999999999]
["Not Applicable - Not Applicable - 00904628461","Not Applicable","Not Applicable","NDC","00904628461","OLANZAPINE 5 MG TABLET",5.13,5.13,1.29,5.13,1.2825]
["Not Applicable - Not Applicable - 00904628561","Not Applicable","Not Applicable","NDC","00904628561","OLANZAPINE 10 MG TABLET",3.42,3.42,0.86,3.42,0.85499999999999998]
["Not Applicable - Not Applicable - 00904628889","Not Applicable","Not Applicable","NDC","00904628889","ASPIRIN 81 MG CHEWABLE TABLET",0.23,0.23,0.06,0.23,5.7500000000000002E-2]
["Not Applicable - Not Applicable - 00904629061","Not Applicable","Not Applicable","NDC","00904629061","ATORVASTATIN 10 MG TABLET",6.51,6.51,0.82,6.51,1.6274999999999999]
["Not Applicable - Not Applicable - 00904629161","Not Applicable","Not Applicable","NDC","00904629161","ATORVASTATIN 20 MG TABLET",4.01,4.01,0.51,4.01,1.0024999999999999]
["Not Applicable - Not Applicable - 00904629261","Not Applicable","Not Applicable","NDC","00904629261","ATORVASTATIN 40 MG TABLET",1.55,1.55,0.39,1.55,0.38750000000000001]
["Not Applicable - Not Applicable - 00904629304","Not Applicable","Not Applicable","NDC","00904629304","ATORVASTATIN 80 MG TABLET",1.07,1.07,1.07,1.07,0.26750000000000002]
["Not Applicable - Not Applicable - 00904629461","Not Applicable","Not Applicable","NDC","00904629461","CLOPIDOGREL 75 MG TABLET",5.04,5.04,0.63,5.04,1.26]
["Not Applicable - Not Applicable - 00904630161","Not Applicable","Not Applicable","NDC","00904630161","CARVEDILOL 6.25 MG TABLET",0.91,0.91,0.12,0.91,0.22750000000000001]
["Not Applicable - Not Applicable - 00904630261","Not Applicable","Not Applicable","NDC","00904630261","CARVEDILOL 12.5 MG TABLET",0.4,0.4,0.05,0.4,0.1]
["Not Applicable - Not Applicable - 00904630521","Not Applicable","Not Applicable","NDC","00904630521","PHENOL 1.4 % MUCOSAL AEROSOL SPRAY",5.04,5.04,5.04,5.04,1.26]
["Not Applicable - Not Applicable - 00904632261","Not Applicable","Not Applicable","NDC","00904632261","METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR",23.22,23.22,2.91,23.22,5.8049999999999997]
["Not Applicable - Not Applicable - 00904632361","Not Applicable","Not Applicable","NDC","00904632361","METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR",13.9,13.9,1.74,13.9,3.4750000000000001]
["Not Applicable - Not Applicable - 00904632461","Not Applicable","Not Applicable","NDC","00904632461","METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR",8.08,8.08,1.01,8.08,2.02]
["Not Applicable - Not Applicable - 00904632661","Not Applicable","Not Applicable","NDC","00904632661","METFORMIN 500 MG TABLET",0.32,0.32,0.16,0.32,0.08]
["Not Applicable - Not Applicable - 00904633860","Not Applicable","Not Applicable","NDC","00904633860","PSEUDOEPHEDRINE 30 MG TABLET",0.15,0.15,0.08,0.15,3.7499999999999999E-2]
["Not Applicable - Not Applicable - 00904634061","Not Applicable","Not Applicable","NDC","00904634061","METOPROLOL TARTRATE 25 MG TABLET",0.74,0.74,0.1,0.74,0.185]
["Not Applicable - Not Applicable - 00904634161","Not Applicable","Not Applicable","NDC","00904634161","METOPROLOL TARTRATE 50 MG TABLET",0.31,0.31,0.04,0.31,7.7499999999999999E-2]
["Not Applicable - Not Applicable - 00904635161","Not Applicable","Not Applicable","NDC","00904635161","LEVOFLOXACIN 250 MG TABLET",2.19,2.19,0.55000000000000004,2.19,0.54749999999999999]
["Not Applicable - Not Applicable - 00904635261","Not Applicable","Not Applicable","NDC","00904635261","LEVOFLOXACIN 500 MG TABLET",1.41,1.41,0.36,1.41,0.35249999999999998]
["Not Applicable - Not Applicable - 00904635361","Not Applicable","Not Applicable","NDC","00904635361","LEVOFLOXACIN 750 MG TABLET",1.77,1.77,0.45,1.77,0.4425]
["Not Applicable - Not Applicable - 00904635961","Not Applicable","Not Applicable","NDC","00904635961","RISPERIDONE 1 MG TABLET",1.57,1.57,0.2,1.57,0.39250000000000002]
["Not Applicable - Not Applicable - 00904636061","Not Applicable","Not Applicable","NDC","00904636061","RISPERIDONE 2 MG TABLET",0.86,0.86,0.11,0.86,0.215]
["Not Applicable - Not Applicable - 00904636461","Not Applicable","Not Applicable","NDC","00904636461","DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR",13.66,13.66,3.42,13.66,3.415]
["Not Applicable - Not Applicable - 00904636561","Not Applicable","Not Applicable","NDC","00904636561","TRAMADOL 50 MG TABLET",0.4,0.4,0.1,0.4,0.1]
["Not Applicable - Not Applicable - 00904636961","Not Applicable","Not Applicable","NDC","00904636961","AMLODIPINE 2.5 MG TABLET",1.53,1.53,0.39,1.53,0.38250000000000001]
["Not Applicable - Not Applicable - 00904637061","Not Applicable","Not Applicable","NDC","00904637061","AMLODIPINE 5 MG TABLET",0.53,0.53,0.14000000000000001,0.53,0.13250000000000001]
["Not Applicable - Not Applicable - 00904637361","Not Applicable","Not Applicable","NDC","00904637361","ROPINIROLE 0.25 MG TABLET",9.07,9.07,1.1399999999999999,9.07,2.2675000000000001]
["Not Applicable - Not Applicable - 00904637661","Not Applicable","Not Applicable","NDC","00904637661","OLANZAPINE 10 MG TABLET",2.5,2.5,0.63,2.5,0.625]
["Not Applicable - Not Applicable - 00904637761","Not Applicable","Not Applicable","NDC","00904637761","OLANZAPINE 5 MG TABLET",4.79,4.79,1.2,4.79,1.1975]
["Not Applicable - Not Applicable - 00904639061","Not Applicable","Not Applicable","NDC","00904639061","LOSARTAN 50 MG TABLET",2.42,2.42,0.61,2.42,0.60499999999999998]
["Not Applicable - Not Applicable - 00904640161","Not Applicable","Not Applicable","NDC","00904640161","TAMSULOSIN 0.4 MG CAPSULE",1.69,1.69,0.85,1.69,0.42249999999999999]
["Not Applicable - Not Applicable - 00904640506","Not Applicable","Not Applicable","NDC","00904640506","AZITHROMYCIN 250 MG TABLET",25.58,25.58,5.33,25.58,6.3949999999999996]
["Not Applicable - Not Applicable - 00904640561","Not Applicable","Not Applicable","NDC","00904640561","AZITHROMYCIN 250 MG TABLET",22.09,22.09,4.6100000000000003,22.09,5.5225]
["Not Applicable - Not Applicable - 00904640761","Not Applicable","Not Applicable","NDC","00904640761","BISACODYL 5 MG TABLET,DELAYED RELEASE",0.15,0.15,0.08,0.15,3.7499999999999999E-2]
["Not Applicable - Not Applicable - 00904640861","Not Applicable","Not Applicable","NDC","00904640861","DONEPEZIL 5 MG TABLET",0.86,0.86,0.43,0.86,0.215]
["Not Applicable - Not Applicable - 00904640961","Not Applicable","Not Applicable","NDC","00904640961","DONEPEZIL 10 MG TABLET",0.32,0.32,0.16,0.32,0.08]
["Not Applicable - Not Applicable - 00904641292","Not Applicable","Not Applicable","NDC","00904641292","CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET",7.0000000000000007E-2,7.0000000000000007E-2,0.04,7.0000000000000007E-2,1.7500000000000002E-2]
["Not Applicable - Not Applicable - 00904642281","Not Applicable","Not Applicable","NDC","00904642281","POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET",377.99,377.99,377.99,377.99,94.497500000000002]
["Not Applicable - Not Applicable - 00904642286","Not Applicable","Not Applicable","NDC","00904642286","POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET",4.95,4.95,4.95,4.95,1.2375]
["Not Applicable - Not Applicable - 00904642304","Not Applicable","Not Applicable","NDC","00904642304","MODAFINIL 100 MG TABLET",42.98,42.98,21.49,42.98,10.744999999999999]
["Not Applicable - Not Applicable - 00904643480","Not Applicable","Not Applicable","NDC","00904643480","SENNOSIDES 8.6 MG TABLET",7.0000000000000007E-2,7.0000000000000007E-2,0.04,7.0000000000000007E-2,1.7500000000000002E-2]
["Not Applicable - Not Applicable - 00904643761","Not Applicable","Not Applicable","NDC","00904643761","OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET",1.97,1.97,0.99,1.97,0.49249999999999999]
["Not Applicable - Not Applicable - 00904644061","Not Applicable","Not Applicable","NDC","00904644061","HYDRALAZINE 10 MG TABLET",2.2999999999999998,2.2999999999999998,0.31,2.2999999999999998,0.57499999999999996]
["Not Applicable - Not Applicable - 00904644161","Not Applicable","Not Applicable","NDC","00904644161","HYDRALAZINE 25 MG TABLET",0.91,0.91,0.13,0.91,0.22750000000000001]
["Not Applicable - Not Applicable - 00904644261","Not Applicable","Not Applicable","NDC","00904644261","HYDRALAZINE 50 MG TABLET",0.53,0.53,7.0000000000000007E-2,0.53,0.13250000000000001]
["Not Applicable - Not Applicable - 00904644461","Not Applicable","Not Applicable","NDC","00904644461","OXYCODONE 5 MG TABLET",3.06,3.06,0.77,3.06,0.76500000000000001]
["Not Applicable - Not Applicable - 00904644961","Not Applicable","Not Applicable","NDC","00904644961","ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR",3.79,3.79,1.27,3.79,0.94750000000000001]
["Not Applicable - Not Applicable - 00904645061","Not Applicable","Not Applicable","NDC","00904645061","ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR",1.52,1.52,0.51,1.52,0.38]
["Not Applicable - Not Applicable - 00904645204","Not Applicable","Not Applicable","NDC","00904645204","DULOXETINE 20 MG CAPSULE,DELAYED RELEASE",14.48,14.48,4.83,14.48,3.62]
["Not Applicable - Not Applicable - 00904645261","Not Applicable","Not Applicable","NDC","00904645261","DULOXETINE 20 MG CAPSULE,DELAYED RELEASE",11.43,11.43,3.81,11.43,2.8574999999999999]
["Not Applicable - Not Applicable - 00904645361","Not Applicable","Not Applicable","NDC","00904645361","DULOXETINE 30 MG CAPSULE,DELAYED RELEASE",9.5299999999999994,9.5299999999999994,3.18,9.5299999999999994,2.3824999999999998]
["Not Applicable - Not Applicable - 00904645561","Not Applicable","Not Applicable","NDC","00904645561","DOCUSATE SODIUM 100 MG CAPSULE",0.13,0.13,0.13,0.13,3.2500000000000001E-2]
["Not Applicable - Not Applicable - 00904645760","Not Applicable","Not Applicable","NDC","00904645760","DOCUSATE SODIUM 100 MG CAPSULE",0.05,0.05,0.05,0.05,1.2500000000000001E-2]
["Not Applicable - Not Applicable - 00904645780","Not Applicable","Not Applicable","NDC","00904645780","DOCUSATE SODIUM 100 MG CAPSULE",0.05,0.05,0.05,0.05,1.2500000000000001E-2]
["Not Applicable - Not Applicable - 00904646961","Not Applicable","Not Applicable","NDC","00904646961","VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR",5.2,5.2,1.74,5.2,1.3]
["Not Applicable - Not Applicable - 00904647104","Not Applicable","Not Applicable","NDC","00904647104","VORICONAZOLE 200 MG TABLET",2303.62,2303.62,2303.62,2303.62,575.90499999999997]
["Not Applicable - Not Applicable - 00904647461","Not Applicable","Not Applicable","NDC","00904647461","PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE",1.51,1.51,0.76,1.51,0.3775]
["Not Applicable - Not Applicable - 00904647561","Not Applicable","Not Applicable","NDC","00904647561","BACLOFEN 10 MG TABLET",4.45,4.45,0.56000000000000005,4.45,1.1125]
["Not Applicable - Not Applicable - 00904647661","Not Applicable","Not Applicable","NDC","00904647661","BACLOFEN 20 MG TABLET",3.41,3.41,0.43,3.41,0.85250000000000004]
["Not Applicable - Not Applicable - 00904647861","Not Applicable","Not Applicable","NDC","00904647861","DONEPEZIL 10 MG TABLET",0.31,0.31,0.16,0.31,7.7499999999999999E-2]
["Not Applicable - Not Applicable - 00904648561","Not Applicable","Not Applicable","NDC","00904648561","LISINOPRIL 10 MG TABLET",0.69,0.69,0.09,0.69,0.17249999999999999]
["Not Applicable - Not Applicable - 00904648661","Not Applicable","Not Applicable","NDC","00904648661","LISINOPRIL 20 MG TABLET",0.41,0.41,0.06,0.41,0.10249999999999999]
["Not Applicable - Not Applicable - 00904648838","Not Applicable","Not Applicable","NDC","00904648838","WHITE PETROLATUM-MINERAL OIL 83 %-15 % EYE OINTMENT",9.89,9.89,9.89,9.89,2.4725000000000001]
["Not Applicable - Not Applicable - 00904649235","Not Applicable","Not Applicable","NDC","00904649235","POLYVINYL ALCOHOL 1.4 % EYE DROPS",5.12,5.12,5.12,5.12,1.28]
["Not Applicable - Not Applicable - 00904650061","Not Applicable","Not Applicable","NDC","00904650061","FLUCONAZOLE 100 MG TABLET",62.3,62.3,3.9,62.3,15.574999999999999]
["Not Applicable - Not Applicable - 00904650161","Not Applicable","Not Applicable","NDC","00904650161","FLUCONAZOLE 200 MG TABLET",42.92,42.92,2.69,42.92,10.73]
["Not Applicable - Not Applicable - 00904650261","Not Applicable","Not Applicable","NDC","00904650261","CELECOXIB 100 MG CAPSULE",6.75,6.75,3.38,6.75,1.6875]
["Not Applicable - Not Applicable - 00904650361","Not Applicable","Not Applicable","NDC","00904650361","CELECOXIB 200 MG CAPSULE",13.21,13.21,3.31,13.21,3.3025000000000002]
["Not Applicable - Not Applicable - 00904650561","Not Applicable","Not Applicable","NDC","00904650561","MEMANTINE 5 MG TABLET",2.87,2.87,1.44,2.87,0.71750000000000003]
["Not Applicable - Not Applicable - 00904650861","Not Applicable","Not Applicable","NDC","00904650861","HYDROXYCHLOROQUINE 200 MG TABLET",30,30,7.5,30,7.5]
["Not Applicable - Not Applicable - 00904651161","Not Applicable","Not Applicable","NDC","00904651161","ARIPIPRAZOLE 10 MG TABLET",104.61,104.61,10.47,104.61,26.1525]
["Not Applicable - Not Applicable - 00904651961","Not Applicable","Not Applicable","NDC","00904651961","MIRTAZAPINE 15 MG TABLET",1.55,1.55,0.26,1.55,0.38750000000000001]
["Not Applicable - Not Applicable - 00904652261","Not Applicable","Not Applicable","NDC","00904652261","SENNOSIDES 8.6 MG TABLET",0.21,0.21,0.11,0.21,5.2499999999999998E-2]
["Not Applicable - Not Applicable - 00904652306","Not Applicable","Not Applicable","NDC","00904652306","ABACAVIR 300 MG TABLET",41.02,41.02,20.51,41.02,10.255000000000001]
["Not Applicable - Not Applicable - 00904652961","Not Applicable","Not Applicable","NDC","00904652961","MONTELUKAST 10 MG TABLET",1.01,1.01,1.01,1.01,0.2525]
["Not Applicable - Not Applicable - 00904653806","Not Applicable","Not Applicable","NDC","00904653806","BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET",7.91,7.91,3.96,7.91,1.9775]
["Not Applicable - Not Applicable - 00904654061","Not Applicable","Not Applicable","NDC","00904654061","BENZTROPINE 1 MG TABLET",1.05,1.05,0.27,1.05,0.26250000000000001]
["Not Applicable - Not Applicable - 00904654661","Not Applicable","Not Applicable","NDC","00904654661","CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE",8.8000000000000007,8.8000000000000007,2.94,8.8000000000000007,2.2000000000000002]
["Not Applicable - Not Applicable - 00904655304","Not Applicable","Not Applicable","NDC","00904655304","LINEZOLID 600 MG TABLET",20.52,20.52,20.52,20.52,5.13]
["Not Applicable - Not Applicable - 00904655461","Not Applicable","Not Applicable","NDC","00904655461","TRAZODONE 50 MG TABLET",1.57,1.57,0.2,1.57,0.39250000000000002]
["Not Applicable - Not Applicable - 00904655561","Not Applicable","Not Applicable","NDC","00904655561","TRAZODONE 100 MG TABLET",1.1299999999999999,1.1299999999999999,0.15,1.1299999999999999,0.28249999999999997]
["Not Applicable - Not Applicable - 00904655661","Not Applicable","Not Applicable","NDC","00904655661","AMIODARONE 200 MG TABLET",1.85,1.85,0.47,1.85,0.46250000000000002]
["Not Applicable - Not Applicable - 00904655761","Not Applicable","Not Applicable","NDC","00904655761","MORPHINE ER 15 MG TABLET,EXTENDED RELEASE",25.3,25.3,3.8,25.3,6.3250000000000002]
["Not Applicable - Not Applicable - 00904655861","Not Applicable","Not Applicable","NDC","00904655861","MORPHINE ER 30 MG TABLET,EXTENDED RELEASE",9.4700000000000006,9.4700000000000006,1.42,9.4700000000000006,2.3675000000000002]
["Not Applicable - Not Applicable - 00904655961","Not Applicable","Not Applicable","NDC","00904655961","MORPHINE ER 60 MG TABLET,EXTENDED RELEASE",23.19,23.19,3.48,23.19,5.7975000000000003]
["Not Applicable - Not Applicable - 00904656061","Not Applicable","Not Applicable","NDC","00904656061","MORPHINE ER 100 MG TABLET,EXTENDED RELEASE",11.62,11.62,1.75,11.62,2.9049999999999998]
["Not Applicable - Not Applicable - 00904656460","Not Applicable","Not Applicable","NDC","00904656460","BENZONATATE 100 MG CAPSULE",1.3,1.3,0.65,1.3,0.32500000000000001]
["Not Applicable - Not Applicable - 00904656461","Not Applicable","Not Applicable","NDC","00904656461","BENZONATATE 100 MG CAPSULE",3.28,3.28,1.64,3.28,0.82]
["Not Applicable - Not Applicable - 00904656561","Not Applicable","Not Applicable","NDC","00904656561","VALACYCLOVIR 500 MG TABLET",32.299999999999997,32.299999999999997,8.08,32.299999999999997,8.0749999999999993]
["Not Applicable - Not Applicable - 00904656861","Not Applicable","Not Applicable","NDC","00904656861","METRONIDAZOLE 500 MG TABLET",1.59,1.59,1.59,1.59,0.39750000000000002]
["Not Applicable - Not Applicable - 00904657006","Not Applicable","Not Applicable","NDC","00904657006","OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR",27.84,27.84,9.2799999999999994,27.84,6.96]
["Not Applicable - Not Applicable - 00904657161","Not Applicable","Not Applicable","NDC","00904657161","ALLOPURINOL 100 MG TABLET",1.99,1.99,0.34,1.99,0.4975]
["Not Applicable - Not Applicable - 00904657261","Not Applicable","Not Applicable","NDC","00904657261","ALLOPURINOL 300 MG TABLET",112.62,112.62,112.62,112.62,28.155000000000001]
["Not Applicable - Not Applicable - 00904657561","Not Applicable","Not Applicable","NDC","00904657561","PHENOBARBITAL 32.4 MG TABLET",2.69,2.69,0.9,2.69,0.67249999999999999]
["Not Applicable - Not Applicable - 00904658261","Not Applicable","Not Applicable","NDC","00904658261","FOLIC ACID 1 MG TABLET",0.17,0.17,0.17,0.17,4.2500000000000003E-2]
["Not Applicable - Not Applicable - 00904658561","Not Applicable","Not Applicable","NDC","00904658561","BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE",2.1800000000000002,2.1800000000000002,1.0900000000000001,2.1800000000000002,0.54500000000000004]
["Not Applicable - Not Applicable - 00904659161","Not Applicable","Not Applicable","NDC","00904659161","OXYCODONE 30 MG TABLET",4.38,4.38,0.73,4.38,1.095]
["Not Applicable - Not Applicable - 00904659204","Not Applicable","Not Applicable","NDC","00904659204","TOLTERODINE ER 2 MG CAPSULE,EXTENDED RELEASE 24 HR",37.4,37.4,18.7,37.4,9.35]
["Not Applicable - Not Applicable - 00904659461","Not Applicable","Not Applicable","NDC","00904659461","VALSARTAN 80 MG TABLET",4.96,4.96,0.62,4.96,1.24]
["Not Applicable - Not Applicable - 00904659604","Not Applicable","Not Applicable","NDC","00904659604","VORICONAZOLE 50 MG TABLET",107.36,107.36,107.36,107.36,26.84]
["Not Applicable - Not Applicable - 00904660961","Not Applicable","Not Applicable","NDC","00904660961","MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET",0.21,0.21,0.11,0.21,5.2499999999999998E-2]
["Not Applicable - Not Applicable - 00904661561","Not Applicable","Not Applicable","NDC","00904661561","DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE",5.01,5.01,2.5099999999999998,5.01,1.2524999999999999]
["Not Applicable - Not Applicable - 00904661761","Not Applicable","Not Applicable","NDC","00904661761","HYDROXYZINE HCL 25 MG TABLET",1.68,1.68,0.34,1.68,0.42]
["Not Applicable - Not Applicable - 00904662061","Not Applicable","Not Applicable","NDC","00904662061","ISOSORBIDE DINITRATE 20 MG TABLET",4.7300000000000004,4.7300000000000004,1.19,4.7300000000000004,1.1825000000000001]
["Not Applicable - Not Applicable - 00904662735","Not Applicable","Not Applicable","NDC","00904662735","CARBAMIDE PEROXIDE 6.5 % EAR DROPS",3.47,3.47,3.47,3.47,0.86750000000000005]
["Not Applicable - Not Applicable - 00904663661","Not Applicable","Not Applicable","NDC","00904663661","BUPROPION HCL 100 MG TABLET",4.92,4.92,2.46,4.92,1.23]
["Not Applicable - Not Applicable - 00904663761","Not Applicable","Not Applicable","NDC","00904663761","GLIPIZIDE 5 MG TABLET",3.2,3.2,0.8,3.2,0.8]
["Not Applicable - Not Applicable - 00904663861","Not Applicable","Not Applicable","NDC","00904663861","QUETIAPINE 25 MG TABLET",5.32,5.32,0.67,5.32,1.33]
["Not Applicable - Not Applicable - 00904664061","Not Applicable","Not Applicable","NDC","00904664061","QUETIAPINE 100 MG TABLET",1.76,1.76,0.59,1.76,0.44]
["Not Applicable - Not Applicable - 00904666361","Not Applicable","Not Applicable","NDC","00904666361","ACETAZOLAMIDE 250 MG TABLET",22.89,22.89,5.73,22.89,5.7225000000000001]
["Not Applicable - Not Applicable - 00904666561","Not Applicable","Not Applicable","NDC","00904666561","GABAPENTIN 100 MG CAPSULE",1.1100000000000001,1.1100000000000001,0.28000000000000003,1.1100000000000001,0.27750000000000002]
["Not Applicable - Not Applicable - 00904666661","Not Applicable","Not Applicable","NDC","00904666661","GABAPENTIN 300 MG CAPSULE",0.44,0.44,0.11,0.44,0.11]
["Not Applicable - Not Applicable - 00904666761","Not Applicable","Not Applicable","NDC","00904666761","GABAPENTIN 400 MG CAPSULE",0.42,0.42,0.11,0.42,0.105]
["Not Applicable - Not Applicable - 00904667104","Not Applicable","Not Applicable","NDC","00904667104","SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET",1.5,1.5,1.5,1.5,0.375]
["Not Applicable - Not Applicable - 00904670310","Not Applicable","Not Applicable","NDC","00904670310","LEUCOVORIN CALCIUM 25 MG TABLET",29.92,29.92,5.99,29.92,7.48]
["Not Applicable - Not Applicable - 00904670706","Not Applicable","Not Applicable","NDC","00904670706","SEVELAMER CARBONATE 800 MG TABLET",28.67,28.67,9.56,28.67,7.1675000000000004]
["Not Applicable - Not Applicable - 00904672580","Not Applicable","Not Applicable","NDC","00904672580","SENNOSIDES 8.6 MG TABLET",0.05,0.05,0.03,0.05,1.2500000000000001E-2]
["Not Applicable - Not Applicable - 00904674759","Not Applicable","Not Applicable","NDC","00904674759","IBUPROFEN 200 MG TABLET",0.33,0.33,0.09,0.33,8.2500000000000004E-2]
["Not Applicable - Not Applicable - 00904674860","Not Applicable","Not Applicable","NDC","00904674860","BISACODYL 5 MG TABLET,DELAYED RELEASE",0.09,0.09,0.05,0.09,2.2499999999999999E-2]
["Not Applicable - Not Applicable - 00904676130","Not Applicable","Not Applicable","NDC","00904676130","OXYMETAZOLINE 0.05 % NASAL SPRAY",4.6900000000000004,4.6900000000000004,4.6900000000000004,4.6900000000000004,1.1725000000000001]
["Not Applicable - Not Applicable - 00904676605","Not Applicable","Not Applicable","NDC","00904676605","ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION",0.89,0.89,0.89,0.89,0.2225]
["Not Applicable - Not Applicable - 00904677361","Not Applicable","Not Applicable","NDC","00904677361","ACETAMINOPHEN 325 MG TABLET",0.36,0.36,0.12,0.36,0.09]
["Not Applicable - Not Applicable - 00904677861","Not Applicable","Not Applicable","NDC","00904677861","ROSUVASTATIN 5 MG TABLET",25.38,25.38,3.18,25.38,6.3449999999999998]
["Not Applicable - Not Applicable - 00904678370","Not Applicable","Not Applicable","NDC","00904678370","ASPIRIN 81 MG TABLET,DELAYED RELEASE",0.26,0.26,0.04,0.26,6.5000000000000002E-2]
["Not Applicable - Not Applicable - 00904678861","Not Applicable","Not Applicable","NDC","00904678861","BENZTROPINE 0.5 MG TABLET",5.87,5.87,1.47,5.87,1.4675]
["Not Applicable - Not Applicable - 00904679480","Not Applicable","Not Applicable","NDC","00904679480","ASPIRIN 81 MG CHEWABLE TABLET",0.08,0.08,0.02,0.08,0.02]
["Not Applicable - Not Applicable - 00904679489","Not Applicable","Not Applicable","NDC","00904679489","ASPIRIN 81 MG CHEWABLE TABLET",0.2,0.2,0.05,0.2,0.05]
["Not Applicable - Not Applicable - 00904679761","Not Applicable","Not Applicable","NDC","00904679761","LISINOPRIL 5 MG TABLET",1.23,1.23,0.16,1.23,0.3075]
["Not Applicable - Not Applicable - 00904679861","Not Applicable","Not Applicable","NDC","00904679861","LISINOPRIL 10 MG TABLET",0.5,0.5,7.0000000000000007E-2,0.5,0.125]
["Not Applicable - Not Applicable - 00904679961","Not Applicable","Not Applicable","NDC","00904679961","LISINOPRIL 20 MG TABLET",0.32,0.32,0.04,0.32,0.08]
["Not Applicable - Not Applicable - 00904683006","Not Applicable","Not Applicable","NDC","00904683006","FINASTERIDE 5 MG TABLET",2.25,2.25,2.25,2.25,0.5625]
["Not Applicable - Not Applicable - 00904685261","Not Applicable","Not Applicable","NDC","00904685261","LORATADINE 10 MG TABLET",0.94,0.94,0.47,0.94,0.23499999999999999]
["Not Applicable - Not Applicable - 00904686061","Not Applicable","Not Applicable","NDC","00904686061","DIVALPROEX 250 MG TABLET,DELAYED RELEASE",1.27,1.27,0.32,1.27,0.3175]
["Not Applicable - Not Applicable - 00904686861","Not Applicable","Not Applicable","NDC","00904686861","TRAZODONE 50 MG TABLET",1.17,1.17,0.15,1.17,0.29249999999999998]
["Not Applicable - Not Applicable - 00904690204","Not Applicable","Not Applicable","NDC","00904690204","RALOXIFENE 60 MG TABLET",16.100000000000001,16.100000000000001,16.100000000000001,16.100000000000001,4.0250000000000004]
["Not Applicable - Not Applicable - 00904690706","Not Applicable","Not Applicable","NDC","00904690706","PSEUDOEPHEDRINE 60 MG TABLET",0.14000000000000001,0.14000000000000001,7.0000000000000007E-2,0.14000000000000001,3.5000000000000003E-2]
["Not Applicable - Not Applicable - 00904691661","Not Applicable","Not Applicable","NDC","00904691661","METOLAZONE 2.5 MG TABLET",31.22,31.22,7.81,31.22,7.8049999999999997]
["Not Applicable - Not Applicable - 00904692561","Not Applicable","Not Applicable","NDC","00904692561","SERTRALINE 50 MG TABLET",2.67,2.67,0.67,2.67,0.66749999999999998]
["Not Applicable - Not Applicable - 00904692661","Not Applicable","Not Applicable","NDC","00904692661","SERTRALINE 100 MG TABLET",1.52,1.52,0.38,1.52,0.38]
["Not Applicable - Not Applicable - 00904693186","Not Applicable","Not Applicable","NDC","00904693186","POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET",5.54,5.54,5.54,5.54,1.385]
["Not Applicable - Not Applicable - 00904695361","Not Applicable","Not Applicable","NDC","00904695361","LEVOTHYROXINE 100 MCG TABLET",3.89,3.89,0.49,3.89,0.97250000000000003]
["Not Applicable - Not Applicable - 00904695461","Not Applicable","Not Applicable","NDC","00904695461","LEVOTHYROXINE 112 MCG TABLET",3.38,3.38,0.43,3.38,0.84499999999999997]
["Not Applicable - Not Applicable - 00904697261","Not Applicable","Not Applicable","NDC","00904697261","DOXEPIN 50 MG CAPSULE",8.6999999999999993,8.6999999999999993,1.45,8.6999999999999993,2.1749999999999998]
["Not Applicable - Not Applicable - 00904699361","Not Applicable","Not Applicable","NDC","00904699361","AMIODARONE 200 MG TABLET",1.97,1.97,0.5,1.97,0.49249999999999999]
["Not Applicable - Not Applicable - 00904699880","Not Applicable","Not Applicable","NDC","00904699880","DOCUSATE SODIUM 100 MG CAPSULE",0.04,0.04,0.04,0.04,0.01]
["Not Applicable - Not Applicable - 00904700761","Not Applicable","Not Applicable","NDC","00904700761","LAMOTRIGINE 25 MG TABLET",3.19,3.19,0.4,3.19,0.79749999999999999]
["Not Applicable - Not Applicable - 00904703588","Not Applicable","Not Applicable","NDC","00904703588","CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH",5.76,5.76,5.76,5.76,1.44]
["Not Applicable - Not Applicable - 00904703604","Not Applicable","Not Applicable","NDC","00904703604","NALTREXONE 50 MG TABLET",17.75,17.75,2.96,17.75,4.4375]
["Not Applicable - Not Applicable - 00904704304","Not Applicable","Not Applicable","NDC","00904704304","DULOXETINE 20 MG CAPSULE,DELAYED RELEASE",14.48,14.48,4.83,14.48,3.62]
["Not Applicable - Not Applicable - 00904704361","Not Applicable","Not Applicable","NDC","00904704361","DULOXETINE 20 MG CAPSULE,DELAYED RELEASE",11.43,11.43,3.81,11.43,2.8574999999999999]
["Not Applicable - Not Applicable - 00904704461","Not Applicable","Not Applicable","NDC","00904704461","DULOXETINE 30 MG CAPSULE,DELAYED RELEASE",8.23,8.23,2.75,8.23,2.0575000000000001]
["Not Applicable - Not Applicable - 00904704761","Not Applicable","Not Applicable","NDC","00904704761","LOSARTAN 25 MG TABLET",5.12,5.12,1.28,5.12,1.28]
["Not Applicable - Not Applicable - 00904704861","Not Applicable","Not Applicable","NDC","00904704861","LOSARTAN 50 MG TABLET",4.4800000000000004,4.4800000000000004,1.1200000000000001,4.4800000000000004,1.1200000000000001]
["Not Applicable - Not Applicable - 00904705361","Not Applicable","Not Applicable","NDC","00904705361","DOXEPIN 25 MG CAPSULE",15.97,15.97,2.67,15.97,3.9925000000000002]
["Not Applicable - Not Applicable - 00904706188","Not Applicable","Not Applicable","NDC","00904706188","POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID",26.6,26.6,26.6,26.6,6.65]
["Not Applicable - Not Applicable - 00904708061","Not Applicable","Not Applicable","NDC","00904708061","NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR",7.65,7.65,2.5499999999999998,7.65,1.9125000000000001]
["Not Applicable - Not Applicable - 00904708106","Not Applicable","Not Applicable","NDC","00904708106","NIFEDIPINE ER 60 MG TABLET,EXTENDED RELEASE 24 HR",8.34,8.34,2.78,8.34,2.085]
["Not Applicable - Not Applicable - 00904708161","Not Applicable","Not Applicable","NDC","00904708161","NIFEDIPINE ER 60 MG TABLET,EXTENDED RELEASE 24 HR",10.25,10.25,3.42,10.25,2.5625]
["Not Applicable - Not Applicable - 00904708204","Not Applicable","Not Applicable","NDC","00904708204","NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR",10.32,10.32,3.44,10.32,2.58]
["Not Applicable - Not Applicable - 00904710561","Not Applicable","Not Applicable","NDC","00904710561","CAPTOPRIL 12.5 MG TABLET",17.57,17.57,2.2000000000000002,17.57,4.3925000000000001]
["Not Applicable - Not Applicable - 00904711561","Not Applicable","Not Applicable","NDC","00904711561","DOCUSATE SODIUM 100 MG CAPSULE",0.14000000000000001,0.14000000000000001,0.14000000000000001,0.14000000000000001,3.5000000000000003E-2]
["Not Applicable - Not Applicable - 00904714260","Not Applicable","Not Applicable","NDC","00904714260","BISACODYL 10 MG RECTAL SUPPOSITORY",0.34,0.34,0.17,0.34,8.5000000000000006E-2]
["Not Applicable - Not Applicable - 00904715661","Not Applicable","Not Applicable","NDC","00904715661","METRONIDAZOLE 250 MG TABLET",1.38,1.38,0.69,1.38,0.34499999999999997]
["Not Applicable - Not Applicable - 00904716261","Not Applicable","Not Applicable","NDC","00904716261","METFORMIN 500 MG TABLET",0.35,0.35,0.18,0.35,8.7499999999999994E-2]
["Not Applicable - Not Applicable - 00904759160","Not Applicable","Not Applicable","NDC","00904759160","FERROUS SULFATE 325 MG (65 MG IRON) TABLET",0.04,0.04,0.04,0.04,0.01]
["Not Applicable - Not Applicable - 00904759161","Not Applicable","Not Applicable","NDC","00904759161","FERROUS SULFATE 325 MG (65 MG IRON) TABLET",0.08,0.08,0.08,0.08,0.02]
["Not Applicable - Not Applicable - 00904759180","Not Applicable","Not Applicable","NDC","00904759180","FERROUS SULFATE 325 MG (65 MG IRON) TABLET",0.04,0.04,0.04,0.04,0.01]
["Not Applicable - Not Applicable - 00904762331","Not Applicable","Not Applicable","NDC","00904762331","HYDROCORTISONE-ALOE VERA 1 % TOPICAL CREAM",3.69,3.69,3.69,3.69,0.92249999999999999]
["Not Applicable - Not Applicable - 00904768822","Not Applicable","Not Applicable","NDC","00904768822","PHENYLEPHRINE 0.25 % RECTAL SUPPOSITORY",0.35,0.35,0.35,0.35,8.7499999999999994E-2]
["Not Applicable - Not Applicable - 00904770480","Not Applicable","Not Applicable","NDC","00904770480","ASPIRIN 81 MG TABLET,DELAYED RELEASE",0.18,0.18,0.03,0.18,4.4999999999999998E-2]
["Not Applicable - Not Applicable - 00904780961","Not Applicable","Not Applicable","NDC","00904780961","CYCLOBENZAPRINE 10 MG TABLET",0.19,0.19,0.1,0.19,4.7500000000000001E-2]
["Not Applicable - Not Applicable - 00904782231","Not Applicable","Not Applicable","NDC","00904782231","CLOTRIMAZOLE 1 % TOPICAL CREAM",6.35,6.35,6.35,6.35,1.5874999999999999]
["Not Applicable - Not Applicable - 00904782236","Not Applicable","Not Applicable","NDC","00904782236","CLOTRIMAZOLE 1 % TOPICAL CREAM",4.59,4.59,4.59,4.59,1.1475]
["Not Applicable - Not Applicable - 00904791259","Not Applicable","Not Applicable","NDC","00904791259","IBUPROFEN 200 MG TABLET",0.2,0.2,0.05,0.2,0.05]
["Not Applicable - Not Applicable - 00904791461","Not Applicable","Not Applicable","NDC","00904791461","IBUPROFEN 200 MG TABLET",0.54,0.54,0.14000000000000001,0.54,0.13500000000000001]
["Not Applicable - Not Applicable - 00904791580","Not Applicable","Not Applicable","NDC","00904791580","IBUPROFEN 200 MG TABLET",0.16,0.16,0.04,0.16,0.04]
["Not Applicable - Not Applicable - 00904792761","Not Applicable","Not Applicable","NDC","00904792761","BISACODYL 5 MG TABLET,DELAYED RELEASE",0.2,0.2,0.1,0.2,0.05]
["Not Applicable - Not Applicable - 00955105027","Not Applicable","Not Applicable","NDC","00955105027","SEVELAMER CARBONATE 800 MG TABLET",16.84,16.84,5.62,16.84,4.21]
["Not Applicable - Not Applicable - 00955173730","Not Applicable","Not Applicable","NDC","00955173730","LEFLUNOMIDE 20 MG TABLET",16.579999999999998,16.579999999999998,8.2899999999999991,16.579999999999998,4.1449999999999996]
["Not Applicable - Not Applicable - 00990793519","Not Applicable","Not Applicable","NDC","00990793519","DEXTROSE 20 % IN WATER (D20W) INTRAVENOUS SOLUTION",15.99,15.99,15.99,15.99,3.9975000000000001]
["Not Applicable - Not Applicable - 00998020415","Not Applicable","Not Applicable","NDC","00998020415","PILOCARPINE 2 % EYE DROPS",321.22000000000003,321.22000000000003,321.22000000000003,321.22000000000003,80.305000000000007]
["Not Applicable - Not Applicable - 00998020615","Not Applicable","Not Applicable","NDC","00998020615","PILOCARPINE 4 % EYE DROPS",332.68,332.68,332.68,332.68,83.17]
["Not Applicable - Not Applicable - 01490003904","Not Applicable","Not Applicable","NDC","01490003904","BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION",8.81,8.81,8.81,8.81,2.2025000000000001]
["Not Applicable - Not Applicable - 01490003908","Not Applicable","Not Applicable","NDC","01490003908","BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION",13.42,13.42,13.42,13.42,3.355]
["Not Applicable - Not Applicable - 01490085602","Not Applicable","Not Applicable","NDC","01490085602","BISMUTH SUBSALICYLATE 525 MG/15 ML ORAL SUSPENSION",13.42,13.42,13.42,13.42,3.355]
["Not Applicable - Not Applicable - 01870074631","Not Applicable","Not Applicable","NDC","01870074631","DEXTROSE-DEXTRIN-MALTOSE 24 GRAM/31 GRAM ORAL GEL",9.48,9.48,9.48,9.48,2.37]
["Not Applicable - Not Applicable - 01870074633","Not Applicable","Not Applicable","NDC","01870074633","DEXTROSE-DEXTRIN-MALTOSE 24 GRAM/31 GRAM ORAL GEL",14.54,14.54,14.54,14.54,3.6349999999999998]
["Not Applicable - Not Applicable - 05047450858","Not Applicable","Not Applicable","NDC","05047450858","SODIUM HYALURONATE 10 MG/ML INTRAOCULAR SYRINGE",345.38,345.38,345.38,345.38,86.344999999999999]
["Not Applicable - Not Applicable - 05074250501","Not Applicable","Not Applicable","NDC","05074250501","SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH",20.55,20.55,20.55,20.55,5.1375000000000002]
["Not Applicable - Not Applicable - 05664119850","Not Applicable","Not Applicable","NDC","05664119850","WHITE PETROLATUM-MINERAL OIL 83 %-15 % EYE OINTMENT",8.52,8.52,8.52,8.52,2.13]
["Not Applicable - Not Applicable - 08065183055","Not Applicable","Not Applicable","NDC","08065183055","SODIUM HYALURONATE 10 MG/ML INTRAOCULAR SYRINGE",500.27,500.27,500.27,500.27,125.0675]
["Not Applicable - Not Applicable - 08065183135","Not Applicable","Not Applicable","NDC","08065183135","CHONDROITIN-SOD HYALURON 3 %-4 %(0.35 ML)1 %(0.4 ML)INTRAOCULAR SYRING",697.29,697.29,697.29,697.29,174.32249999999999]
["Not Applicable - Not Applicable - 08065183150","Not Applicable","Not Applicable","NDC","08065183150","CHONDROITIN-SOD HYALURON 3 %-4 %(0.5 ML)1 %(0.55 ML)INTRAOCULAR SYRING",1405.03,1405.03,1405.03,1405.03,351.25749999999999]
["Not Applicable - Not Applicable - 08290309628","Not Applicable","Not Applicable","NDC","08290309628","SYRINGE (DISPOSABLE) 1 ML",72.12,72.12,72.12,72.12,18.03]
["Not Applicable - Not Applicable - 10006070034","Not Applicable","Not Applicable","NDC","10006070034","VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) CAPSULE",0.13,0.13,0.13,0.13,3.2500000000000001E-2]
["Not Applicable - Not Applicable - 10006073038","Not Applicable","Not Applicable","NDC","10006073038","MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET",0.09,0.09,0.05,0.09,2.2499999999999999E-2]
["Not Applicable - Not Applicable - 10019005561","Not Applicable","Not Applicable","NDC","10019005561","ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV",547.09,547.09,547.09,547.09,136.77250000000001]
["Not Applicable - Not Applicable - 10019007587","Not Applicable","Not Applicable","NDC","10019007587","ESMOLOL 2,000 MG/100 ML (20 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV",572.30999999999995,572.30999999999995,572.30999999999995,572.30999999999995,143.07749999999999]
["Not Applicable - Not Applicable - 10019055303","Not Applicable","Not Applicable","NDC","10019055303","SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH",66.3,66.3,66.3,66.3,16.574999999999999]
["Not Applicable - Not Applicable - 10019055390","Not Applicable","Not Applicable","NDC","10019055390","SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH",75.66,75.66,75.66,75.66,18.914999999999999]
["Not Applicable - Not Applicable - 10119002003","Not Applicable","Not Applicable","NDC","10119002003","PROPYLENE GLYCOL 1 %-GLYCERIN 0.3 % EYE DROPS",16.36,16.36,16.36,16.36,4.09]
["Not Applicable - Not Applicable - 10122032501","Not Applicable","Not Applicable","NDC","10122032501","NICARDIPINE 40 MG/200 ML(0.2 MG/ML) IN SOD CHLOR(ISO) INTRAVENOUS SOLN",722.58,722.58,722.58,722.58,180.64500000000001]
["Not Applicable - Not Applicable - 10122032510","Not Applicable","Not Applicable","NDC","10122032510","NICARDIPINE 40 MG/200 ML(0.2 MG/ML) IN SOD CHLOR(ISO) INTRAVENOUS SOLN",660.77,660.77,660.77,660.77,165.1925]
["Not Applicable - Not Applicable - 10122051001","Not Applicable","Not Applicable","NDC","10122051001","PORACTANT ALFA 120 MG/1.5 ML INTRATRACHEAL SUSPENSION",1633.91,1633.91,1633.91,1633.91,408.47750000000002]
["Not Applicable - Not Applicable - 10122051003","Not Applicable","Not Applicable","NDC","10122051003","PORACTANT ALFA 240 MG/3 ML INTRATRACHEAL SUSPENSION",3179.85,3179.85,3179.85,3179.85,794.96249999999998]
["Not Applicable - Not Applicable - 10122061001","Not Applicable","Not Applicable","NDC","10122061001","CLEVIDIPINE 25 MG/50 ML INTRAVENOUS EMULSION",272.83999999999997,272.83999999999997,272.83999999999997,272.83999999999997,68.209999999999994]
["Not Applicable - Not Applicable - 10147075004","Not Applicable","Not Applicable","NDC","10147075004","KETOCONAZOLE 2 % SHAMPOO",57.56,57.56,57.56,57.56,14.39]
["Not Applicable - Not Applicable - 10147088106","Not Applicable","Not Applicable","NDC","10147088106","GALANTAMINE 4 MG TABLET",33.08,33.08,11.03,33.08,8.27]
["Not Applicable - Not Applicable - 10147170003","Not Applicable","Not Applicable","NDC","10147170003","ITRACONAZOLE 100 MG CAPSULE",73.819999999999993,73.819999999999993,24.61,73.819999999999993,18.454999999999998]
["Not Applicable - Not Applicable - 10370083109","Not Applicable","Not Applicable","NDC","10370083109","DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR",1.75,1.75,0.59,1.75,0.4375]
["Not Applicable - Not Applicable - 10702001101","Not Applicable","Not Applicable","NDC","10702001101","HYDROXYZINE HCL 25 MG TABLET",0.66,0.66,0.14000000000000001,0.66,0.16500000000000001]
["Not Applicable - Not Applicable - 10702006501","Not Applicable","Not Applicable","NDC","10702006501","DEXTROAMPHETAMINE 5 MG TABLET",3.19,3.19,1.6,3.19,0.79749999999999999]
["Not Applicable - Not Applicable - 10702010001","Not Applicable","Not Applicable","NDC","10702010001","METHYLPHENIDATE 5 MG TABLET",1.4,1.4,0.35,1.4,0.35]
["Not Applicable - Not Applicable - 10939079411","Not Applicable","Not Applicable","NDC","10939079411","CLOTRIMAZOLE 100 MG VAGINAL TABLET",2.29,2.29,2.29,2.29,0.57250000000000001]
["Not Applicable - Not Applicable - 11086003010","Not Applicable","Not Applicable","NDC","11086003010","SALICYLIC ACID 6 % TOPICAL GEL",161.63999999999999,161.63999999999999,161.63999999999999,161.63999999999999,40.409999999999997]
["Not Applicable - Not Applicable - 11523723403","Not Applicable","Not Applicable","NDC","11523723403","POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER",40.590000000000003,40.590000000000003,40.590000000000003,40.590000000000003,10.147500000000001]
["Not Applicable - Not Applicable - 11534016501","Not Applicable","Not Applicable","NDC","11534016501","FOLIC ACID 1 MG TABLET",0.14000000000000001,0.14000000000000001,0.14000000000000001,0.14000000000000001,3.5000000000000003E-2]
["Not Applicable - Not Applicable - 11704037001","Not Applicable","Not Applicable","NDC","11704037001","HYDROXOCOBALAMIN 5 GRAM INTRAVENOUS SOLUTION",2944.74,2944.74,2944.74,2944.74,736.18499999999995]
["Not Applicable - Not Applicable - 11788000101","Not Applicable","Not Applicable","NDC","11788000101","FOLIC ACID 1 MG TABLET",0.18,0.18,0.18,0.18,4.4999999999999998E-2]
["Not Applicable - Not Applicable - 11788001001","Not Applicable","Not Applicable","NDC","11788001001","IBUPROFEN 800 MG TABLET",0.24,0.24,0.06,0.24,0.06]
["Not Applicable - Not Applicable - 11845009151","Not Applicable","Not Applicable","NDC","11845009151","CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) TABLET",0.15,0.15,0.15,0.15,3.7499999999999999E-2]
["Not Applicable - Not Applicable - 11845050501","Not Applicable","Not Applicable","NDC","11845050501","VITAMIN E 400 UNIT CAPSULE",0.23,0.23,0.23,0.23,5.7500000000000002E-2]
["Not Applicable - Not Applicable - 11845071401","Not Applicable","Not Applicable","NDC","11845071401","RIBOFLAVIN (VITAMIN B2) 100 MG TABLET",0.2,0.2,0.2,0.2,0.05]
["Not Applicable - Not Applicable - 11980017405","Not Applicable","Not Applicable","NDC","11980017405","PREDNISOLONE ACETATE 0.12 % EYE DROPS,SUSPENSION",541.33000000000004,541.33000000000004,541.33000000000004,541.33000000000004,135.33250000000001]
["Not Applicable - Not Applicable - 12870000101","Not Applicable","Not Applicable","NDC","12870000101","SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK",193.97,193.97,193.97,193.97,48.4925]
["Not Applicable - Not Applicable - 12870000102","Not Applicable","Not Applicable","NDC","12870000102","SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK",184.02,184.02,184.02,184.02,46.005000000000003]
["Not Applicable - Not Applicable - 13273021003","Not Applicable","Not Applicable","NDC","13273021003","SALSALATE 750 MG TABLET",8.1300000000000008,8.1300000000000008,4.07,8.1300000000000008,2.0325000000000002]
["Not Applicable - Not Applicable - 13310015307","Not Applicable","Not Applicable","NDC","13310015307","QUININE 324 MG CAPSULE",46.53,46.53,23.27,46.53,11.6325]
["Not Applicable - Not Applicable - 13668004501","Not Applicable","Not Applicable","NDC","13668004501","LAMOTRIGINE 25 MG TABLET",1.6,1.6,0.2,1.6,0.4]
["Not Applicable - Not Applicable - 13668008030","Not Applicable","Not Applicable","NDC","13668008030","MONTELUKAST 5 MG CHEWABLE TABLET",2.4900000000000002,2.4900000000000002,1.99,2.4900000000000002,0.62250000000000005]
["Not Applicable - Not Applicable - 13668009190","Not Applicable","Not Applicable","NDC","13668009190","PRAMIPEXOLE 0.125 MG TABLET",1.92,1.92,0.16,1.92,0.48]
["Not Applicable - Not Applicable - 13668009490","Not Applicable","Not Applicable","NDC","13668009490","PRAMIPEXOLE 1 MG TABLET",0.26,0.26,0.03,0.26,6.5000000000000002E-2]
["Not Applicable - Not Applicable - 13668013301","Not Applicable","Not Applicable","NDC","13668013301","FELODIPINE ER 5 MG TABLET,EXTENDED RELEASE 24 HR",2.52,2.52,0.63,2.52,0.63]
["Not Applicable - Not Applicable - 13668045301","Not Applicable","Not Applicable","NDC","13668045301","ANAGRELIDE 0.5 MG CAPSULE",4.4800000000000004,4.4800000000000004,2.2400000000000002,4.4800000000000004,1.1200000000000001]
["Not Applicable - Not Applicable - 13668048450","Not Applicable","Not Applicable","NDC","13668048450","MINOCYCLINE 100 MG CAPSULE",2.2599999999999998,2.2599999999999998,1.1299999999999999,2.2599999999999998,0.56499999999999995]
["Not Applicable - Not Applicable - 13668060601","Not Applicable","Not Applicable","NDC","13668060601","ERYTHROMYCIN 250 MG TABLET",22.1,22.1,22.1,22.1,5.5250000000000004]
["Not Applicable - Not Applicable - 13811052501","Not Applicable","Not Applicable","NDC","13811052501","VITAMIN B COMPLEX AND VITAMIN C NO.20-FOLIC ACID 1 MG CAPSULE",1.42,1.42,1.42,1.42,0.35499999999999998]
["Not Applicable - Not Applicable - 13845120202","Not Applicable","Not Applicable","NDC","13845120202","CYCLOSERINE 250 MG CAPSULE",461.87,461.87,230.94,461.87,115.4675]
["Not Applicable - Not Applicable - 13925050530","Not Applicable","Not Applicable","NDC","13925050530","DAPSONE 100 MG TABLET",4.8499999999999996,4.8499999999999996,4.8499999999999996,4.8499999999999996,1.2124999999999999]
["Not Applicable - Not Applicable - 14428000888","Not Applicable","Not Applicable","NDC","14428000888","BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT",4.78,4.78,4.78,4.78,1.1950000000000001]
["Not Applicable - Not Applicable - 15584010101","Not Applicable","Not Applicable","NDC","15584010101","EFAVIRENZ 600 MG-EMTRICITABINE 200 MG-TENOFOVIR DISOPROX 300 MG TABLET",342.22,342.22,342.22,342.22,85.555000000000007]
["Not Applicable - Not Applicable - 16252051401","Not Applicable","Not Applicable","NDC","16252051401","CIPROFLOXACIN 250 MG TABLET",1.05,1.05,0.35,1.05,0.26250000000000001]
["Not Applicable - Not Applicable - 16500007909","Not Applicable","Not Applicable","NDC","16500007909","PEDIATRIC MULTIVIT NO.79-FERROUS FUMARATE 18 MG IRON CHEWABLE TABLET",0.46,0.46,0.46,0.46,0.115]
["Not Applicable - Not Applicable - 16571016010","Not Applicable","Not Applicable","NDC","16571016010","TRIHEXYPHENIDYL 2 MG TABLET",0.88,0.88,0.35,0.88,0.22]
["Not Applicable - Not Applicable - 16571016110","Not Applicable","Not Applicable","NDC","16571016110","TRIHEXYPHENIDYL 5 MG TABLET",0.69,0.69,0.28000000000000003,0.69,0.17249999999999999]
["Not Applicable - Not Applicable - 16571033016","Not Applicable","Not Applicable","NDC","16571033016","PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR",263.82,263.82,263.82,263.82,65.954999999999998]
["Not Applicable - Not Applicable - 16571066101","Not Applicable","Not Applicable","NDC","16571066101","MECLIZINE 25 MG TABLET",0.46,0.46,0.12,0.46,0.115]
["Not Applicable - Not Applicable - 16729000101","Not Applicable","Not Applicable","NDC","16729000101","GLIMEPIRIDE 1 MG TABLET",2.39,2.39,0.3,2.39,0.59750000000000003]
["Not Applicable - Not Applicable - 16729003001","Not Applicable","Not Applicable","NDC","16729003001","METHYLDOPA 250 MG TABLET",1.1299999999999999,1.1299999999999999,0.56999999999999995,1.1299999999999999,0.28249999999999997]
["Not Applicable - Not Applicable - 16729003410","Not Applicable","Not Applicable","NDC","16729003410","LETROZOLE 2.5 MG TABLET",0.37,0.37,0.37,0.37,9.2499999999999999E-2]
["Not Applicable - Not Applicable - 16729009015","Not Applicable","Not Applicable","NDC","16729009015","FINASTERIDE 5 MG TABLET",0.22,0.22,0.22,0.22,5.5E-2]
["Not Applicable - Not Applicable - 16729013600","Not Applicable","Not Applicable","NDC","16729013600","CLONAZEPAM 0.5 MG TABLET",0.36,0.36,0.05,0.36,0.09]
["Not Applicable - Not Applicable - 16729017101","Not Applicable","Not Applicable","NDC","16729017101","AMITRIPTYLINE 10 MG TABLET",1.96,1.96,0.2,1.96,0.49]
["Not Applicable - Not Applicable - 16729018301","Not Applicable","Not Applicable","NDC","16729018301","HYDROCHLOROTHIAZIDE 25 MG TABLET",0.06,0.06,0.06,0.06,1.4999999999999999E-2]
["Not Applicable - Not Applicable - 16729020001","Not Applicable","Not Applicable","NDC","16729020001","BUSPIRONE 5 MG TABLET",0.2,0.2,7.0000000000000007E-2,0.2,0.05]
["Not Applicable - Not Applicable - 16729021615","Not Applicable","Not Applicable","NDC","16729021615","SERTRALINE 50 MG TABLET",0.56999999999999995,0.56999999999999995,0.15,0.56999999999999995,0.14249999999999999]
["Not Applicable - Not Applicable - 16729022516","Not Applicable","Not Applicable","NDC","16729022516","SPIRONOLACTONE 25 MG TABLET",0.56000000000000005,0.56000000000000005,0.14000000000000001,0.56000000000000005,0.14000000000000001]
["Not Applicable - Not Applicable - 17238061015","Not Applicable","Not Applicable","NDC","17238061015","HYPROMELLOSE 2.5 % EYE DROPS",15.83,15.83,15.83,15.83,3.9575]
["Not Applicable - Not Applicable - 17238090011","Not Applicable","Not Applicable","NDC","17238090011","FLUORESCEIN 1 MG EYE STRIPS",0.6,0.6,0.6,0.6,0.15]
["Not Applicable - Not Applicable - 17478006235","Not Applicable","Not Applicable","NDC","17478006235","WHITE PETROLATUM-MINERAL OIL 83 %-15 % EYE OINTMENT",23.92,23.92,23.92,23.92,5.98]
["Not Applicable - Not Applicable - 17478006412","Not Applicable","Not Applicable","NDC","17478006412","HYPROMELLOSE 2.5 % EYE DROPS",55.48,55.48,55.48,55.48,13.87]
["Not Applicable - Not Applicable - 17478007031","Not Applicable","Not Applicable","NDC","17478007031","ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT",13.68,13.68,13.68,13.68,3.42]
["Not Applicable - Not Applicable - 17478009702","Not Applicable","Not Applicable","NDC","17478009702","CYCLOPENTOLATE 2 % EYE DROPS",75.92,75.92,75.92,75.92,18.98]
["Not Applicable - Not Applicable - 17478010002","Not Applicable","Not Applicable","NDC","17478010002","CYCLOPENTOLATE 1 % EYE DROPS",11.48,11.48,11.48,11.48,2.87]
["Not Applicable - Not Applicable - 17478010012","Not Applicable","Not Applicable","NDC","17478010012","CYCLOPENTOLATE 1 % EYE DROPS",37.36,37.36,37.36,37.36,9.34]
["Not Applicable - Not Applicable - 17478010112","Not Applicable","Not Applicable","NDC","17478010112","TROPICAMIDE 0.5 % EYE DROPS",15.3,15.3,15.3,15.3,3.8250000000000002]
["Not Applicable - Not Applicable - 17478010212","Not Applicable","Not Applicable","NDC","17478010212","TROPICAMIDE 1 % EYE DROPS",15.25,15.25,15.25,15.25,3.8125]
["Not Applicable - Not Applicable - 17478015142","Not Applicable","Not Applicable","NDC","17478015142","RIFAMPIN 600 MG INTRAVENOUS SOLUTION",387.23,387.23,387.23,387.23,96.807500000000005]
["Not Applicable - Not Applicable - 17478020020","Not Applicable","Not Applicable","NDC","17478020020","PHENYLEPHRINE 2.5 % EYE DROPS",38.619999999999997,38.619999999999997,38.619999999999997,38.619999999999997,9.6549999999999994]
["Not Applicable - Not Applicable - 17478020115","Not Applicable","Not Applicable","NDC","17478020115","PHENYLEPHRINE 2.5 % EYE DROPS",266.39,266.39,266.39,266.39,66.597499999999997]
["Not Applicable - Not Applicable - 17478020510","Not Applicable","Not Applicable","NDC","17478020510","PHENYLEPHRINE 10 % EYE DROPS",50.81,50.81,50.81,50.81,12.702500000000001]
["Not Applicable - Not Applicable - 17478020810","Not Applicable","Not Applicable","NDC","17478020810","KETOROLAC 0.4 % EYE DROPS",113.76,113.76,113.76,113.76,28.44]
["Not Applicable - Not Applicable - 17478021410","Not Applicable","Not Applicable","NDC","17478021410","ATROPINE 1 % EYE DROPS",54.18,54.18,54.18,54.18,13.545]
["Not Applicable - Not Applicable - 17478021505","Not Applicable","Not Applicable","NDC","17478021505","ATROPINE 1 % EYE DROPS",155.43,155.43,155.43,155.43,38.857500000000002]
["Not Applicable - Not Applicable - 17478023835","Not Applicable","Not Applicable","NDC","17478023835","BACITRACIN-POLYMYXIN B 500 UNIT-10,000 UNIT/GRAM EYE OINTMENT",38.71,38.71,38.71,38.71,9.6775000000000002]
["Not Applicable - Not Applicable - 17478026312","Not Applicable","Not Applicable","NDC","17478026312","PROPARACAINE 0.5 % EYE DROPS",111.75,111.75,111.75,111.75,27.9375]
["Not Applicable - Not Applicable - 17478028310","Not Applicable","Not Applicable","NDC","17478028310","GENTAMICIN 0.3 % EYE DROPS",50.91,50.91,50.91,50.91,12.727499999999999]
["Not Applicable - Not Applicable - 17478028435","Not Applicable","Not Applicable","NDC","17478028435","GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT",90.4,90.4,90.4,90.4,22.6]
["Not Applicable - Not Applicable - 17478028810","Not Applicable","Not Applicable","NDC","17478028810","TIMOLOL MALEATE 0.5 % EYE DROPS",16.100000000000001,16.100000000000001,16.100000000000001,16.100000000000001,4.0250000000000004]
["Not Applicable - Not Applicable - 17478028811","Not Applicable","Not Applicable","NDC","17478028811","TIMOLOL MALEATE 0.5 % EYE DROPS",22.42,22.42,22.42,22.42,5.6050000000000004]
["Not Applicable - Not Applicable - 17478029010","Not Applicable","Not Applicable","NDC","17478029010","TOBRAMYCIN 0.3 % EYE DROPS",17.95,17.95,17.95,17.95,4.4874999999999998]
["Not Applicable - Not Applicable - 17478040401","Not Applicable","Not Applicable","NDC","17478040401","FLUORESCEIN 1 MG EYE STRIPS",0.5,0.5,0.5,0.5,0.125]
["Not Applicable - Not Applicable - 17478060510","Not Applicable","Not Applicable","NDC","17478060510","DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS",694.84,694.84,694.84,694.84,173.71]
["Not Applicable - Not Applicable - 17478062312","Not Applicable","Not Applicable","NDC","17478062312","SODIUM CHLORIDE 5 % EYE DROPS",19.670000000000002,19.670000000000002,19.670000000000002,19.670000000000002,4.9175000000000004]
["Not Applicable - Not Applicable - 17478062512","Not Applicable","Not Applicable","NDC","17478062512","LATANOPROST 0.005 % EYE DROPS",69.03,69.03,69.03,69.03,17.2575]
["Not Applicable - Not Applicable - 17478070311","Not Applicable","Not Applicable","NDC","17478070311","POLYMYXIN B SULFATE 10,000 UNIT-TRIMETHOPRIM 1 MG/ML EYE DROPS",15.81,15.81,15.81,15.81,3.9525000000000001]
["Not Applicable - Not Applicable - 17478071110","Not Applicable","Not Applicable","NDC","17478071110","LIDOCAINE HCL 2 % MUCOSAL JELLY",24.87,24.87,24.87,24.87,6.2175000000000002]
["Not Applicable - Not Applicable - 17478071130","Not Applicable","Not Applicable","NDC","17478071130","LIDOCAINE HCL 2 % MUCOSAL JELLY",272.62,272.62,272.62,272.62,68.155000000000001]
["Not Applicable - Not Applicable - 17478071310","Not Applicable","Not Applicable","NDC","17478071310","OFLOXACIN 0.3 % EYE DROPS",21.57,21.57,21.57,21.57,5.3925000000000001]
["Not Applicable - Not Applicable - 17478071610","Not Applicable","Not Applicable","NDC","17478071610","APRACLONIDINE 0.5 % EYE DROPS",150.56,150.56,150.56,150.56,37.64]
["Not Applicable - Not Applicable - 17478071710","Not Applicable","Not Applicable","NDC","17478071710","KETOTIFEN 0.025 % (0.035 %) EYE DROPS",15.96,15.96,15.96,15.96,3.99]
["Not Applicable - Not Applicable - 17478074202","Not Applicable","Not Applicable","NDC","17478074202","VANCOMYCIN 250 MG CAPSULE",54.5,54.5,27.25,54.5,13.625]
["Not Applicable - Not Applicable - 17478076610","Not Applicable","Not Applicable","NDC","17478076610","PROGESTERONE MICRONIZED 100 MG CAPSULE",3.82,3.82,1.91,3.82,0.95499999999999996]
["Not Applicable - Not Applicable - 17478079201","Not Applicable","Not Applicable","NDC","17478079201","LIDOCAINE (PF) 3.5 % EYE GEL",59.76,59.76,59.76,59.76,14.94]
["Not Applicable - Not Applicable - 17478079225","Not Applicable","Not Applicable","NDC","17478079225","LIDOCAINE (PF) 3.5 % EYE GEL",67.56,67.56,67.56,67.56,16.89]
["Not Applicable - Not Applicable - 20555000100","Not Applicable","Not Applicable","NDC","20555000100","ASCORBIC ACID (VITAMIN C) 250 MG TABLET",0.26,0.26,0.05,0.26,6.5000000000000002E-2]
["Not Applicable - Not Applicable - 20555001900","Not Applicable","Not Applicable","NDC","20555001900","FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET",0.1,0.1,0.1,0.1,2.5000000000000001E-2]
["Not Applicable - Not Applicable - 20555004000","Not Applicable","Not Applicable","NDC","20555004000","ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE",0.45,0.45,0.45,0.45,0.1125]
["Not Applicable - Not Applicable - 21292000431","Not Applicable","Not Applicable","NDC","21292000431","GLUCOSE 4 GRAM CHEWABLE TABLET",0.9,0.9,0.23,0.9,0.22500000000000001]
["Not Applicable - Not Applicable - 21922002107","Not Applicable","Not Applicable","NDC","21922002107","PERMETHRIN 5 % TOPICAL CREAM",76.53,76.53,76.53,76.53,19.1325]
["Not Applicable - Not Applicable - 23155000301","Not Applicable","Not Applicable","NDC","23155000301","HYDRALAZINE 50 MG TABLET",0.38,0.38,0.06,0.38,9.5000000000000001E-2]
["Not Applicable - Not Applicable - 23155002401","Not Applicable","Not Applicable","NDC","23155002401","BUSPIRONE 10 MG TABLET",0.35,0.35,0.12,0.35,8.7499999999999994E-2]
["Not Applicable - Not Applicable - 23155002601","Not Applicable","Not Applicable","NDC","23155002601","VERAPAMIL 80 MG TABLET",0.25,0.25,0.17,0.25,6.25E-2]
["Not Applicable - Not Applicable - 23155003801","Not Applicable","Not Applicable","NDC","23155003801","PAROMOMYCIN 250 MG CAPSULE",32.880000000000003,32.880000000000003,10.96,32.880000000000003,8.2200000000000006]
["Not Applicable - Not Applicable - 23155004403","Not Applicable","Not Applicable","NDC","23155004403","LEFLUNOMIDE 20 MG TABLET",2.4300000000000002,2.4300000000000002,1.22,2.4300000000000002,0.60750000000000004]
["Not Applicable - Not Applicable - 23155005101","Not Applicable","Not Applicable","NDC","23155005101","NYSTATIN 500,000 UNIT TABLET",1.21,1.21,1.21,1.21,0.30249999999999999]
["Not Applicable - Not Applicable - 23155005801","Not Applicable","Not Applicable","NDC","23155005801","GLYBURIDE 5 MG TABLET",0.27,0.27,0.04,0.27,6.7500000000000004E-2]
["Not Applicable - Not Applicable - 23155007001","Not Applicable","Not Applicable","NDC","23155007001","METHIMAZOLE 5 MG TABLET",0.56000000000000005,0.56000000000000005,0.14000000000000001,0.56000000000000005,0.14000000000000001]
["Not Applicable - Not Applicable - 23155007101","Not Applicable","Not Applicable","NDC","23155007101","METHIMAZOLE 10 MG TABLET",0.5,0.5,0.13,0.5,0.125]
["Not Applicable - Not Applicable - 23155010800","Not Applicable","Not Applicable","NDC","23155010800","NIMODIPINE 30 MG CAPSULE",29.14,29.14,14.57,29.14,7.2850000000000001]
["Not Applicable - Not Applicable - 23155010811","Not Applicable","Not Applicable","NDC","23155010811","NIMODIPINE 30 MG CAPSULE",65.37,65.37,32.69,65.37,16.342500000000001]
["Not Applicable - Not Applicable - 23155010830","Not Applicable","Not Applicable","NDC","23155010830","NIMODIPINE 30 MG CAPSULE",34.46,34.46,17.23,34.46,8.6150000000000002]
["Not Applicable - Not Applicable - 23155011001","Not Applicable","Not Applicable","NDC","23155011001","PROPRANOLOL 10 MG TABLET",4.55,4.55,0.56999999999999995,4.55,1.1375]
["Not Applicable - Not Applicable - 23155011801","Not Applicable","Not Applicable","NDC","23155011801","CALCITRIOL 0.25 MCG CAPSULE",4.45,4.45,2.23,4.45,1.1125]
["Not Applicable - Not Applicable - 23155022701","Not Applicable","Not Applicable","NDC","23155022701","ACYCLOVIR 400 MG TABLET",58.62,58.62,58.62,58.62,14.654999999999999]
["Not Applicable - Not Applicable - 23155028801","Not Applicable","Not Applicable","NDC","23155028801","ACETAZOLAMIDE 250 MG TABLET",2.33,2.33,0.59,2.33,0.58250000000000002]
["Not Applicable - Not Applicable - 23155048901","Not Applicable","Not Applicable","NDC","23155048901","DESMOPRESSIN 0.1 MG TABLET",6.96,6.96,1.74,6.96,1.74]
["Not Applicable - Not Applicable - 23155051211","Not Applicable","Not Applicable","NDC","23155051211","NIMODIPINE 30 MG CAPSULE",8.5299999999999994,8.5299999999999994,4.2699999999999996,8.5299999999999994,2.1324999999999998]
["Not Applicable - Not Applicable - 23155051230","Not Applicable","Not Applicable","NDC","23155051230","NIMODIPINE 30 MG CAPSULE",6.92,6.92,3.46,6.92,1.73]
["Not Applicable - Not Applicable - 23155057901","Not Applicable","Not Applicable","NDC","23155057901","DESIPRAMINE 25 MG TABLET",14.04,14.04,3.51,14.04,3.51]
["Not Applicable - Not Applicable - 23155058001","Not Applicable","Not Applicable","NDC","23155058001","DESIPRAMINE 50 MG TABLET",13.21,13.21,3.31,13.21,3.3025000000000002]
["Not Applicable - Not Applicable - 23155066201","Not Applicable","Not Applicable","NDC","23155066201","CALCITRIOL 0.25 MCG CAPSULE",1.75,1.75,0.88,1.75,0.4375]
["Not Applicable - Not Applicable - 23900001252","Not Applicable","Not Applicable","NDC","23900001252","OXYMETAZOLINE 0.05 % NASAL SPRAY",17.86,17.86,17.86,17.86,4.4649999999999999]
["Not Applicable - Not Applicable - 24208029005","Not Applicable","Not Applicable","NDC","24208029005","TOBRAMYCIN 0.3 % EYE DROPS",34.89,34.89,34.89,34.89,8.7225000000000001]
["Not Applicable - Not Applicable - 24208029525","Not Applicable","Not Applicable","NDC","24208029525","TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION",140.04,140.04,140.04,140.04,35.01]
["Not Applicable - Not Applicable - 24208031510","Not Applicable","Not Applicable","NDC","24208031510","POLYMYXIN B SULFATE 10,000 UNIT-TRIMETHOPRIM 1 MG/ML EYE DROPS",35.67,35.67,35.67,35.67,8.9175000000000004]
["Not Applicable - Not Applicable - 24208034205","Not Applicable","Not Applicable","NDC","24208034205","DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY",653.1,653.1,653.1,653.1,163.27500000000001]
["Not Applicable - Not Applicable - 24208041005","Not Applicable","Not Applicable","NDC","24208041005","OFLOXACIN 0.3 % EAR DROPS",29.6,29.6,29.6,29.6,7.4]
["Not Applicable - Not Applicable - 24208048510","Not Applicable","Not Applicable","NDC","24208048510","DORZOLAMIDE 2 % EYE DROPS",99.3,99.3,99.3,99.3,24.824999999999999]
["Not Applicable - Not Applicable - 24208048610","Not Applicable","Not Applicable","NDC","24208048610","DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS",146.05000000000001,146.05000000000001,146.05000000000001,146.05000000000001,36.512500000000003]
["Not Applicable - Not Applicable - 24208050505","Not Applicable","Not Applicable","NDC","24208050505","LEVOBUNOLOL 0.5 % EYE DROPS",44.87,44.87,44.87,44.87,11.217499999999999]
["Not Applicable - Not Applicable - 24208058559","Not Applicable","Not Applicable","NDC","24208058559","TROPICAMIDE 1 % EYE DROPS",26.54,26.54,26.54,26.54,6.6349999999999998]
["Not Applicable - Not Applicable - 24208063562","Not Applicable","Not Applicable","NDC","24208063562","NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP",231.41,231.41,231.41,231.41,57.852499999999999]
["Not Applicable - Not Applicable - 24208072002","Not Applicable","Not Applicable","NDC","24208072002","DEXAMETHASONE SODIUM PHOSPHATE 0.1 % EYE DROPS",149.63999999999999,149.63999999999999,149.63999999999999,149.63999999999999,37.409999999999997]
["Not Applicable - Not Applicable - 24208073006","Not Applicable","Not Applicable","NDC","24208073006","PROPARACAINE 0.5 % EYE DROPS",82.55,82.55,82.55,82.55,20.637499999999999]
["Not Applicable - Not Applicable - 24208073501","Not Applicable","Not Applicable","NDC","24208073501","CYCLOPENTOLATE 1 % EYE DROPS",40.15,40.15,40.15,40.15,10.0375]
["Not Applicable - Not Applicable - 24208078555","Not Applicable","Not Applicable","NDC","24208078555","NEOMYCIN-BACITRACIN-POLY-HC 3.5 MG-400-10,000 UNIT/G-1 % EYE OINTMENT",46.26,46.26,46.26,46.26,11.565]
["Not Applicable - Not Applicable - 24208079535","Not Applicable","Not Applicable","NDC","24208079535","NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT",19.09,19.09,19.09,19.09,4.7725]
["Not Applicable - Not Applicable - 24208082555","Not Applicable","Not Applicable","NDC","24208082555","ATROPINE 1 % EYE OINTMENT",41.53,41.53,41.53,41.53,10.3825]
["Not Applicable - Not Applicable - 24208091019","Not Applicable","Not Applicable","NDC","24208091019","ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT",32.93,32.93,32.93,32.93,8.2324999999999999]
["Not Applicable - Not Applicable - 24208091055","Not Applicable","Not Applicable","NDC","24208091055","ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT",33.08,33.08,33.08,33.08,8.27]
["Not Applicable - Not Applicable - 24208092064","Not Applicable","Not Applicable","NDC","24208092064","TETRACAINE 0.5 % EYE DROPS",24.57,24.57,24.57,24.57,6.1425000000000001]
["Not Applicable - Not Applicable - 24338010213","Not Applicable","Not Applicable","NDC","24338010213","ERYTHROMYCIN 250 MG TABLET",26.93,26.93,26.93,26.93,6.7324999999999999]
["Not Applicable - Not Applicable - 24338012613","Not Applicable","Not Applicable","NDC","24338012613","ERYTHROMYCIN 500 MG TABLET,DELAYED RELEASE",38,38,38,38,9.5]
["Not Applicable - Not Applicable - 24338013213","Not Applicable","Not Applicable","NDC","24338013213","ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL SUSP (PEDIATRIC)",810.69,810.69,810.69,810.69,202.67250000000001]
["Not Applicable - Not Applicable - 24338013402","Not Applicable","Not Applicable","NDC","24338013402","ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL SUSP (PEDIATRIC)",810.69,810.69,810.69,810.69,202.67250000000001]
["Not Applicable - Not Applicable - 24338023005","Not Applicable","Not Applicable","NDC","24338023005","NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY)",290.39,290.39,290.39,290.39,72.597499999999997]
["Not Applicable - Not Applicable - 24357030030","Not Applicable","Not Applicable","NDC","24357030030","POTASSIUM ALUM (BULK) POWDER",219.37,219.37,219.37,219.37,54.842500000000001]
["Not Applicable - Not Applicable - 24357070105","Not Applicable","Not Applicable","NDC","24357070105","LIDOCAINE 4 % TOPICAL CREAM",17.77,17.77,17.77,17.77,4.4424999999999999]
["Not Applicable - Not Applicable - 24357070107","Not Applicable","Not Applicable","NDC","24357070107","LIDOCAINE-TRANSPARENT DRESSING 4 % TOPICAL KIT",10.85,10.85,10.85,10.85,2.7124999999999999]
["Not Applicable - Not Applicable - 24385041396","Not Applicable","Not Applicable","NDC","24385041396","CALAMINE 8 %-ZINC OXIDE 8 % LOTION",5.66,5.66,5.66,5.66,1.415]
["Not Applicable - Not Applicable - 24486060110","Not Applicable","Not Applicable","NDC","24486060110","HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET",3.35,3.35,1.68,3.35,0.83750000000000002]
["Not Applicable - Not Applicable - 24979001101","Not Applicable","Not Applicable","NDC","24979001101","NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR",4.4800000000000004,4.4800000000000004,1.5,4.4800000000000004,1.1200000000000001]
["Not Applicable - Not Applicable - 24987024256","Not Applicable","Not Applicable","NDC","24987024256","DIGOXIN 0.125 MG TABLET",69.239999999999995,69.239999999999995,34.619999999999997,69.239999999999995,17.309999999999999]
["Not Applicable - Not Applicable - 24987024956","Not Applicable","Not Applicable","NDC","24987024956","DIGOXIN 0.25 MG TABLET",2412.15,2412.15,2412.15,2412.15,603.03750000000002]
["Not Applicable - Not Applicable - 25010020515","Not Applicable","Not Applicable","NDC","25010020515","ETHACRYNIC ACID 25 MG TABLET",60.55,60.55,15.14,60.55,15.137499999999999]
["Not Applicable - Not Applicable - 25010021027","Not Applicable","Not Applicable","NDC","25010021027","ETHACRYNATE SODIUM 50 MG INTRAVENOUS SOLUTION",16727.91,16727.91,16727.91,16727.91,4181.9775]
["Not Applicable - Not Applicable - 25010040515","Not Applicable","Not Applicable","NDC","25010040515","PHYTONADIONE (VITAMIN K1) 5 MG TABLET",73,73,18.25,73,18.25]
["Not Applicable - Not Applicable - 25021030884","Not Applicable","Not Applicable","NDC","25021030884","ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV",484.03,484.03,484.03,484.03,121.00749999999999]
["Not Applicable - Not Applicable - 25021065710","Not Applicable","Not Applicable","NDC","25021065710","VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION",28.42,28.42,28.42,28.42,7.1050000000000004]
["Not Applicable - Not Applicable - 25021067377","Not Applicable","Not Applicable","NDC","25021067377","LIDOCAINE 2 % MUCOSAL JELLY PREFILLED SYRINGE",16.34,16.34,16.34,16.34,4.085]
["Not Applicable - Not Applicable - 25357002301","Not Applicable","Not Applicable","NDC","25357002301","RIBOFLAVIN 5-PHOSPHATE SODIUM (VIT B2) 0.146 % EYE DROPS",5062.32,5062.32,5062.32,5062.32,1265.58]
["Not Applicable - Not Applicable - 27241006203","Not Applicable","Not Applicable","NDC","27241006203","VORICONAZOLE 50 MG TABLET",28.74,28.74,28.74,28.74,7.1849999999999996]
["Not Applicable - Not Applicable - 27241006303","Not Applicable","Not Applicable","NDC","27241006303","VORICONAZOLE 200 MG TABLET",745.82,745.82,745.82,745.82,186.45500000000001]
["Not Applicable - Not Applicable - 27241013909","Not Applicable","Not Applicable","NDC","27241013909","OSELTAMIVIR 6 MG/ML ORAL SUSPENSION",116.81,116.81,116.81,116.81,29.202500000000001]
["Not Applicable - Not Applicable - 27241016001","Not Applicable","Not Applicable","NDC","27241016001","CAPTOPRIL 12.5 MG TABLET",9.3000000000000007,9.3000000000000007,1.17,9.3000000000000007,2.3250000000000002]
["Not Applicable - Not Applicable - 27241016101","Not Applicable","Not Applicable","NDC","27241016101","CAPTOPRIL 25 MG TABLET",5.63,5.63,0.71,5.63,1.4075]
["Not Applicable - Not Applicable - 27434001017","Not Applicable","Not Applicable","NDC","27434001017","COPPER GLUCONATE 2 MG CAPSULE",0.38,0.38,0.19,0.38,9.5000000000000001E-2]
["Not Applicable - Not Applicable - 27437005057","Not Applicable","Not Applicable","NDC","27437005057","METHYLERGONOVINE 0.2 MG TABLET",269.8,269.8,269.8,269.8,67.45]
["Not Applicable - Not Applicable - 27437010601","Not Applicable","Not Applicable","NDC","27437010601","NITAZOXANIDE 100 MG/5 ML ORAL SUSPENSION",1729.93,1729.93,1729.93,1729.93,432.48250000000002]
["Not Applicable - Not Applicable - 29033000301","Not Applicable","Not Applicable","NDC","29033000301","SUCRALFATE 1 GRAM TABLET",1.95,1.95,0.98,1.95,0.48749999999999999]
["Not Applicable - Not Applicable - 29033000412","Not Applicable","Not Applicable","NDC","29033000412","CARBAMAZEPINE ER 300 MG CAPSULE,EXTENDED RELEASE MPHASE12HR",3.45,3.45,1.1499999999999999,3.45,0.86250000000000004]
["Not Applicable - Not Applicable - 29033001912","Not Applicable","Not Applicable","NDC","29033001912","CARBAMAZEPINE ER 100 MG CAPSULE,EXTENDED RELEASE MPHASE12HR",13.86,13.86,3.47,13.86,3.4649999999999999]
["Not Applicable - Not Applicable - 29300016810","Not Applicable","Not Applicable","NDC","29300016810","TIZANIDINE 2 MG TABLET",1.1100000000000001,1.1100000000000001,0.56000000000000005,1.1100000000000001,0.27750000000000002]
["Not Applicable - Not Applicable - 29300016815","Not Applicable","Not Applicable","NDC","29300016815","TIZANIDINE 2 MG TABLET",0.5,0.5,0.25,0.5,0.125]
["Not Applicable - Not Applicable - 29300022701","Not Applicable","Not Applicable","NDC","29300022701","METRONIDAZOLE 500 MG TABLET",1.7,1.7,1.7,1.7,0.42499999999999999]
["Not Applicable - Not Applicable - 29300022705","Not Applicable","Not Applicable","NDC","29300022705","METRONIDAZOLE 500 MG TABLET",1.66,1.66,1.66,1.66,0.41499999999999998]
["Not Applicable - Not Applicable - 30698006701","Not Applicable","Not Applicable","NDC","30698006701","FUROSEMIDE 20 MG TABLET",10.39,10.39,1.3,10.39,2.5975000000000001]
["Not Applicable - Not Applicable - 30768003268","Not Applicable","Not Applicable","NDC","30768003268","VITAMIN E 400 UNIT CAPSULE",0.23,0.23,0.23,0.23,5.7500000000000002E-2]
["Not Applicable - Not Applicable - 30768025570","Not Applicable","Not Applicable","NDC","30768025570","ASCORBIC ACID (VITAMIN C) 500 MG TABLET",0.18,0.18,0.03,0.18,4.4999999999999998E-2]
["Not Applicable - Not Applicable - 31604001224","Not Applicable","Not Applicable","NDC","31604001224","VITAMIN E 400 UNIT CAPSULE",0.39,0.39,0.39,0.39,9.7500000000000003E-2]
["Not Applicable - Not Applicable - 31604002850","Not Applicable","Not Applicable","NDC","31604002850","COENZYME Q10 (UBIQUINOL) 100 MG CAPSULE",90.27,90.27,90.27,90.27,22.567499999999999]
["Not Applicable - Not Applicable - 31722026790","Not Applicable","Not Applicable","NDC","31722026790","QUINAPRIL 5 MG TABLET",4.4400000000000004,4.4400000000000004,1.1100000000000001,4.4400000000000004,1.1100000000000001]
["Not Applicable - Not Applicable - 31722028060","Not Applicable","Not Applicable","NDC","31722028060","TOPIRAMATE 100 MG TABLET",3.13,3.13,0.4,3.13,0.78249999999999997]
["Not Applicable - Not Applicable - 31722028160","Not Applicable","Not Applicable","NDC","31722028160","TOPIRAMATE 200 MG TABLET",1.83,1.83,0.23,1.83,0.45750000000000002]
["Not Applicable - Not Applicable - 31722033001","Not Applicable","Not Applicable","NDC","31722033001","WARFARIN 3 MG TABLET",2.09,2.09,0.21,2.09,0.52249999999999996]
["Not Applicable - Not Applicable - 31722033201","Not Applicable","Not Applicable","NDC","31722033201","WARFARIN 5 MG TABLET",1.27,1.27,0.13,1.27,0.3175]
["Not Applicable - Not Applicable - 31722050660","Not Applicable","Not Applicable","NDC","31722050660","LAMIVUDINE 150 MG-ZIDOVUDINE 300 MG TABLET",3.37,3.37,3.37,3.37,0.84250000000000003]
["Not Applicable - Not Applicable - 31722051560","Not Applicable","Not Applicable","NDC","31722051560","STAVUDINE 15 MG CAPSULE",9.15,9.15,3.43,9.15,2.2875000000000001]
["Not Applicable - Not Applicable - 31722052590","Not Applicable","Not Applicable","NDC","31722052590","FINASTERIDE 5 MG TABLET",1.28,1.28,1.28,1.28,0.32]
["Not Applicable - Not Applicable - 31722053001","Not Applicable","Not Applicable","NDC","31722053001","TORSEMIDE 10 MG TABLET",3.88,3.88,0.39,3.88,0.97]
["Not Applicable - Not Applicable - 31722053101","Not Applicable","Not Applicable","NDC","31722053101","TORSEMIDE 20 MG TABLET",3.56,3.56,0.36,3.56,0.89]
["Not Applicable - Not Applicable - 31722053201","Not Applicable","Not Applicable","NDC","31722053201","TORSEMIDE 100 MG TABLET",1.32,1.32,0.14000000000000001,1.32,0.33]
["Not Applicable - Not Applicable - 31722053712","Not Applicable","Not Applicable","NDC","31722053712","LEVETIRACETAM 500 MG TABLET",2.1800000000000002,2.1800000000000002,0.55000000000000004,2.1800000000000002,0.54500000000000004]
["Not Applicable - Not Applicable - 31722062905","Not Applicable","Not Applicable","NDC","31722062905","ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION",33.75,33.75,33.75,33.75,8.4375]
["Not Applicable - Not Applicable - 31722062921","Not Applicable","Not Applicable","NDC","31722062921","ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION",1169.03,1169.03,1169.03,1169.03,292.25749999999999]
["Not Applicable - Not Applicable - 31722063031","Not Applicable","Not Applicable","NDC","31722063031","OSELTAMIVIR 30 MG CAPSULE",21.56,21.56,8.6300000000000008,21.56,5.39]
["Not Applicable - Not Applicable - 31722063231","Not Applicable","Not Applicable","NDC","31722063231","OSELTAMIVIR 75 MG CAPSULE",8.6300000000000008,8.6300000000000008,3.45,8.6300000000000008,2.1575000000000002]
["Not Applicable - Not Applicable - 31722070090","Not Applicable","Not Applicable","NDC","31722070090","LOSARTAN 25 MG TABLET",0.77,0.77,0.2,0.77,0.1925]
["Not Applicable - Not Applicable - 31722073090","Not Applicable","Not Applicable","NDC","31722073090","IRBESARTAN 150 MG TABLET",1.03,1.03,0.52,1.03,0.25750000000000001]
["Not Applicable - Not Applicable - 31722082730","Not Applicable","Not Applicable","NDC","31722082730","ARIPIPRAZOLE 10 MG TABLET",1.99,1.99,0.2,1.99,0.4975]
["Not Applicable - Not Applicable - 31722083260","Not Applicable","Not Applicable","NDC","31722083260","VALGANCICLOVIR 450 MG TABLET",15.7,15.7,7.85,15.7,3.9249999999999998]
["Not Applicable - Not Applicable - 31722083330","Not Applicable","Not Applicable","NDC","31722083330","ENTECAVIR 0.5 MG TABLET",7.8,7.8,3.9,7.8,1.95]
["Not Applicable - Not Applicable - 33342002507","Not Applicable","Not Applicable","NDC","33342002507","FAMCICLOVIR 250 MG TABLET",1.31,1.31,0.66,1.31,0.32750000000000001]
["Not Applicable - Not Applicable - 33342009607","Not Applicable","Not Applicable","NDC","33342009607","TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET",6.37,6.37,6.37,6.37,1.5925]
["Not Applicable - Not Applicable - 33342033315","Not Applicable","Not Applicable","NDC","33342033315","TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT",6.13,6.13,6.13,6.13,1.5325]
["Not Applicable - Not Applicable - 33342033380","Not Applicable","Not Applicable","NDC","33342033380","TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT",15.92,15.92,15.92,15.92,3.98]
["Not Applicable - Not Applicable - 33342046206","Not Applicable","Not Applicable","NDC","33342046206","CYCLOSERINE 250 MG CAPSULE",397.74,397.74,198.87,397.74,99.435000000000002]
["Not Applicable - Not Applicable - 33342046266","Not Applicable","Not Applicable","NDC","33342046266","CYCLOSERINE 250 MG CAPSULE",427.67,427.67,213.84,427.67,106.9175]
["Not Applicable - Not Applicable - 35573043302","Not Applicable","Not Applicable","NDC","35573043302","KETOCONAZOLE 200 MG TABLET",6.98,6.98,1.75,6.98,1.7450000000000001]
["Not Applicable - Not Applicable - 35573043330","Not Applicable","Not Applicable","NDC","35573043330","KETOCONAZOLE 200 MG TABLET",6.98,6.98,1.75,6.98,1.7450000000000001]
["Not Applicable - Not Applicable - 37000002304","Not Applicable","Not Applicable","NDC","37000002304","PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET",1.1100000000000001,1.1100000000000001,1.1100000000000001,1.1100000000000001,0.27750000000000002]
["Not Applicable - Not Applicable - 37000002410","Not Applicable","Not Applicable","NDC","37000002410","PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET",1.66,1.66,1.66,1.66,0.41499999999999998]
["Not Applicable - Not Applicable - 37000025445","Not Applicable","Not Applicable","NDC","37000025445","PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET",51.74,51.74,51.74,51.74,12.935]
["Not Applicable - Not Applicable - 37205006411","Not Applicable","Not Applicable","NDC","37205006411","MINERAL OIL ENEMA",4.26,4.26,4.26,4.26,1.0649999999999999]
["Not Applicable - Not Applicable - 37205011278","Not Applicable","Not Applicable","NDC","37205011278","SIMETHICONE 80 MG CHEWABLE TABLET",0.19,0.19,0.1,0.19,4.7500000000000001E-2]
["Not Applicable - Not Applicable - 37205034665","Not Applicable","Not Applicable","NDC","37205034665","LORATADINE 10 MG TABLET",0.3,0.3,0.15,0.3,7.4999999999999997E-2]
["Not Applicable - Not Applicable - 37205035874","Not Applicable","Not Applicable","NDC","37205035874","NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH",6.54,6.54,6.54,6.54,1.635]
["Not Applicable - Not Applicable - 37205036174","Not Applicable","Not Applicable","NDC","37205036174","NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH",6.54,6.54,6.54,6.54,1.635]
["Not Applicable - Not Applicable - 37205061272","Not Applicable","Not Applicable","NDC","37205061272","POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER",20.3,20.3,20.3,20.3,5.0750000000000002]
["Not Applicable - Not Applicable - 37864000033","Not Applicable","Not Applicable","NDC","37864000033","SENNOSIDES 8.6 MG TABLET",0.15,0.15,0.08,0.15,3.7499999999999999E-2]
["Not Applicable - Not Applicable - 37864008289","Not Applicable","Not Applicable","NDC","37864008289","CALCIUM CARBONATE 500 MG-VITAMIN D3 5 MCG (200 UNIT) TABLET",0.56999999999999995,0.56999999999999995,0.28999999999999998,0.56999999999999995,0.14249999999999999]
["Not Applicable - Not Applicable - 37864076099","Not Applicable","Not Applicable","NDC","37864076099","FERROUS SULFATE 325 MG (65 MG IRON) TABLET",0.11,0.11,0.11,0.11,2.75E-2]
["Not Applicable - Not Applicable - 37864078599","Not Applicable","Not Applicable","NDC","37864078599","MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET",0.13,0.13,7.0000000000000007E-2,0.13,3.2500000000000001E-2]
["Not Applicable - Not Applicable - 37864082699","Not Applicable","Not Applicable","NDC","37864082699","CALCIUM CARBONATE 250 MG-VITAMIN D3 3.125 MCG (125 UNIT) TABLET",0.45,0.45,0.23,0.45,0.1125]
["Not Applicable - Not Applicable - 37864082799","Not Applicable","Not Applicable","NDC","37864082799","CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) TABLET",0.28000000000000003,0.28000000000000003,0.28000000000000003,0.28000000000000003,7.0000000000000007E-2]
["Not Applicable - Not Applicable - 37864086001","Not Applicable","Not Applicable","NDC","37864086001","SIMETHICONE 80 MG CHEWABLE TABLET",0.23,0.23,0.12,0.23,5.7500000000000002E-2]
["Not Applicable - Not Applicable - 37864090901","Not Applicable","Not Applicable","NDC","37864090901","PYRIDOXINE (VITAMIN B6) 50 MG TABLET",0.16,0.16,0.04,0.16,0.04]
["Not Applicable - Not Applicable - 38396054208","Not Applicable","Not Applicable","NDC","38396054208","GLUCOSE 4 GRAM CHEWABLE TABLET",1.17,1.17,0.3,1.17,0.29249999999999998]
["Not Applicable - Not Applicable - 38396090208","Not Applicable","Not Applicable","NDC","38396090208","GLUCOSE 4 GRAM CHEWABLE TABLET",1.1100000000000001,1.1100000000000001,0.28000000000000003,1.1100000000000001,0.27750000000000002]
["Not Applicable - Not Applicable - 38779073106","Not Applicable","Not Applicable","NDC","38779073106","HYDROMORPHONE (BULK) 100 % POWDER",287.76,287.76,287.76,287.76,71.94]
["Not Applicable - Not Applicable - 38779088408","Not Applicable","Not Applicable","NDC","38779088408","PYRIMETHAMINE (BULK) POWDER",536.42999999999995,536.42999999999995,536.42999999999995,536.42999999999995,134.10749999999999]
["Not Applicable - Not Applicable - 38779251008","Not Applicable","Not Applicable","NDC","38779251008","ORA-PLUS ORAL SUSPENSION",50.41,50.41,50.41,50.41,12.602499999999999]
["Not Applicable - Not Applicable - 39328005750","Not Applicable","Not Applicable","NDC","39328005750","FERROUS SULFATE 15 MG IRON (75 MG)/ML ORAL DROPS",8.18,8.18,8.18,8.18,2.0449999999999999]
["Not Applicable - Not Applicable - 39328010710","Not Applicable","Not Applicable","NDC","39328010710","SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET",1.38,1.38,0.69,1.38,0.34499999999999997]
["Not Applicable - Not Applicable - 39328035760","Not Applicable","Not Applicable","NDC","39328035760","ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS",47.244999999999997,47.244999999999997,46.664999999999999,47.244999999999997,11.811249999999999]
["Not Applicable - Not Applicable - 39822016605","Not Applicable","Not Applicable","NDC","39822016605","POLYMYXIN B SULFATE 500,000 UNIT SOLUTION FOR INJECTION",39.97,39.97,39.97,39.97,9.9924999999999997]
["Not Applicable - Not Applicable - 39822017001","Not Applicable","Not Applicable","NDC","39822017001","POLYMYXIN B SULFATE 500,000 UNIT SOLUTION FOR INJECTION",33.33,33.33,33.33,33.33,8.3324999999999996]
["Not Applicable - Not Applicable - 39822017002","Not Applicable","Not Applicable","NDC","39822017002","POLYMYXIN B SULFATE 500,000 UNIT SOLUTION FOR INJECTION",23.25,23.25,23.25,23.25,5.8125]
["Not Applicable - Not Applicable - 39822027801","Not Applicable","Not Applicable","NDC","39822027801","BACITRACIN 50,000 UNIT INTRAMUSCULAR SOLUTION",23.1,23.1,23.1,23.1,5.7750000000000004]
["Not Applicable - Not Applicable - 39822301501","Not Applicable","Not Applicable","NDC","39822301501","NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER",16.260000000000002,16.260000000000002,16.260000000000002,16.260000000000002,4.0650000000000004]
["Not Applicable - Not Applicable - 40085084296","Not Applicable","Not Applicable","NDC","40085084296","ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION (PEDIATRIC)",1717.3,1717.3,1717.3,1717.3,429.32499999999999]
["Not Applicable - Not Applicable - 40565012251","Not Applicable","Not Applicable","NDC","40565012251","CADEXOMER IODINE 0.9 % TOP PADM 5 GRAM",55.81,55.81,55.81,55.81,13.952500000000001]
["Not Applicable - Not Applicable - 40565012253","Not Applicable","Not Applicable","NDC","40565012253","CADEXOMER IODINE 0.9 % TOP PADM 10 GRAM",113.15,113.15,113.15,113.15,28.287500000000001]
["Not Applicable - Not Applicable - 40985021245","Not Applicable","Not Applicable","NDC","40985021245","VITAMIN E 400 UNIT CAPSULE",0.14000000000000001,0.14000000000000001,0.14000000000000001,0.14000000000000001,3.5000000000000003E-2]
["Not Applicable - Not Applicable - 40985022368","Not Applicable","Not Applicable","NDC","40985022368","MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET",0.15,0.15,0.15,0.15,3.7499999999999999E-2]
["Not Applicable - Not Applicable - 41100080676","Not Applicable","Not Applicable","NDC","41100080676","POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET",37.159999999999997,37.159999999999997,37.159999999999997,37.159999999999997,9.2899999999999991]
["Not Applicable - Not Applicable - 41100081122","Not Applicable","Not Applicable","NDC","41100081122","VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT",8.76,8.76,8.76,8.76,2.19]
["Not Applicable - Not Applicable - 41100081123","Not Applicable","Not Applicable","NDC","41100081123","OXYMETAZOLINE 0.05 % NASAL SPRAY",20.57,20.57,20.57,20.57,5.1425000000000001]
["Not Applicable - Not Applicable - 41100082076","Not Applicable","Not Applicable","NDC","41100082076","POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER",21.99,21.99,21.99,21.99,5.4974999999999996]
["Not Applicable - Not Applicable - 41167000879","Not Applicable","Not Applicable","NDC","41167000879","METHYL SALICYLATE-MENTHOL 29 %-7.6 % TOPICAL OINTMENT",18.329999999999998,18.329999999999998,18.329999999999998,18.329999999999998,4.5824999999999996]
["Not Applicable - Not Applicable - 41616048583","Not Applicable","Not Applicable","NDC","41616048583","BICALUTAMIDE 50 MG TABLET",1.78,1.78,1.78,1.78,0.44500000000000001]
["Not Applicable - Not Applicable - 41616093144","Not Applicable","Not Applicable","NDC","41616093144","VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION",30.2,30.2,30.2,30.2,7.55]
["Not Applicable - Not Applicable - 42002030001","Not Applicable","Not Applicable","NDC","42002030001","PRAMOXINE 1 %-MINERAL OIL 46.6 %-ZINC 12.5 % RECTAL OINTMENT",13.07,13.07,13.07,13.07,3.2675000000000001]
["Not Applicable - Not Applicable - 42023010501","Not Applicable","Not Applicable","NDC","42023010501","METHOHEXITAL 500 MG SOLUTION FOR INJECTION",257.60000000000002,257.60000000000002,257.60000000000002,257.60000000000002,64.400000000000006]
["Not Applicable - Not Applicable - 42023012306","Not Applicable","Not Applicable","NDC","42023012306","DANTROLENE 20 MG INTRAVENOUS SOLUTION",191.25,191.25,191.25,191.25,47.8125]
["Not Applicable - Not Applicable - 42023012401","Not Applicable","Not Applicable","NDC","42023012401","DANTROLENE 25 MG CAPSULE",11.46,11.46,2.87,11.46,2.8650000000000002]
["Not Applicable - Not Applicable - 42023015701","Not Applicable","Not Applicable","NDC","42023015701","ETHACRYNATE SODIUM 50 MG INTRAVENOUS SOLUTION",2303.84,2303.84,2303.84,2303.84,575.96]
["Not Applicable - Not Applicable - 42023017204","Not Applicable","Not Applicable","NDC","42023017204","MYCOPHENOLATE 500 MG INTRAVENOUS SOLUTION",211.33,211.33,211.33,211.33,52.832500000000003]
["Not Applicable - Not Applicable - 42023020101","Not Applicable","Not Applicable","NDC","42023020101","LEVOTHYROXINE 100 MCG INTRAVENOUS POWDER FOR SOLUTION",232.05,232.05,58.02,232.05,58.012500000000003]
["Not Applicable - Not Applicable - 42037010478","Not Applicable","Not Applicable","NDC","42037010478","CARBAMIDE PEROXIDE 6.5 % EAR DROPS",17.54,17.54,17.54,17.54,4.3849999999999998]
["Not Applicable - Not Applicable - 42211010243","Not Applicable","Not Applicable","NDC","42211010243","INDOMETHACIN 50 MG RECTAL SUPPOSITORY",1132.24,1132.24,283.06,1132.24,283.06]
["Not Applicable - Not Applicable - 42291014018","Not Applicable","Not Applicable","NDC","42291014018","ATENOLOL 25 MG TABLET",0.53,0.53,7.0000000000000007E-2,0.53,0.13250000000000001]
["Not Applicable - Not Applicable - 42292000101","Not Applicable","Not Applicable","NDC","42292000101","METRONIDAZOLE 500 MG TABLET",2.36,2.36,2.36,2.36,0.59]
["Not Applicable - Not Applicable - 42292000120","Not Applicable","Not Applicable","NDC","42292000120","METRONIDAZOLE 500 MG TABLET",2.12,2.12,2.12,2.12,0.53]
["Not Applicable - Not Applicable - 42292000201","Not Applicable","Not Applicable","NDC","42292000201","DIGOXIN 0.25 MG TABLET",4.79,4.79,4.79,4.79,1.1975]
["Not Applicable - Not Applicable - 42292000801","Not Applicable","Not Applicable","NDC","42292000801","LINEZOLID 600 MG TABLET",21.91,21.91,21.91,21.91,5.4775]
["Not Applicable - Not Applicable - 42292003901","Not Applicable","Not Applicable","NDC","42292003901","LEVOTHYROXINE 112 MCG TABLET",3.74,3.74,0.47,3.74,0.93500000000000005]
["Not Applicable - Not Applicable - 42292005401","Not Applicable","Not Applicable","NDC","42292005401","COLCHICINE 0.6 MG TABLET",66.02,66.02,33.01,66.02,16.504999999999999]
["Not Applicable - Not Applicable - 42367054032","Not Applicable","Not Applicable","NDC","42367054032","DANTROLENE 250 MG INTRAVENOUS SUSPENSION",10018.16,10018.16,10018.16,10018.16,2504.54]
["Not Applicable - Not Applicable - 42385095330","Not Applicable","Not Applicable","NDC","42385095330","EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET",2.76,2.76,2.76,2.76,0.69]
["Not Applicable - Not Applicable - 42702010305","Not Applicable","Not Applicable","NDC","42702010305","PHENYLEPHRINE 10 % EYE DROPS",132.44,132.44,132.44,132.44,33.11]
["Not Applicable - Not Applicable - 42799011901","Not Applicable","Not Applicable","NDC","42799011901","BUMETANIDE 0.5 MG TABLET",4.51,4.51,1.1299999999999999,4.51,1.1274999999999999]
["Not Applicable - Not Applicable - 42799040501","Not Applicable","Not Applicable","NDC","42799040501","ETHACRYNIC ACID 25 MG TABLET",24.69,24.69,6.18,24.69,6.1725000000000003]
["Not Applicable - Not Applicable - 42799080601","Not Applicable","Not Applicable","NDC","42799080601","IVERMECTIN 3 MG TABLET",224.45,224.45,224.45,224.45,56.112499999999997]
["Not Applicable - Not Applicable - 42806001101","Not Applicable","Not Applicable","NDC","42806001101","SULINDAC 200 MG TABLET",0.74,0.74,0.56000000000000005,0.74,0.185]
["Not Applicable - Not Applicable - 42806050301","Not Applicable","Not Applicable","NDC","42806050301","URSODIOL 300 MG CAPSULE",4.1500000000000004,4.1500000000000004,4.1500000000000004,4.1500000000000004,1.0375000000000001]
["Not Applicable - Not Applicable - 42806071401","Not Applicable","Not Applicable","NDC","42806071401","BENZONATATE 100 MG CAPSULE",0.4,0.4,0.2,0.4,0.1]
["Not Applicable - Not Applicable - 42858000110","Not Applicable","Not Applicable","NDC","42858000110","OXYCODONE 5 MG TABLET",5.97,5.97,1.5,5.97,1.4924999999999999]
["Not Applicable - Not Applicable - 42858023401","Not Applicable","Not Applicable","NDC","42858023401","HYDROMORPHONE 4 MG TABLET",25.19,25.19,3.15,25.19,6.2975000000000003]
["Not Applicable - Not Applicable - 42858030101","Not Applicable","Not Applicable","NDC","42858030101","HYDROMORPHONE 2 MG TABLET",1.2,1.2,0.3,1.2,0.3]
["Not Applicable - Not Applicable - 42858030125","Not Applicable","Not Applicable","NDC","42858030125","HYDROMORPHONE 2 MG TABLET",1.87,1.87,0.47,1.87,0.46750000000000003]
["Not Applicable - Not Applicable - 42858030225","Not Applicable","Not Applicable","NDC","42858030225","HYDROMORPHONE 4 MG TABLET",1.05,1.05,0.14000000000000001,1.05,0.26250000000000001]
["Not Applicable - Not Applicable - 42858030416","Not Applicable","Not Applicable","NDC","42858030416","HYDROMORPHONE 1 MG/ML ORAL LIQUID",5.58,5.58,1.4,5.58,1.395]
["Not Applicable - Not Applicable - 43199001101","Not Applicable","Not Applicable","NDC","43199001101","HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET",4.51,4.51,2.2599999999999998,4.51,1.1274999999999999]
["Not Applicable - Not Applicable - 43199002112","Not Applicable","Not Applicable","NDC","43199002112","HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY",8.27,8.27,4.1399999999999997,8.27,2.0674999999999999]
["Not Applicable - Not Applicable - 43386009019","Not Applicable","Not Applicable","NDC","43386009019","PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION",28.42,28.42,28.42,28.42,7.1050000000000004]
["Not Applicable - Not Applicable - 43386014001","Not Applicable","Not Applicable","NDC","43386014001","METHYLERGONOVINE 0.2 MG TABLET",3.73,3.73,3.73,3.73,0.9325]
["Not Applicable - Not Applicable - 43386016006","Not Applicable","Not Applicable","NDC","43386016006","MISOPROSTOL 100 MCG TABLET",13.97,13.97,0.35,13.97,3.4925000000000002]
["Not Applicable - Not Applicable - 43386031208","Not Applicable","Not Applicable","NDC","43386031208","POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER",16.07,16.07,16.07,16.07,4.0175000000000001]
["Not Applicable - Not Applicable - 43386040512","Not Applicable","Not Applicable","NDC","43386040512","NITAZOXANIDE 500 MG TABLET",431.24,431.24,431.24,431.24,107.81]
["Not Applicable - Not Applicable - 43386043201","Not Applicable","Not Applicable","NDC","43386043201","OXYCODONE 5 MG TABLET",1.33,1.33,0.34,1.33,0.33250000000000002]
["Not Applicable - Not Applicable - 43386044024","Not Applicable","Not Applicable","NDC","43386044024","NIFEDIPINE 10 MG CAPSULE",3.09,3.09,1.55,3.09,0.77249999999999996]
["Not Applicable - Not Applicable - 43386051087","Not Applicable","Not Applicable","NDC","43386051087","MESALAMINE 4 GRAM/60 ML ENEMA",47.75,47.75,47.75,47.75,11.9375]
["Not Applicable - Not Applicable - 43386062230","Not Applicable","Not Applicable","NDC","43386062230","LEVONORGESTREL 1.5 MG TABLET",94.11,94.11,47.06,94.11,23.5275]
["Not Applicable - Not Applicable - 43386092047","Not Applicable","Not Applicable","NDC","43386092047","OXYCODONE 20 MG/ML ORAL CONCENTRATE",12.97,12.97,3.25,12.97,3.2425000000000002]
["Not Applicable - Not Applicable - 43478090288","Not Applicable","Not Applicable","NDC","43478090288","PROPRANOLOL ER 120 MG CAPSULE,24 HR,EXTENDED RELEASE",9.32,9.32,3.5,9.32,2.33]
["Not Applicable - Not Applicable - 43547026810","Not Applicable","Not Applicable","NDC","43547026810","ROPINIROLE 0.25 MG TABLET",13.28,13.28,1.66,13.28,3.32]
["Not Applicable - Not Applicable - 43547027010","Not Applicable","Not Applicable","NDC","43547027010","ROPINIROLE 1 MG TABLET",3.32,3.32,0.42,3.32,0.83]
["Not Applicable - Not Applicable - 43547027110","Not Applicable","Not Applicable","NDC","43547027110","ROPINIROLE 2 MG TABLET",1.66,1.66,0.21,1.66,0.41499999999999998]
["Not Applicable - Not Applicable - 43547035410","Not Applicable","Not Applicable","NDC","43547035410","LISINOPRIL 20 MG TABLET",0.54,0.54,7.0000000000000007E-2,0.54,0.13500000000000001]
["Not Applicable - Not Applicable - 43547036809","Not Applicable","Not Applicable","NDC","43547036809","VALSARTAN 80 MG TABLET",7.28,7.28,0.91,7.28,1.82]
["Not Applicable - Not Applicable - 43547040710","Not Applicable","Not Applicable","NDC","43547040710","CLONAZEPAM 1 MG TABLET",0.35,0.35,0.05,0.35,8.7499999999999994E-2]
["Not Applicable - Not Applicable - 43547040810","Not Applicable","Not Applicable","NDC","43547040810","CLONAZEPAM 2 MG TABLET",0.21,0.21,0.03,0.21,5.2499999999999998E-2]
["Not Applicable - Not Applicable - 43598016430","Not Applicable","Not Applicable","NDC","43598016430","OLANZAPINE 5 MG TABLET",1.1000000000000001,1.1000000000000001,0.28000000000000003,1.1000000000000001,0.27500000000000002]
["Not Applicable - Not Applicable - 43598020451","Not Applicable","Not Applicable","NDC","43598020451","AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 62.5 MG/5 ML ORAL SUSPENSION (PEDIATRIC)",118.98,118.98,118.98,118.98,29.745000000000001]
["Not Applicable - Not Applicable - 43598021025","Not Applicable","Not Applicable","NDC","43598021025","SILVER SULFADIAZINE 1 % TOPICAL CREAM",7.73,7.73,7.73,7.73,1.9325000000000001]
["Not Applicable - Not Applicable - 43598021040","Not Applicable","Not Applicable","NDC","43598021040","SILVER SULFADIAZINE 1 % TOPICAL CREAM",99.47,99.47,99.47,99.47,24.8675]
["Not Applicable - Not Applicable - 43598021350","Not Applicable","Not Applicable","NDC","43598021350","AMOXICILLIN 200 MG-POTASSIUM CLAVULANATE 28.5 MG/5 ML ORAL SUSPENSION",49.21,49.21,49.21,49.21,12.3025]
["Not Applicable - Not Applicable - 43598021830","Not Applicable","Not Applicable","NDC","43598021830","AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET",16.87,16.87,16.87,16.87,4.2175000000000002]
["Not Applicable - Not Applicable - 43598022040","Not Applicable","Not Applicable","NDC","43598022040","AMOXICILLIN-POTASSIUM CLAVULANATE 1,000 MG-62.5 MG TABLET,EXT.REL 12HR",47.62,47.62,23.81,47.62,11.904999999999999]
["Not Applicable - Not Applicable - 43598022114","Not Applicable","Not Applicable","NDC","43598022114","AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET",6,6,6,6,1.5]
["Not Applicable - Not Applicable - 43598043635","Not Applicable","Not Applicable","NDC","43598043635","NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET",3.01,3.01,3.01,3.01,0.75249999999999995]
["Not Applicable - Not Applicable - 43598044670","Not Applicable","Not Applicable","NDC","43598044670","NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH",8.2100000000000009,8.2100000000000009,8.2100000000000009,8.2100000000000009,2.0525000000000002]
["Not Applicable - Not Applicable - 43598044671","Not Applicable","Not Applicable","NDC","43598044671","NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH",6.09,6.09,6.09,6.09,1.5225]
["Not Applicable - Not Applicable - 43598044770","Not Applicable","Not Applicable","NDC","43598044770","NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH",8.2100000000000009,8.2100000000000009,8.2100000000000009,8.2100000000000009,2.0525000000000002]
["Not Applicable - Not Applicable - 43598044774","Not Applicable","Not Applicable","NDC","43598044774","NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH",6.95,6.95,6.95,6.95,1.7375]
["Not Applicable - Not Applicable - 43598044871","Not Applicable","Not Applicable","NDC","43598044871","NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH",6.09,6.09,6.09,6.09,1.5225]
["Not Applicable - Not Applicable - 43598044874","Not Applicable","Not Applicable","NDC","43598044874","NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH",6.95,6.95,6.95,6.95,1.7375]
["Not Applicable - Not Applicable - 43598048627","Not Applicable","Not Applicable","NDC","43598048627","NICOTINE (POLACRILEX) 2 MG BUCCAL LOZENGE SUPERORDERABLE",2.61,2.61,1.31,2.61,0.65249999999999997]
["Not Applicable - Not Applicable - 43598055530","Not Applicable","Not Applicable","NDC","43598055530","ARIPIPRAZOLE 5 MG TABLET",18.21,18.21,1.22,18.21,4.5525000000000002]
["Not Applicable - Not Applicable - 43598056178","Not Applicable","Not Applicable","NDC","43598056178","LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET",17.91,17.91,17.91,17.91,4.4775]
["Not Applicable - Not Applicable - 43598056179","Not Applicable","Not Applicable","NDC","43598056179","LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET",22.12,22.12,22.12,22.12,5.53]
["Not Applicable - Not Applicable - 43598072101","Not Applicable","Not Applicable","NDC","43598072101","HYDROXYCHLOROQUINE 200 MG TABLET",6.87,6.87,1.72,6.87,1.7175]
["Not Applicable - Not Applicable - 43825060641","Not Applicable","Not Applicable","NDC","43825060641","THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL SOLUTION",172.3,172.3,172.3,172.3,43.075000000000003]
["Not Applicable - Not Applicable - 43900097647","Not Applicable","Not Applicable","NDC","43900097647","GUAR GUM ORAL PACKET",94.59,94.59,94.59,94.59,23.647500000000001]
["Not Applicable - Not Applicable - 45802000402","Not Applicable","Not Applicable","NDC","45802000402","HYDROCORTISONE 2.5 % TOPICAL CREAM",5.76,5.76,5.76,5.76,1.44]
["Not Applicable - Not Applicable - 45802000403","Not Applicable","Not Applicable","NDC","45802000403","HYDROCORTISONE 2.5 % TOPICAL CREAM",6.83,6.83,6.83,6.83,1.7075]
["Not Applicable - Not Applicable - 45802001402","Not Applicable","Not Applicable","NDC","45802001402","HYDROCORTISONE 2.5 % TOPICAL OINTMENT",5.48,5.48,5.48,5.48,1.37]
["Not Applicable - Not Applicable - 45802004064","Not Applicable","Not Applicable","NDC","45802004064","SELENIUM SULFIDE 2.5 % LOTION",22.17,22.17,22.17,22.17,5.5425000000000004]
["Not Applicable - Not Applicable - 45802004835","Not Applicable","Not Applicable","NDC","45802004835","NYSTATIN 100,000 UNIT/GRAM TOPICAL OINTMENT",14.77,14.77,14.77,14.77,3.6924999999999999]
["Not Applicable - Not Applicable - 45802005635","Not Applicable","Not Applicable","NDC","45802005635","GENTAMICIN 0.1 % TOPICAL CREAM",42.79,42.79,42.79,42.79,10.6975]
["Not Applicable - Not Applicable - 45802005911","Not Applicable","Not Applicable","NDC","45802005911","NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM",20.89,20.89,20.89,20.89,5.2225000000000001]
["Not Applicable - Not Applicable - 45802006001","Not Applicable","Not Applicable","NDC","45802006001","BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT",3.24,3.24,3.24,3.24,0.81]
["Not Applicable - Not Applicable - 45802006101","Not Applicable","Not Applicable","NDC","45802006101","NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT",7.63,7.63,7.63,7.63,1.9075]
["Not Applicable - Not Applicable - 45802006435","Not Applicable","Not Applicable","NDC","45802006435","TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM",6.93,6.93,6.93,6.93,1.7324999999999999]
["Not Applicable - Not Applicable - 45802008801","Not Applicable","Not Applicable","NDC","45802008801","ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER",117.23,117.23,117.23,117.23,29.307500000000001]
["Not Applicable - Not Applicable - 45802009851","Not Applicable","Not Applicable","NDC","45802009851","MESALAMINE 4 GRAM/60 ML ENEMA",36.450000000000003,36.450000000000003,36.450000000000003,36.450000000000003,9.1125000000000007]
["Not Applicable - Not Applicable - 45802011222","Not Applicable","Not Applicable","NDC","45802011222","MUPIROCIN 2 % TOPICAL OINTMENT",19.47,19.47,19.47,19.47,4.8674999999999997]
["Not Applicable - Not Applicable - 45802014301","Not Applicable","Not Applicable","NDC","45802014301","NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT",3.83,3.83,3.83,3.83,0.95750000000000002]
["Not Applicable - Not Applicable - 45802020305","Not Applicable","Not Applicable","NDC","45802020305","ACETAMINOPHEN 160 MG/5 ML ORAL LIQUID",4.9800000000000004,4.9800000000000004,4.9800000000000004,4.9800000000000004,1.2450000000000001]
["Not Applicable - Not Applicable - 45802020326","Not Applicable","Not Applicable","NDC","45802020326","ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION",5.87,5.87,5.87,5.87,1.4675]
["Not Applicable - Not Applicable - 45802020365","Not Applicable","Not Applicable","NDC","45802020365","ACETAMINOPHEN 160 MG/5 ML ORAL LIQUID",3.98,3.98,3.98,3.98,0.995]
["Not Applicable - Not Applicable - 45802026937","Not Applicable","Not Applicable","NDC","45802026937","PERMETHRIN 5 % TOPICAL CREAM",62.46,62.46,62.46,62.46,15.615]
["Not Applicable - Not Applicable - 45802034405","Not Applicable","Not Applicable","NDC","45802034405","NICOTINE (POLACRILEX) 2 MG BUCCAL LOZENGE SUPERORDERABLE",3.08,3.08,1.54,3.08,0.77]
["Not Applicable - Not Applicable - 45802042235","Not Applicable","Not Applicable","NDC","45802042235","DESONIDE 0.05 % TOPICAL CREAM",43.54,43.54,43.54,43.54,10.885]
["Not Applicable - Not Applicable - 45802043411","Not Applicable","Not Applicable","NDC","45802043411","CLOTRIMAZOLE 1 % TOPICAL CREAM",4.2699999999999996,4.2699999999999996,4.2699999999999996,4.2699999999999996,1.0674999999999999]
["Not Applicable - Not Applicable - 45802043803","Not Applicable","Not Applicable","NDC","45802043803","HYDROCORTISONE 1 % TOPICAL CREAM",4.28,4.28,4.28,4.28,1.07]
["Not Applicable - Not Applicable - 45802046564","Not Applicable","Not Applicable","NDC","45802046564","KETOCONAZOLE 2 % SHAMPOO",32.83,32.83,32.83,32.83,8.2074999999999996]
["Not Applicable - Not Applicable - 45802052555","Not Applicable","Not Applicable","NDC","45802052555","AMMONIUM LACTATE 12 % LOTION",47.96,47.96,47.96,47.96,11.99]
["Not Applicable - Not Applicable - 45802058084","Not Applicable","Not Applicable","NDC","45802058084","SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH",53.21,53.21,53.21,53.21,13.3025]
["Not Applicable - Not Applicable - 45802065087","Not Applicable","Not Applicable","NDC","45802065087","LORATADINE 10 MG TABLET",0.13,0.13,7.0000000000000007E-2,0.13,3.2500000000000001E-2]
["Not Applicable - Not Applicable - 45802073000","Not Applicable","Not Applicable","NDC","45802073000","ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY",1,1,0.1,1,0.25]
["Not Applicable - Not Applicable - 45802073030","Not Applicable","Not Applicable","NDC","45802073030","ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY",0.99,0.99,0.1,0.99,0.2475]
["Not Applicable - Not Applicable - 45802073200","Not Applicable","Not Applicable","NDC","45802073200","ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY",5.93,5.93,0.55000000000000004,5.93,1.4824999999999999]
["Not Applicable - Not Applicable - 45802073230","Not Applicable","Not Applicable","NDC","45802073230","ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY",4.87,4.87,0.45,4.87,1.2175]
["Not Applicable - Not Applicable - 45802086801","Not Applicable","Not Applicable","NDC","45802086801","POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER",11,11,11,11,2.75]
["Not Applicable - Not Applicable - 45802089710","Not Applicable","Not Applicable","NDC","45802089710","IBUPROFEN 100 MG/5 ML ORAL SUSPENSION (PEDI SYRINGE)",0.89,0.89,0.89,0.89,0.2225]
["Not Applicable - Not Applicable - 45963034102","Not Applicable","Not Applicable","NDC","45963034102","DESIPRAMINE 10 MG TABLET",21.85,21.85,5.47,21.85,5.4625000000000004]
["Not Applicable - Not Applicable - 45963034202","Not Applicable","Not Applicable","NDC","45963034202","DESIPRAMINE 25 MG TABLET",11.91,11.91,2.98,11.91,2.9775]
["Not Applicable - Not Applicable - 45963034302","Not Applicable","Not Applicable","NDC","45963034302","DESIPRAMINE 50 MG TABLET",11.21,11.21,2.81,11.21,2.8025000000000002]
["Not Applicable - Not Applicable - 45963046110","Not Applicable","Not Applicable","NDC","45963046110","LANSOPRAZOLE 30 MG CAPSULE,DELAYED RELEASE",5.79,5.79,5.79,5.79,1.4475]
["Not Applicable - Not Applicable - 46122017608","Not Applicable","Not Applicable","NDC","46122017608","NICOTINE (POLACRILEX) 2 MG BUCCAL LOZENGE",1.82,1.82,0.91,1.82,0.45500000000000002]
["Not Applicable - Not Applicable - 46122057578","Not Applicable","Not Applicable","NDC","46122057578","SENNOSIDES 8.6 MG TABLET",0.1,0.1,0.05,0.1,2.5000000000000001E-2]
["Not Applicable - Not Applicable - 46287000660","Not Applicable","Not Applicable","NDC","46287000660","SODIUM POLYSTYRENE SULFONATE 15 GRAM-SORBITOL 20 GRAM/60 ML ORAL SUSP",54.36,54.36,54.36,54.36,13.59]
["Not Applicable - Not Applicable - 46287050704","Not Applicable","Not Applicable","NDC","46287050704","WHITE PETROLATUM-MINERAL OIL TOPICAL OINTMENT",16.61,16.61,16.61,16.61,4.1524999999999999]
["Not Applicable - Not Applicable - 47335006186","Not Applicable","Not Applicable","NDC","47335006186","DOFETILIDE 125 MCG CAPSULE",18.71,18.71,4.68,18.71,4.6775000000000002]
["Not Applicable - Not Applicable - 47335053981","Not Applicable","Not Applicable","NDC","47335053981","NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR",1.63,1.63,0.82,1.63,0.40749999999999997]
["Not Applicable - Not Applicable - 47335073686","Not Applicable","Not Applicable","NDC","47335073686","BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE",4.92,4.92,2.46,4.92,1.23]
["Not Applicable - Not Applicable - 47335073786","Not Applicable","Not Applicable","NDC","47335073786","BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE",3.26,3.26,1.63,3.26,0.81499999999999995]
["Not Applicable - Not Applicable - 47335090288","Not Applicable","Not Applicable","NDC","47335090288","QUETIAPINE 25 MG TABLET",1.26,1.26,0.16,1.26,0.315]
["Not Applicable - Not Applicable - 47335090488","Not Applicable","Not Applicable","NDC","47335090488","QUETIAPINE 100 MG TABLET",0.95,0.95,0.32,0.95,0.23749999999999999]
["Not Applicable - Not Applicable - 47335093140","Not Applicable","Not Applicable","NDC","47335093140","VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION",30.2,30.2,30.2,30.2,7.55]
["Not Applicable - Not Applicable - 47682047915","Not Applicable","Not Applicable","NDC","47682047915","MECLIZINE 25 MG TABLET",0.43,0.43,0.11,0.43,0.1075]
["Not Applicable - Not Applicable - 47781030301","Not Applicable","Not Applicable","NDC","47781030301","NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE",5.19,5.19,5.19,5.19,1.2975000000000001]
["Not Applicable - Not Applicable - 47781033201","Not Applicable","Not Applicable","NDC","47781033201","CARBIDOPA 25 MG TABLET",9.68,9.68,4.84,9.68,2.42]
["Not Applicable - Not Applicable - 47781033331","Not Applicable","Not Applicable","NDC","47781033331","DAPSONE 25 MG TABLET",25.2,25.2,25.2,25.2,6.3]
["Not Applicable - Not Applicable - 47781033431","Not Applicable","Not Applicable","NDC","47781033431","DAPSONE 100 MG TABLET",7.92,7.92,7.92,7.92,1.98]
["Not Applicable - Not Applicable - 47781038426","Not Applicable","Not Applicable","NDC","47781038426","OSELTAMIVIR 6 MG/ML ORAL SUSPENSION",332.31,332.31,332.31,332.31,83.077500000000001]
["Not Applicable - Not Applicable - 47781046813","Not Applicable","Not Applicable","NDC","47781046813","OSELTAMIVIR 30 MG CAPSULE",77.56,77.56,31.03,77.56,19.39]
["Not Applicable - Not Applicable - 47781047013","Not Applicable","Not Applicable","NDC","47781047013","OSELTAMIVIR 75 MG CAPSULE",33.82,33.82,13.53,33.82,8.4550000000000001]
["Not Applicable - Not Applicable - 47781049701","Not Applicable","Not Applicable","NDC","47781049701","ETHACRYNIC ACID 25 MG TABLET",260.05,260.05,65.02,260.05,65.012500000000003]
["Not Applicable - Not Applicable - 47781056926","Not Applicable","Not Applicable","NDC","47781056926","FLUOCINONIDE 0.05 % TOPICAL OINTMENT",544.17999999999995,544.17999999999995,544.17999999999995,544.17999999999995,136.04499999999999]
["Not Applicable - Not Applicable - 47781060730","Not Applicable","Not Applicable","NDC","47781060730","DISULFIRAM 250 MG TABLET",10.02,10.02,5.01,10.02,2.5049999999999999]
["Not Applicable - Not Applicable - 47781064726","Not Applicable","Not Applicable","NDC","47781064726","ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS",120.27500000000001,120.27500000000001,118.79499999999999,120.27500000000001,30.068750000000001]
["Not Applicable - Not Applicable - 48433010401","Not Applicable","Not Applicable","NDC","48433010401","CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET",0.37,0.37,0.15,0.37,9.2499999999999999E-2]
["Not Applicable - Not Applicable - 48433010801","Not Applicable","Not Applicable","NDC","48433010801","THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET",1.1499999999999999,1.1499999999999999,0.39,1.1499999999999999,0.28749999999999998]
["Not Applicable - Not Applicable - 48433011101","Not Applicable","Not Applicable","NDC","48433011101","BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES",1.19,1.19,1.19,1.19,0.29749999999999999]
["Not Applicable - Not Applicable - 48433020230","Not Applicable","Not Applicable","NDC","48433020230","MINERAL OIL ORAL",2.35,2.35,2.35,2.35,0.58750000000000002]
["Not Applicable - Not Applicable - 49281051105","Not Applicable","Not Applicable","NDC","49281051105","DTAP-POLIO-HIB CONJ-TET(PF) 15 LF-48MCG-5 LF-62 DU-10MCG/ 0.5ML IM KIT",227.17,227.17,227.17,227.17,56.792499999999997]
["Not Applicable - Not Applicable - 49411005030","Not Applicable","Not Applicable","NDC","49411005030","AMINOCAPROIC ACID 500 MG TABLET",712.03,712.03,142.41,712.03,178.00749999999999]
["Not Applicable - Not Applicable - 49483060701","Not Applicable","Not Applicable","NDC","49483060701","GABAPENTIN 400 MG CAPSULE",0.27,0.27,7.0000000000000007E-2,0.27,6.7500000000000004E-2]
["Not Applicable - Not Applicable - 49702020218","Not Applicable","Not Applicable","NDC","49702020218","LAMIVUDINE 150 MG-ZIDOVUDINE 300 MG TABLET",50.71,50.71,50.71,50.71,12.6775]
["Not Applicable - Not Applicable - 49702020229","Not Applicable","Not Applicable","NDC","49702020229","LAMIVUDINE 150 MG-ZIDOVUDINE 300 MG TABLET",49.82,49.82,49.82,49.82,12.455]
["Not Applicable - Not Applicable - 49702020613","Not Applicable","Not Applicable","NDC","49702020613","ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET",147.61000000000001,147.61000000000001,147.61000000000001,147.61000000000001,36.902500000000003]
["Not Applicable - Not Applicable - 49702020718","Not Applicable","Not Applicable","NDC","49702020718","FOSAMPRENAVIR 700 MG TABLET",130.34,130.34,65.17,130.34,32.585000000000001]
["Not Applicable - Not Applicable - 49702021718","Not Applicable","Not Applicable","NDC","49702021718","ABACAVIR 300 MG-LAMIVUDINE 150 MG-ZIDOVUDINE 300 MG TABLET",90.55,90.55,90.55,90.55,22.637499999999999]
["Not Applicable - Not Applicable - 49702022144","Not Applicable","Not Applicable","NDC","49702022144","ABACAVIR 300 MG TABLET",61.88,61.88,30.94,61.88,15.47]
["Not Applicable - Not Applicable - 49702022318","Not Applicable","Not Applicable","NDC","49702022318","MARAVIROC 150 MG TABLET",343.92,343.92,85.98,343.92,85.98]
["Not Applicable - Not Applicable - 49702022418","Not Applicable","Not Applicable","NDC","49702022418","MARAVIROC 300 MG TABLET",171.96,171.96,42.99,171.96,42.99]
["Not Applicable - Not Applicable - 49702022813","Not Applicable","Not Applicable","NDC","49702022813","DOLUTEGRAVIR 50 MG TABLET",219.03,219.03,219.03,219.03,54.7575]
["Not Applicable - Not Applicable - 49702023113","Not Applicable","Not Applicable","NDC","49702023113","ABACAVIR 600 MG-DOLUTEGRAVIR 50 MG-LAMIVUDINE 300 MG TABLET",363.61,363.61,363.61,363.61,90.902500000000003]
["Not Applicable - Not Applicable - 49702024015","Not Applicable","Not Applicable","NDC","49702024015","CABOTEGRAVIR ER 600 MG/3 ML-RILPIVIRINE ER 900 MG/3ML IM SUSPENSION,ER",21101.85,21101.85,21101.85,21101.85,5275.4624999999996]
["Not Applicable - Not Applicable - 49702025315","Not Applicable","Not Applicable","NDC","49702025315","CABOTEGRAVIR ER 400 MG/2 ML-RILPIVIRINE ER 600 MG/2ML IM SUSPENSION,ER",14067.9,14067.9,14067.9,14067.9,3516.9749999999999]
["Not Applicable - Not Applicable - 49708064490","Not Applicable","Not Applicable","NDC","49708064490","THEOPHYLLINE 80 MG/15 ML ORAL ELIXIR (PEDIATRIC)",53.16,53.16,26.58,53.16,13.29]
["Not Applicable - Not Applicable - 49781008499","Not Applicable","Not Applicable","NDC","49781008499","*DESENSITIZATION* ASPIRIN 81 MG CHEWABLE TABLET",0.06,0.06,0.02,0.06,1.4999999999999999E-2]
["Not Applicable - Not Applicable - 49884000910","Not Applicable","Not Applicable","NDC","49884000910","ISOSORBIDE DINITRATE 30 MG TABLET",1.89,1.89,0.48,1.89,0.47249999999999998]
["Not Applicable - Not Applicable - 49884002901","Not Applicable","Not Applicable","NDC","49884002901","HYDRALAZINE 10 MG TABLET",6.56,6.56,0.88,6.56,1.64]
["Not Applicable - Not Applicable - 49884003501","Not Applicable","Not Applicable","NDC","49884003501","MECLIZINE 25 MG TABLET",2.29,2.29,0.57999999999999996,2.29,0.57250000000000001]
["Not Applicable - Not Applicable - 49884005401","Not Applicable","Not Applicable","NDC","49884005401","IMIPRAMINE 10 MG TABLET",1.83,1.83,0.37,1.83,0.45750000000000002]
["Not Applicable - Not Applicable - 49884022811","Not Applicable","Not Applicable","NDC","49884022811","EZETIMIBE 10 MG TABLET",7.36,7.36,7.36,7.36,1.84]
["Not Applicable - Not Applicable - 49884023183","Not Applicable","Not Applicable","NDC","49884023183","PRAZIQUANTEL 600 MG TABLET",1030.22,1030.22,1030.22,1030.22,257.55500000000001]
["Not Applicable - Not Applicable - 49884025901","Not Applicable","Not Applicable","NDC","49884025901","METAPROTERENOL 20 MG TABLET",3.35,3.35,1.68,3.35,0.83750000000000002]
["Not Applicable - Not Applicable - 49884040501","Not Applicable","Not Applicable","NDC","49884040501","METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR",10.65,10.65,1.34,10.65,2.6625000000000001]
["Not Applicable - Not Applicable - 49884046663","Not Applicable","Not Applicable","NDC","49884046663","CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET",7.29,7.29,7.29,7.29,1.8225]
["Not Applicable - Not Applicable - 49884046665","Not Applicable","Not Applicable","NDC","49884046665","CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET",6.8,6.8,6.8,6.8,1.7]
["Not Applicable - Not Applicable - 49884050101","Not Applicable","Not Applicable","NDC","49884050101","BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE",196.4,196.4,65.47,196.4,49.1]
["Not Applicable - Not Applicable - 49884064001","Not Applicable","Not Applicable","NDC","49884064001","METHIMAZOLE 5 MG TABLET",0.56000000000000005,0.56000000000000005,0.14000000000000001,0.56000000000000005,0.14000000000000001]
["Not Applicable - Not Applicable - 49884064101","Not Applicable","Not Applicable","NDC","49884064101","METHIMAZOLE 10 MG TABLET",0.52,0.52,0.13,0.52,0.13]
["Not Applicable - Not Applicable - 49884072401","Not Applicable","Not Applicable","NDC","49884072401","HYDROXYUREA 500 MG CAPSULE",1.82,1.82,0.91,1.82,0.45500000000000002]
["Not Applicable - Not Applicable - 49884082911","Not Applicable","Not Applicable","NDC","49884082911","DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR",1.53,1.53,0.51,1.53,0.38250000000000001]
["Not Applicable - Not Applicable - 49884098401","Not Applicable","Not Applicable","NDC","49884098401","NATEGLINIDE 60 MG TABLET",3.56,3.56,1.78,3.56,0.89]
["Not Applicable - Not Applicable - 49938010130","Not Applicable","Not Applicable","NDC","49938010130","DAPSONE 100 MG TABLET",9.2899999999999991,9.2899999999999991,9.2899999999999991,9.2899999999999991,2.3224999999999998]
["Not Applicable - Not Applicable - 49938010230","Not Applicable","Not Applicable","NDC","49938010230","DAPSONE 25 MG TABLET",30.27,30.27,30.27,30.27,7.5674999999999999]
["Not Applicable - Not Applicable - 50024043100","Not Applicable","Not Applicable","NDC","50024043100","OXYMETAZOLINE 0.05 % NASAL SPRAY",15.56,15.56,15.56,15.56,3.89]
["Not Applicable - Not Applicable - 50102091101","Not Applicable","Not Applicable","NDC","50102091101","ULIPRISTAL 30 MG TABLET",119.37,119.37,119.37,119.37,29.842500000000001]
["Not Applicable - Not Applicable - 50111033301","Not Applicable","Not Applicable","NDC","50111033301","METRONIDAZOLE 250 MG TABLET (FOR PEDI ORAL SUSP ONLY)",1.5,1.5,0.75,1.5,0.375]
["Not Applicable - Not Applicable - 50111033302","Not Applicable","Not Applicable","NDC","50111033302","METRONIDAZOLE 250 MG TABLET",1.47,1.47,0.74,1.47,0.36749999999999999]
["Not Applicable - Not Applicable - 50111033402","Not Applicable","Not Applicable","NDC","50111033402","METRONIDAZOLE 500 MG TABLET",1.32,1.32,1.32,1.32,0.33]
["Not Applicable - Not Applicable - 50111043301","Not Applicable","Not Applicable","NDC","50111043301","TRAZODONE 50 MG TABLET",0.56000000000000005,0.56000000000000005,7.0000000000000007E-2,0.56000000000000005,0.14000000000000001]
["Not Applicable - Not Applicable - 50111043302","Not Applicable","Not Applicable","NDC","50111043302","TRAZODONE 50 MG TABLET",0.72,0.72,0.09,0.72,0.18]
["Not Applicable - Not Applicable - 50111043402","Not Applicable","Not Applicable","NDC","50111043402","TRAZODONE 100 MG TABLET",0.54,0.54,7.0000000000000007E-2,0.54,0.13500000000000001]
["Not Applicable - Not Applicable - 50111046701","Not Applicable","Not Applicable","NDC","50111046701","PROPRANOLOL 10 MG TABLET",1.6,1.6,0.2,1.6,0.4]
["Not Applicable - Not Applicable - 50111056001","Not Applicable","Not Applicable","NDC","50111056001","TRAZODONE 50 MG TABLET",0.62,0.62,0.08,0.62,0.155]
["Not Applicable - Not Applicable - 50111056101","Not Applicable","Not Applicable","NDC","50111056101","TRAZODONE 100 MG TABLET",0.33,0.33,0.05,0.33,8.2500000000000004E-2]
["Not Applicable - Not Applicable - 50111064701","Not Applicable","Not Applicable","NDC","50111064701","FLUOXETINE 10 MG CAPSULE",0.35,0.35,0.09,0.35,8.7499999999999994E-2]
["Not Applicable - Not Applicable - 50111064702","Not Applicable","Not Applicable","NDC","50111064702","FLUOXETINE 10 MG CAPSULE",0.35,0.35,0.09,0.35,8.7499999999999994E-2]
["Not Applicable - Not Applicable - 50111091601","Not Applicable","Not Applicable","NDC","50111091601","TORSEMIDE 10 MG TABLET",17.45,17.45,1.75,17.45,4.3624999999999998]
["Not Applicable - Not Applicable - 50111091701","Not Applicable","Not Applicable","NDC","50111091701","TORSEMIDE 20 MG TABLET",2.5299999999999998,2.5299999999999998,0.26,2.5299999999999998,0.63249999999999995]
["Not Applicable - Not Applicable - 50111099001","Not Applicable","Not Applicable","NDC","50111099001","ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE",4.32,4.32,4.32,4.32,1.08]
["Not Applicable - Not Applicable - 50268006115","Not Applicable","Not Applicable","NDC","50268006115","ACYCLOVIR 400 MG TABLET",33.04,33.04,33.04,33.04,8.26]
["Not Applicable - Not Applicable - 50268006911","Not Applicable","Not Applicable","NDC","50268006911","AMANTADINE HCL 100 MG CAPSULE",14.19,14.19,7.1,14.19,3.5474999999999999]
["Not Applicable - Not Applicable - 50268007111","Not Applicable","Not Applicable","NDC","50268007111","AMILORIDE 5 MG TABLET",5.14,5.14,2.57,5.14,1.2849999999999999]
["Not Applicable - Not Applicable - 50268008115","Not Applicable","Not Applicable","NDC","50268008115","AMLODIPINE 5 MG TABLET",0.56999999999999995,0.56999999999999995,0.15,0.56999999999999995,0.14249999999999999]
["Not Applicable - Not Applicable - 50268008411","Not Applicable","Not Applicable","NDC","50268008411","AMLODIPINE 5 MG TABLET",0.69,0.69,0.18,0.69,0.17249999999999999]
["Not Applicable - Not Applicable - 50268009315","Not Applicable","Not Applicable","NDC","50268009315","ATORVASTATIN 10 MG TABLET",4.95,4.95,0.62,4.95,1.2375]
["Not Applicable - Not Applicable - 50268009815","Not Applicable","Not Applicable","NDC","50268009815","AZITHROMYCIN 250 MG TABLET",23.72,23.72,4.95,23.72,5.93]
["Not Applicable - Not Applicable - 50268010211","Not Applicable","Not Applicable","NDC","50268010211","BALSALAZIDE 750 MG CAPSULE",19.34,19.34,19.34,19.34,4.835]
["Not Applicable - Not Applicable - 50268010213","Not Applicable","Not Applicable","NDC","50268010213","BALSALAZIDE 750 MG CAPSULE",11.97,11.97,11.97,11.97,2.9925000000000002]
["Not Applicable - Not Applicable - 50268010311","Not Applicable","Not Applicable","NDC","50268010311","AZITHROMYCIN 250 MG TABLET",25.58,25.58,5.33,25.58,6.3949999999999996]
["Not Applicable - Not Applicable - 50268010315","Not Applicable","Not Applicable","NDC","50268010315","AZITHROMYCIN 250 MG TABLET",25.58,25.58,5.33,25.58,6.3949999999999996]
["Not Applicable - Not Applicable - 50268015115","Not Applicable","Not Applicable","NDC","50268015115","CEPHALEXIN 250 MG CAPSULE",1.69,1.69,0.85,1.69,0.42249999999999999]
["Not Applicable - Not Applicable - 50268017611","Not Applicable","Not Applicable","NDC","50268017611","CILOSTAZOL 50 MG TABLET",7.72,7.72,3.86,7.72,1.93]
["Not Applicable - Not Applicable - 50268017615","Not Applicable","Not Applicable","NDC","50268017615","CILOSTAZOL 50 MG TABLET",4.26,4.26,2.13,4.26,1.0649999999999999]
["Not Applicable - Not Applicable - 50268017715","Not Applicable","Not Applicable","NDC","50268017715","CILOSTAZOL 100 MG TABLET",2.15,2.15,1.08,2.15,0.53749999999999998]
["Not Applicable - Not Applicable - 50268027915","Not Applicable","Not Applicable","NDC","50268027915","DOXYCYCLINE HYCLATE 100 MG TABLET",3.77,3.77,3.77,3.77,0.9425]
["Not Applicable - Not Applicable - 50268030315","Not Applicable","Not Applicable","NDC","50268030315","FAMOTIDINE 20 MG TABLET",0.57999999999999996,0.57999999999999996,0.15,0.57999999999999996,0.14499999999999999]
["Not Applicable - Not Applicable - 50268030611","Not Applicable","Not Applicable","NDC","50268030611","FAMCICLOVIR 250 MG TABLET",10.95,10.95,5.48,10.95,2.7374999999999998]
["Not Applicable - Not Applicable - 50268030613","Not Applicable","Not Applicable","NDC","50268030613","FAMCICLOVIR 250 MG TABLET",15.87,15.87,7.94,15.87,3.9674999999999998]
["Not Applicable - Not Applicable - 50268031311","Not Applicable","Not Applicable","NDC","50268031311","FENOFIBRATE 160 MG TABLET",11.37,11.37,3.84,11.37,2.8424999999999998]
["Not Applicable - Not Applicable - 50268032111","Not Applicable","Not Applicable","NDC","50268032111","FLECAINIDE 100 MG TABLET",7.47,7.47,2.4900000000000002,7.47,1.8674999999999999]
["Not Applicable - Not Applicable - 50268032311","Not Applicable","Not Applicable","NDC","50268032311","FINASTERIDE 5 MG TABLET",3.64,3.64,3.64,3.64,0.91]
["Not Applicable - Not Applicable - 50268032315","Not Applicable","Not Applicable","NDC","50268032315","FINASTERIDE 5 MG TABLET",2.33,2.33,2.33,2.33,0.58250000000000002]
["Not Applicable - Not Applicable - 50268034511","Not Applicable","Not Applicable","NDC","50268034511","FOLIC ACID 1 MG TABLET",0.39,0.39,0.39,0.39,9.7500000000000003E-2]
["Not Applicable - Not Applicable - 50268034811","Not Applicable","Not Applicable","NDC","50268034811","GABAPENTIN 300 MG CAPSULE",0.78,0.78,0.2,0.78,0.19500000000000001]
["Not Applicable - Not Applicable - 50268034911","Not Applicable","Not Applicable","NDC","50268034911","GABAPENTIN 400 MG CAPSULE",0.68,0.68,0.17,0.68,0.17]
["Not Applicable - Not Applicable - 50268041211","Not Applicable","Not Applicable","NDC","50268041211","HYDROXYCHLOROQUINE 200 MG TABLET",21.01,21.01,5.26,21.01,5.2525000000000004]
["Not Applicable - Not Applicable - 50268046711","Not Applicable","Not Applicable","NDC","50268046711","LEVETIRACETAM 250 MG TABLET",4.04,4.04,1.01,4.04,1.01]
["Not Applicable - Not Applicable - 50268046715","Not Applicable","Not Applicable","NDC","50268046715","LEVETIRACETAM 250 MG TABLET",3.77,3.77,0.95,3.77,0.9425]
["Not Applicable - Not Applicable - 50268046811","Not Applicable","Not Applicable","NDC","50268046811","LEVETIRACETAM 500 MG TABLET",2.34,2.34,0.59,2.34,0.58499999999999996]
["Not Applicable - Not Applicable - 50268046815","Not Applicable","Not Applicable","NDC","50268046815","LEVETIRACETAM 500 MG TABLET",1.67,1.67,0.42,1.67,0.41749999999999998]
["Not Applicable - Not Applicable - 50268051611","Not Applicable","Not Applicable","NDC","50268051611","LOSARTAN 25 MG TABLET",8.49,8.49,2.13,8.49,2.1225000000000001]
["Not Applicable - Not Applicable - 50268051711","Not Applicable","Not Applicable","NDC","50268051711","LOSARTAN 50 MG TABLET",5.01,5.01,1.26,5.01,1.2524999999999999]
["Not Applicable - Not Applicable - 50268052215","Not Applicable","Not Applicable","NDC","50268052215","MECLIZINE 12.5 MG TABLET",4.0999999999999996,4.0999999999999996,1.03,4.0999999999999996,1.0249999999999999]
["Not Applicable - Not Applicable - 50268052311","Not Applicable","Not Applicable","NDC","50268052311","MECLIZINE 25 MG TABLET",4.83,4.83,1.21,4.83,1.2075]
["Not Applicable - Not Applicable - 50268052315","Not Applicable","Not Applicable","NDC","50268052315","MECLIZINE 25 MG TABLET",2.91,2.91,0.73,2.91,0.72750000000000004]
["Not Applicable - Not Applicable - 50268052411","Not Applicable","Not Applicable","NDC","50268052411","MELATONIN 3 MG TABLET",2.58,2.58,0.86,2.58,0.64500000000000002]
["Not Applicable - Not Applicable - 50268052415","Not Applicable","Not Applicable","NDC","50268052415","MELATONIN 3 MG TABLET",2,2,0.67,2,0.5]
["Not Applicable - Not Applicable - 50268053711","Not Applicable","Not Applicable","NDC","50268053711","METHOCARBAMOL 750 MG TABLET",1.38,1.38,0.69,1.38,0.34499999999999997]
["Not Applicable - Not Applicable - 50268053715","Not Applicable","Not Applicable","NDC","50268053715","METHOCARBAMOL 750 MG TABLET",0.89,0.89,0.45,0.89,0.2225]
["Not Applicable - Not Applicable - 50268053911","Not Applicable","Not Applicable","NDC","50268053911","METRONIDAZOLE 500 MG TABLET",2.4,2.4,2.4,2.4,0.6]
["Not Applicable - Not Applicable - 50268056111","Not Applicable","Not Applicable","NDC","50268056111","MIDODRINE 2.5 MG TABLET",9.75,9.75,2.44,9.75,2.4375]
["Not Applicable - Not Applicable - 50268056115","Not Applicable","Not Applicable","NDC","50268056115","MIDODRINE 2.5 MG TABLET",6.37,6.37,1.6,6.37,1.5925]
["Not Applicable - Not Applicable - 50268056311","Not Applicable","Not Applicable","NDC","50268056311","MIDODRINE 10 MG TABLET",3.1,3.1,0.78,3.1,0.77500000000000002]
["Not Applicable - Not Applicable - 50268056315","Not Applicable","Not Applicable","NDC","50268056315","MIDODRINE 10 MG TABLET",3.1,3.1,0.78,3.1,0.77500000000000002]
["Not Applicable - Not Applicable - 50268056411","Not Applicable","Not Applicable","NDC","50268056411","MIDODRINE 2.5 MG TABLET",12.17,12.17,3.05,12.17,3.0425]
["Not Applicable - Not Applicable - 50268056415","Not Applicable","Not Applicable","NDC","50268056415","MIDODRINE 2.5 MG TABLET",7.89,7.89,1.98,7.89,1.9724999999999999]
["Not Applicable - Not Applicable - 50268056911","Not Applicable","Not Applicable","NDC","50268056911","MINOCYCLINE 100 MG CAPSULE",3.81,3.81,1.91,3.81,0.95250000000000001]
["Not Applicable - Not Applicable - 50268057011","Not Applicable","Not Applicable","NDC","50268057011","MODAFINIL 100 MG TABLET",80.849999999999994,80.849999999999994,40.43,80.849999999999994,20.212499999999999]
["Not Applicable - Not Applicable - 50268057311","Not Applicable","Not Applicable","NDC","50268057311","MONTELUKAST 4 MG CHEWABLE TABLET",4.6500000000000004,4.6500000000000004,3.72,4.6500000000000004,1.1625000000000001]
["Not Applicable - Not Applicable - 50268057315","Not Applicable","Not Applicable","NDC","50268057315","MONTELUKAST 4 MG CHEWABLE TABLET",2.57,2.57,2.0499999999999998,2.57,0.64249999999999996]
["Not Applicable - Not Applicable - 50268059411","Not Applicable","Not Applicable","NDC","50268059411","NAPROXEN 250 MG TABLET",1.85,1.85,0.93,1.85,0.46250000000000002]
["Not Applicable - Not Applicable - 50268059415","Not Applicable","Not Applicable","NDC","50268059415","NAPROXEN 250 MG TABLET",1.1100000000000001,1.1100000000000001,0.56000000000000005,1.1100000000000001,0.27750000000000002]
["Not Applicable - Not Applicable - 50268060311","Not Applicable","Not Applicable","NDC","50268060311","NORTRIPTYLINE 10 MG CAPSULE",16.7,16.7,1.67,16.7,4.1749999999999998]
["Not Applicable - Not Applicable - 50268060315","Not Applicable","Not Applicable","NDC","50268060315","NORTRIPTYLINE 10 MG CAPSULE",9.1,9.1,0.91,9.1,2.2749999999999999]
["Not Applicable - Not Applicable - 50268062715","Not Applicable","Not Applicable","NDC","50268062715","OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR",13.22,13.22,4.41,13.22,3.3050000000000002]
["Not Applicable - Not Applicable - 50268063011","Not Applicable","Not Applicable","NDC","50268063011","QUETIAPINE 25 MG TABLET",9.64,9.64,1.21,9.64,2.41]
["Not Applicable - Not Applicable - 50268063211","Not Applicable","Not Applicable","NDC","50268063211","QUETIAPINE 100 MG TABLET",4.93,4.93,1.65,4.93,1.2324999999999999]
["Not Applicable - Not Applicable - 50268064415","Not Applicable","Not Applicable","NDC","50268064415","OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET",1.47,1.47,0.74,1.47,0.36749999999999999]
["Not Applicable - Not Applicable - 50268071015","Not Applicable","Not Applicable","NDC","50268071015","ROSUVASTATIN 20 MG TABLET",3.63,3.63,0.46,3.63,0.90749999999999997]
["Not Applicable - Not Applicable - 50268071115","Not Applicable","Not Applicable","NDC","50268071115","ROSUVASTATIN 40 MG TABLET",1.85,1.85,0.24,1.85,0.46250000000000002]
["Not Applicable - Not Applicable - 50268071711","Not Applicable","Not Applicable","NDC","50268071711","SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET",4.2300000000000004,4.2300000000000004,4.2300000000000004,4.2300000000000004,1.0575000000000001]
["Not Applicable - Not Applicable - 50268072011","Not Applicable","Not Applicable","NDC","50268072011","SEVELAMER CARBONATE 800 MG TABLET",71.8,71.8,23.94,71.8,17.95]
["Not Applicable - Not Applicable - 50268072811","Not Applicable","Not Applicable","NDC","50268072811","SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG TABLET",4.2699999999999996,4.2699999999999996,1.07,4.2699999999999996,1.0674999999999999]
["Not Applicable - Not Applicable - 50268073211","Not Applicable","Not Applicable","NDC","50268073211","SUCRALFATE 100 MG/ML ORAL SUSPENSION",29.14,29.14,29.14,29.14,7.2850000000000001]
["Not Applicable - Not Applicable - 50268075011","Not Applicable","Not Applicable","NDC","50268075011","TOPIRAMATE 25 MG TABLET",3.96,3.96,0.5,3.96,0.99]
["Not Applicable - Not Applicable - 50268075015","Not Applicable","Not Applicable","NDC","50268075015","TOPIRAMATE 25 MG TABLET",5.6,5.6,0.7,5.6,1.4]
["Not Applicable - Not Applicable - 50268075211","Not Applicable","Not Applicable","NDC","50268075211","TOPIRAMATE 100 MG TABLET",1.99,1.99,0.25,1.99,0.4975]
["Not Applicable - Not Applicable - 50268075215","Not Applicable","Not Applicable","NDC","50268075215","TOPIRAMATE 100 MG TABLET",2.82,2.82,0.36,2.82,0.70499999999999996]
["Not Applicable - Not Applicable - 50268075511","Not Applicable","Not Applicable","NDC","50268075511","TORSEMIDE 10 MG TABLET",10.91,10.91,1.1000000000000001,10.91,2.7275]
["Not Applicable - Not Applicable - 50268075611","Not Applicable","Not Applicable","NDC","50268075611","TORSEMIDE 20 MG TABLET",7.2,7.2,0.72,7.2,1.8]
["Not Applicable - Not Applicable - 50268075915","Not Applicable","Not Applicable","NDC","50268075915","TIZANIDINE 2 MG TABLET",3.56,3.56,1.78,3.56,0.89]
["Not Applicable - Not Applicable - 50268076411","Not Applicable","Not Applicable","NDC","50268076411","TERAZOSIN 1 MG CAPSULE",14.8,14.8,2.96,14.8,3.7]
["Not Applicable - Not Applicable - 50268078711","Not Applicable","Not Applicable","NDC","50268078711","VALGANCICLOVIR 450 MG TABLET",607.39,607.39,303.7,607.39,151.8475]
["Not Applicable - Not Applicable - 50268078712","Not Applicable","Not Applicable","NDC","50268078712","VALGANCICLOVIR 450 MG TABLET",96.86,96.86,48.43,96.86,24.215]
["Not Applicable - Not Applicable - 50268078911","Not Applicable","Not Applicable","NDC","50268078911","VALACYCLOVIR 1 GRAM TABLET",24.3,24.3,6.08,24.3,6.0750000000000002]
["Not Applicable - Not Applicable - 50268078915","Not Applicable","Not Applicable","NDC","50268078915","VALACYCLOVIR 1 GRAM TABLET",9.5299999999999994,9.5299999999999994,2.39,9.5299999999999994,2.3824999999999998]
["Not Applicable - Not Applicable - 50268079611","Not Applicable","Not Applicable","NDC","50268079611","URSODIOL 300 MG CAPSULE",27.23,27.23,27.23,27.23,6.8075000000000001]
["Not Applicable - Not Applicable - 50268079615","Not Applicable","Not Applicable","NDC","50268079615","URSODIOL 300 MG CAPSULE",17.79,17.79,17.79,17.79,4.4474999999999998]
["Not Applicable - Not Applicable - 50268079911","Not Applicable","Not Applicable","NDC","50268079911","VENLAFAXINE 37.5 MG TABLET",4.5,4.5,1.5,4.5,1.125]
["Not Applicable - Not Applicable - 50268080011","Not Applicable","Not Applicable","NDC","50268080011","VENLAFAXINE 50 MG TABLET",5.73,5.73,1.91,5.73,1.4325000000000001]
["Not Applicable - Not Applicable - 50268081611","Not Applicable","Not Applicable","NDC","50268081611","ZONISAMIDE 100 MG CAPSULE",4.3,4.3,0.54,4.3,1.075]
["Not Applicable - Not Applicable - 50268081615","Not Applicable","Not Applicable","NDC","50268081615","ZONISAMIDE 100 MG CAPSULE",2.81,2.81,0.36,2.81,0.70250000000000001]
["Not Applicable - Not Applicable - 50268085411","Not Applicable","Not Applicable","NDC","50268085411","CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET",1.37,1.37,0.14000000000000001,1.37,0.34250000000000003]
["Not Applicable - Not Applicable - 50268085815","Not Applicable","Not Applicable","NDC","50268085815","PYRIDOXINE (VITAMIN B6) 50 MG TABLET",1.24,1.24,0.31,1.24,0.31]
["Not Applicable - Not Applicable - 50323000602","Not Applicable","Not Applicable","NDC","50323000602","PHENYLEPHRINE 0.25 % NASAL SPRAY",11.25,11.25,11.25,11.25,2.8125]
["Not Applicable - Not Applicable - 50323000603","Not Applicable","Not Applicable","NDC","50323000603","PHENYLEPHRINE 0.5 % NASAL SPRAY",11.25,11.25,11.25,11.25,2.8125]
["Not Applicable - Not Applicable - 50323000604","Not Applicable","Not Applicable","NDC","50323000604","PHENYLEPHRINE 1 % NASAL SPRAY",12.63,12.63,12.63,12.63,3.1575000000000002]
["Not Applicable - Not Applicable - 50383006212","Not Applicable","Not Applicable","NDC","50383006212","DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL LIQUID",1.75,1.75,1.75,1.75,0.4375]
["Not Applicable - Not Applicable - 50383006310","Not Applicable","Not Applicable","NDC","50383006310","GUAIFENESIN 100 MG/5 ML ORAL LIQUID",1.67,1.67,1.67,1.67,0.41749999999999998]
["Not Applicable - Not Applicable - 50383016716","Not Applicable","Not Applicable","NDC","50383016716","ASCORBIC ACID (VITAMIN C) 500 MG/5 ML ORAL SYRUP",0.86,0.86,0.15,0.86,0.215]
["Not Applicable - Not Applicable - 50383017290","Not Applicable","Not Applicable","NDC","50383017290","LEVOCARNITINE 330 MG TABLET",8.51,8.51,2.84,8.51,2.1274999999999999]
["Not Applicable - Not Applicable - 50383023210","Not Applicable","Not Applicable","NDC","50383023210","DORZOLAMIDE 2 % EYE DROPS",34.22,34.22,34.22,34.22,8.5549999999999997]
["Not Applicable - Not Applicable - 50383023310","Not Applicable","Not Applicable","NDC","50383023310","DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS",51.73,51.73,51.73,51.73,12.932499999999999]
["Not Applicable - Not Applicable - 50383026730","Not Applicable","Not Applicable","NDC","50383026730","CLOBETASOL 0.05 % TOPICAL CREAM",17.91,17.91,17.91,17.91,4.4775]
["Not Applicable - Not Applicable - 50383061804","Not Applicable","Not Applicable","NDC","50383061804","LOPERAMIDE 1 MG/5 ML ORAL LIQUID (PEDIATRIC)",10.07,10.07,10.07,10.07,2.5175000000000001]
["Not Applicable - Not Applicable - 50383061805","Not Applicable","Not Applicable","NDC","50383061805","LOPERAMIDE 1 MG/5 ML ORAL LIQUID",4.78,4.78,4.78,4.78,1.1950000000000001]
["Not Applicable - Not Applicable - 50383061811","Not Applicable","Not Applicable","NDC","50383061811","LOPERAMIDE 1 MG/5 ML ORAL LIQUID",5.23,5.23,5.23,5.23,1.3075000000000001]
["Not Applicable - Not Applicable - 50383070530","Not Applicable","Not Applicable","NDC","50383070530","LORAZEPAM 2 MG/ML ORAL CONCENTRATE",117.98,117.98,117.98,117.98,29.495000000000001]
["Not Applicable - Not Applicable - 50383072015","Not Applicable","Not Applicable","NDC","50383072015","CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH",3.2,3.2,3.2,3.2,0.8]
["Not Applicable - Not Applicable - 50383072016","Not Applicable","Not Applicable","NDC","50383072016","CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH",0.38,0.38,0.38,0.38,9.5000000000000001E-2]
["Not Applicable - Not Applicable - 50383074016","Not Applicable","Not Applicable","NDC","50383074016","ALBUTEROL SULFATE 2 MG/5 ML ORAL SYRUP",151.22999999999999,151.22999999999999,151.22999999999999,151.22999999999999,37.807499999999997]
["Not Applicable - Not Applicable - 50383077110","Not Applicable","Not Applicable","NDC","50383077110","DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID",1.92,1.92,0.96,1.92,0.48]
["Not Applicable - Not Applicable - 50383077116","Not Applicable","Not Applicable","NDC","50383077116","DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID",0.25,0.25,0.13,0.25,6.25E-2]
["Not Applicable - Not Applicable - 50383078105","Not Applicable","Not Applicable","NDC","50383078105","LIDOCAINE HCL 2 % MUCOSAL JELLY",16.52,16.52,16.52,16.52,4.13]
["Not Applicable - Not Applicable - 50383078130","Not Applicable","Not Applicable","NDC","50383078130","LIDOCAINE HCL 2 % MUCOSAL JELLY",36.99,36.99,36.99,36.99,9.2475000000000005]
["Not Applicable - Not Applicable - 50383078608","Not Applicable","Not Applicable","NDC","50383078608","MULTIVITAMIN WITH IRON-MINERAL ORAL LIQUID",9.3800000000000008,9.3800000000000008,9.3800000000000008,9.3800000000000008,2.3450000000000002]
["Not Applicable - Not Applicable - 50383082316","Not Applicable","Not Applicable","NDC","50383082316","SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION",6.4,6.4,4.8,6.4,1.6]
["Not Applicable - Not Applicable - 50383082416","Not Applicable","Not Applicable","NDC","50383082416","SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML SUSP ORDERABLE",6.4000000000000012,6.4000000000000012,4.8,6.4000000000000012,1.6000000000000003]
["Not Applicable - Not Applicable - 50383091750","Not Applicable","Not Applicable","NDC","50383091750","CHOLECALCIFEROL (VITAMIN D3) 10 MCG/ML (400 UNIT/ML) ORAL DROPS",0.4,0.4,0.1,0.4,0.1]
["Not Applicable - Not Applicable - 50419045201","Not Applicable","Not Applicable","NDC","50419045201","ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH",129.07,129.07,129.07,129.07,32.267499999999998]
["Not Applicable - Not Applicable - 50419045304","Not Applicable","Not Applicable","NDC","50419045304","ESTRADIOL 0.075 MG/24 HR WEEKLY TRANSDERMAL PATCH",120.43,120.43,120.43,120.43,30.107500000000002]
["Not Applicable - Not Applicable - 50419074701","Not Applicable","Not Applicable","NDC","50419074701","PRAZIQUANTEL 600 MG TABLET",1651.56,1651.56,1651.56,1651.56,412.89]
["Not Applicable - Not Applicable - 50419077701","Not Applicable","Not Applicable","NDC","50419077701","CIPROFLOXACIN 250 MG/5 ML ORAL SUSPENSION",440.16,440.16,440.16,440.16,110.04]
["Not Applicable - Not Applicable - 50428322435","Not Applicable","Not Applicable","NDC","50428322435","BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT",48.75,48.75,48.75,48.75,12.1875]
["Not Applicable - Not Applicable - 50458009005","Not Applicable","Not Applicable","NDC","50458009005","FENTANYL 12 MCG/HR TRANSDERMAL PATCH",121.21,121.21,121.21,121.21,30.302499999999998]
["Not Applicable - Not Applicable - 50458009205","Not Applicable","Not Applicable","NDC","50458009205","FENTANYL 50 MCG/HR TRANSDERMAL PATCH",267.56,267.56,267.56,267.56,66.89]
["Not Applicable - Not Applicable - 50458009305","Not Applicable","Not Applicable","NDC","50458009305","FENTANYL 75 MCG/HR TRANSDERMAL PATCH",816.21,816.21,408.11,816.21,204.05250000000001]
["Not Applicable - Not Applicable - 50458057760","Not Applicable","Not Applicable","NDC","50458057760","RIVAROXABAN 2.5 MG TABLET",20.41,20.41,20.41,20.41,5.1025]
["Not Applicable - Not Applicable - 50458057810","Not Applicable","Not Applicable","NDC","50458057810","RIVAROXABAN 15 MG TABLET",54.42,54.42,40.82,54.42,13.605]
["Not Applicable - Not Applicable - 50458057830","Not Applicable","Not Applicable","NDC","50458057830","RIVAROXABAN 15 MG TABLET",54.42,54.42,40.82,54.42,13.605]
["Not Applicable - Not Applicable - 50458057910","Not Applicable","Not Applicable","NDC","50458057910","RIVAROXABAN 20 MG TABLET",40.82,40.82,30.62,40.82,10.205]
["Not Applicable - Not Applicable - 50458057930","Not Applicable","Not Applicable","NDC","50458057930","RIVAROXABAN 20 MG TABLET",40.82,40.82,30.62,40.82,10.205]
["Not Applicable - Not Applicable - 50458057990","Not Applicable","Not Applicable","NDC","50458057990","RIVAROXABAN 20 MG TABLET",40.82,40.82,30.62,40.82,10.205]
["Not Applicable - Not Applicable - 50458058030","Not Applicable","Not Applicable","NDC","50458058030","RIVAROXABAN 10 MG TABLET",40.82,40.82,40.82,40.82,10.205]
["Not Applicable - Not Applicable - 50458063965","Not Applicable","Not Applicable","NDC","50458063965","TOPIRAMATE 25 MG TABLET",167.06,167.06,20.89,167.06,41.765000000000001]
["Not Applicable - Not Applicable - 50458064165","Not Applicable","Not Applicable","NDC","50458064165","TOPIRAMATE 100 MG TABLET",113.82,113.82,14.23,113.82,28.454999999999998]
["Not Applicable - Not Applicable - 50458064265","Not Applicable","Not Applicable","NDC","50458064265","TOPIRAMATE 200 MG TABLET",66.63,66.63,8.33,66.63,16.657499999999999]
["Not Applicable - Not Applicable - 50458064565","Not Applicable","Not Applicable","NDC","50458064565","TOPIRAMATE 25 MG SPRINKLE CAPSULE",23.88,23.88,14.33,23.88,5.97]
["Not Applicable - Not Applicable - 50458064765","Not Applicable","Not Applicable","NDC","50458064765","TOPIRAMATE 15 MG SPRINKLE CAPSULE",32.92,32.92,19.75,32.92,8.23]
["Not Applicable - Not Applicable - 50474047066","Not Applicable","Not Applicable","NDC","50474047066","BRIVARACETAM 25 MG TABLET",268.45,268.45,67.12,268.45,67.112499999999997]
["Not Applicable - Not Applicable - 50474059440","Not Applicable","Not Applicable","NDC","50474059440","LEVETIRACETAM 250 MG TABLET",90.55,90.55,22.64,90.55,22.637499999999999]
["Not Applicable - Not Applicable - 50474059540","Not Applicable","Not Applicable","NDC","50474059540","LEVETIRACETAM 500 MG TABLET",55.34,55.34,13.84,55.34,13.835000000000001]
["Not Applicable - Not Applicable - 50484001030","Not Applicable","Not Applicable","NDC","50484001030","COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT",764.79,764.79,764.79,764.79,191.19749999999999]
["Not Applicable - Not Applicable - 50580029605","Not Applicable","Not Applicable","NDC","50580029605","ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION",0.96,0.96,0.96,0.96,0.24]
["Not Applicable - Not Applicable - 50580029665","Not Applicable","Not Applicable","NDC","50580029665","ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION",0.48,0.48,0.48,0.48,0.12]
["Not Applicable - Not Applicable - 50580050110","Not Applicable","Not Applicable","NDC","50580050110","ACETAMINOPHEN 325 MG TABLET",0.6,0.6,0.2,0.6,0.15]
["Not Applicable - Not Applicable - 50580050130","Not Applicable","Not Applicable","NDC","50580050130","ACETAMINOPHEN 325 MG TABLET",0.14000000000000001,0.14000000000000001,0.05,0.14000000000000001,3.5000000000000003E-2]
["Not Applicable - Not Applicable - 50580050180","Not Applicable","Not Applicable","NDC","50580050180","ACETAMINOPHEN 325 MG TABLET",0.53,0.53,0.18,0.53,0.13250000000000001]
["Not Applicable - Not Applicable - 50580060002","Not Applicable","Not Applicable","NDC","50580060002","ACETAMINOPHEN 325 MG TABLET",0.62,0.62,0.21,0.62,0.155]
["Not Applicable - Not Applicable - 50580060110","Not Applicable","Not Applicable","NDC","50580060110","IBUPROFEN 100 MG/5 ML ORAL SUSPENSION (PEDI SYRINGE)",2.17,2.17,2.17,2.17,0.54249999999999998]
["Not Applicable - Not Applicable - 50580061205","Not Applicable","Not Applicable","NDC","50580061205","ACETAMINOPHEN 160 MG/5 ML ORAL LIQUID",0.93,0.93,0.93,0.93,0.23250000000000001]
["Not Applicable - Not Applicable - 50580061265","Not Applicable","Not Applicable","NDC","50580061265","ACETAMINOPHEN 160 MG/5 ML ORAL LIQUID",0.47,0.47,0.47,0.47,0.11749999999999999]
["Not Applicable - Not Applicable - 50742023301","Not Applicable","Not Applicable","NDC","50742023301","ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE",1.79,1.79,0.9,1.79,0.44750000000000001]
["Not Applicable - Not Applicable - 50742050510","Not Applicable","Not Applicable","NDC","50742050510","SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH",60.93,60.93,60.93,60.93,15.2325]
["Not Applicable - Not Applicable - 50742051530","Not Applicable","Not Applicable","NDC","50742051530","NITROGLYCERIN 0.3 MG/HR TRANSDERMAL 24 HOUR PATCH",130.12,130.12,130.12,130.12,32.53]
["Not Applicable - Not Applicable - 51079002320","Not Applicable","Not Applicable","NDC","51079002320","METOLAZONE 2.5 MG TABLET",25.16,25.16,6.29,25.16,6.29]
["Not Applicable - Not Applicable - 51079002401","Not Applicable","Not Applicable","NDC","51079002401","METOLAZONE 5 MG TABLET",22.11,22.11,5.53,22.11,5.5274999999999999]
["Not Applicable - Not Applicable - 51079002420","Not Applicable","Not Applicable","NDC","51079002420","METOLAZONE 5 MG TABLET",14.61,14.61,3.66,14.61,3.6524999999999999]
["Not Applicable - Not Applicable - 51079002720","Not Applicable","Not Applicable","NDC","51079002720","QUINIDINE GLUCONATE ER 324 MG TABLET,EXTENDED RELEASE",7.59,7.59,3.8,7.59,1.8975]
["Not Applicable - Not Applicable - 51079005101","Not Applicable","Not Applicable","NDC","51079005101","PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE",2.0299999999999998,2.0299999999999998,1.02,2.0299999999999998,0.50749999999999995]
["Not Applicable - Not Applicable - 51079005120","Not Applicable","Not Applicable","NDC","51079005120","PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE",1.59,1.59,0.8,1.59,0.39750000000000002]
["Not Applicable - Not Applicable - 51079006720","Not Applicable","Not Applicable","NDC","51079006720","DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET",2.92,2.92,1.46,2.92,0.73]
["Not Applicable - Not Applicable - 51079007201","Not Applicable","Not Applicable","NDC","51079007201","FUROSEMIDE 20 MG TABLET",0.93,0.93,0.12,0.93,0.23250000000000001]
["Not Applicable - Not Applicable - 51079007301","Not Applicable","Not Applicable","NDC","51079007301","FUROSEMIDE 40 MG TABLET",0.49,0.49,7.0000000000000007E-2,0.49,0.1225]
["Not Applicable - Not Applicable - 51079007320","Not Applicable","Not Applicable","NDC","51079007320","FUROSEMIDE 40 MG TABLET",0.36,0.36,0.05,0.36,0.09]
["Not Applicable - Not Applicable - 51079007401","Not Applicable","Not Applicable","NDC","51079007401","HYDRALAZINE 10 MG TABLET",6.11,6.11,0.82,6.11,1.5275000000000001]
["Not Applicable - Not Applicable - 51079007420","Not Applicable","Not Applicable","NDC","51079007420","HYDRALAZINE 10 MG TABLET",2.11,2.11,0.28999999999999998,2.11,0.52749999999999997]
["Not Applicable - Not Applicable - 51079007501","Not Applicable","Not Applicable","NDC","51079007501","HYDRALAZINE 25 MG TABLET",2.35,2.35,0.32,2.35,0.58750000000000002]
["Not Applicable - Not Applicable - 51079007520","Not Applicable","Not Applicable","NDC","51079007520","HYDRALAZINE 25 MG TABLET",1.02,1.02,0.14000000000000001,1.02,0.255]
["Not Applicable - Not Applicable - 51079007601","Not Applicable","Not Applicable","NDC","51079007601","HYDRALAZINE 50 MG TABLET",1.48,1.48,0.2,1.48,0.37]
["Not Applicable - Not Applicable - 51079007620","Not Applicable","Not Applicable","NDC","51079007620","HYDRALAZINE 50 MG TABLET",0.56000000000000005,0.56000000000000005,0.08,0.56000000000000005,0.14000000000000001]
["Not Applicable - Not Applicable - 51079008601","Not Applicable","Not Applicable","NDC","51079008601","MIRTAZAPINE 15 MG TABLET",1.76,1.76,0.3,1.76,0.44]
["Not Applicable - Not Applicable - 51079008620","Not Applicable","Not Applicable","NDC","51079008620","MIRTAZAPINE 15 MG TABLET",1.29,1.29,0.22,1.29,0.32250000000000001]
["Not Applicable - Not Applicable - 51079010301","Not Applicable","Not Applicable","NDC","51079010301","SPIRONOLACTONE 25 MG TABLET",2.56,2.56,0.64,2.56,0.64]
["Not Applicable - Not Applicable - 51079010320","Not Applicable","Not Applicable","NDC","51079010320","SPIRONOLACTONE 25 MG TABLET",1.84,1.84,0.46,1.84,0.46]
["Not Applicable - Not Applicable - 51079010420","Not Applicable","Not Applicable","NDC","51079010420","SPIRONOLACTONE 25 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET",9.8800000000000008,9.8800000000000008,4.9400000000000004,9.8800000000000008,2.4700000000000002]
["Not Applicable - Not Applicable - 51079010501","Not Applicable","Not Applicable","NDC","51079010501","FOLIC ACID 1 MG TABLET",0.37,0.37,0.37,0.37,9.2499999999999999E-2]
["Not Applicable - Not Applicable - 51079010520","Not Applicable","Not Applicable","NDC","51079010520","FOLIC ACID 1 MG TABLET",0.34,0.34,0.34,0.34,8.5000000000000006E-2]
["Not Applicable - Not Applicable - 51079011901","Not Applicable","Not Applicable","NDC","51079011901","DICYCLOMINE 20 MG TABLET",1.77,1.77,1.77,1.77,0.4425]
["Not Applicable - Not Applicable - 51079011920","Not Applicable","Not Applicable","NDC","51079011920","DICYCLOMINE 20 MG TABLET",1.64,1.64,1.64,1.64,0.41]
["Not Applicable - Not Applicable - 51079012220","Not Applicable","Not Applicable","NDC","51079012220","METRONIDAZOLE 250 MG TABLET",2.78,2.78,1.39,2.78,0.69499999999999995]
["Not Applicable - Not Applicable - 51079012820","Not Applicable","Not Applicable","NDC","51079012820","SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET",1.4,1.4,0.7,1.4,0.35]
["Not Applicable - Not Applicable - 51079013101","Not Applicable","Not Applicable","NDC","51079013101","AMITRIPTYLINE 10 MG TABLET",5.09,5.09,0.51,5.09,1.2725]
["Not Applicable - Not Applicable - 51079013120","Not Applicable","Not Applicable","NDC","51079013120","AMITRIPTYLINE 10 MG TABLET",3.63,3.63,0.37,3.63,0.90749999999999997]
["Not Applicable - Not Applicable - 51079013301","Not Applicable","Not Applicable","NDC","51079013301","AMITRIPTYLINE 50 MG TABLET",4.07,4.07,0.41,4.07,1.0175000000000001]
["Not Applicable - Not Applicable - 51079013320","Not Applicable","Not Applicable","NDC","51079013320","AMITRIPTYLINE 50 MG TABLET",3.78,3.78,0.38,3.78,0.94499999999999995]
["Not Applicable - Not Applicable - 51079014120","Not Applicable","Not Applicable","NDC","51079014120","CHLORDIAZEPOXIDE 25 MG CAPSULE",1.76,1.76,0.36,1.76,0.44]
["Not Applicable - Not Applicable - 51079016120","Not Applicable","Not Applicable","NDC","51079016120","ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET",1.26,1.26,0.63,1.26,0.315]
["Not Applicable - Not Applicable - 51079016501","Not Applicable","Not Applicable","NDC","51079016501","VORICONAZOLE 200 MG TABLET",117.02,117.02,117.02,117.02,29.254999999999999]
["Not Applicable - Not Applicable - 51079017220","Not Applicable","Not Applicable","NDC","51079017220","METFORMIN 500 MG TABLET",0.54,0.54,0.27,0.54,0.13500000000000001]
["Not Applicable - Not Applicable - 51079018120","Not Applicable","Not Applicable","NDC","51079018120","CIPROFLOXACIN 250 MG TABLET",2.12,2.12,0.71,2.12,0.53]
["Not Applicable - Not Applicable - 51079019020","Not Applicable","Not Applicable","NDC","51079019020","INDOMETHACIN 25 MG CAPSULE",1.42,1.42,0.71,1.42,0.35499999999999998]
["Not Applicable - Not Applicable - 51079019120","Not Applicable","Not Applicable","NDC","51079019120","INDOMETHACIN 50 MG CAPSULE",0.84,0.84,0.42,0.84,0.21]
["Not Applicable - Not Applicable - 51079019701","Not Applicable","Not Applicable","NDC","51079019701","TOLTERODINE ER 2 MG CAPSULE,EXTENDED RELEASE 24 HR",71.84,71.84,35.92,71.84,17.96]
["Not Applicable - Not Applicable - 51079019920","Not Applicable","Not Applicable","NDC","51079019920","CELECOXIB 100 MG CAPSULE",8.4700000000000006,8.4700000000000006,4.24,8.4700000000000006,2.1175000000000002]
["Not Applicable - Not Applicable - 51079020120","Not Applicable","Not Applicable","NDC","51079020120","METHYLDOPA 500 MG TABLET",1,1,0.5,1,0.25]
["Not Applicable - Not Applicable - 51079020501","Not Applicable","Not Applicable","NDC","51079020501","ALLOPURINOL 100 MG TABLET",3.35,3.35,0.56000000000000005,3.35,0.83750000000000002]
["Not Applicable - Not Applicable - 51079020520","Not Applicable","Not Applicable","NDC","51079020520","ALLOPURINOL 100 MG TABLET",1.97,1.97,0.33,1.97,0.49249999999999999]
["Not Applicable - Not Applicable - 51079020620","Not Applicable","Not Applicable","NDC","51079020620","ALLOPURINOL 300 MG TABLET",131.09,131.09,131.09,131.09,32.772500000000001]
["Not Applicable - Not Applicable - 51079020801","Not Applicable","Not Applicable","NDC","51079020801","ATORVASTATIN 10 MG TABLET",8.7899999999999991,8.7899999999999991,1.1000000000000001,8.7899999999999991,2.1974999999999998]
["Not Applicable - Not Applicable - 51079020901","Not Applicable","Not Applicable","NDC","51079020901","ATORVASTATIN 20 MG TABLET",5.26,5.26,0.66,5.26,1.3149999999999999]
["Not Applicable - Not Applicable - 51079020920","Not Applicable","Not Applicable","NDC","51079020920","ATORVASTATIN 20 MG TABLET",3.76,3.76,0.47,3.76,0.94]
["Not Applicable - Not Applicable - 51079021101","Not Applicable","Not Applicable","NDC","51079021101","ATORVASTATIN 80 MG TABLET",1.93,1.93,1.93,1.93,0.48249999999999998]
["Not Applicable - Not Applicable - 51079022301","Not Applicable","Not Applicable","NDC","51079022301","MONTELUKAST 10 MG TABLET",2.1800000000000002,2.1800000000000002,2.1800000000000002,2.1800000000000002,0.54500000000000004]
["Not Applicable - Not Applicable - 51079022320","Not Applicable","Not Applicable","NDC","51079022320","MONTELUKAST 10 MG TABLET",3.2,3.2,3.2,3.2,0.8]
["Not Applicable - Not Applicable - 51079024601","Not Applicable","Not Applicable","NDC","51079024601","LORATADINE 10 MG TABLET",1.48,1.48,0.74,1.48,0.37]
["Not Applicable - Not Applicable - 51079025520","Not Applicable","Not Applicable","NDC","51079025520","METOPROLOL TARTRATE 25 MG TABLET",0.66,0.66,0.09,0.66,0.16500000000000001]
["Not Applicable - Not Applicable - 51079027301","Not Applicable","Not Applicable","NDC","51079027301","ENTACAPONE 200 MG TABLET",20.170000000000002,20.170000000000002,20.170000000000002,20.170000000000002,5.0425000000000004]
["Not Applicable - Not Applicable - 51079027303","Not Applicable","Not Applicable","NDC","51079027303","ENTACAPONE 200 MG TABLET",14.87,14.87,14.87,14.87,3.7174999999999998]
["Not Applicable - Not Applicable - 51079027820","Not Applicable","Not Applicable","NDC","51079027820","PROPRANOLOL 20 MG TABLET",0.89,0.89,0.12,0.89,0.2225]
["Not Applicable - Not Applicable - 51079028320","Not Applicable","Not Applicable","NDC","51079028320","METOCLOPRAMIDE 10 MG TABLET",0.53,0.53,0.27,0.53,0.13250000000000001]
["Not Applicable - Not Applicable - 51079028401","Not Applicable","Not Applicable","NDC","51079028401","DIAZEPAM 2 MG TABLET",2.2799999999999998,2.2799999999999998,0.23,2.2799999999999998,0.56999999999999995]
["Not Applicable - Not Applicable - 51079028420","Not Applicable","Not Applicable","NDC","51079028420","DIAZEPAM 2 MG TABLET",1.85,1.85,0.19,1.85,0.46250000000000002]
["Not Applicable - Not Applicable - 51079028501","Not Applicable","Not Applicable","NDC","51079028501","DIAZEPAM 5 MG TABLET",0.96,0.96,0.1,0.96,0.24]
["Not Applicable - Not Applicable - 51079028520","Not Applicable","Not Applicable","NDC","51079028520","DIAZEPAM 5 MG TABLET",0.52,0.52,0.06,0.52,0.13]
["Not Applicable - Not Applicable - 51079028601","Not Applicable","Not Applicable","NDC","51079028601","DIAZEPAM 10 MG TABLET",0.52,0.52,0.06,0.52,0.13]
["Not Applicable - Not Applicable - 51079028620","Not Applicable","Not Applicable","NDC","51079028620","DIAZEPAM 10 MG TABLET",0.4,0.4,0.04,0.4,0.1]
["Not Applicable - Not Applicable - 51079029401","Not Applicable","Not Applicable","NDC","51079029401","TAMSULOSIN 0.4 MG CAPSULE",4.09,4.09,2.0499999999999998,4.09,1.0225]
["Not Applicable - Not Applicable - 51079029420","Not Applicable","Not Applicable","NDC","51079029420","TAMSULOSIN 0.4 MG CAPSULE",2.77,2.77,1.39,2.77,0.6925]
["Not Applicable - Not Applicable - 51079029808","Not Applicable","Not Applicable","NDC","51079029808","VALPROIC ACID 250 MG CAPSULE",1.81,1.81,0.91,1.81,0.45250000000000001]
["Not Applicable - Not Applicable - 51079029901","Not Applicable","Not Applicable","NDC","51079029901","CLONIDINE HCL 0.1 MG TABLET",1.1000000000000001,1.1000000000000001,0.37,1.1000000000000001,0.27500000000000002]
["Not Applicable - Not Applicable - 51079029920","Not Applicable","Not Applicable","NDC","51079029920","CLONIDINE HCL 0.1 MG TABLET",0.39,0.39,0.13,0.39,9.7500000000000003E-2]
["Not Applicable - Not Applicable - 51079030001","Not Applicable","Not Applicable","NDC","51079030001","CLONIDINE HCL 0.2 MG TABLET",0.69,0.69,0.23,0.69,0.17249999999999999]
["Not Applicable - Not Applicable - 51079030120","Not Applicable","Not Applicable","NDC","51079030120","CLONIDINE HCL 0.3 MG TABLET",0.37,0.37,0.13,0.37,9.2499999999999999E-2]
["Not Applicable - Not Applicable - 51079032101","Not Applicable","Not Applicable","NDC","51079032101","FINASTERIDE 5 MG TABLET",4.49,4.49,4.49,4.49,1.1225000000000001]
["Not Applicable - Not Applicable - 51079037420","Not Applicable","Not Applicable","NDC","51079037420","CHLORDIAZEPOXIDE 5 MG CAPSULE",9.77,9.77,1.96,9.77,2.4424999999999999]
["Not Applicable - Not Applicable - 51079037520","Not Applicable","Not Applicable","NDC","51079037520","CHLORDIAZEPOXIDE 10 MG CAPSULE",3.74,3.74,0.75,3.74,0.93500000000000005]
["Not Applicable - Not Applicable - 51079038501","Not Applicable","Not Applicable","NDC","51079038501","CARBAMAZEPINE 200 MG TABLET",6.37,6.37,1.6,6.37,1.5925]
["Not Applicable - Not Applicable - 51079038520","Not Applicable","Not Applicable","NDC","51079038520","CARBAMAZEPINE 200 MG TABLET",5.21,5.21,1.31,5.21,1.3025]
["Not Applicable - Not Applicable - 51079038601","Not Applicable","Not Applicable","NDC","51079038601","LORAZEPAM 1 MG TABLET",1.38,1.38,0.35,1.38,0.34499999999999997]
["Not Applicable - Not Applicable - 51079038620","Not Applicable","Not Applicable","NDC","51079038620","LORAZEPAM 1 MG TABLET",1.01,1.01,0.26,1.01,0.2525]
["Not Applicable - Not Applicable - 51079038701","Not Applicable","Not Applicable","NDC","51079038701","LORAZEPAM 2 MG TABLET",0.83,0.83,0.21,0.83,0.20749999999999999]
["Not Applicable - Not Applicable - 51079038720","Not Applicable","Not Applicable","NDC","51079038720","LORAZEPAM 2 MG TABLET",0.77,0.77,0.2,0.77,0.1925]
["Not Applicable - Not Applicable - 51079039201","Not Applicable","Not Applicable","NDC","51079039201","BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE",4.03,4.03,2.02,4.03,1.0075000000000001]
["Not Applicable - Not Applicable - 51079039820","Not Applicable","Not Applicable","NDC","51079039820","SIMVASTATIN 40 MG TABLET",0.43,0.43,0.11,0.43,0.1075]
["Not Applicable - Not Applicable - 51079040001","Not Applicable","Not Applicable","NDC","51079040001","NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR",12.58,12.58,4.2,12.58,3.145]
["Not Applicable - Not Applicable - 51079040020","Not Applicable","Not Applicable","NDC","51079040020","NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR",8.48,8.48,2.83,8.48,2.12]
["Not Applicable - Not Applicable - 51079041701","Not Applicable","Not Applicable","NDC","51079041701","LORAZEPAM 0.5 MG TABLET",2.85,2.85,0.72,2.85,0.71250000000000002]
["Not Applicable - Not Applicable - 51079041720","Not Applicable","Not Applicable","NDC","51079041720","LORAZEPAM 0.5 MG TABLET",2.02,2.02,0.51,2.02,0.505]
["Not Applicable - Not Applicable - 51079043601","Not Applicable","Not Applicable","NDC","51079043601","DOXEPIN 10 MG CAPSULE",9.4700000000000006,9.4700000000000006,1.9,9.4700000000000006,2.3675000000000002]
["Not Applicable - Not Applicable - 51079043620","Not Applicable","Not Applicable","NDC","51079043620","DOXEPIN 10 MG CAPSULE",6.99,6.99,1.4,6.99,1.7475000000000001]
["Not Applicable - Not Applicable - 51079043720","Not Applicable","Not Applicable","NDC","51079043720","DOXEPIN 25 MG CAPSULE",11.05,11.05,1.85,11.05,2.7625000000000002]
["Not Applicable - Not Applicable - 51079043801","Not Applicable","Not Applicable","NDC","51079043801","DOXEPIN 50 MG CAPSULE",10.37,10.37,1.73,10.37,2.5924999999999998]
["Not Applicable - Not Applicable - 51079043820","Not Applicable","Not Applicable","NDC","51079043820","DOXEPIN 50 MG CAPSULE",7.66,7.66,1.28,7.66,1.915]
["Not Applicable - Not Applicable - 51079044001","Not Applicable","Not Applicable","NDC","51079044001","LEVOTHYROXINE 50 MCG TABLET",7.08,7.08,0.89,7.08,1.77]
["Not Applicable - Not Applicable - 51079044020","Not Applicable","Not Applicable","NDC","51079044020","LEVOTHYROXINE 50 MCG TABLET",5.69,5.69,0.72,5.69,1.4225000000000001]
["Not Applicable - Not Applicable - 51079044120","Not Applicable","Not Applicable","NDC","51079044120","LEVOTHYROXINE 75 MCG TABLET",4.2,4.2,0.53,4.2,1.05]
["Not Applicable - Not Applicable - 51079044220","Not Applicable","Not Applicable","NDC","51079044220","LEVOTHYROXINE 100 MCG TABLET",3.24,3.24,0.41,3.24,0.81]
["Not Applicable - Not Applicable - 51079044320","Not Applicable","Not Applicable","NDC","51079044320","LEVOTHYROXINE 125 MCG TABLET",3.05,3.05,0.39,3.05,0.76249999999999996]
["Not Applicable - Not Applicable - 51079044401","Not Applicable","Not Applicable","NDC","51079044401","LEVOTHYROXINE 25 MCG TABLET",12.48,12.48,1.56,12.48,3.12]
["Not Applicable - Not Applicable - 51079044420","Not Applicable","Not Applicable","NDC","51079044420","LEVOTHYROXINE 25 MCG TABLET",9.98,9.98,1.25,9.98,2.4950000000000001]
["Not Applicable - Not Applicable - 51079044520","Not Applicable","Not Applicable","NDC","51079044520","LEVOTHYROXINE 150 MCG TABLET",1.96,1.96,0.33,1.96,0.49]
["Not Applicable - Not Applicable - 51079045001","Not Applicable","Not Applicable","NDC","51079045001","AMLODIPINE 2.5 MG TABLET",2.4300000000000002,2.4300000000000002,0.61,2.4300000000000002,0.60750000000000004]
["Not Applicable - Not Applicable - 51079045101","Not Applicable","Not Applicable","NDC","51079045101","AMLODIPINE 5 MG TABLET",1.22,1.22,0.31,1.22,0.30499999999999999]
["Not Applicable - Not Applicable - 51079045120","Not Applicable","Not Applicable","NDC","51079045120","AMLODIPINE 5 MG TABLET",0.79,0.79,0.2,0.79,0.19750000000000001]
["Not Applicable - Not Applicable - 51079045401","Not Applicable","Not Applicable","NDC","51079045401","SIMVASTATIN 10 MG TABLET",1.68,1.68,0.42,1.68,0.42]
["Not Applicable - Not Applicable - 51079045420","Not Applicable","Not Applicable","NDC","51079045420","SIMVASTATIN 10 MG TABLET",1.1299999999999999,1.1299999999999999,0.28999999999999998,1.1299999999999999,0.28249999999999997]
["Not Applicable - Not Applicable - 51079045501","Not Applicable","Not Applicable","NDC","51079045501","SIMVASTATIN 20 MG TABLET",0.86,0.86,0.22,0.86,0.215]
["Not Applicable - Not Applicable - 51079045520","Not Applicable","Not Applicable","NDC","51079045520","SIMVASTATIN 20 MG TABLET",0.56999999999999995,0.56999999999999995,0.15,0.56999999999999995,0.14249999999999999]
["Not Applicable - Not Applicable - 51079045601","Not Applicable","Not Applicable","NDC","51079045601","SIMVASTATIN 40 MG TABLET",0.43,0.43,0.11,0.43,0.1075]
["Not Applicable - Not Applicable - 51079045620","Not Applicable","Not Applicable","NDC","51079045620","SIMVASTATIN 40 MG TABLET",0.36,0.36,0.09,0.36,0.09]
["Not Applicable - Not Applicable - 51079046201","Not Applicable","Not Applicable","NDC","51079046201","RISPERIDONE 1 MG TABLET",6.6,6.6,0.83,6.6,1.65]
["Not Applicable - Not Applicable - 51079047508","Not Applicable","Not Applicable","NDC","51079047508","DIVALPROEX 500 MG TABLET,DELAYED RELEASE",1.1200000000000001,1.1200000000000001,0.28000000000000003,1.1200000000000001,0.28000000000000003]
["Not Applicable - Not Applicable - 51079048501","Not Applicable","Not Applicable","NDC","51079048501","FLUPHENAZINE 1 MG TABLET",17.13,17.13,1.72,17.13,4.2824999999999998]
["Not Applicable - Not Applicable - 51079048520","Not Applicable","Not Applicable","NDC","51079048520","FLUPHENAZINE 1 MG TABLET",16.28,16.28,1.63,16.28,4.07]
["Not Applicable - Not Applicable - 51079048601","Not Applicable","Not Applicable","NDC","51079048601","FLUPHENAZINE 2.5 MG TABLET",8.16,8.16,0.82,8.16,2.04]
["Not Applicable - Not Applicable - 51079048620","Not Applicable","Not Applicable","NDC","51079048620","FLUPHENAZINE 2.5 MG TABLET",6.98,6.98,0.7,6.98,1.7450000000000001]
["Not Applicable - Not Applicable - 51079048720","Not Applicable","Not Applicable","NDC","51079048720","FLUPHENAZINE 5 MG TABLET",4.05,4.05,0.41,4.05,1.0125]
["Not Applicable - Not Applicable - 51079048820","Not Applicable","Not Applicable","NDC","51079048820","FLUPHENAZINE 10 MG TABLET",2.31,2.31,0.24,2.31,0.57750000000000001]
["Not Applicable - Not Applicable - 51079049801","Not Applicable","Not Applicable","NDC","51079049801","LAMOTRIGINE 25 MG TABLET",3.39,3.39,0.43,3.39,0.84750000000000003]
["Not Applicable - Not Applicable - 51079049820","Not Applicable","Not Applicable","NDC","51079049820","LAMOTRIGINE 25 MG TABLET",4.2699999999999996,4.2699999999999996,0.54,4.2699999999999996,1.0674999999999999]
["Not Applicable - Not Applicable - 51079049901","Not Applicable","Not Applicable","NDC","51079049901","LAMOTRIGINE 100 MG TABLET",1.1599999999999999,1.1599999999999999,0.15,1.1599999999999999,0.28999999999999998]
["Not Applicable - Not Applicable - 51079052020","Not Applicable","Not Applicable","NDC","51079052020","FINASTERIDE 5 MG TABLET",4.49,4.49,4.49,4.49,1.1225000000000001]
["Not Applicable - Not Applicable - 51079052701","Not Applicable","Not Applicable","NDC","51079052701","FUROSEMIDE 80 MG TABLET",0.43,0.43,0.06,0.43,0.1075]
["Not Applicable - Not Applicable - 51079052720","Not Applicable","Not Applicable","NDC","51079052720","FUROSEMIDE 80 MG TABLET",0.34,0.34,0.05,0.34,8.5000000000000006E-2]
["Not Applicable - Not Applicable - 51079053820","Not Applicable","Not Applicable","NDC","51079053820","LORATADINE 10 MG TABLET",1.48,1.48,0.74,1.48,0.37]
["Not Applicable - Not Applicable - 51079055701","Not Applicable","Not Applicable","NDC","51079055701","CLOPIDOGREL 75 MG TABLET",7.85,7.85,0.99,7.85,1.9624999999999999]
["Not Applicable - Not Applicable - 51079055720","Not Applicable","Not Applicable","NDC","51079055720","CLOPIDOGREL 75 MG TABLET",5.0599999999999996,5.0599999999999996,0.64,5.0599999999999996,1.2649999999999999]
["Not Applicable - Not Applicable - 51079056520","Not Applicable","Not Applicable","NDC","51079056520","THIORIDAZINE 10 MG TABLET",10.24,10.24,1.03,10.24,2.56]
["Not Applicable - Not Applicable - 51079056620","Not Applicable","Not Applicable","NDC","51079056620","THIORIDAZINE 25 MG TABLET",5.82,5.82,0.59,5.82,1.4550000000000001]
["Not Applicable - Not Applicable - 51079056720","Not Applicable","Not Applicable","NDC","51079056720","THIORIDAZINE 50 MG TABLET",3.57,3.57,0.36,3.57,0.89249999999999996]
["Not Applicable - Not Applicable - 51079057220","Not Applicable","Not Applicable","NDC","51079057220","TRIFLUOPERAZINE 1 MG TABLET",29.77,29.77,5.96,29.77,7.4424999999999999]
["Not Applicable - Not Applicable - 51079057420","Not Applicable","Not Applicable","NDC","51079057420","TRIFLUOPERAZINE 5 MG TABLET",5.72,5.72,1.1499999999999999,5.72,1.43]
["Not Applicable - Not Applicable - 51079058001","Not Applicable","Not Applicable","NDC","51079058001","THIORIDAZINE 100 MG TABLET",2.69,2.69,0.27,2.69,0.67249999999999999]
["Not Applicable - Not Applicable - 51079058020","Not Applicable","Not Applicable","NDC","51079058020","THIORIDAZINE 100 MG TABLET",2.1,2.1,0.21,2.1,0.52500000000000002]
["Not Applicable - Not Applicable - 51079058106","Not Applicable","Not Applicable","NDC","51079058106","LEUCOVORIN CALCIUM 5 MG TABLET",22.85,22.85,4.57,22.85,5.7125000000000004]
["Not Applicable - Not Applicable - 51079058201","Not Applicable","Not Applicable","NDC","51079058201","LEUCOVORIN CALCIUM 25 MG TABLET",39.08,39.08,7.82,39.08,9.77]
["Not Applicable - Not Applicable - 51079058205","Not Applicable","Not Applicable","NDC","51079058205","LEUCOVORIN CALCIUM 25 MG TABLET",26.78,26.78,5.36,26.78,6.6950000000000003]
["Not Applicable - Not Applicable - 51079058801","Not Applicable","Not Applicable","NDC","51079058801","THIOTHIXENE 5 MG CAPSULE",10.73,10.73,4.29,10.73,2.6825000000000001]
["Not Applicable - Not Applicable - 51079063001","Not Applicable","Not Applicable","NDC","51079063001","PRAZOSIN 1 MG CAPSULE",26.83,26.83,5.37,26.83,6.7074999999999996]
["Not Applicable - Not Applicable - 51079063020","Not Applicable","Not Applicable","NDC","51079063020","PRAZOSIN 1 MG CAPSULE",19.79,19.79,3.96,19.79,4.9474999999999998]
["Not Applicable - Not Applicable - 51079063101","Not Applicable","Not Applicable","NDC","51079063101","PRAZOSIN 2 MG CAPSULE",18.68,18.68,3.74,18.68,4.67]
["Not Applicable - Not Applicable - 51079063120","Not Applicable","Not Applicable","NDC","51079063120","PRAZOSIN 2 MG CAPSULE",13.78,13.78,2.76,13.78,3.4449999999999998]
["Not Applicable - Not Applicable - 51079063201","Not Applicable","Not Applicable","NDC","51079063201","PRAZOSIN 5 MG CAPSULE",12.76,12.76,2.56,12.76,3.19]
["Not Applicable - Not Applicable - 51079063220","Not Applicable","Not Applicable","NDC","51079063220","PRAZOSIN 5 MG CAPSULE",9.85,9.85,1.97,9.85,2.4624999999999999]
["Not Applicable - Not Applicable - 51079064401","Not Applicable","Not Applicable","NDC","51079064401","CYCLOBENZAPRINE 10 MG TABLET",0.42,0.42,0.21,0.42,0.105]
["Not Applicable - Not Applicable - 51079064420","Not Applicable","Not Applicable","NDC","51079064420","CYCLOBENZAPRINE 10 MG TABLET",0.39,0.39,0.2,0.39,9.7500000000000003E-2]
["Not Applicable - Not Applicable - 51079066701","Not Applicable","Not Applicable","NDC","51079066701","SULINDAC 200 MG TABLET",4.53,4.53,3.4,4.53,1.1325000000000001]
["Not Applicable - Not Applicable - 51079066720","Not Applicable","Not Applicable","NDC","51079066720","SULINDAC 200 MG TABLET",4.1900000000000004,4.1900000000000004,3.15,4.1900000000000004,1.0475000000000001]
["Not Applicable - Not Applicable - 51079068401","Not Applicable","Not Applicable","NDC","51079068401","ATENOLOL 50 MG TABLET",0.65,0.65,0.09,0.65,0.16250000000000001]
["Not Applicable - Not Applicable - 51079068420","Not Applicable","Not Applicable","NDC","51079068420","ATENOLOL 50 MG TABLET",0.54,0.54,7.0000000000000007E-2,0.54,0.13500000000000001]
["Not Applicable - Not Applicable - 51079068520","Not Applicable","Not Applicable","NDC","51079068520","ATENOLOL 100 MG TABLET",0.63,0.63,0.08,0.63,0.1575]
["Not Applicable - Not Applicable - 51079068620","Not Applicable","Not Applicable","NDC","51079068620","SIMVASTATIN 10 MG TABLET",1.68,1.68,0.42,1.68,0.42]
["Not Applicable - Not Applicable - 51079069001","Not Applicable","Not Applicable","NDC","51079069001","LOPERAMIDE 2 MG CAPSULE",5.18,5.18,2.59,5.18,1.2949999999999999]
["Not Applicable - Not Applicable - 51079069020","Not Applicable","Not Applicable","NDC","51079069020","LOPERAMIDE 2 MG CAPSULE",3.82,3.82,1.91,3.82,0.95499999999999996]
["Not Applicable - Not Applicable - 51079072601","Not Applicable","Not Applicable","NDC","51079072601","TOPIRAMATE 25 MG TABLET",3.98,3.98,0.5,3.98,0.995]
["Not Applicable - Not Applicable - 51079072801","Not Applicable","Not Applicable","NDC","51079072801","TOPIRAMATE 100 MG TABLET",1.77,1.77,0.23,1.77,0.4425]
["Not Applicable - Not Applicable - 51079073301","Not Applicable","Not Applicable","NDC","51079073301","HALOPERIDOL 0.5 MG TABLET",20.54,20.54,2.06,20.54,5.1349999999999998]
["Not Applicable - Not Applicable - 51079073320","Not Applicable","Not Applicable","NDC","51079073320","HALOPERIDOL 0.5 MG TABLET",16.84,16.84,1.69,16.84,4.21]
["Not Applicable - Not Applicable - 51079073501","Not Applicable","Not Applicable","NDC","51079073501","HALOPERIDOL 2 MG TABLET",9.99,9.99,1,9.99,2.4975000000000001]
["Not Applicable - Not Applicable - 51079073520","Not Applicable","Not Applicable","NDC","51079073520","HALOPERIDOL 2 MG TABLET",8.25,8.25,0.83,8.25,2.0625]
["Not Applicable - Not Applicable - 51079074501","Not Applicable","Not Applicable","NDC","51079074501","DILTIAZEM 30 MG TABLET",2.4300000000000002,2.4300000000000002,0.61,2.4300000000000002,0.60750000000000004]
["Not Applicable - Not Applicable - 51079074520","Not Applicable","Not Applicable","NDC","51079074520","DILTIAZEM 30 MG TABLET",2.34,2.34,0.59,2.34,0.58499999999999996]
["Not Applicable - Not Applicable - 51079074601","Not Applicable","Not Applicable","NDC","51079074601","DILTIAZEM 60 MG TABLET",1.91,1.91,0.48,1.91,0.47749999999999998]
["Not Applicable - Not Applicable - 51079074620","Not Applicable","Not Applicable","NDC","51079074620","DILTIAZEM 60 MG TABLET",1.7,1.7,0.43,1.7,0.42499999999999999]
["Not Applicable - Not Applicable - 51079075320","Not Applicable","Not Applicable","NDC","51079075320","SUCRALFATE 1 GRAM TABLET",1.9,1.9,0.95,1.9,0.47499999999999998]
["Not Applicable - Not Applicable - 51079075901","Not Applicable","Not Applicable","NDC","51079075901","ATENOLOL 25 MG TABLET",2.48,2.48,0.31,2.48,0.62]
["Not Applicable - Not Applicable - 51079075920","Not Applicable","Not Applicable","NDC","51079075920","ATENOLOL 25 MG TABLET",2.04,2.04,0.26,2.04,0.51]
["Not Applicable - Not Applicable - 51079076601","Not Applicable","Not Applicable","NDC","51079076601","DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR",20.91,20.91,5.23,20.91,5.2275]
["Not Applicable - Not Applicable - 51079077401","Not Applicable","Not Applicable","NDC","51079077401","PAROXETINE 20 MG TABLET",2.04,2.04,0.51,2.04,0.51]
["Not Applicable - Not Applicable - 51079077420","Not Applicable","Not Applicable","NDC","51079077420","PAROXETINE 20 MG TABLET",1.9,1.9,0.48,1.9,0.47499999999999998]
["Not Applicable - Not Applicable - 51079079020","Not Applicable","Not Applicable","NDC","51079079020","ALPRAZOLAM 1 MG TABLET",0.56000000000000005,0.56000000000000005,7.0000000000000007E-2,0.56000000000000005,0.14000000000000001]
["Not Applicable - Not Applicable - 51079079601","Not Applicable","Not Applicable","NDC","51079079601","HYDROXYZINE HCL 10 MG TABLET",4.05,4.05,0.81,4.05,1.0125]
["Not Applicable - Not Applicable - 51079079620","Not Applicable","Not Applicable","NDC","51079079620","HYDROXYZINE HCL 10 MG TABLET",6.22,6.22,1.25,6.22,1.5549999999999999]
["Not Applicable - Not Applicable - 51079080120","Not Applicable","Not Applicable","NDC","51079080120","METOPROLOL TARTRATE 50 MG TABLET",0.45,0.45,0.06,0.45,0.1125]
["Not Applicable - Not Applicable - 51079081001","Not Applicable","Not Applicable","NDC","51079081001","GLIPIZIDE 5 MG TABLET",4.5,4.5,1.1299999999999999,4.5,1.125]
["Not Applicable - Not Applicable - 51079081020","Not Applicable","Not Applicable","NDC","51079081020","GLIPIZIDE 5 MG TABLET",3.07,3.07,0.77,3.07,0.76749999999999996]
["Not Applicable - Not Applicable - 51079081101","Not Applicable","Not Applicable","NDC","51079081101","GLIPIZIDE 10 MG TABLET",4.5,4.5,1.1299999999999999,4.5,1.125]
["Not Applicable - Not Applicable - 51079081120","Not Applicable","Not Applicable","NDC","51079081120","GLIPIZIDE 10 MG TABLET",3.07,3.07,0.77,3.07,0.76749999999999996]
["Not Applicable - Not Applicable - 51079081301","Not Applicable","Not Applicable","NDC","51079081301","NADOLOL 40 MG TABLET",85.58,85.58,10.7,85.58,21.395]
["Not Applicable - Not Applicable - 51079081320","Not Applicable","Not Applicable","NDC","51079081320","NADOLOL 40 MG TABLET",41.1,41.1,5.14,41.1,10.275]
["Not Applicable - Not Applicable - 51079082001","Not Applicable","Not Applicable","NDC","51079082001","LEVETIRACETAM 250 MG TABLET",7.95,7.95,1.99,7.95,1.9875]
["Not Applicable - Not Applicable - 51079082101","Not Applicable","Not Applicable","NDC","51079082101","LEVETIRACETAM 500 MG TABLET",4.1399999999999997,4.1399999999999997,1.04,4.1399999999999997,1.0349999999999999]
["Not Applicable - Not Applicable - 51079086301","Not Applicable","Not Applicable","NDC","51079086301","CAPTOPRIL 12.5 MG TABLET",20.329999999999998,20.329999999999998,2.5499999999999998,20.329999999999998,5.0824999999999996]
["Not Applicable - Not Applicable - 51079086320","Not Applicable","Not Applicable","NDC","51079086320","CAPTOPRIL 12.5 MG TABLET",15.18,15.18,1.9,15.18,3.7949999999999999]
["Not Applicable - Not Applicable - 51079086401","Not Applicable","Not Applicable","NDC","51079086401","CAPTOPRIL 25 MG TABLET",11.04,11.04,1.38,11.04,2.76]
["Not Applicable - Not Applicable - 51079086420","Not Applicable","Not Applicable","NDC","51079086420","CAPTOPRIL 25 MG TABLET",8.24,8.24,1.03,8.24,2.06]
["Not Applicable - Not Applicable - 51079086820","Not Applicable","Not Applicable","NDC","51079086820","INDAPAMIDE 2.5 MG TABLET",1.78,1.78,0.89,1.78,0.44500000000000001]
["Not Applicable - Not Applicable - 51079086920","Not Applicable","Not Applicable","NDC","51079086920","VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE",6.95,6.95,3.48,6.95,1.7375]
["Not Applicable - Not Applicable - 51079087001","Not Applicable","Not Applicable","NDC","51079087001","CARBAMAZEPINE 100 MG CHEWABLE TABLET",2.85,2.85,1.43,2.85,0.71250000000000002]
["Not Applicable - Not Applicable - 51079087020","Not Applicable","Not Applicable","NDC","51079087020","CARBAMAZEPINE 100 MG CHEWABLE TABLET",3.56,3.56,1.78,3.56,0.89]
["Not Applicable - Not Applicable - 51079087120","Not Applicable","Not Applicable","NDC","51079087120","SUCRALFATE 1 GRAM TABLET",2.25,2.25,1.1299999999999999,2.25,0.5625]
["Not Applicable - Not Applicable - 51079088120","Not Applicable","Not Applicable","NDC","51079088120","CLONAZEPAM 0.5 MG TABLET",1.24,1.24,0.16,1.24,0.31]
["Not Applicable - Not Applicable - 51079088201","Not Applicable","Not Applicable","NDC","51079088201","CLONAZEPAM 1 MG TABLET",0.77,0.77,0.1,0.77,0.1925]
["Not Applicable - Not Applicable - 51079088220","Not Applicable","Not Applicable","NDC","51079088220","CLONAZEPAM 1 MG TABLET",0.5,0.5,7.0000000000000007E-2,0.5,0.125]
["Not Applicable - Not Applicable - 51079088301","Not Applicable","Not Applicable","NDC","51079088301","CLONAZEPAM 2 MG TABLET",0.47,0.47,0.06,0.47,0.11749999999999999]
["Not Applicable - Not Applicable - 51079088320","Not Applicable","Not Applicable","NDC","51079088320","CLONAZEPAM 2 MG TABLET",0.25,0.25,0.04,0.25,6.25E-2]
["Not Applicable - Not Applicable - 51079088401","Not Applicable","Not Applicable","NDC","51079088401","CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET",2.21,2.21,0.56000000000000005,2.21,0.55249999999999999]
["Not Applicable - Not Applicable - 51079088420","Not Applicable","Not Applicable","NDC","51079088420","CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET",2.02,2.02,0.51,2.02,0.505]
["Not Applicable - Not Applicable - 51079088801","Not Applicable","Not Applicable","NDC","51079088801","METOCLOPRAMIDE 10 MG TABLET",2.84,2.84,1.42,2.84,0.71]
["Not Applicable - Not Applicable - 51079088820","Not Applicable","Not Applicable","NDC","51079088820","METOCLOPRAMIDE 10 MG TABLET",2.12,2.12,1.06,2.12,0.53]
["Not Applicable - Not Applicable - 51079089401","Not Applicable","Not Applicable","NDC","51079089401","VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE",13.72,13.72,6.86,13.72,3.43]
["Not Applicable - Not Applicable - 51079089601","Not Applicable","Not Applicable","NDC","51079089601","NIFEDIPINE ER 60 MG TABLET,EXTENDED RELEASE 24 HR",10.73,10.73,3.58,10.73,2.6825000000000001]
["Not Applicable - Not Applicable - 51079089708","Not Applicable","Not Applicable","NDC","51079089708","NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR",8.35,8.35,2.79,8.35,2.0874999999999999]
["Not Applicable - Not Applicable - 51079089901","Not Applicable","Not Applicable","NDC","51079089901","VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE",9.84,9.84,4.92,9.84,2.46]
["Not Applicable - Not Applicable - 51079089920","Not Applicable","Not Applicable","NDC","51079089920","VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE",9.1,9.1,4.55,9.1,2.2749999999999999]
["Not Applicable - Not Applicable - 51079090501","Not Applicable","Not Applicable","NDC","51079090501","PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE",6.05,6.05,0.61,6.05,1.5125]
["Not Applicable - Not Applicable - 51079090520","Not Applicable","Not Applicable","NDC","51079090520","PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE",4.7300000000000004,4.7300000000000004,0.48,4.7300000000000004,1.1825000000000001]
["Not Applicable - Not Applicable - 51079092101","Not Applicable","Not Applicable","NDC","51079092101","CLOZAPINE 25 MG TABLET",18.48,18.48,4.62,18.48,4.62]
["Not Applicable - Not Applicable - 51079092120","Not Applicable","Not Applicable","NDC","51079092120","CLOZAPINE 25 MG TABLET",9.58,9.58,2.4,9.58,2.395]
["Not Applicable - Not Applicable - 51079092201","Not Applicable","Not Applicable","NDC","51079092201","CLOZAPINE 100 MG TABLET",11.73,11.73,2.94,11.73,2.9325000000000001]
["Not Applicable - Not Applicable - 51079092220","Not Applicable","Not Applicable","NDC","51079092220","CLOZAPINE 100 MG TABLET",4.08,4.08,1.02,4.08,1.02]
["Not Applicable - Not Applicable - 51079092420","Not Applicable","Not Applicable","NDC","51079092420","DILTIAZEM ER 60 MG CAPSULE,EXTENDED RELEASE 12 HR",18.190000000000001,18.190000000000001,9.1,18.190000000000001,4.5475000000000003]
["Not Applicable - Not Applicable - 51079092520","Not Applicable","Not Applicable","NDC","51079092520","DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR",13.6,13.6,6.8,13.6,3.4]
["Not Applicable - Not Applicable - 51079092601","Not Applicable","Not Applicable","NDC","51079092601","DILTIAZEM ER 120 MG CAPSULE,EXTENDED RELEASE 12 HR",19.309999999999999,19.309999999999999,9.66,19.309999999999999,4.8274999999999997]
["Not Applicable - Not Applicable - 51079092620","Not Applicable","Not Applicable","NDC","51079092620","DILTIAZEM ER 120 MG CAPSULE,EXTENDED RELEASE 12 HR",14.98,14.98,7.49,14.98,3.7450000000000001]
["Not Applicable - Not Applicable - 51079092901","Not Applicable","Not Applicable","NDC","51079092901","LABETALOL 200 MG TABLET",4.5199999999999996,4.5199999999999996,1.1299999999999999,4.5199999999999996,1.1299999999999999]
["Not Applicable - Not Applicable - 51079092920","Not Applicable","Not Applicable","NDC","51079092920","LABETALOL 200 MG TABLET",3.71,3.71,0.93,3.71,0.92749999999999999]
["Not Applicable - Not Applicable - 51079093001","Not Applicable","Not Applicable","NDC","51079093001","CARVEDILOL 6.25 MG TABLET",1.85,1.85,0.24,1.85,0.46250000000000002]
["Not Applicable - Not Applicable - 51079093020","Not Applicable","Not Applicable","NDC","51079093020","CARVEDILOL 6.25 MG TABLET",1.07,1.07,0.14000000000000001,1.07,0.26750000000000002]
["Not Applicable - Not Applicable - 51079093101","Not Applicable","Not Applicable","NDC","51079093101","CARVEDILOL 12.5 MG TABLET",0.93,0.93,0.12,0.93,0.23250000000000001]
["Not Applicable - Not Applicable - 51079093120","Not Applicable","Not Applicable","NDC","51079093120","CARVEDILOL 12.5 MG TABLET",0.54,0.54,7.0000000000000007E-2,0.54,0.13500000000000001]
["Not Applicable - Not Applicable - 51079093501","Not Applicable","Not Applicable","NDC","51079093501","TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG CAPSULE",1.27,1.27,1.27,1.27,0.3175]
["Not Applicable - Not Applicable - 51079093601","Not Applicable","Not Applicable","NDC","51079093601","TERAZOSIN 1 MG CAPSULE",4.2,4.2,0.84,4.2,1.05]
["Not Applicable - Not Applicable - 51079093801","Not Applicable","Not Applicable","NDC","51079093801","TERAZOSIN 5 MG CAPSULE",1.04,1.04,0.21,1.04,0.26]
["Not Applicable - Not Applicable - 51079094301","Not Applicable","Not Applicable","NDC","51079094301","BUPROPION HCL 75 MG TABLET",5.82,5.82,2.91,5.82,1.4550000000000001]
["Not Applicable - Not Applicable - 51079094320","Not Applicable","Not Applicable","NDC","51079094320","BUPROPION HCL 75 MG TABLET",4.68,4.68,2.34,4.68,1.17]
["Not Applicable - Not Applicable - 51079094401","Not Applicable","Not Applicable","NDC","51079094401","BUPROPION HCL 100 MG TABLET",5.82,5.82,2.91,5.82,1.4550000000000001]
["Not Applicable - Not Applicable - 51079094420","Not Applicable","Not Applicable","NDC","51079094420","BUPROPION HCL 100 MG TABLET",5.41,5.41,2.71,5.41,1.3525]
["Not Applicable - Not Applicable - 51079095201","Not Applicable","Not Applicable","NDC","51079095201","ENALAPRIL MALEATE 10 MG TABLET",4.59,4.59,1.1499999999999999,4.59,1.1475]
["Not Applicable - Not Applicable - 51079095220","Not Applicable","Not Applicable","NDC","51079095220","ENALAPRIL MALEATE 10 MG TABLET",4.0999999999999996,4.0999999999999996,1.03,4.0999999999999996,1.0249999999999999]
["Not Applicable - Not Applicable - 51079095820","Not Applicable","Not Applicable","NDC","51079095820","DOXAZOSIN 2 MG TABLET",35.03,35.03,4.38,35.03,8.7575000000000003]
["Not Applicable - Not Applicable - 51079095920","Not Applicable","Not Applicable","NDC","51079095920","DOXAZOSIN 4 MG TABLET",21.61,21.61,2.71,21.61,5.4024999999999999]
["Not Applicable - Not Applicable - 51079096601","Not Applicable","Not Applicable","NDC","51079096601","FAMOTIDINE 20 MG TABLET",0.72,0.72,0.18,0.72,0.18]
["Not Applicable - Not Applicable - 51079096620","Not Applicable","Not Applicable","NDC","51079096620","FAMOTIDINE 20 MG TABLET",0.54,0.54,0.14000000000000001,0.54,0.13500000000000001]
["Not Applicable - Not Applicable - 51079097801","Not Applicable","Not Applicable","NDC","51079097801","CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE",2.7,2.7,1.35,2.7,0.67500000000000004]
["Not Applicable - Not Applicable - 51079098001","Not Applicable","Not Applicable","NDC","51079098001","SPIRONOLACTONE 100 MG TABLET",3.78,3.78,0.95,3.78,0.94499999999999995]
["Not Applicable - Not Applicable - 51079098101","Not Applicable","Not Applicable","NDC","51079098101","LISINOPRIL 5 MG TABLET",3.44,3.44,0.43,3.44,0.86]
["Not Applicable - Not Applicable - 51079098120","Not Applicable","Not Applicable","NDC","51079098120","LISINOPRIL 5 MG TABLET",2.25,2.25,0.28999999999999998,2.25,0.5625]
["Not Applicable - Not Applicable - 51079098301","Not Applicable","Not Applicable","NDC","51079098301","LISINOPRIL 20 MG TABLET",1.01,1.01,0.13,1.01,0.2525]
["Not Applicable - Not Applicable - 51079098320","Not Applicable","Not Applicable","NDC","51079098320","LISINOPRIL 20 MG TABLET",0.81,0.81,0.11,0.81,0.20250000000000001]
["Not Applicable - Not Applicable - 51079098501","Not Applicable","Not Applicable","NDC","51079098501","BUSPIRONE 5 MG TABLET",1.08,1.08,0.36,1.08,0.27]
["Not Applicable - Not Applicable - 51079098520","Not Applicable","Not Applicable","NDC","51079098520","BUSPIRONE 5 MG TABLET",0.89,0.89,0.3,0.89,0.2225]
["Not Applicable - Not Applicable - 51079098601","Not Applicable","Not Applicable","NDC","51079098601","BUSPIRONE 10 MG TABLET",0.74,0.74,0.25,0.74,0.185]
["Not Applicable - Not Applicable - 51079098620","Not Applicable","Not Applicable","NDC","51079098620","BUSPIRONE 10 MG TABLET",0.62,0.62,0.21,0.62,0.155]
["Not Applicable - Not Applicable - 51079099101","Not Applicable","Not Applicable","NDC","51079099101","TRAMADOL 50 MG TABLET",0.55000000000000004,0.55000000000000004,0.14000000000000001,0.55000000000000004,0.13750000000000001]
["Not Applicable - Not Applicable - 51079099120","Not Applicable","Not Applicable","NDC","51079099120","TRAMADOL 50 MG TABLET",0.38,0.38,0.1,0.38,9.5000000000000001E-2]
["Not Applicable - Not Applicable - 51079099130","Not Applicable","Not Applicable","NDC","51079099130","TRAMADOL 50 MG TABLET",0.45,0.45,0.12,0.45,0.1125]
["Not Applicable - Not Applicable - 51224020630","Not Applicable","Not Applicable","NDC","51224020630","NALTREXONE 50 MG TABLET",7.58,7.58,1.27,7.58,1.895]
["Not Applicable - Not Applicable - 51224022230","Not Applicable","Not Applicable","NDC","51224022230","AZITHROMYCIN 600 MG TABLET",6.73,6.73,1.41,6.73,1.6825000000000001]
["Not Applicable - Not Applicable - 51285094288","Not Applicable","Not Applicable","NDC","51285094288","LEVONORGESTREL 1.5 MG TABLET",115.46,115.46,57.73,115.46,28.864999999999998]
["Not Applicable - Not Applicable - 51293061501","Not Applicable","Not Applicable","NDC","51293061501","SALSALATE 500 MG TABLET",1.76,1.76,0.88,1.76,0.44]
["Not Applicable - Not Applicable - 51293080301","Not Applicable","Not Applicable","NDC","51293080301","SALSALATE 500 MG TABLET",1.99,1.99,1,1.99,0.4975]
["Not Applicable - Not Applicable - 51293080401","Not Applicable","Not Applicable","NDC","51293080401","SALSALATE 750 MG TABLET",1.56,1.56,0.78,1.56,0.39]
["Not Applicable - Not Applicable - 51293084610","Not Applicable","Not Applicable","NDC","51293084610","FOLIC ACID 1 MG TABLET",0.04,0.04,0.04,0.04,0.01]
["Not Applicable - Not Applicable - 51525043101","Not Applicable","Not Applicable","NDC","51525043101","FELBAMATE 600 MG TABLET",17.77,17.77,5.93,17.77,4.4424999999999999]
["Not Applicable - Not Applicable - 51525044208","Not Applicable","Not Applicable","NDC","51525044208","FELBAMATE 600 MG/5 ML ORAL SUSPENSION (PEDIATRIC)",4.8499999999999996,4.8499999999999996,3.64,4.8499999999999996,1.2124999999999999]
["Not Applicable - Not Applicable - 51552102606","Not Applicable","Not Applicable","NDC","51552102606","GLYCERIN (BULK) 100 % LIQUID",55.46,55.46,55.46,55.46,13.865]
["Not Applicable - Not Applicable - 51645085101","Not Applicable","Not Applicable","NDC","51645085101","SENNOSIDES 8.6 MG TABLET",0.19,0.19,0.1,0.19,4.7500000000000001E-2]
["Not Applicable - Not Applicable - 51645085110","Not Applicable","Not Applicable","NDC","51645085110","SENNOSIDES 8.6 MG TABLET",0.14000000000000001,0.14000000000000001,7.0000000000000007E-2,0.14000000000000001,3.5000000000000003E-2]
["Not Applicable - Not Applicable - 51645086001","Not Applicable","Not Applicable","NDC","51645086001","SIMETHICONE 80 MG CHEWABLE TABLET",0.28000000000000003,0.28000000000000003,0.14000000000000001,0.28000000000000003,7.0000000000000007E-2]
["Not Applicable - Not Applicable - 51645099101","Not Applicable","Not Applicable","NDC","51645099101","ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE",0.16,0.16,0.16,0.16,0.04]
["Not Applicable - Not Applicable - 51672125301","Not Applicable","Not Applicable","NDC","51672125301","FLUOCINONIDE 0.05 % TOPICAL CREAM",120.91,120.91,120.91,120.91,30.227499999999999]
["Not Applicable - Not Applicable - 51672125303","Not Applicable","Not Applicable","NDC","51672125303","FLUOCINONIDE 0.05 % TOPICAL CREAM",480.66,480.66,480.66,480.66,120.16500000000001]
["Not Applicable - Not Applicable - 51672125802","Not Applicable","Not Applicable","NDC","51672125802","CLOBETASOL 0.05 % TOPICAL CREAM",80.36,80.36,80.36,80.36,20.09]
["Not Applicable - Not Applicable - 51672126401","Not Applicable","Not Applicable","NDC","51672126401","FLUOCINONIDE 0.05 % TOPICAL OINTMENT",36.130000000000003,36.130000000000003,36.130000000000003,36.130000000000003,9.0325000000000006]
["Not Applicable - Not Applicable - 51672126403","Not Applicable","Not Applicable","NDC","51672126403","FLUOCINONIDE 0.05 % TOPICAL OINTMENT",113.61,113.61,113.61,113.61,28.4025]
["Not Applicable - Not Applicable - 51672127501","Not Applicable","Not Applicable","NDC","51672127501","CLOTRIMAZOLE 1 % TOPICAL CREAM",38.799999999999997,38.799999999999997,38.799999999999997,38.799999999999997,9.6999999999999993]
["Not Applicable - Not Applicable - 51672128001","Not Applicable","Not Applicable","NDC","51672128001","DESONIDE 0.05 % TOPICAL CREAM",27.02,27.02,27.02,27.02,6.7549999999999999]
["Not Applicable - Not Applicable - 51672128401","Not Applicable","Not Applicable","NDC","51672128401","TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT",14.39,14.39,14.39,14.39,3.5975000000000001]
["Not Applicable - Not Applicable - 51672128408","Not Applicable","Not Applicable","NDC","51672128408","TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT",32.97,32.97,32.97,32.97,8.2424999999999997]
["Not Applicable - Not Applicable - 51672128902","Not Applicable","Not Applicable","NDC","51672128902","NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM",43.38,43.38,43.38,43.38,10.845000000000001]
["Not Applicable - Not Applicable - 51672129802","Not Applicable","Not Applicable","NDC","51672129802","KETOCONAZOLE 2 % TOPICAL CREAM",126.08,126.08,126.08,126.08,31.52]
["Not Applicable - Not Applicable - 51672131200","Not Applicable","Not Applicable","NDC","51672131200","MUPIROCIN 2 % TOPICAL OINTMENT",66.36,66.36,66.36,66.36,16.59]
["Not Applicable - Not Applicable - 51672138603","Not Applicable","Not Applicable","NDC","51672138603","FLUOCINONIDE 0.05 % TOPICAL CREAM",210.81,210.81,210.81,210.81,52.702500000000001]
["Not Applicable - Not Applicable - 51672200201","Not Applicable","Not Applicable","NDC","51672200201","CLOTRIMAZOLE 1 % TOPICAL CREAM",19.93,19.93,19.93,19.93,4.9824999999999999]
["Not Applicable - Not Applicable - 51672200306","Not Applicable","Not Applicable","NDC","51672200306","CLOTRIMAZOLE 1 % VAGINAL CREAM",15.83,15.83,15.83,15.83,3.9575]
["Not Applicable - Not Applicable - 51672201002","Not Applicable","Not Applicable","NDC","51672201002","HYDROCORTISONE 0.5 % TOPICAL CREAM",12.21,12.21,12.21,12.21,3.0525000000000002]
["Not Applicable - Not Applicable - 51672203506","Not Applicable","Not Applicable","NDC","51672203506","MICONAZOLE NITRATE 2 % VAGINAL CREAM",21.59,21.59,21.59,21.59,5.3975]
["Not Applicable - Not Applicable - 51672211502","Not Applicable","Not Applicable","NDC","51672211502","ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY",14.82,14.82,1.37,14.82,3.7050000000000001]
["Not Applicable - Not Applicable - 51672400201","Not Applicable","Not Applicable","NDC","51672400201","NORTRIPTYLINE 25 MG CAPSULE",1.4,1.4,0.14000000000000001,1.4,0.35]
["Not Applicable - Not Applicable - 51672401106","Not Applicable","Not Applicable","NDC","51672401106","CLOMIPRAMINE 25 MG CAPSULE",134.16,134.16,22.36,134.16,33.54]
["Not Applicable - Not Applicable - 51672401206","Not Applicable","Not Applicable","NDC","51672401206","CLOMIPRAMINE 50 MG CAPSULE",67.08,67.08,11.18,67.08,16.77]
["Not Applicable - Not Applicable - 51672402301","Not Applicable","Not Applicable","NDC","51672402301","ACETAZOLAMIDE 250 MG TABLET",15.29,15.29,3.83,15.29,3.8224999999999998]
["Not Applicable - Not Applicable - 51672402606","Not Applicable","Not Applicable","NDC","51672402606","KETOCONAZOLE 200 MG TABLET",21.28,21.28,5.32,21.28,5.32]
["Not Applicable - Not Applicable - 51672404201","Not Applicable","Not Applicable","NDC","51672404201","CLORAZEPATE DIPOTASSIUM 3.75 MG TABLET",30.16,30.16,7.54,30.16,7.54]
["Not Applicable - Not Applicable - 51672404709","Not Applicable","Not Applicable","NDC","51672404709","CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION",3.31,3.31,0.83,3.31,0.82750000000000001]
["Not Applicable - Not Applicable - 51672406901","Not Applicable","Not Applicable","NDC","51672406901","PHENYTOIN 125 MG/5 ML ORAL SUSPENSION",37.89,37.89,37.89,37.89,9.4725000000000001]
["Not Applicable - Not Applicable - 51672411606","Not Applicable","Not Applicable","NDC","51672411606","METRONIDAZOLE 0.75 % TOPICAL GEL",119.42,119.42,119.42,119.42,29.855]
["Not Applicable - Not Applicable - 51672411704","Not Applicable","Not Applicable","NDC","51672411704","NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION",23.24,23.24,23.24,23.24,5.81]
["Not Applicable - Not Applicable - 51672412401","Not Applicable","Not Applicable","NDC","51672412401","CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR",16.55,16.55,2.76,16.55,4.1375000000000002]
["Not Applicable - Not Applicable - 51672413001","Not Applicable","Not Applicable","NDC","51672413001","LAMOTRIGINE 25 MG TABLET",1.6,1.6,0.2,1.6,0.4]
["Not Applicable - Not Applicable - 51672413101","Not Applicable","Not Applicable","NDC","51672413101","LAMOTRIGINE 100 MG TABLET",0.42,0.42,0.06,0.42,0.105]
["Not Applicable - Not Applicable - 51672414601","Not Applicable","Not Applicable","NDC","51672414601","PHENYTOIN 50 MG CHEWABLE TABLET",1.39,1.39,0.7,1.39,0.34749999999999998]
["Not Applicable - Not Applicable - 51672670800","Not Applicable","Not Applicable","NDC","51672670800","CLOTRIMAZOLE 2 % VAGINAL CREAM",25.4,25.4,25.4,25.4,6.35]
["Not Applicable - Not Applicable - 51862018015","Not Applicable","Not Applicable","NDC","51862018015","PRAMOXINE 1 % TOPICAL FOAM",160.24,160.24,160.24,160.24,40.06]
["Not Applicable - Not Applicable - 51927120200","Not Applicable","Not Applicable","NDC","51927120200","CAFFEINE CITRATE (BULK) POWDER",2.99,2.99,2.99,2.99,0.74750000000000005]
["Not Applicable - Not Applicable - 51991020311","Not Applicable","Not Applicable","NDC","51991020311","POLYSACCHARIDE IRON COMPLEX 150 MG IRON CAPSULE",0.31,0.31,0.31,0.31,7.7499999999999999E-2]
["Not Applicable - Not Applicable - 51991029301","Not Applicable","Not Applicable","NDC","51991029301","OXCARBAZEPINE 300 MG TABLET",1.1000000000000001,1.1000000000000001,0.28000000000000003,1.1000000000000001,0.27500000000000002]
["Not Applicable - Not Applicable - 51991033106","Not Applicable","Not Applicable","NDC","51991033106","NEVIRAPINE 200 MG TABLET",0.88,0.88,0.88,0.88,0.22]
["Not Applicable - Not Applicable - 51991070501","Not Applicable","Not Applicable","NDC","51991070501","ALPRAZOLAM 0.5 MG TABLET",0.49,0.49,7.0000000000000007E-2,0.49,0.1225]
["Not Applicable - Not Applicable - 51991075933","Not Applicable","Not Applicable","NDC","51991075933","LETROZOLE 2.5 MG TABLET",1,1,1,1,0.25]
["Not Applicable - Not Applicable - 51991079306","Not Applicable","Not Applicable","NDC","51991079306","RIVASTIGMINE 1.5 MG CAPSULE",3.42,3.42,0.86,3.42,0.85499999999999998]
["Not Applicable - Not Applicable - 51991081701","Not Applicable","Not Applicable","NDC","51991081701","PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE",8.6999999999999993,8.6999999999999993,3.27,8.6999999999999993,2.1749999999999998]
["Not Applicable - Not Applicable - 51991081801","Not Applicable","Not Applicable","NDC","51991081801","PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE",7.62,7.62,2.86,7.62,1.905]
["Not Applicable - Not Applicable - 51991082001","Not Applicable","Not Applicable","NDC","51991082001","PROPRANOLOL ER 160 MG CAPSULE,24 HR,EXTENDED RELEASE",4.6500000000000004,4.6500000000000004,2.33,4.6500000000000004,1.1625000000000001]
["Not Applicable - Not Applicable - 51991090001","Not Applicable","Not Applicable","NDC","51991090001","CLOBAZAM 10 MG TABLET",3.98,3.98,1,3.98,0.995]
["Not Applicable - Not Applicable - 52015008001","Not Applicable","Not Applicable","NDC","52015008001","FIDAXOMICIN 200 MG TABLET",346.15,346.15,346.15,346.15,86.537499999999994]
["Not Applicable - Not Applicable - 52054033010","Not Applicable","Not Applicable","NDC","52054033010","PYRIMETHAMINE 25 MG TABLET",21315,21315,2664.38,21315,5328.75]
["Not Applicable - Not Applicable - 52054055022","Not Applicable","Not Applicable","NDC","52054055022","ALBENDAZOLE 200 MG TABLET",1620.55,1620.55,810.28,1620.55,405.13749999999999]
["Not Applicable - Not Applicable - 52054055028","Not Applicable","Not Applicable","NDC","52054055028","ALBENDAZOLE 200 MG TABLET",724.63,724.63,362.32,724.63,181.1575]
["Not Applicable - Not Applicable - 52244010010","Not Applicable","Not Applicable","NDC","52244010010","THEOPHYLLINE ER 100 MG CAPSULE,EXTENDED RELEASE 24 HR",35.17,35.17,17.59,35.17,8.7925000000000004]
["Not Applicable - Not Applicable - 52268010001","Not Applicable","Not Applicable","NDC","52268010001","PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION",42.63,42.63,42.63,42.63,10.657500000000001]
["Not Applicable - Not Applicable - 52376002102","Not Applicable","Not Applicable","NDC","52376002102","CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH",0.48,0.48,0.48,0.48,0.12]
["Not Applicable - Not Applicable - 52380127204","Not Applicable","Not Applicable","NDC","52380127204","CHLORHEXIDINE GLUCONATE 4 % TOPICAL LIQUID",23.9,23.9,23.9,23.9,5.9749999999999996]
["Not Applicable - Not Applicable - 52544023854","Not Applicable","Not Applicable","NDC","52544023854","ULIPRISTAL 30 MG TABLET",127.01,127.01,127.01,127.01,31.752500000000001]
["Not Applicable - Not Applicable - 52544046960","Not Applicable","Not Applicable","NDC","52544046960","TESTOSTERONE 2.5 MG/24 HR TRANSDERMAL 24 HOUR PATCH",34.76,34.76,17.38,34.76,8.69]
["Not Applicable - Not Applicable - 52565001480","Not Applicable","Not Applicable","NDC","52565001480","TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT",32.97,32.97,32.97,32.97,8.2424999999999997]
["Not Applicable - Not Applicable - 52565002060","Not Applicable","Not Applicable","NDC","52565002060","FLUOCINOLONE 0.025 % TOPICAL CREAM",88.68,88.68,88.68,88.68,22.17]
["Not Applicable - Not Applicable - 52817018210","Not Applicable","Not Applicable","NDC","52817018210","CLONIDINE HCL 0.3 MG TABLET",0.24,0.24,0.08,0.24,0.06]
["Not Applicable - Not Applicable - 52817021010","Not Applicable","Not Applicable","NDC","52817021010","CYPROHEPTADINE 4 MG TABLET",0.37,0.37,0.37,0.37,9.2499999999999999E-2]
["Not Applicable - Not Applicable - 52817034130","Not Applicable","Not Applicable","NDC","52817034130","SILDENAFIL 50 MG TABLET",1.92,1.92,0.48,1.92,0.48]
["Not Applicable - Not Applicable - 52817036010","Not Applicable","Not Applicable","NDC","52817036010","METOPROLOL TARTRATE 25 MG TABLET",0.3,0.3,0.04,0.3,7.4999999999999997E-2]
["Not Applicable - Not Applicable - 52817036110","Not Applicable","Not Applicable","NDC","52817036110","METOPROLOL TARTRATE 50 MG TABLET",0.19,0.19,0.03,0.19,4.7500000000000001E-2]
["Not Applicable - Not Applicable - 52817036410","Not Applicable","Not Applicable","NDC","52817036410","TRIAMTERENE 50 MG CAPSULE",50.05,50.05,25.03,50.05,12.512499999999999]
["Not Applicable - Not Applicable - 53014053107","Not Applicable","Not Applicable","NDC","53014053107","METHYLPHENIDATE 5 MG TABLET",7.54,7.54,1.89,7.54,1.885]
["Not Applicable - Not Applicable - 53276101002","Not Applicable","Not Applicable","NDC","53276101002","MICROFIBRILLAR COLLAGEN HEMOSTAT POWDER",858.53,858.53,858.53,858.53,214.63249999999999]
["Not Applicable - Not Applicable - 53436008430","Not Applicable","Not Applicable","NDC","53436008430","PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL POWDER PACKET",104.13,104.13,104.13,104.13,26.032499999999999]
["Not Applicable - Not Applicable - 53489012002","Not Applicable","Not Applicable","NDC","53489012002","DOXYCYCLINE HYCLATE 100 MG TABLET",2.08,2.08,2.08,2.08,0.52]
["Not Applicable - Not Applicable - 53489012005","Not Applicable","Not Applicable","NDC","53489012005","DOXYCYCLINE HYCLATE 100 MG TABLET",1.78,1.78,1.78,1.78,0.44500000000000001]
["Not Applicable - Not Applicable - 53489014501","Not Applicable","Not Applicable","NDC","53489014501","SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG TABLET",1.72,1.72,0.43,1.72,0.43]
["Not Applicable - Not Applicable - 53489014601","Not Applicable","Not Applicable","NDC","53489014601","SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET",1.19,1.19,0.6,1.19,0.29749999999999999]
["Not Applicable - Not Applicable - 53489021501","Not Applicable","Not Applicable","NDC","53489021501","CLONIDINE HCL 0.1 MG TABLET",0.75,0.75,0.25,0.75,0.1875]
["Not Applicable - Not Applicable - 53489033001","Not Applicable","Not Applicable","NDC","53489033001","IMIPRAMINE 10 MG TABLET",2.86,2.86,0.57999999999999996,2.86,0.71499999999999997]
["Not Applicable - Not Applicable - 53489033101","Not Applicable","Not Applicable","NDC","53489033101","IMIPRAMINE 25 MG TABLET",1.53,1.53,0.31,1.53,0.38250000000000001]
["Not Applicable - Not Applicable - 53489036801","Not Applicable","Not Applicable","NDC","53489036801","FELODIPINE ER 2.5 MG TABLET,EXTENDED RELEASE 24 HR",15.42,15.42,3.86,15.42,3.855]
["Not Applicable - Not Applicable - 53489036901","Not Applicable","Not Applicable","NDC","53489036901","FELODIPINE ER 5 MG TABLET,EXTENDED RELEASE 24 HR",10.74,10.74,2.69,10.74,2.6850000000000001]
["Not Applicable - Not Applicable - 53489037001","Not Applicable","Not Applicable","NDC","53489037001","FELODIPINE ER 10 MG TABLET,EXTENDED RELEASE 24 HR",9.65,9.65,2.42,9.65,2.4125000000000001]
["Not Applicable - Not Applicable - 53489038601","Not Applicable","Not Applicable","NDC","53489038601","MINOXIDIL 2.5 MG TABLET",2.52,2.52,0.63,2.52,0.63]
["Not Applicable - Not Applicable - 53489047801","Not Applicable","Not Applicable","NDC","53489047801","SULINDAC 150 MG TABLET",1.28,1.28,0.96,1.28,0.32]
["Not Applicable - Not Applicable - 53746027101","Not Applicable","Not Applicable","NDC","53746027101","SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG TABLET",1.68,1.68,0.42,1.68,0.42]
["Not Applicable - Not Applicable - 53746046601","Not Applicable","Not Applicable","NDC","53746046601","IBUPROFEN 800 MG TABLET",0.37,0.37,0.1,0.37,9.2499999999999999E-2]
["Not Applicable - Not Applicable - 53746054401","Not Applicable","Not Applicable","NDC","53746054401","PRIMIDONE 50 MG TABLET",2.5099999999999998,2.5099999999999998,0.51,2.5099999999999998,0.62749999999999995]
["Not Applicable - Not Applicable - 54092017212","Not Applicable","Not Applicable","NDC","54092017212","CARBAMAZEPINE ER 200 MG CAPSULE,EXTENDED RELEASE MPHASE12HR",8.82,8.82,2.94,8.82,2.2050000000000001]
["Not Applicable - Not Applicable - 54092018981","Not Applicable","Not Applicable","NDC","54092018981","MESALAMINE CR 250 MG CAPSULE,CONTROLLED RELEASE",40.26,40.26,20.13,40.26,10.065]
["Not Applicable - Not Applicable - 54162000002","Not Applicable","Not Applicable","NDC","54162000002","VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT",4.9800000000000004,4.9800000000000004,4.9800000000000004,4.9800000000000004,1.2450000000000001]
["Not Applicable - Not Applicable - 54162010002","Not Applicable","Not Applicable","NDC","54162010002","BENZOIN-ALOE VERA-STORAX-TOLU BALSAM 10 %-2 %-8 %-4 % TOPICAL TINCTURE",9.69,9.69,9.69,9.69,2.4224999999999999]
["Not Applicable - Not Applicable - 54162017505","Not Applicable","Not Applicable","NDC","54162017505","MINERAL OIL ENEMA",5.28,5.28,5.28,5.28,1.32]
["Not Applicable - Not Applicable - 54162055002","Not Applicable","Not Applicable","NDC","54162055002","CAMPHOR-MENTHOL 0.5 %-0.5 % LOTION",3.57,3.57,3.57,3.57,0.89249999999999996]
["Not Applicable - Not Applicable - 54162055007","Not Applicable","Not Applicable","NDC","54162055007","CAMPHOR-MENTHOL 0.5 %-0.5 % LOTION",10.26,10.26,10.26,10.26,2.5649999999999999]
["Not Applicable - Not Applicable - 54162055009","Not Applicable","Not Applicable","NDC","54162055009","CAMPHOR-MENTHOL 0.5 %-0.5 % LOTION",9.4700000000000006,9.4700000000000006,9.4700000000000006,9.4700000000000006,2.3675000000000002]
["Not Applicable - Not Applicable - 54162055501","Not Applicable","Not Applicable","NDC","54162055501","METHYL SALICYLATE-MENTHOL TOPICAL OINTMENT",3.4,3.4,3.4,3.4,0.85]
["Not Applicable - Not Applicable - 54162060002","Not Applicable","Not Applicable","NDC","54162060002","LANOLIN ALCOHOLS-MINERAL OIL-W.PETROLATUM-CERESIN TOPICAL CREAM",10.039999999999999,10.039999999999999,10.039999999999999,10.039999999999999,2.5099999999999998]
["Not Applicable - Not Applicable - 54295030815","Not Applicable","Not Applicable","NDC","54295030815","UREA 40 % TOPICAL CREAM",178.47,178.47,178.47,178.47,44.6175]
["Not Applicable - Not Applicable - 54482014407","Not Applicable","Not Applicable","NDC","54482014407","LEVOCARNITINE 330 MG TABLET",10.61,10.61,3.54,10.61,2.6524999999999999]
["Not Applicable - Not Applicable - 54505005522","Not Applicable","Not Applicable","NDC","54505005522","ALBENDAZOLE 200 MG TABLET",1724.18,1724.18,862.09,1724.18,431.04500000000002]
["Not Applicable - Not Applicable - 54505033210","Not Applicable","Not Applicable","NDC","54505033210","HYDROCORTISONE 10 MG TABLET",2.2000000000000002,2.2000000000000002,0.55000000000000004,2.2000000000000002,0.55000000000000004]
["Not Applicable - Not Applicable - 54569519100","Not Applicable","Not Applicable","NDC","54569519100","ABACAVIR 300 MG-LAMIVUDINE 150 MG-ZIDOVUDINE 300 MG TABLET",148.68,148.68,148.68,148.68,37.17]
["Not Applicable - Not Applicable - 54569635200","Not Applicable","Not Applicable","NDC","54569635200","ELVITEG 150 MG-COB 150 MG-EMTRICIT 200 MG-TENOFO DISOPRO 300 MG TABLET",453.93,453.93,453.93,453.93,113.4825]
["Not Applicable - Not Applicable - 54629007101","Not Applicable","Not Applicable","NDC","54629007101","NIACIN 100 MG TABLET",0.56999999999999995,0.56999999999999995,0.12,0.56999999999999995,0.14249999999999999]
["Not Applicable - Not Applicable - 54629068301","Not Applicable","Not Applicable","NDC","54629068301","CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) TABLET",0.18,0.18,0.18,0.18,4.4999999999999998E-2]
["Not Applicable - Not Applicable - 54758000628","Not Applicable","Not Applicable","NDC","54758000628","DEXTROSE 1.2 GRAM/3 ML (40 %) ORAL GEL IN SYRINGE (ORAL USE ONLY)",8.61,8.61,8.61,8.61,2.1524999999999999]
["Not Applicable - Not Applicable - 54799050401","Not Applicable","Not Applicable","NDC","54799050401","TETRACAINE 0.5 % HYPERVISCOUS EYE DROPS IN A DROPPERETTE",27.72,27.72,27.72,27.72,6.93]
["Not Applicable - Not Applicable - 54799050721","Not Applicable","Not Applicable","NDC","54799050721","FLUORESCEIN 0.25 %-PROPARACAINE 0.5 % EYE DROPS",123.06,123.06,123.06,123.06,30.765000000000001]
["Not Applicable - Not Applicable - 54838000530","Not Applicable","Not Applicable","NDC","54838000530","VITAMIN E (DL, ACETATE) 22.5 MG (50 UNIT)/ML ORAL DROPS",80.36,80.36,80.36,80.36,20.09]
["Not Applicable - Not Applicable - 54838000650","Not Applicable","Not Applicable","NDC","54838000650","CHOLECALCIFEROL (VITAMIN D3) 10 MCG/ML (400 UNIT/ML) ORAL DROPS",0.3,0.3,0.08,0.3,7.4999999999999997E-2]
["Not Applicable - Not Applicable - 54838001070","Not Applicable","Not Applicable","NDC","54838001070","MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID",0.91,0.91,0.91,0.91,0.22750000000000001]
["Not Applicable - Not Applicable - 54838001150","Not Applicable","Not Applicable","NDC","54838001150","FERROUS SULFATE 15 MG IRON (75 MG)/ML ORAL DROPS",10.84,10.84,10.84,10.84,2.71]
["Not Applicable - Not Applicable - 54838050140","Not Applicable","Not Applicable","NDC","54838050140","HALOPERIDOL 2 MG/ML ORAL CONCENTRATE (PEDIATRIC)",1.96,1.96,0.2,1.96,0.49]
["Not Applicable - Not Applicable - 54868560000","Not Applicable","Not Applicable","NDC","54868560000","ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET",121.04,121.04,121.04,121.04,30.26]
["Not Applicable - Not Applicable - 54879000100","Not Applicable","Not Applicable","NDC","54879000100","ETHAMBUTOL 100 MG TABLET",17.399999999999999,17.399999999999999,8.6999999999999993,17.399999999999999,4.3499999999999996]
["Not Applicable - Not Applicable - 55111012190","Not Applicable","Not Applicable","NDC","55111012190","ATORVASTATIN 10 MG TABLET",2.11,2.11,0.27,2.11,0.52749999999999997]
["Not Applicable - Not Applicable - 55111012705","Not Applicable","Not Applicable","NDC","55111012705","CIPROFLOXACIN 500 MG TABLET",0.43,0.43,0.15,0.43,0.1075]
["Not Applicable - Not Applicable - 55111016630","Not Applicable","Not Applicable","NDC","55111016630","OLANZAPINE 10 MG TABLET",7.08,7.08,1.77,7.08,1.77]
["Not Applicable - Not Applicable - 55111025660","Not Applicable","Not Applicable","NDC","55111025660","ZIPRASIDONE 20 MG CAPSULE",6.64,6.64,1.66,6.64,1.66]
["Not Applicable - Not Applicable - 55111027950","Not Applicable","Not Applicable","NDC","55111027950","LEVOFLOXACIN 250 MG TABLET",4.47,4.47,1.1200000000000001,4.47,1.1174999999999999]
["Not Applicable - Not Applicable - 55111028130","Not Applicable","Not Applicable","NDC","55111028130","LEVOFLOXACIN 750 MG TABLET",4.47,4.47,1.1200000000000001,4.47,1.1174999999999999]
["Not Applicable - Not Applicable - 55111029109","Not Applicable","Not Applicable","NDC","55111029109","SUMATRIPTAN 25 MG TABLET",5.97,5.97,1.5,5.97,1.4924999999999999]
["Not Applicable - Not Applicable - 55111068301","Not Applicable","Not Applicable","NDC","55111068301","IBUPROFEN 600 MG TABLET",0.75,0.75,0.19,0.75,0.1875]
["Not Applicable - Not Applicable - 55111078927","Not Applicable","Not Applicable","NDC","55111078927","SEVELAMER CARBONATE 800 MG TABLET",4.2699999999999996,4.2699999999999996,1.43,4.2699999999999996,1.0674999999999999]
["Not Applicable - Not Applicable - 55111078948","Not Applicable","Not Applicable","NDC","55111078948","SEVELAMER CARBONATE 800 MG TABLET",17.899999999999999,17.899999999999999,5.97,17.899999999999999,4.4749999999999996]
["Not Applicable - Not Applicable - 55150012215","Not Applicable","Not Applicable","NDC","55150012215","NAFCILLIN 1 GRAM SOLUTION FOR INJECTION",12.28,12.28,12.28,12.28,3.07]
["Not Applicable - Not Applicable - 55150023501","Not Applicable","Not Applicable","NDC","55150023501","VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION",15.64,15.64,15.64,15.64,3.91]
["Not Applicable - Not Applicable - 55154358107","Not Applicable","Not Applicable","NDC","55154358107","GABAPENTIN 300 MG CAPSULE",0.81,0.81,0.21,0.81,0.20250000000000001]
["Not Applicable - Not Applicable - 55390003710","Not Applicable","Not Applicable","NDC","55390003710","VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION",21.32,21.32,21.32,21.32,5.33]
["Not Applicable - Not Applicable - 56151161051","Not Applicable","Not Applicable","NDC","56151161051","GLUCOSE 4 GRAM CHEWABLE TABLET",0.76,0.76,0.19,0.76,0.19]
["Not Applicable - Not Applicable - 56151161151","Not Applicable","Not Applicable","NDC","56151161151","GLUCOSE 4 GRAM CHEWABLE TABLET",0.76,0.76,0.19,0.76,0.19]
["Not Applicable - Not Applicable - 56184010105","Not Applicable","Not Applicable","NDC","56184010105","ACETAMINOPHEN 160 MG/5 ML ORAL LIQUID",0.88,0.88,0.88,0.88,0.22]
["Not Applicable - Not Applicable - 56184012041","Not Applicable","Not Applicable","NDC","56184012041","SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION",20.36,20.36,20.36,20.36,5.09]
["Not Applicable - Not Applicable - 57237001401","Not Applicable","Not Applicable","NDC","57237001401","TAMSULOSIN 0.4 MG CAPSULE",1.6,1.6,0.8,1.6,0.4]
["Not Applicable - Not Applicable - 57237004390","Not Applicable","Not Applicable","NDC","57237004390","VALACYCLOVIR 1 GRAM TABLET",4.05,4.05,1.02,4.05,1.0125]
["Not Applicable - Not Applicable - 57237011001","Not Applicable","Not Applicable","NDC","57237011001","FELODIPINE ER 10 MG TABLET,EXTENDED RELEASE 24 HR",0.7,0.7,0.18,0.7,0.17499999999999999]
["Not Applicable - Not Applicable - 57237014935","Not Applicable","Not Applicable","NDC","57237014935","FLUCONAZOLE 10 MG/ML ORAL SUSPENSION",29.1,29.1,29.1,29.1,7.2750000000000004]
["Not Applicable - Not Applicable - 57237015035","Not Applicable","Not Applicable","NDC","57237015035","FLUCONAZOLE 40 MG/ML ORAL SUSPENSION",47.63,47.63,47.63,47.63,11.907500000000001]
["Not Applicable - Not Applicable - 57237017301","Not Applicable","Not Applicable","NDC","57237017301","VENLAFAXINE 37.5 MG TABLET",0.89,0.89,0.3,0.89,0.2225]
["Not Applicable - Not Applicable - 57237017401","Not Applicable","Not Applicable","NDC","57237017401","VENLAFAXINE 50 MG TABLET",0.69,0.69,0.23,0.69,0.17249999999999999]
["Not Applicable - Not Applicable - 57237021230","Not Applicable","Not Applicable","NDC","57237021230","MONTELUKAST 4 MG CHEWABLE TABLET",0.45,0.45,0.36,0.45,0.1125]
["Not Applicable - Not Applicable - 57664013565","Not Applicable","Not Applicable","NDC","57664013565","NIMODIPINE 30 MG CAPSULE",35.53,35.53,17.77,35.53,8.8825000000000003]
["Not Applicable - Not Applicable - 57664039288","Not Applicable","Not Applicable","NDC","57664039288","VENLAFAXINE 25 MG TABLET",0.71,0.71,0.24,0.71,0.17749999999999999]
["Not Applicable - Not Applicable - 57664039488","Not Applicable","Not Applicable","NDC","57664039488","VENLAFAXINE 50 MG TABLET",0.43,0.43,0.15,0.43,0.1075]
["Not Applicable - Not Applicable - 57664039753","Not Applicable","Not Applicable","NDC","57664039753","METFORMIN 500 MG TABLET",0.5,0.5,0.25,0.5,0.125]
["Not Applicable - Not Applicable - 57664043551","Not Applicable","Not Applicable","NDC","57664043551","METFORMIN 850 MG TABLET",0.49,0.49,0.25,0.49,0.1225]
["Not Applicable - Not Applicable - 57664047752","Not Applicable","Not Applicable","NDC","57664047752","METOPROLOL TARTRATE 50 MG TABLET",0.11,0.11,0.02,0.11,2.75E-2]
["Not Applicable - Not Applicable - 57664050289","Not Applicable","Not Applicable","NDC","57664050289","TIZANIDINE 2 MG TABLET",0.3,0.3,0.15,0.3,7.4999999999999997E-2]
["Not Applicable - Not Applicable - 57664056918","Not Applicable","Not Applicable","NDC","57664056918","AMLODIPINE 5 MG TABLET",0.26,0.26,7.0000000000000007E-2,0.26,6.5000000000000002E-2]
["Not Applicable - Not Applicable - 57664076188","Not Applicable","Not Applicable","NDC","57664076188","HYDROXYCHLOROQUINE 200 MG TABLET",7.24,7.24,1.81,7.24,1.81]
["Not Applicable - Not Applicable - 57770005500","Not Applicable","Not Applicable","NDC","57770005500","HYPROMELLOSE 2 % INTRAOCULAR SYRINGE",223.81,223.81,223.81,223.81,55.952500000000001]
["Not Applicable - Not Applicable - 57896040316","Not Applicable","Not Applicable","NDC","57896040316","DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID",0.54,0.54,0.27,0.54,0.13500000000000001]
["Not Applicable - Not Applicable - 57896045101","Not Applicable","Not Applicable","NDC","57896045101","SENNOSIDES 8.6 MG TABLET",0.1,0.1,0.05,0.1,2.5000000000000001E-2]
["Not Applicable - Not Applicable - 57896045401","Not Applicable","Not Applicable","NDC","57896045401","SENNOSIDES 8.6 MG TABLET",0.11,0.11,0.06,0.11,2.75E-2]
["Not Applicable - Not Applicable - 57896057501","Not Applicable","Not Applicable","NDC","57896057501","PRENATAL VITS 96-FERROUS FUMARATE 27 MG IRON-FOLIC ACID 800 MCG TABLET",0.14000000000000001,0.14000000000000001,0.14000000000000001,0.14000000000000001,3.5000000000000003E-2]
["Not Applicable - Not Applicable - 57896062912","Not Applicable","Not Applicable","NDC","57896062912","ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP",0.64,0.64,0.32,0.64,0.16]
["Not Applicable - Not Applicable - 57896074201","Not Applicable","Not Applicable","NDC","57896074201","CALCIUM CARBONATE 500 MG-VITAMIN D3 5 MCG (200 UNIT) TABLET",0.13,0.13,7.0000000000000007E-2,0.13,3.2500000000000001E-2]
["Not Applicable - Not Applicable - 57896084216","Not Applicable","Not Applicable","NDC","57896084216","ASCORBIC ACID (VITAMIN C) 500 MG/5 ML SYRUP (PEDIATRIC)",1.34,1.34,0.23,1.34,0.33500000000000002]
["Not Applicable - Not Applicable - 57896090101","Not Applicable","Not Applicable","NDC","57896090101","ASPIRIN 325 MG TABLET",0.08,0.08,0.04,0.08,0.02]
["Not Applicable - Not Applicable - 57896098101","Not Applicable","Not Applicable","NDC","57896098101","ASPIRIN 81 MG TABLET,DELAYED RELEASE",0.38,0.38,0.05,0.38,9.5000000000000001E-2]
["Not Applicable - Not Applicable - 57896098112","Not Applicable","Not Applicable","NDC","57896098112","ASPIRIN 81 MG TABLET,DELAYED RELEASE",0.35,0.35,0.05,0.35,8.7499999999999994E-2]
["Not Applicable - Not Applicable - 58160081201","Not Applicable","Not Applicable","NDC","58160081201","DIPH,PERTUS(ACEL),TET,POLIO(PF) 25 LF-58 MCG-10 LF/0.5 ML IM SUSP",187.01,187.01,187.01,187.01,46.752499999999998]
["Not Applicable - Not Applicable - 58160081211","Not Applicable","Not Applicable","NDC","58160081211","DIPH,PERTUS(ACEL),TET,POLIO(PF) 25 LF-58 MCG-10 LF/0.5 ML IM SUSP",185.15,185.15,185.15,185.15,46.287500000000001]
["Not Applicable - Not Applicable - 58468013001","Not Applicable","Not Applicable","NDC","58468013001","SEVELAMER CARBONATE 800 MG TABLET",59.16,59.16,19.72,59.16,14.79]
["Not Applicable - Not Applicable - 58526000540","Not Applicable","Not Applicable","NDC","58526000540","VITAMIN B COMPLEX AND VITAMIN C NO.20-FOLIC ACID 1 MG CAPSULE",3.22,3.22,3.22,3.22,0.80500000000000005]
["Not Applicable - Not Applicable - 58526000541","Not Applicable","Not Applicable","NDC","58526000541","VITAMIN B COMPLEX AND VITAMIN C NO.20-FOLIC ACID 1 MG CAPSULE",3.06,3.06,3.06,3.06,0.76500000000000001]
["Not Applicable - Not Applicable - 58657061110","Not Applicable","Not Applicable","NDC","58657061110","LOSARTAN 50 MG TABLET",0.3,0.3,0.08,0.3,7.4999999999999997E-2]
["Not Applicable - Not Applicable - 58914001516","Not Applicable","Not Applicable","NDC","58914001516","DICYCLOMINE 10 MG/5 ML ORAL SYRUP",6.54,6.54,1.64,6.54,1.635]
["Not Applicable - Not Applicable - 58914011210","Not Applicable","Not Applicable","NDC","58914011210","LIPASE-PROTEASE-AMYLASE 10,440-39,150-39,150 UNIT TABLET",10.32,10.32,10.32,10.32,2.58]
["Not Applicable - Not Applicable - 58914017110","Not Applicable","Not Applicable","NDC","58914017110","SUCRALFATE 1 GRAM TABLET",28.39,28.39,14.2,28.39,7.0975000000000001]
["Not Applicable - Not Applicable - 58914021460","Not Applicable","Not Applicable","NDC","58914021460","PEDIATRIC MULTIVITAMIN NO.40-PHYTONADIONE 400 MCG/ML ORAL DROPS",1.56,1.56,1.56,1.56,0.39]
["Not Applicable - Not Applicable - 58914050101","Not Applicable","Not Applicable","NDC","58914050101","MESALAMINE 1,000 MG RECTAL SUPPOSITORY",137.58000000000001,137.58000000000001,68.790000000000006,137.58000000000001,34.395000000000003]
["Not Applicable - Not Applicable - 58914050156","Not Applicable","Not Applicable","NDC","58914050156","MESALAMINE 1,000 MG RECTAL SUPPOSITORY",128.37,128.37,64.19,128.37,32.092500000000001]
["Not Applicable - Not Applicable - 58914060120","Not Applicable","Not Applicable","NDC","58914060120","BISMUTH SUBCIT K 140 MG-METRONIDAZOLE 125 MG-TETRACYCLINE 125 MG CAP",76.38,76.38,76.38,76.38,19.094999999999999]
["Not Applicable - Not Applicable - 58980041501","Not Applicable","Not Applicable","NDC","58980041501","BISACODYL 10 MG RECTAL SUPPOSITORY",0.82,0.82,0.41,0.82,0.20499999999999999]
["Not Applicable - Not Applicable - 58980062510","Not Applicable","Not Applicable","NDC","58980062510","UREA 40 % TOPICAL CREAM",50.68,50.68,50.68,50.68,12.67]
["Not Applicable - Not Applicable - 59011045101","Not Applicable","Not Applicable","NDC","59011045101","HYDROMORPHONE 1 MG/ML ORAL LIQUID",20.69,20.69,5.18,20.69,5.1725000000000003]
["Not Applicable - Not Applicable - 59011045201","Not Applicable","Not Applicable","NDC","59011045201","HYDROMORPHONE 2 MG TABLET",25.17,25.17,6.3,25.17,6.2925000000000004]
["Not Applicable - Not Applicable - 59148000613","Not Applicable","Not Applicable","NDC","59148000613","ARIPIPRAZOLE 2 MG TABLET",1138.3900000000001,1138.3900000000001,75.900000000000006,1138.3900000000001,284.59750000000003]
["Not Applicable - Not Applicable - 59148000713","Not Applicable","Not Applicable","NDC","59148000713","ARIPIPRAZOLE 5 MG TABLET",455.36,455.36,30.36,455.36,113.84]
["Not Applicable - Not Applicable - 59148000835","Not Applicable","Not Applicable","NDC","59148000835","ARIPIPRAZOLE 10 MG TABLET",211.24,211.24,21.13,211.24,52.81]
["Not Applicable - Not Applicable - 59212056210","Not Applicable","Not Applicable","NDC","59212056210","HYDROXYCHLOROQUINE 200 MG TABLET",146.33000000000001,146.33000000000001,36.590000000000003,146.33000000000001,36.582500000000003]
["Not Applicable - Not Applicable - 59212068010","Not Applicable","Not Applicable","NDC","59212068010","ZONISAMIDE 100 MG CAPSULE",122.39,122.39,15.3,122.39,30.5975]
["Not Applicable - Not Applicable - 59212068110","Not Applicable","Not Applicable","NDC","59212068110","ZONISAMIDE 25 MG CAPSULE",378.42,378.42,47.31,378.42,94.605000000000004]
["Not Applicable - Not Applicable - 59310030240","Not Applicable","Not Applicable","NDC","59310030240","BECLOMETHASONE DIPROP 40 MCG/ACTUATION HFA BREATH ACTIVATED AEROSOL",662.04,662.04,662.04,662.04,165.51]
["Not Applicable - Not Applicable - 59310030480","Not Applicable","Not Applicable","NDC","59310030480","BECLOMETHASONE DIPROP 80 MCG/ACTUATION HFA BREATH ACTIVATED AEROSOL",886.48,886.48,886.48,886.48,221.62]
["Not Applicable - Not Applicable - 59310057922","Not Applicable","Not Applicable","NDC","59310057922","ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER",248.68,248.68,248.68,248.68,62.17]
["Not Applicable - Not Applicable - 59390018213","Not Applicable","Not Applicable","NDC","59390018213","HYPROMELLOSE 2.5 % EYE DROPS",23.24,23.24,23.24,23.24,5.81]
["Not Applicable - Not Applicable - 59390018950","Not Applicable","Not Applicable","NDC","59390018950","WHITE PETROLATUM-MINERAL OIL EYE OINTMENT",20.010000000000002,20.010000000000002,20.010000000000002,20.010000000000002,5.0025000000000004]
["Not Applicable - Not Applicable - 59390019050","Not Applicable","Not Applicable","NDC","59390019050","ARTIFICIAL TEARS WITH LANOLIN EYE OINTMENT",30.02,30.02,30.02,30.02,7.5049999999999999]
["Not Applicable - Not Applicable - 59584013801","Not Applicable","Not Applicable","NDC","59584013801","CANDIDA ALBICANS SKIN TEST FDA STANDARD INTRADERMAL",80.56,80.56,80.56,80.56,20.14]
["Not Applicable - Not Applicable - 59651017301","Not Applicable","Not Applicable","NDC","59651017301","DOXEPIN 10 MG CAPSULE",8.19,8.19,1.64,8.19,2.0474999999999999]
["Not Applicable - Not Applicable - 59676027801","Not Applicable","Not Applicable","NDC","59676027801","RILPIVIRINE 25 MG TABLET",134.56,134.56,134.56,134.56,33.64]
["Not Applicable - Not Applicable - 59676056201","Not Applicable","Not Applicable","NDC","59676056201","DARUNAVIR ETHANOLATE 600 MG TABLET",140.58000000000001,140.58000000000001,105.43,140.58000000000001,35.145000000000003]
["Not Applicable - Not Applicable - 59676056630","Not Applicable","Not Applicable","NDC","59676056630","DARUNAVIR ETHANOLATE 800 MG TABLET",6325.66,6325.66,6325.66,6325.66,1581.415]
["Not Applicable - Not Applicable - 59676057001","Not Applicable","Not Applicable","NDC","59676057001","ETRAVIRINE 100 MG TABLET",80.650000000000006,80.650000000000006,80.650000000000006,80.650000000000006,20.162500000000001]
["Not Applicable - Not Applicable - 59676057101","Not Applicable","Not Applicable","NDC","59676057101","ETRAVIRINE 200 MG TABLET",80.650000000000006,80.650000000000006,80.650000000000006,80.650000000000006,20.162500000000001]
["Not Applicable - Not Applicable - 59676057530","Not Applicable","Not Applicable","NDC","59676057530","DARUNAVIR 800 MG-COBICISTAT 150 MG TABLET",241.01,241.01,241.01,241.01,60.252499999999998]
["Not Applicable - Not Applicable - 59676070101","Not Applicable","Not Applicable","NDC","59676070101","BEDAQUILINE 100 MG TABLET",2267.5500000000002,2267.5500000000002,1133.78,2267.5500000000002,566.88750000000005]
["Not Applicable - Not Applicable - 59746024501","Not Applicable","Not Applicable","NDC","59746024501","LAMOTRIGINE 25 MG TABLET",1.2,1.2,0.15,1.2,0.3]
["Not Applicable - Not Applicable - 59746032530","Not Applicable","Not Applicable","NDC","59746032530","VALACYCLOVIR 1 GRAM TABLET",7.73,7.73,1.94,7.73,1.9325000000000001]
["Not Applicable - Not Applicable - 59762001601","Not Applicable","Not Applicable","NDC","59762001601","CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION",137.13,137.13,137.13,137.13,34.282499999999999]
["Not Applicable - Not Applicable - 59762007401","Not Applicable","Not Applicable","NDC","59762007401","HYDROCORTISONE 10 MG TABLET",1.84,1.84,0.46,1.84,0.46]
["Not Applicable - Not Applicable - 59762014001","Not Applicable","Not Applicable","NDC","59762014001","PIROXICAM 10 MG CAPSULE",4.07,4.07,2.04,4.07,1.0175000000000001]
["Not Applicable - Not Applicable - 59762015501","Not Applicable","Not Applicable","NDC","59762015501","ATORVASTATIN 10 MG TABLET",5.63,5.63,0.71,5.63,1.4075]
["Not Applicable - Not Applicable - 59762015802","Not Applicable","Not Applicable","NDC","59762015802","ATORVASTATIN 80 MG TABLET",1,1,1,1,0.25]
["Not Applicable - Not Applicable - 59762018101","Not Applicable","Not Applicable","NDC","59762018101","VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR",2.1800000000000002,2.1800000000000002,0.73,2.1800000000000002,0.54500000000000004]
["Not Applicable - Not Applicable - 59762024603","Not Applicable","Not Applicable","NDC","59762024603","DONEPEZIL 10 MG TABLET",1.56,1.56,0.78,1.56,0.39]
["Not Applicable - Not Applicable - 59762092501","Not Applicable","Not Applicable","NDC","59762092501","VORICONAZOLE 50 MG TABLET",123.28,123.28,123.28,123.28,30.82]
["Not Applicable - Not Applicable - 59762106101","Not Applicable","Not Applicable","NDC","59762106101","DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET",2.72,2.72,1.36,2.72,0.68]
["Not Applicable - Not Applicable - 59762130702","Not Applicable","Not Applicable","NDC","59762130702","LINEZOLID 600 MG TABLET",41.26,41.26,41.26,41.26,10.315]
["Not Applicable - Not Applicable - 59762130801","Not Applicable","Not Applicable","NDC","59762130801","LINEZOLID 100 MG/5 ML ORAL SUSPENSION (PEDIATRIC)",2174.67,2174.67,2174.67,2174.67,543.66750000000002]
["Not Applicable - Not Applicable - 59762135001","Not Applicable","Not Applicable","NDC","59762135001","RIFABUTIN 150 MG CAPSULE",109.95,109.95,54.98,109.95,27.487500000000001]
["Not Applicable - Not Applicable - 59762153001","Not Applicable","Not Applicable","NDC","59762153001","AMLODIPINE 5 MG TABLET",2.21,2.21,0.56000000000000005,2.21,0.55249999999999999]
["Not Applicable - Not Applicable - 59762153002","Not Applicable","Not Applicable","NDC","59762153002","AMLODIPINE 5 MG TABLET",2.21,2.21,0.56000000000000005,2.21,0.55249999999999999]
["Not Applicable - Not Applicable - 59762153003","Not Applicable","Not Applicable","NDC","59762153003","AMLODIPINE 5 MG TABLET",1.93,1.93,0.49,1.93,0.48249999999999998]
["Not Applicable - Not Applicable - 59762153005","Not Applicable","Not Applicable","NDC","59762153005","AMLODIPINE 5 MG TABLET",1.46,1.46,0.37,1.46,0.36499999999999999]
["Not Applicable - Not Applicable - 59762153401","Not Applicable","Not Applicable","NDC","59762153401","PENICILLIN V POTASSIUM 250 MG TABLET",1.01,1.01,0.51,1.01,0.2525]
["Not Applicable - Not Applicable - 59762153701","Not Applicable","Not Applicable","NDC","59762153701","PENICILLIN V POTASSIUM 500 MG TABLET",0.85,0.85,0.43,0.85,0.21249999999999999]
["Not Applicable - Not Applicable - 59762171001","Not Applicable","Not Applicable","NDC","59762171001","EPLERENONE 25 MG TABLET",15.52,15.52,7.76,15.52,3.88]
["Not Applicable - Not Applicable - 59762171003","Not Applicable","Not Applicable","NDC","59762171003","EPLERENONE 25 MG TABLET",23.02,23.02,11.51,23.02,5.7549999999999999]
["Not Applicable - Not Applicable - 59762306002","Not Applicable","Not Applicable","NDC","59762306002","AZITHROMYCIN 250 MG TABLET",24.42,24.42,5.09,24.42,6.1050000000000004]
["Not Applicable - Not Applicable - 59762306003","Not Applicable","Not Applicable","NDC","59762306003","AZITHROMYCIN 250 MG TABLET",39.14,39.14,8.16,39.14,9.7850000000000001]
["Not Applicable - Not Applicable - 59762308001","Not Applicable","Not Applicable","NDC","59762308001","AZITHROMYCIN 600 MG TABLET",21.38,21.38,4.46,21.38,5.3449999999999998]
["Not Applicable - Not Applicable - 59762314001","Not Applicable","Not Applicable","NDC","59762314001","AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION",86.76,86.76,86.76,86.76,21.69]
["Not Applicable - Not Applicable - 59762332801","Not Applicable","Not Applicable","NDC","59762332801","CLINDAMYCIN HCL 150 MG CAPSULE",2,2,0.67,2,0.5]
["Not Applicable - Not Applicable - 59762371704","Not Applicable","Not Applicable","NDC","59762371704","TRIAZOLAM 0.125 MG TABLET",29.75,29.75,7.44,29.75,7.4375]
["Not Applicable - Not Applicable - 59762371709","Not Applicable","Not Applicable","NDC","59762371709","TRIAZOLAM 0.125 MG TABLET",38.9,38.9,9.73,38.9,9.7249999999999996]
["Not Applicable - Not Applicable - 59762371809","Not Applicable","Not Applicable","NDC","59762371809","TRIAZOLAM 0.25 MG TABLET",19.45,19.45,4.87,19.45,4.8624999999999998]
["Not Applicable - Not Applicable - 59762372001","Not Applicable","Not Applicable","NDC","59762372001","ALPRAZOLAM 0.5 MG TABLET",0.56000000000000005,0.56000000000000005,7.0000000000000007E-2,0.56000000000000005,0.14000000000000001]
["Not Applicable - Not Applicable - 59762374001","Not Applicable","Not Applicable","NDC","59762374001","MEDROXYPROGESTERONE 2.5 MG TABLET",1.3,1.3,0.33,1.3,0.32500000000000001]
["Not Applicable - Not Applicable - 59762374202","Not Applicable","Not Applicable","NDC","59762374202","MEDROXYPROGESTERONE 10 MG TABLET",0.88,0.88,0.44,0.88,0.22]
["Not Applicable - Not Applicable - 59762374301","Not Applicable","Not Applicable","NDC","59762374301","CLINDAMYCIN 1 % TOPICAL GEL",98.8,98.8,98.8,98.8,24.7]
["Not Applicable - Not Applicable - 59762490003","Not Applicable","Not Applicable","NDC","59762490003","SERTRALINE 50 MG TABLET",1.46,1.46,0.37,1.46,0.36499999999999999]
["Not Applicable - Not Applicable - 59762490004","Not Applicable","Not Applicable","NDC","59762490004","SERTRALINE 50 MG TABLET",1.0900000000000001,1.0900000000000001,0.28000000000000003,1.0900000000000001,0.27250000000000002]
["Not Applicable - Not Applicable - 59762491001","Not Applicable","Not Applicable","NDC","59762491001","SERTRALINE 100 MG TABLET",0.24,0.24,0.06,0.24,0.06]
["Not Applicable - Not Applicable - 59762491003","Not Applicable","Not Applicable","NDC","59762491003","SERTRALINE 100 MG TABLET",0.56999999999999995,0.56999999999999995,0.15,0.56999999999999995,0.14249999999999999]
["Not Applicable - Not Applicable - 59762494001","Not Applicable","Not Applicable","NDC","59762494001","SERTRALINE 20 MG/ML ORAL CONCENTRATE",5.45,5.45,1.37,5.45,1.3625]
["Not Applicable - Not Applicable - 59762500001","Not Applicable","Not Applicable","NDC","59762500001","SULFASALAZINE 500 MG TABLET",1.23,1.23,0.62,1.23,0.3075]
["Not Applicable - Not Applicable - 59762500005","Not Applicable","Not Applicable","NDC","59762500005","SULFASALAZINE 500 MG TABLET",1.23,1.23,0.62,1.23,0.3075]
["Not Applicable - Not Applicable - 59762500701","Not Applicable","Not Applicable","NDC","59762500701","MISOPROSTOL 100 MCG TABLET",21.96,21.96,0.55000000000000004,21.96,5.49]
["Not Applicable - Not Applicable - 59762500801","Not Applicable","Not Applicable","NDC","59762500801","MISOPROSTOL 200 MCG TABLET",16.010000000000002,16.010000000000002,0.41,16.010000000000002,4.0025000000000004]
["Not Applicable - Not Applicable - 59762500802","Not Applicable","Not Applicable","NDC","59762500802","MISOPROSTOL 200 MCG TABLET",16.010000000000002,16.010000000000002,0.41,16.010000000000002,4.0025000000000004]
["Not Applicable - Not Applicable - 59762500901","Not Applicable","Not Applicable","NDC","59762500901","CLINDAMYCIN 2 % VAGINAL CREAM",288.04000000000002,288.04000000000002,288.04000000000002,288.04000000000002,72.010000000000005]
["Not Applicable - Not Applicable - 59762501201","Not Applicable","Not Applicable","NDC","59762501201","SPIRONOLACTONE 50 MG TABLET",2.78,2.78,0.7,2.78,0.69499999999999995]
["Not Applicable - Not Applicable - 59762502701","Not Applicable","Not Applicable","NDC","59762502701","GABAPENTIN 300 MG CAPSULE",6.3,6.3,1.58,6.3,1.575]
["Not Applicable - Not Applicable - 59762502901","Not Applicable","Not Applicable","NDC","59762502901","FLUCONAZOLE 10 MG/ML ORAL SUSPENSION",53.72,53.72,53.72,53.72,13.43]
["Not Applicable - Not Applicable - 59762503001","Not Applicable","Not Applicable","NDC","59762503001","FLUCONAZOLE 40 MG/ML ORAL SUSPENSION",209.02500000000001,209.02500000000001,125.41500000000001,209.02500000000001,52.256250000000001]
["Not Applicable - Not Applicable - 59762503201","Not Applicable","Not Applicable","NDC","59762503201","GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR",2.0699999999999998,2.0699999999999998,1.04,2.0699999999999998,0.51749999999999996]
["Not Applicable - Not Applicable - 59762503301","Not Applicable","Not Applicable","NDC","59762503301","GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR",2.04,2.04,1.02,2.04,0.51]
["Not Applicable - Not Applicable - 59762669008","Not Applicable","Not Applicable","NDC","59762669008","NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR",12.92,12.92,4.3099999999999996,12.92,3.23]
["Not Applicable - Not Applicable - 59762669108","Not Applicable","Not Applicable","NDC","59762669108","NIFEDIPINE ER 60 MG TABLET,EXTENDED RELEASE 24 HR",12.21,12.21,4.07,12.21,3.0525000000000002]
["Not Applicable - Not Applicable - 59762669203","Not Applicable","Not Applicable","NDC","59762669203","NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR",9.1,9.1,3.04,9.1,2.2749999999999999]
["Not Applicable - Not Applicable - 60258000601","Not Applicable","Not Applicable","NDC","60258000601","POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET",2.54,2.54,1.27,2.54,0.63500000000000001]
["Not Applicable - Not Applicable - 60258000615","Not Applicable","Not Applicable","NDC","60258000615","POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET",3.87,3.87,1.94,3.87,0.96750000000000003]
["Not Applicable - Not Applicable - 60432006575","Not Applicable","Not Applicable","NDC","60432006575","AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 62.5 MG/5 ML ORAL SUSPENSION (PEDIATRIC)",78.964999999999989,78.964999999999989,78.964999999999989,78.964999999999989,19.741249999999997]
["Not Applicable - Not Applicable - 60432009216","Not Applicable","Not Applicable","NDC","60432009216","OXYBUTYNIN CHLORIDE 5 MG/5 ML ORAL SYRUP",0.32,0.32,0.16,0.32,0.08]
["Not Applicable - Not Applicable - 60432013108","Not Applicable","Not Applicable","NDC","60432013108","PHENYTOIN 125 MG/5 ML ORAL SUSPENSION",72.41,72.41,72.41,72.41,18.102499999999999]
["Not Applicable - Not Applicable - 60432053716","Not Applicable","Not Applicable","NDC","60432053716","NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION (PEDIATRIC)",0.64,0.64,0.64,0.64,0.16]
["Not Applicable - Not Applicable - 60432053760","Not Applicable","Not Applicable","NDC","60432053760","NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION",12.475000000000001,12.475000000000001,12.475000000000001,12.475000000000001,3.1187500000000004]
["Not Applicable - Not Applicable - 60505008000","Not Applicable","Not Applicable","NDC","60505008000","SOTALOL 80 MG TABLET",0.35,0.35,0.23,0.35,8.7499999999999994E-2]
["Not Applicable - Not Applicable - 60505011200","Not Applicable","Not Applicable","NDC","60505011200","GABAPENTIN 100 MG CAPSULE",4.95,4.95,1.24,4.95,1.2375]
["Not Applicable - Not Applicable - 60505011300","Not Applicable","Not Applicable","NDC","60505011300","GABAPENTIN 300 MG CAPSULE",2.63,2.63,0.66,2.63,0.65749999999999997]
["Not Applicable - Not Applicable - 60505011400","Not Applicable","Not Applicable","NDC","60505011400","GABAPENTIN 400 MG CAPSULE",2.66,2.66,0.67,2.66,0.66500000000000004]
["Not Applicable - Not Applicable - 60505011401","Not Applicable","Not Applicable","NDC","60505011401","GABAPENTIN 400 MG CAPSULE",1.04,1.04,0.26,1.04,0.26]
["Not Applicable - Not Applicable - 60505016909","Not Applicable","Not Applicable","NDC","60505016909","PRAVASTATIN 20 MG TABLET",0.63,0.63,0.08,0.63,0.1575]
["Not Applicable - Not Applicable - 60505025701","Not Applicable","Not Applicable","NDC","60505025701","DESMOPRESSIN 0.1 MG TABLET",0.72,0.72,0.18,0.72,0.18]
["Not Applicable - Not Applicable - 60505036301","Not Applicable","Not Applicable","NDC","60505036301","OFLOXACIN 0.3 % EAR DROPS",215.5,215.5,215.5,215.5,53.875]
["Not Applicable - Not Applicable - 60505081500","Not Applicable","Not Applicable","NDC","60505081500","DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY (NON-REFRIGERATED)",57.45,57.45,57.45,57.45,14.362500000000001]
["Not Applicable - Not Applicable - 60505082306","Not Applicable","Not Applicable","NDC","60505082306","CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY",48.74,48.74,48.74,48.74,12.185]
["Not Applicable - Not Applicable - 60505251903","Not Applicable","Not Applicable","NDC","60505251903","CITALOPRAM 20 MG TABLET",0.82,0.82,0.21,0.82,0.20499999999999999]
["Not Applicable - Not Applicable - 60505252101","Not Applicable","Not Applicable","NDC","60505252101","CILOSTAZOL 50 MG TABLET",0.84,0.84,0.42,0.84,0.21]
["Not Applicable - Not Applicable - 60505252603","Not Applicable","Not Applicable","NDC","60505252603","MODAFINIL 100 MG TABLET",0.9,0.9,0.45,0.9,0.22500000000000001]
["Not Applicable - Not Applicable - 60505252806","Not Applicable","Not Applicable","NDC","60505252806","ZIPRASIDONE 20 MG CAPSULE",5.25,5.25,1.32,5.25,1.3125]
["Not Applicable - Not Applicable - 60505257507","Not Applicable","Not Applicable","NDC","60505257507","BALSALAZIDE 750 MG CAPSULE",2.4700000000000002,2.4700000000000002,2.4700000000000002,2.4700000000000002,0.61750000000000005]
["Not Applicable - Not Applicable - 60505257909","Not Applicable","Not Applicable","NDC","60505257909","ATORVASTATIN 20 MG TABLET",0.56999999999999995,0.56999999999999995,0.08,0.56999999999999995,0.14249999999999999]
["Not Applicable - Not Applicable - 60505258008","Not Applicable","Not Applicable","NDC","60505258008","ATORVASTATIN 40 MG TABLET",0.35,0.35,0.09,0.35,8.7499999999999994E-2]
["Not Applicable - Not Applicable - 60505258009","Not Applicable","Not Applicable","NDC","60505258009","ATORVASTATIN 40 MG TABLET",0.3,0.3,0.08,0.3,7.4999999999999997E-2]
["Not Applicable - Not Applicable - 60505264203","Not Applicable","Not Applicable","NDC","60505264203","BICALUTAMIDE 50 MG TABLET",2.67,2.67,2.67,2.67,0.66749999999999998]
["Not Applicable - Not Applicable - 60505265300","Not Applicable","Not Applicable","NDC","60505265300","TRAZODONE 50 MG TABLET",1.1000000000000001,1.1000000000000001,0.14000000000000001,1.1000000000000001,0.27500000000000002]
["Not Applicable - Not Applicable - 60505267109","Not Applicable","Not Applicable","NDC","60505267109","ATORVASTATIN 80 MG TABLET",0.28999999999999998,0.28999999999999998,0.28999999999999998,0.28999999999999998,7.2499999999999995E-2]
["Not Applicable - Not Applicable - 60505267403","Not Applicable","Not Applicable","NDC","60505267403","ARIPIPRAZOLE 10 MG TABLET",3.35,3.35,0.34,3.35,0.83750000000000002]
["Not Applicable - Not Applicable - 60505307503","Not Applicable","Not Applicable","NDC","60505307503","ARIPIPRAZOLE 2 MG TABLET",25.1,25.1,1.68,25.1,6.2750000000000004]
["Not Applicable - Not Applicable - 60505311100","Not Applicable","Not Applicable","NDC","60505311100","OLANZAPINE 5 MG TABLET",3.07,3.07,0.77,3.07,0.76749999999999996]
["Not Applicable - Not Applicable - 60505313301","Not Applicable","Not Applicable","NDC","60505313301","QUETIAPINE 100 MG TABLET",5.16,5.16,1.72,5.16,1.29]
["Not Applicable - Not Applicable - 60505316009","Not Applicable","Not Applicable","NDC","60505316009","LOSARTAN 25 MG TABLET",2.0099999999999998,2.0099999999999998,0.51,2.0099999999999998,0.50249999999999995]
["Not Applicable - Not Applicable - 60505324603","Not Applicable","Not Applicable","NDC","60505324603","FAMCICLOVIR 250 MG TABLET",1.78,1.78,0.89,1.78,0.44500000000000001]
["Not Applicable - Not Applicable - 60505325106","Not Applicable","Not Applicable","NDC","60505325106","LAMIVUDINE 150 MG TABLET",5.74,5.74,1.92,5.74,1.4350000000000001]
["Not Applicable - Not Applicable - 60505327500","Not Applicable","Not Applicable","NDC","60505327500","OLANZAPINE 5 MG DISINTEGRATING TABLET",23.68,23.68,5.92,23.68,5.92]
["Not Applicable - Not Applicable - 60505327700","Not Applicable","Not Applicable","NDC","60505327700","OLANZAPINE 15 MG DISINTEGRATING TABLET",17.100000000000001,17.100000000000001,4.28,17.100000000000001,4.2750000000000004]
["Not Applicable - Not Applicable - 60505327800","Not Applicable","Not Applicable","NDC","60505327800","OLANZAPINE 20 MG DISINTEGRATING TABLET",16.95,16.95,4.24,16.95,4.2374999999999998]
["Not Applicable - Not Applicable - 60505340409","Not Applicable","Not Applicable","NDC","60505340409","SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET",2.59,2.59,2.59,2.59,0.64749999999999996]
["Not Applicable - Not Applicable - 60505436203","Not Applicable","Not Applicable","NDC","60505436203","LINEZOLID 600 MG TABLET",14.82,14.82,14.82,14.82,3.7050000000000001]
["Not Applicable - Not Applicable - 60505464203","Not Applicable","Not Applicable","NDC","60505464203","PRASUGREL 5 MG TABLET",0.7,0.7,0.7,0.7,0.17499999999999999]
["Not Applicable - Not Applicable - 60505464303","Not Applicable","Not Applicable","NDC","60505464303","PRASUGREL 10 MG TABLET",3.8,3.8,0.64,3.8,0.95]
["Not Applicable - Not Applicable - 60505476606","Not Applicable","Not Applicable","NDC","60505476606","VARENICLINE 1 MG TABLET",21.48,21.48,10.74,21.48,5.37]
["Not Applicable - Not Applicable - 60505700302","Not Applicable","Not Applicable","NDC","60505700302","FENTANYL 75 MCG/HR TRANSDERMAL PATCH",87.91,87.91,43.96,87.91,21.977499999999999]
["Not Applicable - Not Applicable - 60505700600","Not Applicable","Not Applicable","NDC","60505700600","FENTANYL 25 MCG/HR TRANSDERMAL PATCH",16.239999999999998,16.239999999999998,16.239999999999998,16.239999999999998,4.0599999999999996]
["Not Applicable - Not Applicable - 60505700602","Not Applicable","Not Applicable","NDC","60505700602","FENTANYL 25 MCG/HR TRANSDERMAL PATCH",23.93,23.93,23.93,23.93,5.9824999999999999]
["Not Applicable - Not Applicable - 60505700700","Not Applicable","Not Applicable","NDC","60505700700","FENTANYL 50 MCG/HR TRANSDERMAL PATCH",34.82,34.82,34.82,34.82,8.7050000000000001]
["Not Applicable - Not Applicable - 60505700702","Not Applicable","Not Applicable","NDC","60505700702","FENTANYL 50 MCG/HR TRANSDERMAL PATCH",28.86,28.86,28.86,28.86,7.2149999999999999]
["Not Applicable - Not Applicable - 60505700902","Not Applicable","Not Applicable","NDC","60505700902","FENTANYL 100 MCG/HR TRANSDERMAL PATCH",27.63,27.63,13.82,27.63,6.9074999999999998]
["Not Applicable - Not Applicable - 60505708202","Not Applicable","Not Applicable","NDC","60505708202","FENTANYL 50 MCG/HR TRANSDERMAL PATCH",8.39,8.39,8.39,8.39,2.0975000000000001]
["Not Applicable - Not Applicable - 60569044202","Not Applicable","Not Applicable","NDC","60569044202","CAPSAICIN 0.033 % TOPICAL CREAM",39.01,39.01,39.01,39.01,9.7524999999999995]
["Not Applicable - Not Applicable - 60687010011","Not Applicable","Not Applicable","NDC","60687010011","URSODIOL 300 MG CAPSULE",21.16,21.16,21.16,21.16,5.29]
["Not Applicable - Not Applicable - 60687011211","Not Applicable","Not Applicable","NDC","60687011211","ANASTROZOLE 1 MG TABLET",3.22,3.22,3.22,3.22,0.80500000000000005]
["Not Applicable - Not Applicable - 60687011501","Not Applicable","Not Applicable","NDC","60687011501","BENZONATATE 100 MG CAPSULE",2.58,2.58,1.29,2.58,0.64500000000000002]
["Not Applicable - Not Applicable - 60687011511","Not Applicable","Not Applicable","NDC","60687011511","BENZONATATE 100 MG CAPSULE",3.3,3.3,1.65,3.3,0.82499999999999996]
["Not Applicable - Not Applicable - 60687012125","Not Applicable","Not Applicable","NDC","60687012125","ACAMPROSATE 333 MG TABLET,DELAYED RELEASE",10.58,10.58,5.29,10.58,2.645]
["Not Applicable - Not Applicable - 60687012401","Not Applicable","Not Applicable","NDC","60687012401","CLONIDINE HCL 0.2 MG TABLET",1.08,1.08,0.36,1.08,0.27]
["Not Applicable - Not Applicable - 60687012411","Not Applicable","Not Applicable","NDC","60687012411","CLONIDINE HCL 0.2 MG TABLET",1.62,1.62,0.54,1.62,0.40500000000000003]
["Not Applicable - Not Applicable - 60687012511","Not Applicable","Not Applicable","NDC","60687012511","LABETALOL 200 MG TABLET",3.34,3.34,0.84,3.34,0.83499999999999996]
["Not Applicable - Not Applicable - 60687012911","Not Applicable","Not Applicable","NDC","60687012911","DOCUSATE SODIUM 100 MG CAPSULE",0.48,0.48,0.48,0.48,0.12]
["Not Applicable - Not Applicable - 60687013601","Not Applicable","Not Applicable","NDC","60687013601","LABETALOL 300 MG TABLET",4.92,4.92,1.23,4.92,1.23]
["Not Applicable - Not Applicable - 60687013611","Not Applicable","Not Applicable","NDC","60687013611","LABETALOL 300 MG TABLET",4.03,4.03,1.01,4.03,1.0075000000000001]
["Not Applicable - Not Applicable - 60687015211","Not Applicable","Not Applicable","NDC","60687015211","CEPHALEXIN 250 MG CAPSULE",2.31,2.31,1.1599999999999999,2.31,0.57750000000000001]
["Not Applicable - Not Applicable - 60687015801","Not Applicable","Not Applicable","NDC","60687015801","ISONIAZID 300 MG TABLET",2.5099999999999998,2.5099999999999998,0.84,2.5099999999999998,0.62749999999999995]
["Not Applicable - Not Applicable - 60687016311","Not Applicable","Not Applicable","NDC","60687016311","CEPHALEXIN 500 MG CAPSULE",2.58,2.58,0.65,2.58,0.64500000000000002]
["Not Applicable - Not Applicable - 60687017811","Not Applicable","Not Applicable","NDC","60687017811","PRAVASTATIN 20 MG TABLET",10.01,10.01,1.26,10.01,2.5024999999999999]
["Not Applicable - Not Applicable - 60687018811","Not Applicable","Not Applicable","NDC","60687018811","ENTACAPONE 200 MG TABLET",14.63,14.63,14.63,14.63,3.6575000000000002]
["Not Applicable - Not Applicable - 60687020601","Not Applicable","Not Applicable","NDC","60687020601","DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR",1.49,1.49,0.5,1.49,0.3725]
["Not Applicable - Not Applicable - 60687021111","Not Applicable","Not Applicable","NDC","60687021111","DIVALPROEX 125 MG TABLET,DELAYED RELEASE",10.59,10.59,2.65,10.59,2.6475]
["Not Applicable - Not Applicable - 60687021401","Not Applicable","Not Applicable","NDC","60687021401","METHADONE 5 MG TABLET",4.1399999999999997,4.1399999999999997,0.69,4.1399999999999997,1.0349999999999999]
["Not Applicable - Not Applicable - 60687021411","Not Applicable","Not Applicable","NDC","60687021411","METHADONE 5 MG TABLET",6.29,6.29,1.05,6.29,1.5725]
["Not Applicable - Not Applicable - 60687022711","Not Applicable","Not Applicable","NDC","60687022711","LEUCOVORIN CALCIUM 25 MG TABLET",38.04,38.04,7.61,38.04,9.51]
["Not Applicable - Not Applicable - 60687022911","Not Applicable","Not Applicable","NDC","60687022911","LOPERAMIDE 2 MG CAPSULE",4.7699999999999996,4.7699999999999996,2.39,4.7699999999999996,1.1924999999999999]
["Not Applicable - Not Applicable - 60687024195","Not Applicable","Not Applicable","NDC","60687024195","CANDESARTAN 16 MG TABLET",31.91,31.91,3.99,31.91,7.9775]
["Not Applicable - Not Applicable - 60687024211","Not Applicable","Not Applicable","NDC","60687024211","SERTRALINE 50 MG TABLET",2.79,2.79,0.7,2.79,0.69750000000000001]
["Not Applicable - Not Applicable - 60687025311","Not Applicable","Not Applicable","NDC","60687025311","SERTRALINE 100 MG TABLET",1.58,1.58,0.4,1.58,0.39500000000000002]
["Not Applicable - Not Applicable - 60687026311","Not Applicable","Not Applicable","NDC","60687026311","AMLODIPINE 5 MG TABLET",1.1299999999999999,1.1299999999999999,0.28999999999999998,1.1299999999999999,0.28249999999999997]
["Not Applicable - Not Applicable - 60687026611","Not Applicable","Not Applicable","NDC","60687026611","RALOXIFENE 60 MG TABLET",20.260000000000002,20.260000000000002,20.260000000000002,20.260000000000002,5.0650000000000004]
["Not Applicable - Not Applicable - 60687028111","Not Applicable","Not Applicable","NDC","60687028111","NORTRIPTYLINE 10 MG CAPSULE",13.08,13.08,1.31,13.08,3.27]
["Not Applicable - Not Applicable - 60687030311","Not Applicable","Not Applicable","NDC","60687030311","DONEPEZIL 10 MG TABLET",0.48,0.48,0.24,0.48,0.12]
["Not Applicable - Not Applicable - 60687030411","Not Applicable","Not Applicable","NDC","60687030411","CAPTOPRIL 12.5 MG TABLET",20.11,20.11,2.52,20.11,5.0274999999999999]
["Not Applicable - Not Applicable - 60687030611","Not Applicable","Not Applicable","NDC","60687030611","PROPRANOLOL 20 MG TABLET",6.57,6.57,0.83,6.57,1.6425000000000001]
["Not Applicable - Not Applicable - 60687032833","Not Applicable","Not Applicable","NDC","60687032833","SEVELAMER CARBONATE 800 MG TABLET",88.06,88.06,29.36,88.06,22.015000000000001]
["Not Applicable - Not Applicable - 60687033011","Not Applicable","Not Applicable","NDC","60687033011","TOLTERODINE ER 4 MG CAPSULE,EXTENDED RELEASE 24 HR",35.68,35.68,17.84,35.68,8.92]
["Not Applicable - Not Applicable - 60687033021","Not Applicable","Not Applicable","NDC","60687033021","TOLTERODINE ER 4 MG CAPSULE,EXTENDED RELEASE 24 HR",16.559999999999999,16.559999999999999,8.2799999999999994,16.559999999999999,4.1399999999999997]
["Not Applicable - Not Applicable - 60687033311","Not Applicable","Not Applicable","NDC","60687033311","LISINOPRIL 20 MG TABLET",0.89,0.89,0.12,0.89,0.2225]
["Not Applicable - Not Applicable - 60687033611","Not Applicable","Not Applicable","NDC","60687033611","MINOCYCLINE 100 MG CAPSULE",3.91,3.91,1.96,3.91,0.97750000000000004]
["Not Applicable - Not Applicable - 60687034001","Not Applicable","Not Applicable","NDC","60687034001","BUPROPION HCL 75 MG TABLET",3.2,3.2,1.6,3.2,0.8]
["Not Applicable - Not Applicable - 60687034011","Not Applicable","Not Applicable","NDC","60687034011","BUPROPION HCL 75 MG TABLET",5.21,5.21,2.61,5.21,1.3025]
["Not Applicable - Not Applicable - 60687034511","Not Applicable","Not Applicable","NDC","60687034511","CALCITRIOL 0.25 MCG CAPSULE",4.55,4.55,2.2799999999999998,4.55,1.1375]
["Not Applicable - Not Applicable - 60687034601","Not Applicable","Not Applicable","NDC","60687034601","BENZONATATE 100 MG CAPSULE",2.08,2.08,1.04,2.08,0.52]
["Not Applicable - Not Applicable - 60687034611","Not Applicable","Not Applicable","NDC","60687034611","BENZONATATE 100 MG CAPSULE",3.3,3.3,1.65,3.3,0.82499999999999996]
["Not Applicable - Not Applicable - 60687035511","Not Applicable","Not Applicable","NDC","60687035511","LORAZEPAM 1 MG TABLET",1.02,1.02,0.26,1.02,0.255]
["Not Applicable - Not Applicable - 60687036211","Not Applicable","Not Applicable","NDC","60687036211","LAMIVUDINE 150 MG TABLET",53.29,53.29,17.77,53.29,13.3225]
["Not Applicable - Not Applicable - 60687036711","Not Applicable","Not Applicable","NDC","60687036711","LORAZEPAM 2 MG TABLET",0.82,0.82,0.21,0.82,0.20499999999999999]
["Not Applicable - Not Applicable - 60687037011","Not Applicable","Not Applicable","NDC","60687037011","METHIMAZOLE 10 MG TABLET",4.59,4.59,1.1499999999999999,4.59,1.1475]
["Not Applicable - Not Applicable - 60687037311","Not Applicable","Not Applicable","NDC","60687037311","EZETIMIBE 10 MG TABLET",36.700000000000003,36.700000000000003,36.700000000000003,36.700000000000003,9.1750000000000007]
["Not Applicable - Not Applicable - 60687038001","Not Applicable","Not Applicable","NDC","60687038001","DICYCLOMINE 20 MG TABLET",0.99,0.99,0.99,0.99,0.2475]
["Not Applicable - Not Applicable - 60687038011","Not Applicable","Not Applicable","NDC","60687038011","DICYCLOMINE 20 MG TABLET",1.62,1.62,1.62,1.62,0.40500000000000003]
["Not Applicable - Not Applicable - 60687038495","Not Applicable","Not Applicable","NDC","60687038495","BUMETANIDE 1 MG TABLET",11.59,11.59,2.9,11.59,2.8975]
["Not Applicable - Not Applicable - 60687038911","Not Applicable","Not Applicable","NDC","60687038911","COLCHICINE 0.6 MG TABLET",66.02,66.02,33.01,66.02,16.504999999999999]
["Not Applicable - Not Applicable - 60687039011","Not Applicable","Not Applicable","NDC","60687039011","METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR",27.63,27.63,3.46,27.63,6.9074999999999998]
["Not Applicable - Not Applicable - 60687039101","Not Applicable","Not Applicable","NDC","60687039101","PIOGLITAZONE 15 MG TABLET",7.74,7.74,2.58,7.74,1.9350000000000001]
["Not Applicable - Not Applicable - 60687040211","Not Applicable","Not Applicable","NDC","60687040211","METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR",13.82,13.82,1.73,13.82,3.4550000000000001]
["Not Applicable - Not Applicable - 60687041311","Not Applicable","Not Applicable","NDC","60687041311","METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR",9.94,9.94,1.25,9.94,2.4849999999999999]
["Not Applicable - Not Applicable - 60687041501","Not Applicable","Not Applicable","NDC","60687041501","CLOZAPINE 100 MG TABLET",4.33,4.33,1.0900000000000001,4.33,1.0825]
["Not Applicable - Not Applicable - 60687042411","Not Applicable","Not Applicable","NDC","60687042411","METRONIDAZOLE 500 MG TABLET",2.67,2.67,2.67,2.67,0.66749999999999998]
["Not Applicable - Not Applicable - 60687043701","Not Applicable","Not Applicable","NDC","60687043701","AMIODARONE 200 MG TABLET",1.42,1.42,0.36,1.42,0.35499999999999998]
["Not Applicable - Not Applicable - 60687044411","Not Applicable","Not Applicable","NDC","60687044411","AMITRIPTYLINE 50 MG TABLET",4.13,4.13,0.42,4.13,1.0325]
["Not Applicable - Not Applicable - 60687044711","Not Applicable","Not Applicable","NDC","60687044711","CELECOXIB 200 MG CAPSULE",14.39,14.39,3.6,14.39,3.5975000000000001]
["Not Applicable - Not Applicable - 60687046111","Not Applicable","Not Applicable","NDC","60687046111","LABETALOL 300 MG TABLET",4.6900000000000004,4.6900000000000004,1.18,4.6900000000000004,1.1725000000000001]
["Not Applicable - Not Applicable - 60687047501","Not Applicable","Not Applicable","NDC","60687047501","LEVOTHYROXINE 75 MCG TABLET",3.05,3.05,0.39,3.05,0.76249999999999996]
["Not Applicable - Not Applicable - 60687047511","Not Applicable","Not Applicable","NDC","60687047511","LEVOTHYROXINE 75 MCG TABLET",5.57,5.57,0.7,5.57,1.3925000000000001]
["Not Applicable - Not Applicable - 60687047611","Not Applicable","Not Applicable","NDC","60687047611","SPIRONOLACTONE 50 MG TABLET",3.27,3.27,0.82,3.27,0.8175]
["Not Applicable - Not Applicable - 60687048801","Not Applicable","Not Applicable","NDC","60687048801","AMLODIPINE 5 MG TABLET",0.43,0.43,0.11,0.43,0.1075]
["Not Applicable - Not Applicable - 60687048811","Not Applicable","Not Applicable","NDC","60687048811","AMLODIPINE 5 MG TABLET",0.69,0.69,0.18,0.69,0.17249999999999999]
["Not Applicable - Not Applicable - 60687049301","Not Applicable","Not Applicable","NDC","60687049301","VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE",5.6,5.6,2.8,5.6,1.4]
["Not Applicable - Not Applicable - 60687050011","Not Applicable","Not Applicable","NDC","60687050011","ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE",5.69,5.69,5.69,5.69,1.4225000000000001]
["Not Applicable - Not Applicable - 60687050201","Not Applicable","Not Applicable","NDC","60687050201","PYRIDOSTIGMINE BROMIDE 60 MG TABLET",5.26,5.26,1.32,5.26,1.3149999999999999]
["Not Applicable - Not Applicable - 60687050211","Not Applicable","Not Applicable","NDC","60687050211","PYRIDOSTIGMINE BROMIDE 60 MG TABLET",8.7799999999999994,8.7799999999999994,2.2000000000000002,8.7799999999999994,2.1949999999999998]
["Not Applicable - Not Applicable - 60687050611","Not Applicable","Not Applicable","NDC","60687050611","PREGABALIN 100 MG CAPSULE",14.36,14.36,3.59,14.36,3.59]
["Not Applicable - Not Applicable - 60687050811","Not Applicable","Not Applicable","NDC","60687050811","LEVOTHYROXINE 112 MCG TABLET",4.33,4.33,0.55000000000000004,4.33,1.0825]
["Not Applicable - Not Applicable - 60687053111","Not Applicable","Not Applicable","NDC","60687053111","SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET",1.87,1.87,0.94,1.87,0.46750000000000003]
["Not Applicable - Not Applicable - 60687054911","Not Applicable","Not Applicable","NDC","60687054911","RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR",9.9499999999999993,9.9499999999999993,4.9800000000000004,9.9499999999999993,2.4874999999999998]
["Not Applicable - Not Applicable - 60687054921","Not Applicable","Not Applicable","NDC","60687054921","RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR",6.13,6.13,3.07,6.13,1.5325]
["Not Applicable - Not Applicable - 60687055011","Not Applicable","Not Applicable","NDC","60687055011","METRONIDAZOLE 500 MG TABLET",2.67,2.67,2.67,2.67,0.66749999999999998]
["Not Applicable - Not Applicable - 60687055211","Not Applicable","Not Applicable","NDC","60687055211","LEVOTHYROXINE 200 MCG TABLET",3.56,3.56,0.45,3.56,0.89]
["Not Applicable - Not Applicable - 60687055501","Not Applicable","Not Applicable","NDC","60687055501","CLONAZEPAM 1 MG TABLET",2.0499999999999998,2.0499999999999998,0.26,2.0499999999999998,0.51249999999999996]
["Not Applicable - Not Applicable - 60687055511","Not Applicable","Not Applicable","NDC","60687055511","CLONAZEPAM 1 MG TABLET",1.57,1.57,0.2,1.57,0.39250000000000002]
["Not Applicable - Not Applicable - 60687056811","Not Applicable","Not Applicable","NDC","60687056811","METHOCARBAMOL 750 MG TABLET",1.47,1.47,0.74,1.47,0.36749999999999999]
["Not Applicable - Not Applicable - 60687057511","Not Applicable","Not Applicable","NDC","60687057511","RIFAMPIN 150 MG CAPSULE",22.64,22.64,5.66,22.64,5.66]
["Not Applicable - Not Applicable - 60687058601","Not Applicable","Not Applicable","NDC","60687058601","RIFAMPIN 300 MG CAPSULE",3.78,3.78,1.89,3.78,0.94499999999999995]
["Not Applicable - Not Applicable - 60687058611","Not Applicable","Not Applicable","NDC","60687058611","RIFAMPIN 300 MG CAPSULE",7.75,7.75,3.88,7.75,1.9375]
["Not Applicable - Not Applicable - 60687058711","Not Applicable","Not Applicable","NDC","60687058711","PROPRANOLOL 10 MG TABLET",7.11,7.11,0.89,7.11,1.7775000000000001]
["Not Applicable - Not Applicable - 60687058811","Not Applicable","Not Applicable","NDC","60687058811","ROPINIROLE 1 MG TABLET",4.13,4.13,0.52,4.13,1.0325]
["Not Applicable - Not Applicable - 60758011905","Not Applicable","Not Applicable","NDC","60758011905","PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION",100.9,100.9,100.9,100.9,25.225000000000001]
["Not Applicable - Not Applicable - 60758011915","Not Applicable","Not Applicable","NDC","60758011915","PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION",302.41000000000003,302.41000000000003,302.41000000000003,302.41000000000003,75.602500000000006]
["Not Applicable - Not Applicable - 60758077305","Not Applicable","Not Applicable","NDC","60758077305","KETOROLAC 0.4 % EYE DROPS",184.81,184.81,184.81,184.81,46.202500000000001]
["Not Applicable - Not Applicable - 60758080105","Not Applicable","Not Applicable","NDC","60758080105","TIMOLOL MALEATE 0.5 % EYE DROPS",18.16,18.16,18.16,18.16,4.54]
["Not Applicable - Not Applicable - 60758080110","Not Applicable","Not Applicable","NDC","60758080110","TIMOLOL MALEATE 0.5 % EYE DROPS",44.38,44.38,44.38,44.38,11.095000000000001]
["Not Applicable - Not Applicable - 60758080205","Not Applicable","Not Applicable","NDC","60758080205","TIMOLOL MALEATE 0.25 % EYE DROPS",8.7100000000000009,8.7100000000000009,8.7100000000000009,8.7100000000000009,2.1775000000000002]
["Not Applicable - Not Applicable - 60758088005","Not Applicable","Not Applicable","NDC","60758088005","FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION",235.54,235.54,235.54,235.54,58.884999999999998]
["Not Applicable - Not Applicable - 60793021505","Not Applicable","Not Applicable","NDC","60793021505","THROMBIN (BOVINE) 5,000 UNIT TOPICAL SOLUTION",137.97999999999999,137.97999999999999,137.97999999999999,137.97999999999999,34.494999999999997]
["Not Applicable - Not Applicable - 60793085401","Not Applicable","Not Applicable","NDC","60793085401","LEVOTHYROXINE 100 MCG TABLET",5.97,5.97,0.75,5.97,1.4924999999999999]
["Not Applicable - Not Applicable - 60793085501","Not Applicable","Not Applicable","NDC","60793085501","LEVOTHYROXINE 112 MCG TABLET",6.16,6.16,0.77,6.16,1.54]
["Not Applicable - Not Applicable - 61269022041","Not Applicable","Not Applicable","NDC","61269022041","CLOTRIMAZOLE 1 % VAGINAL CREAM",15.67,15.67,15.67,15.67,3.9175]
["Not Applicable - Not Applicable - 61314001505","Not Applicable","Not Applicable","NDC","61314001505","OFLOXACIN 0.3 % EAR DROPS",53.29,53.29,53.29,53.29,13.3225]
["Not Applicable - Not Applicable - 61314001601","Not Applicable","Not Applicable","NDC","61314001601","PROPARACAINE 0.5 % EYE DROPS",79.78,79.78,79.78,79.78,19.945]
["Not Applicable - Not Applicable - 61314001910","Not Applicable","Not Applicable","NDC","61314001910","DORZOLAMIDE 2 % EYE DROPS",82.88,82.88,82.88,82.88,20.72]
["Not Applicable - Not Applicable - 61314004475","Not Applicable","Not Applicable","NDC","61314004475","TRIFLURIDINE 1 % EYE DROPS",521.13,521.13,521.13,521.13,130.2825]
["Not Applicable - Not Applicable - 61314014405","Not Applicable","Not Applicable","NDC","61314014405","BRIMONIDINE 0.15 % EYE DROPS",436.07,436.07,436.07,436.07,109.0175]
["Not Applicable - Not Applicable - 61314020315","Not Applicable","Not Applicable","NDC","61314020315","PILOCARPINE 1 % EYE DROPS",217.47,217.47,217.47,217.47,54.3675]
["Not Applicable - Not Applicable - 61314020415","Not Applicable","Not Applicable","NDC","61314020415","PILOCARPINE 2 % EYE DROPS",222.91,222.91,222.91,222.91,55.727499999999999]
["Not Applicable - Not Applicable - 61314020615","Not Applicable","Not Applicable","NDC","61314020615","PILOCARPINE 4 % EYE DROPS",233.88,233.88,233.88,233.88,58.47]
["Not Applicable - Not Applicable - 61314022605","Not Applicable","Not Applicable","NDC","61314022605","TIMOLOL MALEATE 0.25 % EYE DROPS",8.4600000000000009,8.4600000000000009,8.4600000000000009,8.4600000000000009,2.1150000000000002]
["Not Applicable - Not Applicable - 61314022705","Not Applicable","Not Applicable","NDC","61314022705","TIMOLOL MALEATE 0.5 % EYE DROPS",32.01,32.01,32.01,32.01,8.0024999999999995]
["Not Applicable - Not Applicable - 61314022710","Not Applicable","Not Applicable","NDC","61314022710","TIMOLOL MALEATE 0.5 % EYE DROPS",46.86,46.86,46.86,46.86,11.715]
["Not Applicable - Not Applicable - 61314029405","Not Applicable","Not Applicable","NDC","61314029405","DEXAMETHASONE SODIUM PHOSPHATE 0.1 % EYE DROPS",59.69,59.69,59.69,59.69,14.922499999999999]
["Not Applicable - Not Applicable - 61314030301","Not Applicable","Not Applicable","NDC","61314030301","ATROPINE 1 % EYE DROPS",55.42,55.42,55.42,55.42,13.855]
["Not Applicable - Not Applicable - 61314035401","Not Applicable","Not Applicable","NDC","61314035401","TROPICAMIDE 0.5 % EYE DROPS",70.930000000000007,70.930000000000007,70.930000000000007,70.930000000000007,17.732500000000002]
["Not Applicable - Not Applicable - 61314035501","Not Applicable","Not Applicable","NDC","61314035501","TROPICAMIDE 1 % EYE DROPS",28.92,28.92,28.92,28.92,7.23]
["Not Applicable - Not Applicable - 61314035502","Not Applicable","Not Applicable","NDC","61314035502","TROPICAMIDE 1 % EYE DROPS",101.46,101.46,101.46,101.46,25.364999999999998]
["Not Applicable - Not Applicable - 61314039603","Not Applicable","Not Applicable","NDC","61314039603","CYCLOPENTOLATE 1 % EYE DROPS",73.540000000000006,73.540000000000006,73.540000000000006,73.540000000000006,18.385000000000002]
["Not Applicable - Not Applicable - 61314054701","Not Applicable","Not Applicable","NDC","61314054701","LATANOPROST 0.005 % EYE DROPS",14.71,14.71,14.71,14.71,3.6775000000000002]
["Not Applicable - Not Applicable - 61314062810","Not Applicable","Not Applicable","NDC","61314062810","POLYMYXIN B SULFATE 10,000 UNIT-TRIMETHOPRIM 1 MG/ML EYE DROPS",8.0299999999999994,8.0299999999999994,8.0299999999999994,8.0299999999999994,2.0074999999999998]
["Not Applicable - Not Applicable - 61314063136","Not Applicable","Not Applicable","NDC","61314063136","NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT",52.23,52.23,52.23,52.23,13.057499999999999]
["Not Applicable - Not Applicable - 61314063305","Not Applicable","Not Applicable","NDC","61314063305","GENTAMICIN 0.3 % EYE DROPS",16.600000000000001,16.600000000000001,16.600000000000001,16.600000000000001,4.1500000000000004]
["Not Applicable - Not Applicable - 61314063705","Not Applicable","Not Applicable","NDC","61314063705","PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION",72.55,72.55,72.55,72.55,18.137499999999999]
["Not Applicable - Not Applicable - 61314063715","Not Applicable","Not Applicable","NDC","61314063715","PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION",229.99,229.99,229.99,229.99,57.497500000000002]
["Not Applicable - Not Applicable - 61314064305","Not Applicable","Not Applicable","NDC","61314064305","TOBRAMYCIN 0.3 % EYE DROPS",51.41,51.41,51.41,51.41,12.852499999999999]
["Not Applicable - Not Applicable - 61314064511","Not Applicable","Not Applicable","NDC","61314064511","NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP",245.13,245.13,245.13,245.13,61.282499999999999]
["Not Applicable - Not Applicable - 61314066505","Not Applicable","Not Applicable","NDC","61314066505","APRACLONIDINE 0.5 % EYE DROPS",142.46,142.46,142.46,142.46,35.615000000000002]
["Not Applicable - Not Applicable - 61442045101","Not Applicable","Not Applicable","NDC","61442045101","CARISOPRODOL 350 MG TABLET",0.27,0.27,0.27,0.27,6.7500000000000004E-2]
["Not Applicable - Not Applicable - 61570013125","Not Applicable","Not Applicable","NDC","61570013125","SILVER SULFADIAZINE 1 % TOPICAL CREAM",17.059999999999999,17.059999999999999,17.059999999999999,17.059999999999999,4.2649999999999997]
["Not Applicable - Not Applicable - 61570013140","Not Applicable","Not Applicable","NDC","61570013140","SILVER SULFADIAZINE 1 % TOPICAL CREAM",108,108,108,108,27]
["Not Applicable - Not Applicable - 61570013150","Not Applicable","Not Applicable","NDC","61570013150","SILVER SULFADIAZINE 1 % TOPICAL CREAM",29.67,29.67,29.67,29.67,7.4175000000000004]
["Not Applicable - Not Applicable - 61703042153","Not Applicable","Not Applicable","NDC","61703042153","MVI PEDIATRIC",29.18,29.18,29.18,29.18,7.2949999999999999]
["Not Applicable - Not Applicable - 61748001101","Not Applicable","Not Applicable","NDC","61748001101","ETHAMBUTOL 100 MG TABLET",29.79,29.79,14.9,29.79,7.4474999999999998]
["Not Applicable - Not Applicable - 61748001201","Not Applicable","Not Applicable","NDC","61748001201","PYRAZINAMIDE 500 MG TABLET",59.36,59.36,29.68,59.36,14.84]
["Not Applicable - Not Applicable - 61748001211","Not Applicable","Not Applicable","NDC","61748001211","PYRAZINAMIDE 500 MG TABLET",55.25,55.25,27.63,55.25,13.8125]
["Not Applicable - Not Applicable - 61748001530","Not Applicable","Not Applicable","NDC","61748001530","RIFAMPIN 150 MG CAPSULE",6.8,6.8,1.7,6.8,1.7]
["Not Applicable - Not Applicable - 61748001801","Not Applicable","Not Applicable","NDC","61748001801","RIFAMPIN 300 MG CAPSULE",2.98,2.98,1.49,2.98,0.745]
["Not Applicable - Not Applicable - 61748001830","Not Applicable","Not Applicable","NDC","61748001830","RIFAMPIN 300 MG CAPSULE",3.71,3.71,1.86,3.71,0.92749999999999999]
["Not Applicable - Not Applicable - 61748002501","Not Applicable","Not Applicable","NDC","61748002501","ETHOSUXIMIDE 250 MG CAPSULE",15.86,15.86,7.93,15.86,3.9649999999999999]
["Not Applicable - Not Applicable - 61748004501","Not Applicable","Not Applicable","NDC","61748004501","AMINOCAPROIC ACID 500 MG TABLET",155.68,155.68,31.14,155.68,38.92]
["Not Applicable - Not Applicable - 61748009201","Not Applicable","Not Applicable","NDC","61748009201","PYRIDOXINE (VITAMIN B6) 25 MG TABLET",0.67,0.67,0.17,0.67,0.16750000000000001]
["Not Applicable - Not Applicable - 61787044202","Not Applicable","Not Applicable","NDC","61787044202","CAPSAICIN 0.033 % TOPICAL CREAM",36.799999999999997,36.799999999999997,36.799999999999997,36.799999999999997,9.1999999999999993]
["Not Applicable - Not Applicable - 61924018802","Not Applicable","Not Applicable","NDC","61924018802","CAMPHOR-MENTHOL 0.5 %-0.5 % LOTION",22.09,22.09,22.09,22.09,5.5225]
["Not Applicable - Not Applicable - 61924018808","Not Applicable","Not Applicable","NDC","61924018808","CAMPHOR-MENTHOL 0.5 %-0.5 % LOTION",22.09,22.09,22.09,22.09,5.5225]
["Not Applicable - Not Applicable - 61958040101","Not Applicable","Not Applicable","NDC","61958040101","TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET",143.25,143.25,143.25,143.25,35.8125]
["Not Applicable - Not Applicable - 61958040401","Not Applicable","Not Applicable","NDC","61958040401","TENOFOVIR DISOPROXIL FUMARATE 150 MG TABLET",265.51,265.51,132.76,265.51,66.377499999999998]
["Not Applicable - Not Applicable - 61958040501","Not Applicable","Not Applicable","NDC","61958040501","TENOFOVIR DISOPROXIL FUMARATE 200 MG TABLET",3982.61,3982.61,3982.61,3982.61,995.65250000000003]
["Not Applicable - Not Applicable - 61958040601","Not Applicable","Not Applicable","NDC","61958040601","TENOFOVIR DISOPROXIL FUMARATE 250 MG TABLET",3982.61,3982.61,3982.61,3982.61,995.65250000000003]
["Not Applicable - Not Applicable - 61958050101","Not Applicable","Not Applicable","NDC","61958050101","ADEFOVIR 10 MG TABLET",180.14,180.14,180.14,180.14,45.034999999999997]
["Not Applicable - Not Applicable - 61958060101","Not Applicable","Not Applicable","NDC","61958060101","EMTRICITABINE 200 MG CAPSULE",60.36,60.36,60.36,60.36,15.09]
["Not Applicable - Not Applicable - 61958070101","Not Applicable","Not Applicable","NDC","61958070101","EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET",210.53,210.53,210.53,210.53,52.6325]
["Not Applicable - Not Applicable - 61958080101","Not Applicable","Not Applicable","NDC","61958080101","AMBRISENTAN 5 MG TABLET",2525.23,2525.23,1262.6199999999999,2525.23,631.3075]
["Not Applicable - Not Applicable - 61958080201","Not Applicable","Not Applicable","NDC","61958080201","AMBRISENTAN 10 MG TABLET",1262.6199999999999,1262.6199999999999,631.30999999999995,1262.6199999999999,315.65499999999997]
["Not Applicable - Not Applicable - 61958100301","Not Applicable","Not Applicable","NDC","61958100301","RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR",45.43,45.43,22.72,45.43,11.3575]
["Not Applicable - Not Applicable - 61958110101","Not Applicable","Not Applicable","NDC","61958110101","EMTRICITABINE 200 MG-RILPIVIRINE 25 MG-TENOFOVIR DISPROX 300 MG TABLET",352.94,352.94,352.94,352.94,88.234999999999999]
["Not Applicable - Not Applicable - 61958120101","Not Applicable","Not Applicable","NDC","61958120101","ELVITEG 150 MG-COB 150 MG-EMTRICIT 200 MG-TENOFO DISOPRO 300 MG TABLET",406.82,406.82,406.82,406.82,101.705]
["Not Applicable - Not Applicable - 61958180101","Not Applicable","Not Applicable","NDC","61958180101","LEDIPASVIR 90 MG-SOFOSBUVIR 400 MG TABLET",3856.69,3856.69,3856.69,3856.69,964.17250000000001]
["Not Applicable - Not Applicable - 61958190101","Not Applicable","Not Applicable","NDC","61958190101","ELVITEG 150 MG-COB 150 MG-EMTRICIT 200 MG-TENOFO ALAFENAM 10 MG TABLET",387.82,387.82,387.82,387.82,96.954999999999998]
["Not Applicable - Not Applicable - 61958200201","Not Applicable","Not Applicable","NDC","61958200201","EMTRICITABINE 200 MG-TENOFOVIR ALAFENAMIDE FUMARATE 25 MG TABLET",220.63,220.63,220.63,220.63,55.157499999999999]
["Not Applicable - Not Applicable - 61958210101","Not Applicable","Not Applicable","NDC","61958210101","EMTRICITABINE 200 MG-RILPIVIRINE 25 MG-TENOFOVIR ALAFENAM 25 MG TABLET",352.94,352.94,352.94,352.94,88.234999999999999]
["Not Applicable - Not Applicable - 61958220101","Not Applicable","Not Applicable","NDC","61958220101","SOFOSBUVIR 400 MG-VELPATASVIR 100 MG TABLET",3051.07,3051.07,3051.07,3051.07,762.76750000000004]
["Not Applicable - Not Applicable - 61958240101","Not Applicable","Not Applicable","NDC","61958240101","SOFOSBUVIR 400 MG-VELPATASVIR 100 MG-VOXILAPREVIR 100 MG TABLET",3051.07,3051.07,3051.07,3051.07,762.76750000000004]
["Not Applicable - Not Applicable - 61958250101","Not Applicable","Not Applicable","NDC","61958250101","BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET",387.82,387.82,387.82,387.82,96.954999999999998]
["Not Applicable - Not Applicable - 61958290101","Not Applicable","Not Applicable","NDC","61958290101","REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION",1847.3,1847.3,1847.3,1847.3,461.82499999999999]
["Not Applicable - Not Applicable - 62037083001","Not Applicable","Not Applicable","NDC","62037083001","METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR",14.27,14.27,1.79,14.27,3.5674999999999999]
["Not Applicable - Not Applicable - 62037083101","Not Applicable","Not Applicable","NDC","62037083101","METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR",6.83,6.83,0.86,6.83,1.7075]
["Not Applicable - Not Applicable - 62037083201","Not Applicable","Not Applicable","NDC","62037083201","METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR",5.09,5.09,0.64,5.09,1.2725]
["Not Applicable - Not Applicable - 62144551005","Not Applicable","Not Applicable","NDC","62144551005","ARTIFICIAL TEARS (HYPROMELLOSE) (PF) 1.7 % EYE DROPS WITH APPLICATOR",124.34,124.34,124.34,124.34,31.085000000000001]
["Not Applicable - Not Applicable - 62175010701","Not Applicable","Not Applicable","NDC","62175010701","ISOSORBIDE MONONITRATE 20 MG TABLET",0.49,0.49,0.25,0.49,0.1225]
["Not Applicable - Not Applicable - 62175011937","Not Applicable","Not Applicable","NDC","62175011937","ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR",0.64,0.64,0.22,0.64,0.16]
["Not Applicable - Not Applicable - 62175020546","Not Applicable","Not Applicable","NDC","62175020546","MONTELUKAST 5 MG CHEWABLE TABLET",3.41,3.41,2.73,3.41,0.85250000000000004]
["Not Applicable - Not Applicable - 62175021032","Not Applicable","Not Applicable","NDC","62175021032","MONTELUKAST 10 MG TABLET",3.41,3.41,3.41,3.41,0.85250000000000004]
["Not Applicable - Not Applicable - 62175061743","Not Applicable","Not Applicable","NDC","62175061743","PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE",0.45,0.45,0.23,0.45,0.1125]
["Not Applicable - Not Applicable - 62327044404","Not Applicable","Not Applicable","NDC","62327044404","STERILE TALC 4 GRAM INTRAPLEURAL SUSPENSION",497.35,497.35,497.35,497.35,124.33750000000001]
["Not Applicable - Not Applicable - 62327044444","Not Applicable","Not Applicable","NDC","62327044444","STERILE TALC 4 GRAM INTRAPLEURAL SUSPENSION",497.35,497.35,497.35,497.35,124.33750000000001]
["Not Applicable - Not Applicable - 62332009930","Not Applicable","Not Applicable","NDC","62332009930","ARIPIPRAZOLE 10 MG TABLET",1.38,1.38,0.14000000000000001,1.38,0.34499999999999997]
["Not Applicable - Not Applicable - 62332010530","Not Applicable","Not Applicable","NDC","62332010530","MODAFINIL 100 MG TABLET",11.76,11.76,5.88,11.76,2.94]
["Not Applicable - Not Applicable - 62332012390","Not Applicable","Not Applicable","NDC","62332012390","PREGABALIN 150 MG CAPSULE",1.1100000000000001,1.1100000000000001,0.28000000000000003,1.1100000000000001,0.27750000000000002]
["Not Applicable - Not Applicable - 62332038530","Not Applicable","Not Applicable","NDC","62332038530","MODAFINIL 100 MG TABLET",16.14,16.14,8.07,16.14,4.0350000000000001]
["Not Applicable - Not Applicable - 62559013807","Not Applicable","Not Applicable","NDC","62559013807","HYDROCORTISONE 100 MG/60 ML ENEMA",70.98,70.98,70.98,70.98,17.745000000000001]
["Not Applicable - Not Applicable - 62559015304","Not Applicable","Not Applicable","NDC","62559015304","OPIUM TINCTURE 10% (MORPHINE 10 MG/ML) ORAL",7.46,7.46,7.46,7.46,1.865]
["Not Applicable - Not Applicable - 62559015901","Not Applicable","Not Applicable","NDC","62559015901","FLUVOXAMINE 50 MG TABLET",1.33,1.33,0.34,1.33,0.33250000000000002]
["Not Applicable - Not Applicable - 62559021052","Not Applicable","Not Applicable","NDC","62559021052","NIMODIPINE 30 MG CAPSULE",96.37,96.37,48.19,96.37,24.092500000000001]
["Not Applicable - Not Applicable - 62559024101","Not Applicable","Not Applicable","NDC","62559024101","METHAZOLAMIDE 50 MG TABLET",8.5,8.5,4.25,8.5,2.125]
["Not Applicable - Not Applicable - 62559063001","Not Applicable","Not Applicable","NDC","62559063001","ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION",738.57,738.57,738.57,738.57,184.64250000000001]
["Not Applicable - Not Applicable - 62584014301","Not Applicable","Not Applicable","NDC","62584014301","OXCARBAZEPINE 300 MG TABLET",4.3899999999999997,4.3899999999999997,1.1000000000000001,4.3899999999999997,1.0974999999999999]
["Not Applicable - Not Applicable - 62584026501","Not Applicable","Not Applicable","NDC","62584026501","METOPROLOL TARTRATE 25 MG TABLET",0.63,0.63,0.08,0.63,0.1575]
["Not Applicable - Not Applicable - 62584026511","Not Applicable","Not Applicable","NDC","62584026511","METOPROLOL TARTRATE 25 MG TABLET",1.2,1.2,0.15,1.2,0.3]
["Not Applicable - Not Applicable - 62584026601","Not Applicable","Not Applicable","NDC","62584026601","METOPROLOL TARTRATE 50 MG TABLET",0.45,0.45,0.06,0.45,0.1125]
["Not Applicable - Not Applicable - 62584026611","Not Applicable","Not Applicable","NDC","62584026611","METOPROLOL TARTRATE 50 MG TABLET",0.79,0.79,0.1,0.79,0.19750000000000001]
["Not Applicable - Not Applicable - 62584033901","Not Applicable","Not Applicable","NDC","62584033901","CLONIDINE HCL 0.2 MG TABLET",0.66,0.66,0.22,0.66,0.16500000000000001]
["Not Applicable - Not Applicable - 62584046701","Not Applicable","Not Applicable","NDC","62584046701","ATENOLOL 50 MG TABLET",0.95,0.95,0.12,0.95,0.23749999999999999]
["Not Applicable - Not Applicable - 62584046711","Not Applicable","Not Applicable","NDC","62584046711","ATENOLOL 50 MG TABLET",0.87,0.87,0.11,0.87,0.2175]
["Not Applicable - Not Applicable - 62584055911","Not Applicable","Not Applicable","NDC","62584055911","TRAMADOL 50 MG TABLET",1.04,1.04,0.26,1.04,0.26]
["Not Applicable - Not Applicable - 62584065701","Not Applicable","Not Applicable","NDC","62584065701","CLONIDINE HCL 0.1 MG TABLET",1.5,1.5,0.5,1.5,0.375]
["Not Applicable - Not Applicable - 62584071301","Not Applicable","Not Applicable","NDC","62584071301","ALLOPURINOL 300 MG TABLET",112.62,112.62,112.62,112.62,28.155000000000001]
["Not Applicable - Not Applicable - 62584073301","Not Applicable","Not Applicable","NDC","62584073301","HYDRALAZINE 25 MG TABLET",0.9,0.9,0.12,0.9,0.22500000000000001]
["Not Applicable - Not Applicable - 62584073401","Not Applicable","Not Applicable","NDC","62584073401","HYDRALAZINE 50 MG TABLET",0.49,0.49,7.0000000000000007E-2,0.49,0.1225]
["Not Applicable - Not Applicable - 62584074701","Not Applicable","Not Applicable","NDC","62584074701","IBUPROFEN 600 MG TABLET",0.28999999999999998,0.28999999999999998,0.08,0.28999999999999998,7.2499999999999995E-2]
["Not Applicable - Not Applicable - 62584074801","Not Applicable","Not Applicable","NDC","62584074801","IBUPROFEN 800 MG TABLET",0.28999999999999998,0.28999999999999998,0.08,0.28999999999999998,7.2499999999999995E-2]
["Not Applicable - Not Applicable - 62584081201","Not Applicable","Not Applicable","NDC","62584081201","OXAZEPAM 10 MG CAPSULE",15.34,15.34,5.12,15.34,3.835]
["Not Applicable - Not Applicable - 62584081301","Not Applicable","Not Applicable","NDC","62584081301","OXAZEPAM 15 MG CAPSULE",11.42,11.42,3.81,11.42,2.855]
["Not Applicable - Not Applicable - 62584089701","Not Applicable","Not Applicable","NDC","62584089701","FOLIC ACID 1 MG TABLET",0.38,0.38,0.38,0.38,9.5000000000000001E-2]
["Not Applicable - Not Applicable - 62584089711","Not Applicable","Not Applicable","NDC","62584089711","FOLIC ACID 1 MG TABLET",0.54,0.54,0.54,0.54,0.13500000000000001]
["Not Applicable - Not Applicable - 62584097601","Not Applicable","Not Applicable","NDC","62584097601","DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR",3.27,3.27,1.0900000000000001,3.27,0.8175]
["Not Applicable - Not Applicable - 62584097701","Not Applicable","Not Applicable","NDC","62584097701","DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR",3.37,3.37,1.1299999999999999,3.37,0.84250000000000003]
["Not Applicable - Not Applicable - 62584098801","Not Applicable","Not Applicable","NDC","62584098801","ALLOPURINOL 100 MG TABLET",1.67,1.67,0.28000000000000003,1.67,0.41749999999999998]
["Not Applicable - Not Applicable - 62584099001","Not Applicable","Not Applicable","NDC","62584099001","DIGOXIN 0.25 MG TABLET",65.02,65.02,65.02,65.02,16.254999999999999]
["Not Applicable - Not Applicable - 62584099411","Not Applicable","Not Applicable","NDC","62584099411","WARFARIN 5 MG TABLET",2.36,2.36,0.24,2.36,0.59]
["Not Applicable - Not Applicable - 62756016088","Not Applicable","Not Applicable","NDC","62756016088","TAMSULOSIN 0.4 MG CAPSULE",0.59,0.59,0.3,0.59,0.14749999999999999]
["Not Applicable - Not Applicable - 62756018388","Not Applicable","Not Applicable","NDC","62756018388","OXCARBAZEPINE 150 MG TABLET",1.51,1.51,0.38,1.51,0.3775]
["Not Applicable - Not Applicable - 62756018488","Not Applicable","Not Applicable","NDC","62756018488","OXCARBAZEPINE 300 MG TABLET",1.55,1.55,0.39,1.55,0.38750000000000001]
["Not Applicable - Not Applicable - 62756020083","Not Applicable","Not Applicable","NDC","62756020083","TIAGABINE 2 MG TABLET",98.28,98.28,12.29,98.28,24.57]
["Not Applicable - Not Applicable - 62756022483","Not Applicable","Not Applicable","NDC","62756022483","TIAGABINE 4 MG TABLET",37.31,37.31,4.67,37.31,9.3275000000000006]
["Not Applicable - Not Applicable - 62756026002","Not Applicable","Not Applicable","NDC","62756026002","ZONISAMIDE 100 MG CAPSULE",0.68,0.68,0.09,0.68,0.17]
["Not Applicable - Not Applicable - 62756045788","Not Applicable","Not Applicable","NDC","62756045788","CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE",1.94,1.94,0.97,1.94,0.48499999999999999]
["Not Applicable - Not Applicable - 62756051788","Not Applicable","Not Applicable","NDC","62756051788","CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET",0.69,0.69,0.18,0.69,0.17249999999999999]
["Not Applicable - Not Applicable - 62756051888","Not Applicable","Not Applicable","NDC","62756051888","CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET",1.74,1.74,0.44,1.74,0.435]
["Not Applicable - Not Applicable - 62756052069","Not Applicable","Not Applicable","NDC","62756052069","SUMATRIPTAN 25 MG TABLET",7.15,7.15,1.79,7.15,1.7875000000000001]
["Not Applicable - Not Applicable - 62756070786","Not Applicable","Not Applicable","NDC","62756070786","TOPIRAMATE 25 MG TABLET",4.3499999999999996,4.3499999999999996,0.55000000000000004,4.3499999999999996,1.0874999999999999]
["Not Applicable - Not Applicable - 62756071186","Not Applicable","Not Applicable","NDC","62756071186","TOPIRAMATE 100 MG TABLET",2.97,2.97,0.38,2.97,0.74250000000000005]
["Not Applicable - Not Applicable - 62756071286","Not Applicable","Not Applicable","NDC","62756071286","TOPIRAMATE 200 MG TABLET",1.74,1.74,0.22,1.74,0.435]
["Not Applicable - Not Applicable - 62756071860","Not Applicable","Not Applicable","NDC","62756071860","LEVONORGESTREL 1.5 MG TABLET",67.5,67.5,33.75,67.5,16.875]
["Not Applicable - Not Applicable - 62756079688","Not Applicable","Not Applicable","NDC","62756079688","DIVALPROEX 125 MG TABLET,DELAYED RELEASE",0.8,0.8,0.2,0.8,0.2]
["Not Applicable - Not Applicable - 62756079788","Not Applicable","Not Applicable","NDC","62756079788","DIVALPROEX 250 MG TABLET,DELAYED RELEASE",0.45,0.45,0.12,0.45,0.1125]
["Not Applicable - Not Applicable - 62856027230","Not Applicable","Not Applicable","NDC","62856027230","PERAMPANEL 2 MG TABLET",294.47000000000003,294.47000000000003,58.9,294.47000000000003,73.617500000000007]
["Not Applicable - Not Applicable - 62856027630","Not Applicable","Not Applicable","NDC","62856027630","PERAMPANEL 6 MG TABLET",193.92,193.92,38.79,193.92,48.48]
["Not Applicable - Not Applicable - 62856028030","Not Applicable","Not Applicable","NDC","62856028030","PERAMPANEL 10 MG TABLET",116.36,116.36,23.28,116.36,29.09]
["Not Applicable - Not Applicable - 62856058252","Not Applicable","Not Applicable","NDC","62856058252","RUFINAMIDE 200 MG TABLET",175.03,175.03,43.76,175.03,43.7575]
["Not Applicable - Not Applicable - 62856058352","Not Applicable","Not Applicable","NDC","62856058352","RUFINAMIDE 400 MG TABLET",175.03,175.03,43.76,175.03,43.7575]
["Not Applicable - Not Applicable - 62856068010","Not Applicable","Not Applicable","NDC","62856068010","ZONISAMIDE 100 MG CAPSULE",82.78,82.78,10.35,82.78,20.695]
["Not Applicable - Not Applicable - 62856068110","Not Applicable","Not Applicable","NDC","62856068110","ZONISAMIDE 25 MG CAPSULE",312.43,312.43,39.06,312.43,78.107500000000002]
["Not Applicable - Not Applicable - 63010001030","Not Applicable","Not Applicable","NDC","63010001030","NELFINAVIR 250 MG TABLET",67.08,67.08,40.25,67.08,16.77]
["Not Applicable - Not Applicable - 63010002770","Not Applicable","Not Applicable","NDC","63010002770","NELFINAVIR 625 MG TABLET",67.08,67.08,67.08,67.08,16.77]
["Not Applicable - Not Applicable - 63044048409","Not Applicable","Not Applicable","NDC","63044048409","AMMONIUM LACTATE 12 % LOTION",25.58,25.58,25.58,25.58,6.3949999999999996]
["Not Applicable - Not Applicable - 63044062201","Not Applicable","Not Applicable","NDC","63044062201","VITAMIN B COMPLEX AND VITAMIN C NO.20-FOLIC ACID 1 MG CAPSULE",0.36,0.36,0.36,0.36,0.09]
["Not Applicable - Not Applicable - 63256020005","Not Applicable","Not Applicable","NDC","63256020005","STERILE TALC 5 GRAM INTRAPLEURAL SUSPENSION",310.85000000000002,310.85000000000002,310.85000000000002,310.85000000000002,77.712500000000006]
["Not Applicable - Not Applicable - 63304029601","Not Applicable","Not Applicable","NDC","63304029601","HYDROXYCHLOROQUINE 200 MG TABLET",10.220000000000001,10.220000000000001,2.56,10.220000000000001,2.5550000000000002]
["Not Applicable - Not Applicable - 63304057901","Not Applicable","Not Applicable","NDC","63304057901","METOPROLOL TARTRATE 25 MG TABLET",0.47,0.47,0.06,0.47,0.11749999999999999]
["Not Applicable - Not Applicable - 63304058360","Not Applicable","Not Applicable","NDC","63304058360","FOSAMPRENAVIR 700 MG TABLET",88.29,88.29,44.15,88.29,22.072500000000002]
["Not Applicable - Not Applicable - 63304082990","Not Applicable","Not Applicable","NDC","63304082990","ATORVASTATIN 40 MG TABLET",0.37,0.37,0.1,0.37,9.2499999999999999E-2]
["Not Applicable - Not Applicable - 63304083090","Not Applicable","Not Applicable","NDC","63304083090","ATORVASTATIN 80 MG TABLET",0.34,0.34,0.34,0.34,8.5000000000000006E-2]
["Not Applicable - Not Applicable - 63323008861","Not Applicable","Not Applicable","NDC","63323008861","SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION",11.94,11.94,11.94,11.94,2.9849999999999999]
["Not Applicable - Not Applicable - 63323008863","Not Applicable","Not Applicable","NDC","63323008863","SODIUM CHLORIDE",14.07,14.07,14.07,14.07,3.5175000000000001]
["Not Applicable - Not Applicable - 63323011310","Not Applicable","Not Applicable","NDC","63323011310","PENTAMIDINE 300 MG SOLUTION FOR INJECTION",363.24,363.24,363.24,363.24,90.81]
["Not Applicable - Not Applicable - 63323013011","Not Applicable","Not Applicable","NDC","63323013011","DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION",87.29,87.29,87.29,87.29,21.822500000000002]
["Not Applicable - Not Applicable - 63323018730","Not Applicable","Not Applicable","NDC","63323018730","SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION",15.88,15.88,15.88,15.88,3.97]
["Not Applicable - Not Applicable - 63323020500","Not Applicable","Not Applicable","NDC","63323020500","FATTY ACID NO.6-FISH OIL-GLYCERIN-PHOSPHOLIPIDS, EGG 10 % IV EMULSION",231.98,231.98,231.98,231.98,57.994999999999997]
["Not Applicable - Not Applicable - 63323020550","Not Applicable","Not Applicable","NDC","63323020550","FATTY ACID NO.6-FISH OIL-GLYCERIN-PHOSPHOLIPIDS, EGG 10 % IV EMULSION",162.35,162.35,162.35,162.35,40.587499999999999]
["Not Applicable - Not Applicable - 63323025410","Not Applicable","Not Applicable","NDC","63323025410","MINERAL OIL, LIGHT STERILE",28.32,28.32,28.32,28.32,7.08]
["Not Applicable - Not Applicable - 63323032110","Not Applicable","Not Applicable","NDC","63323032110","POLYMYXIN B SULFATE 500,000 UNIT SOLUTION FOR INJECTION",45.12,45.12,45.12,45.12,11.28]
["Not Applicable - Not Applicable - 63323032710","Not Applicable","Not Applicable","NDC","63323032710","*DESENSITIZATION* NAFCILLIN 1G SOLN",49.64,49.64,49.64,49.64,12.41]
["Not Applicable - Not Applicable - 63323032930","Not Applicable","Not Applicable","NDC","63323032930","BACITRACIN 50,000 UNIT INTRAMUSCULAR SOLUTION",38.979999999999997,38.979999999999997,38.979999999999997,38.979999999999997,9.7449999999999992]
["Not Applicable - Not Applicable - 63323032931","Not Applicable","Not Applicable","NDC","63323032931","BACITRACIN 50,000 UNIT INTRAMUSCULAR SOLUTION",29.84,29.84,29.84,29.84,7.46]
["Not Applicable - Not Applicable - 63323035120","Not Applicable","Not Applicable","NDC","63323035120","RIFAMPIN 600 MG INTRAVENOUS SOLUTION",246.9,246.9,246.9,246.9,61.725000000000001]
["Not Applicable - Not Applicable - 63323036711","Not Applicable","Not Applicable","NDC","63323036711","POLYMYXIN B SULFATE 500,000 UNIT SOLUTION FOR INJECTION",17.41,17.41,17.41,17.41,4.3525]
["Not Applicable - Not Applicable - 63323040120","Not Applicable","Not Applicable","NDC","63323040120","AZTREONAM 1 GRAM SOLUTION FOR INJECTION",88.74,88.74,88.74,88.74,22.184999999999999]
["Not Applicable - Not Applicable - 63323040220","Not Applicable","Not Applicable","NDC","63323040220","AZTREONAM 2 GRAM SOLUTION FOR INJECTION",177.48,177.48,177.48,177.48,44.37]
["Not Applicable - Not Applicable - 63323064810","Not Applicable","Not Applicable","NDC","63323064810","LEVOTHYROXINE 500 MCG INTRAVENOUS POWDER FOR SOLUTION",1749.97,1749.97,1749.97,1749.97,437.49250000000001]
["Not Applicable - Not Applicable - 63323064907","Not Applicable","Not Applicable","NDC","63323064907","LEVOTHYROXINE 100 MCG INTRAVENOUS POWDER FOR SOLUTION",350,350,350,350,87.5]
["Not Applicable - Not Applicable - 63323065903","Not Applicable","Not Applicable","NDC","63323065903","INDOMETHACIN 1 MG INTRAVENOUS SOLUTION",951.72,951.72,951.72,951.72,237.93]
["Not Applicable - Not Applicable - 63323072303","Not Applicable","Not Applicable","NDC","63323072303","REMIFENTANIL 1 MG INTRAVENOUS SOLUTION",131.27000000000001,131.27000000000001,131.27000000000001,131.27000000000001,32.817500000000003]
["Not Applicable - Not Applicable - 63323072401","Not Applicable","Not Applicable","NDC","63323072401","REMIFENTANIL 2 MG INTRAVENOUS SOLUTION",456.93,456.93,456.93,456.93,114.2325]
["Not Applicable - Not Applicable - 63323072405","Not Applicable","Not Applicable","NDC","63323072405","REMIFENTANIL 2 MG INTRAVENOUS SOLUTION",260.19,260.19,260.19,260.19,65.047499999999999]
["Not Applicable - Not Applicable - 63323078110","Not Applicable","Not Applicable","NDC","63323078110","VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION",17.25,17.25,17.25,17.25,4.3125]
["Not Applicable - Not Applicable - 63323082003","Not Applicable","Not Applicable","NDC","63323082003","FAT EMULSION-SOYBEAN OIL-MCT(COCONUT OIL)-OLIVE OIL-FISH OIL 20 % INTRAVENOUS",120.79,120.79,120.79,120.79,30.197500000000002]
["Not Applicable - Not Applicable - 63323082050","Not Applicable","Not Applicable","NDC","63323082050","FAT EMULSION-SOYBEAN OIL-MCT(COCONUT OIL)-OLIVE OIL-FISH OIL 20 % INTRAVENOUS",97.7,97.7,97.7,97.7,24.425000000000001]
["Not Applicable - Not Applicable - 63402030430","Not Applicable","Not Applicable","NDC","63402030430","LURASIDONE 40 MG TABLET",371.93,371.93,148.78,371.93,92.982500000000002]
["Not Applicable - Not Applicable - 63402030630","Not Applicable","Not Applicable","NDC","63402030630","LURASIDONE 60 MG TABLET",247.96,247.96,99.19,247.96,61.99]
["Not Applicable - Not Applicable - 63459010130","Not Applicable","Not Applicable","NDC","63459010130","MODAFINIL 100 MG TABLET",286.5,286.5,143.25,286.5,71.625]
["Not Applicable - Not Applicable - 63481068706","Not Applicable","Not Applicable","NDC","63481068706","LIDOCAINE 5 % TOPICAL PATCH",218.25,218.25,72.75,218.25,54.5625]
["Not Applicable - Not Applicable - 63653117103","Not Applicable","Not Applicable","NDC","63653117103","CLOPIDOGREL 75 MG TABLET",171.75,171.75,21.47,171.75,42.9375]
["Not Applicable - Not Applicable - 63739001410","Not Applicable","Not Applicable","NDC","63739001410","DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR",3.21,3.21,1.07,3.21,0.80249999999999999]
["Not Applicable - Not Applicable - 63739001510","Not Applicable","Not Applicable","NDC","63739001510","DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR",1.88,1.88,0.63,1.88,0.47]
["Not Applicable - Not Applicable - 63739001710","Not Applicable","Not Applicable","NDC","63739001710","CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET",1.92,1.92,0.48,1.92,0.48]
["Not Applicable - Not Applicable - 63739004610","Not Applicable","Not Applicable","NDC","63739004610","CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET",1.92,1.92,0.48,1.92,0.48]
["Not Applicable - Not Applicable - 63739004710","Not Applicable","Not Applicable","NDC","63739004710","CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET",1.89,1.89,0.48,1.89,0.47249999999999998]
["Not Applicable - Not Applicable - 63739005007","Not Applicable","Not Applicable","NDC","63739005007","OSELTAMIVIR 75 MG CAPSULE",37.74,37.74,15.1,37.74,9.4350000000000005]
["Not Applicable - Not Applicable - 63739005110","Not Applicable","Not Applicable","NDC","63739005110","AMIODARONE 200 MG TABLET",1.41,1.41,0.36,1.41,0.35249999999999998]
["Not Applicable - Not Applicable - 63739007910","Not Applicable","Not Applicable","NDC","63739007910","DILTIAZEM 30 MG TABLET",1.78,1.78,0.45,1.78,0.44500000000000001]
["Not Applicable - Not Applicable - 63739008010","Not Applicable","Not Applicable","NDC","63739008010","DILTIAZEM 60 MG TABLET",1.42,1.42,0.36,1.42,0.35499999999999998]
["Not Applicable - Not Applicable - 63739008610","Not Applicable","Not Applicable","NDC","63739008610","VALPROIC ACID 250 MG CAPSULE",1.66,1.66,0.83,1.66,0.41499999999999998]
["Not Applicable - Not Applicable - 63739011910","Not Applicable","Not Applicable","NDC","63739011910","GLYBURIDE 5 MG TABLET",2.2400000000000002,2.2400000000000002,0.28000000000000003,2.2400000000000002,0.56000000000000005]
["Not Applicable - Not Applicable - 63739012610","Not Applicable","Not Applicable","NDC","63739012610","HYDRALAZINE 25 MG TABLET",1.77,1.77,0.24,1.77,0.4425]
["Not Applicable - Not Applicable - 63739012710","Not Applicable","Not Applicable","NDC","63739012710","HYDRALAZINE 50 MG TABLET",1.1200000000000001,1.1200000000000001,0.15,1.1200000000000001,0.28000000000000003]
["Not Applicable - Not Applicable - 63739012810","Not Applicable","Not Applicable","NDC","63739012810","HYDROCHLOROTHIAZIDE 25 MG TABLET",0.24,0.24,0.24,0.24,0.06]
["Not Applicable - Not Applicable - 63739016510","Not Applicable","Not Applicable","NDC","63739016510","MEGESTROL 40 MG TABLET",1.17,1.17,0.59,1.17,0.29249999999999998]
["Not Applicable - Not Applicable - 63739016710","Not Applicable","Not Applicable","NDC","63739016710","METHOCARBAMOL 750 MG TABLET",0.66,0.66,0.33,0.66,0.16500000000000001]
["Not Applicable - Not Applicable - 63739017210","Not Applicable","Not Applicable","NDC","63739017210","METOCLOPRAMIDE 10 MG TABLET",0.41,0.41,0.21,0.41,0.10249999999999999]
["Not Applicable - Not Applicable - 63739020010","Not Applicable","Not Applicable","NDC","63739020010","PHENOBARBITAL 16.2 MG TABLET",8.23,8.23,2.75,8.23,2.0575000000000001]
["Not Applicable - Not Applicable - 63739020110","Not Applicable","Not Applicable","NDC","63739020110","PHENOBARBITAL 32.4 MG TABLET",4.8,4.8,1.6,4.8,1.2]
["Not Applicable - Not Applicable - 63739021210","Not Applicable","Not Applicable","NDC","63739021210","ASPIRIN 81 MG TABLET,DELAYED RELEASE",0.83,0.83,0.11,0.83,0.20749999999999999]
["Not Applicable - Not Applicable - 63739022510","Not Applicable","Not Applicable","NDC","63739022510","SIMETHICONE 80 MG CHEWABLE TABLET",0.4,0.4,0.2,0.4,0.1]
["Not Applicable - Not Applicable - 63739022810","Not Applicable","Not Applicable","NDC","63739022810","SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET",2.81,2.81,1.41,2.81,0.70250000000000001]
["Not Applicable - Not Applicable - 63739023610","Not Applicable","Not Applicable","NDC","63739023610","GABAPENTIN 300 MG CAPSULE",0.72,0.72,0.18,0.72,0.18]
["Not Applicable - Not Applicable - 63739025110","Not Applicable","Not Applicable","NDC","63739025110","VALPROIC ACID 250 MG CAPSULE",2.85,2.85,1.43,2.85,0.71250000000000002]
["Not Applicable - Not Applicable - 63739026310","Not Applicable","Not Applicable","NDC","63739026310","CLONAZEPAM 0.5 MG TABLET",1.04,1.04,0.13,1.04,0.26]
["Not Applicable - Not Applicable - 63739026410","Not Applicable","Not Applicable","NDC","63739026410","CLONAZEPAM 1 MG TABLET",0.61,0.61,0.08,0.61,0.1525]
["Not Applicable - Not Applicable - 63739026910","Not Applicable","Not Applicable","NDC","63739026910","TAMOXIFEN 10 MG TABLET",2.21,2.21,1.1100000000000001,2.21,0.55249999999999999]
["Not Applicable - Not Applicable - 63739027201","Not Applicable","Not Applicable","NDC","63739027201","ASPIRIN 81 MG TABLET,DELAYED RELEASE",1.2,1.2,0.15,1.2,0.3]
["Not Applicable - Not Applicable - 63739027510","Not Applicable","Not Applicable","NDC","63739027510","HYDROMORPHONE 2 MG TABLET",1.48,1.48,0.37,1.48,0.37]
["Not Applicable - Not Applicable - 63739028310","Not Applicable","Not Applicable","NDC","63739028310","DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR",6.15,6.15,2.0499999999999998,6.15,1.5375000000000001]
["Not Applicable - Not Applicable - 63739028510","Not Applicable","Not Applicable","NDC","63739028510","DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR",5.38,5.38,1.8,5.38,1.345]
["Not Applicable - Not Applicable - 63739029310","Not Applicable","Not Applicable","NDC","63739029310","METOCLOPRAMIDE 10 MG TABLET",0.31,0.31,0.16,0.31,7.7499999999999999E-2]
["Not Applicable - Not Applicable - 63739035010","Not Applicable","Not Applicable","NDC","63739035010","LISINOPRIL 20 MG TABLET",2.4,2.4,0.3,2.4,0.6]
["Not Applicable - Not Applicable - 63739035410","Not Applicable","Not Applicable","NDC","63739035410","MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET",0.26,0.26,0.13,0.26,6.5000000000000002E-2]
["Not Applicable - Not Applicable - 63739035510","Not Applicable","Not Applicable","NDC","63739035510","MIRTAZAPINE 15 MG TABLET",2.86,2.86,0.48,2.86,0.71499999999999997]
["Not Applicable - Not Applicable - 63739036710","Not Applicable","Not Applicable","NDC","63739036710","ISOSORBIDE DINITRATE 20 MG TABLET",4.2300000000000004,4.2300000000000004,1.06,4.2300000000000004,1.0575000000000001]
["Not Applicable - Not Applicable - 63739037510","Not Applicable","Not Applicable","NDC","63739037510","GABAPENTIN 300 MG CAPSULE",1.9,1.9,0.48,1.9,0.47499999999999998]
["Not Applicable - Not Applicable - 63739038710","Not Applicable","Not Applicable","NDC","63739038710","AMIODARONE 200 MG TABLET",5.38,5.38,1.35,5.38,1.345]
["Not Applicable - Not Applicable - 63739041110","Not Applicable","Not Applicable","NDC","63739041110","LEVETIRACETAM 500 MG TABLET",1.25,1.25,0.32,1.25,0.3125]
["Not Applicable - Not Applicable - 63739043401","Not Applicable","Not Applicable","NDC","63739043401","*DESENSITIZATION* ASPIRIN 81 MG CHEWABLE TABLET",0.52,0.52,0.13,0.52,0.13]
["Not Applicable - Not Applicable - 63739044001","Not Applicable","Not Applicable","NDC","63739044001","ACETAMINOPHEN 325 MG TABLET",0.2,0.2,7.0000000000000007E-2,0.2,0.05]
["Not Applicable - Not Applicable - 63739044310","Not Applicable","Not Applicable","NDC","63739044310","IBUPROFEN 600 MG TABLET",0.32,0.32,0.08,0.32,0.08]
["Not Applicable - Not Applicable - 63739044710","Not Applicable","Not Applicable","NDC","63739044710","POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)",3.78,3.78,1.89,3.78,0.94499999999999995]
["Not Applicable - Not Applicable - 63739045410","Not Applicable","Not Applicable","NDC","63739045410","METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR",7.27,7.27,0.91,7.27,1.8174999999999999]
["Not Applicable - Not Applicable - 63739047810","Not Applicable","Not Applicable","NDC","63739047810","DOCUSATE SODIUM 100 MG CAPSULE",0.12,0.12,0.12,0.12,0.03]
["Not Applicable - Not Applicable - 63739047910","Not Applicable","Not Applicable","NDC","63739047910","BACLOFEN 10 MG TABLET",4,4,0.5,4,1]
["Not Applicable - Not Applicable - 63739048210","Not Applicable","Not Applicable","NDC","63739048210","METOCLOPRAMIDE 10 MG TABLET",0.32,0.32,0.16,0.32,0.08]
["Not Applicable - Not Applicable - 63739048410","Not Applicable","Not Applicable","NDC","63739048410","FAMOTIDINE 20 MG TABLET",0.5,0.5,0.13,0.5,0.125]
["Not Applicable - Not Applicable - 63739048610","Not Applicable","Not Applicable","NDC","63739048610","HYDROXYZINE HCL 25 MG TABLET",1.04,1.04,0.21,1.04,0.26]
["Not Applicable - Not Applicable - 63739049910","Not Applicable","Not Applicable","NDC","63739049910","LORAZEPAM 0.5 MG TABLET",0.97,0.97,0.25,0.97,0.24249999999999999]
["Not Applicable - Not Applicable - 63739050110","Not Applicable","Not Applicable","NDC","63739050110","LORAZEPAM 2 MG TABLET",0.28999999999999998,0.28999999999999998,0.08,0.28999999999999998,7.2499999999999995E-2]
["Not Applicable - Not Applicable - 63739051610","Not Applicable","Not Applicable","NDC","63739051610","LAMOTRIGINE 100 MG TABLET",0.68,0.68,0.09,0.68,0.17]
["Not Applicable - Not Applicable - 63739052201","Not Applicable","Not Applicable","NDC","63739052201","ASPIRIN 81 MG TABLET,DELAYED RELEASE",1.74,1.74,0.22,1.74,0.435]
["Not Applicable - Not Applicable - 63739052210","Not Applicable","Not Applicable","NDC","63739052210","ASPIRIN 81 MG TABLET,DELAYED RELEASE",1.34,1.34,0.17,1.34,0.33500000000000002]
["Not Applicable - Not Applicable - 63739052510","Not Applicable","Not Applicable","NDC","63739052510","VALACYCLOVIR 500 MG TABLET",23.05,23.05,5.77,23.05,5.7625000000000002]
["Not Applicable - Not Applicable - 63739053110","Not Applicable","Not Applicable","NDC","63739053110","CYCLOBENZAPRINE 10 MG TABLET",0.35,0.35,0.18,0.35,8.7499999999999994E-2]
["Not Applicable - Not Applicable - 63739053710","Not Applicable","Not Applicable","NDC","63739053710","FOLIC ACID 1 MG TABLET",0.61,0.61,0.61,0.61,0.1525]
["Not Applicable - Not Applicable - 63739054110","Not Applicable","Not Applicable","NDC","63739054110","FUROSEMIDE 20 MG TABLET",0.7,0.7,0.09,0.7,0.17499999999999999]
["Not Applicable - Not Applicable - 63739054210","Not Applicable","Not Applicable","NDC","63739054210","FUROSEMIDE 40 MG TABLET",0.36,0.36,0.05,0.36,0.09]
["Not Applicable - Not Applicable - 63739054410","Not Applicable","Not Applicable","NDC","63739054410","SPIRONOLACTONE 25 MG TABLET",3.05,3.05,0.77,3.05,0.76249999999999996]
["Not Applicable - Not Applicable - 63739054833","Not Applicable","Not Applicable","NDC","63739054833","OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR",12.19,12.19,4.07,12.19,3.0474999999999999]
["Not Applicable - Not Applicable - 63739056710","Not Applicable","Not Applicable","NDC","63739056710","TAMSULOSIN 0.4 MG CAPSULE",2.63,2.63,1.32,2.63,0.65749999999999997]
["Not Applicable - Not Applicable - 63739056910","Not Applicable","Not Applicable","NDC","63739056910","ISOSORBIDE DINITRATE 10 MG TABLET",8.23,8.23,1.03,8.23,2.0575000000000001]
["Not Applicable - Not Applicable - 63739057210","Not Applicable","Not Applicable","NDC","63739057210","SIMVASTATIN 20 MG TABLET",0.53,0.53,0.14000000000000001,0.53,0.13250000000000001]
["Not Applicable - Not Applicable - 63739057310","Not Applicable","Not Applicable","NDC","63739057310","SIMVASTATIN 40 MG TABLET",0.31,0.31,0.08,0.31,7.7499999999999999E-2]
["Not Applicable - Not Applicable - 63739059110","Not Applicable","Not Applicable","NDC","63739059110","GABAPENTIN 100 MG CAPSULE",1.2,1.2,0.3,1.2,0.3]
["Not Applicable - Not Applicable - 63739064510","Not Applicable","Not Applicable","NDC","63739064510","FAMOTIDINE 20 MG TABLET",0.52,0.52,0.13,0.52,0.13]
["Not Applicable - Not Applicable - 63739064610","Not Applicable","Not Applicable","NDC","63739064610","DONEPEZIL 5 MG TABLET",0.76,0.76,0.38,0.76,0.19]
["Not Applicable - Not Applicable - 63739066510","Not Applicable","Not Applicable","NDC","63739066510","QUETIAPINE 100 MG TABLET",4.9800000000000004,4.9800000000000004,1.66,4.9800000000000004,1.2450000000000001]
["Not Applicable - Not Applicable - 63739067110","Not Applicable","Not Applicable","NDC","63739067110","TRAMADOL 50 MG TABLET",0.45,0.45,0.12,0.45,0.1125]
["Not Applicable - Not Applicable - 63739068410","Not Applicable","Not Applicable","NDC","63739068410","IBUPROFEN 600 MG TABLET",0.33,0.33,0.09,0.33,8.2500000000000004E-2]
["Not Applicable - Not Applicable - 63739068910","Not Applicable","Not Applicable","NDC","63739068910","GABAPENTIN 300 MG CAPSULE",0.74,0.74,0.19,0.74,0.185]
["Not Applicable - Not Applicable - 63739070610","Not Applicable","Not Applicable","NDC","63739070610","BUPROPION HCL 75 MG TABLET",6.58,6.58,3.29,6.58,1.645]
["Not Applicable - Not Applicable - 63739071410","Not Applicable","Not Applicable","NDC","63739071410","BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE",3.5,3.5,1.75,3.5,0.875]
["Not Applicable - Not Applicable - 63739079110","Not Applicable","Not Applicable","NDC","63739079110","HYDROMORPHONE 4 MG TABLET",0.86,0.86,0.11,0.86,0.215]
["Not Applicable - Not Applicable - 63739079733","Not Applicable","Not Applicable","NDC","63739079733","NIMODIPINE 30 MG CAPSULE",15.12,15.12,7.56,15.12,3.78]
["Not Applicable - Not Applicable - 63739089910","Not Applicable","Not Applicable","NDC","63739089910","MORPHINE ER 15 MG TABLET,EXTENDED RELEASE",14.48,14.48,2.1800000000000002,14.48,3.62]
["Not Applicable - Not Applicable - 63739094310","Not Applicable","Not Applicable","NDC","63739094310","SUCRALFATE 1 GRAM TABLET",1.54,1.54,0.77,1.54,0.38500000000000001]
["Not Applicable - Not Applicable - 63739098410","Not Applicable","Not Applicable","NDC","63739098410","GABAPENTIN 400 MG CAPSULE",0.62,0.62,0.16,0.62,0.155]
["Not Applicable - Not Applicable - 63739098832","Not Applicable","Not Applicable","NDC","63739098832","ZIPRASIDONE 20 MG CAPSULE",24.9,24.9,6.23,24.9,6.2249999999999996]
["Not Applicable - Not Applicable - 63807010001","Not Applicable","Not Applicable","NDC","63807010001","SODIUM CHLORIDE 0.9 % (FLUSH) INJECTION SYRINGE",0.72,0.72,0.72,0.72,0.18]
["Not Applicable - Not Applicable - 63807010035","Not Applicable","Not Applicable","NDC","63807010035","SODIUM CHLORIDE 0.9 % (FLUSH) INJECTION SYRINGE",0.73,0.73,0.73,0.73,0.1825]
["Not Applicable - Not Applicable - 63807010055","Not Applicable","Not Applicable","NDC","63807010055","SODIUM CHLORIDE 0.9 % (FLUSH) INJECTION SYRINGE",1.6,1.6,1.6,1.6,0.4]
["Not Applicable - Not Applicable - 63824071016","Not Applicable","Not Applicable","NDC","63824071016","BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES",0.54,0.54,0.54,0.54,0.13500000000000001]
["Not Applicable - Not Applicable - 64253090030","Not Applicable","Not Applicable","NDC","64253090030","CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE",31.98,31.98,31.98,31.98,7.9950000000000001]
["Not Applicable - Not Applicable - 64376012801","Not Applicable","Not Applicable","NDC","64376012801","ZIDOVUDINE 100 MG CAPSULE",21.52,21.52,7.18,21.52,5.38]
["Not Applicable - Not Applicable - 64376012923","Not Applicable","Not Applicable","NDC","64376012923","ZIDOVUDINE 10 MG/ML SYRUP (PEDIATRIC)",23.13,23.13,7.71,23.13,5.7824999999999998]
["Not Applicable - Not Applicable - 64376013612","Not Applicable","Not Applicable","NDC","64376013612","LEVETIRACETAM 250 MG TABLET",3.27,3.27,0.82,3.27,0.8175]
["Not Applicable - Not Applicable - 64376013712","Not Applicable","Not Applicable","NDC","64376013712","LEVETIRACETAM 500 MG TABLET",0.79,0.79,0.2,0.79,0.19750000000000001]
["Not Applicable - Not Applicable - 64380073706","Not Applicable","Not Applicable","NDC","64380073706","ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE",1.21,1.21,1.21,1.21,0.30249999999999999]
["Not Applicable - Not Applicable - 64679042202","Not Applicable","Not Applicable","NDC","64679042202","AMLODIPINE 5 MG TABLET",0.54,0.54,0.14000000000000001,0.54,0.13500000000000001]
["Not Applicable - Not Applicable - 64679043402","Not Applicable","Not Applicable","NDC","64679043402","PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE",0.76,0.76,0.38,0.76,0.19]
["Not Applicable - Not Applicable - 64679073402","Not Applicable","Not Applicable","NDC","64679073402","METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR",21.29,21.29,2.67,21.29,5.3224999999999998]
["Not Applicable - Not Applicable - 64679073602","Not Applicable","Not Applicable","NDC","64679073602","METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR",8.01,8.01,1.01,8.01,2.0024999999999999]
["Not Applicable - Not Applicable - 64679078102","Not Applicable","Not Applicable","NDC","64679078102","ENTACAPONE 200 MG TABLET",2.06,2.06,2.06,2.06,0.51500000000000001]
["Not Applicable - Not Applicable - 64679093603","Not Applicable","Not Applicable","NDC","64679093603","FAMOTIDINE 20 MG TABLET",0.47,0.47,0.12,0.47,0.11749999999999999]
["Not Applicable - Not Applicable - 64720013910","Not Applicable","Not Applicable","NDC","64720013910","METHENAMINE HIPPURATE 1 GRAM TABLET",3.95,3.95,1.98,3.95,0.98750000000000004]
["Not Applicable - Not Applicable - 64764011901","Not Applicable","Not Applicable","NDC","64764011901","COLCHICINE 0.6 MG TABLET",47.68,47.68,23.84,47.68,11.92]
["Not Applicable - Not Applicable - 64764011907","Not Applicable","Not Applicable","NDC","64764011907","COLCHICINE 0.6 MG TABLET",47.68,47.68,23.84,47.68,11.92]
["Not Applicable - Not Applicable - 64764015105","Not Applicable","Not Applicable","NDC","64764015105","PIOGLITAZONE 15 MG TABLET",126.37,126.37,42.13,126.37,31.592500000000001]
["Not Applicable - Not Applicable - 64764024060","Not Applicable","Not Applicable","NDC","64764024060","LUBIPROSTONE 24 MCG CAPSULE",20.51,20.51,6.84,20.51,5.1275000000000004]
["Not Applicable - Not Applicable - 64764054411","Not Applicable","Not Applicable","NDC","64764054411","LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET",45.87,45.87,45.87,45.87,11.467499999999999]
["Not Applicable - Not Applicable - 64875000103","Not Applicable","Not Applicable","NDC","64875000103","MIFEPRISTONE 200 MG TABLET",959.18,959.18,639.45000000000005,959.18,239.79499999999999]
["Not Applicable - Not Applicable - 64980010401","Not Applicable","Not Applicable","NDC","64980010401","SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET",1.99,1.99,1,1.99,0.4975]
["Not Applicable - Not Applicable - 64980013501","Not Applicable","Not Applicable","NDC","64980013501","DIPYRIDAMOLE 75 MG TABLET",5.67,5.67,1.89,5.67,1.4175]
["Not Applicable - Not Applicable - 64980014612","Not Applicable","Not Applicable","NDC","64980014612","LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET",51.46,51.46,51.46,51.46,12.865]
["Not Applicable - Not Applicable - 64980014698","Not Applicable","Not Applicable","NDC","64980014698","LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET",5.78,5.78,5.78,5.78,1.4450000000000001]
["Not Applicable - Not Applicable - 64980015101","Not Applicable","Not Applicable","NDC","64980015101","AMILORIDE 5 MG TABLET",3.24,3.24,1.62,3.24,0.81]
["Not Applicable - Not Applicable - 64980015701","Not Applicable","Not Applicable","NDC","64980015701","ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE",2.14,2.14,2.14,2.14,0.53500000000000003]
["Not Applicable - Not Applicable - 64980016001","Not Applicable","Not Applicable","NDC","64980016001","BETHANECHOL CHLORIDE 5 MG TABLET",8.57,8.57,0.86,8.57,2.1425000000000001]
["Not Applicable - Not Applicable - 64980016201","Not Applicable","Not Applicable","NDC","64980016201","BETHANECHOL CHLORIDE 25 MG TABLET",3.24,3.24,0.33,3.24,0.81]
["Not Applicable - Not Applicable - 64980017802","Not Applicable","Not Applicable","NDC","64980017802","CHLOROQUINE PHOSPHATE 500 MG TABLET",46.97,46.97,11.75,46.97,11.7425]
["Not Applicable - Not Applicable - 64980017901","Not Applicable","Not Applicable","NDC","64980017901","FLUCYTOSINE 250 MG CAPSULE",600.82000000000005,600.82000000000005,300.41000000000003,600.82000000000005,150.20500000000001]
["Not Applicable - Not Applicable - 64980017903","Not Applicable","Not Applicable","NDC","64980017903","FLUCYTOSINE 250 MG CAPSULE",1166.21,1166.21,583.11,1166.21,291.55250000000001]
["Not Applicable - Not Applicable - 64980018001","Not Applicable","Not Applicable","NDC","64980018001","FLUCYTOSINE 500 MG CAPSULE",541.58000000000004,541.58000000000004,270.79000000000002,541.58000000000004,135.39500000000001]
["Not Applicable - Not Applicable - 64980018210","Not Applicable","Not Applicable","NDC","64980018210","SODIUM BICARBONATE 650 MG TABLET",0.04,0.04,0.04,0.04,0.01]
["Not Applicable - Not Applicable - 64980023601","Not Applicable","Not Applicable","NDC","64980023601","METRONIDAZOLE 500 MG TABLET",2.21,2.21,2.21,2.21,0.55249999999999999]
["Not Applicable - Not Applicable - 64980029410","Not Applicable","Not Applicable","NDC","64980029410","SODIUM BICARBONATE 650 MG TABLET",0.04,0.04,0.04,0.04,0.01]
["Not Applicable - Not Applicable - 64980033990","Not Applicable","Not Applicable","NDC","64980033990","MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET",0.38,0.38,0.19,0.38,9.5000000000000001E-2]
["Not Applicable - Not Applicable - 64980040603","Not Applicable","Not Applicable","NDC","64980040603","EFAVIRENZ 50 MG CAPSULE",78.489999999999995,78.489999999999995,26.17,78.489999999999995,19.622499999999999]
["Not Applicable - Not Applicable - 64980050448","Not Applicable","Not Applicable","NDC","64980050448","CYPROHEPTADINE 2 MG/5 ML ORAL SYRUP",91.074999999999989,91.074999999999989,88.305000000000007,91.074999999999989,22.768749999999997]
["Not Applicable - Not Applicable - 64980051401","Not Applicable","Not Applicable","NDC","64980051401","TIMOLOL MALEATE 0.5 % EYE DROPS",47.11,47.11,47.11,47.11,11.7775]
["Not Applicable - Not Applicable - 64980051505","Not Applicable","Not Applicable","NDC","64980051505","OFLOXACIN 0.3 % EYE DROPS",33.82,33.82,33.82,33.82,8.4550000000000001]
["Not Applicable - Not Applicable - 64980052621","Not Applicable","Not Applicable","NDC","64980052621","NITAZOXANIDE 500 MG TABLET",360.14,360.14,360.14,360.14,90.034999999999997]
["Not Applicable - Not Applicable - 65162005827","Not Applicable","Not Applicable","NDC","65162005827","SEVELAMER CARBONATE 800 MG TABLET",2.3199999999999998,2.3199999999999998,0.78,2.3199999999999998,0.57999999999999996]
["Not Applicable - Not Applicable - 65162027110","Not Applicable","Not Applicable","NDC","65162027110","SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG TABLET",0.93,0.93,0.24,0.93,0.23250000000000001]
["Not Applicable - Not Applicable - 65162035109","Not Applicable","Not Applicable","NDC","65162035109","SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET",0.67,0.67,0.67,0.67,0.16750000000000001]
["Not Applicable - Not Applicable - 65162044210","Not Applicable","Not Applicable","NDC","65162044210","MECLIZINE 25 MG TABLET",1.27,1.27,0.32,1.27,0.3175]
["Not Applicable - Not Applicable - 65162051210","Not Applicable","Not Applicable","NDC","65162051210","SALSALATE 500 MG TABLET",1.99,1.99,1,1.99,0.4975]
["Not Applicable - Not Applicable - 65162054510","Not Applicable","Not Applicable","NDC","65162054510","PRIMIDONE 250 MG TABLET",0.86,0.86,0.18,0.86,0.215]
["Not Applicable - Not Applicable - 65162055410","Not Applicable","Not Applicable","NDC","65162055410","DEMECLOCYCLINE 150 MG TABLET",32.69,32.69,16.350000000000001,32.69,8.1724999999999994]
["Not Applicable - Not Applicable - 65162059606","Not Applicable","Not Applicable","NDC","65162059606","ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE",3.32,3.32,3.32,3.32,0.83]
["Not Applicable - Not Applicable - 65162064978","Not Applicable","Not Applicable","NDC","65162064978","OXCARBAZEPINE 300 MG/5 ML (60 MG/ML) ORAL SUSPENSION",22.85,22.85,11.43,22.85,5.7125000000000004]
["Not Applicable - Not Applicable - 65162068688","Not Applicable","Not Applicable","NDC","65162068688","FELBAMATE 600 MG/5 ML ORAL SUSPENSION (PEDIATRIC)",9.6199999999999992,9.6199999999999992,7.22,9.6199999999999992,2.4049999999999998]
["Not Applicable - Not Applicable - 65162068988","Not Applicable","Not Applicable","NDC","65162068988","NITROFURANTOIN 25 MG/5 ML ORAL SUSPENSION (PEDIATRIC)",1746.91,1746.91,1746.91,1746.91,436.72750000000002]
["Not Applicable - Not Applicable - 65162069305","Not Applicable","Not Applicable","NDC","65162069305","ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION",29.58,29.58,29.58,29.58,7.3949999999999996]
["Not Applicable - Not Applicable - 65162073403","Not Applicable","Not Applicable","NDC","65162073403","FELBAMATE 400 MG TABLET",23.88,23.88,7.96,23.88,5.97]
["Not Applicable - Not Applicable - 65162073503","Not Applicable","Not Applicable","NDC","65162073503","FELBAMATE 600 MG TABLET",25.04,25.04,8.35,25.04,6.26]
["Not Applicable - Not Applicable - 65162075710","Not Applicable","Not Applicable","NDC","65162075710","DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR",2.85,2.85,0.72,2.85,0.71250000000000002]
["Not Applicable - Not Applicable - 65162089603","Not Applicable","Not Applicable","NDC","65162089603","ARIPIPRAZOLE 2 MG TABLET",15.25,15.25,1.02,15.25,3.8125]
["Not Applicable - Not Applicable - 65162089703","Not Applicable","Not Applicable","NDC","65162089703","ARIPIPRAZOLE 5 MG TABLET",6.1,6.1,0.41,6.1,1.5249999999999999]
["Not Applicable - Not Applicable - 65162089803","Not Applicable","Not Applicable","NDC","65162089803","ARIPIPRAZOLE 10 MG TABLET",2.04,2.04,0.21,2.04,0.51]
["Not Applicable - Not Applicable - 65197000101","Not Applicable","Not Applicable","NDC","65197000101","PHENOXYBENZAMINE 10 MG CAPSULE",3410.12,3410.12,852.53,3410.12,852.53]
["Not Applicable - Not Applicable - 65197000201","Not Applicable","Not Applicable","NDC","65197000201","TRIAMTERENE 50 MG CAPSULE",68.069999999999993,68.069999999999993,34.04,68.069999999999993,17.017499999999998]
["Not Applicable - Not Applicable - 65197000301","Not Applicable","Not Applicable","NDC","65197000301","TRIAMTERENE 100 MG CAPSULE",3176.65,3176.65,3176.65,3176.65,794.16250000000002]
["Not Applicable - Not Applicable - 65628020605","Not Applicable","Not Applicable","NDC","65628020605","VANCOMYCIN 50 MG/ML ORAL SOLUTION",433.77,433.77,433.77,433.77,108.4425]
["Not Applicable - Not Applicable - 65649030302","Not Applicable","Not Applicable","NDC","65649030302","RIFAXIMIN 550 MG TABLET",157.55000000000001,157.55000000000001,157.55000000000001,157.55000000000001,39.387500000000003]
["Not Applicable - Not Applicable - 65649030303","Not Applicable","Not Applicable","NDC","65649030303","RIFAXIMIN 550 MG TABLET",157.55000000000001,157.55000000000001,157.55000000000001,157.55000000000001,39.387500000000003]
["Not Applicable - Not Applicable - 65649031112","Not Applicable","Not Applicable","NDC","65649031112","CHLOROTHIAZIDE 250 MG/5 ML ORAL SUSPENSION",19.05,19.05,4.7699999999999996,19.05,4.7625000000000002]
["Not Applicable - Not Applicable - 65862000901","Not Applicable","Not Applicable","NDC","65862000901","METFORMIN 850 MG TABLET",0.46,0.46,0.23,0.46,0.115]
["Not Applicable - Not Applicable - 65862001230","Not Applicable","Not Applicable","NDC","65862001230","SERTRALINE 50 MG TABLET",0.3,0.3,0.08,0.3,7.4999999999999997E-2]
["Not Applicable - Not Applicable - 65862001330","Not Applicable","Not Applicable","NDC","65862001330","SERTRALINE 100 MG TABLET",0.19,0.19,0.05,0.19,4.7500000000000001E-2]
["Not Applicable - Not Applicable - 65862002901","Not Applicable","Not Applicable","NDC","65862002901","GLYBURIDE 2.5 MG TABLET",3.2,3.2,0.4,3.2,0.8]
["Not Applicable - Not Applicable - 65862004824","Not Applicable","Not Applicable","NDC","65862004824","ZIDOVUDINE 10 MG/ML SYRUP (PEDIATRIC)",13.11,13.11,4.37,13.11,3.2774999999999999]
["Not Applicable - Not Applicable - 65862006201","Not Applicable","Not Applicable","NDC","65862006201","METOPROLOL TARTRATE 25 MG TABLET",0.43,0.43,0.06,0.43,0.1075]
["Not Applicable - Not Applicable - 65862007360","Not Applicable","Not Applicable","NDC","65862007360","ABACAVIR 300 MG TABLET",16.579999999999998,16.579999999999998,8.2899999999999991,16.579999999999998,4.1449999999999996]
["Not Applicable - Not Applicable - 65862008301","Not Applicable","Not Applicable","NDC","65862008301","CEFADROXIL 250 MG/5 ML ORAL SUSPENSION",161.29,161.29,161.29,161.29,40.322499999999998]
["Not Applicable - Not Applicable - 65862009520","Not Applicable","Not Applicable","NDC","65862009520","CEFPODOXIME 100 MG TABLET",44.17,44.17,11.05,44.17,11.0425]
["Not Applicable - Not Applicable - 65862009620","Not Applicable","Not Applicable","NDC","65862009620","CEFPODOXIME 200 MG TABLET",29.98,29.98,7.5,29.98,7.4950000000000001]
["Not Applicable - Not Applicable - 65862010701","Not Applicable","Not Applicable","NDC","65862010701","ZIDOVUDINE 100 MG CAPSULE",13.28,13.28,4.43,13.28,3.32]
["Not Applicable - Not Applicable - 65862014636","Not Applicable","Not Applicable","NDC","65862014636","SUMATRIPTAN 25 MG TABLET",7.76,7.76,1.94,7.76,1.94]
["Not Applicable - Not Applicable - 65862020190","Not Applicable","Not Applicable","NDC","65862020190","LOSARTAN 25 MG TABLET",0.91,0.91,0.23,0.91,0.22750000000000001]
["Not Applicable - Not Applicable - 65862020299","Not Applicable","Not Applicable","NDC","65862020299","LOSARTAN 50 MG TABLET",0.32,0.32,0.08,0.32,0.08]
["Not Applicable - Not Applicable - 65862031030","Not Applicable","Not Applicable","NDC","65862031030","DIDANOSINE 125 MG CAPSULE,DELAYED RELEASE",31.6,31.6,9.8800000000000008,31.6,7.9]
["Not Applicable - Not Applicable - 65862042130","Not Applicable","Not Applicable","NDC","65862042130","TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET",6.63,6.63,6.63,6.63,1.6575]
["Not Applicable - Not Applicable - 65862049647","Not Applicable","Not Applicable","NDC","65862049647","SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION",11.94,11.94,8.9600000000000009,11.94,2.9849999999999999]
["Not Applicable - Not Applicable - 65862049730","Not Applicable","Not Applicable","NDC","65862049730","EFAVIRENZ 600 MG-EMTRICITABINE 200 MG-TENOFOVIR DISOPROX 300 MG TABLET",26.52,26.52,26.52,26.52,6.63]
["Not Applicable - Not Applicable - 65862052830","Not Applicable","Not Applicable","NDC","65862052830","VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR",1.17,1.17,0.39,1.17,0.29249999999999998]
["Not Applicable - Not Applicable - 65862053350","Not Applicable","Not Applicable","NDC","65862053350","AMOXICILLIN 200 MG-POTASSIUM CLAVULANATE 28.5 MG/5 ML ORAL SUSPENSION",10.48,10.48,10.48,10.48,2.62]
["Not Applicable - Not Applicable - 65862053450","Not Applicable","Not Applicable","NDC","65862053450","AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION",12.26,12.26,12.26,12.26,3.0649999999999999]
["Not Applicable - Not Applicable - 65862053513","Not Applicable","Not Applicable","NDC","65862053513","AMOXICILLIN 600 MG-POTASSIUM CLAVULANATE 42.9 MG/5 ML ORAL SUSPENSION",60.4,60.4,60.4,60.4,15.1]
["Not Applicable - Not Applicable - 65862059401","Not Applicable","Not Applicable","NDC","65862059401","DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR",1.65,1.65,0.42,1.65,0.41249999999999998]
["Not Applicable - Not Applicable - 65862059601","Not Applicable","Not Applicable","NDC","65862059601","CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION",44.77,44.77,44.77,44.77,11.192500000000001]
["Not Applicable - Not Applicable - 65862060330","Not Applicable","Not Applicable","NDC","65862060330","MOXIFLOXACIN 400 MG TABLET",9.76,9.76,9.76,9.76,2.44]
["Not Applicable - Not Applicable - 65862064163","Not Applicable","Not Applicable","NDC","65862064163","AZITHROMYCIN 250 MG TABLET",4.6100000000000003,4.6100000000000003,0.96,4.6100000000000003,1.1525000000000001]
["Not Applicable - Not Applicable - 65862064860","Not Applicable","Not Applicable","NDC","65862064860","RIVASTIGMINE 1.5 MG CAPSULE",7.72,7.72,1.93,7.72,1.93]
["Not Applicable - Not Applicable - 65862067701","Not Applicable","Not Applicable","NDC","65862067701","ALPRAZOLAM 0.5 MG TABLET",0.3,0.3,0.04,0.3,7.4999999999999997E-2]
["Not Applicable - Not Applicable - 65862067801","Not Applicable","Not Applicable","NDC","65862067801","ALPRAZOLAM 1 MG TABLET",0.17,0.17,0.03,0.17,4.2500000000000003E-2]
["Not Applicable - Not Applicable - 65862071330","Not Applicable","Not Applicable","NDC","65862071330","ATAZANAVIR 300 MG CAPSULE",26.26,26.26,19.7,26.26,6.5650000000000004]
["Not Applicable - Not Applicable - 65862075150","Not Applicable","Not Applicable","NDC","65862075150","CEFIXIME 100 MG/5 ML ORAL SUSPENSION",266.26,266.26,266.26,266.26,66.564999999999998]
["Not Applicable - Not Applicable - 65862083030","Not Applicable","Not Applicable","NDC","65862083030","PRASUGREL 10 MG TABLET",16.420000000000002,16.420000000000002,2.74,16.420000000000002,4.1050000000000004]
["Not Applicable - Not Applicable - 65862084003","Not Applicable","Not Applicable","NDC","65862084003","MOXIFLOXACIN 0.5 % EYE DROPS",110.98,110.98,110.98,110.98,27.745000000000001]
["Not Applicable - Not Applicable - 65862093008","Not Applicable","Not Applicable","NDC","65862093008","SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET",43.88,43.88,43.88,43.88,10.97]
["Not Applicable - Not Applicable - 66215010106","Not Applicable","Not Applicable","NDC","66215010106","BOSENTAN 62.5 MG TABLET",1377.38,1377.38,344.35,1377.38,344.34500000000003]
["Not Applicable - Not Applicable - 66215010206","Not Applicable","Not Applicable","NDC","66215010206","BOSENTAN 125 MG TABLET",688.69,688.69,172.18,688.69,172.17250000000001]
["Not Applicable - Not Applicable - 66490065020","Not Applicable","Not Applicable","NDC","66490065020","DIAZEPAM 2.5 MG RECTAL KIT",980.14,980.14,980.14,980.14,245.035]
["Not Applicable - Not Applicable - 66553000201","Not Applicable","Not Applicable","NDC","66553000201","ASPIRIN 81 MG CHEWABLE TABLET",1.21,1.21,0.31,1.21,0.30249999999999999]
["Not Applicable - Not Applicable - 66553000401","Not Applicable","Not Applicable","NDC","66553000401","CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET",0.62,0.62,0.31,0.62,0.155]
["Not Applicable - Not Applicable - 66553000801","Not Applicable","Not Applicable","NDC","66553000801","SODIUM BICARBONATE 650 MG TABLET",0.35,0.35,0.35,0.35,8.7499999999999994E-2]
["Not Applicable - Not Applicable - 66582041428","Not Applicable","Not Applicable","NDC","66582041428","EZETIMIBE 10 MG TABLET",31.9,31.9,31.9,31.9,7.9749999999999996]
["Not Applicable - Not Applicable - 66647600342","Not Applicable","Not Applicable","NDC","66647600342","EPHEDRINE SULFATE 50 MG/10 ML (5 MG/ML) IN 0.9%SOD.CHLORIDE IV SYRINGE",168.75,168.75,168.75,168.75,42.1875]
["Not Applicable - Not Applicable - 66647601242","Not Applicable","Not Applicable","NDC","66647601242","VECURONIUM IN STERILE WATER 10 MG/10 ML (1 MG/ML) INTRAVENOUS SYRINGE",23.1,23.1,23.1,23.1,5.7750000000000004]
["Not Applicable - Not Applicable - 66685100100","Not Applicable","Not Applicable","NDC","66685100100","AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET",8.84,8.84,8.84,8.84,2.21]
["Not Applicable - Not Applicable - 66685100101","Not Applicable","Not Applicable","NDC","66685100101","AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET",1.31,1.31,1.31,1.31,0.32750000000000001]
["Not Applicable - Not Applicable - 66685100200","Not Applicable","Not Applicable","NDC","66685100200","AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET",4.1900000000000004,4.1900000000000004,4.1900000000000004,4.1900000000000004,1.0475000000000001]
["Not Applicable - Not Applicable - 66685101100","Not Applicable","Not Applicable","NDC","66685101100","AMOXICILLIN 200 MG-POTASSIUM CLAVULANATE 28.5 MG/5 ML ORAL SUSP (PEDI)",15.81,15.81,15.81,15.81,3.9525000000000001]
["Not Applicable - Not Applicable - 66685101200","Not Applicable","Not Applicable","NDC","66685101200","AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION",35.89,35.89,35.89,35.89,8.9725000000000001]
["Not Applicable - Not Applicable - 66689000802","Not Applicable","Not Applicable","NDC","66689000802","NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION",27.29,27.29,27.29,27.29,6.8224999999999998]
["Not Applicable - Not Applicable - 66689003601","Not Applicable","Not Applicable","NDC","66689003601","PHENYTOIN 100 MG/4 ML ORAL SUSPENSION",45.474999999999994,45.474999999999994,22.74,45.474999999999994,11.368749999999999]
["Not Applicable - Not Applicable - 66689003650","Not Applicable","Not Applicable","NDC","66689003650","PHENYTOIN 100 MG/4 ML ORAL SUSPENSION",34.17,34.17,17.09,34.17,8.5425000000000004]
["Not Applicable - Not Applicable - 66689003701","Not Applicable","Not Applicable","NDC","66689003701","NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION",2.99,2.99,2.99,2.99,0.74750000000000005]
["Not Applicable - Not Applicable - 66689004701","Not Applicable","Not Applicable","NDC","66689004701","POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID",48.98,48.98,48.98,48.98,12.244999999999999]
["Not Applicable - Not Applicable - 66689020108","Not Applicable","Not Applicable","NDC","66689020108","ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION",98.05,98.05,98.05,98.05,24.512499999999999]
["Not Applicable - Not Applicable - 66689020204","Not Applicable","Not Applicable","NDC","66689020204","ACTIVATED CHARCOAL 25 GRAM/120 ML ORAL SUSPENSION",70.77,70.77,70.77,70.77,17.692499999999999]
["Not Applicable - Not Applicable - 66689020304","Not Applicable","Not Applicable","NDC","66689020304","ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSPENSION",70.77,70.77,70.77,70.77,17.692499999999999]
["Not Applicable - Not Applicable - 66689020308","Not Applicable","Not Applicable","NDC","66689020308","ACTIVATED CHARCOAL-SORBITOL 50 GRAM/240 ML ORAL SUSPENSION",98.05,98.05,98.05,98.05,24.512499999999999]
["Not Applicable - Not Applicable - 66689069404","Not Applicable","Not Applicable","NDC","66689069404","METHADONE 10 MG/ML ORAL CONCENTRATE",5.94,5.94,5.94,5.94,1.4850000000000001]
["Not Applicable - Not Applicable - 66758019006","Not Applicable","Not Applicable","NDC","66758019006","POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)",3.87,3.87,1.94,3.87,0.96750000000000003]
["Not Applicable - Not Applicable - 66758019013","Not Applicable","Not Applicable","NDC","66758019013","POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)",2.2000000000000002,2.2000000000000002,1.1000000000000001,2.2000000000000002,0.55000000000000004]
["Not Applicable - Not Applicable - 66758020854","Not Applicable","Not Applicable","NDC","66758020854","SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH",62.5,62.5,62.5,62.5,15.625]
["Not Applicable - Not Applicable - 66758020858","Not Applicable","Not Applicable","NDC","66758020858","SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH",66.53,66.53,66.53,66.53,16.6325]
["Not Applicable - Not Applicable - 66993001968","Not Applicable","Not Applicable","NDC","66993001968","ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER",248.68,248.68,248.68,248.68,62.17]
["Not Applicable - Not Applicable - 66993005430","Not Applicable","Not Applicable","NDC","66993005430","OLANZAPINE 10 MG DISINTEGRATING TABLET",124.05,124.05,31.02,124.05,31.012499999999999]
["Not Applicable - Not Applicable - 66993005702","Not Applicable","Not Applicable","NDC","66993005702","HYDROXYCHLOROQUINE 200 MG TABLET",11.27,11.27,2.82,11.27,2.8174999999999999]
["Not Applicable - Not Applicable - 66993006205","Not Applicable","Not Applicable","NDC","66993006205","ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION",86.97,86.97,86.97,86.97,21.7425]
["Not Applicable - Not Applicable - 66993006851","Not Applicable","Not Applicable","NDC","66993006851","PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE",2.68,2.68,1.34,2.68,0.67]
["Not Applicable - Not Applicable - 66993016502","Not Applicable","Not Applicable","NDC","66993016502","COLCHICINE 0.6 MG TABLET",47.68,47.68,23.84,47.68,11.92]
["Not Applicable - Not Applicable - 66993021019","Not Applicable","Not Applicable","NDC","66993021019","VANCOMYCIN 125 MG CAPSULE",185.36,185.36,92.68,185.36,46.34]
["Not Applicable - Not Applicable - 66993040932","Not Applicable","Not Applicable","NDC","66993040932","CARBAMAZEPINE ER 300 MG CAPSULE,EXTENDED RELEASE MPHASE12HR",3.4,3.4,1.1399999999999999,3.4,0.85]
["Not Applicable - Not Applicable - 66993066130","Not Applicable","Not Applicable","NDC","66993066130","RALOXIFENE 60 MG TABLET",9.9499999999999993,9.9499999999999993,9.9499999999999993,9.9499999999999993,2.4874999999999998]
["Not Applicable - Not Applicable - 67253020320","Not Applicable","Not Applicable","NDC","67253020320","PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLUTION (PEDIATRIC)",18.48,18.48,18.48,18.48,4.62]
["Not Applicable - Not Applicable - 67253039115","Not Applicable","Not Applicable","NDC","67253039115","DOXYCYCLINE HYCLATE 100 MG TABLET",14.75,14.75,14.75,14.75,3.6875]
["Not Applicable - Not Applicable - 67253070006","Not Applicable","Not Applicable","NDC","67253070006","SELEGILINE 5 MG CAPSULE",3.8,3.8,3.8,3.8,0.95]
["Not Applicable - Not Applicable - 67253090010","Not Applicable","Not Applicable","NDC","67253090010","ALPRAZOLAM 0.25 MG TABLET",0.74,0.74,0.1,0.74,0.185]
["Not Applicable - Not Applicable - 67386031321","Not Applicable","Not Applicable","NDC","67386031321","CLOBAZAM 2.5 MG/ML ORAL SUSPENSION",4201.1899999999996,4201.1899999999996,4201.1899999999996,4201.1899999999996,1050.2974999999999]
["Not Applicable - Not Applicable - 67386031401","Not Applicable","Not Applicable","NDC","67386031401","CLOBAZAM 10 MG TABLET",159.91999999999999,159.91999999999999,39.979999999999997,159.91999999999999,39.979999999999997]
["Not Applicable - Not Applicable - 67386082019","Not Applicable","Not Applicable","NDC","67386082019","DROXIDOPA 100 MG CAPSULE",254.36,254.36,84.79,254.36,63.59]
["Not Applicable - Not Applicable - 67386082219","Not Applicable","Not Applicable","NDC","67386082219","DROXIDOPA 300 MG CAPSULE",254.33,254.33,254.33,254.33,63.582500000000003]
["Not Applicable - Not Applicable - 67457019803","Not Applicable","Not Applicable","NDC","67457019803","REMIFENTANIL 1 MG INTRAVENOUS SOLUTION",206.86,206.86,206.86,206.86,51.715000000000003]
["Not Applicable - Not Applicable - 67457043700","Not Applicable","Not Applicable","NDC","67457043700","DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION",59.23,59.23,59.23,59.23,14.807499999999999]
["Not Applicable - Not Applicable - 67457043800","Not Applicable","Not Applicable","NDC","67457043800","VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION",17.77,17.77,17.77,17.77,4.4424999999999999]
["Not Applicable - Not Applicable - 67457043810","Not Applicable","Not Applicable","NDC","67457043810","VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION",16.579999999999998,16.579999999999998,16.579999999999998,16.579999999999998,4.1449999999999996]
["Not Applicable - Not Applicable - 67457065725","Not Applicable","Not Applicable","NDC","67457065725","ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV",508.9,508.9,508.9,508.9,127.22499999999999]
["Not Applicable - Not Applicable - 67546011114","Not Applicable","Not Applicable","NDC","67546011114","NITAZOXANIDE 500 MG TABLET",480.38,480.38,480.38,480.38,120.095]
["Not Applicable - Not Applicable - 67877010501","Not Applicable","Not Applicable","NDC","67877010501","BENZONATATE 100 MG CAPSULE",1.25,1.25,0.63,1.25,0.3125]
["Not Applicable - Not Applicable - 67877011601","Not Applicable","Not Applicable","NDC","67877011601","METHADONE 10 MG TABLET",0.69,0.69,0.18,0.69,0.17249999999999999]
["Not Applicable - Not Applicable - 67877012425","Not Applicable","Not Applicable","NDC","67877012425","SILVER SULFADIAZINE 1 % TOPICAL CREAM",21.76,21.76,21.76,21.76,5.44]
["Not Applicable - Not Applicable - 67877012440","Not Applicable","Not Applicable","NDC","67877012440","SILVER SULFADIAZINE 1 % TOPICAL CREAM",174.79,174.79,174.79,174.79,43.697499999999998]
["Not Applicable - Not Applicable - 67877019805","Not Applicable","Not Applicable","NDC","67877019805","AMLODIPINE 5 MG TABLET",0.09,0.09,0.03,0.09,2.2499999999999999E-2]
["Not Applicable - Not Applicable - 67877021901","Not Applicable","Not Applicable","NDC","67877021901","CEPHALEXIN 500 MG CAPSULE",1.88,1.88,0.47,1.88,0.47]
["Not Applicable - Not Applicable - 67877022305","Not Applicable","Not Applicable","NDC","67877022305","GABAPENTIN 300 MG CAPSULE",0.22,0.22,0.06,0.22,5.5E-2]
["Not Applicable - Not Applicable - 67877022401","Not Applicable","Not Applicable","NDC","67877022401","GABAPENTIN 400 MG CAPSULE",0.21,0.21,0.06,0.21,5.2499999999999998E-2]
["Not Applicable - Not Applicable - 67877024201","Not Applicable","Not Applicable","NDC","67877024201","QUETIAPINE 25 MG TABLET",0.94,0.94,0.12,0.94,0.23499999999999999]
["Not Applicable - Not Applicable - 67877025001","Not Applicable","Not Applicable","NDC","67877025001","QUETIAPINE 100 MG TABLET",0.71,0.71,0.24,0.71,0.17749999999999999]
["Not Applicable - Not Applicable - 67877025115","Not Applicable","Not Applicable","NDC","67877025115","TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM",14.13,14.13,14.13,14.13,3.5325000000000002]
["Not Applicable - Not Applicable - 67877025180","Not Applicable","Not Applicable","NDC","67877025180","TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM",15.92,15.92,15.92,15.92,3.98]
["Not Applicable - Not Applicable - 67877026490","Not Applicable","Not Applicable","NDC","67877026490","DULOXETINE 30 MG CAPSULE,DELAYED RELEASE",0.79,0.79,0.27,0.79,0.19750000000000001]
["Not Applicable - Not Applicable - 67877028660","Not Applicable","Not Applicable","NDC","67877028660","RILUZOLE 50 MG TABLET",1.95,1.95,1.95,1.95,0.48749999999999999]
["Not Applicable - Not Applicable - 67877032001","Not Applicable","Not Applicable","NDC","67877032001","IBUPROFEN 600 MG TABLET",0.31,0.31,0.08,0.31,7.7499999999999999E-2]
["Not Applicable - Not Applicable - 67877032101","Not Applicable","Not Applicable","NDC","67877032101","IBUPROFEN 800 MG TABLET",0.18,0.18,0.05,0.18,4.4999999999999998E-2]
["Not Applicable - Not Applicable - 67877041984","Not Applicable","Not Applicable","NDC","67877041984","LINEZOLID 600 MG TABLET",6.28,6.28,6.28,6.28,1.57]
["Not Applicable - Not Applicable - 67877054568","Not Applicable","Not Applicable","NDC","67877054568","CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION",86.69,86.69,86.69,86.69,21.672499999999999]
["Not Applicable - Not Applicable - 67877057301","Not Applicable","Not Applicable","NDC","67877057301","BENZONATATE 100 MG CAPSULE",1.1399999999999999,1.1399999999999999,0.56999999999999995,1.1399999999999999,0.28499999999999998]
["Not Applicable - Not Applicable - 68001015900","Not Applicable","Not Applicable","NDC","68001015900","VENLAFAXINE 50 MG TABLET",0.63,0.63,0.21,0.63,0.1575]
["Not Applicable - Not Applicable - 68001033500","Not Applicable","Not Applicable","NDC","68001033500","LISINOPRIL 20 MG TABLET",0.18,0.18,0.03,0.18,4.4999999999999998E-2]
["Not Applicable - Not Applicable - 68001043592","Not Applicable","Not Applicable","NDC","68001043592","IBUPROFEN 100 MG/5 ML ORAL SUSPENSION",11.52,11.52,11.52,11.52,2.88]
["Not Applicable - Not Applicable - 68001043594","Not Applicable","Not Applicable","NDC","68001043594","IBUPROFEN 100 MG/5 ML ORAL SUSPENSION",16.2,16.2,16.2,16.2,4.05]
["Not Applicable - Not Applicable - 68001043816","Not Applicable","Not Applicable","NDC","68001043816","LORATADINE 10 MG TABLET",1.04,1.04,0.52,1.04,0.26]
["Not Applicable - Not Applicable - 68001043896","Not Applicable","Not Applicable","NDC","68001043896","LORATADINE 10 MG TABLET",0.56000000000000005,0.56000000000000005,0.28000000000000003,0.56000000000000005,0.14000000000000001]
["Not Applicable - Not Applicable - 68001047300","Not Applicable","Not Applicable","NDC","68001047300","DIVALPROEX 250 MG TABLET,DELAYED RELEASE",0.56000000000000005,0.56000000000000005,0.14000000000000001,0.56000000000000005,0.14000000000000001]
["Not Applicable - Not Applicable - 68001047547","Not Applicable","Not Applicable","NDC","68001047547","CLOTRIMAZOLE 1 % TOPICAL CREAM",5.45,5.45,5.45,5.45,1.3625]
["Not Applicable - Not Applicable - 68084001601","Not Applicable","Not Applicable","NDC","68084001601","FUROSEMIDE 40 MG TABLET",0.49,0.49,7.0000000000000007E-2,0.49,0.1225]
["Not Applicable - Not Applicable - 68084001901","Not Applicable","Not Applicable","NDC","68084001901","ALPRAZOLAM 0.5 MG TABLET",0.99,0.99,0.13,0.99,0.2475]
["Not Applicable - Not Applicable - 68084001911","Not Applicable","Not Applicable","NDC","68084001911","ALPRAZOLAM 0.5 MG TABLET",0.99,0.99,0.13,0.99,0.2475]
["Not Applicable - Not Applicable - 68084002711","Not Applicable","Not Applicable","NDC","68084002711","WARFARIN 2.5 MG TABLET",4.57,4.57,0.46,4.57,1.1425000000000001]
["Not Applicable - Not Applicable - 68084002801","Not Applicable","Not Applicable","NDC","68084002801","BUSPIRONE 5 MG TABLET",1.72,1.72,0.57999999999999996,1.72,0.43]
["Not Applicable - Not Applicable - 68084003101","Not Applicable","Not Applicable","NDC","68084003101","NORTRIPTYLINE 10 MG CAPSULE",11.02,11.02,1.1100000000000001,11.02,2.7549999999999999]
["Not Applicable - Not Applicable - 68084003201","Not Applicable","Not Applicable","NDC","68084003201","NORTRIPTYLINE 25 MG CAPSULE",4.95,4.95,0.5,4.95,1.2375]
["Not Applicable - Not Applicable - 68084004101","Not Applicable","Not Applicable","NDC","68084004101","MISOPROSTOL 200 MCG TABLET",23.24,23.24,0.59,23.24,5.81]
["Not Applicable - Not Applicable - 68084004111","Not Applicable","Not Applicable","NDC","68084004111","MISOPROSTOL 200 MCG TABLET",40.340000000000003,40.340000000000003,1.01,40.340000000000003,10.085000000000001]
["Not Applicable - Not Applicable - 68084004501","Not Applicable","Not Applicable","NDC","68084004501","PAROXETINE 20 MG TABLET",0.97,0.97,0.25,0.97,0.24249999999999999]
["Not Applicable - Not Applicable - 68084005411","Not Applicable","Not Applicable","NDC","68084005411","DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR",3.27,3.27,1.0900000000000001,3.27,0.8175]
["Not Applicable - Not Applicable - 68084006001","Not Applicable","Not Applicable","NDC","68084006001","LISINOPRIL 5 MG TABLET",4.8600000000000003,4.8600000000000003,0.61,4.8600000000000003,1.2150000000000001]
["Not Applicable - Not Applicable - 68084006101","Not Applicable","Not Applicable","NDC","68084006101","LISINOPRIL 10 MG TABLET",1.4,1.4,0.18,1.4,0.35]
["Not Applicable - Not Applicable - 68084006501","Not Applicable","Not Applicable","NDC","68084006501","VITAMIN B COMPLEX AND VITAMIN C NO.20-FOLIC ACID 1 MG CAPSULE",2.7,2.7,2.7,2.7,0.67500000000000004]
["Not Applicable - Not Applicable - 68084006901","Not Applicable","Not Applicable","NDC","68084006901","CIPROFLOXACIN 250 MG TABLET",2.0699999999999998,2.0699999999999998,0.69,2.0699999999999998,0.51749999999999996]
["Not Applicable - Not Applicable - 68084007101","Not Applicable","Not Applicable","NDC","68084007101","CIPROFLOXACIN 750 MG TABLET",1.52,1.52,0.51,1.52,0.38]
["Not Applicable - Not Applicable - 68084007421","Not Applicable","Not Applicable","NDC","68084007421","DANAZOL 200 MG CAPSULE",15.5,15.5,3.88,15.5,3.875]
["Not Applicable - Not Applicable - 68084008211","Not Applicable","Not Applicable","NDC","68084008211","ISOSORBIDE DINITRATE 10 MG TABLET",13.23,13.23,1.66,13.23,3.3075000000000001]
["Not Applicable - Not Applicable - 68084008601","Not Applicable","Not Applicable","NDC","68084008601","HYDROCHLOROTHIAZIDE 25 MG TABLET",0.45,0.45,0.45,0.45,0.1125]
["Not Applicable - Not Applicable - 68084008901","Not Applicable","Not Applicable","NDC","68084008901","LORAZEPAM 1 MG TABLET",1.1200000000000001,1.1200000000000001,0.28000000000000003,1.1200000000000001,0.28000000000000003]
["Not Applicable - Not Applicable - 68084009101","Not Applicable","Not Applicable","NDC","68084009101","METOCLOPRAMIDE 10 MG TABLET",0.36,0.36,0.18,0.36,0.09]
["Not Applicable - Not Applicable - 68084009701","Not Applicable","Not Applicable","NDC","68084009701","ATORVASTATIN 10 MG TABLET",3.84,3.84,0.48,3.84,0.96]
["Not Applicable - Not Applicable - 68084009711","Not Applicable","Not Applicable","NDC","68084009711","ATORVASTATIN 10 MG TABLET",10.52,10.52,1.32,10.52,2.63]
["Not Applicable - Not Applicable - 68084009811","Not Applicable","Not Applicable","NDC","68084009811","ATORVASTATIN 20 MG TABLET",6.4,6.4,0.8,6.4,1.6]
["Not Applicable - Not Applicable - 68084009911","Not Applicable","Not Applicable","NDC","68084009911","ATORVASTATIN 40 MG TABLET",3.2,3.2,0.8,3.2,0.8]
["Not Applicable - Not Applicable - 68084010311","Not Applicable","Not Applicable","NDC","68084010311","ZIPRASIDONE 20 MG CAPSULE",39.369999999999997,39.369999999999997,9.85,39.369999999999997,9.8424999999999994]
["Not Applicable - Not Applicable - 68084011211","Not Applicable","Not Applicable","NDC","68084011211","GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR",3.15,3.15,1.58,3.15,0.78749999999999998]
["Not Applicable - Not Applicable - 68084011901","Not Applicable","Not Applicable","NDC","68084011901","MIRTAZAPINE 15 MG TABLET",1.08,1.08,0.18,1.08,0.27]
["Not Applicable - Not Applicable - 68084012511","Not Applicable","Not Applicable","NDC","68084012511","TRAZODONE 100 MG TABLET",0.75,0.75,0.1,0.75,0.1875]
["Not Applicable - Not Applicable - 68084017965","Not Applicable","Not Applicable","NDC","68084017965","RIBAVIRIN 200 MG CAPSULE",33.450000000000003,33.450000000000003,22.3,33.450000000000003,8.3625000000000007]
["Not Applicable - Not Applicable - 68084018101","Not Applicable","Not Applicable","NDC","68084018101","SERTRALINE 50 MG TABLET",1.07,1.07,0.27,1.07,0.26750000000000002]
["Not Applicable - Not Applicable - 68084018111","Not Applicable","Not Applicable","NDC","68084018111","SERTRALINE 50 MG TABLET",1.1399999999999999,1.1399999999999999,0.28999999999999998,1.1399999999999999,0.28499999999999998]
["Not Applicable - Not Applicable - 68084018201","Not Applicable","Not Applicable","NDC","68084018201","SERTRALINE 100 MG TABLET",0.54,0.54,0.14000000000000001,0.54,0.13500000000000001]
["Not Applicable - Not Applicable - 68084018211","Not Applicable","Not Applicable","NDC","68084018211","SERTRALINE 100 MG TABLET",0.54,0.54,0.14000000000000001,0.54,0.13500000000000001]
["Not Applicable - Not Applicable - 68084018501","Not Applicable","Not Applicable","NDC","68084018501","OXYCODONE 30 MG TABLET",7.75,7.75,1.3,7.75,1.9375]
["Not Applicable - Not Applicable - 68084018511","Not Applicable","Not Applicable","NDC","68084018511","OXYCODONE 30 MG TABLET",4.93,4.93,0.83,4.93,1.2324999999999999]
["Not Applicable - Not Applicable - 68084019611","Not Applicable","Not Applicable","NDC","68084019611","LISINOPRIL 5 MG TABLET",4.8600000000000003,4.8600000000000003,0.61,4.8600000000000003,1.2150000000000001]
["Not Applicable - Not Applicable - 68084019811","Not Applicable","Not Applicable","NDC","68084019811","LISINOPRIL 20 MG TABLET",0.84,0.84,0.11,0.84,0.21]
["Not Applicable - Not Applicable - 68084020211","Not Applicable","Not Applicable","NDC","68084020211","PRIMIDONE 50 MG TABLET",9.67,9.67,1.94,9.67,2.4175]
["Not Applicable - Not Applicable - 68084020311","Not Applicable","Not Applicable","NDC","68084020311","PRIMIDONE 250 MG TABLET",3.11,3.11,0.63,3.11,0.77749999999999997]
["Not Applicable - Not Applicable - 68084020601","Not Applicable","Not Applicable","NDC","68084020601","SPIRONOLACTONE 25 MG TABLET",4.74,4.74,1.19,4.74,1.1850000000000001]
["Not Applicable - Not Applicable - 68084020701","Not Applicable","Not Applicable","NDC","68084020701","SPIRONOLACTONE 50 MG TABLET",5.43,5.43,1.36,5.43,1.3574999999999999]
["Not Applicable - Not Applicable - 68084020711","Not Applicable","Not Applicable","NDC","68084020711","SPIRONOLACTONE 50 MG TABLET",3.58,3.58,0.9,3.58,0.89500000000000002]
["Not Applicable - Not Applicable - 68084020801","Not Applicable","Not Applicable","NDC","68084020801","SPIRONOLACTONE 100 MG TABLET",4.42,4.42,1.1100000000000001,4.42,1.105]
["Not Applicable - Not Applicable - 68084021411","Not Applicable","Not Applicable","NDC","68084021411","BENZONATATE 100 MG CAPSULE",3.3,3.3,1.65,3.3,0.82499999999999996]
["Not Applicable - Not Applicable - 68084023001","Not Applicable","Not Applicable","NDC","68084023001","SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET",2.16,2.16,1.08,2.16,0.54]
["Not Applicable - Not Applicable - 68084023011","Not Applicable","Not Applicable","NDC","68084023011","SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET",1.87,1.87,0.94,1.87,0.46750000000000003]
["Not Applicable - Not Applicable - 68084024001","Not Applicable","Not Applicable","NDC","68084024001","MIDODRINE 2.5 MG TABLET",8.8000000000000007,8.8000000000000007,2.2000000000000002,8.8000000000000007,2.2000000000000002]
["Not Applicable - Not Applicable - 68084024011","Not Applicable","Not Applicable","NDC","68084024011","MIDODRINE 2.5 MG TABLET",13.9,13.9,3.48,13.9,3.4750000000000001]
["Not Applicable - Not Applicable - 68084024311","Not Applicable","Not Applicable","NDC","68084024311","CLINDAMYCIN HCL 150 MG CAPSULE",4.68,4.68,1.56,4.68,1.17]
["Not Applicable - Not Applicable - 68084024411","Not Applicable","Not Applicable","NDC","68084024411","CLINDAMYCIN HCL 300 MG CAPSULE",3.93,3.93,1.97,3.93,0.98250000000000004]
["Not Applicable - Not Applicable - 68084024801","Not Applicable","Not Applicable","NDC","68084024801","LORATADINE 10 MG TABLET",0.62,0.62,0.31,0.62,0.155]
["Not Applicable - Not Applicable - 68084024811","Not Applicable","Not Applicable","NDC","68084024811","LORATADINE 10 MG TABLET",1.04,1.04,0.52,1.04,0.26]
["Not Applicable - Not Applicable - 68084025301","Not Applicable","Not Applicable","NDC","68084025301","HYDROXYZINE HCL 10 MG TABLET",2.15,2.15,0.43,2.15,0.53749999999999998]
["Not Applicable - Not Applicable - 68084025311","Not Applicable","Not Applicable","NDC","68084025311","HYDROXYZINE HCL 10 MG TABLET",4.8,4.8,0.96,4.8,1.2]
["Not Applicable - Not Applicable - 68084025401","Not Applicable","Not Applicable","NDC","68084025401","HYDROXYZINE HCL 25 MG TABLET",0.96,0.96,0.2,0.96,0.24]
["Not Applicable - Not Applicable - 68084025411","Not Applicable","Not Applicable","NDC","68084025411","HYDROXYZINE HCL 25 MG TABLET",2.25,2.25,0.45,2.25,0.5625]
["Not Applicable - Not Applicable - 68084025901","Not Applicable","Not Applicable","NDC","68084025901","AMLODIPINE 5 MG TABLET",0.66,0.66,0.17,0.66,0.16500000000000001]
["Not Applicable - Not Applicable - 68084025911","Not Applicable","Not Applicable","NDC","68084025911","AMLODIPINE 5 MG TABLET",1.1299999999999999,1.1299999999999999,0.28999999999999998,1.1299999999999999,0.28249999999999997]
["Not Applicable - Not Applicable - 68084026201","Not Applicable","Not Applicable","NDC","68084026201","CARVEDILOL 6.25 MG TABLET",1.7,1.7,0.22,1.7,0.42499999999999999]
["Not Applicable - Not Applicable - 68084026901","Not Applicable","Not Applicable","NDC","68084026901","HYDROXYCHLOROQUINE 200 MG TABLET",11.61,11.61,2.91,11.61,2.9024999999999999]
["Not Applicable - Not Applicable - 68084026911","Not Applicable","Not Applicable","NDC","68084026911","HYDROXYCHLOROQUINE 200 MG TABLET",27.71,27.71,6.93,27.71,6.9275000000000002]
["Not Applicable - Not Applicable - 68084027511","Not Applicable","Not Applicable","NDC","68084027511","METHIMAZOLE 5 MG TABLET",5.22,5.22,1.31,5.22,1.3049999999999999]
["Not Applicable - Not Applicable - 68084027801","Not Applicable","Not Applicable","NDC","68084027801","AZITHROMYCIN 250 MG TABLET",38.22,38.22,7.97,38.22,9.5549999999999997]
["Not Applicable - Not Applicable - 68084027811","Not Applicable","Not Applicable","NDC","68084027811","AZITHROMYCIN 250 MG TABLET",29.62,29.62,6.18,29.62,7.4050000000000002]
["Not Applicable - Not Applicable - 68084028001","Not Applicable","Not Applicable","NDC","68084028001","ETHAMBUTOL 400 MG TABLET",6.09,6.09,3.05,6.09,1.5225]
["Not Applicable - Not Applicable - 68084028101","Not Applicable","Not Applicable","NDC","68084028101","CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE",3.67,3.67,1.84,3.67,0.91749999999999998]
["Not Applicable - Not Applicable - 68084028201","Not Applicable","Not Applicable","NDC","68084028201","CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE",3.36,3.36,1.68,3.36,0.84]
["Not Applicable - Not Applicable - 68084028401","Not Applicable","Not Applicable","NDC","68084028401","HYDROXYUREA 500 MG CAPSULE",3.98,3.98,1.99,3.98,0.995]
["Not Applicable - Not Applicable - 68084028411","Not Applicable","Not Applicable","NDC","68084028411","HYDROXYUREA 500 MG CAPSULE",6.54,6.54,3.27,6.54,1.635]
["Not Applicable - Not Applicable - 68084028811","Not Applicable","Not Applicable","NDC","68084028811","FLUDROCORTISONE 0.1 MG TABLET",6,6,1.5,6,1.5]
["Not Applicable - Not Applicable - 68084029111","Not Applicable","Not Applicable","NDC","68084029111","NALTREXONE 50 MG TABLET",22.99,22.99,3.84,22.99,5.7474999999999996]
["Not Applicable - Not Applicable - 68084029201","Not Applicable","Not Applicable","NDC","68084029201","PHENAZOPYRIDINE 100 MG TABLET",8.32,8.32,4.16,8.32,2.08]
["Not Applicable - Not Applicable - 68084029301","Not Applicable","Not Applicable","NDC","68084029301","PHENAZOPYRIDINE 200 MG TABLET",8.15,8.15,4.08,8.15,2.0375000000000001]
["Not Applicable - Not Applicable - 68084031011","Not Applicable","Not Applicable","NDC","68084031011","DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR",20.91,20.91,5.23,20.91,5.2275]
["Not Applicable - Not Applicable - 68084031301","Not Applicable","Not Applicable","NDC","68084031301","DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE",4.17,4.17,2.09,4.17,1.0425]
["Not Applicable - Not Applicable - 68084031311","Not Applicable","Not Applicable","NDC","68084031311","DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE",5.96,5.96,2.98,5.96,1.49]
["Not Applicable - Not Applicable - 68084031401","Not Applicable","Not Applicable","NDC","68084031401","DIVALPROEX 250 MG TABLET,DELAYED RELEASE",1.57,1.57,0.4,1.57,0.39250000000000002]
["Not Applicable - Not Applicable - 68084031501","Not Applicable","Not Applicable","NDC","68084031501","DIVALPROEX 500 MG TABLET,DELAYED RELEASE",1.32,1.32,0.33,1.32,0.33]
["Not Applicable - Not Applicable - 68084031711","Not Applicable","Not Applicable","NDC","68084031711","DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR",23.16,23.16,5.79,23.16,5.79]
["Not Applicable - Not Applicable - 68084031801","Not Applicable","Not Applicable","NDC","68084031801","LAMOTRIGINE 25 MG TABLET",3.76,3.76,0.47,3.76,0.94]
["Not Applicable - Not Applicable - 68084032811","Not Applicable","Not Applicable","NDC","68084032811","FENOFIBRATE 160 MG TABLET",10.39,10.39,3.51,10.39,2.5975000000000001]
["Not Applicable - Not Applicable - 68084032821","Not Applicable","Not Applicable","NDC","68084032821","FENOFIBRATE 160 MG TABLET",4.88,4.88,1.65,4.88,1.22]
["Not Applicable - Not Applicable - 68084033511","Not Applicable","Not Applicable","NDC","68084033511","LAMOTRIGINE 25 MG CHEWABLE DISPERSIBLE TABLET",76.53,76.53,76.53,76.53,19.1325]
["Not Applicable - Not Applicable - 68084033521","Not Applicable","Not Applicable","NDC","68084033521","LAMOTRIGINE 25 MG CHEWABLE DISPERSIBLE TABLET",98.69,98.69,98.69,98.69,24.672499999999999]
["Not Applicable - Not Applicable - 68084033996","Not Applicable","Not Applicable","NDC","68084033996","SUMATRIPTAN 25 MG TABLET",17.82,17.82,4.46,17.82,4.4550000000000001]
["Not Applicable - Not Applicable - 68084034211","Not Applicable","Not Applicable","NDC","68084034211","TOPIRAMATE 25 MG TABLET",8.4700000000000006,8.4700000000000006,1.06,8.4700000000000006,2.1175000000000002]
["Not Applicable - Not Applicable - 68084034411","Not Applicable","Not Applicable","NDC","68084034411","TOPIRAMATE 100 MG TABLET",3.38,3.38,0.43,3.38,0.84499999999999997]
["Not Applicable - Not Applicable - 68084035501","Not Applicable","Not Applicable","NDC","68084035501","OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET",1.62,1.62,0.81,1.62,0.40500000000000003]
["Not Applicable - Not Applicable - 68084035811","Not Applicable","Not Applicable","NDC","68084035811","RIFAMPIN 300 MG CAPSULE",7.75,7.75,3.88,7.75,1.9375]
["Not Applicable - Not Applicable - 68084036011","Not Applicable","Not Applicable","NDC","68084036011","POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)",4.91,4.91,2.46,4.91,1.2275]
["Not Applicable - Not Applicable - 68084036101","Not Applicable","Not Applicable","NDC","68084036101","PROPAFENONE 150 MG TABLET",3.03,3.03,1.52,3.03,0.75749999999999995]
["Not Applicable - Not Applicable - 68084037101","Not Applicable","Not Applicable","NDC","68084037101","AMIODARONE 200 MG TABLET",4.13,4.13,1.04,4.13,1.0325]
["Not Applicable - Not Applicable - 68084037211","Not Applicable","Not Applicable","NDC","68084037211","ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET",1.89,1.89,0.95,1.89,0.47249999999999998]
["Not Applicable - Not Applicable - 68084038101","Not Applicable","Not Applicable","NDC","68084038101","BENZTROPINE 0.5 MG TABLET",11.34,11.34,2.84,11.34,2.835]
["Not Applicable - Not Applicable - 68084038111","Not Applicable","Not Applicable","NDC","68084038111","BENZTROPINE 0.5 MG TABLET",8.01,8.01,2.0099999999999998,8.01,2.0024999999999999]
["Not Applicable - Not Applicable - 68084038801","Not Applicable","Not Applicable","NDC","68084038801","BENZTROPINE 1 MG TABLET",3.57,3.57,0.9,3.57,0.89249999999999996]
["Not Applicable - Not Applicable - 68084039701","Not Applicable","Not Applicable","NDC","68084039701","CYCLOBENZAPRINE 10 MG TABLET",0.27,0.27,0.14000000000000001,0.27,6.7500000000000004E-2]
["Not Applicable - Not Applicable - 68084039901","Not Applicable","Not Applicable","NDC","68084039901","FINASTERIDE 5 MG TABLET",6.18,6.18,6.18,6.18,1.5449999999999999]
["Not Applicable - Not Applicable - 68084040011","Not Applicable","Not Applicable","NDC","68084040011","OXYBUTYNIN CHLORIDE 5 MG TABLET",3.24,3.24,0.81,3.24,0.81]
["Not Applicable - Not Applicable - 68084040111","Not Applicable","Not Applicable","NDC","68084040111","ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE",27.83,27.83,13.92,27.83,6.9574999999999996]
["Not Applicable - Not Applicable - 68084040711","Not Applicable","Not Applicable","NDC","68084040711","TAMSULOSIN 0.4 MG CAPSULE",4.2,4.2,2.1,4.2,1.05]
["Not Applicable - Not Applicable - 68084040811","Not Applicable","Not Applicable","NDC","68084040811","VALACYCLOVIR 500 MG TABLET",45.48,45.48,11.37,45.48,11.37]
["Not Applicable - Not Applicable - 68084040911","Not Applicable","Not Applicable","NDC","68084040911","VALACYCLOVIR 1 GRAM TABLET",35.53,35.53,8.89,35.53,8.8825000000000003]
["Not Applicable - Not Applicable - 68084041511","Not Applicable","Not Applicable","NDC","68084041511","DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR",15.54,15.54,3.89,15.54,3.8849999999999998]
["Not Applicable - Not Applicable - 68084042301","Not Applicable","Not Applicable","NDC","68084042301","HYDROMORPHONE 2 MG TABLET",3.61,3.61,0.91,3.61,0.90249999999999997]
["Not Applicable - Not Applicable - 68084042311","Not Applicable","Not Applicable","NDC","68084042311","HYDROMORPHONE 2 MG TABLET",2.39,2.39,0.6,2.39,0.59750000000000003]
["Not Applicable - Not Applicable - 68084043098","Not Applicable","Not Applicable","NDC","68084043098","POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET",56.8,56.8,56.8,56.8,14.2]
["Not Applicable - Not Applicable - 68084043099","Not Applicable","Not Applicable","NDC","68084043099","POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET",5.99,5.99,5.99,5.99,1.4975000000000001]
["Not Applicable - Not Applicable - 68084044001","Not Applicable","Not Applicable","NDC","68084044001","PRAMIPEXOLE 0.25 MG TABLET",6.85,6.85,0.57999999999999996,6.85,1.7124999999999999]
["Not Applicable - Not Applicable - 68084044011","Not Applicable","Not Applicable","NDC","68084044011","PRAMIPEXOLE 0.25 MG TABLET",4.55,4.55,0.38,4.55,1.1375]
["Not Applicable - Not Applicable - 68084044701","Not Applicable","Not Applicable","NDC","68084044701","HYDRALAZINE 10 MG TABLET",2.2400000000000002,2.2400000000000002,0.3,2.2400000000000002,0.56000000000000005]
["Not Applicable - Not Applicable - 68084046911","Not Applicable","Not Applicable","NDC","68084046911","HYDROCORTISONE 10 MG TABLET",10.31,10.31,2.58,10.31,2.5775000000000001]
["Not Applicable - Not Applicable - 68084047211","Not Applicable","Not Applicable","NDC","68084047211","HYDROMORPHONE 4 MG TABLET",1.54,1.54,0.2,1.54,0.38500000000000001]
["Not Applicable - Not Applicable - 68084047901","Not Applicable","Not Applicable","NDC","68084047901","CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE",8.58,8.58,2.86,8.58,2.145]
["Not Applicable - Not Applicable - 68084047911","Not Applicable","Not Applicable","NDC","68084047911","CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE",14.91,14.91,4.97,14.91,3.7275]
["Not Applicable - Not Applicable - 68084048001","Not Applicable","Not Applicable","NDC","68084048001","OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR",11.94,11.94,3.98,11.94,2.9849999999999999]
["Not Applicable - Not Applicable - 68084048011","Not Applicable","Not Applicable","NDC","68084048011","OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR",27.41,27.41,9.14,27.41,6.8525]
["Not Applicable - Not Applicable - 68084048101","Not Applicable","Not Applicable","NDC","68084048101","LEVOFLOXACIN 250 MG TABLET",3.74,3.74,0.94,3.74,0.93500000000000005]
["Not Applicable - Not Applicable - 68084048511","Not Applicable","Not Applicable","NDC","68084048511","VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR",5.83,5.83,1.95,5.83,1.4575]
["Not Applicable - Not Applicable - 68084049411","Not Applicable","Not Applicable","NDC","68084049411","PYRIDOSTIGMINE BROMIDE 60 MG TABLET",8.7799999999999994,8.7799999999999994,2.2000000000000002,8.7799999999999994,2.1949999999999998]
["Not Applicable - Not Applicable - 68084050501","Not Applicable","Not Applicable","NDC","68084050501","AMLODIPINE 5 MG TABLET",1.1299999999999999,1.1299999999999999,0.28999999999999998,1.1299999999999999,0.28249999999999997]
["Not Applicable - Not Applicable - 68084051101","Not Applicable","Not Applicable","NDC","68084051101","SIMVASTATIN 10 MG TABLET",1.48,1.48,0.37,1.48,0.37]
["Not Applicable - Not Applicable - 68084051111","Not Applicable","Not Applicable","NDC","68084051111","SIMVASTATIN 10 MG TABLET",2.41,2.41,0.61,2.41,0.60250000000000004]
["Not Applicable - Not Applicable - 68084051211","Not Applicable","Not Applicable","NDC","68084051211","SIMVASTATIN 20 MG TABLET",1.71,1.71,0.43,1.71,0.42749999999999999]
["Not Applicable - Not Applicable - 68084051301","Not Applicable","Not Applicable","NDC","68084051301","SIMVASTATIN 40 MG TABLET",0.61,0.61,0.16,0.61,0.1525]
["Not Applicable - Not Applicable - 68084053211","Not Applicable","Not Applicable","NDC","68084053211","QUETIAPINE 100 MG TABLET",10.37,10.37,3.46,10.37,2.5924999999999998]
["Not Applicable - Not Applicable - 68084053601","Not Applicable","Not Applicable","NDC","68084053601","CLOPIDOGREL 75 MG TABLET",3.87,3.87,0.49,3.87,0.96750000000000003]
["Not Applicable - Not Applicable - 68084053611","Not Applicable","Not Applicable","NDC","68084053611","CLOPIDOGREL 75 MG TABLET",7.37,7.37,0.93,7.37,1.8425]
["Not Applicable - Not Applicable - 68084053911","Not Applicable","Not Applicable","NDC","68084053911","TORSEMIDE 20 MG TABLET",6.33,6.33,0.64,6.33,1.5825]
["Not Applicable - Not Applicable - 68084056111","Not Applicable","Not Applicable","NDC","68084056111","CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR",35.85,35.85,5.98,35.85,8.9625000000000004]
["Not Applicable - Not Applicable - 68084056211","Not Applicable","Not Applicable","NDC","68084056211","CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR",30.93,30.93,5.16,30.93,7.7324999999999999]
["Not Applicable - Not Applicable - 68084056301","Not Applicable","Not Applicable","NDC","68084056301","GABAPENTIN 300 MG CAPSULE",0.67,0.67,0.17,0.67,0.16750000000000001]
["Not Applicable - Not Applicable - 68084059025","Not Applicable","Not Applicable","NDC","68084059025","ATORVASTATIN 80 MG TABLET",0.97,0.97,0.97,0.97,0.24249999999999999]
["Not Applicable - Not Applicable - 68084059095","Not Applicable","Not Applicable","NDC","68084059095","ATORVASTATIN 80 MG TABLET",2.41,2.41,2.41,2.41,0.60250000000000004]
["Not Applicable - Not Applicable - 68084059201","Not Applicable","Not Applicable","NDC","68084059201","ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR",1.27,1.27,0.43,1.27,0.3175]
["Not Applicable - Not Applicable - 68084059211","Not Applicable","Not Applicable","NDC","68084059211","ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR",3.72,3.72,1.24,3.72,0.93]
["Not Applicable - Not Applicable - 68084059701","Not Applicable","Not Applicable","NDC","68084059701","NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR",6.58,6.58,2.2000000000000002,6.58,1.645]
["Not Applicable - Not Applicable - 68084059711","Not Applicable","Not Applicable","NDC","68084059711","NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR",15.88,15.88,5.3,15.88,3.97]
["Not Applicable - Not Applicable - 68084059811","Not Applicable","Not Applicable","NDC","68084059811","NIFEDIPINE ER 60 MG TABLET,EXTENDED RELEASE 24 HR",13.18,13.18,4.4000000000000004,13.18,3.2949999999999999]
["Not Applicable - Not Applicable - 68084060901","Not Applicable","Not Applicable","NDC","68084060901","CLOPIDOGREL 75 MG TABLET",9.9499999999999993,9.9499999999999993,1.25,9.9499999999999993,2.4874999999999998]
["Not Applicable - Not Applicable - 68084061901","Not Applicable","Not Applicable","NDC","68084061901","MONTELUKAST 5 MG CHEWABLE TABLET",2.88,2.88,2.31,2.88,0.72]
["Not Applicable - Not Applicable - 68084062001","Not Applicable","Not Applicable","NDC","68084062001","MONTELUKAST 10 MG TABLET",1.78,1.78,1.78,1.78,0.44500000000000001]
["Not Applicable - Not Applicable - 68084062221","Not Applicable","Not Applicable","NDC","68084062221","SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET",3.49,3.49,3.49,3.49,0.87250000000000005]
["Not Applicable - Not Applicable - 68084065411","Not Applicable","Not Applicable","NDC","68084065411","SOTALOL 80 MG TABLET",6.78,6.78,4.5199999999999996,6.78,1.6950000000000001]
["Not Applicable - Not Applicable - 68084065611","Not Applicable","Not Applicable","NDC","68084065611","AZITHROMYCIN 250 MG TABLET",29.62,29.62,6.18,29.62,7.4050000000000002]
["Not Applicable - Not Applicable - 68084065901","Not Applicable","Not Applicable","NDC","68084065901","METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR",19.36,19.36,2.42,19.36,4.84]
["Not Applicable - Not Applicable - 68084065911","Not Applicable","Not Applicable","NDC","68084065911","METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR",27.63,27.63,3.46,27.63,6.9074999999999998]
["Not Applicable - Not Applicable - 68084066601","Not Applicable","Not Applicable","NDC","68084066601","METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR",8.91,8.91,1.1200000000000001,8.91,2.2275]
["Not Applicable - Not Applicable - 68084066611","Not Applicable","Not Applicable","NDC","68084066611","METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR",13.82,13.82,1.73,13.82,3.4550000000000001]
["Not Applicable - Not Applicable - 68084067511","Not Applicable","Not Applicable","NDC","68084067511","DULOXETINE 20 MG CAPSULE,DELAYED RELEASE",18.84,18.84,6.28,18.84,4.71]
["Not Applicable - Not Applicable - 68084067521","Not Applicable","Not Applicable","NDC","68084067521","DULOXETINE 20 MG CAPSULE,DELAYED RELEASE",7.89,7.89,2.63,7.89,1.9724999999999999]
["Not Applicable - Not Applicable - 68084067611","Not Applicable","Not Applicable","NDC","68084067611","METOCLOPRAMIDE 10 MG TABLET",2.14,2.14,1.07,2.14,0.53500000000000003]
["Not Applicable - Not Applicable - 68084068311","Not Applicable","Not Applicable","NDC","68084068311","DULOXETINE 30 MG CAPSULE,DELAYED RELEASE",11.37,11.37,3.79,11.37,2.8424999999999998]
["Not Applicable - Not Applicable - 68084069711","Not Applicable","Not Applicable","NDC","68084069711","BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE",5.0599999999999996,5.0599999999999996,2.5299999999999998,5.0599999999999996,1.2649999999999999]
["Not Applicable - Not Applicable - 68084069811","Not Applicable","Not Applicable","NDC","68084069811","VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR",7.04,7.04,1.76,7.04,1.76]
["Not Applicable - Not Applicable - 68084070301","Not Applicable","Not Applicable","NDC","68084070301","IBUPROFEN 600 MG TABLET",0.85,0.85,0.22,0.85,0.21249999999999999]
["Not Applicable - Not Applicable - 68084070311","Not Applicable","Not Applicable","NDC","68084070311","IBUPROFEN 600 MG TABLET",0.91,0.91,0.23,0.91,0.22750000000000001]
["Not Applicable - Not Applicable - 68084070825","Not Applicable","Not Applicable","NDC","68084070825","BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE",1.5,1.5,0.75,1.5,0.375]
["Not Applicable - Not Applicable - 68084070895","Not Applicable","Not Applicable","NDC","68084070895","BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE",2.9,2.9,1.45,2.9,0.72499999999999998]
["Not Applicable - Not Applicable - 68084072301","Not Applicable","Not Applicable","NDC","68084072301","OLANZAPINE 5 MG TABLET",3.51,3.51,0.88,3.51,0.87749999999999995]
["Not Applicable - Not Applicable - 68084072311","Not Applicable","Not Applicable","NDC","68084072311","OLANZAPINE 5 MG TABLET",7.1,7.1,1.78,7.1,1.7749999999999999]
["Not Applicable - Not Applicable - 68084072911","Not Applicable","Not Applicable","NDC","68084072911","GALANTAMINE 4 MG TABLET",37.31,37.31,12.44,37.31,9.3275000000000006]
["Not Applicable - Not Applicable - 68084073501","Not Applicable","Not Applicable","NDC","68084073501","FLUCONAZOLE 200 MG TABLET",40.9,40.9,2.56,40.9,10.225]
["Not Applicable - Not Applicable - 68084074211","Not Applicable","Not Applicable","NDC","68084074211","LORAZEPAM 1 MG TABLET",1.1200000000000001,1.1200000000000001,0.28000000000000003,1.1200000000000001,0.28000000000000003]
["Not Applicable - Not Applicable - 68084075411","Not Applicable","Not Applicable","NDC","68084075411","LORAZEPAM 2 MG TABLET",1.78,1.78,0.45,1.78,0.44500000000000001]
["Not Applicable - Not Applicable - 68084076211","Not Applicable","Not Applicable","NDC","68084076211","GABAPENTIN 300 MG CAPSULE",0.67,0.67,0.17,0.67,0.16750000000000001]
["Not Applicable - Not Applicable - 68084077201","Not Applicable","Not Applicable","NDC","68084077201","IBUPROFEN 800 MG TABLET",0.57999999999999996,0.57999999999999996,0.15,0.57999999999999996,0.14499999999999999]
["Not Applicable - Not Applicable - 68084077211","Not Applicable","Not Applicable","NDC","68084077211","IBUPROFEN 800 MG TABLET",0.62,0.62,0.16,0.62,0.155]
["Not Applicable - Not Applicable - 68084077401","Not Applicable","Not Applicable","NDC","68084077401","GABAPENTIN 400 MG CAPSULE",0.5,0.5,0.13,0.5,0.125]
["Not Applicable - Not Applicable - 68084077411","Not Applicable","Not Applicable","NDC","68084077411","GABAPENTIN 400 MG CAPSULE",0.59,0.59,0.15,0.59,0.14749999999999999]
["Not Applicable - Not Applicable - 68084077525","Not Applicable","Not Applicable","NDC","68084077525","TIZANIDINE 2 MG TABLET",3.56,3.56,1.78,3.56,0.89]
["Not Applicable - Not Applicable - 68084077595","Not Applicable","Not Applicable","NDC","68084077595","TIZANIDINE 2 MG TABLET",7.66,7.66,3.83,7.66,1.915]
["Not Applicable - Not Applicable - 68084077611","Not Applicable","Not Applicable","NDC","68084077611","DIVALPROEX 250 MG TABLET,DELAYED RELEASE",1.6,1.6,0.4,1.6,0.4]
["Not Applicable - Not Applicable - 68084078211","Not Applicable","Not Applicable","NDC","68084078211","DIVALPROEX 500 MG TABLET,DELAYED RELEASE",1.27,1.27,0.32,1.27,0.3175]
["Not Applicable - Not Applicable - 68084078301","Not Applicable","Not Applicable","NDC","68084078301","GABAPENTIN 100 MG CAPSULE",2.68,2.68,0.67,2.68,0.67]
["Not Applicable - Not Applicable - 68084078311","Not Applicable","Not Applicable","NDC","68084078311","GABAPENTIN 100 MG CAPSULE",1.78,1.78,0.45,1.78,0.44500000000000001]
["Not Applicable - Not Applicable - 68084080811","Not Applicable","Not Applicable","NDC","68084080811","TRAMADOL 50 MG TABLET",0.93,0.93,0.24,0.93,0.23250000000000001]
["Not Applicable - Not Applicable - 68084082725","Not Applicable","Not Applicable","NDC","68084082725","FENOFIBRATE 54 MG TABLET",7.58,7.58,2.56,7.58,1.895]
["Not Applicable - Not Applicable - 68084082795","Not Applicable","Not Applicable","NDC","68084082795","FENOFIBRATE 54 MG TABLET",11.43,11.43,3.86,11.43,2.8574999999999999]
["Not Applicable - Not Applicable - 68084084401","Not Applicable","Not Applicable","NDC","68084084401","VENLAFAXINE 37.5 MG TABLET",2.36,2.36,0.79,2.36,0.59]
["Not Applicable - Not Applicable - 68084084411","Not Applicable","Not Applicable","NDC","68084084411","VENLAFAXINE 37.5 MG TABLET",4.8,4.8,1.6,4.8,1.2]
["Not Applicable - Not Applicable - 68084084695","Not Applicable","Not Applicable","NDC","68084084695","FLUPHENAZINE 5 MG TABLET",63.18,63.18,6.32,63.18,15.795]
["Not Applicable - Not Applicable - 68084085311","Not Applicable","Not Applicable","NDC","68084085311","OXCARBAZEPINE 300 MG TABLET",6.28,6.28,1.57,6.28,1.57]
["Not Applicable - Not Applicable - 68084085511","Not Applicable","Not Applicable","NDC","68084085511","BACLOFEN 10 MG TABLET",8.1199999999999992,8.1199999999999992,1.02,8.1199999999999992,2.0299999999999998]
["Not Applicable - Not Applicable - 68084087501","Not Applicable","Not Applicable","NDC","68084087501","MONTELUKAST 10 MG TABLET",0.97,0.97,0.97,0.97,0.24249999999999999]
["Not Applicable - Not Applicable - 68084091695","Not Applicable","Not Applicable","NDC","68084091695","PROPRANOLOL ER 120 MG CAPSULE,24 HR,EXTENDED RELEASE",15.44,15.44,5.79,15.44,3.86]
["Not Applicable - Not Applicable - 68084094733","Not Applicable","Not Applicable","NDC","68084094733","QUININE 324 MG CAPSULE",31.35,31.35,15.68,31.35,7.8375000000000004]
["Not Applicable - Not Applicable - 68084094895","Not Applicable","Not Applicable","NDC","68084094895","EPLERENONE 25 MG TABLET",21.65,21.65,10.83,21.65,5.4124999999999996]
["Not Applicable - Not Applicable - 68084096595","Not Applicable","Not Applicable","NDC","68084096595","VALGANCICLOVIR 450 MG TABLET",301.97000000000003,301.97000000000003,150.99,301.97000000000003,75.492500000000007]
["Not Applicable - Not Applicable - 68084096901","Not Applicable","Not Applicable","NDC","68084096901","CELECOXIB 100 MG CAPSULE",11,11,5.5,11,2.75]
["Not Applicable - Not Applicable - 68084096911","Not Applicable","Not Applicable","NDC","68084096911","CELECOXIB 100 MG CAPSULE",16.68,16.68,8.34,16.68,4.17]
["Not Applicable - Not Applicable - 68084097611","Not Applicable","Not Applicable","NDC","68084097611","CELECOXIB 200 MG CAPSULE",14.39,14.39,3.6,14.39,3.5975000000000001]
["Not Applicable - Not Applicable - 68084098833","Not Applicable","Not Applicable","NDC","68084098833","CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET",5.23,5.23,2.62,5.23,1.3075000000000001]
["Not Applicable - Not Applicable - 68094000261","Not Applicable","Not Applicable","NDC","68094000261","CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE",8.93,8.93,2.98,8.93,2.2324999999999999]
["Not Applicable - Not Applicable - 68094002861","Not Applicable","Not Applicable","NDC","68094002861","CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH",6.61,6.61,6.61,6.61,1.6525000000000001]
["Not Applicable - Not Applicable - 68094017159","Not Applicable","Not Applicable","NDC","68094017159","SUCRALFATE 100 MG/ML ORAL SUSPENSION",33.33,33.33,33.33,33.33,8.3324999999999996]
["Not Applicable - Not Applicable - 68094017161","Not Applicable","Not Applicable","NDC","68094017161","SUCRALFATE 100 MG/ML ORAL SUSPENSION (PEDIATRIC)",30.45,30.45,30.45,30.45,7.6124999999999998]
["Not Applicable - Not Applicable - 68094050359","Not Applicable","Not Applicable","NDC","68094050359","IBUPROFEN 100 MG/5 ML ORAL SUSPENSION",4.3,4.3,4.3,4.3,1.075]
["Not Applicable - Not Applicable - 68094050361","Not Applicable","Not Applicable","NDC","68094050361","IBUPROFEN 100 MG/5 ML ORAL SUSPENSION",3.42,3.42,3.42,3.42,0.85499999999999998]
["Not Applicable - Not Applicable - 68094059959","Not Applicable","Not Applicable","NDC","68094059959","NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION",4.91,4.91,4.91,4.91,1.2275]
["Not Applicable - Not Applicable - 68094085362","Not Applicable","Not Applicable","NDC","68094085362","NALTREXONE 50 MG TABLET",18.8,18.8,3.14,18.8,4.7]
["Not Applicable - Not Applicable - 68134020116","Not Applicable","Not Applicable","NDC","68134020116","NAPROXEN 125 MG/5 ML ORAL SUSPENSION",1201.675,1201.675,1178.5649999999998,1201.675,300.41874999999999]
["Not Applicable - Not Applicable - 68176000010","Not Applicable","Not Applicable","NDC","68176000010","PEDIATRIC MULTIVITAMIN NO.128-VITAMIN K 500 MCG/ML ORAL LIQUID",1.47,1.47,1.47,1.47,0.36749999999999999]
["Not Applicable - Not Applicable - 68180012301","Not Applicable","Not Applicable","NDC","68180012301","CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION",54.36,54.36,54.36,54.36,13.59]
["Not Applicable - Not Applicable - 68180012401","Not Applicable","Not Applicable","NDC","68180012401","CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION",53.29,53.29,53.29,53.29,13.3225]
["Not Applicable - Not Applicable - 68180015001","Not Applicable","Not Applicable","NDC","68180015001","FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION",236.6,236.6,236.6,236.6,59.15]
["Not Applicable - Not Applicable - 68180015601","Not Applicable","Not Applicable","NDC","68180015601","CLOBAZAM 2.5 MG/ML ORAL SUSPENSION",785.68,785.68,785.68,785.68,196.42]
["Not Applicable - Not Applicable - 68180015901","Not Applicable","Not Applicable","NDC","68180015901","ETHACRYNIC ACID 25 MG TABLET",132.31,132.31,33.08,132.31,33.077500000000001]
["Not Applicable - Not Applicable - 68180018008","Not Applicable","Not Applicable","NDC","68180018008","CEFADROXIL 500 MG CAPSULE",1.24,1.24,0.62,1.24,0.31]
["Not Applicable - Not Applicable - 68180018202","Not Applicable","Not Applicable","NDC","68180018202","CEFADROXIL 500 MG/5 ML ORAL SUSPENSION",6.4,6.4,6.4,6.4,1.6]
["Not Applicable - Not Applicable - 68180020203","Not Applicable","Not Applicable","NDC","68180020203","CEFIXIME 100 MG/5 ML ORAL SUSPENSION",755.44,755.44,755.44,755.44,188.86]
["Not Applicable - Not Applicable - 68180024101","Not Applicable","Not Applicable","NDC","68180024101","LEVOFLOXACIN 500 MG TABLET",4.41,4.41,1.1100000000000001,4.41,1.1025]
["Not Applicable - Not Applicable - 68180028501","Not Applicable","Not Applicable","NDC","68180028501","RIFABUTIN 150 MG CAPSULE",126.82,126.82,63.41,126.82,31.704999999999998]
["Not Applicable - Not Applicable - 68180028806","Not Applicable","Not Applicable","NDC","68180028806","ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET",152.96,152.96,152.96,152.96,38.24]
["Not Applicable - Not Applicable - 68180035209","Not Applicable","Not Applicable","NDC","68180035209","SERTRALINE 50 MG TABLET",1.21,1.21,0.31,1.21,0.30249999999999999]
["Not Applicable - Not Applicable - 68180035306","Not Applicable","Not Applicable","NDC","68180035306","SERTRALINE 100 MG TABLET",0.78,0.78,0.2,0.78,0.19500000000000001]
["Not Applicable - Not Applicable - 68180035309","Not Applicable","Not Applicable","NDC","68180035309","SERTRALINE 100 MG TABLET",0.61,0.61,0.16,0.61,0.1525]
["Not Applicable - Not Applicable - 68180036209","Not Applicable","Not Applicable","NDC","68180036209","FENOFIBRATE 54 MG TABLET",3.75,3.75,1.27,3.75,0.9375]
["Not Applicable - Not Applicable - 68180036309","Not Applicable","Not Applicable","NDC","68180036309","FENOFIBRATE 160 MG TABLET",4.3499999999999996,4.3499999999999996,1.47,4.3499999999999996,1.0874999999999999]
["Not Applicable - Not Applicable - 68180040101","Not Applicable","Not Applicable","NDC","68180040101","CEFPROZIL 125 MG/5 ML ORAL SUSPENSION",10.31,10.31,10.31,10.31,2.5775000000000001]
["Not Applicable - Not Applicable - 68180040201","Not Applicable","Not Applicable","NDC","68180040201","CEFPROZIL 250 MG/5 ML ORAL SUSPENSION",40.15,40.15,40.15,40.15,10.0375]
["Not Applicable - Not Applicable - 68180040301","Not Applicable","Not Applicable","NDC","68180040301","CEFPROZIL 250 MG TABLET",3.12,3.12,1.56,3.12,0.78]
["Not Applicable - Not Applicable - 68180040401","Not Applicable","Not Applicable","NDC","68180040401","CEFPROZIL 500 MG TABLET",3.02,3.02,1.51,3.02,0.755]
["Not Applicable - Not Applicable - 68180047801","Not Applicable","Not Applicable","NDC","68180047801","SIMVASTATIN 10 MG TABLET",0.43,0.43,0.11,0.43,0.1075]
["Not Applicable - Not Applicable - 68180048001","Not Applicable","Not Applicable","NDC","68180048001","SIMVASTATIN 40 MG TABLET",0.39,0.39,0.1,0.39,9.7500000000000003E-2]
["Not Applicable - Not Applicable - 68180051301","Not Applicable","Not Applicable","NDC","68180051301","LISINOPRIL 5 MG TABLET",0.86,0.86,0.11,0.86,0.215]
["Not Applicable - Not Applicable - 68180051401","Not Applicable","Not Applicable","NDC","68180051401","LISINOPRIL 10 MG TABLET",0.13,0.13,0.02,0.13,3.2500000000000001E-2]
["Not Applicable - Not Applicable - 68180051501","Not Applicable","Not Applicable","NDC","68180051501","LISINOPRIL 20 MG TABLET",0.39,0.39,0.05,0.39,9.7500000000000003E-2]
["Not Applicable - Not Applicable - 68180051503","Not Applicable","Not Applicable","NDC","68180051503","LISINOPRIL 20 MG TABLET",0.19,0.19,0.03,0.19,4.7500000000000001E-2]
["Not Applicable - Not Applicable - 68180056006","Not Applicable","Not Applicable","NDC","68180056006","QUININE 324 MG CAPSULE",37.520000000000003,37.520000000000003,18.760000000000002,37.520000000000003,9.3800000000000008]
["Not Applicable - Not Applicable - 68180065806","Not Applicable","Not Applicable","NDC","68180065806","RIFAMPIN 150 MG CAPSULE",23.93,23.93,5.99,23.93,5.9824999999999999]
["Not Applicable - Not Applicable - 68180096509","Not Applicable","Not Applicable","NDC","68180096509","LEVOTHYROXINE 25 MCG TABLET",4.47,4.47,0.56000000000000005,4.47,1.1174999999999999]
["Not Applicable - Not Applicable - 68180098001","Not Applicable","Not Applicable","NDC","68180098001","LISINOPRIL 10 MG TABLET",0.6,0.6,0.08,0.6,0.15]
["Not Applicable - Not Applicable - 68220014315","Not Applicable","Not Applicable","NDC","68220014315","PRAMOXINE 1 % TOPICAL FOAM",171.91,171.91,171.91,171.91,42.977499999999999]
["Not Applicable - Not Applicable - 68308040547","Not Applicable","Not Applicable","NDC","68308040547","OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET",3.98,3.98,1.99,3.98,0.995]
["Not Applicable - Not Applicable - 68308050547","Not Applicable","Not Applicable","NDC","68308050547","OXYCODONE 5 MG TABLET",3.93,3.93,0.99,3.93,0.98250000000000004]
["Not Applicable - Not Applicable - 68382000514","Not Applicable","Not Applicable","NDC","68382000514","TOPIRAMATE 25 MG SPRINKLE CAPSULE",1.58,1.58,0.95,1.58,0.39500000000000002]
["Not Applicable - Not Applicable - 68382000601","Not Applicable","Not Applicable","NDC","68382000601","LAMOTRIGINE 25 MG TABLET",1.03,1.03,0.13,1.03,0.25750000000000001]
["Not Applicable - Not Applicable - 68382000801","Not Applicable","Not Applicable","NDC","68382000801","LAMOTRIGINE 100 MG TABLET",0.28000000000000003,0.28000000000000003,0.04,0.28000000000000003,7.0000000000000007E-2]
["Not Applicable - Not Applicable - 68382002805","Not Applicable","Not Applicable","NDC","68382002805","METFORMIN 500 MG TABLET",0.56999999999999995,0.56999999999999995,0.28999999999999998,0.56999999999999995,0.14249999999999999]
["Not Applicable - Not Applicable - 68382002901","Not Applicable","Not Applicable","NDC","68382002901","METFORMIN 850 MG TABLET",0.5,0.5,0.25,0.5,0.125]
["Not Applicable - Not Applicable - 68382007116","Not Applicable","Not Applicable","NDC","68382007116","PRAVASTATIN 20 MG TABLET",1.92,1.92,0.24,1.92,0.48]
["Not Applicable - Not Applicable - 68382007901","Not Applicable","Not Applicable","NDC","68382007901","HALOPERIDOL 5 MG TABLET",4.1500000000000004,4.1500000000000004,0.42,4.1500000000000004,1.0375000000000001]
["Not Applicable - Not Applicable - 68382009301","Not Applicable","Not Applicable","NDC","68382009301","CARVEDILOL 6.25 MG TABLET",0.67,0.67,0.09,0.67,0.16750000000000001]
["Not Applicable - Not Applicable - 68382009601","Not Applicable","Not Applicable","NDC","68382009601","HYDROXYCHLOROQUINE 200 MG TABLET",4.9400000000000004,4.9400000000000004,1.24,4.9400000000000004,1.2350000000000001]
["Not Applicable - Not Applicable - 68382013814","Not Applicable","Not Applicable","NDC","68382013814","TOPIRAMATE 25 MG TABLET",0.63,0.63,0.08,0.63,0.1575]
["Not Applicable - Not Applicable - 68382014014","Not Applicable","Not Applicable","NDC","68382014014","TOPIRAMATE 100 MG TABLET",0.32,0.32,0.04,0.32,0.08]
["Not Applicable - Not Applicable - 68382014114","Not Applicable","Not Applicable","NDC","68382014114","TOPIRAMATE 200 MG TABLET",0.23,0.23,0.03,0.23,5.7500000000000002E-2]
["Not Applicable - Not Applicable - 68382019716","Not Applicable","Not Applicable","NDC","68382019716","PRAMIPEXOLE 0.25 MG TABLET",2.31,2.31,0.2,2.31,0.57750000000000001]
["Not Applicable - Not Applicable - 68382020016","Not Applicable","Not Applicable","NDC","68382020016","PRAMIPEXOLE 1.5 MG TABLET",0.41,0.41,0.04,0.41,0.10249999999999999]
["Not Applicable - Not Applicable - 68382022714","Not Applicable","Not Applicable","NDC","68382022714","AMIODARONE 200 MG TABLET",1.8,1.8,0.45,1.8,0.45]
["Not Applicable - Not Applicable - 68382026012","Not Applicable","Not Applicable","NDC","68382026012","RIBAVIRIN 200 MG CAPSULE",19.71,19.71,13.14,19.71,4.9275000000000002]
["Not Applicable - Not Applicable - 68382026101","Not Applicable","Not Applicable","NDC","68382026101","ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE",30.48,30.48,15.24,30.48,7.62]
["Not Applicable - Not Applicable - 68382031130","Not Applicable","Not Applicable","NDC","68382031130","NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH",2.76,2.76,2.76,2.76,0.69]
["Not Applicable - Not Applicable - 68382031818","Not Applicable","Not Applicable","NDC","68382031818","MINOCYCLINE 100 MG CAPSULE",1.5,1.5,0.75,1.5,0.375]
["Not Applicable - Not Applicable - 68382044405","Not Applicable","Not Applicable","NDC","68382044405","FAMOTIDINE 40 MG/5 ML ORAL SUSPENSION (PEDIATRIC)",117.06,117.06,117.06,117.06,29.265000000000001]
["Not Applicable - Not Applicable - 68382052960","Not Applicable","Not Applicable","NDC","68382052960","CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET",3.86,3.86,3.86,3.86,0.96499999999999997]
["Not Applicable - Not Applicable - 68382056928","Not Applicable","Not Applicable","NDC","68382056928","ACAMPROSATE 333 MG TABLET,DELAYED RELEASE",9.33,9.33,4.67,9.33,2.3325]
["Not Applicable - Not Applicable - 68382059616","Not Applicable","Not Applicable","NDC","68382059616","DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR",3.65,3.65,1.22,3.65,0.91249999999999998]
["Not Applicable - Not Applicable - 68382065101","Not Applicable","Not Applicable","NDC","68382065101","ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR",1.57,1.57,0.53,1.57,0.39250000000000002]
["Not Applicable - Not Applicable - 68382066101","Not Applicable","Not Applicable","NDC","68382066101","SPIRONOLACTONE 50 MG TABLET",1.99,1.99,0.5,1.99,0.4975]
["Not Applicable - Not Applicable - 68382077230","Not Applicable","Not Applicable","NDC","68382077230","LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET",22.44,22.44,22.44,22.44,5.61]
["Not Applicable - Not Applicable - 68382080001","Not Applicable","Not Applicable","NDC","68382080001","LABETALOL 300 MG TABLET",2.4,2.4,0.6,2.4,0.6]
["Not Applicable - Not Applicable - 68382089906","Not Applicable","Not Applicable","NDC","68382089906","TADALAFIL 20 MG TABLET",3.87,3.87,1.94,3.87,0.96750000000000003]
["Not Applicable - Not Applicable - 68455010690","Not Applicable","Not Applicable","NDC","68455010690","OSTOMY ADHESIVE PASTE",28.41,28.41,28.41,28.41,7.1025]
["Not Applicable - Not Applicable - 68462010130","Not Applicable","Not Applicable","NDC","68462010130","FLUCONAZOLE 50 MG TABLET",8.84,8.84,4.42,8.84,2.21]
["Not Applicable - Not Applicable - 68462010230","Not Applicable","Not Applicable","NDC","68462010230","FLUCONAZOLE 100 MG TABLET",53.04,53.04,3.32,53.04,13.26]
["Not Applicable - Not Applicable - 68462010860","Not Applicable","Not Applicable","NDC","68462010860","TOPIRAMATE 25 MG TABLET",1.77,1.77,0.23,1.77,0.4425]
["Not Applicable - Not Applicable - 68462012801","Not Applicable","Not Applicable","NDC","68462012801","ZONISAMIDE 25 MG CAPSULE",4.1500000000000004,4.1500000000000004,0.52,4.1500000000000004,1.0375000000000001]
["Not Applicable - Not Applicable - 68462016301","Not Applicable","Not Applicable","NDC","68462016301","CARVEDILOL 6.25 MG TABLET",0.8,0.8,0.1,0.8,0.2]
["Not Applicable - Not Applicable - 68462019690","Not Applicable","Not Applicable","NDC","68462019690","PRAVASTATIN 20 MG TABLET",4.88,4.88,0.61,4.88,1.22]
["Not Applicable - Not Applicable - 68462022801","Not Applicable","Not Applicable","NDC","68462022801","LAMOTRIGINE 5 MG CHEWABLE DISPERSIBLE TABLET",137.49,137.49,137.49,137.49,34.372500000000002]
["Not Applicable - Not Applicable - 68462022901","Not Applicable","Not Applicable","NDC","68462022901","LAMOTRIGINE 25 MG CHEWABLE DISPERSIBLE TABLET",146.01,146.01,146.01,146.01,36.502499999999998]
["Not Applicable - Not Applicable - 68462023501","Not Applicable","Not Applicable","NDC","68462023501","FELODIPINE ER 10 MG TABLET,EXTENDED RELEASE 24 HR",2.27,2.27,0.56999999999999995,2.27,0.5675]
["Not Applicable - Not Applicable - 68462033190","Not Applicable","Not Applicable","NDC","68462033190","PRAMIPEXOLE 0.25 MG TABLET",2.2200000000000002,2.2200000000000002,0.19,2.2200000000000002,0.55500000000000005]
["Not Applicable - Not Applicable - 68462033490","Not Applicable","Not Applicable","NDC","68462033490","PRAMIPEXOLE 1.5 MG TABLET",0.37,0.37,0.04,0.37,9.2499999999999999E-2]
["Not Applicable - Not Applicable - 68462035801","Not Applicable","Not Applicable","NDC","68462035801","NABUMETONE 500 MG TABLET",3.13,3.13,1.57,3.13,0.78249999999999997]
["Not Applicable - Not Applicable - 68462036001","Not Applicable","Not Applicable","NDC","68462036001","HYDROXYZINE HCL 10 MG TABLET",8.09,8.09,1.62,8.09,2.0225]
["Not Applicable - Not Applicable - 68462036101","Not Applicable","Not Applicable","NDC","68462036101","HYDROXYZINE HCL 25 MG TABLET",4.58,4.58,0.92,4.58,1.145]
["Not Applicable - Not Applicable - 68462039230","Not Applicable","Not Applicable","NDC","68462039230","MONTELUKAST 10 MG TABLET",8.8000000000000007,8.8000000000000007,8.8000000000000007,8.8000000000000007,2.2000000000000002]
["Not Applicable - Not Applicable - 68462039290","Not Applicable","Not Applicable","NDC","68462039290","MONTELUKAST 10 MG TABLET",12.74,12.74,12.74,12.74,3.1850000000000001]
["Not Applicable - Not Applicable - 68462040444","Not Applicable","Not Applicable","NDC","68462040444","ATOVAQUONE 250 MG-PROGUANIL 100 MG TABLET",82.95,82.95,82.95,82.95,20.737500000000001]
["Not Applicable - Not Applicable - 68462040601","Not Applicable","Not Applicable","NDC","68462040601","INDOMETHACIN 25 MG CAPSULE",0.46,0.46,0.23,0.46,0.115]
["Not Applicable - Not Applicable - 68462043518","Not Applicable","Not Applicable","NDC","68462043518","ACAMPROSATE 333 MG TABLET,DELAYED RELEASE",7.29,7.29,3.65,7.29,1.8225]
["Not Applicable - Not Applicable - 68462063925","Not Applicable","Not Applicable","NDC","68462063925","NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET",2.93,2.93,2.93,2.93,0.73250000000000004]
["Not Applicable - Not Applicable - 68462063945","Not Applicable","Not Applicable","NDC","68462063945","NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET",0.59,0.59,0.59,0.59,0.14749999999999999]
["Not Applicable - Not Applicable - 68516360702","Not Applicable","Not Applicable","NDC","68516360702","COAGULATION FACTOR IX (ALPHANINE) INTRAVENOUS SOLUTION SUPERORDERABLE",1435.36,1435.36,1435.36,1435.36,358.84]
["Not Applicable - Not Applicable - 68516360902","Not Applicable","Not Applicable","NDC","68516360902","COAGULATION FACTOR IX (ALPHANINE) INTRAVENOUS SOLUTION SUPERORDERABLE",4611.3999999999996,4611.3999999999996,4611.3999999999996,4611.3999999999996,1152.8499999999999]
["Not Applicable - Not Applicable - 68585000612","Not Applicable","Not Applicable","NDC","68585000612","MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET",0.12,0.12,0.06,0.12,0.03]
["Not Applicable - Not Applicable - 68585000641","Not Applicable","Not Applicable","NDC","68585000641","MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET",0.27,0.27,0.14000000000000001,0.27,6.7500000000000004E-2]
["Not Applicable - Not Applicable - 68585000698","Not Applicable","Not Applicable","NDC","68585000698","MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET",0.38,0.38,0.19,0.38,9.5000000000000001E-2]
["Not Applicable - Not Applicable - 68682010910","Not Applicable","Not Applicable","NDC","68682010910","NIFEDIPINE ER 60 MG TABLET,EXTENDED RELEASE 24 HR",9.2100000000000009,9.2100000000000009,3.07,9.2100000000000009,2.3025000000000002]
["Not Applicable - Not Applicable - 68682045570","Not Applicable","Not Applicable","NDC","68682045570","METRONIDAZOLE 0.75 % VAGINAL GEL",369.78,369.78,369.78,369.78,92.444999999999993]
["Not Applicable - Not Applicable - 68682065020","Not Applicable","Not Applicable","NDC","68682065020","DIAZEPAM 2.5 MG RECTAL KIT",351.92,351.92,351.92,351.92,87.98]
["Not Applicable - Not Applicable - 68682065220","Not Applicable","Not Applicable","NDC","68682065220","DIAZEPAM 5 MG-7.5 MG-10 MG RECTAL KIT",886.46,886.46,886.46,886.46,221.61500000000001]
["Not Applicable - Not Applicable - 68682065520","Not Applicable","Not Applicable","NDC","68682065520","DIAZEPAM 12.5 MG-15 MG-17.5 MG-20 MG RECTAL KIT",821.88,821.88,821.88,821.88,205.47]
["Not Applicable - Not Applicable - 68682092005","Not Applicable","Not Applicable","NDC","68682092005","TETRACAINE 0.5 % EYE DROPS",68.040000000000006,68.040000000000006,68.040000000000006,68.040000000000006,17.010000000000002]
["Not Applicable - Not Applicable - 68682099398","Not Applicable","Not Applicable","NDC","68682099398","DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR",2.99,2.99,1,2.99,0.74750000000000005]
["Not Applicable - Not Applicable - 68803061210","Not Applicable","Not Applicable","NDC","68803061210","TRYPAN BLUE 0.06 % INTRAOCULAR SYRINGE",247.97,247.97,247.97,247.97,61.9925]
["Not Applicable - Not Applicable - 68803067205","Not Applicable","Not Applicable","NDC","68803067205","TRYPAN BLUE 0.15 % INTRAOCULAR SYRINGE",478.17,478.17,478.17,478.17,119.5425]
["Not Applicable - Not Applicable - 68803072225","Not Applicable","Not Applicable","NDC","68803072225","C.I. ACID BLUE 90  0.025 % INTRAOCULAR SYRINGE",497.35,497.35,497.35,497.35,124.33750000000001]
["Not Applicable - Not Applicable - 68850001202","Not Applicable","Not Applicable","NDC","68850001202","ETHAMBUTOL 400 MG TABLET",7.56,7.56,3.78,7.56,1.89]
["Not Applicable - Not Applicable - 68968449201","Not Applicable","Not Applicable","NDC","68968449201","LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE",32.14,32.14,10.72,32.14,8.0350000000000001]
["Not Applicable - Not Applicable - 69097012705","Not Applicable","Not Applicable","NDC","69097012705","AMLODIPINE 5 MG TABLET",0.37,0.37,0.1,0.37,9.2499999999999999E-2]
["Not Applicable - Not Applicable - 69097014260","Not Applicable","Not Applicable","NDC","69097014260","ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER",70.77,70.77,70.77,70.77,17.692499999999999]
["Not Applicable - Not Applicable - 69097021002","Not Applicable","Not Applicable","NDC","69097021002","EFAVIRENZ 600 MG-EMTRICITABINE 200 MG-TENOFOVIR DISOPROX 300 MG TABLET",23.14,23.14,23.14,23.14,5.7850000000000001]
["Not Applicable - Not Applicable - 69097023772","Not Applicable","Not Applicable","NDC","69097023772","ALBENDAZOLE 200 MG TABLET",215.5,215.5,107.75,215.5,53.875]
["Not Applicable - Not Applicable - 69097042602","Not Applicable","Not Applicable","NDC","69097042602","ENTECAVIR 0.5 MG TABLET",14.15,14.15,7.08,14.15,3.5375000000000001]
["Not Applicable - Not Applicable - 69097064202","Not Applicable","Not Applicable","NDC","69097064202","EMTRICITABINE 200 MG CAPSULE",45.15,45.15,45.15,45.15,11.2875]
["Not Applicable - Not Applicable - 69097084607","Not Applicable","Not Applicable","NDC","69097084607","CYCLOBENZAPRINE 10 MG TABLET",0.14000000000000001,0.14000000000000001,7.0000000000000007E-2,0.14000000000000001,3.5000000000000003E-2]
["Not Applicable - Not Applicable - 69097094505","Not Applicable","Not Applicable","NDC","69097094505","ATORVASTATIN 20 MG TABLET",2.42,2.42,0.31,2.42,0.60499999999999998]
["Not Applicable - Not Applicable - 69097096507","Not Applicable","Not Applicable","NDC","69097096507","NABUMETONE 500 MG TABLET",1.37,1.37,0.69,1.37,0.34250000000000003]
["Not Applicable - Not Applicable - 69238110005","Not Applicable","Not Applicable","NDC","69238110005","DOXYCYCLINE HYCLATE 100 MG CAPSULE",0.93,0.93,0.93,0.93,0.23250000000000001]
["Not Applicable - Not Applicable - 69238115403","Not Applicable","Not Applicable","NDC","69238115403","EZETIMIBE 10 MG TABLET",1,1,1,1,0.25]
["Not Applicable - Not Applicable - 69238131009","Not Applicable","Not Applicable","NDC","69238131009","PREGABALIN 25 MG CAPSULE",2.66,2.66,0.89,2.66,0.66500000000000004]
["Not Applicable - Not Applicable - 69238131309","Not Applicable","Not Applicable","NDC","69238131309","PREGABALIN 100 MG CAPSULE",0.97,0.97,0.25,0.97,0.24249999999999999]
["Not Applicable - Not Applicable - 69238148401","Not Applicable","Not Applicable","NDC","69238148401","ERYTHROMYCIN 250 MG TABLET",35.72,35.72,35.72,35.72,8.93]
["Not Applicable - Not Applicable - 69238148901","Not Applicable","Not Applicable","NDC","69238148901","BUMETANIDE 0.5 MG TABLET",4.51,4.51,1.1299999999999999,4.51,1.1274999999999999]
["Not Applicable - Not Applicable - 69238149001","Not Applicable","Not Applicable","NDC","69238149001","BUMETANIDE 1 MG TABLET",2.2599999999999998,2.2599999999999998,0.56999999999999995,2.2599999999999998,0.56499999999999995]
["Not Applicable - Not Applicable - 69238152301","Not Applicable","Not Applicable","NDC","69238152301","TETRACYCLINE 500 MG CAPSULE",8.18,8.18,4.09,8.18,2.0449999999999999]
["Not Applicable - Not Applicable - 69238154401","Not Applicable","Not Applicable","NDC","69238154401","HYDROXYCHLOROQUINE 200 MG TABLET",7.21,7.21,1.81,7.21,1.8025]
["Not Applicable - Not Applicable - 69238160502","Not Applicable","Not Applicable","NDC","69238160502","METHYLERGONOVINE 0.2 MG TABLET",66.31,66.31,66.31,66.31,16.577500000000001]
["Not Applicable - Not Applicable - 69238183301","Not Applicable","Not Applicable","NDC","69238183301","LEVOTHYROXINE 88 MCG TABLET",2.15,2.15,0.27,2.15,0.53749999999999998]
["Not Applicable - Not Applicable - 69315021101","Not Applicable","Not Applicable","NDC","69315021101","NIFEDIPINE 10 MG CAPSULE",2.31,2.31,1.1599999999999999,2.31,0.57750000000000001]
["Not Applicable - Not Applicable - 69315070150","Not Applicable","Not Applicable","NDC","69315070150","ETHACRYNATE SODIUM 50 MG INTRAVENOUS SOLUTION",6298.2,6298.2,6298.2,6298.2,1574.55]
["Not Applicable - Not Applicable - 69315090501","Not Applicable","Not Applicable","NDC","69315090501","LORAZEPAM 1 MG TABLET",0.55000000000000004,0.55000000000000004,0.14000000000000001,0.55000000000000004,0.13750000000000001]
["Not Applicable - Not Applicable - 69339014801","Not Applicable","Not Applicable","NDC","69339014801","SUCRALFATE 100 MG/ML ORAL SUSPENSION",36.06,36.06,36.06,36.06,9.0150000000000006]
["Not Applicable - Not Applicable - 69339014817","Not Applicable","Not Applicable","NDC","69339014817","SUCRALFATE 100 MG/ML ORAL SUSPENSION",23.13,23.13,23.13,23.13,5.7824999999999998]
["Not Applicable - Not Applicable - 69367016504","Not Applicable","Not Applicable","NDC","69367016504","FERROUS GLUCONATE 324 MG (38 MG IRON) TABLET",0.14000000000000001,0.14000000000000001,0.14000000000000001,0.14000000000000001,3.5000000000000003E-2]
["Not Applicable - Not Applicable - 69367022001","Not Applicable","Not Applicable","NDC","69367022001","SODIUM CHLORIDE 1 GRAM TABLET",0.47,0.47,0.24,0.47,0.11749999999999999]
["Not Applicable - Not Applicable - 69374052930","Not Applicable","Not Applicable","NDC","69374052930","HYDROMORPHONE(PF) 6 MG/30 ML (0.2 MG/ML)-WATER INTRAVENOUS PCA SYRINGE",32.299999999999997,32.299999999999997,32.299999999999997,32.299999999999997,8.0749999999999993]
["Not Applicable - Not Applicable - 69374055930","Not Applicable","Not Applicable","NDC","69374055930","HYDROMORPHONE 30 MG/30 ML (1 MG/ML) NS CCO SRYINGE",42.63,42.63,42.63,42.63,10.657500000000001]
["Not Applicable - Not Applicable - 69374090105","Not Applicable","Not Applicable","NDC","69374090105","EPHEDRINE (PF) 25 MG/5 ML (5 MG/ML) IN 0.9% SODIUM CHLORIDE IV SYRINGE",60.22,60.22,60.22,60.22,15.055]
["Not Applicable - Not Applicable - 69374092405","Not Applicable","Not Applicable","NDC","69374092405","ROCURONIUM 50 MG/5 ML (10 MG/ML) INTRAVENOUS SYRINGE",26.65,26.65,26.65,26.65,6.6624999999999996]
["Not Applicable - Not Applicable - 69374094604","Not Applicable","Not Applicable","NDC","69374094604","LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE",23.17,23.17,23.17,23.17,5.7925000000000004]
["Not Applicable - Not Applicable - 69374098330","Not Applicable","Not Applicable","NDC","69374098330","HYDROMORPHONE 30 MG/30 ML (1 MG/ML) STERILE WATER CCO SYRINGE",16.52,16.52,16.52,16.52,4.13]
["Not Applicable - Not Applicable - 69452011420","Not Applicable","Not Applicable","NDC","69452011420","CLOBAZAM 10 MG TABLET",4.9800000000000004,4.9800000000000004,1.25,4.9800000000000004,1.2450000000000001]
["Not Applicable - Not Applicable - 69452015020","Not Applicable","Not Applicable","NDC","69452015020","VALPROIC ACID 250 MG CAPSULE",2.33,2.33,1.17,2.33,0.58250000000000002]
["Not Applicable - Not Applicable - 69452015120","Not Applicable","Not Applicable","NDC","69452015120","ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE",0.44,0.44,0.44,0.44,0.11]
["Not Applicable - Not Applicable - 69452020907","Not Applicable","Not Applicable","NDC","69452020907","NIMODIPINE 30 MG CAPSULE",20.420000000000002,20.420000000000002,10.210000000000001,20.420000000000002,5.1050000000000004]
["Not Applicable - Not Applicable - 69543021712","Not Applicable","Not Applicable","NDC","69543021712","MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET",0.18,0.18,0.09,0.18,4.4999999999999998E-2]
["Not Applicable - Not Applicable - 69543026010","Not Applicable","Not Applicable","NDC","69543026010","VITAMIN B COMPLEX AND VITAMIN C NO.20-FOLIC ACID 1 MG CAPSULE",1.2,1.2,1.2,1.2,0.3]
["Not Applicable - Not Applicable - 69543026810","Not Applicable","Not Applicable","NDC","69543026810","SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET",2.25,2.25,1.1299999999999999,2.25,0.5625]
["Not Applicable - Not Applicable - 69547035302","Not Applicable","Not Applicable","NDC","69547035302","NALOXONE 4 MG/ACTUATION NASAL SPRAY",310.77999999999997,310.77999999999997,310.77999999999997,310.77999999999997,77.694999999999993]
["Not Applicable - Not Applicable - 69618000815","Not Applicable","Not Applicable","NDC","69618000815","MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID",9.6,9.6,9.6,9.6,2.4]
["Not Applicable - Not Applicable - 69618000858","Not Applicable","Not Applicable","NDC","69618000858","MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID",0.96,0.96,0.96,0.96,0.24]
["Not Applicable - Not Applicable - 69618003301","Not Applicable","Not Applicable","NDC","69618003301","SIMETHICONE 80 MG CHEWABLE TABLET",0.17,0.17,0.09,0.17,4.2500000000000003E-2]
["Not Applicable - Not Applicable - 69918050105","Not Applicable","Not Applicable","NDC","69918050105","DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY (NON-REFRIGERATED)",699.81,699.81,699.81,699.81,174.95249999999999]
["Not Applicable - Not Applicable - 70000011701","Not Applicable","Not Applicable","NDC","70000011701","NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE",2.82,2.82,1.41,2.82,0.70499999999999996]
["Not Applicable - Not Applicable - 70000012100","Not Applicable","Not Applicable","NDC","70000012100","NICOTINE (POLACRILEX) 4 MG BUCCAL MINI LOZENGE",113.95,113.95,113.95,113.95,28.487500000000001]
["Not Applicable - Not Applicable - 70000012101","Not Applicable","Not Applicable","NDC","70000012101","NICOTINE (POLACRILEX) 4 MG BUCCAL MINI LOZENGE",1.43,1.43,1.43,1.43,0.35749999999999998]
["Not Applicable - Not Applicable - 70000012401","Not Applicable","Not Applicable","NDC","70000012401","KETOTIFEN 0.025 % (0.035 %) EYE DROPS",19.54,19.54,19.54,19.54,4.8849999999999998]
["Not Applicable - Not Applicable - 70000017365","Not Applicable","Not Applicable","NDC","70000017365","ACETAMINOPHEN 160 MG/5 ML ORAL LIQUID",5.19,5.19,5.19,5.19,1.2975000000000001]
["Not Applicable - Not Applicable - 70000017802","Not Applicable","Not Applicable","NDC","70000017802","ASPIRIN 81 MG TABLET,DELAYED RELEASE",0.52,0.52,7.0000000000000007E-2,0.52,0.13]
["Not Applicable - Not Applicable - 70000041501","Not Applicable","Not Applicable","NDC","70000041501","POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER",8.8800000000000008,8.8800000000000008,8.8800000000000008,8.8800000000000008,2.2200000000000002]
["Not Applicable - Not Applicable - 70000041701","Not Applicable","Not Applicable","NDC","70000041701","LOPERAMIDE 1 MG/7.5 ML ORAL LIQUID",10.66,10.66,10.66,10.66,2.665]
["Not Applicable - Not Applicable - 70000043401","Not Applicable","Not Applicable","NDC","70000043401","SIMETHICONE 80 MG CHEWABLE TABLET",0.23,0.23,0.12,0.23,5.7500000000000002E-2]
["Not Applicable - Not Applicable - 70000044701","Not Applicable","Not Applicable","NDC","70000044701","SENNOSIDES 8.6 MG TABLET",0.14000000000000001,0.14000000000000001,7.0000000000000007E-2,0.14000000000000001,3.5000000000000003E-2]
["Not Applicable - Not Applicable - 70000044702","Not Applicable","Not Applicable","NDC","70000044702","SENNOSIDES 8.6 MG TABLET",0.44,0.44,0.22,0.44,0.11]
["Not Applicable - Not Applicable - 70000049601","Not Applicable","Not Applicable","NDC","70000049601","ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION",11.32,11.32,11.32,11.32,2.83]
["Not Applicable - Not Applicable - 70000054601","Not Applicable","Not Applicable","NDC","70000054601","CAMPHOR-MENTHOL 0.5 %-0.5 % LOTION",14.2,14.2,14.2,14.2,3.55]
["Not Applicable - Not Applicable - 70003030020","Not Applicable","Not Applicable","NDC","70003030020","NITROGLYCERIN 400 MCG/SPRAY TRANSLINGUAL",637.20000000000005,637.20000000000005,637.20000000000005,637.20000000000005,159.30000000000001]
["Not Applicable - Not Applicable - 70010006301","Not Applicable","Not Applicable","NDC","70010006301","METFORMIN 500 MG TABLET",0.1,0.1,0.05,0.1,2.5000000000000001E-2]
["Not Applicable - Not Applicable - 70030051063","Not Applicable","Not Applicable","NDC","70030051063","GLUCOSE 4 GRAM CHEWABLE TABLET",1.57,1.57,0.4,1.57,0.39250000000000002]
["Not Applicable - Not Applicable - 70030051066","Not Applicable","Not Applicable","NDC","70030051066","GLUCOSE 4 GRAM CHEWABLE TABLET",1.57,1.57,0.4,1.57,0.39250000000000002]
["Not Applicable - Not Applicable - 70074067397","Not Applicable","Not Applicable","NDC","70074067397","BIFIDO ANIMALIS-B.INFANTIS-S.THERMOPHILUS 1 BILLION ORAL POWDER PACKET",292.73,292.73,97.58,292.73,73.182500000000005]
["Not Applicable - Not Applicable - 70074067398","Not Applicable","Not Applicable","NDC","70074067398","BIFIDO ANIMALIS-B.INFANTIS-S.THERMOPHILUS 1 BILLION ORAL POWDER PACKET",29.38,29.38,9.8000000000000007,29.38,7.3449999999999998]
["Not Applicable - Not Applicable - 70436005106","Not Applicable","Not Applicable","NDC","70436005106","CILOSTAZOL 100 MG TABLET",1.43,1.43,0.72,1.43,0.35749999999999998]
["Not Applicable - Not Applicable - 70436009205","Not Applicable","Not Applicable","NDC","70436009205","ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE",16.66,16.66,16.66,16.66,4.165]
["Not Applicable - Not Applicable - 70710100802","Not Applicable","Not Applicable","NDC","70710100802","OSELTAMIVIR 30 MG CAPSULE",61.33,61.33,24.54,61.33,15.3325]
["Not Applicable - Not Applicable - 70710100902","Not Applicable","Not Applicable","NDC","70710100902","OSELTAMIVIR 45 MG CAPSULE",40.89,40.89,16.36,40.89,10.2225]
["Not Applicable - Not Applicable - 70710101002","Not Applicable","Not Applicable","NDC","70710101002","OSELTAMIVIR 75 MG CAPSULE",26.52,26.52,10.61,26.52,6.63]
["Not Applicable - Not Applicable - 70710102108","Not Applicable","Not Applicable","NDC","70710102108","ALBENDAZOLE 200 MG TABLET",789.23,789.23,394.62,789.23,197.3075]
["Not Applicable - Not Applicable - 70710145701","Not Applicable","Not Applicable","NDC","70710145701","AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION",69.86,69.86,69.86,69.86,17.465]
["Not Applicable - Not Applicable - 70756072111","Not Applicable","Not Applicable","NDC","70756072111","ACETAZOLAMIDE 250 MG TABLET",2.44,2.44,0.61,2.44,0.61]
["Not Applicable - Not Applicable - 70860010310","Not Applicable","Not Applicable","NDC","70860010310","POLYMYXIN B SULFATE 500,000 UNIT SOLUTION FOR INJECTION",29.84,29.84,29.84,29.84,7.46]
["Not Applicable - Not Applicable - 70860045110","Not Applicable","Not Applicable","NDC","70860045110","LEVOTHYROXINE 100 MCG INTRAVENOUS POWDER FOR SOLUTION",313.26,313.26,78.319999999999993,313.26,78.314999999999998]
["Not Applicable - Not Applicable - 70954001610","Not Applicable","Not Applicable","NDC","70954001610","THIOTHIXENE 5 MG CAPSULE",4.54,4.54,1.82,4.54,1.135]
["Not Applicable - Not Applicable - 70954014810","Not Applicable","Not Applicable","NDC","70954014810","PYRIDOSTIGMINE BROMIDE 60 MG/5 ML ORAL SYRUP",3239.69,3239.69,3239.69,3239.69,809.92250000000001]
["Not Applicable - Not Applicable - 70954015110","Not Applicable","Not Applicable","NDC","70954015110","NAPROXEN 125 MG/5 ML ORAL SUSPENSION",655.44,655.44,655.44,655.44,163.86]
["Not Applicable - Not Applicable - 71019037404","Not Applicable","Not Applicable","NDC","71019037404","VECURONIUM IN STERILE WATER 10 MG/10 ML (1 MG/ML) INTRAVENOUS SYRINGE",50.91,50.91,50.91,50.91,12.727499999999999]
["Not Applicable - Not Applicable - 71321080230","Not Applicable","Not Applicable","NDC","71321080230","VITAMIN E (DL, ACETATE) 22.5 MG (50 UNIT)/ML ORAL DROPS",80.150000000000006,80.150000000000006,80.150000000000006,80.150000000000006,20.037500000000001]
["Not Applicable - Not Applicable - 71399862701","Not Applicable","Not Applicable","NDC","71399862701","ASPIRIN 81 MG TABLET,DELAYED RELEASE",0.15,0.15,0.02,0.15,3.7499999999999999E-2]
["Not Applicable - Not Applicable - 71546001010","Not Applicable","Not Applicable","NDC","71546001010","EPHEDRINE SULFATE 50 MG/10 ML (5 MG/ML) IN 0.9%SOD.CHLORIDE IV SYRINGE",278.49,278.49,278.49,278.49,69.622500000000002]
["Not Applicable - Not Applicable - 71546001205","Not Applicable","Not Applicable","NDC","71546001205","EPHEDRINE (PF) 25 MG/5 ML (5 MG/ML) IN 0.9% SODIUM CHLORIDE IV SYRINGE",60.22,60.22,60.22,60.22,15.055]
["Not Applicable - Not Applicable - 71546009005","Not Applicable","Not Applicable","NDC","71546009005","ROCURONIUM 50 MG/5 ML (10 MG/ML) INTRAVENOUS SYRINGE",26.65,26.65,26.65,26.65,6.6624999999999996]
["Not Applicable - Not Applicable - 71546010052","Not Applicable","Not Applicable","NDC","71546010052","EPHEDRINE (PF) 25 MG/5 ML (5 MG/ML) IN 0.9% SODIUM CHLORIDE IV SYRINGE",60.22,60.22,60.22,60.22,15.055]
["Not Applicable - Not Applicable - 72140000022","Not Applicable","Not Applicable","NDC","72140000022","LANOLIN ALCOHOLS-MINERAL OIL-W.PETROLATUM-CERESIN TOPICAL CREAM",16.46,16.46,16.46,16.46,4.1150000000000002]
["Not Applicable - Not Applicable - 72205005108","Not Applicable","Not Applicable","NDC","72205005108","ALBENDAZOLE 200 MG TABLET",198.09,198.09,99.05,198.09,49.522500000000001]
["Not Applicable - Not Applicable - 72508000407","Not Applicable","Not Applicable","NDC","72508000407","AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 62.5 MG/5 ML ORAL SUSPENSION",2041.18,2041.18,2041.18,2041.18,510.29500000000002]
["Not Applicable - Not Applicable - 72508020407","Not Applicable","Not Applicable","NDC","72508020407","AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 62.5 MG/5 ML ORAL SUSPENSION",300.27999999999997,300.27999999999997,300.27999999999997,300.27999999999997,75.069999999999993]
["Not Applicable - Not Applicable - 72627250503","Not Applicable","Not Applicable","NDC","72627250503","PAPAVERINE 150 MG-PHENTOLAMIN 5 MG-ALPROST 50 MCG INTRACAVERNOSAL SOLN",20.04,20.04,8.02,20.04,5.01]
["Not Applicable - Not Applicable - 73657002001","Not Applicable","Not Applicable","NDC","73657002001","MELPHALAN FLUFENAMIDE 20 MG INTRAVENOUS SOLUTION",33748.75,33748.75,33748.75,33748.75,8437.1875]
["Not Applicable - Not Applicable - 75826011510","Not Applicable","Not Applicable","NDC","75826011510","PHENAZOPYRIDINE 200 MG TABLET",3.54,3.54,1.77,3.54,0.88500000000000001]
["Not Applicable - Not Applicable - 75834017001","Not Applicable","Not Applicable","NDC","75834017001","ZINC OXIDE 20 % TOPICAL OINTMENT",9.59,9.59,9.59,9.59,2.3975]
["Not Applicable - Not Applicable - 76045073701","Not Applicable","Not Applicable","NDC","76045073701","HALOPERIDOL LACTATE 5 MG/ML INTRAMUSCULAR SYRINGE",13.33,13.33,13.33,13.33,3.3325]
["Not Applicable - Not Applicable - 76329301105","Not Applicable","Not Applicable","NDC","76329301105","LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR",15.69,15.69,15.69,15.69,3.9224999999999999]
["Not Applicable - Not Applicable - 76329301205","Not Applicable","Not Applicable","NDC","76329301205","LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR",15.69,15.69,15.69,15.69,3.9224999999999999]
["Not Applicable - Not Applicable - 76329330201","Not Applicable","Not Applicable","NDC","76329330201","DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE",54.18,54.18,54.18,54.18,13.545]
["Not Applicable - Not Applicable - 76329330401","Not Applicable","Not Applicable","NDC","76329330401","CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE",28.35,28.35,28.35,28.35,7.0875000000000004]
["Not Applicable - Not Applicable - 76385010401","Not Applicable","Not Applicable","NDC","76385010401","BENZTROPINE 1 MG TABLET",0.96,0.96,0.24,0.96,0.24]
["Not Applicable - Not Applicable - 76388063525","Not Applicable","Not Applicable","NDC","76388063525","CHLORAMBUCIL 2 MG TABLET",2197.4899999999998,2197.4899999999998,439.5,2197.4899999999998,549.37249999999995]
["Not Applicable - Not Applicable - 77333051610","Not Applicable","Not Applicable","NDC","77333051610","MELATONIN 3 MG TABLET",1.93,1.93,0.65,1.93,0.48249999999999998]
["Not Applicable - Not Applicable - 77333083110","Not Applicable","Not Applicable","NDC","77333083110","SODIUM BICARBONATE 650 MG TABLET",0.48,0.48,0.48,0.48,0.12]
["Not Applicable - Not Applicable - 77333083125","Not Applicable","Not Applicable","NDC","77333083125","SODIUM BICARBONATE 650 MG TABLET",0.47,0.47,0.47,0.47,0.11749999999999999]
["Not Applicable - Not Applicable - 77333093410","Not Applicable","Not Applicable","NDC","77333093410","THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET",1.44,1.44,0.48,1.44,0.36]
["Not Applicable - Not Applicable - 77333098310","Not Applicable","Not Applicable","NDC","77333098310","ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE",0.57999999999999996,0.57999999999999996,0.57999999999999996,0.57999999999999996,0.14499999999999999]
["Not Applicable - Not Applicable - 77333098325","Not Applicable","Not Applicable","NDC","77333098325","ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE",0.53,0.53,0.53,0.53,0.13250000000000001]
["Not Applicable - Not Applicable - 78112073623","Not Applicable","Not Applicable","NDC","78112073623","CARBAMIDE PEROXIDE 6.5 % EAR DROPS",17.8,17.8,17.8,17.8,4.45]
["Not Applicable - Not Applicable - 78112073632","Not Applicable","Not Applicable","NDC","78112073632","CARBAMIDE PEROXIDE 6.5 % EAR DROPS",17.78,17.78,17.78,17.78,4.4450000000000003]
["Not Applicable - Not Applicable - 78206011101","Not Applicable","Not Applicable","NDC","78206011101","MOMETASONE 50 MCG/ACTUATION HFA AEROSOL INHALER",382.21,382.21,382.21,382.21,95.552499999999995]
["Not Applicable - Not Applicable - 78206011201","Not Applicable","Not Applicable","NDC","78206011201","MOMETASONE 100 MCG/ACTUATION HFA AEROSOL INHALER",3.42,3.42,3.42,3.42,0.85499999999999998]
["Not Applicable - Not Applicable - 78206011301","Not Applicable","Not Applicable","NDC","78206011301","MOMETASONE 200 MCG/ACTUATION HFA AEROSOL INHALER",4.0199999999999996,4.0199999999999996,4.0199999999999996,4.0199999999999996,1.0049999999999999]
["Not Applicable - Not Applicable - 79854007723","Not Applicable","Not Applicable","NDC","79854007723","CHOLECALCIFEROL (VITAMIN D3) 10 MCG/ML (400 UNIT/ML) ORAL DROPS",0.7,0.7,0.18,0.7,0.17499999999999999]
["Not Applicable - Not Applicable - 79854030035","Not Applicable","Not Applicable","NDC","79854030035","ASCORBIC ACID (VITAMIN C) 500 MG TABLET",0.41,0.41,7.0000000000000007E-2,0.41,0.10249999999999999]
["Not Applicable - Not Applicable - 79854050021","Not Applicable","Not Applicable","NDC","79854050021","CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) TABLET",0.16,0.16,0.16,0.16,0.04]
["Not Applicable - Not Applicable - 80681007100","Not Applicable","Not Applicable","NDC","80681007100","CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET",0.36,0.36,0.04,0.36,0.09]
["Not Applicable - Not Applicable - 80681016000","Not Applicable","Not Applicable","NDC","80681016000","MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET",0.09,0.09,0.09,0.09,2.2499999999999999E-2]
["Not Applicable - Not Applicable - 80681016900","Not Applicable","Not Applicable","NDC","80681016900","CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET",0.04,0.04,0.02,0.04,0.01]
["Not Applicable - Not Applicable - 81421002002","Not Applicable","Not Applicable","NDC","81421002002","BISACODYL 5 MG TABLET,DELAYED RELEASE",1.57,1.57,0.79,1.57,0.39250000000000002]
["Not Applicable - Not Applicable - 81421002102","Not Applicable","Not Applicable","NDC","81421002102","BISACODYL 10 MG RECTAL SUPPOSITORY",3.73,3.73,1.87,3.73,0.9325]
["Not Applicable - Not Applicable - 81421002105","Not Applicable","Not Applicable","NDC","81421002105","BISACODYL 10 MG RECTAL SUPPOSITORY",3.17,3.17,1.59,3.17,0.79249999999999998]
["Not Applicable - Not Applicable - 85446036991","Not Applicable","Not Applicable","NDC","85446036991","SODIUM HYALURONATE 23 MG/ML INTRAOCULAR SYRINGE",397.25,397.25,397.25,397.25,99.3125]
["Not Applicable - Not Applicable - 87701041285","Not Applicable","Not Applicable","NDC","87701041285","NICOTINE (POLACRILEX) 2 MG BUCCAL LOZENGE SUPERORDERABLE",2.89,2.89,1.45,2.89,0.72250000000000003]
["Not Applicable - Not Applicable - 96295012528","Not Applicable","Not Applicable","NDC","96295012528","LOPERAMIDE 1 MG/7.5 ML ORAL LIQUID",10.66,10.66,10.66,10.66,2.665]
["Not Applicable - Not Applicable - 96295013836","Not Applicable","Not Applicable","NDC","96295013836","MULTIVITAMIN WITH FOLIC ACID 400 MCG TABLET",0.08,0.08,0.08,0.08,0.02]
["Not Applicable - Not Applicable - 98515000103","Not Applicable","Not Applicable","NDC","98515000103","AMINO ACIDS-PROTEIN HYDROLYSATE 15 GRAM-101 KCAL/30 ML ORAL LIQUID",3.95,3.95,3.95,3.95,0.98750000000000004]
["Not Applicable - Not Applicable - 99400899664","Not Applicable","Not Applicable","NDC","99400899664","WARFARIN 1.25 MG SPLIT TAB",53.52,53.52,5.36,53.52,13.38]
["Not Applicable - Not Applicable - 99400899665","Not Applicable","Not Applicable","NDC","99400899665","WARFARIN 3.75 MG SPLIT TAB",17.84,17.84,1.79,17.84,4.46]
["Not Applicable - Not Applicable - 99940801136","Not Applicable","Not Applicable","NDC","99940801136","METHOHEXITAL 5 MG/5 ML INJECTION",13.58,13.58,13.58,13.58,3.395]
["Not Applicable - Not Applicable - 99940840536","Not Applicable","Not Applicable","NDC","99940840536","HYDROMORPHONE 30 MG/30 ML (1 MG/ML) NS CCO SRYINGE",42.63,42.63,42.63,42.63,10.657500000000001]
["Not Applicable - Not Applicable - 99990998823","Not Applicable","Not Applicable","NDC","99990998823","WARFARIN 0.5 MG SPLIT TAB",6.69,6.69,6.69,6.69,1.6725000000000001]
["Not Applicable - Not Applicable - 99990998824","Not Applicable","Not Applicable","NDC","99990998824","MISOPROSTOL 25 MCG SPLIT TAB",0.89,0.89,0.89,0.89,0.2225]
["Not Applicable - Not Applicable - 99990999140","Not Applicable","Not Applicable","NDC","99990999140","ALUMINUM HYDROXIDE GEL 320 MG/5 ML ORAL SUSPENSION",0.6,0.6,0.2,0.6,0.15]
["Not Applicable - Not Applicable - 99994080107","Not Applicable","Not Applicable","NDC","99994080107","HEMOSTATIC MATRIX WITHOUT THROMBIN (SURGIFLO) 8 ML KIT",3066.24,3066.24,3066.24,3066.24,766.56]
["Not Applicable - Not Applicable - 99994080113","Not Applicable","Not Applicable","NDC","99994080113","ZINC SULFATE (10 MG ELEMENTAL PER ML) ORAL SUSPENSION (PEDIATRIC)",2.2200000000000002,2.2200000000000002,2.2200000000000002,2.2200000000000002,0.55500000000000005]
["Not Applicable - Not Applicable - 99994080119","Not Applicable","Not Applicable","NDC","99994080119","RALTEGRAVIR 10 MG/ML ORAL SUSPENSION (PEDIATRIC)",2.09,2.09,2.09,2.09,0.52249999999999996]
["Not Applicable - Not Applicable - 99994080149","Not Applicable","Not Applicable","NDC","99994080149","ALLOPURINOL 20 MG/ML ORAL SUSPENSION (NEONATE/PEDIATRIC)",132.16,132.16,132.16,132.16,33.04]
["Not Applicable - Not Applicable - 99994080155","Not Applicable","Not Applicable","NDC","99994080155","HYDROMORPHONE(PF) 6 MG/30 ML (0.2 MG/ML)-WATER INTRAVENOUS PCA SYRINGE",5.65,5.65,5.65,5.65,1.4125000000000001]
["Not Applicable - Not Applicable - 99999102460","Not Applicable","Not Applicable","NDC","99999102460","IBUPROFEN 100 MG/5 ML ORAL SUSPENSION",261.97000000000003,261.97000000000003,261.97000000000003,261.97000000000003,65.492500000000007]
["Not Applicable - Not Applicable - 99999125642","Not Applicable","Not Applicable","NDC","99999125642","SENNA LEAF EXTRACT 176 MG/5 ML ORAL SYRUP",1.87,1.87,1.87,1.87,0.46750000000000003]
["Not Applicable - Not Applicable - 99999128932","Not Applicable","Not Applicable","NDC","99999128932","MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID",1.76,1.76,1.76,1.76,0.44]
["Not Applicable - Not Applicable - 99999164620","Not Applicable","Not Applicable","NDC","99999164620","CLOBAZAM 2.5 MG/ML ORAL SUSPENSION",1594.37,1594.37,1594.37,1594.37,398.59249999999997]
["Not Applicable - Not Applicable - 99999190195","Not Applicable","Not Applicable","NDC","99999190195","HYDROMORPHONE 30 MG/30 ML (1 MG/ML) STERILE WATER CCO SYRINGE",16.52,16.52,16.52,16.52,4.13]
["Not Applicable - Not Applicable - 99999401010","Not Applicable","Not Applicable","NDC","99999401010","ON Q PUMP SINGLE CATHETER",4167.09,4167.09,4167.09,4167.09,1041.7725]
["Not Applicable - Not Applicable - 99999401011","Not Applicable","Not Applicable","NDC","99999401011","ON Q PUMP DUAL CATHETER",996.84,996.84,996.84,996.84,249.21]
["Not Applicable - Not Applicable - 99999408147","Not Applicable","Not Applicable","NDC","99999408147","HYDROXYCHLOROQUINE 25 MG/ML ORAL SUSPENSION",51.84,51.84,25.92,51.84,12.96]
["Not Applicable - Not Applicable - 99999408410","Not Applicable","Not Applicable","NDC","99999408410","METHADONE 10 MG/ML 1 ML ORAL SYRINGE (TCC/SCC USE ONLY)",0.22,0.22,0.22,0.22,5.5E-2]
["Not Applicable - Not Applicable - 99999408520","Not Applicable","Not Applicable","NDC","99999408520","HYDROCHLOROTHIAZIDE 5 MG/ML ORAL SUSPENSION",1064.69,1064.69,1064.69,1064.69,266.17250000000001]
["Not Applicable - Not Applicable - 99999408778","Not Applicable","Not Applicable","NDC","99999408778","THIAMINE 25 MG/ML ORAL SUSPENSION",1.43,1.43,0.36,1.43,0.35749999999999998]
["Not Applicable - Not Applicable - 99999900155","Not Applicable","Not Applicable","NDC","99999900155","MILRINONE IN DEXTROSE 5% INFUSION 200 MCG/ML",53.72,53.72,53.72,53.72,13.43]
["Not Applicable - Not Applicable - 99999909901","Not Applicable","Not Applicable","NDC","99999909901","CLOBAZAM 2.5 MG/ML ORAL SUSPENSION",13.1,13.1,13.1,13.1,3.2749999999999999]
["Not Applicable - Not Applicable - 99999910023","Not Applicable","Not Applicable","NDC","99999910023","FELBAMATE 600 MG/5 ML ORAL SUSPENSION",311.2,311.2,311.2,311.2,77.8]
["Not Applicable - Not Applicable - 99999910810","Not Applicable","Not Applicable","NDC","99999910810","OXYBUTYNIN CHLORIDE 5 MG/5 ML ORAL SYRUP",5.55,5.55,5.55,5.55,1.3875]
["Not Applicable - Not Applicable - 99999922560","Not Applicable","Not Applicable","NDC","99999922560","SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML SUSP ORDERABLE",53.86,53.86,40.4,53.86,13.465]
["Not Applicable - Not Applicable - 99999936962","Not Applicable","Not Applicable","NDC","99999936962","DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID",0.25,0.25,0.13,0.25,6.25E-2]
["Not Applicable - Not Applicable - 99999940802","Not Applicable","Not Applicable","NDC","99999940802","HYDROXYUREA 100 MG/ML ORAL SUSPENSION",4.7699999999999996,4.7699999999999996,2.39,4.7699999999999996,1.1924999999999999]
["Not Applicable - Not Applicable - 99999988801","Not Applicable","Not Applicable","NDC","99999988801","PEDIATRIC MULTIVIT NO.80-IRON 10 MG-750 UNIT-400 UNIT/ML ORAL DROPS",0.51,0.51,0.51,0.51,0.1275]
["Not Applicable - Not Applicable - 99999988803","Not Applicable","Not Applicable","NDC","99999988803","PEDIATRIC MULTIVITAMIN NO.192 250 MCG-50 MG-10 MCG/ML ORAL DROPS",0.51,0.51,0.26,0.51,0.1275]
["Not Applicable - Not Applicable - 99999988869","Not Applicable","Not Applicable","NDC","99999988869","HYDROXYUREA 100 MG/ML ORAL SUSPENSION",2.56,2.56,1.28,2.56,0.64]
["Not Applicable - Not Applicable - 99999990051","Not Applicable","Not Applicable","NDC","99999990051","ZONISAMIDE 10 MG/ML ORAL SUSPENSION",8.5299999999999994,8.5299999999999994,2.85,8.5299999999999994,2.1324999999999998]
["Not Applicable - Not Applicable - 99999990057","Not Applicable","Not Applicable","NDC","99999990057","URSODIOL 20 MG/ML ORAL SUSPENSION",14.39,14.39,14.39,14.39,3.5975000000000001]
["Not Applicable - Not Applicable - 99999990059","Not Applicable","Not Applicable","NDC","99999990059","SILDENAFIL 2.5 MG/ML ORAL SUSPENSION",225.38,225.38,225.38,225.38,56.344999999999999]
["Not Applicable - Not Applicable - 99999990068","Not Applicable","Not Applicable","NDC","99999990068","METRONIDAZOLE 50 MG/ML ORAL SUSPENSION",4.6399999999999997,4.6399999999999997,3.1,4.6399999999999997,1.1599999999999999]
["Not Applicable - Not Applicable - 99999990069","Not Applicable","Not Applicable","NDC","99999990069","LEVOTHYROXINE 25 MCG/ML ORAL SUSPENSION",32.69,32.69,32.69,32.69,8.1724999999999994]
["Not Applicable - Not Applicable - 99999990071","Not Applicable","Not Applicable","NDC","99999990071","LANSOPRAZOLE 3 MG/ML ORAL SUSPENSION",45.83,45.83,22.92,45.83,11.4575]
["Not Applicable - Not Applicable - 99999990072","Not Applicable","Not Applicable","NDC","99999990072","LABETALOL 10 MG/ML ORAL SUSPENSION",4.2699999999999996,4.2699999999999996,1.43,4.2699999999999996,1.0674999999999999]
["Not Applicable - Not Applicable - 99999990073","Not Applicable","Not Applicable","NDC","99999990073","HYDROCORTISONE 2 MG/ML ORAL SUSPENSION",44.06,44.06,44.06,44.06,11.015000000000001]
["Not Applicable - Not Applicable - 99999990074","Not Applicable","Not Applicable","NDC","99999990074","HYDRALAZINE 4 MG/ML ORAL SOLUTION",7.47,7.47,7.47,7.47,1.8674999999999999]
["Not Applicable - Not Applicable - 99999990077","Not Applicable","Not Applicable","NDC","99999990077","FLUCYTOSINE ORAL SUSPENSION 50 MG/ML ",401.69,401.69,133.9,401.69,100.4225]
["Not Applicable - Not Applicable - 99999990082","Not Applicable","Not Applicable","NDC","99999990082","DIPHENHYDRAMINE/LIDOCAINE/MAALOX ORAL SUSPENSION",350.85,350.85,350.85,350.85,87.712500000000006]
["Not Applicable - Not Applicable - 99999990083","Not Applicable","Not Applicable","NDC","99999990083","CLOPIDOGREL 5 MG/ML ORAL SUSPENSION",2.14,2.14,2.14,2.14,0.53500000000000003]
["Not Applicable - Not Applicable - 99999990085","Not Applicable","Not Applicable","NDC","99999990085","CLONIDINE 0.1 MG/ML ORAL SUSPENSION",13.86,13.86,13.86,13.86,3.4649999999999999]
["Not Applicable - Not Applicable - 99999990086","Not Applicable","Not Applicable","NDC","99999990086","CLONAZEPAM 0.1 MG/ML ORAL SUSPENSION",15.35,15.35,15.35,15.35,3.8374999999999999]
["Not Applicable - Not Applicable - 99999990087","Not Applicable","Not Applicable","NDC","99999990087","CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET",0.19,0.19,0.1,0.19,4.7500000000000001E-2]
["Not Applicable - Not Applicable - 99999990088","Not Applicable","Not Applicable","NDC","99999990088","CHLOROQUINE BASE 10 MG/ML ORAL SUSPENSION",30.06,30.06,30.06,30.06,7.5149999999999997]
["Not Applicable - Not Applicable - 99999990089","Not Applicable","Not Applicable","NDC","99999990089","CEFTAZIDIME 50 MG/ML FORTIFIED EYE DROPS",18.440000000000001,18.440000000000001,18.440000000000001,18.440000000000001,4.6100000000000003]
["Not Applicable - Not Applicable - 99999990096","Not Applicable","Not Applicable","NDC","99999990096","ATENOLOL 2 MG/ML ORAL SUSPENSION",21.32,21.32,21.32,21.32,5.33]
["Not Applicable - Not Applicable - 99999990097","Not Applicable","Not Applicable","NDC","99999990097","AMLODIPINE 1 MG/ML ORAL SUSPENSION",2.4900000000000002,2.4900000000000002,1.25,2.4900000000000002,0.62250000000000005]
["Not Applicable - Not Applicable - 99999990099","Not Applicable","Not Applicable","NDC","99999990099","ACETAZOLAMIDE 25 MG/ML ORAL SUSPENSION",22.17,22.17,22.17,22.17,5.5425000000000004]
["Not Applicable - Not Applicable - 99999990258","Not Applicable","Not Applicable","NDC","99999990258","MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID",0.96,0.96,0.96,0.96,0.24]
["Not Applicable - Not Applicable - 99999990266","Not Applicable","Not Applicable","NDC","99999990266","CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH",0.32,0.32,0.32,0.32,0.08]
["Not Applicable - Not Applicable - 99999990997","Not Applicable","Not Applicable","NDC","99999990997","LAMICTAL 100 MG ORAL TAB (BRAND)",0.42,0.42,0.06,0.42,0.105]
["Not Applicable - Not Applicable - 99999992032","Not Applicable","Not Applicable","NDC","99999992032","CYPROHEPTADINE 2 MG/5 ML ORAL SYRUP",9.5299999999999976,9.5299999999999976,7.7449999999999992,9.5299999999999976,2.3824999999999994]
["Not Applicable - Not Applicable - 99999993585","Not Applicable","Not Applicable","NDC","99999993585","HALOPERIDOL LACTATE 2 MG/ML ORAL CONCENTRATE",17.91,17.91,17.91,17.91,4.4775]
["Not Applicable - Not Applicable - 99999996212","Not Applicable","Not Applicable","NDC","99999996212","PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR",23.88,23.88,23.88,23.88,5.97]
["Not Applicable - Not Applicable - 99999996930","Not Applicable","Not Applicable","NDC","99999996930","CHOLECALCIFEROL (VITAMIN D3) 10 MCG/ML (400 UNIT/ML) ORAL DROPS",0.3,0.3,0.08,0.3,7.4999999999999997E-2]
["Not Applicable - Not Applicable - 99999997120","Not Applicable","Not Applicable","NDC","99999997120","SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK",13.47,13.47,13.47,13.47,3.3675000000000002]
["Not Applicable - Not Applicable - 99999999077","Not Applicable","Not Applicable","NDC","99999999077","CLONAZEPAM 0.1 MG/ML ORAL SUSPENSION",15.35,15.35,15.35,15.35,3.8374999999999999]
["Not Applicable - Not Applicable - 99999999131","Not Applicable","Not Applicable","NDC","99999999131","POLYETHYLENE GLYCOL 3350-119 GRAM ORAL SOLUTION",21.32,21.32,21.32,21.32,5.33]
["Not Applicable - Not Applicable - 99999999501","Not Applicable","Not Applicable","NDC","99999999501","ALBUTEROL SULFATE 2 MG/5 ML ORAL SYRUP",14.07,14.07,14.07,14.07,3.5175000000000001]
["Not Applicable - Not Applicable - 99999999505","Not Applicable","Not Applicable","NDC","99999999505","LOPERAMIDE 1 MG/5 ML ORAL LIQUID",4.91,4.91,4.91,4.91,1.2275]
["Not Applicable - Not Applicable - 99999999507","Not Applicable","Not Applicable","NDC","99999999507","THEOPHYLLINE 80 MG/15 ML ORAL ELIXIR",30.27,30.27,30.27,30.27,7.5674999999999999]
["Not Applicable - Not Applicable - 99999999509","Not Applicable","Not Applicable","NDC","99999999509","ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION",104.45,104.45,104.45,104.45,26.112500000000001]
["Not Applicable - Not Applicable - 99999999511","Not Applicable","Not Applicable","NDC","99999999511","DIDANOSINE 10 MG/ML (FINAL CONC.) ORAL SOLUTION",121.5,121.5,121.5,121.5,30.375]
["Not Applicable - Not Applicable - 99999999512","Not Applicable","Not Applicable","NDC","99999999512","FLUPHENAZINE 2.5 MG/5 ML ORAL ELIXIR",72.48,72.48,72.48,72.48,18.12]
["Not Applicable - Not Applicable - 99999999513","Not Applicable","Not Applicable","NDC","99999999513","MEGESTROL 400 MG/10 ML (40 MG/ML) ORAL SUSPENSION",40.5,40.5,40.5,40.5,10.125]
["Not Applicable - Not Applicable - 99999999514","Not Applicable","Not Applicable","NDC","99999999514","NAPROXEN 125 MG/5 ML ORAL SUSPENSION",253.65,253.65,253.65,253.65,63.412500000000001]
["Not Applicable - Not Applicable - 99999999515","Not Applicable","Not Applicable","NDC","99999999515","NITROFURANTOIN 25 MG/5 ML ORAL SUSPENSION",285.63,285.63,285.63,285.63,71.407499999999999]
["Not Applicable - Not Applicable - 99999999517","Not Applicable","Not Applicable","NDC","99999999517","PYRIDOSTIGMINE BROMIDE 60 MG/5 ML ORAL SYRUP",484.71,484.71,484.71,484.71,121.17749999999999]
["Not Applicable - Not Applicable - 99999999518","Not Applicable","Not Applicable","NDC","99999999518","ZIDOVUDINE 10 MG/ML ORAL SYRUP",21.32,21.32,21.32,21.32,5.33]
["Not Applicable - Not Applicable - 99999999522","Not Applicable","Not Applicable","NDC","99999999522","NEVIRAPINE 50 MG/5 ML ORAL SUSPENSION",153.26,153.26,153.26,153.26,38.314999999999998]
["Not Applicable - Not Applicable - 99999999525","Not Applicable","Not Applicable","NDC","99999999525","OXCARBAZEPINE 300 MG/5 ML (60 MG/ML) ORAL SUSPENSION",81,81,81,81,20.25]
["Not Applicable - Not Applicable - 99999999527","Not Applicable","Not Applicable","NDC","99999999527","DICYCLOMINE 10 MG/5 ML ORAL SYRUP",13.65,13.65,3.42,13.65,3.4125000000000001]
["Not Applicable - Not Applicable - 99999999528","Not Applicable","Not Applicable","NDC","99999999528","ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION",10.66,10.66,10.66,10.66,2.665]
["Not Applicable - Not Applicable - 99999999529","Not Applicable","Not Applicable","NDC","99999999529","CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION",3.56,3.56,0.89,3.56,0.89]
["Not Applicable - Not Applicable - 99999999530","Not Applicable","Not Applicable","NDC","99999999530","ASCORBIC ACID (VITAMIN C) 500 MG/5 ML ORAL SYRUP",656.51,656.51,656.51,656.51,164.1275]
["Not Applicable - Not Applicable - 99999999596","Not Applicable","Not Applicable","NDC","99999999596","CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH",1.5,1.5,1.5,1.5,0.375]
["Not Applicable - Not Applicable - 99999999621","Not Applicable","Not Applicable","NDC","99999999621","NITROGLYCERIN 500 MCG/2.5 ML SYRINGE (CATH LAB)",0.72,0.72,0.72,0.72,0.18]
["Not Applicable - Not Applicable - 99999999631","Not Applicable","Not Applicable","NDC","99999999631","INDOCYANINE GREEN 5 MG/ML OPHTHALMIC SOLUTION",45.19,45.19,45.19,45.19,11.297499999999999]
["Not Applicable - Not Applicable - 99999999632","Not Applicable","Not Applicable","NDC","99999999632","FAT EMULSION 20 % INTRAVENOUS",9.8800000000000008,9.8800000000000008,9.8800000000000008,9.8800000000000008,2.4700000000000002]
["Not Applicable - Not Applicable - 99999999633","Not Applicable","Not Applicable","NDC","99999999633","FAT EMULSION 20 % INTRAVENOUS",19.760000000000002,19.760000000000002,19.760000000000002,19.760000000000002,4.9400000000000004]
["Not Applicable - Not Applicable - 99999999634","Not Applicable","Not Applicable","NDC","99999999634","SODIUM CHLORIDE 4 MEQ/ML ORAL SOLN (PEDIATRIC)",15.88,15.88,15.88,15.88,3.97]
["Not Applicable - Not Applicable - 99999999646","Not Applicable","Not Applicable","NDC","99999999646","ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS",122.89,122.89,122.89,122.89,30.7225]
["Not Applicable - Not Applicable - 99999999655","Not Applicable","Not Applicable","NDC","99999999655","PYRIMETHAMINE 2 MG/ML ORAL SUSPENSION",85.26,85.26,85.26,85.26,21.315000000000001]
["Not Applicable - Not Applicable - 99999999681","Not Applicable","Not Applicable","NDC","99999999681","METHADONE 10 MG/ML ORAL CONCENTRATE",1.01,1.01,1.01,1.01,0.2525]
["Not Applicable - Not Applicable - 99999999724","Not Applicable","Not Applicable","NDC","99999999724","SODIUM CHLORIDE 0.225 % INFUSION",2.67,2.67,2.67,2.67,0.66749999999999998]
["Not Applicable - Not Applicable - 99999999739","Not Applicable","Not Applicable","NDC","99999999739","PEDIATRIC MULTIVITAMIN NO.20 1,500 UNIT-35 MG-400 UNIT/ML ORAL DROPS",0.28999999999999998,0.28999999999999998,0.28999999999999998,0.28999999999999998,7.2499999999999995E-2]
["Not Applicable - Not Applicable - 99999999740","Not Applicable","Not Applicable","NDC","99999999740","OPIUM TINCTURE 10% (MORPHINE 10 MG/ML) ORAL",7.46,7.46,7.46,7.46,1.865]
["Not Applicable - Not Applicable - 99999999742","Not Applicable","Not Applicable","NDC","99999999742","MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID",1.76,1.76,1.76,1.76,0.44]
["Not Applicable - Not Applicable - 99999999750","Not Applicable","Not Applicable","NDC","99999999750","NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION",1.25,1.25,1.25,1.25,0.3125]
["Not Applicable - Not Applicable - 99999999751","Not Applicable","Not Applicable","NDC","99999999751","SIMETHICONE 40 MG/0.6 ML ORAL DROPS, SUSPENSION (PEDIATRIC)",0.13,0.13,0.13,0.13,3.2500000000000001E-2]
["Not Applicable - Not Applicable - 99999999754","Not Applicable","Not Applicable","NDC","99999999754","NAPROXEN 125 MG/5 ML ORAL SUSPENSION (PEDIATRIC)",21.14,21.14,21.14,21.14,5.2850000000000001]
["Not Applicable - Not Applicable - 99999999758","Not Applicable","Not Applicable","NDC","99999999758","MIDAZOLAM 2 MG/ML ORAL SYRUP",3.98,3.98,3.98,3.98,0.995]
["Not Applicable - Not Applicable - 99999999759","Not Applicable","Not Applicable","NDC","99999999759","POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER",17.22,17.22,17.22,17.22,4.3049999999999997]
["Not Applicable - Not Applicable - 99999999760","Not Applicable","Not Applicable","NDC","99999999760","POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER",0.31,0.31,0.31,0.31,7.7499999999999999E-2]
["Not Applicable - Not Applicable - 99999999762","Not Applicable","Not Applicable","NDC","99999999762","HYDROMORPHONE 1 MG/ML ORAL LIQUID",5.97,5.97,1.5,5.97,1.4924999999999999]
["Not Applicable - Not Applicable - 99999999810","Not Applicable","Not Applicable","NDC","99999999810","TOPAMAX 25 MG TABLET (BRAND)",167.06,167.06,20.89,167.06,41.765000000000001]
["Not Applicable - Not Applicable - 99999999811","Not Applicable","Not Applicable","NDC","99999999811","TOPAMAX 100 MG TABLET (BRAND)",113.82,113.82,14.23,113.82,28.454999999999998]
["Not Applicable - Not Applicable - 99999999812","Not Applicable","Not Applicable","NDC","99999999812","TOPAMAX 200 MG TABLET (BRAND)",66.63,66.63,8.33,66.63,16.657499999999999]
["Not Applicable - Not Applicable - 99999999813","Not Applicable","Not Applicable","NDC","99999999813","DEPAKOTE 125 MG SPRINKLE CAPSULE (BRAND)",11.15,11.15,5.58,11.15,2.7875000000000001]
["Not Applicable - Not Applicable - 99999999814","Not Applicable","Not Applicable","NDC","99999999814","DEPAKOTE 125 MG TABLET,DELAYED RELEASE (BRAND)",23.55,23.55,5.89,23.55,5.8875000000000002]
["Not Applicable - Not Applicable - 99999999815","Not Applicable","Not Applicable","NDC","99999999815","DEPAKOTE 250 MG TABLET,DELAYED RELEASE (BRAND)",23.13,23.13,5.79,23.13,5.7824999999999998]
["Not Applicable - Not Applicable - 99999999816","Not Applicable","Not Applicable","NDC","99999999816","DEPAKOTE 500 MG TABLET,DELAYED RELEASE (BRAND)",21.33,21.33,5.34,21.33,5.3324999999999996]
["Not Applicable - Not Applicable - 99999999817","Not Applicable","Not Applicable","NDC","99999999817","DEPAKOTE ER 250 MG TABLET,EXTENDED RELEASE 24 HR (BRAND)",44.81,44.81,11.21,44.81,11.202500000000001]
["Not Applicable - Not Applicable - 99999999818","Not Applicable","Not Applicable","NDC","99999999818","DEPAKOTE ER 500 MG TABLET,EXTENDED RELEASE 24 HR (BRAND)",39.31,39.31,9.83,39.31,9.8275000000000006]
["Not Applicable - Not Applicable - 99999999850","Not Applicable","Not Applicable","NDC","99999999850","ZONISAMIDE 100 MG CAPSULE (BRAND)",82.78,82.78,10.35,82.78,20.695]
["Not Applicable - Not Applicable - 99999999851","Not Applicable","Not Applicable","NDC","99999999851","ZONISAMIDE 25 MG CAPSULE (BRAND)",312.43,312.43,39.06,312.43,78.107500000000002]
["Not Applicable - Not Applicable - 99999999879","Not Applicable","Not Applicable","NDC","99999999879","TRILEPTAL 300 MG TABLET (BRAND)",58.91,58.91,14.73,58.91,14.727499999999999]
["Not Applicable - Not Applicable - 99999999880","Not Applicable","Not Applicable","NDC","99999999880","TRILEPTAL 150 MG TABLET (BRAND)",64.52,64.52,16.13,64.52,16.13]
["Not Applicable - Not Applicable - 99999999906","Not Applicable","Not Applicable","NDC","99999999906","IBUPROFEN 100 MG/5 ML ORAL SUSPENSION (PEDI SYRINGE)",1.32,1.32,1.32,1.32,0.33]
["Not Applicable - Not Applicable - 99999999907","Not Applicable","Not Applicable","NDC","99999999907","MIDAZOLAM 2 MG/ML ORAL SYRUP",1.03,1.03,1.03,1.03,0.25750000000000001]
["Not Applicable - Not Applicable - 99999999925","Not Applicable","Not Applicable","NDC","99999999925","CEFTAZIDIME 50 MG/ML FORTIFIED EYE DROPS",111.38,111.38,111.38,111.38,27.844999999999999]
["Not Applicable - Not Applicable - 99999999952","Not Applicable","Not Applicable","NDC","99999999952","CLONIDINE 0.1 MG/ML ORAL SUSPENSION",94704.68,94704.68,94704.68,94704.68,23676.17]
["Not Applicable - Not Applicable - 99999999984","Not Applicable","Not Applicable","NDC","99999999984","KEPPRA 500 MG ORAL TAB (BRAND)",0.79,0.79,0.2,0.79,0.19750000000000001]
["Not Applicable - Not Applicable - 99999999985","Not Applicable","Not Applicable","NDC","99999999985","KEPPRA 250 MG ORAL TAB (BRAND)",3.27,3.27,0.82,3.27,0.8175]
["Not Applicable - Not Applicable - 99999999986","Not Applicable","Not Applicable","NDC","99999999986","LAMICTAL 5 MG ORAL TCHD (BRAND)",102.32,102.32,102.32,102.32,25.58]
["Not Applicable - Not Applicable - 99999999987","Not Applicable","Not Applicable","NDC","99999999987","LAMICTAL 25 MG ORAL TCHD (BRAND)",46.9,46.9,46.9,46.9,11.725]
["Not Applicable - Not Applicable - 99999999988","Not Applicable","Not Applicable","NDC","99999999988","LAMICTAL 25 MG ORAL TAB (BRAND)",3.76,3.76,0.47,3.76,0.94]
["Select Insurance Carrier - Select Insurance Plan - Select Bill Code","Select Insurance Carrier","Select Insurance Plan","Select Bill Type","Select NDC","-","-","-","-","-","-"]

{"sheet":"Average Table","index":5,"n_rows":86228,"n_cols":14,"rows_kept":4500,"cut":true,"hidden":true,"merged":[],"bounds":{"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0}}
["Payer - Plan - Bill Type - Bill Code","Payer - Plan - Bill Code","Payer - Plan - Bill Code & Description","Payer","Plan","Bill Type","Bill Code","Bill Code Description","Bill Code & Description","Gross Charge Amount","Payer Charge Amount","Minimum Charge Amount","Maximum Charge Amount","Self-Pay Charge"]
["UNICARE - UNICARE - HCPCS - 45378","UNICARE - UNICARE - 45378","UNICARE - UNICARE - 45378 - COLON CA SCRN NOT HI RSK IND","UNICARE","UNICARE","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,1020.59,1020.59,3264.67,418]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - 45378","UNICARE - UNICARE STATE INDEMNITY PLAN - 45378","UNICARE - UNICARE STATE INDEMNITY PLAN - 45378 - COLON CA SCRN NOT HI RSK IND","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,1020.59,1020.59,3264.67,418]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - 45378","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 45378","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 45378 - COLON CA SCRN NOT HI RSK IND","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,1608.22,1020.59,3264.67,418]
["TUFTS - TUFTS SELECT - HCPCS - 45378","TUFTS - TUFTS SELECT - 45378","TUFTS - TUFTS SELECT - 45378 - COLON CA SCRN NOT HI RSK IND","TUFTS","TUFTS SELECT","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,1098.98,1020.59,3264.67,418]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - 45378","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 45378","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 45378 - COLON CA SCRN NOT HI RSK IND","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,1568.74,1020.59,3264.67,418]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - 45378","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 45378","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 45378 - COLON CA SCRN NOT HI RSK IND","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,1608.22,1020.59,3264.67,418]
["TUFTS - TUFTS POS - HCPCS - 45378","TUFTS - TUFTS POS - 45378","TUFTS - TUFTS POS - 45378 - COLON CA SCRN NOT HI RSK IND","TUFTS","TUFTS POS","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,2058.17,1020.59,3264.67,418]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - 45378","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 45378","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 45378 - COLON CA SCRN NOT HI RSK IND","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,1608.22,1020.59,3264.67,418]
["TUFTS - TUFTS PPO - HCPCS - 45378","TUFTS - TUFTS PPO - 45378","TUFTS - TUFTS PPO - 45378 - COLON CA SCRN NOT HI RSK IND","TUFTS","TUFTS PPO","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,2058.16,1020.59,3264.67,418]
["TUFTS - TUFTS HMO - HCPCS - 45378","TUFTS - TUFTS HMO - 45378","TUFTS - TUFTS HMO - 45378 - COLON CA SCRN NOT HI RSK IND","TUFTS","TUFTS HMO","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,2057.7399999999998,1020.59,3264.67,418]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - 45378","CIGNA HEALTHCARE - CIGNA CARELINK - 45378","CIGNA HEALTHCARE - CIGNA CARELINK - 45378 - COLON CA SCRN NOT HI RSK IND","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,3264.67,1020.59,3264.67,418]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - 45378","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 45378","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 45378 - COLON CA SCRN NOT HI RSK IND","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,1250.94,1020.59,3264.67,418]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - 45378","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 45378","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 45378 - COLON CA SCRN NOT HI RSK IND","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,1250.94,1020.59,3264.67,418]
["AETNA - AETNA - HCPCS - 45378","AETNA - AETNA - 45378","AETNA - AETNA - 45378 - COLON CA SCRN NOT HI RSK IND","AETNA","AETNA","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,1500.85,1020.59,3264.67,418]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - 45378","BLUE CROSS - BLUE CROSS-PPO - 45378","BLUE CROSS - BLUE CROSS-PPO - 45378 - COLON CA SCRN NOT HI RSK IND","BLUE CROSS","BLUE CROSS-PPO","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,1250.94,1020.59,3264.67,418]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - 45378","BLUE CROSS - BLUE CROSS-HMO BLUE - 45378","BLUE CROSS - BLUE CROSS-HMO BLUE - 45378 - COLON CA SCRN NOT HI RSK IND","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,1250.94,1020.59,3264.67,418]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - 45378","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 45378","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 45378 - COLON CA SCRN NOT HI RSK IND","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,1250.94,1020.59,3264.67,418]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - 45378","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 45378","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 45378 - COLON CA SCRN NOT HI RSK IND","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,1250.94,1020.59,3264.67,418]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - 45378","BLUE CROSS - BLUE CROSS-INDEMNITY - 45378","BLUE CROSS - BLUE CROSS-INDEMNITY - 45378 - COLON CA SCRN NOT HI RSK IND","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,1250.94,1020.59,3264.67,418]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - 81170","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 81170","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,360,159,2909.77,199.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - 81170","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 81170","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,631.79999999999995,159,2909.77,199.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - 81170","UNITED HEALTHCARE - UNITED HEALTHCARE - 81170","UNITED HEALTHCARE - UNITED HEALTHCARE - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,631.79999999999995,159,2909.77,199.5]
["TUFTS - TUFTS SELECT - HCPCS - 81170","TUFTS - TUFTS SELECT - 81170","TUFTS - TUFTS SELECT - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","TUFTS","TUFTS SELECT","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,451.91,159,2909.77,199.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - 81170","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 81170","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,360,159,2909.77,199.5]
["TUFTS - TUFTS SPIRIT - HCPCS - 81170","TUFTS - TUFTS SPIRIT - 81170","TUFTS - TUFTS SPIRIT - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","TUFTS","TUFTS SPIRIT","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,330,159,2909.77,199.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - HCPCS - 81170","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 81170","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,260.89,159,2909.77,199.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - 81170","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 81170","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,404.46,159,2909.77,199.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - 81170","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 81170","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,647.70000000000005,159,2909.77,199.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - HCPCS - 81170","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 81170","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,335.15,159,2909.77,199.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - 81170","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 81170","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,265.99,159,2909.77,199.5]
["FALLON - FALLON SENIOR PLAN - HCPCS - 81170","FALLON - FALLON SENIOR PLAN - 81170","FALLON - FALLON SENIOR PLAN - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","FALLON","FALLON SENIOR PLAN","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,300,159,2909.77,199.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - 81170","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 81170","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,647.70000000000005,159,2909.77,199.5]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - 81170","TUFTS - TUFTS MEDICARE SCO - 81170","TUFTS - TUFTS MEDICARE SCO - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","TUFTS","TUFTS MEDICARE SCO","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,435,159,2909.77,199.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - 81170","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 81170","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,647.70000000000005,159,2909.77,199.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - 81170","TUFTS - TUFTS MEDICARE PREFERRED HMO - 81170","TUFTS - TUFTS MEDICARE PREFERRED HMO - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,435,159,2909.77,199.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - 81170","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - 81170","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,647.70000000000005,159,2909.77,199.5]
["TUFTS - TUFTS POS - HCPCS - 81170","TUFTS - TUFTS POS - 81170","TUFTS - TUFTS POS - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","TUFTS","TUFTS POS","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,967.76,159,2909.77,199.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - 81170","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 81170","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,522,159,2909.77,199.5]
["TUFTS - TUFTS PPO - HCPCS - 81170","TUFTS - TUFTS PPO - 81170","TUFTS - TUFTS PPO - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","TUFTS","TUFTS PPO","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,1035.23,159,2909.77,199.5]
["TUFTS - TUFTS HMO - HCPCS - 81170","TUFTS - TUFTS HMO - 81170","TUFTS - TUFTS HMO - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","TUFTS","TUFTS HMO","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,1161.31,159,2909.77,199.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - 81170","ELDER SERVICE PLAN - ELEMENT CARE INC - 81170","ELDER SERVICE PLAN - ELEMENT CARE INC - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,300,159,2909.77,199.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - 81170","CIGNA HEALTHCARE - CIGNA CARELINK - 81170","CIGNA HEALTHCARE - CIGNA CARELINK - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,2909.77,159,2909.77,199.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - 81170","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 81170","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,300,159,2909.77,199.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - 81170","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 81170","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,548.09,159,2909.77,199.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - 81170","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - 81170","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,331.82,159,2909.77,199.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - 81170","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 81170","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,662.96,159,2909.77,199.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - 81170","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 81170","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,300,159,2909.77,199.5]
["BMC HEALTHNET - BMCHN WELL SENSE - HCPCS - 81170","BMC HEALTHNET - BMCHN WELL SENSE - 81170","BMC HEALTHNET - BMCHN WELL SENSE - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","BMC HEALTHNET","BMCHN WELL SENSE","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,159,159,2909.77,199.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - 81170","BMC HEALTHNET - BMCHN ACO - 81170","BMC HEALTHNET - BMCHN ACO - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","BMC HEALTHNET","BMCHN ACO","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,484.99,159,2909.77,199.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - 81170","BMC HEALTHNET - BMCHN MCO - 81170","BMC HEALTHNET - BMCHN MCO - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","BMC HEALTHNET","BMCHN MCO","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,221.66,159,2909.77,199.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - 81170","BMC HEALTHNET - BMCHN MEDICAID - 81170","BMC HEALTHNET - BMCHN MEDICAID - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","BMC HEALTHNET","BMCHN MEDICAID","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,221.66,159,2909.77,199.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - 81170","BMC HEALTHNET - BMCHN QHP - 81170","BMC HEALTHNET - BMCHN QHP - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","BMC HEALTHNET","BMCHN QHP","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,265.99,159,2909.77,199.5]
["FALLON - FALLON MEDICAID - HCPCS - 81170","FALLON - FALLON MEDICAID - 81170","FALLON - FALLON MEDICAID - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","FALLON","FALLON MEDICAID","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,221.66,159,2909.77,199.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - 81170","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 81170","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,261.56,159,2909.77,199.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - 81170","BLUE CROSS - BLUE CROSS-PPO - 81170","BLUE CROSS - BLUE CROSS-PPO - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","BLUE CROSS","BLUE CROSS-PPO","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,548.09,159,2909.77,199.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - 81170","AETNA - AETNA-MEDICARE ADVANTAGE - 81170","AETNA - AETNA-MEDICARE ADVANTAGE - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,354,159,2909.77,199.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - 81170","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 81170","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,548.09,159,2909.77,199.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - 81170","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 81170","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,300.79000000000002,159,2909.77,199.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - 81170","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 81170","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,548.09,159,2909.77,199.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - 81170","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 81170","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,548.09,159,2909.77,199.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - 81170","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 81170","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,754.86,159,2909.77,199.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - 81170","BLUE CROSS - BLUE CROSS-HMO BLUE - 81170","BLUE CROSS - BLUE CROSS-HMO BLUE - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,548.09,159,2909.77,199.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - 81170","BLUE CROSS - BLUE CROSS-INDEMNITY - 81170","BLUE CROSS - BLUE CROSS-INDEMNITY - 81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,548.09,159,2909.77,199.5]
["TUFTS - TUFTS SELECT - HCPCS - 90471","TUFTS - TUFTS SELECT - 90471","TUFTS - TUFTS SELECT - 90471 - HC ADMIN PNEUMOCOCCAL VACCINE","TUFTS","TUFTS SELECT","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE",64,108.45,76.22,345.64,16]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - 90471","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 90471","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 90471 - HC ADMIN PNEUMOCOCCAL VACCINE","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE",64,129,76.22,345.64,16]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - 90471","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 90471","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 90471 - HC ADMIN PNEUMOCOCCAL VACCINE","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE",64,125.83,76.22,345.64,16]
["TUFTS - TUFTS POS - HCPCS - 90471","TUFTS - TUFTS POS - 90471","TUFTS - TUFTS POS - 90471 - HC ADMIN PNEUMOCOCCAL VACCINE","TUFTS","TUFTS POS","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE",64,203.7,76.22,345.64,16]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - 90471","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 90471","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 90471 - HC ADMIN PNEUMOCOCCAL VACCINE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE",64,129,76.22,345.64,16]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - 90471","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 90471","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 90471 - HC ADMIN PNEUMOCOCCAL VACCINE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE",64,129,76.22,345.64,16]
["TUFTS - TUFTS PPO - HCPCS - 90471","TUFTS - TUFTS PPO - 90471","TUFTS - TUFTS PPO - 90471 - HC ADMIN PNEUMOCOCCAL VACCINE","TUFTS","TUFTS PPO","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE",64,217.91,76.22,345.64,16]
["TUFTS - TUFTS HMO - HCPCS - 90471","TUFTS - TUFTS HMO - 90471","TUFTS - TUFTS HMO - 90471 - HC ADMIN PNEUMOCOCCAL VACCINE","TUFTS","TUFTS HMO","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE",64,203.7,76.22,345.64,16]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - 90471","CIGNA HEALTHCARE - CIGNA CARELINK - 90471","CIGNA HEALTHCARE - CIGNA CARELINK - 90471 - HC ADMIN PNEUMOCOCCAL VACCINE","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE",64,345.64,76.22,345.64,16]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - 90471","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 90471","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 90471 - HC ADMIN PNEUMOCOCCAL VACCINE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE",64,76.22,76.22,345.64,16]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - 90471","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 90471","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 90471 - HC ADMIN PNEUMOCOCCAL VACCINE","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE",64,76.22,76.22,345.64,16]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - 90471","BLUE CROSS - BLUE CROSS-PPO - 90471","BLUE CROSS - BLUE CROSS-PPO - 90471 - HC ADMIN PNEUMOCOCCAL VACCINE","BLUE CROSS","BLUE CROSS-PPO","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE",64,76.22,76.22,345.64,16]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - 90471","BLUE CROSS - BLUE CROSS-HMO BLUE - 90471","BLUE CROSS - BLUE CROSS-HMO BLUE - 90471 - HC ADMIN PNEUMOCOCCAL VACCINE","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE",64,76.22,76.22,345.64,16]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - 90471","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 90471","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 90471 - HC ADMIN PNEUMOCOCCAL VACCINE","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE",64,76.22,76.22,345.64,16]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - 90471","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 90471","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 90471 - HC ADMIN PNEUMOCOCCAL VACCINE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE",64,76.22,76.22,345.64,16]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - 90471","BLUE CROSS - BLUE CROSS-INDEMNITY - 90471","BLUE CROSS - BLUE CROSS-INDEMNITY - 90471 - HC ADMIN PNEUMOCOCCAL VACCINE","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE",64,76.22,76.22,345.64,16]
["TUFTS - TUFTS SELECT - HCPCS - 92083","TUFTS - TUFTS SELECT - 92083","TUFTS - TUFTS SELECT - 92083 - VISUAL FIELD EXAM,EXTENDED","TUFTS","TUFTS SELECT","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,190.72,68.75,607.84,115.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - 92083","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 92083","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 92083 - VISUAL FIELD EXAM,EXTENDED","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,224.25,68.75,607.84,115.25]
["UNICARE - UNICARE - HCPCS - 92083","UNICARE - UNICARE - 92083","UNICARE - UNICARE - 92083 - VISUAL FIELD EXAM,EXTENDED","UNICARE","UNICARE","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,82.5,68.75,607.84,115.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - 92083","UNICARE - UNICARE STATE INDEMNITY PLAN - 92083","UNICARE - UNICARE STATE INDEMNITY PLAN - 92083 - VISUAL FIELD EXAM,EXTENDED","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,68.75,68.75,607.84,115.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - 92083","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 92083","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 92083 - VISUAL FIELD EXAM,EXTENDED","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,229.89,68.75,607.84,115.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - 92083","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 92083","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 92083 - VISUAL FIELD EXAM,EXTENDED","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,229.89,68.75,607.84,115.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - 92083","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 92083","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 92083 - VISUAL FIELD EXAM,EXTENDED","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,229.89,68.75,607.84,115.25]
["TUFTS - TUFTS POS - HCPCS - 92083","TUFTS - TUFTS POS - 92083","TUFTS - TUFTS POS - 92083 - VISUAL FIELD EXAM,EXTENDED","TUFTS","TUFTS POS","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,358.22,68.75,607.84,115.25]
["TUFTS - TUFTS PPO - HCPCS - 92083","TUFTS - TUFTS PPO - 92083","TUFTS - TUFTS PPO - 92083 - VISUAL FIELD EXAM,EXTENDED","TUFTS","TUFTS PPO","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,383.21,68.75,607.84,115.25]
["TUFTS - TUFTS HMO - HCPCS - 92083","TUFTS - TUFTS HMO - 92083","TUFTS - TUFTS HMO - 92083 - VISUAL FIELD EXAM,EXTENDED","TUFTS","TUFTS HMO","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,358.22,68.75,607.84,115.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - 92083","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 92083","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 92083 - VISUAL FIELD EXAM,EXTENDED","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,178.83,68.75,607.84,115.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - 92083","CIGNA HEALTHCARE - CIGNA CARELINK - 92083","CIGNA HEALTHCARE - CIGNA CARELINK - 92083 - VISUAL FIELD EXAM,EXTENDED","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,607.84,68.75,607.84,115.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - 92083","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 92083","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 92083 - VISUAL FIELD EXAM,EXTENDED","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,178.83,68.75,607.84,115.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - 92083","BLUE CROSS - BLUE CROSS-PPO - 92083","BLUE CROSS - BLUE CROSS-PPO - 92083 - VISUAL FIELD EXAM,EXTENDED","BLUE CROSS","BLUE CROSS-PPO","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,178.83,68.75,607.84,115.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - 92083","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 92083","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 92083 - VISUAL FIELD EXAM,EXTENDED","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,178.83,68.75,607.84,115.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - 92083","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 92083","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 92083 - VISUAL FIELD EXAM,EXTENDED","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,178.83,68.75,607.84,115.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - 92083","BLUE CROSS - BLUE CROSS-HMO BLUE - 92083","BLUE CROSS - BLUE CROSS-HMO BLUE - 92083 - VISUAL FIELD EXAM,EXTENDED","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,178.83,68.75,607.84,115.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - 92083","BLUE CROSS - BLUE CROSS-INDEMNITY - 92083","BLUE CROSS - BLUE CROSS-INDEMNITY - 92083 - VISUAL FIELD EXAM,EXTENDED","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,178.83,68.75,607.84,115.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - 95800","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 95800","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 95800 - HOME SLEEP TEST/TYPE 3 PORTA","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,293.52,228.32,1412.44,51.25]
["TUFTS - TUFTS SELECT - HCPCS - 95800","TUFTS - TUFTS SELECT - 95800","TUFTS - TUFTS SELECT - 95800 - HOME SLEEP TEST/TYPE 3 PORTA","TUFTS","TUFTS SELECT","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,250.1,228.32,1412.44,51.25]
["UNICARE - UNICARE - HCPCS - 95800","UNICARE - UNICARE - 95800","UNICARE - UNICARE - 95800 - HOME SLEEP TEST/TYPE 3 PORTA","UNICARE","UNICARE","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,351.84,228.32,1412.44,51.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - 95800","UNICARE - UNICARE STATE INDEMNITY PLAN - 95800","UNICARE - UNICARE STATE INDEMNITY PLAN - 95800 - HOME SLEEP TEST/TYPE 3 PORTA","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,293.2,228.32,1412.44,51.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - 95800","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 95800","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 95800 - HOME SLEEP TEST/TYPE 3 PORTA","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,286.31,228.32,1412.44,51.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - 95800","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 95800","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 95800 - HOME SLEEP TEST/TYPE 3 PORTA","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,293.52,228.32,1412.44,51.25]
["TUFTS - TUFTS POS - HCPCS - 95800","TUFTS - TUFTS POS - 95800","TUFTS - TUFTS POS - 95800 - HOME SLEEP TEST/TYPE 3 PORTA","TUFTS","TUFTS POS","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,469.76,228.32,1412.44,51.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - 95800","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 95800","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 95800 - HOME SLEEP TEST/TYPE 3 PORTA","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,293.52,228.32,1412.44,51.25]
["TUFTS - TUFTS PPO - HCPCS - 95800","TUFTS - TUFTS PPO - 95800","TUFTS - TUFTS PPO - 95800 - HOME SLEEP TEST/TYPE 3 PORTA","TUFTS","TUFTS PPO","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,502.51,228.32,1412.44,51.25]
["TUFTS - TUFTS HMO - HCPCS - 95800","TUFTS - TUFTS HMO - 95800","TUFTS - TUFTS HMO - 95800 - HOME SLEEP TEST/TYPE 3 PORTA","TUFTS","TUFTS HMO","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,563.71,228.32,1412.44,51.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - 95800","CIGNA HEALTHCARE - CIGNA CARELINK - 95800","CIGNA HEALTHCARE - CIGNA CARELINK - 95800 - HOME SLEEP TEST/TYPE 3 PORTA","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,1412.44,228.32,1412.44,51.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - 95800","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 95800","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 95800 - HOME SLEEP TEST/TYPE 3 PORTA","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,228.32,228.32,1412.44,51.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - 95800","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 95800","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 95800 - HOME SLEEP TEST/TYPE 3 PORTA","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,228.32,228.32,1412.44,51.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - 95800","BLUE CROSS - BLUE CROSS-PPO - 95800","BLUE CROSS - BLUE CROSS-PPO - 95800 - HOME SLEEP TEST/TYPE 3 PORTA","BLUE CROSS","BLUE CROSS-PPO","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,228.32,228.32,1412.44,51.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - 95800","BLUE CROSS - BLUE CROSS-HMO BLUE - 95800","BLUE CROSS - BLUE CROSS-HMO BLUE - 95800 - HOME SLEEP TEST/TYPE 3 PORTA","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,228.32,228.32,1412.44,51.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - 95800","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 95800","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 95800 - HOME SLEEP TEST/TYPE 3 PORTA","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,228.32,228.32,1412.44,51.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - 95800","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 95800","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 95800 - HOME SLEEP TEST/TYPE 3 PORTA","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,228.32,228.32,1412.44,51.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - 95800","BLUE CROSS - BLUE CROSS-INDEMNITY - 95800","BLUE CROSS - BLUE CROSS-INDEMNITY - 95800 - HOME SLEEP TEST/TYPE 3 PORTA","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,228.32,228.32,1412.44,51.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - 0042T","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 0042T","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",767,0,1452,1452,191.75]
["TUFTS - TUFTS SELECT - HCPCS - 0042T","TUFTS - TUFTS SELECT - 0042T","TUFTS - TUFTS SELECT - 0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","TUFTS","TUFTS SELECT","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",767,0,1452,1452,191.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - 0042T","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 0042T","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",767,0,1452,1452,191.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - 0042T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 0042T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",767,0,1452,1452,191.75]
["TUFTS - TUFTS POS - HCPCS - 0042T","TUFTS - TUFTS POS - 0042T","TUFTS - TUFTS POS - 0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","TUFTS","TUFTS POS","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",767,0,1452,1452,191.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - 0042T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 0042T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",767,0,1452,1452,191.75]
["TUFTS - TUFTS PPO - HCPCS - 0042T","TUFTS - TUFTS PPO - 0042T","TUFTS - TUFTS PPO - 0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","TUFTS","TUFTS PPO","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",767,0,1452,1452,191.75]
["TUFTS - TUFTS HMO - HCPCS - 0042T","TUFTS - TUFTS HMO - 0042T","TUFTS - TUFTS HMO - 0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","TUFTS","TUFTS HMO","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",767,0,1452,1452,191.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - 0042T","CIGNA HEALTHCARE - CIGNA CARELINK - 0042T","CIGNA HEALTHCARE - CIGNA CARELINK - 0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",767,0,1452,1452,191.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - 0042T","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 0042T","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",767,1452,1452,1452,191.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - 0042T","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 0042T","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",767,1452,1452,1452,191.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - 0042T","BLUE CROSS - BLUE CROSS-PPO - 0042T","BLUE CROSS - BLUE CROSS-PPO - 0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","BLUE CROSS","BLUE CROSS-PPO","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",767,1452,1452,1452,191.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - 0042T","BLUE CROSS - BLUE CROSS-HMO BLUE - 0042T","BLUE CROSS - BLUE CROSS-HMO BLUE - 0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",767,1452,1452,1452,191.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - 0042T","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 0042T","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",767,1452,1452,1452,191.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - 0042T","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 0042T","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",767,1452,1452,1452,191.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - 0042T","BLUE CROSS - BLUE CROSS-INDEMNITY - 0042T","BLUE CROSS - BLUE CROSS-INDEMNITY - 0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",767,1452,1452,1452,191.75]
["TUFTS - TUFTS SELECT - HCPCS - 0278T","TUFTS - TUFTS SELECT - 0278T","TUFTS - TUFTS SELECT - 0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS","TUFTS","TUFTS SELECT","HCPCS","0278T","HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS","0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS",77,317.70999999999998,286.31,943.8,19.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - 0278T","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 0278T","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","0278T","HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS","0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS",77,293.52,286.31,943.8,19.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - 0278T","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 0278T","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","0278T","HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS","0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS",77,286.31,286.31,943.8,19.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - 0278T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 0278T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","0278T","HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS","0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS",77,293.52,286.31,943.8,19.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - 0278T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 0278T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","0278T","HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS","0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS",77,293.52,286.31,943.8,19.25]
["TUFTS - TUFTS POS - HCPCS - 0278T","TUFTS - TUFTS POS - 0278T","TUFTS - TUFTS POS - 0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS","TUFTS","TUFTS POS","HCPCS","0278T","HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS","0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS",77,595.01,286.31,943.8,19.25]
["TUFTS - TUFTS PPO - HCPCS - 0278T","TUFTS - TUFTS PPO - 0278T","TUFTS - TUFTS PPO - 0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS","TUFTS","TUFTS PPO","HCPCS","0278T","HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS","0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS",77,595.01,286.31,943.8,19.25]
["TUFTS - TUFTS HMO - HCPCS - 0278T","TUFTS - TUFTS HMO - 0278T","TUFTS - TUFTS HMO - 0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS","TUFTS","TUFTS HMO","HCPCS","0278T","HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS","0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS",77,595.01,286.31,943.8,19.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - 0278T","CIGNA HEALTHCARE - CIGNA CARELINK - 0278T","CIGNA HEALTHCARE - CIGNA CARELINK - 0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","0278T","HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS","0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS",77,943.8,286.31,943.8,19.25]
["TUFTS - TUFTS SELECT - HCPCS - 0399T","TUFTS - TUFTS SELECT - 0399T","TUFTS - TUFTS SELECT - 0399T - PR MYOCARDIAL STRAIN IMAGING","TUFTS","TUFTS SELECT","HCPCS","0399T","PR MYOCARDIAL STRAIN IMAGING","0399T - PR MYOCARDIAL STRAIN IMAGING",1022,0,0,0,255.5]
["TUFTS - TUFTS POS - HCPCS - 0399T","TUFTS - TUFTS POS - 0399T","TUFTS - TUFTS POS - 0399T - PR MYOCARDIAL STRAIN IMAGING","TUFTS","TUFTS POS","HCPCS","0399T","PR MYOCARDIAL STRAIN IMAGING","0399T - PR MYOCARDIAL STRAIN IMAGING",1022,0,0,0,255.5]
["TUFTS - TUFTS PPO - HCPCS - 0399T","TUFTS - TUFTS PPO - 0399T","TUFTS - TUFTS PPO - 0399T - PR MYOCARDIAL STRAIN IMAGING","TUFTS","TUFTS PPO","HCPCS","0399T","PR MYOCARDIAL STRAIN IMAGING","0399T - PR MYOCARDIAL STRAIN IMAGING",1022,0,0,0,255.5]
["TUFTS - TUFTS HMO - HCPCS - 0399T","TUFTS - TUFTS HMO - 0399T","TUFTS - TUFTS HMO - 0399T - PR MYOCARDIAL STRAIN IMAGING","TUFTS","TUFTS HMO","HCPCS","0399T","PR MYOCARDIAL STRAIN IMAGING","0399T - PR MYOCARDIAL STRAIN IMAGING",1022,0,0,0,255.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - 0399T","CIGNA HEALTHCARE - CIGNA CARELINK - 0399T","CIGNA HEALTHCARE - CIGNA CARELINK - 0399T - PR MYOCARDIAL STRAIN IMAGING","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","0399T","PR MYOCARDIAL STRAIN IMAGING","0399T - PR MYOCARDIAL STRAIN IMAGING",1022,0,0,0,255.5]
["TUFTS - TUFTS SELECT - HCPCS - 0402T","TUFTS - TUFTS SELECT - 0402T","TUFTS - TUFTS SELECT - 0402T - HC COLLAGEN CROSS-LINKING OF CORNEA","TUFTS","TUFTS SELECT","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",2880,3987.49,1198.25,11845.41,720]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - 0402T","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 0402T","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 0402T - HC COLLAGEN CROSS-LINKING OF CORNEA","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",2880,3435.75,1198.25,11845.41,720]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - 0402T","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 0402T","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 0402T - HC COLLAGEN CROSS-LINKING OF CORNEA","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",2880,3522.21,1198.25,11845.41,720]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - 0402T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 0402T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 0402T - HC COLLAGEN CROSS-LINKING OF CORNEA","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",2880,3522.21,1198.25,11845.41,720]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - 0402T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 0402T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 0402T - HC COLLAGEN CROSS-LINKING OF CORNEA","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",2880,3522.21,1198.25,11845.41,720]
["TUFTS - TUFTS POS - HCPCS - 0402T","TUFTS - TUFTS POS - 0402T","TUFTS - TUFTS POS - 0402T - HC COLLAGEN CROSS-LINKING OF CORNEA","TUFTS","TUFTS POS","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",2880,7467.76,1198.25,11845.41,720]
["TUFTS - TUFTS PPO - HCPCS - 0402T","TUFTS - TUFTS PPO - 0402T","TUFTS - TUFTS PPO - 0402T - HC COLLAGEN CROSS-LINKING OF CORNEA","TUFTS","TUFTS PPO","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",2880,7467.76,1198.25,11845.41,720]
["TUFTS - TUFTS HMO - HCPCS - 0402T","TUFTS - TUFTS HMO - 0402T","TUFTS - TUFTS HMO - 0402T - HC COLLAGEN CROSS-LINKING OF CORNEA","TUFTS","TUFTS HMO","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",2880,7467.76,1198.25,11845.41,720]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - 0402T","CIGNA HEALTHCARE - CIGNA CARELINK - 0402T","CIGNA HEALTHCARE - CIGNA CARELINK - 0402T - HC COLLAGEN CROSS-LINKING OF CORNEA","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",2880,11845.41,1198.25,11845.41,720]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - 0402T","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 0402T","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 0402T - HC COLLAGEN CROSS-LINKING OF CORNEA","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",2880,3044.16,1198.25,11845.41,720]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - 0402T","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 0402T","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 0402T - HC COLLAGEN CROSS-LINKING OF CORNEA","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",2880,3044.16,1198.25,11845.41,720]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - 0402T","BLUE CROSS - BLUE CROSS-PPO - 0402T","BLUE CROSS - BLUE CROSS-PPO - 0402T - HC COLLAGEN CROSS-LINKING OF CORNEA","BLUE CROSS","BLUE CROSS-PPO","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",2880,3044.16,1198.25,11845.41,720]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - 0402T","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 0402T","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 0402T - HC COLLAGEN CROSS-LINKING OF CORNEA","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",2880,3044.16,1198.25,11845.41,720]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - 0402T","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 0402T","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 0402T - HC COLLAGEN CROSS-LINKING OF CORNEA","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",2880,3044.16,1198.25,11845.41,720]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - 0402T","BLUE CROSS - BLUE CROSS-HMO BLUE - 0402T","BLUE CROSS - BLUE CROSS-HMO BLUE - 0402T - HC COLLAGEN CROSS-LINKING OF CORNEA","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",2880,3044.16,1198.25,11845.41,720]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - 0402T","BLUE CROSS - BLUE CROSS-INDEMNITY - 0402T","BLUE CROSS - BLUE CROSS-INDEMNITY - 0402T - HC COLLAGEN CROSS-LINKING OF CORNEA","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",2880,3044.16,1198.25,11845.41,720]
["AETNA - AETNA - HCPCS - 0402T","AETNA - AETNA - 0402T","AETNA - AETNA - 0402T - HC COLLAGEN CROSS-LINKING OF CORNEA","AETNA","AETNA","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",2880,1198.25,1198.25,11845.41,720]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A4215","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A4215","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A4215 - STERILE NEEDLE","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A4215","STERILE NEEDLE","A4215 - STERILE NEEDLE",433,0,0,0,108.25]
["TUFTS - TUFTS SELECT - HCPCS - A4215","TUFTS - TUFTS SELECT - A4215","TUFTS - TUFTS SELECT - A4215 - STERILE NEEDLE","TUFTS","TUFTS SELECT","HCPCS","A4215","STERILE NEEDLE","A4215 - STERILE NEEDLE",433,0,0,0,108.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A4215","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A4215","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A4215 - STERILE NEEDLE","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A4215","STERILE NEEDLE","A4215 - STERILE NEEDLE",433,0,0,0,108.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A4215","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A4215","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A4215 - STERILE NEEDLE","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A4215","STERILE NEEDLE","A4215 - STERILE NEEDLE",433,0,0,0,108.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A4215","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A4215","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A4215 - STERILE NEEDLE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A4215","STERILE NEEDLE","A4215 - STERILE NEEDLE",433,0,0,0,108.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A4215","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A4215","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A4215 - STERILE NEEDLE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A4215","STERILE NEEDLE","A4215 - STERILE NEEDLE",433,0,0,0,108.25]
["TUFTS - TUFTS POS - HCPCS - A4215","TUFTS - TUFTS POS - A4215","TUFTS - TUFTS POS - A4215 - STERILE NEEDLE","TUFTS","TUFTS POS","HCPCS","A4215","STERILE NEEDLE","A4215 - STERILE NEEDLE",433,0,0,0,108.25]
["TUFTS - TUFTS PPO - HCPCS - A4215","TUFTS - TUFTS PPO - A4215","TUFTS - TUFTS PPO - A4215 - STERILE NEEDLE","TUFTS","TUFTS PPO","HCPCS","A4215","STERILE NEEDLE","A4215 - STERILE NEEDLE",433,0,0,0,108.25]
["TUFTS - TUFTS HMO - HCPCS - A4215","TUFTS - TUFTS HMO - A4215","TUFTS - TUFTS HMO - A4215 - STERILE NEEDLE","TUFTS","TUFTS HMO","HCPCS","A4215","STERILE NEEDLE","A4215 - STERILE NEEDLE",433,0,0,0,108.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A4215","CIGNA HEALTHCARE - CIGNA CARELINK - A4215","CIGNA HEALTHCARE - CIGNA CARELINK - A4215 - STERILE NEEDLE","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A4215","STERILE NEEDLE","A4215 - STERILE NEEDLE",433,0,0,0,108.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A4215","BMC HEALTHNET - BMCHN ACO - A4215","BMC HEALTHNET - BMCHN ACO - A4215 - STERILE NEEDLE","BMC HEALTHNET","BMCHN ACO","HCPCS","A4215","STERILE NEEDLE","A4215 - STERILE NEEDLE",433,0,0,0,108.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A4215","BMC HEALTHNET - BMCHN MCO - A4215","BMC HEALTHNET - BMCHN MCO - A4215 - STERILE NEEDLE","BMC HEALTHNET","BMCHN MCO","HCPCS","A4215","STERILE NEEDLE","A4215 - STERILE NEEDLE",433,0,0,0,108.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A4215","BMC HEALTHNET - BMCHN MEDICAID - A4215","BMC HEALTHNET - BMCHN MEDICAID - A4215 - STERILE NEEDLE","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A4215","STERILE NEEDLE","A4215 - STERILE NEEDLE",433,0,0,0,108.25]
["FALLON - FALLON MEDICAID - HCPCS - A4215","FALLON - FALLON MEDICAID - A4215","FALLON - FALLON MEDICAID - A4215 - STERILE NEEDLE","FALLON","FALLON MEDICAID","HCPCS","A4215","STERILE NEEDLE","A4215 - STERILE NEEDLE",433,0,0,0,108.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A4215","BMC HEALTHNET - BMCHN QHP - A4215","BMC HEALTHNET - BMCHN QHP - A4215 - STERILE NEEDLE","BMC HEALTHNET","BMCHN QHP","HCPCS","A4215","STERILE NEEDLE","A4215 - STERILE NEEDLE",433,0,0,0,108.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A4215","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A4215","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A4215 - STERILE NEEDLE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A4215","STERILE NEEDLE","A4215 - STERILE NEEDLE",433,0,0,0,108.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A4215","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A4215","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A4215 - STERILE NEEDLE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A4215","STERILE NEEDLE","A4215 - STERILE NEEDLE",433,0,0,0,108.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A4467","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A4467","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A4467 - BELT STRAP SLEEV GRMNT COVER","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A4467","BELT STRAP SLEEV GRMNT COVER","A4467 - BELT STRAP SLEEV GRMNT COVER",151,0,0,0,37.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A4467","BMC HEALTHNET - BMCHN ACO - A4467","BMC HEALTHNET - BMCHN ACO - A4467 - BELT STRAP SLEEV GRMNT COVER","BMC HEALTHNET","BMCHN ACO","HCPCS","A4467","BELT STRAP SLEEV GRMNT COVER","A4467 - BELT STRAP SLEEV GRMNT COVER",151,0,0,0,37.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A4467","BMC HEALTHNET - BMCHN MCO - A4467","BMC HEALTHNET - BMCHN MCO - A4467 - BELT STRAP SLEEV GRMNT COVER","BMC HEALTHNET","BMCHN MCO","HCPCS","A4467","BELT STRAP SLEEV GRMNT COVER","A4467 - BELT STRAP SLEEV GRMNT COVER",151,0,0,0,37.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A4467","BMC HEALTHNET - BMCHN MEDICAID - A4467","BMC HEALTHNET - BMCHN MEDICAID - A4467 - BELT STRAP SLEEV GRMNT COVER","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A4467","BELT STRAP SLEEV GRMNT COVER","A4467 - BELT STRAP SLEEV GRMNT COVER",151,0,0,0,37.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A4467","BMC HEALTHNET - BMCHN QHP - A4467","BMC HEALTHNET - BMCHN QHP - A4467 - BELT STRAP SLEEV GRMNT COVER","BMC HEALTHNET","BMCHN QHP","HCPCS","A4467","BELT STRAP SLEEV GRMNT COVER","A4467 - BELT STRAP SLEEV GRMNT COVER",151,0,0,0,37.75]
["FALLON - FALLON MEDICAID - HCPCS - A4467","FALLON - FALLON MEDICAID - A4467","FALLON - FALLON MEDICAID - A4467 - BELT STRAP SLEEV GRMNT COVER","FALLON","FALLON MEDICAID","HCPCS","A4467","BELT STRAP SLEEV GRMNT COVER","A4467 - BELT STRAP SLEEV GRMNT COVER",151,0,0,0,37.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A4467","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A4467","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A4467 - BELT STRAP SLEEV GRMNT COVER","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A4467","BELT STRAP SLEEV GRMNT COVER","A4467 - BELT STRAP SLEEV GRMNT COVER",151,0,0,0,37.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A4467","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A4467","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A4467 - BELT STRAP SLEEV GRMNT COVER","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A4467","BELT STRAP SLEEV GRMNT COVER","A4467 - BELT STRAP SLEEV GRMNT COVER",151,0,0,0,37.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A4561","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - A4561","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - A4561 - HC PESSARY RUBBER, ANY TYPE","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,27.82,23.18,58.33,27]
["TUFTS - TUFTS SELECT - HCPCS - A4561","TUFTS - TUFTS SELECT - A4561","TUFTS - TUFTS SELECT - A4561 - HC PESSARY RUBBER, ANY TYPE","TUFTS","TUFTS SELECT","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,0,23.18,58.33,27]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A4561","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A4561","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A4561 - HC PESSARY RUBBER, ANY TYPE","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,0,23.18,58.33,27]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A4561","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - A4561","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - A4561 - HC PESSARY RUBBER, ANY TYPE","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,27.82,23.18,58.33,27]
["TUFTS - TUFTS SPIRIT - HCPCS - A4561","TUFTS - TUFTS SPIRIT - A4561","TUFTS - TUFTS SPIRIT - A4561 - HC PESSARY RUBBER, ANY TYPE","TUFTS","TUFTS SPIRIT","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,25.5,23.18,58.33,27]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A4561","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A4561","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A4561 - HC PESSARY RUBBER, ANY TYPE","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,0,23.18,58.33,27]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A4561","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - A4561","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - A4561 - HC PESSARY RUBBER, ANY TYPE","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,31.25,23.18,58.33,27]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A4561","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A4561","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A4561 - HC PESSARY RUBBER, ANY TYPE","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,0,23.18,58.33,27]
["TUFTS - TUFTS POS - HCPCS - A4561","TUFTS - TUFTS POS - A4561","TUFTS - TUFTS POS - A4561 - HC PESSARY RUBBER, ANY TYPE","TUFTS","TUFTS POS","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,0,23.18,58.33,27]
["FALLON - FALLON SENIOR PLAN - HCPCS - A4561","FALLON - FALLON SENIOR PLAN - A4561","FALLON - FALLON SENIOR PLAN - A4561 - HC PESSARY RUBBER, ANY TYPE","FALLON","FALLON SENIOR PLAN","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,23.18,23.18,58.33,27]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A4561","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A4561","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A4561 - HC PESSARY RUBBER, ANY TYPE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,0,23.18,58.33,27]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A4561","TUFTS - TUFTS MEDICARE PREFERRED HMO - A4561","TUFTS - TUFTS MEDICARE PREFERRED HMO - A4561 - HC PESSARY RUBBER, ANY TYPE","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,33.61,23.18,58.33,27]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A4561","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A4561","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A4561 - HC PESSARY RUBBER, ANY TYPE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,0,23.18,58.33,27]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - A4561","TUFTS - TUFTS MEDICARE SCO - A4561","TUFTS - TUFTS MEDICARE SCO - A4561 - HC PESSARY RUBBER, ANY TYPE","TUFTS","TUFTS MEDICARE SCO","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,33.61,23.18,58.33,27]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A4561","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - A4561","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - A4561 - HC PESSARY RUBBER, ANY TYPE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,50.05,23.18,58.33,27]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A4561","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - A4561","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - A4561 - HC PESSARY RUBBER, ANY TYPE","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,40.33,23.18,58.33,27]
["TUFTS - TUFTS PPO - HCPCS - A4561","TUFTS - TUFTS PPO - A4561","TUFTS - TUFTS PPO - A4561 - HC PESSARY RUBBER, ANY TYPE","TUFTS","TUFTS PPO","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,0,23.18,58.33,27]
["TUFTS - TUFTS HMO - HCPCS - A4561","TUFTS - TUFTS HMO - A4561","TUFTS - TUFTS HMO - A4561 - HC PESSARY RUBBER, ANY TYPE","TUFTS","TUFTS HMO","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,0,23.18,58.33,27]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A4561","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - A4561","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - A4561 - HC PESSARY RUBBER, ANY TYPE","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,51.23,23.18,58.33,27]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A4561","BMC HEALTHNET - BMCHN ACO - A4561","BMC HEALTHNET - BMCHN ACO - A4561 - HC PESSARY RUBBER, ANY TYPE","BMC HEALTHNET","BMCHN ACO","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,0,23.18,58.33,27]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A4561","BMC HEALTHNET - BMCHN MCO - A4561","BMC HEALTHNET - BMCHN MCO - A4561 - HC PESSARY RUBBER, ANY TYPE","BMC HEALTHNET","BMCHN MCO","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,0,23.18,58.33,27]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A4561","CIGNA HEALTHCARE - CIGNA CARELINK - A4561","CIGNA HEALTHCARE - CIGNA CARELINK - A4561 - HC PESSARY RUBBER, ANY TYPE","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,0,23.18,58.33,27]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A4561","BMC HEALTHNET - BMCHN MEDICAID - A4561","BMC HEALTHNET - BMCHN MEDICAID - A4561 - HC PESSARY RUBBER, ANY TYPE","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,0,23.18,58.33,27]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A4561","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - A4561","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - A4561 - HC PESSARY RUBBER, ANY TYPE","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,23.18,23.18,58.33,27]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A4561","ELDER SERVICE PLAN - ELEMENT CARE INC - A4561","ELDER SERVICE PLAN - ELEMENT CARE INC - A4561 - HC PESSARY RUBBER, ANY TYPE","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,23.18,23.18,58.33,27]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A4561","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A4561","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A4561 - HC PESSARY RUBBER, ANY TYPE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,33.729999999999997,23.18,58.33,27]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A4561","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - A4561","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - A4561 - HC PESSARY RUBBER, ANY TYPE","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,23.18,23.18,58.33,27]
["FALLON - FALLON MEDICAID - HCPCS - A4561","FALLON - FALLON MEDICAID - A4561","FALLON - FALLON MEDICAID - A4561 - HC PESSARY RUBBER, ANY TYPE","FALLON","FALLON MEDICAID","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,0,23.18,58.33,27]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A4561","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - A4561","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - A4561 - HC PESSARY RUBBER, ANY TYPE","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,23.18,23.18,58.33,27]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A4561","BMC HEALTHNET - BMCHN QHP - A4561","BMC HEALTHNET - BMCHN QHP - A4561 - HC PESSARY RUBBER, ANY TYPE","BMC HEALTHNET","BMCHN QHP","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,0,23.18,58.33,27]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A4561","AETNA - AETNA-MEDICARE ADVANTAGE - A4561","AETNA - AETNA-MEDICARE ADVANTAGE - A4561 - HC PESSARY RUBBER, ANY TYPE","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,27.35,23.18,58.33,27]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A4561","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A4561","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A4561 - HC PESSARY RUBBER, ANY TYPE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,0,23.18,58.33,27]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A4561","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A4561","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A4561 - HC PESSARY RUBBER, ANY TYPE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,33.729999999999997,23.18,58.33,27]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A4561","BLUE CROSS - BLUE CROSS-PPO - A4561","BLUE CROSS - BLUE CROSS-PPO - A4561 - HC PESSARY RUBBER, ANY TYPE","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,33.729999999999997,23.18,58.33,27]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A4561","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A4561","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A4561 - HC PESSARY RUBBER, ANY TYPE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,0,23.18,58.33,27]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A4561","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - A4561","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - A4561 - HC PESSARY RUBBER, ANY TYPE","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,58.33,23.18,58.33,27]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A4561","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A4561","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A4561 - HC PESSARY RUBBER, ANY TYPE","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,33.729999999999997,23.18,58.33,27]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A4561","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A4561","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A4561 - HC PESSARY RUBBER, ANY TYPE","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,33.729999999999997,23.18,58.33,27]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A4561","BLUE CROSS - BLUE CROSS-HMO BLUE - A4561","BLUE CROSS - BLUE CROSS-HMO BLUE - A4561 - HC PESSARY RUBBER, ANY TYPE","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,33.729999999999997,23.18,58.33,27]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A4561","BLUE CROSS - BLUE CROSS-INDEMNITY - A4561","BLUE CROSS - BLUE CROSS-INDEMNITY - A4561 - HC PESSARY RUBBER, ANY TYPE","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,33.729999999999997,23.18,58.33,27]
["TUFTS - TUFTS SELECT - HCPCS - A4562","TUFTS - TUFTS SELECT - A4562","TUFTS - TUFTS SELECT - A4562 - PESSARY NONRUBBER","TUFTS","TUFTS SELECT","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,0,57.71,145.21,16]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A4562","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - A4562","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - A4562 - PESSARY NONRUBBER","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,69.25,57.71,145.21,16]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A4562","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A4562","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A4562 - PESSARY NONRUBBER","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,0,57.71,145.21,16]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A4562","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - A4562","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - A4562 - PESSARY NONRUBBER","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,69.25,57.71,145.21,16]
["TUFTS - TUFTS SPIRIT - HCPCS - A4562","TUFTS - TUFTS SPIRIT - A4562","TUFTS - TUFTS SPIRIT - A4562 - PESSARY NONRUBBER","TUFTS","TUFTS SPIRIT","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,63.48,57.71,145.21,16]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A4562","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - A4562","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - A4562 - PESSARY NONRUBBER","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,77.8,57.71,145.21,16]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A4562","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A4562","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A4562 - PESSARY NONRUBBER","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,0,57.71,145.21,16]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A4562","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A4562","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A4562 - PESSARY NONRUBBER","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,0,57.71,145.21,16]
["FALLON - FALLON SENIOR PLAN - HCPCS - A4562","FALLON - FALLON SENIOR PLAN - A4562","FALLON - FALLON SENIOR PLAN - A4562 - PESSARY NONRUBBER","FALLON","FALLON SENIOR PLAN","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,57.71,57.71,145.21,16]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - A4562","TUFTS - TUFTS MEDICARE SCO - A4562","TUFTS - TUFTS MEDICARE SCO - A4562 - PESSARY NONRUBBER","TUFTS","TUFTS MEDICARE SCO","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,83.68,57.71,145.21,16]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A4562","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A4562","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A4562 - PESSARY NONRUBBER","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,0,57.71,145.21,16]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A4562","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A4562","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A4562 - PESSARY NONRUBBER","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,0,57.71,145.21,16]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A4562","TUFTS - TUFTS MEDICARE PREFERRED HMO - A4562","TUFTS - TUFTS MEDICARE PREFERRED HMO - A4562 - PESSARY NONRUBBER","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,83.68,57.71,145.21,16]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A4562","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - A4562","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - A4562 - PESSARY NONRUBBER","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,124.6,57.71,145.21,16]
["TUFTS - TUFTS POS - HCPCS - A4562","TUFTS - TUFTS POS - A4562","TUFTS - TUFTS POS - A4562 - PESSARY NONRUBBER","TUFTS","TUFTS POS","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,0,57.71,145.21,16]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A4562","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - A4562","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - A4562 - PESSARY NONRUBBER","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,100.42,57.71,145.21,16]
["TUFTS - TUFTS PPO - HCPCS - A4562","TUFTS - TUFTS PPO - A4562","TUFTS - TUFTS PPO - A4562 - PESSARY NONRUBBER","TUFTS","TUFTS PPO","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,0,57.71,145.21,16]
["TUFTS - TUFTS HMO - HCPCS - A4562","TUFTS - TUFTS HMO - A4562","TUFTS - TUFTS HMO - A4562 - PESSARY NONRUBBER","TUFTS","TUFTS HMO","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,0,57.71,145.21,16]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A4562","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - A4562","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - A4562 - PESSARY NONRUBBER","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,127.53,57.71,145.21,16]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A4562","CIGNA HEALTHCARE - CIGNA CARELINK - A4562","CIGNA HEALTHCARE - CIGNA CARELINK - A4562 - PESSARY NONRUBBER","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,0,57.71,145.21,16]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A4562","BMC HEALTHNET - BMCHN ACO - A4562","BMC HEALTHNET - BMCHN ACO - A4562 - PESSARY NONRUBBER","BMC HEALTHNET","BMCHN ACO","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,0,57.71,145.21,16]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A4562","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - A4562","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - A4562 - PESSARY NONRUBBER","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,57.71,57.71,145.21,16]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A4562","ELDER SERVICE PLAN - ELEMENT CARE INC - A4562","ELDER SERVICE PLAN - ELEMENT CARE INC - A4562 - PESSARY NONRUBBER","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,57.71,57.71,145.21,16]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A4562","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - A4562","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - A4562 - PESSARY NONRUBBER","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,57.71,57.71,145.21,16]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A4562","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - A4562","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - A4562 - PESSARY NONRUBBER","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,57.71,57.71,145.21,16]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A4562","BMC HEALTHNET - BMCHN MCO - A4562","BMC HEALTHNET - BMCHN MCO - A4562 - PESSARY NONRUBBER","BMC HEALTHNET","BMCHN MCO","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,0,57.71,145.21,16]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A4562","BMC HEALTHNET - BMCHN MEDICAID - A4562","BMC HEALTHNET - BMCHN MEDICAID - A4562 - PESSARY NONRUBBER","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,0,57.71,145.21,16]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A4562","BMC HEALTHNET - BMCHN QHP - A4562","BMC HEALTHNET - BMCHN QHP - A4562 - PESSARY NONRUBBER","BMC HEALTHNET","BMCHN QHP","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,0,57.71,145.21,16]
["FALLON - FALLON MEDICAID - HCPCS - A4562","FALLON - FALLON MEDICAID - A4562","FALLON - FALLON MEDICAID - A4562 - PESSARY NONRUBBER","FALLON","FALLON MEDICAID","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,0,57.71,145.21,16]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A4562","AETNA - AETNA-MEDICARE ADVANTAGE - A4562","AETNA - AETNA-MEDICARE ADVANTAGE - A4562 - PESSARY NONRUBBER","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,68.099999999999994,57.71,145.21,16]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A4562","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A4562","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A4562 - PESSARY NONRUBBER","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,0,57.71,145.21,16]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A4562","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A4562","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A4562 - PESSARY NONRUBBER","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,0,57.71,145.21,16]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A4562","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - A4562","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - A4562 - PESSARY NONRUBBER","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,145.21,57.71,145.21,16]
["TUFTS - TUFTS SELECT - HCPCS - A4570","TUFTS - TUFTS SELECT - A4570","TUFTS - TUFTS SELECT - A4570 - HC MISC SPLINT SUPPLY LV1","TUFTS","TUFTS SELECT","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1","A4570 - HC MISC SPLINT SUPPLY LV1",40,19.010000000000002,19.010000000000002,107.35,10]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A4570","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A4570","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A4570 - HC MISC SPLINT SUPPLY LV1","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1","A4570 - HC MISC SPLINT SUPPLY LV1",40,0,19.010000000000002,107.35,10]
["TUFTS - TUFTS POS - HCPCS - A4570","TUFTS - TUFTS POS - A4570","TUFTS - TUFTS POS - A4570 - HC MISC SPLINT SUPPLY LV1","TUFTS","TUFTS POS","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1","A4570 - HC MISC SPLINT SUPPLY LV1",40,35.700000000000003,19.010000000000002,107.35,10]
["TUFTS - TUFTS PPO - HCPCS - A4570","TUFTS - TUFTS PPO - A4570","TUFTS - TUFTS PPO - A4570 - HC MISC SPLINT SUPPLY LV1","TUFTS","TUFTS PPO","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1","A4570 - HC MISC SPLINT SUPPLY LV1",40,38.19,19.010000000000002,107.35,10]
["TUFTS - TUFTS HMO - HCPCS - A4570","TUFTS - TUFTS HMO - A4570","TUFTS - TUFTS HMO - A4570 - HC MISC SPLINT SUPPLY LV1","TUFTS","TUFTS HMO","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1","A4570 - HC MISC SPLINT SUPPLY LV1",40,42.84,19.010000000000002,107.35,10]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A4570","BMC HEALTHNET - BMCHN ACO - A4570","BMC HEALTHNET - BMCHN ACO - A4570 - HC MISC SPLINT SUPPLY LV1","BMC HEALTHNET","BMCHN ACO","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1","A4570 - HC MISC SPLINT SUPPLY LV1",40,0,19.010000000000002,107.35,10]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A4570","BMC HEALTHNET - BMCHN MCO - A4570","BMC HEALTHNET - BMCHN MCO - A4570 - HC MISC SPLINT SUPPLY LV1","BMC HEALTHNET","BMCHN MCO","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1","A4570 - HC MISC SPLINT SUPPLY LV1",40,0,19.010000000000002,107.35,10]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A4570","CIGNA HEALTHCARE - CIGNA CARELINK - A4570","CIGNA HEALTHCARE - CIGNA CARELINK - A4570 - HC MISC SPLINT SUPPLY LV1","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1","A4570 - HC MISC SPLINT SUPPLY LV1",40,107.35,19.010000000000002,107.35,10]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A4570","BMC HEALTHNET - BMCHN MEDICAID - A4570","BMC HEALTHNET - BMCHN MEDICAID - A4570 - HC MISC SPLINT SUPPLY LV1","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1","A4570 - HC MISC SPLINT SUPPLY LV1",40,0,19.010000000000002,107.35,10]
["FALLON - FALLON MEDICAID - HCPCS - A4570","FALLON - FALLON MEDICAID - A4570","FALLON - FALLON MEDICAID - A4570 - HC MISC SPLINT SUPPLY LV1","FALLON","FALLON MEDICAID","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1","A4570 - HC MISC SPLINT SUPPLY LV1",40,0,19.010000000000002,107.35,10]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A4570","BMC HEALTHNET - BMCHN QHP - A4570","BMC HEALTHNET - BMCHN QHP - A4570 - HC MISC SPLINT SUPPLY LV1","BMC HEALTHNET","BMCHN QHP","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1","A4570 - HC MISC SPLINT SUPPLY LV1",40,0,19.010000000000002,107.35,10]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A4570","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A4570","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A4570 - HC MISC SPLINT SUPPLY LV1","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1","A4570 - HC MISC SPLINT SUPPLY LV1",40,0,19.010000000000002,107.35,10]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A4570","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A4570","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A4570 - HC MISC SPLINT SUPPLY LV1","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1","A4570 - HC MISC SPLINT SUPPLY LV1",40,0,19.010000000000002,107.35,10]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A4648","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A4648","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A4648 - IMPLANTABLE TISSUE MARKER","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A4648","IMPLANTABLE TISSUE MARKER","A4648 - IMPLANTABLE TISSUE MARKER",281,0,0,0,70.25]
["TUFTS - TUFTS SELECT - HCPCS - A4648","TUFTS - TUFTS SELECT - A4648","TUFTS - TUFTS SELECT - A4648 - IMPLANTABLE TISSUE MARKER","TUFTS","TUFTS SELECT","HCPCS","A4648","IMPLANTABLE TISSUE MARKER","A4648 - IMPLANTABLE TISSUE MARKER",281,0,0,0,70.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A4648","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A4648","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A4648 - IMPLANTABLE TISSUE MARKER","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A4648","IMPLANTABLE TISSUE MARKER","A4648 - IMPLANTABLE TISSUE MARKER",281,0,0,0,70.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A4648","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A4648","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A4648 - IMPLANTABLE TISSUE MARKER","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A4648","IMPLANTABLE TISSUE MARKER","A4648 - IMPLANTABLE TISSUE MARKER",281,0,0,0,70.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A4648","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A4648","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A4648 - IMPLANTABLE TISSUE MARKER","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A4648","IMPLANTABLE TISSUE MARKER","A4648 - IMPLANTABLE TISSUE MARKER",281,0,0,0,70.25]
["TUFTS - TUFTS POS - HCPCS - A4648","TUFTS - TUFTS POS - A4648","TUFTS - TUFTS POS - A4648 - IMPLANTABLE TISSUE MARKER","TUFTS","TUFTS POS","HCPCS","A4648","IMPLANTABLE TISSUE MARKER","A4648 - IMPLANTABLE TISSUE MARKER",281,0,0,0,70.25]
["TUFTS - TUFTS PPO - HCPCS - A4648","TUFTS - TUFTS PPO - A4648","TUFTS - TUFTS PPO - A4648 - IMPLANTABLE TISSUE MARKER","TUFTS","TUFTS PPO","HCPCS","A4648","IMPLANTABLE TISSUE MARKER","A4648 - IMPLANTABLE TISSUE MARKER",281,0,0,0,70.25]
["TUFTS - TUFTS HMO - HCPCS - A4648","TUFTS - TUFTS HMO - A4648","TUFTS - TUFTS HMO - A4648 - IMPLANTABLE TISSUE MARKER","TUFTS","TUFTS HMO","HCPCS","A4648","IMPLANTABLE TISSUE MARKER","A4648 - IMPLANTABLE TISSUE MARKER",281,0,0,0,70.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A4648","CIGNA HEALTHCARE - CIGNA CARELINK - A4648","CIGNA HEALTHCARE - CIGNA CARELINK - A4648 - IMPLANTABLE TISSUE MARKER","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A4648","IMPLANTABLE TISSUE MARKER","A4648 - IMPLANTABLE TISSUE MARKER",281,0,0,0,70.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A4725","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A4725","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A4725 - DIALYS SOL FLD VOL > 4999CC","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC","A4725 - DIALYS SOL FLD VOL > 4999CC",87,0,0,0,21.75]
["TUFTS - TUFTS SELECT - HCPCS - A4725","TUFTS - TUFTS SELECT - A4725","TUFTS - TUFTS SELECT - A4725 - DIALYS SOL FLD VOL > 4999CC","TUFTS","TUFTS SELECT","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC","A4725 - DIALYS SOL FLD VOL > 4999CC",87,0,0,0,21.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A4725","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A4725","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A4725 - DIALYS SOL FLD VOL > 4999CC","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC","A4725 - DIALYS SOL FLD VOL > 4999CC",87,0,0,0,21.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A4725","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A4725","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A4725 - DIALYS SOL FLD VOL > 4999CC","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC","A4725 - DIALYS SOL FLD VOL > 4999CC",87,0,0,0,21.75]
["TUFTS - TUFTS POS - HCPCS - A4725","TUFTS - TUFTS POS - A4725","TUFTS - TUFTS POS - A4725 - DIALYS SOL FLD VOL > 4999CC","TUFTS","TUFTS POS","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC","A4725 - DIALYS SOL FLD VOL > 4999CC",87,0,0,0,21.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A4725","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A4725","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A4725 - DIALYS SOL FLD VOL > 4999CC","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC","A4725 - DIALYS SOL FLD VOL > 4999CC",87,0,0,0,21.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A4725","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A4725","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A4725 - DIALYS SOL FLD VOL > 4999CC","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC","A4725 - DIALYS SOL FLD VOL > 4999CC",87,0,0,0,21.75]
["TUFTS - TUFTS PPO - HCPCS - A4725","TUFTS - TUFTS PPO - A4725","TUFTS - TUFTS PPO - A4725 - DIALYS SOL FLD VOL > 4999CC","TUFTS","TUFTS PPO","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC","A4725 - DIALYS SOL FLD VOL > 4999CC",87,0,0,0,21.75]
["TUFTS - TUFTS HMO - HCPCS - A4725","TUFTS - TUFTS HMO - A4725","TUFTS - TUFTS HMO - A4725 - DIALYS SOL FLD VOL > 4999CC","TUFTS","TUFTS HMO","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC","A4725 - DIALYS SOL FLD VOL > 4999CC",87,0,0,0,21.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A4725","BMC HEALTHNET - BMCHN ACO - A4725","BMC HEALTHNET - BMCHN ACO - A4725 - DIALYS SOL FLD VOL > 4999CC","BMC HEALTHNET","BMCHN ACO","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC","A4725 - DIALYS SOL FLD VOL > 4999CC",87,0,0,0,21.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A4725","BMC HEALTHNET - BMCHN MCO - A4725","BMC HEALTHNET - BMCHN MCO - A4725 - DIALYS SOL FLD VOL > 4999CC","BMC HEALTHNET","BMCHN MCO","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC","A4725 - DIALYS SOL FLD VOL > 4999CC",87,0,0,0,21.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A4725","CIGNA HEALTHCARE - CIGNA CARELINK - A4725","CIGNA HEALTHCARE - CIGNA CARELINK - A4725 - DIALYS SOL FLD VOL > 4999CC","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC","A4725 - DIALYS SOL FLD VOL > 4999CC",87,0,0,0,21.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A4725","BMC HEALTHNET - BMCHN MEDICAID - A4725","BMC HEALTHNET - BMCHN MEDICAID - A4725 - DIALYS SOL FLD VOL > 4999CC","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC","A4725 - DIALYS SOL FLD VOL > 4999CC",87,0,0,0,21.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A4725","BMC HEALTHNET - BMCHN QHP - A4725","BMC HEALTHNET - BMCHN QHP - A4725 - DIALYS SOL FLD VOL > 4999CC","BMC HEALTHNET","BMCHN QHP","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC","A4725 - DIALYS SOL FLD VOL > 4999CC",87,0,0,0,21.75]
["FALLON - FALLON MEDICAID - HCPCS - A4725","FALLON - FALLON MEDICAID - A4725","FALLON - FALLON MEDICAID - A4725 - DIALYS SOL FLD VOL > 4999CC","FALLON","FALLON MEDICAID","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC","A4725 - DIALYS SOL FLD VOL > 4999CC",87,0,0,0,21.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A4725","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A4725","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A4725 - DIALYS SOL FLD VOL > 4999CC","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC","A4725 - DIALYS SOL FLD VOL > 4999CC",87,0,0,0,21.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A4725","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A4725","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A4725 - DIALYS SOL FLD VOL > 4999CC","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC","A4725 - DIALYS SOL FLD VOL > 4999CC",87,0,0,0,21.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A6209","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - A6209","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,10.42,8.68,21.84,40.75]
["TUFTS - TUFTS SELECT - HCPCS - A6209","TUFTS - TUFTS SELECT - A6209","TUFTS - TUFTS SELECT - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","TUFTS","TUFTS SELECT","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,0,8.68,21.84,40.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A6209","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A6209","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,0,8.68,21.84,40.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A6209","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - A6209","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,10.42,8.68,21.84,40.75]
["TUFTS - TUFTS SPIRIT - HCPCS - A6209","TUFTS - TUFTS SPIRIT - A6209","TUFTS - TUFTS SPIRIT - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","TUFTS","TUFTS SPIRIT","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,9.5500000000000007,8.68,21.84,40.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A6209","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A6209","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,0,8.68,21.84,40.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A6209","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - A6209","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,11.7,8.68,21.84,40.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A6209","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A6209","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,0,8.68,21.84,40.75]
["TUFTS - TUFTS PPO - HCPCS - A6209","TUFTS - TUFTS PPO - A6209","TUFTS - TUFTS PPO - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","TUFTS","TUFTS PPO","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,0,8.68,21.84,40.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - A6209","FALLON - FALLON SENIOR PLAN - A6209","FALLON - FALLON SENIOR PLAN - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","FALLON","FALLON SENIOR PLAN","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,8.68,8.68,21.84,40.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A6209","TUFTS - TUFTS MEDICARE PREFERRED HMO - A6209","TUFTS - TUFTS MEDICARE PREFERRED HMO - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,12.59,8.68,21.84,40.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A6209","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A6209","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,0,8.68,21.84,40.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A6209","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A6209","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,0,8.68,21.84,40.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - A6209","TUFTS - TUFTS MEDICARE SCO - A6209","TUFTS - TUFTS MEDICARE SCO - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","TUFTS","TUFTS MEDICARE SCO","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,12.59,8.68,21.84,40.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A6209","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - A6209","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,18.739999999999998,8.68,21.84,40.75]
["TUFTS - TUFTS POS - HCPCS - A6209","TUFTS - TUFTS POS - A6209","TUFTS - TUFTS POS - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","TUFTS","TUFTS POS","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,0,8.68,21.84,40.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A6209","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - A6209","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,15.1,8.68,21.84,40.75]
["TUFTS - TUFTS HMO - HCPCS - A6209","TUFTS - TUFTS HMO - A6209","TUFTS - TUFTS HMO - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","TUFTS","TUFTS HMO","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,0,8.68,21.84,40.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A6209","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - A6209","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,19.18,8.68,21.84,40.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A6209","CIGNA HEALTHCARE - CIGNA CARELINK - A6209","CIGNA HEALTHCARE - CIGNA CARELINK - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,0,8.68,21.84,40.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A6209","BMC HEALTHNET - BMCHN ACO - A6209","BMC HEALTHNET - BMCHN ACO - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","BMC HEALTHNET","BMCHN ACO","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,0,8.68,21.84,40.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A6209","BMC HEALTHNET - BMCHN MCO - A6209","BMC HEALTHNET - BMCHN MCO - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","BMC HEALTHNET","BMCHN MCO","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,0,8.68,21.84,40.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A6209","BMC HEALTHNET - BMCHN MEDICAID - A6209","BMC HEALTHNET - BMCHN MEDICAID - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,0,8.68,21.84,40.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A6209","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - A6209","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,8.68,8.68,21.84,40.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A6209","ELDER SERVICE PLAN - ELEMENT CARE INC - A6209","ELDER SERVICE PLAN - ELEMENT CARE INC - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,8.68,8.68,21.84,40.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A6209","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A6209","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,12.63,8.68,21.84,40.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A6209","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - A6209","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,8.68,8.68,21.84,40.75]
["FALLON - FALLON MEDICAID - HCPCS - A6209","FALLON - FALLON MEDICAID - A6209","FALLON - FALLON MEDICAID - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","FALLON","FALLON MEDICAID","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,0,8.68,21.84,40.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A6209","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - A6209","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,8.68,8.68,21.84,40.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A6209","BMC HEALTHNET - BMCHN QHP - A6209","BMC HEALTHNET - BMCHN QHP - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","BMC HEALTHNET","BMCHN QHP","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,0,8.68,21.84,40.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A6209","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A6209","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,0,8.68,21.84,40.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A6209","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - A6209","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,21.84,8.68,21.84,40.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A6209","AETNA - AETNA-MEDICARE ADVANTAGE - A6209","AETNA - AETNA-MEDICARE ADVANTAGE - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,10.24,8.68,21.84,40.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A6209","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A6209","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,0,8.68,21.84,40.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A6209","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A6209","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,12.63,8.68,21.84,40.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A6209","BLUE CROSS - BLUE CROSS-PPO - A6209","BLUE CROSS - BLUE CROSS-PPO - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,12.63,8.68,21.84,40.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A6209","BLUE CROSS - BLUE CROSS-HMO BLUE - A6209","BLUE CROSS - BLUE CROSS-HMO BLUE - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,12.63,8.68,21.84,40.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A6209","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A6209","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,12.63,8.68,21.84,40.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A6209","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A6209","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,12.63,8.68,21.84,40.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A6209","BLUE CROSS - BLUE CROSS-INDEMNITY - A6209","BLUE CROSS - BLUE CROSS-INDEMNITY - A6209 - FOAM DRSG <=16 SQ IN W/O BDR","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,12.63,8.68,21.84,40.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A6258","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - A6258","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - A6258 - TRANSPARENT FILM >16<=48 IN","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,6,5,12.58,20.75]
["TUFTS - TUFTS SELECT - HCPCS - A6258","TUFTS - TUFTS SELECT - A6258","TUFTS - TUFTS SELECT - A6258 - TRANSPARENT FILM >16<=48 IN","TUFTS","TUFTS SELECT","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,0,5,12.58,20.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A6258","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A6258","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A6258 - TRANSPARENT FILM >16<=48 IN","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,0,5,12.58,20.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A6258","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - A6258","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - A6258 - TRANSPARENT FILM >16<=48 IN","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,6,5,12.58,20.75]
["TUFTS - TUFTS SPIRIT - HCPCS - A6258","TUFTS - TUFTS SPIRIT - A6258","TUFTS - TUFTS SPIRIT - A6258 - TRANSPARENT FILM >16<=48 IN","TUFTS","TUFTS SPIRIT","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,5.5,5,12.58,20.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A6258","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - A6258","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - A6258 - TRANSPARENT FILM >16<=48 IN","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,6.74,5,12.58,20.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A6258","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A6258","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A6258 - TRANSPARENT FILM >16<=48 IN","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,0,5,12.58,20.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A6258","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A6258","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A6258 - TRANSPARENT FILM >16<=48 IN","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,0,5,12.58,20.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - A6258","FALLON - FALLON SENIOR PLAN - A6258","FALLON - FALLON SENIOR PLAN - A6258 - TRANSPARENT FILM >16<=48 IN","FALLON","FALLON SENIOR PLAN","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,5,5,12.58,20.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A6258","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A6258","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A6258 - TRANSPARENT FILM >16<=48 IN","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,0,5,12.58,20.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - A6258","TUFTS - TUFTS MEDICARE SCO - A6258","TUFTS - TUFTS MEDICARE SCO - A6258 - TRANSPARENT FILM >16<=48 IN","TUFTS","TUFTS MEDICARE SCO","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,7.25,5,12.58,20.75]
["TUFTS - TUFTS POS - HCPCS - A6258","TUFTS - TUFTS POS - A6258","TUFTS - TUFTS POS - A6258 - TRANSPARENT FILM >16<=48 IN","TUFTS","TUFTS POS","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,0,5,12.58,20.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A6258","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A6258","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A6258 - TRANSPARENT FILM >16<=48 IN","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,0,5,12.58,20.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A6258","TUFTS - TUFTS MEDICARE PREFERRED HMO - A6258","TUFTS - TUFTS MEDICARE PREFERRED HMO - A6258 - TRANSPARENT FILM >16<=48 IN","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,7.25,5,12.58,20.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A6258","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - A6258","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - A6258 - TRANSPARENT FILM >16<=48 IN","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,10.8,5,12.58,20.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A6258","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - A6258","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - A6258 - TRANSPARENT FILM >16<=48 IN","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,8.6999999999999993,5,12.58,20.75]
["TUFTS - TUFTS PPO - HCPCS - A6258","TUFTS - TUFTS PPO - A6258","TUFTS - TUFTS PPO - A6258 - TRANSPARENT FILM >16<=48 IN","TUFTS","TUFTS PPO","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,0,5,12.58,20.75]
["FALLON - FALLON MEDICAID - HCPCS - A6258","FALLON - FALLON MEDICAID - A6258","FALLON - FALLON MEDICAID - A6258 - TRANSPARENT FILM >16<=48 IN","FALLON","FALLON MEDICAID","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,0,5,12.58,20.75]
["TUFTS - TUFTS HMO - HCPCS - A6258","TUFTS - TUFTS HMO - A6258","TUFTS - TUFTS HMO - A6258 - TRANSPARENT FILM >16<=48 IN","TUFTS","TUFTS HMO","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,0,5,12.58,20.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A6258","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - A6258","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - A6258 - TRANSPARENT FILM >16<=48 IN","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,5,5,12.58,20.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A6258","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - A6258","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - A6258 - TRANSPARENT FILM >16<=48 IN","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,5,5,12.58,20.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A6258","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - A6258","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - A6258 - TRANSPARENT FILM >16<=48 IN","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,5,5,12.58,20.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A6258","ELDER SERVICE PLAN - ELEMENT CARE INC - A6258","ELDER SERVICE PLAN - ELEMENT CARE INC - A6258 - TRANSPARENT FILM >16<=48 IN","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,5,5,12.58,20.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A6258","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - A6258","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - A6258 - TRANSPARENT FILM >16<=48 IN","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,11.05,5,12.58,20.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A6258","BMC HEALTHNET - BMCHN ACO - A6258","BMC HEALTHNET - BMCHN ACO - A6258 - TRANSPARENT FILM >16<=48 IN","BMC HEALTHNET","BMCHN ACO","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,0,5,12.58,20.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A6258","BMC HEALTHNET - BMCHN MCO - A6258","BMC HEALTHNET - BMCHN MCO - A6258 - TRANSPARENT FILM >16<=48 IN","BMC HEALTHNET","BMCHN MCO","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,0,5,12.58,20.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A6258","CIGNA HEALTHCARE - CIGNA CARELINK - A6258","CIGNA HEALTHCARE - CIGNA CARELINK - A6258 - TRANSPARENT FILM >16<=48 IN","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,0,5,12.58,20.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A6258","BMC HEALTHNET - BMCHN MEDICAID - A6258","BMC HEALTHNET - BMCHN MEDICAID - A6258 - TRANSPARENT FILM >16<=48 IN","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,0,5,12.58,20.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A6258","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A6258","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A6258 - TRANSPARENT FILM >16<=48 IN","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,7.28,5,12.58,20.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A6258","BMC HEALTHNET - BMCHN QHP - A6258","BMC HEALTHNET - BMCHN QHP - A6258 - TRANSPARENT FILM >16<=48 IN","BMC HEALTHNET","BMCHN QHP","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,0,5,12.58,20.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A6258","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A6258","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A6258 - TRANSPARENT FILM >16<=48 IN","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,0,5,12.58,20.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A6258","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A6258","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A6258 - TRANSPARENT FILM >16<=48 IN","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,7.28,5,12.58,20.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A6258","AETNA - AETNA-MEDICARE ADVANTAGE - A6258","AETNA - AETNA-MEDICARE ADVANTAGE - A6258 - TRANSPARENT FILM >16<=48 IN","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,5.9,5,12.58,20.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A6258","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A6258","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A6258 - TRANSPARENT FILM >16<=48 IN","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,0,5,12.58,20.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A6258","BLUE CROSS - BLUE CROSS-PPO - A6258","BLUE CROSS - BLUE CROSS-PPO - A6258 - TRANSPARENT FILM >16<=48 IN","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,7.28,5,12.58,20.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A6258","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A6258","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A6258 - TRANSPARENT FILM >16<=48 IN","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,7.28,5,12.58,20.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A6258","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A6258","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A6258 - TRANSPARENT FILM >16<=48 IN","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,7.28,5,12.58,20.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A6258","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - A6258","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - A6258 - TRANSPARENT FILM >16<=48 IN","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,12.58,5,12.58,20.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A6258","BLUE CROSS - BLUE CROSS-HMO BLUE - A6258","BLUE CROSS - BLUE CROSS-HMO BLUE - A6258 - TRANSPARENT FILM >16<=48 IN","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,7.28,5,12.58,20.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A6258","BLUE CROSS - BLUE CROSS-INDEMNITY - A6258","BLUE CROSS - BLUE CROSS-INDEMNITY - A6258 - TRANSPARENT FILM >16<=48 IN","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,7.28,5,12.58,20.75]
["TUFTS - TUFTS SELECT - HCPCS - A6549","TUFTS - TUFTS SELECT - A6549","TUFTS - TUFTS SELECT - A6549 - G COMPRESSION STOCKING","TUFTS","TUFTS SELECT","HCPCS","A6549","G COMPRESSION STOCKING","A6549 - G COMPRESSION STOCKING",37,0,0,0,9.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A6549","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A6549","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A6549 - G COMPRESSION STOCKING","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A6549","G COMPRESSION STOCKING","A6549 - G COMPRESSION STOCKING",37,0,0,0,9.25]
["FALLON - FALLON MEDICAID - HCPCS - A6549","FALLON - FALLON MEDICAID - A6549","FALLON - FALLON MEDICAID - A6549 - G COMPRESSION STOCKING","FALLON","FALLON MEDICAID","HCPCS","A6549","G COMPRESSION STOCKING","A6549 - G COMPRESSION STOCKING",37,0,0,0,9.25]
["TUFTS - TUFTS PPO - HCPCS - A6549","TUFTS - TUFTS PPO - A6549","TUFTS - TUFTS PPO - A6549 - G COMPRESSION STOCKING","TUFTS","TUFTS PPO","HCPCS","A6549","G COMPRESSION STOCKING","A6549 - G COMPRESSION STOCKING",37,0,0,0,9.25]
["TUFTS - TUFTS HMO - HCPCS - A6549","TUFTS - TUFTS HMO - A6549","TUFTS - TUFTS HMO - A6549 - G COMPRESSION STOCKING","TUFTS","TUFTS HMO","HCPCS","A6549","G COMPRESSION STOCKING","A6549 - G COMPRESSION STOCKING",37,0,0,0,9.25]
["TUFTS - TUFTS POS - HCPCS - A6549","TUFTS - TUFTS POS - A6549","TUFTS - TUFTS POS - A6549 - G COMPRESSION STOCKING","TUFTS","TUFTS POS","HCPCS","A6549","G COMPRESSION STOCKING","A6549 - G COMPRESSION STOCKING",37,0,0,0,9.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A6549","CIGNA HEALTHCARE - CIGNA CARELINK - A6549","CIGNA HEALTHCARE - CIGNA CARELINK - A6549 - G COMPRESSION STOCKING","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A6549","G COMPRESSION STOCKING","A6549 - G COMPRESSION STOCKING",37,0,0,0,9.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A6549","BMC HEALTHNET - BMCHN ACO - A6549","BMC HEALTHNET - BMCHN ACO - A6549 - G COMPRESSION STOCKING","BMC HEALTHNET","BMCHN ACO","HCPCS","A6549","G COMPRESSION STOCKING","A6549 - G COMPRESSION STOCKING",37,0,0,0,9.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A6549","BMC HEALTHNET - BMCHN MCO - A6549","BMC HEALTHNET - BMCHN MCO - A6549 - G COMPRESSION STOCKING","BMC HEALTHNET","BMCHN MCO","HCPCS","A6549","G COMPRESSION STOCKING","A6549 - G COMPRESSION STOCKING",37,0,0,0,9.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A6549","BMC HEALTHNET - BMCHN MEDICAID - A6549","BMC HEALTHNET - BMCHN MEDICAID - A6549 - G COMPRESSION STOCKING","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A6549","G COMPRESSION STOCKING","A6549 - G COMPRESSION STOCKING",37,0,0,0,9.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A6549","BMC HEALTHNET - BMCHN QHP - A6549","BMC HEALTHNET - BMCHN QHP - A6549 - G COMPRESSION STOCKING","BMC HEALTHNET","BMCHN QHP","HCPCS","A6549","G COMPRESSION STOCKING","A6549 - G COMPRESSION STOCKING",37,0,0,0,9.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A6549","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A6549","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A6549 - G COMPRESSION STOCKING","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A6549","G COMPRESSION STOCKING","A6549 - G COMPRESSION STOCKING",37,0,0,0,9.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A6549","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A6549","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A6549 - G COMPRESSION STOCKING","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A6549","G COMPRESSION STOCKING","A6549 - G COMPRESSION STOCKING",37,0,0,0,9.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A6550","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - A6550","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - A6550 - NEG PRES WOUND THER DRSG SET","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,30.85,25.71,64.69,1]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A6550","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A6550","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A6550 - NEG PRES WOUND THER DRSG SET","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,0,25.71,64.69,1]
["TUFTS - TUFTS SELECT - HCPCS - A6550","TUFTS - TUFTS SELECT - A6550","TUFTS - TUFTS SELECT - A6550 - NEG PRES WOUND THER DRSG SET","TUFTS","TUFTS SELECT","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,0,25.71,64.69,1]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A6550","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - A6550","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - A6550 - NEG PRES WOUND THER DRSG SET","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,30.85,25.71,64.69,1]
["TUFTS - TUFTS SPIRIT - HCPCS - A6550","TUFTS - TUFTS SPIRIT - A6550","TUFTS - TUFTS SPIRIT - A6550 - NEG PRES WOUND THER DRSG SET","TUFTS","TUFTS SPIRIT","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,28.28,25.71,64.69,1]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A6550","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A6550","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A6550 - NEG PRES WOUND THER DRSG SET","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,0,25.71,64.69,1]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A6550","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - A6550","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - A6550 - NEG PRES WOUND THER DRSG SET","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,34.659999999999997,25.71,64.69,1]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A6550","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A6550","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A6550 - NEG PRES WOUND THER DRSG SET","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,0,25.71,64.69,1]
["TUFTS - TUFTS POS - HCPCS - A6550","TUFTS - TUFTS POS - A6550","TUFTS - TUFTS POS - A6550 - NEG PRES WOUND THER DRSG SET","TUFTS","TUFTS POS","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,0,25.71,64.69,1]
["FALLON - FALLON SENIOR PLAN - HCPCS - A6550","FALLON - FALLON SENIOR PLAN - A6550","FALLON - FALLON SENIOR PLAN - A6550 - NEG PRES WOUND THER DRSG SET","FALLON","FALLON SENIOR PLAN","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,25.71,25.71,64.69,1]
["FALLON - FALLON MEDICAID - HCPCS - A6550","FALLON - FALLON MEDICAID - A6550","FALLON - FALLON MEDICAID - A6550 - NEG PRES WOUND THER DRSG SET","FALLON","FALLON MEDICAID","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,0,25.71,64.69,1]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A6550","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A6550","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A6550 - NEG PRES WOUND THER DRSG SET","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,0,25.71,64.69,1]
["TUFTS - TUFTS HMO - HCPCS - A6550","TUFTS - TUFTS HMO - A6550","TUFTS - TUFTS HMO - A6550 - NEG PRES WOUND THER DRSG SET","TUFTS","TUFTS HMO","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,0,25.71,64.69,1]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A6550","TUFTS - TUFTS MEDICARE PREFERRED HMO - A6550","TUFTS - TUFTS MEDICARE PREFERRED HMO - A6550 - NEG PRES WOUND THER DRSG SET","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,37.28,25.71,64.69,1]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A6550","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A6550","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A6550 - NEG PRES WOUND THER DRSG SET","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,0,25.71,64.69,1]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - A6550","TUFTS - TUFTS MEDICARE SCO - A6550","TUFTS - TUFTS MEDICARE SCO - A6550 - NEG PRES WOUND THER DRSG SET","TUFTS","TUFTS MEDICARE SCO","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,37.28,25.71,64.69,1]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A6550","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - A6550","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - A6550 - NEG PRES WOUND THER DRSG SET","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,55.51,25.71,64.69,1]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A6550","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - A6550","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - A6550 - NEG PRES WOUND THER DRSG SET","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,44.74,25.71,64.69,1]
["TUFTS - TUFTS PPO - HCPCS - A6550","TUFTS - TUFTS PPO - A6550","TUFTS - TUFTS PPO - A6550 - NEG PRES WOUND THER DRSG SET","TUFTS","TUFTS PPO","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,0,25.71,64.69,1]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A6550","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - A6550","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - A6550 - NEG PRES WOUND THER DRSG SET","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,56.82,25.71,64.69,1]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A6550","BMC HEALTHNET - BMCHN ACO - A6550","BMC HEALTHNET - BMCHN ACO - A6550 - NEG PRES WOUND THER DRSG SET","BMC HEALTHNET","BMCHN ACO","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,0,25.71,64.69,1]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A6550","BMC HEALTHNET - BMCHN MCO - A6550","BMC HEALTHNET - BMCHN MCO - A6550 - NEG PRES WOUND THER DRSG SET","BMC HEALTHNET","BMCHN MCO","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,0,25.71,64.69,1]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A6550","CIGNA HEALTHCARE - CIGNA CARELINK - A6550","CIGNA HEALTHCARE - CIGNA CARELINK - A6550 - NEG PRES WOUND THER DRSG SET","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,0,25.71,64.69,1]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A6550","BMC HEALTHNET - BMCHN MEDICAID - A6550","BMC HEALTHNET - BMCHN MEDICAID - A6550 - NEG PRES WOUND THER DRSG SET","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,0,25.71,64.69,1]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A6550","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - A6550","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - A6550 - NEG PRES WOUND THER DRSG SET","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,25.71,25.71,64.69,1]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A6550","ELDER SERVICE PLAN - ELEMENT CARE INC - A6550","ELDER SERVICE PLAN - ELEMENT CARE INC - A6550 - NEG PRES WOUND THER DRSG SET","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,25.71,25.71,64.69,1]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A6550","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - A6550","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - A6550 - NEG PRES WOUND THER DRSG SET","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,25.71,25.71,64.69,1]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A6550","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - A6550","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - A6550 - NEG PRES WOUND THER DRSG SET","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,25.71,25.71,64.69,1]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A6550","BMC HEALTHNET - BMCHN QHP - A6550","BMC HEALTHNET - BMCHN QHP - A6550 - NEG PRES WOUND THER DRSG SET","BMC HEALTHNET","BMCHN QHP","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,0,25.71,64.69,1]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A6550","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A6550","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A6550 - NEG PRES WOUND THER DRSG SET","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,0,25.71,64.69,1]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A6550","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A6550","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A6550 - NEG PRES WOUND THER DRSG SET","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,0,25.71,64.69,1]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A6550","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - A6550","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - A6550 - NEG PRES WOUND THER DRSG SET","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,64.69,25.71,64.69,1]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A6550","AETNA - AETNA-MEDICARE ADVANTAGE - A6550","AETNA - AETNA-MEDICARE ADVANTAGE - A6550 - NEG PRES WOUND THER DRSG SET","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,30.34,25.71,64.69,1]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A7520","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A7520","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A7520 - TRACH/LARYN TUBE NON-CUFFED","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,0,55.16,138.79,293.25]
["TUFTS - TUFTS SELECT - HCPCS - A7520","TUFTS - TUFTS SELECT - A7520","TUFTS - TUFTS SELECT - A7520 - TRACH/LARYN TUBE NON-CUFFED","TUFTS","TUFTS SELECT","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,0,55.16,138.79,293.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A7520","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - A7520","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - A7520 - TRACH/LARYN TUBE NON-CUFFED","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,66.19,55.16,138.79,293.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A7520","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - A7520","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - A7520 - TRACH/LARYN TUBE NON-CUFFED","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,66.19,55.16,138.79,293.25]
["TUFTS - TUFTS SPIRIT - HCPCS - A7520","TUFTS - TUFTS SPIRIT - A7520","TUFTS - TUFTS SPIRIT - A7520 - TRACH/LARYN TUBE NON-CUFFED","TUFTS","TUFTS SPIRIT","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,60.68,55.16,138.79,293.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A7520","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - A7520","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - A7520 - TRACH/LARYN TUBE NON-CUFFED","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,74.37,55.16,138.79,293.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A7520","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A7520","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A7520 - TRACH/LARYN TUBE NON-CUFFED","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,0,55.16,138.79,293.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A7520","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A7520","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A7520 - TRACH/LARYN TUBE NON-CUFFED","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,0,55.16,138.79,293.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - A7520","TUFTS - TUFTS MEDICARE SCO - A7520","TUFTS - TUFTS MEDICARE SCO - A7520 - TRACH/LARYN TUBE NON-CUFFED","TUFTS","TUFTS MEDICARE SCO","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,79.98,55.16,138.79,293.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - A7520","FALLON - FALLON SENIOR PLAN - A7520","FALLON - FALLON SENIOR PLAN - A7520 - TRACH/LARYN TUBE NON-CUFFED","FALLON","FALLON SENIOR PLAN","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,55.16,55.16,138.79,293.25]
["FALLON - FALLON MEDICAID - HCPCS - A7520","FALLON - FALLON MEDICAID - A7520","FALLON - FALLON MEDICAID - A7520 - TRACH/LARYN TUBE NON-CUFFED","FALLON","FALLON MEDICAID","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,0,55.16,138.79,293.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A7520","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A7520","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A7520 - TRACH/LARYN TUBE NON-CUFFED","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,0,55.16,138.79,293.25]
["TUFTS - TUFTS PPO - HCPCS - A7520","TUFTS - TUFTS PPO - A7520","TUFTS - TUFTS PPO - A7520 - TRACH/LARYN TUBE NON-CUFFED","TUFTS","TUFTS PPO","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,0,55.16,138.79,293.25]
["TUFTS - TUFTS HMO - HCPCS - A7520","TUFTS - TUFTS HMO - A7520","TUFTS - TUFTS HMO - A7520 - TRACH/LARYN TUBE NON-CUFFED","TUFTS","TUFTS HMO","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,0,55.16,138.79,293.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A7520","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A7520","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A7520 - TRACH/LARYN TUBE NON-CUFFED","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,0,55.16,138.79,293.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A7520","TUFTS - TUFTS MEDICARE PREFERRED HMO - A7520","TUFTS - TUFTS MEDICARE PREFERRED HMO - A7520 - TRACH/LARYN TUBE NON-CUFFED","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,79.98,55.16,138.79,293.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A7520","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - A7520","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - A7520 - TRACH/LARYN TUBE NON-CUFFED","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,119.09,55.16,138.79,293.25]
["TUFTS - TUFTS POS - HCPCS - A7520","TUFTS - TUFTS POS - A7520","TUFTS - TUFTS POS - A7520 - TRACH/LARYN TUBE NON-CUFFED","TUFTS","TUFTS POS","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,0,55.16,138.79,293.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A7520","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - A7520","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - A7520 - TRACH/LARYN TUBE NON-CUFFED","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,95.98,55.16,138.79,293.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A7520","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A7520","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A7520 - TRACH/LARYN TUBE NON-CUFFED","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,80.290000000000006,55.16,138.79,293.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A7520","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - A7520","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - A7520 - TRACH/LARYN TUBE NON-CUFFED","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,121.9,55.16,138.79,293.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A7520","CIGNA HEALTHCARE - CIGNA CARELINK - A7520","CIGNA HEALTHCARE - CIGNA CARELINK - A7520 - TRACH/LARYN TUBE NON-CUFFED","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,0,55.16,138.79,293.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A7520","BMC HEALTHNET - BMCHN ACO - A7520","BMC HEALTHNET - BMCHN ACO - A7520 - TRACH/LARYN TUBE NON-CUFFED","BMC HEALTHNET","BMCHN ACO","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,0,55.16,138.79,293.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A7520","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - A7520","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - A7520 - TRACH/LARYN TUBE NON-CUFFED","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,55.16,55.16,138.79,293.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A7520","ELDER SERVICE PLAN - ELEMENT CARE INC - A7520","ELDER SERVICE PLAN - ELEMENT CARE INC - A7520 - TRACH/LARYN TUBE NON-CUFFED","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,55.16,55.16,138.79,293.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A7520","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - A7520","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - A7520 - TRACH/LARYN TUBE NON-CUFFED","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,55.16,55.16,138.79,293.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A7520","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - A7520","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - A7520 - TRACH/LARYN TUBE NON-CUFFED","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,55.16,55.16,138.79,293.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A7520","BMC HEALTHNET - BMCHN MCO - A7520","BMC HEALTHNET - BMCHN MCO - A7520 - TRACH/LARYN TUBE NON-CUFFED","BMC HEALTHNET","BMCHN MCO","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,0,55.16,138.79,293.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A7520","BMC HEALTHNET - BMCHN MEDICAID - A7520","BMC HEALTHNET - BMCHN MEDICAID - A7520 - TRACH/LARYN TUBE NON-CUFFED","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,0,55.16,138.79,293.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A7520","BMC HEALTHNET - BMCHN QHP - A7520","BMC HEALTHNET - BMCHN QHP - A7520 - TRACH/LARYN TUBE NON-CUFFED","BMC HEALTHNET","BMCHN QHP","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,0,55.16,138.79,293.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A7520","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A7520","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A7520 - TRACH/LARYN TUBE NON-CUFFED","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,0,55.16,138.79,293.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A7520","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A7520","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A7520 - TRACH/LARYN TUBE NON-CUFFED","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,0,55.16,138.79,293.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A7520","AETNA - AETNA-MEDICARE ADVANTAGE - A7520","AETNA - AETNA-MEDICARE ADVANTAGE - A7520 - TRACH/LARYN TUBE NON-CUFFED","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,65.09,55.16,138.79,293.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A7520","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A7520","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A7520 - TRACH/LARYN TUBE NON-CUFFED","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,80.290000000000006,55.16,138.79,293.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A7520","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - A7520","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - A7520 - TRACH/LARYN TUBE NON-CUFFED","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,138.79,55.16,138.79,293.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A7520","BLUE CROSS - BLUE CROSS-PPO - A7520","BLUE CROSS - BLUE CROSS-PPO - A7520 - TRACH/LARYN TUBE NON-CUFFED","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,80.290000000000006,55.16,138.79,293.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A7520","BLUE CROSS - BLUE CROSS-HMO BLUE - A7520","BLUE CROSS - BLUE CROSS-HMO BLUE - A7520 - TRACH/LARYN TUBE NON-CUFFED","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,80.290000000000006,55.16,138.79,293.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A7520","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A7520","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A7520 - TRACH/LARYN TUBE NON-CUFFED","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,80.290000000000006,55.16,138.79,293.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A7520","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A7520","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A7520 - TRACH/LARYN TUBE NON-CUFFED","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,80.290000000000006,55.16,138.79,293.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A7520","BLUE CROSS - BLUE CROSS-INDEMNITY - A7520","BLUE CROSS - BLUE CROSS-INDEMNITY - A7520 - TRACH/LARYN TUBE NON-CUFFED","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,80.290000000000006,55.16,138.79,293.25]
["TUFTS - TUFTS SELECT - HCPCS - A9500","TUFTS - TUFTS SELECT - A9500","TUFTS - TUFTS SELECT - A9500 - TC99M SESTAMIBI","TUFTS","TUFTS SELECT","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,0,463.42,463.42,68.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9500","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9500","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9500 - TC99M SESTAMIBI","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,0,463.42,463.42,68.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9500","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9500","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9500 - TC99M SESTAMIBI","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,0,463.42,463.42,68.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9500","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9500","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9500 - TC99M SESTAMIBI","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,0,463.42,463.42,68.5]
["TUFTS - TUFTS HMO - HCPCS - A9500","TUFTS - TUFTS HMO - A9500","TUFTS - TUFTS HMO - A9500 - TC99M SESTAMIBI","TUFTS","TUFTS HMO","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,0,463.42,463.42,68.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9500","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9500","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9500 - TC99M SESTAMIBI","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,0,463.42,463.42,68.5]
["TUFTS - TUFTS POS - HCPCS - A9500","TUFTS - TUFTS POS - A9500","TUFTS - TUFTS POS - A9500 - TC99M SESTAMIBI","TUFTS","TUFTS POS","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,0,463.42,463.42,68.5]
["FALLON - FALLON MEDICAID - HCPCS - A9500","FALLON - FALLON MEDICAID - A9500","FALLON - FALLON MEDICAID - A9500 - TC99M SESTAMIBI","FALLON","FALLON MEDICAID","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,0,463.42,463.42,68.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9500","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9500","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9500 - TC99M SESTAMIBI","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,0,463.42,463.42,68.5]
["TUFTS - TUFTS PPO - HCPCS - A9500","TUFTS - TUFTS PPO - A9500","TUFTS - TUFTS PPO - A9500 - TC99M SESTAMIBI","TUFTS","TUFTS PPO","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,0,463.42,463.42,68.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9500","BMC HEALTHNET - BMCHN ACO - A9500","BMC HEALTHNET - BMCHN ACO - A9500 - TC99M SESTAMIBI","BMC HEALTHNET","BMCHN ACO","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,0,463.42,463.42,68.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9500","BMC HEALTHNET - BMCHN MCO - A9500","BMC HEALTHNET - BMCHN MCO - A9500 - TC99M SESTAMIBI","BMC HEALTHNET","BMCHN MCO","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,0,463.42,463.42,68.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9500","CIGNA HEALTHCARE - CIGNA CARELINK - A9500","CIGNA HEALTHCARE - CIGNA CARELINK - A9500 - TC99M SESTAMIBI","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,0,463.42,463.42,68.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9500","BMC HEALTHNET - BMCHN MEDICAID - A9500","BMC HEALTHNET - BMCHN MEDICAID - A9500 - TC99M SESTAMIBI","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,0,463.42,463.42,68.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9500","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9500","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9500 - TC99M SESTAMIBI","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,463.42,463.42,463.42,68.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9500","BMC HEALTHNET - BMCHN QHP - A9500","BMC HEALTHNET - BMCHN QHP - A9500 - TC99M SESTAMIBI","BMC HEALTHNET","BMCHN QHP","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,0,463.42,463.42,68.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9500","BLUE CROSS - BLUE CROSS-PPO - A9500","BLUE CROSS - BLUE CROSS-PPO - A9500 - TC99M SESTAMIBI","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,463.42,463.42,463.42,68.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9500","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9500","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9500 - TC99M SESTAMIBI","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,0,463.42,463.42,68.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9500","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9500","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9500 - TC99M SESTAMIBI","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,463.42,463.42,463.42,68.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9500","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9500","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9500 - TC99M SESTAMIBI","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,0,463.42,463.42,68.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9500","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9500","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9500 - TC99M SESTAMIBI","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,463.42,463.42,463.42,68.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9500","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9500","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9500 - TC99M SESTAMIBI","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,463.42,463.42,463.42,68.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9500","BLUE CROSS - BLUE CROSS-HMO BLUE - A9500","BLUE CROSS - BLUE CROSS-HMO BLUE - A9500 - TC99M SESTAMIBI","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,463.42,463.42,463.42,68.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9500","BLUE CROSS - BLUE CROSS-INDEMNITY - A9500","BLUE CROSS - BLUE CROSS-INDEMNITY - A9500 - TC99M SESTAMIBI","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,463.42,463.42,463.42,68.5]
["TUFTS - TUFTS SELECT - HCPCS - A9502","TUFTS - TUFTS SELECT - A9502","TUFTS - TUFTS SELECT - A9502 - HC TC99M TETROFOSMIN","TUFTS","TUFTS SELECT","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,0,278.27,278.27,35]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9502","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9502","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9502 - HC TC99M TETROFOSMIN","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,0,278.27,278.27,35]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9502","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9502","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9502 - HC TC99M TETROFOSMIN","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,0,278.27,278.27,35]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9502","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9502","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9502 - HC TC99M TETROFOSMIN","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,0,278.27,278.27,35]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9502","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9502","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9502 - HC TC99M TETROFOSMIN","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,0,278.27,278.27,35]
["FALLON - FALLON MEDICAID - HCPCS - A9502","FALLON - FALLON MEDICAID - A9502","FALLON - FALLON MEDICAID - A9502 - HC TC99M TETROFOSMIN","FALLON","FALLON MEDICAID","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,0,278.27,278.27,35]
["TUFTS - TUFTS PPO - HCPCS - A9502","TUFTS - TUFTS PPO - A9502","TUFTS - TUFTS PPO - A9502 - HC TC99M TETROFOSMIN","TUFTS","TUFTS PPO","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,0,278.27,278.27,35]
["TUFTS - TUFTS HMO - HCPCS - A9502","TUFTS - TUFTS HMO - A9502","TUFTS - TUFTS HMO - A9502 - HC TC99M TETROFOSMIN","TUFTS","TUFTS HMO","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,0,278.27,278.27,35]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9502","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9502","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9502 - HC TC99M TETROFOSMIN","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,0,278.27,278.27,35]
["TUFTS - TUFTS POS - HCPCS - A9502","TUFTS - TUFTS POS - A9502","TUFTS - TUFTS POS - A9502 - HC TC99M TETROFOSMIN","TUFTS","TUFTS POS","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,0,278.27,278.27,35]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9502","CIGNA HEALTHCARE - CIGNA CARELINK - A9502","CIGNA HEALTHCARE - CIGNA CARELINK - A9502 - HC TC99M TETROFOSMIN","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,0,278.27,278.27,35]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9502","BMC HEALTHNET - BMCHN ACO - A9502","BMC HEALTHNET - BMCHN ACO - A9502 - HC TC99M TETROFOSMIN","BMC HEALTHNET","BMCHN ACO","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,0,278.27,278.27,35]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9502","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9502","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9502 - HC TC99M TETROFOSMIN","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,278.27,278.27,278.27,35]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9502","BMC HEALTHNET - BMCHN MCO - A9502","BMC HEALTHNET - BMCHN MCO - A9502 - HC TC99M TETROFOSMIN","BMC HEALTHNET","BMCHN MCO","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,0,278.27,278.27,35]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9502","BMC HEALTHNET - BMCHN MEDICAID - A9502","BMC HEALTHNET - BMCHN MEDICAID - A9502 - HC TC99M TETROFOSMIN","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,0,278.27,278.27,35]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9502","BMC HEALTHNET - BMCHN QHP - A9502","BMC HEALTHNET - BMCHN QHP - A9502 - HC TC99M TETROFOSMIN","BMC HEALTHNET","BMCHN QHP","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,0,278.27,278.27,35]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9502","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9502","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9502 - HC TC99M TETROFOSMIN","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,0,278.27,278.27,35]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9502","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9502","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9502 - HC TC99M TETROFOSMIN","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,0,278.27,278.27,35]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9502","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9502","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9502 - HC TC99M TETROFOSMIN","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,278.27,278.27,278.27,35]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9502","BLUE CROSS - BLUE CROSS-PPO - A9502","BLUE CROSS - BLUE CROSS-PPO - A9502 - HC TC99M TETROFOSMIN","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,278.27,278.27,278.27,35]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9502","BLUE CROSS - BLUE CROSS-HMO BLUE - A9502","BLUE CROSS - BLUE CROSS-HMO BLUE - A9502 - HC TC99M TETROFOSMIN","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,278.27,278.27,278.27,35]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9502","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9502","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9502 - HC TC99M TETROFOSMIN","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,278.27,278.27,278.27,35]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9502","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9502","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9502 - HC TC99M TETROFOSMIN","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,278.27,278.27,278.27,35]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9502","BLUE CROSS - BLUE CROSS-INDEMNITY - A9502","BLUE CROSS - BLUE CROSS-INDEMNITY - A9502 - HC TC99M TETROFOSMIN","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,278.27,278.27,278.27,35]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9503","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9503","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9503 - TC99M MEDRONATE","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,0,37.119999999999997,37.119999999999997,5.75]
["TUFTS - TUFTS SELECT - HCPCS - A9503","TUFTS - TUFTS SELECT - A9503","TUFTS - TUFTS SELECT - A9503 - TC99M MEDRONATE","TUFTS","TUFTS SELECT","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,0,37.119999999999997,37.119999999999997,5.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9503","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9503","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9503 - TC99M MEDRONATE","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,0,37.119999999999997,37.119999999999997,5.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9503","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9503","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9503 - TC99M MEDRONATE","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,0,37.119999999999997,37.119999999999997,5.75]
["TUFTS - TUFTS POS - HCPCS - A9503","TUFTS - TUFTS POS - A9503","TUFTS - TUFTS POS - A9503 - TC99M MEDRONATE","TUFTS","TUFTS POS","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,0,37.119999999999997,37.119999999999997,5.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9503","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9503","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9503 - TC99M MEDRONATE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,0,37.119999999999997,37.119999999999997,5.75]
["TUFTS - TUFTS HMO - HCPCS - A9503","TUFTS - TUFTS HMO - A9503","TUFTS - TUFTS HMO - A9503 - TC99M MEDRONATE","TUFTS","TUFTS HMO","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,0,37.119999999999997,37.119999999999997,5.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9503","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9503","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9503 - TC99M MEDRONATE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,0,37.119999999999997,37.119999999999997,5.75]
["FALLON - FALLON MEDICAID - HCPCS - A9503","FALLON - FALLON MEDICAID - A9503","FALLON - FALLON MEDICAID - A9503 - TC99M MEDRONATE","FALLON","FALLON MEDICAID","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,0,37.119999999999997,37.119999999999997,5.75]
["TUFTS - TUFTS PPO - HCPCS - A9503","TUFTS - TUFTS PPO - A9503","TUFTS - TUFTS PPO - A9503 - TC99M MEDRONATE","TUFTS","TUFTS PPO","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,0,37.119999999999997,37.119999999999997,5.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9503","BMC HEALTHNET - BMCHN ACO - A9503","BMC HEALTHNET - BMCHN ACO - A9503 - TC99M MEDRONATE","BMC HEALTHNET","BMCHN ACO","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,0,37.119999999999997,37.119999999999997,5.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9503","BMC HEALTHNET - BMCHN MCO - A9503","BMC HEALTHNET - BMCHN MCO - A9503 - TC99M MEDRONATE","BMC HEALTHNET","BMCHN MCO","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,0,37.119999999999997,37.119999999999997,5.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9503","CIGNA HEALTHCARE - CIGNA CARELINK - A9503","CIGNA HEALTHCARE - CIGNA CARELINK - A9503 - TC99M MEDRONATE","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,0,37.119999999999997,37.119999999999997,5.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9503","BMC HEALTHNET - BMCHN MEDICAID - A9503","BMC HEALTHNET - BMCHN MEDICAID - A9503 - TC99M MEDRONATE","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,0,37.119999999999997,37.119999999999997,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9503","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9503","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9503 - TC99M MEDRONATE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,37.119999999999997,37.119999999999997,37.119999999999997,5.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9503","BMC HEALTHNET - BMCHN QHP - A9503","BMC HEALTHNET - BMCHN QHP - A9503 - TC99M MEDRONATE","BMC HEALTHNET","BMCHN QHP","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,0,37.119999999999997,37.119999999999997,5.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9503","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9503","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9503 - TC99M MEDRONATE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,0,37.119999999999997,37.119999999999997,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9503","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9503","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9503 - TC99M MEDRONATE","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,37.119999999999997,37.119999999999997,37.119999999999997,5.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9503","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9503","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9503 - TC99M MEDRONATE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,0,37.119999999999997,37.119999999999997,5.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9503","BLUE CROSS - BLUE CROSS-PPO - A9503","BLUE CROSS - BLUE CROSS-PPO - A9503 - TC99M MEDRONATE","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,37.119999999999997,37.119999999999997,37.119999999999997,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9503","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9503","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9503 - TC99M MEDRONATE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,37.119999999999997,37.119999999999997,37.119999999999997,5.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9503","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9503","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9503 - TC99M MEDRONATE","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,37.119999999999997,37.119999999999997,37.119999999999997,5.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9503","BLUE CROSS - BLUE CROSS-HMO BLUE - A9503","BLUE CROSS - BLUE CROSS-HMO BLUE - A9503 - TC99M MEDRONATE","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,37.119999999999997,37.119999999999997,37.119999999999997,5.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9503","BLUE CROSS - BLUE CROSS-INDEMNITY - A9503","BLUE CROSS - BLUE CROSS-INDEMNITY - A9503 - TC99M MEDRONATE","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,37.119999999999997,37.119999999999997,37.119999999999997,5.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9505","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9505","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9505 - THALLIUM CHLORIDE PER MCI","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,0,395.74,395.74,5.75]
["TUFTS - TUFTS SELECT - HCPCS - A9505","TUFTS - TUFTS SELECT - A9505","TUFTS - TUFTS SELECT - A9505 - THALLIUM CHLORIDE PER MCI","TUFTS","TUFTS SELECT","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,0,395.74,395.74,5.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9505","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9505","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9505 - THALLIUM CHLORIDE PER MCI","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,0,395.74,395.74,5.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9505","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9505","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9505 - THALLIUM CHLORIDE PER MCI","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,0,395.74,395.74,5.75]
["TUFTS - TUFTS PPO - HCPCS - A9505","TUFTS - TUFTS PPO - A9505","TUFTS - TUFTS PPO - A9505 - THALLIUM CHLORIDE PER MCI","TUFTS","TUFTS PPO","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,0,395.74,395.74,5.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9505","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9505","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9505 - THALLIUM CHLORIDE PER MCI","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,0,395.74,395.74,5.75]
["TUFTS - TUFTS HMO - HCPCS - A9505","TUFTS - TUFTS HMO - A9505","TUFTS - TUFTS HMO - A9505 - THALLIUM CHLORIDE PER MCI","TUFTS","TUFTS HMO","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,0,395.74,395.74,5.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9505","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9505","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9505 - THALLIUM CHLORIDE PER MCI","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,0,395.74,395.74,5.75]
["FALLON - FALLON MEDICAID - HCPCS - A9505","FALLON - FALLON MEDICAID - A9505","FALLON - FALLON MEDICAID - A9505 - THALLIUM CHLORIDE PER MCI","FALLON","FALLON MEDICAID","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,0,395.74,395.74,5.75]
["TUFTS - TUFTS POS - HCPCS - A9505","TUFTS - TUFTS POS - A9505","TUFTS - TUFTS POS - A9505 - THALLIUM CHLORIDE PER MCI","TUFTS","TUFTS POS","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,0,395.74,395.74,5.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9505","CIGNA HEALTHCARE - CIGNA CARELINK - A9505","CIGNA HEALTHCARE - CIGNA CARELINK - A9505 - THALLIUM CHLORIDE PER MCI","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,0,395.74,395.74,5.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9505","BMC HEALTHNET - BMCHN ACO - A9505","BMC HEALTHNET - BMCHN ACO - A9505 - THALLIUM CHLORIDE PER MCI","BMC HEALTHNET","BMCHN ACO","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,0,395.74,395.74,5.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9505","BMC HEALTHNET - BMCHN MCO - A9505","BMC HEALTHNET - BMCHN MCO - A9505 - THALLIUM CHLORIDE PER MCI","BMC HEALTHNET","BMCHN MCO","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,0,395.74,395.74,5.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9505","BMC HEALTHNET - BMCHN MEDICAID - A9505","BMC HEALTHNET - BMCHN MEDICAID - A9505 - THALLIUM CHLORIDE PER MCI","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,0,395.74,395.74,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9505","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9505","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9505 - THALLIUM CHLORIDE PER MCI","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,395.74,395.74,395.74,5.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9505","BMC HEALTHNET - BMCHN QHP - A9505","BMC HEALTHNET - BMCHN QHP - A9505 - THALLIUM CHLORIDE PER MCI","BMC HEALTHNET","BMCHN QHP","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,0,395.74,395.74,5.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9505","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9505","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9505 - THALLIUM CHLORIDE PER MCI","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,0,395.74,395.74,5.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9505","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9505","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9505 - THALLIUM CHLORIDE PER MCI","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,0,395.74,395.74,5.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9505","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9505","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9505 - THALLIUM CHLORIDE PER MCI","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,395.74,395.74,395.74,5.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9505","BLUE CROSS - BLUE CROSS-PPO - A9505","BLUE CROSS - BLUE CROSS-PPO - A9505 - THALLIUM CHLORIDE PER MCI","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,395.74,395.74,395.74,5.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9505","BLUE CROSS - BLUE CROSS-HMO BLUE - A9505","BLUE CROSS - BLUE CROSS-HMO BLUE - A9505 - THALLIUM CHLORIDE PER MCI","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,395.74,395.74,395.74,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9505","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9505","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9505 - THALLIUM CHLORIDE PER MCI","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,395.74,395.74,395.74,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9505","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9505","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9505 - THALLIUM CHLORIDE PER MCI","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,395.74,395.74,395.74,5.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9505","BLUE CROSS - BLUE CROSS-INDEMNITY - A9505","BLUE CROSS - BLUE CROSS-INDEMNITY - A9505 - THALLIUM CHLORIDE PER MCI","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,395.74,395.74,395.74,5.75]
["TUFTS - TUFTS SELECT - HCPCS - A9509","TUFTS - TUFTS SELECT - A9509","TUFTS - TUFTS SELECT - A9509 - HC IODINE I-123 PER MCI","TUFTS","TUFTS SELECT","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,0,5163.91,5163.91,23.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9509","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9509","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9509 - HC IODINE I-123 PER MCI","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,0,5163.91,5163.91,23.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9509","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9509","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9509 - HC IODINE I-123 PER MCI","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,0,5163.91,5163.91,23.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9509","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9509","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9509 - HC IODINE I-123 PER MCI","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,0,5163.91,5163.91,23.75]
["TUFTS - TUFTS HMO - HCPCS - A9509","TUFTS - TUFTS HMO - A9509","TUFTS - TUFTS HMO - A9509 - HC IODINE I-123 PER MCI","TUFTS","TUFTS HMO","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,0,5163.91,5163.91,23.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9509","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9509","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9509 - HC IODINE I-123 PER MCI","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,0,5163.91,5163.91,23.75]
["TUFTS - TUFTS POS - HCPCS - A9509","TUFTS - TUFTS POS - A9509","TUFTS - TUFTS POS - A9509 - HC IODINE I-123 PER MCI","TUFTS","TUFTS POS","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,0,5163.91,5163.91,23.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9509","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9509","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9509 - HC IODINE I-123 PER MCI","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,0,5163.91,5163.91,23.75]
["FALLON - FALLON MEDICAID - HCPCS - A9509","FALLON - FALLON MEDICAID - A9509","FALLON - FALLON MEDICAID - A9509 - HC IODINE I-123 PER MCI","FALLON","FALLON MEDICAID","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,0,5163.91,5163.91,23.75]
["TUFTS - TUFTS PPO - HCPCS - A9509","TUFTS - TUFTS PPO - A9509","TUFTS - TUFTS PPO - A9509 - HC IODINE I-123 PER MCI","TUFTS","TUFTS PPO","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,0,5163.91,5163.91,23.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9509","BMC HEALTHNET - BMCHN ACO - A9509","BMC HEALTHNET - BMCHN ACO - A9509 - HC IODINE I-123 PER MCI","BMC HEALTHNET","BMCHN ACO","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,0,5163.91,5163.91,23.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9509","BMC HEALTHNET - BMCHN MCO - A9509","BMC HEALTHNET - BMCHN MCO - A9509 - HC IODINE I-123 PER MCI","BMC HEALTHNET","BMCHN MCO","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,0,5163.91,5163.91,23.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9509","CIGNA HEALTHCARE - CIGNA CARELINK - A9509","CIGNA HEALTHCARE - CIGNA CARELINK - A9509 - HC IODINE I-123 PER MCI","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,0,5163.91,5163.91,23.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9509","BMC HEALTHNET - BMCHN MEDICAID - A9509","BMC HEALTHNET - BMCHN MEDICAID - A9509 - HC IODINE I-123 PER MCI","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,0,5163.91,5163.91,23.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9509","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9509","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9509 - HC IODINE I-123 PER MCI","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,5163.91,5163.91,5163.91,23.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9509","BMC HEALTHNET - BMCHN QHP - A9509","BMC HEALTHNET - BMCHN QHP - A9509 - HC IODINE I-123 PER MCI","BMC HEALTHNET","BMCHN QHP","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,0,5163.91,5163.91,23.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9509","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9509","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9509 - HC IODINE I-123 PER MCI","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,0,5163.91,5163.91,23.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9509","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9509","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9509 - HC IODINE I-123 PER MCI","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,5163.91,5163.91,5163.91,23.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9509","BLUE CROSS - BLUE CROSS-PPO - A9509","BLUE CROSS - BLUE CROSS-PPO - A9509 - HC IODINE I-123 PER MCI","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,5163.91,5163.91,5163.91,23.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9509","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9509","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9509 - HC IODINE I-123 PER MCI","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,0,5163.91,5163.91,23.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9509","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9509","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9509 - HC IODINE I-123 PER MCI","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,5163.91,5163.91,5163.91,23.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9509","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9509","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9509 - HC IODINE I-123 PER MCI","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,5163.91,5163.91,5163.91,23.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9509","BLUE CROSS - BLUE CROSS-HMO BLUE - A9509","BLUE CROSS - BLUE CROSS-HMO BLUE - A9509 - HC IODINE I-123 PER MCI","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,5163.91,5163.91,5163.91,23.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9509","BLUE CROSS - BLUE CROSS-INDEMNITY - A9509","BLUE CROSS - BLUE CROSS-INDEMNITY - A9509 - HC IODINE I-123 PER MCI","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,5163.91,5163.91,5163.91,23.75]
["TUFTS - TUFTS SELECT - HCPCS - A9512","TUFTS - TUFTS SELECT - A9512","TUFTS - TUFTS SELECT - A9512 - TC99M PERTECHNETATE","TUFTS","TUFTS SELECT","HCPCS","A9512","TC99M PERTECHNETATE","A9512 - TC99M PERTECHNETATE",1,0,0,0,0.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9512","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9512","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9512 - TC99M PERTECHNETATE","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9512","TC99M PERTECHNETATE","A9512 - TC99M PERTECHNETATE",1,0,0,0,0.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9512","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9512","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9512 - TC99M PERTECHNETATE","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9512","TC99M PERTECHNETATE","A9512 - TC99M PERTECHNETATE",1,0,0,0,0.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9512","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9512","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9512 - TC99M PERTECHNETATE","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9512","TC99M PERTECHNETATE","A9512 - TC99M PERTECHNETATE",1,0,0,0,0.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9512","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9512","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9512 - TC99M PERTECHNETATE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9512","TC99M PERTECHNETATE","A9512 - TC99M PERTECHNETATE",1,0,0,0,0.25]
["TUFTS - TUFTS PPO - HCPCS - A9512","TUFTS - TUFTS PPO - A9512","TUFTS - TUFTS PPO - A9512 - TC99M PERTECHNETATE","TUFTS","TUFTS PPO","HCPCS","A9512","TC99M PERTECHNETATE","A9512 - TC99M PERTECHNETATE",1,0,0,0,0.25]
["TUFTS - TUFTS HMO - HCPCS - A9512","TUFTS - TUFTS HMO - A9512","TUFTS - TUFTS HMO - A9512 - TC99M PERTECHNETATE","TUFTS","TUFTS HMO","HCPCS","A9512","TC99M PERTECHNETATE","A9512 - TC99M PERTECHNETATE",1,0,0,0,0.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9512","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9512","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9512 - TC99M PERTECHNETATE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9512","TC99M PERTECHNETATE","A9512 - TC99M PERTECHNETATE",1,0,0,0,0.25]
["TUFTS - TUFTS POS - HCPCS - A9512","TUFTS - TUFTS POS - A9512","TUFTS - TUFTS POS - A9512 - TC99M PERTECHNETATE","TUFTS","TUFTS POS","HCPCS","A9512","TC99M PERTECHNETATE","A9512 - TC99M PERTECHNETATE",1,0,0,0,0.25]
["FALLON - FALLON MEDICAID - HCPCS - A9512","FALLON - FALLON MEDICAID - A9512","FALLON - FALLON MEDICAID - A9512 - TC99M PERTECHNETATE","FALLON","FALLON MEDICAID","HCPCS","A9512","TC99M PERTECHNETATE","A9512 - TC99M PERTECHNETATE",1,0,0,0,0.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9512","CIGNA HEALTHCARE - CIGNA CARELINK - A9512","CIGNA HEALTHCARE - CIGNA CARELINK - A9512 - TC99M PERTECHNETATE","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9512","TC99M PERTECHNETATE","A9512 - TC99M PERTECHNETATE",1,0,0,0,0.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9512","BMC HEALTHNET - BMCHN ACO - A9512","BMC HEALTHNET - BMCHN ACO - A9512 - TC99M PERTECHNETATE","BMC HEALTHNET","BMCHN ACO","HCPCS","A9512","TC99M PERTECHNETATE","A9512 - TC99M PERTECHNETATE",1,0,0,0,0.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9512","BMC HEALTHNET - BMCHN MCO - A9512","BMC HEALTHNET - BMCHN MCO - A9512 - TC99M PERTECHNETATE","BMC HEALTHNET","BMCHN MCO","HCPCS","A9512","TC99M PERTECHNETATE","A9512 - TC99M PERTECHNETATE",1,0,0,0,0.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9512","BMC HEALTHNET - BMCHN MEDICAID - A9512","BMC HEALTHNET - BMCHN MEDICAID - A9512 - TC99M PERTECHNETATE","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9512","TC99M PERTECHNETATE","A9512 - TC99M PERTECHNETATE",1,0,0,0,0.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9512","BMC HEALTHNET - BMCHN QHP - A9512","BMC HEALTHNET - BMCHN QHP - A9512 - TC99M PERTECHNETATE","BMC HEALTHNET","BMCHN QHP","HCPCS","A9512","TC99M PERTECHNETATE","A9512 - TC99M PERTECHNETATE",1,0,0,0,0.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9512","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9512","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9512 - TC99M PERTECHNETATE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9512","TC99M PERTECHNETATE","A9512 - TC99M PERTECHNETATE",1,0,0,0,0.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9512","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9512","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9512 - TC99M PERTECHNETATE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9512","TC99M PERTECHNETATE","A9512 - TC99M PERTECHNETATE",1,0,0,0,0.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9513","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9513","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9513 - TECHNETIUM TC-99M MEBROFENIN","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,441.49,294.27999999999997,1097.56,80]
["TUFTS - TUFTS SELECT - HCPCS - A9513","TUFTS - TUFTS SELECT - A9513","TUFTS - TUFTS SELECT - A9513 - TECHNETIUM TC-99M MEBROFENIN","TUFTS","TUFTS SELECT","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,365.04,294.27999999999997,1097.56,80]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9513","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9513","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9513 - TECHNETIUM TC-99M MEBROFENIN","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,441.49,294.27999999999997,1097.56,80]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9513","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9513","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9513 - TECHNETIUM TC-99M MEBROFENIN","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,0,294.27999999999997,1097.56,80]
["TUFTS - TUFTS POS - HCPCS - A9513","TUFTS - TUFTS POS - A9513","TUFTS - TUFTS POS - A9513 - TECHNETIUM TC-99M MEBROFENIN","TUFTS","TUFTS POS","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,365.04,294.27999999999997,1097.56,80]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9513","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9513","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9513 - TECHNETIUM TC-99M MEBROFENIN","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,441.49,294.27999999999997,1097.56,80]
["TUFTS - TUFTS HMO - HCPCS - A9513","TUFTS - TUFTS HMO - A9513","TUFTS - TUFTS HMO - A9513 - TECHNETIUM TC-99M MEBROFENIN","TUFTS","TUFTS HMO","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,438.05,294.27999999999997,1097.56,80]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9513","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9513","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9513 - TECHNETIUM TC-99M MEBROFENIN","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,441.49,294.27999999999997,1097.56,80]
["FALLON - FALLON MEDICAID - HCPCS - A9513","FALLON - FALLON MEDICAID - A9513","FALLON - FALLON MEDICAID - A9513 - TECHNETIUM TC-99M MEBROFENIN","FALLON","FALLON MEDICAID","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,0,294.27999999999997,1097.56,80]
["TUFTS - TUFTS PPO - HCPCS - A9513","TUFTS - TUFTS PPO - A9513","TUFTS - TUFTS PPO - A9513 - TECHNETIUM TC-99M MEBROFENIN","TUFTS","TUFTS PPO","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,390.48,294.27999999999997,1097.56,80]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9513","BMC HEALTHNET - BMCHN ACO - A9513","BMC HEALTHNET - BMCHN ACO - A9513 - TECHNETIUM TC-99M MEBROFENIN","BMC HEALTHNET","BMCHN ACO","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,0,294.27999999999997,1097.56,80]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9513","BMC HEALTHNET - BMCHN MCO - A9513","BMC HEALTHNET - BMCHN MCO - A9513 - TECHNETIUM TC-99M MEBROFENIN","BMC HEALTHNET","BMCHN MCO","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,0,294.27999999999997,1097.56,80]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9513","CIGNA HEALTHCARE - CIGNA CARELINK - A9513","CIGNA HEALTHCARE - CIGNA CARELINK - A9513 - TECHNETIUM TC-99M MEBROFENIN","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,1097.56,294.27999999999997,1097.56,80]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9513","BMC HEALTHNET - BMCHN MEDICAID - A9513","BMC HEALTHNET - BMCHN MEDICAID - A9513 - TECHNETIUM TC-99M MEBROFENIN","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,0,294.27999999999997,1097.56,80]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9513","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9513","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9513 - TECHNETIUM TC-99M MEBROFENIN","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,329.72,294.27999999999997,1097.56,80]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9513","BMC HEALTHNET - BMCHN QHP - A9513","BMC HEALTHNET - BMCHN QHP - A9513 - TECHNETIUM TC-99M MEBROFENIN","BMC HEALTHNET","BMCHN QHP","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,0,294.27999999999997,1097.56,80]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9513","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9513","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9513 - TECHNETIUM TC-99M MEBROFENIN","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,0,294.27999999999997,1097.56,80]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9513","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9513","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9513 - TECHNETIUM TC-99M MEBROFENIN","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,0,294.27999999999997,1097.56,80]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9513","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9513","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9513 - TECHNETIUM TC-99M MEBROFENIN","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,329.72,294.27999999999997,1097.56,80]
["AETNA - AETNA - HCPCS - A9513","AETNA - AETNA - A9513","AETNA - AETNA - A9513 - TECHNETIUM TC-99M MEBROFENIN","AETNA","AETNA","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,294.27999999999997,294.27999999999997,1097.56,80]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9513","BLUE CROSS - BLUE CROSS-PPO - A9513","BLUE CROSS - BLUE CROSS-PPO - A9513 - TECHNETIUM TC-99M MEBROFENIN","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,329.72,294.27999999999997,1097.56,80]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9513","BLUE CROSS - BLUE CROSS-HMO BLUE - A9513","BLUE CROSS - BLUE CROSS-HMO BLUE - A9513 - TECHNETIUM TC-99M MEBROFENIN","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,329.72,294.27999999999997,1097.56,80]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9513","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9513","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9513 - TECHNETIUM TC-99M MEBROFENIN","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,329.72,294.27999999999997,1097.56,80]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9513","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9513","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9513 - TECHNETIUM TC-99M MEBROFENIN","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,329.72,294.27999999999997,1097.56,80]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9513","BLUE CROSS - BLUE CROSS-INDEMNITY - A9513","BLUE CROSS - BLUE CROSS-INDEMNITY - A9513 - TECHNETIUM TC-99M MEBROFENIN","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,329.72,294.27999999999997,1097.56,80]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9516","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9516","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9516 - I123 IODIDE CAP, DX","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,0,516.39,516.39,48]
["TUFTS - TUFTS SELECT - HCPCS - A9516","TUFTS - TUFTS SELECT - A9516","TUFTS - TUFTS SELECT - A9516 - I123 IODIDE CAP, DX","TUFTS","TUFTS SELECT","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,0,516.39,516.39,48]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9516","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9516","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9516 - I123 IODIDE CAP, DX","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,0,516.39,516.39,48]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9516","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9516","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9516 - I123 IODIDE CAP, DX","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,0,516.39,516.39,48]
["FALLON - FALLON MEDICAID - HCPCS - A9516","FALLON - FALLON MEDICAID - A9516","FALLON - FALLON MEDICAID - A9516 - I123 IODIDE CAP, DX","FALLON","FALLON MEDICAID","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,0,516.39,516.39,48]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9516","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9516","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9516 - I123 IODIDE CAP, DX","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,0,516.39,516.39,48]
["TUFTS - TUFTS PPO - HCPCS - A9516","TUFTS - TUFTS PPO - A9516","TUFTS - TUFTS PPO - A9516 - I123 IODIDE CAP, DX","TUFTS","TUFTS PPO","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,0,516.39,516.39,48]
["TUFTS - TUFTS HMO - HCPCS - A9516","TUFTS - TUFTS HMO - A9516","TUFTS - TUFTS HMO - A9516 - I123 IODIDE CAP, DX","TUFTS","TUFTS HMO","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,0,516.39,516.39,48]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9516","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9516","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9516 - I123 IODIDE CAP, DX","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,0,516.39,516.39,48]
["TUFTS - TUFTS POS - HCPCS - A9516","TUFTS - TUFTS POS - A9516","TUFTS - TUFTS POS - A9516 - I123 IODIDE CAP, DX","TUFTS","TUFTS POS","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,0,516.39,516.39,48]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9516","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9516","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9516 - I123 IODIDE CAP, DX","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,516.39,516.39,516.39,48]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9516","BMC HEALTHNET - BMCHN QHP - A9516","BMC HEALTHNET - BMCHN QHP - A9516 - I123 IODIDE CAP, DX","BMC HEALTHNET","BMCHN QHP","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,0,516.39,516.39,48]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9516","CIGNA HEALTHCARE - CIGNA CARELINK - A9516","CIGNA HEALTHCARE - CIGNA CARELINK - A9516 - I123 IODIDE CAP, DX","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,0,516.39,516.39,48]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9516","BMC HEALTHNET - BMCHN ACO - A9516","BMC HEALTHNET - BMCHN ACO - A9516 - I123 IODIDE CAP, DX","BMC HEALTHNET","BMCHN ACO","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,0,516.39,516.39,48]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9516","BMC HEALTHNET - BMCHN MCO - A9516","BMC HEALTHNET - BMCHN MCO - A9516 - I123 IODIDE CAP, DX","BMC HEALTHNET","BMCHN MCO","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,0,516.39,516.39,48]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9516","BMC HEALTHNET - BMCHN MEDICAID - A9516","BMC HEALTHNET - BMCHN MEDICAID - A9516 - I123 IODIDE CAP, DX","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,0,516.39,516.39,48]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9516","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9516","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9516 - I123 IODIDE CAP, DX","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,0,516.39,516.39,48]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9516","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9516","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9516 - I123 IODIDE CAP, DX","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,516.39,516.39,516.39,48]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9516","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9516","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9516 - I123 IODIDE CAP, DX","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,0,516.39,516.39,48]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9516","BLUE CROSS - BLUE CROSS-PPO - A9516","BLUE CROSS - BLUE CROSS-PPO - A9516 - I123 IODIDE CAP, DX","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,516.39,516.39,516.39,48]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9516","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9516","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9516 - I123 IODIDE CAP, DX","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,516.39,516.39,516.39,48]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9516","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9516","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9516 - I123 IODIDE CAP, DX","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,516.39,516.39,516.39,48]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9516","BLUE CROSS - BLUE CROSS-HMO BLUE - A9516","BLUE CROSS - BLUE CROSS-HMO BLUE - A9516 - I123 IODIDE CAP, DX","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,516.39,516.39,516.39,48]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9516","BLUE CROSS - BLUE CROSS-INDEMNITY - A9516","BLUE CROSS - BLUE CROSS-INDEMNITY - A9516 - I123 IODIDE CAP, DX","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,516.39,516.39,516.39,48]
["TUFTS - TUFTS SELECT - HCPCS - A9517","TUFTS - TUFTS SELECT - A9517","TUFTS - TUFTS SELECT - A9517 - I131 IODIDE CAP, RX","TUFTS","TUFTS SELECT","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,30.1,30.1,101.94,109.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9517","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9517","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9517 - I131 IODIDE CAP, RX","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,62.66,30.1,101.94,109.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9517","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9517","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9517 - I131 IODIDE CAP, RX","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,62.66,30.1,101.94,109.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9517","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9517","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9517 - I131 IODIDE CAP, RX","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,0,30.1,101.94,109.25]
["TUFTS - TUFTS HMO - HCPCS - A9517","TUFTS - TUFTS HMO - A9517","TUFTS - TUFTS HMO - A9517 - I131 IODIDE CAP, RX","TUFTS","TUFTS HMO","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,36.119999999999997,30.1,101.94,109.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9517","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9517","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9517 - I131 IODIDE CAP, RX","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,62.66,30.1,101.94,109.25]
["FALLON - FALLON MEDICAID - HCPCS - A9517","FALLON - FALLON MEDICAID - A9517","FALLON - FALLON MEDICAID - A9517 - I131 IODIDE CAP, RX","FALLON","FALLON MEDICAID","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,0,30.1,101.94,109.25]
["TUFTS - TUFTS POS - HCPCS - A9517","TUFTS - TUFTS POS - A9517","TUFTS - TUFTS POS - A9517 - I131 IODIDE CAP, RX","TUFTS","TUFTS POS","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,30.1,30.1,101.94,109.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9517","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9517","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9517 - I131 IODIDE CAP, RX","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,62.66,30.1,101.94,109.25]
["TUFTS - TUFTS PPO - HCPCS - A9517","TUFTS - TUFTS PPO - A9517","TUFTS - TUFTS PPO - A9517 - I131 IODIDE CAP, RX","TUFTS","TUFTS PPO","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,32.200000000000003,30.1,101.94,109.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9517","BMC HEALTHNET - BMCHN ACO - A9517","BMC HEALTHNET - BMCHN ACO - A9517 - I131 IODIDE CAP, RX","BMC HEALTHNET","BMCHN ACO","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,0,30.1,101.94,109.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9517","BMC HEALTHNET - BMCHN QHP - A9517","BMC HEALTHNET - BMCHN QHP - A9517 - I131 IODIDE CAP, RX","BMC HEALTHNET","BMCHN QHP","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,0,30.1,101.94,109.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9517","BMC HEALTHNET - BMCHN MCO - A9517","BMC HEALTHNET - BMCHN MCO - A9517 - I131 IODIDE CAP, RX","BMC HEALTHNET","BMCHN MCO","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,0,30.1,101.94,109.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9517","CIGNA HEALTHCARE - CIGNA CARELINK - A9517","CIGNA HEALTHCARE - CIGNA CARELINK - A9517 - I131 IODIDE CAP, RX","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,90.52,30.1,101.94,109.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9517","BMC HEALTHNET - BMCHN MEDICAID - A9517","BMC HEALTHNET - BMCHN MEDICAID - A9517 - I131 IODIDE CAP, RX","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,0,30.1,101.94,109.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9517","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9517","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9517 - I131 IODIDE CAP, RX","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,101.94,30.1,101.94,109.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9517","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9517","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9517 - I131 IODIDE CAP, RX","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,0,30.1,101.94,109.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9517","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9517","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9517 - I131 IODIDE CAP, RX","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,0,30.1,101.94,109.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9517","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9517","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9517 - I131 IODIDE CAP, RX","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,101.94,30.1,101.94,109.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9517","BLUE CROSS - BLUE CROSS-PPO - A9517","BLUE CROSS - BLUE CROSS-PPO - A9517 - I131 IODIDE CAP, RX","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,101.94,30.1,101.94,109.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9517","BLUE CROSS - BLUE CROSS-HMO BLUE - A9517","BLUE CROSS - BLUE CROSS-HMO BLUE - A9517 - I131 IODIDE CAP, RX","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,101.94,30.1,101.94,109.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9517","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9517","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9517 - I131 IODIDE CAP, RX","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,101.94,30.1,101.94,109.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9517","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9517","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9517 - I131 IODIDE CAP, RX","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,101.94,30.1,101.94,109.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9517","BLUE CROSS - BLUE CROSS-INDEMNITY - A9517","BLUE CROSS - BLUE CROSS-INDEMNITY - A9517 - I131 IODIDE CAP, RX","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,101.94,30.1,101.94,109.25]
["TUFTS - TUFTS SELECT - HCPCS - A9520","TUFTS - TUFTS SELECT - A9520","TUFTS - TUFTS SELECT - A9520 - TECHNETIUMTC-99M SULFUR CLLD","TUFTS","TUFTS SELECT","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD","A9520 - TECHNETIUMTC-99M SULFUR CLLD",1951,0,0,0,487.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9520","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9520","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9520 - TECHNETIUMTC-99M SULFUR CLLD","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD","A9520 - TECHNETIUMTC-99M SULFUR CLLD",1951,0,0,0,487.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9520","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9520","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9520 - TECHNETIUMTC-99M SULFUR CLLD","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD","A9520 - TECHNETIUMTC-99M SULFUR CLLD",1951,0,0,0,487.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9520","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9520","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9520 - TECHNETIUMTC-99M SULFUR CLLD","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD","A9520 - TECHNETIUMTC-99M SULFUR CLLD",1951,0,0,0,487.75]
["FALLON - FALLON MEDICAID - HCPCS - A9520","FALLON - FALLON MEDICAID - A9520","FALLON - FALLON MEDICAID - A9520 - TECHNETIUMTC-99M SULFUR CLLD","FALLON","FALLON MEDICAID","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD","A9520 - TECHNETIUMTC-99M SULFUR CLLD",1951,0,0,0,487.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9520","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9520","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9520 - TECHNETIUMTC-99M SULFUR CLLD","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD","A9520 - TECHNETIUMTC-99M SULFUR CLLD",1951,0,0,0,487.75]
["TUFTS - TUFTS PPO - HCPCS - A9520","TUFTS - TUFTS PPO - A9520","TUFTS - TUFTS PPO - A9520 - TECHNETIUMTC-99M SULFUR CLLD","TUFTS","TUFTS PPO","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD","A9520 - TECHNETIUMTC-99M SULFUR CLLD",1951,0,0,0,487.75]
["TUFTS - TUFTS HMO - HCPCS - A9520","TUFTS - TUFTS HMO - A9520","TUFTS - TUFTS HMO - A9520 - TECHNETIUMTC-99M SULFUR CLLD","TUFTS","TUFTS HMO","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD","A9520 - TECHNETIUMTC-99M SULFUR CLLD",1951,0,0,0,487.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9520","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9520","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9520 - TECHNETIUMTC-99M SULFUR CLLD","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD","A9520 - TECHNETIUMTC-99M SULFUR CLLD",1951,0,0,0,487.75]
["TUFTS - TUFTS POS - HCPCS - A9520","TUFTS - TUFTS POS - A9520","TUFTS - TUFTS POS - A9520 - TECHNETIUMTC-99M SULFUR CLLD","TUFTS","TUFTS POS","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD","A9520 - TECHNETIUMTC-99M SULFUR CLLD",1951,0,0,0,487.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9520","CIGNA HEALTHCARE - CIGNA CARELINK - A9520","CIGNA HEALTHCARE - CIGNA CARELINK - A9520 - TECHNETIUMTC-99M SULFUR CLLD","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD","A9520 - TECHNETIUMTC-99M SULFUR CLLD",1951,0,0,0,487.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9520","BMC HEALTHNET - BMCHN QHP - A9520","BMC HEALTHNET - BMCHN QHP - A9520 - TECHNETIUMTC-99M SULFUR CLLD","BMC HEALTHNET","BMCHN QHP","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD","A9520 - TECHNETIUMTC-99M SULFUR CLLD",1951,0,0,0,487.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9520","BMC HEALTHNET - BMCHN ACO - A9520","BMC HEALTHNET - BMCHN ACO - A9520 - TECHNETIUMTC-99M SULFUR CLLD","BMC HEALTHNET","BMCHN ACO","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD","A9520 - TECHNETIUMTC-99M SULFUR CLLD",1951,0,0,0,487.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9520","BMC HEALTHNET - BMCHN MCO - A9520","BMC HEALTHNET - BMCHN MCO - A9520 - TECHNETIUMTC-99M SULFUR CLLD","BMC HEALTHNET","BMCHN MCO","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD","A9520 - TECHNETIUMTC-99M SULFUR CLLD",1951,0,0,0,487.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9520","BMC HEALTHNET - BMCHN MEDICAID - A9520","BMC HEALTHNET - BMCHN MEDICAID - A9520 - TECHNETIUMTC-99M SULFUR CLLD","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD","A9520 - TECHNETIUMTC-99M SULFUR CLLD",1951,0,0,0,487.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9520","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9520","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9520 - TECHNETIUMTC-99M SULFUR CLLD","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD","A9520 - TECHNETIUMTC-99M SULFUR CLLD",1951,0,0,0,487.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9520","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9520","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9520 - TECHNETIUMTC-99M SULFUR CLLD","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD","A9520 - TECHNETIUMTC-99M SULFUR CLLD",1951,0,0,0,487.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9521","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9521","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9521 - TC99M EXAMETAZIME","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,0,4157.3,4157.3,90]
["TUFTS - TUFTS SELECT - HCPCS - A9521","TUFTS - TUFTS SELECT - A9521","TUFTS - TUFTS SELECT - A9521 - TC99M EXAMETAZIME","TUFTS","TUFTS SELECT","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,0,4157.3,4157.3,90]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9521","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9521","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9521 - TC99M EXAMETAZIME","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,0,4157.3,4157.3,90]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9521","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9521","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9521 - TC99M EXAMETAZIME","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,0,4157.3,4157.3,90]
["TUFTS - TUFTS POS - HCPCS - A9521","TUFTS - TUFTS POS - A9521","TUFTS - TUFTS POS - A9521 - TC99M EXAMETAZIME","TUFTS","TUFTS POS","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,0,4157.3,4157.3,90]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9521","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9521","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9521 - TC99M EXAMETAZIME","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,0,4157.3,4157.3,90]
["TUFTS - TUFTS HMO - HCPCS - A9521","TUFTS - TUFTS HMO - A9521","TUFTS - TUFTS HMO - A9521 - TC99M EXAMETAZIME","TUFTS","TUFTS HMO","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,0,4157.3,4157.3,90]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9521","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9521","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9521 - TC99M EXAMETAZIME","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,0,4157.3,4157.3,90]
["FALLON - FALLON MEDICAID - HCPCS - A9521","FALLON - FALLON MEDICAID - A9521","FALLON - FALLON MEDICAID - A9521 - TC99M EXAMETAZIME","FALLON","FALLON MEDICAID","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,0,4157.3,4157.3,90]
["TUFTS - TUFTS PPO - HCPCS - A9521","TUFTS - TUFTS PPO - A9521","TUFTS - TUFTS PPO - A9521 - TC99M EXAMETAZIME","TUFTS","TUFTS PPO","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,0,4157.3,4157.3,90]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9521","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9521","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9521 - TC99M EXAMETAZIME","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,4157.3,4157.3,4157.3,90]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9521","BMC HEALTHNET - BMCHN ACO - A9521","BMC HEALTHNET - BMCHN ACO - A9521 - TC99M EXAMETAZIME","BMC HEALTHNET","BMCHN ACO","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,0,4157.3,4157.3,90]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9521","BMC HEALTHNET - BMCHN QHP - A9521","BMC HEALTHNET - BMCHN QHP - A9521 - TC99M EXAMETAZIME","BMC HEALTHNET","BMCHN QHP","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,0,4157.3,4157.3,90]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9521","BMC HEALTHNET - BMCHN MCO - A9521","BMC HEALTHNET - BMCHN MCO - A9521 - TC99M EXAMETAZIME","BMC HEALTHNET","BMCHN MCO","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,0,4157.3,4157.3,90]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9521","CIGNA HEALTHCARE - CIGNA CARELINK - A9521","CIGNA HEALTHCARE - CIGNA CARELINK - A9521 - TC99M EXAMETAZIME","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,0,4157.3,4157.3,90]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9521","BMC HEALTHNET - BMCHN MEDICAID - A9521","BMC HEALTHNET - BMCHN MEDICAID - A9521 - TC99M EXAMETAZIME","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,0,4157.3,4157.3,90]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9521","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9521","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9521 - TC99M EXAMETAZIME","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,0,4157.3,4157.3,90]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9521","BLUE CROSS - BLUE CROSS-PPO - A9521","BLUE CROSS - BLUE CROSS-PPO - A9521 - TC99M EXAMETAZIME","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,4157.3,4157.3,4157.3,90]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9521","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9521","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9521 - TC99M EXAMETAZIME","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,4157.3,4157.3,4157.3,90]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9521","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9521","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9521 - TC99M EXAMETAZIME","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,0,4157.3,4157.3,90]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9521","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9521","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9521 - TC99M EXAMETAZIME","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,4157.3,4157.3,4157.3,90]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9521","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9521","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9521 - TC99M EXAMETAZIME","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,4157.3,4157.3,4157.3,90]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9521","BLUE CROSS - BLUE CROSS-HMO BLUE - A9521","BLUE CROSS - BLUE CROSS-HMO BLUE - A9521 - TC99M EXAMETAZIME","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,4157.3,4157.3,4157.3,90]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9521","BLUE CROSS - BLUE CROSS-INDEMNITY - A9521","BLUE CROSS - BLUE CROSS-INDEMNITY - A9521 - TC99M EXAMETAZIME","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,4157.3,4157.3,4157.3,90]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9537","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9537","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9537 - TC99M MEBROFENIN","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,0,157.94999999999999,157.94999999999999,34.5]
["TUFTS - TUFTS SELECT - HCPCS - A9537","TUFTS - TUFTS SELECT - A9537","TUFTS - TUFTS SELECT - A9537 - TC99M MEBROFENIN","TUFTS","TUFTS SELECT","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,0,157.94999999999999,157.94999999999999,34.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9537","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9537","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9537 - TC99M MEBROFENIN","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,0,157.94999999999999,157.94999999999999,34.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9537","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9537","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9537 - TC99M MEBROFENIN","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,0,157.94999999999999,157.94999999999999,34.5]
["TUFTS - TUFTS PPO - HCPCS - A9537","TUFTS - TUFTS PPO - A9537","TUFTS - TUFTS PPO - A9537 - TC99M MEBROFENIN","TUFTS","TUFTS PPO","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,0,157.94999999999999,157.94999999999999,34.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9537","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9537","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9537 - TC99M MEBROFENIN","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,0,157.94999999999999,157.94999999999999,34.5]
["TUFTS - TUFTS HMO - HCPCS - A9537","TUFTS - TUFTS HMO - A9537","TUFTS - TUFTS HMO - A9537 - TC99M MEBROFENIN","TUFTS","TUFTS HMO","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,0,157.94999999999999,157.94999999999999,34.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9537","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9537","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9537 - TC99M MEBROFENIN","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,0,157.94999999999999,157.94999999999999,34.5]
["FALLON - FALLON MEDICAID - HCPCS - A9537","FALLON - FALLON MEDICAID - A9537","FALLON - FALLON MEDICAID - A9537 - TC99M MEBROFENIN","FALLON","FALLON MEDICAID","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,0,157.94999999999999,157.94999999999999,34.5]
["TUFTS - TUFTS POS - HCPCS - A9537","TUFTS - TUFTS POS - A9537","TUFTS - TUFTS POS - A9537 - TC99M MEBROFENIN","TUFTS","TUFTS POS","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,0,157.94999999999999,157.94999999999999,34.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9537","BMC HEALTHNET - BMCHN QHP - A9537","BMC HEALTHNET - BMCHN QHP - A9537 - TC99M MEBROFENIN","BMC HEALTHNET","BMCHN QHP","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,0,157.94999999999999,157.94999999999999,34.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9537","CIGNA HEALTHCARE - CIGNA CARELINK - A9537","CIGNA HEALTHCARE - CIGNA CARELINK - A9537 - TC99M MEBROFENIN","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,0,157.94999999999999,157.94999999999999,34.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9537","BMC HEALTHNET - BMCHN ACO - A9537","BMC HEALTHNET - BMCHN ACO - A9537 - TC99M MEBROFENIN","BMC HEALTHNET","BMCHN ACO","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,0,157.94999999999999,157.94999999999999,34.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9537","BMC HEALTHNET - BMCHN MCO - A9537","BMC HEALTHNET - BMCHN MCO - A9537 - TC99M MEBROFENIN","BMC HEALTHNET","BMCHN MCO","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,0,157.94999999999999,157.94999999999999,34.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9537","BMC HEALTHNET - BMCHN MEDICAID - A9537","BMC HEALTHNET - BMCHN MEDICAID - A9537 - TC99M MEBROFENIN","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,0,157.94999999999999,157.94999999999999,34.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9537","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9537","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9537 - TC99M MEBROFENIN","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,157.94999999999999,157.94999999999999,157.94999999999999,34.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9537","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9537","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9537 - TC99M MEBROFENIN","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,0,157.94999999999999,157.94999999999999,34.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9537","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9537","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9537 - TC99M MEBROFENIN","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,0,157.94999999999999,157.94999999999999,34.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9537","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9537","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9537 - TC99M MEBROFENIN","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,157.94999999999999,157.94999999999999,157.94999999999999,34.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9537","BLUE CROSS - BLUE CROSS-PPO - A9537","BLUE CROSS - BLUE CROSS-PPO - A9537 - TC99M MEBROFENIN","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,157.94999999999999,157.94999999999999,157.94999999999999,34.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9537","BLUE CROSS - BLUE CROSS-HMO BLUE - A9537","BLUE CROSS - BLUE CROSS-HMO BLUE - A9537 - TC99M MEBROFENIN","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,157.94999999999999,157.94999999999999,157.94999999999999,34.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9537","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9537","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9537 - TC99M MEBROFENIN","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,157.94999999999999,157.94999999999999,157.94999999999999,34.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9537","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9537","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9537 - TC99M MEBROFENIN","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,157.94999999999999,157.94999999999999,157.94999999999999,34.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9537","BLUE CROSS - BLUE CROSS-INDEMNITY - A9537","BLUE CROSS - BLUE CROSS-INDEMNITY - A9537 - TC99M MEBROFENIN","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,157.94999999999999,157.94999999999999,157.94999999999999,34.5]
["TUFTS - TUFTS SELECT - HCPCS - A9538","TUFTS - TUFTS SELECT - A9538","TUFTS - TUFTS SELECT - A9538 - TC99M PYROPHOSPHATE","TUFTS","TUFTS SELECT","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,0,114.21,114.21,27.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9538","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9538","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9538 - TC99M PYROPHOSPHATE","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,0,114.21,114.21,27.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9538","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9538","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9538 - TC99M PYROPHOSPHATE","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,0,114.21,114.21,27.75]
["TUFTS - TUFTS PPO - HCPCS - A9538","TUFTS - TUFTS PPO - A9538","TUFTS - TUFTS PPO - A9538 - TC99M PYROPHOSPHATE","TUFTS","TUFTS PPO","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,0,114.21,114.21,27.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9538","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9538","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9538 - TC99M PYROPHOSPHATE","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,0,114.21,114.21,27.75]
["TUFTS - TUFTS HMO - HCPCS - A9538","TUFTS - TUFTS HMO - A9538","TUFTS - TUFTS HMO - A9538 - TC99M PYROPHOSPHATE","TUFTS","TUFTS HMO","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,0,114.21,114.21,27.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9538","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9538","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9538 - TC99M PYROPHOSPHATE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,0,114.21,114.21,27.75]
["TUFTS - TUFTS POS - HCPCS - A9538","TUFTS - TUFTS POS - A9538","TUFTS - TUFTS POS - A9538 - TC99M PYROPHOSPHATE","TUFTS","TUFTS POS","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,0,114.21,114.21,27.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9538","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9538","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9538 - TC99M PYROPHOSPHATE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,0,114.21,114.21,27.75]
["FALLON - FALLON MEDICAID - HCPCS - A9538","FALLON - FALLON MEDICAID - A9538","FALLON - FALLON MEDICAID - A9538 - TC99M PYROPHOSPHATE","FALLON","FALLON MEDICAID","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,0,114.21,114.21,27.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9538","BMC HEALTHNET - BMCHN ACO - A9538","BMC HEALTHNET - BMCHN ACO - A9538 - TC99M PYROPHOSPHATE","BMC HEALTHNET","BMCHN ACO","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,0,114.21,114.21,27.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9538","BMC HEALTHNET - BMCHN QHP - A9538","BMC HEALTHNET - BMCHN QHP - A9538 - TC99M PYROPHOSPHATE","BMC HEALTHNET","BMCHN QHP","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,0,114.21,114.21,27.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9538","BMC HEALTHNET - BMCHN MCO - A9538","BMC HEALTHNET - BMCHN MCO - A9538 - TC99M PYROPHOSPHATE","BMC HEALTHNET","BMCHN MCO","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,0,114.21,114.21,27.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9538","CIGNA HEALTHCARE - CIGNA CARELINK - A9538","CIGNA HEALTHCARE - CIGNA CARELINK - A9538 - TC99M PYROPHOSPHATE","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,0,114.21,114.21,27.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9538","BMC HEALTHNET - BMCHN MEDICAID - A9538","BMC HEALTHNET - BMCHN MEDICAID - A9538 - TC99M PYROPHOSPHATE","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,0,114.21,114.21,27.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9538","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9538","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9538 - TC99M PYROPHOSPHATE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,114.21,114.21,114.21,27.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9538","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9538","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9538 - TC99M PYROPHOSPHATE","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,114.21,114.21,114.21,27.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9538","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9538","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9538 - TC99M PYROPHOSPHATE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,0,114.21,114.21,27.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9538","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9538","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9538 - TC99M PYROPHOSPHATE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,0,114.21,114.21,27.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9538","BLUE CROSS - BLUE CROSS-PPO - A9538","BLUE CROSS - BLUE CROSS-PPO - A9538 - TC99M PYROPHOSPHATE","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,114.21,114.21,114.21,27.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9538","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9538","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9538 - TC99M PYROPHOSPHATE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,114.21,114.21,114.21,27.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9538","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9538","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9538 - TC99M PYROPHOSPHATE","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,114.21,114.21,114.21,27.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9538","BLUE CROSS - BLUE CROSS-HMO BLUE - A9538","BLUE CROSS - BLUE CROSS-HMO BLUE - A9538 - TC99M PYROPHOSPHATE","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,114.21,114.21,114.21,27.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9538","BLUE CROSS - BLUE CROSS-INDEMNITY - A9538","BLUE CROSS - BLUE CROSS-INDEMNITY - A9538 - TC99M PYROPHOSPHATE","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,114.21,114.21,114.21,27.75]
["TUFTS - TUFTS SELECT - HCPCS - A9539","TUFTS - TUFTS SELECT - A9539","TUFTS - TUFTS SELECT - A9539 - TC99M PENTETATE","TUFTS","TUFTS SELECT","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,0,89.47,89.47,167]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9539","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9539","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9539 - TC99M PENTETATE","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,0,89.47,89.47,167]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9539","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9539","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9539 - TC99M PENTETATE","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,0,89.47,89.47,167]
["TUFTS - TUFTS PPO - HCPCS - A9539","TUFTS - TUFTS PPO - A9539","TUFTS - TUFTS PPO - A9539 - TC99M PENTETATE","TUFTS","TUFTS PPO","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,0,89.47,89.47,167]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9539","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9539","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9539 - TC99M PENTETATE","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,0,89.47,89.47,167]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9539","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9539","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9539 - TC99M PENTETATE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,0,89.47,89.47,167]
["TUFTS - TUFTS HMO - HCPCS - A9539","TUFTS - TUFTS HMO - A9539","TUFTS - TUFTS HMO - A9539 - TC99M PENTETATE","TUFTS","TUFTS HMO","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,0,89.47,89.47,167]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9539","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9539","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9539 - TC99M PENTETATE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,0,89.47,89.47,167]
["TUFTS - TUFTS POS - HCPCS - A9539","TUFTS - TUFTS POS - A9539","TUFTS - TUFTS POS - A9539 - TC99M PENTETATE","TUFTS","TUFTS POS","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,0,89.47,89.47,167]
["FALLON - FALLON MEDICAID - HCPCS - A9539","FALLON - FALLON MEDICAID - A9539","FALLON - FALLON MEDICAID - A9539 - TC99M PENTETATE","FALLON","FALLON MEDICAID","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,0,89.47,89.47,167]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9539","CIGNA HEALTHCARE - CIGNA CARELINK - A9539","CIGNA HEALTHCARE - CIGNA CARELINK - A9539 - TC99M PENTETATE","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,0,89.47,89.47,167]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9539","BMC HEALTHNET - BMCHN QHP - A9539","BMC HEALTHNET - BMCHN QHP - A9539 - TC99M PENTETATE","BMC HEALTHNET","BMCHN QHP","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,0,89.47,89.47,167]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9539","BMC HEALTHNET - BMCHN ACO - A9539","BMC HEALTHNET - BMCHN ACO - A9539 - TC99M PENTETATE","BMC HEALTHNET","BMCHN ACO","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,0,89.47,89.47,167]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9539","BMC HEALTHNET - BMCHN MCO - A9539","BMC HEALTHNET - BMCHN MCO - A9539 - TC99M PENTETATE","BMC HEALTHNET","BMCHN MCO","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,0,89.47,89.47,167]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9539","BMC HEALTHNET - BMCHN MEDICAID - A9539","BMC HEALTHNET - BMCHN MEDICAID - A9539 - TC99M PENTETATE","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,0,89.47,89.47,167]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9539","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9539","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9539 - TC99M PENTETATE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,89.47,89.47,89.47,167]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9539","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9539","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9539 - TC99M PENTETATE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,0,89.47,89.47,167]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9539","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9539","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9539 - TC99M PENTETATE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,0,89.47,89.47,167]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9539","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9539","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9539 - TC99M PENTETATE","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,89.47,89.47,89.47,167]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9539","BLUE CROSS - BLUE CROSS-PPO - A9539","BLUE CROSS - BLUE CROSS-PPO - A9539 - TC99M PENTETATE","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,89.47,89.47,89.47,167]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9539","BLUE CROSS - BLUE CROSS-HMO BLUE - A9539","BLUE CROSS - BLUE CROSS-HMO BLUE - A9539 - TC99M PENTETATE","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,89.47,89.47,89.47,167]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9539","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9539","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9539 - TC99M PENTETATE","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,89.47,89.47,89.47,167]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9539","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9539","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9539 - TC99M PENTETATE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,89.47,89.47,89.47,167]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9539","BLUE CROSS - BLUE CROSS-INDEMNITY - A9539","BLUE CROSS - BLUE CROSS-INDEMNITY - A9539 - TC99M PENTETATE","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,89.47,89.47,89.47,167]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9540","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9540","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9540 - TC99M MAA","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,0,85.66,85.66,457.75]
["TUFTS - TUFTS PPO - HCPCS - A9540","TUFTS - TUFTS PPO - A9540","TUFTS - TUFTS PPO - A9540 - TC99M MAA","TUFTS","TUFTS PPO","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,0,85.66,85.66,457.75]
["TUFTS - TUFTS SELECT - HCPCS - A9540","TUFTS - TUFTS SELECT - A9540","TUFTS - TUFTS SELECT - A9540 - TC99M MAA","TUFTS","TUFTS SELECT","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,0,85.66,85.66,457.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9540","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9540","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9540 - TC99M MAA","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,0,85.66,85.66,457.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9540","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9540","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9540 - TC99M MAA","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,0,85.66,85.66,457.75]
["TUFTS - TUFTS POS - HCPCS - A9540","TUFTS - TUFTS POS - A9540","TUFTS - TUFTS POS - A9540 - TC99M MAA","TUFTS","TUFTS POS","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,0,85.66,85.66,457.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9540","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9540","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9540 - TC99M MAA","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,0,85.66,85.66,457.75]
["TUFTS - TUFTS HMO - HCPCS - A9540","TUFTS - TUFTS HMO - A9540","TUFTS - TUFTS HMO - A9540 - TC99M MAA","TUFTS","TUFTS HMO","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,0,85.66,85.66,457.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9540","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9540","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9540 - TC99M MAA","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,0,85.66,85.66,457.75]
["FALLON - FALLON MEDICAID - HCPCS - A9540","FALLON - FALLON MEDICAID - A9540","FALLON - FALLON MEDICAID - A9540 - TC99M MAA","FALLON","FALLON MEDICAID","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,0,85.66,85.66,457.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9540","BMC HEALTHNET - BMCHN ACO - A9540","BMC HEALTHNET - BMCHN ACO - A9540 - TC99M MAA","BMC HEALTHNET","BMCHN ACO","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,0,85.66,85.66,457.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9540","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9540","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9540 - TC99M MAA","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,85.66,85.66,85.66,457.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9540","BMC HEALTHNET - BMCHN QHP - A9540","BMC HEALTHNET - BMCHN QHP - A9540 - TC99M MAA","BMC HEALTHNET","BMCHN QHP","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,0,85.66,85.66,457.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9540","BMC HEALTHNET - BMCHN MCO - A9540","BMC HEALTHNET - BMCHN MCO - A9540 - TC99M MAA","BMC HEALTHNET","BMCHN MCO","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,0,85.66,85.66,457.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9540","CIGNA HEALTHCARE - CIGNA CARELINK - A9540","CIGNA HEALTHCARE - CIGNA CARELINK - A9540 - TC99M MAA","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,0,85.66,85.66,457.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9540","BMC HEALTHNET - BMCHN MEDICAID - A9540","BMC HEALTHNET - BMCHN MEDICAID - A9540 - TC99M MAA","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,0,85.66,85.66,457.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9540","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9540","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9540 - TC99M MAA","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,0,85.66,85.66,457.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9540","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9540","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9540 - TC99M MAA","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,85.66,85.66,85.66,457.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9540","BLUE CROSS - BLUE CROSS-PPO - A9540","BLUE CROSS - BLUE CROSS-PPO - A9540 - TC99M MAA","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,85.66,85.66,85.66,457.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9540","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9540","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9540 - TC99M MAA","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,0,85.66,85.66,457.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9540","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9540","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9540 - TC99M MAA","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,85.66,85.66,85.66,457.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9540","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9540","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9540 - TC99M MAA","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,85.66,85.66,85.66,457.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9540","BLUE CROSS - BLUE CROSS-HMO BLUE - A9540","BLUE CROSS - BLUE CROSS-HMO BLUE - A9540 - TC99M MAA","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,85.66,85.66,85.66,457.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9540","BLUE CROSS - BLUE CROSS-INDEMNITY - A9540","BLUE CROSS - BLUE CROSS-INDEMNITY - A9540 - TC99M MAA","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,85.66,85.66,85.66,457.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9541","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9541","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9541 - TC99M SULFUR COLLOID","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,0,152.69,152.69,30]
["TUFTS - TUFTS PPO - HCPCS - A9541","TUFTS - TUFTS PPO - A9541","TUFTS - TUFTS PPO - A9541 - TC99M SULFUR COLLOID","TUFTS","TUFTS PPO","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,0,152.69,152.69,30]
["TUFTS - TUFTS SELECT - HCPCS - A9541","TUFTS - TUFTS SELECT - A9541","TUFTS - TUFTS SELECT - A9541 - TC99M SULFUR COLLOID","TUFTS","TUFTS SELECT","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,0,152.69,152.69,30]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9541","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9541","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9541 - TC99M SULFUR COLLOID","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,0,152.69,152.69,30]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9541","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9541","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9541 - TC99M SULFUR COLLOID","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,0,152.69,152.69,30]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9541","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9541","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9541 - TC99M SULFUR COLLOID","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,0,152.69,152.69,30]
["FALLON - FALLON MEDICAID - HCPCS - A9541","FALLON - FALLON MEDICAID - A9541","FALLON - FALLON MEDICAID - A9541 - TC99M SULFUR COLLOID","FALLON","FALLON MEDICAID","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,0,152.69,152.69,30]
["TUFTS - TUFTS HMO - HCPCS - A9541","TUFTS - TUFTS HMO - A9541","TUFTS - TUFTS HMO - A9541 - TC99M SULFUR COLLOID","TUFTS","TUFTS HMO","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,0,152.69,152.69,30]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9541","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9541","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9541 - TC99M SULFUR COLLOID","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,0,152.69,152.69,30]
["TUFTS - TUFTS POS - HCPCS - A9541","TUFTS - TUFTS POS - A9541","TUFTS - TUFTS POS - A9541 - TC99M SULFUR COLLOID","TUFTS","TUFTS POS","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,0,152.69,152.69,30]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9541","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9541","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9541 - TC99M SULFUR COLLOID","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,152.69,152.69,152.69,30]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9541","BMC HEALTHNET - BMCHN QHP - A9541","BMC HEALTHNET - BMCHN QHP - A9541 - TC99M SULFUR COLLOID","BMC HEALTHNET","BMCHN QHP","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,0,152.69,152.69,30]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9541","CIGNA HEALTHCARE - CIGNA CARELINK - A9541","CIGNA HEALTHCARE - CIGNA CARELINK - A9541 - TC99M SULFUR COLLOID","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,0,152.69,152.69,30]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9541","BMC HEALTHNET - BMCHN ACO - A9541","BMC HEALTHNET - BMCHN ACO - A9541 - TC99M SULFUR COLLOID","BMC HEALTHNET","BMCHN ACO","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,0,152.69,152.69,30]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9541","BMC HEALTHNET - BMCHN MCO - A9541","BMC HEALTHNET - BMCHN MCO - A9541 - TC99M SULFUR COLLOID","BMC HEALTHNET","BMCHN MCO","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,0,152.69,152.69,30]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9541","BMC HEALTHNET - BMCHN MEDICAID - A9541","BMC HEALTHNET - BMCHN MEDICAID - A9541 - TC99M SULFUR COLLOID","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,0,152.69,152.69,30]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9541","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9541","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9541 - TC99M SULFUR COLLOID","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,0,152.69,152.69,30]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9541","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9541","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9541 - TC99M SULFUR COLLOID","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,0,152.69,152.69,30]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9541","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9541","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9541 - TC99M SULFUR COLLOID","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,152.69,152.69,152.69,30]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9541","BLUE CROSS - BLUE CROSS-INDEMNITY - A9541","BLUE CROSS - BLUE CROSS-INDEMNITY - A9541 - TC99M SULFUR COLLOID","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,152.69,152.69,152.69,30]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9541","BLUE CROSS - BLUE CROSS-PPO - A9541","BLUE CROSS - BLUE CROSS-PPO - A9541 - TC99M SULFUR COLLOID","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,152.69,152.69,152.69,30]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9541","BLUE CROSS - BLUE CROSS-HMO BLUE - A9541","BLUE CROSS - BLUE CROSS-HMO BLUE - A9541 - TC99M SULFUR COLLOID","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,152.69,152.69,152.69,30]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9541","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9541","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9541 - TC99M SULFUR COLLOID","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,152.69,152.69,152.69,30]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9541","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9541","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9541 - TC99M SULFUR COLLOID","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,152.69,152.69,152.69,30]
["TUFTS - TUFTS PPO - HCPCS - A9543","TUFTS - TUFTS PPO - A9543","TUFTS - TUFTS PPO - A9543 - Y90 IBRITUMOMAB, RX","TUFTS","TUFTS PPO","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,77447.320000000007,72400.97,217685.7,16580.5]
["TUFTS - TUFTS SELECT - HCPCS - A9543","TUFTS - TUFTS SELECT - A9543","TUFTS - TUFTS SELECT - A9543 - Y90 IBRITUMOMAB, RX","TUFTS","TUFTS SELECT","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,72400.97,72400.97,217685.7,16580.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9543","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9543","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9543 - Y90 IBRITUMOMAB, RX","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,97558.58,72400.97,217685.7,16580.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9543","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9543","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9543 - Y90 IBRITUMOMAB, RX","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,97558.58,72400.97,217685.7,16580.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9543","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9543","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9543 - Y90 IBRITUMOMAB, RX","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,0,72400.97,217685.7,16580.5]
["TUFTS - TUFTS HMO - HCPCS - A9543","TUFTS - TUFTS HMO - A9543","TUFTS - TUFTS HMO - A9543 - Y90 IBRITUMOMAB, RX","TUFTS","TUFTS HMO","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,86881.16,72400.97,217685.7,16580.5]
["FALLON - FALLON MEDICAID - HCPCS - A9543","FALLON - FALLON MEDICAID - A9543","FALLON - FALLON MEDICAID - A9543 - Y90 IBRITUMOMAB, RX","FALLON","FALLON MEDICAID","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,0,72400.97,217685.7,16580.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9543","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9543","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9543 - Y90 IBRITUMOMAB, RX","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,97558.58,72400.97,217685.7,16580.5]
["TUFTS - TUFTS POS - HCPCS - A9543","TUFTS - TUFTS POS - A9543","TUFTS - TUFTS POS - A9543 - Y90 IBRITUMOMAB, RX","TUFTS","TUFTS POS","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,72400.97,72400.97,217685.7,16580.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9543","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9543","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9543 - Y90 IBRITUMOMAB, RX","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,97558.58,72400.97,217685.7,16580.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9543","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9543","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9543 - Y90 IBRITUMOMAB, RX","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,139963.56,72400.97,217685.7,16580.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9543","BMC HEALTHNET - BMCHN ACO - A9543","BMC HEALTHNET - BMCHN ACO - A9543 - Y90 IBRITUMOMAB, RX","BMC HEALTHNET","BMCHN ACO","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,0,72400.97,217685.7,16580.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9543","BMC HEALTHNET - BMCHN QHP - A9543","BMC HEALTHNET - BMCHN QHP - A9543 - Y90 IBRITUMOMAB, RX","BMC HEALTHNET","BMCHN QHP","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,0,72400.97,217685.7,16580.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9543","BMC HEALTHNET - BMCHN MCO - A9543","BMC HEALTHNET - BMCHN MCO - A9543 - Y90 IBRITUMOMAB, RX","BMC HEALTHNET","BMCHN MCO","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,0,72400.97,217685.7,16580.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9543","CIGNA HEALTHCARE - CIGNA CARELINK - A9543","CIGNA HEALTHCARE - CIGNA CARELINK - A9543 - Y90 IBRITUMOMAB, RX","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,217685.7,72400.97,217685.7,16580.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9543","BMC HEALTHNET - BMCHN MEDICAID - A9543","BMC HEALTHNET - BMCHN MEDICAID - A9543 - Y90 IBRITUMOMAB, RX","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,0,72400.97,217685.7,16580.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9543","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9543","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9543 - Y90 IBRITUMOMAB, RX","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,0,72400.97,217685.7,16580.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9543","BLUE CROSS - BLUE CROSS-INDEMNITY - A9543","BLUE CROSS - BLUE CROSS-INDEMNITY - A9543 - Y90 IBRITUMOMAB, RX","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,139963.56,72400.97,217685.7,16580.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9543","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9543","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9543 - Y90 IBRITUMOMAB, RX","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,139963.56,72400.97,217685.7,16580.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9543","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9543","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9543 - Y90 IBRITUMOMAB, RX","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,0,72400.97,217685.7,16580.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9543","BLUE CROSS - BLUE CROSS-PPO - A9543","BLUE CROSS - BLUE CROSS-PPO - A9543 - Y90 IBRITUMOMAB, RX","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,139963.56,72400.97,217685.7,16580.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9543","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9543","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9543 - Y90 IBRITUMOMAB, RX","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,139963.56,72400.97,217685.7,16580.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9543","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9543","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9543 - Y90 IBRITUMOMAB, RX","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,139963.56,72400.97,217685.7,16580.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9543","BLUE CROSS - BLUE CROSS-HMO BLUE - A9543","BLUE CROSS - BLUE CROSS-HMO BLUE - A9543 - Y90 IBRITUMOMAB, RX","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,139963.56,72400.97,217685.7,16580.5]
["TUFTS - TUFTS PPO - HCPCS - A9547","TUFTS - TUFTS PPO - A9547","TUFTS - TUFTS PPO - A9547 - IN111 OXYQUINOLINE","TUFTS","TUFTS PPO","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,0,5105.7299999999996,5105.7299999999996,110]
["TUFTS - TUFTS SELECT - HCPCS - A9547","TUFTS - TUFTS SELECT - A9547","TUFTS - TUFTS SELECT - A9547 - IN111 OXYQUINOLINE","TUFTS","TUFTS SELECT","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,0,5105.7299999999996,5105.7299999999996,110]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9547","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9547","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9547 - IN111 OXYQUINOLINE","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,0,5105.7299999999996,5105.7299999999996,110]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9547","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9547","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9547 - IN111 OXYQUINOLINE","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,0,5105.7299999999996,5105.7299999999996,110]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9547","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9547","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9547 - IN111 OXYQUINOLINE","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,0,5105.7299999999996,5105.7299999999996,110]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9547","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9547","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9547 - IN111 OXYQUINOLINE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,0,5105.7299999999996,5105.7299999999996,110]
["FALLON - FALLON MEDICAID - HCPCS - A9547","FALLON - FALLON MEDICAID - A9547","FALLON - FALLON MEDICAID - A9547 - IN111 OXYQUINOLINE","FALLON","FALLON MEDICAID","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,0,5105.7299999999996,5105.7299999999996,110]
["TUFTS - TUFTS HMO - HCPCS - A9547","TUFTS - TUFTS HMO - A9547","TUFTS - TUFTS HMO - A9547 - IN111 OXYQUINOLINE","TUFTS","TUFTS HMO","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,0,5105.7299999999996,5105.7299999999996,110]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9547","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9547","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9547 - IN111 OXYQUINOLINE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,0,5105.7299999999996,5105.7299999999996,110]
["TUFTS - TUFTS POS - HCPCS - A9547","TUFTS - TUFTS POS - A9547","TUFTS - TUFTS POS - A9547 - IN111 OXYQUINOLINE","TUFTS","TUFTS POS","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,0,5105.7299999999996,5105.7299999999996,110]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9547","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9547","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9547 - IN111 OXYQUINOLINE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,5105.7299999999996,5105.7299999999996,5105.7299999999996,110]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9547","CIGNA HEALTHCARE - CIGNA CARELINK - A9547","CIGNA HEALTHCARE - CIGNA CARELINK - A9547 - IN111 OXYQUINOLINE","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,0,5105.7299999999996,5105.7299999999996,110]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9547","BMC HEALTHNET - BMCHN QHP - A9547","BMC HEALTHNET - BMCHN QHP - A9547 - IN111 OXYQUINOLINE","BMC HEALTHNET","BMCHN QHP","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,0,5105.7299999999996,5105.7299999999996,110]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9547","BMC HEALTHNET - BMCHN ACO - A9547","BMC HEALTHNET - BMCHN ACO - A9547 - IN111 OXYQUINOLINE","BMC HEALTHNET","BMCHN ACO","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,0,5105.7299999999996,5105.7299999999996,110]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9547","BMC HEALTHNET - BMCHN MCO - A9547","BMC HEALTHNET - BMCHN MCO - A9547 - IN111 OXYQUINOLINE","BMC HEALTHNET","BMCHN MCO","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,0,5105.7299999999996,5105.7299999999996,110]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9547","BMC HEALTHNET - BMCHN MEDICAID - A9547","BMC HEALTHNET - BMCHN MEDICAID - A9547 - IN111 OXYQUINOLINE","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,0,5105.7299999999996,5105.7299999999996,110]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9547","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9547","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9547 - IN111 OXYQUINOLINE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,0,5105.7299999999996,5105.7299999999996,110]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9547","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9547","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9547 - IN111 OXYQUINOLINE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,0,5105.7299999999996,5105.7299999999996,110]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9547","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9547","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9547 - IN111 OXYQUINOLINE","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,5105.7299999999996,5105.7299999999996,5105.7299999999996,110]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9547","BLUE CROSS - BLUE CROSS-INDEMNITY - A9547","BLUE CROSS - BLUE CROSS-INDEMNITY - A9547 - IN111 OXYQUINOLINE","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,5105.7299999999996,5105.7299999999996,5105.7299999999996,110]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9547","BLUE CROSS - BLUE CROSS-PPO - A9547","BLUE CROSS - BLUE CROSS-PPO - A9547 - IN111 OXYQUINOLINE","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,5105.7299999999996,5105.7299999999996,5105.7299999999996,110]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9547","BLUE CROSS - BLUE CROSS-HMO BLUE - A9547","BLUE CROSS - BLUE CROSS-HMO BLUE - A9547 - IN111 OXYQUINOLINE","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,5105.7299999999996,5105.7299999999996,5105.7299999999996,110]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9547","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9547","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9547 - IN111 OXYQUINOLINE","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,5105.7299999999996,5105.7299999999996,5105.7299999999996,110]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9547","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9547","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9547 - IN111 OXYQUINOLINE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,5105.7299999999996,5105.7299999999996,5105.7299999999996,110]
["TUFTS - TUFTS PPO - HCPCS - A9551","TUFTS - TUFTS PPO - A9551","TUFTS - TUFTS PPO - A9551 - HC TC99M SUCCIMER/10MCI,DX","TUFTS","TUFTS PPO","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,0,1711.56,1711.56,38.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9551","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9551","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9551 - HC TC99M SUCCIMER/10MCI,DX","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,0,1711.56,1711.56,38.5]
["TUFTS - TUFTS SELECT - HCPCS - A9551","TUFTS - TUFTS SELECT - A9551","TUFTS - TUFTS SELECT - A9551 - HC TC99M SUCCIMER/10MCI,DX","TUFTS","TUFTS SELECT","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,0,1711.56,1711.56,38.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9551","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9551","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9551 - HC TC99M SUCCIMER/10MCI,DX","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,0,1711.56,1711.56,38.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9551","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9551","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9551 - HC TC99M SUCCIMER/10MCI,DX","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,0,1711.56,1711.56,38.5]
["TUFTS - TUFTS POS - HCPCS - A9551","TUFTS - TUFTS POS - A9551","TUFTS - TUFTS POS - A9551 - HC TC99M SUCCIMER/10MCI,DX","TUFTS","TUFTS POS","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,0,1711.56,1711.56,38.5]
["TUFTS - TUFTS HMO - HCPCS - A9551","TUFTS - TUFTS HMO - A9551","TUFTS - TUFTS HMO - A9551 - HC TC99M SUCCIMER/10MCI,DX","TUFTS","TUFTS HMO","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,0,1711.56,1711.56,38.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9551","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9551","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9551 - HC TC99M SUCCIMER/10MCI,DX","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,0,1711.56,1711.56,38.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9551","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9551","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9551 - HC TC99M SUCCIMER/10MCI,DX","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,0,1711.56,1711.56,38.5]
["FALLON - FALLON MEDICAID - HCPCS - A9551","FALLON - FALLON MEDICAID - A9551","FALLON - FALLON MEDICAID - A9551 - HC TC99M SUCCIMER/10MCI,DX","FALLON","FALLON MEDICAID","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,0,1711.56,1711.56,38.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9551","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9551","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9551 - HC TC99M SUCCIMER/10MCI,DX","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,1711.56,1711.56,1711.56,38.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9551","BMC HEALTHNET - BMCHN ACO - A9551","BMC HEALTHNET - BMCHN ACO - A9551 - HC TC99M SUCCIMER/10MCI,DX","BMC HEALTHNET","BMCHN ACO","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,0,1711.56,1711.56,38.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9551","BMC HEALTHNET - BMCHN QHP - A9551","BMC HEALTHNET - BMCHN QHP - A9551 - HC TC99M SUCCIMER/10MCI,DX","BMC HEALTHNET","BMCHN QHP","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,0,1711.56,1711.56,38.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9551","BMC HEALTHNET - BMCHN MCO - A9551","BMC HEALTHNET - BMCHN MCO - A9551 - HC TC99M SUCCIMER/10MCI,DX","BMC HEALTHNET","BMCHN MCO","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,0,1711.56,1711.56,38.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9551","CIGNA HEALTHCARE - CIGNA CARELINK - A9551","CIGNA HEALTHCARE - CIGNA CARELINK - A9551 - HC TC99M SUCCIMER/10MCI,DX","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,0,1711.56,1711.56,38.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9551","BMC HEALTHNET - BMCHN MEDICAID - A9551","BMC HEALTHNET - BMCHN MEDICAID - A9551 - HC TC99M SUCCIMER/10MCI,DX","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,0,1711.56,1711.56,38.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9551","BLUE CROSS - BLUE CROSS-PPO - A9551","BLUE CROSS - BLUE CROSS-PPO - A9551 - HC TC99M SUCCIMER/10MCI,DX","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,1711.56,1711.56,1711.56,38.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9551","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9551","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9551 - HC TC99M SUCCIMER/10MCI,DX","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,0,1711.56,1711.56,38.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9551","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9551","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9551 - HC TC99M SUCCIMER/10MCI,DX","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,1711.56,1711.56,1711.56,38.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9551","BLUE CROSS - BLUE CROSS-INDEMNITY - A9551","BLUE CROSS - BLUE CROSS-INDEMNITY - A9551 - HC TC99M SUCCIMER/10MCI,DX","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,1711.56,1711.56,1711.56,38.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9551","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9551","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9551 - HC TC99M SUCCIMER/10MCI,DX","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,0,1711.56,1711.56,38.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9551","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9551","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9551 - HC TC99M SUCCIMER/10MCI,DX","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,1711.56,1711.56,1711.56,38.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9551","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9551","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9551 - HC TC99M SUCCIMER/10MCI,DX","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,1711.56,1711.56,1711.56,38.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9551","BLUE CROSS - BLUE CROSS-HMO BLUE - A9551","BLUE CROSS - BLUE CROSS-HMO BLUE - A9551 - HC TC99M SUCCIMER/10MCI,DX","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,1711.56,1711.56,1711.56,38.5]
["TUFTS - TUFTS PPO - HCPCS - A9552","TUFTS - TUFTS PPO - A9552","TUFTS - TUFTS PPO - A9552 - F18 FDG","TUFTS","TUFTS PPO","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,0,1166.46,1166.46,243]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9552","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9552","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9552 - F18 FDG","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,0,1166.46,1166.46,243]
["TUFTS - TUFTS SELECT - HCPCS - A9552","TUFTS - TUFTS SELECT - A9552","TUFTS - TUFTS SELECT - A9552 - F18 FDG","TUFTS","TUFTS SELECT","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,0,1166.46,1166.46,243]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9552","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9552","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9552 - F18 FDG","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,0,1166.46,1166.46,243]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9552","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9552","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9552 - F18 FDG","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,0,1166.46,1166.46,243]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9552","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9552","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9552 - F18 FDG","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,0,1166.46,1166.46,243]
["TUFTS - TUFTS HMO - HCPCS - A9552","TUFTS - TUFTS HMO - A9552","TUFTS - TUFTS HMO - A9552 - F18 FDG","TUFTS","TUFTS HMO","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,0,1166.46,1166.46,243]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9552","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9552","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9552 - F18 FDG","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,0,1166.46,1166.46,243]
["TUFTS - TUFTS POS - HCPCS - A9552","TUFTS - TUFTS POS - A9552","TUFTS - TUFTS POS - A9552 - F18 FDG","TUFTS","TUFTS POS","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,0,1166.46,1166.46,243]
["FALLON - FALLON MEDICAID - HCPCS - A9552","FALLON - FALLON MEDICAID - A9552","FALLON - FALLON MEDICAID - A9552 - F18 FDG","FALLON","FALLON MEDICAID","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,0,1166.46,1166.46,243]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9552","BMC HEALTHNET - BMCHN QHP - A9552","BMC HEALTHNET - BMCHN QHP - A9552 - F18 FDG","BMC HEALTHNET","BMCHN QHP","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,0,1166.46,1166.46,243]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9552","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9552","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9552 - F18 FDG","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,1166.46,1166.46,1166.46,243]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9552","CIGNA HEALTHCARE - CIGNA CARELINK - A9552","CIGNA HEALTHCARE - CIGNA CARELINK - A9552 - F18 FDG","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,0,1166.46,1166.46,243]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9552","BMC HEALTHNET - BMCHN ACO - A9552","BMC HEALTHNET - BMCHN ACO - A9552 - F18 FDG","BMC HEALTHNET","BMCHN ACO","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,0,1166.46,1166.46,243]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9552","BMC HEALTHNET - BMCHN MCO - A9552","BMC HEALTHNET - BMCHN MCO - A9552 - F18 FDG","BMC HEALTHNET","BMCHN MCO","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,0,1166.46,1166.46,243]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9552","BMC HEALTHNET - BMCHN MEDICAID - A9552","BMC HEALTHNET - BMCHN MEDICAID - A9552 - F18 FDG","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,0,1166.46,1166.46,243]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9552","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9552","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9552 - F18 FDG","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,0,1166.46,1166.46,243]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9552","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9552","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9552 - F18 FDG","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,0,1166.46,1166.46,243]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9552","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9552","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9552 - F18 FDG","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,1166.46,1166.46,1166.46,243]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9552","BLUE CROSS - BLUE CROSS-INDEMNITY - A9552","BLUE CROSS - BLUE CROSS-INDEMNITY - A9552 - F18 FDG","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,1166.46,1166.46,1166.46,243]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9552","BLUE CROSS - BLUE CROSS-PPO - A9552","BLUE CROSS - BLUE CROSS-PPO - A9552 - F18 FDG","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,1166.46,1166.46,1166.46,243]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9552","BLUE CROSS - BLUE CROSS-HMO BLUE - A9552","BLUE CROSS - BLUE CROSS-HMO BLUE - A9552 - F18 FDG","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,1166.46,1166.46,1166.46,243]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9552","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9552","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9552 - F18 FDG","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,1166.46,1166.46,1166.46,243]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9552","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9552","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9552 - F18 FDG","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,1166.46,1166.46,1166.46,243]
["TUFTS - TUFTS PPO - HCPCS - A9555","TUFTS - TUFTS PPO - A9555","TUFTS - TUFTS PPO - A9555 - RADIOPHARMACIAL","TUFTS","TUFTS PPO","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,0,1604.08,1604.08,266.25]
["TUFTS - TUFTS SELECT - HCPCS - A9555","TUFTS - TUFTS SELECT - A9555","TUFTS - TUFTS SELECT - A9555 - RADIOPHARMACIAL","TUFTS","TUFTS SELECT","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,0,1604.08,1604.08,266.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9555","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9555","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9555 - RADIOPHARMACIAL","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,0,1604.08,1604.08,266.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9555","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9555","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9555 - RADIOPHARMACIAL","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,0,1604.08,1604.08,266.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9555","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9555","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9555 - RADIOPHARMACIAL","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,0,1604.08,1604.08,266.25]
["TUFTS - TUFTS HMO - HCPCS - A9555","TUFTS - TUFTS HMO - A9555","TUFTS - TUFTS HMO - A9555 - RADIOPHARMACIAL","TUFTS","TUFTS HMO","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,0,1604.08,1604.08,266.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9555","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9555","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9555 - RADIOPHARMACIAL","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,0,1604.08,1604.08,266.25]
["TUFTS - TUFTS POS - HCPCS - A9555","TUFTS - TUFTS POS - A9555","TUFTS - TUFTS POS - A9555 - RADIOPHARMACIAL","TUFTS","TUFTS POS","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,0,1604.08,1604.08,266.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9555","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9555","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9555 - RADIOPHARMACIAL","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,0,1604.08,1604.08,266.25]
["FALLON - FALLON MEDICAID - HCPCS - A9555","FALLON - FALLON MEDICAID - A9555","FALLON - FALLON MEDICAID - A9555 - RADIOPHARMACIAL","FALLON","FALLON MEDICAID","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,0,1604.08,1604.08,266.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9555","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9555","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9555 - RADIOPHARMACIAL","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,1604.08,1604.08,1604.08,266.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9555","BMC HEALTHNET - BMCHN ACO - A9555","BMC HEALTHNET - BMCHN ACO - A9555 - RADIOPHARMACIAL","BMC HEALTHNET","BMCHN ACO","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,0,1604.08,1604.08,266.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9555","BMC HEALTHNET - BMCHN QHP - A9555","BMC HEALTHNET - BMCHN QHP - A9555 - RADIOPHARMACIAL","BMC HEALTHNET","BMCHN QHP","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,0,1604.08,1604.08,266.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9555","BMC HEALTHNET - BMCHN MCO - A9555","BMC HEALTHNET - BMCHN MCO - A9555 - RADIOPHARMACIAL","BMC HEALTHNET","BMCHN MCO","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,0,1604.08,1604.08,266.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9555","CIGNA HEALTHCARE - CIGNA CARELINK - A9555","CIGNA HEALTHCARE - CIGNA CARELINK - A9555 - RADIOPHARMACIAL","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,0,1604.08,1604.08,266.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9555","BMC HEALTHNET - BMCHN MEDICAID - A9555","BMC HEALTHNET - BMCHN MEDICAID - A9555 - RADIOPHARMACIAL","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,0,1604.08,1604.08,266.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9555","BLUE CROSS - BLUE CROSS-INDEMNITY - A9555","BLUE CROSS - BLUE CROSS-INDEMNITY - A9555 - RADIOPHARMACIAL","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,1604.08,1604.08,1604.08,266.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9555","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9555","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9555 - RADIOPHARMACIAL","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,0,1604.08,1604.08,266.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9555","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9555","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9555 - RADIOPHARMACIAL","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,1604.08,1604.08,1604.08,266.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9555","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9555","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9555 - RADIOPHARMACIAL","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,0,1604.08,1604.08,266.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9555","BLUE CROSS - BLUE CROSS-PPO - A9555","BLUE CROSS - BLUE CROSS-PPO - A9555 - RADIOPHARMACIAL","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,1604.08,1604.08,1604.08,266.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9555","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9555","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9555 - RADIOPHARMACIAL","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,1604.08,1604.08,1604.08,266.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9555","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9555","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9555 - RADIOPHARMACIAL","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,1604.08,1604.08,1604.08,266.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9555","BLUE CROSS - BLUE CROSS-HMO BLUE - A9555","BLUE CROSS - BLUE CROSS-HMO BLUE - A9555 - RADIOPHARMACIAL","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,1604.08,1604.08,1604.08,266.25]
["TUFTS - TUFTS PPO - HCPCS - A9556","TUFTS - TUFTS PPO - A9556","TUFTS - TUFTS PPO - A9556 - GA67 GALLIUM","TUFTS","TUFTS PPO","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,0,311.94,311.94,5]
["TUFTS - TUFTS SELECT - HCPCS - A9556","TUFTS - TUFTS SELECT - A9556","TUFTS - TUFTS SELECT - A9556 - GA67 GALLIUM","TUFTS","TUFTS SELECT","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,0,311.94,311.94,5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9556","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9556","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9556 - GA67 GALLIUM","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,0,311.94,311.94,5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9556","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9556","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9556 - GA67 GALLIUM","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,0,311.94,311.94,5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9556","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9556","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9556 - GA67 GALLIUM","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,0,311.94,311.94,5]
["FALLON - FALLON MEDICAID - HCPCS - A9556","FALLON - FALLON MEDICAID - A9556","FALLON - FALLON MEDICAID - A9556 - GA67 GALLIUM","FALLON","FALLON MEDICAID","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,0,311.94,311.94,5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9556","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9556","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9556 - GA67 GALLIUM","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,0,311.94,311.94,5]
["TUFTS - TUFTS HMO - HCPCS - A9556","TUFTS - TUFTS HMO - A9556","TUFTS - TUFTS HMO - A9556 - GA67 GALLIUM","TUFTS","TUFTS HMO","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,0,311.94,311.94,5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9556","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9556","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9556 - GA67 GALLIUM","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,0,311.94,311.94,5]
["TUFTS - TUFTS POS - HCPCS - A9556","TUFTS - TUFTS POS - A9556","TUFTS - TUFTS POS - A9556 - GA67 GALLIUM","TUFTS","TUFTS POS","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,0,311.94,311.94,5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9556","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9556","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9556 - GA67 GALLIUM","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,311.94,311.94,311.94,5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9556","CIGNA HEALTHCARE - CIGNA CARELINK - A9556","CIGNA HEALTHCARE - CIGNA CARELINK - A9556 - GA67 GALLIUM","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,0,311.94,311.94,5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9556","BMC HEALTHNET - BMCHN QHP - A9556","BMC HEALTHNET - BMCHN QHP - A9556 - GA67 GALLIUM","BMC HEALTHNET","BMCHN QHP","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,0,311.94,311.94,5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9556","BMC HEALTHNET - BMCHN ACO - A9556","BMC HEALTHNET - BMCHN ACO - A9556 - GA67 GALLIUM","BMC HEALTHNET","BMCHN ACO","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,0,311.94,311.94,5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9556","BMC HEALTHNET - BMCHN MCO - A9556","BMC HEALTHNET - BMCHN MCO - A9556 - GA67 GALLIUM","BMC HEALTHNET","BMCHN MCO","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,0,311.94,311.94,5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9556","BMC HEALTHNET - BMCHN MEDICAID - A9556","BMC HEALTHNET - BMCHN MEDICAID - A9556 - GA67 GALLIUM","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,0,311.94,311.94,5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9556","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9556","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9556 - GA67 GALLIUM","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,0,311.94,311.94,5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9556","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9556","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9556 - GA67 GALLIUM","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,0,311.94,311.94,5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9556","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9556","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9556 - GA67 GALLIUM","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,311.94,311.94,311.94,5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9556","BLUE CROSS - BLUE CROSS-INDEMNITY - A9556","BLUE CROSS - BLUE CROSS-INDEMNITY - A9556 - GA67 GALLIUM","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,311.94,311.94,311.94,5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9556","BLUE CROSS - BLUE CROSS-PPO - A9556","BLUE CROSS - BLUE CROSS-PPO - A9556 - GA67 GALLIUM","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,311.94,311.94,311.94,5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9556","BLUE CROSS - BLUE CROSS-HMO BLUE - A9556","BLUE CROSS - BLUE CROSS-HMO BLUE - A9556 - GA67 GALLIUM","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,311.94,311.94,311.94,5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9556","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9556","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9556 - GA67 GALLIUM","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,311.94,311.94,311.94,5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9556","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9556","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9556 - GA67 GALLIUM","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,311.94,311.94,311.94,5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9557","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9557","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9557 - TC99M BICISATE","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,0,1062.44,1062.44,59.75]
["TUFTS - TUFTS PPO - HCPCS - A9557","TUFTS - TUFTS PPO - A9557","TUFTS - TUFTS PPO - A9557 - TC99M BICISATE","TUFTS","TUFTS PPO","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,0,1062.44,1062.44,59.75]
["TUFTS - TUFTS SELECT - HCPCS - A9557","TUFTS - TUFTS SELECT - A9557","TUFTS - TUFTS SELECT - A9557 - TC99M BICISATE","TUFTS","TUFTS SELECT","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,0,1062.44,1062.44,59.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9557","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9557","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9557 - TC99M BICISATE","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,0,1062.44,1062.44,59.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9557","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9557","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9557 - TC99M BICISATE","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,0,1062.44,1062.44,59.75]
["FALLON - FALLON MEDICAID - HCPCS - A9557","FALLON - FALLON MEDICAID - A9557","FALLON - FALLON MEDICAID - A9557 - TC99M BICISATE","FALLON","FALLON MEDICAID","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,0,1062.44,1062.44,59.75]
["TUFTS - TUFTS POS - HCPCS - A9557","TUFTS - TUFTS POS - A9557","TUFTS - TUFTS POS - A9557 - TC99M BICISATE","TUFTS","TUFTS POS","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,0,1062.44,1062.44,59.75]
["TUFTS - TUFTS HMO - HCPCS - A9557","TUFTS - TUFTS HMO - A9557","TUFTS - TUFTS HMO - A9557 - TC99M BICISATE","TUFTS","TUFTS HMO","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,0,1062.44,1062.44,59.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9557","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9557","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9557 - TC99M BICISATE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,0,1062.44,1062.44,59.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9557","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9557","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9557 - TC99M BICISATE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,0,1062.44,1062.44,59.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9557","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9557","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9557 - TC99M BICISATE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,1062.44,1062.44,1062.44,59.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9557","BMC HEALTHNET - BMCHN ACO - A9557","BMC HEALTHNET - BMCHN ACO - A9557 - TC99M BICISATE","BMC HEALTHNET","BMCHN ACO","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,0,1062.44,1062.44,59.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9557","BMC HEALTHNET - BMCHN QHP - A9557","BMC HEALTHNET - BMCHN QHP - A9557 - TC99M BICISATE","BMC HEALTHNET","BMCHN QHP","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,0,1062.44,1062.44,59.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9557","BMC HEALTHNET - BMCHN MCO - A9557","BMC HEALTHNET - BMCHN MCO - A9557 - TC99M BICISATE","BMC HEALTHNET","BMCHN MCO","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,0,1062.44,1062.44,59.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9557","CIGNA HEALTHCARE - CIGNA CARELINK - A9557","CIGNA HEALTHCARE - CIGNA CARELINK - A9557 - TC99M BICISATE","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,0,1062.44,1062.44,59.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9557","BMC HEALTHNET - BMCHN MEDICAID - A9557","BMC HEALTHNET - BMCHN MEDICAID - A9557 - TC99M BICISATE","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,0,1062.44,1062.44,59.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9557","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9557","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9557 - TC99M BICISATE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,1062.44,1062.44,1062.44,59.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9557","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9557","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9557 - TC99M BICISATE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,0,1062.44,1062.44,59.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9557","BLUE CROSS - BLUE CROSS-PPO - A9557","BLUE CROSS - BLUE CROSS-PPO - A9557 - TC99M BICISATE","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,1062.44,1062.44,1062.44,59.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9557","BLUE CROSS - BLUE CROSS-INDEMNITY - A9557","BLUE CROSS - BLUE CROSS-INDEMNITY - A9557 - TC99M BICISATE","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,1062.44,1062.44,1062.44,59.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9557","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9557","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9557 - TC99M BICISATE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,0,1062.44,1062.44,59.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9557","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9557","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9557 - TC99M BICISATE","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,1062.44,1062.44,1062.44,59.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9557","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9557","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9557 - TC99M BICISATE","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,1062.44,1062.44,1062.44,59.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9557","BLUE CROSS - BLUE CROSS-HMO BLUE - A9557","BLUE CROSS - BLUE CROSS-HMO BLUE - A9557 - TC99M BICISATE","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,1062.44,1062.44,1062.44,59.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9558","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9558","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9558 - HC XENON133/10MCI","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,0,108.88,108.88,5.75]
["TUFTS - TUFTS SELECT - HCPCS - A9558","TUFTS - TUFTS SELECT - A9558","TUFTS - TUFTS SELECT - A9558 - HC XENON133/10MCI","TUFTS","TUFTS SELECT","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,0,108.88,108.88,5.75]
["TUFTS - TUFTS PPO - HCPCS - A9558","TUFTS - TUFTS PPO - A9558","TUFTS - TUFTS PPO - A9558 - HC XENON133/10MCI","TUFTS","TUFTS PPO","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,0,108.88,108.88,5.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9558","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9558","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9558 - HC XENON133/10MCI","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,0,108.88,108.88,5.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9558","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9558","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9558 - HC XENON133/10MCI","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,0,108.88,108.88,5.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9558","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9558","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9558 - HC XENON133/10MCI","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,0,108.88,108.88,5.75]
["TUFTS - TUFTS HMO - HCPCS - A9558","TUFTS - TUFTS HMO - A9558","TUFTS - TUFTS HMO - A9558 - HC XENON133/10MCI","TUFTS","TUFTS HMO","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,0,108.88,108.88,5.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9558","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9558","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9558 - HC XENON133/10MCI","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,0,108.88,108.88,5.75]
["FALLON - FALLON MEDICAID - HCPCS - A9558","FALLON - FALLON MEDICAID - A9558","FALLON - FALLON MEDICAID - A9558 - HC XENON133/10MCI","FALLON","FALLON MEDICAID","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,0,108.88,108.88,5.75]
["TUFTS - TUFTS POS - HCPCS - A9558","TUFTS - TUFTS POS - A9558","TUFTS - TUFTS POS - A9558 - HC XENON133/10MCI","TUFTS","TUFTS POS","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,0,108.88,108.88,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9558","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9558","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9558 - HC XENON133/10MCI","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,108.88,108.88,108.88,5.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9558","BMC HEALTHNET - BMCHN QHP - A9558","BMC HEALTHNET - BMCHN QHP - A9558 - HC XENON133/10MCI","BMC HEALTHNET","BMCHN QHP","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,0,108.88,108.88,5.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9558","CIGNA HEALTHCARE - CIGNA CARELINK - A9558","CIGNA HEALTHCARE - CIGNA CARELINK - A9558 - HC XENON133/10MCI","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,0,108.88,108.88,5.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9558","BMC HEALTHNET - BMCHN ACO - A9558","BMC HEALTHNET - BMCHN ACO - A9558 - HC XENON133/10MCI","BMC HEALTHNET","BMCHN ACO","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,0,108.88,108.88,5.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9558","BMC HEALTHNET - BMCHN MCO - A9558","BMC HEALTHNET - BMCHN MCO - A9558 - HC XENON133/10MCI","BMC HEALTHNET","BMCHN MCO","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,0,108.88,108.88,5.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9558","BMC HEALTHNET - BMCHN MEDICAID - A9558","BMC HEALTHNET - BMCHN MEDICAID - A9558 - HC XENON133/10MCI","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,0,108.88,108.88,5.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9558","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9558","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9558 - HC XENON133/10MCI","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,0,108.88,108.88,5.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9558","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9558","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9558 - HC XENON133/10MCI","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,0,108.88,108.88,5.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9558","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9558","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9558 - HC XENON133/10MCI","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,108.88,108.88,108.88,5.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9558","BLUE CROSS - BLUE CROSS-INDEMNITY - A9558","BLUE CROSS - BLUE CROSS-INDEMNITY - A9558 - HC XENON133/10MCI","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,108.88,108.88,108.88,5.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9558","BLUE CROSS - BLUE CROSS-PPO - A9558","BLUE CROSS - BLUE CROSS-PPO - A9558 - HC XENON133/10MCI","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,108.88,108.88,108.88,5.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9558","BLUE CROSS - BLUE CROSS-HMO BLUE - A9558","BLUE CROSS - BLUE CROSS-HMO BLUE - A9558 - HC XENON133/10MCI","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,108.88,108.88,108.88,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9558","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9558","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9558 - HC XENON133/10MCI","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,108.88,108.88,108.88,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9558","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9558","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9558 - HC XENON133/10MCI","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,108.88,108.88,108.88,5.75]
["TUFTS - TUFTS SELECT - HCPCS - A9560","TUFTS - TUFTS SELECT - A9560","TUFTS - TUFTS SELECT - A9560 - TC99M LABELED RBC","TUFTS","TUFTS SELECT","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,0,266.7,266.7,61.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9560","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9560","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9560 - TC99M LABELED RBC","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,0,266.7,266.7,61.5]
["TUFTS - TUFTS PPO - HCPCS - A9560","TUFTS - TUFTS PPO - A9560","TUFTS - TUFTS PPO - A9560 - TC99M LABELED RBC","TUFTS","TUFTS PPO","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,0,266.7,266.7,61.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9560","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9560","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9560 - TC99M LABELED RBC","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,0,266.7,266.7,61.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9560","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9560","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9560 - TC99M LABELED RBC","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,0,266.7,266.7,61.5]
["TUFTS - TUFTS HMO - HCPCS - A9560","TUFTS - TUFTS HMO - A9560","TUFTS - TUFTS HMO - A9560 - TC99M LABELED RBC","TUFTS","TUFTS HMO","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,0,266.7,266.7,61.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9560","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9560","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9560 - TC99M LABELED RBC","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,0,266.7,266.7,61.5]
["TUFTS - TUFTS POS - HCPCS - A9560","TUFTS - TUFTS POS - A9560","TUFTS - TUFTS POS - A9560 - TC99M LABELED RBC","TUFTS","TUFTS POS","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,0,266.7,266.7,61.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9560","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9560","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9560 - TC99M LABELED RBC","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,0,266.7,266.7,61.5]
["FALLON - FALLON MEDICAID - HCPCS - A9560","FALLON - FALLON MEDICAID - A9560","FALLON - FALLON MEDICAID - A9560 - TC99M LABELED RBC","FALLON","FALLON MEDICAID","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,0,266.7,266.7,61.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9560","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9560","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9560 - TC99M LABELED RBC","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,266.7,266.7,266.7,61.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9560","BMC HEALTHNET - BMCHN ACO - A9560","BMC HEALTHNET - BMCHN ACO - A9560 - TC99M LABELED RBC","BMC HEALTHNET","BMCHN ACO","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,0,266.7,266.7,61.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9560","BMC HEALTHNET - BMCHN QHP - A9560","BMC HEALTHNET - BMCHN QHP - A9560 - TC99M LABELED RBC","BMC HEALTHNET","BMCHN QHP","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,0,266.7,266.7,61.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9560","BMC HEALTHNET - BMCHN MCO - A9560","BMC HEALTHNET - BMCHN MCO - A9560 - TC99M LABELED RBC","BMC HEALTHNET","BMCHN MCO","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,0,266.7,266.7,61.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9560","CIGNA HEALTHCARE - CIGNA CARELINK - A9560","CIGNA HEALTHCARE - CIGNA CARELINK - A9560 - TC99M LABELED RBC","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,0,266.7,266.7,61.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9560","BMC HEALTHNET - BMCHN MEDICAID - A9560","BMC HEALTHNET - BMCHN MEDICAID - A9560 - TC99M LABELED RBC","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,0,266.7,266.7,61.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9560","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9560","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9560 - TC99M LABELED RBC","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,0,266.7,266.7,61.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9560","BLUE CROSS - BLUE CROSS-INDEMNITY - A9560","BLUE CROSS - BLUE CROSS-INDEMNITY - A9560 - TC99M LABELED RBC","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,266.7,266.7,266.7,61.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9560","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9560","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9560 - TC99M LABELED RBC","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,266.7,266.7,266.7,61.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9560","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9560","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9560 - TC99M LABELED RBC","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,0,266.7,266.7,61.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9560","BLUE CROSS - BLUE CROSS-PPO - A9560","BLUE CROSS - BLUE CROSS-PPO - A9560 - TC99M LABELED RBC","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,266.7,266.7,266.7,61.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9560","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9560","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9560 - TC99M LABELED RBC","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,266.7,266.7,266.7,61.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9560","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9560","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9560 - TC99M LABELED RBC","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,266.7,266.7,266.7,61.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9560","BLUE CROSS - BLUE CROSS-HMO BLUE - A9560","BLUE CROSS - BLUE CROSS-HMO BLUE - A9560 - TC99M LABELED RBC","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,266.7,266.7,266.7,61.5]
["TUFTS - TUFTS SELECT - HCPCS - A9561","TUFTS - TUFTS SELECT - A9561","TUFTS - TUFTS SELECT - A9561 - TC99M OXIDRONATE","TUFTS","TUFTS SELECT","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,0,125.64,125.64,31.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9561","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9561","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9561 - TC99M OXIDRONATE","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,0,125.64,125.64,31.75]
["TUFTS - TUFTS PPO - HCPCS - A9561","TUFTS - TUFTS PPO - A9561","TUFTS - TUFTS PPO - A9561 - TC99M OXIDRONATE","TUFTS","TUFTS PPO","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,0,125.64,125.64,31.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9561","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9561","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9561 - TC99M OXIDRONATE","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,0,125.64,125.64,31.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9561","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9561","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9561 - TC99M OXIDRONATE","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,0,125.64,125.64,31.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9561","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9561","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9561 - TC99M OXIDRONATE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,0,125.64,125.64,31.75]
["TUFTS - TUFTS HMO - HCPCS - A9561","TUFTS - TUFTS HMO - A9561","TUFTS - TUFTS HMO - A9561 - TC99M OXIDRONATE","TUFTS","TUFTS HMO","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,0,125.64,125.64,31.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9561","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9561","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9561 - TC99M OXIDRONATE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,0,125.64,125.64,31.75]
["FALLON - FALLON MEDICAID - HCPCS - A9561","FALLON - FALLON MEDICAID - A9561","FALLON - FALLON MEDICAID - A9561 - TC99M OXIDRONATE","FALLON","FALLON MEDICAID","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,0,125.64,125.64,31.75]
["TUFTS - TUFTS POS - HCPCS - A9561","TUFTS - TUFTS POS - A9561","TUFTS - TUFTS POS - A9561 - TC99M OXIDRONATE","TUFTS","TUFTS POS","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,0,125.64,125.64,31.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9561","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9561","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9561 - TC99M OXIDRONATE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,125.64,125.64,125.64,31.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9561","CIGNA HEALTHCARE - CIGNA CARELINK - A9561","CIGNA HEALTHCARE - CIGNA CARELINK - A9561 - TC99M OXIDRONATE","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,0,125.64,125.64,31.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9561","BMC HEALTHNET - BMCHN QHP - A9561","BMC HEALTHNET - BMCHN QHP - A9561 - TC99M OXIDRONATE","BMC HEALTHNET","BMCHN QHP","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,0,125.64,125.64,31.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9561","BMC HEALTHNET - BMCHN ACO - A9561","BMC HEALTHNET - BMCHN ACO - A9561 - TC99M OXIDRONATE","BMC HEALTHNET","BMCHN ACO","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,0,125.64,125.64,31.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9561","BMC HEALTHNET - BMCHN MCO - A9561","BMC HEALTHNET - BMCHN MCO - A9561 - TC99M OXIDRONATE","BMC HEALTHNET","BMCHN MCO","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,0,125.64,125.64,31.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9561","BMC HEALTHNET - BMCHN MEDICAID - A9561","BMC HEALTHNET - BMCHN MEDICAID - A9561 - TC99M OXIDRONATE","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,0,125.64,125.64,31.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9561","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9561","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9561 - TC99M OXIDRONATE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,0,125.64,125.64,31.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9561","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9561","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9561 - TC99M OXIDRONATE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,0,125.64,125.64,31.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9561","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9561","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9561 - TC99M OXIDRONATE","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,125.64,125.64,125.64,31.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9561","BLUE CROSS - BLUE CROSS-INDEMNITY - A9561","BLUE CROSS - BLUE CROSS-INDEMNITY - A9561 - TC99M OXIDRONATE","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,125.64,125.64,125.64,31.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9561","BLUE CROSS - BLUE CROSS-PPO - A9561","BLUE CROSS - BLUE CROSS-PPO - A9561 - TC99M OXIDRONATE","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,125.64,125.64,125.64,31.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9561","BLUE CROSS - BLUE CROSS-HMO BLUE - A9561","BLUE CROSS - BLUE CROSS-HMO BLUE - A9561 - TC99M OXIDRONATE","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,125.64,125.64,125.64,31.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9561","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9561","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9561 - TC99M OXIDRONATE","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,125.64,125.64,125.64,31.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9561","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9561","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9561 - TC99M OXIDRONATE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,125.64,125.64,125.64,31.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9562","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9562","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9562 - TC99M MERTIATIDE","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,0,2212.25,2212.25,309.25]
["TUFTS - TUFTS SELECT - HCPCS - A9562","TUFTS - TUFTS SELECT - A9562","TUFTS - TUFTS SELECT - A9562 - TC99M MERTIATIDE","TUFTS","TUFTS SELECT","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,0,2212.25,2212.25,309.25]
["TUFTS - TUFTS PPO - HCPCS - A9562","TUFTS - TUFTS PPO - A9562","TUFTS - TUFTS PPO - A9562 - TC99M MERTIATIDE","TUFTS","TUFTS PPO","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,0,2212.25,2212.25,309.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9562","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9562","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9562 - TC99M MERTIATIDE","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,0,2212.25,2212.25,309.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9562","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9562","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9562 - TC99M MERTIATIDE","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,0,2212.25,2212.25,309.25]
["TUFTS - TUFTS POS - HCPCS - A9562","TUFTS - TUFTS POS - A9562","TUFTS - TUFTS POS - A9562 - TC99M MERTIATIDE","TUFTS","TUFTS POS","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,0,2212.25,2212.25,309.25]
["TUFTS - TUFTS HMO - HCPCS - A9562","TUFTS - TUFTS HMO - A9562","TUFTS - TUFTS HMO - A9562 - TC99M MERTIATIDE","TUFTS","TUFTS HMO","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,0,2212.25,2212.25,309.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9562","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9562","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9562 - TC99M MERTIATIDE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,0,2212.25,2212.25,309.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9562","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9562","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9562 - TC99M MERTIATIDE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,0,2212.25,2212.25,309.25]
["FALLON - FALLON MEDICAID - HCPCS - A9562","FALLON - FALLON MEDICAID - A9562","FALLON - FALLON MEDICAID - A9562 - TC99M MERTIATIDE","FALLON","FALLON MEDICAID","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,0,2212.25,2212.25,309.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9562","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9562","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9562 - TC99M MERTIATIDE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,2212.25,2212.25,2212.25,309.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9562","BMC HEALTHNET - BMCHN ACO - A9562","BMC HEALTHNET - BMCHN ACO - A9562 - TC99M MERTIATIDE","BMC HEALTHNET","BMCHN ACO","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,0,2212.25,2212.25,309.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9562","BMC HEALTHNET - BMCHN QHP - A9562","BMC HEALTHNET - BMCHN QHP - A9562 - TC99M MERTIATIDE","BMC HEALTHNET","BMCHN QHP","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,0,2212.25,2212.25,309.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9562","BMC HEALTHNET - BMCHN MCO - A9562","BMC HEALTHNET - BMCHN MCO - A9562 - TC99M MERTIATIDE","BMC HEALTHNET","BMCHN MCO","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,0,2212.25,2212.25,309.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9562","CIGNA HEALTHCARE - CIGNA CARELINK - A9562","CIGNA HEALTHCARE - CIGNA CARELINK - A9562 - TC99M MERTIATIDE","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,0,2212.25,2212.25,309.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9562","BMC HEALTHNET - BMCHN MEDICAID - A9562","BMC HEALTHNET - BMCHN MEDICAID - A9562 - TC99M MERTIATIDE","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,0,2212.25,2212.25,309.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9562","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9562","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9562 - TC99M MERTIATIDE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,0,2212.25,2212.25,309.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9562","BLUE CROSS - BLUE CROSS-PPO - A9562","BLUE CROSS - BLUE CROSS-PPO - A9562 - TC99M MERTIATIDE","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,2212.25,2212.25,2212.25,309.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9562","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9562","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9562 - TC99M MERTIATIDE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,2212.25,2212.25,2212.25,309.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9562","BLUE CROSS - BLUE CROSS-INDEMNITY - A9562","BLUE CROSS - BLUE CROSS-INDEMNITY - A9562 - TC99M MERTIATIDE","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,2212.25,2212.25,2212.25,309.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9562","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9562","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9562 - TC99M MERTIATIDE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,0,2212.25,2212.25,309.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9562","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9562","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9562 - TC99M MERTIATIDE","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,2212.25,2212.25,2212.25,309.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9562","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9562","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9562 - TC99M MERTIATIDE","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,2212.25,2212.25,2212.25,309.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9562","BLUE CROSS - BLUE CROSS-HMO BLUE - A9562","BLUE CROSS - BLUE CROSS-HMO BLUE - A9562 - TC99M MERTIATIDE","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,2212.25,2212.25,2212.25,309.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9563","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9563","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9563 - P32 NA PHOSPHATE","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,535.17999999999995,535.17999999999995,3182.68,0]
["TUFTS - TUFTS SELECT - HCPCS - A9563","TUFTS - TUFTS SELECT - A9563","TUFTS - TUFTS SELECT - A9563 - P32 NA PHOSPHATE","TUFTS","TUFTS SELECT","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,1058.54,535.17999999999995,3182.68,0]
["TUFTS - TUFTS PPO - HCPCS - A9563","TUFTS - TUFTS PPO - A9563","TUFTS - TUFTS PPO - A9563 - P32 NA PHOSPHATE","TUFTS","TUFTS PPO","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,1132.32,535.17999999999995,3182.68,0]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9563","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9563","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9563 - P32 NA PHOSPHATE","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,535.17999999999995,535.17999999999995,3182.68,0]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9563","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9563","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9563 - P32 NA PHOSPHATE","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,0,535.17999999999995,3182.68,0]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9563","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9563","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9563 - P32 NA PHOSPHATE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,535.17999999999995,535.17999999999995,3182.68,0]
["FALLON - FALLON MEDICAID - HCPCS - A9563","FALLON - FALLON MEDICAID - A9563","FALLON - FALLON MEDICAID - A9563 - P32 NA PHOSPHATE","FALLON","FALLON MEDICAID","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,0,535.17999999999995,3182.68,0]
["TUFTS - TUFTS HMO - HCPCS - A9563","TUFTS - TUFTS HMO - A9563","TUFTS - TUFTS HMO - A9563 - P32 NA PHOSPHATE","TUFTS","TUFTS HMO","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,1270.25,535.17999999999995,3182.68,0]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9563","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9563","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9563 - P32 NA PHOSPHATE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,535.17999999999995,535.17999999999995,3182.68,0]
["TUFTS - TUFTS POS - HCPCS - A9563","TUFTS - TUFTS POS - A9563","TUFTS - TUFTS POS - A9563 - P32 NA PHOSPHATE","TUFTS","TUFTS POS","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,1058.54,535.17999999999995,3182.68,0]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9563","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9563","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9563 - P32 NA PHOSPHATE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,870.53,535.17999999999995,3182.68,0]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9563","BMC HEALTHNET - BMCHN QHP - A9563","BMC HEALTHNET - BMCHN QHP - A9563 - P32 NA PHOSPHATE","BMC HEALTHNET","BMCHN QHP","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,0,535.17999999999995,3182.68,0]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9563","CIGNA HEALTHCARE - CIGNA CARELINK - A9563","CIGNA HEALTHCARE - CIGNA CARELINK - A9563 - P32 NA PHOSPHATE","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,3182.68,535.17999999999995,3182.68,0]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9563","BMC HEALTHNET - BMCHN ACO - A9563","BMC HEALTHNET - BMCHN ACO - A9563 - P32 NA PHOSPHATE","BMC HEALTHNET","BMCHN ACO","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,0,535.17999999999995,3182.68,0]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9563","BMC HEALTHNET - BMCHN MCO - A9563","BMC HEALTHNET - BMCHN MCO - A9563 - P32 NA PHOSPHATE","BMC HEALTHNET","BMCHN MCO","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,0,535.17999999999995,3182.68,0]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9563","BMC HEALTHNET - BMCHN MEDICAID - A9563","BMC HEALTHNET - BMCHN MEDICAID - A9563 - P32 NA PHOSPHATE","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,0,535.17999999999995,3182.68,0]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9563","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9563","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9563 - P32 NA PHOSPHATE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,0,535.17999999999995,3182.68,0]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9563","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9563","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9563 - P32 NA PHOSPHATE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,0,535.17999999999995,3182.68,0]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9563","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9563","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9563 - P32 NA PHOSPHATE","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,870.53,535.17999999999995,3182.68,0]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9563","BLUE CROSS - BLUE CROSS-INDEMNITY - A9563","BLUE CROSS - BLUE CROSS-INDEMNITY - A9563 - P32 NA PHOSPHATE","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,870.53,535.17999999999995,3182.68,0]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9563","BLUE CROSS - BLUE CROSS-PPO - A9563","BLUE CROSS - BLUE CROSS-PPO - A9563 - P32 NA PHOSPHATE","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,870.53,535.17999999999995,3182.68,0]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9563","BLUE CROSS - BLUE CROSS-HMO BLUE - A9563","BLUE CROSS - BLUE CROSS-HMO BLUE - A9563 - P32 NA PHOSPHATE","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,870.53,535.17999999999995,3182.68,0]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9563","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9563","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9563 - P32 NA PHOSPHATE","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,870.53,535.17999999999995,3182.68,0]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9563","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9563","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9563 - P32 NA PHOSPHATE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,870.53,535.17999999999995,3182.68,0]
["TUFTS - TUFTS SELECT - HCPCS - A9569","TUFTS - TUFTS SELECT - A9569","TUFTS - TUFTS SELECT - A9569 - TECHNETIUM TC-99M AUTO WBC","TUFTS","TUFTS SELECT","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,0,4157.3,4157.3,1271.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9569","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9569","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9569 - TECHNETIUM TC-99M AUTO WBC","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,0,4157.3,4157.3,1271.5]
["TUFTS - TUFTS PPO - HCPCS - A9569","TUFTS - TUFTS PPO - A9569","TUFTS - TUFTS PPO - A9569 - TECHNETIUM TC-99M AUTO WBC","TUFTS","TUFTS PPO","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,0,4157.3,4157.3,1271.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9569","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9569","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9569 - TECHNETIUM TC-99M AUTO WBC","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,0,4157.3,4157.3,1271.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9569","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9569","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9569 - TECHNETIUM TC-99M AUTO WBC","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,0,4157.3,4157.3,1271.5]
["FALLON - FALLON MEDICAID - HCPCS - A9569","FALLON - FALLON MEDICAID - A9569","FALLON - FALLON MEDICAID - A9569 - TECHNETIUM TC-99M AUTO WBC","FALLON","FALLON MEDICAID","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,0,4157.3,4157.3,1271.5]
["TUFTS - TUFTS HMO - HCPCS - A9569","TUFTS - TUFTS HMO - A9569","TUFTS - TUFTS HMO - A9569 - TECHNETIUM TC-99M AUTO WBC","TUFTS","TUFTS HMO","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,0,4157.3,4157.3,1271.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9569","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9569","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9569 - TECHNETIUM TC-99M AUTO WBC","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,0,4157.3,4157.3,1271.5]
["TUFTS - TUFTS POS - HCPCS - A9569","TUFTS - TUFTS POS - A9569","TUFTS - TUFTS POS - A9569 - TECHNETIUM TC-99M AUTO WBC","TUFTS","TUFTS POS","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,0,4157.3,4157.3,1271.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9569","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9569","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9569 - TECHNETIUM TC-99M AUTO WBC","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,0,4157.3,4157.3,1271.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9569","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9569","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9569 - TECHNETIUM TC-99M AUTO WBC","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,4157.3,4157.3,4157.3,1271.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9569","BMC HEALTHNET - BMCHN ACO - A9569","BMC HEALTHNET - BMCHN ACO - A9569 - TECHNETIUM TC-99M AUTO WBC","BMC HEALTHNET","BMCHN ACO","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,0,4157.3,4157.3,1271.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9569","BMC HEALTHNET - BMCHN QHP - A9569","BMC HEALTHNET - BMCHN QHP - A9569 - TECHNETIUM TC-99M AUTO WBC","BMC HEALTHNET","BMCHN QHP","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,0,4157.3,4157.3,1271.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9569","BMC HEALTHNET - BMCHN MCO - A9569","BMC HEALTHNET - BMCHN MCO - A9569 - TECHNETIUM TC-99M AUTO WBC","BMC HEALTHNET","BMCHN MCO","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,0,4157.3,4157.3,1271.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9569","CIGNA HEALTHCARE - CIGNA CARELINK - A9569","CIGNA HEALTHCARE - CIGNA CARELINK - A9569 - TECHNETIUM TC-99M AUTO WBC","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,0,4157.3,4157.3,1271.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9569","BMC HEALTHNET - BMCHN MEDICAID - A9569","BMC HEALTHNET - BMCHN MEDICAID - A9569 - TECHNETIUM TC-99M AUTO WBC","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,0,4157.3,4157.3,1271.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9569","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9569","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9569 - TECHNETIUM TC-99M AUTO WBC","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,4157.3,4157.3,4157.3,1271.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9569","BLUE CROSS - BLUE CROSS-INDEMNITY - A9569","BLUE CROSS - BLUE CROSS-INDEMNITY - A9569 - TECHNETIUM TC-99M AUTO WBC","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,4157.3,4157.3,4157.3,1271.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9569","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9569","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9569 - TECHNETIUM TC-99M AUTO WBC","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,0,4157.3,4157.3,1271.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9569","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9569","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9569 - TECHNETIUM TC-99M AUTO WBC","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,0,4157.3,4157.3,1271.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9569","BLUE CROSS - BLUE CROSS-PPO - A9569","BLUE CROSS - BLUE CROSS-PPO - A9569 - TECHNETIUM TC-99M AUTO WBC","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,4157.3,4157.3,4157.3,1271.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9569","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9569","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9569 - TECHNETIUM TC-99M AUTO WBC","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,4157.3,4157.3,4157.3,1271.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9569","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9569","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9569 - TECHNETIUM TC-99M AUTO WBC","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,4157.3,4157.3,4157.3,1271.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9569","BLUE CROSS - BLUE CROSS-HMO BLUE - A9569","BLUE CROSS - BLUE CROSS-HMO BLUE - A9569 - TECHNETIUM TC-99M AUTO WBC","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,4157.3,4157.3,4157.3,1271.5]
["TUFTS - TUFTS SELECT - HCPCS - A9570","TUFTS - TUFTS SELECT - A9570","TUFTS - TUFTS SELECT - A9570 - HC INDIUM IN-111 AUTO WBC","TUFTS","TUFTS SELECT","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC","A9570 - HC INDIUM IN-111 AUTO WBC",6395,0,0,0,1598.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9570","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9570","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9570 - HC INDIUM IN-111 AUTO WBC","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC","A9570 - HC INDIUM IN-111 AUTO WBC",6395,0,0,0,1598.75]
["TUFTS - TUFTS PPO - HCPCS - A9570","TUFTS - TUFTS PPO - A9570","TUFTS - TUFTS PPO - A9570 - HC INDIUM IN-111 AUTO WBC","TUFTS","TUFTS PPO","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC","A9570 - HC INDIUM IN-111 AUTO WBC",6395,0,0,0,1598.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9570","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9570","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9570 - HC INDIUM IN-111 AUTO WBC","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC","A9570 - HC INDIUM IN-111 AUTO WBC",6395,0,0,0,1598.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9570","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9570","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9570 - HC INDIUM IN-111 AUTO WBC","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC","A9570 - HC INDIUM IN-111 AUTO WBC",6395,0,0,0,1598.75]
["FALLON - FALLON MEDICAID - HCPCS - A9570","FALLON - FALLON MEDICAID - A9570","FALLON - FALLON MEDICAID - A9570 - HC INDIUM IN-111 AUTO WBC","FALLON","FALLON MEDICAID","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC","A9570 - HC INDIUM IN-111 AUTO WBC",6395,0,0,0,1598.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9570","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9570","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9570 - HC INDIUM IN-111 AUTO WBC","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC","A9570 - HC INDIUM IN-111 AUTO WBC",6395,0,0,0,1598.75]
["TUFTS - TUFTS HMO - HCPCS - A9570","TUFTS - TUFTS HMO - A9570","TUFTS - TUFTS HMO - A9570 - HC INDIUM IN-111 AUTO WBC","TUFTS","TUFTS HMO","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC","A9570 - HC INDIUM IN-111 AUTO WBC",6395,0,0,0,1598.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9570","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9570","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9570 - HC INDIUM IN-111 AUTO WBC","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC","A9570 - HC INDIUM IN-111 AUTO WBC",6395,0,0,0,1598.75]
["TUFTS - TUFTS POS - HCPCS - A9570","TUFTS - TUFTS POS - A9570","TUFTS - TUFTS POS - A9570 - HC INDIUM IN-111 AUTO WBC","TUFTS","TUFTS POS","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC","A9570 - HC INDIUM IN-111 AUTO WBC",6395,0,0,0,1598.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9570","CIGNA HEALTHCARE - CIGNA CARELINK - A9570","CIGNA HEALTHCARE - CIGNA CARELINK - A9570 - HC INDIUM IN-111 AUTO WBC","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC","A9570 - HC INDIUM IN-111 AUTO WBC",6395,0,0,0,1598.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9570","BMC HEALTHNET - BMCHN QHP - A9570","BMC HEALTHNET - BMCHN QHP - A9570 - HC INDIUM IN-111 AUTO WBC","BMC HEALTHNET","BMCHN QHP","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC","A9570 - HC INDIUM IN-111 AUTO WBC",6395,0,0,0,1598.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9570","BMC HEALTHNET - BMCHN ACO - A9570","BMC HEALTHNET - BMCHN ACO - A9570 - HC INDIUM IN-111 AUTO WBC","BMC HEALTHNET","BMCHN ACO","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC","A9570 - HC INDIUM IN-111 AUTO WBC",6395,0,0,0,1598.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9570","BMC HEALTHNET - BMCHN MCO - A9570","BMC HEALTHNET - BMCHN MCO - A9570 - HC INDIUM IN-111 AUTO WBC","BMC HEALTHNET","BMCHN MCO","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC","A9570 - HC INDIUM IN-111 AUTO WBC",6395,0,0,0,1598.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9570","BMC HEALTHNET - BMCHN MEDICAID - A9570","BMC HEALTHNET - BMCHN MEDICAID - A9570 - HC INDIUM IN-111 AUTO WBC","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC","A9570 - HC INDIUM IN-111 AUTO WBC",6395,0,0,0,1598.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9570","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9570","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9570 - HC INDIUM IN-111 AUTO WBC","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC","A9570 - HC INDIUM IN-111 AUTO WBC",6395,0,0,0,1598.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9570","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9570","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9570 - HC INDIUM IN-111 AUTO WBC","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC","A9570 - HC INDIUM IN-111 AUTO WBC",6395,0,0,0,1598.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9572","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9572","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9572 - INDIUM IN-111 PENTETREOTIDE","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,0,16207.01,16207.01,32.75]
["TUFTS - TUFTS SELECT - HCPCS - A9572","TUFTS - TUFTS SELECT - A9572","TUFTS - TUFTS SELECT - A9572 - INDIUM IN-111 PENTETREOTIDE","TUFTS","TUFTS SELECT","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,0,16207.01,16207.01,32.75]
["TUFTS - TUFTS PPO - HCPCS - A9572","TUFTS - TUFTS PPO - A9572","TUFTS - TUFTS PPO - A9572 - INDIUM IN-111 PENTETREOTIDE","TUFTS","TUFTS PPO","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,0,16207.01,16207.01,32.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9572","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9572","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9572 - INDIUM IN-111 PENTETREOTIDE","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,0,16207.01,16207.01,32.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9572","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9572","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9572 - INDIUM IN-111 PENTETREOTIDE","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,0,16207.01,16207.01,32.75]
["FALLON - FALLON MEDICAID - HCPCS - A9572","FALLON - FALLON MEDICAID - A9572","FALLON - FALLON MEDICAID - A9572 - INDIUM IN-111 PENTETREOTIDE","FALLON","FALLON MEDICAID","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,0,16207.01,16207.01,32.75]
["TUFTS - TUFTS POS - HCPCS - A9572","TUFTS - TUFTS POS - A9572","TUFTS - TUFTS POS - A9572 - INDIUM IN-111 PENTETREOTIDE","TUFTS","TUFTS POS","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,0,16207.01,16207.01,32.75]
["TUFTS - TUFTS HMO - HCPCS - A9572","TUFTS - TUFTS HMO - A9572","TUFTS - TUFTS HMO - A9572 - INDIUM IN-111 PENTETREOTIDE","TUFTS","TUFTS HMO","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,0,16207.01,16207.01,32.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9572","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9572","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9572 - INDIUM IN-111 PENTETREOTIDE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,0,16207.01,16207.01,32.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9572","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9572","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9572 - INDIUM IN-111 PENTETREOTIDE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,0,16207.01,16207.01,32.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9572","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9572","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9572 - INDIUM IN-111 PENTETREOTIDE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,16207.01,16207.01,16207.01,32.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9572","BMC HEALTHNET - BMCHN ACO - A9572","BMC HEALTHNET - BMCHN ACO - A9572 - INDIUM IN-111 PENTETREOTIDE","BMC HEALTHNET","BMCHN ACO","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,0,16207.01,16207.01,32.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9572","BMC HEALTHNET - BMCHN QHP - A9572","BMC HEALTHNET - BMCHN QHP - A9572 - INDIUM IN-111 PENTETREOTIDE","BMC HEALTHNET","BMCHN QHP","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,0,16207.01,16207.01,32.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9572","BMC HEALTHNET - BMCHN MCO - A9572","BMC HEALTHNET - BMCHN MCO - A9572 - INDIUM IN-111 PENTETREOTIDE","BMC HEALTHNET","BMCHN MCO","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,0,16207.01,16207.01,32.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9572","CIGNA HEALTHCARE - CIGNA CARELINK - A9572","CIGNA HEALTHCARE - CIGNA CARELINK - A9572 - INDIUM IN-111 PENTETREOTIDE","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,0,16207.01,16207.01,32.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9572","BMC HEALTHNET - BMCHN MEDICAID - A9572","BMC HEALTHNET - BMCHN MEDICAID - A9572 - INDIUM IN-111 PENTETREOTIDE","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,0,16207.01,16207.01,32.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9572","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9572","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9572 - INDIUM IN-111 PENTETREOTIDE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,0,16207.01,16207.01,32.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9572","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9572","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9572 - INDIUM IN-111 PENTETREOTIDE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,0,16207.01,16207.01,32.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9572","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9572","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9572 - INDIUM IN-111 PENTETREOTIDE","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,16207.01,16207.01,16207.01,32.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9572","BLUE CROSS - BLUE CROSS-INDEMNITY - A9572","BLUE CROSS - BLUE CROSS-INDEMNITY - A9572 - INDIUM IN-111 PENTETREOTIDE","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,16207.01,16207.01,16207.01,32.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9572","BLUE CROSS - BLUE CROSS-PPO - A9572","BLUE CROSS - BLUE CROSS-PPO - A9572 - INDIUM IN-111 PENTETREOTIDE","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,16207.01,16207.01,16207.01,32.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9572","BLUE CROSS - BLUE CROSS-HMO BLUE - A9572","BLUE CROSS - BLUE CROSS-HMO BLUE - A9572 - INDIUM IN-111 PENTETREOTIDE","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,16207.01,16207.01,16207.01,32.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9572","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9572","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9572 - INDIUM IN-111 PENTETREOTIDE","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,16207.01,16207.01,16207.01,32.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9572","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9572","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9572 - INDIUM IN-111 PENTETREOTIDE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,16207.01,16207.01,16207.01,32.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9575","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9575","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9575 - INJ GADOTERATE MEGLUMI 0.1ML","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0,0.18,0.45,2]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A9575","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - A9575","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - A9575 - INJ GADOTERATE MEGLUMI 0.1ML","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.22,0.18,0.45,2]
["TUFTS - TUFTS SELECT - HCPCS - A9575","TUFTS - TUFTS SELECT - A9575","TUFTS - TUFTS SELECT - A9575 - INJ GADOTERATE MEGLUMI 0.1ML","TUFTS","TUFTS SELECT","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0,0.18,0.45,2]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A9575","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - A9575","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - A9575 - INJ GADOTERATE MEGLUMI 0.1ML","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.22,0.18,0.45,2]
["TUFTS - TUFTS PPO - HCPCS - A9575","TUFTS - TUFTS PPO - A9575","TUFTS - TUFTS PPO - A9575 - INJ GADOTERATE MEGLUMI 0.1ML","TUFTS","TUFTS PPO","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0,0.18,0.45,2]
["UNICARE - UNICARE - HCPCS - A9575","UNICARE - UNICARE - A9575","UNICARE - UNICARE - A9575 - INJ GADOTERATE MEGLUMI 0.1ML","UNICARE","UNICARE","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.19,0.18,0.45,2]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - A9575","UNICARE - UNICARE STATE INDEMNITY PLAN - A9575","UNICARE - UNICARE STATE INDEMNITY PLAN - A9575 - INJ GADOTERATE MEGLUMI 0.1ML","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.19,0.18,0.45,2]
["TUFTS - TUFTS SPIRIT - HCPCS - A9575","TUFTS - TUFTS SPIRIT - A9575","TUFTS - TUFTS SPIRIT - A9575 - INJ GADOTERATE MEGLUMI 0.1ML","TUFTS","TUFTS SPIRIT","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.2,0.18,0.45,2]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A9575","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - A9575","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - A9575 - INJ GADOTERATE MEGLUMI 0.1ML","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.24,0.18,0.45,2]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9575","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9575","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9575 - INJ GADOTERATE MEGLUMI 0.1ML","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0,0.18,0.45,2]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A9575","TUFTS - TUFTS MEDICARE PREFERRED HMO - A9575","TUFTS - TUFTS MEDICARE PREFERRED HMO - A9575 - INJ GADOTERATE MEGLUMI 0.1ML","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.26,0.18,0.45,2]
["FALLON - FALLON SENIOR PLAN - HCPCS - A9575","FALLON - FALLON SENIOR PLAN - A9575","FALLON - FALLON SENIOR PLAN - A9575 - INJ GADOTERATE MEGLUMI 0.1ML","FALLON","FALLON SENIOR PLAN","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.18,0.18,0.45,2]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9575","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9575","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9575 - INJ GADOTERATE MEGLUMI 0.1ML","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0,0.18,0.45,2]
["TUFTS - TUFTS HMO - HCPCS - A9575","TUFTS - TUFTS HMO - A9575","TUFTS - TUFTS HMO - A9575 - INJ GADOTERATE MEGLUMI 0.1ML","TUFTS","TUFTS HMO","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0,0.18,0.45,2]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9575","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9575","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9575 - INJ GADOTERATE MEGLUMI 0.1ML","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0,0.18,0.45,2]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - A9575","TUFTS - TUFTS MEDICARE SCO - A9575","TUFTS - TUFTS MEDICARE SCO - A9575 - INJ GADOTERATE MEGLUMI 0.1ML","TUFTS","TUFTS MEDICARE SCO","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.26,0.18,0.45,2]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A9575","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - A9575","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - A9575 - INJ GADOTERATE MEGLUMI 0.1ML","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.39,0.18,0.45,2]
["TUFTS - TUFTS POS - HCPCS - A9575","TUFTS - TUFTS POS - A9575","TUFTS - TUFTS POS - A9575 - INJ GADOTERATE MEGLUMI 0.1ML","TUFTS","TUFTS POS","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0,0.18,0.45,2]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A9575","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - A9575","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - A9575 - INJ GADOTERATE MEGLUMI 0.1ML","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.31,0.18,0.45,2]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9575","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9575","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9575 - INJ GADOTERATE MEGLUMI 0.1ML","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.21,0.18,0.45,2]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A9575","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - A9575","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - A9575 - INJ GADOTERATE MEGLUMI 0.1ML","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.4,0.18,0.45,2]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9575","CIGNA HEALTHCARE - CIGNA CARELINK - A9575","CIGNA HEALTHCARE - CIGNA CARELINK - A9575 - INJ GADOTERATE MEGLUMI 0.1ML","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0,0.18,0.45,2]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A9575","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - A9575","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - A9575 - INJ GADOTERATE MEGLUMI 0.1ML","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.18,0.18,0.45,2]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A9575","ELDER SERVICE PLAN - ELEMENT CARE INC - A9575","ELDER SERVICE PLAN - ELEMENT CARE INC - A9575 - INJ GADOTERATE MEGLUMI 0.1ML","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.18,0.18,0.45,2]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A9575","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - A9575","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - A9575 - INJ GADOTERATE MEGLUMI 0.1ML","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.18,0.18,0.45,2]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A9575","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - A9575","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - A9575 - INJ GADOTERATE MEGLUMI 0.1ML","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.18,0.18,0.45,2]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A9575","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - A9575","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - A9575 - INJ GADOTERATE MEGLUMI 0.1ML","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.45,0.18,0.45,2]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9575","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9575","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9575 - INJ GADOTERATE MEGLUMI 0.1ML","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.21,0.18,0.45,2]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9575","BLUE CROSS - BLUE CROSS-PPO - A9575","BLUE CROSS - BLUE CROSS-PPO - A9575 - INJ GADOTERATE MEGLUMI 0.1ML","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.21,0.18,0.45,2]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9575","BLUE CROSS - BLUE CROSS-INDEMNITY - A9575","BLUE CROSS - BLUE CROSS-INDEMNITY - A9575 - INJ GADOTERATE MEGLUMI 0.1ML","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.21,0.18,0.45,2]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9575","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9575","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9575 - INJ GADOTERATE MEGLUMI 0.1ML","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.21,0.18,0.45,2]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9575","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9575","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9575 - INJ GADOTERATE MEGLUMI 0.1ML","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.21,0.18,0.45,2]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A9575","AETNA - AETNA-MEDICARE ADVANTAGE - A9575","AETNA - AETNA-MEDICARE ADVANTAGE - A9575 - INJ GADOTERATE MEGLUMI 0.1ML","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.21,0.18,0.45,2]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9575","BLUE CROSS - BLUE CROSS-HMO BLUE - A9575","BLUE CROSS - BLUE CROSS-HMO BLUE - A9575 - INJ GADOTERATE MEGLUMI 0.1ML","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.21,0.18,0.45,2]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A9576","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - A9576","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - A9576 - HC PROHANCE IV CONTRAST PER ML","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,1.8,1.5,3.77,1.25]
["UNICARE - UNICARE - HCPCS - A9576","UNICARE - UNICARE - A9576","UNICARE - UNICARE - A9576 - HC PROHANCE IV CONTRAST PER ML","UNICARE","UNICARE","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,1.56,1.5,3.77,1.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - A9576","UNICARE - UNICARE STATE INDEMNITY PLAN - A9576","UNICARE - UNICARE STATE INDEMNITY PLAN - A9576 - HC PROHANCE IV CONTRAST PER ML","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,1.56,1.5,3.77,1.25]
["TUFTS - TUFTS SELECT - HCPCS - A9576","TUFTS - TUFTS SELECT - A9576","TUFTS - TUFTS SELECT - A9576 - HC PROHANCE IV CONTRAST PER ML","TUFTS","TUFTS SELECT","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,0,1.5,3.77,1.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9576","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9576","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9576 - HC PROHANCE IV CONTRAST PER ML","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,0,1.5,3.77,1.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A9576","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - A9576","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - A9576 - HC PROHANCE IV CONTRAST PER ML","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,1.8,1.5,3.77,1.25]
["TUFTS - TUFTS PPO - HCPCS - A9576","TUFTS - TUFTS PPO - A9576","TUFTS - TUFTS PPO - A9576 - HC PROHANCE IV CONTRAST PER ML","TUFTS","TUFTS PPO","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,0,1.5,3.77,1.25]
["TUFTS - TUFTS SPIRIT - HCPCS - A9576","TUFTS - TUFTS SPIRIT - A9576","TUFTS - TUFTS SPIRIT - A9576 - HC PROHANCE IV CONTRAST PER ML","TUFTS","TUFTS SPIRIT","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,1.65,1.5,3.77,1.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9576","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9576","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9576 - HC PROHANCE IV CONTRAST PER ML","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,0,1.5,3.77,1.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A9576","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - A9576","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - A9576 - HC PROHANCE IV CONTRAST PER ML","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,2.02,1.5,3.77,1.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - A9576","FALLON - FALLON SENIOR PLAN - A9576","FALLON - FALLON SENIOR PLAN - A9576 - HC PROHANCE IV CONTRAST PER ML","FALLON","FALLON SENIOR PLAN","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,1.5,1.5,3.77,1.25]
["TUFTS - TUFTS HMO - HCPCS - A9576","TUFTS - TUFTS HMO - A9576","TUFTS - TUFTS HMO - A9576 - HC PROHANCE IV CONTRAST PER ML","TUFTS","TUFTS HMO","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,0,1.5,3.77,1.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9576","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9576","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9576 - HC PROHANCE IV CONTRAST PER ML","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,0,1.5,3.77,1.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - A9576","TUFTS - TUFTS MEDICARE SCO - A9576","TUFTS - TUFTS MEDICARE SCO - A9576 - HC PROHANCE IV CONTRAST PER ML","TUFTS","TUFTS MEDICARE SCO","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,2.1800000000000002,1.5,3.77,1.25]
["TUFTS - TUFTS POS - HCPCS - A9576","TUFTS - TUFTS POS - A9576","TUFTS - TUFTS POS - A9576 - HC PROHANCE IV CONTRAST PER ML","TUFTS","TUFTS POS","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,0,1.5,3.77,1.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9576","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9576","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9576 - HC PROHANCE IV CONTRAST PER ML","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,0,1.5,3.77,1.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A9576","TUFTS - TUFTS MEDICARE PREFERRED HMO - A9576","TUFTS - TUFTS MEDICARE PREFERRED HMO - A9576 - HC PROHANCE IV CONTRAST PER ML","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,2.1800000000000002,1.5,3.77,1.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A9576","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - A9576","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - A9576 - HC PROHANCE IV CONTRAST PER ML","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,3.24,1.5,3.77,1.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A9576","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - A9576","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - A9576 - HC PROHANCE IV CONTRAST PER ML","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,2.61,1.5,3.77,1.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9576","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9576","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9576 - HC PROHANCE IV CONTRAST PER ML","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,3.76,1.5,3.77,1.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A9576","ELDER SERVICE PLAN - ELEMENT CARE INC - A9576","ELDER SERVICE PLAN - ELEMENT CARE INC - A9576 - HC PROHANCE IV CONTRAST PER ML","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,1.5,1.5,3.77,1.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A9576","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - A9576","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - A9576 - HC PROHANCE IV CONTRAST PER ML","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,1.5,1.5,3.77,1.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A9576","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - A9576","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - A9576 - HC PROHANCE IV CONTRAST PER ML","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,1.5,1.5,3.77,1.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A9576","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - A9576","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - A9576 - HC PROHANCE IV CONTRAST PER ML","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,1.5,1.5,3.77,1.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A9576","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - A9576","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - A9576 - HC PROHANCE IV CONTRAST PER ML","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,3.31,1.5,3.77,1.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9576","CIGNA HEALTHCARE - CIGNA CARELINK - A9576","CIGNA HEALTHCARE - CIGNA CARELINK - A9576 - HC PROHANCE IV CONTRAST PER ML","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,0,1.5,3.77,1.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9576","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9576","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9576 - HC PROHANCE IV CONTRAST PER ML","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,3.76,1.5,3.77,1.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9576","BLUE CROSS - BLUE CROSS-INDEMNITY - A9576","BLUE CROSS - BLUE CROSS-INDEMNITY - A9576 - HC PROHANCE IV CONTRAST PER ML","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,3.76,1.5,3.77,1.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A9576","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - A9576","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - A9576 - HC PROHANCE IV CONTRAST PER ML","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,3.77,1.5,3.77,1.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A9576","AETNA - AETNA-MEDICARE ADVANTAGE - A9576","AETNA - AETNA-MEDICARE ADVANTAGE - A9576 - HC PROHANCE IV CONTRAST PER ML","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,1.77,1.5,3.77,1.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9576","BLUE CROSS - BLUE CROSS-PPO - A9576","BLUE CROSS - BLUE CROSS-PPO - A9576 - HC PROHANCE IV CONTRAST PER ML","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,3.76,1.5,3.77,1.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9576","BLUE CROSS - BLUE CROSS-HMO BLUE - A9576","BLUE CROSS - BLUE CROSS-HMO BLUE - A9576 - HC PROHANCE IV CONTRAST PER ML","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,3.76,1.5,3.77,1.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9576","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9576","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9576 - HC PROHANCE IV CONTRAST PER ML","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,3.76,1.5,3.77,1.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9576","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9576","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9576 - HC PROHANCE IV CONTRAST PER ML","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,3.76,1.5,3.77,1.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A9577","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - A9577","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,2.17,1.81,5.03,5.25]
["TUFTS - TUFTS SELECT - HCPCS - A9577","TUFTS - TUFTS SELECT - A9577","TUFTS - TUFTS SELECT - A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","TUFTS","TUFTS SELECT","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,0,1.81,5.03,5.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9577","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9577","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,0,1.81,5.03,5.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A9577","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - A9577","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,2.17,1.81,5.03,5.25]
["UNICARE - UNICARE - HCPCS - A9577","UNICARE - UNICARE - A9577","UNICARE - UNICARE - A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","UNICARE","UNICARE","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,1.88,1.81,5.03,5.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - A9577","UNICARE - UNICARE STATE INDEMNITY PLAN - A9577","UNICARE - UNICARE STATE INDEMNITY PLAN - A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,1.88,1.81,5.03,5.25]
["TUFTS - TUFTS SPIRIT - HCPCS - A9577","TUFTS - TUFTS SPIRIT - A9577","TUFTS - TUFTS SPIRIT - A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","TUFTS","TUFTS SPIRIT","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,1.99,1.81,5.03,5.25]
["TUFTS - TUFTS PPO - HCPCS - A9577","TUFTS - TUFTS PPO - A9577","TUFTS - TUFTS PPO - A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","TUFTS","TUFTS PPO","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,0,1.81,5.03,5.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A9577","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - A9577","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,2.44,1.81,5.03,5.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9577","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9577","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,0,1.81,5.03,5.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - A9577","FALLON - FALLON SENIOR PLAN - A9577","FALLON - FALLON SENIOR PLAN - A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","FALLON","FALLON SENIOR PLAN","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,1.81,1.81,5.03,5.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9577","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9577","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,0,1.81,5.03,5.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A9577","TUFTS - TUFTS MEDICARE PREFERRED HMO - A9577","TUFTS - TUFTS MEDICARE PREFERRED HMO - A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,2.62,1.81,5.03,5.25]
["TUFTS - TUFTS HMO - HCPCS - A9577","TUFTS - TUFTS HMO - A9577","TUFTS - TUFTS HMO - A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","TUFTS","TUFTS HMO","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,0,1.81,5.03,5.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9577","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9577","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,0,1.81,5.03,5.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - A9577","TUFTS - TUFTS MEDICARE SCO - A9577","TUFTS - TUFTS MEDICARE SCO - A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","TUFTS","TUFTS MEDICARE SCO","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,2.62,1.81,5.03,5.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A9577","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - A9577","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,3.91,1.81,5.03,5.25]
["TUFTS - TUFTS POS - HCPCS - A9577","TUFTS - TUFTS POS - A9577","TUFTS - TUFTS POS - A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","TUFTS","TUFTS POS","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,0,1.81,5.03,5.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A9577","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - A9577","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,3.15,1.81,5.03,5.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9577","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9577","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,5.03,1.81,5.03,5.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9577","CIGNA HEALTHCARE - CIGNA CARELINK - A9577","CIGNA HEALTHCARE - CIGNA CARELINK - A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,0,1.81,5.03,5.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A9577","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - A9577","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,4,1.81,5.03,5.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A9577","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - A9577","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,1.81,1.81,5.03,5.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A9577","ELDER SERVICE PLAN - ELEMENT CARE INC - A9577","ELDER SERVICE PLAN - ELEMENT CARE INC - A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,1.81,1.81,5.03,5.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A9577","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - A9577","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,1.81,1.81,5.03,5.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A9577","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - A9577","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,1.81,1.81,5.03,5.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9577","BLUE CROSS - BLUE CROSS-INDEMNITY - A9577","BLUE CROSS - BLUE CROSS-INDEMNITY - A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,5.03,1.81,5.03,5.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9577","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9577","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,5.03,1.81,5.03,5.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A9577","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - A9577","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,4.55,1.81,5.03,5.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9577","BLUE CROSS - BLUE CROSS-PPO - A9577","BLUE CROSS - BLUE CROSS-PPO - A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,5.03,1.81,5.03,5.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9577","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9577","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,5.03,1.81,5.03,5.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9577","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9577","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,5.03,1.81,5.03,5.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A9577","AETNA - AETNA-MEDICARE ADVANTAGE - A9577","AETNA - AETNA-MEDICARE ADVANTAGE - A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,2.14,1.81,5.03,5.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9577","BLUE CROSS - BLUE CROSS-HMO BLUE - A9577","BLUE CROSS - BLUE CROSS-HMO BLUE - A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,5.03,1.81,5.03,5.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9579","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9579","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9579 - GAD-BASE MR CONTRAST NOS,1ML","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,0,1.53,4.38,1.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A9579","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - A9579","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - A9579 - GAD-BASE MR CONTRAST NOS,1ML","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,1.84,1.53,4.38,1.25]
["UNICARE - UNICARE - HCPCS - A9579","UNICARE - UNICARE - A9579","UNICARE - UNICARE - A9579 - GAD-BASE MR CONTRAST NOS,1ML","UNICARE","UNICARE","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,1.58,1.53,4.38,1.25]
["TUFTS - TUFTS SELECT - HCPCS - A9579","TUFTS - TUFTS SELECT - A9579","TUFTS - TUFTS SELECT - A9579 - GAD-BASE MR CONTRAST NOS,1ML","TUFTS","TUFTS SELECT","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,0,1.53,4.38,1.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - A9579","UNICARE - UNICARE STATE INDEMNITY PLAN - A9579","UNICARE - UNICARE STATE INDEMNITY PLAN - A9579 - GAD-BASE MR CONTRAST NOS,1ML","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,1.58,1.53,4.38,1.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A9579","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - A9579","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - A9579 - GAD-BASE MR CONTRAST NOS,1ML","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,1.84,1.53,4.38,1.25]
["TUFTS - TUFTS SPIRIT - HCPCS - A9579","TUFTS - TUFTS SPIRIT - A9579","TUFTS - TUFTS SPIRIT - A9579 - GAD-BASE MR CONTRAST NOS,1ML","TUFTS","TUFTS SPIRIT","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,1.68,1.53,4.38,1.25]
["TUFTS - TUFTS PPO - HCPCS - A9579","TUFTS - TUFTS PPO - A9579","TUFTS - TUFTS PPO - A9579 - GAD-BASE MR CONTRAST NOS,1ML","TUFTS","TUFTS PPO","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,0,1.53,4.38,1.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9579","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9579","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9579 - GAD-BASE MR CONTRAST NOS,1ML","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,0,1.53,4.38,1.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A9579","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - A9579","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - A9579 - GAD-BASE MR CONTRAST NOS,1ML","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,2.06,1.53,4.38,1.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - A9579","FALLON - FALLON SENIOR PLAN - A9579","FALLON - FALLON SENIOR PLAN - A9579 - GAD-BASE MR CONTRAST NOS,1ML","FALLON","FALLON SENIOR PLAN","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,1.53,1.53,4.38,1.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - A9579","TUFTS - TUFTS MEDICARE SCO - A9579","TUFTS - TUFTS MEDICARE SCO - A9579 - GAD-BASE MR CONTRAST NOS,1ML","TUFTS","TUFTS MEDICARE SCO","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,2.2200000000000002,1.53,4.38,1.25]
["TUFTS - TUFTS POS - HCPCS - A9579","TUFTS - TUFTS POS - A9579","TUFTS - TUFTS POS - A9579 - GAD-BASE MR CONTRAST NOS,1ML","TUFTS","TUFTS POS","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,0,1.53,4.38,1.25]
["TUFTS - TUFTS HMO - HCPCS - A9579","TUFTS - TUFTS HMO - A9579","TUFTS - TUFTS HMO - A9579 - GAD-BASE MR CONTRAST NOS,1ML","TUFTS","TUFTS HMO","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,0,1.53,4.38,1.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9579","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9579","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9579 - GAD-BASE MR CONTRAST NOS,1ML","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,0,1.53,4.38,1.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9579","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9579","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9579 - GAD-BASE MR CONTRAST NOS,1ML","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,0,1.53,4.38,1.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A9579","TUFTS - TUFTS MEDICARE PREFERRED HMO - A9579","TUFTS - TUFTS MEDICARE PREFERRED HMO - A9579 - GAD-BASE MR CONTRAST NOS,1ML","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,2.2200000000000002,1.53,4.38,1.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A9579","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - A9579","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - A9579 - GAD-BASE MR CONTRAST NOS,1ML","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,3.3,1.53,4.38,1.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A9579","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - A9579","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - A9579 - GAD-BASE MR CONTRAST NOS,1ML","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,2.66,1.53,4.38,1.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9579","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9579","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9579 - GAD-BASE MR CONTRAST NOS,1ML","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,4.38,1.53,4.38,1.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A9579","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - A9579","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - A9579 - GAD-BASE MR CONTRAST NOS,1ML","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,3.38,1.53,4.38,1.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A9579","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - A9579","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - A9579 - GAD-BASE MR CONTRAST NOS,1ML","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,1.53,1.53,4.38,1.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A9579","ELDER SERVICE PLAN - ELEMENT CARE INC - A9579","ELDER SERVICE PLAN - ELEMENT CARE INC - A9579 - GAD-BASE MR CONTRAST NOS,1ML","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,1.53,1.53,4.38,1.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A9579","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - A9579","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - A9579 - GAD-BASE MR CONTRAST NOS,1ML","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,1.53,1.53,4.38,1.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A9579","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - A9579","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - A9579 - GAD-BASE MR CONTRAST NOS,1ML","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,1.53,1.53,4.38,1.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9579","CIGNA HEALTHCARE - CIGNA CARELINK - A9579","CIGNA HEALTHCARE - CIGNA CARELINK - A9579 - GAD-BASE MR CONTRAST NOS,1ML","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,0,1.53,4.38,1.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9579","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9579","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9579 - GAD-BASE MR CONTRAST NOS,1ML","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,4.38,1.53,4.38,1.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9579","BLUE CROSS - BLUE CROSS-INDEMNITY - A9579","BLUE CROSS - BLUE CROSS-INDEMNITY - A9579 - GAD-BASE MR CONTRAST NOS,1ML","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,4.38,1.53,4.38,1.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A9579","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - A9579","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - A9579 - GAD-BASE MR CONTRAST NOS,1ML","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,3.85,1.53,4.38,1.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A9579","AETNA - AETNA-MEDICARE ADVANTAGE - A9579","AETNA - AETNA-MEDICARE ADVANTAGE - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,1.81,1.53,4.38,1.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9579","BLUE CROSS - BLUE CROSS-PPO - A9579","BLUE CROSS - BLUE CROSS-PPO - A9579 - GAD-BASE MR CONTRAST NOS,1ML","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,4.38,1.53,4.38,1.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9579","BLUE CROSS - BLUE CROSS-HMO BLUE - A9579","BLUE CROSS - BLUE CROSS-HMO BLUE - A9579 - GAD-BASE MR CONTRAST NOS,1ML","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,4.38,1.53,4.38,1.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9579","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9579","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9579 - GAD-BASE MR CONTRAST NOS,1ML","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,4.38,1.53,4.38,1.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9579","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9579","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9579 - GAD-BASE MR CONTRAST NOS,1ML","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,4.38,1.53,4.38,1.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9580","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9580","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9580 - HC NA FLUORIDE F-18, DOSE","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE","A9580 - HC NA FLUORIDE F-18, DOSE",158,0,0,0,39.5]
["TUFTS - TUFTS SELECT - HCPCS - A9580","TUFTS - TUFTS SELECT - A9580","TUFTS - TUFTS SELECT - A9580 - HC NA FLUORIDE F-18, DOSE","TUFTS","TUFTS SELECT","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE","A9580 - HC NA FLUORIDE F-18, DOSE",158,0,0,0,39.5]
["TUFTS - TUFTS PPO - HCPCS - A9580","TUFTS - TUFTS PPO - A9580","TUFTS - TUFTS PPO - A9580 - HC NA FLUORIDE F-18, DOSE","TUFTS","TUFTS PPO","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE","A9580 - HC NA FLUORIDE F-18, DOSE",158,0,0,0,39.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9580","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9580","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9580 - HC NA FLUORIDE F-18, DOSE","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE","A9580 - HC NA FLUORIDE F-18, DOSE",158,0,0,0,39.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9580","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9580","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9580 - HC NA FLUORIDE F-18, DOSE","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE","A9580 - HC NA FLUORIDE F-18, DOSE",158,0,0,0,39.5]
["FALLON - FALLON MEDICAID - HCPCS - A9580","FALLON - FALLON MEDICAID - A9580","FALLON - FALLON MEDICAID - A9580 - HC NA FLUORIDE F-18, DOSE","FALLON","FALLON MEDICAID","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE","A9580 - HC NA FLUORIDE F-18, DOSE",158,0,0,0,39.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9580","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9580","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9580 - HC NA FLUORIDE F-18, DOSE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE","A9580 - HC NA FLUORIDE F-18, DOSE",158,0,0,0,39.5]
["TUFTS - TUFTS HMO - HCPCS - A9580","TUFTS - TUFTS HMO - A9580","TUFTS - TUFTS HMO - A9580 - HC NA FLUORIDE F-18, DOSE","TUFTS","TUFTS HMO","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE","A9580 - HC NA FLUORIDE F-18, DOSE",158,0,0,0,39.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9580","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9580","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9580 - HC NA FLUORIDE F-18, DOSE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE","A9580 - HC NA FLUORIDE F-18, DOSE",158,0,0,0,39.5]
["TUFTS - TUFTS POS - HCPCS - A9580","TUFTS - TUFTS POS - A9580","TUFTS - TUFTS POS - A9580 - HC NA FLUORIDE F-18, DOSE","TUFTS","TUFTS POS","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE","A9580 - HC NA FLUORIDE F-18, DOSE",158,0,0,0,39.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9580","BMC HEALTHNET - BMCHN QHP - A9580","BMC HEALTHNET - BMCHN QHP - A9580 - HC NA FLUORIDE F-18, DOSE","BMC HEALTHNET","BMCHN QHP","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE","A9580 - HC NA FLUORIDE F-18, DOSE",158,0,0,0,39.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9580","CIGNA HEALTHCARE - CIGNA CARELINK - A9580","CIGNA HEALTHCARE - CIGNA CARELINK - A9580 - HC NA FLUORIDE F-18, DOSE","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE","A9580 - HC NA FLUORIDE F-18, DOSE",158,0,0,0,39.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9580","BMC HEALTHNET - BMCHN ACO - A9580","BMC HEALTHNET - BMCHN ACO - A9580 - HC NA FLUORIDE F-18, DOSE","BMC HEALTHNET","BMCHN ACO","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE","A9580 - HC NA FLUORIDE F-18, DOSE",158,0,0,0,39.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9580","BMC HEALTHNET - BMCHN MCO - A9580","BMC HEALTHNET - BMCHN MCO - A9580 - HC NA FLUORIDE F-18, DOSE","BMC HEALTHNET","BMCHN MCO","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE","A9580 - HC NA FLUORIDE F-18, DOSE",158,0,0,0,39.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9580","BMC HEALTHNET - BMCHN MEDICAID - A9580","BMC HEALTHNET - BMCHN MEDICAID - A9580 - HC NA FLUORIDE F-18, DOSE","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE","A9580 - HC NA FLUORIDE F-18, DOSE",158,0,0,0,39.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9580","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9580","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9580 - HC NA FLUORIDE F-18, DOSE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE","A9580 - HC NA FLUORIDE F-18, DOSE",158,0,0,0,39.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9580","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9580","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9580 - HC NA FLUORIDE F-18, DOSE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE","A9580 - HC NA FLUORIDE F-18, DOSE",158,0,0,0,39.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A9581","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - A9581","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - A9581 - GADOXETATE DISODIUM INJ","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,17.71,14.76,37.14,24.75]
["TUFTS - TUFTS SELECT - HCPCS - A9581","TUFTS - TUFTS SELECT - A9581","TUFTS - TUFTS SELECT - A9581 - GADOXETATE DISODIUM INJ","TUFTS","TUFTS SELECT","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,0,14.76,37.14,24.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9581","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9581","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9581 - GADOXETATE DISODIUM INJ","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,0,14.76,37.14,24.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A9581","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - A9581","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - A9581 - GADOXETATE DISODIUM INJ","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,17.71,14.76,37.14,24.75]
["UNICARE - UNICARE - HCPCS - A9581","UNICARE - UNICARE - A9581","UNICARE - UNICARE - A9581 - GADOXETATE DISODIUM INJ","UNICARE","UNICARE","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,15.32,14.76,37.14,24.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - A9581","UNICARE - UNICARE STATE INDEMNITY PLAN - A9581","UNICARE - UNICARE STATE INDEMNITY PLAN - A9581 - GADOXETATE DISODIUM INJ","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,15.32,14.76,37.14,24.75]
["TUFTS - TUFTS SPIRIT - HCPCS - A9581","TUFTS - TUFTS SPIRIT - A9581","TUFTS - TUFTS SPIRIT - A9581 - GADOXETATE DISODIUM INJ","TUFTS","TUFTS SPIRIT","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,16.239999999999998,14.76,37.14,24.75]
["TUFTS - TUFTS PPO - HCPCS - A9581","TUFTS - TUFTS PPO - A9581","TUFTS - TUFTS PPO - A9581 - GADOXETATE DISODIUM INJ","TUFTS","TUFTS PPO","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,0,14.76,37.14,24.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9581","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9581","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9581 - GADOXETATE DISODIUM INJ","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,0,14.76,37.14,24.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A9581","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - A9581","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - A9581 - GADOXETATE DISODIUM INJ","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,19.899999999999999,14.76,37.14,24.75]
["TUFTS - TUFTS HMO - HCPCS - A9581","TUFTS - TUFTS HMO - A9581","TUFTS - TUFTS HMO - A9581 - GADOXETATE DISODIUM INJ","TUFTS","TUFTS HMO","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,0,14.76,37.14,24.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - A9581","FALLON - FALLON SENIOR PLAN - A9581","FALLON - FALLON SENIOR PLAN - A9581 - GADOXETATE DISODIUM INJ","FALLON","FALLON SENIOR PLAN","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,14.76,14.76,37.14,24.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A9581","TUFTS - TUFTS MEDICARE PREFERRED HMO - A9581","TUFTS - TUFTS MEDICARE PREFERRED HMO - A9581 - GADOXETATE DISODIUM INJ","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,21.4,14.76,37.14,24.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9581","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9581","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9581 - GADOXETATE DISODIUM INJ","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,0,14.76,37.14,24.75]
["TUFTS - TUFTS POS - HCPCS - A9581","TUFTS - TUFTS POS - A9581","TUFTS - TUFTS POS - A9581 - GADOXETATE DISODIUM INJ","TUFTS","TUFTS POS","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,0,14.76,37.14,24.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9581","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9581","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9581 - GADOXETATE DISODIUM INJ","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,0,14.76,37.14,24.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - A9581","TUFTS - TUFTS MEDICARE SCO - A9581","TUFTS - TUFTS MEDICARE SCO - A9581 - GADOXETATE DISODIUM INJ","TUFTS","TUFTS MEDICARE SCO","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,21.4,14.76,37.14,24.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A9581","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - A9581","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - A9581 - GADOXETATE DISODIUM INJ","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,31.87,14.76,37.14,24.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A9581","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - A9581","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - A9581 - GADOXETATE DISODIUM INJ","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,25.68,14.76,37.14,24.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9581","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9581","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9581 - GADOXETATE DISODIUM INJ","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,16.97,14.76,37.14,24.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A9581","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - A9581","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - A9581 - GADOXETATE DISODIUM INJ","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,32.619999999999997,14.76,37.14,24.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9581","CIGNA HEALTHCARE - CIGNA CARELINK - A9581","CIGNA HEALTHCARE - CIGNA CARELINK - A9581 - GADOXETATE DISODIUM INJ","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,0,14.76,37.14,24.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A9581","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - A9581","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - A9581 - GADOXETATE DISODIUM INJ","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,14.76,14.76,37.14,24.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A9581","ELDER SERVICE PLAN - ELEMENT CARE INC - A9581","ELDER SERVICE PLAN - ELEMENT CARE INC - A9581 - GADOXETATE DISODIUM INJ","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,14.76,14.76,37.14,24.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A9581","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - A9581","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - A9581 - GADOXETATE DISODIUM INJ","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,14.76,14.76,37.14,24.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A9581","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - A9581","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - A9581 - GADOXETATE DISODIUM INJ","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,14.76,14.76,37.14,24.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9581","BLUE CROSS - BLUE CROSS-PPO - A9581","BLUE CROSS - BLUE CROSS-PPO - A9581 - GADOXETATE DISODIUM INJ","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,16.97,14.76,37.14,24.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A9581","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - A9581","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - A9581 - GADOXETATE DISODIUM INJ","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,37.14,14.76,37.14,24.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9581","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9581","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9581 - GADOXETATE DISODIUM INJ","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,16.97,14.76,37.14,24.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9581","BLUE CROSS - BLUE CROSS-INDEMNITY - A9581","BLUE CROSS - BLUE CROSS-INDEMNITY - A9581 - GADOXETATE DISODIUM INJ","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,16.97,14.76,37.14,24.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9581","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9581","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9581 - GADOXETATE DISODIUM INJ","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,16.97,14.76,37.14,24.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9581","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9581","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9581 - GADOXETATE DISODIUM INJ","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,16.97,14.76,37.14,24.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A9581","AETNA - AETNA-MEDICARE ADVANTAGE - A9581","AETNA - AETNA-MEDICARE ADVANTAGE - A9581 - GADOXETATE DISODIUM INJ","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,17.420000000000002,14.76,37.14,24.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9581","BLUE CROSS - BLUE CROSS-HMO BLUE - A9581","BLUE CROSS - BLUE CROSS-HMO BLUE - A9581 - GADOXETATE DISODIUM INJ","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,16.97,14.76,37.14,24.75]
["TUFTS - TUFTS SELECT - HCPCS - A9582","TUFTS - TUFTS SELECT - A9582","TUFTS - TUFTS SELECT - A9582 - IODINE I-123 IOBENGUANE","TUFTS","TUFTS SELECT","HCPCS","A9582","IODINE I-123 IOBENGUANE","A9582 - IODINE I-123 IOBENGUANE",10370,0,0,0,2592.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9582","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9582","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9582 - IODINE I-123 IOBENGUANE","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9582","IODINE I-123 IOBENGUANE","A9582 - IODINE I-123 IOBENGUANE",10370,0,0,0,2592.5]
["TUFTS - TUFTS PPO - HCPCS - A9582","TUFTS - TUFTS PPO - A9582","TUFTS - TUFTS PPO - A9582 - IODINE I-123 IOBENGUANE","TUFTS","TUFTS PPO","HCPCS","A9582","IODINE I-123 IOBENGUANE","A9582 - IODINE I-123 IOBENGUANE",10370,0,0,0,2592.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9582","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9582","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9582 - IODINE I-123 IOBENGUANE","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9582","IODINE I-123 IOBENGUANE","A9582 - IODINE I-123 IOBENGUANE",10370,0,0,0,2592.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9582","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9582","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9582 - IODINE I-123 IOBENGUANE","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9582","IODINE I-123 IOBENGUANE","A9582 - IODINE I-123 IOBENGUANE",10370,0,0,0,2592.5]
["FALLON - FALLON MEDICAID - HCPCS - A9582","FALLON - FALLON MEDICAID - A9582","FALLON - FALLON MEDICAID - A9582 - IODINE I-123 IOBENGUANE","FALLON","FALLON MEDICAID","HCPCS","A9582","IODINE I-123 IOBENGUANE","A9582 - IODINE I-123 IOBENGUANE",10370,0,0,0,2592.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9582","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9582","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9582 - IODINE I-123 IOBENGUANE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9582","IODINE I-123 IOBENGUANE","A9582 - IODINE I-123 IOBENGUANE",10370,0,0,0,2592.5]
["TUFTS - TUFTS HMO - HCPCS - A9582","TUFTS - TUFTS HMO - A9582","TUFTS - TUFTS HMO - A9582 - IODINE I-123 IOBENGUANE","TUFTS","TUFTS HMO","HCPCS","A9582","IODINE I-123 IOBENGUANE","A9582 - IODINE I-123 IOBENGUANE",10370,0,0,0,2592.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9582","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9582","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9582 - IODINE I-123 IOBENGUANE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9582","IODINE I-123 IOBENGUANE","A9582 - IODINE I-123 IOBENGUANE",10370,0,0,0,2592.5]
["TUFTS - TUFTS POS - HCPCS - A9582","TUFTS - TUFTS POS - A9582","TUFTS - TUFTS POS - A9582 - IODINE I-123 IOBENGUANE","TUFTS","TUFTS POS","HCPCS","A9582","IODINE I-123 IOBENGUANE","A9582 - IODINE I-123 IOBENGUANE",10370,0,0,0,2592.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9582","CIGNA HEALTHCARE - CIGNA CARELINK - A9582","CIGNA HEALTHCARE - CIGNA CARELINK - A9582 - IODINE I-123 IOBENGUANE","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9582","IODINE I-123 IOBENGUANE","A9582 - IODINE I-123 IOBENGUANE",10370,0,0,0,2592.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9582","BMC HEALTHNET - BMCHN ACO - A9582","BMC HEALTHNET - BMCHN ACO - A9582 - IODINE I-123 IOBENGUANE","BMC HEALTHNET","BMCHN ACO","HCPCS","A9582","IODINE I-123 IOBENGUANE","A9582 - IODINE I-123 IOBENGUANE",10370,0,0,0,2592.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9582","BMC HEALTHNET - BMCHN QHP - A9582","BMC HEALTHNET - BMCHN QHP - A9582 - IODINE I-123 IOBENGUANE","BMC HEALTHNET","BMCHN QHP","HCPCS","A9582","IODINE I-123 IOBENGUANE","A9582 - IODINE I-123 IOBENGUANE",10370,0,0,0,2592.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9582","BMC HEALTHNET - BMCHN MCO - A9582","BMC HEALTHNET - BMCHN MCO - A9582 - IODINE I-123 IOBENGUANE","BMC HEALTHNET","BMCHN MCO","HCPCS","A9582","IODINE I-123 IOBENGUANE","A9582 - IODINE I-123 IOBENGUANE",10370,0,0,0,2592.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9582","BMC HEALTHNET - BMCHN MEDICAID - A9582","BMC HEALTHNET - BMCHN MEDICAID - A9582 - IODINE I-123 IOBENGUANE","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9582","IODINE I-123 IOBENGUANE","A9582 - IODINE I-123 IOBENGUANE",10370,0,0,0,2592.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9582","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9582","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9582 - IODINE I-123 IOBENGUANE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9582","IODINE I-123 IOBENGUANE","A9582 - IODINE I-123 IOBENGUANE",10370,0,0,0,2592.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9582","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9582","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9582 - IODINE I-123 IOBENGUANE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9582","IODINE I-123 IOBENGUANE","A9582 - IODINE I-123 IOBENGUANE",10370,0,0,0,2592.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9583","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9583","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9583 - GADOFOSVESET TRISODIUM INJ","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,0,19.260000000000002,21.34,3.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - A9583","UNICARE - UNICARE STATE INDEMNITY PLAN - A9583","UNICARE - UNICARE STATE INDEMNITY PLAN - A9583 - GADOFOSVESET TRISODIUM INJ","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,19.260000000000002,19.260000000000002,21.34,3.25]
["UNICARE - UNICARE - HCPCS - A9583","UNICARE - UNICARE - A9583","UNICARE - UNICARE - A9583 - GADOFOSVESET TRISODIUM INJ","UNICARE","UNICARE","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,19.260000000000002,19.260000000000002,21.34,3.25]
["TUFTS - TUFTS SELECT - HCPCS - A9583","TUFTS - TUFTS SELECT - A9583","TUFTS - TUFTS SELECT - A9583 - GADOFOSVESET TRISODIUM INJ","TUFTS","TUFTS SELECT","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,0,19.260000000000002,21.34,3.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9583","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9583","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9583 - GADOFOSVESET TRISODIUM INJ","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,0,19.260000000000002,21.34,3.25]
["TUFTS - TUFTS PPO - HCPCS - A9583","TUFTS - TUFTS PPO - A9583","TUFTS - TUFTS PPO - A9583 - GADOFOSVESET TRISODIUM INJ","TUFTS","TUFTS PPO","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,0,19.260000000000002,21.34,3.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9583","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9583","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9583 - GADOFOSVESET TRISODIUM INJ","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,0,19.260000000000002,21.34,3.25]
["TUFTS - TUFTS POS - HCPCS - A9583","TUFTS - TUFTS POS - A9583","TUFTS - TUFTS POS - A9583 - GADOFOSVESET TRISODIUM INJ","TUFTS","TUFTS POS","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,0,19.260000000000002,21.34,3.25]
["FALLON - FALLON MEDICAID - HCPCS - A9583","FALLON - FALLON MEDICAID - A9583","FALLON - FALLON MEDICAID - A9583 - GADOFOSVESET TRISODIUM INJ","FALLON","FALLON MEDICAID","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,0,19.260000000000002,21.34,3.25]
["TUFTS - TUFTS HMO - HCPCS - A9583","TUFTS - TUFTS HMO - A9583","TUFTS - TUFTS HMO - A9583 - GADOFOSVESET TRISODIUM INJ","TUFTS","TUFTS HMO","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,0,19.260000000000002,21.34,3.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9583","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9583","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9583 - GADOFOSVESET TRISODIUM INJ","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,0,19.260000000000002,21.34,3.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9583","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9583","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9583 - GADOFOSVESET TRISODIUM INJ","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,0,19.260000000000002,21.34,3.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9583","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9583","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9583 - GADOFOSVESET TRISODIUM INJ","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,21.34,19.260000000000002,21.34,3.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9583","BMC HEALTHNET - BMCHN QHP - A9583","BMC HEALTHNET - BMCHN QHP - A9583 - GADOFOSVESET TRISODIUM INJ","BMC HEALTHNET","BMCHN QHP","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,0,19.260000000000002,21.34,3.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9583","BMC HEALTHNET - BMCHN ACO - A9583","BMC HEALTHNET - BMCHN ACO - A9583 - GADOFOSVESET TRISODIUM INJ","BMC HEALTHNET","BMCHN ACO","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,0,19.260000000000002,21.34,3.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9583","BMC HEALTHNET - BMCHN MCO - A9583","BMC HEALTHNET - BMCHN MCO - A9583 - GADOFOSVESET TRISODIUM INJ","BMC HEALTHNET","BMCHN MCO","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,0,19.260000000000002,21.34,3.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9583","CIGNA HEALTHCARE - CIGNA CARELINK - A9583","CIGNA HEALTHCARE - CIGNA CARELINK - A9583 - GADOFOSVESET TRISODIUM INJ","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,0,19.260000000000002,21.34,3.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9583","BMC HEALTHNET - BMCHN MEDICAID - A9583","BMC HEALTHNET - BMCHN MEDICAID - A9583 - GADOFOSVESET TRISODIUM INJ","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,0,19.260000000000002,21.34,3.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9583","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9583","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9583 - GADOFOSVESET TRISODIUM INJ","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,0,19.260000000000002,21.34,3.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9583","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9583","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9583 - GADOFOSVESET TRISODIUM INJ","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,0,19.260000000000002,21.34,3.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9583","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9583","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9583 - GADOFOSVESET TRISODIUM INJ","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,21.34,19.260000000000002,21.34,3.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9583","BLUE CROSS - BLUE CROSS-INDEMNITY - A9583","BLUE CROSS - BLUE CROSS-INDEMNITY - A9583 - GADOFOSVESET TRISODIUM INJ","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,21.34,19.260000000000002,21.34,3.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9583","BLUE CROSS - BLUE CROSS-PPO - A9583","BLUE CROSS - BLUE CROSS-PPO - A9583 - GADOFOSVESET TRISODIUM INJ","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,21.34,19.260000000000002,21.34,3.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9583","BLUE CROSS - BLUE CROSS-HMO BLUE - A9583","BLUE CROSS - BLUE CROSS-HMO BLUE - A9583 - GADOFOSVESET TRISODIUM INJ","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,21.34,19.260000000000002,21.34,3.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9583","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9583","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9583 - GADOFOSVESET TRISODIUM INJ","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,21.34,19.260000000000002,21.34,3.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9583","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9583","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9583 - GADOFOSVESET TRISODIUM INJ","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,21.34,19.260000000000002,21.34,3.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9584","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9584","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9584 - IODINE I-123 IOFLUPANE","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,0,3235.55,3235.55,682.25]
["TUFTS - TUFTS SELECT - HCPCS - A9584","TUFTS - TUFTS SELECT - A9584","TUFTS - TUFTS SELECT - A9584 - IODINE I-123 IOFLUPANE","TUFTS","TUFTS SELECT","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,0,3235.55,3235.55,682.25]
["TUFTS - TUFTS PPO - HCPCS - A9584","TUFTS - TUFTS PPO - A9584","TUFTS - TUFTS PPO - A9584 - IODINE I-123 IOFLUPANE","TUFTS","TUFTS PPO","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,0,3235.55,3235.55,682.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9584","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9584","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9584 - IODINE I-123 IOFLUPANE","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,0,3235.55,3235.55,682.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9584","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9584","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9584 - IODINE I-123 IOFLUPANE","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,0,3235.55,3235.55,682.25]
["FALLON - FALLON MEDICAID - HCPCS - A9584","FALLON - FALLON MEDICAID - A9584","FALLON - FALLON MEDICAID - A9584 - IODINE I-123 IOFLUPANE","FALLON","FALLON MEDICAID","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,0,3235.55,3235.55,682.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9584","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9584","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9584 - IODINE I-123 IOFLUPANE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,0,3235.55,3235.55,682.25]
["TUFTS - TUFTS HMO - HCPCS - A9584","TUFTS - TUFTS HMO - A9584","TUFTS - TUFTS HMO - A9584 - IODINE I-123 IOFLUPANE","TUFTS","TUFTS HMO","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,0,3235.55,3235.55,682.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9584","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9584","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9584 - IODINE I-123 IOFLUPANE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,0,3235.55,3235.55,682.25]
["TUFTS - TUFTS POS - HCPCS - A9584","TUFTS - TUFTS POS - A9584","TUFTS - TUFTS POS - A9584 - IODINE I-123 IOFLUPANE","TUFTS","TUFTS POS","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,0,3235.55,3235.55,682.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9584","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9584","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9584 - IODINE I-123 IOFLUPANE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,3235.55,3235.55,3235.55,682.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9584","CIGNA HEALTHCARE - CIGNA CARELINK - A9584","CIGNA HEALTHCARE - CIGNA CARELINK - A9584 - IODINE I-123 IOFLUPANE","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,0,3235.55,3235.55,682.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9584","BMC HEALTHNET - BMCHN ACO - A9584","BMC HEALTHNET - BMCHN ACO - A9584 - IODINE I-123 IOFLUPANE","BMC HEALTHNET","BMCHN ACO","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,0,3235.55,3235.55,682.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9584","BMC HEALTHNET - BMCHN QHP - A9584","BMC HEALTHNET - BMCHN QHP - A9584 - IODINE I-123 IOFLUPANE","BMC HEALTHNET","BMCHN QHP","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,0,3235.55,3235.55,682.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9584","BMC HEALTHNET - BMCHN MCO - A9584","BMC HEALTHNET - BMCHN MCO - A9584 - IODINE I-123 IOFLUPANE","BMC HEALTHNET","BMCHN MCO","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,0,3235.55,3235.55,682.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9584","BMC HEALTHNET - BMCHN MEDICAID - A9584","BMC HEALTHNET - BMCHN MEDICAID - A9584 - IODINE I-123 IOFLUPANE","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,0,3235.55,3235.55,682.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9584","BLUE CROSS - BLUE CROSS-INDEMNITY - A9584","BLUE CROSS - BLUE CROSS-INDEMNITY - A9584 - IODINE I-123 IOFLUPANE","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,3235.55,3235.55,3235.55,682.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9584","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9584","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9584 - IODINE I-123 IOFLUPANE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,0,3235.55,3235.55,682.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9584","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9584","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9584 - IODINE I-123 IOFLUPANE","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,3235.55,3235.55,3235.55,682.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9584","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9584","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9584 - IODINE I-123 IOFLUPANE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,0,3235.55,3235.55,682.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9584","BLUE CROSS - BLUE CROSS-PPO - A9584","BLUE CROSS - BLUE CROSS-PPO - A9584 - IODINE I-123 IOFLUPANE","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,3235.55,3235.55,3235.55,682.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9584","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9584","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9584 - IODINE I-123 IOFLUPANE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,3235.55,3235.55,3235.55,682.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9584","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9584","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9584 - IODINE I-123 IOFLUPANE","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,3235.55,3235.55,3235.55,682.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9584","BLUE CROSS - BLUE CROSS-HMO BLUE - A9584","BLUE CROSS - BLUE CROSS-HMO BLUE - A9584 - IODINE I-123 IOFLUPANE","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,3235.55,3235.55,3235.55,682.25]
["TUFTS - TUFTS SELECT - HCPCS - A9586","TUFTS - TUFTS SELECT - A9586","TUFTS - TUFTS SELECT - A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","TUFTS","TUFTS SELECT","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",4402,4392.1499999999996,3746.06,7452.46,1100.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9586","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9586","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",4402,5015.9399999999996,3746.06,7452.46,1100.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9586","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9586","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",4402,5015.9399999999996,3746.06,7452.46,1100.5]
["TUFTS - TUFTS PPO - HCPCS - A9586","TUFTS - TUFTS PPO - A9586","TUFTS - TUFTS PPO - A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","TUFTS","TUFTS PPO","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",4402,4698.29,3746.06,7452.46,1100.5]
["TUFTS - TUFTS HMO - HCPCS - A9586","TUFTS - TUFTS HMO - A9586","TUFTS - TUFTS HMO - A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","TUFTS","TUFTS HMO","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",4402,4392.1499999999996,3746.06,7452.46,1100.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9586","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9586","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",4402,5015.9399999999996,3746.06,7452.46,1100.5]
["TUFTS - TUFTS POS - HCPCS - A9586","TUFTS - TUFTS POS - A9586","TUFTS - TUFTS POS - A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","TUFTS","TUFTS POS","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",4402,4392.1499999999996,3746.06,7452.46,1100.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9586","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9586","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",4402,5015.9399999999996,3746.06,7452.46,1100.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9586","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9586","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",4402,3746.06,3746.06,7452.46,1100.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9586","CIGNA HEALTHCARE - CIGNA CARELINK - A9586","CIGNA HEALTHCARE - CIGNA CARELINK - A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",4402,7452.46,3746.06,7452.46,1100.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9586","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9586","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",4402,3746.06,3746.06,7452.46,1100.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9586","BLUE CROSS - BLUE CROSS-INDEMNITY - A9586","BLUE CROSS - BLUE CROSS-INDEMNITY - A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",4402,3746.06,3746.06,7452.46,1100.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9586","BLUE CROSS - BLUE CROSS-PPO - A9586","BLUE CROSS - BLUE CROSS-PPO - A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",4402,3746.06,3746.06,7452.46,1100.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9586","BLUE CROSS - BLUE CROSS-HMO BLUE - A9586","BLUE CROSS - BLUE CROSS-HMO BLUE - A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",4402,3746.06,3746.06,7452.46,1100.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9586","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9586","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",4402,3746.06,3746.06,7452.46,1100.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9586","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9586","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",4402,3746.06,3746.06,7452.46,1100.5]
["TUFTS - TUFTS SELECT - HCPCS - A9587","TUFTS - TUFTS SELECT - A9587","TUFTS - TUFTS SELECT - A9587 - GALLIUM GA-68","TUFTS","TUFTS SELECT","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,0,84.97,113.78,3246.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9587","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9587","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9587 - GALLIUM GA-68","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,113.78,84.97,113.78,3246.25]
["TUFTS - TUFTS PPO - HCPCS - A9587","TUFTS - TUFTS PPO - A9587","TUFTS - TUFTS PPO - A9587 - GALLIUM GA-68","TUFTS","TUFTS PPO","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,0,84.97,113.78,3246.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9587","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9587","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9587 - GALLIUM GA-68","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,113.78,84.97,113.78,3246.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9587","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9587","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9587 - GALLIUM GA-68","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,0,84.97,113.78,3246.25]
["FALLON - FALLON MEDICAID - HCPCS - A9587","FALLON - FALLON MEDICAID - A9587","FALLON - FALLON MEDICAID - A9587 - GALLIUM GA-68","FALLON","FALLON MEDICAID","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,0,84.97,113.78,3246.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9587","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9587","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9587 - GALLIUM GA-68","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,113.78,84.97,113.78,3246.25]
["TUFTS - TUFTS HMO - HCPCS - A9587","TUFTS - TUFTS HMO - A9587","TUFTS - TUFTS HMO - A9587 - GALLIUM GA-68","TUFTS","TUFTS HMO","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,0,84.97,113.78,3246.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9587","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9587","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9587 - GALLIUM GA-68","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,113.78,84.97,113.78,3246.25]
["TUFTS - TUFTS POS - HCPCS - A9587","TUFTS - TUFTS POS - A9587","TUFTS - TUFTS POS - A9587 - GALLIUM GA-68","TUFTS","TUFTS POS","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,0,84.97,113.78,3246.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9587","CIGNA HEALTHCARE - CIGNA CARELINK - A9587","CIGNA HEALTHCARE - CIGNA CARELINK - A9587 - GALLIUM GA-68","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,0,84.97,113.78,3246.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9587","BMC HEALTHNET - BMCHN QHP - A9587","BMC HEALTHNET - BMCHN QHP - A9587 - GALLIUM GA-68","BMC HEALTHNET","BMCHN QHP","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,0,84.97,113.78,3246.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9587","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9587","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9587 - GALLIUM GA-68","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,84.97,84.97,113.78,3246.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9587","BMC HEALTHNET - BMCHN ACO - A9587","BMC HEALTHNET - BMCHN ACO - A9587 - GALLIUM GA-68","BMC HEALTHNET","BMCHN ACO","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,0,84.97,113.78,3246.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9587","BMC HEALTHNET - BMCHN MCO - A9587","BMC HEALTHNET - BMCHN MCO - A9587 - GALLIUM GA-68","BMC HEALTHNET","BMCHN MCO","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,0,84.97,113.78,3246.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9587","BMC HEALTHNET - BMCHN MEDICAID - A9587","BMC HEALTHNET - BMCHN MEDICAID - A9587 - GALLIUM GA-68","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,0,84.97,113.78,3246.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9587","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9587","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9587 - GALLIUM GA-68","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,84.97,84.97,113.78,3246.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9587","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9587","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9587 - GALLIUM GA-68","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,0,84.97,113.78,3246.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9587","BLUE CROSS - BLUE CROSS-PPO - A9587","BLUE CROSS - BLUE CROSS-PPO - A9587 - GALLIUM GA-68","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,84.97,84.97,113.78,3246.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9587","BLUE CROSS - BLUE CROSS-INDEMNITY - A9587","BLUE CROSS - BLUE CROSS-INDEMNITY - A9587 - GALLIUM GA-68","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,84.97,84.97,113.78,3246.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9587","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9587","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9587 - GALLIUM GA-68","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,0,84.97,113.78,3246.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9587","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9587","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9587 - GALLIUM GA-68","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,84.97,84.97,113.78,3246.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9587","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9587","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9587 - GALLIUM GA-68","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,84.97,84.97,113.78,3246.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9587","BLUE CROSS - BLUE CROSS-HMO BLUE - A9587","BLUE CROSS - BLUE CROSS-HMO BLUE - A9587 - GALLIUM GA-68","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,84.97,84.97,113.78,3246.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9588","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9588","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9588 - FLUCICLOVINE F-18","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,703.05,525.05999999999995,703.05,3859.5]
["TUFTS - TUFTS SELECT - HCPCS - A9588","TUFTS - TUFTS SELECT - A9588","TUFTS - TUFTS SELECT - A9588 - FLUCICLOVINE F-18","TUFTS","TUFTS SELECT","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,0,525.05999999999995,703.05,3859.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9588","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9588","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9588 - FLUCICLOVINE F-18","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,703.05,525.05999999999995,703.05,3859.5]
["TUFTS - TUFTS PPO - HCPCS - A9588","TUFTS - TUFTS PPO - A9588","TUFTS - TUFTS PPO - A9588 - FLUCICLOVINE F-18","TUFTS","TUFTS PPO","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,0,525.05999999999995,703.05,3859.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9588","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9588","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9588 - FLUCICLOVINE F-18","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,0,525.05999999999995,703.05,3859.5]
["FALLON - FALLON MEDICAID - HCPCS - A9588","FALLON - FALLON MEDICAID - A9588","FALLON - FALLON MEDICAID - A9588 - FLUCICLOVINE F-18","FALLON","FALLON MEDICAID","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,0,525.05999999999995,703.05,3859.5]
["TUFTS - TUFTS POS - HCPCS - A9588","TUFTS - TUFTS POS - A9588","TUFTS - TUFTS POS - A9588 - FLUCICLOVINE F-18","TUFTS","TUFTS POS","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,0,525.05999999999995,703.05,3859.5]
["TUFTS - TUFTS HMO - HCPCS - A9588","TUFTS - TUFTS HMO - A9588","TUFTS - TUFTS HMO - A9588 - FLUCICLOVINE F-18","TUFTS","TUFTS HMO","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,0,525.05999999999995,703.05,3859.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9588","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9588","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9588 - FLUCICLOVINE F-18","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,703.05,525.05999999999995,703.05,3859.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9588","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9588","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9588 - FLUCICLOVINE F-18","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,703.05,525.05999999999995,703.05,3859.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9588","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9588","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9588 - FLUCICLOVINE F-18","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,525.05999999999995,525.05999999999995,703.05,3859.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9588","BMC HEALTHNET - BMCHN ACO - A9588","BMC HEALTHNET - BMCHN ACO - A9588 - FLUCICLOVINE F-18","BMC HEALTHNET","BMCHN ACO","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,0,525.05999999999995,703.05,3859.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9588","BMC HEALTHNET - BMCHN QHP - A9588","BMC HEALTHNET - BMCHN QHP - A9588 - FLUCICLOVINE F-18","BMC HEALTHNET","BMCHN QHP","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,0,525.05999999999995,703.05,3859.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9588","BMC HEALTHNET - BMCHN MCO - A9588","BMC HEALTHNET - BMCHN MCO - A9588 - FLUCICLOVINE F-18","BMC HEALTHNET","BMCHN MCO","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,0,525.05999999999995,703.05,3859.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9588","CIGNA HEALTHCARE - CIGNA CARELINK - A9588","CIGNA HEALTHCARE - CIGNA CARELINK - A9588 - FLUCICLOVINE F-18","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,0,525.05999999999995,703.05,3859.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9588","BMC HEALTHNET - BMCHN MEDICAID - A9588","BMC HEALTHNET - BMCHN MEDICAID - A9588 - FLUCICLOVINE F-18","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,0,525.05999999999995,703.05,3859.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9588","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9588","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9588 - FLUCICLOVINE F-18","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,0,525.05999999999995,703.05,3859.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9588","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9588","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9588 - FLUCICLOVINE F-18","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,0,525.05999999999995,703.05,3859.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9588","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9588","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9588 - FLUCICLOVINE F-18","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,525.05999999999995,525.05999999999995,703.05,3859.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9588","BLUE CROSS - BLUE CROSS-INDEMNITY - A9588","BLUE CROSS - BLUE CROSS-INDEMNITY - A9588 - FLUCICLOVINE F-18","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,525.05999999999995,525.05999999999995,703.05,3859.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9588","BLUE CROSS - BLUE CROSS-PPO - A9588","BLUE CROSS - BLUE CROSS-PPO - A9588 - FLUCICLOVINE F-18","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,525.05999999999995,525.05999999999995,703.05,3859.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9588","BLUE CROSS - BLUE CROSS-HMO BLUE - A9588","BLUE CROSS - BLUE CROSS-HMO BLUE - A9588 - FLUCICLOVINE F-18","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,525.05999999999995,525.05999999999995,703.05,3859.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9588","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9588","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9588 - FLUCICLOVINE F-18","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,525.05999999999995,525.05999999999995,703.05,3859.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9588","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9588","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9588 - FLUCICLOVINE F-18","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,525.05999999999995,525.05999999999995,703.05,3859.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9592","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9592","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - A9592 - HC COPPER CU 64 DOTATATE DIAG","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9592","HC COPPER CU 64 DOTATATE DIAG","A9592 - HC COPPER CU 64 DOTATATE DIAG",5634,0,0,0,1408.5]
["FALLON - FALLON MEDICAID - HCPCS - A9592","FALLON - FALLON MEDICAID - A9592","FALLON - FALLON MEDICAID - A9592 - HC COPPER CU 64 DOTATATE DIAG","FALLON","FALLON MEDICAID","HCPCS","A9592","HC COPPER CU 64 DOTATATE DIAG","A9592 - HC COPPER CU 64 DOTATATE DIAG",5634,0,0,0,1408.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9592","BMC HEALTHNET - BMCHN QHP - A9592","BMC HEALTHNET - BMCHN QHP - A9592 - HC COPPER CU 64 DOTATATE DIAG","BMC HEALTHNET","BMCHN QHP","HCPCS","A9592","HC COPPER CU 64 DOTATATE DIAG","A9592 - HC COPPER CU 64 DOTATATE DIAG",5634,0,0,0,1408.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9592","BMC HEALTHNET - BMCHN ACO - A9592","BMC HEALTHNET - BMCHN ACO - A9592 - HC COPPER CU 64 DOTATATE DIAG","BMC HEALTHNET","BMCHN ACO","HCPCS","A9592","HC COPPER CU 64 DOTATATE DIAG","A9592 - HC COPPER CU 64 DOTATATE DIAG",5634,0,0,0,1408.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9592","BMC HEALTHNET - BMCHN MCO - A9592","BMC HEALTHNET - BMCHN MCO - A9592 - HC COPPER CU 64 DOTATATE DIAG","BMC HEALTHNET","BMCHN MCO","HCPCS","A9592","HC COPPER CU 64 DOTATATE DIAG","A9592 - HC COPPER CU 64 DOTATATE DIAG",5634,0,0,0,1408.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9592","BMC HEALTHNET - BMCHN MEDICAID - A9592","BMC HEALTHNET - BMCHN MEDICAID - A9592 - HC COPPER CU 64 DOTATATE DIAG","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9592","HC COPPER CU 64 DOTATATE DIAG","A9592 - HC COPPER CU 64 DOTATATE DIAG",5634,0,0,0,1408.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9592","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9592","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - A9592 - HC COPPER CU 64 DOTATATE DIAG","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9592","HC COPPER CU 64 DOTATATE DIAG","A9592 - HC COPPER CU 64 DOTATATE DIAG",5634,0,0,0,1408.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9592","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9592","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - A9592 - HC COPPER CU 64 DOTATATE DIAG","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9592","HC COPPER CU 64 DOTATATE DIAG","A9592 - HC COPPER CU 64 DOTATATE DIAG",5634,0,0,0,1408.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9606","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9606","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - A9606 - RADIUM RA223 DICHLORIDE THER","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER","A9606 - RADIUM RA223 DICHLORIDE THER",493,247.36,198.62,597.20000000000005,123.25]
["TUFTS - TUFTS SELECT - HCPCS - A9606","TUFTS - TUFTS SELECT - A9606","TUFTS - TUFTS SELECT - A9606 - RADIUM RA223 DICHLORIDE THER","TUFTS","TUFTS SELECT","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER","A9606 - RADIUM RA223 DICHLORIDE THER",493,198.62,198.62,597.20000000000005,123.25]
["TUFTS - TUFTS PPO - HCPCS - A9606","TUFTS - TUFTS PPO - A9606","TUFTS - TUFTS PPO - A9606 - RADIUM RA223 DICHLORIDE THER","TUFTS","TUFTS PPO","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER","A9606 - RADIUM RA223 DICHLORIDE THER",493,212.47,198.62,597.20000000000005,123.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9606","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9606","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - A9606 - RADIUM RA223 DICHLORIDE THER","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER","A9606 - RADIUM RA223 DICHLORIDE THER",493,247.36,198.62,597.20000000000005,123.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9606","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9606","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - A9606 - RADIUM RA223 DICHLORIDE THER","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER","A9606 - RADIUM RA223 DICHLORIDE THER",493,247.36,198.62,597.20000000000005,123.25]
["TUFTS - TUFTS HMO - HCPCS - A9606","TUFTS - TUFTS HMO - A9606","TUFTS - TUFTS HMO - A9606 - RADIUM RA223 DICHLORIDE THER","TUFTS","TUFTS HMO","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER","A9606 - RADIUM RA223 DICHLORIDE THER",493,238.35,198.62,597.20000000000005,123.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9606","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9606","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - A9606 - RADIUM RA223 DICHLORIDE THER","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER","A9606 - RADIUM RA223 DICHLORIDE THER",493,247.36,198.62,597.20000000000005,123.25]
["TUFTS - TUFTS POS - HCPCS - A9606","TUFTS - TUFTS POS - A9606","TUFTS - TUFTS POS - A9606 - RADIUM RA223 DICHLORIDE THER","TUFTS","TUFTS POS","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER","A9606 - RADIUM RA223 DICHLORIDE THER",493,198.62,198.62,597.20000000000005,123.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9606","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9606","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - A9606 - RADIUM RA223 DICHLORIDE THER","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER","A9606 - RADIUM RA223 DICHLORIDE THER",493,378.21,198.62,597.20000000000005,123.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9606","CIGNA HEALTHCARE - CIGNA CARELINK - A9606","CIGNA HEALTHCARE - CIGNA CARELINK - A9606 - RADIUM RA223 DICHLORIDE THER","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER","A9606 - RADIUM RA223 DICHLORIDE THER",493,597.20000000000005,198.62,597.20000000000005,123.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9606","BLUE CROSS - BLUE CROSS-INDEMNITY - A9606","BLUE CROSS - BLUE CROSS-INDEMNITY - A9606 - RADIUM RA223 DICHLORIDE THER","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER","A9606 - RADIUM RA223 DICHLORIDE THER",493,378.21,198.62,597.20000000000005,123.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9606","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9606","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - A9606 - RADIUM RA223 DICHLORIDE THER","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER","A9606 - RADIUM RA223 DICHLORIDE THER",493,378.21,198.62,597.20000000000005,123.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9606","BLUE CROSS - BLUE CROSS-PPO - A9606","BLUE CROSS - BLUE CROSS-PPO - A9606 - RADIUM RA223 DICHLORIDE THER","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER","A9606 - RADIUM RA223 DICHLORIDE THER",493,378.21,198.62,597.20000000000005,123.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9606","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9606","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - A9606 - RADIUM RA223 DICHLORIDE THER","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER","A9606 - RADIUM RA223 DICHLORIDE THER",493,378.21,198.62,597.20000000000005,123.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9606","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9606","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - A9606 - RADIUM RA223 DICHLORIDE THER","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER","A9606 - RADIUM RA223 DICHLORIDE THER",493,378.21,198.62,597.20000000000005,123.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9606","BLUE CROSS - BLUE CROSS-HMO BLUE - A9606","BLUE CROSS - BLUE CROSS-HMO BLUE - A9606 - RADIUM RA223 DICHLORIDE THER","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER","A9606 - RADIUM RA223 DICHLORIDE THER",493,378.21,198.62,597.20000000000005,123.25]
["TUFTS - TUFTS SELECT - HCPCS - C1713","TUFTS - TUFTS SELECT - C1713","TUFTS - TUFTS SELECT - C1713 - HC CORE 10 BONE PLUG","TUFTS","TUFTS SELECT","HCPCS","C1713","HC CORE 10 BONE PLUG","C1713 - HC CORE 10 BONE PLUG",4568,0,0,0,1142]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1713","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1713","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1713 - HC CORE 10 BONE PLUG","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1713","HC CORE 10 BONE PLUG","C1713 - HC CORE 10 BONE PLUG",4568,0,0,0,1142]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1713","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1713","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1713 - HC CORE 10 BONE PLUG","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1713","HC CORE 10 BONE PLUG","C1713 - HC CORE 10 BONE PLUG",4568,0,0,0,1142]
["TUFTS - TUFTS PPO - HCPCS - C1713","TUFTS - TUFTS PPO - C1713","TUFTS - TUFTS PPO - C1713 - HC CORE 10 BONE PLUG","TUFTS","TUFTS PPO","HCPCS","C1713","HC CORE 10 BONE PLUG","C1713 - HC CORE 10 BONE PLUG",4568,0,0,0,1142]
["TUFTS - TUFTS HMO - HCPCS - C1713","TUFTS - TUFTS HMO - C1713","TUFTS - TUFTS HMO - C1713 - HC CORE 10 BONE PLUG","TUFTS","TUFTS HMO","HCPCS","C1713","HC CORE 10 BONE PLUG","C1713 - HC CORE 10 BONE PLUG",4568,0,0,0,1142]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1713","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1713","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1713 - HC CORE 10 BONE PLUG","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1713","HC CORE 10 BONE PLUG","C1713 - HC CORE 10 BONE PLUG",4568,0,0,0,1142]
["TUFTS - TUFTS POS - HCPCS - C1713","TUFTS - TUFTS POS - C1713","TUFTS - TUFTS POS - C1713 - HC CORE 10 BONE PLUG","TUFTS","TUFTS POS","HCPCS","C1713","HC CORE 10 BONE PLUG","C1713 - HC CORE 10 BONE PLUG",4568,0,0,0,1142]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1713","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1713","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1713 - HC CORE 10 BONE PLUG","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1713","HC CORE 10 BONE PLUG","C1713 - HC CORE 10 BONE PLUG",4568,0,0,0,1142]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1713","CIGNA HEALTHCARE - CIGNA CARELINK - C1713","CIGNA HEALTHCARE - CIGNA CARELINK - C1713 - HC CORE 10 BONE PLUG","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1713","HC CORE 10 BONE PLUG","C1713 - HC CORE 10 BONE PLUG",4568,0,0,0,1142]
["TUFTS - TUFTS SELECT - HCPCS - C1714","TUFTS - TUFTS SELECT - C1714","TUFTS - TUFTS SELECT - C1714 - HC WATHMAN SYS ANTER CURVE","TUFTS","TUFTS SELECT","HCPCS","C1714","HC WATHMAN SYS ANTER CURVE","C1714 - HC WATHMAN SYS ANTER CURVE",6114,0,0,0,1528.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1714","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1714","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1714 - HC WATHMAN SYS ANTER CURVE","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1714","HC WATHMAN SYS ANTER CURVE","C1714 - HC WATHMAN SYS ANTER CURVE",6114,0,0,0,1528.5]
["TUFTS - TUFTS PPO - HCPCS - C1714","TUFTS - TUFTS PPO - C1714","TUFTS - TUFTS PPO - C1714 - HC WATHMAN SYS ANTER CURVE","TUFTS","TUFTS PPO","HCPCS","C1714","HC WATHMAN SYS ANTER CURVE","C1714 - HC WATHMAN SYS ANTER CURVE",6114,0,0,0,1528.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1714","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1714","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1714 - HC WATHMAN SYS ANTER CURVE","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1714","HC WATHMAN SYS ANTER CURVE","C1714 - HC WATHMAN SYS ANTER CURVE",6114,0,0,0,1528.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1714","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1714","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1714 - HC WATHMAN SYS ANTER CURVE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1714","HC WATHMAN SYS ANTER CURVE","C1714 - HC WATHMAN SYS ANTER CURVE",6114,0,0,0,1528.5]
["TUFTS - TUFTS HMO - HCPCS - C1714","TUFTS - TUFTS HMO - C1714","TUFTS - TUFTS HMO - C1714 - HC WATHMAN SYS ANTER CURVE","TUFTS","TUFTS HMO","HCPCS","C1714","HC WATHMAN SYS ANTER CURVE","C1714 - HC WATHMAN SYS ANTER CURVE",6114,0,0,0,1528.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1714","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1714","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1714 - HC WATHMAN SYS ANTER CURVE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1714","HC WATHMAN SYS ANTER CURVE","C1714 - HC WATHMAN SYS ANTER CURVE",6114,0,0,0,1528.5]
["TUFTS - TUFTS POS - HCPCS - C1714","TUFTS - TUFTS POS - C1714","TUFTS - TUFTS POS - C1714 - HC WATHMAN SYS ANTER CURVE","TUFTS","TUFTS POS","HCPCS","C1714","HC WATHMAN SYS ANTER CURVE","C1714 - HC WATHMAN SYS ANTER CURVE",6114,0,0,0,1528.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1714","CIGNA HEALTHCARE - CIGNA CARELINK - C1714","CIGNA HEALTHCARE - CIGNA CARELINK - C1714 - HC WATHMAN SYS ANTER CURVE","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1714","HC WATHMAN SYS ANTER CURVE","C1714 - HC WATHMAN SYS ANTER CURVE",6114,0,0,0,1528.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1715","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1715","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1715 - BRACHYTHERAPY NEEDLE","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1715","BRACHYTHERAPY NEEDLE","C1715 - BRACHYTHERAPY NEEDLE",21,0,0,0,5.25]
["TUFTS - TUFTS SELECT - HCPCS - C1715","TUFTS - TUFTS SELECT - C1715","TUFTS - TUFTS SELECT - C1715 - BRACHYTHERAPY NEEDLE","TUFTS","TUFTS SELECT","HCPCS","C1715","BRACHYTHERAPY NEEDLE","C1715 - BRACHYTHERAPY NEEDLE",21,0,0,0,5.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1715","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1715","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1715 - BRACHYTHERAPY NEEDLE","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1715","BRACHYTHERAPY NEEDLE","C1715 - BRACHYTHERAPY NEEDLE",21,0,0,0,5.25]
["TUFTS - TUFTS PPO - HCPCS - C1715","TUFTS - TUFTS PPO - C1715","TUFTS - TUFTS PPO - C1715 - BRACHYTHERAPY NEEDLE","TUFTS","TUFTS PPO","HCPCS","C1715","BRACHYTHERAPY NEEDLE","C1715 - BRACHYTHERAPY NEEDLE",21,0,0,0,5.25]
["TUFTS - TUFTS POS - HCPCS - C1715","TUFTS - TUFTS POS - C1715","TUFTS - TUFTS POS - C1715 - BRACHYTHERAPY NEEDLE","TUFTS","TUFTS POS","HCPCS","C1715","BRACHYTHERAPY NEEDLE","C1715 - BRACHYTHERAPY NEEDLE",21,0,0,0,5.25]
["TUFTS - TUFTS HMO - HCPCS - C1715","TUFTS - TUFTS HMO - C1715","TUFTS - TUFTS HMO - C1715 - BRACHYTHERAPY NEEDLE","TUFTS","TUFTS HMO","HCPCS","C1715","BRACHYTHERAPY NEEDLE","C1715 - BRACHYTHERAPY NEEDLE",21,0,0,0,5.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1715","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1715","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1715 - BRACHYTHERAPY NEEDLE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1715","BRACHYTHERAPY NEEDLE","C1715 - BRACHYTHERAPY NEEDLE",21,0,0,0,5.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1715","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1715","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1715 - BRACHYTHERAPY NEEDLE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1715","BRACHYTHERAPY NEEDLE","C1715 - BRACHYTHERAPY NEEDLE",21,0,0,0,5.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1715","CIGNA HEALTHCARE - CIGNA CARELINK - C1715","CIGNA HEALTHCARE - CIGNA CARELINK - C1715 - BRACHYTHERAPY NEEDLE","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1715","BRACHYTHERAPY NEEDLE","C1715 - BRACHYTHERAPY NEEDLE",21,0,0,0,5.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1716","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1716","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1716 - BRACHYTX SOURCE, GOLD 198","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1716","BRACHYTX SOURCE, GOLD 198","C1716 - BRACHYTX SOURCE, GOLD 198",0,200.39,168.52,506.68,0]
["TUFTS - TUFTS SELECT - HCPCS - C1716","TUFTS - TUFTS SELECT - C1716","TUFTS - TUFTS SELECT - C1716 - BRACHYTX SOURCE, GOLD 198","TUFTS","TUFTS SELECT","HCPCS","C1716","BRACHYTX SOURCE, GOLD 198","C1716 - BRACHYTX SOURCE, GOLD 198",0,168.52,168.52,506.68,0]
["TUFTS - TUFTS PPO - HCPCS - C1716","TUFTS - TUFTS PPO - C1716","TUFTS - TUFTS PPO - C1716 - BRACHYTX SOURCE, GOLD 198","TUFTS","TUFTS PPO","HCPCS","C1716","BRACHYTX SOURCE, GOLD 198","C1716 - BRACHYTX SOURCE, GOLD 198",0,180.26,168.52,506.68,0]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1716","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1716","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1716 - BRACHYTX SOURCE, GOLD 198","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1716","BRACHYTX SOURCE, GOLD 198","C1716 - BRACHYTX SOURCE, GOLD 198",0,200.39,168.52,506.68,0]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1716","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1716","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1716 - BRACHYTX SOURCE, GOLD 198","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1716","BRACHYTX SOURCE, GOLD 198","C1716 - BRACHYTX SOURCE, GOLD 198",0,200.39,168.52,506.68,0]
["TUFTS - TUFTS HMO - HCPCS - C1716","TUFTS - TUFTS HMO - C1716","TUFTS - TUFTS HMO - C1716 - BRACHYTX SOURCE, GOLD 198","TUFTS","TUFTS HMO","HCPCS","C1716","BRACHYTX SOURCE, GOLD 198","C1716 - BRACHYTX SOURCE, GOLD 198",0,202.22,168.52,506.68,0]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1716","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1716","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1716 - BRACHYTX SOURCE, GOLD 198","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1716","BRACHYTX SOURCE, GOLD 198","C1716 - BRACHYTX SOURCE, GOLD 198",0,200.39,168.52,506.68,0]
["TUFTS - TUFTS POS - HCPCS - C1716","TUFTS - TUFTS POS - C1716","TUFTS - TUFTS POS - C1716 - BRACHYTX SOURCE, GOLD 198","TUFTS","TUFTS POS","HCPCS","C1716","BRACHYTX SOURCE, GOLD 198","C1716 - BRACHYTX SOURCE, GOLD 198",0,168.52,168.52,506.68,0]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1716","CIGNA HEALTHCARE - CIGNA CARELINK - C1716","CIGNA HEALTHCARE - CIGNA CARELINK - C1716 - BRACHYTX SOURCE, GOLD 198","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1716","BRACHYTX SOURCE, GOLD 198","C1716 - BRACHYTX SOURCE, GOLD 198",0,506.68,168.52,506.68,0]
["TUFTS - TUFTS SELECT - HCPCS - C1717","TUFTS - TUFTS SELECT - C1717","TUFTS - TUFTS SELECT - C1717 - HC BRACHYTX, NON-STR,HDR IR-192","TUFTS","TUFTS SELECT","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192","C1717 - HC BRACHYTX, NON-STR,HDR IR-192",607,469.29,469.29,1411.01,151.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1717","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1717","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1717 - HC BRACHYTX, NON-STR,HDR IR-192","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192","C1717 - HC BRACHYTX, NON-STR,HDR IR-192",607,554.13,469.29,1411.01,151.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1717","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1717","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1717 - HC BRACHYTX, NON-STR,HDR IR-192","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192","C1717 - HC BRACHYTX, NON-STR,HDR IR-192",607,554.13,469.29,1411.01,151.75]
["TUFTS - TUFTS PPO - HCPCS - C1717","TUFTS - TUFTS PPO - C1717","TUFTS - TUFTS PPO - C1717 - HC BRACHYTX, NON-STR,HDR IR-192","TUFTS","TUFTS PPO","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192","C1717 - HC BRACHYTX, NON-STR,HDR IR-192",607,502,469.29,1411.01,151.75]
["TUFTS - TUFTS HMO - HCPCS - C1717","TUFTS - TUFTS HMO - C1717","TUFTS - TUFTS HMO - C1717 - HC BRACHYTX, NON-STR,HDR IR-192","TUFTS","TUFTS HMO","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192","C1717 - HC BRACHYTX, NON-STR,HDR IR-192",607,563.15,469.29,1411.01,151.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1717","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1717","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1717 - HC BRACHYTX, NON-STR,HDR IR-192","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192","C1717 - HC BRACHYTX, NON-STR,HDR IR-192",607,554.13,469.29,1411.01,151.75]
["TUFTS - TUFTS POS - HCPCS - C1717","TUFTS - TUFTS POS - C1717","TUFTS - TUFTS POS - C1717 - HC BRACHYTX, NON-STR,HDR IR-192","TUFTS","TUFTS POS","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192","C1717 - HC BRACHYTX, NON-STR,HDR IR-192",607,469.29,469.29,1411.01,151.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1717","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1717","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1717 - HC BRACHYTX, NON-STR,HDR IR-192","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192","C1717 - HC BRACHYTX, NON-STR,HDR IR-192",607,554.13,469.29,1411.01,151.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - C1717","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - C1717","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - C1717 - HC BRACHYTX, NON-STR,HDR IR-192","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192","C1717 - HC BRACHYTX, NON-STR,HDR IR-192",607,836.69,469.29,1411.01,151.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1717","CIGNA HEALTHCARE - CIGNA CARELINK - C1717","CIGNA HEALTHCARE - CIGNA CARELINK - C1717 - HC BRACHYTX, NON-STR,HDR IR-192","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192","C1717 - HC BRACHYTX, NON-STR,HDR IR-192",607,1411.01,469.29,1411.01,151.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - C1717","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - C1717","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - C1717 - HC BRACHYTX, NON-STR,HDR IR-192","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192","C1717 - HC BRACHYTX, NON-STR,HDR IR-192",607,836.69,469.29,1411.01,151.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - C1717","BLUE CROSS - BLUE CROSS-INDEMNITY - C1717","BLUE CROSS - BLUE CROSS-INDEMNITY - C1717 - HC BRACHYTX, NON-STR,HDR IR-192","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192","C1717 - HC BRACHYTX, NON-STR,HDR IR-192",607,836.69,469.29,1411.01,151.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - C1717","BLUE CROSS - BLUE CROSS-PPO - C1717","BLUE CROSS - BLUE CROSS-PPO - C1717 - HC BRACHYTX, NON-STR,HDR IR-192","BLUE CROSS","BLUE CROSS-PPO","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192","C1717 - HC BRACHYTX, NON-STR,HDR IR-192",607,836.69,469.29,1411.01,151.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - C1717","BLUE CROSS - BLUE CROSS-HMO BLUE - C1717","BLUE CROSS - BLUE CROSS-HMO BLUE - C1717 - HC BRACHYTX, NON-STR,HDR IR-192","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192","C1717 - HC BRACHYTX, NON-STR,HDR IR-192",607,836.69,469.29,1411.01,151.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - C1717","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - C1717","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - C1717 - HC BRACHYTX, NON-STR,HDR IR-192","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192","C1717 - HC BRACHYTX, NON-STR,HDR IR-192",607,836.69,469.29,1411.01,151.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - C1717","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - C1717","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - C1717 - HC BRACHYTX, NON-STR,HDR IR-192","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192","C1717 - HC BRACHYTX, NON-STR,HDR IR-192",607,836.69,469.29,1411.01,151.75]
["TUFTS - TUFTS SELECT - HCPCS - C1719","TUFTS - TUFTS SELECT - C1719","TUFTS - TUFTS SELECT - C1719 - BRACHYTX SOUR,NON-HDR IR-192","TUFTS","TUFTS SELECT","HCPCS","C1719","BRACHYTX SOUR,NON-HDR IR-192","C1719 - BRACHYTX SOUR,NON-HDR IR-192",95,118.86,108.35,357.35,23.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1719","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1719","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1719 - BRACHYTX SOUR,NON-HDR IR-192","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1719","BRACHYTX SOUR,NON-HDR IR-192","C1719 - BRACHYTX SOUR,NON-HDR IR-192",95,108.35,108.35,357.35,23.75]
["TUFTS - TUFTS PPO - HCPCS - C1719","TUFTS - TUFTS PPO - C1719","TUFTS - TUFTS PPO - C1719 - BRACHYTX SOUR,NON-HDR IR-192","TUFTS","TUFTS PPO","HCPCS","C1719","BRACHYTX SOUR,NON-HDR IR-192","C1719 - BRACHYTX SOUR,NON-HDR IR-192",95,127.14,108.35,357.35,23.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1719","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1719","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1719 - BRACHYTX SOUR,NON-HDR IR-192","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1719","BRACHYTX SOUR,NON-HDR IR-192","C1719 - BRACHYTX SOUR,NON-HDR IR-192",95,108.35,108.35,357.35,23.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1719","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1719","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1719 - BRACHYTX SOUR,NON-HDR IR-192","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1719","BRACHYTX SOUR,NON-HDR IR-192","C1719 - BRACHYTX SOUR,NON-HDR IR-192",95,108.35,108.35,357.35,23.75]
["TUFTS - TUFTS HMO - HCPCS - C1719","TUFTS - TUFTS HMO - C1719","TUFTS - TUFTS HMO - C1719 - BRACHYTX SOUR,NON-HDR IR-192","TUFTS","TUFTS HMO","HCPCS","C1719","BRACHYTX SOUR,NON-HDR IR-192","C1719 - BRACHYTX SOUR,NON-HDR IR-192",95,142.63,108.35,357.35,23.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1719","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1719","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1719 - BRACHYTX SOUR,NON-HDR IR-192","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1719","BRACHYTX SOUR,NON-HDR IR-192","C1719 - BRACHYTX SOUR,NON-HDR IR-192",95,108.35,108.35,357.35,23.75]
["TUFTS - TUFTS POS - HCPCS - C1719","TUFTS - TUFTS POS - C1719","TUFTS - TUFTS POS - C1719 - BRACHYTX SOUR,NON-HDR IR-192","TUFTS","TUFTS POS","HCPCS","C1719","BRACHYTX SOUR,NON-HDR IR-192","C1719 - BRACHYTX SOUR,NON-HDR IR-192",95,118.86,108.35,357.35,23.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1719","CIGNA HEALTHCARE - CIGNA CARELINK - C1719","CIGNA HEALTHCARE - CIGNA CARELINK - C1719 - BRACHYTX SOUR,NON-HDR IR-192","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1719","BRACHYTX SOUR,NON-HDR IR-192","C1719 - BRACHYTX SOUR,NON-HDR IR-192",95,357.35,108.35,357.35,23.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1721","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1721","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1721 - HC ICD,2CH, GEN ONLY, RECALL $0","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1721","HC ICD,2CH, GEN ONLY, RECALL $0","C1721 - HC ICD,2CH, GEN ONLY, RECALL $0",39674,0,0,0,9918.5]
["TUFTS - TUFTS SELECT - HCPCS - C1721","TUFTS - TUFTS SELECT - C1721","TUFTS - TUFTS SELECT - C1721 - HC ICD,2CH, GEN ONLY, RECALL $0","TUFTS","TUFTS SELECT","HCPCS","C1721","HC ICD,2CH, GEN ONLY, RECALL $0","C1721 - HC ICD,2CH, GEN ONLY, RECALL $0",39674,0,0,0,9918.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1721","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1721","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1721 - HC ICD,2CH, GEN ONLY, RECALL $0","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1721","HC ICD,2CH, GEN ONLY, RECALL $0","C1721 - HC ICD,2CH, GEN ONLY, RECALL $0",39674,0,0,0,9918.5]
["TUFTS - TUFTS PPO - HCPCS - C1721","TUFTS - TUFTS PPO - C1721","TUFTS - TUFTS PPO - C1721 - HC ICD,2CH, GEN ONLY, RECALL $0","TUFTS","TUFTS PPO","HCPCS","C1721","HC ICD,2CH, GEN ONLY, RECALL $0","C1721 - HC ICD,2CH, GEN ONLY, RECALL $0",39674,0,0,0,9918.5]
["TUFTS - TUFTS POS - HCPCS - C1721","TUFTS - TUFTS POS - C1721","TUFTS - TUFTS POS - C1721 - HC ICD,2CH, GEN ONLY, RECALL $0","TUFTS","TUFTS POS","HCPCS","C1721","HC ICD,2CH, GEN ONLY, RECALL $0","C1721 - HC ICD,2CH, GEN ONLY, RECALL $0",39674,0,0,0,9918.5]
["TUFTS - TUFTS HMO - HCPCS - C1721","TUFTS - TUFTS HMO - C1721","TUFTS - TUFTS HMO - C1721 - HC ICD,2CH, GEN ONLY, RECALL $0","TUFTS","TUFTS HMO","HCPCS","C1721","HC ICD,2CH, GEN ONLY, RECALL $0","C1721 - HC ICD,2CH, GEN ONLY, RECALL $0",39674,0,0,0,9918.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1721","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1721","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1721 - HC ICD,2CH, GEN ONLY, RECALL $0","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1721","HC ICD,2CH, GEN ONLY, RECALL $0","C1721 - HC ICD,2CH, GEN ONLY, RECALL $0",39674,0,0,0,9918.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1721","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1721","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1721 - HC ICD,2CH, GEN ONLY, RECALL $0","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1721","HC ICD,2CH, GEN ONLY, RECALL $0","C1721 - HC ICD,2CH, GEN ONLY, RECALL $0",39674,0,0,0,9918.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1721","CIGNA HEALTHCARE - CIGNA CARELINK - C1721","CIGNA HEALTHCARE - CIGNA CARELINK - C1721 - HC ICD,2CH, GEN ONLY, RECALL $0","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1721","HC ICD,2CH, GEN ONLY, RECALL $0","C1721 - HC ICD,2CH, GEN ONLY, RECALL $0",39674,0,0,0,9918.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1722","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1722","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1722 - HC ICD,1CH, GEN ONLY, RECALL $0","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1722","HC ICD,1CH, GEN ONLY, RECALL $0","C1722 - HC ICD,1CH, GEN ONLY, RECALL $0",43645,0,0,0,10911.25]
["TUFTS - TUFTS SELECT - HCPCS - C1722","TUFTS - TUFTS SELECT - C1722","TUFTS - TUFTS SELECT - C1722 - HC ICD,1CH, GEN ONLY, RECALL $0","TUFTS","TUFTS SELECT","HCPCS","C1722","HC ICD,1CH, GEN ONLY, RECALL $0","C1722 - HC ICD,1CH, GEN ONLY, RECALL $0",43645,0,0,0,10911.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1722","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1722","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1722 - HC ICD,1CH, GEN ONLY, RECALL $0","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1722","HC ICD,1CH, GEN ONLY, RECALL $0","C1722 - HC ICD,1CH, GEN ONLY, RECALL $0",43645,0,0,0,10911.25]
["TUFTS - TUFTS PPO - HCPCS - C1722","TUFTS - TUFTS PPO - C1722","TUFTS - TUFTS PPO - C1722 - HC ICD,1CH, GEN ONLY, RECALL $0","TUFTS","TUFTS PPO","HCPCS","C1722","HC ICD,1CH, GEN ONLY, RECALL $0","C1722 - HC ICD,1CH, GEN ONLY, RECALL $0",43645,0,0,0,10911.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1722","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1722","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1722 - HC ICD,1CH, GEN ONLY, RECALL $0","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1722","HC ICD,1CH, GEN ONLY, RECALL $0","C1722 - HC ICD,1CH, GEN ONLY, RECALL $0",43645,0,0,0,10911.25]
["TUFTS - TUFTS HMO - HCPCS - C1722","TUFTS - TUFTS HMO - C1722","TUFTS - TUFTS HMO - C1722 - HC ICD,1CH, GEN ONLY, RECALL $0","TUFTS","TUFTS HMO","HCPCS","C1722","HC ICD,1CH, GEN ONLY, RECALL $0","C1722 - HC ICD,1CH, GEN ONLY, RECALL $0",43645,0,0,0,10911.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1722","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1722","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1722 - HC ICD,1CH, GEN ONLY, RECALL $0","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1722","HC ICD,1CH, GEN ONLY, RECALL $0","C1722 - HC ICD,1CH, GEN ONLY, RECALL $0",43645,0,0,0,10911.25]
["TUFTS - TUFTS POS - HCPCS - C1722","TUFTS - TUFTS POS - C1722","TUFTS - TUFTS POS - C1722 - HC ICD,1CH, GEN ONLY, RECALL $0","TUFTS","TUFTS POS","HCPCS","C1722","HC ICD,1CH, GEN ONLY, RECALL $0","C1722 - HC ICD,1CH, GEN ONLY, RECALL $0",43645,0,0,0,10911.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1722","CIGNA HEALTHCARE - CIGNA CARELINK - C1722","CIGNA HEALTHCARE - CIGNA CARELINK - C1722 - HC ICD,1CH, GEN ONLY, RECALL $0","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1722","HC ICD,1CH, GEN ONLY, RECALL $0","C1722 - HC ICD,1CH, GEN ONLY, RECALL $0",43645,0,0,0,10911.25]
["TUFTS - TUFTS SELECT - HCPCS - C1724","TUFTS - TUFTS SELECT - C1724","TUFTS - TUFTS SELECT - C1724 - HC CATH, TRANS ATHEREC BURR","TUFTS","TUFTS SELECT","HCPCS","C1724","HC CATH, TRANS ATHEREC BURR","C1724 - HC CATH, TRANS ATHEREC BURR",7410,0,0,0,1852.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1724","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1724","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1724 - HC CATH, TRANS ATHEREC BURR","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1724","HC CATH, TRANS ATHEREC BURR","C1724 - HC CATH, TRANS ATHEREC BURR",7410,0,0,0,1852.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1724","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1724","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1724 - HC CATH, TRANS ATHEREC BURR","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1724","HC CATH, TRANS ATHEREC BURR","C1724 - HC CATH, TRANS ATHEREC BURR",7410,0,0,0,1852.5]
["TUFTS - TUFTS PPO - HCPCS - C1724","TUFTS - TUFTS PPO - C1724","TUFTS - TUFTS PPO - C1724 - HC CATH, TRANS ATHEREC BURR","TUFTS","TUFTS PPO","HCPCS","C1724","HC CATH, TRANS ATHEREC BURR","C1724 - HC CATH, TRANS ATHEREC BURR",7410,0,0,0,1852.5]
["TUFTS - TUFTS HMO - HCPCS - C1724","TUFTS - TUFTS HMO - C1724","TUFTS - TUFTS HMO - C1724 - HC CATH, TRANS ATHEREC BURR","TUFTS","TUFTS HMO","HCPCS","C1724","HC CATH, TRANS ATHEREC BURR","C1724 - HC CATH, TRANS ATHEREC BURR",7410,0,0,0,1852.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1724","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1724","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1724 - HC CATH, TRANS ATHEREC BURR","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1724","HC CATH, TRANS ATHEREC BURR","C1724 - HC CATH, TRANS ATHEREC BURR",7410,0,0,0,1852.5]
["TUFTS - TUFTS POS - HCPCS - C1724","TUFTS - TUFTS POS - C1724","TUFTS - TUFTS POS - C1724 - HC CATH, TRANS ATHEREC BURR","TUFTS","TUFTS POS","HCPCS","C1724","HC CATH, TRANS ATHEREC BURR","C1724 - HC CATH, TRANS ATHEREC BURR",7410,0,0,0,1852.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1724","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1724","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1724 - HC CATH, TRANS ATHEREC BURR","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1724","HC CATH, TRANS ATHEREC BURR","C1724 - HC CATH, TRANS ATHEREC BURR",7410,0,0,0,1852.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1724","CIGNA HEALTHCARE - CIGNA CARELINK - C1724","CIGNA HEALTHCARE - CIGNA CARELINK - C1724 - HC CATH, TRANS ATHEREC BURR","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1724","HC CATH, TRANS ATHEREC BURR","C1724 - HC CATH, TRANS ATHEREC BURR",7410,0,0,0,1852.5]
["TUFTS - TUFTS SELECT - HCPCS - C1725","TUFTS - TUFTS SELECT - C1725","TUFTS - TUFTS SELECT - C1725 - HC SIZING AMPLATZ BALLOON","TUFTS","TUFTS SELECT","HCPCS","C1725","HC SIZING AMPLATZ BALLOON","C1725 - HC SIZING AMPLATZ BALLOON",1693,0,0,0,423.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1725","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1725","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1725 - HC SIZING AMPLATZ BALLOON","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1725","HC SIZING AMPLATZ BALLOON","C1725 - HC SIZING AMPLATZ BALLOON",1693,0,0,0,423.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1725","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1725","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1725 - HC SIZING AMPLATZ BALLOON","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1725","HC SIZING AMPLATZ BALLOON","C1725 - HC SIZING AMPLATZ BALLOON",1693,0,0,0,423.25]
["TUFTS - TUFTS PPO - HCPCS - C1725","TUFTS - TUFTS PPO - C1725","TUFTS - TUFTS PPO - C1725 - HC SIZING AMPLATZ BALLOON","TUFTS","TUFTS PPO","HCPCS","C1725","HC SIZING AMPLATZ BALLOON","C1725 - HC SIZING AMPLATZ BALLOON",1693,0,0,0,423.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1725","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1725","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1725 - HC SIZING AMPLATZ BALLOON","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1725","HC SIZING AMPLATZ BALLOON","C1725 - HC SIZING AMPLATZ BALLOON",1693,0,0,0,423.25]
["TUFTS - TUFTS HMO - HCPCS - C1725","TUFTS - TUFTS HMO - C1725","TUFTS - TUFTS HMO - C1725 - HC SIZING AMPLATZ BALLOON","TUFTS","TUFTS HMO","HCPCS","C1725","HC SIZING AMPLATZ BALLOON","C1725 - HC SIZING AMPLATZ BALLOON",1693,0,0,0,423.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1725","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1725","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1725 - HC SIZING AMPLATZ BALLOON","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1725","HC SIZING AMPLATZ BALLOON","C1725 - HC SIZING AMPLATZ BALLOON",1693,0,0,0,423.25]
["TUFTS - TUFTS POS - HCPCS - C1725","TUFTS - TUFTS POS - C1725","TUFTS - TUFTS POS - C1725 - HC SIZING AMPLATZ BALLOON","TUFTS","TUFTS POS","HCPCS","C1725","HC SIZING AMPLATZ BALLOON","C1725 - HC SIZING AMPLATZ BALLOON",1693,0,0,0,423.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1725","CIGNA HEALTHCARE - CIGNA CARELINK - C1725","CIGNA HEALTHCARE - CIGNA CARELINK - C1725 - HC SIZING AMPLATZ BALLOON","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1725","HC SIZING AMPLATZ BALLOON","C1725 - HC SIZING AMPLATZ BALLOON",1693,0,0,0,423.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1726","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1726","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1726 - HC CATHETER BALLN LVL 4","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1726","HC CATHETER BALLN LVL 4","C1726 - HC CATHETER BALLN LVL 4",387,0,0,0,96.75]
["TUFTS - TUFTS SELECT - HCPCS - C1726","TUFTS - TUFTS SELECT - C1726","TUFTS - TUFTS SELECT - C1726 - HC CATHETER BALLN LVL 4","TUFTS","TUFTS SELECT","HCPCS","C1726","HC CATHETER BALLN LVL 4","C1726 - HC CATHETER BALLN LVL 4",387,0,0,0,96.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1726","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1726","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1726 - HC CATHETER BALLN LVL 4","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1726","HC CATHETER BALLN LVL 4","C1726 - HC CATHETER BALLN LVL 4",387,0,0,0,96.75]
["TUFTS - TUFTS PPO - HCPCS - C1726","TUFTS - TUFTS PPO - C1726","TUFTS - TUFTS PPO - C1726 - HC CATHETER BALLN LVL 4","TUFTS","TUFTS PPO","HCPCS","C1726","HC CATHETER BALLN LVL 4","C1726 - HC CATHETER BALLN LVL 4",387,0,0,0,96.75]
["TUFTS - TUFTS POS - HCPCS - C1726","TUFTS - TUFTS POS - C1726","TUFTS - TUFTS POS - C1726 - HC CATHETER BALLN LVL 4","TUFTS","TUFTS POS","HCPCS","C1726","HC CATHETER BALLN LVL 4","C1726 - HC CATHETER BALLN LVL 4",387,0,0,0,96.75]
["TUFTS - TUFTS HMO - HCPCS - C1726","TUFTS - TUFTS HMO - C1726","TUFTS - TUFTS HMO - C1726 - HC CATHETER BALLN LVL 4","TUFTS","TUFTS HMO","HCPCS","C1726","HC CATHETER BALLN LVL 4","C1726 - HC CATHETER BALLN LVL 4",387,0,0,0,96.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1726","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1726","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1726 - HC CATHETER BALLN LVL 4","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1726","HC CATHETER BALLN LVL 4","C1726 - HC CATHETER BALLN LVL 4",387,0,0,0,96.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1726","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1726","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1726 - HC CATHETER BALLN LVL 4","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1726","HC CATHETER BALLN LVL 4","C1726 - HC CATHETER BALLN LVL 4",387,0,0,0,96.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1726","CIGNA HEALTHCARE - CIGNA CARELINK - C1726","CIGNA HEALTHCARE - CIGNA CARELINK - C1726 - HC CATHETER BALLN LVL 4","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1726","HC CATHETER BALLN LVL 4","C1726 - HC CATHETER BALLN LVL 4",387,0,0,0,96.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1729","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1729","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1729 - HC CATH; THORA PARA","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1729","HC CATH; THORA PARA","C1729 - HC CATH; THORA PARA",2283,0,0,0,570.75]
["TUFTS - TUFTS SELECT - HCPCS - C1729","TUFTS - TUFTS SELECT - C1729","TUFTS - TUFTS SELECT - C1729 - HC CATH; THORA PARA","TUFTS","TUFTS SELECT","HCPCS","C1729","HC CATH; THORA PARA","C1729 - HC CATH; THORA PARA",2283,0,0,0,570.75]
["TUFTS - TUFTS PPO - HCPCS - C1729","TUFTS - TUFTS PPO - C1729","TUFTS - TUFTS PPO - C1729 - HC CATH; THORA PARA","TUFTS","TUFTS PPO","HCPCS","C1729","HC CATH; THORA PARA","C1729 - HC CATH; THORA PARA",2283,0,0,0,570.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1729","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1729","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1729 - HC CATH; THORA PARA","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1729","HC CATH; THORA PARA","C1729 - HC CATH; THORA PARA",2283,0,0,0,570.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1729","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1729","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1729 - HC CATH; THORA PARA","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1729","HC CATH; THORA PARA","C1729 - HC CATH; THORA PARA",2283,0,0,0,570.75]
["TUFTS - TUFTS HMO - HCPCS - C1729","TUFTS - TUFTS HMO - C1729","TUFTS - TUFTS HMO - C1729 - HC CATH; THORA PARA","TUFTS","TUFTS HMO","HCPCS","C1729","HC CATH; THORA PARA","C1729 - HC CATH; THORA PARA",2283,0,0,0,570.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1729","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1729","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1729 - HC CATH; THORA PARA","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1729","HC CATH; THORA PARA","C1729 - HC CATH; THORA PARA",2283,0,0,0,570.75]
["TUFTS - TUFTS POS - HCPCS - C1729","TUFTS - TUFTS POS - C1729","TUFTS - TUFTS POS - C1729 - HC CATH; THORA PARA","TUFTS","TUFTS POS","HCPCS","C1729","HC CATH; THORA PARA","C1729 - HC CATH; THORA PARA",2283,0,0,0,570.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1729","CIGNA HEALTHCARE - CIGNA CARELINK - C1729","CIGNA HEALTHCARE - CIGNA CARELINK - C1729 - HC CATH; THORA PARA","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1729","HC CATH; THORA PARA","C1729 - HC CATH; THORA PARA",2283,0,0,0,570.75]
["TUFTS - TUFTS PPO - HCPCS - C1730","TUFTS - TUFTS PPO - C1730","TUFTS - TUFTS PPO - C1730 - HC CATH,EP;STEER,DEC(LASSO)","TUFTS","TUFTS PPO","HCPCS","C1730","HC CATH,EP;STEER,DEC(LASSO)","C1730 - HC CATH,EP;STEER,DEC(LASSO)",2283,0,0,0,570.75]
["TUFTS - TUFTS SELECT - HCPCS - C1730","TUFTS - TUFTS SELECT - C1730","TUFTS - TUFTS SELECT - C1730 - HC CATH,EP;STEER,DEC(LASSO)","TUFTS","TUFTS SELECT","HCPCS","C1730","HC CATH,EP;STEER,DEC(LASSO)","C1730 - HC CATH,EP;STEER,DEC(LASSO)",2283,0,0,0,570.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1730","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1730","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1730 - HC CATH,EP;STEER,DEC(LASSO)","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1730","HC CATH,EP;STEER,DEC(LASSO)","C1730 - HC CATH,EP;STEER,DEC(LASSO)",2283,0,0,0,570.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1730","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1730","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1730 - HC CATH,EP;STEER,DEC(LASSO)","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1730","HC CATH,EP;STEER,DEC(LASSO)","C1730 - HC CATH,EP;STEER,DEC(LASSO)",2283,0,0,0,570.75]
["TUFTS - TUFTS HMO - HCPCS - C1730","TUFTS - TUFTS HMO - C1730","TUFTS - TUFTS HMO - C1730 - HC CATH,EP;STEER,DEC(LASSO)","TUFTS","TUFTS HMO","HCPCS","C1730","HC CATH,EP;STEER,DEC(LASSO)","C1730 - HC CATH,EP;STEER,DEC(LASSO)",2283,0,0,0,570.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1730","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1730","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1730 - HC CATH,EP;STEER,DEC(LASSO)","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1730","HC CATH,EP;STEER,DEC(LASSO)","C1730 - HC CATH,EP;STEER,DEC(LASSO)",2283,0,0,0,570.75]
["TUFTS - TUFTS POS - HCPCS - C1730","TUFTS - TUFTS POS - C1730","TUFTS - TUFTS POS - C1730 - HC CATH,EP;STEER,DEC(LASSO)","TUFTS","TUFTS POS","HCPCS","C1730","HC CATH,EP;STEER,DEC(LASSO)","C1730 - HC CATH,EP;STEER,DEC(LASSO)",2283,0,0,0,570.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1730","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1730","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1730 - HC CATH,EP;STEER,DEC(LASSO)","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1730","HC CATH,EP;STEER,DEC(LASSO)","C1730 - HC CATH,EP;STEER,DEC(LASSO)",2283,0,0,0,570.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1730","CIGNA HEALTHCARE - CIGNA CARELINK - C1730","CIGNA HEALTHCARE - CIGNA CARELINK - C1730 - HC CATH,EP;STEER,DEC(LASSO)","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1730","HC CATH,EP;STEER,DEC(LASSO)","C1730 - HC CATH,EP;STEER,DEC(LASSO)",2283,0,0,0,570.75]
["TUFTS - TUFTS SELECT - HCPCS - C1731","TUFTS - TUFTS SELECT - C1731","TUFTS - TUFTS SELECT - C1731 - HC CATH,EP PENTARAY NAV","TUFTS","TUFTS SELECT","HCPCS","C1731","HC CATH,EP PENTARAY NAV","C1731 - HC CATH,EP PENTARAY NAV",3847,0,0,0,961.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1731","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1731","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1731 - HC CATH,EP PENTARAY NAV","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1731","HC CATH,EP PENTARAY NAV","C1731 - HC CATH,EP PENTARAY NAV",3847,0,0,0,961.75]
["TUFTS - TUFTS PPO - HCPCS - C1731","TUFTS - TUFTS PPO - C1731","TUFTS - TUFTS PPO - C1731 - HC CATH,EP PENTARAY NAV","TUFTS","TUFTS PPO","HCPCS","C1731","HC CATH,EP PENTARAY NAV","C1731 - HC CATH,EP PENTARAY NAV",3847,0,0,0,961.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1731","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1731","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1731 - HC CATH,EP PENTARAY NAV","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1731","HC CATH,EP PENTARAY NAV","C1731 - HC CATH,EP PENTARAY NAV",3847,0,0,0,961.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1731","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1731","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1731 - HC CATH,EP PENTARAY NAV","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1731","HC CATH,EP PENTARAY NAV","C1731 - HC CATH,EP PENTARAY NAV",3847,0,0,0,961.75]
["TUFTS - TUFTS HMO - HCPCS - C1731","TUFTS - TUFTS HMO - C1731","TUFTS - TUFTS HMO - C1731 - HC CATH,EP PENTARAY NAV","TUFTS","TUFTS HMO","HCPCS","C1731","HC CATH,EP PENTARAY NAV","C1731 - HC CATH,EP PENTARAY NAV",3847,0,0,0,961.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1731","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1731","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1731 - HC CATH,EP PENTARAY NAV","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1731","HC CATH,EP PENTARAY NAV","C1731 - HC CATH,EP PENTARAY NAV",3847,0,0,0,961.75]
["TUFTS - TUFTS POS - HCPCS - C1731","TUFTS - TUFTS POS - C1731","TUFTS - TUFTS POS - C1731 - HC CATH,EP PENTARAY NAV","TUFTS","TUFTS POS","HCPCS","C1731","HC CATH,EP PENTARAY NAV","C1731 - HC CATH,EP PENTARAY NAV",3847,0,0,0,961.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1731","CIGNA HEALTHCARE - CIGNA CARELINK - C1731","CIGNA HEALTHCARE - CIGNA CARELINK - C1731 - HC CATH,EP PENTARAY NAV","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1731","HC CATH,EP PENTARAY NAV","C1731 - HC CATH,EP PENTARAY NAV",3847,0,0,0,961.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1732","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1732","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1732 - HC CATH,EP DECA NAV","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1732","HC CATH,EP DECA NAV","C1732 - HC CATH,EP DECA NAV",7766,0,0,0,1941.5]
["TUFTS - TUFTS SELECT - HCPCS - C1732","TUFTS - TUFTS SELECT - C1732","TUFTS - TUFTS SELECT - C1732 - HC CATH,EP DECA NAV","TUFTS","TUFTS SELECT","HCPCS","C1732","HC CATH,EP DECA NAV","C1732 - HC CATH,EP DECA NAV",7766,0,0,0,1941.5]
["TUFTS - TUFTS PPO - HCPCS - C1732","TUFTS - TUFTS PPO - C1732","TUFTS - TUFTS PPO - C1732 - HC CATH,EP DECA NAV","TUFTS","TUFTS PPO","HCPCS","C1732","HC CATH,EP DECA NAV","C1732 - HC CATH,EP DECA NAV",7766,0,0,0,1941.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1732","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1732","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1732 - HC CATH,EP DECA NAV","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1732","HC CATH,EP DECA NAV","C1732 - HC CATH,EP DECA NAV",7766,0,0,0,1941.5]
["TUFTS - TUFTS POS - HCPCS - C1732","TUFTS - TUFTS POS - C1732","TUFTS - TUFTS POS - C1732 - HC CATH,EP DECA NAV","TUFTS","TUFTS POS","HCPCS","C1732","HC CATH,EP DECA NAV","C1732 - HC CATH,EP DECA NAV",7766,0,0,0,1941.5]
["TUFTS - TUFTS HMO - HCPCS - C1732","TUFTS - TUFTS HMO - C1732","TUFTS - TUFTS HMO - C1732 - HC CATH,EP DECA NAV","TUFTS","TUFTS HMO","HCPCS","C1732","HC CATH,EP DECA NAV","C1732 - HC CATH,EP DECA NAV",7766,0,0,0,1941.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1732","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1732","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1732 - HC CATH,EP DECA NAV","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1732","HC CATH,EP DECA NAV","C1732 - HC CATH,EP DECA NAV",7766,0,0,0,1941.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1732","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1732","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1732 - HC CATH,EP DECA NAV","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1732","HC CATH,EP DECA NAV","C1732 - HC CATH,EP DECA NAV",7766,0,0,0,1941.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1732","CIGNA HEALTHCARE - CIGNA CARELINK - C1732","CIGNA HEALTHCARE - CIGNA CARELINK - C1732 - HC CATH,EP DECA NAV","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1732","HC CATH,EP DECA NAV","C1732 - HC CATH,EP DECA NAV",7766,0,0,0,1941.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1733","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1733","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1733 - CATH CRYABL  ARCTIC FRN","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1733","CATH CRYABL  ARCTIC FRN","C1733 - CATH CRYABL  ARCTIC FRN",10475,0,0,0,2618.75]
["TUFTS - TUFTS PPO - HCPCS - C1733","TUFTS - TUFTS PPO - C1733","TUFTS - TUFTS PPO - C1733 - CATH CRYABL  ARCTIC FRN","TUFTS","TUFTS PPO","HCPCS","C1733","CATH CRYABL  ARCTIC FRN","C1733 - CATH CRYABL  ARCTIC FRN",10475,0,0,0,2618.75]
["TUFTS - TUFTS SELECT - HCPCS - C1733","TUFTS - TUFTS SELECT - C1733","TUFTS - TUFTS SELECT - C1733 - CATH CRYABL  ARCTIC FRN","TUFTS","TUFTS SELECT","HCPCS","C1733","CATH CRYABL  ARCTIC FRN","C1733 - CATH CRYABL  ARCTIC FRN",10475,0,0,0,2618.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1733","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1733","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1733 - CATH CRYABL  ARCTIC FRN","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1733","CATH CRYABL  ARCTIC FRN","C1733 - CATH CRYABL  ARCTIC FRN",10475,0,0,0,2618.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1733","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1733","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1733 - CATH CRYABL  ARCTIC FRN","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1733","CATH CRYABL  ARCTIC FRN","C1733 - CATH CRYABL  ARCTIC FRN",10475,0,0,0,2618.75]
["TUFTS - TUFTS HMO - HCPCS - C1733","TUFTS - TUFTS HMO - C1733","TUFTS - TUFTS HMO - C1733 - CATH CRYABL  ARCTIC FRN","TUFTS","TUFTS HMO","HCPCS","C1733","CATH CRYABL  ARCTIC FRN","C1733 - CATH CRYABL  ARCTIC FRN",10475,0,0,0,2618.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1733","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1733","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1733 - CATH CRYABL  ARCTIC FRN","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1733","CATH CRYABL  ARCTIC FRN","C1733 - CATH CRYABL  ARCTIC FRN",10475,0,0,0,2618.75]
["TUFTS - TUFTS POS - HCPCS - C1733","TUFTS - TUFTS POS - C1733","TUFTS - TUFTS POS - C1733 - CATH CRYABL  ARCTIC FRN","TUFTS","TUFTS POS","HCPCS","C1733","CATH CRYABL  ARCTIC FRN","C1733 - CATH CRYABL  ARCTIC FRN",10475,0,0,0,2618.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1733","CIGNA HEALTHCARE - CIGNA CARELINK - C1733","CIGNA HEALTHCARE - CIGNA CARELINK - C1733 - CATH CRYABL  ARCTIC FRN","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1733","CATH CRYABL  ARCTIC FRN","C1733 - CATH CRYABL  ARCTIC FRN",10475,0,0,0,2618.75]
["TUFTS - TUFTS SELECT - HCPCS - C1750","TUFTS - TUFTS SELECT - C1750","TUFTS - TUFTS SELECT - C1750 - HC CATH 2 LUMEN QUINTON","TUFTS","TUFTS SELECT","HCPCS","C1750","HC CATH 2 LUMEN QUINTON","C1750 - HC CATH 2 LUMEN QUINTON",1693,0,0,0,423.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1750","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1750","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1750 - HC CATH 2 LUMEN QUINTON","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1750","HC CATH 2 LUMEN QUINTON","C1750 - HC CATH 2 LUMEN QUINTON",1693,0,0,0,423.25]
["TUFTS - TUFTS PPO - HCPCS - C1750","TUFTS - TUFTS PPO - C1750","TUFTS - TUFTS PPO - C1750 - HC CATH 2 LUMEN QUINTON","TUFTS","TUFTS PPO","HCPCS","C1750","HC CATH 2 LUMEN QUINTON","C1750 - HC CATH 2 LUMEN QUINTON",1693,0,0,0,423.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1750","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1750","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1750 - HC CATH 2 LUMEN QUINTON","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1750","HC CATH 2 LUMEN QUINTON","C1750 - HC CATH 2 LUMEN QUINTON",1693,0,0,0,423.25]
["TUFTS - TUFTS HMO - HCPCS - C1750","TUFTS - TUFTS HMO - C1750","TUFTS - TUFTS HMO - C1750 - HC CATH 2 LUMEN QUINTON","TUFTS","TUFTS HMO","HCPCS","C1750","HC CATH 2 LUMEN QUINTON","C1750 - HC CATH 2 LUMEN QUINTON",1693,0,0,0,423.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1750","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1750","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1750 - HC CATH 2 LUMEN QUINTON","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1750","HC CATH 2 LUMEN QUINTON","C1750 - HC CATH 2 LUMEN QUINTON",1693,0,0,0,423.25]
["TUFTS - TUFTS POS - HCPCS - C1750","TUFTS - TUFTS POS - C1750","TUFTS - TUFTS POS - C1750 - HC CATH 2 LUMEN QUINTON","TUFTS","TUFTS POS","HCPCS","C1750","HC CATH 2 LUMEN QUINTON","C1750 - HC CATH 2 LUMEN QUINTON",1693,0,0,0,423.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1750","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1750","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1750 - HC CATH 2 LUMEN QUINTON","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1750","HC CATH 2 LUMEN QUINTON","C1750 - HC CATH 2 LUMEN QUINTON",1693,0,0,0,423.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1750","CIGNA HEALTHCARE - CIGNA CARELINK - C1750","CIGNA HEALTHCARE - CIGNA CARELINK - C1750 - HC CATH 2 LUMEN QUINTON","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1750","HC CATH 2 LUMEN QUINTON","C1750 - HC CATH 2 LUMEN QUINTON",1693,0,0,0,423.25]
["TUFTS - TUFTS SELECT - HCPCS - C1751","TUFTS - TUFTS SELECT - C1751","TUFTS - TUFTS SELECT - C1751 - HC CATH, PACING","TUFTS","TUFTS SELECT","HCPCS","C1751","HC CATH, PACING","C1751 - HC CATH, PACING",1438,0,0,0,359.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1751","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1751","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1751 - HC CATH, PACING","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1751","HC CATH, PACING","C1751 - HC CATH, PACING",1438,0,0,0,359.5]
["TUFTS - TUFTS PPO - HCPCS - C1751","TUFTS - TUFTS PPO - C1751","TUFTS - TUFTS PPO - C1751 - HC CATH, PACING","TUFTS","TUFTS PPO","HCPCS","C1751","HC CATH, PACING","C1751 - HC CATH, PACING",1438,0,0,0,359.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1751","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1751","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1751 - HC CATH, PACING","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1751","HC CATH, PACING","C1751 - HC CATH, PACING",1438,0,0,0,359.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1751","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1751","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1751 - HC CATH, PACING","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1751","HC CATH, PACING","C1751 - HC CATH, PACING",1438,0,0,0,359.5]
["TUFTS - TUFTS HMO - HCPCS - C1751","TUFTS - TUFTS HMO - C1751","TUFTS - TUFTS HMO - C1751 - HC CATH, PACING","TUFTS","TUFTS HMO","HCPCS","C1751","HC CATH, PACING","C1751 - HC CATH, PACING",1438,0,0,0,359.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1751","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1751","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1751 - HC CATH, PACING","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1751","HC CATH, PACING","C1751 - HC CATH, PACING",1438,0,0,0,359.5]
["TUFTS - TUFTS POS - HCPCS - C1751","TUFTS - TUFTS POS - C1751","TUFTS - TUFTS POS - C1751 - HC CATH, PACING","TUFTS","TUFTS POS","HCPCS","C1751","HC CATH, PACING","C1751 - HC CATH, PACING",1438,0,0,0,359.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1751","CIGNA HEALTHCARE - CIGNA CARELINK - C1751","CIGNA HEALTHCARE - CIGNA CARELINK - C1751 - HC CATH, PACING","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1751","HC CATH, PACING","C1751 - HC CATH, PACING",1438,0,0,0,359.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1753","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1753","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1753 - HC BIOPSY FORC LVL D","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1753","HC BIOPSY FORC LVL D","C1753 - HC BIOPSY FORC LVL D",3947,0,0,0,986.75]
["TUFTS - TUFTS PPO - HCPCS - C1753","TUFTS - TUFTS PPO - C1753","TUFTS - TUFTS PPO - C1753 - HC BIOPSY FORC LVL D","TUFTS","TUFTS PPO","HCPCS","C1753","HC BIOPSY FORC LVL D","C1753 - HC BIOPSY FORC LVL D",3947,0,0,0,986.75]
["TUFTS - TUFTS SELECT - HCPCS - C1753","TUFTS - TUFTS SELECT - C1753","TUFTS - TUFTS SELECT - C1753 - HC BIOPSY FORC LVL D","TUFTS","TUFTS SELECT","HCPCS","C1753","HC BIOPSY FORC LVL D","C1753 - HC BIOPSY FORC LVL D",3947,0,0,0,986.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1753","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1753","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1753 - HC BIOPSY FORC LVL D","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1753","HC BIOPSY FORC LVL D","C1753 - HC BIOPSY FORC LVL D",3947,0,0,0,986.75]
["TUFTS - TUFTS POS - HCPCS - C1753","TUFTS - TUFTS POS - C1753","TUFTS - TUFTS POS - C1753 - HC BIOPSY FORC LVL D","TUFTS","TUFTS POS","HCPCS","C1753","HC BIOPSY FORC LVL D","C1753 - HC BIOPSY FORC LVL D",3947,0,0,0,986.75]
["TUFTS - TUFTS HMO - HCPCS - C1753","TUFTS - TUFTS HMO - C1753","TUFTS - TUFTS HMO - C1753 - HC BIOPSY FORC LVL D","TUFTS","TUFTS HMO","HCPCS","C1753","HC BIOPSY FORC LVL D","C1753 - HC BIOPSY FORC LVL D",3947,0,0,0,986.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1753","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1753","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1753 - HC BIOPSY FORC LVL D","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1753","HC BIOPSY FORC LVL D","C1753 - HC BIOPSY FORC LVL D",3947,0,0,0,986.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1753","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1753","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1753 - HC BIOPSY FORC LVL D","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1753","HC BIOPSY FORC LVL D","C1753 - HC BIOPSY FORC LVL D",3947,0,0,0,986.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1753","CIGNA HEALTHCARE - CIGNA CARELINK - C1753","CIGNA HEALTHCARE - CIGNA CARELINK - C1753 - HC BIOPSY FORC LVL D","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1753","HC BIOPSY FORC LVL D","C1753 - HC BIOPSY FORC LVL D",3947,0,0,0,986.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1756","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1756","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1756 - HC PACING WIRE","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1756","HC PACING WIRE","C1756 - HC PACING WIRE",1438,0,0,0,359.5]
["TUFTS - TUFTS SELECT - HCPCS - C1756","TUFTS - TUFTS SELECT - C1756","TUFTS - TUFTS SELECT - C1756 - HC PACING WIRE","TUFTS","TUFTS SELECT","HCPCS","C1756","HC PACING WIRE","C1756 - HC PACING WIRE",1438,0,0,0,359.5]
["TUFTS - TUFTS PPO - HCPCS - C1756","TUFTS - TUFTS PPO - C1756","TUFTS - TUFTS PPO - C1756 - HC PACING WIRE","TUFTS","TUFTS PPO","HCPCS","C1756","HC PACING WIRE","C1756 - HC PACING WIRE",1438,0,0,0,359.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1756","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1756","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1756 - HC PACING WIRE","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1756","HC PACING WIRE","C1756 - HC PACING WIRE",1438,0,0,0,359.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1756","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1756","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1756 - HC PACING WIRE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1756","HC PACING WIRE","C1756 - HC PACING WIRE",1438,0,0,0,359.5]
["TUFTS - TUFTS HMO - HCPCS - C1756","TUFTS - TUFTS HMO - C1756","TUFTS - TUFTS HMO - C1756 - HC PACING WIRE","TUFTS","TUFTS HMO","HCPCS","C1756","HC PACING WIRE","C1756 - HC PACING WIRE",1438,0,0,0,359.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1756","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1756","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1756 - HC PACING WIRE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1756","HC PACING WIRE","C1756 - HC PACING WIRE",1438,0,0,0,359.5]
["TUFTS - TUFTS POS - HCPCS - C1756","TUFTS - TUFTS POS - C1756","TUFTS - TUFTS POS - C1756 - HC PACING WIRE","TUFTS","TUFTS POS","HCPCS","C1756","HC PACING WIRE","C1756 - HC PACING WIRE",1438,0,0,0,359.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1756","CIGNA HEALTHCARE - CIGNA CARELINK - C1756","CIGNA HEALTHCARE - CIGNA CARELINK - C1756 - HC PACING WIRE","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1756","HC PACING WIRE","C1756 - HC PACING WIRE",1438,0,0,0,359.5]
["TUFTS - TUFTS PPO - HCPCS - C1757","TUFTS - TUFTS PPO - C1757","TUFTS - TUFTS PPO - C1757 - HC CATH,THROMB/EMB,LVL 2","TUFTS","TUFTS PPO","HCPCS","C1757","HC CATH,THROMB/EMB,LVL 2","C1757 - HC CATH,THROMB/EMB,LVL 2",15822,0,0,0,3955.5]
["TUFTS - TUFTS SELECT - HCPCS - C1757","TUFTS - TUFTS SELECT - C1757","TUFTS - TUFTS SELECT - C1757 - HC CATH,THROMB/EMB,LVL 2","TUFTS","TUFTS SELECT","HCPCS","C1757","HC CATH,THROMB/EMB,LVL 2","C1757 - HC CATH,THROMB/EMB,LVL 2",15822,0,0,0,3955.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1757","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1757","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1757 - HC CATH,THROMB/EMB,LVL 2","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1757","HC CATH,THROMB/EMB,LVL 2","C1757 - HC CATH,THROMB/EMB,LVL 2",15822,0,0,0,3955.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1757","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1757","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1757 - HC CATH,THROMB/EMB,LVL 2","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1757","HC CATH,THROMB/EMB,LVL 2","C1757 - HC CATH,THROMB/EMB,LVL 2",15822,0,0,0,3955.5]
["TUFTS - TUFTS HMO - HCPCS - C1757","TUFTS - TUFTS HMO - C1757","TUFTS - TUFTS HMO - C1757 - HC CATH,THROMB/EMB,LVL 2","TUFTS","TUFTS HMO","HCPCS","C1757","HC CATH,THROMB/EMB,LVL 2","C1757 - HC CATH,THROMB/EMB,LVL 2",15822,0,0,0,3955.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1757","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1757","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1757 - HC CATH,THROMB/EMB,LVL 2","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1757","HC CATH,THROMB/EMB,LVL 2","C1757 - HC CATH,THROMB/EMB,LVL 2",15822,0,0,0,3955.5]
["TUFTS - TUFTS POS - HCPCS - C1757","TUFTS - TUFTS POS - C1757","TUFTS - TUFTS POS - C1757 - HC CATH,THROMB/EMB,LVL 2","TUFTS","TUFTS POS","HCPCS","C1757","HC CATH,THROMB/EMB,LVL 2","C1757 - HC CATH,THROMB/EMB,LVL 2",15822,0,0,0,3955.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1757","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1757","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1757 - HC CATH,THROMB/EMB,LVL 2","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1757","HC CATH,THROMB/EMB,LVL 2","C1757 - HC CATH,THROMB/EMB,LVL 2",15822,0,0,0,3955.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1757","CIGNA HEALTHCARE - CIGNA CARELINK - C1757","CIGNA HEALTHCARE - CIGNA CARELINK - C1757 - HC CATH,THROMB/EMB,LVL 2","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1757","HC CATH,THROMB/EMB,LVL 2","C1757 - HC CATH,THROMB/EMB,LVL 2",15822,0,0,0,3955.5]
["TUFTS - TUFTS PPO - HCPCS - C1759","TUFTS - TUFTS PPO - C1759","TUFTS - TUFTS PPO - C1759 - HC CATH, ULTRASOUND LVL 2","TUFTS","TUFTS PPO","HCPCS","C1759","HC CATH, ULTRASOUND LVL 2","C1759 - HC CATH, ULTRASOUND LVL 2",6295,0,0,0,1573.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1759","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1759","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1759 - HC CATH, ULTRASOUND LVL 2","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1759","HC CATH, ULTRASOUND LVL 2","C1759 - HC CATH, ULTRASOUND LVL 2",6295,0,0,0,1573.75]
["TUFTS - TUFTS SELECT - HCPCS - C1759","TUFTS - TUFTS SELECT - C1759","TUFTS - TUFTS SELECT - C1759 - HC CATH, ULTRASOUND LVL 2","TUFTS","TUFTS SELECT","HCPCS","C1759","HC CATH, ULTRASOUND LVL 2","C1759 - HC CATH, ULTRASOUND LVL 2",6295,0,0,0,1573.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1759","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1759","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1759 - HC CATH, ULTRASOUND LVL 2","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1759","HC CATH, ULTRASOUND LVL 2","C1759 - HC CATH, ULTRASOUND LVL 2",6295,0,0,0,1573.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1759","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1759","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1759 - HC CATH, ULTRASOUND LVL 2","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1759","HC CATH, ULTRASOUND LVL 2","C1759 - HC CATH, ULTRASOUND LVL 2",6295,0,0,0,1573.75]
["TUFTS - TUFTS HMO - HCPCS - C1759","TUFTS - TUFTS HMO - C1759","TUFTS - TUFTS HMO - C1759 - HC CATH, ULTRASOUND LVL 2","TUFTS","TUFTS HMO","HCPCS","C1759","HC CATH, ULTRASOUND LVL 2","C1759 - HC CATH, ULTRASOUND LVL 2",6295,0,0,0,1573.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1759","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1759","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1759 - HC CATH, ULTRASOUND LVL 2","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1759","HC CATH, ULTRASOUND LVL 2","C1759 - HC CATH, ULTRASOUND LVL 2",6295,0,0,0,1573.75]
["TUFTS - TUFTS POS - HCPCS - C1759","TUFTS - TUFTS POS - C1759","TUFTS - TUFTS POS - C1759 - HC CATH, ULTRASOUND LVL 2","TUFTS","TUFTS POS","HCPCS","C1759","HC CATH, ULTRASOUND LVL 2","C1759 - HC CATH, ULTRASOUND LVL 2",6295,0,0,0,1573.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1759","CIGNA HEALTHCARE - CIGNA CARELINK - C1759","CIGNA HEALTHCARE - CIGNA CARELINK - C1759 - HC CATH, ULTRASOUND LVL 2","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1759","HC CATH, ULTRASOUND LVL 2","C1759 - HC CATH, ULTRASOUND LVL 2",6295,0,0,0,1573.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1760","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1760","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1760 - HC CENTRAL LINE KIT","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1760","HC CENTRAL LINE KIT","C1760 - HC CENTRAL LINE KIT",1799,0,0,0,449.75]
["TUFTS - TUFTS PPO - HCPCS - C1760","TUFTS - TUFTS PPO - C1760","TUFTS - TUFTS PPO - C1760 - HC CENTRAL LINE KIT","TUFTS","TUFTS PPO","HCPCS","C1760","HC CENTRAL LINE KIT","C1760 - HC CENTRAL LINE KIT",1799,0,0,0,449.75]
["TUFTS - TUFTS SELECT - HCPCS - C1760","TUFTS - TUFTS SELECT - C1760","TUFTS - TUFTS SELECT - C1760 - HC CENTRAL LINE KIT","TUFTS","TUFTS SELECT","HCPCS","C1760","HC CENTRAL LINE KIT","C1760 - HC CENTRAL LINE KIT",1799,0,0,0,449.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1760","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1760","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1760 - HC CENTRAL LINE KIT","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1760","HC CENTRAL LINE KIT","C1760 - HC CENTRAL LINE KIT",1799,0,0,0,449.75]
["TUFTS - TUFTS POS - HCPCS - C1760","TUFTS - TUFTS POS - C1760","TUFTS - TUFTS POS - C1760 - HC CENTRAL LINE KIT","TUFTS","TUFTS POS","HCPCS","C1760","HC CENTRAL LINE KIT","C1760 - HC CENTRAL LINE KIT",1799,0,0,0,449.75]
["TUFTS - TUFTS HMO - HCPCS - C1760","TUFTS - TUFTS HMO - C1760","TUFTS - TUFTS HMO - C1760 - HC CENTRAL LINE KIT","TUFTS","TUFTS HMO","HCPCS","C1760","HC CENTRAL LINE KIT","C1760 - HC CENTRAL LINE KIT",1799,0,0,0,449.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1760","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1760","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1760 - HC CENTRAL LINE KIT","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1760","HC CENTRAL LINE KIT","C1760 - HC CENTRAL LINE KIT",1799,0,0,0,449.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1760","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1760","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1760 - HC CENTRAL LINE KIT","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1760","HC CENTRAL LINE KIT","C1760 - HC CENTRAL LINE KIT",1799,0,0,0,449.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1760","CIGNA HEALTHCARE - CIGNA CARELINK - C1760","CIGNA HEALTHCARE - CIGNA CARELINK - C1760 - HC CENTRAL LINE KIT","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1760","HC CENTRAL LINE KIT","C1760 - HC CENTRAL LINE KIT",1799,0,0,0,449.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1762","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1762","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1762","HC NERVE - CONNEVTIVE TISSUE, HUMAN","C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN",12010,0,0,0,3002.5]
["TUFTS - TUFTS SELECT - HCPCS - C1762","TUFTS - TUFTS SELECT - C1762","TUFTS - TUFTS SELECT - C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN","TUFTS","TUFTS SELECT","HCPCS","C1762","HC NERVE - CONNEVTIVE TISSUE, HUMAN","C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN",12010,0,0,0,3002.5]
["TUFTS - TUFTS PPO - HCPCS - C1762","TUFTS - TUFTS PPO - C1762","TUFTS - TUFTS PPO - C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN","TUFTS","TUFTS PPO","HCPCS","C1762","HC NERVE - CONNEVTIVE TISSUE, HUMAN","C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN",12010,0,0,0,3002.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1762","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1762","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1762","HC NERVE - CONNEVTIVE TISSUE, HUMAN","C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN",12010,0,0,0,3002.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1762","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1762","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1762","HC NERVE - CONNEVTIVE TISSUE, HUMAN","C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN",12010,0,0,0,3002.5]
["TUFTS - TUFTS HMO - HCPCS - C1762","TUFTS - TUFTS HMO - C1762","TUFTS - TUFTS HMO - C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN","TUFTS","TUFTS HMO","HCPCS","C1762","HC NERVE - CONNEVTIVE TISSUE, HUMAN","C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN",12010,0,0,0,3002.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1762","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1762","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1762","HC NERVE - CONNEVTIVE TISSUE, HUMAN","C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN",12010,0,0,0,3002.5]
["TUFTS - TUFTS POS - HCPCS - C1762","TUFTS - TUFTS POS - C1762","TUFTS - TUFTS POS - C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN","TUFTS","TUFTS POS","HCPCS","C1762","HC NERVE - CONNEVTIVE TISSUE, HUMAN","C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN",12010,0,0,0,3002.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1762","CIGNA HEALTHCARE - CIGNA CARELINK - C1762","CIGNA HEALTHCARE - CIGNA CARELINK - C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1762","HC NERVE - CONNEVTIVE TISSUE, HUMAN","C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN",12010,0,0,0,3002.5]
["TUFTS - TUFTS PPO - HCPCS - C1763","TUFTS - TUFTS PPO - C1763","TUFTS - TUFTS PPO - C1763 - HC SM6X16-STEM HEM","TUFTS","TUFTS PPO","HCPCS","C1763","HC SM6X16-STEM HEM","C1763 - HC SM6X16-STEM HEM",2242,0,0,0,560.5]
["TUFTS - TUFTS SELECT - HCPCS - C1763","TUFTS - TUFTS SELECT - C1763","TUFTS - TUFTS SELECT - C1763 - HC SM6X16-STEM HEM","TUFTS","TUFTS SELECT","HCPCS","C1763","HC SM6X16-STEM HEM","C1763 - HC SM6X16-STEM HEM",2242,0,0,0,560.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1763","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1763","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1763 - HC SM6X16-STEM HEM","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1763","HC SM6X16-STEM HEM","C1763 - HC SM6X16-STEM HEM",2242,0,0,0,560.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1763","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1763","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1763 - HC SM6X16-STEM HEM","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1763","HC SM6X16-STEM HEM","C1763 - HC SM6X16-STEM HEM",2242,0,0,0,560.5]
["TUFTS - TUFTS HMO - HCPCS - C1763","TUFTS - TUFTS HMO - C1763","TUFTS - TUFTS HMO - C1763 - HC SM6X16-STEM HEM","TUFTS","TUFTS HMO","HCPCS","C1763","HC SM6X16-STEM HEM","C1763 - HC SM6X16-STEM HEM",2242,0,0,0,560.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1763","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1763","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1763 - HC SM6X16-STEM HEM","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1763","HC SM6X16-STEM HEM","C1763 - HC SM6X16-STEM HEM",2242,0,0,0,560.5]
["TUFTS - TUFTS POS - HCPCS - C1763","TUFTS - TUFTS POS - C1763","TUFTS - TUFTS POS - C1763 - HC SM6X16-STEM HEM","TUFTS","TUFTS POS","HCPCS","C1763","HC SM6X16-STEM HEM","C1763 - HC SM6X16-STEM HEM",2242,0,0,0,560.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1763","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1763","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1763 - HC SM6X16-STEM HEM","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1763","HC SM6X16-STEM HEM","C1763 - HC SM6X16-STEM HEM",2242,0,0,0,560.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1763","CIGNA HEALTHCARE - CIGNA CARELINK - C1763","CIGNA HEALTHCARE - CIGNA CARELINK - C1763 - HC SM6X16-STEM HEM","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1763","HC SM6X16-STEM HEM","C1763 - HC SM6X16-STEM HEM",2242,0,0,0,560.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1764","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1764","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1764 - HC RECORDER;IMPLANTABLE LOOP","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1764","HC RECORDER;IMPLANTABLE LOOP","C1764 - HC RECORDER;IMPLANTABLE LOOP",8983,0,0,0,2245.75]
["TUFTS - TUFTS SELECT - HCPCS - C1764","TUFTS - TUFTS SELECT - C1764","TUFTS - TUFTS SELECT - C1764 - HC RECORDER;IMPLANTABLE LOOP","TUFTS","TUFTS SELECT","HCPCS","C1764","HC RECORDER;IMPLANTABLE LOOP","C1764 - HC RECORDER;IMPLANTABLE LOOP",8983,0,0,0,2245.75]
["TUFTS - TUFTS PPO - HCPCS - C1764","TUFTS - TUFTS PPO - C1764","TUFTS - TUFTS PPO - C1764 - HC RECORDER;IMPLANTABLE LOOP","TUFTS","TUFTS PPO","HCPCS","C1764","HC RECORDER;IMPLANTABLE LOOP","C1764 - HC RECORDER;IMPLANTABLE LOOP",8983,0,0,0,2245.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1764","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1764","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1764 - HC RECORDER;IMPLANTABLE LOOP","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1764","HC RECORDER;IMPLANTABLE LOOP","C1764 - HC RECORDER;IMPLANTABLE LOOP",8983,0,0,0,2245.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1764","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1764","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1764 - HC RECORDER;IMPLANTABLE LOOP","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1764","HC RECORDER;IMPLANTABLE LOOP","C1764 - HC RECORDER;IMPLANTABLE LOOP",8983,0,0,0,2245.75]
["TUFTS - TUFTS HMO - HCPCS - C1764","TUFTS - TUFTS HMO - C1764","TUFTS - TUFTS HMO - C1764 - HC RECORDER;IMPLANTABLE LOOP","TUFTS","TUFTS HMO","HCPCS","C1764","HC RECORDER;IMPLANTABLE LOOP","C1764 - HC RECORDER;IMPLANTABLE LOOP",8983,0,0,0,2245.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1764","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1764","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1764 - HC RECORDER;IMPLANTABLE LOOP","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1764","HC RECORDER;IMPLANTABLE LOOP","C1764 - HC RECORDER;IMPLANTABLE LOOP",8983,0,0,0,2245.75]
["TUFTS - TUFTS POS - HCPCS - C1764","TUFTS - TUFTS POS - C1764","TUFTS - TUFTS POS - C1764 - HC RECORDER;IMPLANTABLE LOOP","TUFTS","TUFTS POS","HCPCS","C1764","HC RECORDER;IMPLANTABLE LOOP","C1764 - HC RECORDER;IMPLANTABLE LOOP",8983,0,0,0,2245.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1764","CIGNA HEALTHCARE - CIGNA CARELINK - C1764","CIGNA HEALTHCARE - CIGNA CARELINK - C1764 - HC RECORDER;IMPLANTABLE LOOP","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1764","HC RECORDER;IMPLANTABLE LOOP","C1764 - HC RECORDER;IMPLANTABLE LOOP",8983,0,0,0,2245.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1765","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1765","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1765 - ADHESION BARRIER","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1765","ADHESION BARRIER","C1765 - ADHESION BARRIER",569,0,0,0,142.25]
["TUFTS - TUFTS PPO - HCPCS - C1765","TUFTS - TUFTS PPO - C1765","TUFTS - TUFTS PPO - C1765 - ADHESION BARRIER","TUFTS","TUFTS PPO","HCPCS","C1765","ADHESION BARRIER","C1765 - ADHESION BARRIER",569,0,0,0,142.25]
["TUFTS - TUFTS SELECT - HCPCS - C1765","TUFTS - TUFTS SELECT - C1765","TUFTS - TUFTS SELECT - C1765 - ADHESION BARRIER","TUFTS","TUFTS SELECT","HCPCS","C1765","ADHESION BARRIER","C1765 - ADHESION BARRIER",569,0,0,0,142.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1765","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1765","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1765 - ADHESION BARRIER","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1765","ADHESION BARRIER","C1765 - ADHESION BARRIER",569,0,0,0,142.25]
["TUFTS - TUFTS POS - HCPCS - C1765","TUFTS - TUFTS POS - C1765","TUFTS - TUFTS POS - C1765 - ADHESION BARRIER","TUFTS","TUFTS POS","HCPCS","C1765","ADHESION BARRIER","C1765 - ADHESION BARRIER",569,0,0,0,142.25]
["TUFTS - TUFTS HMO - HCPCS - C1765","TUFTS - TUFTS HMO - C1765","TUFTS - TUFTS HMO - C1765 - ADHESION BARRIER","TUFTS","TUFTS HMO","HCPCS","C1765","ADHESION BARRIER","C1765 - ADHESION BARRIER",569,0,0,0,142.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1765","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1765","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1765 - ADHESION BARRIER","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1765","ADHESION BARRIER","C1765 - ADHESION BARRIER",569,0,0,0,142.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1765","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1765","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1765 - ADHESION BARRIER","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1765","ADHESION BARRIER","C1765 - ADHESION BARRIER",569,0,0,0,142.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1765","CIGNA HEALTHCARE - CIGNA CARELINK - C1765","CIGNA HEALTHCARE - CIGNA CARELINK - C1765 - ADHESION BARRIER","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1765","ADHESION BARRIER","C1765 - ADHESION BARRIER",569,0,0,0,142.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1766","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1766","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1766 - SHTH INTRO 65CM 15FR 12FR","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1766","SHTH INTRO 65CM 15FR 12FR","C1766 - SHTH INTRO 65CM 15FR 12FR",2619,0,0,0,654.75]
["TUFTS - TUFTS SELECT - HCPCS - C1766","TUFTS - TUFTS SELECT - C1766","TUFTS - TUFTS SELECT - C1766 - SHTH INTRO 65CM 15FR 12FR","TUFTS","TUFTS SELECT","HCPCS","C1766","SHTH INTRO 65CM 15FR 12FR","C1766 - SHTH INTRO 65CM 15FR 12FR",2619,0,0,0,654.75]
["TUFTS - TUFTS PPO - HCPCS - C1766","TUFTS - TUFTS PPO - C1766","TUFTS - TUFTS PPO - C1766 - SHTH INTRO 65CM 15FR 12FR","TUFTS","TUFTS PPO","HCPCS","C1766","SHTH INTRO 65CM 15FR 12FR","C1766 - SHTH INTRO 65CM 15FR 12FR",2619,0,0,0,654.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1766","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1766","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1766 - SHTH INTRO 65CM 15FR 12FR","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1766","SHTH INTRO 65CM 15FR 12FR","C1766 - SHTH INTRO 65CM 15FR 12FR",2619,0,0,0,654.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1766","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1766","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1766 - SHTH INTRO 65CM 15FR 12FR","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1766","SHTH INTRO 65CM 15FR 12FR","C1766 - SHTH INTRO 65CM 15FR 12FR",2619,0,0,0,654.75]
["TUFTS - TUFTS HMO - HCPCS - C1766","TUFTS - TUFTS HMO - C1766","TUFTS - TUFTS HMO - C1766 - SHTH INTRO 65CM 15FR 12FR","TUFTS","TUFTS HMO","HCPCS","C1766","SHTH INTRO 65CM 15FR 12FR","C1766 - SHTH INTRO 65CM 15FR 12FR",2619,0,0,0,654.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1766","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1766","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1766 - SHTH INTRO 65CM 15FR 12FR","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1766","SHTH INTRO 65CM 15FR 12FR","C1766 - SHTH INTRO 65CM 15FR 12FR",2619,0,0,0,654.75]
["TUFTS - TUFTS POS - HCPCS - C1766","TUFTS - TUFTS POS - C1766","TUFTS - TUFTS POS - C1766 - SHTH INTRO 65CM 15FR 12FR","TUFTS","TUFTS POS","HCPCS","C1766","SHTH INTRO 65CM 15FR 12FR","C1766 - SHTH INTRO 65CM 15FR 12FR",2619,0,0,0,654.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1766","CIGNA HEALTHCARE - CIGNA CARELINK - C1766","CIGNA HEALTHCARE - CIGNA CARELINK - C1766 - SHTH INTRO 65CM 15FR 12FR","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1766","SHTH INTRO 65CM 15FR 12FR","C1766 - SHTH INTRO 65CM 15FR 12FR",2619,0,0,0,654.75]
["TUFTS - TUFTS SELECT - HCPCS - C1768","TUFTS - TUFTS SELECT - C1768","TUFTS - TUFTS SELECT - C1768 - HC TAVR HEART VALVE KIT","TUFTS","TUFTS SELECT","HCPCS","C1768","HC TAVR HEART VALVE KIT","C1768 - HC TAVR HEART VALVE KIT",76125,0,0,0,19031.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1768","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1768","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1768 - HC TAVR HEART VALVE KIT","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1768","HC TAVR HEART VALVE KIT","C1768 - HC TAVR HEART VALVE KIT",76125,0,0,0,19031.25]
["TUFTS - TUFTS PPO - HCPCS - C1768","TUFTS - TUFTS PPO - C1768","TUFTS - TUFTS PPO - C1768 - HC TAVR HEART VALVE KIT","TUFTS","TUFTS PPO","HCPCS","C1768","HC TAVR HEART VALVE KIT","C1768 - HC TAVR HEART VALVE KIT",76125,0,0,0,19031.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1768","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1768","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1768 - HC TAVR HEART VALVE KIT","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1768","HC TAVR HEART VALVE KIT","C1768 - HC TAVR HEART VALVE KIT",76125,0,0,0,19031.25]
["TUFTS - TUFTS HMO - HCPCS - C1768","TUFTS - TUFTS HMO - C1768","TUFTS - TUFTS HMO - C1768 - HC TAVR HEART VALVE KIT","TUFTS","TUFTS HMO","HCPCS","C1768","HC TAVR HEART VALVE KIT","C1768 - HC TAVR HEART VALVE KIT",76125,0,0,0,19031.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1768","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1768","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1768 - HC TAVR HEART VALVE KIT","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1768","HC TAVR HEART VALVE KIT","C1768 - HC TAVR HEART VALVE KIT",76125,0,0,0,19031.25]
["TUFTS - TUFTS POS - HCPCS - C1768","TUFTS - TUFTS POS - C1768","TUFTS - TUFTS POS - C1768 - HC TAVR HEART VALVE KIT","TUFTS","TUFTS POS","HCPCS","C1768","HC TAVR HEART VALVE KIT","C1768 - HC TAVR HEART VALVE KIT",76125,0,0,0,19031.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1768","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1768","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1768 - HC TAVR HEART VALVE KIT","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1768","HC TAVR HEART VALVE KIT","C1768 - HC TAVR HEART VALVE KIT",76125,0,0,0,19031.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1768","CIGNA HEALTHCARE - CIGNA CARELINK - C1768","CIGNA HEALTHCARE - CIGNA CARELINK - C1768 - HC TAVR HEART VALVE KIT","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1768","HC TAVR HEART VALVE KIT","C1768 - HC TAVR HEART VALVE KIT",76125,0,0,0,19031.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1769","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1769","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1769 - GUIDE WIRE","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1769","GUIDE WIRE","C1769 - GUIDE WIRE",4759,0,0,0,1189.75]
["TUFTS - TUFTS SELECT - HCPCS - C1769","TUFTS - TUFTS SELECT - C1769","TUFTS - TUFTS SELECT - C1769 - GUIDE WIRE","TUFTS","TUFTS SELECT","HCPCS","C1769","GUIDE WIRE","C1769 - GUIDE WIRE",4759,0,0,0,1189.75]
["TUFTS - TUFTS PPO - HCPCS - C1769","TUFTS - TUFTS PPO - C1769","TUFTS - TUFTS PPO - C1769 - GUIDE WIRE","TUFTS","TUFTS PPO","HCPCS","C1769","GUIDE WIRE","C1769 - GUIDE WIRE",4759,0,0,0,1189.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1769","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1769","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1769 - GUIDE WIRE","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1769","GUIDE WIRE","C1769 - GUIDE WIRE",4759,0,0,0,1189.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1769","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1769","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1769 - GUIDE WIRE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1769","GUIDE WIRE","C1769 - GUIDE WIRE",4759,0,0,0,1189.75]
["TUFTS - TUFTS HMO - HCPCS - C1769","TUFTS - TUFTS HMO - C1769","TUFTS - TUFTS HMO - C1769 - GUIDE WIRE","TUFTS","TUFTS HMO","HCPCS","C1769","GUIDE WIRE","C1769 - GUIDE WIRE",4759,0,0,0,1189.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1769","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1769","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1769 - GUIDE WIRE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1769","GUIDE WIRE","C1769 - GUIDE WIRE",4759,0,0,0,1189.75]
["TUFTS - TUFTS POS - HCPCS - C1769","TUFTS - TUFTS POS - C1769","TUFTS - TUFTS POS - C1769 - GUIDE WIRE","TUFTS","TUFTS POS","HCPCS","C1769","GUIDE WIRE","C1769 - GUIDE WIRE",4759,0,0,0,1189.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1769","CIGNA HEALTHCARE - CIGNA CARELINK - C1769","CIGNA HEALTHCARE - CIGNA CARELINK - C1769 - GUIDE WIRE","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1769","GUIDE WIRE","C1769 - GUIDE WIRE",4759,0,0,0,1189.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1770","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1770","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1770 - IMAGING COIL, MR, INSERTABLE","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1770","IMAGING COIL, MR, INSERTABLE","C1770 - IMAGING COIL, MR, INSERTABLE",3667,0,0,0,916.75]
["TUFTS - TUFTS SELECT - HCPCS - C1770","TUFTS - TUFTS SELECT - C1770","TUFTS - TUFTS SELECT - C1770 - IMAGING COIL, MR, INSERTABLE","TUFTS","TUFTS SELECT","HCPCS","C1770","IMAGING COIL, MR, INSERTABLE","C1770 - IMAGING COIL, MR, INSERTABLE",3667,0,0,0,916.75]
["TUFTS - TUFTS PPO - HCPCS - C1770","TUFTS - TUFTS PPO - C1770","TUFTS - TUFTS PPO - C1770 - IMAGING COIL, MR, INSERTABLE","TUFTS","TUFTS PPO","HCPCS","C1770","IMAGING COIL, MR, INSERTABLE","C1770 - IMAGING COIL, MR, INSERTABLE",3667,0,0,0,916.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1770","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1770","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1770 - IMAGING COIL, MR, INSERTABLE","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1770","IMAGING COIL, MR, INSERTABLE","C1770 - IMAGING COIL, MR, INSERTABLE",3667,0,0,0,916.75]
["TUFTS - TUFTS POS - HCPCS - C1770","TUFTS - TUFTS POS - C1770","TUFTS - TUFTS POS - C1770 - IMAGING COIL, MR, INSERTABLE","TUFTS","TUFTS POS","HCPCS","C1770","IMAGING COIL, MR, INSERTABLE","C1770 - IMAGING COIL, MR, INSERTABLE",3667,0,0,0,916.75]
["TUFTS - TUFTS HMO - HCPCS - C1770","TUFTS - TUFTS HMO - C1770","TUFTS - TUFTS HMO - C1770 - IMAGING COIL, MR, INSERTABLE","TUFTS","TUFTS HMO","HCPCS","C1770","IMAGING COIL, MR, INSERTABLE","C1770 - IMAGING COIL, MR, INSERTABLE",3667,0,0,0,916.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1770","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1770","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1770 - IMAGING COIL, MR, INSERTABLE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1770","IMAGING COIL, MR, INSERTABLE","C1770 - IMAGING COIL, MR, INSERTABLE",3667,0,0,0,916.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1770","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1770","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1770 - IMAGING COIL, MR, INSERTABLE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1770","IMAGING COIL, MR, INSERTABLE","C1770 - IMAGING COIL, MR, INSERTABLE",3667,0,0,0,916.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1770","CIGNA HEALTHCARE - CIGNA CARELINK - C1770","CIGNA HEALTHCARE - CIGNA CARELINK - C1770 - IMAGING COIL, MR, INSERTABLE","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1770","IMAGING COIL, MR, INSERTABLE","C1770 - IMAGING COIL, MR, INSERTABLE",3667,0,0,0,916.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1773","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1773","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1773 - HC GUIDEWIRE LVL E","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1773","HC GUIDEWIRE LVL E","C1773 - HC GUIDEWIRE LVL E",2163,0,0,0,540.75]
["TUFTS - TUFTS SELECT - HCPCS - C1773","TUFTS - TUFTS SELECT - C1773","TUFTS - TUFTS SELECT - C1773 - HC GUIDEWIRE LVL E","TUFTS","TUFTS SELECT","HCPCS","C1773","HC GUIDEWIRE LVL E","C1773 - HC GUIDEWIRE LVL E",2163,0,0,0,540.75]
["TUFTS - TUFTS PPO - HCPCS - C1773","TUFTS - TUFTS PPO - C1773","TUFTS - TUFTS PPO - C1773 - HC GUIDEWIRE LVL E","TUFTS","TUFTS PPO","HCPCS","C1773","HC GUIDEWIRE LVL E","C1773 - HC GUIDEWIRE LVL E",2163,0,0,0,540.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1773","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1773","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1773 - HC GUIDEWIRE LVL E","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1773","HC GUIDEWIRE LVL E","C1773 - HC GUIDEWIRE LVL E",2163,0,0,0,540.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1773","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1773","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1773 - HC GUIDEWIRE LVL E","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1773","HC GUIDEWIRE LVL E","C1773 - HC GUIDEWIRE LVL E",2163,0,0,0,540.75]
["TUFTS - TUFTS HMO - HCPCS - C1773","TUFTS - TUFTS HMO - C1773","TUFTS - TUFTS HMO - C1773 - HC GUIDEWIRE LVL E","TUFTS","TUFTS HMO","HCPCS","C1773","HC GUIDEWIRE LVL E","C1773 - HC GUIDEWIRE LVL E",2163,0,0,0,540.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1773","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1773","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1773 - HC GUIDEWIRE LVL E","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1773","HC GUIDEWIRE LVL E","C1773 - HC GUIDEWIRE LVL E",2163,0,0,0,540.75]
["TUFTS - TUFTS POS - HCPCS - C1773","TUFTS - TUFTS POS - C1773","TUFTS - TUFTS POS - C1773 - HC GUIDEWIRE LVL E","TUFTS","TUFTS POS","HCPCS","C1773","HC GUIDEWIRE LVL E","C1773 - HC GUIDEWIRE LVL E",2163,0,0,0,540.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1773","CIGNA HEALTHCARE - CIGNA CARELINK - C1773","CIGNA HEALTHCARE - CIGNA CARELINK - C1773 - HC GUIDEWIRE LVL E","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1773","HC GUIDEWIRE LVL E","C1773 - HC GUIDEWIRE LVL E",2163,0,0,0,540.75]
["TUFTS - TUFTS PPO - HCPCS - C1776","TUFTS - TUFTS PPO - C1776","TUFTS - TUFTS PPO - C1776 - HC HEMI-TIB PLATEAU W MENISC","TUFTS","TUFTS PPO","HCPCS","C1776","HC HEMI-TIB PLATEAU W MENISC","C1776 - HC HEMI-TIB PLATEAU W MENISC",21721,0,0,0,5430.25]
["TUFTS - TUFTS SELECT - HCPCS - C1776","TUFTS - TUFTS SELECT - C1776","TUFTS - TUFTS SELECT - C1776 - HC HEMI-TIB PLATEAU W MENISC","TUFTS","TUFTS SELECT","HCPCS","C1776","HC HEMI-TIB PLATEAU W MENISC","C1776 - HC HEMI-TIB PLATEAU W MENISC",21721,0,0,0,5430.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1776","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1776","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1776 - HC HEMI-TIB PLATEAU W MENISC","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1776","HC HEMI-TIB PLATEAU W MENISC","C1776 - HC HEMI-TIB PLATEAU W MENISC",21721,0,0,0,5430.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1776","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1776","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1776 - HC HEMI-TIB PLATEAU W MENISC","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1776","HC HEMI-TIB PLATEAU W MENISC","C1776 - HC HEMI-TIB PLATEAU W MENISC",21721,0,0,0,5430.25]
["TUFTS - TUFTS HMO - HCPCS - C1776","TUFTS - TUFTS HMO - C1776","TUFTS - TUFTS HMO - C1776 - HC HEMI-TIB PLATEAU W MENISC","TUFTS","TUFTS HMO","HCPCS","C1776","HC HEMI-TIB PLATEAU W MENISC","C1776 - HC HEMI-TIB PLATEAU W MENISC",21721,0,0,0,5430.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1776","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1776","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1776 - HC HEMI-TIB PLATEAU W MENISC","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1776","HC HEMI-TIB PLATEAU W MENISC","C1776 - HC HEMI-TIB PLATEAU W MENISC",21721,0,0,0,5430.25]
["TUFTS - TUFTS POS - HCPCS - C1776","TUFTS - TUFTS POS - C1776","TUFTS - TUFTS POS - C1776 - HC HEMI-TIB PLATEAU W MENISC","TUFTS","TUFTS POS","HCPCS","C1776","HC HEMI-TIB PLATEAU W MENISC","C1776 - HC HEMI-TIB PLATEAU W MENISC",21721,0,0,0,5430.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1776","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1776","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1776 - HC HEMI-TIB PLATEAU W MENISC","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1776","HC HEMI-TIB PLATEAU W MENISC","C1776 - HC HEMI-TIB PLATEAU W MENISC",21721,0,0,0,5430.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1776","CIGNA HEALTHCARE - CIGNA CARELINK - C1776","CIGNA HEALTHCARE - CIGNA CARELINK - C1776 - HC HEMI-TIB PLATEAU W MENISC","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1776","HC HEMI-TIB PLATEAU W MENISC","C1776 - HC HEMI-TIB PLATEAU W MENISC",21721,0,0,0,5430.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1777","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1777","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1777 - HC LEAD,ICD,1COIL","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1777","HC LEAD,ICD,1COIL","C1777 - HC LEAD,ICD,1COIL",13038,0,0,0,3259.5]
["TUFTS - TUFTS SELECT - HCPCS - C1777","TUFTS - TUFTS SELECT - C1777","TUFTS - TUFTS SELECT - C1777 - HC LEAD,ICD,1COIL","TUFTS","TUFTS SELECT","HCPCS","C1777","HC LEAD,ICD,1COIL","C1777 - HC LEAD,ICD,1COIL",13038,0,0,0,3259.5]
["TUFTS - TUFTS PPO - HCPCS - C1777","TUFTS - TUFTS PPO - C1777","TUFTS - TUFTS PPO - C1777 - HC LEAD,ICD,1COIL","TUFTS","TUFTS PPO","HCPCS","C1777","HC LEAD,ICD,1COIL","C1777 - HC LEAD,ICD,1COIL",13038,0,0,0,3259.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1777","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1777","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1777 - HC LEAD,ICD,1COIL","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1777","HC LEAD,ICD,1COIL","C1777 - HC LEAD,ICD,1COIL",13038,0,0,0,3259.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1777","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1777","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1777 - HC LEAD,ICD,1COIL","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1777","HC LEAD,ICD,1COIL","C1777 - HC LEAD,ICD,1COIL",13038,0,0,0,3259.5]
["TUFTS - TUFTS HMO - HCPCS - C1777","TUFTS - TUFTS HMO - C1777","TUFTS - TUFTS HMO - C1777 - HC LEAD,ICD,1COIL","TUFTS","TUFTS HMO","HCPCS","C1777","HC LEAD,ICD,1COIL","C1777 - HC LEAD,ICD,1COIL",13038,0,0,0,3259.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1777","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1777","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1777 - HC LEAD,ICD,1COIL","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1777","HC LEAD,ICD,1COIL","C1777 - HC LEAD,ICD,1COIL",13038,0,0,0,3259.5]
["TUFTS - TUFTS POS - HCPCS - C1777","TUFTS - TUFTS POS - C1777","TUFTS - TUFTS POS - C1777 - HC LEAD,ICD,1COIL","TUFTS","TUFTS POS","HCPCS","C1777","HC LEAD,ICD,1COIL","C1777 - HC LEAD,ICD,1COIL",13038,0,0,0,3259.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1777","CIGNA HEALTHCARE - CIGNA CARELINK - C1777","CIGNA HEALTHCARE - CIGNA CARELINK - C1777 - HC LEAD,ICD,1COIL","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1777","HC LEAD,ICD,1COIL","C1777 - HC LEAD,ICD,1COIL",13038,0,0,0,3259.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1781","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1781","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1781 - MESH (IMPLANTABLE)","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1781","MESH (IMPLANTABLE)","C1781 - MESH (IMPLANTABLE)",36449,0,0,0,9112.25]
["TUFTS - TUFTS SELECT - HCPCS - C1781","TUFTS - TUFTS SELECT - C1781","TUFTS - TUFTS SELECT - C1781 - MESH (IMPLANTABLE)","TUFTS","TUFTS SELECT","HCPCS","C1781","MESH (IMPLANTABLE)","C1781 - MESH (IMPLANTABLE)",36449,0,0,0,9112.25]
["TUFTS - TUFTS PPO - HCPCS - C1781","TUFTS - TUFTS PPO - C1781","TUFTS - TUFTS PPO - C1781 - MESH (IMPLANTABLE)","TUFTS","TUFTS PPO","HCPCS","C1781","MESH (IMPLANTABLE)","C1781 - MESH (IMPLANTABLE)",36449,0,0,0,9112.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1781","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1781","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1781 - MESH (IMPLANTABLE)","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1781","MESH (IMPLANTABLE)","C1781 - MESH (IMPLANTABLE)",36449,0,0,0,9112.25]
["TUFTS - TUFTS POS - HCPCS - C1781","TUFTS - TUFTS POS - C1781","TUFTS - TUFTS POS - C1781 - MESH (IMPLANTABLE)","TUFTS","TUFTS POS","HCPCS","C1781","MESH (IMPLANTABLE)","C1781 - MESH (IMPLANTABLE)",36449,0,0,0,9112.25]
["TUFTS - TUFTS HMO - HCPCS - C1781","TUFTS - TUFTS HMO - C1781","TUFTS - TUFTS HMO - C1781 - MESH (IMPLANTABLE)","TUFTS","TUFTS HMO","HCPCS","C1781","MESH (IMPLANTABLE)","C1781 - MESH (IMPLANTABLE)",36449,0,0,0,9112.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1781","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1781","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1781 - MESH (IMPLANTABLE)","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1781","MESH (IMPLANTABLE)","C1781 - MESH (IMPLANTABLE)",36449,0,0,0,9112.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1781","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1781","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1781 - MESH (IMPLANTABLE)","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1781","MESH (IMPLANTABLE)","C1781 - MESH (IMPLANTABLE)",36449,0,0,0,9112.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1781","CIGNA HEALTHCARE - CIGNA CARELINK - C1781","CIGNA HEALTHCARE - CIGNA CARELINK - C1781 - MESH (IMPLANTABLE)","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1781","MESH (IMPLANTABLE)","C1781 - MESH (IMPLANTABLE)",36449,0,0,0,9112.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1784","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1784","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1784 - HC DES PERIPHERAL STENT","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1784","HC DES PERIPHERAL STENT","C1784 - HC DES PERIPHERAL STENT",2734,0,0,0,683.5]
["TUFTS - TUFTS SELECT - HCPCS - C1784","TUFTS - TUFTS SELECT - C1784","TUFTS - TUFTS SELECT - C1784 - HC DES PERIPHERAL STENT","TUFTS","TUFTS SELECT","HCPCS","C1784","HC DES PERIPHERAL STENT","C1784 - HC DES PERIPHERAL STENT",2734,0,0,0,683.5]
["TUFTS - TUFTS PPO - HCPCS - C1784","TUFTS - TUFTS PPO - C1784","TUFTS - TUFTS PPO - C1784 - HC DES PERIPHERAL STENT","TUFTS","TUFTS PPO","HCPCS","C1784","HC DES PERIPHERAL STENT","C1784 - HC DES PERIPHERAL STENT",2734,0,0,0,683.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1784","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1784","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1784 - HC DES PERIPHERAL STENT","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1784","HC DES PERIPHERAL STENT","C1784 - HC DES PERIPHERAL STENT",2734,0,0,0,683.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1784","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1784","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1784 - HC DES PERIPHERAL STENT","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1784","HC DES PERIPHERAL STENT","C1784 - HC DES PERIPHERAL STENT",2734,0,0,0,683.5]
["TUFTS - TUFTS HMO - HCPCS - C1784","TUFTS - TUFTS HMO - C1784","TUFTS - TUFTS HMO - C1784 - HC DES PERIPHERAL STENT","TUFTS","TUFTS HMO","HCPCS","C1784","HC DES PERIPHERAL STENT","C1784 - HC DES PERIPHERAL STENT",2734,0,0,0,683.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1784","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1784","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1784 - HC DES PERIPHERAL STENT","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1784","HC DES PERIPHERAL STENT","C1784 - HC DES PERIPHERAL STENT",2734,0,0,0,683.5]
["TUFTS - TUFTS POS - HCPCS - C1784","TUFTS - TUFTS POS - C1784","TUFTS - TUFTS POS - C1784 - HC DES PERIPHERAL STENT","TUFTS","TUFTS POS","HCPCS","C1784","HC DES PERIPHERAL STENT","C1784 - HC DES PERIPHERAL STENT",2734,0,0,0,683.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1784","CIGNA HEALTHCARE - CIGNA CARELINK - C1784","CIGNA HEALTHCARE - CIGNA CARELINK - C1784 - HC DES PERIPHERAL STENT","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1784","HC DES PERIPHERAL STENT","C1784 - HC DES PERIPHERAL STENT",2734,0,0,0,683.5]
["TUFTS - TUFTS SELECT - HCPCS - C1785","TUFTS - TUFTS SELECT - C1785","TUFTS - TUFTS SELECT - C1785 - HC PACER;2CH, RECALL $0","TUFTS","TUFTS SELECT","HCPCS","C1785","HC PACER;2CH, RECALL $0","C1785 - HC PACER;2CH, RECALL $0",12546,0,0,0,3136.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1785","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1785","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1785 - HC PACER;2CH, RECALL $0","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1785","HC PACER;2CH, RECALL $0","C1785 - HC PACER;2CH, RECALL $0",12546,0,0,0,3136.5]
["TUFTS - TUFTS PPO - HCPCS - C1785","TUFTS - TUFTS PPO - C1785","TUFTS - TUFTS PPO - C1785 - HC PACER;2CH, RECALL $0","TUFTS","TUFTS PPO","HCPCS","C1785","HC PACER;2CH, RECALL $0","C1785 - HC PACER;2CH, RECALL $0",12546,0,0,0,3136.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1785","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1785","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1785 - HC PACER;2CH, RECALL $0","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1785","HC PACER;2CH, RECALL $0","C1785 - HC PACER;2CH, RECALL $0",12546,0,0,0,3136.5]
["TUFTS - TUFTS HMO - HCPCS - C1785","TUFTS - TUFTS HMO - C1785","TUFTS - TUFTS HMO - C1785 - HC PACER;2CH, RECALL $0","TUFTS","TUFTS HMO","HCPCS","C1785","HC PACER;2CH, RECALL $0","C1785 - HC PACER;2CH, RECALL $0",12546,0,0,0,3136.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1785","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1785","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1785 - HC PACER;2CH, RECALL $0","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1785","HC PACER;2CH, RECALL $0","C1785 - HC PACER;2CH, RECALL $0",12546,0,0,0,3136.5]
["TUFTS - TUFTS POS - HCPCS - C1785","TUFTS - TUFTS POS - C1785","TUFTS - TUFTS POS - C1785 - HC PACER;2CH, RECALL $0","TUFTS","TUFTS POS","HCPCS","C1785","HC PACER;2CH, RECALL $0","C1785 - HC PACER;2CH, RECALL $0",12546,0,0,0,3136.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1785","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1785","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1785 - HC PACER;2CH, RECALL $0","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1785","HC PACER;2CH, RECALL $0","C1785 - HC PACER;2CH, RECALL $0",12546,0,0,0,3136.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1785","CIGNA HEALTHCARE - CIGNA CARELINK - C1785","CIGNA HEALTHCARE - CIGNA CARELINK - C1785 - HC PACER;2CH, RECALL $0","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1785","HC PACER;2CH, RECALL $0","C1785 - HC PACER;2CH, RECALL $0",12546,0,0,0,3136.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1786","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1786","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1786 - HC PACER;1CH, RECALL $0","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1786","HC PACER;1CH, RECALL $0","C1786 - HC PACER;1CH, RECALL $0",23460,0,0,0,5865]
["TUFTS - TUFTS SELECT - HCPCS - C1786","TUFTS - TUFTS SELECT - C1786","TUFTS - TUFTS SELECT - C1786 - HC PACER;1CH, RECALL $0","TUFTS","TUFTS SELECT","HCPCS","C1786","HC PACER;1CH, RECALL $0","C1786 - HC PACER;1CH, RECALL $0",23460,0,0,0,5865]
["TUFTS - TUFTS PPO - HCPCS - C1786","TUFTS - TUFTS PPO - C1786","TUFTS - TUFTS PPO - C1786 - HC PACER;1CH, RECALL $0","TUFTS","TUFTS PPO","HCPCS","C1786","HC PACER;1CH, RECALL $0","C1786 - HC PACER;1CH, RECALL $0",23460,0,0,0,5865]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1786","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1786","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1786 - HC PACER;1CH, RECALL $0","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1786","HC PACER;1CH, RECALL $0","C1786 - HC PACER;1CH, RECALL $0",23460,0,0,0,5865]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1786","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1786","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1786 - HC PACER;1CH, RECALL $0","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1786","HC PACER;1CH, RECALL $0","C1786 - HC PACER;1CH, RECALL $0",23460,0,0,0,5865]
["TUFTS - TUFTS HMO - HCPCS - C1786","TUFTS - TUFTS HMO - C1786","TUFTS - TUFTS HMO - C1786 - HC PACER;1CH, RECALL $0","TUFTS","TUFTS HMO","HCPCS","C1786","HC PACER;1CH, RECALL $0","C1786 - HC PACER;1CH, RECALL $0",23460,0,0,0,5865]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1786","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1786","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1786 - HC PACER;1CH, RECALL $0","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1786","HC PACER;1CH, RECALL $0","C1786 - HC PACER;1CH, RECALL $0",23460,0,0,0,5865]
["TUFTS - TUFTS POS - HCPCS - C1786","TUFTS - TUFTS POS - C1786","TUFTS - TUFTS POS - C1786 - HC PACER;1CH, RECALL $0","TUFTS","TUFTS POS","HCPCS","C1786","HC PACER;1CH, RECALL $0","C1786 - HC PACER;1CH, RECALL $0",23460,0,0,0,5865]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1786","CIGNA HEALTHCARE - CIGNA CARELINK - C1786","CIGNA HEALTHCARE - CIGNA CARELINK - C1786 - HC PACER;1CH, RECALL $0","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1786","HC PACER;1CH, RECALL $0","C1786 - HC PACER;1CH, RECALL $0",23460,0,0,0,5865]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1788","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1788","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1788 - HC PORTACATH ANY","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1788","HC PORTACATH ANY","C1788 - HC PORTACATH ANY",540,0,0,0,135]
["TUFTS - TUFTS PPO - HCPCS - C1788","TUFTS - TUFTS PPO - C1788","TUFTS - TUFTS PPO - C1788 - HC PORTACATH ANY","TUFTS","TUFTS PPO","HCPCS","C1788","HC PORTACATH ANY","C1788 - HC PORTACATH ANY",540,0,0,0,135]
["TUFTS - TUFTS SELECT - HCPCS - C1788","TUFTS - TUFTS SELECT - C1788","TUFTS - TUFTS SELECT - C1788 - HC PORTACATH ANY","TUFTS","TUFTS SELECT","HCPCS","C1788","HC PORTACATH ANY","C1788 - HC PORTACATH ANY",540,0,0,0,135]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1788","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1788","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1788 - HC PORTACATH ANY","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1788","HC PORTACATH ANY","C1788 - HC PORTACATH ANY",540,0,0,0,135]
["TUFTS - TUFTS POS - HCPCS - C1788","TUFTS - TUFTS POS - C1788","TUFTS - TUFTS POS - C1788 - HC PORTACATH ANY","TUFTS","TUFTS POS","HCPCS","C1788","HC PORTACATH ANY","C1788 - HC PORTACATH ANY",540,0,0,0,135]
["TUFTS - TUFTS HMO - HCPCS - C1788","TUFTS - TUFTS HMO - C1788","TUFTS - TUFTS HMO - C1788 - HC PORTACATH ANY","TUFTS","TUFTS HMO","HCPCS","C1788","HC PORTACATH ANY","C1788 - HC PORTACATH ANY",540,0,0,0,135]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1788","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1788","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1788 - HC PORTACATH ANY","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1788","HC PORTACATH ANY","C1788 - HC PORTACATH ANY",540,0,0,0,135]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1788","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1788","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1788 - HC PORTACATH ANY","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1788","HC PORTACATH ANY","C1788 - HC PORTACATH ANY",540,0,0,0,135]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1788","CIGNA HEALTHCARE - CIGNA CARELINK - C1788","CIGNA HEALTHCARE - CIGNA CARELINK - C1788 - HC PORTACATH ANY","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1788","HC PORTACATH ANY","C1788 - HC PORTACATH ANY",540,0,0,0,135]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1817","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1817","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1817 - HC OCCKYDER;ASD/PFO","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1817","HC OCCKYDER;ASD/PFO","C1817 - HC OCCKYDER;ASD/PFO",9668,0,0,0,2417]
["TUFTS - TUFTS SELECT - HCPCS - C1817","TUFTS - TUFTS SELECT - C1817","TUFTS - TUFTS SELECT - C1817 - HC OCCKYDER;ASD/PFO","TUFTS","TUFTS SELECT","HCPCS","C1817","HC OCCKYDER;ASD/PFO","C1817 - HC OCCKYDER;ASD/PFO",9668,0,0,0,2417]
["TUFTS - TUFTS PPO - HCPCS - C1817","TUFTS - TUFTS PPO - C1817","TUFTS - TUFTS PPO - C1817 - HC OCCKYDER;ASD/PFO","TUFTS","TUFTS PPO","HCPCS","C1817","HC OCCKYDER;ASD/PFO","C1817 - HC OCCKYDER;ASD/PFO",9668,0,0,0,2417]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1817","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1817","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1817 - HC OCCKYDER;ASD/PFO","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1817","HC OCCKYDER;ASD/PFO","C1817 - HC OCCKYDER;ASD/PFO",9668,0,0,0,2417]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1817","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1817","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1817 - HC OCCKYDER;ASD/PFO","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1817","HC OCCKYDER;ASD/PFO","C1817 - HC OCCKYDER;ASD/PFO",9668,0,0,0,2417]
["TUFTS - TUFTS HMO - HCPCS - C1817","TUFTS - TUFTS HMO - C1817","TUFTS - TUFTS HMO - C1817 - HC OCCKYDER;ASD/PFO","TUFTS","TUFTS HMO","HCPCS","C1817","HC OCCKYDER;ASD/PFO","C1817 - HC OCCKYDER;ASD/PFO",9668,0,0,0,2417]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1817","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1817","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1817 - HC OCCKYDER;ASD/PFO","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1817","HC OCCKYDER;ASD/PFO","C1817 - HC OCCKYDER;ASD/PFO",9668,0,0,0,2417]
["TUFTS - TUFTS POS - HCPCS - C1817","TUFTS - TUFTS POS - C1817","TUFTS - TUFTS POS - C1817 - HC OCCKYDER;ASD/PFO","TUFTS","TUFTS POS","HCPCS","C1817","HC OCCKYDER;ASD/PFO","C1817 - HC OCCKYDER;ASD/PFO",9668,0,0,0,2417]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1817","CIGNA HEALTHCARE - CIGNA CARELINK - C1817","CIGNA HEALTHCARE - CIGNA CARELINK - C1817 - HC OCCKYDER;ASD/PFO","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1817","HC OCCKYDER;ASD/PFO","C1817 - HC OCCKYDER;ASD/PFO",9668,0,0,0,2417]
["TUFTS - TUFTS SELECT - HCPCS - C1821","TUFTS - TUFTS SELECT - C1821","TUFTS - TUFTS SELECT - C1821 - HC INTERSPINOUS IMPLANT","TUFTS","TUFTS SELECT","HCPCS","C1821","HC INTERSPINOUS IMPLANT","C1821 - HC INTERSPINOUS IMPLANT",9770,0,0,0,2442.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1821","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1821","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1821 - HC INTERSPINOUS IMPLANT","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1821","HC INTERSPINOUS IMPLANT","C1821 - HC INTERSPINOUS IMPLANT",9770,0,0,0,2442.5]
["TUFTS - TUFTS PPO - HCPCS - C1821","TUFTS - TUFTS PPO - C1821","TUFTS - TUFTS PPO - C1821 - HC INTERSPINOUS IMPLANT","TUFTS","TUFTS PPO","HCPCS","C1821","HC INTERSPINOUS IMPLANT","C1821 - HC INTERSPINOUS IMPLANT",9770,0,0,0,2442.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1821","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1821","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1821 - HC INTERSPINOUS IMPLANT","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1821","HC INTERSPINOUS IMPLANT","C1821 - HC INTERSPINOUS IMPLANT",9770,0,0,0,2442.5]
["TUFTS - TUFTS HMO - HCPCS - C1821","TUFTS - TUFTS HMO - C1821","TUFTS - TUFTS HMO - C1821 - HC INTERSPINOUS IMPLANT","TUFTS","TUFTS HMO","HCPCS","C1821","HC INTERSPINOUS IMPLANT","C1821 - HC INTERSPINOUS IMPLANT",9770,0,0,0,2442.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1821","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1821","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1821 - HC INTERSPINOUS IMPLANT","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1821","HC INTERSPINOUS IMPLANT","C1821 - HC INTERSPINOUS IMPLANT",9770,0,0,0,2442.5]
["TUFTS - TUFTS POS - HCPCS - C1821","TUFTS - TUFTS POS - C1821","TUFTS - TUFTS POS - C1821 - HC INTERSPINOUS IMPLANT","TUFTS","TUFTS POS","HCPCS","C1821","HC INTERSPINOUS IMPLANT","C1821 - HC INTERSPINOUS IMPLANT",9770,0,0,0,2442.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1821","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1821","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1821 - HC INTERSPINOUS IMPLANT","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1821","HC INTERSPINOUS IMPLANT","C1821 - HC INTERSPINOUS IMPLANT",9770,0,0,0,2442.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1821","CIGNA HEALTHCARE - CIGNA CARELINK - C1821","CIGNA HEALTHCARE - CIGNA CARELINK - C1821 - HC INTERSPINOUS IMPLANT","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1821","HC INTERSPINOUS IMPLANT","C1821 - HC INTERSPINOUS IMPLANT",9770,0,0,0,2442.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1874","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1874","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1874 - STENT WALLFLEX SYSTEM","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1874","STENT WALLFLEX SYSTEM","C1874 - STENT WALLFLEX SYSTEM",8879,0,0,0,2219.75]
["TUFTS - TUFTS SELECT - HCPCS - C1874","TUFTS - TUFTS SELECT - C1874","TUFTS - TUFTS SELECT - C1874 - STENT WALLFLEX SYSTEM","TUFTS","TUFTS SELECT","HCPCS","C1874","STENT WALLFLEX SYSTEM","C1874 - STENT WALLFLEX SYSTEM",8879,0,0,0,2219.75]
["TUFTS - TUFTS PPO - HCPCS - C1874","TUFTS - TUFTS PPO - C1874","TUFTS - TUFTS PPO - C1874 - STENT WALLFLEX SYSTEM","TUFTS","TUFTS PPO","HCPCS","C1874","STENT WALLFLEX SYSTEM","C1874 - STENT WALLFLEX SYSTEM",8879,0,0,0,2219.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1874","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1874","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1874 - STENT WALLFLEX SYSTEM","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1874","STENT WALLFLEX SYSTEM","C1874 - STENT WALLFLEX SYSTEM",8879,0,0,0,2219.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1874","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1874","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1874 - STENT WALLFLEX SYSTEM","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1874","STENT WALLFLEX SYSTEM","C1874 - STENT WALLFLEX SYSTEM",8879,0,0,0,2219.75]
["TUFTS - TUFTS HMO - HCPCS - C1874","TUFTS - TUFTS HMO - C1874","TUFTS - TUFTS HMO - C1874 - STENT WALLFLEX SYSTEM","TUFTS","TUFTS HMO","HCPCS","C1874","STENT WALLFLEX SYSTEM","C1874 - STENT WALLFLEX SYSTEM",8879,0,0,0,2219.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1874","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1874","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1874 - STENT WALLFLEX SYSTEM","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1874","STENT WALLFLEX SYSTEM","C1874 - STENT WALLFLEX SYSTEM",8879,0,0,0,2219.75]
["TUFTS - TUFTS POS - HCPCS - C1874","TUFTS - TUFTS POS - C1874","TUFTS - TUFTS POS - C1874 - STENT WALLFLEX SYSTEM","TUFTS","TUFTS POS","HCPCS","C1874","STENT WALLFLEX SYSTEM","C1874 - STENT WALLFLEX SYSTEM",8879,0,0,0,2219.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1874","CIGNA HEALTHCARE - CIGNA CARELINK - C1874","CIGNA HEALTHCARE - CIGNA CARELINK - C1874 - STENT WALLFLEX SYSTEM","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1874","STENT WALLFLEX SYSTEM","C1874 - STENT WALLFLEX SYSTEM",8879,0,0,0,2219.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1876","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1876","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1876 - STENT BILIARY","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1876","STENT BILIARY","C1876 - STENT BILIARY",11691,0,0,0,2922.75]
["TUFTS - TUFTS SELECT - HCPCS - C1876","TUFTS - TUFTS SELECT - C1876","TUFTS - TUFTS SELECT - C1876 - STENT BILIARY","TUFTS","TUFTS SELECT","HCPCS","C1876","STENT BILIARY","C1876 - STENT BILIARY",11691,0,0,0,2922.75]
["TUFTS - TUFTS PPO - HCPCS - C1876","TUFTS - TUFTS PPO - C1876","TUFTS - TUFTS PPO - C1876 - STENT BILIARY","TUFTS","TUFTS PPO","HCPCS","C1876","STENT BILIARY","C1876 - STENT BILIARY",11691,0,0,0,2922.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1876","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1876","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1876 - STENT BILIARY","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1876","STENT BILIARY","C1876 - STENT BILIARY",11691,0,0,0,2922.75]
["TUFTS - TUFTS POS - HCPCS - C1876","TUFTS - TUFTS POS - C1876","TUFTS - TUFTS POS - C1876 - STENT BILIARY","TUFTS","TUFTS POS","HCPCS","C1876","STENT BILIARY","C1876 - STENT BILIARY",11691,0,0,0,2922.75]
["TUFTS - TUFTS HMO - HCPCS - C1876","TUFTS - TUFTS HMO - C1876","TUFTS - TUFTS HMO - C1876 - STENT BILIARY","TUFTS","TUFTS HMO","HCPCS","C1876","STENT BILIARY","C1876 - STENT BILIARY",11691,0,0,0,2922.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1876","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1876","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1876 - STENT BILIARY","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1876","STENT BILIARY","C1876 - STENT BILIARY",11691,0,0,0,2922.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1876","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1876","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1876 - STENT BILIARY","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1876","STENT BILIARY","C1876 - STENT BILIARY",11691,0,0,0,2922.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1876","CIGNA HEALTHCARE - CIGNA CARELINK - C1876","CIGNA HEALTHCARE - CIGNA CARELINK - C1876 - STENT BILIARY","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1876","STENT BILIARY","C1876 - STENT BILIARY",11691,0,0,0,2922.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1880","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1880","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1880 - IVC FILTERS","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1880","IVC FILTERS","C1880 - IVC FILTERS",7726,0,0,0,1931.5]
["TUFTS - TUFTS PPO - HCPCS - C1880","TUFTS - TUFTS PPO - C1880","TUFTS - TUFTS PPO - C1880 - IVC FILTERS","TUFTS","TUFTS PPO","HCPCS","C1880","IVC FILTERS","C1880 - IVC FILTERS",7726,0,0,0,1931.5]
["TUFTS - TUFTS SELECT - HCPCS - C1880","TUFTS - TUFTS SELECT - C1880","TUFTS - TUFTS SELECT - C1880 - IVC FILTERS","TUFTS","TUFTS SELECT","HCPCS","C1880","IVC FILTERS","C1880 - IVC FILTERS",7726,0,0,0,1931.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1880","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1880","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1880 - IVC FILTERS","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1880","IVC FILTERS","C1880 - IVC FILTERS",7726,0,0,0,1931.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1880","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1880","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1880 - IVC FILTERS","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1880","IVC FILTERS","C1880 - IVC FILTERS",7726,0,0,0,1931.5]
["TUFTS - TUFTS HMO - HCPCS - C1880","TUFTS - TUFTS HMO - C1880","TUFTS - TUFTS HMO - C1880 - IVC FILTERS","TUFTS","TUFTS HMO","HCPCS","C1880","IVC FILTERS","C1880 - IVC FILTERS",7726,0,0,0,1931.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1880","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1880","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1880 - IVC FILTERS","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1880","IVC FILTERS","C1880 - IVC FILTERS",7726,0,0,0,1931.5]
["TUFTS - TUFTS POS - HCPCS - C1880","TUFTS - TUFTS POS - C1880","TUFTS - TUFTS POS - C1880 - IVC FILTERS","TUFTS","TUFTS POS","HCPCS","C1880","IVC FILTERS","C1880 - IVC FILTERS",7726,0,0,0,1931.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1880","CIGNA HEALTHCARE - CIGNA CARELINK - C1880","CIGNA HEALTHCARE - CIGNA CARELINK - C1880 - IVC FILTERS","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1880","IVC FILTERS","C1880 - IVC FILTERS",7726,0,0,0,1931.5]
["TUFTS - TUFTS PPO - HCPCS - C1882","TUFTS - TUFTS PPO - C1882","TUFTS - TUFTS PPO - C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0","TUFTS","TUFTS PPO","HCPCS","C1882","HC ICD,BI-VENT, GEN ONLY, RECALL $0","C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0",53226,0,0,0,13306.5]
["TUFTS - TUFTS SELECT - HCPCS - C1882","TUFTS - TUFTS SELECT - C1882","TUFTS - TUFTS SELECT - C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0","TUFTS","TUFTS SELECT","HCPCS","C1882","HC ICD,BI-VENT, GEN ONLY, RECALL $0","C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0",53226,0,0,0,13306.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1882","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1882","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1882","HC ICD,BI-VENT, GEN ONLY, RECALL $0","C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0",53226,0,0,0,13306.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1882","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1882","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1882","HC ICD,BI-VENT, GEN ONLY, RECALL $0","C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0",53226,0,0,0,13306.5]
["TUFTS - TUFTS HMO - HCPCS - C1882","TUFTS - TUFTS HMO - C1882","TUFTS - TUFTS HMO - C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0","TUFTS","TUFTS HMO","HCPCS","C1882","HC ICD,BI-VENT, GEN ONLY, RECALL $0","C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0",53226,0,0,0,13306.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1882","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1882","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1882","HC ICD,BI-VENT, GEN ONLY, RECALL $0","C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0",53226,0,0,0,13306.5]
["TUFTS - TUFTS POS - HCPCS - C1882","TUFTS - TUFTS POS - C1882","TUFTS - TUFTS POS - C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0","TUFTS","TUFTS POS","HCPCS","C1882","HC ICD,BI-VENT, GEN ONLY, RECALL $0","C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0",53226,0,0,0,13306.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1882","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1882","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1882","HC ICD,BI-VENT, GEN ONLY, RECALL $0","C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0",53226,0,0,0,13306.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1882","CIGNA HEALTHCARE - CIGNA CARELINK - C1882","CIGNA HEALTHCARE - CIGNA CARELINK - C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1882","HC ICD,BI-VENT, GEN ONLY, RECALL $0","C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0",53226,0,0,0,13306.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1883","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1883","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1883 - HC ADAPTOR;BI-VENT PACER","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1883","HC ADAPTOR;BI-VENT PACER","C1883 - HC ADAPTOR;BI-VENT PACER",1257,0,0,0,314.25]
["TUFTS - TUFTS SELECT - HCPCS - C1883","TUFTS - TUFTS SELECT - C1883","TUFTS - TUFTS SELECT - C1883 - HC ADAPTOR;BI-VENT PACER","TUFTS","TUFTS SELECT","HCPCS","C1883","HC ADAPTOR;BI-VENT PACER","C1883 - HC ADAPTOR;BI-VENT PACER",1257,0,0,0,314.25]
["TUFTS - TUFTS PPO - HCPCS - C1883","TUFTS - TUFTS PPO - C1883","TUFTS - TUFTS PPO - C1883 - HC ADAPTOR;BI-VENT PACER","TUFTS","TUFTS PPO","HCPCS","C1883","HC ADAPTOR;BI-VENT PACER","C1883 - HC ADAPTOR;BI-VENT PACER",1257,0,0,0,314.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1883","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1883","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1883 - HC ADAPTOR;BI-VENT PACER","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1883","HC ADAPTOR;BI-VENT PACER","C1883 - HC ADAPTOR;BI-VENT PACER",1257,0,0,0,314.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1883","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1883","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1883 - HC ADAPTOR;BI-VENT PACER","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1883","HC ADAPTOR;BI-VENT PACER","C1883 - HC ADAPTOR;BI-VENT PACER",1257,0,0,0,314.25]
["TUFTS - TUFTS HMO - HCPCS - C1883","TUFTS - TUFTS HMO - C1883","TUFTS - TUFTS HMO - C1883 - HC ADAPTOR;BI-VENT PACER","TUFTS","TUFTS HMO","HCPCS","C1883","HC ADAPTOR;BI-VENT PACER","C1883 - HC ADAPTOR;BI-VENT PACER",1257,0,0,0,314.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1883","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1883","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1883 - HC ADAPTOR;BI-VENT PACER","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1883","HC ADAPTOR;BI-VENT PACER","C1883 - HC ADAPTOR;BI-VENT PACER",1257,0,0,0,314.25]
["TUFTS - TUFTS POS - HCPCS - C1883","TUFTS - TUFTS POS - C1883","TUFTS - TUFTS POS - C1883 - HC ADAPTOR;BI-VENT PACER","TUFTS","TUFTS POS","HCPCS","C1883","HC ADAPTOR;BI-VENT PACER","C1883 - HC ADAPTOR;BI-VENT PACER",1257,0,0,0,314.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1883","CIGNA HEALTHCARE - CIGNA CARELINK - C1883","CIGNA HEALTHCARE - CIGNA CARELINK - C1883 - HC ADAPTOR;BI-VENT PACER","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1883","HC ADAPTOR;BI-VENT PACER","C1883 - HC ADAPTOR;BI-VENT PACER",1257,0,0,0,314.25]
["TUFTS - TUFTS PPO - HCPCS - C1884","TUFTS - TUFTS PPO - C1884","TUFTS - TUFTS PPO - C1884 - EMBOLIZATION PROTECT SYST","TUFTS","TUFTS PPO","HCPCS","C1884","EMBOLIZATION PROTECT SYST","C1884 - EMBOLIZATION PROTECT SYST",31469,0,0,0,7867.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1884","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1884","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1884 - EMBOLIZATION PROTECT SYST","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1884","EMBOLIZATION PROTECT SYST","C1884 - EMBOLIZATION PROTECT SYST",31469,0,0,0,7867.25]
["TUFTS - TUFTS SELECT - HCPCS - C1884","TUFTS - TUFTS SELECT - C1884","TUFTS - TUFTS SELECT - C1884 - EMBOLIZATION PROTECT SYST","TUFTS","TUFTS SELECT","HCPCS","C1884","EMBOLIZATION PROTECT SYST","C1884 - EMBOLIZATION PROTECT SYST",31469,0,0,0,7867.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1884","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1884","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1884 - EMBOLIZATION PROTECT SYST","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1884","EMBOLIZATION PROTECT SYST","C1884 - EMBOLIZATION PROTECT SYST",31469,0,0,0,7867.25]
["TUFTS - TUFTS POS - HCPCS - C1884","TUFTS - TUFTS POS - C1884","TUFTS - TUFTS POS - C1884 - EMBOLIZATION PROTECT SYST","TUFTS","TUFTS POS","HCPCS","C1884","EMBOLIZATION PROTECT SYST","C1884 - EMBOLIZATION PROTECT SYST",31469,0,0,0,7867.25]
["TUFTS - TUFTS HMO - HCPCS - C1884","TUFTS - TUFTS HMO - C1884","TUFTS - TUFTS HMO - C1884 - EMBOLIZATION PROTECT SYST","TUFTS","TUFTS HMO","HCPCS","C1884","EMBOLIZATION PROTECT SYST","C1884 - EMBOLIZATION PROTECT SYST",31469,0,0,0,7867.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1884","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1884","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1884 - EMBOLIZATION PROTECT SYST","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1884","EMBOLIZATION PROTECT SYST","C1884 - EMBOLIZATION PROTECT SYST",31469,0,0,0,7867.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1884","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1884","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1884 - EMBOLIZATION PROTECT SYST","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1884","EMBOLIZATION PROTECT SYST","C1884 - EMBOLIZATION PROTECT SYST",31469,0,0,0,7867.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1884","CIGNA HEALTHCARE - CIGNA CARELINK - C1884","CIGNA HEALTHCARE - CIGNA CARELINK - C1884 - EMBOLIZATION PROTECT SYST","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1884","EMBOLIZATION PROTECT SYST","C1884 - EMBOLIZATION PROTECT SYST",31469,0,0,0,7867.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1887","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1887","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1887 - HC CATH,EP;R-F,30D THERM RMT","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1887","HC CATH,EP;R-F,30D THERM RMT","C1887 - HC CATH,EP;R-F,30D THERM RMT",3731,0,0,0,932.75]
["TUFTS - TUFTS PPO - HCPCS - C1887","TUFTS - TUFTS PPO - C1887","TUFTS - TUFTS PPO - C1887 - HC CATH,EP;R-F,30D THERM RMT","TUFTS","TUFTS PPO","HCPCS","C1887","HC CATH,EP;R-F,30D THERM RMT","C1887 - HC CATH,EP;R-F,30D THERM RMT",3731,0,0,0,932.75]
["TUFTS - TUFTS SELECT - HCPCS - C1887","TUFTS - TUFTS SELECT - C1887","TUFTS - TUFTS SELECT - C1887 - HC CATH,EP;R-F,30D THERM RMT","TUFTS","TUFTS SELECT","HCPCS","C1887","HC CATH,EP;R-F,30D THERM RMT","C1887 - HC CATH,EP;R-F,30D THERM RMT",3731,0,0,0,932.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1887","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1887","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1887 - HC CATH,EP;R-F,30D THERM RMT","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1887","HC CATH,EP;R-F,30D THERM RMT","C1887 - HC CATH,EP;R-F,30D THERM RMT",3731,0,0,0,932.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1887","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1887","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1887 - HC CATH,EP;R-F,30D THERM RMT","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1887","HC CATH,EP;R-F,30D THERM RMT","C1887 - HC CATH,EP;R-F,30D THERM RMT",3731,0,0,0,932.75]
["TUFTS - TUFTS HMO - HCPCS - C1887","TUFTS - TUFTS HMO - C1887","TUFTS - TUFTS HMO - C1887 - HC CATH,EP;R-F,30D THERM RMT","TUFTS","TUFTS HMO","HCPCS","C1887","HC CATH,EP;R-F,30D THERM RMT","C1887 - HC CATH,EP;R-F,30D THERM RMT",3731,0,0,0,932.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1887","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1887","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1887 - HC CATH,EP;R-F,30D THERM RMT","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1887","HC CATH,EP;R-F,30D THERM RMT","C1887 - HC CATH,EP;R-F,30D THERM RMT",3731,0,0,0,932.75]
["TUFTS - TUFTS POS - HCPCS - C1887","TUFTS - TUFTS POS - C1887","TUFTS - TUFTS POS - C1887 - HC CATH,EP;R-F,30D THERM RMT","TUFTS","TUFTS POS","HCPCS","C1887","HC CATH,EP;R-F,30D THERM RMT","C1887 - HC CATH,EP;R-F,30D THERM RMT",3731,0,0,0,932.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1887","CIGNA HEALTHCARE - CIGNA CARELINK - C1887","CIGNA HEALTHCARE - CIGNA CARELINK - C1887 - HC CATH,EP;R-F,30D THERM RMT","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1887","HC CATH,EP;R-F,30D THERM RMT","C1887 - HC CATH,EP;R-F,30D THERM RMT",3731,0,0,0,932.75]
["TUFTS - TUFTS SELECT - HCPCS - C1892","TUFTS - TUFTS SELECT - C1892","TUFTS - TUFTS SELECT - C1892 - HC SHEATH;GUIDING","TUFTS","TUFTS SELECT","HCPCS","C1892","HC SHEATH;GUIDING","C1892 - HC SHEATH;GUIDING",340,0,0,0,85]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1892","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1892","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1892 - HC SHEATH;GUIDING","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1892","HC SHEATH;GUIDING","C1892 - HC SHEATH;GUIDING",340,0,0,0,85]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1892","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1892","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1892 - HC SHEATH;GUIDING","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1892","HC SHEATH;GUIDING","C1892 - HC SHEATH;GUIDING",340,0,0,0,85]
["TUFTS - TUFTS PPO - HCPCS - C1892","TUFTS - TUFTS PPO - C1892","TUFTS - TUFTS PPO - C1892 - HC SHEATH;GUIDING","TUFTS","TUFTS PPO","HCPCS","C1892","HC SHEATH;GUIDING","C1892 - HC SHEATH;GUIDING",340,0,0,0,85]
["TUFTS - TUFTS HMO - HCPCS - C1892","TUFTS - TUFTS HMO - C1892","TUFTS - TUFTS HMO - C1892 - HC SHEATH;GUIDING","TUFTS","TUFTS HMO","HCPCS","C1892","HC SHEATH;GUIDING","C1892 - HC SHEATH;GUIDING",340,0,0,0,85]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1892","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1892","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1892 - HC SHEATH;GUIDING","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1892","HC SHEATH;GUIDING","C1892 - HC SHEATH;GUIDING",340,0,0,0,85]
["TUFTS - TUFTS POS - HCPCS - C1892","TUFTS - TUFTS POS - C1892","TUFTS - TUFTS POS - C1892 - HC SHEATH;GUIDING","TUFTS","TUFTS POS","HCPCS","C1892","HC SHEATH;GUIDING","C1892 - HC SHEATH;GUIDING",340,0,0,0,85]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1892","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1892","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1892 - HC SHEATH;GUIDING","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1892","HC SHEATH;GUIDING","C1892 - HC SHEATH;GUIDING",340,0,0,0,85]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1892","CIGNA HEALTHCARE - CIGNA CARELINK - C1892","CIGNA HEALTHCARE - CIGNA CARELINK - C1892 - HC SHEATH;GUIDING","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1892","HC SHEATH;GUIDING","C1892 - HC SHEATH;GUIDING",340,0,0,0,85]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1893","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1893","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1893 - HC DILATOR SHEATH/VISISHEATH","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1893","HC DILATOR SHEATH/VISISHEATH","C1893 - HC DILATOR SHEATH/VISISHEATH",406,0,0,0,101.5]
["TUFTS - TUFTS PPO - HCPCS - C1893","TUFTS - TUFTS PPO - C1893","TUFTS - TUFTS PPO - C1893 - HC DILATOR SHEATH/VISISHEATH","TUFTS","TUFTS PPO","HCPCS","C1893","HC DILATOR SHEATH/VISISHEATH","C1893 - HC DILATOR SHEATH/VISISHEATH",406,0,0,0,101.5]
["TUFTS - TUFTS SELECT - HCPCS - C1893","TUFTS - TUFTS SELECT - C1893","TUFTS - TUFTS SELECT - C1893 - HC DILATOR SHEATH/VISISHEATH","TUFTS","TUFTS SELECT","HCPCS","C1893","HC DILATOR SHEATH/VISISHEATH","C1893 - HC DILATOR SHEATH/VISISHEATH",406,0,0,0,101.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1893","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1893","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1893 - HC DILATOR SHEATH/VISISHEATH","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1893","HC DILATOR SHEATH/VISISHEATH","C1893 - HC DILATOR SHEATH/VISISHEATH",406,0,0,0,101.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1893","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1893","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1893 - HC DILATOR SHEATH/VISISHEATH","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1893","HC DILATOR SHEATH/VISISHEATH","C1893 - HC DILATOR SHEATH/VISISHEATH",406,0,0,0,101.5]
["TUFTS - TUFTS HMO - HCPCS - C1893","TUFTS - TUFTS HMO - C1893","TUFTS - TUFTS HMO - C1893 - HC DILATOR SHEATH/VISISHEATH","TUFTS","TUFTS HMO","HCPCS","C1893","HC DILATOR SHEATH/VISISHEATH","C1893 - HC DILATOR SHEATH/VISISHEATH",406,0,0,0,101.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1893","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1893","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1893 - HC DILATOR SHEATH/VISISHEATH","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1893","HC DILATOR SHEATH/VISISHEATH","C1893 - HC DILATOR SHEATH/VISISHEATH",406,0,0,0,101.5]
["TUFTS - TUFTS POS - HCPCS - C1893","TUFTS - TUFTS POS - C1893","TUFTS - TUFTS POS - C1893 - HC DILATOR SHEATH/VISISHEATH","TUFTS","TUFTS POS","HCPCS","C1893","HC DILATOR SHEATH/VISISHEATH","C1893 - HC DILATOR SHEATH/VISISHEATH",406,0,0,0,101.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1893","CIGNA HEALTHCARE - CIGNA CARELINK - C1893","CIGNA HEALTHCARE - CIGNA CARELINK - C1893 - HC DILATOR SHEATH/VISISHEATH","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1893","HC DILATOR SHEATH/VISISHEATH","C1893 - HC DILATOR SHEATH/VISISHEATH",406,0,0,0,101.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1894","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1894","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - C1894 - HC INTRO/SHEATH NON-CARD LV2","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1894","HC INTRO/SHEATH NON-CARD LV2","C1894 - HC INTRO/SHEATH NON-CARD LV2",252,0,0,0,63]
["TUFTS - TUFTS SELECT - HCPCS - C1894","TUFTS - TUFTS SELECT - C1894","TUFTS - TUFTS SELECT - C1894 - HC INTRO/SHEATH NON-CARD LV2","TUFTS","TUFTS SELECT","HCPCS","C1894","HC INTRO/SHEATH NON-CARD LV2","C1894 - HC INTRO/SHEATH NON-CARD LV2",252,0,0,0,63]
["TUFTS - TUFTS PPO - HCPCS - C1894","TUFTS - TUFTS PPO - C1894","TUFTS - TUFTS PPO - C1894 - HC INTRO/SHEATH NON-CARD LV2","TUFTS","TUFTS PPO","HCPCS","C1894","HC INTRO/SHEATH NON-CARD LV2","C1894 - HC INTRO/SHEATH NON-CARD LV2",252,0,0,0,63]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1894","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1894","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1894 - HC INTRO/SHEATH NON-CARD LV2","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1894","HC INTRO/SHEATH NON-CARD LV2","C1894 - HC INTRO/SHEATH NON-CARD LV2",252,0,0,0,63]
["TUFTS - TUFTS POS - HCPCS - C1894","TUFTS - TUFTS POS - C1894","TUFTS - TUFTS POS - C1894 - HC INTRO/SHEATH NON-CARD LV2","TUFTS","TUFTS POS","HCPCS","C1894","HC INTRO/SHEATH NON-CARD LV2","C1894 - HC INTRO/SHEATH NON-CARD LV2",252,0,0,0,63]
["TUFTS - TUFTS HMO - HCPCS - C1894","TUFTS - TUFTS HMO - C1894","TUFTS - TUFTS HMO - C1894 - HC INTRO/SHEATH NON-CARD LV2","TUFTS","TUFTS HMO","HCPCS","C1894","HC INTRO/SHEATH NON-CARD LV2","C1894 - HC INTRO/SHEATH NON-CARD LV2",252,0,0,0,63]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1894","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1894","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - C1894 - HC INTRO/SHEATH NON-CARD LV2","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1894","HC INTRO/SHEATH NON-CARD LV2","C1894 - HC INTRO/SHEATH NON-CARD LV2",252,0,0,0,63]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1894","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1894","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1894 - HC INTRO/SHEATH NON-CARD LV2","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1894","HC INTRO/SHEATH NON-CARD LV2","C1894 - HC INTRO/SHEATH NON-CARD LV2",252,0,0,0,63]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1894","CIGNA HEALTHCARE - CIGNA CARELINK - C1894","CIGNA HEALTHCARE - CIGNA CARELINK - C1894 - HC INTRO/SHEATH NON-CARD LV2","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1894","HC INTRO/SHEATH NON-CARD LV2","C1894 - HC INTRO/SHEATH NON-CARD LV2",252,0,0,0,63]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1895","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1895","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C1895 - HC ICD LEAD,2COIL","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1895","HC ICD LEAD,2COIL","C1895 - HC ICD LEAD,2COIL",13382,0,0,0,3345.5]
["TUFTS - TUFTS SELECT - HCPCS - C1895","TUFTS - TUFTS SELECT - C1895","TUFTS - TUFTS SELECT - C1895 - HC ICD LEAD,2COIL","TUFTS","TUFTS SELECT","HCPCS","C1895","HC ICD LEAD,2COIL","C1895 - HC ICD LEAD,2COIL",13382,0,0,0,3345.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1895","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1895","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - C1895 - HC ICD LEAD,2COIL","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1895","HC ICD LEAD,2COIL","C1895 - HC ICD LEAD,2COIL",13382,0,0,0,3345.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - C2616","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - C2616","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","C2616","HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE",60393,47839.61,25512.2,76706.740000000005,15098.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C2634","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C2634","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C2634 - BRACHYTX, NON-STR, HA, I-125","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C2634","BRACHYTX, NON-STR, HA, I-125","C2634 - BRACHYTX, NON-STR, HA, I-125",0,313.02999999999997,232.45,698.88,0]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - C2635","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - C2635","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - C2635 - BRACHYTX, NON-STR, HA, P-103","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","C2635","BRACHYTX, NON-STR, HA, P-103","C2635 - BRACHYTX, NON-STR, HA, P-103",0,78.03,78.03,242.54,0]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C8937","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C8937","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - C8937 - CAD BREAST MRI","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C8937","CAD BREAST MRI","C8937 - CAD BREAST MRI",331,0,0,0,82.75]
["TUFTS - TUFTS POS - HCPCS - C9803","TUFTS - TUFTS POS - C9803","TUFTS - TUFTS POS - C9803 - HC OP VISIT SPEC COLLECTION SEVERE ACUTE RESP SYDROM COVID-19","TUFTS","TUFTS POS","HCPCS","C9803","HC OP VISIT SPEC COLLECTION SEVERE ACUTE RESP SYDROM COVID-19","C9803 - HC OP VISIT SPEC COLLECTION SEVERE ACUTE RESP SYDROM COVID-19",35,87.7,87.7,246.49,8.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D0220","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - D0220","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - D0220 - INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D0220","INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE","D0220 - INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE",165,23.78,23.78,23.78,41.25]
["TUFTS - TUFTS POS - HCPCS - D0473","TUFTS - TUFTS POS - D0473","TUFTS - TUFTS POS - D0473 - HC ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAM, PREP AND TRANS OF RPT.","TUFTS","TUFTS POS","HCPCS","D0473","HC ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAM, PREP AND TRANS OF RPT.","D0473 - HC ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAM, PREP AND TRANS OF RPT.",110,3646.27,1941.26,6187.11,27.5]
["TUFTS - TUFTS HMO - HCPCS - D0480","TUFTS - TUFTS HMO - D0480","TUFTS - TUFTS HMO - D0480 - HC ACCESSION OF EXFOLIATIVE CYTOLOGIC SMEARS, MICROSCOPIC EXAM, PREP AND TRANS OF RPT","TUFTS","TUFTS HMO","HCPCS","D0480","HC ACCESSION OF EXFOLIATIVE CYTOLOGIC SMEARS, MICROSCOPIC EXAM, PREP AND TRANS OF RPT","D0480 - HC ACCESSION OF EXFOLIATIVE CYTOLOGIC SMEARS, MICROSCOPIC EXAM, PREP AND TRANS OF RPT",110,3646.27,1941.26,6187.11,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2150","BLUE CROSS - BLUE CROSS-INDEMNITY - D2150","BLUE CROSS - BLUE CROSS-INDEMNITY - D2150 - AMALGAM - TWO SURFACES, PRIMARY OR PERMANENT","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D2150","AMALGAM - TWO SURFACES, PRIMARY OR PERMANENT","D2150 - AMALGAM - TWO SURFACES, PRIMARY OR PERMANENT",110,126.81,126.81,126.81,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2391","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - D2391","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - D2391 - RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D2391","RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR","D2391 - RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR",110,141.69,141.69,141.69,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2394","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - D2394","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - D2394 - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D2394","RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR","D2394 - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR",110,282.64,282.64,282.64,27.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D3310","BLUE CROSS - BLUE CROSS-PPO - D3310","BLUE CROSS - BLUE CROSS-PPO - D3310 - ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION)","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D3310","ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION)","D3310 - ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION)",110,587.95000000000005,587.95000000000005,587.95000000000005,27.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D3460","CIGNA HEALTHCARE - CIGNA CARELINK - D3460","CIGNA HEALTHCARE - CIGNA CARELINK - D3460 - HC ENDODONTIC ENDOSSEOUS IMPLANT","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D3460","HC ENDODONTIC ENDOSSEOUS IMPLANT","D3460 - HC ENDODONTIC ENDOSSEOUS IMPLANT",1451,4066.77,1275.99,4066.77,362.75]
["TUFTS - TUFTS PPO - HCPCS - D7140","TUFTS - TUFTS PPO - D7140","TUFTS - TUFTS PPO - D7140 - EXTRACTION ERUPTED TOOTH/EXR","TUFTS","TUFTS PPO","HCPCS","D7140","EXTRACTION ERUPTED TOOTH/EXR","D7140 - EXTRACTION ERUPTED TOOTH/EXR",836,2563.83,1275.99,4066.77,209]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D7230","BLUE CROSS - BLUE CROSS-HMO BLUE - D7230","BLUE CROSS - BLUE CROSS-HMO BLUE - D7230 - REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D7230","REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY","D7230 - REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY",836,1510.05,1275.99,4066.77,209]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D7250","CIGNA HEALTHCARE - CIGNA CARELINK - D7250","CIGNA HEALTHCARE - CIGNA CARELINK - D7250 - REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D7250","REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)","D7250 - REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)",836,4066.77,1275.99,4066.77,209]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D9630","CIGNA HEALTHCARE - CIGNA CARELINK - D9630","CIGNA HEALTHCARE - CIGNA CARELINK - D9630 - HC DRUGS OR MEDICAMENTS DISPENSED IN THE OFFICE FOR HOME USE","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D9630","HC DRUGS OR MEDICAMENTS DISPENSED IN THE OFFICE FOR HOME USE","D9630 - HC DRUGS OR MEDICAMENTS DISPENSED IN THE OFFICE FOR HOME USE",110,3340.65,591.51,3340.65,27.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D9951","CIGNA HEALTHCARE - CIGNA CARELINK - D9951","CIGNA HEALTHCARE - CIGNA CARELINK - D9951 - OCCLUSAL ADJUSTMENT - LIMITED","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D9951","OCCLUSAL ADJUSTMENT - LIMITED","D9951 - OCCLUSAL ADJUSTMENT - LIMITED",1350,4066.77,1275.99,4066.77,337.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - G0103","UNITED HEALTHCARE - UNITED HEALTHCARE - G0103","UNITED HEALTHCARE - UNITED HEALTHCARE - G0103 - PSA, TOTAL SCREENING","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,40.67,16.78,181.16,23.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0108","BLUE CROSS - BLUE CROSS-PPO - G0108","BLUE CROSS - BLUE CROSS-PPO - G0108 - DIAB MANAGE TRN  PER INDIV","BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0108","DIAB MANAGE TRN  PER INDIV","G0108 - DIAB MANAGE TRN  PER INDIV",425,136.19,72.41,230.78,106.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0109","BLUE CROSS - BLUE CROSS-HMO BLUE - G0109","BLUE CROSS - BLUE CROSS-HMO BLUE - G0109 - DIAB MANAGE TRN IND/GROUP","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0109","DIAB MANAGE TRN IND/GROUP","G0109 - DIAB MANAGE TRN IND/GROUP",267,37.520000000000003,32.64,134.25,66.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0239","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - G0239","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - G0239 - OTH RESP PROC, GROUP","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0239","OTH RESP PROC, GROUP","G0239 - OTH RESP PROC, GROUP",99,69.349999999999994,53.94,373.41,24.75]
["FALLON - FALLON MEDICAID - HCPCS - G0257","FALLON - FALLON MEDICAID - G0257","FALLON - FALLON MEDICAID - G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP","FALLON","FALLON MEDICAID","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP",911,0,1027.32,3651.55,227.75]
["TUFTS - TUFTS SELECT - HCPCS - G0269","TUFTS - TUFTS SELECT - G0269","TUFTS - TUFTS SELECT - G0269 - HC CLOSURE DEVICE PLACEMENT","TUFTS","TUFTS SELECT","HCPCS","G0269","HC CLOSURE DEVICE PLACEMENT","G0269 - HC CLOSURE DEVICE PLACEMENT",200,0,0,0,50]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - G0279","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - G0279","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - G0279 - TOMOSYNTHESIS, MAMMO","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,64.959999999999994,30.09,295.68,13.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - G0279","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - G0279","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - G0279 - TOMOSYNTHESIS, MAMMO","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,75.709999999999994,30.09,295.68,13.75]
["TUFTS - TUFTS SELECT - HCPCS - G0378","TUFTS - TUFTS SELECT - G0378","TUFTS - TUFTS SELECT - G0378 - HOSPITAL OBSERVATION PER HR","TUFTS","TUFTS SELECT","HCPCS","G0378","HOSPITAL OBSERVATION PER HR","G0378 - HOSPITAL OBSERVATION PER HR",319,0,0,0,79.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0396","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - G0396","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - G0396 - ALCOHOL/SUBS INTERV 15-30MN","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN","G0396 - ALCOHOL/SUBS INTERV 15-30MN",42,0,56.05,336.32,10.5]
["TUFTS - TUFTS SELECT - HCPCS - G0397","TUFTS - TUFTS SELECT - G0397","TUFTS - TUFTS SELECT - G0397 - ALCOHOL/SUBS INTERV >30 MIN","TUFTS","TUFTS SELECT","HCPCS","G0397","ALCOHOL/SUBS INTERV >30 MIN","G0397 - ALCOHOL/SUBS INTERV >30 MIN",118,144.46,128.29,815.89,29.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0420","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - G0420","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - G0420 - HC ED SVC CKD IND PER SESSION","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0420","HC ED SVC CKD IND PER SESSION","G0420 - HC ED SVC CKD IND PER SESSION",156,0,184.9,589.33000000000004,39]
["TUFTS - TUFTS HMO - HCPCS - G0421","TUFTS - TUFTS HMO - G0421","TUFTS - TUFTS HMO - G0421 - HC ED SVC CKD GRP PER SESSION","TUFTS","TUFTS HMO","HCPCS","G0421","HC ED SVC CKD GRP PER SESSION","G0421 - HC ED SVC CKD GRP PER SESSION",37,80.23,42.72,136.13999999999999,9.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0424","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - G0424","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - G0424 - PULMONARY REHAB W EXER","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0424","PULMONARY REHAB W EXER","G0424 - PULMONARY REHAB W EXER",284,117.73,93.87,343.09,71]
["TUFTS - TUFTS HMO - HCPCS - G0443","TUFTS - TUFTS HMO - G0443","TUFTS - TUFTS HMO - G0443 - BRIEF ALCOHOL MISUSE COUNSEL","TUFTS","TUFTS HMO","HCPCS","G0443","BRIEF ALCOHOL MISUSE COUNSEL","G0443 - BRIEF ALCOHOL MISUSE COUNSEL",118,21.18,18.52,33.6,29.5]
["FALLON - FALLON MEDICAID - HCPCS - G0444","FALLON - FALLON MEDICAID - G0444","FALLON - FALLON MEDICAID - G0444 - DEPRESSION SCREEN ANNUAL","FALLON","FALLON MEDICAID","HCPCS","G0444","DEPRESSION SCREEN ANNUAL","G0444 - DEPRESSION SCREEN ANNUAL",42,0,8.9,16.149999999999999,10.5]
["TUFTS - TUFTS HMO - HCPCS - G0480","TUFTS - TUFTS HMO - G0480","TUFTS - TUFTS HMO - G0480 - DRUG TEST DEF 1-7 CLASSES","TUFTS","TUFTS HMO","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,388.52,59.69,973.54,63.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0480","BMC HEALTHNET - BMCHN QHP - G0480","BMC HEALTHNET - BMCHN QHP - G0480 - DRUG TEST DEF 1-7 CLASSES","BMC HEALTHNET","BMCHN QHP","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,71.63,59.69,973.54,63.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0481","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - G0481","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - G0481 - DRUG TEST DEF 8-14 CLASSES","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,286.56,91.84,1332.11,48]
["FALLON - FALLON MEDICAID - HCPCS - G0514","FALLON - FALLON MEDICAID - G0514","FALLON - FALLON MEDICAID - G0514 - HC PROLONG PREV SVCS, ADDL 30M","FALLON","FALLON MEDICAID","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M","G0514 - HC PROLONG PREV SVCS, ADDL 30M",84,0,148.6,148.6,21]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0514","BLUE CROSS - BLUE CROSS-HMO BLUE - G0514","BLUE CROSS - BLUE CROSS-HMO BLUE - G0514 - HC PROLONG PREV SVCS, ADDL 30M","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M","G0514 - HC PROLONG PREV SVCS, ADDL 30M",84,148.6,148.6,148.6,21]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - G2023","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - G2023","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,50.65,23.46,212.71,7.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - G2023","AETNA - AETNA-MEDICARE ADVANTAGE - G2023","AETNA - AETNA-MEDICARE ADVANTAGE - G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,27.68,23.46,212.71,7.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G2066","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - G2066","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH",165,58.35,58.35,370.47,41.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G2212","BMC HEALTHNET - BMCHN ACO - G2212","BMC HEALTHNET - BMCHN ACO - G2212 - HC PROLONG OUTPT/OFFICE VIS","BMC HEALTHNET","BMCHN ACO","HCPCS","G2212","HC PROLONG OUTPT/OFFICE VIS","G2212 - HC PROLONG OUTPT/OFFICE VIS",188,0,0,0,47]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - J0702","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - J0702","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - J0702 - HC BETAMETHASONE ACET&SOD PHOSP","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - J1030","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - J1030","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.69,23.59,26.88,6.72]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - J1250","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - J1250","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - J1250 - HC DOBUTAMINE SDV/250MG","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - J2790","ELDER SERVICE PLAN - ELEMENT CARE INC - J2790","ELDER SERVICE PLAN - ELEMENT CARE INC - J2790 - HC IG;RHO D,HUMAN/300MCG","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - J7307","BLUE CROSS - BLUE CROSS-INDEMNITY - J7307","BLUE CROSS - BLUE CROSS-INDEMNITY - J7307 - HC ETONOGESTREL IMPLANT SYSTEM","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM","J7307 - HC ETONOGESTREL IMPLANT SYSTEM",3487,3324.9,3162.8,3487,871.75]
["TUFTS - TUFTS HMO - HCPCS - L0120","TUFTS - TUFTS HMO - L0120","TUFTS - TUFTS HMO - L0120 - CERV FLEXIBLE NON-ADJUSTABLE","TUFTS","TUFTS HMO","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,44.54,24.86,111.59,6.25]
["TUFTS - TUFTS SPIRIT - HCPCS - L1820","TUFTS - TUFTS SPIRIT - L1820","TUFTS - TUFTS SPIRIT - L1820 - KO ELAS W/ CONDYLE PADS & JO","TUFTS","TUFTS SPIRIT","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,156.85,142.59,640.03,39.75]
["TUFTS - TUFTS PPO - HCPCS - L1830","TUFTS - TUFTS PPO - L1830","TUFTS - TUFTS PPO - L1830 - KO IMMOBILIZER CANVAS LONGIT","TUFTS","TUFTS PPO","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,130.88,81.95,367.86,19.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L1832","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - L1832","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - L1832 - KO ADJ JNT POS RIGID SUPPORT","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,0,743.59,3337.75,380.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L1836","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - L1836","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - L1836 - HC RIGID KO WO JOINTS","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,130.47999999999999,130.47999999999999,585.70000000000005,52.25]
["TUFTS - TUFTS SELECT - HCPCS - L1902","TUFTS - TUFTS SELECT - L1902","TUFTS - TUFTS SELECT - L1902 - AFO ANKLE GAUNTLET","TUFTS","TUFTS SELECT","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,128.6,86.14,386.65,54.75]
["FALLON - FALLON MEDICAID - HCPCS - L3350","FALLON - FALLON MEDICAID - L3350","FALLON - FALLON MEDICAID - L3350 - SHOE HEEL WEDGE","FALLON","FALLON MEDICAID","HCPCS","L3350","SHOE HEEL WEDGE","L3350 - SHOE HEEL WEDGE",41,0,22.41,100.59,10.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3350","BMC HEALTHNET - BMCHN MEDICAID - L3350","BMC HEALTHNET - BMCHN MEDICAID - L3350 - SHOE HEEL WEDGE","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L3350","SHOE HEEL WEDGE","L3350 - SHOE HEEL WEDGE",41,0,22.41,100.59,10.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3670","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - L3670","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - L3670 - ACROMIO/CLAVICULAR CANVAS&WE","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,124.38,103.65,465.27,725.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L3760","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - L3760","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - L3760 - EO WITHJOINT, PREFABRICATED","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,599.98,445.02,1997.57,204.75]
["TUFTS - TUFTS SPIRIT - HCPCS - L3762","TUFTS - TUFTS SPIRIT - L3762","TUFTS - TUFTS SPIRIT - L3762 - RIGID EO WO JOINTS","TUFTS","TUFTS SPIRIT","HCPCS","L3762","RIGID EO WO JOINTS","L3762 - RIGID EO WO JOINTS",57,105.25,95.68,429.49,14.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L3807","BLUE CROSS - BLUE CROSS-PPO - L3807","BLUE CROSS - BLUE CROSS-PPO - L3807 - WHFO,NO JOINT, PREFABRICATED","BLUE CROSS","BLUE CROSS-PPO","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,323.87,222.52,998.85,120.75]
["TUFTS - TUFTS POS - HCPCS - L3808","TUFTS - TUFTS POS - L3808","TUFTS - TUFTS POS - L3808 - HC EPITRAIN","TUFTS","TUFTS POS","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,561.25,375.94,1687.5,127.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L3905","BLUE CROSS - BLUE CROSS-HMO BLUE - L3905","BLUE CROSS - BLUE CROSS-HMO BLUE - L3905 - HC WHO W/NONTORSION JNT(S) CF","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,1284.45,882.51,3961.32,610.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L3967","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - L3967","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - L3967 - HC SEWHO AIRPLANE W/O JNTS CF","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,1765.23,1765.23,7923.54,29.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L3980","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - L3980","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - L3980 - HC UPP EXT FX ORTHOSIS HUMERAL","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,453.41,377.84,1695.98,33]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L3982","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - L3982","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",176,398.23,398.23,1787.56,44]
["TUFTS - TUFTS HMO - HCPCS - L4360","TUFTS - TUFTS HMO - L4360","TUFTS - TUFTS HMO - L4360 - PNEUMATI WALKING BOOT PREFAB","TUFTS","TUFTS HMO","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,619.55999999999995,345.83,1552.36,139.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L4360","BLUE CROSS - BLUE CROSS-INDEMNITY - L4360","BLUE CROSS - BLUE CROSS-INDEMNITY - L4360 - PNEUMATI WALKING BOOT PREFAB","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,503.35,345.83,1552.36,139.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L4386","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - L4386","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - L4386 - NON-PNEUM WALK BOOT PREFAB","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,342.58,155.02000000000001,695.83,41.25]
["TUFTS - TUFTS PPO - HCPCS - L4396","TUFTS - TUFTS PPO - L4396","TUFTS - TUFTS PPO - L4396 - STATIC AFO","TUFTS","TUFTS PPO","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,273.75,171.42,769.43,101.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L4398","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - L4398","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - L4398 - HC FOOT DROP SPLINT RECUMBENT","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,174.4,78.92,354.25,101.5]
["TUFTS - TUFTS POS - HCPCS - L8507","TUFTS - TUFTS POS - L8507","TUFTS - TUFTS POS - L8507 - HC PROLARYNX VOICE (PLUS)","TUFTS","TUFTS POS","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)","L8507 - HC PROLARYNX VOICE (PLUS)",1604,61.25,41.03,184.14,401]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L8507","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - L8507","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - L8507 - HC PROLARYNX VOICE (PLUS)","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)","L8507 - HC PROLARYNX VOICE (PLUS)",1604,103.24,41.03,184.14,401]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L8514","BMC HEALTHNET - BMCHN MCO - L8514","BMC HEALTHNET - BMCHN MCO - L8514 - REPL TRACH PUNCTURE DILATOR","BMC HEALTHNET","BMCHN MCO","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR","L8514 - REPL TRACH PUNCTURE DILATOR",387,0,92.38,414.69,96.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L8693","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - L8693","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - L8693 - HC AUD OSSEO DEV, ABUTMENT","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,2002.85,1485.57,6668.25,365.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - M0239","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - M0239","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",393,518.74,309.60000000000002,779.02,98.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9012","BLUE CROSS - BLUE CROSS-HMO BLUE - P9012","BLUE CROSS - BLUE CROSS-HMO BLUE - P9012 - HC CRYOPRECIPITATE UNIT","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","P9012","HC CRYOPRECIPITATE UNIT","P9012 - HC CRYOPRECIPITATE UNIT",134,64.959999999999994,64.959999999999994,125.33,33.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9016","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - P9016","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - P9016 - HC RBC:LEU-RED","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","P9016","HC RBC:LEU-RED","P9016 - HC RBC:LEU-RED",576,243.01,243.01,478.65,144]
["TUFTS - TUFTS POS - HCPCS - P9037","TUFTS - TUFTS POS - P9037","TUFTS - TUFTS POS - P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT","TUFTS","TUFTS POS","HCPCS","P9037","HC PLT:PHER,LEU-RED,IRR/UNIT","P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT",939,956.33,821.84,1622.67,234.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9040","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - P9040","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - P9040 - HC RBC:LEU-RED,IRR/UNIT","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","P9040","HC RBC:LEU-RED,IRR/UNIT","P9040 - HC RBC:LEU-RED,IRR/UNIT",523,336.11,336.11,669.97,130.75]
["TUFTS - TUFTS HMO - HCPCS - P9047","TUFTS - TUFTS HMO - P9047","TUFTS - TUFTS HMO - P9047 - HC ALBUMIN (HUMAN) 25% 50ML","TUFTS","TUFTS HMO","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9073","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - P9073","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - P9073 - HC PLATELETS PHERESIS PATH REDU","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","P9073","HC PLATELETS PHERESIS PATH REDU","P9073 - HC PLATELETS PHERESIS PATH REDU",889,821.84,821.84,2619.59,222.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9100","BLUE CROSS - BLUE CROSS-HMO BLUE - P9100","BLUE CROSS - BLUE CROSS-HMO BLUE - P9100 - PATHOGEN TEST FOR PLATELETS","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","P9100","PATHOGEN TEST FOR PLATELETS","P9100 - PATHOGEN TEST FOR PLATELETS",1310,33.53,33.53,256.64,327.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q0091","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - Q0091","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - Q0091 - HC OBTAINING SCREEN PAP SMEAR","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR","Q0091 - HC OBTAINING SCREEN PAP SMEAR",83,28.83,28.83,175.66,20.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q0111","BMC HEALTHNET - BMCHN MCO - Q0111","BMC HEALTHNET - BMCHN MCO - Q0111 - HC WET MOUNTS W PREPARATIONS","BMC HEALTHNET","BMCHN MCO","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,5.41,5.86,127.48,5.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - Q0114","UNITED HEALTHCARE - UNITED HEALTHCARE - Q0114","UNITED HEALTHCARE - UNITED HEALTHCARE - Q0114 - HC  FERN TEST","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,20.51,7.2,82.86,10.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q3014","BMC HEALTHNET - BMCHN MEDICAID - Q3014","BMC HEALTHNET - BMCHN MEDICAID - Q3014 - HC TELEHEALTH FACILITY FEE","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE","Q3014 - HC TELEHEALTH FACILITY FEE",67,0,26.65,67.06,16.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q4101","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - Q4101","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - Q4101 - APLIGRAF","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,0,30.46,76.64,400.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q4102","TUFTS - TUFTS MEDICARE PREFERRED HMO - Q4102","TUFTS - TUFTS MEDICARE PREFERRED HMO - Q4102 - OASIS WOUND MATRIX","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,14.8,10.210000000000001,25.69,17.25]
["UNICARE - UNICARE - HCPCS - Q4116","UNICARE - UNICARE - Q4116","UNICARE - UNICARE - Q4116 - HC ALLODERM 8 X 16 MEDIUM","UNICARE","UNICARE","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM","Q4116 - HC ALLODERM 8 X 16 MEDIUM",5248,32.29,32.29,35.78,1312]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q4116","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - Q4116","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - Q4116 - HC ALLODERM 8 X 16 MEDIUM","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM","Q4116 - HC ALLODERM 8 X 16 MEDIUM",5248,35.78,32.29,35.78,1312]
["TUFTS - TUFTS SELECT - HCPCS - Q4130","TUFTS - TUFTS SELECT - Q4130","TUFTS - TUFTS SELECT - Q4130 - PR STRATTICE TM","TUFTS","TUFTS SELECT","HCPCS","Q4130","PR STRATTICE TM","Q4130 - PR STRATTICE TM",65718,0,45.89,45.89,16429.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q4130","BLUE CROSS - BLUE CROSS-PPO - Q4130","BLUE CROSS - BLUE CROSS-PPO - Q4130 - PR STRATTICE TM","BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q4130","PR STRATTICE TM","Q4130 - PR STRATTICE TM",65718,45.89,45.89,45.89,16429.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q4133","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - Q4133","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,151.77000000000001,131.97,332.06,939]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q9954","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - Q9954","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - Q9954 - ORAL MR CONTRAST, 100 ML","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML","Q9954 - ORAL MR CONTRAST, 100 ML",0,0,12.1,13.41,0]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q9954","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - Q9954","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - Q9954 - ORAL MR CONTRAST, 100 ML","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML","Q9954 - ORAL MR CONTRAST, 100 ML",0,0,12.1,13.41,0]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - Q9957","TUFTS - TUFTS MEDICARE SCO - Q9957","TUFTS - TUFTS MEDICARE SCO - Q9957 - HC INJ;PERFLUTR LIP MIC/1ML","TUFTS","TUFTS MEDICARE SCO","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,69.06,47.63,119.85,104.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q9957","BLUE CROSS - BLUE CROSS-INDEMNITY - Q9957","BLUE CROSS - BLUE CROSS-INDEMNITY - Q9957 - HC INJ;PERFLUTR LIP MIC/1ML","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,54.77,47.63,119.85,104.25]
["TUFTS - TUFTS SPIRIT - HCPCS - Q9961","TUFTS - TUFTS SPIRIT - Q9961","TUFTS - TUFTS SPIRIT - Q9961 - HOCM 250-299MG/ML IODINE,1ML","TUFTS","TUFTS SPIRIT","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0.28000000000000003,0.25,0.63,0.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q9963","BMC HEALTHNET - BMCHN QHP - Q9963","BMC HEALTHNET - BMCHN QHP - Q9963 - HOCM 350-399MG/ML IODINE,1ML","BMC HEALTHNET","BMCHN QHP","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q9963","BLUE CROSS - BLUE CROSS-HMO BLUE - Q9963","BLUE CROSS - BLUE CROSS-HMO BLUE - Q9963 - HOCM 350-399MG/ML IODINE,1ML","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["FALLON - FALLON MEDICAID - HCPCS - Q9967","FALLON - FALLON MEDICAID - Q9967","FALLON - FALLON MEDICAID - Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","FALLON","FALLON MEDICAID","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - S5101","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - S5101","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - S5101 - HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","S5101","HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)","S5101 - HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)",63,0,0,0,15.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - S8037","BMC HEALTHNET - BMCHN MCO - S8037","BMC HEALTHNET - BMCHN MCO - S8037 - MRCP","BMC HEALTHNET","BMCHN MCO","HCPCS","S8037","MRCP","S8037 - MRCP",1440,0,585.76,3771.6,360]
["FALLON - FALLON SENIOR PLAN - HCPCS - U0002","FALLON - FALLON SENIOR PLAN - U0002","FALLON - FALLON SENIOR PLAN - U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","FALLON","FALLON SENIOR PLAN","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,51.31,51.31,465.19,23]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - U0002","AETNA - AETNA-MEDICARE ADVANTAGE - U0002","AETNA - AETNA-MEDICARE ADVANTAGE - U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,60.55,51.31,465.19,23]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 10005","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 10005","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 10005 - HC FNA BX W/US GDN 1ST LES","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","10005","HC FNA BX W/US GDN 1ST LES","10005 - HC FNA BX W/US GDN 1ST LES",892,972.93,684.11,2032.26,223]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 10005","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 10005","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 10005 - HC FNA BX W/US GDN 1ST LES","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","10005","HC FNA BX W/US GDN 1ST LES","10005 - HC FNA BX W/US GDN 1ST LES",892,1250.8,684.11,2032.26,223]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 10009","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 10009","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 10009 - HC FNA BX W/CT GDN 1ST LES","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","10009","HC FNA BX W/CT GDN 1ST LES","10009 - HC FNA BX W/CT GDN 1ST LES",892,1250.8,684.11,2032.26,223]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 10021","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 10021","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 10021 - FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","10021","FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE","10021 - FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE",538,527.46,317.70999999999998,1198.25,134.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 10030","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 10030","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 10030 - IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","10030","IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE","10030 - IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE",1149,1250.8,317.70999999999998,1500.85,287.25]
["BMC HEALTHNET - BMCHN QHP - CPT - 10040","BMC HEALTHNET - BMCHN QHP - 10040","BMC HEALTHNET - BMCHN QHP - 10040 - ACNE SURGERY","BMC HEALTHNET","BMCHN QHP","CPT","10040","ACNE SURGERY","10040 - ACNE SURGERY",681,0,171.09,508.23,170.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 10060","BLUE CROSS - BLUE CROSS-HMO BLUE - 10060","BLUE CROSS - BLUE CROSS-HMO BLUE - 10060 - INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","10060","INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE","10060 - INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE",729,296.32,296.32,1198.25,182.25]
["TUFTS - TUFTS POS - CPT - 10081","TUFTS - TUFTS POS - 10081","TUFTS - TUFTS POS - 10081 - INCISION & DRAINAGE PILONIDAL CYST COMPLICATED","TUFTS","TUFTS POS","CPT","10081","INCISION & DRAINAGE PILONIDAL CYST COMPLICATED","10081 - INCISION & DRAINAGE PILONIDAL CYST COMPLICATED",1356,2058.17,972.93,3264.67,339]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 10160","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 10160","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","10160","PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST",729,527.46,317.70999999999998,1198.25,182.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 10160","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 10160","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","10160","PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST",729,678.1,317.70999999999998,1198.25,182.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11012","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 11012","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 11012 - HC DBRDMT FX&/DISLC SUBQ T/M/F BONE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11012","HC DBRDMT FX&/DISLC SUBQ T/M/F BONE","11012 - HC DBRDMT FX&/DISLC SUBQ T/M/F BONE",3490,4621.25,684.11,4621.25,872.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11043","BLUE CROSS - BLUE CROSS-INDEMNITY - 11043","BLUE CROSS - BLUE CROSS-INDEMNITY - 11043 - DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11043","DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<","11043 - DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<",1202,810.95,317.70999999999998,1500.85,300.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11045","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 11045","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 11045 - DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11045","DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM","11045 - DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM",206,0,65.06,1198.25,51.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11056","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 11056","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 11056 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11056","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4","11056 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4",171,296.32,171.09,1198.25,42.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11057","BLUE CROSS - BLUE CROSS-INDEMNITY - 11057","BLUE CROSS - BLUE CROSS-INDEMNITY - 11057 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11057","PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4","11057 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4",273,296.32,296.32,1198.25,68.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11104","CIGNA HEALTHCARE - CIGNA CARELINK - 11104","CIGNA HEALTHCARE - CIGNA CARELINK - 11104 - HC PUNCH BX SKIN SINGLE LESION","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11104","HC PUNCH BX SKIN SINGLE LESION","11104 - HC PUNCH BX SKIN SINGLE LESION",272,943.8,296.32,1198.25,68]
["TUFTS - TUFTS SELECT - CPT - 11107","TUFTS - TUFTS SELECT - 11107","TUFTS - TUFTS SELECT - 11107 - HC INCAL BX SKN EA SEP/ADDL","TUFTS","TUFTS SELECT","CPT","11107","HC INCAL BX SKN EA SEP/ADDL","11107 - HC INCAL BX SKN EA SEP/ADDL",236,0,80.709999999999994,1198.25,59]
["TUFTS - TUFTS POS - CPT - 11200","TUFTS - TUFTS POS - 11200","TUFTS - TUFTS POS - 11200 - REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15","TUFTS","TUFTS POS","CPT","11200","REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15","11200 - REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15",559,595.01,296.32,1198.25,139.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11303","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 11303","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 11303 - SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11303","SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM","11303 - SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM",570,678.1,317.70999999999998,943.8,142.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11307","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 11307","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 11307 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11307","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM","11307 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM",487,296.32,171.09,508.23,121.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11310","BLUE CROSS - BLUE CROSS-PPO - 11310","BLUE CROSS - BLUE CROSS-PPO - 11310 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<","BLUE CROSS","BLUE CROSS-PPO","CPT","11310","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<","11310 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<",334,296.32,171.09,508.23,83.5]
["TUFTS - TUFTS PPO - CPT - 11313","TUFTS - TUFTS PPO - 11313","TUFTS - TUFTS PPO - 11313 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM","TUFTS","TUFTS PPO","CPT","11313","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM","11313 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM",750,595.01,317.70999999999998,943.8,187.5]
["TUFTS - TUFTS HMO - CPT - 11400","TUFTS - TUFTS HMO - 11400","TUFTS - TUFTS HMO - 11400 - EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<","TUFTS","TUFTS HMO","CPT","11400","EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<","11400 - EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<",611,1281.21,684.11,2032.26,152.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11404","BLUE CROSS - BLUE CROSS-PPO - 11404","BLUE CROSS - BLUE CROSS-PPO - 11404 - EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM","BLUE CROSS","BLUE CROSS-PPO","CPT","11404","EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM","11404 - EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM",1972,2309.9699999999998,1098.98,3264.67,493]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11406","BLUE CROSS - BLUE CROSS-HMO BLUE - 11406","BLUE CROSS - BLUE CROSS-HMO BLUE - 11406 - EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11406","EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM","11406 - EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM",1873,2309.9699999999998,1500.85,7703.8,468.25]
["TUFTS - TUFTS POS - CPT - 11422","TUFTS - TUFTS POS - 11422","TUFTS - TUFTS POS - 11422 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM","TUFTS","TUFTS POS","CPT","11422","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM","11422 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM",1039,2058.17,1098.98,3264.67,259.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11426","CIGNA HEALTHCARE - CIGNA CARELINK - 11426","CIGNA HEALTHCARE - CIGNA CARELINK - 11426 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11426","EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM","11426 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM",2987,7703.8,1500.85,7703.8,746.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11440","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 11440","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 11440 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11440","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<","11440 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<",792,1220.0899999999999,684.11,2032.26,198]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11444","CIGNA HEALTHCARE - CIGNA CARELINK - 11444","CIGNA HEALTHCARE - CIGNA CARELINK - 11444 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11444","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM","11444 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM",1752,3264.67,1098.98,3264.67,438]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11446","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 11446","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 11446 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11446","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM","11446 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM",2492,3994.03,1500.85,7703.8,623]
["TUFTS - TUFTS POS - CPT - 11470","TUFTS - TUFTS POS - 11470","TUFTS - TUFTS POS - 11470 - EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR","TUFTS","TUFTS POS","CPT","11470","EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR","11470 - EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR",2987,4856.75,1500.85,7703.8,746.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11603","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 11603","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 11603 - EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11603","EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<","11603 - EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<",1505,972.93,972.93,3264.67,376.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11604","BLUE CROSS - BLUE CROSS-INDEMNITY - 11604","BLUE CROSS - BLUE CROSS-INDEMNITY - 11604 - EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11604","EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM","11604 - EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM",1656,972.93,972.93,7703.8,414]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11621","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 11621","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 11621 - HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11621","HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM","11621 - HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM",860,972.93,684.11,2032.26,215]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11622","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 11622","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 11622 - EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11622","EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM","11622 - EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM",1324,1250.8,972.93,3264.67,331]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11626","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 11626","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 11626 - EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11626","EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM","11626 - EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM",2987,4621.25,1500.85,7703.8,746.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11644","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 11644","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 11644 - EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11644","EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM","11644 - EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM",2210,2672.73,1500.85,7703.8,552.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11646","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 11646","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 11646 - EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11646","EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM","11646 - EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM",3063,3994.03,1500.85,7703.8,765.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11730","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 11730","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 11730 - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11730","AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1","11730 - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1",383,296.32,296.32,1198.25,95.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11730","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 11730","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 11730 - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11730","AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1","11730 - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1",383,380.96,296.32,1198.25,95.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11755","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 11755","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 11755 - BIOPSY NAIL UNIT SEPARATE PROCEDURE","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11755","BIOPSY NAIL UNIT SEPARATE PROCEDURE","11755 - BIOPSY NAIL UNIT SEPARATE PROCEDURE",600,972.93,684.11,2032.26,150]
["AETNA - AETNA - CPT - 11765","AETNA - AETNA - 11765","AETNA - AETNA - 11765 - WEDGE EXCISION SKIN NAIL FOLD","AETNA","AETNA","CPT","11765","WEDGE EXCISION SKIN NAIL FOLD","11765 - WEDGE EXCISION SKIN NAIL FOLD",704,1198.25,317.70999999999998,1198.25,176]
["TUFTS - TUFTS POS - CPT - 11772","TUFTS - TUFTS POS - 11772","TUFTS - TUFTS POS - 11772 - EXCISION PILONIDAL CYST/SINUS COMPLICATED","TUFTS","TUFTS POS","CPT","11772","EXCISION PILONIDAL CYST/SINUS COMPLICATED","11772 - EXCISION PILONIDAL CYST/SINUS COMPLICATED",4398,7467.76,1990.62,11845.41,1099.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 11922","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 11922","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","11922","HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",371,0,73.66,1198.25,92.75]
["TUFTS - TUFTS PPO - CPT - 11922","TUFTS - TUFTS PPO - 11922","TUFTS - TUFTS PPO - 11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","TUFTS","TUFTS PPO","CPT","11922","HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",371,0,73.66,1198.25,92.75]
["AETNA - AETNA - CPT - 11982","AETNA - AETNA - 11982","AETNA - AETNA - 11982 - REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","AETNA","AETNA","CPT","11982","REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11982 - REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",734,1198.25,317.70999999999998,1198.25,183.5]
["TUFTS - TUFTS HMO - CPT - 12002","TUFTS - TUFTS HMO - 12002","TUFTS - TUFTS HMO - 12002 - SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM","TUFTS","TUFTS HMO","CPT","12002","SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM","12002 - SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM",454,595.01,296.32,943.8,113.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 12004","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 12004","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 12004 - SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","12004","SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM","12004 - SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM",565,380.96,296.32,3264.67,141.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 12006","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 12006","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 12006 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","12006","SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM","12006 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM",930,678.1,527.46,7703.8,232.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 12013","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 12013","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 12013 - SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","12013","SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM","12013 - SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM",476,296.32,296.32,3264.67,119]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 12016","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 12016","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 12016 - SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","12016","SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM","12016 - SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM",1029,527.46,527.46,7703.8,257.25]
["TUFTS - TUFTS PPO - CPT - 12020","TUFTS - TUFTS PPO - 12020","TUFTS - TUFTS PPO - 12020 - TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE","TUFTS","TUFTS PPO","CPT","12020","TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE","12020 - TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE",1435,1281.21,684.11,2032.26,358.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 12021","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 12021","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 12021 - TX SUPERFICIAL WOUND DEHISCENCE W/PACKING","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","12021","TX SUPERFICIAL WOUND DEHISCENCE W/PACKING","12021 - TX SUPERFICIAL WOUND DEHISCENCE W/PACKING",1090,661.45,527.46,2032.26,272.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 12035","BLUE CROSS - BLUE CROSS-PPO - 12035","BLUE CROSS - BLUE CROSS-PPO - 12035 - REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM","BLUE CROSS","BLUE CROSS-PPO","CPT","12035","REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM","12035 - REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM",1839,527.46,527.46,2032.26,459.75]
["TUFTS - TUFTS SELECT - CPT - 12041","TUFTS - TUFTS SELECT - 12041","TUFTS - TUFTS SELECT - 12041 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<","TUFTS","TUFTS SELECT","CPT","12041","REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<","12041 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<",1204,317.70999999999998,317.70999999999998,1198.25,301]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 12044","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 12044","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 12044 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","12044","REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM","12044 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM",1648,1042.56,684.11,2032.26,412]
["AETNA - AETNA - CPT - 12047","AETNA - AETNA - 12047","AETNA - AETNA - 12047 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM","AETNA","AETNA","CPT","12047","REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM","12047 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM",2627,1500.85,684.11,3344.2,656.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 12051","BLUE CROSS - BLUE CROSS-HMO BLUE - 12051","BLUE CROSS - BLUE CROSS-HMO BLUE - 12051 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","12051","REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<","12051 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<",1324,527.46,527.46,2032.26,331]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 12054","CIGNA HEALTHCARE - CIGNA CARELINK - 12054","CIGNA HEALTHCARE - CIGNA CARELINK - 12054 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","12054","REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM","12054 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM",1758,943.8,317.70999999999998,1500.85,439.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 13100","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 13100","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 13100 - REPAIR COMPLEX TRUNK 1.1-2.5 CM","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","13100","REPAIR COMPLEX TRUNK 1.1-2.5 CM","13100 - REPAIR COMPLEX TRUNK 1.1-2.5 CM",1793,810.95,684.11,2032.26,448.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 13100","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 13100","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 13100 - REPAIR COMPLEX TRUNK 1.1-2.5 CM","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","13100","REPAIR COMPLEX TRUNK 1.1-2.5 CM","13100 - REPAIR COMPLEX TRUNK 1.1-2.5 CM",1793,1042.56,684.11,2032.26,448.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 13121","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 13121","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 13121 - REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","13121","REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM","13121 - REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM",2517,810.95,684.11,2032.26,629.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 13122","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 13122","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 13122 - REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","13122","REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<","13122 - REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<",661,213.81,213.81,1198.25,165.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 13133","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 13133","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 13133 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","13133","REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<","13133 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<",1015,0,326.66000000000003,1198.25,253.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 14000","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 14000","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 14000 - ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","14000","ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<","14000 - ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<",3904,2601.27,1500.85,7703.8,976]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 14001","BLUE CROSS - BLUE CROSS-INDEMNITY - 14001","BLUE CROSS - BLUE CROSS-INDEMNITY - 14001 - ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","14001","ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM","14001 - ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM",5072,2601.27,1990.62,11845.41,1268]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 14040","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 14040","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 14040 - ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","14040","ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<","14040 - ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<",4928,3344.2,1500.85,7703.8,1232]
["TUFTS - TUFTS HMO - CPT - 14041","TUFTS - TUFTS HMO - 14041","TUFTS - TUFTS HMO - 14041 - ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM","TUFTS","TUFTS HMO","CPT","14041","ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM","14041 - ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM",6040,7467.76,1990.62,11845.41,1510]
["AETNA - AETNA - CPT - 14302","AETNA - AETNA - 14302","AETNA - AETNA - 14302 - ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM/<","AETNA","AETNA","CPT","14302","ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM/<","14302 - ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM/<",1598,1198.25,548.05999999999995,1198.25,399.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 15004","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 15004","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 15004 - PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","15004","PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT","15004 - PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT",2072,810.95,684.11,2032.26,518]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 15050","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 15050","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 15050 - PINCH GRAFT 1/MLT SM ULCER TIP/OTH AREA 2CM","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","15050","PINCH GRAFT 1/MLT SM ULCER TIP/OTH AREA 2CM","15050 - PINCH GRAFT 1/MLT SM ULCER TIP/OTH AREA 2CM",3469,810.95,684.11,2032.26,867.25]
["TUFTS - TUFTS PPO - CPT - 15220","TUFTS - TUFTS PPO - 15220","TUFTS - TUFTS PPO - 15220 - HC FULL THICK GRFT SCALP, ARM, LEG, <20SQC","TUFTS","TUFTS PPO","CPT","15220","HC FULL THICK GRFT SCALP, ARM, LEG, <20SQC","15220 - HC FULL THICK GRFT SCALP, ARM, LEG, <20SQC",4788,4856.75,1500.85,7703.8,1197]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 15271","BLUE CROSS - BLUE CROSS-HMO BLUE - 15271","BLUE CROSS - BLUE CROSS-HMO BLUE - 15271 - APP SKN SUB GRFT T/A/L AREA/100SCM /<1ST 25","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","15271","APP SKN SUB GRFT T/A/L AREA/100SCM /<1ST 25","15271 - APP SKN SUB GRFT T/A/L AREA/100SCM /<1ST 25",2356,2601.27,1098.98,3344.2,589]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 15272","BLUE CROSS - BLUE CROSS-PPO - 15272","BLUE CROSS - BLUE CROSS-PPO - 15272 - APP SKN SUB GRFT T/A/L AREA/100SCM EA ADL 25SC","BLUE CROSS","BLUE CROSS-PPO","CPT","15272","APP SKN SUB GRFT T/A/L AREA/100SCM EA ADL 25SC","15272 - APP SKN SUB GRFT T/A/L AREA/100SCM EA ADL 25SC",133,42.82,42.82,1198.25,33.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 15275","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 15275","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 15275 - SUB GRFT F/S/N/H/F/G/M/D <100SCM 1ST 25 SCM","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","15275","SUB GRFT F/S/N/H/F/G/M/D <100SCM 1ST 25 SCM","15275 - SUB GRFT F/S/N/H/F/G/M/D <100SCM 1ST 25 SCM",2356,3344.2,1098.98,3344.2,589]
["TUFTS - TUFTS POS - CPT - 15276","TUFTS - TUFTS POS - 15276","TUFTS - TUFTS POS - 15276 - SUB GRFT F/S/N/H/F/G/M/D <100SCM EA ADDL 25 SCM","TUFTS","TUFTS POS","CPT","15276","SUB GRFT F/S/N/H/F/G/M/D <100SCM EA ADDL 25 SCM","15276 - SUB GRFT F/S/N/H/F/G/M/D <100SCM EA ADDL 25 SCM",191,0,62.43,1198.25,47.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 15630","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 15630","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 15630 - HC DELAY/SECTN FLAP LID,NOS,EAR,LIP","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","15630","HC DELAY/SECTN FLAP LID,NOS,EAR,LIP","15630 - HC DELAY/SECTN FLAP LID,NOS,EAR,LIP",2701,2601.27,1990.62,11845.41,675.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 15731","CIGNA HEALTHCARE - CIGNA CARELINK - 15731","CIGNA HEALTHCARE - CIGNA CARELINK - 15731 - FOREHEAD FLAP W/VASC PEDICLE","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","15731","FOREHEAD FLAP W/VASC PEDICLE","15731 - FOREHEAD FLAP W/VASC PEDICLE",5186,7703.8,1990.62,7703.8,1296.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 15771","CIGNA HEALTHCARE - CIGNA CARELINK - 15771","CIGNA HEALTHCARE - CIGNA CARELINK - 15771 - HC GRFG AUTOL FAT LIPO 50 CC/<","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","15771","HC GRFG AUTOL FAT LIPO 50 CC/<","15771 - HC GRFG AUTOL FAT LIPO 50 CC/<",3778,11845.41,2166.09,11845.41,944.5]
["TUFTS - TUFTS SELECT - CPT - 15774","TUFTS - TUFTS SELECT - 15774","TUFTS - TUFTS SELECT - 15774 - HC GFRG AUTOL FAT LIPO EA ADDL","TUFTS","TUFTS SELECT","CPT","15774","HC GFRG AUTOL FAT LIPO EA ADDL","15774 - HC GFRG AUTOL FAT LIPO EA ADDL",1031,0,336.33,1198.25,257.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 15820","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 15820","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 15820 - HC REVISION OF LOWER EYELID","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","15820","HC REVISION OF LOWER EYELID","15820 - HC REVISION OF LOWER EYELID",2527,3344.2,1990.62,7703.8,631.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 15828","BLUE CROSS - BLUE CROSS-INDEMNITY - 15828","BLUE CROSS - BLUE CROSS-INDEMNITY - 15828 - HC RHYTIDECTOMY CHEEK CHIN & NECK","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","15828","HC RHYTIDECTOMY CHEEK CHIN & NECK","15828 - HC RHYTIDECTOMY CHEEK CHIN & NECK",5109,4645.3599999999997,1990.62,7703.8,1277.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 15839","BLUE CROSS - BLUE CROSS-HMO BLUE - 15839","BLUE CROSS - BLUE CROSS-HMO BLUE - 15839 - EXCISION EXCESSIVE SKIN & SUBQ TISSUE OTHER AREA","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","15839","EXCISION EXCESSIVE SKIN & SUBQ TISSUE OTHER AREA","15839 - EXCISION EXCESSIVE SKIN & SUBQ TISSUE OTHER AREA",5680,3994.03,1098.98,4621.25,1420]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 15850","BLUE CROSS - BLUE CROSS-PPO - 15850","BLUE CROSS - BLUE CROSS-PPO - 15850 - REMOVE SUTURES SAME SURGEON","BLUE CROSS","BLUE CROSS-PPO","CPT","15850","REMOVE SUTURES SAME SURGEON","15850 - REMOVE SUTURES SAME SURGEON",773,810.95,317.70999999999998,1198.25,193.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 15936","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 15936","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 15936 - HC EXC SACR HCESS ULC W MUSC FLAP CLO","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","15936","HC EXC SACR HCESS ULC W MUSC FLAP CLO","15936 - HC EXC SACR HCESS ULC W MUSC FLAP CLO",1858,3344.2,2166.09,11845.41,464.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 16025","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 16025","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 16025 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","16025","DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM","16025 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM",864,296.32,296.32,1500.85,216]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 17000","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 17000","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 17000 - DESTRUCTION PREMALIGNANT LESION 1ST","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","17000","DESTRUCTION PREMALIGNANT LESION 1ST","17000 - DESTRUCTION PREMALIGNANT LESION 1ST",430,296.32,171.09,1198.25,107.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 17106","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 17106","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 17106 - DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","17106","DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM","17106 - DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM",2104,527.46,317.70999999999998,1198.25,526]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 17107","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 17107","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 17107 - DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","17107","DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM","17107 - DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM",2675,1042.56,317.70999999999998,1198.25,668.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 17111","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 17111","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 17111 - DESTRUCTION BENIGN LESIONS 15/>","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","17111","DESTRUCTION BENIGN LESIONS 15/>","17111 - DESTRUCTION BENIGN LESIONS 15/>",657,371.6,296.32,1198.25,164.25]
["TUFTS - TUFTS PPO - CPT - 17250","TUFTS - TUFTS PPO - 17250","TUFTS - TUFTS PPO - 17250 - CHEMICAL CAUTERIZATION GRANULATION TISSUE","TUFTS","TUFTS PPO","CPT","17250","CHEMICAL CAUTERIZATION GRANULATION TISSUE","17250 - CHEMICAL CAUTERIZATION GRANULATION TISSUE",328,620.02,296.32,1198.25,82]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 17263","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 17263","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 17263 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","17263","DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM","17263 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM",995,296.32,296.32,1198.25,248.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 17271","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 17271","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 17271 - DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","17271","DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM","17271 - DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM",858,371.6,296.32,1198.25,214.5]
["TUFTS - TUFTS PPO - CPT - 17281","TUFTS - TUFTS PPO - 17281","TUFTS - TUFTS PPO - 17281 - DESTRUCTION OF SKIN LESIONS","TUFTS","TUFTS PPO","CPT","17281","DESTRUCTION OF SKIN LESIONS","17281 - DESTRUCTION OF SKIN LESIONS",510,595.01,317.70999999999998,1198.25,127.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 17314","BLUE CROSS - BLUE CROSS-HMO BLUE - 17314","BLUE CROSS - BLUE CROSS-HMO BLUE - 17314 - MOHS TRUNK/ARM/LEG EA STAGE AFTER 1ST STAGE","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","17314","MOHS TRUNK/ARM/LEG EA STAGE AFTER 1ST STAGE","17314 - MOHS TRUNK/ARM/LEG EA STAGE AFTER 1ST STAGE",1437,463.49,463.49,1198.25,359.25]
["AETNA - AETNA - CPT - 17315","AETNA - AETNA - 17315","AETNA - AETNA - 17315 - MOHS TRUNK/ARM/LEG EA ADDL BLOCK ANY STAGE","AETNA","AETNA","CPT","17315","MOHS TRUNK/ARM/LEG EA ADDL BLOCK ANY STAGE","17315 - MOHS TRUNK/ARM/LEG EA ADDL BLOCK ANY STAGE",405,1198.25,131.91999999999999,1198.25,101.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 19001","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 19001","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 19001 - HC CY ASP BREAST;EA ADD","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","19001","HC CY ASP BREAST;EA ADD","19001 - HC CY ASP BREAST;EA ADD",163,53.07,53.07,1198.25,40.75]
["TUFTS - TUFTS HMO - CPT - 19082","TUFTS - TUFTS HMO - 19082","TUFTS - TUFTS HMO - 19082 - BX BREAST W/DEVICE ADDL LESION STEREOTACT GUID","TUFTS","TUFTS HMO","CPT","19082","BX BREAST W/DEVICE ADDL LESION STEREOTACT GUID","19082 - BX BREAST W/DEVICE ADDL LESION STEREOTACT GUID",646,0,209.09,1198.25,161.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 19083","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 19083","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 19083 - BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","19083","BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID","19083 - BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID",1266,2672.73,1098.98,3264.67,316.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 19086","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 19086","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 19086 - BX BREAST W/DEVICE ADDL LESION MAGNET RES GUID","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","19086","BX BREAST W/DEVICE ADDL LESION MAGNET RES GUID","19086 - BX BREAST W/DEVICE ADDL LESION MAGNET RES GUID",660,227.08,227.08,1198.25,165]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 19100","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 19100","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 19100 - BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","19100","BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX","19100 - BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX",709,2672.73,684.11,2672.73,177.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 19282","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 19282","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 19282 - PERQ DEVICE PLACEMT BREAST LOC EA LESION W/GDNCE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","19282","PERQ DEVICE PLACEMT BREAST LOC EA LESION W/GDNCE","19282 - PERQ DEVICE PLACEMT BREAST LOC EA LESION W/GDNCE",362,0,125.12,1198.25,90.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 19285","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 19285","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 19285 - PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","19285","PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG","19285 - PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG",650,1220.0899999999999,317.70999999999998,1500.85,162.5]
["TUFTS - TUFTS PPO - CPT - 19286","TUFTS - TUFTS PPO - 19286","TUFTS - TUFTS PPO - 19286 - PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE","TUFTS","TUFTS PPO","CPT","19286","PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE","19286 - PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE",314,0,107.09,1198.25,78.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 19316","BLUE CROSS - BLUE CROSS-PPO - 19316","BLUE CROSS - BLUE CROSS-PPO - 19316 - SUSPENSION OF BREAST","BLUE CROSS","BLUE CROSS-PPO","CPT","19316","SUSPENSION OF BREAST","19316 - SUSPENSION OF BREAST",7790,8254.4500000000007,2166.09,11845.41,1947.5]
["TUFTS - TUFTS SELECT - CPT - 19316","TUFTS - TUFTS SELECT - 19316","TUFTS - TUFTS SELECT - 19316 - SUSPENSION OF BREAST","TUFTS","TUFTS SELECT","CPT","19316","SUSPENSION OF BREAST","19316 - SUSPENSION OF BREAST",7790,3987.49,2166.09,11845.41,1947.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 19350","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 19350","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 19350 - NIPPLE/AREOLA RECONSTRUCTION","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","19350","NIPPLE/AREOLA RECONSTRUCTION","19350 - NIPPLE/AREOLA RECONSTRUCTION",2893,4729.13,2166.09,11845.41,723.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 20100","BLUE CROSS - BLUE CROSS-HMO BLUE - 20100","BLUE CROSS - BLUE CROSS-HMO BLUE - 20100 - HC EXPLORE WOUND,NECK","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","20100","HC EXPLORE WOUND,NECK","20100 - HC EXPLORE WOUND,NECK",658,818.07,818.07,3264.67,164.5]
["TUFTS - TUFTS HMO - CPT - 20100","TUFTS - TUFTS HMO - 20100","TUFTS - TUFTS HMO - 20100 - HC EXPLORE WOUND,NECK","TUFTS","TUFTS HMO","CPT","20100","HC EXPLORE WOUND,NECK","20100 - HC EXPLORE WOUND,NECK",658,2057.7399999999998,818.07,3264.67,164.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 20205","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 20205","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 20205 - BIOPSY,MUSCLE,DEEP","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","20205","BIOPSY,MUSCLE,DEEP","20205 - BIOPSY,MUSCLE,DEEP",1972,3994.03,1990.62,11845.41,493]
["TUFTS - TUFTS HMO - CPT - 20225","TUFTS - TUFTS HMO - 20225","TUFTS - TUFTS HMO - 20225 - HC BIOPSY BONE TROCAR/NEEDLE DEEP","TUFTS","TUFTS HMO","CPT","20225","HC BIOPSY BONE TROCAR/NEEDLE DEEP","20225 - HC BIOPSY BONE TROCAR/NEEDLE DEEP",1972,4856.75,1500.85,7703.8,493]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 20240","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 20240","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 20240 - HC BIOPSY BONE OPEN SUPERFICIAL","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","20240","HC BIOPSY BONE OPEN SUPERFICIAL","20240 - HC BIOPSY BONE OPEN SUPERFICIAL",3570,4621.25,1500.85,7703.8,892.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 20525","BLUE CROSS - BLUE CROSS-HMO BLUE - 20525","BLUE CROSS - BLUE CROSS-HMO BLUE - 20525 - RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","20525","RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP","20525 - RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP",2987,3994.03,1990.62,11845.41,746.75]
["AETNA - AETNA - CPT - 20526","AETNA - AETNA - 20526","AETNA - AETNA - 20526 - INJECTION THERAPEUTIC CARPAL TUNNEL","AETNA","AETNA","CPT","20526","INJECTION THERAPEUTIC CARPAL TUNNEL","20526 - INJECTION THERAPEUTIC CARPAL TUNNEL",433,1198.25,317.70999999999998,1198.25,108.25]
["AETNA - AETNA - CPT - 20552","AETNA - AETNA - 20552","AETNA - AETNA - 20552 - INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES","AETNA","AETNA","CPT","20552","INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES","20552 - INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES",288,1198.25,317.70999999999998,1198.25,72]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 20600","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 20600","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 20600 - ARTHROCENTESIS ASPIR&/INJECTION SMALL JT/BURSA","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","20600","ARTHROCENTESIS ASPIR&/INJECTION SMALL JT/BURSA","20600 - ARTHROCENTESIS ASPIR&/INJECTION SMALL JT/BURSA",293,521.19000000000005,317.70999999999998,1198.25,73.25]
["TUFTS - TUFTS PPO - CPT - 20604","TUFTS - TUFTS PPO - 20604","TUFTS - TUFTS PPO - 20604 - HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT","TUFTS","TUFTS PPO","CPT","20604","HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT","20604 - HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT",323,595.01,317.70999999999998,1198.25,80.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 20611","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 20611","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 20611 - HC PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","20611","HC PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US","20611 - HC PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US",430,415.61,317.70999999999998,1198.25,107.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 20612","BLUE CROSS - BLUE CROSS-PPO - 20612","BLUE CROSS - BLUE CROSS-PPO - 20612 - ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ","BLUE CROSS","BLUE CROSS-PPO","CPT","20612","ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ","20612 - ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ",316,415.61,317.70999999999998,1198.25,79]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 20670","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 20670","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 20670 - REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","20670","REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE","20670 - REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE",1972,2969.7,1098.98,3264.67,493]
["TUFTS - TUFTS PPO - CPT - 20930","TUFTS - TUFTS PPO - 20930","TUFTS - TUFTS PPO - 20930 - HC ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED","TUFTS","TUFTS PPO","CPT","20930","HC ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED","20930 - HC ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED",2590,0,270.92,1198.25,647.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 20982","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 20982","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 20982 - HC ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","20982","HC ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE","20982 - HC ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE",6499,11074.87,1198.25,11074.87,1624.75]
["TUFTS - TUFTS POS - CPT - 21011","TUFTS - TUFTS POS - 21011","TUFTS - TUFTS POS - 21011 - EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ <2CM","TUFTS","TUFTS POS","CPT","21011","EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ <2CM","21011 - EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ <2CM",1996,2058.17,1098.98,3264.67,499]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 21012","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 21012","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 21012 - EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/>","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","21012","EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/>","21012 - EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/>",2586,2672.73,1098.98,3264.67,646.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 21025","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 21025","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 21025 - HC EXCISION OF BONE, LOWER JAW","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","21025","HC EXCISION OF BONE, LOWER JAW","21025 - HC EXCISION OF BONE, LOWER JAW",5755,8596.73,1500.85,8596.73,1438.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 21031","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 21031","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 21031 - HC EXCISION TORUS MANDIBULARIS","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","21031","HC EXCISION TORUS MANDIBULARIS","21031 - HC EXCISION TORUS MANDIBULARIS",3301,4335.57,1198.25,7703.8,825.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 21032","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 21032","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 21032 - HC EXCISION,MAXILLARY TORUS PALATINUS","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","21032","HC EXCISION,MAXILLARY TORUS PALATINUS","21032 - HC EXCISION,MAXILLARY TORUS PALATINUS",3896,3747.12,1198.25,7703.8,974]
["TUFTS - TUFTS PPO - CPT - 21046","TUFTS - TUFTS PPO - 21046","TUFTS - TUFTS PPO - 21046 - HC EXCISION,BEN TUMOR,MANDIBLE,INTRA-ORAL","TUFTS","TUFTS PPO","CPT","21046","HC EXCISION,BEN TUMOR,MANDIBLE,INTRA-ORAL","21046 - HC EXCISION,BEN TUMOR,MANDIBLE,INTRA-ORAL",5309,4856.75,1500.85,8596.73,1327.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 21047","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 21047","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 21047 - HC EXCISION,BEN TUMOR,MANDIBLE,EXTRA-ORAL","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","21047","HC EXCISION,BEN TUMOR,MANDIBLE,EXTRA-ORAL","21047 - HC EXCISION,BEN TUMOR,MANDIBLE,EXTRA-ORAL",7214,8385.69,1500.85,8596.73,1803.5]
["TUFTS - TUFTS SELECT - CPT - 21073","TUFTS - TUFTS SELECT - 21073","TUFTS - TUFTS SELECT - 21073 - HC MANIPULATION TMJ THERAPEUTIC REQUIRE ANESTHESIA","TUFTS","TUFTS SELECT","CPT","21073","HC MANIPULATION TMJ THERAPEUTIC REQUIRE ANESTHESIA","21073 - HC MANIPULATION TMJ THERAPEUTIC REQUIRE ANESTHESIA",2007,1098.98,1098.98,3264.67,501.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 21083","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 21083","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 21083 - PREPARE FACE/ORAL PROSTHESIS","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","21083","PREPARE FACE/ORAL PROSTHESIS","21083 - PREPARE FACE/ORAL PROSTHESIS",4030,3747.12,3747.12,17023.61,1007.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 21083","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 21083","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 21083 - PREPARE FACE/ORAL PROSTHESIS","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","21083","PREPARE FACE/ORAL PROSTHESIS","21083 - PREPARE FACE/ORAL PROSTHESIS",4030,4335.57,3747.12,17023.61,1007.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 21121","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 21121","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 21121 - HC RECONST CHIN SLIDE SINGL OSTEOTOMY","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","21121","HC RECONST CHIN SLIDE SINGL OSTEOTOMY","21121 - HC RECONST CHIN SLIDE SINGL OSTEOTOMY",3896,0,2531.06,17023.61,974]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 21198","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 21198","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 21198 - HC OSTEOTOMY, MANDIBLE","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","21198","HC OSTEOTOMY, MANDIBLE","21198 - HC OSTEOTOMY, MANDIBLE",7214,8596.73,1990.62,11845.41,1803.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 21240","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 21240","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 21240 - HC ARTHROPLASTY TMJ","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","21240","HC ARTHROPLASTY TMJ","21240 - HC ARTHROPLASTY TMJ",7214,7429.92,2166.09,11845.41,1803.5]
["FALLON - FALLON MEDICAID - CPT - 21248","FALLON - FALLON MEDICAID - 21248","FALLON - FALLON MEDICAID - 21248 - HC RECONSTR JAW,PART-ENDO IMPLNT","FALLON","FALLON MEDICAID","CPT","21248","HC RECONSTR JAW,PART-ENDO IMPLNT","21248 - HC RECONSTR JAW,PART-ENDO IMPLNT",6644,0,2531.06,15242.01,1661]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 21248","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 21248","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 21248 - HC RECONSTR JAW,PART-ENDO IMPLNT","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","21248","HC RECONSTR JAW,PART-ENDO IMPLNT","21248 - HC RECONSTR JAW,PART-ENDO IMPLNT",6644,8596.73,2531.06,15242.01,1661]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 21325","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 21325","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 21325 - HC OPEN RX NOSE FRACTURE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","21325","HC OPEN RX NOSE FRACTURE","21325 - HC OPEN RX NOSE FRACTURE",3350,4335.57,2166.09,11845.41,837.5]
["TUFTS - TUFTS HMO - CPT - 21337","TUFTS - TUFTS HMO - 21337","TUFTS - TUFTS HMO - 21337 - HC CLOSED RX NASAL SEPTAL FRACTURE","TUFTS","TUFTS HMO","CPT","21337","HC CLOSED RX NASAL SEPTAL FRACTURE","21337 - HC CLOSED RX NASAL SEPTAL FRACTURE",3896,4856.75,1500.85,7703.8,974]
["AETNA - AETNA - CPT - 21407","AETNA - AETNA - 21407","AETNA - AETNA - 21407 - HC OPEN RX FX ORBIT W IMPLANT","AETNA","AETNA","CPT","21407","HC OPEN RX FX ORBIT W IMPLANT","21407 - HC OPEN RX FX ORBIT W IMPLANT",7214,2354.5,2354.5,15242.01,1803.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 21445","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 21445","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 21445 - HC OPEN RX DENTAL RIDGE FX","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","21445","HC OPEN RX DENTAL RIDGE FX","21445 - HC OPEN RX DENTAL RIDGE FX",7214,7429.92,2166.09,11845.41,1803.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 21450","CIGNA HEALTHCARE - CIGNA CARELINK - 21450","CIGNA HEALTHCARE - CIGNA CARELINK - 21450 - HC CLOSED RX MANDIBLE FX","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","21450","HC CLOSED RX MANDIBLE FX","21450 - HC CLOSED RX MANDIBLE FX",658,11845.41,818.07,11845.41,164.5]
["TUFTS - TUFTS SELECT - CPT - 21461","TUFTS - TUFTS SELECT - 21461","TUFTS - TUFTS SELECT - 21461 - HC OPEN RX MANDIBLE FX","TUFTS","TUFTS SELECT","CPT","21461","HC OPEN RX MANDIBLE FX","21461 - HC OPEN RX MANDIBLE FX",7214,3987.49,2166.09,11845.41,1803.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 21462","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 21462","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 21462 - HC OPEN RX MANDIBLE FX+DENTAL FIX","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","21462","HC OPEN RX MANDIBLE FX+DENTAL FIX","21462 - HC OPEN RX MANDIBLE FX+DENTAL FIX",7214,8596.73,2354.5,15242.01,1803.5]
["AETNA - AETNA - CPT - 21552","AETNA - AETNA - 21552","AETNA - AETNA - 21552 - EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>","AETNA","AETNA","CPT","21552","EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>","21552 - EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>",3405,1990.62,1990.62,11845.41,851.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 21555","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 21555","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 21555 - EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","21555","EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM","21555 - EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM",2366,2672.73,1500.85,7703.8,591.5]
["TUFTS - TUFTS POS - CPT - 21556","TUFTS - TUFTS POS - 21556","TUFTS - TUFTS POS - 21556 - EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM","TUFTS","TUFTS POS","CPT","21556","EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM","21556 - EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM",4117,4856.75,1500.85,7703.8,1029.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 21931","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 21931","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 21931 - EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/>","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","21931","EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/>","21931 - EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/>",2987,2309.9699999999998,1990.62,11845.41,746.75]
["TUFTS - TUFTS HMO - CPT - 22310","TUFTS - TUFTS HMO - 22310","TUFTS - TUFTS HMO - 22310 - CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING","TUFTS","TUFTS HMO","CPT","22310","CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING","22310 - CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING",1336,2057.7399999999998,378,3264.67,334]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 22510","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 22510","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 22510 - PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","22510","PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC","22510 - PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC",9073,5097.42,2397.88,7703.8,2268.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 22513","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 22513","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 22513 - HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","22513","HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION","22513 - HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION",8897,10803,1990.62,17023.61,2224.25]
["TUFTS - TUFTS SELECT - CPT - 22515","TUFTS - TUFTS SELECT - 22515","TUFTS - TUFTS SELECT - 22515 - PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH","TUFTS","TUFTS SELECT","CPT","22515","PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH","22515 - PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH",11021,0,554.91,1198.25,2755.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 22870","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 22870","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 22870 - HC INSJ STABLJ DEV W/O DCMPRN LUMBAR SECOND LEVEL","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","22870","HC INSJ STABLJ DEV W/O DCMPRN LUMBAR SECOND LEVEL","22870 - HC INSJ STABLJ DEV W/O DCMPRN LUMBAR SECOND LEVEL",2523,311.33,311.33,1198.25,630.75]
["TUFTS - TUFTS HMO - CPT - 22903","TUFTS - TUFTS HMO - 22903","TUFTS - TUFTS HMO - 22903 - HC EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3+CM","TUFTS","TUFTS HMO","CPT","22903","HC EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3+CM","22903 - HC EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3+CM",3338,7467.76,1990.62,11845.41,834.5]
["TUFTS - TUFTS PPO - CPT - 23031","TUFTS - TUFTS PPO - 23031","TUFTS - TUFTS PPO - 23031 - HC DRAIN INFECT SHOULDER BURSA","TUFTS","TUFTS PPO","CPT","23031","HC DRAIN INFECT SHOULDER BURSA","23031 - HC DRAIN INFECT SHOULDER BURSA",2066,4856.75,1990.62,7703.8,516.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 23073","BLUE CROSS - BLUE CROSS-HMO BLUE - 23073","BLUE CROSS - BLUE CROSS-HMO BLUE - 23073 - HC EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/>","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","23073","HC EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/>","23073 - HC EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/>",1528,3994.03,1990.62,11845.41,382]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 23075","BLUE CROSS - BLUE CROSS-PPO - 23075","BLUE CROSS - BLUE CROSS-PPO - 23075 - EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM","BLUE CROSS","BLUE CROSS-PPO","CPT","23075","EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM","23075 - EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM",1972,2309.9699999999998,1500.85,7703.8,493]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 23350","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 23350","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 23350 - HC INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI ARTHG","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","23350","HC INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI ARTHG","23350 - HC INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI ARTHG",637,0,126.08,1198.25,159.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 23500","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 23500","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 23500 - CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","23500","CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION","23500 - CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION",1217,474.04,378,3264.67,304.25]
["AETNA - AETNA - CPT - 23540","AETNA - AETNA - 23540","AETNA - AETNA - 23540 - CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION","AETNA","AETNA","CPT","23540","CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION","23540 - CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION",1217,1198.25,378,3264.67,304.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 23575","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 23575","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 23575 - CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","23575","CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION","23575 - CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION",1738,2205.59,1098.98,3264.67,434.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 23600","BLUE CROSS - BLUE CROSS-PPO - 23600","BLUE CROSS - BLUE CROSS-PPO - 23600 - CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION","BLUE CROSS","BLUE CROSS-PPO","CPT","23600","CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION","23600 - CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION",1217,378,378,3264.67,304.25]
["TUFTS - TUFTS SELECT - CPT - 23625","TUFTS - TUFTS SELECT - 23625","TUFTS - TUFTS SELECT - 23625 - CLTX GRTER HUMERAL TUBEROSITY FX W/MANIPULATION","TUFTS","TUFTS SELECT","CPT","23625","CLTX GRTER HUMERAL TUBEROSITY FX W/MANIPULATION","23625 - CLTX GRTER HUMERAL TUBEROSITY FX W/MANIPULATION",2021,2593.31,1500.85,7703.8,505.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 24065","BLUE CROSS - BLUE CROSS-INDEMNITY - 24065","BLUE CROSS - BLUE CROSS-INDEMNITY - 24065 - HC BX ARM/ELBOW SOFT TISSUE,SUPERFICIAL","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","24065","HC BX ARM/ELBOW SOFT TISSUE,SUPERFICIAL","24065 - HC BX ARM/ELBOW SOFT TISSUE,SUPERFICIAL",2043,2309.9699999999998,1098.98,3264.67,510.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 24066","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 24066","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 24066 - HC BX ARM/ELBOW SOFT TISSUE,DEEP","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","24066","HC BX ARM/ELBOW SOFT TISSUE,DEEP","24066 - HC BX ARM/ELBOW SOFT TISSUE,DEEP",3449,3994.03,1500.85,7703.8,862.25]
["TUFTS - TUFTS HMO - CPT - 24076","TUFTS - TUFTS HMO - 24076","TUFTS - TUFTS HMO - 24076 - HC EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM","TUFTS","TUFTS HMO","CPT","24076","HC EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM","24076 - HC EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM",3490,4856.75,1500.85,7703.8,872.5]
["AETNA - AETNA - CPT - 24357","AETNA - AETNA - 24357","AETNA - AETNA - 24357 - HC REPAIR ELBOW PERC","AETNA","AETNA","CPT","24357","HC REPAIR ELBOW PERC","24357 - HC REPAIR ELBOW PERC",4106,1990.62,1990.62,11845.41,1026.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 24500","BLUE CROSS - BLUE CROSS-HMO BLUE - 24500","BLUE CROSS - BLUE CROSS-HMO BLUE - 24500 - CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","24500","CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION","24500 - CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION",1217,378,378,3264.67,304.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 24535","CIGNA HEALTHCARE - CIGNA CARELINK - 24535","CIGNA HEALTHCARE - CIGNA CARELINK - 24535 - CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","24535","CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ","24535 - CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ",1738,3264.67,1098.98,3264.67,434.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 24560","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 24560","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 24560 - CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","24560","CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ","24560 - CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ",1217,485.97,378,3264.67,304.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 24577","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 24577","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 24577 - CLTX HUMERAL CONDYLAR FX MEDIAL/LATERAL W/MANJ","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","24577","CLTX HUMERAL CONDYLAR FX MEDIAL/LATERAL W/MANJ","24577 - CLTX HUMERAL CONDYLAR FX MEDIAL/LATERAL W/MANJ",3821,2551.96,1098.98,3264.67,955.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 24640","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 24640","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 24640 - CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","24640","CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ","24640 - CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ",720,378,317.70999999999998,943.8,180]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 24650","CIGNA HEALTHCARE - CIGNA CARELINK - 24650","CIGNA HEALTHCARE - CIGNA CARELINK - 24650 - CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","24650","CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION","24650 - CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION",1836,943.8,317.70999999999998,1198.25,459]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 24675","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 24675","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 24675 - CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","24675","CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ","24675 - CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ",3187,2489.31,1098.98,3264.67,796.75]
["TUFTS - TUFTS HMO - CPT - 25000","TUFTS - TUFTS HMO - 25000","TUFTS - TUFTS HMO - 25000 - HC INCISION EXTENSOR TENDON SHEATH WRIST","TUFTS","TUFTS HMO","CPT","25000","HC INCISION EXTENSOR TENDON SHEATH WRIST","25000 - HC INCISION EXTENSOR TENDON SHEATH WRIST",2568,7467.76,1990.62,11845.41,642]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 25071","BLUE CROSS - BLUE CROSS-PPO - 25071","BLUE CROSS - BLUE CROSS-PPO - 25071 - EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/>","BLUE CROSS","BLUE CROSS-PPO","CPT","25071","EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/>","25071 - EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/>",3254,2309.9699999999998,1990.62,11845.41,813.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 25076","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 25076","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 25076 - EXC FOREARM TUM DEEP < 3 CM","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","25076","EXC FOREARM TUM DEEP < 3 CM","25076 - EXC FOREARM TUM DEEP < 3 CM",2041,2672.73,1990.62,11845.41,510.25]
["TUFTS - TUFTS POS - CPT - 25111","TUFTS - TUFTS POS - 25111","TUFTS - TUFTS POS - 25111 - EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY","TUFTS","TUFTS POS","CPT","25111","EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY","25111 - EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY",2450,7467.76,1990.62,11845.41,612.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 25248","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 25248","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 25248 - HC REMOVE FOREARM/WRIST FOREIGN BODY","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","25248","HC REMOVE FOREARM/WRIST FOREIGN BODY","25248 - HC REMOVE FOREARM/WRIST FOREIGN BODY",2026,2205.59,1500.85,7703.8,506.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 25248","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 25248","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 25248 - HC REMOVE FOREARM/WRIST FOREIGN BODY","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","25248","HC REMOVE FOREARM/WRIST FOREIGN BODY","25248 - HC REMOVE FOREARM/WRIST FOREIGN BODY",2026,2551.96,1500.85,7703.8,506.5]
["TUFTS - TUFTS POS - CPT - 25530","TUFTS - TUFTS POS - 25530","TUFTS - TUFTS POS - 25530 - CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION","TUFTS","TUFTS POS","CPT","25530","CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION","25530 - CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION",1808,595.01,317.70999999999998,1198.25,452]
["TUFTS - TUFTS SELECT - CPT - 25565","TUFTS - TUFTS SELECT - 25565","TUFTS - TUFTS SELECT - 25565 - CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ","TUFTS","TUFTS SELECT","CPT","25565","CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ","25565 - CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ",3607,2593.31,1500.85,7703.8,901.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 25600","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 25600","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 25600 - CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","25600","CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ","25600 - CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ",2371,485.97,317.70999999999998,1198.25,592.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 25624","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 25624","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 25624 - CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","25624","CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ","25624 - CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ",3297,2205.59,1500.85,7703.8,824.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 25630","BLUE CROSS - BLUE CROSS-PPO - 25630","BLUE CROSS - BLUE CROSS-PPO - 25630 - CLTX CARPAL BONE FX W/O MANJ EACH BONE","BLUE CROSS","BLUE CROSS-PPO","CPT","25630","CLTX CARPAL BONE FX W/O MANJ EACH BONE","25630 - CLTX CARPAL BONE FX W/O MANJ EACH BONE",2151,378,317.70999999999998,1198.25,537.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 25660","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 25660","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 25660 - CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MANJ","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","25660","CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MANJ","25660 - CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MANJ",325,474.04,378,3264.67,81.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 26010","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 26010","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 26010 - DRAINAGE FINGER ABSCESS SIMPLE","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","26010","DRAINAGE FINGER ABSCESS SIMPLE","26010 - DRAINAGE FINGER ABSCESS SIMPLE",1058,296.32,296.32,943.8,264.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 26011","BLUE CROSS - BLUE CROSS-INDEMNITY - 26011","BLUE CROSS - BLUE CROSS-INDEMNITY - 26011 - DRAINAGE FINGER ABSCESS COMPLICATED","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","26011","DRAINAGE FINGER ABSCESS COMPLICATED","26011 - DRAINAGE FINGER ABSCESS COMPLICATED",1418,2309.9699999999998,1098.98,3264.67,354.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 26060","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 26060","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 26060 - HC INCIS PERCUT FINGER TENDON,SINGLE,EA","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","26060","HC INCIS PERCUT FINGER TENDON,SINGLE,EA","26060 - HC INCIS PERCUT FINGER TENDON,SINGLE,EA",3045,2551.96,1500.85,7703.8,761.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 26111","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 26111","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 26111 - HC EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5+CM","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","26111","HC EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5+CM","26111 - HC EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5+CM",4001,2672.73,1990.62,11845.41,1000.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 26160","BLUE CROSS - BLUE CROSS-INDEMNITY - 26160","BLUE CROSS - BLUE CROSS-INDEMNITY - 26160 - EXC LES TDN SHTH/JT CAPSL HAND/FNGR","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","26160","EXC LES TDN SHTH/JT CAPSL HAND/FNGR","26160 - EXC LES TDN SHTH/JT CAPSL HAND/FNGR",2559,2205.59,1990.62,11845.41,639.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 26410","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 26410","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 26410 - HC REPAIR EXTEN TENDON,DORSUM HAND,EA","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","26410","HC REPAIR EXTEN TENDON,DORSUM HAND,EA","26410 - HC REPAIR EXTEN TENDON,DORSUM HAND,EA",2026,2551.96,1990.62,11845.41,506.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 26418","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 26418","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 26418 - HC REPAIR EXTEN TENDON,DORSUM FINGER,EA","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","26418","HC REPAIR EXTEN TENDON,DORSUM FINGER,EA","26418 - HC REPAIR EXTEN TENDON,DORSUM FINGER,EA",3693,2205.59,2166.09,11845.41,923.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 26605","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 26605","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 26605 - CLTX METACARPAL FX W/MANIPULATION EACH BONE","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","26605","CLTX METACARPAL FX W/MANIPULATION EACH BONE","26605 - CLTX METACARPAL FX W/MANIPULATION EACH BONE",2246,378,378,7703.8,561.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 26605","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 26605","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 26605 - CLTX METACARPAL FX W/MANIPULATION EACH BONE","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","26605","CLTX METACARPAL FX W/MANIPULATION EACH BONE","26605 - CLTX METACARPAL FX W/MANIPULATION EACH BONE",2246,485.97,378,7703.8,561.5]
["TUFTS - TUFTS POS - CPT - 26650","TUFTS - TUFTS POS - 26650","TUFTS - TUFTS POS - 26650 - HC PRQ SKEL FIXATION CARP/MTCRPL FX DISLOCATE THUMB","TUFTS","TUFTS POS","CPT","26650","HC PRQ SKEL FIXATION CARP/MTCRPL FX DISLOCATE THUMB","26650 - HC PRQ SKEL FIXATION CARP/MTCRPL FX DISLOCATE THUMB",4072,4856.75,1500.85,7703.8,1018]
["AETNA - AETNA - CPT - 26740","AETNA - AETNA - 26740","AETNA - AETNA - 26740 - CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ","AETNA","AETNA","CPT","26740","CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ","26740 - CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ",1643,1198.25,317.70999999999998,1198.25,410.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 26740","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 26740","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 26740 - CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","26740","CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ","26740 - CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ",1643,474.04,317.70999999999998,1198.25,410.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 26765","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 26765","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 26765 - HC OPEN TX DISTAL PHALANGEAL FRACTURE EACH","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","26765","HC OPEN TX DISTAL PHALANGEAL FRACTURE EACH","26765 - HC OPEN TX DISTAL PHALANGEAL FRACTURE EACH",3938,5097.42,2166.09,11845.41,984.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 26770","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 26770","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 26770 - CLTX IPHAL JT DISLC W/MANJ W/O ANES","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","26770","CLTX IPHAL JT DISLC W/MANJ W/O ANES","26770 - CLTX IPHAL JT DISLC W/MANJ W/O ANES",1939,485.97,317.70999999999998,943.8,484.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 26990","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 26990","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 26990 - HC INCIS/DRAIN PELVIS/HIP,DEEP ABCESS","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","26990","HC INCIS/DRAIN PELVIS/HIP,DEEP ABCESS","26990 - HC INCIS/DRAIN PELVIS/HIP,DEEP ABCESS",3970,5097.42,1098.98,5097.42,992.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 27047","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 27047","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 27047 - EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ <3CM","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","27047","EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ <3CM","27047 - EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ <3CM",2794,4621.25,1500.85,7703.8,698.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 27087","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 27087","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 27087 - REMOVAL FOREIGN BODY PELVIS/HIP DEEP","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","27087","REMOVAL FOREIGN BODY PELVIS/HIP DEEP","27087 - REMOVAL FOREIGN BODY PELVIS/HIP DEEP",4826,4405.5600000000004,1990.62,11845.41,1206.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 27093","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 27093","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 27093 - HC INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","27093","HC INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA","27093 - HC INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA",533,0,173.01,1198.25,133.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 27220","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 27220","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 27220 - CLTX ACETABULUM HIP/SOCKT FX W/O MANJ","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","27220","CLTX ACETABULUM HIP/SOCKT FX W/O MANJ","27220 - CLTX ACETABULUM HIP/SOCKT FX W/O MANJ",4008,378,378,2032.26,1002]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 27230","BLUE CROSS - BLUE CROSS-PPO - 27230","BLUE CROSS - BLUE CROSS-PPO - 27230 - CLTX FEM FX PROX END NCK W/O MANJ","BLUE CROSS","BLUE CROSS-PPO","CPT","27230","CLTX FEM FX PROX END NCK W/O MANJ","27230 - CLTX FEM FX PROX END NCK W/O MANJ",3600,378,378,3264.67,900]
["TUFTS - TUFTS SELECT - CPT - 27250","TUFTS - TUFTS SELECT - 27250","TUFTS - TUFTS SELECT - 27250 - CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA","TUFTS","TUFTS SELECT","CPT","27250","CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA","27250 - CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA",325,1098.98,378,3264.67,81.25]
["TUFTS - TUFTS POS - CPT - 27252","TUFTS - TUFTS POS - 27252","TUFTS - TUFTS POS - 27252 - HC TX HIP DISLOC W/ANESTH","TUFTS","TUFTS POS","CPT","27252","HC TX HIP DISLOC W/ANESTH","27252 - HC TX HIP DISLOC W/ANESTH",2025,4856.75,1500.85,7703.8,506.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 27266","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 27266","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 27266 - HC CLOSED RX POST HIP FIX DISLOC,ANESTH","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","27266","HC CLOSED RX POST HIP FIX DISLOC,ANESTH","27266 - HC CLOSED RX POST HIP FIX DISLOC,ANESTH",2021,2205.59,1098.98,3264.67,505.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 27323","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 27323","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 27323 - HC BX THIGH/KNEE SOFT TISSUES,SUPERF","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","27323","HC BX THIGH/KNEE SOFT TISSUES,SUPERF","27323 - HC BX THIGH/KNEE SOFT TISSUES,SUPERF",2043,2309.9699999999998,1098.98,3264.67,510.75]
["TUFTS - TUFTS HMO - CPT - 27324","TUFTS - TUFTS HMO - 27324","TUFTS - TUFTS HMO - 27324 - HC BX THIGH/KNEE SOFT TISSUES,DEEP","TUFTS","TUFTS HMO","CPT","27324","HC BX THIGH/KNEE SOFT TISSUES,DEEP","27324 - HC BX THIGH/KNEE SOFT TISSUES,DEEP",3449,2057.7399999999998,1098.98,4621.25,862.25]
["TUFTS - TUFTS POS - CPT - 27337","TUFTS - TUFTS POS - 27337","TUFTS - TUFTS POS - 27337 - EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/>","TUFTS","TUFTS POS","CPT","27337","EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/>","27337 - EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/>",3207,7467.76,1990.62,11845.41,801.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 27339","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 27339","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 27339 - HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC 5+ CM","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","27339","HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC 5+ CM","27339 - HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC 5+ CM",4466,4621.25,1990.62,11845.41,1116.5]
["TUFTS - TUFTS HMO - CPT - 27500","TUFTS - TUFTS HMO - 27500","TUFTS - TUFTS HMO - 27500 - CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION","TUFTS","TUFTS HMO","CPT","27500","CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION","27500 - CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION",3651,2057.7399999999998,378,3264.67,912.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 27520","BLUE CROSS - BLUE CROSS-PPO - 27520","BLUE CROSS - BLUE CROSS-PPO - 27520 - CLOSED TX PATELLAR FRACTURE W/O MANIPULATION","BLUE CROSS","BLUE CROSS-PPO","CPT","27520","CLOSED TX PATELLAR FRACTURE W/O MANIPULATION","27520 - CLOSED TX PATELLAR FRACTURE W/O MANIPULATION",2263,378,378,3264.67,565.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 27530","BLUE CROSS - BLUE CROSS-HMO BLUE - 27530","BLUE CROSS - BLUE CROSS-HMO BLUE - 27530 - CLTX TIBIAL FX PROXIMAL W/O MANIPULATION","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","27530","CLTX TIBIAL FX PROXIMAL W/O MANIPULATION","27530 - CLTX TIBIAL FX PROXIMAL W/O MANIPULATION",2146,378,378,3264.67,536.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 27550","CIGNA HEALTHCARE - CIGNA CARELINK - 27550","CIGNA HEALTHCARE - CIGNA CARELINK - 27550 - CLOSED TX KNEE DISLOCATION W/O ANESTHESIA","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","27550","CLOSED TX KNEE DISLOCATION W/O ANESTHESIA","27550 - CLOSED TX KNEE DISLOCATION W/O ANESTHESIA",3509,3264.67,378,3264.67,877.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 27603","BLUE CROSS - BLUE CROSS-INDEMNITY - 27603","BLUE CROSS - BLUE CROSS-INDEMNITY - 27603 - HC DRAIN LOWER LEG DEEP ABSC/HEMATOMA","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","27603","HC DRAIN LOWER LEG DEEP ABSC/HEMATOMA","27603 - HC DRAIN LOWER LEG DEEP ABSC/HEMATOMA",3573,3994.03,1500.85,7703.8,893.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 27613","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 27613","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 27613 - HC BX LOW LEG SOFT TISSUE,SUPERFICIAL","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","27613","HC BX LOW LEG SOFT TISSUE,SUPERFICIAL","27613 - HC BX LOW LEG SOFT TISSUE,SUPERFICIAL",2043,2607.12,1098.98,3264.67,510.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 27634","CIGNA HEALTHCARE - CIGNA CARELINK - 27634","CIGNA HEALTHCARE - CIGNA CARELINK - 27634 - HC EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5+CM","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","27634","HC EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5+CM","27634 - HC EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5+CM",3570,11845.41,1990.62,11845.41,892.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 27648","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 27648","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 27648 - HC INJECTION ANKLE ARTHROGRAPHY","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","27648","HC INJECTION ANKLE ARTHROGRAPHY","27648 - HC INJECTION ANKLE ARTHROGRAPHY",396,130.88,130.88,1198.25,99]
["TUFTS - TUFTS POS - CPT - 27752","TUFTS - TUFTS POS - 27752","TUFTS - TUFTS POS - 27752 - CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ","TUFTS","TUFTS POS","CPT","27752","CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ","27752 - CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ",3806,2058.17,1098.98,3264.67,951.5]
["TUFTS - TUFTS SELECT - CPT - 27759","TUFTS - TUFTS SELECT - 27759","TUFTS - TUFTS SELECT - 27759 - HC TREAT TIBIAL SHAFT FX, INTRAMED IMPLANT","TUFTS","TUFTS SELECT","CPT","27759","HC TREAT TIBIAL SHAFT FX, INTRAMED IMPLANT","27759 - HC TREAT TIBIAL SHAFT FX, INTRAMED IMPLANT",16080,3987.49,2166.09,20818.13,4020]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 27768","BLUE CROSS - BLUE CROSS-INDEMNITY - 27768","BLUE CROSS - BLUE CROSS-INDEMNITY - 27768 - HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","27768","HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ","27768 - HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ",3357,2205.59,317.70999999999998,2551.96,839.25]
["AETNA - AETNA - CPT - 27781","AETNA - AETNA - 27781","AETNA - AETNA - 27781 - CLTX PROX FIBULA/SHFT FX W/MANJ","AETNA","AETNA","CPT","27781","CLTX PROX FIBULA/SHFT FX W/MANJ","27781 - CLTX PROX FIBULA/SHFT FX W/MANJ",3029,1198.25,1098.98,3264.67,757.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 27788","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 27788","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 27788 - CLTX DSTL FIBULAR FX LAT MALLS W/MANJ","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","27788","CLTX DSTL FIBULAR FX LAT MALLS W/MANJ","27788 - CLTX DSTL FIBULAR FX LAT MALLS W/MANJ",2964,485.97,378,3264.67,741]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 27814","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 27814","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 27814 - HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","27814","HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE","27814 - HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE",8554,11074.87,1990.62,11845.41,2138.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 27818","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 27818","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 27818 - CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","27818","CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION","27818 - CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION",3337,2205.59,1098.98,3264.67,834.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 27830","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 27830","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 27830 - CLTX PROX TIBFIB JT DISLC W/O ANES","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","27830","CLTX PROX TIBFIB JT DISLC W/O ANES","27830 - CLTX PROX TIBFIB JT DISLC W/O ANES",2510,378,378,3264.67,627.5]
["TUFTS - TUFTS PPO - CPT - 28010","TUFTS - TUFTS PPO - 28010","TUFTS - TUFTS PPO - 28010 - TENOTOMY PERCUTANEOUS TOE SINGLE TENDON","TUFTS","TUFTS PPO","CPT","28010","TENOTOMY PERCUTANEOUS TOE SINGLE TENDON","28010 - TENOTOMY PERCUTANEOUS TOE SINGLE TENDON",2895,2058.16,1098.98,3264.67,723.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 28011","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 28011","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 28011 - HC INCISION OF TOE TENDONS","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","28011","HC INCISION OF TOE TENDONS","28011 - HC INCISION OF TOE TENDONS",2020,2489.31,1990.62,7703.8,505]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 28043","BLUE CROSS - BLUE CROSS-PPO - 28043","BLUE CROSS - BLUE CROSS-PPO - 28043 - EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM","BLUE CROSS","BLUE CROSS-PPO","CPT","28043","EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM","28043 - EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM",2008,2309.9699999999998,1500.85,7703.8,502]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 28090","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 28090","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 28090 - HC REMOVAL OF FOOT LESION","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","28090","HC REMOVAL OF FOOT LESION","28090 - HC REMOVAL OF FOOT LESION",2051,2205.59,1990.62,11845.41,512.75]
["TUFTS - TUFTS HMO - CPT - 28124","TUFTS - TUFTS HMO - 28124","TUFTS - TUFTS HMO - 28124 - PARTIAL REMOVAL OF TOE","TUFTS","TUFTS HMO","CPT","28124","PARTIAL REMOVAL OF TOE","28124 - PARTIAL REMOVAL OF TOE",4168,2057.7399999999998,1098.98,5097.42,1042]
["AETNA - AETNA - CPT - 28192","AETNA - AETNA - 28192","AETNA - AETNA - 28192 - REMOVAL FOREIGN BODY FOOT DEEP","AETNA","AETNA","CPT","28192","REMOVAL FOREIGN BODY FOOT DEEP","28192 - REMOVAL FOREIGN BODY FOOT DEEP",2407,1500.85,1500.85,7703.8,601.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 28220","BLUE CROSS - BLUE CROSS-HMO BLUE - 28220","BLUE CROSS - BLUE CROSS-HMO BLUE - 28220 - HC RELEASE FLEX FOOT TENDON,SINGLE","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","28220","HC RELEASE FLEX FOOT TENDON,SINGLE","28220 - HC RELEASE FLEX FOOT TENDON,SINGLE",2837,2205.59,1098.98,3264.67,709.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 28232","CIGNA HEALTHCARE - CIGNA CARELINK - 28232","CIGNA HEALTHCARE - CIGNA CARELINK - 28232 - TX OPEN TENDON FLEXOR TOE 1 TENDON SPX","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","28232","TX OPEN TENDON FLEXOR TOE 1 TENDON SPX","28232 - TX OPEN TENDON FLEXOR TOE 1 TENDON SPX",2895,3264.67,1098.98,3264.67,723.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 28234","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 28234","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 28234 - TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","28234","TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON","28234 - TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON",2895,2551.96,1098.98,3264.67,723.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 28308","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 28308","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 28308 - OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","28308","OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA","28308 - OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA",2861,5097.42,1500.85,7703.8,715.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 28435","BLUE CROSS - BLUE CROSS-HMO BLUE - 28435","BLUE CROSS - BLUE CROSS-HMO BLUE - 28435 - CLOSED TX TALUS FRACTURE W/MANIPULATION","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","28435","CLOSED TX TALUS FRACTURE W/MANIPULATION","28435 - CLOSED TX TALUS FRACTURE W/MANIPULATION",1918,2205.59,1500.85,7703.8,479.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 28450","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 28450","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 28450 - TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","28450","TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ","28450 - TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ",1480,378,317.70999999999998,1198.25,370]
["TUFTS - TUFTS POS - CPT - 28470","TUFTS - TUFTS POS - 28470","TUFTS - TUFTS POS - 28470 - CLOSED TX METATARSAL FRACTURE W/O MANIPULATION","TUFTS","TUFTS POS","CPT","28470","CLOSED TX METATARSAL FRACTURE W/O MANIPULATION","28470 - CLOSED TX METATARSAL FRACTURE W/O MANIPULATION",1468,595.01,317.70999999999998,1198.25,367]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 28510","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 28510","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 28510 - CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","28510","CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ","28510 - CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ",914,378,317.70999999999998,1198.25,228.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 28515","BLUE CROSS - BLUE CROSS-INDEMNITY - 28515","BLUE CROSS - BLUE CROSS-INDEMNITY - 28515 - CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","28515","CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ","28515 - CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ",1084,378,317.70999999999998,1198.25,271]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 28540","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 28540","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 28540 - CLTX TARSAL DISLC OTH/THN TALOTARSAL W/O ANES","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","28540","CLTX TARSAL DISLC OTH/THN TALOTARSAL W/O ANES","28540 - CLTX TARSAL DISLC OTH/THN TALOTARSAL W/O ANES",1406,485.97,378,2032.26,351.5]
["TUFTS - TUFTS HMO - CPT - 28570","TUFTS - TUFTS HMO - 28570","TUFTS - TUFTS HMO - 28570 - HC CLOSED RX TALOTARSAL DISLOC","TUFTS","TUFTS HMO","CPT","28570","HC CLOSED RX TALOTARSAL DISLOC","28570 - HC CLOSED RX TALOTARSAL DISLOC",321,2057.7399999999998,378,3264.67,80.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 28660","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 28660","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 28660 - HC CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","28660","HC CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES","28660 - HC CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES",323,485.97,317.70999999999998,1198.25,80.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 29085","BLUE CROSS - BLUE CROSS-HMO BLUE - 29085","BLUE CROSS - BLUE CROSS-HMO BLUE - 29085 - APPLICATION CAST HAND & LOWER FOREARM GAUNTLET","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","29085","APPLICATION CAST HAND & LOWER FOREARM GAUNTLET","29085 - APPLICATION CAST HAND & LOWER FOREARM GAUNTLET",516,226.08,226.08,764.24,129]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 29086","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 29086","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 29086 - HC APPLY CAST,FINGER (CONTRACTURE)","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","29086","HC APPLY CAST,FINGER (CONTRACTURE)","29086 - HC APPLY CAST,FINGER (CONTRACTURE)",203,226.08,226.08,764.24,50.75]
["TUFTS - TUFTS SELECT - CPT - 29126","TUFTS - TUFTS SELECT - 29126","TUFTS - TUFTS SELECT - 29126 - APPLICATION SHORT ARM SPLINT DYNAMIC","TUFTS","TUFTS SELECT","CPT","29126","APPLICATION SHORT ARM SPLINT DYNAMIC","29126 - APPLICATION SHORT ARM SPLINT DYNAMIC",373,190.72,178.83,607.84,93.25]
["TUFTS - TUFTS PPO - CPT - 29130","TUFTS - TUFTS PPO - 29130","TUFTS - TUFTS PPO - 29130 - APPLICATION FINGER SPLINT STATIC","TUFTS","TUFTS PPO","CPT","29130","APPLICATION FINGER SPLINT STATIC","29130 - APPLICATION FINGER SPLINT STATIC",218,200.07,93.87,317.35000000000002,54.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 29280","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 29280","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 29280 - HC STRAPPING OF HAND OR FINGER","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","29280","HC STRAPPING OF HAND OR FINGER","29280 - HC STRAPPING OF HAND OR FINGER",224,69.349999999999994,53.94,194.97,56]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 29405","BLUE CROSS - BLUE CROSS-HMO BLUE - 29405","BLUE CROSS - BLUE CROSS-HMO BLUE - 29405 - APPLICATION SHORT LEG CAST BELOW KNEE-TOE","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","29405","APPLICATION SHORT LEG CAST BELOW KNEE-TOE","29405 - APPLICATION SHORT LEG CAST BELOW KNEE-TOE",459,395.63,395.63,1308.22,114.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 29425","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 29425","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 29425 - APPLICATION SHORT LEG CAST WALKING/AMBULATORY","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","29425","APPLICATION SHORT LEG CAST WALKING/AMBULATORY","29425 - APPLICATION SHORT LEG CAST WALKING/AMBULATORY",435,395.63,395.63,1308.22,108.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 29445","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 29445","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 29445 - HC APPLICATION RIGID TOTAL CONTACT LEG CAST","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","29445","HC APPLICATION RIGID TOTAL CONTACT LEG CAST","29445 - HC APPLICATION RIGID TOTAL CONTACT LEG CAST",357,395.63,395.63,1308.22,89.25]
["TUFTS - TUFTS POS - CPT - 29505","TUFTS - TUFTS POS - 29505","TUFTS - TUFTS POS - 29505 - APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES","TUFTS","TUFTS POS","CPT","29505","APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES","29505 - APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES",378,450.38,226.08,764.24,94.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 29540","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 29540","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 29540 - STRAPPING ANKLE &/FOOT","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","29540","STRAPPING ANKLE &/FOOT","29540 - STRAPPING ANKLE &/FOOT",198,290.64,226.08,740.26,49.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 29700","BLUE CROSS - BLUE CROSS-HMO BLUE - 29700","BLUE CROSS - BLUE CROSS-HMO BLUE - 29700 - REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","29700","REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST","29700 - REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST",262,395.63,374.59,1193.8800000000001,65.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 29705","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 29705","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 29705 - HC REMV/REVISN FULL ARM/LEG CAST","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","29705","HC REMV/REVISN FULL ARM/LEG CAST","29705 - HC REMV/REVISN FULL ARM/LEG CAST",354,395.63,395.63,1274.1099999999999,88.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 29804","CIGNA HEALTHCARE - CIGNA CARELINK - 29804","CIGNA HEALTHCARE - CIGNA CARELINK - 29804 - HC TMJ ARTHROSCOPY/SURGERY","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","29804","HC TMJ ARTHROSCOPY/SURGERY","29804 - HC TMJ ARTHROSCOPY/SURGERY",4072,7703.8,1990.62,7703.8,1018]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 29827","CIGNA HEALTHCARE - CIGNA CARELINK - 29827","CIGNA HEALTHCARE - CIGNA CARELINK - 29827 - HC SHLDR ARTHROSCOP,SURG,W/ROTAT CUFF REPR","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","29827","HC SHLDR ARTHROSCOP,SURG,W/ROTAT CUFF REPR","29827 - HC SHLDR ARTHROSCOP,SURG,W/ROTAT CUFF REPR",10676,15242.01,2354.5,15242.01,2669]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 29882","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 29882","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 29882 - HC KNEE SCOPE,MED OR LAT MENIS REPAIR","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","29882","HC KNEE SCOPE,MED OR LAT MENIS REPAIR","29882 - HC KNEE SCOPE,MED OR LAT MENIS REPAIR",4072,4405.5600000000004,1990.62,7703.8,1018]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 30000","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 30000","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 30000 - DRAINAGE ABSCESS/HEMATOMA NASAL INT APPROACH","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","30000","DRAINAGE ABSCESS/HEMATOMA NASAL INT APPROACH","30000 - DRAINAGE ABSCESS/HEMATOMA NASAL INT APPROACH",933,346.18,346.18,2032.26,233.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 30020","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 30020","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 30020 - DRAINAGE ABSCESS/HEMATOMA NASAL SEPTUM","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","30020","DRAINAGE ABSCESS/HEMATOMA NASAL SEPTUM","30020 - DRAINAGE ABSCESS/HEMATOMA NASAL SEPTUM",933,818.07,684.11,2032.26,233.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 30117","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 30117","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 30117 - EXCISION/DESTRUCTION INTRANASAL LESION INT APPR","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","30117","EXCISION/DESTRUCTION INTRANASAL LESION INT APPR","30117 - EXCISION/DESTRUCTION INTRANASAL LESION INT APPR",2646,4229.1400000000003,1990.62,11845.41,661.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 30220","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 30220","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 30220 - INSERTION NASAL SEPTAL PROSTHESIS BUTTON","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","30220","INSERTION NASAL SEPTAL PROSTHESIS BUTTON","30220 - INSERTION NASAL SEPTAL PROSTHESIS BUTTON",2094,2148.08,1990.62,7703.8,523.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 30300","CIGNA HEALTHCARE - CIGNA CARELINK - 30300","CIGNA HEALTHCARE - CIGNA CARELINK - 30300 - REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","30300","REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE","30300 - REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE",993,943.8,178.83,943.8,248.25]
["TUFTS - TUFTS SELECT - CPT - 30520","TUFTS - TUFTS SELECT - 30520","TUFTS - TUFTS SELECT - 30520 - HC REPAIR OF NASAL SEPTUM","TUFTS","TUFTS SELECT","CPT","30520","HC REPAIR OF NASAL SEPTUM","30520 - HC REPAIR OF NASAL SEPTUM",3896,3987.49,2166.09,11845.41,974]
["TUFTS - TUFTS POS - CPT - 30560","TUFTS - TUFTS POS - 30560","TUFTS - TUFTS POS - 30560 - HC RELEASE OF NASAL ADHESIONS","TUFTS","TUFTS POS","CPT","30560","HC RELEASE OF NASAL ADHESIONS","30560 - HC RELEASE OF NASAL ADHESIONS",731,4856.75,818.07,7703.8,182.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 30801","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 30801","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 30801 - ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","30801","ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC","30801 - ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC",1076,2485.42,1098.98,3264.67,269]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 30905","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 30905","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 30905 - CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","30905","CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST","30905 - CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST",781,229.89,178.83,3264.67,195.25]
["TUFTS - TUFTS POS - CPT - 30906","TUFTS - TUFTS POS - 30906","TUFTS - TUFTS POS - 30906 - CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ","TUFTS","TUFTS POS","CPT","30906","CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ","30906 - CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ",280,2058.17,346.18,3264.67,70]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 31237","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 31237","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 31237 - NASAL/SINUS NDSC SURG W/BX POLYPECT/DBRDMT SPX","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","31237","NASAL/SINUS NDSC SURG W/BX POLYPECT/DBRDMT SPX","31237 - NASAL/SINUS NDSC SURG W/BX POLYPECT/DBRDMT SPX",2091,2299.54,1500.85,7703.8,522.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 31237","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 31237","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 31237 - NASAL/SINUS NDSC SURG W/BX POLYPECT/DBRDMT SPX","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","31237","NASAL/SINUS NDSC SURG W/BX POLYPECT/DBRDMT SPX","31237 - NASAL/SINUS NDSC SURG W/BX POLYPECT/DBRDMT SPX",2091,2660.67,1500.85,7703.8,522.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 31267","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 31267","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 31267 - HC NASAL/SINUS ENDOSCOPY,RMV TISS MAXILL SINUS","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","31267","HC NASAL/SINUS ENDOSCOPY,RMV TISS MAXILL SINUS","31267 - HC NASAL/SINUS ENDOSCOPY,RMV TISS MAXILL SINUS",6192,10002.24,1990.62,11845.41,1548]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 31505","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 31505","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 31505 - LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","31505","LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX","31505 - LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX",383,354.01,275.37,943.8,95.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 31511","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 31511","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 31511 - HC LARYNGOSCOPY,INDIRECT+REMV FOR.BODY","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","31511","HC LARYNGOSCOPY,INDIRECT+REMV FOR.BODY","31511 - HC LARYNGOSCOPY,INDIRECT+REMV FOR.BODY",234,275.37,275.37,2032.26,58.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 31552","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 31552","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 31552 - HC LARYNGOPLASTY LARYNGEAL STEN W/O STENT 12 YRS>","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","31552","HC LARYNGOPLASTY LARYNGEAL STEN W/O STENT 12 YRS>","31552 - HC LARYNGOPLASTY LARYNGEAL STEN W/O STENT 12 YRS>",6641,7429.92,2354.5,15242.01,1660.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 31570","BLUE CROSS - BLUE CROSS-PPO - 31570","BLUE CROSS - BLUE CROSS-PPO - 31570 - HC LARYNGOSCOPY,DIRCT,INJ VOCAL CORD","BLUE CROSS","BLUE CROSS-PPO","CPT","31570","HC LARYNGOSCOPY,DIRCT,INJ VOCAL CORD","31570 - HC LARYNGOSCOPY,DIRCT,INJ VOCAL CORD",4112,4602.58,1500.85,7703.8,1028]
["TUFTS - TUFTS SELECT - CPT - 31573","TUFTS - TUFTS SELECT - 31573","TUFTS - TUFTS SELECT - 31573 - HC LARYNGOSCOPY FLEXIBLE THERAPEUTIC INJECTION UNI","TUFTS","TUFTS SELECT","CPT","31573","HC LARYNGOSCOPY FLEXIBLE THERAPEUTIC INJECTION UNI","31573 - HC LARYNGOSCOPY FLEXIBLE THERAPEUTIC INJECTION UNI",2069,2593.31,1500.85,7703.8,517.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 31577","BLUE CROSS - BLUE CROSS-INDEMNITY - 31577","BLUE CROSS - BLUE CROSS-INDEMNITY - 31577 - LARYNGOSCOPY FLX FIBEROPTIC RMVL FOREIGN BODY","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","31577","LARYNGOSCOPY FLX FIBEROPTIC RMVL FOREIGN BODY","31577 - LARYNGOSCOPY FLX FIBEROPTIC RMVL FOREIGN BODY",1156,649.07000000000005,649.07000000000005,2032.26,289]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 31578","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 31578","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 31578 - LARYNGOSCOPY FLEXIBLE FIBEROPTIC REMOVAL LESION","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","31578","LARYNGOSCOPY FLEXIBLE FIBEROPTIC REMOVAL LESION","31578 - LARYNGOSCOPY FLEXIBLE FIBEROPTIC REMOVAL LESION",2091,4602.58,1500.85,7703.8,522.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 31605","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 31605","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 31605 - HC TRACHEOSTOMY,EMERG,CRICOTHYROID","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","31605","HC TRACHEOSTOMY,EMERG,CRICOTHYROID","31605 - HC TRACHEOSTOMY,EMERG,CRICOTHYROID",254,346.18,346.18,3264.67,63.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 31611","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 31611","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 31611 - CONSTJ TRACHEOESOPHGL FSTL&INSJ SP PROSTH","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","31611","CONSTJ TRACHEOESOPHGL FSTL&INSJ SP PROSTH","31611 - CONSTJ TRACHEOESOPHGL FSTL&INSJ SP PROSTH",4242,4335.57,1990.62,11845.41,1060.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 31622","CIGNA HEALTHCARE - CIGNA CARELINK - 31622","CIGNA HEALTHCARE - CIGNA CARELINK - 31622 - BRNCHSC INCL FLUOR GID DX W/CELL WASHG SPX","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","31622","BRNCHSC INCL FLUOR GID DX W/CELL WASHG SPX","31622 - BRNCHSC INCL FLUOR GID DX W/CELL WASHG SPX",1637,3264.67,1098.98,3264.67,409.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 31626","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 31626","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 31626 - HC BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","31626","HC BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT","31626 - HC BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT",8573,8644.68,1990.62,10002.24,2143.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 31626","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 31626","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 31626 - HC BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","31626","HC BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT","31626 - HC BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT",8573,10002.24,1990.62,10002.24,2143.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 31632","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 31632","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 31632 - HC BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","31632","HC BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE","31632 - HC BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE",378,0,120.16,1500.85,94.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 31635","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 31635","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 31635 - HC BRONCHOSCOPY W/REMOVAL FOREIGN BODY","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","31635","HC BRONCHOSCOPY W/REMOVAL FOREIGN BODY","31635 - HC BRONCHOSCOPY W/REMOVAL FOREIGN BODY",1445,2299.54,1500.85,7703.8,361.25]
["TUFTS - TUFTS PPO - CPT - 31646","TUFTS - TUFTS PPO - 31646","TUFTS - TUFTS PPO - 31646 - HC BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE SBSQ","TUFTS","TUFTS PPO","CPT","31646","HC BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE SBSQ","31646 - HC BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE SBSQ",1637,2058.16,649.07000000000005,3264.67,409.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 31820","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 31820","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 31820 - HC SURG CLOSURE TRACH/FISTULA","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","31820","HC SURG CLOSURE TRACH/FISTULA","31820 - HC SURG CLOSURE TRACH/FISTULA",3301,3747.12,1098.98,4335.57,825.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 32400","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 32400","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 32400 - HC BIOPSY PLEURA PERCUTANEOUS NEEDLE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","32400","HC BIOPSY PLEURA PERCUTANEOUS NEEDLE","32400 - HC BIOPSY PLEURA PERCUTANEOUS NEEDLE",1304,2309.9699999999998,1098.98,3264.67,326]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 32550","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 32550","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 32550 - HC INS TUNN PLEURAL CATH W/U","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","32550","HC INS TUNN PLEURAL CATH W/U","32550 - HC INS TUNN PLEURAL CATH W/U",4154,5726.94,1500.85,7703.8,1038.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 32551","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 32551","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 32551 - TUBE THORACOSTOMY INCLUDES WATER SEAL","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","32551","TUBE THORACOSTOMY INCLUDES WATER SEAL","32551 - TUBE THORACOSTOMY INCLUDES WATER SEAL",1299,1836.61,1500.85,7703.8,324.75]
["TUFTS - TUFTS PPO - CPT - 32554","TUFTS - TUFTS PPO - 32554","TUFTS - TUFTS PPO - 32554 - THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING","TUFTS","TUFTS PPO","CPT","32554","THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING","32554 - THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING",836,2058.16,1041.23,3264.67,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 32994","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 32994","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 32994 - HC ABLATION THER 1+ PULM TUMORS PREQ CRYOABLATION","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","32994","HC ABLATION THER 1+ PULM TUMORS PREQ CRYOABLATION","32994 - HC ABLATION THER 1+ PULM TUMORS PREQ CRYOABLATION",1343,7718.14,2166.09,15242.01,335.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 32998","BLUE CROSS - BLUE CROSS-PPO - 32998","BLUE CROSS - BLUE CROSS-PPO - 32998 - HC ABLATION PULMONARY TUMOR PERQ RADIOFREQUENCY UNI","BLUE CROSS","BLUE CROSS-PPO","CPT","32998","HC ABLATION PULMONARY TUMOR PERQ RADIOFREQUENCY UNI","32998 - HC ABLATION PULMONARY TUMOR PERQ RADIOFREQUENCY UNI",7058,7718.14,2166.09,15242.01,1764.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 33016","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 33016","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 33016 - HC PERICARDIOCENTESIS W/IMAGING","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","33016","HC PERICARDIOCENTESIS W/IMAGING","33016 - HC PERICARDIOCENTESIS W/IMAGING",2070,2303.1799999999998,1500.85,7703.8,517.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 33208","CIGNA HEALTHCARE - CIGNA CARELINK - 33208","CIGNA HEALTHCARE - CIGNA CARELINK - 33208 - HC INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","33208","HC INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT","33208 - HC INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT",10670,31200.07,2531.06,31200.07,2667.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 33212","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 33212","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 33212 - HC INS PM PLS GEN W/EXIST SINGLE LEAD","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","33212","HC INS PM PLS GEN W/EXIST SINGLE LEAD","33212 - HC INS PM PLS GEN W/EXIST SINGLE LEAD",11115,12434.24,1990.62,31200.07,2778.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 33215","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 33215","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 33215 - HC RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","33215","HC RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE","33215 - HC RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE",2275,5006.74,1098.98,5132.74,568.75]
["TUFTS - TUFTS PPO - CPT - 33216","TUFTS - TUFTS PPO - 33216","TUFTS - TUFTS PPO - 33216 - HC INSJ 1 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB","TUFTS","TUFTS PPO","CPT","33216","HC INSJ 1 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB","33216 - HC INSJ 1 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB",7357,19666.71,2166.09,31200.07,1839.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 33223","BLUE CROSS - BLUE CROSS-HMO BLUE - 33223","BLUE CROSS - BLUE CROSS-HMO BLUE - 33223 - HC RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","33223","HC RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR","33223 - HC RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR",3089,2601.27,1098.98,3344.2,772.25]
["TUFTS - TUFTS POS - CPT - 33226","TUFTS - TUFTS POS - 33226","TUFTS - TUFTS POS - 33226 - HC RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD","TUFTS","TUFTS POS","CPT","33226","HC RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD","33226 - HC RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD",3654,2058.17,1098.98,5132.74,913.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 33227","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 33227","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 33227 - HC REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","33227","HC REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD","33227 - HC REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD",7357,10390.549999999999,1990.62,62742.78,1839.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 33230","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 33230","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 33230 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST DUAL LEADS","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","33230","HC INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST DUAL LEADS","33230 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST DUAL LEADS",26390,30868.73,1990.62,62742.78,6597.5]
["AETNA - AETNA - CPT - 33233","AETNA - AETNA - 33233","AETNA - AETNA - 33233 - HC REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY","AETNA","AETNA","CPT","33233","HC REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY","33233 - HC REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY",7357,1500.85,1098.98,12434.24,1839.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 33240","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 33240","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 33240 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/1 EXISTING LD","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","33240","HC INSJ IMPLNTBL DEFIB PULSE GEN W/1 EXISTING LD","33240 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/1 EXISTING LD",25757,36940.21,2531.06,62742.78,6439.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 33249","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 33249","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 33249 - HC INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","33249","HC INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR","33249 - HC INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR",34636,43021.64,2531.06,62742.78,8659]
["TUFTS - TUFTS SELECT - CPT - 33262","TUFTS - TUFTS SELECT - 33262","TUFTS - TUFTS SELECT - 33262 - HC RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD","TUFTS","TUFTS SELECT","CPT","33262","HC RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD","33262 - HC RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD",25757,21120.9,1990.62,62742.78,6439.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 33271","BLUE CROSS - BLUE CROSS-INDEMNITY - 33271","BLUE CROSS - BLUE CROSS-INDEMNITY - 33271 - INSJ OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","33271","INSJ OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE","33271 - INSJ OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE",11405,12434.24,1990.62,31200.07,2851.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 33273","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 33273","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 33273 - REPOS PREVIOUSLY IMPLANTED SUBQ IMPLANTABLE DFB","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","33273","REPOS PREVIOUSLY IMPLANTED SUBQ IMPLANTABLE DFB","33273 - REPOS PREVIOUSLY IMPLANTED SUBQ IMPLANTABLE DFB",4700,5257.32,1990.62,7703.8,1175]
["TUFTS - TUFTS HMO - CPT - 33285","TUFTS - TUFTS HMO - 33285","TUFTS - TUFTS HMO - 33285 - HC INSJ SUBQ CAR RHYTHM MNTR","TUFTS","TUFTS HMO","CPT","33285","HC INSJ SUBQ CAR RHYTHM MNTR","33285 - HC INSJ SUBQ CAR RHYTHM MNTR",11393,16146.45,1198.25,25611.61,2848.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 33440","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 33440","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 33440 - HC RPLCMT AORTIC VALVE BY TLCJ AUTOL PULM VALVE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","33440","HC RPLCMT AORTIC VALVE BY TLCJ AUTOL PULM VALVE","33440 - HC RPLCMT AORTIC VALVE BY TLCJ AUTOL PULM VALVE",22850,8368.99,8368.99,8368.99,5712.5]
["BMC HEALTHNET - BMCHN MCO - CPT - 33967","BMC HEALTHNET - BMCHN MCO - 33967","BMC HEALTHNET - BMCHN MCO - 33967 - HC PERC INS IAB","BMC HEALTHNET","BMCHN MCO","CPT","33967","HC PERC INS IAB","33967 - HC PERC INS IAB",1979,0,645.88,26020.16,494.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 36000","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 36000","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 36000 - INTRODUCTION NEEDLE/INTRACATHETER VEIN","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","36000","INTRODUCTION NEEDLE/INTRACATHETER VEIN","36000 - INTRODUCTION NEEDLE/INTRACATHETER VEIN",73,0,23.16,23.16,18.25]
["AETNA - AETNA - CPT - 36005","AETNA - AETNA - 36005","AETNA - AETNA - 36005 - HC NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH","AETNA","AETNA","CPT","36005","HC NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH","36005 - HC NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH",366,1198.25,119.48,1198.25,91.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 36012","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 36012","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 36012 - HC SLCTV CATH PLMT VEN SYS 2ND ORDER/> SLCTV BRANC","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","36012","HC SLCTV CATH PLMT VEN SYS 2ND ORDER/> SLCTV BRANC","36012 - HC SLCTV CATH PLMT VEN SYS 2ND ORDER/> SLCTV BRANC",1351,428.26,428.26,1198.25,337.75]
["TUFTS - TUFTS POS - CPT - 36015","TUFTS - TUFTS POS - 36015","TUFTS - TUFTS POS - 36015 - HC SLCTV CATH PLMT SEGMENTAL/SUBSEGMENTAL PULM ART","TUFTS","TUFTS POS","CPT","36015","HC SLCTV CATH PLMT SEGMENTAL/SUBSEGMENTAL PULM ART","36015 - HC SLCTV CATH PLMT SEGMENTAL/SUBSEGMENTAL PULM ART",1312,0,424.76,1198.25,328]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 36140","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 36140","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 36140 - HC INTRO NEEDLE/INTRACATH EXTREMITY ARTERY","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","36140","HC INTRO NEEDLE/INTRACATH EXTREMITY ARTERY","36140 - HC INTRO NEEDLE/INTRACATH EXTREMITY ARTERY",794,0,223.07,1198.25,198.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 36216","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 36216","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 36216 - HC SLCTV CATHJ 1ST 2ND ORD THRC/BRCH/CPHLC BRNCH","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","36216","HC SLCTV CATHJ 1ST 2ND ORD THRC/BRCH/CPHLC BRNCH","36216 - HC SLCTV CATHJ 1ST 2ND ORD THRC/BRCH/CPHLC BRNCH",2108,0,676.88,1500.85,527]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 36216","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 36216","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 36216 - HC SLCTV CATHJ 1ST 2ND ORD THRC/BRCH/CPHLC BRNCH","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","36216","HC SLCTV CATHJ 1ST 2ND ORD THRC/BRCH/CPHLC BRNCH","36216 - HC SLCTV CATHJ 1ST 2ND ORD THRC/BRCH/CPHLC BRNCH",2108,0,676.88,1500.85,527]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 36222","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 36222","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 36222 - HC SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","36222","HC SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART","36222 - HC SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART",4429,4436.09,1500.85,15242.01,1107.25]
["TUFTS - TUFTS HMO - CPT - 36225","TUFTS - TUFTS HMO - 36225","TUFTS - TUFTS HMO - 36225 - HC SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY","TUFTS","TUFTS HMO","CPT","36225","HC SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY","36225 - HC SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY",4429,9609.09,1500.85,15242.01,1107.25]
["TUFTS - TUFTS PPO - CPT - 36226","TUFTS - TUFTS PPO - 36226","TUFTS - TUFTS PPO - 36226 - HC SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY","TUFTS","TUFTS PPO","CPT","36226","HC SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY","36226 - HC SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY",7758,10732.28,1990.62,17023.61,1939.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 36246","BLUE CROSS - BLUE CROSS-HMO BLUE - 36246","BLUE CROSS - BLUE CROSS-HMO BLUE - 36246 - HC SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","36246","HC SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH","36246 - HC SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH",2072,628.98,628.98,1500.85,518]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 36247","BLUE CROSS - BLUE CROSS-PPO - 36247","BLUE CROSS - BLUE CROSS-PPO - 36247 - HC SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH","BLUE CROSS","BLUE CROSS-PPO","CPT","36247","HC SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH","36247 - HC SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH",2469,747.57,747.57,1500.85,617.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 36253","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 36253","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 36253 - HC SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","36253","HC SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I","36253 - HC SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I",4429,7349.8,1500.85,11845.41,1107.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 36406","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 36406","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 36406 - HC VNPNXR <3 YEARS PHYS/QHP SKILL OTHER VEIN","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","36406","HC VNPNXR <3 YEARS PHYS/QHP SKILL OTHER VEIN","36406 - HC VNPNXR <3 YEARS PHYS/QHP SKILL OTHER VEIN",78,21.37,21.37,21.37,19.5]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 36410","CIGNA HEALTHCARE - CIGNA PPO - 36410","CIGNA HEALTHCARE - CIGNA PPO - 36410 - VNPNXR 3 YEARS/> PHYS/QHP SKILL","CIGNA HEALTHCARE","CIGNA PPO","CPT","36410","VNPNXR 3 YEARS/> PHYS/QHP SKILL","36410 - VNPNXR 3 YEARS/> PHYS/QHP SKILL",78,54.26,23.16,96.14,19.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 36416","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 36416","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 36416 - HC COLLECTION CAPILLARY BLOOD SPECIMEN","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","36416","HC COLLECTION CAPILLARY BLOOD SPECIMEN","36416 - HC COLLECTION CAPILLARY BLOOD SPECIMEN",22,0,5.27,5.27,5.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 36455","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 36455","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 36455 - HC EXCHANGE TRANSFUION, OTHR","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","36455","HC EXCHANGE TRANSFUION, OTHR","36455 - HC EXCHANGE TRANSFUION, OTHR",1271,826.68,643.03,2230.38,317.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 36471","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 36471","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 36471 - NJX SCLEROSING SOLUTION MULTIPLE VEINS SAME LEG","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","36471","NJX SCLEROSING SOLUTION MULTIPLE VEINS SAME LEG","36471 - NJX SCLEROSING SOLUTION MULTIPLE VEINS SAME LEG",783,527.46,521.32000000000005,1661.52,195.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 36475","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 36475","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 36475 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","36475","HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN","36475 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN",3421,4436.09,1990.62,11845.41,855.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 36476","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 36476","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 36476 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","36476","HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS","36476 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS",2062,0,334.4,1198.25,515.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 36481","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 36481","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 36481 - HC PERC PORTAL VEIN CATH","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","36481","HC PERC PORTAL VEIN CATH","36481 - HC PERC PORTAL VEIN CATH",2753,826.81,826.81,1198.25,688.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 36511","BLUE CROSS - BLUE CROSS-INDEMNITY - 36511","BLUE CROSS - BLUE CROSS-INDEMNITY - 36511 - HC THER APHERESIS,WHITE BLOOD CELLS","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","36511","HC THER APHERESIS,WHITE BLOOD CELLS","36511 - HC THER APHERESIS,WHITE BLOOD CELLS",1867,2094.1799999999998,1500.85,7279.25,466.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 36512","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 36512","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 36512 - THERAPEUTIC APHERESIS RED BLOOD CELLS","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","36512","THERAPEUTIC APHERESIS RED BLOOD CELLS","36512 - THERAPEUTIC APHERESIS RED BLOOD CELLS",1867,2094.1799999999998,1500.85,7279.25,466.75]
["TUFTS - TUFTS HMO - CPT - 36522","TUFTS - TUFTS HMO - 36522","TUFTS - TUFTS HMO - 36522 - PHOTOPHERESIS EXTRACORPOREAL","TUFTS","TUFTS HMO","CPT","36522","PHOTOPHERESIS EXTRACORPOREAL","36522 - PHOTOPHERESIS EXTRACORPOREAL",7093,12292.06,1500.85,20857.57,1773.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 36555","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 36555","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 36555 - HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","36555","HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y","36555 - HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y",1359,2361.15,1098.98,3264.67,339.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 36561","BLUE CROSS - BLUE CROSS-HMO BLUE - 36561","BLUE CROSS - BLUE CROSS-HMO BLUE - 36561 - HC INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","36561","HC INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>","36561 - HC INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>",4034,4436.09,1990.62,7703.8,1008.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 36568","CIGNA HEALTHCARE - CIGNA CARELINK - 36568","CIGNA HEALTHCARE - CIGNA CARELINK - 36568 - HC INS PICC;W/O PMP/PRT;<5YR","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","36568","HC INS PICC;W/O PMP/PRT;<5YR","36568 - HC INS PICC;W/O PMP/PRT;<5YR",1461,7703.8,1041.23,7703.8,365.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 36569","BLUE CROSS - BLUE CROSS-HMO BLUE - 36569","BLUE CROSS - BLUE CROSS-HMO BLUE - 36569 - INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/>","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","36569","INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/>","36569 - INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/>",1461,1836.61,1198.25,7703.8,365.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 36572","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 36572","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 36572 - HC INSJ PICC RS&I <5 YR","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","36572","HC INSJ PICC RS&I <5 YR","36572 - HC INSJ PICC RS&I <5 YR",955,1305.74,1041.23,3264.67,238.75]
["TUFTS - TUFTS PPO - CPT - 36573","TUFTS - TUFTS PPO - 36573","TUFTS - TUFTS PPO - 36573 - HC INSJ PICC RS&I 5 YR+","TUFTS","TUFTS PPO","CPT","36573","HC INSJ PICC RS&I 5 YR+","36573 - HC INSJ PICC RS&I 5 YR+",1683,4856.75,1198.25,7703.8,420.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 36580","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 36580","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 36580 - HC REPL CVC,NON_TUN;5/+YO","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","36580","HC REPL CVC,NON_TUN;5/+YO","36580 - HC REPL CVC,NON_TUN;5/+YO",1461,1836.61,1198.25,7703.8,365.25]
["TUFTS - TUFTS POS - CPT - 36584","TUFTS - TUFTS POS - 36584","TUFTS - TUFTS POS - 36584 - RPLCMT COMPL PRPH CVC W/O SUBQ PORT/PMP","TUFTS","TUFTS POS","CPT","36584","RPLCMT COMPL PRPH CVC W/O SUBQ PORT/PMP","36584 - RPLCMT COMPL PRPH CVC W/O SUBQ PORT/PMP",1461,4856.75,1198.25,7703.8,365.25]
["TUFTS - TUFTS SELECT - CPT - 36585","TUFTS - TUFTS SELECT - 36585","TUFTS - TUFTS SELECT - 36585 - HC RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT","TUFTS","TUFTS SELECT","CPT","36585","HC RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT","36585 - HC RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT",3308,2593.31,1990.62,7703.8,827]
["TUFTS - TUFTS SELECT - CPT - 36591","TUFTS - TUFTS SELECT - 36591","TUFTS - TUFTS SELECT - 36591 - COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE","TUFTS","TUFTS SELECT","CPT","36591","COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE","36591 - COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE",192,190.66,178.83,607.66,48]
["BMC HEALTHNET - BMCHN QHP - CPT - 36592","BMC HEALTHNET - BMCHN QHP - 36592","BMC HEALTHNET - BMCHN QHP - 36592 - COLLECT BLOOD FROM CATHETER VENOUS NOS","BMC HEALTHNET","BMCHN QHP","CPT","36592","COLLECT BLOOD FROM CATHETER VENOUS NOS","36592 - COLLECT BLOOD FROM CATHETER VENOUS NOS",196,0,178.83,1076.77,49]
["TUFTS - TUFTS HMO - CPT - 36596","TUFTS - TUFTS HMO - 36596","TUFTS - TUFTS HMO - 36596 - HC MCHNL RMVL INTRAL OBSTR CV DEV THRU DEV LUMEN","TUFTS","TUFTS HMO","CPT","36596","HC MCHNL RMVL INTRAL OBSTR CV DEV THRU DEV LUMEN","36596 - HC MCHNL RMVL INTRAL OBSTR CV DEV THRU DEV LUMEN",1461,4856.75,1198.25,7703.8,365.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 36620","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 36620","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 36620 - HC INSERT CATH,ART,PERCUT,SHORTTERM","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","36620","HC INSERT CATH,ART,PERCUT,SHORTTERM","36620 - HC INSERT CATH,ART,PERCUT,SHORTTERM",366,0,108.25,1198.25,91.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 36680","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 36680","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 36680 - HC PLACEMENT NEEDLE INTRAOSSEOUS INFUSION","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","36680","HC PLACEMENT NEEDLE INTRAOSSEOUS INFUSION","36680 - HC PLACEMENT NEEDLE INTRAOSSEOUS INFUSION",454,584.69000000000005,317.70999999999998,1198.25,113.5]
["AETNA - AETNA - CPT - 36904","AETNA - AETNA - 36904","AETNA - AETNA - 36904 - HC PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH","AETNA","AETNA","CPT","36904","HC PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH","36904 - HC PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH",7857,2354.5,2354.5,9090.86,1964.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 36907","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 36907","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 36907 - HC TRLUML BAL ANGIO CTR DIAL","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","36907","HC TRLUML BAL ANGIO CTR DIAL","36907 - HC TRLUML BAL ANGIO CTR DIAL",11188,362.66,362.66,1198.25,2797]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 36908","CIGNA HEALTHCARE - CIGNA CARELINK - 36908","CIGNA HEALTHCARE - CIGNA CARELINK - 36908 - HC STENT PLMT CENTRAL DIAYLSIS SEG PFRMD DIAL CIR","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","36908","HC STENT PLMT CENTRAL DIAYLSIS SEG PFRMD DIAL CIR","36908 - HC STENT PLMT CENTRAL DIAYLSIS SEG PFRMD DIAL CIR",1114,0,512.95000000000005,1198.25,278.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 37184","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 37184","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 37184 - HC PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","37184","HC PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST","37184 - HC PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST",5624,9090.86,2397.88,15242.01,1406]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 37186","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 37186","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 37186 - HC SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","37186","HC SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL","37186 - HC SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL",1951,0,603,1198.25,487.75]
["AETNA - AETNA - CPT - 37191","AETNA - AETNA - 37191","AETNA - AETNA - 37191 - HC INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I","AETNA","AETNA","CPT","37191","HC INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I","37191 - HC INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I",4893,1990.62,1990.62,17023.61,1223.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 37195","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 37195","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 37195 - HC THROMBOLYTIC THERAPY, STROKE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","37195","HC THROMBOLYTIC THERAPY, STROKE","37195 - HC THROMBOLYTIC THERAPY, STROKE",346,484.3,484.3,3264.67,86.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 37197","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 37197","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 37197 - HC PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","37197","HC PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING","37197 - HC PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING",4034,4436.09,1098.98,5132.74,1008.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 37212","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 37212","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 37212 - HC THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","37212","HC THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX","37212 - HC THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX",3354,5006.74,1098.98,5132.74,838.5]
["TUFTS - TUFTS PPO - CPT - 37213","TUFTS - TUFTS PPO - 37213","TUFTS - TUFTS PPO - 37213 - HC THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX","TUFTS","TUFTS PPO","CPT","37213","HC THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX","37213 - HC THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX",3308,2058.16,1098.98,3264.67,827]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 37220","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 37220","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 37220 - HC REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","37220","HC REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL","37220 - HC REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL",7580,7856.99,2166.09,25611.61,1895]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 37222","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 37222","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 37222 - HC REVASC;ILIAC,EAAD,TRN ANG","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","37222","HC REVASC;ILIAC,EAAD,TRN ANG","37222 - HC REVASC;ILIAC,EAAD,TRN ANG",7580,459.91,459.91,1198.25,1895]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 37224","CIGNA HEALTHCARE - CIGNA CARELINK - 37224","CIGNA HEALTHCARE - CIGNA CARELINK - 37224 - HC REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","37224","HC REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI","37224 - HC REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI",7580,11845.41,2166.09,11845.41,1895]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 37228","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 37228","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 37228 - HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","37228","HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI","37228 - HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI",10821,16237.9,2166.09,37129.18,2705.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 37228","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 37228","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 37228 - HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","37228","HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI","37228 - HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI",10821,18787.919999999998,2166.09,37129.18,2705.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 37232","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 37232","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 37232 - HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","37232","HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL","37232 - HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL",7580,0,497.3,1198.25,1895]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 37237","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 37237","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 37237 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","37237","OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL","37237 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL",7580,0,525.59,1198.25,1895]
["TUFTS - TUFTS PPO - CPT - 37238","TUFTS - TUFTS PPO - 37238","TUFTS - TUFTS PPO - 37238 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST","TUFTS","TUFTS PPO","CPT","37238","OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST","37238 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST",15672,4856.75,1990.62,18787.919999999998,3918]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 37242","BLUE CROSS - BLUE CROSS-PPO - 37242","BLUE CROSS - BLUE CROSS-PPO - 37242 - VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I","BLUE CROSS","BLUE CROSS-PPO","CPT","37242","VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I","37242 - VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I",15195,16237.9,1990.62,37129.18,3798.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 37244","BLUE CROSS - BLUE CROSS-INDEMNITY - 37244","BLUE CROSS - BLUE CROSS-INDEMNITY - 37244 - VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","37244","VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE","37244 - VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE",15195,16237.9,1990.62,37129.18,3798.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 37248","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 37248","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 37248 - HC TRLUML BAL ANGIO 1ST VEIN","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","37248","HC TRLUML BAL ANGIO 1ST VEIN","37248 - HC TRLUML BAL ANGIO 1ST VEIN",7857,9090.86,2531.06,11845.41,1964.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 37609","BLUE CROSS - BLUE CROSS-HMO BLUE - 37609","BLUE CROSS - BLUE CROSS-HMO BLUE - 37609 - HC TEMPORAL ARTERY LIGATN OR BX","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","37609","HC TEMPORAL ARTERY LIGATN OR BX","37609 - HC TEMPORAL ARTERY LIGATN OR BX",1633,2309.9699999999998,1500.85,7703.8,408.25]
["AETNA - AETNA - CPT - 37799","AETNA - AETNA - 37799","AETNA - AETNA - 37799 - UNLISTED PROCEDURE,VASCULAR SURGERY","AETNA","AETNA","CPT","37799","UNLISTED PROCEDURE,VASCULAR SURGERY","37799 - UNLISTED PROCEDURE,VASCULAR SURGERY",494,1500.85,317.70999999999998,1500.85,123.5]
["TUFTS - TUFTS SELECT - CPT - 38208","TUFTS - TUFTS SELECT - 38208","TUFTS - TUFTS SELECT - 38208 - HC TRNSPL PREP HEMATOP PROGEN THAW PREV HRV PER DNR","TUFTS","TUFTS SELECT","CPT","38208","HC TRNSPL PREP HEMATOP PROGEN THAW PREV HRV PER DNR","38208 - HC TRNSPL PREP HEMATOP PROGEN THAW PREV HRV PER DNR",1015,684.11,643.03,2032.26,253.75]
["TUFTS - TUFTS POS - CPT - 38220","TUFTS - TUFTS POS - 38220","TUFTS - TUFTS POS - 38220 - MARROW ASPIRATION ONLY","TUFTS","TUFTS POS","CPT","38220","MARROW ASPIRATION ONLY","38220 - MARROW ASPIRATION ONLY",1103,2058.17,1098.98,3264.67,275.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 38300","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 38300","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 38300 - DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","38300","DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL","38300 - DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL",1435,2309.9699999999998,1098.98,3264.67,358.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 38510","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 38510","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 38510 - HC BX/REMV,LYMPH NODE,DEEP CERV","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","38510","HC BX/REMV,LYMPH NODE,DEEP CERV","38510 - HC BX/REMV,LYMPH NODE,DEEP CERV",4506,5471.79,1500.85,7703.8,1126.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 38531","CIGNA HEALTHCARE - CIGNA CARELINK - 38531","CIGNA HEALTHCARE - CIGNA CARELINK - 38531 - HC OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","38531","HC OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES","38531 - HC OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES",4334,11845.41,1500.85,11845.41,1083.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 38792","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 38792","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 38792 - HC INJ PROC;SENTINAL NODE ID","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","38792","HC INJ PROC;SENTINAL NODE ID","38792 - HC INJ PROC;SENTINAL NODE ID",444,593.65,593.65,2063.4,111]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 38792","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 38792","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 38792 - HC INJ PROC;SENTINAL NODE ID","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","38792","HC INJ PROC;SENTINAL NODE ID","38792 - HC INJ PROC;SENTINAL NODE ID",444,763.18,593.65,2063.4,111]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 40520","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 40520","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 40520 - HC PARTIAL EXCISION OF LIP","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","40520","HC PARTIAL EXCISION OF LIP","40520 - HC PARTIAL EXCISION OF LIP",4029,3747.12,1500.85,7703.8,1007.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 40650","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 40650","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 40650 - HC REPAIR LIP,FULL THICK,VERMILION","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","40650","HC REPAIR LIP,FULL THICK,VERMILION","40650 - HC REPAIR LIP,FULL THICK,VERMILION",691,1051.71,818.07,11845.41,172.75]
["TUFTS - TUFTS SELECT - CPT - 40652","TUFTS - TUFTS SELECT - 40652","TUFTS - TUFTS SELECT - 40652 - HC REPAIR LIP,<1/2 VERT HEIGHT","TUFTS","TUFTS SELECT","CPT","40652","HC REPAIR LIP,<1/2 VERT HEIGHT","40652 - HC REPAIR LIP,<1/2 VERT HEIGHT",658,3987.49,818.07,11845.41,164.5]
["TUFTS - TUFTS PPO - CPT - 40804","TUFTS - TUFTS PPO - 40804","TUFTS - TUFTS PPO - 40804 - HC REM FB,MOUTH;SIMP","TUFTS","TUFTS PPO","CPT","40804","HC REM FB,MOUTH;SIMP","40804 - HC REM FB,MOUTH;SIMP",1058,320.41000000000003,171.09,1644.19,264.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 40805","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 40805","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 40805 - HC REMOVAL FOREIGN BODY,MOUTH,COMPLEX","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","40805","HC REMOVAL FOREIGN BODY,MOUTH,COMPLEX","40805 - HC REMOVAL FOREIGN BODY,MOUTH,COMPLEX",658,818.07,818.07,7703.8,164.5]
["TUFTS - TUFTS POS - CPT - 40810","TUFTS - TUFTS POS - 40810","TUFTS - TUFTS POS - 40810 - EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR","TUFTS","TUFTS POS","CPT","40810","EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR","40810 - EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR",2094,2058.17,1098.98,4335.57,523.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 40819","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 40819","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 40819 - EXC FRENUM LABIAL/BUCCAL","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","40819","EXC FRENUM LABIAL/BUCCAL","40819 - EXC FRENUM LABIAL/BUCCAL",1836,2148.08,1098.98,3264.67,459]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 40820","BLUE CROSS - BLUE CROSS-INDEMNITY - 40820","BLUE CROSS - BLUE CROSS-INDEMNITY - 40820 - HC DESTRUC MOUTH LESION/SCAR","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","40820","HC DESTRUC MOUTH LESION/SCAR","40820 - HC DESTRUC MOUTH LESION/SCAR",3301,3747.12,1098.98,4335.57,825.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 40840","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 40840","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 40840 - HC RECONSTRUC MOUTH ANTERIOR","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","40840","HC RECONSTRUC MOUTH ANTERIOR","40840 - HC RECONSTRUC MOUTH ANTERIOR",6641,8596.73,1500.85,8596.73,1660.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 41007","BLUE CROSS - BLUE CROSS-INDEMNITY - 41007","BLUE CROSS - BLUE CROSS-INDEMNITY - 41007 - HC I&D MOUTH/TONG INTRA,SUBMENTAL","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","41007","HC I&D MOUTH/TONG INTRA,SUBMENTAL","41007 - HC I&D MOUTH/TONG INTRA,SUBMENTAL",1921,2148.08,1098.98,3264.67,480.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 41008","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 41008","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 41008 - HC I&D MOUTH/TONG INTRA,SUBMANDIBULAR","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","41008","HC I&D MOUTH/TONG INTRA,SUBMANDIBULAR","41008 - HC I&D MOUTH/TONG INTRA,SUBMANDIBULAR",3349,3747.12,1098.98,4335.57,837.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 41010","CIGNA HEALTHCARE - CIGNA CARELINK - 41010","CIGNA HEALTHCARE - CIGNA CARELINK - 41010 - INCISION LINGUAL FRENUM FRENOTOMY","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","41010","INCISION LINGUAL FRENUM FRENOTOMY","41010 - INCISION LINGUAL FRENUM FRENOTOMY",870,3264.67,1098.98,3264.67,217.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 41017","CIGNA HEALTHCARE - CIGNA CARELINK - 41017","CIGNA HEALTHCARE - CIGNA CARELINK - 41017 - HC XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","41017","HC XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB","41017 - HC XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB",3301,3264.67,1098.98,4335.57,825.25]
["TUFTS - TUFTS SELECT - CPT - 41105","TUFTS - TUFTS SELECT - 41105","TUFTS - TUFTS SELECT - 41105 - HC BIOPSY TONGUE,POSTER 1/3","TUFTS","TUFTS SELECT","CPT","41105","HC BIOPSY TONGUE,POSTER 1/3","41105 - HC BIOPSY TONGUE,POSTER 1/3",2618,2593.31,1500.85,7703.8,654.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 41113","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 41113","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 41113 - HC EXCIS TONGUE LESN,POST 1/3","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","41113","HC EXCIS TONGUE LESN,POST 1/3","41113 - HC EXCIS TONGUE LESN,POST 1/3",2737,3747.12,1500.85,7703.8,684.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 41115","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 41115","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 41115 - EXCIISION LINGUAL FRENUM FRENECTOMY","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","41115","EXCIISION LINGUAL FRENUM FRENECTOMY","41115 - EXCIISION LINGUAL FRENUM FRENECTOMY",1164,2148.08,1098.98,3264.67,291]
["TUFTS - TUFTS HMO - CPT - 41250","TUFTS - TUFTS HMO - 41250","TUFTS - TUFTS HMO - 41250 - HC RLAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG","TUFTS","TUFTS HMO","CPT","41250","HC RLAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG","41250 - HC RLAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG",1199,4856.75,178.83,7703.8,299.75]
["TUFTS - TUFTS PPO - CPT - 41251","TUFTS - TUFTS PPO - 41251","TUFTS - TUFTS PPO - 41251 - HC REPAIR TONGUE LACER,POST 1/3","TUFTS","TUFTS PPO","CPT","41251","HC REPAIR TONGUE LACER,POST 1/3","41251 - HC REPAIR TONGUE LACER,POST 1/3",310,1281.21,346.18,2032.26,77.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 41820","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 41820","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 41820 - HC EXCISION, GUM, EACH QUADRANT","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","41820","HC EXCISION, GUM, EACH QUADRANT","41820 - HC EXCISION, GUM, EACH QUADRANT",4466,3747.12,1198.25,11845.41,1116.5]
["TUFTS - TUFTS HMO - CPT - 41825","TUFTS - TUFTS HMO - 41825","TUFTS - TUFTS HMO - 41825 - EXCISION OF GUM LESION","TUFTS","TUFTS HMO","CPT","41825","EXCISION OF GUM LESION","41825 - EXCISION OF GUM LESION",4030,2057.7399999999998,1098.98,4335.57,1007.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 41826","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 41826","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 41826 - HC EXCIS DENTOALV LESN,SIMPL REPR","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","41826","HC EXCIS DENTOALV LESN,SIMPL REPR","41826 - HC EXCIS DENTOALV LESN,SIMPL REPR",3350,4335.57,1098.98,4335.57,837.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 41874","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 41874","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 41874 - HC REPAIR TOOTH SOCKET","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","41874","HC REPAIR TOOTH SOCKET","41874 - HC REPAIR TOOTH SOCKET",3996,4229.1400000000003,1198.25,7703.8,999]
["TUFTS - TUFTS HMO - CPT - 42000","TUFTS - TUFTS HMO - 42000","TUFTS - TUFTS HMO - 42000 - HC DRAINAGE ABSCESS PALATE UVULA","TUFTS","TUFTS HMO","CPT","42000","HC DRAINAGE ABSCESS PALATE UVULA","42000 - HC DRAINAGE ABSCESS PALATE UVULA",823,1281.21,346.18,2032.26,205.75]
["AETNA - AETNA - CPT - 42120","AETNA - AETNA - 42120","AETNA - AETNA - 42120 - HC RESCJ PALATE/EXTENSIVE RESCJ LESION","AETNA","AETNA","CPT","42120","HC RESCJ PALATE/EXTENSIVE RESCJ LESION","42120 - HC RESCJ PALATE/EXTENSIVE RESCJ LESION",6512,2166.09,2166.09,11845.41,1628]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 42180","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 42180","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 42180 - HC REPAIR PALATE LACER <2 CM","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","42180","HC REPAIR PALATE LACER <2 CM","42180 - HC REPAIR PALATE LACER <2 CM",589,818.07,684.11,2032.26,147.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 42330","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 42330","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 42330 - SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","42330","SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL","42330 - SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL",2094,4229.1400000000003,1198.25,7703.8,523.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 42400","CIGNA HEALTHCARE - CIGNA CARELINK - 42400","CIGNA HEALTHCARE - CIGNA CARELINK - 42400 - BIOPSY SALIVARY GLAND NEEDLE","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","42400","BIOPSY SALIVARY GLAND NEEDLE","42400 - BIOPSY SALIVARY GLAND NEEDLE",1209,3264.67,972.93,3264.67,302.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 42405","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 42405","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 42405 - BIOPSY SALIVARY GLAND INCISIONAL","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","42405","BIOPSY SALIVARY GLAND INCISIONAL","42405 - BIOPSY SALIVARY GLAND INCISIONAL",3197,4335.57,1500.85,7703.8,799.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 42440","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 42440","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 42440 - HC EXCISION SUBMAXILLARY GLAND","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","42440","HC EXCISION SUBMAXILLARY GLAND","42440 - HC EXCISION SUBMAXILLARY GLAND",7214,8596.73,1990.62,11845.41,1803.5]
["TUFTS - TUFTS SELECT - CPT - 42699","TUFTS - TUFTS SELECT - 42699","TUFTS - TUFTS SELECT - 42699 - SIAOENDOSCOPY","TUFTS","TUFTS SELECT","CPT","42699","SIAOENDOSCOPY","42699 - SIAOENDOSCOPY",268,317.70999999999998,317.70999999999998,1198.25,67]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 42720","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 42720","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 42720 - HC INC/DRAIN RETROPHARYNG ABSCESS,ORAL","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","42720","HC INC/DRAIN RETROPHARYNG ABSCESS,ORAL","42720 - HC INC/DRAIN RETROPHARYNG ABSCESS,ORAL",3349,3747.12,1098.98,4335.57,837.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 42804","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 42804","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 42804 - BIOPSY NASOPHARYNX VISIBLE LESION SIMPLE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","42804","BIOPSY NASOPHARYNX VISIBLE LESION SIMPLE","42804 - BIOPSY NASOPHARYNX VISIBLE LESION SIMPLE",2094,3747.12,1098.98,4335.57,523.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 42808","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 42808","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 42808 - EXCISION/DESTRUCTION LESION PHARYNX ANY METHOD","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","42808","EXCISION/DESTRUCTION LESION PHARYNX ANY METHOD","42808 - EXCISION/DESTRUCTION LESION PHARYNX ANY METHOD",3197,4335.57,1500.85,7703.8,799.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 42826","BLUE CROSS - BLUE CROSS-INDEMNITY - 42826","BLUE CROSS - BLUE CROSS-INDEMNITY - 42826 - TONSILLECTOMY ONE-HALF AGE 12/>","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","42826","TONSILLECTOMY ONE-HALF AGE 12/>","42826 - TONSILLECTOMY ONE-HALF AGE 12/>",3197,3747.12,2166.09,11845.41,799.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 42960","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 42960","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 42960 - HC CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","42960","HC CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE","42960 - HC CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE",1334,818.07,818.07,3264.67,333.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 42970","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 42970","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 42970 - HC CTRL NASOPHARYNGEAL HEMRRG SMPL W/PST NSL PACKS","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","42970","HC CTRL NASOPHARYNGEAL HEMRRG SMPL W/PST NSL PACKS","42970 - HC CTRL NASOPHARYNGEAL HEMRRG SMPL W/PST NSL PACKS",268,346.18,317.70999999999998,1198.25,67]
["TUFTS - TUFTS PPO - CPT - 43195","TUFTS - TUFTS PPO - 43195","TUFTS - TUFTS PPO - 43195 - HC ESOPHAGOSCOPY RIGID TRANSORAL BALLOON DILATION","TUFTS","TUFTS PPO","CPT","43195","HC ESOPHAGOSCOPY RIGID TRANSORAL BALLOON DILATION","43195 - HC ESOPHAGOSCOPY RIGID TRANSORAL BALLOON DILATION",4537,4856.75,1500.85,7703.8,1134.25]
["AETNA - AETNA - CPT - 43201","AETNA - AETNA - 43201","AETNA - AETNA - 43201 - HC ESOPHAGOSCOPY FLEXIBLE TRANSORAL W SUBMUCOUS INJ","AETNA","AETNA","CPT","43201","HC ESOPHAGOSCOPY FLEXIBLE TRANSORAL W SUBMUCOUS INJ","43201 - HC ESOPHAGOSCOPY FLEXIBLE TRANSORAL W SUBMUCOUS INJ",2394,1198.25,1010.64,3264.67,598.5]
["AETNA - AETNA - CPT - 43202","AETNA - AETNA - 43202","AETNA - AETNA - 43202 - ESPHGSC RGD/FLX W/BIOPSY SINGLE/MULTIPLE","AETNA","AETNA","CPT","43202","ESPHGSC RGD/FLX W/BIOPSY SINGLE/MULTIPLE","43202 - ESPHGSC RGD/FLX W/BIOPSY SINGLE/MULTIPLE",1154,1198.25,1010.64,3264.67,288.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 43220","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 43220","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 43220 - HC ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","43220","HC ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM","43220 - HC ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM",2226,2882.31,1010.64,3264.67,556.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 43229","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 43229","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 43229 - HC ESOPHAGOSCOPY FLEX TRANSORAL LESION ABLATION","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","43229","HC ESOPHAGOSCOPY FLEX TRANSORAL LESION ABLATION","43229 - HC ESOPHAGOSCOPY FLEX TRANSORAL LESION ABLATION",3385,5488.65,1500.85,7703.8,846.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 43235","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 43235","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 43235 - HC UPPER GI NDSC DX W/WO COLLECTION SPECIMEN","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","43235","HC UPPER GI NDSC DX W/WO COLLECTION SPECIMEN","43235 - HC UPPER GI NDSC DX W/WO COLLECTION SPECIMEN",1123,1644.19,1010.64,3264.67,280.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 43238","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 43238","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 43238 - HC UPR GI NDSC TNDSC US FINE NDL ASPIR/BX ESOPH","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","43238","HC UPR GI NDSC TNDSC US FINE NDL ASPIR/BX ESOPH","43238 - HC UPR GI NDSC TNDSC US FINE NDL ASPIR/BX ESOPH",2244,2882.31,1010.64,3264.67,561]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 43239","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 43239","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 43239 - HC UPPER NDSC BIOPSY SINGLE/MULTIPLE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","43239","HC UPPER NDSC BIOPSY SINGLE/MULTIPLE","43239 - HC UPPER NDSC BIOPSY SINGLE/MULTIPLE",1322,1644.19,1010.64,3264.67,330.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 43242","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 43242","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 43242 - HC UPPER GI NDSC ULTRASOUND GUIDED BIOPSY","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","43242","HC UPPER GI NDSC ULTRASOUND GUIDED BIOPSY","43242 - HC UPPER GI NDSC ULTRASOUND GUIDED BIOPSY",3252,2882.31,1010.64,7703.8,813]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 43243","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 43243","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 43243 - HC UPR GI NDSC NJX SCLEROSIS ESOPHGL&/GSTR VARICE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","43243","HC UPR GI NDSC NJX SCLEROSIS ESOPHGL&/GSTR VARICE","43243 - HC UPR GI NDSC NJX SCLEROSIS ESOPHGL&/GSTR VARICE",2056,2491.1,1010.64,7703.8,514]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 43246","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 43246","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 43246 - HC UPR GI NDSC PLMT PRQ GASTROSTOMY TUBE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","43246","HC UPR GI NDSC PLMT PRQ GASTROSTOMY TUBE","43246 - HC UPR GI NDSC PLMT PRQ GASTROSTOMY TUBE",1937,2882.31,1010.64,7703.8,484.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 43248","BLUE CROSS - BLUE CROSS-PPO - 43248","BLUE CROSS - BLUE CROSS-PPO - 43248 - HC UPR GI NDSC INSJ GUIDE WIRE DILAT ESOPHAGUS","BLUE CROSS","BLUE CROSS-PPO","CPT","43248","HC UPR GI NDSC INSJ GUIDE WIRE DILAT ESOPHAGUS","43248 - HC UPR GI NDSC INSJ GUIDE WIRE DILAT ESOPHAGUS",1449,1278.93,1010.64,7703.8,362.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 43250","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 43250","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 43250 - HC UPR GI NDSC RMVL LESION HOT BX/BIPOLAR CAUTERY","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","43250","HC UPR GI NDSC RMVL LESION HOT BX/BIPOLAR CAUTERY","43250 - HC UPR GI NDSC RMVL LESION HOT BX/BIPOLAR CAUTERY",1459,2882.31,1010.64,7703.8,364.75]
["TUFTS - TUFTS HMO - CPT - 43254","TUFTS - TUFTS HMO - 43254","TUFTS - TUFTS HMO - 43254 - HC EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION","TUFTS","TUFTS HMO","CPT","43254","HC EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION","43254 - HC EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION",2099,2057.7399999999998,1098.98,3264.67,524.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 43255","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 43255","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 43255 - HC UPR GI NDSC CONTROL BLEEDING ANY METHOD","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","43255","HC UPR GI NDSC CONTROL BLEEDING ANY METHOD","43255 - HC UPR GI NDSC CONTROL BLEEDING ANY METHOD",2170,2882.31,1010.64,7703.8,542.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 43260","BLUE CROSS - BLUE CROSS-PPO - 43260","BLUE CROSS - BLUE CROSS-PPO - 43260 - HC ERCP DX W/WO COLLJ SPEC BRUSHING/WASHING SPX","BLUE CROSS","BLUE CROSS-PPO","CPT","43260","HC ERCP DX W/WO COLLJ SPEC BRUSHING/WASHING SPX","43260 - HC ERCP DX W/WO COLLJ SPEC BRUSHING/WASHING SPX",2660,4743.7,1500.85,7703.8,665]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 43264","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 43264","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 43264 - HC ERCP W/RMVCALCULI BILIARY&/PANCREATIC DUCTS","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","43264","HC ERCP W/RMVCALCULI BILIARY&/PANCREATIC DUCTS","43264 - HC ERCP W/RMVCALCULI BILIARY&/PANCREATIC DUCTS",3937,5488.65,1500.85,7703.8,984.25]
["TUFTS - TUFTS POS - CPT - 43265","TUFTS - TUFTS POS - 43265","TUFTS - TUFTS POS - 43265 - HC ERCP W/DSTRJ LITHOTRIPSY CALCULI ANY METHOD","TUFTS","TUFTS POS","CPT","43265","HC ERCP W/DSTRJ LITHOTRIPSY CALCULI ANY METHOD","43265 - HC ERCP W/DSTRJ LITHOTRIPSY CALCULI ANY METHOD",4415,4856.75,1500.85,8736.31,1103.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 43274","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 43274","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 43274 - HC ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","43274","HC ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT","43274 - HC ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT",3592,7550.56,1990.62,8736.31,898]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 43276","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 43276","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 43276 - HC ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","43276","HC ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE","43276 - HC ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE",3736,8736.31,1990.62,8736.31,934]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 43278","CIGNA HEALTHCARE - CIGNA CARELINK - 43278","CIGNA HEALTHCARE - CIGNA CARELINK - 43278 - HC ERCP LESION ABLATE W/DILATE","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","43278","HC ERCP LESION ABLATE W/DILATE","43278 - HC ERCP LESION ABLATE W/DILATE",4537,7703.8,1990.62,7703.8,1134.25]
["TUFTS - TUFTS SELECT - CPT - 43753","TUFTS - TUFTS SELECT - 43753","TUFTS - TUFTS SELECT - 43753 - GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE","TUFTS","TUFTS SELECT","CPT","43753","GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE","43753 - GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE",158,317.70999999999998,317.70999999999998,1198.25,39.5]
["TUFTS - TUFTS POS - CPT - 43754","TUFTS - TUFTS POS - 43754","TUFTS - TUFTS POS - 43754 - HC GASTRIC INTUBAT DX W/ASPIRATION SINGLE SPECIME","TUFTS","TUFTS POS","CPT","43754","HC GASTRIC INTUBAT DX W/ASPIRATION SINGLE SPECIME","43754 - HC GASTRIC INTUBAT DX W/ASPIRATION SINGLE SPECIME",374,595.01,317.70999999999998,1198.25,93.5]
["TUFTS - TUFTS POS - CPT - 43999","TUFTS - TUFTS POS - 43999","TUFTS - TUFTS POS - 43999 - ENDOSCOPIC ENDOLUMINAL GASTRIC PLICATION","TUFTS","TUFTS POS","CPT","43999","ENDOSCOPIC ENDOLUMINAL GASTRIC PLICATION","43999 - ENDOSCOPIC ENDOLUMINAL GASTRIC PLICATION",1209,2058.17,1098.98,3264.67,302.25]
["TUFTS - TUFTS POS - CPT - 44180","TUFTS - TUFTS POS - 44180","TUFTS - TUFTS POS - 44180 - HC LAP, SURG ENTEROLYSIS","TUFTS","TUFTS POS","CPT","44180","HC LAP, SURG ENTEROLYSIS","44180 - HC LAP, SURG ENTEROLYSIS",7452,9609.09,1990.62,15242.01,1863]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 44363","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 44363","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 44363 - HC ENTEROSCOPY > 2ND PRTN W/RMVL FOREIGN BODY","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","44363","HC ENTEROSCOPY > 2ND PRTN W/RMVL FOREIGN BODY","44363 - HC ENTEROSCOPY > 2ND PRTN W/RMVL FOREIGN BODY",1598,2882.31,1013.38,7703.8,399.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 44369","BLUE CROSS - BLUE CROSS-INDEMNITY - 44369","BLUE CROSS - BLUE CROSS-INDEMNITY - 44369 - HC ENTEROSCOPY > 2ND PRTN ABLTJ LESION","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","44369","HC ENTEROSCOPY > 2ND PRTN ABLTJ LESION","44369 - HC ENTEROSCOPY > 2ND PRTN ABLTJ LESION",2282,2491.1,1013.38,7703.8,570.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 44376","BLUE CROSS - BLUE CROSS-PPO - 44376","BLUE CROSS - BLUE CROSS-PPO - 44376 - HC ENTEROSC >2ND PRTN W/ILEUM W/WO COLLJ SPEC SPX","BLUE CROSS","BLUE CROSS-PPO","CPT","44376","HC ENTEROSC >2ND PRTN W/ILEUM W/WO COLLJ SPEC SPX","44376 - HC ENTEROSC >2ND PRTN W/ILEUM W/WO COLLJ SPEC SPX",2337,2491.1,1013.38,3264.67,584.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 44380","CIGNA HEALTHCARE - CIGNA CARELINK - 44380","CIGNA HEALTHCARE - CIGNA CARELINK - 44380 - HC ILEOSCOPY STOMA DX W/WO COLLJ SPEC BR/WA SPX","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","44380","HC ILEOSCOPY STOMA DX W/WO COLLJ SPEC BR/WA SPX","44380 - HC ILEOSCOPY STOMA DX W/WO COLLJ SPEC BR/WA SPX",1441,3264.67,1013.38,3264.67,360.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 44384","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 44384","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 44384 - ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","44384","ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT","44384 - ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT",4118,4743.7,1500.85,15242.01,1029.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 44384","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 44384","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 44384 - ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","44384","ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT","44384 - ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT",4118,5488.65,1500.85,15242.01,1029.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 44389","BLUE CROSS - BLUE CROSS-INDEMNITY - 44389","BLUE CROSS - BLUE CROSS-INDEMNITY - 44389 - HC COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","44389","HC COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE","44389 - HC COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE",1429,1645.44,1020.59,3264.67,357.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 44389","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 44389","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 44389 - HC COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","44389","HC COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE","44389 - HC COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE",1429,2115.37,1020.59,3264.67,357.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 44405","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 44405","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 44405 - HC COLONOSCOPY STOMA W/BALLOON DILATION","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","44405","HC COLONOSCOPY STOMA W/BALLOON DILATION","44405 - HC COLONOSCOPY STOMA W/BALLOON DILATION",1378,1645.44,1098.98,3264.67,344.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 44604","BMC HEALTHNET - BMCHN MEDICAID - 44604","BMC HEALTHNET - BMCHN MEDICAID - 44604 - HC SUTURE LRG INTEST","BMC HEALTHNET","BMCHN MEDICAID","CPT","44604","HC SUTURE LRG INTEST","44604 - HC SUTURE LRG INTEST",1472,0,2644.98,2644.98,368]
["BMC HEALTHNET - BMCHN ACO - CPT - 44705","BMC HEALTHNET - BMCHN ACO - 44705","BMC HEALTHNET - BMCHN ACO - 44705 - PREPARE FECAL MICROBIOTA FOR INSTILLATION","BMC HEALTHNET","BMCHN ACO","CPT","44705","PREPARE FECAL MICROBIOTA FOR INSTILLATION","44705 - PREPARE FECAL MICROBIOTA FOR INSTILLATION",260,0,185.27,1198.25,65]
["TUFTS - TUFTS POS - CPT - 45190","TUFTS - TUFTS POS - 45190","TUFTS - TUFTS POS - 45190 - HC DESTRUCT,RECTAL TUMOR,TRANSANAL APPROACH","TUFTS","TUFTS POS","CPT","45190","HC DESTRUCT,RECTAL TUMOR,TRANSANAL APPROACH","45190 - HC DESTRUCT,RECTAL TUMOR,TRANSANAL APPROACH",3504,9609.09,1500.85,15242.01,876]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 45300","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 45300","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 45300 - PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","45300","PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX","45300 - PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX",794,1608.22,420.29,3264.67,198.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 45317","UNICARE - UNICARE STATE INDEMNITY PLAN - 45317","UNICARE - UNICARE STATE INDEMNITY PLAN - 45317 - HC PROCTOSIGMOIDOSCOPY BLEED","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","45317","HC PROCTOSIGMOIDOSCOPY BLEED","45317 - HC PROCTOSIGMOIDOSCOPY BLEED",1505,737.96,737.96,3264.67,376.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 45332","UNICARE - UNICARE STATE INDEMNITY PLAN - 45332","UNICARE - UNICARE STATE INDEMNITY PLAN - 45332 - HC SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","45332","HC SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY","45332 - HC SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY",1341,420.29,420.29,2115.37,335.25]
["TUFTS - TUFTS POS - CPT - 45333","TUFTS - TUFTS POS - 45333","TUFTS - TUFTS POS - 45333 - HC SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS","TUFTS","TUFTS POS","CPT","45333","HC SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS","45333 - HC SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS",1137,1281.21,684.11,2032.26,284.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 45335","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 45335","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 45335 - HC SGMDSC FLX DIRED SBMCSL NJX ANY SBST","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","45335","HC SGMDSC FLX DIRED SBMCSL NJX ANY SBST","45335 - HC SGMDSC FLX DIRED SBMCSL NJX ANY SBST",715,1250.94,420.29,2032.26,178.75]
["TUFTS - TUFTS HMO - CPT - 45338","TUFTS - TUFTS HMO - 45338","TUFTS - TUFTS HMO - 45338 - HC SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ","TUFTS","TUFTS HMO","CPT","45338","HC SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ","45338 - HC SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ",1092,2057.7399999999998,737.96,3264.67,273]
["TUFTS - TUFTS HMO - CPT - 45342","TUFTS - TUFTS HMO - 45342","TUFTS - TUFTS HMO - 45342 - HC SIGMOIDOSCOPY FLX TNDSC US GID NDL ASPIR/BX","TUFTS","TUFTS HMO","CPT","45342","HC SIGMOIDOSCOPY FLX TNDSC US GID NDL ASPIR/BX","45342 - HC SIGMOIDOSCOPY FLX TNDSC US GID NDL ASPIR/BX",1841,2057.7399999999998,737.96,3264.67,460.25]
["TUFTS - TUFTS POS - CPT - 45349","TUFTS - TUFTS POS - 45349","TUFTS - TUFTS POS - 45349 - SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION","TUFTS","TUFTS POS","CPT","45349","SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION","45349 - SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION",2215,2058.17,1098.98,3264.67,553.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 45350","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 45350","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 45350 - HC SIGMOIDOSCOPY FLX WITH WITH BAND LIGATION(S)","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","45350","HC SIGMOIDOSCOPY FLX WITH WITH BAND LIGATION(S)","45350 - HC SIGMOIDOSCOPY FLX WITH WITH BAND LIGATION(S)",1509,1645.44,1098.98,3264.67,377.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 45381","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 45381","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 45381 - HC COLSC FLX PROX SPLENIC FLXR SBMCSL NJX","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","45381","HC COLSC FLX PROX SPLENIC FLXR SBMCSL NJX","45381 - HC COLSC FLX PROX SPLENIC FLXR SBMCSL NJX",1897,1645.44,1020.59,3264.67,474.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 45382","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 45382","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 45382 - HC COLSC FLX PROX SPLENIC FLXR CTRL BLD","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","45382","HC COLSC FLX PROX SPLENIC FLXR CTRL BLD","45382 - HC COLSC FLX PROX SPLENIC FLXR CTRL BLD",2540,1645.44,1020.59,3264.67,635]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 45385","BLUE CROSS - BLUE CROSS-HMO BLUE - 45385","BLUE CROSS - BLUE CROSS-HMO BLUE - 45385 - HC COLSC FLX PROX SPLENIC FLXR RMVL LES SNARE TQ","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","45385","HC COLSC FLX PROX SPLENIC FLXR RMVL LES SNARE TQ","45385 - HC COLSC FLX PROX SPLENIC FLXR RMVL LES SNARE TQ",2371,1645.44,1020.59,3264.67,592.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 45390","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 45390","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 45390 - HC COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","45390","HC COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION","45390 - HC COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION",1378,1645.44,1098.98,3264.67,344.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 45390","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 45390","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 45390 - HC COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","45390","HC COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION","45390 - HC COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION",1378,0,1098.98,3264.67,344.5]
["TUFTS - TUFTS PPO - CPT - 45398","TUFTS - TUFTS PPO - 45398","TUFTS - TUFTS PPO - 45398 - HC COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S)","TUFTS","TUFTS PPO","CPT","45398","HC COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S)","45398 - HC COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S)",1378,2058.16,1098.98,3264.67,344.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 45910","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 45910","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 45910 - HC DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","45910","HC DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL","45910 - HC DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL",2442,2115.37,1098.98,3264.67,610.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 46030","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 46030","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 46030 - REMOVAL OF RECTAL MARKER","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","46030","REMOVAL OF RECTAL MARKER","46030 - REMOVAL OF RECTAL MARKER",1221,2063.44,684.11,2115.37,305.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 46083","CIGNA HEALTHCARE - CIGNA CARELINK - 46083","CIGNA HEALTHCARE - CIGNA CARELINK - 46083 - INCISION THROMBOSED HEMORRHOID EXTERNAL","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","46083","INCISION THROMBOSED HEMORRHOID EXTERNAL","46083 - INCISION THROMBOSED HEMORRHOID EXTERNAL",821,943.8,317.70999999999998,1198.25,205.25]
["TUFTS - TUFTS SELECT - CPT - 46221","TUFTS - TUFTS SELECT - 46221","TUFTS - TUFTS SELECT - 46221 - HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS","TUFTS","TUFTS SELECT","CPT","46221","HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS","46221 - HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS",1473,1098.98,1098.98,3264.67,368.25]
["TUFTS - TUFTS HMO - CPT - 46255","TUFTS - TUFTS HMO - 46255","TUFTS - TUFTS HMO - 46255 - HC HEMORRHOIDECTOMY,INT/EXT,1 COLUMN/GROUP","TUFTS","TUFTS HMO","CPT","46255","HC HEMORRHOIDECTOMY,INT/EXT,1 COLUMN/GROUP","46255 - HC HEMORRHOIDECTOMY,INT/EXT,1 COLUMN/GROUP",4466,7467.76,1990.62,11845.41,1116.5]
["TUFTS - TUFTS PPO - CPT - 46260","TUFTS - TUFTS PPO - 46260","TUFTS - TUFTS PPO - 46260 - HC HEMORRHOIDECTOMY INT & XTRNL 2/> COLUMN/GRO","TUFTS","TUFTS PPO","CPT","46260","HC HEMORRHOIDECTOMY INT & XTRNL 2/> COLUMN/GRO","46260 - HC HEMORRHOIDECTOMY INT & XTRNL 2/> COLUMN/GRO",3476,7467.76,1990.62,11845.41,869]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 46601","BLUE CROSS - BLUE CROSS-HMO BLUE - 46601","BLUE CROSS - BLUE CROSS-HMO BLUE - 46601 - HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","46601","HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT","46601 - HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT",483,178.83,178.83,1198.25,120.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 46607","CIGNA HEALTHCARE - CIGNA CARELINK - 46607","CIGNA HEALTHCARE - CIGNA CARELINK - 46607 - HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT W/BX","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","46607","HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT W/BX","46607 - HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT W/BX",930,3264.67,1098.98,3264.67,232.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 46608","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 46608","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 46608 - HC ANOSCOPY,REMOVE FOREIGN BODY","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","46608","HC ANOSCOPY,REMOVE FOREIGN BODY","46608 - HC ANOSCOPY,REMOVE FOREIGN BODY",1137,1250.94,737.96,3264.67,284.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 46900","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 46900","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 46900 - DSTRJ LESION ANUS SIMPLE CHEMICAL","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","46900","DSTRJ LESION ANUS SIMPLE CHEMICAL","46900 - DSTRJ LESION ANUS SIMPLE CHEMICAL",1062,678.1,317.70999999999998,1198.25,265.5]
["TUFTS - TUFTS POS - CPT - 46910","TUFTS - TUFTS POS - 46910","TUFTS - TUFTS POS - 46910 - DSTRJ LESION ANUS SMPL ELTRDSICCATION","TUFTS","TUFTS POS","CPT","46910","DSTRJ LESION ANUS SMPL ELTRDSICCATION","46910 - DSTRJ LESION ANUS SMPL ELTRDSICCATION",2598,2058.17,1098.98,3344.2,649.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 47000","BLUE CROSS - BLUE CROSS-HMO BLUE - 47000","BLUE CROSS - BLUE CROSS-HMO BLUE - 47000 - HEARING AID EXAMINATION & SELECTION MONAURAL","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","47000","HEARING AID EXAMINATION & SELECTION MONAURAL","47000 - HEARING AID EXAMINATION & SELECTION MONAURAL",1304,2309.9699999999998,1098.98,3264.67,326]
["BMC HEALTHNET - BMCHN QHP - CPT - 47383","BMC HEALTHNET - BMCHN QHP - 47383","BMC HEALTHNET - BMCHN QHP - 47383 - HC ABLATION 1/> LIVER TUMOR PERQ CRYOABLATION","BMC HEALTHNET","BMCHN QHP","CPT","47383","HC ABLATION 1/> LIVER TUMOR PERQ CRYOABLATION","47383 - HC ABLATION 1/> LIVER TUMOR PERQ CRYOABLATION",7189,0,2397.88,15242.01,1797.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 47490","BLUE CROSS - BLUE CROSS-HMO BLUE - 47490","BLUE CROSS - BLUE CROSS-HMO BLUE - 47490 - HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","47490","HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT","47490 - HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT",4625,4949.6400000000003,3987.49,11845.41,1156.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 47533","CIGNA HEALTHCARE - CIGNA CARELINK - 47533","CIGNA HEALTHCARE - CIGNA CARELINK - 47533 - PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","47533","PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL","47533 - PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL",2142,3264.67,1098.98,5726.94,535.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 47537","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 47537","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 47537 - REMOVAL BILIARY DRG CATHETER REQ FLUOR GUID RAD S&I","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","47537","REMOVAL BILIARY DRG CATHETER REQ FLUOR GUID RAD S&I","47537 - REMOVAL BILIARY DRG CATHETER REQ FLUOR GUID RAD S&I",698,1278.93,684.11,2032.26,174.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 47537","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 47537","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 47537 - REMOVAL BILIARY DRG CATHETER REQ FLUOR GUID RAD S&I","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","47537","REMOVAL BILIARY DRG CATHETER REQ FLUOR GUID RAD S&I","47537 - REMOVAL BILIARY DRG CATHETER REQ FLUOR GUID RAD S&I",698,1644.19,684.11,2032.26,174.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 47554","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 47554","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 47554 - HC BILIARY ENDOSCOPY,PERCUT,W/REM, STONE(S)","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","47554","HC BILIARY ENDOSCOPY,PERCUT,W/REM, STONE(S)","47554 - HC BILIARY ENDOSCOPY,PERCUT,W/REM, STONE(S)",5522,7718.14,1990.62,11845.41,1380.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 47555","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 47555","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 47555 - HC BIL ENDO,PERC;DIL W/O STE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","47555","HC BIL ENDO,PERC;DIL W/O STE","47555 - HC BIL ENDO,PERC;DIL W/O STE",2787,5726.94,1990.62,11845.41,696.75]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 49010","BMC HEALTHNET - BMCHN MEDICAID - 49010","BMC HEALTHNET - BMCHN MEDICAID - 49010 - HC EXPLORATORY RETROPERITONEAL","BMC HEALTHNET","BMCHN MEDICAID","CPT","49010","HC EXPLORATORY RETROPERITONEAL","49010 - HC EXPLORATORY RETROPERITONEAL",4688,0,2166.09,11845.41,1172]
["AETNA - AETNA - CPT - 49185","AETNA - AETNA - 49185","AETNA - AETNA - 49185 - SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID","AETNA","AETNA","CPT","49185","SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID","49185 - SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID",862,1500.85,972.93,3264.67,215.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 49185","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 49185","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 49185 - SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","49185","SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID","49185 - SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID",862,1220.0899999999999,972.93,3264.67,215.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 49324","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 49324","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 49324 - HC LAP INSERTION TUNNELED INTRAPERITONEAL CATHETER","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","49324","HC LAP INSERTION TUNNELED INTRAPERITONEAL CATHETER","49324 - HC LAP INSERTION TUNNELED INTRAPERITONEAL CATHETER",6897,8710.98,2166.09,17023.61,1724.25]
["TUFTS - TUFTS HMO - CPT - 49405","TUFTS - TUFTS HMO - 49405","TUFTS - TUFTS HMO - 49405 - IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ","TUFTS","TUFTS HMO","CPT","49405","IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ","49405 - IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ",2105,4856.75,1500.85,7703.8,526.25]
["AETNA - AETNA - CPT - 49418","AETNA - AETNA - 49418","AETNA - AETNA - 49418 - INSJ INTRAPERITONEAL CATHETER W/IMG GID","AETNA","AETNA","CPT","49418","INSJ INTRAPERITONEAL CATHETER W/IMG GID","49418 - INSJ INTRAPERITONEAL CATHETER W/IMG GID",4154,1500.85,1098.98,5726.94,1038.5]
["TUFTS - TUFTS HMO - CPT - 49422","TUFTS - TUFTS HMO - 49422","TUFTS - TUFTS HMO - 49422 - REMOVE TUNNELED IP CATH","TUFTS","TUFTS HMO","CPT","49422","REMOVE TUNNELED IP CATH","49422 - REMOVE TUNNELED IP CATH",4214,2057.7399999999998,1098.98,5703.04,1053.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 49427","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 49427","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 49427 - HC INJ PROC EXIST VP SHUNT","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","49427","HC INJ PROC EXIST VP SHUNT","49427 - HC INJ PROC EXIST VP SHUNT",341,112.93,112.93,1198.25,85.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 49446","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 49446","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 49446 - HC CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERQ","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","49446","HC CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERQ","49446 - HC CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERQ",1743,2882.31,1010.64,3264.67,435.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 49450","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 49450","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 49450 - HC REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","49450","HC REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS","49450 - HC REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS",803,1644.19,684.11,2032.26,200.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 49460","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 49460","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 49460 - HC FIX G/COLON TUBE W/DEVICE","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","49460","HC FIX G/COLON TUBE W/DEVICE","49460 - HC FIX G/COLON TUBE W/DEVICE",1116,1603.82,684.11,2032.26,279]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 50382","BLUE CROSS - BLUE CROSS-PPO - 50382","BLUE CROSS - BLUE CROSS-PPO - 50382 - HC RMVL & RPLCMT INTLY DWELLING URETERAL STENT PRQ","BLUE CROSS","BLUE CROSS-PPO","CPT","50382","HC RMVL & RPLCMT INTLY DWELLING URETERAL STENT PRQ","50382 - HC RMVL & RPLCMT INTLY DWELLING URETERAL STENT PRQ",2635,2921.68,1198.25,11845.41,658.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 50385","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 50385","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 50385 - HC REMOVE & REPLACE INDWELL URETERAL STENT TRURTHRL","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","50385","HC REMOVE & REPLACE INDWELL URETERAL STENT TRURTHRL","50385 - HC REMOVE & REPLACE INDWELL URETERAL STENT TRURTHRL",2635,2921.68,1198.25,7703.8,658.75]
["TUFTS - TUFTS POS - CPT - 50389","TUFTS - TUFTS POS - 50389","TUFTS - TUFTS POS - 50389 - HC RMVL NFROS TUBE REQ FLUORO GUIDANCE","TUFTS","TUFTS POS","CPT","50389","HC RMVL NFROS TUBE REQ FLUORO GUIDANCE","50389 - HC RMVL NFROS TUBE REQ FLUORO GUIDANCE",928,2058.17,944.22,3264.67,232]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 50431","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 50431","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 50431 - HC NJX ANTGRD NPHRSTGRM &/OR URTRGRM COMPL DIAG INCL IMG GUI RAD S&I; EXSTNG ACCES","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","50431","HC NJX ANTGRD NPHRSTGRM &/OR URTRGRM COMPL DIAG INCL IMG GUI RAD S&I; EXSTNG ACCES","50431 - HC NJX ANTGRD NPHRSTGRM &/OR URTRGRM COMPL DIAG INCL IMG GUI RAD S&I; EXSTNG ACCES",844,944.22,944.22,3176.09,211]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 50433","BLUE CROSS - BLUE CROSS-HMO BLUE - 50433","BLUE CROSS - BLUE CROSS-HMO BLUE - 50433 - PLACEMENT NEPHROURETERAL CATH PRQ NEW ACCESS RAD S&I","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","50433","PLACEMENT NEPHROURETERAL CATH PRQ NEW ACCESS RAD S&I","50433 - PLACEMENT NEPHROURETERAL CATH PRQ NEW ACCESS RAD S&I",1900,2921.68,1098.98,3380.52,475]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 50436","CIGNA HEALTHCARE - CIGNA CARELINK - 50436","CIGNA HEALTHCARE - CIGNA CARELINK - 50436 - HC DILAT XST TRC NDURLGC PX","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","50436","HC DILAT XST TRC NDURLGC PX","50436 - HC DILAT XST TRC NDURLGC PX",2677,3264.67,1098.98,3380.52,669.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 50437","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 50437","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 50437 - HC DILAT XST TRC NEW ACCESS RCS","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","50437","HC DILAT XST TRC NEW ACCESS RCS","50437 - HC DILAT XST TRC NEW ACCESS RCS",4504,5687.17,1098.98,5687.17,1126]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 50593","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 50593","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 50593 - HC ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","50593","HC ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY","50593 - HC ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY",12512,15042.77,2397.88,15242.01,3128]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 50694","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 50694","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 50694 - PLACEMENT URETERAL STENT PRQ NEW ACESS WITHOUT SEP NEPHROSTOMY CATH","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","50694","PLACEMENT URETERAL STENT PRQ NEW ACESS WITHOUT SEP NEPHROSTOMY CATH","50694 - PLACEMENT URETERAL STENT PRQ NEW ACESS WITHOUT SEP NEPHROSTOMY CATH",1971,4915.28,1098.98,5687.17,492.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 50695","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 50695","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 50695 - HC PLMT URET STNTW/SEP NEPH","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","50695","HC PLMT URET STNTW/SEP NEPH","50695 - HC PLMT URET STNTW/SEP NEPH",2495,4915.28,1098.98,5687.17,623.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 51600","BLUE CROSS - BLUE CROSS-PPO - 51600","BLUE CROSS - BLUE CROSS-PPO - 51600 - NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPY","BLUE CROSS","BLUE CROSS-PPO","CPT","51600","NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPY","51600 - NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPY",329,110.49,110.49,110.49,82.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 51610","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 51610","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 51610 - NJX RETROGRADE URETHROCSTOGRAPY","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","51610","NJX RETROGRADE URETHROCSTOGRAPY","51610 - NJX RETROGRADE URETHROCSTOGRAPY",478,0,161.22,161.22,119.5]
["BMC HEALTHNET - BMCHN QHP - CPT - 51702","BMC HEALTHNET - BMCHN QHP - 51702","BMC HEALTHNET - BMCHN QHP - 51702 - INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE","BMC HEALTHNET","BMCHN QHP","CPT","51702","INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE","51702 - INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE",228,0,178.83,1198.25,57]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 51710","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 51710","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 51710 - CHANGE CYSTOSTOMY TUBE COMPLICATED","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","51710","CHANGE CYSTOSTOMY TUBE COMPLICATED","51710 - CHANGE CYSTOSTOMY TUBE COMPLICATED",803,1213.9000000000001,944.22,3176.09,200.75]
["TUFTS - TUFTS POS - CPT - 51720","TUFTS - TUFTS POS - 51720","TUFTS - TUFTS POS - 51720 - BLADDER INSTILLATION ANTICARCINOGENIC AGENT","TUFTS","TUFTS POS","CPT","51720","BLADDER INSTILLATION ANTICARCINOGENIC AGENT","51720 - BLADDER INSTILLATION ANTICARCINOGENIC AGENT",600,789,388.64,1338.81,150]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 51728","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 51728","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 51728 - COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","51728","COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES","51728 - COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES",2386,944.22,944.22,3176.09,596.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 51728","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 51728","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 51728 - COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","51728","COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES","51728 - COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES",2386,1213.9000000000001,944.22,3176.09,596.5]
["TUFTS - TUFTS POS - CPT - 51784","TUFTS - TUFTS POS - 51784","TUFTS - TUFTS POS - 51784 - EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL","TUFTS","TUFTS POS","CPT","51784","EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL","51784 - EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL",1471,469.76,228.32,797.09,367.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 51797","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 51797","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 51797 - VOID PRESSURE STUDIES INTRAABDOMINAL","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","51797","VOID PRESSURE STUDIES INTRAABDOMINAL","51797 - VOID PRESSURE STUDIES INTRAABDOMINAL",835,263.05,263.05,1198.25,208.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 52005","BLUE CROSS - BLUE CROSS-INDEMNITY - 52005","BLUE CROSS - BLUE CROSS-INDEMNITY - 52005 - HC CYSTOURETHROSCOPY,URETER CATHETER","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","52005","HC CYSTOURETHROSCOPY,URETER CATHETER","52005 - HC CYSTOURETHROSCOPY,URETER CATHETER",2091,2921.68,1500.85,7703.8,522.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 52281","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 52281","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 52281 - CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","52281","CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS","52281 - CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS",2072,3380.52,1500.85,7703.8,518]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 52285","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 52285","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 52285 - HC CYSTOSCOPY AND TREATMENT","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","52285","HC CYSTOSCOPY AND TREATMENT","52285 - HC CYSTOSCOPY AND TREATMENT",834,944.22,944.22,7703.8,208.5]
["AETNA - AETNA - CPT - 52356","AETNA - AETNA - 52356","AETNA - AETNA - 52356 - HC CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT","AETNA","AETNA","CPT","52356","HC CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT","52356 - HC CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT",6500,2166.09,2166.09,17023.61,1625]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 53620","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 53620","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 53620 - DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE 1ST","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","53620","DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE 1ST","53620 - DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE 1ST",2441,944.22,944.22,11845.41,610.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 53660","CIGNA HEALTHCARE - CIGNA CARELINK - 53660","CIGNA HEALTHCARE - CIGNA CARELINK - 53660 - HC DILATION OF URETHRA","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","53660","HC DILATION OF URETHRA","53660 - HC DILATION OF URETHRA",203,943.8,228.32,1198.25,50.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 54055","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 54055","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 54055 - DSTRJ LESION PENIS SIMPLE ELECTRODESICCATION","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","54055","DSTRJ LESION PENIS SIMPLE ELECTRODESICCATION","54055 - DSTRJ LESION PENIS SIMPLE ELECTRODESICCATION",2598,3344.2,1098.98,3344.2,649.5]
["TUFTS - TUFTS SELECT - CPT - 54055","TUFTS - TUFTS SELECT - 54055","TUFTS - TUFTS SELECT - 54055 - DSTRJ LESION PENIS SIMPLE ELECTRODESICCATION","TUFTS","TUFTS SELECT","CPT","54055","DSTRJ LESION PENIS SIMPLE ELECTRODESICCATION","54055 - DSTRJ LESION PENIS SIMPLE ELECTRODESICCATION",2598,1098.98,1098.98,3344.2,649.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 54100","CIGNA HEALTHCARE - CIGNA CARELINK - 54100","CIGNA HEALTHCARE - CIGNA CARELINK - 54100 - BIOPSY PENIS SEPARATE PROCEDURE","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","54100","BIOPSY PENIS SEPARATE PROCEDURE","54100 - BIOPSY PENIS SEPARATE PROCEDURE",1972,3264.67,1098.98,3264.67,493]
["TUFTS - TUFTS SELECT - CPT - 54161","TUFTS - TUFTS SELECT - 54161","TUFTS - TUFTS SELECT - 54161 - HC CIRCUM 28 DAYS OR OLDER","TUFTS","TUFTS SELECT","CPT","54161","HC CIRCUM 28 DAYS OR OLDER","54161 - HC CIRCUM 28 DAYS OR OLDER",2601,2593.31,1500.85,7703.8,650.25]
["TUFTS - TUFTS POS - CPT - 54162","TUFTS - TUFTS POS - 54162","TUFTS - TUFTS POS - 54162 - HC LYSIS/EXCIS,PENILE POSTCIRCUM ADHESIONS","TUFTS","TUFTS POS","CPT","54162","HC LYSIS/EXCIS,PENILE POSTCIRCUM ADHESIONS","54162 - HC LYSIS/EXCIS,PENILE POSTCIRCUM ADHESIONS",2614,4856.75,1500.85,7703.8,653.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 54231","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 54231","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 54231 - DYNAMIC CAVERNOSOMETRY NJX VASOACTIVE DRUGS","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","54231","DYNAMIC CAVERNOSOMETRY NJX VASOACTIVE DRUGS","54231 - DYNAMIC CAVERNOSOMETRY NJX VASOACTIVE DRUGS",2441,388.64,388.64,11845.41,610.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 54235","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 54235","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 54235 - NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","54235","NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT","54235 - NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT",550,388.64,388.64,1338.81,137.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 54700","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 54700","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 54700 - I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","54700","I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE","54700 - I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE",2985,3380.52,1500.85,7703.8,746.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 55120","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 55120","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 55120 - HB REMOVAL OF SCROTAL FOR BODY","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","55120","HB REMOVAL OF SCROTAL FOR BODY","55120 - HB REMOVAL OF SCROTAL FOR BODY",2611,2921.68,1500.85,7703.8,652.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 55250","BLUE CROSS - BLUE CROSS-INDEMNITY - 55250","BLUE CROSS - BLUE CROSS-INDEMNITY - 55250 - VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","55250","VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS","55250 - VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS",2985,2921.68,1098.98,3380.52,746.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 55700","BLUE CROSS - BLUE CROSS-PPO - 55700","BLUE CROSS - BLUE CROSS-PPO - 55700 - PROSTATE NEEDLE BIOPSY ANY APPROACH","BLUE CROSS","BLUE CROSS-PPO","CPT","55700","PROSTATE NEEDLE BIOPSY ANY APPROACH","55700 - PROSTATE NEEDLE BIOPSY ANY APPROACH",1826,2921.68,1098.98,3380.52,456.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 55876","BLUE CROSS - BLUE CROSS-HMO BLUE - 55876","BLUE CROSS - BLUE CROSS-HMO BLUE - 55876 - PLMT INTERSTITIAL DEV RADIAT TX PROSTATE 1/MULT","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","55876","PLMT INTERSTITIAL DEV RADIAT TX PROSTATE 1/MULT","55876 - PLMT INTERSTITIAL DEV RADIAT TX PROSTATE 1/MULT",1783,2001.68,1198.25,7703.8,445.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 56440","BLUE CROSS - BLUE CROSS-HMO BLUE - 56440","BLUE CROSS - BLUE CROSS-HMO BLUE - 56440 - MARSUPIALIZATION BARTHOLINS GLAND CYST","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","56440","MARSUPIALIZATION BARTHOLINS GLAND CYST","56440 - MARSUPIALIZATION BARTHOLINS GLAND CYST",2365,3965.45,1500.85,7703.8,591.25]
["TUFTS - TUFTS POS - CPT - 56515","TUFTS - TUFTS POS - 56515","TUFTS - TUFTS POS - 56515 - DESTRUCTION LESIONS VULVA EXTENSIVE","TUFTS","TUFTS POS","CPT","56515","DESTRUCTION LESIONS VULVA EXTENSIVE","56515 - DESTRUCTION LESIONS VULVA EXTENSIVE",2598,7467.76,1990.62,11845.41,649.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 56605","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 56605","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 56605 - BIOPSY VULVA/PERINEUM 1 LESION SPX","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","56605","BIOPSY VULVA/PERINEUM 1 LESION SPX","56605 - BIOPSY VULVA/PERINEUM 1 LESION SPX",635,1204.81,684.11,2032.26,158.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 56700","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 56700","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 56700 - HC PARTIAL REMOVAL OF HYMEN","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","56700","HC PARTIAL REMOVAL OF HYMEN","56700 - HC PARTIAL REMOVAL OF HYMEN",3863,3965.45,1098.98,4588.18,965.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 56821","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 56821","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 56821 - COLPOSCOPY VULVA W/BIOPSY","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","56821","COLPOSCOPY VULVA W/BIOPSY","56821 - COLPOSCOPY VULVA W/BIOPSY",891,589.41,317.70999999999998,1198.25,222.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 57020","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 57020","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 57020 - COLPOCENTESIS SEPARATE PROCEDURE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","57020","COLPOCENTESIS SEPARATE PROCEDURE","57020 - COLPOCENTESIS SEPARATE PROCEDURE",4336,3965.45,1500.85,7703.8,1084]
["AETNA - AETNA - CPT - 57105","AETNA - AETNA - 57105","AETNA - AETNA - 57105 - HC BIOPSY OF VAGINA","AETNA","AETNA","CPT","57105","HC BIOPSY OF VAGINA","57105 - HC BIOPSY OF VAGINA",3805,1500.85,1500.85,7703.8,951.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 57105","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 57105","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 57105 - HC BIOPSY OF VAGINA","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","57105","HC BIOPSY OF VAGINA","57105 - HC BIOPSY OF VAGINA",3805,4475.54,1500.85,7703.8,951.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 57156","CIGNA HEALTHCARE - CIGNA CARELINK - 57156","CIGNA HEALTHCARE - CIGNA CARELINK - 57156 - HC INSERTION OF CYLINDER","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","57156","HC INSERTION OF CYLINDER","57156 - HC INSERTION OF CYLINDER",406,2032.26,458.47,2032.26,101.5]
["AETNA - AETNA - CPT - 57200","AETNA - AETNA - 57200","AETNA - AETNA - 57200 - HC COLPORRHAPHY, SUTURE VAGINAL INJURY, NON-OB","AETNA","AETNA","CPT","57200","HC COLPORRHAPHY, SUTURE VAGINAL INJURY, NON-OB","57200 - HC COLPORRHAPHY, SUTURE VAGINAL INJURY, NON-OB",3715,1198.25,1098.98,4588.18,928.75]
["TUFTS - TUFTS POS - CPT - 57200","TUFTS - TUFTS POS - 57200","TUFTS - TUFTS POS - 57200 - HC COLPORRHAPHY, SUTURE VAGINAL INJURY, NON-OB","TUFTS","TUFTS POS","CPT","57200","HC COLPORRHAPHY, SUTURE VAGINAL INJURY, NON-OB","57200 - HC COLPORRHAPHY, SUTURE VAGINAL INJURY, NON-OB",3715,2058.17,1098.98,4588.18,928.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 57420","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 57420","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 57420 - COLPOSCOPY ENTIRE VAGINA W/CERVIX IF PRESENT","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","57420","COLPOSCOPY ENTIRE VAGINA W/CERVIX IF PRESENT","57420 - COLPOSCOPY ENTIRE VAGINA W/CERVIX IF PRESENT",702,458.47,458.47,2032.26,175.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 57421","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 57421","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 57421 - COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","57421","COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX","57421 - COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX",955,937.16,684.11,2032.26,238.75]
["TUFTS - TUFTS HMO - CPT - 57455","TUFTS - TUFTS HMO - 57455","TUFTS - TUFTS HMO - 57455 - COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX","TUFTS","TUFTS HMO","CPT","57455","COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX","57455 - COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX",861,1281.21,458.47,2032.26,215.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 57500","BLUE CROSS - BLUE CROSS-PPO - 57500","BLUE CROSS - BLUE CROSS-PPO - 57500 - BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX","BLUE CROSS","BLUE CROSS-PPO","CPT","57500","BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX","57500 - BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX",589,937.16,937.16,3264.67,147.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 57505","BLUE CROSS - BLUE CROSS-HMO BLUE - 57505","BLUE CROSS - BLUE CROSS-HMO BLUE - 57505 - ENDOCERVICAL CURETTAGE W/DILATION & CURETTAGE","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","57505","ENDOCERVICAL CURETTAGE W/DILATION & CURETTAGE","57505 - ENDOCERVICAL CURETTAGE W/DILATION & CURETTAGE",709,937.16,937.16,3264.67,177.25]
["TUFTS - TUFTS POS - CPT - 57520","TUFTS - TUFTS POS - 57520","TUFTS - TUFTS POS - 57520 - HC CONIZATION CERVIX, KNIFE/LASER","TUFTS","TUFTS POS","CPT","57520","HC CONIZATION CERVIX, KNIFE/LASER","57520 - HC CONIZATION CERVIX, KNIFE/LASER",3553,4856.75,1500.85,7703.8,888.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 57522","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 57522","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 57522 - CONIZATION CERVIX W/WO D&C RPR ELTRD EXC","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","57522","CONIZATION CERVIX W/WO D&C RPR ELTRD EXC","57522 - CONIZATION CERVIX W/WO D&C RPR ELTRD EXC",4911,4588.18,1098.98,4588.18,1227.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 58100","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 58100","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 58100 - ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","58100","ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX","58100 - ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX",683,349.45,278.66000000000003,1198.25,170.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 58300","CIGNA HEALTHCARE - CIGNA CARELINK - 58300","CIGNA HEALTHCARE - CIGNA CARELINK - 58300 - INSERTION INTRAUTERINE DEVICE IUD","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","58300","INSERTION INTRAUTERINE DEVICE IUD","58300 - INSERTION INTRAUTERINE DEVICE IUD",387,943.8,132.08000000000001,1198.25,96.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 58301","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 58301","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 58301 - REMOVAL INTRAUTERINE DEVICE IUD","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","58301","REMOVAL INTRAUTERINE DEVICE IUD","58301 - REMOVAL INTRAUTERINE DEVICE IUD",531,278.66000000000003,278.66000000000003,1198.25,132.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 58323","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 58323","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 58323 - SPERM WASHING ARTIFICIAL INSEMINATION","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","58323","SPERM WASHING ARTIFICIAL INSEMINATION","58323 - SPERM WASHING ARTIFICIAL INSEMINATION",219,0,278.66000000000003,2032.26,54.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 58323","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 58323","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 58323 - SPERM WASHING ARTIFICIAL INSEMINATION","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","58323","SPERM WASHING ARTIFICIAL INSEMINATION","58323 - SPERM WASHING ARTIFICIAL INSEMINATION",219,358.24,278.66000000000003,2032.26,54.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 58555","BLUE CROSS - BLUE CROSS-PPO - 58555","BLUE CROSS - BLUE CROSS-PPO - 58555 - HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE","BLUE CROSS","BLUE CROSS-PPO","CPT","58555","HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE","58555 - HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE",3031,3965.45,1098.98,4588.18,757.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 58561","CIGNA HEALTHCARE - CIGNA CARELINK - 58561","CIGNA HEALTHCARE - CIGNA CARELINK - 58561 - HC HYSTEROSCOPY,RMV MYOMA","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","58561","HC HYSTEROSCOPY,RMV MYOMA","58561 - HC HYSTEROSCOPY,RMV MYOMA",7714,11845.41,1990.62,11845.41,1928.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 58565","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 58565","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 58565 - HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","58565","HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS","58565 - HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS",6134,6928.79,1990.62,11845.41,1533.5]
["TUFTS - TUFTS HMO - CPT - 58674","TUFTS - TUFTS HMO - 58674","TUFTS - TUFTS HMO - 58674 - HC LAPS ABLTJ UTERINE FIBROIDS","TUFTS","TUFTS HMO","CPT","58674","HC LAPS ABLTJ UTERINE FIBROIDS","58674 - HC LAPS ABLTJ UTERINE FIBROIDS",15505,23407.53,2354.5,37129.18,3876.25]
["TUFTS - TUFTS PPO - CPT - 58925","TUFTS - TUFTS PPO - 58925","TUFTS - TUFTS PPO - 58925 - HC OVARIAN CYSTECTOMY UNI/BI","TUFTS","TUFTS PPO","CPT","58925","HC OVARIAN CYSTECTOMY UNI/BI","58925 - HC OVARIAN CYSTECTOMY UNI/BI",6172,9609.09,2354.5,15242.01,1543]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 59020","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 59020","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 59020 - FETAL CONTRACTION STRESS TEST","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","59020","FETAL CONTRACTION STRESS TEST","59020 - FETAL CONTRACTION STRESS TEST",546,349.45,278.66000000000003,951.58,136.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 59300","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 59300","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 59300 - HC EPISIOTOMY/VAG RPR OTH/THN ATTENDING","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","59300","HC EPISIOTOMY/VAG RPR OTH/THN ATTENDING","59300 - HC EPISIOTOMY/VAG RPR OTH/THN ATTENDING",3412,4588.18,1098.98,4588.18,853]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 59320","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 59320","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 59320 - CERCLAGE CERVIX PREGNANCY VAGINAL","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","59320","CERCLAGE CERVIX PREGNANCY VAGINAL","59320 - CERCLAGE CERVIX PREGNANCY VAGINAL",2365,3965.45,1098.98,4588.18,591.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 59414","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 59414","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 59414 - HC DELIVER PLACENTA","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","59414","HC DELIVER PLACENTA","59414 - HC DELIVER PLACENTA",3553,3965.45,3965.45,13969.53,888.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 59820","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 59820","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 59820 - TX MISSED ABORTION FIRST TRIMESTER SURGICAL","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","59820","TX MISSED ABORTION FIRST TRIMESTER SURGICAL","59820 - TX MISSED ABORTION FIRST TRIMESTER SURGICAL",2772,4588.18,2354.5,11845.41,693]
["TUFTS - TUFTS PPO - CPT - 59840","TUFTS - TUFTS PPO - 59840","TUFTS - TUFTS PPO - 59840 - INDUCED ABORTION DILATION AND CURETTAGE","TUFTS","TUFTS PPO","CPT","59840","INDUCED ABORTION DILATION AND CURETTAGE","59840 - INDUCED ABORTION DILATION AND CURETTAGE",2365,7467.76,2354.5,11845.41,591.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 59897","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 59897","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 59897 - HC FETAL INVAS PX W/ US","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","59897","HC FETAL INVAS PX W/ US","59897 - HC FETAL INVAS PX W/ US",356,0,684.11,2032.26,89]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 60100","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 60100","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 60100 - BIOPSY THYROID PERCUTANEOUS CORE NEEDLE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","60100","BIOPSY THYROID PERCUTANEOUS CORE NEEDLE","60100 - BIOPSY THYROID PERCUTANEOUS CORE NEEDLE",592,972.93,684.11,2032.26,148]
["TUFTS - TUFTS POS - CPT - 60500","TUFTS - TUFTS POS - 60500","TUFTS - TUFTS POS - 60500 - HC EXPLORE PARATHYROID GLANDS","TUFTS","TUFTS POS","CPT","60500","HC EXPLORE PARATHYROID GLANDS","60500 - HC EXPLORE PARATHYROID GLANDS",7490,9609.09,2531.06,15242.01,1872.5]
["TUFTS - TUFTS SELECT - CPT - 61050","TUFTS - TUFTS SELECT - 61050","TUFTS - TUFTS SELECT - 61050 - HC CISTERNAL/C1-2 PUNCTURE","TUFTS","TUFTS SELECT","CPT","61050","HC CISTERNAL/C1-2 PUNCTURE","61050 - HC CISTERNAL/C1-2 PUNCTURE",390,1098.98,415.61,3264.67,97.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 61624","BLUE CROSS - BLUE CROSS-HMO BLUE - 61624","BLUE CROSS - BLUE CROSS-HMO BLUE - 61624 - HC TCAT PERMANENT OCCLUSION/EMBOLIZATION PRQ CNS","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","61624","HC TCAT PERMANENT OCCLUSION/EMBOLIZATION PRQ CNS","61624 - HC TCAT PERMANENT OCCLUSION/EMBOLIZATION PRQ CNS",8320,2890.31,2890.31,15242.01,2080]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 61630","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 61630","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 61630 - HC INTRACRANIAL BALLOON ANGIOPLASTY","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","61630","HC INTRACRANIAL BALLOON ANGIOPLASTY","61630 - HC INTRACRANIAL BALLOON ANGIOPLASTY",10401,0,0,0,2600.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 61641","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 61641","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 61641 - HC BALLOON DIALT INTRACRAN VASOSPASM, ADD SAME FAM","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","61641","HC BALLOON DIALT INTRACRAN VASOSPASM, ADD SAME FAM","61641 - HC BALLOON DIALT INTRACRAN VASOSPASM, ADD SAME FAM",5444,406.01,406.01,406.01,1361]
["BMC HEALTHNET - BMCHN ACO - CPT - 61650","BMC HEALTHNET - BMCHN ACO - 61650","BMC HEALTHNET - BMCHN ACO - 61650 - ENDOVASCULAR INTRACRANIAL PROLNG ADMN RX AGENT; INITIAL VASCULAR TERRITORY","BMC HEALTHNET","BMCHN ACO","CPT","61650","ENDOVASCULAR INTRACRANIAL PROLNG ADMN RX AGENT; INITIAL VASCULAR TERRITORY","61650 - ENDOVASCULAR INTRACRANIAL PROLNG ADMN RX AGENT; INITIAL VASCULAR TERRITORY",3730,0,1377.69,1377.69,932.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 62264","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 62264","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 62264 - HC PRQ LYSIS EPIDURAL ADHESIONS MULT SESSIONS 1 DAY","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","62264","HC PRQ LYSIS EPIDURAL ADHESIONS MULT SESSIONS 1 DAY","62264 - HC PRQ LYSIS EPIDURAL ADHESIONS MULT SESSIONS 1 DAY",1734,1284.45,1098.98,3264.67,433.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 62268","BLUE CROSS - BLUE CROSS-INDEMNITY - 62268","BLUE CROSS - BLUE CROSS-INDEMNITY - 62268 - HC PERCUTANEOUS ASPIRATION SPINAL CORD CYST/SYRINX","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","62268","HC PERCUTANEOUS ASPIRATION SPINAL CORD CYST/SYRINX","62268 - HC PERCUTANEOUS ASPIRATION SPINAL CORD CYST/SYRINX",1979,1284.45,1098.98,3264.67,494.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 62272","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 62272","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 62272 - HC SPINAL PUNCTURE THER DRAIN CEREBROSPINAL FLUID","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","62272","HC SPINAL PUNCTURE THER DRAIN CEREBROSPINAL FLUID","62272 - HC SPINAL PUNCTURE THER DRAIN CEREBROSPINAL FLUID",647,1292.83,1005.62,3264.67,161.75]
["TUFTS - TUFTS HMO - CPT - 62273","TUFTS - TUFTS HMO - 62273","TUFTS - TUFTS HMO - 62273 - HC INJECTION EPIDURAL BLOOD/CLOT PATCH","TUFTS","TUFTS HMO","CPT","62273","HC INJECTION EPIDURAL BLOOD/CLOT PATCH","62273 - HC INJECTION EPIDURAL BLOOD/CLOT PATCH",1153,2057.7399999999998,1005.62,3264.67,288.25]
["AETNA - AETNA - CPT - 62305","AETNA - AETNA - 62305","AETNA - AETNA - 62305 - MYELOGRAPHY VIA LUMBAR INJECTION RS&I 2+ REGIONS","AETNA","AETNA","CPT","62305","MYELOGRAPHY VIA LUMBAR INJECTION RS&I 2+ REGIONS","62305 - MYELOGRAPHY VIA LUMBAR INJECTION RS&I 2+ REGIONS",899,1500.85,1098.98,3264.67,224.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 62322","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 62322","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 62322 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","62322","HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1153,1005.62,829.82,3264.67,288.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 62323","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 62323","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 62323 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","62323","HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1153,1005.62,829.82,3264.67,288.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 62327","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 62327","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 62327 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","62327","HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62327 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1153,1284.45,829.82,3264.67,288.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 62328","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 62328","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 62328 - HC DX LMBR SPI PNXR W/FLUOR/CT","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","62328","HC DX LMBR SPI PNXR W/FLUOR/CT","62328 - HC DX LMBR SPI PNXR W/FLUOR/CT",794,0,1005.99,3264.67,198.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 62365","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 62365","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 62365 - HC REMOVE INFUSN DEVICE/PUMP","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","62365","HC REMOVE INFUSN DEVICE/PUMP","62365 - HC REMOVE INFUSN DEVICE/PUMP",8194,7668.11,1098.98,9858.1200000000008,2048.5]
["TUFTS - TUFTS PPO - CPT - 62369","TUFTS - TUFTS PPO - 62369","TUFTS - TUFTS PPO - 62369 - ELECT ANLYS IMPLT ITHCL/EDRL PMP W/REPRG&REFIL","TUFTS","TUFTS PPO","CPT","62369","ELECT ANLYS IMPLT ITHCL/EDRL PMP W/REPRG&REFIL","62369 - ELECT ANLYS IMPLT ITHCL/EDRL PMP W/REPRG&REFIL",476,2058.16,470.91,3264.67,119]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 62370","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 62370","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 62370 - ELEC ANLYS IMPLT ITHCL/EDRL PMP W/REPR PHYS/QHP","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","62370","ELEC ANLYS IMPLT ITHCL/EDRL PMP W/REPR PHYS/QHP","62370 - ELEC ANLYS IMPLT ITHCL/EDRL PMP W/REPR PHYS/QHP",476,590.54,470.91,3264.67,119]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 64400","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 64400","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 64400 - NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","64400","NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH","64400 - NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH",531,534.30999999999995,310.58,2032.26,132.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 64400","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 64400","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 64400 - NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","64400","NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH","64400 - NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH",531,534.30999999999995,310.58,2032.26,132.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 64415","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 64415","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 64415 - SINGLE NERVE BLOCK INJECTION ARM NERVE","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","64415","SINGLE NERVE BLOCK INJECTION ARM NERVE","64415 - SINGLE NERVE BLOCK INJECTION ARM NERVE",503,1284.45,310.58,3264.67,125.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 64418","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 64418","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 64418 - INJECTION ANESTHETIC AGENT SUPRASCAPULAR NERVE","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","64418","INJECTION ANESTHETIC AGENT SUPRASCAPULAR NERVE","64418 - INJECTION ANESTHETIC AGENT SUPRASCAPULAR NERVE",575,1005.62,310.58,2032.26,143.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 64420","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 64420","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 64420 - INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","64420","INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE","64420 - INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE",531,1005.62,310.58,2032.26,132.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 64430","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 64430","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 64430 - HC INJ,ANES;PUDEND NER","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","64430","HC INJ,ANES;PUDEND NER","64430 - HC INJ,ANES;PUDEND NER",1153,1284.45,310.58,3264.67,288.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 64447","BLUE CROSS - BLUE CROSS-HMO BLUE - 64447","BLUE CROSS - BLUE CROSS-HMO BLUE - 64447 - HC INJECTION ANESTHETIC AGENT FEMORAL NERVE SINGLE","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","64447","HC INJECTION ANESTHETIC AGENT FEMORAL NERVE SINGLE","64447 - HC INJECTION ANESTHETIC AGENT FEMORAL NERVE SINGLE",509,1005.62,310.58,2032.26,127.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 64450","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 64450","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 64450 - INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","64450","INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH","64450 - INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH",529,1292.83,310.58,2032.26,132.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 64454","CIGNA HEALTHCARE - CIGNA CARELINK - 64454","CIGNA HEALTHCARE - CIGNA CARELINK - 64454 - HC NJX AA&/STRD GNCLR NRV BRNCH","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","64454","HC NJX AA&/STRD GNCLR NRV BRNCH","64454 - HC NJX AA&/STRD GNCLR NRV BRNCH",794,3474.13,1005.99,3474.13,198.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 64455","CIGNA HEALTHCARE - CIGNA CARELINK - 64455","CIGNA HEALTHCARE - CIGNA CARELINK - 64455 - NJX ANES&/STEROID PLANTAR COMMON DIGITAL NERVE","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","64455","NJX ANES&/STEROID PLANTAR COMMON DIGITAL NERVE","64455 - NJX ANES&/STEROID PLANTAR COMMON DIGITAL NERVE",350,943.8,310.58,1198.25,87.5]
["TUFTS - TUFTS POS - CPT - 64479","TUFTS - TUFTS POS - 64479","TUFTS - TUFTS POS - 64479 - HC INJECT ANES/STEROID FORAMEN CERV/THORACIC W IMG GUIDE ,1 LEVEL","TUFTS","TUFTS POS","CPT","64479","HC INJECT ANES/STEROID FORAMEN CERV/THORACIC W IMG GUIDE ,1 LEVEL","64479 - HC INJECT ANES/STEROID FORAMEN CERV/THORACIC W IMG GUIDE ,1 LEVEL",1211,2058.17,829.82,3264.67,302.75]
["TUFTS - TUFTS POS - CPT - 64486","TUFTS - TUFTS POS - 64486","TUFTS - TUFTS POS - 64486 - TAP BLOCK UNILATERAL BY INJECTION(S)","TUFTS","TUFTS POS","CPT","64486","TAP BLOCK UNILATERAL BY INJECTION(S)","64486 - TAP BLOCK UNILATERAL BY INJECTION(S)",423,0,136.02000000000001,1500.85,105.75]
["TUFTS - TUFTS SELECT - CPT - 64488","TUFTS - TUFTS SELECT - 64488","TUFTS - TUFTS SELECT - 64488 - HC TAP BLOCK BILATERAL BY INJECTION(S)","TUFTS","TUFTS SELECT","CPT","64488","HC TAP BLOCK BILATERAL BY INJECTION(S)","64488 - HC TAP BLOCK BILATERAL BY INJECTION(S)",3619,0,170.54,1500.85,904.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 64492","UNICARE - UNICARE STATE INDEMNITY PLAN - 64492","UNICARE - UNICARE STATE INDEMNITY PLAN - 64492 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","64492","NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL","64492 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL",442,829.82,149.56,1198.25,110.5]
["TUFTS - TUFTS POS - CPT - 64493","TUFTS - TUFTS POS - 64493","TUFTS - TUFTS POS - 64493 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL","TUFTS","TUFTS POS","CPT","64493","NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL","64493 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL",2074,2578.84,829.82,4375.87,518.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 64495","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 64495","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 64495 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","64495","NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL","64495 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL",377,0,129.83000000000001,1198.25,94.25]
["UNICARE - UNICARE - CPT - 64530","UNICARE - UNICARE - 64530","UNICARE - UNICARE - 64530 - INJX ANES CELIAC PLEXUS W/WO RADIOLOGIC MONITRNG","UNICARE","UNICARE","CPT","64530","INJX ANES CELIAC PLEXUS W/WO RADIOLOGIC MONITRNG","64530 - INJX ANES CELIAC PLEXUS W/WO RADIOLOGIC MONITRNG",1071,995.78,829.82,3264.67,267.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 64561","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 64561","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 64561 - IMPLANT NEUROELECTRODES","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","64561","IMPLANT NEUROELECTRODES","64561 - IMPLANT NEUROELECTRODES",9071,11333.61,1098.98,11618.83,2267.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 64611","BLUE CROSS - BLUE CROSS-PPO - 64611","BLUE CROSS - BLUE CROSS-PPO - 64611 - CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS","BLUE CROSS","BLUE CROSS-PPO","CPT","64611","CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS","64611 - CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS",760,415.61,317.70999999999998,1198.25,190]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 64612","BLUE CROSS - BLUE CROSS-HMO BLUE - 64612","BLUE CROSS - BLUE CROSS-HMO BLUE - 64612 - CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","64612","CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL","64612 - CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL",1247,415.61,415.61,2032.26,311.75]
["TUFTS - TUFTS POS - CPT - 64617","TUFTS - TUFTS POS - 64617","TUFTS - TUFTS POS - 64617 - CHEMODENERVATION MUSCLE LARYNX UNILAT W/EMG","TUFTS","TUFTS POS","CPT","64617","CHEMODENERVATION MUSCLE LARYNX UNILAT W/EMG","64617 - CHEMODENERVATION MUSCLE LARYNX UNILAT W/EMG",842,1281.21,415.61,2032.26,210.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 64625","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 64625","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 64625 - HC RF ABLTJ NRV NRVTG SI JT","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","64625","HC RF ABLTJ NRV NRVTG SI JT","64625 - HC RF ABLTJ NRV NRVTG SI JT",2182,3170.12,2166.09,7703.8,545.5]
["TUFTS - TUFTS PPO - CPT - 64625","TUFTS - TUFTS PPO - 64625","TUFTS - TUFTS PPO - 64625 - HC RF ABLTJ NRV NRVTG SI JT","TUFTS","TUFTS PPO","CPT","64625","HC RF ABLTJ NRV NRVTG SI JT","64625 - HC RF ABLTJ NRV NRVTG SI JT",2182,4856.75,2166.09,7703.8,545.5]
["TUFTS - TUFTS SELECT - CPT - 64635","TUFTS - TUFTS SELECT - 64635","TUFTS - TUFTS SELECT - 64635 - DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL","TUFTS","TUFTS SELECT","CPT","64635","DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL","64635 - DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL",2471,1098.98,1098.98,3264.67,617.75]
["TUFTS - TUFTS POS - CPT - 64636","TUFTS - TUFTS POS - 64636","TUFTS - TUFTS POS - 64636 - DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL","TUFTS","TUFTS POS","CPT","64636","DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL","64636 - DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL",433,0,146.83000000000001,1198.25,108.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64644","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 64644","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 64644 - CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","64644","CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES","64644 - CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES",865,1005.62,684.11,2032.26,216.25]
["TUFTS - TUFTS HMO - CPT - 64647","TUFTS - TUFTS HMO - 64647","TUFTS - TUFTS HMO - 64647 - CHEMODENERVATION OF TRUNK 6 OR MORE MUSCLES","TUFTS","TUFTS HMO","CPT","64647","CHEMODENERVATION OF TRUNK 6 OR MORE MUSCLES","64647 - CHEMODENERVATION OF TRUNK 6 OR MORE MUSCLES",988,1281.21,684.11,2032.26,247]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 64650","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 64650","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 64650 - CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","64650","CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE","64650 - CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE",309,534.30999999999995,415.61,2032.26,77.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 64771","BLUE CROSS - BLUE CROSS-HMO BLUE - 64771","BLUE CROSS - BLUE CROSS-HMO BLUE - 64771 - HC TRANSECT OTHER CRAN N,EXTRADURAL","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","64771","HC TRANSECT OTHER CRAN N,EXTRADURAL","64771 - HC TRANSECT OTHER CRAN N,EXTRADURAL",1959,2739.86,1500.85,7703.8,489.75]
["TUFTS - TUFTS PPO - CPT - 65093","TUFTS - TUFTS PPO - 65093","TUFTS - TUFTS PPO - 65093 - HC REVISE EYE WITH IMPLANT","TUFTS","TUFTS PPO","CPT","65093","HC REVISE EYE WITH IMPLANT","65093 - HC REVISE EYE WITH IMPLANT",4867,7467.76,1990.62,11845.41,1216.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 65103","BLUE CROSS - BLUE CROSS-INDEMNITY - 65103","BLUE CROSS - BLUE CROSS-INDEMNITY - 65103 - HC REMOVE EYE/INSERT IMPLANT","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","65103","HC REMOVE EYE/INSERT IMPLANT","65103 - HC REMOVE EYE/INSERT IMPLANT",4867,4996.58,1990.62,11845.41,1216.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 65135","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 65135","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 65135 - HC INSJ OC IMPLT AFTER ENCL MUSC X ATTACHED","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","65135","HC INSJ OC IMPLT AFTER ENCL MUSC X ATTACHED","65135 - HC INSJ OC IMPLT AFTER ENCL MUSC X ATTACHED",4867,5781.24,1500.85,7703.8,1216.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 65175","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 65175","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 65175 - HC REMOVAL OF OCULAR IMPLANT","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","65175","HC REMOVAL OF OCULAR IMPLANT","65175 - HC REMOVAL OF OCULAR IMPLANT",4867,4996.58,1098.98,5781.24,1216.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 65222","BLUE CROSS - BLUE CROSS-PPO - 65222","BLUE CROSS - BLUE CROSS-PPO - 65222 - RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP","BLUE CROSS","BLUE CROSS-PPO","CPT","65222","RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP","65222 - RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP",449,178.83,178.83,943.8,112.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 65265","BLUE CROSS - BLUE CROSS-HMO BLUE - 65265","BLUE CROSS - BLUE CROSS-HMO BLUE - 65265 - HC REMOVE FOREIGN BODY FROM EYE","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","65265","HC REMOVE FOREIGN BODY FROM EYE","65265 - HC REMOVE FOREIGN BODY FROM EYE",3062,3219.62,2166.09,11845.41,765.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 65286","CIGNA HEALTHCARE - CIGNA CARELINK - 65286","CIGNA HEALTHCARE - CIGNA CARELINK - 65286 - RPR LAC APPL TISSUE GLUE WOUND CORNEA&/SCLERA","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","65286","RPR LAC APPL TISSUE GLUE WOUND CORNEA&/SCLERA","65286 - RPR LAC APPL TISSUE GLUE WOUND CORNEA&/SCLERA",3808,3264.67,1098.98,3725.22,952]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 65430","BLUE CROSS - BLUE CROSS-HMO BLUE - 65430","BLUE CROSS - BLUE CROSS-HMO BLUE - 65430 - CORNEA SCRAPING DIAGNOSTIC SMEAR &/CULTURE","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","65430","CORNEA SCRAPING DIAGNOSTIC SMEAR &/CULTURE","65430 - CORNEA SCRAPING DIAGNOSTIC SMEAR &/CULTURE",804,584.69000000000005,317.70999999999998,943.8,201]
["TUFTS - TUFTS POS - CPT - 65435","TUFTS - TUFTS POS - 65435","TUFTS - TUFTS POS - 65435 - RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION","TUFTS","TUFTS POS","CPT","65435","RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION","65435 - RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION",1108,2058.17,1098.98,3264.67,277]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 65750","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 65750","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 65750 - HC KERATOPLASTY PENETRAING APHAKIA","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","65750","HC KERATOPLASTY PENETRAING APHAKIA","65750 - HC KERATOPLASTY PENETRAING APHAKIA",5769,7073.38,2531.06,15242.01,1442.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 65755","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 65755","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 65755 - HC KERATOPLASTY PENETRATING PSEUDOPHAKIA","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","65755","HC KERATOPLASTY PENETRATING PSEUDOPHAKIA","65755 - HC KERATOPLASTY PENETRATING PSEUDOPHAKIA",5769,6113.35,2531.06,15242.01,1442.25]
["TUFTS - TUFTS PPO - CPT - 65778","TUFTS - TUFTS PPO - 65778","TUFTS - TUFTS PPO - 65778 - PLACE AMNIOTIC MEMB OCULAR SURFACE SELF RETAIN","TUFTS","TUFTS PPO","CPT","65778","PLACE AMNIOTIC MEMB OCULAR SURFACE SELF RETAIN","65778 - PLACE AMNIOTIC MEMB OCULAR SURFACE SELF RETAIN",2051,2058.16,1098.98,3264.67,512.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 65782","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 65782","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 65782 - HC OCCULAR SURFACE RECONSTRUCTION LIMBAL AUTOGRAFT","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","65782","HC OCCULAR SURFACE RECONSTRUCTION LIMBAL AUTOGRAFT","65782 - HC OCCULAR SURFACE RECONSTRUCTION LIMBAL AUTOGRAFT",4867,0,2354.5,11845.41,1216.75]
["TUFTS - TUFTS POS - CPT - 65800","TUFTS - TUFTS POS - 65800","TUFTS - TUFTS POS - 65800 - PARACENTSIS ANT CHAMB EYE ASPIR AQUEOUS SPX","TUFTS","TUFTS POS","CPT","65800","PARACENTSIS ANT CHAMB EYE ASPIR AQUEOUS SPX","65800 - PARACENTSIS ANT CHAMB EYE ASPIR AQUEOUS SPX",1284,2058.17,1098.98,3725.22,321]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 65860","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 65860","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 65860 - SEVERING ADHESIONS ANTERIOR SEGMENT LASER SPX","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","65860","SEVERING ADHESIONS ANTERIOR SEGMENT LASER SPX","65860 - SEVERING ADHESIONS ANTERIOR SEGMENT LASER SPX",2164,833.27,833.27,3264.67,541]
["AETNA - AETNA - CPT - 65870","AETNA - AETNA - 65870","AETNA - AETNA - 65870 - HC SEVERING ADS ANT SEG INCAL SPX ANT SYNECHIAE","AETNA","AETNA","CPT","65870","HC SEVERING ADS ANT SEG INCAL SPX ANT SYNECHIAE","65870 - HC SEVERING ADS ANT SEG INCAL SPX ANT SYNECHIAE",3062,2166.09,2166.09,11845.41,765.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 65920","CIGNA HEALTHCARE - CIGNA CARELINK - 65920","CIGNA HEALTHCARE - CIGNA CARELINK - 65920 - HC REMOVE IMPLANT OF EYE","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","65920","HC REMOVE IMPLANT OF EYE","65920 - HC REMOVE IMPLANT OF EYE",3062,15242.01,2531.06,15242.01,765.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 66172","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 66172","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 66172 - HC INCISION OF EYE","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","66172","HC INCISION OF EYE","66172 - HC INCISION OF EYE",3062,3219.62,2166.09,11845.41,765.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 66172","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 66172","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 66172 - HC INCISION OF EYE","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","66172","HC INCISION OF EYE","66172 - HC INCISION OF EYE",3062,3725.22,2166.09,11845.41,765.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 66185","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 66185","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 66185 - HC REVISE AQUEOUS SHUNT EYE","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","66185","HC REVISE AQUEOUS SHUNT EYE","66185 - HC REVISE AQUEOUS SHUNT EYE",3062,3219.62,1500.85,7703.8,765.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 66625","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 66625","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 66625 - HC REMV IRIS PERIPH FOR GLAUCOMA","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","66625","HC REMV IRIS PERIPH FOR GLAUCOMA","66625 - HC REMV IRIS PERIPH FOR GLAUCOMA",2878,3633.78,1990.62,11845.41,719.5]
["TUFTS - TUFTS PPO - CPT - 66682","TUFTS - TUFTS PPO - 66682","TUFTS - TUFTS PPO - 66682 - HC REPAIR IRIS & CILIARY BODY","TUFTS","TUFTS PPO","CPT","66682","HC REPAIR IRIS & CILIARY BODY","66682 - HC REPAIR IRIS & CILIARY BODY",3062,4856.75,1500.85,7703.8,765.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 66762","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 66762","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 66762 - IRIDOPLASTY PHOTOCOAGULATION 1/> SESSIONS","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","66762","IRIDOPLASTY PHOTOCOAGULATION 1/> SESSIONS","66762 - IRIDOPLASTY PHOTOCOAGULATION 1/> SESSIONS",3256,833.27,833.27,3264.67,814]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 66840","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 66840","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 66840 - HC RMVL LENS MATERIAL ASPIR TQ 1/> STAGES","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","66840","HC RMVL LENS MATERIAL ASPIR TQ 1/> STAGES","66840 - HC RMVL LENS MATERIAL ASPIR TQ 1/> STAGES",3062,3219.62,2166.09,11845.41,765.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 66850","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 66850","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 66850 - HC RMVL LENS MATERIAL PHACOFRAGMENTATION ASPIR","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","66850","HC RMVL LENS MATERIAL PHACOFRAGMENTATION ASPIR","66850 - HC RMVL LENS MATERIAL PHACOFRAGMENTATION ASPIR",3062,3725.22,2531.06,15242.01,765.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 66984","BLUE CROSS - BLUE CROSS-HMO BLUE - 66984","BLUE CROSS - BLUE CROSS-HMO BLUE - 66984 - REMV CATARACT EXTRACAP,INSERT LENS","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","66984","REMV CATARACT EXTRACAP,INSERT LENS","66984 - REMV CATARACT EXTRACAP,INSERT LENS",2878,3219.62,2574.12,7703.8,719.5]
["AETNA - AETNA - CPT - 66985","AETNA - AETNA - 66985","AETNA - AETNA - 66985 - INSERT LENS PROSTHESIS ONLY","AETNA","AETNA","CPT","66985","INSERT LENS PROSTHESIS ONLY","66985 - INSERT LENS PROSTHESIS ONLY",3062,2398.64,2398.64,7703.8,765.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 67010","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 67010","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 67010 - HC RMVL VITREOUS ANT APPR SUBTOT RMVL MECH VITRECT","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","67010","HC RMVL VITREOUS ANT APPR SUBTOT RMVL MECH VITRECT","67010 - HC RMVL VITREOUS ANT APPR SUBTOT RMVL MECH VITRECT",3062,3725.22,2166.09,11845.41,765.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 67015","CIGNA HEALTHCARE - CIGNA CARELINK - 67015","CIGNA HEALTHCARE - CIGNA CARELINK - 67015 - ASPIRATION/RELEASE VITREOUS SUBRETINAL/CHOROIDAL","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","67015","ASPIRATION/RELEASE VITREOUS SUBRETINAL/CHOROIDAL","67015 - ASPIRATION/RELEASE VITREOUS SUBRETINAL/CHOROIDAL",4446,3264.67,1098.98,3725.22,1111.5]
["TUFTS - TUFTS SELECT - CPT - 67036","TUFTS - TUFTS SELECT - 67036","TUFTS - TUFTS SELECT - 67036 - HC VITRECTOMY,MECHANICAL","TUFTS","TUFTS SELECT","CPT","67036","HC VITRECTOMY,MECHANICAL","67036 - HC VITRECTOMY,MECHANICAL",6923,3987.49,2166.09,11845.41,1730.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 67041","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 67041","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 67041 - HC VIT FOR MACULAR PUCKER","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","67041","HC VIT FOR MACULAR PUCKER","67041 - HC VIT FOR MACULAR PUCKER",5769,6899.74,2354.5,15242.01,1442.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 67101","BLUE CROSS - BLUE CROSS-PPO - 67101","BLUE CROSS - BLUE CROSS-PPO - 67101 - HC RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID CRTX","BLUE CROSS","BLUE CROSS-PPO","CPT","67101","HC RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID CRTX","67101 - HC RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID CRTX",3007,3219.62,2166.09,11845.41,751.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 67108","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 67108","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 67108 - HC RPR RETINAL DTCHMNT W/VITRECTOMY ANY METH","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","67108","HC RPR RETINAL DTCHMNT W/VITRECTOMY ANY METH","67108 - HC RPR RETINAL DTCHMNT W/VITRECTOMY ANY METH",5769,7073.38,2531.06,15242.01,1442.25]
["TUFTS - TUFTS PPO - CPT - 67110","TUFTS - TUFTS PPO - 67110","TUFTS - TUFTS PPO - 67110 - RPR RETINAL DTCHMNT INJECTION AIR/OTHER GAS","TUFTS","TUFTS PPO","CPT","67110","RPR RETINAL DTCHMNT INJECTION AIR/OTHER GAS","67110 - RPR RETINAL DTCHMNT INJECTION AIR/OTHER GAS",5928,7467.76,3219.62,11845.41,1482]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 67141","BLUE CROSS - BLUE CROSS-HMO BLUE - 67141","BLUE CROSS - BLUE CROSS-HMO BLUE - 67141 - HC PROPH RTA DTCHMNT CRTX DTHRM","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","67141","HC PROPH RTA DTCHMNT CRTX DTHRM","67141 - HC PROPH RTA DTCHMNT CRTX DTHRM",427,476.13,476.13,2032.26,106.75]
["TUFTS - TUFTS POS - CPT - 67220","TUFTS - TUFTS POS - 67220","TUFTS - TUFTS POS - 67220 - DSTRJ LES CHOROID PC 1/> SESS","TUFTS","TUFTS POS","CPT","67220","DSTRJ LES CHOROID PC 1/> SESS","67220 - DSTRJ LES CHOROID PC 1/> SESS",3904,1281.21,684.11,2032.26,976]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 67221","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 67221","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 67221 - DSTRJ LESION CHOROID PHOTODYNAMIC THERAPY","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","67221","DSTRJ LESION CHOROID PHOTODYNAMIC THERAPY","67221 - DSTRJ LESION CHOROID PHOTODYNAMIC THERAPY",1654,1071.25,684.11,2032.26,413.5]
["TUFTS - TUFTS POS - CPT - 67312","TUFTS - TUFTS POS - 67312","TUFTS - TUFTS POS - 67312 - HC STRABISMUS RECESSION/RESCJ 2 HRZNTL MUSC","TUFTS","TUFTS POS","CPT","67312","HC STRABISMUS RECESSION/RESCJ 2 HRZNTL MUSC","67312 - HC STRABISMUS RECESSION/RESCJ 2 HRZNTL MUSC",4867,7467.76,2166.09,11845.41,1216.75]
["TUFTS - TUFTS POS - CPT - 67314","TUFTS - TUFTS POS - 67314","TUFTS - TUFTS POS - 67314 - HC STRABISMUS RECESSION/RESCJ 1 VER MUSC","TUFTS","TUFTS POS","CPT","67314","HC STRABISMUS RECESSION/RESCJ 1 VER MUSC","67314 - HC STRABISMUS RECESSION/RESCJ 1 VER MUSC",2949,7467.76,2166.09,11845.41,737.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 67332","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 67332","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 67332 - HC STRABISMUS SCARRING EO MUSC/RSTCV MYOPATHY ADD-ON","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","67332","HC STRABISMUS SCARRING EO MUSC/RSTCV MYOPATHY ADD-ON","67332 - HC STRABISMUS SCARRING EO MUSC/RSTCV MYOPATHY ADD-ON",3426,821.24,821.24,2166.09,856.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 67400","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 67400","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 67400 - HC EXPLORE/BIOPSY EYE SOCKET","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","67400","HC EXPLORE/BIOPSY EYE SOCKET","67400 - HC EXPLORE/BIOPSY EYE SOCKET",4867,4996.58,1990.62,11845.41,1216.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 67405","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 67405","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 67405 - HC EXPLORE/DRAIN EYE SOCKET","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","67405","HC EXPLORE/DRAIN EYE SOCKET","67405 - HC EXPLORE/DRAIN EYE SOCKET",2949,3522.21,2166.09,11845.41,737.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 67420","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 67420","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 67420 - HC EXPLORE/TREAT EYE SOCKET","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","67420","HC EXPLORE/TREAT EYE SOCKET","67420 - HC EXPLORE/TREAT EYE SOCKET",4867,5639.32,2354.5,15242.01,1216.75]
["AETNA - AETNA - CPT - 67515","AETNA - AETNA - 67515","AETNA - AETNA - 67515 - INJECTION MEDICATION/OTHER SUBST TENON CAPSULE","AETNA","AETNA","CPT","67515","INJECTION MEDICATION/OTHER SUBST TENON CAPSULE","67515 - INJECTION MEDICATION/OTHER SUBST TENON CAPSULE",706,1198.25,476.13,2032.26,176.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 67710","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 67710","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 67710 - SEVERING TARSORRHAPHY","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","67710","SEVERING TARSORRHAPHY","67710 - SEVERING TARSORRHAPHY",1108,1355.74,1098.98,3264.67,277]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 67800","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 67800","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 67800 - EXCISION CHALAZION SINGLE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","67800","EXCISION CHALAZION SINGLE","67800 - EXCISION CHALAZION SINGLE",808,476.13,476.13,2032.26,202]
["TUFTS - TUFTS PPO - CPT - 67805","TUFTS - TUFTS PPO - 67805","TUFTS - TUFTS PPO - 67805 - EXCISION CHALAZION MULTIPLE DIFFERENT LIDS","TUFTS","TUFTS PPO","CPT","67805","EXCISION CHALAZION MULTIPLE DIFFERENT LIDS","67805 - EXCISION CHALAZION MULTIPLE DIFFERENT LIDS",1303,1281.21,476.13,2032.26,325.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 67825","BLUE CROSS - BLUE CROSS-PPO - 67825","BLUE CROSS - BLUE CROSS-PPO - 67825 - CORRECTION TRICHIASIS EPILATION OTH/THAN FORCEPS","BLUE CROSS","BLUE CROSS-PPO","CPT","67825","CORRECTION TRICHIASIS EPILATION OTH/THAN FORCEPS","67825 - CORRECTION TRICHIASIS EPILATION OTH/THAN FORCEPS",953,476.13,476.13,2032.26,238.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 67840","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 67840","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 67840 - EXC LESION EYELID W/O CLSR/W/SIMPLE DIR CLOSURE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","67840","EXC LESION EYELID W/O CLSR/W/SIMPLE DIR CLOSURE","67840 - EXC LESION EYELID W/O CLSR/W/SIMPLE DIR CLOSURE",1231,1355.74,1098.98,3264.67,307.75]
["TUFTS - TUFTS POS - CPT - 67880","TUFTS - TUFTS POS - 67880","TUFTS - TUFTS POS - 67880 - HC REVISION OF EYELID","TUFTS","TUFTS POS","CPT","67880","HC REVISION OF EYELID","67880 - HC REVISION OF EYELID",2874,7467.76,1990.62,11845.41,718.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 67902","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 67902","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 67902 - HC RPR BLEPHAROPT FRONTALIS MUSC AUTOL FASCAL SLING","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","67902","HC RPR BLEPHAROPT FRONTALIS MUSC AUTOL FASCAL SLING","67902 - HC RPR BLEPHAROPT FRONTALIS MUSC AUTOL FASCAL SLING",4867,4996.58,2354.5,15242.01,1216.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 67903","BLUE CROSS - BLUE CROSS-INDEMNITY - 67903","BLUE CROSS - BLUE CROSS-INDEMNITY - 67903 - HC RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT INTERNAL","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","67903","HC RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT INTERNAL","67903 - HC RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT INTERNAL",2949,3044.16,2166.09,11845.41,737.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67911","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 67911","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 67911 - HC CORRECT LID RETRACTN","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","67911","HC CORRECT LID RETRACTN","67911 - HC CORRECT LID RETRACTN",2721,3044.16,1990.62,11845.41,680.25]
["TUFTS - TUFTS SELECT - CPT - 67923","TUFTS - TUFTS SELECT - 67923","TUFTS - TUFTS SELECT - 67923 - HC REPAIR ENTROPION EXCISION TARSAL WEDGE","TUFTS","TUFTS SELECT","CPT","67923","HC REPAIR ENTROPION EXCISION TARSAL WEDGE","67923 - HC REPAIR ENTROPION EXCISION TARSAL WEDGE",2949,3987.49,2166.09,11845.41,737.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 67924","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 67924","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 67924 - HC FIX ENTROPION,EXTENSV LID REPAIR","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","67924","HC FIX ENTROPION,EXTENSV LID REPAIR","67924 - HC FIX ENTROPION,EXTENSV LID REPAIR",2880,3522.21,2166.09,11845.41,720]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67966","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 67966","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 67966 - HC EXCISION & REPAIR EYELID ONE-FOURTH LID MARGIN","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","67966","HC EXCISION & REPAIR EYELID ONE-FOURTH LID MARGIN","67966 - HC EXCISION & REPAIR EYELID ONE-FOURTH LID MARGIN",2949,3044.16,1990.62,11845.41,737.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 67971","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 67971","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 67971 - HC RCNSTJ EYELID FULL THICKNESS </TWO-THIRDS 1 STG","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","67971","HC RCNSTJ EYELID FULL THICKNESS </TWO-THIRDS 1 STG","67971 - HC RCNSTJ EYELID FULL THICKNESS </TWO-THIRDS 1 STG",2949,3044.16,1990.62,11845.41,737.25]
["TUFTS - TUFTS PPO - CPT - 68100","TUFTS - TUFTS PPO - 68100","TUFTS - TUFTS PPO - 68100 - HC BIOPSY OF CONJUNCTIVA","TUFTS","TUFTS PPO","CPT","68100","HC BIOPSY OF CONJUNCTIVA","68100 - HC BIOPSY OF CONJUNCTIVA",1108,2058.16,1098.98,3522.21,277]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 68320","BLUE CROSS - BLUE CROSS-INDEMNITY - 68320","BLUE CROSS - BLUE CROSS-INDEMNITY - 68320 - HC CONJUNCTIVOPLASTY W/GRF/XTNSV REARRANGEMENT","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","68320","HC CONJUNCTIVOPLASTY W/GRF/XTNSV REARRANGEMENT","68320 - HC CONJUNCTIVOPLASTY W/GRF/XTNSV REARRANGEMENT",2949,3044.16,2166.09,11845.41,737.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 68335","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 68335","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 68335 - HC RPR SYMBLEPHARON FR GRF CJNC/BUCCAL MUC MEMB","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","68335","HC RPR SYMBLEPHARON FR GRF CJNC/BUCCAL MUC MEMB","68335 - HC RPR SYMBLEPHARON FR GRF CJNC/BUCCAL MUC MEMB",4867,5781.24,2166.09,11845.41,1216.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 68362","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 68362","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 68362 - HC CONJUNCTIVAL FLAP TOTAL","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","68362","HC CONJUNCTIVAL FLAP TOTAL","68362 - HC CONJUNCTIVAL FLAP TOTAL",2949,3522.21,1500.85,7703.8,737.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 68440","CIGNA HEALTHCARE - CIGNA CARELINK - 68440","CIGNA HEALTHCARE - CIGNA CARELINK - 68440 - HC INCISE TEAR DUCT OPENING","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","68440","HC INCISE TEAR DUCT OPENING","68440 - HC INCISE TEAR DUCT OPENING",427,2032.26,476.13,2032.26,106.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 68750","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 68750","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 68750 - HC CREATE TEAR DUCT DRAIN","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","68750","HC CREATE TEAR DUCT DRAIN","68750 - HC CREATE TEAR DUCT DRAIN",4867,4996.58,2166.09,11845.41,1216.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 68801","CIGNA HEALTHCARE - CIGNA CARELINK - 68801","CIGNA HEALTHCARE - CIGNA CARELINK - 68801 - DILATION LACRIMAL PUNCTUM W/WO IRRGATION","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","68801","DILATION LACRIMAL PUNCTUM W/WO IRRGATION","68801 - DILATION LACRIMAL PUNCTUM W/WO IRRGATION",830,508.23,171.09,751.68,207.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 68810","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 68810","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 68810 - HC PROBE NASOLACRIMAL DUCT","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","68810","HC PROBE NASOLACRIMAL DUCT","68810 - HC PROBE NASOLACRIMAL DUCT",264,612.12,476.13,2032.26,66]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 68816","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 68816","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 68816 - HC PROBE NL DUCT W/BALLOON","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","68816","HC PROBE NL DUCT W/BALLOON","68816 - HC PROBE NL DUCT W/BALLOON",2949,3522.21,1500.85,7703.8,737.25]
["TUFTS - TUFTS SELECT - CPT - 68840","TUFTS - TUFTS SELECT - 68840","TUFTS - TUFTS SELECT - 68840 - HC EXPLORE LACRIMAL CANALICULI","TUFTS","TUFTS SELECT","CPT","68840","HC EXPLORE LACRIMAL CANALICULI","68840 - HC EXPLORE LACRIMAL CANALICULI",1137,317.70999999999998,317.70999999999998,1198.25,284.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 69090","BLUE CROSS - BLUE CROSS-PPO - 69090","BLUE CROSS - BLUE CROSS-PPO - 69090 - EAR PIERCING","BLUE CROSS","BLUE CROSS-PPO","CPT","69090","EAR PIERCING","69090 - EAR PIERCING",104,68.89,68.89,943.8,26]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 69110","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 69110","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 69110 - HC REMOVAL EXTERNAL EAR,PARTIAL","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","69110","HC REMOVAL EXTERNAL EAR,PARTIAL","69110 - HC REMOVAL EXTERNAL EAR,PARTIAL",2858,4621.25,1098.98,4621.25,714.5]
["TUFTS - TUFTS POS - CPT - 69145","TUFTS - TUFTS POS - 69145","TUFTS - TUFTS POS - 69145 - EXCISION SOFT TIS LES EXTERNAL AUDITORY CANAL","TUFTS","TUFTS POS","CPT","69145","EXCISION SOFT TIS LES EXTERNAL AUDITORY CANAL","69145 - EXCISION SOFT TIS LES EXTERNAL AUDITORY CANAL",1972,4856.75,1500.85,7703.8,493]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 69220","BLUE CROSS - BLUE CROSS-INDEMNITY - 69220","BLUE CROSS - BLUE CROSS-INDEMNITY - 69220 - DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","69220","DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE","69220 - DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE",487,296.32,171.09,508.23,121.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 69420","BLUE CROSS - BLUE CROSS-PPO - 69420","BLUE CROSS - BLUE CROSS-PPO - 69420 - MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ","BLUE CROSS","BLUE CROSS-PPO","CPT","69420","MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ","69420 - MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ",955,346.18,346.18,2032.26,238.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 69433","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 69433","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 69433 - TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","69433","TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA","69433 - TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA",1031,818.07,818.07,3264.67,257.75]
["TUFTS - TUFTS POS - CPT - 69540","TUFTS - TUFTS POS - 69540","TUFTS - TUFTS POS - 69540 - HC REMV AURAL POLYP","TUFTS","TUFTS POS","CPT","69540","HC REMV AURAL POLYP","69540 - HC REMV AURAL POLYP",2094,2058.17,1098.98,3264.67,523.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 69631","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 69631","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 69631 - HC TYMPANOPLASTY","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","69631","HC TYMPANOPLASTY","69631 - HC TYMPANOPLASTY",7489,7429.92,2354.5,15242.01,1872.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 70030","BLUE CROSS - BLUE CROSS-HMO BLUE - 70030","BLUE CROSS - BLUE CROSS-HMO BLUE - 70030 - HC CHG RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","70030","HC CHG RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY","70030 - HC CHG RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY",275,81.93,72.290000000000006,801.26,68.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 70130","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 70130","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 70130 - HC CHG RADEX MASTOIDS COMPL MINIMUM 3 VIEWS SIDE","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","70130","HC CHG RADEX MASTOIDS COMPL MINIMUM 3 VIEWS SIDE","70130 - HC CHG RADEX MASTOIDS COMPL MINIMUM 3 VIEWS SIDE",546,147.96,72.290000000000006,1103.3900000000001,136.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 70140","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 70140","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 70140 - HC CHG RADEX FACIAL BONES < 3 VIEWS","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","70140","HC CHG RADEX FACIAL BONES < 3 VIEWS","70140 - HC CHG RADEX FACIAL BONES < 3 VIEWS",288,81.93,72.290000000000006,801.26,72]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 70200","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 70200","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 70200 - HC CHG RADEX ORBITS COMPLETE MINIMUM 4 VIEWS","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","70200","HC CHG RADEX ORBITS COMPLETE MINIMUM 4 VIEWS","70200 - HC CHG RADEX ORBITS COMPLETE MINIMUM 4 VIEWS",416,193.63,72.290000000000006,1103.3900000000001,104]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 70210","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 70210","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 70210 - HC CHG RADEX SINUSES PARANASAL <3 VIEWS","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","70210","HC CHG RADEX SINUSES PARANASAL <3 VIEWS","70210 - HC CHG RADEX SINUSES PARANASAL <3 VIEWS",302,81.93,72.290000000000006,801.26,75.5]
["TUFTS - TUFTS PPO - CPT - 70260","TUFTS - TUFTS PPO - 70260","TUFTS - TUFTS PPO - 70260 - HC CHG RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS","TUFTS","TUFTS PPO","CPT","70260","HC CHG RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS","70260 - HC CHG RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS",446,453.34,125.38,1274.24,111.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 70310","BLUE CROSS - BLUE CROSS-HMO BLUE - 70310","BLUE CROSS - BLUE CROSS-HMO BLUE - 70310 - RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","70310","RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH","70310 - RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH",364,303.20999999999998,136.68,2574.88,91]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 70328","UNICARE - UNICARE STATE INDEMNITY PLAN - 70328","UNICARE - UNICARE STATE INDEMNITY PLAN - 70328 - RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","70328","RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT","70328 - RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT",294,72.290000000000006,72.290000000000006,801.26,73.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 70355","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 70355","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 70355 - ORTHOPANTOGRAM","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","70355","ORTHOPANTOGRAM","70355 - ORTHOPANTOGRAM",196,81.93,72.290000000000006,796.29,49]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 70355","UNICARE - UNICARE STATE INDEMNITY PLAN - 70355","UNICARE - UNICARE STATE INDEMNITY PLAN - 70355 - ORTHOPANTOGRAM","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","70355","ORTHOPANTOGRAM","70355 - ORTHOPANTOGRAM",196,72.290000000000006,72.290000000000006,796.29,49]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 70390","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 70390","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 70390 - HC SIALOGRAPHY","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","70390","HC SIALOGRAPHY","70390 - HC SIALOGRAPHY",971,303.20999999999998,173.86,2562.5700000000002,242.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 70470","CIGNA HEALTHCARE - CIGNA CARELINK - 70470","CIGNA HEALTHCARE - CIGNA CARELINK - 70470 - HC CHG CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","70470","HC CHG CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL","70470 - HC CHG CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL",2070,2420.09,347.19,2420.09,517.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 70480","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 70480","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 70480 - HC CHG CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","70480","HC CHG CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL","70480 - HC CHG CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL",2648,322.25,193.63,1274.24,662]
["TUFTS - TUFTS POS - CPT - 70486","TUFTS - TUFTS POS - 70486","TUFTS - TUFTS POS - 70486 - HC CHG CT MAXILLOFACIAL W/O CONTRAST MATERIAL","TUFTS","TUFTS POS","CPT","70486","HC CHG CT MAXILLOFACIAL W/O CONTRAST MATERIAL","70486 - HC CHG CT MAXILLOFACIAL W/O CONTRAST MATERIAL",2178,423.79,193.63,1274.24,544.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 70488","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 70488","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 70488 - HC CHG CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","70488","HC CHG CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL","70488 - HC CHG CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL",3151,347.19,347.19,2420.09,787.75]
["UNICARE - UNICARE - CPT - 70491","UNICARE - UNICARE - 70491","UNICARE - UNICARE - 70491 - HC CHG CT SOFT TISSUE NECK W/CONTRAST MATERIAL","UNICARE","UNICARE","CPT","70491","HC CHG CT SOFT TISSUE NECK W/CONTRAST MATERIAL","70491 - HC CHG CT SOFT TISSUE NECK W/CONTRAST MATERIAL",2545,535.08000000000004,347.19,2420.09,636.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 70498","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 70498","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 70498 - HC CHG CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","70498","HC CHG CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST","70498 - HC CHG CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST",4973,347.19,347.19,2420.09,1243.25]
["UNICARE - UNICARE - CPT - 70540","UNICARE - UNICARE - 70540","UNICARE - UNICARE - 70540 - HC CHG MRI ORBIT FACE &/NECK W/O CONTRAST","UNICARE","UNICARE","CPT","70540","HC CHG MRI ORBIT FACE &/NECK W/O CONTRAST","70540 - HC CHG MRI ORBIT FACE &/NECK W/O CONTRAST",3898,711.62,396.79,2653.95,974.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 70545","BLUE CROSS - BLUE CROSS-PPO - 70545","BLUE CROSS - BLUE CROSS-PPO - 70545 - HC CHG MRA HEAD W/CONTRAST MATERIAL","BLUE CROSS","BLUE CROSS-PPO","CPT","70545","HC CHG MRA HEAD W/CONTRAST MATERIAL","70545 - HC CHG MRA HEAD W/CONTRAST MATERIAL",4315,1105.27,637.16,4285.49,1078.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 70546","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 70546","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 70546 - HC CHG MRA HEAD W/O & W/CONTRAST MATERIAL","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","70546","HC CHG MRA HEAD W/O & W/CONTRAST MATERIAL","70546 - HC CHG MRA HEAD W/O & W/CONTRAST MATERIAL",6651,1105.27,664.1,4299.8,1662.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 70549","BLUE CROSS - BLUE CROSS-PPO - 70549","BLUE CROSS - BLUE CROSS-PPO - 70549 - HC MRA,NECK;W/WO","BLUE CROSS","BLUE CROSS-PPO","CPT","70549","HC MRA,NECK;W/WO","70549 - HC MRA,NECK;W/WO",6668,1105.27,664.1,4299.8,1667]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 70552","UNICARE - UNICARE STATE INDEMNITY PLAN - 70552","UNICARE - UNICARE STATE INDEMNITY PLAN - 70552 - HC CHG MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","70552","HC CHG MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL","70552 - HC CHG MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL",4596,637.16,637.16,4285.49,1149]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 70555","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 70555","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 70555 - HC CHG MRI BRAIN FUNCTIONAL W/PHYSICIAN ADMNISTRATION","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","70555","HC CHG MRI BRAIN FUNCTIONAL W/PHYSICIAN ADMNISTRATION","70555 - HC CHG MRI BRAIN FUNCTIONAL W/PHYSICIAN ADMNISTRATION",1185,660.39,396.79,2653.95,296.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 71047","BLUE CROSS - BLUE CROSS-HMO BLUE - 71047","BLUE CROSS - BLUE CROSS-HMO BLUE - 71047 - HC XRAY CHEST 3 VIEWS","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","71047","HC XRAY CHEST 3 VIEWS","71047 - HC XRAY CHEST 3 VIEWS",355,81.93,81.93,801.26,88.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 71048","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 71048","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 71048 - HC XRAY CHEST 4+ VIEWS","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","71048","HC XRAY CHEST 4+ VIEWS","71048 - HC XRAY CHEST 4+ VIEWS",446,147.96,147.96,1026.3599999999999,111.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 71110","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 71110","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 71110 - HC CHG RADEX RIBS BILATERAL 3 VIEWS","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","71110","HC CHG RADEX RIBS BILATERAL 3 VIEWS","71110 - HC CHG RADEX RIBS BILATERAL 3 VIEWS",387,147.96,72.290000000000006,1274.24,96.75]
["TUFTS - TUFTS PPO - CPT - 71130","TUFTS - TUFTS PPO - 71130","TUFTS - TUFTS PPO - 71130 - HC CHG RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS","TUFTS","TUFTS PPO","CPT","71130","HC CHG RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS","71130 - HC CHG RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS",348,285.07,72.290000000000006,801.26,87]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 71250","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 71250","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 71250 - HC CHG CT THORAX W/O CONTRAST MATERIAL","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","71250","HC CHG CT THORAX W/O CONTRAST MATERIAL","71250 - HC CHG CT THORAX W/O CONTRAST MATERIAL",2000,193.63,193.63,1274.24,500]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 71275","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 71275","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 71275 - HC CHG CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","71275","HC CHG CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST","71275 - HC CHG CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST",3800,577.83000000000004,347.19,2420.09,950]
["TUFTS - TUFTS PPO - CPT - 71550","TUFTS - TUFTS PPO - 71550","TUFTS - TUFTS PPO - 71550 - HC CHG MRI CHEST W/O CONTRAST MATERIAL","TUFTS","TUFTS PPO","CPT","71550","HC CHG MRI CHEST W/O CONTRAST MATERIAL","71550 - HC CHG MRI CHEST W/O CONTRAST MATERIAL",4542,944.21,396.79,2653.95,1135.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 71555","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 71555","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 71555 - HC CHG MRA CHEST W/O & W/CONTRAST MATERIAL","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","71555","HC CHG MRA CHEST W/O & W/CONTRAST MATERIAL","71555 - HC CHG MRA CHEST W/O & W/CONTRAST MATERIAL",4450,664.1,543.27,3498.05,1112.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 72052","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 72052","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 72052 - HC CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","72052","HC CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS","72052 - HC CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS",650,147.96,125.38,1304.76,162.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 72070","BLUE CROSS - BLUE CROSS-PPO - 72070","BLUE CROSS - BLUE CROSS-PPO - 72070 - HC CHG RADEX SPINE THORACIC 2 VIEWS","BLUE CROSS","BLUE CROSS-PPO","CPT","72070","HC CHG RADEX SPINE THORACIC 2 VIEWS","72070 - HC CHG RADEX SPINE THORACIC 2 VIEWS",319,147.96,72.290000000000006,1262.6600000000001,79.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 72080","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 72080","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 72080 - HC CHG RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","72080","HC CHG RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS","72080 - HC CHG RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS",353,81.93,72.290000000000006,801.26,88.25]
["TUFTS - TUFTS SELECT - CPT - 72083","TUFTS - TUFTS SELECT - 72083","TUFTS - TUFTS SELECT - 72083 - XRAY EXAM ENTIRE SPINE INCLUDING SKULL, CERV AND SACRAL SPINE; 4 OR 5 VIEWS","TUFTS","TUFTS SELECT","CPT","72083","XRAY EXAM ENTIRE SPINE INCLUDING SKULL, CERV AND SACRAL SPINE; 4 OR 5 VIEWS","72083 - XRAY EXAM ENTIRE SPINE INCLUDING SKULL, CERV AND SACRAL SPINE; 4 OR 5 VIEWS",519,260.45999999999998,147.96,1677.11,129.75]
["TUFTS - TUFTS HMO - CPT - 72084","TUFTS - TUFTS HMO - 72084","TUFTS - TUFTS HMO - 72084 - X-RAY EXAM ENTIRE SPI 6/> VW","TUFTS","TUFTS HMO","CPT","72084","X-RAY EXAM ENTIRE SPI 6/> VW","72084 - X-RAY EXAM ENTIRE SPI 6/> VW",162,669.34,147.96,1677.11,40.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 72120","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 72120","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 72120 - HC X-RAY LUMBAR SPINE FLEX/EXTEN","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","72120","HC X-RAY LUMBAR SPINE FLEX/EXTEN","72120 - HC X-RAY LUMBAR SPINE FLEX/EXTEN",169,147.96,72.290000000000006,1102.33,42.25]
["TUFTS - TUFTS SELECT - CPT - 72120","TUFTS - TUFTS SELECT - 72120","TUFTS - TUFTS SELECT - 72120 - HC X-RAY LUMBAR SPINE FLEX/EXTEN","TUFTS","TUFTS SELECT","CPT","72120","HC X-RAY LUMBAR SPINE FLEX/EXTEN","72120 - HC X-RAY LUMBAR SPINE FLEX/EXTEN",169,171.2,72.290000000000006,1102.33,42.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 72127","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 72127","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 72127 - HC CT,C SPINE;W/WO","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","72127","HC CT,C SPINE;W/WO","72127 - HC CT,C SPINE;W/WO",2974,347.19,347.19,2420.09,743.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 72131","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 72131","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 72131 - HC CHG CT LUMBAR SPINE W/O CONTRAST MATERIAL","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","72131","HC CHG CT LUMBAR SPINE W/O CONTRAST MATERIAL","72131 - HC CHG CT LUMBAR SPINE W/O CONTRAST MATERIAL",1997,322.25,193.63,1307.74,499.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 72132","BLUE CROSS - BLUE CROSS-INDEMNITY - 72132","BLUE CROSS - BLUE CROSS-INDEMNITY - 72132 - HC CHG CT LUMBAR SPINE W/CONTRAST MATERIAL","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","72132","HC CHG CT LUMBAR SPINE W/CONTRAST MATERIAL","72132 - HC CHG CT LUMBAR SPINE W/CONTRAST MATERIAL",2494,1105.27,445.9,4285.49,623.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 72142","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 72142","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 72142 - HC CHG MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","72142","HC CHG MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL","72142 - HC CHG MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL",4685,1105.27,637.16,4299.8,1171.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 72146","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 72146","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 72146 - HC CHG MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","72146","HC CHG MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL","72146 - HC CHG MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL",3654,660.39,396.79,2653.95,913.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 72156","CIGNA HEALTHCARE - CIGNA CARELINK - 72156","CIGNA HEALTHCARE - CIGNA CARELINK - 72156 - HC CHG MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","72156","HC CHG MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL","72156 - HC CHG MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL",5367,4707.1099999999997,664.1,4707.1099999999997,1341.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 72158","UNICARE - UNICARE STATE INDEMNITY PLAN - 72158","UNICARE - UNICARE STATE INDEMNITY PLAN - 72158 - HC CHG MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","72158","HC CHG MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL","72158 - HC CHG MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL",5266,861.13,664.1,4707.1099999999997,1316.5]
["TUFTS - TUFTS PPO - CPT - 72159","TUFTS - TUFTS PPO - 72159","TUFTS - TUFTS PPO - 72159 - HC MRA,SPINE,W/WO","TUFTS","TUFTS PPO","CPT","72159","HC MRA,SPINE,W/WO","72159 - HC MRA,SPINE,W/WO",4562,1300.23,567.59,3654.63,1140.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 72191","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 72191","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 72191 - HC CHG CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","72191","HC CHG CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST","72191 - HC CHG CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST",4023,347.19,347.19,2420.09,1005.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 72193","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 72193","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 72193 - HC CHG CT PELVIS W/CONTRAST MATERIAL","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","72193","HC CHG CT PELVIS W/CONTRAST MATERIAL","72193 - HC CHG CT PELVIS W/CONTRAST MATERIAL",2361,577.83000000000004,347.19,2420.09,590.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 72196","BLUE CROSS - BLUE CROSS-PPO - 72196","BLUE CROSS - BLUE CROSS-PPO - 72196 - HC CHG MRI PELVIS W/CONTRAST MATERIAL","BLUE CROSS","BLUE CROSS-PPO","CPT","72196","HC CHG MRI PELVIS W/CONTRAST MATERIAL","72196 - HC CHG MRI PELVIS W/CONTRAST MATERIAL",4533,1105.27,637.16,4285.49,1133.25]
["TUFTS - TUFTS PPO - CPT - 72200","TUFTS - TUFTS PPO - 72200","TUFTS - TUFTS PPO - 72200 - X-RAY EXAM SI JOINTS","TUFTS","TUFTS PPO","CPT","72200","X-RAY EXAM SI JOINTS","72200 - X-RAY EXAM SI JOINTS",162,430.32,72.290000000000006,1209.52,40.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 72220","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 72220","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 72220 - HC CHG RADEX SACRUM & COCCYX MINIMUM 2 VIEWS","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","72220","HC CHG RADEX SACRUM & COCCYX MINIMUM 2 VIEWS","72220 - HC CHG RADEX SACRUM & COCCYX MINIMUM 2 VIEWS",275,107.22,72.290000000000006,801.26,68.75]
["TUFTS - TUFTS POS - CPT - 72255","TUFTS - TUFTS POS - 72255","TUFTS - TUFTS POS - 72255 - HC CHG MYELOGRAPHY THORACIC RS&I","TUFTS","TUFTS POS","CPT","72255","HC CHG MYELOGRAPHY THORACIC RS&I","72255 - HC CHG MYELOGRAPHY THORACIC RS&I",1185,2350.15,308.97000000000003,7066.23,296.25]
["TUFTS - TUFTS PPO - CPT - 72265","TUFTS - TUFTS PPO - 72265","TUFTS - TUFTS PPO - 72265 - HC CHG MYELOGRAPY LUMBOSACRAL RS&I","TUFTS","TUFTS PPO","CPT","72265","HC CHG MYELOGRAPY LUMBOSACRAL RS&I","72265 - HC CHG MYELOGRAPY LUMBOSACRAL RS&I",1195,2514,308.97000000000003,7066.23,298.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 73020","UNICARE - UNICARE STATE INDEMNITY PLAN - 73020","UNICARE - UNICARE STATE INDEMNITY PLAN - 73020 - HC CHG RADEX SHOULDER 1 VIEW","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","73020","HC CHG RADEX SHOULDER 1 VIEW","73020 - HC CHG RADEX SHOULDER 1 VIEW",229,72.290000000000006,72.290000000000006,801.26,57.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 73070","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 73070","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 73070 - HC CHG RADEX ELBOW 2 VIEWS","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","73070","HC CHG RADEX ELBOW 2 VIEWS","73070 - HC CHG RADEX ELBOW 2 VIEWS",275,81.93,72.290000000000006,801.26,68.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 73080","BLUE CROSS - BLUE CROSS-HMO BLUE - 73080","BLUE CROSS - BLUE CROSS-HMO BLUE - 73080 - HC CHG RADEX ELBOW COMPLETE MINIMUM 3 VIEWS","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","73080","HC CHG RADEX ELBOW COMPLETE MINIMUM 3 VIEWS","73080 - HC CHG RADEX ELBOW COMPLETE MINIMUM 3 VIEWS",323,81.93,72.290000000000006,851.68,80.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 73100","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 73100","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 73100 - XTRNL ECG & 48 HR RECORDING","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","73100","XTRNL ECG & 48 HR RECORDING","73100 - XTRNL ECG & 48 HR RECORDING",313,81.93,72.290000000000006,801.26,78.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 73110","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 73110","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 73110 - HC CHG RADEX WRIST COMPLETE MINIMUM 3 VIEWS","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","73110","HC CHG RADEX WRIST COMPLETE MINIMUM 3 VIEWS","73110 - HC CHG RADEX WRIST COMPLETE MINIMUM 3 VIEWS",360,81.93,72.290000000000006,801.26,90]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 73140","BLUE CROSS - BLUE CROSS-INDEMNITY - 73140","BLUE CROSS - BLUE CROSS-INDEMNITY - 73140 - HC CHG RADEX FINGR MINIMUM 2 VIEWS","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","73140","HC CHG RADEX FINGR MINIMUM 2 VIEWS","73140 - HC CHG RADEX FINGR MINIMUM 2 VIEWS",325,81.93,72.290000000000006,801.26,81.25]
["TUFTS - TUFTS HMO - CPT - 73202","TUFTS - TUFTS HMO - 73202","TUFTS - TUFTS HMO - 73202 - HC CHG CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL","TUFTS","TUFTS HMO","CPT","73202","HC CHG CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL","73202 - HC CHG CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL",3140,965.87,347.19,2420.09,785]
["TUFTS - TUFTS POS - CPT - 73206","TUFTS - TUFTS POS - 73206","TUFTS - TUFTS POS - 73206 - HC CHG CT ANGIOGRAPHY UPPER EXTREMITY","TUFTS","TUFTS POS","CPT","73206","HC CHG CT ANGIOGRAPHY UPPER EXTREMITY","73206 - HC CHG CT ANGIOGRAPHY UPPER EXTREMITY",3440,804.9,347.19,2420.09,860]
["UNICARE - UNICARE - CPT - 73220","UNICARE - UNICARE - 73220","UNICARE - UNICARE - 73220 - HC CHG MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS","UNICARE","UNICARE","CPT","73220","HC CHG MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS","73220 - HC CHG MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS",5462,1033.3599999999999,664.1,4299.8,1365.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 73221","UNICARE - UNICARE STATE INDEMNITY PLAN - 73221","UNICARE - UNICARE STATE INDEMNITY PLAN - 73221 - HC CHG MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","73221","HC CHG MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL","73221 - HC CHG MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL",3843,593.02,396.79,2653.95,960.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 73501","BLUE CROSS - BLUE CROSS-INDEMNITY - 73501","BLUE CROSS - BLUE CROSS-INDEMNITY - 73501 - XRAY EXAM OF HIP UNILATERAL W/PELVIS WHEN PERFORMED; 1 VIEW","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","73501","XRAY EXAM OF HIP UNILATERAL W/PELVIS WHEN PERFORMED; 1 VIEW","73501 - XRAY EXAM OF HIP UNILATERAL W/PELVIS WHEN PERFORMED; 1 VIEW",251,81.93,72.290000000000006,801.26,62.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 73521","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 73521","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 73521 - XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; 2 VIEWS","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","73521","XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; 2 VIEWS","73521 - XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; 2 VIEWS",236,147.96,72.290000000000006,1274.24,59]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 73522","BLUE CROSS - BLUE CROSS-INDEMNITY - 73522","BLUE CROSS - BLUE CROSS-INDEMNITY - 73522 - XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; 3-4 VIEWS","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","73522","XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; 3-4 VIEWS","73522 - XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; 3-4 VIEWS",282,147.96,72.290000000000006,1274.24,70.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 73552","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 73552","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 73552 - XRAY EXAM FEMUR; MINIMUM 2 VIEWS","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","73552","XRAY EXAM FEMUR; MINIMUM 2 VIEWS","73552 - XRAY EXAM FEMUR; MINIMUM 2 VIEWS",193,107.22,72.290000000000006,801.26,48.25]
["TUFTS - TUFTS POS - CPT - 73564","TUFTS - TUFTS POS - 73564","TUFTS - TUFTS POS - 73564 - HC CHG RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS","TUFTS","TUFTS POS","CPT","73564","HC CHG RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS","73564 - HC CHG RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS",422,366.97,72.290000000000006,1103.3900000000001,105.5]
["TUFTS - TUFTS PPO - CPT - 73565","TUFTS - TUFTS PPO - 73565","TUFTS - TUFTS PPO - 73565 - HC CHG RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST","TUFTS","TUFTS PPO","CPT","73565","HC CHG RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST","73565 - HC CHG RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST",353,285.07,72.290000000000006,801.26,88.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 73600","UNICARE - UNICARE STATE INDEMNITY PLAN - 73600","UNICARE - UNICARE STATE INDEMNITY PLAN - 73600 - HC CHG RADIOLOGIC EXAMINATION ANKLE 2 VIEWS","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","73600","HC CHG RADIOLOGIC EXAMINATION ANKLE 2 VIEWS","73600 - HC CHG RADIOLOGIC EXAMINATION ANKLE 2 VIEWS",279,72.290000000000006,72.290000000000006,851.68,69.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 73610","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 73610","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 73610 - HC CHG RADEX ANKLE COMPLETE MINIMUM 3 VIEWS","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","73610","HC CHG RADEX ANKLE COMPLETE MINIMUM 3 VIEWS","73610 - HC CHG RADEX ANKLE COMPLETE MINIMUM 3 VIEWS",319,107.22,72.290000000000006,851.68,79.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 73660","BLUE CROSS - BLUE CROSS-HMO BLUE - 73660","BLUE CROSS - BLUE CROSS-HMO BLUE - 73660 - HC CHG RADEX TOE MINIMUM 2 VIEWS","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","73660","HC CHG RADEX TOE MINIMUM 2 VIEWS","73660 - HC CHG RADEX TOE MINIMUM 2 VIEWS",294,81.93,72.290000000000006,801.26,73.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 73702","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 73702","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 73702 - HC CHG CT LOWER EXTREMITY W/O & W/CONTRAST MATRL","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","73702","HC CHG CT LOWER EXTREMITY W/O & W/CONTRAST MATRL","73702 - HC CHG CT LOWER EXTREMITY W/O & W/CONTRAST MATRL",3135,577.83000000000004,347.19,2420.09,783.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 73718","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 73718","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 73718 - HC CHG MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","73718","HC CHG MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL","73718 - HC CHG MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL",3974,660.39,396.79,2653.95,993.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 73720","CIGNA HEALTHCARE - CIGNA CARELINK - 73720","CIGNA HEALTHCARE - CIGNA CARELINK - 73720 - HC CHG MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","73720","HC CHG MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR","73720 - HC CHG MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR",5507,4299.8,664.1,4299.8,1376.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 73721","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 73721","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 73721 - HC CHG MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","73721","HC CHG MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL","73721 - HC CHG MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL",3933,660.39,396.79,2653.95,983.25]
["TUFTS - TUFTS POS - CPT - 73725","TUFTS - TUFTS POS - 73725","TUFTS - TUFTS POS - 73725 - HC MRA,LE,W/O","TUFTS","TUFTS POS","CPT","73725","HC MRA,LE,W/O","73725 - HC MRA,LE,W/O",4484,1733.71,664.1,5212.7700000000004,1121]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 74021","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 74021","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 74021 - HC XRAY ABD 3+ VIEWS","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","74021","HC XRAY ABD 3+ VIEWS","74021 - HC XRAY ABD 3+ VIEWS",381,193.63,147.96,1026.3599999999999,95.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 74150","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 74150","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 74150 - HC CHG CT ABDOMEN W/O CONTRAST MATERIAL","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","74150","HC CHG CT ABDOMEN W/O CONTRAST MATERIAL","74150 - HC CHG CT ABDOMEN W/O CONTRAST MATERIAL",1978,193.63,193.63,1307.74,494.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 74175","BLUE CROSS - BLUE CROSS-INDEMNITY - 74175","BLUE CROSS - BLUE CROSS-INDEMNITY - 74175 - HC CHG CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","74175","HC CHG CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST","74175 - HC CHG CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST",4281,577.83000000000004,347.19,2420.09,1070.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 74177","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 74177","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 74177 - HC CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","74177","HC CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL","74177 - HC CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL",3344,1105.27,639.20000000000005,4115.74,836]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 74181","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 74181","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 74181 - HC CHG MRI ABDOMEN W/O CONTRAST MATERIAL","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","74181","HC CHG MRI ABDOMEN W/O CONTRAST MATERIAL","74181 - HC CHG MRI ABDOMEN W/O CONTRAST MATERIAL",3605,660.39,396.79,2653.95,901.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 74185","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 74185","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 74185 - HC MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, ABDOMEN","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","74185","HC MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, ABDOMEN","74185 - HC MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, ABDOMEN",4461,664.1,549.66999999999996,3539.25,1115.25]
["TUFTS - TUFTS POS - CPT - 74220","TUFTS - TUFTS POS - 74220","TUFTS - TUFTS POS - 74220 - HC CHG RADEX ESOPHAGUS","TUFTS","TUFTS POS","CPT","74220","HC CHG RADEX ESOPHAGUS","74220 - HC CHG RADEX ESOPHAGUS",864,578.33000000000004,148.44,1738.9,216]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 74240","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 74240","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 74240 - HC XRAY UPPER GI TRACT","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","74240","HC XRAY UPPER GI TRACT","74240 - HC XRAY UPPER GI TRACT",797,347.19,148.44,1899.39,199.25]
["UNICARE - UNICARE - CPT - 74241","UNICARE - UNICARE - 74241","UNICARE - UNICARE - 74241 - XR UGI W KUB","UNICARE","UNICARE","CPT","74241","XR UGI W KUB","74241 - XR UGI W KUB",1140,178.13,148.44,1750.1,285]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 74248","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 74248","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 74248 - HC X-RAY SM INT F-THRU STD","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","74248","HC X-RAY SM INT F-THRU STD","74248 - HC X-RAY SM INT F-THRU STD",1832,0,99.33,99.33,458]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 74250","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 74250","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 74250 - HC CHG RADEX SMALL INTESTINE W/MULTIPLE SERIAL IMAGES","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","74250","HC CHG RADEX SMALL INTESTINE W/MULTIPLE SERIAL IMAGES","74250 - HC CHG RADEX SMALL INTESTINE W/MULTIPLE SERIAL IMAGES",1033,193.63,147.96,1536.95,258.25]
["TUFTS - TUFTS PPO - CPT - 74261","TUFTS - TUFTS PPO - 74261","TUFTS - TUFTS PPO - 74261 - HC CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST","TUFTS","TUFTS PPO","CPT","74261","HC CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST","74261 - HC CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST",5060,417.01,182.03,1172.0999999999999,1265]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 74280","BLUE CROSS - BLUE CROSS-PPO - 74280","BLUE CROSS - BLUE CROSS-PPO - 74280 - HC CHG RADEX COLON W/SPEC HI DNS BARIUM W/WO GLUCAGON","BLUE CROSS","BLUE CROSS-PPO","CPT","74280","HC CHG RADEX COLON W/SPEC HI DNS BARIUM W/WO GLUCAGON","74280 - HC CHG RADEX COLON W/SPEC HI DNS BARIUM W/WO GLUCAGON",2072,265.3,228.79,2136.63,518]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 74329","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 74329","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 74329 - HC ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","74329","HC ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I","74329 - HC ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I",2193,0,183.87,183.87,548.25]
["TUFTS - TUFTS POS - CPT - 74330","TUFTS - TUFTS POS - 74330","TUFTS - TUFTS POS - 74330 - HC CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I","TUFTS","TUFTS POS","CPT","74330","HC CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I","74330 - HC CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I",418,0,306.10000000000002,306.10000000000002,104.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 74363","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 74363","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 74363 - HC CHG PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","74363","HC CHG PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I","74363 - HC CHG PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I",1534,0,221.67,589.28,383.5]
["TUFTS - TUFTS SELECT - CPT - 74420","TUFTS - TUFTS SELECT - 74420","TUFTS - TUFTS SELECT - 74420 - X-RAY URINARY TRACT EXAM WITH CONTRAST MATERIAL","TUFTS","TUFTS SELECT","CPT","74420","X-RAY URINARY TRACT EXAM WITH CONTRAST MATERIAL","74420 - X-RAY URINARY TRACT EXAM WITH CONTRAST MATERIAL",375,669.93,267.85000000000002,4313.6099999999997,93.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 74450","BLUE CROSS - BLUE CROSS-INDEMNITY - 74450","BLUE CROSS - BLUE CROSS-INDEMNITY - 74450 - URETHROCYSTOGRAPHY RETROGRADE RS&I","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","74450","URETHROCYSTOGRAPHY RETROGRADE RS&I","74450 - URETHROCYSTOGRAPHY RETROGRADE RS&I",375,303.20999999999998,267.85000000000002,2562.5700000000002,93.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 74713","CIGNA HEALTHCARE - CIGNA CARELINK - 74713","CIGNA HEALTHCARE - CIGNA CARELINK - 74713 - HC MRI FETAL EA ADD GEST","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","74713","HC MRI FETAL EA ADD GEST","74713 - HC MRI FETAL EA ADD GEST",1377,0,635.02,635.02,344.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 74740","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 74740","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 74740 - HC CHG HYSTEROSALPINGOGRAPHY RS&I","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","74740","HC CHG HYSTEROSALPINGOGRAPHY RS&I","74740 - HC CHG HYSTEROSALPINGOGRAPHY RS&I",792,396.79,303.20999999999998,2562.5700000000002,198]
["TUFTS - TUFTS PPO - CPT - 75561","TUFTS - TUFTS PPO - 75561","TUFTS - TUFTS PPO - 75561 - HC CHG CARDIAC MRI W/WO CONTRAST & FURTHER SEQ","TUFTS","TUFTS PPO","CPT","75561","HC CHG CARDIAC MRI W/WO CONTRAST & FURTHER SEQ","75561 - HC CHG CARDIAC MRI W/WO CONTRAST & FURTHER SEQ",4658,1529.76,664.1,4299.8,1164.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 75563","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 75563","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 75563 - HC CHG CARDIAC MRI W/W/O CONTRAST W/STRESS","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","75563","HC CHG CARDIAC MRI W/W/O CONTRAST W/STRESS","75563 - HC CHG CARDIAC MRI W/W/O CONTRAST W/STRESS",5514,1190.5,861.13,7795.97,1378.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 75574","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 75574","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 75574 - HC CHG CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","75574","HC CHG CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST","75574 - HC CHG CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST",4340,347.19,347.19,2420.09,1085]
["TUFTS - TUFTS PPO - CPT - 75625","TUFTS - TUFTS PPO - 75625","TUFTS - TUFTS PPO - 75625 - HC CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I","TUFTS","TUFTS PPO","CPT","75625","HC CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I","75625 - HC CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I",7093,11095.41,1894.5,31186.53,1773.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 75630","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 75630","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 75630 - HC CHG AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","75630","HC CHG AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I","75630 - HC CHG AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I",4288,4546.0600000000004,1894.5,31186.53,1072]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 75710","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 75710","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 75710 - HC CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","75710","HC CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I","75710 - HC CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I",6293,4546.0600000000004,1894.5,31186.53,1573.25]
["TUFTS - TUFTS HMO - CPT - 75716","TUFTS - TUFTS HMO - 75716","TUFTS - TUFTS HMO - 75716 - HC CHG ANGIOGRAPHY EXTREMITY BILATERAL RS&I","TUFTS","TUFTS HMO","CPT","75716","HC CHG ANGIOGRAPHY EXTREMITY BILATERAL RS&I","75716 - HC CHG ANGIOGRAPHY EXTREMITY BILATERAL RS&I",4288,12446.74,1894.5,31186.53,1072]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 75733","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 75733","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 75733 - HC ANGIO ADRENAL BILAT SELECT","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","75733","HC ANGIO ADRENAL BILAT SELECT","75733 - HC ANGIO ADRENAL BILAT SELECT",4214,4546.0600000000004,632.41999999999996,31186.53,1053.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 75746","BLUE CROSS - BLUE CROSS-INDEMNITY - 75746","BLUE CROSS - BLUE CROSS-INDEMNITY - 75746 - HC CHG ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","75746","HC CHG ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I","75746 - HC CHG ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I",1610,1438.22,827.44,14505.83,402.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 75746","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 75746","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 75746 - HC CHG ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","75746","HC CHG ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I","75746 - HC CHG ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I",1610,1882.14,827.44,14505.83,402.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 75807","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 75807","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 75807 - HC LYMPH VESSEL X-RAY TRUNK","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","75807","HC LYMPH VESSEL X-RAY TRUNK","75807 - HC LYMPH VESSEL X-RAY TRUNK",4214,3473.84,321.11,24088.06,1053.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 75809","BLUE CROSS - BLUE CROSS-PPO - 75809","BLUE CROSS - BLUE CROSS-PPO - 75809 - HC INJ&IMAGE PERITONL SHUNT","BLUE CROSS","BLUE CROSS-PPO","CPT","75809","HC INJ&IMAGE PERITONL SHUNT","75809 - HC INJ&IMAGE PERITONL SHUNT",1011,147.96,147.96,1274.24,252.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 75825","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 75825","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 75825 - HC CHG VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","75825","HC CHG VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I","75825 - HC CHG VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I",4288,3473.84,827.44,31186.53,1072]
["TUFTS - TUFTS PPO - CPT - 75831","TUFTS - TUFTS PPO - 75831","TUFTS - TUFTS PPO - 75831 - HC CHG VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I","TUFTS","TUFTS PPO","CPT","75831","HC CHG VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I","75831 - HC CHG VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I",4288,11095.41,780.65,31186.53,1072]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 75833","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 75833","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 75833 - HC CHG VENOGRAM RENAL BILAT","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","75833","HC CHG VENOGRAM RENAL BILAT","75833 - HC CHG VENOGRAM RENAL BILAT",4122,4546.0600000000004,827.44,31186.53,1030.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 75870","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 75870","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 75870 - VENOGRAM SUPER SAG SINUS","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","75870","VENOGRAM SUPER SAG SINUS","75870 - VENOGRAM SUPER SAG SINUS",2426,1882.14,780.65,11330.17,606.5]
["TUFTS - TUFTS SELECT - CPT - 75885","TUFTS - TUFTS SELECT - 75885","TUFTS - TUFTS SELECT - 75885 - HC CHG PERCUT XHEPATIC PORTO+DYNAMIC","TUFTS","TUFTS SELECT","CPT","75885","HC CHG PERCUT XHEPATIC PORTO+DYNAMIC","75885 - HC CHG PERCUT XHEPATIC PORTO+DYNAMIC",4122,4843.46,1894.5,31186.53,1030.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 75891","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 75891","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 75891 - HC CHG HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","75891","HC CHG HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I","75891 - HC CHG HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I",4288,4546.0600000000004,827.44,31186.53,1072]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 75902","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 75902","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 75902 - HC CHG MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","75902","HC CHG MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I","75902 - HC CHG MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I",730,123.96,123.96,208.63,182.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 75970","BLUE CROSS - BLUE CROSS-INDEMNITY - 75970","BLUE CROSS - BLUE CROSS-INDEMNITY - 75970 - HC CHG TRANSCATHETER BIOPSY RS&I","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","75970","HC CHG TRANSCATHETER BIOPSY RS&I","75970 - HC CHG TRANSCATHETER BIOPSY RS&I",3286,816.53,632.41999999999996,816.53,821.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 75989","CIGNA HEALTHCARE - CIGNA CARELINK - 75989","CIGNA HEALTHCARE - CIGNA CARELINK - 75989 - RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","75989","RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I","75989 - RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I",1182,0,130.61000000000001,130.61000000000001,295.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 76010","BLUE CROSS - BLUE CROSS-INDEMNITY - 76010","BLUE CROSS - BLUE CROSS-INDEMNITY - 76010 - HC CHG RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","76010","HC CHG RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD","76010 - HC CHG RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD",249,81.93,72.290000000000006,801.26,62.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 76140","BLUE CROSS - BLUE CROSS-PPO - 76140","BLUE CROSS - BLUE CROSS-PPO - 76140 - HC CONSULT,OUTSIDE EXAM","BLUE CROSS","BLUE CROSS-PPO","CPT","76140","HC CONSULT,OUTSIDE EXAM","76140 - HC CONSULT,OUTSIDE EXAM",0,7.9,7.9,7.9,0]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 76390","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 76390","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 76390 - HC CHG MRI SPECTROSCOPY","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","76390","HC CHG MRI SPECTROSCOPY","76390 - HC CHG MRI SPECTROSCOPY",4489,1660.94,640.69000000000005,4256.72,1122.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 76390","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 76390","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 76390 - HC CHG MRI SPECTROSCOPY","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","76390","HC CHG MRI SPECTROSCOPY","76390 - HC CHG MRI SPECTROSCOPY",4489,640.69000000000005,640.69000000000005,4256.72,1122.25]
["TUFTS - TUFTS SELECT - CPT - 76498","TUFTS - TUFTS SELECT - 76498","TUFTS - TUFTS SELECT - 76498 - PR MRI PROSTATE FOR RADIATION TREATMENT PLANNING","TUFTS","TUFTS SELECT","CPT","76498","PR MRI PROSTATE FOR RADIATION TREATMENT PLANNING","76498 - PR MRI PROSTATE FOR RADIATION TREATMENT PLANNING",1775,195.69,107.22,1260.05,443.75]
["TUFTS - TUFTS PPO - CPT - 76506","TUFTS - TUFTS PPO - 76506","TUFTS - TUFTS PPO - 76506 - HC CHG ECHOENCEPHALOGRAPHY REAL TIME IMAGING","TUFTS","TUFTS PPO","CPT","76506","HC CHG ECHOENCEPHALOGRAPHY REAL TIME IMAGING","76506 - HC CHG ECHOENCEPHALOGRAPHY REAL TIME IMAGING",1185,453.34,147.96,1274.24,296.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 76513","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 76513","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 76513 - OPH US DX ANT SGM US IMMERSION B-SCAN/HR BIOM","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","76513","OPH US DX ANT SGM US IMMERSION B-SCAN/HR BIOM","76513 - OPH US DX ANT SGM US IMMERSION B-SCAN/HR BIOM",869,147.96,147.96,1307.74,217.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 76529","BLUE CROSS - BLUE CROSS-PPO - 76529","BLUE CROSS - BLUE CROSS-PPO - 76529 - OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION","BLUE CROSS","BLUE CROSS-PPO","CPT","76529","OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION","76529 - OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION",738,81.93,81.93,824.29,184.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 76536","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 76536","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 76536 - US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","76536","US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM","76536 - US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM",1167,147.96,147.96,1307.74,291.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 76642","BLUE CROSS - BLUE CROSS-PPO - 76642","BLUE CROSS - BLUE CROSS-PPO - 76642 - US BREAST UNI REAL TIME WITH IMAGE LIMITED","BLUE CROSS","BLUE CROSS-PPO","CPT","76642","US BREAST UNI REAL TIME WITH IMAGE LIMITED","76642 - US BREAST UNI REAL TIME WITH IMAGE LIMITED",471,81.93,81.93,932.7,117.75]
["TUFTS - TUFTS HMO - CPT - 76706","TUFTS - TUFTS HMO - 76706","TUFTS - TUFTS HMO - 76706 - HC CHG US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA","TUFTS","TUFTS HMO","CPT","76706","HC CHG US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA","76706 - HC CHG US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA",301,508.55,147.96,1274.24,75.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 76770","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 76770","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 76770 - US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","76770","US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE","76770 - US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE",1256,193.63,147.96,1333.33,314]
["TUFTS - TUFTS PPO - CPT - 76800","TUFTS - TUFTS PPO - 76800","TUFTS - TUFTS PPO - 76800 - HC CHG ULTRASOUND SPINAL CANAL & CONTENTS","TUFTS","TUFTS PPO","CPT","76800","HC CHG ULTRASOUND SPINAL CANAL & CONTENTS","76800 - HC CHG ULTRASOUND SPINAL CANAL & CONTENTS",1268,429.95,147.96,1208.5,317]
["TUFTS - TUFTS HMO - CPT - 76805","TUFTS - TUFTS HMO - 76805","TUFTS - TUFTS HMO - 76805 - US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION","TUFTS","TUFTS HMO","CPT","76805","US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION","76805 - US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION",1417,543.38,147.96,1361.54,354.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 76810","UNICARE - UNICARE STATE INDEMNITY PLAN - 76810","UNICARE - UNICARE STATE INDEMNITY PLAN - 76810 - US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","76810","US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO","76810 - US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO",930,152.84,88.6,183.41,232.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 76814","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 76814","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 76814 - US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","76814","US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION","76814 - US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION",770,59.73,59.73,118.01,192.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 76815","BLUE CROSS - BLUE CROSS-HMO BLUE - 76815","BLUE CROSS - BLUE CROSS-HMO BLUE - 76815 - US PREGNANT UTERUS LIMITED 1/> FETUSES","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","76815","US PREGNANT UTERUS LIMITED 1/> FETUSES","76815 - US PREGNANT UTERUS LIMITED 1/> FETUSES",864,147.96,98.34,1274.24,216]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 76818","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 76818","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 76818 - FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","76818","FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING","76818 - FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING",1172,147.96,147.96,1333.33,293]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 76819","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 76819","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 76819 - FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","76819","FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING","76819 - FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING",852,147.96,147.96,1333.33,213]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 76825","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 76825","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 76825 - ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","76825","ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING","76825 - ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING",2097,856.18,160.47,5444.31,524.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 76828","UNICARE - UNICARE STATE INDEMNITY PLAN - 76828","UNICARE - UNICARE STATE INDEMNITY PLAN - 76828 - DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","76828","DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT","76828 - DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT",425,142.59,142.59,1307.74,106.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 76831","BLUE CROSS - BLUE CROSS-PPO - 76831","BLUE CROSS - BLUE CROSS-PPO - 76831 - SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER","BLUE CROSS","BLUE CROSS-PPO","CPT","76831","SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER","76831 - SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER",1228,303.20999999999998,152.84,2653.95,307]
["UNICARE - UNICARE - CPT - 76857","UNICARE - UNICARE - 76857","UNICARE - UNICARE - 76857 - US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U","UNICARE","UNICARE","CPT","76857","US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U","76857 - US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U",919,118.01,98.34,1179.76,229.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 76870","UNICARE - UNICARE STATE INDEMNITY PLAN - 76870","UNICARE - UNICARE STATE INDEMNITY PLAN - 76870 - ULTRASOUND SCROTUM & CONTENTS","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","76870","ULTRASOUND SCROTUM & CONTENTS","76870 - ULTRASOUND SCROTUM & CONTENTS",1177,152.84,147.96,1307.74,294.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 76882","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 76882","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 76882 - US EXTREMITY NON-VASC REAL-TIME IMG LMTD","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","76882","US EXTREMITY NON-VASC REAL-TIME IMG LMTD","76882 - US EXTREMITY NON-VASC REAL-TIME IMG LMTD",325,147.96,98.34,1179.76,81.25]
["TUFTS - TUFTS PPO - CPT - 76930","TUFTS - TUFTS PPO - 76930","TUFTS - TUFTS PPO - 76930 - US PERICARDIOCENT","TUFTS","TUFTS PPO","CPT","76930","US PERICARDIOCENT","76930 - US PERICARDIOCENT",329,0,111.15,133.38,82.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 76937","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 76937","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 76937 - HC CHG US VASC ACCESS SITS VSL PATENCY NDL ENTRY","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","76937","HC CHG US VASC ACCESS SITS VSL PATENCY NDL ENTRY","76937 - HC CHG US VASC ACCESS SITS VSL PATENCY NDL ENTRY",329,0,40.61,40.61,82.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 76946","BLUE CROSS - BLUE CROSS-INDEMNITY - 76946","BLUE CROSS - BLUE CROSS-INDEMNITY - 76946 - US GUIDANCE AMNIOCENTESIS RS&I","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","76946","US GUIDANCE AMNIOCENTESIS RS&I","76946 - US GUIDANCE AMNIOCENTESIS RS&I",304,27.24,27.24,133.38,76]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 76978","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 76978","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 76978 - HC US TRGT DYN MBUBB 1ST LES","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","76978","HC US TRGT DYN MBUBB 1ST LES","76978 - HC US TRGT DYN MBUBB 1ST LES",267,347.19,265.3,2420.09,66.75]
["TUFTS - TUFTS POS - CPT - 76982","TUFTS - TUFTS POS - 76982","TUFTS - TUFTS POS - 76982 - HC USE 1ST TARGET LESION","TUFTS","TUFTS POS","CPT","76982","HC USE 1ST TARGET LESION","76982 - HC USE 1ST TARGET LESION",174,331.51,141.28,996.77,43.5]
["TUFTS - TUFTS SELECT - CPT - 77001","TUFTS - TUFTS SELECT - 77001","TUFTS - TUFTS SELECT - 77001 - HC CHG FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT","TUFTS","TUFTS SELECT","CPT","77001","HC CHG FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT","77001 - HC CHG FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT",1131,0,149.06,149.06,282.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 77003","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 77003","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 77003 - HC CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","77003","HC CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON","77003 - HC CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON",619,140.94,140.94,140.94,154.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 77013","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 77013","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 77013 - HC CHG CT GUIDANCE &MONITORING VISC TISS ABLATION","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","77013","HC CHG CT GUIDANCE &MONITORING VISC TISS ABLATION","77013 - HC CHG CT GUIDANCE &MONITORING VISC TISS ABLATION",1822,962.03,318.45,962.03,455.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 77014","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 77014","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 77014 - HC CT GUIDANCE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","77014","HC CT GUIDANCE","77014 - HC CT GUIDANCE",1088,345.55,161,345.55,272]
["TUFTS - TUFTS POS - CPT - 77047","TUFTS - TUFTS POS - 77047","TUFTS - TUFTS POS - 77047 - HC MRI BREAST C- BILATERAL","TUFTS","TUFTS POS","CPT","77047","HC MRI BREAST C- BILATERAL","77047 - HC MRI BREAST C- BILATERAL",356,904.73,396.79,2720.22,89]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 77049","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 77049","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 77049 - HC MRI BREAST C-+ W/CAD BI","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","77049","HC MRI BREAST C-+ W/CAD BI","77049 - HC MRI BREAST C-+ W/CAD BI",594,664.1,664.1,4750.68,148.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 77063","BLUE CROSS - BLUE CROSS-HMO BLUE - 77063","BLUE CROSS - BLUE CROSS-HMO BLUE - 77063 - SCREENING DIGITAL BREAST TOMOSYNTHESIS BI","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","77063","SCREENING DIGITAL BREAST TOMOSYNTHESIS BI","77063 - SCREENING DIGITAL BREAST TOMOSYNTHESIS BI",100,51.68,26.06,295.68,25]
["TUFTS - TUFTS PPO - CPT - 77065","TUFTS - TUFTS PPO - 77065","TUFTS - TUFTS PPO - 77065 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","TUFTS","TUFTS PPO","CPT","77065","HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",812,392.08,92.17,1102.04,203]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 77067","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 77067","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 77067 - HC SCR MAMM CAD, BI","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","77067","HC SCR MAMM CAD, BI","77067 - HC SCR MAMM CAD, BI",378,118.98,107.96,1165.46,94.5]
["UNICARE - UNICARE - CPT - 77067","UNICARE - UNICARE - 77067","UNICARE - UNICARE - 77067 - HC SCR MAMM CAD, BI","UNICARE","UNICARE","CPT","77067","HC SCR MAMM CAD, BI","77067 - HC SCR MAMM CAD, BI",378,129.55000000000001,107.96,1165.46,94.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 77073","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 77073","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 77073 - HC CHG BONE LENGTH STUDIES","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","77073","HC CHG BONE LENGTH STUDIES","77073 - HC CHG BONE LENGTH STUDIES",371,193.63,72.290000000000006,1102.33,92.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 77074","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 77074","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 77074 - HC CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","77074","HC CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED","77074 - HC CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED",653,193.63,125.38,1304.76,163.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 77080","BLUE CROSS - BLUE CROSS-INDEMNITY - 77080","BLUE CROSS - BLUE CROSS-INDEMNITY - 77080 - DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","77080","DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL","77080 - DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL",913,147.96,119.6,1198.1400000000001,228.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 77261","BLUE CROSS - BLUE CROSS-HMO BLUE - 77261","BLUE CROSS - BLUE CROSS-HMO BLUE - 77261 - HC CHG THERAPEUTIC RADIOLOGY TX PLANNING SIMPLE","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","77261","HC CHG THERAPEUTIC RADIOLOGY TX PLANNING SIMPLE","77261 - HC CHG THERAPEUTIC RADIOLOGY TX PLANNING SIMPLE",643,300.45999999999998,300.45999999999998,300.45999999999998,160.75]
["TUFTS - TUFTS SELECT - CPT - 77262","TUFTS - TUFTS SELECT - 77262","TUFTS - TUFTS SELECT - 77262 - RADIATION THERAPY PLAN INTERM","TUFTS","TUFTS SELECT","CPT","77262","RADIATION THERAPY PLAN INTERM","77262 - RADIATION THERAPY PLAN INTERM",0,0,452.04,452.04,0]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 77293","BLUE CROSS - BLUE CROSS-INDEMNITY - 77293","BLUE CROSS - BLUE CROSS-INDEMNITY - 77293 - RESPIRATORY MOTION MANAGEMENT SIMULATION","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","77293","RESPIRATORY MOTION MANAGEMENT SIMULATION","77293 - RESPIRATORY MOTION MANAGEMENT SIMULATION",2899,1626.4,1626.4,1626.4,724.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 77295","BLUE CROSS - BLUE CROSS-HMO BLUE - 77295","BLUE CROSS - BLUE CROSS-HMO BLUE - 77295 - HC COMPUTER GEN PLAN  3D","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","77295","HC COMPUTER GEN PLAN  3D","77295 - HC COMPUTER GEN PLAN  3D",3774,3429.66,1340.75,14341.71,943.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 77306","BLUE CROSS - BLUE CROSS-PPO - 77306","BLUE CROSS - BLUE CROSS-PPO - 77306 - TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION","BLUE CROSS","BLUE CROSS-PPO","CPT","77306","TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION","77306 - TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION",630,926.01,160.66,3236.35,157.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 77317","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 77317","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 77317 - BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","77317","BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL","77317 - BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL",1185,926.01,369.25,3892.44,296.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 77318","CIGNA HEALTHCARE - CIGNA CARELINK - 77318","CIGNA HEALTHCARE - CIGNA CARELINK - 77318 - BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","77318","BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL","77318 - BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL",1727,3892.44,369.25,3892.44,431.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 77332","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 77332","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 77332 - HC TX DEVICES SIMP","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","77332","HC TX DEVICES SIMP","77332 - HC TX DEVICES SIMP",686,213.01,213.01,1474.02,171.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 77333","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 77333","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 77333 - HC TX DEVICES INT","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","77333","HC TX DEVICES INT","77333 - HC TX DEVICES INT",467,356.14,213.01,1474.02,116.75]
["TUFTS - TUFTS SELECT - CPT - 77338","TUFTS - TUFTS SELECT - 77338","TUFTS - TUFTS SELECT - 77338 - HC MLC DEVICES FOR IMRT","TUFTS","TUFTS SELECT","CPT","77338","HC MLC DEVICES FOR IMRT","77338 - HC MLC DEVICES FOR IMRT",4273,604.52,369.25,3892.44,1068.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 77373","BLUE CROSS - BLUE CROSS-INDEMNITY - 77373","BLUE CROSS - BLUE CROSS-INDEMNITY - 77373 - HC SRS FRACTIONATED 1-5 BODY; 2-5 CRANIAL","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","77373","HC SRS FRACTIONATED 1-5 BODY; 2-5 CRANIAL","77373 - HC SRS FRACTIONATED 1-5 BODY; 2-5 CRANIAL",13470,4864.47,2909.47,20524.84,3367.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 77385","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 77385","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 77385 - INTENSITY MODULATED RADIATION TX DLVR SIMPLE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","77385","INTENSITY MODULATED RADIATION TX DLVR SIMPLE","77385 - INTENSITY MODULATED RADIATION TX DLVR SIMPLE",4369,1495.83,523.85,6278.62,1092.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 77402","BLUE CROSS - BLUE CROSS-HMO BLUE - 77402","BLUE CROSS - BLUE CROSS-HMO BLUE - 77402 - HC TX DEL =>1 MEV SIMPLE","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","77402","HC TX DEL =>1 MEV SIMPLE","77402 - HC TX DEL =>1 MEV SIMPLE",1675,336.62,143.49,1421.57,418.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 77402","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 77402","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 77402 - HC TX DEL =>1 MEV SIMPLE","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","77402","HC TX DEL =>1 MEV SIMPLE","77402 - HC TX DEL =>1 MEV SIMPLE",1675,201.34,143.49,1421.57,418.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 77435","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 77435","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 77435 - RADN RX DELIV,BODY, MANAGEMENT, PER COURSE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","77435","RADN RX DELIV,BODY, MANAGEMENT, PER COURSE","77435 - RADN RX DELIV,BODY, MANAGEMENT, PER COURSE",2386,2684.18,2684.18,2684.18,596.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 77522","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 77522","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 77522 - PROTON BEAM DEL,SINGLE, W/COMPENSAT","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","77522","PROTON BEAM DEL,SINGLE, W/COMPENSAT","77522 - PROTON BEAM DEL,SINGLE, W/COMPENSAT",1883,1856.91,925.54,13219.58,470.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 77523","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 77523","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 77523 - PROTON,BEAM DEL,INTERMED","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","77523","PROTON,BEAM DEL,INTERMED","77523 - PROTON,BEAM DEL,INTERMED",1883,3104.64,1400.79,13219.58,470.75]
["TUFTS - TUFTS SELECT - CPT - 77762","TUFTS - TUFTS SELECT - 77762","TUFTS - TUFTS SELECT - 77762 - HC BRACHY INCAV INT","TUFTS","TUFTS SELECT","CPT","77762","HC BRACHY INCAV INT","77762 - HC BRACHY INCAV INT",4541,877.6,523.85,5650.74,1135.25]
["TUFTS - TUFTS HMO - CPT - 77763","TUFTS - TUFTS HMO - 77763","TUFTS - TUFTS HMO - 77763 - HC BRACHY INCAV CMP","TUFTS","TUFTS HMO","CPT","77763","HC BRACHY INCAV CMP","77763 - HC BRACHY INCAV CMP",5993,3223.87,523.85,8077.76,1498.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 77770","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 77770","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 77770 - HC HDR RDNCL NTRSTL/1ST","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","77770","HC HDR RDNCL NTRSTL/1ST","77770 - HC HDR RDNCL NTRSTL/1ST",1716,1212.82,523.85,8624.5,429]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 77789","BLUE CROSS - BLUE CROSS-INDEMNITY - 77789","BLUE CROSS - BLUE CROSS-INDEMNITY - 77789 - HC BRACHY SURF APP","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","77789","HC BRACHY SURF APP","77789 - HC BRACHY SURF APP",978,336.62,143.49,1421.57,244.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 77789","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 77789","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 77789 - HC BRACHY SURF APP","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","77789","HC BRACHY SURF APP","77789 - HC BRACHY SURF APP",978,201.34,143.49,1421.57,244.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 78012","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 78012","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 78012 - HC CHG THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","78012","HC CHG THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT","78012 - HC CHG THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT",782,464.88,167.19,3840.32,195.5]
["UNICARE - UNICARE - CPT - 78020","UNICARE - UNICARE - 78020","UNICARE - UNICARE - 78020 - HC CHG THYROID CARCINOMA METASTASES UPTAKE","UNICARE","UNICARE","CPT","78020","HC CHG THYROID CARCINOMA METASTASES UPTAKE","78020 - HC CHG THYROID CARCINOMA METASTASES UPTAKE",765,179.88,119.46,179.88,191.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 78070","UNICARE - UNICARE STATE INDEMNITY PLAN - 78070","UNICARE - UNICARE STATE INDEMNITY PLAN - 78070 - HC PARATHYROID IM","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","78070","HC PARATHYROID IM","78070 - HC PARATHYROID IM",1430,310.3,310.3,4270.45,357.5]
["TUFTS - TUFTS POS - CPT - 78102","TUFTS - TUFTS POS - 78102","TUFTS - TUFTS POS - 78102 - HC BONE MARROW IM;LIM","TUFTS","TUFTS POS","CPT","78102","HC BONE MARROW IM;LIM","78102 - HC BONE MARROW IM;LIM",1579,1420.3,393.08,4270.45,394.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 78104","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 78104","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 78104 - HC CHG BONE MARROW IMAGING WHOLE BODY","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","78104","HC CHG BONE MARROW IMAGING WHOLE BODY","78104 - HC CHG BONE MARROW IMAGING WHOLE BODY",2302,608.36,393.08,4270.45,575.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 78205","UNICARE - UNICARE STATE INDEMNITY PLAN - 78205","UNICARE - UNICARE STATE INDEMNITY PLAN - 78205 - NM LIVER W SPECT","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","78205","NM LIVER W SPECT","78205 - NM LIVER W SPECT",1997,430.8,430.8,10212.15,499.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 78227","BLUE CROSS - BLUE CROSS-INDEMNITY - 78227","BLUE CROSS - BLUE CROSS-INDEMNITY - 78227 - HC CHG HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","78227","HC CHG HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ","78227 - HC CHG HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ",4204,599.04999999999995,430.8,5427.23,1051]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 78264","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 78264","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 78264 - HC CHG GASTRIC EMPTYING IMAGING STUDY","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","78264","HC CHG GASTRIC EMPTYING IMAGING STUDY","78264 - HC CHG GASTRIC EMPTYING IMAGING STUDY",2744,608.36,373.93,4270.45,686]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 78290","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 78290","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 78290 - HC CHG INTESTINE IMAGING","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","78290","HC CHG INTESTINE IMAGING","78290 - HC CHG INTESTINE IMAGING",3183,464.88,373.93,4270.45,795.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 78291","BLUE CROSS - BLUE CROSS-INDEMNITY - 78291","BLUE CROSS - BLUE CROSS-INDEMNITY - 78291 - HC PV SHUNT PATENCY","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","78291","HC PV SHUNT PATENCY","78291 - HC PV SHUNT PATENCY",2409,464.88,373.93,4270.45,602.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 78306","BLUE CROSS - BLUE CROSS-INDEMNITY - 78306","BLUE CROSS - BLUE CROSS-INDEMNITY - 78306 - HC CHG BONE &/JOINT IMAGING WHOLE BODY","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","78306","HC CHG BONE &/JOINT IMAGING WHOLE BODY","78306 - HC CHG BONE &/JOINT IMAGING WHOLE BODY",2372,464.88,394.65,4270.45,593]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 78428","CIGNA HEALTHCARE - CIGNA CARELINK - 78428","CIGNA HEALTHCARE - CIGNA CARELINK - 78428 - HC CHG CARDIAC SHUNT DETECTION","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","78428","HC CHG CARDIAC SHUNT DETECTION","78428 - HC CHG CARDIAC SHUNT DETECTION",1736,4270.45,434.6,4270.45,434]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 78429","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 78429","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 78429 - HC MYOCRD IMG PET 1 STD W/CT","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","78429","HC MYOCRD IMG PET 1 STD W/CT","78429 - HC MYOCRD IMG PET 1 STD W/CT",1832,3961.48,2367.3000000000002,16731.72,458]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 78433","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 78433","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 78433 - HC MYOCRD IMG PET 2RTRACER CT","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","78433","HC MYOCRD IMG PET 2RTRACER CT","78433 - HC MYOCRD IMG PET 2RTRACER CT",3491,7550.99,4733.6099999999997,14700.77,872.75]
["TUFTS - TUFTS PPO - CPT - 78434","TUFTS - TUFTS PPO - 78434","TUFTS - TUFTS PPO - 78434 - HC AQMBF PET REST & RX STRESS","TUFTS","TUFTS PPO","CPT","78434","HC AQMBF PET REST & RX STRESS","78434 - HC AQMBF PET REST & RX STRESS",1615,0,0,0,403.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 78453","BLUE CROSS - BLUE CROSS-INDEMNITY - 78453","BLUE CROSS - BLUE CROSS-INDEMNITY - 78453 - HC MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","78453","HC MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS","78453 - HC MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS",1924,3521.28,1360.45,13344.86,481]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 78459","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 78459","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 78459 - HC CHG MYOCARDIAL IMAGING PET METABOLIC EVALUATION","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","78459","HC CHG MYOCARDIAL IMAGING PET METABOLIC EVALUATION","78459 - HC CHG MYOCARDIAL IMAGING PET METABOLIC EVALUATION",7162,3521.28,1212.54,14762.31,1790.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 78469","BLUE CROSS - BLUE CROSS-INDEMNITY - 78469","BLUE CROSS - BLUE CROSS-INDEMNITY - 78469 - HC MYO INFARCT AVID SPECT","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","78469","HC MYO INFARCT AVID SPECT","78469 - HC MYO INFARCT AVID SPECT",2207,3521.28,434.6,12286.51,551.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 78492","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 78492","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 78492 - HC CHG MYOCRD IMAGE PET PERFUS MULTPL STUDY REST/STRESS","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","78492","HC CHG MYOCRD IMAGE PET PERFUS MULTPL STUDY REST/STRESS","78492 - HC CHG MYOCRD IMAGE PET PERFUS MULTPL STUDY REST/STRESS",3274,2367.3000000000002,1212.54,16731.72,818.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 78579","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 78579","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 78579 - HC PUL VENT IMAG (AERO/GAS)","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","78579","HC PUL VENT IMAG (AERO/GAS)","78579 - HC PUL VENT IMAG (AERO/GAS)",1634,464.88,315.47000000000003,4270.45,408.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 78597","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 78597","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 78597 - HC CHG QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","78597","HC CHG QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING","78597 - HC CHG QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING",1840,608.36,315.47000000000003,4270.45,460]
["TUFTS - TUFTS POS - CPT - 78607","TUFTS - TUFTS POS - 78607","TUFTS - TUFTS POS - 78607 - NM BRAIN CMPL W SPECT","TUFTS","TUFTS POS","CPT","78607","NM BRAIN CMPL W SPECT","78607 - NM BRAIN CMPL W SPECT",3412,4312.87,489.45,12967.58,853]
["TUFTS - TUFTS SELECT - CPT - 78608","TUFTS - TUFTS SELECT - 78608","TUFTS - TUFTS SELECT - 78608 - HC CHG BRAIN IMAGING PET METABOLIC EVALUATION","TUFTS","TUFTS SELECT","CPT","78608","HC CHG BRAIN IMAGING PET METABOLIC EVALUATION","78608 - HC CHG BRAIN IMAGING PET METABOLIC EVALUATION",3899,2598.5500000000002,1895.18,16731.72,974.75]
["UNICARE - UNICARE - CPT - 78650","UNICARE - UNICARE - 78650","UNICARE - UNICARE - 78650 - HC CSF LEAK DETECT/LOC","UNICARE","UNICARE","CPT","78650","HC CSF LEAK DETECT/LOC","78650 - HC CSF LEAK DETECT/LOC",3153,414.72,345.6,12480.42,788.25]
["TUFTS - TUFTS POS - CPT - 78700","TUFTS - TUFTS POS - 78700","TUFTS - TUFTS POS - 78700 - HC RENAL IM MORPH","TUFTS","TUFTS POS","CPT","78700","HC RENAL IM MORPH","78700 - HC RENAL IM MORPH",1665,1420.3,370.89,4270.45,416.25]
["UNICARE - UNICARE - CPT - 78740","UNICARE - UNICARE - 78740","UNICARE - UNICARE - 78740 - HC URETERAL REFLUX","UNICARE","UNICARE","CPT","78740","HC URETERAL REFLUX","78740 - HC URETERAL REFLUX",2222,445.07,370.89,4270.45,555.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 78803","BLUE CROSS - BLUE CROSS-PPO - 78803","BLUE CROSS - BLUE CROSS-PPO - 78803 - HC CHG RP LOCLZJ TUMOR/DSTRBJ AGENT TOMOG SPECT","BLUE CROSS","BLUE CROSS-PPO","CPT","78803","HC CHG RP LOCLZJ TUMOR/DSTRBJ AGENT TOMOG SPECT","78803 - HC CHG RP LOCLZJ TUMOR/DSTRBJ AGENT TOMOG SPECT",2995,599.04999999999995,425.49,5502.59,748.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 78804","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 78804","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 78804 - HC RP TUM LOC/RP DIS;BODY,2/","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","78804","HC RP TUM LOC/RP DIS;BODY,2/","78804 - HC RP TUM LOC/RP DIS;BODY,2/",5251,1616.75,1071.19,14762.31,1312.75]
["FALLON - FALLON MEDICAID - CPT - 78807","FALLON - FALLON MEDICAID - 78807","FALLON - FALLON MEDICAID - 78807 - NM INFLAM LOCAL W SPECT","FALLON","FALLON MEDICAID","CPT","78807","NM INFLAM LOCAL W SPECT","78807 - NM INFLAM LOCAL W SPECT",3227,0,425.49,5210.82,806.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 78811","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 78811","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 78811 - HC CHG PET IMAGING LIMITED AREA CHEST HEAD/NECK","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","78811","HC CHG PET IMAGING LIMITED AREA CHEST HEAD/NECK","78811 - HC CHG PET IMAGING LIMITED AREA CHEST HEAD/NECK",1892,2115.7600000000002,1895.18,14691.07,473]
["TUFTS - TUFTS PPO - CPT - 78815","TUFTS - TUFTS PPO - 78815","TUFTS - TUFTS PPO - 78815 - HC CHG PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH","TUFTS","TUFTS PPO","CPT","78815","HC CHG PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH","78815 - HC CHG PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH",4921,5952.74,2059.9699999999998,16731.72,1230.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 78832","CIGNA HEALTHCARE - CIGNA CARELINK - 78832","CIGNA HEALTHCARE - CIGNA CARELINK - 78832 - HC RP LOCLZJ TUM SPECT W/CT 2","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","78832","HC RP LOCLZJ TUM SPECT W/CT 2","78832 - HC RP LOCLZJ TUM SPECT W/CT 2",1832,16731.72,2367.3000000000002,16731.72,458]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 78835","CIGNA HEALTHCARE - CIGNA CARELINK - 78835","CIGNA HEALTHCARE - CIGNA CARELINK - 78835 - HC RP QUAN MEAS SINGLE AREA","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","78835","HC RP QUAN MEAS SINGLE AREA","78835 - HC RP QUAN MEAS SINGLE AREA",1832,0,375.38,375.38,458]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 79200","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 79200","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 79200 - HC CHG RP THERAPY INRACAVITARY ADMINISTRATION","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","79200","HC CHG RP THERAPY INRACAVITARY ADMINISTRATION","79200 - HC CHG RP THERAPY INRACAVITARY ADMINISTRATION",1480,303.64999999999998,303.64999999999998,2756.08,370]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 79445","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 79445","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 79445 - HC CHG RP THERAPY INTRA-ARTERIAL PARTICULATE ADMN","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","79445","HC CHG RP THERAPY INTRA-ARTERIAL PARTICULATE ADMN","79445 - HC CHG RP THERAPY INTRA-ARTERIAL PARTICULATE ADMN",1061,303.64999999999998,303.64999999999998,2756.08,265.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 80048","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 80048","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 80048 - HC CHG BASIC METABOLIC PANEL CALCIUM TOTAL","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","80048","HC CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - HC CHG BASIC METABOLIC PANEL CALCIUM TOTAL",226,21.99,7.71,94.96,56.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 80053","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 80053","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 80053 - HC CHG COMPREHENSIVE METABOLIC PANEL","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","80053","HC CHG COMPREHENSIVE METABOLIC PANEL","80053 - HC CHG COMPREHENSIVE METABOLIC PANEL",375,26.57,9.6300000000000008,118.56,93.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 80055","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 80055","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 80055 - HC CHG OBSTETRIC PANEL","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","80055","HC CHG OBSTETRIC PANEL","80055 - HC CHG OBSTETRIC PANEL",264,51.46,41.91,536.66999999999996,66]
["TUFTS - TUFTS POS - CPT - 80055","TUFTS - TUFTS POS - 80055","TUFTS - TUFTS POS - 80055 - HC CHG OBSTETRIC PANEL","TUFTS","TUFTS POS","CPT","80055","HC CHG OBSTETRIC PANEL","80055 - HC CHG OBSTETRIC PANEL",264,178.48,41.91,536.66999999999996,66]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 80069","AETNA - AETNA-MEDICARE ADVANTAGE - 80069","AETNA - AETNA-MEDICARE ADVANTAGE - 80069 - HC CHG RENAL FUNCTION PANEL","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","80069","HC CHG RENAL FUNCTION PANEL","80069 - HC CHG RENAL FUNCTION PANEL",218,10.24,7.92,97.49,54.5]
["BMC HEALTHNET - BMCHN QHP - CPT - 80069","BMC HEALTHNET - BMCHN QHP - 80069","BMC HEALTHNET - BMCHN QHP - 80069 - HC CHG RENAL FUNCTION PANEL","BMC HEALTHNET","BMCHN QHP","CPT","80069","HC CHG RENAL FUNCTION PANEL","80069 - HC CHG RENAL FUNCTION PANEL",218,9.5,7.92,97.49,54.5]
["FALLON - FALLON MEDICAID - CPT - 80074","FALLON - FALLON MEDICAID - 80074","FALLON - FALLON MEDICAID - 80074 - HC CHG ACUTE HEPATITIS PANEL","FALLON","FALLON MEDICAID","CPT","80074","HC CHG ACUTE HEPATITIS PANEL","80074 - HC CHG ACUTE HEPATITIS PANEL",391,43.45,43.45,534.79999999999995,97.75]
["UNICARE - UNICARE - CPT - 80074","UNICARE - UNICARE - 80074","UNICARE - UNICARE - 80074 - HC CHG ACUTE HEPATITIS PANEL","UNICARE","UNICARE","CPT","80074","HC CHG ACUTE HEPATITIS PANEL","80074 - HC CHG ACUTE HEPATITIS PANEL",391,109.18,43.45,534.79999999999995,97.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 80145","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 80145","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 80145 - HC DRUG ASSAY ADALIMUMAB","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","80145","HC DRUG ASSAY ADALIMUMAB","80145 - HC DRUG ASSAY ADALIMUMAB",91,38.57,38.57,206.18,22.75]
["FALLON - FALLON SENIOR PLAN - CPT - 80150","FALLON - FALLON SENIOR PLAN - 80150","FALLON - FALLON SENIOR PLAN - 80150 - HC AMIKACIN","FALLON","FALLON SENIOR PLAN","CPT","80150","HC AMIKACIN","80150 - HC AMIKACIN",124,15.08,13.75,169.26,31]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 80156","BLUE CROSS - BLUE CROSS-PPO - 80156","BLUE CROSS - BLUE CROSS-PPO - 80156 - HC CHG DRUG ASSAY CARBAMAZEPINE TOTAL","BLUE CROSS","BLUE CROSS-PPO","CPT","80156","HC CHG DRUG ASSAY CARBAMAZEPINE TOTAL","80156 - HC CHG DRUG ASSAY CARBAMAZEPINE TOTAL",72,32.94,13.28,163.47,18]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 80158","BMC HEALTHNET - BMCHN WELL SENSE - 80158","BMC HEALTHNET - BMCHN WELL SENSE - 80158 - HC CHG DRUG ASSAY CYCLOSPORINE","BMC HEALTHNET","BMCHN WELL SENSE","CPT","80158","HC CHG DRUG ASSAY CYCLOSPORINE","80158 - HC CHG DRUG ASSAY CYCLOSPORINE",91,35.700000000000003,16.46,202.6,22.75]
["TUFTS - TUFTS SELECT - CPT - 80158","TUFTS - TUFTS SELECT - 80158","TUFTS - TUFTS SELECT - 80158 - HC CHG DRUG ASSAY CYCLOSPORINE","TUFTS","TUFTS SELECT","CPT","80158","HC CHG DRUG ASSAY CYCLOSPORINE","80158 - HC CHG DRUG ASSAY CYCLOSPORINE",91,31.47,16.46,202.6,22.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 80162","UNICARE - UNICARE STATE INDEMNITY PLAN - 80162","UNICARE - UNICARE STATE INDEMNITY PLAN - 80162 - HC CHG DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","80162","HC CHG DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL","80162 - HC CHG DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL",66,26.86,12.11,149,16.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 80168","BLUE CROSS - BLUE CROSS-INDEMNITY - 80168","BLUE CROSS - BLUE CROSS-INDEMNITY - 80168 - HC CHG DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","80168","HC CHG DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE","80168 - HC CHG DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE",75,36.89,14.9,183.36,18.75]
["FALLON - FALLON MEDICAID - CPT - 80168","FALLON - FALLON MEDICAID - 80168","FALLON - FALLON MEDICAID - 80168 - HC CHG DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE","FALLON","FALLON MEDICAID","CPT","80168","HC CHG DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE","80168 - HC CHG DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE",75,14.9,14.9,183.36,18.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 80169","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 80169","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 80169 - DRUG SCREEN QUANTITATIVE EVEROLIMUS","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","80169","DRUG SCREEN QUANTITATIVE EVEROLIMUS","80169 - DRUG SCREEN QUANTITATIVE EVEROLIMUS",310,23.89,10.01,154.22,77.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 80170","BLUE CROSS - BLUE CROSS-PPO - 80170","BLUE CROSS - BLUE CROSS-PPO - 80170 - HC CHG DRUG SCREEN QUANTITATIVE GENTAMICIN","BLUE CROSS","BLUE CROSS-PPO","CPT","80170","HC CHG DRUG SCREEN QUANTITATIVE GENTAMICIN","80170 - HC CHG DRUG SCREEN QUANTITATIVE GENTAMICIN",82,36.89,14.94,183.85,20.5]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 80171","BMC HEALTHNET - BMCHN WELL SENSE - 80171","BMC HEALTHNET - BMCHN WELL SENSE - 80171 - DRUG SCREEN QUANTITATIVE GABAPENTIN","BMC HEALTHNET","BMCHN WELL SENSE","CPT","80171","DRUG SCREEN QUANTITATIVE GABAPENTIN","80171 - DRUG SCREEN QUANTITATIVE GABAPENTIN",83,24.95,16.010000000000002,210.18,20.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 80175","TUFTS - TUFTS MEDICARE PREFERRED HMO - 80175","TUFTS - TUFTS MEDICARE PREFERRED HMO - 80175 - DRUG SCREEN QUANTITATIVE LAMOTRIGINE","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","80175","DRUG SCREEN QUANTITATIVE LAMOTRIGINE","80175 - DRUG SCREEN QUANTITATIVE LAMOTRIGINE",64,19.21,12.09,148.84,16]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 80177","BLUE CROSS - BLUE CROSS-HMO BLUE - 80177","BLUE CROSS - BLUE CROSS-HMO BLUE - 80177 - DRUG SCREEN QUANTITATIVE LEVETIRACETAM","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","80177","DRUG SCREEN QUANTITATIVE LEVETIRACETAM","80177 - DRUG SCREEN QUANTITATIVE LEVETIRACETAM",174,29.65,12.09,148.84,43.5]
["CIGNA HEALTHCARE - CIGNA - CPT - 80178","CIGNA HEALTHCARE - CIGNA - 80178","CIGNA HEALTHCARE - CIGNA - 80178 - HC CHG DRUG SCREEN QUANTITATIVE LITHIUM","CIGNA HEALTHCARE","CIGNA","CPT","80178","HC CHG DRUG SCREEN QUANTITATIVE LITHIUM","80178 - HC CHG DRUG SCREEN QUANTITATIVE LITHIUM",34,29.75,6.03,74.22,8.5]
["TUFTS - TUFTS SPIRIT - CPT - 80178","TUFTS - TUFTS SPIRIT - 80178","TUFTS - TUFTS SPIRIT - 80178 - HC CHG DRUG SCREEN QUANTITATIVE LITHIUM","TUFTS","TUFTS SPIRIT","CPT","80178","HC CHG DRUG SCREEN QUANTITATIVE LITHIUM","80178 - HC CHG DRUG SCREEN QUANTITATIVE LITHIUM",34,7.27,6.03,74.22,8.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 80184","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 80184","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 80184 - HC CHG DRUG SCREEN QUANTITATIVE PHENOBARBITAL","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","80184","HC CHG DRUG SCREEN QUANTITATIVE PHENOBARBITAL","80184 - HC CHG DRUG SCREEN QUANTITATIVE PHENOBARBITAL",46,32.22,11.3,148.35,11.5]
["FALLON - FALLON MEDICAID - CPT - 80185","FALLON - FALLON MEDICAID - 80185","FALLON - FALLON MEDICAID - 80185 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL","FALLON","FALLON MEDICAID","CPT","80185","HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL","80185 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL",66,12.09,12.09,148.84,16.5]
["FALLON - FALLON MEDICAID - CPT - 80186","FALLON - FALLON MEDICAID - 80186","FALLON - FALLON MEDICAID - 80186 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN FREE","FALLON","FALLON MEDICAID","CPT","80186","HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN FREE","80186 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN FREE",46,12.55,12.55,154.51,11.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 80195","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 80195","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 80195 - HC CHG DRUG SCREEN QUANTITATIVE SIROLIMUS","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","80195","HC CHG DRUG SCREEN QUANTITATIVE SIROLIMUS","80195 - HC CHG DRUG SCREEN QUANTITATIVE SIROLIMUS",35,30.96,10.01,154.22,8.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 80197","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 80197","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 80197 - HC CHG DRUG SCREEN QUANTITATIVE TACROLIMUS","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","80197","HC CHG DRUG SCREEN QUANTITATIVE TACROLIMUS","80197 - HC CHG DRUG SCREEN QUANTITATIVE TACROLIMUS",36,13.73,10.01,154.22,9]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 80197","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 80197","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 80197 - HC CHG DRUG SCREEN QUANTITATIVE TACROLIMUS","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT","80197","HC CHG DRUG SCREEN QUANTITATIVE TACROLIMUS","80197 - HC CHG DRUG SCREEN QUANTITATIVE TACROLIMUS",36,18.95,10.01,154.22,9]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 80201","AETNA - AETNA-MEDICARE ADVANTAGE - 80201","AETNA - AETNA-MEDICARE ADVANTAGE - 80201 - HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","80201","HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE","80201 - HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE",46,14.07,10.88,133.80000000000001,11.5]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 80201","CIGNA HEALTHCARE - CIGNA PPO - 80201","CIGNA HEALTHCARE - CIGNA PPO - 80201 - HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE","CIGNA HEALTHCARE","CIGNA PPO","CPT","80201","HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE","80201 - HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE",46,30.31,10.88,133.80000000000001,11.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 80202","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 80202","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 80202 - HC CHG DRUG SCREEN QUANTITATIVE VANCOMYCIN","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","80202","HC CHG DRUG SCREEN QUANTITATIVE VANCOMYCIN","80202 - HC CHG DRUG SCREEN QUANTITATIVE VANCOMYCIN",67,16.25,12.35,151.97999999999999,16.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 80203","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 80203","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 80203 - DRUG SCREEN QUANTITATIVE ZONISAMIDE","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT","80203","DRUG SCREEN QUANTITATIVE ZONISAMIDE","80203 - DRUG SCREEN QUANTITATIVE ZONISAMIDE",64,17.86,12.09,148.84,16]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 80230","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 80230","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 80230 - HC DRUG ASSAY INFLIXIMAB","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","80230","HC DRUG ASSAY INFLIXIMAB","80230 - HC DRUG ASSAY INFLIXIMAB",67,67.11,38.57,206.18,16.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 80280","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 80280","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 80280 - HC DRUG ASSAY VEDOLIZUMAB","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","80280","HC DRUG ASSAY VEDOLIZUMAB","80280 - HC DRUG ASSAY VEDOLIZUMAB",67,46.28,38.57,206.18,16.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 80285","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 80285","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 80285 - HC DRUG ASSAY VORICONAZOLE","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","80285","HC DRUG ASSAY VORICONAZOLE","80285 - HC DRUG ASSAY VORICONAZOLE",67,47.17,27.11,144.88999999999999,16.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 80306","AETNA - AETNA-MEDICARE ADVANTAGE - 80306","AETNA - AETNA-MEDICARE ADVANTAGE - 80306 - HC DRUG TEST PRSMV INSTRMNT","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","80306","HC DRUG TEST PRSMV INSTRMNT","80306 - HC DRUG TEST PRSMV INSTRMNT",192,20.23,11.89,145.87,48]
["BMC HEALTHNET - BMCHN ACO - CPT - 80307","BMC HEALTHNET - BMCHN ACO - 80307","BMC HEALTHNET - BMCHN ACO - 80307 - HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS","BMC HEALTHNET","BMCHN ACO","CPT","80307","HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS","80307 - HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS",762,104.04,47.55,572.91,190.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 80320","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 80320","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 80320 - DRUG SCREEN QUANTITATIVE ALCOHOLS","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","80320","DRUG SCREEN QUANTITATIVE ALCOHOLS","80320 - DRUG SCREEN QUANTITATIVE ALCOHOLS",235,0,16.89,108.78,58.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 80329","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 80329","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 80329 - DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","80329","DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2","80329 - DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2",235,11.01,10.74,111.18,58.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 80339","BLUE CROSS - BLUE CROSS-HMO BLUE - 80339","BLUE CROSS - BLUE CROSS-HMO BLUE - 80339 - HC CHG ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 1-3","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","80339","HC CHG ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 1-3","80339 - HC CHG ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 1-3",104,44.14,7.53,48.46,26]
["BMC HEALTHNET - BMCHN MCO - CPT - 80348","BMC HEALTHNET - BMCHN MCO - 80348","BMC HEALTHNET - BMCHN MCO - 80348 - HC CHG DRUG SCREENING BUPRENORPHINE","BMC HEALTHNET","BMCHN MCO","CPT","80348","HC CHG DRUG SCREENING BUPRENORPHINE","80348 - HC CHG DRUG SCREENING BUPRENORPHINE",51,0,18.809999999999999,158.69999999999999,12.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 80354","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 80354","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 80354 - DRUG SCREENING FENTANYL","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","80354","DRUG SCREENING FENTANYL","80354 - DRUG SCREENING FENTANYL",86,19.82,19.329999999999998,147.9,21.5]
["BMC HEALTHNET - BMCHN ACO - CPT - 80356","BMC HEALTHNET - BMCHN ACO - 80356","BMC HEALTHNET - BMCHN ACO - 80356 - HC CHG DRUG SCREENING HEROIN METABOLITE","BMC HEALTHNET","BMCHN ACO","CPT","80356","HC CHG DRUG SCREENING HEROIN METABOLITE","80356 - HC CHG DRUG SCREENING HEROIN METABOLITE",235,0,23.95,154.22,58.75]
["FALLON - FALLON MEDICAID - CPT - 80366","FALLON - FALLON MEDICAID - 80366","FALLON - FALLON MEDICAID - 80366 - HC CHG DRUG SCREENING PREGABALIN","FALLON","FALLON MEDICAID","CPT","80366","HC CHG DRUG SCREENING PREGABALIN","80366 - HC CHG DRUG SCREENING PREGABALIN",56,0,12.43,80,14]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 80438","BLUE CROSS - BLUE CROSS-HMO BLUE - 80438","BLUE CROSS - BLUE CROSS-HMO BLUE - 80438 - HC CHG TRH STIM PANEL 1 HR","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","80438","HC CHG TRH STIM PANEL 1 HR","80438 - HC CHG TRH STIM PANEL 1 HR",65,113.96,45.99,565.98,16.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 81000","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 81000","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 81000 - URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","81000","URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY","81000 - URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY",17,7.24,2.97,39.04,4.25]
["FALLON - FALLON SENIOR PLAN - CPT - 81001","FALLON - FALLON SENIOR PLAN - 81001","FALLON - FALLON SENIOR PLAN - 81001 - URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY","FALLON","FALLON SENIOR PLAN","CPT","81001","URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY","81001 - URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY",17,3.17,2.9,35.659999999999997,4.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81001","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 81001","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 81001 - URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","81001","URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY","81001 - URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY",17,3.48,2.9,35.659999999999997,4.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 81003","BLUE CROSS - BLUE CROSS-INDEMNITY - 81003","BLUE CROSS - BLUE CROSS-INDEMNITY - 81003 - URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","81003","URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY","81003 - URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY",12,5.27,2.0499999999999998,25.23,3]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 81003","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 81003","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 81003 - URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","81003","URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY","81003 - URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY",12,2.25,2.0499999999999998,25.23,3]
["TUFTS - TUFTS POS - CPT - 81015","TUFTS - TUFTS POS - 81015","TUFTS - TUFTS POS - 81015 - HC CHG URINALYSIS MICROSCOPIC ONLY","TUFTS","TUFTS POS","CPT","81015","HC CHG URINALYSIS MICROSCOPIC ONLY","81015 - HC CHG URINALYSIS MICROSCOPIC ONLY",15,11.37,2.78,34.15,3.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 81025","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 81025","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 81025 - URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","81025","URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS","81025 - URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS",32,10.33,6.36,83.47,8]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 81050","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 81050","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 81050 - HC CHG VOLUME MEASUREMENT TIMED COLLECTION EACH","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","81050","HC CHG VOLUME MEASUREMENT TIMED COLLECTION EACH","81050 - HC CHG VOLUME MEASUREMENT TIMED COLLECTION EACH",15,6.59,2.74,35.29,3.75]
["FALLON - FALLON MEDICAID - CPT - 81161","FALLON - FALLON MEDICAID - 81161","FALLON - FALLON MEDICAID - 81161 - HC DMD DUPLICATION/DELETION ANALYSIS","FALLON","FALLON MEDICAID","CPT","81161","HC DMD DUPLICATION/DELETION ANALYSIS","81161 - HC DMD DUPLICATION/DELETION ANALYSIS",366,0,141.12,2706.08,91.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81161","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 81161","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 81161 - HC DMD DUPLICATION/DELETION ANALYSIS","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","81161","HC DMD DUPLICATION/DELETION ANALYSIS","81161 - HC DMD DUPLICATION/DELETION ANALYSIS",366,0,141.12,2706.08,91.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 81179","BLUE CROSS - BLUE CROSS-PPO - 81179","BLUE CROSS - BLUE CROSS-PPO - 81179 - HC CHG ATXN2 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","BLUE CROSS","BLUE CROSS-PPO","CPT","81179","HC CHG ATXN2 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","81179 - HC CHG ATXN2 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES",175,157.55000000000001,102.3,1328.77,43.75]
["TUFTS - TUFTS HMO - CPT - 81180","TUFTS - TUFTS HMO - 81180","TUFTS - TUFTS HMO - 81180 - HC CHG ATXN3 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","TUFTS","TUFTS HMO","CPT","81180","HC CHG ATXN3 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","81180 - HC CHG ATXN3 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES",175,530.32000000000005,102.3,1328.77,43.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 81180","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 81180","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 81180 - HC CHG ATXN3 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","81180","HC CHG ATXN3 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","81180 - HC CHG ATXN3 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES",175,295.77999999999997,102.3,1328.77,43.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 81207","BMC HEALTHNET - BMCHN QHP - 81207","BMC HEALTHNET - BMCHN QHP - 81207 - HC Q;P190 BCR-ABL 1","BMC HEALTHNET","BMCHN QHP","CPT","81207","HC Q;P190 BCR-ABL 1","81207 - HC Q;P190 BCR-ABL 1",287,79.27,132.12,1625.92,71.75]
["TUFTS - TUFTS SPIRIT - CPT - 81207","TUFTS - TUFTS SPIRIT - 81207","TUFTS - TUFTS SPIRIT - 81207 - HC Q;P190 BCR-ABL 1","TUFTS","TUFTS SPIRIT","CPT","81207","HC Q;P190 BCR-ABL 1","81207 - HC Q;P190 BCR-ABL 1",287,159.32,132.12,1625.92,71.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 81210","UNICARE - UNICARE STATE INDEMNITY PLAN - 81210","UNICARE - UNICARE STATE INDEMNITY PLAN - 81210 - HC CHG BRAF GENE ANALYSIS V600 VARIANT(S)","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","81210","HC CHG BRAF GENE ANALYSIS V600 VARIANT(S)","81210 - HC CHG BRAF GENE ANALYSIS V600 VARIANT(S)",492,265.29000000000002,129.6,1701.28,123]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 81220","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 81220","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 81220 - HC CHG CFTR GENE ANALYSIS COMMON VARIANTS","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","81220","HC CHG CFTR GENE ANALYSIS COMMON VARIANTS","81220 - HC CHG CFTR GENE ANALYSIS COMMON VARIANTS",847,1230.02,411.25,1400.52,211.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 81220","TUFTS - TUFTS MEDICARE PREFERRED HMO - 81220","TUFTS - TUFTS MEDICARE PREFERRED HMO - 81220 - HC CHG CFTR GENE ANALYSIS COMMON VARIANTS","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","81220","HC CHG CFTR GENE ANALYSIS COMMON VARIANTS","81220 - HC CHG CFTR GENE ANALYSIS COMMON VARIANTS",847,807.07,411.25,1400.52,211.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 81222","BMC HEALTHNET - BMCHN MCO - 81222","BMC HEALTHNET - BMCHN MCO - 81222 - HC GEN CYSTIC FIBROSIS DEL/DUP","BMC HEALTHNET","BMCHN MCO","CPT","81222","HC GEN CYSTIC FIBROSIS DEL/DUP","81222 - HC GEN CYSTIC FIBROSIS DEL/DUP",762,0,435.07,1094.72,190.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 81223","UNITED HEALTHCARE - UNITED HEALTHCARE - 81223","UNITED HEALTHCARE - UNITED HEALTHCARE - 81223 - HC CFTR GENE ANALYSIS FULL GENE SEQUENCE","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","81223","HC CFTR GENE ANALYSIS FULL GENE SEQUENCE","81223 - HC CFTR GENE ANALYSIS FULL GENE SEQUENCE",1523,1050.8900000000001,499,1255.58,380.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 81229","BMC HEALTHNET - BMCHN MCO - 81229","BMC HEALTHNET - BMCHN MCO - 81229 - HC CYTOG ALYS CHRML ABNR SNPCGH","BMC HEALTHNET","BMCHN MCO","CPT","81229","HC CYTOG ALYS CHRML ABNR SNPCGH","81229 - HC CYTOG ALYS CHRML ABNR SNPCGH",4882,0,1035,2918.79,1220.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81235","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 81235","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 81235 - HC CHG EGFR GENE ANALYSIS COMMON VARIANTS","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","81235","HC CHG EGFR GENE ANALYSIS COMMON VARIANTS","81235 - HC CHG EGFR GENE ANALYSIS COMMON VARIANTS",1038,143.88999999999999,239.82,3148.12,259.5]
["TUFTS - TUFTS HMO - CPT - 81240","TUFTS - TUFTS HMO - 81240","TUFTS - TUFTS HMO - 81240 - HC CHG F2 GENE ANALYSIS 20210G >A VARIANT","TUFTS","TUFTS HMO","CPT","81240","HC CHG F2 GENE ANALYSIS 20210G >A VARIANT","81240 - HC CHG F2 GENE ANALYSIS 20210G >A VARIANT",434,254.28,48.54,637.1,108.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 81241","ELDER SERVICE PLAN - ELEMENT CARE INC - 81241","ELDER SERVICE PLAN - ELEMENT CARE INC - 81241 - HC CHG F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","81241","HC CHG F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT","81241 - HC CHG F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT",434,73.37,55.74,711.6,108.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 81243","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 81243","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 81243 - HC CHG FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","81243","HC CHG FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES","81243 - HC CHG FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES",434,120.13,57.04,371.04,108.5]
["BMC HEALTHNET - BMCHN ACO - CPT - 81252","BMC HEALTHNET - BMCHN ACO - 81252","BMC HEALTHNET - BMCHN ACO - 81252 - HC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCEHC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCE","BMC HEALTHNET","BMCHN ACO","CPT","81252","HC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCEHC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCE","81252 - HC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCEHC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCE",153,0,101.12,254.44,38.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 81254","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 81254","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 81254 - HC CHG GJB6 GENE ANALYSIS COMMON VARIANTS","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","81254","HC CHG GJB6 GENE ANALYSIS COMMON VARIANTS","81254 - HC CHG GJB6 GENE ANALYSIS COMMON VARIANTS",51,0,35,88.07,12.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 81254","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 81254","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 81254 - HC CHG GJB6 GENE ANALYSIS COMMON VARIANTS","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","81254","HC CHG GJB6 GENE ANALYSIS COMMON VARIANTS","81254 - HC CHG GJB6 GENE ANALYSIS COMMON VARIANTS",51,35,35,88.07,12.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81256","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 81256","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 81256 - HC CHG HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","81256","HC CHG HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS","81256 - HC CHG HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS",434,35.770000000000003,59.62,733.73,108.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 81257","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 81257","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 81257 - HC CHG HBA1/HBA2 ANALYSIS FOR COMMON DELETIONS/VARIANT","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","81257","HC CHG HBA1/HBA2 ANALYSIS FOR COMMON DELETIONS/VARIANT","81257 - HC CHG HBA1/HBA2 ANALYSIS FOR COMMON DELETIONS/VARIANT",455,215.36,102.26,257.31,113.75]
["TUFTS - TUFTS SELECT - CPT - 81259","TUFTS - TUFTS SELECT - 81259","TUFTS - TUFTS SELECT - 81259 - HC HBA1/HBA2 GENE ANALYSIS FULL GENE SEQUENCE","TUFTS","TUFTS SELECT","CPT","81259","HC HBA1/HBA2 GENE ANALYSIS FULL GENE SEQUENCE","81259 - HC HBA1/HBA2 GENE ANALYSIS FULL GENE SEQUENCE",629,903.81,443.32,5819.55,157.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 81269","BLUE CROSS - BLUE CROSS-INDEMNITY - 81269","BLUE CROSS - BLUE CROSS-INDEMNITY - 81269 - HC HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIENTS","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","81269","HC HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIENTS","81269 - HC HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIENTS",455,370.22,149.54,1963.05,113.75]
["FALLON - FALLON MEDICAID - CPT - 81269","FALLON - FALLON MEDICAID - 81269","FALLON - FALLON MEDICAID - 81269 - HC HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIENTS","FALLON","FALLON MEDICAID","CPT","81269","HC HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIENTS","81269 - HC HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIENTS",455,149.54,149.54,1963.05,113.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 81270","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 81270","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 81270 - HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT","81270","HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT","81270 - HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT",434,123.58,83.62,1029.05,108.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 81272","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 81272","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 81272 - HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","81272","HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS","81272 - HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS",660,602.11,159,3195.92,165]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 81272","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 81272","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 81272 - HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","81272","HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS","81272 - HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS",660,711.41,159,3195.92,165]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 81274","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 81274","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 81274 - HC HTT GENE ANALYSIS CHARACTERIZATION ALLELES","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","81274","HC HTT GENE ANALYSIS CHARACTERIZATION ALLELES","81274 - HC HTT GENE ANALYSIS CHARACTERIZATION ALLELES",175,478.2,205.22,2665.65,43.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 81275","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 81275","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 81275 - HC CHG KRAS GENE ANALYSIS VARIANTS IN EXON 2","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","81275","HC CHG KRAS GENE ANALYSIS VARIANTS IN EXON 2","81275 - HC CHG KRAS GENE ANALYSIS VARIANTS IN EXON 2",534,427.06,142.78,1874.37,133.5]
["FALLON - FALLON SENIOR PLAN - CPT - 81276","FALLON - FALLON SENIOR PLAN - 81276","FALLON - FALLON SENIOR PLAN - 81276 - HC CHG KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)","FALLON","FALLON SENIOR PLAN","CPT","81276","HC CHG KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)","81276 - HC CHG KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)",3198,193.25,142.78,1874.37,799.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 81288","BLUE CROSS - BLUE CROSS-PPO - 81288","BLUE CROSS - BLUE CROSS-PPO - 81288 - MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS","BLUE CROSS","BLUE CROSS-PPO","CPT","81288","MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS","81288 - MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS",1882,351.77,142.1,1865.32,470.5]
["FALLON - FALLON SENIOR PLAN - CPT - 81288","FALLON - FALLON SENIOR PLAN - 81288","FALLON - FALLON SENIOR PLAN - 81288 - MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS","FALLON","FALLON SENIOR PLAN","CPT","81288","MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS","81288 - MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS",1882,192.32,142.1,1865.32,470.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 81291","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 81291","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 81291 - HC CHG MTHFR GENE ANALYSIS COMMON VARIANTS","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","81291","HC CHG MTHFR GENE ANALYSIS COMMON VARIANTS","81291 - HC CHG MTHFR GENE ANALYSIS COMMON VARIANTS",434,28.414999999999999,48.28,633.76,108.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 81301","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 81301","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 81301 - HC CHG MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","81301","HC CHG MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF","81301 - HC CHG MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF",534,653.49,264.13,3380.71,133.5]
["FALLON - FALLON SENIOR PLAN - CPT - 81302","FALLON - FALLON SENIOR PLAN - 81302","FALLON - FALLON SENIOR PLAN - 81302 - HC Q;RETT SYN ANLY","FALLON","FALLON SENIOR PLAN","CPT","81302","HC Q;RETT SYN ANLY","81302 - HC Q;RETT SYN ANLY",559,527.87,527.87,1328.23,139.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 81305","BMC HEALTHNET - BMCHN ACO - 81305","BMC HEALTHNET - BMCHN ACO - 81305 - HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT","BMC HEALTHNET","BMCHN ACO","CPT","81305","HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT","81305 - HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT",223,143.28,130.97,1701.28,55.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 81305","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 81305","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 81305 - HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","81305","HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT","81305 - HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT",223,378.69,130.97,1701.28,55.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 81308","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 81308","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 81308 - HC PALB2 GENE KNOWN FAMIL VRNT","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","81308","HC PALB2 GENE KNOWN FAMIL VRNT","81308 - HC PALB2 GENE KNOWN FAMIL VRNT",223,346.55,301.35000000000002,1610.68,55.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 81308","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 81308","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 81308 - HC PALB2 GENE KNOWN FAMIL VRNT","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","81308","HC PALB2 GENE KNOWN FAMIL VRNT","81308 - HC PALB2 GENE KNOWN FAMIL VRNT",223,361.62,301.35000000000002,1610.68,55.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 81311","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 81311","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 81311 - HC CHG NRAS GENE ANALYSIS VARIANTS IN EXON 2&3","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT","81311","HC CHG NRAS GENE ANALYSIS VARIANTS IN EXON 2&3","81311 - HC CHG NRAS GENE ANALYSIS VARIANTS IN EXON 2&3",4795,295.79000000000002,218.55,2868.9,1198.75]
["TUFTS - TUFTS SELECT - CPT - 81315","TUFTS - TUFTS SELECT - 81315","TUFTS - TUFTS SELECT - 81315 - HC PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT","TUFTS","TUFTS SELECT","CPT","81315","HC PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT","81315 - HC PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT",675,361.44,189.1,2327.29,168.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 81329","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 81329","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 81329 - HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","81329","HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS","81329 - HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS",174,344.72,102.3,1328.77,43.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81331","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 81331","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 81331 - HC PRADER-WILLI/ANGELMAN","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","81331","HC PRADER-WILLI/ANGELMAN","81331 - HC PRADER-WILLI/ANGELMAN",301,0,51.07,128.5,75.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 81350","AETNA - AETNA-MEDICARE ADVANTAGE - 81350","AETNA - AETNA-MEDICARE ADVANTAGE - 81350 - HC CHG UGT1A1 GENE ANALYSIS COMMON VARIANTS","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","81350","HC CHG UGT1A1 GENE ANALYSIS COMMON VARIANTS","81350 - HC CHG UGT1A1 GENE ANALYSIS COMMON VARIANTS",815,276.12,234,588.79,203.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 81350","BMC HEALTHNET - BMCHN QHP - 81350","BMC HEALTHNET - BMCHN QHP - 81350 - HC CHG UGT1A1 GENE ANALYSIS COMMON VARIANTS","BMC HEALTHNET","BMCHN QHP","CPT","81350","HC CHG UGT1A1 GENE ANALYSIS COMMON VARIANTS","81350 - HC CHG UGT1A1 GENE ANALYSIS COMMON VARIANTS",815,0,234,588.79,203.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81363","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 81363","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 81363 - HC HBB DUPLICATION/DELETION VARIANTS","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","81363","HC HBB DUPLICATION/DELETION VARIANTS","81363 - HC HBB DUPLICATION/DELETION VARIANTS",455,179.45,149.54,1963.05,113.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 81364","BMC HEALTHNET - BMCHN MCO - 81364","BMC HEALTHNET - BMCHN MCO - 81364 - HC HBB FULL GENE SEQUENCE","BMC HEALTHNET","BMCHN MCO","CPT","81364","HC HBB FULL GENE SEQUENCE","81364 - HC HBB FULL GENE SEQUENCE",629,239.82,239.82,3148.12,157.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 81401","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 81401","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 81401 - HC CHG, MOLECULAR PATHOLOGY PROCEDURE LEVEL 2","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","81401","HC CHG, MOLECULAR PATHOLOGY PROCEDURE LEVEL 2","81401 - HC CHG, MOLECULAR PATHOLOGY PROCEDURE LEVEL 2",678,0,137,344.72,169.5]
["BMC HEALTHNET - BMCHN MCO - CPT - 81403","BMC HEALTHNET - BMCHN MCO - 81403","BMC HEALTHNET - BMCHN MCO - 81403 - SEQ & EXON 13 SEQ, IF PERFORMED KRAS (EG, CARCINOMA), GENE ANALYSIS, PRO/TECH","BMC HEALTHNET","BMCHN MCO","CPT","81403","SEQ & EXON 13 SEQ, IF PERFORMED KRAS (EG, CARCINOMA), GENE ANALYSIS, PRO/TECH","81403 - SEQ & EXON 13 SEQ, IF PERFORMED KRAS (EG, CARCINOMA), GENE ANALYSIS, PRO/TECH",659,0,185.2,466,164.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 81403","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 81403","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 81403 - SEQ & EXON 13 SEQ, IF PERFORMED KRAS (EG, CARCINOMA), GENE ANALYSIS, PRO/TECH","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","81403","SEQ & EXON 13 SEQ, IF PERFORMED KRAS (EG, CARCINOMA), GENE ANALYSIS, PRO/TECH","81403 - SEQ & EXON 13 SEQ, IF PERFORMED KRAS (EG, CARCINOMA), GENE ANALYSIS, PRO/TECH",659,222.24,185.2,466,164.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 81405","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 81405","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 81405 - HC MOPATH PROCEDURE LEVEL 6","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","81405","HC MOPATH PROCEDURE LEVEL 6","81405 - HC MOPATH PROCEDURE LEVEL 6",629,0,301.35000000000002,758.26,157.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 81405","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 81405","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 81405 - HC MOPATH PROCEDURE LEVEL 6","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","81405","HC MOPATH PROCEDURE LEVEL 6","81405 - HC MOPATH PROCEDURE LEVEL 6",629,650.61,301.35000000000002,758.26,157.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 81430","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 81430","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 81430 - HC CHG HEARING LOSS GENOMIC SEQUENCE ANALYSIS 60 GENES","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT","81430","HC CHG HEARING LOSS GENOMIC SEQUENCE ANALYSIS 60 GENES","81430 - HC CHG HEARING LOSS GENOMIC SEQUENCE ANALYSIS 60 GENES",2063,1625,1625,15761.12,515.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 81431","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 81431","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 81431 - HC CHG HEARING LOSS DUP/DEL ANALYSIS","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","81431","HC CHG HEARING LOSS DUP/DEL ANALYSIS","81431 - HC CHG HEARING LOSS DUP/DEL ANALYSIS",863,295.49,679.57,6591.3,215.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 81450","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 81450","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 81450 - HC CHG GENOMIC SEQ ANALYS DNA&RNA ANALYS 5-50 GENE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","81450","HC CHG GENOMIC SEQ ANALYS DNA&RNA ANALYS 5-50 GENE","81450 - HC CHG GENOMIC SEQ ANALYS DNA&RNA ANALYS 5-50 GENE",2132,1388.66,561.19000000000005,7366.77,533]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 81522","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 81522","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 81522 - HC ONC BREAST MRNA 12 GENES","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","81522","HC ONC BREAST MRNA 12 GENES","81522 - HC ONC BREAST MRNA 12 GENES",92,4453.95,3873,20700.3,23]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 81522","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 81522","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 81522 - HC ONC BREAST MRNA 12 GENES","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT","81522","HC ONC BREAST MRNA 12 GENES","81522 - HC ONC BREAST MRNA 12 GENES",92,5221.58,3873,20700.3,23]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 81596","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 81596","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 81596 - HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","81596","HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR","81596 - HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR",92,155.86000000000001,53.9,700.23,23]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 82009","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 82009","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 82009 - HC CHG KETONE BODIES SERUM QUALITATIVE","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","82009","HC CHG KETONE BODIES SERUM QUALITATIVE","82009 - HC CHG KETONE BODIES SERUM QUALITATIVE",24,4.9400000000000004,4.12,50.7,6]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 82010","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 82010","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 82010 - HC CHG KETONE BODIES SERUM QUANTITATIVE","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","82010","HC CHG KETONE BODIES SERUM QUANTITATIVE","82010 - HC CHG KETONE BODIES SERUM QUANTITATIVE",40,18.05,7.46,91.78,10]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 82017","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 82017","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 82017 - HC CHG ACYLCARNITINES QUANTIATIVE EACH SPECIMEN","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","82017","HC CHG ACYLCARNITINES QUANTIATIVE EACH SPECIMEN","82017 - HC CHG ACYLCARNITINES QUANTIATIVE EACH SPECIMEN",83,16.87,14.65,189.43,20.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 82024","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 82024","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 82024 - HC CHG ADRENOCORTICOTROPIC HORMONE ACTH","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","82024","HC CHG ADRENOCORTICOTROPIC HORMONE ACTH","82024 - HC CHG ADRENOCORTICOTROPIC HORMONE ACTH",185,67.2,35.229999999999997,433.56,46.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 82040","AETNA - AETNA-MEDICARE ADVANTAGE - 82040","AETNA - AETNA-MEDICARE ADVANTAGE - 82040 - HC CHG ALBUMIN SERUM PLASMA/WHOLE BLOOD","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","82040","HC CHG ALBUMIN SERUM PLASMA/WHOLE BLOOD","82040 - HC CHG ALBUMIN SERUM PLASMA/WHOLE BLOOD",26,5.84,4.51,55.55,6.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 82042","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 82042","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 82042 - HC CHG ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","82042","HC CHG ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN","82042 - HC CHG ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN",26,14.49,5.75,75.44,6.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 82043","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 82043","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 82043 - HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","82043","HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE","82043 - HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE",27,13.18,5.28,64.88,6.75]
["TUFTS - TUFTS SPIRIT - CPT - 82043","TUFTS - TUFTS SPIRIT - 82043","TUFTS - TUFTS SPIRIT - 82043 - HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE","TUFTS","TUFTS SPIRIT","CPT","82043","HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE","82043 - HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE",27,6.36,5.28,64.88,6.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 82075","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 82075","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 82075 - HC CHG ASSAY OF ALCOHOL BREATH","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","82075","HC CHG ASSAY OF ALCOHOL BREATH","82075 - HC CHG ASSAY OF ALCOHOL BREATH",86,63.18,16.53,291,21.5]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 82085","BMC HEALTHNET - BMCHN WELL SENSE - 82085","BMC HEALTHNET - BMCHN WELL SENSE - 82085 - HC CHG ASSAY OF ALDOLASE","BMC HEALTHNET","BMCHN WELL SENSE","CPT","82085","HC CHG ASSAY OF ALDOLASE","82085 - HC CHG ASSAY OF ALDOLASE",48,19.18,8.86,109.06,12]
["FALLON - FALLON SENIOR PLAN - CPT - 82088","FALLON - FALLON SENIOR PLAN - 82088","FALLON - FALLON SENIOR PLAN - 82088 - HC CHG ASSAY OF ALDOSTERONE","FALLON","FALLON SENIOR PLAN","CPT","82088","HC CHG ASSAY OF ALDOSTERONE","82088 - HC CHG ASSAY OF ALDOSTERONE",196,40.75,37.17,457.49,49]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 82088","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 82088","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 82088 - HC CHG ASSAY OF ALDOSTERONE","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","82088","HC CHG ASSAY OF ALDOSTERONE","82088 - HC CHG ASSAY OF ALDOSTERONE",196,44.6,37.17,457.49,49]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 82104","BLUE CROSS - BLUE CROSS-INDEMNITY - 82104","BLUE CROSS - BLUE CROSS-INDEMNITY - 82104 - HC CHG ALPHA-1-ANTITRYPSIN PHENOTYPE","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","82104","HC CHG ALPHA-1-ANTITRYPSIN PHENOTYPE","82104 - HC CHG ALPHA-1-ANTITRYPSIN PHENOTYPE",64,32.94,13.2,162.37,16]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 82105","BMC HEALTHNET - BMCHN MEDICAID - 82105","BMC HEALTHNET - BMCHN MEDICAID - 82105 - HC CHG ALPHA-FETOPROTEIN SERUM","BMC HEALTHNET","BMCHN MEDICAID","CPT","82105","HC CHG ALPHA-FETOPROTEIN SERUM","82105 - HC CHG ALPHA-FETOPROTEIN SERUM",84,15.3,15.3,188.33,21]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 82105","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 82105","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 82105 - HC CHG ALPHA-FETOPROTEIN SERUM","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT","82105","HC CHG ALPHA-FETOPROTEIN SERUM","82105 - HC CHG ALPHA-FETOPROTEIN SERUM",84,23.13,15.3,188.33,21]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 82139","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 82139","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 82139 - HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","82139","HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE","82139 - HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE",98,20.239999999999998,14.65,189.43,24.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 82140","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 82140","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 82140 - HC CHG ASSAY OF AMMONIA","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","82140","HC CHG ASSAY OF AMMONIA","82140 - HC CHG ASSAY OF AMMONIA",72,32.94,13.29,163.55000000000001,18]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 82150","ELDER SERVICE PLAN - ELEMENT CARE INC - 82150","ELDER SERVICE PLAN - ELEMENT CARE INC - 82150 - HC CHG ASSAY OF AMYLASE","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","82150","HC CHG ASSAY OF AMYLASE","82150 - HC CHG ASSAY OF AMYLASE",33,6.48,5.91,72.75,8.25]
["TUFTS - TUFTS HMO - CPT - 82157","TUFTS - TUFTS HMO - 82157","TUFTS - TUFTS HMO - 82157 - HC CHG ANDROSTENEDIONE","TUFTS","TUFTS HMO","CPT","82157","HC CHG ANDROSTENEDIONE","82157 - HC CHG ANDROSTENEDIONE",141,131.16,26.7,328.66,35.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 82164","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 82164","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 82164 - HC CHG ANGIOTENSIN I-CONVERTING ENZYME","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","82164","HC CHG ANGIOTENSIN I-CONVERTING ENZYME","82164 - HC CHG ANGIOTENSIN I-CONVERTING ENZYME",71,15.72,13.32,163.96,17.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 82172","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 82172","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 82172 - HC CHG APOLIPOPROTEIN EACH","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","82172","HC CHG APOLIPOPROTEIN EACH","82172 - HC CHG APOLIPOPROTEIN EACH",146,38.869999999999997,15.58,204.55,36.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 82172","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 82172","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 82172 - HC CHG APOLIPOPROTEIN EACH","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","82172","HC CHG APOLIPOPROTEIN EACH","82172 - HC CHG APOLIPOPROTEIN EACH",146,25.31,15.58,204.55,36.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 82175","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 82175","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 82175 - HC CHG ASSAY OF ARSENIC","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","82175","HC CHG ASSAY OF ARSENIC","82175 - HC CHG ASSAY OF ARSENIC",92,20.36,17.3,212.95,23]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 82180","UNITED HEALTHCARE - UNITED HEALTHCARE - 82180","UNITED HEALTHCARE - UNITED HEALTHCARE - 82180 - HC CHG ASSAY OF ASCORBIC ACID BLOOD","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","82180","HC CHG ASSAY OF ASCORBIC ACID BLOOD","82180 - HC CHG ASSAY OF ASCORBIC ACID BLOOD",49,20.83,9.01,110.9,12.25]
["BMC HEALTHNET - BMCHN MCO - CPT - 82232","BMC HEALTHNET - BMCHN MCO - 82232","BMC HEALTHNET - BMCHN MCO - 82232 - HC CHG BETA-2 MICROGLOBULIN","BMC HEALTHNET","BMCHN MCO","CPT","82232","HC CHG BETA-2 MICROGLOBULIN","82232 - HC CHG BETA-2 MICROGLOBULIN",81,14.76,14.76,181.61,20.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 82247","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 82247","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 82247 - HC CHG BILIRUBIN TOTAL","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","82247","HC CHG BILIRUBIN TOTAL","82247 - HC CHG BILIRUBIN TOTAL",26,13.36,4.57,56.28,6.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 82247","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 82247","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 82247 - HC CHG BILIRUBIN TOTAL","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","82247","HC CHG BILIRUBIN TOTAL","82247 - HC CHG BILIRUBIN TOTAL",26,6.02,4.57,56.28,6.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 82270","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 82270","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 82270 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","82270","HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER","82270 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER",17,11.02,3.24,42.47,4.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 82270","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 82270","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 82270 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT","82270","HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER","82270 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER",17,4.9000000000000004,3.24,42.47,4.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82271","TUFTS - TUFTS MEDICARE PREFERRED HMO - 82271","TUFTS - TUFTS MEDICARE PREFERRED HMO - 82271 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","82271","HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES","82271 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES",15,7.71,3.93,51.64,3.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 82274","UNITED HEALTHCARE - UNITED HEALTHCARE - 82274","UNITED HEALTHCARE - UNITED HEALTHCARE - 82274 - HC CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","82274","HC CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3","82274 - HC CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3",159,33.53,14.51,178.59,39.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 82306","BMC HEALTHNET - BMCHN MCO - 82306","BMC HEALTHNET - BMCHN MCO - 82306 - HC CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED","BMC HEALTHNET","BMCHN MCO","CPT","82306","HC CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED","82306 - HC CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED",146,27.01,27.01,332.37,36.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 82308","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - 82308","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - 82308 - HC CHG CALCITONIN","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","82308","HC CHG CALCITONIN","82308 - HC CHG CALCITONIN",128,36.75,24.44,300.82,32]
["TUFTS - TUFTS SELECT - CPT - 82310","TUFTS - TUFTS SELECT - 82310","TUFTS - TUFTS SELECT - 82310 - HC CHG CALCIUM TOTAL","TUFTS","TUFTS SELECT","CPT","82310","HC CHG CALCIUM TOTAL","82310 - HC CHG CALCIUM TOTAL",26,8.99,4.71,57.87,6.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 82330","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 82330","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 82330 - HC CHG CALCIUM IONIZED","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","82330","HC CHG CALCIUM IONIZED","82330 - HC CHG CALCIUM IONIZED",69,16.920000000000002,12.47,153.49,17.25]
["BMC HEALTHNET - BMCHN QHP - CPT - 82340","BMC HEALTHNET - BMCHN QHP - 82340","BMC HEALTHNET - BMCHN QHP - 82340 - HC Q;KID STONE, UR CALCIUM","BMC HEALTHNET","BMCHN QHP","CPT","82340","HC Q;KID STONE, UR CALCIUM","82340 - HC Q;KID STONE, UR CALCIUM",31,6.6,5.5,67.7,7.75]
["CIGNA HEALTHCARE - CIGNA - CPT - 82365","CIGNA HEALTHCARE - CIGNA - 82365","CIGNA HEALTHCARE - CIGNA - 82365 - HC CHG CALCULUS INFRARED SPECTROSCOPY","CIGNA HEALTHCARE","CIGNA","CPT","82365","HC CHG CALCULUS INFRARED SPECTROSCOPY","82365 - HC CHG CALCULUS INFRARED SPECTROSCOPY",120,58.12,11.76,144.81,30]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 82365","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 82365","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 82365 - HC CHG CALCULUS INFRARED SPECTROSCOPY","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT","82365","HC CHG CALCULUS INFRARED SPECTROSCOPY","82365 - HC CHG CALCULUS INFRARED SPECTROSCOPY",120,17.39,11.76,144.81,30]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 82375","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 82375","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 82375 - HC CHG CARBOXYHEMOGLOBIN QUANTITATIVE","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","82375","HC CHG CARBOXYHEMOGLOBIN QUANTITATIVE","82375 - HC CHG CARBOXYHEMOGLOBIN QUANTITATIVE",62,27.67,11.24,138.29,15.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 82375","CIGNA HEALTHCARE - CIGNA CARELINK - 82375","CIGNA HEALTHCARE - CIGNA CARELINK - 82375 - HC CHG CARBOXYHEMOGLOBIN QUANTITATIVE","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","82375","HC CHG CARBOXYHEMOGLOBIN QUANTITATIVE","82375 - HC CHG CARBOXYHEMOGLOBIN QUANTITATIVE",62,138.29,11.24,138.29,15.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82378","TUFTS - TUFTS MEDICARE PREFERRED HMO - 82378","TUFTS - TUFTS MEDICARE PREFERRED HMO - 82378 - HC CHG CARCINOEMBRYONIC ANTIGEN CEA","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","82378","HC CHG CARCINOEMBRYONIC ANTIGEN CEA","82378 - HC CHG CARCINOEMBRYONIC ANTIGEN CEA",95,27.49,17.3,212.87,23.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 82379","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 82379","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 82379 - HC CRL;CARNITINE","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","82379","HC CRL;CARNITINE","82379 - HC CRL;CARNITINE",52,18.47,14.65,189.43,13]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 82384","BLUE CROSS - BLUE CROSS-PPO - 82384","BLUE CROSS - BLUE CROSS-PPO - 82384 - HC CHG CATECHOLAMINES FRACTIONATED","BLUE CROSS","BLUE CROSS-PPO","CPT","82384","HC CHG CATECHOLAMINES FRACTIONATED","82384 - HC CHG CATECHOLAMINES FRACTIONATED",122,57.32,23.04,283.54000000000002,30.5]
["BMC HEALTHNET - BMCHN QHP - CPT - 82390","BMC HEALTHNET - BMCHN QHP - 82390","BMC HEALTHNET - BMCHN QHP - 82390 - HC CHG CERULOPLASMIN","BMC HEALTHNET","BMCHN QHP","CPT","82390","HC CHG CERULOPLASMIN","82390 - HC CHG CERULOPLASMIN",52,11.76,9.8000000000000007,120.52,13]
["TUFTS - TUFTS PPO - CPT - 82390","TUFTS - TUFTS PPO - 82390","TUFTS - TUFTS PPO - 82390 - HC CHG CERULOPLASMIN","TUFTS","TUFTS PPO","CPT","82390","HC CHG CERULOPLASMIN","82390 - HC CHG CERULOPLASMIN",52,42.88,9.8000000000000007,120.52,13]
["UNICARE - UNICARE - CPT - 82397","UNICARE - UNICARE - 82397","UNICARE - UNICARE - 82397 - HC CHEMILUMINESCENT ASSAY","UNICARE","UNICARE","CPT","82397","HC CHEMILUMINESCENT ASSAY","82397 - HC CHEMILUMINESCENT ASSAY",718,25.96,12.88,158.54,179.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 82436","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 82436","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 82436 - HC CHG CHLORIDE URINE","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","82436","HC CHG CHLORIDE URINE","82436 - HC CHG CHLORIDE URINE",26,11.2,4.59,56.85,6.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 82436","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 82436","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 82436 - HC CHG CHLORIDE URINE","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT","82436","HC CHG CHLORIDE URINE","82436 - HC CHG CHLORIDE URINE",26,5.75,4.59,56.85,6.5]
["TUFTS - TUFTS SPIRIT - CPT - 82438","TUFTS - TUFTS SPIRIT - 82438","TUFTS - TUFTS SPIRIT - 82438 - HC CHG CHLORIDE OTHER SOURCE","TUFTS","TUFTS SPIRIT","CPT","82438","HC CHG CHLORIDE OTHER SOURCE","82438 - HC CHG CHLORIDE OTHER SOURCE",25,5.5,4.46,54.82,6.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 82465","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 82465","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 82465 - CHOLESTEROL SERUM/WHOLE BLOOD TOTAL","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","82465","CHOLESTEROL SERUM/WHOLE BLOOD TOTAL","82465 - CHOLESTEROL SERUM/WHOLE BLOOD TOTAL",23,9.8800000000000008,3.97,48.83,5.75]
["CIGNA HEALTHCARE - CIGNA - CPT - 82495","CIGNA HEALTHCARE - CIGNA - 82495","CIGNA HEALTHCARE - CIGNA - 82495 - HC CHG ASSAY OF CHROMIUM","CIGNA HEALTHCARE","CIGNA","CPT","82495","HC CHG ASSAY OF CHROMIUM","82495 - HC CHG ASSAY OF CHROMIUM",98,91.37,18.5,227.7,24.5]
["FALLON - FALLON MEDICAID - CPT - 82507","FALLON - FALLON MEDICAID - 82507","FALLON - FALLON MEDICAID - 82507 - HC CHG ASSAY OF CITRATE","FALLON","FALLON MEDICAID","CPT","82507","HC CHG ASSAY OF CITRATE","82507 - HC CHG ASSAY OF CITRATE",134,25.37,25.37,312.11,33.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 82507","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 82507","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 82507 - HC CHG ASSAY OF CITRATE","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT","82507","HC CHG ASSAY OF CITRATE","82507 - HC CHG ASSAY OF CITRATE",134,38.36,25.37,312.11,33.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 82525","BLUE CROSS - BLUE CROSS-HMO BLUE - 82525","BLUE CROSS - BLUE CROSS-HMO BLUE - 82525 - HC CHG ASSAY OF COPPER","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","82525","HC CHG ASSAY OF COPPER","82525 - HC CHG ASSAY OF COPPER",62,28.32,11.32,139.30000000000001,15.5]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 82525","CIGNA HEALTHCARE - CIGNA PPO - 82525","CIGNA HEALTHCARE - CIGNA PPO - 82525 - HC CHG ASSAY OF COPPER","CIGNA HEALTHCARE","CIGNA PPO","CPT","82525","HC CHG ASSAY OF COPPER","82525 - HC CHG ASSAY OF COPPER",62,31.56,11.32,139.30000000000001,15.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 82530","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - 82530","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - 82530 - HC CHG CORTISOL FREE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","82530","HC CHG CORTISOL FREE","82530 - HC CHG CORTISOL FREE",82,36.08,15.24,187.56,20.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 82533","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 82533","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 82533 - HC CHG CORTISOL TOTAL","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","82533","HC CHG CORTISOL TOTAL","82533 - HC CHG CORTISOL TOTAL",82,19.559999999999999,14.87,182.99,20.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 82540","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 82540","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 82540 - HC CHG ASSAY OF CREATINE","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","82540","HC CHG ASSAY OF CREATINE","82540 - HC CHG ASSAY OF CREATINE",23,10.55,4.2300000000000004,52,5.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 82540","UNITED HEALTHCARE - UNITED HEALTHCARE - 82540","UNITED HEALTHCARE - UNITED HEALTHCARE - 82540 - HC CHG ASSAY OF CREATINE","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","82540","HC CHG ASSAY OF CREATINE","82540 - HC CHG ASSAY OF CREATINE",23,9.77,4.2300000000000004,52,5.75]
["TUFTS - TUFTS SELECT - CPT - 82542","TUFTS - TUFTS SELECT - 82542","TUFTS - TUFTS SELECT - 82542 - HC CHG COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC","TUFTS","TUFTS SELECT","CPT","82542","HC CHG COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC","82542 - HC CHG COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC",926,36.29,17.8,233.69,231.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 82550","UNICARE - UNICARE STATE INDEMNITY PLAN - 82550","UNICARE - UNICARE STATE INDEMNITY PLAN - 82550 - HC CHG CREATINE KINASE TOTAL","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","82550","HC CHG CREATINE KINASE TOTAL","82550 - HC CHG CREATINE KINASE TOTAL",33,13.17,5.94,73.12,8.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 82565","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 82565","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 82565 - HC CHG CREATININE BLOOD","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","82565","HC CHG CREATININE BLOOD","82565 - HC CHG CREATININE BLOOD",26,11.86,4.68,57.51,6.5]
["FALLON - FALLON MEDICAID - CPT - 82565","FALLON - FALLON MEDICAID - 82565","FALLON - FALLON MEDICAID - 82565 - HC CHG CREATININE BLOOD","FALLON","FALLON MEDICAID","CPT","82565","HC CHG CREATININE BLOOD","82565 - HC CHG CREATININE BLOOD",26,4.68,4.68,57.51,6.5]
["TUFTS - TUFTS POS - CPT - 82570","TUFTS - TUFTS POS - 82570","TUFTS - TUFTS POS - 82570 - HC CHG CREATININE OTHER SOURCE","TUFTS","TUFTS POS","CPT","82570","HC CHG CREATININE OTHER SOURCE","82570 - HC CHG CREATININE OTHER SOURCE",26,19.309999999999999,4.72,58.08,6.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 82575","BLUE CROSS - BLUE CROSS-HMO BLUE - 82575","BLUE CROSS - BLUE CROSS-HMO BLUE - 82575 - HC CHG CREATININE CLEARANCE","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","82575","HC CHG CREATININE CLEARANCE","82575 - HC CHG CREATININE CLEARANCE",48,21.08,8.6199999999999992,106.17,12]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 82575","UNICARE - UNICARE STATE INDEMNITY PLAN - 82575","UNICARE - UNICARE STATE INDEMNITY PLAN - 82575 - HC CHG CREATININE CLEARANCE","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","82575","HC CHG CREATININE CLEARANCE","82575 - HC CHG CREATININE CLEARANCE",48,19.11,8.6199999999999992,106.17,12]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 82595","ELDER SERVICE PLAN - ELEMENT CARE INC - 82595","ELDER SERVICE PLAN - ELEMENT CARE INC - 82595 - HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","82595","HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE","82595 - HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE",33,6.47,5.9,72.55,8.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 82595","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 82595","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 82595 - HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","82595","HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE","82595 - HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE",33,7.08,5.9,72.55,8.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 82626","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 82626","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 82626 - HC CHG DEHYDROEPIANDROSTERONE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","82626","HC CHG DEHYDROEPIANDROSTERONE","82626 - HC CHG DEHYDROEPIANDROSTERONE",122,27.2,23.05,283.74,30.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 82626","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 82626","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 82626 - HC CHG DEHYDROEPIANDROSTERONE","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","82626","HC CHG DEHYDROEPIANDROSTERONE","82626 - HC CHG DEHYDROEPIANDROSTERONE",122,25.27,23.05,283.74,30.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 82627","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 82627","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 82627 - HC CHG DEHYDROEPIANDROSTERONE-SULFATE","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","82627","HC CHG DEHYDROEPIANDROSTERONE-SULFATE","82627 - HC CHG DEHYDROEPIANDROSTERONE-SULFATE",110,38.68,20.28,249.67,27.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 82652","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 82652","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 82652 - HC CHG 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT","82652","HC CHG 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED","82652 - HC CHG 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED",191,51.91,35.119999999999997,432.18,47.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 82656","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 82656","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 82656 - HC CHG ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","82656","HC CHG ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN","82656 - HC CHG ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN",55,12.38,10.52,129.47999999999999,13.75]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 82657","CIGNA HEALTHCARE - CIGNA PPO - 82657","CIGNA HEALTHCARE - CIGNA PPO - 82657 - HC CHG NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA","CIGNA HEALTHCARE","CIGNA PPO","CPT","82657","HC CHG NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA","82657 - HC CHG NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA",1263,45.93,16.47,215.03,315.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 82657","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 82657","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 82657 - HC CHG NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT","82657","HC CHG NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA","82657 - HC CHG NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA",1263,29.89,16.47,215.03,315.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 82668","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 82668","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 82668 - HC CHG ASSAY OF ERYTHROPOIETIN","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","82668","HC CHG ASSAY OF ERYTHROPOIETIN","82668 - HC CHG ASSAY OF ERYTHROPOIETIN",91,45.08,17.14,210.99,22.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 82677","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 82677","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 82677 - HC CHG ASSAY OF ESTRIOL","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","82677","HC CHG ASSAY OF ESTRIOL","82677 - HC CHG ASSAY OF ESTRIOL",90,54.68,22.05,271.39,22.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 82677","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 82677","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 82677 - HC CHG ASSAY OF ESTRIOL","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","82677","HC CHG ASSAY OF ESTRIOL","82677 - HC CHG ASSAY OF ESTRIOL",90,58.01,22.05,271.39,22.5]
["TUFTS - TUFTS SPIRIT - CPT - 82693","TUFTS - TUFTS SPIRIT - 82693","TUFTS - TUFTS SPIRIT - 82693 - HC CHG ASSAY OF ETHYLENE GLYCOL","TUFTS","TUFTS SPIRIT","CPT","82693","HC CHG ASSAY OF ETHYLENE GLYCOL","82693 - HC CHG ASSAY OF ETHYLENE GLYCOL",72,16.39,13.59,167.3,18]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 82705","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 82705","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 82705 - HC CHG FAT/LIPIDS FECES QUALITATIVE","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","82705","HC CHG FAT/LIPIDS FECES QUALITATIVE","82705 - HC CHG FAT/LIPIDS FECES QUALITATIVE",25,11.92,4.6500000000000004,57.22,6.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 82728","CIGNA HEALTHCARE - CIGNA CARELINK - 82728","CIGNA HEALTHCARE - CIGNA CARELINK - 82728 - HC CHG ASSAY OF FERRITIN","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","82728","HC CHG ASSAY OF FERRITIN","82728 - HC CHG ASSAY OF FERRITIN",67,153.04,12.43,153.04,16.75]
["FALLON - FALLON MEDICAID - CPT - 82731","FALLON - FALLON MEDICAID - 82731","FALLON - FALLON MEDICAID - 82731 - HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN","FALLON","FALLON MEDICAID","CPT","82731","HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN","82731 - HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN",318,58.75,28.7,723.09,79.5]
["UNICARE - UNICARE - CPT - 82731","UNICARE - UNICARE - 82731","UNICARE - UNICARE - 82731 - HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN","UNICARE","UNICARE","CPT","82731","HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN","82731 - HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN",318,156.34,28.7,723.09,79.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 82747","BLUE CROSS - BLUE CROSS-HMO BLUE - 82747","BLUE CROSS - BLUE CROSS-HMO BLUE - 82747 - HC CHG ASSAY OF FOLIC ACID RBC","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","82747","HC CHG ASSAY OF FOLIC ACID RBC","82747 - HC CHG ASSAY OF FOLIC ACID RBC",76,38.869999999999997,15.8,194.37,19]
["BMC HEALTHNET - BMCHN MCO - CPT - 82784","BMC HEALTHNET - BMCHN MCO - 82784","BMC HEALTHNET - BMCHN MCO - 82784 - HC CHG ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH","BMC HEALTHNET","BMCHN MCO","CPT","82784","HC CHG ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH","82784 - HC CHG ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH",37,8.48,8.48,104.38,9.25]
["TUFTS - TUFTS MEDICARE SCO - CPT - 82784","TUFTS - TUFTS MEDICARE SCO - 82784","TUFTS - TUFTS MEDICARE SCO - 82784 - HC CHG ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH","TUFTS","TUFTS MEDICARE SCO","CPT","82784","HC CHG ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH","82784 - HC CHG ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH",37,13.49,8.48,104.38,9.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 82785","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 82785","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 82785 - HC CHG ASSAY OF GAMMAGLOBULIN IGE","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","82785","HC CHG ASSAY OF GAMMAGLOBULIN IGE","82785 - HC CHG ASSAY OF GAMMAGLOBULIN IGE",82,19.75,15.01,184.75,20.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 82787","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 82787","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 82787 - HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","82787","HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES","82787 - HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES",19,8.02,5.07,89.99,4.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 82803","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 82803","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 82803 - HC CHG BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","82803","HC CHG BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3","82803 - HC CHG BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3",97,26.07,19.260000000000002,252.81,24.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 82805","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 82805","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 82805 - HC CHG GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","82805","HC CHG GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY","82805 - HC CHG GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY",141,137.06,38.92,764.01,35.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 82810","AETNA - AETNA-MEDICARE ADVANTAGE - 82810","AETNA - AETNA-MEDICARE ADVANTAGE - 82810 - HC BLOOD GASSES O2 SAT ONLY","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","82810","HC BLOOD GASSES O2 SAT ONLY","82810 - HC BLOOD GASSES O2 SAT ONLY",52,11.53,7.96,98.14,13]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 82941","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 82941","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 82941 - HC CHG ASSAY OF GASTRIN","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","82941","HC CHG ASSAY OF GASTRIN","82941 - HC CHG ASSAY OF GASTRIN",85,39.53,16.079999999999998,197.91,21.25]
["FALLON - FALLON MEDICAID - CPT - 82941","FALLON - FALLON MEDICAID - 82941","FALLON - FALLON MEDICAID - 82941 - HC CHG ASSAY OF GASTRIN","FALLON","FALLON MEDICAID","CPT","82941","HC CHG ASSAY OF GASTRIN","82941 - HC CHG ASSAY OF GASTRIN",85,16.079999999999998,16.079999999999998,197.91,21.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 82945","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 82945","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 82945 - HC CHG GLUCOSE BODY FLUID OTHER THAN BLOOD","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","82945","HC CHG GLUCOSE BODY FLUID OTHER THAN BLOOD","82945 - HC CHG GLUCOSE BODY FLUID OTHER THAN BLOOD",21,4.21,3.58,44.06,5.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 82947","CIGNA HEALTHCARE - CIGNA CARELINK - 82947","CIGNA HEALTHCARE - CIGNA CARELINK - 82947 - HC CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","82947","HC CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP","82947 - HC CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP",21,44.06,3.58,44.06,5.25]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 82950","BMC HEALTHNET - BMCHN WELL SENSE - 82950","BMC HEALTHNET - BMCHN WELL SENSE - 82950 - HC CHG GLUCOSE POST GLUCOSE DOSE","BMC HEALTHNET","BMCHN WELL SENSE","CPT","82950","HC CHG GLUCOSE POST GLUCOSE DOSE","82950 - HC CHG GLUCOSE POST GLUCOSE DOSE",25,9.3800000000000008,4.33,53.31,6.25]
["FALLON - FALLON SENIOR PLAN - CPT - 82951","FALLON - FALLON SENIOR PLAN - 82951","FALLON - FALLON SENIOR PLAN - 82951 - HC CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS","FALLON","FALLON SENIOR PLAN","CPT","82951","HC CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS","82951 - HC CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS",64,12.87,11.74,144.52000000000001,16]
["TUFTS - TUFTS PPO - CPT - 82952","TUFTS - TUFTS PPO - 82952","TUFTS - TUFTS PPO - 82952 - HC CHG GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS","TUFTS","TUFTS PPO","CPT","82952","HC CHG GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS","82952 - HC CHG GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS",15,15.65,3.58,43.98,3.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 82960","BLUE CROSS - BLUE CROSS-INDEMNITY - 82960","BLUE CROSS - BLUE CROSS-INDEMNITY - 82960 - HC CHG GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","82960","HC CHG GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN","82960 - HC CHG GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN",29,13.83,5.52,67.86,7.25]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 82962","BMC HEALTHNET - BMCHN MEDICAID - 82962","BMC HEALTHNET - BMCHN MEDICAID - 82962 - HC GLUCOMETER - PHARM","BMC HEALTHNET","BMCHN MEDICAID","CPT","82962","HC GLUCOMETER - PHARM","82962 - HC GLUCOMETER - PHARM",12,1.21,2.42,31.83,3]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 82962","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 82962","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 82962 - HC GLUCOMETER - PHARM","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","82962","HC GLUCOMETER - PHARM","82962 - HC GLUCOMETER - PHARM",12,5.71,2.42,31.83,3]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 82977","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 82977","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 82977 - HC CHG ASSAY OF GGT","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","82977","HC CHG ASSAY OF GGT","82977 - HC CHG ASSAY OF GGT",36,8.64,6.57,80.86,9]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 82985","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 82985","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 82985 - HC CHG ASSAY OF GLYCATED PROTEIN","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","82985","HC CHG ASSAY OF GLYCATED PROTEIN","82985 - HC CHG ASSAY OF GLYCATED PROTEIN",73,16.5,13.75,169.26,18.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 83001","ELDER SERVICE PLAN - ELEMENT CARE INC - 83001","ELDER SERVICE PLAN - ELEMENT CARE INC - 83001 - HC CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","83001","HC CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE","83001 - HC CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE",93,18.579999999999998,16.95,208.59,23.25]
["TUFTS - TUFTS HMO - CPT - 83002","TUFTS - TUFTS HMO - 83002","TUFTS - TUFTS HMO - 83002 - HC CHG GONADOTROPIN LUTEINIZING HORMONE","TUFTS","TUFTS HMO","CPT","83002","HC CHG GONADOTROPIN LUTEINIZING HORMONE","83002 - HC CHG GONADOTROPIN LUTEINIZING HORMONE",93,82.95,16.89,207.81,23.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 83002","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 83002","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 83002 - HC CHG GONADOTROPIN LUTEINIZING HORMONE","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","83002","HC CHG GONADOTROPIN LUTEINIZING HORMONE","83002 - HC CHG GONADOTROPIN LUTEINIZING HORMONE",93,48.14,16.89,207.81,23.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 83010","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 83010","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 83010 - HC CHG ASSAY OF HAPTOGLOBIN, QUANT","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","83010","HC CHG ASSAY OF HAPTOGLOBIN, QUANT","83010 - HC CHG ASSAY OF HAPTOGLOBIN, QUANT",63,28.32,11.47,141.18,15.75]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 83013","CIGNA HEALTHCARE - CIGNA PPO - 83013","CIGNA HEALTHCARE - CIGNA PPO - 83013 - HC H PYLORI (C-13) BREATH","CIGNA HEALTHCARE","CIGNA PPO","CPT","83013","HC H PYLORI (C-13) BREATH","83013 - HC H PYLORI (C-13) BREATH",180,171.28,61.44,756.15,45]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 83013","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 83013","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 83013 - HC H PYLORI (C-13) BREATH","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT","83013","HC H PYLORI (C-13) BREATH","83013 - HC H PYLORI (C-13) BREATH",180,90.81,61.44,756.15,45]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 83014","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 83014","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 83014 - HC H PYLORI DRUG ADMIN","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT","83014","HC H PYLORI DRUG ADMIN","83014 - HC H PYLORI DRUG ADMIN",40,10.6,7.17,88.24,10]
["BMC HEALTHNET - BMCHN MCO - CPT - 83020","BMC HEALTHNET - BMCHN MCO - 83020","BMC HEALTHNET - BMCHN MCO - 83020 - HC CHG HEMOGLOBIN ELECTROPHORESIS","BMC HEALTHNET","BMCHN MCO","CPT","83020","HC CHG HEMOGLOBIN ELECTROPHORESIS","83020 - HC CHG HEMOGLOBIN ELECTROPHORESIS",63,11.74,11.74,144.52000000000001,15.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 83021","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 83021","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 83021 - HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","83021","HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY","83021 - HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY",91,43.31,16.47,202.68,22.75]
["TUFTS - TUFTS SELECT - CPT - 83030","TUFTS - TUFTS SELECT - 83030","TUFTS - TUFTS SELECT - 83030 - HC CHG HEMOGLOBIN F FETAL CHEMICAL","TUFTS","TUFTS SELECT","CPT","83030","HC CHG HEMOGLOBIN F FETAL CHEMICAL","83030 - HC CHG HEMOGLOBIN F FETAL CHEMICAL",42,16.18,7.94,104.21,10.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 83036","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 83036","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 83036 - HEMOGLOBIN GLYCOSYLATED A1C","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","83036","HEMOGLOBIN GLYCOSYLATED A1C","83036 - HEMOGLOBIN GLYCOSYLATED A1C",49,12.02,8.86,109.06,12.25]
["BMC HEALTHNET - BMCHN QHP - CPT - 83050","BMC HEALTHNET - BMCHN QHP - 83050","BMC HEALTHNET - BMCHN QHP - 83050 - HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE","BMC HEALTHNET","BMCHN QHP","CPT","83050","HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE","83050 - HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE",37,8.0299999999999994,6.69,82.45,9.25]
["TUFTS - TUFTS HMO - CPT - 83050","TUFTS - TUFTS HMO - 83050","TUFTS - TUFTS HMO - 83050 - HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE","TUFTS","TUFTS HMO","CPT","83050","HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE","83050 - HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE",37,32.9,6.69,82.45,9.25]
["UNICARE - UNICARE - CPT - 83070","UNICARE - UNICARE - 83070","UNICARE - UNICARE - 83070 - HC CHG ASSAY OF HEMOSIDERIN QUALITATIVE","UNICARE","UNICARE","CPT","83070","HC CHG ASSAY OF HEMOSIDERIN QUALITATIVE","83070 - HC CHG ASSAY OF HEMOSIDERIN QUALITATIVE",25,11.52,4.33,53.31,6.25]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 83090","CIGNA HEALTHCARE - CIGNA PPO - 83090","CIGNA HEALTHCARE - CIGNA PPO - 83090 - HC CHG ASSAY OF HOMOCYSTEINE","CIGNA HEALTHCARE","CIGNA PPO","CPT","83090","HC CHG ASSAY OF HOMOCYSTEINE","83090 - HC CHG ASSAY OF HOMOCYSTEINE",84,42.89,15.39,189.43,21]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 83497","CIGNA HEALTHCARE - CIGNA CARELINK - 83497","CIGNA HEALTHCARE - CIGNA CARELINK - 83497 - HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","83497","HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA","83497 - HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA",62,144.81,11.76,144.81,15.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 83498","TUFTS - TUFTS MEDICARE PREFERRED HMO - 83498","TUFTS - TUFTS MEDICARE PREFERRED HMO - 83498 - HC CHG ASSAY OF HYDROXYPROGESTERONE 17-D","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","83498","HC CHG ASSAY OF HYDROXYPROGESTERONE 17-D","83498 - HC CHG ASSAY OF HYDROXYPROGESTERONE 17-D",130,39.4,24.78,305.02,32.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 83498","UNITED HEALTHCARE - UNITED HEALTHCARE - 83498","UNITED HEALTHCARE - UNITED HEALTHCARE - 83498 - HC CHG ASSAY OF HYDROXYPROGESTERONE 17-D","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","83498","HC CHG ASSAY OF HYDROXYPROGESTERONE 17-D","83498 - HC CHG ASSAY OF HYDROXYPROGESTERONE 17-D",130,57.22,24.78,305.02,32.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 83519","BLUE CROSS - BLUE CROSS-PPO - 83519","BLUE CROSS - BLUE CROSS-PPO - 83519 - HC CHG IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","BLUE CROSS","BLUE CROSS-PPO","CPT","83519","HC CHG IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","83519 - HC CHG IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY",115,33.590000000000003,13.59,178.43,28.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 83520","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 83520","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 83520 - HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","83520","HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE","83520 - HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE",63,17.27,12.76,167.51,15.75]
["TUFTS - TUFTS SELECT - CPT - 83520","TUFTS - TUFTS SELECT - 83520","TUFTS - TUFTS SELECT - 83520 - HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE","TUFTS","TUFTS SELECT","CPT","83520","HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE","83520 - HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE",63,26.01,12.76,167.51,15.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 83540","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 83540","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 83540 - HC CHG ASSAY OF IRON","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","83540","HC CHG ASSAY OF IRON","83540 - HC CHG ASSAY OF IRON",33,14.49,5.9,72.63,8.25]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 83540","BMC HEALTHNET - BMCHN MEDICAID - 83540","BMC HEALTHNET - BMCHN MEDICAID - 83540 - HC CHG ASSAY OF IRON","BMC HEALTHNET","BMCHN MEDICAID","CPT","83540","HC CHG ASSAY OF IRON","83540 - HC CHG ASSAY OF IRON",33,5.9,5.9,72.63,8.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 83550","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 83550","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 83550 - HC CHG IRON BINDING CAPACITY","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT","83550","HC CHG IRON BINDING CAPACITY","83550 - HC CHG IRON BINDING CAPACITY",44,8.74,7.97,98.14,11]
["TUFTS - TUFTS SPIRIT - CPT - 83605","TUFTS - TUFTS SPIRIT - 83605","TUFTS - TUFTS SPIRIT - 83605 - HC CHG ASSAY OF LACTATE","TUFTS","TUFTS SPIRIT","CPT","83605","HC CHG ASSAY OF LACTATE","83605 - HC CHG ASSAY OF LACTATE",54,12.73,9.75,119.99,13.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 83615","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 83615","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 83615 - HC CHG LACTATE DEHYDROGENASE LDH","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","83615","HC CHG LACTATE DEHYDROGENASE LDH","83615 - HC CHG LACTATE DEHYDROGENASE LDH",31,13.83,5.5,67.78,7.75]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 83630","BMC HEALTHNET - BMCHN WELL SENSE - 83630","BMC HEALTHNET - BMCHN WELL SENSE - 83630 - HC CHG LACTOFERRIN FECAL QUALITATIVE","BMC HEALTHNET","BMCHN WELL SENSE","CPT","83630","HC CHG LACTOFERRIN FECAL QUALITATIVE","83630 - HC CHG LACTOFERRIN FECAL QUALITATIVE",112,28.31,17.91,220.45,28]
["TUFTS - TUFTS POS - CPT - 83630","TUFTS - TUFTS POS - 83630","TUFTS - TUFTS POS - 83630 - HC CHG LACTOFERRIN FECAL QUALITATIVE","TUFTS","TUFTS POS","CPT","83630","HC CHG LACTOFERRIN FECAL QUALITATIVE","83630 - HC CHG LACTOFERRIN FECAL QUALITATIVE",112,73.31,17.91,220.45,28]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 83662","BMC HEALTHNET - BMCHN MEDICAID - 83662","BMC HEALTHNET - BMCHN MEDICAID - 83662 - HC L/S RATIO, FOAM STABILITY","BMC HEALTHNET","BMCHN MEDICAID","CPT","83662","HC L/S RATIO, FOAM STABILITY","83662 - HC L/S RATIO, FOAM STABILITY",31,17.25,17.25,212.3,7.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 83690","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 83690","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 83690 - HC CHG ASSAY OF LIPASE","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","83690","HC CHG ASSAY OF LIPASE","83690 - HC CHG ASSAY OF LIPASE",35,17.34,6.29,77.400000000000006,8.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 83690","ELDER SERVICE PLAN - ELEMENT CARE INC - 83690","ELDER SERVICE PLAN - ELEMENT CARE INC - 83690 - HC CHG ASSAY OF LIPASE","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","83690","HC CHG ASSAY OF LIPASE","83690 - HC CHG ASSAY OF LIPASE",35,6.89,6.29,77.400000000000006,8.75]
["TUFTS - TUFTS MEDICARE SCO - CPT - 83695","TUFTS - TUFTS MEDICARE SCO - 83695","TUFTS - TUFTS MEDICARE SCO - 83695 - HC CHG LIPOPROTEIN (A)","TUFTS","TUFTS MEDICARE SCO","CPT","83695","HC CHG LIPOPROTEIN (A)","83695 - HC CHG LIPOPROTEIN (A)",63,20.76,11.81,145.38,15.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 83718","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 83718","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 83718 - HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","83718","HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL","83718 - HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL",41,21.31,7.48,91.95,10.25]
["BMC HEALTHNET - BMCHN ACO - CPT - 83721","BMC HEALTHNET - BMCHN ACO - 83721","BMC HEALTHNET - BMCHN ACO - 83721 - HC CRL;DIRECT LDL","BMC HEALTHNET","BMCHN ACO","CPT","83721","HC CRL;DIRECT LDL","83721 - HC CRL;DIRECT LDL",44,19.04,8.6999999999999993,107.11,11]
["FALLON - FALLON SENIOR PLAN - CPT - 83735","FALLON - FALLON SENIOR PLAN - 83735","FALLON - FALLON SENIOR PLAN - 83735 - HC CHG ASSAY OF MAGNESIUM","FALLON","FALLON SENIOR PLAN","CPT","83735","HC CHG ASSAY OF MAGNESIUM","83735 - HC CHG ASSAY OF MAGNESIUM",34,6.7,6.11,75.150000000000006,8.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 83735","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 83735","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 83735 - HC CHG ASSAY OF MAGNESIUM","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","83735","HC CHG ASSAY OF MAGNESIUM","83735 - HC CHG ASSAY OF MAGNESIUM",34,7.33,6.11,75.150000000000006,8.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 83785","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 83785","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 83785 - HC CHG, ASSAY OF MANGANESE","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","83785","HC CHG, ASSAY OF MANGANESE","83785 - HC CHG, ASSAY OF MANGANESE",109,57.56,22.44,276.16000000000003,27.25]
["BMC HEALTHNET - BMCHN MCO - CPT - 83825","BMC HEALTHNET - BMCHN MCO - 83825","BMC HEALTHNET - BMCHN MCO - 83825 - HC CHG ASSAY OF MERCURY QUANTITATIVE","BMC HEALTHNET","BMCHN MCO","CPT","83825","HC CHG ASSAY OF MERCURY QUANTITATIVE","83825 - HC CHG ASSAY OF MERCURY QUANTITATIVE",80,14.83,14.83,182.55,20]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 83825","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - 83825","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - 83825 - HC CHG ASSAY OF MERCURY QUANTITATIVE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","83825","HC CHG ASSAY OF MERCURY QUANTITATIVE","83825 - HC CHG ASSAY OF MERCURY QUANTITATIVE",80,35.11,14.83,182.55,20]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 83835","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 83835","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 83835 - HC CHG METANEPHRINES","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","83835","HC CHG METANEPHRINES","83835 - HC CHG METANEPHRINES",83,20.329999999999998,15.46,190.17,20.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 83873","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 83873","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 83873 - HC CHG MYELIN BASIC PROTEIN CEREBROSPINAL FLUID","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","83873","HC CHG MYELIN BASIC PROTEIN CEREBROSPINAL FLUID","83873 - HC CHG MYELIN BASIC PROTEIN CEREBROSPINAL FLUID",84,38.869999999999997,15.69,193.18,21]
["CIGNA HEALTHCARE - CIGNA - CPT - 83874","CIGNA HEALTHCARE - CIGNA - 83874","CIGNA HEALTHCARE - CIGNA - 83874 - HC CHG MYOGLOBIN","CIGNA HEALTHCARE","CIGNA","CPT","83874","HC CHG MYOGLOBIN","83874 - HC CHG MYOGLOBIN",62,58.16,11.78,145.01,15.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 83880","TUFTS - TUFTS MEDICARE SCO - 83880","TUFTS - TUFTS MEDICARE SCO - 83880 - HC CHG NATRIURETIC PEPTIDE","TUFTS","TUFTS MEDICARE SCO","CPT","83880","HC CHG NATRIURETIC PEPTIDE","83880 - HC CHG NATRIURETIC PEPTIDE",169,56.93,30.96,384.74,42.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 83880","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 83880","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 83880 - HC CHG NATRIURETIC PEPTIDE","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","83880","HC CHG NATRIURETIC PEPTIDE","83880 - HC CHG NATRIURETIC PEPTIDE",169,88.24,30.96,384.74,42.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 83915","BLUE CROSS - BLUE CROSS-PPO - 83915","BLUE CROSS - BLUE CROSS-PPO - 83915 - HC CHG ASSAY OF NUCLEOTIDASE 5'-","BLUE CROSS","BLUE CROSS-PPO","CPT","83915","HC CHG ASSAY OF NUCLEOTIDASE 5'-","83915 - HC CHG ASSAY OF NUCLEOTIDASE 5'-",54,25.04,10.17,125.2,13.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 83915","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 83915","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 83915 - HC CHG ASSAY OF NUCLEOTIDASE 5'-","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","83915","HC CHG ASSAY OF NUCLEOTIDASE 5'-","83915 - HC CHG ASSAY OF NUCLEOTIDASE 5'-",54,26.75,10.17,125.2,13.5]
["TUFTS - TUFTS SELECT - CPT - 83916","TUFTS - TUFTS SELECT - 83916","TUFTS - TUFTS SELECT - 83916 - HC CHG OLIGOCLONAL IMMUNE","TUFTS","TUFTS SELECT","CPT","83916","HC CHG OLIGOCLONAL IMMUNE","83916 - HC CHG OLIGOCLONAL IMMUNE",97,41.25,20.239999999999998,265.61,24.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 83921","AETNA - AETNA-MEDICARE ADVANTAGE - 83921","AETNA - AETNA-MEDICARE ADVANTAGE - 83921 - HC CHG ORGANIC ACID 1 QUANTITATIVE","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","83921","HC CHG ORGANIC ACID 1 QUANTITATIVE","83921 - HC CHG ORGANIC ACID 1 QUANTITATIVE",80,25.03,15.67,205.7,20]
["BMC HEALTHNET - BMCHN QHP - CPT - 83921","BMC HEALTHNET - BMCHN QHP - 83921","BMC HEALTHNET - BMCHN QHP - 83921 - HC CHG ORGANIC ACID 1 QUANTITATIVE","BMC HEALTHNET","BMCHN QHP","CPT","83921","HC CHG ORGANIC ACID 1 QUANTITATIVE","83921 - HC CHG ORGANIC ACID 1 QUANTITATIVE",80,18.8,15.67,205.7,20]
["FALLON - FALLON MEDICAID - CPT - 83930","FALLON - FALLON MEDICAID - 83930","FALLON - FALLON MEDICAID - 83930 - HC Q;OSMOLALITY,SER","FALLON","FALLON MEDICAID","CPT","83930","HC Q;OSMOLALITY,SER","83930 - HC Q;OSMOLALITY,SER",33,6.03,6.03,74.22,8.25]
["UNICARE - UNICARE - CPT - 83930","UNICARE - UNICARE - 83930","UNICARE - UNICARE - 83930 - HC Q;OSMOLALITY,SER","UNICARE","UNICARE","CPT","83930","HC Q;OSMOLALITY,SER","83930 - HC Q;OSMOLALITY,SER",33,16.04,6.03,74.22,8.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 83937","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 83937","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 83937 - HC CHG ASSAY OF OSTEOCALCIN","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","83937","HC CHG ASSAY OF OSTEOCALCIN","83937 - HC CHG ASSAY OF OSTEOCALCIN",143,67.19,27.23,335.1,35.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 83945","BMC HEALTHNET - BMCHN ACO - 83945","BMC HEALTHNET - BMCHN ACO - 83945 - HC CHG ASSAY OF OXALATE","BMC HEALTHNET","BMCHN ACO","CPT","83945","HC CHG ASSAY OF OXALATE","83945 - HC CHG ASSAY OF OXALATE",62,25.69,11.74,144.81,15.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 83945","TUFTS - TUFTS MEDICARE PREFERRED HMO - 83945","TUFTS - TUFTS MEDICARE PREFERRED HMO - 83945 - HC CHG ASSAY OF OXALATE","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","83945","HC CHG ASSAY OF OXALATE","83945 - HC CHG ASSAY OF OXALATE",62,20.95,11.74,144.81,15.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 83970","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 83970","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 83970 - HC CHG ASSAY OF PARATHORMONE","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","83970","HC CHG ASSAY OF PARATHORMONE","83970 - HC CHG ASSAY OF PARATHORMONE",206,45.18,37.65,463.35,51.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 83986","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 83986","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 83986 - HC CHG PH BODY FLUID NOT ELSEWHERE SPECIFIED","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","83986","HC CHG PH BODY FLUID NOT ELSEWHERE SPECIFIED","83986 - HC CHG PH BODY FLUID NOT ELSEWHERE SPECIFIED",20,7.91,3.27,40.229999999999997,5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 83992","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 83992","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 83992 - HC CHG ASSAY OF PHENCYCLIDINE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","83992","HC CHG ASSAY OF PHENCYCLIDINE","83992 - HC CHG ASSAY OF PHENCYCLIDINE",71,36.270000000000003,15.16,162.9,17.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 83993","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 83993","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 83993 - HC CHG ASSAY OF CALPROTECTIN FECAL","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","83993","HC CHG ASSAY OF CALPROTECTIN FECAL","83993 - HC CHG ASSAY OF CALPROTECTIN FECAL",95,47.09,17.91,220.45,23.75]
["TUFTS - TUFTS SELECT - CPT - 84075","TUFTS - TUFTS SELECT - 84075","TUFTS - TUFTS SELECT - 84075 - HC CHG ASSAY OF PHOSPHATASE ALKALINE","TUFTS","TUFTS SELECT","CPT","84075","HC CHG ASSAY OF PHOSPHATASE ALKALINE","84075 - HC CHG ASSAY OF PHOSPHATASE ALKALINE",26,9.02,4.72,58.08,6.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 84080","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 84080","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 84080 - HC CHG ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","84080","HC CHG ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES","84080 - HC CHG ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES",71,35.47,13.48,166,17.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 84080","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 84080","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 84080 - HC CHG ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","84080","HC CHG ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES","84080 - HC CHG ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES",71,34.6,13.48,166,17.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 84105","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 84105","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 84105 - HC CHG ASSAY OF PHOSPHORUS INORGANIC URINE","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","84105","HC CHG ASSAY OF PHOSPHORUS INORGANIC URINE","84105 - HC CHG ASSAY OF PHOSPHORUS INORGANIC URINE",26,14.54,4.72,58.16,6.5]
["BMC HEALTHNET - BMCHN QHP - CPT - 84132","BMC HEALTHNET - BMCHN QHP - 84132","BMC HEALTHNET - BMCHN QHP - 84132 - HC CHG POTASSIUM SERUM PLASMA/WHOLE BLOOD","BMC HEALTHNET","BMCHN QHP","CPT","84132","HC CHG POTASSIUM SERUM PLASMA/WHOLE BLOOD","84132 - HC CHG POTASSIUM SERUM PLASMA/WHOLE BLOOD",24,5.04,4.2,51.64,6]
["TUFTS - TUFTS PPO - CPT - 84132","TUFTS - TUFTS PPO - 84132","TUFTS - TUFTS PPO - 84132 - HC CHG POTASSIUM SERUM PLASMA/WHOLE BLOOD","TUFTS","TUFTS PPO","CPT","84132","HC CHG POTASSIUM SERUM PLASMA/WHOLE BLOOD","84132 - HC CHG POTASSIUM SERUM PLASMA/WHOLE BLOOD",24,18.37,4.2,51.64,6]
["UNICARE - UNICARE - CPT - 84133","UNICARE - UNICARE - 84133","UNICARE - UNICARE - 84133 - HC CHG POTASSIUM URINE","UNICARE","UNICARE","CPT","84133","HC CHG POTASSIUM URINE","84133 - HC CHG POTASSIUM URINE",23,10.45,3.93,48.38,5.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 84134","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 84134","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 84134 - HC CHG PREALBUMIN","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","84134","HC CHG PREALBUMIN","84134 - HC CHG PREALBUMIN",72,15.67,13.31,163.76,18]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 84144","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - 84144","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - 84144 - HC CHG ASSAY OF PROGESTERONE","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","84144","HC CHG ASSAY OF PROGESTERONE","84144 - HC CHG ASSAY OF PROGESTERONE",104,28.62,19.03,234.27,26]
["TUFTS - TUFTS POS - CPT - 84145","TUFTS - TUFTS POS - 84145","TUFTS - TUFTS POS - 84145 - HC CHG PROCALCITONIN (PCT)","TUFTS","TUFTS POS","CPT","84145","HC CHG PROCALCITONIN (PCT)","84145 - HC CHG PROCALCITONIN (PCT)",99,100.05,24.44,300.82,24.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84146","BLUE CROSS - BLUE CROSS-HMO BLUE - 84146","BLUE CROSS - BLUE CROSS-HMO BLUE - 84146 - HC CHG ASSAY OF PROLACTIN","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","84146","HC CHG ASSAY OF PROLACTIN","84146 - HC CHG ASSAY OF PROLACTIN",97,43.48,17.670000000000002,217.56,24.25]
["BMC HEALTHNET - BMCHN MCO - CPT - 84153","BMC HEALTHNET - BMCHN MCO - 84153","BMC HEALTHNET - BMCHN MCO - 84153 - HC CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL","BMC HEALTHNET","BMCHN MCO","CPT","84153","HC CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL","84153 - HC CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL",93,16.78,16.78,206.51,23.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 84155","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - 84155","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - 84155 - HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","84155","HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD","84155 - HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD",20,5.03,3.35,41.16,5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 84155","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 84155","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 84155 - HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","84155","HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD","84155 - HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD",20,4.4000000000000004,3.35,41.16,5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 84156","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 84156","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 84156 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY URINE","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT","84156","HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY URINE","84156 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY URINE",20,5.07,3.35,41.16,5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 84157","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 84157","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 84157 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","84157","HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC","84157 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC",20,4,3.35,41.16,5]
["TUFTS - TUFTS SELECT - CPT - 84163","TUFTS - TUFTS SELECT - 84163","TUFTS - TUFTS SELECT - 84163 - HC CHG PREGNANCY-ASSOCIATED PLASMA PROTEIN-A","TUFTS","TUFTS SELECT","CPT","84163","HC CHG PREGNANCY-ASSOCIATED PLASMA PROTEIN-A","84163 - HC CHG PREGNANCY-ASSOCIATED PLASMA PROTEIN-A",72,26.26,13.74,169.1,18]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 84165","UNICARE - UNICARE STATE INDEMNITY PLAN - 84165","UNICARE - UNICARE STATE INDEMNITY PLAN - 84165 - HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","84165","HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM","84165 - HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM",63,21.72,9.8000000000000007,120.52,15.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 84166","BMC HEALTHNET - BMCHN QHP - 84166","BMC HEALTHNET - BMCHN QHP - 84166 - HC CHG PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI","BMC HEALTHNET","BMCHN QHP","CPT","84166","HC CHG PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI","84166 - HC CHG PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI",99,19.510000000000002,16.260000000000002,200.15,24.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 84182","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 84182","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 84182 - HC CHG PROTEIN, WESTERN BLOT TEST, W BAND","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","84182","HC CHG PROTEIN, WESTERN BLOT TEST, W BAND","84182 - HC CHG PROTEIN, WESTERN BLOT TEST, W BAND",264,63.06,21.58,283.38,66]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 84182","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 84182","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 84182 - HC CHG PROTEIN, WESTERN BLOT TEST, W BAND","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","84182","HC CHG PROTEIN, WESTERN BLOT TEST, W BAND","84182 - HC CHG PROTEIN, WESTERN BLOT TEST, W BAND",264,35.049999999999997,21.58,283.38,66]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 84206","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 84206","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 84206 - HC CHG ASSAY OF PROINSULIN","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","84206","HC CHG ASSAY OF PROINSULIN","84206 - HC CHG ASSAY OF PROINSULIN",86,67.16,19.72,258.88,21.5]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 84207","CIGNA HEALTHCARE - CIGNA PPO - 84207","CIGNA HEALTHCARE - CIGNA PPO - 84207 - HC CHG ASSAY OF PYRIDOXAL PHOSPHATE","CIGNA HEALTHCARE","CIGNA PPO","CPT","84207","HC CHG ASSAY OF PYRIDOXAL PHOSPHATE","84207 - HC CHG ASSAY OF PYRIDOXAL PHOSPHATE",130,69.09,25.63,315.49,32.5]
["TUFTS - TUFTS POS - CPT - 84207","TUFTS - TUFTS POS - 84207","TUFTS - TUFTS POS - 84207 - HC CHG ASSAY OF PYRIDOXAL PHOSPHATE","TUFTS","TUFTS POS","CPT","84207","HC CHG ASSAY OF PYRIDOXAL PHOSPHATE","84207 - HC CHG ASSAY OF PYRIDOXAL PHOSPHATE",130,104.92,25.63,315.49,32.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 84210","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 84210","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 84210 - HC CHG ASSAY OF PYRUVATE","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","84210","HC CHG ASSAY OF PYRUVATE","84210 - HC CHG ASSAY OF PYRUVATE",53,17.38,10.7,140.4,13.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 84244","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 84244","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 84244 - HC CHG ASSAY OF RENIN","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","84244","HC CHG ASSAY OF RENIN","84244 - HC CHG ASSAY OF RENIN",106,49.4,20.059999999999999,246.86,26.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 84255","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - 84255","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - 84255 - HC CHG ASSAY OF SELENIUM","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","84255","HC CHG ASSAY OF SELENIUM","84255 - HC CHG ASSAY OF SELENIUM",123,35.020000000000003,23.29,286.64,30.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 84270","TUFTS - TUFTS MEDICARE PREFERRED HMO - 84270","TUFTS - TUFTS MEDICARE PREFERRED HMO - 84270 - HC CHG ASSAY OF SEX HORMONE BINDING GLOBULIN","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","84270","HC CHG ASSAY OF SEX HORMONE BINDING GLOBULIN","84270 - HC CHG ASSAY OF SEX HORMONE BINDING GLOBULIN",105,31.51,19.82,243.97,26.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 84270","UNITED HEALTHCARE - UNITED HEALTHCARE - 84270","UNITED HEALTHCARE - UNITED HEALTHCARE - 84270 - HC CHG ASSAY OF SEX HORMONE BINDING GLOBULIN","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","84270","HC CHG ASSAY OF SEX HORMONE BINDING GLOBULIN","84270 - HC CHG ASSAY OF SEX HORMONE BINDING GLOBULIN",105,45.76,19.82,243.97,26.25]
["CIGNA HEALTHCARE - CIGNA - CPT - 84300","CIGNA HEALTHCARE - CIGNA - 84300","CIGNA HEALTHCARE - CIGNA - 84300 - HC CHG ASSAY OF URINE SODIUM","CIGNA HEALTHCARE","CIGNA","CPT","84300","HC CHG ASSAY OF URINE SODIUM","84300 - HC CHG ASSAY OF URINE SODIUM",25,21.93,4.43,54.53,6.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 84302","ELDER SERVICE PLAN - ELEMENT CARE INC - 84302","ELDER SERVICE PLAN - ELEMENT CARE INC - 84302 - HC CHG ASSAY OF SODIUM OTHER SOURCE","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","84302","HC CHG ASSAY OF SODIUM OTHER SOURCE","84302 - HC CHG ASSAY OF SODIUM OTHER SOURCE",25,4.8600000000000003,4.43,54.53,6.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 84302","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 84302","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 84302 - HC CHG ASSAY OF SODIUM OTHER SOURCE","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","84302","HC CHG ASSAY OF SODIUM OTHER SOURCE","84302 - HC CHG ASSAY OF SODIUM OTHER SOURCE",25,5.32,4.43,54.53,6.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 84307","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 84307","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 84307 - HC CHG ASSAY OF SOMATOSTATIN","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","84307","HC CHG ASSAY OF SOMATOSTATIN","84307 - HC CHG ASSAY OF SOMATOSTATIN",515,19.670000000000002,16.670000000000002,205.12,128.75]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 84307","BMC HEALTHNET - BMCHN WELL SENSE - 84307","BMC HEALTHNET - BMCHN WELL SENSE - 84307 - HC CHG ASSAY OF SOMATOSTATIN","BMC HEALTHNET","BMCHN WELL SENSE","CPT","84307","HC CHG ASSAY OF SOMATOSTATIN","84307 - HC CHG ASSAY OF SOMATOSTATIN",515,42.99,16.670000000000002,205.12,128.75]
["TUFTS - TUFTS HMO - CPT - 84311","TUFTS - TUFTS HMO - 84311","TUFTS - TUFTS HMO - 84311 - HC CHG SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED","TUFTS","TUFTS HMO","CPT","84311","HC CHG SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED","84311 - HC CHG SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED",32,31.63,6.38,79.27,8]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 84376","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 84376","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 84376 - HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT","84376","HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC","84376 - HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC",27,7.59,5.0199999999999996,61.7,6.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 84402","CIGNA HEALTHCARE - CIGNA CARELINK - 84402","CIGNA HEALTHCARE - CIGNA CARELINK - 84402 - HC CHG ASSAY OF TESTOSTERONE FREE","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","84402","HC CHG ASSAY OF TESTOSTERONE FREE","84402 - HC CHG ASSAY OF TESTOSTERONE FREE",123,285.98,23.24,285.98,30.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 84403","CIGNA HEALTHCARE - CIGNA CARELINK - 84403","CIGNA HEALTHCARE - CIGNA CARELINK - 84403 - HC CHG ASSAY OF TESTOSTERONE TOTAL","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","84403","HC CHG ASSAY OF TESTOSTERONE TOTAL","84403 - HC CHG ASSAY OF TESTOSTERONE TOTAL",124,289.82,23.55,289.82,31]
["TUFTS - TUFTS POS - CPT - 84403","TUFTS - TUFTS POS - 84403","TUFTS - TUFTS POS - 84403 - HC CHG ASSAY OF TESTOSTERONE TOTAL","TUFTS","TUFTS POS","CPT","84403","HC CHG ASSAY OF TESTOSTERONE TOTAL","84403 - HC CHG ASSAY OF TESTOSTERONE TOTAL",124,96.38,23.55,289.82,31]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 84425","UNITED HEALTHCARE - UNITED HEALTHCARE - 84425","UNITED HEALTHCARE - UNITED HEALTHCARE - 84425 - HC CHG ASSAY OF THIAMINE-VITAMIN B-1","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","84425","HC CHG ASSAY OF THIAMINE-VITAMIN B-1","84425 - HC CHG ASSAY OF THIAMINE-VITAMIN B-1",102,44.71,19.37,238.34,25.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 84432","BLUE CROSS - BLUE CROSS-PPO - 84432","BLUE CROSS - BLUE CROSS-PPO - 84432 - HC CHG ASSAY OF THYROGLOBULIN","BLUE CROSS","BLUE CROSS-PPO","CPT","84432","HC CHG ASSAY OF THYROGLOBULIN","84432 - HC CHG ASSAY OF THYROGLOBULIN",79,36.24,14.65,180.3,19.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 84432","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - 84432","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - 84432 - HC CHG ASSAY OF THYROGLOBULIN","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","84432","HC CHG ASSAY OF THYROGLOBULIN","84432 - HC CHG ASSAY OF THYROGLOBULIN",79,22.03,14.65,180.3,19.75]
["TUFTS - TUFTS SELECT - CPT - 84436","TUFTS - TUFTS SELECT - 84436","TUFTS - TUFTS SELECT - 84436 - HC CHG ASSAY OF THYROXINE TOTAL","TUFTS","TUFTS SELECT","CPT","84436","HC CHG ASSAY OF THYROXINE TOTAL","84436 - HC CHG ASSAY OF THYROXINE TOTAL",35,11.98,6.27,77.11,8.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 84439","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 84439","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 84439 - HC CHG ASSAY OF FREE THYROXINE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","84439","HC CHG ASSAY OF FREE THYROXINE","84439 - HC CHG ASSAY OF FREE THYROXINE",46,11.15,8.2200000000000006,101.2,11.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 84439","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 84439","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 84439 - HC CHG ASSAY OF FREE THYROXINE","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","84439","HC CHG ASSAY OF FREE THYROXINE","84439 - HC CHG ASSAY OF FREE THYROXINE",46,21.63,8.2200000000000006,101.2,11.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 84443","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 84443","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 84443 - HC CHG ASSAY OF THYROID STIMULATING HORMONE TSH","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT","84443","HC CHG ASSAY OF THYROID STIMULATING HORMONE TSH","84443 - HC CHG ASSAY OF THYROID STIMULATING HORMONE TSH",84,16.8,15.33,188.7,21]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 84443","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 84443","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 84443 - HC CHG ASSAY OF THYROID STIMULATING HORMONE TSH","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT","84443","HC CHG ASSAY OF THYROID STIMULATING HORMONE TSH","84443 - HC CHG ASSAY OF THYROID STIMULATING HORMONE TSH",84,22.65,15.33,188.7,21]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 84446","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 84446","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 84446 - HC CHG ASSAY OF TOCOPHEROL ALPHA VITAMIN E","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","84446","HC CHG ASSAY OF TOCOPHEROL ALPHA VITAMIN E","84446 - HC CHG ASSAY OF TOCOPHEROL ALPHA VITAMIN E",69,32.28,12.94,159.19,17.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 84446","CIGNA HEALTHCARE - CIGNA CARELINK - 84446","CIGNA HEALTHCARE - CIGNA CARELINK - 84446 - HC CHG ASSAY OF TOCOPHEROL ALPHA VITAMIN E","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","84446","HC CHG ASSAY OF TOCOPHEROL ALPHA VITAMIN E","84446 - HC CHG ASSAY OF TOCOPHEROL ALPHA VITAMIN E",69,159.19,12.94,159.19,17.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 84450","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 84450","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 84450 - HC CHG TRANSFERASE ASPARTATE AMINO AST SGOT","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","84450","HC CHG TRANSFERASE ASPARTATE AMINO AST SGOT","84450 - HC CHG TRANSFERASE ASPARTATE AMINO AST SGOT",26,13.8,4.72,58.08,6.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 84460","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 84460","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 84460 - HC CHG TRANSFERASE ALANINE AMINO (ALT) (SGPT)","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","84460","HC CHG TRANSFERASE ALANINE AMINO (ALT) (SGPT)","84460 - HC CHG TRANSFERASE ALANINE AMINO (ALT) (SGPT)",27,5.8,4.83,59.46,6.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 84466","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 84466","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 84466 - HC CHG ASSAY OF L7383TRANSFERRIN","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","84466","HC CHG ASSAY OF L7383TRANSFERRIN","84466 - HC CHG ASSAY OF L7383TRANSFERRIN",64,13.74,11.64,143.30000000000001,16]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 84478","CIGNA HEALTHCARE - CIGNA PPO - 84478","CIGNA HEALTHCARE - CIGNA PPO - 84478 - HC CHG ASSAY OF TRIGLYCERIDES","CIGNA HEALTHCARE","CIGNA PPO","CPT","84478","HC CHG ASSAY OF TRIGLYCERIDES","84478 - HC CHG ASSAY OF TRIGLYCERIDES",29,14.63,5.24,64.44,7.25]
["TUFTS - TUFTS PPO - CPT - 84478","TUFTS - TUFTS PPO - 84478","TUFTS - TUFTS PPO - 84478 - HC CHG ASSAY OF TRIGLYCERIDES","TUFTS","TUFTS PPO","CPT","84478","HC CHG ASSAY OF TRIGLYCERIDES","84478 - HC CHG ASSAY OF TRIGLYCERIDES",29,22.92,5.24,64.44,7.25]
["UNICARE - UNICARE - CPT - 84479","UNICARE - UNICARE - 84479","UNICARE - UNICARE - 84479 - HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO","UNICARE","UNICARE","CPT","84479","HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO","84479 - HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO",33,15.71,5.9,72.55,8.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 84481","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 84481","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 84481 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 FREE","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","84481","HC CHG ASSAY OF TRIIODOTHYRONINE T3 FREE","84481 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 FREE",83,38.200000000000003,15.46,190.17,20.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 84481","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 84481","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 84481 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 FREE","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT","84481","HC CHG ASSAY OF TRIIODOTHYRONINE T3 FREE","84481 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 FREE",83,16.940000000000001,15.46,190.17,20.75]
["TUFTS - TUFTS SPIRIT - CPT - 84482","TUFTS - TUFTS SPIRIT - 84482","TUFTS - TUFTS SPIRIT - 84482 - HC CHG TRIIODOTHYRONINE T3 REVERSE","TUFTS","TUFTS SPIRIT","CPT","84482","HC CHG TRIIODOTHYRONINE T3 REVERSE","84482 - HC CHG TRIIODOTHYRONINE T3 REVERSE",73,17.34,14.38,176.92,18.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 84484","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 84484","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 84484 - HC CHG ASSAY OF TROPONIN QUANTITATIVE","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","84484","HC CHG ASSAY OF TROPONIN QUANTITATIVE","84484 - HC CHG ASSAY OF TROPONIN QUANTITATIVE",49,11.05,9.2100000000000009,120.92,12.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 84520","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 84520","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 84520 - HC CHG ASSAY OF UREA NITROGEN QUANTITATIVE","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","84520","HC CHG ASSAY OF UREA NITROGEN QUANTITATIVE","84520 - HC CHG ASSAY OF UREA NITROGEN QUANTITATIVE",21,8.73,3.61,44.34,5.25]
["FALLON - FALLON MEDICAID - CPT - 84540","FALLON - FALLON MEDICAID - 84540","FALLON - FALLON MEDICAID - 84540 - HC CHG ASSAY OF UREA NITROGEN URINE","FALLON","FALLON MEDICAID","CPT","84540","HC CHG ASSAY OF UREA NITROGEN URINE","84540 - HC CHG ASSAY OF UREA NITROGEN URINE",25,4.33,4.33,53.96,6.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 84540","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 84540","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 84540 - HC CHG ASSAY OF UREA NITROGEN URINE","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT","84540","HC CHG ASSAY OF UREA NITROGEN URINE","84540 - HC CHG ASSAY OF UREA NITROGEN URINE",25,6.55,4.33,53.96,6.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 84560","AETNA - AETNA-MEDICARE ADVANTAGE - 84560","AETNA - AETNA-MEDICARE ADVANTAGE - 84560 - HC CHG ASSAY OF URIC ACID OTHER SOURCE","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","84560","HC CHG ASSAY OF URIC ACID OTHER SOURCE","84560 - HC CHG ASSAY OF URIC ACID OTHER SOURCE",25,5.99,4.33,53.31,6.25]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 84560","CIGNA HEALTHCARE - CIGNA PPO - 84560","CIGNA HEALTHCARE - CIGNA PPO - 84560 - HC CHG ASSAY OF URIC ACID OTHER SOURCE","CIGNA HEALTHCARE","CIGNA PPO","CPT","84560","HC CHG ASSAY OF URIC ACID OTHER SOURCE","84560 - HC CHG ASSAY OF URIC ACID OTHER SOURCE",25,12.07,4.33,53.31,6.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 84590","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - 84590","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - 84590 - HC CHG ASSAY OF VITAMIN A","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","84590","HC CHG ASSAY OF VITAMIN A","84590 - HC CHG ASSAY OF VITAMIN A",56,25.07,10.59,130.34,14]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 84591","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 84591","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 84591 - HC CHG ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","84591","HC CHG ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED","84591 - HC CHG ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED",58,20.47,12.6,165.43,14.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 84597","ELDER SERVICE PLAN - ELEMENT CARE INC - 84597","ELDER SERVICE PLAN - ELEMENT CARE INC - 84597 - HC CHG ASSAY OF VITAMIN K","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","84597","HC CHG ASSAY OF VITAMIN K","84597 - HC CHG ASSAY OF VITAMIN K",149,13.72,12.52,154.06,37.25]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 84630","BMC HEALTHNET - BMCHN WELL SENSE - 84630","BMC HEALTHNET - BMCHN WELL SENSE - 84630 - HC CHG ASSAY OF ZINC","BMC HEALTHNET","BMCHN WELL SENSE","CPT","84630","HC CHG ASSAY OF ZINC","84630 - HC CHG ASSAY OF ZINC",55,22.52,10.39,127.81,13.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 84681","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 84681","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 84681 - HC CHG ASSAY OF C-PEPTIDE","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","84681","HC CHG ASSAY OF C-PEPTIDE","84681 - HC CHG ASSAY OF C-PEPTIDE",100,36.21,18.989999999999998,233.69,25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 84681","UNICARE - UNICARE STATE INDEMNITY PLAN - 84681","UNICARE - UNICARE STATE INDEMNITY PLAN - 84681 - HC CHG ASSAY OF C-PEPTIDE","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","84681","HC CHG ASSAY OF C-PEPTIDE","84681 - HC CHG ASSAY OF C-PEPTIDE",100,42.08,18.989999999999998,233.69,25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 84703","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 84703","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 84703 - HC GONAD,CHOR(HCG);QL","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","84703","HC GONAD,CHOR(HCG);QL","84703 - HC GONAD,CHOR(HCG);QL",37,17.12,6.86,84.49,9.25]
["FALLON - FALLON MEDICAID - CPT - 84703","FALLON - FALLON MEDICAID - 84703","FALLON - FALLON MEDICAID - 84703 - HC GONAD,CHOR(HCG);QL","FALLON","FALLON MEDICAID","CPT","84703","HC GONAD,CHOR(HCG);QL","84703 - HC GONAD,CHOR(HCG);QL",37,6.86,6.86,84.49,9.25]
["TUFTS - TUFTS SELECT - CPT - 85004","TUFTS - TUFTS SELECT - 85004","TUFTS - TUFTS SELECT - 85004 - HC AUTO DIFF","TUFTS","TUFTS SELECT","CPT","85004","HC AUTO DIFF","85004 - HC AUTO DIFF",22,11.27,5.9,72.55,5.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 85014","ELDER SERVICE PLAN - ELEMENT CARE INC - 85014","ELDER SERVICE PLAN - ELEMENT CARE INC - 85014 - HC CHG BLOOD COUNT HEMATOCRIT","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","85014","HC CHG BLOOD COUNT HEMATOCRIT","85014 - HC CHG BLOOD COUNT HEMATOCRIT",12,2.37,2.16,26.61,3]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 85018","BMC HEALTHNET - BMCHN MEDICAID - 85018","BMC HEALTHNET - BMCHN MEDICAID - 85018 - POC;HEMOGLOBIN","BMC HEALTHNET","BMCHN MEDICAID","CPT","85018","POC;HEMOGLOBIN","85018 - POC;HEMOGLOBIN",12,2.16,2.16,26.61,3]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 85025","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 85025","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 85025 - HC CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT","85025","HC CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC","85025 - HC CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC",40,7.77,7.09,87.22,10]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 85025","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 85025","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 85025 - HC CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","85025","HC CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC","85025 - HC CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC",40,9.32,7.09,87.22,10]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 85045","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 85045","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 85045 - HC CHG BLOOD COUNT RETICULOCYTE AUTOMATED","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","85045","HC CHG BLOOD COUNT RETICULOCYTE AUTOMATED","85045 - HC CHG BLOOD COUNT RETICULOCYTE AUTOMATED",22,9.2200000000000006,3.64,44.83,5.5]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 85046","BMC HEALTHNET - BMCHN WELL SENSE - 85046","BMC HEALTHNET - BMCHN WELL SENSE - 85046 - HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS","BMC HEALTHNET","BMCHN WELL SENSE","CPT","85046","HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS","85046 - HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS",141,7.82,5.08,62.56,35.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 85046","TUFTS - TUFTS MEDICARE PREFERRED HMO - 85046","TUFTS - TUFTS MEDICARE PREFERRED HMO - 85046 - HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","85046","HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS","85046 - HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS",141,8.08,5.08,62.56,35.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 85048","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 85048","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 85048 - HC CHG BLOOD COUNT LEUKOCYTE WBC AUTOMATED","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","85048","HC CHG BLOOD COUNT LEUKOCYTE WBC AUTOMATED","85048 - HC CHG BLOOD COUNT LEUKOCYTE WBC AUTOMATED",12,2.77,2.31,28.49,3]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 85049","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 85049","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 85049 - HC CHG BLOOD COUNT PLATELET AUTOMATED","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","85049","HC CHG BLOOD COUNT PLATELET AUTOMATED","85049 - HC CHG BLOOD COUNT PLATELET AUTOMATED",23,10.47,4.09,50.21,5.75]
["FALLON - FALLON MEDICAID - CPT - 85055","FALLON - FALLON MEDICAID - 85055","FALLON - FALLON MEDICAID - 85055 - HC CHG RETICULATED PLATELET ASSAY","FALLON","FALLON MEDICAID","CPT","85055","HC CHG RETICULATED PLATELET ASSAY","85055 - HC CHG RETICULATED PLATELET ASSAY",141,26.41,15.07,346.67,35.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 85210","BLUE CROSS - BLUE CROSS-INDEMNITY - 85210","BLUE CROSS - BLUE CROSS-INDEMNITY - 85210 - HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","85210","HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC","85210 - HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC",65,28.98,11.84,145.74,16.25]
["FALLON - FALLON MEDICAID - CPT - 85210","FALLON - FALLON MEDICAID - 85210","FALLON - FALLON MEDICAID - 85210 - HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC","FALLON","FALLON MEDICAID","CPT","85210","HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC","85210 - HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC",65,11.84,11.84,145.74,16.25]
["TUFTS - TUFTS POS - CPT - 85220","TUFTS - TUFTS POS - 85220","TUFTS - TUFTS POS - 85220 - HC CHG CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR","TUFTS","TUFTS POS","CPT","85220","HC CHG CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR","85220 - HC CHG CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR",90,65.89,16.100000000000001,198.11,22.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85230","BLUE CROSS - BLUE CROSS-HMO BLUE - 85230","BLUE CROSS - BLUE CROSS-HMO BLUE - 85230 - HC CHG CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","85230","HC CHG CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR","85230 - HC CHG CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR",91,40.18,16.329999999999998,200.93,22.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 85240","BMC HEALTHNET - BMCHN MCO - 85240","BMC HEALTHNET - BMCHN MCO - 85240 - HC CHG CLOTTING FACTOR VIII AHG 1 STAGE","BMC HEALTHNET","BMCHN MCO","CPT","85240","HC CHG CLOTTING FACTOR VIII AHG 1 STAGE","85240 - HC CHG CLOTTING FACTOR VIII AHG 1 STAGE",91,16.329999999999998,16.329999999999998,200.93,22.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 85245","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - 85245","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - 85245 - HC CHG CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","85245","HC CHG CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT","85245 - HC CHG CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT",180,31.47,20.92,257.5,45]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 85245","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 85245","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 85245 - HC CHG CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","85245","HC CHG CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT","85245 - HC CHG CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT",180,25.1,20.92,257.5,45]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 85250","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 85250","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 85250 - HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","85250","HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS","85250 - HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS",95,20.5,17.37,213.81,23.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 85250","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 85250","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 85250 - HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","85250","HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS","85250 - HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS",95,19.04,17.37,213.81,23.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 85260","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 85260","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 85260 - HC CHG CLOTTING FACTOR X STUART-PROWER","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","85260","HC CHG CLOTTING FACTOR X STUART-PROWER","85260 - HC CHG CLOTTING FACTOR X STUART-PROWER",91,31.15,16.329999999999998,200.93,22.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 85270","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 85270","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 85270 - HC CHG CLOTTING FACTOR XI PTA","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT","85270","HC CHG CLOTTING FACTOR XI PTA","85270 - HC CHG CLOTTING FACTOR XI PTA",91,24.13,16.329999999999998,200.93,22.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 85280","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 85280","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 85280 - HC CHG CLOTTING FACTOR XII HAGEMAN","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","85280","HC CHG CLOTTING FACTOR XII HAGEMAN","85280 - HC CHG CLOTTING FACTOR XII HAGEMAN",97,43.48,17.649999999999999,217.27,24.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 85290","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 85290","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 85290 - HC CHG CLOTTING FACTOR XIII FIBRIN STABILIZING","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","85290","HC CHG CLOTTING FACTOR XIII FIBRIN STABILIZING","85290 - HC CHG CLOTTING FACTOR XIII FIBRIN STABILIZING",82,16.34,14.9,183.36,20.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 85300","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 85300","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 85300 - HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","85300","HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY","85300 - HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY",57,28.43,10.81,133.03,14.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 85300","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 85300","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 85300 - HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","85300","HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY","85300 - HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY",57,27.74,10.81,133.03,14.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 85302","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 85302","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 85302 - HC CHG CLOTTING INHIBITORS PROTEIN C ANTIGEN","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","85302","HC CHG CLOTTING INHIBITORS PROTEIN C ANTIGEN","85302 - HC CHG CLOTTING INHIBITORS PROTEIN C ANTIGEN",58,30.22,10.96,134.82,14.5]
["FALLON - FALLON SENIOR PLAN - CPT - 85302","FALLON - FALLON SENIOR PLAN - 85302","FALLON - FALLON SENIOR PLAN - 85302 - HC CHG CLOTTING INHIBITORS PROTEIN C ANTIGEN","FALLON","FALLON SENIOR PLAN","CPT","85302","HC CHG CLOTTING INHIBITORS PROTEIN C ANTIGEN","85302 - HC CHG CLOTTING INHIBITORS PROTEIN C ANTIGEN",58,12.01,10.96,134.82,14.5]
["TUFTS - TUFTS PPO - CPT - 85303","TUFTS - TUFTS PPO - 85303","TUFTS - TUFTS PPO - 85303 - HC CHG CLOTTING INHIBITORS PROTEIN C ACTIVITY","TUFTS","TUFTS PPO","CPT","85303","HC CHG CLOTTING INHIBITORS PROTEIN C ACTIVITY","85303 - HC CHG CLOTTING INHIBITORS PROTEIN C ACTIVITY",62,55.24,12.62,155.28,15.5]
["UNICARE - UNICARE - CPT - 85305","UNICARE - UNICARE - 85305","UNICARE - UNICARE - 85305 - HC CHG CLOTTING INHIBITORS PROTEIN S TOTAL","UNICARE","UNICARE","CPT","85305","HC CHG CLOTTING INHIBITORS PROTEIN S TOTAL","85305 - HC CHG CLOTTING INHIBITORS PROTEIN S TOTAL",56,28.14,10.59,130.34,14]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 85306","BMC HEALTHNET - BMCHN MEDICAID - 85306","BMC HEALTHNET - BMCHN MEDICAID - 85306 - HC CHG CLOTTING INHIBITORS PROTEIN S FREE","BMC HEALTHNET","BMCHN MEDICAID","CPT","85306","HC CHG CLOTTING INHIBITORS PROTEIN S FREE","85306 - HC CHG CLOTTING INHIBITORS PROTEIN S FREE",69,13.98,13.98,172.07,17.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 85307","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 85307","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 85307 - HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","85307","HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY","85307 - HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY",69,16.5,13.98,172.07,17.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 85307","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 85307","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 85307 - HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","85307","HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY","85307 - HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY",69,16.45,13.98,172.07,17.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 85366","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 85366","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 85366 - HC CHG FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","85366","HC CHG FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ","85366 - HC CHG FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ",38,80.67,10.33,780.44,9.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 85378","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 85378","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 85378 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","85378","HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN","85378 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN",36,21.48,7.18,94.31,9]
["TUFTS - TUFTS HMO - CPT - 85378","TUFTS - TUFTS HMO - 85378","TUFTS - TUFTS HMO - 85378 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN","TUFTS","TUFTS HMO","CPT","85378","HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN","85378 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN",36,37.64,7.18,94.31,9]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 85379","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 85379","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 85379 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT","85379","HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE","85379 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE",51,14.03,9.2799999999999994,114.2,12.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 85384","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 85384","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 85384 - HC CHG FIBRINOGEN ACTIVITY","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","85384","HC CHG FIBRINOGEN ACTIVITY","85384 - HC CHG FIBRINOGEN ACTIVITY",43,24.46,7.75,96.06,10.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 85384","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 85384","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 85384 - HC CHG FIBRINOGEN ACTIVITY","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","85384","HC CHG FIBRINOGEN ACTIVITY","85384 - HC CHG FIBRINOGEN ACTIVITY",43,20.99,7.75,96.06,10.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 85461","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 85461","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 85461 - HC CHG HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","85461","HC CHG HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE","85461 - HC CHG HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE",34,16.29,6.92,90.76,8.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 85520","AETNA - AETNA-MEDICARE ADVANTAGE - 85520","AETNA - AETNA-MEDICARE ADVANTAGE - 85520 - HC CHG HEPARIN ASSAY","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","85520","HC CHG HEPARIN ASSAY","85520 - HC CHG HEPARIN ASSAY",138,15.45,11.94,146.97,34.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 85549","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 85549","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 85549 - HC CHG MURAMIDASE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","85549","HC CHG MURAMIDASE","85549 - HC CHG MURAMIDASE",91,42.16,17.100000000000001,210.55,22.75]
["FALLON - FALLON MEDICAID - CPT - 85549","FALLON - FALLON MEDICAID - 85549","FALLON - FALLON MEDICAID - 85549 - HC CHG MURAMIDASE","FALLON","FALLON MEDICAID","CPT","85549","HC CHG MURAMIDASE","85549 - HC CHG MURAMIDASE",91,17.100000000000001,17.100000000000001,210.55,22.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 85576","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 85576","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 85576 - HC CHG PLATELET AGGREGATION IN VITRO EACH AGENT","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","85576","HC CHG PLATELET AGGREGATION IN VITRO EACH AGENT","85576 - HC CHG PLATELET AGGREGATION IN VITRO EACH AGENT",311,23.06,19.59,243.68,77.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 85610","UNITED HEALTHCARE - UNITED HEALTHCARE - 85610","UNITED HEALTHCARE - UNITED HEALTHCARE - 85610 - POC;INR","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","85610","POC;INR","85610 - POC;INR",21,9.0299999999999994,3.58,44.06,5.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 85611","UNICARE - UNICARE STATE INDEMNITY PLAN - 85611","UNICARE - UNICARE STATE INDEMNITY PLAN - 85611 - HC CHG PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","85611","HC CHG PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH","85611 - HC CHG PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH",21,7.98,3.6,44.26,5.25]
["FALLON - FALLON SENIOR PLAN - CPT - 85613","FALLON - FALLON SENIOR PLAN - 85613","FALLON - FALLON SENIOR PLAN - 85613 - HC CHG RUSSELL VIPER VENOM DILUTED","FALLON","FALLON SENIOR PLAN","CPT","85613","HC CHG RUSSELL VIPER VENOM DILUTED","85613 - HC CHG RUSSELL VIPER VENOM DILUTED",13,9.58,8.23,107.56,3.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 85613","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 85613","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 85613 - HC CHG RUSSELL VIPER VENOM DILUTED","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","85613","HC CHG RUSSELL VIPER VENOM DILUTED","85613 - HC CHG RUSSELL VIPER VENOM DILUTED",13,10.49,8.23,107.56,3.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 85652","BLUE CROSS - BLUE CROSS-INDEMNITY - 85652","BLUE CROSS - BLUE CROSS-INDEMNITY - 85652 - HC CHG SEDIMENTATION RATE RBC AUTOMATED","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","85652","HC CHG SEDIMENTATION RATE RBC AUTOMATED","85652 - HC CHG SEDIMENTATION RATE RBC AUTOMATED",14,5.93,2.46,30.24,3.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 85660","BMC HEALTHNET - BMCHN MEDICAID - 85660","BMC HEALTHNET - BMCHN MEDICAID - 85660 - HC CHG SICKLING RBC REDUCTION","BMC HEALTHNET","BMCHN MEDICAID","CPT","85660","HC CHG SICKLING RBC REDUCTION","85660 - HC CHG SICKLING RBC REDUCTION",28,5.0199999999999996,5.0199999999999996,61.83,7]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 85660","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 85660","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 85660 - HC CHG SICKLING RBC REDUCTION","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","85660","HC CHG SICKLING RBC REDUCTION","85660 - HC CHG SICKLING RBC REDUCTION",28,9.59,5.0199999999999996,61.83,7]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 85670","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 85670","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 85670 - HC CHG THROMBIN TIME PLASMA","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","85670","HC CHG THROMBIN TIME PLASMA","85670 - HC CHG THROMBIN TIME PLASMA",29,6.92,5.26,64.72,7.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 85730","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 85730","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 85730 - HC CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","85730","HC CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD","85730 - HC CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD",31,13.83,5.48,67.41,7.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 85730","ELDER SERVICE PLAN - ELEMENT CARE INC - 85730","ELDER SERVICE PLAN - ELEMENT CARE INC - 85730 - HC CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","85730","HC CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD","85730 - HC CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD",31,6.01,5.48,67.41,7.75]
["TUFTS - TUFTS HMO - CPT - 85732","TUFTS - TUFTS HMO - 85732","TUFTS - TUFTS HMO - 85732 - HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA","TUFTS","TUFTS HMO","CPT","85732","HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA","85732 - HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA",33,28.95,5.9,72.55,8.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 85732","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 85732","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 85732 - HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","85732","HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA","85732 - HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA",33,15.12,5.9,72.55,8.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 86003","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 86003","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 86003 - HC CHG ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","86003","HC CHG ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN","86003 - HC CHG ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN",22,11.86,4.76,58.53,5.5]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 86021","CIGNA HEALTHCARE - CIGNA PPO - 86021","CIGNA HEALTHCARE - CIGNA PPO - 86021 - HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES","CIGNA HEALTHCARE","CIGNA PPO","CPT","86021","HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES","86021 - HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES",72,38.270000000000003,13.74,169.1,18]
["TUFTS - TUFTS PPO - CPT - 86021","TUFTS - TUFTS PPO - 86021","TUFTS - TUFTS PPO - 86021 - HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES","TUFTS","TUFTS PPO","CPT","86021","HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES","86021 - HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES",72,60.16,13.74,169.1,18]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 86022","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 86022","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 86022 - HC CRL;SEROTONIN RLS ASSAY","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","86022","HC CRL;SEROTONIN RLS ASSAY","86022 - HC CRL;SEROTONIN RLS ASSAY",265,44.07,16.760000000000002,206.23,66.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 86038","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 86038","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 86038 - HC CHG ANTINUCLEAR ANTIBODIES ANA","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT","86038","HC CHG ANTINUCLEAR ANTIBODIES ANA","86038 - HC CHG ANTINUCLEAR ANTIBODIES ANA",175,12.09,11.02,135.68,43.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 86039","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 86039","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 86039 - HC CHG ANTINUCLEAR ANTIBODIES ANA TITER","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","86039","HC CHG ANTINUCLEAR ANTIBODIES ANA TITER","86039 - HC CHG ANTINUCLEAR ANTIBODIES ANA TITER",170,26.77,10.18,125.28,42.5]
["TUFTS - TUFTS SELECT - CPT - 86060","TUFTS - TUFTS SELECT - 86060","TUFTS - TUFTS SELECT - 86060 - HC CHG ANTISTREPTOLYSIN O TITER","TUFTS","TUFTS SELECT","CPT","86060","HC CHG ANTISTREPTOLYSIN O TITER","86060 - HC CHG ANTISTREPTOLYSIN O TITER",36,12.73,6.66,81.96,9]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 86140","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 86140","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 86140 - C-REACTIVE PROTEIN","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","86140","C-REACTIVE PROTEIN","86140 - C-REACTIVE PROTEIN",106,6.41,4.72,58.08,26.5]
["BMC HEALTHNET - BMCHN QHP - CPT - 86141","BMC HEALTHNET - BMCHN QHP - 86141","BMC HEALTHNET - BMCHN QHP - 86141 - HC CRL;CARDIO CRP","BMC HEALTHNET","BMCHN QHP","CPT","86141","HC CRL;CARDIO CRP","86141 - HC CRL;CARDIO CRP",63,14.17,11.81,145.38,15.75]
["TUFTS - TUFTS HMO - CPT - 86141","TUFTS - TUFTS HMO - 86141","TUFTS - TUFTS HMO - 86141 - HC CRL;CARDIO CRP","TUFTS","TUFTS HMO","CPT","86141","HC CRL;CARDIO CRP","86141 - HC CRL;CARDIO CRP",63,58.01,11.81,145.38,15.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 86146","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 86146","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 86146 - HC CRL;BETA-2 GLYCPRTN 1 AB","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT","86146","HC CRL;BETA-2 GLYCPRTN 1 AB","86146 - HC CRL;BETA-2 GLYCPRTN 1 AB",197,35.090000000000003,18.87,285.7,49.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 86147","ELDER SERVICE PLAN - ELEMENT CARE INC - 86147","ELDER SERVICE PLAN - ELEMENT CARE INC - 86147 - HC Q;CARDLIP AB;IGG,IGM,IGA","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","86147","HC Q;CARDLIP AB;IGG,IGM,IGA","86147 - HC Q;CARDLIP AB;IGG,IGM,IGA",83,25.45,18.87,285.7,20.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 86157","CIGNA HEALTHCARE - CIGNA CARELINK - 86157","CIGNA HEALTHCARE - CIGNA CARELINK - 86157 - HC CHG COLD AGGLUTININ TITER","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","86157","HC CHG COLD AGGLUTININ TITER","86157 - HC CHG COLD AGGLUTININ TITER",38,90.48,7.35,90.48,9.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 86160","TUFTS - TUFTS MEDICARE PREFERRED HMO - 86160","TUFTS - TUFTS MEDICARE PREFERRED HMO - 86160 - HC CHG COMPLEMENT ANTIGEN EACH COMPONENT","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","86160","HC CHG COMPLEMENT ANTIGEN EACH COMPONENT","86160 - HC CHG COMPLEMENT ANTIGEN EACH COMPONENT",61,17.399999999999999,10.94,134.62,15.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 86160","UNITED HEALTHCARE - UNITED HEALTHCARE - 86160","UNITED HEALTHCARE - UNITED HEALTHCARE - 86160 - HC CHG COMPLEMENT ANTIGEN EACH COMPONENT","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","86160","HC CHG COMPLEMENT ANTIGEN EACH COMPONENT","86160 - HC CHG COMPLEMENT ANTIGEN EACH COMPONENT",61,25.27,10.94,134.62,15.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 86162","BLUE CROSS - BLUE CROSS-PPO - 86162","BLUE CROSS - BLUE CROSS-PPO - 86162 - HC CHG COMPLEMENT TOTAL HEMOLYTIC","BLUE CROSS","BLUE CROSS-PPO","CPT","86162","HC CHG COMPLEMENT TOTAL HEMOLYTIC","86162 - HC CHG COMPLEMENT TOTAL HEMOLYTIC",98,46.11,18.54,228.19,24.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 86200","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - 86200","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - 86200 - HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","86200","HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY","86200 - HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY",63,17.760000000000002,11.81,145.38,15.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 86200","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 86200","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 86200 - HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","86200","HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY","86200 - HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY",63,13.9,11.81,145.38,15.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 86255","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 86255","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 86255 - HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","86255","HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY","86255 - HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY",35,14.91,10.99,135.27000000000001,8.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 86255","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 86255","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 86255 - HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","86255","HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY","86255 - HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY",35,28.2,10.99,135.27000000000001,8.75]
["FALLON - FALLON SENIOR PLAN - CPT - 86256","FALLON - FALLON SENIOR PLAN - 86256","FALLON - FALLON SENIOR PLAN - 86256 - HC CHG FLUORESCENT ANTIBODY; TITER","FALLON","FALLON SENIOR PLAN","CPT","86256","HC CHG FLUORESCENT ANTIBODY; TITER","86256 - HC CHG FLUORESCENT ANTIBODY; TITER",53,12.05,10.99,135.27000000000001,13.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 86300","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 86300","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 86300 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT","86300","HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3","86300 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3",96,28.06,18.989999999999998,233.69,24]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 86301","BLUE CROSS - BLUE CROSS-INDEMNITY - 86301","BLUE CROSS - BLUE CROSS-INDEMNITY - 86301 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","86301","HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9","86301 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9",100,46.77,18.989999999999998,233.69,25]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 86304","BMC HEALTHNET - BMCHN MEDICAID - 86304","BMC HEALTHNET - BMCHN MEDICAID - 86304 - HC CRL;CA-125","BMC HEALTHNET","BMCHN MEDICAID","CPT","86304","HC CRL;CA-125","86304 - HC CRL;CA-125",100,18.989999999999998,18.989999999999998,233.69,25]
["TUFTS - TUFTS POS - CPT - 86304","TUFTS - TUFTS POS - 86304","TUFTS - TUFTS POS - 86304 - HC CRL;CA-125","TUFTS","TUFTS POS","CPT","86304","HC CRL;CA-125","86304 - HC CRL;CA-125",100,77.72,18.989999999999998,233.69,25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 86308","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 86308","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 86308 - HC CHG HETEROPHILE ANTIBODIES SCREEN","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","86308","HC CHG HETEROPHILE ANTIBODIES SCREEN","86308 - HC CHG HETEROPHILE ANTIBODIES SCREEN",24,6.22,4.72,58.08,6]
["UNICARE - UNICARE - CPT - 86316","UNICARE - UNICARE - 86316","UNICARE - UNICARE - 86316 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE","UNICARE","UNICARE","CPT","86316","HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE","86316 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE",93,50.5,18.989999999999998,233.69,23.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 86317","ELDER SERVICE PLAN - ELEMENT CARE INC - 86317","ELDER SERVICE PLAN - ELEMENT CARE INC - 86317 - HC IMMUNOASSAY,INFECT AGENT,QUANT","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","86317","HC IMMUNOASSAY,INFECT AGENT,QUANT","86317 - HC IMMUNOASSAY,INFECT AGENT,QUANT",72,14.99,13.67,168.24,18]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 86328","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 86328","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 86328 - IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY; CORONAVIRUS 2","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","86328","IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY; CORONAVIRUS 2","86328 - IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY; CORONAVIRUS 2",203,53.24,45.23,410.13,50.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 86331","BMC HEALTHNET - BMCHN ACO - 86331","BMC HEALTHNET - BMCHN ACO - 86331 - HC CHG IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY","BMC HEALTHNET","BMCHN ACO","CPT","86331","HC CHG IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY","86331 - HC CHG IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY",57,23.91,10.93,134.44999999999999,14.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 86334","ELDER SERVICE PLAN - ELEMENT CARE INC - 86334","ELDER SERVICE PLAN - ELEMENT CARE INC - 86334 - HC CHG IMMUNOFIXJ ELECTROPHORESIS SERUM","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","86334","HC CHG IMMUNOFIXJ ELECTROPHORESIS SERUM","86334 - HC CHG IMMUNOFIXJ ELECTROPHORESIS SERUM",80,22.34,20.39,250.85,20]
["TUFTS - TUFTS MEDICARE SCO - CPT - 86335","TUFTS - TUFTS MEDICARE SCO - 86335","TUFTS - TUFTS MEDICARE SCO - 86335 - HC CHG IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS","TUFTS","TUFTS MEDICARE SCO","CPT","86335","HC CHG IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS","86335 - HC CHG IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS",138,42.56,26.77,329.47,34.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 86336","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 86336","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 86336 - HC CHG INHIBIN A","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","86336","HC CHG INHIBIN A","86336 - HC CHG INHIBIN A",76,34.909999999999997,14.22,174.97,19]
["BMC HEALTHNET - BMCHN ACO - CPT - 86340","BMC HEALTHNET - BMCHN ACO - 86340","BMC HEALTHNET - BMCHN ACO - 86340 - HC CHG INTRINSIC FACTOR ANTIBODIES","BMC HEALTHNET","BMCHN ACO","CPT","86340","HC CHG INTRINSIC FACTOR ANTIBODIES","86340 - HC CHG INTRINSIC FACTOR ANTIBODIES",73,30.08,13.75,169.26,18.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 86341","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 86341","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 86341 - HC CHG ISLET CELL ANTIBODY","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","86341","HC CHG ISLET CELL ANTIBODY","86341 - HC CHG ISLET CELL ANTIBODY",96,50.89,18.05,228.64,24]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 86341","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 86341","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 86341 - HC CHG ISLET CELL ANTIBODY","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","86341","HC CHG ISLET CELL ANTIBODY","86341 - HC CHG ISLET CELL ANTIBODY",96,28.28,18.05,228.64,24]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 86355","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 86355","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 86355 - HC B CELLS TOTAL COUNT","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","86355","HC B CELLS TOTAL COUNT","86355 - HC B CELLS TOTAL COUNT",412,46.71,15.71,423.58,103]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 86355","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 86355","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 86355 - HC B CELLS TOTAL COUNT","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT","86355","HC B CELLS TOTAL COUNT","86355 - HC B CELLS TOTAL COUNT",412,37.729999999999997,15.71,423.58,103]
["TUFTS - TUFTS PPO - CPT - 86357","TUFTS - TUFTS PPO - 86357","TUFTS - TUFTS PPO - 86357 - HC NK CELLS, TOTAL COUNT","TUFTS","TUFTS PPO","CPT","86357","HC NK CELLS, TOTAL COUNT","86357 - HC NK CELLS, TOTAL COUNT",412,150.69999999999999,15.71,423.58,103]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 86359","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 86359","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 86359 - HC CHG T CELLS TOTAL COUNT","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","86359","HC CHG T CELLS TOTAL COUNT","86359 - HC CHG T CELLS TOTAL COUNT",57,90.51,15.71,423.58,14.25]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 86360","BMC HEALTHNET - BMCHN MEDICAID - 86360","BMC HEALTHNET - BMCHN MEDICAID - 86360 - HC CHG T CELLS ABSOLUTE CD4&CD8 COUNT RATIO","BMC HEALTHNET","BMCHN MEDICAID","CPT","86360","HC CHG T CELLS ABSOLUTE CD4&CD8 COUNT RATIO","86360 - HC CHG T CELLS ABSOLUTE CD4&CD8 COUNT RATIO",69,42.86,18.87,527.5,17.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 86360","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 86360","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 86360 - HC CHG T CELLS ABSOLUTE CD4&CD8 COUNT RATIO","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","86360","HC CHG T CELLS ABSOLUTE CD4&CD8 COUNT RATIO","86360 - HC CHG T CELLS ABSOLUTE CD4&CD8 COUNT RATIO",69,109.93,18.87,527.5,17.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 86376","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 86376","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 86376 - HC CHG MICROSOMAL ANTIBODIES EACH","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","86376","HC CHG MICROSOMAL ANTIBODIES EACH","86376 - HC CHG MICROSOMAL ANTIBODIES EACH",70,17.46,13.27,163.31,17.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 86403","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 86403","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 86403 - HC CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","86403","HC CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY","86403 - HC CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY",269,12.61,9.2899999999999991,114.93,67.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 86431","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 86431","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 86431 - HC CHG RHEUMATOID FACTOR QUANTITATIVE","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","86431","HC CHG RHEUMATOID FACTOR QUANTITATIVE","86431 - HC CHG RHEUMATOID FACTOR QUANTITATIVE",27,12.53,5.17,63.66,6.75]
["TUFTS - TUFTS HMO - CPT - 86431","TUFTS - TUFTS HMO - 86431","TUFTS - TUFTS HMO - 86431 - HC CHG RHEUMATOID FACTOR QUANTITATIVE","TUFTS","TUFTS HMO","CPT","86431","HC CHG RHEUMATOID FACTOR QUANTITATIVE","86431 - HC CHG RHEUMATOID FACTOR QUANTITATIVE",27,25.42,5.17,63.66,6.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 86480","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 86480","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 86480 - HC CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","86480","HC CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON","86480 - HC CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON",93,74.38,56.54,695.83,23.25]
["BMC HEALTHNET - BMCHN ACO - CPT - 86481","BMC HEALTHNET - BMCHN ACO - 86481","BMC HEALTHNET - BMCHN ACO - 86481 - HC TB TEST CELL MEDIATED ANTIGEN RESPONSE, ENUM GAMMA INTERFRON T-CELL","BMC HEALTHNET","BMCHN ACO","CPT","86481","HC TB TEST CELL MEDIATED ANTIGEN RESPONSE, ENUM GAMMA INTERFRON T-CELL","86481 - HC TB TEST CELL MEDIATED ANTIGEN RESPONSE, ENUM GAMMA INTERFRON T-CELL",127,161.66999999999999,73.89,969.95,31.75]
["TUFTS - TUFTS HMO - CPT - 86486","TUFTS - TUFTS HMO - 86486","TUFTS - TUFTS HMO - 86486 - SKIN TEST UNLISTED ANTIGEN EACH","TUFTS","TUFTS HMO","CPT","86486","SKIN TEST UNLISTED ANTIGEN EACH","86486 - SKIN TEST UNLISTED ANTIGEN EACH",34,79.55,4.09,199.34,8.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 86592","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 86592","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 86592 - HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","86592","HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL","86592 - HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL",28,9.8800000000000008,3.89,47.89,7]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 86592","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - 86592","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - 86592 - HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","86592","HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL","86592 - HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL",28,5.86,3.89,47.89,7]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 86593","TUFTS - TUFTS MEDICARE PREFERRED HMO - 86593","TUFTS - TUFTS MEDICARE PREFERRED HMO - 86593 - HC SYPHILIS;QN","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","86593","HC SYPHILIS;QN","86593 - HC SYPHILIS;QN",23,6.38,4.0199999999999996,49.48,5.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 86606","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 86606","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 86606 - HC CHG ANTIBODY ASPERGILLUS","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","86606","HC CHG ANTIBODY ASPERGILLUS","86606 - HC CHG ANTIBODY ASPERGILLUS",71,18.649999999999999,13.74,169.1,17.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 86609","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 86609","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 86609 - HC CHG ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","86609","HC CHG ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED","86609 - HC CHG ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED",48,28.46,11.75,144.6,12]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 86611","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 86611","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 86611 - HC BARTONELLA, ANTIBODY","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","86611","HC BARTONELLA, ANTIBODY","86611 - HC BARTONELLA, ANTIBODY",61,10.18,9.2799999999999994,114.2,15.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 86612","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 86612","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 86612 - HC CHG BLASTOMYCES ANTIBODY","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","86612","HC CHG BLASTOMYCES ANTIBODY","86612 - HC CHG BLASTOMYCES ANTIBODY",83,28.98,11.77,144.88999999999999,20.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 86612","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 86612","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 86612 - HC CHG BLASTOMYCES ANTIBODY","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","86612","HC CHG BLASTOMYCES ANTIBODY","86612 - HC CHG BLASTOMYCES ANTIBODY",83,30.96,11.77,144.88999999999999,20.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 86617","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 86617","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 86617 - HC CHG ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","86617","HC CHG ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST","86617 - HC CHG ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST",27,34.909999999999997,14.13,173.95,6.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 86617","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 86617","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 86617 - HC CHG ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","86617","HC CHG ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST","86617 - HC CHG ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST",27,37.159999999999997,14.13,173.95,6.75]
["TUFTS - TUFTS SPIRIT - CPT - 86618","TUFTS - TUFTS SPIRIT - 86618","TUFTS - TUFTS SPIRIT - 86618 - HC Q;LYME AB INDEX CNS INFEC","TUFTS","TUFTS SPIRIT","CPT","86618","HC Q;LYME AB INDEX CNS INFEC","86618 - HC Q;LYME AB INDEX CNS INFEC",191,18.73,15.53,191.1,47.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 86622","BLUE CROSS - BLUE CROSS-PPO - 86622","BLUE CROSS - BLUE CROSS-PPO - 86622 - HC CHG ANTIBODY BRUCELLA","BLUE CROSS","BLUE CROSS-PPO","CPT","86622","HC CHG ANTIBODY BRUCELLA","86622 - HC CHG ANTIBODY BRUCELLA",79,20.420000000000002,8.15,100.26,19.75]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 86625","BMC HEALTHNET - BMCHN WELL SENSE - 86625","BMC HEALTHNET - BMCHN WELL SENSE - 86625 - HC CAMPYLOBACTER, ANTIBODY","BMC HEALTHNET","BMCHN WELL SENSE","CPT","86625","HC CAMPYLOBACTER, ANTIBODY","86625 - HC CAMPYLOBACTER, ANTIBODY",16,24.82,11.97,147.33000000000001,4]
["FALLON - FALLON SENIOR PLAN - CPT - 86631","FALLON - FALLON SENIOR PLAN - 86631","FALLON - FALLON SENIOR PLAN - 86631 - HC CHG, CHLAMYDIA, ANTIBODY","FALLON","FALLON SENIOR PLAN","CPT","86631","HC CHG, CHLAMYDIA, ANTIBODY","86631 - HC CHG, CHLAMYDIA, ANTIBODY",52,11.82,10.79,132.78,13]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 86631","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 86631","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 86631 - HC CHG, CHLAMYDIA, ANTIBODY","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT","86631","HC CHG, CHLAMYDIA, ANTIBODY","86631 - HC CHG, CHLAMYDIA, ANTIBODY",52,16.309999999999999,10.79,132.78,13]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86635","BLUE CROSS - BLUE CROSS-HMO BLUE - 86635","BLUE CROSS - BLUE CROSS-HMO BLUE - 86635 - HC CHG ANTIBODY COCCIDIOIDES","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","86635","HC CHG ANTIBODY COCCIDIOIDES","86635 - HC CHG ANTIBODY COCCIDIOIDES",42,25.69,10.47,128.83000000000001,10.5]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 86635","CIGNA HEALTHCARE - CIGNA PPO - 86635","CIGNA HEALTHCARE - CIGNA PPO - 86635 - HC CHG ANTIBODY COCCIDIOIDES","CIGNA HEALTHCARE","CIGNA PPO","CPT","86635","HC CHG ANTIBODY COCCIDIOIDES","86635 - HC CHG ANTIBODY COCCIDIOIDES",42,29.16,10.47,128.83000000000001,10.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 86638","TUFTS - TUFTS MEDICARE SCO - 86638","TUFTS - TUFTS MEDICARE SCO - 86638 - HC CHG, Q FEVER ANTIBODY","TUFTS","TUFTS MEDICARE SCO","CPT","86638","HC CHG, Q FEVER ANTIBODY","86638 - HC CHG, Q FEVER ANTIBODY",63,17.57,11.06,136.13,15.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 86644","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 86644","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 86644 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","86644","HC CHG ANTIBODY CYTOMEGALOVIRUS CMV","86644 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV",72,17.27,13.13,161.6,18]
["BMC HEALTHNET - BMCHN ACO - CPT - 86645","BMC HEALTHNET - BMCHN ACO - 86645","BMC HEALTHNET - BMCHN ACO - 86645 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV IGM","BMC HEALTHNET","BMCHN ACO","CPT","86645","HC CHG ANTIBODY CYTOMEGALOVIRUS CMV IGM","86645 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV IGM",71,33.630000000000003,15.37,189.15,17.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 86648","ELDER SERVICE PLAN - ELEMENT CARE INC - 86648","ELDER SERVICE PLAN - ELEMENT CARE INC - 86648 - HC CHG ANTIBODY DIPHTHERIA","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","86648","HC CHG ANTIBODY DIPHTHERIA","86648 - HC CHG ANTIBODY DIPHTHERIA",83,15.21,13.39,170.69,20.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 86648","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 86648","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 86648 - HC CHG ANTIBODY DIPHTHERIA","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","86648","HC CHG ANTIBODY DIPHTHERIA","86648 - HC CHG ANTIBODY DIPHTHERIA",83,18.25,13.39,170.69,20.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 86654","AETNA - AETNA-MEDICARE ADVANTAGE - 86654","AETNA - AETNA-MEDICARE ADVANTAGE - 86654 - CHG ANTIBODY ENCEPHALITIS WESTRN EQUINE","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","86654","CHG ANTIBODY ENCEPHALITIS WESTRN EQUINE","86654 - CHG ANTIBODY ENCEPHALITIS WESTRN EQUINE",28,15.56,12.03,148.07,7]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 86658","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 86658","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 86658 - HC CHG ENTEROVIRUS ANTIBODY","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","86658","HC CHG ENTEROVIRUS ANTIBODY","86658 - HC CHG ENTEROVIRUS ANTIBODY",70,29.65,11.88,146.19,17.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 86658","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - 86658","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - 86658 - HC CHG ENTEROVIRUS ANTIBODY","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","86658","HC CHG ENTEROVIRUS ANTIBODY","86658 - HC CHG ENTEROVIRUS ANTIBODY",70,28.13,11.88,146.19,17.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 86663","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 86663","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 86663 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","86663","HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA","86663 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA",37,14.09,11.97,147.33000000000001,9.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86664","BLUE CROSS - BLUE CROSS-HMO BLUE - 86664","BLUE CROSS - BLUE CROSS-HMO BLUE - 86664 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","86664","HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA","86664 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA",37,34.26,13.95,171.71,9.25]
["CIGNA HEALTHCARE - CIGNA - CPT - 86665","CIGNA HEALTHCARE - CIGNA - 86665","CIGNA HEALTHCARE - CIGNA - 86665 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA","CIGNA HEALTHCARE","CIGNA","CPT","86665","HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA","86665 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA",37,64.39,16.55,203.74,9.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 86666","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 86666","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 86666 - HC CHG ANTIBODY EHRLICHIA","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","86666","HC CHG ANTIBODY EHRLICHIA","86666 - HC CHG ANTIBODY EHRLICHIA",77,24.42,9.2799999999999994,114.2,19.25]
["BMC HEALTHNET - BMCHN QHP - CPT - 86677","BMC HEALTHNET - BMCHN QHP - 86677","BMC HEALTHNET - BMCHN QHP - 86677 - HC CHG ANTIBODY HELICOBACTER PYLORI","BMC HEALTHNET","BMCHN QHP","CPT","86677","HC CHG ANTIBODY HELICOBACTER PYLORI","86677 - HC CHG ANTIBODY HELICOBACTER PYLORI",66,15.88,13.23,164.61,16.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 86682","BLUE CROSS - BLUE CROSS-INDEMNITY - 86682","BLUE CROSS - BLUE CROSS-INDEMNITY - 86682 - HC Q;CYSTICERCUS AB,BLOT","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","86682","HC Q;CYSTICERCUS AB,BLOT","86682 - HC Q;CYSTICERCUS AB,BLOT",104,29.65,11.87,146.03,26]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 86682","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 86682","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 86682 - HC Q;CYSTICERCUS AB,BLOT","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","86682","HC Q;CYSTICERCUS AB,BLOT","86682 - HC Q;CYSTICERCUS AB,BLOT",104,13.01,11.87,146.03,26]
["TUFTS - TUFTS POS - CPT - 86689","TUFTS - TUFTS POS - 86689","TUFTS - TUFTS POS - 86689 - HC HTLV/HIV CONFIRMATORY TEST","TUFTS","TUFTS POS","CPT","86689","HC HTLV/HIV CONFIRMATORY TEST","86689 - HC HTLV/HIV CONFIRMATORY TEST",52,72.28,17.66,217.35,13]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 86692","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 86692","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 86692 - HC CHG ANTIBODY HEP DELTA AGENT","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","86692","HC CHG ANTIBODY HEP DELTA AGENT","86692 - HC CHG ANTIBODY HEP DELTA AGENT",143,20.59,15.66,192.69,35.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 86694","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 86694","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 86694 - HC CHG ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","86694","HC CHG ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST","86694 - HC CHG ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST",34,32.28,13.13,161.6,8.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 86695","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - 86695","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - 86695 - HC CHG ANTIBODY HERPES SMPLX TYPE 1","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","86695","HC CHG ANTIBODY HERPES SMPLX TYPE 1","86695 - HC CHG ANTIBODY HERPES SMPLX TYPE 1",66,18.09,12.03,148.07,16.5]
["BMC HEALTHNET - BMCHN MCO - CPT - 86696","BMC HEALTHNET - BMCHN MCO - 86696","BMC HEALTHNET - BMCHN MCO - 86696 - HC CHG ANTIBODY HERPES SMPLX TYPE 2","BMC HEALTHNET","BMCHN MCO","CPT","86696","HC CHG ANTIBODY HERPES SMPLX TYPE 2","86696 - HC CHG ANTIBODY HERPES SMPLX TYPE 2",77,17.66,17.66,217.35,19.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 86698","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 86698","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 86698 - HC CHG ANTIBODY HISTOPLASMA","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","86698","HC CHG ANTIBODY HISTOPLASMA","86698 - HC CHG ANTIBODY HISTOPLASMA",28,13.45,11.4,140.32,7]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 86701","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 86701","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 86701 - HC HIV-1","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","86701","HC HIV-1","86701 - HC HIV-1",44,19.760000000000002,8.11,99.73,11]
["FALLON - FALLON SENIOR PLAN - CPT - 86701","FALLON - FALLON SENIOR PLAN - 86701","FALLON - FALLON SENIOR PLAN - 86701 - HC HIV-1","FALLON","FALLON SENIOR PLAN","CPT","86701","HC HIV-1","86701 - HC HIV-1",44,8.89,8.11,99.73,11]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 86702","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 86702","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 86702 - HC QL/SEMI MULT AB;HIV2","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT","86702","HC QL/SEMI MULT AB;HIV2","86702 - HC QL/SEMI MULT AB;HIV2",82,18.23,12.33,151.72999999999999,20.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 86703","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 86703","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 86703 - HC HIV 1/2 ANTIBODY","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","86703","HC HIV 1/2 ANTIBODY","86703 - HC HIV 1/2 ANTIBODY",50,32.880000000000003,12.5,153.85,12.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 86704","BMC HEALTHNET - BMCHN MEDICAID - 86704","BMC HEALTHNET - BMCHN MEDICAID - 86704 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB TOTAL","BMC HEALTHNET","BMCHN MEDICAID","CPT","86704","HC CHG HEPATITIS B CORE ANTIBODY HBCAB TOTAL","86704 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB TOTAL",61,10.99,10.99,135.27000000000001,15.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 86705","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 86705","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 86705 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","86705","HC CHG HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY","86705 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY",60,26.01,10.74,132.21,15]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 86705","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 86705","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 86705 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","86705","HC CHG HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY","86705 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY",60,14.12,10.74,132.21,15]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 86707","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 86707","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 86707 - HC CHG HEPATITIS BE ANTIBODY HBEAB","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","86707","HC CHG HEPATITIS BE ANTIBODY HBEAB","86707 - HC CHG HEPATITIS BE ANTIBODY HBEAB",56,29.11,10.55,129.88999999999999,14]
["BMC HEALTHNET - BMCHN QHP - CPT - 86708","BMC HEALTHNET - BMCHN QHP - 86708","BMC HEALTHNET - BMCHN QHP - 86708 - HC CHG HEPATITIS A ANTIBODY HAAB","BMC HEALTHNET","BMCHN QHP","CPT","86708","HC CHG HEPATITIS A ANTIBODY HAAB","86708 - HC CHG HEPATITIS A ANTIBODY HAAB",58,13.56,11.3,139.02000000000001,14.5]
["TUFTS - TUFTS HMO - CPT - 86708","TUFTS - TUFTS HMO - 86708","TUFTS - TUFTS HMO - 86708 - HC CHG HEPATITIS A ANTIBODY HAAB","TUFTS","TUFTS HMO","CPT","86708","HC CHG HEPATITIS A ANTIBODY HAAB","86708 - HC CHG HEPATITIS A ANTIBODY HAAB",58,55.49,11.3,139.02000000000001,14.5]
["UNICARE - UNICARE - CPT - 86709","UNICARE - UNICARE - 86709","UNICARE - UNICARE - 86709 - HC CHG HEPATITIS ANTIBODY HAAB IGM ANTIBODY","UNICARE","UNICARE","CPT","86709","HC CHG HEPATITIS ANTIBODY HAAB IGM ANTIBODY","86709 - HC CHG HEPATITIS ANTIBODY HAAB IGM ANTIBODY",56,27.32,10.27,126.43,14]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 86710","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 86710","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 86710 - HC INFLUENZA VIRUS","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","86710","HC INFLUENZA VIRUS","86710 - HC INFLUENZA VIRUS",35,30.3,12.36,152.1,8.75]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 86735","CIGNA HEALTHCARE - CIGNA PPO - 86735","CIGNA HEALTHCARE - CIGNA PPO - 86735 - HC CHG ANTIBODY MUMPS","CIGNA HEALTHCARE","CIGNA PPO","CPT","86735","HC CHG ANTIBODY MUMPS","86735 - HC CHG ANTIBODY MUMPS",65,33.17,11.9,146.47999999999999,16.25]
["TUFTS - TUFTS POS - CPT - 86738","TUFTS - TUFTS POS - 86738","TUFTS - TUFTS POS - 86738 - HC CHG ANTIBODY MYCOPLSM","TUFTS","TUFTS POS","CPT","86738","HC CHG ANTIBODY MYCOPLSM","86738 - HC CHG ANTIBODY MYCOPLSM",32,49.43,12.07,148.63999999999999,8]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 86738","UNITED HEALTHCARE - UNITED HEALTHCARE - 86738","UNITED HEALTHCARE - UNITED HEALTHCARE - 86738 - HC CHG ANTIBODY MYCOPLSM","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","86738","HC CHG ANTIBODY MYCOPLSM","86738 - HC CHG ANTIBODY MYCOPLSM",32,27.88,12.07,148.63999999999999,8]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 86747","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 86747","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 86747 - HC CHG ANTIBODY PARVOVIRUS","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","86747","HC CHG ANTIBODY PARVOVIRUS","86747 - HC CHG ANTIBODY PARVOVIRUS",26,33.21,12.77,168.81,6.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 86747","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 86747","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 86747 - HC CHG ANTIBODY PARVOVIRUS","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","86747","HC CHG ANTIBODY PARVOVIRUS","86747 - HC CHG ANTIBODY PARVOVIRUS",26,36.06,12.77,168.81,6.5]
["TUFTS - TUFTS SELECT - CPT - 86753","TUFTS - TUFTS SELECT - 86753","TUFTS - TUFTS SELECT - 86753 - HC CHG ANTIBODY PROTOZOA NES","TUFTS","TUFTS SELECT","CPT","86753","HC CHG ANTIBODY PROTOZOA NES","86753 - HC CHG ANTIBODY PROTOZOA NES",42,21.59,11.3,139.02000000000001,10.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 86762","AETNA - AETNA-MEDICARE ADVANTAGE - 86762","AETNA - AETNA-MEDICARE ADVANTAGE - 86762 - HC CHG ANTIBODY RUBELLA","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","86762","HC CHG ANTIBODY RUBELLA","86762 - HC CHG ANTIBODY RUBELLA",70,16.98,13.13,161.6,17.5]
["BMC HEALTHNET - BMCHN QHP - CPT - 86762","BMC HEALTHNET - BMCHN QHP - 86762","BMC HEALTHNET - BMCHN QHP - 86762 - HC CHG ANTIBODY RUBELLA","BMC HEALTHNET","BMCHN QHP","CPT","86762","HC CHG ANTIBODY RUBELLA","86762 - HC CHG ANTIBODY RUBELLA",70,15.76,13.13,161.6,17.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 86765","TUFTS - TUFTS MEDICARE PREFERRED HMO - 86765","TUFTS - TUFTS MEDICARE PREFERRED HMO - 86765 - HC CHG ANTIBODY RUBEOLA","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","86765","HC CHG ANTIBODY RUBEOLA","86765 - HC CHG ANTIBODY RUBEOLA",102,18.68,11.75,144.6,25.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 86765","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 86765","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 86765 - HC CHG ANTIBODY RUBEOLA","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","86765","HC CHG ANTIBODY RUBEOLA","86765 - HC CHG ANTIBODY RUBEOLA",102,15.46,11.75,144.6,25.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 86774","BMC HEALTHNET - BMCHN MEDICAID - 86774","BMC HEALTHNET - BMCHN MEDICAID - 86774 - HC CHG ANTIBODY TETANUS","BMC HEALTHNET","BMCHN MEDICAID","CPT","86774","HC CHG ANTIBODY TETANUS","86774 - HC CHG ANTIBODY TETANUS",83,13.5,12.77,166.08,20.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 86777","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 86777","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 86777 - HC CHG ANTIBODY TOXOPLASMA","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","86777","HC CHG ANTIBODY TOXOPLASMA","86777 - HC CHG ANTIBODY TOXOPLASMA",180,34.520000000000003,13.13,161.6,45]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 86777","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 86777","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 86777 - HC CHG ANTIBODY TOXOPLASMA","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","86777","HC CHG ANTIBODY TOXOPLASMA","86777 - HC CHG ANTIBODY TOXOPLASMA",180,17.27,13.13,161.6,45]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 86780","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 86780","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 86780 - HC CHG ANTIBODY TREPONEMA PALLIDUM","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","86780","HC CHG ANTIBODY TREPONEMA PALLIDUM","86780 - HC CHG ANTIBODY TREPONEMA PALLIDUM",61,29.65,12.07,148.63999999999999,15.25]
["FALLON - FALLON MEDICAID - CPT - 86780","FALLON - FALLON MEDICAID - 86780","FALLON - FALLON MEDICAID - 86780 - HC CHG ANTIBODY TREPONEMA PALLIDUM","FALLON","FALLON MEDICAID","CPT","86780","HC CHG ANTIBODY TREPONEMA PALLIDUM","86780 - HC CHG ANTIBODY TREPONEMA PALLIDUM",61,12.07,12.07,148.63999999999999,15.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 86787","UNITED HEALTHCARE - UNITED HEALTHCARE - 86787","UNITED HEALTHCARE - UNITED HEALTHCARE - 86787 - HC CHG ANTIBODY VARICELLA-ZOSTER","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","86787","HC CHG ANTIBODY VARICELLA-ZOSTER","86787 - HC CHG ANTIBODY VARICELLA-ZOSTER",101,27.13,11.75,144.6,25.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 86788","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 86788","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 86788 - HC CHG ANTIBODY WEST NILE VIRUS IGM","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","86788","HC CHG ANTIBODY WEST NILE VIRUS IGM","86788 - HC CHG ANTIBODY WEST NILE VIRUS IGM",88,40.42,15.37,189.15,22]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 86789","BMC HEALTHNET - BMCHN MEDICAID - 86789","BMC HEALTHNET - BMCHN MEDICAID - 86789 - HC CHG ANTIBODY WEST NILE VIRUS","BMC HEALTHNET","BMCHN MEDICAID","CPT","86789","HC CHG ANTIBODY WEST NILE VIRUS","86789 - HC CHG ANTIBODY WEST NILE VIRUS",79,13.13,13.13,161.6,19.75]
["FALLON - FALLON SENIOR PLAN - CPT - 86790","FALLON - FALLON SENIOR PLAN - 86790","FALLON - FALLON SENIOR PLAN - 86790 - HC CHG ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED","FALLON","FALLON SENIOR PLAN","CPT","86790","HC CHG ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED","86790 - HC CHG ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED",32,12.88,11.75,144.6,8]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 86790","UNICARE - UNICARE STATE INDEMNITY PLAN - 86790","UNICARE - UNICARE STATE INDEMNITY PLAN - 86790 - HC CHG ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","86790","HC CHG ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED","86790 - HC CHG ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED",32,18.809999999999999,11.75,144.6,8]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 86803","BLUE CROSS - BLUE CROSS-INDEMNITY - 86803","BLUE CROSS - BLUE CROSS-INDEMNITY - 86803 - HC CHG HEPATITIS C ANTIBODY","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","86803","HC CHG HEPATITIS C ANTIBODY","86803 - HC CHG HEPATITIS C ANTIBODY",58,32.28,13.01,160.13,14.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 86807","BMC HEALTHNET - BMCHN MEDICAID - 86807","BMC HEALTHNET - BMCHN MEDICAID - 86807 - HC CHG SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH","BMC HEALTHNET","BMCHN MEDICAID","CPT","86807","HC CHG SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH","86807 - HC CHG SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH",183,58.11,54.29,762.87,45.75]
["TUFTS - TUFTS POS - CPT - 86807","TUFTS - TUFTS POS - 86807","TUFTS - TUFTS POS - 86807 - HC CHG SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH","TUFTS","TUFTS POS","CPT","86807","HC CHG SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH","86807 - HC CHG SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH",183,253.72,54.29,762.87,45.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 86812","TUFTS - TUFTS MEDICARE PREFERRED HMO - 86812","TUFTS - TUFTS MEDICARE PREFERRED HMO - 86812 - HC CHG HLA TYPING A/B/C SINGLE ANTIGEN","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","86812","HC CHG HLA TYPING A/B/C SINGLE ANTIGEN","86812 - HC CHG HLA TYPING A/B/C SINGLE ANTIGEN",119,37.42,23.54,289.69,29.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 86813","BMC HEALTHNET - BMCHN ACO - 86813","BMC HEALTHNET - BMCHN ACO - 86813 - HC CHG HLA TYPING A/B/C MULTIPLE ANTIGENS","BMC HEALTHNET","BMCHN ACO","CPT","86813","HC CHG HLA TYPING A/B/C MULTIPLE ANTIGENS","86813 - HC CHG HLA TYPING A/B/C MULTIPLE ANTIGENS",266,115.75,52.9,651.04,66.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 86817","ELDER SERVICE PLAN - ELEMENT CARE INC - 86817","ELDER SERVICE PLAN - ELEMENT CARE INC - 86817 - HC CHG HLA TYPING DR/DQ MULTIPLE ANTIGENS","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","86817","HC CHG HLA TYPING DR/DQ MULTIPLE ANTIGENS","86817 - HC CHG HLA TYPING DR/DQ MULTIPLE ANTIGENS",296,106.14,78.42,1029.42,74]
["TUFTS - TUFTS MEDICARE SCO - CPT - 86850","TUFTS - TUFTS MEDICARE SCO - 86850","TUFTS - TUFTS MEDICARE SCO - 86850 - HC CHG ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE","TUFTS","TUFTS MEDICARE SCO","CPT","86850","HC CHG ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE","86850 - HC CHG ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE",87,14.17,5.25,501.09,21.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 86860","BLUE CROSS - BLUE CROSS-PPO - 86860","BLUE CROSS - BLUE CROSS-PPO - 86860 - HC CHG ANTIBODY ELUTION RBC EACH ELUTION","BLUE CROSS","BLUE CROSS-PPO","CPT","86860","HC CHG ANTIBODY ELUTION RBC EACH ELUTION","86860 - HC CHG ANTIBODY ELUTION RBC EACH ELUTION",142,190.34,23.92,1356.56,35.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 86880","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 86880","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 86880 - HC CHG ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","86880","HC CHG ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM","86880 - HC CHG ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM",142,42.24,4.91,366.72,35.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 86886","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 86886","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 86886 - HC CHG ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT","86886","HC CHG ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER","86886 - HC CHG ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER",315,5.18,4.72,1267.31,78.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 86886","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 86886","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 86886 - HC CHG ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","86886","HC CHG ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER","86886 - HC CHG ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER",315,9.01,4.72,1267.31,78.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 86900","UNITED HEALTHCARE - UNITED HEALTHCARE - 86900","UNITED HEALTHCARE - UNITED HEALTHCARE - 86900 - HC CHG BLOOD TYPING SEROLOGIC ABO","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","86900","HC CHG BLOOD TYPING SEROLOGIC ABO","86900 - HC CHG BLOOD TYPING SEROLOGIC ABO",87,6.3,2.73,923.73,21.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 86901","CIGNA HEALTHCARE - CIGNA CARELINK - 86901","CIGNA HEALTHCARE - CIGNA CARELINK - 86901 - HC CHG BLOOD TYPING SEROLOGIC RH (D)","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","86901","HC CHG BLOOD TYPING SEROLOGIC RH (D)","86901 - HC CHG BLOOD TYPING SEROLOGIC RH (D)",87,348.71,2.73,348.71,21.75]
["TUFTS - TUFTS HMO - CPT - 86902","TUFTS - TUFTS HMO - 86902","TUFTS - TUFTS HMO - 86902 - HC CHG BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH","TUFTS","TUFTS HMO","CPT","86902","HC CHG BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH","86902 - HC CHG BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH",87,906.96,4.6900000000000004,2272.4699999999998,21.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 86905","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 86905","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 86905 - HC CHG BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT","86905","HC CHG BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH","86905 - HC CHG BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH",87,5.28,3.49,2229.4299999999998,21.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 86910","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 86910","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 86910 - HC CHG BLOOD TYPING PATERNITY INDIV ABO RH&MN","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","86910","HC CHG BLOOD TYPING PATERNITY INDIV ABO RH&MN","86910 - HC CHG BLOOD TYPING PATERNITY INDIV ABO RH&MN",67,0,74.83,76.709999999999994,16.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 86923","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 86923","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 86923 - HC CHG COMPATIBILITY EACH UNIT ELECTRONIC","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","86923","HC CHG COMPATIBILITY EACH UNIT ELECTRONIC","86923 - HC CHG COMPATIBILITY EACH UNIT ELECTRONIC",142,190.34,190.34,1319.88,35.5]
["BMC HEALTHNET - BMCHN ACO - CPT - 87015","BMC HEALTHNET - BMCHN ACO - 87015","BMC HEALTHNET - BMCHN ACO - 87015 - HC CHG CONCENTRATION INFECTIOUS AGENTS","BMC HEALTHNET","BMCHN ACO","CPT","87015","HC CHG CONCENTRATION INFECTIOUS AGENTS","87015 - HC CHG CONCENTRATION INFECTIOUS AGENTS",34,13.32,6.09,74.989999999999995,8.5]
["TUFTS - TUFTS PPO - CPT - 87015","TUFTS - TUFTS PPO - 87015","TUFTS - TUFTS PPO - 87015 - HC CHG CONCENTRATION INFECTIOUS AGENTS","TUFTS","TUFTS PPO","CPT","87015","HC CHG CONCENTRATION INFECTIOUS AGENTS","87015 - HC CHG CONCENTRATION INFECTIOUS AGENTS",34,26.68,6.09,74.989999999999995,8.5]
["UNICARE - UNICARE - CPT - 87040","UNICARE - UNICARE - 87040","UNICARE - UNICARE - 87040 - HC CHG CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES","UNICARE","UNICARE","CPT","87040","HC CHG CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES","87040 - HC CHG CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES",51,25.06,9.41,115.87,12.75]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 87045","BMC HEALTHNET - BMCHN MEDICAID - 87045","BMC HEALTHNET - BMCHN MEDICAID - 87045 - HC CHG CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL","BMC HEALTHNET","BMCHN MEDICAID","CPT","87045","HC CHG CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL","87045 - HC CHG CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL",48,8.6199999999999992,8.6199999999999992,105.97,12]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 87046","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 87046","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 87046 - HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT","87046","HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA","87046 - HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA",48,9.44,6,105.97,12]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 87046","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 87046","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 87046 - HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","87046","HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA","87046 - HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA",48,11.33,6,105.97,12]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 87075","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 87075","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 87075 - HC CHG CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","87075","HC CHG CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID","87075 - HC CHG CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID",41,21.08,8.64,106.25,10.25]
["BMC HEALTHNET - BMCHN ACO - CPT - 87076","BMC HEALTHNET - BMCHN ACO - 87076","BMC HEALTHNET - BMCHN ACO - 87076 - HC CHG CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL","BMC HEALTHNET","BMCHN ACO","CPT","87076","HC CHG CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL","87076 - HC CHG CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL",27,16.13,7.18,90.64,6.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 87076","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 87076","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 87076 - HC CHG CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","87076","HC CHG CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL","87076 - HC CHG CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL",27,9.6999999999999993,7.18,90.64,6.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 87077","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 87077","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 87077 - HC CHG CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT","87077","HC CHG CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL","87077 - HC CHG CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL",27,11.14,7.18,90.64,6.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 87086","AETNA - AETNA-MEDICARE ADVANTAGE - 87086","AETNA - AETNA-MEDICARE ADVANTAGE - 87086 - HC CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","87086","HC CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE","87086 - HC CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE",41,9.52,7.36,90.56,10.25]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 87086","CIGNA HEALTHCARE - CIGNA PPO - 87086","CIGNA HEALTHCARE - CIGNA PPO - 87086 - HC CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE","CIGNA HEALTHCARE","CIGNA PPO","CPT","87086","HC CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE","87086 - HC CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE",41,20.54,7.36,90.56,10.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 87088","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - 87088","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - 87088 - HC CHG CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","87088","HC CHG CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE","87088 - HC CHG CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE",41,17.47,7.38,90.85,10.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 87088","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 87088","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 87088 - HC CHG CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","87088","HC CHG CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE","87088 - HC CHG CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE",41,19.41,7.38,90.85,10.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 87103","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 87103","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 87103 - HC CHG CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","87103","HC CHG CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD","87103 - HC CHG CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD",46,37.549999999999997,12.37,198.48,11.5]
["UNICARE - UNICARE - CPT - 87103","UNICARE - UNICARE - 87103","UNICARE - UNICARE - 87103 - HC CHG CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD","UNICARE","UNICARE","CPT","87103","HC CHG CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD","87103 - HC CHG CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD",46,21.9,12.37,198.48,11.5]
["TUFTS - TUFTS SELECT - CPT - 87106","TUFTS - TUFTS SELECT - 87106","TUFTS - TUFTS SELECT - 87106 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST","TUFTS","TUFTS SELECT","CPT","87106","HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST","87106 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST",51,17.989999999999998,9.41,115.87,12.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 87107","UNICARE - UNICARE STATE INDEMNITY PLAN - 87107","UNICARE - UNICARE STATE INDEMNITY PLAN - 87107 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","87107","HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD","87107 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD",51,20.88,9.41,115.87,12.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 87110","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 87110","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 87110 - HC CHG CULTURE, CHLAMYDIA","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","87110","HC CHG CULTURE, CHLAMYDIA","87110 - HC CHG CULTURE, CHLAMYDIA",25,43.31,17.87,219.96,6.25]
["FALLON - FALLON MEDICAID - CPT - 87116","FALLON - FALLON MEDICAID - 87116","FALLON - FALLON MEDICAID - 87116 - HC CHG CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL","FALLON","FALLON MEDICAID","CPT","87116","HC CHG CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL","87116 - HC CHG CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL",54,9.86,9.86,121.29,13.5]
["TUFTS - TUFTS POS - CPT - 87118","TUFTS - TUFTS POS - 87118","TUFTS - TUFTS POS - 87118 - HC CHG CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL","TUFTS","TUFTS POS","CPT","87118","HC CHG CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL","87118 - HC CHG CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL",55,47.14,10.79,141.71,13.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 87140","BLUE CROSS - BLUE CROSS-HMO BLUE - 87140","BLUE CROSS - BLUE CROSS-HMO BLUE - 87140 - HC CHG CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","87140","HC CHG CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM","87140 - HC CHG CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM",28,12.51,5.08,62.56,7]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 87140","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 87140","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 87140 - HC CHG CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","87140","HC CHG CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM","87140 - HC CHG CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM",28,6.68,5.08,62.56,7]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 87149","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 87149","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 87149 - HC CHG CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","87149","HC CHG CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM","87149 - HC CHG CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM",100,48.1,18.29,225.1,25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 87150","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 87150","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 87150 - HC CHG CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","87150","HC CHG CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM","87150 - HC CHG CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM",460,42.11,32.01,393.99,115]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 87172","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 87172","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 87172 - HC CHG PINWORM EXAMINATION","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","87172","HC CHG PINWORM EXAMINATION","87172 - HC CHG PINWORM EXAMINATION",23,10.74,3.89,47.89,5.75]
["FALLON - FALLON SENIOR PLAN - CPT - 87172","FALLON - FALLON SENIOR PLAN - 87172","FALLON - FALLON SENIOR PLAN - 87172 - HC CHG PINWORM EXAMINATION","FALLON","FALLON SENIOR PLAN","CPT","87172","HC CHG PINWORM EXAMINATION","87172 - HC CHG PINWORM EXAMINATION",23,4.2699999999999996,3.89,47.89,5.75]
["TUFTS - TUFTS PPO - CPT - 87176","TUFTS - TUFTS PPO - 87176","TUFTS - TUFTS PPO - 87176 - HC CHG HOMOGENIZATION TISSUE CULTURE","TUFTS","TUFTS PPO","CPT","87176","HC CHG HOMOGENIZATION TISSUE CULTURE","87176 - HC CHG HOMOGENIZATION TISSUE CULTURE",29,23.49,5.36,66.02,7.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 87177","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 87177","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 87177 - HC CHG OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","87177","HC CHG OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID","87177 - HC CHG OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID",44,9.58,8.1199999999999992,99.89,11]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 87181","BMC HEALTHNET - BMCHN MEDICAID - 87181","BMC HEALTHNET - BMCHN MEDICAID - 87181 - HC CHG SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ","BMC HEALTHNET","BMCHN MEDICAID","CPT","87181","HC CHG SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ","87181 - HC CHG SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ",25,4.33,3.54,53.31,6.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 87184","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 87184","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 87184 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","87184","HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD","87184 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD",35,7.48,6.29,77.400000000000006,8.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 87184","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 87184","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 87184 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","87184","HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD","87184 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD",35,7.4,6.29,77.400000000000006,8.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 87186","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 87186","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 87186 - HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","87186","HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ","87186 - HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ",43,10.69,7.88,97,10.75]
["CIGNA HEALTHCARE - CIGNA - CPT - 87186","CIGNA HEALTHCARE - CIGNA - 87186","CIGNA HEALTHCARE - CIGNA - 87186 - HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ","CIGNA HEALTHCARE","CIGNA","CPT","87186","HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ","87186 - HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ",43,38.92,7.88,97,10.75]
["TUFTS - TUFTS HMO - CPT - 87188","TUFTS - TUFTS HMO - 87188","TUFTS - TUFTS HMO - 87188 - HC CHG SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT","TUFTS","TUFTS HMO","CPT","87188","HC CHG SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT","87188 - HC CHG SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT",81,29.77,6.06,74.58,20.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 87205","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 87205","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 87205 - HC CHG SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT","87205","HC CHG SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL","87205 - HC CHG SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL",23,5.88,3.89,47.89,5.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 87206","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 87206","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 87206 - HC CHG SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","87206","HC CHG SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT","87206 - HC CHG SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT",27,13.56,4.91,60.48,6.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 87207","CIGNA HEALTHCARE - CIGNA CARELINK - 87207","CIGNA HEALTHCARE - CIGNA CARELINK - 87207 - SMR PRIM SRC SPEC STAIN BODIES/PARASITS","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","87207","SMR PRIM SRC SPEC STAIN BODIES/PARASITS","87207 - SMR PRIM SRC SPEC STAIN BODIES/PARASITS",281,67.33,5.47,67.33,70.25]
["TUFTS - TUFTS POS - CPT - 87207","TUFTS - TUFTS POS - 87207","TUFTS - TUFTS POS - 87207 - SMR PRIM SRC SPEC STAIN BODIES/PARASITS","TUFTS","TUFTS POS","CPT","87207","SMR PRIM SRC SPEC STAIN BODIES/PARASITS","87207 - SMR PRIM SRC SPEC STAIN BODIES/PARASITS",281,22.39,5.47,67.33,70.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 87209","UNICARE - UNICARE STATE INDEMNITY PLAN - 87209","UNICARE - UNICARE STATE INDEMNITY PLAN - 87209 - HC CHG SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","87209","HC CHG SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS","87209 - HC CHG SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS",91,36.32,16.399999999999999,201.74,22.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 87220","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 87220","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 87220 - TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","87220","TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT","87220 - TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT",23,9.8800000000000008,3.89,47.89,5.75]
["FALLON - FALLON MEDICAID - CPT - 87220","FALLON - FALLON MEDICAID - 87220","FALLON - FALLON MEDICAID - 87220 - TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT","FALLON","FALLON MEDICAID","CPT","87220","TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT","87220 - TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT",23,3.89,3.89,47.89,5.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 87252","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 87252","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 87252 - HC CHG VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","87252","HC CHG VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT","87252 - HC CHG VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT",172,27.99,23.78,292.58999999999997,43]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 87253","BLUE CROSS - BLUE CROSS-HMO BLUE - 87253","BLUE CROSS - BLUE CROSS-HMO BLUE - 87253 - HC CHG VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","87253","HC CHG VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE","87253 - HC CHG VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE",100,45.46,18.43,226.77,25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 87254","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - 87254","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - 87254 - HC CHG VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","87254","HC CHG VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA","87254 - HC CHG VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA",98,26.83,12.44,219.59,24.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 87255","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 87255","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 87255 - HC CHG VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","87255","HC CHG VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC","87255 - HC CHG VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC",168,81.22,30.89,380.17,42]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 87255","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 87255","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 87255 - HC CHG VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","87255","HC CHG VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC","87255 - HC CHG VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC",168,40.630000000000003,30.89,380.17,42]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 87269","BLUE CROSS - BLUE CROSS-PPO - 87269","BLUE CROSS - BLUE CROSS-PPO - 87269 - HC CHG IAADI GIARDIA","BLUE CROSS","BLUE CROSS-PPO","CPT","87269","HC CHG IAADI GIARDIA","87269 - HC CHG IAADI GIARDIA",57,27.01,10.94,135.27000000000001,14.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 87272","CIGNA HEALTHCARE - CIGNA CARELINK - 87272","CIGNA HEALTHCARE - CIGNA CARELINK - 87272 - HC CHG IAADI CRYPTOSPORIDIUM","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","87272","HC CHG IAADI CRYPTOSPORIDIUM","87272 - HC CHG IAADI CRYPTOSPORIDIUM",57,134.54,10.94,134.54,14.25]
["TUFTS - TUFTS POS - CPT - 87272","TUFTS - TUFTS POS - 87272","TUFTS - TUFTS POS - 87272 - HC CHG IAADI CRYPTOSPORIDIUM","TUFTS","TUFTS POS","CPT","87272","HC CHG IAADI CRYPTOSPORIDIUM","87272 - HC CHG IAADI CRYPTOSPORIDIUM",57,44.75,10.94,134.54,14.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 87275","UNITED HEALTHCARE - UNITED HEALTHCARE - 87275","UNITED HEALTHCARE - UNITED HEALTHCARE - 87275 - HC CHG IAADI INFLUENZA B VIRUS","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","87275","HC CHG IAADI INFLUENZA B VIRUS","87275 - HC CHG IAADI INFLUENZA B VIRUS",57,25.8,10.94,134.54,14.25]
["BMC HEALTHNET - BMCHN MCO - CPT - 87276","BMC HEALTHNET - BMCHN MCO - 87276","BMC HEALTHNET - BMCHN MCO - 87276 - HC CHG IAADI INFFLUENZA A VIRUS","BMC HEALTHNET","BMCHN MCO","CPT","87276","HC CHG IAADI INFFLUENZA A VIRUS","87276 - HC CHG IAADI INFFLUENZA A VIRUS",57,11.87,11.87,155.81,14.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 87279","BLUE CROSS - BLUE CROSS-PPO - 87279","BLUE CROSS - BLUE CROSS-PPO - 87279 - HC CHG IAADI PARAINFLUENZA VIRUS EACH TYPE","BLUE CROSS","BLUE CROSS-PPO","CPT","87279","HC CHG IAADI PARAINFLUENZA VIRUS EACH TYPE","87279 - HC CHG IAADI PARAINFLUENZA VIRUS EACH TYPE",57,30.3,12.14,159.36000000000001,14.25]
["TUFTS - TUFTS PPO - CPT - 87281","TUFTS - TUFTS PPO - 87281","TUFTS - TUFTS PPO - 87281 - HC CHG IAADI PNEUMOCUSTIS CARINII","TUFTS","TUFTS PPO","CPT","87281","HC CHG IAADI PNEUMOCUSTIS CARINII","87281 - HC CHG IAADI PNEUMOCUSTIS CARINII",57,47.86,10.94,134.54,14.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 87299","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 87299","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 87299 - HC CHG AG DETECTION NOS, FLUOR","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","87299","HC CHG AG DETECTION NOS, FLUOR","87299 - HC CHG AG DETECTION NOS, FLUOR",92,14.04,11.9,156.22,23]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 87305","BMC HEALTHNET - BMCHN MEDICAID - 87305","BMC HEALTHNET - BMCHN MEDICAID - 87305 - HC CHG IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS","BMC HEALTHNET","BMCHN MEDICAID","CPT","87305","HC CHG IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS","87305 - HC CHG IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS",272,10.94,10.94,134.54,68]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 87305","TUFTS - TUFTS MEDICARE PREFERRED HMO - 87305","TUFTS - TUFTS MEDICARE PREFERRED HMO - 87305 - HC CHG IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","87305","HC CHG IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS","87305 - HC CHG IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS",272,17.37,10.94,134.54,68]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 87324","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 87324","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 87324 - HC CHG IAAD IA CLOSTRIDIUM DIFFICILE TOXIN","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","87324","HC CHG IAAD IA CLOSTRIDIUM DIFFICILE TOXIN","87324 - HC CHG IAAD IA CLOSTRIDIUM DIFFICILE TOXIN",57,13.13,10.94,134.54,14.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 87338","BLUE CROSS - BLUE CROSS-INDEMNITY - 87338","BLUE CROSS - BLUE CROSS-INDEMNITY - 87338 - HC CHG IAAD IA HPYLORI STOOL","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","87338","HC CHG IAAD IA HPYLORI STOOL","87338 - HC CHG IAAD IA HPYLORI STOOL",102,32.28,13.12,161.52000000000001,25.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 87340","AETNA - AETNA-MEDICARE ADVANTAGE - 87340","AETNA - AETNA-MEDICARE ADVANTAGE - 87340 - HC CHG IAAD IA HEPATITIS B SURFACE ANTIGEN","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","87340","HC CHG IAAD IA HEPATITIS B SURFACE ANTIGEN","87340 - HC CHG IAAD IA HEPATITIS B SURFACE ANTIGEN",51,12.19,9.42,115.95,12.75]
["TUFTS - TUFTS MEDICARE SCO - CPT - 87340","TUFTS - TUFTS MEDICARE SCO - 87340","TUFTS - TUFTS MEDICARE SCO - 87340 - HC CHG IAAD IA HEPATITIS B SURFACE ANTIGEN","TUFTS","TUFTS MEDICARE SCO","CPT","87340","HC CHG IAAD IA HEPATITIS B SURFACE ANTIGEN","87340 - HC CHG IAAD IA HEPATITIS B SURFACE ANTIGEN",51,14.98,9.42,115.95,12.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 87340","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 87340","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 87340 - HC CHG IAAD IA HEPATITIS B SURFACE ANTIGEN","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","87340","HC CHG IAAD IA HEPATITIS B SURFACE ANTIGEN","87340 - HC CHG IAAD IA HEPATITIS B SURFACE ANTIGEN",51,24.79,9.42,115.95,12.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 87350","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 87350","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 87350 - HC CHG IAAD IA HEPATITIS BE ANTIGEN","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","87350","HC CHG IAAD IA HEPATITIS BE ANTIGEN","87350 - HC CHG IAAD IA HEPATITIS BE ANTIGEN",55,25.69,10.51,129.4,13.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 87385","ELDER SERVICE PLAN - ELEMENT CARE INC - 87385","ELDER SERVICE PLAN - ELEMENT CARE INC - 87385 - HC CHG IAAD IA HISTOPLASM CAPSULATUM","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","87385","HC CHG IAAD IA HISTOPLASM CAPSULATUM","87385 - HC CHG IAAD IA HISTOPLASM CAPSULATUM",46,13.25,10.94,134.54,11.5]
["TUFTS - TUFTS SPIRIT - CPT - 87385","TUFTS - TUFTS SPIRIT - 87385","TUFTS - TUFTS SPIRIT - 87385 - HC CHG IAAD IA HISTOPLASM CAPSULATUM","TUFTS","TUFTS SPIRIT","CPT","87385","HC CHG IAAD IA HISTOPLASM CAPSULATUM","87385 - HC CHG IAAD IA HISTOPLASM CAPSULATUM",46,14.58,10.94,134.54,11.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 87390","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 87390","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 87390 - HC CHG IAAD IA HIV-1","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","87390","HC CHG IAAD IA HIV-1","87390 - HC CHG IAAD IA HIV-1",87,20.98,17.78,233.33,21.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 87390","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 87390","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 87390 - HC CHG IAAD IA HIV-1","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","87390","HC CHG IAAD IA HIV-1","87390 - HC CHG IAAD IA HIV-1",87,24.06,17.78,233.33,21.75]
["TUFTS - TUFTS POS - CPT - 87391","TUFTS - TUFTS POS - 87391","TUFTS - TUFTS POS - 87391 - HC CHG IAAD IA HIV-2","TUFTS","TUFTS POS","CPT","87391","HC CHG IAAD IA HIV-2","87391 - HC CHG IAAD IA HIV-2",87,70.64,16.18,212.42,21.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 87400","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 87400","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 87400 - HC CHG IAAD IA INFLUENZA A/B EACH","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","87400","HC CHG IAAD IA INFLUENZA A/B EACH","87400 - HC CHG IAAD IA INFLUENZA A/B EACH",57,16.96,10.94,137.06,14.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 87420","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 87420","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 87420 - HC CHG IAAD IA RESPIRATORY SYNCTIAL VIRUS","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","87420","HC CHG IAAD IA RESPIRATORY SYNCTIAL VIRUS","87420 - HC CHG IAAD IA RESPIRATORY SYNCTIAL VIRUS",57,27.01,10.94,136.04,14.25]
["CIGNA HEALTHCARE - CIGNA - CPT - 87425","CIGNA HEALTHCARE - CIGNA - 87425","CIGNA HEALTHCARE - CIGNA - 87425 - HC CHG IAAD IA ROTAVIRUS","CIGNA HEALTHCARE","CIGNA","CPT","87425","HC CHG IAAD IA ROTAVIRUS","87425 - HC CHG IAAD IA ROTAVIRUS",57,51.64,10.94,134.54,14.25]
["TUFTS - TUFTS SPIRIT - CPT - 87425","TUFTS - TUFTS SPIRIT - 87425","TUFTS - TUFTS SPIRIT - 87425 - HC CHG IAAD IA ROTAVIRUS","TUFTS","TUFTS SPIRIT","CPT","87425","HC CHG IAAD IA ROTAVIRUS","87425 - HC CHG IAAD IA ROTAVIRUS",57,13.18,10.94,134.54,14.25]
["BMC HEALTHNET - BMCHN ACO - CPT - 87430","BMC HEALTHNET - BMCHN ACO - 87430","BMC HEALTHNET - BMCHN ACO - 87430 - HC CHG IAAD IA STREPTOCOCCUS GROUP A","BMC HEALTHNET","BMCHN ACO","CPT","87430","HC CHG IAAD IA STREPTOCOCCUS GROUP A","87430 - HC CHG IAAD IA STREPTOCOCCUS GROUP A",57,27.17,12.42,163.02000000000001,14.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 87449","ELDER SERVICE PLAN - ELEMENT CARE INC - 87449","ELDER SERVICE PLAN - ELEMENT CARE INC - 87449 - HC AG DET,ENZ IMM;OTH,EA","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","87449","HC AG DET,ENZ IMM;OTH,EA","87449 - HC AG DET,ENZ IMM;OTH,EA",57,11.98,10.94,134.54,14.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 87449","UNITED HEALTHCARE - UNITED HEALTHCARE - 87449","UNITED HEALTHCARE - UNITED HEALTHCARE - 87449 - HC AG DET,ENZ IMM;OTH,EA","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","87449","HC AG DET,ENZ IMM;OTH,EA","87449 - HC AG DET,ENZ IMM;OTH,EA",57,25.23,10.94,134.54,14.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 87481","AETNA - AETNA-MEDICARE ADVANTAGE - 87481","AETNA - AETNA-MEDICARE ADVANTAGE - 87481 - HC CHG CANDIDA, DNA, AMP PROBE","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","87481","HC CHG CANDIDA, DNA, AMP PROBE","87481 - HC CHG CANDIDA, DNA, AMP PROBE",124,41.41,32.01,393.99,31]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 87481","CIGNA HEALTHCARE - CIGNA PPO - 87481","CIGNA HEALTHCARE - CIGNA PPO - 87481 - HC CHG CANDIDA, DNA, AMP PROBE","CIGNA HEALTHCARE","CIGNA PPO","CPT","87481","HC CHG CANDIDA, DNA, AMP PROBE","87481 - HC CHG CANDIDA, DNA, AMP PROBE",124,66.22,32.01,393.99,31]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 87486","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - 87486","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - 87486 - HC CHG IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","87486","HC CHG IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ","87486 - HC CHG IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ",127,75.760000000000005,32.01,393.99,31.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 87490","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 87490","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 87490 - HC CHG IADNA CHLAMYDIA TRACHOMATIS DIRECT PROBE TQ","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","87490","HC CHG IADNA CHLAMYDIA TRACHOMATIS DIRECT PROBE TQ","87490 - HC CHG IADNA CHLAMYDIA TRACHOMATIS DIRECT PROBE TQ",100,21.53,18.29,226.32,25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 87491","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 87491","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 87491 - HC CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","87491","HC CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ","87491 - HC CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ",129,79.05,32.01,393.99,32.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 87493","CIGNA HEALTHCARE - CIGNA CARELINK - 87493","CIGNA HEALTHCARE - CIGNA CARELINK - 87493 - HC CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","87493","HC CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE","87493 - HC CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE",120,393.99,32.01,393.99,30]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 87493","UNITED HEALTHCARE - UNITED HEALTHCARE - 87493","UNITED HEALTHCARE - UNITED HEALTHCARE - 87493 - HC CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","87493","HC CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE","87493 - HC CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE",120,78.489999999999995,32.01,393.99,30]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 87496","UNITED HEALTHCARE - UNITED HEALTHCARE - 87496","UNITED HEALTHCARE - UNITED HEALTHCARE - 87496 - HC ARUP;CYTOMEG VIR PCR,CSF","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","87496","HC ARUP;CYTOMEG VIR PCR,CSF","87496 - HC ARUP;CYTOMEG VIR PCR,CSF",41,73.900000000000006,32.01,393.99,10.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 87498","BLUE CROSS - BLUE CROSS-PPO - 87498","BLUE CROSS - BLUE CROSS-PPO - 87498 - HC CHG IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP","BLUE CROSS","BLUE CROSS-PPO","CPT","87498","HC CHG IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP","87498 - HC CHG IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP",322,79.05,32.01,393.99,80.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 87498","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - 87498","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - 87498 - HC CHG IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","87498","HC CHG IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP","87498 - HC CHG IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP",322,75.760000000000005,32.01,393.99,80.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 87502","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 87502","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 87502 - HC Q;FLU AG DET,MULT TYP,2,2","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT","87502","HC Q;FLU AG DET,MULT TYP,2,2","87502 - HC Q;FLU AG DET,MULT TYP,2,2",269,117.36,77.11,958.3,67.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 87506","BLUE CROSS - BLUE CROSS-HMO BLUE - 87506","BLUE CROSS - BLUE CROSS-HMO BLUE - 87506 - HC CHG IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","87506","HC CHG IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11","87506 - HC CHG IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11",334,481.55,157.59,2550.8000000000002,83.5]
["FALLON - FALLON SENIOR PLAN - CPT - 87506","FALLON - FALLON SENIOR PLAN - 87506","FALLON - FALLON SENIOR PLAN - 87506 - HC CHG IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11","FALLON","FALLON SENIOR PLAN","CPT","87506","HC CHG IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11","87506 - HC CHG IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11",334,262.99,157.59,2550.8000000000002,83.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 87507","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 87507","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 87507 - HC IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT","87507","HC IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25","87507 - HC IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25",588,561.9,291.7,4678.75,147]
["TUFTS - TUFTS SPIRIT - CPT - 87510","TUFTS - TUFTS SPIRIT - 87510","TUFTS - TUFTS SPIRIT - 87510 - HC CHG IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ","TUFTS","TUFTS SPIRIT","CPT","87510","HC CHG IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ","87510 - HC CHG IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ",157,22.06,18.29,225.1,39.25]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 87511","CIGNA HEALTHCARE - CIGNA PPO - 87511","CIGNA HEALTHCARE - CIGNA PPO - 87511 - HC CHG GARDNER VAG, DNA  AMP PROBE","CIGNA HEALTHCARE","CIGNA PPO","CPT","87511","HC CHG GARDNER VAG, DNA  AMP PROBE","87511 - HC CHG GARDNER VAG, DNA  AMP PROBE",109,66.22,32.01,393.99,27.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 87517","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - 87517","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - 87517 - HC CHG IADNA HEPATITIS B VIRUS QUANTIFICATION","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","87517","HC CHG IADNA HEPATITIS B VIRUS QUANTIFICATION","87517 - HC CHG IADNA HEPATITIS B VIRUS QUANTIFICATION",213,92.49,39.07,480.84,53.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 87517","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 87517","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 87517 - HC CHG IADNA HEPATITIS B VIRUS QUANTIFICATION","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","87517","HC CHG IADNA HEPATITIS B VIRUS QUANTIFICATION","87517 - HC CHG IADNA HEPATITIS B VIRUS QUANTIFICATION",213,102.77,39.07,480.84,53.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 87529","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 87529","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 87529 - HC CHG IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","87529","HC CHG IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ","87529 - HC CHG IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ",140,79.05,32.01,393.99,35]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 87529","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 87529","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 87529 - HC CHG IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","87529","HC CHG IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ","87529 - HC CHG IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ",140,84.18,32.01,393.99,35]
["TUFTS - TUFTS SPIRIT - CPT - 87532","TUFTS - TUFTS SPIRIT - 87532","TUFTS - TUFTS SPIRIT - 87532 - HC CHG IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ","TUFTS","TUFTS SPIRIT","CPT","87532","HC CHG IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ","87532 - HC CHG IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ",38,38.6,32.01,393.99,9.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 87535","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 87535","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 87535 - HC CHG IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT","87535","HC CHG IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ","87535 - HC CHG IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ",359,47.31,32.01,393.99,89.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 87536","BMC HEALTHNET - BMCHN QHP - 87536","BMC HEALTHNET - BMCHN QHP - 87536 - HC CHG IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION","BMC HEALTHNET","BMCHN QHP","CPT","87536","HC CHG IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION","87536 - HC CHG IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION",279,93.14,77.09,955.28,69.75]
["FALLON - FALLON MEDICAID - CPT - 87538","FALLON - FALLON MEDICAID - 87538","FALLON - FALLON MEDICAID - 87538 - HC HIV-2 PROBE&REVRSE TRNSCRIPJ","FALLON","FALLON MEDICAID","CPT","87538","HC HIV-2 PROBE&REVRSE TRNSCRIPJ","87538 - HC HIV-2 PROBE&REVRSE TRNSCRIPJ",326,32.01,32.01,393.99,81.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 87538","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 87538","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 87538 - HC HIV-2 PROBE&REVRSE TRNSCRIPJ","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT","87538","HC HIV-2 PROBE&REVRSE TRNSCRIPJ","87538 - HC HIV-2 PROBE&REVRSE TRNSCRIPJ",326,48.4,32.01,393.99,81.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 87563","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 87563","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 87563 - HC M. GENITALIUM AMP PROBE","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","87563","HC M. GENITALIUM AMP PROBE","87563 - HC M. GENITALIUM AMP PROBE",129,35.090000000000003,35.090000000000003,187.56,32.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 87581","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 87581","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 87581 - HC CHG IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","87581","HC CHG IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ","87581 - HC CHG IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ",127,37.68,32.01,393.99,31.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 87591","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 87591","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 87591 - HC CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","87591","HC CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ","87591 - HC CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ",129,79.05,32.01,393.99,32.25]
["BMC HEALTHNET - BMCHN ACO - CPT - 87624","BMC HEALTHNET - BMCHN ACO - 87624","BMC HEALTHNET - BMCHN ACO - 87624 - IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES","BMC HEALTHNET","BMCHN ACO","CPT","87624","IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES","87624 - IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES",110,70.040000000000006,32.01,393.99,27.5]
["TUFTS - TUFTS HMO - CPT - 87631","TUFTS - TUFTS HMO - 87631","TUFTS - TUFTS HMO - 87631 - HC INFLUENZA A/B,RSV PCR","TUFTS","TUFTS HMO","CPT","87631","HC INFLUENZA A/B,RSV PCR","87631 - HC INFLUENZA A/B,RSV PCR",504,574.84,103.92,1440.32,126]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 87632","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 87632","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 87632 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 6-11 TARGETS","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","87632","HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 6-11 TARGETS","87632 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 6-11 TARGETS",504,481.55,157.59,2395.92,126]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 87633","CIGNA HEALTHCARE - CIGNA CARELINK - 87633","CIGNA HEALTHCARE - CIGNA CARELINK - 87633 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","87633","HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET","87633 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET",820,4678.75,291.7,4678.75,205]
["TUFTS - TUFTS PPO - CPT - 87633","TUFTS - TUFTS PPO - 87633","TUFTS - TUFTS PPO - 87633 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET","TUFTS","TUFTS PPO","CPT","87633","HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET","87633 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET",820,1664.59,291.7,4678.75,205]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 87636","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 87636","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 87636 - HC SARSCOV2 & INF A&B AMP PRB","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","87636","HC SARSCOV2 & INF A&B AMP PRB","87636 - HC SARSCOV2 & INF A&B AMP PRB",378,315.2,142.63,358.89,94.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 87640","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 87640","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 87640 - HC CHG IADNA S AUREUS AMPLIFIED PROBE TQ","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT","87640","HC CHG IADNA S AUREUS AMPLIFIED PROBE TQ","87640 - HC CHG IADNA S AUREUS AMPLIFIED PROBE TQ",194,47.31,32.01,393.99,48.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 87641","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 87641","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 87641 - HC CHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","87641","HC CHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ","87641 - HC CHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ",129,79.05,32.01,393.99,32.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 87641","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 87641","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 87641 - HC CHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT","87641","HC CHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ","87641 - HC CHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ",129,48.4,32.01,393.99,32.25]
["TUFTS - TUFTS SPIRIT - CPT - 87653","TUFTS - TUFTS SPIRIT - 87653","TUFTS - TUFTS SPIRIT - 87653 - HC CHG IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ","TUFTS","TUFTS SPIRIT","CPT","87653","HC CHG IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ","87653 - HC CHG IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ",129,38.6,32.01,393.99,32.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 87661","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 87661","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 87661 - IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","87661","IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH","87661 - IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH",380,79.05,32.01,393.99,95]
["CIGNA HEALTHCARE - CIGNA - CPT - 87797","CIGNA HEALTHCARE - CIGNA - 87797","CIGNA HEALTHCARE - CIGNA - 87797 - HC CHG DETECT AGENT NOS, DNA, DIR","CIGNA HEALTHCARE","CIGNA","CPT","87797","HC CHG DETECT AGENT NOS, DNA, DIR","87797 - HC CHG DETECT AGENT NOS, DNA, DIR",31,90.36,22.19,291.27999999999997,7.75]
["TUFTS - TUFTS SPIRIT - CPT - 87797","TUFTS - TUFTS SPIRIT - 87797","TUFTS - TUFTS SPIRIT - 87797 - HC CHG DETECT AGENT NOS, DNA, DIR","TUFTS","TUFTS SPIRIT","CPT","87797","HC CHG DETECT AGENT NOS, DNA, DIR","87797 - HC CHG DETECT AGENT NOS, DNA, DIR",31,33.03,22.19,291.27999999999997,7.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 87798","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 87798","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 87798 - HC EBV DNA, QL PCR","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","87798","HC EBV DNA, QL PCR","87798 - HC EBV DNA, QL PCR",129,82.11,32.01,393.99,32.25]
["BMC HEALTHNET - BMCHN ACO - CPT - 87799","BMC HEALTHNET - BMCHN ACO - 87799","BMC HEALTHNET - BMCHN ACO - 87799 - HC CHG IADNA NOS QUANTIFICATION EACH ORGANISM","BMC HEALTHNET","BMCHN ACO","CPT","87799","HC CHG IADNA NOS QUANTIFICATION EACH ORGANISM","87799 - HC CHG IADNA NOS QUANTIFICATION EACH ORGANISM",307,85.49,39.07,480.84,76.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 87801","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 87801","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - 87801 - HC CHG DETECT AGENT, MULT ORGS, DNA  AMP","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT","87801","HC CHG DETECT AGENT, MULT ORGS, DNA  AMP","87801 - HC CHG DETECT AGENT, MULT ORGS, DNA  AMP",310,96.81,64.03,787.98,77.5]
["TUFTS - TUFTS POS - CPT - 87880","TUFTS - TUFTS POS - 87880","TUFTS - TUFTS POS - 87880 - IAADIADOO STREPTOCOCCUS GROUP A","TUFTS","TUFTS POS","CPT","87880","IAADIADOO STREPTOCOCCUS GROUP A","87880 - IAADIADOO STREPTOCOCCUS GROUP A",57,53.32,12.21,160.29,14.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 87899","AETNA - AETNA-MEDICARE ADVANTAGE - 87899","AETNA - AETNA-MEDICARE ADVANTAGE - 87899 - HC MALARIA ANTIGEN","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","87899","HC MALARIA ANTIGEN","87899 - HC MALARIA ANTIGEN",94,18.96,11.87,155.81,23.5]
["BMC HEALTHNET - BMCHN MCO - CPT - 87900","BMC HEALTHNET - BMCHN MCO - 87900","BMC HEALTHNET - BMCHN MCO - 87900 - HC CHG NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION","BMC HEALTHNET","BMCHN MCO","CPT","87900","HC CHG NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION","87900 - HC CHG NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION",600,118.9,118.9,1463.3,150]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 87900","TUFTS - TUFTS MEDICARE PREFERRED HMO - 87900","TUFTS - TUFTS MEDICARE PREFERRED HMO - 87900 - HC CHG NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","87900","HC CHG NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION","87900 - HC CHG NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION",600,189.01,118.9,1463.3,150]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 87901","UNICARE - UNICARE STATE INDEMNITY PLAN - 87901","UNICARE - UNICARE STATE INDEMNITY PLAN - 87901 - HC CHG NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEAS","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","87901","HC CHG NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEAS","87901 - HC CHG NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEAS",675,166.42,112.85,2890.09,168.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 87906","BLUE CROSS - BLUE CROSS-INDEMNITY - 87906","BLUE CROSS - BLUE CROSS-INDEMNITY - 87906 - HC Q;HIV1 GENO","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","87906","HC Q;HIV1 GENO","87906 - HC Q;HIV1 GENO",2063,290.51,56.44,1445.09,515.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 87906","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 87906","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 87906 - HC Q;HIV1 GENO","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","87906","HC Q;HIV1 GENO","87906 - HC Q;HIV1 GENO",2063,308.8,56.44,1445.09,515.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 87912","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 87912","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 87912 - HC CHG NFCT AGENT GENOTYPE HEPATITIS B VIRUS","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT","87912","HC CHG NFCT AGENT GENOTYPE HEPATITIS B VIRUS","87912 - HC CHG NFCT AGENT GENOTYPE HEPATITIS B VIRUS",675,347.09,112.85,2890.09,168.75]
["FALLON - FALLON MEDICAID - CPT - 87999","FALLON - FALLON MEDICAID - 87999","FALLON - FALLON MEDICAID - 87999 - HC CHG UNLISTED MICROBIOLOGY","FALLON","FALLON MEDICAID","CPT","87999","HC CHG UNLISTED MICROBIOLOGY","87999 - HC CHG UNLISTED MICROBIOLOGY",87,0,0,0,21.75]
["TUFTS - TUFTS PPO - CPT - 88108","TUFTS - TUFTS PPO - 88108","TUFTS - TUFTS PPO - 88108 - HC CHG CYTP CONCENTRATION SMEARS & INTERPRETATION","TUFTS","TUFTS PPO","CPT","88108","HC CHG CYTP CONCENTRATION SMEARS & INTERPRETATION","88108 - HC CHG CYTP CONCENTRATION SMEARS & INTERPRETATION",224,130.47,39.479999999999997,366.72,56]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 88142","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 88142","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 88142 - CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","88142","CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN","88142 - CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN",101,21.81,18.48,227.42,25.25]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 88142","BMC HEALTHNET - BMCHN WELL SENSE - 88142","BMC HEALTHNET - BMCHN WELL SENSE - 88142 - CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN","BMC HEALTHNET","BMCHN WELL SENSE","CPT","88142","CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN","88142 - CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN",101,40.04,18.48,227.42,25.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 88143","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 88143","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 88143 - HC CHG CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","88143","HC CHG CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS","88143 - HC CHG CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS",101,40.090000000000003,18.48,228.72,25.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 88143","UNICARE - UNICARE STATE INDEMNITY PLAN - 88143","UNICARE - UNICARE STATE INDEMNITY PLAN - 88143 - HC CHG CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","88143","HC CHG CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS","88143 - HC CHG CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS",101,41,18.48,228.72,25.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 88152","BLUE CROSS - BLUE CROSS-INDEMNITY - 88152","BLUE CROSS - BLUE CROSS-INDEMNITY - 88152 - HC CHG CYTOPATH SMEAR CERV/VAG,AUTO REDO","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","88152","HC CHG CYTOPATH SMEAR CERV/VAG,AUTO REDO","88152 - HC CHG CYTOPATH SMEAR CERV/VAG,AUTO REDO",36,50.73,13.16,268.05,9]
["FALLON - FALLON MEDICAID - CPT - 88160","FALLON - FALLON MEDICAID - 88160","FALLON - FALLON MEDICAID - 88160 - HC CHG CYTP SMRS ANY OTH SRC SCR&INTERPJ","FALLON","FALLON MEDICAID","CPT","88160","HC CHG CYTP SMRS ANY OTH SRC SCR&INTERPJ","88160 - HC CHG CYTP SMRS ANY OTH SRC SCR&INTERPJ",182,24.43,22.57,200.27,45.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 88161","BLUE CROSS - BLUE CROSS-INDEMNITY - 88161","BLUE CROSS - BLUE CROSS-INDEMNITY - 88161 - HC CHG CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","88161","HC CHG CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ","88161 - HC CHG CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ",183,42.24,24.99,308.39999999999998,45.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 88164","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 88164","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 88164 - HC CHG CYTOPATH TBS CERV/VAG MANUAL","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","88164","HC CHG CYTOPATH TBS CERV/VAG MANUAL","88164 - HC CHG CYTOPATH TBS CERV/VAG MANUAL",52,12.74,10.82,145.38,13]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 88165","BLUE CROSS - BLUE CROSS-HMO BLUE - 88165","BLUE CROSS - BLUE CROSS-HMO BLUE - 88165 - HC CHG CYTP SLIDES C/V MNL SCR&RESCR PHYS SUPV","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","88165","HC CHG CYTP SLIDES C/V MNL SCR&RESCR PHYS SUPV","88165 - HC CHG CYTP SLIDES C/V MNL SCR&RESCR PHYS SUPV",52,77.069999999999993,13.16,409.48,13]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 88172","BMC HEALTHNET - BMCHN WELL SENSE - 88172","BMC HEALTHNET - BMCHN WELL SENSE - 88172 - CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST","BMC HEALTHNET","BMCHN WELL SENSE","CPT","88172","CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST","88172 - CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST",166,46,16.91,1400.17,41.5]
["TUFTS - TUFTS HMO - CPT - 88184","TUFTS - TUFTS HMO - 88184","TUFTS - TUFTS HMO - 88184 - HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST","TUFTS","TUFTS HMO","CPT","88184","HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST","88184 - HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST",256,981.08,68.739999999999995,2458.16,64]
["BMC HEALTHNET - BMCHN ACO - CPT - 88185","BMC HEALTHNET - BMCHN ACO - 88185","BMC HEALTHNET - BMCHN ACO - 88185 - HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA","BMC HEALTHNET","BMCHN ACO","CPT","88185","HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA","88185 - HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA",158,41.15,35.42,62.22,39.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 88188","BMC HEALTHNET - BMCHN MEDICAID - 88188","BMC HEALTHNET - BMCHN MEDICAID - 88188 - FLOWCYTOMETRY/READ, 9-15 MARKERS","BMC HEALTHNET","BMCHN MEDICAID","CPT","88188","FLOWCYTOMETRY/READ, 9-15 MARKERS","88188 - FLOWCYTOMETRY/READ, 9-15 MARKERS",272,61.72,59.25,381.48,68]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 88230","UNITED HEALTHCARE - UNITED HEALTHCARE - 88230","UNITED HEALTHCARE - UNITED HEALTHCARE - 88230 - HC CHG TISS CUL NON-NEO DISORDERS LYMPHOCYTE","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","88230","HC CHG TISS CUL NON-NEO DISORDERS LYMPHOCYTE","88230 - HC CHG TISS CUL NON-NEO DISORDERS LYMPHOCYTE",424,245.33,47.5,1307.74,106]
["BMC HEALTHNET - BMCHN MCO - CPT - 88235","BMC HEALTHNET - BMCHN MCO - 88235","BMC HEALTHNET - BMCHN MCO - 88235 - HC CHG TISSUE CULTURE, PLACENTA","BMC HEALTHNET","BMCHN MCO","CPT","88235","HC CHG TISSUE CULTURE, PLACENTA","88235 - HC CHG TISSUE CULTURE, PLACENTA",594,134.33000000000001,120.58,1653.19,148.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 88237","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 88237","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 88237 - HC CHG TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","88237","HC CHG TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS","88237 - HC CHG TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS",425,310.36,54.81,1426.13,106.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 88237","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 88237","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 88237 - HC CHG TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","88237","HC CHG TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS","88237 - HC CHG TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS",425,172.5,54.81,1426.13,106.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 88264","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 88264","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 88264 - HC CHG CHRMSM ANALYZE 20-25 CELLS","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","88264","HC CHG CHRMSM ANALYZE 20-25 CELLS","88264 - HC CHG CHRMSM ANALYZE 20-25 CELLS",519,154.29,113.7,1414.07,129.75]
["FALLON - FALLON SENIOR PLAN - CPT - 88264","FALLON - FALLON SENIOR PLAN - 88264","FALLON - FALLON SENIOR PLAN - 88264 - HC CHG CHRMSM ANALYZE 20-25 CELLS","FALLON","FALLON SENIOR PLAN","CPT","88264","HC CHG CHRMSM ANALYZE 20-25 CELLS","88264 - HC CHG CHRMSM ANALYZE 20-25 CELLS",519,144.61000000000001,113.7,1414.07,129.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 88271","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 88271","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 88271 - HC CHG MOLECULAR CYTOGENETICS DNA PROBE EACH","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","88271","HC CHG MOLECULAR CYTOGENETICS DNA PROBE EACH","88271 - HC CHG MOLECULAR CYTOGENETICS DNA PROBE EACH",373,37.270000000000003,19.54,240.42,93.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 88274","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 88274","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 88274 - HC CHG MOLECULAR CYTOGENETICS INTERPHASE ISH 25-99 CLL","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","88274","HC CHG MOLECULAR CYTOGENETICS INTERPHASE ISH 25-99 CLL","88274 - HC CHG MOLECULAR CYTOGENETICS INTERPHASE ISH 25-99 CLL",172,50.86,31.76,411.07,43]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 88275","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 88275","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 88275 - HC CHG MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","88275","HC CHG MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL","88275 - HC CHG MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL",373,93.54,37.82,496.49,93.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 88280","CIGNA HEALTHCARE - CIGNA CARELINK - 88280","CIGNA HEALTHCARE - CIGNA CARELINK - 88280 - HC CHG CHROMOSOME KARYOTYPE STUDY","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","88280","HC CHG CHROMOSOME KARYOTYPE STUDY","88280 - HC CHG CHROMOSOME KARYOTYPE STUDY",149,324.62,24.73,324.62,37.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 88300","BLUE CROSS - BLUE CROSS-PPO - 88300","BLUE CROSS - BLUE CROSS-PPO - 88300 - HC CHG LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY","BLUE CROSS","BLUE CROSS-PPO","CPT","88300","HC CHG LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY","88300 - HC CHG LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY",93,22.57,14.72,270.45999999999998,23.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 88300","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 88300","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 88300 - HC CHG LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","88300","HC CHG LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY","88300 - HC CHG LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY",93,37.07,14.72,270.45999999999998,23.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 88305","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 88305","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 88305 - CELL BLCK","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","88305","CELL BLCK","88305 - CELL BLCK",331,110.07,67.040000000000006,557.29999999999995,82.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 88311","BLUE CROSS - BLUE CROSS-HMO BLUE - 88311","BLUE CROSS - BLUE CROSS-HMO BLUE - 88311 - HC CHG DECALCIFICATION PROCEDURE","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","88311","HC CHG DECALCIFICATION PROCEDURE","88311 - HC CHG DECALCIFICATION PROCEDURE",62,18.39,10.97,29.44,15.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 88312","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 88312","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 88312 - HC CHG SPECIAL STAIN GROUP 1 MICROORGANISMS I&R","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","88312","HC CHG SPECIAL STAIN GROUP 1 MICROORGANISMS I&R","88312 - HC CHG SPECIAL STAIN GROUP 1 MICROORGANISMS I&R",284,107.36,51.52,557.29999999999995,71]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 88329","BLUE CROSS - BLUE CROSS-INDEMNITY - 88329","BLUE CROSS - BLUE CROSS-INDEMNITY - 88329 - HC CHG PATHOLOGY CONSULTATION DURING SURGERY","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","88329","HC CHG PATHOLOGY CONSULTATION DURING SURGERY","88329 - HC CHG PATHOLOGY CONSULTATION DURING SURGERY",110,42.24,42.24,364.6,27.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 88329","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 88329","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 88329 - HC CHG PATHOLOGY CONSULTATION DURING SURGERY","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","88329","HC CHG PATHOLOGY CONSULTATION DURING SURGERY","88329 - HC CHG PATHOLOGY CONSULTATION DURING SURGERY",110,67.64,42.24,364.6,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 88342","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 88342","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 88342 - HC CHG IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","88342","HC CHG IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE","88342 - HC CHG IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE",336,190.34,36.799999999999997,1705.48,84]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 88344","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 88344","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 88344 - IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","88344","IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE","88344 - IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE",423,360.63,159.9,2519.54,105.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 88350","BLUE CROSS - BLUE CROSS-INDEMNITY - 88350","BLUE CROSS - BLUE CROSS-INDEMNITY - 88350 - IMMUNOFLUORESCENCE PER SPEC ADD SINGL ANTB STAIN","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","88350","IMMUNOFLUORESCENCE PER SPEC ADD SINGL ANTB STAIN","88350 - IMMUNOFLUORESCENCE PER SPEC ADD SINGL ANTB STAIN",389,99.67,99.67,103.96,97.25]
["BMC HEALTHNET - BMCHN QHP - CPT - 88360","BMC HEALTHNET - BMCHN QHP - 88360","BMC HEALTHNET - BMCHN QHP - 88360 - HC CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL","BMC HEALTHNET","BMCHN QHP","CPT","88360","HC CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL","88360 - HC CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL",380,69.78,58.15,1705.48,95]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 88361","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 88361","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 88361 - HC CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","88361","HC CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST","88361 - HC CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST",475,577.51,194.53,2458.16,118.75]
["TUFTS - TUFTS HMO - CPT - 88364","TUFTS - TUFTS HMO - 88364","TUFTS - TUFTS HMO - 88364 - IN SITU HYBRIDIZATION EA ADDL PROBE STAIN","TUFTS","TUFTS HMO","CPT","88364","IN SITU HYBRIDIZATION EA ADDL PROBE STAIN","88364 - IN SITU HYBRIDIZATION EA ADDL PROBE STAIN",221,0,133.29,201.48,55.25]
["TUFTS - TUFTS HMO - CPT - 88365","TUFTS - TUFTS HMO - 88365","TUFTS - TUFTS HMO - 88365 - HC CHG IN SITU HYBRIDIZATION 1ST PROBE STAIN","TUFTS","TUFTS HMO","CPT","88365","HC CHG IN SITU HYBRIDIZATION 1ST PROBE STAIN","88365 - HC CHG IN SITU HYBRIDIZATION 1ST PROBE STAIN",523,546.45000000000005,110.4,1369.2,130.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 88380","CIGNA HEALTHCARE - CIGNA CARELINK - 88380","CIGNA HEALTHCARE - CIGNA CARELINK - 88380 - HC CHG MICRODISSECTION PREP IDENTIFIED TARGET LASER","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","88380","HC CHG MICRODISSECTION PREP IDENTIFIED TARGET LASER","88380 - HC CHG MICRODISSECTION PREP IDENTIFIED TARGET LASER",3123,0,28.59,161.54,780.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 89050","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - 89050","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - 89050 - HC CHG CELL COUNT MISCELLANEOUS BODY FLUIDS","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","89050","HC CHG CELL COUNT MISCELLANEOUS BODY FLUIDS","89050 - HC CHG CELL COUNT MISCELLANEOUS BODY FLUIDS",25,6.48,4.3099999999999996,53.02,6.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 89050","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 89050","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 89050 - HC CHG CELL COUNT MISCELLANEOUS BODY FLUIDS","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","89050","HC CHG CELL COUNT MISCELLANEOUS BODY FLUIDS","89050 - HC CHG CELL COUNT MISCELLANEOUS BODY FLUIDS",25,5.66,4.3099999999999996,53.02,6.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 89051","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 89051","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 89051 - HC CHG CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","89051","HC CHG CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT","89051 - HC CHG CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT",28,6.72,5.0199999999999996,61.83,7]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 89060","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 89060","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 89060 - HC CHG CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","89060","HC CHG CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID","89060 - HC CHG CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID",63,7.33,6.52,80.290000000000006,15.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 89320","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 89320","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 89320 - SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","89320","SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT","89320 - SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT",118,21.42,10.99,135.27000000000001,29.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90384","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 90384","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 90384 - HC IG;RHO D HUMAN/300MCG","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","90384","HC IG;RHO D HUMAN/300MCG","90384 - HC IG;RHO D HUMAN/300MCG",196,99,95.92,288.39,49]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90389","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 90389","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 90389 - HC US SCREENING SAAAVE MCR","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","90389","HC US SCREENING SAAAVE MCR","90389 - HC US SCREENING SAAAVE MCR",544,729.44,123.13,1744.97,136]
["TUFTS - TUFTS PPO - CPT - 90472","TUFTS - TUFTS PPO - 90472","TUFTS - TUFTS PPO - 90472 - IMADM PRQ ID SUBQ/IM NJXS EA VACCINE","TUFTS","TUFTS PPO","CPT","90472","IMADM PRQ ID SUBQ/IM NJXS EA VACCINE","90472 - IMADM PRQ ID SUBQ/IM NJXS EA VACCINE",64,0,25.32,25.32,16]
["TUFTS - TUFTS PPO - CPT - 90621","TUFTS - TUFTS PPO - 90621","TUFTS - TUFTS PPO - 90621 - MENB-FHBP RECOMBNT LIPOPROTEIN VACC 2/3 DOSE IM","TUFTS","TUFTS PPO","CPT","90621","MENB-FHBP RECOMBNT LIPOPROTEIN VACC 2/3 DOSE IM","90621 - MENB-FHBP RECOMBNT LIPOPROTEIN VACC 2/3 DOSE IM",444,157.11000000000001,146.87,441.59,111]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 90632","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 90632","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 90632 - CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","90632","CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL","90632 - CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",266.16000000000003,254.69499999999999,244.66,266.16000000000003,66.540000000000006]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90636","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 90636","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 90636 - HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","90636","HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM","90636 - HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM",123,0,74.239999999999995,150.25,30.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 90648","BMC HEALTHNET - BMCHN ACO - 90648","BMC HEALTHNET - BMCHN ACO - 90648 - HC HIB VACCINE, PRP-T, IM,DPH","BMC HEALTHNET","BMCHN ACO","CPT","90648","HC HIB VACCINE, PRP-T, IM,DPH","90648 - HC HIB VACCINE, PRP-T, IM,DPH",355.01,135.465,35.97,355.01,88.752499999999998]
["TUFTS - TUFTS POS - CPT - 90653","TUFTS - TUFTS POS - 90653","TUFTS - TUFTS POS - 90653 - HC IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE","TUFTS","TUFTS POS","CPT","90653","HC IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE","90653 - HC IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE",79,86.32,59.53,149.79,19.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 90662","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 90662","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 90662 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM FLUZONE HIGH DOSE","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT","90662","INFLUENZA VACCINE CELL CULT PRSRV FREE IM FLUZONE HIGH DOSE","90662 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM FLUZONE HIGH DOSE",129,82.21,60.98,244.17,32.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 90670","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 90670","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 90670 - CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","90670","CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH","90670 - CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH",749.99,725.45,700.91,749.99,187.4975]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90672","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 90672","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 90672 - CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","90672","CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST","90672 - CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST",81.53,80.009999999999991,78.489999999999995,81.53,20.3825]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 90673","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - 90673","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - 90673 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","90673","INFLUENZA VACCINE CELL CULT PRSRV FREE IM","90673 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM",127,87.68,40.61,177.04,31.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 90675","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - 90675","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - 90675 - CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","90675","CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL","90675 - CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["UNICARE - UNICARE - CPT - 90686","UNICARE - UNICARE - 90686","UNICARE - UNICARE - 90686 - HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE","UNICARE","UNICARE","CPT","90686","HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE","90686 - HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",66.930000000000007,62.792500000000004,59.699999999999996,66.930000000000007,16.732500000000002]
["UNICARE - UNICARE - CPT - 90690","UNICARE - UNICARE - 90690","UNICARE - UNICARE - 90690 - CR BUILD ONLY - TYPHOID VACCINE, ORAL,TRAVEL","UNICARE","UNICARE","CPT","90690","CR BUILD ONLY - TYPHOID VACCINE, ORAL,TRAVEL","90690 - CR BUILD ONLY - TYPHOID VACCINE, ORAL,TRAVEL",234.33,234.33,234.33,234.33,58.582500000000003]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 90694","TUFTS - TUFTS MEDICARE PREFERRED HMO - 90694","TUFTS - TUFTS MEDICARE PREFERRED HMO - 90694 - HC VACC AIIV4 NO PRSRV 0.5ML IM","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","90694","HC VACC AIIV4 NO PRSRV 0.5ML IM","90694 - HC VACC AIIV4 NO PRSRV 0.5ML IM",180.47,180.42500000000001,180.38,180.47,45.1175]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90698","BLUE CROSS - BLUE CROSS-INDEMNITY - 90698","BLUE CROSS - BLUE CROSS-INDEMNITY - 90698 - CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","90698","CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH","90698 - CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",355.01,290.488,160.24,355.01,88.752499999999998]
["TUFTS - TUFTS POS - CPT - 90707","TUFTS - TUFTS POS - 90707","TUFTS - TUFTS POS - 90707 - CR BUILD ONLY - MMR VIRUS IMMUNIZATION, SUBCUT,TRAVEL,PEDI","TUFTS","TUFTS POS","CPT","90707","CR BUILD ONLY - MMR VIRUS IMMUNIZATION, SUBCUT,TRAVEL,PEDI","90707 - CR BUILD ONLY - MMR VIRUS IMMUNIZATION, SUBCUT,TRAVEL,PEDI",280.73,280.73,280.73,280.73,70.182500000000005]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90714","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 90714","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 90714 - CR BUILD ONLY - TD VACCINE NO PRSRV >/= 7 YO, IM,DPH","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","90714","CR BUILD ONLY - TD VACCINE NO PRSRV >/= 7 YO, IM,DPH","90714 - CR BUILD ONLY - TD VACCINE NO PRSRV >/= 7 YO, IM,DPH",63.91,61.674999999999997,59.44,63.91,15.977499999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90715","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 90715","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 90715 - CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","90715","CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH","90715 - CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",163.03,145.40857142857143,121.14999999999999,163.03,40.7575]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90717","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 90717","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 90717 - YELLOW FEVER VACCINE SUBQ","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","90717","YELLOW FEVER VACCINE SUBQ","90717 - YELLOW FEVER VACCINE SUBQ",578.47,578.47,578.47,578.47,144.61750000000001]
["TUFTS - TUFTS POS - CPT - 90723","TUFTS - TUFTS POS - 90723","TUFTS - TUFTS POS - 90723 - CR BUILD ONLY - DTAP/HEPB/IPV VACCINE,IM,DPH","TUFTS","TUFTS POS","CPT","90723","CR BUILD ONLY - DTAP/HEPB/IPV VACCINE,IM,DPH","90723 - CR BUILD ONLY - DTAP/HEPB/IPV VACCINE,IM,DPH",306.57,306.57,306.57,306.57,76.642499999999998]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 90736","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 90736","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 90736 - ZOSTER SHINGLES VACCINE LIVE SUBCUTANEOUS","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","90736","ZOSTER SHINGLES VACCINE LIVE SUBCUTANEOUS","90736 - ZOSTER SHINGLES VACCINE LIVE SUBCUTANEOUS",1017,293.48,129.41999999999999,424.4,254.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 90739","TUFTS - TUFTS MEDICARE PREFERRED HMO - 90739","TUFTS - TUFTS MEDICARE PREFERRED HMO - 90739 - HC HEPATITIS B VACCINE ADULT 2 DOSE IM","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","90739","HC HEPATITIS B VACCINE ADULT 2 DOSE IM","90739 - HC HEPATITIS B VACCINE ADULT 2 DOSE IM",411.21,300.65499999999997,411.21,411.21,102.80249999999999]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90740","BLUE CROSS - BLUE CROSS-HMO BLUE - 90740","BLUE CROSS - BLUE CROSS-HMO BLUE - 90740 - HC HEP B VACCINE,DIAL/IMMUNOSUP, IM","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","90740","HC HEP B VACCINE,DIAL/IMMUNOSUP, IM","90740 - HC HEP B VACCINE,DIAL/IMMUNOSUP, IM",350.28,144.89333333333332,0.18000000000000002,350.28,87.57]
["TUFTS - TUFTS MEDICARE SCO - CPT - 90744","TUFTS - TUFTS MEDICARE SCO - 90744","TUFTS - TUFTS MEDICARE SCO - 90744 - CR BUILD ONLY - HEP B VACCINE,PED/ADOL,IM,DPH","TUFTS","TUFTS MEDICARE SCO","CPT","90744","CR BUILD ONLY - HEP B VACCINE,PED/ADOL,IM,DPH","90744 - CR BUILD ONLY - HEP B VACCINE,PED/ADOL,IM,DPH",87.01,87.01,87.01,87.01,21.752500000000001]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90750","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 90750","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 90750 - HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","90750","HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX","90750 - HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX",540.45000000000005,404.48500000000001,268.52,540.45000000000005,135.11250000000001]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 90756","AETNA - AETNA-MEDICARE ADVANTAGE - 90756","AETNA - AETNA-MEDICARE ADVANTAGE - 90756 - HC CCIIV4 VACCINE ANTIBIOTIC FREE 0.5ML DOS IM USE","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","90756","HC CCIIV4 VACCINE ANTIBIOTIC FREE 0.5ML DOS IM USE","90756 - HC CCIIV4 VACCINE ANTIBIOTIC FREE 0.5ML DOS IM USE",67.58,67.58,67.58,67.58,16.895]
["TUFTS - TUFTS POS - CPT - 90792","TUFTS - TUFTS POS - 90792","TUFTS - TUFTS POS - 90792 - PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES","TUFTS","TUFTS POS","CPT","90792","PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES","90792 - PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES",165,46.18,40.369999999999997,214.2,41.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 90833","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 90833","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 90833 - PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 30 MIN","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","90833","PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 30 MIN","90833 - PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 30 MIN",27,155.30000000000001,155.30000000000001,155.30000000000001,6.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90839","BLUE CROSS - BLUE CROSS-HMO BLUE - 90839","BLUE CROSS - BLUE CROSS-HMO BLUE - 90839 - HC PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","90839","HC PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES","90839 - HC PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES",153,214.2,40.369999999999997,214.2,38.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90847","BLUE CROSS - BLUE CROSS-HMO BLUE - 90847","BLUE CROSS - BLUE CROSS-HMO BLUE - 90847 - FAMILY PSYCHOTHERAPY W/PATIENT PRESENT","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","90847","FAMILY PSYCHOTHERAPY W/PATIENT PRESENT","90847 - FAMILY PSYCHOTHERAPY W/PATIENT PRESENT",281,214.2,44.81,214.2,70.25]
["TUFTS - TUFTS HMO - CPT - 90849","TUFTS - TUFTS HMO - 90849","TUFTS - TUFTS HMO - 90849 - MULTIPLE FAMILY GROUP PSYCHOTHERAPY","TUFTS","TUFTS HMO","CPT","90849","MULTIPLE FAMILY GROUP PSYCHOTHERAPY","90849 - MULTIPLE FAMILY GROUP PSYCHOTHERAPY",121,31.11,22.66,214.2,30.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90882","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 90882","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 90882 - HC ENVIRONMENTAL IVNTJ MGMT PURPOSES PSYC PT","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","90882","HC ENVIRONMENTAL IVNTJ MGMT PURPOSES PSYC PT","90882 - HC ENVIRONMENTAL IVNTJ MGMT PURPOSES PSYC PT",218,184.27,158.44,894.84,54.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90887","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 90887","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 90887 - INTERPJ/EXPLNAJ RESULTS PSYCHIATRIC EXAM FAMILY","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","90887","INTERPJ/EXPLNAJ RESULTS PSYCHIATRIC EXAM FAMILY","90887 - INTERPJ/EXPLNAJ RESULTS PSYCHIATRIC EXAM FAMILY",231,183.64,183.64,183.64,57.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90912","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 90912","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 90912 - HC BFB TRAINING 1ST 15 MIN","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","90912","HC BFB TRAINING 1ST 15 MIN","90912 - HC BFB TRAINING 1ST 15 MIN",260,286.31,108.42,1370.62,65]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90945","CIGNA HEALTHCARE - CIGNA CARELINK - 90945","CIGNA HEALTHCARE - CIGNA CARELINK - 90945 - HC DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","90945","HC DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL","90945 - HC DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL",565,2035.73,605.19000000000005,2035.73,141.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 91010","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 91010","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 91010 - ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","91010","ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT","91010 - ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT",906,982.93,764.57,4807.5,226.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 91038","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 91038","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 91038 - ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","91038","ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG","91038 - ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG",2395,764.57,764.57,4429.7299999999996,598.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 91065","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 91065","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 91065 - BREATH HYDROGEN TEST","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","91065","BREATH HYDROGEN TEST","91065 - BREATH HYDROGEN TEST",470,228.32,228.32,1412.44,117.5]
["TUFTS - TUFTS POS - CPT - 91112","TUFTS - TUFTS POS - 91112","TUFTS - TUFTS POS - 91112 - GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP","TUFTS","TUFTS POS","CPT","91112","GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP","91112 - GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP",5914,2545.0700000000002,1278.93,4318.55,1478.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 92002","BLUE CROSS - BLUE CROSS-INDEMNITY - 92002","BLUE CROSS - BLUE CROSS-INDEMNITY - 92002 - OPHTH MEDICAL XM&EVAL INTERMEDIATE NEW PT","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","92002","OPHTH MEDICAL XM&EVAL INTERMEDIATE NEW PT","92002 - OPHTH MEDICAL XM&EVAL INTERMEDIATE NEW PT",240,194.55,37.130000000000003,194.55,60]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 92012","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 92012","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 92012 - OPHTH MEDICAL XM&EVAL INTERMEDIATE ESTAB PT","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","92012","OPHTH MEDICAL XM&EVAL INTERMEDIATE ESTAB PT","92012 - OPHTH MEDICAL XM&EVAL INTERMEDIATE ESTAB PT",265,194.55,31.68,194.55,66.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 92018","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 92018","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 92018 - HC NEW EYE EXAM & TREATMENT","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","92018","HC NEW EYE EXAM & TREATMENT","92018 - HC NEW EYE EXAM & TREATMENT",2949,3044.16,486.48,3522.21,737.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 92020","BLUE CROSS - BLUE CROSS-INDEMNITY - 92020","BLUE CROSS - BLUE CROSS-INDEMNITY - 92020 - GONIOSCOPY SEPARATE PROCEDURE","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","92020","GONIOSCOPY SEPARATE PROCEDURE","92020 - GONIOSCOPY SEPARATE PROCEDURE",192,178.83,68.75,587.33000000000004,48]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 92065","CIGNA HEALTHCARE - CIGNA CARELINK - 92065","CIGNA HEALTHCARE - CIGNA CARELINK - 92065 - ORTHOPTIC &/PLEOPTIC TRAINING W/MEDICAL DIRECTJ","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","92065","ORTHOPTIC &/PLEOPTIC TRAINING W/MEDICAL DIRECTJ","92065 - ORTHOPTIC &/PLEOPTIC TRAINING W/MEDICAL DIRECTJ",269,344.19,68.75,344.19,67.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 92082","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 92082","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 92082 - VISUAL FIELD XM UNI/BI W/INTERP INTERMED EXAM","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","92082","VISUAL FIELD XM UNI/BI W/INTERP INTERMED EXAM","92082 - VISUAL FIELD XM UNI/BI W/INTERP INTERMED EXAM",347,93.87,68.75,317.35000000000002,86.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 92082","UNICARE - UNICARE STATE INDEMNITY PLAN - 92082","UNICARE - UNICARE STATE INDEMNITY PLAN - 92082 - VISUAL FIELD XM UNI/BI W/INTERP INTERMED EXAM","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","92082","VISUAL FIELD XM UNI/BI W/INTERP INTERMED EXAM","92082 - VISUAL FIELD XM UNI/BI W/INTERP INTERMED EXAM",347,68.75,68.75,317.35000000000002,86.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 92136","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 92136","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 92136 - OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","92136","OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL","92136 - OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL",442,178.83,68.75,607.84,110.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 92202","BLUE CROSS - BLUE CROSS-PPO - 92202","BLUE CROSS - BLUE CROSS-PPO - 92202 - HC OPSCPY EXTND ON/MAC DRAW","BLUE CROSS","BLUE CROSS-PPO","CPT","92202","HC OPSCPY EXTND ON/MAC DRAW","92202 - HC OPSCPY EXTND ON/MAC DRAW",71,88.54,88.54,320.3,17.75]
["TUFTS - TUFTS SELECT - CPT - 92235","TUFTS - TUFTS SELECT - 92235","TUFTS - TUFTS SELECT - 92235 - FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT","TUFTS","TUFTS SELECT","CPT","92235","FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT","92235 - FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT",941,457.32,172.1,2582.75,235.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 92260","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 92260","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 92260 - OPHTHALMODYNAMOMETRY","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","92260","OPHTHALMODYNAMOMETRY","92260 - OPHTHALMODYNAMOMETRY",92,53.94,53.94,341.01,23]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 92265","BLUE CROSS - BLUE CROSS-HMO BLUE - 92265","BLUE CROSS - BLUE CROSS-HMO BLUE - 92265 - NEEDLE OCULOGRAPHY 1/ XOC MUSC 1/BOTH EYE W/I&R","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","92265","NEEDLE OCULOGRAPHY 1/ XOC MUSC 1/BOTH EYE W/I&R","92265 - NEEDLE OCULOGRAPHY 1/ XOC MUSC 1/BOTH EYE W/I&R",420,93.87,68.75,562.35,105]
["TUFTS - TUFTS HMO - CPT - 92274","TUFTS - TUFTS HMO - 92274","TUFTS - TUFTS HMO - 92274 - HC MULTIFOCAL ERG W/I&R","TUFTS","TUFTS HMO","CPT","92274","HC MULTIFOCAL ERG W/I&R","92274 - HC MULTIFOCAL ERG W/I&R",210,469.76,228.32,797.09,52.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 92283","CIGNA HEALTHCARE - CIGNA CARELINK - 92283","CIGNA HEALTHCARE - CIGNA CARELINK - 92283 - HC COLOR VISION EXAMINATION","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","92283","HC COLOR VISION EXAMINATION","92283 - HC COLOR VISION EXAMINATION",163,861.5,68.75,861.5,40.75]
["TUFTS - TUFTS HMO - CPT - 92286","TUFTS - TUFTS HMO - 92286","TUFTS - TUFTS HMO - 92286 - ANT SGM IMAGING W/MICROSCOPY ENDOTHELIAL ANALY","TUFTS","TUFTS HMO","CPT","92286","ANT SGM IMAGING W/MICROSCOPY ENDOTHELIAL ANALY","92286 - ANT SGM IMAGING W/MICROSCOPY ENDOTHELIAL ANALY",615,429.87,125.6,1077.0999999999999,153.75]
["TUFTS - TUFTS PPO - CPT - 92310","TUFTS - TUFTS PPO - 92310","TUFTS - TUFTS PPO - 92310 - RX&FITG C-LENS SUPVJ CRNL LENS OU XCPT APHK","TUFTS","TUFTS PPO","CPT","92310","RX&FITG C-LENS SUPVJ CRNL LENS OU XCPT APHK","92310 - RX&FITG C-LENS SUPVJ CRNL LENS OU XCPT APHK",20,116.57,58.01,751.68,5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 92312","UNICARE - UNICARE STATE INDEMNITY PLAN - 92312","UNICARE - UNICARE STATE INDEMNITY PLAN - 92312 - HC CONTACT LENS FIT,APHAKIA BILAT","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","92312","HC CONTACT LENS FIT,APHAKIA BILAT","92312 - HC CONTACT LENS FIT,APHAKIA BILAT",163,93.14,93.14,587.33000000000004,40.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 92507","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 92507","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 92507 - TX SPEECH LANG VOICE COMMJ &/AUDITORY PROC IND","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","92507","TX SPEECH LANG VOICE COMMJ &/AUDITORY PROC IND","92507 - TX SPEECH LANG VOICE COMMJ &/AUDITORY PROC IND",343,194.6,130.62,421.06,85.75]
["TUFTS - TUFTS POS - CPT - 92508","TUFTS - TUFTS POS - 92508","TUFTS - TUFTS POS - 92508 - TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV","TUFTS","TUFTS POS","CPT","92508","TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV","92508 - TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV",165,75.53,40.21,128.16,41.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 92522","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 92522","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 92522 - EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","92522","EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE","92522 - EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE",440,226.86,179.09,570.79,110]
["BMC HEALTHNET - BMCHN QHP - CPT - 92532","BMC HEALTHNET - BMCHN QHP - 92532","BMC HEALTHNET - BMCHN QHP - 92532 - POSITIONAL NYSTAGMUS TEST","BMC HEALTHNET","BMCHN QHP","CPT","92532","POSITIONAL NYSTAGMUS TEST","92532 - POSITIONAL NYSTAGMUS TEST",163,0,42.65,42.65,40.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 92537","BLUE CROSS - BLUE CROSS-INDEMNITY - 92537","BLUE CROSS - BLUE CROSS-INDEMNITY - 92537 - CALORIC VESTIBULAR WITH RECORDING, BILATERAL; BITHERMAL","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","92537","CALORIC VESTIBULAR WITH RECORDING, BILATERAL; BITHERMAL","92537 - CALORIC VESTIBULAR WITH RECORDING, BILATERAL; BITHERMAL",660,228.32,228.32,1610.39,165]
["TUFTS - TUFTS POS - CPT - 92541","TUFTS - TUFTS POS - 92541","TUFTS - TUFTS POS - 92541 - SPONTANEOUS NYSTAGMUS TEST","TUFTS","TUFTS POS","CPT","92541","SPONTANEOUS NYSTAGMUS TEST","92541 - SPONTANEOUS NYSTAGMUS TEST",150,358.22,178.83,1077.0999999999999,37.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 92546","BLUE CROSS - BLUE CROSS-INDEMNITY - 92546","BLUE CROSS - BLUE CROSS-INDEMNITY - 92546 - SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","92546","SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING","92546 - SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING",524,228.32,228.32,1412.44,131]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 92550","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 92550","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 92550 - TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","92550","TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS","92550 - TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS",134,228.32,225.69,1274.6400000000001,33.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 92555","UNICARE - UNICARE STATE INDEMNITY PLAN - 92555","UNICARE - UNICARE STATE INDEMNITY PLAN - 92555 - SPEECH AUDIOMETRY THRESHOLD","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","92555","SPEECH AUDIOMETRY THRESHOLD","92555 - SPEECH AUDIOMETRY THRESHOLD",165,59.1,53.94,336.64,41.25]
["TUFTS - TUFTS PPO - CPT - 92556","TUFTS - TUFTS PPO - 92556","TUFTS - TUFTS PPO - 92556 - SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ","TUFTS","TUFTS PPO","CPT","92556","SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ","92556 - SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ",181,119.77,53.94,336.64,45.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 92562","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 92562","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 92562 - LOUDNESS BALANCE BINAURAL/MONAURAL","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","92562","LOUDNESS BALANCE BINAURAL/MONAURAL","92562 - LOUDNESS BALANCE BINAURAL/MONAURAL",215,0,59.1,1274.6400000000001,53.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 92568","BLUE CROSS - BLUE CROSS-HMO BLUE - 92568","BLUE CROSS - BLUE CROSS-HMO BLUE - 92568 - ACOUSTIC REFLEX THRESHOLD","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","92568","ACOUSTIC REFLEX THRESHOLD","92568 - ACOUSTIC REFLEX THRESHOLD",79,53.94,53.94,326.01,19.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 92568","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 92568","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 92568 - ACOUSTIC REFLEX THRESHOLD","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","92568","ACOUSTIC REFLEX THRESHOLD","92568 - ACOUSTIC REFLEX THRESHOLD",79,67.64,53.94,326.01,19.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 92576","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 92576","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 92576 - SYNTHETIC SENTENCE IDENTIFICATION TEST","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","92576","SYNTHETIC SENTENCE IDENTIFICATION TEST","92576 - SYNTHETIC SENTENCE IDENTIFICATION TEST",189,53.94,53.94,336.64,47.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 92577","BLUE CROSS - BLUE CROSS-HMO BLUE - 92577","BLUE CROSS - BLUE CROSS-HMO BLUE - 92577 - STENGER TEST SPEECH","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","92577","STENGER TEST SPEECH","92577 - STENGER TEST SPEECH",286,764.57,158,3800.82,71.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 92584","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 92584","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 92584 - ELECTROCOCHLEOGRAPY","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","92584","ELECTROCOCHLEOGRAPY","92584 - ELECTROCOCHLEOGRAPY",492,228.32,211.54,1412.44,123]
["TUFTS - TUFTS POS - CPT - 92587","TUFTS - TUFTS POS - 92587","TUFTS - TUFTS POS - 92587 - DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD","TUFTS","TUFTS POS","CPT","92587","DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD","92587 - DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD",457,777.33,107.3,2337.23,114.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 92588","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 92588","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 92588 - DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","92588","DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL","92588 - DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL",457,544.74,107.3,2337.23,114.25]
["TUFTS - TUFTS SELECT - CPT - 92593","TUFTS - TUFTS SELECT - 92593","TUFTS - TUFTS SELECT - 92593 - HEARING AID CHECK BINAURAL","TUFTS","TUFTS SELECT","CPT","92593","HEARING AID CHECK BINAURAL","92593 - HEARING AID CHECK BINAURAL",100,39.32,39.32,222.08,25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 92595","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 92595","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 92595 - ELECTROACOUS EVAL HEARING AID BINAURAL","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","92595","ELECTROACOUS EVAL HEARING AID BINAURAL","92595 - ELECTROACOUS EVAL HEARING AID BINAURAL",371,102.26,39.32,222.08,92.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 92603","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 92603","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 92603 - HC DX ANAL COCHLEAR IMP,PT >7 YRS,W/PROG","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","92603","HC DX ANAL COCHLEAR IMP,PT >7 YRS,W/PROG","92603 - HC DX ANAL COCHLEAR IMP,PT >7 YRS,W/PROG",259,228.32,228.32,1412.44,64.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 92607","BLUE CROSS - BLUE CROSS-HMO BLUE - 92607","BLUE CROSS - BLUE CROSS-HMO BLUE - 92607 - RX SP-GENRATJ AUGMNT&COMUNICAJ DEV 1ST HR","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","92607","RX SP-GENRATJ AUGMNT&COMUNICAJ DEV 1ST HR","92607 - RX SP-GENRATJ AUGMNT&COMUNICAJ DEV 1ST HR",518,325.64,166.37,939.63,129.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 92609","BLUE CROSS - BLUE CROSS-HMO BLUE - 92609","BLUE CROSS - BLUE CROSS-HMO BLUE - 92609 - HC USE OF SPEECH DEVICE SERVICE","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","92609","HC USE OF SPEECH DEVICE SERVICE","92609 - HC USE OF SPEECH DEVICE SERVICE",309,272.39999999999998,139.9,790.1,77.25]
["TUFTS - TUFTS PPO - CPT - 92616","TUFTS - TUFTS PPO - 92616","TUFTS - TUFTS PPO - 92616 - FLX FIBOPT NDSC EVAL SWLNG&LARYN SENS C/V REC","TUFTS","TUFTS PPO","CPT","92616","FLX FIBOPT NDSC EVAL SWLNG&LARYN SENS C/V REC","92616 - FLX FIBOPT NDSC EVAL SWLNG&LARYN SENS C/V REC",519,860.3,244.78,2418.09,129.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 92621","BLUE CROSS - BLUE CROSS-HMO BLUE - 92621","BLUE CROSS - BLUE CROSS-HMO BLUE - 92621 - EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","92621","EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN","92621 - EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN",95,46.73,46.73,46.73,23.75]
["TUFTS - TUFTS HMO - CPT - 92627","TUFTS - TUFTS HMO - 92627","TUFTS - TUFTS HMO - 92627 - HC EVAL AUDITORY REHAB STATUS, EA ADD 15","TUFTS","TUFTS HMO","CPT","92627","HC EVAL AUDITORY REHAB STATUS, EA ADD 15","92627 - HC EVAL AUDITORY REHAB STATUS, EA ADD 15",208,0,44.13,44.13,52]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 92921","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 92921","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 92921 - HC PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","92921","HC PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH","92921 - HC PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH",5911,6476.91,6476.91,6476.91,1477.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 92924","BLUE CROSS - BLUE CROSS-PPO - 92924","BLUE CROSS - BLUE CROSS-PPO - 92924 - HC PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH","BLUE CROSS","BLUE CROSS-PPO","CPT","92924","HC PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH","92924 - HC PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH",10821,16237.9,12498.68,37129.18,2705.25]
["TUFTS - TUFTS HMO - CPT - 92928","TUFTS - TUFTS HMO - 92928","TUFTS - TUFTS HMO - 92928 - HC PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH","TUFTS","TUFTS HMO","CPT","92928","HC PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH","92928 - HC PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH",14515,23407.53,12498.68,37129.18,3628.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 92933","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 92933","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 92933 - HC PRQ TRLUML CORONRY STENT/ATH/ANGIO ONE ART/BRNCH","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","92933","HC PRQ TRLUML CORONRY STENT/ATH/ANGIO ONE ART/BRNCH","92933 - HC PRQ TRLUML CORONRY STENT/ATH/ANGIO ONE ART/BRNCH",16686,29102.92,3954.83,62742.78,4171.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 92941","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 92941","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 92941 - HC PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","92941","HC PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL","92941 - HC PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL",10821,1657.51,1657.51,37129.18,2705.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 92950","CIGNA HEALTHCARE - CIGNA CARELINK - 92950","CIGNA HEALTHCARE - CIGNA CARELINK - 92950 - CARDIOPULMONARY RESUSCITATION","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","92950","CARDIOPULMONARY RESUSCITATION","92950 - CARDIOPULMONARY RESUSCITATION",1712,2582.75,423.72,2582.75,428]
["TUFTS - TUFTS HMO - CPT - 92953","TUFTS - TUFTS HMO - 92953","TUFTS - TUFTS HMO - 92953 - HC TEMPORARY TRANSCUTANEOUS PACING","TUFTS","TUFTS HMO","CPT","92953","HC TEMPORARY TRANSCUTANEOUS PACING","92953 - HC TEMPORARY TRANSCUTANEOUS PACING",798,1998.67,884.17,5007.9799999999996,199.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 92977","BLUE CROSS - BLUE CROSS-PPO - 92977","BLUE CROSS - BLUE CROSS-PPO - 92977 - HC THROMBOLYSIS,CORONARY,IV INFUSN","BLUE CROSS","BLUE CROSS-PPO","CPT","92977","HC THROMBOLYSIS,CORONARY,IV INFUSN","92977 - HC THROMBOLYSIS,CORONARY,IV INFUSN",437,484.3,484.3,3021.28,109.25]
["TUFTS - TUFTS PPO - CPT - 92986","TUFTS - TUFTS PPO - 92986","TUFTS - TUFTS PPO - 92986 - HC PRQ BALLOON VALVULOPLASTY AORTIC VALVE","TUFTS","TUFTS PPO","CPT","92986","HC PRQ BALLOON VALVULOPLASTY AORTIC VALVE","92986 - HC PRQ BALLOON VALVULOPLASTY AORTIC VALVE",12443,9609.09,5130.87,15242.01,3110.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 92986","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 92986","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 92986 - HC PRQ BALLOON VALVULOPLASTY AORTIC VALVE","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","92986","HC PRQ BALLOON VALVULOPLASTY AORTIC VALVE","92986 - HC PRQ BALLOON VALVULOPLASTY AORTIC VALVE",12443,9090.86,5130.87,15242.01,3110.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 93225","BLUE CROSS - BLUE CROSS-PPO - 93225","BLUE CROSS - BLUE CROSS-PPO - 93225 - HC XTRNL ECG & 48 HR RECORDING","BLUE CROSS","BLUE CROSS-PPO","CPT","93225","HC XTRNL ECG & 48 HR RECORDING","93225 - HC XTRNL ECG & 48 HR RECORDING",245,178.83,126.22,1077.0999999999999,61.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 93226","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 93226","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 93226 - EXTERNAL ECG SCANNING ANALYSIS REPORT","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","93226","EXTERNAL ECG SCANNING ANALYSIS REPORT","93226 - EXTERNAL ECG SCANNING ANALYSIS REPORT",360,178.83,126.22,1077.0999999999999,90]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 93271","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 93271","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 93271 - HC EXT ECG,PT DEMAND EVENT, SYMPT MEMORY LOOP, TRANSMIT","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","93271","HC EXT ECG,PT DEMAND EVENT, SYMPT MEMORY LOOP, TRANSMIT","93271 - HC EXT ECG,PT DEMAND EVENT, SYMPT MEMORY LOOP, TRANSMIT",170,253.77,126.22,1144.02,42.5]
["TUFTS - TUFTS PPO - CPT - 93280","TUFTS - TUFTS PPO - 93280","TUFTS - TUFTS PPO - 93280 - PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER","TUFTS","TUFTS PPO","CPT","93280","PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER","93280 - PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER",519,131.81,41.48,370.47,129.75]
["TUFTS - TUFTS SELECT - CPT - 93281","TUFTS - TUFTS SELECT - 93281","TUFTS - TUFTS SELECT - 93281 - PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER","TUFTS","TUFTS SELECT","CPT","93281","PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER","93281 - PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER",604,65.599999999999994,41.48,370.47,151]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 93284","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 93284","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 93284 - PROGRM EVAL IMPLANTABLE IN PRSN MLT LD CARD/DFB","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","93284","PROGRM EVAL IMPLANTABLE IN PRSN MLT LD CARD/DFB","93284 - PROGRM EVAL IMPLANTABLE IN PRSN MLT LD CARD/DFB",792,78.260000000000005,62.4,370.47,198]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 93287","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 93287","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 93287 - HC PERI-PX DEV EVAL & PROG SING/DUAL/MULTI LEAD DFB","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","93287","HC PERI-PX DEV EVAL & PROG SING/DUAL/MULTI LEAD DFB","93287 - HC PERI-PX DEV EVAL & PROG SING/DUAL/MULTI LEAD DFB",315,0,52.71,52.71,78.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 93289","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 93289","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 93289 - HC INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","93289","HC INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB","93289 - HC INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB",57,62.4,62.4,370.47,14.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 93293","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 93293","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 93293 - HC TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","93293","HC TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL","93293 - HC TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL",56,80.23,62.4,370.47,14]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 93294","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 93294","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 93294 - INTERROGATION EVAL REMOTE </90 D 1/2/MLT LEAD PM","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","93294","INTERROGATION EVAL REMOTE </90 D 1/2/MLT LEAD PM","93294 - INTERROGATION EVAL REMOTE </90 D 1/2/MLT LEAD PM",277,80.23,47.21,266.63,69.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 93299","CIGNA HEALTHCARE - CIGNA CARELINK - 93299","CIGNA HEALTHCARE - CIGNA CARELINK - 93299 - INTERROGATION EVAL REMOTE </30 D TECH REVIEW","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","93299","INTERROGATION EVAL REMOTE </30 D TECH REVIEW","93299 - INTERROGATION EVAL REMOTE </30 D TECH REVIEW",165,369.9,65.5,369.9,41.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 93303","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 93303","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 93303 - HC COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","93303","HC COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY","93303 - HC COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY",1861,1074.08,403.66,4775.3,465.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 93307","UNICARE - UNICARE STATE INDEMNITY PLAN - 93307","UNICARE - UNICARE STATE INDEMNITY PLAN - 93307 - HC ECHO HEART XTHORACIC,COMPLETE, W/O DOPPLER  WITH CONTRAST","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","93307","HC ECHO HEART XTHORACIC,COMPLETE, W/O DOPPLER  WITH CONTRAST","93307 - HC ECHO HEART XTHORACIC,COMPLETE, W/O DOPPLER  WITH CONTRAST",1065,403.66,387.2,2940.06,266.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 93315","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 93315","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 93315 - HC ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R WITH CONTRAST","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","93315","HC ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R WITH CONTRAST","93315 - HC ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R WITH CONTRAST",1271,835.47,756.94,5016.9799999999996,317.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 93316","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 93316","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 93316 - HC ECHO TRANSESOPHAG CONGEN PROBE PLCMT ONLY","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","93316","HC ECHO TRANSESOPHAG CONGEN PROBE PLCMT ONLY","93316 - HC ECHO TRANSESOPHAG CONGEN PROBE PLCMT ONLY",1378,835.47,756.94,4775.3,344.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 93321","BLUE CROSS - BLUE CROSS-PPO - 93321","BLUE CROSS - BLUE CROSS-PPO - 93321 - HC DOP ECHOCARD PULSE WAVE W/SPECTRAL F-UP/LMTD STD","BLUE CROSS","BLUE CROSS-PPO","CPT","93321","HC DOP ECHOCARD PULSE WAVE W/SPECTRAL F-UP/LMTD STD","93321 - HC DOP ECHOCARD PULSE WAVE W/SPECTRAL F-UP/LMTD STD",224,51.85,51.85,225.94,56]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 93325","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 93325","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 93325 - DOP ECHOCARD COLOR FLOW VELOCITY MAPPING","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","93325","DOP ECHOCARD COLOR FLOW VELOCITY MAPPING","93325 - DOP ECHOCARD COLOR FLOW VELOCITY MAPPING",189,58.45,58.45,225.94,47.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 93355","CIGNA HEALTHCARE - CIGNA CARELINK - 93355","CIGNA HEALTHCARE - CIGNA CARELINK - 93355 - ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","93355","ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN","93355 - ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN",280,0,562.1,562.1,70]
["TUFTS - TUFTS HMO - CPT - 93452","TUFTS - TUFTS HMO - 93452","TUFTS - TUFTS HMO - 93452 - HC L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","TUFTS","TUFTS HMO","CPT","93452","HC L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - HC L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",8230,4856.75,2531.06,7703.8,2057.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 93453","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 93453","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 93453 - HC R & L HRT CATH W/NJX L VENTRICULOG IMG S&I","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","93453","HC R & L HRT CATH W/NJX L VENTRICULOG IMG S&I","93453 - HC R & L HRT CATH W/NJX L VENTRICULOG IMG S&I",10776,4719.71,2531.06,7703.8,2694]
["TUFTS - TUFTS HMO - CPT - 93456","TUFTS - TUFTS HMO - 93456","TUFTS - TUFTS HMO - 93456 - HC CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I","TUFTS","TUFTS HMO","CPT","93456","HC CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I","93456 - HC CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I",10614,4856.75,2531.06,7703.8,2653.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 93458","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 93458","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 93458 - HC CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","93458","HC CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I","93458 - HC CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I",10240,4719.71,2531.06,7703.8,2560]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 93460","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 93460","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 93460 - HC R & L HRT CATH WINJX HRT ART& L VENTR IMG","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","93460","HC R & L HRT CATH WINJX HRT ART& L VENTR IMG","93460 - HC R & L HRT CATH WINJX HRT ART& L VENTR IMG",12086,5460.91,2531.06,7703.8,3021.5]
["TUFTS - TUFTS HMO - CPT - 93463","TUFTS - TUFTS HMO - 93463","TUFTS - TUFTS HMO - 93463 - HC DRUG ADMIN & HEMODYNMIC MEAS","TUFTS","TUFTS HMO","CPT","93463","HC DRUG ADMIN & HEMODYNMIC MEAS","93463 - HC DRUG ADMIN & HEMODYNMIC MEAS",1006,0,241.3,241.3,251.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 93464","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 93464","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 93464 - HC PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","93464","HC PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU","93464 - HC PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU",845,0,427.95,427.95,211.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 93530","UNICARE - UNICARE STATE INDEMNITY PLAN - 93530","UNICARE - UNICARE STATE INDEMNITY PLAN - 93530 - RHC CNGNITL ANMLES","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","93530","RHC CNGNITL ANMLES","93530 - RHC CNGNITL ANMLES",2897,4496.8,2531.06,7703.8,724.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 93565","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 93565","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 93565 - HC NJX SEL L VENT/ATRIAL ANGIO HRT CATH W/S&I","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","93565","HC NJX SEL L VENT/ATRIAL ANGIO HRT CATH W/S&I","93565 - HC NJX SEL L VENT/ATRIAL ANGIO HRT CATH W/S&I",401,112.05,112.05,112.05,100.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 93566","BLUE CROSS - BLUE CROSS-PPO - 93566","BLUE CROSS - BLUE CROSS-PPO - 93566 - HC NJX SEL R VENT/ATRIAL ANGIO HRT CATH W/S&I","BLUE CROSS","BLUE CROSS-PPO","CPT","93566","HC NJX SEL R VENT/ATRIAL ANGIO HRT CATH W/S&I","93566 - HC NJX SEL R VENT/ATRIAL ANGIO HRT CATH W/S&I",397,115.44,115.44,115.44,99.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 93568","BLUE CROSS - BLUE CROSS-HMO BLUE - 93568","BLUE CROSS - BLUE CROSS-HMO BLUE - 93568 - HC NJX PULMONARY ANGIO HRT CATH W/S&I","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","93568","HC NJX PULMONARY ANGIO HRT CATH W/S&I","93568 - HC NJX PULMONARY ANGIO HRT CATH W/S&I",411,118.04,118.04,118.04,102.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 93572","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 93572","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 93572 - HC IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","93572","HC IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL","93572 - HC IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL",661,0,310.94,716.93,165.25]
["TUFTS - TUFTS PPO - CPT - 93590","TUFTS - TUFTS PPO - 93590","TUFTS - TUFTS PPO - 93590 - HC PERQ TRANSCATH CLS PARAVALVR LEAK 1 MITRAL VALVE","TUFTS","TUFTS PPO","CPT","93590","HC PERQ TRANSCATH CLS PARAVALVR LEAK 1 MITRAL VALVE","93590 - HC PERQ TRANSCATH CLS PARAVALVR LEAK 1 MITRAL VALVE",24055,39555.230000000003,2574.12,62742.78,6013.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 93610","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 93610","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 93610 - HC INTRA-ATRIAL PACING","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","93610","HC INTRA-ATRIAL PACING","93610 - HC INTRA-ATRIAL PACING",8754,8560.41,4616.53,47572.639999999999,2188.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 93610","UNICARE - UNICARE STATE INDEMNITY PLAN - 93610","UNICARE - UNICARE STATE INDEMNITY PLAN - 93610 - HC INTRA-ATRIAL PACING","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","93610","HC INTRA-ATRIAL PACING","93610 - HC INTRA-ATRIAL PACING",8754,4616.53,4616.53,47572.639999999999,2188.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 93621","BLUE CROSS - BLUE CROSS-HMO BLUE - 93621","BLUE CROSS - BLUE CROSS-HMO BLUE - 93621 - HC COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","93621","HC COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC","93621 - HC COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC",1056,354.32,354.32,5170.4799999999996,264]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 93621","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 93621","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 93621 - HC COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","93621","HC COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC","93621 - HC COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC",1056,0,354.32,5170.4799999999996,264]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 93642","BLUE CROSS - BLUE CROSS-INDEMNITY - 93642","BLUE CROSS - BLUE CROSS-INDEMNITY - 93642 - HC EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","93642","HC EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS","93642 - HC EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS",3473,1543.9,1318.95,9798.84,868.25]
["UNICARE - UNICARE - CPT - 93650","UNICARE - UNICARE - 93650","UNICARE - UNICARE - 93650 - HC ICAR CATHETER ABLATION ATRIOVENTR NODE FUNCTION","UNICARE","UNICARE","CPT","93650","HC ICAR CATHETER ABLATION ATRIOVENTR NODE FUNCTION","93650 - HC ICAR CATHETER ABLATION ATRIOVENTR NODE FUNCTION",5358,6703.03,2531.06,17023.61,1339.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 93654","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 93654","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 93654 - HC COMPRE EP EVAL TX VT","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","93654","HC COMPRE EP EVAL TX VT","93654 - HC COMPRE EP EVAL TX VT",16142,32266.99,2531.06,62742.78,4035.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 93657","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 93657","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 93657 - HC ABLATE L/R ATRIAL FIBRIL W/ISOLATED PULM VEIN","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","93657","HC ABLATE L/R ATRIAL FIBRIL W/ISOLATED PULM VEIN","93657 - HC ABLATE L/R ATRIAL FIBRIL W/ISOLATED PULM VEIN",3838,1063.23,1063.23,1198.25,959.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 93660","BLUE CROSS - BLUE CROSS-PPO - 93660","BLUE CROSS - BLUE CROSS-PPO - 93660 - CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR","BLUE CROSS","BLUE CROSS-PPO","CPT","93660","CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR","93660 - CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR",1399,764.57,545.01,4807.5,349.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 93724","BLUE CROSS - BLUE CROSS-PPO - 93724","BLUE CROSS - BLUE CROSS-PPO - 93724 - ANALYZE PACEMAKER SYSTEM","BLUE CROSS","BLUE CROSS-PPO","CPT","93724","ANALYZE PACEMAKER SYSTEM","93724 - ANALYZE PACEMAKER SYSTEM",402,470.91,49.14,2359.77,100.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 93788","BLUE CROSS - BLUE CROSS-PPO - 93788","BLUE CROSS - BLUE CROSS-PPO - 93788 - AMBL BLD PRESS W/TAPE/DISK 24/>HR ALYS W/REPRT","BLUE CROSS","BLUE CROSS-PPO","CPT","93788","AMBL BLD PRESS W/TAPE/DISK 24/>HR ALYS W/REPRT","93788 - AMBL BLD PRESS W/TAPE/DISK 24/>HR ALYS W/REPRT",123,178.83,126.22,1077.0999999999999,30.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 93797","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 93797","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 93797 - SP CARD REHAB MAINTAIN","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","93797","SP CARD REHAB MAINTAIN","93797 - SP CARD REHAB MAINTAIN",274,198.42,74.930000000000007,1130.1600000000001,68.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 93880","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 93880","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 93880 - HC DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","93880","HC DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY","93880 - HC DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY",2300,497.78,300.69,2134.23,575]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 93886","BLUE CROSS - BLUE CROSS-PPO - 93886","BLUE CROSS - BLUE CROSS-PPO - 93886 - TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL","BLUE CROSS","BLUE CROSS-PPO","CPT","93886","TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL","93886 - TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL",3426,387.2,300.69,2134.23,856.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 93892","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 93892","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 93892 - HC TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","93892","HC TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT","93892 - HC TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT",3107,188.94,188.94,1117.6500000000001,776.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 93923","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 93923","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 93923 - NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","93923","NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS","93923 - NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS",381,228.32,211.22,1412.44,95.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 93923","UNICARE - UNICARE STATE INDEMNITY PLAN - 93923","UNICARE - UNICARE STATE INDEMNITY PLAN - 93923 - NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","93923","NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS","93923 - NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS",381,211.22,211.22,1412.44,95.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 93930","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 93930","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 93930 - HC DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","93930","HC DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY","93930 - HC DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY",2332,387.2,300.69,2134.23,583]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 93931","BLUE CROSS - BLUE CROSS-HMO BLUE - 93931","BLUE CROSS - BLUE CROSS-HMO BLUE - 93931 - DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","93931","DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY","93931 - DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY",1540,188.94,188.94,1169.49,385]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 93975","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 93975","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 93975 - DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","93975","DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM","93975 - DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM",3476,387.2,300.69,2134.23,869]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 93976","UNICARE - UNICARE STATE INDEMNITY PLAN - 93976","UNICARE - UNICARE STATE INDEMNITY PLAN - 93976 - HC DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RORGN LMT","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","93976","HC DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RORGN LMT","93976 - HC DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RORGN LMT",1992,300.69,188.94,1378.16,498]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 93980","CIGNA HEALTHCARE - CIGNA CARELINK - 93980","CIGNA HEALTHCARE - CIGNA CARELINK - 93980 - DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","93980","DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL","93980 - DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL",1568,1117.6500000000001,188.94,1117.6500000000001,392]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 93986","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 93986","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 93986 - DUP-SCAN HEMO COMPL UNI STD","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","93986","DUP-SCAN HEMO COMPL UNI STD","93986 - DUP-SCAN HEMO COMPL UNI STD",168,236.95,180.4,1117.6500000000001,42]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 93990","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 93990","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 93990 - HC DUPLEX SCAN HEMODIALYSIS ACCESS","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","93990","HC DUPLEX SCAN HEMODIALYSIS ACCESS","93990 - HC DUPLEX SCAN HEMODIALYSIS ACCESS",2030,242.91,188.94,1117.6500000000001,507.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 94060","BLUE CROSS - BLUE CROSS-INDEMNITY - 94060","BLUE CROSS - BLUE CROSS-INDEMNITY - 94060 - BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","94060","BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN","94060 - BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN",574,423.72,117.36,2582.75,143.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 94200","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 94200","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 94200 - HC MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","94200","HC MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ","94200 - HC MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ",192,229.89,71.61,847.64,48]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 94250","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 94250","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 94250 - HC EXPIRED GAS COLLECTION QUANT 1 PROCEDURE SPX","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","94250","HC EXPIRED GAS COLLECTION QUANT 1 PROCEDURE SPX","94250 - HC EXPIRED GAS COLLECTION QUANT 1 PROCEDURE SPX",143,93.87,71.61,562.35,35.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 94450","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 94450","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 94450 - HYPOXIA RESPONSE CURVE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","94450","HYPOXIA RESPONSE CURVE","94450 - HYPOXIA RESPONSE CURVE",390,228.32,117.36,1412.44,97.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 94617","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 94617","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 94617 - HC EXERCISE TEST FOR BRONCHOSPASM","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","94617","HC EXERCISE TEST FOR BRONCHOSPASM","94617 - HC EXERCISE TEST FOR BRONCHOSPASM",276,229.89,178.83,1085.78,69]
["UNICARE - UNICARE - CPT - 94640","UNICARE - UNICARE - 94640","UNICARE - UNICARE - 94640 - PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT","UNICARE","UNICARE","CPT","94640","PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT","94640 - PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT",330,48.02,40.020000000000003,1630.85,82.5]
["FALLON - FALLON MEDICAID - CPT - 94645","FALLON - FALLON MEDICAID - 94645","FALLON - FALLON MEDICAID - 94645 - CONTINUOUS INHALATION TREATMENT EA ADDL HR","FALLON","FALLON MEDICAID","CPT","94645","CONTINUOUS INHALATION TREATMENT EA ADDL HR","94645 - CONTINUOUS INHALATION TREATMENT EA ADDL HR",72,0,44.22,44.22,18]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 94660","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 94660","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 94660 - HC CPAP VENTILATION CPAP INITIATION&MGMT","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","94660","HC CPAP VENTILATION CPAP INITIATION&MGMT","94660 - HC CPAP VENTILATION CPAP INITIATION&MGMT",187,321.77,143.15,1789.64,46.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 94681","CIGNA HEALTHCARE - CIGNA CARELINK - 94681","CIGNA HEALTHCARE - CIGNA CARELINK - 94681 - O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","94681","O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC","94681 - O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC",421,2582.75,117.36,2582.75,105.25]
["UNICARE - UNICARE - CPT - 94727","UNICARE - UNICARE - 94727","UNICARE - UNICARE - 94727 - HC GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&VOL","UNICARE","UNICARE","CPT","94727","HC GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&VOL","94727 - HC GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&VOL",207,140.83000000000001,117.36,1412.44,51.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 94761","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 94761","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 94761 - MEASURE BLOOD OXYGEN LEVEL","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","94761","MEASURE BLOOD OXYGEN LEVEL","94761 - MEASURE BLOOD OXYGEN LEVEL",189,0,11.22,11.22,47.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 94770","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 94770","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 94770 - CARBON DIOXIDE EXP GAS DETER INFRARED ANALYZER","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","94770","CARBON DIOXIDE EXP GAS DETER INFRARED ANALYZER","94770 - CARBON DIOXIDE EXP GAS DETER INFRARED ANALYZER",414,293.52,71.61,2153.34,103.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 94780","BLUE CROSS - BLUE CROSS-INDEMNITY - 94780","BLUE CROSS - BLUE CROSS-INDEMNITY - 94780 - HC CAR SEAT/BED TESTING W/INTERP & REPORT 60 MIN","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","94780","HC CAR SEAT/BED TESTING W/INTERP & REPORT 60 MIN","94780 - HC CAR SEAT/BED TESTING W/INTERP & REPORT 60 MIN",48,53.94,53.94,344.43,12]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 95018","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 95018","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 95018 - ALLG TEST PERQ & IC DRUG/BIOL IMMED REACT W/ I&R","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","95018","ALLG TEST PERQ & IC DRUG/BIOL IMMED REACT W/ I&R","95018 - ALLG TEST PERQ & IC DRUG/BIOL IMMED REACT W/ I&R",83,53.94,53.94,183.98,20.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 95076","BLUE CROSS - BLUE CROSS-PPO - 95076","BLUE CROSS - BLUE CROSS-PPO - 95076 - INGESTION CHALLENGE TEST INITIAL 120 MINUTES","BLUE CROSS","BLUE CROSS-PPO","CPT","95076","INGESTION CHALLENGE TEST INITIAL 120 MINUTES","95076 - INGESTION CHALLENGE TEST INITIAL 120 MINUTES",629,764.57,764.57,2713.03,157.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 95079","BLUE CROSS - BLUE CROSS-INDEMNITY - 95079","BLUE CROSS - BLUE CROSS-INDEMNITY - 95079 - INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","95079","INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES","95079 - INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES",330,169.15,169.15,169.15,82.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 95120","BMC HEALTHNET - BMCHN MEDICAID - 95120","BMC HEALTHNET - BMCHN MEDICAID - 95120 - PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX","BMC HEALTHNET","BMCHN MEDICAID","CPT","95120","PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX","95120 - PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX",232,0,18.04,163.57,58]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 95125","BLUE CROSS - BLUE CROSS-PPO - 95125","BLUE CROSS - BLUE CROSS-PPO - 95125 - PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 2/> NJX","BLUE CROSS","BLUE CROSS-PPO","CPT","95125","PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 2/> NJX","95125 - PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 2/> NJX",257,30.55,30.55,163.57,64.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 95146","CIGNA HEALTHCARE - CIGNA CARELINK - 95146","CIGNA HEALTHCARE - CIGNA CARELINK - 95146 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 2 INSECT","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","95146","PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 2 INSECT","95146 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 2 INSECT",183,259.07,63.62,259.07,45.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 95170","BLUE CROSS - BLUE CROSS-INDEMNITY - 95170","BLUE CROSS - BLUE CROSS-INDEMNITY - 95170 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY WHL INSE","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","95170","PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY WHL INSE","95170 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY WHL INSE",78,63.62,63.62,218.59,19.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 95180","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 95180","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 95180 - HC RAPID DESENSITIZATION PROC,EACH HOUR","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","95180","HC RAPID DESENSITIZATION PROC,EACH HOUR","95180 - HC RAPID DESENSITIZATION PROC,EACH HOUR",523,584.69000000000005,459.29,2593.92,130.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 95700","BMC HEALTHNET - BMCHN ACO - 95700","BMC HEALTHNET - BMCHN ACO - 95700 - HC EEG CONT REC W/VID EEG TECH","BMC HEALTHNET","BMCHN ACO","CPT","95700","HC EEG CONT REC W/VID EEG TECH","95700 - HC EEG CONT REC W/VID EEG TECH",377,0,407.35,2582.75,94.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 95705","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 95705","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 95705 - HC EEG W/O VID 2-12 HR UNMNTR","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","95705","HC EEG W/O VID 2-12 HR UNMNTR","95705 - HC EEG W/O VID 2-12 HR UNMNTR",377,407.35,407.35,2582.75,94.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 95709","BLUE CROSS - BLUE CROSS-HMO BLUE - 95709","BLUE CROSS - BLUE CROSS-HMO BLUE - 95709 - HC EEG W/O VID EA 12-26HR INTMT","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","95709","HC EEG W/O VID EA 12-26HR INTMT","95709 - HC EEG W/O VID EA 12-26HR INTMT",723,781.56,781.56,4577.47,180.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 95712","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 95712","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 95712 - HC VEEG 2-12 HR INTMT MNTR","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","95712","HC VEEG 2-12 HR INTMT MNTR","95712 - HC VEEG 2-12 HR INTMT MNTR",377,531.36,407.35,2582.75,94.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 95714","BLUE CROSS - BLUE CROSS-HMO BLUE - 95714","BLUE CROSS - BLUE CROSS-HMO BLUE - 95714 - HC VEEG EA 12-26 HR UNMNTR","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","95714","HC VEEG EA 12-26 HR UNMNTR","95714 - HC VEEG EA 12-26 HR UNMNTR",723,781.56,781.56,4577.47,180.75]
["TUFTS - TUFTS POS - CPT - 95803","TUFTS - TUFTS POS - 95803","TUFTS - TUFTS POS - 95803 - ACTIGRAPHY TESTING RECORDING ANALYSIS I&R","TUFTS","TUFTS POS","CPT","95803","ACTIGRAPHY TESTING RECORDING ANALYSIS I&R","95803 - ACTIGRAPHY TESTING RECORDING ANALYSIS I&R",905,204.57,93.87,615.09,226.25]
["UNICARE - UNICARE - CPT - 95805","UNICARE - UNICARE - 95805","UNICARE - UNICARE - 95805 - HC MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG","UNICARE","UNICARE","CPT","95805","HC MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG","95805 - HC MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG",2045,1728.55,764.57,6282.78,511.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 95810","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 95810","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 95810 - POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","95810","POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3056,1970.71,1440.46,9266.61,764]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 95816","BLUE CROSS - BLUE CROSS-INDEMNITY - 95816","BLUE CROSS - BLUE CROSS-INDEMNITY - 95816 - ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","95816","ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY","95816 - ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY",1832,423.72,282.57,2582.75,458]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 95819","BLUE CROSS - BLUE CROSS-PPO - 95819","BLUE CROSS - BLUE CROSS-PPO - 95819 - ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP","BLUE CROSS","BLUE CROSS-PPO","CPT","95819","ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP","95819 - ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP",2105,423.72,282.57,2582.75,526.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 95852","BLUE CROSS - BLUE CROSS-HMO BLUE - 95852","BLUE CROSS - BLUE CROSS-HMO BLUE - 95852 - HC ROM MEAS;HAND(S)","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","95852","HC ROM MEAS;HAND(S)","95852 - HC ROM MEAS;HAND(S)",31,14.66,9.9499999999999993,56.16,7.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 95860","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 95860","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 95860 - NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","95860","NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS","95860 - NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS",497,229.89,178.83,1036.18,124.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 95864","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 95864","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 95864 - NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","95864","NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS","95864 - NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS",939,228.32,228.32,1412.44,234.75]
["TUFTS - TUFTS SELECT - CPT - 95867","TUFTS - TUFTS SELECT - 95867","TUFTS - TUFTS SELECT - 95867 - NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI","TUFTS","TUFTS SELECT","CPT","95867","NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI","95867 - NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI",486,250.1,228.32,1412.44,121.5]
["UNICARE - UNICARE - CPT - 95868","UNICARE - UNICARE - 95868","UNICARE - UNICARE - 95868 - NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI","UNICARE","UNICARE","CPT","95868","NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI","95868 - NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI",648,371.29,228.32,1412.44,162]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 95872","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 95872","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 95872 - NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","95872","NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER","95872 - NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER",954,293.52,228.32,1412.44,238.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 95886","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 95886","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 95886 - NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","95886","NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE","95886 - NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE",436,0,128.22,128.22,109]
["TUFTS - TUFTS POS - CPT - 95887","TUFTS - TUFTS POS - 95887","TUFTS - TUFTS POS - 95887 - NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION","TUFTS","TUFTS POS","CPT","95887","NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION","95887 - NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION",389,0,117.85,117.85,97.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 95908","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 95908","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 95908 - MOTOR &/SENS 3-4 NRV CNDJ PRECONF ELTRODE LIMB","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","95908","MOTOR &/SENS 3-4 NRV CNDJ PRECONF ELTRODE LIMB","95908 - MOTOR &/SENS 3-4 NRV CNDJ PRECONF ELTRODE LIMB",582,531.36,282.57,1457.53,145.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 95911","BLUE CROSS - BLUE CROSS-PPO - 95911","BLUE CROSS - BLUE CROSS-PPO - 95911 - MOTOR &/SENS 9-10 NRV CNDJ PRECONF ELTRODE LIMB","BLUE CROSS","BLUE CROSS-PPO","CPT","95911","MOTOR &/SENS 9-10 NRV CNDJ PRECONF ELTRODE LIMB","95911 - MOTOR &/SENS 9-10 NRV CNDJ PRECONF ELTRODE LIMB",1110,764.57,282.57,2677.27,277.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 95913","BLUE CROSS - BLUE CROSS-HMO BLUE - 95913","BLUE CROSS - BLUE CROSS-HMO BLUE - 95913 - MOTOR &/SENS 13/> NRV CNDJ PRECONF ELTRODE LIMB","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","95913","MOTOR &/SENS 13/> NRV CNDJ PRECONF ELTRODE LIMB","95913 - MOTOR &/SENS 13/> NRV CNDJ PRECONF ELTRODE LIMB",1506,764.57,282.57,2677.27,376.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 95924","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 95924","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 95924 - TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","95924","TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT","95924 - TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT",734,293.52,228.32,797.09,183.5]
["TUFTS - TUFTS POS - CPT - 95925","TUFTS - TUFTS POS - 95925","TUFTS - TUFTS POS - 95925 - HC SOMATOSENSORY TEST,UPPER LIMBS","TUFTS","TUFTS POS","CPT","95925","HC SOMATOSENSORY TEST,UPPER LIMBS","95925 - HC SOMATOSENSORY TEST,UPPER LIMBS",433,858.98,423.72,2582.75,108.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 95937","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 95937","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 95937 - NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","95937","NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH","95937 - NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH",364,228.32,228.32,1412.44,91]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 95940","BLUE CROSS - BLUE CROSS-PPO - 95940","BLUE CROSS - BLUE CROSS-PPO - 95940 - HC IONM 1 ON 1 IN OR W/ATTENDANCE EACH 15 MINUTES","BLUE CROSS","BLUE CROSS-PPO","CPT","95940","HC IONM 1 ON 1 IN OR W/ATTENDANCE EACH 15 MINUTES","95940 - HC IONM 1 ON 1 IN OR W/ATTENDANCE EACH 15 MINUTES",854,80.3,80.3,80.3,213.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 95958","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 95958","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 95958 - WADA ACTIVATION TEST HEMISPHERIC FUNCTION W/EEG","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","95958","WADA ACTIVATION TEST HEMISPHERIC FUNCTION W/EEG","95958 - WADA ACTIVATION TEST HEMISPHERIC FUNCTION W/EEG",2612,1532.92,1469.11,8297.02,653]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 95962","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 95962","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 95962 - HC FUNCJAL CORT & SUBCORT MAPG PHYS/QHP ATTND ADDL HR","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","95962","HC FUNCJAL CORT & SUBCORT MAPG PHYS/QHP ATTND ADDL HR","95962 - HC FUNCJAL CORT & SUBCORT MAPG PHYS/QHP ATTND ADDL HR",676,0,236.55,236.55,169]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 95970","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 95970","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 95970 - ELEC ALYS NSTIM PLS GEN BRN/SC/PERPH W/O REPRGRM","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","95970","ELEC ALYS NSTIM PLS GEN BRN/SC/PERPH W/O REPRGRM","95970 - ELEC ALYS NSTIM PLS GEN BRN/SC/PERPH W/O REPRGRM",175,178.83,178.83,1036.18,43.75]
["TUFTS - TUFTS HMO - CPT - 95976","TUFTS - TUFTS HMO - 95976","TUFTS - TUFTS HMO - 95976 - HC ALYS SMPL CN NPGT PRGRMG","TUFTS","TUFTS HMO","CPT","95976","HC ALYS SMPL CN NPGT PRGRMG","95976 - HC ALYS SMPL CN NPGT PRGRMG",57,123.21,62.4,209.07,14.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 95977","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 95977","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 95977 - HC ALYS CPLX CN NPGT PRGRMG","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","95977","HC ALYS CPLX CN NPGT PRGRMG","95977 - HC ALYS CPLX CN NPGT PRGRMG",181,253.77,197.39,645.61,45.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 95991","BLUE CROSS - BLUE CROSS-HMO BLUE - 95991","BLUE CROSS - BLUE CROSS-HMO BLUE - 95991 - RFL&MAIN IMPLT PMP/RSVR DLVR SPI/BRN PHY/QHP","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","95991","RFL&MAIN IMPLT PMP/RSVR DLVR SPI/BRN PHY/QHP","95991 - RFL&MAIN IMPLT PMP/RSVR DLVR SPI/BRN PHY/QHP",298,415.61,415.61,1447.83,74.5]
["BMC HEALTHNET - BMCHN QHP - CPT - 96040","BMC HEALTHNET - BMCHN QHP - 96040","BMC HEALTHNET - BMCHN QHP - 96040 - MEDICAL GENETICS COUNSELING EACH 30 MINUTES","BMC HEALTHNET","BMCHN QHP","CPT","96040","MEDICAL GENETICS COUNSELING EACH 30 MINUTES","96040 - MEDICAL GENETICS COUNSELING EACH 30 MINUTES",231,0,33.74,122.29,57.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 96105","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 96105","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 96105 - ASSESSMENT PHASIA W/INTERP & REPORT PER HOUR","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","96105","ASSESSMENT PHASIA W/INTERP & REPORT PER HOUR","96105 - ASSESSMENT PHASIA W/INTERP & REPORT PER HOUR",448,0,162.37,917.01,112]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 96112","CIGNA HEALTHCARE - CIGNA CARELINK - 96112","CIGNA HEALTHCARE - CIGNA CARELINK - 96112 - HC DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","96112","HC DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR","96112 - HC DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR",341,618.47,194.05,618.47,85.25]
["FALLON - FALLON MEDICAID - CPT - 96113","FALLON - FALLON MEDICAID - 96113","FALLON - FALLON MEDICAID - 96113 - HC DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN","FALLON","FALLON MEDICAID","CPT","96113","HC DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN","96113 - HC DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN",170,0,141.36000000000001,141.36000000000001,42.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 96125","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 96125","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 96125 - STANDARDIZED COGNITIVE PERFORMANCE TESTING","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","96125","STANDARDIZED COGNITIVE PERFORMANCE TESTING","96125 - STANDARDIZED COGNITIVE PERFORMANCE TESTING",504,0,273.64999999999998,273.64999999999998,126]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 96130","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 96130","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 96130 - HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","96130","HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR","96130 - HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR",341,293.52,71.41,293.52,85.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 96131","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 96131","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 96131 - HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","96131","HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR","96131 - HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR",341,198.96,198.96,198.96,85.25]
["TUFTS - TUFTS HMO - CPT - 96133","TUFTS - TUFTS HMO - 96133","TUFTS - TUFTS HMO - 96133 - HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR","TUFTS","TUFTS HMO","CPT","96133","HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR","96133 - HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR",341,0,196.14,196.14,85.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 96136","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 96136","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 96136 - HC PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","96136","HC PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN","96136 - HC PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN",341,28.83,28.83,129.58000000000001,85.25]
["TUFTS - TUFTS POS - CPT - 96138","TUFTS - TUFTS POS - 96138","TUFTS - TUFTS POS - 96138 - HC PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN","TUFTS","TUFTS POS","CPT","96138","HC PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN","96138 - HC PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN",341,81.69,28.83,129.58000000000001,85.25]
["TUFTS - TUFTS POS - CPT - 96152","TUFTS - TUFTS POS - 96152","TUFTS - TUFTS POS - 96152 - HC HEAL & BEHAV INTERVENT,EA 15 MIN,INDIV","TUFTS","TUFTS POS","CPT","96152","HC HEAL & BEHAV INTERVENT,EA 15 MIN,INDIV","96152 - HC HEAL & BEHAV INTERVENT,EA 15 MIN,INDIV",64,241.9,128.79,727.37,16]
["TUFTS - TUFTS HMO - CPT - 96154","TUFTS - TUFTS HMO - 96154","TUFTS - TUFTS HMO - 96154 - HC HEAL & BEHAV INTERV,EA 15 MIN,FAM W/PT","TUFTS","TUFTS HMO","CPT","96154","HC HEAL & BEHAV INTERV,EA 15 MIN,FAM W/PT","96154 - HC HEAL & BEHAV INTERV,EA 15 MIN,FAM W/PT",67,290.27999999999997,128.79,727.37,16.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 96159","BMC HEALTHNET - BMCHN QHP - 96159","BMC HEALTHNET - BMCHN QHP - 96159 - HC HLTH BHV IVNTJ INDIV EA ADDL","BMC HEALTHNET","BMCHN QHP","CPT","96159","HC HLTH BHV IVNTJ INDIV EA ADDL","96159 - HC HLTH BHV IVNTJ INDIV EA ADDL",41,0,49.89,49.89,10.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 96161","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 96161","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 96161 - CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","96161","CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM","96161 - CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM",42,70.3,50.95,162.4,10.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 96164","CIGNA HEALTHCARE - CIGNA CARELINK - 96164","CIGNA HEALTHCARE - CIGNA CARELINK - 96164 - HC HLTH BHV IVNTJ GRP 1ST 30","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","96164","HC HLTH BHV IVNTJ GRP 1ST 30","96164 - HC HLTH BHV IVNTJ GRP 1ST 30",36,129.58000000000001,43.97,129.58000000000001,9]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 96168","CIGNA HEALTHCARE - CIGNA CARELINK - 96168","CIGNA HEALTHCARE - CIGNA CARELINK - 96168 - HC HLTH BHV IVNTJ FAM EA ADDL","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","96168","HC HLTH BHV IVNTJ FAM EA ADDL","96168 - HC HLTH BHV IVNTJ FAM EA ADDL",19,0,55.01,55.01,4.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 96170","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 96170","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 96170 - HC HLTH BHV IVNTJ FAM WO PT 1ST","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","96170","HC HLTH BHV IVNTJ FAM WO PT 1ST","96170 - HC HLTH BHV IVNTJ FAM WO PT 1ST",56,188.77,188.77,188.77,14]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 96365","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 96365","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 96365 - IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","96365","IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR","96365 - IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR",492,404.12,222.53,1054.69,123]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 96368","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 96368","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 96368 - IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","96368","IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS","96368 - IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS",90,0,53.54,53.54,22.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 96369","CIGNA HEALTHCARE - CIGNA CARELINK - 96369","CIGNA HEALTHCARE - CIGNA CARELINK - 96369 - HC SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","96369","HC SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR","96369 - HC SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR",289,1054.69,314.33999999999997,1054.69,72.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 96374","BLUE CROSS - BLUE CROSS-INDEMNITY - 96374","BLUE CROSS - BLUE CROSS-INDEMNITY - 96374 - THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","96374","THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG","96374 - THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG",254,314.33999999999997,65.72,917.77,63.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 96374","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 96374","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 96374 - THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","96374","THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG","96374 - THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG",254,404.12,65.72,917.77,63.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 96377","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 96377","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 96377 - HC APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","96377","HC APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION","96377 - HC APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION",165,79.78,63.62,1198.25,41.25]
["TUFTS - TUFTS POS - CPT - 96409","TUFTS - TUFTS POS - 96409","TUFTS - TUFTS POS - 96409 - CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG","TUFTS","TUFTS POS","CPT","96409","CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG","96409 - CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG",498,621.57000000000005,314.33999999999997,1868.91,124.5]
["TUFTS - TUFTS POS - CPT - 96413","TUFTS - TUFTS POS - 96413","TUFTS - TUFTS POS - 96413 - CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG","TUFTS","TUFTS POS","CPT","96413","CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG","96413 - CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG",754,1030.5899999999999,484.3,3098.76,188.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 96417","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 96417","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 96417 - CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","96417","CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR","96417 - CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR",316,100.35,100.35,612.48,79]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 96450","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 96450","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 96450 - CHEMOTX ADMN CNS REQ SPINAL PUNCTURE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","96450","CHEMOTX ADMN CNS REQ SPINAL PUNCTURE","96450 - CHEMOTX ADMN CNS REQ SPINAL PUNCTURE",1158,484.3,484.3,3098.76,289.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 96542","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 96542","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 96542 - HC CHEMOTHER INJECT,CUBARACH/INTRAVENT","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","96542","HC CHEMOTHER INJECT,CUBARACH/INTRAVENT","96542 - HC CHEMOTHER INJECT,CUBARACH/INTRAVENT",281,394.2,308.91000000000003,1744.6,70.25]
["TUFTS - TUFTS POS - CPT - 97010","TUFTS - TUFTS POS - 97010","TUFTS - TUFTS POS - 97010 - HC APPLICATION MODALITY 1/> AREAS HOT/COLD PACKS","TUFTS","TUFTS POS","CPT","97010","HC APPLICATION MODALITY 1/> AREAS HOT/COLD PACKS","97010 - HC APPLICATION MODALITY 1/> AREAS HOT/COLD PACKS",31,24.1,8.8800000000000008,40.869999999999997,7.75]
["TUFTS - TUFTS PPO - CPT - 97012","TUFTS - TUFTS PPO - 97012","TUFTS - TUFTS PPO - 97012 - HC APPL MODALITY 1/> AREAS TRACTION MECHANICAL","TUFTS","TUFTS PPO","CPT","97012","HC APPL MODALITY 1/> AREAS TRACTION MECHANICAL","97012 - HC APPL MODALITY 1/> AREAS TRACTION MECHANICAL",80,58.32,24.84,92.51,20]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 97032","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 97032","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 97032 - HC APPL MODALITY 1/> AREAS ELEC STIMJ EA 15 MIN","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","97032","HC APPL MODALITY 1/> AREAS ELEC STIMJ EA 15 MIN","97032 - HC APPL MODALITY 1/> AREAS ELEC STIMJ EA 15 MIN",95,36.58,24.84,92.51,23.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 97033","CIGNA HEALTHCARE - CIGNA CARELINK - 97033","CIGNA HEALTHCARE - CIGNA CARELINK - 97033 - APPL MODALITY 1/> AREAS IONTOPHORESIS EA 15 MIN","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","97033","APPL MODALITY 1/> AREAS IONTOPHORESIS EA 15 MIN","97033 - APPL MODALITY 1/> AREAS IONTOPHORESIS EA 15 MIN",162,132.72999999999999,35.64,132.72999999999999,40.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 97116","BLUE CROSS - BLUE CROSS-HMO BLUE - 97116","BLUE CROSS - BLUE CROSS-HMO BLUE - 97116 - HC THER PX 1/> AREAS EA 15 MIN GAIT TRAINJ W/STAIR","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","97116","HC THER PX 1/> AREAS EA 15 MIN GAIT TRAINJ W/STAIR","97116 - HC THER PX 1/> AREAS EA 15 MIN GAIT TRAINJ W/STAIR",139,75.650000000000006,48.21,191.22,34.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 97140","BLUE CROSS - BLUE CROSS-PPO - 97140","BLUE CROSS - BLUE CROSS-PPO - 97140 - HC MANUAL THER TECH,1+REGIONS,EA 15 MIN","BLUE CROSS","BLUE CROSS-PPO","CPT","97140","HC MANUAL THER TECH,1+REGIONS,EA 15 MIN","97140 - HC MANUAL THER TECH,1+REGIONS,EA 15 MIN",145,69.37,47.1,175.4,36.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 97150","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 97150","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 97150 - HC THERAPEUTIC PROCEDURES GROUP 2/> INDIVIDUALS","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","97150","HC THERAPEUTIC PROCEDURES GROUP 2/> INDIVIDUALS","97150 - HC THERAPEUTIC PROCEDURES GROUP 2/> INDIVIDUALS",102,45.54,30.91,115.14,25.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 97152","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 97152","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 97152 - HC BHV ID SUPRT ASSMT BY 1 TECH","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","97152","HC BHV ID SUPRT ASSMT BY 1 TECH","97152 - HC BHV ID SUPRT ASSMT BY 1 TECH",378,0,56.05,129.58000000000001,94.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 97153","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 97153","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 97153 - HC ADAPTIVE BEHAVIOR TX BY TECH","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","97153","HC ADAPTIVE BEHAVIOR TX BY TECH","97153 - HC ADAPTIVE BEHAVIOR TX BY TECH",378,72.069999999999993,56.05,129.58000000000001,94.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 97155","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 97155","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 97155 - HC ADAPT BEHAVIOR TX PHYS/QHP","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","97155","HC ADAPT BEHAVIOR TX PHYS/QHP","97155 - HC ADAPT BEHAVIOR TX PHYS/QHP",378,70.3,56.05,129.58000000000001,94.5]
["BMC HEALTHNET - BMCHN ACO - CPT - 97158","BMC HEALTHNET - BMCHN ACO - 97158","BMC HEALTHNET - BMCHN ACO - 97158 - HC GRP ADAPT BHV TX BY PHY/QHP","BMC HEALTHNET","BMCHN ACO","CPT","97158","HC GRP ADAPT BHV TX BY PHY/QHP","97158 - HC GRP ADAPT BHV TX BY PHY/QHP",378,0,56.05,129.58000000000001,94.5]
["TUFTS - TUFTS PPO - CPT - 97158","TUFTS - TUFTS PPO - 97158","TUFTS - TUFTS PPO - 97158 - HC GRP ADAPT BHV TX BY PHY/QHP","TUFTS","TUFTS PPO","CPT","97158","HC GRP ADAPT BHV TX BY PHY/QHP","97158 - HC GRP ADAPT BHV TX BY PHY/QHP",378,81.69,56.05,129.58000000000001,94.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 97165","CIGNA HEALTHCARE - CIGNA CARELINK - 97165","CIGNA HEALTHCARE - CIGNA CARELINK - 97165 - HC OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","97165","HC OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS","97165 - HC OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS",366,494.96,155.29,494.96,91.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 97167","BLUE CROSS - BLUE CROSS-INDEMNITY - 97167","BLUE CROSS - BLUE CROSS-INDEMNITY - 97167 - HC OCCUPATIONAL THERAPY EVAL HIGH COMPLEX 60 MINS","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","97167","HC OCCUPATIONAL THERAPY EVAL HIGH COMPLEX 60 MINS","97167 - HC OCCUPATIONAL THERAPY EVAL HIGH COMPLEX 60 MINS",475,228.77,155.29,494.96,118.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 97535","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 97535","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 97535 - HC SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","97535","HC SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES","97535 - HC SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES",172,86.01,58.39,217.46,43]
["UNICARE - UNICARE - CPT - 97597","UNICARE - UNICARE - 97597","UNICARE - UNICARE - 97597 - DEBRIDEMENT OPEN WOUND 20 SQ CM/<","UNICARE","UNICARE","CPT","97597","DEBRIDEMENT OPEN WOUND 20 SQ CM/<","97597 - DEBRIDEMENT OPEN WOUND 20 SQ CM/<",625,117.86,98.22,1198.25,156.25]
["TUFTS - TUFTS HMO - CPT - 97598","TUFTS - TUFTS HMO - 97598","TUFTS - TUFTS HMO - 97598 - DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM","TUFTS","TUFTS HMO","CPT","97598","DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM","97598 - DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM",625,0,27.27,1198.25,156.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 97750","BLUE CROSS - BLUE CROSS-HMO BLUE - 97750","BLUE CROSS - BLUE CROSS-HMO BLUE - 97750 - HC PHYSICAL PERFORMANCE TEST/MEAS W/REPRT EA 15 MIN","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","97750","HC PHYSICAL PERFORMANCE TEST/MEAS W/REPRT EA 15 MIN","97750 - HC PHYSICAL PERFORMANCE TEST/MEAS W/REPRT EA 15 MIN",165,87.89,58.95,227.31,41.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 97763","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 97763","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 97763 - HC ORTH/PROST MGMT ENC 15MIN","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","97763","HC ORTH/PROST MGMT ENC 15MIN","97763 - HC ORTH/PROST MGMT ENC 15MIN",236,129.03,87.59,326.23,59]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 97802","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 97802","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 97802 - MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","97802","MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI","97802 - MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI",165,84.13,57.12,182.04,41.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 97813","BLUE CROSS - BLUE CROSS-HMO BLUE - 97813","BLUE CROSS - BLUE CROSS-HMO BLUE - 97813 - HC ACUPUNCT W/ ELEC STIMUL 15 MIN","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","97813","HC ACUPUNCT W/ ELEC STIMUL 15 MIN","97813 - HC ACUPUNCT W/ ELEC STIMUL 15 MIN",61,81.84,81.84,81.84,15.25]
["TUFTS - TUFTS SELECT - CPT - 98925","TUFTS - TUFTS SELECT - 98925","TUFTS - TUFTS SELECT - 98925 - HC OSTEOPATHIC MANIP,1-2 BODY REGN","TUFTS","TUFTS SELECT","CPT","98925","HC OSTEOPATHIC MANIP,1-2 BODY REGN","98925 - HC OSTEOPATHIC MANIP,1-2 BODY REGN",38,49.18,49.18,156.77000000000001,9.5]
["TUFTS - TUFTS POS - CPT - 99151","TUFTS - TUFTS POS - 99151","TUFTS - TUFTS POS - 99151 - HC MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS","TUFTS","TUFTS POS","CPT","99151","HC MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS","99151 - HC MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS",110,0,61.58,61.58,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 99155","BLUE CROSS - BLUE CROSS-INDEMNITY - 99155","BLUE CROSS - BLUE CROSS-INDEMNITY - 99155 - HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","99155","HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS","99155 - HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS",101,215.6,215.6,215.6,25.25]
["TUFTS - TUFTS PPO - CPT - 99155","TUFTS - TUFTS PPO - 99155","TUFTS - TUFTS PPO - 99155 - HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS","TUFTS","TUFTS PPO","CPT","99155","HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS","99155 - HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS",101,0,215.6,215.6,25.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 99172","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 99172","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 99172 - VISUAL FUNCT SCRNG AUTO SEMI-AUTO BI QUAN DETERM","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","99172","VISUAL FUNCT SCRNG AUTO SEMI-AUTO BI QUAN DETERM","99172 - VISUAL FUNCT SCRNG AUTO SEMI-AUTO BI QUAN DETERM",72,0,39.39,39.39,18]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 99195","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 99195","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 99195 - PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","99195","PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE","99195 - PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE",454,178.83,178.83,607.66,113.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 99203","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 99203","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 99203 - OFFICE OUTPATIENT NEW 30 MINUTES","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","99203","OFFICE OUTPATIENT NEW 30 MINUTES","99203 - OFFICE OUTPATIENT NEW 30 MINUTES",322,184.8,33.74,184.8,80.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 99212","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 99212","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 99212 - ESTABLISHED PATIENT - PHARM - LEVEL 2","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","99212","ESTABLISHED PATIENT - PHARM - LEVEL 2","99212 - ESTABLISHED PATIENT - PHARM - LEVEL 2",113,61.9,33.74,108.49,28.25]
["TUFTS - TUFTS PPO - CPT - 99213","TUFTS - TUFTS PPO - 99213","TUFTS - TUFTS PPO - 99213 - ESTABLISHED PATIENT - PHARM - LEVEL 3","TUFTS","TUFTS PPO","CPT","99213","ESTABLISHED PATIENT - PHARM - LEVEL 3","99213 - ESTABLISHED PATIENT - PHARM - LEVEL 3",214,38.6,33.74,123.78,53.5]
["TUFTS - TUFTS SELECT - CPT - 99281","TUFTS - TUFTS SELECT - 99281","TUFTS - TUFTS SELECT - 99281 - HC ED VAWA W/MSAECK","TUFTS","TUFTS SELECT","CPT","99281","HC ED VAWA W/MSAECK","99281 - HC ED VAWA W/MSAECK",492,239.26,116.13,1429.96,123]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 99283","BLUE CROSS - BLUE CROSS-INDEMNITY - 99283","BLUE CROSS - BLUE CROSS-INDEMNITY - 99283 - HC EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","99283","HC EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY","99283 - HC EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY",1310,374.48,205.15,2769.45,327.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 99292","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 99292","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 99292 - CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","99292","CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN","99292 - CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN",1377,268.83,268.83,268.83,344.25]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 99358","BMC HEALTHNET - BMCHN MEDICAID - 99358","BMC HEALTHNET - BMCHN MEDICAID - 99358 - HC PROLONGED SERV,NO CONTACT,1ST HR","BMC HEALTHNET","BMCHN MEDICAID","CPT","99358","HC PROLONGED SERV,NO CONTACT,1ST HR","99358 - HC PROLONGED SERV,NO CONTACT,1ST HR",125,0,0,0,31.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 99366","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 99366","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 99366 - HC TEAM CONFERENCE FACE-TO-FACE NONPHYSICIAN","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","99366","HC TEAM CONFERENCE FACE-TO-FACE NONPHYSICIAN","99366 - HC TEAM CONFERENCE FACE-TO-FACE NONPHYSICIAN",525,0,0,0,131.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 99386","UNICARE - UNICARE STATE INDEMNITY PLAN - 99386","UNICARE - UNICARE STATE INDEMNITY PLAN - 99386 - INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","99386","INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS","99386 - INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS",497,279.61,33.74,335.53,124.25]
["TUFTS - TUFTS SELECT - CPT - 99392","TUFTS - TUFTS SELECT - 99392","TUFTS - TUFTS SELECT - 99392 - PERIODIC PREVENTIVE MED EST PATIENT 1-4YRS","TUFTS","TUFTS SELECT","CPT","99392","PERIODIC PREVENTIVE MED EST PATIENT 1-4YRS","99392 - PERIODIC PREVENTIVE MED EST PATIENT 1-4YRS",320,33.74,33.74,211.61,80]
["BMC HEALTHNET - BMCHN MCO - CPT - 99402","BMC HEALTHNET - BMCHN MCO - 99402","BMC HEALTHNET - BMCHN MCO - 99402 - PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 30 M","BMC HEALTHNET","BMCHN MCO","CPT","99402","PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 30 M","99402 - PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 30 M",211,0,34.03,170.08,52.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 99406","BMC HEALTHNET - BMCHN QHP - 99406","BMC HEALTHNET - BMCHN QHP - 99406 - TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES","BMC HEALTHNET","BMCHN QHP","CPT","99406","TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES","99406 - TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES",83,0,50.95,287.77999999999997,20.75]
["TUFTS - TUFTS PPO - CPT - 99407","TUFTS - TUFTS PPO - 99407","TUFTS - TUFTS PPO - 99407 - TOBACCO USE CESSATION INTENSIVE >10 MINUTES","TUFTS","TUFTS PPO","CPT","99407","TOBACCO USE CESSATION INTENSIVE >10 MINUTES","99407 - TOBACCO USE CESSATION INTENSIVE >10 MINUTES",107,102.38,50.95,287.77999999999997,26.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 99453","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 99453","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 99453 - REM MNTR PHYSIOL PARAM SETUP","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","99453","REM MNTR PHYSIOL PARAM SETUP","99453 - REM MNTR PHYSIOL PARAM SETUP",176,243.98,194.55,665.76,44]
["FALLON - FALLON MEDICAID - CPT - 99454","FALLON - FALLON MEDICAID - 99454","FALLON - FALLON MEDICAID - 99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","FALLON","FALLON MEDICAID","CPT","99454","HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D",55,0,62.4,209.07,13.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 99454","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 99454","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","99454","HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D",55,80.23,62.4,209.07,13.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 99454","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 99454","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","99454","HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D",55,80.23,62.4,209.07,13.75]
["TUFTS - TUFTS HMO - CPT - 99454","TUFTS - TUFTS HMO - 99454","TUFTS - TUFTS HMO - 99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","TUFTS","TUFTS HMO","CPT","99454","HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D",55,123.21,62.4,209.07,13.75]
["TUFTS - TUFTS POS - CPT - 99454","TUFTS - TUFTS POS - 99454","TUFTS - TUFTS POS - 99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","TUFTS","TUFTS POS","CPT","99454","HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D",55,123.21,62.4,209.07,13.75]
["TUFTS - TUFTS PPO - CPT - 99454","TUFTS - TUFTS PPO - 99454","TUFTS - TUFTS PPO - 99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","TUFTS","TUFTS PPO","CPT","99454","HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D",55,131.81,62.4,209.07,13.75]
["TUFTS - TUFTS SELECT - CPT - 99454","TUFTS - TUFTS SELECT - 99454","TUFTS - TUFTS SELECT - 99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","TUFTS","TUFTS SELECT","CPT","99454","HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D",55,65.599999999999994,62.4,209.07,13.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 99454","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 99454","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","99454","HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D",55,0,62.4,209.07,13.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 99454","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 99454","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","99454","HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D",55,0,62.4,209.07,13.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 99454","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 99454","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","99454","HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D",55,78.260000000000005,62.4,209.07,13.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 99454","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 99454","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","99454","HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D",55,80.23,62.4,209.07,13.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 99456","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 99456","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 99456 - WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","99456","WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS","99456 - WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS",348,0,0,0,87]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 99456","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 99456","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 99456 - WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","99456","WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS","99456 - WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS",348,0,0,0,87]
["BMC HEALTHNET - BMCHN ACO - CPT - 99456","BMC HEALTHNET - BMCHN ACO - 99456","BMC HEALTHNET - BMCHN ACO - 99456 - WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS","BMC HEALTHNET","BMCHN ACO","CPT","99456","WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS","99456 - WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS",348,0,0,0,87]
["BMC HEALTHNET - BMCHN MCO - CPT - 99456","BMC HEALTHNET - BMCHN MCO - 99456","BMC HEALTHNET - BMCHN MCO - 99456 - WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS","BMC HEALTHNET","BMCHN MCO","CPT","99456","WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS","99456 - WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS",348,0,0,0,87]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 99456","BMC HEALTHNET - BMCHN MEDICAID - 99456","BMC HEALTHNET - BMCHN MEDICAID - 99456 - WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS","BMC HEALTHNET","BMCHN MEDICAID","CPT","99456","WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS","99456 - WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS",348,0,0,0,87]
["BMC HEALTHNET - BMCHN QHP - CPT - 99456","BMC HEALTHNET - BMCHN QHP - 99456","BMC HEALTHNET - BMCHN QHP - 99456 - WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS","BMC HEALTHNET","BMCHN QHP","CPT","99456","WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS","99456 - WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS",348,0,0,0,87]
["FALLON - FALLON MEDICAID - CPT - 99456","FALLON - FALLON MEDICAID - 99456","FALLON - FALLON MEDICAID - 99456 - WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS","FALLON","FALLON MEDICAID","CPT","99456","WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS","99456 - WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS",348,0,0,0,87]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 99456","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 99456","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 99456 - WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","99456","WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS","99456 - WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS",348,0,0,0,87]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 99456","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 99456","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 99456 - WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","99456","WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS","99456 - WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS",348,0,0,0,87]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 99473","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 99473","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,0,36.99,229.62,9]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 99473","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 99473","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,0,36.99,229.62,9]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 99473","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 99473","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,36.99,36.99,229.62,9]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 99473","BLUE CROSS - BLUE CROSS-HMO BLUE - 99473","BLUE CROSS - BLUE CROSS-HMO BLUE - 99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,36.99,36.99,229.62,9]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 99473","BLUE CROSS - BLUE CROSS-INDEMNITY - 99473","BLUE CROSS - BLUE CROSS-INDEMNITY - 99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,36.99,36.99,229.62,9]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 99473","BLUE CROSS - BLUE CROSS-PPO - 99473","BLUE CROSS - BLUE CROSS-PPO - 99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN","BLUE CROSS","BLUE CROSS-PPO","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,36.99,36.99,229.62,9]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 99473","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 99473","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,36.99,36.99,229.62,9]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 99473","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 99473","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,36.99,36.99,229.62,9]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 99473","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 99473","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,36.99,36.99,229.62,9]
["BMC HEALTHNET - BMCHN ACO - CPT - 99473","BMC HEALTHNET - BMCHN ACO - 99473","BMC HEALTHNET - BMCHN ACO - 99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN","BMC HEALTHNET","BMCHN ACO","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,0,36.99,229.62,9]
["BMC HEALTHNET - BMCHN MCO - CPT - 99473","BMC HEALTHNET - BMCHN MCO - 99473","BMC HEALTHNET - BMCHN MCO - 99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN","BMC HEALTHNET","BMCHN MCO","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,0,36.99,229.62,9]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 99473","BMC HEALTHNET - BMCHN MEDICAID - 99473","BMC HEALTHNET - BMCHN MEDICAID - 99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN","BMC HEALTHNET","BMCHN MEDICAID","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,0,36.99,229.62,9]
["BMC HEALTHNET - BMCHN QHP - CPT - 99473","BMC HEALTHNET - BMCHN QHP - 99473","BMC HEALTHNET - BMCHN QHP - 99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN","BMC HEALTHNET","BMCHN QHP","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,0,36.99,229.62,9]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 99473","CIGNA HEALTHCARE - CIGNA CARELINK - 99473","CIGNA HEALTHCARE - CIGNA CARELINK - 99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,114.81,36.99,229.62,9]
["FALLON - FALLON MEDICAID - CPT - 99473","FALLON - FALLON MEDICAID - 99473","FALLON - FALLON MEDICAID - 99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN","FALLON","FALLON MEDICAID","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,0,36.99,229.62,9]
["TUFTS - TUFTS HMO - CPT - 99473","TUFTS - TUFTS HMO - 99473","TUFTS - TUFTS HMO - 99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN","TUFTS","TUFTS HMO","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,49.015000000000001,36.99,229.62,9]
["TUFTS - TUFTS POS - CPT - 99473","TUFTS - TUFTS POS - 99473","TUFTS - TUFTS POS - 99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN","TUFTS","TUFTS POS","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,40.844999999999999,36.99,229.62,9]
["TUFTS - TUFTS PPO - CPT - 99473","TUFTS - TUFTS PPO - 99473","TUFTS - TUFTS PPO - 99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN","TUFTS","TUFTS PPO","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,40.844999999999999,36.99,229.62,9]
["TUFTS - TUFTS SELECT - CPT - 99473","TUFTS - TUFTS SELECT - 99473","TUFTS - TUFTS SELECT - 99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN","TUFTS","TUFTS SELECT","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,0,36.99,229.62,9]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 99473","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 99473","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,0,36.99,229.62,9]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 99473","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 99473","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,0,36.99,229.62,9]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 99483","CIGNA HEALTHCARE - CIGNA CARELINK - 99483","CIGNA HEALTHCARE - CIGNA CARELINK - 99483 - HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","99483","HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT","99483 - HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT",359,102.42,31.86,102.42,89.75]
["TUFTS - TUFTS HMO - CPT - 99483","TUFTS - TUFTS HMO - 99483","TUFTS - TUFTS HMO - 99483 - HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT","TUFTS","TUFTS HMO","CPT","99483","HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT","99483 - HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT",359,43.73,31.86,102.42,89.75]
["TUFTS - TUFTS POS - CPT - 99483","TUFTS - TUFTS POS - 99483","TUFTS - TUFTS POS - 99483 - HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT","TUFTS","TUFTS POS","CPT","99483","HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT","99483 - HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT",359,36.44,31.86,102.42,89.75]
["TUFTS - TUFTS PPO - CPT - 99483","TUFTS - TUFTS PPO - 99483","TUFTS - TUFTS PPO - 99483 - HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT","TUFTS","TUFTS PPO","CPT","99483","HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT","99483 - HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT",359,36.44,31.86,102.42,89.75]
["TUFTS - TUFTS SELECT - CPT - 99483","TUFTS - TUFTS SELECT - 99483","TUFTS - TUFTS SELECT - 99483 - HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT","TUFTS","TUFTS SELECT","CPT","99483","HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT","99483 - HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT",359,31.86,31.86,102.42,89.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 99495","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 99495","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,0,194.55,1179.72,109.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 99495","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 99495","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,0,194.55,1179.72,109.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 99495","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 99495","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,194.55,194.55,1179.72,109.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 99495","BLUE CROSS - BLUE CROSS-HMO BLUE - 99495","BLUE CROSS - BLUE CROSS-HMO BLUE - 99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,194.55,194.55,1179.72,109.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 99495","BLUE CROSS - BLUE CROSS-INDEMNITY - 99495","BLUE CROSS - BLUE CROSS-INDEMNITY - 99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,194.55,194.55,1179.72,109.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 99495","BLUE CROSS - BLUE CROSS-PPO - 99495","BLUE CROSS - BLUE CROSS-PPO - 99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","BLUE CROSS","BLUE CROSS-PPO","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,194.55,194.55,1179.72,109.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 99495","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 99495","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,194.55,194.55,1179.72,109.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 99495","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 99495","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,194.55,194.55,1179.72,109.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 99495","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 99495","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,194.55,194.55,1179.72,109.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 99495","BMC HEALTHNET - BMCHN ACO - 99495","BMC HEALTHNET - BMCHN ACO - 99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","BMC HEALTHNET","BMCHN ACO","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,0,194.55,1179.72,109.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 99495","BMC HEALTHNET - BMCHN MCO - 99495","BMC HEALTHNET - BMCHN MCO - 99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","BMC HEALTHNET","BMCHN MCO","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,0,194.55,1179.72,109.75]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 99495","BMC HEALTHNET - BMCHN MEDICAID - 99495","BMC HEALTHNET - BMCHN MEDICAID - 99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","BMC HEALTHNET","BMCHN MEDICAID","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,0,194.55,1179.72,109.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 99495","BMC HEALTHNET - BMCHN QHP - 99495","BMC HEALTHNET - BMCHN QHP - 99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","BMC HEALTHNET","BMCHN QHP","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,0,194.55,1179.72,109.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 99495","CIGNA HEALTHCARE - CIGNA CARELINK - 99495","CIGNA HEALTHCARE - CIGNA CARELINK - 99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,589.86,194.55,1179.72,109.75]
["FALLON - FALLON MEDICAID - CPT - 99495","FALLON - FALLON MEDICAID - 99495","FALLON - FALLON MEDICAID - 99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","FALLON","FALLON MEDICAID","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,0,194.55,1179.72,109.75]
["TUFTS - TUFTS HMO - CPT - 99495","TUFTS - TUFTS HMO - 99495","TUFTS - TUFTS HMO - 99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","TUFTS","TUFTS HMO","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,235.41499999999999,194.55,1179.72,109.75]
["TUFTS - TUFTS POS - CPT - 99495","TUFTS - TUFTS POS - 99495","TUFTS - TUFTS POS - 99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","TUFTS","TUFTS POS","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,196.18,194.55,1179.72,109.75]
["TUFTS - TUFTS PPO - CPT - 99495","TUFTS - TUFTS PPO - 99495","TUFTS - TUFTS PPO - 99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","TUFTS","TUFTS PPO","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,209.86,194.55,1179.72,109.75]
["TUFTS - TUFTS SELECT - CPT - 99495","TUFTS - TUFTS SELECT - 99495","TUFTS - TUFTS SELECT - 99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","TUFTS","TUFTS SELECT","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,104.44499999999999,194.55,1179.72,109.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 99495","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 99495","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,0,194.55,1179.72,109.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 99495","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 99495","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,0,194.55,1179.72,109.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 99496","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 99496","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,0,194.55,1179.72,206.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 99496","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 99496","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,0,194.55,1179.72,206.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 99496","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 99496","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,194.55,194.55,1179.72,206.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 99496","BLUE CROSS - BLUE CROSS-HMO BLUE - 99496","BLUE CROSS - BLUE CROSS-HMO BLUE - 99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,194.55,194.55,1179.72,206.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 99496","BLUE CROSS - BLUE CROSS-INDEMNITY - 99496","BLUE CROSS - BLUE CROSS-INDEMNITY - 99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,194.55,194.55,1179.72,206.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 99496","BLUE CROSS - BLUE CROSS-PPO - 99496","BLUE CROSS - BLUE CROSS-PPO - 99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","BLUE CROSS","BLUE CROSS-PPO","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,194.55,194.55,1179.72,206.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 99496","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 99496","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,194.55,194.55,1179.72,206.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 99496","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 99496","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,194.55,194.55,1179.72,206.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 99496","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 99496","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,194.55,194.55,1179.72,206.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 99496","BMC HEALTHNET - BMCHN ACO - 99496","BMC HEALTHNET - BMCHN ACO - 99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","BMC HEALTHNET","BMCHN ACO","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,0,194.55,1179.72,206.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 99496","BMC HEALTHNET - BMCHN MCO - 99496","BMC HEALTHNET - BMCHN MCO - 99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","BMC HEALTHNET","BMCHN MCO","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,0,194.55,1179.72,206.75]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 99496","BMC HEALTHNET - BMCHN MEDICAID - 99496","BMC HEALTHNET - BMCHN MEDICAID - 99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","BMC HEALTHNET","BMCHN MEDICAID","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,0,194.55,1179.72,206.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 99496","BMC HEALTHNET - BMCHN QHP - 99496","BMC HEALTHNET - BMCHN QHP - 99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","BMC HEALTHNET","BMCHN QHP","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,0,194.55,1179.72,206.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 99496","CIGNA HEALTHCARE - CIGNA CARELINK - 99496","CIGNA HEALTHCARE - CIGNA CARELINK - 99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,589.86,194.55,1179.72,206.75]
["FALLON - FALLON MEDICAID - CPT - 99496","FALLON - FALLON MEDICAID - 99496","FALLON - FALLON MEDICAID - 99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","FALLON","FALLON MEDICAID","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,0,194.55,1179.72,206.75]
["TUFTS - TUFTS HMO - CPT - 99496","TUFTS - TUFTS HMO - 99496","TUFTS - TUFTS HMO - 99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","TUFTS","TUFTS HMO","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,235.41499999999999,194.55,1179.72,206.75]
["TUFTS - TUFTS POS - CPT - 99496","TUFTS - TUFTS POS - 99496","TUFTS - TUFTS POS - 99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","TUFTS","TUFTS POS","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,196.18,194.55,1179.72,206.75]
["TUFTS - TUFTS PPO - CPT - 99496","TUFTS - TUFTS PPO - 99496","TUFTS - TUFTS PPO - 99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","TUFTS","TUFTS PPO","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,209.86,194.55,1179.72,206.75]
["TUFTS - TUFTS SELECT - CPT - 99496","TUFTS - TUFTS SELECT - 99496","TUFTS - TUFTS SELECT - 99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","TUFTS","TUFTS SELECT","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,104.44499999999999,194.55,1179.72,206.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 99496","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 99496","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,0,194.55,1179.72,206.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 99496","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 99496","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,0,194.55,1179.72,206.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 99497","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 99497","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 99497 - HC ADVANCED CARE PLANNING; 1ST HR","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,0,128.29,439.53,75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 99497","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 99497","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 99497 - HC ADVANCED CARE PLANNING; 1ST HR","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,0,128.29,439.53,75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 99497","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 99497","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 99497 - HC ADVANCED CARE PLANNING; 1ST HR","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,128.29,128.29,439.53,75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 99497","BLUE CROSS - BLUE CROSS-HMO BLUE - 99497","BLUE CROSS - BLUE CROSS-HMO BLUE - 99497 - HC ADVANCED CARE PLANNING; 1ST HR","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,128.29,128.29,439.53,75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 99497","BLUE CROSS - BLUE CROSS-INDEMNITY - 99497","BLUE CROSS - BLUE CROSS-INDEMNITY - 99497 - HC ADVANCED CARE PLANNING; 1ST HR","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,128.29,128.29,439.53,75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 99497","BLUE CROSS - BLUE CROSS-PPO - 99497","BLUE CROSS - BLUE CROSS-PPO - 99497 - HC ADVANCED CARE PLANNING; 1ST HR","BLUE CROSS","BLUE CROSS-PPO","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,128.29,128.29,439.53,75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 99497","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 99497","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 99497 - HC ADVANCED CARE PLANNING; 1ST HR","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,128.29,128.29,439.53,75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 99497","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 99497","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 99497 - HC ADVANCED CARE PLANNING; 1ST HR","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,128.29,128.29,439.53,75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 99497","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 99497","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 99497 - HC ADVANCED CARE PLANNING; 1ST HR","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,128.29,128.29,439.53,75]
["BMC HEALTHNET - BMCHN ACO - CPT - 99497","BMC HEALTHNET - BMCHN ACO - 99497","BMC HEALTHNET - BMCHN ACO - 99497 - HC ADVANCED CARE PLANNING; 1ST HR","BMC HEALTHNET","BMCHN ACO","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,0,128.29,439.53,75]
["BMC HEALTHNET - BMCHN MCO - CPT - 99497","BMC HEALTHNET - BMCHN MCO - 99497","BMC HEALTHNET - BMCHN MCO - 99497 - HC ADVANCED CARE PLANNING; 1ST HR","BMC HEALTHNET","BMCHN MCO","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,0,128.29,439.53,75]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 99497","BMC HEALTHNET - BMCHN MEDICAID - 99497","BMC HEALTHNET - BMCHN MEDICAID - 99497 - HC ADVANCED CARE PLANNING; 1ST HR","BMC HEALTHNET","BMCHN MEDICAID","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,0,128.29,439.53,75]
["BMC HEALTHNET - BMCHN QHP - CPT - 99497","BMC HEALTHNET - BMCHN QHP - 99497","BMC HEALTHNET - BMCHN QHP - 99497 - HC ADVANCED CARE PLANNING; 1ST HR","BMC HEALTHNET","BMCHN QHP","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,0,128.29,439.53,75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 99497","CIGNA HEALTHCARE - CIGNA CARELINK - 99497","CIGNA HEALTHCARE - CIGNA CARELINK - 99497 - HC ADVANCED CARE PLANNING; 1ST HR","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,439.53,128.29,439.53,75]
["FALLON - FALLON MEDICAID - CPT - 99497","FALLON - FALLON MEDICAID - 99497","FALLON - FALLON MEDICAID - 99497 - HC ADVANCED CARE PLANNING; 1ST HR","FALLON","FALLON MEDICAID","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,0,128.29,439.53,75]
["TUFTS - TUFTS HMO - CPT - 99497","TUFTS - TUFTS HMO - 99497","TUFTS - TUFTS HMO - 99497 - HC ADVANCED CARE PLANNING; 1ST HR","TUFTS","TUFTS HMO","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,259.04000000000002,128.29,439.53,75]
["TUFTS - TUFTS POS - CPT - 99497","TUFTS - TUFTS POS - 99497","TUFTS - TUFTS POS - 99497 - HC ADVANCED CARE PLANNING; 1ST HR","TUFTS","TUFTS POS","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,259.04000000000002,128.29,439.53,75]
["TUFTS - TUFTS PPO - CPT - 99497","TUFTS - TUFTS PPO - 99497","TUFTS - TUFTS PPO - 99497 - HC ADVANCED CARE PLANNING; 1ST HR","TUFTS","TUFTS PPO","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,277.10000000000002,128.29,439.53,75]
["TUFTS - TUFTS SELECT - CPT - 99497","TUFTS - TUFTS SELECT - 99497","TUFTS - TUFTS SELECT - 99497 - HC ADVANCED CARE PLANNING; 1ST HR","TUFTS","TUFTS SELECT","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,137.91,128.29,439.53,75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 99497","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 99497","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 99497 - HC ADVANCED CARE PLANNING; 1ST HR","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,0,128.29,439.53,75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 99497","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 99497","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 99497 - HC ADVANCED CARE PLANNING; 1ST HR","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,0,128.29,439.53,75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 99498","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 99498","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","99498","HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS",283,180.79,180.79,180.79,70.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 99498","BLUE CROSS - BLUE CROSS-HMO BLUE - 99498","BLUE CROSS - BLUE CROSS-HMO BLUE - 99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","99498","HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS",283,180.79,180.79,180.79,70.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 99498","BLUE CROSS - BLUE CROSS-INDEMNITY - 99498","BLUE CROSS - BLUE CROSS-INDEMNITY - 99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","99498","HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS",283,180.79,180.79,180.79,70.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 99498","BLUE CROSS - BLUE CROSS-PPO - 99498","BLUE CROSS - BLUE CROSS-PPO - 99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","BLUE CROSS","BLUE CROSS-PPO","CPT","99498","HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS",283,180.79,180.79,180.79,70.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 99498","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 99498","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","99498","HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS",283,180.79,180.79,180.79,70.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 99498","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 99498","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","99498","HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS",283,180.79,180.79,180.79,70.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 99498","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 99498","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","99498","HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS",283,180.79,180.79,180.79,70.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 99498","CIGNA HEALTHCARE - CIGNA CARELINK - 99498","CIGNA HEALTHCARE - CIGNA CARELINK - 99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","99498","HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS",283,0,180.79,180.79,70.75]
["TUFTS - TUFTS HMO - CPT - 99498","TUFTS - TUFTS HMO - 99498","TUFTS - TUFTS HMO - 99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","TUFTS","TUFTS HMO","CPT","99498","HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS",283,0,180.79,180.79,70.75]
["TUFTS - TUFTS POS - CPT - 99498","TUFTS - TUFTS POS - 99498","TUFTS - TUFTS POS - 99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","TUFTS","TUFTS POS","CPT","99498","HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS",283,0,180.79,180.79,70.75]
["TUFTS - TUFTS PPO - CPT - 99498","TUFTS - TUFTS PPO - 99498","TUFTS - TUFTS PPO - 99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","TUFTS","TUFTS PPO","CPT","99498","HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS",283,0,180.79,180.79,70.75]
["TUFTS - TUFTS SELECT - CPT - 99498","TUFTS - TUFTS SELECT - 99498","TUFTS - TUFTS SELECT - 99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","TUFTS","TUFTS SELECT","CPT","99498","HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS",283,0,180.79,180.79,70.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 99605","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 99605","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","99605","MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM",62,0,0,0,15.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 99605","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 99605","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","99605","MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM",62,0,0,0,15.5]
["BMC HEALTHNET - BMCHN ACO - CPT - 99605","BMC HEALTHNET - BMCHN ACO - 99605","BMC HEALTHNET - BMCHN ACO - 99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","BMC HEALTHNET","BMCHN ACO","CPT","99605","MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM",62,0,0,0,15.5]
["BMC HEALTHNET - BMCHN MCO - CPT - 99605","BMC HEALTHNET - BMCHN MCO - 99605","BMC HEALTHNET - BMCHN MCO - 99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","BMC HEALTHNET","BMCHN MCO","CPT","99605","MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM",62,0,0,0,15.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 99605","BMC HEALTHNET - BMCHN MEDICAID - 99605","BMC HEALTHNET - BMCHN MEDICAID - 99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","BMC HEALTHNET","BMCHN MEDICAID","CPT","99605","MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM",62,0,0,0,15.5]
["BMC HEALTHNET - BMCHN QHP - CPT - 99605","BMC HEALTHNET - BMCHN QHP - 99605","BMC HEALTHNET - BMCHN QHP - 99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","BMC HEALTHNET","BMCHN QHP","CPT","99605","MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM",62,0,0,0,15.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 99605","CIGNA HEALTHCARE - CIGNA CARELINK - 99605","CIGNA HEALTHCARE - CIGNA CARELINK - 99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","99605","MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM",62,0,0,0,15.5]
["FALLON - FALLON MEDICAID - CPT - 99605","FALLON - FALLON MEDICAID - 99605","FALLON - FALLON MEDICAID - 99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","FALLON","FALLON MEDICAID","CPT","99605","MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM",62,0,0,0,15.5]
["TUFTS - TUFTS HMO - CPT - 99605","TUFTS - TUFTS HMO - 99605","TUFTS - TUFTS HMO - 99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","TUFTS","TUFTS HMO","CPT","99605","MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM",62,0,0,0,15.5]
["TUFTS - TUFTS POS - CPT - 99605","TUFTS - TUFTS POS - 99605","TUFTS - TUFTS POS - 99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","TUFTS","TUFTS POS","CPT","99605","MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM",62,0,0,0,15.5]
["TUFTS - TUFTS PPO - CPT - 99605","TUFTS - TUFTS PPO - 99605","TUFTS - TUFTS PPO - 99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","TUFTS","TUFTS PPO","CPT","99605","MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM",62,0,0,0,15.5]
["TUFTS - TUFTS SELECT - CPT - 99605","TUFTS - TUFTS SELECT - 99605","TUFTS - TUFTS SELECT - 99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","TUFTS","TUFTS SELECT","CPT","99605","MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM",62,0,0,0,15.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 99605","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 99605","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","99605","MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM",62,0,0,0,15.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 99605","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 99605","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","99605","MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM",62,0,0,0,15.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 99606","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 99606","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","99606","MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM",43,0,0,0,10.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 99606","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 99606","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","99606","MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM",43,0,0,0,10.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 99606","BMC HEALTHNET - BMCHN ACO - 99606","BMC HEALTHNET - BMCHN ACO - 99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","BMC HEALTHNET","BMCHN ACO","CPT","99606","MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM",43,0,0,0,10.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 99606","BMC HEALTHNET - BMCHN MCO - 99606","BMC HEALTHNET - BMCHN MCO - 99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","BMC HEALTHNET","BMCHN MCO","CPT","99606","MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM",43,0,0,0,10.75]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 99606","BMC HEALTHNET - BMCHN MEDICAID - 99606","BMC HEALTHNET - BMCHN MEDICAID - 99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","BMC HEALTHNET","BMCHN MEDICAID","CPT","99606","MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM",43,0,0,0,10.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 99606","BMC HEALTHNET - BMCHN QHP - 99606","BMC HEALTHNET - BMCHN QHP - 99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","BMC HEALTHNET","BMCHN QHP","CPT","99606","MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM",43,0,0,0,10.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 99606","CIGNA HEALTHCARE - CIGNA CARELINK - 99606","CIGNA HEALTHCARE - CIGNA CARELINK - 99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","99606","MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM",43,0,0,0,10.75]
["FALLON - FALLON MEDICAID - CPT - 99606","FALLON - FALLON MEDICAID - 99606","FALLON - FALLON MEDICAID - 99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","FALLON","FALLON MEDICAID","CPT","99606","MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM",43,0,0,0,10.75]
["TUFTS - TUFTS HMO - CPT - 99606","TUFTS - TUFTS HMO - 99606","TUFTS - TUFTS HMO - 99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","TUFTS","TUFTS HMO","CPT","99606","MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM",43,0,0,0,10.75]
["TUFTS - TUFTS POS - CPT - 99606","TUFTS - TUFTS POS - 99606","TUFTS - TUFTS POS - 99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","TUFTS","TUFTS POS","CPT","99606","MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM",43,0,0,0,10.75]
["TUFTS - TUFTS PPO - CPT - 99606","TUFTS - TUFTS PPO - 99606","TUFTS - TUFTS PPO - 99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","TUFTS","TUFTS PPO","CPT","99606","MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM",43,0,0,0,10.75]
["TUFTS - TUFTS SELECT - CPT - 99606","TUFTS - TUFTS SELECT - 99606","TUFTS - TUFTS SELECT - 99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","TUFTS","TUFTS SELECT","CPT","99606","MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM",43,0,0,0,10.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 99606","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 99606","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","99606","MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM",43,0,0,0,10.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 99606","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 99606","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","99606","MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM",43,0,0,0,10.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 99607","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 99607","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","99607","MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM",32,0,0,0,8]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 99607","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 99607","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","99607","MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM",32,0,0,0,8]
["BMC HEALTHNET - BMCHN ACO - CPT - 99607","BMC HEALTHNET - BMCHN ACO - 99607","BMC HEALTHNET - BMCHN ACO - 99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","BMC HEALTHNET","BMCHN ACO","CPT","99607","MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM",32,0,0,0,8]
["BMC HEALTHNET - BMCHN MCO - CPT - 99607","BMC HEALTHNET - BMCHN MCO - 99607","BMC HEALTHNET - BMCHN MCO - 99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","BMC HEALTHNET","BMCHN MCO","CPT","99607","MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM",32,0,0,0,8]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 99607","BMC HEALTHNET - BMCHN MEDICAID - 99607","BMC HEALTHNET - BMCHN MEDICAID - 99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","BMC HEALTHNET","BMCHN MEDICAID","CPT","99607","MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM",32,0,0,0,8]
["BMC HEALTHNET - BMCHN QHP - CPT - 99607","BMC HEALTHNET - BMCHN QHP - 99607","BMC HEALTHNET - BMCHN QHP - 99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","BMC HEALTHNET","BMCHN QHP","CPT","99607","MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM",32,0,0,0,8]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 99607","CIGNA HEALTHCARE - CIGNA CARELINK - 99607","CIGNA HEALTHCARE - CIGNA CARELINK - 99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","99607","MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM",32,0,0,0,8]
["FALLON - FALLON MEDICAID - CPT - 99607","FALLON - FALLON MEDICAID - 99607","FALLON - FALLON MEDICAID - 99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","FALLON","FALLON MEDICAID","CPT","99607","MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM",32,0,0,0,8]
["TUFTS - TUFTS HMO - CPT - 99607","TUFTS - TUFTS HMO - 99607","TUFTS - TUFTS HMO - 99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","TUFTS","TUFTS HMO","CPT","99607","MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM",32,0,0,0,8]
["TUFTS - TUFTS POS - CPT - 99607","TUFTS - TUFTS POS - 99607","TUFTS - TUFTS POS - 99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","TUFTS","TUFTS POS","CPT","99607","MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM",32,0,0,0,8]
["TUFTS - TUFTS PPO - CPT - 99607","TUFTS - TUFTS PPO - 99607","TUFTS - TUFTS PPO - 99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","TUFTS","TUFTS PPO","CPT","99607","MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM",32,0,0,0,8]
["TUFTS - TUFTS SELECT - CPT - 99607","TUFTS - TUFTS SELECT - 99607","TUFTS - TUFTS SELECT - 99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","TUFTS","TUFTS SELECT","CPT","99607","MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM",32,0,0,0,8]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 99607","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 99607","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - 99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","99607","MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM",32,0,0,0,8]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 99607","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 99607","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - 99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","99607","MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM",32,0,0,0,8]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 0001A","AETNA - AETNA-MEDICARE ADVANTAGE - 0001A","AETNA - AETNA-MEDICARE ADVANTAGE - 0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,19.989999999999998,16.940000000000001,74.13,14.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 0001A","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 0001A","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,39.979999999999997,16.940000000000001,74.13,14.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 0001A","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 0001A","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,45.98,16.940000000000001,74.13,14.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 0001A","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 0001A","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,38.97,16.940000000000001,74.13,14.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 0001A","BLUE CROSS - BLUE CROSS-HMO BLUE - 0001A","BLUE CROSS - BLUE CROSS-HMO BLUE - 0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,38.97,16.940000000000001,74.13,14.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 0001A","BLUE CROSS - BLUE CROSS-INDEMNITY - 0001A","BLUE CROSS - BLUE CROSS-INDEMNITY - 0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,38.97,16.940000000000001,74.13,14.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 0001A","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 0001A","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,42.62,16.940000000000001,74.13,14.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 0001A","BLUE CROSS - BLUE CROSS-PPO - 0001A","BLUE CROSS - BLUE CROSS-PPO - 0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","BLUE CROSS","BLUE CROSS-PPO","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,38.97,16.940000000000001,74.13,14.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 0001A","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 0001A","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,38.97,16.940000000000001,74.13,14.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 0001A","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 0001A","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,38.97,16.940000000000001,74.13,14.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 0001A","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 0001A","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,38.97,16.940000000000001,74.13,14.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 0001A","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 0001A","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,37.44,16.940000000000001,74.13,14.5]
["BMC HEALTHNET - BMCHN ACO - CPT - 0001A","BMC HEALTHNET - BMCHN ACO - 0001A","BMC HEALTHNET - BMCHN ACO - 0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","BMC HEALTHNET","BMCHN ACO","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,74.13,16.940000000000001,74.13,14.5]
["BMC HEALTHNET - BMCHN MCO - CPT - 0001A","BMC HEALTHNET - BMCHN MCO - 0001A","BMC HEALTHNET - BMCHN MCO - 0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","BMC HEALTHNET","BMCHN MCO","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,33.880000000000003,16.940000000000001,74.13,14.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 0001A","BMC HEALTHNET - BMCHN MEDICAID - 0001A","BMC HEALTHNET - BMCHN MEDICAID - 0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","BMC HEALTHNET","BMCHN MEDICAID","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,33.880000000000003,16.940000000000001,74.13,14.5]
["BMC HEALTHNET - BMCHN QHP - CPT - 0001A","BMC HEALTHNET - BMCHN QHP - 0001A","BMC HEALTHNET - BMCHN QHP - 0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","BMC HEALTHNET","BMCHN QHP","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,40.659999999999997,16.940000000000001,74.13,14.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 0001A","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 0001A","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,16.940000000000001,16.940000000000001,74.13,14.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 0001A","ELDER SERVICE PLAN - ELEMENT CARE INC - 0001A","ELDER SERVICE PLAN - ELEMENT CARE INC - 0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,16.940000000000001,16.940000000000001,74.13,14.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 0001A","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - 0001A","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - 0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,16.940000000000001,16.940000000000001,74.13,14.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 0001A","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 0001A","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,16.940000000000001,16.940000000000001,74.13,14.5]
["FALLON - FALLON MEDICAID - CPT - 0001A","FALLON - FALLON MEDICAID - 0001A","FALLON - FALLON MEDICAID - 0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","FALLON","FALLON MEDICAID","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,33.880000000000003,16.940000000000001,74.13,14.5]
["FALLON - FALLON SENIOR PLAN - CPT - 0001A","FALLON - FALLON SENIOR PLAN - 0001A","FALLON - FALLON SENIOR PLAN - 0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","FALLON","FALLON SENIOR PLAN","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,16.940000000000001,16.940000000000001,74.13,14.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 0001A","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - 0001A","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - 0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,36.57,16.940000000000001,74.13,14.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 0001A","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 0001A","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,29.48,16.940000000000001,74.13,14.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 0001A","TUFTS - TUFTS MEDICARE SCO - 0001A","TUFTS - TUFTS MEDICARE SCO - 0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","TUFTS","TUFTS MEDICARE SCO","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,24.56,16.940000000000001,74.13,14.5]
["TUFTS - TUFTS SPIRIT - CPT - 0001A","TUFTS - TUFTS SPIRIT - 0001A","TUFTS - TUFTS SPIRIT - 0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","TUFTS","TUFTS SPIRIT","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,18.63,16.940000000000001,74.13,14.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 0001A","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 0001A","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,20.329999999999998,16.940000000000001,74.13,14.5]
["UNICARE - UNICARE - CPT - 0001A","UNICARE - UNICARE - 0001A","UNICARE - UNICARE - 0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","UNICARE","UNICARE","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,33.89,16.940000000000001,74.13,14.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 0001A","UNICARE - UNICARE STATE INDEMNITY PLAN - 0001A","UNICARE - UNICARE STATE INDEMNITY PLAN - 0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,33.89,16.940000000000001,74.13,14.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 0001A","UNITED HEALTHCARE - UNITED HEALTHCARE - 0001A","UNITED HEALTHCARE - UNITED HEALTHCARE - 0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,35.68,16.940000000000001,74.13,14.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 0002A","AETNA - AETNA-MEDICARE ADVANTAGE - 0002A","AETNA - AETNA-MEDICARE ADVANTAGE - 0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,33.5,28.39,124.23,14.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 0002A","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 0002A","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,67,28.39,124.23,14.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 0002A","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 0002A","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,77.05,28.39,124.23,14.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 0002A","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 0002A","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,65.31,28.39,124.23,14.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 0002A","BLUE CROSS - BLUE CROSS-HMO BLUE - 0002A","BLUE CROSS - BLUE CROSS-HMO BLUE - 0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,65.31,28.39,124.23,14.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 0002A","BLUE CROSS - BLUE CROSS-INDEMNITY - 0002A","BLUE CROSS - BLUE CROSS-INDEMNITY - 0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,65.31,28.39,124.23,14.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 0002A","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 0002A","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,71.430000000000007,28.39,124.23,14.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 0002A","BLUE CROSS - BLUE CROSS-PPO - 0002A","BLUE CROSS - BLUE CROSS-PPO - 0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","BLUE CROSS","BLUE CROSS-PPO","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,65.31,28.39,124.23,14.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 0002A","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 0002A","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,65.31,28.39,124.23,14.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 0002A","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 0002A","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,65.31,28.39,124.23,14.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 0002A","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 0002A","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,65.31,28.39,124.23,14.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 0002A","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 0002A","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,62.74,28.39,124.23,14.5]
["BMC HEALTHNET - BMCHN ACO - CPT - 0002A","BMC HEALTHNET - BMCHN ACO - 0002A","BMC HEALTHNET - BMCHN ACO - 0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","BMC HEALTHNET","BMCHN ACO","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,124.23,28.39,124.23,14.5]
["BMC HEALTHNET - BMCHN MCO - CPT - 0002A","BMC HEALTHNET - BMCHN MCO - 0002A","BMC HEALTHNET - BMCHN MCO - 0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","BMC HEALTHNET","BMCHN MCO","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,56.78,28.39,124.23,14.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 0002A","BMC HEALTHNET - BMCHN MEDICAID - 0002A","BMC HEALTHNET - BMCHN MEDICAID - 0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","BMC HEALTHNET","BMCHN MEDICAID","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,56.78,28.39,124.23,14.5]
["BMC HEALTHNET - BMCHN QHP - CPT - 0002A","BMC HEALTHNET - BMCHN QHP - 0002A","BMC HEALTHNET - BMCHN QHP - 0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","BMC HEALTHNET","BMCHN QHP","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,68.14,28.39,124.23,14.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 0002A","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 0002A","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,28.39,28.39,124.23,14.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 0002A","ELDER SERVICE PLAN - ELEMENT CARE INC - 0002A","ELDER SERVICE PLAN - ELEMENT CARE INC - 0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,28.39,28.39,124.23,14.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 0002A","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - 0002A","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - 0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,28.39,28.39,124.23,14.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 0002A","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 0002A","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,28.39,28.39,124.23,14.5]
["FALLON - FALLON MEDICAID - CPT - 0002A","FALLON - FALLON MEDICAID - 0002A","FALLON - FALLON MEDICAID - 0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","FALLON","FALLON MEDICAID","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,56.78,28.39,124.23,14.5]
["FALLON - FALLON SENIOR PLAN - CPT - 0002A","FALLON - FALLON SENIOR PLAN - 0002A","FALLON - FALLON SENIOR PLAN - 0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","FALLON","FALLON SENIOR PLAN","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,28.39,28.39,124.23,14.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 0002A","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - 0002A","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - 0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,61.29,28.39,124.23,14.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 0002A","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 0002A","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,49.4,28.39,124.23,14.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 0002A","TUFTS - TUFTS MEDICARE SCO - 0002A","TUFTS - TUFTS MEDICARE SCO - 0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","TUFTS","TUFTS MEDICARE SCO","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,41.17,28.39,124.23,14.5]
["TUFTS - TUFTS SPIRIT - CPT - 0002A","TUFTS - TUFTS SPIRIT - 0002A","TUFTS - TUFTS SPIRIT - 0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","TUFTS","TUFTS SPIRIT","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,31.23,28.39,124.23,14.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 0002A","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 0002A","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,34.07,28.39,124.23,14.5]
["UNICARE - UNICARE - CPT - 0002A","UNICARE - UNICARE - 0002A","UNICARE - UNICARE - 0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","UNICARE","UNICARE","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,56.79,28.39,124.23,14.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 0002A","UNICARE - UNICARE STATE INDEMNITY PLAN - 0002A","UNICARE - UNICARE STATE INDEMNITY PLAN - 0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,56.79,28.39,124.23,14.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 0002A","UNITED HEALTHCARE - UNITED HEALTHCARE - 0002A","UNITED HEALTHCARE - UNITED HEALTHCARE - 0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,59.79,28.39,124.23,14.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 0011A","AETNA - AETNA-MEDICARE ADVANTAGE - 0011A","AETNA - AETNA-MEDICARE ADVANTAGE - 0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,19.989999999999998,16.940000000000001,74.13,14.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 0011A","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 0011A","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,39.979999999999997,16.940000000000001,74.13,14.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 0011A","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 0011A","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,45.98,16.940000000000001,74.13,14.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 0011A","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 0011A","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,38.97,16.940000000000001,74.13,14.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 0011A","BLUE CROSS - BLUE CROSS-HMO BLUE - 0011A","BLUE CROSS - BLUE CROSS-HMO BLUE - 0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,38.97,16.940000000000001,74.13,14.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 0011A","BLUE CROSS - BLUE CROSS-INDEMNITY - 0011A","BLUE CROSS - BLUE CROSS-INDEMNITY - 0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,38.97,16.940000000000001,74.13,14.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 0011A","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 0011A","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,42.62,16.940000000000001,74.13,14.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 0011A","BLUE CROSS - BLUE CROSS-PPO - 0011A","BLUE CROSS - BLUE CROSS-PPO - 0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","BLUE CROSS","BLUE CROSS-PPO","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,38.97,16.940000000000001,74.13,14.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 0011A","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 0011A","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,38.97,16.940000000000001,74.13,14.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 0011A","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 0011A","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,38.97,16.940000000000001,74.13,14.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 0011A","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 0011A","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,38.97,16.940000000000001,74.13,14.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 0011A","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 0011A","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,37.44,16.940000000000001,74.13,14.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 0011A","BMC HEALTHNET - BMCHN ACO - 0011A","BMC HEALTHNET - BMCHN ACO - 0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","BMC HEALTHNET","BMCHN ACO","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,74.13,16.940000000000001,74.13,14.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 0011A","BMC HEALTHNET - BMCHN MCO - 0011A","BMC HEALTHNET - BMCHN MCO - 0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","BMC HEALTHNET","BMCHN MCO","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,33.880000000000003,16.940000000000001,74.13,14.75]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 0011A","BMC HEALTHNET - BMCHN MEDICAID - 0011A","BMC HEALTHNET - BMCHN MEDICAID - 0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","BMC HEALTHNET","BMCHN MEDICAID","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,33.880000000000003,16.940000000000001,74.13,14.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 0011A","BMC HEALTHNET - BMCHN QHP - 0011A","BMC HEALTHNET - BMCHN QHP - 0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","BMC HEALTHNET","BMCHN QHP","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,40.659999999999997,16.940000000000001,74.13,14.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 0011A","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 0011A","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,16.940000000000001,16.940000000000001,74.13,14.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 0011A","ELDER SERVICE PLAN - ELEMENT CARE INC - 0011A","ELDER SERVICE PLAN - ELEMENT CARE INC - 0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,16.940000000000001,16.940000000000001,74.13,14.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 0011A","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - 0011A","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - 0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,16.940000000000001,16.940000000000001,74.13,14.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 0011A","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 0011A","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,16.940000000000001,16.940000000000001,74.13,14.75]
["FALLON - FALLON MEDICAID - CPT - 0011A","FALLON - FALLON MEDICAID - 0011A","FALLON - FALLON MEDICAID - 0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","FALLON","FALLON MEDICAID","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,33.880000000000003,16.940000000000001,74.13,14.75]
["FALLON - FALLON SENIOR PLAN - CPT - 0011A","FALLON - FALLON SENIOR PLAN - 0011A","FALLON - FALLON SENIOR PLAN - 0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","FALLON","FALLON SENIOR PLAN","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,16.940000000000001,16.940000000000001,74.13,14.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 0011A","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - 0011A","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - 0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,36.57,16.940000000000001,74.13,14.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 0011A","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 0011A","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,29.48,16.940000000000001,74.13,14.75]
["TUFTS - TUFTS MEDICARE SCO - CPT - 0011A","TUFTS - TUFTS MEDICARE SCO - 0011A","TUFTS - TUFTS MEDICARE SCO - 0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","TUFTS","TUFTS MEDICARE SCO","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,24.56,16.940000000000001,74.13,14.75]
["TUFTS - TUFTS SPIRIT - CPT - 0011A","TUFTS - TUFTS SPIRIT - 0011A","TUFTS - TUFTS SPIRIT - 0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","TUFTS","TUFTS SPIRIT","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,18.63,16.940000000000001,74.13,14.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 0011A","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 0011A","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,20.329999999999998,16.940000000000001,74.13,14.75]
["UNICARE - UNICARE - CPT - 0011A","UNICARE - UNICARE - 0011A","UNICARE - UNICARE - 0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","UNICARE","UNICARE","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,33.89,16.940000000000001,74.13,14.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 0011A","UNICARE - UNICARE STATE INDEMNITY PLAN - 0011A","UNICARE - UNICARE STATE INDEMNITY PLAN - 0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,33.89,16.940000000000001,74.13,14.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 0011A","UNITED HEALTHCARE - UNITED HEALTHCARE - 0011A","UNITED HEALTHCARE - UNITED HEALTHCARE - 0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,35.68,16.940000000000001,74.13,14.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 0012A","AETNA - AETNA-MEDICARE ADVANTAGE - 0012A","AETNA - AETNA-MEDICARE ADVANTAGE - 0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,33.5,28.39,124.23,14.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 0012A","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 0012A","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - 0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,67,28.39,124.23,14.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 0012A","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 0012A","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - 0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,77.05,28.39,124.23,14.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 0012A","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 0012A","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,65.31,28.39,124.23,14.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 0012A","BLUE CROSS - BLUE CROSS-HMO BLUE - 0012A","BLUE CROSS - BLUE CROSS-HMO BLUE - 0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,65.31,28.39,124.23,14.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 0012A","BLUE CROSS - BLUE CROSS-INDEMNITY - 0012A","BLUE CROSS - BLUE CROSS-INDEMNITY - 0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,65.31,28.39,124.23,14.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 0012A","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 0012A","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,71.430000000000007,28.39,124.23,14.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 0012A","BLUE CROSS - BLUE CROSS-PPO - 0012A","BLUE CROSS - BLUE CROSS-PPO - 0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","BLUE CROSS","BLUE CROSS-PPO","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,65.31,28.39,124.23,14.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 0012A","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 0012A","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,65.31,28.39,124.23,14.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 0012A","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 0012A","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,65.31,28.39,124.23,14.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 0012A","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 0012A","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,65.31,28.39,124.23,14.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 0012A","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 0012A","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,62.74,28.39,124.23,14.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 0012A","BMC HEALTHNET - BMCHN ACO - 0012A","BMC HEALTHNET - BMCHN ACO - 0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","BMC HEALTHNET","BMCHN ACO","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,124.23,28.39,124.23,14.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 0012A","BMC HEALTHNET - BMCHN MCO - 0012A","BMC HEALTHNET - BMCHN MCO - 0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","BMC HEALTHNET","BMCHN MCO","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,56.78,28.39,124.23,14.75]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 0012A","BMC HEALTHNET - BMCHN MEDICAID - 0012A","BMC HEALTHNET - BMCHN MEDICAID - 0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","BMC HEALTHNET","BMCHN MEDICAID","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,56.78,28.39,124.23,14.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 0012A","BMC HEALTHNET - BMCHN QHP - 0012A","BMC HEALTHNET - BMCHN QHP - 0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","BMC HEALTHNET","BMCHN QHP","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,68.14,28.39,124.23,14.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 0012A","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 0012A","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,28.39,28.39,124.23,14.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 0012A","ELDER SERVICE PLAN - ELEMENT CARE INC - 0012A","ELDER SERVICE PLAN - ELEMENT CARE INC - 0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,28.39,28.39,124.23,14.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 0012A","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - 0012A","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - 0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,28.39,28.39,124.23,14.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 0012A","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 0012A","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,28.39,28.39,124.23,14.75]
["FALLON - FALLON MEDICAID - CPT - 0012A","FALLON - FALLON MEDICAID - 0012A","FALLON - FALLON MEDICAID - 0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","FALLON","FALLON MEDICAID","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,56.78,28.39,124.23,14.75]
["FALLON - FALLON SENIOR PLAN - CPT - 0012A","FALLON - FALLON SENIOR PLAN - 0012A","FALLON - FALLON SENIOR PLAN - 0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","FALLON","FALLON SENIOR PLAN","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,28.39,28.39,124.23,14.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 0012A","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - 0012A","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - 0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,61.29,28.39,124.23,14.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 0012A","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 0012A","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,49.4,28.39,124.23,14.75]
["TUFTS - TUFTS MEDICARE SCO - CPT - 0012A","TUFTS - TUFTS MEDICARE SCO - 0012A","TUFTS - TUFTS MEDICARE SCO - 0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","TUFTS","TUFTS MEDICARE SCO","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,41.17,28.39,124.23,14.75]
["TUFTS - TUFTS SPIRIT - CPT - 0012A","TUFTS - TUFTS SPIRIT - 0012A","TUFTS - TUFTS SPIRIT - 0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","TUFTS","TUFTS SPIRIT","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,31.23,28.39,124.23,14.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 0012A","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 0012A","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,34.07,28.39,124.23,14.75]
["UNICARE - UNICARE - CPT - 0012A","UNICARE - UNICARE - 0012A","UNICARE - UNICARE - 0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","UNICARE","UNICARE","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,56.79,28.39,124.23,14.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 0012A","UNICARE - UNICARE STATE INDEMNITY PLAN - 0012A","UNICARE - UNICARE STATE INDEMNITY PLAN - 0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,56.79,28.39,124.23,14.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 0012A","UNITED HEALTHCARE - UNITED HEALTHCARE - 0012A","UNITED HEALTHCARE - UNITED HEALTHCARE - 0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,59.79,28.39,124.23,14.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 0106T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 0106T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 0106T - HC QUANT SENSORY TEST, PER EXTREMITY, TOUCH STIMULI","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","0106T","HC QUANT SENSORY TEST, PER EXTREMITY, TOUCH STIMULI","0106T - HC QUANT SENSORY TEST, PER EXTREMITY, TOUCH STIMULI",49,69.349999999999994,67.64,69.349999999999994,12.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 0106T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 0106T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 0106T - HC QUANT SENSORY TEST, PER EXTREMITY, TOUCH STIMULI","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","0106T","HC QUANT SENSORY TEST, PER EXTREMITY, TOUCH STIMULI","0106T - HC QUANT SENSORY TEST, PER EXTREMITY, TOUCH STIMULI",49,69.349999999999994,67.64,69.349999999999994,12.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 0106T","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 0106T","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 0106T - HC QUANT SENSORY TEST, PER EXTREMITY, TOUCH STIMULI","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","0106T","HC QUANT SENSORY TEST, PER EXTREMITY, TOUCH STIMULI","0106T - HC QUANT SENSORY TEST, PER EXTREMITY, TOUCH STIMULI",49,67.64,67.64,69.349999999999994,12.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 0106T","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 0106T","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 0106T - HC QUANT SENSORY TEST, PER EXTREMITY, TOUCH STIMULI","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","0106T","HC QUANT SENSORY TEST, PER EXTREMITY, TOUCH STIMULI","0106T - HC QUANT SENSORY TEST, PER EXTREMITY, TOUCH STIMULI",49,69.349999999999994,67.64,69.349999999999994,12.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 0126T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 0126T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 0126T - HC COMMON CAROTID INTIMA-MEDIA THICK FOR AHD/CHD RISK ASSESS","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","0126T","HC COMMON CAROTID INTIMA-MEDIA THICK FOR AHD/CHD RISK ASSESS","0126T - HC COMMON CAROTID INTIMA-MEDIA THICK FOR AHD/CHD RISK ASSESS",650,69.349999999999994,67.64,69.349999999999994,162.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 0126T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 0126T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 0126T - HC COMMON CAROTID INTIMA-MEDIA THICK FOR AHD/CHD RISK ASSESS","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","0126T","HC COMMON CAROTID INTIMA-MEDIA THICK FOR AHD/CHD RISK ASSESS","0126T - HC COMMON CAROTID INTIMA-MEDIA THICK FOR AHD/CHD RISK ASSESS",650,69.349999999999994,67.64,69.349999999999994,162.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 0126T","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 0126T","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 0126T - HC COMMON CAROTID INTIMA-MEDIA THICK FOR AHD/CHD RISK ASSESS","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","0126T","HC COMMON CAROTID INTIMA-MEDIA THICK FOR AHD/CHD RISK ASSESS","0126T - HC COMMON CAROTID INTIMA-MEDIA THICK FOR AHD/CHD RISK ASSESS",650,67.64,67.64,69.349999999999994,162.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 0126T","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 0126T","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 0126T - HC COMMON CAROTID INTIMA-MEDIA THICK FOR AHD/CHD RISK ASSESS","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","0126T","HC COMMON CAROTID INTIMA-MEDIA THICK FOR AHD/CHD RISK ASSESS","0126T - HC COMMON CAROTID INTIMA-MEDIA THICK FOR AHD/CHD RISK ASSESS",650,69.349999999999994,67.64,69.349999999999994,162.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 0159T","CIGNA HEALTHCARE - CIGNA CARELINK - 0159T","CIGNA HEALTHCARE - CIGNA CARELINK - 0159T - HC COMPUTER AIDED DETECTION BREAST MRI","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","0159T","HC COMPUTER AIDED DETECTION BREAST MRI","0159T - HC COMPUTER AIDED DETECTION BREAST MRI",331,0,0,0,82.75]
["TUFTS - TUFTS HMO - CPT - 0159T","TUFTS - TUFTS HMO - 0159T","TUFTS - TUFTS HMO - 0159T - HC COMPUTER AIDED DETECTION BREAST MRI","TUFTS","TUFTS HMO","CPT","0159T","HC COMPUTER AIDED DETECTION BREAST MRI","0159T - HC COMPUTER AIDED DETECTION BREAST MRI",331,0,0,0,82.75]
["TUFTS - TUFTS POS - CPT - 0159T","TUFTS - TUFTS POS - 0159T","TUFTS - TUFTS POS - 0159T - HC COMPUTER AIDED DETECTION BREAST MRI","TUFTS","TUFTS POS","CPT","0159T","HC COMPUTER AIDED DETECTION BREAST MRI","0159T - HC COMPUTER AIDED DETECTION BREAST MRI",331,0,0,0,82.75]
["TUFTS - TUFTS PPO - CPT - 0159T","TUFTS - TUFTS PPO - 0159T","TUFTS - TUFTS PPO - 0159T - HC COMPUTER AIDED DETECTION BREAST MRI","TUFTS","TUFTS PPO","CPT","0159T","HC COMPUTER AIDED DETECTION BREAST MRI","0159T - HC COMPUTER AIDED DETECTION BREAST MRI",331,0,0,0,82.75]
["TUFTS - TUFTS SELECT - CPT - 0159T","TUFTS - TUFTS SELECT - 0159T","TUFTS - TUFTS SELECT - 0159T - HC COMPUTER AIDED DETECTION BREAST MRI","TUFTS","TUFTS SELECT","CPT","0159T","HC COMPUTER AIDED DETECTION BREAST MRI","0159T - HC COMPUTER AIDED DETECTION BREAST MRI",331,0,0,0,82.75]
["AETNA - AETNA - CPT - 0191T","AETNA - AETNA - 0191T","AETNA - AETNA - 0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","AETNA","AETNA","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",5769,1990.62,1990.62,17023.61,1442.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 0191T","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 0191T","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",5769,6113.35,1990.62,17023.61,1442.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 0191T","BLUE CROSS - BLUE CROSS-HMO BLUE - 0191T","BLUE CROSS - BLUE CROSS-HMO BLUE - 0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",5769,6113.35,1990.62,17023.61,1442.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 0191T","BLUE CROSS - BLUE CROSS-INDEMNITY - 0191T","BLUE CROSS - BLUE CROSS-INDEMNITY - 0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",5769,6113.35,1990.62,17023.61,1442.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 0191T","BLUE CROSS - BLUE CROSS-PPO - 0191T","BLUE CROSS - BLUE CROSS-PPO - 0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","BLUE CROSS","BLUE CROSS-PPO","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",5769,6113.35,1990.62,17023.61,1442.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 0191T","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 0191T","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",5769,6113.35,1990.62,17023.61,1442.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 0191T","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 0191T","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",5769,6113.35,1990.62,17023.61,1442.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 0191T","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 0191T","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",5769,6113.35,1990.62,17023.61,1442.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 0191T","CIGNA HEALTHCARE - CIGNA CARELINK - 0191T","CIGNA HEALTHCARE - CIGNA CARELINK - 0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",5769,17023.61,1990.62,17023.61,1442.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 0191T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 0191T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",5769,7073.38,1990.62,17023.61,1442.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 0191T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 0191T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",5769,7073.38,1990.62,17023.61,1442.25]
["TUFTS - TUFTS HMO - CPT - 0191T","TUFTS - TUFTS HMO - 0191T","TUFTS - TUFTS HMO - 0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","TUFTS","TUFTS HMO","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",5769,10732.28,1990.62,17023.61,1442.25]
["TUFTS - TUFTS POS - CPT - 0191T","TUFTS - TUFTS POS - 0191T","TUFTS - TUFTS POS - 0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","TUFTS","TUFTS POS","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",5769,10732.28,1990.62,17023.61,1442.25]
["TUFTS - TUFTS PPO - CPT - 0191T","TUFTS - TUFTS PPO - 0191T","TUFTS - TUFTS PPO - 0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","TUFTS","TUFTS PPO","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",5769,10732.28,1990.62,17023.61,1442.25]
["TUFTS - TUFTS SELECT - CPT - 0191T","TUFTS - TUFTS SELECT - 0191T","TUFTS - TUFTS SELECT - 0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","TUFTS","TUFTS SELECT","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",5769,5730.6,1990.62,17023.61,1442.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 0191T","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 0191T","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",5769,6899.74,1990.62,17023.61,1442.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 0191T","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 0191T","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",5769,7073.38,1990.62,17023.61,1442.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 0202U","AETNA - AETNA-MEDICARE ADVANTAGE - 0202U","AETNA - AETNA-MEDICARE ADVANTAGE - 0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",1355,0,0,0,338.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 0202U","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 0202U","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",1355,0,0,0,338.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 0202U","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 0202U","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",1355,0,0,0,338.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 0202U","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 0202U","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",1355,0,0,0,338.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 0202U","ELDER SERVICE PLAN - ELEMENT CARE INC - 0202U","ELDER SERVICE PLAN - ELEMENT CARE INC - 0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",1355,0,0,0,338.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 0202U","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 0202U","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",1355,0,0,0,338.75]
["FALLON - FALLON SENIOR PLAN - CPT - 0202U","FALLON - FALLON SENIOR PLAN - 0202U","FALLON - FALLON SENIOR PLAN - 0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","FALLON","FALLON SENIOR PLAN","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",1355,0,0,0,338.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 0202U","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - 0202U","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - 0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",1355,0,0,0,338.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 0202U","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 0202U","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",1355,0,0,0,338.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 0202U","TUFTS - TUFTS MEDICARE PREFERRED HMO - 0202U","TUFTS - TUFTS MEDICARE PREFERRED HMO - 0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",1355,0,0,0,338.75]
["TUFTS - TUFTS MEDICARE SCO - CPT - 0202U","TUFTS - TUFTS MEDICARE SCO - 0202U","TUFTS - TUFTS MEDICARE SCO - 0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","TUFTS","TUFTS MEDICARE SCO","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",1355,0,0,0,338.75]
["TUFTS - TUFTS SPIRIT - CPT - 0202U","TUFTS - TUFTS SPIRIT - 0202U","TUFTS - TUFTS SPIRIT - 0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","TUFTS","TUFTS SPIRIT","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",1355,0,0,0,338.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 0202U","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 0202U","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",1355,0,0,0,338.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 0202U","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 0202U","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",1355,0,0,0,338.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 0202U","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 0202U","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",1355,0,0,0,338.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 0202U","UNITED HEALTHCARE - UNITED HEALTHCARE - 0202U","UNITED HEALTHCARE - UNITED HEALTHCARE - 0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",1355,0,0,0,338.75]
["AETNA - AETNA - CPT - 0207T","AETNA - AETNA - 0207T","AETNA - AETNA - 0207T - HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL","AETNA","AETNA","CPT","0207T","HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL","0207T - HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL",85,1198.25,117.73,1198.25,21.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 0207T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 0207T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 0207T - HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","0207T","HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL","0207T - HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL",85,120.69,117.73,1198.25,21.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 0207T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 0207T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 0207T - HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","0207T","HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL","0207T - HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL",85,120.69,117.73,1198.25,21.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 0207T","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 0207T","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 0207T - HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","0207T","HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL","0207T - HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL",85,117.73,117.73,1198.25,21.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 0207T","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 0207T","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 0207T - HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","0207T","HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL","0207T - HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL",85,120.69,117.73,1198.25,21.25]
["AETNA - AETNA - CPT - 0234T","AETNA - AETNA - 0234T","AETNA - AETNA - 0234T - HC TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA","AETNA","AETNA","CPT","0234T","HC TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA","0234T - HC TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA",9897,1990.62,1990.62,18787.919999999998,2474.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 0234T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 0234T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 0234T - HC TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","0234T","HC TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA","0234T - HC TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA",9897,18787.919999999998,1990.62,18787.919999999998,2474.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 0234T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 0234T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 0234T - HC TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","0234T","HC TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA","0234T - HC TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA",9897,18787.919999999998,1990.62,18787.919999999998,2474.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 0234T","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 0234T","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 0234T - HC TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","0234T","HC TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA","0234T - HC TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA",9897,18326.71,1990.62,18787.919999999998,2474.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 0234T","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 0234T","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 0234T - HC TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","0234T","HC TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA","0234T - HC TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA",9897,18787.919999999998,1990.62,18787.919999999998,2474.25]
["AETNA - AETNA - CPT - 0236T","AETNA - AETNA - 0236T","AETNA - AETNA - 0236T - HC TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA","AETNA","AETNA","CPT","0236T","HC TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA","0236T - HC TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA",3620,1990.62,1990.62,18787.919999999998,905]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 0236T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 0236T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 0236T - HC TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","0236T","HC TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA","0236T - HC TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA",3620,18787.919999999998,1990.62,18787.919999999998,905]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 0236T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 0236T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 0236T - HC TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","0236T","HC TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA","0236T - HC TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA",3620,18787.919999999998,1990.62,18787.919999999998,905]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 0236T","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 0236T","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 0236T - HC TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","0236T","HC TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA","0236T - HC TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA",3620,18326.71,1990.62,18787.919999999998,905]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 0236T","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 0236T","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 0236T - HC TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","0236T","HC TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA","0236T - HC TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA",3620,18787.919999999998,1990.62,18787.919999999998,905]
["AETNA - AETNA - CPT - 0237T","AETNA - AETNA - 0237T","AETNA - AETNA - 0237T - HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL","AETNA","AETNA","CPT","0237T","HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL","0237T - HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL",3620,1990.62,1990.62,18787.919999999998,905]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 0237T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 0237T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 0237T - HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","0237T","HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL","0237T - HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL",3620,18787.919999999998,1990.62,18787.919999999998,905]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 0237T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 0237T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 0237T - HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","0237T","HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL","0237T - HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL",3620,18787.919999999998,1990.62,18787.919999999998,905]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 0237T","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 0237T","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 0237T - HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","0237T","HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL","0237T - HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL",3620,18326.71,1990.62,18787.919999999998,905]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 0237T","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 0237T","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 0237T - HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","0237T","HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL","0237T - HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL",3620,18787.919999999998,1990.62,18787.919999999998,905]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 0238T","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 0238T","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - 0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","0238T","HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA",15225,25785.9,25785.9,29835.33,3806.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 0238T","BLUE CROSS - BLUE CROSS-HMO BLUE - 0238T","BLUE CROSS - BLUE CROSS-HMO BLUE - 0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","0238T","HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA",15225,25785.9,25785.9,29835.33,3806.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 0238T","BLUE CROSS - BLUE CROSS-INDEMNITY - 0238T","BLUE CROSS - BLUE CROSS-INDEMNITY - 0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","0238T","HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA",15225,25785.9,25785.9,29835.33,3806.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 0238T","BLUE CROSS - BLUE CROSS-PPO - 0238T","BLUE CROSS - BLUE CROSS-PPO - 0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","BLUE CROSS","BLUE CROSS-PPO","CPT","0238T","HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA",15225,25785.9,25785.9,29835.33,3806.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 0238T","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 0238T","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - 0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","0238T","HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA",15225,25785.9,25785.9,29835.33,3806.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 0238T","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 0238T","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - 0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","0238T","HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA",15225,25785.9,25785.9,29835.33,3806.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 0238T","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 0238T","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - 0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","0238T","HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA",15225,25785.9,25785.9,29835.33,3806.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 0238T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 0238T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","0238T","HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA",15225,29835.33,25785.9,29835.33,3806.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 0238T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 0238T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","0238T","HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA",15225,29835.33,25785.9,29835.33,3806.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 0238T","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 0238T","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","0238T","HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA",15225,29102.92,25785.9,29835.33,3806.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 0238T","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 0238T","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","0238T","HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA",15225,29835.33,25785.9,29835.33,3806.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 0241U","AETNA - AETNA-MEDICARE ADVANTAGE - 0241U","AETNA - AETNA-MEDICARE ADVANTAGE - 0241U - HC NFCT DS VIR RESP RNA 4 TRGT","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT","0241U - HC NFCT DS VIR RESP RNA 4 TRGT",229,168.3,142.63,358.89,57.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 0241U","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 0241U","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - 0241U - HC NFCT DS VIR RESP RNA 4 TRGT","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT","0241U - HC NFCT DS VIR RESP RNA 4 TRGT",229,358.89,142.63,358.89,57.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 0241U","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 0241U","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - 0241U - HC NFCT DS VIR RESP RNA 4 TRGT","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT","0241U - HC NFCT DS VIR RESP RNA 4 TRGT",229,315.2,142.63,358.89,57.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 0241U","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 0241U","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - 0241U - HC NFCT DS VIR RESP RNA 4 TRGT","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT","0241U - HC NFCT DS VIR RESP RNA 4 TRGT",229,142.63,142.63,358.89,57.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 0241U","ELDER SERVICE PLAN - ELEMENT CARE INC - 0241U","ELDER SERVICE PLAN - ELEMENT CARE INC - 0241U - HC NFCT DS VIR RESP RNA 4 TRGT","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT","0241U - HC NFCT DS VIR RESP RNA 4 TRGT",229,142.63,142.63,358.89,57.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 0241U","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 0241U","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - 0241U - HC NFCT DS VIR RESP RNA 4 TRGT","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT","0241U - HC NFCT DS VIR RESP RNA 4 TRGT",229,142.63,142.63,358.89,57.25]
["FALLON - FALLON SENIOR PLAN - CPT - 0241U","FALLON - FALLON SENIOR PLAN - 0241U","FALLON - FALLON SENIOR PLAN - 0241U - HC NFCT DS VIR RESP RNA 4 TRGT","FALLON","FALLON SENIOR PLAN","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT","0241U - HC NFCT DS VIR RESP RNA 4 TRGT",229,142.63,142.63,358.89,57.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 0241U","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - 0241U","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - 0241U - HC NFCT DS VIR RESP RNA 4 TRGT","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT","0241U - HC NFCT DS VIR RESP RNA 4 TRGT",229,307.94,142.63,358.89,57.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 0241U","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 0241U","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - 0241U - HC NFCT DS VIR RESP RNA 4 TRGT","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT","0241U - HC NFCT DS VIR RESP RNA 4 TRGT",229,248.18,142.63,358.89,57.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 0241U","TUFTS - TUFTS MEDICARE PREFERRED HMO - 0241U","TUFTS - TUFTS MEDICARE PREFERRED HMO - 0241U - HC NFCT DS VIR RESP RNA 4 TRGT","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT","0241U - HC NFCT DS VIR RESP RNA 4 TRGT",229,206.81,142.63,358.89,57.25]
["TUFTS - TUFTS MEDICARE SCO - CPT - 0241U","TUFTS - TUFTS MEDICARE SCO - 0241U","TUFTS - TUFTS MEDICARE SCO - 0241U - HC NFCT DS VIR RESP RNA 4 TRGT","TUFTS","TUFTS MEDICARE SCO","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT","0241U - HC NFCT DS VIR RESP RNA 4 TRGT",229,206.81,142.63,358.89,57.25]
["TUFTS - TUFTS SPIRIT - CPT - 0241U","TUFTS - TUFTS SPIRIT - 0241U","TUFTS - TUFTS SPIRIT - 0241U - HC NFCT DS VIR RESP RNA 4 TRGT","TUFTS","TUFTS SPIRIT","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT","0241U - HC NFCT DS VIR RESP RNA 4 TRGT",229,156.88999999999999,142.63,358.89,57.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 0241U","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 0241U","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - 0241U - HC NFCT DS VIR RESP RNA 4 TRGT","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT","0241U - HC NFCT DS VIR RESP RNA 4 TRGT",229,192.29,142.63,358.89,57.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 0241U","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 0241U","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - 0241U - HC NFCT DS VIR RESP RNA 4 TRGT","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT","0241U - HC NFCT DS VIR RESP RNA 4 TRGT",229,171.16,142.63,358.89,57.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 0241U","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 0241U","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - 0241U - HC NFCT DS VIR RESP RNA 4 TRGT","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT","0241U - HC NFCT DS VIR RESP RNA 4 TRGT",229,171.16,142.63,358.89,57.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 0241U","UNITED HEALTHCARE - UNITED HEALTHCARE - 0241U","UNITED HEALTHCARE - UNITED HEALTHCARE - 0241U - HC NFCT DS VIR RESP RNA 4 TRGT","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT","0241U - HC NFCT DS VIR RESP RNA 4 TRGT",229,300.38,142.63,358.89,57.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 0346T","CIGNA HEALTHCARE - CIGNA CARELINK - 0346T","CIGNA HEALTHCARE - CIGNA CARELINK - 0346T - ULTRASOUND ELASTOGRAPHY","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","0346T","ULTRASOUND ELASTOGRAPHY","0346T - ULTRASOUND ELASTOGRAPHY",1279,0,0,0,319.75]
["TUFTS - TUFTS HMO - CPT - 0346T","TUFTS - TUFTS HMO - 0346T","TUFTS - TUFTS HMO - 0346T - ULTRASOUND ELASTOGRAPHY","TUFTS","TUFTS HMO","CPT","0346T","ULTRASOUND ELASTOGRAPHY","0346T - ULTRASOUND ELASTOGRAPHY",1279,0,0,0,319.75]
["TUFTS - TUFTS POS - CPT - 0346T","TUFTS - TUFTS POS - 0346T","TUFTS - TUFTS POS - 0346T - ULTRASOUND ELASTOGRAPHY","TUFTS","TUFTS POS","CPT","0346T","ULTRASOUND ELASTOGRAPHY","0346T - ULTRASOUND ELASTOGRAPHY",1279,0,0,0,319.75]
["TUFTS - TUFTS PPO - CPT - 0346T","TUFTS - TUFTS PPO - 0346T","TUFTS - TUFTS PPO - 0346T - ULTRASOUND ELASTOGRAPHY","TUFTS","TUFTS PPO","CPT","0346T","ULTRASOUND ELASTOGRAPHY","0346T - ULTRASOUND ELASTOGRAPHY",1279,0,0,0,319.75]
["TUFTS - TUFTS SELECT - CPT - 0346T","TUFTS - TUFTS SELECT - 0346T","TUFTS - TUFTS SELECT - 0346T - ULTRASOUND ELASTOGRAPHY","TUFTS","TUFTS SELECT","CPT","0346T","ULTRASOUND ELASTOGRAPHY","0346T - ULTRASOUND ELASTOGRAPHY",1279,0,0,0,319.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 0362T","CIGNA HEALTHCARE - CIGNA CARELINK - 0362T","CIGNA HEALTHCARE - CIGNA CARELINK - 0362T - HC BHV ID SUPRT ASSMT EA 15 MIN","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","0362T","HC BHV ID SUPRT ASSMT EA 15 MIN","0362T - HC BHV ID SUPRT ASSMT EA 15 MIN",378,61.23,33.74,61.23,94.5]
["TUFTS - TUFTS HMO - CPT - 0362T","TUFTS - TUFTS HMO - 0362T","TUFTS - TUFTS HMO - 0362T - HC BHV ID SUPRT ASSMT EA 15 MIN","TUFTS","TUFTS HMO","CPT","0362T","HC BHV ID SUPRT ASSMT EA 15 MIN","0362T - HC BHV ID SUPRT ASSMT EA 15 MIN",378,38.6,33.74,61.23,94.5]
["TUFTS - TUFTS POS - CPT - 0362T","TUFTS - TUFTS POS - 0362T","TUFTS - TUFTS POS - 0362T - HC BHV ID SUPRT ASSMT EA 15 MIN","TUFTS","TUFTS POS","CPT","0362T","HC BHV ID SUPRT ASSMT EA 15 MIN","0362T - HC BHV ID SUPRT ASSMT EA 15 MIN",378,38.6,33.74,61.23,94.5]
["TUFTS - TUFTS PPO - CPT - 0362T","TUFTS - TUFTS PPO - 0362T","TUFTS - TUFTS PPO - 0362T - HC BHV ID SUPRT ASSMT EA 15 MIN","TUFTS","TUFTS PPO","CPT","0362T","HC BHV ID SUPRT ASSMT EA 15 MIN","0362T - HC BHV ID SUPRT ASSMT EA 15 MIN",378,38.6,33.74,61.23,94.5]
["TUFTS - TUFTS SELECT - CPT - 0362T","TUFTS - TUFTS SELECT - 0362T","TUFTS - TUFTS SELECT - 0362T - HC BHV ID SUPRT ASSMT EA 15 MIN","TUFTS","TUFTS SELECT","CPT","0362T","HC BHV ID SUPRT ASSMT EA 15 MIN","0362T - HC BHV ID SUPRT ASSMT EA 15 MIN",378,33.74,33.74,61.23,94.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 0373T","CIGNA HEALTHCARE - CIGNA CARELINK - 0373T","CIGNA HEALTHCARE - CIGNA CARELINK - 0373T - HC ADAPT BHV TX EA 15 MIN","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","0373T","HC ADAPT BHV TX EA 15 MIN","0373T - HC ADAPT BHV TX EA 15 MIN",378,61.23,33.74,61.23,94.5]
["TUFTS - TUFTS HMO - CPT - 0373T","TUFTS - TUFTS HMO - 0373T","TUFTS - TUFTS HMO - 0373T - HC ADAPT BHV TX EA 15 MIN","TUFTS","TUFTS HMO","CPT","0373T","HC ADAPT BHV TX EA 15 MIN","0373T - HC ADAPT BHV TX EA 15 MIN",378,38.6,33.74,61.23,94.5]
["TUFTS - TUFTS POS - CPT - 0373T","TUFTS - TUFTS POS - 0373T","TUFTS - TUFTS POS - 0373T - HC ADAPT BHV TX EA 15 MIN","TUFTS","TUFTS POS","CPT","0373T","HC ADAPT BHV TX EA 15 MIN","0373T - HC ADAPT BHV TX EA 15 MIN",378,38.6,33.74,61.23,94.5]
["TUFTS - TUFTS PPO - CPT - 0373T","TUFTS - TUFTS PPO - 0373T","TUFTS - TUFTS PPO - 0373T - HC ADAPT BHV TX EA 15 MIN","TUFTS","TUFTS PPO","CPT","0373T","HC ADAPT BHV TX EA 15 MIN","0373T - HC ADAPT BHV TX EA 15 MIN",378,38.6,33.74,61.23,94.5]
["TUFTS - TUFTS SELECT - CPT - 0373T","TUFTS - TUFTS SELECT - 0373T","TUFTS - TUFTS SELECT - 0373T - HC ADAPT BHV TX EA 15 MIN","TUFTS","TUFTS SELECT","CPT","0373T","HC ADAPT BHV TX EA 15 MIN","0373T - HC ADAPT BHV TX EA 15 MIN",378,33.74,33.74,61.23,94.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 0482T","CIGNA HEALTHCARE - CIGNA CARELINK - 0482T","CIGNA HEALTHCARE - CIGNA CARELINK - 0482T - ABSOLUTE QUAN MYOCARD BLD FLO PET STRESS & REST","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","0482T","ABSOLUTE QUAN MYOCARD BLD FLO PET STRESS & REST","0482T - ABSOLUTE QUAN MYOCARD BLD FLO PET STRESS & REST",1350,0,0,0,337.5]
["TUFTS - TUFTS HMO - CPT - 0482T","TUFTS - TUFTS HMO - 0482T","TUFTS - TUFTS HMO - 0482T - ABSOLUTE QUAN MYOCARD BLD FLO PET STRESS & REST","TUFTS","TUFTS HMO","CPT","0482T","ABSOLUTE QUAN MYOCARD BLD FLO PET STRESS & REST","0482T - ABSOLUTE QUAN MYOCARD BLD FLO PET STRESS & REST",1350,0,0,0,337.5]
["TUFTS - TUFTS POS - CPT - 0482T","TUFTS - TUFTS POS - 0482T","TUFTS - TUFTS POS - 0482T - ABSOLUTE QUAN MYOCARD BLD FLO PET STRESS & REST","TUFTS","TUFTS POS","CPT","0482T","ABSOLUTE QUAN MYOCARD BLD FLO PET STRESS & REST","0482T - ABSOLUTE QUAN MYOCARD BLD FLO PET STRESS & REST",1350,0,0,0,337.5]
["TUFTS - TUFTS PPO - CPT - 0482T","TUFTS - TUFTS PPO - 0482T","TUFTS - TUFTS PPO - 0482T - ABSOLUTE QUAN MYOCARD BLD FLO PET STRESS & REST","TUFTS","TUFTS PPO","CPT","0482T","ABSOLUTE QUAN MYOCARD BLD FLO PET STRESS & REST","0482T - ABSOLUTE QUAN MYOCARD BLD FLO PET STRESS & REST",1350,0,0,0,337.5]
["TUFTS - TUFTS SELECT - CPT - 0482T","TUFTS - TUFTS SELECT - 0482T","TUFTS - TUFTS SELECT - 0482T - ABSOLUTE QUAN MYOCARD BLD FLO PET STRESS & REST","TUFTS","TUFTS SELECT","CPT","0482T","ABSOLUTE QUAN MYOCARD BLD FLO PET STRESS & REST","0482T - ABSOLUTE QUAN MYOCARD BLD FLO PET STRESS & REST",1350,0,0,0,337.5]
["AETNA - AETNA - CPT - 0505T","AETNA - AETNA - 0505T","AETNA - AETNA - 0505T - HC EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR","AETNA","AETNA","CPT","0505T","HC EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR","0505T - HC EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR",14877,2166.09,2166.09,18787.919999999998,3719.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 0505T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 0505T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 0505T - HC EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","0505T","HC EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR","0505T - HC EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR",14877,18787.919999999998,2166.09,18787.919999999998,3719.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 0505T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 0505T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 0505T - HC EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","0505T","HC EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR","0505T - HC EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR",14877,18787.919999999998,2166.09,18787.919999999998,3719.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 0505T","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 0505T","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 0505T - HC EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","0505T","HC EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR","0505T - HC EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR",14877,18326.71,2166.09,18787.919999999998,3719.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 0505T","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 0505T","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 0505T - HC EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","0505T","HC EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR","0505T - HC EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR",14877,18787.919999999998,2166.09,18787.919999999998,3719.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 0509T","CIGNA HEALTHCARE - CIGNA CARELINK - 0509T","CIGNA HEALTHCARE - CIGNA CARELINK - 0509T - HC PATTERN ERG W/I&R","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","0509T","HC PATTERN ERG W/I&R","0509T - HC PATTERN ERG W/I&R",210,797.09,250.1,797.09,52.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 0509T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 0509T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 0509T - HC PATTERN ERG W/I&R","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","0509T","HC PATTERN ERG W/I&R","0509T - HC PATTERN ERG W/I&R",210,293.52,250.1,797.09,52.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 0509T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 0509T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 0509T - HC PATTERN ERG W/I&R","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","0509T","HC PATTERN ERG W/I&R","0509T - HC PATTERN ERG W/I&R",210,293.52,250.1,797.09,52.5]
["TUFTS - TUFTS HMO - CPT - 0509T","TUFTS - TUFTS HMO - 0509T","TUFTS - TUFTS HMO - 0509T - HC PATTERN ERG W/I&R","TUFTS","TUFTS HMO","CPT","0509T","HC PATTERN ERG W/I&R","0509T - HC PATTERN ERG W/I&R",210,469.76,250.1,797.09,52.5]
["TUFTS - TUFTS POS - CPT - 0509T","TUFTS - TUFTS POS - 0509T","TUFTS - TUFTS POS - 0509T - HC PATTERN ERG W/I&R","TUFTS","TUFTS POS","CPT","0509T","HC PATTERN ERG W/I&R","0509T - HC PATTERN ERG W/I&R",210,469.76,250.1,797.09,52.5]
["TUFTS - TUFTS PPO - CPT - 0509T","TUFTS - TUFTS PPO - 0509T","TUFTS - TUFTS PPO - 0509T - HC PATTERN ERG W/I&R","TUFTS","TUFTS PPO","CPT","0509T","HC PATTERN ERG W/I&R","0509T - HC PATTERN ERG W/I&R",210,502.51,250.1,797.09,52.5]
["TUFTS - TUFTS SELECT - CPT - 0509T","TUFTS - TUFTS SELECT - 0509T","TUFTS - TUFTS SELECT - 0509T - HC PATTERN ERG W/I&R","TUFTS","TUFTS SELECT","CPT","0509T","HC PATTERN ERG W/I&R","0509T - HC PATTERN ERG W/I&R",210,250.1,250.1,797.09,52.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 0509T","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 0509T","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 0509T - HC PATTERN ERG W/I&R","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","0509T","HC PATTERN ERG W/I&R","0509T - HC PATTERN ERG W/I&R",210,286.31,250.1,797.09,52.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 0509T","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 0509T","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 0509T - HC PATTERN ERG W/I&R","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","0509T","HC PATTERN ERG W/I&R","0509T - HC PATTERN ERG W/I&R",210,293.52,250.1,797.09,52.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 0523T","CIGNA HEALTHCARE - CIGNA CARELINK - 0523T","CIGNA HEALTHCARE - CIGNA CARELINK - 0523T - HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","0523T","HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING","0523T - HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING",2178,0,0,0,544.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 0523T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 0523T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 0523T - HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","0523T","HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING","0523T - HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING",2178,0,0,0,544.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 0523T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 0523T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 0523T - HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","0523T","HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING","0523T - HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING",2178,0,0,0,544.5]
["TUFTS - TUFTS HMO - CPT - 0523T","TUFTS - TUFTS HMO - 0523T","TUFTS - TUFTS HMO - 0523T - HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING","TUFTS","TUFTS HMO","CPT","0523T","HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING","0523T - HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING",2178,0,0,0,544.5]
["TUFTS - TUFTS POS - CPT - 0523T","TUFTS - TUFTS POS - 0523T","TUFTS - TUFTS POS - 0523T - HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING","TUFTS","TUFTS POS","CPT","0523T","HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING","0523T - HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING",2178,0,0,0,544.5]
["TUFTS - TUFTS PPO - CPT - 0523T","TUFTS - TUFTS PPO - 0523T","TUFTS - TUFTS PPO - 0523T - HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING","TUFTS","TUFTS PPO","CPT","0523T","HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING","0523T - HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING",2178,0,0,0,544.5]
["TUFTS - TUFTS SELECT - CPT - 0523T","TUFTS - TUFTS SELECT - 0523T","TUFTS - TUFTS SELECT - 0523T - HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING","TUFTS","TUFTS SELECT","CPT","0523T","HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING","0523T - HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING",2178,0,0,0,544.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 0523T","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 0523T","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 0523T - HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","0523T","HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING","0523T - HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING",2178,0,0,0,544.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 0523T","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 0523T","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 0523T - HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","0523T","HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING","0523T - HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING",2178,0,0,0,544.5]
["AETNA - AETNA - CPT - 0524T","AETNA - AETNA - 0524T","AETNA - AETNA - 0524T - HC EV CATHETER DIR CHEM ABLTJ INCMPTNT XTR VEIN","AETNA","AETNA","CPT","0524T","HC EV CATHETER DIR CHEM ABLTJ INCMPTNT XTR VEIN","0524T - HC EV CATHETER DIR CHEM ABLTJ INCMPTNT XTR VEIN",4065,1990.62,1990.62,5703.04,1016.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 0524T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 0524T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - 0524T - HC EV CATHETER DIR CHEM ABLTJ INCMPTNT XTR VEIN","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","0524T","HC EV CATHETER DIR CHEM ABLTJ INCMPTNT XTR VEIN","0524T - HC EV CATHETER DIR CHEM ABLTJ INCMPTNT XTR VEIN",4065,5703.04,1990.62,5703.04,1016.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 0524T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 0524T","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - 0524T - HC EV CATHETER DIR CHEM ABLTJ INCMPTNT XTR VEIN","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","0524T","HC EV CATHETER DIR CHEM ABLTJ INCMPTNT XTR VEIN","0524T - HC EV CATHETER DIR CHEM ABLTJ INCMPTNT XTR VEIN",4065,5703.04,1990.62,5703.04,1016.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 0524T","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 0524T","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - 0524T - HC EV CATHETER DIR CHEM ABLTJ INCMPTNT XTR VEIN","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","0524T","HC EV CATHETER DIR CHEM ABLTJ INCMPTNT XTR VEIN","0524T - HC EV CATHETER DIR CHEM ABLTJ INCMPTNT XTR VEIN",4065,5563.04,1990.62,5703.04,1016.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 0524T","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 0524T","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - 0524T - HC EV CATHETER DIR CHEM ABLTJ INCMPTNT XTR VEIN","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","0524T","HC EV CATHETER DIR CHEM ABLTJ INCMPTNT XTR VEIN","0524T - HC EV CATHETER DIR CHEM ABLTJ INCMPTNT XTR VEIN",4065,5703.04,1990.62,5703.04,1016.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 0540T","CIGNA HEALTHCARE - CIGNA CARELINK - 0540T","CIGNA HEALTHCARE - CIGNA CARELINK - 0540T - HC CAR-T CLL ADMN AUTOLOGOUS","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","0540T","HC CAR-T CLL ADMN AUTOLOGOUS","0540T - HC CAR-T CLL ADMN AUTOLOGOUS",451,1748.74,548.67999999999995,1748.74,112.75]
["TUFTS - TUFTS HMO - CPT - 0540T","TUFTS - TUFTS HMO - 0540T","TUFTS - TUFTS HMO - 0540T - HC CAR-T CLL ADMN AUTOLOGOUS","TUFTS","TUFTS HMO","CPT","0540T","HC CAR-T CLL ADMN AUTOLOGOUS","0540T - HC CAR-T CLL ADMN AUTOLOGOUS",451,1030.5899999999999,548.67999999999995,1748.74,112.75]
["TUFTS - TUFTS POS - CPT - 0540T","TUFTS - TUFTS POS - 0540T","TUFTS - TUFTS POS - 0540T - HC CAR-T CLL ADMN AUTOLOGOUS","TUFTS","TUFTS POS","CPT","0540T","HC CAR-T CLL ADMN AUTOLOGOUS","0540T - HC CAR-T CLL ADMN AUTOLOGOUS",451,1030.5899999999999,548.67999999999995,1748.74,112.75]
["TUFTS - TUFTS PPO - CPT - 0540T","TUFTS - TUFTS PPO - 0540T","TUFTS - TUFTS PPO - 0540T - HC CAR-T CLL ADMN AUTOLOGOUS","TUFTS","TUFTS PPO","CPT","0540T","HC CAR-T CLL ADMN AUTOLOGOUS","0540T - HC CAR-T CLL ADMN AUTOLOGOUS",451,1102.46,548.67999999999995,1748.74,112.75]
["TUFTS - TUFTS SELECT - CPT - 0540T","TUFTS - TUFTS SELECT - 0540T","TUFTS - TUFTS SELECT - 0540T - HC CAR-T CLL ADMN AUTOLOGOUS","TUFTS","TUFTS SELECT","CPT","0540T","HC CAR-T CLL ADMN AUTOLOGOUS","0540T - HC CAR-T CLL ADMN AUTOLOGOUS",451,548.67999999999995,548.67999999999995,1748.74,112.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - G0399","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - G0399","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",206,0,286.31,1634.89,51.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - G0399","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - G0399","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",206,0,286.31,1634.89,51.5]
["BMC HEALTHNET - BMCHN ACO - CPT - G0399","BMC HEALTHNET - BMCHN ACO - G0399","BMC HEALTHNET - BMCHN ACO - G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA","BMC HEALTHNET","BMCHN ACO","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",206,0,286.31,1634.89,51.5]
["BMC HEALTHNET - BMCHN MCO - CPT - G0399","BMC HEALTHNET - BMCHN MCO - G0399","BMC HEALTHNET - BMCHN MCO - G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA","BMC HEALTHNET","BMCHN MCO","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",206,0,286.31,1634.89,51.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - G0399","BMC HEALTHNET - BMCHN MEDICAID - G0399","BMC HEALTHNET - BMCHN MEDICAID - G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA","BMC HEALTHNET","BMCHN MEDICAID","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",206,0,286.31,1634.89,51.5]
["BMC HEALTHNET - BMCHN QHP - CPT - G0399","BMC HEALTHNET - BMCHN QHP - G0399","BMC HEALTHNET - BMCHN QHP - G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA","BMC HEALTHNET","BMCHN QHP","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",206,0,286.31,1634.89,51.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - G0399","CIGNA HEALTHCARE - CIGNA CARELINK - G0399","CIGNA HEALTHCARE - CIGNA CARELINK - G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",206,1634.89,286.31,1634.89,51.5]
["FALLON - FALLON MEDICAID - CPT - G0399","FALLON - FALLON MEDICAID - G0399","FALLON - FALLON MEDICAID - G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA","FALLON","FALLON MEDICAID","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",206,0,286.31,1634.89,51.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - G0399","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - G0399","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",206,293.52,286.31,1634.89,51.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - G0399","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - G0399","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",206,293.52,286.31,1634.89,51.5]
["TUFTS - TUFTS HMO - CPT - G0399","TUFTS - TUFTS HMO - G0399","TUFTS - TUFTS HMO - G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA","TUFTS","TUFTS HMO","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",206,652.5,286.31,1634.89,51.5]
["TUFTS - TUFTS POS - CPT - G0399","TUFTS - TUFTS POS - G0399","TUFTS - TUFTS POS - G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA","TUFTS","TUFTS POS","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",206,543.75,286.31,1634.89,51.5]
["TUFTS - TUFTS PPO - CPT - G0399","TUFTS - TUFTS PPO - G0399","TUFTS - TUFTS PPO - G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA","TUFTS","TUFTS PPO","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",206,581.65,286.31,1634.89,51.5]
["TUFTS - TUFTS SELECT - CPT - G0399","TUFTS - TUFTS SELECT - G0399","TUFTS - TUFTS SELECT - G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA","TUFTS","TUFTS SELECT","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",206,543.75,286.31,1634.89,51.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - G0399","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - G0399","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",206,0,286.31,1634.89,51.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - G0399","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - G0399","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",206,286.31,286.31,1634.89,51.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - G0399","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - G0399","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",206,293.52,286.31,1634.89,51.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - G0465","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - G0465","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - G0465 - HC AUTOLOG PRP DIAB WOUND ULCER","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","G0465","HC AUTOLOG PRP DIAB WOUND ULCER","G0465 - HC AUTOLOG PRP DIAB WOUND ULCER",2187,0,0,0,546.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - G0465","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - G0465","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - G0465 - HC AUTOLOG PRP DIAB WOUND ULCER","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","G0465","HC AUTOLOG PRP DIAB WOUND ULCER","G0465 - HC AUTOLOG PRP DIAB WOUND ULCER",2187,0,0,0,546.75]
["BMC HEALTHNET - BMCHN ACO - CPT - G0465","BMC HEALTHNET - BMCHN ACO - G0465","BMC HEALTHNET - BMCHN ACO - G0465 - HC AUTOLOG PRP DIAB WOUND ULCER","BMC HEALTHNET","BMCHN ACO","CPT","G0465","HC AUTOLOG PRP DIAB WOUND ULCER","G0465 - HC AUTOLOG PRP DIAB WOUND ULCER",2187,0,0,0,546.75]
["BMC HEALTHNET - BMCHN MCO - CPT - G0465","BMC HEALTHNET - BMCHN MCO - G0465","BMC HEALTHNET - BMCHN MCO - G0465 - HC AUTOLOG PRP DIAB WOUND ULCER","BMC HEALTHNET","BMCHN MCO","CPT","G0465","HC AUTOLOG PRP DIAB WOUND ULCER","G0465 - HC AUTOLOG PRP DIAB WOUND ULCER",2187,0,0,0,546.75]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - G0465","BMC HEALTHNET - BMCHN MEDICAID - G0465","BMC HEALTHNET - BMCHN MEDICAID - G0465 - HC AUTOLOG PRP DIAB WOUND ULCER","BMC HEALTHNET","BMCHN MEDICAID","CPT","G0465","HC AUTOLOG PRP DIAB WOUND ULCER","G0465 - HC AUTOLOG PRP DIAB WOUND ULCER",2187,0,0,0,546.75]
["BMC HEALTHNET - BMCHN QHP - CPT - G0465","BMC HEALTHNET - BMCHN QHP - G0465","BMC HEALTHNET - BMCHN QHP - G0465 - HC AUTOLOG PRP DIAB WOUND ULCER","BMC HEALTHNET","BMCHN QHP","CPT","G0465","HC AUTOLOG PRP DIAB WOUND ULCER","G0465 - HC AUTOLOG PRP DIAB WOUND ULCER",2187,0,0,0,546.75]
["FALLON - FALLON MEDICAID - CPT - G0465","FALLON - FALLON MEDICAID - G0465","FALLON - FALLON MEDICAID - G0465 - HC AUTOLOG PRP DIAB WOUND ULCER","FALLON","FALLON MEDICAID","CPT","G0465","HC AUTOLOG PRP DIAB WOUND ULCER","G0465 - HC AUTOLOG PRP DIAB WOUND ULCER",2187,0,0,0,546.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - G0465","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - G0465","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - G0465 - HC AUTOLOG PRP DIAB WOUND ULCER","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","G0465","HC AUTOLOG PRP DIAB WOUND ULCER","G0465 - HC AUTOLOG PRP DIAB WOUND ULCER",2187,0,0,0,546.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - G2215","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - G2215","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - G2215 - HC HOME SUPPLY NASAL NALOXONE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","G2215","HC HOME SUPPLY NASAL NALOXONE","G2215 - HC HOME SUPPLY NASAL NALOXONE",118,0,0,0,29.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - G2215","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - G2215","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - G2215 - HC HOME SUPPLY NASAL NALOXONE","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","G2215","HC HOME SUPPLY NASAL NALOXONE","G2215 - HC HOME SUPPLY NASAL NALOXONE",118,0,0,0,29.5]
["BMC HEALTHNET - BMCHN ACO - CPT - G2215","BMC HEALTHNET - BMCHN ACO - G2215","BMC HEALTHNET - BMCHN ACO - G2215 - HC HOME SUPPLY NASAL NALOXONE","BMC HEALTHNET","BMCHN ACO","CPT","G2215","HC HOME SUPPLY NASAL NALOXONE","G2215 - HC HOME SUPPLY NASAL NALOXONE",118,0,0,0,29.5]
["BMC HEALTHNET - BMCHN MCO - CPT - G2215","BMC HEALTHNET - BMCHN MCO - G2215","BMC HEALTHNET - BMCHN MCO - G2215 - HC HOME SUPPLY NASAL NALOXONE","BMC HEALTHNET","BMCHN MCO","CPT","G2215","HC HOME SUPPLY NASAL NALOXONE","G2215 - HC HOME SUPPLY NASAL NALOXONE",118,0,0,0,29.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - G2215","BMC HEALTHNET - BMCHN MEDICAID - G2215","BMC HEALTHNET - BMCHN MEDICAID - G2215 - HC HOME SUPPLY NASAL NALOXONE","BMC HEALTHNET","BMCHN MEDICAID","CPT","G2215","HC HOME SUPPLY NASAL NALOXONE","G2215 - HC HOME SUPPLY NASAL NALOXONE",118,0,0,0,29.5]
["BMC HEALTHNET - BMCHN QHP - CPT - G2215","BMC HEALTHNET - BMCHN QHP - G2215","BMC HEALTHNET - BMCHN QHP - G2215 - HC HOME SUPPLY NASAL NALOXONE","BMC HEALTHNET","BMCHN QHP","CPT","G2215","HC HOME SUPPLY NASAL NALOXONE","G2215 - HC HOME SUPPLY NASAL NALOXONE",118,0,0,0,29.5]
["FALLON - FALLON MEDICAID - CPT - G2215","FALLON - FALLON MEDICAID - G2215","FALLON - FALLON MEDICAID - G2215 - HC HOME SUPPLY NASAL NALOXONE","FALLON","FALLON MEDICAID","CPT","G2215","HC HOME SUPPLY NASAL NALOXONE","G2215 - HC HOME SUPPLY NASAL NALOXONE",118,0,0,0,29.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - G2215","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - G2215","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - G2215 - HC HOME SUPPLY NASAL NALOXONE","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","G2215","HC HOME SUPPLY NASAL NALOXONE","G2215 - HC HOME SUPPLY NASAL NALOXONE",118,0,0,0,29.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - U0004","AETNA - AETNA-MEDICARE ADVANTAGE - U0004","AETNA - AETNA-MEDICARE ADVANTAGE - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,118,100,906.74,37.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - U0004","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - U0004","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,118,100,906.74,37.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - U0004","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - U0004","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,135.69999999999999,100,906.74,37.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - U0004","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - U0004","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,115.01,100,906.74,37.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - U0004","BLUE CROSS - BLUE CROSS-HMO BLUE - U0004","BLUE CROSS - BLUE CROSS-HMO BLUE - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,115.01,100,906.74,37.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - U0004","BLUE CROSS - BLUE CROSS-INDEMNITY - U0004","BLUE CROSS - BLUE CROSS-INDEMNITY - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,115.01,100,906.74,37.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - U0004","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - U0004","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,251.62,100,906.74,37.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - U0004","BLUE CROSS - BLUE CROSS-PPO - U0004","BLUE CROSS - BLUE CROSS-PPO - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","BLUE CROSS","BLUE CROSS-PPO","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,115.01,100,906.74,37.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - U0004","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - U0004","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,115.01,100,906.74,37.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - U0004","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - U0004","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,115.01,100,906.74,37.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - U0004","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - U0004","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,115.01,100,906.74,37.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - U0004","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - U0004","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,220.99,100,906.74,37.5]
["BMC HEALTHNET - BMCHN ACO - CPT - U0004","BMC HEALTHNET - BMCHN ACO - U0004","BMC HEALTHNET - BMCHN ACO - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","BMC HEALTHNET","BMCHN ACO","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,218.8,100,906.74,37.5]
["BMC HEALTHNET - BMCHN MCO - CPT - U0004","BMC HEALTHNET - BMCHN MCO - U0004","BMC HEALTHNET - BMCHN MCO - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","BMC HEALTHNET","BMCHN MCO","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,100,100,906.74,37.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - U0004","BMC HEALTHNET - BMCHN MEDICAID - U0004","BMC HEALTHNET - BMCHN MEDICAID - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","BMC HEALTHNET","BMCHN MEDICAID","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,100,100,906.74,37.5]
["BMC HEALTHNET - BMCHN QHP - CPT - U0004","BMC HEALTHNET - BMCHN QHP - U0004","BMC HEALTHNET - BMCHN QHP - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","BMC HEALTHNET","BMCHN QHP","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,120,100,906.74,37.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - U0004","CIGNA HEALTHCARE - CIGNA CARELINK - U0004","CIGNA HEALTHCARE - CIGNA CARELINK - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,906.74,100,906.74,37.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - U0004","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - U0004","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,100,100,906.74,37.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - U0004","ELDER SERVICE PLAN - ELEMENT CARE INC - U0004","ELDER SERVICE PLAN - ELEMENT CARE INC - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,100,100,906.74,37.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - U0004","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - U0004","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,100,100,906.74,37.5]
["FALLON - FALLON MEDICAID - CPT - U0004","FALLON - FALLON MEDICAID - U0004","FALLON - FALLON MEDICAID - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","FALLON","FALLON MEDICAID","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,100,100,906.74,37.5]
["FALLON - FALLON SENIOR PLAN - CPT - U0004","FALLON - FALLON SENIOR PLAN - U0004","FALLON - FALLON SENIOR PLAN - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","FALLON","FALLON SENIOR PLAN","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,100,100,906.74,37.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - U0004","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - U0004","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,215.9,100,906.74,37.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - U0004","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - U0004","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,174,100,906.74,37.5]
["TUFTS - TUFTS HMO - CPT - U0004","TUFTS - TUFTS HMO - U0004","TUFTS - TUFTS HMO - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","TUFTS","TUFTS HMO","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,387.12,100,906.74,37.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - U0004","TUFTS - TUFTS MEDICARE PREFERRED HMO - U0004","TUFTS - TUFTS MEDICARE PREFERRED HMO - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,145,100,906.74,37.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - U0004","TUFTS - TUFTS MEDICARE SCO - U0004","TUFTS - TUFTS MEDICARE SCO - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","TUFTS","TUFTS MEDICARE SCO","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,145,100,906.74,37.5]
["TUFTS - TUFTS POS - CPT - U0004","TUFTS - TUFTS POS - U0004","TUFTS - TUFTS POS - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","TUFTS","TUFTS POS","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,322.60000000000002,100,906.74,37.5]
["TUFTS - TUFTS PPO - CPT - U0004","TUFTS - TUFTS PPO - U0004","TUFTS - TUFTS PPO - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","TUFTS","TUFTS PPO","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,322.60000000000002,100,906.74,37.5]
["TUFTS - TUFTS SPIRIT - CPT - U0004","TUFTS - TUFTS SPIRIT - U0004","TUFTS - TUFTS SPIRIT - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","TUFTS","TUFTS SPIRIT","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,110,100,906.74,37.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - U0004","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - U0004","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,117.7,100,906.74,37.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - U0004","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - U0004","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,134.82,100,906.74,37.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - U0004","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - U0004","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,151.19999999999999,100,906.74,37.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - U0004","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - U0004","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,120,100,906.74,37.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - U0004","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - U0004","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,120,100,906.74,37.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - U0004","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - U0004","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,120,100,906.74,37.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - U0004","UNITED HEALTHCARE - UNITED HEALTHCARE - U0004","UNITED HEALTHCARE - UNITED HEALTHCARE - U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,210.6,100,906.74,37.5]
["Select Insurance Carrier - Select Insurance Plan - Select Bill Type - Select Bill Code","Select Insurance Carrier - Select Insurance Plan - Select Bill Code","Select Insurance Carrier - Select Insurance Plan - Select Bill Code","Select Insurance Carrier","Select Insurance Plan","Select Bill Type","Select Bill Code","-","Select Bill Code","-","-","-","-","-"]

{"sheet":"HCPCS Pivot","index":6,"n_rows":6451,"n_cols":7,"rows_kept":6451,"cut":false,"hidden":true,"merged":[]}
[]
[]
["Row Labels","Sum of Duplicate","Average of Gross Charge Amount","Average of Payer Charge Amount","Average of Minimum Charge Amount","Average of Maximum Charge Amount","Average of Self-Pay Charge"]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - J3301",7,157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - J3301",7,157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - J3301",7,157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["TUFTS - TUFTS PPO - HCPCS - J3301",7,157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - J3301",7,157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["TUFTS - TUFTS SELECT - HCPCS - J3301",7,157.52000000000001,47.705714285714294,3.11,157.52000000000001,39.380000000000003]
["UNICARE - UNICARE - HCPCS - J3301",7,157.52000000000001,47.705714285714294,3.11,157.52000000000001,39.380000000000003]
["TUFTS - TUFTS SPIRIT - HCPCS - J3301",7,157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - J3301",7,157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - J3301",7,157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - J3301",7,157.52000000000001,47.705714285714294,3.11,157.52000000000001,39.380000000000003]
["TUFTS - TUFTS HMO - HCPCS - J3301",7,157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - J3301",7,157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["FALLON - FALLON SENIOR PLAN - HCPCS - J3301",7,157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - J3301",7,157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - J3301",7,157.52000000000001,47.705714285714294,3.11,157.52000000000001,39.380000000000003]
["TUFTS - TUFTS POS - HCPCS - J3301",7,157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - J3301",7,157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - J3301",7,157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - J3301",7,157.52000000000001,47.705714285714294,3.11,157.52000000000001,39.380000000000003]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - J3301",7,157.52000000000001,47.705714285714294,3.11,157.52000000000001,39.380000000000003]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - J3301",7,157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - J3301",7,157.52000000000001,47.705714285714294,3.11,157.52000000000001,39.380000000000003]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - J3301",7,157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - J3301",7,157.52000000000001,47.705714285714294,3.11,157.52000000000001,39.380000000000003]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - J3301",7,157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - J3301",7,157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - J3301",7,157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - J3301",7,157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - J3301",7,157.52000000000001,47.705714285714294,3.11,157.52000000000001,39.380000000000003]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - J3301",7,157.52000000000001,47.705714285714294,3.11,157.52000000000001,39.380000000000003]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - J3301",7,157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - J3301",7,157.52000000000001,47.705714285714294,3.11,157.52000000000001,39.380000000000003]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - J3301",7,157.52000000000001,47.705714285714294,3.11,157.52000000000001,39.380000000000003]
["UNICARE - UNICARE - HCPCS - Q9967",6,50.449999999999996,16.309999999999999,14.75,50.449999999999996,12.612499999999999]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q9967",6,50.449999999999996,16.315000000000001,14.75,50.449999999999996,12.612499999999999]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q9967",6,50.449999999999996,16.309999999999999,14.75,50.449999999999996,12.612499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q9967",6,50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q9967",6,50.449999999999996,16.319999999999997,14.75,50.449999999999996,12.612499999999999]
["TUFTS - TUFTS SPIRIT - HCPCS - Q9967",6,50.449999999999996,16.309999999999999,14.75,50.449999999999996,12.612499999999999]
["TUFTS - TUFTS PPO - HCPCS - Q9967",6,50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q9967",6,50.449999999999996,16.315000000000001,14.75,50.449999999999996,12.612499999999999]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q9967",6,50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["TUFTS - TUFTS SELECT - HCPCS - Q9967",6,50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q9967",6,50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - Q9967",6,50.449999999999996,16.330000000000002,14.75,50.449999999999996,12.612499999999999]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q9967",6,50.449999999999996,16.330000000000002,14.75,50.449999999999996,12.612499999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q9967",6,50.449999999999996,16.364999999999998,14.75,50.449999999999996,12.612499999999999]
["FALLON - FALLON MEDICAID - HCPCS - Q9967",6,50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q9967",6,50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q9967",6,50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["TUFTS - TUFTS POS - HCPCS - Q9967",6,50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["TUFTS - TUFTS HMO - HCPCS - Q9967",6,50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["FALLON - FALLON SENIOR PLAN - HCPCS - Q9967",6,50.449999999999996,16.304999999999996,14.75,50.449999999999996,12.612499999999999]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q9967",6,50.449999999999996,16.34,14.75,50.449999999999996,12.612499999999999]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q9967",6,50.449999999999996,16.364999999999998,14.75,50.449999999999996,12.612499999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q9967",6,50.449999999999996,16.315000000000001,14.75,50.449999999999996,12.612499999999999]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q9967",6,50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q9967",6,50.449999999999996,16.305,14.75,50.449999999999996,12.612499999999999]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q9967",6,50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q9967",6,50.449999999999996,16.304999999999996,14.75,50.449999999999996,12.612499999999999]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q9967",6,50.449999999999996,16.305,14.75,50.449999999999996,12.612499999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q9967",6,50.449999999999996,16.315000000000001,14.75,50.449999999999996,12.612499999999999]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q9967",6,50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q9967",6,50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q9967",6,50.449999999999996,16.305,14.75,50.449999999999996,12.612499999999999]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q9967",6,50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q9967",6,50.449999999999996,16.38,14.75,50.449999999999996,12.612499999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q9967",6,50.449999999999996,16.314999999999998,14.75,50.449999999999996,12.612499999999999]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q9967",6,50.449999999999996,16.315000000000001,14.75,50.449999999999996,12.612499999999999]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q9967",6,50.449999999999996,16.315000000000001,14.75,50.449999999999996,12.612499999999999]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q9967",6,50.449999999999996,16.315000000000001,14.75,50.449999999999996,12.612499999999999]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q9967",6,50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q9967",6,50.449999999999996,16.315000000000001,14.75,50.449999999999996,12.612499999999999]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q9967",6,50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q9967",6,50.449999999999996,16.315000000000001,14.75,50.449999999999996,12.612499999999999]
["TUFTS - TUFTS SELECT - HCPCS - P9047",5,279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9047",5,279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - P9047",5,279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["TUFTS - TUFTS SPIRIT - HCPCS - P9047",5,279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - P9047",5,279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["TUFTS - TUFTS PPO - HCPCS - P9047",5,279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["UNICARE - UNICARE - HCPCS - P9047",5,279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - P9047",5,279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9047",5,279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - P9047",5,279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - P9047",5,279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - P9047",5,279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - P9047",5,279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["FALLON - FALLON SENIOR PLAN - HCPCS - P9047",5,279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["TUFTS - TUFTS HMO - HCPCS - P9047",5,279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9047",5,279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - P9047",5,279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9047",5,279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["TUFTS - TUFTS POS - HCPCS - P9047",5,279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - P9047",5,279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9047",5,279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - P9047",5,279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - P9047",5,279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - P9047",5,279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9047",5,279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - P9047",5,279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - P9047",5,279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - P9047",5,279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - P9047",5,279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - P9047",5,279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9047",5,279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9047",5,279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9047",5,279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - P9047",5,279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["TUFTS - TUFTS PPO - HCPCS - J3590",4,3907.79,1932.97,576,3907.79,976.94749999999999]
["TUFTS - TUFTS SELECT - HCPCS - J3590",4,3907.79,1932.97,576,3907.79,976.94749999999999]
["TUFTS - TUFTS HMO - HCPCS - J3590",4,3907.79,1932.97,576,3907.79,976.94749999999999]
["TUFTS - TUFTS POS - HCPCS - J3590",4,3907.79,1932.97,576,3907.79,976.94749999999999]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - J3590",4,3907.79,1932.97,576,3907.79,976.94749999999999]
["TUFTS - TUFTS PPO - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - J1030",3,26.88,24.69,23.59,26.88,6.72]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - J1030",3,26.88,24.689999999999998,23.59,26.88,6.72]
["TUFTS - TUFTS SPIRIT - HCPCS - J1030",3,26.88,24.689999999999998,23.59,26.88,6.72]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - J0702",3,132.62,122.30666666666666,116.03000000000002,132.62,33.155000000000001]
["TUFTS - TUFTS SELECT - HCPCS - J0702",3,132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["UNICARE - UNICARE - HCPCS - J1030",3,26.88,24.689999999999998,23.59,26.88,6.72]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - J0702",3,132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["TUFTS - TUFTS SPIRIT - HCPCS - E0191",3,321,7.8733333333333322,11.61,52.13,80.25]
["TUFTS - TUFTS SELECT - HCPCS - J1030",3,26.88,24.689999999999998,23.59,26.88,6.72]
["TUFTS - TUFTS SPIRIT - HCPCS - J0702",3,132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - E0191",3,321,8.586666666666666,11.61,52.13,80.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - J0702",3,132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - J0702",3,132.62,122.30666666666666,116.03000000000002,132.62,33.155000000000001]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - J1030",3,26.88,24.689999999999998,23.59,26.88,6.72]
["UNICARE - UNICARE - HCPCS - J0702",3,132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["UNICARE - UNICARE - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["TUFTS - TUFTS SELECT - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - E0191",3,321,9.65,11.61,52.13,80.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - J1030",3,26.88,24.69,23.59,26.88,6.72]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - J0702",3,132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["TUFTS - TUFTS PPO - HCPCS - C2615",3,1447.7,1012.6500000000001,748.44,1447.7,361.92500000000001]
["TUFTS - TUFTS PPO - HCPCS - J0702",3,132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - J0702",3,132.62,122.30666666666666,116.03000000000002,132.62,33.155000000000001]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C2615",3,1447.7,1012.65,748.44,1447.7,361.92500000000001]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - J1030",3,26.88,24.69,23.59,26.88,6.72]
["TUFTS - TUFTS SELECT - HCPCS - C2615",3,1447.7,1012.6500000000001,748.44,1447.7,361.92500000000001]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["TUFTS - TUFTS SPIRIT - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["TUFTS - TUFTS PPO - HCPCS - J1030",3,26.88,24.69,23.59,26.88,6.72]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - E0191",3,321,8.5866666666666678,11.61,52.13,80.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C2615",3,1447.7,1012.6500000000001,748.44,1447.7,361.92500000000001]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - J1030",3,26.88,24.689999999999998,23.59,26.88,6.72]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - J0702",3,132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["TUFTS - TUFTS HMO - HCPCS - J0702",3,132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - J0702",3,132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["FALLON - FALLON MEDICAID - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - J0702",3,132.62,122.30666666666666,116.03000000000002,132.62,33.155000000000001]
["FALLON - FALLON SENIOR PLAN - HCPCS - E0191",3,321,7.1566666666666663,11.61,52.13,80.25]
["TUFTS - TUFTS POS - HCPCS - J0702",3,132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["FALLON - FALLON SENIOR PLAN - HCPCS - J0702",3,132.62,122.30666666666666,116.03000000000002,132.62,33.155000000000001]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["FALLON - FALLON SENIOR PLAN - HCPCS - J1030",3,26.88,24.689999999999998,23.59,26.88,6.72]
["TUFTS - TUFTS HMO - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["FALLON - FALLON SENIOR PLAN - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C2615",3,1447.7,1012.6500000000001,748.44,1447.7,361.92500000000001]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - J0702",3,132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - E0191",3,321,12.453333333333333,11.61,52.13,80.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - J1030",3,26.88,24.689999999999998,23.59,26.88,6.72]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - J1030",3,26.88,24.689999999999998,23.59,26.88,6.72]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["TUFTS - TUFTS HMO - HCPCS - C2615",3,1447.7,1012.65,748.44,1447.7,361.92500000000001]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C2615",3,1447.7,1012.6500000000001,748.44,1447.7,361.92500000000001]
["TUFTS - TUFTS HMO - HCPCS - J1030",3,26.88,24.689999999999998,23.59,26.88,6.72]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - J0702",3,132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - E0191",3,321,10.376666666666667,11.61,52.13,80.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - J1030",3,26.88,24.689999999999998,23.59,26.88,6.72]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - J1030",3,26.88,24.689999999999998,23.59,26.88,6.72]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - E0191",3,321,10.376666666666665,11.61,52.13,80.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - E0191",3,321,15.453333333333333,11.61,52.13,80.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - J1030",3,26.88,24.69,23.59,26.88,6.72]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - J0702",3,132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["TUFTS - TUFTS POS - HCPCS - C2615",3,1447.7,1012.6500000000001,748.44,1447.7,361.92500000000001]
["TUFTS - TUFTS POS - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["TUFTS - TUFTS POS - HCPCS - J1030",3,26.88,24.689999999999998,23.59,26.88,6.72]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - J1030",3,26.88,24.689999999999998,23.59,26.88,6.72]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - J0702",3,132.62,122.30666666666666,116.03000000000002,132.62,33.155000000000001]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["BMC HEALTHNET - BMCHN MCO - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - J1030",3,26.88,24.689999999999998,23.59,26.88,6.72]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - E0191",3,321,15.816666666666665,11.61,52.13,80.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - J0702",3,132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["BMC HEALTHNET - BMCHN QHP - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - E0191",3,321,7.1566666666666663,11.61,52.13,80.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - J0702",3,132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - E0191",3,321,7.1566666666666663,11.61,52.13,80.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C2615",3,1447.7,1012.65,748.44,1447.7,361.92500000000001]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - J1030",3,26.88,24.689999999999998,23.59,26.88,6.72]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - J0702",3,132.62,122.30666666666666,116.03000000000002,132.62,33.155000000000001]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - J1030",3,26.88,24.69,23.59,26.88,6.72]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - J1030",3,26.88,24.689999999999998,23.59,26.88,6.72]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - E0191",3,321,7.1566666666666663,11.61,52.13,80.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - J1030",3,26.88,24.689999999999998,23.59,26.88,6.72]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - J1030",3,26.88,24.689999999999998,23.59,26.88,6.72]
["BMC HEALTHNET - BMCHN ACO - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - J1030",3,26.88,24.689999999999998,23.59,26.88,6.72]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - J0702",3,132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - J0702",3,132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - J0702",3,132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - E0191",3,321,7.1566666666666663,11.61,52.13,80.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - J1030",3,26.88,24.689999999999998,23.59,26.88,6.72]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - J1030",3,26.88,24.689999999999998,23.59,26.88,6.72]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - J1030",3,26.88,24.69,23.59,26.88,6.72]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - J0702",3,132.62,122.30666666666666,116.03000000000002,132.62,33.155000000000001]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - J0702",3,132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - J0702",3,132.62,122.30666666666666,116.03000000000002,132.62,33.155000000000001]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - J1030",3,26.88,24.69,23.59,26.88,6.72]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - J0702",3,132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - J0702",3,132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - J1030",3,26.88,24.689999999999998,23.59,26.88,6.72]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - J1030",3,26.88,24.689999999999998,23.59,26.88,6.72]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - J1030",3,26.88,24.689999999999998,23.59,26.88,6.72]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - J0702",3,132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - E0191",3,321,8.4466666666666672,11.61,52.13,80.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - E0191",3,321,18.006666666666664,11.61,52.13,80.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - J0702",3,132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - J0702",3,132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - J1030",3,26.88,24.689999999999998,23.59,26.88,6.72]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - J1250",3,44.41,26.86,17.55,44.41,11.102499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G2023",2,31,40.634999999999998,23.46,212.71,7.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q0111",2,23,6.49,5.86,127.48,5.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G2024",2,33,43.035000000000004,25.46,230.84,8.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - HCPCS - G2023",2,31,51.204999999999998,23.46,212.71,7.75]
["TUFTS - TUFTS PPO - HCPCS - J7307",2,3487,3324.9,3162.8,3487,871.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - HCPCS - G2024",2,33,54.23,25.46,230.84,8.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - J7307",2,3487,3324.9,3162.8,3487,871.75]
["TUFTS - TUFTS PPO - HCPCS - G0402",2,168,209.86,208.89,1179.72,42]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - HCPCS - G2024",2,33,42.215000000000003,25.46,230.84,8.25]
["TUFTS - TUFTS SELECT - HCPCS - J7307",2,3487,3324.9,3162.8,3487,871.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q0114",2,41,4.32,7.2,82.86,10.25]
["TUFTS - TUFTS SELECT - HCPCS - G0402",2,168,104.44499999999999,208.89,1179.72,42]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - HCPCS - G2023",2,31,39.86,23.46,212.71,7.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0103",2,93,10.07,16.78,181.16,23.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - J7307",2,3487,3324.9,3162.8,3487,871.75]
["TUFTS - TUFTS POS - HCPCS - G0402",2,168,196.18,208.89,1179.72,42]
["FALLON - FALLON MEDICAID - HCPCS - G2023",2,31,33.865000000000002,23.46,212.71,7.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - J7307",2,3487,3324.9,3162.8,3487,871.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - J7307",2,3487,3324.9,3162.8,3487,871.75]
["TUFTS - TUFTS HMO - HCPCS - J7307",2,3487,3324.9,3162.8,3487,871.75]
["TUFTS - TUFTS HMO - HCPCS - G0402",2,168,235.41499999999999,208.89,1179.72,42]
["FALLON - FALLON MEDICAID - HCPCS - G2024",2,33,35.865000000000002,25.46,230.84,8.25]
["FALLON - FALLON MEDICAID - HCPCS - Q0111",2,23,5.41,5.86,127.48,5.75]
["FALLON - FALLON MEDICAID - HCPCS - G0103",2,93,8.39,16.78,181.16,23.25]
["FALLON - FALLON MEDICAID - HCPCS - Q0114",2,41,3.6,7.2,82.86,10.25]
["TUFTS - TUFTS POS - HCPCS - J7307",2,3487,3324.9,3162.8,3487,871.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G2023",2,31,33.865000000000002,23.46,212.71,7.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G2024",2,33,78.474999999999994,25.46,230.84,8.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0396",2,42,51.384999999999998,56.05,336.32,10.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q0114",2,41,3.6,7.2,82.86,10.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q0111",2,23,5.41,5.86,127.48,5.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q0111",2,23,6.49,5.86,127.48,5.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q0111",2,23,11.835000000000001,5.86,127.48,5.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q0114",2,41,4.32,7.2,82.86,10.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G2023",2,31,40.634999999999998,23.46,212.71,7.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - J7307",2,3487,3324.9,3162.8,3487,871.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G2024",2,33,35.865000000000002,25.46,230.84,8.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0103",2,93,18.355,16.78,181.16,23.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0397",2,118,110.38499999999999,128.29,815.89,29.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0103",2,93,8.39,16.78,181.16,23.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0506",2,62,87.234999999999999,110.9,110.9,15.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0402",2,168,589.86,208.89,1179.72,42]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q0114",2,41,7.875,7.2,82.86,10.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G2023",2,31,33.865000000000002,23.46,212.71,7.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q0111",2,23,5.41,5.86,127.48,5.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G2024",2,33,35.865000000000002,25.46,230.84,8.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G2024",2,33,43.035000000000004,25.46,230.84,8.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G2023",2,31,74.094999999999999,23.46,212.71,7.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0103",2,93,8.39,16.78,181.16,23.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - J7307",2,3487,3324.9,3162.8,3487,871.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0103",2,93,10.07,16.78,181.16,23.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q0114",2,41,3.6,7.2,82.86,10.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - J7307",2,3487,3324.9,3162.8,3487,871.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - J7307",2,3487,3324.9,3162.8,3487,871.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q0111",2,23,7.34,5.86,127.48,5.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0103",2,93,9.9,16.78,181.16,23.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - J7307",2,3487,3324.9,3162.8,3487,871.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G2023",2,31,39.96,23.46,212.71,7.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G2024",2,33,48.67,25.46,230.84,8.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G2024",2,33,42.32,25.46,230.84,8.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q0114",2,41,4.8849999999999998,7.2,82.86,10.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q0111",2,23,6.3849999999999998,5.86,127.48,5.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - J7307",2,3487,3324.9,3162.8,3487,871.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q0114",2,41,4.25,7.2,82.86,10.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - J7307",2,3487,3324.9,3162.8,3487,871.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0103",2,93,11.385,16.78,181.16,23.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G2023",2,31,45.954999999999998,23.46,212.71,7.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - J7307",2,3487,3324.9,3162.8,3487,871.75]
["UNICARE - UNICARE - HCPCS - Q9954",1,0,12.1,12.1,13.41,0]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0506",1,62,0,110.9,110.9,15.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - G0481",1,192,329.78,91.84,1332.11,48]
["TUFTS - TUFTS PPO - HCPCS - C2616",1,60393,27290.41,25512.2,76706.740000000005,15098.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L8693",1,1462,1782.68,1485.57,6668.25,365.5]
["TUFTS - TUFTS PPO - HCPCS - C2617",1,638,0,null,null,159.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1756",1,1438,0,null,null,359.5]
["TUFTS - TUFTS PPO - HCPCS - C2621",1,21692,0,null,null,5423]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1765",1,569,0,null,null,142.25]
["TUFTS - TUFTS PPO - HCPCS - C2623",1,2837,0,null,null,709.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["TUFTS - TUFTS PPO - HCPCS - C2625",1,246,0,null,null,61.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L4360",1,557,415,345.83,1552.36,139.25]
["TUFTS - TUFTS PPO - HCPCS - C2628",1,2308,0,null,null,577]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A7520",1,1173,0,55.16,138.79,293.25]
["TUFTS - TUFTS PPO - HCPCS - C2630",1,4966,0,null,null,1241.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0278",1,3138,0,34.229999999999997,34.229999999999997,784.5]
["TUFTS - TUFTS PPO - HCPCS - C2634",1,0,248.65,232.45,698.88,0]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9513",1,320,441.49,294.27999999999997,1097.56,80]
["TUFTS - TUFTS PPO - HCPCS - C2635",1,0,86.29,78.03,242.54,0]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0424",1,284,120.69,93.87,343.09,71]
["TUFTS - TUFTS PPO - HCPCS - C2639",1,47,56.54,52.85,100.75,11.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3967",1,117,0,1765.23,7923.54,29.25]
["TUFTS - TUFTS PPO - HCPCS - C5275",1,743,1281.21,684.11,2032.26,185.75]
["TUFTS - TUFTS PPO - HCPCS - C1757",1,15822,0,null,null,3955.5]
["TUFTS - TUFTS PPO - HCPCS - C8908",1,579,1529.76,664.1,4299.8,144.75]
["TUFTS - TUFTS PPO - HCPCS - C1763",1,2242,0,null,null,560.5]
["TUFTS - TUFTS PPO - HCPCS - C8937",1,331,0,null,null,82.75]
["UNICARE - UNICARE - HCPCS - 45378",1,1672,1020.59,1020.59,3264.67,418]
["TUFTS - TUFTS PPO - HCPCS - C9358",1,8526,0,24.42,24.42,2131.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q4102",1,69,10.6,10.210000000000001,25.69,17.25]
["TUFTS - TUFTS PPO - HCPCS - C9728",1,1957,4475.4399999999996,2227.36,7098.97,489.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9575",1,8,0,0.18,0.45,2]
["TUFTS - TUFTS PPO - HCPCS - C9739",1,6035,9609.09,2166.09,15242.01,1508.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1895",1,13382,0,null,null,3345.5]
["TUFTS - TUFTS PPO - HCPCS - C9803",1,35,87.7,87.7,246.49,8.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9057",1,785,472.82,395.89,671.74,196.25]
["TUFTS - TUFTS PPO - HCPCS - D0150",1,265,2563.83,1275.99,4066.77,66.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L8693",1,1462,3100.71,1485.57,6668.25,365.5]
["TUFTS - TUFTS PPO - HCPCS - D0240",1,836,2563.83,1275.99,4066.77,209]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9583",1,13,0,19.260000000000002,21.34,3.25]
["TUFTS - TUFTS PPO - HCPCS - D0250",1,1451,2563.83,1275.99,4066.77,362.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C2621",1,21692,0,null,null,5423]
["TUFTS - TUFTS PPO - HCPCS - D0251",1,119,0,null,null,29.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0410",1,220,0,null,null,55]
["TUFTS - TUFTS PPO - HCPCS - D0270",1,836,2563.83,1275.99,4066.77,209]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L1820",1,159,0,142.59,640.03,39.75]
["TUFTS - TUFTS PPO - HCPCS - D0272",1,836,2563.83,1182.5,4066.77,209]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q0091",1,83,0,28.83,175.66,20.75]
["TUFTS - TUFTS PPO - HCPCS - D0274",1,836,2563.83,1182.5,4066.77,209]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A6550",1,4,30.85,25.71,64.69,1]
["TUFTS - TUFTS PPO - HCPCS - D0277",1,1451,2563.83,1275.99,4066.77,362.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L3808",1,509,451.13,375.94,1687.5,127.25]
["TUFTS - TUFTS PPO - HCPCS - D0472",1,110,3900.57,1941.26,6187.11,27.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["TUFTS - TUFTS PPO - HCPCS - D0473",1,110,3900.57,1941.26,6187.11,27.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L1832",1,1523,892.31,743.59,3337.75,380.75]
["TUFTS - TUFTS PPO - HCPCS - D0474",1,110,3900.57,1941.26,6187.11,27.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q0114",1,41,11.69,7.2,82.86,10.25]
["TUFTS - TUFTS PPO - HCPCS - D0480",1,110,3900.57,1941.26,6187.11,27.5]
["UNICARE - UNICARE - HCPCS - J2790",1,186.95,0,74.3,186.95,46.737499999999997]
["TUFTS - TUFTS PPO - HCPCS - D1110",1,110,102.91,51.21,163.22999999999999,27.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - A9583",1,13,19.260000000000002,19.260000000000002,21.34,3.25]
["TUFTS - TUFTS PPO - HCPCS - D1510",1,836,2563.83,1275.99,4066.77,209]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - 0042T",1,767,0,1452,1452,191.75]
["TUFTS - TUFTS PPO - HCPCS - D1516",1,1350,0,null,null,337.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9541",1,120,0,152.69,152.69,30]
["TUFTS - TUFTS PPO - HCPCS - D1517",1,1451,0,null,null,362.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1716",1,0,200.39,168.52,506.68,0]
["TUFTS - TUFTS PPO - HCPCS - D1575",1,1451,3463.11,1723.54,5493.21,362.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1784",1,2734,0,null,null,683.5]
["TUFTS - TUFTS PPO - HCPCS - D2999",1,1451,2563.83,1275.99,4066.77,362.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C8908",1,579,664.1,664.1,4299.8,144.75]
["TUFTS - TUFTS PPO - HCPCS - D3460",1,1451,2563.83,1275.99,4066.77,362.75]
["TUFTS - TUFTS PPO - HCPCS - C1884",1,31469,0,null,null,7867.25]
["TUFTS - TUFTS PPO - HCPCS - D3999",1,1451,2563.83,1275.99,4066.77,362.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q4132",1,3754,0,114.63,288.43,938.5]
["TUFTS - TUFTS PPO - HCPCS - D4260",1,1451,2563.83,1275.99,4066.77,362.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L3808",1,509,784.67,375.94,1687.5,127.25]
["TUFTS - TUFTS PPO - HCPCS - D4263",1,1451,2563.83,1275.99,4066.77,362.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - 95800",1,205,293.52,228.32,1412.44,51.25]
["TUFTS - TUFTS PPO - HCPCS - D4264",1,1451,2563.83,1275.99,4066.77,362.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9557",1,239,0,1062.44,1062.44,59.75]
["TUFTS - TUFTS PPO - HCPCS - D4270",1,1451,2563.83,1275.99,4066.77,362.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1726",1,387,0,null,null,96.75]
["TUFTS - TUFTS PPO - HCPCS - D4273",1,1451,2563.83,1275.99,4066.77,362.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1876",1,11691,0,null,null,2922.75]
["TUFTS - TUFTS PPO - HCPCS - D4355",1,836,2563.83,1275.99,4066.77,209]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0108",1,425,121.38,72.41,230.78,106.25]
["TUFTS - TUFTS PPO - HCPCS - D4381",1,1451,2563.83,1275.99,4066.77,362.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0296",1,118,0,102.62,660.74,29.5]
["TUFTS - TUFTS PPO - HCPCS - D5911",1,1451,2563.83,1275.99,4066.77,362.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0442",1,42,0,13.34,33.6,10.5]
["TUFTS - TUFTS PPO - HCPCS - D5912",1,1451,2563.83,1275.99,4066.77,362.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G2086",1,194,0,46.18,211.43,48.5]
["TUFTS - TUFTS PPO - HCPCS - D5983",1,1451,2563.83,1275.99,4066.77,362.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3650",1,1955,0,67.38,302.45,488.75]
["TUFTS - TUFTS PPO - HCPCS - D5984",1,1451,2563.83,1275.99,4066.77,362.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L4398",1,406,0,78.92,354.25,101.5]
["TUFTS - TUFTS PPO - HCPCS - D5985",1,1451,2563.83,1275.99,4066.77,362.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q4130",1,65718,0,45.89,45.89,16429.5]
["TUFTS - TUFTS PPO - HCPCS - D5987",1,1451,2563.83,1275.99,4066.77,362.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - U0002",1,92,61.57,51.31,465.19,23]
["TUFTS - TUFTS PPO - HCPCS - D7140",1,836,2563.83,1275.99,4066.77,209]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - G0103",1,93,23.17,16.78,181.16,23.25]
["TUFTS - TUFTS PPO - HCPCS - D7210",1,836,2563.83,1275.99,4066.77,209]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L1836",1,209,156.58000000000001,130.47999999999999,585.70000000000005,52.25]
["TUFTS - TUFTS PPO - HCPCS - D7220",1,836,2563.83,1275.99,4066.77,209]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L4370",1,107,282.95,235.79,1058.3900000000001,26.75]
["TUFTS - TUFTS PPO - HCPCS - D7230",1,836,2563.83,1275.99,4066.77,209]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q4132",1,3754,137.56,114.63,288.43,938.5]
["TUFTS - TUFTS PPO - HCPCS - D7240",1,836,2563.83,1275.99,4066.77,209]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A6258",1,83,6,5,12.58,20.75]
["TUFTS - TUFTS PPO - HCPCS - D7250",1,836,2563.83,1275.99,4066.77,209]
["TUFTS - TUFTS PPO - HCPCS - C1765",1,569,0,null,null,142.25]
["TUFTS - TUFTS PPO - HCPCS - D7260",1,1081,2563.83,1275.99,4066.77,270.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3807",1,483,267.02,222.52,998.85,120.75]
["TUFTS - TUFTS PPO - HCPCS - D7261",1,836,2563.83,1275.99,4066.77,209]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L8514",1,387,110.86,92.38,414.69,96.75]
["TUFTS - TUFTS PPO - HCPCS - D7940",1,1451,2563.83,1275.99,4066.77,362.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q9957",1,417,57.16,47.63,119.85,104.25]
["TUFTS - TUFTS PPO - HCPCS - D9110",1,110,0,null,null,27.5]
["UNICARE - UNICARE - HCPCS - A9583",1,13,19.260000000000002,19.260000000000002,21.34,3.25]
["TUFTS - TUFTS PPO - HCPCS - D9230",1,110,0,null,null,27.5]
["UNICARE - UNICARE - HCPCS - Q4102",1,69,10.6,10.210000000000001,25.69,17.25]
["TUFTS - TUFTS PPO - HCPCS - D9630",1,110,1188.52,591.51,3340.65,27.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - 45378",1,1672,1020.59,1020.59,3264.67,418]
["TUFTS - TUFTS PPO - HCPCS - D9930",1,1451,2563.83,1275.99,4066.77,362.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - J2790",1,186.95,0,74.3,186.95,46.737499999999997]
["TUFTS - TUFTS PPO - HCPCS - D9944",1,51,0,null,null,12.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q9954",1,0,12.1,12.1,13.41,0]
["TUFTS - TUFTS PPO - HCPCS - D9951",1,1350,2563.83,1275.99,4066.77,337.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A4215",1,433,0,null,null,108.25]
["TUFTS - TUFTS PPO - HCPCS - E0191",1,321,18.55,11.61,52.13,80.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9516",1,192,0,516.39,516.39,48]
["TUFTS - TUFTS PPO - HCPCS - G0101",1,148,20.6,18.010000000000002,128.29,37]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9558",1,23,0,108.88,108.88,5.75]
["TUFTS - TUFTS PPO - HCPCS - G0103",1,93,64.45,16.78,181.16,23.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9584",1,2729,0,3235.55,3235.55,682.25]
["TUFTS - TUFTS PPO - HCPCS - G0105",1,1152,2058.16,1020.59,3264.67,288]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1729",1,2283,0,null,null,570.75]
["TUFTS - TUFTS PPO - HCPCS - G0108",1,425,145.49,72.41,230.78,106.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1766",1,2619,0,null,null,654.75]
["TUFTS - TUFTS PPO - HCPCS - G0109",1,267,84.64,32.64,134.25,66.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1880",1,7726,0,null,null,1931.5]
["TUFTS - TUFTS PPO - HCPCS - G0127",1,189,200.07,93.87,317.35000000000002,47.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C2623",1,2837,0,null,null,709.25]
["TUFTS - TUFTS PPO - HCPCS - G0175",1,565,1283.4000000000001,638.73,2035.73,141.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0109",1,267,32.64,32.64,134.25,66.75]
["TUFTS - TUFTS PPO - HCPCS - G0239",1,99,132.85,53.94,373.41,24.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0480",1,254,240.99,59.69,973.54,63.5]
["TUFTS - TUFTS PPO - HCPCS - G0257",1,911,2302.06,1027.32,3651.55,227.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9021",1,323,295.08999999999997,184.28,354.25,80.75]
["TUFTS - TUFTS PPO - HCPCS - G0259",1,1513,0,1198.25,1198.25,378.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q4102",1,69,0,10.210000000000001,25.69,17.25]
["TUFTS - TUFTS PPO - HCPCS - G0260",1,817,2190.21,1005.62,3474.13,204.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["TUFTS - TUFTS PPO - HCPCS - G0269",1,200,0,null,null,50]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L1836",1,209,272.35000000000002,130.47999999999999,585.70000000000005,52.25]
["TUFTS - TUFTS PPO - HCPCS - G0278",1,3138,0,34.229999999999997,34.229999999999997,784.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L4370",1,107,492.15,235.79,1058.3900000000001,26.75]
["TUFTS - TUFTS PPO - HCPCS - G0279",1,55,105.2,30.09,295.68,13.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - U0002",1,92,108.06,51.31,465.19,23]
["TUFTS - TUFTS PPO - HCPCS - G0296",1,118,235.07,102.62,660.74,29.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A6550",1,4,0,25.71,64.69,1]
["TUFTS - TUFTS PPO - HCPCS - G0297",1,1437,285.07,107.22,801.26,359.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9540",1,1831,0,85.66,85.66,457.75]
["TUFTS - TUFTS PPO - HCPCS - G0365",1,498,546.59,272.02999999999997,867.01,124.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9572",1,131,0,16207.01,16207.01,32.75]
["TUFTS - TUFTS PPO - HCPCS - G0378",1,319,0,null,null,79.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1715",1,21,0,null,null,5.25]
["TUFTS - TUFTS PPO - HCPCS - G0379",1,752,1757.21,874.54,2787.3,188]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1753",1,3947,0,null,null,986.75]
["TUFTS - TUFTS PPO - HCPCS - G0390",1,3274,3174.35,1579.83,5035.18,818.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1781",1,36449,0,null,null,9112.25]
["TUFTS - TUFTS PPO - HCPCS - G0396",1,42,119.65,56.05,336.32,10.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1894",1,252,0,null,null,63]
["TUFTS - TUFTS PPO - HCPCS - G0397",1,118,290.27999999999997,128.29,815.89,29.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C5275",1,743,1042.56,684.11,2032.26,185.75]
["TUFTS - TUFTS PPO - HCPCS - A9540",1,1831,0,85.66,85.66,457.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0270",1,86,70.819999999999993,69.08,70.819999999999993,21.5]
["TUFTS - TUFTS PPO - HCPCS - G0410",1,220,0,null,null,55]
["TUFTS - TUFTS PPO - HCPCS - C1898",1,1575,0,null,null,393.75]
["TUFTS - TUFTS PPO - HCPCS - G0416",1,425,874.13,360.63,2456.98,106.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0390",1,3274,0,1579.83,5035.18,818.5]
["TUFTS - TUFTS PPO - HCPCS - G0420",1,156,371.53,184.9,589.33000000000004,39]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0422",1,169,0,198.42,637.79,42.25]
["TUFTS - TUFTS PPO - HCPCS - G0421",1,37,85.83,42.72,136.13999999999999,9.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0446",1,42,0,8.9,16.149999999999999,10.5]
["TUFTS - TUFTS PPO - HCPCS - G0422",1,169,402.08,198.42,637.79,42.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G2012",1,42,0,31.78,31.78,10.5]
["TUFTS - TUFTS PPO - HCPCS - G0423",1,169,402.08,198.42,637.79,42.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G2216",1,118,0,null,null,29.5]
["TUFTS - TUFTS PPO - HCPCS - G0424",1,284,216.3,93.87,343.09,71]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L1902",1,219,0,86.14,386.65,54.75]
["TUFTS - TUFTS PPO - HCPCS - G0438",1,547,38.93,34.03,61.76,136.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3807",1,483,0,222.52,998.85,120.75]
["TUFTS - TUFTS PPO - HCPCS - G0439",1,327,38.93,34.03,61.76,81.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L4360",1,557,0,345.83,1552.36,139.25]
["TUFTS - TUFTS PPO - HCPCS - G0442",1,42,21.18,13.34,33.6,10.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L8514",1,387,0,92.38,414.69,96.75]
["TUFTS - TUFTS PPO - HCPCS - G0443",1,118,21.18,18.52,33.6,29.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q3014",1,67,0,26.65,67.06,16.75]
["TUFTS - TUFTS PPO - HCPCS - G0444",1,42,10.18,8.9,16.149999999999999,10.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q9957",1,417,0,47.63,119.85,104.25]
["TUFTS - TUFTS PPO - HCPCS - G0445",1,118,10.18,8.9,16.149999999999999,29.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - S5101",1,63,0,null,null,15.75]
["TUFTS - TUFTS PPO - HCPCS - G0446",1,42,10.18,8.9,16.149999999999999,10.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A4561",1,108,27.82,23.18,58.33,27]
["TUFTS - TUFTS PPO - HCPCS - G0447",1,118,21.18,18.52,33.6,29.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A9577",1,21,2.17,1.81,5.03,5.25]
["TUFTS - TUFTS PPO - HCPCS - G0480",1,254,346.36,59.69,973.54,63.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - G2023",1,31,28.15,23.46,212.71,7.75]
["TUFTS - TUFTS PPO - HCPCS - G0481",1,192,473.93,91.84,1332.11,48]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L0140",1,189,93.02,77.52,347.97,47.25]
["TUFTS - TUFTS PPO - HCPCS - G0506",1,62,0,110.9,110.9,15.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L3670",1,2903,124.38,103.65,465.27,725.75]
["TUFTS - TUFTS PPO - HCPCS - G0513",1,84,0,148.6,148.6,21]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L3980",1,132,453.41,377.84,1695.98,33]
["TUFTS - TUFTS PPO - HCPCS - G0514",1,84,0,148.6,148.6,21]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L8501",1,219,192.89,160.74,721.54,54.75]
["TUFTS - TUFTS PPO - HCPCS - G2011",1,35,84.4,28.83,133.88,8.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q0111",1,23,18.14,5.86,127.48,5.75]
["TUFTS - TUFTS PPO - HCPCS - G2012",1,42,0,31.78,31.78,10.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q9957",1,417,57.16,47.63,119.85,104.25]
["TUFTS - TUFTS PPO - HCPCS - G2023",1,31,75.680000000000007,23.46,212.71,7.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - 81170",1,798,360,159,2909.77,199.5]
["TUFTS - TUFTS PPO - HCPCS - G2024",1,33,82.13,25.46,230.84,8.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A9576",1,5,1.8,1.5,3.77,1.25]
["TUFTS - TUFTS PPO - HCPCS - G2066",1,165,131.81,58.35,370.47,41.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - G0481",1,192,187.91,91.84,1332.11,48]
["TUFTS - TUFTS PPO - HCPCS - G2086",1,194,46.18,46.18,211.43,48.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L0120",1,25,29.83,24.86,111.59,6.25]
["TUFTS - TUFTS PPO - HCPCS - G2087",1,194,46.18,46.18,211.43,48.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3650",1,1955,80.86,67.38,302.45,488.75]
["TUFTS - TUFTS PPO - HCPCS - A9541",1,120,0,152.69,152.69,30]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3967",1,117,2118.2800000000002,1765.23,7923.54,29.25]
["TUFTS - TUFTS PPO - HCPCS - A9543",1,66322,77447.320000000007,72400.97,217685.7,16580.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L4398",1,406,94.7,78.92,354.25,101.5]
["TUFTS - TUFTS PPO - HCPCS - A9547",1,440,0,5105.7299999999996,5105.7299999999996,110]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - P9045",1,238,62.94,52.45,131.97,59.5]
["TUFTS - TUFTS PPO - HCPCS - J2790",1,186.95,0,74.3,186.95,46.737499999999997]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q4132",1,3754,137.56,114.63,288.43,938.5]
["TUFTS - TUFTS PPO - HCPCS - A9551",1,154,0,1711.56,1711.56,38.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["TUFTS - TUFTS PPO - HCPCS - A9552",1,972,0,1166.46,1166.46,243]
["UNICARE - UNICARE - HCPCS - A9576",1,5,1.56,1.5,3.77,1.25]
["TUFTS - TUFTS PPO - HCPCS - A9555",1,1065,0,1604.08,1604.08,266.25]
["UNICARE - UNICARE - HCPCS - G0481",1,192,284.38,91.84,1332.11,48]
["TUFTS - TUFTS PPO - HCPCS - L0120",1,25,39.700000000000003,24.86,111.59,6.25]
["UNICARE - UNICARE - HCPCS - P9612",1,90,5.21,2.2200000000000002,1198.25,22.5]
["TUFTS - TUFTS PPO - HCPCS - L0140",1,189,123.8,77.52,347.97,47.25]
["UNICARE - UNICARE - HCPCS - Q4116",1,5248,32.29,32.29,35.78,1312]
["TUFTS - TUFTS PPO - HCPCS - L1820",1,159,227.71,142.59,640.03,39.75]
["UNICARE - UNICARE - HCPCS - Q9961",1,1,0.25,0.25,0.63,0.25]
["TUFTS - TUFTS PPO - HCPCS - L1830",1,78,130.88,81.95,367.86,19.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - A9576",1,5,1.56,1.5,3.77,1.25]
["TUFTS - TUFTS PPO - HCPCS - L1832",1,1523,1187.49,743.59,3337.75,380.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - G0481",1,192,236.98,91.84,1332.11,48]
["TUFTS - TUFTS PPO - HCPCS - L1836",1,209,208.38,130.47999999999999,585.70000000000005,52.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - P9612",1,90,4.34,2.2200000000000002,1198.25,22.5]
["TUFTS - TUFTS PPO - HCPCS - L1902",1,219,137.56,86.14,386.65,54.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q4116",1,5248,32.29,32.29,35.78,1312]
["TUFTS - TUFTS PPO - HCPCS - L3260",1,279,127.35,31.12,357.96,69.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q9961",1,1,0.25,0.25,0.63,0.25]
["TUFTS - TUFTS PPO - HCPCS - L3350",1,41,35.79,22.41,100.59,10.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - 81170",1,798,631.79999999999995,159,2909.77,199.5]
["TUFTS - TUFTS PPO - HCPCS - L3650",1,1955,107.6,67.38,302.45,488.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A4725",1,87,0,null,null,21.75]
["TUFTS - TUFTS PPO - HCPCS - L3670",1,2903,165.53,103.65,465.27,725.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9505",1,23,0,395.74,395.74,5.75]
["TUFTS - TUFTS PPO - HCPCS - L3760",1,819,710.69,445.02,1997.57,204.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9537",1,138,0,157.94999999999999,157.94999999999999,34.5]
["TUFTS - TUFTS PPO - HCPCS - L3762",1,57,152.80000000000001,95.68,429.49,14.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9552",1,972,0,1166.46,1166.46,243]
["TUFTS - TUFTS PPO - HCPCS - L3807",1,483,355.37,222.52,998.85,120.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9563",1,0,535.17999999999995,535.17999999999995,3182.68,0]
["TUFTS - TUFTS PPO - HCPCS - L3808",1,509,600.37,375.94,1687.5,127.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9580",1,158,0,null,null,39.5]
["TUFTS - TUFTS PPO - HCPCS - L3905",1,2442,1409.34,882.51,3961.32,610.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9606",1,493,247.36,198.62,597.20000000000005,123.25]
["TUFTS - TUFTS PPO - HCPCS - L3908",1,143,116.93,73.22,328.66,35.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1722",1,43645,0,null,null,10911.25]
["TUFTS - TUFTS PPO - HCPCS - L3967",1,117,2819,1765.23,7923.54,29.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1733",1,10475,0,null,null,2618.75]
["TUFTS - TUFTS PPO - HCPCS - L3980",1,132,603.39,377.84,1695.98,33]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1762",1,12010,0,null,null,3002.5]
["TUFTS - TUFTS PPO - HCPCS - L3982",1,176,635.97,398.23,1787.56,44]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1773",1,2163,0,null,null,540.75]
["TUFTS - TUFTS PPO - HCPCS - L4350",1,360,155.35,97.28,436.66,90]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1817",1,9668,0,null,null,2417]
["TUFTS - TUFTS PPO - HCPCS - L4360",1,557,552.29,345.83,1552.36,139.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1887",1,3731,0,null,null,932.75]
["TUFTS - TUFTS PPO - HCPCS - L4370",1,107,376.55,235.79,1058.3900000000001,26.75]
["TUFTS - TUFTS PPO - HCPCS - C1880",1,7726,0,null,null,1931.5]
["TUFTS - TUFTS PPO - HCPCS - L4386",1,165,247.56,155.02000000000001,695.83,41.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C2634",1,0,313.02999999999997,232.45,698.88,0]
["TUFTS - TUFTS PPO - HCPCS - L4396",1,406,273.75,171.42,769.43,101.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C9739",1,6035,7620.54,2166.09,15242.01,1508.75]
["TUFTS - TUFTS PPO - HCPCS - L4398",1,406,126.03,78.92,354.25,101.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0259",1,1513,0,1198.25,1198.25,378.25]
["TUFTS - TUFTS PPO - HCPCS - L8501",1,219,256.70999999999998,160.74,721.54,54.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0416",1,425,577.51,360.63,2456.98,106.25]
["TUFTS - TUFTS PPO - HCPCS - L8507",1,1604,65.510000000000005,41.03,184.14,401]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0514",1,84,0,148.6,148.6,21]
["TUFTS - TUFTS PPO - HCPCS - L8509",1,1144,170.87,106.99,480.27,286]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - L8699",1,13957,0,null,null,3489.25]
["TUFTS - TUFTS PPO - HCPCS - L8514",1,387,147.54,92.38,414.69,96.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9044",1,133,186.87,144.19999999999999,244.67,33.25]
["TUFTS - TUFTS PPO - HCPCS - L8693",1,1462,2372.4,1485.57,6668.25,365.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q0091",1,83,36.159999999999997,28.83,175.66,20.75]
["TUFTS - TUFTS PPO - HCPCS - L8699",1,13957,0,null,null,3489.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q4116",1,5248,0,32.29,35.78,1312]
["TUFTS - TUFTS PPO - HCPCS - P9012",1,134,79.010000000000005,64.959999999999994,125.33,33.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q9956",1,76,0,31.75,79.89,19]
["TUFTS - TUFTS PPO - HCPCS - P9016",1,576,301.76,243.01,478.65,144]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - 81170",1,798,631.79999999999995,159,2909.77,199.5]
["TUFTS - TUFTS PPO - HCPCS - P9017",1,291,137.26,94.07,217.72,72.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L0140",1,189,161.80000000000001,77.52,347.97,47.25]
["TUFTS - TUFTS PPO - HCPCS - P9021",1,323,223.33,184.28,354.25,80.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L3670",1,2903,216.35,103.65,465.27,725.75]
["TUFTS - TUFTS PPO - HCPCS - P9034",1,506,504.18,443.29,799.73,126.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L3980",1,132,788.63,377.84,1695.98,33]
["TUFTS - TUFTS PPO - HCPCS - P9037",1,939,1022.99,821.84,1622.67,234.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L8501",1,219,335.51,160.74,721.54,54.75]
["TUFTS - TUFTS PPO - HCPCS - P9040",1,523,422.37,336.11,669.97,130.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - Q0111",1,23,31.84,5.86,127.48,5.75]
["TUFTS - TUFTS PPO - HCPCS - P9044",1,133,154.25,144.19999999999999,244.67,33.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - 45378",1,1672,1608.22,1020.59,3264.67,418]
["TUFTS - TUFTS PPO - HCPCS - P9045",1,238,81.36,52.45,131.97,59.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A4648",1,281,0,null,null,70.25]
["TUFTS - TUFTS PPO - HCPCS - A9556",1,20,0,311.94,311.94,5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9503",1,23,0,37.119999999999997,37.119999999999997,5.75]
["TUFTS - TUFTS PPO - HCPCS - P9056",1,1619,333.7,311.95,529.32000000000005,404.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9521",1,360,0,4157.3,4157.3,90]
["TUFTS - TUFTS PPO - HCPCS - P9057",1,785,423.49,395.89,671.74,196.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9551",1,154,0,1711.56,1711.56,38.5]
["TUFTS - TUFTS PPO - HCPCS - P9073",1,889,931.99,821.84,2619.59,222.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9562",1,1237,0,2212.25,2212.25,309.25]
["TUFTS - TUFTS PPO - HCPCS - P9100",1,1310,91.31,33.53,256.64,327.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9579",1,5,0,1.53,4.38,1.25]
["TUFTS - TUFTS PPO - HCPCS - P9612",1,90,9.09,2.2200000000000002,1198.25,22.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9588",1,15438,703.05,525.05999999999995,703.05,3859.5]
["TUFTS - TUFTS PPO - HCPCS - Q0091",1,83,62.49,28.83,175.66,20.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1721",1,39674,0,null,null,9918.5]
["TUFTS - TUFTS PPO - HCPCS - Q0111",1,23,45.36,5.86,127.48,5.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1732",1,7766,0,null,null,1941.5]
["TUFTS - TUFTS PPO - HCPCS - Q0114",1,41,29.48,7.2,82.86,10.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1760",1,1799,0,null,null,449.75]
["TUFTS - TUFTS PPO - HCPCS - Q3014",1,67,38.6,26.65,67.06,16.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1770",1,3667,0,null,null,916.75]
["TUFTS - TUFTS PPO - HCPCS - Q4100",1,12079,0,null,null,3019.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1788",1,540,0,null,null,135]
["TUFTS - TUFTS PPO - HCPCS - Q4101",1,1601,0,30.46,76.64,400.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1884",1,31469,0,null,null,7867.25]
["TUFTS - TUFTS PPO - HCPCS - Q4102",1,69,0,10.210000000000001,25.69,17.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1900",1,8293,0,null,null,2073.25]
["TUFTS - TUFTS PPO - HCPCS - Q4104",1,7748,0,42.08,56.11,1937]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C2630",1,4966,0,null,null,1241.5]
["TUFTS - TUFTS PPO - HCPCS - Q4107",1,2233,0,86.55,110.48,558.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C9728",1,1957,2573.36,2227.36,7098.97,489.25]
["TUFTS - TUFTS PPO - HCPCS - Q4112",1,535,0,904.99,1002.89,133.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0257",1,911,1320.72,1027.32,3651.55,227.75]
["TUFTS - TUFTS PPO - HCPCS - Q4116",1,5248,0,32.29,35.78,1312]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0390",1,3274,0,1579.83,5035.18,818.5]
["TUFTS - TUFTS PPO - HCPCS - Q4124",1,23,0,16.39,16.39,5.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0513",1,84,0,148.6,148.6,21]
["TUFTS - TUFTS PPO - HCPCS - Q4125",1,4060,0,3.79,3.79,1015]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0269",1,200,0,null,null,50]
["TUFTS - TUFTS PPO - HCPCS - Q4130",1,65718,0,45.89,45.89,16429.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0365",1,498,0,272.02999999999997,867.01,124.5]
["TUFTS - TUFTS PPO - HCPCS - Q4132",1,3754,0,114.63,288.43,938.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0397",1,118,0,128.29,815.89,29.5]
["TUFTS - TUFTS PPO - HCPCS - Q4133",1,3756,0,131.97,332.06,939]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0420",1,156,0,184.9,589.33000000000004,39]
["TUFTS - TUFTS PPO - HCPCS - Q4196",1,9044,162.6,111.59,280.77999999999997,2261]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0438",1,547,0,34.03,61.76,136.75]
["TUFTS - TUFTS PPO - HCPCS - Q9954",1,0,0,12.1,13.41,0]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0444",1,42,0,8.9,16.149999999999999,10.5]
["TUFTS - TUFTS PPO - HCPCS - Q9956",1,76,0,31.75,79.89,19]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0480",1,254,71.63,59.69,973.54,63.5]
["TUFTS - TUFTS PPO - HCPCS - Q9957",1,417,0,47.63,119.85,104.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0514",1,84,0,148.6,148.6,21]
["TUFTS - TUFTS PPO - HCPCS - Q9958",1,1,0,7.0000000000000007E-2,0.18,0.25]
["TUFTS - TUFTS PPO - HCPCS - C1730",1,2283,0,null,null,570.75]
["TUFTS - TUFTS PPO - HCPCS - Q9961",1,1,0,0.25,0.63,0.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G2088",1,45,0,82.11,82.11,11.25]
["TUFTS - TUFTS PPO - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L0120",1,25,0,24.86,111.59,6.25]
["TUFTS - TUFTS PPO - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L1832",1,1523,0,743.59,3337.75,380.75]
["TUFTS - TUFTS PPO - HCPCS - A9557",1,239,0,1062.44,1062.44,59.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3350",1,41,0,22.41,100.59,10.25]
["TUFTS - TUFTS PPO - HCPCS - S2083",1,211,595.01,317.70999999999998,1198.25,52.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3760",1,819,0,445.02,1997.57,204.75]
["TUFTS - TUFTS PPO - HCPCS - S8037",1,1440,1341.84,585.76,3771.6,360]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3905",1,2442,0,882.51,3961.32,610.5]
["TUFTS - TUFTS PPO - HCPCS - U0001",1,124,115.86,35.909999999999997,325.64,31]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3982",1,176,0,398.23,1787.56,44]
["TUFTS - TUFTS PPO - HCPCS - U0002",1,92,165.5,51.31,465.19,23]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L4386",1,165,0,155.02000000000001,695.83,41.25]
["TUFTS - TUFTS PPO - HCPCS - V2785",1,7848,9609.09,5130.87,15242.01,1962]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L8507",1,1604,0,41.03,184.14,401]
["TUFTS - TUFTS PPO - HCPCS - V2790",1,1136,0,null,null,284]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L8699",1,13957,0,null,null,3489.25]
["TUFTS - TUFTS SELECT - HCPCS - 0042T",1,767,0,1452,1452,191.75]
["TUFTS - TUFTS PPO - HCPCS - C1733",1,10475,0,null,null,2618.75]
["TUFTS - TUFTS SELECT - HCPCS - 0278T",1,77,317.70999999999998,286.31,943.8,19.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q4124",1,23,0,16.39,16.39,5.75]
["TUFTS - TUFTS SELECT - HCPCS - 0399T",1,1022,0,null,null,255.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q9954",1,0,0,12.1,13.41,0]
["TUFTS - TUFTS SELECT - HCPCS - 0402T",1,2880,3987.49,1198.25,11845.41,720]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q9961",1,1,0,0.25,0.63,0.25]
["TUFTS - TUFTS SELECT - HCPCS - 45378",1,1672,1098.98,1020.59,3264.67,418]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q9987",1,1218,0,null,null,304.5]
["TUFTS - TUFTS SELECT - HCPCS - 81170",1,798,451.91,159,2909.77,199.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - S8037",1,1440,0,585.76,3771.6,360]
["TUFTS - TUFTS SELECT - HCPCS - 90471",1,64,108.45,76.22,345.64,16]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - V2790",1,1136,0,null,null,284]
["TUFTS - TUFTS SELECT - HCPCS - 92083",1,461,190.72,68.75,607.84,115.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A6209",1,163,10.42,8.68,21.84,40.75]
["TUFTS - TUFTS SELECT - HCPCS - 95800",1,205,250.1,228.32,1412.44,51.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A9575",1,8,0.22,0.18,0.45,2]
["TUFTS - TUFTS SELECT - HCPCS - A4215",1,433,0,null,null,108.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A9581",1,99,17.71,14.76,37.14,24.75]
["TUFTS - TUFTS SELECT - HCPCS - A4561",1,108,0,23.18,58.33,27]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - G0480",1,254,137.32,59.69,973.54,63.5]
["TUFTS - TUFTS SELECT - HCPCS - A4562",1,64,0,57.71,145.21,16]
["TUFTS - TUFTS PPO - HCPCS - C1753",1,3947,0,null,null,986.75]
["TUFTS - TUFTS SELECT - HCPCS - A4570",1,40,19.010000000000002,19.010000000000002,107.35,10]
["TUFTS - TUFTS PPO - HCPCS - C1759",1,6295,0,null,null,1573.75]
["TUFTS - TUFTS SELECT - HCPCS - A4648",1,281,0,null,null,70.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L1830",1,78,98.34,81.95,367.86,19.5]
["TUFTS - TUFTS SELECT - HCPCS - A4725",1,87,0,null,null,21.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L3350",1,41,26.89,22.41,100.59,10.25]
["TUFTS - TUFTS SELECT - HCPCS - A6209",1,163,0,8.68,21.84,40.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L3762",1,57,114.82,95.68,429.49,14.25]
["TUFTS - TUFTS SELECT - HCPCS - A6258",1,83,0,5,12.58,20.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L3908",1,143,87.86,73.22,328.66,35.75]
["TUFTS - TUFTS SELECT - HCPCS - A6549",1,37,0,null,null,9.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L4350",1,360,116.74,97.28,436.66,90]
["TUFTS - TUFTS SELECT - HCPCS - A6550",1,4,0,25.71,64.69,1]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L4396",1,406,205.7,171.42,769.43,101.5]
["TUFTS - TUFTS SELECT - HCPCS - A7520",1,1173,0,55.16,138.79,293.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L8509",1,1144,128.38999999999999,106.99,480.27,286]
["TUFTS - TUFTS SELECT - HCPCS - A9500",1,274,0,463.42,463.42,68.5]
["TUFTS - TUFTS PPO - HCPCS - C1760",1,1799,0,null,null,449.75]
["TUFTS - TUFTS SELECT - HCPCS - A9502",1,140,0,278.27,278.27,35]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q4101",1,1601,36.549999999999997,30.46,76.64,400.25]
["TUFTS - TUFTS SELECT - HCPCS - A9503",1,23,0,37.119999999999997,37.119999999999997,5.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q4196",1,9044,133.91,111.59,280.77999999999997,2261]
["TUFTS - TUFTS SELECT - HCPCS - A9505",1,23,0,395.74,395.74,5.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q9961",1,1,0.3,0.25,0.63,0.25]
["TUFTS - TUFTS SELECT - HCPCS - A9509",1,95,0,5163.91,5163.91,23.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - U0001",1,124,43.09,35.909999999999997,325.64,31]
["TUFTS - TUFTS SELECT - HCPCS - A9512",1,1,0,null,null,0.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A4562",1,64,69.25,57.71,145.21,16]
["TUFTS - TUFTS SELECT - HCPCS - A9513",1,320,365.04,294.27999999999997,1097.56,80]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A7520",1,1173,66.19,55.16,138.79,293.25]
["TUFTS - TUFTS SELECT - HCPCS - A9516",1,192,0,516.39,516.39,48]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A9579",1,5,1.84,1.53,4.38,1.25]
["TUFTS - TUFTS SELECT - HCPCS - A9517",1,437,30.1,30.1,101.94,109.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - G0279",1,55,36.11,30.09,295.68,13.75]
["TUFTS - TUFTS SELECT - HCPCS - A9520",1,1951,0,null,null,487.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - G2024",1,33,30.55,25.46,230.84,8.25]
["TUFTS - TUFTS SELECT - HCPCS - A9521",1,360,0,4157.3,4157.3,90]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - J2790",1,186.95,0,74.3,186.95,46.737499999999997]
["TUFTS - TUFTS SELECT - HCPCS - A9537",1,138,0,157.94999999999999,157.94999999999999,34.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L1820",1,159,171.11,142.59,640.03,39.75]
["TUFTS - TUFTS SELECT - HCPCS - A9538",1,111,0,114.21,114.21,27.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L1902",1,219,103.37,86.14,386.65,54.75]
["TUFTS - TUFTS SELECT - HCPCS - A9539",1,668,0,89.47,89.47,167]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3760",1,819,534.02,445.02,1997.57,204.75]
["TUFTS - TUFTS SELECT - HCPCS - A9540",1,1831,0,85.66,85.66,457.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3905",1,2442,1059.01,882.51,3961.32,610.5]
["TUFTS - TUFTS SELECT - HCPCS - A9541",1,120,0,152.69,152.69,30]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3982",1,176,477.88,398.23,1787.56,44]
["TUFTS - TUFTS SELECT - HCPCS - A9543",1,66322,72400.97,72400.97,217685.7,16580.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L4386",1,165,186.02,155.02000000000001,695.83,41.25]
["TUFTS - TUFTS SELECT - HCPCS - A9547",1,440,0,5105.7299999999996,5105.7299999999996,110]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L8507",1,1604,49.24,41.03,184.14,401]
["TUFTS - TUFTS SELECT - HCPCS - A9551",1,154,0,1711.56,1711.56,38.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - M0239",1,393,371.52,309.60000000000002,779.02,98.25]
["TUFTS - TUFTS SELECT - HCPCS - A9552",1,972,0,1166.46,1166.46,243]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - P9612",1,90,3.6,2.2200000000000002,1198.25,22.5]
["TUFTS - TUFTS SELECT - HCPCS - A9555",1,1065,0,1604.08,1604.08,266.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q4101",1,1601,36.549999999999997,30.46,76.64,400.25]
["TUFTS - TUFTS SELECT - HCPCS - A9556",1,20,0,311.94,311.94,5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q4196",1,9044,133.91,111.59,280.77999999999997,2261]
["TUFTS - TUFTS SELECT - HCPCS - A9557",1,239,0,1062.44,1062.44,59.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q9961",1,1,0.3,0.25,0.63,0.25]
["TUFTS - TUFTS SELECT - HCPCS - A9558",1,23,0,108.88,108.88,5.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - U0001",1,124,43.09,35.909999999999997,325.64,31]
["TUFTS - TUFTS SELECT - HCPCS - A9560",1,246,0,266.7,266.7,61.5]
["UNICARE - UNICARE - HCPCS - 95800",1,205,351.84,228.32,1412.44,51.25]
["TUFTS - TUFTS SELECT - HCPCS - A9561",1,127,0,125.64,125.64,31.75]
["UNICARE - UNICARE - HCPCS - A9579",1,5,1.58,1.53,4.38,1.25]
["TUFTS - TUFTS SELECT - HCPCS - A9562",1,1237,0,2212.25,2212.25,309.25]
["UNICARE - UNICARE - HCPCS - G0105",1,1152,1020.59,1020.59,3264.67,288]
["TUFTS - TUFTS SELECT - HCPCS - A9563",1,0,1058.54,535.17999999999995,3182.68,0]
["TUFTS - TUFTS PPO - HCPCS - C1776",1,21721,0,null,null,5430.25]
["TUFTS - TUFTS SELECT - HCPCS - A9569",1,5086,0,4157.3,4157.3,1271.5]
["UNICARE - UNICARE - HCPCS - P9045",1,238,54.43,52.45,131.97,59.5]
["TUFTS - TUFTS SELECT - HCPCS - A9570",1,6395,0,null,null,1598.75]
["UNICARE - UNICARE - HCPCS - Q0114",1,41,17.36,7.2,82.86,10.25]
["TUFTS - TUFTS SELECT - HCPCS - A9572",1,131,0,16207.01,16207.01,32.75]
["UNICARE - UNICARE - HCPCS - Q4107",1,2233,86.55,86.55,110.48,558.25]
["TUFTS - TUFTS SELECT - HCPCS - A9575",1,8,0,0.18,0.45,2]
["UNICARE - UNICARE - HCPCS - Q4133",1,3756,136.94999999999999,131.97,332.06,939]
["TUFTS - TUFTS SELECT - HCPCS - A9576",1,5,0,1.5,3.77,1.25]
["UNICARE - UNICARE - HCPCS - Q9957",1,417,49.42,47.63,119.85,104.25]
["TUFTS - TUFTS SELECT - HCPCS - A9577",1,21,0,1.81,5.03,5.25]
["UNICARE - UNICARE - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["TUFTS - TUFTS SELECT - HCPCS - A9579",1,5,0,1.53,4.38,1.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - 95800",1,205,293.2,228.32,1412.44,51.25]
["TUFTS - TUFTS SELECT - HCPCS - A9580",1,158,0,null,null,39.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - A9579",1,5,1.58,1.53,4.38,1.25]
["TUFTS - TUFTS SELECT - HCPCS - A9581",1,99,0,14.76,37.14,24.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - G0105",1,1152,1020.59,1020.59,3264.67,288]
["TUFTS - TUFTS SELECT - HCPCS - A9582",1,10370,0,null,null,2592.5]
["TUFTS - TUFTS PPO - HCPCS - C1788",1,540,0,null,null,135]
["TUFTS - TUFTS SELECT - HCPCS - A9583",1,13,0,19.260000000000002,21.34,3.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - P9045",1,238,54.43,52.45,131.97,59.5]
["TUFTS - TUFTS SELECT - HCPCS - A9584",1,2729,0,3235.55,3235.55,682.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q0114",1,41,14.47,7.2,82.86,10.25]
["TUFTS - TUFTS SELECT - HCPCS - A9586",1,4402,4392.1499999999996,3746.06,7452.46,1100.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q4107",1,2233,86.55,86.55,110.48,558.25]
["TUFTS - TUFTS SELECT - HCPCS - A9587",1,12985,0,84.97,113.78,3246.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q4133",1,3756,136.94999999999999,131.97,332.06,939]
["TUFTS - TUFTS SELECT - HCPCS - A9588",1,15438,0,525.05999999999995,703.05,3859.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q9957",1,417,49.42,47.63,119.85,104.25]
["TUFTS - TUFTS SELECT - HCPCS - A9606",1,493,198.62,198.62,597.20000000000005,123.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["TUFTS - TUFTS SELECT - HCPCS - C1713",1,4568,0,null,null,1142]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - 0402T",1,2880,3435.75,1198.25,11845.41,720]
["TUFTS - TUFTS SELECT - HCPCS - C1714",1,6114,0,null,null,1528.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - 92083",1,461,224.25,68.75,607.84,115.25]
["TUFTS - TUFTS SELECT - HCPCS - C1715",1,21,0,null,null,5.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A4562",1,64,0,57.71,145.21,16]
["TUFTS - TUFTS SELECT - HCPCS - C1716",1,0,168.52,168.52,506.68,0]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A6258",1,83,0,5,12.58,20.75]
["TUFTS - TUFTS SELECT - HCPCS - C1717",1,607,469.29,469.29,1411.01,151.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9502",1,140,0,278.27,278.27,35]
["TUFTS - TUFTS SELECT - HCPCS - C1719",1,95,118.86,108.35,357.35,23.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9512",1,1,0,null,null,0.25]
["TUFTS - TUFTS SELECT - HCPCS - C1721",1,39674,0,null,null,9918.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9520",1,1951,0,null,null,487.75]
["TUFTS - TUFTS SELECT - HCPCS - C1722",1,43645,0,null,null,10911.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9539",1,668,0,89.47,89.47,167]
["TUFTS - TUFTS SELECT - HCPCS - C1724",1,7410,0,null,null,1852.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9547",1,440,0,5105.7299999999996,5105.7299999999996,110]
["TUFTS - TUFTS SELECT - HCPCS - C1725",1,1693,0,null,null,423.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9556",1,20,0,311.94,311.94,5]
["TUFTS - TUFTS SELECT - HCPCS - C1726",1,387,0,null,null,96.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9561",1,127,0,125.64,125.64,31.75]
["TUFTS - TUFTS SELECT - HCPCS - C1729",1,2283,0,null,null,570.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9570",1,6395,0,null,null,1598.75]
["TUFTS - TUFTS SELECT - HCPCS - C1730",1,2283,0,null,null,570.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9577",1,21,0,1.81,5.03,5.25]
["TUFTS - TUFTS SELECT - HCPCS - C1731",1,3847,0,null,null,961.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9582",1,10370,0,null,null,2592.5]
["TUFTS - TUFTS SELECT - HCPCS - C1732",1,7766,0,null,null,1941.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9587",1,12985,113.78,84.97,113.78,3246.25]
["TUFTS - TUFTS SELECT - HCPCS - C1733",1,10475,0,null,null,2618.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1714",1,6114,0,null,null,1528.5]
["TUFTS - TUFTS SELECT - HCPCS - C1750",1,1693,0,null,null,423.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1719",1,95,108.35,108.35,357.35,23.75]
["TUFTS - TUFTS SELECT - HCPCS - C1751",1,1438,0,null,null,359.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1725",1,1693,0,null,null,423.25]
["TUFTS - TUFTS SELECT - HCPCS - C1753",1,3947,0,null,null,986.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1731",1,3847,0,null,null,961.75]
["TUFTS - TUFTS SELECT - HCPCS - C1756",1,1438,0,null,null,359.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1751",1,1438,0,null,null,359.5]
["TUFTS - TUFTS SELECT - HCPCS - C1757",1,15822,0,null,null,3955.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1759",1,6295,0,null,null,1573.75]
["TUFTS - TUFTS SELECT - HCPCS - C1759",1,6295,0,null,null,1573.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1764",1,8983,0,null,null,2245.75]
["TUFTS - TUFTS SELECT - HCPCS - C1760",1,1799,0,null,null,449.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1769",1,4759,0,null,null,1189.75]
["TUFTS - TUFTS SELECT - HCPCS - C1762",1,12010,0,null,null,3002.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1777",1,13038,0,null,null,3259.5]
["TUFTS - TUFTS SELECT - HCPCS - C1763",1,2242,0,null,null,560.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1786",1,23460,0,null,null,5865]
["TUFTS - TUFTS SELECT - HCPCS - C1764",1,8983,0,null,null,2245.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1874",1,8879,0,null,null,2219.75]
["TUFTS - TUFTS SELECT - HCPCS - C1765",1,569,0,null,null,142.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1883",1,1257,0,null,null,314.25]
["TUFTS - TUFTS SELECT - HCPCS - C1766",1,2619,0,null,null,654.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1893",1,406,0,null,null,101.5]
["TUFTS - TUFTS SELECT - HCPCS - C1768",1,76125,0,null,null,19031.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1898",1,1575,0,null,null,393.75]
["TUFTS - TUFTS SELECT - HCPCS - C1769",1,4759,0,null,null,1189.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C2617",1,638,0,null,null,159.5]
["TUFTS - TUFTS SELECT - HCPCS - C1770",1,3667,0,null,null,916.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C2628",1,2308,0,null,null,577]
["TUFTS - TUFTS SELECT - HCPCS - C1773",1,2163,0,null,null,540.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C2639",1,47,61.32,52.85,100.75,11.75]
["TUFTS - TUFTS SELECT - HCPCS - C1776",1,21721,0,null,null,5430.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C9358",1,8526,0,24.42,24.42,2131.5]
["TUFTS - TUFTS SELECT - HCPCS - C1777",1,13038,0,null,null,3259.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0105",1,1152,1568.74,1020.59,3264.67,288]
["TUFTS - TUFTS SELECT - HCPCS - C1781",1,36449,0,null,null,9112.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0239",1,99,67.64,53.94,373.41,24.75]
["TUFTS - TUFTS SELECT - HCPCS - C1784",1,2734,0,null,null,683.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0269",1,200,0,null,null,50]
["TUFTS - TUFTS SELECT - HCPCS - C1785",1,12546,0,null,null,3136.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0297",1,1437,107.22,107.22,801.26,359.25]
["TUFTS - TUFTS SELECT - HCPCS - C1786",1,23460,0,null,null,5865]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0423",1,169,248.82,198.42,637.79,42.25]
["TUFTS - TUFTS SELECT - HCPCS - C1788",1,540,0,null,null,135]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0506",1,62,0,110.9,110.9,15.5]
["TUFTS - TUFTS SELECT - HCPCS - C1817",1,9668,0,null,null,2417]
["TUFTS - TUFTS PPO - HCPCS - C1882",1,53226,0,null,null,13306.5]
["TUFTS - TUFTS SELECT - HCPCS - C1821",1,9770,0,null,null,2442.5]
["TUFTS - TUFTS PPO - HCPCS - C1887",1,3731,0,null,null,932.75]
["TUFTS - TUFTS SELECT - HCPCS - C1874",1,8879,0,null,null,2219.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9016",1,576,389.15,243.01,478.65,144]
["TUFTS - TUFTS SELECT - HCPCS - C1876",1,11691,0,null,null,2922.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9037",1,939,1316.1,821.84,1622.67,234.75]
["TUFTS - TUFTS SELECT - HCPCS - C1880",1,7726,0,null,null,1931.5]
["TUFTS - TUFTS PPO - HCPCS - C1893",1,406,0,null,null,101.5]
["TUFTS - TUFTS SELECT - HCPCS - C1882",1,53226,0,null,null,13306.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9100",1,1310,53.7,33.53,256.64,327.5]
["TUFTS - TUFTS SELECT - HCPCS - C1883",1,1257,0,null,null,314.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q0114",1,41,20.51,7.2,82.86,10.25]
["TUFTS - TUFTS SELECT - HCPCS - C1884",1,31469,0,null,null,7867.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q4107",1,2233,0,86.55,110.48,558.25]
["TUFTS - TUFTS SELECT - HCPCS - C1887",1,3731,0,null,null,932.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q4125",1,4060,0,3.79,3.79,1015]
["TUFTS - TUFTS SELECT - HCPCS - C1892",1,340,0,null,null,85]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q4196",1,9044,192.05,111.59,280.77999999999997,2261]
["TUFTS - TUFTS SELECT - HCPCS - C1893",1,406,0,null,null,101.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q9958",1,1,0,7.0000000000000007E-2,0.18,0.25]
["TUFTS - TUFTS SELECT - HCPCS - C1894",1,252,0,null,null,63]
["TUFTS - TUFTS PPO - HCPCS - C1894",1,252,0,null,null,63]
["TUFTS - TUFTS SELECT - HCPCS - C1895",1,13382,0,null,null,3345.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - G0279",1,55,63.37,30.09,295.68,13.75]
["TUFTS - TUFTS SELECT - HCPCS - C1896",1,10912,0,null,null,2728]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - G2024",1,33,53.62,25.46,230.84,8.25]
["TUFTS - TUFTS SELECT - HCPCS - C1898",1,1575,0,null,null,393.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L1830",1,78,171.05,81.95,367.86,19.5]
["TUFTS - TUFTS SELECT - HCPCS - C1900",1,8293,0,null,null,2073.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L3350",1,41,46.77,22.41,100.59,10.25]
["TUFTS - TUFTS PPO - HCPCS - A9558",1,23,0,108.88,108.88,5.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L3762",1,57,199.71,95.68,429.49,14.25]
["TUFTS - TUFTS SELECT - HCPCS - C2616",1,60393,25512.2,25512.2,76706.740000000005,15098.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L3908",1,143,152.83000000000001,73.22,328.66,35.75]
["TUFTS - TUFTS SELECT - HCPCS - C2617",1,638,0,null,null,159.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L4350",1,360,203.04,97.28,436.66,90]
["TUFTS - TUFTS SELECT - HCPCS - C2621",1,21692,0,null,null,5423]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L4396",1,406,357.79,171.42,769.43,101.5]
["TUFTS - TUFTS SELECT - HCPCS - C2623",1,2837,0,null,null,709.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L8509",1,1144,223.32,106.99,480.27,286]
["TUFTS - TUFTS SELECT - HCPCS - C2625",1,246,0,null,null,61.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - M0243",1,572,652.02,309.60000000000002,779.02,143]
["TUFTS - TUFTS SELECT - HCPCS - C2628",1,2308,0,null,null,577]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - Q3014",1,67,56.12,26.65,67.06,16.75]
["TUFTS - TUFTS SELECT - HCPCS - C2630",1,4966,0,null,null,1241.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - 0278T",1,77,293.52,286.31,943.8,19.25]
["TUFTS - TUFTS SELECT - HCPCS - C2634",1,0,232.45,232.45,698.88,0]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - 90471",1,64,129,76.22,345.64,16]
["TUFTS - TUFTS SELECT - HCPCS - C2635",1,0,80.66,78.03,242.54,0]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A4561",1,108,0,23.18,58.33,27]
["TUFTS - TUFTS SELECT - HCPCS - C2639",1,47,52.85,52.85,100.75,11.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A6209",1,163,0,8.68,21.84,40.75]
["TUFTS - TUFTS SELECT - HCPCS - C5275",1,743,684.11,684.11,2032.26,185.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9500",1,274,0,463.42,463.42,68.5]
["TUFTS - TUFTS SELECT - HCPCS - C8908",1,579,667.78,664.1,4299.8,144.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9509",1,95,0,5163.91,5163.91,23.75]
["TUFTS - TUFTS SELECT - HCPCS - C8937",1,331,0,null,null,82.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9517",1,437,62.66,30.1,101.94,109.25]
["TUFTS - TUFTS SELECT - HCPCS - C9358",1,8526,0,24.42,24.42,2131.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9538",1,111,0,114.21,114.21,27.75]
["TUFTS - TUFTS SELECT - HCPCS - C9728",1,1957,2227.36,2227.36,7098.97,489.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9543",1,66322,97558.58,72400.97,217685.7,16580.5]
["TUFTS - TUFTS SELECT - HCPCS - C9739",1,6035,5130.87,2166.09,15242.01,1508.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9555",1,1065,0,1604.08,1604.08,266.25]
["TUFTS - TUFTS SELECT - HCPCS - D0150",1,265,1275.99,1275.99,4066.77,66.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9560",1,246,0,266.7,266.7,61.5]
["TUFTS - TUFTS SELECT - HCPCS - D0240",1,836,1275.99,1275.99,4066.77,209]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9569",1,5086,0,4157.3,4157.3,1271.5]
["TUFTS - TUFTS SELECT - HCPCS - D0250",1,1451,1275.99,1275.99,4066.77,362.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9576",1,5,0,1.5,3.77,1.25]
["TUFTS - TUFTS SELECT - HCPCS - D0251",1,119,0,null,null,29.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9581",1,99,0,14.76,37.14,24.75]
["TUFTS - TUFTS SELECT - HCPCS - D0270",1,836,1275.99,1275.99,4066.77,209]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9586",1,4402,5015.9399999999996,3746.06,7452.46,1100.5]
["TUFTS - TUFTS SELECT - HCPCS - D0272",1,836,1275.99,1182.5,4066.77,209]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1713",1,4568,0,null,null,1142]
["TUFTS - TUFTS SELECT - HCPCS - D0274",1,836,1275.99,1182.5,4066.77,209]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1717",1,607,554.13,469.29,1411.01,151.75]
["TUFTS - TUFTS SELECT - HCPCS - D0277",1,1451,1275.99,1275.99,4066.77,362.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1724",1,7410,0,null,null,1852.5]
["TUFTS - TUFTS SELECT - HCPCS - D0472",1,110,1941.26,1941.26,6187.11,27.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1730",1,2283,0,null,null,570.75]
["TUFTS - TUFTS SELECT - HCPCS - D0473",1,110,1941.26,1941.26,6187.11,27.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1750",1,1693,0,null,null,423.25]
["TUFTS - TUFTS SELECT - HCPCS - D0474",1,110,1941.26,1941.26,6187.11,27.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1757",1,15822,0,null,null,3955.5]
["TUFTS - TUFTS SELECT - HCPCS - D0480",1,110,1941.26,1941.26,6187.11,27.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1763",1,2242,0,null,null,560.5]
["TUFTS - TUFTS SELECT - HCPCS - D1110",1,110,51.21,51.21,163.22999999999999,27.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1768",1,76125,0,null,null,19031.25]
["TUFTS - TUFTS SELECT - HCPCS - D1510",1,836,1275.99,1275.99,4066.77,209]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1776",1,21721,0,null,null,5430.25]
["TUFTS - TUFTS SELECT - HCPCS - D1516",1,1350,0,null,null,337.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1785",1,12546,0,null,null,3136.5]
["TUFTS - TUFTS SELECT - HCPCS - D1517",1,1451,0,null,null,362.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1821",1,9770,0,null,null,2442.5]
["TUFTS - TUFTS SELECT - HCPCS - D1575",1,1451,1723.54,1723.54,5493.21,362.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1882",1,53226,0,null,null,13306.5]
["TUFTS - TUFTS SELECT - HCPCS - D2999",1,1451,1275.99,1275.99,4066.77,362.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1892",1,340,0,null,null,85]
["TUFTS - TUFTS SELECT - HCPCS - D3460",1,1451,1275.99,1275.99,4066.77,362.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1896",1,10912,0,null,null,2728]
["TUFTS - TUFTS SELECT - HCPCS - D3999",1,1451,1275.99,1275.99,4066.77,362.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C2616",1,60393,29411.3,25512.2,76706.740000000005,15098.25]
["TUFTS - TUFTS SELECT - HCPCS - D4260",1,1451,1275.99,1275.99,4066.77,362.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C2625",1,246,0,null,null,61.5]
["TUFTS - TUFTS SELECT - HCPCS - D4263",1,1451,1275.99,1275.99,4066.77,362.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C2635",1,0,97.01,78.03,242.54,0]
["TUFTS - TUFTS SELECT - HCPCS - D4264",1,1451,1275.99,1275.99,4066.77,362.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C8937",1,331,0,null,null,82.75]
["TUFTS - TUFTS SELECT - HCPCS - D4270",1,1451,1275.99,1275.99,4066.77,362.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0103",1,93,44.13,16.78,181.16,23.25]
["TUFTS - TUFTS SELECT - HCPCS - D4273",1,1451,1275.99,1275.99,4066.77,362.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0127",1,189,120.69,93.87,317.35000000000002,47.25]
["TUFTS - TUFTS SELECT - HCPCS - D4355",1,836,1275.99,1275.99,4066.77,209]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0260",1,817,1292.83,1005.62,3474.13,204.25]
["TUFTS - TUFTS SELECT - HCPCS - D4381",1,1451,1275.99,1275.99,4066.77,362.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0279",1,55,32.69,30.09,295.68,13.75]
["TUFTS - TUFTS SELECT - HCPCS - D5911",1,1451,1275.99,1275.99,4066.77,362.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0422",1,169,255.09,198.42,637.79,42.25]
["TUFTS - TUFTS SELECT - HCPCS - D5912",1,1451,1275.99,1275.99,4066.77,362.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0481",1,192,338.08,91.84,1332.11,48]
["TUFTS - TUFTS SELECT - HCPCS - D5983",1,1451,1275.99,1275.99,4066.77,362.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G2066",1,165,80.23,58.35,370.47,41.25]
["TUFTS - TUFTS SELECT - HCPCS - D5984",1,1451,1275.99,1275.99,4066.77,362.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - J2790",1,186.95,0,74.3,186.95,46.737499999999997]
["TUFTS - TUFTS SELECT - HCPCS - D5985",1,1451,1275.99,1275.99,4066.77,362.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0278",1,3138,0,34.229999999999997,34.229999999999997,784.5]
["TUFTS - TUFTS SELECT - HCPCS - D5987",1,1451,1275.99,1275.99,4066.77,362.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0297",1,1437,0,107.22,801.26,359.25]
["TUFTS - TUFTS SELECT - HCPCS - D7140",1,836,1275.99,1275.99,4066.77,209]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0389",1,544,0,null,null,136]
["TUFTS - TUFTS SELECT - HCPCS - D7210",1,836,1275.99,1275.99,4066.77,209]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0396",1,42,0,56.05,336.32,10.5]
["TUFTS - TUFTS SELECT - HCPCS - D7220",1,836,1275.99,1275.99,4066.77,209]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0402",1,168,0,208.89,1179.72,42]
["TUFTS - TUFTS SELECT - HCPCS - D7230",1,836,1275.99,1275.99,4066.77,209]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0416",1,425,0,360.63,2456.98,106.25]
["TUFTS - TUFTS SELECT - HCPCS - D7240",1,836,1275.99,1275.99,4066.77,209]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0421",1,37,0,42.72,136.13999999999999,9.25]
["TUFTS - TUFTS SELECT - HCPCS - D7250",1,836,1275.99,1275.99,4066.77,209]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0423",1,169,0,198.42,637.79,42.25]
["TUFTS - TUFTS SELECT - HCPCS - D7260",1,1081,1275.99,1275.99,4066.77,270.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0439",1,327,0,34.03,61.76,81.75]
["TUFTS - TUFTS SELECT - HCPCS - D7261",1,836,1275.99,1275.99,4066.77,209]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0443",1,118,0,18.52,33.6,29.5]
["TUFTS - TUFTS SELECT - HCPCS - D7940",1,1451,1275.99,1275.99,4066.77,362.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0445",1,118,0,8.9,16.149999999999999,29.5]
["TUFTS - TUFTS SELECT - HCPCS - D9110",1,110,0,null,null,27.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0447",1,118,0,18.52,33.6,29.5]
["TUFTS - TUFTS SELECT - HCPCS - D9230",1,110,0,null,null,27.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0481",1,192,110.21,91.84,1332.11,48]
["TUFTS - TUFTS SELECT - HCPCS - D9630",1,110,591.51,591.51,3340.65,27.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0513",1,84,0,148.6,148.6,21]
["TUFTS - TUFTS SELECT - HCPCS - D9930",1,1451,1275.99,1275.99,4066.77,362.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G2011",1,35,0,28.83,133.88,8.75]
["TUFTS - TUFTS SELECT - HCPCS - D9944",1,51,0,null,null,12.75]
["TUFTS - TUFTS PPO - HCPCS - C1729",1,2283,0,null,null,570.75]
["TUFTS - TUFTS SELECT - HCPCS - D9951",1,1350,1275.99,1275.99,4066.77,337.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G2066",1,165,0,58.35,370.47,41.25]
["TUFTS - TUFTS SELECT - HCPCS - E0191",1,321,17.34,11.61,52.13,80.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G2087",1,194,0,46.18,211.43,48.5]
["TUFTS - TUFTS SELECT - HCPCS - G0101",1,148,18.010000000000002,18.010000000000002,128.29,37]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G2212",1,188,0,null,null,47]
["TUFTS - TUFTS SELECT - HCPCS - G0103",1,93,32.07,16.78,181.16,23.25]
["TUFTS - TUFTS PPO - HCPCS - C1731",1,3847,0,null,null,961.75]
["TUFTS - TUFTS SELECT - HCPCS - G0105",1,1152,1098.98,1020.59,3264.67,288]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L0140",1,189,0,77.52,347.97,47.25]
["TUFTS - TUFTS SELECT - HCPCS - G0108",1,425,72.41,72.41,230.78,106.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L1830",1,78,0,81.95,367.86,19.5]
["TUFTS - TUFTS SELECT - HCPCS - G0109",1,267,42.12,32.64,134.25,66.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L1836",1,209,0,130.47999999999999,585.70000000000005,52.25]
["TUFTS - TUFTS SELECT - HCPCS - G0127",1,189,99.57,93.87,317.35000000000002,47.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3260",1,279,0,31.12,357.96,69.75]
["TUFTS - TUFTS SELECT - HCPCS - G0175",1,565,638.73,638.73,2035.73,141.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3496",1,406,0,null,null,101.5]
["TUFTS - TUFTS SELECT - HCPCS - G0239",1,99,66.12,53.94,373.41,24.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3670",1,2903,0,103.65,465.27,725.75]
["TUFTS - TUFTS SELECT - HCPCS - G0257",1,911,1145.7,1027.32,3651.55,227.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3762",1,57,0,95.68,429.49,14.25]
["TUFTS - TUFTS SELECT - HCPCS - G0259",1,1513,0,1198.25,1198.25,378.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3808",1,509,0,375.94,1687.5,127.25]
["TUFTS - TUFTS SELECT - HCPCS - G0260",1,817,1090.04,1005.62,3474.13,204.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3908",1,143,0,73.22,328.66,35.75]
["TUFTS - TUFTS SELECT - HCPCS - G0269",1,200,0,null,null,50]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3980",1,132,0,377.84,1695.98,33]
["TUFTS - TUFTS SELECT - HCPCS - G0278",1,3138,0,34.229999999999997,34.229999999999997,784.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L4350",1,360,0,97.28,436.66,90]
["TUFTS - TUFTS SELECT - HCPCS - G0279",1,55,44.81,30.09,295.68,13.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L4370",1,107,0,235.79,1058.3900000000001,26.75]
["TUFTS - TUFTS SELECT - HCPCS - G0296",1,118,102.62,102.62,660.74,29.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L4396",1,406,0,171.42,769.43,101.5]
["TUFTS - TUFTS SELECT - HCPCS - G0297",1,1437,124.44,107.22,801.26,359.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L8501",1,219,0,160.74,721.54,54.75]
["TUFTS - TUFTS SELECT - HCPCS - G0365",1,498,272.02999999999997,272.02999999999997,867.01,124.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L8509",1,1144,0,106.99,480.27,286]
["TUFTS - TUFTS SELECT - HCPCS - G0378",1,319,0,null,null,79.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L8693",1,1462,0,1485.57,6668.25,365.5]
["TUFTS - TUFTS SELECT - HCPCS - G0379",1,752,874.54,874.54,2787.3,188]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - P9612",1,90,2.66,2.2200000000000002,1198.25,22.5]
["TUFTS - TUFTS SELECT - HCPCS - G0390",1,3274,1579.83,1579.83,5035.18,818.5]
["TUFTS - TUFTS PPO - HCPCS - C1732",1,7766,0,null,null,1941.5]
["TUFTS - TUFTS SELECT - HCPCS - G0396",1,42,59.55,56.05,336.32,10.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q0249",1,9,0,null,null,2.25]
["TUFTS - TUFTS SELECT - HCPCS - G0397",1,118,144.46,128.29,815.89,29.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q4116",1,5248,0,32.29,35.78,1312]
["TUFTS - TUFTS PPO - HCPCS - A9560",1,246,0,266.7,266.7,61.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q4125",1,4060,0,3.79,3.79,1015]
["TUFTS - TUFTS SELECT - HCPCS - G0410",1,220,0,null,null,55]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q4196",1,9044,0,111.59,280.77999999999997,2261]
["TUFTS - TUFTS SELECT - HCPCS - G0416",1,425,435.04,360.63,2456.98,106.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q9956",1,76,0,31.75,79.89,19]
["TUFTS - TUFTS SELECT - HCPCS - G0420",1,156,184.9,184.9,589.33000000000004,39]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q9958",1,1,0,7.0000000000000007E-2,0.18,0.25]
["TUFTS - TUFTS SELECT - HCPCS - G0421",1,37,42.72,42.72,136.13999999999999,9.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["TUFTS - TUFTS SELECT - HCPCS - G0422",1,169,200.11,198.42,637.79,42.25]
["TUFTS - TUFTS PPO - HCPCS - C1750",1,1693,0,null,null,423.25]
["TUFTS - TUFTS SELECT - HCPCS - G0423",1,169,200.11,198.42,637.79,42.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - S5100",1,6,0,null,null,1.5]
["TUFTS - TUFTS SELECT - HCPCS - G0424",1,284,107.65,93.87,343.09,71]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - S5102",1,126,0,null,null,31.5]
["TUFTS - TUFTS SELECT - HCPCS - G0438",1,547,34.03,34.03,61.76,136.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - T2003",1,25,0,null,null,6.25]
["TUFTS - TUFTS SELECT - HCPCS - G0439",1,327,34.03,34.03,61.76,81.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - V2785",1,7848,0,5130.87,15242.01,1962]
["TUFTS - TUFTS SELECT - HCPCS - G0442",1,42,18.52,13.34,33.6,10.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - 81170",1,798,360,159,2909.77,199.5]
["TUFTS - TUFTS SELECT - HCPCS - G0443",1,118,18.52,18.52,33.6,29.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A4562",1,64,69.25,57.71,145.21,16]
["TUFTS - TUFTS SELECT - HCPCS - G0444",1,42,8.9,8.9,16.149999999999999,10.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A6258",1,83,6,5,12.58,20.75]
["TUFTS - TUFTS SELECT - HCPCS - G0445",1,118,8.9,8.9,16.149999999999999,29.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A7520",1,1173,66.19,55.16,138.79,293.25]
["TUFTS - TUFTS SELECT - HCPCS - G0446",1,42,8.9,8.9,16.149999999999999,10.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A9576",1,5,1.8,1.5,3.77,1.25]
["TUFTS - TUFTS SELECT - HCPCS - G0447",1,118,18.52,18.52,33.6,29.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A9579",1,5,1.84,1.53,4.38,1.25]
["TUFTS - TUFTS SELECT - HCPCS - G0480",1,254,172.38,59.69,973.54,63.5]
["TUFTS - TUFTS PPO - HCPCS - C1751",1,1438,0,null,null,359.5]
["TUFTS - TUFTS SELECT - HCPCS - G0481",1,192,235.87,91.84,1332.11,48]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - G0279",1,55,36.11,30.09,295.68,13.75]
["TUFTS - TUFTS SELECT - HCPCS - G0506",1,62,0,110.9,110.9,15.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - G0481",1,192,187.91,91.84,1332.11,48]
["TUFTS - TUFTS SELECT - HCPCS - G0513",1,84,0,148.6,148.6,21]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - G2024",1,33,30.55,25.46,230.84,8.25]
["TUFTS - TUFTS SELECT - HCPCS - G0514",1,84,0,148.6,148.6,21]
["TUFTS - TUFTS PPO - HCPCS - C1756",1,1438,0,null,null,359.5]
["TUFTS - TUFTS SELECT - HCPCS - G2011",1,35,42.01,28.83,133.88,8.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - J2790",1,186.95,0,74.3,186.95,46.737499999999997]
["TUFTS - TUFTS SELECT - HCPCS - G2012",1,42,0,31.78,31.78,10.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L0120",1,25,29.83,24.86,111.59,6.25]
["TUFTS - TUFTS PPO - HCPCS - A9561",1,127,0,125.64,125.64,31.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L1820",1,159,171.11,142.59,640.03,39.75]
["TUFTS - TUFTS PPO - HCPCS - A9562",1,1237,0,2212.25,2212.25,309.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L1832",1,1523,892.31,743.59,3337.75,380.75]
["TUFTS - TUFTS PPO - HCPCS - A9563",1,0,1132.32,535.17999999999995,3182.68,0]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L1902",1,219,103.37,86.14,386.65,54.75]
["TUFTS - TUFTS SELECT - HCPCS - J2790",1,186.95,0,74.3,186.95,46.737499999999997]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L3650",1,1955,80.86,67.38,302.45,488.75]
["TUFTS - TUFTS PPO - HCPCS - A9569",1,5086,0,4157.3,4157.3,1271.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L3760",1,819,534.02,445.02,1997.57,204.75]
["TUFTS - TUFTS PPO - HCPCS - A9570",1,6395,0,null,null,1598.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L3807",1,483,267.02,222.52,998.85,120.75]
["TUFTS - TUFTS PPO - HCPCS - A9572",1,131,0,16207.01,16207.01,32.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L3905",1,2442,1059.01,882.51,3961.32,610.5]
["TUFTS - TUFTS SELECT - HCPCS - L0120",1,25,37.119999999999997,24.86,111.59,6.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L3967",1,117,2118.2800000000002,1765.23,7923.54,29.25]
["TUFTS - TUFTS SELECT - HCPCS - L0140",1,189,115.74,77.52,347.97,47.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L3982",1,176,477.88,398.23,1787.56,44]
["TUFTS - TUFTS SELECT - HCPCS - L1820",1,159,212.87,142.59,640.03,39.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L4360",1,557,415,345.83,1552.36,139.25]
["TUFTS - TUFTS SELECT - HCPCS - L1830",1,78,122.35,81.95,367.86,19.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L4386",1,165,186.02,155.02000000000001,695.83,41.25]
["TUFTS - TUFTS SELECT - HCPCS - L1832",1,1523,1110.1199999999999,743.59,3337.75,380.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L4398",1,406,94.7,78.92,354.25,101.5]
["TUFTS - TUFTS SELECT - HCPCS - L1836",1,209,194.81,130.47999999999999,585.70000000000005,52.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L8507",1,1604,49.24,41.03,184.14,401]
["TUFTS - TUFTS SELECT - HCPCS - L1902",1,219,128.6,86.14,386.65,54.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L8514",1,387,110.86,92.38,414.69,96.75]
["TUFTS - TUFTS SELECT - HCPCS - L3260",1,279,63.38,31.12,357.96,69.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - P9045",1,238,62.94,52.45,131.97,59.5]
["TUFTS - TUFTS SELECT - HCPCS - L3350",1,41,33.450000000000003,22.41,100.59,10.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - P9612",1,90,3.6,2.2200000000000002,1198.25,22.5]
["TUFTS - TUFTS SELECT - HCPCS - L3650",1,1955,100.59,67.38,302.45,488.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q0114",1,41,11.69,7.2,82.86,10.25]
["TUFTS - TUFTS SELECT - HCPCS - L3670",1,2903,154.74,103.65,465.27,725.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q4102",1,69,12.25,10.210000000000001,25.69,17.25]
["TUFTS - TUFTS SELECT - HCPCS - L3760",1,819,664.38,445.02,1997.57,204.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q4133",1,3756,158.36000000000001,131.97,332.06,939]
["TUFTS - TUFTS SELECT - HCPCS - L3762",1,57,142.84,95.68,429.49,14.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q9956",1,76,38.1,31.75,79.89,19]
["TUFTS - TUFTS SELECT - HCPCS - L3807",1,483,332.21,222.52,998.85,120.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q9958",1,1,0.08,7.0000000000000007E-2,0.18,0.25]
["TUFTS - TUFTS SELECT - HCPCS - L3808",1,509,561.25,375.94,1687.5,127.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["TUFTS - TUFTS SELECT - HCPCS - L3905",1,2442,1317.51,882.51,3961.32,610.5]
["TUFTS - TUFTS PPO - HCPCS - C1762",1,12010,0,null,null,3002.5]
["TUFTS - TUFTS SELECT - HCPCS - L3908",1,143,109.32,73.22,328.66,35.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - U0002",1,92,61.57,51.31,465.19,23]
["TUFTS - TUFTS SELECT - HCPCS - L3967",1,117,2635.32,1765.23,7923.54,29.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A4561",1,108,27.82,23.18,58.33,27]
["TUFTS - TUFTS SELECT - HCPCS - L3980",1,132,564.08000000000004,377.84,1695.98,33]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A6209",1,163,10.42,8.68,21.84,40.75]
["TUFTS - TUFTS SELECT - HCPCS - L3982",1,176,594.53,398.23,1787.56,44]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A6550",1,4,30.85,25.71,64.69,1]
["TUFTS - TUFTS SELECT - HCPCS - L4350",1,360,145.22999999999999,97.28,436.66,90]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A9575",1,8,0.22,0.18,0.45,2]
["TUFTS - TUFTS SELECT - HCPCS - L4360",1,557,516.29999999999995,345.83,1552.36,139.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A9577",1,21,2.17,1.81,5.03,5.25]
["TUFTS - TUFTS SELECT - HCPCS - L4370",1,107,352.02,235.79,1058.3900000000001,26.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A9581",1,99,17.71,14.76,37.14,24.75]
["TUFTS - TUFTS SELECT - HCPCS - L4386",1,165,231.43,155.02000000000001,695.83,41.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - G0103",1,93,23.17,16.78,181.16,23.25]
["TUFTS - TUFTS SELECT - HCPCS - L4396",1,406,255.91,171.42,769.43,101.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - G0480",1,254,137.32,59.69,973.54,63.5]
["TUFTS - TUFTS SELECT - HCPCS - L4398",1,406,117.83,78.92,354.25,101.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - G2023",1,31,28.15,23.46,212.71,7.75]
["TUFTS - TUFTS SELECT - HCPCS - L8501",1,219,239.98,160.74,721.54,54.75]
["TUFTS - TUFTS PPO - HCPCS - C1764",1,8983,0,null,null,2245.75]
["TUFTS - TUFTS SELECT - HCPCS - L8507",1,1604,61.25,41.03,184.14,401]
["TUFTS - TUFTS PPO - HCPCS - C1766",1,2619,0,null,null,654.75]
["TUFTS - TUFTS SELECT - HCPCS - L8509",1,1144,159.72999999999999,106.99,480.27,286]
["TUFTS - TUFTS PPO - HCPCS - C1768",1,76125,0,null,null,19031.25]
["TUFTS - TUFTS SELECT - HCPCS - L8514",1,387,137.91999999999999,92.38,414.69,96.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L0140",1,189,93.02,77.52,347.97,47.25]
["TUFTS - TUFTS SELECT - HCPCS - L8693",1,1462,2217.8200000000002,1485.57,6668.25,365.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L1830",1,78,98.34,81.95,367.86,19.5]
["TUFTS - TUFTS SELECT - HCPCS - L8699",1,13957,0,null,null,3489.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L1836",1,209,156.58000000000001,130.47999999999999,585.70000000000005,52.25]
["TUFTS - TUFTS SELECT - HCPCS - P9012",1,134,73.86,64.959999999999994,125.33,33.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3350",1,41,26.89,22.41,100.59,10.25]
["TUFTS - TUFTS SELECT - HCPCS - P9016",1,576,282.10000000000002,243.01,478.65,144]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3670",1,2903,124.38,103.65,465.27,725.75]
["TUFTS - TUFTS SELECT - HCPCS - P9017",1,291,128.31,94.07,217.72,72.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3762",1,57,114.82,95.68,429.49,14.25]
["TUFTS - TUFTS SELECT - HCPCS - P9021",1,323,208.77,184.28,354.25,80.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3808",1,509,451.13,375.94,1687.5,127.25]
["TUFTS - TUFTS SELECT - HCPCS - P9034",1,506,471.32,443.29,799.73,126.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3908",1,143,87.86,73.22,328.66,35.75]
["TUFTS - TUFTS SELECT - HCPCS - P9037",1,939,956.33,821.84,1622.67,234.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3980",1,132,453.41,377.84,1695.98,33]
["TUFTS - TUFTS SELECT - HCPCS - P9040",1,523,394.85,336.11,669.97,130.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L4350",1,360,116.74,97.28,436.66,90]
["TUFTS - TUFTS SELECT - HCPCS - P9044",1,133,144.19999999999999,144.19999999999999,244.67,33.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L4370",1,107,282.95,235.79,1058.3900000000001,26.75]
["TUFTS - TUFTS SELECT - HCPCS - P9045",1,238,76.05,52.45,131.97,59.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L4396",1,406,205.7,171.42,769.43,101.5]
["TUFTS - TUFTS PPO - HCPCS - A9575",1,8,0,0.18,0.45,2]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L8501",1,219,192.89,160.74,721.54,54.75]
["TUFTS - TUFTS SELECT - HCPCS - P9056",1,1619,311.95,311.95,529.32000000000005,404.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L8509",1,1144,128.38999999999999,106.99,480.27,286]
["TUFTS - TUFTS SELECT - HCPCS - P9057",1,785,395.89,395.89,671.74,196.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L8693",1,1462,1782.68,1485.57,6668.25,365.5]
["TUFTS - TUFTS SELECT - HCPCS - P9073",1,889,871.26,821.84,2619.59,222.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - M0243",1,572,371.52,309.60000000000002,779.02,143]
["TUFTS - TUFTS SELECT - HCPCS - P9100",1,1310,45.44,33.53,256.64,327.5]
["TUFTS - TUFTS PPO - HCPCS - C1769",1,4759,0,null,null,1189.75]
["TUFTS - TUFTS SELECT - HCPCS - P9612",1,90,4.5199999999999996,2.2200000000000002,1198.25,22.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q0111",1,23,18.14,5.86,127.48,5.75]
["TUFTS - TUFTS SELECT - HCPCS - Q0091",1,83,31.1,28.83,175.66,20.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q3014",1,67,31.98,26.65,67.06,16.75]
["TUFTS - TUFTS SELECT - HCPCS - Q0111",1,23,22.58,5.86,127.48,5.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q4102",1,69,12.25,10.210000000000001,25.69,17.25]
["TUFTS - TUFTS SELECT - HCPCS - Q0114",1,41,14.67,7.2,82.86,10.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q4133",1,3756,158.36000000000001,131.97,332.06,939]
["TUFTS - TUFTS SELECT - HCPCS - Q4100",1,12079,0,null,null,3019.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q9956",1,76,38.1,31.75,79.89,19]
["TUFTS - TUFTS SELECT - HCPCS - Q4101",1,1601,0,30.46,76.64,400.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q9958",1,1,0.08,7.0000000000000007E-2,0.18,0.25]
["TUFTS - TUFTS SELECT - HCPCS - Q4102",1,69,0,10.210000000000001,25.69,17.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["TUFTS - TUFTS SELECT - HCPCS - Q4104",1,7748,0,42.08,56.11,1937]
["TUFTS - TUFTS PPO - HCPCS - C1770",1,3667,0,null,null,916.75]
["TUFTS - TUFTS SELECT - HCPCS - Q4107",1,2233,0,86.55,110.48,558.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - U0002",1,92,61.57,51.31,465.19,23]
["TUFTS - TUFTS SELECT - HCPCS - Q4112",1,535,0,904.99,1002.89,133.75]
["UNICARE - UNICARE - HCPCS - 92083",1,461,82.5,68.75,607.84,115.25]
["TUFTS - TUFTS SELECT - HCPCS - Q4116",1,5248,0,32.29,35.78,1312]
["UNICARE - UNICARE - HCPCS - A9575",1,8,0.19,0.18,0.45,2]
["TUFTS - TUFTS SELECT - HCPCS - Q4124",1,23,0,16.39,16.39,5.75]
["UNICARE - UNICARE - HCPCS - A9577",1,21,1.88,1.81,5.03,5.25]
["TUFTS - TUFTS SELECT - HCPCS - Q4125",1,4060,0,3.79,3.79,1015]
["UNICARE - UNICARE - HCPCS - A9581",1,99,15.32,14.76,37.14,24.75]
["TUFTS - TUFTS SELECT - HCPCS - Q4130",1,65718,0,45.89,45.89,16429.5]
["UNICARE - UNICARE - HCPCS - G0103",1,93,44.64,16.78,181.16,23.25]
["TUFTS - TUFTS SELECT - HCPCS - Q4132",1,3754,0,114.63,288.43,938.5]
["UNICARE - UNICARE - HCPCS - G0480",1,254,207.82,59.69,973.54,63.5]
["TUFTS - TUFTS SELECT - HCPCS - Q4133",1,3756,0,131.97,332.06,939]
["TUFTS - TUFTS PPO - HCPCS - C1773",1,2163,0,null,null,540.75]
["TUFTS - TUFTS SELECT - HCPCS - Q4196",1,9044,152,111.59,280.77999999999997,2261]
["TUFTS - TUFTS PPO - HCPCS - C1777",1,13038,0,null,null,3259.5]
["TUFTS - TUFTS SELECT - HCPCS - Q9954",1,0,0,12.1,13.41,0]
["TUFTS - TUFTS PPO - HCPCS - C1781",1,36449,0,null,null,9112.25]
["TUFTS - TUFTS SELECT - HCPCS - Q9956",1,76,0,31.75,79.89,19]
["TUFTS - TUFTS PPO - HCPCS - C1784",1,2734,0,null,null,683.5]
["TUFTS - TUFTS SELECT - HCPCS - Q9957",1,417,0,47.63,119.85,104.25]
["UNICARE - UNICARE - HCPCS - Q0111",1,23,10.36,5.86,127.48,5.75]
["TUFTS - TUFTS SELECT - HCPCS - Q9958",1,1,0,7.0000000000000007E-2,0.18,0.25]
["UNICARE - UNICARE - HCPCS - Q4101",1,1601,31.6,30.46,76.64,400.25]
["TUFTS - TUFTS SELECT - HCPCS - Q9961",1,1,0,0.25,0.63,0.25]
["UNICARE - UNICARE - HCPCS - Q4104",1,7748,42.08,42.08,56.11,1937]
["TUFTS - TUFTS SELECT - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["UNICARE - UNICARE - HCPCS - Q4112",1,535,904.99,904.99,1002.89,133.75]
["TUFTS - TUFTS SELECT - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["UNICARE - UNICARE - HCPCS - Q4132",1,3754,118.95,114.63,288.43,938.5]
["TUFTS - TUFTS PPO - HCPCS - A9576",1,5,0,1.5,3.77,1.25]
["UNICARE - UNICARE - HCPCS - Q4196",1,9044,115.8,111.59,280.77999999999997,2261]
["TUFTS - TUFTS SELECT - HCPCS - S2083",1,211,317.70999999999998,317.70999999999998,1198.25,52.75]
["UNICARE - UNICARE - HCPCS - Q9956",1,76,32.950000000000003,31.75,79.89,19]
["TUFTS - TUFTS SELECT - HCPCS - S8037",1,1440,585.76,585.76,3771.6,360]
["UNICARE - UNICARE - HCPCS - Q9958",1,1,7.0000000000000007E-2,7.0000000000000007E-2,0.18,0.25]
["TUFTS - TUFTS SELECT - HCPCS - V2785",1,7848,5130.87,5130.87,15242.01,1962]
["UNICARE - UNICARE - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["TUFTS - TUFTS SELECT - HCPCS - V2790",1,1136,0,null,null,284]
["TUFTS - TUFTS PPO - HCPCS - C1785",1,12546,0,null,null,3136.5]
["TUFTS - TUFTS SPIRIT - HCPCS - 81170",1,798,330,159,2909.77,199.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - 92083",1,461,68.75,68.75,607.84,115.25]
["TUFTS - TUFTS SPIRIT - HCPCS - A4561",1,108,25.5,23.18,58.33,27]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - A9575",1,8,0.19,0.18,0.45,2]
["TUFTS - TUFTS SPIRIT - HCPCS - A4562",1,64,63.48,57.71,145.21,16]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - A9577",1,21,1.88,1.81,5.03,5.25]
["TUFTS - TUFTS SPIRIT - HCPCS - A6209",1,163,9.5500000000000007,8.68,21.84,40.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - A9581",1,99,15.32,14.76,37.14,24.75]
["TUFTS - TUFTS SPIRIT - HCPCS - A6258",1,83,5.5,5,12.58,20.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - G0103",1,93,37.200000000000003,16.78,181.16,23.25]
["TUFTS - TUFTS SPIRIT - HCPCS - A6550",1,4,28.28,25.71,64.69,1]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - G0480",1,254,173.18,59.69,973.54,63.5]
["TUFTS - TUFTS SPIRIT - HCPCS - A7520",1,1173,60.68,55.16,138.79,293.25]
["TUFTS - TUFTS PPO - HCPCS - C1786",1,23460,0,null,null,5865]
["TUFTS - TUFTS SPIRIT - HCPCS - A9575",1,8,0.2,0.18,0.45,2]
["TUFTS - TUFTS PPO - HCPCS - C1817",1,9668,0,null,null,2417]
["TUFTS - TUFTS SPIRIT - HCPCS - A9576",1,5,1.65,1.5,3.77,1.25]
["TUFTS - TUFTS PPO - HCPCS - C1821",1,9770,0,null,null,2442.5]
["TUFTS - TUFTS SPIRIT - HCPCS - A9577",1,21,1.99,1.81,5.03,5.25]
["TUFTS - TUFTS PPO - HCPCS - C1874",1,8879,0,null,null,2219.75]
["TUFTS - TUFTS SPIRIT - HCPCS - A9579",1,5,1.68,1.53,4.38,1.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q0111",1,23,8.6300000000000008,5.86,127.48,5.75]
["TUFTS - TUFTS SPIRIT - HCPCS - A9581",1,99,16.239999999999998,14.76,37.14,24.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q4101",1,1601,31.6,30.46,76.64,400.25]
["TUFTS - TUFTS PPO - HCPCS - A9577",1,21,0,1.81,5.03,5.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q4104",1,7748,42.08,42.08,56.11,1937]
["TUFTS - TUFTS SPIRIT - HCPCS - G0103",1,93,21.24,16.78,181.16,23.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q4112",1,535,904.99,904.99,1002.89,133.75]
["TUFTS - TUFTS SPIRIT - HCPCS - G0279",1,55,33.1,30.09,295.68,13.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q4132",1,3754,118.95,114.63,288.43,938.5]
["TUFTS - TUFTS SPIRIT - HCPCS - G0480",1,254,125.87,59.69,973.54,63.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q4196",1,9044,115.8,111.59,280.77999999999997,2261]
["TUFTS - TUFTS SPIRIT - HCPCS - G0481",1,192,172.25,91.84,1332.11,48]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q9956",1,76,32.950000000000003,31.75,79.89,19]
["TUFTS - TUFTS SPIRIT - HCPCS - G2023",1,31,25.81,23.46,212.71,7.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q9958",1,1,7.0000000000000007E-2,7.0000000000000007E-2,0.18,0.25]
["TUFTS - TUFTS SPIRIT - HCPCS - G2024",1,33,28.01,25.46,230.84,8.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["TUFTS - TUFTS PPO - HCPCS - A9579",1,5,0,1.53,4.38,1.25]
["TUFTS - TUFTS PPO - HCPCS - C1876",1,11691,0,null,null,2922.75]
["TUFTS - TUFTS PPO - HCPCS - A9580",1,158,0,null,null,39.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - 0278T",1,77,286.31,286.31,943.8,19.25]
["TUFTS - TUFTS PPO - HCPCS - A9581",1,99,0,14.76,37.14,24.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - 45378",1,1672,1568.74,1020.59,3264.67,418]
["TUFTS - TUFTS SPIRIT - HCPCS - J2790",1,186.95,0,74.3,186.95,46.737499999999997]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - 90471",1,64,125.83,76.22,345.64,16]
["TUFTS - TUFTS PPO - HCPCS - A9582",1,10370,0,null,null,2592.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - 95800",1,205,286.31,228.32,1412.44,51.25]
["TUFTS - TUFTS SPIRIT - HCPCS - L0120",1,25,27.35,24.86,111.59,6.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A4561",1,108,0,23.18,58.33,27]
["TUFTS - TUFTS SPIRIT - HCPCS - L0140",1,189,85.27,77.52,347.97,47.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A4648",1,281,0,null,null,70.25]
["TUFTS - TUFTS SPIRIT - HCPCS - L1820",1,159,156.85,142.59,640.03,39.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A6209",1,163,0,8.68,21.84,40.75]
["TUFTS - TUFTS SPIRIT - HCPCS - L1830",1,78,90.14,81.95,367.86,19.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A6550",1,4,0,25.71,64.69,1]
["TUFTS - TUFTS SPIRIT - HCPCS - L1832",1,1523,817.95,743.59,3337.75,380.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9500",1,274,0,463.42,463.42,68.5]
["TUFTS - TUFTS SPIRIT - HCPCS - L1836",1,209,143.53,130.47999999999999,585.70000000000005,52.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9503",1,23,0,37.119999999999997,37.119999999999997,5.75]
["TUFTS - TUFTS SPIRIT - HCPCS - L1902",1,219,94.75,86.14,386.65,54.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9509",1,95,0,5163.91,5163.91,23.75]
["TUFTS - TUFTS SPIRIT - HCPCS - L3350",1,41,24.65,22.41,100.59,10.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9513",1,320,441.49,294.27999999999997,1097.56,80]
["TUFTS - TUFTS SPIRIT - HCPCS - L3650",1,1955,74.12,67.38,302.45,488.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9517",1,437,62.66,30.1,101.94,109.25]
["TUFTS - TUFTS SPIRIT - HCPCS - L3670",1,2903,114.02,103.65,465.27,725.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9521",1,360,0,4157.3,4157.3,90]
["TUFTS - TUFTS SPIRIT - HCPCS - L3760",1,819,489.52,445.02,1997.57,204.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9538",1,111,0,114.21,114.21,27.75]
["TUFTS - TUFTS SPIRIT - HCPCS - L3762",1,57,105.25,95.68,429.49,14.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9540",1,1831,0,85.66,85.66,457.75]
["TUFTS - TUFTS SPIRIT - HCPCS - L3807",1,483,244.77,222.52,998.85,120.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9543",1,66322,97558.58,72400.97,217685.7,16580.5]
["TUFTS - TUFTS SPIRIT - HCPCS - L3808",1,509,413.53,375.94,1687.5,127.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9551",1,154,0,1711.56,1711.56,38.5]
["TUFTS - TUFTS SPIRIT - HCPCS - L3905",1,2442,970.76,882.51,3961.32,610.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9555",1,1065,0,1604.08,1604.08,266.25]
["TUFTS - TUFTS SPIRIT - HCPCS - L3908",1,143,80.540000000000006,73.22,328.66,35.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9557",1,239,0,1062.44,1062.44,59.75]
["TUFTS - TUFTS SPIRIT - HCPCS - L3967",1,117,1941.75,1765.23,7923.54,29.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9560",1,246,0,266.7,266.7,61.5]
["TUFTS - TUFTS SPIRIT - HCPCS - L3980",1,132,415.62,377.84,1695.98,33]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9562",1,1237,0,2212.25,2212.25,309.25]
["TUFTS - TUFTS SPIRIT - HCPCS - L3982",1,176,438.05,398.23,1787.56,44]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9569",1,5086,0,4157.3,4157.3,1271.5]
["TUFTS - TUFTS SPIRIT - HCPCS - L4350",1,360,107.01,97.28,436.66,90]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9572",1,131,0,16207.01,16207.01,32.75]
["TUFTS - TUFTS SPIRIT - HCPCS - L4360",1,557,380.41,345.83,1552.36,139.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9576",1,5,0,1.5,3.77,1.25]
["TUFTS - TUFTS SPIRIT - HCPCS - L4370",1,107,259.37,235.79,1058.3900000000001,26.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9579",1,5,0,1.53,4.38,1.25]
["TUFTS - TUFTS SPIRIT - HCPCS - L4386",1,165,170.52,155.02000000000001,695.83,41.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9581",1,99,0,14.76,37.14,24.75]
["TUFTS - TUFTS SPIRIT - HCPCS - L4396",1,406,188.56,171.42,769.43,101.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9583",1,13,0,19.260000000000002,21.34,3.25]
["TUFTS - TUFTS SPIRIT - HCPCS - L4398",1,406,86.81,78.92,354.25,101.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9586",1,4402,5015.9399999999996,3746.06,7452.46,1100.5]
["TUFTS - TUFTS SPIRIT - HCPCS - L8501",1,219,176.81,160.74,721.54,54.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9588",1,15438,703.05,525.05999999999995,703.05,3859.5]
["TUFTS - TUFTS SPIRIT - HCPCS - L8507",1,1604,45.13,41.03,184.14,401]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1713",1,4568,0,null,null,1142]
["TUFTS - TUFTS SPIRIT - HCPCS - L8509",1,1144,117.69,106.99,480.27,286]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1715",1,21,0,null,null,5.25]
["TUFTS - TUFTS SPIRIT - HCPCS - L8514",1,387,101.62,92.38,414.69,96.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1717",1,607,554.13,469.29,1411.01,151.75]
["TUFTS - TUFTS SPIRIT - HCPCS - L8693",1,1462,1634.13,1485.57,6668.25,365.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1721",1,39674,0,null,null,9918.5]
["TUFTS - TUFTS SPIRIT - HCPCS - M0239",1,393,340.56,309.60000000000002,779.02,98.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1724",1,7410,0,null,null,1852.5]
["TUFTS - TUFTS SPIRIT - HCPCS - M0243",1,572,340.56,309.60000000000002,779.02,143]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1726",1,387,0,null,null,96.75]
["TUFTS - TUFTS SPIRIT - HCPCS - P9045",1,238,57.7,52.45,131.97,59.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1730",1,2283,0,null,null,570.75]
["TUFTS - TUFTS PPO - HCPCS - A9583",1,13,0,19.260000000000002,21.34,3.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1732",1,7766,0,null,null,1941.5]
["TUFTS - TUFTS SPIRIT - HCPCS - P9612",1,90,3.3,2.2200000000000002,1198.25,22.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1750",1,1693,0,null,null,423.25]
["TUFTS - TUFTS SPIRIT - HCPCS - Q0111",1,23,16.63,5.86,127.48,5.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1753",1,3947,0,null,null,986.75]
["TUFTS - TUFTS SPIRIT - HCPCS - Q0114",1,41,10.71,7.2,82.86,10.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1757",1,15822,0,null,null,3955.5]
["TUFTS - TUFTS SPIRIT - HCPCS - Q3014",1,67,29.32,26.65,67.06,16.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1760",1,1799,0,null,null,449.75]
["TUFTS - TUFTS SPIRIT - HCPCS - Q4101",1,1601,33.51,30.46,76.64,400.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1763",1,2242,0,null,null,560.5]
["TUFTS - TUFTS SPIRIT - HCPCS - Q4102",1,69,11.23,10.210000000000001,25.69,17.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1765",1,569,0,null,null,142.25]
["TUFTS - TUFTS SPIRIT - HCPCS - Q4132",1,3754,126.09,114.63,288.43,938.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1768",1,76125,0,null,null,19031.25]
["TUFTS - TUFTS SPIRIT - HCPCS - Q4133",1,3756,145.16999999999999,131.97,332.06,939]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1770",1,3667,0,null,null,916.75]
["TUFTS - TUFTS SPIRIT - HCPCS - Q4196",1,9044,122.75,111.59,280.77999999999997,2261]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1776",1,21721,0,null,null,5430.25]
["TUFTS - TUFTS SPIRIT - HCPCS - Q9956",1,76,34.92,31.75,79.89,19]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1781",1,36449,0,null,null,9112.25]
["TUFTS - TUFTS SPIRIT - HCPCS - Q9957",1,417,52.39,47.63,119.85,104.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1785",1,12546,0,null,null,3136.5]
["TUFTS - TUFTS SPIRIT - HCPCS - Q9958",1,1,0.08,7.0000000000000007E-2,0.18,0.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1788",1,540,0,null,null,135]
["TUFTS - TUFTS SPIRIT - HCPCS - Q9961",1,1,0.28000000000000003,0.25,0.63,0.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1821",1,9770,0,null,null,2442.5]
["TUFTS - TUFTS SPIRIT - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1876",1,11691,0,null,null,2922.75]
["TUFTS - TUFTS SPIRIT - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1882",1,53226,0,null,null,13306.5]
["TUFTS - TUFTS PPO - HCPCS - A9584",1,2729,0,3235.55,3235.55,682.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1884",1,31469,0,null,null,7867.25]
["TUFTS - TUFTS SPIRIT - HCPCS - U0001",1,124,39.5,35.909999999999997,325.64,31]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1892",1,340,0,null,null,85]
["TUFTS - TUFTS SPIRIT - HCPCS - U0002",1,92,56.44,51.31,465.19,23]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1894",1,252,0,null,null,63]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - HCPCS - 81170",1,798,260.89,159,2909.77,199.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1896",1,10912,0,null,null,2728]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - HCPCS - G0103",1,93,19.75,16.78,181.16,23.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1900",1,8293,0,null,null,2073.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - HCPCS - G0480",1,254,70.260000000000005,59.69,973.54,63.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C2616",1,60393,29411.3,25512.2,76706.740000000005,15098.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - HCPCS - G0481",1,192,108.1,91.84,1332.11,48]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C2621",1,21692,0,null,null,5423]
["TUFTS - TUFTS PPO - HCPCS - A9586",1,4402,4698.29,3746.06,7452.46,1100.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C2625",1,246,0,null,null,61.5]
["TUFTS - TUFTS PPO - HCPCS - A9587",1,12985,0,84.97,113.78,3246.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C2630",1,4966,0,null,null,1241.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - HCPCS - P9612",1,90,2.61,2.2200000000000002,1198.25,22.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C2635",1,0,97.01,78.03,242.54,0]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - HCPCS - Q0111",1,23,12.74,5.86,127.48,5.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C5275",1,743,1016.97,684.11,2032.26,185.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - HCPCS - Q0114",1,41,8.4700000000000006,7.2,82.86,10.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C8937",1,331,0,null,null,82.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - HCPCS - U0002",1,92,60.39,51.31,465.19,23]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C9728",1,1957,2510.1799999999998,2227.36,7098.97,489.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - 81170",1,798,404.46,159,2909.77,199.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0103",1,93,43.05,16.78,181.16,23.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A4561",1,108,31.25,23.18,58.33,27]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0108",1,425,118.4,72.41,230.78,106.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A4562",1,64,77.8,57.71,145.21,16]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0127",1,189,117.73,93.87,317.35000000000002,47.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A6209",1,163,11.7,8.68,21.84,40.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0257",1,911,1288.3,1027.32,3651.55,227.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A6258",1,83,6.74,5,12.58,20.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0260",1,817,1261.0899999999999,1005.62,3474.13,204.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A6550",1,4,34.659999999999997,25.71,64.69,1]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0270",1,86,69.08,69.08,70.819999999999993,21.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A7520",1,1173,74.37,55.16,138.79,293.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0279",1,55,31.88,30.09,295.68,13.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A9575",1,8,0.24,0.18,0.45,2]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0390",1,3274,0,1579.83,5035.18,818.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A9576",1,5,2.02,1.5,3.77,1.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0422",1,169,248.82,198.42,637.79,42.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A9577",1,21,2.44,1.81,5.03,5.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0424",1,284,117.73,93.87,343.09,71]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A9579",1,5,2.06,1.53,4.38,1.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0481",1,192,329.78,91.84,1332.11,48]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A9581",1,99,19.899999999999999,14.76,37.14,24.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0513",1,84,0,148.6,148.6,21]
["TUFTS - TUFTS PPO - HCPCS - A9588",1,15438,0,525.05999999999995,703.05,3859.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G2066",1,165,78.260000000000005,58.35,370.47,41.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - G0103",1,93,26.03,16.78,181.16,23.25]
["TUFTS - TUFTS PPO - HCPCS - C1883",1,1257,0,null,null,314.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - G0279",1,55,40.57,30.09,295.68,13.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - J2790",1,186.95,0,74.3,186.95,46.737499999999997]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - G0480",1,254,154.27000000000001,59.69,973.54,63.5]
["TUFTS - TUFTS PPO - HCPCS - C1892",1,340,0,null,null,85]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - G0481",1,192,211.11,91.84,1332.11,48]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9012",1,134,104.04,64.959999999999994,125.33,33.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - G2023",1,31,31.63,23.46,212.71,7.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9017",1,291,150.63999999999999,94.07,217.72,72.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - G2024",1,33,34.33,25.46,230.84,8.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9034",1,506,709.89,443.29,799.73,126.5]
["TUFTS - TUFTS PPO - HCPCS - A9606",1,493,212.47,198.62,597.20000000000005,123.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9040",1,523,538.25,336.11,669.97,130.75]
["TUFTS - TUFTS PPO - HCPCS - C1713",1,4568,0,null,null,1142]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9045",1,238,110.46,52.45,131.97,59.5]
["TUFTS - TUFTS PPO - HCPCS - C1714",1,6114,0,null,null,1528.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9056",1,1619,474.84,311.95,529.32000000000005,404.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - J2790",1,186.95,0,74.3,186.95,46.737499999999997]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9073",1,889,1316.1,821.84,2619.59,222.25]
["TUFTS - TUFTS PPO - HCPCS - C1715",1,21,0,null,null,5.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9612",1,90,0,2.2200000000000002,1198.25,22.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L0120",1,25,33.520000000000003,24.86,111.59,6.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q0111",1,23,31.57,5.86,127.48,5.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L0140",1,189,104.51,77.52,347.97,47.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q4101",1,1601,0,30.46,76.64,400.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L1820",1,159,192.24,142.59,640.03,39.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q4104",1,7748,0,42.08,56.11,1937]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L1830",1,78,110.48,81.95,367.86,19.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q4112",1,535,0,904.99,1002.89,133.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L1832",1,1523,1002.51,743.59,3337.75,380.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q4124",1,23,0,16.39,16.39,5.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L1836",1,209,175.91,130.47999999999999,585.70000000000005,52.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q4130",1,65718,0,45.89,45.89,16429.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L1902",1,219,116.13,86.14,386.65,54.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q4133",1,3756,0,131.97,332.06,939]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L3350",1,41,30.21,22.41,100.59,10.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q9954",1,0,0,12.1,13.41,0]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L3650",1,1955,90.84,67.38,302.45,488.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q9957",1,417,0,47.63,119.85,104.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L3670",1,2903,139.74,103.65,465.27,725.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q9961",1,1,0,0.25,0.63,0.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L3760",1,819,599.98,445.02,1997.57,204.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L3762",1,57,129,95.68,429.49,14.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - V2790",1,1136,0,null,null,284]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L3807",1,483,300,222.52,998.85,120.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - G0103",1,93,40.67,16.78,181.16,23.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L3808",1,509,506.84,375.94,1687.5,127.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - G0480",1,254,240.99,59.69,973.54,63.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L3905",1,2442,1189.8,882.51,3961.32,610.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - G2023",1,31,49.41,23.46,212.71,7.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L3908",1,143,98.72,73.22,328.66,35.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L0120",1,25,51.89,24.86,111.59,6.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L3967",1,117,2379.88,1765.23,7923.54,29.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L1820",1,159,297.62,142.59,640.03,39.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L3980",1,132,509.4,377.84,1695.98,33]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L1832",1,1523,1552.04,743.59,3337.75,380.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L3982",1,176,536.89,398.23,1787.56,44]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L1902",1,219,179.79,86.14,386.65,54.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L4350",1,360,131.15,97.28,436.66,90]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L3650",1,1955,140.63999999999999,67.38,302.45,488.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L4360",1,557,466.25,345.83,1552.36,139.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L3760",1,819,928.85,445.02,1997.57,204.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L4370",1,107,317.89,235.79,1058.3900000000001,26.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L3807",1,483,464.46,222.52,998.85,120.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L4386",1,165,209,155.02000000000001,695.83,41.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L3905",1,2442,1841.99,882.51,3961.32,610.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L4396",1,406,231.11,171.42,769.43,101.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L3967",1,117,3684.4,1765.23,7923.54,29.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L4398",1,406,106.4,78.92,354.25,101.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L3982",1,176,831.2,398.23,1787.56,44]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L8501",1,219,216.71,160.74,721.54,54.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L4360",1,557,721.83,345.83,1552.36,139.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L8507",1,1604,55.32,41.03,184.14,401]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L4386",1,165,323.57,155.02000000000001,695.83,41.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L8509",1,1144,144.24,106.99,480.27,286]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L4398",1,406,164.73,78.92,354.25,101.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L8514",1,387,124.55,92.38,414.69,96.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L8507",1,1604,85.63,41.03,184.14,401]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L8693",1,1462,2002.85,1485.57,6668.25,365.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L8514",1,387,192.83,92.38,414.69,96.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - P9045",1,238,70.709999999999994,52.45,131.97,59.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - M0239",1,393,652.02,309.60000000000002,779.02,98.25]
["TUFTS - TUFTS PPO - HCPCS - C1716",1,0,180.26,168.52,506.68,0]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - P9612",1,90,6.32,2.2200000000000002,1198.25,22.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - P9612",1,90,4.04,2.2200000000000002,1198.25,22.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - Q0114",1,41,20.51,7.2,82.86,10.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q0111",1,23,20.38,5.86,127.48,5.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - U0001",1,124,75.63,35.909999999999997,325.64,31]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q0114",1,41,13.13,7.2,82.86,10.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - 0042T",1,767,0,1452,1452,191.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q4101",1,1601,41.07,30.46,76.64,400.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - 0402T",1,2880,3522.21,1198.25,11845.41,720]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q4102",1,69,13.77,10.210000000000001,25.69,17.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - 81170",1,798,647.70000000000005,159,2909.77,199.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q4132",1,3754,154.54,114.63,288.43,938.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - 92083",1,461,229.89,68.75,607.84,115.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q4133",1,3756,177.92,131.97,332.06,939]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A4215",1,433,0,null,null,108.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q4196",1,9044,150.44999999999999,111.59,280.77999999999997,2261]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A4562",1,64,0,57.71,145.21,16]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q9956",1,76,42.81,31.75,79.89,19]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A4725",1,87,0,null,null,21.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q9957",1,417,64.209999999999994,47.63,119.85,104.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A6258",1,83,0,5,12.58,20.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q9958",1,1,0.09,7.0000000000000007E-2,0.18,0.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A7520",1,1173,0,55.16,138.79,293.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q9961",1,1,0.34,0.25,0.63,0.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9502",1,140,0,278.27,278.27,35]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9505",1,23,0,395.74,395.74,5.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9512",1,1,0,null,null,0.25]
["TUFTS - TUFTS PPO - HCPCS - C1717",1,607,502,469.29,1411.01,151.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9516",1,192,0,516.39,516.39,48]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - U0001",1,124,48.41,35.909999999999997,325.64,31]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9520",1,1951,0,null,null,487.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - U0002",1,92,69.180000000000007,51.31,465.19,23]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9537",1,138,0,157.94999999999999,157.94999999999999,34.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - HCPCS - 81170",1,798,335.15,159,2909.77,199.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9539",1,668,0,89.47,89.47,167]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - HCPCS - G0103",1,93,25.37,16.78,181.16,23.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9541",1,120,0,152.69,152.69,30]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - HCPCS - G0480",1,254,90.25,59.69,973.54,63.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9547",1,440,0,5105.7299999999996,5105.7299999999996,110]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - HCPCS - G0481",1,192,138.86000000000001,91.84,1332.11,48]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9552",1,972,0,1166.46,1166.46,243]
["TUFTS - TUFTS PPO - HCPCS - C1719",1,95,127.14,108.35,357.35,23.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9556",1,20,0,311.94,311.94,5]
["TUFTS - TUFTS PPO - HCPCS - C1721",1,39674,0,null,null,9918.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9558",1,23,0,108.88,108.88,5.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - HCPCS - P9612",1,90,3.36,2.2200000000000002,1198.25,22.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9561",1,127,0,125.64,125.64,31.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - HCPCS - Q0111",1,23,16.36,5.86,127.48,5.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9563",1,0,535.17999999999995,535.17999999999995,3182.68,0]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - HCPCS - Q0114",1,41,10.89,7.2,82.86,10.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9570",1,6395,0,null,null,1598.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - HCPCS - U0002",1,92,77.58,51.31,465.19,23]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9575",1,8,0,0.18,0.45,2]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - 81170",1,798,265.99,159,2909.77,199.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9577",1,21,0,1.81,5.03,5.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A4215",1,433,0,null,null,108.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9580",1,158,0,null,null,39.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A4467",1,151,0,null,null,37.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9582",1,10370,0,null,null,2592.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A4561",1,108,0,23.18,58.33,27]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9584",1,2729,0,3235.55,3235.55,682.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A4562",1,64,0,57.71,145.21,16]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9587",1,12985,113.78,84.97,113.78,3246.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A4570",1,40,0,19.010000000000002,107.35,10]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9606",1,493,247.36,198.62,597.20000000000005,123.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A4725",1,87,0,null,null,21.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1714",1,6114,0,null,null,1528.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A6209",1,163,0,8.68,21.84,40.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1716",1,0,200.39,168.52,506.68,0]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A6258",1,83,0,5,12.58,20.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1719",1,95,108.35,108.35,357.35,23.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A6549",1,37,0,null,null,9.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1722",1,43645,0,null,null,10911.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A6550",1,4,0,25.71,64.69,1]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1725",1,1693,0,null,null,423.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A7520",1,1173,0,55.16,138.79,293.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1729",1,2283,0,null,null,570.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9500",1,274,0,463.42,463.42,68.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1731",1,3847,0,null,null,961.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9502",1,140,0,278.27,278.27,35]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1733",1,10475,0,null,null,2618.75]
["TUFTS - TUFTS PPO - HCPCS - C1722",1,43645,0,null,null,10911.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1751",1,1438,0,null,null,359.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - L8699",1,13957,0,null,null,3489.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1756",1,1438,0,null,null,359.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9016",1,576,398.94,243.01,478.65,144]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1759",1,6295,0,null,null,1573.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9021",1,323,302.52,184.28,354.25,80.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1762",1,12010,0,null,null,3002.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9037",1,939,1349.22,821.84,1622.67,234.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1764",1,8983,0,null,null,2245.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9044",1,133,191.57,144.19999999999999,244.67,33.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1766",1,2619,0,null,null,654.75]
["TUFTS - TUFTS PPO - HCPCS - C1724",1,7410,0,null,null,1852.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1769",1,4759,0,null,null,1189.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9057",1,785,484.72,395.89,671.74,196.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1773",1,2163,0,null,null,540.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9100",1,1310,55.05,33.53,256.64,327.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1777",1,13038,0,null,null,3259.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q0091",1,83,37.07,28.83,175.66,20.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1784",1,2734,0,null,null,683.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q0114",1,41,21.03,7.2,82.86,10.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1786",1,23460,0,null,null,5865]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q4102",1,69,0,10.210000000000001,25.69,17.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1817",1,9668,0,null,null,2417]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q4107",1,2233,0,86.55,110.48,558.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1874",1,8879,0,null,null,2219.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q4116",1,5248,0,32.29,35.78,1312]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1880",1,7726,0,null,null,1931.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q4125",1,4060,0,3.79,3.79,1015]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1883",1,1257,0,null,null,314.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q4132",1,3754,0,114.63,288.43,938.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1887",1,3731,0,null,null,932.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q4196",1,9044,192.05,111.59,280.77999999999997,2261]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1893",1,406,0,null,null,101.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q9956",1,76,0,31.75,79.89,19]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1895",1,13382,0,null,null,3345.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q9958",1,1,0,7.0000000000000007E-2,0.18,0.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1898",1,1575,0,null,null,393.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["TUFTS - TUFTS PPO - HCPCS - C1895",1,13382,0,null,null,3345.5]
["TUFTS - TUFTS PPO - HCPCS - C1725",1,1693,0,null,null,423.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C2617",1,638,0,null,null,159.5]
["TUFTS - TUFTS PPO - HCPCS - A9538",1,111,0,114.21,114.21,27.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C2623",1,2837,0,null,null,709.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9560",1,246,0,266.7,266.7,61.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C2628",1,2308,0,null,null,577]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9561",1,127,0,125.64,125.64,31.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C2634",1,0,313.02999999999997,232.45,698.88,0]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9562",1,1237,0,2212.25,2212.25,309.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C2639",1,47,61.32,52.85,100.75,11.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9563",1,0,0,535.17999999999995,3182.68,0]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C8908",1,579,664.1,664.1,4299.8,144.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9569",1,5086,0,4157.3,4157.3,1271.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C9358",1,8526,0,24.42,24.42,2131.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9570",1,6395,0,null,null,1598.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C9739",1,6035,7812.32,2166.09,15242.01,1508.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9572",1,131,0,16207.01,16207.01,32.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0105",1,1152,1608.22,1020.59,3264.67,288]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9580",1,158,0,null,null,39.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0109",1,267,33.46,32.64,134.25,66.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9582",1,10370,0,null,null,2592.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0239",1,99,69.349999999999994,53.94,373.41,24.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9583",1,13,0,19.260000000000002,21.34,3.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0259",1,1513,0,1198.25,1198.25,378.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9584",1,2729,0,3235.55,3235.55,682.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0269",1,200,0,null,null,50]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9587",1,12985,0,84.97,113.78,3246.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0278",1,3138,0,34.229999999999997,34.229999999999997,784.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9588",1,15438,0,525.05999999999995,703.05,3859.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0297",1,1437,107.22,107.22,801.26,359.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9592",1,5634,0,null,null,1408.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0416",1,425,592.04,360.63,2456.98,106.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0101",1,148,0,18.010000000000002,128.29,37]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0423",1,169,255.09,198.42,637.79,42.25]
["TUFTS - TUFTS PPO - HCPCS - C1726",1,387,0,null,null,96.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0480",1,254,247.05,59.69,973.54,63.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0127",1,189,0,93.87,317.35000000000002,47.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0506",1,62,0,110.9,110.9,15.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0175",1,565,0,638.73,2035.73,141.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0514",1,84,0,148.6,148.6,21]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0239",1,99,0,53.94,373.41,24.75]
["TUFTS - TUFTS PPO - HCPCS - C1896",1,10912,0,null,null,2728]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0257",1,911,0,1027.32,3651.55,227.75]
["TUFTS - TUFTS PPO - HCPCS - C1900",1,8293,0,null,null,2073.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0259",1,1513,0,1198.25,1198.25,378.25]
["TUFTS - TUFTS PPO - HCPCS - A9539",1,668,0,89.47,89.47,167]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0260",1,817,0,1005.62,3474.13,204.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9503",1,23,0,37.119999999999997,37.119999999999997,5.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9012",1,134,106.65,64.959999999999994,125.33,33.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9505",1,23,0,395.74,395.74,5.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9017",1,291,154.43,94.07,217.72,72.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9509",1,95,0,5163.91,5163.91,23.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9034",1,506,727.76,443.29,799.73,126.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9512",1,1,0,null,null,0.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9040",1,523,551.79999999999995,336.11,669.97,130.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9513",1,320,0,294.27999999999997,1097.56,80]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9045",1,238,113.24,52.45,131.97,59.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9516",1,192,0,516.39,516.39,48]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9056",1,1619,486.79,311.95,529.32000000000005,404.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9517",1,437,0,30.1,101.94,109.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9073",1,889,1349.22,821.84,2619.59,222.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9520",1,1951,0,null,null,487.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9612",1,90,0,2.2200000000000002,1198.25,22.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9521",1,360,0,4157.3,4157.3,90]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q0111",1,23,32.36,5.86,127.48,5.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9537",1,138,0,157.94999999999999,157.94999999999999,34.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q4101",1,1601,0,30.46,76.64,400.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9538",1,111,0,114.21,114.21,27.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q4104",1,7748,0,42.08,56.11,1937]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9539",1,668,0,89.47,89.47,167]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q4112",1,535,0,904.99,1002.89,133.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9540",1,1831,0,85.66,85.66,457.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q4124",1,23,0,16.39,16.39,5.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9541",1,120,0,152.69,152.69,30]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q4130",1,65718,0,45.89,45.89,16429.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9543",1,66322,0,72400.97,217685.7,16580.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q4133",1,3756,0,131.97,332.06,939]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9547",1,440,0,5105.7299999999996,5105.7299999999996,110]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q9954",1,0,0,12.1,13.41,0]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9551",1,154,0,1711.56,1711.56,38.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q9957",1,417,0,47.63,119.85,104.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9552",1,972,0,1166.46,1166.46,243]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q9961",1,1,0,0.25,0.63,0.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9555",1,1065,0,1604.08,1604.08,266.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9556",1,20,0,311.94,311.94,5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - V2790",1,1136,0,null,null,284]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9557",1,239,0,1062.44,1062.44,59.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9558",1,23,0,108.88,108.88,5.75]
["TUFTS - TUFTS HMO - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["TUFTS - TUFTS HMO - HCPCS - A9581",1,99,0,14.76,37.14,24.75]
["TUFTS - TUFTS POS - HCPCS - C1781",1,36449,0,null,null,9112.25]
["FALLON - FALLON MEDICAID - HCPCS - G2011",1,35,0,28.83,133.88,8.75]
["TUFTS - TUFTS HMO - HCPCS - D9951",1,1350,2396.69,1275.99,4066.77,337.5]
["FALLON - FALLON MEDICAID - HCPCS - G2012",1,42,0,31.78,31.78,10.5]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L4386",1,165,224.78,155.02000000000001,695.83,41.25]
["FALLON - FALLON MEDICAID - HCPCS - A9569",1,5086,0,4157.3,4157.3,1271.5]
["TUFTS - TUFTS POS - HCPCS - G0506",1,62,0,110.9,110.9,15.5]
["FALLON - FALLON MEDICAID - HCPCS - A9570",1,6395,0,null,null,1598.75]
["TUFTS - TUFTS HMO - HCPCS - C2616",1,60393,30614.639999999999,25512.2,76706.740000000005,15098.25]
["FALLON - FALLON MEDICAID - HCPCS - G2066",1,165,0,58.35,370.47,41.25]
["TUFTS - TUFTS HMO - HCPCS - L1836",1,209,233.77,130.47999999999999,585.70000000000005,52.25]
["FALLON - FALLON MEDICAID - HCPCS - G2086",1,194,0,46.18,211.43,48.5]
["FALLON - FALLON MEDICAID - HCPCS - A9557",1,239,0,1062.44,1062.44,59.75]
["FALLON - FALLON MEDICAID - HCPCS - G2087",1,194,0,46.18,211.43,48.5]
["TUFTS - TUFTS POS - HCPCS - A9540",1,1831,0,85.66,85.66,457.75]
["FALLON - FALLON MEDICAID - HCPCS - G2088",1,45,0,82.11,82.11,11.25]
["TUFTS - TUFTS POS - HCPCS - D4355",1,836,2396.69,1275.99,4066.77,209]
["FALLON - FALLON MEDICAID - HCPCS - G2212",1,188,0,null,null,47]
["TUFTS - TUFTS HMO - HCPCS - A9509",1,95,0,5163.91,5163.91,23.75]
["FALLON - FALLON MEDICAID - HCPCS - G2216",1,118,0,null,null,29.5]
["TUFTS - TUFTS HMO - HCPCS - C1763",1,2242,0,null,null,560.5]
["FALLON - FALLON MEDICAID - HCPCS - A9572",1,131,0,16207.01,16207.01,32.75]
["TUFTS - TUFTS HMO - HCPCS - D1517",1,1451,0,null,null,362.75]
["FALLON - FALLON MEDICAID - HCPCS - L0120",1,25,0,24.86,111.59,6.25]
["TUFTS - TUFTS HMO - HCPCS - G0438",1,547,38.93,34.03,61.76,136.75]
["FALLON - FALLON MEDICAID - HCPCS - L0140",1,189,0,77.52,347.97,47.25]
["TUFTS - TUFTS HMO - HCPCS - P9037",1,939,956.33,821.84,1622.67,234.75]
["FALLON - FALLON MEDICAID - HCPCS - L1820",1,159,0,142.59,640.03,39.75]
["FALLON - FALLON MEDICAID - HCPCS - A9520",1,1951,0,null,null,487.75]
["FALLON - FALLON MEDICAID - HCPCS - L1830",1,78,0,81.95,367.86,19.5]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - G0279",1,55,43.63,30.09,295.68,13.75]
["FALLON - FALLON MEDICAID - HCPCS - L1832",1,1523,0,743.59,3337.75,380.75]
["TUFTS - TUFTS POS - HCPCS - 0399T",1,1022,0,null,null,255.5]
["FALLON - FALLON MEDICAID - HCPCS - L1836",1,209,0,130.47999999999999,585.70000000000005,52.25]
["TUFTS - TUFTS POS - HCPCS - C1715",1,21,0,null,null,5.25]
["FALLON - FALLON MEDICAID - HCPCS - L1902",1,219,0,86.14,386.65,54.75]
["TUFTS - TUFTS POS - HCPCS - C5275",1,743,1281.21,684.11,2032.26,185.75]
["FALLON - FALLON MEDICAID - HCPCS - L3260",1,279,0,31.12,357.96,69.75]
["TUFTS - TUFTS POS - HCPCS - G0257",1,911,2151.9699999999998,1027.32,3651.55,227.75]
["FALLON - FALLON MEDICAID - HCPCS - L3350",1,41,0,22.41,100.59,10.25]
["TUFTS - TUFTS PPO - HCPCS - A6209",1,163,0,8.68,21.84,40.75]
["FALLON - FALLON MEDICAID - HCPCS - L3496",1,406,0,null,null,101.5]
["TUFTS - TUFTS HMO - HCPCS - A9555",1,1065,0,1604.08,1604.08,266.25]
["FALLON - FALLON MEDICAID - HCPCS - L3650",1,1955,0,67.38,302.45,488.75]
["TUFTS - TUFTS HMO - HCPCS - C1724",1,7410,0,null,null,1852.5]
["FALLON - FALLON MEDICAID - HCPCS - L3670",1,2903,0,103.65,465.27,725.75]
["TUFTS - TUFTS HMO - HCPCS - C1821",1,9770,0,null,null,2442.5]
["FALLON - FALLON MEDICAID - HCPCS - L3760",1,819,0,445.02,1997.57,204.75]
["TUFTS - TUFTS HMO - HCPCS - C9803",1,35,105.24,87.7,246.49,8.75]
["FALLON - FALLON MEDICAID - HCPCS - L3762",1,57,0,95.68,429.49,14.25]
["TUFTS - TUFTS HMO - HCPCS - D5985",1,1451,2396.69,1275.99,4066.77,362.75]
["FALLON - FALLON MEDICAID - HCPCS - L3807",1,483,0,222.52,998.85,120.75]
["TUFTS - TUFTS HMO - HCPCS - G0296",1,118,263.7,102.62,660.74,29.5]
["FALLON - FALLON MEDICAID - HCPCS - L3808",1,509,0,375.94,1687.5,127.25]
["TUFTS - TUFTS HMO - HCPCS - G2024",1,33,98.55,25.46,230.84,8.25]
["FALLON - FALLON MEDICAID - HCPCS - L3905",1,2442,0,882.51,3961.32,610.5]
["TUFTS - TUFTS HMO - HCPCS - L4360",1,557,619.55999999999995,345.83,1552.36,139.25]
["FALLON - FALLON MEDICAID - HCPCS - L3908",1,143,0,73.22,328.66,35.75]
["TUFTS - TUFTS HMO - HCPCS - Q4102",1,69,0,10.210000000000001,25.69,17.25]
["FALLON - FALLON MEDICAID - HCPCS - L3967",1,117,0,1765.23,7923.54,29.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A9575",1,8,0.26,0.18,0.45,2]
["FALLON - FALLON MEDICAID - HCPCS - L3980",1,132,0,377.84,1695.98,33]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L3908",1,143,106.17,73.22,328.66,35.75]
["FALLON - FALLON MEDICAID - HCPCS - L3982",1,176,0,398.23,1787.56,44]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - U0001",1,124,52.07,35.909999999999997,325.64,31]
["FALLON - FALLON MEDICAID - HCPCS - L4350",1,360,0,97.28,436.66,90]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L1902",1,219,124.9,86.14,386.65,54.75]
["FALLON - FALLON MEDICAID - HCPCS - L4360",1,557,0,345.83,1552.36,139.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - Q4101",1,1601,44.17,30.46,76.64,400.25]
["FALLON - FALLON MEDICAID - HCPCS - L4370",1,107,0,235.79,1058.3900000000001,26.75]
["TUFTS - TUFTS POS - HCPCS - A6550",1,4,0,25.71,64.69,1]
["FALLON - FALLON MEDICAID - HCPCS - L4386",1,165,0,155.02000000000001,695.83,41.25]
["TUFTS - TUFTS POS - HCPCS - A9572",1,131,0,16207.01,16207.01,32.75]
["FALLON - FALLON MEDICAID - HCPCS - L4396",1,406,0,171.42,769.43,101.5]
["TUFTS - TUFTS POS - HCPCS - C1753",1,3947,0,null,null,986.75]
["FALLON - FALLON MEDICAID - HCPCS - L4398",1,406,0,78.92,354.25,101.5]
["TUFTS - TUFTS POS - HCPCS - C1894",1,252,0,null,null,63]
["FALLON - FALLON MEDICAID - HCPCS - L8501",1,219,0,160.74,721.54,54.75]
["TUFTS - TUFTS POS - HCPCS - D0473",1,110,3646.27,1941.26,6187.11,27.5]
["FALLON - FALLON MEDICAID - HCPCS - L8507",1,1604,0,41.03,184.14,401]
["TUFTS - TUFTS POS - HCPCS - D7940",1,1451,2396.69,1275.99,4066.77,362.75]
["FALLON - FALLON MEDICAID - HCPCS - L8509",1,1144,0,106.99,480.27,286]
["TUFTS - TUFTS POS - HCPCS - G0416",1,425,817.15,360.63,2456.98,106.25]
["FALLON - FALLON MEDICAID - HCPCS - L8514",1,387,0,92.38,414.69,96.75]
["TUFTS - TUFTS POS - HCPCS - Q4124",1,23,0,16.39,16.39,5.75]
["FALLON - FALLON MEDICAID - HCPCS - L8693",1,1462,0,1485.57,6668.25,365.5]
["TUFTS - TUFTS PPO - HCPCS - A9537",1,138,0,157.94999999999999,157.94999999999999,34.5]
["FALLON - FALLON MEDICAID - HCPCS - L8699",1,13957,0,null,null,3489.25]
["TUFTS - TUFTS HMO - HCPCS - A9538",1,111,0,114.21,114.21,27.75]
["FALLON - FALLON MEDICAID - HCPCS - M0239",1,393,309.60000000000002,309.60000000000002,779.02,98.25]
["TUFTS - TUFTS HMO - HCPCS - A9569",1,5086,0,4157.3,4157.3,1271.5]
["FALLON - FALLON MEDICAID - HCPCS - M0243",1,572,309.60000000000002,309.60000000000002,779.02,143]
["TUFTS - TUFTS HMO - HCPCS - C1713",1,4568,0,null,null,1142]
["FALLON - FALLON MEDICAID - HCPCS - P9612",1,90,2.2200000000000002,2.2200000000000002,1198.25,22.5]
["TUFTS - TUFTS HMO - HCPCS - C1750",1,1693,0,null,null,423.25]
["FALLON - FALLON MEDICAID - HCPCS - Q0091",1,83,0,28.83,175.66,20.75]
["TUFTS - TUFTS HMO - HCPCS - C1776",1,21721,0,null,null,5430.25]
["FALLON - FALLON MEDICAID - HCPCS - A9580",1,158,0,null,null,39.5]
["TUFTS - TUFTS HMO - HCPCS - C1892",1,340,0,null,null,85]
["FALLON - FALLON MEDICAID - HCPCS - A9582",1,10370,0,null,null,2592.5]
["TUFTS - TUFTS HMO - HCPCS - C2635",1,0,96.8,78.03,242.54,0]
["FALLON - FALLON MEDICAID - HCPCS - Q0249",1,9,0,null,null,2.25]
["TUFTS - TUFTS HMO - HCPCS - D0277",1,1451,2396.69,1275.99,4066.77,362.75]
["FALLON - FALLON MEDICAID - HCPCS - Q3014",1,67,0,26.65,67.06,16.75]
["TUFTS - TUFTS HMO - HCPCS - D4270",1,1451,2396.69,1275.99,4066.77,362.75]
["FALLON - FALLON MEDICAID - HCPCS - Q4116",1,5248,0,32.29,35.78,1312]
["TUFTS - TUFTS HMO - HCPCS - D7260",1,1081,2396.69,1275.99,4066.77,270.25]
["FALLON - FALLON MEDICAID - HCPCS - Q4124",1,23,0,16.39,16.39,5.75]
["TUFTS - TUFTS HMO - HCPCS - G0175",1,565,1199.72,638.73,2035.73,141.25]
["FALLON - FALLON MEDICAID - HCPCS - Q4125",1,4060,0,3.79,3.79,1015]
["FALLON - FALLON MEDICAID - HCPCS - G0410",1,220,0,null,null,55]
["FALLON - FALLON MEDICAID - HCPCS - Q4130",1,65718,0,45.89,45.89,16429.5]
["TUFTS - TUFTS HMO - HCPCS - G0480",1,254,388.52,59.69,973.54,63.5]
["FALLON - FALLON MEDICAID - HCPCS - Q4196",1,9044,0,111.59,280.77999999999997,2261]
["FALLON - FALLON MEDICAID - HCPCS - A9516",1,192,0,516.39,516.39,48]
["FALLON - FALLON MEDICAID - HCPCS - Q9954",1,0,0,12.1,13.41,0]
["TUFTS - TUFTS HMO - HCPCS - L3807",1,483,398.65,222.52,998.85,120.75]
["FALLON - FALLON MEDICAID - HCPCS - Q9956",1,76,0,31.75,79.89,19]
["TUFTS - TUFTS HMO - HCPCS - L8514",1,387,165.51,92.38,414.69,96.75]
["FALLON - FALLON MEDICAID - HCPCS - Q9957",1,417,0,47.63,119.85,104.25]
["TUFTS - TUFTS HMO - HCPCS - P9100",1,1310,102.43,33.53,256.64,327.5]
["FALLON - FALLON MEDICAID - HCPCS - Q9958",1,1,0,7.0000000000000007E-2,0.18,0.25]
["TUFTS - TUFTS HMO - HCPCS - Q4132",1,3754,0,114.63,288.43,938.5]
["FALLON - FALLON MEDICAID - HCPCS - Q9961",1,1,0,0.25,0.63,0.25]
["TUFTS - TUFTS HMO - HCPCS - V2790",1,1136,0,null,null,284]
["FALLON - FALLON MEDICAID - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - G0480",1,254,165.92,59.69,973.54,63.5]
["FALLON - FALLON MEDICAID - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L3350",1,41,32.49,22.41,100.59,10.25]
["FALLON - FALLON MEDICAID - HCPCS - A6549",1,37,0,null,null,9.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L4396",1,406,248.56,171.42,769.43,101.5]
["FALLON - FALLON MEDICAID - HCPCS - Q9987",1,1218,0,null,null,304.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q4196",1,9044,161.81,111.59,280.77999999999997,2261]
["FALLON - FALLON MEDICAID - HCPCS - S5100",1,6,0,null,null,1.5]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - A7520",1,1173,79.98,55.16,138.79,293.25]
["FALLON - FALLON MEDICAID - HCPCS - S5101",1,63,0,null,null,15.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - J2790",1,186.95,0,74.3,186.95,46.737499999999997]
["FALLON - FALLON MEDICAID - HCPCS - S5102",1,126,0,null,null,31.5]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L3905",1,2442,1279.6400000000001,882.51,3961.32,610.5]
["FALLON - FALLON MEDICAID - HCPCS - S8037",1,1440,0,585.76,3771.6,360]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - M0239",1,393,448.92,309.60000000000002,779.02,98.25]
["FALLON - FALLON MEDICAID - HCPCS - T2003",1,25,0,null,null,6.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - Q9961",1,1,0.36,0.25,0.63,0.25]
["FALLON - FALLON MEDICAID - HCPCS - U0002",1,92,51.31,51.31,465.19,23]
["TUFTS - TUFTS POS - HCPCS - A4561",1,108,0,23.18,58.33,27]
["FALLON - FALLON MEDICAID - HCPCS - V2785",1,7848,0,5130.87,15242.01,1962]
["TUFTS - TUFTS POS - HCPCS - A9513",1,320,365.04,294.27999999999997,1097.56,80]
["FALLON - FALLON MEDICAID - HCPCS - V2790",1,1136,0,null,null,284]
["TUFTS - TUFTS POS - HCPCS - A9557",1,239,0,1062.44,1062.44,59.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - 81170",1,798,300,159,2909.77,199.5]
["TUFTS - TUFTS POS - HCPCS - A9583",1,13,0,19.260000000000002,21.34,3.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - A4561",1,108,23.18,23.18,58.33,27]
["TUFTS - TUFTS POS - HCPCS - C1726",1,387,0,null,null,96.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - A4562",1,64,57.71,57.71,145.21,16]
["TUFTS - TUFTS POS - HCPCS - C1765",1,569,0,null,null,142.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - A6209",1,163,8.68,8.68,21.84,40.75]
["TUFTS - TUFTS POS - HCPCS - C1876",1,11691,0,null,null,2922.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - A6258",1,83,5,5,12.58,20.75]
["TUFTS - TUFTS POS - HCPCS - C2621",1,21692,0,null,null,5423]
["FALLON - FALLON SENIOR PLAN - HCPCS - A6550",1,4,25.71,25.71,64.69,1]
["TUFTS - TUFTS POS - HCPCS - D0240",1,836,2396.69,1275.99,4066.77,209]
["FALLON - FALLON SENIOR PLAN - HCPCS - A7520",1,1173,55.16,55.16,138.79,293.25]
["TUFTS - TUFTS POS - HCPCS - D2999",1,1451,2396.69,1275.99,4066.77,362.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - A9575",1,8,0.18,0.18,0.45,2]
["TUFTS - TUFTS POS - HCPCS - D7140",1,836,2396.69,1275.99,4066.77,209]
["FALLON - FALLON SENIOR PLAN - HCPCS - A9576",1,5,1.5,1.5,3.77,1.25]
["TUFTS - TUFTS POS - HCPCS - G0101",1,148,20.6,18.010000000000002,128.29,37]
["FALLON - FALLON SENIOR PLAN - HCPCS - A9577",1,21,1.81,1.81,5.03,5.25]
["TUFTS - TUFTS POS - HCPCS - G0365",1,498,510.97,272.02999999999997,867.01,124.5]
["FALLON - FALLON SENIOR PLAN - HCPCS - A9579",1,5,1.53,1.53,4.38,1.25]
["TUFTS - TUFTS POS - HCPCS - G0442",1,42,21.18,13.34,33.6,10.5]
["FALLON - FALLON SENIOR PLAN - HCPCS - A9581",1,99,14.76,14.76,37.14,24.75]
["TUFTS - TUFTS POS - HCPCS - G2086",1,194,46.18,46.18,211.43,48.5]
["FALLON - FALLON MEDICAID - HCPCS - A9583",1,13,0,19.260000000000002,21.34,3.25]
["TUFTS - TUFTS POS - HCPCS - Q9957",1,417,0,47.63,119.85,104.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - G0103",1,93,19.309999999999999,16.78,181.16,23.25]
["TUFTS - TUFTS PPO - HCPCS - A9505",1,23,0,395.74,395.74,5.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - G0279",1,55,30.09,30.09,295.68,13.75]
["TUFTS - TUFTS HMO - HCPCS - A9500",1,274,0,463.42,463.42,68.5]
["FALLON - FALLON SENIOR PLAN - HCPCS - G0480",1,254,114.43,59.69,973.54,63.5]
["TUFTS - TUFTS HMO - HCPCS - A9517",1,437,36.119999999999997,30.1,101.94,109.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - G0481",1,192,156.59,91.84,1332.11,48]
["TUFTS - TUFTS HMO - HCPCS - A9543",1,66322,86881.16,72400.97,217685.7,16580.5]
["FALLON - FALLON SENIOR PLAN - HCPCS - G2023",1,31,23.46,23.46,212.71,7.75]
["TUFTS - TUFTS HMO - HCPCS - A9560",1,246,0,266.7,266.7,61.5]
["FALLON - FALLON SENIOR PLAN - HCPCS - G2024",1,33,25.46,25.46,230.84,8.25]
["TUFTS - TUFTS HMO - HCPCS - A9576",1,5,0,1.5,3.77,1.25]
["FALLON - FALLON MEDICAID - HCPCS - A9584",1,2729,0,3235.55,3235.55,682.25]
["TUFTS - TUFTS HMO - HCPCS - A9586",1,4402,4392.1499999999996,3746.06,7452.46,1100.5]
["FALLON - FALLON MEDICAID - HCPCS - A9587",1,12985,0,84.97,113.78,3246.25]
["TUFTS - TUFTS HMO - HCPCS - C1717",1,607,563.15,469.29,1411.01,151.75]
["FALLON - FALLON MEDICAID - HCPCS - A9588",1,15438,0,525.05999999999995,703.05,3859.5]
["TUFTS - TUFTS HMO - HCPCS - C1730",1,2283,0,null,null,570.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - J2790",1,186.95,0,74.3,186.95,46.737499999999997]
["TUFTS - TUFTS HMO - HCPCS - C1757",1,15822,0,null,null,3955.5]
["FALLON - FALLON MEDICAID - HCPCS - A6550",1,4,0,25.71,64.69,1]
["TUFTS - TUFTS HMO - HCPCS - C1768",1,76125,0,null,null,19031.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - L0120",1,25,24.86,24.86,111.59,6.25]
["TUFTS - TUFTS HMO - HCPCS - C1785",1,12546,0,null,null,3136.5]
["FALLON - FALLON SENIOR PLAN - HCPCS - L0140",1,189,77.52,77.52,347.97,47.25]
["TUFTS - TUFTS HMO - HCPCS - C1882",1,53226,0,null,null,13306.5]
["FALLON - FALLON SENIOR PLAN - HCPCS - L1820",1,159,142.59,142.59,640.03,39.75]
["TUFTS - TUFTS HMO - HCPCS - C1896",1,10912,0,null,null,2728]
["FALLON - FALLON SENIOR PLAN - HCPCS - L1830",1,78,81.95,81.95,367.86,19.5]
["TUFTS - TUFTS HMO - HCPCS - C2625",1,246,0,null,null,61.5]
["FALLON - FALLON SENIOR PLAN - HCPCS - L1832",1,1523,743.59,743.59,3337.75,380.75]
["TUFTS - TUFTS HMO - HCPCS - C8937",1,331,0,null,null,82.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - L1836",1,209,130.47999999999999,130.47999999999999,585.70000000000005,52.25]
["TUFTS - TUFTS HMO - HCPCS - D0251",1,119,0,null,null,29.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - L1902",1,219,86.14,86.14,386.65,54.75]
["TUFTS - TUFTS HMO - HCPCS - D0480",1,110,3646.27,1941.26,6187.11,27.5]
["FALLON - FALLON SENIOR PLAN - HCPCS - L3350",1,41,22.41,22.41,100.59,10.25]
["TUFTS - TUFTS HMO - HCPCS - D3999",1,1451,2396.69,1275.99,4066.77,362.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - L3650",1,1955,67.38,67.38,302.45,488.75]
["TUFTS - TUFTS HMO - HCPCS - D5911",1,1451,2396.69,1275.99,4066.77,362.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - L3670",1,2903,103.65,103.65,465.27,725.75]
["TUFTS - TUFTS HMO - HCPCS - D7220",1,836,2396.69,1275.99,4066.77,209]
["FALLON - FALLON SENIOR PLAN - HCPCS - L3760",1,819,445.02,445.02,1997.57,204.75]
["TUFTS - TUFTS HMO - HCPCS - D9230",1,110,0,null,null,27.5]
["FALLON - FALLON SENIOR PLAN - HCPCS - L3762",1,57,95.68,95.68,429.49,14.25]
["TUFTS - TUFTS HMO - HCPCS - G0105",1,1152,2057.7399999999998,1020.59,3264.67,288]
["FALLON - FALLON SENIOR PLAN - HCPCS - L3807",1,483,222.52,222.52,998.85,120.75]
["TUFTS - TUFTS HMO - HCPCS - G0260",1,817,2047.41,1005.62,3474.13,204.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - L3808",1,509,375.94,375.94,1687.5,127.25]
["TUFTS - TUFTS HMO - HCPCS - G0379",1,752,1642.65,874.54,2787.3,188]
["FALLON - FALLON SENIOR PLAN - HCPCS - L3905",1,2442,882.51,882.51,3961.32,610.5]
["TUFTS - TUFTS HMO - HCPCS - G0421",1,37,80.23,42.72,136.13999999999999,9.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - L3908",1,143,73.22,73.22,328.66,35.75]
["TUFTS - TUFTS HMO - HCPCS - G0444",1,42,10.18,8.9,16.149999999999999,10.5]
["FALLON - FALLON SENIOR PLAN - HCPCS - L3967",1,117,1765.23,1765.23,7923.54,29.25]
["TUFTS - TUFTS HMO - HCPCS - G0514",1,84,0,148.6,148.6,21]
["FALLON - FALLON SENIOR PLAN - HCPCS - L3980",1,132,377.84,377.84,1695.98,33]
["FALLON - FALLON MEDICAID - HCPCS - G0416",1,425,0,360.63,2456.98,106.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - L3982",1,176,398.23,398.23,1787.56,44]
["TUFTS - TUFTS HMO - HCPCS - L0140",1,189,138.88999999999999,77.52,347.97,47.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - L4350",1,360,97.28,97.28,436.66,90]
["TUFTS - TUFTS HMO - HCPCS - L3650",1,1955,120.7,67.38,302.45,488.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - L4360",1,557,345.83,345.83,1552.36,139.25]
["TUFTS - TUFTS HMO - HCPCS - L3967",1,117,3162.38,1765.23,7923.54,29.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - L4370",1,107,235.79,235.79,1058.3900000000001,26.75]
["TUFTS - TUFTS HMO - HCPCS - L4398",1,406,141.38999999999999,78.92,354.25,101.5]
["FALLON - FALLON SENIOR PLAN - HCPCS - L4386",1,165,155.02000000000001,155.02000000000001,695.83,41.25]
["TUFTS - TUFTS HMO - HCPCS - P9016",1,576,282.10000000000002,243.01,478.65,144]
["FALLON - FALLON SENIOR PLAN - HCPCS - L4396",1,406,171.42,171.42,769.43,101.5]
["FALLON - FALLON MEDICAID - HCPCS - A9556",1,20,0,311.94,311.94,5]
["FALLON - FALLON SENIOR PLAN - HCPCS - L4398",1,406,78.92,78.92,354.25,101.5]
["TUFTS - TUFTS HMO - HCPCS - Q0114",1,41,33.08,7.2,82.86,10.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - L8501",1,219,160.74,160.74,721.54,54.75]
["TUFTS - TUFTS HMO - HCPCS - Q4116",1,5248,0,32.29,35.78,1312]
["FALLON - FALLON SENIOR PLAN - HCPCS - L8507",1,1604,41.03,41.03,184.14,401]
["TUFTS - TUFTS HMO - HCPCS - Q9956",1,76,0,31.75,79.89,19]
["FALLON - FALLON SENIOR PLAN - HCPCS - L8509",1,1144,106.99,106.99,480.27,286]
["TUFTS - TUFTS HMO - HCPCS - S8037",1,1440,1505.27,585.76,3771.6,360]
["FALLON - FALLON SENIOR PLAN - HCPCS - L8514",1,387,92.38,92.38,414.69,96.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A6209",1,163,12.59,8.68,21.84,40.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - L8693",1,1462,1485.57,1485.57,6668.25,365.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A9581",1,99,21.4,14.76,37.14,24.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - M0239",1,393,309.60000000000002,309.60000000000002,779.02,98.25]
["FALLON - FALLON MEDICAID - HCPCS - G0438",1,547,0,34.03,61.76,136.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - M0243",1,572,309.60000000000002,309.60000000000002,779.02,143]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L1830",1,78,118.83,81.95,367.86,19.5]
["FALLON - FALLON SENIOR PLAN - HCPCS - P9045",1,238,52.45,52.45,131.97,59.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L3762",1,57,138.74,95.68,429.49,14.25]
["FALLON - FALLON MEDICAID - HCPCS - A9543",1,66322,0,72400.97,217685.7,16580.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L4350",1,360,141.06,97.28,436.66,90]
["FALLON - FALLON SENIOR PLAN - HCPCS - P9612",1,90,3,2.2200000000000002,1198.25,22.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L8509",1,1144,155.13999999999999,106.99,480.27,286]
["FALLON - FALLON SENIOR PLAN - HCPCS - Q0111",1,23,15.12,5.86,127.48,5.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q4101",1,1601,44.17,30.46,76.64,400.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - Q0114",1,41,9.74,7.2,82.86,10.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q9961",1,1,0.36,0.25,0.63,0.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - Q3014",1,67,26.65,26.65,67.06,16.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - A4562",1,64,83.68,57.71,145.21,16]
["FALLON - FALLON SENIOR PLAN - HCPCS - Q4101",1,1601,30.46,30.46,76.64,400.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - A9579",1,5,2.2200000000000002,1.53,4.38,1.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - Q4102",1,69,10.210000000000001,10.210000000000001,25.69,17.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - G2024",1,33,36.92,25.46,230.84,8.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - Q4132",1,3754,114.63,114.63,288.43,938.5]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L1820",1,159,206.76,142.59,640.03,39.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - Q4133",1,3756,131.97,131.97,332.06,939]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L3760",1,819,645.28,445.02,1997.57,204.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - Q4196",1,9044,111.59,111.59,280.77999999999997,2261]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L3982",1,176,577.42999999999995,398.23,1787.56,44]
["FALLON - FALLON SENIOR PLAN - HCPCS - Q9956",1,76,31.75,31.75,79.89,19]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L8507",1,1604,59.49,41.03,184.14,401]
["FALLON - FALLON SENIOR PLAN - HCPCS - Q9957",1,417,47.63,47.63,119.85,104.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - P9612",1,90,4.3499999999999996,2.2200000000000002,1198.25,22.5]
["FALLON - FALLON SENIOR PLAN - HCPCS - Q9958",1,1,7.0000000000000007E-2,7.0000000000000007E-2,0.18,0.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - Q4196",1,9044,161.81,111.59,280.77999999999997,2261]
["FALLON - FALLON SENIOR PLAN - HCPCS - Q9961",1,1,0.25,0.25,0.63,0.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - U0001",1,124,52.07,35.909999999999997,325.64,31]
["FALLON - FALLON SENIOR PLAN - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["TUFTS - TUFTS POS - HCPCS - 90471",1,64,203.7,76.22,345.64,16]
["FALLON - FALLON SENIOR PLAN - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["TUFTS - TUFTS POS - HCPCS - A4725",1,87,0,null,null,21.75]
["FALLON - FALLON MEDICAID - HCPCS - A7520",1,1173,0,55.16,138.79,293.25]
["TUFTS - TUFTS POS - HCPCS - A9503",1,23,0,37.119999999999997,37.119999999999997,5.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - U0001",1,124,35.909999999999997,35.909999999999997,325.64,31]
["TUFTS - TUFTS POS - HCPCS - A9521",1,360,0,4157.3,4157.3,90]
["FALLON - FALLON SENIOR PLAN - HCPCS - U0002",1,92,51.31,51.31,465.19,23]
["TUFTS - TUFTS POS - HCPCS - A9551",1,154,0,1711.56,1711.56,38.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - 0042T",1,767,0,1452,1452,191.75]
["TUFTS - TUFTS POS - HCPCS - A9562",1,1237,0,2212.25,2212.25,309.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - 0278T",1,77,293.52,286.31,943.8,19.25]
["TUFTS - TUFTS POS - HCPCS - A9579",1,5,0,1.53,4.38,1.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - 0402T",1,2880,3522.21,1198.25,11845.41,720]
["TUFTS - TUFTS POS - HCPCS - A9588",1,15438,0,525.05999999999995,703.05,3859.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - 45378",1,1672,1608.22,1020.59,3264.67,418]
["TUFTS - TUFTS POS - HCPCS - C1721",1,39674,0,null,null,9918.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - 81170",1,798,647.70000000000005,159,2909.77,199.5]
["TUFTS - TUFTS POS - HCPCS - C1732",1,7766,0,null,null,1941.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - 90471",1,64,129,76.22,345.64,16]
["TUFTS - TUFTS POS - HCPCS - C1760",1,1799,0,null,null,449.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - 92083",1,461,229.89,68.75,607.84,115.25]
["TUFTS - TUFTS POS - HCPCS - C1770",1,3667,0,null,null,916.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - 95800",1,205,293.52,228.32,1412.44,51.25]
["TUFTS - TUFTS POS - HCPCS - C1788",1,540,0,null,null,135]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A4215",1,433,0,null,null,108.25]
["TUFTS - TUFTS POS - HCPCS - C1884",1,31469,0,null,null,7867.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A4561",1,108,0,23.18,58.33,27]
["TUFTS - TUFTS POS - HCPCS - C1900",1,8293,0,null,null,2073.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A4562",1,64,0,57.71,145.21,16]
["TUFTS - TUFTS POS - HCPCS - C2630",1,4966,0,null,null,1241.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A4648",1,281,0,null,null,70.25]
["TUFTS - TUFTS POS - HCPCS - C9728",1,1957,4183.66,2227.36,7098.97,489.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A4725",1,87,0,null,null,21.75]
["TUFTS - TUFTS POS - HCPCS - D0272",1,836,2396.69,1182.5,4066.77,209]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A6209",1,163,0,8.68,21.84,40.75]
["TUFTS - TUFTS POS - HCPCS - D1510",1,836,2396.69,1275.99,4066.77,209]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A6258",1,83,0,5,12.58,20.75]
["TUFTS - TUFTS POS - HCPCS - D4263",1,1451,2396.69,1275.99,4066.77,362.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A6550",1,4,0,25.71,64.69,1]
["TUFTS - TUFTS POS - HCPCS - D5983",1,1451,2396.69,1275.99,4066.77,362.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A7520",1,1173,0,55.16,138.79,293.25]
["TUFTS - TUFTS POS - HCPCS - D7240",1,836,2396.69,1275.99,4066.77,209]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9500",1,274,0,463.42,463.42,68.5]
["TUFTS - TUFTS POS - HCPCS - D9930",1,1451,2396.69,1275.99,4066.77,362.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9502",1,140,0,278.27,278.27,35]
["TUFTS - TUFTS POS - HCPCS - G0109",1,267,79.11,32.64,134.25,66.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9503",1,23,0,37.119999999999997,37.119999999999997,5.75]
["TUFTS - TUFTS POS - HCPCS - G0278",1,3138,0,34.229999999999997,34.229999999999997,784.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9505",1,23,0,395.74,395.74,5.75]
["TUFTS - TUFTS POS - HCPCS - G0396",1,42,111.85,56.05,336.32,10.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9509",1,95,0,5163.91,5163.91,23.75]
["TUFTS - TUFTS POS - HCPCS - G0423",1,169,375.87,198.42,637.79,42.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9512",1,1,0,null,null,0.25]
["TUFTS - TUFTS POS - HCPCS - G0446",1,42,10.18,8.9,16.149999999999999,10.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9513",1,320,441.49,294.27999999999997,1097.56,80]
["TUFTS - TUFTS POS - HCPCS - G2012",1,42,0,31.78,31.78,10.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9516",1,192,0,516.39,516.39,48]
["FALLON - FALLON MEDICAID - HCPCS - G0513",1,84,0,148.6,148.6,21]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9517",1,437,62.66,30.1,101.94,109.25]
["TUFTS - TUFTS POS - HCPCS - Q4133",1,3756,0,131.97,332.06,939]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9520",1,1951,0,null,null,487.75]
["TUFTS - TUFTS POS - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9521",1,360,0,4157.3,4157.3,90]
["TUFTS - TUFTS PPO - HCPCS - A7520",1,1173,0,55.16,138.79,293.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9537",1,138,0,157.94999999999999,157.94999999999999,34.5]
["TUFTS - TUFTS PPO - HCPCS - A9516",1,192,0,516.39,516.39,48]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9538",1,111,0,114.21,114.21,27.75]
["TUFTS - TUFTS HMO - HCPCS - A6550",1,4,0,25.71,64.69,1]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9539",1,668,0,89.47,89.47,167]
["TUFTS - TUFTS HMO - HCPCS - A9503",1,23,0,37.119999999999997,37.119999999999997,5.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9540",1,1831,0,85.66,85.66,457.75]
["TUFTS - TUFTS HMO - HCPCS - A9513",1,320,438.05,294.27999999999997,1097.56,80]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9541",1,120,0,152.69,152.69,30]
["TUFTS - TUFTS HMO - HCPCS - A9521",1,360,0,4157.3,4157.3,90]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9543",1,66322,97558.58,72400.97,217685.7,16580.5]
["TUFTS - TUFTS HMO - HCPCS - A9540",1,1831,0,85.66,85.66,457.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9547",1,440,0,5105.7299999999996,5105.7299999999996,110]
["TUFTS - TUFTS HMO - HCPCS - A9551",1,154,0,1711.56,1711.56,38.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9551",1,154,0,1711.56,1711.56,38.5]
["TUFTS - TUFTS HMO - HCPCS - A9557",1,239,0,1062.44,1062.44,59.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9552",1,972,0,1166.46,1166.46,243]
["TUFTS - TUFTS HMO - HCPCS - A9562",1,1237,0,2212.25,2212.25,309.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9555",1,1065,0,1604.08,1604.08,266.25]
["TUFTS - TUFTS HMO - HCPCS - A9572",1,131,0,16207.01,16207.01,32.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9556",1,20,0,311.94,311.94,5]
["TUFTS - TUFTS HMO - HCPCS - A9579",1,5,0,1.53,4.38,1.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9557",1,239,0,1062.44,1062.44,59.75]
["TUFTS - TUFTS HMO - HCPCS - A9583",1,13,0,19.260000000000002,21.34,3.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9558",1,23,0,108.88,108.88,5.75]
["TUFTS - TUFTS HMO - HCPCS - A9588",1,15438,0,525.05999999999995,703.05,3859.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9560",1,246,0,266.7,266.7,61.5]
["TUFTS - TUFTS HMO - HCPCS - C1715",1,21,0,null,null,5.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9561",1,127,0,125.64,125.64,31.75]
["TUFTS - TUFTS HMO - HCPCS - C1721",1,39674,0,null,null,9918.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9562",1,1237,0,2212.25,2212.25,309.25]
["TUFTS - TUFTS HMO - HCPCS - C1726",1,387,0,null,null,96.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9563",1,0,535.17999999999995,535.17999999999995,3182.68,0]
["TUFTS - TUFTS HMO - HCPCS - C1732",1,7766,0,null,null,1941.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9569",1,5086,0,4157.3,4157.3,1271.5]
["TUFTS - TUFTS HMO - HCPCS - C1753",1,3947,0,null,null,986.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9570",1,6395,0,null,null,1598.75]
["TUFTS - TUFTS HMO - HCPCS - C1760",1,1799,0,null,null,449.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9572",1,131,0,16207.01,16207.01,32.75]
["TUFTS - TUFTS HMO - HCPCS - C1765",1,569,0,null,null,142.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9575",1,8,0,0.18,0.45,2]
["TUFTS - TUFTS HMO - HCPCS - C1770",1,3667,0,null,null,916.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9576",1,5,0,1.5,3.77,1.25]
["TUFTS - TUFTS HMO - HCPCS - C1781",1,36449,0,null,null,9112.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9577",1,21,0,1.81,5.03,5.25]
["TUFTS - TUFTS HMO - HCPCS - C1788",1,540,0,null,null,135]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9579",1,5,0,1.53,4.38,1.25]
["TUFTS - TUFTS HMO - HCPCS - C1876",1,11691,0,null,null,2922.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9580",1,158,0,null,null,39.5]
["TUFTS - TUFTS HMO - HCPCS - C1884",1,31469,0,null,null,7867.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9581",1,99,0,14.76,37.14,24.75]
["TUFTS - TUFTS HMO - HCPCS - C1894",1,252,0,null,null,63]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9582",1,10370,0,null,null,2592.5]
["TUFTS - TUFTS HMO - HCPCS - C1900",1,8293,0,null,null,2073.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9583",1,13,0,19.260000000000002,21.34,3.25]
["TUFTS - TUFTS HMO - HCPCS - C2621",1,21692,0,null,null,5423]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9584",1,2729,0,3235.55,3235.55,682.25]
["TUFTS - TUFTS HMO - HCPCS - C2630",1,4966,0,null,null,1241.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9586",1,4402,5015.9399999999996,3746.06,7452.46,1100.5]
["TUFTS - TUFTS HMO - HCPCS - C5275",1,743,1281.21,684.11,2032.26,185.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9587",1,12985,113.78,84.97,113.78,3246.25]
["TUFTS - TUFTS HMO - HCPCS - C9728",1,1957,4183.66,2227.36,7098.97,489.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9588",1,15438,703.05,525.05999999999995,703.05,3859.5]
["TUFTS - TUFTS HMO - HCPCS - D0240",1,836,2396.69,1275.99,4066.77,209]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9606",1,493,247.36,198.62,597.20000000000005,123.25]
["TUFTS - TUFTS HMO - HCPCS - D0272",1,836,2396.69,1182.5,4066.77,209]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1713",1,4568,0,null,null,1142]
["TUFTS - TUFTS HMO - HCPCS - D0473",1,110,3646.27,1941.26,6187.11,27.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1714",1,6114,0,null,null,1528.5]
["TUFTS - TUFTS HMO - HCPCS - D1510",1,836,2396.69,1275.99,4066.77,209]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1715",1,21,0,null,null,5.25]
["TUFTS - TUFTS HMO - HCPCS - D2999",1,1451,2396.69,1275.99,4066.77,362.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1716",1,0,200.39,168.52,506.68,0]
["TUFTS - TUFTS HMO - HCPCS - D4263",1,1451,2396.69,1275.99,4066.77,362.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1717",1,607,554.13,469.29,1411.01,151.75]
["TUFTS - TUFTS HMO - HCPCS - D4355",1,836,2396.69,1275.99,4066.77,209]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1719",1,95,108.35,108.35,357.35,23.75]
["TUFTS - TUFTS HMO - HCPCS - D5983",1,1451,2396.69,1275.99,4066.77,362.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1721",1,39674,0,null,null,9918.5]
["TUFTS - TUFTS HMO - HCPCS - D7140",1,836,2396.69,1275.99,4066.77,209]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1722",1,43645,0,null,null,10911.25]
["TUFTS - TUFTS HMO - HCPCS - D7240",1,836,2396.69,1275.99,4066.77,209]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1724",1,7410,0,null,null,1852.5]
["TUFTS - TUFTS HMO - HCPCS - D7940",1,1451,2396.69,1275.99,4066.77,362.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1725",1,1693,0,null,null,423.25]
["TUFTS - TUFTS HMO - HCPCS - D9930",1,1451,2396.69,1275.99,4066.77,362.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1726",1,387,0,null,null,96.75]
["TUFTS - TUFTS HMO - HCPCS - G0101",1,148,24.73,18.010000000000002,128.29,37]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1729",1,2283,0,null,null,570.75]
["TUFTS - TUFTS HMO - HCPCS - G0109",1,267,79.11,32.64,134.25,66.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1730",1,2283,0,null,null,570.75]
["TUFTS - TUFTS HMO - HCPCS - G0257",1,911,2151.9699999999998,1027.32,3651.55,227.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1731",1,3847,0,null,null,961.75]
["TUFTS - TUFTS HMO - HCPCS - G0278",1,3138,0,34.229999999999997,34.229999999999997,784.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1732",1,7766,0,null,null,1941.5]
["TUFTS - TUFTS HMO - HCPCS - G0365",1,498,510.97,272.02999999999997,867.01,124.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1733",1,10475,0,null,null,2618.75]
["TUFTS - TUFTS HMO - HCPCS - G0396",1,42,134.22,56.05,336.32,10.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1750",1,1693,0,null,null,423.25]
["TUFTS - TUFTS HMO - HCPCS - G0416",1,425,980.58,360.63,2456.98,106.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1751",1,1438,0,null,null,359.5]
["TUFTS - TUFTS HMO - HCPCS - G0423",1,169,375.87,198.42,637.79,42.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1753",1,3947,0,null,null,986.75]
["TUFTS - TUFTS HMO - HCPCS - G0442",1,42,21.18,13.34,33.6,10.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1756",1,1438,0,null,null,359.5]
["TUFTS - TUFTS HMO - HCPCS - G0446",1,42,10.18,8.9,16.149999999999999,10.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1757",1,15822,0,null,null,3955.5]
["TUFTS - TUFTS HMO - HCPCS - G0506",1,62,0,110.9,110.9,15.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1759",1,6295,0,null,null,1573.75]
["TUFTS - TUFTS HMO - HCPCS - G2012",1,42,0,31.78,31.78,10.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1760",1,1799,0,null,null,449.75]
["TUFTS - TUFTS HMO - HCPCS - G2086",1,194,55.42,46.18,211.43,48.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1762",1,12010,0,null,null,3002.5]
["FALLON - FALLON MEDICAID - HCPCS - G0421",1,37,0,42.72,136.13999999999999,9.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1763",1,2242,0,null,null,560.5]
["FALLON - FALLON MEDICAID - HCPCS - G0422",1,169,0,198.42,637.79,42.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1764",1,8983,0,null,null,2245.75]
["TUFTS - TUFTS HMO - HCPCS - L1830",1,78,146.82,81.95,367.86,19.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1765",1,569,0,null,null,142.25]
["TUFTS - TUFTS HMO - HCPCS - L3260",1,279,142.85,31.12,357.96,69.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1766",1,2619,0,null,null,654.75]
["TUFTS - TUFTS HMO - HCPCS - L3760",1,819,797.25,445.02,1997.57,204.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1768",1,76125,0,null,null,19031.25]
["TUFTS - TUFTS HMO - HCPCS - L3905",1,2442,1581.02,882.51,3961.32,610.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1769",1,4759,0,null,null,1189.75]
["TUFTS - TUFTS HMO - HCPCS - L3982",1,176,713.43,398.23,1787.56,44]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1770",1,3667,0,null,null,916.75]
["TUFTS - TUFTS HMO - HCPCS - L4386",1,165,277.72000000000003,155.02000000000001,695.83,41.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1773",1,2163,0,null,null,540.75]
["TUFTS - TUFTS HMO - HCPCS - L8507",1,1604,73.5,41.03,184.14,401]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1776",1,21721,0,null,null,5430.25]
["TUFTS - TUFTS HMO - HCPCS - L8699",1,13957,0,null,null,3489.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1777",1,13038,0,null,null,3259.5]
["TUFTS - TUFTS HMO - HCPCS - P9021",1,323,208.77,184.28,354.25,80.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1781",1,36449,0,null,null,9112.25]
["TUFTS - TUFTS HMO - HCPCS - P9044",1,133,144.19999999999999,144.19999999999999,244.67,33.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1784",1,2734,0,null,null,683.5]
["TUFTS - TUFTS HMO - HCPCS - P9057",1,785,395.89,395.89,671.74,196.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1785",1,12546,0,null,null,3136.5]
["TUFTS - TUFTS HMO - HCPCS - Q0091",1,83,70.099999999999994,28.83,175.66,20.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1786",1,23460,0,null,null,5865]
["TUFTS - TUFTS HMO - HCPCS - Q4100",1,12079,0,null,null,3019.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1788",1,540,0,null,null,135]
["TUFTS - TUFTS HMO - HCPCS - Q4107",1,2233,0,86.55,110.48,558.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1817",1,9668,0,null,null,2417]
["TUFTS - TUFTS HMO - HCPCS - Q4125",1,4060,0,3.79,3.79,1015]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1821",1,9770,0,null,null,2442.5]
["TUFTS - TUFTS HMO - HCPCS - Q4196",1,9044,152,111.59,280.77999999999997,2261]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1874",1,8879,0,null,null,2219.75]
["TUFTS - TUFTS HMO - HCPCS - Q9958",1,1,0,7.0000000000000007E-2,0.18,0.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1876",1,11691,0,null,null,2922.75]
["FALLON - FALLON MEDICAID - HCPCS - A9517",1,437,0,30.1,101.94,109.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1880",1,7726,0,null,null,1931.5]
["TUFTS - TUFTS HMO - HCPCS - U0002",1,92,198.6,51.31,465.19,23]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1882",1,53226,0,null,null,13306.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A4561",1,108,33.61,23.18,58.33,27]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1883",1,1257,0,null,null,314.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A6550",1,4,37.28,25.71,64.69,1]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1884",1,31469,0,null,null,7867.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A9577",1,21,2.62,1.81,5.03,5.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1887",1,3731,0,null,null,932.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - G0103",1,93,28,16.78,181.16,23.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1892",1,340,0,null,null,85]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - G2023",1,31,34.020000000000003,23.46,212.71,7.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1893",1,406,0,null,null,101.5]
["FALLON - FALLON MEDICAID - HCPCS - G0442",1,42,0,13.34,33.6,10.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1894",1,252,0,null,null,63]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L0140",1,189,112.4,77.52,347.97,47.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1895",1,13382,0,null,null,3345.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L1836",1,209,189.2,130.47999999999999,585.70000000000005,52.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1896",1,10912,0,null,null,2728]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L3670",1,2903,150.29,103.65,465.27,725.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1898",1,1575,0,null,null,393.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L3808",1,509,545.11,375.94,1687.5,127.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1900",1,8293,0,null,null,2073.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L3980",1,132,547.87,377.84,1695.98,33]
["FALLON - FALLON MEDICAID - HCPCS - A9592",1,5634,0,null,null,1408.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L4370",1,107,341.9,235.79,1058.3900000000001,26.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C2616",1,60393,29411.3,25512.2,76706.740000000005,15098.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L8501",1,219,233.07,160.74,721.54,54.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C2617",1,638,0,null,null,159.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L8693",1,1462,2154.08,1485.57,6668.25,365.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C2621",1,21692,0,null,null,5423]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q0111",1,23,21.92,5.86,127.48,5.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C2623",1,2837,0,null,null,709.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q4132",1,3754,166.21,114.63,288.43,938.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C2625",1,246,0,null,null,61.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q9957",1,417,69.06,47.63,119.85,104.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C2628",1,2308,0,null,null,577]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C2630",1,4966,0,null,null,1241.5]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - 81170",1,798,435,159,2909.77,199.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C2634",1,0,313.02999999999997,232.45,698.88,0]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - A6258",1,83,7.25,5,12.58,20.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C2635",1,0,97.01,78.03,242.54,0]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - A9576",1,5,2.1800000000000002,1.5,3.77,1.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C2639",1,47,61.32,52.85,100.75,11.75]
["FALLON - FALLON MEDICAID - HCPCS - G0443",1,118,0,18.52,33.6,29.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C5275",1,743,1042.56,684.11,2032.26,185.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - G0481",1,192,227.06,91.84,1332.11,48]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C8908",1,579,664.1,664.1,4299.8,144.75]
["FALLON - FALLON MEDICAID - HCPCS - G0445",1,118,0,8.9,16.149999999999999,29.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C8937",1,331,0,null,null,82.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L0120",1,25,36.049999999999997,24.86,111.59,6.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C9358",1,8526,0,24.42,24.42,2131.5]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L1832",1,1523,1078.21,743.59,3337.75,380.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C9728",1,1957,2573.36,2227.36,7098.97,489.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L3650",1,1955,97.7,67.38,302.45,488.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C9739",1,6035,7812.32,2166.09,15242.01,1508.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L3807",1,483,322.64999999999998,222.52,998.85,120.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0103",1,93,44.13,16.78,181.16,23.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L3967",1,117,2559.58,1765.23,7923.54,29.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0105",1,1152,1608.22,1020.59,3264.67,288]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L4360",1,557,501.45,345.83,1552.36,139.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0108",1,425,121.38,72.41,230.78,106.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L4398",1,406,114.43,78.92,354.25,101.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0109",1,267,33.46,32.64,134.25,66.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L8514",1,387,133.94999999999999,92.38,414.69,96.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0127",1,189,120.69,93.87,317.35000000000002,47.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - P9045",1,238,76.05,52.45,131.97,59.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0239",1,99,69.349999999999994,53.94,373.41,24.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - Q0114",1,41,14.12,7.2,82.86,10.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0257",1,911,1320.72,1027.32,3651.55,227.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - Q4132",1,3754,166.21,114.63,288.43,938.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0259",1,1513,0,1198.25,1198.25,378.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - Q9957",1,417,69.06,47.63,119.85,104.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0260",1,817,1292.83,1005.62,3474.13,204.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0269",1,200,0,null,null,50]
["TUFTS - TUFTS POS - HCPCS - 0042T",1,767,0,1452,1452,191.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0270",1,86,70.819999999999993,69.08,70.819999999999993,21.5]
["TUFTS - TUFTS POS - HCPCS - 45378",1,1672,2058.17,1020.59,3264.67,418]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0278",1,3138,0,34.229999999999997,34.229999999999997,784.5]
["TUFTS - TUFTS POS - HCPCS - 95800",1,205,469.76,228.32,1412.44,51.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0279",1,55,32.69,30.09,295.68,13.75]
["TUFTS - TUFTS POS - HCPCS - A4570",1,40,35.700000000000003,19.010000000000002,107.35,10]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0297",1,1437,107.22,107.22,801.26,359.25]
["TUFTS - TUFTS POS - HCPCS - A6258",1,83,0,5,12.58,20.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0390",1,3274,0,1579.83,5035.18,818.5]
["TUFTS - TUFTS POS - HCPCS - A9500",1,274,0,463.42,463.42,68.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0416",1,425,592.04,360.63,2456.98,106.25]
["TUFTS - TUFTS POS - HCPCS - A9509",1,95,0,5163.91,5163.91,23.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0422",1,169,255.09,198.42,637.79,42.25]
["TUFTS - TUFTS POS - HCPCS - A9517",1,437,30.1,30.1,101.94,109.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0423",1,169,255.09,198.42,637.79,42.25]
["TUFTS - TUFTS POS - HCPCS - A9538",1,111,0,114.21,114.21,27.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0424",1,284,120.69,93.87,343.09,71]
["TUFTS - TUFTS POS - HCPCS - A9543",1,66322,72400.97,72400.97,217685.7,16580.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0480",1,254,247.05,59.69,973.54,63.5]
["TUFTS - TUFTS POS - HCPCS - A9555",1,1065,0,1604.08,1604.08,266.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0481",1,192,338.08,91.84,1332.11,48]
["TUFTS - TUFTS POS - HCPCS - A9560",1,246,0,266.7,266.7,61.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0506",1,62,0,110.9,110.9,15.5]
["TUFTS - TUFTS POS - HCPCS - A9569",1,5086,0,4157.3,4157.3,1271.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0513",1,84,0,148.6,148.6,21]
["TUFTS - TUFTS POS - HCPCS - A9576",1,5,0,1.5,3.77,1.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0514",1,84,0,148.6,148.6,21]
["TUFTS - TUFTS POS - HCPCS - A9581",1,99,0,14.76,37.14,24.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G2066",1,165,80.23,58.35,370.47,41.25]
["TUFTS - TUFTS POS - HCPCS - A9586",1,4402,4392.1499999999996,3746.06,7452.46,1100.5]
["FALLON - FALLON MEDICAID - HCPCS - G0101",1,148,0,18.010000000000002,128.29,37]
["TUFTS - TUFTS POS - HCPCS - C1713",1,4568,0,null,null,1142]
["FALLON - FALLON MEDICAID - HCPCS - A9563",1,0,0,535.17999999999995,3182.68,0]
["TUFTS - TUFTS POS - HCPCS - C1717",1,607,469.29,469.29,1411.01,151.75]
["FALLON - FALLON MEDICAID - HCPCS - G0127",1,189,0,93.87,317.35000000000002,47.25]
["TUFTS - TUFTS POS - HCPCS - C1724",1,7410,0,null,null,1852.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - J2790",1,186.95,0,74.3,186.95,46.737499999999997]
["TUFTS - TUFTS POS - HCPCS - C1730",1,2283,0,null,null,570.75]
["FALLON - FALLON MEDICAID - HCPCS - A9500",1,274,0,463.42,463.42,68.5]
["TUFTS - TUFTS POS - HCPCS - C1750",1,1693,0,null,null,423.25]
["FALLON - FALLON MEDICAID - HCPCS - G0175",1,565,0,638.73,2035.73,141.25]
["TUFTS - TUFTS POS - HCPCS - C1757",1,15822,0,null,null,3955.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - L8699",1,13957,0,null,null,3489.25]
["TUFTS - TUFTS POS - HCPCS - C1763",1,2242,0,null,null,560.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9012",1,134,106.65,64.959999999999994,125.33,33.5]
["TUFTS - TUFTS POS - HCPCS - C1768",1,76125,0,null,null,19031.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9016",1,576,398.94,243.01,478.65,144]
["TUFTS - TUFTS POS - HCPCS - C1776",1,21721,0,null,null,5430.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9017",1,291,154.43,94.07,217.72,72.75]
["TUFTS - TUFTS POS - HCPCS - C1785",1,12546,0,null,null,3136.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9021",1,323,302.52,184.28,354.25,80.75]
["TUFTS - TUFTS POS - HCPCS - C1821",1,9770,0,null,null,2442.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9034",1,506,727.76,443.29,799.73,126.5]
["TUFTS - TUFTS POS - HCPCS - C1882",1,53226,0,null,null,13306.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9037",1,939,1349.22,821.84,1622.67,234.75]
["TUFTS - TUFTS POS - HCPCS - C1892",1,340,0,null,null,85]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9040",1,523,551.79999999999995,336.11,669.97,130.75]
["TUFTS - TUFTS POS - HCPCS - C1896",1,10912,0,null,null,2728]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9044",1,133,191.57,144.19999999999999,244.67,33.25]
["TUFTS - TUFTS POS - HCPCS - C2616",1,60393,25512.2,25512.2,76706.740000000005,15098.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9045",1,238,113.24,52.45,131.97,59.5]
["TUFTS - TUFTS POS - HCPCS - C2625",1,246,0,null,null,61.5]
["FALLON - FALLON MEDICAID - HCPCS - A9547",1,440,0,5105.7299999999996,5105.7299999999996,110]
["TUFTS - TUFTS POS - HCPCS - C2635",1,0,80.66,78.03,242.54,0]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9056",1,1619,486.79,311.95,529.32000000000005,404.75]
["TUFTS - TUFTS POS - HCPCS - C8937",1,331,0,null,null,82.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9057",1,785,484.72,395.89,671.74,196.25]
["TUFTS - TUFTS POS - HCPCS - C9803",1,35,87.7,87.7,246.49,8.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9073",1,889,1349.22,821.84,2619.59,222.25]
["TUFTS - TUFTS POS - HCPCS - D0251",1,119,0,null,null,29.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9100",1,1310,55.05,33.53,256.64,327.5]
["TUFTS - TUFTS POS - HCPCS - D0277",1,1451,2396.69,1275.99,4066.77,362.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9612",1,90,0,2.2200000000000002,1198.25,22.5]
["TUFTS - TUFTS POS - HCPCS - D0480",1,110,3646.27,1941.26,6187.11,27.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q0091",1,83,37.07,28.83,175.66,20.75]
["TUFTS - TUFTS POS - HCPCS - D1517",1,1451,0,null,null,362.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q0111",1,23,32.36,5.86,127.48,5.75]
["TUFTS - TUFTS POS - HCPCS - D3999",1,1451,2396.69,1275.99,4066.77,362.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q0114",1,41,21.03,7.2,82.86,10.25]
["TUFTS - TUFTS POS - HCPCS - D4270",1,1451,2396.69,1275.99,4066.77,362.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q4101",1,1601,0,30.46,76.64,400.25]
["TUFTS - TUFTS POS - HCPCS - D5911",1,1451,2396.69,1275.99,4066.77,362.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q4102",1,69,0,10.210000000000001,25.69,17.25]
["TUFTS - TUFTS POS - HCPCS - D5985",1,1451,2396.69,1275.99,4066.77,362.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q4104",1,7748,0,42.08,56.11,1937]
["TUFTS - TUFTS POS - HCPCS - D7220",1,836,2396.69,1275.99,4066.77,209]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q4107",1,2233,0,86.55,110.48,558.25]
["TUFTS - TUFTS POS - HCPCS - D7260",1,1081,2396.69,1275.99,4066.77,270.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q4112",1,535,0,904.99,1002.89,133.75]
["TUFTS - TUFTS POS - HCPCS - D9230",1,110,0,null,null,27.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q4116",1,5248,0,32.29,35.78,1312]
["TUFTS - TUFTS POS - HCPCS - D9951",1,1350,2396.69,1275.99,4066.77,337.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q4124",1,23,0,16.39,16.39,5.75]
["TUFTS - TUFTS POS - HCPCS - G0105",1,1152,2058.17,1020.59,3264.67,288]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q4125",1,4060,0,3.79,3.79,1015]
["TUFTS - TUFTS POS - HCPCS - G0175",1,565,1199.72,638.73,2035.73,141.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q4130",1,65718,0,45.89,45.89,16429.5]
["TUFTS - TUFTS POS - HCPCS - G0260",1,817,2047.41,1005.62,3474.13,204.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q4132",1,3754,0,114.63,288.43,938.5]
["TUFTS - TUFTS POS - HCPCS - G0296",1,118,219.75,102.62,660.74,29.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q4133",1,3756,0,131.97,332.06,939]
["TUFTS - TUFTS POS - HCPCS - G0379",1,752,1642.65,874.54,2787.3,188]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q4196",1,9044,192.05,111.59,280.77999999999997,2261]
["FALLON - FALLON MEDICAID - HCPCS - G0480",1,254,59.69,59.69,973.54,63.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q9954",1,0,0,12.1,13.41,0]
["TUFTS - TUFTS POS - HCPCS - G0421",1,37,80.23,42.72,136.13999999999999,9.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q9956",1,76,0,31.75,79.89,19]
["TUFTS - TUFTS POS - HCPCS - G0438",1,547,38.93,34.03,61.76,136.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q9957",1,417,0,47.63,119.85,104.25]
["TUFTS - TUFTS POS - HCPCS - G0444",1,42,10.18,8.9,16.149999999999999,10.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q9958",1,1,0,7.0000000000000007E-2,0.18,0.25]
["TUFTS - TUFTS POS - HCPCS - G0480",1,254,323.77,59.69,973.54,63.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q9961",1,1,0,0.25,0.63,0.25]
["TUFTS - TUFTS POS - HCPCS - G0514",1,84,0,148.6,148.6,21]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["TUFTS - TUFTS POS - HCPCS - G2024",1,33,82.13,25.46,230.84,8.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["FALLON - FALLON MEDICAID - HCPCS - G0481",1,192,91.84,91.84,1332.11,48]
["FALLON - FALLON MEDICAID - HCPCS - A9502",1,140,0,278.27,278.27,35]
["FALLON - FALLON MEDICAID - HCPCS - G0514",1,84,0,148.6,148.6,21]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - V2790",1,1136,0,null,null,284]
["TUFTS - TUFTS POS - HCPCS - Q4130",1,65718,0,45.89,45.89,16429.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - 0042T",1,767,0,1452,1452,191.75]
["TUFTS - TUFTS POS - HCPCS - Q9954",1,0,0,12.1,13.41,0]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - 0278T",1,77,293.52,286.31,943.8,19.25]
["TUFTS - TUFTS POS - HCPCS - Q9961",1,1,0,0.25,0.63,0.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - 0402T",1,2880,3522.21,1198.25,11845.41,720]
["FALLON - FALLON MEDICAID - HCPCS - A9541",1,120,0,152.69,152.69,30]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - 45378",1,1672,1608.22,1020.59,3264.67,418]
["TUFTS - TUFTS PPO - HCPCS - A6549",1,37,0,null,null,9.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - 81170",1,798,647.70000000000005,159,2909.77,199.5]
["TUFTS - TUFTS PPO - HCPCS - A9502",1,140,0,278.27,278.27,35]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - 90471",1,64,129,76.22,345.64,16]
["TUFTS - TUFTS PPO - HCPCS - A9512",1,1,0,null,null,0.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - 92083",1,461,229.89,68.75,607.84,115.25]
["TUFTS - TUFTS PPO - HCPCS - A9520",1,1951,0,null,null,487.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - 95800",1,205,293.52,228.32,1412.44,51.25]
["TUFTS - TUFTS HMO - HCPCS - A6549",1,37,0,null,null,9.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A4215",1,433,0,null,null,108.25]
["TUFTS - TUFTS HMO - HCPCS - A7520",1,1173,0,55.16,138.79,293.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A4561",1,108,0,23.18,58.33,27]
["TUFTS - TUFTS HMO - HCPCS - A9502",1,140,0,278.27,278.27,35]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A4562",1,64,0,57.71,145.21,16]
["TUFTS - TUFTS HMO - HCPCS - A9505",1,23,0,395.74,395.74,5.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A4648",1,281,0,null,null,70.25]
["TUFTS - TUFTS HMO - HCPCS - A9512",1,1,0,null,null,0.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A4725",1,87,0,null,null,21.75]
["TUFTS - TUFTS HMO - HCPCS - A9516",1,192,0,516.39,516.39,48]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A6209",1,163,0,8.68,21.84,40.75]
["TUFTS - TUFTS HMO - HCPCS - A9520",1,1951,0,null,null,487.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A6258",1,83,0,5,12.58,20.75]
["TUFTS - TUFTS HMO - HCPCS - A9537",1,138,0,157.94999999999999,157.94999999999999,34.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A6550",1,4,0,25.71,64.69,1]
["TUFTS - TUFTS HMO - HCPCS - A9539",1,668,0,89.47,89.47,167]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A7520",1,1173,0,55.16,138.79,293.25]
["TUFTS - TUFTS HMO - HCPCS - A9541",1,120,0,152.69,152.69,30]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9500",1,274,0,463.42,463.42,68.5]
["TUFTS - TUFTS HMO - HCPCS - A9547",1,440,0,5105.7299999999996,5105.7299999999996,110]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9502",1,140,0,278.27,278.27,35]
["TUFTS - TUFTS HMO - HCPCS - A9552",1,972,0,1166.46,1166.46,243]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9503",1,23,0,37.119999999999997,37.119999999999997,5.75]
["TUFTS - TUFTS HMO - HCPCS - A9556",1,20,0,311.94,311.94,5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9505",1,23,0,395.74,395.74,5.75]
["TUFTS - TUFTS HMO - HCPCS - A9558",1,23,0,108.88,108.88,5.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9509",1,95,0,5163.91,5163.91,23.75]
["TUFTS - TUFTS HMO - HCPCS - A9561",1,127,0,125.64,125.64,31.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9512",1,1,0,null,null,0.25]
["TUFTS - TUFTS HMO - HCPCS - A9563",1,0,1270.25,535.17999999999995,3182.68,0]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9513",1,320,441.49,294.27999999999997,1097.56,80]
["TUFTS - TUFTS HMO - HCPCS - A9570",1,6395,0,null,null,1598.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9516",1,192,0,516.39,516.39,48]
["TUFTS - TUFTS HMO - HCPCS - A9575",1,8,0,0.18,0.45,2]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9517",1,437,62.66,30.1,101.94,109.25]
["TUFTS - TUFTS HMO - HCPCS - A9577",1,21,0,1.81,5.03,5.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9520",1,1951,0,null,null,487.75]
["TUFTS - TUFTS HMO - HCPCS - A9580",1,158,0,null,null,39.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9521",1,360,0,4157.3,4157.3,90]
["TUFTS - TUFTS HMO - HCPCS - A9582",1,10370,0,null,null,2592.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9537",1,138,0,157.94999999999999,157.94999999999999,34.5]
["TUFTS - TUFTS HMO - HCPCS - A9584",1,2729,0,3235.55,3235.55,682.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9538",1,111,0,114.21,114.21,27.75]
["TUFTS - TUFTS HMO - HCPCS - A9587",1,12985,0,84.97,113.78,3246.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9539",1,668,0,89.47,89.47,167]
["TUFTS - TUFTS HMO - HCPCS - A9606",1,493,238.35,198.62,597.20000000000005,123.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9540",1,1831,0,85.66,85.66,457.75]
["TUFTS - TUFTS HMO - HCPCS - C1714",1,6114,0,null,null,1528.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9541",1,120,0,152.69,152.69,30]
["TUFTS - TUFTS HMO - HCPCS - C1716",1,0,202.22,168.52,506.68,0]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9543",1,66322,97558.58,72400.97,217685.7,16580.5]
["TUFTS - TUFTS HMO - HCPCS - C1719",1,95,142.63,108.35,357.35,23.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9547",1,440,0,5105.7299999999996,5105.7299999999996,110]
["TUFTS - TUFTS HMO - HCPCS - C1722",1,43645,0,null,null,10911.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9551",1,154,0,1711.56,1711.56,38.5]
["TUFTS - TUFTS HMO - HCPCS - C1725",1,1693,0,null,null,423.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9552",1,972,0,1166.46,1166.46,243]
["TUFTS - TUFTS HMO - HCPCS - C1729",1,2283,0,null,null,570.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9555",1,1065,0,1604.08,1604.08,266.25]
["TUFTS - TUFTS HMO - HCPCS - C1731",1,3847,0,null,null,961.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9556",1,20,0,311.94,311.94,5]
["TUFTS - TUFTS HMO - HCPCS - C1733",1,10475,0,null,null,2618.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9557",1,239,0,1062.44,1062.44,59.75]
["TUFTS - TUFTS HMO - HCPCS - C1751",1,1438,0,null,null,359.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9558",1,23,0,108.88,108.88,5.75]
["TUFTS - TUFTS HMO - HCPCS - C1756",1,1438,0,null,null,359.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9560",1,246,0,266.7,266.7,61.5]
["TUFTS - TUFTS HMO - HCPCS - C1759",1,6295,0,null,null,1573.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9561",1,127,0,125.64,125.64,31.75]
["TUFTS - TUFTS HMO - HCPCS - C1762",1,12010,0,null,null,3002.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9562",1,1237,0,2212.25,2212.25,309.25]
["TUFTS - TUFTS HMO - HCPCS - C1764",1,8983,0,null,null,2245.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9563",1,0,535.17999999999995,535.17999999999995,3182.68,0]
["TUFTS - TUFTS HMO - HCPCS - C1766",1,2619,0,null,null,654.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9569",1,5086,0,4157.3,4157.3,1271.5]
["TUFTS - TUFTS HMO - HCPCS - C1769",1,4759,0,null,null,1189.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9570",1,6395,0,null,null,1598.75]
["TUFTS - TUFTS HMO - HCPCS - C1773",1,2163,0,null,null,540.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9572",1,131,0,16207.01,16207.01,32.75]
["TUFTS - TUFTS HMO - HCPCS - C1777",1,13038,0,null,null,3259.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9575",1,8,0,0.18,0.45,2]
["TUFTS - TUFTS HMO - HCPCS - C1784",1,2734,0,null,null,683.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9576",1,5,0,1.5,3.77,1.25]
["TUFTS - TUFTS HMO - HCPCS - C1786",1,23460,0,null,null,5865]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9577",1,21,0,1.81,5.03,5.25]
["TUFTS - TUFTS HMO - HCPCS - C1817",1,9668,0,null,null,2417]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9579",1,5,0,1.53,4.38,1.25]
["TUFTS - TUFTS HMO - HCPCS - C1874",1,8879,0,null,null,2219.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9580",1,158,0,null,null,39.5]
["TUFTS - TUFTS HMO - HCPCS - C1880",1,7726,0,null,null,1931.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9581",1,99,0,14.76,37.14,24.75]
["TUFTS - TUFTS HMO - HCPCS - C1883",1,1257,0,null,null,314.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9582",1,10370,0,null,null,2592.5]
["TUFTS - TUFTS HMO - HCPCS - C1887",1,3731,0,null,null,932.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9583",1,13,0,19.260000000000002,21.34,3.25]
["TUFTS - TUFTS HMO - HCPCS - C1893",1,406,0,null,null,101.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9584",1,2729,0,3235.55,3235.55,682.25]
["TUFTS - TUFTS HMO - HCPCS - C1895",1,13382,0,null,null,3345.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9586",1,4402,5015.9399999999996,3746.06,7452.46,1100.5]
["TUFTS - TUFTS HMO - HCPCS - C1898",1,1575,0,null,null,393.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9587",1,12985,113.78,84.97,113.78,3246.25]
["FALLON - FALLON MEDICAID - HCPCS - G0402",1,168,0,208.89,1179.72,42]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9588",1,15438,703.05,525.05999999999995,703.05,3859.5]
["TUFTS - TUFTS HMO - HCPCS - C2617",1,638,0,null,null,159.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9606",1,493,247.36,198.62,597.20000000000005,123.25]
["TUFTS - TUFTS HMO - HCPCS - C2623",1,2837,0,null,null,709.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1713",1,4568,0,null,null,1142]
["TUFTS - TUFTS HMO - HCPCS - C2628",1,2308,0,null,null,577]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1714",1,6114,0,null,null,1528.5]
["TUFTS - TUFTS HMO - HCPCS - C2634",1,0,278.94,232.45,698.88,0]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1715",1,21,0,null,null,5.25]
["TUFTS - TUFTS HMO - HCPCS - C2639",1,47,52.85,52.85,100.75,11.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1716",1,0,200.39,168.52,506.68,0]
["TUFTS - TUFTS HMO - HCPCS - C8908",1,579,1716.08,664.1,4299.8,144.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1717",1,607,554.13,469.29,1411.01,151.75]
["TUFTS - TUFTS HMO - HCPCS - C9358",1,8526,0,24.42,24.42,2131.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1719",1,95,108.35,108.35,357.35,23.75]
["TUFTS - TUFTS HMO - HCPCS - C9739",1,6035,9609.09,2166.09,15242.01,1508.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1721",1,39674,0,null,null,9918.5]
["TUFTS - TUFTS HMO - HCPCS - D0150",1,265,2396.69,1275.99,4066.77,66.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1722",1,43645,0,null,null,10911.25]
["TUFTS - TUFTS HMO - HCPCS - D0250",1,1451,2396.69,1275.99,4066.77,362.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1724",1,7410,0,null,null,1852.5]
["TUFTS - TUFTS HMO - HCPCS - D0270",1,836,2396.69,1275.99,4066.77,209]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1725",1,1693,0,null,null,423.25]
["TUFTS - TUFTS HMO - HCPCS - D0274",1,836,2396.69,1182.5,4066.77,209]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1726",1,387,0,null,null,96.75]
["TUFTS - TUFTS HMO - HCPCS - D0472",1,110,3646.27,1941.26,6187.11,27.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1729",1,2283,0,null,null,570.75]
["TUFTS - TUFTS HMO - HCPCS - D0474",1,110,3646.27,1941.26,6187.11,27.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1730",1,2283,0,null,null,570.75]
["TUFTS - TUFTS HMO - HCPCS - D1110",1,110,96.19,51.21,163.22999999999999,27.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1731",1,3847,0,null,null,961.75]
["TUFTS - TUFTS HMO - HCPCS - D1516",1,1350,0,null,null,337.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1732",1,7766,0,null,null,1941.5]
["TUFTS - TUFTS HMO - HCPCS - D1575",1,1451,3237.33,1723.54,5493.21,362.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1733",1,10475,0,null,null,2618.75]
["TUFTS - TUFTS HMO - HCPCS - D3460",1,1451,2396.69,1275.99,4066.77,362.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1750",1,1693,0,null,null,423.25]
["TUFTS - TUFTS HMO - HCPCS - D4260",1,1451,2396.69,1275.99,4066.77,362.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1751",1,1438,0,null,null,359.5]
["TUFTS - TUFTS HMO - HCPCS - D4264",1,1451,2396.69,1275.99,4066.77,362.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1753",1,3947,0,null,null,986.75]
["TUFTS - TUFTS HMO - HCPCS - D4273",1,1451,2396.69,1275.99,4066.77,362.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1756",1,1438,0,null,null,359.5]
["TUFTS - TUFTS HMO - HCPCS - D4381",1,1451,2396.69,1275.99,4066.77,362.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1757",1,15822,0,null,null,3955.5]
["TUFTS - TUFTS HMO - HCPCS - D5912",1,1451,2396.69,1275.99,4066.77,362.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1759",1,6295,0,null,null,1573.75]
["TUFTS - TUFTS HMO - HCPCS - D5984",1,1451,2396.69,1275.99,4066.77,362.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1760",1,1799,0,null,null,449.75]
["TUFTS - TUFTS HMO - HCPCS - D5987",1,1451,2396.69,1275.99,4066.77,362.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1762",1,12010,0,null,null,3002.5]
["TUFTS - TUFTS HMO - HCPCS - D7210",1,836,2396.69,1275.99,4066.77,209]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1763",1,2242,0,null,null,560.5]
["TUFTS - TUFTS HMO - HCPCS - D7230",1,836,2396.69,1275.99,4066.77,209]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1764",1,8983,0,null,null,2245.75]
["TUFTS - TUFTS HMO - HCPCS - D7250",1,836,2396.69,1275.99,4066.77,209]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1765",1,569,0,null,null,142.25]
["TUFTS - TUFTS HMO - HCPCS - D7261",1,836,2396.69,1275.99,4066.77,209]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1766",1,2619,0,null,null,654.75]
["TUFTS - TUFTS HMO - HCPCS - D9110",1,110,0,null,null,27.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1768",1,76125,0,null,null,19031.25]
["TUFTS - TUFTS HMO - HCPCS - D9630",1,110,1333.24,591.51,3340.65,27.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1769",1,4759,0,null,null,1189.75]
["TUFTS - TUFTS HMO - HCPCS - D9944",1,51,0,null,null,12.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1770",1,3667,0,null,null,916.75]
["TUFTS - TUFTS HMO - HCPCS - E0191",1,321,20.81,11.61,52.13,80.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1773",1,2163,0,null,null,540.75]
["TUFTS - TUFTS HMO - HCPCS - G0103",1,93,72.3,16.78,181.16,23.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1776",1,21721,0,null,null,5430.25]
["TUFTS - TUFTS HMO - HCPCS - G0108",1,425,136.01,72.41,230.78,106.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1777",1,13038,0,null,null,3259.5]
["TUFTS - TUFTS HMO - HCPCS - G0127",1,189,187.02,93.87,317.35000000000002,47.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1781",1,36449,0,null,null,9112.25]
["TUFTS - TUFTS HMO - HCPCS - G0239",1,99,149.03,53.94,373.41,24.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1784",1,2734,0,null,null,683.5]
["TUFTS - TUFTS HMO - HCPCS - G0259",1,1513,0,1198.25,1198.25,378.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1785",1,12546,0,null,null,3136.5]
["TUFTS - TUFTS HMO - HCPCS - G0269",1,200,0,null,null,50]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1786",1,23460,0,null,null,5865]
["TUFTS - TUFTS HMO - HCPCS - G0279",1,55,118.02,30.09,295.68,13.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1788",1,540,0,null,null,135]
["TUFTS - TUFTS HMO - HCPCS - G0297",1,1437,319.77999999999997,107.22,801.26,359.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1817",1,9668,0,null,null,2417]
["TUFTS - TUFTS HMO - HCPCS - G0378",1,319,0,null,null,79.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1821",1,9770,0,null,null,2442.5]
["TUFTS - TUFTS HMO - HCPCS - G0390",1,3274,2967.4,1579.83,5035.18,818.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1874",1,8879,0,null,null,2219.75]
["TUFTS - TUFTS HMO - HCPCS - G0397",1,118,325.62,128.29,815.89,29.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1876",1,11691,0,null,null,2922.75]
["TUFTS - TUFTS HMO - HCPCS - G0410",1,220,0,null,null,55]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1880",1,7726,0,null,null,1931.5]
["TUFTS - TUFTS HMO - HCPCS - G0420",1,156,347.3,184.9,589.33000000000004,39]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1882",1,53226,0,null,null,13306.5]
["TUFTS - TUFTS HMO - HCPCS - G0422",1,169,375.87,198.42,637.79,42.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1883",1,1257,0,null,null,314.25]
["TUFTS - TUFTS HMO - HCPCS - G0424",1,284,202.19,93.87,343.09,71]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1884",1,31469,0,null,null,7867.25]
["TUFTS - TUFTS HMO - HCPCS - G0439",1,327,38.93,34.03,61.76,81.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1887",1,3731,0,null,null,932.75]
["TUFTS - TUFTS HMO - HCPCS - G0443",1,118,21.18,18.52,33.6,29.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1892",1,340,0,null,null,85]
["TUFTS - TUFTS HMO - HCPCS - G0445",1,118,10.18,8.9,16.149999999999999,29.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1893",1,406,0,null,null,101.5]
["TUFTS - TUFTS HMO - HCPCS - G0447",1,118,21.18,18.52,33.6,29.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1894",1,252,0,null,null,63]
["TUFTS - TUFTS HMO - HCPCS - G0481",1,192,531.64,91.84,1332.11,48]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1895",1,13382,0,null,null,3345.5]
["TUFTS - TUFTS HMO - HCPCS - G0513",1,84,0,148.6,148.6,21]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1896",1,10912,0,null,null,2728]
["TUFTS - TUFTS HMO - HCPCS - G2011",1,35,78.89,28.83,133.88,8.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1898",1,1575,0,null,null,393.75]
["TUFTS - TUFTS HMO - HCPCS - G2023",1,31,90.81,23.46,212.71,7.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1900",1,8293,0,null,null,2073.25]
["TUFTS - TUFTS HMO - HCPCS - G2066",1,165,147.85,58.35,370.47,41.25]
["FALLON - FALLON MEDICAID - HCPCS - G0239",1,99,0,53.94,373.41,24.75]
["TUFTS - TUFTS HMO - HCPCS - G2087",1,194,55.42,46.18,211.43,48.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C2616",1,60393,29411.3,25512.2,76706.740000000005,15098.25]
["FALLON - FALLON MEDICAID - HCPCS - G0420",1,156,0,184.9,589.33000000000004,39]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C2617",1,638,0,null,null,159.5]
["TUFTS - TUFTS HMO - HCPCS - J2790",1,186.95,0,74.3,186.95,46.737499999999997]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C2621",1,21692,0,null,null,5423]
["FALLON - FALLON MEDICAID - HCPCS - A9561",1,127,0,125.64,125.64,31.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C2623",1,2837,0,null,null,709.25]
["TUFTS - TUFTS HMO - HCPCS - L0120",1,25,44.54,24.86,111.59,6.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C2625",1,246,0,null,null,61.5]
["TUFTS - TUFTS HMO - HCPCS - L1820",1,159,255.45,142.59,640.03,39.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C2628",1,2308,0,null,null,577]
["TUFTS - TUFTS HMO - HCPCS - L1832",1,1523,1332.14,743.59,3337.75,380.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C2630",1,4966,0,null,null,1241.5]
["TUFTS - TUFTS HMO - HCPCS - L1902",1,219,154.32,86.14,386.65,54.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C2634",1,0,313.02999999999997,232.45,698.88,0]
["TUFTS - TUFTS HMO - HCPCS - L3350",1,41,40.14,22.41,100.59,10.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C2635",1,0,97.01,78.03,242.54,0]
["TUFTS - TUFTS HMO - HCPCS - L3670",1,2903,185.69,103.65,465.27,725.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C2639",1,47,61.32,52.85,100.75,11.75]
["TUFTS - TUFTS HMO - HCPCS - L3762",1,57,171.41,95.68,429.49,14.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C5275",1,743,1042.56,684.11,2032.26,185.75]
["TUFTS - TUFTS HMO - HCPCS - L3808",1,509,673.5,375.94,1687.5,127.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C8908",1,579,664.1,664.1,4299.8,144.75]
["TUFTS - TUFTS HMO - HCPCS - L3908",1,143,131.18,73.22,328.66,35.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C8937",1,331,0,null,null,82.75]
["TUFTS - TUFTS HMO - HCPCS - L3980",1,132,676.89,377.84,1695.98,33]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C9358",1,8526,0,24.42,24.42,2131.5]
["TUFTS - TUFTS HMO - HCPCS - L4350",1,360,174.28,97.28,436.66,90]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C9728",1,1957,2573.36,2227.36,7098.97,489.25]
["TUFTS - TUFTS HMO - HCPCS - L4370",1,107,422.42,235.79,1058.3900000000001,26.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C9739",1,6035,7812.32,2166.09,15242.01,1508.75]
["TUFTS - TUFTS HMO - HCPCS - L4396",1,406,307.08999999999997,171.42,769.43,101.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0103",1,93,44.13,16.78,181.16,23.25]
["TUFTS - TUFTS HMO - HCPCS - L8501",1,219,287.97000000000003,160.74,721.54,54.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0105",1,1152,1608.22,1020.59,3264.67,288]
["TUFTS - TUFTS HMO - HCPCS - L8509",1,1144,191.68,106.99,480.27,286]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0108",1,425,121.38,72.41,230.78,106.25]
["TUFTS - TUFTS HMO - HCPCS - L8693",1,1462,2661.38,1485.57,6668.25,365.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0109",1,267,33.46,32.64,134.25,66.75]
["TUFTS - TUFTS HMO - HCPCS - P9012",1,134,73.86,64.959999999999994,125.33,33.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0127",1,189,120.69,93.87,317.35000000000002,47.25]
["TUFTS - TUFTS HMO - HCPCS - P9017",1,291,128.31,94.07,217.72,72.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0239",1,99,69.349999999999994,53.94,373.41,24.75]
["TUFTS - TUFTS HMO - HCPCS - P9034",1,506,471.32,443.29,799.73,126.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0257",1,911,1320.72,1027.32,3651.55,227.75]
["TUFTS - TUFTS HMO - HCPCS - P9040",1,523,394.85,336.11,669.97,130.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0259",1,1513,0,1198.25,1198.25,378.25]
["TUFTS - TUFTS HMO - HCPCS - P9045",1,238,76.05,52.45,131.97,59.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0260",1,817,1292.83,1005.62,3474.13,204.25]
["TUFTS - TUFTS HMO - HCPCS - P9056",1,1619,311.95,311.95,529.32000000000005,404.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0269",1,200,0,null,null,50]
["TUFTS - TUFTS HMO - HCPCS - P9073",1,889,1045.51,821.84,2619.59,222.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0270",1,86,70.819999999999993,69.08,70.819999999999993,21.5]
["TUFTS - TUFTS HMO - HCPCS - P9612",1,90,10.199999999999999,2.2200000000000002,1198.25,22.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0278",1,3138,0,34.229999999999997,34.229999999999997,784.5]
["TUFTS - TUFTS HMO - HCPCS - Q0111",1,23,50.9,5.86,127.48,5.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0279",1,55,32.69,30.09,295.68,13.75]
["TUFTS - TUFTS HMO - HCPCS - Q3014",1,67,38.6,26.65,67.06,16.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0297",1,1437,107.22,107.22,801.26,359.25]
["TUFTS - TUFTS HMO - HCPCS - Q4101",1,1601,0,30.46,76.64,400.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0390",1,3274,0,1579.83,5035.18,818.5]
["TUFTS - TUFTS HMO - HCPCS - Q4104",1,7748,0,42.08,56.11,1937]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0416",1,425,592.04,360.63,2456.98,106.25]
["TUFTS - TUFTS HMO - HCPCS - Q4112",1,535,0,904.99,1002.89,133.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0422",1,169,255.09,198.42,637.79,42.25]
["TUFTS - TUFTS HMO - HCPCS - Q4124",1,23,0,16.39,16.39,5.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0423",1,169,255.09,198.42,637.79,42.25]
["TUFTS - TUFTS HMO - HCPCS - Q4130",1,65718,0,45.89,45.89,16429.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0424",1,284,120.69,93.87,343.09,71]
["TUFTS - TUFTS HMO - HCPCS - Q4133",1,3756,0,131.97,332.06,939]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0480",1,254,247.05,59.69,973.54,63.5]
["TUFTS - TUFTS HMO - HCPCS - Q9954",1,0,0,12.1,13.41,0]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0481",1,192,338.08,91.84,1332.11,48]
["TUFTS - TUFTS HMO - HCPCS - Q9957",1,417,0,47.63,119.85,104.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0506",1,62,0,110.9,110.9,15.5]
["TUFTS - TUFTS HMO - HCPCS - Q9961",1,1,0,0.25,0.63,0.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0513",1,84,0,148.6,148.6,21]
["TUFTS - TUFTS HMO - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0514",1,84,0,148.6,148.6,21]
["TUFTS - TUFTS HMO - HCPCS - S2083",1,211,595.01,317.70999999999998,1198.25,52.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G2066",1,165,80.23,58.35,370.47,41.25]
["TUFTS - TUFTS HMO - HCPCS - U0001",1,124,139.03,35.909999999999997,325.64,31]
["FALLON - FALLON MEDICAID - HCPCS - G0257",1,911,0,1027.32,3651.55,227.75]
["TUFTS - TUFTS HMO - HCPCS - V2785",1,7848,9609.09,5130.87,15242.01,1962]
["FALLON - FALLON MEDICAID - HCPCS - G0259",1,1513,0,1198.25,1198.25,378.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - 81170",1,798,435,159,2909.77,199.5]
["FALLON - FALLON MEDICAID - HCPCS - G0260",1,817,0,1005.62,3474.13,204.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A4562",1,64,83.68,57.71,145.21,16]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - J2790",1,186.95,0,74.3,186.95,46.737499999999997]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A6258",1,83,7.25,5,12.58,20.75]
["FALLON - FALLON MEDICAID - HCPCS - A9503",1,23,0,37.119999999999997,37.119999999999997,5.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A7520",1,1173,79.98,55.16,138.79,293.25]
["FALLON - FALLON MEDICAID - HCPCS - G0269",1,200,0,null,null,50]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A9576",1,5,2.1800000000000002,1.5,3.77,1.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - L8699",1,13957,0,null,null,3489.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A9579",1,5,2.2200000000000002,1.53,4.38,1.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9012",1,134,106.65,64.959999999999994,125.33,33.5]
["FALLON - FALLON MEDICAID - HCPCS - G0423",1,169,0,198.42,637.79,42.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9016",1,576,398.94,243.01,478.65,144]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - G0279",1,55,43.63,30.09,295.68,13.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9017",1,291,154.43,94.07,217.72,72.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - G0481",1,192,227.06,91.84,1332.11,48]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9021",1,323,302.52,184.28,354.25,80.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - G2024",1,33,36.92,25.46,230.84,8.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9034",1,506,727.76,443.29,799.73,126.5]
["FALLON - FALLON MEDICAID - HCPCS - G0439",1,327,0,34.03,61.76,81.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9037",1,939,1349.22,821.84,1622.67,234.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - J2790",1,186.95,0,74.3,186.95,46.737499999999997]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9040",1,523,551.79999999999995,336.11,669.97,130.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L0120",1,25,36.049999999999997,24.86,111.59,6.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9044",1,133,191.57,144.19999999999999,244.67,33.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L1820",1,159,206.76,142.59,640.03,39.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9045",1,238,113.24,52.45,131.97,59.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L1832",1,1523,1078.21,743.59,3337.75,380.75]
["FALLON - FALLON MEDICAID - HCPCS - A9551",1,154,0,1711.56,1711.56,38.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L1902",1,219,124.9,86.14,386.65,54.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9056",1,1619,486.79,311.95,529.32000000000005,404.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L3650",1,1955,97.7,67.38,302.45,488.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9057",1,785,484.72,395.89,671.74,196.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L3760",1,819,645.28,445.02,1997.57,204.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9073",1,889,1349.22,821.84,2619.59,222.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L3807",1,483,322.64999999999998,222.52,998.85,120.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9100",1,1310,55.05,33.53,256.64,327.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L3905",1,2442,1279.6400000000001,882.51,3961.32,610.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9612",1,90,0,2.2200000000000002,1198.25,22.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L3967",1,117,2559.58,1765.23,7923.54,29.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q0091",1,83,37.07,28.83,175.66,20.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L3982",1,176,577.42999999999995,398.23,1787.56,44]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q0111",1,23,32.36,5.86,127.48,5.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L4360",1,557,501.45,345.83,1552.36,139.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q0114",1,41,21.03,7.2,82.86,10.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L4386",1,165,224.78,155.02000000000001,695.83,41.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q4101",1,1601,0,30.46,76.64,400.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L4398",1,406,114.43,78.92,354.25,101.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q4102",1,69,0,10.210000000000001,25.69,17.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L8507",1,1604,59.49,41.03,184.14,401]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q4104",1,7748,0,42.08,56.11,1937]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L8514",1,387,133.94999999999999,92.38,414.69,96.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q4107",1,2233,0,86.55,110.48,558.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - P9045",1,238,76.05,52.45,131.97,59.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q4112",1,535,0,904.99,1002.89,133.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - P9612",1,90,4.3499999999999996,2.2200000000000002,1198.25,22.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q4116",1,5248,0,32.29,35.78,1312]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q0114",1,41,14.12,7.2,82.86,10.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q4124",1,23,0,16.39,16.39,5.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q4102",1,69,14.8,10.210000000000001,25.69,17.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q4125",1,4060,0,3.79,3.79,1015]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q4133",1,3756,191.36,131.97,332.06,939]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q4130",1,65718,0,45.89,45.89,16429.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q9956",1,76,46.04,31.75,79.89,19]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q4132",1,3754,0,114.63,288.43,938.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q9958",1,1,0.1,7.0000000000000007E-2,0.18,0.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q4133",1,3756,0,131.97,332.06,939]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q4196",1,9044,192.05,111.59,280.77999999999997,2261]
["FALLON - FALLON MEDICAID - HCPCS - A9521",1,360,0,4157.3,4157.3,90]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q9954",1,0,0,12.1,13.41,0]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - U0002",1,92,74.400000000000006,51.31,465.19,23]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q9956",1,76,0,31.75,79.89,19]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - A4561",1,108,33.61,23.18,58.33,27]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q9957",1,417,0,47.63,119.85,104.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - A6209",1,163,12.59,8.68,21.84,40.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q9958",1,1,0,7.0000000000000007E-2,0.18,0.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - A6550",1,4,37.28,25.71,64.69,1]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q9961",1,1,0,0.25,0.63,0.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - A9575",1,8,0.26,0.18,0.45,2]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - A9577",1,21,2.62,1.81,5.03,5.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - A9581",1,99,21.4,14.76,37.14,24.75]
["FALLON - FALLON MEDICAID - HCPCS - A9505",1,23,0,395.74,395.74,5.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - G0103",1,93,28,16.78,181.16,23.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - V2790",1,1136,0,null,null,284]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - G0480",1,254,165.92,59.69,973.54,63.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - 81170",1,798,647.70000000000005,159,2909.77,199.5]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - G2023",1,31,34.020000000000003,23.46,212.71,7.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A4561",1,108,50.05,23.18,58.33,27]
["FALLON - FALLON MEDICAID - HCPCS - G0444",1,42,0,8.9,16.149999999999999,10.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A4562",1,64,124.6,57.71,145.21,16]
["FALLON - FALLON MEDICAID - HCPCS - G0446",1,42,0,8.9,16.149999999999999,10.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A6209",1,163,18.739999999999998,8.68,21.84,40.75]
["FALLON - FALLON MEDICAID - HCPCS - A9537",1,138,0,157.94999999999999,157.94999999999999,34.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A6258",1,83,10.8,5,12.58,20.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L0140",1,189,112.4,77.52,347.97,47.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A6550",1,4,55.51,25.71,64.69,1]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L1830",1,78,118.83,81.95,367.86,19.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A7520",1,1173,119.09,55.16,138.79,293.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L1836",1,209,189.2,130.47999999999999,585.70000000000005,52.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A9575",1,8,0.39,0.18,0.45,2]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L3350",1,41,32.49,22.41,100.59,10.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A9576",1,5,3.24,1.5,3.77,1.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L3670",1,2903,150.29,103.65,465.27,725.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A9577",1,21,3.91,1.81,5.03,5.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L3762",1,57,138.74,95.68,429.49,14.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A9579",1,5,3.3,1.53,4.38,1.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L3808",1,509,545.11,375.94,1687.5,127.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A9581",1,99,31.87,14.76,37.14,24.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L3908",1,143,106.17,73.22,328.66,35.75]
["FALLON - FALLON MEDICAID - HCPCS - G0278",1,3138,0,34.229999999999997,34.229999999999997,784.5]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L3980",1,132,547.87,377.84,1695.98,33]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - G0103",1,93,41.69,16.78,181.16,23.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L4350",1,360,141.06,97.28,436.66,90]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - G0279",1,55,64.959999999999994,30.09,295.68,13.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L4370",1,107,341.9,235.79,1058.3900000000001,26.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - G0480",1,254,247.05,59.69,973.54,63.5]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L4396",1,406,248.56,171.42,769.43,101.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - G0481",1,192,338.08,91.84,1332.11,48]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L8501",1,219,233.07,160.74,721.54,54.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - G2023",1,31,50.65,23.46,212.71,7.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L8509",1,1144,155.13999999999999,106.99,480.27,286]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - G2024",1,33,54.97,25.46,230.84,8.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L8693",1,1462,2154.08,1485.57,6668.25,365.5]
["FALLON - FALLON MEDICAID - HCPCS - G0296",1,118,0,102.62,660.74,29.5]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - M0243",1,572,448.92,309.60000000000002,779.02,143]
["FALLON - FALLON MEDICAID - HCPCS - G0297",1,1437,0,107.22,801.26,359.25]
["FALLON - FALLON MEDICAID - HCPCS - A9558",1,23,0,108.88,108.88,5.75]
["FALLON - FALLON MEDICAID - HCPCS - G0365",1,498,0,272.02999999999997,867.01,124.5]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - Q0111",1,23,21.92,5.86,127.48,5.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - J2790",1,186.95,0,74.3,186.95,46.737499999999997]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - Q3014",1,67,38.64,26.65,67.06,16.75]
["FALLON - FALLON MEDICAID - HCPCS - A9509",1,95,0,5163.91,5163.91,23.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - Q4102",1,69,14.8,10.210000000000001,25.69,17.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L0120",1,25,53.67,24.86,111.59,6.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - Q4133",1,3756,191.36,131.97,332.06,939]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L0140",1,189,167.37,77.52,347.97,47.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - Q9956",1,76,46.04,31.75,79.89,19]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L1820",1,159,307.85000000000002,142.59,640.03,39.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - Q9958",1,1,0.1,7.0000000000000007E-2,0.18,0.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L1830",1,78,176.93,81.95,367.86,19.5]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L1832",1,1523,1605.41,743.59,3337.75,380.75]
["FALLON - FALLON MEDICAID - HCPCS - A9538",1,111,0,114.21,114.21,27.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L1836",1,209,281.70999999999998,130.47999999999999,585.70000000000005,52.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - U0002",1,92,74.400000000000006,51.31,465.19,23]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L1902",1,219,185.98,86.14,386.65,54.75]
["TUFTS - TUFTS POS - HCPCS - 0278T",1,77,595.01,286.31,943.8,19.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L3350",1,41,48.38,22.41,100.59,10.25]
["TUFTS - TUFTS POS - HCPCS - 0402T",1,2880,7467.76,1198.25,11845.41,720]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L3650",1,1955,145.47,67.38,302.45,488.75]
["TUFTS - TUFTS POS - HCPCS - 81170",1,798,967.76,159,2909.77,199.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L3670",1,2903,223.78,103.65,465.27,725.75]
["TUFTS - TUFTS POS - HCPCS - 92083",1,461,358.22,68.75,607.84,115.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L3760",1,819,960.8,445.02,1997.57,204.75]
["TUFTS - TUFTS POS - HCPCS - A4215",1,433,0,null,null,108.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L3762",1,57,206.57,95.68,429.49,14.25]
["TUFTS - TUFTS POS - HCPCS - A4562",1,64,0,57.71,145.21,16]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L3807",1,483,480.42,222.52,998.85,120.75]
["TUFTS - TUFTS POS - HCPCS - A4648",1,281,0,null,null,70.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L3808",1,509,811.65,375.94,1687.5,127.25]
["TUFTS - TUFTS POS - HCPCS - A6209",1,163,0,8.68,21.84,40.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L3905",1,2442,1905.34,882.51,3961.32,610.5]
["TUFTS - TUFTS POS - HCPCS - A6549",1,37,0,null,null,9.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L3908",1,143,158.08000000000001,73.22,328.66,35.75]
["TUFTS - TUFTS POS - HCPCS - A7520",1,1173,0,55.16,138.79,293.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L3967",1,117,3811.13,1765.23,7923.54,29.25]
["TUFTS - TUFTS POS - HCPCS - A9502",1,140,0,278.27,278.27,35]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L3980",1,132,815.76,377.84,1695.98,33]
["TUFTS - TUFTS POS - HCPCS - A9505",1,23,0,395.74,395.74,5.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L3982",1,176,859.78,398.23,1787.56,44]
["TUFTS - TUFTS POS - HCPCS - A9512",1,1,0,null,null,0.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L4350",1,360,210.03,97.28,436.66,90]
["TUFTS - TUFTS POS - HCPCS - A9516",1,192,0,516.39,516.39,48]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L4360",1,557,746.65,345.83,1552.36,139.25]
["TUFTS - TUFTS POS - HCPCS - A9520",1,1951,0,null,null,487.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L4370",1,107,509.07,235.79,1058.3900000000001,26.75]
["TUFTS - TUFTS POS - HCPCS - A9537",1,138,0,157.94999999999999,157.94999999999999,34.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L4386",1,165,334.69,155.02000000000001,695.83,41.25]
["TUFTS - TUFTS POS - HCPCS - A9539",1,668,0,89.47,89.47,167]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L4396",1,406,370.1,171.42,769.43,101.5]
["TUFTS - TUFTS POS - HCPCS - A9541",1,120,0,152.69,152.69,30]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L4398",1,406,170.39,78.92,354.25,101.5]
["TUFTS - TUFTS POS - HCPCS - A9547",1,440,0,5105.7299999999996,5105.7299999999996,110]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L8501",1,219,347.04,160.74,721.54,54.75]
["TUFTS - TUFTS POS - HCPCS - A9552",1,972,0,1166.46,1166.46,243]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L8507",1,1604,88.58,41.03,184.14,401]
["TUFTS - TUFTS POS - HCPCS - A9556",1,20,0,311.94,311.94,5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L8509",1,1144,230.99,106.99,480.27,286]
["TUFTS - TUFTS POS - HCPCS - A9558",1,23,0,108.88,108.88,5.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L8514",1,387,199.45,92.38,414.69,96.75]
["TUFTS - TUFTS POS - HCPCS - A9561",1,127,0,125.64,125.64,31.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L8693",1,1462,3207.35,1485.57,6668.25,365.5]
["TUFTS - TUFTS POS - HCPCS - A9563",1,0,1058.54,535.17999999999995,3182.68,0]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - M0239",1,393,668.43,309.60000000000002,779.02,98.25]
["TUFTS - TUFTS POS - HCPCS - A9570",1,6395,0,null,null,1598.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - M0243",1,572,668.43,309.60000000000002,779.02,143]
["TUFTS - TUFTS POS - HCPCS - A9575",1,8,0,0.18,0.45,2]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - P9045",1,238,113.24,52.45,131.97,59.5]
["TUFTS - TUFTS POS - HCPCS - A9577",1,21,0,1.81,5.03,5.25]
["FALLON - FALLON MEDICAID - HCPCS - A9552",1,972,0,1166.46,1166.46,243]
["TUFTS - TUFTS POS - HCPCS - A9580",1,158,0,null,null,39.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - P9612",1,90,6.48,2.2200000000000002,1198.25,22.5]
["TUFTS - TUFTS POS - HCPCS - A9582",1,10370,0,null,null,2592.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q0111",1,23,32.64,5.86,127.48,5.75]
["TUFTS - TUFTS POS - HCPCS - A9584",1,2729,0,3235.55,3235.55,682.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q0114",1,41,21.03,7.2,82.86,10.25]
["TUFTS - TUFTS POS - HCPCS - A9587",1,12985,0,84.97,113.78,3246.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q3014",1,67,57.54,26.65,67.06,16.75]
["TUFTS - TUFTS POS - HCPCS - A9606",1,493,198.62,198.62,597.20000000000005,123.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q4101",1,1601,65.760000000000005,30.46,76.64,400.25]
["TUFTS - TUFTS POS - HCPCS - C1714",1,6114,0,null,null,1528.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q4102",1,69,22.04,10.210000000000001,25.69,17.25]
["TUFTS - TUFTS POS - HCPCS - C1716",1,0,168.52,168.52,506.68,0]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q4132",1,3754,247.49,114.63,288.43,938.5]
["TUFTS - TUFTS POS - HCPCS - C1719",1,95,118.86,108.35,357.35,23.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q4133",1,3756,284.92,131.97,332.06,939]
["TUFTS - TUFTS POS - HCPCS - C1722",1,43645,0,null,null,10911.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q4196",1,9044,240.92,111.59,280.77999999999997,2261]
["TUFTS - TUFTS POS - HCPCS - C1725",1,1693,0,null,null,423.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q9956",1,76,68.55,31.75,79.89,19]
["TUFTS - TUFTS POS - HCPCS - C1729",1,2283,0,null,null,570.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q9957",1,417,102.83,47.63,119.85,104.25]
["TUFTS - TUFTS POS - HCPCS - C1731",1,3847,0,null,null,961.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q9958",1,1,0.15,7.0000000000000007E-2,0.18,0.25]
["TUFTS - TUFTS POS - HCPCS - C1733",1,10475,0,null,null,2618.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q9961",1,1,0.54,0.25,0.63,0.25]
["TUFTS - TUFTS POS - HCPCS - C1751",1,1438,0,null,null,359.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["TUFTS - TUFTS POS - HCPCS - C1756",1,1438,0,null,null,359.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["TUFTS - TUFTS POS - HCPCS - C1759",1,6295,0,null,null,1573.75]
["FALLON - FALLON MEDICAID - HCPCS - A9512",1,1,0,null,null,0.25]
["TUFTS - TUFTS POS - HCPCS - C1762",1,12010,0,null,null,3002.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - U0001",1,124,77.53,35.909999999999997,325.64,31]
["TUFTS - TUFTS POS - HCPCS - C1764",1,8983,0,null,null,2245.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - U0002",1,92,110.78,51.31,465.19,23]
["TUFTS - TUFTS POS - HCPCS - C1766",1,2619,0,null,null,654.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - 81170",1,798,522,159,2909.77,199.5]
["TUFTS - TUFTS POS - HCPCS - C1769",1,4759,0,null,null,1189.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A4561",1,108,40.33,23.18,58.33,27]
["TUFTS - TUFTS POS - HCPCS - C1773",1,2163,0,null,null,540.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A4562",1,64,100.42,57.71,145.21,16]
["TUFTS - TUFTS POS - HCPCS - C1777",1,13038,0,null,null,3259.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A6209",1,163,15.1,8.68,21.84,40.75]
["TUFTS - TUFTS POS - HCPCS - C1784",1,2734,0,null,null,683.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A6258",1,83,8.6999999999999993,5,12.58,20.75]
["TUFTS - TUFTS POS - HCPCS - C1786",1,23460,0,null,null,5865]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A6550",1,4,44.74,25.71,64.69,1]
["TUFTS - TUFTS POS - HCPCS - C1817",1,9668,0,null,null,2417]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A7520",1,1173,95.98,55.16,138.79,293.25]
["TUFTS - TUFTS POS - HCPCS - C1874",1,8879,0,null,null,2219.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A9575",1,8,0.31,0.18,0.45,2]
["TUFTS - TUFTS POS - HCPCS - C1880",1,7726,0,null,null,1931.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A9576",1,5,2.61,1.5,3.77,1.25]
["TUFTS - TUFTS POS - HCPCS - C1883",1,1257,0,null,null,314.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A9577",1,21,3.15,1.81,5.03,5.25]
["TUFTS - TUFTS POS - HCPCS - C1887",1,3731,0,null,null,932.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A9579",1,5,2.66,1.53,4.38,1.25]
["TUFTS - TUFTS POS - HCPCS - C1893",1,406,0,null,null,101.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A9581",1,99,25.68,14.76,37.14,24.75]
["TUFTS - TUFTS POS - HCPCS - C1895",1,13382,0,null,null,3345.5]
["FALLON - FALLON MEDICAID - HCPCS - G0389",1,544,0,null,null,136]
["TUFTS - TUFTS POS - HCPCS - C1898",1,1575,0,null,null,393.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - G0103",1,93,33.6,16.78,181.16,23.25]
["FALLON - FALLON MEDICAID - HCPCS - G0447",1,118,0,18.52,33.6,29.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - G0279",1,55,52.36,30.09,295.68,13.75]
["TUFTS - TUFTS POS - HCPCS - C2617",1,638,0,null,null,159.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - G0480",1,254,199.11,59.69,973.54,63.5]
["TUFTS - TUFTS POS - HCPCS - C2623",1,2837,0,null,null,709.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - G0481",1,192,272.47000000000003,91.84,1332.11,48]
["TUFTS - TUFTS POS - HCPCS - C2628",1,2308,0,null,null,577]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - G2023",1,31,40.82,23.46,212.71,7.75]
["TUFTS - TUFTS POS - HCPCS - C2634",1,0,232.45,232.45,698.88,0]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - G2024",1,33,44.3,25.46,230.84,8.25]
["TUFTS - TUFTS POS - HCPCS - C2639",1,47,52.85,52.85,100.75,11.75]
["FALLON - FALLON MEDICAID - HCPCS - G0390",1,3274,0,1579.83,5035.18,818.5]
["TUFTS - TUFTS POS - HCPCS - C8908",1,579,1430.06,664.1,4299.8,144.75]
["FALLON - FALLON MEDICAID - HCPCS - G0396",1,42,0,56.05,336.32,10.5]
["TUFTS - TUFTS POS - HCPCS - C9358",1,8526,0,24.42,24.42,2131.5]
["FALLON - FALLON MEDICAID - HCPCS - G0397",1,118,0,128.29,815.89,29.5]
["TUFTS - TUFTS POS - HCPCS - C9739",1,6035,9609.09,2166.09,15242.01,1508.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - J2790",1,186.95,0,74.3,186.95,46.737499999999997]
["TUFTS - TUFTS POS - HCPCS - D0150",1,265,2396.69,1275.99,4066.77,66.25]
["FALLON - FALLON MEDICAID - HCPCS - A9513",1,320,0,294.27999999999997,1097.56,80]
["TUFTS - TUFTS POS - HCPCS - D0250",1,1451,2396.69,1275.99,4066.77,362.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L0120",1,25,43.26,24.86,111.59,6.25]
["TUFTS - TUFTS POS - HCPCS - D0270",1,836,2396.69,1275.99,4066.77,209]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L0140",1,189,134.88,77.52,347.97,47.25]
["TUFTS - TUFTS POS - HCPCS - D0274",1,836,2396.69,1182.5,4066.77,209]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L1820",1,159,248.11,142.59,640.03,39.75]
["TUFTS - TUFTS POS - HCPCS - D0472",1,110,3646.27,1941.26,6187.11,27.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L1830",1,78,142.59,81.95,367.86,19.5]
["TUFTS - TUFTS POS - HCPCS - D0474",1,110,3646.27,1941.26,6187.11,27.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L1832",1,1523,1293.8499999999999,743.59,3337.75,380.75]
["TUFTS - TUFTS POS - HCPCS - D1110",1,110,96.19,51.21,163.22999999999999,27.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L1836",1,209,227.04,130.47999999999999,585.70000000000005,52.25]
["TUFTS - TUFTS POS - HCPCS - D1516",1,1350,0,null,null,337.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L1902",1,219,149.88,86.14,386.65,54.75]
["TUFTS - TUFTS POS - HCPCS - D1575",1,1451,3237.33,1723.54,5493.21,362.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L3350",1,41,38.99,22.41,100.59,10.25]
["TUFTS - TUFTS POS - HCPCS - D3460",1,1451,2396.69,1275.99,4066.77,362.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L3650",1,1955,117.24,67.38,302.45,488.75]
["TUFTS - TUFTS POS - HCPCS - D4260",1,1451,2396.69,1275.99,4066.77,362.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L3670",1,2903,180.35,103.65,465.27,725.75]
["TUFTS - TUFTS POS - HCPCS - D4264",1,1451,2396.69,1275.99,4066.77,362.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L3760",1,819,774.33,445.02,1997.57,204.75]
["TUFTS - TUFTS POS - HCPCS - D4273",1,1451,2396.69,1275.99,4066.77,362.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L3762",1,57,166.48,95.68,429.49,14.25]
["TUFTS - TUFTS POS - HCPCS - D4381",1,1451,2396.69,1275.99,4066.77,362.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L3807",1,483,387.18,222.52,998.85,120.75]
["TUFTS - TUFTS POS - HCPCS - D5912",1,1451,2396.69,1275.99,4066.77,362.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L3808",1,509,654.14,375.94,1687.5,127.25]
["TUFTS - TUFTS POS - HCPCS - D5984",1,1451,2396.69,1275.99,4066.77,362.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L3905",1,2442,1535.57,882.51,3961.32,610.5]
["TUFTS - TUFTS POS - HCPCS - D5987",1,1451,2396.69,1275.99,4066.77,362.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L3908",1,143,127.4,73.22,328.66,35.75]
["TUFTS - TUFTS POS - HCPCS - D7210",1,836,2396.69,1275.99,4066.77,209]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L3967",1,117,3071.5,1765.23,7923.54,29.25]
["TUFTS - TUFTS POS - HCPCS - D7230",1,836,2396.69,1275.99,4066.77,209]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L3980",1,132,657.44,377.84,1695.98,33]
["TUFTS - TUFTS POS - HCPCS - D7250",1,836,2396.69,1275.99,4066.77,209]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L3982",1,176,692.92,398.23,1787.56,44]
["TUFTS - TUFTS POS - HCPCS - D7261",1,836,2396.69,1275.99,4066.77,209]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L4350",1,360,169.27,97.28,436.66,90]
["TUFTS - TUFTS POS - HCPCS - D9110",1,110,0,null,null,27.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L4360",1,557,601.74,345.83,1552.36,139.25]
["TUFTS - TUFTS POS - HCPCS - D9630",1,110,1111.03,591.51,3340.65,27.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L4370",1,107,410.27,235.79,1058.3900000000001,26.75]
["TUFTS - TUFTS POS - HCPCS - D9944",1,51,0,null,null,12.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L4386",1,165,269.73,155.02000000000001,695.83,41.25]
["TUFTS - TUFTS POS - HCPCS - E0191",1,321,17.34,11.61,52.13,80.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L4396",1,406,298.27,171.42,769.43,101.5]
["TUFTS - TUFTS POS - HCPCS - G0103",1,93,60.25,16.78,181.16,23.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L4398",1,406,137.32,78.92,354.25,101.5]
["TUFTS - TUFTS POS - HCPCS - G0108",1,425,136.01,72.41,230.78,106.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L8501",1,219,279.69,160.74,721.54,54.75]
["TUFTS - TUFTS POS - HCPCS - G0127",1,189,187.02,93.87,317.35000000000002,47.25]
["FALLON - FALLON MEDICAID - HCPCS - A9539",1,668,0,89.47,89.47,167]
["TUFTS - TUFTS POS - HCPCS - G0239",1,99,124.19,53.94,373.41,24.75]
["FALLON - FALLON MEDICAID - HCPCS - A9562",1,1237,0,2212.25,2212.25,309.25]
["TUFTS - TUFTS POS - HCPCS - G0259",1,1513,0,1198.25,1198.25,378.25]
["TUFTS - TUFTS POS - HCPCS - L0140",1,189,115.74,77.52,347.97,47.25]
["TUFTS - TUFTS POS - HCPCS - G0269",1,200,0,null,null,50]
["TUFTS - TUFTS POS - HCPCS - L1830",1,78,122.35,81.95,367.86,19.5]
["TUFTS - TUFTS POS - HCPCS - G0279",1,55,98.35,30.09,295.68,13.75]
["TUFTS - TUFTS POS - HCPCS - L1836",1,209,194.81,130.47999999999999,585.70000000000005,52.25]
["TUFTS - TUFTS POS - HCPCS - G0297",1,1437,266.48,107.22,801.26,359.25]
["TUFTS - TUFTS POS - HCPCS - L3260",1,279,119.04,31.12,357.96,69.75]
["TUFTS - TUFTS POS - HCPCS - G0378",1,319,0,null,null,79.75]
["TUFTS - TUFTS POS - HCPCS - L3650",1,1955,100.59,67.38,302.45,488.75]
["TUFTS - TUFTS POS - HCPCS - G0390",1,3274,2967.4,1579.83,5035.18,818.5]
["TUFTS - TUFTS POS - HCPCS - L3760",1,819,664.38,445.02,1997.57,204.75]
["TUFTS - TUFTS POS - HCPCS - G0397",1,118,271.35000000000002,128.29,815.89,29.5]
["TUFTS - TUFTS POS - HCPCS - L3807",1,483,332.21,222.52,998.85,120.75]
["TUFTS - TUFTS POS - HCPCS - G0410",1,220,0,null,null,55]
["TUFTS - TUFTS POS - HCPCS - L3905",1,2442,1317.51,882.51,3961.32,610.5]
["TUFTS - TUFTS POS - HCPCS - G0420",1,156,347.3,184.9,589.33000000000004,39]
["TUFTS - TUFTS POS - HCPCS - L3967",1,117,2635.32,1765.23,7923.54,29.25]
["TUFTS - TUFTS POS - HCPCS - G0422",1,169,375.87,198.42,637.79,42.25]
["TUFTS - TUFTS POS - HCPCS - L3982",1,176,594.53,398.23,1787.56,44]
["TUFTS - TUFTS POS - HCPCS - G0424",1,284,202.19,93.87,343.09,71]
["TUFTS - TUFTS POS - HCPCS - L4360",1,557,516.29999999999995,345.83,1552.36,139.25]
["TUFTS - TUFTS POS - HCPCS - G0439",1,327,38.93,34.03,61.76,81.75]
["TUFTS - TUFTS POS - HCPCS - L4386",1,165,231.43,155.02000000000001,695.83,41.25]
["TUFTS - TUFTS POS - HCPCS - G0443",1,118,21.18,18.52,33.6,29.5]
["TUFTS - TUFTS POS - HCPCS - L4398",1,406,117.83,78.92,354.25,101.5]
["TUFTS - TUFTS POS - HCPCS - G0445",1,118,10.18,8.9,16.149999999999999,29.5]
["TUFTS - TUFTS POS - HCPCS - L8507",1,1604,61.25,41.03,184.14,401]
["TUFTS - TUFTS POS - HCPCS - G0447",1,118,21.18,18.52,33.6,29.5]
["TUFTS - TUFTS POS - HCPCS - L8514",1,387,137.91999999999999,92.38,414.69,96.75]
["TUFTS - TUFTS POS - HCPCS - G0481",1,192,443.03,91.84,1332.11,48]
["TUFTS - TUFTS POS - HCPCS - L8699",1,13957,0,null,null,3489.25]
["TUFTS - TUFTS POS - HCPCS - G0513",1,84,0,148.6,148.6,21]
["TUFTS - TUFTS POS - HCPCS - P9016",1,576,282.10000000000002,243.01,478.65,144]
["TUFTS - TUFTS POS - HCPCS - G2011",1,35,78.89,28.83,133.88,8.75]
["TUFTS - TUFTS POS - HCPCS - P9021",1,323,208.77,184.28,354.25,80.75]
["TUFTS - TUFTS POS - HCPCS - G2023",1,31,75.680000000000007,23.46,212.71,7.75]
["TUFTS - TUFTS POS - HCPCS - P9037",1,939,956.33,821.84,1622.67,234.75]
["TUFTS - TUFTS POS - HCPCS - G2066",1,165,123.21,58.35,370.47,41.25]
["TUFTS - TUFTS POS - HCPCS - P9044",1,133,144.19999999999999,144.19999999999999,244.67,33.25]
["TUFTS - TUFTS POS - HCPCS - G2087",1,194,46.18,46.18,211.43,48.5]
["TUFTS - TUFTS POS - HCPCS - Q3014",1,67,38.6,26.65,67.06,16.75]
["FALLON - FALLON MEDICAID - HCPCS - G0506",1,62,0,110.9,110.9,15.5]
["TUFTS - TUFTS POS - HCPCS - Q4101",1,1601,0,30.46,76.64,400.25]
["TUFTS - TUFTS POS - HCPCS - J2790",1,186.95,0,74.3,186.95,46.737499999999997]
["TUFTS - TUFTS POS - HCPCS - Q4104",1,7748,0,42.08,56.11,1937]
["TUFTS - TUFTS POS - HCPCS - Q4112",1,535,0,904.99,1002.89,133.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L8507",1,1604,71.39,41.03,184.14,401]
["TUFTS - TUFTS POS - HCPCS - L0120",1,25,37.119999999999997,24.86,111.59,6.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L8509",1,1144,186.16,106.99,480.27,286]
["TUFTS - TUFTS POS - HCPCS - L1820",1,159,212.87,142.59,640.03,39.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L8514",1,387,160.74,92.38,414.69,96.75]
["TUFTS - TUFTS POS - HCPCS - L1832",1,1523,1110.1199999999999,743.59,3337.75,380.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L8693",1,1462,2584.89,1485.57,6668.25,365.5]
["TUFTS - TUFTS POS - HCPCS - L1902",1,219,128.6,86.14,386.65,54.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - M0239",1,393,538.70000000000005,309.60000000000002,779.02,98.25]
["TUFTS - TUFTS POS - HCPCS - L3350",1,41,33.450000000000003,22.41,100.59,10.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - M0243",1,572,538.70000000000005,309.60000000000002,779.02,143]
["TUFTS - TUFTS POS - HCPCS - L3670",1,2903,154.74,103.65,465.27,725.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - P9045",1,238,91.26,52.45,131.97,59.5]
["TUFTS - TUFTS POS - HCPCS - L3762",1,57,142.84,95.68,429.49,14.25]
["FALLON - FALLON MEDICAID - HCPCS - A9555",1,1065,0,1604.08,1604.08,266.25]
["TUFTS - TUFTS POS - HCPCS - L3808",1,509,561.25,375.94,1687.5,127.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - P9612",1,90,5.22,2.2200000000000002,1198.25,22.5]
["TUFTS - TUFTS POS - HCPCS - L3908",1,143,109.32,73.22,328.66,35.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q0111",1,23,26.31,5.86,127.48,5.75]
["TUFTS - TUFTS POS - HCPCS - L3980",1,132,564.08000000000004,377.84,1695.98,33]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q0114",1,41,16.95,7.2,82.86,10.25]
["TUFTS - TUFTS POS - HCPCS - L4350",1,360,145.22999999999999,97.28,436.66,90]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q3014",1,67,46.37,26.65,67.06,16.75]
["TUFTS - TUFTS POS - HCPCS - L4370",1,107,352.02,235.79,1058.3900000000001,26.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q4101",1,1601,53,30.46,76.64,400.25]
["TUFTS - TUFTS POS - HCPCS - L4396",1,406,255.91,171.42,769.43,101.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q4102",1,69,17.77,10.210000000000001,25.69,17.25]
["TUFTS - TUFTS POS - HCPCS - L8501",1,219,239.98,160.74,721.54,54.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q4132",1,3754,199.46,114.63,288.43,938.5]
["TUFTS - TUFTS POS - HCPCS - L8509",1,1144,159.72999999999999,106.99,480.27,286]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q4133",1,3756,229.63,131.97,332.06,939]
["TUFTS - TUFTS POS - HCPCS - L8693",1,1462,2217.8200000000002,1485.57,6668.25,365.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q4196",1,9044,194.17,111.59,280.77999999999997,2261]
["TUFTS - TUFTS POS - HCPCS - P9012",1,134,73.86,64.959999999999994,125.33,33.5]
["TUFTS - TUFTS POS - HCPCS - P9045",1,238,76.05,52.45,131.97,59.5]
["TUFTS - TUFTS POS - HCPCS - P9017",1,291,128.31,94.07,217.72,72.75]
["TUFTS - TUFTS POS - HCPCS - P9056",1,1619,311.95,311.95,529.32000000000005,404.75]
["TUFTS - TUFTS POS - HCPCS - P9034",1,506,471.32,443.29,799.73,126.5]
["TUFTS - TUFTS POS - HCPCS - P9073",1,889,871.26,821.84,2619.59,222.25]
["TUFTS - TUFTS POS - HCPCS - P9040",1,523,394.85,336.11,669.97,130.75]
["TUFTS - TUFTS POS - HCPCS - P9612",1,90,8.5,2.2200000000000002,1198.25,22.5]
["FALLON - FALLON MEDICAID - HCPCS - A9560",1,246,0,266.7,266.7,61.5]
["TUFTS - TUFTS POS - HCPCS - Q0111",1,23,42.41,5.86,127.48,5.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q9956",1,76,55.25,31.75,79.89,19]
["TUFTS - TUFTS POS - HCPCS - P9057",1,785,395.89,395.89,671.74,196.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q9957",1,417,82.88,47.63,119.85,104.25]
["TUFTS - TUFTS POS - HCPCS - P9100",1,1310,85.36,33.53,256.64,327.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q9958",1,1,0.12,7.0000000000000007E-2,0.18,0.25]
["TUFTS - TUFTS POS - HCPCS - Q0091",1,83,58.42,28.83,175.66,20.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q9961",1,1,0.44,0.25,0.63,0.25]
["TUFTS - TUFTS POS - HCPCS - Q0114",1,41,27.56,7.2,82.86,10.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["TUFTS - TUFTS POS - HCPCS - Q4100",1,12079,0,null,null,3019.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["TUFTS - TUFTS POS - HCPCS - Q4102",1,69,0,10.210000000000001,25.69,17.25]
["TUFTS - TUFTS POS - HCPCS - S2083",1,211,595.01,317.70999999999998,1198.25,52.75]
["TUFTS - TUFTS POS - HCPCS - Q4107",1,2233,0,86.55,110.48,558.25]
["TUFTS - TUFTS POS - HCPCS - S8037",1,1440,1254.4000000000001,585.76,3771.6,360]
["TUFTS - TUFTS POS - HCPCS - Q4116",1,5248,0,32.29,35.78,1312]
["TUFTS - TUFTS POS - HCPCS - U0002",1,92,165.5,51.31,465.19,23]
["TUFTS - TUFTS POS - HCPCS - Q4125",1,4060,0,3.79,3.79,1015]
["TUFTS - TUFTS POS - HCPCS - V2790",1,1136,0,null,null,284]
["TUFTS - TUFTS POS - HCPCS - Q4132",1,3754,0,114.63,288.43,938.5]
["TUFTS - TUFTS PPO - HCPCS - 0278T",1,77,595.01,286.31,943.8,19.25]
["TUFTS - TUFTS POS - HCPCS - Q4196",1,9044,152,111.59,280.77999999999997,2261]
["TUFTS - TUFTS PPO - HCPCS - 0402T",1,2880,7467.76,1198.25,11845.41,720]
["TUFTS - TUFTS POS - HCPCS - Q9956",1,76,0,31.75,79.89,19]
["TUFTS - TUFTS PPO - HCPCS - 81170",1,798,1035.23,159,2909.77,199.5]
["TUFTS - TUFTS POS - HCPCS - Q9958",1,1,0,7.0000000000000007E-2,0.18,0.25]
["TUFTS - TUFTS PPO - HCPCS - 92083",1,461,383.21,68.75,607.84,115.25]
["TUFTS - TUFTS POS - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["TUFTS - TUFTS PPO - HCPCS - A4215",1,433,0,null,null,108.25]
["FALLON - FALLON MEDICAID - HCPCS - A9540",1,1831,0,85.66,85.66,457.75]
["TUFTS - TUFTS PPO - HCPCS - A4562",1,64,0,57.71,145.21,16]
["TUFTS - TUFTS PPO - HCPCS - A4648",1,281,0,null,null,70.25]
["TUFTS - TUFTS POS - HCPCS - U0001",1,124,115.86,35.909999999999997,325.64,31]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - U0001",1,124,62.48,35.909999999999997,325.64,31]
["TUFTS - TUFTS POS - HCPCS - V2785",1,7848,9609.09,5130.87,15242.01,1962]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - U0002",1,92,89.28,51.31,465.19,23]
["TUFTS - TUFTS PPO - HCPCS - 0042T",1,767,0,1452,1452,191.75]
["TUFTS - TUFTS HMO - HCPCS - 0042T",1,767,0,1452,1452,191.75]
["TUFTS - TUFTS PPO - HCPCS - 0399T",1,1022,0,null,null,255.5]
["TUFTS - TUFTS HMO - HCPCS - 0278T",1,77,595.01,286.31,943.8,19.25]
["TUFTS - TUFTS PPO - HCPCS - 45378",1,1672,2058.16,1020.59,3264.67,418]
["TUFTS - TUFTS HMO - HCPCS - 0399T",1,1022,0,null,null,255.5]
["TUFTS - TUFTS PPO - HCPCS - 90471",1,64,217.91,76.22,345.64,16]
["TUFTS - TUFTS HMO - HCPCS - 0402T",1,2880,7467.76,1198.25,11845.41,720]
["TUFTS - TUFTS PPO - HCPCS - 95800",1,205,502.51,228.32,1412.44,51.25]
["TUFTS - TUFTS HMO - HCPCS - 45378",1,1672,2057.7399999999998,1020.59,3264.67,418]
["TUFTS - TUFTS PPO - HCPCS - A4561",1,108,0,23.18,58.33,27]
["TUFTS - TUFTS HMO - HCPCS - 81170",1,798,1161.31,159,2909.77,199.5]
["TUFTS - TUFTS PPO - HCPCS - A4570",1,40,38.19,19.010000000000002,107.35,10]
["TUFTS - TUFTS HMO - HCPCS - 90471",1,64,203.7,76.22,345.64,16]
["TUFTS - TUFTS PPO - HCPCS - A4725",1,87,0,null,null,21.75]
["TUFTS - TUFTS HMO - HCPCS - 92083",1,461,358.22,68.75,607.84,115.25]
["TUFTS - TUFTS PPO - HCPCS - A6258",1,83,0,5,12.58,20.75]
["TUFTS - TUFTS HMO - HCPCS - 95800",1,205,563.71,228.32,1412.44,51.25]
["TUFTS - TUFTS PPO - HCPCS - A6550",1,4,0,25.71,64.69,1]
["TUFTS - TUFTS HMO - HCPCS - A4215",1,433,0,null,null,108.25]
["TUFTS - TUFTS PPO - HCPCS - A9500",1,274,0,463.42,463.42,68.5]
["TUFTS - TUFTS HMO - HCPCS - A4561",1,108,0,23.18,58.33,27]
["TUFTS - TUFTS PPO - HCPCS - A9503",1,23,0,37.119999999999997,37.119999999999997,5.75]
["TUFTS - TUFTS HMO - HCPCS - A4562",1,64,0,57.71,145.21,16]
["TUFTS - TUFTS PPO - HCPCS - A9509",1,95,0,5163.91,5163.91,23.75]
["TUFTS - TUFTS HMO - HCPCS - A4570",1,40,42.84,19.010000000000002,107.35,10]
["TUFTS - TUFTS PPO - HCPCS - A9513",1,320,390.48,294.27999999999997,1097.56,80]
["TUFTS - TUFTS HMO - HCPCS - A4648",1,281,0,null,null,70.25]
["TUFTS - TUFTS PPO - HCPCS - A9517",1,437,32.200000000000003,30.1,101.94,109.25]
["TUFTS - TUFTS HMO - HCPCS - A4725",1,87,0,null,null,21.75]
["TUFTS - TUFTS PPO - HCPCS - A9521",1,360,0,4157.3,4157.3,90]
["TUFTS - TUFTS HMO - HCPCS - A6209",1,163,0,8.68,21.84,40.75]
["FALLON - FALLON MEDICAID - HCPCS - A6258",1,83,0,5,12.58,20.75]
["TUFTS - TUFTS HMO - HCPCS - A6258",1,83,0,5,12.58,20.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C2628",1,2308,0,null,null,577]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9552",1,972,0,1166.46,1166.46,243]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q0114",1,41,9.74,7.2,82.86,10.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9541",1,120,152.69,152.69,152.69,30]
["BMC HEALTHNET - BMCHN QHP - HCPCS - V2785",1,7848,0,5130.87,15242.01,1962]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9543",1,66322,139963.56,72400.97,217685.7,16580.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L3670",1,2903,465.27,103.65,465.27,725.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9547",1,440,5105.7299999999996,5105.7299999999996,5105.7299999999996,110]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L3905",1,2442,882.51,882.51,3961.32,610.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9551",1,154,1711.56,1711.56,1711.56,38.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G2212",1,188,0,null,null,47]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9552",1,972,1166.46,1166.46,1166.46,243]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9587",1,12985,0,84.97,113.78,3246.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9555",1,1065,1604.08,1604.08,1604.08,266.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0108",1,425,230.78,72.41,230.78,106.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9556",1,20,311.94,311.94,311.94,5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - U0001",1,124,325.64,35.909999999999997,325.64,31]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9557",1,239,1062.44,1062.44,1062.44,59.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L4398",1,406,78.92,78.92,354.25,101.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9558",1,23,108.88,108.88,108.88,5.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L1832",1,1523,743.59,743.59,3337.75,380.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9560",1,246,266.7,266.7,266.7,61.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0389",1,544,0,null,null,136]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9561",1,127,125.64,125.64,125.64,31.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L8509",1,1144,0,106.99,480.27,286]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9562",1,1237,2212.25,2212.25,2212.25,309.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9520",1,1951,0,null,null,487.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9563",1,0,870.53,535.17999999999995,3182.68,0]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1769",1,4759,0,null,null,1189.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9569",1,5086,4157.3,4157.3,4157.3,1271.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D4260",1,1451,4066.77,1275.99,4066.77,362.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9572",1,131,16207.01,16207.01,16207.01,32.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0445",1,118,16.149999999999999,8.9,16.149999999999999,29.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9575",1,8,0.21,0.18,0.45,2]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9056",1,1619,529.32000000000005,311.95,529.32000000000005,404.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9576",1,5,3.76,1.5,3.77,1.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L1832",1,1523,743.59,743.59,3337.75,380.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9577",1,21,5.03,1.81,5.03,5.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - G0481",1,192,156.59,91.84,1332.11,48]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9579",1,5,4.38,1.53,4.38,1.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A6258",1,83,5,5,12.58,20.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9581",1,99,16.97,14.76,37.14,24.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q9961",1,1,0.25,0.25,0.63,0.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9583",1,13,21.34,19.260000000000002,21.34,3.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q0114",1,41,9.74,7.2,82.86,10.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9584",1,2729,3235.55,3235.55,3235.55,682.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9587",1,12985,0,84.97,113.78,3246.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9586",1,4402,3746.06,3746.06,7452.46,1100.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0445",1,118,0,8.9,16.149999999999999,29.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9587",1,12985,84.97,84.97,113.78,3246.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L3762",1,57,0,95.68,429.49,14.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9588",1,15438,525.05999999999995,525.05999999999995,703.05,3859.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q4196",1,9044,0,111.59,280.77999999999997,2261]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9606",1,493,378.21,198.62,597.20000000000005,123.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A4648",1,281,0,null,null,70.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - C1717",1,607,836.69,469.29,1411.01,151.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9561",1,127,0,125.64,125.64,31.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - C2616",1,60393,47839.61,25512.2,76706.740000000005,15098.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1731",1,3847,0,null,null,961.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - C2635",1,0,78.03,78.03,242.54,0]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1883",1,1257,0,null,null,314.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - C2639",1,47,100.75,52.85,100.75,11.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D0270",1,836,4066.77,1275.99,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - C5275",1,743,810.95,684.11,2032.26,185.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D7230",1,836,4066.77,1275.99,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - C8908",1,579,1105.27,664.1,4299.8,144.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0390",1,3274,5035.18,1579.83,5035.18,818.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - C9358",1,8526,24.42,24.42,24.42,2131.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q9954",1,0,13.41,12.1,13.41,0]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - C9728",1,1957,3429.66,2227.36,7098.97,489.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L8501",1,219,721.54,160.74,721.54,54.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - C9739",1,6035,6751.98,2166.09,15242.01,1508.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q4124",1,23,0,16.39,16.39,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D0210",1,165,120.47,120.47,120.47,41.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L1830",1,78,119.28,81.95,367.86,19.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D0220",1,165,23.78,23.78,23.78,41.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L4360",1,557,345.83,345.83,1552.36,139.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D0230",1,110,21.35,21.35,21.35,27.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - 81170",1,798,300,159,2909.77,199.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D0272",1,836,1182.5,1182.5,4066.77,209]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L3650",1,1955,67.38,67.38,302.45,488.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D0274",1,836,1182.5,1182.5,4066.77,209]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q4132",1,3754,114.63,114.63,288.43,938.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D1110",1,110,84.56,51.21,163.22999999999999,27.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - J2790",1,186.95,0,74.3,186.95,46.737499999999997]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D1120",1,110,57.92,57.92,57.92,27.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - M0239",1,393,309.60000000000002,309.60000000000002,779.02,98.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D1351",1,110,45.91,45.91,45.91,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9516",1,192,516.39,516.39,516.39,48]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2140",1,110,98.66,98.66,98.66,27.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L4360",1,557,345.83,345.83,1552.36,139.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2150",1,110,126.81,126.81,126.81,27.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9537",1,138,0,157.94999999999999,157.94999999999999,34.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2160",1,110,153.4,153.4,153.4,27.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9563",1,0,0,535.17999999999995,3182.68,0]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2161",1,110,187.9,187.9,187.9,27.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0257",1,911,0,1027.32,3651.55,227.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2330",1,110,121.33,121.33,121.33,27.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0421",1,37,0,42.72,136.13999999999999,9.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2331",1,110,154.99,154.99,154.99,27.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G2011",1,35,0,28.83,133.88,8.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2332",1,110,189.47,189.47,189.47,27.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L1836",1,209,0,130.47999999999999,585.70000000000005,52.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2335",1,110,223.88,223.88,223.88,27.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L4350",1,360,0,97.28,436.66,90]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2390",1,110,248.14,248.14,248.14,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q4116",1,5248,35.78,32.29,35.78,1312]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2391",1,110,141.69,141.69,141.69,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q4125",1,4060,3.79,3.79,3.79,1015]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2392",1,110,186.31,186.31,186.31,27.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - 81170",1,798,2909.77,159,2909.77,199.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2393",1,110,230.94,230.94,230.94,27.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9502",1,140,0,278.27,278.27,35]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2394",1,110,282.64,282.64,282.64,27.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9547",1,440,0,5105.7299999999996,5105.7299999999996,110]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2740",1,110,1036.53,1036.53,1036.53,27.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9577",1,21,0,1.81,5.03,5.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2930",1,110,228.61,228.61,228.61,27.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1719",1,95,357.35,108.35,357.35,23.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2931",1,110,259.95,259.95,259.95,27.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1759",1,6295,0,null,null,1573.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2940",1,110,87.67,87.67,87.67,27.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1786",1,23460,0,null,null,5865]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D3110",1,110,68.89,68.89,68.89,27.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1898",1,1575,0,null,null,393.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D3220",1,110,141.69,141.69,141.69,27.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C9358",1,8526,0,24.42,24.42,2131.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D3310",1,110,587.95000000000005,587.95000000000005,587.95000000000005,27.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D1110",1,110,163.22999999999999,51.21,163.22999999999999,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D3330",1,110,894.85,894.85,894.85,27.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D5912",1,1451,4066.77,1275.99,4066.77,362.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D7140",1,836,1510.05,1275.99,4066.77,209]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D9630",1,110,3340.65,591.51,3340.65,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D7210",1,836,1510.05,1275.99,4066.77,209]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0269",1,200,0,null,null,50]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D7220",1,836,1510.05,1275.99,4066.77,209]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0422",1,169,637.79,198.42,637.79,42.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D7230",1,836,1510.05,1275.99,4066.77,209]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G2011",1,35,133.88,28.83,133.88,8.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D7240",1,836,1510.05,1275.99,4066.77,209]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L1820",1,159,640.03,142.59,640.03,39.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D7250",1,836,1510.05,1275.99,4066.77,209]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L3980",1,132,1695.98,377.84,1695.98,33]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D7310",1,110,230.94,230.94,230.94,27.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9017",1,291,217.72,94.07,217.72,72.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D7311",1,110,202.78,202.78,202.78,27.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q3014",1,67,61.23,26.65,67.06,16.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D7410",1,110,692.83,692.83,692.83,27.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q9957",1,417,0,47.63,119.85,104.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0101",1,148,128.29,18.010000000000002,128.29,37]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A6258",1,83,5,5,12.58,20.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0103",1,93,41.5,16.78,181.16,23.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - U0001",1,124,41.31,35.909999999999997,325.64,31]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0105",1,1152,1250.94,1020.59,3264.67,288]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L3807",1,483,222.52,222.52,998.85,120.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0108",1,425,136.19,72.41,230.78,106.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L8514",1,387,92.38,92.38,414.69,96.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0109",1,267,37.520000000000003,32.64,134.25,66.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q9957",1,417,47.63,47.63,119.85,104.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0127",1,189,93.87,93.87,317.35000000000002,47.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A9576",1,5,1.5,1.5,3.77,1.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0239",1,99,53.94,53.94,373.41,24.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L0120",1,25,24.86,24.86,111.59,6.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0257",1,911,1027.32,1027.32,3651.55,227.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L3967",1,117,1765.23,1765.23,7923.54,29.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0260",1,817,1005.62,1005.62,3474.13,204.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - P9045",1,238,52.45,52.45,131.97,59.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0278",1,3138,34.229999999999997,34.229999999999997,34.229999999999997,784.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0279",1,55,51.68,30.09,295.68,13.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A7520",1,1173,80.290000000000006,55.16,138.79,293.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0296",1,118,128.29,102.62,660.74,29.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L1902",1,219,86.14,86.14,386.65,54.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0297",1,1437,178.43,107.22,801.26,359.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L4386",1,165,155.02000000000001,155.02000000000001,695.83,41.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0390",1,3274,1587.59,1579.83,5035.18,818.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q4101",1,1601,30.46,30.46,76.64,400.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L1832",1,1523,1082.26,743.59,3337.75,380.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A6258",1,83,5,5,12.58,20.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L1836",1,209,189.91,130.47999999999999,585.70000000000005,52.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9521",1,360,4157.3,4157.3,4157.3,90]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0416",1,425,360.63,360.63,2456.98,106.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L3807",1,483,222.52,222.52,998.85,120.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0422",1,169,198.42,198.42,637.79,42.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L8514",1,387,92.38,92.38,414.69,96.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0423",1,169,198.42,198.42,637.79,42.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9516",1,192,0,516.39,516.39,48]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0424",1,284,93.87,93.87,343.09,71]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9541",1,120,0,152.69,152.69,30]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0442",1,42,13.34,13.34,33.6,10.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9558",1,23,0,108.88,108.88,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0443",1,118,33.04,18.52,33.6,29.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9580",1,158,0,null,null,39.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0480",1,254,209.48,59.69,973.54,63.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q4102",1,69,11.74,10.210000000000001,25.69,17.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0481",1,192,286.56,91.84,1332.11,48]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0278",1,3138,0,34.229999999999997,34.229999999999997,784.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L1902",1,219,125.37,86.14,386.65,54.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0402",1,168,0,208.89,1179.72,42]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0513",1,84,148.6,148.6,148.6,21]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0439",1,327,0,34.03,61.76,81.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0514",1,84,148.6,148.6,148.6,21]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0481",1,192,110.21,91.84,1332.11,48]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G2011",1,35,28.83,28.83,133.88,8.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G2066",1,165,0,58.35,370.47,41.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G2012",1,42,31.78,31.78,31.78,10.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L0140",1,189,0,77.52,347.97,47.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G2023",1,31,26.99,23.46,212.71,7.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L3496",1,406,0,null,null,101.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G2024",1,33,29.29,25.46,230.84,8.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L3908",1,143,0,73.22,328.66,35.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G2066",1,165,58.35,58.35,370.47,41.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L4396",1,406,0,171.42,769.43,101.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G2086",1,194,211.43,46.18,211.43,48.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - M0239",1,393,371.52,309.60000000000002,779.02,98.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G2087",1,194,211.43,46.18,211.43,48.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q4116",1,5248,0,32.29,35.78,1312]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G2088",1,45,82.11,82.11,82.11,11.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q9958",1,1,0,7.0000000000000007E-2,0.18,0.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L3260",1,279,31.12,31.12,357.96,69.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - S5102",1,126,0,null,null,31.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L3650",1,1955,98.07,67.38,302.45,488.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - 0278T",1,77,943.8,286.31,943.8,19.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L3670",1,2903,150.86000000000001,103.65,465.27,725.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A4215",1,433,0,null,null,108.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - J2790",1,186.95,0,74.3,186.95,46.737499999999997]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A6549",1,37,0,null,null,9.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L3760",1,819,647.70000000000005,445.02,1997.57,204.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9512",1,1,0,null,null,0.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L3807",1,483,323.87,222.52,998.85,120.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9539",1,668,0,89.47,89.47,167]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L0120",1,25,36.19,24.86,111.59,6.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9556",1,20,0,311.94,311.94,5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L1820",1,159,207.54,142.59,640.03,39.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9570",1,6395,0,null,null,1598.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L1830",1,78,119.28,81.95,367.86,19.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9582",1,10370,0,null,null,2592.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L1832",1,1523,1082.26,743.59,3337.75,380.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1714",1,6114,0,null,null,1528.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L1836",1,209,189.91,130.47999999999999,585.70000000000005,52.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1725",1,1693,0,null,null,423.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L1902",1,219,125.37,86.14,386.65,54.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1751",1,1438,0,null,null,359.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L3260",1,279,31.12,31.12,357.96,69.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1764",1,8983,0,null,null,2245.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L3650",1,1955,98.07,67.38,302.45,488.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1777",1,13038,0,null,null,3259.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L3670",1,2903,150.86000000000001,103.65,465.27,725.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1874",1,8879,0,null,null,2219.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L3760",1,819,647.70000000000005,445.02,1997.57,204.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1893",1,406,0,null,null,101.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L3807",1,483,323.87,222.52,998.85,120.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C2617",1,638,0,null,null,159.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L3808",1,509,547.16999999999996,375.94,1687.5,127.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C2639",1,47,89.68,52.85,100.75,11.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L3905",1,2442,1284.45,882.51,3961.32,610.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D0150",1,265,4066.77,1275.99,4066.77,66.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L3908",1,143,106.57,73.22,328.66,35.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D0472",1,110,6187.11,1941.26,6187.11,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L3967",1,117,2569.1999999999998,1765.23,7923.54,29.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D1575",1,1451,5493.21,1723.54,5493.21,362.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L3980",1,132,549.92999999999995,377.84,1695.98,33]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D4273",1,1451,4066.77,1275.99,4066.77,362.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L4350",1,360,141.58000000000001,97.28,436.66,90]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D5987",1,1451,4066.77,1275.99,4066.77,362.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L4360",1,557,503.35,345.83,1552.36,139.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D7261",1,836,4066.77,1275.99,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L4386",1,165,225.63,155.02000000000001,695.83,41.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - E0191",1,321,52.13,11.61,52.13,80.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L4396",1,406,249.49,171.42,769.43,101.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0239",1,99,373.41,53.94,373.41,24.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L4398",1,406,114.87,78.92,354.25,101.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0297",1,1437,801.26,107.22,801.26,359.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L8509",1,1144,155.72999999999999,106.99,480.27,286]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0410",1,220,0,null,null,55]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L8693",1,1462,2162.1799999999998,1485.57,6668.25,365.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0439",1,327,61.76,34.03,61.76,81.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - M0239",1,393,518.74,309.60000000000002,779.02,98.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0481",1,192,1332.11,91.84,1332.11,48]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - M0243",1,572,518.74,309.60000000000002,779.02,143]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G2066",1,165,370.47,58.35,370.47,41.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - P9012",1,134,64.959999999999994,64.959999999999994,125.33,33.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q9958",1,1,0.08,7.0000000000000007E-2,0.18,0.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - P9016",1,576,243.01,243.01,478.65,144]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L1902",1,219,386.65,86.14,386.65,54.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - P9017",1,291,94.07,94.07,217.72,72.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L3808",1,509,1687.5,375.94,1687.5,127.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - P9021",1,323,184.28,184.28,354.25,80.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L4370",1,107,1058.3900000000001,235.79,1058.3900000000001,26.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - P9034",1,506,443.29,443.29,799.73,126.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L8693",1,1462,6668.25,1485.57,6668.25,365.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - P9037",1,939,821.84,821.84,1622.67,234.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9040",1,523,669.97,336.11,669.97,130.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - P9040",1,523,336.11,336.11,669.97,130.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9612",1,90,25.55,2.2200000000000002,1198.25,22.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - P9045",1,238,60.32,52.45,131.97,59.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q4104",1,7748,0,42.08,56.11,1937]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L3808",1,509,547.16999999999996,375.94,1687.5,127.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q4133",1,3756,0,131.97,332.06,939]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - P9073",1,889,821.84,821.84,2619.59,222.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - P9100",1,1310,33.53,33.53,256.64,327.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - 81170",1,798,300,159,2909.77,199.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - P9612",1,90,5.27,2.2200000000000002,1198.25,22.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A9576",1,5,1.5,1.5,3.77,1.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q0091",1,83,28.83,28.83,175.66,20.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - G0481",1,192,156.59,91.84,1332.11,48]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q0111",1,23,27.01,5.86,127.48,5.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L0120",1,25,24.86,24.86,111.59,6.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q0114",1,41,17.79,7.2,82.86,10.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L3650",1,1955,67.38,67.38,302.45,488.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q4101",1,1601,35.03,30.46,76.64,400.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L3967",1,117,1765.23,1765.23,7923.54,29.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q4102",1,69,11.74,10.210000000000001,25.69,17.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L4398",1,406,78.92,78.92,354.25,101.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q4104",1,7748,56.11,42.08,56.11,1937]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - P9045",1,238,52.45,52.45,131.97,59.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q4107",1,2233,110.48,86.55,110.48,558.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q4132",1,3754,114.63,114.63,288.43,938.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q4112",1,535,1002.89,904.99,1002.89,133.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q4116",1,5248,35.78,32.29,35.78,1312]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A6258",1,83,5,5,12.58,20.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q4124",1,23,16.39,16.39,16.39,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - 81170",1,798,548.09,159,2909.77,199.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q4125",1,4060,3.79,3.79,3.79,1015]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - 92083",1,461,178.83,68.75,607.84,115.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q4130",1,65718,45.89,45.89,45.89,16429.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L1832",1,1523,743.59,743.59,3337.75,380.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q4132",1,3754,131.82,114.63,288.43,938.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L3807",1,483,222.52,222.52,998.85,120.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q4133",1,3756,151.77000000000001,131.97,332.06,939]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L4360",1,557,345.83,345.83,1552.36,139.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q9954",1,0,13.41,12.1,13.41,0]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L8514",1,387,92.38,92.38,414.69,96.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q9956",1,76,36.51,31.75,79.89,19]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q0114",1,41,9.74,7.2,82.86,10.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q9957",1,417,54.77,47.63,119.85,104.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q9957",1,417,47.63,47.63,119.85,104.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q9958",1,1,0.08,7.0000000000000007E-2,0.18,0.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - 81170",1,798,331.82,159,2909.77,199.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q9961",1,1,0.28999999999999998,0.25,0.63,0.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A9576",1,5,1.5,1.5,3.77,1.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - G0481",1,192,160.99,91.84,1332.11,48]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L1820",1,159,142.59,142.59,640.03,39.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L3905",1,2442,1284.45,882.51,3961.32,610.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L3760",1,819,445.02,445.02,1997.57,204.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - S8037",1,1440,1396.47,585.76,3771.6,360]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L3982",1,176,398.23,398.23,1787.56,44]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - U0001",1,124,41.31,35.909999999999997,325.64,31]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L8507",1,1604,41.03,41.03,184.14,401]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - U0002",1,92,59.02,51.31,465.19,23]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - P9612",1,90,3,2.2200000000000002,1198.25,22.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - 81170",1,798,662.96,159,2909.77,199.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q4196",1,9044,111.59,111.59,280.77999999999997,2261]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A4561",1,108,51.23,23.18,58.33,27]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - 81170",1,798,300,159,2909.77,199.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A4562",1,64,127.53,57.71,145.21,16]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A9576",1,5,1.5,1.5,3.77,1.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A6209",1,163,19.18,8.68,21.84,40.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - G0481",1,192,156.59,91.84,1332.11,48]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A6258",1,83,11.05,5,12.58,20.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L0120",1,25,24.86,24.86,111.59,6.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A6550",1,4,56.82,25.71,64.69,1]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L3650",1,1955,67.38,67.38,302.45,488.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A7520",1,1173,121.9,55.16,138.79,293.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L3967",1,117,1765.23,1765.23,7923.54,29.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A9575",1,8,0.4,0.18,0.45,2]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L4398",1,406,78.92,78.92,354.25,101.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A9576",1,5,3.31,1.5,3.77,1.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - P9045",1,238,52.45,52.45,131.97,59.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A9577",1,21,4,1.81,5.03,5.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q4132",1,3754,114.63,114.63,288.43,938.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A9579",1,5,3.38,1.53,4.38,1.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9520",1,1951,0,null,null,487.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A9581",1,99,32.619999999999997,14.76,37.14,24.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9539",1,668,0,89.47,89.47,167]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L3908",1,143,106.57,73.22,328.66,35.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9547",1,440,0,5105.7299999999996,5105.7299999999996,110]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - G0103",1,93,42.67,16.78,181.16,23.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9556",1,20,0,311.94,311.94,5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - G0279",1,55,66.5,30.09,295.68,13.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9561",1,127,0,125.64,125.64,31.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - G0480",1,254,252.88,59.69,973.54,63.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9570",1,6395,0,null,null,1598.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - G0481",1,192,346.05,91.84,1332.11,48]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9583",1,13,0,19.260000000000002,21.34,3.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - G2023",1,31,51.84,23.46,212.71,7.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9592",1,5634,0,null,null,1408.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - G2024",1,33,56.26,25.46,230.84,8.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0175",1,565,0,638.73,2035.73,141.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L3967",1,117,2569.1999999999998,1765.23,7923.54,29.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0260",1,817,0,1005.62,3474.13,204.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L3980",1,132,549.92999999999995,377.84,1695.98,33]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0297",1,1437,0,107.22,801.26,359.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L4350",1,360,141.58000000000001,97.28,436.66,90]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0396",1,42,0,56.05,336.32,10.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - J2790",1,186.95,0,74.3,186.95,46.737499999999997]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0416",1,425,0,360.63,2456.98,106.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L4360",1,557,503.35,345.83,1552.36,139.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0423",1,169,0,198.42,637.79,42.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L0120",1,25,54.94,24.86,111.59,6.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0443",1,118,0,18.52,33.6,29.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L0140",1,189,171.31,77.52,347.97,47.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0447",1,118,0,18.52,33.6,29.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L1820",1,159,315.11,142.59,640.03,39.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0513",1,84,0,148.6,148.6,21]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L1830",1,78,181.1,81.95,367.86,19.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q4104",1,7748,56.11,42.08,56.11,1937]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L1832",1,1523,1643.24,743.59,3337.75,380.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G2087",1,194,0,46.18,211.43,48.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L1836",1,209,288.35000000000002,130.47999999999999,585.70000000000005,52.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q4112",1,535,1002.89,904.99,1002.89,133.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L1902",1,219,190.36,86.14,386.65,54.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L1830",1,78,0,81.95,367.86,19.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L3350",1,41,49.52,22.41,100.59,10.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L3260",1,279,0,31.12,357.96,69.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L3650",1,1955,148.9,67.38,302.45,488.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L3670",1,2903,0,103.65,465.27,725.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L3670",1,2903,229.05,103.65,465.27,725.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L3808",1,509,0,375.94,1687.5,127.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L3760",1,819,983.44,445.02,1997.57,204.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L3980",1,132,0,377.84,1695.98,33]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L3762",1,57,211.44,95.68,429.49,14.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L4370",1,107,0,235.79,1058.3900000000001,26.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L3807",1,483,491.74,222.52,998.85,120.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L8501",1,219,0,160.74,721.54,54.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L3808",1,509,830.78,375.94,1687.5,127.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L8693",1,1462,0,1485.57,6668.25,365.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L3905",1,2442,1950.24,882.51,3961.32,610.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - P9612",1,90,2.66,2.2200000000000002,1198.25,22.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L3908",1,143,161.81,73.22,328.66,35.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q0249",1,9,0,null,null,2.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L3967",1,117,3900.95,1765.23,7923.54,29.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q4125",1,4060,0,3.79,3.79,1015]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L3980",1,132,834.98,377.84,1695.98,33]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q9956",1,76,0,31.75,79.89,19]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L3982",1,176,880.04,398.23,1787.56,44]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L4350",1,360,214.98,97.28,436.66,90]
["BMC HEALTHNET - BMCHN QHP - HCPCS - S5100",1,6,0,null,null,1.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L4360",1,557,764.24,345.83,1552.36,139.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - T2003",1,25,0,null,null,6.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L4370",1,107,521.07000000000005,235.79,1058.3900000000001,26.75]
["BMC HEALTHNET - BMCHN WELL SENSE - HCPCS - 81170",1,798,159,159,2909.77,199.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L4386",1,165,342.58,155.02000000000001,695.83,41.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - 0402T",1,2880,11845.41,1198.25,11845.41,720]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L4396",1,406,378.82,171.42,769.43,101.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - 92083",1,461,607.84,68.75,607.84,115.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L4398",1,406,174.4,78.92,354.25,101.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A4562",1,64,0,57.71,145.21,16]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L8501",1,219,355.22,160.74,721.54,54.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A6209",1,163,0,8.68,21.84,40.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L8507",1,1604,90.67,41.03,184.14,401]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A7520",1,1173,0,55.16,138.79,293.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L8509",1,1144,236.44,106.99,480.27,286]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9505",1,23,0,395.74,395.74,5.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L8514",1,387,204.15,92.38,414.69,96.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9516",1,192,0,516.39,516.39,48]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L8693",1,1462,3282.93,1485.57,6668.25,365.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9537",1,138,0,157.94999999999999,157.94999999999999,34.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - M0239",1,393,684.18,309.60000000000002,779.02,98.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9541",1,120,0,152.69,152.69,30]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - M0243",1,572,684.18,309.60000000000002,779.02,143]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9552",1,972,0,1166.46,1166.46,243]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - P9045",1,238,115.91,52.45,131.97,59.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9558",1,23,0,108.88,108.88,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L4386",1,165,225.63,155.02000000000001,695.83,41.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9563",1,0,3182.68,535.17999999999995,3182.68,0]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - P9612",1,90,6.63,2.2200000000000002,1198.25,22.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9575",1,8,0,0.18,0.45,2]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q0111",1,23,33.409999999999997,5.86,127.48,5.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9580",1,158,0,null,null,39.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q0114",1,41,21.52,7.2,82.86,10.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9584",1,2729,0,3235.55,3235.55,682.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q3014",1,67,58.89,26.65,67.06,16.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9606",1,493,597.20000000000005,198.62,597.20000000000005,123.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q4101",1,1601,67.31,30.46,76.64,400.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1716",1,0,506.68,168.52,506.68,0]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q4102",1,69,22.56,10.210000000000001,25.69,17.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1722",1,43645,0,null,null,10911.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q4132",1,3754,253.32,114.63,288.43,938.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1729",1,2283,0,null,null,570.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q4133",1,3756,291.64,131.97,332.06,939]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1733",1,10475,0,null,null,2618.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q4196",1,9044,246.6,111.59,280.77999999999997,2261]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1756",1,1438,0,null,null,359.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q9956",1,76,70.16,31.75,79.89,19]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1762",1,12010,0,null,null,3002.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q9957",1,417,105.26,47.63,119.85,104.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1766",1,2619,0,null,null,654.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q9958",1,1,0.15,7.0000000000000007E-2,0.18,0.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1773",1,2163,0,null,null,540.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q9961",1,1,0.55000000000000004,0.25,0.63,0.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1784",1,2734,0,null,null,683.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1817",1,9668,0,null,null,2417]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1880",1,7726,0,null,null,1931.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L4396",1,406,249.49,171.42,769.43,101.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1887",1,3731,0,null,null,932.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - U0001",1,124,79.36,35.909999999999997,325.64,31]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1895",1,13382,0,null,null,3345.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - U0002",1,92,113.39,51.31,465.19,23]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q4130",1,65718,45.89,45.89,45.89,16429.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - 81170",1,798,484.99,159,2909.77,199.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C2623",1,2837,0,null,null,709.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A4215",1,433,0,null,null,108.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C2634",1,0,698.88,232.45,698.88,0]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A4467",1,151,0,null,null,37.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C8908",1,579,4299.8,664.1,4299.8,144.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A4561",1,108,0,23.18,58.33,27]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C9739",1,6035,15242.01,2166.09,15242.01,1508.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A4562",1,64,0,57.71,145.21,16]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D0250",1,1451,4066.77,1275.99,4066.77,362.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A4570",1,40,0,19.010000000000002,107.35,10]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D0274",1,836,4066.77,1182.5,4066.77,209]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A4725",1,87,0,null,null,21.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D0474",1,110,6187.11,1941.26,6187.11,27.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A6209",1,163,0,8.68,21.84,40.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D1516",1,1350,0,null,null,337.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A6258",1,83,0,5,12.58,20.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D3460",1,1451,4066.77,1275.99,4066.77,362.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A6549",1,37,0,null,null,9.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D4264",1,1451,4066.77,1275.99,4066.77,362.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A6550",1,4,0,25.71,64.69,1]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D4381",1,1451,4066.77,1275.99,4066.77,362.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A7520",1,1173,0,55.16,138.79,293.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D5984",1,1451,4066.77,1275.99,4066.77,362.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9500",1,274,0,463.42,463.42,68.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D7210",1,836,4066.77,1275.99,4066.77,209]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9502",1,140,0,278.27,278.27,35]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D7250",1,836,4066.77,1275.99,4066.77,209]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9503",1,23,0,37.119999999999997,37.119999999999997,5.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D9110",1,110,0,null,null,27.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9505",1,23,0,395.74,395.74,5.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D9944",1,51,0,null,null,12.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9509",1,95,0,5163.91,5163.91,23.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0103",1,93,181.16,16.78,181.16,23.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9512",1,1,0,null,null,0.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0127",1,189,317.35000000000002,93.87,317.35000000000002,47.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9513",1,320,0,294.27999999999997,1097.56,80]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0259",1,1513,0,1198.25,1198.25,378.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9516",1,192,0,516.39,516.39,48]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0279",1,55,295.68,30.09,295.68,13.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9517",1,437,0,30.1,101.94,109.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0378",1,319,0,null,null,79.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9520",1,1951,0,null,null,487.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0397",1,118,815.89,128.29,815.89,29.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9521",1,360,0,4157.3,4157.3,90]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0420",1,156,589.33000000000004,184.9,589.33000000000004,39]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9537",1,138,0,157.94999999999999,157.94999999999999,34.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0424",1,284,343.09,93.87,343.09,71]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9538",1,111,0,114.21,114.21,27.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0443",1,118,33.6,18.52,33.6,29.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9539",1,668,0,89.47,89.47,167]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0447",1,118,33.6,18.52,33.6,29.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9540",1,1831,0,85.66,85.66,457.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0513",1,84,0,148.6,148.6,21]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9541",1,120,0,152.69,152.69,30]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G2023",1,31,212.71,23.46,212.71,7.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9543",1,66322,0,72400.97,217685.7,16580.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G2087",1,194,129.81,46.18,211.43,48.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9547",1,440,0,5105.7299999999996,5105.7299999999996,110]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - J2790",1,186.95,0,74.3,186.95,46.737499999999997]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9551",1,154,0,1711.56,1711.56,38.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L0120",1,25,111.59,24.86,111.59,6.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9552",1,972,0,1166.46,1166.46,243]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L1832",1,1523,3337.75,743.59,3337.75,380.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9555",1,1065,0,1604.08,1604.08,266.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L3350",1,41,100.59,22.41,100.59,10.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9556",1,20,0,311.94,311.94,5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L3762",1,57,429.49,95.68,429.49,14.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9557",1,239,0,1062.44,1062.44,59.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L3908",1,143,328.66,73.22,328.66,35.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9558",1,23,0,108.88,108.88,5.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L4350",1,360,436.66,97.28,436.66,90]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9560",1,246,0,266.7,266.7,61.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L4396",1,406,769.43,171.42,769.43,101.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9561",1,127,0,125.64,125.64,31.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L8509",1,1144,480.27,106.99,480.27,286]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9562",1,1237,0,2212.25,2212.25,309.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9012",1,134,125.33,64.959999999999994,125.33,33.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9563",1,0,0,535.17999999999995,3182.68,0]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9034",1,506,799.73,443.29,799.73,126.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9569",1,5086,0,4157.3,4157.3,1271.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9045",1,238,129.05000000000001,52.45,131.97,59.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9570",1,6395,0,null,null,1598.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9073",1,889,2619.59,821.84,2619.59,222.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9572",1,131,0,16207.01,16207.01,32.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q0111",1,23,127.48,5.86,127.48,5.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9580",1,158,0,null,null,39.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q4101",1,1601,0,30.46,76.64,400.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9582",1,10370,0,null,null,2592.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q4112",1,535,0,904.99,1002.89,133.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9583",1,13,0,19.260000000000002,21.34,3.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q4130",1,65718,0,45.89,45.89,16429.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9584",1,2729,0,3235.55,3235.55,682.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q9954",1,0,0,12.1,13.41,0]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9587",1,12985,0,84.97,113.78,3246.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q9961",1,1,0,0.25,0.63,0.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9588",1,15438,0,525.05999999999995,703.05,3859.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - S2083",1,211,943.8,317.70999999999998,1198.25,52.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9592",1,5634,0,null,null,1408.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - V2785",1,7848,15242.01,5130.87,15242.01,1962]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0101",1,148,0,18.010000000000002,128.29,37]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A4562",1,64,57.71,57.71,145.21,16]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L4398",1,406,114.87,78.92,354.25,101.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A7520",1,1173,55.16,55.16,138.79,293.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0127",1,189,0,93.87,317.35000000000002,47.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A9579",1,5,1.53,1.53,4.38,1.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0175",1,565,0,638.73,2035.73,141.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - G0279",1,55,30.09,30.09,295.68,13.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0239",1,99,0,53.94,373.41,24.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - G2024",1,33,25.46,25.46,230.84,8.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0257",1,911,0,1027.32,3651.55,227.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - J2790",1,186.95,0,74.3,186.95,46.737499999999997]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0259",1,1513,0,1198.25,1198.25,378.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L1820",1,159,142.59,142.59,640.03,39.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0260",1,817,0,1005.62,3474.13,204.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L1902",1,219,86.14,86.14,386.65,54.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0269",1,200,0,null,null,50]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L3760",1,819,445.02,445.02,1997.57,204.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0278",1,3138,0,34.229999999999997,34.229999999999997,784.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L3905",1,2442,882.51,882.51,3961.32,610.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0296",1,118,0,102.62,660.74,29.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L3982",1,176,398.23,398.23,1787.56,44]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0297",1,1437,0,107.22,801.26,359.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L4386",1,165,155.02000000000001,155.02000000000001,695.83,41.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0365",1,498,0,272.02999999999997,867.01,124.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L8507",1,1604,41.03,41.03,184.14,401]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0389",1,544,0,null,null,136]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - M0239",1,393,309.60000000000002,309.60000000000002,779.02,98.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0390",1,3274,0,1579.83,5035.18,818.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - P9612",1,90,3,2.2200000000000002,1198.25,22.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0396",1,42,0,56.05,336.32,10.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q4101",1,1601,30.46,30.46,76.64,400.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0397",1,118,0,128.29,815.89,29.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q4196",1,9044,111.59,111.59,280.77999999999997,2261]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0402",1,168,0,208.89,1179.72,42]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q9961",1,1,0.25,0.25,0.63,0.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0410",1,220,0,null,null,55]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - U0001",1,124,35.909999999999997,35.909999999999997,325.64,31]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0416",1,425,0,360.63,2456.98,106.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A4562",1,64,57.71,57.71,145.21,16]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0420",1,156,0,184.9,589.33000000000004,39]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A7520",1,1173,55.16,55.16,138.79,293.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0421",1,37,0,42.72,136.13999999999999,9.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A9579",1,5,1.53,1.53,4.38,1.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0422",1,169,0,198.42,637.79,42.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - G0279",1,55,30.09,30.09,295.68,13.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0423",1,169,0,198.42,637.79,42.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - G2024",1,33,25.46,25.46,230.84,8.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0438",1,547,0,34.03,61.76,136.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - J2790",1,186.95,0,74.3,186.95,46.737499999999997]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0439",1,327,0,34.03,61.76,81.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L1820",1,159,142.59,142.59,640.03,39.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0442",1,42,0,13.34,33.6,10.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L1902",1,219,86.14,86.14,386.65,54.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0443",1,118,0,18.52,33.6,29.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L3760",1,819,445.02,445.02,1997.57,204.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0444",1,42,0,8.9,16.149999999999999,10.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L3905",1,2442,882.51,882.51,3961.32,610.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0445",1,118,0,8.9,16.149999999999999,29.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L3982",1,176,398.23,398.23,1787.56,44]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0446",1,42,0,8.9,16.149999999999999,10.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L4386",1,165,155.02000000000001,155.02000000000001,695.83,41.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0447",1,118,0,18.52,33.6,29.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L8507",1,1604,41.03,41.03,184.14,401]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0480",1,254,130.6,59.69,973.54,63.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - M0239",1,393,309.60000000000002,309.60000000000002,779.02,98.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0481",1,192,200.95,91.84,1332.11,48]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - P9612",1,90,3,2.2200000000000002,1198.25,22.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0506",1,62,0,110.9,110.9,15.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q4101",1,1601,30.46,30.46,76.64,400.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0513",1,84,0,148.6,148.6,21]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q4196",1,9044,111.59,111.59,280.77999999999997,2261]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0514",1,84,0,148.6,148.6,21]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q9961",1,1,0.25,0.25,0.63,0.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G2011",1,35,0,28.83,133.88,8.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - U0001",1,124,35.909999999999997,35.909999999999997,325.64,31]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G2012",1,42,0,31.78,31.78,10.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A4562",1,64,57.71,57.71,145.21,16]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L8509",1,1144,155.72999999999999,106.99,480.27,286]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A7520",1,1173,55.16,55.16,138.79,293.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L8693",1,1462,2162.1799999999998,1485.57,6668.25,365.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A9579",1,5,1.53,1.53,4.38,1.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G2066",1,165,0,58.35,370.47,41.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - G0279",1,55,30.09,30.09,295.68,13.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G2086",1,194,0,46.18,211.43,48.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9502",1,140,278.27,278.27,278.27,35]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G2087",1,194,0,46.18,211.43,48.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L0120",1,25,24.86,24.86,111.59,6.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G2088",1,45,0,82.11,82.11,11.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L1832",1,1523,743.59,743.59,3337.75,380.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G2212",1,188,0,null,null,47]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L3650",1,1955,67.38,67.38,302.45,488.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G2216",1,118,0,null,null,29.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L3807",1,483,222.52,222.52,998.85,120.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - M0239",1,393,518.74,309.60000000000002,779.02,98.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L3967",1,117,1765.23,1765.23,7923.54,29.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L0120",1,25,0,24.86,111.59,6.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L4360",1,557,345.83,345.83,1552.36,139.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L0140",1,189,0,77.52,347.97,47.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L4398",1,406,78.92,78.92,354.25,101.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L1820",1,159,0,142.59,640.03,39.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L8514",1,387,92.38,92.38,414.69,96.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L1830",1,78,0,81.95,367.86,19.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - P9045",1,238,52.45,52.45,131.97,59.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L1832",1,1523,0,743.59,3337.75,380.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q0114",1,41,9.81,7.2,82.86,10.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L1836",1,209,0,130.47999999999999,585.70000000000005,52.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q4132",1,3754,114.63,114.63,288.43,938.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L1902",1,219,0,86.14,386.65,54.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q9957",1,417,47.63,47.63,119.85,104.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L3260",1,279,0,31.12,357.96,69.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L3350",1,41,0,22.41,100.59,10.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A4562",1,64,57.71,57.71,145.21,16]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L3496",1,406,0,null,null,101.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A7520",1,1173,55.16,55.16,138.79,293.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L3650",1,1955,0,67.38,302.45,488.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A9579",1,5,1.53,1.53,4.38,1.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L3670",1,2903,0,103.65,465.27,725.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - G0279",1,55,30.09,30.09,295.68,13.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L3760",1,819,0,445.02,1997.57,204.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - G2024",1,33,25.46,25.46,230.84,8.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L3762",1,57,0,95.68,429.49,14.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - J2790",1,186.95,0,74.3,186.95,46.737499999999997]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L3807",1,483,0,222.52,998.85,120.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L1820",1,159,142.59,142.59,640.03,39.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L3808",1,509,0,375.94,1687.5,127.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L1902",1,219,86.14,86.14,386.65,54.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L3905",1,2442,0,882.51,3961.32,610.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L3760",1,819,445.02,445.02,1997.57,204.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L3908",1,143,0,73.22,328.66,35.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L3905",1,2442,882.51,882.51,3961.32,610.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L3967",1,117,0,1765.23,7923.54,29.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L3982",1,176,398.23,398.23,1787.56,44]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L3980",1,132,0,377.84,1695.98,33]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L4386",1,165,155.02000000000001,155.02000000000001,695.83,41.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L3982",1,176,0,398.23,1787.56,44]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L8507",1,1604,41.03,41.03,184.14,401]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L4350",1,360,0,97.28,436.66,90]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - M0239",1,393,309.60000000000002,309.60000000000002,779.02,98.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L4360",1,557,0,345.83,1552.36,139.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - P9612",1,90,3,2.2200000000000002,1198.25,22.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L4370",1,107,0,235.79,1058.3900000000001,26.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q4101",1,1601,30.46,30.46,76.64,400.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L4386",1,165,0,155.02000000000001,695.83,41.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9540",1,1831,85.66,85.66,85.66,457.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L4396",1,406,0,171.42,769.43,101.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9517",1,437,0,30.1,101.94,109.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L4398",1,406,0,78.92,354.25,101.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9521",1,360,0,4157.3,4157.3,90]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L8501",1,219,0,160.74,721.54,54.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9538",1,111,0,114.21,114.21,27.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L8507",1,1604,0,41.03,184.14,401]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9540",1,1831,0,85.66,85.66,457.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L8509",1,1144,0,106.99,480.27,286]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9543",1,66322,0,72400.97,217685.7,16580.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L8514",1,387,0,92.38,414.69,96.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9551",1,154,0,1711.56,1711.56,38.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L8693",1,1462,0,1485.57,6668.25,365.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9555",1,1065,0,1604.08,1604.08,266.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L8699",1,13957,0,null,null,3489.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9557",1,239,0,1062.44,1062.44,59.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - M0239",1,393,677.4,309.60000000000002,779.02,98.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9560",1,246,0,266.7,266.7,61.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - M0243",1,572,677.4,309.60000000000002,779.02,143]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9562",1,1237,0,2212.25,2212.25,309.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - P9612",1,90,4.8600000000000003,2.2200000000000002,1198.25,22.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9569",1,5086,0,4157.3,4157.3,1271.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q0091",1,83,0,28.83,175.66,20.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9572",1,131,0,16207.01,16207.01,32.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - M0243",1,572,518.74,309.60000000000002,779.02,143]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9582",1,10370,0,null,null,2592.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9012",1,134,64.959999999999994,64.959999999999994,125.33,33.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9584",1,2729,0,3235.55,3235.55,682.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q0249",1,9,0,null,null,2.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9588",1,15438,0,525.05999999999995,703.05,3859.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q3014",1,67,0,26.65,67.06,16.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0101",1,148,0,18.010000000000002,128.29,37]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q4116",1,5248,0,32.29,35.78,1312]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0127",1,189,0,93.87,317.35000000000002,47.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q4124",1,23,0,16.39,16.39,5.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0239",1,99,0,53.94,373.41,24.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q4125",1,4060,0,3.79,3.79,1015]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0259",1,1513,0,1198.25,1198.25,378.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q4130",1,65718,0,45.89,45.89,16429.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0269",1,200,0,null,null,50]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q4196",1,9044,0,111.59,280.77999999999997,2261]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0296",1,118,0,102.62,660.74,29.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q9954",1,0,0,12.1,13.41,0]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0365",1,498,0,272.02999999999997,867.01,124.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q9956",1,76,0,31.75,79.89,19]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0390",1,3274,0,1579.83,5035.18,818.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q9957",1,417,0,47.63,119.85,104.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0397",1,118,0,128.29,815.89,29.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q9958",1,1,0,7.0000000000000007E-2,0.18,0.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0410",1,220,0,null,null,55]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q9961",1,1,0,0.25,0.63,0.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0420",1,156,0,184.9,589.33000000000004,39]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0422",1,169,0,198.42,637.79,42.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0438",1,547,0,34.03,61.76,136.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9016",1,576,243.01,243.01,478.65,144]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0442",1,42,0,13.34,33.6,10.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q9987",1,1218,0,null,null,304.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0444",1,42,0,8.9,16.149999999999999,10.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - S5100",1,6,0,null,null,1.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0446",1,42,0,8.9,16.149999999999999,10.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - S5101",1,63,0,null,null,15.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0480",1,254,71.63,59.69,973.54,63.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - S5102",1,126,0,null,null,31.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0506",1,62,0,110.9,110.9,15.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - S8037",1,1440,0,585.76,3771.6,360]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0514",1,84,0,148.6,148.6,21]
["BMC HEALTHNET - BMCHN ACO - HCPCS - T2003",1,25,0,null,null,6.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G2012",1,42,0,31.78,31.78,10.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - U0002",1,92,112.27,51.31,465.19,23]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q4107",1,2233,110.48,86.55,110.48,558.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - V2785",1,7848,0,5130.87,15242.01,1962]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G2086",1,194,0,46.18,211.43,48.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - V2790",1,1136,0,null,null,284]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G2088",1,45,0,82.11,82.11,11.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - 81170",1,798,221.66,159,2909.77,199.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G2216",1,118,0,null,null,29.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A4215",1,433,0,null,null,108.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L0120",1,25,0,24.86,111.59,6.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A4467",1,151,0,null,null,37.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L1820",1,159,0,142.59,640.03,39.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A4561",1,108,0,23.18,58.33,27]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L1832",1,1523,0,743.59,3337.75,380.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A4562",1,64,0,57.71,145.21,16]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L1902",1,219,0,86.14,386.65,54.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A4570",1,40,0,19.010000000000002,107.35,10]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L3350",1,41,0,22.41,100.59,10.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A4725",1,87,0,null,null,21.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L3650",1,1955,0,67.38,302.45,488.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A6209",1,163,0,8.68,21.84,40.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L3760",1,819,0,445.02,1997.57,204.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A6258",1,83,0,5,12.58,20.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L3807",1,483,0,222.52,998.85,120.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A6549",1,37,0,null,null,9.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L3905",1,2442,0,882.51,3961.32,610.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A6550",1,4,0,25.71,64.69,1]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L3967",1,117,0,1765.23,7923.54,29.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A7520",1,1173,0,55.16,138.79,293.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L3982",1,176,0,398.23,1787.56,44]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9500",1,274,0,463.42,463.42,68.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L4360",1,557,0,345.83,1552.36,139.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9502",1,140,0,278.27,278.27,35]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L4386",1,165,0,155.02000000000001,695.83,41.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9503",1,23,0,37.119999999999997,37.119999999999997,5.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L4398",1,406,0,78.92,354.25,101.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9505",1,23,0,395.74,395.74,5.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L8507",1,1604,0,41.03,184.14,401]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9509",1,95,0,5163.91,5163.91,23.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L8514",1,387,0,92.38,414.69,96.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9512",1,1,0,null,null,0.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L8699",1,13957,0,null,null,3489.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9513",1,320,0,294.27999999999997,1097.56,80]
["BMC HEALTHNET - BMCHN QHP - HCPCS - M0243",1,572,371.52,309.60000000000002,779.02,143]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9516",1,192,0,516.39,516.39,48]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q0091",1,83,0,28.83,175.66,20.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9517",1,437,0,30.1,101.94,109.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q4124",1,23,16.39,16.39,16.39,5.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9520",1,1951,0,null,null,487.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q3014",1,67,0,26.65,67.06,16.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9521",1,360,0,4157.3,4157.3,90]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q4124",1,23,0,16.39,16.39,5.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9537",1,138,0,157.94999999999999,157.94999999999999,34.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q4130",1,65718,0,45.89,45.89,16429.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9538",1,111,0,114.21,114.21,27.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q9954",1,0,0,12.1,13.41,0]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9539",1,668,0,89.47,89.47,167]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q9957",1,417,0,47.63,119.85,104.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9540",1,1831,0,85.66,85.66,457.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q9961",1,1,0,0.25,0.63,0.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9541",1,120,0,152.69,152.69,30]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9543",1,66322,0,72400.97,217685.7,16580.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q9987",1,1218,0,null,null,304.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9547",1,440,0,5105.7299999999996,5105.7299999999996,110]
["BMC HEALTHNET - BMCHN QHP - HCPCS - S5101",1,63,0,null,null,15.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9551",1,154,0,1711.56,1711.56,38.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - S8037",1,1440,0,585.76,3771.6,360]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9552",1,972,0,1166.46,1166.46,243]
["BMC HEALTHNET - BMCHN QHP - HCPCS - U0002",1,92,61.57,51.31,465.19,23]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9555",1,1065,0,1604.08,1604.08,266.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - V2790",1,1136,0,null,null,284]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9556",1,20,0,311.94,311.94,5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - 0042T",1,767,0,1452,1452,191.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9557",1,239,0,1062.44,1062.44,59.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - 0399T",1,1022,0,null,null,255.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9558",1,23,0,108.88,108.88,5.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - 45378",1,1672,3264.67,1020.59,3264.67,418]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9560",1,246,0,266.7,266.7,61.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - 90471",1,64,345.64,76.22,345.64,16]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9561",1,127,0,125.64,125.64,31.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - 95800",1,205,1412.44,228.32,1412.44,51.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9562",1,1237,0,2212.25,2212.25,309.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A4561",1,108,0,23.18,58.33,27]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9563",1,0,0,535.17999999999995,3182.68,0]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A4570",1,40,107.35,19.010000000000002,107.35,10]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9569",1,5086,0,4157.3,4157.3,1271.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A4725",1,87,0,null,null,21.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9570",1,6395,0,null,null,1598.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A6258",1,83,0,5,12.58,20.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9572",1,131,0,16207.01,16207.01,32.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A6550",1,4,0,25.71,64.69,1]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9580",1,158,0,null,null,39.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9500",1,274,0,463.42,463.42,68.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9582",1,10370,0,null,null,2592.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9503",1,23,0,37.119999999999997,37.119999999999997,5.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9583",1,13,0,19.260000000000002,21.34,3.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9509",1,95,0,5163.91,5163.91,23.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9584",1,2729,0,3235.55,3235.55,682.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9513",1,320,1097.56,294.27999999999997,1097.56,80]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9587",1,12985,0,84.97,113.78,3246.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9517",1,437,90.52,30.1,101.94,109.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9588",1,15438,0,525.05999999999995,703.05,3859.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9521",1,360,0,4157.3,4157.3,90]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9592",1,5634,0,null,null,1408.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9538",1,111,0,114.21,114.21,27.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0101",1,148,0,18.010000000000002,128.29,37]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9540",1,1831,0,85.66,85.66,457.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9017",1,291,94.07,94.07,217.72,72.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9543",1,66322,217685.7,72400.97,217685.7,16580.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0127",1,189,0,93.87,317.35000000000002,47.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9551",1,154,0,1711.56,1711.56,38.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0175",1,565,0,638.73,2035.73,141.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9555",1,1065,0,1604.08,1604.08,266.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0239",1,99,0,53.94,373.41,24.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9557",1,239,0,1062.44,1062.44,59.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0257",1,911,0,1027.32,3651.55,227.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9560",1,246,0,266.7,266.7,61.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0259",1,1513,0,1198.25,1198.25,378.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9562",1,1237,0,2212.25,2212.25,309.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0260",1,817,0,1005.62,3474.13,204.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9569",1,5086,0,4157.3,4157.3,1271.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0269",1,200,0,null,null,50]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9572",1,131,0,16207.01,16207.01,32.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0278",1,3138,0,34.229999999999997,34.229999999999997,784.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9576",1,5,0,1.5,3.77,1.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0296",1,118,0,102.62,660.74,29.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9579",1,5,0,1.53,4.38,1.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0297",1,1437,0,107.22,801.26,359.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9581",1,99,0,14.76,37.14,24.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0365",1,498,0,272.02999999999997,867.01,124.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9583",1,13,0,19.260000000000002,21.34,3.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0389",1,544,0,null,null,136]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9586",1,4402,7452.46,3746.06,7452.46,1100.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0390",1,3274,0,1579.83,5035.18,818.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9588",1,15438,0,525.05999999999995,703.05,3859.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0396",1,42,0,56.05,336.32,10.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1713",1,4568,0,null,null,1142]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0397",1,118,0,128.29,815.89,29.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1715",1,21,0,null,null,5.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0402",1,168,0,208.89,1179.72,42]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1717",1,607,1411.01,469.29,1411.01,151.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0410",1,220,0,null,null,55]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1721",1,39674,0,null,null,9918.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0416",1,425,0,360.63,2456.98,106.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1724",1,7410,0,null,null,1852.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0420",1,156,0,184.9,589.33000000000004,39]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1726",1,387,0,null,null,96.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0421",1,37,0,42.72,136.13999999999999,9.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1730",1,2283,0,null,null,570.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0422",1,169,0,198.42,637.79,42.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1732",1,7766,0,null,null,1941.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0423",1,169,0,198.42,637.79,42.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1750",1,1693,0,null,null,423.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0438",1,547,0,34.03,61.76,136.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1753",1,3947,0,null,null,986.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0439",1,327,0,34.03,61.76,81.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1757",1,15822,0,null,null,3955.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0442",1,42,0,13.34,33.6,10.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1760",1,1799,0,null,null,449.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0443",1,118,0,18.52,33.6,29.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1763",1,2242,0,null,null,560.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0444",1,42,0,8.9,16.149999999999999,10.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1765",1,569,0,null,null,142.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0445",1,118,0,8.9,16.149999999999999,29.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1768",1,76125,0,null,null,19031.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0446",1,42,0,8.9,16.149999999999999,10.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1770",1,3667,0,null,null,916.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0447",1,118,0,18.52,33.6,29.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1776",1,21721,0,null,null,5430.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0480",1,254,59.69,59.69,973.54,63.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1781",1,36449,0,null,null,9112.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0481",1,192,91.84,91.84,1332.11,48]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1785",1,12546,0,null,null,3136.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0506",1,62,0,110.9,110.9,15.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1788",1,540,0,null,null,135]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0513",1,84,0,148.6,148.6,21]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1821",1,9770,0,null,null,2442.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0514",1,84,0,148.6,148.6,21]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1876",1,11691,0,null,null,2922.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G2011",1,35,0,28.83,133.88,8.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1882",1,53226,0,null,null,13306.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G2012",1,42,0,31.78,31.78,10.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1884",1,31469,0,null,null,7867.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9021",1,323,184.28,184.28,354.25,80.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1892",1,340,0,null,null,85]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9034",1,506,443.29,443.29,799.73,126.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1894",1,252,0,null,null,63]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G2066",1,165,0,58.35,370.47,41.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1896",1,10912,0,null,null,2728]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G2086",1,194,0,46.18,211.43,48.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1900",1,8293,0,null,null,2073.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G2087",1,194,0,46.18,211.43,48.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C2616",1,60393,76706.740000000005,25512.2,76706.740000000005,15098.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G2088",1,45,0,82.11,82.11,11.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C2621",1,21692,0,null,null,5423]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G2212",1,188,0,null,null,47]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C2625",1,246,0,null,null,61.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G2216",1,118,0,null,null,29.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C2630",1,4966,0,null,null,1241.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9037",1,939,821.84,821.84,1622.67,234.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C2635",1,0,242.54,78.03,242.54,0]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L0120",1,25,0,24.86,111.59,6.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C5275",1,743,2032.26,684.11,2032.26,185.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L0140",1,189,0,77.52,347.97,47.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C8937",1,331,0,null,null,82.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L1820",1,159,0,142.59,640.03,39.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C9728",1,1957,7098.97,2227.36,7098.97,489.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L1830",1,78,0,81.95,367.86,19.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C9803",1,35,246.49,87.7,246.49,8.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L1832",1,1523,0,743.59,3337.75,380.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D0240",1,836,4066.77,1275.99,4066.77,209]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L1836",1,209,0,130.47999999999999,585.70000000000005,52.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D0251",1,119,0,null,null,29.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L1902",1,219,0,86.14,386.65,54.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D0272",1,836,4066.77,1182.5,4066.77,209]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L3260",1,279,0,31.12,357.96,69.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D0277",1,1451,4066.77,1275.99,4066.77,362.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L3350",1,41,0,22.41,100.59,10.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D0473",1,110,6187.11,1941.26,6187.11,27.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L3496",1,406,0,null,null,101.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D0480",1,110,6187.11,1941.26,6187.11,27.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L3650",1,1955,0,67.38,302.45,488.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D1510",1,836,4066.77,1275.99,4066.77,209]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L3670",1,2903,0,103.65,465.27,725.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D1517",1,1451,0,null,null,362.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L3760",1,819,0,445.02,1997.57,204.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D2999",1,1451,4066.77,1275.99,4066.77,362.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L3762",1,57,0,95.68,429.49,14.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D3999",1,1451,4066.77,1275.99,4066.77,362.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L3807",1,483,0,222.52,998.85,120.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D4263",1,1451,4066.77,1275.99,4066.77,362.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L3808",1,509,0,375.94,1687.5,127.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D4270",1,1451,4066.77,1275.99,4066.77,362.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L3905",1,2442,0,882.51,3961.32,610.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D4355",1,836,4066.77,1275.99,4066.77,209]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L3908",1,143,0,73.22,328.66,35.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D5911",1,1451,4066.77,1275.99,4066.77,362.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L3967",1,117,0,1765.23,7923.54,29.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D5983",1,1451,4066.77,1275.99,4066.77,362.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L3980",1,132,0,377.84,1695.98,33]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D5985",1,1451,4066.77,1275.99,4066.77,362.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L3982",1,176,0,398.23,1787.56,44]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D7140",1,836,4066.77,1275.99,4066.77,209]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L4350",1,360,0,97.28,436.66,90]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D7220",1,836,4066.77,1275.99,4066.77,209]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L4360",1,557,0,345.83,1552.36,139.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D7240",1,836,4066.77,1275.99,4066.77,209]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L4370",1,107,0,235.79,1058.3900000000001,26.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D7260",1,1081,4066.77,1275.99,4066.77,270.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L4386",1,165,0,155.02000000000001,695.83,41.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D7940",1,1451,4066.77,1275.99,4066.77,362.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L4396",1,406,0,171.42,769.43,101.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D9230",1,110,0,null,null,27.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L4398",1,406,0,78.92,354.25,101.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D9930",1,1451,4066.77,1275.99,4066.77,362.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L8501",1,219,0,160.74,721.54,54.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D9951",1,1350,4066.77,1275.99,4066.77,337.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L8507",1,1604,0,41.03,184.14,401]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0101",1,148,57.91,18.010000000000002,128.29,37]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L8509",1,1144,0,106.99,480.27,286]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0105",1,1152,3264.67,1020.59,3264.67,288]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L8514",1,387,0,92.38,414.69,96.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0109",1,267,134.25,32.64,134.25,66.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L8693",1,1462,0,1485.57,6668.25,365.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0175",1,565,2035.73,638.73,2035.73,141.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L8699",1,13957,0,null,null,3489.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0257",1,911,3651.55,1027.32,3651.55,227.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - M0239",1,393,309.60000000000002,309.60000000000002,779.02,98.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0260",1,817,3474.13,1005.62,3474.13,204.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - M0243",1,572,309.60000000000002,309.60000000000002,779.02,143]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0278",1,3138,0,34.229999999999997,34.229999999999997,784.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - P9612",1,90,2.2200000000000002,2.2200000000000002,1198.25,22.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0296",1,118,660.74,102.62,660.74,29.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q0091",1,83,0,28.83,175.66,20.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0365",1,498,867.01,272.02999999999997,867.01,124.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9040",1,523,336.11,336.11,669.97,130.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0379",1,752,2787.3,874.54,2787.3,188]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9045",1,238,60.32,52.45,131.97,59.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0396",1,42,336.32,56.05,336.32,10.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q0249",1,9,0,null,null,2.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q4132",1,3754,131.82,114.63,288.43,938.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q3014",1,67,0,26.65,67.06,16.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0416",1,425,2456.98,360.63,2456.98,106.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q4116",1,5248,0,32.29,35.78,1312]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0421",1,37,136.13999999999999,42.72,136.13999999999999,9.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q4124",1,23,0,16.39,16.39,5.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0423",1,169,637.79,198.42,637.79,42.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q4125",1,4060,0,3.79,3.79,1015]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0438",1,547,61.76,34.03,61.76,136.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q4130",1,65718,0,45.89,45.89,16429.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0442",1,42,33.6,13.34,33.6,10.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q4196",1,9044,0,111.59,280.77999999999997,2261]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0444",1,42,16.149999999999999,8.9,16.149999999999999,10.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q9954",1,0,0,12.1,13.41,0]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0446",1,42,16.149999999999999,8.9,16.149999999999999,10.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q9956",1,76,0,31.75,79.89,19]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0480",1,254,973.54,59.69,973.54,63.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q9957",1,417,0,47.63,119.85,104.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0506",1,62,0,110.9,110.9,15.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q9958",1,1,0,7.0000000000000007E-2,0.18,0.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0514",1,84,0,148.6,148.6,21]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q9961",1,1,0,0.25,0.63,0.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G2012",1,42,0,31.78,31.78,10.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G2024",1,33,230.84,25.46,230.84,8.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G2086",1,194,129.81,46.18,211.43,48.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L1820",1,159,207.54,142.59,640.03,39.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q4133",1,3756,151.77000000000001,131.97,332.06,939]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q9987",1,1218,0,null,null,304.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q9956",1,76,36.51,31.75,79.89,19]
["BMC HEALTHNET - BMCHN MCO - HCPCS - S5100",1,6,0,null,null,1.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q9957",1,417,54.77,47.63,119.85,104.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - S5101",1,63,0,null,null,15.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q9961",1,1,0.28999999999999998,0.25,0.63,0.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - S5102",1,126,0,null,null,31.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L0140",1,189,347.97,77.52,347.97,47.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - S8037",1,1440,0,585.76,3771.6,360]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L1830",1,78,367.86,81.95,367.86,19.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - T2003",1,25,0,null,null,6.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L1836",1,209,585.70000000000005,130.47999999999999,585.70000000000005,52.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - U0002",1,92,51.31,51.31,465.19,23]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L3260",1,279,357.96,31.12,357.96,69.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - V2785",1,7848,0,5130.87,15242.01,1962]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L3650",1,1955,302.45,67.38,302.45,488.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - V2790",1,1136,0,null,null,284]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L3760",1,819,1997.57,445.02,1997.57,204.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - 81170",1,798,221.66,159,2909.77,199.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L3807",1,483,998.85,222.52,998.85,120.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A4215",1,433,0,null,null,108.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L3905",1,2442,3961.32,882.51,3961.32,610.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A4467",1,151,0,null,null,37.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L3967",1,117,7923.54,1765.23,7923.54,29.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A4561",1,108,0,23.18,58.33,27]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L3982",1,176,1787.56,398.23,1787.56,44]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A4562",1,64,0,57.71,145.21,16]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L4360",1,557,1552.36,345.83,1552.36,139.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A4570",1,40,0,19.010000000000002,107.35,10]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L4386",1,165,695.83,155.02000000000001,695.83,41.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A4725",1,87,0,null,null,21.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L4398",1,406,354.25,78.92,354.25,101.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A6209",1,163,0,8.68,21.84,40.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L8507",1,1604,184.14,41.03,184.14,401]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A6258",1,83,0,5,12.58,20.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L8514",1,387,414.69,92.38,414.69,96.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A6549",1,37,0,null,null,9.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L8699",1,13957,0,null,null,3489.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A6550",1,4,0,25.71,64.69,1]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9016",1,576,478.65,243.01,478.65,144]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A7520",1,1173,0,55.16,138.79,293.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9021",1,323,354.25,184.28,354.25,80.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9500",1,274,0,463.42,463.42,68.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9037",1,939,1622.67,821.84,1622.67,234.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9502",1,140,0,278.27,278.27,35]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9044",1,133,244.67,144.19999999999999,244.67,33.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9503",1,23,0,37.119999999999997,37.119999999999997,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9505",1,23,0,395.74,395.74,5.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9057",1,785,671.74,395.89,671.74,196.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9509",1,95,0,5163.91,5163.91,23.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9100",1,1310,256.64,33.53,256.64,327.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9512",1,1,0,null,null,0.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q0091",1,83,175.66,28.83,175.66,20.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9513",1,320,0,294.27999999999997,1097.56,80]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q0114",1,41,82.86,7.2,82.86,10.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9516",1,192,0,516.39,516.39,48]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q4100",1,12079,0,null,null,3019.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9517",1,437,0,30.1,101.94,109.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q4102",1,69,0,10.210000000000001,25.69,17.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9520",1,1951,0,null,null,487.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q4107",1,2233,0,86.55,110.48,558.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9521",1,360,0,4157.3,4157.3,90]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q4116",1,5248,0,32.29,35.78,1312]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9537",1,138,0,157.94999999999999,157.94999999999999,34.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q4125",1,4060,0,3.79,3.79,1015]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9538",1,111,0,114.21,114.21,27.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q4132",1,3754,0,114.63,288.43,938.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9539",1,668,0,89.47,89.47,167]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q4196",1,9044,257.92,111.59,280.77999999999997,2261]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9540",1,1831,0,85.66,85.66,457.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q9956",1,76,0,31.75,79.89,19]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9541",1,120,0,152.69,152.69,30]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q9958",1,1,0,7.0000000000000007E-2,0.18,0.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9543",1,66322,0,72400.97,217685.7,16580.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9547",1,440,0,5105.7299999999996,5105.7299999999996,110]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9551",1,154,0,1711.56,1711.56,38.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - S8037",1,1440,3771.6,585.76,3771.6,360]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9552",1,972,0,1166.46,1166.46,243]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - U0002",1,92,465.19,51.31,465.19,23]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9555",1,1065,0,1604.08,1604.08,266.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - V2790",1,1136,0,null,null,284]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9556",1,20,0,311.94,311.94,5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A4561",1,108,23.18,23.18,58.33,27]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9557",1,239,0,1062.44,1062.44,59.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A6209",1,163,8.68,8.68,21.84,40.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9558",1,23,0,108.88,108.88,5.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A6550",1,4,25.71,25.71,64.69,1]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9560",1,246,0,266.7,266.7,61.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A9575",1,8,0.18,0.18,0.45,2]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9561",1,127,0,125.64,125.64,31.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A9577",1,21,1.81,1.81,5.03,5.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9562",1,1237,0,2212.25,2212.25,309.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A9581",1,99,14.76,14.76,37.14,24.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9563",1,0,0,535.17999999999995,3182.68,0]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - G0103",1,93,19.309999999999999,16.78,181.16,23.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9569",1,5086,0,4157.3,4157.3,1271.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - G0480",1,254,114.43,59.69,973.54,63.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9570",1,6395,0,null,null,1598.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - G2023",1,31,23.46,23.46,212.71,7.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9572",1,131,0,16207.01,16207.01,32.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - S8037",1,1440,1396.47,585.76,3771.6,360]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9580",1,158,0,null,null,39.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - U0002",1,92,59.02,51.31,465.19,23]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9582",1,10370,0,null,null,2592.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - 0042T",1,767,1452,1452,1452,191.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9583",1,13,0,19.260000000000002,21.34,3.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L0140",1,189,77.52,77.52,347.97,47.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9584",1,2729,0,3235.55,3235.55,682.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L1830",1,78,81.95,81.95,367.86,19.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9587",1,12985,0,84.97,113.78,3246.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L1836",1,209,130.47999999999999,130.47999999999999,585.70000000000005,52.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9588",1,15438,0,525.05999999999995,703.05,3859.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L3350",1,41,22.41,22.41,100.59,10.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9592",1,5634,0,null,null,1408.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L3670",1,2903,103.65,103.65,465.27,725.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0101",1,148,0,18.010000000000002,128.29,37]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L3762",1,57,95.68,95.68,429.49,14.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9073",1,889,821.84,821.84,2619.59,222.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L3808",1,509,375.94,375.94,1687.5,127.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0127",1,189,0,93.87,317.35000000000002,47.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L3908",1,143,73.22,73.22,328.66,35.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0175",1,565,0,638.73,2035.73,141.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L3980",1,132,377.84,377.84,1695.98,33]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0239",1,99,0,53.94,373.41,24.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L4350",1,360,97.28,97.28,436.66,90]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0257",1,911,0,1027.32,3651.55,227.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L4370",1,107,235.79,235.79,1058.3900000000001,26.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0259",1,1513,0,1198.25,1198.25,378.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L4396",1,406,171.42,171.42,769.43,101.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0260",1,817,0,1005.62,3474.13,204.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L8501",1,219,160.74,160.74,721.54,54.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0269",1,200,0,null,null,50]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L8509",1,1144,106.99,106.99,480.27,286]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0278",1,3138,0,34.229999999999997,34.229999999999997,784.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L8693",1,1462,1485.57,1485.57,6668.25,365.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0296",1,118,0,102.62,660.74,29.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - M0243",1,572,309.60000000000002,309.60000000000002,779.02,143]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0297",1,1437,0,107.22,801.26,359.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - 0402T",1,2880,3044.16,1198.25,11845.41,720]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0365",1,498,0,272.02999999999997,867.01,124.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q0111",1,23,15.12,5.86,127.48,5.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0389",1,544,0,null,null,136]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q3014",1,67,26.65,26.65,67.06,16.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0390",1,3274,0,1579.83,5035.18,818.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q4102",1,69,10.210000000000001,10.210000000000001,25.69,17.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0396",1,42,0,56.05,336.32,10.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q4133",1,3756,131.97,131.97,332.06,939]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0397",1,118,0,128.29,815.89,29.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q9956",1,76,31.75,31.75,79.89,19]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0402",1,168,0,208.89,1179.72,42]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q9958",1,1,7.0000000000000007E-2,7.0000000000000007E-2,0.18,0.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0410",1,220,0,null,null,55]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0416",1,425,0,360.63,2456.98,106.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - 45378",1,1672,1250.94,1020.59,3264.67,418]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0420",1,156,0,184.9,589.33000000000004,39]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - U0002",1,92,51.31,51.31,465.19,23]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0421",1,37,0,42.72,136.13999999999999,9.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A4561",1,108,23.18,23.18,58.33,27]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0422",1,169,0,198.42,637.79,42.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A6209",1,163,8.68,8.68,21.84,40.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0423",1,169,0,198.42,637.79,42.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A6550",1,4,25.71,25.71,64.69,1]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0438",1,547,0,34.03,61.76,136.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A9575",1,8,0.18,0.18,0.45,2]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0439",1,327,0,34.03,61.76,81.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A9577",1,21,1.81,1.81,5.03,5.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0442",1,42,0,13.34,33.6,10.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A9581",1,99,14.76,14.76,37.14,24.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0443",1,118,0,18.52,33.6,29.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - G0103",1,93,19.309999999999999,16.78,181.16,23.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0444",1,42,0,8.9,16.149999999999999,10.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - G0480",1,254,114.43,59.69,973.54,63.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0445",1,118,0,8.9,16.149999999999999,29.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - G2023",1,31,23.46,23.46,212.71,7.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0446",1,42,0,8.9,16.149999999999999,10.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - 90471",1,64,76.22,76.22,345.64,16]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0447",1,118,0,18.52,33.6,29.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - 95800",1,205,228.32,228.32,1412.44,51.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0480",1,254,59.69,59.69,973.54,63.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A4561",1,108,33.729999999999997,23.18,58.33,27]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0481",1,192,91.84,91.84,1332.11,48]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L0140",1,189,77.52,77.52,347.97,47.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0506",1,62,0,110.9,110.9,15.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L1830",1,78,81.95,81.95,367.86,19.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0513",1,84,0,148.6,148.6,21]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L1836",1,209,130.47999999999999,130.47999999999999,585.70000000000005,52.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0514",1,84,0,148.6,148.6,21]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L3350",1,41,22.41,22.41,100.59,10.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G2011",1,35,0,28.83,133.88,8.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L3670",1,2903,103.65,103.65,465.27,725.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G2012",1,42,0,31.78,31.78,10.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L3762",1,57,95.68,95.68,429.49,14.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9100",1,1310,33.53,33.53,256.64,327.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L3808",1,509,375.94,375.94,1687.5,127.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9612",1,90,5.27,2.2200000000000002,1198.25,22.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L3908",1,143,73.22,73.22,328.66,35.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G2066",1,165,0,58.35,370.47,41.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L3980",1,132,377.84,377.84,1695.98,33]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G2086",1,194,0,46.18,211.43,48.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L4350",1,360,97.28,97.28,436.66,90]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G2087",1,194,0,46.18,211.43,48.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L4370",1,107,235.79,235.79,1058.3900000000001,26.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G2088",1,45,0,82.11,82.11,11.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L4396",1,406,171.42,171.42,769.43,101.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G2212",1,188,0,null,null,47]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L8501",1,219,160.74,160.74,721.54,54.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G2216",1,118,0,null,null,29.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L8509",1,1144,106.99,106.99,480.27,286]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q0091",1,83,28.83,28.83,175.66,20.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L8693",1,1462,1485.57,1485.57,6668.25,365.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L0120",1,25,0,24.86,111.59,6.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - M0243",1,572,309.60000000000002,309.60000000000002,779.02,143]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L0140",1,189,0,77.52,347.97,47.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A6209",1,163,12.63,8.68,21.84,40.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L1820",1,159,0,142.59,640.03,39.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q0111",1,23,15.12,5.86,127.48,5.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L1830",1,78,0,81.95,367.86,19.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q3014",1,67,26.65,26.65,67.06,16.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L1832",1,1523,0,743.59,3337.75,380.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q4102",1,69,10.210000000000001,10.210000000000001,25.69,17.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L1836",1,209,0,130.47999999999999,585.70000000000005,52.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q4133",1,3756,131.97,131.97,332.06,939]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L1902",1,219,0,86.14,386.65,54.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q9956",1,76,31.75,31.75,79.89,19]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3260",1,279,0,31.12,357.96,69.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q9958",1,1,7.0000000000000007E-2,7.0000000000000007E-2,0.18,0.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3350",1,41,0,22.41,100.59,10.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3496",1,406,0,null,null,101.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A6258",1,83,7.28,5,12.58,20.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3650",1,1955,0,67.38,302.45,488.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - U0002",1,92,51.31,51.31,465.19,23]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3670",1,2903,0,103.65,465.27,725.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A4561",1,108,23.18,23.18,58.33,27]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3760",1,819,0,445.02,1997.57,204.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A6209",1,163,8.68,8.68,21.84,40.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3762",1,57,0,95.68,429.49,14.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A6550",1,4,25.71,25.71,64.69,1]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3807",1,483,0,222.52,998.85,120.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A9575",1,8,0.18,0.18,0.45,2]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3808",1,509,0,375.94,1687.5,127.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A9577",1,21,1.81,1.81,5.03,5.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3905",1,2442,0,882.51,3961.32,610.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A9581",1,99,14.76,14.76,37.14,24.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3908",1,143,0,73.22,328.66,35.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - G0103",1,93,25.23,16.78,181.16,23.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3967",1,117,0,1765.23,7923.54,29.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - G0480",1,254,117.65,59.69,973.54,63.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3980",1,132,0,377.84,1695.98,33]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9500",1,274,463.42,463.42,463.42,68.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3982",1,176,0,398.23,1787.56,44]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9503",1,23,37.119999999999997,37.119999999999997,37.119999999999997,5.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L4350",1,360,0,97.28,436.66,90]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9505",1,23,395.74,395.74,395.74,5.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L4360",1,557,0,345.83,1552.36,139.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L0140",1,189,77.52,77.52,347.97,47.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L4370",1,107,0,235.79,1058.3900000000001,26.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L1830",1,78,81.95,81.95,367.86,19.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L4386",1,165,0,155.02000000000001,695.83,41.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L1836",1,209,130.47999999999999,130.47999999999999,585.70000000000005,52.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L4396",1,406,0,171.42,769.43,101.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L3350",1,41,22.41,22.41,100.59,10.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L4398",1,406,0,78.92,354.25,101.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L3670",1,2903,103.65,103.65,465.27,725.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L8501",1,219,0,160.74,721.54,54.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L3762",1,57,95.68,95.68,429.49,14.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L8507",1,1604,0,41.03,184.14,401]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L3808",1,509,375.94,375.94,1687.5,127.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L8509",1,1144,0,106.99,480.27,286]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L3908",1,143,73.22,73.22,328.66,35.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L8514",1,387,0,92.38,414.69,96.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L3980",1,132,377.84,377.84,1695.98,33]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L8693",1,1462,0,1485.57,6668.25,365.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L4350",1,360,97.28,97.28,436.66,90]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L8699",1,13957,0,null,null,3489.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L4370",1,107,235.79,235.79,1058.3900000000001,26.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - M0239",1,393,309.60000000000002,309.60000000000002,779.02,98.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L4396",1,406,171.42,171.42,769.43,101.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - M0243",1,572,309.60000000000002,309.60000000000002,779.02,143]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L8501",1,219,160.74,160.74,721.54,54.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - P9612",1,90,2.2200000000000002,2.2200000000000002,1198.25,22.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L8509",1,1144,106.99,106.99,480.27,286]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q0091",1,83,0,28.83,175.66,20.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L8693",1,1462,1485.57,1485.57,6668.25,365.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q0111",1,23,27.01,5.86,127.48,5.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - M0243",1,572,309.60000000000002,309.60000000000002,779.02,143]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q4196",1,9044,111.59,111.59,280.77999999999997,2261]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9509",1,95,5163.91,5163.91,5163.91,23.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q9956",1,76,31.75,31.75,79.89,19]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q0111",1,23,5.86,5.86,127.48,5.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q9958",1,1,7.0000000000000007E-2,7.0000000000000007E-2,0.18,0.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q3014",1,67,26.65,26.65,67.06,16.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q4102",1,69,10.210000000000001,10.210000000000001,25.69,17.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q0114",1,41,17.79,7.2,82.86,10.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q4133",1,3756,131.97,131.97,332.06,939]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - U0002",1,92,51.31,51.31,465.19,23]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q9956",1,76,31.75,31.75,79.89,19]
["FALLON - FALLON MEDICAID - HCPCS - A4215",1,433,0,null,null,108.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q9958",1,1,7.0000000000000007E-2,7.0000000000000007E-2,0.18,0.25]
["FALLON - FALLON MEDICAID - HCPCS - A4561",1,108,0,23.18,58.33,27]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["FALLON - FALLON MEDICAID - HCPCS - A4570",1,40,0,19.010000000000002,107.35,10]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9513",1,320,329.72,294.27999999999997,1097.56,80]
["FALLON - FALLON MEDICAID - HCPCS - A6209",1,163,0,8.68,21.84,40.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A4561",1,108,23.18,23.18,58.33,27]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q9957",1,417,0,47.63,119.85,104.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A6209",1,163,8.68,8.68,21.84,40.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q9958",1,1,0,7.0000000000000007E-2,0.18,0.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A6550",1,4,25.71,25.71,64.69,1]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q9961",1,1,0,0.25,0.63,0.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A9575",1,8,0.18,0.18,0.45,2]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A9577",1,21,1.81,1.81,5.03,5.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A9581",1,99,14.76,14.76,37.14,24.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q4101",1,1601,35.03,30.46,76.64,400.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - G0103",1,93,19.309999999999999,16.78,181.16,23.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q9987",1,1218,0,null,null,304.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - G0480",1,254,114.43,59.69,973.54,63.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - S5100",1,6,0,null,null,1.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - G2023",1,31,23.46,23.46,212.71,7.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - S5101",1,63,0,null,null,15.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9517",1,437,101.94,30.1,101.94,109.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - S5102",1,126,0,null,null,31.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9537",1,138,157.94999999999999,157.94999999999999,157.94999999999999,34.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - S8037",1,1440,0,585.76,3771.6,360]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9538",1,111,114.21,114.21,114.21,27.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - T2003",1,25,0,null,null,6.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L0140",1,189,77.52,77.52,347.97,47.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - U0002",1,92,51.31,51.31,465.19,23]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L1830",1,78,81.95,81.95,367.86,19.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - V2785",1,7848,0,5130.87,15242.01,1962]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L1836",1,209,130.47999999999999,130.47999999999999,585.70000000000005,52.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - V2790",1,1136,0,null,null,284]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L3350",1,41,22.41,22.41,100.59,10.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - 81170",1,798,265.99,159,2909.77,199.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L3670",1,2903,103.65,103.65,465.27,725.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A4215",1,433,0,null,null,108.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L3762",1,57,95.68,95.68,429.49,14.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A4467",1,151,0,null,null,37.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L3808",1,509,375.94,375.94,1687.5,127.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A4561",1,108,0,23.18,58.33,27]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L3908",1,143,73.22,73.22,328.66,35.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A4562",1,64,0,57.71,145.21,16]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L3980",1,132,377.84,377.84,1695.98,33]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A4570",1,40,0,19.010000000000002,107.35,10]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L4350",1,360,97.28,97.28,436.66,90]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A4725",1,87,0,null,null,21.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L4370",1,107,235.79,235.79,1058.3900000000001,26.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A6209",1,163,0,8.68,21.84,40.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L4396",1,406,171.42,171.42,769.43,101.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A6258",1,83,0,5,12.58,20.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L8501",1,219,160.74,160.74,721.54,54.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A6549",1,37,0,null,null,9.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L8509",1,1144,106.99,106.99,480.27,286]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A6550",1,4,0,25.71,64.69,1]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L8693",1,1462,1485.57,1485.57,6668.25,365.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A7520",1,1173,0,55.16,138.79,293.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - M0243",1,572,309.60000000000002,309.60000000000002,779.02,143]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9500",1,274,0,463.42,463.42,68.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9539",1,668,89.47,89.47,89.47,167]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9502",1,140,0,278.27,278.27,35]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q0111",1,23,15.12,5.86,127.48,5.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9503",1,23,0,37.119999999999997,37.119999999999997,5.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q3014",1,67,26.65,26.65,67.06,16.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9505",1,23,0,395.74,395.74,5.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q4102",1,69,10.210000000000001,10.210000000000001,25.69,17.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9509",1,95,0,5163.91,5163.91,23.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q4133",1,3756,131.97,131.97,332.06,939]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9512",1,1,0,null,null,0.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9513",1,320,0,294.27999999999997,1097.56,80]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q9957",1,417,47.63,47.63,119.85,104.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q0249",1,9,0,null,null,2.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q9961",1,1,0.25,0.25,0.63,0.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q3014",1,67,0,26.65,67.06,16.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q4116",1,5248,0,32.29,35.78,1312]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - U0001",1,124,35.909999999999997,35.909999999999997,325.64,31]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q4124",1,23,0,16.39,16.39,5.75]
["FALLON - FALLON MEDICAID - HCPCS - 81170",1,798,221.66,159,2909.77,199.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q4125",1,4060,0,3.79,3.79,1015]
["FALLON - FALLON MEDICAID - HCPCS - A4467",1,151,0,null,null,37.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q4130",1,65718,0,45.89,45.89,16429.5]
["FALLON - FALLON MEDICAID - HCPCS - A4562",1,64,0,57.71,145.21,16]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q4196",1,9044,0,111.59,280.77999999999997,2261]
["FALLON - FALLON MEDICAID - HCPCS - A4725",1,87,0,null,null,21.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q9954",1,0,0,12.1,13.41,0]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L0120",1,25,36.19,24.86,111.59,6.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q9956",1,76,0,31.75,79.89,19]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9500",1,274,463.42,463.42,463.42,68.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9555",1,1065,1604.08,1604.08,1604.08,266.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2160",1,110,153.4,153.4,153.4,27.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A4561",1,108,27.35,23.18,58.33,27]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L8509",1,1144,155.72999999999999,106.99,480.27,286]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - P9612",1,90,3.54,2.2200000000000002,1198.25,22.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L1832",1,1523,1082.26,743.59,3337.75,380.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q0111",1,23,17.84,5.86,127.48,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - U0002",1,92,59.02,51.31,465.19,23]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q0114",1,41,11.49,7.2,82.86,10.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D7250",1,836,1510.05,1275.99,4066.77,209]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q3014",1,67,31.45,26.65,67.06,16.75]
["AETNA - AETNA - HCPCS - G0105",1,1152,1500.85,1020.59,3264.67,288]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q4101",1,1601,35.94,30.46,76.64,400.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2390",1,110,248.14,248.14,248.14,27.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q4102",1,69,12.05,10.210000000000001,25.69,17.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - 92083",1,461,178.83,68.75,607.84,115.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q4132",1,3754,135.26,114.63,288.43,938.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - J2790",1,186.95,0,74.3,186.95,46.737499999999997]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q4133",1,3756,155.72,131.97,332.06,939]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D0274",1,836,1182.5,1182.5,4066.77,209]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q4196",1,9044,131.68,111.59,280.77999999999997,2261]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D0230",1,110,21.35,21.35,21.35,27.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q9956",1,76,37.47,31.75,79.89,19]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G2024",1,33,29.29,25.46,230.84,8.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q9957",1,417,56.2,47.63,119.85,104.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q9957",1,417,54.77,47.63,119.85,104.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q9958",1,1,0.08,7.0000000000000007E-2,0.18,0.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - M0243",1,572,779.02,309.60000000000002,779.02,143]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q9961",1,1,0.28999999999999998,0.25,0.63,0.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9581",1,99,16.97,14.76,37.14,24.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0279",1,55,51.68,30.09,295.68,13.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - P9100",1,1310,33.53,33.53,256.64,327.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A4562",1,64,68.099999999999994,57.71,145.21,16]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9569",1,5086,4157.3,4157.3,4157.3,1271.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - U0001",1,124,42.37,35.909999999999997,325.64,31]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0109",1,267,37.520000000000003,32.64,134.25,66.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - U0002",1,92,60.55,51.31,465.19,23]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9034",1,506,443.29,443.29,799.73,126.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - 81170",1,798,261.56,159,2909.77,199.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9557",1,239,1062.44,1062.44,1062.44,59.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A4215",1,433,0,null,null,108.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0396",1,42,56.05,56.05,336.32,10.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A4467",1,151,0,null,null,37.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9584",1,2729,3235.55,3235.55,3235.55,682.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A4561",1,108,0,23.18,58.33,27]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2392",1,110,186.31,186.31,186.31,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A4562",1,64,0,57.71,145.21,16]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0297",1,1437,178.43,107.22,801.26,359.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A4570",1,40,0,19.010000000000002,107.35,10]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L1902",1,219,125.37,86.14,386.65,54.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A4725",1,87,0,null,null,21.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q0091",1,83,28.83,28.83,175.66,20.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A6209",1,163,0,8.68,21.84,40.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A9575",1,8,0.45,0.18,0.45,2]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A6258",1,83,0,5,12.58,20.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L3908",1,143,184.24,73.22,328.66,35.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A6549",1,37,0,null,null,9.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A6550",1,4,0,25.71,64.69,1]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9551",1,154,1711.56,1711.56,1711.56,38.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A7520",1,1173,0,55.16,138.79,293.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D0210",1,165,120.47,120.47,120.47,41.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9500",1,274,0,463.42,463.42,68.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D7230",1,836,1510.05,1275.99,4066.77,209]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9502",1,140,0,278.27,278.27,35]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G2012",1,42,31.78,31.78,31.78,10.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9503",1,23,0,37.119999999999997,37.119999999999997,5.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L4396",1,406,249.49,171.42,769.43,101.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9505",1,23,0,395.74,395.74,5.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q9954",1,0,13.41,12.1,13.41,0]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9509",1,95,0,5163.91,5163.91,23.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9538",1,111,114.21,114.21,114.21,27.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9512",1,1,0,null,null,0.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - C2639",1,47,100.75,52.85,100.75,11.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9513",1,320,0,294.27999999999997,1097.56,80]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D3220",1,110,141.69,141.69,141.69,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9516",1,192,0,516.39,516.39,48]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0480",1,254,209.48,59.69,973.54,63.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9517",1,437,0,30.1,101.94,109.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L3908",1,143,106.57,73.22,328.66,35.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9520",1,1951,0,null,null,487.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q4116",1,5248,35.78,32.29,35.78,1312]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9521",1,360,0,4157.3,4157.3,90]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9509",1,95,5163.91,5163.91,5163.91,23.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9537",1,138,0,157.94999999999999,157.94999999999999,34.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9587",1,12985,84.97,84.97,113.78,3246.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9538",1,111,0,114.21,114.21,27.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2394",1,110,282.64,282.64,282.64,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9539",1,668,0,89.47,89.47,167]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G2086",1,194,211.43,46.18,211.43,48.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9540",1,1831,0,85.66,85.66,457.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9569",1,5086,4157.3,4157.3,4157.3,1271.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9541",1,120,0,152.69,152.69,30]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - C2639",1,47,100.75,52.85,100.75,11.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9543",1,66322,0,72400.97,217685.7,16580.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2160",1,110,153.4,153.4,153.4,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9547",1,440,0,5105.7299999999996,5105.7299999999996,110]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D3220",1,110,141.69,141.69,141.69,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9551",1,154,0,1711.56,1711.56,38.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0109",1,267,37.520000000000003,32.64,134.25,66.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9552",1,972,0,1166.46,1166.46,243]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0480",1,254,209.48,59.69,973.54,63.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9555",1,1065,0,1604.08,1604.08,266.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - J2790",1,186.95,0,74.3,186.95,46.737499999999997]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9556",1,20,0,311.94,311.94,5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L3908",1,143,106.57,73.22,328.66,35.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9557",1,239,0,1062.44,1062.44,59.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - P9034",1,506,443.29,443.29,799.73,126.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9558",1,23,0,108.88,108.88,5.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q4116",1,5248,35.78,32.29,35.78,1312]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9560",1,246,0,266.7,266.7,61.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - U0002",1,92,59.02,51.31,465.19,23]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9561",1,127,0,125.64,125.64,31.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - G0480",1,254,287.93,59.69,973.54,63.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9562",1,1237,0,2212.25,2212.25,309.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L3350",1,41,56.39,22.41,100.59,10.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9563",1,0,0,535.17999999999995,3182.68,0]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L4396",1,406,431.33,171.42,769.43,101.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9569",1,5086,0,4157.3,4157.3,1271.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q4102",1,69,25.69,10.210000000000001,25.69,17.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9570",1,6395,0,null,null,1598.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - 81170",1,798,548.09,159,2909.77,199.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9572",1,131,0,16207.01,16207.01,32.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9521",1,360,4157.3,4157.3,4157.3,90]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9580",1,158,0,null,null,39.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9562",1,1237,2212.25,2212.25,2212.25,309.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9582",1,10370,0,null,null,2592.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - C2616",1,60393,47839.61,25512.2,76706.740000000005,15098.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9583",1,13,0,19.260000000000002,21.34,3.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2140",1,110,98.66,98.66,98.66,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9584",1,2729,0,3235.55,3235.55,682.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2940",1,110,87.67,87.67,87.67,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9587",1,12985,0,84.97,113.78,3246.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0105",1,1152,1250.94,1020.59,3264.67,288]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9588",1,15438,0,525.05999999999995,703.05,3859.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0423",1,169,198.42,198.42,637.79,42.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9592",1,5634,0,null,null,1408.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L1902",1,219,101.65,86.14,386.65,54.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0101",1,148,0,18.010000000000002,128.29,37]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L3808",1,509,547.16999999999996,375.94,1687.5,127.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L3980",1,132,445.85,377.84,1695.98,33]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - P9017",1,291,94.07,94.07,217.72,72.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0127",1,189,0,93.87,317.35000000000002,47.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q4107",1,2233,110.48,86.55,110.48,558.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0175",1,565,0,638.73,2035.73,141.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - S8037",1,1440,1396.47,585.76,3771.6,360]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0239",1,99,0,53.94,373.41,24.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9503",1,23,37.119999999999997,37.119999999999997,37.119999999999997,5.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0257",1,911,0,1027.32,3651.55,227.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9555",1,1065,1604.08,1604.08,1604.08,266.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0259",1,1513,0,1198.25,1198.25,378.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9584",1,2729,3235.55,3235.55,3235.55,682.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0260",1,817,0,1005.62,3474.13,204.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D0230",1,110,21.35,21.35,21.35,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0269",1,200,0,null,null,50]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2392",1,110,186.31,186.31,186.31,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0278",1,3138,0,34.229999999999997,34.229999999999997,784.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D7250",1,836,1510.05,1275.99,4066.77,209]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0296",1,118,0,102.62,660.74,29.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0297",1,1437,178.43,107.22,801.26,359.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0297",1,1437,0,107.22,801.26,359.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G2024",1,33,29.29,25.46,230.84,8.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0365",1,498,0,272.02999999999997,867.01,124.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L1902",1,219,125.37,86.14,386.65,54.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0389",1,544,0,null,null,136]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L8509",1,1144,155.72999999999999,106.99,480.27,286]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0390",1,3274,0,1579.83,5035.18,818.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q0091",1,83,28.83,28.83,175.66,20.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0396",1,42,0,56.05,336.32,10.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q9957",1,417,54.77,47.63,119.85,104.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0397",1,118,0,128.29,815.89,29.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A4561",1,108,33.729999999999997,23.18,58.33,27]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0402",1,168,0,208.89,1179.72,42]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9540",1,1831,85.66,85.66,85.66,457.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0410",1,220,0,null,null,55]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9575",1,8,0.21,0.18,0.45,2]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0416",1,425,0,360.63,2456.98,106.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - C8908",1,579,1105.27,664.1,4299.8,144.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0420",1,156,0,184.9,589.33000000000004,39]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2330",1,110,121.33,121.33,121.33,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0421",1,37,0,42.72,136.13999999999999,9.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0239",1,99,53.94,53.94,373.41,24.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0422",1,169,0,198.42,637.79,42.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0506",1,62,110.9,110.9,110.9,15.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0423",1,169,0,198.42,637.79,42.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9543",1,66322,139963.56,72400.97,217685.7,16580.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0438",1,547,0,34.03,61.76,136.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9560",1,246,266.7,266.7,266.7,61.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0439",1,327,0,34.03,61.76,81.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9577",1,21,5.03,1.81,5.03,5.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0442",1,42,0,13.34,33.6,10.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9606",1,493,378.21,198.62,597.20000000000005,123.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0443",1,118,0,18.52,33.6,29.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - C9728",1,1957,3429.66,2227.36,7098.97,489.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0444",1,42,0,8.9,16.149999999999999,10.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D1120",1,110,57.92,57.92,57.92,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0445",1,118,0,8.9,16.149999999999999,29.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2332",1,110,189.47,189.47,189.47,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0446",1,42,0,8.9,16.149999999999999,10.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2930",1,110,228.61,228.61,228.61,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0447",1,118,0,18.52,33.6,29.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D7210",1,836,1510.05,1275.99,4066.77,209]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0480",1,254,70.430000000000007,59.69,973.54,63.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0101",1,148,128.29,18.010000000000002,128.29,37]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0481",1,192,108.37,91.84,1332.11,48]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0260",1,817,1005.62,1005.62,3474.13,204.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0506",1,62,0,110.9,110.9,15.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0416",1,425,360.63,360.63,2456.98,106.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0513",1,84,0,148.6,148.6,21]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0514",1,84,148.6,148.6,148.6,21]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0514",1,84,0,148.6,148.6,21]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G2088",1,45,82.11,82.11,82.11,11.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G2011",1,35,0,28.83,133.88,8.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L1820",1,159,207.54,142.59,640.03,39.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G2012",1,42,0,31.78,31.78,10.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L3760",1,819,647.70000000000005,445.02,1997.57,204.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L3982",1,176,469.91,398.23,1787.56,44]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L4360",1,557,503.35,345.83,1552.36,139.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L4350",1,360,114.79,97.28,436.66,90]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - P9012",1,134,64.959999999999994,64.959999999999994,125.33,33.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G2066",1,165,0,58.35,370.47,41.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - 81170",1,798,354,159,2909.77,199.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G2086",1,194,0,46.18,211.43,48.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q4102",1,69,11.74,10.210000000000001,25.69,17.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G2087",1,194,0,46.18,211.43,48.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q4132",1,3754,131.82,114.63,288.43,938.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G2088",1,45,0,82.11,82.11,11.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G2212",1,188,0,null,null,47]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A6209",1,163,21.84,8.68,21.84,40.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G2216",1,118,0,null,null,29.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A9581",1,99,37.14,14.76,37.14,24.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A6209",1,163,10.24,8.68,21.84,40.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L0120",1,25,29.33,24.86,111.59,6.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L0120",1,25,0,24.86,111.59,6.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L1830",1,78,206.2,81.95,367.86,19.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L0140",1,189,0,77.52,347.97,47.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L3762",1,57,240.75,95.68,429.49,14.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L1820",1,159,0,142.59,640.03,39.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L4350",1,360,244.78,97.28,436.66,90]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L1830",1,78,0,81.95,367.86,19.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L8509",1,1144,269.20999999999998,106.99,480.27,286]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L1832",1,1523,0,743.59,3337.75,380.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q0111",1,23,38.04,5.86,127.48,5.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L1836",1,209,0,130.47999999999999,585.70000000000005,52.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q9956",1,76,79.89,31.75,79.89,19]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L1902",1,219,0,86.14,386.65,54.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - U0002",1,92,129.11000000000001,51.31,465.19,23]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3260",1,279,0,31.12,357.96,69.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A4561",1,108,33.729999999999997,23.18,58.33,27]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3350",1,41,0,22.41,100.59,10.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9509",1,95,5163.91,5163.91,5163.91,23.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3496",1,406,0,null,null,101.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9540",1,1831,85.66,85.66,85.66,457.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3650",1,1955,0,67.38,302.45,488.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9557",1,239,1062.44,1062.44,1062.44,59.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3670",1,2903,0,103.65,465.27,725.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9575",1,8,0.21,0.18,0.45,2]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3760",1,819,0,445.02,1997.57,204.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9587",1,12985,84.97,84.97,113.78,3246.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3762",1,57,0,95.68,429.49,14.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - C8908",1,579,1105.27,664.1,4299.8,144.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3807",1,483,0,222.52,998.85,120.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D0274",1,836,1182.5,1182.5,4066.77,209]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3808",1,509,0,375.94,1687.5,127.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2330",1,110,121.33,121.33,121.33,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3905",1,2442,0,882.51,3961.32,610.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2394",1,110,282.64,282.64,282.64,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3908",1,143,0,73.22,328.66,35.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D3330",1,110,894.85,894.85,894.85,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3967",1,117,0,1765.23,7923.54,29.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D7311",1,110,202.78,202.78,202.78,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3980",1,132,0,377.84,1695.98,33]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0239",1,99,53.94,53.94,373.41,24.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3982",1,176,0,398.23,1787.56,44]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0396",1,42,56.05,56.05,336.32,10.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L4350",1,360,0,97.28,436.66,90]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0506",1,62,110.9,110.9,110.9,15.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L4360",1,557,0,345.83,1552.36,139.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G2086",1,194,211.43,46.18,211.43,48.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L4370",1,107,0,235.79,1058.3900000000001,26.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - M0239",1,393,365.33,309.60000000000002,779.02,98.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L4386",1,165,0,155.02000000000001,695.83,41.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L3650",1,1955,98.07,67.38,302.45,488.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L4396",1,406,0,171.42,769.43,101.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L3980",1,132,549.92999999999995,377.84,1695.98,33]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L4398",1,406,0,78.92,354.25,101.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - M0239",1,393,518.74,309.60000000000002,779.02,98.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L8501",1,219,0,160.74,721.54,54.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - P9040",1,523,336.11,336.11,669.97,130.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L8507",1,1604,0,41.03,184.14,401]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q0114",1,41,17.79,7.2,82.86,10.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L8509",1,1144,0,106.99,480.27,286]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q4125",1,4060,3.79,3.79,3.79,1015]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L8514",1,387,0,92.38,414.69,96.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q9961",1,1,0.28999999999999998,0.25,0.63,0.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L8693",1,1462,0,1485.57,6668.25,365.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - 0402T",1,2880,3044.16,1198.25,11845.41,720]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L8699",1,13957,0,null,null,3489.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A6258",1,83,7.28,5,12.58,20.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - M0239",1,393,365.33,309.60000000000002,779.02,98.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9516",1,192,516.39,516.39,516.39,48]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - M0243",1,572,365.33,309.60000000000002,779.02,143]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9543",1,66322,139963.56,72400.97,217685.7,16580.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - P9612",1,90,2.62,2.2200000000000002,1198.25,22.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9560",1,246,266.7,266.7,266.7,61.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q0091",1,83,0,28.83,175.66,20.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9577",1,21,5.03,1.81,5.03,5.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L4360",1,557,408.08,345.83,1552.36,139.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9606",1,493,378.21,198.62,597.20000000000005,123.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L4370",1,107,278.23,235.79,1058.3900000000001,26.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - C9728",1,1957,3429.66,2227.36,7098.97,489.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q0249",1,9,0,null,null,2.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D1120",1,110,57.92,57.92,57.92,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q3014",1,67,0,26.65,67.06,16.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2332",1,110,189.47,189.47,189.47,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q4116",1,5248,0,32.29,35.78,1312]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2930",1,110,228.61,228.61,228.61,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q4124",1,23,0,16.39,16.39,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D7210",1,836,1510.05,1275.99,4066.77,209]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q4125",1,4060,0,3.79,3.79,1015]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0101",1,148,128.29,18.010000000000002,128.29,37]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q4130",1,65718,0,45.89,45.89,16429.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0260",1,817,1005.62,1005.62,3474.13,204.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q4196",1,9044,0,111.59,280.77999999999997,2261]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0416",1,425,360.63,360.63,2456.98,106.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q9954",1,0,0,12.1,13.41,0]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0514",1,84,148.6,148.6,148.6,21]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q9956",1,76,0,31.75,79.89,19]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G2088",1,45,82.11,82.11,82.11,11.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q9957",1,417,0,47.63,119.85,104.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L1820",1,159,207.54,142.59,640.03,39.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q9958",1,1,0,7.0000000000000007E-2,0.18,0.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L3760",1,819,647.70000000000005,445.02,1997.57,204.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q9961",1,1,0,0.25,0.63,0.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L4360",1,557,503.35,345.83,1552.36,139.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9012",1,134,64.959999999999994,64.959999999999994,125.33,33.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L3808",1,509,443.61,375.94,1687.5,127.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A6258",1,83,5.9,5,12.58,20.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q4102",1,69,11.74,10.210000000000001,25.69,17.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q9987",1,1218,0,null,null,304.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q4132",1,3754,131.82,114.63,288.43,938.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - S5100",1,6,0,null,null,1.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - S5101",1,63,0,null,null,15.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - 81170",1,798,548.09,159,2909.77,199.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - S5102",1,126,0,null,null,31.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9500",1,274,463.42,463.42,463.42,68.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - S8037",1,1440,0,585.76,3771.6,360]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9521",1,360,4157.3,4157.3,4157.3,90]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - T2003",1,25,0,null,null,6.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9551",1,154,1711.56,1711.56,1711.56,38.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - U0002",1,92,60.55,51.31,465.19,23]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9562",1,1237,2212.25,2212.25,2212.25,309.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - V2785",1,7848,0,5130.87,15242.01,1962]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9581",1,99,16.97,14.76,37.14,24.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - V2790",1,1136,0,null,null,284]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - C2616",1,60393,47839.61,25512.2,76706.740000000005,15098.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - 81170",1,798,300.79000000000002,159,2909.77,199.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D0210",1,165,120.47,120.47,120.47,41.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A4215",1,433,0,null,null,108.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2140",1,110,98.66,98.66,98.66,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A4467",1,151,0,null,null,37.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2390",1,110,248.14,248.14,248.14,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A4561",1,108,0,23.18,58.33,27]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2940",1,110,87.67,87.67,87.67,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A4562",1,64,0,57.71,145.21,16]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0279",1,55,51.68,30.09,295.68,13.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A4570",1,40,0,19.010000000000002,107.35,10]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0423",1,169,198.42,198.42,637.79,42.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A4725",1,87,0,null,null,21.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G2012",1,42,31.78,31.78,31.78,10.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A6209",1,163,0,8.68,21.84,40.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L3967",1,117,2082.9699999999998,1765.23,7923.54,29.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A6258",1,83,0,5,12.58,20.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9551",1,154,1711.56,1711.56,1711.56,38.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A6549",1,37,0,null,null,9.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9557",1,239,1062.44,1062.44,1062.44,59.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A6550",1,4,0,25.71,64.69,1]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9562",1,1237,2212.25,2212.25,2212.25,309.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A7520",1,1173,0,55.16,138.79,293.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9575",1,8,0.21,0.18,0.45,2]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9500",1,274,0,463.42,463.42,68.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9581",1,99,16.97,14.76,37.14,24.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9502",1,140,0,278.27,278.27,35]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9587",1,12985,84.97,84.97,113.78,3246.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9503",1,23,0,37.119999999999997,37.119999999999997,5.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - C2616",1,60393,47839.61,25512.2,76706.740000000005,15098.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9505",1,23,0,395.74,395.74,5.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - C8908",1,579,1105.27,664.1,4299.8,144.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9509",1,95,0,5163.91,5163.91,23.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D0210",1,165,120.47,120.47,120.47,41.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9512",1,1,0,null,null,0.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D0274",1,836,1182.5,1182.5,4066.77,209]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9513",1,320,0,294.27999999999997,1097.56,80]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2140",1,110,98.66,98.66,98.66,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9516",1,192,0,516.39,516.39,48]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2330",1,110,121.33,121.33,121.33,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9517",1,437,0,30.1,101.94,109.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2390",1,110,248.14,248.14,248.14,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9520",1,1951,0,null,null,487.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2394",1,110,282.64,282.64,282.64,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9521",1,360,0,4157.3,4157.3,90]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2940",1,110,87.67,87.67,87.67,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9537",1,138,0,157.94999999999999,157.94999999999999,34.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D3330",1,110,894.85,894.85,894.85,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9538",1,111,0,114.21,114.21,27.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D7230",1,836,1510.05,1275.99,4066.77,209]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9539",1,668,0,89.47,89.47,167]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D7311",1,110,202.78,202.78,202.78,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9540",1,1831,0,85.66,85.66,457.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0105",1,1152,1250.94,1020.59,3264.67,288]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9541",1,120,0,152.69,152.69,30]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0239",1,99,53.94,53.94,373.41,24.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9543",1,66322,0,72400.97,217685.7,16580.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0279",1,55,51.68,30.09,295.68,13.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9547",1,440,0,5105.7299999999996,5105.7299999999996,110]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0396",1,42,56.05,56.05,336.32,10.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9551",1,154,0,1711.56,1711.56,38.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0423",1,169,198.42,198.42,637.79,42.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9552",1,972,0,1166.46,1166.46,243]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0506",1,62,110.9,110.9,110.9,15.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9555",1,1065,0,1604.08,1604.08,266.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G2012",1,42,31.78,31.78,31.78,10.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9556",1,20,0,311.94,311.94,5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G2086",1,194,211.43,46.18,211.43,48.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9557",1,239,0,1062.44,1062.44,59.75]
["AETNA - AETNA - HCPCS - U0001",1,124,35.909999999999997,35.909999999999997,325.64,31]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9558",1,23,0,108.88,108.88,5.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L8693",1,1462,1752.97,1485.57,6668.25,365.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9560",1,246,0,266.7,266.7,61.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L1832",1,1523,1082.26,743.59,3337.75,380.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9561",1,127,0,125.64,125.64,31.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L3650",1,1955,98.07,67.38,302.45,488.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9562",1,1237,0,2212.25,2212.25,309.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L3808",1,509,547.16999999999996,375.94,1687.5,127.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9563",1,0,0,535.17999999999995,3182.68,0]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L3980",1,132,549.92999999999995,377.84,1695.98,33]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9569",1,5086,0,4157.3,4157.3,1271.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L4396",1,406,249.49,171.42,769.43,101.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9570",1,6395,0,null,null,1598.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - M0239",1,393,518.74,309.60000000000002,779.02,98.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9572",1,131,0,16207.01,16207.01,32.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - P9017",1,291,94.07,94.07,217.72,72.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9580",1,158,0,null,null,39.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - P9040",1,523,336.11,336.11,669.97,130.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9582",1,10370,0,null,null,2592.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - P9100",1,1310,33.53,33.53,256.64,327.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9583",1,13,0,19.260000000000002,21.34,3.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q0114",1,41,17.79,7.2,82.86,10.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9584",1,2729,0,3235.55,3235.55,682.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q4107",1,2233,110.48,86.55,110.48,558.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9587",1,12985,0,84.97,113.78,3246.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q4125",1,4060,3.79,3.79,3.79,1015]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9588",1,15438,0,525.05999999999995,703.05,3859.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q9954",1,0,13.41,12.1,13.41,0]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9592",1,5634,0,null,null,1408.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q9961",1,1,0.28999999999999998,0.25,0.63,0.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0101",1,148,0,18.010000000000002,128.29,37]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - S8037",1,1440,1396.47,585.76,3771.6,360]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L4386",1,165,182.92,155.02000000000001,695.83,41.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A4561",1,108,58.33,23.18,58.33,27]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0127",1,189,0,93.87,317.35000000000002,47.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A6550",1,4,64.69,25.71,64.69,1]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0175",1,565,0,638.73,2035.73,141.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A9577",1,21,4.55,1.81,5.03,5.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0239",1,99,0,53.94,373.41,24.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - G0103",1,93,48.59,16.78,181.16,23.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0257",1,911,0,1027.32,3651.55,227.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - G2023",1,31,59.03,23.46,212.71,7.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0259",1,1513,0,1198.25,1198.25,378.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L1820",1,159,168.26,142.59,640.03,39.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0260",1,817,0,1005.62,3474.13,204.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L0140",1,189,195.06,77.52,347.97,47.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0269",1,200,0,null,null,50]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L1836",1,209,328.31,130.47999999999999,585.70000000000005,52.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0278",1,3138,0,34.229999999999997,34.229999999999997,784.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L3670",1,2903,260.8,103.65,465.27,725.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0296",1,118,0,102.62,660.74,29.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L3808",1,509,945.94,375.94,1687.5,127.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0297",1,1437,0,107.22,801.26,359.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L3980",1,132,950.72,377.84,1695.98,33]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0365",1,498,0,272.02999999999997,867.01,124.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L4370",1,107,593.29,235.79,1058.3900000000001,26.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0389",1,544,0,null,null,136]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L8501",1,219,404.45,160.74,721.54,54.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0390",1,3274,0,1579.83,5035.18,818.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L8693",1,1462,3737.99,1485.57,6668.25,365.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0396",1,42,0,56.05,336.32,10.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L1830",1,78,96.7,81.95,367.86,19.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0397",1,118,0,128.29,815.89,29.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q3014",1,67,67.06,26.65,67.06,16.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0402",1,168,0,208.89,1179.72,42]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q4133",1,3756,332.06,131.97,332.06,939]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0410",1,220,0,null,null,55]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q9958",1,1,0.18,7.0000000000000007E-2,0.18,0.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0416",1,425,0,360.63,2456.98,106.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L1832",1,1523,877.44,743.59,3337.75,380.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0420",1,156,0,184.9,589.33000000000004,39]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - 0402T",1,2880,3044.16,1198.25,11845.41,720]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0421",1,37,0,42.72,136.13999999999999,9.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - 92083",1,461,178.83,68.75,607.84,115.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0422",1,169,0,198.42,637.79,42.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A6258",1,83,7.28,5,12.58,20.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0423",1,169,0,198.42,637.79,42.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9503",1,23,37.119999999999997,37.119999999999997,37.119999999999997,5.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0438",1,547,0,34.03,61.76,136.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9516",1,192,516.39,516.39,516.39,48]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0439",1,327,0,34.03,61.76,81.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9538",1,111,114.21,114.21,114.21,27.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0442",1,42,0,13.34,33.6,10.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9543",1,66322,139963.56,72400.97,217685.7,16580.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0443",1,118,0,18.52,33.6,29.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9555",1,1065,1604.08,1604.08,1604.08,266.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0444",1,42,0,8.9,16.149999999999999,10.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9560",1,246,266.7,266.7,266.7,61.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0445",1,118,0,8.9,16.149999999999999,29.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9569",1,5086,4157.3,4157.3,4157.3,1271.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0446",1,42,0,8.9,16.149999999999999,10.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9577",1,21,5.03,1.81,5.03,5.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0447",1,118,0,18.52,33.6,29.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9584",1,2729,3235.55,3235.55,3235.55,682.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0480",1,254,81,59.69,973.54,63.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9606",1,493,378.21,198.62,597.20000000000005,123.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0481",1,192,124.63,91.84,1332.11,48]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - C2639",1,47,100.75,52.85,100.75,11.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0506",1,62,0,110.9,110.9,15.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - C9728",1,1957,3429.66,2227.36,7098.97,489.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0513",1,84,0,148.6,148.6,21]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D0230",1,110,21.35,21.35,21.35,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0514",1,84,0,148.6,148.6,21]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D1120",1,110,57.92,57.92,57.92,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G2011",1,35,0,28.83,133.88,8.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2160",1,110,153.4,153.4,153.4,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G2012",1,42,0,31.78,31.78,10.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2332",1,110,189.47,189.47,189.47,27.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L4396",1,406,202.28,171.42,769.43,101.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2392",1,110,186.31,186.31,186.31,27.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L4398",1,406,93.13,78.92,354.25,101.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2930",1,110,228.61,228.61,228.61,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G2066",1,165,0,58.35,370.47,41.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D3220",1,110,141.69,141.69,141.69,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G2086",1,194,0,46.18,211.43,48.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D7210",1,836,1510.05,1275.99,4066.77,209]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G2087",1,194,0,46.18,211.43,48.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D7250",1,836,1510.05,1275.99,4066.77,209]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G2088",1,45,0,82.11,82.11,11.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0101",1,148,128.29,18.010000000000002,128.29,37]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G2212",1,188,0,null,null,47]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0109",1,267,37.520000000000003,32.64,134.25,66.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G2216",1,118,0,null,null,29.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0260",1,817,1005.62,1005.62,3474.13,204.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A6550",1,4,30.34,25.71,64.69,1]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0297",1,1437,178.43,107.22,801.26,359.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L0120",1,25,0,24.86,111.59,6.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0416",1,425,360.63,360.63,2456.98,106.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L0140",1,189,0,77.52,347.97,47.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0480",1,254,209.48,59.69,973.54,63.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L1820",1,159,0,142.59,640.03,39.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0514",1,84,148.6,148.6,148.6,21]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L1830",1,78,0,81.95,367.86,19.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G2024",1,33,29.29,25.46,230.84,8.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L1832",1,1523,0,743.59,3337.75,380.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G2088",1,45,82.11,82.11,82.11,11.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L1836",1,209,0,130.47999999999999,585.70000000000005,52.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - J2790",1,186.95,0,74.3,186.95,46.737499999999997]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L1902",1,219,0,86.14,386.65,54.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L1820",1,159,207.54,142.59,640.03,39.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3260",1,279,0,31.12,357.96,69.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L1902",1,219,125.37,86.14,386.65,54.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3350",1,41,0,22.41,100.59,10.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L3760",1,819,647.70000000000005,445.02,1997.57,204.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3496",1,406,0,null,null,101.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L3908",1,143,106.57,73.22,328.66,35.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3650",1,1955,0,67.38,302.45,488.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L4360",1,557,503.35,345.83,1552.36,139.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3670",1,2903,0,103.65,465.27,725.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L8509",1,1144,155.72999999999999,106.99,480.27,286]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3760",1,819,0,445.02,1997.57,204.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - P9012",1,134,64.959999999999994,64.959999999999994,125.33,33.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3762",1,57,0,95.68,429.49,14.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - P9034",1,506,443.29,443.29,799.73,126.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3807",1,483,0,222.52,998.85,120.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L3650",1,1955,79.510000000000005,67.38,302.45,488.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3808",1,509,0,375.94,1687.5,127.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q0091",1,83,28.83,28.83,175.66,20.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3905",1,2442,0,882.51,3961.32,610.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q4102",1,69,11.74,10.210000000000001,25.69,17.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3908",1,143,0,73.22,328.66,35.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q4116",1,5248,35.78,32.29,35.78,1312]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3967",1,117,0,1765.23,7923.54,29.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q4132",1,3754,131.82,114.63,288.43,938.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3980",1,132,0,377.84,1695.98,33]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q9957",1,417,54.77,47.63,119.85,104.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3982",1,176,0,398.23,1787.56,44]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L4350",1,360,0,97.28,436.66,90]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - U0002",1,92,59.02,51.31,465.19,23]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L4360",1,557,0,345.83,1552.36,139.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - 81170",1,798,548.09,159,2909.77,199.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L4370",1,107,0,235.79,1058.3900000000001,26.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A4561",1,108,33.729999999999997,23.18,58.33,27]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L4386",1,165,0,155.02000000000001,695.83,41.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9500",1,274,463.42,463.42,463.42,68.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L4396",1,406,0,171.42,769.43,101.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9509",1,95,5163.91,5163.91,5163.91,23.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L4398",1,406,0,78.92,354.25,101.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9521",1,360,4157.3,4157.3,4157.3,90]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L8501",1,219,0,160.74,721.54,54.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9540",1,1831,85.66,85.66,85.66,457.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L8507",1,1604,0,41.03,184.14,401]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9551",1,154,1711.56,1711.56,1711.56,38.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L8509",1,1144,0,106.99,480.27,286]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9557",1,239,1062.44,1062.44,1062.44,59.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L8514",1,387,0,92.38,414.69,96.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9562",1,1237,2212.25,2212.25,2212.25,309.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L8693",1,1462,0,1485.57,6668.25,365.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9575",1,8,0.21,0.18,0.45,2]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L8699",1,13957,0,null,null,3489.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9581",1,99,16.97,14.76,37.14,24.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - M0239",1,393,420.13,309.60000000000002,779.02,98.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9587",1,12985,84.97,84.97,113.78,3246.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - M0243",1,572,420.13,309.60000000000002,779.02,143]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - C2616",1,60393,47839.61,25512.2,76706.740000000005,15098.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - P9612",1,90,3.01,2.2200000000000002,1198.25,22.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - C8908",1,579,1105.27,664.1,4299.8,144.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q0091",1,83,0,28.83,175.66,20.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D0210",1,165,120.47,120.47,120.47,41.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L8501",1,219,189.67,160.74,721.54,54.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D0274",1,836,1182.5,1182.5,4066.77,209]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L8507",1,1604,48.42,41.03,184.14,401]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2140",1,110,98.66,98.66,98.66,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q0249",1,9,0,null,null,2.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2330",1,110,121.33,121.33,121.33,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q3014",1,67,0,26.65,67.06,16.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2390",1,110,248.14,248.14,248.14,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q4116",1,5248,0,32.29,35.78,1312]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2394",1,110,282.64,282.64,282.64,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q4124",1,23,0,16.39,16.39,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2940",1,110,87.67,87.67,87.67,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q4125",1,4060,0,3.79,3.79,1015]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D3330",1,110,894.85,894.85,894.85,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q4130",1,65718,0,45.89,45.89,16429.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D7230",1,836,1510.05,1275.99,4066.77,209]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q4196",1,9044,0,111.59,280.77999999999997,2261]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D7311",1,110,202.78,202.78,202.78,27.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q9954",1,0,0,12.1,13.41,0]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0105",1,1152,1250.94,1020.59,3264.67,288]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q9956",1,76,0,31.75,79.89,19]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0239",1,99,53.94,53.94,373.41,24.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q9957",1,417,0,47.63,119.85,104.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0279",1,55,51.68,30.09,295.68,13.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q9958",1,1,0,7.0000000000000007E-2,0.18,0.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0396",1,42,56.05,56.05,336.32,10.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q9961",1,1,0,0.25,0.63,0.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0423",1,169,198.42,198.42,637.79,42.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0506",1,62,110.9,110.9,110.9,15.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G2012",1,42,31.78,31.78,31.78,10.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A7520",1,1173,65.09,55.16,138.79,293.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G2086",1,194,211.43,46.18,211.43,48.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q9987",1,1218,0,null,null,304.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L3762",1,57,112.9,95.68,429.49,14.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - S5100",1,6,0,null,null,1.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - M0243",1,572,365.33,309.60000000000002,779.02,143]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - S5101",1,63,0,null,null,15.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L1832",1,1523,1082.26,743.59,3337.75,380.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - S5102",1,126,0,null,null,31.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L3650",1,1955,98.07,67.38,302.45,488.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - S8037",1,1440,0,585.76,3771.6,360]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L3808",1,509,547.16999999999996,375.94,1687.5,127.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - T2003",1,25,0,null,null,6.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L3980",1,132,549.92999999999995,377.84,1695.98,33]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - U0002",1,92,69.63,51.31,465.19,23]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L4396",1,406,249.49,171.42,769.43,101.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - V2785",1,7848,0,5130.87,15242.01,1962]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - M0239",1,393,518.74,309.60000000000002,779.02,98.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - V2790",1,1136,0,null,null,284]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9017",1,291,94.07,94.07,217.72,72.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - 0042T",1,767,1452,1452,1452,191.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9040",1,523,336.11,336.11,669.97,130.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - 0402T",1,2880,3044.16,1198.25,11845.41,720]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9100",1,1310,33.53,33.53,256.64,327.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - 45378",1,1672,1250.94,1020.59,3264.67,418]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q0114",1,41,17.79,7.2,82.86,10.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - 81170",1,798,548.09,159,2909.77,199.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q4107",1,2233,110.48,86.55,110.48,558.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - 90471",1,64,76.22,76.22,345.64,16]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q4125",1,4060,3.79,3.79,3.79,1015]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - 92083",1,461,178.83,68.75,607.84,115.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q9954",1,0,13.41,12.1,13.41,0]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - 95800",1,205,228.32,228.32,1412.44,51.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q9961",1,1,0.28999999999999998,0.25,0.63,0.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A4561",1,108,33.729999999999997,23.18,58.33,27]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - S8037",1,1440,1396.47,585.76,3771.6,360]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A6209",1,163,12.63,8.68,21.84,40.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - 0402T",1,2880,3044.16,1198.25,11845.41,720]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A6258",1,83,7.28,5,12.58,20.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - 92083",1,461,178.83,68.75,607.84,115.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A7520",1,1173,80.290000000000006,55.16,138.79,293.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A6258",1,83,7.28,5,12.58,20.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9500",1,274,463.42,463.42,463.42,68.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9503",1,23,37.119999999999997,37.119999999999997,37.119999999999997,5.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9502",1,140,278.27,278.27,278.27,35]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9516",1,192,516.39,516.39,516.39,48]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9503",1,23,37.119999999999997,37.119999999999997,37.119999999999997,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9538",1,111,114.21,114.21,114.21,27.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9505",1,23,395.74,395.74,395.74,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9543",1,66322,139963.56,72400.97,217685.7,16580.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9509",1,95,5163.91,5163.91,5163.91,23.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9555",1,1065,1604.08,1604.08,1604.08,266.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9513",1,320,329.72,294.27999999999997,1097.56,80]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9560",1,246,266.7,266.7,266.7,61.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9516",1,192,516.39,516.39,516.39,48]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9569",1,5086,4157.3,4157.3,4157.3,1271.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9517",1,437,101.94,30.1,101.94,109.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9577",1,21,5.03,1.81,5.03,5.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9521",1,360,4157.3,4157.3,4157.3,90]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9584",1,2729,3235.55,3235.55,3235.55,682.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9537",1,138,157.94999999999999,157.94999999999999,157.94999999999999,34.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9606",1,493,378.21,198.62,597.20000000000005,123.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9538",1,111,114.21,114.21,114.21,27.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - C2639",1,47,100.75,52.85,100.75,11.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9539",1,668,89.47,89.47,89.47,167]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - C9728",1,1957,3429.66,2227.36,7098.97,489.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9540",1,1831,85.66,85.66,85.66,457.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D0230",1,110,21.35,21.35,21.35,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9541",1,120,152.69,152.69,152.69,30]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D1120",1,110,57.92,57.92,57.92,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9543",1,66322,139963.56,72400.97,217685.7,16580.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2160",1,110,153.4,153.4,153.4,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9547",1,440,5105.7299999999996,5105.7299999999996,5105.7299999999996,110]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2332",1,110,189.47,189.47,189.47,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9551",1,154,1711.56,1711.56,1711.56,38.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2392",1,110,186.31,186.31,186.31,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9552",1,972,1166.46,1166.46,1166.46,243]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2930",1,110,228.61,228.61,228.61,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9555",1,1065,1604.08,1604.08,1604.08,266.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0109",1,267,37.520000000000003,32.64,134.25,66.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9556",1,20,311.94,311.94,311.94,5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0260",1,817,1005.62,1005.62,3474.13,204.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9557",1,239,1062.44,1062.44,1062.44,59.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0297",1,1437,178.43,107.22,801.26,359.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9558",1,23,108.88,108.88,108.88,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0416",1,425,360.63,360.63,2456.98,106.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9560",1,246,266.7,266.7,266.7,61.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0480",1,254,209.48,59.69,973.54,63.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9561",1,127,125.64,125.64,125.64,31.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0514",1,84,148.6,148.6,148.6,21]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9562",1,1237,2212.25,2212.25,2212.25,309.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G2024",1,33,29.29,25.46,230.84,8.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9563",1,0,870.53,535.17999999999995,3182.68,0]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G2088",1,45,82.11,82.11,82.11,11.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9569",1,5086,4157.3,4157.3,4157.3,1271.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9541",1,120,152.69,152.69,152.69,30]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9572",1,131,16207.01,16207.01,16207.01,32.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9547",1,440,5105.7299999999996,5105.7299999999996,5105.7299999999996,110]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9575",1,8,0.21,0.18,0.45,2]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9552",1,972,1166.46,1166.46,1166.46,243]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9576",1,5,3.76,1.5,3.77,1.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9556",1,20,311.94,311.94,311.94,5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9577",1,21,5.03,1.81,5.03,5.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9558",1,23,108.88,108.88,108.88,5.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9579",1,5,4.38,1.53,4.38,1.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9561",1,127,125.64,125.64,125.64,31.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9581",1,99,16.97,14.76,37.14,24.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9563",1,0,870.53,535.17999999999995,3182.68,0]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9583",1,13,21.34,19.260000000000002,21.34,3.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9572",1,131,16207.01,16207.01,16207.01,32.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9584",1,2729,3235.55,3235.55,3235.55,682.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9576",1,5,3.76,1.5,3.77,1.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9586",1,4402,3746.06,3746.06,7452.46,1100.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9579",1,5,4.38,1.53,4.38,1.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9587",1,12985,84.97,84.97,113.78,3246.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9583",1,13,21.34,19.260000000000002,21.34,3.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9588",1,15438,525.05999999999995,525.05999999999995,703.05,3859.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9586",1,4402,3746.06,3746.06,7452.46,1100.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9606",1,493,378.21,198.62,597.20000000000005,123.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9588",1,15438,525.05999999999995,525.05999999999995,703.05,3859.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - C1717",1,607,836.69,469.29,1411.01,151.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - C1717",1,607,836.69,469.29,1411.01,151.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - C2616",1,60393,47839.61,25512.2,76706.740000000005,15098.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - C2635",1,0,78.03,78.03,242.54,0]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - C2635",1,0,78.03,78.03,242.54,0]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - C5275",1,743,810.95,684.11,2032.26,185.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - C2639",1,47,100.75,52.85,100.75,11.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - C9358",1,8526,24.42,24.42,24.42,2131.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - C5275",1,743,810.95,684.11,2032.26,185.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - C9739",1,6035,6751.98,2166.09,15242.01,1508.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - C8908",1,579,1105.27,664.1,4299.8,144.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D0220",1,165,23.78,23.78,23.78,41.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - C9358",1,8526,24.42,24.42,24.42,2131.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D0272",1,836,1182.5,1182.5,4066.77,209]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - C9728",1,1957,3429.66,2227.36,7098.97,489.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D1110",1,110,84.56,51.21,163.22999999999999,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - C9739",1,6035,6751.98,2166.09,15242.01,1508.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D1351",1,110,45.91,45.91,45.91,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D0210",1,165,120.47,120.47,120.47,41.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2150",1,110,126.81,126.81,126.81,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D0220",1,165,23.78,23.78,23.78,41.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2161",1,110,187.9,187.9,187.9,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D0230",1,110,21.35,21.35,21.35,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2331",1,110,154.99,154.99,154.99,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D0272",1,836,1182.5,1182.5,4066.77,209]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2335",1,110,223.88,223.88,223.88,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D0274",1,836,1182.5,1182.5,4066.77,209]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2391",1,110,141.69,141.69,141.69,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D1110",1,110,84.56,51.21,163.22999999999999,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2393",1,110,230.94,230.94,230.94,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D1120",1,110,57.92,57.92,57.92,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2740",1,110,1036.53,1036.53,1036.53,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D1351",1,110,45.91,45.91,45.91,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2931",1,110,259.95,259.95,259.95,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2140",1,110,98.66,98.66,98.66,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D3110",1,110,68.89,68.89,68.89,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2150",1,110,126.81,126.81,126.81,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D3310",1,110,587.95000000000005,587.95000000000005,587.95000000000005,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2160",1,110,153.4,153.4,153.4,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D7140",1,836,1510.05,1275.99,4066.77,209]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2161",1,110,187.9,187.9,187.9,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D7220",1,836,1510.05,1275.99,4066.77,209]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2330",1,110,121.33,121.33,121.33,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D7240",1,836,1510.05,1275.99,4066.77,209]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2331",1,110,154.99,154.99,154.99,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D7310",1,110,230.94,230.94,230.94,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2332",1,110,189.47,189.47,189.47,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D7410",1,110,692.83,692.83,692.83,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2335",1,110,223.88,223.88,223.88,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0103",1,93,41.5,16.78,181.16,23.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2390",1,110,248.14,248.14,248.14,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0108",1,425,136.19,72.41,230.78,106.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2391",1,110,141.69,141.69,141.69,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0127",1,189,93.87,93.87,317.35000000000002,47.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2392",1,110,186.31,186.31,186.31,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0257",1,911,1027.32,1027.32,3651.55,227.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2393",1,110,230.94,230.94,230.94,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0278",1,3138,34.229999999999997,34.229999999999997,34.229999999999997,784.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2394",1,110,282.64,282.64,282.64,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0296",1,118,128.29,102.62,660.74,29.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2740",1,110,1036.53,1036.53,1036.53,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0390",1,3274,1587.59,1579.83,5035.18,818.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2930",1,110,228.61,228.61,228.61,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0397",1,118,128.29,128.29,815.89,29.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2931",1,110,259.95,259.95,259.95,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0422",1,169,198.42,198.42,637.79,42.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2940",1,110,87.67,87.67,87.67,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0424",1,284,93.87,93.87,343.09,71]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D3110",1,110,68.89,68.89,68.89,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0481",1,192,286.56,91.84,1332.11,48]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D3220",1,110,141.69,141.69,141.69,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0513",1,84,148.6,148.6,148.6,21]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D3310",1,110,587.95000000000005,587.95000000000005,587.95000000000005,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G2011",1,35,28.83,28.83,133.88,8.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D3330",1,110,894.85,894.85,894.85,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G2023",1,31,26.99,23.46,212.71,7.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D7140",1,836,1510.05,1275.99,4066.77,209]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G2066",1,165,58.35,58.35,370.47,41.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D7210",1,836,1510.05,1275.99,4066.77,209]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G2087",1,194,211.43,46.18,211.43,48.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D7220",1,836,1510.05,1275.99,4066.77,209]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - G2024",1,33,30.04,25.46,230.84,8.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D7230",1,836,1510.05,1275.99,4066.77,209]
["AETNA - AETNA - HCPCS - U0002",1,92,51.31,51.31,465.19,23]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D7240",1,836,1510.05,1275.99,4066.77,209]
["AETNA - AETNA - HCPCS - C9739",1,6035,2166.09,2166.09,15242.01,1508.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D7250",1,836,1510.05,1275.99,4066.77,209]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L0120",1,25,36.19,24.86,111.59,6.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D7310",1,110,230.94,230.94,230.94,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L1830",1,78,119.28,81.95,367.86,19.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D7311",1,110,202.78,202.78,202.78,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L1836",1,209,189.91,130.47999999999999,585.70000000000005,52.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D7410",1,110,692.83,692.83,692.83,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L3260",1,279,31.12,31.12,357.96,69.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0101",1,148,128.29,18.010000000000002,128.29,37]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L3670",1,2903,150.86000000000001,103.65,465.27,725.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0103",1,93,41.5,16.78,181.16,23.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L3807",1,483,323.87,222.52,998.85,120.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0105",1,1152,1250.94,1020.59,3264.67,288]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L3905",1,2442,1284.45,882.51,3961.32,610.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0108",1,425,136.19,72.41,230.78,106.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L3967",1,117,2569.1999999999998,1765.23,7923.54,29.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0109",1,267,37.520000000000003,32.64,134.25,66.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L4350",1,360,141.58000000000001,97.28,436.66,90]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0127",1,189,93.87,93.87,317.35000000000002,47.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L4386",1,165,225.63,155.02000000000001,695.83,41.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0239",1,99,53.94,53.94,373.41,24.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L4398",1,406,114.87,78.92,354.25,101.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0257",1,911,1027.32,1027.32,3651.55,227.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L8693",1,1462,2162.1799999999998,1485.57,6668.25,365.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0260",1,817,1005.62,1005.62,3474.13,204.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - M0243",1,572,518.74,309.60000000000002,779.02,143]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0278",1,3138,34.229999999999997,34.229999999999997,34.229999999999997,784.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - P9016",1,576,243.01,243.01,478.65,144]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0279",1,55,51.68,30.09,295.68,13.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - P9021",1,323,184.28,184.28,354.25,80.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0296",1,118,128.29,102.62,660.74,29.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - P9037",1,939,821.84,821.84,1622.67,234.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0297",1,1437,178.43,107.22,801.26,359.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - P9045",1,238,60.32,52.45,131.97,59.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0390",1,3274,1587.59,1579.83,5035.18,818.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - P9073",1,889,821.84,821.84,2619.59,222.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0396",1,42,56.05,56.05,336.32,10.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - P9612",1,90,5.27,2.2200000000000002,1198.25,22.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0397",1,118,128.29,128.29,815.89,29.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q0111",1,23,27.01,5.86,127.48,5.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0416",1,425,360.63,360.63,2456.98,106.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q4101",1,1601,35.03,30.46,76.64,400.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0422",1,169,198.42,198.42,637.79,42.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q4104",1,7748,56.11,42.08,56.11,1937]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0423",1,169,198.42,198.42,637.79,42.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q4112",1,535,1002.89,904.99,1002.89,133.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0424",1,284,93.87,93.87,343.09,71]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q4124",1,23,16.39,16.39,16.39,5.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0480",1,254,209.48,59.69,973.54,63.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q4130",1,65718,45.89,45.89,45.89,16429.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0481",1,192,286.56,91.84,1332.11,48]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q4133",1,3756,151.77000000000001,131.97,332.06,939]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0506",1,62,110.9,110.9,110.9,15.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q9956",1,76,36.51,31.75,79.89,19]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0513",1,84,148.6,148.6,148.6,21]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q9958",1,1,0.08,7.0000000000000007E-2,0.18,0.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0514",1,84,148.6,148.6,148.6,21]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G2011",1,35,28.83,28.83,133.88,8.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - J2790",1,186.95,0,74.3,186.95,46.737499999999997]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G2012",1,42,31.78,31.78,31.78,10.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - U0001",1,124,41.31,35.909999999999997,325.64,31]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G2023",1,31,26.99,23.46,212.71,7.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - 81170",1,798,754.86,159,2909.77,199.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G2024",1,33,29.29,25.46,230.84,8.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A4562",1,64,145.21,57.71,145.21,16]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G2066",1,165,58.35,58.35,370.47,41.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A6258",1,83,12.58,5,12.58,20.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G2086",1,194,211.43,46.18,211.43,48.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A7520",1,1173,138.79,55.16,138.79,293.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G2087",1,194,211.43,46.18,211.43,48.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A9576",1,5,3.77,1.5,3.77,1.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G2088",1,45,82.11,82.11,82.11,11.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A9579",1,5,3.85,1.53,4.38,1.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A9575",1,8,0.21,0.18,0.45,2]
["AETNA - AETNA - HCPCS - 45378",1,1672,1500.85,1020.59,3264.67,418]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A9576",1,5,1.77,1.5,3.77,1.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - G0279",1,55,75.709999999999994,30.09,295.68,13.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A9577",1,21,2.14,1.81,5.03,5.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - G0481",1,192,394.01,91.84,1332.11,48]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - J2790",1,186.95,0,74.3,186.95,46.737499999999997]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - G2024",1,33,64.06,25.46,230.84,8.25]
["AETNA - AETNA - HCPCS - A9513",1,320,294.27999999999997,294.27999999999997,1097.56,80]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L0140",1,189,91.47,77.52,347.97,47.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L8509",1,1144,126.25,106.99,480.27,286]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - J2790",1,186.95,0,74.3,186.95,46.737499999999997]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L0120",1,25,36.19,24.86,111.59,6.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L0120",1,25,62.55,24.86,111.59,6.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L1820",1,159,207.54,142.59,640.03,39.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L1820",1,159,358.78,142.59,640.03,39.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L1830",1,78,119.28,81.95,367.86,19.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L1832",1,1523,1871.02,743.59,3337.75,380.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L1832",1,1523,1082.26,743.59,3337.75,380.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L1902",1,219,216.75,86.14,386.65,54.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L1836",1,209,189.91,130.47999999999999,585.70000000000005,52.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L3650",1,1955,169.54,67.38,302.45,488.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L1902",1,219,125.37,86.14,386.65,54.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L3760",1,819,1119.76,445.02,1997.57,204.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L3260",1,279,31.12,31.12,357.96,69.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L3807",1,483,559.9,222.52,998.85,120.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L3650",1,1955,98.07,67.38,302.45,488.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L3905",1,2442,2220.5700000000002,882.51,3961.32,610.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L3670",1,2903,150.86000000000001,103.65,465.27,725.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L3967",1,117,4441.67,1765.23,7923.54,29.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L3760",1,819,647.70000000000005,445.02,1997.57,204.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L3982",1,176,1002.03,398.23,1787.56,44]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L3807",1,483,323.87,222.52,998.85,120.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L4360",1,557,870.18,345.83,1552.36,139.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L3808",1,509,547.16999999999996,375.94,1687.5,127.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L4386",1,165,390.06,155.02000000000001,695.83,41.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L3905",1,2442,1284.45,882.51,3961.32,610.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L4398",1,406,198.58,78.92,354.25,101.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L3908",1,143,106.57,73.22,328.66,35.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L8507",1,1604,103.24,41.03,184.14,401]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L3967",1,117,2569.1999999999998,1765.23,7923.54,29.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L8514",1,387,232.45,92.38,414.69,96.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L3980",1,132,549.92999999999995,377.84,1695.98,33]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - M0239",1,393,779.02,309.60000000000002,779.02,98.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L4350",1,360,141.58000000000001,97.28,436.66,90]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - P9045",1,238,131.97,52.45,131.97,59.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L4360",1,557,503.35,345.83,1552.36,139.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - P9612",1,90,7.55,2.2200000000000002,1198.25,22.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L4386",1,165,225.63,155.02000000000001,695.83,41.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q0114",1,41,24.51,7.2,82.86,10.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L4396",1,406,249.49,171.42,769.43,101.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q4101",1,1601,76.64,30.46,76.64,400.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L4398",1,406,114.87,78.92,354.25,101.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q4132",1,3754,288.43,114.63,288.43,938.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L8509",1,1144,155.72999999999999,106.99,480.27,286]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q4196",1,9044,280.77999999999997,111.59,280.77999999999997,2261]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L8693",1,1462,2162.1799999999998,1485.57,6668.25,365.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q9957",1,417,119.85,47.63,119.85,104.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - M0239",1,393,518.74,309.60000000000002,779.02,98.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q9961",1,1,0.63,0.25,0.63,0.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - M0243",1,572,518.74,309.60000000000002,779.02,143]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9012",1,134,64.959999999999994,64.959999999999994,125.33,33.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - U0001",1,124,90.36,35.909999999999997,325.64,31]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9016",1,576,243.01,243.01,478.65,144]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - 0042T",1,767,1452,1452,1452,191.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9017",1,291,94.07,94.07,217.72,72.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - 45378",1,1672,1250.94,1020.59,3264.67,418]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9021",1,323,184.28,184.28,354.25,80.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - 90471",1,64,76.22,76.22,345.64,16]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9034",1,506,443.29,443.29,799.73,126.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - 95800",1,205,228.32,228.32,1412.44,51.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9037",1,939,821.84,821.84,1622.67,234.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A6209",1,163,12.63,8.68,21.84,40.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9040",1,523,336.11,336.11,669.97,130.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A7520",1,1173,80.290000000000006,55.16,138.79,293.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9045",1,238,60.32,52.45,131.97,59.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9502",1,140,278.27,278.27,278.27,35]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A9579",1,5,1.81,1.53,4.38,1.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9505",1,23,395.74,395.74,395.74,5.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9073",1,889,821.84,821.84,2619.59,222.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9513",1,320,329.72,294.27999999999997,1097.56,80]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9100",1,1310,33.53,33.53,256.64,327.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9517",1,437,101.94,30.1,101.94,109.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9612",1,90,5.27,2.2200000000000002,1198.25,22.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9537",1,138,157.94999999999999,157.94999999999999,157.94999999999999,34.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q0091",1,83,28.83,28.83,175.66,20.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9539",1,668,89.47,89.47,89.47,167]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q0111",1,23,27.01,5.86,127.48,5.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9541",1,120,152.69,152.69,152.69,30]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q0114",1,41,17.79,7.2,82.86,10.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9547",1,440,5105.7299999999996,5105.7299999999996,5105.7299999999996,110]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q4101",1,1601,35.03,30.46,76.64,400.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9552",1,972,1166.46,1166.46,1166.46,243]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q4102",1,69,11.74,10.210000000000001,25.69,17.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9556",1,20,311.94,311.94,311.94,5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q4104",1,7748,56.11,42.08,56.11,1937]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9558",1,23,108.88,108.88,108.88,5.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q4107",1,2233,110.48,86.55,110.48,558.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9561",1,127,125.64,125.64,125.64,31.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q4112",1,535,1002.89,904.99,1002.89,133.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9563",1,0,870.53,535.17999999999995,3182.68,0]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q4116",1,5248,35.78,32.29,35.78,1312]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9572",1,131,16207.01,16207.01,16207.01,32.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q4124",1,23,16.39,16.39,16.39,5.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9576",1,5,3.76,1.5,3.77,1.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q4125",1,4060,3.79,3.79,3.79,1015]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9579",1,5,4.38,1.53,4.38,1.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q4130",1,65718,45.89,45.89,45.89,16429.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9583",1,13,21.34,19.260000000000002,21.34,3.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q4132",1,3754,131.82,114.63,288.43,938.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9586",1,4402,3746.06,3746.06,7452.46,1100.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q4133",1,3756,151.77000000000001,131.97,332.06,939]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9588",1,15438,525.05999999999995,525.05999999999995,703.05,3859.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q9954",1,0,13.41,12.1,13.41,0]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - C1717",1,607,836.69,469.29,1411.01,151.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q9956",1,76,36.51,31.75,79.89,19]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - C2635",1,0,78.03,78.03,242.54,0]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q9957",1,417,54.77,47.63,119.85,104.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - C5275",1,743,810.95,684.11,2032.26,185.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q9958",1,1,0.08,7.0000000000000007E-2,0.18,0.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - C9358",1,8526,24.42,24.42,24.42,2131.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q9961",1,1,0.28999999999999998,0.25,0.63,0.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - C9739",1,6035,6751.98,2166.09,15242.01,1508.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D0220",1,165,23.78,23.78,23.78,41.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D0272",1,836,1182.5,1182.5,4066.77,209]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A9581",1,99,17.420000000000002,14.76,37.14,24.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D1110",1,110,84.56,51.21,163.22999999999999,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - S8037",1,1440,1396.47,585.76,3771.6,360]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D1351",1,110,45.91,45.91,45.91,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - U0001",1,124,41.31,35.909999999999997,325.64,31]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2150",1,110,126.81,126.81,126.81,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - U0002",1,92,59.02,51.31,465.19,23]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2161",1,110,187.9,187.9,187.9,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - 0042T",1,767,1452,1452,1452,191.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2331",1,110,154.99,154.99,154.99,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - 0402T",1,2880,3044.16,1198.25,11845.41,720]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2335",1,110,223.88,223.88,223.88,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - 45378",1,1672,1250.94,1020.59,3264.67,418]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2391",1,110,141.69,141.69,141.69,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - 81170",1,798,548.09,159,2909.77,199.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2393",1,110,230.94,230.94,230.94,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - 90471",1,64,76.22,76.22,345.64,16]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2740",1,110,1036.53,1036.53,1036.53,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - 92083",1,461,178.83,68.75,607.84,115.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2931",1,110,259.95,259.95,259.95,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - 95800",1,205,228.32,228.32,1412.44,51.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D3110",1,110,68.89,68.89,68.89,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A4561",1,108,33.729999999999997,23.18,58.33,27]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D3310",1,110,587.95000000000005,587.95000000000005,587.95000000000005,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A6209",1,163,12.63,8.68,21.84,40.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D7140",1,836,1510.05,1275.99,4066.77,209]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A6258",1,83,7.28,5,12.58,20.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D7220",1,836,1510.05,1275.99,4066.77,209]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A7520",1,1173,80.290000000000006,55.16,138.79,293.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D7240",1,836,1510.05,1275.99,4066.77,209]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9500",1,274,463.42,463.42,463.42,68.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D7310",1,110,230.94,230.94,230.94,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9502",1,140,278.27,278.27,278.27,35]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D7410",1,110,692.83,692.83,692.83,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9503",1,23,37.119999999999997,37.119999999999997,37.119999999999997,5.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0103",1,93,41.5,16.78,181.16,23.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9505",1,23,395.74,395.74,395.74,5.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0108",1,425,136.19,72.41,230.78,106.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9509",1,95,5163.91,5163.91,5163.91,23.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0127",1,189,93.87,93.87,317.35000000000002,47.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9513",1,320,329.72,294.27999999999997,1097.56,80]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0257",1,911,1027.32,1027.32,3651.55,227.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9516",1,192,516.39,516.39,516.39,48]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0278",1,3138,34.229999999999997,34.229999999999997,34.229999999999997,784.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9517",1,437,101.94,30.1,101.94,109.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0296",1,118,128.29,102.62,660.74,29.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9521",1,360,4157.3,4157.3,4157.3,90]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0390",1,3274,1587.59,1579.83,5035.18,818.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9537",1,138,157.94999999999999,157.94999999999999,157.94999999999999,34.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0397",1,118,128.29,128.29,815.89,29.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9538",1,111,114.21,114.21,114.21,27.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0422",1,169,198.42,198.42,637.79,42.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9539",1,668,89.47,89.47,89.47,167]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0424",1,284,93.87,93.87,343.09,71]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9540",1,1831,85.66,85.66,85.66,457.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0481",1,192,286.56,91.84,1332.11,48]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9541",1,120,152.69,152.69,152.69,30]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0513",1,84,148.6,148.6,148.6,21]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9543",1,66322,139963.56,72400.97,217685.7,16580.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G2011",1,35,28.83,28.83,133.88,8.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9547",1,440,5105.7299999999996,5105.7299999999996,5105.7299999999996,110]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G2023",1,31,26.99,23.46,212.71,7.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9551",1,154,1711.56,1711.56,1711.56,38.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G2066",1,165,58.35,58.35,370.47,41.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9552",1,972,1166.46,1166.46,1166.46,243]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G2087",1,194,211.43,46.18,211.43,48.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9555",1,1065,1604.08,1604.08,1604.08,266.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L1836",1,209,153.97,130.47999999999999,585.70000000000005,52.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9556",1,20,311.94,311.94,311.94,5]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L3350",1,41,26.44,22.41,100.59,10.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9557",1,239,1062.44,1062.44,1062.44,59.75]
["AETNA - AETNA - HCPCS - G0259",1,1513,1198.25,1198.25,1198.25,378.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9558",1,23,108.88,108.88,108.88,5.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L0120",1,25,36.19,24.86,111.59,6.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9560",1,246,266.7,266.7,266.7,61.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L1830",1,78,119.28,81.95,367.86,19.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9561",1,127,125.64,125.64,125.64,31.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L1836",1,209,189.91,130.47999999999999,585.70000000000005,52.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9562",1,1237,2212.25,2212.25,2212.25,309.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L3260",1,279,31.12,31.12,357.96,69.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9563",1,0,870.53,535.17999999999995,3182.68,0]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L3670",1,2903,150.86000000000001,103.65,465.27,725.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9569",1,5086,4157.3,4157.3,4157.3,1271.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L3807",1,483,323.87,222.52,998.85,120.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9572",1,131,16207.01,16207.01,16207.01,32.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L3905",1,2442,1284.45,882.51,3961.32,610.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9575",1,8,0.21,0.18,0.45,2]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L3967",1,117,2569.1999999999998,1765.23,7923.54,29.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9576",1,5,3.76,1.5,3.77,1.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L4350",1,360,141.58000000000001,97.28,436.66,90]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9577",1,21,5.03,1.81,5.03,5.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L4386",1,165,225.63,155.02000000000001,695.83,41.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9579",1,5,4.38,1.53,4.38,1.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L4398",1,406,114.87,78.92,354.25,101.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9581",1,99,16.97,14.76,37.14,24.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L8693",1,1462,2162.1799999999998,1485.57,6668.25,365.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9583",1,13,21.34,19.260000000000002,21.34,3.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - M0243",1,572,518.74,309.60000000000002,779.02,143]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9584",1,2729,3235.55,3235.55,3235.55,682.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - P9016",1,576,243.01,243.01,478.65,144]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9586",1,4402,3746.06,3746.06,7452.46,1100.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - P9021",1,323,184.28,184.28,354.25,80.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9587",1,12985,84.97,84.97,113.78,3246.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - P9037",1,939,821.84,821.84,1622.67,234.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9588",1,15438,525.05999999999995,525.05999999999995,703.05,3859.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - P9045",1,238,60.32,52.45,131.97,59.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9606",1,493,378.21,198.62,597.20000000000005,123.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - P9073",1,889,821.84,821.84,2619.59,222.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - C1717",1,607,836.69,469.29,1411.01,151.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - P9612",1,90,5.27,2.2200000000000002,1198.25,22.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - C2616",1,60393,47839.61,25512.2,76706.740000000005,15098.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q0111",1,23,27.01,5.86,127.48,5.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - C2635",1,0,78.03,78.03,242.54,0]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q4101",1,1601,35.03,30.46,76.64,400.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - C2639",1,47,100.75,52.85,100.75,11.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q4104",1,7748,56.11,42.08,56.11,1937]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - C5275",1,743,810.95,684.11,2032.26,185.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q4112",1,535,1002.89,904.99,1002.89,133.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - C8908",1,579,1105.27,664.1,4299.8,144.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q4124",1,23,16.39,16.39,16.39,5.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - C9358",1,8526,24.42,24.42,24.42,2131.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q4130",1,65718,45.89,45.89,45.89,16429.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - C9728",1,1957,3429.66,2227.36,7098.97,489.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q4133",1,3756,151.77000000000001,131.97,332.06,939]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - C9739",1,6035,6751.98,2166.09,15242.01,1508.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q9956",1,76,36.51,31.75,79.89,19]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D0210",1,165,120.47,120.47,120.47,41.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q9958",1,1,0.08,7.0000000000000007E-2,0.18,0.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D0220",1,165,23.78,23.78,23.78,41.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D0230",1,110,21.35,21.35,21.35,27.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L3670",1,2903,122.31,103.65,465.27,725.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D0272",1,836,1182.5,1182.5,4066.77,209]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - U0001",1,124,41.31,35.909999999999997,325.64,31]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D0274",1,836,1182.5,1182.5,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - 0042T",1,767,1452,1452,1452,191.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D1110",1,110,84.56,51.21,163.22999999999999,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - 45378",1,1672,1250.94,1020.59,3264.67,418]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D1120",1,110,57.92,57.92,57.92,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - 90471",1,64,76.22,76.22,345.64,16]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D1351",1,110,45.91,45.91,45.91,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - 95800",1,205,228.32,228.32,1412.44,51.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2140",1,110,98.66,98.66,98.66,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A6209",1,163,12.63,8.68,21.84,40.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2150",1,110,126.81,126.81,126.81,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A7520",1,1173,80.290000000000006,55.16,138.79,293.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2160",1,110,153.4,153.4,153.4,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9502",1,140,278.27,278.27,278.27,35]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2161",1,110,187.9,187.9,187.9,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9505",1,23,395.74,395.74,395.74,5.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2330",1,110,121.33,121.33,121.33,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9513",1,320,329.72,294.27999999999997,1097.56,80]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2331",1,110,154.99,154.99,154.99,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9517",1,437,101.94,30.1,101.94,109.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2332",1,110,189.47,189.47,189.47,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9537",1,138,157.94999999999999,157.94999999999999,157.94999999999999,34.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2335",1,110,223.88,223.88,223.88,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9539",1,668,89.47,89.47,89.47,167]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2390",1,110,248.14,248.14,248.14,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9541",1,120,152.69,152.69,152.69,30]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2391",1,110,141.69,141.69,141.69,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9547",1,440,5105.7299999999996,5105.7299999999996,5105.7299999999996,110]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2392",1,110,186.31,186.31,186.31,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9552",1,972,1166.46,1166.46,1166.46,243]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2393",1,110,230.94,230.94,230.94,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9556",1,20,311.94,311.94,311.94,5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2394",1,110,282.64,282.64,282.64,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9558",1,23,108.88,108.88,108.88,5.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2740",1,110,1036.53,1036.53,1036.53,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9561",1,127,125.64,125.64,125.64,31.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2930",1,110,228.61,228.61,228.61,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9563",1,0,870.53,535.17999999999995,3182.68,0]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2931",1,110,259.95,259.95,259.95,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9572",1,131,16207.01,16207.01,16207.01,32.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2940",1,110,87.67,87.67,87.67,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9576",1,5,3.76,1.5,3.77,1.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D3110",1,110,68.89,68.89,68.89,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9579",1,5,4.38,1.53,4.38,1.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D3220",1,110,141.69,141.69,141.69,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9583",1,13,21.34,19.260000000000002,21.34,3.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D3310",1,110,587.95000000000005,587.95000000000005,587.95000000000005,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9586",1,4402,3746.06,3746.06,7452.46,1100.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D3330",1,110,894.85,894.85,894.85,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9588",1,15438,525.05999999999995,525.05999999999995,703.05,3859.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D7140",1,836,1510.05,1275.99,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - C1717",1,607,836.69,469.29,1411.01,151.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D7210",1,836,1510.05,1275.99,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - C2635",1,0,78.03,78.03,242.54,0]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D7220",1,836,1510.05,1275.99,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - C5275",1,743,810.95,684.11,2032.26,185.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D7230",1,836,1510.05,1275.99,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - C9358",1,8526,24.42,24.42,24.42,2131.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D7240",1,836,1510.05,1275.99,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - C9739",1,6035,6751.98,2166.09,15242.01,1508.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D7250",1,836,1510.05,1275.99,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D0220",1,165,23.78,23.78,23.78,41.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D7310",1,110,230.94,230.94,230.94,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D0272",1,836,1182.5,1182.5,4066.77,209]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D7311",1,110,202.78,202.78,202.78,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D1110",1,110,84.56,51.21,163.22999999999999,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D7410",1,110,692.83,692.83,692.83,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D1351",1,110,45.91,45.91,45.91,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0101",1,148,128.29,18.010000000000002,128.29,37]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2150",1,110,126.81,126.81,126.81,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0103",1,93,41.5,16.78,181.16,23.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2161",1,110,187.9,187.9,187.9,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0105",1,1152,1250.94,1020.59,3264.67,288]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2331",1,110,154.99,154.99,154.99,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0108",1,425,136.19,72.41,230.78,106.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2335",1,110,223.88,223.88,223.88,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0109",1,267,37.520000000000003,32.64,134.25,66.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2391",1,110,141.69,141.69,141.69,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0127",1,189,93.87,93.87,317.35000000000002,47.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2393",1,110,230.94,230.94,230.94,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0239",1,99,53.94,53.94,373.41,24.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2740",1,110,1036.53,1036.53,1036.53,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0257",1,911,1027.32,1027.32,3651.55,227.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2931",1,110,259.95,259.95,259.95,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0260",1,817,1005.62,1005.62,3474.13,204.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D3110",1,110,68.89,68.89,68.89,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0278",1,3138,34.229999999999997,34.229999999999997,34.229999999999997,784.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D3310",1,110,587.95000000000005,587.95000000000005,587.95000000000005,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0279",1,55,51.68,30.09,295.68,13.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D7140",1,836,1510.05,1275.99,4066.77,209]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0296",1,118,128.29,102.62,660.74,29.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D7220",1,836,1510.05,1275.99,4066.77,209]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0297",1,1437,178.43,107.22,801.26,359.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D7240",1,836,1510.05,1275.99,4066.77,209]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0390",1,3274,1587.59,1579.83,5035.18,818.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D7310",1,110,230.94,230.94,230.94,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0396",1,42,56.05,56.05,336.32,10.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D7410",1,110,692.83,692.83,692.83,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0397",1,118,128.29,128.29,815.89,29.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0103",1,93,41.5,16.78,181.16,23.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0416",1,425,360.63,360.63,2456.98,106.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0108",1,425,136.19,72.41,230.78,106.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0422",1,169,198.42,198.42,637.79,42.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0127",1,189,93.87,93.87,317.35000000000002,47.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0423",1,169,198.42,198.42,637.79,42.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0257",1,911,1027.32,1027.32,3651.55,227.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0424",1,284,93.87,93.87,343.09,71]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0278",1,3138,34.229999999999997,34.229999999999997,34.229999999999997,784.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0480",1,254,209.48,59.69,973.54,63.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0296",1,118,128.29,102.62,660.74,29.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0481",1,192,286.56,91.84,1332.11,48]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0390",1,3274,1587.59,1579.83,5035.18,818.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0506",1,62,110.9,110.9,110.9,15.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0397",1,118,128.29,128.29,815.89,29.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0513",1,84,148.6,148.6,148.6,21]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0422",1,169,198.42,198.42,637.79,42.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0514",1,84,148.6,148.6,148.6,21]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0424",1,284,93.87,93.87,343.09,71]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G2011",1,35,28.83,28.83,133.88,8.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0481",1,192,286.56,91.84,1332.11,48]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G2012",1,42,31.78,31.78,31.78,10.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0513",1,84,148.6,148.6,148.6,21]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G2023",1,31,26.99,23.46,212.71,7.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G2011",1,35,28.83,28.83,133.88,8.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G2024",1,33,29.29,25.46,230.84,8.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G2023",1,31,26.99,23.46,212.71,7.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G2066",1,165,58.35,58.35,370.47,41.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G2066",1,165,58.35,58.35,370.47,41.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G2086",1,194,211.43,46.18,211.43,48.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G2087",1,194,211.43,46.18,211.43,48.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G2087",1,194,211.43,46.18,211.43,48.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L3760",1,819,525.12,445.02,1997.57,204.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G2088",1,45,82.11,82.11,82.11,11.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L3807",1,483,262.57,222.52,998.85,120.75]
["AETNA - AETNA - HCPCS - S2083",1,211,1198.25,317.70999999999998,1198.25,52.75]
["AETNA - AETNA - HCPCS - G0260",1,817,1198.25,1005.62,3474.13,204.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - G0103",1,93,22.79,16.78,181.16,23.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L0120",1,25,36.19,24.86,111.59,6.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - G0279",1,55,35.51,30.09,295.68,13.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L1830",1,78,119.28,81.95,367.86,19.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - J2790",1,186.95,0,74.3,186.95,46.737499999999997]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L1836",1,209,189.91,130.47999999999999,585.70000000000005,52.25]
["AETNA - AETNA - HCPCS - C5275",1,743,1500.85,684.11,2032.26,185.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L3260",1,279,31.12,31.12,357.96,69.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L8514",1,387,109.01,92.38,414.69,96.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L3670",1,2903,150.86000000000001,103.65,465.27,725.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L0120",1,25,36.19,24.86,111.59,6.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L3807",1,483,323.87,222.52,998.85,120.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L1820",1,159,207.54,142.59,640.03,39.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L3905",1,2442,1284.45,882.51,3961.32,610.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L1830",1,78,119.28,81.95,367.86,19.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L3967",1,117,2569.1999999999998,1765.23,7923.54,29.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L1832",1,1523,1082.26,743.59,3337.75,380.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L4350",1,360,141.58000000000001,97.28,436.66,90]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L1836",1,209,189.91,130.47999999999999,585.70000000000005,52.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L4386",1,165,225.63,155.02000000000001,695.83,41.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L1902",1,219,125.37,86.14,386.65,54.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L4398",1,406,114.87,78.92,354.25,101.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L3260",1,279,31.12,31.12,357.96,69.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L8693",1,1462,2162.1799999999998,1485.57,6668.25,365.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L3650",1,1955,98.07,67.38,302.45,488.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - M0243",1,572,518.74,309.60000000000002,779.02,143]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L3670",1,2903,150.86000000000001,103.65,465.27,725.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9016",1,576,243.01,243.01,478.65,144]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L3760",1,819,647.70000000000005,445.02,1997.57,204.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9021",1,323,184.28,184.28,354.25,80.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L3807",1,483,323.87,222.52,998.85,120.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9037",1,939,821.84,821.84,1622.67,234.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L3808",1,509,547.16999999999996,375.94,1687.5,127.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9045",1,238,60.32,52.45,131.97,59.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L3905",1,2442,1284.45,882.51,3961.32,610.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9073",1,889,821.84,821.84,2619.59,222.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L3908",1,143,106.57,73.22,328.66,35.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9612",1,90,5.27,2.2200000000000002,1198.25,22.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L3967",1,117,2569.1999999999998,1765.23,7923.54,29.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q0111",1,23,27.01,5.86,127.48,5.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L3980",1,132,549.92999999999995,377.84,1695.98,33]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q4101",1,1601,35.03,30.46,76.64,400.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L4350",1,360,141.58000000000001,97.28,436.66,90]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q4104",1,7748,56.11,42.08,56.11,1937]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L4360",1,557,503.35,345.83,1552.36,139.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q4112",1,535,1002.89,904.99,1002.89,133.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L4386",1,165,225.63,155.02000000000001,695.83,41.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q4124",1,23,16.39,16.39,16.39,5.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L4396",1,406,249.49,171.42,769.43,101.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q4130",1,65718,45.89,45.89,45.89,16429.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L4398",1,406,114.87,78.92,354.25,101.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q4133",1,3756,151.77000000000001,131.97,332.06,939]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L8509",1,1144,155.72999999999999,106.99,480.27,286]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q9956",1,76,36.51,31.75,79.89,19]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L8693",1,1462,2162.1799999999998,1485.57,6668.25,365.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q9958",1,1,0.08,7.0000000000000007E-2,0.18,0.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - M0239",1,393,518.74,309.60000000000002,779.02,98.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - M0243",1,572,518.74,309.60000000000002,779.02,143]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L3905",1,2442,1041.3599999999999,882.51,3961.32,610.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9012",1,134,64.959999999999994,64.959999999999994,125.33,33.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - U0001",1,124,41.31,35.909999999999997,325.64,31]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9016",1,576,243.01,243.01,478.65,144]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - 0042T",1,767,1452,1452,1452,191.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9017",1,291,94.07,94.07,217.72,72.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - 45378",1,1672,1250.94,1020.59,3264.67,418]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9021",1,323,184.28,184.28,354.25,80.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - 90471",1,64,76.22,76.22,345.64,16]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9034",1,506,443.29,443.29,799.73,126.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - 95800",1,205,228.32,228.32,1412.44,51.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9037",1,939,821.84,821.84,1622.67,234.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A6209",1,163,12.63,8.68,21.84,40.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9040",1,523,336.11,336.11,669.97,130.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A7520",1,1173,80.290000000000006,55.16,138.79,293.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9045",1,238,60.32,52.45,131.97,59.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9502",1,140,278.27,278.27,278.27,35]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - G0480",1,254,135.03,59.69,973.54,63.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9505",1,23,395.74,395.74,395.74,5.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9073",1,889,821.84,821.84,2619.59,222.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9513",1,320,329.72,294.27999999999997,1097.56,80]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9100",1,1310,33.53,33.53,256.64,327.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9517",1,437,101.94,30.1,101.94,109.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9612",1,90,5.27,2.2200000000000002,1198.25,22.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9537",1,138,157.94999999999999,157.94999999999999,157.94999999999999,34.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q0091",1,83,28.83,28.83,175.66,20.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9539",1,668,89.47,89.47,89.47,167]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q0111",1,23,27.01,5.86,127.48,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9541",1,120,152.69,152.69,152.69,30]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q0114",1,41,17.79,7.2,82.86,10.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9547",1,440,5105.7299999999996,5105.7299999999996,5105.7299999999996,110]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q4101",1,1601,35.03,30.46,76.64,400.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9552",1,972,1166.46,1166.46,1166.46,243]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q4102",1,69,11.74,10.210000000000001,25.69,17.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9556",1,20,311.94,311.94,311.94,5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q4104",1,7748,56.11,42.08,56.11,1937]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9558",1,23,108.88,108.88,108.88,5.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q4107",1,2233,110.48,86.55,110.48,558.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9561",1,127,125.64,125.64,125.64,31.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q4112",1,535,1002.89,904.99,1002.89,133.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9563",1,0,870.53,535.17999999999995,3182.68,0]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q4116",1,5248,35.78,32.29,35.78,1312]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9572",1,131,16207.01,16207.01,16207.01,32.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q4124",1,23,16.39,16.39,16.39,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9576",1,5,3.76,1.5,3.77,1.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q4125",1,4060,3.79,3.79,3.79,1015]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9579",1,5,4.38,1.53,4.38,1.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q4130",1,65718,45.89,45.89,45.89,16429.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9583",1,13,21.34,19.260000000000002,21.34,3.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q4132",1,3754,131.82,114.63,288.43,938.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9586",1,4402,3746.06,3746.06,7452.46,1100.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q4133",1,3756,151.77000000000001,131.97,332.06,939]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9588",1,15438,525.05999999999995,525.05999999999995,703.05,3859.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q9954",1,0,13.41,12.1,13.41,0]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - C1717",1,607,836.69,469.29,1411.01,151.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q9956",1,76,36.51,31.75,79.89,19]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - C2635",1,0,78.03,78.03,242.54,0]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q9957",1,417,54.77,47.63,119.85,104.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - C5275",1,743,810.95,684.11,2032.26,185.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q9958",1,1,0.08,7.0000000000000007E-2,0.18,0.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - C9358",1,8526,24.42,24.42,24.42,2131.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q9961",1,1,0.28999999999999998,0.25,0.63,0.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - C9739",1,6035,6751.98,2166.09,15242.01,1508.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q9963",1,30.27,30.27,30.27,30.27,7.5674999999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D0220",1,165,23.78,23.78,23.78,41.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q9966",1,69.63,69.63,34.82,69.63,17.407499999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D0272",1,836,1182.5,1182.5,4066.77,209]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - G0481",1,192,184.78,91.84,1332.11,48]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D1110",1,110,84.56,51.21,163.22999999999999,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - S8037",1,1440,1396.47,585.76,3771.6,360]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D1351",1,110,45.91,45.91,45.91,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - J2790",1,186.95,0,74.3,186.95,46.737499999999997]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2150",1,110,126.81,126.81,126.81,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D3110",1,110,68.89,68.89,68.89,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2161",1,110,187.9,187.9,187.9,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D3220",1,110,141.69,141.69,141.69,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2331",1,110,154.99,154.99,154.99,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D3330",1,110,894.85,894.85,894.85,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2335",1,110,223.88,223.88,223.88,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D7210",1,836,1510.05,1275.99,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2391",1,110,141.69,141.69,141.69,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D7230",1,836,1510.05,1275.99,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2393",1,110,230.94,230.94,230.94,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D7250",1,836,1510.05,1275.99,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2740",1,110,1036.53,1036.53,1036.53,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D7311",1,110,202.78,202.78,202.78,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2931",1,110,259.95,259.95,259.95,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0101",1,148,128.29,18.010000000000002,128.29,37]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - P9045",1,238,61.89,52.45,131.97,59.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0105",1,1152,1250.94,1020.59,3264.67,288]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D3310",1,110,587.95000000000005,587.95000000000005,587.95000000000005,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - 0042T",1,767,1452,1452,1452,191.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D7140",1,836,1510.05,1275.99,4066.77,209]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - G2023",1,31,27.68,23.46,212.71,7.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D7220",1,836,1510.05,1275.99,4066.77,209]
["AETNA - AETNA - HCPCS - P9612",1,90,1198.25,2.2200000000000002,1198.25,22.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D7240",1,836,1510.05,1275.99,4066.77,209]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - 81170",1,798,548.09,159,2909.77,199.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D7310",1,110,230.94,230.94,230.94,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - 90471",1,64,76.22,76.22,345.64,16]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D7410",1,110,692.83,692.83,692.83,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - 92083",1,461,178.83,68.75,607.84,115.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0103",1,93,41.5,16.78,181.16,23.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - 95800",1,205,228.32,228.32,1412.44,51.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0108",1,425,136.19,72.41,230.78,106.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A4561",1,108,33.729999999999997,23.18,58.33,27]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0127",1,189,93.87,93.87,317.35000000000002,47.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A6209",1,163,12.63,8.68,21.84,40.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0257",1,911,1027.32,1027.32,3651.55,227.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A6258",1,83,7.28,5,12.58,20.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0278",1,3138,34.229999999999997,34.229999999999997,34.229999999999997,784.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A7520",1,1173,80.290000000000006,55.16,138.79,293.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0296",1,118,128.29,102.62,660.74,29.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9500",1,274,463.42,463.42,463.42,68.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0390",1,3274,1587.59,1579.83,5035.18,818.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9502",1,140,278.27,278.27,278.27,35]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0397",1,118,128.29,128.29,815.89,29.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9503",1,23,37.119999999999997,37.119999999999997,37.119999999999997,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0422",1,169,198.42,198.42,637.79,42.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9505",1,23,395.74,395.74,395.74,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0424",1,284,93.87,93.87,343.09,71]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9509",1,95,5163.91,5163.91,5163.91,23.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0481",1,192,286.56,91.84,1332.11,48]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9513",1,320,329.72,294.27999999999997,1097.56,80]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0513",1,84,148.6,148.6,148.6,21]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9516",1,192,516.39,516.39,516.39,48]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G2011",1,35,28.83,28.83,133.88,8.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9517",1,437,101.94,30.1,101.94,109.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G2023",1,31,26.99,23.46,212.71,7.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9521",1,360,4157.3,4157.3,4157.3,90]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G2066",1,165,58.35,58.35,370.47,41.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9537",1,138,157.94999999999999,157.94999999999999,157.94999999999999,34.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G2087",1,194,211.43,46.18,211.43,48.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9538",1,111,114.21,114.21,114.21,27.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L3908",1,143,86.4,73.22,328.66,35.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9539",1,668,89.47,89.47,89.47,167]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9540",1,1831,85.66,85.66,85.66,457.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - 0402T",1,2880,3044.16,1198.25,11845.41,720]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - 45378",1,1672,1250.94,1020.59,3264.67,418]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - U0001",1,124,41.31,35.909999999999997,325.64,31]
["AETNA - AETNA - HCPCS - 0402T",1,2880,1198.25,1198.25,11845.41,720]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - U0002",1,92,59.02,51.31,465.19,23]
["Grand Total",7350,2045.8042748299101,699.00663537414948,761.38150316700035,2058.6153020237448,511.45106870747753]

{"sheet":"Average Table - HCPCS","index":7,"n_rows":6448,"n_cols":12,"rows_kept":6448,"cut":false,"hidden":true,"merged":[]}
["Payer - Plan - Bill Type - Bill Code","Payer","Plan","Bill Type","Bill Code","Bill Code Description","HCPCS & Description","Gross Charge Amount","Payer Charge Amount","Minimum Charge Amount","Maximum Charge Amount","Self-Pay Charge"]
["UNICARE - UNICARE - HCPCS - 45378","UNICARE","UNICARE","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,1020.59,1020.59,3264.67,418]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - 45378","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,1020.59,1020.59,3264.67,418]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - 45378","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,1608.22,1020.59,3264.67,418]
["TUFTS - TUFTS SELECT - HCPCS - 45378","TUFTS","TUFTS SELECT","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,1098.98,1020.59,3264.67,418]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - 45378","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,1568.74,1020.59,3264.67,418]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - 45378","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,1608.22,1020.59,3264.67,418]
["TUFTS - TUFTS POS - HCPCS - 45378","TUFTS","TUFTS POS","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,2058.17,1020.59,3264.67,418]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - 45378","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,1608.22,1020.59,3264.67,418]
["TUFTS - TUFTS PPO - HCPCS - 45378","TUFTS","TUFTS PPO","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,2058.16,1020.59,3264.67,418]
["TUFTS - TUFTS HMO - HCPCS - 45378","TUFTS","TUFTS HMO","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,2057.7399999999998,1020.59,3264.67,418]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - 45378","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,3264.67,1020.59,3264.67,418]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - 45378","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,1250.94,1020.59,3264.67,418]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - 45378","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,1250.94,1020.59,3264.67,418]
["AETNA - AETNA - HCPCS - 45378","AETNA","AETNA","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,1500.85,1020.59,3264.67,418]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - 45378","BLUE CROSS","BLUE CROSS-PPO","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,1250.94,1020.59,3264.67,418]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - 45378","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,1250.94,1020.59,3264.67,418]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - 45378","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,1250.94,1020.59,3264.67,418]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - 45378","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,1250.94,1020.59,3264.67,418]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - 45378","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND",1672,1250.94,1020.59,3264.67,418]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - 81170","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,360,159,2909.77,199.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - 81170","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,631.79999999999995,159,2909.77,199.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - 81170","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,631.79999999999995,159,2909.77,199.5]
["TUFTS - TUFTS SELECT - HCPCS - 81170","TUFTS","TUFTS SELECT","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,451.91,159,2909.77,199.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - 81170","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,360,159,2909.77,199.5]
["TUFTS - TUFTS SPIRIT - HCPCS - 81170","TUFTS","TUFTS SPIRIT","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,330,159,2909.77,199.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - HCPCS - 81170","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,260.89,159,2909.77,199.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - 81170","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,404.46,159,2909.77,199.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - 81170","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,647.70000000000005,159,2909.77,199.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - HCPCS - 81170","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,335.15,159,2909.77,199.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - 81170","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,265.99,159,2909.77,199.5]
["FALLON - FALLON SENIOR PLAN - HCPCS - 81170","FALLON","FALLON SENIOR PLAN","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,300,159,2909.77,199.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - 81170","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,647.70000000000005,159,2909.77,199.5]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - 81170","TUFTS","TUFTS MEDICARE SCO","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,435,159,2909.77,199.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - 81170","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,647.70000000000005,159,2909.77,199.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - 81170","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,435,159,2909.77,199.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - 81170","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,647.70000000000005,159,2909.77,199.5]
["TUFTS - TUFTS POS - HCPCS - 81170","TUFTS","TUFTS POS","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,967.76,159,2909.77,199.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - 81170","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,522,159,2909.77,199.5]
["TUFTS - TUFTS PPO - HCPCS - 81170","TUFTS","TUFTS PPO","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,1035.23,159,2909.77,199.5]
["TUFTS - TUFTS HMO - HCPCS - 81170","TUFTS","TUFTS HMO","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,1161.31,159,2909.77,199.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - 81170","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,300,159,2909.77,199.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - 81170","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,2909.77,159,2909.77,199.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - 81170","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,300,159,2909.77,199.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - 81170","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,548.09,159,2909.77,199.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - 81170","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,331.82,159,2909.77,199.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - 81170","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,662.96,159,2909.77,199.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - 81170","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,300,159,2909.77,199.5]
["BMC HEALTHNET - BMCHN WELL SENSE - HCPCS - 81170","BMC HEALTHNET","BMCHN WELL SENSE","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,159,159,2909.77,199.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - 81170","BMC HEALTHNET","BMCHN ACO","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,484.99,159,2909.77,199.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - 81170","BMC HEALTHNET","BMCHN MCO","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,221.66,159,2909.77,199.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - 81170","BMC HEALTHNET","BMCHN MEDICAID","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,221.66,159,2909.77,199.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - 81170","BMC HEALTHNET","BMCHN QHP","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,265.99,159,2909.77,199.5]
["FALLON - FALLON MEDICAID - HCPCS - 81170","FALLON","FALLON MEDICAID","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,221.66,159,2909.77,199.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - 81170","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,261.56,159,2909.77,199.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - 81170","BLUE CROSS","BLUE CROSS-PPO","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,548.09,159,2909.77,199.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - 81170","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,354,159,2909.77,199.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - 81170","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,548.09,159,2909.77,199.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - 81170","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,300.79000000000002,159,2909.77,199.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - 81170","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,548.09,159,2909.77,199.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - 81170","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,548.09,159,2909.77,199.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - 81170","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,754.86,159,2909.77,199.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - 81170","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,548.09,159,2909.77,199.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - 81170","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",798,548.09,159,2909.77,199.5]
["TUFTS - TUFTS SELECT - HCPCS - 90471","TUFTS","TUFTS SELECT","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE",64,108.45,76.22,345.64,16]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - 90471","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE",64,129,76.22,345.64,16]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - 90471","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE",64,125.83,76.22,345.64,16]
["TUFTS - TUFTS POS - HCPCS - 90471","TUFTS","TUFTS POS","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE",64,203.7,76.22,345.64,16]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - 90471","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE",64,129,76.22,345.64,16]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - 90471","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE",64,129,76.22,345.64,16]
["TUFTS - TUFTS PPO - HCPCS - 90471","TUFTS","TUFTS PPO","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE",64,217.91,76.22,345.64,16]
["TUFTS - TUFTS HMO - HCPCS - 90471","TUFTS","TUFTS HMO","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE",64,203.7,76.22,345.64,16]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - 90471","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE",64,345.64,76.22,345.64,16]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - 90471","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE",64,76.22,76.22,345.64,16]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - 90471","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE",64,76.22,76.22,345.64,16]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - 90471","BLUE CROSS","BLUE CROSS-PPO","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE",64,76.22,76.22,345.64,16]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - 90471","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE",64,76.22,76.22,345.64,16]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - 90471","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE",64,76.22,76.22,345.64,16]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - 90471","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE",64,76.22,76.22,345.64,16]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - 90471","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE",64,76.22,76.22,345.64,16]
["TUFTS - TUFTS SELECT - HCPCS - 92083","TUFTS","TUFTS SELECT","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,190.72,68.75,607.84,115.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - 92083","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,224.25,68.75,607.84,115.25]
["UNICARE - UNICARE - HCPCS - 92083","UNICARE","UNICARE","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,82.5,68.75,607.84,115.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - 92083","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,68.75,68.75,607.84,115.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - 92083","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,229.89,68.75,607.84,115.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - 92083","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,229.89,68.75,607.84,115.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - 92083","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,229.89,68.75,607.84,115.25]
["TUFTS - TUFTS POS - HCPCS - 92083","TUFTS","TUFTS POS","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,358.22,68.75,607.84,115.25]
["TUFTS - TUFTS PPO - HCPCS - 92083","TUFTS","TUFTS PPO","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,383.21,68.75,607.84,115.25]
["TUFTS - TUFTS HMO - HCPCS - 92083","TUFTS","TUFTS HMO","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,358.22,68.75,607.84,115.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - 92083","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,178.83,68.75,607.84,115.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - 92083","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,607.84,68.75,607.84,115.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - 92083","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,178.83,68.75,607.84,115.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - 92083","BLUE CROSS","BLUE CROSS-PPO","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,178.83,68.75,607.84,115.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - 92083","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,178.83,68.75,607.84,115.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - 92083","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,178.83,68.75,607.84,115.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - 92083","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,178.83,68.75,607.84,115.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - 92083","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED",461,178.83,68.75,607.84,115.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - 95800","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,293.52,228.32,1412.44,51.25]
["TUFTS - TUFTS SELECT - HCPCS - 95800","TUFTS","TUFTS SELECT","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,250.1,228.32,1412.44,51.25]
["UNICARE - UNICARE - HCPCS - 95800","UNICARE","UNICARE","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,351.84,228.32,1412.44,51.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - 95800","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,293.2,228.32,1412.44,51.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - 95800","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,286.31,228.32,1412.44,51.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - 95800","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,293.52,228.32,1412.44,51.25]
["TUFTS - TUFTS POS - HCPCS - 95800","TUFTS","TUFTS POS","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,469.76,228.32,1412.44,51.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - 95800","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,293.52,228.32,1412.44,51.25]
["TUFTS - TUFTS PPO - HCPCS - 95800","TUFTS","TUFTS PPO","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,502.51,228.32,1412.44,51.25]
["TUFTS - TUFTS HMO - HCPCS - 95800","TUFTS","TUFTS HMO","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,563.71,228.32,1412.44,51.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - 95800","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,1412.44,228.32,1412.44,51.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - 95800","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,228.32,228.32,1412.44,51.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - 95800","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,228.32,228.32,1412.44,51.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - 95800","BLUE CROSS","BLUE CROSS-PPO","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,228.32,228.32,1412.44,51.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - 95800","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,228.32,228.32,1412.44,51.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - 95800","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,228.32,228.32,1412.44,51.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - 95800","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,228.32,228.32,1412.44,51.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - 95800","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA",205,228.32,228.32,1412.44,51.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - 0042T","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",767,0,1452,1452,191.75]
["TUFTS - TUFTS SELECT - HCPCS - 0042T","TUFTS","TUFTS SELECT","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",767,0,1452,1452,191.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - 0042T","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",767,0,1452,1452,191.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - 0042T","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",767,0,1452,1452,191.75]
["TUFTS - TUFTS POS - HCPCS - 0042T","TUFTS","TUFTS POS","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",767,0,1452,1452,191.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - 0042T","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",767,0,1452,1452,191.75]
["TUFTS - TUFTS PPO - HCPCS - 0042T","TUFTS","TUFTS PPO","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",767,0,1452,1452,191.75]
["TUFTS - TUFTS HMO - HCPCS - 0042T","TUFTS","TUFTS HMO","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",767,0,1452,1452,191.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - 0042T","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",767,0,1452,1452,191.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - 0042T","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",767,1452,1452,1452,191.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - 0042T","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",767,1452,1452,1452,191.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - 0042T","BLUE CROSS","BLUE CROSS-PPO","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",767,1452,1452,1452,191.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - 0042T","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",767,1452,1452,1452,191.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - 0042T","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",767,1452,1452,1452,191.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - 0042T","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",767,1452,1452,1452,191.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - 0042T","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",767,1452,1452,1452,191.75]
["TUFTS - TUFTS SELECT - HCPCS - 0278T","TUFTS","TUFTS SELECT","HCPCS","0278T","HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS","0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS",77,317.70999999999998,286.31,943.8,19.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - 0278T","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","0278T","HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS","0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS",77,293.52,286.31,943.8,19.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - 0278T","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","0278T","HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS","0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS",77,286.31,286.31,943.8,19.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - 0278T","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","0278T","HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS","0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS",77,293.52,286.31,943.8,19.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - 0278T","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","0278T","HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS","0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS",77,293.52,286.31,943.8,19.25]
["TUFTS - TUFTS POS - HCPCS - 0278T","TUFTS","TUFTS POS","HCPCS","0278T","HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS","0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS",77,595.01,286.31,943.8,19.25]
["TUFTS - TUFTS PPO - HCPCS - 0278T","TUFTS","TUFTS PPO","HCPCS","0278T","HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS","0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS",77,595.01,286.31,943.8,19.25]
["TUFTS - TUFTS HMO - HCPCS - 0278T","TUFTS","TUFTS HMO","HCPCS","0278T","HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS","0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS",77,595.01,286.31,943.8,19.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - 0278T","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","0278T","HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS","0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS",77,943.8,286.31,943.8,19.25]
["TUFTS - TUFTS SELECT - HCPCS - 0399T","TUFTS","TUFTS SELECT","HCPCS","0399T","PR MYOCARDIAL STRAIN IMAGING","0399T - PR MYOCARDIAL STRAIN IMAGING",1022,0,0,0,255.5]
["TUFTS - TUFTS POS - HCPCS - 0399T","TUFTS","TUFTS POS","HCPCS","0399T","PR MYOCARDIAL STRAIN IMAGING","0399T - PR MYOCARDIAL STRAIN IMAGING",1022,0,0,0,255.5]
["TUFTS - TUFTS PPO - HCPCS - 0399T","TUFTS","TUFTS PPO","HCPCS","0399T","PR MYOCARDIAL STRAIN IMAGING","0399T - PR MYOCARDIAL STRAIN IMAGING",1022,0,0,0,255.5]
["TUFTS - TUFTS HMO - HCPCS - 0399T","TUFTS","TUFTS HMO","HCPCS","0399T","PR MYOCARDIAL STRAIN IMAGING","0399T - PR MYOCARDIAL STRAIN IMAGING",1022,0,0,0,255.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - 0399T","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","0399T","PR MYOCARDIAL STRAIN IMAGING","0399T - PR MYOCARDIAL STRAIN IMAGING",1022,0,0,0,255.5]
["TUFTS - TUFTS SELECT - HCPCS - 0402T","TUFTS","TUFTS SELECT","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",2880,3987.49,1198.25,11845.41,720]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - 0402T","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",2880,3435.75,1198.25,11845.41,720]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - 0402T","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",2880,3522.21,1198.25,11845.41,720]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - 0402T","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",2880,3522.21,1198.25,11845.41,720]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - 0402T","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",2880,3522.21,1198.25,11845.41,720]
["TUFTS - TUFTS POS - HCPCS - 0402T","TUFTS","TUFTS POS","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",2880,7467.76,1198.25,11845.41,720]
["TUFTS - TUFTS PPO - HCPCS - 0402T","TUFTS","TUFTS PPO","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",2880,7467.76,1198.25,11845.41,720]
["TUFTS - TUFTS HMO - HCPCS - 0402T","TUFTS","TUFTS HMO","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",2880,7467.76,1198.25,11845.41,720]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - 0402T","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",2880,11845.41,1198.25,11845.41,720]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - 0402T","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",2880,3044.16,1198.25,11845.41,720]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - 0402T","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",2880,3044.16,1198.25,11845.41,720]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - 0402T","BLUE CROSS","BLUE CROSS-PPO","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",2880,3044.16,1198.25,11845.41,720]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - 0402T","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",2880,3044.16,1198.25,11845.41,720]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - 0402T","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",2880,3044.16,1198.25,11845.41,720]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - 0402T","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",2880,3044.16,1198.25,11845.41,720]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - 0402T","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",2880,3044.16,1198.25,11845.41,720]
["AETNA - AETNA - HCPCS - 0402T","AETNA","AETNA","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",2880,1198.25,1198.25,11845.41,720]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A4215","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A4215","STERILE NEEDLE","A4215 - STERILE NEEDLE",433,0,0,0,108.25]
["TUFTS - TUFTS SELECT - HCPCS - A4215","TUFTS","TUFTS SELECT","HCPCS","A4215","STERILE NEEDLE","A4215 - STERILE NEEDLE",433,0,0,0,108.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A4215","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A4215","STERILE NEEDLE","A4215 - STERILE NEEDLE",433,0,0,0,108.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A4215","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A4215","STERILE NEEDLE","A4215 - STERILE NEEDLE",433,0,0,0,108.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A4215","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A4215","STERILE NEEDLE","A4215 - STERILE NEEDLE",433,0,0,0,108.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A4215","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A4215","STERILE NEEDLE","A4215 - STERILE NEEDLE",433,0,0,0,108.25]
["TUFTS - TUFTS POS - HCPCS - A4215","TUFTS","TUFTS POS","HCPCS","A4215","STERILE NEEDLE","A4215 - STERILE NEEDLE",433,0,0,0,108.25]
["TUFTS - TUFTS PPO - HCPCS - A4215","TUFTS","TUFTS PPO","HCPCS","A4215","STERILE NEEDLE","A4215 - STERILE NEEDLE",433,0,0,0,108.25]
["TUFTS - TUFTS HMO - HCPCS - A4215","TUFTS","TUFTS HMO","HCPCS","A4215","STERILE NEEDLE","A4215 - STERILE NEEDLE",433,0,0,0,108.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A4215","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A4215","STERILE NEEDLE","A4215 - STERILE NEEDLE",433,0,0,0,108.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A4215","BMC HEALTHNET","BMCHN ACO","HCPCS","A4215","STERILE NEEDLE","A4215 - STERILE NEEDLE",433,0,0,0,108.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A4215","BMC HEALTHNET","BMCHN MCO","HCPCS","A4215","STERILE NEEDLE","A4215 - STERILE NEEDLE",433,0,0,0,108.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A4215","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A4215","STERILE NEEDLE","A4215 - STERILE NEEDLE",433,0,0,0,108.25]
["FALLON - FALLON MEDICAID - HCPCS - A4215","FALLON","FALLON MEDICAID","HCPCS","A4215","STERILE NEEDLE","A4215 - STERILE NEEDLE",433,0,0,0,108.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A4215","BMC HEALTHNET","BMCHN QHP","HCPCS","A4215","STERILE NEEDLE","A4215 - STERILE NEEDLE",433,0,0,0,108.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A4215","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A4215","STERILE NEEDLE","A4215 - STERILE NEEDLE",433,0,0,0,108.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A4215","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A4215","STERILE NEEDLE","A4215 - STERILE NEEDLE",433,0,0,0,108.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A4467","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A4467","BELT STRAP SLEEV GRMNT COVER","A4467 - BELT STRAP SLEEV GRMNT COVER",151,0,0,0,37.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A4467","BMC HEALTHNET","BMCHN ACO","HCPCS","A4467","BELT STRAP SLEEV GRMNT COVER","A4467 - BELT STRAP SLEEV GRMNT COVER",151,0,0,0,37.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A4467","BMC HEALTHNET","BMCHN MCO","HCPCS","A4467","BELT STRAP SLEEV GRMNT COVER","A4467 - BELT STRAP SLEEV GRMNT COVER",151,0,0,0,37.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A4467","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A4467","BELT STRAP SLEEV GRMNT COVER","A4467 - BELT STRAP SLEEV GRMNT COVER",151,0,0,0,37.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A4467","BMC HEALTHNET","BMCHN QHP","HCPCS","A4467","BELT STRAP SLEEV GRMNT COVER","A4467 - BELT STRAP SLEEV GRMNT COVER",151,0,0,0,37.75]
["FALLON - FALLON MEDICAID - HCPCS - A4467","FALLON","FALLON MEDICAID","HCPCS","A4467","BELT STRAP SLEEV GRMNT COVER","A4467 - BELT STRAP SLEEV GRMNT COVER",151,0,0,0,37.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A4467","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A4467","BELT STRAP SLEEV GRMNT COVER","A4467 - BELT STRAP SLEEV GRMNT COVER",151,0,0,0,37.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A4467","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A4467","BELT STRAP SLEEV GRMNT COVER","A4467 - BELT STRAP SLEEV GRMNT COVER",151,0,0,0,37.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A4561","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,27.82,23.18,58.33,27]
["TUFTS - TUFTS SELECT - HCPCS - A4561","TUFTS","TUFTS SELECT","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,0,23.18,58.33,27]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A4561","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,0,23.18,58.33,27]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A4561","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,27.82,23.18,58.33,27]
["TUFTS - TUFTS SPIRIT - HCPCS - A4561","TUFTS","TUFTS SPIRIT","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,25.5,23.18,58.33,27]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A4561","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,0,23.18,58.33,27]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A4561","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,31.25,23.18,58.33,27]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A4561","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,0,23.18,58.33,27]
["TUFTS - TUFTS POS - HCPCS - A4561","TUFTS","TUFTS POS","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,0,23.18,58.33,27]
["FALLON - FALLON SENIOR PLAN - HCPCS - A4561","FALLON","FALLON SENIOR PLAN","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,23.18,23.18,58.33,27]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A4561","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,0,23.18,58.33,27]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A4561","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,33.61,23.18,58.33,27]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A4561","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,0,23.18,58.33,27]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - A4561","TUFTS","TUFTS MEDICARE SCO","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,33.61,23.18,58.33,27]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A4561","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,50.05,23.18,58.33,27]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A4561","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,40.33,23.18,58.33,27]
["TUFTS - TUFTS PPO - HCPCS - A4561","TUFTS","TUFTS PPO","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,0,23.18,58.33,27]
["TUFTS - TUFTS HMO - HCPCS - A4561","TUFTS","TUFTS HMO","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,0,23.18,58.33,27]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A4561","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,51.23,23.18,58.33,27]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A4561","BMC HEALTHNET","BMCHN ACO","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,0,23.18,58.33,27]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A4561","BMC HEALTHNET","BMCHN MCO","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,0,23.18,58.33,27]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A4561","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,0,23.18,58.33,27]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A4561","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,0,23.18,58.33,27]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A4561","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,23.18,23.18,58.33,27]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A4561","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,23.18,23.18,58.33,27]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A4561","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,33.729999999999997,23.18,58.33,27]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A4561","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,23.18,23.18,58.33,27]
["FALLON - FALLON MEDICAID - HCPCS - A4561","FALLON","FALLON MEDICAID","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,0,23.18,58.33,27]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A4561","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,23.18,23.18,58.33,27]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A4561","BMC HEALTHNET","BMCHN QHP","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,0,23.18,58.33,27]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A4561","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,27.35,23.18,58.33,27]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A4561","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,0,23.18,58.33,27]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A4561","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,33.729999999999997,23.18,58.33,27]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A4561","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,33.729999999999997,23.18,58.33,27]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A4561","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,0,23.18,58.33,27]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A4561","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,58.33,23.18,58.33,27]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A4561","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,33.729999999999997,23.18,58.33,27]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A4561","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,33.729999999999997,23.18,58.33,27]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A4561","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,33.729999999999997,23.18,58.33,27]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A4561","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE",108,33.729999999999997,23.18,58.33,27]
["TUFTS - TUFTS SELECT - HCPCS - A4562","TUFTS","TUFTS SELECT","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,0,57.71,145.21,16]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A4562","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,69.25,57.71,145.21,16]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A4562","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,0,57.71,145.21,16]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A4562","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,69.25,57.71,145.21,16]
["TUFTS - TUFTS SPIRIT - HCPCS - A4562","TUFTS","TUFTS SPIRIT","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,63.48,57.71,145.21,16]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A4562","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,77.8,57.71,145.21,16]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A4562","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,0,57.71,145.21,16]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A4562","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,0,57.71,145.21,16]
["FALLON - FALLON SENIOR PLAN - HCPCS - A4562","FALLON","FALLON SENIOR PLAN","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,57.71,57.71,145.21,16]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - A4562","TUFTS","TUFTS MEDICARE SCO","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,83.68,57.71,145.21,16]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A4562","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,0,57.71,145.21,16]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A4562","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,0,57.71,145.21,16]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A4562","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,83.68,57.71,145.21,16]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A4562","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,124.6,57.71,145.21,16]
["TUFTS - TUFTS POS - HCPCS - A4562","TUFTS","TUFTS POS","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,0,57.71,145.21,16]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A4562","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,100.42,57.71,145.21,16]
["TUFTS - TUFTS PPO - HCPCS - A4562","TUFTS","TUFTS PPO","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,0,57.71,145.21,16]
["TUFTS - TUFTS HMO - HCPCS - A4562","TUFTS","TUFTS HMO","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,0,57.71,145.21,16]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A4562","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,127.53,57.71,145.21,16]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A4562","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,0,57.71,145.21,16]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A4562","BMC HEALTHNET","BMCHN ACO","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,0,57.71,145.21,16]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A4562","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,57.71,57.71,145.21,16]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A4562","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,57.71,57.71,145.21,16]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A4562","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,57.71,57.71,145.21,16]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A4562","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,57.71,57.71,145.21,16]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A4562","BMC HEALTHNET","BMCHN MCO","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,0,57.71,145.21,16]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A4562","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,0,57.71,145.21,16]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A4562","BMC HEALTHNET","BMCHN QHP","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,0,57.71,145.21,16]
["FALLON - FALLON MEDICAID - HCPCS - A4562","FALLON","FALLON MEDICAID","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,0,57.71,145.21,16]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A4562","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,68.099999999999994,57.71,145.21,16]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A4562","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,0,57.71,145.21,16]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A4562","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,0,57.71,145.21,16]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A4562","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","A4562","PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER",64,145.21,57.71,145.21,16]
["TUFTS - TUFTS SELECT - HCPCS - A4570","TUFTS","TUFTS SELECT","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1","A4570 - HC MISC SPLINT SUPPLY LV1",40,19.010000000000002,19.010000000000002,107.35,10]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A4570","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1","A4570 - HC MISC SPLINT SUPPLY LV1",40,0,19.010000000000002,107.35,10]
["TUFTS - TUFTS POS - HCPCS - A4570","TUFTS","TUFTS POS","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1","A4570 - HC MISC SPLINT SUPPLY LV1",40,35.700000000000003,19.010000000000002,107.35,10]
["TUFTS - TUFTS PPO - HCPCS - A4570","TUFTS","TUFTS PPO","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1","A4570 - HC MISC SPLINT SUPPLY LV1",40,38.19,19.010000000000002,107.35,10]
["TUFTS - TUFTS HMO - HCPCS - A4570","TUFTS","TUFTS HMO","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1","A4570 - HC MISC SPLINT SUPPLY LV1",40,42.84,19.010000000000002,107.35,10]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A4570","BMC HEALTHNET","BMCHN ACO","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1","A4570 - HC MISC SPLINT SUPPLY LV1",40,0,19.010000000000002,107.35,10]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A4570","BMC HEALTHNET","BMCHN MCO","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1","A4570 - HC MISC SPLINT SUPPLY LV1",40,0,19.010000000000002,107.35,10]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A4570","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1","A4570 - HC MISC SPLINT SUPPLY LV1",40,107.35,19.010000000000002,107.35,10]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A4570","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1","A4570 - HC MISC SPLINT SUPPLY LV1",40,0,19.010000000000002,107.35,10]
["FALLON - FALLON MEDICAID - HCPCS - A4570","FALLON","FALLON MEDICAID","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1","A4570 - HC MISC SPLINT SUPPLY LV1",40,0,19.010000000000002,107.35,10]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A4570","BMC HEALTHNET","BMCHN QHP","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1","A4570 - HC MISC SPLINT SUPPLY LV1",40,0,19.010000000000002,107.35,10]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A4570","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1","A4570 - HC MISC SPLINT SUPPLY LV1",40,0,19.010000000000002,107.35,10]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A4570","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1","A4570 - HC MISC SPLINT SUPPLY LV1",40,0,19.010000000000002,107.35,10]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A4648","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A4648","IMPLANTABLE TISSUE MARKER","A4648 - IMPLANTABLE TISSUE MARKER",281,0,0,0,70.25]
["TUFTS - TUFTS SELECT - HCPCS - A4648","TUFTS","TUFTS SELECT","HCPCS","A4648","IMPLANTABLE TISSUE MARKER","A4648 - IMPLANTABLE TISSUE MARKER",281,0,0,0,70.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A4648","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A4648","IMPLANTABLE TISSUE MARKER","A4648 - IMPLANTABLE TISSUE MARKER",281,0,0,0,70.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A4648","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A4648","IMPLANTABLE TISSUE MARKER","A4648 - IMPLANTABLE TISSUE MARKER",281,0,0,0,70.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A4648","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A4648","IMPLANTABLE TISSUE MARKER","A4648 - IMPLANTABLE TISSUE MARKER",281,0,0,0,70.25]
["TUFTS - TUFTS POS - HCPCS - A4648","TUFTS","TUFTS POS","HCPCS","A4648","IMPLANTABLE TISSUE MARKER","A4648 - IMPLANTABLE TISSUE MARKER",281,0,0,0,70.25]
["TUFTS - TUFTS PPO - HCPCS - A4648","TUFTS","TUFTS PPO","HCPCS","A4648","IMPLANTABLE TISSUE MARKER","A4648 - IMPLANTABLE TISSUE MARKER",281,0,0,0,70.25]
["TUFTS - TUFTS HMO - HCPCS - A4648","TUFTS","TUFTS HMO","HCPCS","A4648","IMPLANTABLE TISSUE MARKER","A4648 - IMPLANTABLE TISSUE MARKER",281,0,0,0,70.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A4648","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A4648","IMPLANTABLE TISSUE MARKER","A4648 - IMPLANTABLE TISSUE MARKER",281,0,0,0,70.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A4725","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC","A4725 - DIALYS SOL FLD VOL > 4999CC",87,0,0,0,21.75]
["TUFTS - TUFTS SELECT - HCPCS - A4725","TUFTS","TUFTS SELECT","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC","A4725 - DIALYS SOL FLD VOL > 4999CC",87,0,0,0,21.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A4725","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC","A4725 - DIALYS SOL FLD VOL > 4999CC",87,0,0,0,21.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A4725","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC","A4725 - DIALYS SOL FLD VOL > 4999CC",87,0,0,0,21.75]
["TUFTS - TUFTS POS - HCPCS - A4725","TUFTS","TUFTS POS","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC","A4725 - DIALYS SOL FLD VOL > 4999CC",87,0,0,0,21.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A4725","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC","A4725 - DIALYS SOL FLD VOL > 4999CC",87,0,0,0,21.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A4725","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC","A4725 - DIALYS SOL FLD VOL > 4999CC",87,0,0,0,21.75]
["TUFTS - TUFTS PPO - HCPCS - A4725","TUFTS","TUFTS PPO","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC","A4725 - DIALYS SOL FLD VOL > 4999CC",87,0,0,0,21.75]
["TUFTS - TUFTS HMO - HCPCS - A4725","TUFTS","TUFTS HMO","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC","A4725 - DIALYS SOL FLD VOL > 4999CC",87,0,0,0,21.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A4725","BMC HEALTHNET","BMCHN ACO","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC","A4725 - DIALYS SOL FLD VOL > 4999CC",87,0,0,0,21.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A4725","BMC HEALTHNET","BMCHN MCO","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC","A4725 - DIALYS SOL FLD VOL > 4999CC",87,0,0,0,21.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A4725","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC","A4725 - DIALYS SOL FLD VOL > 4999CC",87,0,0,0,21.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A4725","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC","A4725 - DIALYS SOL FLD VOL > 4999CC",87,0,0,0,21.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A4725","BMC HEALTHNET","BMCHN QHP","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC","A4725 - DIALYS SOL FLD VOL > 4999CC",87,0,0,0,21.75]
["FALLON - FALLON MEDICAID - HCPCS - A4725","FALLON","FALLON MEDICAID","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC","A4725 - DIALYS SOL FLD VOL > 4999CC",87,0,0,0,21.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A4725","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC","A4725 - DIALYS SOL FLD VOL > 4999CC",87,0,0,0,21.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A4725","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC","A4725 - DIALYS SOL FLD VOL > 4999CC",87,0,0,0,21.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A6209","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,10.42,8.68,21.84,40.75]
["TUFTS - TUFTS SELECT - HCPCS - A6209","TUFTS","TUFTS SELECT","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,0,8.68,21.84,40.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A6209","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,0,8.68,21.84,40.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A6209","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,10.42,8.68,21.84,40.75]
["TUFTS - TUFTS SPIRIT - HCPCS - A6209","TUFTS","TUFTS SPIRIT","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,9.5500000000000007,8.68,21.84,40.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A6209","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,0,8.68,21.84,40.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A6209","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,11.7,8.68,21.84,40.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A6209","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,0,8.68,21.84,40.75]
["TUFTS - TUFTS PPO - HCPCS - A6209","TUFTS","TUFTS PPO","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,0,8.68,21.84,40.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - A6209","FALLON","FALLON SENIOR PLAN","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,8.68,8.68,21.84,40.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A6209","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,12.59,8.68,21.84,40.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A6209","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,0,8.68,21.84,40.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A6209","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,0,8.68,21.84,40.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - A6209","TUFTS","TUFTS MEDICARE SCO","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,12.59,8.68,21.84,40.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A6209","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,18.739999999999998,8.68,21.84,40.75]
["TUFTS - TUFTS POS - HCPCS - A6209","TUFTS","TUFTS POS","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,0,8.68,21.84,40.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A6209","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,15.1,8.68,21.84,40.75]
["TUFTS - TUFTS HMO - HCPCS - A6209","TUFTS","TUFTS HMO","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,0,8.68,21.84,40.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A6209","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,19.18,8.68,21.84,40.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A6209","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,0,8.68,21.84,40.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A6209","BMC HEALTHNET","BMCHN ACO","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,0,8.68,21.84,40.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A6209","BMC HEALTHNET","BMCHN MCO","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,0,8.68,21.84,40.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A6209","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,0,8.68,21.84,40.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A6209","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,8.68,8.68,21.84,40.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A6209","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,8.68,8.68,21.84,40.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A6209","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,12.63,8.68,21.84,40.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A6209","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,8.68,8.68,21.84,40.75]
["FALLON - FALLON MEDICAID - HCPCS - A6209","FALLON","FALLON MEDICAID","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,0,8.68,21.84,40.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A6209","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,8.68,8.68,21.84,40.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A6209","BMC HEALTHNET","BMCHN QHP","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,0,8.68,21.84,40.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A6209","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,0,8.68,21.84,40.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A6209","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,21.84,8.68,21.84,40.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A6209","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,10.24,8.68,21.84,40.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A6209","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,0,8.68,21.84,40.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A6209","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,12.63,8.68,21.84,40.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A6209","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,12.63,8.68,21.84,40.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A6209","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,12.63,8.68,21.84,40.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A6209","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,12.63,8.68,21.84,40.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A6209","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,12.63,8.68,21.84,40.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A6209","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",163,12.63,8.68,21.84,40.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A6258","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,6,5,12.58,20.75]
["TUFTS - TUFTS SELECT - HCPCS - A6258","TUFTS","TUFTS SELECT","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,0,5,12.58,20.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A6258","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,0,5,12.58,20.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A6258","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,6,5,12.58,20.75]
["TUFTS - TUFTS SPIRIT - HCPCS - A6258","TUFTS","TUFTS SPIRIT","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,5.5,5,12.58,20.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A6258","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,6.74,5,12.58,20.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A6258","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,0,5,12.58,20.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A6258","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,0,5,12.58,20.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - A6258","FALLON","FALLON SENIOR PLAN","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,5,5,12.58,20.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A6258","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,0,5,12.58,20.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - A6258","TUFTS","TUFTS MEDICARE SCO","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,7.25,5,12.58,20.75]
["TUFTS - TUFTS POS - HCPCS - A6258","TUFTS","TUFTS POS","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,0,5,12.58,20.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A6258","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,0,5,12.58,20.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A6258","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,7.25,5,12.58,20.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A6258","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,10.8,5,12.58,20.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A6258","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,8.6999999999999993,5,12.58,20.75]
["TUFTS - TUFTS PPO - HCPCS - A6258","TUFTS","TUFTS PPO","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,0,5,12.58,20.75]
["FALLON - FALLON MEDICAID - HCPCS - A6258","FALLON","FALLON MEDICAID","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,0,5,12.58,20.75]
["TUFTS - TUFTS HMO - HCPCS - A6258","TUFTS","TUFTS HMO","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,0,5,12.58,20.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A6258","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,5,5,12.58,20.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A6258","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,5,5,12.58,20.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A6258","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,5,5,12.58,20.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A6258","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,5,5,12.58,20.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A6258","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,11.05,5,12.58,20.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A6258","BMC HEALTHNET","BMCHN ACO","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,0,5,12.58,20.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A6258","BMC HEALTHNET","BMCHN MCO","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,0,5,12.58,20.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A6258","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,0,5,12.58,20.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A6258","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,0,5,12.58,20.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A6258","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,7.28,5,12.58,20.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A6258","BMC HEALTHNET","BMCHN QHP","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,0,5,12.58,20.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A6258","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,0,5,12.58,20.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A6258","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,7.28,5,12.58,20.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A6258","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,5.9,5,12.58,20.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A6258","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,0,5,12.58,20.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A6258","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,7.28,5,12.58,20.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A6258","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,7.28,5,12.58,20.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A6258","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,7.28,5,12.58,20.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A6258","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,12.58,5,12.58,20.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A6258","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,7.28,5,12.58,20.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A6258","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN",83,7.28,5,12.58,20.75]
["TUFTS - TUFTS SELECT - HCPCS - A6549","TUFTS","TUFTS SELECT","HCPCS","A6549","G COMPRESSION STOCKING","A6549 - G COMPRESSION STOCKING",37,0,0,0,9.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A6549","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A6549","G COMPRESSION STOCKING","A6549 - G COMPRESSION STOCKING",37,0,0,0,9.25]
["FALLON - FALLON MEDICAID - HCPCS - A6549","FALLON","FALLON MEDICAID","HCPCS","A6549","G COMPRESSION STOCKING","A6549 - G COMPRESSION STOCKING",37,0,0,0,9.25]
["TUFTS - TUFTS PPO - HCPCS - A6549","TUFTS","TUFTS PPO","HCPCS","A6549","G COMPRESSION STOCKING","A6549 - G COMPRESSION STOCKING",37,0,0,0,9.25]
["TUFTS - TUFTS HMO - HCPCS - A6549","TUFTS","TUFTS HMO","HCPCS","A6549","G COMPRESSION STOCKING","A6549 - G COMPRESSION STOCKING",37,0,0,0,9.25]
["TUFTS - TUFTS POS - HCPCS - A6549","TUFTS","TUFTS POS","HCPCS","A6549","G COMPRESSION STOCKING","A6549 - G COMPRESSION STOCKING",37,0,0,0,9.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A6549","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A6549","G COMPRESSION STOCKING","A6549 - G COMPRESSION STOCKING",37,0,0,0,9.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A6549","BMC HEALTHNET","BMCHN ACO","HCPCS","A6549","G COMPRESSION STOCKING","A6549 - G COMPRESSION STOCKING",37,0,0,0,9.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A6549","BMC HEALTHNET","BMCHN MCO","HCPCS","A6549","G COMPRESSION STOCKING","A6549 - G COMPRESSION STOCKING",37,0,0,0,9.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A6549","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A6549","G COMPRESSION STOCKING","A6549 - G COMPRESSION STOCKING",37,0,0,0,9.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A6549","BMC HEALTHNET","BMCHN QHP","HCPCS","A6549","G COMPRESSION STOCKING","A6549 - G COMPRESSION STOCKING",37,0,0,0,9.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A6549","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A6549","G COMPRESSION STOCKING","A6549 - G COMPRESSION STOCKING",37,0,0,0,9.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A6549","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A6549","G COMPRESSION STOCKING","A6549 - G COMPRESSION STOCKING",37,0,0,0,9.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A6550","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,30.85,25.71,64.69,1]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A6550","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,0,25.71,64.69,1]
["TUFTS - TUFTS SELECT - HCPCS - A6550","TUFTS","TUFTS SELECT","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,0,25.71,64.69,1]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A6550","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,30.85,25.71,64.69,1]
["TUFTS - TUFTS SPIRIT - HCPCS - A6550","TUFTS","TUFTS SPIRIT","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,28.28,25.71,64.69,1]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A6550","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,0,25.71,64.69,1]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A6550","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,34.659999999999997,25.71,64.69,1]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A6550","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,0,25.71,64.69,1]
["TUFTS - TUFTS POS - HCPCS - A6550","TUFTS","TUFTS POS","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,0,25.71,64.69,1]
["FALLON - FALLON SENIOR PLAN - HCPCS - A6550","FALLON","FALLON SENIOR PLAN","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,25.71,25.71,64.69,1]
["FALLON - FALLON MEDICAID - HCPCS - A6550","FALLON","FALLON MEDICAID","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,0,25.71,64.69,1]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A6550","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,0,25.71,64.69,1]
["TUFTS - TUFTS HMO - HCPCS - A6550","TUFTS","TUFTS HMO","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,0,25.71,64.69,1]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A6550","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,37.28,25.71,64.69,1]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A6550","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,0,25.71,64.69,1]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - A6550","TUFTS","TUFTS MEDICARE SCO","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,37.28,25.71,64.69,1]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A6550","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,55.51,25.71,64.69,1]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A6550","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,44.74,25.71,64.69,1]
["TUFTS - TUFTS PPO - HCPCS - A6550","TUFTS","TUFTS PPO","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,0,25.71,64.69,1]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A6550","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,56.82,25.71,64.69,1]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A6550","BMC HEALTHNET","BMCHN ACO","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,0,25.71,64.69,1]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A6550","BMC HEALTHNET","BMCHN MCO","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,0,25.71,64.69,1]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A6550","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,0,25.71,64.69,1]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A6550","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,0,25.71,64.69,1]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A6550","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,25.71,25.71,64.69,1]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A6550","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,25.71,25.71,64.69,1]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A6550","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,25.71,25.71,64.69,1]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A6550","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,25.71,25.71,64.69,1]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A6550","BMC HEALTHNET","BMCHN QHP","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,0,25.71,64.69,1]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A6550","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,0,25.71,64.69,1]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A6550","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,0,25.71,64.69,1]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A6550","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,64.69,25.71,64.69,1]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A6550","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","A6550","NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET",4,30.34,25.71,64.69,1]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A7520","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,0,55.16,138.79,293.25]
["TUFTS - TUFTS SELECT - HCPCS - A7520","TUFTS","TUFTS SELECT","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,0,55.16,138.79,293.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A7520","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,66.19,55.16,138.79,293.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A7520","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,66.19,55.16,138.79,293.25]
["TUFTS - TUFTS SPIRIT - HCPCS - A7520","TUFTS","TUFTS SPIRIT","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,60.68,55.16,138.79,293.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A7520","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,74.37,55.16,138.79,293.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A7520","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,0,55.16,138.79,293.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A7520","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,0,55.16,138.79,293.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - A7520","TUFTS","TUFTS MEDICARE SCO","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,79.98,55.16,138.79,293.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - A7520","FALLON","FALLON SENIOR PLAN","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,55.16,55.16,138.79,293.25]
["FALLON - FALLON MEDICAID - HCPCS - A7520","FALLON","FALLON MEDICAID","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,0,55.16,138.79,293.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A7520","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,0,55.16,138.79,293.25]
["TUFTS - TUFTS PPO - HCPCS - A7520","TUFTS","TUFTS PPO","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,0,55.16,138.79,293.25]
["TUFTS - TUFTS HMO - HCPCS - A7520","TUFTS","TUFTS HMO","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,0,55.16,138.79,293.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A7520","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,0,55.16,138.79,293.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A7520","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,79.98,55.16,138.79,293.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A7520","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,119.09,55.16,138.79,293.25]
["TUFTS - TUFTS POS - HCPCS - A7520","TUFTS","TUFTS POS","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,0,55.16,138.79,293.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A7520","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,95.98,55.16,138.79,293.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A7520","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,80.290000000000006,55.16,138.79,293.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A7520","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,121.9,55.16,138.79,293.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A7520","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,0,55.16,138.79,293.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A7520","BMC HEALTHNET","BMCHN ACO","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,0,55.16,138.79,293.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A7520","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,55.16,55.16,138.79,293.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A7520","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,55.16,55.16,138.79,293.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A7520","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,55.16,55.16,138.79,293.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A7520","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,55.16,55.16,138.79,293.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A7520","BMC HEALTHNET","BMCHN MCO","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,0,55.16,138.79,293.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A7520","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,0,55.16,138.79,293.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A7520","BMC HEALTHNET","BMCHN QHP","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,0,55.16,138.79,293.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A7520","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,0,55.16,138.79,293.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A7520","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,0,55.16,138.79,293.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A7520","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,65.09,55.16,138.79,293.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A7520","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,80.290000000000006,55.16,138.79,293.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A7520","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,138.79,55.16,138.79,293.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A7520","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,80.290000000000006,55.16,138.79,293.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A7520","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,80.290000000000006,55.16,138.79,293.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A7520","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,80.290000000000006,55.16,138.79,293.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A7520","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,80.290000000000006,55.16,138.79,293.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A7520","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED",1173,80.290000000000006,55.16,138.79,293.25]
["TUFTS - TUFTS SELECT - HCPCS - A9500","TUFTS","TUFTS SELECT","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,0,463.42,463.42,68.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9500","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,0,463.42,463.42,68.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9500","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,0,463.42,463.42,68.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9500","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,0,463.42,463.42,68.5]
["TUFTS - TUFTS HMO - HCPCS - A9500","TUFTS","TUFTS HMO","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,0,463.42,463.42,68.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9500","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,0,463.42,463.42,68.5]
["TUFTS - TUFTS POS - HCPCS - A9500","TUFTS","TUFTS POS","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,0,463.42,463.42,68.5]
["FALLON - FALLON MEDICAID - HCPCS - A9500","FALLON","FALLON MEDICAID","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,0,463.42,463.42,68.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9500","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,0,463.42,463.42,68.5]
["TUFTS - TUFTS PPO - HCPCS - A9500","TUFTS","TUFTS PPO","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,0,463.42,463.42,68.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9500","BMC HEALTHNET","BMCHN ACO","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,0,463.42,463.42,68.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9500","BMC HEALTHNET","BMCHN MCO","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,0,463.42,463.42,68.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9500","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,0,463.42,463.42,68.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9500","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,0,463.42,463.42,68.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9500","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,463.42,463.42,463.42,68.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9500","BMC HEALTHNET","BMCHN QHP","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,0,463.42,463.42,68.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9500","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,463.42,463.42,463.42,68.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9500","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,0,463.42,463.42,68.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9500","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,463.42,463.42,463.42,68.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9500","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,0,463.42,463.42,68.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9500","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,463.42,463.42,463.42,68.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9500","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,463.42,463.42,463.42,68.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9500","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,463.42,463.42,463.42,68.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9500","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9500","TC99M SESTAMIBI","A9500 - TC99M SESTAMIBI",274,463.42,463.42,463.42,68.5]
["TUFTS - TUFTS SELECT - HCPCS - A9502","TUFTS","TUFTS SELECT","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,0,278.27,278.27,35]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9502","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,0,278.27,278.27,35]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9502","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,0,278.27,278.27,35]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9502","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,0,278.27,278.27,35]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9502","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,0,278.27,278.27,35]
["FALLON - FALLON MEDICAID - HCPCS - A9502","FALLON","FALLON MEDICAID","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,0,278.27,278.27,35]
["TUFTS - TUFTS PPO - HCPCS - A9502","TUFTS","TUFTS PPO","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,0,278.27,278.27,35]
["TUFTS - TUFTS HMO - HCPCS - A9502","TUFTS","TUFTS HMO","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,0,278.27,278.27,35]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9502","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,0,278.27,278.27,35]
["TUFTS - TUFTS POS - HCPCS - A9502","TUFTS","TUFTS POS","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,0,278.27,278.27,35]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9502","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,0,278.27,278.27,35]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9502","BMC HEALTHNET","BMCHN ACO","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,0,278.27,278.27,35]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9502","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,278.27,278.27,278.27,35]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9502","BMC HEALTHNET","BMCHN MCO","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,0,278.27,278.27,35]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9502","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,0,278.27,278.27,35]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9502","BMC HEALTHNET","BMCHN QHP","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,0,278.27,278.27,35]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9502","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,0,278.27,278.27,35]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9502","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,0,278.27,278.27,35]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9502","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,278.27,278.27,278.27,35]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9502","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,278.27,278.27,278.27,35]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9502","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,278.27,278.27,278.27,35]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9502","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,278.27,278.27,278.27,35]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9502","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,278.27,278.27,278.27,35]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9502","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9502","HC TC99M TETROFOSMIN","A9502 - HC TC99M TETROFOSMIN",140,278.27,278.27,278.27,35]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9503","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,0,37.119999999999997,37.119999999999997,5.75]
["TUFTS - TUFTS SELECT - HCPCS - A9503","TUFTS","TUFTS SELECT","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,0,37.119999999999997,37.119999999999997,5.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9503","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,0,37.119999999999997,37.119999999999997,5.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9503","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,0,37.119999999999997,37.119999999999997,5.75]
["TUFTS - TUFTS POS - HCPCS - A9503","TUFTS","TUFTS POS","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,0,37.119999999999997,37.119999999999997,5.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9503","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,0,37.119999999999997,37.119999999999997,5.75]
["TUFTS - TUFTS HMO - HCPCS - A9503","TUFTS","TUFTS HMO","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,0,37.119999999999997,37.119999999999997,5.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9503","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,0,37.119999999999997,37.119999999999997,5.75]
["FALLON - FALLON MEDICAID - HCPCS - A9503","FALLON","FALLON MEDICAID","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,0,37.119999999999997,37.119999999999997,5.75]
["TUFTS - TUFTS PPO - HCPCS - A9503","TUFTS","TUFTS PPO","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,0,37.119999999999997,37.119999999999997,5.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9503","BMC HEALTHNET","BMCHN ACO","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,0,37.119999999999997,37.119999999999997,5.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9503","BMC HEALTHNET","BMCHN MCO","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,0,37.119999999999997,37.119999999999997,5.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9503","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,0,37.119999999999997,37.119999999999997,5.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9503","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,0,37.119999999999997,37.119999999999997,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9503","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,37.119999999999997,37.119999999999997,37.119999999999997,5.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9503","BMC HEALTHNET","BMCHN QHP","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,0,37.119999999999997,37.119999999999997,5.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9503","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,0,37.119999999999997,37.119999999999997,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9503","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,37.119999999999997,37.119999999999997,37.119999999999997,5.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9503","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,0,37.119999999999997,37.119999999999997,5.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9503","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,37.119999999999997,37.119999999999997,37.119999999999997,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9503","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,37.119999999999997,37.119999999999997,37.119999999999997,5.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9503","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,37.119999999999997,37.119999999999997,37.119999999999997,5.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9503","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,37.119999999999997,37.119999999999997,37.119999999999997,5.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9503","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9503","TC99M MEDRONATE","A9503 - TC99M MEDRONATE",23,37.119999999999997,37.119999999999997,37.119999999999997,5.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9505","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,0,395.74,395.74,5.75]
["TUFTS - TUFTS SELECT - HCPCS - A9505","TUFTS","TUFTS SELECT","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,0,395.74,395.74,5.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9505","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,0,395.74,395.74,5.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9505","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,0,395.74,395.74,5.75]
["TUFTS - TUFTS PPO - HCPCS - A9505","TUFTS","TUFTS PPO","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,0,395.74,395.74,5.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9505","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,0,395.74,395.74,5.75]
["TUFTS - TUFTS HMO - HCPCS - A9505","TUFTS","TUFTS HMO","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,0,395.74,395.74,5.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9505","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,0,395.74,395.74,5.75]
["FALLON - FALLON MEDICAID - HCPCS - A9505","FALLON","FALLON MEDICAID","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,0,395.74,395.74,5.75]
["TUFTS - TUFTS POS - HCPCS - A9505","TUFTS","TUFTS POS","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,0,395.74,395.74,5.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9505","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,0,395.74,395.74,5.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9505","BMC HEALTHNET","BMCHN ACO","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,0,395.74,395.74,5.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9505","BMC HEALTHNET","BMCHN MCO","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,0,395.74,395.74,5.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9505","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,0,395.74,395.74,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9505","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,395.74,395.74,395.74,5.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9505","BMC HEALTHNET","BMCHN QHP","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,0,395.74,395.74,5.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9505","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,0,395.74,395.74,5.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9505","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,0,395.74,395.74,5.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9505","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,395.74,395.74,395.74,5.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9505","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,395.74,395.74,395.74,5.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9505","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,395.74,395.74,395.74,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9505","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,395.74,395.74,395.74,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9505","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,395.74,395.74,395.74,5.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9505","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9505","THALLIUM CHLORIDE PER MCI","A9505 - THALLIUM CHLORIDE PER MCI",23,395.74,395.74,395.74,5.75]
["TUFTS - TUFTS SELECT - HCPCS - A9509","TUFTS","TUFTS SELECT","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,0,5163.91,5163.91,23.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9509","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,0,5163.91,5163.91,23.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9509","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,0,5163.91,5163.91,23.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9509","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,0,5163.91,5163.91,23.75]
["TUFTS - TUFTS HMO - HCPCS - A9509","TUFTS","TUFTS HMO","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,0,5163.91,5163.91,23.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9509","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,0,5163.91,5163.91,23.75]
["TUFTS - TUFTS POS - HCPCS - A9509","TUFTS","TUFTS POS","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,0,5163.91,5163.91,23.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9509","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,0,5163.91,5163.91,23.75]
["FALLON - FALLON MEDICAID - HCPCS - A9509","FALLON","FALLON MEDICAID","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,0,5163.91,5163.91,23.75]
["TUFTS - TUFTS PPO - HCPCS - A9509","TUFTS","TUFTS PPO","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,0,5163.91,5163.91,23.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9509","BMC HEALTHNET","BMCHN ACO","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,0,5163.91,5163.91,23.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9509","BMC HEALTHNET","BMCHN MCO","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,0,5163.91,5163.91,23.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9509","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,0,5163.91,5163.91,23.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9509","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,0,5163.91,5163.91,23.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9509","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,5163.91,5163.91,5163.91,23.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9509","BMC HEALTHNET","BMCHN QHP","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,0,5163.91,5163.91,23.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9509","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,0,5163.91,5163.91,23.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9509","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,5163.91,5163.91,5163.91,23.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9509","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,5163.91,5163.91,5163.91,23.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9509","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,0,5163.91,5163.91,23.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9509","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,5163.91,5163.91,5163.91,23.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9509","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,5163.91,5163.91,5163.91,23.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9509","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,5163.91,5163.91,5163.91,23.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9509","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9509","HC IODINE I-123 PER MCI","A9509 - HC IODINE I-123 PER MCI",95,5163.91,5163.91,5163.91,23.75]
["TUFTS - TUFTS SELECT - HCPCS - A9512","TUFTS","TUFTS SELECT","HCPCS","A9512","TC99M PERTECHNETATE","A9512 - TC99M PERTECHNETATE",1,0,0,0,0.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9512","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9512","TC99M PERTECHNETATE","A9512 - TC99M PERTECHNETATE",1,0,0,0,0.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9512","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9512","TC99M PERTECHNETATE","A9512 - TC99M PERTECHNETATE",1,0,0,0,0.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9512","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9512","TC99M PERTECHNETATE","A9512 - TC99M PERTECHNETATE",1,0,0,0,0.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9512","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9512","TC99M PERTECHNETATE","A9512 - TC99M PERTECHNETATE",1,0,0,0,0.25]
["TUFTS - TUFTS PPO - HCPCS - A9512","TUFTS","TUFTS PPO","HCPCS","A9512","TC99M PERTECHNETATE","A9512 - TC99M PERTECHNETATE",1,0,0,0,0.25]
["TUFTS - TUFTS HMO - HCPCS - A9512","TUFTS","TUFTS HMO","HCPCS","A9512","TC99M PERTECHNETATE","A9512 - TC99M PERTECHNETATE",1,0,0,0,0.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9512","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9512","TC99M PERTECHNETATE","A9512 - TC99M PERTECHNETATE",1,0,0,0,0.25]
["TUFTS - TUFTS POS - HCPCS - A9512","TUFTS","TUFTS POS","HCPCS","A9512","TC99M PERTECHNETATE","A9512 - TC99M PERTECHNETATE",1,0,0,0,0.25]
["FALLON - FALLON MEDICAID - HCPCS - A9512","FALLON","FALLON MEDICAID","HCPCS","A9512","TC99M PERTECHNETATE","A9512 - TC99M PERTECHNETATE",1,0,0,0,0.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9512","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9512","TC99M PERTECHNETATE","A9512 - TC99M PERTECHNETATE",1,0,0,0,0.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9512","BMC HEALTHNET","BMCHN ACO","HCPCS","A9512","TC99M PERTECHNETATE","A9512 - TC99M PERTECHNETATE",1,0,0,0,0.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9512","BMC HEALTHNET","BMCHN MCO","HCPCS","A9512","TC99M PERTECHNETATE","A9512 - TC99M PERTECHNETATE",1,0,0,0,0.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9512","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9512","TC99M PERTECHNETATE","A9512 - TC99M PERTECHNETATE",1,0,0,0,0.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9512","BMC HEALTHNET","BMCHN QHP","HCPCS","A9512","TC99M PERTECHNETATE","A9512 - TC99M PERTECHNETATE",1,0,0,0,0.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9512","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9512","TC99M PERTECHNETATE","A9512 - TC99M PERTECHNETATE",1,0,0,0,0.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9512","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9512","TC99M PERTECHNETATE","A9512 - TC99M PERTECHNETATE",1,0,0,0,0.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9513","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,441.49,294.27999999999997,1097.56,80]
["TUFTS - TUFTS SELECT - HCPCS - A9513","TUFTS","TUFTS SELECT","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,365.04,294.27999999999997,1097.56,80]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9513","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,441.49,294.27999999999997,1097.56,80]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9513","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,0,294.27999999999997,1097.56,80]
["TUFTS - TUFTS POS - HCPCS - A9513","TUFTS","TUFTS POS","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,365.04,294.27999999999997,1097.56,80]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9513","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,441.49,294.27999999999997,1097.56,80]
["TUFTS - TUFTS HMO - HCPCS - A9513","TUFTS","TUFTS HMO","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,438.05,294.27999999999997,1097.56,80]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9513","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,441.49,294.27999999999997,1097.56,80]
["FALLON - FALLON MEDICAID - HCPCS - A9513","FALLON","FALLON MEDICAID","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,0,294.27999999999997,1097.56,80]
["TUFTS - TUFTS PPO - HCPCS - A9513","TUFTS","TUFTS PPO","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,390.48,294.27999999999997,1097.56,80]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9513","BMC HEALTHNET","BMCHN ACO","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,0,294.27999999999997,1097.56,80]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9513","BMC HEALTHNET","BMCHN MCO","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,0,294.27999999999997,1097.56,80]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9513","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,1097.56,294.27999999999997,1097.56,80]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9513","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,0,294.27999999999997,1097.56,80]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9513","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,329.72,294.27999999999997,1097.56,80]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9513","BMC HEALTHNET","BMCHN QHP","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,0,294.27999999999997,1097.56,80]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9513","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,0,294.27999999999997,1097.56,80]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9513","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,0,294.27999999999997,1097.56,80]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9513","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,329.72,294.27999999999997,1097.56,80]
["AETNA - AETNA - HCPCS - A9513","AETNA","AETNA","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,294.27999999999997,294.27999999999997,1097.56,80]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9513","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,329.72,294.27999999999997,1097.56,80]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9513","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,329.72,294.27999999999997,1097.56,80]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9513","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,329.72,294.27999999999997,1097.56,80]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9513","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,329.72,294.27999999999997,1097.56,80]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9513","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN",320,329.72,294.27999999999997,1097.56,80]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9516","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,0,516.39,516.39,48]
["TUFTS - TUFTS SELECT - HCPCS - A9516","TUFTS","TUFTS SELECT","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,0,516.39,516.39,48]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9516","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,0,516.39,516.39,48]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9516","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,0,516.39,516.39,48]
["FALLON - FALLON MEDICAID - HCPCS - A9516","FALLON","FALLON MEDICAID","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,0,516.39,516.39,48]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9516","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,0,516.39,516.39,48]
["TUFTS - TUFTS PPO - HCPCS - A9516","TUFTS","TUFTS PPO","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,0,516.39,516.39,48]
["TUFTS - TUFTS HMO - HCPCS - A9516","TUFTS","TUFTS HMO","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,0,516.39,516.39,48]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9516","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,0,516.39,516.39,48]
["TUFTS - TUFTS POS - HCPCS - A9516","TUFTS","TUFTS POS","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,0,516.39,516.39,48]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9516","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,516.39,516.39,516.39,48]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9516","BMC HEALTHNET","BMCHN QHP","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,0,516.39,516.39,48]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9516","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,0,516.39,516.39,48]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9516","BMC HEALTHNET","BMCHN ACO","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,0,516.39,516.39,48]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9516","BMC HEALTHNET","BMCHN MCO","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,0,516.39,516.39,48]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9516","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,0,516.39,516.39,48]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9516","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,0,516.39,516.39,48]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9516","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,516.39,516.39,516.39,48]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9516","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,0,516.39,516.39,48]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9516","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,516.39,516.39,516.39,48]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9516","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,516.39,516.39,516.39,48]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9516","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,516.39,516.39,516.39,48]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9516","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,516.39,516.39,516.39,48]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9516","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9516","I123 IODIDE CAP, DX","A9516 - I123 IODIDE CAP, DX",192,516.39,516.39,516.39,48]
["TUFTS - TUFTS SELECT - HCPCS - A9517","TUFTS","TUFTS SELECT","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,30.1,30.1,101.94,109.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9517","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,62.66,30.1,101.94,109.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9517","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,62.66,30.1,101.94,109.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9517","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,0,30.1,101.94,109.25]
["TUFTS - TUFTS HMO - HCPCS - A9517","TUFTS","TUFTS HMO","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,36.119999999999997,30.1,101.94,109.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9517","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,62.66,30.1,101.94,109.25]
["FALLON - FALLON MEDICAID - HCPCS - A9517","FALLON","FALLON MEDICAID","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,0,30.1,101.94,109.25]
["TUFTS - TUFTS POS - HCPCS - A9517","TUFTS","TUFTS POS","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,30.1,30.1,101.94,109.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9517","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,62.66,30.1,101.94,109.25]
["TUFTS - TUFTS PPO - HCPCS - A9517","TUFTS","TUFTS PPO","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,32.200000000000003,30.1,101.94,109.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9517","BMC HEALTHNET","BMCHN ACO","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,0,30.1,101.94,109.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9517","BMC HEALTHNET","BMCHN QHP","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,0,30.1,101.94,109.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9517","BMC HEALTHNET","BMCHN MCO","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,0,30.1,101.94,109.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9517","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,90.52,30.1,101.94,109.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9517","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,0,30.1,101.94,109.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9517","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,101.94,30.1,101.94,109.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9517","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,0,30.1,101.94,109.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9517","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,0,30.1,101.94,109.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9517","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,101.94,30.1,101.94,109.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9517","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,101.94,30.1,101.94,109.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9517","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,101.94,30.1,101.94,109.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9517","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,101.94,30.1,101.94,109.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9517","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,101.94,30.1,101.94,109.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9517","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9517","I131 IODIDE CAP, RX","A9517 - I131 IODIDE CAP, RX",437,101.94,30.1,101.94,109.25]
["TUFTS - TUFTS SELECT - HCPCS - A9520","TUFTS","TUFTS SELECT","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD","A9520 - TECHNETIUMTC-99M SULFUR CLLD",1951,0,0,0,487.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9520","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD","A9520 - TECHNETIUMTC-99M SULFUR CLLD",1951,0,0,0,487.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9520","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD","A9520 - TECHNETIUMTC-99M SULFUR CLLD",1951,0,0,0,487.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9520","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD","A9520 - TECHNETIUMTC-99M SULFUR CLLD",1951,0,0,0,487.75]
["FALLON - FALLON MEDICAID - HCPCS - A9520","FALLON","FALLON MEDICAID","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD","A9520 - TECHNETIUMTC-99M SULFUR CLLD",1951,0,0,0,487.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9520","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD","A9520 - TECHNETIUMTC-99M SULFUR CLLD",1951,0,0,0,487.75]
["TUFTS - TUFTS PPO - HCPCS - A9520","TUFTS","TUFTS PPO","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD","A9520 - TECHNETIUMTC-99M SULFUR CLLD",1951,0,0,0,487.75]
["TUFTS - TUFTS HMO - HCPCS - A9520","TUFTS","TUFTS HMO","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD","A9520 - TECHNETIUMTC-99M SULFUR CLLD",1951,0,0,0,487.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9520","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD","A9520 - TECHNETIUMTC-99M SULFUR CLLD",1951,0,0,0,487.75]
["TUFTS - TUFTS POS - HCPCS - A9520","TUFTS","TUFTS POS","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD","A9520 - TECHNETIUMTC-99M SULFUR CLLD",1951,0,0,0,487.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9520","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD","A9520 - TECHNETIUMTC-99M SULFUR CLLD",1951,0,0,0,487.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9520","BMC HEALTHNET","BMCHN QHP","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD","A9520 - TECHNETIUMTC-99M SULFUR CLLD",1951,0,0,0,487.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9520","BMC HEALTHNET","BMCHN ACO","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD","A9520 - TECHNETIUMTC-99M SULFUR CLLD",1951,0,0,0,487.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9520","BMC HEALTHNET","BMCHN MCO","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD","A9520 - TECHNETIUMTC-99M SULFUR CLLD",1951,0,0,0,487.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9520","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD","A9520 - TECHNETIUMTC-99M SULFUR CLLD",1951,0,0,0,487.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9520","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD","A9520 - TECHNETIUMTC-99M SULFUR CLLD",1951,0,0,0,487.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9520","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD","A9520 - TECHNETIUMTC-99M SULFUR CLLD",1951,0,0,0,487.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9521","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,0,4157.3,4157.3,90]
["TUFTS - TUFTS SELECT - HCPCS - A9521","TUFTS","TUFTS SELECT","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,0,4157.3,4157.3,90]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9521","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,0,4157.3,4157.3,90]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9521","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,0,4157.3,4157.3,90]
["TUFTS - TUFTS POS - HCPCS - A9521","TUFTS","TUFTS POS","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,0,4157.3,4157.3,90]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9521","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,0,4157.3,4157.3,90]
["TUFTS - TUFTS HMO - HCPCS - A9521","TUFTS","TUFTS HMO","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,0,4157.3,4157.3,90]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9521","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,0,4157.3,4157.3,90]
["FALLON - FALLON MEDICAID - HCPCS - A9521","FALLON","FALLON MEDICAID","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,0,4157.3,4157.3,90]
["TUFTS - TUFTS PPO - HCPCS - A9521","TUFTS","TUFTS PPO","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,0,4157.3,4157.3,90]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9521","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,4157.3,4157.3,4157.3,90]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9521","BMC HEALTHNET","BMCHN ACO","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,0,4157.3,4157.3,90]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9521","BMC HEALTHNET","BMCHN QHP","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,0,4157.3,4157.3,90]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9521","BMC HEALTHNET","BMCHN MCO","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,0,4157.3,4157.3,90]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9521","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,0,4157.3,4157.3,90]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9521","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,0,4157.3,4157.3,90]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9521","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,0,4157.3,4157.3,90]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9521","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,4157.3,4157.3,4157.3,90]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9521","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,4157.3,4157.3,4157.3,90]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9521","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,0,4157.3,4157.3,90]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9521","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,4157.3,4157.3,4157.3,90]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9521","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,4157.3,4157.3,4157.3,90]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9521","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,4157.3,4157.3,4157.3,90]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9521","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9521","TC99M EXAMETAZIME","A9521 - TC99M EXAMETAZIME",360,4157.3,4157.3,4157.3,90]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9537","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,0,157.94999999999999,157.94999999999999,34.5]
["TUFTS - TUFTS SELECT - HCPCS - A9537","TUFTS","TUFTS SELECT","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,0,157.94999999999999,157.94999999999999,34.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9537","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,0,157.94999999999999,157.94999999999999,34.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9537","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,0,157.94999999999999,157.94999999999999,34.5]
["TUFTS - TUFTS PPO - HCPCS - A9537","TUFTS","TUFTS PPO","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,0,157.94999999999999,157.94999999999999,34.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9537","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,0,157.94999999999999,157.94999999999999,34.5]
["TUFTS - TUFTS HMO - HCPCS - A9537","TUFTS","TUFTS HMO","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,0,157.94999999999999,157.94999999999999,34.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9537","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,0,157.94999999999999,157.94999999999999,34.5]
["FALLON - FALLON MEDICAID - HCPCS - A9537","FALLON","FALLON MEDICAID","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,0,157.94999999999999,157.94999999999999,34.5]
["TUFTS - TUFTS POS - HCPCS - A9537","TUFTS","TUFTS POS","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,0,157.94999999999999,157.94999999999999,34.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9537","BMC HEALTHNET","BMCHN QHP","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,0,157.94999999999999,157.94999999999999,34.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9537","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,0,157.94999999999999,157.94999999999999,34.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9537","BMC HEALTHNET","BMCHN ACO","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,0,157.94999999999999,157.94999999999999,34.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9537","BMC HEALTHNET","BMCHN MCO","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,0,157.94999999999999,157.94999999999999,34.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9537","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,0,157.94999999999999,157.94999999999999,34.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9537","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,157.94999999999999,157.94999999999999,157.94999999999999,34.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9537","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,0,157.94999999999999,157.94999999999999,34.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9537","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,0,157.94999999999999,157.94999999999999,34.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9537","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,157.94999999999999,157.94999999999999,157.94999999999999,34.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9537","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,157.94999999999999,157.94999999999999,157.94999999999999,34.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9537","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,157.94999999999999,157.94999999999999,157.94999999999999,34.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9537","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,157.94999999999999,157.94999999999999,157.94999999999999,34.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9537","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,157.94999999999999,157.94999999999999,157.94999999999999,34.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9537","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9537","TC99M MEBROFENIN","A9537 - TC99M MEBROFENIN",138,157.94999999999999,157.94999999999999,157.94999999999999,34.5]
["TUFTS - TUFTS SELECT - HCPCS - A9538","TUFTS","TUFTS SELECT","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,0,114.21,114.21,27.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9538","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,0,114.21,114.21,27.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9538","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,0,114.21,114.21,27.75]
["TUFTS - TUFTS PPO - HCPCS - A9538","TUFTS","TUFTS PPO","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,0,114.21,114.21,27.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9538","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,0,114.21,114.21,27.75]
["TUFTS - TUFTS HMO - HCPCS - A9538","TUFTS","TUFTS HMO","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,0,114.21,114.21,27.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9538","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,0,114.21,114.21,27.75]
["TUFTS - TUFTS POS - HCPCS - A9538","TUFTS","TUFTS POS","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,0,114.21,114.21,27.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9538","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,0,114.21,114.21,27.75]
["FALLON - FALLON MEDICAID - HCPCS - A9538","FALLON","FALLON MEDICAID","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,0,114.21,114.21,27.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9538","BMC HEALTHNET","BMCHN ACO","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,0,114.21,114.21,27.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9538","BMC HEALTHNET","BMCHN QHP","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,0,114.21,114.21,27.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9538","BMC HEALTHNET","BMCHN MCO","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,0,114.21,114.21,27.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9538","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,0,114.21,114.21,27.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9538","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,0,114.21,114.21,27.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9538","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,114.21,114.21,114.21,27.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9538","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,114.21,114.21,114.21,27.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9538","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,0,114.21,114.21,27.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9538","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,0,114.21,114.21,27.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9538","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,114.21,114.21,114.21,27.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9538","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,114.21,114.21,114.21,27.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9538","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,114.21,114.21,114.21,27.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9538","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,114.21,114.21,114.21,27.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9538","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9538","TC99M PYROPHOSPHATE","A9538 - TC99M PYROPHOSPHATE",111,114.21,114.21,114.21,27.75]
["TUFTS - TUFTS SELECT - HCPCS - A9539","TUFTS","TUFTS SELECT","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,0,89.47,89.47,167]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9539","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,0,89.47,89.47,167]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9539","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,0,89.47,89.47,167]
["TUFTS - TUFTS PPO - HCPCS - A9539","TUFTS","TUFTS PPO","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,0,89.47,89.47,167]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9539","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,0,89.47,89.47,167]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9539","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,0,89.47,89.47,167]
["TUFTS - TUFTS HMO - HCPCS - A9539","TUFTS","TUFTS HMO","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,0,89.47,89.47,167]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9539","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,0,89.47,89.47,167]
["TUFTS - TUFTS POS - HCPCS - A9539","TUFTS","TUFTS POS","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,0,89.47,89.47,167]
["FALLON - FALLON MEDICAID - HCPCS - A9539","FALLON","FALLON MEDICAID","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,0,89.47,89.47,167]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9539","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,0,89.47,89.47,167]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9539","BMC HEALTHNET","BMCHN QHP","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,0,89.47,89.47,167]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9539","BMC HEALTHNET","BMCHN ACO","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,0,89.47,89.47,167]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9539","BMC HEALTHNET","BMCHN MCO","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,0,89.47,89.47,167]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9539","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,0,89.47,89.47,167]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9539","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,89.47,89.47,89.47,167]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9539","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,0,89.47,89.47,167]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9539","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,0,89.47,89.47,167]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9539","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,89.47,89.47,89.47,167]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9539","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,89.47,89.47,89.47,167]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9539","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,89.47,89.47,89.47,167]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9539","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,89.47,89.47,89.47,167]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9539","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,89.47,89.47,89.47,167]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9539","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9539","TC99M PENTETATE","A9539 - TC99M PENTETATE",668,89.47,89.47,89.47,167]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9540","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,0,85.66,85.66,457.75]
["TUFTS - TUFTS PPO - HCPCS - A9540","TUFTS","TUFTS PPO","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,0,85.66,85.66,457.75]
["TUFTS - TUFTS SELECT - HCPCS - A9540","TUFTS","TUFTS SELECT","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,0,85.66,85.66,457.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9540","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,0,85.66,85.66,457.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9540","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,0,85.66,85.66,457.75]
["TUFTS - TUFTS POS - HCPCS - A9540","TUFTS","TUFTS POS","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,0,85.66,85.66,457.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9540","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,0,85.66,85.66,457.75]
["TUFTS - TUFTS HMO - HCPCS - A9540","TUFTS","TUFTS HMO","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,0,85.66,85.66,457.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9540","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,0,85.66,85.66,457.75]
["FALLON - FALLON MEDICAID - HCPCS - A9540","FALLON","FALLON MEDICAID","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,0,85.66,85.66,457.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9540","BMC HEALTHNET","BMCHN ACO","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,0,85.66,85.66,457.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9540","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,85.66,85.66,85.66,457.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9540","BMC HEALTHNET","BMCHN QHP","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,0,85.66,85.66,457.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9540","BMC HEALTHNET","BMCHN MCO","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,0,85.66,85.66,457.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9540","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,0,85.66,85.66,457.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9540","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,0,85.66,85.66,457.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9540","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,0,85.66,85.66,457.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9540","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,85.66,85.66,85.66,457.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9540","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,85.66,85.66,85.66,457.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9540","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,0,85.66,85.66,457.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9540","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,85.66,85.66,85.66,457.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9540","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,85.66,85.66,85.66,457.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9540","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,85.66,85.66,85.66,457.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9540","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9540","TC99M MAA","A9540 - TC99M MAA",1831,85.66,85.66,85.66,457.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9541","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,0,152.69,152.69,30]
["TUFTS - TUFTS PPO - HCPCS - A9541","TUFTS","TUFTS PPO","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,0,152.69,152.69,30]
["TUFTS - TUFTS SELECT - HCPCS - A9541","TUFTS","TUFTS SELECT","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,0,152.69,152.69,30]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9541","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,0,152.69,152.69,30]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9541","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,0,152.69,152.69,30]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9541","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,0,152.69,152.69,30]
["FALLON - FALLON MEDICAID - HCPCS - A9541","FALLON","FALLON MEDICAID","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,0,152.69,152.69,30]
["TUFTS - TUFTS HMO - HCPCS - A9541","TUFTS","TUFTS HMO","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,0,152.69,152.69,30]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9541","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,0,152.69,152.69,30]
["TUFTS - TUFTS POS - HCPCS - A9541","TUFTS","TUFTS POS","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,0,152.69,152.69,30]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9541","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,152.69,152.69,152.69,30]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9541","BMC HEALTHNET","BMCHN QHP","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,0,152.69,152.69,30]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9541","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,0,152.69,152.69,30]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9541","BMC HEALTHNET","BMCHN ACO","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,0,152.69,152.69,30]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9541","BMC HEALTHNET","BMCHN MCO","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,0,152.69,152.69,30]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9541","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,0,152.69,152.69,30]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9541","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,0,152.69,152.69,30]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9541","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,0,152.69,152.69,30]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9541","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,152.69,152.69,152.69,30]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9541","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,152.69,152.69,152.69,30]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9541","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,152.69,152.69,152.69,30]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9541","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,152.69,152.69,152.69,30]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9541","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,152.69,152.69,152.69,30]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9541","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9541","TC99M SULFUR COLLOID","A9541 - TC99M SULFUR COLLOID",120,152.69,152.69,152.69,30]
["TUFTS - TUFTS PPO - HCPCS - A9543","TUFTS","TUFTS PPO","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,77447.320000000007,72400.97,217685.7,16580.5]
["TUFTS - TUFTS SELECT - HCPCS - A9543","TUFTS","TUFTS SELECT","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,72400.97,72400.97,217685.7,16580.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9543","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,97558.58,72400.97,217685.7,16580.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9543","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,97558.58,72400.97,217685.7,16580.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9543","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,0,72400.97,217685.7,16580.5]
["TUFTS - TUFTS HMO - HCPCS - A9543","TUFTS","TUFTS HMO","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,86881.16,72400.97,217685.7,16580.5]
["FALLON - FALLON MEDICAID - HCPCS - A9543","FALLON","FALLON MEDICAID","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,0,72400.97,217685.7,16580.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9543","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,97558.58,72400.97,217685.7,16580.5]
["TUFTS - TUFTS POS - HCPCS - A9543","TUFTS","TUFTS POS","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,72400.97,72400.97,217685.7,16580.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9543","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,97558.58,72400.97,217685.7,16580.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9543","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,139963.56,72400.97,217685.7,16580.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9543","BMC HEALTHNET","BMCHN ACO","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,0,72400.97,217685.7,16580.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9543","BMC HEALTHNET","BMCHN QHP","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,0,72400.97,217685.7,16580.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9543","BMC HEALTHNET","BMCHN MCO","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,0,72400.97,217685.7,16580.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9543","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,217685.7,72400.97,217685.7,16580.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9543","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,0,72400.97,217685.7,16580.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9543","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,0,72400.97,217685.7,16580.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9543","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,139963.56,72400.97,217685.7,16580.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9543","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,139963.56,72400.97,217685.7,16580.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9543","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,0,72400.97,217685.7,16580.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9543","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,139963.56,72400.97,217685.7,16580.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9543","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,139963.56,72400.97,217685.7,16580.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9543","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,139963.56,72400.97,217685.7,16580.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9543","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9543","Y90 IBRITUMOMAB, RX","A9543 - Y90 IBRITUMOMAB, RX",66322,139963.56,72400.97,217685.7,16580.5]
["TUFTS - TUFTS PPO - HCPCS - A9547","TUFTS","TUFTS PPO","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,0,5105.7299999999996,5105.7299999999996,110]
["TUFTS - TUFTS SELECT - HCPCS - A9547","TUFTS","TUFTS SELECT","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,0,5105.7299999999996,5105.7299999999996,110]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9547","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,0,5105.7299999999996,5105.7299999999996,110]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9547","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,0,5105.7299999999996,5105.7299999999996,110]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9547","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,0,5105.7299999999996,5105.7299999999996,110]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9547","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,0,5105.7299999999996,5105.7299999999996,110]
["FALLON - FALLON MEDICAID - HCPCS - A9547","FALLON","FALLON MEDICAID","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,0,5105.7299999999996,5105.7299999999996,110]
["TUFTS - TUFTS HMO - HCPCS - A9547","TUFTS","TUFTS HMO","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,0,5105.7299999999996,5105.7299999999996,110]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9547","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,0,5105.7299999999996,5105.7299999999996,110]
["TUFTS - TUFTS POS - HCPCS - A9547","TUFTS","TUFTS POS","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,0,5105.7299999999996,5105.7299999999996,110]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9547","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,5105.7299999999996,5105.7299999999996,5105.7299999999996,110]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9547","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,0,5105.7299999999996,5105.7299999999996,110]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9547","BMC HEALTHNET","BMCHN QHP","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,0,5105.7299999999996,5105.7299999999996,110]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9547","BMC HEALTHNET","BMCHN ACO","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,0,5105.7299999999996,5105.7299999999996,110]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9547","BMC HEALTHNET","BMCHN MCO","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,0,5105.7299999999996,5105.7299999999996,110]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9547","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,0,5105.7299999999996,5105.7299999999996,110]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9547","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,0,5105.7299999999996,5105.7299999999996,110]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9547","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,0,5105.7299999999996,5105.7299999999996,110]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9547","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,5105.7299999999996,5105.7299999999996,5105.7299999999996,110]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9547","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,5105.7299999999996,5105.7299999999996,5105.7299999999996,110]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9547","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,5105.7299999999996,5105.7299999999996,5105.7299999999996,110]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9547","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,5105.7299999999996,5105.7299999999996,5105.7299999999996,110]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9547","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,5105.7299999999996,5105.7299999999996,5105.7299999999996,110]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9547","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9547","IN111 OXYQUINOLINE","A9547 - IN111 OXYQUINOLINE",440,5105.7299999999996,5105.7299999999996,5105.7299999999996,110]
["TUFTS - TUFTS PPO - HCPCS - A9551","TUFTS","TUFTS PPO","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,0,1711.56,1711.56,38.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9551","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,0,1711.56,1711.56,38.5]
["TUFTS - TUFTS SELECT - HCPCS - A9551","TUFTS","TUFTS SELECT","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,0,1711.56,1711.56,38.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9551","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,0,1711.56,1711.56,38.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9551","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,0,1711.56,1711.56,38.5]
["TUFTS - TUFTS POS - HCPCS - A9551","TUFTS","TUFTS POS","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,0,1711.56,1711.56,38.5]
["TUFTS - TUFTS HMO - HCPCS - A9551","TUFTS","TUFTS HMO","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,0,1711.56,1711.56,38.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9551","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,0,1711.56,1711.56,38.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9551","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,0,1711.56,1711.56,38.5]
["FALLON - FALLON MEDICAID - HCPCS - A9551","FALLON","FALLON MEDICAID","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,0,1711.56,1711.56,38.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9551","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,1711.56,1711.56,1711.56,38.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9551","BMC HEALTHNET","BMCHN ACO","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,0,1711.56,1711.56,38.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9551","BMC HEALTHNET","BMCHN QHP","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,0,1711.56,1711.56,38.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9551","BMC HEALTHNET","BMCHN MCO","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,0,1711.56,1711.56,38.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9551","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,0,1711.56,1711.56,38.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9551","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,0,1711.56,1711.56,38.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9551","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,1711.56,1711.56,1711.56,38.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9551","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,0,1711.56,1711.56,38.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9551","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,1711.56,1711.56,1711.56,38.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9551","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,1711.56,1711.56,1711.56,38.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9551","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,0,1711.56,1711.56,38.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9551","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,1711.56,1711.56,1711.56,38.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9551","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,1711.56,1711.56,1711.56,38.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9551","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX","A9551 - HC TC99M SUCCIMER/10MCI,DX",154,1711.56,1711.56,1711.56,38.5]
["TUFTS - TUFTS PPO - HCPCS - A9552","TUFTS","TUFTS PPO","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,0,1166.46,1166.46,243]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9552","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,0,1166.46,1166.46,243]
["TUFTS - TUFTS SELECT - HCPCS - A9552","TUFTS","TUFTS SELECT","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,0,1166.46,1166.46,243]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9552","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,0,1166.46,1166.46,243]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9552","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,0,1166.46,1166.46,243]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9552","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,0,1166.46,1166.46,243]
["TUFTS - TUFTS HMO - HCPCS - A9552","TUFTS","TUFTS HMO","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,0,1166.46,1166.46,243]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9552","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,0,1166.46,1166.46,243]
["TUFTS - TUFTS POS - HCPCS - A9552","TUFTS","TUFTS POS","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,0,1166.46,1166.46,243]
["FALLON - FALLON MEDICAID - HCPCS - A9552","FALLON","FALLON MEDICAID","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,0,1166.46,1166.46,243]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9552","BMC HEALTHNET","BMCHN QHP","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,0,1166.46,1166.46,243]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9552","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,1166.46,1166.46,1166.46,243]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9552","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,0,1166.46,1166.46,243]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9552","BMC HEALTHNET","BMCHN ACO","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,0,1166.46,1166.46,243]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9552","BMC HEALTHNET","BMCHN MCO","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,0,1166.46,1166.46,243]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9552","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,0,1166.46,1166.46,243]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9552","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,0,1166.46,1166.46,243]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9552","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,0,1166.46,1166.46,243]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9552","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,1166.46,1166.46,1166.46,243]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9552","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,1166.46,1166.46,1166.46,243]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9552","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,1166.46,1166.46,1166.46,243]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9552","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,1166.46,1166.46,1166.46,243]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9552","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,1166.46,1166.46,1166.46,243]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9552","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9552","F18 FDG","A9552 - F18 FDG",972,1166.46,1166.46,1166.46,243]
["TUFTS - TUFTS PPO - HCPCS - A9555","TUFTS","TUFTS PPO","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,0,1604.08,1604.08,266.25]
["TUFTS - TUFTS SELECT - HCPCS - A9555","TUFTS","TUFTS SELECT","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,0,1604.08,1604.08,266.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9555","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,0,1604.08,1604.08,266.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9555","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,0,1604.08,1604.08,266.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9555","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,0,1604.08,1604.08,266.25]
["TUFTS - TUFTS HMO - HCPCS - A9555","TUFTS","TUFTS HMO","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,0,1604.08,1604.08,266.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9555","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,0,1604.08,1604.08,266.25]
["TUFTS - TUFTS POS - HCPCS - A9555","TUFTS","TUFTS POS","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,0,1604.08,1604.08,266.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9555","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,0,1604.08,1604.08,266.25]
["FALLON - FALLON MEDICAID - HCPCS - A9555","FALLON","FALLON MEDICAID","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,0,1604.08,1604.08,266.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9555","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,1604.08,1604.08,1604.08,266.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9555","BMC HEALTHNET","BMCHN ACO","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,0,1604.08,1604.08,266.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9555","BMC HEALTHNET","BMCHN QHP","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,0,1604.08,1604.08,266.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9555","BMC HEALTHNET","BMCHN MCO","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,0,1604.08,1604.08,266.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9555","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,0,1604.08,1604.08,266.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9555","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,0,1604.08,1604.08,266.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9555","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,1604.08,1604.08,1604.08,266.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9555","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,0,1604.08,1604.08,266.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9555","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,1604.08,1604.08,1604.08,266.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9555","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,0,1604.08,1604.08,266.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9555","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,1604.08,1604.08,1604.08,266.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9555","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,1604.08,1604.08,1604.08,266.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9555","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,1604.08,1604.08,1604.08,266.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9555","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9555","RADIOPHARMACIAL","A9555 - RADIOPHARMACIAL",1065,1604.08,1604.08,1604.08,266.25]
["TUFTS - TUFTS PPO - HCPCS - A9556","TUFTS","TUFTS PPO","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,0,311.94,311.94,5]
["TUFTS - TUFTS SELECT - HCPCS - A9556","TUFTS","TUFTS SELECT","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,0,311.94,311.94,5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9556","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,0,311.94,311.94,5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9556","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,0,311.94,311.94,5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9556","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,0,311.94,311.94,5]
["FALLON - FALLON MEDICAID - HCPCS - A9556","FALLON","FALLON MEDICAID","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,0,311.94,311.94,5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9556","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,0,311.94,311.94,5]
["TUFTS - TUFTS HMO - HCPCS - A9556","TUFTS","TUFTS HMO","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,0,311.94,311.94,5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9556","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,0,311.94,311.94,5]
["TUFTS - TUFTS POS - HCPCS - A9556","TUFTS","TUFTS POS","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,0,311.94,311.94,5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9556","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,311.94,311.94,311.94,5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9556","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,0,311.94,311.94,5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9556","BMC HEALTHNET","BMCHN QHP","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,0,311.94,311.94,5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9556","BMC HEALTHNET","BMCHN ACO","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,0,311.94,311.94,5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9556","BMC HEALTHNET","BMCHN MCO","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,0,311.94,311.94,5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9556","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,0,311.94,311.94,5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9556","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,0,311.94,311.94,5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9556","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,0,311.94,311.94,5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9556","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,311.94,311.94,311.94,5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9556","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,311.94,311.94,311.94,5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9556","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,311.94,311.94,311.94,5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9556","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,311.94,311.94,311.94,5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9556","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,311.94,311.94,311.94,5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9556","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9556","GA67 GALLIUM","A9556 - GA67 GALLIUM",20,311.94,311.94,311.94,5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9557","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,0,1062.44,1062.44,59.75]
["TUFTS - TUFTS PPO - HCPCS - A9557","TUFTS","TUFTS PPO","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,0,1062.44,1062.44,59.75]
["TUFTS - TUFTS SELECT - HCPCS - A9557","TUFTS","TUFTS SELECT","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,0,1062.44,1062.44,59.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9557","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,0,1062.44,1062.44,59.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9557","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,0,1062.44,1062.44,59.75]
["FALLON - FALLON MEDICAID - HCPCS - A9557","FALLON","FALLON MEDICAID","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,0,1062.44,1062.44,59.75]
["TUFTS - TUFTS POS - HCPCS - A9557","TUFTS","TUFTS POS","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,0,1062.44,1062.44,59.75]
["TUFTS - TUFTS HMO - HCPCS - A9557","TUFTS","TUFTS HMO","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,0,1062.44,1062.44,59.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9557","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,0,1062.44,1062.44,59.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9557","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,0,1062.44,1062.44,59.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9557","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,1062.44,1062.44,1062.44,59.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9557","BMC HEALTHNET","BMCHN ACO","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,0,1062.44,1062.44,59.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9557","BMC HEALTHNET","BMCHN QHP","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,0,1062.44,1062.44,59.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9557","BMC HEALTHNET","BMCHN MCO","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,0,1062.44,1062.44,59.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9557","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,0,1062.44,1062.44,59.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9557","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,0,1062.44,1062.44,59.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9557","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,1062.44,1062.44,1062.44,59.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9557","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,0,1062.44,1062.44,59.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9557","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,1062.44,1062.44,1062.44,59.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9557","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,1062.44,1062.44,1062.44,59.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9557","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,0,1062.44,1062.44,59.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9557","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,1062.44,1062.44,1062.44,59.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9557","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,1062.44,1062.44,1062.44,59.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9557","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9557","TC99M BICISATE","A9557 - TC99M BICISATE",239,1062.44,1062.44,1062.44,59.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9558","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,0,108.88,108.88,5.75]
["TUFTS - TUFTS SELECT - HCPCS - A9558","TUFTS","TUFTS SELECT","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,0,108.88,108.88,5.75]
["TUFTS - TUFTS PPO - HCPCS - A9558","TUFTS","TUFTS PPO","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,0,108.88,108.88,5.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9558","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,0,108.88,108.88,5.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9558","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,0,108.88,108.88,5.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9558","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,0,108.88,108.88,5.75]
["TUFTS - TUFTS HMO - HCPCS - A9558","TUFTS","TUFTS HMO","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,0,108.88,108.88,5.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9558","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,0,108.88,108.88,5.75]
["FALLON - FALLON MEDICAID - HCPCS - A9558","FALLON","FALLON MEDICAID","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,0,108.88,108.88,5.75]
["TUFTS - TUFTS POS - HCPCS - A9558","TUFTS","TUFTS POS","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,0,108.88,108.88,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9558","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,108.88,108.88,108.88,5.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9558","BMC HEALTHNET","BMCHN QHP","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,0,108.88,108.88,5.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9558","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,0,108.88,108.88,5.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9558","BMC HEALTHNET","BMCHN ACO","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,0,108.88,108.88,5.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9558","BMC HEALTHNET","BMCHN MCO","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,0,108.88,108.88,5.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9558","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,0,108.88,108.88,5.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9558","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,0,108.88,108.88,5.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9558","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,0,108.88,108.88,5.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9558","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,108.88,108.88,108.88,5.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9558","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,108.88,108.88,108.88,5.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9558","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,108.88,108.88,108.88,5.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9558","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,108.88,108.88,108.88,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9558","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,108.88,108.88,108.88,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9558","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9558","HC XENON133/10MCI","A9558 - HC XENON133/10MCI",23,108.88,108.88,108.88,5.75]
["TUFTS - TUFTS SELECT - HCPCS - A9560","TUFTS","TUFTS SELECT","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,0,266.7,266.7,61.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9560","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,0,266.7,266.7,61.5]
["TUFTS - TUFTS PPO - HCPCS - A9560","TUFTS","TUFTS PPO","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,0,266.7,266.7,61.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9560","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,0,266.7,266.7,61.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9560","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,0,266.7,266.7,61.5]
["TUFTS - TUFTS HMO - HCPCS - A9560","TUFTS","TUFTS HMO","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,0,266.7,266.7,61.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9560","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,0,266.7,266.7,61.5]
["TUFTS - TUFTS POS - HCPCS - A9560","TUFTS","TUFTS POS","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,0,266.7,266.7,61.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9560","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,0,266.7,266.7,61.5]
["FALLON - FALLON MEDICAID - HCPCS - A9560","FALLON","FALLON MEDICAID","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,0,266.7,266.7,61.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9560","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,266.7,266.7,266.7,61.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9560","BMC HEALTHNET","BMCHN ACO","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,0,266.7,266.7,61.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9560","BMC HEALTHNET","BMCHN QHP","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,0,266.7,266.7,61.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9560","BMC HEALTHNET","BMCHN MCO","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,0,266.7,266.7,61.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9560","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,0,266.7,266.7,61.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9560","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,0,266.7,266.7,61.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9560","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,0,266.7,266.7,61.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9560","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,266.7,266.7,266.7,61.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9560","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,266.7,266.7,266.7,61.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9560","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,0,266.7,266.7,61.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9560","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,266.7,266.7,266.7,61.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9560","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,266.7,266.7,266.7,61.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9560","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,266.7,266.7,266.7,61.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9560","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9560","TC99M LABELED RBC","A9560 - TC99M LABELED RBC",246,266.7,266.7,266.7,61.5]
["TUFTS - TUFTS SELECT - HCPCS - A9561","TUFTS","TUFTS SELECT","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,0,125.64,125.64,31.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9561","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,0,125.64,125.64,31.75]
["TUFTS - TUFTS PPO - HCPCS - A9561","TUFTS","TUFTS PPO","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,0,125.64,125.64,31.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9561","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,0,125.64,125.64,31.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9561","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,0,125.64,125.64,31.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9561","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,0,125.64,125.64,31.75]
["TUFTS - TUFTS HMO - HCPCS - A9561","TUFTS","TUFTS HMO","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,0,125.64,125.64,31.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9561","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,0,125.64,125.64,31.75]
["FALLON - FALLON MEDICAID - HCPCS - A9561","FALLON","FALLON MEDICAID","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,0,125.64,125.64,31.75]
["TUFTS - TUFTS POS - HCPCS - A9561","TUFTS","TUFTS POS","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,0,125.64,125.64,31.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9561","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,125.64,125.64,125.64,31.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9561","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,0,125.64,125.64,31.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9561","BMC HEALTHNET","BMCHN QHP","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,0,125.64,125.64,31.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9561","BMC HEALTHNET","BMCHN ACO","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,0,125.64,125.64,31.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9561","BMC HEALTHNET","BMCHN MCO","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,0,125.64,125.64,31.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9561","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,0,125.64,125.64,31.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9561","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,0,125.64,125.64,31.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9561","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,0,125.64,125.64,31.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9561","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,125.64,125.64,125.64,31.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9561","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,125.64,125.64,125.64,31.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9561","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,125.64,125.64,125.64,31.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9561","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,125.64,125.64,125.64,31.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9561","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,125.64,125.64,125.64,31.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9561","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9561","TC99M OXIDRONATE","A9561 - TC99M OXIDRONATE",127,125.64,125.64,125.64,31.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9562","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,0,2212.25,2212.25,309.25]
["TUFTS - TUFTS SELECT - HCPCS - A9562","TUFTS","TUFTS SELECT","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,0,2212.25,2212.25,309.25]
["TUFTS - TUFTS PPO - HCPCS - A9562","TUFTS","TUFTS PPO","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,0,2212.25,2212.25,309.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9562","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,0,2212.25,2212.25,309.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9562","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,0,2212.25,2212.25,309.25]
["TUFTS - TUFTS POS - HCPCS - A9562","TUFTS","TUFTS POS","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,0,2212.25,2212.25,309.25]
["TUFTS - TUFTS HMO - HCPCS - A9562","TUFTS","TUFTS HMO","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,0,2212.25,2212.25,309.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9562","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,0,2212.25,2212.25,309.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9562","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,0,2212.25,2212.25,309.25]
["FALLON - FALLON MEDICAID - HCPCS - A9562","FALLON","FALLON MEDICAID","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,0,2212.25,2212.25,309.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9562","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,2212.25,2212.25,2212.25,309.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9562","BMC HEALTHNET","BMCHN ACO","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,0,2212.25,2212.25,309.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9562","BMC HEALTHNET","BMCHN QHP","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,0,2212.25,2212.25,309.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9562","BMC HEALTHNET","BMCHN MCO","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,0,2212.25,2212.25,309.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9562","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,0,2212.25,2212.25,309.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9562","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,0,2212.25,2212.25,309.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9562","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,0,2212.25,2212.25,309.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9562","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,2212.25,2212.25,2212.25,309.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9562","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,2212.25,2212.25,2212.25,309.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9562","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,2212.25,2212.25,2212.25,309.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9562","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,0,2212.25,2212.25,309.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9562","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,2212.25,2212.25,2212.25,309.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9562","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,2212.25,2212.25,2212.25,309.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9562","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9562","TC99M MERTIATIDE","A9562 - TC99M MERTIATIDE",1237,2212.25,2212.25,2212.25,309.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9563","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,535.17999999999995,535.17999999999995,3182.68,0]
["TUFTS - TUFTS SELECT - HCPCS - A9563","TUFTS","TUFTS SELECT","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,1058.54,535.17999999999995,3182.68,0]
["TUFTS - TUFTS PPO - HCPCS - A9563","TUFTS","TUFTS PPO","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,1132.32,535.17999999999995,3182.68,0]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9563","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,535.17999999999995,535.17999999999995,3182.68,0]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9563","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,0,535.17999999999995,3182.68,0]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9563","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,535.17999999999995,535.17999999999995,3182.68,0]
["FALLON - FALLON MEDICAID - HCPCS - A9563","FALLON","FALLON MEDICAID","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,0,535.17999999999995,3182.68,0]
["TUFTS - TUFTS HMO - HCPCS - A9563","TUFTS","TUFTS HMO","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,1270.25,535.17999999999995,3182.68,0]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9563","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,535.17999999999995,535.17999999999995,3182.68,0]
["TUFTS - TUFTS POS - HCPCS - A9563","TUFTS","TUFTS POS","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,1058.54,535.17999999999995,3182.68,0]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9563","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,870.53,535.17999999999995,3182.68,0]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9563","BMC HEALTHNET","BMCHN QHP","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,0,535.17999999999995,3182.68,0]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9563","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,3182.68,535.17999999999995,3182.68,0]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9563","BMC HEALTHNET","BMCHN ACO","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,0,535.17999999999995,3182.68,0]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9563","BMC HEALTHNET","BMCHN MCO","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,0,535.17999999999995,3182.68,0]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9563","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,0,535.17999999999995,3182.68,0]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9563","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,0,535.17999999999995,3182.68,0]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9563","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,0,535.17999999999995,3182.68,0]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9563","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,870.53,535.17999999999995,3182.68,0]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9563","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,870.53,535.17999999999995,3182.68,0]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9563","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,870.53,535.17999999999995,3182.68,0]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9563","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,870.53,535.17999999999995,3182.68,0]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9563","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,870.53,535.17999999999995,3182.68,0]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9563","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9563","P32 NA PHOSPHATE","A9563 - P32 NA PHOSPHATE",0,870.53,535.17999999999995,3182.68,0]
["TUFTS - TUFTS SELECT - HCPCS - A9569","TUFTS","TUFTS SELECT","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,0,4157.3,4157.3,1271.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9569","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,0,4157.3,4157.3,1271.5]
["TUFTS - TUFTS PPO - HCPCS - A9569","TUFTS","TUFTS PPO","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,0,4157.3,4157.3,1271.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9569","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,0,4157.3,4157.3,1271.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9569","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,0,4157.3,4157.3,1271.5]
["FALLON - FALLON MEDICAID - HCPCS - A9569","FALLON","FALLON MEDICAID","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,0,4157.3,4157.3,1271.5]
["TUFTS - TUFTS HMO - HCPCS - A9569","TUFTS","TUFTS HMO","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,0,4157.3,4157.3,1271.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9569","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,0,4157.3,4157.3,1271.5]
["TUFTS - TUFTS POS - HCPCS - A9569","TUFTS","TUFTS POS","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,0,4157.3,4157.3,1271.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9569","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,0,4157.3,4157.3,1271.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9569","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,4157.3,4157.3,4157.3,1271.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9569","BMC HEALTHNET","BMCHN ACO","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,0,4157.3,4157.3,1271.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9569","BMC HEALTHNET","BMCHN QHP","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,0,4157.3,4157.3,1271.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9569","BMC HEALTHNET","BMCHN MCO","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,0,4157.3,4157.3,1271.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9569","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,0,4157.3,4157.3,1271.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9569","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,0,4157.3,4157.3,1271.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9569","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,4157.3,4157.3,4157.3,1271.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9569","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,4157.3,4157.3,4157.3,1271.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9569","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,0,4157.3,4157.3,1271.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9569","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,0,4157.3,4157.3,1271.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9569","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,4157.3,4157.3,4157.3,1271.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9569","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,4157.3,4157.3,4157.3,1271.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9569","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,4157.3,4157.3,4157.3,1271.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9569","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC","A9569 - TECHNETIUM TC-99M AUTO WBC",5086,4157.3,4157.3,4157.3,1271.5]
["TUFTS - TUFTS SELECT - HCPCS - A9570","TUFTS","TUFTS SELECT","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC","A9570 - HC INDIUM IN-111 AUTO WBC",6395,0,0,0,1598.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9570","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC","A9570 - HC INDIUM IN-111 AUTO WBC",6395,0,0,0,1598.75]
["TUFTS - TUFTS PPO - HCPCS - A9570","TUFTS","TUFTS PPO","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC","A9570 - HC INDIUM IN-111 AUTO WBC",6395,0,0,0,1598.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9570","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC","A9570 - HC INDIUM IN-111 AUTO WBC",6395,0,0,0,1598.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9570","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC","A9570 - HC INDIUM IN-111 AUTO WBC",6395,0,0,0,1598.75]
["FALLON - FALLON MEDICAID - HCPCS - A9570","FALLON","FALLON MEDICAID","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC","A9570 - HC INDIUM IN-111 AUTO WBC",6395,0,0,0,1598.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9570","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC","A9570 - HC INDIUM IN-111 AUTO WBC",6395,0,0,0,1598.75]
["TUFTS - TUFTS HMO - HCPCS - A9570","TUFTS","TUFTS HMO","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC","A9570 - HC INDIUM IN-111 AUTO WBC",6395,0,0,0,1598.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9570","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC","A9570 - HC INDIUM IN-111 AUTO WBC",6395,0,0,0,1598.75]
["TUFTS - TUFTS POS - HCPCS - A9570","TUFTS","TUFTS POS","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC","A9570 - HC INDIUM IN-111 AUTO WBC",6395,0,0,0,1598.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9570","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC","A9570 - HC INDIUM IN-111 AUTO WBC",6395,0,0,0,1598.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9570","BMC HEALTHNET","BMCHN QHP","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC","A9570 - HC INDIUM IN-111 AUTO WBC",6395,0,0,0,1598.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9570","BMC HEALTHNET","BMCHN ACO","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC","A9570 - HC INDIUM IN-111 AUTO WBC",6395,0,0,0,1598.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9570","BMC HEALTHNET","BMCHN MCO","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC","A9570 - HC INDIUM IN-111 AUTO WBC",6395,0,0,0,1598.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9570","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC","A9570 - HC INDIUM IN-111 AUTO WBC",6395,0,0,0,1598.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9570","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC","A9570 - HC INDIUM IN-111 AUTO WBC",6395,0,0,0,1598.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9570","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC","A9570 - HC INDIUM IN-111 AUTO WBC",6395,0,0,0,1598.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9572","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,0,16207.01,16207.01,32.75]
["TUFTS - TUFTS SELECT - HCPCS - A9572","TUFTS","TUFTS SELECT","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,0,16207.01,16207.01,32.75]
["TUFTS - TUFTS PPO - HCPCS - A9572","TUFTS","TUFTS PPO","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,0,16207.01,16207.01,32.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9572","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,0,16207.01,16207.01,32.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9572","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,0,16207.01,16207.01,32.75]
["FALLON - FALLON MEDICAID - HCPCS - A9572","FALLON","FALLON MEDICAID","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,0,16207.01,16207.01,32.75]
["TUFTS - TUFTS POS - HCPCS - A9572","TUFTS","TUFTS POS","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,0,16207.01,16207.01,32.75]
["TUFTS - TUFTS HMO - HCPCS - A9572","TUFTS","TUFTS HMO","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,0,16207.01,16207.01,32.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9572","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,0,16207.01,16207.01,32.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9572","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,0,16207.01,16207.01,32.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9572","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,16207.01,16207.01,16207.01,32.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9572","BMC HEALTHNET","BMCHN ACO","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,0,16207.01,16207.01,32.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9572","BMC HEALTHNET","BMCHN QHP","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,0,16207.01,16207.01,32.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9572","BMC HEALTHNET","BMCHN MCO","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,0,16207.01,16207.01,32.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9572","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,0,16207.01,16207.01,32.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9572","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,0,16207.01,16207.01,32.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9572","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,0,16207.01,16207.01,32.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9572","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,0,16207.01,16207.01,32.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9572","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,16207.01,16207.01,16207.01,32.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9572","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,16207.01,16207.01,16207.01,32.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9572","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,16207.01,16207.01,16207.01,32.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9572","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,16207.01,16207.01,16207.01,32.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9572","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,16207.01,16207.01,16207.01,32.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9572","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE","A9572 - INDIUM IN-111 PENTETREOTIDE",131,16207.01,16207.01,16207.01,32.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9575","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0,0.18,0.45,2]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A9575","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.22,0.18,0.45,2]
["TUFTS - TUFTS SELECT - HCPCS - A9575","TUFTS","TUFTS SELECT","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0,0.18,0.45,2]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A9575","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.22,0.18,0.45,2]
["TUFTS - TUFTS PPO - HCPCS - A9575","TUFTS","TUFTS PPO","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0,0.18,0.45,2]
["UNICARE - UNICARE - HCPCS - A9575","UNICARE","UNICARE","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.19,0.18,0.45,2]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - A9575","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.19,0.18,0.45,2]
["TUFTS - TUFTS SPIRIT - HCPCS - A9575","TUFTS","TUFTS SPIRIT","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.2,0.18,0.45,2]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A9575","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.24,0.18,0.45,2]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9575","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0,0.18,0.45,2]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A9575","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.26,0.18,0.45,2]
["FALLON - FALLON SENIOR PLAN - HCPCS - A9575","FALLON","FALLON SENIOR PLAN","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.18,0.18,0.45,2]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9575","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0,0.18,0.45,2]
["TUFTS - TUFTS HMO - HCPCS - A9575","TUFTS","TUFTS HMO","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0,0.18,0.45,2]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9575","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0,0.18,0.45,2]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - A9575","TUFTS","TUFTS MEDICARE SCO","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.26,0.18,0.45,2]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A9575","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.39,0.18,0.45,2]
["TUFTS - TUFTS POS - HCPCS - A9575","TUFTS","TUFTS POS","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0,0.18,0.45,2]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A9575","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.31,0.18,0.45,2]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9575","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.21,0.18,0.45,2]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A9575","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.4,0.18,0.45,2]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9575","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0,0.18,0.45,2]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A9575","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.18,0.18,0.45,2]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A9575","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.18,0.18,0.45,2]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A9575","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.18,0.18,0.45,2]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A9575","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.18,0.18,0.45,2]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A9575","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.45,0.18,0.45,2]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9575","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.21,0.18,0.45,2]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9575","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.21,0.18,0.45,2]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9575","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.21,0.18,0.45,2]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9575","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.21,0.18,0.45,2]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9575","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.21,0.18,0.45,2]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A9575","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.21,0.18,0.45,2]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9575","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",8,0.21,0.18,0.45,2]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A9576","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,1.8,1.5,3.77,1.25]
["UNICARE - UNICARE - HCPCS - A9576","UNICARE","UNICARE","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,1.56,1.5,3.77,1.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - A9576","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,1.56,1.5,3.77,1.25]
["TUFTS - TUFTS SELECT - HCPCS - A9576","TUFTS","TUFTS SELECT","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,0,1.5,3.77,1.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9576","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,0,1.5,3.77,1.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A9576","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,1.8,1.5,3.77,1.25]
["TUFTS - TUFTS PPO - HCPCS - A9576","TUFTS","TUFTS PPO","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,0,1.5,3.77,1.25]
["TUFTS - TUFTS SPIRIT - HCPCS - A9576","TUFTS","TUFTS SPIRIT","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,1.65,1.5,3.77,1.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9576","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,0,1.5,3.77,1.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A9576","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,2.02,1.5,3.77,1.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - A9576","FALLON","FALLON SENIOR PLAN","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,1.5,1.5,3.77,1.25]
["TUFTS - TUFTS HMO - HCPCS - A9576","TUFTS","TUFTS HMO","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,0,1.5,3.77,1.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9576","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,0,1.5,3.77,1.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - A9576","TUFTS","TUFTS MEDICARE SCO","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,2.1800000000000002,1.5,3.77,1.25]
["TUFTS - TUFTS POS - HCPCS - A9576","TUFTS","TUFTS POS","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,0,1.5,3.77,1.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9576","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,0,1.5,3.77,1.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A9576","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,2.1800000000000002,1.5,3.77,1.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A9576","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,3.24,1.5,3.77,1.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A9576","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,2.61,1.5,3.77,1.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9576","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,3.76,1.5,3.77,1.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A9576","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,1.5,1.5,3.77,1.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A9576","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,1.5,1.5,3.77,1.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A9576","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,1.5,1.5,3.77,1.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A9576","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,1.5,1.5,3.77,1.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A9576","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,3.31,1.5,3.77,1.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9576","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,0,1.5,3.77,1.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9576","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,3.76,1.5,3.77,1.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9576","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,3.76,1.5,3.77,1.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A9576","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,3.77,1.5,3.77,1.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A9576","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,1.77,1.5,3.77,1.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9576","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,3.76,1.5,3.77,1.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9576","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,3.76,1.5,3.77,1.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9576","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,3.76,1.5,3.77,1.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9576","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML",5,3.76,1.5,3.77,1.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A9577","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,2.17,1.81,5.03,5.25]
["TUFTS - TUFTS SELECT - HCPCS - A9577","TUFTS","TUFTS SELECT","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,0,1.81,5.03,5.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9577","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,0,1.81,5.03,5.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A9577","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,2.17,1.81,5.03,5.25]
["UNICARE - UNICARE - HCPCS - A9577","UNICARE","UNICARE","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,1.88,1.81,5.03,5.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - A9577","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,1.88,1.81,5.03,5.25]
["TUFTS - TUFTS SPIRIT - HCPCS - A9577","TUFTS","TUFTS SPIRIT","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,1.99,1.81,5.03,5.25]
["TUFTS - TUFTS PPO - HCPCS - A9577","TUFTS","TUFTS PPO","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,0,1.81,5.03,5.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A9577","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,2.44,1.81,5.03,5.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9577","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,0,1.81,5.03,5.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - A9577","FALLON","FALLON SENIOR PLAN","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,1.81,1.81,5.03,5.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9577","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,0,1.81,5.03,5.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A9577","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,2.62,1.81,5.03,5.25]
["TUFTS - TUFTS HMO - HCPCS - A9577","TUFTS","TUFTS HMO","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,0,1.81,5.03,5.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9577","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,0,1.81,5.03,5.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - A9577","TUFTS","TUFTS MEDICARE SCO","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,2.62,1.81,5.03,5.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A9577","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,3.91,1.81,5.03,5.25]
["TUFTS - TUFTS POS - HCPCS - A9577","TUFTS","TUFTS POS","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,0,1.81,5.03,5.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A9577","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,3.15,1.81,5.03,5.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9577","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,5.03,1.81,5.03,5.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9577","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,0,1.81,5.03,5.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A9577","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,4,1.81,5.03,5.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A9577","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,1.81,1.81,5.03,5.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A9577","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,1.81,1.81,5.03,5.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A9577","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,1.81,1.81,5.03,5.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A9577","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,1.81,1.81,5.03,5.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9577","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,5.03,1.81,5.03,5.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9577","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,5.03,1.81,5.03,5.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A9577","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,4.55,1.81,5.03,5.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9577","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,5.03,1.81,5.03,5.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9577","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,5.03,1.81,5.03,5.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9577","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,5.03,1.81,5.03,5.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A9577","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,2.14,1.81,5.03,5.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9577","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",21,5.03,1.81,5.03,5.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9579","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,0,1.53,4.38,1.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A9579","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,1.84,1.53,4.38,1.25]
["UNICARE - UNICARE - HCPCS - A9579","UNICARE","UNICARE","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,1.58,1.53,4.38,1.25]
["TUFTS - TUFTS SELECT - HCPCS - A9579","TUFTS","TUFTS SELECT","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,0,1.53,4.38,1.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - A9579","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,1.58,1.53,4.38,1.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A9579","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,1.84,1.53,4.38,1.25]
["TUFTS - TUFTS SPIRIT - HCPCS - A9579","TUFTS","TUFTS SPIRIT","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,1.68,1.53,4.38,1.25]
["TUFTS - TUFTS PPO - HCPCS - A9579","TUFTS","TUFTS PPO","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,0,1.53,4.38,1.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9579","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,0,1.53,4.38,1.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A9579","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,2.06,1.53,4.38,1.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - A9579","FALLON","FALLON SENIOR PLAN","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,1.53,1.53,4.38,1.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - A9579","TUFTS","TUFTS MEDICARE SCO","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,2.2200000000000002,1.53,4.38,1.25]
["TUFTS - TUFTS POS - HCPCS - A9579","TUFTS","TUFTS POS","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,0,1.53,4.38,1.25]
["TUFTS - TUFTS HMO - HCPCS - A9579","TUFTS","TUFTS HMO","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,0,1.53,4.38,1.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9579","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,0,1.53,4.38,1.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9579","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,0,1.53,4.38,1.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A9579","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,2.2200000000000002,1.53,4.38,1.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A9579","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,3.3,1.53,4.38,1.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A9579","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,2.66,1.53,4.38,1.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9579","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,4.38,1.53,4.38,1.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A9579","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,3.38,1.53,4.38,1.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A9579","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,1.53,1.53,4.38,1.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A9579","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,1.53,1.53,4.38,1.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A9579","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,1.53,1.53,4.38,1.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A9579","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,1.53,1.53,4.38,1.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9579","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,0,1.53,4.38,1.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9579","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,4.38,1.53,4.38,1.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9579","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,4.38,1.53,4.38,1.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A9579","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,3.85,1.53,4.38,1.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A9579","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,1.81,1.53,4.38,1.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9579","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,4.38,1.53,4.38,1.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9579","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,4.38,1.53,4.38,1.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9579","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,4.38,1.53,4.38,1.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9579","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,4.38,1.53,4.38,1.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9580","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE","A9580 - HC NA FLUORIDE F-18, DOSE",158,0,0,0,39.5]
["TUFTS - TUFTS SELECT - HCPCS - A9580","TUFTS","TUFTS SELECT","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE","A9580 - HC NA FLUORIDE F-18, DOSE",158,0,0,0,39.5]
["TUFTS - TUFTS PPO - HCPCS - A9580","TUFTS","TUFTS PPO","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE","A9580 - HC NA FLUORIDE F-18, DOSE",158,0,0,0,39.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9580","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE","A9580 - HC NA FLUORIDE F-18, DOSE",158,0,0,0,39.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9580","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE","A9580 - HC NA FLUORIDE F-18, DOSE",158,0,0,0,39.5]
["FALLON - FALLON MEDICAID - HCPCS - A9580","FALLON","FALLON MEDICAID","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE","A9580 - HC NA FLUORIDE F-18, DOSE",158,0,0,0,39.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9580","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE","A9580 - HC NA FLUORIDE F-18, DOSE",158,0,0,0,39.5]
["TUFTS - TUFTS HMO - HCPCS - A9580","TUFTS","TUFTS HMO","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE","A9580 - HC NA FLUORIDE F-18, DOSE",158,0,0,0,39.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9580","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE","A9580 - HC NA FLUORIDE F-18, DOSE",158,0,0,0,39.5]
["TUFTS - TUFTS POS - HCPCS - A9580","TUFTS","TUFTS POS","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE","A9580 - HC NA FLUORIDE F-18, DOSE",158,0,0,0,39.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9580","BMC HEALTHNET","BMCHN QHP","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE","A9580 - HC NA FLUORIDE F-18, DOSE",158,0,0,0,39.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9580","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE","A9580 - HC NA FLUORIDE F-18, DOSE",158,0,0,0,39.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9580","BMC HEALTHNET","BMCHN ACO","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE","A9580 - HC NA FLUORIDE F-18, DOSE",158,0,0,0,39.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9580","BMC HEALTHNET","BMCHN MCO","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE","A9580 - HC NA FLUORIDE F-18, DOSE",158,0,0,0,39.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9580","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE","A9580 - HC NA FLUORIDE F-18, DOSE",158,0,0,0,39.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9580","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE","A9580 - HC NA FLUORIDE F-18, DOSE",158,0,0,0,39.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9580","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE","A9580 - HC NA FLUORIDE F-18, DOSE",158,0,0,0,39.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A9581","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,17.71,14.76,37.14,24.75]
["TUFTS - TUFTS SELECT - HCPCS - A9581","TUFTS","TUFTS SELECT","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,0,14.76,37.14,24.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9581","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,0,14.76,37.14,24.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A9581","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,17.71,14.76,37.14,24.75]
["UNICARE - UNICARE - HCPCS - A9581","UNICARE","UNICARE","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,15.32,14.76,37.14,24.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - A9581","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,15.32,14.76,37.14,24.75]
["TUFTS - TUFTS SPIRIT - HCPCS - A9581","TUFTS","TUFTS SPIRIT","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,16.239999999999998,14.76,37.14,24.75]
["TUFTS - TUFTS PPO - HCPCS - A9581","TUFTS","TUFTS PPO","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,0,14.76,37.14,24.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9581","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,0,14.76,37.14,24.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A9581","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,19.899999999999999,14.76,37.14,24.75]
["TUFTS - TUFTS HMO - HCPCS - A9581","TUFTS","TUFTS HMO","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,0,14.76,37.14,24.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - A9581","FALLON","FALLON SENIOR PLAN","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,14.76,14.76,37.14,24.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A9581","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,21.4,14.76,37.14,24.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9581","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,0,14.76,37.14,24.75]
["TUFTS - TUFTS POS - HCPCS - A9581","TUFTS","TUFTS POS","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,0,14.76,37.14,24.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9581","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,0,14.76,37.14,24.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - A9581","TUFTS","TUFTS MEDICARE SCO","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,21.4,14.76,37.14,24.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A9581","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,31.87,14.76,37.14,24.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A9581","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,25.68,14.76,37.14,24.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9581","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,16.97,14.76,37.14,24.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A9581","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,32.619999999999997,14.76,37.14,24.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9581","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,0,14.76,37.14,24.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A9581","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,14.76,14.76,37.14,24.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A9581","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,14.76,14.76,37.14,24.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A9581","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,14.76,14.76,37.14,24.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A9581","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,14.76,14.76,37.14,24.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9581","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,16.97,14.76,37.14,24.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A9581","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,37.14,14.76,37.14,24.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9581","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,16.97,14.76,37.14,24.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9581","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,16.97,14.76,37.14,24.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9581","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,16.97,14.76,37.14,24.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9581","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,16.97,14.76,37.14,24.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A9581","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,17.420000000000002,14.76,37.14,24.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9581","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9581","GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ",99,16.97,14.76,37.14,24.75]
["TUFTS - TUFTS SELECT - HCPCS - A9582","TUFTS","TUFTS SELECT","HCPCS","A9582","IODINE I-123 IOBENGUANE","A9582 - IODINE I-123 IOBENGUANE",10370,0,0,0,2592.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9582","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9582","IODINE I-123 IOBENGUANE","A9582 - IODINE I-123 IOBENGUANE",10370,0,0,0,2592.5]
["TUFTS - TUFTS PPO - HCPCS - A9582","TUFTS","TUFTS PPO","HCPCS","A9582","IODINE I-123 IOBENGUANE","A9582 - IODINE I-123 IOBENGUANE",10370,0,0,0,2592.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9582","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9582","IODINE I-123 IOBENGUANE","A9582 - IODINE I-123 IOBENGUANE",10370,0,0,0,2592.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9582","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9582","IODINE I-123 IOBENGUANE","A9582 - IODINE I-123 IOBENGUANE",10370,0,0,0,2592.5]
["FALLON - FALLON MEDICAID - HCPCS - A9582","FALLON","FALLON MEDICAID","HCPCS","A9582","IODINE I-123 IOBENGUANE","A9582 - IODINE I-123 IOBENGUANE",10370,0,0,0,2592.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9582","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9582","IODINE I-123 IOBENGUANE","A9582 - IODINE I-123 IOBENGUANE",10370,0,0,0,2592.5]
["TUFTS - TUFTS HMO - HCPCS - A9582","TUFTS","TUFTS HMO","HCPCS","A9582","IODINE I-123 IOBENGUANE","A9582 - IODINE I-123 IOBENGUANE",10370,0,0,0,2592.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9582","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9582","IODINE I-123 IOBENGUANE","A9582 - IODINE I-123 IOBENGUANE",10370,0,0,0,2592.5]
["TUFTS - TUFTS POS - HCPCS - A9582","TUFTS","TUFTS POS","HCPCS","A9582","IODINE I-123 IOBENGUANE","A9582 - IODINE I-123 IOBENGUANE",10370,0,0,0,2592.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9582","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9582","IODINE I-123 IOBENGUANE","A9582 - IODINE I-123 IOBENGUANE",10370,0,0,0,2592.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9582","BMC HEALTHNET","BMCHN ACO","HCPCS","A9582","IODINE I-123 IOBENGUANE","A9582 - IODINE I-123 IOBENGUANE",10370,0,0,0,2592.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9582","BMC HEALTHNET","BMCHN QHP","HCPCS","A9582","IODINE I-123 IOBENGUANE","A9582 - IODINE I-123 IOBENGUANE",10370,0,0,0,2592.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9582","BMC HEALTHNET","BMCHN MCO","HCPCS","A9582","IODINE I-123 IOBENGUANE","A9582 - IODINE I-123 IOBENGUANE",10370,0,0,0,2592.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9582","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9582","IODINE I-123 IOBENGUANE","A9582 - IODINE I-123 IOBENGUANE",10370,0,0,0,2592.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9582","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9582","IODINE I-123 IOBENGUANE","A9582 - IODINE I-123 IOBENGUANE",10370,0,0,0,2592.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9582","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9582","IODINE I-123 IOBENGUANE","A9582 - IODINE I-123 IOBENGUANE",10370,0,0,0,2592.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9583","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,0,19.260000000000002,21.34,3.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - A9583","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,19.260000000000002,19.260000000000002,21.34,3.25]
["UNICARE - UNICARE - HCPCS - A9583","UNICARE","UNICARE","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,19.260000000000002,19.260000000000002,21.34,3.25]
["TUFTS - TUFTS SELECT - HCPCS - A9583","TUFTS","TUFTS SELECT","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,0,19.260000000000002,21.34,3.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9583","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,0,19.260000000000002,21.34,3.25]
["TUFTS - TUFTS PPO - HCPCS - A9583","TUFTS","TUFTS PPO","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,0,19.260000000000002,21.34,3.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9583","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,0,19.260000000000002,21.34,3.25]
["TUFTS - TUFTS POS - HCPCS - A9583","TUFTS","TUFTS POS","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,0,19.260000000000002,21.34,3.25]
["FALLON - FALLON MEDICAID - HCPCS - A9583","FALLON","FALLON MEDICAID","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,0,19.260000000000002,21.34,3.25]
["TUFTS - TUFTS HMO - HCPCS - A9583","TUFTS","TUFTS HMO","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,0,19.260000000000002,21.34,3.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9583","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,0,19.260000000000002,21.34,3.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9583","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,0,19.260000000000002,21.34,3.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9583","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,21.34,19.260000000000002,21.34,3.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9583","BMC HEALTHNET","BMCHN QHP","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,0,19.260000000000002,21.34,3.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9583","BMC HEALTHNET","BMCHN ACO","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,0,19.260000000000002,21.34,3.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9583","BMC HEALTHNET","BMCHN MCO","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,0,19.260000000000002,21.34,3.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9583","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,0,19.260000000000002,21.34,3.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9583","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,0,19.260000000000002,21.34,3.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9583","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,0,19.260000000000002,21.34,3.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9583","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,0,19.260000000000002,21.34,3.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9583","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,21.34,19.260000000000002,21.34,3.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9583","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,21.34,19.260000000000002,21.34,3.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9583","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,21.34,19.260000000000002,21.34,3.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9583","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,21.34,19.260000000000002,21.34,3.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9583","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,21.34,19.260000000000002,21.34,3.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9583","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ","A9583 - GADOFOSVESET TRISODIUM INJ",13,21.34,19.260000000000002,21.34,3.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9584","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,0,3235.55,3235.55,682.25]
["TUFTS - TUFTS SELECT - HCPCS - A9584","TUFTS","TUFTS SELECT","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,0,3235.55,3235.55,682.25]
["TUFTS - TUFTS PPO - HCPCS - A9584","TUFTS","TUFTS PPO","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,0,3235.55,3235.55,682.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9584","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,0,3235.55,3235.55,682.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9584","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,0,3235.55,3235.55,682.25]
["FALLON - FALLON MEDICAID - HCPCS - A9584","FALLON","FALLON MEDICAID","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,0,3235.55,3235.55,682.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9584","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,0,3235.55,3235.55,682.25]
["TUFTS - TUFTS HMO - HCPCS - A9584","TUFTS","TUFTS HMO","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,0,3235.55,3235.55,682.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9584","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,0,3235.55,3235.55,682.25]
["TUFTS - TUFTS POS - HCPCS - A9584","TUFTS","TUFTS POS","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,0,3235.55,3235.55,682.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9584","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,3235.55,3235.55,3235.55,682.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9584","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,0,3235.55,3235.55,682.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9584","BMC HEALTHNET","BMCHN ACO","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,0,3235.55,3235.55,682.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9584","BMC HEALTHNET","BMCHN QHP","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,0,3235.55,3235.55,682.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9584","BMC HEALTHNET","BMCHN MCO","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,0,3235.55,3235.55,682.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9584","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,0,3235.55,3235.55,682.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9584","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,3235.55,3235.55,3235.55,682.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9584","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,0,3235.55,3235.55,682.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9584","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,3235.55,3235.55,3235.55,682.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9584","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,0,3235.55,3235.55,682.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9584","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,3235.55,3235.55,3235.55,682.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9584","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,3235.55,3235.55,3235.55,682.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9584","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,3235.55,3235.55,3235.55,682.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9584","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9584","IODINE I-123 IOFLUPANE","A9584 - IODINE I-123 IOFLUPANE",2729,3235.55,3235.55,3235.55,682.25]
["TUFTS - TUFTS SELECT - HCPCS - A9586","TUFTS","TUFTS SELECT","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",4402,4392.1499999999996,3746.06,7452.46,1100.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9586","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",4402,5015.9399999999996,3746.06,7452.46,1100.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9586","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",4402,5015.9399999999996,3746.06,7452.46,1100.5]
["TUFTS - TUFTS PPO - HCPCS - A9586","TUFTS","TUFTS PPO","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",4402,4698.29,3746.06,7452.46,1100.5]
["TUFTS - TUFTS HMO - HCPCS - A9586","TUFTS","TUFTS HMO","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",4402,4392.1499999999996,3746.06,7452.46,1100.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9586","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",4402,5015.9399999999996,3746.06,7452.46,1100.5]
["TUFTS - TUFTS POS - HCPCS - A9586","TUFTS","TUFTS POS","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",4402,4392.1499999999996,3746.06,7452.46,1100.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9586","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",4402,5015.9399999999996,3746.06,7452.46,1100.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9586","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",4402,3746.06,3746.06,7452.46,1100.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9586","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",4402,7452.46,3746.06,7452.46,1100.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9586","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",4402,3746.06,3746.06,7452.46,1100.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9586","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",4402,3746.06,3746.06,7452.46,1100.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9586","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",4402,3746.06,3746.06,7452.46,1100.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9586","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",4402,3746.06,3746.06,7452.46,1100.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9586","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",4402,3746.06,3746.06,7452.46,1100.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9586","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",4402,3746.06,3746.06,7452.46,1100.5]
["TUFTS - TUFTS SELECT - HCPCS - A9587","TUFTS","TUFTS SELECT","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,0,84.97,113.78,3246.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9587","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,113.78,84.97,113.78,3246.25]
["TUFTS - TUFTS PPO - HCPCS - A9587","TUFTS","TUFTS PPO","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,0,84.97,113.78,3246.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9587","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,113.78,84.97,113.78,3246.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9587","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,0,84.97,113.78,3246.25]
["FALLON - FALLON MEDICAID - HCPCS - A9587","FALLON","FALLON MEDICAID","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,0,84.97,113.78,3246.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9587","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,113.78,84.97,113.78,3246.25]
["TUFTS - TUFTS HMO - HCPCS - A9587","TUFTS","TUFTS HMO","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,0,84.97,113.78,3246.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9587","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,113.78,84.97,113.78,3246.25]
["TUFTS - TUFTS POS - HCPCS - A9587","TUFTS","TUFTS POS","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,0,84.97,113.78,3246.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9587","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,0,84.97,113.78,3246.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9587","BMC HEALTHNET","BMCHN QHP","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,0,84.97,113.78,3246.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9587","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,84.97,84.97,113.78,3246.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9587","BMC HEALTHNET","BMCHN ACO","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,0,84.97,113.78,3246.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9587","BMC HEALTHNET","BMCHN MCO","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,0,84.97,113.78,3246.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9587","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,0,84.97,113.78,3246.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9587","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,84.97,84.97,113.78,3246.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9587","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,0,84.97,113.78,3246.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9587","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,84.97,84.97,113.78,3246.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9587","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,84.97,84.97,113.78,3246.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9587","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,0,84.97,113.78,3246.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9587","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,84.97,84.97,113.78,3246.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9587","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,84.97,84.97,113.78,3246.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9587","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9587","GALLIUM GA-68","A9587 - GALLIUM GA-68",12985,84.97,84.97,113.78,3246.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9588","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,703.05,525.05999999999995,703.05,3859.5]
["TUFTS - TUFTS SELECT - HCPCS - A9588","TUFTS","TUFTS SELECT","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,0,525.05999999999995,703.05,3859.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9588","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,703.05,525.05999999999995,703.05,3859.5]
["TUFTS - TUFTS PPO - HCPCS - A9588","TUFTS","TUFTS PPO","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,0,525.05999999999995,703.05,3859.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9588","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,0,525.05999999999995,703.05,3859.5]
["FALLON - FALLON MEDICAID - HCPCS - A9588","FALLON","FALLON MEDICAID","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,0,525.05999999999995,703.05,3859.5]
["TUFTS - TUFTS POS - HCPCS - A9588","TUFTS","TUFTS POS","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,0,525.05999999999995,703.05,3859.5]
["TUFTS - TUFTS HMO - HCPCS - A9588","TUFTS","TUFTS HMO","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,0,525.05999999999995,703.05,3859.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9588","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,703.05,525.05999999999995,703.05,3859.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9588","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,703.05,525.05999999999995,703.05,3859.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9588","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,525.05999999999995,525.05999999999995,703.05,3859.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9588","BMC HEALTHNET","BMCHN ACO","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,0,525.05999999999995,703.05,3859.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9588","BMC HEALTHNET","BMCHN QHP","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,0,525.05999999999995,703.05,3859.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9588","BMC HEALTHNET","BMCHN MCO","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,0,525.05999999999995,703.05,3859.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9588","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,0,525.05999999999995,703.05,3859.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9588","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,0,525.05999999999995,703.05,3859.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9588","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,0,525.05999999999995,703.05,3859.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9588","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,0,525.05999999999995,703.05,3859.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9588","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,525.05999999999995,525.05999999999995,703.05,3859.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9588","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,525.05999999999995,525.05999999999995,703.05,3859.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9588","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,525.05999999999995,525.05999999999995,703.05,3859.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9588","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,525.05999999999995,525.05999999999995,703.05,3859.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9588","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,525.05999999999995,525.05999999999995,703.05,3859.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9588","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9588","FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18",15438,525.05999999999995,525.05999999999995,703.05,3859.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9592","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9592","HC COPPER CU 64 DOTATATE DIAG","A9592 - HC COPPER CU 64 DOTATATE DIAG",5634,0,0,0,1408.5]
["FALLON - FALLON MEDICAID - HCPCS - A9592","FALLON","FALLON MEDICAID","HCPCS","A9592","HC COPPER CU 64 DOTATATE DIAG","A9592 - HC COPPER CU 64 DOTATATE DIAG",5634,0,0,0,1408.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - A9592","BMC HEALTHNET","BMCHN QHP","HCPCS","A9592","HC COPPER CU 64 DOTATATE DIAG","A9592 - HC COPPER CU 64 DOTATATE DIAG",5634,0,0,0,1408.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - A9592","BMC HEALTHNET","BMCHN ACO","HCPCS","A9592","HC COPPER CU 64 DOTATATE DIAG","A9592 - HC COPPER CU 64 DOTATATE DIAG",5634,0,0,0,1408.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - A9592","BMC HEALTHNET","BMCHN MCO","HCPCS","A9592","HC COPPER CU 64 DOTATATE DIAG","A9592 - HC COPPER CU 64 DOTATATE DIAG",5634,0,0,0,1408.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9592","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9592","HC COPPER CU 64 DOTATATE DIAG","A9592 - HC COPPER CU 64 DOTATATE DIAG",5634,0,0,0,1408.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9592","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9592","HC COPPER CU 64 DOTATATE DIAG","A9592 - HC COPPER CU 64 DOTATATE DIAG",5634,0,0,0,1408.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9592","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9592","HC COPPER CU 64 DOTATATE DIAG","A9592 - HC COPPER CU 64 DOTATATE DIAG",5634,0,0,0,1408.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9606","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER","A9606 - RADIUM RA223 DICHLORIDE THER",493,247.36,198.62,597.20000000000005,123.25]
["TUFTS - TUFTS SELECT - HCPCS - A9606","TUFTS","TUFTS SELECT","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER","A9606 - RADIUM RA223 DICHLORIDE THER",493,198.62,198.62,597.20000000000005,123.25]
["TUFTS - TUFTS PPO - HCPCS - A9606","TUFTS","TUFTS PPO","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER","A9606 - RADIUM RA223 DICHLORIDE THER",493,212.47,198.62,597.20000000000005,123.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9606","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER","A9606 - RADIUM RA223 DICHLORIDE THER",493,247.36,198.62,597.20000000000005,123.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9606","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER","A9606 - RADIUM RA223 DICHLORIDE THER",493,247.36,198.62,597.20000000000005,123.25]
["TUFTS - TUFTS HMO - HCPCS - A9606","TUFTS","TUFTS HMO","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER","A9606 - RADIUM RA223 DICHLORIDE THER",493,238.35,198.62,597.20000000000005,123.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9606","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER","A9606 - RADIUM RA223 DICHLORIDE THER",493,247.36,198.62,597.20000000000005,123.25]
["TUFTS - TUFTS POS - HCPCS - A9606","TUFTS","TUFTS POS","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER","A9606 - RADIUM RA223 DICHLORIDE THER",493,198.62,198.62,597.20000000000005,123.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9606","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER","A9606 - RADIUM RA223 DICHLORIDE THER",493,378.21,198.62,597.20000000000005,123.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9606","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER","A9606 - RADIUM RA223 DICHLORIDE THER",493,597.20000000000005,198.62,597.20000000000005,123.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9606","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER","A9606 - RADIUM RA223 DICHLORIDE THER",493,378.21,198.62,597.20000000000005,123.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9606","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER","A9606 - RADIUM RA223 DICHLORIDE THER",493,378.21,198.62,597.20000000000005,123.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9606","BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER","A9606 - RADIUM RA223 DICHLORIDE THER",493,378.21,198.62,597.20000000000005,123.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9606","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER","A9606 - RADIUM RA223 DICHLORIDE THER",493,378.21,198.62,597.20000000000005,123.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9606","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER","A9606 - RADIUM RA223 DICHLORIDE THER",493,378.21,198.62,597.20000000000005,123.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9606","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER","A9606 - RADIUM RA223 DICHLORIDE THER",493,378.21,198.62,597.20000000000005,123.25]
["TUFTS - TUFTS SELECT - HCPCS - C1713","TUFTS","TUFTS SELECT","HCPCS","C1713","HC CORE 10 BONE PLUG","C1713 - HC CORE 10 BONE PLUG",4568,0,0,0,1142]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1713","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1713","HC CORE 10 BONE PLUG","C1713 - HC CORE 10 BONE PLUG",4568,0,0,0,1142]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1713","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1713","HC CORE 10 BONE PLUG","C1713 - HC CORE 10 BONE PLUG",4568,0,0,0,1142]
["TUFTS - TUFTS PPO - HCPCS - C1713","TUFTS","TUFTS PPO","HCPCS","C1713","HC CORE 10 BONE PLUG","C1713 - HC CORE 10 BONE PLUG",4568,0,0,0,1142]
["TUFTS - TUFTS HMO - HCPCS - C1713","TUFTS","TUFTS HMO","HCPCS","C1713","HC CORE 10 BONE PLUG","C1713 - HC CORE 10 BONE PLUG",4568,0,0,0,1142]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1713","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1713","HC CORE 10 BONE PLUG","C1713 - HC CORE 10 BONE PLUG",4568,0,0,0,1142]
["TUFTS - TUFTS POS - HCPCS - C1713","TUFTS","TUFTS POS","HCPCS","C1713","HC CORE 10 BONE PLUG","C1713 - HC CORE 10 BONE PLUG",4568,0,0,0,1142]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1713","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1713","HC CORE 10 BONE PLUG","C1713 - HC CORE 10 BONE PLUG",4568,0,0,0,1142]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1713","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1713","HC CORE 10 BONE PLUG","C1713 - HC CORE 10 BONE PLUG",4568,0,0,0,1142]
["TUFTS - TUFTS SELECT - HCPCS - C1714","TUFTS","TUFTS SELECT","HCPCS","C1714","HC WATHMAN SYS ANTER CURVE","C1714 - HC WATHMAN SYS ANTER CURVE",6114,0,0,0,1528.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1714","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1714","HC WATHMAN SYS ANTER CURVE","C1714 - HC WATHMAN SYS ANTER CURVE",6114,0,0,0,1528.5]
["TUFTS - TUFTS PPO - HCPCS - C1714","TUFTS","TUFTS PPO","HCPCS","C1714","HC WATHMAN SYS ANTER CURVE","C1714 - HC WATHMAN SYS ANTER CURVE",6114,0,0,0,1528.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1714","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1714","HC WATHMAN SYS ANTER CURVE","C1714 - HC WATHMAN SYS ANTER CURVE",6114,0,0,0,1528.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1714","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1714","HC WATHMAN SYS ANTER CURVE","C1714 - HC WATHMAN SYS ANTER CURVE",6114,0,0,0,1528.5]
["TUFTS - TUFTS HMO - HCPCS - C1714","TUFTS","TUFTS HMO","HCPCS","C1714","HC WATHMAN SYS ANTER CURVE","C1714 - HC WATHMAN SYS ANTER CURVE",6114,0,0,0,1528.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1714","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1714","HC WATHMAN SYS ANTER CURVE","C1714 - HC WATHMAN SYS ANTER CURVE",6114,0,0,0,1528.5]
["TUFTS - TUFTS POS - HCPCS - C1714","TUFTS","TUFTS POS","HCPCS","C1714","HC WATHMAN SYS ANTER CURVE","C1714 - HC WATHMAN SYS ANTER CURVE",6114,0,0,0,1528.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1714","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1714","HC WATHMAN SYS ANTER CURVE","C1714 - HC WATHMAN SYS ANTER CURVE",6114,0,0,0,1528.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1715","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1715","BRACHYTHERAPY NEEDLE","C1715 - BRACHYTHERAPY NEEDLE",21,0,0,0,5.25]
["TUFTS - TUFTS SELECT - HCPCS - C1715","TUFTS","TUFTS SELECT","HCPCS","C1715","BRACHYTHERAPY NEEDLE","C1715 - BRACHYTHERAPY NEEDLE",21,0,0,0,5.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1715","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1715","BRACHYTHERAPY NEEDLE","C1715 - BRACHYTHERAPY NEEDLE",21,0,0,0,5.25]
["TUFTS - TUFTS PPO - HCPCS - C1715","TUFTS","TUFTS PPO","HCPCS","C1715","BRACHYTHERAPY NEEDLE","C1715 - BRACHYTHERAPY NEEDLE",21,0,0,0,5.25]
["TUFTS - TUFTS POS - HCPCS - C1715","TUFTS","TUFTS POS","HCPCS","C1715","BRACHYTHERAPY NEEDLE","C1715 - BRACHYTHERAPY NEEDLE",21,0,0,0,5.25]
["TUFTS - TUFTS HMO - HCPCS - C1715","TUFTS","TUFTS HMO","HCPCS","C1715","BRACHYTHERAPY NEEDLE","C1715 - BRACHYTHERAPY NEEDLE",21,0,0,0,5.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1715","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1715","BRACHYTHERAPY NEEDLE","C1715 - BRACHYTHERAPY NEEDLE",21,0,0,0,5.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1715","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1715","BRACHYTHERAPY NEEDLE","C1715 - BRACHYTHERAPY NEEDLE",21,0,0,0,5.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1715","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1715","BRACHYTHERAPY NEEDLE","C1715 - BRACHYTHERAPY NEEDLE",21,0,0,0,5.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1716","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1716","BRACHYTX SOURCE, GOLD 198","C1716 - BRACHYTX SOURCE, GOLD 198",0,200.39,168.52,506.68,0]
["TUFTS - TUFTS SELECT - HCPCS - C1716","TUFTS","TUFTS SELECT","HCPCS","C1716","BRACHYTX SOURCE, GOLD 198","C1716 - BRACHYTX SOURCE, GOLD 198",0,168.52,168.52,506.68,0]
["TUFTS - TUFTS PPO - HCPCS - C1716","TUFTS","TUFTS PPO","HCPCS","C1716","BRACHYTX SOURCE, GOLD 198","C1716 - BRACHYTX SOURCE, GOLD 198",0,180.26,168.52,506.68,0]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1716","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1716","BRACHYTX SOURCE, GOLD 198","C1716 - BRACHYTX SOURCE, GOLD 198",0,200.39,168.52,506.68,0]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1716","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1716","BRACHYTX SOURCE, GOLD 198","C1716 - BRACHYTX SOURCE, GOLD 198",0,200.39,168.52,506.68,0]
["TUFTS - TUFTS HMO - HCPCS - C1716","TUFTS","TUFTS HMO","HCPCS","C1716","BRACHYTX SOURCE, GOLD 198","C1716 - BRACHYTX SOURCE, GOLD 198",0,202.22,168.52,506.68,0]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1716","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1716","BRACHYTX SOURCE, GOLD 198","C1716 - BRACHYTX SOURCE, GOLD 198",0,200.39,168.52,506.68,0]
["TUFTS - TUFTS POS - HCPCS - C1716","TUFTS","TUFTS POS","HCPCS","C1716","BRACHYTX SOURCE, GOLD 198","C1716 - BRACHYTX SOURCE, GOLD 198",0,168.52,168.52,506.68,0]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1716","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1716","BRACHYTX SOURCE, GOLD 198","C1716 - BRACHYTX SOURCE, GOLD 198",0,506.68,168.52,506.68,0]
["TUFTS - TUFTS SELECT - HCPCS - C1717","TUFTS","TUFTS SELECT","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192","C1717 - HC BRACHYTX, NON-STR,HDR IR-192",607,469.29,469.29,1411.01,151.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1717","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192","C1717 - HC BRACHYTX, NON-STR,HDR IR-192",607,554.13,469.29,1411.01,151.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1717","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192","C1717 - HC BRACHYTX, NON-STR,HDR IR-192",607,554.13,469.29,1411.01,151.75]
["TUFTS - TUFTS PPO - HCPCS - C1717","TUFTS","TUFTS PPO","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192","C1717 - HC BRACHYTX, NON-STR,HDR IR-192",607,502,469.29,1411.01,151.75]
["TUFTS - TUFTS HMO - HCPCS - C1717","TUFTS","TUFTS HMO","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192","C1717 - HC BRACHYTX, NON-STR,HDR IR-192",607,563.15,469.29,1411.01,151.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1717","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192","C1717 - HC BRACHYTX, NON-STR,HDR IR-192",607,554.13,469.29,1411.01,151.75]
["TUFTS - TUFTS POS - HCPCS - C1717","TUFTS","TUFTS POS","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192","C1717 - HC BRACHYTX, NON-STR,HDR IR-192",607,469.29,469.29,1411.01,151.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1717","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192","C1717 - HC BRACHYTX, NON-STR,HDR IR-192",607,554.13,469.29,1411.01,151.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - C1717","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192","C1717 - HC BRACHYTX, NON-STR,HDR IR-192",607,836.69,469.29,1411.01,151.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1717","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192","C1717 - HC BRACHYTX, NON-STR,HDR IR-192",607,1411.01,469.29,1411.01,151.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - C1717","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192","C1717 - HC BRACHYTX, NON-STR,HDR IR-192",607,836.69,469.29,1411.01,151.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - C1717","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192","C1717 - HC BRACHYTX, NON-STR,HDR IR-192",607,836.69,469.29,1411.01,151.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - C1717","BLUE CROSS","BLUE CROSS-PPO","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192","C1717 - HC BRACHYTX, NON-STR,HDR IR-192",607,836.69,469.29,1411.01,151.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - C1717","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192","C1717 - HC BRACHYTX, NON-STR,HDR IR-192",607,836.69,469.29,1411.01,151.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - C1717","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192","C1717 - HC BRACHYTX, NON-STR,HDR IR-192",607,836.69,469.29,1411.01,151.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - C1717","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192","C1717 - HC BRACHYTX, NON-STR,HDR IR-192",607,836.69,469.29,1411.01,151.75]
["TUFTS - TUFTS SELECT - HCPCS - C1719","TUFTS","TUFTS SELECT","HCPCS","C1719","BRACHYTX SOUR,NON-HDR IR-192","C1719 - BRACHYTX SOUR,NON-HDR IR-192",95,118.86,108.35,357.35,23.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1719","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1719","BRACHYTX SOUR,NON-HDR IR-192","C1719 - BRACHYTX SOUR,NON-HDR IR-192",95,108.35,108.35,357.35,23.75]
["TUFTS - TUFTS PPO - HCPCS - C1719","TUFTS","TUFTS PPO","HCPCS","C1719","BRACHYTX SOUR,NON-HDR IR-192","C1719 - BRACHYTX SOUR,NON-HDR IR-192",95,127.14,108.35,357.35,23.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1719","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1719","BRACHYTX SOUR,NON-HDR IR-192","C1719 - BRACHYTX SOUR,NON-HDR IR-192",95,108.35,108.35,357.35,23.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1719","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1719","BRACHYTX SOUR,NON-HDR IR-192","C1719 - BRACHYTX SOUR,NON-HDR IR-192",95,108.35,108.35,357.35,23.75]
["TUFTS - TUFTS HMO - HCPCS - C1719","TUFTS","TUFTS HMO","HCPCS","C1719","BRACHYTX SOUR,NON-HDR IR-192","C1719 - BRACHYTX SOUR,NON-HDR IR-192",95,142.63,108.35,357.35,23.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1719","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1719","BRACHYTX SOUR,NON-HDR IR-192","C1719 - BRACHYTX SOUR,NON-HDR IR-192",95,108.35,108.35,357.35,23.75]
["TUFTS - TUFTS POS - HCPCS - C1719","TUFTS","TUFTS POS","HCPCS","C1719","BRACHYTX SOUR,NON-HDR IR-192","C1719 - BRACHYTX SOUR,NON-HDR IR-192",95,118.86,108.35,357.35,23.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1719","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1719","BRACHYTX SOUR,NON-HDR IR-192","C1719 - BRACHYTX SOUR,NON-HDR IR-192",95,357.35,108.35,357.35,23.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1721","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1721","HC ICD,2CH, GEN ONLY, RECALL $0","C1721 - HC ICD,2CH, GEN ONLY, RECALL $0",39674,0,0,0,9918.5]
["TUFTS - TUFTS SELECT - HCPCS - C1721","TUFTS","TUFTS SELECT","HCPCS","C1721","HC ICD,2CH, GEN ONLY, RECALL $0","C1721 - HC ICD,2CH, GEN ONLY, RECALL $0",39674,0,0,0,9918.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1721","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1721","HC ICD,2CH, GEN ONLY, RECALL $0","C1721 - HC ICD,2CH, GEN ONLY, RECALL $0",39674,0,0,0,9918.5]
["TUFTS - TUFTS PPO - HCPCS - C1721","TUFTS","TUFTS PPO","HCPCS","C1721","HC ICD,2CH, GEN ONLY, RECALL $0","C1721 - HC ICD,2CH, GEN ONLY, RECALL $0",39674,0,0,0,9918.5]
["TUFTS - TUFTS POS - HCPCS - C1721","TUFTS","TUFTS POS","HCPCS","C1721","HC ICD,2CH, GEN ONLY, RECALL $0","C1721 - HC ICD,2CH, GEN ONLY, RECALL $0",39674,0,0,0,9918.5]
["TUFTS - TUFTS HMO - HCPCS - C1721","TUFTS","TUFTS HMO","HCPCS","C1721","HC ICD,2CH, GEN ONLY, RECALL $0","C1721 - HC ICD,2CH, GEN ONLY, RECALL $0",39674,0,0,0,9918.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1721","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1721","HC ICD,2CH, GEN ONLY, RECALL $0","C1721 - HC ICD,2CH, GEN ONLY, RECALL $0",39674,0,0,0,9918.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1721","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1721","HC ICD,2CH, GEN ONLY, RECALL $0","C1721 - HC ICD,2CH, GEN ONLY, RECALL $0",39674,0,0,0,9918.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1721","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1721","HC ICD,2CH, GEN ONLY, RECALL $0","C1721 - HC ICD,2CH, GEN ONLY, RECALL $0",39674,0,0,0,9918.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1722","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1722","HC ICD,1CH, GEN ONLY, RECALL $0","C1722 - HC ICD,1CH, GEN ONLY, RECALL $0",43645,0,0,0,10911.25]
["TUFTS - TUFTS SELECT - HCPCS - C1722","TUFTS","TUFTS SELECT","HCPCS","C1722","HC ICD,1CH, GEN ONLY, RECALL $0","C1722 - HC ICD,1CH, GEN ONLY, RECALL $0",43645,0,0,0,10911.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1722","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1722","HC ICD,1CH, GEN ONLY, RECALL $0","C1722 - HC ICD,1CH, GEN ONLY, RECALL $0",43645,0,0,0,10911.25]
["TUFTS - TUFTS PPO - HCPCS - C1722","TUFTS","TUFTS PPO","HCPCS","C1722","HC ICD,1CH, GEN ONLY, RECALL $0","C1722 - HC ICD,1CH, GEN ONLY, RECALL $0",43645,0,0,0,10911.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1722","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1722","HC ICD,1CH, GEN ONLY, RECALL $0","C1722 - HC ICD,1CH, GEN ONLY, RECALL $0",43645,0,0,0,10911.25]
["TUFTS - TUFTS HMO - HCPCS - C1722","TUFTS","TUFTS HMO","HCPCS","C1722","HC ICD,1CH, GEN ONLY, RECALL $0","C1722 - HC ICD,1CH, GEN ONLY, RECALL $0",43645,0,0,0,10911.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1722","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1722","HC ICD,1CH, GEN ONLY, RECALL $0","C1722 - HC ICD,1CH, GEN ONLY, RECALL $0",43645,0,0,0,10911.25]
["TUFTS - TUFTS POS - HCPCS - C1722","TUFTS","TUFTS POS","HCPCS","C1722","HC ICD,1CH, GEN ONLY, RECALL $0","C1722 - HC ICD,1CH, GEN ONLY, RECALL $0",43645,0,0,0,10911.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1722","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1722","HC ICD,1CH, GEN ONLY, RECALL $0","C1722 - HC ICD,1CH, GEN ONLY, RECALL $0",43645,0,0,0,10911.25]
["TUFTS - TUFTS SELECT - HCPCS - C1724","TUFTS","TUFTS SELECT","HCPCS","C1724","HC CATH, TRANS ATHEREC BURR","C1724 - HC CATH, TRANS ATHEREC BURR",7410,0,0,0,1852.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1724","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1724","HC CATH, TRANS ATHEREC BURR","C1724 - HC CATH, TRANS ATHEREC BURR",7410,0,0,0,1852.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1724","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1724","HC CATH, TRANS ATHEREC BURR","C1724 - HC CATH, TRANS ATHEREC BURR",7410,0,0,0,1852.5]
["TUFTS - TUFTS PPO - HCPCS - C1724","TUFTS","TUFTS PPO","HCPCS","C1724","HC CATH, TRANS ATHEREC BURR","C1724 - HC CATH, TRANS ATHEREC BURR",7410,0,0,0,1852.5]
["TUFTS - TUFTS HMO - HCPCS - C1724","TUFTS","TUFTS HMO","HCPCS","C1724","HC CATH, TRANS ATHEREC BURR","C1724 - HC CATH, TRANS ATHEREC BURR",7410,0,0,0,1852.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1724","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1724","HC CATH, TRANS ATHEREC BURR","C1724 - HC CATH, TRANS ATHEREC BURR",7410,0,0,0,1852.5]
["TUFTS - TUFTS POS - HCPCS - C1724","TUFTS","TUFTS POS","HCPCS","C1724","HC CATH, TRANS ATHEREC BURR","C1724 - HC CATH, TRANS ATHEREC BURR",7410,0,0,0,1852.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1724","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1724","HC CATH, TRANS ATHEREC BURR","C1724 - HC CATH, TRANS ATHEREC BURR",7410,0,0,0,1852.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1724","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1724","HC CATH, TRANS ATHEREC BURR","C1724 - HC CATH, TRANS ATHEREC BURR",7410,0,0,0,1852.5]
["TUFTS - TUFTS SELECT - HCPCS - C1725","TUFTS","TUFTS SELECT","HCPCS","C1725","HC SIZING AMPLATZ BALLOON","C1725 - HC SIZING AMPLATZ BALLOON",1693,0,0,0,423.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1725","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1725","HC SIZING AMPLATZ BALLOON","C1725 - HC SIZING AMPLATZ BALLOON",1693,0,0,0,423.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1725","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1725","HC SIZING AMPLATZ BALLOON","C1725 - HC SIZING AMPLATZ BALLOON",1693,0,0,0,423.25]
["TUFTS - TUFTS PPO - HCPCS - C1725","TUFTS","TUFTS PPO","HCPCS","C1725","HC SIZING AMPLATZ BALLOON","C1725 - HC SIZING AMPLATZ BALLOON",1693,0,0,0,423.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1725","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1725","HC SIZING AMPLATZ BALLOON","C1725 - HC SIZING AMPLATZ BALLOON",1693,0,0,0,423.25]
["TUFTS - TUFTS HMO - HCPCS - C1725","TUFTS","TUFTS HMO","HCPCS","C1725","HC SIZING AMPLATZ BALLOON","C1725 - HC SIZING AMPLATZ BALLOON",1693,0,0,0,423.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1725","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1725","HC SIZING AMPLATZ BALLOON","C1725 - HC SIZING AMPLATZ BALLOON",1693,0,0,0,423.25]
["TUFTS - TUFTS POS - HCPCS - C1725","TUFTS","TUFTS POS","HCPCS","C1725","HC SIZING AMPLATZ BALLOON","C1725 - HC SIZING AMPLATZ BALLOON",1693,0,0,0,423.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1725","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1725","HC SIZING AMPLATZ BALLOON","C1725 - HC SIZING AMPLATZ BALLOON",1693,0,0,0,423.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1726","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1726","HC CATHETER BALLN LVL 4","C1726 - HC CATHETER BALLN LVL 4",387,0,0,0,96.75]
["TUFTS - TUFTS SELECT - HCPCS - C1726","TUFTS","TUFTS SELECT","HCPCS","C1726","HC CATHETER BALLN LVL 4","C1726 - HC CATHETER BALLN LVL 4",387,0,0,0,96.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1726","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1726","HC CATHETER BALLN LVL 4","C1726 - HC CATHETER BALLN LVL 4",387,0,0,0,96.75]
["TUFTS - TUFTS PPO - HCPCS - C1726","TUFTS","TUFTS PPO","HCPCS","C1726","HC CATHETER BALLN LVL 4","C1726 - HC CATHETER BALLN LVL 4",387,0,0,0,96.75]
["TUFTS - TUFTS POS - HCPCS - C1726","TUFTS","TUFTS POS","HCPCS","C1726","HC CATHETER BALLN LVL 4","C1726 - HC CATHETER BALLN LVL 4",387,0,0,0,96.75]
["TUFTS - TUFTS HMO - HCPCS - C1726","TUFTS","TUFTS HMO","HCPCS","C1726","HC CATHETER BALLN LVL 4","C1726 - HC CATHETER BALLN LVL 4",387,0,0,0,96.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1726","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1726","HC CATHETER BALLN LVL 4","C1726 - HC CATHETER BALLN LVL 4",387,0,0,0,96.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1726","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1726","HC CATHETER BALLN LVL 4","C1726 - HC CATHETER BALLN LVL 4",387,0,0,0,96.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1726","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1726","HC CATHETER BALLN LVL 4","C1726 - HC CATHETER BALLN LVL 4",387,0,0,0,96.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1729","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1729","HC CATH; THORA PARA","C1729 - HC CATH; THORA PARA",2283,0,0,0,570.75]
["TUFTS - TUFTS SELECT - HCPCS - C1729","TUFTS","TUFTS SELECT","HCPCS","C1729","HC CATH; THORA PARA","C1729 - HC CATH; THORA PARA",2283,0,0,0,570.75]
["TUFTS - TUFTS PPO - HCPCS - C1729","TUFTS","TUFTS PPO","HCPCS","C1729","HC CATH; THORA PARA","C1729 - HC CATH; THORA PARA",2283,0,0,0,570.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1729","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1729","HC CATH; THORA PARA","C1729 - HC CATH; THORA PARA",2283,0,0,0,570.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1729","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1729","HC CATH; THORA PARA","C1729 - HC CATH; THORA PARA",2283,0,0,0,570.75]
["TUFTS - TUFTS HMO - HCPCS - C1729","TUFTS","TUFTS HMO","HCPCS","C1729","HC CATH; THORA PARA","C1729 - HC CATH; THORA PARA",2283,0,0,0,570.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1729","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1729","HC CATH; THORA PARA","C1729 - HC CATH; THORA PARA",2283,0,0,0,570.75]
["TUFTS - TUFTS POS - HCPCS - C1729","TUFTS","TUFTS POS","HCPCS","C1729","HC CATH; THORA PARA","C1729 - HC CATH; THORA PARA",2283,0,0,0,570.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1729","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1729","HC CATH; THORA PARA","C1729 - HC CATH; THORA PARA",2283,0,0,0,570.75]
["TUFTS - TUFTS PPO - HCPCS - C1730","TUFTS","TUFTS PPO","HCPCS","C1730","HC CATH,EP;STEER,DEC(LASSO)","C1730 - HC CATH,EP;STEER,DEC(LASSO)",2283,0,0,0,570.75]
["TUFTS - TUFTS SELECT - HCPCS - C1730","TUFTS","TUFTS SELECT","HCPCS","C1730","HC CATH,EP;STEER,DEC(LASSO)","C1730 - HC CATH,EP;STEER,DEC(LASSO)",2283,0,0,0,570.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1730","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1730","HC CATH,EP;STEER,DEC(LASSO)","C1730 - HC CATH,EP;STEER,DEC(LASSO)",2283,0,0,0,570.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1730","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1730","HC CATH,EP;STEER,DEC(LASSO)","C1730 - HC CATH,EP;STEER,DEC(LASSO)",2283,0,0,0,570.75]
["TUFTS - TUFTS HMO - HCPCS - C1730","TUFTS","TUFTS HMO","HCPCS","C1730","HC CATH,EP;STEER,DEC(LASSO)","C1730 - HC CATH,EP;STEER,DEC(LASSO)",2283,0,0,0,570.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1730","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1730","HC CATH,EP;STEER,DEC(LASSO)","C1730 - HC CATH,EP;STEER,DEC(LASSO)",2283,0,0,0,570.75]
["TUFTS - TUFTS POS - HCPCS - C1730","TUFTS","TUFTS POS","HCPCS","C1730","HC CATH,EP;STEER,DEC(LASSO)","C1730 - HC CATH,EP;STEER,DEC(LASSO)",2283,0,0,0,570.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1730","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1730","HC CATH,EP;STEER,DEC(LASSO)","C1730 - HC CATH,EP;STEER,DEC(LASSO)",2283,0,0,0,570.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1730","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1730","HC CATH,EP;STEER,DEC(LASSO)","C1730 - HC CATH,EP;STEER,DEC(LASSO)",2283,0,0,0,570.75]
["TUFTS - TUFTS SELECT - HCPCS - C1731","TUFTS","TUFTS SELECT","HCPCS","C1731","HC CATH,EP PENTARAY NAV","C1731 - HC CATH,EP PENTARAY NAV",3847,0,0,0,961.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1731","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1731","HC CATH,EP PENTARAY NAV","C1731 - HC CATH,EP PENTARAY NAV",3847,0,0,0,961.75]
["TUFTS - TUFTS PPO - HCPCS - C1731","TUFTS","TUFTS PPO","HCPCS","C1731","HC CATH,EP PENTARAY NAV","C1731 - HC CATH,EP PENTARAY NAV",3847,0,0,0,961.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1731","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1731","HC CATH,EP PENTARAY NAV","C1731 - HC CATH,EP PENTARAY NAV",3847,0,0,0,961.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1731","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1731","HC CATH,EP PENTARAY NAV","C1731 - HC CATH,EP PENTARAY NAV",3847,0,0,0,961.75]
["TUFTS - TUFTS HMO - HCPCS - C1731","TUFTS","TUFTS HMO","HCPCS","C1731","HC CATH,EP PENTARAY NAV","C1731 - HC CATH,EP PENTARAY NAV",3847,0,0,0,961.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1731","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1731","HC CATH,EP PENTARAY NAV","C1731 - HC CATH,EP PENTARAY NAV",3847,0,0,0,961.75]
["TUFTS - TUFTS POS - HCPCS - C1731","TUFTS","TUFTS POS","HCPCS","C1731","HC CATH,EP PENTARAY NAV","C1731 - HC CATH,EP PENTARAY NAV",3847,0,0,0,961.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1731","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1731","HC CATH,EP PENTARAY NAV","C1731 - HC CATH,EP PENTARAY NAV",3847,0,0,0,961.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1732","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1732","HC CATH,EP DECA NAV","C1732 - HC CATH,EP DECA NAV",7766,0,0,0,1941.5]
["TUFTS - TUFTS SELECT - HCPCS - C1732","TUFTS","TUFTS SELECT","HCPCS","C1732","HC CATH,EP DECA NAV","C1732 - HC CATH,EP DECA NAV",7766,0,0,0,1941.5]
["TUFTS - TUFTS PPO - HCPCS - C1732","TUFTS","TUFTS PPO","HCPCS","C1732","HC CATH,EP DECA NAV","C1732 - HC CATH,EP DECA NAV",7766,0,0,0,1941.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1732","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1732","HC CATH,EP DECA NAV","C1732 - HC CATH,EP DECA NAV",7766,0,0,0,1941.5]
["TUFTS - TUFTS POS - HCPCS - C1732","TUFTS","TUFTS POS","HCPCS","C1732","HC CATH,EP DECA NAV","C1732 - HC CATH,EP DECA NAV",7766,0,0,0,1941.5]
["TUFTS - TUFTS HMO - HCPCS - C1732","TUFTS","TUFTS HMO","HCPCS","C1732","HC CATH,EP DECA NAV","C1732 - HC CATH,EP DECA NAV",7766,0,0,0,1941.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1732","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1732","HC CATH,EP DECA NAV","C1732 - HC CATH,EP DECA NAV",7766,0,0,0,1941.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1732","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1732","HC CATH,EP DECA NAV","C1732 - HC CATH,EP DECA NAV",7766,0,0,0,1941.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1732","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1732","HC CATH,EP DECA NAV","C1732 - HC CATH,EP DECA NAV",7766,0,0,0,1941.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1733","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1733","CATH CRYABL  ARCTIC FRN","C1733 - CATH CRYABL  ARCTIC FRN",10475,0,0,0,2618.75]
["TUFTS - TUFTS PPO - HCPCS - C1733","TUFTS","TUFTS PPO","HCPCS","C1733","CATH CRYABL  ARCTIC FRN","C1733 - CATH CRYABL  ARCTIC FRN",10475,0,0,0,2618.75]
["TUFTS - TUFTS SELECT - HCPCS - C1733","TUFTS","TUFTS SELECT","HCPCS","C1733","CATH CRYABL  ARCTIC FRN","C1733 - CATH CRYABL  ARCTIC FRN",10475,0,0,0,2618.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1733","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1733","CATH CRYABL  ARCTIC FRN","C1733 - CATH CRYABL  ARCTIC FRN",10475,0,0,0,2618.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1733","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1733","CATH CRYABL  ARCTIC FRN","C1733 - CATH CRYABL  ARCTIC FRN",10475,0,0,0,2618.75]
["TUFTS - TUFTS HMO - HCPCS - C1733","TUFTS","TUFTS HMO","HCPCS","C1733","CATH CRYABL  ARCTIC FRN","C1733 - CATH CRYABL  ARCTIC FRN",10475,0,0,0,2618.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1733","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1733","CATH CRYABL  ARCTIC FRN","C1733 - CATH CRYABL  ARCTIC FRN",10475,0,0,0,2618.75]
["TUFTS - TUFTS POS - HCPCS - C1733","TUFTS","TUFTS POS","HCPCS","C1733","CATH CRYABL  ARCTIC FRN","C1733 - CATH CRYABL  ARCTIC FRN",10475,0,0,0,2618.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1733","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1733","CATH CRYABL  ARCTIC FRN","C1733 - CATH CRYABL  ARCTIC FRN",10475,0,0,0,2618.75]
["TUFTS - TUFTS SELECT - HCPCS - C1750","TUFTS","TUFTS SELECT","HCPCS","C1750","HC CATH 2 LUMEN QUINTON","C1750 - HC CATH 2 LUMEN QUINTON",1693,0,0,0,423.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1750","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1750","HC CATH 2 LUMEN QUINTON","C1750 - HC CATH 2 LUMEN QUINTON",1693,0,0,0,423.25]
["TUFTS - TUFTS PPO - HCPCS - C1750","TUFTS","TUFTS PPO","HCPCS","C1750","HC CATH 2 LUMEN QUINTON","C1750 - HC CATH 2 LUMEN QUINTON",1693,0,0,0,423.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1750","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1750","HC CATH 2 LUMEN QUINTON","C1750 - HC CATH 2 LUMEN QUINTON",1693,0,0,0,423.25]
["TUFTS - TUFTS HMO - HCPCS - C1750","TUFTS","TUFTS HMO","HCPCS","C1750","HC CATH 2 LUMEN QUINTON","C1750 - HC CATH 2 LUMEN QUINTON",1693,0,0,0,423.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1750","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1750","HC CATH 2 LUMEN QUINTON","C1750 - HC CATH 2 LUMEN QUINTON",1693,0,0,0,423.25]
["TUFTS - TUFTS POS - HCPCS - C1750","TUFTS","TUFTS POS","HCPCS","C1750","HC CATH 2 LUMEN QUINTON","C1750 - HC CATH 2 LUMEN QUINTON",1693,0,0,0,423.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1750","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1750","HC CATH 2 LUMEN QUINTON","C1750 - HC CATH 2 LUMEN QUINTON",1693,0,0,0,423.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1750","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1750","HC CATH 2 LUMEN QUINTON","C1750 - HC CATH 2 LUMEN QUINTON",1693,0,0,0,423.25]
["TUFTS - TUFTS SELECT - HCPCS - C1751","TUFTS","TUFTS SELECT","HCPCS","C1751","HC CATH, PACING","C1751 - HC CATH, PACING",1438,0,0,0,359.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1751","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1751","HC CATH, PACING","C1751 - HC CATH, PACING",1438,0,0,0,359.5]
["TUFTS - TUFTS PPO - HCPCS - C1751","TUFTS","TUFTS PPO","HCPCS","C1751","HC CATH, PACING","C1751 - HC CATH, PACING",1438,0,0,0,359.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1751","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1751","HC CATH, PACING","C1751 - HC CATH, PACING",1438,0,0,0,359.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1751","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1751","HC CATH, PACING","C1751 - HC CATH, PACING",1438,0,0,0,359.5]
["TUFTS - TUFTS HMO - HCPCS - C1751","TUFTS","TUFTS HMO","HCPCS","C1751","HC CATH, PACING","C1751 - HC CATH, PACING",1438,0,0,0,359.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1751","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1751","HC CATH, PACING","C1751 - HC CATH, PACING",1438,0,0,0,359.5]
["TUFTS - TUFTS POS - HCPCS - C1751","TUFTS","TUFTS POS","HCPCS","C1751","HC CATH, PACING","C1751 - HC CATH, PACING",1438,0,0,0,359.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1751","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1751","HC CATH, PACING","C1751 - HC CATH, PACING",1438,0,0,0,359.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1753","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1753","HC BIOPSY FORC LVL D","C1753 - HC BIOPSY FORC LVL D",3947,0,0,0,986.75]
["TUFTS - TUFTS PPO - HCPCS - C1753","TUFTS","TUFTS PPO","HCPCS","C1753","HC BIOPSY FORC LVL D","C1753 - HC BIOPSY FORC LVL D",3947,0,0,0,986.75]
["TUFTS - TUFTS SELECT - HCPCS - C1753","TUFTS","TUFTS SELECT","HCPCS","C1753","HC BIOPSY FORC LVL D","C1753 - HC BIOPSY FORC LVL D",3947,0,0,0,986.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1753","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1753","HC BIOPSY FORC LVL D","C1753 - HC BIOPSY FORC LVL D",3947,0,0,0,986.75]
["TUFTS - TUFTS POS - HCPCS - C1753","TUFTS","TUFTS POS","HCPCS","C1753","HC BIOPSY FORC LVL D","C1753 - HC BIOPSY FORC LVL D",3947,0,0,0,986.75]
["TUFTS - TUFTS HMO - HCPCS - C1753","TUFTS","TUFTS HMO","HCPCS","C1753","HC BIOPSY FORC LVL D","C1753 - HC BIOPSY FORC LVL D",3947,0,0,0,986.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1753","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1753","HC BIOPSY FORC LVL D","C1753 - HC BIOPSY FORC LVL D",3947,0,0,0,986.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1753","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1753","HC BIOPSY FORC LVL D","C1753 - HC BIOPSY FORC LVL D",3947,0,0,0,986.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1753","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1753","HC BIOPSY FORC LVL D","C1753 - HC BIOPSY FORC LVL D",3947,0,0,0,986.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1756","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1756","HC PACING WIRE","C1756 - HC PACING WIRE",1438,0,0,0,359.5]
["TUFTS - TUFTS SELECT - HCPCS - C1756","TUFTS","TUFTS SELECT","HCPCS","C1756","HC PACING WIRE","C1756 - HC PACING WIRE",1438,0,0,0,359.5]
["TUFTS - TUFTS PPO - HCPCS - C1756","TUFTS","TUFTS PPO","HCPCS","C1756","HC PACING WIRE","C1756 - HC PACING WIRE",1438,0,0,0,359.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1756","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1756","HC PACING WIRE","C1756 - HC PACING WIRE",1438,0,0,0,359.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1756","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1756","HC PACING WIRE","C1756 - HC PACING WIRE",1438,0,0,0,359.5]
["TUFTS - TUFTS HMO - HCPCS - C1756","TUFTS","TUFTS HMO","HCPCS","C1756","HC PACING WIRE","C1756 - HC PACING WIRE",1438,0,0,0,359.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1756","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1756","HC PACING WIRE","C1756 - HC PACING WIRE",1438,0,0,0,359.5]
["TUFTS - TUFTS POS - HCPCS - C1756","TUFTS","TUFTS POS","HCPCS","C1756","HC PACING WIRE","C1756 - HC PACING WIRE",1438,0,0,0,359.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1756","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1756","HC PACING WIRE","C1756 - HC PACING WIRE",1438,0,0,0,359.5]
["TUFTS - TUFTS PPO - HCPCS - C1757","TUFTS","TUFTS PPO","HCPCS","C1757","HC CATH,THROMB/EMB,LVL 2","C1757 - HC CATH,THROMB/EMB,LVL 2",15822,0,0,0,3955.5]
["TUFTS - TUFTS SELECT - HCPCS - C1757","TUFTS","TUFTS SELECT","HCPCS","C1757","HC CATH,THROMB/EMB,LVL 2","C1757 - HC CATH,THROMB/EMB,LVL 2",15822,0,0,0,3955.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1757","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1757","HC CATH,THROMB/EMB,LVL 2","C1757 - HC CATH,THROMB/EMB,LVL 2",15822,0,0,0,3955.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1757","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1757","HC CATH,THROMB/EMB,LVL 2","C1757 - HC CATH,THROMB/EMB,LVL 2",15822,0,0,0,3955.5]
["TUFTS - TUFTS HMO - HCPCS - C1757","TUFTS","TUFTS HMO","HCPCS","C1757","HC CATH,THROMB/EMB,LVL 2","C1757 - HC CATH,THROMB/EMB,LVL 2",15822,0,0,0,3955.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1757","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1757","HC CATH,THROMB/EMB,LVL 2","C1757 - HC CATH,THROMB/EMB,LVL 2",15822,0,0,0,3955.5]
["TUFTS - TUFTS POS - HCPCS - C1757","TUFTS","TUFTS POS","HCPCS","C1757","HC CATH,THROMB/EMB,LVL 2","C1757 - HC CATH,THROMB/EMB,LVL 2",15822,0,0,0,3955.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1757","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1757","HC CATH,THROMB/EMB,LVL 2","C1757 - HC CATH,THROMB/EMB,LVL 2",15822,0,0,0,3955.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1757","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1757","HC CATH,THROMB/EMB,LVL 2","C1757 - HC CATH,THROMB/EMB,LVL 2",15822,0,0,0,3955.5]
["TUFTS - TUFTS PPO - HCPCS - C1759","TUFTS","TUFTS PPO","HCPCS","C1759","HC CATH, ULTRASOUND LVL 2","C1759 - HC CATH, ULTRASOUND LVL 2",6295,0,0,0,1573.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1759","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1759","HC CATH, ULTRASOUND LVL 2","C1759 - HC CATH, ULTRASOUND LVL 2",6295,0,0,0,1573.75]
["TUFTS - TUFTS SELECT - HCPCS - C1759","TUFTS","TUFTS SELECT","HCPCS","C1759","HC CATH, ULTRASOUND LVL 2","C1759 - HC CATH, ULTRASOUND LVL 2",6295,0,0,0,1573.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1759","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1759","HC CATH, ULTRASOUND LVL 2","C1759 - HC CATH, ULTRASOUND LVL 2",6295,0,0,0,1573.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1759","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1759","HC CATH, ULTRASOUND LVL 2","C1759 - HC CATH, ULTRASOUND LVL 2",6295,0,0,0,1573.75]
["TUFTS - TUFTS HMO - HCPCS - C1759","TUFTS","TUFTS HMO","HCPCS","C1759","HC CATH, ULTRASOUND LVL 2","C1759 - HC CATH, ULTRASOUND LVL 2",6295,0,0,0,1573.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1759","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1759","HC CATH, ULTRASOUND LVL 2","C1759 - HC CATH, ULTRASOUND LVL 2",6295,0,0,0,1573.75]
["TUFTS - TUFTS POS - HCPCS - C1759","TUFTS","TUFTS POS","HCPCS","C1759","HC CATH, ULTRASOUND LVL 2","C1759 - HC CATH, ULTRASOUND LVL 2",6295,0,0,0,1573.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1759","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1759","HC CATH, ULTRASOUND LVL 2","C1759 - HC CATH, ULTRASOUND LVL 2",6295,0,0,0,1573.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1760","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1760","HC CENTRAL LINE KIT","C1760 - HC CENTRAL LINE KIT",1799,0,0,0,449.75]
["TUFTS - TUFTS PPO - HCPCS - C1760","TUFTS","TUFTS PPO","HCPCS","C1760","HC CENTRAL LINE KIT","C1760 - HC CENTRAL LINE KIT",1799,0,0,0,449.75]
["TUFTS - TUFTS SELECT - HCPCS - C1760","TUFTS","TUFTS SELECT","HCPCS","C1760","HC CENTRAL LINE KIT","C1760 - HC CENTRAL LINE KIT",1799,0,0,0,449.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1760","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1760","HC CENTRAL LINE KIT","C1760 - HC CENTRAL LINE KIT",1799,0,0,0,449.75]
["TUFTS - TUFTS POS - HCPCS - C1760","TUFTS","TUFTS POS","HCPCS","C1760","HC CENTRAL LINE KIT","C1760 - HC CENTRAL LINE KIT",1799,0,0,0,449.75]
["TUFTS - TUFTS HMO - HCPCS - C1760","TUFTS","TUFTS HMO","HCPCS","C1760","HC CENTRAL LINE KIT","C1760 - HC CENTRAL LINE KIT",1799,0,0,0,449.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1760","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1760","HC CENTRAL LINE KIT","C1760 - HC CENTRAL LINE KIT",1799,0,0,0,449.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1760","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1760","HC CENTRAL LINE KIT","C1760 - HC CENTRAL LINE KIT",1799,0,0,0,449.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1760","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1760","HC CENTRAL LINE KIT","C1760 - HC CENTRAL LINE KIT",1799,0,0,0,449.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1762","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1762","HC NERVE - CONNEVTIVE TISSUE, HUMAN","C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN",12010,0,0,0,3002.5]
["TUFTS - TUFTS SELECT - HCPCS - C1762","TUFTS","TUFTS SELECT","HCPCS","C1762","HC NERVE - CONNEVTIVE TISSUE, HUMAN","C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN",12010,0,0,0,3002.5]
["TUFTS - TUFTS PPO - HCPCS - C1762","TUFTS","TUFTS PPO","HCPCS","C1762","HC NERVE - CONNEVTIVE TISSUE, HUMAN","C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN",12010,0,0,0,3002.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1762","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1762","HC NERVE - CONNEVTIVE TISSUE, HUMAN","C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN",12010,0,0,0,3002.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1762","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1762","HC NERVE - CONNEVTIVE TISSUE, HUMAN","C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN",12010,0,0,0,3002.5]
["TUFTS - TUFTS HMO - HCPCS - C1762","TUFTS","TUFTS HMO","HCPCS","C1762","HC NERVE - CONNEVTIVE TISSUE, HUMAN","C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN",12010,0,0,0,3002.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1762","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1762","HC NERVE - CONNEVTIVE TISSUE, HUMAN","C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN",12010,0,0,0,3002.5]
["TUFTS - TUFTS POS - HCPCS - C1762","TUFTS","TUFTS POS","HCPCS","C1762","HC NERVE - CONNEVTIVE TISSUE, HUMAN","C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN",12010,0,0,0,3002.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1762","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1762","HC NERVE - CONNEVTIVE TISSUE, HUMAN","C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN",12010,0,0,0,3002.5]
["TUFTS - TUFTS PPO - HCPCS - C1763","TUFTS","TUFTS PPO","HCPCS","C1763","HC SM6X16-STEM HEM","C1763 - HC SM6X16-STEM HEM",2242,0,0,0,560.5]
["TUFTS - TUFTS SELECT - HCPCS - C1763","TUFTS","TUFTS SELECT","HCPCS","C1763","HC SM6X16-STEM HEM","C1763 - HC SM6X16-STEM HEM",2242,0,0,0,560.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1763","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1763","HC SM6X16-STEM HEM","C1763 - HC SM6X16-STEM HEM",2242,0,0,0,560.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1763","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1763","HC SM6X16-STEM HEM","C1763 - HC SM6X16-STEM HEM",2242,0,0,0,560.5]
["TUFTS - TUFTS HMO - HCPCS - C1763","TUFTS","TUFTS HMO","HCPCS","C1763","HC SM6X16-STEM HEM","C1763 - HC SM6X16-STEM HEM",2242,0,0,0,560.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1763","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1763","HC SM6X16-STEM HEM","C1763 - HC SM6X16-STEM HEM",2242,0,0,0,560.5]
["TUFTS - TUFTS POS - HCPCS - C1763","TUFTS","TUFTS POS","HCPCS","C1763","HC SM6X16-STEM HEM","C1763 - HC SM6X16-STEM HEM",2242,0,0,0,560.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1763","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1763","HC SM6X16-STEM HEM","C1763 - HC SM6X16-STEM HEM",2242,0,0,0,560.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1763","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1763","HC SM6X16-STEM HEM","C1763 - HC SM6X16-STEM HEM",2242,0,0,0,560.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1764","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1764","HC RECORDER;IMPLANTABLE LOOP","C1764 - HC RECORDER;IMPLANTABLE LOOP",8983,0,0,0,2245.75]
["TUFTS - TUFTS SELECT - HCPCS - C1764","TUFTS","TUFTS SELECT","HCPCS","C1764","HC RECORDER;IMPLANTABLE LOOP","C1764 - HC RECORDER;IMPLANTABLE LOOP",8983,0,0,0,2245.75]
["TUFTS - TUFTS PPO - HCPCS - C1764","TUFTS","TUFTS PPO","HCPCS","C1764","HC RECORDER;IMPLANTABLE LOOP","C1764 - HC RECORDER;IMPLANTABLE LOOP",8983,0,0,0,2245.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1764","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1764","HC RECORDER;IMPLANTABLE LOOP","C1764 - HC RECORDER;IMPLANTABLE LOOP",8983,0,0,0,2245.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1764","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1764","HC RECORDER;IMPLANTABLE LOOP","C1764 - HC RECORDER;IMPLANTABLE LOOP",8983,0,0,0,2245.75]
["TUFTS - TUFTS HMO - HCPCS - C1764","TUFTS","TUFTS HMO","HCPCS","C1764","HC RECORDER;IMPLANTABLE LOOP","C1764 - HC RECORDER;IMPLANTABLE LOOP",8983,0,0,0,2245.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1764","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1764","HC RECORDER;IMPLANTABLE LOOP","C1764 - HC RECORDER;IMPLANTABLE LOOP",8983,0,0,0,2245.75]
["TUFTS - TUFTS POS - HCPCS - C1764","TUFTS","TUFTS POS","HCPCS","C1764","HC RECORDER;IMPLANTABLE LOOP","C1764 - HC RECORDER;IMPLANTABLE LOOP",8983,0,0,0,2245.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1764","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1764","HC RECORDER;IMPLANTABLE LOOP","C1764 - HC RECORDER;IMPLANTABLE LOOP",8983,0,0,0,2245.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1765","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1765","ADHESION BARRIER","C1765 - ADHESION BARRIER",569,0,0,0,142.25]
["TUFTS - TUFTS PPO - HCPCS - C1765","TUFTS","TUFTS PPO","HCPCS","C1765","ADHESION BARRIER","C1765 - ADHESION BARRIER",569,0,0,0,142.25]
["TUFTS - TUFTS SELECT - HCPCS - C1765","TUFTS","TUFTS SELECT","HCPCS","C1765","ADHESION BARRIER","C1765 - ADHESION BARRIER",569,0,0,0,142.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1765","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1765","ADHESION BARRIER","C1765 - ADHESION BARRIER",569,0,0,0,142.25]
["TUFTS - TUFTS POS - HCPCS - C1765","TUFTS","TUFTS POS","HCPCS","C1765","ADHESION BARRIER","C1765 - ADHESION BARRIER",569,0,0,0,142.25]
["TUFTS - TUFTS HMO - HCPCS - C1765","TUFTS","TUFTS HMO","HCPCS","C1765","ADHESION BARRIER","C1765 - ADHESION BARRIER",569,0,0,0,142.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1765","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1765","ADHESION BARRIER","C1765 - ADHESION BARRIER",569,0,0,0,142.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1765","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1765","ADHESION BARRIER","C1765 - ADHESION BARRIER",569,0,0,0,142.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1765","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1765","ADHESION BARRIER","C1765 - ADHESION BARRIER",569,0,0,0,142.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1766","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1766","SHTH INTRO 65CM 15FR 12FR","C1766 - SHTH INTRO 65CM 15FR 12FR",2619,0,0,0,654.75]
["TUFTS - TUFTS SELECT - HCPCS - C1766","TUFTS","TUFTS SELECT","HCPCS","C1766","SHTH INTRO 65CM 15FR 12FR","C1766 - SHTH INTRO 65CM 15FR 12FR",2619,0,0,0,654.75]
["TUFTS - TUFTS PPO - HCPCS - C1766","TUFTS","TUFTS PPO","HCPCS","C1766","SHTH INTRO 65CM 15FR 12FR","C1766 - SHTH INTRO 65CM 15FR 12FR",2619,0,0,0,654.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1766","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1766","SHTH INTRO 65CM 15FR 12FR","C1766 - SHTH INTRO 65CM 15FR 12FR",2619,0,0,0,654.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1766","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1766","SHTH INTRO 65CM 15FR 12FR","C1766 - SHTH INTRO 65CM 15FR 12FR",2619,0,0,0,654.75]
["TUFTS - TUFTS HMO - HCPCS - C1766","TUFTS","TUFTS HMO","HCPCS","C1766","SHTH INTRO 65CM 15FR 12FR","C1766 - SHTH INTRO 65CM 15FR 12FR",2619,0,0,0,654.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1766","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1766","SHTH INTRO 65CM 15FR 12FR","C1766 - SHTH INTRO 65CM 15FR 12FR",2619,0,0,0,654.75]
["TUFTS - TUFTS POS - HCPCS - C1766","TUFTS","TUFTS POS","HCPCS","C1766","SHTH INTRO 65CM 15FR 12FR","C1766 - SHTH INTRO 65CM 15FR 12FR",2619,0,0,0,654.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1766","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1766","SHTH INTRO 65CM 15FR 12FR","C1766 - SHTH INTRO 65CM 15FR 12FR",2619,0,0,0,654.75]
["TUFTS - TUFTS SELECT - HCPCS - C1768","TUFTS","TUFTS SELECT","HCPCS","C1768","HC TAVR HEART VALVE KIT","C1768 - HC TAVR HEART VALVE KIT",76125,0,0,0,19031.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1768","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1768","HC TAVR HEART VALVE KIT","C1768 - HC TAVR HEART VALVE KIT",76125,0,0,0,19031.25]
["TUFTS - TUFTS PPO - HCPCS - C1768","TUFTS","TUFTS PPO","HCPCS","C1768","HC TAVR HEART VALVE KIT","C1768 - HC TAVR HEART VALVE KIT",76125,0,0,0,19031.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1768","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1768","HC TAVR HEART VALVE KIT","C1768 - HC TAVR HEART VALVE KIT",76125,0,0,0,19031.25]
["TUFTS - TUFTS HMO - HCPCS - C1768","TUFTS","TUFTS HMO","HCPCS","C1768","HC TAVR HEART VALVE KIT","C1768 - HC TAVR HEART VALVE KIT",76125,0,0,0,19031.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1768","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1768","HC TAVR HEART VALVE KIT","C1768 - HC TAVR HEART VALVE KIT",76125,0,0,0,19031.25]
["TUFTS - TUFTS POS - HCPCS - C1768","TUFTS","TUFTS POS","HCPCS","C1768","HC TAVR HEART VALVE KIT","C1768 - HC TAVR HEART VALVE KIT",76125,0,0,0,19031.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1768","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1768","HC TAVR HEART VALVE KIT","C1768 - HC TAVR HEART VALVE KIT",76125,0,0,0,19031.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1768","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1768","HC TAVR HEART VALVE KIT","C1768 - HC TAVR HEART VALVE KIT",76125,0,0,0,19031.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1769","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1769","GUIDE WIRE","C1769 - GUIDE WIRE",4759,0,0,0,1189.75]
["TUFTS - TUFTS SELECT - HCPCS - C1769","TUFTS","TUFTS SELECT","HCPCS","C1769","GUIDE WIRE","C1769 - GUIDE WIRE",4759,0,0,0,1189.75]
["TUFTS - TUFTS PPO - HCPCS - C1769","TUFTS","TUFTS PPO","HCPCS","C1769","GUIDE WIRE","C1769 - GUIDE WIRE",4759,0,0,0,1189.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1769","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1769","GUIDE WIRE","C1769 - GUIDE WIRE",4759,0,0,0,1189.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1769","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1769","GUIDE WIRE","C1769 - GUIDE WIRE",4759,0,0,0,1189.75]
["TUFTS - TUFTS HMO - HCPCS - C1769","TUFTS","TUFTS HMO","HCPCS","C1769","GUIDE WIRE","C1769 - GUIDE WIRE",4759,0,0,0,1189.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1769","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1769","GUIDE WIRE","C1769 - GUIDE WIRE",4759,0,0,0,1189.75]
["TUFTS - TUFTS POS - HCPCS - C1769","TUFTS","TUFTS POS","HCPCS","C1769","GUIDE WIRE","C1769 - GUIDE WIRE",4759,0,0,0,1189.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1769","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1769","GUIDE WIRE","C1769 - GUIDE WIRE",4759,0,0,0,1189.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1770","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1770","IMAGING COIL, MR, INSERTABLE","C1770 - IMAGING COIL, MR, INSERTABLE",3667,0,0,0,916.75]
["TUFTS - TUFTS SELECT - HCPCS - C1770","TUFTS","TUFTS SELECT","HCPCS","C1770","IMAGING COIL, MR, INSERTABLE","C1770 - IMAGING COIL, MR, INSERTABLE",3667,0,0,0,916.75]
["TUFTS - TUFTS PPO - HCPCS - C1770","TUFTS","TUFTS PPO","HCPCS","C1770","IMAGING COIL, MR, INSERTABLE","C1770 - IMAGING COIL, MR, INSERTABLE",3667,0,0,0,916.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1770","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1770","IMAGING COIL, MR, INSERTABLE","C1770 - IMAGING COIL, MR, INSERTABLE",3667,0,0,0,916.75]
["TUFTS - TUFTS POS - HCPCS - C1770","TUFTS","TUFTS POS","HCPCS","C1770","IMAGING COIL, MR, INSERTABLE","C1770 - IMAGING COIL, MR, INSERTABLE",3667,0,0,0,916.75]
["TUFTS - TUFTS HMO - HCPCS - C1770","TUFTS","TUFTS HMO","HCPCS","C1770","IMAGING COIL, MR, INSERTABLE","C1770 - IMAGING COIL, MR, INSERTABLE",3667,0,0,0,916.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1770","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1770","IMAGING COIL, MR, INSERTABLE","C1770 - IMAGING COIL, MR, INSERTABLE",3667,0,0,0,916.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1770","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1770","IMAGING COIL, MR, INSERTABLE","C1770 - IMAGING COIL, MR, INSERTABLE",3667,0,0,0,916.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1770","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1770","IMAGING COIL, MR, INSERTABLE","C1770 - IMAGING COIL, MR, INSERTABLE",3667,0,0,0,916.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1773","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1773","HC GUIDEWIRE LVL E","C1773 - HC GUIDEWIRE LVL E",2163,0,0,0,540.75]
["TUFTS - TUFTS SELECT - HCPCS - C1773","TUFTS","TUFTS SELECT","HCPCS","C1773","HC GUIDEWIRE LVL E","C1773 - HC GUIDEWIRE LVL E",2163,0,0,0,540.75]
["TUFTS - TUFTS PPO - HCPCS - C1773","TUFTS","TUFTS PPO","HCPCS","C1773","HC GUIDEWIRE LVL E","C1773 - HC GUIDEWIRE LVL E",2163,0,0,0,540.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1773","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1773","HC GUIDEWIRE LVL E","C1773 - HC GUIDEWIRE LVL E",2163,0,0,0,540.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1773","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1773","HC GUIDEWIRE LVL E","C1773 - HC GUIDEWIRE LVL E",2163,0,0,0,540.75]
["TUFTS - TUFTS HMO - HCPCS - C1773","TUFTS","TUFTS HMO","HCPCS","C1773","HC GUIDEWIRE LVL E","C1773 - HC GUIDEWIRE LVL E",2163,0,0,0,540.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1773","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1773","HC GUIDEWIRE LVL E","C1773 - HC GUIDEWIRE LVL E",2163,0,0,0,540.75]
["TUFTS - TUFTS POS - HCPCS - C1773","TUFTS","TUFTS POS","HCPCS","C1773","HC GUIDEWIRE LVL E","C1773 - HC GUIDEWIRE LVL E",2163,0,0,0,540.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1773","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1773","HC GUIDEWIRE LVL E","C1773 - HC GUIDEWIRE LVL E",2163,0,0,0,540.75]
["TUFTS - TUFTS PPO - HCPCS - C1776","TUFTS","TUFTS PPO","HCPCS","C1776","HC HEMI-TIB PLATEAU W MENISC","C1776 - HC HEMI-TIB PLATEAU W MENISC",21721,0,0,0,5430.25]
["TUFTS - TUFTS SELECT - HCPCS - C1776","TUFTS","TUFTS SELECT","HCPCS","C1776","HC HEMI-TIB PLATEAU W MENISC","C1776 - HC HEMI-TIB PLATEAU W MENISC",21721,0,0,0,5430.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1776","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1776","HC HEMI-TIB PLATEAU W MENISC","C1776 - HC HEMI-TIB PLATEAU W MENISC",21721,0,0,0,5430.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1776","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1776","HC HEMI-TIB PLATEAU W MENISC","C1776 - HC HEMI-TIB PLATEAU W MENISC",21721,0,0,0,5430.25]
["TUFTS - TUFTS HMO - HCPCS - C1776","TUFTS","TUFTS HMO","HCPCS","C1776","HC HEMI-TIB PLATEAU W MENISC","C1776 - HC HEMI-TIB PLATEAU W MENISC",21721,0,0,0,5430.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1776","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1776","HC HEMI-TIB PLATEAU W MENISC","C1776 - HC HEMI-TIB PLATEAU W MENISC",21721,0,0,0,5430.25]
["TUFTS - TUFTS POS - HCPCS - C1776","TUFTS","TUFTS POS","HCPCS","C1776","HC HEMI-TIB PLATEAU W MENISC","C1776 - HC HEMI-TIB PLATEAU W MENISC",21721,0,0,0,5430.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1776","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1776","HC HEMI-TIB PLATEAU W MENISC","C1776 - HC HEMI-TIB PLATEAU W MENISC",21721,0,0,0,5430.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1776","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1776","HC HEMI-TIB PLATEAU W MENISC","C1776 - HC HEMI-TIB PLATEAU W MENISC",21721,0,0,0,5430.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1777","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1777","HC LEAD,ICD,1COIL","C1777 - HC LEAD,ICD,1COIL",13038,0,0,0,3259.5]
["TUFTS - TUFTS SELECT - HCPCS - C1777","TUFTS","TUFTS SELECT","HCPCS","C1777","HC LEAD,ICD,1COIL","C1777 - HC LEAD,ICD,1COIL",13038,0,0,0,3259.5]
["TUFTS - TUFTS PPO - HCPCS - C1777","TUFTS","TUFTS PPO","HCPCS","C1777","HC LEAD,ICD,1COIL","C1777 - HC LEAD,ICD,1COIL",13038,0,0,0,3259.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1777","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1777","HC LEAD,ICD,1COIL","C1777 - HC LEAD,ICD,1COIL",13038,0,0,0,3259.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1777","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1777","HC LEAD,ICD,1COIL","C1777 - HC LEAD,ICD,1COIL",13038,0,0,0,3259.5]
["TUFTS - TUFTS HMO - HCPCS - C1777","TUFTS","TUFTS HMO","HCPCS","C1777","HC LEAD,ICD,1COIL","C1777 - HC LEAD,ICD,1COIL",13038,0,0,0,3259.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1777","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1777","HC LEAD,ICD,1COIL","C1777 - HC LEAD,ICD,1COIL",13038,0,0,0,3259.5]
["TUFTS - TUFTS POS - HCPCS - C1777","TUFTS","TUFTS POS","HCPCS","C1777","HC LEAD,ICD,1COIL","C1777 - HC LEAD,ICD,1COIL",13038,0,0,0,3259.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1777","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1777","HC LEAD,ICD,1COIL","C1777 - HC LEAD,ICD,1COIL",13038,0,0,0,3259.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1781","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1781","MESH (IMPLANTABLE)","C1781 - MESH (IMPLANTABLE)",36449,0,0,0,9112.25]
["TUFTS - TUFTS SELECT - HCPCS - C1781","TUFTS","TUFTS SELECT","HCPCS","C1781","MESH (IMPLANTABLE)","C1781 - MESH (IMPLANTABLE)",36449,0,0,0,9112.25]
["TUFTS - TUFTS PPO - HCPCS - C1781","TUFTS","TUFTS PPO","HCPCS","C1781","MESH (IMPLANTABLE)","C1781 - MESH (IMPLANTABLE)",36449,0,0,0,9112.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1781","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1781","MESH (IMPLANTABLE)","C1781 - MESH (IMPLANTABLE)",36449,0,0,0,9112.25]
["TUFTS - TUFTS POS - HCPCS - C1781","TUFTS","TUFTS POS","HCPCS","C1781","MESH (IMPLANTABLE)","C1781 - MESH (IMPLANTABLE)",36449,0,0,0,9112.25]
["TUFTS - TUFTS HMO - HCPCS - C1781","TUFTS","TUFTS HMO","HCPCS","C1781","MESH (IMPLANTABLE)","C1781 - MESH (IMPLANTABLE)",36449,0,0,0,9112.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1781","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1781","MESH (IMPLANTABLE)","C1781 - MESH (IMPLANTABLE)",36449,0,0,0,9112.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1781","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1781","MESH (IMPLANTABLE)","C1781 - MESH (IMPLANTABLE)",36449,0,0,0,9112.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1781","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1781","MESH (IMPLANTABLE)","C1781 - MESH (IMPLANTABLE)",36449,0,0,0,9112.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1784","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1784","HC DES PERIPHERAL STENT","C1784 - HC DES PERIPHERAL STENT",2734,0,0,0,683.5]
["TUFTS - TUFTS SELECT - HCPCS - C1784","TUFTS","TUFTS SELECT","HCPCS","C1784","HC DES PERIPHERAL STENT","C1784 - HC DES PERIPHERAL STENT",2734,0,0,0,683.5]
["TUFTS - TUFTS PPO - HCPCS - C1784","TUFTS","TUFTS PPO","HCPCS","C1784","HC DES PERIPHERAL STENT","C1784 - HC DES PERIPHERAL STENT",2734,0,0,0,683.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1784","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1784","HC DES PERIPHERAL STENT","C1784 - HC DES PERIPHERAL STENT",2734,0,0,0,683.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1784","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1784","HC DES PERIPHERAL STENT","C1784 - HC DES PERIPHERAL STENT",2734,0,0,0,683.5]
["TUFTS - TUFTS HMO - HCPCS - C1784","TUFTS","TUFTS HMO","HCPCS","C1784","HC DES PERIPHERAL STENT","C1784 - HC DES PERIPHERAL STENT",2734,0,0,0,683.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1784","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1784","HC DES PERIPHERAL STENT","C1784 - HC DES PERIPHERAL STENT",2734,0,0,0,683.5]
["TUFTS - TUFTS POS - HCPCS - C1784","TUFTS","TUFTS POS","HCPCS","C1784","HC DES PERIPHERAL STENT","C1784 - HC DES PERIPHERAL STENT",2734,0,0,0,683.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1784","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1784","HC DES PERIPHERAL STENT","C1784 - HC DES PERIPHERAL STENT",2734,0,0,0,683.5]
["TUFTS - TUFTS SELECT - HCPCS - C1785","TUFTS","TUFTS SELECT","HCPCS","C1785","HC PACER;2CH, RECALL $0","C1785 - HC PACER;2CH, RECALL $0",12546,0,0,0,3136.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1785","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1785","HC PACER;2CH, RECALL $0","C1785 - HC PACER;2CH, RECALL $0",12546,0,0,0,3136.5]
["TUFTS - TUFTS PPO - HCPCS - C1785","TUFTS","TUFTS PPO","HCPCS","C1785","HC PACER;2CH, RECALL $0","C1785 - HC PACER;2CH, RECALL $0",12546,0,0,0,3136.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1785","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1785","HC PACER;2CH, RECALL $0","C1785 - HC PACER;2CH, RECALL $0",12546,0,0,0,3136.5]
["TUFTS - TUFTS HMO - HCPCS - C1785","TUFTS","TUFTS HMO","HCPCS","C1785","HC PACER;2CH, RECALL $0","C1785 - HC PACER;2CH, RECALL $0",12546,0,0,0,3136.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1785","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1785","HC PACER;2CH, RECALL $0","C1785 - HC PACER;2CH, RECALL $0",12546,0,0,0,3136.5]
["TUFTS - TUFTS POS - HCPCS - C1785","TUFTS","TUFTS POS","HCPCS","C1785","HC PACER;2CH, RECALL $0","C1785 - HC PACER;2CH, RECALL $0",12546,0,0,0,3136.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1785","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1785","HC PACER;2CH, RECALL $0","C1785 - HC PACER;2CH, RECALL $0",12546,0,0,0,3136.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1785","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1785","HC PACER;2CH, RECALL $0","C1785 - HC PACER;2CH, RECALL $0",12546,0,0,0,3136.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1786","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1786","HC PACER;1CH, RECALL $0","C1786 - HC PACER;1CH, RECALL $0",23460,0,0,0,5865]
["TUFTS - TUFTS SELECT - HCPCS - C1786","TUFTS","TUFTS SELECT","HCPCS","C1786","HC PACER;1CH, RECALL $0","C1786 - HC PACER;1CH, RECALL $0",23460,0,0,0,5865]
["TUFTS - TUFTS PPO - HCPCS - C1786","TUFTS","TUFTS PPO","HCPCS","C1786","HC PACER;1CH, RECALL $0","C1786 - HC PACER;1CH, RECALL $0",23460,0,0,0,5865]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1786","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1786","HC PACER;1CH, RECALL $0","C1786 - HC PACER;1CH, RECALL $0",23460,0,0,0,5865]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1786","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1786","HC PACER;1CH, RECALL $0","C1786 - HC PACER;1CH, RECALL $0",23460,0,0,0,5865]
["TUFTS - TUFTS HMO - HCPCS - C1786","TUFTS","TUFTS HMO","HCPCS","C1786","HC PACER;1CH, RECALL $0","C1786 - HC PACER;1CH, RECALL $0",23460,0,0,0,5865]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1786","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1786","HC PACER;1CH, RECALL $0","C1786 - HC PACER;1CH, RECALL $0",23460,0,0,0,5865]
["TUFTS - TUFTS POS - HCPCS - C1786","TUFTS","TUFTS POS","HCPCS","C1786","HC PACER;1CH, RECALL $0","C1786 - HC PACER;1CH, RECALL $0",23460,0,0,0,5865]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1786","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1786","HC PACER;1CH, RECALL $0","C1786 - HC PACER;1CH, RECALL $0",23460,0,0,0,5865]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1788","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1788","HC PORTACATH ANY","C1788 - HC PORTACATH ANY",540,0,0,0,135]
["TUFTS - TUFTS PPO - HCPCS - C1788","TUFTS","TUFTS PPO","HCPCS","C1788","HC PORTACATH ANY","C1788 - HC PORTACATH ANY",540,0,0,0,135]
["TUFTS - TUFTS SELECT - HCPCS - C1788","TUFTS","TUFTS SELECT","HCPCS","C1788","HC PORTACATH ANY","C1788 - HC PORTACATH ANY",540,0,0,0,135]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1788","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1788","HC PORTACATH ANY","C1788 - HC PORTACATH ANY",540,0,0,0,135]
["TUFTS - TUFTS POS - HCPCS - C1788","TUFTS","TUFTS POS","HCPCS","C1788","HC PORTACATH ANY","C1788 - HC PORTACATH ANY",540,0,0,0,135]
["TUFTS - TUFTS HMO - HCPCS - C1788","TUFTS","TUFTS HMO","HCPCS","C1788","HC PORTACATH ANY","C1788 - HC PORTACATH ANY",540,0,0,0,135]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1788","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1788","HC PORTACATH ANY","C1788 - HC PORTACATH ANY",540,0,0,0,135]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1788","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1788","HC PORTACATH ANY","C1788 - HC PORTACATH ANY",540,0,0,0,135]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1788","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1788","HC PORTACATH ANY","C1788 - HC PORTACATH ANY",540,0,0,0,135]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1817","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1817","HC OCCKYDER;ASD/PFO","C1817 - HC OCCKYDER;ASD/PFO",9668,0,0,0,2417]
["TUFTS - TUFTS SELECT - HCPCS - C1817","TUFTS","TUFTS SELECT","HCPCS","C1817","HC OCCKYDER;ASD/PFO","C1817 - HC OCCKYDER;ASD/PFO",9668,0,0,0,2417]
["TUFTS - TUFTS PPO - HCPCS - C1817","TUFTS","TUFTS PPO","HCPCS","C1817","HC OCCKYDER;ASD/PFO","C1817 - HC OCCKYDER;ASD/PFO",9668,0,0,0,2417]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1817","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1817","HC OCCKYDER;ASD/PFO","C1817 - HC OCCKYDER;ASD/PFO",9668,0,0,0,2417]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1817","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1817","HC OCCKYDER;ASD/PFO","C1817 - HC OCCKYDER;ASD/PFO",9668,0,0,0,2417]
["TUFTS - TUFTS HMO - HCPCS - C1817","TUFTS","TUFTS HMO","HCPCS","C1817","HC OCCKYDER;ASD/PFO","C1817 - HC OCCKYDER;ASD/PFO",9668,0,0,0,2417]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1817","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1817","HC OCCKYDER;ASD/PFO","C1817 - HC OCCKYDER;ASD/PFO",9668,0,0,0,2417]
["TUFTS - TUFTS POS - HCPCS - C1817","TUFTS","TUFTS POS","HCPCS","C1817","HC OCCKYDER;ASD/PFO","C1817 - HC OCCKYDER;ASD/PFO",9668,0,0,0,2417]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1817","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1817","HC OCCKYDER;ASD/PFO","C1817 - HC OCCKYDER;ASD/PFO",9668,0,0,0,2417]
["TUFTS - TUFTS SELECT - HCPCS - C1821","TUFTS","TUFTS SELECT","HCPCS","C1821","HC INTERSPINOUS IMPLANT","C1821 - HC INTERSPINOUS IMPLANT",9770,0,0,0,2442.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1821","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1821","HC INTERSPINOUS IMPLANT","C1821 - HC INTERSPINOUS IMPLANT",9770,0,0,0,2442.5]
["TUFTS - TUFTS PPO - HCPCS - C1821","TUFTS","TUFTS PPO","HCPCS","C1821","HC INTERSPINOUS IMPLANT","C1821 - HC INTERSPINOUS IMPLANT",9770,0,0,0,2442.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1821","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1821","HC INTERSPINOUS IMPLANT","C1821 - HC INTERSPINOUS IMPLANT",9770,0,0,0,2442.5]
["TUFTS - TUFTS HMO - HCPCS - C1821","TUFTS","TUFTS HMO","HCPCS","C1821","HC INTERSPINOUS IMPLANT","C1821 - HC INTERSPINOUS IMPLANT",9770,0,0,0,2442.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1821","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1821","HC INTERSPINOUS IMPLANT","C1821 - HC INTERSPINOUS IMPLANT",9770,0,0,0,2442.5]
["TUFTS - TUFTS POS - HCPCS - C1821","TUFTS","TUFTS POS","HCPCS","C1821","HC INTERSPINOUS IMPLANT","C1821 - HC INTERSPINOUS IMPLANT",9770,0,0,0,2442.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1821","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1821","HC INTERSPINOUS IMPLANT","C1821 - HC INTERSPINOUS IMPLANT",9770,0,0,0,2442.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1821","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1821","HC INTERSPINOUS IMPLANT","C1821 - HC INTERSPINOUS IMPLANT",9770,0,0,0,2442.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1874","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1874","STENT WALLFLEX SYSTEM","C1874 - STENT WALLFLEX SYSTEM",8879,0,0,0,2219.75]
["TUFTS - TUFTS SELECT - HCPCS - C1874","TUFTS","TUFTS SELECT","HCPCS","C1874","STENT WALLFLEX SYSTEM","C1874 - STENT WALLFLEX SYSTEM",8879,0,0,0,2219.75]
["TUFTS - TUFTS PPO - HCPCS - C1874","TUFTS","TUFTS PPO","HCPCS","C1874","STENT WALLFLEX SYSTEM","C1874 - STENT WALLFLEX SYSTEM",8879,0,0,0,2219.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1874","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1874","STENT WALLFLEX SYSTEM","C1874 - STENT WALLFLEX SYSTEM",8879,0,0,0,2219.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1874","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1874","STENT WALLFLEX SYSTEM","C1874 - STENT WALLFLEX SYSTEM",8879,0,0,0,2219.75]
["TUFTS - TUFTS HMO - HCPCS - C1874","TUFTS","TUFTS HMO","HCPCS","C1874","STENT WALLFLEX SYSTEM","C1874 - STENT WALLFLEX SYSTEM",8879,0,0,0,2219.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1874","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1874","STENT WALLFLEX SYSTEM","C1874 - STENT WALLFLEX SYSTEM",8879,0,0,0,2219.75]
["TUFTS - TUFTS POS - HCPCS - C1874","TUFTS","TUFTS POS","HCPCS","C1874","STENT WALLFLEX SYSTEM","C1874 - STENT WALLFLEX SYSTEM",8879,0,0,0,2219.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1874","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1874","STENT WALLFLEX SYSTEM","C1874 - STENT WALLFLEX SYSTEM",8879,0,0,0,2219.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1876","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1876","STENT BILIARY","C1876 - STENT BILIARY",11691,0,0,0,2922.75]
["TUFTS - TUFTS SELECT - HCPCS - C1876","TUFTS","TUFTS SELECT","HCPCS","C1876","STENT BILIARY","C1876 - STENT BILIARY",11691,0,0,0,2922.75]
["TUFTS - TUFTS PPO - HCPCS - C1876","TUFTS","TUFTS PPO","HCPCS","C1876","STENT BILIARY","C1876 - STENT BILIARY",11691,0,0,0,2922.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1876","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1876","STENT BILIARY","C1876 - STENT BILIARY",11691,0,0,0,2922.75]
["TUFTS - TUFTS POS - HCPCS - C1876","TUFTS","TUFTS POS","HCPCS","C1876","STENT BILIARY","C1876 - STENT BILIARY",11691,0,0,0,2922.75]
["TUFTS - TUFTS HMO - HCPCS - C1876","TUFTS","TUFTS HMO","HCPCS","C1876","STENT BILIARY","C1876 - STENT BILIARY",11691,0,0,0,2922.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1876","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1876","STENT BILIARY","C1876 - STENT BILIARY",11691,0,0,0,2922.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1876","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1876","STENT BILIARY","C1876 - STENT BILIARY",11691,0,0,0,2922.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1876","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1876","STENT BILIARY","C1876 - STENT BILIARY",11691,0,0,0,2922.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1880","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1880","IVC FILTERS","C1880 - IVC FILTERS",7726,0,0,0,1931.5]
["TUFTS - TUFTS PPO - HCPCS - C1880","TUFTS","TUFTS PPO","HCPCS","C1880","IVC FILTERS","C1880 - IVC FILTERS",7726,0,0,0,1931.5]
["TUFTS - TUFTS SELECT - HCPCS - C1880","TUFTS","TUFTS SELECT","HCPCS","C1880","IVC FILTERS","C1880 - IVC FILTERS",7726,0,0,0,1931.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1880","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1880","IVC FILTERS","C1880 - IVC FILTERS",7726,0,0,0,1931.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1880","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1880","IVC FILTERS","C1880 - IVC FILTERS",7726,0,0,0,1931.5]
["TUFTS - TUFTS HMO - HCPCS - C1880","TUFTS","TUFTS HMO","HCPCS","C1880","IVC FILTERS","C1880 - IVC FILTERS",7726,0,0,0,1931.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1880","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1880","IVC FILTERS","C1880 - IVC FILTERS",7726,0,0,0,1931.5]
["TUFTS - TUFTS POS - HCPCS - C1880","TUFTS","TUFTS POS","HCPCS","C1880","IVC FILTERS","C1880 - IVC FILTERS",7726,0,0,0,1931.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1880","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1880","IVC FILTERS","C1880 - IVC FILTERS",7726,0,0,0,1931.5]
["TUFTS - TUFTS PPO - HCPCS - C1882","TUFTS","TUFTS PPO","HCPCS","C1882","HC ICD,BI-VENT, GEN ONLY, RECALL $0","C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0",53226,0,0,0,13306.5]
["TUFTS - TUFTS SELECT - HCPCS - C1882","TUFTS","TUFTS SELECT","HCPCS","C1882","HC ICD,BI-VENT, GEN ONLY, RECALL $0","C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0",53226,0,0,0,13306.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1882","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1882","HC ICD,BI-VENT, GEN ONLY, RECALL $0","C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0",53226,0,0,0,13306.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1882","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1882","HC ICD,BI-VENT, GEN ONLY, RECALL $0","C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0",53226,0,0,0,13306.5]
["TUFTS - TUFTS HMO - HCPCS - C1882","TUFTS","TUFTS HMO","HCPCS","C1882","HC ICD,BI-VENT, GEN ONLY, RECALL $0","C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0",53226,0,0,0,13306.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1882","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1882","HC ICD,BI-VENT, GEN ONLY, RECALL $0","C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0",53226,0,0,0,13306.5]
["TUFTS - TUFTS POS - HCPCS - C1882","TUFTS","TUFTS POS","HCPCS","C1882","HC ICD,BI-VENT, GEN ONLY, RECALL $0","C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0",53226,0,0,0,13306.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1882","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1882","HC ICD,BI-VENT, GEN ONLY, RECALL $0","C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0",53226,0,0,0,13306.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1882","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1882","HC ICD,BI-VENT, GEN ONLY, RECALL $0","C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0",53226,0,0,0,13306.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1883","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1883","HC ADAPTOR;BI-VENT PACER","C1883 - HC ADAPTOR;BI-VENT PACER",1257,0,0,0,314.25]
["TUFTS - TUFTS SELECT - HCPCS - C1883","TUFTS","TUFTS SELECT","HCPCS","C1883","HC ADAPTOR;BI-VENT PACER","C1883 - HC ADAPTOR;BI-VENT PACER",1257,0,0,0,314.25]
["TUFTS - TUFTS PPO - HCPCS - C1883","TUFTS","TUFTS PPO","HCPCS","C1883","HC ADAPTOR;BI-VENT PACER","C1883 - HC ADAPTOR;BI-VENT PACER",1257,0,0,0,314.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1883","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1883","HC ADAPTOR;BI-VENT PACER","C1883 - HC ADAPTOR;BI-VENT PACER",1257,0,0,0,314.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1883","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1883","HC ADAPTOR;BI-VENT PACER","C1883 - HC ADAPTOR;BI-VENT PACER",1257,0,0,0,314.25]
["TUFTS - TUFTS HMO - HCPCS - C1883","TUFTS","TUFTS HMO","HCPCS","C1883","HC ADAPTOR;BI-VENT PACER","C1883 - HC ADAPTOR;BI-VENT PACER",1257,0,0,0,314.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1883","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1883","HC ADAPTOR;BI-VENT PACER","C1883 - HC ADAPTOR;BI-VENT PACER",1257,0,0,0,314.25]
["TUFTS - TUFTS POS - HCPCS - C1883","TUFTS","TUFTS POS","HCPCS","C1883","HC ADAPTOR;BI-VENT PACER","C1883 - HC ADAPTOR;BI-VENT PACER",1257,0,0,0,314.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1883","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1883","HC ADAPTOR;BI-VENT PACER","C1883 - HC ADAPTOR;BI-VENT PACER",1257,0,0,0,314.25]
["TUFTS - TUFTS PPO - HCPCS - C1884","TUFTS","TUFTS PPO","HCPCS","C1884","EMBOLIZATION PROTECT SYST","C1884 - EMBOLIZATION PROTECT SYST",31469,0,0,0,7867.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1884","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1884","EMBOLIZATION PROTECT SYST","C1884 - EMBOLIZATION PROTECT SYST",31469,0,0,0,7867.25]
["TUFTS - TUFTS SELECT - HCPCS - C1884","TUFTS","TUFTS SELECT","HCPCS","C1884","EMBOLIZATION PROTECT SYST","C1884 - EMBOLIZATION PROTECT SYST",31469,0,0,0,7867.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1884","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1884","EMBOLIZATION PROTECT SYST","C1884 - EMBOLIZATION PROTECT SYST",31469,0,0,0,7867.25]
["TUFTS - TUFTS POS - HCPCS - C1884","TUFTS","TUFTS POS","HCPCS","C1884","EMBOLIZATION PROTECT SYST","C1884 - EMBOLIZATION PROTECT SYST",31469,0,0,0,7867.25]
["TUFTS - TUFTS HMO - HCPCS - C1884","TUFTS","TUFTS HMO","HCPCS","C1884","EMBOLIZATION PROTECT SYST","C1884 - EMBOLIZATION PROTECT SYST",31469,0,0,0,7867.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1884","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1884","EMBOLIZATION PROTECT SYST","C1884 - EMBOLIZATION PROTECT SYST",31469,0,0,0,7867.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1884","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1884","EMBOLIZATION PROTECT SYST","C1884 - EMBOLIZATION PROTECT SYST",31469,0,0,0,7867.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1884","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1884","EMBOLIZATION PROTECT SYST","C1884 - EMBOLIZATION PROTECT SYST",31469,0,0,0,7867.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1887","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1887","HC CATH,EP;R-F,30D THERM RMT","C1887 - HC CATH,EP;R-F,30D THERM RMT",3731,0,0,0,932.75]
["TUFTS - TUFTS PPO - HCPCS - C1887","TUFTS","TUFTS PPO","HCPCS","C1887","HC CATH,EP;R-F,30D THERM RMT","C1887 - HC CATH,EP;R-F,30D THERM RMT",3731,0,0,0,932.75]
["TUFTS - TUFTS SELECT - HCPCS - C1887","TUFTS","TUFTS SELECT","HCPCS","C1887","HC CATH,EP;R-F,30D THERM RMT","C1887 - HC CATH,EP;R-F,30D THERM RMT",3731,0,0,0,932.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1887","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1887","HC CATH,EP;R-F,30D THERM RMT","C1887 - HC CATH,EP;R-F,30D THERM RMT",3731,0,0,0,932.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1887","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1887","HC CATH,EP;R-F,30D THERM RMT","C1887 - HC CATH,EP;R-F,30D THERM RMT",3731,0,0,0,932.75]
["TUFTS - TUFTS HMO - HCPCS - C1887","TUFTS","TUFTS HMO","HCPCS","C1887","HC CATH,EP;R-F,30D THERM RMT","C1887 - HC CATH,EP;R-F,30D THERM RMT",3731,0,0,0,932.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1887","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1887","HC CATH,EP;R-F,30D THERM RMT","C1887 - HC CATH,EP;R-F,30D THERM RMT",3731,0,0,0,932.75]
["TUFTS - TUFTS POS - HCPCS - C1887","TUFTS","TUFTS POS","HCPCS","C1887","HC CATH,EP;R-F,30D THERM RMT","C1887 - HC CATH,EP;R-F,30D THERM RMT",3731,0,0,0,932.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1887","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1887","HC CATH,EP;R-F,30D THERM RMT","C1887 - HC CATH,EP;R-F,30D THERM RMT",3731,0,0,0,932.75]
["TUFTS - TUFTS SELECT - HCPCS - C1892","TUFTS","TUFTS SELECT","HCPCS","C1892","HC SHEATH;GUIDING","C1892 - HC SHEATH;GUIDING",340,0,0,0,85]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1892","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1892","HC SHEATH;GUIDING","C1892 - HC SHEATH;GUIDING",340,0,0,0,85]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1892","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1892","HC SHEATH;GUIDING","C1892 - HC SHEATH;GUIDING",340,0,0,0,85]
["TUFTS - TUFTS PPO - HCPCS - C1892","TUFTS","TUFTS PPO","HCPCS","C1892","HC SHEATH;GUIDING","C1892 - HC SHEATH;GUIDING",340,0,0,0,85]
["TUFTS - TUFTS HMO - HCPCS - C1892","TUFTS","TUFTS HMO","HCPCS","C1892","HC SHEATH;GUIDING","C1892 - HC SHEATH;GUIDING",340,0,0,0,85]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1892","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1892","HC SHEATH;GUIDING","C1892 - HC SHEATH;GUIDING",340,0,0,0,85]
["TUFTS - TUFTS POS - HCPCS - C1892","TUFTS","TUFTS POS","HCPCS","C1892","HC SHEATH;GUIDING","C1892 - HC SHEATH;GUIDING",340,0,0,0,85]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1892","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1892","HC SHEATH;GUIDING","C1892 - HC SHEATH;GUIDING",340,0,0,0,85]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1892","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1892","HC SHEATH;GUIDING","C1892 - HC SHEATH;GUIDING",340,0,0,0,85]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1893","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1893","HC DILATOR SHEATH/VISISHEATH","C1893 - HC DILATOR SHEATH/VISISHEATH",406,0,0,0,101.5]
["TUFTS - TUFTS PPO - HCPCS - C1893","TUFTS","TUFTS PPO","HCPCS","C1893","HC DILATOR SHEATH/VISISHEATH","C1893 - HC DILATOR SHEATH/VISISHEATH",406,0,0,0,101.5]
["TUFTS - TUFTS SELECT - HCPCS - C1893","TUFTS","TUFTS SELECT","HCPCS","C1893","HC DILATOR SHEATH/VISISHEATH","C1893 - HC DILATOR SHEATH/VISISHEATH",406,0,0,0,101.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1893","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1893","HC DILATOR SHEATH/VISISHEATH","C1893 - HC DILATOR SHEATH/VISISHEATH",406,0,0,0,101.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1893","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1893","HC DILATOR SHEATH/VISISHEATH","C1893 - HC DILATOR SHEATH/VISISHEATH",406,0,0,0,101.5]
["TUFTS - TUFTS HMO - HCPCS - C1893","TUFTS","TUFTS HMO","HCPCS","C1893","HC DILATOR SHEATH/VISISHEATH","C1893 - HC DILATOR SHEATH/VISISHEATH",406,0,0,0,101.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1893","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1893","HC DILATOR SHEATH/VISISHEATH","C1893 - HC DILATOR SHEATH/VISISHEATH",406,0,0,0,101.5]
["TUFTS - TUFTS POS - HCPCS - C1893","TUFTS","TUFTS POS","HCPCS","C1893","HC DILATOR SHEATH/VISISHEATH","C1893 - HC DILATOR SHEATH/VISISHEATH",406,0,0,0,101.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1893","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1893","HC DILATOR SHEATH/VISISHEATH","C1893 - HC DILATOR SHEATH/VISISHEATH",406,0,0,0,101.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1894","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1894","HC INTRO/SHEATH NON-CARD LV2","C1894 - HC INTRO/SHEATH NON-CARD LV2",252,0,0,0,63]
["TUFTS - TUFTS SELECT - HCPCS - C1894","TUFTS","TUFTS SELECT","HCPCS","C1894","HC INTRO/SHEATH NON-CARD LV2","C1894 - HC INTRO/SHEATH NON-CARD LV2",252,0,0,0,63]
["TUFTS - TUFTS PPO - HCPCS - C1894","TUFTS","TUFTS PPO","HCPCS","C1894","HC INTRO/SHEATH NON-CARD LV2","C1894 - HC INTRO/SHEATH NON-CARD LV2",252,0,0,0,63]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1894","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1894","HC INTRO/SHEATH NON-CARD LV2","C1894 - HC INTRO/SHEATH NON-CARD LV2",252,0,0,0,63]
["TUFTS - TUFTS POS - HCPCS - C1894","TUFTS","TUFTS POS","HCPCS","C1894","HC INTRO/SHEATH NON-CARD LV2","C1894 - HC INTRO/SHEATH NON-CARD LV2",252,0,0,0,63]
["TUFTS - TUFTS HMO - HCPCS - C1894","TUFTS","TUFTS HMO","HCPCS","C1894","HC INTRO/SHEATH NON-CARD LV2","C1894 - HC INTRO/SHEATH NON-CARD LV2",252,0,0,0,63]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1894","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1894","HC INTRO/SHEATH NON-CARD LV2","C1894 - HC INTRO/SHEATH NON-CARD LV2",252,0,0,0,63]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1894","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1894","HC INTRO/SHEATH NON-CARD LV2","C1894 - HC INTRO/SHEATH NON-CARD LV2",252,0,0,0,63]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1894","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1894","HC INTRO/SHEATH NON-CARD LV2","C1894 - HC INTRO/SHEATH NON-CARD LV2",252,0,0,0,63]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1895","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1895","HC ICD LEAD,2COIL","C1895 - HC ICD LEAD,2COIL",13382,0,0,0,3345.5]
["TUFTS - TUFTS SELECT - HCPCS - C1895","TUFTS","TUFTS SELECT","HCPCS","C1895","HC ICD LEAD,2COIL","C1895 - HC ICD LEAD,2COIL",13382,0,0,0,3345.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1895","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1895","HC ICD LEAD,2COIL","C1895 - HC ICD LEAD,2COIL",13382,0,0,0,3345.5]
["TUFTS - TUFTS PPO - HCPCS - C1895","TUFTS","TUFTS PPO","HCPCS","C1895","HC ICD LEAD,2COIL","C1895 - HC ICD LEAD,2COIL",13382,0,0,0,3345.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1895","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1895","HC ICD LEAD,2COIL","C1895 - HC ICD LEAD,2COIL",13382,0,0,0,3345.5]
["TUFTS - TUFTS HMO - HCPCS - C1895","TUFTS","TUFTS HMO","HCPCS","C1895","HC ICD LEAD,2COIL","C1895 - HC ICD LEAD,2COIL",13382,0,0,0,3345.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1895","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1895","HC ICD LEAD,2COIL","C1895 - HC ICD LEAD,2COIL",13382,0,0,0,3345.5]
["TUFTS - TUFTS POS - HCPCS - C1895","TUFTS","TUFTS POS","HCPCS","C1895","HC ICD LEAD,2COIL","C1895 - HC ICD LEAD,2COIL",13382,0,0,0,3345.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1895","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1895","HC ICD LEAD,2COIL","C1895 - HC ICD LEAD,2COIL",13382,0,0,0,3345.5]
["TUFTS - TUFTS SELECT - HCPCS - C1896","TUFTS","TUFTS SELECT","HCPCS","C1896","HC SICD PULSE GENERATOR","C1896 - HC SICD PULSE GENERATOR",10912,0,0,0,2728]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1896","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1896","HC SICD PULSE GENERATOR","C1896 - HC SICD PULSE GENERATOR",10912,0,0,0,2728]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1896","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1896","HC SICD PULSE GENERATOR","C1896 - HC SICD PULSE GENERATOR",10912,0,0,0,2728]
["TUFTS - TUFTS PPO - HCPCS - C1896","TUFTS","TUFTS PPO","HCPCS","C1896","HC SICD PULSE GENERATOR","C1896 - HC SICD PULSE GENERATOR",10912,0,0,0,2728]
["TUFTS - TUFTS HMO - HCPCS - C1896","TUFTS","TUFTS HMO","HCPCS","C1896","HC SICD PULSE GENERATOR","C1896 - HC SICD PULSE GENERATOR",10912,0,0,0,2728]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1896","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1896","HC SICD PULSE GENERATOR","C1896 - HC SICD PULSE GENERATOR",10912,0,0,0,2728]
["TUFTS - TUFTS POS - HCPCS - C1896","TUFTS","TUFTS POS","HCPCS","C1896","HC SICD PULSE GENERATOR","C1896 - HC SICD PULSE GENERATOR",10912,0,0,0,2728]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1896","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1896","HC SICD PULSE GENERATOR","C1896 - HC SICD PULSE GENERATOR",10912,0,0,0,2728]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1896","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1896","HC SICD PULSE GENERATOR","C1896 - HC SICD PULSE GENERATOR",10912,0,0,0,2728]
["TUFTS - TUFTS PPO - HCPCS - C1898","TUFTS","TUFTS PPO","HCPCS","C1898","HC KIT,PACER;BI-VENT(#6216/8","C1898 - HC KIT,PACER;BI-VENT(#6216/8",1575,0,0,0,393.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1898","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1898","HC KIT,PACER;BI-VENT(#6216/8","C1898 - HC KIT,PACER;BI-VENT(#6216/8",1575,0,0,0,393.75]
["TUFTS - TUFTS SELECT - HCPCS - C1898","TUFTS","TUFTS SELECT","HCPCS","C1898","HC KIT,PACER;BI-VENT(#6216/8","C1898 - HC KIT,PACER;BI-VENT(#6216/8",1575,0,0,0,393.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1898","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1898","HC KIT,PACER;BI-VENT(#6216/8","C1898 - HC KIT,PACER;BI-VENT(#6216/8",1575,0,0,0,393.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1898","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1898","HC KIT,PACER;BI-VENT(#6216/8","C1898 - HC KIT,PACER;BI-VENT(#6216/8",1575,0,0,0,393.75]
["TUFTS - TUFTS HMO - HCPCS - C1898","TUFTS","TUFTS HMO","HCPCS","C1898","HC KIT,PACER;BI-VENT(#6216/8","C1898 - HC KIT,PACER;BI-VENT(#6216/8",1575,0,0,0,393.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1898","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1898","HC KIT,PACER;BI-VENT(#6216/8","C1898 - HC KIT,PACER;BI-VENT(#6216/8",1575,0,0,0,393.75]
["TUFTS - TUFTS POS - HCPCS - C1898","TUFTS","TUFTS POS","HCPCS","C1898","HC KIT,PACER;BI-VENT(#6216/8","C1898 - HC KIT,PACER;BI-VENT(#6216/8",1575,0,0,0,393.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1898","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1898","HC KIT,PACER;BI-VENT(#6216/8","C1898 - HC KIT,PACER;BI-VENT(#6216/8",1575,0,0,0,393.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1900","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1900","HC INJ;OCTAFLUORO MICRO/1ML","C1900 - HC INJ;OCTAFLUORO MICRO/1ML",8293,0,0,0,2073.25]
["TUFTS - TUFTS SELECT - HCPCS - C1900","TUFTS","TUFTS SELECT","HCPCS","C1900","HC INJ;OCTAFLUORO MICRO/1ML","C1900 - HC INJ;OCTAFLUORO MICRO/1ML",8293,0,0,0,2073.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1900","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1900","HC INJ;OCTAFLUORO MICRO/1ML","C1900 - HC INJ;OCTAFLUORO MICRO/1ML",8293,0,0,0,2073.25]
["TUFTS - TUFTS PPO - HCPCS - C1900","TUFTS","TUFTS PPO","HCPCS","C1900","HC INJ;OCTAFLUORO MICRO/1ML","C1900 - HC INJ;OCTAFLUORO MICRO/1ML",8293,0,0,0,2073.25]
["TUFTS - TUFTS POS - HCPCS - C1900","TUFTS","TUFTS POS","HCPCS","C1900","HC INJ;OCTAFLUORO MICRO/1ML","C1900 - HC INJ;OCTAFLUORO MICRO/1ML",8293,0,0,0,2073.25]
["TUFTS - TUFTS HMO - HCPCS - C1900","TUFTS","TUFTS HMO","HCPCS","C1900","HC INJ;OCTAFLUORO MICRO/1ML","C1900 - HC INJ;OCTAFLUORO MICRO/1ML",8293,0,0,0,2073.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1900","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1900","HC INJ;OCTAFLUORO MICRO/1ML","C1900 - HC INJ;OCTAFLUORO MICRO/1ML",8293,0,0,0,2073.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1900","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1900","HC INJ;OCTAFLUORO MICRO/1ML","C1900 - HC INJ;OCTAFLUORO MICRO/1ML",8293,0,0,0,2073.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1900","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1900","HC INJ;OCTAFLUORO MICRO/1ML","C1900 - HC INJ;OCTAFLUORO MICRO/1ML",8293,0,0,0,2073.25]
["TUFTS - TUFTS PPO - HCPCS - C2615","TUFTS","TUFTS PPO","HCPCS","C2615","SEALANT, PULMONARY, LIQUID","C2615 - SEALANT, PULMONARY, LIQUID",1447.7,1012.6500000000001,748.44,1447.7,361.92500000000001]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C2615","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C2615","SEALANT, PULMONARY, LIQUID","C2615 - SEALANT, PULMONARY, LIQUID",1447.7,1012.65,748.44,1447.7,361.92500000000001]
["TUFTS - TUFTS SELECT - HCPCS - C2615","TUFTS","TUFTS SELECT","HCPCS","C2615","SEALANT, PULMONARY, LIQUID","C2615 - SEALANT, PULMONARY, LIQUID",1447.7,1012.6500000000001,748.44,1447.7,361.92500000000001]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C2615","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C2615","SEALANT, PULMONARY, LIQUID","C2615 - SEALANT, PULMONARY, LIQUID",1447.7,1012.6500000000001,748.44,1447.7,361.92500000000001]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C2615","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C2615","SEALANT, PULMONARY, LIQUID","C2615 - SEALANT, PULMONARY, LIQUID",1447.7,1012.6500000000001,748.44,1447.7,361.92500000000001]
["TUFTS - TUFTS HMO - HCPCS - C2615","TUFTS","TUFTS HMO","HCPCS","C2615","SEALANT, PULMONARY, LIQUID","C2615 - SEALANT, PULMONARY, LIQUID",1447.7,1012.65,748.44,1447.7,361.92500000000001]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C2615","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C2615","SEALANT, PULMONARY, LIQUID","C2615 - SEALANT, PULMONARY, LIQUID",1447.7,1012.6500000000001,748.44,1447.7,361.92500000000001]
["TUFTS - TUFTS POS - HCPCS - C2615","TUFTS","TUFTS POS","HCPCS","C2615","SEALANT, PULMONARY, LIQUID","C2615 - SEALANT, PULMONARY, LIQUID",1447.7,1012.6500000000001,748.44,1447.7,361.92500000000001]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C2615","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C2615","SEALANT, PULMONARY, LIQUID","C2615 - SEALANT, PULMONARY, LIQUID",1447.7,1012.65,748.44,1447.7,361.92500000000001]
["TUFTS - TUFTS PPO - HCPCS - C2616","TUFTS","TUFTS PPO","HCPCS","C2616","HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE",60393,27290.41,25512.2,76706.740000000005,15098.25]
["TUFTS - TUFTS SELECT - HCPCS - C2616","TUFTS","TUFTS SELECT","HCPCS","C2616","HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE",60393,25512.2,25512.2,76706.740000000005,15098.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C2616","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C2616","HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE",60393,29411.3,25512.2,76706.740000000005,15098.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C2616","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C2616","HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE",60393,29411.3,25512.2,76706.740000000005,15098.25]
["TUFTS - TUFTS HMO - HCPCS - C2616","TUFTS","TUFTS HMO","HCPCS","C2616","HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE",60393,30614.639999999999,25512.2,76706.740000000005,15098.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C2616","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C2616","HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE",60393,29411.3,25512.2,76706.740000000005,15098.25]
["TUFTS - TUFTS POS - HCPCS - C2616","TUFTS","TUFTS POS","HCPCS","C2616","HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE",60393,25512.2,25512.2,76706.740000000005,15098.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C2616","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C2616","HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE",60393,29411.3,25512.2,76706.740000000005,15098.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - C2616","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","C2616","HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE",60393,47839.61,25512.2,76706.740000000005,15098.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C2616","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C2616","HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE",60393,76706.740000000005,25512.2,76706.740000000005,15098.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - C2616","BLUE CROSS","BLUE CROSS-PPO","HCPCS","C2616","HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE",60393,47839.61,25512.2,76706.740000000005,15098.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - C2616","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","C2616","HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE",60393,47839.61,25512.2,76706.740000000005,15098.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - C2616","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","C2616","HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE",60393,47839.61,25512.2,76706.740000000005,15098.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - C2616","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","C2616","HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE",60393,47839.61,25512.2,76706.740000000005,15098.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - C2616","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","C2616","HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE",60393,47839.61,25512.2,76706.740000000005,15098.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - C2616","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","C2616","HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE",60393,47839.61,25512.2,76706.740000000005,15098.25]
["TUFTS - TUFTS PPO - HCPCS - C2617","TUFTS","TUFTS PPO","HCPCS","C2617","STENT ZIMMON BILIARY","C2617 - STENT ZIMMON BILIARY",638,0,0,0,159.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C2617","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C2617","STENT ZIMMON BILIARY","C2617 - STENT ZIMMON BILIARY",638,0,0,0,159.5]
["TUFTS - TUFTS SELECT - HCPCS - C2617","TUFTS","TUFTS SELECT","HCPCS","C2617","STENT ZIMMON BILIARY","C2617 - STENT ZIMMON BILIARY",638,0,0,0,159.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C2617","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C2617","STENT ZIMMON BILIARY","C2617 - STENT ZIMMON BILIARY",638,0,0,0,159.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C2617","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C2617","STENT ZIMMON BILIARY","C2617 - STENT ZIMMON BILIARY",638,0,0,0,159.5]
["TUFTS - TUFTS HMO - HCPCS - C2617","TUFTS","TUFTS HMO","HCPCS","C2617","STENT ZIMMON BILIARY","C2617 - STENT ZIMMON BILIARY",638,0,0,0,159.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C2617","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C2617","STENT ZIMMON BILIARY","C2617 - STENT ZIMMON BILIARY",638,0,0,0,159.5]
["TUFTS - TUFTS POS - HCPCS - C2617","TUFTS","TUFTS POS","HCPCS","C2617","STENT ZIMMON BILIARY","C2617 - STENT ZIMMON BILIARY",638,0,0,0,159.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C2617","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C2617","STENT ZIMMON BILIARY","C2617 - STENT ZIMMON BILIARY",638,0,0,0,159.5]
["TUFTS - TUFTS PPO - HCPCS - C2621","TUFTS","TUFTS PPO","HCPCS","C2621","HC PACER;2CH, W/ BACKUP DEFIB","C2621 - HC PACER;2CH, W/ BACKUP DEFIB",21692,0,0,0,5423]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C2621","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C2621","HC PACER;2CH, W/ BACKUP DEFIB","C2621 - HC PACER;2CH, W/ BACKUP DEFIB",21692,0,0,0,5423]
["TUFTS - TUFTS SELECT - HCPCS - C2621","TUFTS","TUFTS SELECT","HCPCS","C2621","HC PACER;2CH, W/ BACKUP DEFIB","C2621 - HC PACER;2CH, W/ BACKUP DEFIB",21692,0,0,0,5423]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C2621","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C2621","HC PACER;2CH, W/ BACKUP DEFIB","C2621 - HC PACER;2CH, W/ BACKUP DEFIB",21692,0,0,0,5423]
["TUFTS - TUFTS POS - HCPCS - C2621","TUFTS","TUFTS POS","HCPCS","C2621","HC PACER;2CH, W/ BACKUP DEFIB","C2621 - HC PACER;2CH, W/ BACKUP DEFIB",21692,0,0,0,5423]
["TUFTS - TUFTS HMO - HCPCS - C2621","TUFTS","TUFTS HMO","HCPCS","C2621","HC PACER;2CH, W/ BACKUP DEFIB","C2621 - HC PACER;2CH, W/ BACKUP DEFIB",21692,0,0,0,5423]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C2621","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C2621","HC PACER;2CH, W/ BACKUP DEFIB","C2621 - HC PACER;2CH, W/ BACKUP DEFIB",21692,0,0,0,5423]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C2621","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C2621","HC PACER;2CH, W/ BACKUP DEFIB","C2621 - HC PACER;2CH, W/ BACKUP DEFIB",21692,0,0,0,5423]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C2621","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C2621","HC PACER;2CH, W/ BACKUP DEFIB","C2621 - HC PACER;2CH, W/ BACKUP DEFIB",21692,0,0,0,5423]
["TUFTS - TUFTS PPO - HCPCS - C2623","TUFTS","TUFTS PPO","HCPCS","C2623","CATH TRANSLUMIN DRUG-COAT","C2623 - CATH TRANSLUMIN DRUG-COAT",2837,0,0,0,709.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C2623","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C2623","CATH TRANSLUMIN DRUG-COAT","C2623 - CATH TRANSLUMIN DRUG-COAT",2837,0,0,0,709.25]
["TUFTS - TUFTS SELECT - HCPCS - C2623","TUFTS","TUFTS SELECT","HCPCS","C2623","CATH TRANSLUMIN DRUG-COAT","C2623 - CATH TRANSLUMIN DRUG-COAT",2837,0,0,0,709.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C2623","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C2623","CATH TRANSLUMIN DRUG-COAT","C2623 - CATH TRANSLUMIN DRUG-COAT",2837,0,0,0,709.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C2623","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C2623","CATH TRANSLUMIN DRUG-COAT","C2623 - CATH TRANSLUMIN DRUG-COAT",2837,0,0,0,709.25]
["TUFTS - TUFTS HMO - HCPCS - C2623","TUFTS","TUFTS HMO","HCPCS","C2623","CATH TRANSLUMIN DRUG-COAT","C2623 - CATH TRANSLUMIN DRUG-COAT",2837,0,0,0,709.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C2623","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C2623","CATH TRANSLUMIN DRUG-COAT","C2623 - CATH TRANSLUMIN DRUG-COAT",2837,0,0,0,709.25]
["TUFTS - TUFTS POS - HCPCS - C2623","TUFTS","TUFTS POS","HCPCS","C2623","CATH TRANSLUMIN DRUG-COAT","C2623 - CATH TRANSLUMIN DRUG-COAT",2837,0,0,0,709.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C2623","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C2623","CATH TRANSLUMIN DRUG-COAT","C2623 - CATH TRANSLUMIN DRUG-COAT",2837,0,0,0,709.25]
["TUFTS - TUFTS PPO - HCPCS - C2625","TUFTS","TUFTS PPO","HCPCS","C2625","STENT BILIARY COTTON","C2625 - STENT BILIARY COTTON",246,0,0,0,61.5]
["TUFTS - TUFTS SELECT - HCPCS - C2625","TUFTS","TUFTS SELECT","HCPCS","C2625","STENT BILIARY COTTON","C2625 - STENT BILIARY COTTON",246,0,0,0,61.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C2625","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C2625","STENT BILIARY COTTON","C2625 - STENT BILIARY COTTON",246,0,0,0,61.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C2625","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C2625","STENT BILIARY COTTON","C2625 - STENT BILIARY COTTON",246,0,0,0,61.5]
["TUFTS - TUFTS HMO - HCPCS - C2625","TUFTS","TUFTS HMO","HCPCS","C2625","STENT BILIARY COTTON","C2625 - STENT BILIARY COTTON",246,0,0,0,61.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C2625","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C2625","STENT BILIARY COTTON","C2625 - STENT BILIARY COTTON",246,0,0,0,61.5]
["TUFTS - TUFTS POS - HCPCS - C2625","TUFTS","TUFTS POS","HCPCS","C2625","STENT BILIARY COTTON","C2625 - STENT BILIARY COTTON",246,0,0,0,61.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C2625","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C2625","STENT BILIARY COTTON","C2625 - STENT BILIARY COTTON",246,0,0,0,61.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C2625","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C2625","STENT BILIARY COTTON","C2625 - STENT BILIARY COTTON",246,0,0,0,61.5]
["TUFTS - TUFTS PPO - HCPCS - C2628","TUFTS","TUFTS PPO","HCPCS","C2628","HC KIT CATH BRIDGE PRE","C2628 - HC KIT CATH BRIDGE PRE",2308,0,0,0,577]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C2628","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C2628","HC KIT CATH BRIDGE PRE","C2628 - HC KIT CATH BRIDGE PRE",2308,0,0,0,577]
["TUFTS - TUFTS SELECT - HCPCS - C2628","TUFTS","TUFTS SELECT","HCPCS","C2628","HC KIT CATH BRIDGE PRE","C2628 - HC KIT CATH BRIDGE PRE",2308,0,0,0,577]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C2628","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C2628","HC KIT CATH BRIDGE PRE","C2628 - HC KIT CATH BRIDGE PRE",2308,0,0,0,577]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C2628","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C2628","HC KIT CATH BRIDGE PRE","C2628 - HC KIT CATH BRIDGE PRE",2308,0,0,0,577]
["TUFTS - TUFTS HMO - HCPCS - C2628","TUFTS","TUFTS HMO","HCPCS","C2628","HC KIT CATH BRIDGE PRE","C2628 - HC KIT CATH BRIDGE PRE",2308,0,0,0,577]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C2628","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C2628","HC KIT CATH BRIDGE PRE","C2628 - HC KIT CATH BRIDGE PRE",2308,0,0,0,577]
["TUFTS - TUFTS POS - HCPCS - C2628","TUFTS","TUFTS POS","HCPCS","C2628","HC KIT CATH BRIDGE PRE","C2628 - HC KIT CATH BRIDGE PRE",2308,0,0,0,577]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C2628","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C2628","HC KIT CATH BRIDGE PRE","C2628 - HC KIT CATH BRIDGE PRE",2308,0,0,0,577]
["TUFTS - TUFTS PPO - HCPCS - C2630","TUFTS","TUFTS PPO","HCPCS","C2630","HC CATH;EP CRYOABLATION, 8 MM","C2630 - HC CATH;EP CRYOABLATION, 8 MM",4966,0,0,0,1241.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C2630","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C2630","HC CATH;EP CRYOABLATION, 8 MM","C2630 - HC CATH;EP CRYOABLATION, 8 MM",4966,0,0,0,1241.5]
["TUFTS - TUFTS SELECT - HCPCS - C2630","TUFTS","TUFTS SELECT","HCPCS","C2630","HC CATH;EP CRYOABLATION, 8 MM","C2630 - HC CATH;EP CRYOABLATION, 8 MM",4966,0,0,0,1241.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C2630","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C2630","HC CATH;EP CRYOABLATION, 8 MM","C2630 - HC CATH;EP CRYOABLATION, 8 MM",4966,0,0,0,1241.5]
["TUFTS - TUFTS POS - HCPCS - C2630","TUFTS","TUFTS POS","HCPCS","C2630","HC CATH;EP CRYOABLATION, 8 MM","C2630 - HC CATH;EP CRYOABLATION, 8 MM",4966,0,0,0,1241.5]
["TUFTS - TUFTS HMO - HCPCS - C2630","TUFTS","TUFTS HMO","HCPCS","C2630","HC CATH;EP CRYOABLATION, 8 MM","C2630 - HC CATH;EP CRYOABLATION, 8 MM",4966,0,0,0,1241.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C2630","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C2630","HC CATH;EP CRYOABLATION, 8 MM","C2630 - HC CATH;EP CRYOABLATION, 8 MM",4966,0,0,0,1241.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C2630","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C2630","HC CATH;EP CRYOABLATION, 8 MM","C2630 - HC CATH;EP CRYOABLATION, 8 MM",4966,0,0,0,1241.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C2630","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C2630","HC CATH;EP CRYOABLATION, 8 MM","C2630 - HC CATH;EP CRYOABLATION, 8 MM",4966,0,0,0,1241.5]
["TUFTS - TUFTS PPO - HCPCS - C2634","TUFTS","TUFTS PPO","HCPCS","C2634","BRACHYTX, NON-STR, HA, I-125","C2634 - BRACHYTX, NON-STR, HA, I-125",0,248.65,232.45,698.88,0]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C2634","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C2634","BRACHYTX, NON-STR, HA, I-125","C2634 - BRACHYTX, NON-STR, HA, I-125",0,313.02999999999997,232.45,698.88,0]
["TUFTS - TUFTS SELECT - HCPCS - C2634","TUFTS","TUFTS SELECT","HCPCS","C2634","BRACHYTX, NON-STR, HA, I-125","C2634 - BRACHYTX, NON-STR, HA, I-125",0,232.45,232.45,698.88,0]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C2634","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C2634","BRACHYTX, NON-STR, HA, I-125","C2634 - BRACHYTX, NON-STR, HA, I-125",0,313.02999999999997,232.45,698.88,0]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C2634","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C2634","BRACHYTX, NON-STR, HA, I-125","C2634 - BRACHYTX, NON-STR, HA, I-125",0,313.02999999999997,232.45,698.88,0]
["TUFTS - TUFTS HMO - HCPCS - C2634","TUFTS","TUFTS HMO","HCPCS","C2634","BRACHYTX, NON-STR, HA, I-125","C2634 - BRACHYTX, NON-STR, HA, I-125",0,278.94,232.45,698.88,0]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C2634","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C2634","BRACHYTX, NON-STR, HA, I-125","C2634 - BRACHYTX, NON-STR, HA, I-125",0,313.02999999999997,232.45,698.88,0]
["TUFTS - TUFTS POS - HCPCS - C2634","TUFTS","TUFTS POS","HCPCS","C2634","BRACHYTX, NON-STR, HA, I-125","C2634 - BRACHYTX, NON-STR, HA, I-125",0,232.45,232.45,698.88,0]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C2634","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C2634","BRACHYTX, NON-STR, HA, I-125","C2634 - BRACHYTX, NON-STR, HA, I-125",0,698.88,232.45,698.88,0]
["TUFTS - TUFTS PPO - HCPCS - C2635","TUFTS","TUFTS PPO","HCPCS","C2635","BRACHYTX, NON-STR, HA, P-103","C2635 - BRACHYTX, NON-STR, HA, P-103",0,86.29,78.03,242.54,0]
["TUFTS - TUFTS SELECT - HCPCS - C2635","TUFTS","TUFTS SELECT","HCPCS","C2635","BRACHYTX, NON-STR, HA, P-103","C2635 - BRACHYTX, NON-STR, HA, P-103",0,80.66,78.03,242.54,0]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C2635","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C2635","BRACHYTX, NON-STR, HA, P-103","C2635 - BRACHYTX, NON-STR, HA, P-103",0,97.01,78.03,242.54,0]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C2635","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C2635","BRACHYTX, NON-STR, HA, P-103","C2635 - BRACHYTX, NON-STR, HA, P-103",0,97.01,78.03,242.54,0]
["TUFTS - TUFTS HMO - HCPCS - C2635","TUFTS","TUFTS HMO","HCPCS","C2635","BRACHYTX, NON-STR, HA, P-103","C2635 - BRACHYTX, NON-STR, HA, P-103",0,96.8,78.03,242.54,0]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C2635","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C2635","BRACHYTX, NON-STR, HA, P-103","C2635 - BRACHYTX, NON-STR, HA, P-103",0,97.01,78.03,242.54,0]
["TUFTS - TUFTS POS - HCPCS - C2635","TUFTS","TUFTS POS","HCPCS","C2635","BRACHYTX, NON-STR, HA, P-103","C2635 - BRACHYTX, NON-STR, HA, P-103",0,80.66,78.03,242.54,0]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C2635","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C2635","BRACHYTX, NON-STR, HA, P-103","C2635 - BRACHYTX, NON-STR, HA, P-103",0,97.01,78.03,242.54,0]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - C2635","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","C2635","BRACHYTX, NON-STR, HA, P-103","C2635 - BRACHYTX, NON-STR, HA, P-103",0,78.03,78.03,242.54,0]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C2635","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C2635","BRACHYTX, NON-STR, HA, P-103","C2635 - BRACHYTX, NON-STR, HA, P-103",0,242.54,78.03,242.54,0]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - C2635","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","C2635","BRACHYTX, NON-STR, HA, P-103","C2635 - BRACHYTX, NON-STR, HA, P-103",0,78.03,78.03,242.54,0]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - C2635","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","C2635","BRACHYTX, NON-STR, HA, P-103","C2635 - BRACHYTX, NON-STR, HA, P-103",0,78.03,78.03,242.54,0]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - C2635","BLUE CROSS","BLUE CROSS-PPO","HCPCS","C2635","BRACHYTX, NON-STR, HA, P-103","C2635 - BRACHYTX, NON-STR, HA, P-103",0,78.03,78.03,242.54,0]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - C2635","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","C2635","BRACHYTX, NON-STR, HA, P-103","C2635 - BRACHYTX, NON-STR, HA, P-103",0,78.03,78.03,242.54,0]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - C2635","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","C2635","BRACHYTX, NON-STR, HA, P-103","C2635 - BRACHYTX, NON-STR, HA, P-103",0,78.03,78.03,242.54,0]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - C2635","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","C2635","BRACHYTX, NON-STR, HA, P-103","C2635 - BRACHYTX, NON-STR, HA, P-103",0,78.03,78.03,242.54,0]
["TUFTS - TUFTS PPO - HCPCS - C2639","TUFTS","TUFTS PPO","HCPCS","C2639","BRACHYTX, NON-STRANDED,I-125","C2639 - BRACHYTX, NON-STRANDED,I-125",47,56.54,52.85,100.75,11.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C2639","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C2639","BRACHYTX, NON-STRANDED,I-125","C2639 - BRACHYTX, NON-STRANDED,I-125",47,61.32,52.85,100.75,11.75]
["TUFTS - TUFTS SELECT - HCPCS - C2639","TUFTS","TUFTS SELECT","HCPCS","C2639","BRACHYTX, NON-STRANDED,I-125","C2639 - BRACHYTX, NON-STRANDED,I-125",47,52.85,52.85,100.75,11.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C2639","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C2639","BRACHYTX, NON-STRANDED,I-125","C2639 - BRACHYTX, NON-STRANDED,I-125",47,61.32,52.85,100.75,11.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C2639","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C2639","BRACHYTX, NON-STRANDED,I-125","C2639 - BRACHYTX, NON-STRANDED,I-125",47,61.32,52.85,100.75,11.75]
["TUFTS - TUFTS HMO - HCPCS - C2639","TUFTS","TUFTS HMO","HCPCS","C2639","BRACHYTX, NON-STRANDED,I-125","C2639 - BRACHYTX, NON-STRANDED,I-125",47,52.85,52.85,100.75,11.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C2639","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C2639","BRACHYTX, NON-STRANDED,I-125","C2639 - BRACHYTX, NON-STRANDED,I-125",47,61.32,52.85,100.75,11.75]
["TUFTS - TUFTS POS - HCPCS - C2639","TUFTS","TUFTS POS","HCPCS","C2639","BRACHYTX, NON-STRANDED,I-125","C2639 - BRACHYTX, NON-STRANDED,I-125",47,52.85,52.85,100.75,11.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - C2639","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","C2639","BRACHYTX, NON-STRANDED,I-125","C2639 - BRACHYTX, NON-STRANDED,I-125",47,100.75,52.85,100.75,11.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C2639","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C2639","BRACHYTX, NON-STRANDED,I-125","C2639 - BRACHYTX, NON-STRANDED,I-125",47,89.68,52.85,100.75,11.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - C2639","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","C2639","BRACHYTX, NON-STRANDED,I-125","C2639 - BRACHYTX, NON-STRANDED,I-125",47,100.75,52.85,100.75,11.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - C2639","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","C2639","BRACHYTX, NON-STRANDED,I-125","C2639 - BRACHYTX, NON-STRANDED,I-125",47,100.75,52.85,100.75,11.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - C2639","BLUE CROSS","BLUE CROSS-PPO","HCPCS","C2639","BRACHYTX, NON-STRANDED,I-125","C2639 - BRACHYTX, NON-STRANDED,I-125",47,100.75,52.85,100.75,11.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - C2639","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","C2639","BRACHYTX, NON-STRANDED,I-125","C2639 - BRACHYTX, NON-STRANDED,I-125",47,100.75,52.85,100.75,11.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - C2639","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","C2639","BRACHYTX, NON-STRANDED,I-125","C2639 - BRACHYTX, NON-STRANDED,I-125",47,100.75,52.85,100.75,11.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - C2639","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","C2639","BRACHYTX, NON-STRANDED,I-125","C2639 - BRACHYTX, NON-STRANDED,I-125",47,100.75,52.85,100.75,11.75]
["TUFTS - TUFTS PPO - HCPCS - C5275","TUFTS","TUFTS PPO","HCPCS","C5275","HC LOW COST SKIN SUBSTITUTE","C5275 - HC LOW COST SKIN SUBSTITUTE",743,1281.21,684.11,2032.26,185.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C5275","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C5275","HC LOW COST SKIN SUBSTITUTE","C5275 - HC LOW COST SKIN SUBSTITUTE",743,1042.56,684.11,2032.26,185.75]
["TUFTS - TUFTS SELECT - HCPCS - C5275","TUFTS","TUFTS SELECT","HCPCS","C5275","HC LOW COST SKIN SUBSTITUTE","C5275 - HC LOW COST SKIN SUBSTITUTE",743,684.11,684.11,2032.26,185.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C5275","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C5275","HC LOW COST SKIN SUBSTITUTE","C5275 - HC LOW COST SKIN SUBSTITUTE",743,1016.97,684.11,2032.26,185.75]
["TUFTS - TUFTS POS - HCPCS - C5275","TUFTS","TUFTS POS","HCPCS","C5275","HC LOW COST SKIN SUBSTITUTE","C5275 - HC LOW COST SKIN SUBSTITUTE",743,1281.21,684.11,2032.26,185.75]
["TUFTS - TUFTS HMO - HCPCS - C5275","TUFTS","TUFTS HMO","HCPCS","C5275","HC LOW COST SKIN SUBSTITUTE","C5275 - HC LOW COST SKIN SUBSTITUTE",743,1281.21,684.11,2032.26,185.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C5275","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C5275","HC LOW COST SKIN SUBSTITUTE","C5275 - HC LOW COST SKIN SUBSTITUTE",743,1042.56,684.11,2032.26,185.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C5275","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C5275","HC LOW COST SKIN SUBSTITUTE","C5275 - HC LOW COST SKIN SUBSTITUTE",743,1042.56,684.11,2032.26,185.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - C5275","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","C5275","HC LOW COST SKIN SUBSTITUTE","C5275 - HC LOW COST SKIN SUBSTITUTE",743,810.95,684.11,2032.26,185.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C5275","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C5275","HC LOW COST SKIN SUBSTITUTE","C5275 - HC LOW COST SKIN SUBSTITUTE",743,2032.26,684.11,2032.26,185.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - C5275","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","C5275","HC LOW COST SKIN SUBSTITUTE","C5275 - HC LOW COST SKIN SUBSTITUTE",743,810.95,684.11,2032.26,185.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - C5275","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","C5275","HC LOW COST SKIN SUBSTITUTE","C5275 - HC LOW COST SKIN SUBSTITUTE",743,810.95,684.11,2032.26,185.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - C5275","BLUE CROSS","BLUE CROSS-PPO","HCPCS","C5275","HC LOW COST SKIN SUBSTITUTE","C5275 - HC LOW COST SKIN SUBSTITUTE",743,810.95,684.11,2032.26,185.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - C5275","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","C5275","HC LOW COST SKIN SUBSTITUTE","C5275 - HC LOW COST SKIN SUBSTITUTE",743,810.95,684.11,2032.26,185.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - C5275","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","C5275","HC LOW COST SKIN SUBSTITUTE","C5275 - HC LOW COST SKIN SUBSTITUTE",743,810.95,684.11,2032.26,185.75]
["AETNA - AETNA - HCPCS - C5275","AETNA","AETNA","HCPCS","C5275","HC LOW COST SKIN SUBSTITUTE","C5275 - HC LOW COST SKIN SUBSTITUTE",743,1500.85,684.11,2032.26,185.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - C5275","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","C5275","HC LOW COST SKIN SUBSTITUTE","C5275 - HC LOW COST SKIN SUBSTITUTE",743,810.95,684.11,2032.26,185.75]
["TUFTS - TUFTS PPO - HCPCS - C8908","TUFTS","TUFTS PPO","HCPCS","C8908","HC MRI W/O FOL W/CONT, BREAST,","C8908 - HC MRI W/O FOL W/CONT, BREAST,",579,1529.76,664.1,4299.8,144.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C8908","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C8908","HC MRI W/O FOL W/CONT, BREAST,","C8908 - HC MRI W/O FOL W/CONT, BREAST,",579,664.1,664.1,4299.8,144.75]
["TUFTS - TUFTS SELECT - HCPCS - C8908","TUFTS","TUFTS SELECT","HCPCS","C8908","HC MRI W/O FOL W/CONT, BREAST,","C8908 - HC MRI W/O FOL W/CONT, BREAST,",579,667.78,664.1,4299.8,144.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C8908","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C8908","HC MRI W/O FOL W/CONT, BREAST,","C8908 - HC MRI W/O FOL W/CONT, BREAST,",579,664.1,664.1,4299.8,144.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C8908","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C8908","HC MRI W/O FOL W/CONT, BREAST,","C8908 - HC MRI W/O FOL W/CONT, BREAST,",579,664.1,664.1,4299.8,144.75]
["TUFTS - TUFTS HMO - HCPCS - C8908","TUFTS","TUFTS HMO","HCPCS","C8908","HC MRI W/O FOL W/CONT, BREAST,","C8908 - HC MRI W/O FOL W/CONT, BREAST,",579,1716.08,664.1,4299.8,144.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C8908","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C8908","HC MRI W/O FOL W/CONT, BREAST,","C8908 - HC MRI W/O FOL W/CONT, BREAST,",579,664.1,664.1,4299.8,144.75]
["TUFTS - TUFTS POS - HCPCS - C8908","TUFTS","TUFTS POS","HCPCS","C8908","HC MRI W/O FOL W/CONT, BREAST,","C8908 - HC MRI W/O FOL W/CONT, BREAST,",579,1430.06,664.1,4299.8,144.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - C8908","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","C8908","HC MRI W/O FOL W/CONT, BREAST,","C8908 - HC MRI W/O FOL W/CONT, BREAST,",579,1105.27,664.1,4299.8,144.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C8908","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C8908","HC MRI W/O FOL W/CONT, BREAST,","C8908 - HC MRI W/O FOL W/CONT, BREAST,",579,4299.8,664.1,4299.8,144.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - C8908","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","C8908","HC MRI W/O FOL W/CONT, BREAST,","C8908 - HC MRI W/O FOL W/CONT, BREAST,",579,1105.27,664.1,4299.8,144.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - C8908","BLUE CROSS","BLUE CROSS-PPO","HCPCS","C8908","HC MRI W/O FOL W/CONT, BREAST,","C8908 - HC MRI W/O FOL W/CONT, BREAST,",579,1105.27,664.1,4299.8,144.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - C8908","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","C8908","HC MRI W/O FOL W/CONT, BREAST,","C8908 - HC MRI W/O FOL W/CONT, BREAST,",579,1105.27,664.1,4299.8,144.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - C8908","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","C8908","HC MRI W/O FOL W/CONT, BREAST,","C8908 - HC MRI W/O FOL W/CONT, BREAST,",579,1105.27,664.1,4299.8,144.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - C8908","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","C8908","HC MRI W/O FOL W/CONT, BREAST,","C8908 - HC MRI W/O FOL W/CONT, BREAST,",579,1105.27,664.1,4299.8,144.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - C8908","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","C8908","HC MRI W/O FOL W/CONT, BREAST,","C8908 - HC MRI W/O FOL W/CONT, BREAST,",579,1105.27,664.1,4299.8,144.75]
["TUFTS - TUFTS PPO - HCPCS - C8937","TUFTS","TUFTS PPO","HCPCS","C8937","CAD BREAST MRI","C8937 - CAD BREAST MRI",331,0,0,0,82.75]
["TUFTS - TUFTS SELECT - HCPCS - C8937","TUFTS","TUFTS SELECT","HCPCS","C8937","CAD BREAST MRI","C8937 - CAD BREAST MRI",331,0,0,0,82.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C8937","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C8937","CAD BREAST MRI","C8937 - CAD BREAST MRI",331,0,0,0,82.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C8937","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C8937","CAD BREAST MRI","C8937 - CAD BREAST MRI",331,0,0,0,82.75]
["TUFTS - TUFTS HMO - HCPCS - C8937","TUFTS","TUFTS HMO","HCPCS","C8937","CAD BREAST MRI","C8937 - CAD BREAST MRI",331,0,0,0,82.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C8937","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C8937","CAD BREAST MRI","C8937 - CAD BREAST MRI",331,0,0,0,82.75]
["TUFTS - TUFTS POS - HCPCS - C8937","TUFTS","TUFTS POS","HCPCS","C8937","CAD BREAST MRI","C8937 - CAD BREAST MRI",331,0,0,0,82.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C8937","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C8937","CAD BREAST MRI","C8937 - CAD BREAST MRI",331,0,0,0,82.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C8937","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C8937","CAD BREAST MRI","C8937 - CAD BREAST MRI",331,0,0,0,82.75]
["TUFTS - TUFTS PPO - HCPCS - C9358","TUFTS","TUFTS PPO","HCPCS","C9358","SURGIMEND, FETAL","C9358 - SURGIMEND, FETAL",8526,0,24.42,24.42,2131.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C9358","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C9358","SURGIMEND, FETAL","C9358 - SURGIMEND, FETAL",8526,0,24.42,24.42,2131.5]
["TUFTS - TUFTS SELECT - HCPCS - C9358","TUFTS","TUFTS SELECT","HCPCS","C9358","SURGIMEND, FETAL","C9358 - SURGIMEND, FETAL",8526,0,24.42,24.42,2131.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C9358","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C9358","SURGIMEND, FETAL","C9358 - SURGIMEND, FETAL",8526,0,24.42,24.42,2131.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C9358","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C9358","SURGIMEND, FETAL","C9358 - SURGIMEND, FETAL",8526,0,24.42,24.42,2131.5]
["TUFTS - TUFTS HMO - HCPCS - C9358","TUFTS","TUFTS HMO","HCPCS","C9358","SURGIMEND, FETAL","C9358 - SURGIMEND, FETAL",8526,0,24.42,24.42,2131.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C9358","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C9358","SURGIMEND, FETAL","C9358 - SURGIMEND, FETAL",8526,0,24.42,24.42,2131.5]
["TUFTS - TUFTS POS - HCPCS - C9358","TUFTS","TUFTS POS","HCPCS","C9358","SURGIMEND, FETAL","C9358 - SURGIMEND, FETAL",8526,0,24.42,24.42,2131.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - C9358","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","C9358","SURGIMEND, FETAL","C9358 - SURGIMEND, FETAL",8526,24.42,24.42,24.42,2131.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C9358","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C9358","SURGIMEND, FETAL","C9358 - SURGIMEND, FETAL",8526,0,24.42,24.42,2131.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - C9358","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","C9358","SURGIMEND, FETAL","C9358 - SURGIMEND, FETAL",8526,24.42,24.42,24.42,2131.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - C9358","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","C9358","SURGIMEND, FETAL","C9358 - SURGIMEND, FETAL",8526,24.42,24.42,24.42,2131.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - C9358","BLUE CROSS","BLUE CROSS-PPO","HCPCS","C9358","SURGIMEND, FETAL","C9358 - SURGIMEND, FETAL",8526,24.42,24.42,24.42,2131.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - C9358","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","C9358","SURGIMEND, FETAL","C9358 - SURGIMEND, FETAL",8526,24.42,24.42,24.42,2131.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - C9358","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","C9358","SURGIMEND, FETAL","C9358 - SURGIMEND, FETAL",8526,24.42,24.42,24.42,2131.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - C9358","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","C9358","SURGIMEND, FETAL","C9358 - SURGIMEND, FETAL",8526,24.42,24.42,24.42,2131.5]
["TUFTS - TUFTS PPO - HCPCS - C9728","TUFTS","TUFTS PPO","HCPCS","C9728","PLACE DEVICE/MARKER, NON PRO","C9728 - PLACE DEVICE/MARKER, NON PRO",1957,4475.4399999999996,2227.36,7098.97,489.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C9728","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C9728","PLACE DEVICE/MARKER, NON PRO","C9728 - PLACE DEVICE/MARKER, NON PRO",1957,2573.36,2227.36,7098.97,489.25]
["TUFTS - TUFTS SELECT - HCPCS - C9728","TUFTS","TUFTS SELECT","HCPCS","C9728","PLACE DEVICE/MARKER, NON PRO","C9728 - PLACE DEVICE/MARKER, NON PRO",1957,2227.36,2227.36,7098.97,489.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C9728","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C9728","PLACE DEVICE/MARKER, NON PRO","C9728 - PLACE DEVICE/MARKER, NON PRO",1957,2510.1799999999998,2227.36,7098.97,489.25]
["TUFTS - TUFTS POS - HCPCS - C9728","TUFTS","TUFTS POS","HCPCS","C9728","PLACE DEVICE/MARKER, NON PRO","C9728 - PLACE DEVICE/MARKER, NON PRO",1957,4183.66,2227.36,7098.97,489.25]
["TUFTS - TUFTS HMO - HCPCS - C9728","TUFTS","TUFTS HMO","HCPCS","C9728","PLACE DEVICE/MARKER, NON PRO","C9728 - PLACE DEVICE/MARKER, NON PRO",1957,4183.66,2227.36,7098.97,489.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C9728","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C9728","PLACE DEVICE/MARKER, NON PRO","C9728 - PLACE DEVICE/MARKER, NON PRO",1957,2573.36,2227.36,7098.97,489.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C9728","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C9728","PLACE DEVICE/MARKER, NON PRO","C9728 - PLACE DEVICE/MARKER, NON PRO",1957,2573.36,2227.36,7098.97,489.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - C9728","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","C9728","PLACE DEVICE/MARKER, NON PRO","C9728 - PLACE DEVICE/MARKER, NON PRO",1957,3429.66,2227.36,7098.97,489.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C9728","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C9728","PLACE DEVICE/MARKER, NON PRO","C9728 - PLACE DEVICE/MARKER, NON PRO",1957,7098.97,2227.36,7098.97,489.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - C9728","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","C9728","PLACE DEVICE/MARKER, NON PRO","C9728 - PLACE DEVICE/MARKER, NON PRO",1957,3429.66,2227.36,7098.97,489.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - C9728","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","C9728","PLACE DEVICE/MARKER, NON PRO","C9728 - PLACE DEVICE/MARKER, NON PRO",1957,3429.66,2227.36,7098.97,489.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - C9728","BLUE CROSS","BLUE CROSS-PPO","HCPCS","C9728","PLACE DEVICE/MARKER, NON PRO","C9728 - PLACE DEVICE/MARKER, NON PRO",1957,3429.66,2227.36,7098.97,489.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - C9728","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","C9728","PLACE DEVICE/MARKER, NON PRO","C9728 - PLACE DEVICE/MARKER, NON PRO",1957,3429.66,2227.36,7098.97,489.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - C9728","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","C9728","PLACE DEVICE/MARKER, NON PRO","C9728 - PLACE DEVICE/MARKER, NON PRO",1957,3429.66,2227.36,7098.97,489.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - C9728","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","C9728","PLACE DEVICE/MARKER, NON PRO","C9728 - PLACE DEVICE/MARKER, NON PRO",1957,3429.66,2227.36,7098.97,489.25]
["TUFTS - TUFTS PPO - HCPCS - C9739","TUFTS","TUFTS PPO","HCPCS","C9739","HC CYSTOSCOPY PROSTATIC IMP 1-3","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3",6035,9609.09,2166.09,15242.01,1508.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C9739","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C9739","HC CYSTOSCOPY PROSTATIC IMP 1-3","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3",6035,7620.54,2166.09,15242.01,1508.75]
["TUFTS - TUFTS SELECT - HCPCS - C9739","TUFTS","TUFTS SELECT","HCPCS","C9739","HC CYSTOSCOPY PROSTATIC IMP 1-3","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3",6035,5130.87,2166.09,15242.01,1508.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C9739","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C9739","HC CYSTOSCOPY PROSTATIC IMP 1-3","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3",6035,7812.32,2166.09,15242.01,1508.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C9739","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C9739","HC CYSTOSCOPY PROSTATIC IMP 1-3","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3",6035,7812.32,2166.09,15242.01,1508.75]
["TUFTS - TUFTS HMO - HCPCS - C9739","TUFTS","TUFTS HMO","HCPCS","C9739","HC CYSTOSCOPY PROSTATIC IMP 1-3","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3",6035,9609.09,2166.09,15242.01,1508.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C9739","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C9739","HC CYSTOSCOPY PROSTATIC IMP 1-3","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3",6035,7812.32,2166.09,15242.01,1508.75]
["TUFTS - TUFTS POS - HCPCS - C9739","TUFTS","TUFTS POS","HCPCS","C9739","HC CYSTOSCOPY PROSTATIC IMP 1-3","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3",6035,9609.09,2166.09,15242.01,1508.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - C9739","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","C9739","HC CYSTOSCOPY PROSTATIC IMP 1-3","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3",6035,6751.98,2166.09,15242.01,1508.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C9739","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C9739","HC CYSTOSCOPY PROSTATIC IMP 1-3","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3",6035,15242.01,2166.09,15242.01,1508.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - C9739","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","C9739","HC CYSTOSCOPY PROSTATIC IMP 1-3","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3",6035,6751.98,2166.09,15242.01,1508.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - C9739","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","C9739","HC CYSTOSCOPY PROSTATIC IMP 1-3","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3",6035,6751.98,2166.09,15242.01,1508.75]
["AETNA - AETNA - HCPCS - C9739","AETNA","AETNA","HCPCS","C9739","HC CYSTOSCOPY PROSTATIC IMP 1-3","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3",6035,2166.09,2166.09,15242.01,1508.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - C9739","BLUE CROSS","BLUE CROSS-PPO","HCPCS","C9739","HC CYSTOSCOPY PROSTATIC IMP 1-3","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3",6035,6751.98,2166.09,15242.01,1508.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - C9739","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","C9739","HC CYSTOSCOPY PROSTATIC IMP 1-3","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3",6035,6751.98,2166.09,15242.01,1508.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - C9739","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","C9739","HC CYSTOSCOPY PROSTATIC IMP 1-3","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3",6035,6751.98,2166.09,15242.01,1508.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - C9739","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","C9739","HC CYSTOSCOPY PROSTATIC IMP 1-3","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3",6035,6751.98,2166.09,15242.01,1508.75]
["TUFTS - TUFTS PPO - HCPCS - C9803","TUFTS","TUFTS PPO","HCPCS","C9803","HC OP VISIT SPEC COLLECTION SEVERE ACUTE RESP SYDROM COVID-19","C9803 - HC OP VISIT SPEC COLLECTION SEVERE ACUTE RESP SYDROM COVID-19",35,87.7,87.7,246.49,8.75]
["TUFTS - TUFTS HMO - HCPCS - C9803","TUFTS","TUFTS HMO","HCPCS","C9803","HC OP VISIT SPEC COLLECTION SEVERE ACUTE RESP SYDROM COVID-19","C9803 - HC OP VISIT SPEC COLLECTION SEVERE ACUTE RESP SYDROM COVID-19",35,105.24,87.7,246.49,8.75]
["TUFTS - TUFTS POS - HCPCS - C9803","TUFTS","TUFTS POS","HCPCS","C9803","HC OP VISIT SPEC COLLECTION SEVERE ACUTE RESP SYDROM COVID-19","C9803 - HC OP VISIT SPEC COLLECTION SEVERE ACUTE RESP SYDROM COVID-19",35,87.7,87.7,246.49,8.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C9803","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C9803","HC OP VISIT SPEC COLLECTION SEVERE ACUTE RESP SYDROM COVID-19","C9803 - HC OP VISIT SPEC COLLECTION SEVERE ACUTE RESP SYDROM COVID-19",35,246.49,87.7,246.49,8.75]
["TUFTS - TUFTS PPO - HCPCS - D0150","TUFTS","TUFTS PPO","HCPCS","D0150","COMPREHENSIVE ORAL EXAM 60MIN","D0150 - COMPREHENSIVE ORAL EXAM 60MIN",265,2563.83,1275.99,4066.77,66.25]
["TUFTS - TUFTS SELECT - HCPCS - D0150","TUFTS","TUFTS SELECT","HCPCS","D0150","COMPREHENSIVE ORAL EXAM 60MIN","D0150 - COMPREHENSIVE ORAL EXAM 60MIN",265,1275.99,1275.99,4066.77,66.25]
["TUFTS - TUFTS HMO - HCPCS - D0150","TUFTS","TUFTS HMO","HCPCS","D0150","COMPREHENSIVE ORAL EXAM 60MIN","D0150 - COMPREHENSIVE ORAL EXAM 60MIN",265,2396.69,1275.99,4066.77,66.25]
["TUFTS - TUFTS POS - HCPCS - D0150","TUFTS","TUFTS POS","HCPCS","D0150","COMPREHENSIVE ORAL EXAM 60MIN","D0150 - COMPREHENSIVE ORAL EXAM 60MIN",265,2396.69,1275.99,4066.77,66.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D0150","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D0150","COMPREHENSIVE ORAL EXAM 60MIN","D0150 - COMPREHENSIVE ORAL EXAM 60MIN",265,4066.77,1275.99,4066.77,66.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D0210","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D0210","INTRAORAL - COMPLETE SERIES OF RADIOGRAPHIC IMAGES","D0210 - INTRAORAL - COMPLETE SERIES OF RADIOGRAPHIC IMAGES",165,120.47,120.47,120.47,41.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D0210","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D0210","INTRAORAL - COMPLETE SERIES OF RADIOGRAPHIC IMAGES","D0210 - INTRAORAL - COMPLETE SERIES OF RADIOGRAPHIC IMAGES",165,120.47,120.47,120.47,41.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D0210","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D0210","INTRAORAL - COMPLETE SERIES OF RADIOGRAPHIC IMAGES","D0210 - INTRAORAL - COMPLETE SERIES OF RADIOGRAPHIC IMAGES",165,120.47,120.47,120.47,41.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D0210","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D0210","INTRAORAL - COMPLETE SERIES OF RADIOGRAPHIC IMAGES","D0210 - INTRAORAL - COMPLETE SERIES OF RADIOGRAPHIC IMAGES",165,120.47,120.47,120.47,41.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D0210","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D0210","INTRAORAL - COMPLETE SERIES OF RADIOGRAPHIC IMAGES","D0210 - INTRAORAL - COMPLETE SERIES OF RADIOGRAPHIC IMAGES",165,120.47,120.47,120.47,41.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D0210","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D0210","INTRAORAL - COMPLETE SERIES OF RADIOGRAPHIC IMAGES","D0210 - INTRAORAL - COMPLETE SERIES OF RADIOGRAPHIC IMAGES",165,120.47,120.47,120.47,41.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D0210","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D0210","INTRAORAL - COMPLETE SERIES OF RADIOGRAPHIC IMAGES","D0210 - INTRAORAL - COMPLETE SERIES OF RADIOGRAPHIC IMAGES",165,120.47,120.47,120.47,41.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D0220","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D0220","INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE","D0220 - INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE",165,23.78,23.78,23.78,41.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D0220","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D0220","INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE","D0220 - INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE",165,23.78,23.78,23.78,41.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D0220","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D0220","INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE","D0220 - INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE",165,23.78,23.78,23.78,41.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D0220","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D0220","INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE","D0220 - INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE",165,23.78,23.78,23.78,41.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D0220","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D0220","INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE","D0220 - INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE",165,23.78,23.78,23.78,41.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D0220","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D0220","INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE","D0220 - INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE",165,23.78,23.78,23.78,41.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D0220","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D0220","INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE","D0220 - INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE",165,23.78,23.78,23.78,41.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D0230","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D0230","INTRAORAL - PERIAPICAL EACH ADDITIONAL RADIOGRAPHIC IMAGE","D0230 - INTRAORAL - PERIAPICAL EACH ADDITIONAL RADIOGRAPHIC IMAGE",110,21.35,21.35,21.35,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D0230","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D0230","INTRAORAL - PERIAPICAL EACH ADDITIONAL RADIOGRAPHIC IMAGE","D0230 - INTRAORAL - PERIAPICAL EACH ADDITIONAL RADIOGRAPHIC IMAGE",110,21.35,21.35,21.35,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D0230","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D0230","INTRAORAL - PERIAPICAL EACH ADDITIONAL RADIOGRAPHIC IMAGE","D0230 - INTRAORAL - PERIAPICAL EACH ADDITIONAL RADIOGRAPHIC IMAGE",110,21.35,21.35,21.35,27.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D0230","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D0230","INTRAORAL - PERIAPICAL EACH ADDITIONAL RADIOGRAPHIC IMAGE","D0230 - INTRAORAL - PERIAPICAL EACH ADDITIONAL RADIOGRAPHIC IMAGE",110,21.35,21.35,21.35,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D0230","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D0230","INTRAORAL - PERIAPICAL EACH ADDITIONAL RADIOGRAPHIC IMAGE","D0230 - INTRAORAL - PERIAPICAL EACH ADDITIONAL RADIOGRAPHIC IMAGE",110,21.35,21.35,21.35,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D0230","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D0230","INTRAORAL - PERIAPICAL EACH ADDITIONAL RADIOGRAPHIC IMAGE","D0230 - INTRAORAL - PERIAPICAL EACH ADDITIONAL RADIOGRAPHIC IMAGE",110,21.35,21.35,21.35,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D0230","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D0230","INTRAORAL - PERIAPICAL EACH ADDITIONAL RADIOGRAPHIC IMAGE","D0230 - INTRAORAL - PERIAPICAL EACH ADDITIONAL RADIOGRAPHIC IMAGE",110,21.35,21.35,21.35,27.5]
["TUFTS - TUFTS PPO - HCPCS - D0240","TUFTS","TUFTS PPO","HCPCS","D0240","INTRAORAL - OCCLUSAL RADIOGRAPHIC IMAGE","D0240 - INTRAORAL - OCCLUSAL RADIOGRAPHIC IMAGE",836,2563.83,1275.99,4066.77,209]
["TUFTS - TUFTS SELECT - HCPCS - D0240","TUFTS","TUFTS SELECT","HCPCS","D0240","INTRAORAL - OCCLUSAL RADIOGRAPHIC IMAGE","D0240 - INTRAORAL - OCCLUSAL RADIOGRAPHIC IMAGE",836,1275.99,1275.99,4066.77,209]
["TUFTS - TUFTS POS - HCPCS - D0240","TUFTS","TUFTS POS","HCPCS","D0240","INTRAORAL - OCCLUSAL RADIOGRAPHIC IMAGE","D0240 - INTRAORAL - OCCLUSAL RADIOGRAPHIC IMAGE",836,2396.69,1275.99,4066.77,209]
["TUFTS - TUFTS HMO - HCPCS - D0240","TUFTS","TUFTS HMO","HCPCS","D0240","INTRAORAL - OCCLUSAL RADIOGRAPHIC IMAGE","D0240 - INTRAORAL - OCCLUSAL RADIOGRAPHIC IMAGE",836,2396.69,1275.99,4066.77,209]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D0240","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D0240","INTRAORAL - OCCLUSAL RADIOGRAPHIC IMAGE","D0240 - INTRAORAL - OCCLUSAL RADIOGRAPHIC IMAGE",836,4066.77,1275.99,4066.77,209]
["TUFTS - TUFTS PPO - HCPCS - D0250","TUFTS","TUFTS PPO","HCPCS","D0250","HC EXTRA-ORAL - 2D PROJECTION RAD IMAGE CREATED USING A STATIONARY RADIATION SOURCE, AND DETECTOR","D0250 - HC EXTRA-ORAL - 2D PROJECTION RAD IMAGE CREATED USING A STATIONARY RADIATION SOURCE, AND DETECTOR",1451,2563.83,1275.99,4066.77,362.75]
["TUFTS - TUFTS SELECT - HCPCS - D0250","TUFTS","TUFTS SELECT","HCPCS","D0250","HC EXTRA-ORAL - 2D PROJECTION RAD IMAGE CREATED USING A STATIONARY RADIATION SOURCE, AND DETECTOR","D0250 - HC EXTRA-ORAL - 2D PROJECTION RAD IMAGE CREATED USING A STATIONARY RADIATION SOURCE, AND DETECTOR",1451,1275.99,1275.99,4066.77,362.75]
["TUFTS - TUFTS HMO - HCPCS - D0250","TUFTS","TUFTS HMO","HCPCS","D0250","HC EXTRA-ORAL - 2D PROJECTION RAD IMAGE CREATED USING A STATIONARY RADIATION SOURCE, AND DETECTOR","D0250 - HC EXTRA-ORAL - 2D PROJECTION RAD IMAGE CREATED USING A STATIONARY RADIATION SOURCE, AND DETECTOR",1451,2396.69,1275.99,4066.77,362.75]
["TUFTS - TUFTS POS - HCPCS - D0250","TUFTS","TUFTS POS","HCPCS","D0250","HC EXTRA-ORAL - 2D PROJECTION RAD IMAGE CREATED USING A STATIONARY RADIATION SOURCE, AND DETECTOR","D0250 - HC EXTRA-ORAL - 2D PROJECTION RAD IMAGE CREATED USING A STATIONARY RADIATION SOURCE, AND DETECTOR",1451,2396.69,1275.99,4066.77,362.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D0250","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D0250","HC EXTRA-ORAL - 2D PROJECTION RAD IMAGE CREATED USING A STATIONARY RADIATION SOURCE, AND DETECTOR","D0250 - HC EXTRA-ORAL - 2D PROJECTION RAD IMAGE CREATED USING A STATIONARY RADIATION SOURCE, AND DETECTOR",1451,4066.77,1275.99,4066.77,362.75]
["TUFTS - TUFTS PPO - HCPCS - D0251","TUFTS","TUFTS PPO","HCPCS","D0251","HC EXTRA-ORAL POSTERIOR DENTAL RADIOGRAPHIC IMAGE","D0251 - HC EXTRA-ORAL POSTERIOR DENTAL RADIOGRAPHIC IMAGE",119,0,0,0,29.75]
["TUFTS - TUFTS SELECT - HCPCS - D0251","TUFTS","TUFTS SELECT","HCPCS","D0251","HC EXTRA-ORAL POSTERIOR DENTAL RADIOGRAPHIC IMAGE","D0251 - HC EXTRA-ORAL POSTERIOR DENTAL RADIOGRAPHIC IMAGE",119,0,0,0,29.75]
["TUFTS - TUFTS HMO - HCPCS - D0251","TUFTS","TUFTS HMO","HCPCS","D0251","HC EXTRA-ORAL POSTERIOR DENTAL RADIOGRAPHIC IMAGE","D0251 - HC EXTRA-ORAL POSTERIOR DENTAL RADIOGRAPHIC IMAGE",119,0,0,0,29.75]
["TUFTS - TUFTS POS - HCPCS - D0251","TUFTS","TUFTS POS","HCPCS","D0251","HC EXTRA-ORAL POSTERIOR DENTAL RADIOGRAPHIC IMAGE","D0251 - HC EXTRA-ORAL POSTERIOR DENTAL RADIOGRAPHIC IMAGE",119,0,0,0,29.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D0251","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D0251","HC EXTRA-ORAL POSTERIOR DENTAL RADIOGRAPHIC IMAGE","D0251 - HC EXTRA-ORAL POSTERIOR DENTAL RADIOGRAPHIC IMAGE",119,0,0,0,29.75]
["TUFTS - TUFTS PPO - HCPCS - D0270","TUFTS","TUFTS PPO","HCPCS","D0270","BITEWING - SINGLE RADIOGRAPHIC IMAGE","D0270 - BITEWING - SINGLE RADIOGRAPHIC IMAGE",836,2563.83,1275.99,4066.77,209]
["TUFTS - TUFTS SELECT - HCPCS - D0270","TUFTS","TUFTS SELECT","HCPCS","D0270","BITEWING - SINGLE RADIOGRAPHIC IMAGE","D0270 - BITEWING - SINGLE RADIOGRAPHIC IMAGE",836,1275.99,1275.99,4066.77,209]
["TUFTS - TUFTS HMO - HCPCS - D0270","TUFTS","TUFTS HMO","HCPCS","D0270","BITEWING - SINGLE RADIOGRAPHIC IMAGE","D0270 - BITEWING - SINGLE RADIOGRAPHIC IMAGE",836,2396.69,1275.99,4066.77,209]
["TUFTS - TUFTS POS - HCPCS - D0270","TUFTS","TUFTS POS","HCPCS","D0270","BITEWING - SINGLE RADIOGRAPHIC IMAGE","D0270 - BITEWING - SINGLE RADIOGRAPHIC IMAGE",836,2396.69,1275.99,4066.77,209]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D0270","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D0270","BITEWING - SINGLE RADIOGRAPHIC IMAGE","D0270 - BITEWING - SINGLE RADIOGRAPHIC IMAGE",836,4066.77,1275.99,4066.77,209]
["TUFTS - TUFTS PPO - HCPCS - D0272","TUFTS","TUFTS PPO","HCPCS","D0272","BITEWINGS - TWO RADIOGRAPHIC IMAGES","D0272 - BITEWINGS - TWO RADIOGRAPHIC IMAGES",836,2563.83,1182.5,4066.77,209]
["TUFTS - TUFTS SELECT - HCPCS - D0272","TUFTS","TUFTS SELECT","HCPCS","D0272","BITEWINGS - TWO RADIOGRAPHIC IMAGES","D0272 - BITEWINGS - TWO RADIOGRAPHIC IMAGES",836,1275.99,1182.5,4066.77,209]
["TUFTS - TUFTS POS - HCPCS - D0272","TUFTS","TUFTS POS","HCPCS","D0272","BITEWINGS - TWO RADIOGRAPHIC IMAGES","D0272 - BITEWINGS - TWO RADIOGRAPHIC IMAGES",836,2396.69,1182.5,4066.77,209]
["TUFTS - TUFTS HMO - HCPCS - D0272","TUFTS","TUFTS HMO","HCPCS","D0272","BITEWINGS - TWO RADIOGRAPHIC IMAGES","D0272 - BITEWINGS - TWO RADIOGRAPHIC IMAGES",836,2396.69,1182.5,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D0272","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D0272","BITEWINGS - TWO RADIOGRAPHIC IMAGES","D0272 - BITEWINGS - TWO RADIOGRAPHIC IMAGES",836,1182.5,1182.5,4066.77,209]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D0272","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D0272","BITEWINGS - TWO RADIOGRAPHIC IMAGES","D0272 - BITEWINGS - TWO RADIOGRAPHIC IMAGES",836,4066.77,1182.5,4066.77,209]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D0272","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D0272","BITEWINGS - TWO RADIOGRAPHIC IMAGES","D0272 - BITEWINGS - TWO RADIOGRAPHIC IMAGES",836,1182.5,1182.5,4066.77,209]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D0272","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D0272","BITEWINGS - TWO RADIOGRAPHIC IMAGES","D0272 - BITEWINGS - TWO RADIOGRAPHIC IMAGES",836,1182.5,1182.5,4066.77,209]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D0272","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D0272","BITEWINGS - TWO RADIOGRAPHIC IMAGES","D0272 - BITEWINGS - TWO RADIOGRAPHIC IMAGES",836,1182.5,1182.5,4066.77,209]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D0272","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D0272","BITEWINGS - TWO RADIOGRAPHIC IMAGES","D0272 - BITEWINGS - TWO RADIOGRAPHIC IMAGES",836,1182.5,1182.5,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D0272","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D0272","BITEWINGS - TWO RADIOGRAPHIC IMAGES","D0272 - BITEWINGS - TWO RADIOGRAPHIC IMAGES",836,1182.5,1182.5,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D0272","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D0272","BITEWINGS - TWO RADIOGRAPHIC IMAGES","D0272 - BITEWINGS - TWO RADIOGRAPHIC IMAGES",836,1182.5,1182.5,4066.77,209]
["TUFTS - TUFTS PPO - HCPCS - D0274","TUFTS","TUFTS PPO","HCPCS","D0274","BITEWINGS - FOUR RADIOGRAPHIC IMAGES","D0274 - BITEWINGS - FOUR RADIOGRAPHIC IMAGES",836,2563.83,1182.5,4066.77,209]
["TUFTS - TUFTS SELECT - HCPCS - D0274","TUFTS","TUFTS SELECT","HCPCS","D0274","BITEWINGS - FOUR RADIOGRAPHIC IMAGES","D0274 - BITEWINGS - FOUR RADIOGRAPHIC IMAGES",836,1275.99,1182.5,4066.77,209]
["TUFTS - TUFTS HMO - HCPCS - D0274","TUFTS","TUFTS HMO","HCPCS","D0274","BITEWINGS - FOUR RADIOGRAPHIC IMAGES","D0274 - BITEWINGS - FOUR RADIOGRAPHIC IMAGES",836,2396.69,1182.5,4066.77,209]
["TUFTS - TUFTS POS - HCPCS - D0274","TUFTS","TUFTS POS","HCPCS","D0274","BITEWINGS - FOUR RADIOGRAPHIC IMAGES","D0274 - BITEWINGS - FOUR RADIOGRAPHIC IMAGES",836,2396.69,1182.5,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D0274","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D0274","BITEWINGS - FOUR RADIOGRAPHIC IMAGES","D0274 - BITEWINGS - FOUR RADIOGRAPHIC IMAGES",836,1182.5,1182.5,4066.77,209]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D0274","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D0274","BITEWINGS - FOUR RADIOGRAPHIC IMAGES","D0274 - BITEWINGS - FOUR RADIOGRAPHIC IMAGES",836,4066.77,1182.5,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D0274","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D0274","BITEWINGS - FOUR RADIOGRAPHIC IMAGES","D0274 - BITEWINGS - FOUR RADIOGRAPHIC IMAGES",836,1182.5,1182.5,4066.77,209]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D0274","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D0274","BITEWINGS - FOUR RADIOGRAPHIC IMAGES","D0274 - BITEWINGS - FOUR RADIOGRAPHIC IMAGES",836,1182.5,1182.5,4066.77,209]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D0274","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D0274","BITEWINGS - FOUR RADIOGRAPHIC IMAGES","D0274 - BITEWINGS - FOUR RADIOGRAPHIC IMAGES",836,1182.5,1182.5,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D0274","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D0274","BITEWINGS - FOUR RADIOGRAPHIC IMAGES","D0274 - BITEWINGS - FOUR RADIOGRAPHIC IMAGES",836,1182.5,1182.5,4066.77,209]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D0274","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D0274","BITEWINGS - FOUR RADIOGRAPHIC IMAGES","D0274 - BITEWINGS - FOUR RADIOGRAPHIC IMAGES",836,1182.5,1182.5,4066.77,209]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D0274","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D0274","BITEWINGS - FOUR RADIOGRAPHIC IMAGES","D0274 - BITEWINGS - FOUR RADIOGRAPHIC IMAGES",836,1182.5,1182.5,4066.77,209]
["TUFTS - TUFTS PPO - HCPCS - D0277","TUFTS","TUFTS PPO","HCPCS","D0277","HC VERTICAL BITEWINGS - 7 TO 8 RADIOGRAPHIC IMAGES","D0277 - HC VERTICAL BITEWINGS - 7 TO 8 RADIOGRAPHIC IMAGES",1451,2563.83,1275.99,4066.77,362.75]
["TUFTS - TUFTS SELECT - HCPCS - D0277","TUFTS","TUFTS SELECT","HCPCS","D0277","HC VERTICAL BITEWINGS - 7 TO 8 RADIOGRAPHIC IMAGES","D0277 - HC VERTICAL BITEWINGS - 7 TO 8 RADIOGRAPHIC IMAGES",1451,1275.99,1275.99,4066.77,362.75]
["TUFTS - TUFTS HMO - HCPCS - D0277","TUFTS","TUFTS HMO","HCPCS","D0277","HC VERTICAL BITEWINGS - 7 TO 8 RADIOGRAPHIC IMAGES","D0277 - HC VERTICAL BITEWINGS - 7 TO 8 RADIOGRAPHIC IMAGES",1451,2396.69,1275.99,4066.77,362.75]
["TUFTS - TUFTS POS - HCPCS - D0277","TUFTS","TUFTS POS","HCPCS","D0277","HC VERTICAL BITEWINGS - 7 TO 8 RADIOGRAPHIC IMAGES","D0277 - HC VERTICAL BITEWINGS - 7 TO 8 RADIOGRAPHIC IMAGES",1451,2396.69,1275.99,4066.77,362.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D0277","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D0277","HC VERTICAL BITEWINGS - 7 TO 8 RADIOGRAPHIC IMAGES","D0277 - HC VERTICAL BITEWINGS - 7 TO 8 RADIOGRAPHIC IMAGES",1451,4066.77,1275.99,4066.77,362.75]
["TUFTS - TUFTS PPO - HCPCS - D0472","TUFTS","TUFTS PPO","HCPCS","D0472","HC ACCESSION OF TISSUE, GROSS EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN REPORT","D0472 - HC ACCESSION OF TISSUE, GROSS EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN REPORT",110,3900.57,1941.26,6187.11,27.5]
["TUFTS - TUFTS SELECT - HCPCS - D0472","TUFTS","TUFTS SELECT","HCPCS","D0472","HC ACCESSION OF TISSUE, GROSS EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN REPORT","D0472 - HC ACCESSION OF TISSUE, GROSS EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN REPORT",110,1941.26,1941.26,6187.11,27.5]
["TUFTS - TUFTS HMO - HCPCS - D0472","TUFTS","TUFTS HMO","HCPCS","D0472","HC ACCESSION OF TISSUE, GROSS EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN REPORT","D0472 - HC ACCESSION OF TISSUE, GROSS EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN REPORT",110,3646.27,1941.26,6187.11,27.5]
["TUFTS - TUFTS POS - HCPCS - D0472","TUFTS","TUFTS POS","HCPCS","D0472","HC ACCESSION OF TISSUE, GROSS EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN REPORT","D0472 - HC ACCESSION OF TISSUE, GROSS EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN REPORT",110,3646.27,1941.26,6187.11,27.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D0472","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D0472","HC ACCESSION OF TISSUE, GROSS EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN REPORT","D0472 - HC ACCESSION OF TISSUE, GROSS EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN REPORT",110,6187.11,1941.26,6187.11,27.5]
["TUFTS - TUFTS PPO - HCPCS - D0473","TUFTS","TUFTS PPO","HCPCS","D0473","HC ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAM, PREP AND TRANS OF RPT.","D0473 - HC ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAM, PREP AND TRANS OF RPT.",110,3900.57,1941.26,6187.11,27.5]
["TUFTS - TUFTS SELECT - HCPCS - D0473","TUFTS","TUFTS SELECT","HCPCS","D0473","HC ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAM, PREP AND TRANS OF RPT.","D0473 - HC ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAM, PREP AND TRANS OF RPT.",110,1941.26,1941.26,6187.11,27.5]
["TUFTS - TUFTS POS - HCPCS - D0473","TUFTS","TUFTS POS","HCPCS","D0473","HC ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAM, PREP AND TRANS OF RPT.","D0473 - HC ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAM, PREP AND TRANS OF RPT.",110,3646.27,1941.26,6187.11,27.5]
["TUFTS - TUFTS HMO - HCPCS - D0473","TUFTS","TUFTS HMO","HCPCS","D0473","HC ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAM, PREP AND TRANS OF RPT.","D0473 - HC ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAM, PREP AND TRANS OF RPT.",110,3646.27,1941.26,6187.11,27.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D0473","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D0473","HC ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAM, PREP AND TRANS OF RPT.","D0473 - HC ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAM, PREP AND TRANS OF RPT.",110,6187.11,1941.26,6187.11,27.5]
["TUFTS - TUFTS PPO - HCPCS - D0474","TUFTS","TUFTS PPO","HCPCS","D0474","HC ACCESSION OF TISSUE, GROSS AND MICRO EXAM, INCL. ASSESS. OF MARGINS FOR DISEASE, PREP., TX OF RPT","D0474 - HC ACCESSION OF TISSUE, GROSS AND MICRO EXAM, INCL. ASSESS. OF MARGINS FOR DISEASE, PREP., TX OF RPT",110,3900.57,1941.26,6187.11,27.5]
["TUFTS - TUFTS SELECT - HCPCS - D0474","TUFTS","TUFTS SELECT","HCPCS","D0474","HC ACCESSION OF TISSUE, GROSS AND MICRO EXAM, INCL. ASSESS. OF MARGINS FOR DISEASE, PREP., TX OF RPT","D0474 - HC ACCESSION OF TISSUE, GROSS AND MICRO EXAM, INCL. ASSESS. OF MARGINS FOR DISEASE, PREP., TX OF RPT",110,1941.26,1941.26,6187.11,27.5]
["TUFTS - TUFTS HMO - HCPCS - D0474","TUFTS","TUFTS HMO","HCPCS","D0474","HC ACCESSION OF TISSUE, GROSS AND MICRO EXAM, INCL. ASSESS. OF MARGINS FOR DISEASE, PREP., TX OF RPT","D0474 - HC ACCESSION OF TISSUE, GROSS AND MICRO EXAM, INCL. ASSESS. OF MARGINS FOR DISEASE, PREP., TX OF RPT",110,3646.27,1941.26,6187.11,27.5]
["TUFTS - TUFTS POS - HCPCS - D0474","TUFTS","TUFTS POS","HCPCS","D0474","HC ACCESSION OF TISSUE, GROSS AND MICRO EXAM, INCL. ASSESS. OF MARGINS FOR DISEASE, PREP., TX OF RPT","D0474 - HC ACCESSION OF TISSUE, GROSS AND MICRO EXAM, INCL. ASSESS. OF MARGINS FOR DISEASE, PREP., TX OF RPT",110,3646.27,1941.26,6187.11,27.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D0474","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D0474","HC ACCESSION OF TISSUE, GROSS AND MICRO EXAM, INCL. ASSESS. OF MARGINS FOR DISEASE, PREP., TX OF RPT","D0474 - HC ACCESSION OF TISSUE, GROSS AND MICRO EXAM, INCL. ASSESS. OF MARGINS FOR DISEASE, PREP., TX OF RPT",110,6187.11,1941.26,6187.11,27.5]
["TUFTS - TUFTS PPO - HCPCS - D0480","TUFTS","TUFTS PPO","HCPCS","D0480","HC ACCESSION OF EXFOLIATIVE CYTOLOGIC SMEARS, MICROSCOPIC EXAM, PREP AND TRANS OF RPT","D0480 - HC ACCESSION OF EXFOLIATIVE CYTOLOGIC SMEARS, MICROSCOPIC EXAM, PREP AND TRANS OF RPT",110,3900.57,1941.26,6187.11,27.5]
["TUFTS - TUFTS SELECT - HCPCS - D0480","TUFTS","TUFTS SELECT","HCPCS","D0480","HC ACCESSION OF EXFOLIATIVE CYTOLOGIC SMEARS, MICROSCOPIC EXAM, PREP AND TRANS OF RPT","D0480 - HC ACCESSION OF EXFOLIATIVE CYTOLOGIC SMEARS, MICROSCOPIC EXAM, PREP AND TRANS OF RPT",110,1941.26,1941.26,6187.11,27.5]
["TUFTS - TUFTS HMO - HCPCS - D0480","TUFTS","TUFTS HMO","HCPCS","D0480","HC ACCESSION OF EXFOLIATIVE CYTOLOGIC SMEARS, MICROSCOPIC EXAM, PREP AND TRANS OF RPT","D0480 - HC ACCESSION OF EXFOLIATIVE CYTOLOGIC SMEARS, MICROSCOPIC EXAM, PREP AND TRANS OF RPT",110,3646.27,1941.26,6187.11,27.5]
["TUFTS - TUFTS POS - HCPCS - D0480","TUFTS","TUFTS POS","HCPCS","D0480","HC ACCESSION OF EXFOLIATIVE CYTOLOGIC SMEARS, MICROSCOPIC EXAM, PREP AND TRANS OF RPT","D0480 - HC ACCESSION OF EXFOLIATIVE CYTOLOGIC SMEARS, MICROSCOPIC EXAM, PREP AND TRANS OF RPT",110,3646.27,1941.26,6187.11,27.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D0480","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D0480","HC ACCESSION OF EXFOLIATIVE CYTOLOGIC SMEARS, MICROSCOPIC EXAM, PREP AND TRANS OF RPT","D0480 - HC ACCESSION OF EXFOLIATIVE CYTOLOGIC SMEARS, MICROSCOPIC EXAM, PREP AND TRANS OF RPT",110,6187.11,1941.26,6187.11,27.5]
["TUFTS - TUFTS PPO - HCPCS - D1110","TUFTS","TUFTS PPO","HCPCS","D1110","PROPHYLAXIS - ADULT","D1110 - PROPHYLAXIS - ADULT",110,102.91,51.21,163.22999999999999,27.5]
["TUFTS - TUFTS SELECT - HCPCS - D1110","TUFTS","TUFTS SELECT","HCPCS","D1110","PROPHYLAXIS - ADULT","D1110 - PROPHYLAXIS - ADULT",110,51.21,51.21,163.22999999999999,27.5]
["TUFTS - TUFTS HMO - HCPCS - D1110","TUFTS","TUFTS HMO","HCPCS","D1110","PROPHYLAXIS - ADULT","D1110 - PROPHYLAXIS - ADULT",110,96.19,51.21,163.22999999999999,27.5]
["TUFTS - TUFTS POS - HCPCS - D1110","TUFTS","TUFTS POS","HCPCS","D1110","PROPHYLAXIS - ADULT","D1110 - PROPHYLAXIS - ADULT",110,96.19,51.21,163.22999999999999,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D1110","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D1110","PROPHYLAXIS - ADULT","D1110 - PROPHYLAXIS - ADULT",110,84.56,51.21,163.22999999999999,27.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D1110","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D1110","PROPHYLAXIS - ADULT","D1110 - PROPHYLAXIS - ADULT",110,163.22999999999999,51.21,163.22999999999999,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D1110","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D1110","PROPHYLAXIS - ADULT","D1110 - PROPHYLAXIS - ADULT",110,84.56,51.21,163.22999999999999,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D1110","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D1110","PROPHYLAXIS - ADULT","D1110 - PROPHYLAXIS - ADULT",110,84.56,51.21,163.22999999999999,27.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D1110","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D1110","PROPHYLAXIS - ADULT","D1110 - PROPHYLAXIS - ADULT",110,84.56,51.21,163.22999999999999,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D1110","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D1110","PROPHYLAXIS - ADULT","D1110 - PROPHYLAXIS - ADULT",110,84.56,51.21,163.22999999999999,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D1110","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D1110","PROPHYLAXIS - ADULT","D1110 - PROPHYLAXIS - ADULT",110,84.56,51.21,163.22999999999999,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D1110","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D1110","PROPHYLAXIS - ADULT","D1110 - PROPHYLAXIS - ADULT",110,84.56,51.21,163.22999999999999,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D1120","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D1120","PROPHYLAXIS - CHILD","D1120 - PROPHYLAXIS - CHILD",110,57.92,57.92,57.92,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D1120","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D1120","PROPHYLAXIS - CHILD","D1120 - PROPHYLAXIS - CHILD",110,57.92,57.92,57.92,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D1120","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D1120","PROPHYLAXIS - CHILD","D1120 - PROPHYLAXIS - CHILD",110,57.92,57.92,57.92,27.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D1120","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D1120","PROPHYLAXIS - CHILD","D1120 - PROPHYLAXIS - CHILD",110,57.92,57.92,57.92,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D1120","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D1120","PROPHYLAXIS - CHILD","D1120 - PROPHYLAXIS - CHILD",110,57.92,57.92,57.92,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D1120","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D1120","PROPHYLAXIS - CHILD","D1120 - PROPHYLAXIS - CHILD",110,57.92,57.92,57.92,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D1120","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D1120","PROPHYLAXIS - CHILD","D1120 - PROPHYLAXIS - CHILD",110,57.92,57.92,57.92,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D1351","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D1351","SEALANT - PER TOOTH","D1351 - SEALANT - PER TOOTH",110,45.91,45.91,45.91,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D1351","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D1351","SEALANT - PER TOOTH","D1351 - SEALANT - PER TOOTH",110,45.91,45.91,45.91,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D1351","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D1351","SEALANT - PER TOOTH","D1351 - SEALANT - PER TOOTH",110,45.91,45.91,45.91,27.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D1351","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D1351","SEALANT - PER TOOTH","D1351 - SEALANT - PER TOOTH",110,45.91,45.91,45.91,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D1351","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D1351","SEALANT - PER TOOTH","D1351 - SEALANT - PER TOOTH",110,45.91,45.91,45.91,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D1351","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D1351","SEALANT - PER TOOTH","D1351 - SEALANT - PER TOOTH",110,45.91,45.91,45.91,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D1351","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D1351","SEALANT - PER TOOTH","D1351 - SEALANT - PER TOOTH",110,45.91,45.91,45.91,27.5]
["TUFTS - TUFTS PPO - HCPCS - D1510","TUFTS","TUFTS PPO","HCPCS","D1510","SPACE MAINTAINER - FIXED - UNILATERAL","D1510 - SPACE MAINTAINER - FIXED - UNILATERAL",836,2563.83,1275.99,4066.77,209]
["TUFTS - TUFTS SELECT - HCPCS - D1510","TUFTS","TUFTS SELECT","HCPCS","D1510","SPACE MAINTAINER - FIXED - UNILATERAL","D1510 - SPACE MAINTAINER - FIXED - UNILATERAL",836,1275.99,1275.99,4066.77,209]
["TUFTS - TUFTS POS - HCPCS - D1510","TUFTS","TUFTS POS","HCPCS","D1510","SPACE MAINTAINER - FIXED - UNILATERAL","D1510 - SPACE MAINTAINER - FIXED - UNILATERAL",836,2396.69,1275.99,4066.77,209]
["TUFTS - TUFTS HMO - HCPCS - D1510","TUFTS","TUFTS HMO","HCPCS","D1510","SPACE MAINTAINER - FIXED - UNILATERAL","D1510 - SPACE MAINTAINER - FIXED - UNILATERAL",836,2396.69,1275.99,4066.77,209]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D1510","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D1510","SPACE MAINTAINER - FIXED - UNILATERAL","D1510 - SPACE MAINTAINER - FIXED - UNILATERAL",836,4066.77,1275.99,4066.77,209]
["TUFTS - TUFTS PPO - HCPCS - D1516","TUFTS","TUFTS PPO","HCPCS","D1516","SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MAXILLARY","D1516 - SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MAXILLARY",1350,0,0,0,337.5]
["TUFTS - TUFTS SELECT - HCPCS - D1516","TUFTS","TUFTS SELECT","HCPCS","D1516","SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MAXILLARY","D1516 - SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MAXILLARY",1350,0,0,0,337.5]
["TUFTS - TUFTS HMO - HCPCS - D1516","TUFTS","TUFTS HMO","HCPCS","D1516","SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MAXILLARY","D1516 - SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MAXILLARY",1350,0,0,0,337.5]
["TUFTS - TUFTS POS - HCPCS - D1516","TUFTS","TUFTS POS","HCPCS","D1516","SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MAXILLARY","D1516 - SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MAXILLARY",1350,0,0,0,337.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D1516","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D1516","SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MAXILLARY","D1516 - SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MAXILLARY",1350,0,0,0,337.5]
["TUFTS - TUFTS PPO - HCPCS - D1517","TUFTS","TUFTS PPO","HCPCS","D1517","SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MANDIBULAR","D1517 - SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MANDIBULAR",1451,0,0,0,362.75]
["TUFTS - TUFTS SELECT - HCPCS - D1517","TUFTS","TUFTS SELECT","HCPCS","D1517","SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MANDIBULAR","D1517 - SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MANDIBULAR",1451,0,0,0,362.75]
["TUFTS - TUFTS HMO - HCPCS - D1517","TUFTS","TUFTS HMO","HCPCS","D1517","SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MANDIBULAR","D1517 - SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MANDIBULAR",1451,0,0,0,362.75]
["TUFTS - TUFTS POS - HCPCS - D1517","TUFTS","TUFTS POS","HCPCS","D1517","SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MANDIBULAR","D1517 - SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MANDIBULAR",1451,0,0,0,362.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D1517","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D1517","SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MANDIBULAR","D1517 - SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MANDIBULAR",1451,0,0,0,362.75]
["TUFTS - TUFTS PPO - HCPCS - D1575","TUFTS","TUFTS PPO","HCPCS","D1575","HC DISTAL SHOE SPACE MAINTAINER ¿ FIXED ¿ UNILATERAL","D1575 - HC DISTAL SHOE SPACE MAINTAINER ¿ FIXED ¿ UNILATERAL",1451,3463.11,1723.54,5493.21,362.75]
["TUFTS - TUFTS SELECT - HCPCS - D1575","TUFTS","TUFTS SELECT","HCPCS","D1575","HC DISTAL SHOE SPACE MAINTAINER ¿ FIXED ¿ UNILATERAL","D1575 - HC DISTAL SHOE SPACE MAINTAINER ¿ FIXED ¿ UNILATERAL",1451,1723.54,1723.54,5493.21,362.75]
["TUFTS - TUFTS HMO - HCPCS - D1575","TUFTS","TUFTS HMO","HCPCS","D1575","HC DISTAL SHOE SPACE MAINTAINER ¿ FIXED ¿ UNILATERAL","D1575 - HC DISTAL SHOE SPACE MAINTAINER ¿ FIXED ¿ UNILATERAL",1451,3237.33,1723.54,5493.21,362.75]
["TUFTS - TUFTS POS - HCPCS - D1575","TUFTS","TUFTS POS","HCPCS","D1575","HC DISTAL SHOE SPACE MAINTAINER ¿ FIXED ¿ UNILATERAL","D1575 - HC DISTAL SHOE SPACE MAINTAINER ¿ FIXED ¿ UNILATERAL",1451,3237.33,1723.54,5493.21,362.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D1575","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D1575","HC DISTAL SHOE SPACE MAINTAINER ¿ FIXED ¿ UNILATERAL","D1575 - HC DISTAL SHOE SPACE MAINTAINER ¿ FIXED ¿ UNILATERAL",1451,5493.21,1723.54,5493.21,362.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2140","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D2140","AMALGAM - ONE SURFACE, PRIMARY OR PERMANENT","D2140 - AMALGAM - ONE SURFACE, PRIMARY OR PERMANENT",110,98.66,98.66,98.66,27.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2140","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D2140","AMALGAM - ONE SURFACE, PRIMARY OR PERMANENT","D2140 - AMALGAM - ONE SURFACE, PRIMARY OR PERMANENT",110,98.66,98.66,98.66,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2140","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D2140","AMALGAM - ONE SURFACE, PRIMARY OR PERMANENT","D2140 - AMALGAM - ONE SURFACE, PRIMARY OR PERMANENT",110,98.66,98.66,98.66,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2140","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D2140","AMALGAM - ONE SURFACE, PRIMARY OR PERMANENT","D2140 - AMALGAM - ONE SURFACE, PRIMARY OR PERMANENT",110,98.66,98.66,98.66,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2140","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D2140","AMALGAM - ONE SURFACE, PRIMARY OR PERMANENT","D2140 - AMALGAM - ONE SURFACE, PRIMARY OR PERMANENT",110,98.66,98.66,98.66,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2140","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D2140","AMALGAM - ONE SURFACE, PRIMARY OR PERMANENT","D2140 - AMALGAM - ONE SURFACE, PRIMARY OR PERMANENT",110,98.66,98.66,98.66,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2140","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D2140","AMALGAM - ONE SURFACE, PRIMARY OR PERMANENT","D2140 - AMALGAM - ONE SURFACE, PRIMARY OR PERMANENT",110,98.66,98.66,98.66,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2150","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D2150","AMALGAM - TWO SURFACES, PRIMARY OR PERMANENT","D2150 - AMALGAM - TWO SURFACES, PRIMARY OR PERMANENT",110,126.81,126.81,126.81,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2150","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D2150","AMALGAM - TWO SURFACES, PRIMARY OR PERMANENT","D2150 - AMALGAM - TWO SURFACES, PRIMARY OR PERMANENT",110,126.81,126.81,126.81,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2150","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D2150","AMALGAM - TWO SURFACES, PRIMARY OR PERMANENT","D2150 - AMALGAM - TWO SURFACES, PRIMARY OR PERMANENT",110,126.81,126.81,126.81,27.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2150","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D2150","AMALGAM - TWO SURFACES, PRIMARY OR PERMANENT","D2150 - AMALGAM - TWO SURFACES, PRIMARY OR PERMANENT",110,126.81,126.81,126.81,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2150","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D2150","AMALGAM - TWO SURFACES, PRIMARY OR PERMANENT","D2150 - AMALGAM - TWO SURFACES, PRIMARY OR PERMANENT",110,126.81,126.81,126.81,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2150","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D2150","AMALGAM - TWO SURFACES, PRIMARY OR PERMANENT","D2150 - AMALGAM - TWO SURFACES, PRIMARY OR PERMANENT",110,126.81,126.81,126.81,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2150","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D2150","AMALGAM - TWO SURFACES, PRIMARY OR PERMANENT","D2150 - AMALGAM - TWO SURFACES, PRIMARY OR PERMANENT",110,126.81,126.81,126.81,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2160","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D2160","AMALGAM - THREE SURFACES, PRIMARY OR PERMANENT","D2160 - AMALGAM - THREE SURFACES, PRIMARY OR PERMANENT",110,153.4,153.4,153.4,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2160","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D2160","AMALGAM - THREE SURFACES, PRIMARY OR PERMANENT","D2160 - AMALGAM - THREE SURFACES, PRIMARY OR PERMANENT",110,153.4,153.4,153.4,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2160","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D2160","AMALGAM - THREE SURFACES, PRIMARY OR PERMANENT","D2160 - AMALGAM - THREE SURFACES, PRIMARY OR PERMANENT",110,153.4,153.4,153.4,27.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2160","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D2160","AMALGAM - THREE SURFACES, PRIMARY OR PERMANENT","D2160 - AMALGAM - THREE SURFACES, PRIMARY OR PERMANENT",110,153.4,153.4,153.4,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2160","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D2160","AMALGAM - THREE SURFACES, PRIMARY OR PERMANENT","D2160 - AMALGAM - THREE SURFACES, PRIMARY OR PERMANENT",110,153.4,153.4,153.4,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2160","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D2160","AMALGAM - THREE SURFACES, PRIMARY OR PERMANENT","D2160 - AMALGAM - THREE SURFACES, PRIMARY OR PERMANENT",110,153.4,153.4,153.4,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2160","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D2160","AMALGAM - THREE SURFACES, PRIMARY OR PERMANENT","D2160 - AMALGAM - THREE SURFACES, PRIMARY OR PERMANENT",110,153.4,153.4,153.4,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2161","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D2161","AMALGAM - FOUR OR MORE SURFACES, PRIMARY OR PERMANENT","D2161 - AMALGAM - FOUR OR MORE SURFACES, PRIMARY OR PERMANENT",110,187.9,187.9,187.9,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2161","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D2161","AMALGAM - FOUR OR MORE SURFACES, PRIMARY OR PERMANENT","D2161 - AMALGAM - FOUR OR MORE SURFACES, PRIMARY OR PERMANENT",110,187.9,187.9,187.9,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2161","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D2161","AMALGAM - FOUR OR MORE SURFACES, PRIMARY OR PERMANENT","D2161 - AMALGAM - FOUR OR MORE SURFACES, PRIMARY OR PERMANENT",110,187.9,187.9,187.9,27.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2161","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D2161","AMALGAM - FOUR OR MORE SURFACES, PRIMARY OR PERMANENT","D2161 - AMALGAM - FOUR OR MORE SURFACES, PRIMARY OR PERMANENT",110,187.9,187.9,187.9,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2161","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D2161","AMALGAM - FOUR OR MORE SURFACES, PRIMARY OR PERMANENT","D2161 - AMALGAM - FOUR OR MORE SURFACES, PRIMARY OR PERMANENT",110,187.9,187.9,187.9,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2161","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D2161","AMALGAM - FOUR OR MORE SURFACES, PRIMARY OR PERMANENT","D2161 - AMALGAM - FOUR OR MORE SURFACES, PRIMARY OR PERMANENT",110,187.9,187.9,187.9,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2161","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D2161","AMALGAM - FOUR OR MORE SURFACES, PRIMARY OR PERMANENT","D2161 - AMALGAM - FOUR OR MORE SURFACES, PRIMARY OR PERMANENT",110,187.9,187.9,187.9,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2330","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D2330","RESIN-BASED COMPOSITE - ONE SURFACE, ANTERIOR","D2330 - RESIN-BASED COMPOSITE - ONE SURFACE, ANTERIOR",110,121.33,121.33,121.33,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2330","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D2330","RESIN-BASED COMPOSITE - ONE SURFACE, ANTERIOR","D2330 - RESIN-BASED COMPOSITE - ONE SURFACE, ANTERIOR",110,121.33,121.33,121.33,27.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2330","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D2330","RESIN-BASED COMPOSITE - ONE SURFACE, ANTERIOR","D2330 - RESIN-BASED COMPOSITE - ONE SURFACE, ANTERIOR",110,121.33,121.33,121.33,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2330","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D2330","RESIN-BASED COMPOSITE - ONE SURFACE, ANTERIOR","D2330 - RESIN-BASED COMPOSITE - ONE SURFACE, ANTERIOR",110,121.33,121.33,121.33,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2330","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D2330","RESIN-BASED COMPOSITE - ONE SURFACE, ANTERIOR","D2330 - RESIN-BASED COMPOSITE - ONE SURFACE, ANTERIOR",110,121.33,121.33,121.33,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2330","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D2330","RESIN-BASED COMPOSITE - ONE SURFACE, ANTERIOR","D2330 - RESIN-BASED COMPOSITE - ONE SURFACE, ANTERIOR",110,121.33,121.33,121.33,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2330","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D2330","RESIN-BASED COMPOSITE - ONE SURFACE, ANTERIOR","D2330 - RESIN-BASED COMPOSITE - ONE SURFACE, ANTERIOR",110,121.33,121.33,121.33,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2331","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D2331","RESIN-BASED COMPOSITE - TWO SURFACES, ANTERIOR","D2331 - RESIN-BASED COMPOSITE - TWO SURFACES, ANTERIOR",110,154.99,154.99,154.99,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2331","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D2331","RESIN-BASED COMPOSITE - TWO SURFACES, ANTERIOR","D2331 - RESIN-BASED COMPOSITE - TWO SURFACES, ANTERIOR",110,154.99,154.99,154.99,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2331","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D2331","RESIN-BASED COMPOSITE - TWO SURFACES, ANTERIOR","D2331 - RESIN-BASED COMPOSITE - TWO SURFACES, ANTERIOR",110,154.99,154.99,154.99,27.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2331","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D2331","RESIN-BASED COMPOSITE - TWO SURFACES, ANTERIOR","D2331 - RESIN-BASED COMPOSITE - TWO SURFACES, ANTERIOR",110,154.99,154.99,154.99,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2331","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D2331","RESIN-BASED COMPOSITE - TWO SURFACES, ANTERIOR","D2331 - RESIN-BASED COMPOSITE - TWO SURFACES, ANTERIOR",110,154.99,154.99,154.99,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2331","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D2331","RESIN-BASED COMPOSITE - TWO SURFACES, ANTERIOR","D2331 - RESIN-BASED COMPOSITE - TWO SURFACES, ANTERIOR",110,154.99,154.99,154.99,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2331","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D2331","RESIN-BASED COMPOSITE - TWO SURFACES, ANTERIOR","D2331 - RESIN-BASED COMPOSITE - TWO SURFACES, ANTERIOR",110,154.99,154.99,154.99,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2332","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D2332","RESIN-BASED COMPOSITE - THREE SURFACES, ANTERIOR","D2332 - RESIN-BASED COMPOSITE - THREE SURFACES, ANTERIOR",110,189.47,189.47,189.47,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2332","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D2332","RESIN-BASED COMPOSITE - THREE SURFACES, ANTERIOR","D2332 - RESIN-BASED COMPOSITE - THREE SURFACES, ANTERIOR",110,189.47,189.47,189.47,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2332","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D2332","RESIN-BASED COMPOSITE - THREE SURFACES, ANTERIOR","D2332 - RESIN-BASED COMPOSITE - THREE SURFACES, ANTERIOR",110,189.47,189.47,189.47,27.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2332","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D2332","RESIN-BASED COMPOSITE - THREE SURFACES, ANTERIOR","D2332 - RESIN-BASED COMPOSITE - THREE SURFACES, ANTERIOR",110,189.47,189.47,189.47,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2332","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D2332","RESIN-BASED COMPOSITE - THREE SURFACES, ANTERIOR","D2332 - RESIN-BASED COMPOSITE - THREE SURFACES, ANTERIOR",110,189.47,189.47,189.47,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2332","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D2332","RESIN-BASED COMPOSITE - THREE SURFACES, ANTERIOR","D2332 - RESIN-BASED COMPOSITE - THREE SURFACES, ANTERIOR",110,189.47,189.47,189.47,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2332","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D2332","RESIN-BASED COMPOSITE - THREE SURFACES, ANTERIOR","D2332 - RESIN-BASED COMPOSITE - THREE SURFACES, ANTERIOR",110,189.47,189.47,189.47,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2335","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D2335","RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR)","D2335 - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR)",110,223.88,223.88,223.88,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2335","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D2335","RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR)","D2335 - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR)",110,223.88,223.88,223.88,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2335","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D2335","RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR)","D2335 - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR)",110,223.88,223.88,223.88,27.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2335","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D2335","RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR)","D2335 - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR)",110,223.88,223.88,223.88,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2335","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D2335","RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR)","D2335 - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR)",110,223.88,223.88,223.88,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2335","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D2335","RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR)","D2335 - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR)",110,223.88,223.88,223.88,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2335","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D2335","RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR)","D2335 - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR)",110,223.88,223.88,223.88,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2390","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D2390","RESIN-BASED COMPOSITE CROWN, ANTERIOR","D2390 - RESIN-BASED COMPOSITE CROWN, ANTERIOR",110,248.14,248.14,248.14,27.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2390","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D2390","RESIN-BASED COMPOSITE CROWN, ANTERIOR","D2390 - RESIN-BASED COMPOSITE CROWN, ANTERIOR",110,248.14,248.14,248.14,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2390","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D2390","RESIN-BASED COMPOSITE CROWN, ANTERIOR","D2390 - RESIN-BASED COMPOSITE CROWN, ANTERIOR",110,248.14,248.14,248.14,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2390","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D2390","RESIN-BASED COMPOSITE CROWN, ANTERIOR","D2390 - RESIN-BASED COMPOSITE CROWN, ANTERIOR",110,248.14,248.14,248.14,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2390","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D2390","RESIN-BASED COMPOSITE CROWN, ANTERIOR","D2390 - RESIN-BASED COMPOSITE CROWN, ANTERIOR",110,248.14,248.14,248.14,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2390","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D2390","RESIN-BASED COMPOSITE CROWN, ANTERIOR","D2390 - RESIN-BASED COMPOSITE CROWN, ANTERIOR",110,248.14,248.14,248.14,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2390","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D2390","RESIN-BASED COMPOSITE CROWN, ANTERIOR","D2390 - RESIN-BASED COMPOSITE CROWN, ANTERIOR",110,248.14,248.14,248.14,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2391","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D2391","RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR","D2391 - RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR",110,141.69,141.69,141.69,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2391","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D2391","RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR","D2391 - RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR",110,141.69,141.69,141.69,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2391","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D2391","RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR","D2391 - RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR",110,141.69,141.69,141.69,27.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2391","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D2391","RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR","D2391 - RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR",110,141.69,141.69,141.69,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2391","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D2391","RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR","D2391 - RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR",110,141.69,141.69,141.69,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2391","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D2391","RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR","D2391 - RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR",110,141.69,141.69,141.69,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2391","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D2391","RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR","D2391 - RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR",110,141.69,141.69,141.69,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2392","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D2392","RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR","D2392 - RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR",110,186.31,186.31,186.31,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2392","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D2392","RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR","D2392 - RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR",110,186.31,186.31,186.31,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2392","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D2392","RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR","D2392 - RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR",110,186.31,186.31,186.31,27.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2392","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D2392","RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR","D2392 - RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR",110,186.31,186.31,186.31,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2392","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D2392","RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR","D2392 - RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR",110,186.31,186.31,186.31,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2392","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D2392","RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR","D2392 - RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR",110,186.31,186.31,186.31,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2392","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D2392","RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR","D2392 - RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR",110,186.31,186.31,186.31,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2393","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D2393","RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR","D2393 - RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR",110,230.94,230.94,230.94,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2393","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D2393","RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR","D2393 - RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR",110,230.94,230.94,230.94,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2393","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D2393","RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR","D2393 - RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR",110,230.94,230.94,230.94,27.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2393","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D2393","RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR","D2393 - RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR",110,230.94,230.94,230.94,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2393","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D2393","RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR","D2393 - RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR",110,230.94,230.94,230.94,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2393","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D2393","RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR","D2393 - RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR",110,230.94,230.94,230.94,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2393","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D2393","RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR","D2393 - RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR",110,230.94,230.94,230.94,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2394","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D2394","RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR","D2394 - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR",110,282.64,282.64,282.64,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2394","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D2394","RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR","D2394 - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR",110,282.64,282.64,282.64,27.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2394","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D2394","RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR","D2394 - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR",110,282.64,282.64,282.64,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2394","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D2394","RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR","D2394 - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR",110,282.64,282.64,282.64,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2394","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D2394","RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR","D2394 - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR",110,282.64,282.64,282.64,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2394","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D2394","RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR","D2394 - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR",110,282.64,282.64,282.64,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2394","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D2394","RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR","D2394 - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR",110,282.64,282.64,282.64,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2740","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D2740","CROWN - PORCELAIN/CERAMIC SUBSTRATE","D2740 - CROWN - PORCELAIN/CERAMIC SUBSTRATE",110,1036.53,1036.53,1036.53,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2740","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D2740","CROWN - PORCELAIN/CERAMIC SUBSTRATE","D2740 - CROWN - PORCELAIN/CERAMIC SUBSTRATE",110,1036.53,1036.53,1036.53,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2740","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D2740","CROWN - PORCELAIN/CERAMIC SUBSTRATE","D2740 - CROWN - PORCELAIN/CERAMIC SUBSTRATE",110,1036.53,1036.53,1036.53,27.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2740","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D2740","CROWN - PORCELAIN/CERAMIC SUBSTRATE","D2740 - CROWN - PORCELAIN/CERAMIC SUBSTRATE",110,1036.53,1036.53,1036.53,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2740","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D2740","CROWN - PORCELAIN/CERAMIC SUBSTRATE","D2740 - CROWN - PORCELAIN/CERAMIC SUBSTRATE",110,1036.53,1036.53,1036.53,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2740","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D2740","CROWN - PORCELAIN/CERAMIC SUBSTRATE","D2740 - CROWN - PORCELAIN/CERAMIC SUBSTRATE",110,1036.53,1036.53,1036.53,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2740","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D2740","CROWN - PORCELAIN/CERAMIC SUBSTRATE","D2740 - CROWN - PORCELAIN/CERAMIC SUBSTRATE",110,1036.53,1036.53,1036.53,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2930","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D2930","PREFABRICATED STAINLESS STEEL CROWN - PRIMARY TOOTH","D2930 - PREFABRICATED STAINLESS STEEL CROWN - PRIMARY TOOTH",110,228.61,228.61,228.61,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2930","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D2930","PREFABRICATED STAINLESS STEEL CROWN - PRIMARY TOOTH","D2930 - PREFABRICATED STAINLESS STEEL CROWN - PRIMARY TOOTH",110,228.61,228.61,228.61,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2930","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D2930","PREFABRICATED STAINLESS STEEL CROWN - PRIMARY TOOTH","D2930 - PREFABRICATED STAINLESS STEEL CROWN - PRIMARY TOOTH",110,228.61,228.61,228.61,27.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2930","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D2930","PREFABRICATED STAINLESS STEEL CROWN - PRIMARY TOOTH","D2930 - PREFABRICATED STAINLESS STEEL CROWN - PRIMARY TOOTH",110,228.61,228.61,228.61,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2930","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D2930","PREFABRICATED STAINLESS STEEL CROWN - PRIMARY TOOTH","D2930 - PREFABRICATED STAINLESS STEEL CROWN - PRIMARY TOOTH",110,228.61,228.61,228.61,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2930","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D2930","PREFABRICATED STAINLESS STEEL CROWN - PRIMARY TOOTH","D2930 - PREFABRICATED STAINLESS STEEL CROWN - PRIMARY TOOTH",110,228.61,228.61,228.61,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2930","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D2930","PREFABRICATED STAINLESS STEEL CROWN - PRIMARY TOOTH","D2930 - PREFABRICATED STAINLESS STEEL CROWN - PRIMARY TOOTH",110,228.61,228.61,228.61,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2931","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D2931","PREFABRICATED STAINLESS STEEL CROWN - PERMANENT TOOTH","D2931 - PREFABRICATED STAINLESS STEEL CROWN - PERMANENT TOOTH",110,259.95,259.95,259.95,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2931","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D2931","PREFABRICATED STAINLESS STEEL CROWN - PERMANENT TOOTH","D2931 - PREFABRICATED STAINLESS STEEL CROWN - PERMANENT TOOTH",110,259.95,259.95,259.95,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2931","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D2931","PREFABRICATED STAINLESS STEEL CROWN - PERMANENT TOOTH","D2931 - PREFABRICATED STAINLESS STEEL CROWN - PERMANENT TOOTH",110,259.95,259.95,259.95,27.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2931","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D2931","PREFABRICATED STAINLESS STEEL CROWN - PERMANENT TOOTH","D2931 - PREFABRICATED STAINLESS STEEL CROWN - PERMANENT TOOTH",110,259.95,259.95,259.95,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2931","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D2931","PREFABRICATED STAINLESS STEEL CROWN - PERMANENT TOOTH","D2931 - PREFABRICATED STAINLESS STEEL CROWN - PERMANENT TOOTH",110,259.95,259.95,259.95,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2931","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D2931","PREFABRICATED STAINLESS STEEL CROWN - PERMANENT TOOTH","D2931 - PREFABRICATED STAINLESS STEEL CROWN - PERMANENT TOOTH",110,259.95,259.95,259.95,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2931","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D2931","PREFABRICATED STAINLESS STEEL CROWN - PERMANENT TOOTH","D2931 - PREFABRICATED STAINLESS STEEL CROWN - PERMANENT TOOTH",110,259.95,259.95,259.95,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2940","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D2940","PROTECTIVE RESTORATION","D2940 - PROTECTIVE RESTORATION",110,87.67,87.67,87.67,27.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2940","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D2940","PROTECTIVE RESTORATION","D2940 - PROTECTIVE RESTORATION",110,87.67,87.67,87.67,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2940","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D2940","PROTECTIVE RESTORATION","D2940 - PROTECTIVE RESTORATION",110,87.67,87.67,87.67,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2940","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D2940","PROTECTIVE RESTORATION","D2940 - PROTECTIVE RESTORATION",110,87.67,87.67,87.67,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2940","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D2940","PROTECTIVE RESTORATION","D2940 - PROTECTIVE RESTORATION",110,87.67,87.67,87.67,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2940","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D2940","PROTECTIVE RESTORATION","D2940 - PROTECTIVE RESTORATION",110,87.67,87.67,87.67,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2940","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D2940","PROTECTIVE RESTORATION","D2940 - PROTECTIVE RESTORATION",110,87.67,87.67,87.67,27.5]
["TUFTS - TUFTS PPO - HCPCS - D2999","TUFTS","TUFTS PPO","HCPCS","D2999","HC UNSPECIFIED RESTORATIVE PROCEDURE, BY REPORT","D2999 - HC UNSPECIFIED RESTORATIVE PROCEDURE, BY REPORT",1451,2563.83,1275.99,4066.77,362.75]
["TUFTS - TUFTS SELECT - HCPCS - D2999","TUFTS","TUFTS SELECT","HCPCS","D2999","HC UNSPECIFIED RESTORATIVE PROCEDURE, BY REPORT","D2999 - HC UNSPECIFIED RESTORATIVE PROCEDURE, BY REPORT",1451,1275.99,1275.99,4066.77,362.75]
["TUFTS - TUFTS POS - HCPCS - D2999","TUFTS","TUFTS POS","HCPCS","D2999","HC UNSPECIFIED RESTORATIVE PROCEDURE, BY REPORT","D2999 - HC UNSPECIFIED RESTORATIVE PROCEDURE, BY REPORT",1451,2396.69,1275.99,4066.77,362.75]
["TUFTS - TUFTS HMO - HCPCS - D2999","TUFTS","TUFTS HMO","HCPCS","D2999","HC UNSPECIFIED RESTORATIVE PROCEDURE, BY REPORT","D2999 - HC UNSPECIFIED RESTORATIVE PROCEDURE, BY REPORT",1451,2396.69,1275.99,4066.77,362.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D2999","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D2999","HC UNSPECIFIED RESTORATIVE PROCEDURE, BY REPORT","D2999 - HC UNSPECIFIED RESTORATIVE PROCEDURE, BY REPORT",1451,4066.77,1275.99,4066.77,362.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D3110","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D3110","HC PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION)","D3110 - HC PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION)",110,68.89,68.89,68.89,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D3110","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D3110","HC PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION)","D3110 - HC PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION)",110,68.89,68.89,68.89,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D3110","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D3110","HC PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION)","D3110 - HC PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION)",110,68.89,68.89,68.89,27.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D3110","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D3110","HC PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION)","D3110 - HC PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION)",110,68.89,68.89,68.89,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D3110","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D3110","HC PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION)","D3110 - HC PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION)",110,68.89,68.89,68.89,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D3110","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D3110","HC PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION)","D3110 - HC PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION)",110,68.89,68.89,68.89,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D3110","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D3110","HC PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION)","D3110 - HC PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION)",110,68.89,68.89,68.89,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D3220","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D3220","THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) - REMOVAL OF PULP CORONAL TO THE DENTINOCEMENTAL JUNCTION AND APPLICATION OF MEDICAMENT","D3220 - THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) - REMOVAL OF PULP CORONAL TO THE DENTINOCEMENTAL JUNCTION AND APPLICATION OF MEDICAMENT",110,141.69,141.69,141.69,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D3220","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D3220","THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) - REMOVAL OF PULP CORONAL TO THE DENTINOCEMENTAL JUNCTION AND APPLICATION OF MEDICAMENT","D3220 - THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) - REMOVAL OF PULP CORONAL TO THE DENTINOCEMENTAL JUNCTION AND APPLICATION OF MEDICAMENT",110,141.69,141.69,141.69,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D3220","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D3220","THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) - REMOVAL OF PULP CORONAL TO THE DENTINOCEMENTAL JUNCTION AND APPLICATION OF MEDICAMENT","D3220 - THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) - REMOVAL OF PULP CORONAL TO THE DENTINOCEMENTAL JUNCTION AND APPLICATION OF MEDICAMENT",110,141.69,141.69,141.69,27.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D3220","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D3220","THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) - REMOVAL OF PULP CORONAL TO THE DENTINOCEMENTAL JUNCTION AND APPLICATION OF MEDICAMENT","D3220 - THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) - REMOVAL OF PULP CORONAL TO THE DENTINOCEMENTAL JUNCTION AND APPLICATION OF MEDICAMENT",110,141.69,141.69,141.69,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D3220","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D3220","THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) - REMOVAL OF PULP CORONAL TO THE DENTINOCEMENTAL JUNCTION AND APPLICATION OF MEDICAMENT","D3220 - THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) - REMOVAL OF PULP CORONAL TO THE DENTINOCEMENTAL JUNCTION AND APPLICATION OF MEDICAMENT",110,141.69,141.69,141.69,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D3220","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D3220","THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) - REMOVAL OF PULP CORONAL TO THE DENTINOCEMENTAL JUNCTION AND APPLICATION OF MEDICAMENT","D3220 - THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) - REMOVAL OF PULP CORONAL TO THE DENTINOCEMENTAL JUNCTION AND APPLICATION OF MEDICAMENT",110,141.69,141.69,141.69,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D3220","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D3220","THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) - REMOVAL OF PULP CORONAL TO THE DENTINOCEMENTAL JUNCTION AND APPLICATION OF MEDICAMENT","D3220 - THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) - REMOVAL OF PULP CORONAL TO THE DENTINOCEMENTAL JUNCTION AND APPLICATION OF MEDICAMENT",110,141.69,141.69,141.69,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D3310","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D3310","ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION)","D3310 - ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION)",110,587.95000000000005,587.95000000000005,587.95000000000005,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D3310","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D3310","ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION)","D3310 - ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION)",110,587.95000000000005,587.95000000000005,587.95000000000005,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D3310","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D3310","ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION)","D3310 - ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION)",110,587.95000000000005,587.95000000000005,587.95000000000005,27.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D3310","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D3310","ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION)","D3310 - ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION)",110,587.95000000000005,587.95000000000005,587.95000000000005,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D3310","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D3310","ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION)","D3310 - ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION)",110,587.95000000000005,587.95000000000005,587.95000000000005,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D3310","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D3310","ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION)","D3310 - ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION)",110,587.95000000000005,587.95000000000005,587.95000000000005,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D3310","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D3310","ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION)","D3310 - ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION)",110,587.95000000000005,587.95000000000005,587.95000000000005,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D3330","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D3330","ENDODONTIC THERAPY, MOLAR (EXCLUDING FINAL RESTORATION)","D3330 - ENDODONTIC THERAPY, MOLAR (EXCLUDING FINAL RESTORATION)",110,894.85,894.85,894.85,27.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D3330","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D3330","ENDODONTIC THERAPY, MOLAR (EXCLUDING FINAL RESTORATION)","D3330 - ENDODONTIC THERAPY, MOLAR (EXCLUDING FINAL RESTORATION)",110,894.85,894.85,894.85,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D3330","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D3330","ENDODONTIC THERAPY, MOLAR (EXCLUDING FINAL RESTORATION)","D3330 - ENDODONTIC THERAPY, MOLAR (EXCLUDING FINAL RESTORATION)",110,894.85,894.85,894.85,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D3330","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D3330","ENDODONTIC THERAPY, MOLAR (EXCLUDING FINAL RESTORATION)","D3330 - ENDODONTIC THERAPY, MOLAR (EXCLUDING FINAL RESTORATION)",110,894.85,894.85,894.85,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D3330","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D3330","ENDODONTIC THERAPY, MOLAR (EXCLUDING FINAL RESTORATION)","D3330 - ENDODONTIC THERAPY, MOLAR (EXCLUDING FINAL RESTORATION)",110,894.85,894.85,894.85,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D3330","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D3330","ENDODONTIC THERAPY, MOLAR (EXCLUDING FINAL RESTORATION)","D3330 - ENDODONTIC THERAPY, MOLAR (EXCLUDING FINAL RESTORATION)",110,894.85,894.85,894.85,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D3330","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D3330","ENDODONTIC THERAPY, MOLAR (EXCLUDING FINAL RESTORATION)","D3330 - ENDODONTIC THERAPY, MOLAR (EXCLUDING FINAL RESTORATION)",110,894.85,894.85,894.85,27.5]
["TUFTS - TUFTS PPO - HCPCS - D3460","TUFTS","TUFTS PPO","HCPCS","D3460","HC ENDODONTIC ENDOSSEOUS IMPLANT","D3460 - HC ENDODONTIC ENDOSSEOUS IMPLANT",1451,2563.83,1275.99,4066.77,362.75]
["TUFTS - TUFTS SELECT - HCPCS - D3460","TUFTS","TUFTS SELECT","HCPCS","D3460","HC ENDODONTIC ENDOSSEOUS IMPLANT","D3460 - HC ENDODONTIC ENDOSSEOUS IMPLANT",1451,1275.99,1275.99,4066.77,362.75]
["TUFTS - TUFTS HMO - HCPCS - D3460","TUFTS","TUFTS HMO","HCPCS","D3460","HC ENDODONTIC ENDOSSEOUS IMPLANT","D3460 - HC ENDODONTIC ENDOSSEOUS IMPLANT",1451,2396.69,1275.99,4066.77,362.75]
["TUFTS - TUFTS POS - HCPCS - D3460","TUFTS","TUFTS POS","HCPCS","D3460","HC ENDODONTIC ENDOSSEOUS IMPLANT","D3460 - HC ENDODONTIC ENDOSSEOUS IMPLANT",1451,2396.69,1275.99,4066.77,362.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D3460","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D3460","HC ENDODONTIC ENDOSSEOUS IMPLANT","D3460 - HC ENDODONTIC ENDOSSEOUS IMPLANT",1451,4066.77,1275.99,4066.77,362.75]
["TUFTS - TUFTS PPO - HCPCS - D3999","TUFTS","TUFTS PPO","HCPCS","D3999","HC UNSPECIFIED ENDODONTIC PROCEDURE, BY REPORT","D3999 - HC UNSPECIFIED ENDODONTIC PROCEDURE, BY REPORT",1451,2563.83,1275.99,4066.77,362.75]
["TUFTS - TUFTS SELECT - HCPCS - D3999","TUFTS","TUFTS SELECT","HCPCS","D3999","HC UNSPECIFIED ENDODONTIC PROCEDURE, BY REPORT","D3999 - HC UNSPECIFIED ENDODONTIC PROCEDURE, BY REPORT",1451,1275.99,1275.99,4066.77,362.75]
["TUFTS - TUFTS HMO - HCPCS - D3999","TUFTS","TUFTS HMO","HCPCS","D3999","HC UNSPECIFIED ENDODONTIC PROCEDURE, BY REPORT","D3999 - HC UNSPECIFIED ENDODONTIC PROCEDURE, BY REPORT",1451,2396.69,1275.99,4066.77,362.75]
["TUFTS - TUFTS POS - HCPCS - D3999","TUFTS","TUFTS POS","HCPCS","D3999","HC UNSPECIFIED ENDODONTIC PROCEDURE, BY REPORT","D3999 - HC UNSPECIFIED ENDODONTIC PROCEDURE, BY REPORT",1451,2396.69,1275.99,4066.77,362.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D3999","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D3999","HC UNSPECIFIED ENDODONTIC PROCEDURE, BY REPORT","D3999 - HC UNSPECIFIED ENDODONTIC PROCEDURE, BY REPORT",1451,4066.77,1275.99,4066.77,362.75]
["TUFTS - TUFTS PPO - HCPCS - D4260","TUFTS","TUFTS PPO","HCPCS","D4260","HC OSSEOUS SURGERY FOUR OR MORE CONT. TEETH OR TOOTH BOUNDED SPACES PER QUAD.","D4260 - HC OSSEOUS SURGERY FOUR OR MORE CONT. TEETH OR TOOTH BOUNDED SPACES PER QUAD.",1451,2563.83,1275.99,4066.77,362.75]
["TUFTS - TUFTS SELECT - HCPCS - D4260","TUFTS","TUFTS SELECT","HCPCS","D4260","HC OSSEOUS SURGERY FOUR OR MORE CONT. TEETH OR TOOTH BOUNDED SPACES PER QUAD.","D4260 - HC OSSEOUS SURGERY FOUR OR MORE CONT. TEETH OR TOOTH BOUNDED SPACES PER QUAD.",1451,1275.99,1275.99,4066.77,362.75]
["TUFTS - TUFTS HMO - HCPCS - D4260","TUFTS","TUFTS HMO","HCPCS","D4260","HC OSSEOUS SURGERY FOUR OR MORE CONT. TEETH OR TOOTH BOUNDED SPACES PER QUAD.","D4260 - HC OSSEOUS SURGERY FOUR OR MORE CONT. TEETH OR TOOTH BOUNDED SPACES PER QUAD.",1451,2396.69,1275.99,4066.77,362.75]
["TUFTS - TUFTS POS - HCPCS - D4260","TUFTS","TUFTS POS","HCPCS","D4260","HC OSSEOUS SURGERY FOUR OR MORE CONT. TEETH OR TOOTH BOUNDED SPACES PER QUAD.","D4260 - HC OSSEOUS SURGERY FOUR OR MORE CONT. TEETH OR TOOTH BOUNDED SPACES PER QUAD.",1451,2396.69,1275.99,4066.77,362.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D4260","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D4260","HC OSSEOUS SURGERY FOUR OR MORE CONT. TEETH OR TOOTH BOUNDED SPACES PER QUAD.","D4260 - HC OSSEOUS SURGERY FOUR OR MORE CONT. TEETH OR TOOTH BOUNDED SPACES PER QUAD.",1451,4066.77,1275.99,4066.77,362.75]
["TUFTS - TUFTS PPO - HCPCS - D4263","TUFTS","TUFTS PPO","HCPCS","D4263","HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ FIRST SITE IN QUADRANT","D4263 - HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ FIRST SITE IN QUADRANT",1451,2563.83,1275.99,4066.77,362.75]
["TUFTS - TUFTS SELECT - HCPCS - D4263","TUFTS","TUFTS SELECT","HCPCS","D4263","HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ FIRST SITE IN QUADRANT","D4263 - HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ FIRST SITE IN QUADRANT",1451,1275.99,1275.99,4066.77,362.75]
["TUFTS - TUFTS POS - HCPCS - D4263","TUFTS","TUFTS POS","HCPCS","D4263","HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ FIRST SITE IN QUADRANT","D4263 - HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ FIRST SITE IN QUADRANT",1451,2396.69,1275.99,4066.77,362.75]
["TUFTS - TUFTS HMO - HCPCS - D4263","TUFTS","TUFTS HMO","HCPCS","D4263","HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ FIRST SITE IN QUADRANT","D4263 - HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ FIRST SITE IN QUADRANT",1451,2396.69,1275.99,4066.77,362.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D4263","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D4263","HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ FIRST SITE IN QUADRANT","D4263 - HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ FIRST SITE IN QUADRANT",1451,4066.77,1275.99,4066.77,362.75]
["TUFTS - TUFTS PPO - HCPCS - D4264","TUFTS","TUFTS PPO","HCPCS","D4264","HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ EACH ADDITIONAL SITE IN QUADRANT","D4264 - HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ EACH ADDITIONAL SITE IN QUADRANT",1451,2563.83,1275.99,4066.77,362.75]
["TUFTS - TUFTS SELECT - HCPCS - D4264","TUFTS","TUFTS SELECT","HCPCS","D4264","HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ EACH ADDITIONAL SITE IN QUADRANT","D4264 - HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ EACH ADDITIONAL SITE IN QUADRANT",1451,1275.99,1275.99,4066.77,362.75]
["TUFTS - TUFTS HMO - HCPCS - D4264","TUFTS","TUFTS HMO","HCPCS","D4264","HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ EACH ADDITIONAL SITE IN QUADRANT","D4264 - HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ EACH ADDITIONAL SITE IN QUADRANT",1451,2396.69,1275.99,4066.77,362.75]
["TUFTS - TUFTS POS - HCPCS - D4264","TUFTS","TUFTS POS","HCPCS","D4264","HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ EACH ADDITIONAL SITE IN QUADRANT","D4264 - HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ EACH ADDITIONAL SITE IN QUADRANT",1451,2396.69,1275.99,4066.77,362.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D4264","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D4264","HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ EACH ADDITIONAL SITE IN QUADRANT","D4264 - HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ EACH ADDITIONAL SITE IN QUADRANT",1451,4066.77,1275.99,4066.77,362.75]
["TUFTS - TUFTS PPO - HCPCS - D4270","TUFTS","TUFTS PPO","HCPCS","D4270","HC PEDICLE SOFT TISSUE GRAFT PROCEDURE","D4270 - HC PEDICLE SOFT TISSUE GRAFT PROCEDURE",1451,2563.83,1275.99,4066.77,362.75]
["TUFTS - TUFTS SELECT - HCPCS - D4270","TUFTS","TUFTS SELECT","HCPCS","D4270","HC PEDICLE SOFT TISSUE GRAFT PROCEDURE","D4270 - HC PEDICLE SOFT TISSUE GRAFT PROCEDURE",1451,1275.99,1275.99,4066.77,362.75]
["TUFTS - TUFTS HMO - HCPCS - D4270","TUFTS","TUFTS HMO","HCPCS","D4270","HC PEDICLE SOFT TISSUE GRAFT PROCEDURE","D4270 - HC PEDICLE SOFT TISSUE GRAFT PROCEDURE",1451,2396.69,1275.99,4066.77,362.75]
["TUFTS - TUFTS POS - HCPCS - D4270","TUFTS","TUFTS POS","HCPCS","D4270","HC PEDICLE SOFT TISSUE GRAFT PROCEDURE","D4270 - HC PEDICLE SOFT TISSUE GRAFT PROCEDURE",1451,2396.69,1275.99,4066.77,362.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D4270","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D4270","HC PEDICLE SOFT TISSUE GRAFT PROCEDURE","D4270 - HC PEDICLE SOFT TISSUE GRAFT PROCEDURE",1451,4066.77,1275.99,4066.77,362.75]
["TUFTS - TUFTS PPO - HCPCS - D4273","TUFTS","TUFTS PPO","HCPCS","D4273","HC AUTOGENOUS CONN. TISSUE GRAFT PROC. 1ST TOOTH, IMPLANT, OR EDENTULOUS TOOTH POSITION IN GRAFT","D4273 - HC AUTOGENOUS CONN. TISSUE GRAFT PROC. 1ST TOOTH, IMPLANT, OR EDENTULOUS TOOTH POSITION IN GRAFT",1451,2563.83,1275.99,4066.77,362.75]
["TUFTS - TUFTS SELECT - HCPCS - D4273","TUFTS","TUFTS SELECT","HCPCS","D4273","HC AUTOGENOUS CONN. TISSUE GRAFT PROC. 1ST TOOTH, IMPLANT, OR EDENTULOUS TOOTH POSITION IN GRAFT","D4273 - HC AUTOGENOUS CONN. TISSUE GRAFT PROC. 1ST TOOTH, IMPLANT, OR EDENTULOUS TOOTH POSITION IN GRAFT",1451,1275.99,1275.99,4066.77,362.75]
["TUFTS - TUFTS HMO - HCPCS - D4273","TUFTS","TUFTS HMO","HCPCS","D4273","HC AUTOGENOUS CONN. TISSUE GRAFT PROC. 1ST TOOTH, IMPLANT, OR EDENTULOUS TOOTH POSITION IN GRAFT","D4273 - HC AUTOGENOUS CONN. TISSUE GRAFT PROC. 1ST TOOTH, IMPLANT, OR EDENTULOUS TOOTH POSITION IN GRAFT",1451,2396.69,1275.99,4066.77,362.75]
["TUFTS - TUFTS POS - HCPCS - D4273","TUFTS","TUFTS POS","HCPCS","D4273","HC AUTOGENOUS CONN. TISSUE GRAFT PROC. 1ST TOOTH, IMPLANT, OR EDENTULOUS TOOTH POSITION IN GRAFT","D4273 - HC AUTOGENOUS CONN. TISSUE GRAFT PROC. 1ST TOOTH, IMPLANT, OR EDENTULOUS TOOTH POSITION IN GRAFT",1451,2396.69,1275.99,4066.77,362.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D4273","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D4273","HC AUTOGENOUS CONN. TISSUE GRAFT PROC. 1ST TOOTH, IMPLANT, OR EDENTULOUS TOOTH POSITION IN GRAFT","D4273 - HC AUTOGENOUS CONN. TISSUE GRAFT PROC. 1ST TOOTH, IMPLANT, OR EDENTULOUS TOOTH POSITION IN GRAFT",1451,4066.77,1275.99,4066.77,362.75]
["TUFTS - TUFTS PPO - HCPCS - D4355","TUFTS","TUFTS PPO","HCPCS","D4355","FULL MOUTH DEBRIDEMENT TO ENABLE COMPREHENSIVE EVALUATION AND DIAGNOSIS","D4355 - FULL MOUTH DEBRIDEMENT TO ENABLE COMPREHENSIVE EVALUATION AND DIAGNOSIS",836,2563.83,1275.99,4066.77,209]
["TUFTS - TUFTS SELECT - HCPCS - D4355","TUFTS","TUFTS SELECT","HCPCS","D4355","FULL MOUTH DEBRIDEMENT TO ENABLE COMPREHENSIVE EVALUATION AND DIAGNOSIS","D4355 - FULL MOUTH DEBRIDEMENT TO ENABLE COMPREHENSIVE EVALUATION AND DIAGNOSIS",836,1275.99,1275.99,4066.77,209]
["TUFTS - TUFTS POS - HCPCS - D4355","TUFTS","TUFTS POS","HCPCS","D4355","FULL MOUTH DEBRIDEMENT TO ENABLE COMPREHENSIVE EVALUATION AND DIAGNOSIS","D4355 - FULL MOUTH DEBRIDEMENT TO ENABLE COMPREHENSIVE EVALUATION AND DIAGNOSIS",836,2396.69,1275.99,4066.77,209]
["TUFTS - TUFTS HMO - HCPCS - D4355","TUFTS","TUFTS HMO","HCPCS","D4355","FULL MOUTH DEBRIDEMENT TO ENABLE COMPREHENSIVE EVALUATION AND DIAGNOSIS","D4355 - FULL MOUTH DEBRIDEMENT TO ENABLE COMPREHENSIVE EVALUATION AND DIAGNOSIS",836,2396.69,1275.99,4066.77,209]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D4355","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D4355","FULL MOUTH DEBRIDEMENT TO ENABLE COMPREHENSIVE EVALUATION AND DIAGNOSIS","D4355 - FULL MOUTH DEBRIDEMENT TO ENABLE COMPREHENSIVE EVALUATION AND DIAGNOSIS",836,4066.77,1275.99,4066.77,209]
["TUFTS - TUFTS PPO - HCPCS - D4381","TUFTS","TUFTS PPO","HCPCS","D4381","HC LOCALIZED DELIVERY - CONTROLLED RELEASE ANTIMICROB. AGENTS TO DISEASED CREVICULAR TISSUE /TOOTH","D4381 - HC LOCALIZED DELIVERY - CONTROLLED RELEASE ANTIMICROB. AGENTS TO DISEASED CREVICULAR TISSUE /TOOTH",1451,2563.83,1275.99,4066.77,362.75]
["TUFTS - TUFTS SELECT - HCPCS - D4381","TUFTS","TUFTS SELECT","HCPCS","D4381","HC LOCALIZED DELIVERY - CONTROLLED RELEASE ANTIMICROB. AGENTS TO DISEASED CREVICULAR TISSUE /TOOTH","D4381 - HC LOCALIZED DELIVERY - CONTROLLED RELEASE ANTIMICROB. AGENTS TO DISEASED CREVICULAR TISSUE /TOOTH",1451,1275.99,1275.99,4066.77,362.75]
["TUFTS - TUFTS HMO - HCPCS - D4381","TUFTS","TUFTS HMO","HCPCS","D4381","HC LOCALIZED DELIVERY - CONTROLLED RELEASE ANTIMICROB. AGENTS TO DISEASED CREVICULAR TISSUE /TOOTH","D4381 - HC LOCALIZED DELIVERY - CONTROLLED RELEASE ANTIMICROB. AGENTS TO DISEASED CREVICULAR TISSUE /TOOTH",1451,2396.69,1275.99,4066.77,362.75]
["TUFTS - TUFTS POS - HCPCS - D4381","TUFTS","TUFTS POS","HCPCS","D4381","HC LOCALIZED DELIVERY - CONTROLLED RELEASE ANTIMICROB. AGENTS TO DISEASED CREVICULAR TISSUE /TOOTH","D4381 - HC LOCALIZED DELIVERY - CONTROLLED RELEASE ANTIMICROB. AGENTS TO DISEASED CREVICULAR TISSUE /TOOTH",1451,2396.69,1275.99,4066.77,362.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D4381","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D4381","HC LOCALIZED DELIVERY - CONTROLLED RELEASE ANTIMICROB. AGENTS TO DISEASED CREVICULAR TISSUE /TOOTH","D4381 - HC LOCALIZED DELIVERY - CONTROLLED RELEASE ANTIMICROB. AGENTS TO DISEASED CREVICULAR TISSUE /TOOTH",1451,4066.77,1275.99,4066.77,362.75]
["TUFTS - TUFTS PPO - HCPCS - D5911","TUFTS","TUFTS PPO","HCPCS","D5911","HC FACIAL MOULAGE (SECTIONAL)","D5911 - HC FACIAL MOULAGE (SECTIONAL)",1451,2563.83,1275.99,4066.77,362.75]
["TUFTS - TUFTS SELECT - HCPCS - D5911","TUFTS","TUFTS SELECT","HCPCS","D5911","HC FACIAL MOULAGE (SECTIONAL)","D5911 - HC FACIAL MOULAGE (SECTIONAL)",1451,1275.99,1275.99,4066.77,362.75]
["TUFTS - TUFTS HMO - HCPCS - D5911","TUFTS","TUFTS HMO","HCPCS","D5911","HC FACIAL MOULAGE (SECTIONAL)","D5911 - HC FACIAL MOULAGE (SECTIONAL)",1451,2396.69,1275.99,4066.77,362.75]
["TUFTS - TUFTS POS - HCPCS - D5911","TUFTS","TUFTS POS","HCPCS","D5911","HC FACIAL MOULAGE (SECTIONAL)","D5911 - HC FACIAL MOULAGE (SECTIONAL)",1451,2396.69,1275.99,4066.77,362.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D5911","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D5911","HC FACIAL MOULAGE (SECTIONAL)","D5911 - HC FACIAL MOULAGE (SECTIONAL)",1451,4066.77,1275.99,4066.77,362.75]
["TUFTS - TUFTS PPO - HCPCS - D5912","TUFTS","TUFTS PPO","HCPCS","D5912","HC FACIAL MOULAGE (COMPLETE)","D5912 - HC FACIAL MOULAGE (COMPLETE)",1451,2563.83,1275.99,4066.77,362.75]
["TUFTS - TUFTS SELECT - HCPCS - D5912","TUFTS","TUFTS SELECT","HCPCS","D5912","HC FACIAL MOULAGE (COMPLETE)","D5912 - HC FACIAL MOULAGE (COMPLETE)",1451,1275.99,1275.99,4066.77,362.75]
["TUFTS - TUFTS HMO - HCPCS - D5912","TUFTS","TUFTS HMO","HCPCS","D5912","HC FACIAL MOULAGE (COMPLETE)","D5912 - HC FACIAL MOULAGE (COMPLETE)",1451,2396.69,1275.99,4066.77,362.75]
["TUFTS - TUFTS POS - HCPCS - D5912","TUFTS","TUFTS POS","HCPCS","D5912","HC FACIAL MOULAGE (COMPLETE)","D5912 - HC FACIAL MOULAGE (COMPLETE)",1451,2396.69,1275.99,4066.77,362.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D5912","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D5912","HC FACIAL MOULAGE (COMPLETE)","D5912 - HC FACIAL MOULAGE (COMPLETE)",1451,4066.77,1275.99,4066.77,362.75]
["TUFTS - TUFTS PPO - HCPCS - D5983","TUFTS","TUFTS PPO","HCPCS","D5983","HC RADIATION CARRIER","D5983 - HC RADIATION CARRIER",1451,2563.83,1275.99,4066.77,362.75]
["TUFTS - TUFTS SELECT - HCPCS - D5983","TUFTS","TUFTS SELECT","HCPCS","D5983","HC RADIATION CARRIER","D5983 - HC RADIATION CARRIER",1451,1275.99,1275.99,4066.77,362.75]
["TUFTS - TUFTS POS - HCPCS - D5983","TUFTS","TUFTS POS","HCPCS","D5983","HC RADIATION CARRIER","D5983 - HC RADIATION CARRIER",1451,2396.69,1275.99,4066.77,362.75]
["TUFTS - TUFTS HMO - HCPCS - D5983","TUFTS","TUFTS HMO","HCPCS","D5983","HC RADIATION CARRIER","D5983 - HC RADIATION CARRIER",1451,2396.69,1275.99,4066.77,362.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D5983","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D5983","HC RADIATION CARRIER","D5983 - HC RADIATION CARRIER",1451,4066.77,1275.99,4066.77,362.75]
["TUFTS - TUFTS PPO - HCPCS - D5984","TUFTS","TUFTS PPO","HCPCS","D5984","HC RADIATION SHIELD","D5984 - HC RADIATION SHIELD",1451,2563.83,1275.99,4066.77,362.75]
["TUFTS - TUFTS SELECT - HCPCS - D5984","TUFTS","TUFTS SELECT","HCPCS","D5984","HC RADIATION SHIELD","D5984 - HC RADIATION SHIELD",1451,1275.99,1275.99,4066.77,362.75]
["TUFTS - TUFTS HMO - HCPCS - D5984","TUFTS","TUFTS HMO","HCPCS","D5984","HC RADIATION SHIELD","D5984 - HC RADIATION SHIELD",1451,2396.69,1275.99,4066.77,362.75]
["TUFTS - TUFTS POS - HCPCS - D5984","TUFTS","TUFTS POS","HCPCS","D5984","HC RADIATION SHIELD","D5984 - HC RADIATION SHIELD",1451,2396.69,1275.99,4066.77,362.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D5984","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D5984","HC RADIATION SHIELD","D5984 - HC RADIATION SHIELD",1451,4066.77,1275.99,4066.77,362.75]
["TUFTS - TUFTS PPO - HCPCS - D5985","TUFTS","TUFTS PPO","HCPCS","D5985","HC RADIATION CONE LOCATOR","D5985 - HC RADIATION CONE LOCATOR",1451,2563.83,1275.99,4066.77,362.75]
["TUFTS - TUFTS SELECT - HCPCS - D5985","TUFTS","TUFTS SELECT","HCPCS","D5985","HC RADIATION CONE LOCATOR","D5985 - HC RADIATION CONE LOCATOR",1451,1275.99,1275.99,4066.77,362.75]
["TUFTS - TUFTS HMO - HCPCS - D5985","TUFTS","TUFTS HMO","HCPCS","D5985","HC RADIATION CONE LOCATOR","D5985 - HC RADIATION CONE LOCATOR",1451,2396.69,1275.99,4066.77,362.75]
["TUFTS - TUFTS POS - HCPCS - D5985","TUFTS","TUFTS POS","HCPCS","D5985","HC RADIATION CONE LOCATOR","D5985 - HC RADIATION CONE LOCATOR",1451,2396.69,1275.99,4066.77,362.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D5985","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D5985","HC RADIATION CONE LOCATOR","D5985 - HC RADIATION CONE LOCATOR",1451,4066.77,1275.99,4066.77,362.75]
["TUFTS - TUFTS PPO - HCPCS - D5987","TUFTS","TUFTS PPO","HCPCS","D5987","HC COMMISSURE SPLINT","D5987 - HC COMMISSURE SPLINT",1451,2563.83,1275.99,4066.77,362.75]
["TUFTS - TUFTS SELECT - HCPCS - D5987","TUFTS","TUFTS SELECT","HCPCS","D5987","HC COMMISSURE SPLINT","D5987 - HC COMMISSURE SPLINT",1451,1275.99,1275.99,4066.77,362.75]
["TUFTS - TUFTS HMO - HCPCS - D5987","TUFTS","TUFTS HMO","HCPCS","D5987","HC COMMISSURE SPLINT","D5987 - HC COMMISSURE SPLINT",1451,2396.69,1275.99,4066.77,362.75]
["TUFTS - TUFTS POS - HCPCS - D5987","TUFTS","TUFTS POS","HCPCS","D5987","HC COMMISSURE SPLINT","D5987 - HC COMMISSURE SPLINT",1451,2396.69,1275.99,4066.77,362.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D5987","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D5987","HC COMMISSURE SPLINT","D5987 - HC COMMISSURE SPLINT",1451,4066.77,1275.99,4066.77,362.75]
["TUFTS - TUFTS PPO - HCPCS - D7140","TUFTS","TUFTS PPO","HCPCS","D7140","EXTRACTION ERUPTED TOOTH/EXR","D7140 - EXTRACTION ERUPTED TOOTH/EXR",836,2563.83,1275.99,4066.77,209]
["TUFTS - TUFTS SELECT - HCPCS - D7140","TUFTS","TUFTS SELECT","HCPCS","D7140","EXTRACTION ERUPTED TOOTH/EXR","D7140 - EXTRACTION ERUPTED TOOTH/EXR",836,1275.99,1275.99,4066.77,209]
["TUFTS - TUFTS POS - HCPCS - D7140","TUFTS","TUFTS POS","HCPCS","D7140","EXTRACTION ERUPTED TOOTH/EXR","D7140 - EXTRACTION ERUPTED TOOTH/EXR",836,2396.69,1275.99,4066.77,209]
["TUFTS - TUFTS HMO - HCPCS - D7140","TUFTS","TUFTS HMO","HCPCS","D7140","EXTRACTION ERUPTED TOOTH/EXR","D7140 - EXTRACTION ERUPTED TOOTH/EXR",836,2396.69,1275.99,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D7140","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D7140","EXTRACTION ERUPTED TOOTH/EXR","D7140 - EXTRACTION ERUPTED TOOTH/EXR",836,1510.05,1275.99,4066.77,209]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D7140","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D7140","EXTRACTION ERUPTED TOOTH/EXR","D7140 - EXTRACTION ERUPTED TOOTH/EXR",836,4066.77,1275.99,4066.77,209]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D7140","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D7140","EXTRACTION ERUPTED TOOTH/EXR","D7140 - EXTRACTION ERUPTED TOOTH/EXR",836,1510.05,1275.99,4066.77,209]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D7140","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D7140","EXTRACTION ERUPTED TOOTH/EXR","D7140 - EXTRACTION ERUPTED TOOTH/EXR",836,1510.05,1275.99,4066.77,209]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D7140","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D7140","EXTRACTION ERUPTED TOOTH/EXR","D7140 - EXTRACTION ERUPTED TOOTH/EXR",836,1510.05,1275.99,4066.77,209]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D7140","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D7140","EXTRACTION ERUPTED TOOTH/EXR","D7140 - EXTRACTION ERUPTED TOOTH/EXR",836,1510.05,1275.99,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D7140","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D7140","EXTRACTION ERUPTED TOOTH/EXR","D7140 - EXTRACTION ERUPTED TOOTH/EXR",836,1510.05,1275.99,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D7140","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D7140","EXTRACTION ERUPTED TOOTH/EXR","D7140 - EXTRACTION ERUPTED TOOTH/EXR",836,1510.05,1275.99,4066.77,209]
["TUFTS - TUFTS PPO - HCPCS - D7210","TUFTS","TUFTS PPO","HCPCS","D7210","EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED","D7210 - EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED",836,2563.83,1275.99,4066.77,209]
["TUFTS - TUFTS SELECT - HCPCS - D7210","TUFTS","TUFTS SELECT","HCPCS","D7210","EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED","D7210 - EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED",836,1275.99,1275.99,4066.77,209]
["TUFTS - TUFTS HMO - HCPCS - D7210","TUFTS","TUFTS HMO","HCPCS","D7210","EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED","D7210 - EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED",836,2396.69,1275.99,4066.77,209]
["TUFTS - TUFTS POS - HCPCS - D7210","TUFTS","TUFTS POS","HCPCS","D7210","EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED","D7210 - EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED",836,2396.69,1275.99,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D7210","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D7210","EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED","D7210 - EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED",836,1510.05,1275.99,4066.77,209]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D7210","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D7210","EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED","D7210 - EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED",836,4066.77,1275.99,4066.77,209]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D7210","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D7210","EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED","D7210 - EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED",836,1510.05,1275.99,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D7210","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D7210","EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED","D7210 - EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED",836,1510.05,1275.99,4066.77,209]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D7210","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D7210","EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED","D7210 - EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED",836,1510.05,1275.99,4066.77,209]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D7210","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D7210","EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED","D7210 - EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED",836,1510.05,1275.99,4066.77,209]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D7210","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D7210","EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED","D7210 - EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED",836,1510.05,1275.99,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D7210","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D7210","EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED","D7210 - EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED",836,1510.05,1275.99,4066.77,209]
["TUFTS - TUFTS PPO - HCPCS - D7220","TUFTS","TUFTS PPO","HCPCS","D7220","REMOVAL OF IMPACTED TOOTH - SOFT TISSUE","D7220 - REMOVAL OF IMPACTED TOOTH - SOFT TISSUE",836,2563.83,1275.99,4066.77,209]
["TUFTS - TUFTS SELECT - HCPCS - D7220","TUFTS","TUFTS SELECT","HCPCS","D7220","REMOVAL OF IMPACTED TOOTH - SOFT TISSUE","D7220 - REMOVAL OF IMPACTED TOOTH - SOFT TISSUE",836,1275.99,1275.99,4066.77,209]
["TUFTS - TUFTS HMO - HCPCS - D7220","TUFTS","TUFTS HMO","HCPCS","D7220","REMOVAL OF IMPACTED TOOTH - SOFT TISSUE","D7220 - REMOVAL OF IMPACTED TOOTH - SOFT TISSUE",836,2396.69,1275.99,4066.77,209]
["TUFTS - TUFTS POS - HCPCS - D7220","TUFTS","TUFTS POS","HCPCS","D7220","REMOVAL OF IMPACTED TOOTH - SOFT TISSUE","D7220 - REMOVAL OF IMPACTED TOOTH - SOFT TISSUE",836,2396.69,1275.99,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D7220","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D7220","REMOVAL OF IMPACTED TOOTH - SOFT TISSUE","D7220 - REMOVAL OF IMPACTED TOOTH - SOFT TISSUE",836,1510.05,1275.99,4066.77,209]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D7220","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D7220","REMOVAL OF IMPACTED TOOTH - SOFT TISSUE","D7220 - REMOVAL OF IMPACTED TOOTH - SOFT TISSUE",836,4066.77,1275.99,4066.77,209]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D7220","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D7220","REMOVAL OF IMPACTED TOOTH - SOFT TISSUE","D7220 - REMOVAL OF IMPACTED TOOTH - SOFT TISSUE",836,1510.05,1275.99,4066.77,209]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D7220","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D7220","REMOVAL OF IMPACTED TOOTH - SOFT TISSUE","D7220 - REMOVAL OF IMPACTED TOOTH - SOFT TISSUE",836,1510.05,1275.99,4066.77,209]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D7220","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D7220","REMOVAL OF IMPACTED TOOTH - SOFT TISSUE","D7220 - REMOVAL OF IMPACTED TOOTH - SOFT TISSUE",836,1510.05,1275.99,4066.77,209]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D7220","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D7220","REMOVAL OF IMPACTED TOOTH - SOFT TISSUE","D7220 - REMOVAL OF IMPACTED TOOTH - SOFT TISSUE",836,1510.05,1275.99,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D7220","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D7220","REMOVAL OF IMPACTED TOOTH - SOFT TISSUE","D7220 - REMOVAL OF IMPACTED TOOTH - SOFT TISSUE",836,1510.05,1275.99,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D7220","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D7220","REMOVAL OF IMPACTED TOOTH - SOFT TISSUE","D7220 - REMOVAL OF IMPACTED TOOTH - SOFT TISSUE",836,1510.05,1275.99,4066.77,209]
["TUFTS - TUFTS PPO - HCPCS - D7230","TUFTS","TUFTS PPO","HCPCS","D7230","REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY","D7230 - REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY",836,2563.83,1275.99,4066.77,209]
["TUFTS - TUFTS SELECT - HCPCS - D7230","TUFTS","TUFTS SELECT","HCPCS","D7230","REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY","D7230 - REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY",836,1275.99,1275.99,4066.77,209]
["TUFTS - TUFTS HMO - HCPCS - D7230","TUFTS","TUFTS HMO","HCPCS","D7230","REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY","D7230 - REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY",836,2396.69,1275.99,4066.77,209]
["TUFTS - TUFTS POS - HCPCS - D7230","TUFTS","TUFTS POS","HCPCS","D7230","REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY","D7230 - REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY",836,2396.69,1275.99,4066.77,209]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D7230","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D7230","REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY","D7230 - REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY",836,4066.77,1275.99,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D7230","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D7230","REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY","D7230 - REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY",836,1510.05,1275.99,4066.77,209]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D7230","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D7230","REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY","D7230 - REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY",836,1510.05,1275.99,4066.77,209]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D7230","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D7230","REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY","D7230 - REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY",836,1510.05,1275.99,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D7230","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D7230","REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY","D7230 - REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY",836,1510.05,1275.99,4066.77,209]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D7230","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D7230","REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY","D7230 - REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY",836,1510.05,1275.99,4066.77,209]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D7230","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D7230","REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY","D7230 - REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY",836,1510.05,1275.99,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D7230","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D7230","REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY","D7230 - REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY",836,1510.05,1275.99,4066.77,209]
["TUFTS - TUFTS PPO - HCPCS - D7240","TUFTS","TUFTS PPO","HCPCS","D7240","REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY","D7240 - REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY",836,2563.83,1275.99,4066.77,209]
["TUFTS - TUFTS SELECT - HCPCS - D7240","TUFTS","TUFTS SELECT","HCPCS","D7240","REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY","D7240 - REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY",836,1275.99,1275.99,4066.77,209]
["TUFTS - TUFTS POS - HCPCS - D7240","TUFTS","TUFTS POS","HCPCS","D7240","REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY","D7240 - REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY",836,2396.69,1275.99,4066.77,209]
["TUFTS - TUFTS HMO - HCPCS - D7240","TUFTS","TUFTS HMO","HCPCS","D7240","REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY","D7240 - REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY",836,2396.69,1275.99,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D7240","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D7240","REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY","D7240 - REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY",836,1510.05,1275.99,4066.77,209]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D7240","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D7240","REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY","D7240 - REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY",836,4066.77,1275.99,4066.77,209]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D7240","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D7240","REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY","D7240 - REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY",836,1510.05,1275.99,4066.77,209]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D7240","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D7240","REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY","D7240 - REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY",836,1510.05,1275.99,4066.77,209]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D7240","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D7240","REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY","D7240 - REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY",836,1510.05,1275.99,4066.77,209]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D7240","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D7240","REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY","D7240 - REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY",836,1510.05,1275.99,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D7240","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D7240","REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY","D7240 - REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY",836,1510.05,1275.99,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D7240","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D7240","REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY","D7240 - REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY",836,1510.05,1275.99,4066.77,209]
["TUFTS - TUFTS PPO - HCPCS - D7250","TUFTS","TUFTS PPO","HCPCS","D7250","REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)","D7250 - REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)",836,2563.83,1275.99,4066.77,209]
["TUFTS - TUFTS SELECT - HCPCS - D7250","TUFTS","TUFTS SELECT","HCPCS","D7250","REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)","D7250 - REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)",836,1275.99,1275.99,4066.77,209]
["TUFTS - TUFTS HMO - HCPCS - D7250","TUFTS","TUFTS HMO","HCPCS","D7250","REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)","D7250 - REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)",836,2396.69,1275.99,4066.77,209]
["TUFTS - TUFTS POS - HCPCS - D7250","TUFTS","TUFTS POS","HCPCS","D7250","REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)","D7250 - REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)",836,2396.69,1275.99,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D7250","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D7250","REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)","D7250 - REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)",836,1510.05,1275.99,4066.77,209]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D7250","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D7250","REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)","D7250 - REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)",836,4066.77,1275.99,4066.77,209]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D7250","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D7250","REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)","D7250 - REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)",836,1510.05,1275.99,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D7250","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D7250","REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)","D7250 - REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)",836,1510.05,1275.99,4066.77,209]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D7250","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D7250","REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)","D7250 - REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)",836,1510.05,1275.99,4066.77,209]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D7250","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D7250","REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)","D7250 - REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)",836,1510.05,1275.99,4066.77,209]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D7250","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D7250","REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)","D7250 - REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)",836,1510.05,1275.99,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D7250","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D7250","REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)","D7250 - REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)",836,1510.05,1275.99,4066.77,209]
["TUFTS - TUFTS PPO - HCPCS - D7260","TUFTS","TUFTS PPO","HCPCS","D7260","HC OROANTRAL FISTULA CLOSURE","D7260 - HC OROANTRAL FISTULA CLOSURE",1081,2563.83,1275.99,4066.77,270.25]
["TUFTS - TUFTS SELECT - HCPCS - D7260","TUFTS","TUFTS SELECT","HCPCS","D7260","HC OROANTRAL FISTULA CLOSURE","D7260 - HC OROANTRAL FISTULA CLOSURE",1081,1275.99,1275.99,4066.77,270.25]
["TUFTS - TUFTS HMO - HCPCS - D7260","TUFTS","TUFTS HMO","HCPCS","D7260","HC OROANTRAL FISTULA CLOSURE","D7260 - HC OROANTRAL FISTULA CLOSURE",1081,2396.69,1275.99,4066.77,270.25]
["TUFTS - TUFTS POS - HCPCS - D7260","TUFTS","TUFTS POS","HCPCS","D7260","HC OROANTRAL FISTULA CLOSURE","D7260 - HC OROANTRAL FISTULA CLOSURE",1081,2396.69,1275.99,4066.77,270.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D7260","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D7260","HC OROANTRAL FISTULA CLOSURE","D7260 - HC OROANTRAL FISTULA CLOSURE",1081,4066.77,1275.99,4066.77,270.25]
["TUFTS - TUFTS PPO - HCPCS - D7261","TUFTS","TUFTS PPO","HCPCS","D7261","PRIMARY CLOSURE OF A SINUS PERFORATION","D7261 - PRIMARY CLOSURE OF A SINUS PERFORATION",836,2563.83,1275.99,4066.77,209]
["TUFTS - TUFTS SELECT - HCPCS - D7261","TUFTS","TUFTS SELECT","HCPCS","D7261","PRIMARY CLOSURE OF A SINUS PERFORATION","D7261 - PRIMARY CLOSURE OF A SINUS PERFORATION",836,1275.99,1275.99,4066.77,209]
["TUFTS - TUFTS HMO - HCPCS - D7261","TUFTS","TUFTS HMO","HCPCS","D7261","PRIMARY CLOSURE OF A SINUS PERFORATION","D7261 - PRIMARY CLOSURE OF A SINUS PERFORATION",836,2396.69,1275.99,4066.77,209]
["TUFTS - TUFTS POS - HCPCS - D7261","TUFTS","TUFTS POS","HCPCS","D7261","PRIMARY CLOSURE OF A SINUS PERFORATION","D7261 - PRIMARY CLOSURE OF A SINUS PERFORATION",836,2396.69,1275.99,4066.77,209]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D7261","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D7261","PRIMARY CLOSURE OF A SINUS PERFORATION","D7261 - PRIMARY CLOSURE OF A SINUS PERFORATION",836,4066.77,1275.99,4066.77,209]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D7310","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D7310","ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH SPACES, PER QUADRANT","D7310 - ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH SPACES, PER QUADRANT",110,230.94,230.94,230.94,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D7310","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D7310","ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH SPACES, PER QUADRANT","D7310 - ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH SPACES, PER QUADRANT",110,230.94,230.94,230.94,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D7310","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D7310","ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH SPACES, PER QUADRANT","D7310 - ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH SPACES, PER QUADRANT",110,230.94,230.94,230.94,27.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D7310","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D7310","ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH SPACES, PER QUADRANT","D7310 - ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH SPACES, PER QUADRANT",110,230.94,230.94,230.94,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D7310","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D7310","ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH SPACES, PER QUADRANT","D7310 - ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH SPACES, PER QUADRANT",110,230.94,230.94,230.94,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D7310","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D7310","ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH SPACES, PER QUADRANT","D7310 - ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH SPACES, PER QUADRANT",110,230.94,230.94,230.94,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D7310","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D7310","ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH SPACES, PER QUADRANT","D7310 - ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH SPACES, PER QUADRANT",110,230.94,230.94,230.94,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D7311","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D7311","ALVEOLOPLASTY W/EXTRACT 1-3","D7311 - ALVEOLOPLASTY W/EXTRACT 1-3",110,202.78,202.78,202.78,27.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D7311","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D7311","ALVEOLOPLASTY W/EXTRACT 1-3","D7311 - ALVEOLOPLASTY W/EXTRACT 1-3",110,202.78,202.78,202.78,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D7311","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D7311","ALVEOLOPLASTY W/EXTRACT 1-3","D7311 - ALVEOLOPLASTY W/EXTRACT 1-3",110,202.78,202.78,202.78,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D7311","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D7311","ALVEOLOPLASTY W/EXTRACT 1-3","D7311 - ALVEOLOPLASTY W/EXTRACT 1-3",110,202.78,202.78,202.78,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D7311","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D7311","ALVEOLOPLASTY W/EXTRACT 1-3","D7311 - ALVEOLOPLASTY W/EXTRACT 1-3",110,202.78,202.78,202.78,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D7311","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D7311","ALVEOLOPLASTY W/EXTRACT 1-3","D7311 - ALVEOLOPLASTY W/EXTRACT 1-3",110,202.78,202.78,202.78,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D7311","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D7311","ALVEOLOPLASTY W/EXTRACT 1-3","D7311 - ALVEOLOPLASTY W/EXTRACT 1-3",110,202.78,202.78,202.78,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D7410","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D7410","EXCISION OF BENIGN LESION UP TO 1.25 CM","D7410 - EXCISION OF BENIGN LESION UP TO 1.25 CM",110,692.83,692.83,692.83,27.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D7410","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D7410","EXCISION OF BENIGN LESION UP TO 1.25 CM","D7410 - EXCISION OF BENIGN LESION UP TO 1.25 CM",110,692.83,692.83,692.83,27.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D7410","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D7410","EXCISION OF BENIGN LESION UP TO 1.25 CM","D7410 - EXCISION OF BENIGN LESION UP TO 1.25 CM",110,692.83,692.83,692.83,27.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - D7410","BLUE CROSS","BLUE CROSS-PPO","HCPCS","D7410","EXCISION OF BENIGN LESION UP TO 1.25 CM","D7410 - EXCISION OF BENIGN LESION UP TO 1.25 CM",110,692.83,692.83,692.83,27.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D7410","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D7410","EXCISION OF BENIGN LESION UP TO 1.25 CM","D7410 - EXCISION OF BENIGN LESION UP TO 1.25 CM",110,692.83,692.83,692.83,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D7410","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D7410","EXCISION OF BENIGN LESION UP TO 1.25 CM","D7410 - EXCISION OF BENIGN LESION UP TO 1.25 CM",110,692.83,692.83,692.83,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D7410","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D7410","EXCISION OF BENIGN LESION UP TO 1.25 CM","D7410 - EXCISION OF BENIGN LESION UP TO 1.25 CM",110,692.83,692.83,692.83,27.5]
["TUFTS - TUFTS PPO - HCPCS - D7940","TUFTS","TUFTS PPO","HCPCS","D7940","HC OSTEOPLASTY - FOR ORTHOGNATHIC DEFORMITIES","D7940 - HC OSTEOPLASTY - FOR ORTHOGNATHIC DEFORMITIES",1451,2563.83,1275.99,4066.77,362.75]
["TUFTS - TUFTS SELECT - HCPCS - D7940","TUFTS","TUFTS SELECT","HCPCS","D7940","HC OSTEOPLASTY - FOR ORTHOGNATHIC DEFORMITIES","D7940 - HC OSTEOPLASTY - FOR ORTHOGNATHIC DEFORMITIES",1451,1275.99,1275.99,4066.77,362.75]
["TUFTS - TUFTS POS - HCPCS - D7940","TUFTS","TUFTS POS","HCPCS","D7940","HC OSTEOPLASTY - FOR ORTHOGNATHIC DEFORMITIES","D7940 - HC OSTEOPLASTY - FOR ORTHOGNATHIC DEFORMITIES",1451,2396.69,1275.99,4066.77,362.75]
["TUFTS - TUFTS HMO - HCPCS - D7940","TUFTS","TUFTS HMO","HCPCS","D7940","HC OSTEOPLASTY - FOR ORTHOGNATHIC DEFORMITIES","D7940 - HC OSTEOPLASTY - FOR ORTHOGNATHIC DEFORMITIES",1451,2396.69,1275.99,4066.77,362.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D7940","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D7940","HC OSTEOPLASTY - FOR ORTHOGNATHIC DEFORMITIES","D7940 - HC OSTEOPLASTY - FOR ORTHOGNATHIC DEFORMITIES",1451,4066.77,1275.99,4066.77,362.75]
["TUFTS - TUFTS PPO - HCPCS - D9110","TUFTS","TUFTS PPO","HCPCS","D9110","PALLIATIVE (EMERGENCY) TREATMENT OF DENTAL PAIN - MINOR PROCEDURE","D9110 - PALLIATIVE (EMERGENCY) TREATMENT OF DENTAL PAIN - MINOR PROCEDURE",110,0,0,0,27.5]
["TUFTS - TUFTS SELECT - HCPCS - D9110","TUFTS","TUFTS SELECT","HCPCS","D9110","PALLIATIVE (EMERGENCY) TREATMENT OF DENTAL PAIN - MINOR PROCEDURE","D9110 - PALLIATIVE (EMERGENCY) TREATMENT OF DENTAL PAIN - MINOR PROCEDURE",110,0,0,0,27.5]
["TUFTS - TUFTS HMO - HCPCS - D9110","TUFTS","TUFTS HMO","HCPCS","D9110","PALLIATIVE (EMERGENCY) TREATMENT OF DENTAL PAIN - MINOR PROCEDURE","D9110 - PALLIATIVE (EMERGENCY) TREATMENT OF DENTAL PAIN - MINOR PROCEDURE",110,0,0,0,27.5]
["TUFTS - TUFTS POS - HCPCS - D9110","TUFTS","TUFTS POS","HCPCS","D9110","PALLIATIVE (EMERGENCY) TREATMENT OF DENTAL PAIN - MINOR PROCEDURE","D9110 - PALLIATIVE (EMERGENCY) TREATMENT OF DENTAL PAIN - MINOR PROCEDURE",110,0,0,0,27.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D9110","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D9110","PALLIATIVE (EMERGENCY) TREATMENT OF DENTAL PAIN - MINOR PROCEDURE","D9110 - PALLIATIVE (EMERGENCY) TREATMENT OF DENTAL PAIN - MINOR PROCEDURE",110,0,0,0,27.5]
["TUFTS - TUFTS PPO - HCPCS - D9230","TUFTS","TUFTS PPO","HCPCS","D9230","INHALATION OF NITROUS OXIDE/ANALGESIA, ANXIOLYSIS","D9230 - INHALATION OF NITROUS OXIDE/ANALGESIA, ANXIOLYSIS",110,0,0,0,27.5]
["TUFTS - TUFTS SELECT - HCPCS - D9230","TUFTS","TUFTS SELECT","HCPCS","D9230","INHALATION OF NITROUS OXIDE/ANALGESIA, ANXIOLYSIS","D9230 - INHALATION OF NITROUS OXIDE/ANALGESIA, ANXIOLYSIS",110,0,0,0,27.5]
["TUFTS - TUFTS HMO - HCPCS - D9230","TUFTS","TUFTS HMO","HCPCS","D9230","INHALATION OF NITROUS OXIDE/ANALGESIA, ANXIOLYSIS","D9230 - INHALATION OF NITROUS OXIDE/ANALGESIA, ANXIOLYSIS",110,0,0,0,27.5]
["TUFTS - TUFTS POS - HCPCS - D9230","TUFTS","TUFTS POS","HCPCS","D9230","INHALATION OF NITROUS OXIDE/ANALGESIA, ANXIOLYSIS","D9230 - INHALATION OF NITROUS OXIDE/ANALGESIA, ANXIOLYSIS",110,0,0,0,27.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D9230","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D9230","INHALATION OF NITROUS OXIDE/ANALGESIA, ANXIOLYSIS","D9230 - INHALATION OF NITROUS OXIDE/ANALGESIA, ANXIOLYSIS",110,0,0,0,27.5]
["TUFTS - TUFTS PPO - HCPCS - D9630","TUFTS","TUFTS PPO","HCPCS","D9630","HC DRUGS OR MEDICAMENTS DISPENSED IN THE OFFICE FOR HOME USE","D9630 - HC DRUGS OR MEDICAMENTS DISPENSED IN THE OFFICE FOR HOME USE",110,1188.52,591.51,3340.65,27.5]
["TUFTS - TUFTS SELECT - HCPCS - D9630","TUFTS","TUFTS SELECT","HCPCS","D9630","HC DRUGS OR MEDICAMENTS DISPENSED IN THE OFFICE FOR HOME USE","D9630 - HC DRUGS OR MEDICAMENTS DISPENSED IN THE OFFICE FOR HOME USE",110,591.51,591.51,3340.65,27.5]
["TUFTS - TUFTS HMO - HCPCS - D9630","TUFTS","TUFTS HMO","HCPCS","D9630","HC DRUGS OR MEDICAMENTS DISPENSED IN THE OFFICE FOR HOME USE","D9630 - HC DRUGS OR MEDICAMENTS DISPENSED IN THE OFFICE FOR HOME USE",110,1333.24,591.51,3340.65,27.5]
["TUFTS - TUFTS POS - HCPCS - D9630","TUFTS","TUFTS POS","HCPCS","D9630","HC DRUGS OR MEDICAMENTS DISPENSED IN THE OFFICE FOR HOME USE","D9630 - HC DRUGS OR MEDICAMENTS DISPENSED IN THE OFFICE FOR HOME USE",110,1111.03,591.51,3340.65,27.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D9630","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D9630","HC DRUGS OR MEDICAMENTS DISPENSED IN THE OFFICE FOR HOME USE","D9630 - HC DRUGS OR MEDICAMENTS DISPENSED IN THE OFFICE FOR HOME USE",110,3340.65,591.51,3340.65,27.5]
["TUFTS - TUFTS PPO - HCPCS - D9930","TUFTS","TUFTS PPO","HCPCS","D9930","HC TREATMENT OF COMPLICATIONS (POST-SURGICAL) - UNUSUAL CIRCUMSTANCES, BY REPORT","D9930 - HC TREATMENT OF COMPLICATIONS (POST-SURGICAL) - UNUSUAL CIRCUMSTANCES, BY REPORT",1451,2563.83,1275.99,4066.77,362.75]
["TUFTS - TUFTS SELECT - HCPCS - D9930","TUFTS","TUFTS SELECT","HCPCS","D9930","HC TREATMENT OF COMPLICATIONS (POST-SURGICAL) - UNUSUAL CIRCUMSTANCES, BY REPORT","D9930 - HC TREATMENT OF COMPLICATIONS (POST-SURGICAL) - UNUSUAL CIRCUMSTANCES, BY REPORT",1451,1275.99,1275.99,4066.77,362.75]
["TUFTS - TUFTS POS - HCPCS - D9930","TUFTS","TUFTS POS","HCPCS","D9930","HC TREATMENT OF COMPLICATIONS (POST-SURGICAL) - UNUSUAL CIRCUMSTANCES, BY REPORT","D9930 - HC TREATMENT OF COMPLICATIONS (POST-SURGICAL) - UNUSUAL CIRCUMSTANCES, BY REPORT",1451,2396.69,1275.99,4066.77,362.75]
["TUFTS - TUFTS HMO - HCPCS - D9930","TUFTS","TUFTS HMO","HCPCS","D9930","HC TREATMENT OF COMPLICATIONS (POST-SURGICAL) - UNUSUAL CIRCUMSTANCES, BY REPORT","D9930 - HC TREATMENT OF COMPLICATIONS (POST-SURGICAL) - UNUSUAL CIRCUMSTANCES, BY REPORT",1451,2396.69,1275.99,4066.77,362.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D9930","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D9930","HC TREATMENT OF COMPLICATIONS (POST-SURGICAL) - UNUSUAL CIRCUMSTANCES, BY REPORT","D9930 - HC TREATMENT OF COMPLICATIONS (POST-SURGICAL) - UNUSUAL CIRCUMSTANCES, BY REPORT",1451,4066.77,1275.99,4066.77,362.75]
["TUFTS - TUFTS PPO - HCPCS - D9944","TUFTS","TUFTS PPO","HCPCS","D9944","HC OCCLUSAL GUARD ¿ HARD APPLIANCE, FULL ARCH","D9944 - HC OCCLUSAL GUARD ¿ HARD APPLIANCE, FULL ARCH",51,0,0,0,12.75]
["TUFTS - TUFTS SELECT - HCPCS - D9944","TUFTS","TUFTS SELECT","HCPCS","D9944","HC OCCLUSAL GUARD ¿ HARD APPLIANCE, FULL ARCH","D9944 - HC OCCLUSAL GUARD ¿ HARD APPLIANCE, FULL ARCH",51,0,0,0,12.75]
["TUFTS - TUFTS HMO - HCPCS - D9944","TUFTS","TUFTS HMO","HCPCS","D9944","HC OCCLUSAL GUARD ¿ HARD APPLIANCE, FULL ARCH","D9944 - HC OCCLUSAL GUARD ¿ HARD APPLIANCE, FULL ARCH",51,0,0,0,12.75]
["TUFTS - TUFTS POS - HCPCS - D9944","TUFTS","TUFTS POS","HCPCS","D9944","HC OCCLUSAL GUARD ¿ HARD APPLIANCE, FULL ARCH","D9944 - HC OCCLUSAL GUARD ¿ HARD APPLIANCE, FULL ARCH",51,0,0,0,12.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D9944","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D9944","HC OCCLUSAL GUARD ¿ HARD APPLIANCE, FULL ARCH","D9944 - HC OCCLUSAL GUARD ¿ HARD APPLIANCE, FULL ARCH",51,0,0,0,12.75]
["TUFTS - TUFTS PPO - HCPCS - D9951","TUFTS","TUFTS PPO","HCPCS","D9951","OCCLUSAL ADJUSTMENT - LIMITED","D9951 - OCCLUSAL ADJUSTMENT - LIMITED",1350,2563.83,1275.99,4066.77,337.5]
["TUFTS - TUFTS SELECT - HCPCS - D9951","TUFTS","TUFTS SELECT","HCPCS","D9951","OCCLUSAL ADJUSTMENT - LIMITED","D9951 - OCCLUSAL ADJUSTMENT - LIMITED",1350,1275.99,1275.99,4066.77,337.5]
["TUFTS - TUFTS HMO - HCPCS - D9951","TUFTS","TUFTS HMO","HCPCS","D9951","OCCLUSAL ADJUSTMENT - LIMITED","D9951 - OCCLUSAL ADJUSTMENT - LIMITED",1350,2396.69,1275.99,4066.77,337.5]
["TUFTS - TUFTS POS - HCPCS - D9951","TUFTS","TUFTS POS","HCPCS","D9951","OCCLUSAL ADJUSTMENT - LIMITED","D9951 - OCCLUSAL ADJUSTMENT - LIMITED",1350,2396.69,1275.99,4066.77,337.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D9951","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D9951","OCCLUSAL ADJUSTMENT - LIMITED","D9951 - OCCLUSAL ADJUSTMENT - LIMITED",1350,4066.77,1275.99,4066.77,337.5]
["TUFTS - TUFTS SPIRIT - HCPCS - E0191","TUFTS","TUFTS SPIRIT","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","E0191 - PROTECTOR HEEL OR ELBOW",321,7.8733333333333322,11.61,52.13,80.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - E0191","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","E0191 - PROTECTOR HEEL OR ELBOW",321,8.586666666666666,11.61,52.13,80.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - E0191","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","E0191 - PROTECTOR HEEL OR ELBOW",321,9.65,11.61,52.13,80.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - E0191","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","E0191 - PROTECTOR HEEL OR ELBOW",321,8.5866666666666678,11.61,52.13,80.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - E0191","FALLON","FALLON SENIOR PLAN","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","E0191 - PROTECTOR HEEL OR ELBOW",321,7.1566666666666663,11.61,52.13,80.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - E0191","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","E0191 - PROTECTOR HEEL OR ELBOW",321,12.453333333333333,11.61,52.13,80.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - E0191","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","E0191 - PROTECTOR HEEL OR ELBOW",321,10.376666666666667,11.61,52.13,80.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - E0191","TUFTS","TUFTS MEDICARE SCO","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","E0191 - PROTECTOR HEEL OR ELBOW",321,10.376666666666665,11.61,52.13,80.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - E0191","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","E0191 - PROTECTOR HEEL OR ELBOW",321,15.453333333333333,11.61,52.13,80.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - E0191","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","E0191 - PROTECTOR HEEL OR ELBOW",321,15.816666666666665,11.61,52.13,80.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - E0191","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","E0191 - PROTECTOR HEEL OR ELBOW",321,7.1566666666666663,11.61,52.13,80.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - E0191","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","E0191 - PROTECTOR HEEL OR ELBOW",321,7.1566666666666663,11.61,52.13,80.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - E0191","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","E0191 - PROTECTOR HEEL OR ELBOW",321,7.1566666666666663,11.61,52.13,80.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - E0191","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","E0191 - PROTECTOR HEEL OR ELBOW",321,7.1566666666666663,11.61,52.13,80.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - E0191","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","E0191 - PROTECTOR HEEL OR ELBOW",321,8.4466666666666672,11.61,52.13,80.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - E0191","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","E0191 - PROTECTOR HEEL OR ELBOW",321,18.006666666666664,11.61,52.13,80.25]
["TUFTS - TUFTS PPO - HCPCS - E0191","TUFTS","TUFTS PPO","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","E0191 - PROTECTOR HEEL OR ELBOW",321,18.55,11.61,52.13,80.25]
["TUFTS - TUFTS SELECT - HCPCS - E0191","TUFTS","TUFTS SELECT","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","E0191 - PROTECTOR HEEL OR ELBOW",321,17.34,11.61,52.13,80.25]
["TUFTS - TUFTS HMO - HCPCS - E0191","TUFTS","TUFTS HMO","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","E0191 - PROTECTOR HEEL OR ELBOW",321,20.81,11.61,52.13,80.25]
["TUFTS - TUFTS POS - HCPCS - E0191","TUFTS","TUFTS POS","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","E0191 - PROTECTOR HEEL OR ELBOW",321,17.34,11.61,52.13,80.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - E0191","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","E0191 - PROTECTOR HEEL OR ELBOW",321,52.13,11.61,52.13,80.25]
["TUFTS - TUFTS PPO - HCPCS - G0101","TUFTS","TUFTS PPO","HCPCS","G0101","CA SCREEN;PELVIC/BREAST EXAM","G0101 - CA SCREEN;PELVIC/BREAST EXAM",148,20.6,18.010000000000002,128.29,37]
["TUFTS - TUFTS SELECT - HCPCS - G0101","TUFTS","TUFTS SELECT","HCPCS","G0101","CA SCREEN;PELVIC/BREAST EXAM","G0101 - CA SCREEN;PELVIC/BREAST EXAM",148,18.010000000000002,18.010000000000002,128.29,37]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0101","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0101","CA SCREEN;PELVIC/BREAST EXAM","G0101 - CA SCREEN;PELVIC/BREAST EXAM",148,0,18.010000000000002,128.29,37]
["TUFTS - TUFTS POS - HCPCS - G0101","TUFTS","TUFTS POS","HCPCS","G0101","CA SCREEN;PELVIC/BREAST EXAM","G0101 - CA SCREEN;PELVIC/BREAST EXAM",148,20.6,18.010000000000002,128.29,37]
["TUFTS - TUFTS HMO - HCPCS - G0101","TUFTS","TUFTS HMO","HCPCS","G0101","CA SCREEN;PELVIC/BREAST EXAM","G0101 - CA SCREEN;PELVIC/BREAST EXAM",148,24.73,18.010000000000002,128.29,37]
["FALLON - FALLON MEDICAID - HCPCS - G0101","FALLON","FALLON MEDICAID","HCPCS","G0101","CA SCREEN;PELVIC/BREAST EXAM","G0101 - CA SCREEN;PELVIC/BREAST EXAM",148,0,18.010000000000002,128.29,37]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0101","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0101","CA SCREEN;PELVIC/BREAST EXAM","G0101 - CA SCREEN;PELVIC/BREAST EXAM",148,128.29,18.010000000000002,128.29,37]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0101","BMC HEALTHNET","BMCHN ACO","HCPCS","G0101","CA SCREEN;PELVIC/BREAST EXAM","G0101 - CA SCREEN;PELVIC/BREAST EXAM",148,0,18.010000000000002,128.29,37]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0101","BMC HEALTHNET","BMCHN QHP","HCPCS","G0101","CA SCREEN;PELVIC/BREAST EXAM","G0101 - CA SCREEN;PELVIC/BREAST EXAM",148,0,18.010000000000002,128.29,37]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0101","BMC HEALTHNET","BMCHN MCO","HCPCS","G0101","CA SCREEN;PELVIC/BREAST EXAM","G0101 - CA SCREEN;PELVIC/BREAST EXAM",148,0,18.010000000000002,128.29,37]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0101","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0101","CA SCREEN;PELVIC/BREAST EXAM","G0101 - CA SCREEN;PELVIC/BREAST EXAM",148,57.91,18.010000000000002,128.29,37]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0101","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0101","CA SCREEN;PELVIC/BREAST EXAM","G0101 - CA SCREEN;PELVIC/BREAST EXAM",148,0,18.010000000000002,128.29,37]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0101","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0101","CA SCREEN;PELVIC/BREAST EXAM","G0101 - CA SCREEN;PELVIC/BREAST EXAM",148,0,18.010000000000002,128.29,37]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0101","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0101","CA SCREEN;PELVIC/BREAST EXAM","G0101 - CA SCREEN;PELVIC/BREAST EXAM",148,128.29,18.010000000000002,128.29,37]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0101","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0101","CA SCREEN;PELVIC/BREAST EXAM","G0101 - CA SCREEN;PELVIC/BREAST EXAM",148,128.29,18.010000000000002,128.29,37]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0101","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0101","CA SCREEN;PELVIC/BREAST EXAM","G0101 - CA SCREEN;PELVIC/BREAST EXAM",148,0,18.010000000000002,128.29,37]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0101","BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0101","CA SCREEN;PELVIC/BREAST EXAM","G0101 - CA SCREEN;PELVIC/BREAST EXAM",148,128.29,18.010000000000002,128.29,37]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0101","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0101","CA SCREEN;PELVIC/BREAST EXAM","G0101 - CA SCREEN;PELVIC/BREAST EXAM",148,128.29,18.010000000000002,128.29,37]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0101","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0101","CA SCREEN;PELVIC/BREAST EXAM","G0101 - CA SCREEN;PELVIC/BREAST EXAM",148,128.29,18.010000000000002,128.29,37]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0101","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0101","CA SCREEN;PELVIC/BREAST EXAM","G0101 - CA SCREEN;PELVIC/BREAST EXAM",148,128.29,18.010000000000002,128.29,37]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0103","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,10.07,16.78,181.16,23.25]
["FALLON - FALLON MEDICAID - HCPCS - G0103","FALLON","FALLON MEDICAID","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,8.39,16.78,181.16,23.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0103","BMC HEALTHNET","BMCHN ACO","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,18.355,16.78,181.16,23.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0103","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,8.39,16.78,181.16,23.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0103","BMC HEALTHNET","BMCHN MCO","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,8.39,16.78,181.16,23.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0103","BMC HEALTHNET","BMCHN QHP","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,10.07,16.78,181.16,23.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0103","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,9.9,16.78,181.16,23.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0103","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,11.385,16.78,181.16,23.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - G0103","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,23.17,16.78,181.16,23.25]
["TUFTS - TUFTS PPO - HCPCS - G0103","TUFTS","TUFTS PPO","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,64.45,16.78,181.16,23.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0103","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,44.13,16.78,181.16,23.25]
["TUFTS - TUFTS SELECT - HCPCS - G0103","TUFTS","TUFTS SELECT","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,32.07,16.78,181.16,23.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - G0103","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,23.17,16.78,181.16,23.25]
["UNICARE - UNICARE - HCPCS - G0103","UNICARE","UNICARE","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,44.64,16.78,181.16,23.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - G0103","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,37.200000000000003,16.78,181.16,23.25]
["TUFTS - TUFTS SPIRIT - HCPCS - G0103","TUFTS","TUFTS SPIRIT","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,21.24,16.78,181.16,23.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - HCPCS - G0103","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,19.75,16.78,181.16,23.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0103","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,43.05,16.78,181.16,23.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - G0103","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,26.03,16.78,181.16,23.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - G0103","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,40.67,16.78,181.16,23.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - HCPCS - G0103","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,25.37,16.78,181.16,23.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - G0103","FALLON","FALLON SENIOR PLAN","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,19.309999999999999,16.78,181.16,23.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - G0103","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,28,16.78,181.16,23.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0103","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,44.13,16.78,181.16,23.25]
["TUFTS - TUFTS HMO - HCPCS - G0103","TUFTS","TUFTS HMO","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,72.3,16.78,181.16,23.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0103","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,44.13,16.78,181.16,23.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - G0103","TUFTS","TUFTS MEDICARE SCO","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,28,16.78,181.16,23.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - G0103","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,41.69,16.78,181.16,23.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - G0103","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,33.6,16.78,181.16,23.25]
["TUFTS - TUFTS POS - HCPCS - G0103","TUFTS","TUFTS POS","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,60.25,16.78,181.16,23.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0103","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,41.5,16.78,181.16,23.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - G0103","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,42.67,16.78,181.16,23.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0103","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,181.16,16.78,181.16,23.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - G0103","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,19.309999999999999,16.78,181.16,23.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - G0103","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,19.309999999999999,16.78,181.16,23.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - G0103","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,25.23,16.78,181.16,23.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - G0103","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,19.309999999999999,16.78,181.16,23.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - G0103","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,48.59,16.78,181.16,23.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0103","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,41.5,16.78,181.16,23.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0103","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,41.5,16.78,181.16,23.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0103","BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,41.5,16.78,181.16,23.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0103","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,41.5,16.78,181.16,23.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0103","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,41.5,16.78,181.16,23.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - G0103","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,22.79,16.78,181.16,23.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0103","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0103","PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING",93,41.5,16.78,181.16,23.25]
["TUFTS - TUFTS PPO - HCPCS - G0105","TUFTS","TUFTS PPO","HCPCS","G0105","HC COLORECTAL SCRN; HI RISK IND","G0105 - HC COLORECTAL SCRN; HI RISK IND",1152,2058.16,1020.59,3264.67,288]
["UNICARE - UNICARE - HCPCS - G0105","UNICARE","UNICARE","HCPCS","G0105","HC COLORECTAL SCRN; HI RISK IND","G0105 - HC COLORECTAL SCRN; HI RISK IND",1152,1020.59,1020.59,3264.67,288]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - G0105","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","G0105","HC COLORECTAL SCRN; HI RISK IND","G0105 - HC COLORECTAL SCRN; HI RISK IND",1152,1020.59,1020.59,3264.67,288]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0105","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0105","HC COLORECTAL SCRN; HI RISK IND","G0105 - HC COLORECTAL SCRN; HI RISK IND",1152,1568.74,1020.59,3264.67,288]
["TUFTS - TUFTS SELECT - HCPCS - G0105","TUFTS","TUFTS SELECT","HCPCS","G0105","HC COLORECTAL SCRN; HI RISK IND","G0105 - HC COLORECTAL SCRN; HI RISK IND",1152,1098.98,1020.59,3264.67,288]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0105","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G0105","HC COLORECTAL SCRN; HI RISK IND","G0105 - HC COLORECTAL SCRN; HI RISK IND",1152,1608.22,1020.59,3264.67,288]
["TUFTS - TUFTS HMO - HCPCS - G0105","TUFTS","TUFTS HMO","HCPCS","G0105","HC COLORECTAL SCRN; HI RISK IND","G0105 - HC COLORECTAL SCRN; HI RISK IND",1152,2057.7399999999998,1020.59,3264.67,288]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0105","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0105","HC COLORECTAL SCRN; HI RISK IND","G0105 - HC COLORECTAL SCRN; HI RISK IND",1152,1608.22,1020.59,3264.67,288]
["TUFTS - TUFTS POS - HCPCS - G0105","TUFTS","TUFTS POS","HCPCS","G0105","HC COLORECTAL SCRN; HI RISK IND","G0105 - HC COLORECTAL SCRN; HI RISK IND",1152,2058.17,1020.59,3264.67,288]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0105","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0105","HC COLORECTAL SCRN; HI RISK IND","G0105 - HC COLORECTAL SCRN; HI RISK IND",1152,1608.22,1020.59,3264.67,288]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0105","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0105","HC COLORECTAL SCRN; HI RISK IND","G0105 - HC COLORECTAL SCRN; HI RISK IND",1152,1250.94,1020.59,3264.67,288]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0105","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0105","HC COLORECTAL SCRN; HI RISK IND","G0105 - HC COLORECTAL SCRN; HI RISK IND",1152,3264.67,1020.59,3264.67,288]
["AETNA - AETNA - HCPCS - G0105","AETNA","AETNA","HCPCS","G0105","HC COLORECTAL SCRN; HI RISK IND","G0105 - HC COLORECTAL SCRN; HI RISK IND",1152,1500.85,1020.59,3264.67,288]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0105","BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0105","HC COLORECTAL SCRN; HI RISK IND","G0105 - HC COLORECTAL SCRN; HI RISK IND",1152,1250.94,1020.59,3264.67,288]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0105","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0105","HC COLORECTAL SCRN; HI RISK IND","G0105 - HC COLORECTAL SCRN; HI RISK IND",1152,1250.94,1020.59,3264.67,288]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0105","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0105","HC COLORECTAL SCRN; HI RISK IND","G0105 - HC COLORECTAL SCRN; HI RISK IND",1152,1250.94,1020.59,3264.67,288]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0105","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0105","HC COLORECTAL SCRN; HI RISK IND","G0105 - HC COLORECTAL SCRN; HI RISK IND",1152,1250.94,1020.59,3264.67,288]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0105","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0105","HC COLORECTAL SCRN; HI RISK IND","G0105 - HC COLORECTAL SCRN; HI RISK IND",1152,1250.94,1020.59,3264.67,288]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0105","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0105","HC COLORECTAL SCRN; HI RISK IND","G0105 - HC COLORECTAL SCRN; HI RISK IND",1152,1250.94,1020.59,3264.67,288]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0108","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G0108","DIAB MANAGE TRN  PER INDIV","G0108 - DIAB MANAGE TRN  PER INDIV",425,121.38,72.41,230.78,106.25]
["TUFTS - TUFTS PPO - HCPCS - G0108","TUFTS","TUFTS PPO","HCPCS","G0108","DIAB MANAGE TRN  PER INDIV","G0108 - DIAB MANAGE TRN  PER INDIV",425,145.49,72.41,230.78,106.25]
["TUFTS - TUFTS SELECT - HCPCS - G0108","TUFTS","TUFTS SELECT","HCPCS","G0108","DIAB MANAGE TRN  PER INDIV","G0108 - DIAB MANAGE TRN  PER INDIV",425,72.41,72.41,230.78,106.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0108","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0108","DIAB MANAGE TRN  PER INDIV","G0108 - DIAB MANAGE TRN  PER INDIV",425,118.4,72.41,230.78,106.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0108","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0108","DIAB MANAGE TRN  PER INDIV","G0108 - DIAB MANAGE TRN  PER INDIV",425,121.38,72.41,230.78,106.25]
["TUFTS - TUFTS HMO - HCPCS - G0108","TUFTS","TUFTS HMO","HCPCS","G0108","DIAB MANAGE TRN  PER INDIV","G0108 - DIAB MANAGE TRN  PER INDIV",425,136.01,72.41,230.78,106.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0108","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0108","DIAB MANAGE TRN  PER INDIV","G0108 - DIAB MANAGE TRN  PER INDIV",425,121.38,72.41,230.78,106.25]
["TUFTS - TUFTS POS - HCPCS - G0108","TUFTS","TUFTS POS","HCPCS","G0108","DIAB MANAGE TRN  PER INDIV","G0108 - DIAB MANAGE TRN  PER INDIV",425,136.01,72.41,230.78,106.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0108","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0108","DIAB MANAGE TRN  PER INDIV","G0108 - DIAB MANAGE TRN  PER INDIV",425,230.78,72.41,230.78,106.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0108","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0108","DIAB MANAGE TRN  PER INDIV","G0108 - DIAB MANAGE TRN  PER INDIV",425,136.19,72.41,230.78,106.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0108","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0108","DIAB MANAGE TRN  PER INDIV","G0108 - DIAB MANAGE TRN  PER INDIV",425,136.19,72.41,230.78,106.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0108","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0108","DIAB MANAGE TRN  PER INDIV","G0108 - DIAB MANAGE TRN  PER INDIV",425,136.19,72.41,230.78,106.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0108","BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0108","DIAB MANAGE TRN  PER INDIV","G0108 - DIAB MANAGE TRN  PER INDIV",425,136.19,72.41,230.78,106.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0108","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0108","DIAB MANAGE TRN  PER INDIV","G0108 - DIAB MANAGE TRN  PER INDIV",425,136.19,72.41,230.78,106.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0108","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0108","DIAB MANAGE TRN  PER INDIV","G0108 - DIAB MANAGE TRN  PER INDIV",425,136.19,72.41,230.78,106.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0108","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0108","DIAB MANAGE TRN  PER INDIV","G0108 - DIAB MANAGE TRN  PER INDIV",425,136.19,72.41,230.78,106.25]
["TUFTS - TUFTS PPO - HCPCS - G0109","TUFTS","TUFTS PPO","HCPCS","G0109","DIAB MANAGE TRN IND/GROUP","G0109 - DIAB MANAGE TRN IND/GROUP",267,84.64,32.64,134.25,66.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0109","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0109","DIAB MANAGE TRN IND/GROUP","G0109 - DIAB MANAGE TRN IND/GROUP",267,32.64,32.64,134.25,66.75]
["TUFTS - TUFTS SELECT - HCPCS - G0109","TUFTS","TUFTS SELECT","HCPCS","G0109","DIAB MANAGE TRN IND/GROUP","G0109 - DIAB MANAGE TRN IND/GROUP",267,42.12,32.64,134.25,66.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0109","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G0109","DIAB MANAGE TRN IND/GROUP","G0109 - DIAB MANAGE TRN IND/GROUP",267,33.46,32.64,134.25,66.75]
["TUFTS - TUFTS POS - HCPCS - G0109","TUFTS","TUFTS POS","HCPCS","G0109","DIAB MANAGE TRN IND/GROUP","G0109 - DIAB MANAGE TRN IND/GROUP",267,79.11,32.64,134.25,66.75]
["TUFTS - TUFTS HMO - HCPCS - G0109","TUFTS","TUFTS HMO","HCPCS","G0109","DIAB MANAGE TRN IND/GROUP","G0109 - DIAB MANAGE TRN IND/GROUP",267,79.11,32.64,134.25,66.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0109","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0109","DIAB MANAGE TRN IND/GROUP","G0109 - DIAB MANAGE TRN IND/GROUP",267,33.46,32.64,134.25,66.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0109","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0109","DIAB MANAGE TRN IND/GROUP","G0109 - DIAB MANAGE TRN IND/GROUP",267,33.46,32.64,134.25,66.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0109","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0109","DIAB MANAGE TRN IND/GROUP","G0109 - DIAB MANAGE TRN IND/GROUP",267,37.520000000000003,32.64,134.25,66.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0109","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0109","DIAB MANAGE TRN IND/GROUP","G0109 - DIAB MANAGE TRN IND/GROUP",267,134.25,32.64,134.25,66.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0109","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0109","DIAB MANAGE TRN IND/GROUP","G0109 - DIAB MANAGE TRN IND/GROUP",267,37.520000000000003,32.64,134.25,66.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0109","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0109","DIAB MANAGE TRN IND/GROUP","G0109 - DIAB MANAGE TRN IND/GROUP",267,37.520000000000003,32.64,134.25,66.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0109","BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0109","DIAB MANAGE TRN IND/GROUP","G0109 - DIAB MANAGE TRN IND/GROUP",267,37.520000000000003,32.64,134.25,66.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0109","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0109","DIAB MANAGE TRN IND/GROUP","G0109 - DIAB MANAGE TRN IND/GROUP",267,37.520000000000003,32.64,134.25,66.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0109","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0109","DIAB MANAGE TRN IND/GROUP","G0109 - DIAB MANAGE TRN IND/GROUP",267,37.520000000000003,32.64,134.25,66.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0109","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0109","DIAB MANAGE TRN IND/GROUP","G0109 - DIAB MANAGE TRN IND/GROUP",267,37.520000000000003,32.64,134.25,66.75]
["TUFTS - TUFTS PPO - HCPCS - G0127","TUFTS","TUFTS PPO","HCPCS","G0127","TRIM NAIL(S)","G0127 - TRIM NAIL(S)",189,200.07,93.87,317.35000000000002,47.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0127","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G0127","TRIM NAIL(S)","G0127 - TRIM NAIL(S)",189,120.69,93.87,317.35000000000002,47.25]
["TUFTS - TUFTS SELECT - HCPCS - G0127","TUFTS","TUFTS SELECT","HCPCS","G0127","TRIM NAIL(S)","G0127 - TRIM NAIL(S)",189,99.57,93.87,317.35000000000002,47.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0127","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0127","TRIM NAIL(S)","G0127 - TRIM NAIL(S)",189,117.73,93.87,317.35000000000002,47.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0127","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0127","TRIM NAIL(S)","G0127 - TRIM NAIL(S)",189,0,93.87,317.35000000000002,47.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0127","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0127","TRIM NAIL(S)","G0127 - TRIM NAIL(S)",189,120.69,93.87,317.35000000000002,47.25]
["FALLON - FALLON MEDICAID - HCPCS - G0127","FALLON","FALLON MEDICAID","HCPCS","G0127","TRIM NAIL(S)","G0127 - TRIM NAIL(S)",189,0,93.87,317.35000000000002,47.25]
["TUFTS - TUFTS HMO - HCPCS - G0127","TUFTS","TUFTS HMO","HCPCS","G0127","TRIM NAIL(S)","G0127 - TRIM NAIL(S)",189,187.02,93.87,317.35000000000002,47.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0127","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0127","TRIM NAIL(S)","G0127 - TRIM NAIL(S)",189,120.69,93.87,317.35000000000002,47.25]
["TUFTS - TUFTS POS - HCPCS - G0127","TUFTS","TUFTS POS","HCPCS","G0127","TRIM NAIL(S)","G0127 - TRIM NAIL(S)",189,187.02,93.87,317.35000000000002,47.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0127","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0127","TRIM NAIL(S)","G0127 - TRIM NAIL(S)",189,93.87,93.87,317.35000000000002,47.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0127","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0127","TRIM NAIL(S)","G0127 - TRIM NAIL(S)",189,317.35000000000002,93.87,317.35000000000002,47.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0127","BMC HEALTHNET","BMCHN ACO","HCPCS","G0127","TRIM NAIL(S)","G0127 - TRIM NAIL(S)",189,0,93.87,317.35000000000002,47.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0127","BMC HEALTHNET","BMCHN QHP","HCPCS","G0127","TRIM NAIL(S)","G0127 - TRIM NAIL(S)",189,0,93.87,317.35000000000002,47.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0127","BMC HEALTHNET","BMCHN MCO","HCPCS","G0127","TRIM NAIL(S)","G0127 - TRIM NAIL(S)",189,0,93.87,317.35000000000002,47.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0127","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0127","TRIM NAIL(S)","G0127 - TRIM NAIL(S)",189,0,93.87,317.35000000000002,47.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0127","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0127","TRIM NAIL(S)","G0127 - TRIM NAIL(S)",189,0,93.87,317.35000000000002,47.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0127","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0127","TRIM NAIL(S)","G0127 - TRIM NAIL(S)",189,0,93.87,317.35000000000002,47.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0127","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0127","TRIM NAIL(S)","G0127 - TRIM NAIL(S)",189,93.87,93.87,317.35000000000002,47.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0127","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0127","TRIM NAIL(S)","G0127 - TRIM NAIL(S)",189,93.87,93.87,317.35000000000002,47.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0127","BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0127","TRIM NAIL(S)","G0127 - TRIM NAIL(S)",189,93.87,93.87,317.35000000000002,47.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0127","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0127","TRIM NAIL(S)","G0127 - TRIM NAIL(S)",189,93.87,93.87,317.35000000000002,47.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0127","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0127","TRIM NAIL(S)","G0127 - TRIM NAIL(S)",189,93.87,93.87,317.35000000000002,47.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0127","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0127","TRIM NAIL(S)","G0127 - TRIM NAIL(S)",189,93.87,93.87,317.35000000000002,47.25]
["TUFTS - TUFTS PPO - HCPCS - G0175","TUFTS","TUFTS PPO","HCPCS","G0175","OPPS SERVICE,SCHED TEAM CONF","G0175 - OPPS SERVICE,SCHED TEAM CONF",565,1283.4000000000001,638.73,2035.73,141.25]
["TUFTS - TUFTS SELECT - HCPCS - G0175","TUFTS","TUFTS SELECT","HCPCS","G0175","OPPS SERVICE,SCHED TEAM CONF","G0175 - OPPS SERVICE,SCHED TEAM CONF",565,638.73,638.73,2035.73,141.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0175","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0175","OPPS SERVICE,SCHED TEAM CONF","G0175 - OPPS SERVICE,SCHED TEAM CONF",565,0,638.73,2035.73,141.25]
["TUFTS - TUFTS HMO - HCPCS - G0175","TUFTS","TUFTS HMO","HCPCS","G0175","OPPS SERVICE,SCHED TEAM CONF","G0175 - OPPS SERVICE,SCHED TEAM CONF",565,1199.72,638.73,2035.73,141.25]
["FALLON - FALLON MEDICAID - HCPCS - G0175","FALLON","FALLON MEDICAID","HCPCS","G0175","OPPS SERVICE,SCHED TEAM CONF","G0175 - OPPS SERVICE,SCHED TEAM CONF",565,0,638.73,2035.73,141.25]
["TUFTS - TUFTS POS - HCPCS - G0175","TUFTS","TUFTS POS","HCPCS","G0175","OPPS SERVICE,SCHED TEAM CONF","G0175 - OPPS SERVICE,SCHED TEAM CONF",565,1199.72,638.73,2035.73,141.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0175","BMC HEALTHNET","BMCHN QHP","HCPCS","G0175","OPPS SERVICE,SCHED TEAM CONF","G0175 - OPPS SERVICE,SCHED TEAM CONF",565,0,638.73,2035.73,141.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0175","BMC HEALTHNET","BMCHN ACO","HCPCS","G0175","OPPS SERVICE,SCHED TEAM CONF","G0175 - OPPS SERVICE,SCHED TEAM CONF",565,0,638.73,2035.73,141.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0175","BMC HEALTHNET","BMCHN MCO","HCPCS","G0175","OPPS SERVICE,SCHED TEAM CONF","G0175 - OPPS SERVICE,SCHED TEAM CONF",565,0,638.73,2035.73,141.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0175","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0175","OPPS SERVICE,SCHED TEAM CONF","G0175 - OPPS SERVICE,SCHED TEAM CONF",565,2035.73,638.73,2035.73,141.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0175","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0175","OPPS SERVICE,SCHED TEAM CONF","G0175 - OPPS SERVICE,SCHED TEAM CONF",565,0,638.73,2035.73,141.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0175","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0175","OPPS SERVICE,SCHED TEAM CONF","G0175 - OPPS SERVICE,SCHED TEAM CONF",565,0,638.73,2035.73,141.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0175","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0175","OPPS SERVICE,SCHED TEAM CONF","G0175 - OPPS SERVICE,SCHED TEAM CONF",565,0,638.73,2035.73,141.25]
["TUFTS - TUFTS PPO - HCPCS - G0239","TUFTS","TUFTS PPO","HCPCS","G0239","OTH RESP PROC, GROUP","G0239 - OTH RESP PROC, GROUP",99,132.85,53.94,373.41,24.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0239","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0239","OTH RESP PROC, GROUP","G0239 - OTH RESP PROC, GROUP",99,67.64,53.94,373.41,24.75]
["TUFTS - TUFTS SELECT - HCPCS - G0239","TUFTS","TUFTS SELECT","HCPCS","G0239","OTH RESP PROC, GROUP","G0239 - OTH RESP PROC, GROUP",99,66.12,53.94,373.41,24.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0239","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G0239","OTH RESP PROC, GROUP","G0239 - OTH RESP PROC, GROUP",99,69.349999999999994,53.94,373.41,24.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0239","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0239","OTH RESP PROC, GROUP","G0239 - OTH RESP PROC, GROUP",99,0,53.94,373.41,24.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0239","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0239","OTH RESP PROC, GROUP","G0239 - OTH RESP PROC, GROUP",99,69.349999999999994,53.94,373.41,24.75]
["TUFTS - TUFTS HMO - HCPCS - G0239","TUFTS","TUFTS HMO","HCPCS","G0239","OTH RESP PROC, GROUP","G0239 - OTH RESP PROC, GROUP",99,149.03,53.94,373.41,24.75]
["FALLON - FALLON MEDICAID - HCPCS - G0239","FALLON","FALLON MEDICAID","HCPCS","G0239","OTH RESP PROC, GROUP","G0239 - OTH RESP PROC, GROUP",99,0,53.94,373.41,24.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0239","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0239","OTH RESP PROC, GROUP","G0239 - OTH RESP PROC, GROUP",99,69.349999999999994,53.94,373.41,24.75]
["TUFTS - TUFTS POS - HCPCS - G0239","TUFTS","TUFTS POS","HCPCS","G0239","OTH RESP PROC, GROUP","G0239 - OTH RESP PROC, GROUP",99,124.19,53.94,373.41,24.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0239","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0239","OTH RESP PROC, GROUP","G0239 - OTH RESP PROC, GROUP",99,53.94,53.94,373.41,24.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0239","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0239","OTH RESP PROC, GROUP","G0239 - OTH RESP PROC, GROUP",99,373.41,53.94,373.41,24.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0239","BMC HEALTHNET","BMCHN ACO","HCPCS","G0239","OTH RESP PROC, GROUP","G0239 - OTH RESP PROC, GROUP",99,0,53.94,373.41,24.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0239","BMC HEALTHNET","BMCHN QHP","HCPCS","G0239","OTH RESP PROC, GROUP","G0239 - OTH RESP PROC, GROUP",99,0,53.94,373.41,24.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0239","BMC HEALTHNET","BMCHN MCO","HCPCS","G0239","OTH RESP PROC, GROUP","G0239 - OTH RESP PROC, GROUP",99,0,53.94,373.41,24.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0239","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0239","OTH RESP PROC, GROUP","G0239 - OTH RESP PROC, GROUP",99,0,53.94,373.41,24.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0239","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0239","OTH RESP PROC, GROUP","G0239 - OTH RESP PROC, GROUP",99,0,53.94,373.41,24.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0239","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0239","OTH RESP PROC, GROUP","G0239 - OTH RESP PROC, GROUP",99,53.94,53.94,373.41,24.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0239","BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0239","OTH RESP PROC, GROUP","G0239 - OTH RESP PROC, GROUP",99,53.94,53.94,373.41,24.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0239","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0239","OTH RESP PROC, GROUP","G0239 - OTH RESP PROC, GROUP",99,53.94,53.94,373.41,24.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0239","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0239","OTH RESP PROC, GROUP","G0239 - OTH RESP PROC, GROUP",99,0,53.94,373.41,24.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0239","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0239","OTH RESP PROC, GROUP","G0239 - OTH RESP PROC, GROUP",99,53.94,53.94,373.41,24.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0239","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0239","OTH RESP PROC, GROUP","G0239 - OTH RESP PROC, GROUP",99,53.94,53.94,373.41,24.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0239","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0239","OTH RESP PROC, GROUP","G0239 - OTH RESP PROC, GROUP",99,53.94,53.94,373.41,24.75]
["TUFTS - TUFTS PPO - HCPCS - G0257","TUFTS","TUFTS PPO","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP",911,2302.06,1027.32,3651.55,227.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0257","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP",911,1320.72,1027.32,3651.55,227.75]
["TUFTS - TUFTS SELECT - HCPCS - G0257","TUFTS","TUFTS SELECT","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP",911,1145.7,1027.32,3651.55,227.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0257","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP",911,1288.3,1027.32,3651.55,227.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0257","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP",911,0,1027.32,3651.55,227.75]
["TUFTS - TUFTS POS - HCPCS - G0257","TUFTS","TUFTS POS","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP",911,2151.9699999999998,1027.32,3651.55,227.75]
["TUFTS - TUFTS HMO - HCPCS - G0257","TUFTS","TUFTS HMO","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP",911,2151.9699999999998,1027.32,3651.55,227.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0257","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP",911,1320.72,1027.32,3651.55,227.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0257","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP",911,1320.72,1027.32,3651.55,227.75]
["FALLON - FALLON MEDICAID - HCPCS - G0257","FALLON","FALLON MEDICAID","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP",911,0,1027.32,3651.55,227.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0257","BMC HEALTHNET","BMCHN QHP","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP",911,0,1027.32,3651.55,227.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0257","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP",911,1027.32,1027.32,3651.55,227.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0257","BMC HEALTHNET","BMCHN ACO","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP",911,0,1027.32,3651.55,227.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0257","BMC HEALTHNET","BMCHN MCO","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP",911,0,1027.32,3651.55,227.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0257","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP",911,3651.55,1027.32,3651.55,227.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0257","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP",911,0,1027.32,3651.55,227.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0257","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP",911,0,1027.32,3651.55,227.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0257","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP",911,0,1027.32,3651.55,227.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0257","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP",911,1027.32,1027.32,3651.55,227.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0257","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP",911,1027.32,1027.32,3651.55,227.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0257","BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP",911,1027.32,1027.32,3651.55,227.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0257","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP",911,1027.32,1027.32,3651.55,227.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0257","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP",911,1027.32,1027.32,3651.55,227.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0257","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP",911,1027.32,1027.32,3651.55,227.75]
["TUFTS - TUFTS PPO - HCPCS - G0259","TUFTS","TUFTS PPO","HCPCS","G0259","HC INJECT FOR SACROILIAC JOINT","G0259 - HC INJECT FOR SACROILIAC JOINT",1513,0,1198.25,1198.25,378.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0259","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0259","HC INJECT FOR SACROILIAC JOINT","G0259 - HC INJECT FOR SACROILIAC JOINT",1513,0,1198.25,1198.25,378.25]
["TUFTS - TUFTS SELECT - HCPCS - G0259","TUFTS","TUFTS SELECT","HCPCS","G0259","HC INJECT FOR SACROILIAC JOINT","G0259 - HC INJECT FOR SACROILIAC JOINT",1513,0,1198.25,1198.25,378.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0259","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G0259","HC INJECT FOR SACROILIAC JOINT","G0259 - HC INJECT FOR SACROILIAC JOINT",1513,0,1198.25,1198.25,378.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0259","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0259","HC INJECT FOR SACROILIAC JOINT","G0259 - HC INJECT FOR SACROILIAC JOINT",1513,0,1198.25,1198.25,378.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0259","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0259","HC INJECT FOR SACROILIAC JOINT","G0259 - HC INJECT FOR SACROILIAC JOINT",1513,0,1198.25,1198.25,378.25]
["TUFTS - TUFTS HMO - HCPCS - G0259","TUFTS","TUFTS HMO","HCPCS","G0259","HC INJECT FOR SACROILIAC JOINT","G0259 - HC INJECT FOR SACROILIAC JOINT",1513,0,1198.25,1198.25,378.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0259","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0259","HC INJECT FOR SACROILIAC JOINT","G0259 - HC INJECT FOR SACROILIAC JOINT",1513,0,1198.25,1198.25,378.25]
["FALLON - FALLON MEDICAID - HCPCS - G0259","FALLON","FALLON MEDICAID","HCPCS","G0259","HC INJECT FOR SACROILIAC JOINT","G0259 - HC INJECT FOR SACROILIAC JOINT",1513,0,1198.25,1198.25,378.25]
["TUFTS - TUFTS POS - HCPCS - G0259","TUFTS","TUFTS POS","HCPCS","G0259","HC INJECT FOR SACROILIAC JOINT","G0259 - HC INJECT FOR SACROILIAC JOINT",1513,0,1198.25,1198.25,378.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0259","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0259","HC INJECT FOR SACROILIAC JOINT","G0259 - HC INJECT FOR SACROILIAC JOINT",1513,0,1198.25,1198.25,378.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0259","BMC HEALTHNET","BMCHN ACO","HCPCS","G0259","HC INJECT FOR SACROILIAC JOINT","G0259 - HC INJECT FOR SACROILIAC JOINT",1513,0,1198.25,1198.25,378.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0259","BMC HEALTHNET","BMCHN QHP","HCPCS","G0259","HC INJECT FOR SACROILIAC JOINT","G0259 - HC INJECT FOR SACROILIAC JOINT",1513,0,1198.25,1198.25,378.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0259","BMC HEALTHNET","BMCHN MCO","HCPCS","G0259","HC INJECT FOR SACROILIAC JOINT","G0259 - HC INJECT FOR SACROILIAC JOINT",1513,0,1198.25,1198.25,378.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0259","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0259","HC INJECT FOR SACROILIAC JOINT","G0259 - HC INJECT FOR SACROILIAC JOINT",1513,0,1198.25,1198.25,378.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0259","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0259","HC INJECT FOR SACROILIAC JOINT","G0259 - HC INJECT FOR SACROILIAC JOINT",1513,0,1198.25,1198.25,378.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0259","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0259","HC INJECT FOR SACROILIAC JOINT","G0259 - HC INJECT FOR SACROILIAC JOINT",1513,0,1198.25,1198.25,378.25]
["AETNA - AETNA - HCPCS - G0259","AETNA","AETNA","HCPCS","G0259","HC INJECT FOR SACROILIAC JOINT","G0259 - HC INJECT FOR SACROILIAC JOINT",1513,1198.25,1198.25,1198.25,378.25]
["TUFTS - TUFTS PPO - HCPCS - G0260","TUFTS","TUFTS PPO","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH","G0260 - INJ FOR SACROILIAC JT ANESTH",817,2190.21,1005.62,3474.13,204.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0260","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH","G0260 - INJ FOR SACROILIAC JT ANESTH",817,1292.83,1005.62,3474.13,204.25]
["TUFTS - TUFTS SELECT - HCPCS - G0260","TUFTS","TUFTS SELECT","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH","G0260 - INJ FOR SACROILIAC JT ANESTH",817,1090.04,1005.62,3474.13,204.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0260","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH","G0260 - INJ FOR SACROILIAC JT ANESTH",817,1261.0899999999999,1005.62,3474.13,204.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0260","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH","G0260 - INJ FOR SACROILIAC JT ANESTH",817,0,1005.62,3474.13,204.25]
["TUFTS - TUFTS HMO - HCPCS - G0260","TUFTS","TUFTS HMO","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH","G0260 - INJ FOR SACROILIAC JT ANESTH",817,2047.41,1005.62,3474.13,204.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0260","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH","G0260 - INJ FOR SACROILIAC JT ANESTH",817,1292.83,1005.62,3474.13,204.25]
["TUFTS - TUFTS POS - HCPCS - G0260","TUFTS","TUFTS POS","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH","G0260 - INJ FOR SACROILIAC JT ANESTH",817,2047.41,1005.62,3474.13,204.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0260","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH","G0260 - INJ FOR SACROILIAC JT ANESTH",817,1292.83,1005.62,3474.13,204.25]
["FALLON - FALLON MEDICAID - HCPCS - G0260","FALLON","FALLON MEDICAID","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH","G0260 - INJ FOR SACROILIAC JT ANESTH",817,0,1005.62,3474.13,204.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0260","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH","G0260 - INJ FOR SACROILIAC JT ANESTH",817,1005.62,1005.62,3474.13,204.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0260","BMC HEALTHNET","BMCHN QHP","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH","G0260 - INJ FOR SACROILIAC JT ANESTH",817,0,1005.62,3474.13,204.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0260","BMC HEALTHNET","BMCHN ACO","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH","G0260 - INJ FOR SACROILIAC JT ANESTH",817,0,1005.62,3474.13,204.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0260","BMC HEALTHNET","BMCHN MCO","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH","G0260 - INJ FOR SACROILIAC JT ANESTH",817,0,1005.62,3474.13,204.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0260","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH","G0260 - INJ FOR SACROILIAC JT ANESTH",817,3474.13,1005.62,3474.13,204.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0260","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH","G0260 - INJ FOR SACROILIAC JT ANESTH",817,0,1005.62,3474.13,204.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0260","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH","G0260 - INJ FOR SACROILIAC JT ANESTH",817,0,1005.62,3474.13,204.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0260","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH","G0260 - INJ FOR SACROILIAC JT ANESTH",817,1005.62,1005.62,3474.13,204.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0260","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH","G0260 - INJ FOR SACROILIAC JT ANESTH",817,1005.62,1005.62,3474.13,204.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0260","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH","G0260 - INJ FOR SACROILIAC JT ANESTH",817,0,1005.62,3474.13,204.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0260","BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH","G0260 - INJ FOR SACROILIAC JT ANESTH",817,1005.62,1005.62,3474.13,204.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0260","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH","G0260 - INJ FOR SACROILIAC JT ANESTH",817,1005.62,1005.62,3474.13,204.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0260","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH","G0260 - INJ FOR SACROILIAC JT ANESTH",817,1005.62,1005.62,3474.13,204.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0260","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH","G0260 - INJ FOR SACROILIAC JT ANESTH",817,1005.62,1005.62,3474.13,204.25]
["AETNA - AETNA - HCPCS - G0260","AETNA","AETNA","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH","G0260 - INJ FOR SACROILIAC JT ANESTH",817,1198.25,1005.62,3474.13,204.25]
["TUFTS - TUFTS PPO - HCPCS - G0269","TUFTS","TUFTS PPO","HCPCS","G0269","HC CLOSURE DEVICE PLACEMENT","G0269 - HC CLOSURE DEVICE PLACEMENT",200,0,0,0,50]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0269","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0269","HC CLOSURE DEVICE PLACEMENT","G0269 - HC CLOSURE DEVICE PLACEMENT",200,0,0,0,50]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0269","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0269","HC CLOSURE DEVICE PLACEMENT","G0269 - HC CLOSURE DEVICE PLACEMENT",200,0,0,0,50]
["TUFTS - TUFTS SELECT - HCPCS - G0269","TUFTS","TUFTS SELECT","HCPCS","G0269","HC CLOSURE DEVICE PLACEMENT","G0269 - HC CLOSURE DEVICE PLACEMENT",200,0,0,0,50]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0269","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G0269","HC CLOSURE DEVICE PLACEMENT","G0269 - HC CLOSURE DEVICE PLACEMENT",200,0,0,0,50]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0269","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0269","HC CLOSURE DEVICE PLACEMENT","G0269 - HC CLOSURE DEVICE PLACEMENT",200,0,0,0,50]
["TUFTS - TUFTS HMO - HCPCS - G0269","TUFTS","TUFTS HMO","HCPCS","G0269","HC CLOSURE DEVICE PLACEMENT","G0269 - HC CLOSURE DEVICE PLACEMENT",200,0,0,0,50]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0269","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0269","HC CLOSURE DEVICE PLACEMENT","G0269 - HC CLOSURE DEVICE PLACEMENT",200,0,0,0,50]
["FALLON - FALLON MEDICAID - HCPCS - G0269","FALLON","FALLON MEDICAID","HCPCS","G0269","HC CLOSURE DEVICE PLACEMENT","G0269 - HC CLOSURE DEVICE PLACEMENT",200,0,0,0,50]
["TUFTS - TUFTS POS - HCPCS - G0269","TUFTS","TUFTS POS","HCPCS","G0269","HC CLOSURE DEVICE PLACEMENT","G0269 - HC CLOSURE DEVICE PLACEMENT",200,0,0,0,50]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0269","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0269","HC CLOSURE DEVICE PLACEMENT","G0269 - HC CLOSURE DEVICE PLACEMENT",200,0,0,0,50]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0269","BMC HEALTHNET","BMCHN ACO","HCPCS","G0269","HC CLOSURE DEVICE PLACEMENT","G0269 - HC CLOSURE DEVICE PLACEMENT",200,0,0,0,50]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0269","BMC HEALTHNET","BMCHN QHP","HCPCS","G0269","HC CLOSURE DEVICE PLACEMENT","G0269 - HC CLOSURE DEVICE PLACEMENT",200,0,0,0,50]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0269","BMC HEALTHNET","BMCHN MCO","HCPCS","G0269","HC CLOSURE DEVICE PLACEMENT","G0269 - HC CLOSURE DEVICE PLACEMENT",200,0,0,0,50]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0269","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0269","HC CLOSURE DEVICE PLACEMENT","G0269 - HC CLOSURE DEVICE PLACEMENT",200,0,0,0,50]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0269","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0269","HC CLOSURE DEVICE PLACEMENT","G0269 - HC CLOSURE DEVICE PLACEMENT",200,0,0,0,50]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0269","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0269","HC CLOSURE DEVICE PLACEMENT","G0269 - HC CLOSURE DEVICE PLACEMENT",200,0,0,0,50]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0270","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G0270","MNT SUBS TX FOR CHANGE DX","G0270 - MNT SUBS TX FOR CHANGE DX",86,70.819999999999993,69.08,70.819999999999993,21.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0270","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0270","MNT SUBS TX FOR CHANGE DX","G0270 - MNT SUBS TX FOR CHANGE DX",86,69.08,69.08,70.819999999999993,21.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0270","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0270","MNT SUBS TX FOR CHANGE DX","G0270 - MNT SUBS TX FOR CHANGE DX",86,70.819999999999993,69.08,70.819999999999993,21.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0270","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0270","MNT SUBS TX FOR CHANGE DX","G0270 - MNT SUBS TX FOR CHANGE DX",86,70.819999999999993,69.08,70.819999999999993,21.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0278","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH","G0278 - ILIAC ART ANGIO,CARDIAC CATH",3138,0,34.229999999999997,34.229999999999997,784.5]
["TUFTS - TUFTS PPO - HCPCS - G0278","TUFTS","TUFTS PPO","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH","G0278 - ILIAC ART ANGIO,CARDIAC CATH",3138,0,34.229999999999997,34.229999999999997,784.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0278","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH","G0278 - ILIAC ART ANGIO,CARDIAC CATH",3138,0,34.229999999999997,34.229999999999997,784.5]
["TUFTS - TUFTS SELECT - HCPCS - G0278","TUFTS","TUFTS SELECT","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH","G0278 - ILIAC ART ANGIO,CARDIAC CATH",3138,0,34.229999999999997,34.229999999999997,784.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0278","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH","G0278 - ILIAC ART ANGIO,CARDIAC CATH",3138,0,34.229999999999997,34.229999999999997,784.5]
["TUFTS - TUFTS POS - HCPCS - G0278","TUFTS","TUFTS POS","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH","G0278 - ILIAC ART ANGIO,CARDIAC CATH",3138,0,34.229999999999997,34.229999999999997,784.5]
["TUFTS - TUFTS HMO - HCPCS - G0278","TUFTS","TUFTS HMO","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH","G0278 - ILIAC ART ANGIO,CARDIAC CATH",3138,0,34.229999999999997,34.229999999999997,784.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0278","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH","G0278 - ILIAC ART ANGIO,CARDIAC CATH",3138,0,34.229999999999997,34.229999999999997,784.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0278","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH","G0278 - ILIAC ART ANGIO,CARDIAC CATH",3138,0,34.229999999999997,34.229999999999997,784.5]
["FALLON - FALLON MEDICAID - HCPCS - G0278","FALLON","FALLON MEDICAID","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH","G0278 - ILIAC ART ANGIO,CARDIAC CATH",3138,0,34.229999999999997,34.229999999999997,784.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0278","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH","G0278 - ILIAC ART ANGIO,CARDIAC CATH",3138,34.229999999999997,34.229999999999997,34.229999999999997,784.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0278","BMC HEALTHNET","BMCHN QHP","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH","G0278 - ILIAC ART ANGIO,CARDIAC CATH",3138,0,34.229999999999997,34.229999999999997,784.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0278","BMC HEALTHNET","BMCHN ACO","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH","G0278 - ILIAC ART ANGIO,CARDIAC CATH",3138,0,34.229999999999997,34.229999999999997,784.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0278","BMC HEALTHNET","BMCHN MCO","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH","G0278 - ILIAC ART ANGIO,CARDIAC CATH",3138,0,34.229999999999997,34.229999999999997,784.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0278","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH","G0278 - ILIAC ART ANGIO,CARDIAC CATH",3138,0,34.229999999999997,34.229999999999997,784.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0278","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH","G0278 - ILIAC ART ANGIO,CARDIAC CATH",3138,0,34.229999999999997,34.229999999999997,784.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0278","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH","G0278 - ILIAC ART ANGIO,CARDIAC CATH",3138,0,34.229999999999997,34.229999999999997,784.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0278","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH","G0278 - ILIAC ART ANGIO,CARDIAC CATH",3138,0,34.229999999999997,34.229999999999997,784.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0278","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH","G0278 - ILIAC ART ANGIO,CARDIAC CATH",3138,34.229999999999997,34.229999999999997,34.229999999999997,784.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0278","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH","G0278 - ILIAC ART ANGIO,CARDIAC CATH",3138,34.229999999999997,34.229999999999997,34.229999999999997,784.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0278","BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH","G0278 - ILIAC ART ANGIO,CARDIAC CATH",3138,34.229999999999997,34.229999999999997,34.229999999999997,784.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0278","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH","G0278 - ILIAC ART ANGIO,CARDIAC CATH",3138,34.229999999999997,34.229999999999997,34.229999999999997,784.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0278","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH","G0278 - ILIAC ART ANGIO,CARDIAC CATH",3138,34.229999999999997,34.229999999999997,34.229999999999997,784.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0278","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH","G0278 - ILIAC ART ANGIO,CARDIAC CATH",3138,34.229999999999997,34.229999999999997,34.229999999999997,784.5]
["TUFTS - TUFTS PPO - HCPCS - G0279","TUFTS","TUFTS PPO","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,105.2,30.09,295.68,13.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - G0279","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,36.11,30.09,295.68,13.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - G0279","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,63.37,30.09,295.68,13.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0279","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,32.69,30.09,295.68,13.75]
["TUFTS - TUFTS SELECT - HCPCS - G0279","TUFTS","TUFTS SELECT","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,44.81,30.09,295.68,13.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - G0279","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,36.11,30.09,295.68,13.75]
["TUFTS - TUFTS SPIRIT - HCPCS - G0279","TUFTS","TUFTS SPIRIT","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,33.1,30.09,295.68,13.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0279","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,31.88,30.09,295.68,13.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - G0279","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,40.57,30.09,295.68,13.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - G0279","TUFTS","TUFTS MEDICARE SCO","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,43.63,30.09,295.68,13.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - G0279","FALLON","FALLON SENIOR PLAN","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,30.09,30.09,295.68,13.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0279","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,32.69,30.09,295.68,13.75]
["TUFTS - TUFTS HMO - HCPCS - G0279","TUFTS","TUFTS HMO","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,118.02,30.09,295.68,13.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0279","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,32.69,30.09,295.68,13.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - G0279","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,43.63,30.09,295.68,13.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - G0279","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,64.959999999999994,30.09,295.68,13.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - G0279","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,52.36,30.09,295.68,13.75]
["TUFTS - TUFTS POS - HCPCS - G0279","TUFTS","TUFTS POS","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,98.35,30.09,295.68,13.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0279","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,51.68,30.09,295.68,13.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - G0279","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,66.5,30.09,295.68,13.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0279","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,295.68,30.09,295.68,13.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - G0279","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,30.09,30.09,295.68,13.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - G0279","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,30.09,30.09,295.68,13.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - G0279","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,30.09,30.09,295.68,13.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - G0279","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,30.09,30.09,295.68,13.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0279","BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,51.68,30.09,295.68,13.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0279","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,51.68,30.09,295.68,13.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0279","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,51.68,30.09,295.68,13.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0279","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,51.68,30.09,295.68,13.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0279","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,51.68,30.09,295.68,13.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - G0279","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,75.709999999999994,30.09,295.68,13.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0279","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,51.68,30.09,295.68,13.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - G0279","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","G0279","TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO",55,35.51,30.09,295.68,13.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0296","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0296","HC VISIT TO DETERM LDCT ELIG","G0296 - HC VISIT TO DETERM LDCT ELIG",118,0,102.62,660.74,29.5]
["TUFTS - TUFTS PPO - HCPCS - G0296","TUFTS","TUFTS PPO","HCPCS","G0296","HC VISIT TO DETERM LDCT ELIG","G0296 - HC VISIT TO DETERM LDCT ELIG",118,235.07,102.62,660.74,29.5]
["TUFTS - TUFTS SELECT - HCPCS - G0296","TUFTS","TUFTS SELECT","HCPCS","G0296","HC VISIT TO DETERM LDCT ELIG","G0296 - HC VISIT TO DETERM LDCT ELIG",118,102.62,102.62,660.74,29.5]
["TUFTS - TUFTS HMO - HCPCS - G0296","TUFTS","TUFTS HMO","HCPCS","G0296","HC VISIT TO DETERM LDCT ELIG","G0296 - HC VISIT TO DETERM LDCT ELIG",118,263.7,102.62,660.74,29.5]
["TUFTS - TUFTS POS - HCPCS - G0296","TUFTS","TUFTS POS","HCPCS","G0296","HC VISIT TO DETERM LDCT ELIG","G0296 - HC VISIT TO DETERM LDCT ELIG",118,219.75,102.62,660.74,29.5]
["FALLON - FALLON MEDICAID - HCPCS - G0296","FALLON","FALLON MEDICAID","HCPCS","G0296","HC VISIT TO DETERM LDCT ELIG","G0296 - HC VISIT TO DETERM LDCT ELIG",118,0,102.62,660.74,29.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0296","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0296","HC VISIT TO DETERM LDCT ELIG","G0296 - HC VISIT TO DETERM LDCT ELIG",118,128.29,102.62,660.74,29.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0296","BMC HEALTHNET","BMCHN ACO","HCPCS","G0296","HC VISIT TO DETERM LDCT ELIG","G0296 - HC VISIT TO DETERM LDCT ELIG",118,0,102.62,660.74,29.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0296","BMC HEALTHNET","BMCHN QHP","HCPCS","G0296","HC VISIT TO DETERM LDCT ELIG","G0296 - HC VISIT TO DETERM LDCT ELIG",118,0,102.62,660.74,29.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0296","BMC HEALTHNET","BMCHN MCO","HCPCS","G0296","HC VISIT TO DETERM LDCT ELIG","G0296 - HC VISIT TO DETERM LDCT ELIG",118,0,102.62,660.74,29.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0296","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0296","HC VISIT TO DETERM LDCT ELIG","G0296 - HC VISIT TO DETERM LDCT ELIG",118,660.74,102.62,660.74,29.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0296","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0296","HC VISIT TO DETERM LDCT ELIG","G0296 - HC VISIT TO DETERM LDCT ELIG",118,0,102.62,660.74,29.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0296","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0296","HC VISIT TO DETERM LDCT ELIG","G0296 - HC VISIT TO DETERM LDCT ELIG",118,0,102.62,660.74,29.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0296","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0296","HC VISIT TO DETERM LDCT ELIG","G0296 - HC VISIT TO DETERM LDCT ELIG",118,0,102.62,660.74,29.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0296","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0296","HC VISIT TO DETERM LDCT ELIG","G0296 - HC VISIT TO DETERM LDCT ELIG",118,128.29,102.62,660.74,29.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0296","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0296","HC VISIT TO DETERM LDCT ELIG","G0296 - HC VISIT TO DETERM LDCT ELIG",118,128.29,102.62,660.74,29.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0296","BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0296","HC VISIT TO DETERM LDCT ELIG","G0296 - HC VISIT TO DETERM LDCT ELIG",118,128.29,102.62,660.74,29.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0296","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0296","HC VISIT TO DETERM LDCT ELIG","G0296 - HC VISIT TO DETERM LDCT ELIG",118,128.29,102.62,660.74,29.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0296","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0296","HC VISIT TO DETERM LDCT ELIG","G0296 - HC VISIT TO DETERM LDCT ELIG",118,128.29,102.62,660.74,29.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0296","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0296","HC VISIT TO DETERM LDCT ELIG","G0296 - HC VISIT TO DETERM LDCT ELIG",118,128.29,102.62,660.74,29.5]
["TUFTS - TUFTS PPO - HCPCS - G0297","TUFTS","TUFTS PPO","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN","G0297 - HC LDCT FOR LUNG CA SCREEN",1437,285.07,107.22,801.26,359.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0297","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN","G0297 - HC LDCT FOR LUNG CA SCREEN",1437,107.22,107.22,801.26,359.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0297","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN","G0297 - HC LDCT FOR LUNG CA SCREEN",1437,0,107.22,801.26,359.25]
["TUFTS - TUFTS SELECT - HCPCS - G0297","TUFTS","TUFTS SELECT","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN","G0297 - HC LDCT FOR LUNG CA SCREEN",1437,124.44,107.22,801.26,359.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0297","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN","G0297 - HC LDCT FOR LUNG CA SCREEN",1437,107.22,107.22,801.26,359.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0297","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN","G0297 - HC LDCT FOR LUNG CA SCREEN",1437,107.22,107.22,801.26,359.25]
["TUFTS - TUFTS HMO - HCPCS - G0297","TUFTS","TUFTS HMO","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN","G0297 - HC LDCT FOR LUNG CA SCREEN",1437,319.77999999999997,107.22,801.26,359.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0297","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN","G0297 - HC LDCT FOR LUNG CA SCREEN",1437,107.22,107.22,801.26,359.25]
["FALLON - FALLON MEDICAID - HCPCS - G0297","FALLON","FALLON MEDICAID","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN","G0297 - HC LDCT FOR LUNG CA SCREEN",1437,0,107.22,801.26,359.25]
["TUFTS - TUFTS POS - HCPCS - G0297","TUFTS","TUFTS POS","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN","G0297 - HC LDCT FOR LUNG CA SCREEN",1437,266.48,107.22,801.26,359.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0297","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN","G0297 - HC LDCT FOR LUNG CA SCREEN",1437,178.43,107.22,801.26,359.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0297","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN","G0297 - HC LDCT FOR LUNG CA SCREEN",1437,801.26,107.22,801.26,359.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0297","BMC HEALTHNET","BMCHN QHP","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN","G0297 - HC LDCT FOR LUNG CA SCREEN",1437,0,107.22,801.26,359.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0297","BMC HEALTHNET","BMCHN ACO","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN","G0297 - HC LDCT FOR LUNG CA SCREEN",1437,0,107.22,801.26,359.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0297","BMC HEALTHNET","BMCHN MCO","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN","G0297 - HC LDCT FOR LUNG CA SCREEN",1437,0,107.22,801.26,359.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0297","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN","G0297 - HC LDCT FOR LUNG CA SCREEN",1437,0,107.22,801.26,359.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0297","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN","G0297 - HC LDCT FOR LUNG CA SCREEN",1437,178.43,107.22,801.26,359.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0297","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN","G0297 - HC LDCT FOR LUNG CA SCREEN",1437,178.43,107.22,801.26,359.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0297","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN","G0297 - HC LDCT FOR LUNG CA SCREEN",1437,0,107.22,801.26,359.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0297","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN","G0297 - HC LDCT FOR LUNG CA SCREEN",1437,0,107.22,801.26,359.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0297","BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN","G0297 - HC LDCT FOR LUNG CA SCREEN",1437,178.43,107.22,801.26,359.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0297","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN","G0297 - HC LDCT FOR LUNG CA SCREEN",1437,178.43,107.22,801.26,359.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0297","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN","G0297 - HC LDCT FOR LUNG CA SCREEN",1437,178.43,107.22,801.26,359.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0297","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN","G0297 - HC LDCT FOR LUNG CA SCREEN",1437,178.43,107.22,801.26,359.25]
["TUFTS - TUFTS PPO - HCPCS - G0365","TUFTS","TUFTS PPO","HCPCS","G0365","HC VESSEL MAPPING HEMO ACCESS","G0365 - HC VESSEL MAPPING HEMO ACCESS",498,546.59,272.02999999999997,867.01,124.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0365","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0365","HC VESSEL MAPPING HEMO ACCESS","G0365 - HC VESSEL MAPPING HEMO ACCESS",498,0,272.02999999999997,867.01,124.5]
["TUFTS - TUFTS SELECT - HCPCS - G0365","TUFTS","TUFTS SELECT","HCPCS","G0365","HC VESSEL MAPPING HEMO ACCESS","G0365 - HC VESSEL MAPPING HEMO ACCESS",498,272.02999999999997,272.02999999999997,867.01,124.5]
["TUFTS - TUFTS POS - HCPCS - G0365","TUFTS","TUFTS POS","HCPCS","G0365","HC VESSEL MAPPING HEMO ACCESS","G0365 - HC VESSEL MAPPING HEMO ACCESS",498,510.97,272.02999999999997,867.01,124.5]
["TUFTS - TUFTS HMO - HCPCS - G0365","TUFTS","TUFTS HMO","HCPCS","G0365","HC VESSEL MAPPING HEMO ACCESS","G0365 - HC VESSEL MAPPING HEMO ACCESS",498,510.97,272.02999999999997,867.01,124.5]
["FALLON - FALLON MEDICAID - HCPCS - G0365","FALLON","FALLON MEDICAID","HCPCS","G0365","HC VESSEL MAPPING HEMO ACCESS","G0365 - HC VESSEL MAPPING HEMO ACCESS",498,0,272.02999999999997,867.01,124.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0365","BMC HEALTHNET","BMCHN ACO","HCPCS","G0365","HC VESSEL MAPPING HEMO ACCESS","G0365 - HC VESSEL MAPPING HEMO ACCESS",498,0,272.02999999999997,867.01,124.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0365","BMC HEALTHNET","BMCHN QHP","HCPCS","G0365","HC VESSEL MAPPING HEMO ACCESS","G0365 - HC VESSEL MAPPING HEMO ACCESS",498,0,272.02999999999997,867.01,124.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0365","BMC HEALTHNET","BMCHN MCO","HCPCS","G0365","HC VESSEL MAPPING HEMO ACCESS","G0365 - HC VESSEL MAPPING HEMO ACCESS",498,0,272.02999999999997,867.01,124.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0365","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0365","HC VESSEL MAPPING HEMO ACCESS","G0365 - HC VESSEL MAPPING HEMO ACCESS",498,867.01,272.02999999999997,867.01,124.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0365","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0365","HC VESSEL MAPPING HEMO ACCESS","G0365 - HC VESSEL MAPPING HEMO ACCESS",498,0,272.02999999999997,867.01,124.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0365","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0365","HC VESSEL MAPPING HEMO ACCESS","G0365 - HC VESSEL MAPPING HEMO ACCESS",498,0,272.02999999999997,867.01,124.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0365","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0365","HC VESSEL MAPPING HEMO ACCESS","G0365 - HC VESSEL MAPPING HEMO ACCESS",498,0,272.02999999999997,867.01,124.5]
["TUFTS - TUFTS PPO - HCPCS - G0378","TUFTS","TUFTS PPO","HCPCS","G0378","HOSPITAL OBSERVATION PER HR","G0378 - HOSPITAL OBSERVATION PER HR",319,0,0,0,79.75]
["TUFTS - TUFTS SELECT - HCPCS - G0378","TUFTS","TUFTS SELECT","HCPCS","G0378","HOSPITAL OBSERVATION PER HR","G0378 - HOSPITAL OBSERVATION PER HR",319,0,0,0,79.75]
["TUFTS - TUFTS HMO - HCPCS - G0378","TUFTS","TUFTS HMO","HCPCS","G0378","HOSPITAL OBSERVATION PER HR","G0378 - HOSPITAL OBSERVATION PER HR",319,0,0,0,79.75]
["TUFTS - TUFTS POS - HCPCS - G0378","TUFTS","TUFTS POS","HCPCS","G0378","HOSPITAL OBSERVATION PER HR","G0378 - HOSPITAL OBSERVATION PER HR",319,0,0,0,79.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0378","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0378","HOSPITAL OBSERVATION PER HR","G0378 - HOSPITAL OBSERVATION PER HR",319,0,0,0,79.75]
["TUFTS - TUFTS PPO - HCPCS - G0379","TUFTS","TUFTS PPO","HCPCS","G0379","DIRECT REFER HOSPITAL OBSERV","G0379 - DIRECT REFER HOSPITAL OBSERV",752,1757.21,874.54,2787.3,188]
["TUFTS - TUFTS SELECT - HCPCS - G0379","TUFTS","TUFTS SELECT","HCPCS","G0379","DIRECT REFER HOSPITAL OBSERV","G0379 - DIRECT REFER HOSPITAL OBSERV",752,874.54,874.54,2787.3,188]
["TUFTS - TUFTS HMO - HCPCS - G0379","TUFTS","TUFTS HMO","HCPCS","G0379","DIRECT REFER HOSPITAL OBSERV","G0379 - DIRECT REFER HOSPITAL OBSERV",752,1642.65,874.54,2787.3,188]
["TUFTS - TUFTS POS - HCPCS - G0379","TUFTS","TUFTS POS","HCPCS","G0379","DIRECT REFER HOSPITAL OBSERV","G0379 - DIRECT REFER HOSPITAL OBSERV",752,1642.65,874.54,2787.3,188]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0379","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0379","DIRECT REFER HOSPITAL OBSERV","G0379 - DIRECT REFER HOSPITAL OBSERV",752,2787.3,874.54,2787.3,188]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0389","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0389","ULTRASOUND EXAM AAA SCREEN","G0389 - ULTRASOUND EXAM AAA SCREEN",544,0,0,0,136]
["FALLON - FALLON MEDICAID - HCPCS - G0389","FALLON","FALLON MEDICAID","HCPCS","G0389","ULTRASOUND EXAM AAA SCREEN","G0389 - ULTRASOUND EXAM AAA SCREEN",544,0,0,0,136]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0389","BMC HEALTHNET","BMCHN QHP","HCPCS","G0389","ULTRASOUND EXAM AAA SCREEN","G0389 - ULTRASOUND EXAM AAA SCREEN",544,0,0,0,136]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0389","BMC HEALTHNET","BMCHN ACO","HCPCS","G0389","ULTRASOUND EXAM AAA SCREEN","G0389 - ULTRASOUND EXAM AAA SCREEN",544,0,0,0,136]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0389","BMC HEALTHNET","BMCHN MCO","HCPCS","G0389","ULTRASOUND EXAM AAA SCREEN","G0389 - ULTRASOUND EXAM AAA SCREEN",544,0,0,0,136]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0389","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0389","ULTRASOUND EXAM AAA SCREEN","G0389 - ULTRASOUND EXAM AAA SCREEN",544,0,0,0,136]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0389","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0389","ULTRASOUND EXAM AAA SCREEN","G0389 - ULTRASOUND EXAM AAA SCREEN",544,0,0,0,136]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0389","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0389","ULTRASOUND EXAM AAA SCREEN","G0389 - ULTRASOUND EXAM AAA SCREEN",544,0,0,0,136]
["TUFTS - TUFTS PPO - HCPCS - G0390","TUFTS","TUFTS PPO","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI","G0390 - TRAUMA RESPONS W/HOSP CRITI",3274,3174.35,1579.83,5035.18,818.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0390","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI","G0390 - TRAUMA RESPONS W/HOSP CRITI",3274,0,1579.83,5035.18,818.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0390","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI","G0390 - TRAUMA RESPONS W/HOSP CRITI",3274,0,1579.83,5035.18,818.5]
["TUFTS - TUFTS SELECT - HCPCS - G0390","TUFTS","TUFTS SELECT","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI","G0390 - TRAUMA RESPONS W/HOSP CRITI",3274,1579.83,1579.83,5035.18,818.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0390","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI","G0390 - TRAUMA RESPONS W/HOSP CRITI",3274,0,1579.83,5035.18,818.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0390","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI","G0390 - TRAUMA RESPONS W/HOSP CRITI",3274,0,1579.83,5035.18,818.5]
["TUFTS - TUFTS HMO - HCPCS - G0390","TUFTS","TUFTS HMO","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI","G0390 - TRAUMA RESPONS W/HOSP CRITI",3274,2967.4,1579.83,5035.18,818.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0390","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI","G0390 - TRAUMA RESPONS W/HOSP CRITI",3274,0,1579.83,5035.18,818.5]
["FALLON - FALLON MEDICAID - HCPCS - G0390","FALLON","FALLON MEDICAID","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI","G0390 - TRAUMA RESPONS W/HOSP CRITI",3274,0,1579.83,5035.18,818.5]
["TUFTS - TUFTS POS - HCPCS - G0390","TUFTS","TUFTS POS","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI","G0390 - TRAUMA RESPONS W/HOSP CRITI",3274,2967.4,1579.83,5035.18,818.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0390","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI","G0390 - TRAUMA RESPONS W/HOSP CRITI",3274,5035.18,1579.83,5035.18,818.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0390","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI","G0390 - TRAUMA RESPONS W/HOSP CRITI",3274,1587.59,1579.83,5035.18,818.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0390","BMC HEALTHNET","BMCHN ACO","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI","G0390 - TRAUMA RESPONS W/HOSP CRITI",3274,0,1579.83,5035.18,818.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0390","BMC HEALTHNET","BMCHN QHP","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI","G0390 - TRAUMA RESPONS W/HOSP CRITI",3274,0,1579.83,5035.18,818.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0390","BMC HEALTHNET","BMCHN MCO","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI","G0390 - TRAUMA RESPONS W/HOSP CRITI",3274,0,1579.83,5035.18,818.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0390","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI","G0390 - TRAUMA RESPONS W/HOSP CRITI",3274,0,1579.83,5035.18,818.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0390","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI","G0390 - TRAUMA RESPONS W/HOSP CRITI",3274,0,1579.83,5035.18,818.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0390","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI","G0390 - TRAUMA RESPONS W/HOSP CRITI",3274,0,1579.83,5035.18,818.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0390","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI","G0390 - TRAUMA RESPONS W/HOSP CRITI",3274,1587.59,1579.83,5035.18,818.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0390","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI","G0390 - TRAUMA RESPONS W/HOSP CRITI",3274,1587.59,1579.83,5035.18,818.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0390","BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI","G0390 - TRAUMA RESPONS W/HOSP CRITI",3274,1587.59,1579.83,5035.18,818.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0390","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI","G0390 - TRAUMA RESPONS W/HOSP CRITI",3274,1587.59,1579.83,5035.18,818.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0390","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI","G0390 - TRAUMA RESPONS W/HOSP CRITI",3274,1587.59,1579.83,5035.18,818.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0390","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI","G0390 - TRAUMA RESPONS W/HOSP CRITI",3274,1587.59,1579.83,5035.18,818.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0396","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN","G0396 - ALCOHOL/SUBS INTERV 15-30MN",42,51.384999999999998,56.05,336.32,10.5]
["TUFTS - TUFTS PPO - HCPCS - G0396","TUFTS","TUFTS PPO","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN","G0396 - ALCOHOL/SUBS INTERV 15-30MN",42,119.65,56.05,336.32,10.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0396","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN","G0396 - ALCOHOL/SUBS INTERV 15-30MN",42,0,56.05,336.32,10.5]
["TUFTS - TUFTS SELECT - HCPCS - G0396","TUFTS","TUFTS SELECT","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN","G0396 - ALCOHOL/SUBS INTERV 15-30MN",42,59.55,56.05,336.32,10.5]
["TUFTS - TUFTS POS - HCPCS - G0396","TUFTS","TUFTS POS","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN","G0396 - ALCOHOL/SUBS INTERV 15-30MN",42,111.85,56.05,336.32,10.5]
["TUFTS - TUFTS HMO - HCPCS - G0396","TUFTS","TUFTS HMO","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN","G0396 - ALCOHOL/SUBS INTERV 15-30MN",42,134.22,56.05,336.32,10.5]
["FALLON - FALLON MEDICAID - HCPCS - G0396","FALLON","FALLON MEDICAID","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN","G0396 - ALCOHOL/SUBS INTERV 15-30MN",42,0,56.05,336.32,10.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0396","BMC HEALTHNET","BMCHN QHP","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN","G0396 - ALCOHOL/SUBS INTERV 15-30MN",42,0,56.05,336.32,10.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0396","BMC HEALTHNET","BMCHN ACO","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN","G0396 - ALCOHOL/SUBS INTERV 15-30MN",42,0,56.05,336.32,10.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0396","BMC HEALTHNET","BMCHN MCO","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN","G0396 - ALCOHOL/SUBS INTERV 15-30MN",42,0,56.05,336.32,10.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0396","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN","G0396 - ALCOHOL/SUBS INTERV 15-30MN",42,336.32,56.05,336.32,10.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0396","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN","G0396 - ALCOHOL/SUBS INTERV 15-30MN",42,0,56.05,336.32,10.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0396","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN","G0396 - ALCOHOL/SUBS INTERV 15-30MN",42,56.05,56.05,336.32,10.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0396","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN","G0396 - ALCOHOL/SUBS INTERV 15-30MN",42,0,56.05,336.32,10.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0396","BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN","G0396 - ALCOHOL/SUBS INTERV 15-30MN",42,56.05,56.05,336.32,10.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0396","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN","G0396 - ALCOHOL/SUBS INTERV 15-30MN",42,56.05,56.05,336.32,10.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0396","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN","G0396 - ALCOHOL/SUBS INTERV 15-30MN",42,0,56.05,336.32,10.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0396","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN","G0396 - ALCOHOL/SUBS INTERV 15-30MN",42,56.05,56.05,336.32,10.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0396","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN","G0396 - ALCOHOL/SUBS INTERV 15-30MN",42,56.05,56.05,336.32,10.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0396","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN","G0396 - ALCOHOL/SUBS INTERV 15-30MN",42,56.05,56.05,336.32,10.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0397","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0397","ALCOHOL/SUBS INTERV >30 MIN","G0397 - ALCOHOL/SUBS INTERV >30 MIN",118,110.38499999999999,128.29,815.89,29.5]
["TUFTS - TUFTS PPO - HCPCS - G0397","TUFTS","TUFTS PPO","HCPCS","G0397","ALCOHOL/SUBS INTERV >30 MIN","G0397 - ALCOHOL/SUBS INTERV >30 MIN",118,290.27999999999997,128.29,815.89,29.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0397","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0397","ALCOHOL/SUBS INTERV >30 MIN","G0397 - ALCOHOL/SUBS INTERV >30 MIN",118,0,128.29,815.89,29.5]
["TUFTS - TUFTS SELECT - HCPCS - G0397","TUFTS","TUFTS SELECT","HCPCS","G0397","ALCOHOL/SUBS INTERV >30 MIN","G0397 - ALCOHOL/SUBS INTERV >30 MIN",118,144.46,128.29,815.89,29.5]
["TUFTS - TUFTS HMO - HCPCS - G0397","TUFTS","TUFTS HMO","HCPCS","G0397","ALCOHOL/SUBS INTERV >30 MIN","G0397 - ALCOHOL/SUBS INTERV >30 MIN",118,325.62,128.29,815.89,29.5]
["FALLON - FALLON MEDICAID - HCPCS - G0397","FALLON","FALLON MEDICAID","HCPCS","G0397","ALCOHOL/SUBS INTERV >30 MIN","G0397 - ALCOHOL/SUBS INTERV >30 MIN",118,0,128.29,815.89,29.5]
["TUFTS - TUFTS POS - HCPCS - G0397","TUFTS","TUFTS POS","HCPCS","G0397","ALCOHOL/SUBS INTERV >30 MIN","G0397 - ALCOHOL/SUBS INTERV >30 MIN",118,271.35000000000002,128.29,815.89,29.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0397","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0397","ALCOHOL/SUBS INTERV >30 MIN","G0397 - ALCOHOL/SUBS INTERV >30 MIN",118,815.89,128.29,815.89,29.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0397","BMC HEALTHNET","BMCHN ACO","HCPCS","G0397","ALCOHOL/SUBS INTERV >30 MIN","G0397 - ALCOHOL/SUBS INTERV >30 MIN",118,0,128.29,815.89,29.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0397","BMC HEALTHNET","BMCHN QHP","HCPCS","G0397","ALCOHOL/SUBS INTERV >30 MIN","G0397 - ALCOHOL/SUBS INTERV >30 MIN",118,0,128.29,815.89,29.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0397","BMC HEALTHNET","BMCHN MCO","HCPCS","G0397","ALCOHOL/SUBS INTERV >30 MIN","G0397 - ALCOHOL/SUBS INTERV >30 MIN",118,0,128.29,815.89,29.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0397","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0397","ALCOHOL/SUBS INTERV >30 MIN","G0397 - ALCOHOL/SUBS INTERV >30 MIN",118,0,128.29,815.89,29.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0397","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0397","ALCOHOL/SUBS INTERV >30 MIN","G0397 - ALCOHOL/SUBS INTERV >30 MIN",118,0,128.29,815.89,29.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0397","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0397","ALCOHOL/SUBS INTERV >30 MIN","G0397 - ALCOHOL/SUBS INTERV >30 MIN",118,0,128.29,815.89,29.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0397","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0397","ALCOHOL/SUBS INTERV >30 MIN","G0397 - ALCOHOL/SUBS INTERV >30 MIN",118,128.29,128.29,815.89,29.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0397","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0397","ALCOHOL/SUBS INTERV >30 MIN","G0397 - ALCOHOL/SUBS INTERV >30 MIN",118,128.29,128.29,815.89,29.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0397","BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0397","ALCOHOL/SUBS INTERV >30 MIN","G0397 - ALCOHOL/SUBS INTERV >30 MIN",118,128.29,128.29,815.89,29.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0397","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0397","ALCOHOL/SUBS INTERV >30 MIN","G0397 - ALCOHOL/SUBS INTERV >30 MIN",118,128.29,128.29,815.89,29.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0397","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0397","ALCOHOL/SUBS INTERV >30 MIN","G0397 - ALCOHOL/SUBS INTERV >30 MIN",118,128.29,128.29,815.89,29.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0397","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0397","ALCOHOL/SUBS INTERV >30 MIN","G0397 - ALCOHOL/SUBS INTERV >30 MIN",118,128.29,128.29,815.89,29.5]
["TUFTS - TUFTS PPO - HCPCS - G0402","TUFTS","TUFTS PPO","HCPCS","G0402","INITIAL PREVENTIVE EXAM","G0402 - INITIAL PREVENTIVE EXAM",168,209.86,208.89,1179.72,42]
["TUFTS - TUFTS SELECT - HCPCS - G0402","TUFTS","TUFTS SELECT","HCPCS","G0402","INITIAL PREVENTIVE EXAM","G0402 - INITIAL PREVENTIVE EXAM",168,104.44499999999999,208.89,1179.72,42]
["TUFTS - TUFTS POS - HCPCS - G0402","TUFTS","TUFTS POS","HCPCS","G0402","INITIAL PREVENTIVE EXAM","G0402 - INITIAL PREVENTIVE EXAM",168,196.18,208.89,1179.72,42]
["TUFTS - TUFTS HMO - HCPCS - G0402","TUFTS","TUFTS HMO","HCPCS","G0402","INITIAL PREVENTIVE EXAM","G0402 - INITIAL PREVENTIVE EXAM",168,235.41499999999999,208.89,1179.72,42]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0402","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0402","INITIAL PREVENTIVE EXAM","G0402 - INITIAL PREVENTIVE EXAM",168,589.86,208.89,1179.72,42]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0402","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0402","INITIAL PREVENTIVE EXAM","G0402 - INITIAL PREVENTIVE EXAM",168,0,208.89,1179.72,42]
["FALLON - FALLON MEDICAID - HCPCS - G0402","FALLON","FALLON MEDICAID","HCPCS","G0402","INITIAL PREVENTIVE EXAM","G0402 - INITIAL PREVENTIVE EXAM",168,0,208.89,1179.72,42]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0402","BMC HEALTHNET","BMCHN QHP","HCPCS","G0402","INITIAL PREVENTIVE EXAM","G0402 - INITIAL PREVENTIVE EXAM",168,0,208.89,1179.72,42]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0402","BMC HEALTHNET","BMCHN ACO","HCPCS","G0402","INITIAL PREVENTIVE EXAM","G0402 - INITIAL PREVENTIVE EXAM",168,0,208.89,1179.72,42]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0402","BMC HEALTHNET","BMCHN MCO","HCPCS","G0402","INITIAL PREVENTIVE EXAM","G0402 - INITIAL PREVENTIVE EXAM",168,0,208.89,1179.72,42]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0402","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0402","INITIAL PREVENTIVE EXAM","G0402 - INITIAL PREVENTIVE EXAM",168,0,208.89,1179.72,42]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0402","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0402","INITIAL PREVENTIVE EXAM","G0402 - INITIAL PREVENTIVE EXAM",168,0,208.89,1179.72,42]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0402","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0402","INITIAL PREVENTIVE EXAM","G0402 - INITIAL PREVENTIVE EXAM",168,0,208.89,1179.72,42]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0410","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0410","HC GRP PSYCH PARTIAL HOSP 45-50","G0410 - HC GRP PSYCH PARTIAL HOSP 45-50",220,0,0,0,55]
["TUFTS - TUFTS PPO - HCPCS - G0410","TUFTS","TUFTS PPO","HCPCS","G0410","HC GRP PSYCH PARTIAL HOSP 45-50","G0410 - HC GRP PSYCH PARTIAL HOSP 45-50",220,0,0,0,55]
["TUFTS - TUFTS SELECT - HCPCS - G0410","TUFTS","TUFTS SELECT","HCPCS","G0410","HC GRP PSYCH PARTIAL HOSP 45-50","G0410 - HC GRP PSYCH PARTIAL HOSP 45-50",220,0,0,0,55]
["FALLON - FALLON MEDICAID - HCPCS - G0410","FALLON","FALLON MEDICAID","HCPCS","G0410","HC GRP PSYCH PARTIAL HOSP 45-50","G0410 - HC GRP PSYCH PARTIAL HOSP 45-50",220,0,0,0,55]
["TUFTS - TUFTS HMO - HCPCS - G0410","TUFTS","TUFTS HMO","HCPCS","G0410","HC GRP PSYCH PARTIAL HOSP 45-50","G0410 - HC GRP PSYCH PARTIAL HOSP 45-50",220,0,0,0,55]
["TUFTS - TUFTS POS - HCPCS - G0410","TUFTS","TUFTS POS","HCPCS","G0410","HC GRP PSYCH PARTIAL HOSP 45-50","G0410 - HC GRP PSYCH PARTIAL HOSP 45-50",220,0,0,0,55]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0410","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0410","HC GRP PSYCH PARTIAL HOSP 45-50","G0410 - HC GRP PSYCH PARTIAL HOSP 45-50",220,0,0,0,55]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0410","BMC HEALTHNET","BMCHN ACO","HCPCS","G0410","HC GRP PSYCH PARTIAL HOSP 45-50","G0410 - HC GRP PSYCH PARTIAL HOSP 45-50",220,0,0,0,55]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0410","BMC HEALTHNET","BMCHN QHP","HCPCS","G0410","HC GRP PSYCH PARTIAL HOSP 45-50","G0410 - HC GRP PSYCH PARTIAL HOSP 45-50",220,0,0,0,55]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0410","BMC HEALTHNET","BMCHN MCO","HCPCS","G0410","HC GRP PSYCH PARTIAL HOSP 45-50","G0410 - HC GRP PSYCH PARTIAL HOSP 45-50",220,0,0,0,55]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0410","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0410","HC GRP PSYCH PARTIAL HOSP 45-50","G0410 - HC GRP PSYCH PARTIAL HOSP 45-50",220,0,0,0,55]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0410","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0410","HC GRP PSYCH PARTIAL HOSP 45-50","G0410 - HC GRP PSYCH PARTIAL HOSP 45-50",220,0,0,0,55]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0410","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0410","HC GRP PSYCH PARTIAL HOSP 45-50","G0410 - HC GRP PSYCH PARTIAL HOSP 45-50",220,0,0,0,55]
["TUFTS - TUFTS PPO - HCPCS - G0416","TUFTS","TUFTS PPO","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD","G0416 - HC PROSTATE BIOPSY ANY MTHD",425,874.13,360.63,2456.98,106.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0416","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD","G0416 - HC PROSTATE BIOPSY ANY MTHD",425,577.51,360.63,2456.98,106.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0416","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD","G0416 - HC PROSTATE BIOPSY ANY MTHD",425,0,360.63,2456.98,106.25]
["TUFTS - TUFTS SELECT - HCPCS - G0416","TUFTS","TUFTS SELECT","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD","G0416 - HC PROSTATE BIOPSY ANY MTHD",425,435.04,360.63,2456.98,106.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0416","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD","G0416 - HC PROSTATE BIOPSY ANY MTHD",425,592.04,360.63,2456.98,106.25]
["TUFTS - TUFTS POS - HCPCS - G0416","TUFTS","TUFTS POS","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD","G0416 - HC PROSTATE BIOPSY ANY MTHD",425,817.15,360.63,2456.98,106.25]
["FALLON - FALLON MEDICAID - HCPCS - G0416","FALLON","FALLON MEDICAID","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD","G0416 - HC PROSTATE BIOPSY ANY MTHD",425,0,360.63,2456.98,106.25]
["TUFTS - TUFTS HMO - HCPCS - G0416","TUFTS","TUFTS HMO","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD","G0416 - HC PROSTATE BIOPSY ANY MTHD",425,980.58,360.63,2456.98,106.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0416","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD","G0416 - HC PROSTATE BIOPSY ANY MTHD",425,592.04,360.63,2456.98,106.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0416","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD","G0416 - HC PROSTATE BIOPSY ANY MTHD",425,592.04,360.63,2456.98,106.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0416","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD","G0416 - HC PROSTATE BIOPSY ANY MTHD",425,360.63,360.63,2456.98,106.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0416","BMC HEALTHNET","BMCHN QHP","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD","G0416 - HC PROSTATE BIOPSY ANY MTHD",425,0,360.63,2456.98,106.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0416","BMC HEALTHNET","BMCHN ACO","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD","G0416 - HC PROSTATE BIOPSY ANY MTHD",425,0,360.63,2456.98,106.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0416","BMC HEALTHNET","BMCHN MCO","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD","G0416 - HC PROSTATE BIOPSY ANY MTHD",425,0,360.63,2456.98,106.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0416","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD","G0416 - HC PROSTATE BIOPSY ANY MTHD",425,2456.98,360.63,2456.98,106.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0416","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD","G0416 - HC PROSTATE BIOPSY ANY MTHD",425,0,360.63,2456.98,106.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0416","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD","G0416 - HC PROSTATE BIOPSY ANY MTHD",425,0,360.63,2456.98,106.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0416","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD","G0416 - HC PROSTATE BIOPSY ANY MTHD",425,360.63,360.63,2456.98,106.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0416","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD","G0416 - HC PROSTATE BIOPSY ANY MTHD",425,360.63,360.63,2456.98,106.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0416","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD","G0416 - HC PROSTATE BIOPSY ANY MTHD",425,0,360.63,2456.98,106.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0416","BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD","G0416 - HC PROSTATE BIOPSY ANY MTHD",425,360.63,360.63,2456.98,106.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0416","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD","G0416 - HC PROSTATE BIOPSY ANY MTHD",425,360.63,360.63,2456.98,106.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0416","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD","G0416 - HC PROSTATE BIOPSY ANY MTHD",425,360.63,360.63,2456.98,106.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0416","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD","G0416 - HC PROSTATE BIOPSY ANY MTHD",425,360.63,360.63,2456.98,106.25]
["TUFTS - TUFTS PPO - HCPCS - G0420","TUFTS","TUFTS PPO","HCPCS","G0420","HC ED SVC CKD IND PER SESSION","G0420 - HC ED SVC CKD IND PER SESSION",156,371.53,184.9,589.33000000000004,39]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0420","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0420","HC ED SVC CKD IND PER SESSION","G0420 - HC ED SVC CKD IND PER SESSION",156,0,184.9,589.33000000000004,39]
["TUFTS - TUFTS SELECT - HCPCS - G0420","TUFTS","TUFTS SELECT","HCPCS","G0420","HC ED SVC CKD IND PER SESSION","G0420 - HC ED SVC CKD IND PER SESSION",156,184.9,184.9,589.33000000000004,39]
["TUFTS - TUFTS HMO - HCPCS - G0420","TUFTS","TUFTS HMO","HCPCS","G0420","HC ED SVC CKD IND PER SESSION","G0420 - HC ED SVC CKD IND PER SESSION",156,347.3,184.9,589.33000000000004,39]
["FALLON - FALLON MEDICAID - HCPCS - G0420","FALLON","FALLON MEDICAID","HCPCS","G0420","HC ED SVC CKD IND PER SESSION","G0420 - HC ED SVC CKD IND PER SESSION",156,0,184.9,589.33000000000004,39]
["TUFTS - TUFTS POS - HCPCS - G0420","TUFTS","TUFTS POS","HCPCS","G0420","HC ED SVC CKD IND PER SESSION","G0420 - HC ED SVC CKD IND PER SESSION",156,347.3,184.9,589.33000000000004,39]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0420","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0420","HC ED SVC CKD IND PER SESSION","G0420 - HC ED SVC CKD IND PER SESSION",156,589.33000000000004,184.9,589.33000000000004,39]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0420","BMC HEALTHNET","BMCHN ACO","HCPCS","G0420","HC ED SVC CKD IND PER SESSION","G0420 - HC ED SVC CKD IND PER SESSION",156,0,184.9,589.33000000000004,39]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0420","BMC HEALTHNET","BMCHN QHP","HCPCS","G0420","HC ED SVC CKD IND PER SESSION","G0420 - HC ED SVC CKD IND PER SESSION",156,0,184.9,589.33000000000004,39]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0420","BMC HEALTHNET","BMCHN MCO","HCPCS","G0420","HC ED SVC CKD IND PER SESSION","G0420 - HC ED SVC CKD IND PER SESSION",156,0,184.9,589.33000000000004,39]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0420","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0420","HC ED SVC CKD IND PER SESSION","G0420 - HC ED SVC CKD IND PER SESSION",156,0,184.9,589.33000000000004,39]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0420","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0420","HC ED SVC CKD IND PER SESSION","G0420 - HC ED SVC CKD IND PER SESSION",156,0,184.9,589.33000000000004,39]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0420","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0420","HC ED SVC CKD IND PER SESSION","G0420 - HC ED SVC CKD IND PER SESSION",156,0,184.9,589.33000000000004,39]
["TUFTS - TUFTS PPO - HCPCS - G0421","TUFTS","TUFTS PPO","HCPCS","G0421","HC ED SVC CKD GRP PER SESSION","G0421 - HC ED SVC CKD GRP PER SESSION",37,85.83,42.72,136.13999999999999,9.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0421","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0421","HC ED SVC CKD GRP PER SESSION","G0421 - HC ED SVC CKD GRP PER SESSION",37,0,42.72,136.13999999999999,9.25]
["TUFTS - TUFTS SELECT - HCPCS - G0421","TUFTS","TUFTS SELECT","HCPCS","G0421","HC ED SVC CKD GRP PER SESSION","G0421 - HC ED SVC CKD GRP PER SESSION",37,42.72,42.72,136.13999999999999,9.25]
["TUFTS - TUFTS HMO - HCPCS - G0421","TUFTS","TUFTS HMO","HCPCS","G0421","HC ED SVC CKD GRP PER SESSION","G0421 - HC ED SVC CKD GRP PER SESSION",37,80.23,42.72,136.13999999999999,9.25]
["FALLON - FALLON MEDICAID - HCPCS - G0421","FALLON","FALLON MEDICAID","HCPCS","G0421","HC ED SVC CKD GRP PER SESSION","G0421 - HC ED SVC CKD GRP PER SESSION",37,0,42.72,136.13999999999999,9.25]
["TUFTS - TUFTS POS - HCPCS - G0421","TUFTS","TUFTS POS","HCPCS","G0421","HC ED SVC CKD GRP PER SESSION","G0421 - HC ED SVC CKD GRP PER SESSION",37,80.23,42.72,136.13999999999999,9.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0421","BMC HEALTHNET","BMCHN QHP","HCPCS","G0421","HC ED SVC CKD GRP PER SESSION","G0421 - HC ED SVC CKD GRP PER SESSION",37,0,42.72,136.13999999999999,9.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0421","BMC HEALTHNET","BMCHN ACO","HCPCS","G0421","HC ED SVC CKD GRP PER SESSION","G0421 - HC ED SVC CKD GRP PER SESSION",37,0,42.72,136.13999999999999,9.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0421","BMC HEALTHNET","BMCHN MCO","HCPCS","G0421","HC ED SVC CKD GRP PER SESSION","G0421 - HC ED SVC CKD GRP PER SESSION",37,0,42.72,136.13999999999999,9.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0421","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0421","HC ED SVC CKD GRP PER SESSION","G0421 - HC ED SVC CKD GRP PER SESSION",37,136.13999999999999,42.72,136.13999999999999,9.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0421","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0421","HC ED SVC CKD GRP PER SESSION","G0421 - HC ED SVC CKD GRP PER SESSION",37,0,42.72,136.13999999999999,9.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0421","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0421","HC ED SVC CKD GRP PER SESSION","G0421 - HC ED SVC CKD GRP PER SESSION",37,0,42.72,136.13999999999999,9.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0421","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0421","HC ED SVC CKD GRP PER SESSION","G0421 - HC ED SVC CKD GRP PER SESSION",37,0,42.72,136.13999999999999,9.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0422","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC","G0422 - HC INTENS CARDIAC REHAB W/EXERC",169,0,198.42,637.79,42.25]
["TUFTS - TUFTS PPO - HCPCS - G0422","TUFTS","TUFTS PPO","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC","G0422 - HC INTENS CARDIAC REHAB W/EXERC",169,402.08,198.42,637.79,42.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0422","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC","G0422 - HC INTENS CARDIAC REHAB W/EXERC",169,255.09,198.42,637.79,42.25]
["TUFTS - TUFTS SELECT - HCPCS - G0422","TUFTS","TUFTS SELECT","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC","G0422 - HC INTENS CARDIAC REHAB W/EXERC",169,200.11,198.42,637.79,42.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0422","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC","G0422 - HC INTENS CARDIAC REHAB W/EXERC",169,248.82,198.42,637.79,42.25]
["FALLON - FALLON MEDICAID - HCPCS - G0422","FALLON","FALLON MEDICAID","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC","G0422 - HC INTENS CARDIAC REHAB W/EXERC",169,0,198.42,637.79,42.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0422","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC","G0422 - HC INTENS CARDIAC REHAB W/EXERC",169,255.09,198.42,637.79,42.25]
["TUFTS - TUFTS HMO - HCPCS - G0422","TUFTS","TUFTS HMO","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC","G0422 - HC INTENS CARDIAC REHAB W/EXERC",169,375.87,198.42,637.79,42.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0422","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC","G0422 - HC INTENS CARDIAC REHAB W/EXERC",169,255.09,198.42,637.79,42.25]
["TUFTS - TUFTS POS - HCPCS - G0422","TUFTS","TUFTS POS","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC","G0422 - HC INTENS CARDIAC REHAB W/EXERC",169,375.87,198.42,637.79,42.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0422","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC","G0422 - HC INTENS CARDIAC REHAB W/EXERC",169,637.79,198.42,637.79,42.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0422","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC","G0422 - HC INTENS CARDIAC REHAB W/EXERC",169,198.42,198.42,637.79,42.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0422","BMC HEALTHNET","BMCHN ACO","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC","G0422 - HC INTENS CARDIAC REHAB W/EXERC",169,0,198.42,637.79,42.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0422","BMC HEALTHNET","BMCHN QHP","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC","G0422 - HC INTENS CARDIAC REHAB W/EXERC",169,0,198.42,637.79,42.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0422","BMC HEALTHNET","BMCHN MCO","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC","G0422 - HC INTENS CARDIAC REHAB W/EXERC",169,0,198.42,637.79,42.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0422","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC","G0422 - HC INTENS CARDIAC REHAB W/EXERC",169,0,198.42,637.79,42.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0422","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC","G0422 - HC INTENS CARDIAC REHAB W/EXERC",169,0,198.42,637.79,42.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0422","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC","G0422 - HC INTENS CARDIAC REHAB W/EXERC",169,0,198.42,637.79,42.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0422","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC","G0422 - HC INTENS CARDIAC REHAB W/EXERC",169,198.42,198.42,637.79,42.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0422","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC","G0422 - HC INTENS CARDIAC REHAB W/EXERC",169,198.42,198.42,637.79,42.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0422","BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC","G0422 - HC INTENS CARDIAC REHAB W/EXERC",169,198.42,198.42,637.79,42.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0422","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC","G0422 - HC INTENS CARDIAC REHAB W/EXERC",169,198.42,198.42,637.79,42.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0422","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC","G0422 - HC INTENS CARDIAC REHAB W/EXERC",169,198.42,198.42,637.79,42.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0422","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC","G0422 - HC INTENS CARDIAC REHAB W/EXERC",169,198.42,198.42,637.79,42.25]
["TUFTS - TUFTS PPO - HCPCS - G0423","TUFTS","TUFTS PPO","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER","G0423 - HC INTENS CARDIAC REHAB NO EXER",169,402.08,198.42,637.79,42.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0423","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER","G0423 - HC INTENS CARDIAC REHAB NO EXER",169,248.82,198.42,637.79,42.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0423","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER","G0423 - HC INTENS CARDIAC REHAB NO EXER",169,0,198.42,637.79,42.25]
["TUFTS - TUFTS SELECT - HCPCS - G0423","TUFTS","TUFTS SELECT","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER","G0423 - HC INTENS CARDIAC REHAB NO EXER",169,200.11,198.42,637.79,42.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0423","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER","G0423 - HC INTENS CARDIAC REHAB NO EXER",169,255.09,198.42,637.79,42.25]
["TUFTS - TUFTS POS - HCPCS - G0423","TUFTS","TUFTS POS","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER","G0423 - HC INTENS CARDIAC REHAB NO EXER",169,375.87,198.42,637.79,42.25]
["TUFTS - TUFTS HMO - HCPCS - G0423","TUFTS","TUFTS HMO","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER","G0423 - HC INTENS CARDIAC REHAB NO EXER",169,375.87,198.42,637.79,42.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0423","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER","G0423 - HC INTENS CARDIAC REHAB NO EXER",169,255.09,198.42,637.79,42.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0423","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER","G0423 - HC INTENS CARDIAC REHAB NO EXER",169,255.09,198.42,637.79,42.25]
["FALLON - FALLON MEDICAID - HCPCS - G0423","FALLON","FALLON MEDICAID","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER","G0423 - HC INTENS CARDIAC REHAB NO EXER",169,0,198.42,637.79,42.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0423","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER","G0423 - HC INTENS CARDIAC REHAB NO EXER",169,198.42,198.42,637.79,42.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0423","BMC HEALTHNET","BMCHN QHP","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER","G0423 - HC INTENS CARDIAC REHAB NO EXER",169,0,198.42,637.79,42.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0423","BMC HEALTHNET","BMCHN ACO","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER","G0423 - HC INTENS CARDIAC REHAB NO EXER",169,0,198.42,637.79,42.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0423","BMC HEALTHNET","BMCHN MCO","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER","G0423 - HC INTENS CARDIAC REHAB NO EXER",169,0,198.42,637.79,42.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0423","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER","G0423 - HC INTENS CARDIAC REHAB NO EXER",169,637.79,198.42,637.79,42.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0423","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER","G0423 - HC INTENS CARDIAC REHAB NO EXER",169,0,198.42,637.79,42.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0423","BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER","G0423 - HC INTENS CARDIAC REHAB NO EXER",169,198.42,198.42,637.79,42.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0423","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER","G0423 - HC INTENS CARDIAC REHAB NO EXER",169,0,198.42,637.79,42.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0423","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER","G0423 - HC INTENS CARDIAC REHAB NO EXER",169,198.42,198.42,637.79,42.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0423","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER","G0423 - HC INTENS CARDIAC REHAB NO EXER",169,198.42,198.42,637.79,42.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0423","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER","G0423 - HC INTENS CARDIAC REHAB NO EXER",169,0,198.42,637.79,42.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0423","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER","G0423 - HC INTENS CARDIAC REHAB NO EXER",169,198.42,198.42,637.79,42.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0423","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER","G0423 - HC INTENS CARDIAC REHAB NO EXER",169,198.42,198.42,637.79,42.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0423","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER","G0423 - HC INTENS CARDIAC REHAB NO EXER",169,198.42,198.42,637.79,42.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0424","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G0424","PULMONARY REHAB W EXER","G0424 - PULMONARY REHAB W EXER",284,120.69,93.87,343.09,71]
["TUFTS - TUFTS PPO - HCPCS - G0424","TUFTS","TUFTS PPO","HCPCS","G0424","PULMONARY REHAB W EXER","G0424 - PULMONARY REHAB W EXER",284,216.3,93.87,343.09,71]
["TUFTS - TUFTS SELECT - HCPCS - G0424","TUFTS","TUFTS SELECT","HCPCS","G0424","PULMONARY REHAB W EXER","G0424 - PULMONARY REHAB W EXER",284,107.65,93.87,343.09,71]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0424","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0424","PULMONARY REHAB W EXER","G0424 - PULMONARY REHAB W EXER",284,117.73,93.87,343.09,71]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0424","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0424","PULMONARY REHAB W EXER","G0424 - PULMONARY REHAB W EXER",284,120.69,93.87,343.09,71]
["TUFTS - TUFTS HMO - HCPCS - G0424","TUFTS","TUFTS HMO","HCPCS","G0424","PULMONARY REHAB W EXER","G0424 - PULMONARY REHAB W EXER",284,202.19,93.87,343.09,71]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0424","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0424","PULMONARY REHAB W EXER","G0424 - PULMONARY REHAB W EXER",284,120.69,93.87,343.09,71]
["TUFTS - TUFTS POS - HCPCS - G0424","TUFTS","TUFTS POS","HCPCS","G0424","PULMONARY REHAB W EXER","G0424 - PULMONARY REHAB W EXER",284,202.19,93.87,343.09,71]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0424","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0424","PULMONARY REHAB W EXER","G0424 - PULMONARY REHAB W EXER",284,93.87,93.87,343.09,71]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0424","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0424","PULMONARY REHAB W EXER","G0424 - PULMONARY REHAB W EXER",284,343.09,93.87,343.09,71]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0424","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0424","PULMONARY REHAB W EXER","G0424 - PULMONARY REHAB W EXER",284,93.87,93.87,343.09,71]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0424","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0424","PULMONARY REHAB W EXER","G0424 - PULMONARY REHAB W EXER",284,93.87,93.87,343.09,71]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0424","BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0424","PULMONARY REHAB W EXER","G0424 - PULMONARY REHAB W EXER",284,93.87,93.87,343.09,71]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0424","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0424","PULMONARY REHAB W EXER","G0424 - PULMONARY REHAB W EXER",284,93.87,93.87,343.09,71]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0424","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0424","PULMONARY REHAB W EXER","G0424 - PULMONARY REHAB W EXER",284,93.87,93.87,343.09,71]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0424","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0424","PULMONARY REHAB W EXER","G0424 - PULMONARY REHAB W EXER",284,93.87,93.87,343.09,71]
["TUFTS - TUFTS PPO - HCPCS - G0438","TUFTS","TUFTS PPO","HCPCS","G0438","PPPS, INITIAL VISIT","G0438 - PPPS, INITIAL VISIT",547,38.93,34.03,61.76,136.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0438","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0438","PPPS, INITIAL VISIT","G0438 - PPPS, INITIAL VISIT",547,0,34.03,61.76,136.75]
["TUFTS - TUFTS SELECT - HCPCS - G0438","TUFTS","TUFTS SELECT","HCPCS","G0438","PPPS, INITIAL VISIT","G0438 - PPPS, INITIAL VISIT",547,34.03,34.03,61.76,136.75]
["TUFTS - TUFTS HMO - HCPCS - G0438","TUFTS","TUFTS HMO","HCPCS","G0438","PPPS, INITIAL VISIT","G0438 - PPPS, INITIAL VISIT",547,38.93,34.03,61.76,136.75]
["FALLON - FALLON MEDICAID - HCPCS - G0438","FALLON","FALLON MEDICAID","HCPCS","G0438","PPPS, INITIAL VISIT","G0438 - PPPS, INITIAL VISIT",547,0,34.03,61.76,136.75]
["TUFTS - TUFTS POS - HCPCS - G0438","TUFTS","TUFTS POS","HCPCS","G0438","PPPS, INITIAL VISIT","G0438 - PPPS, INITIAL VISIT",547,38.93,34.03,61.76,136.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0438","BMC HEALTHNET","BMCHN ACO","HCPCS","G0438","PPPS, INITIAL VISIT","G0438 - PPPS, INITIAL VISIT",547,0,34.03,61.76,136.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0438","BMC HEALTHNET","BMCHN QHP","HCPCS","G0438","PPPS, INITIAL VISIT","G0438 - PPPS, INITIAL VISIT",547,0,34.03,61.76,136.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0438","BMC HEALTHNET","BMCHN MCO","HCPCS","G0438","PPPS, INITIAL VISIT","G0438 - PPPS, INITIAL VISIT",547,0,34.03,61.76,136.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0438","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0438","PPPS, INITIAL VISIT","G0438 - PPPS, INITIAL VISIT",547,61.76,34.03,61.76,136.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0438","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0438","PPPS, INITIAL VISIT","G0438 - PPPS, INITIAL VISIT",547,0,34.03,61.76,136.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0438","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0438","PPPS, INITIAL VISIT","G0438 - PPPS, INITIAL VISIT",547,0,34.03,61.76,136.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0438","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0438","PPPS, INITIAL VISIT","G0438 - PPPS, INITIAL VISIT",547,0,34.03,61.76,136.75]
["TUFTS - TUFTS PPO - HCPCS - G0439","TUFTS","TUFTS PPO","HCPCS","G0439","PPPS, SUBSEQ VISIT","G0439 - PPPS, SUBSEQ VISIT",327,38.93,34.03,61.76,81.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0439","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0439","PPPS, SUBSEQ VISIT","G0439 - PPPS, SUBSEQ VISIT",327,0,34.03,61.76,81.75]
["TUFTS - TUFTS SELECT - HCPCS - G0439","TUFTS","TUFTS SELECT","HCPCS","G0439","PPPS, SUBSEQ VISIT","G0439 - PPPS, SUBSEQ VISIT",327,34.03,34.03,61.76,81.75]
["TUFTS - TUFTS HMO - HCPCS - G0439","TUFTS","TUFTS HMO","HCPCS","G0439","PPPS, SUBSEQ VISIT","G0439 - PPPS, SUBSEQ VISIT",327,38.93,34.03,61.76,81.75]
["FALLON - FALLON MEDICAID - HCPCS - G0439","FALLON","FALLON MEDICAID","HCPCS","G0439","PPPS, SUBSEQ VISIT","G0439 - PPPS, SUBSEQ VISIT",327,0,34.03,61.76,81.75]
["TUFTS - TUFTS POS - HCPCS - G0439","TUFTS","TUFTS POS","HCPCS","G0439","PPPS, SUBSEQ VISIT","G0439 - PPPS, SUBSEQ VISIT",327,38.93,34.03,61.76,81.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0439","BMC HEALTHNET","BMCHN QHP","HCPCS","G0439","PPPS, SUBSEQ VISIT","G0439 - PPPS, SUBSEQ VISIT",327,0,34.03,61.76,81.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0439","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0439","PPPS, SUBSEQ VISIT","G0439 - PPPS, SUBSEQ VISIT",327,61.76,34.03,61.76,81.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0439","BMC HEALTHNET","BMCHN ACO","HCPCS","G0439","PPPS, SUBSEQ VISIT","G0439 - PPPS, SUBSEQ VISIT",327,0,34.03,61.76,81.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0439","BMC HEALTHNET","BMCHN MCO","HCPCS","G0439","PPPS, SUBSEQ VISIT","G0439 - PPPS, SUBSEQ VISIT",327,0,34.03,61.76,81.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0439","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0439","PPPS, SUBSEQ VISIT","G0439 - PPPS, SUBSEQ VISIT",327,0,34.03,61.76,81.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0439","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0439","PPPS, SUBSEQ VISIT","G0439 - PPPS, SUBSEQ VISIT",327,0,34.03,61.76,81.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0439","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0439","PPPS, SUBSEQ VISIT","G0439 - PPPS, SUBSEQ VISIT",327,0,34.03,61.76,81.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0442","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0442","ANNUAL ALCOHOL SCREEN 15 MIN","G0442 - ANNUAL ALCOHOL SCREEN 15 MIN",42,0,13.34,33.6,10.5]
["TUFTS - TUFTS PPO - HCPCS - G0442","TUFTS","TUFTS PPO","HCPCS","G0442","ANNUAL ALCOHOL SCREEN 15 MIN","G0442 - ANNUAL ALCOHOL SCREEN 15 MIN",42,21.18,13.34,33.6,10.5]
["TUFTS - TUFTS SELECT - HCPCS - G0442","TUFTS","TUFTS SELECT","HCPCS","G0442","ANNUAL ALCOHOL SCREEN 15 MIN","G0442 - ANNUAL ALCOHOL SCREEN 15 MIN",42,18.52,13.34,33.6,10.5]
["TUFTS - TUFTS POS - HCPCS - G0442","TUFTS","TUFTS POS","HCPCS","G0442","ANNUAL ALCOHOL SCREEN 15 MIN","G0442 - ANNUAL ALCOHOL SCREEN 15 MIN",42,21.18,13.34,33.6,10.5]
["TUFTS - TUFTS HMO - HCPCS - G0442","TUFTS","TUFTS HMO","HCPCS","G0442","ANNUAL ALCOHOL SCREEN 15 MIN","G0442 - ANNUAL ALCOHOL SCREEN 15 MIN",42,21.18,13.34,33.6,10.5]
["FALLON - FALLON MEDICAID - HCPCS - G0442","FALLON","FALLON MEDICAID","HCPCS","G0442","ANNUAL ALCOHOL SCREEN 15 MIN","G0442 - ANNUAL ALCOHOL SCREEN 15 MIN",42,0,13.34,33.6,10.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0442","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0442","ANNUAL ALCOHOL SCREEN 15 MIN","G0442 - ANNUAL ALCOHOL SCREEN 15 MIN",42,13.34,13.34,33.6,10.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0442","BMC HEALTHNET","BMCHN ACO","HCPCS","G0442","ANNUAL ALCOHOL SCREEN 15 MIN","G0442 - ANNUAL ALCOHOL SCREEN 15 MIN",42,0,13.34,33.6,10.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0442","BMC HEALTHNET","BMCHN QHP","HCPCS","G0442","ANNUAL ALCOHOL SCREEN 15 MIN","G0442 - ANNUAL ALCOHOL SCREEN 15 MIN",42,0,13.34,33.6,10.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0442","BMC HEALTHNET","BMCHN MCO","HCPCS","G0442","ANNUAL ALCOHOL SCREEN 15 MIN","G0442 - ANNUAL ALCOHOL SCREEN 15 MIN",42,0,13.34,33.6,10.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0442","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0442","ANNUAL ALCOHOL SCREEN 15 MIN","G0442 - ANNUAL ALCOHOL SCREEN 15 MIN",42,33.6,13.34,33.6,10.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0442","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0442","ANNUAL ALCOHOL SCREEN 15 MIN","G0442 - ANNUAL ALCOHOL SCREEN 15 MIN",42,0,13.34,33.6,10.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0442","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0442","ANNUAL ALCOHOL SCREEN 15 MIN","G0442 - ANNUAL ALCOHOL SCREEN 15 MIN",42,0,13.34,33.6,10.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0442","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0442","ANNUAL ALCOHOL SCREEN 15 MIN","G0442 - ANNUAL ALCOHOL SCREEN 15 MIN",42,0,13.34,33.6,10.5]
["TUFTS - TUFTS PPO - HCPCS - G0443","TUFTS","TUFTS PPO","HCPCS","G0443","BRIEF ALCOHOL MISUSE COUNSEL","G0443 - BRIEF ALCOHOL MISUSE COUNSEL",118,21.18,18.52,33.6,29.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0443","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0443","BRIEF ALCOHOL MISUSE COUNSEL","G0443 - BRIEF ALCOHOL MISUSE COUNSEL",118,0,18.52,33.6,29.5]
["TUFTS - TUFTS SELECT - HCPCS - G0443","TUFTS","TUFTS SELECT","HCPCS","G0443","BRIEF ALCOHOL MISUSE COUNSEL","G0443 - BRIEF ALCOHOL MISUSE COUNSEL",118,18.52,18.52,33.6,29.5]
["FALLON - FALLON MEDICAID - HCPCS - G0443","FALLON","FALLON MEDICAID","HCPCS","G0443","BRIEF ALCOHOL MISUSE COUNSEL","G0443 - BRIEF ALCOHOL MISUSE COUNSEL",118,0,18.52,33.6,29.5]
["TUFTS - TUFTS HMO - HCPCS - G0443","TUFTS","TUFTS HMO","HCPCS","G0443","BRIEF ALCOHOL MISUSE COUNSEL","G0443 - BRIEF ALCOHOL MISUSE COUNSEL",118,21.18,18.52,33.6,29.5]
["TUFTS - TUFTS POS - HCPCS - G0443","TUFTS","TUFTS POS","HCPCS","G0443","BRIEF ALCOHOL MISUSE COUNSEL","G0443 - BRIEF ALCOHOL MISUSE COUNSEL",118,21.18,18.52,33.6,29.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0443","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0443","BRIEF ALCOHOL MISUSE COUNSEL","G0443 - BRIEF ALCOHOL MISUSE COUNSEL",118,33.04,18.52,33.6,29.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0443","BMC HEALTHNET","BMCHN QHP","HCPCS","G0443","BRIEF ALCOHOL MISUSE COUNSEL","G0443 - BRIEF ALCOHOL MISUSE COUNSEL",118,0,18.52,33.6,29.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0443","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0443","BRIEF ALCOHOL MISUSE COUNSEL","G0443 - BRIEF ALCOHOL MISUSE COUNSEL",118,33.6,18.52,33.6,29.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0443","BMC HEALTHNET","BMCHN ACO","HCPCS","G0443","BRIEF ALCOHOL MISUSE COUNSEL","G0443 - BRIEF ALCOHOL MISUSE COUNSEL",118,0,18.52,33.6,29.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0443","BMC HEALTHNET","BMCHN MCO","HCPCS","G0443","BRIEF ALCOHOL MISUSE COUNSEL","G0443 - BRIEF ALCOHOL MISUSE COUNSEL",118,0,18.52,33.6,29.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0443","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0443","BRIEF ALCOHOL MISUSE COUNSEL","G0443 - BRIEF ALCOHOL MISUSE COUNSEL",118,0,18.52,33.6,29.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0443","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0443","BRIEF ALCOHOL MISUSE COUNSEL","G0443 - BRIEF ALCOHOL MISUSE COUNSEL",118,0,18.52,33.6,29.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0443","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0443","BRIEF ALCOHOL MISUSE COUNSEL","G0443 - BRIEF ALCOHOL MISUSE COUNSEL",118,0,18.52,33.6,29.5]
["TUFTS - TUFTS PPO - HCPCS - G0444","TUFTS","TUFTS PPO","HCPCS","G0444","DEPRESSION SCREEN ANNUAL","G0444 - DEPRESSION SCREEN ANNUAL",42,10.18,8.9,16.149999999999999,10.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0444","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0444","DEPRESSION SCREEN ANNUAL","G0444 - DEPRESSION SCREEN ANNUAL",42,0,8.9,16.149999999999999,10.5]
["TUFTS - TUFTS SELECT - HCPCS - G0444","TUFTS","TUFTS SELECT","HCPCS","G0444","DEPRESSION SCREEN ANNUAL","G0444 - DEPRESSION SCREEN ANNUAL",42,8.9,8.9,16.149999999999999,10.5]
["TUFTS - TUFTS HMO - HCPCS - G0444","TUFTS","TUFTS HMO","HCPCS","G0444","DEPRESSION SCREEN ANNUAL","G0444 - DEPRESSION SCREEN ANNUAL",42,10.18,8.9,16.149999999999999,10.5]
["TUFTS - TUFTS POS - HCPCS - G0444","TUFTS","TUFTS POS","HCPCS","G0444","DEPRESSION SCREEN ANNUAL","G0444 - DEPRESSION SCREEN ANNUAL",42,10.18,8.9,16.149999999999999,10.5]
["FALLON - FALLON MEDICAID - HCPCS - G0444","FALLON","FALLON MEDICAID","HCPCS","G0444","DEPRESSION SCREEN ANNUAL","G0444 - DEPRESSION SCREEN ANNUAL",42,0,8.9,16.149999999999999,10.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0444","BMC HEALTHNET","BMCHN ACO","HCPCS","G0444","DEPRESSION SCREEN ANNUAL","G0444 - DEPRESSION SCREEN ANNUAL",42,0,8.9,16.149999999999999,10.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0444","BMC HEALTHNET","BMCHN QHP","HCPCS","G0444","DEPRESSION SCREEN ANNUAL","G0444 - DEPRESSION SCREEN ANNUAL",42,0,8.9,16.149999999999999,10.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0444","BMC HEALTHNET","BMCHN MCO","HCPCS","G0444","DEPRESSION SCREEN ANNUAL","G0444 - DEPRESSION SCREEN ANNUAL",42,0,8.9,16.149999999999999,10.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0444","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0444","DEPRESSION SCREEN ANNUAL","G0444 - DEPRESSION SCREEN ANNUAL",42,16.149999999999999,8.9,16.149999999999999,10.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0444","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0444","DEPRESSION SCREEN ANNUAL","G0444 - DEPRESSION SCREEN ANNUAL",42,0,8.9,16.149999999999999,10.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0444","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0444","DEPRESSION SCREEN ANNUAL","G0444 - DEPRESSION SCREEN ANNUAL",42,0,8.9,16.149999999999999,10.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0444","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0444","DEPRESSION SCREEN ANNUAL","G0444 - DEPRESSION SCREEN ANNUAL",42,0,8.9,16.149999999999999,10.5]
["TUFTS - TUFTS PPO - HCPCS - G0445","TUFTS","TUFTS PPO","HCPCS","G0445","HIGH INTEN BEH COUNS STD 30M","G0445 - HIGH INTEN BEH COUNS STD 30M",118,10.18,8.9,16.149999999999999,29.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0445","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0445","HIGH INTEN BEH COUNS STD 30M","G0445 - HIGH INTEN BEH COUNS STD 30M",118,0,8.9,16.149999999999999,29.5]
["TUFTS - TUFTS SELECT - HCPCS - G0445","TUFTS","TUFTS SELECT","HCPCS","G0445","HIGH INTEN BEH COUNS STD 30M","G0445 - HIGH INTEN BEH COUNS STD 30M",118,8.9,8.9,16.149999999999999,29.5]
["FALLON - FALLON MEDICAID - HCPCS - G0445","FALLON","FALLON MEDICAID","HCPCS","G0445","HIGH INTEN BEH COUNS STD 30M","G0445 - HIGH INTEN BEH COUNS STD 30M",118,0,8.9,16.149999999999999,29.5]
["TUFTS - TUFTS HMO - HCPCS - G0445","TUFTS","TUFTS HMO","HCPCS","G0445","HIGH INTEN BEH COUNS STD 30M","G0445 - HIGH INTEN BEH COUNS STD 30M",118,10.18,8.9,16.149999999999999,29.5]
["TUFTS - TUFTS POS - HCPCS - G0445","TUFTS","TUFTS POS","HCPCS","G0445","HIGH INTEN BEH COUNS STD 30M","G0445 - HIGH INTEN BEH COUNS STD 30M",118,10.18,8.9,16.149999999999999,29.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0445","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0445","HIGH INTEN BEH COUNS STD 30M","G0445 - HIGH INTEN BEH COUNS STD 30M",118,16.149999999999999,8.9,16.149999999999999,29.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0445","BMC HEALTHNET","BMCHN QHP","HCPCS","G0445","HIGH INTEN BEH COUNS STD 30M","G0445 - HIGH INTEN BEH COUNS STD 30M",118,0,8.9,16.149999999999999,29.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0445","BMC HEALTHNET","BMCHN ACO","HCPCS","G0445","HIGH INTEN BEH COUNS STD 30M","G0445 - HIGH INTEN BEH COUNS STD 30M",118,0,8.9,16.149999999999999,29.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0445","BMC HEALTHNET","BMCHN MCO","HCPCS","G0445","HIGH INTEN BEH COUNS STD 30M","G0445 - HIGH INTEN BEH COUNS STD 30M",118,0,8.9,16.149999999999999,29.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0445","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0445","HIGH INTEN BEH COUNS STD 30M","G0445 - HIGH INTEN BEH COUNS STD 30M",118,0,8.9,16.149999999999999,29.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0445","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0445","HIGH INTEN BEH COUNS STD 30M","G0445 - HIGH INTEN BEH COUNS STD 30M",118,0,8.9,16.149999999999999,29.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0445","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0445","HIGH INTEN BEH COUNS STD 30M","G0445 - HIGH INTEN BEH COUNS STD 30M",118,0,8.9,16.149999999999999,29.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0446","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0446","INTENS BEHAVE THER CARDIO DX","G0446 - INTENS BEHAVE THER CARDIO DX",42,0,8.9,16.149999999999999,10.5]
["TUFTS - TUFTS PPO - HCPCS - G0446","TUFTS","TUFTS PPO","HCPCS","G0446","INTENS BEHAVE THER CARDIO DX","G0446 - INTENS BEHAVE THER CARDIO DX",42,10.18,8.9,16.149999999999999,10.5]
["TUFTS - TUFTS SELECT - HCPCS - G0446","TUFTS","TUFTS SELECT","HCPCS","G0446","INTENS BEHAVE THER CARDIO DX","G0446 - INTENS BEHAVE THER CARDIO DX",42,8.9,8.9,16.149999999999999,10.5]
["TUFTS - TUFTS POS - HCPCS - G0446","TUFTS","TUFTS POS","HCPCS","G0446","INTENS BEHAVE THER CARDIO DX","G0446 - INTENS BEHAVE THER CARDIO DX",42,10.18,8.9,16.149999999999999,10.5]
["TUFTS - TUFTS HMO - HCPCS - G0446","TUFTS","TUFTS HMO","HCPCS","G0446","INTENS BEHAVE THER CARDIO DX","G0446 - INTENS BEHAVE THER CARDIO DX",42,10.18,8.9,16.149999999999999,10.5]
["FALLON - FALLON MEDICAID - HCPCS - G0446","FALLON","FALLON MEDICAID","HCPCS","G0446","INTENS BEHAVE THER CARDIO DX","G0446 - INTENS BEHAVE THER CARDIO DX",42,0,8.9,16.149999999999999,10.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0446","BMC HEALTHNET","BMCHN ACO","HCPCS","G0446","INTENS BEHAVE THER CARDIO DX","G0446 - INTENS BEHAVE THER CARDIO DX",42,0,8.9,16.149999999999999,10.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0446","BMC HEALTHNET","BMCHN QHP","HCPCS","G0446","INTENS BEHAVE THER CARDIO DX","G0446 - INTENS BEHAVE THER CARDIO DX",42,0,8.9,16.149999999999999,10.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0446","BMC HEALTHNET","BMCHN MCO","HCPCS","G0446","INTENS BEHAVE THER CARDIO DX","G0446 - INTENS BEHAVE THER CARDIO DX",42,0,8.9,16.149999999999999,10.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0446","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0446","INTENS BEHAVE THER CARDIO DX","G0446 - INTENS BEHAVE THER CARDIO DX",42,16.149999999999999,8.9,16.149999999999999,10.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0446","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0446","INTENS BEHAVE THER CARDIO DX","G0446 - INTENS BEHAVE THER CARDIO DX",42,0,8.9,16.149999999999999,10.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0446","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0446","INTENS BEHAVE THER CARDIO DX","G0446 - INTENS BEHAVE THER CARDIO DX",42,0,8.9,16.149999999999999,10.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0446","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0446","INTENS BEHAVE THER CARDIO DX","G0446 - INTENS BEHAVE THER CARDIO DX",42,0,8.9,16.149999999999999,10.5]
["TUFTS - TUFTS PPO - HCPCS - G0447","TUFTS","TUFTS PPO","HCPCS","G0447","HC BEHAVIOR COUNSEL OBESITY 15M","G0447 - HC BEHAVIOR COUNSEL OBESITY 15M",118,21.18,18.52,33.6,29.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0447","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0447","HC BEHAVIOR COUNSEL OBESITY 15M","G0447 - HC BEHAVIOR COUNSEL OBESITY 15M",118,0,18.52,33.6,29.5]
["TUFTS - TUFTS SELECT - HCPCS - G0447","TUFTS","TUFTS SELECT","HCPCS","G0447","HC BEHAVIOR COUNSEL OBESITY 15M","G0447 - HC BEHAVIOR COUNSEL OBESITY 15M",118,18.52,18.52,33.6,29.5]
["TUFTS - TUFTS HMO - HCPCS - G0447","TUFTS","TUFTS HMO","HCPCS","G0447","HC BEHAVIOR COUNSEL OBESITY 15M","G0447 - HC BEHAVIOR COUNSEL OBESITY 15M",118,21.18,18.52,33.6,29.5]
["FALLON - FALLON MEDICAID - HCPCS - G0447","FALLON","FALLON MEDICAID","HCPCS","G0447","HC BEHAVIOR COUNSEL OBESITY 15M","G0447 - HC BEHAVIOR COUNSEL OBESITY 15M",118,0,18.52,33.6,29.5]
["TUFTS - TUFTS POS - HCPCS - G0447","TUFTS","TUFTS POS","HCPCS","G0447","HC BEHAVIOR COUNSEL OBESITY 15M","G0447 - HC BEHAVIOR COUNSEL OBESITY 15M",118,21.18,18.52,33.6,29.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0447","BMC HEALTHNET","BMCHN QHP","HCPCS","G0447","HC BEHAVIOR COUNSEL OBESITY 15M","G0447 - HC BEHAVIOR COUNSEL OBESITY 15M",118,0,18.52,33.6,29.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0447","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0447","HC BEHAVIOR COUNSEL OBESITY 15M","G0447 - HC BEHAVIOR COUNSEL OBESITY 15M",118,33.6,18.52,33.6,29.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0447","BMC HEALTHNET","BMCHN ACO","HCPCS","G0447","HC BEHAVIOR COUNSEL OBESITY 15M","G0447 - HC BEHAVIOR COUNSEL OBESITY 15M",118,0,18.52,33.6,29.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0447","BMC HEALTHNET","BMCHN MCO","HCPCS","G0447","HC BEHAVIOR COUNSEL OBESITY 15M","G0447 - HC BEHAVIOR COUNSEL OBESITY 15M",118,0,18.52,33.6,29.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0447","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0447","HC BEHAVIOR COUNSEL OBESITY 15M","G0447 - HC BEHAVIOR COUNSEL OBESITY 15M",118,0,18.52,33.6,29.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0447","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0447","HC BEHAVIOR COUNSEL OBESITY 15M","G0447 - HC BEHAVIOR COUNSEL OBESITY 15M",118,0,18.52,33.6,29.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0447","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0447","HC BEHAVIOR COUNSEL OBESITY 15M","G0447 - HC BEHAVIOR COUNSEL OBESITY 15M",118,0,18.52,33.6,29.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0480","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,240.99,59.69,973.54,63.5]
["TUFTS - TUFTS PPO - HCPCS - G0480","TUFTS","TUFTS PPO","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,346.36,59.69,973.54,63.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0480","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,71.63,59.69,973.54,63.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - G0480","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,137.32,59.69,973.54,63.5]
["TUFTS - TUFTS SELECT - HCPCS - G0480","TUFTS","TUFTS SELECT","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,172.38,59.69,973.54,63.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - G0480","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,137.32,59.69,973.54,63.5]
["UNICARE - UNICARE - HCPCS - G0480","UNICARE","UNICARE","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,207.82,59.69,973.54,63.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - G0480","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,173.18,59.69,973.54,63.5]
["TUFTS - TUFTS SPIRIT - HCPCS - G0480","TUFTS","TUFTS SPIRIT","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,125.87,59.69,973.54,63.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - HCPCS - G0480","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,70.260000000000005,59.69,973.54,63.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - G0480","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,154.27000000000001,59.69,973.54,63.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - G0480","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,240.99,59.69,973.54,63.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - HCPCS - G0480","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,90.25,59.69,973.54,63.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0480","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,247.05,59.69,973.54,63.5]
["TUFTS - TUFTS HMO - HCPCS - G0480","TUFTS","TUFTS HMO","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,388.52,59.69,973.54,63.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - G0480","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,165.92,59.69,973.54,63.5]
["FALLON - FALLON SENIOR PLAN - HCPCS - G0480","FALLON","FALLON SENIOR PLAN","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,114.43,59.69,973.54,63.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0480","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,247.05,59.69,973.54,63.5]
["FALLON - FALLON MEDICAID - HCPCS - G0480","FALLON","FALLON MEDICAID","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,59.69,59.69,973.54,63.5]
["TUFTS - TUFTS POS - HCPCS - G0480","TUFTS","TUFTS POS","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,323.77,59.69,973.54,63.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0480","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,247.05,59.69,973.54,63.5]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - G0480","TUFTS","TUFTS MEDICARE SCO","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,165.92,59.69,973.54,63.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - G0480","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,247.05,59.69,973.54,63.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - G0480","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,199.11,59.69,973.54,63.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0480","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,209.48,59.69,973.54,63.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - G0480","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,252.88,59.69,973.54,63.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0480","BMC HEALTHNET","BMCHN ACO","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,130.6,59.69,973.54,63.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0480","BMC HEALTHNET","BMCHN QHP","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,71.63,59.69,973.54,63.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0480","BMC HEALTHNET","BMCHN MCO","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,59.69,59.69,973.54,63.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0480","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,973.54,59.69,973.54,63.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - G0480","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,114.43,59.69,973.54,63.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - G0480","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,114.43,59.69,973.54,63.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0480","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,59.69,59.69,973.54,63.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - G0480","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,117.65,59.69,973.54,63.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - G0480","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,114.43,59.69,973.54,63.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0480","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,209.48,59.69,973.54,63.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0480","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,209.48,59.69,973.54,63.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - G0480","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,287.93,59.69,973.54,63.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0480","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,70.430000000000007,59.69,973.54,63.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0480","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,81,59.69,973.54,63.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0480","BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,209.48,59.69,973.54,63.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0480","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,209.48,59.69,973.54,63.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0480","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,209.48,59.69,973.54,63.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0480","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,209.48,59.69,973.54,63.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - G0480","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES",254,135.03,59.69,973.54,63.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - G0481","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,329.78,91.84,1332.11,48]
["TUFTS - TUFTS PPO - HCPCS - G0481","TUFTS","TUFTS PPO","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,473.93,91.84,1332.11,48]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - G0481","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,187.91,91.84,1332.11,48]
["UNICARE - UNICARE - HCPCS - G0481","UNICARE","UNICARE","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,284.38,91.84,1332.11,48]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - G0481","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,236.98,91.84,1332.11,48]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0481","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,338.08,91.84,1332.11,48]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0481","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,110.21,91.84,1332.11,48]
["TUFTS - TUFTS SELECT - HCPCS - G0481","TUFTS","TUFTS SELECT","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,235.87,91.84,1332.11,48]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - G0481","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,187.91,91.84,1332.11,48]
["TUFTS - TUFTS SPIRIT - HCPCS - G0481","TUFTS","TUFTS SPIRIT","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,172.25,91.84,1332.11,48]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - HCPCS - G0481","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,108.1,91.84,1332.11,48]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0481","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,329.78,91.84,1332.11,48]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - G0481","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,211.11,91.84,1332.11,48]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - HCPCS - G0481","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,138.86000000000001,91.84,1332.11,48]
["FALLON - FALLON SENIOR PLAN - HCPCS - G0481","FALLON","FALLON SENIOR PLAN","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,156.59,91.84,1332.11,48]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - G0481","TUFTS","TUFTS MEDICARE SCO","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,227.06,91.84,1332.11,48]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0481","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,338.08,91.84,1332.11,48]
["FALLON - FALLON MEDICAID - HCPCS - G0481","FALLON","FALLON MEDICAID","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,91.84,91.84,1332.11,48]
["TUFTS - TUFTS HMO - HCPCS - G0481","TUFTS","TUFTS HMO","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,531.64,91.84,1332.11,48]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0481","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,338.08,91.84,1332.11,48]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - G0481","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,227.06,91.84,1332.11,48]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - G0481","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,338.08,91.84,1332.11,48]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - G0481","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,272.47000000000003,91.84,1332.11,48]
["TUFTS - TUFTS POS - HCPCS - G0481","TUFTS","TUFTS POS","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,443.03,91.84,1332.11,48]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - G0481","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,156.59,91.84,1332.11,48]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0481","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,286.56,91.84,1332.11,48]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0481","BMC HEALTHNET","BMCHN QHP","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,110.21,91.84,1332.11,48]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0481","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,1332.11,91.84,1332.11,48]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - G0481","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,156.59,91.84,1332.11,48]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - G0481","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,160.99,91.84,1332.11,48]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - G0481","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,156.59,91.84,1332.11,48]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - G0481","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,346.05,91.84,1332.11,48]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0481","BMC HEALTHNET","BMCHN ACO","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,200.95,91.84,1332.11,48]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0481","BMC HEALTHNET","BMCHN MCO","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,91.84,91.84,1332.11,48]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0481","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,91.84,91.84,1332.11,48]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0481","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,108.37,91.84,1332.11,48]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0481","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,124.63,91.84,1332.11,48]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0481","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,286.56,91.84,1332.11,48]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0481","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,286.56,91.84,1332.11,48]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - G0481","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,394.01,91.84,1332.11,48]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0481","BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,286.56,91.84,1332.11,48]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0481","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,286.56,91.84,1332.11,48]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0481","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,286.56,91.84,1332.11,48]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - G0481","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,184.78,91.84,1332.11,48]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0481","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES",192,286.56,91.84,1332.11,48]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0506","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC","G0506 - HC COMP ASSESS CARE PLAN CCM SVC",62,87.234999999999999,110.9,110.9,15.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0506","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC","G0506 - HC COMP ASSESS CARE PLAN CCM SVC",62,0,110.9,110.9,15.5]
["TUFTS - TUFTS PPO - HCPCS - G0506","TUFTS","TUFTS PPO","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC","G0506 - HC COMP ASSESS CARE PLAN CCM SVC",62,0,110.9,110.9,15.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0506","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC","G0506 - HC COMP ASSESS CARE PLAN CCM SVC",62,0,110.9,110.9,15.5]
["TUFTS - TUFTS SELECT - HCPCS - G0506","TUFTS","TUFTS SELECT","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC","G0506 - HC COMP ASSESS CARE PLAN CCM SVC",62,0,110.9,110.9,15.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0506","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC","G0506 - HC COMP ASSESS CARE PLAN CCM SVC",62,0,110.9,110.9,15.5]
["TUFTS - TUFTS POS - HCPCS - G0506","TUFTS","TUFTS POS","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC","G0506 - HC COMP ASSESS CARE PLAN CCM SVC",62,0,110.9,110.9,15.5]
["TUFTS - TUFTS HMO - HCPCS - G0506","TUFTS","TUFTS HMO","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC","G0506 - HC COMP ASSESS CARE PLAN CCM SVC",62,0,110.9,110.9,15.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0506","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC","G0506 - HC COMP ASSESS CARE PLAN CCM SVC",62,0,110.9,110.9,15.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0506","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC","G0506 - HC COMP ASSESS CARE PLAN CCM SVC",62,0,110.9,110.9,15.5]
["FALLON - FALLON MEDICAID - HCPCS - G0506","FALLON","FALLON MEDICAID","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC","G0506 - HC COMP ASSESS CARE PLAN CCM SVC",62,0,110.9,110.9,15.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0506","BMC HEALTHNET","BMCHN ACO","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC","G0506 - HC COMP ASSESS CARE PLAN CCM SVC",62,0,110.9,110.9,15.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0506","BMC HEALTHNET","BMCHN QHP","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC","G0506 - HC COMP ASSESS CARE PLAN CCM SVC",62,0,110.9,110.9,15.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0506","BMC HEALTHNET","BMCHN MCO","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC","G0506 - HC COMP ASSESS CARE PLAN CCM SVC",62,0,110.9,110.9,15.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0506","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC","G0506 - HC COMP ASSESS CARE PLAN CCM SVC",62,0,110.9,110.9,15.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0506","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC","G0506 - HC COMP ASSESS CARE PLAN CCM SVC",62,0,110.9,110.9,15.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0506","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC","G0506 - HC COMP ASSESS CARE PLAN CCM SVC",62,110.9,110.9,110.9,15.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0506","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC","G0506 - HC COMP ASSESS CARE PLAN CCM SVC",62,0,110.9,110.9,15.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0506","BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC","G0506 - HC COMP ASSESS CARE PLAN CCM SVC",62,110.9,110.9,110.9,15.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0506","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC","G0506 - HC COMP ASSESS CARE PLAN CCM SVC",62,110.9,110.9,110.9,15.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0506","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC","G0506 - HC COMP ASSESS CARE PLAN CCM SVC",62,0,110.9,110.9,15.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0506","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC","G0506 - HC COMP ASSESS CARE PLAN CCM SVC",62,110.9,110.9,110.9,15.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0506","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC","G0506 - HC COMP ASSESS CARE PLAN CCM SVC",62,110.9,110.9,110.9,15.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0506","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC","G0506 - HC COMP ASSESS CARE PLAN CCM SVC",62,110.9,110.9,110.9,15.5]
["TUFTS - TUFTS PPO - HCPCS - G0513","TUFTS","TUFTS PPO","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M","G0513 - HC PROLONG PREV SVCS, FIRST 30M",84,0,148.6,148.6,21]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0513","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M","G0513 - HC PROLONG PREV SVCS, FIRST 30M",84,0,148.6,148.6,21]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0513","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M","G0513 - HC PROLONG PREV SVCS, FIRST 30M",84,0,148.6,148.6,21]
["TUFTS - TUFTS SELECT - HCPCS - G0513","TUFTS","TUFTS SELECT","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M","G0513 - HC PROLONG PREV SVCS, FIRST 30M",84,0,148.6,148.6,21]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0513","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M","G0513 - HC PROLONG PREV SVCS, FIRST 30M",84,0,148.6,148.6,21]
["FALLON - FALLON MEDICAID - HCPCS - G0513","FALLON","FALLON MEDICAID","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M","G0513 - HC PROLONG PREV SVCS, FIRST 30M",84,0,148.6,148.6,21]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0513","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M","G0513 - HC PROLONG PREV SVCS, FIRST 30M",84,0,148.6,148.6,21]
["TUFTS - TUFTS HMO - HCPCS - G0513","TUFTS","TUFTS HMO","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M","G0513 - HC PROLONG PREV SVCS, FIRST 30M",84,0,148.6,148.6,21]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0513","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M","G0513 - HC PROLONG PREV SVCS, FIRST 30M",84,0,148.6,148.6,21]
["TUFTS - TUFTS POS - HCPCS - G0513","TUFTS","TUFTS POS","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M","G0513 - HC PROLONG PREV SVCS, FIRST 30M",84,0,148.6,148.6,21]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0513","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M","G0513 - HC PROLONG PREV SVCS, FIRST 30M",84,148.6,148.6,148.6,21]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0513","BMC HEALTHNET","BMCHN QHP","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M","G0513 - HC PROLONG PREV SVCS, FIRST 30M",84,0,148.6,148.6,21]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0513","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M","G0513 - HC PROLONG PREV SVCS, FIRST 30M",84,0,148.6,148.6,21]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0513","BMC HEALTHNET","BMCHN ACO","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M","G0513 - HC PROLONG PREV SVCS, FIRST 30M",84,0,148.6,148.6,21]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0513","BMC HEALTHNET","BMCHN MCO","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M","G0513 - HC PROLONG PREV SVCS, FIRST 30M",84,0,148.6,148.6,21]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0513","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M","G0513 - HC PROLONG PREV SVCS, FIRST 30M",84,0,148.6,148.6,21]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0513","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M","G0513 - HC PROLONG PREV SVCS, FIRST 30M",84,0,148.6,148.6,21]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0513","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M","G0513 - HC PROLONG PREV SVCS, FIRST 30M",84,0,148.6,148.6,21]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0513","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M","G0513 - HC PROLONG PREV SVCS, FIRST 30M",84,148.6,148.6,148.6,21]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0513","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M","G0513 - HC PROLONG PREV SVCS, FIRST 30M",84,148.6,148.6,148.6,21]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0513","BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M","G0513 - HC PROLONG PREV SVCS, FIRST 30M",84,148.6,148.6,148.6,21]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0513","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M","G0513 - HC PROLONG PREV SVCS, FIRST 30M",84,148.6,148.6,148.6,21]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0513","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M","G0513 - HC PROLONG PREV SVCS, FIRST 30M",84,148.6,148.6,148.6,21]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0513","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M","G0513 - HC PROLONG PREV SVCS, FIRST 30M",84,148.6,148.6,148.6,21]
["TUFTS - TUFTS PPO - HCPCS - G0514","TUFTS","TUFTS PPO","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M","G0514 - HC PROLONG PREV SVCS, ADDL 30M",84,0,148.6,148.6,21]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0514","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M","G0514 - HC PROLONG PREV SVCS, ADDL 30M",84,0,148.6,148.6,21]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0514","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M","G0514 - HC PROLONG PREV SVCS, ADDL 30M",84,0,148.6,148.6,21]
["TUFTS - TUFTS SELECT - HCPCS - G0514","TUFTS","TUFTS SELECT","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M","G0514 - HC PROLONG PREV SVCS, ADDL 30M",84,0,148.6,148.6,21]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0514","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M","G0514 - HC PROLONG PREV SVCS, ADDL 30M",84,0,148.6,148.6,21]
["TUFTS - TUFTS HMO - HCPCS - G0514","TUFTS","TUFTS HMO","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M","G0514 - HC PROLONG PREV SVCS, ADDL 30M",84,0,148.6,148.6,21]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0514","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M","G0514 - HC PROLONG PREV SVCS, ADDL 30M",84,0,148.6,148.6,21]
["TUFTS - TUFTS POS - HCPCS - G0514","TUFTS","TUFTS POS","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M","G0514 - HC PROLONG PREV SVCS, ADDL 30M",84,0,148.6,148.6,21]
["FALLON - FALLON MEDICAID - HCPCS - G0514","FALLON","FALLON MEDICAID","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M","G0514 - HC PROLONG PREV SVCS, ADDL 30M",84,0,148.6,148.6,21]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0514","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M","G0514 - HC PROLONG PREV SVCS, ADDL 30M",84,0,148.6,148.6,21]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0514","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M","G0514 - HC PROLONG PREV SVCS, ADDL 30M",84,148.6,148.6,148.6,21]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G0514","BMC HEALTHNET","BMCHN ACO","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M","G0514 - HC PROLONG PREV SVCS, ADDL 30M",84,0,148.6,148.6,21]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G0514","BMC HEALTHNET","BMCHN QHP","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M","G0514 - HC PROLONG PREV SVCS, ADDL 30M",84,0,148.6,148.6,21]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G0514","BMC HEALTHNET","BMCHN MCO","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M","G0514 - HC PROLONG PREV SVCS, ADDL 30M",84,0,148.6,148.6,21]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0514","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M","G0514 - HC PROLONG PREV SVCS, ADDL 30M",84,0,148.6,148.6,21]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0514","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M","G0514 - HC PROLONG PREV SVCS, ADDL 30M",84,0,148.6,148.6,21]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0514","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M","G0514 - HC PROLONG PREV SVCS, ADDL 30M",84,148.6,148.6,148.6,21]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0514","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M","G0514 - HC PROLONG PREV SVCS, ADDL 30M",84,0,148.6,148.6,21]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0514","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M","G0514 - HC PROLONG PREV SVCS, ADDL 30M",84,148.6,148.6,148.6,21]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0514","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M","G0514 - HC PROLONG PREV SVCS, ADDL 30M",84,0,148.6,148.6,21]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0514","BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M","G0514 - HC PROLONG PREV SVCS, ADDL 30M",84,148.6,148.6,148.6,21]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0514","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M","G0514 - HC PROLONG PREV SVCS, ADDL 30M",84,148.6,148.6,148.6,21]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0514","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M","G0514 - HC PROLONG PREV SVCS, ADDL 30M",84,148.6,148.6,148.6,21]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0514","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M","G0514 - HC PROLONG PREV SVCS, ADDL 30M",84,148.6,148.6,148.6,21]
["TUFTS - TUFTS PPO - HCPCS - G2011","TUFTS","TUFTS PPO","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS","G2011 - ALCOHOL/SUB ABUSE ASSESS",35,84.4,28.83,133.88,8.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G2011","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS","G2011 - ALCOHOL/SUB ABUSE ASSESS",35,0,28.83,133.88,8.75]
["TUFTS - TUFTS SELECT - HCPCS - G2011","TUFTS","TUFTS SELECT","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS","G2011 - ALCOHOL/SUB ABUSE ASSESS",35,42.01,28.83,133.88,8.75]
["FALLON - FALLON MEDICAID - HCPCS - G2011","FALLON","FALLON MEDICAID","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS","G2011 - ALCOHOL/SUB ABUSE ASSESS",35,0,28.83,133.88,8.75]
["TUFTS - TUFTS HMO - HCPCS - G2011","TUFTS","TUFTS HMO","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS","G2011 - ALCOHOL/SUB ABUSE ASSESS",35,78.89,28.83,133.88,8.75]
["TUFTS - TUFTS POS - HCPCS - G2011","TUFTS","TUFTS POS","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS","G2011 - ALCOHOL/SUB ABUSE ASSESS",35,78.89,28.83,133.88,8.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G2011","BMC HEALTHNET","BMCHN QHP","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS","G2011 - ALCOHOL/SUB ABUSE ASSESS",35,0,28.83,133.88,8.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G2011","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS","G2011 - ALCOHOL/SUB ABUSE ASSESS",35,133.88,28.83,133.88,8.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G2011","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS","G2011 - ALCOHOL/SUB ABUSE ASSESS",35,28.83,28.83,133.88,8.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G2011","BMC HEALTHNET","BMCHN ACO","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS","G2011 - ALCOHOL/SUB ABUSE ASSESS",35,0,28.83,133.88,8.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G2011","BMC HEALTHNET","BMCHN MCO","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS","G2011 - ALCOHOL/SUB ABUSE ASSESS",35,0,28.83,133.88,8.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G2011","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS","G2011 - ALCOHOL/SUB ABUSE ASSESS",35,0,28.83,133.88,8.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G2011","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS","G2011 - ALCOHOL/SUB ABUSE ASSESS",35,0,28.83,133.88,8.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G2011","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS","G2011 - ALCOHOL/SUB ABUSE ASSESS",35,0,28.83,133.88,8.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G2011","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS","G2011 - ALCOHOL/SUB ABUSE ASSESS",35,28.83,28.83,133.88,8.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G2011","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS","G2011 - ALCOHOL/SUB ABUSE ASSESS",35,28.83,28.83,133.88,8.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G2011","BLUE CROSS","BLUE CROSS-PPO","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS","G2011 - ALCOHOL/SUB ABUSE ASSESS",35,28.83,28.83,133.88,8.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G2011","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS","G2011 - ALCOHOL/SUB ABUSE ASSESS",35,28.83,28.83,133.88,8.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G2011","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS","G2011 - ALCOHOL/SUB ABUSE ASSESS",35,28.83,28.83,133.88,8.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G2011","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS","G2011 - ALCOHOL/SUB ABUSE ASSESS",35,28.83,28.83,133.88,8.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G2012","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G2012","HC BRIEF CHECK IN BY MD/QHP","G2012 - HC BRIEF CHECK IN BY MD/QHP",42,0,31.78,31.78,10.5]
["TUFTS - TUFTS PPO - HCPCS - G2012","TUFTS","TUFTS PPO","HCPCS","G2012","HC BRIEF CHECK IN BY MD/QHP","G2012 - HC BRIEF CHECK IN BY MD/QHP",42,0,31.78,31.78,10.5]
["TUFTS - TUFTS SELECT - HCPCS - G2012","TUFTS","TUFTS SELECT","HCPCS","G2012","HC BRIEF CHECK IN BY MD/QHP","G2012 - HC BRIEF CHECK IN BY MD/QHP",42,0,31.78,31.78,10.5]
["FALLON - FALLON MEDICAID - HCPCS - G2012","FALLON","FALLON MEDICAID","HCPCS","G2012","HC BRIEF CHECK IN BY MD/QHP","G2012 - HC BRIEF CHECK IN BY MD/QHP",42,0,31.78,31.78,10.5]
["TUFTS - TUFTS POS - HCPCS - G2012","TUFTS","TUFTS POS","HCPCS","G2012","HC BRIEF CHECK IN BY MD/QHP","G2012 - HC BRIEF CHECK IN BY MD/QHP",42,0,31.78,31.78,10.5]
["TUFTS - TUFTS HMO - HCPCS - G2012","TUFTS","TUFTS HMO","HCPCS","G2012","HC BRIEF CHECK IN BY MD/QHP","G2012 - HC BRIEF CHECK IN BY MD/QHP",42,0,31.78,31.78,10.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G2012","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G2012","HC BRIEF CHECK IN BY MD/QHP","G2012 - HC BRIEF CHECK IN BY MD/QHP",42,31.78,31.78,31.78,10.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G2012","BMC HEALTHNET","BMCHN ACO","HCPCS","G2012","HC BRIEF CHECK IN BY MD/QHP","G2012 - HC BRIEF CHECK IN BY MD/QHP",42,0,31.78,31.78,10.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G2012","BMC HEALTHNET","BMCHN QHP","HCPCS","G2012","HC BRIEF CHECK IN BY MD/QHP","G2012 - HC BRIEF CHECK IN BY MD/QHP",42,0,31.78,31.78,10.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G2012","BMC HEALTHNET","BMCHN MCO","HCPCS","G2012","HC BRIEF CHECK IN BY MD/QHP","G2012 - HC BRIEF CHECK IN BY MD/QHP",42,0,31.78,31.78,10.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G2012","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G2012","HC BRIEF CHECK IN BY MD/QHP","G2012 - HC BRIEF CHECK IN BY MD/QHP",42,0,31.78,31.78,10.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G2012","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G2012","HC BRIEF CHECK IN BY MD/QHP","G2012 - HC BRIEF CHECK IN BY MD/QHP",42,0,31.78,31.78,10.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G2012","BLUE CROSS","BLUE CROSS-PPO","HCPCS","G2012","HC BRIEF CHECK IN BY MD/QHP","G2012 - HC BRIEF CHECK IN BY MD/QHP",42,31.78,31.78,31.78,10.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G2012","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G2012","HC BRIEF CHECK IN BY MD/QHP","G2012 - HC BRIEF CHECK IN BY MD/QHP",42,0,31.78,31.78,10.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G2012","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G2012","HC BRIEF CHECK IN BY MD/QHP","G2012 - HC BRIEF CHECK IN BY MD/QHP",42,31.78,31.78,31.78,10.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G2012","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G2012","HC BRIEF CHECK IN BY MD/QHP","G2012 - HC BRIEF CHECK IN BY MD/QHP",42,31.78,31.78,31.78,10.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G2012","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G2012","HC BRIEF CHECK IN BY MD/QHP","G2012 - HC BRIEF CHECK IN BY MD/QHP",42,0,31.78,31.78,10.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G2012","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G2012","HC BRIEF CHECK IN BY MD/QHP","G2012 - HC BRIEF CHECK IN BY MD/QHP",42,31.78,31.78,31.78,10.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G2012","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G2012","HC BRIEF CHECK IN BY MD/QHP","G2012 - HC BRIEF CHECK IN BY MD/QHP",42,31.78,31.78,31.78,10.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G2012","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G2012","HC BRIEF CHECK IN BY MD/QHP","G2012 - HC BRIEF CHECK IN BY MD/QHP",42,31.78,31.78,31.78,10.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G2023","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,40.634999999999998,23.46,212.71,7.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - HCPCS - G2023","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,51.204999999999998,23.46,212.71,7.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - HCPCS - G2023","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,39.86,23.46,212.71,7.75]
["FALLON - FALLON MEDICAID - HCPCS - G2023","FALLON","FALLON MEDICAID","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,33.865000000000002,23.46,212.71,7.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G2023","BMC HEALTHNET","BMCHN MCO","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,33.865000000000002,23.46,212.71,7.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G2023","BMC HEALTHNET","BMCHN QHP","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,40.634999999999998,23.46,212.71,7.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G2023","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,33.865000000000002,23.46,212.71,7.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G2023","BMC HEALTHNET","BMCHN ACO","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,74.094999999999999,23.46,212.71,7.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G2023","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,39.96,23.46,212.71,7.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G2023","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,45.954999999999998,23.46,212.71,7.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - G2023","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,28.15,23.46,212.71,7.75]
["TUFTS - TUFTS PPO - HCPCS - G2023","TUFTS","TUFTS PPO","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,75.680000000000007,23.46,212.71,7.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - G2023","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,28.15,23.46,212.71,7.75]
["TUFTS - TUFTS SPIRIT - HCPCS - G2023","TUFTS","TUFTS SPIRIT","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,25.81,23.46,212.71,7.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - G2023","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,31.63,23.46,212.71,7.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - G2023","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,49.41,23.46,212.71,7.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - G2023","FALLON","FALLON SENIOR PLAN","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,23.46,23.46,212.71,7.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - G2023","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,34.020000000000003,23.46,212.71,7.75]
["TUFTS - TUFTS HMO - HCPCS - G2023","TUFTS","TUFTS HMO","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,90.81,23.46,212.71,7.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - G2023","TUFTS","TUFTS MEDICARE SCO","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,34.020000000000003,23.46,212.71,7.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - G2023","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,50.65,23.46,212.71,7.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - G2023","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,40.82,23.46,212.71,7.75]
["TUFTS - TUFTS POS - HCPCS - G2023","TUFTS","TUFTS POS","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,75.680000000000007,23.46,212.71,7.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G2023","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,26.99,23.46,212.71,7.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - G2023","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,51.84,23.46,212.71,7.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G2023","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,212.71,23.46,212.71,7.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - G2023","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,23.46,23.46,212.71,7.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - G2023","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,23.46,23.46,212.71,7.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - G2023","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,23.46,23.46,212.71,7.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - G2023","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,59.03,23.46,212.71,7.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G2023","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,26.99,23.46,212.71,7.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G2023","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,26.99,23.46,212.71,7.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G2023","BLUE CROSS","BLUE CROSS-PPO","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,26.99,23.46,212.71,7.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G2023","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,26.99,23.46,212.71,7.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G2023","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,26.99,23.46,212.71,7.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - G2023","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,27.68,23.46,212.71,7.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G2023","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",31,26.99,23.46,212.71,7.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G2024","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,43.035000000000004,25.46,230.84,8.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - HCPCS - G2024","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,54.23,25.46,230.84,8.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - HCPCS - G2024","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,42.215000000000003,25.46,230.84,8.25]
["FALLON - FALLON MEDICAID - HCPCS - G2024","FALLON","FALLON MEDICAID","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,35.865000000000002,25.46,230.84,8.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G2024","BMC HEALTHNET","BMCHN ACO","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,78.474999999999994,25.46,230.84,8.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G2024","BMC HEALTHNET","BMCHN MCO","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,35.865000000000002,25.46,230.84,8.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G2024","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,35.865000000000002,25.46,230.84,8.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G2024","BMC HEALTHNET","BMCHN QHP","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,43.035000000000004,25.46,230.84,8.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G2024","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,48.67,25.46,230.84,8.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G2024","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,42.32,25.46,230.84,8.25]
["TUFTS - TUFTS PPO - HCPCS - G2024","TUFTS","TUFTS PPO","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,82.13,25.46,230.84,8.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - G2024","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,30.55,25.46,230.84,8.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - G2024","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,53.62,25.46,230.84,8.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - G2024","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,30.55,25.46,230.84,8.25]
["TUFTS - TUFTS SPIRIT - HCPCS - G2024","TUFTS","TUFTS SPIRIT","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,28.01,25.46,230.84,8.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - G2024","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,34.33,25.46,230.84,8.25]
["TUFTS - TUFTS HMO - HCPCS - G2024","TUFTS","TUFTS HMO","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,98.55,25.46,230.84,8.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - G2024","FALLON","FALLON SENIOR PLAN","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,25.46,25.46,230.84,8.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - G2024","TUFTS","TUFTS MEDICARE SCO","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,36.92,25.46,230.84,8.25]
["TUFTS - TUFTS POS - HCPCS - G2024","TUFTS","TUFTS POS","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,82.13,25.46,230.84,8.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - G2024","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,36.92,25.46,230.84,8.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - G2024","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,54.97,25.46,230.84,8.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - G2024","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,44.3,25.46,230.84,8.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G2024","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,29.29,25.46,230.84,8.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - G2024","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,56.26,25.46,230.84,8.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - G2024","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,25.46,25.46,230.84,8.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - G2024","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,25.46,25.46,230.84,8.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - G2024","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,25.46,25.46,230.84,8.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G2024","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,230.84,25.46,230.84,8.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G2024","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,29.29,25.46,230.84,8.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G2024","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,29.29,25.46,230.84,8.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G2024","BLUE CROSS","BLUE CROSS-PPO","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,29.29,25.46,230.84,8.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G2024","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,29.29,25.46,230.84,8.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - G2024","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,30.04,25.46,230.84,8.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G2024","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,29.29,25.46,230.84,8.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - G2024","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,64.06,25.46,230.84,8.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G2024","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",33,29.29,25.46,230.84,8.25]
["TUFTS - TUFTS PPO - HCPCS - G2066","TUFTS","TUFTS PPO","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH",165,131.81,58.35,370.47,41.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G2066","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH",165,80.23,58.35,370.47,41.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G2066","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH",165,0,58.35,370.47,41.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G2066","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH",165,78.260000000000005,58.35,370.47,41.25]
["FALLON - FALLON MEDICAID - HCPCS - G2066","FALLON","FALLON MEDICAID","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH",165,0,58.35,370.47,41.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G2066","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH",165,80.23,58.35,370.47,41.25]
["TUFTS - TUFTS HMO - HCPCS - G2066","TUFTS","TUFTS HMO","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH",165,147.85,58.35,370.47,41.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G2066","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH",165,80.23,58.35,370.47,41.25]
["TUFTS - TUFTS POS - HCPCS - G2066","TUFTS","TUFTS POS","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH",165,123.21,58.35,370.47,41.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G2066","BMC HEALTHNET","BMCHN QHP","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH",165,0,58.35,370.47,41.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G2066","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH",165,58.35,58.35,370.47,41.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G2066","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH",165,370.47,58.35,370.47,41.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G2066","BMC HEALTHNET","BMCHN ACO","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH",165,0,58.35,370.47,41.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G2066","BMC HEALTHNET","BMCHN MCO","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH",165,0,58.35,370.47,41.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G2066","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH",165,0,58.35,370.47,41.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G2066","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH",165,0,58.35,370.47,41.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G2066","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH",165,0,58.35,370.47,41.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G2066","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH",165,58.35,58.35,370.47,41.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G2066","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH",165,58.35,58.35,370.47,41.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G2066","BLUE CROSS","BLUE CROSS-PPO","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH",165,58.35,58.35,370.47,41.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G2066","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH",165,58.35,58.35,370.47,41.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G2066","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH",165,58.35,58.35,370.47,41.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G2066","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH",165,58.35,58.35,370.47,41.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G2086","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G2086","HC OFF BASE OPIOID TX 70MIN","G2086 - HC OFF BASE OPIOID TX 70MIN",194,0,46.18,211.43,48.5]
["TUFTS - TUFTS PPO - HCPCS - G2086","TUFTS","TUFTS PPO","HCPCS","G2086","HC OFF BASE OPIOID TX 70MIN","G2086 - HC OFF BASE OPIOID TX 70MIN",194,46.18,46.18,211.43,48.5]
["FALLON - FALLON MEDICAID - HCPCS - G2086","FALLON","FALLON MEDICAID","HCPCS","G2086","HC OFF BASE OPIOID TX 70MIN","G2086 - HC OFF BASE OPIOID TX 70MIN",194,0,46.18,211.43,48.5]
["TUFTS - TUFTS POS - HCPCS - G2086","TUFTS","TUFTS POS","HCPCS","G2086","HC OFF BASE OPIOID TX 70MIN","G2086 - HC OFF BASE OPIOID TX 70MIN",194,46.18,46.18,211.43,48.5]
["TUFTS - TUFTS HMO - HCPCS - G2086","TUFTS","TUFTS HMO","HCPCS","G2086","HC OFF BASE OPIOID TX 70MIN","G2086 - HC OFF BASE OPIOID TX 70MIN",194,55.42,46.18,211.43,48.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G2086","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G2086","HC OFF BASE OPIOID TX 70MIN","G2086 - HC OFF BASE OPIOID TX 70MIN",194,211.43,46.18,211.43,48.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G2086","BMC HEALTHNET","BMCHN ACO","HCPCS","G2086","HC OFF BASE OPIOID TX 70MIN","G2086 - HC OFF BASE OPIOID TX 70MIN",194,0,46.18,211.43,48.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G2086","BMC HEALTHNET","BMCHN QHP","HCPCS","G2086","HC OFF BASE OPIOID TX 70MIN","G2086 - HC OFF BASE OPIOID TX 70MIN",194,0,46.18,211.43,48.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G2086","BMC HEALTHNET","BMCHN MCO","HCPCS","G2086","HC OFF BASE OPIOID TX 70MIN","G2086 - HC OFF BASE OPIOID TX 70MIN",194,0,46.18,211.43,48.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G2086","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G2086","HC OFF BASE OPIOID TX 70MIN","G2086 - HC OFF BASE OPIOID TX 70MIN",194,129.81,46.18,211.43,48.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G2086","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G2086","HC OFF BASE OPIOID TX 70MIN","G2086 - HC OFF BASE OPIOID TX 70MIN",194,0,46.18,211.43,48.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G2086","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G2086","HC OFF BASE OPIOID TX 70MIN","G2086 - HC OFF BASE OPIOID TX 70MIN",194,211.43,46.18,211.43,48.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G2086","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G2086","HC OFF BASE OPIOID TX 70MIN","G2086 - HC OFF BASE OPIOID TX 70MIN",194,0,46.18,211.43,48.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G2086","BLUE CROSS","BLUE CROSS-PPO","HCPCS","G2086","HC OFF BASE OPIOID TX 70MIN","G2086 - HC OFF BASE OPIOID TX 70MIN",194,211.43,46.18,211.43,48.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G2086","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G2086","HC OFF BASE OPIOID TX 70MIN","G2086 - HC OFF BASE OPIOID TX 70MIN",194,211.43,46.18,211.43,48.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G2086","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G2086","HC OFF BASE OPIOID TX 70MIN","G2086 - HC OFF BASE OPIOID TX 70MIN",194,0,46.18,211.43,48.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G2086","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G2086","HC OFF BASE OPIOID TX 70MIN","G2086 - HC OFF BASE OPIOID TX 70MIN",194,211.43,46.18,211.43,48.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G2086","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G2086","HC OFF BASE OPIOID TX 70MIN","G2086 - HC OFF BASE OPIOID TX 70MIN",194,211.43,46.18,211.43,48.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G2086","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G2086","HC OFF BASE OPIOID TX 70MIN","G2086 - HC OFF BASE OPIOID TX 70MIN",194,211.43,46.18,211.43,48.5]
["TUFTS - TUFTS PPO - HCPCS - G2087","TUFTS","TUFTS PPO","HCPCS","G2087","HC OFF BASE OPIOID TX, 60 M","G2087 - HC OFF BASE OPIOID TX, 60 M",194,46.18,46.18,211.43,48.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G2087","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G2087","HC OFF BASE OPIOID TX, 60 M","G2087 - HC OFF BASE OPIOID TX, 60 M",194,0,46.18,211.43,48.5]
["FALLON - FALLON MEDICAID - HCPCS - G2087","FALLON","FALLON MEDICAID","HCPCS","G2087","HC OFF BASE OPIOID TX, 60 M","G2087 - HC OFF BASE OPIOID TX, 60 M",194,0,46.18,211.43,48.5]
["TUFTS - TUFTS HMO - HCPCS - G2087","TUFTS","TUFTS HMO","HCPCS","G2087","HC OFF BASE OPIOID TX, 60 M","G2087 - HC OFF BASE OPIOID TX, 60 M",194,55.42,46.18,211.43,48.5]
["TUFTS - TUFTS POS - HCPCS - G2087","TUFTS","TUFTS POS","HCPCS","G2087","HC OFF BASE OPIOID TX, 60 M","G2087 - HC OFF BASE OPIOID TX, 60 M",194,46.18,46.18,211.43,48.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G2087","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G2087","HC OFF BASE OPIOID TX, 60 M","G2087 - HC OFF BASE OPIOID TX, 60 M",194,211.43,46.18,211.43,48.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G2087","BMC HEALTHNET","BMCHN QHP","HCPCS","G2087","HC OFF BASE OPIOID TX, 60 M","G2087 - HC OFF BASE OPIOID TX, 60 M",194,0,46.18,211.43,48.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G2087","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G2087","HC OFF BASE OPIOID TX, 60 M","G2087 - HC OFF BASE OPIOID TX, 60 M",194,129.81,46.18,211.43,48.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G2087","BMC HEALTHNET","BMCHN ACO","HCPCS","G2087","HC OFF BASE OPIOID TX, 60 M","G2087 - HC OFF BASE OPIOID TX, 60 M",194,0,46.18,211.43,48.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G2087","BMC HEALTHNET","BMCHN MCO","HCPCS","G2087","HC OFF BASE OPIOID TX, 60 M","G2087 - HC OFF BASE OPIOID TX, 60 M",194,0,46.18,211.43,48.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G2087","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G2087","HC OFF BASE OPIOID TX, 60 M","G2087 - HC OFF BASE OPIOID TX, 60 M",194,0,46.18,211.43,48.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G2087","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G2087","HC OFF BASE OPIOID TX, 60 M","G2087 - HC OFF BASE OPIOID TX, 60 M",194,0,46.18,211.43,48.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G2087","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G2087","HC OFF BASE OPIOID TX, 60 M","G2087 - HC OFF BASE OPIOID TX, 60 M",194,0,46.18,211.43,48.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G2087","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G2087","HC OFF BASE OPIOID TX, 60 M","G2087 - HC OFF BASE OPIOID TX, 60 M",194,211.43,46.18,211.43,48.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G2087","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G2087","HC OFF BASE OPIOID TX, 60 M","G2087 - HC OFF BASE OPIOID TX, 60 M",194,211.43,46.18,211.43,48.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G2087","BLUE CROSS","BLUE CROSS-PPO","HCPCS","G2087","HC OFF BASE OPIOID TX, 60 M","G2087 - HC OFF BASE OPIOID TX, 60 M",194,211.43,46.18,211.43,48.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G2087","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G2087","HC OFF BASE OPIOID TX, 60 M","G2087 - HC OFF BASE OPIOID TX, 60 M",194,211.43,46.18,211.43,48.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G2087","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G2087","HC OFF BASE OPIOID TX, 60 M","G2087 - HC OFF BASE OPIOID TX, 60 M",194,211.43,46.18,211.43,48.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G2087","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G2087","HC OFF BASE OPIOID TX, 60 M","G2087 - HC OFF BASE OPIOID TX, 60 M",194,211.43,46.18,211.43,48.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G2088","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G2088","HC OFF BASE OPIOID TX, ADD30","G2088 - HC OFF BASE OPIOID TX, ADD30",45,0,82.11,82.11,11.25]
["FALLON - FALLON MEDICAID - HCPCS - G2088","FALLON","FALLON MEDICAID","HCPCS","G2088","HC OFF BASE OPIOID TX, ADD30","G2088 - HC OFF BASE OPIOID TX, ADD30",45,0,82.11,82.11,11.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G2088","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G2088","HC OFF BASE OPIOID TX, ADD30","G2088 - HC OFF BASE OPIOID TX, ADD30",45,82.11,82.11,82.11,11.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G2088","BMC HEALTHNET","BMCHN ACO","HCPCS","G2088","HC OFF BASE OPIOID TX, ADD30","G2088 - HC OFF BASE OPIOID TX, ADD30",45,0,82.11,82.11,11.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G2088","BMC HEALTHNET","BMCHN QHP","HCPCS","G2088","HC OFF BASE OPIOID TX, ADD30","G2088 - HC OFF BASE OPIOID TX, ADD30",45,0,82.11,82.11,11.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G2088","BMC HEALTHNET","BMCHN MCO","HCPCS","G2088","HC OFF BASE OPIOID TX, ADD30","G2088 - HC OFF BASE OPIOID TX, ADD30",45,0,82.11,82.11,11.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G2088","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G2088","HC OFF BASE OPIOID TX, ADD30","G2088 - HC OFF BASE OPIOID TX, ADD30",45,0,82.11,82.11,11.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G2088","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G2088","HC OFF BASE OPIOID TX, ADD30","G2088 - HC OFF BASE OPIOID TX, ADD30",45,82.11,82.11,82.11,11.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G2088","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G2088","HC OFF BASE OPIOID TX, ADD30","G2088 - HC OFF BASE OPIOID TX, ADD30",45,0,82.11,82.11,11.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G2088","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G2088","HC OFF BASE OPIOID TX, ADD30","G2088 - HC OFF BASE OPIOID TX, ADD30",45,82.11,82.11,82.11,11.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G2088","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G2088","HC OFF BASE OPIOID TX, ADD30","G2088 - HC OFF BASE OPIOID TX, ADD30",45,0,82.11,82.11,11.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - G2088","BLUE CROSS","BLUE CROSS-PPO","HCPCS","G2088","HC OFF BASE OPIOID TX, ADD30","G2088 - HC OFF BASE OPIOID TX, ADD30",45,82.11,82.11,82.11,11.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G2088","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G2088","HC OFF BASE OPIOID TX, ADD30","G2088 - HC OFF BASE OPIOID TX, ADD30",45,82.11,82.11,82.11,11.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G2088","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G2088","HC OFF BASE OPIOID TX, ADD30","G2088 - HC OFF BASE OPIOID TX, ADD30",45,82.11,82.11,82.11,11.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G2088","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G2088","HC OFF BASE OPIOID TX, ADD30","G2088 - HC OFF BASE OPIOID TX, ADD30",45,82.11,82.11,82.11,11.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G2212","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G2212","HC PROLONG OUTPT/OFFICE VIS","G2212 - HC PROLONG OUTPT/OFFICE VIS",188,0,0,0,47]
["FALLON - FALLON MEDICAID - HCPCS - G2212","FALLON","FALLON MEDICAID","HCPCS","G2212","HC PROLONG OUTPT/OFFICE VIS","G2212 - HC PROLONG OUTPT/OFFICE VIS",188,0,0,0,47]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G2212","BMC HEALTHNET","BMCHN QHP","HCPCS","G2212","HC PROLONG OUTPT/OFFICE VIS","G2212 - HC PROLONG OUTPT/OFFICE VIS",188,0,0,0,47]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G2212","BMC HEALTHNET","BMCHN ACO","HCPCS","G2212","HC PROLONG OUTPT/OFFICE VIS","G2212 - HC PROLONG OUTPT/OFFICE VIS",188,0,0,0,47]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G2212","BMC HEALTHNET","BMCHN MCO","HCPCS","G2212","HC PROLONG OUTPT/OFFICE VIS","G2212 - HC PROLONG OUTPT/OFFICE VIS",188,0,0,0,47]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G2212","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G2212","HC PROLONG OUTPT/OFFICE VIS","G2212 - HC PROLONG OUTPT/OFFICE VIS",188,0,0,0,47]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G2212","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G2212","HC PROLONG OUTPT/OFFICE VIS","G2212 - HC PROLONG OUTPT/OFFICE VIS",188,0,0,0,47]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G2212","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G2212","HC PROLONG OUTPT/OFFICE VIS","G2212 - HC PROLONG OUTPT/OFFICE VIS",188,0,0,0,47]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G2216","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G2216","HC HOME SUPPLY INJECT NALOXON","G2216 - HC HOME SUPPLY INJECT NALOXON",118,0,0,0,29.5]
["FALLON - FALLON MEDICAID - HCPCS - G2216","FALLON","FALLON MEDICAID","HCPCS","G2216","HC HOME SUPPLY INJECT NALOXON","G2216 - HC HOME SUPPLY INJECT NALOXON",118,0,0,0,29.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - G2216","BMC HEALTHNET","BMCHN ACO","HCPCS","G2216","HC HOME SUPPLY INJECT NALOXON","G2216 - HC HOME SUPPLY INJECT NALOXON",118,0,0,0,29.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - G2216","BMC HEALTHNET","BMCHN QHP","HCPCS","G2216","HC HOME SUPPLY INJECT NALOXON","G2216 - HC HOME SUPPLY INJECT NALOXON",118,0,0,0,29.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - G2216","BMC HEALTHNET","BMCHN MCO","HCPCS","G2216","HC HOME SUPPLY INJECT NALOXON","G2216 - HC HOME SUPPLY INJECT NALOXON",118,0,0,0,29.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G2216","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G2216","HC HOME SUPPLY INJECT NALOXON","G2216 - HC HOME SUPPLY INJECT NALOXON",118,0,0,0,29.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G2216","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G2216","HC HOME SUPPLY INJECT NALOXON","G2216 - HC HOME SUPPLY INJECT NALOXON",118,0,0,0,29.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G2216","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G2216","HC HOME SUPPLY INJECT NALOXON","G2216 - HC HOME SUPPLY INJECT NALOXON",118,0,0,0,29.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - J0702","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666666,116.03000000000002,132.62,33.155000000000001]
["TUFTS - TUFTS SELECT - HCPCS - J0702","TUFTS","TUFTS SELECT","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - J0702","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["TUFTS - TUFTS SPIRIT - HCPCS - J0702","TUFTS","TUFTS SPIRIT","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - J0702","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - J0702","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666666,116.03000000000002,132.62,33.155000000000001]
["UNICARE - UNICARE - HCPCS - J0702","UNICARE","UNICARE","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - J0702","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["TUFTS - TUFTS PPO - HCPCS - J0702","TUFTS","TUFTS PPO","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - J0702","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666666,116.03000000000002,132.62,33.155000000000001]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - J0702","TUFTS","TUFTS MEDICARE SCO","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["TUFTS - TUFTS HMO - HCPCS - J0702","TUFTS","TUFTS HMO","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - J0702","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - J0702","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666666,116.03000000000002,132.62,33.155000000000001]
["TUFTS - TUFTS POS - HCPCS - J0702","TUFTS","TUFTS POS","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["FALLON - FALLON SENIOR PLAN - HCPCS - J0702","FALLON","FALLON SENIOR PLAN","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666666,116.03000000000002,132.62,33.155000000000001]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - J0702","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - J0702","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - J0702","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - J0702","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666666,116.03000000000002,132.62,33.155000000000001]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - J0702","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - J0702","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - J0702","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666666,116.03000000000002,132.62,33.155000000000001]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - J0702","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - J0702","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - J0702","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - J0702","BLUE CROSS","BLUE CROSS-PPO","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666666,116.03000000000002,132.62,33.155000000000001]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - J0702","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - J0702","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666666,116.03000000000002,132.62,33.155000000000001]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - J0702","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - J0702","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - J0702","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - J0702","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - J0702","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",132.62,122.30666666666667,116.03000000000002,132.62,33.155000000000001]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - J1030","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.69,23.59,26.88,6.72]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - J1030","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.689999999999998,23.59,26.88,6.72]
["TUFTS - TUFTS SPIRIT - HCPCS - J1030","TUFTS","TUFTS SPIRIT","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.689999999999998,23.59,26.88,6.72]
["UNICARE - UNICARE - HCPCS - J1030","UNICARE","UNICARE","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.689999999999998,23.59,26.88,6.72]
["TUFTS - TUFTS SELECT - HCPCS - J1030","TUFTS","TUFTS SELECT","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.689999999999998,23.59,26.88,6.72]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - J1030","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.689999999999998,23.59,26.88,6.72]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - J1030","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.69,23.59,26.88,6.72]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - J1030","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.69,23.59,26.88,6.72]
["TUFTS - TUFTS PPO - HCPCS - J1030","TUFTS","TUFTS PPO","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.69,23.59,26.88,6.72]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - J1030","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.689999999999998,23.59,26.88,6.72]
["FALLON - FALLON SENIOR PLAN - HCPCS - J1030","FALLON","FALLON SENIOR PLAN","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.689999999999998,23.59,26.88,6.72]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - J1030","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.689999999999998,23.59,26.88,6.72]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - J1030","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.689999999999998,23.59,26.88,6.72]
["TUFTS - TUFTS HMO - HCPCS - J1030","TUFTS","TUFTS HMO","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.689999999999998,23.59,26.88,6.72]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - J1030","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.689999999999998,23.59,26.88,6.72]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - J1030","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.689999999999998,23.59,26.88,6.72]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - J1030","TUFTS","TUFTS MEDICARE SCO","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.69,23.59,26.88,6.72]
["TUFTS - TUFTS POS - HCPCS - J1030","TUFTS","TUFTS POS","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.689999999999998,23.59,26.88,6.72]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - J1030","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.689999999999998,23.59,26.88,6.72]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - J1030","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.689999999999998,23.59,26.88,6.72]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - J1030","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.689999999999998,23.59,26.88,6.72]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - J1030","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.69,23.59,26.88,6.72]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - J1030","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.689999999999998,23.59,26.88,6.72]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - J1030","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.689999999999998,23.59,26.88,6.72]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - J1030","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.689999999999998,23.59,26.88,6.72]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - J1030","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.689999999999998,23.59,26.88,6.72]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - J1030","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.689999999999998,23.59,26.88,6.72]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - J1030","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.689999999999998,23.59,26.88,6.72]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - J1030","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.69,23.59,26.88,6.72]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - J1030","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.69,23.59,26.88,6.72]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - J1030","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.689999999999998,23.59,26.88,6.72]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - J1030","BLUE CROSS","BLUE CROSS-PPO","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.689999999999998,23.59,26.88,6.72]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - J1030","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.689999999999998,23.59,26.88,6.72]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - J1030","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",26.88,24.689999999999998,23.59,26.88,6.72]
["TUFTS - TUFTS PPO - HCPCS - J1250","TUFTS","TUFTS PPO","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - J1250","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - J1250","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["UNICARE - UNICARE - HCPCS - J1250","UNICARE","UNICARE","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["TUFTS - TUFTS SELECT - HCPCS - J1250","TUFTS","TUFTS SELECT","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - J1250","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - J1250","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - J1250","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["TUFTS - TUFTS SPIRIT - HCPCS - J1250","TUFTS","TUFTS SPIRIT","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - J1250","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - J1250","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["FALLON - FALLON MEDICAID - HCPCS - J1250","FALLON","FALLON MEDICAID","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - J1250","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["TUFTS - TUFTS HMO - HCPCS - J1250","TUFTS","TUFTS HMO","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["FALLON - FALLON SENIOR PLAN - HCPCS - J1250","FALLON","FALLON SENIOR PLAN","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - J1250","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - J1250","TUFTS","TUFTS MEDICARE SCO","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - J1250","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - J1250","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["TUFTS - TUFTS POS - HCPCS - J1250","TUFTS","TUFTS POS","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - J1250","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - J1250","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - J1250","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["BMC HEALTHNET - BMCHN MCO - HCPCS - J1250","BMC HEALTHNET","BMCHN MCO","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - J1250","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - J1250","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["BMC HEALTHNET - BMCHN QHP - HCPCS - J1250","BMC HEALTHNET","BMCHN QHP","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - J1250","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["BMC HEALTHNET - BMCHN ACO - HCPCS - J1250","BMC HEALTHNET","BMCHN ACO","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - J1250","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - J1250","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - J1250","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - J1250","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - J1250","BLUE CROSS","BLUE CROSS-PPO","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - J1250","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - J1250","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - J1250","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - J1250","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - J1250","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - J1250","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - J1250","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - J1250","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","J1250","HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG",44.41,26.86,17.55,44.41,11.102499999999999]
["UNICARE - UNICARE - HCPCS - J2790","UNICARE","UNICARE","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - J2790","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["TUFTS - TUFTS PPO - HCPCS - J2790","TUFTS","TUFTS PPO","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - J2790","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - J2790","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - J2790","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["TUFTS - TUFTS SELECT - HCPCS - J2790","TUFTS","TUFTS SELECT","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["TUFTS - TUFTS SPIRIT - HCPCS - J2790","TUFTS","TUFTS SPIRIT","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - J2790","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - J2790","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - J2790","TUFTS","TUFTS MEDICARE SCO","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["FALLON - FALLON SENIOR PLAN - HCPCS - J2790","FALLON","FALLON SENIOR PLAN","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - J2790","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["TUFTS - TUFTS HMO - HCPCS - J2790","TUFTS","TUFTS HMO","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - J2790","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - J2790","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - J2790","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - J2790","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["TUFTS - TUFTS POS - HCPCS - J2790","TUFTS","TUFTS POS","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - J2790","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - J2790","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - J2790","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - J2790","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - J2790","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - J2790","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - J2790","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - J2790","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - J2790","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - J2790","BLUE CROSS","BLUE CROSS-PPO","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - J2790","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - J2790","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - J2790","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - J2790","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - J2790","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG",186.95,0,74.3,186.95,46.737499999999997]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - J3301","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS",157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - J3301","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS",157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - J3301","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS",157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["TUFTS - TUFTS PPO - HCPCS - J3301","TUFTS","TUFTS PPO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS",157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - J3301","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS",157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["TUFTS - TUFTS SELECT - HCPCS - J3301","TUFTS","TUFTS SELECT","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS",157.52000000000001,47.705714285714294,3.11,157.52000000000001,39.380000000000003]
["UNICARE - UNICARE - HCPCS - J3301","UNICARE","UNICARE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS",157.52000000000001,47.705714285714294,3.11,157.52000000000001,39.380000000000003]
["TUFTS - TUFTS SPIRIT - HCPCS - J3301","TUFTS","TUFTS SPIRIT","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS",157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - J3301","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS",157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - J3301","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS",157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - J3301","TUFTS","TUFTS MEDICARE SCO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS",157.52000000000001,47.705714285714294,3.11,157.52000000000001,39.380000000000003]
["TUFTS - TUFTS HMO - HCPCS - J3301","TUFTS","TUFTS HMO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS",157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - J3301","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS",157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["FALLON - FALLON SENIOR PLAN - HCPCS - J3301","FALLON","FALLON SENIOR PLAN","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS",157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - J3301","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS",157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - J3301","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS",157.52000000000001,47.705714285714294,3.11,157.52000000000001,39.380000000000003]
["TUFTS - TUFTS POS - HCPCS - J3301","TUFTS","TUFTS POS","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS",157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - J3301","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS",157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - J3301","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS",157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - J3301","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS",157.52000000000001,47.705714285714294,3.11,157.52000000000001,39.380000000000003]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - J3301","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS",157.52000000000001,47.705714285714294,3.11,157.52000000000001,39.380000000000003]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - J3301","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS",157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - J3301","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS",157.52000000000001,47.705714285714294,3.11,157.52000000000001,39.380000000000003]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - J3301","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS",157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - J3301","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS",157.52000000000001,47.705714285714294,3.11,157.52000000000001,39.380000000000003]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - J3301","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS",157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - J3301","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS",157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - J3301","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS",157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - J3301","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS",157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - J3301","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS",157.52000000000001,47.705714285714294,3.11,157.52000000000001,39.380000000000003]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - J3301","BLUE CROSS","BLUE CROSS-PPO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS",157.52000000000001,47.705714285714294,3.11,157.52000000000001,39.380000000000003]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - J3301","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS",157.52000000000001,47.705714285714286,3.11,157.52000000000001,39.380000000000003]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - J3301","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS",157.52000000000001,47.705714285714294,3.11,157.52000000000001,39.380000000000003]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - J3301","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS",157.52000000000001,47.705714285714294,3.11,157.52000000000001,39.380000000000003]
["TUFTS - TUFTS PPO - HCPCS - J3590","TUFTS","TUFTS PPO","HCPCS","J3590","COSTAL CARTILAGE ALLOGRAFT","J3590 - COSTAL CARTILAGE ALLOGRAFT",3907.79,1932.97,576,3907.79,976.94749999999999]
["TUFTS - TUFTS SELECT - HCPCS - J3590","TUFTS","TUFTS SELECT","HCPCS","J3590","COSTAL CARTILAGE ALLOGRAFT","J3590 - COSTAL CARTILAGE ALLOGRAFT",3907.79,1932.97,576,3907.79,976.94749999999999]
["TUFTS - TUFTS HMO - HCPCS - J3590","TUFTS","TUFTS HMO","HCPCS","J3590","COSTAL CARTILAGE ALLOGRAFT","J3590 - COSTAL CARTILAGE ALLOGRAFT",3907.79,1932.97,576,3907.79,976.94749999999999]
["TUFTS - TUFTS POS - HCPCS - J3590","TUFTS","TUFTS POS","HCPCS","J3590","COSTAL CARTILAGE ALLOGRAFT","J3590 - COSTAL CARTILAGE ALLOGRAFT",3907.79,1932.97,576,3907.79,976.94749999999999]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - J3590","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","J3590","COSTAL CARTILAGE ALLOGRAFT","J3590 - COSTAL CARTILAGE ALLOGRAFT",3907.79,1932.97,576,3907.79,976.94749999999999]
["TUFTS - TUFTS PPO - HCPCS - J7307","TUFTS","TUFTS PPO","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM","J7307 - HC ETONOGESTREL IMPLANT SYSTEM",3487,3324.9,3162.8,3487,871.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - J7307","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM","J7307 - HC ETONOGESTREL IMPLANT SYSTEM",3487,3324.9,3162.8,3487,871.75]
["TUFTS - TUFTS SELECT - HCPCS - J7307","TUFTS","TUFTS SELECT","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM","J7307 - HC ETONOGESTREL IMPLANT SYSTEM",3487,3324.9,3162.8,3487,871.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - J7307","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM","J7307 - HC ETONOGESTREL IMPLANT SYSTEM",3487,3324.9,3162.8,3487,871.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - J7307","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM","J7307 - HC ETONOGESTREL IMPLANT SYSTEM",3487,3324.9,3162.8,3487,871.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - J7307","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM","J7307 - HC ETONOGESTREL IMPLANT SYSTEM",3487,3324.9,3162.8,3487,871.75]
["TUFTS - TUFTS HMO - HCPCS - J7307","TUFTS","TUFTS HMO","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM","J7307 - HC ETONOGESTREL IMPLANT SYSTEM",3487,3324.9,3162.8,3487,871.75]
["TUFTS - TUFTS POS - HCPCS - J7307","TUFTS","TUFTS POS","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM","J7307 - HC ETONOGESTREL IMPLANT SYSTEM",3487,3324.9,3162.8,3487,871.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - J7307","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM","J7307 - HC ETONOGESTREL IMPLANT SYSTEM",3487,3324.9,3162.8,3487,871.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - J7307","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM","J7307 - HC ETONOGESTREL IMPLANT SYSTEM",3487,3324.9,3162.8,3487,871.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - J7307","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM","J7307 - HC ETONOGESTREL IMPLANT SYSTEM",3487,3324.9,3162.8,3487,871.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - J7307","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM","J7307 - HC ETONOGESTREL IMPLANT SYSTEM",3487,3324.9,3162.8,3487,871.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - J7307","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM","J7307 - HC ETONOGESTREL IMPLANT SYSTEM",3487,3324.9,3162.8,3487,871.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - J7307","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM","J7307 - HC ETONOGESTREL IMPLANT SYSTEM",3487,3324.9,3162.8,3487,871.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - J7307","BLUE CROSS","BLUE CROSS-PPO","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM","J7307 - HC ETONOGESTREL IMPLANT SYSTEM",3487,3324.9,3162.8,3487,871.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - J7307","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM","J7307 - HC ETONOGESTREL IMPLANT SYSTEM",3487,3324.9,3162.8,3487,871.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L0120","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,29.83,24.86,111.59,6.25]
["TUFTS - TUFTS PPO - HCPCS - L0120","TUFTS","TUFTS PPO","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,39.700000000000003,24.86,111.59,6.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L0120","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,0,24.86,111.59,6.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L0120","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,29.83,24.86,111.59,6.25]
["TUFTS - TUFTS SELECT - HCPCS - L0120","TUFTS","TUFTS SELECT","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,37.119999999999997,24.86,111.59,6.25]
["TUFTS - TUFTS SPIRIT - HCPCS - L0120","TUFTS","TUFTS SPIRIT","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,27.35,24.86,111.59,6.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L0120","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,33.520000000000003,24.86,111.59,6.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L0120","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,51.89,24.86,111.59,6.25]
["FALLON - FALLON MEDICAID - HCPCS - L0120","FALLON","FALLON MEDICAID","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,0,24.86,111.59,6.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - L0120","FALLON","FALLON SENIOR PLAN","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,24.86,24.86,111.59,6.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L0120","TUFTS","TUFTS MEDICARE SCO","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,36.049999999999997,24.86,111.59,6.25]
["TUFTS - TUFTS HMO - HCPCS - L0120","TUFTS","TUFTS HMO","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,44.54,24.86,111.59,6.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L0120","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,36.049999999999997,24.86,111.59,6.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L0120","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,53.67,24.86,111.59,6.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L0120","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,43.26,24.86,111.59,6.25]
["TUFTS - TUFTS POS - HCPCS - L0120","TUFTS","TUFTS POS","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,37.119999999999997,24.86,111.59,6.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L0120","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,24.86,24.86,111.59,6.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L0120","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,36.19,24.86,111.59,6.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L0120","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,24.86,24.86,111.59,6.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L0120","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,24.86,24.86,111.59,6.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L0120","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,54.94,24.86,111.59,6.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L0120","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,111.59,24.86,111.59,6.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L0120","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,24.86,24.86,111.59,6.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L0120","BMC HEALTHNET","BMCHN ACO","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,0,24.86,111.59,6.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L0120","BMC HEALTHNET","BMCHN QHP","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,0,24.86,111.59,6.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L0120","BMC HEALTHNET","BMCHN MCO","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,0,24.86,111.59,6.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L0120","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,0,24.86,111.59,6.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L0120","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,36.19,24.86,111.59,6.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L0120","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,29.33,24.86,111.59,6.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L0120","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,0,24.86,111.59,6.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L0120","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,0,24.86,111.59,6.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L0120","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,36.19,24.86,111.59,6.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L0120","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,36.19,24.86,111.59,6.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L0120","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,62.55,24.86,111.59,6.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L0120","BLUE CROSS","BLUE CROSS-PPO","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,36.19,24.86,111.59,6.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L0120","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,36.19,24.86,111.59,6.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L0120","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",25,36.19,24.86,111.59,6.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L0140","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB","L0140 - CERVICAL SEMI-RIGID ADJUSTAB",189,93.02,77.52,347.97,47.25]
["TUFTS - TUFTS PPO - HCPCS - L0140","TUFTS","TUFTS PPO","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB","L0140 - CERVICAL SEMI-RIGID ADJUSTAB",189,123.8,77.52,347.97,47.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L0140","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB","L0140 - CERVICAL SEMI-RIGID ADJUSTAB",189,161.80000000000001,77.52,347.97,47.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L0140","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB","L0140 - CERVICAL SEMI-RIGID ADJUSTAB",189,0,77.52,347.97,47.25]
["TUFTS - TUFTS SELECT - HCPCS - L0140","TUFTS","TUFTS SELECT","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB","L0140 - CERVICAL SEMI-RIGID ADJUSTAB",189,115.74,77.52,347.97,47.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L0140","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB","L0140 - CERVICAL SEMI-RIGID ADJUSTAB",189,93.02,77.52,347.97,47.25]
["TUFTS - TUFTS SPIRIT - HCPCS - L0140","TUFTS","TUFTS SPIRIT","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB","L0140 - CERVICAL SEMI-RIGID ADJUSTAB",189,85.27,77.52,347.97,47.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L0140","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB","L0140 - CERVICAL SEMI-RIGID ADJUSTAB",189,104.51,77.52,347.97,47.25]
["FALLON - FALLON MEDICAID - HCPCS - L0140","FALLON","FALLON MEDICAID","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB","L0140 - CERVICAL SEMI-RIGID ADJUSTAB",189,0,77.52,347.97,47.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - L0140","FALLON","FALLON SENIOR PLAN","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB","L0140 - CERVICAL SEMI-RIGID ADJUSTAB",189,77.52,77.52,347.97,47.25]
["TUFTS - TUFTS HMO - HCPCS - L0140","TUFTS","TUFTS HMO","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB","L0140 - CERVICAL SEMI-RIGID ADJUSTAB",189,138.88999999999999,77.52,347.97,47.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L0140","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB","L0140 - CERVICAL SEMI-RIGID ADJUSTAB",189,112.4,77.52,347.97,47.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L0140","TUFTS","TUFTS MEDICARE SCO","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB","L0140 - CERVICAL SEMI-RIGID ADJUSTAB",189,112.4,77.52,347.97,47.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L0140","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB","L0140 - CERVICAL SEMI-RIGID ADJUSTAB",189,167.37,77.52,347.97,47.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L0140","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB","L0140 - CERVICAL SEMI-RIGID ADJUSTAB",189,134.88,77.52,347.97,47.25]
["TUFTS - TUFTS POS - HCPCS - L0140","TUFTS","TUFTS POS","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB","L0140 - CERVICAL SEMI-RIGID ADJUSTAB",189,115.74,77.52,347.97,47.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L0140","BMC HEALTHNET","BMCHN QHP","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB","L0140 - CERVICAL SEMI-RIGID ADJUSTAB",189,0,77.52,347.97,47.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L0140","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB","L0140 - CERVICAL SEMI-RIGID ADJUSTAB",189,171.31,77.52,347.97,47.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L0140","BMC HEALTHNET","BMCHN ACO","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB","L0140 - CERVICAL SEMI-RIGID ADJUSTAB",189,0,77.52,347.97,47.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L0140","BMC HEALTHNET","BMCHN MCO","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB","L0140 - CERVICAL SEMI-RIGID ADJUSTAB",189,0,77.52,347.97,47.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L0140","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB","L0140 - CERVICAL SEMI-RIGID ADJUSTAB",189,347.97,77.52,347.97,47.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L0140","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB","L0140 - CERVICAL SEMI-RIGID ADJUSTAB",189,77.52,77.52,347.97,47.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L0140","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB","L0140 - CERVICAL SEMI-RIGID ADJUSTAB",189,77.52,77.52,347.97,47.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L0140","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB","L0140 - CERVICAL SEMI-RIGID ADJUSTAB",189,0,77.52,347.97,47.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L0140","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB","L0140 - CERVICAL SEMI-RIGID ADJUSTAB",189,77.52,77.52,347.97,47.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L0140","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB","L0140 - CERVICAL SEMI-RIGID ADJUSTAB",189,77.52,77.52,347.97,47.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L0140","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB","L0140 - CERVICAL SEMI-RIGID ADJUSTAB",189,0,77.52,347.97,47.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L0140","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB","L0140 - CERVICAL SEMI-RIGID ADJUSTAB",189,195.06,77.52,347.97,47.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L0140","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB","L0140 - CERVICAL SEMI-RIGID ADJUSTAB",189,0,77.52,347.97,47.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L0140","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB","L0140 - CERVICAL SEMI-RIGID ADJUSTAB",189,91.47,77.52,347.97,47.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L1820","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,0,142.59,640.03,39.75]
["TUFTS - TUFTS PPO - HCPCS - L1820","TUFTS","TUFTS PPO","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,227.71,142.59,640.03,39.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L1820","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,171.11,142.59,640.03,39.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L1820","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,171.11,142.59,640.03,39.75]
["TUFTS - TUFTS SELECT - HCPCS - L1820","TUFTS","TUFTS SELECT","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,212.87,142.59,640.03,39.75]
["TUFTS - TUFTS SPIRIT - HCPCS - L1820","TUFTS","TUFTS SPIRIT","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,156.85,142.59,640.03,39.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L1820","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,192.24,142.59,640.03,39.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L1820","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,297.62,142.59,640.03,39.75]
["FALLON - FALLON MEDICAID - HCPCS - L1820","FALLON","FALLON MEDICAID","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,0,142.59,640.03,39.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - L1820","FALLON","FALLON SENIOR PLAN","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,142.59,142.59,640.03,39.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L1820","TUFTS","TUFTS MEDICARE SCO","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,206.76,142.59,640.03,39.75]
["TUFTS - TUFTS HMO - HCPCS - L1820","TUFTS","TUFTS HMO","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,255.45,142.59,640.03,39.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L1820","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,206.76,142.59,640.03,39.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L1820","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,307.85000000000002,142.59,640.03,39.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L1820","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,248.11,142.59,640.03,39.75]
["TUFTS - TUFTS POS - HCPCS - L1820","TUFTS","TUFTS POS","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,212.87,142.59,640.03,39.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L1820","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,640.03,142.59,640.03,39.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L1820","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,207.54,142.59,640.03,39.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L1820","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,142.59,142.59,640.03,39.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L1820","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,315.11,142.59,640.03,39.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L1820","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,142.59,142.59,640.03,39.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L1820","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,142.59,142.59,640.03,39.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L1820","BMC HEALTHNET","BMCHN ACO","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,0,142.59,640.03,39.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L1820","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,142.59,142.59,640.03,39.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L1820","BMC HEALTHNET","BMCHN QHP","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,0,142.59,640.03,39.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L1820","BMC HEALTHNET","BMCHN MCO","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,0,142.59,640.03,39.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L1820","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,207.54,142.59,640.03,39.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L1820","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,0,142.59,640.03,39.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L1820","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,207.54,142.59,640.03,39.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L1820","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,0,142.59,640.03,39.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L1820","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,207.54,142.59,640.03,39.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L1820","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,168.26,142.59,640.03,39.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L1820","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,0,142.59,640.03,39.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L1820","BLUE CROSS","BLUE CROSS-PPO","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,207.54,142.59,640.03,39.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L1820","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,207.54,142.59,640.03,39.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L1820","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,358.78,142.59,640.03,39.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L1820","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO",159,207.54,142.59,640.03,39.75]
["TUFTS - TUFTS PPO - HCPCS - L1830","TUFTS","TUFTS PPO","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,130.88,81.95,367.86,19.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L1830","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,98.34,81.95,367.86,19.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L1830","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,171.05,81.95,367.86,19.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L1830","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,0,81.95,367.86,19.5]
["TUFTS - TUFTS SELECT - HCPCS - L1830","TUFTS","TUFTS SELECT","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,122.35,81.95,367.86,19.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L1830","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,98.34,81.95,367.86,19.5]
["TUFTS - TUFTS SPIRIT - HCPCS - L1830","TUFTS","TUFTS SPIRIT","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,90.14,81.95,367.86,19.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L1830","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,110.48,81.95,367.86,19.5]
["FALLON - FALLON MEDICAID - HCPCS - L1830","FALLON","FALLON MEDICAID","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,0,81.95,367.86,19.5]
["FALLON - FALLON SENIOR PLAN - HCPCS - L1830","FALLON","FALLON SENIOR PLAN","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,81.95,81.95,367.86,19.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L1830","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,118.83,81.95,367.86,19.5]
["TUFTS - TUFTS HMO - HCPCS - L1830","TUFTS","TUFTS HMO","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,146.82,81.95,367.86,19.5]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L1830","TUFTS","TUFTS MEDICARE SCO","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,118.83,81.95,367.86,19.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L1830","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,176.93,81.95,367.86,19.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L1830","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,142.59,81.95,367.86,19.5]
["TUFTS - TUFTS POS - HCPCS - L1830","TUFTS","TUFTS POS","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,122.35,81.95,367.86,19.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L1830","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,119.28,81.95,367.86,19.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L1830","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,119.28,81.95,367.86,19.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L1830","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,181.1,81.95,367.86,19.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L1830","BMC HEALTHNET","BMCHN QHP","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,0,81.95,367.86,19.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L1830","BMC HEALTHNET","BMCHN ACO","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,0,81.95,367.86,19.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L1830","BMC HEALTHNET","BMCHN MCO","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,0,81.95,367.86,19.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L1830","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,367.86,81.95,367.86,19.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L1830","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,81.95,81.95,367.86,19.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L1830","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,81.95,81.95,367.86,19.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L1830","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,0,81.95,367.86,19.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L1830","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,81.95,81.95,367.86,19.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L1830","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,81.95,81.95,367.86,19.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L1830","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,206.2,81.95,367.86,19.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L1830","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,0,81.95,367.86,19.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L1830","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,96.7,81.95,367.86,19.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L1830","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,0,81.95,367.86,19.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L1830","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,119.28,81.95,367.86,19.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L1830","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,119.28,81.95,367.86,19.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L1830","BLUE CROSS","BLUE CROSS-PPO","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,119.28,81.95,367.86,19.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L1830","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,119.28,81.95,367.86,19.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L1830","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT",78,119.28,81.95,367.86,19.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L1832","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,892.31,743.59,3337.75,380.75]
["TUFTS - TUFTS PPO - HCPCS - L1832","TUFTS","TUFTS PPO","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,1187.49,743.59,3337.75,380.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L1832","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,0,743.59,3337.75,380.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L1832","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,892.31,743.59,3337.75,380.75]
["TUFTS - TUFTS SELECT - HCPCS - L1832","TUFTS","TUFTS SELECT","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,1110.1199999999999,743.59,3337.75,380.75]
["TUFTS - TUFTS SPIRIT - HCPCS - L1832","TUFTS","TUFTS SPIRIT","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,817.95,743.59,3337.75,380.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L1832","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,1002.51,743.59,3337.75,380.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L1832","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,1552.04,743.59,3337.75,380.75]
["FALLON - FALLON MEDICAID - HCPCS - L1832","FALLON","FALLON MEDICAID","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,0,743.59,3337.75,380.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - L1832","FALLON","FALLON SENIOR PLAN","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,743.59,743.59,3337.75,380.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L1832","TUFTS","TUFTS MEDICARE SCO","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,1078.21,743.59,3337.75,380.75]
["TUFTS - TUFTS HMO - HCPCS - L1832","TUFTS","TUFTS HMO","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,1332.14,743.59,3337.75,380.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L1832","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,1078.21,743.59,3337.75,380.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L1832","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,1605.41,743.59,3337.75,380.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L1832","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,1293.8499999999999,743.59,3337.75,380.75]
["TUFTS - TUFTS POS - HCPCS - L1832","TUFTS","TUFTS POS","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,1110.1199999999999,743.59,3337.75,380.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L1832","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,743.59,743.59,3337.75,380.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L1832","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,743.59,743.59,3337.75,380.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L1832","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,1082.26,743.59,3337.75,380.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L1832","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,1082.26,743.59,3337.75,380.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L1832","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,743.59,743.59,3337.75,380.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L1832","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,1643.24,743.59,3337.75,380.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L1832","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,3337.75,743.59,3337.75,380.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L1832","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,743.59,743.59,3337.75,380.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L1832","BMC HEALTHNET","BMCHN ACO","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,0,743.59,3337.75,380.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L1832","BMC HEALTHNET","BMCHN QHP","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,0,743.59,3337.75,380.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L1832","BMC HEALTHNET","BMCHN MCO","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,0,743.59,3337.75,380.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L1832","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,0,743.59,3337.75,380.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L1832","BLUE CROSS","BLUE CROSS-PPO","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,1082.26,743.59,3337.75,380.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L1832","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,0,743.59,3337.75,380.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L1832","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,1082.26,743.59,3337.75,380.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L1832","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,877.44,743.59,3337.75,380.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L1832","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,0,743.59,3337.75,380.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L1832","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,1082.26,743.59,3337.75,380.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L1832","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,1871.02,743.59,3337.75,380.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L1832","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,1082.26,743.59,3337.75,380.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L1832","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT",1523,1082.26,743.59,3337.75,380.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L1836","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,156.58000000000001,130.47999999999999,585.70000000000005,52.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L1836","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,272.35000000000002,130.47999999999999,585.70000000000005,52.25]
["TUFTS - TUFTS PPO - HCPCS - L1836","TUFTS","TUFTS PPO","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,208.38,130.47999999999999,585.70000000000005,52.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L1836","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,0,130.47999999999999,585.70000000000005,52.25]
["TUFTS - TUFTS SELECT - HCPCS - L1836","TUFTS","TUFTS SELECT","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,194.81,130.47999999999999,585.70000000000005,52.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L1836","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,156.58000000000001,130.47999999999999,585.70000000000005,52.25]
["TUFTS - TUFTS SPIRIT - HCPCS - L1836","TUFTS","TUFTS SPIRIT","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,143.53,130.47999999999999,585.70000000000005,52.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L1836","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,175.91,130.47999999999999,585.70000000000005,52.25]
["TUFTS - TUFTS HMO - HCPCS - L1836","TUFTS","TUFTS HMO","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,233.77,130.47999999999999,585.70000000000005,52.25]
["FALLON - FALLON MEDICAID - HCPCS - L1836","FALLON","FALLON MEDICAID","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,0,130.47999999999999,585.70000000000005,52.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - L1836","FALLON","FALLON SENIOR PLAN","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,130.47999999999999,130.47999999999999,585.70000000000005,52.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L1836","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,189.2,130.47999999999999,585.70000000000005,52.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L1836","TUFTS","TUFTS MEDICARE SCO","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,189.2,130.47999999999999,585.70000000000005,52.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L1836","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,281.70999999999998,130.47999999999999,585.70000000000005,52.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L1836","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,227.04,130.47999999999999,585.70000000000005,52.25]
["TUFTS - TUFTS POS - HCPCS - L1836","TUFTS","TUFTS POS","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,194.81,130.47999999999999,585.70000000000005,52.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L1836","BMC HEALTHNET","BMCHN QHP","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,0,130.47999999999999,585.70000000000005,52.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L1836","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,189.91,130.47999999999999,585.70000000000005,52.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L1836","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,189.91,130.47999999999999,585.70000000000005,52.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L1836","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,288.35000000000002,130.47999999999999,585.70000000000005,52.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L1836","BMC HEALTHNET","BMCHN ACO","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,0,130.47999999999999,585.70000000000005,52.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L1836","BMC HEALTHNET","BMCHN MCO","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,0,130.47999999999999,585.70000000000005,52.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L1836","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,585.70000000000005,130.47999999999999,585.70000000000005,52.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L1836","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,130.47999999999999,130.47999999999999,585.70000000000005,52.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L1836","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,130.47999999999999,130.47999999999999,585.70000000000005,52.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L1836","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,0,130.47999999999999,585.70000000000005,52.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L1836","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,130.47999999999999,130.47999999999999,585.70000000000005,52.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L1836","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,130.47999999999999,130.47999999999999,585.70000000000005,52.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L1836","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,0,130.47999999999999,585.70000000000005,52.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L1836","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,328.31,130.47999999999999,585.70000000000005,52.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L1836","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,0,130.47999999999999,585.70000000000005,52.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L1836","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,189.91,130.47999999999999,585.70000000000005,52.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L1836","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,189.91,130.47999999999999,585.70000000000005,52.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L1836","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,153.97,130.47999999999999,585.70000000000005,52.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L1836","BLUE CROSS","BLUE CROSS-PPO","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,189.91,130.47999999999999,585.70000000000005,52.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L1836","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,189.91,130.47999999999999,585.70000000000005,52.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L1836","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L1836","HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS",209,189.91,130.47999999999999,585.70000000000005,52.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L1902","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,0,86.14,386.65,54.75]
["TUFTS - TUFTS PPO - HCPCS - L1902","TUFTS","TUFTS PPO","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,137.56,86.14,386.65,54.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L1902","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,103.37,86.14,386.65,54.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L1902","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,103.37,86.14,386.65,54.75]
["TUFTS - TUFTS SELECT - HCPCS - L1902","TUFTS","TUFTS SELECT","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,128.6,86.14,386.65,54.75]
["TUFTS - TUFTS SPIRIT - HCPCS - L1902","TUFTS","TUFTS SPIRIT","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,94.75,86.14,386.65,54.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L1902","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,116.13,86.14,386.65,54.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L1902","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,179.79,86.14,386.65,54.75]
["FALLON - FALLON MEDICAID - HCPCS - L1902","FALLON","FALLON MEDICAID","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,0,86.14,386.65,54.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L1902","TUFTS","TUFTS MEDICARE SCO","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,124.9,86.14,386.65,54.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - L1902","FALLON","FALLON SENIOR PLAN","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,86.14,86.14,386.65,54.75]
["TUFTS - TUFTS HMO - HCPCS - L1902","TUFTS","TUFTS HMO","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,154.32,86.14,386.65,54.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L1902","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,124.9,86.14,386.65,54.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L1902","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,185.98,86.14,386.65,54.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L1902","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,149.88,86.14,386.65,54.75]
["TUFTS - TUFTS POS - HCPCS - L1902","TUFTS","TUFTS POS","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,128.6,86.14,386.65,54.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L1902","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,86.14,86.14,386.65,54.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L1902","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,125.37,86.14,386.65,54.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L1902","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,125.37,86.14,386.65,54.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L1902","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,386.65,86.14,386.65,54.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L1902","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,190.36,86.14,386.65,54.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L1902","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,86.14,86.14,386.65,54.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L1902","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,86.14,86.14,386.65,54.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L1902","BMC HEALTHNET","BMCHN ACO","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,0,86.14,386.65,54.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L1902","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,86.14,86.14,386.65,54.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L1902","BMC HEALTHNET","BMCHN QHP","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,0,86.14,386.65,54.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L1902","BMC HEALTHNET","BMCHN MCO","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,0,86.14,386.65,54.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L1902","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,0,86.14,386.65,54.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L1902","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,125.37,86.14,386.65,54.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L1902","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,101.65,86.14,386.65,54.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L1902","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,125.37,86.14,386.65,54.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L1902","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,0,86.14,386.65,54.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L1902","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,0,86.14,386.65,54.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L1902","BLUE CROSS","BLUE CROSS-PPO","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,125.37,86.14,386.65,54.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L1902","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,216.75,86.14,386.65,54.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L1902","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,125.37,86.14,386.65,54.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L1902","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L1902","AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET",219,125.37,86.14,386.65,54.75]
["TUFTS - TUFTS PPO - HCPCS - L3260","TUFTS","TUFTS PPO","HCPCS","L3260","AMBULATORY SURGICAL BOOT EAC","L3260 - AMBULATORY SURGICAL BOOT EAC",279,127.35,31.12,357.96,69.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3260","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L3260","AMBULATORY SURGICAL BOOT EAC","L3260 - AMBULATORY SURGICAL BOOT EAC",279,0,31.12,357.96,69.75]
["TUFTS - TUFTS SELECT - HCPCS - L3260","TUFTS","TUFTS SELECT","HCPCS","L3260","AMBULATORY SURGICAL BOOT EAC","L3260 - AMBULATORY SURGICAL BOOT EAC",279,63.38,31.12,357.96,69.75]
["FALLON - FALLON MEDICAID - HCPCS - L3260","FALLON","FALLON MEDICAID","HCPCS","L3260","AMBULATORY SURGICAL BOOT EAC","L3260 - AMBULATORY SURGICAL BOOT EAC",279,0,31.12,357.96,69.75]
["TUFTS - TUFTS HMO - HCPCS - L3260","TUFTS","TUFTS HMO","HCPCS","L3260","AMBULATORY SURGICAL BOOT EAC","L3260 - AMBULATORY SURGICAL BOOT EAC",279,142.85,31.12,357.96,69.75]
["TUFTS - TUFTS POS - HCPCS - L3260","TUFTS","TUFTS POS","HCPCS","L3260","AMBULATORY SURGICAL BOOT EAC","L3260 - AMBULATORY SURGICAL BOOT EAC",279,119.04,31.12,357.96,69.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L3260","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L3260","AMBULATORY SURGICAL BOOT EAC","L3260 - AMBULATORY SURGICAL BOOT EAC",279,31.12,31.12,357.96,69.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L3260","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L3260","AMBULATORY SURGICAL BOOT EAC","L3260 - AMBULATORY SURGICAL BOOT EAC",279,31.12,31.12,357.96,69.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L3260","BMC HEALTHNET","BMCHN QHP","HCPCS","L3260","AMBULATORY SURGICAL BOOT EAC","L3260 - AMBULATORY SURGICAL BOOT EAC",279,0,31.12,357.96,69.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L3260","BMC HEALTHNET","BMCHN ACO","HCPCS","L3260","AMBULATORY SURGICAL BOOT EAC","L3260 - AMBULATORY SURGICAL BOOT EAC",279,0,31.12,357.96,69.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L3260","BMC HEALTHNET","BMCHN MCO","HCPCS","L3260","AMBULATORY SURGICAL BOOT EAC","L3260 - AMBULATORY SURGICAL BOOT EAC",279,0,31.12,357.96,69.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L3260","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L3260","AMBULATORY SURGICAL BOOT EAC","L3260 - AMBULATORY SURGICAL BOOT EAC",279,357.96,31.12,357.96,69.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3260","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L3260","AMBULATORY SURGICAL BOOT EAC","L3260 - AMBULATORY SURGICAL BOOT EAC",279,0,31.12,357.96,69.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3260","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L3260","AMBULATORY SURGICAL BOOT EAC","L3260 - AMBULATORY SURGICAL BOOT EAC",279,0,31.12,357.96,69.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3260","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L3260","AMBULATORY SURGICAL BOOT EAC","L3260 - AMBULATORY SURGICAL BOOT EAC",279,0,31.12,357.96,69.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L3260","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L3260","AMBULATORY SURGICAL BOOT EAC","L3260 - AMBULATORY SURGICAL BOOT EAC",279,31.12,31.12,357.96,69.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L3260","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","L3260","AMBULATORY SURGICAL BOOT EAC","L3260 - AMBULATORY SURGICAL BOOT EAC",279,31.12,31.12,357.96,69.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L3260","BLUE CROSS","BLUE CROSS-PPO","HCPCS","L3260","AMBULATORY SURGICAL BOOT EAC","L3260 - AMBULATORY SURGICAL BOOT EAC",279,31.12,31.12,357.96,69.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L3260","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L3260","AMBULATORY SURGICAL BOOT EAC","L3260 - AMBULATORY SURGICAL BOOT EAC",279,31.12,31.12,357.96,69.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L3260","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L3260","AMBULATORY SURGICAL BOOT EAC","L3260 - AMBULATORY SURGICAL BOOT EAC",279,31.12,31.12,357.96,69.75]
["TUFTS - TUFTS PPO - HCPCS - L3350","TUFTS","TUFTS PPO","HCPCS","L3350","SHOE HEEL WEDGE","L3350 - SHOE HEEL WEDGE",41,35.79,22.41,100.59,10.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3350","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L3350","SHOE HEEL WEDGE","L3350 - SHOE HEEL WEDGE",41,0,22.41,100.59,10.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L3350","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L3350","SHOE HEEL WEDGE","L3350 - SHOE HEEL WEDGE",41,26.89,22.41,100.59,10.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L3350","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L3350","SHOE HEEL WEDGE","L3350 - SHOE HEEL WEDGE",41,46.77,22.41,100.59,10.25]
["TUFTS - TUFTS SELECT - HCPCS - L3350","TUFTS","TUFTS SELECT","HCPCS","L3350","SHOE HEEL WEDGE","L3350 - SHOE HEEL WEDGE",41,33.450000000000003,22.41,100.59,10.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3350","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L3350","SHOE HEEL WEDGE","L3350 - SHOE HEEL WEDGE",41,26.89,22.41,100.59,10.25]
["TUFTS - TUFTS SPIRIT - HCPCS - L3350","TUFTS","TUFTS SPIRIT","HCPCS","L3350","SHOE HEEL WEDGE","L3350 - SHOE HEEL WEDGE",41,24.65,22.41,100.59,10.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L3350","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L3350","SHOE HEEL WEDGE","L3350 - SHOE HEEL WEDGE",41,30.21,22.41,100.59,10.25]
["FALLON - FALLON MEDICAID - HCPCS - L3350","FALLON","FALLON MEDICAID","HCPCS","L3350","SHOE HEEL WEDGE","L3350 - SHOE HEEL WEDGE",41,0,22.41,100.59,10.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L3350","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L3350","SHOE HEEL WEDGE","L3350 - SHOE HEEL WEDGE",41,32.49,22.41,100.59,10.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - L3350","FALLON","FALLON SENIOR PLAN","HCPCS","L3350","SHOE HEEL WEDGE","L3350 - SHOE HEEL WEDGE",41,22.41,22.41,100.59,10.25]
["TUFTS - TUFTS HMO - HCPCS - L3350","TUFTS","TUFTS HMO","HCPCS","L3350","SHOE HEEL WEDGE","L3350 - SHOE HEEL WEDGE",41,40.14,22.41,100.59,10.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L3350","TUFTS","TUFTS MEDICARE SCO","HCPCS","L3350","SHOE HEEL WEDGE","L3350 - SHOE HEEL WEDGE",41,32.49,22.41,100.59,10.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L3350","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L3350","SHOE HEEL WEDGE","L3350 - SHOE HEEL WEDGE",41,48.38,22.41,100.59,10.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L3350","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L3350","SHOE HEEL WEDGE","L3350 - SHOE HEEL WEDGE",41,38.99,22.41,100.59,10.25]
["TUFTS - TUFTS POS - HCPCS - L3350","TUFTS","TUFTS POS","HCPCS","L3350","SHOE HEEL WEDGE","L3350 - SHOE HEEL WEDGE",41,33.450000000000003,22.41,100.59,10.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L3350","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L3350","SHOE HEEL WEDGE","L3350 - SHOE HEEL WEDGE",41,49.52,22.41,100.59,10.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L3350","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L3350","SHOE HEEL WEDGE","L3350 - SHOE HEEL WEDGE",41,100.59,22.41,100.59,10.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L3350","BMC HEALTHNET","BMCHN ACO","HCPCS","L3350","SHOE HEEL WEDGE","L3350 - SHOE HEEL WEDGE",41,0,22.41,100.59,10.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L3350","BMC HEALTHNET","BMCHN QHP","HCPCS","L3350","SHOE HEEL WEDGE","L3350 - SHOE HEEL WEDGE",41,0,22.41,100.59,10.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L3350","BMC HEALTHNET","BMCHN MCO","HCPCS","L3350","SHOE HEEL WEDGE","L3350 - SHOE HEEL WEDGE",41,0,22.41,100.59,10.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L3350","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L3350","SHOE HEEL WEDGE","L3350 - SHOE HEEL WEDGE",41,22.41,22.41,100.59,10.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L3350","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L3350","SHOE HEEL WEDGE","L3350 - SHOE HEEL WEDGE",41,22.41,22.41,100.59,10.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3350","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L3350","SHOE HEEL WEDGE","L3350 - SHOE HEEL WEDGE",41,0,22.41,100.59,10.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L3350","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L3350","SHOE HEEL WEDGE","L3350 - SHOE HEEL WEDGE",41,22.41,22.41,100.59,10.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L3350","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L3350","SHOE HEEL WEDGE","L3350 - SHOE HEEL WEDGE",41,22.41,22.41,100.59,10.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L3350","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L3350","SHOE HEEL WEDGE","L3350 - SHOE HEEL WEDGE",41,56.39,22.41,100.59,10.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3350","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L3350","SHOE HEEL WEDGE","L3350 - SHOE HEEL WEDGE",41,0,22.41,100.59,10.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3350","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L3350","SHOE HEEL WEDGE","L3350 - SHOE HEEL WEDGE",41,0,22.41,100.59,10.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L3350","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L3350","SHOE HEEL WEDGE","L3350 - SHOE HEEL WEDGE",41,26.44,22.41,100.59,10.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3496","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L3496","HC STATIC AFO","L3496 - HC STATIC AFO",406,0,0,0,101.5]
["FALLON - FALLON MEDICAID - HCPCS - L3496","FALLON","FALLON MEDICAID","HCPCS","L3496","HC STATIC AFO","L3496 - HC STATIC AFO",406,0,0,0,101.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L3496","BMC HEALTHNET","BMCHN QHP","HCPCS","L3496","HC STATIC AFO","L3496 - HC STATIC AFO",406,0,0,0,101.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L3496","BMC HEALTHNET","BMCHN ACO","HCPCS","L3496","HC STATIC AFO","L3496 - HC STATIC AFO",406,0,0,0,101.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L3496","BMC HEALTHNET","BMCHN MCO","HCPCS","L3496","HC STATIC AFO","L3496 - HC STATIC AFO",406,0,0,0,101.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3496","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L3496","HC STATIC AFO","L3496 - HC STATIC AFO",406,0,0,0,101.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3496","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L3496","HC STATIC AFO","L3496 - HC STATIC AFO",406,0,0,0,101.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3496","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L3496","HC STATIC AFO","L3496 - HC STATIC AFO",406,0,0,0,101.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3650","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,0,67.38,302.45,488.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3650","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,80.86,67.38,302.45,488.75]
["TUFTS - TUFTS PPO - HCPCS - L3650","TUFTS","TUFTS PPO","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,107.6,67.38,302.45,488.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L3650","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,80.86,67.38,302.45,488.75]
["TUFTS - TUFTS SELECT - HCPCS - L3650","TUFTS","TUFTS SELECT","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,100.59,67.38,302.45,488.75]
["TUFTS - TUFTS SPIRIT - HCPCS - L3650","TUFTS","TUFTS SPIRIT","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,74.12,67.38,302.45,488.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L3650","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,90.84,67.38,302.45,488.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L3650","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,140.63999999999999,67.38,302.45,488.75]
["FALLON - FALLON MEDICAID - HCPCS - L3650","FALLON","FALLON MEDICAID","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,0,67.38,302.45,488.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - L3650","FALLON","FALLON SENIOR PLAN","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,67.38,67.38,302.45,488.75]
["TUFTS - TUFTS HMO - HCPCS - L3650","TUFTS","TUFTS HMO","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,120.7,67.38,302.45,488.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L3650","TUFTS","TUFTS MEDICARE SCO","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,97.7,67.38,302.45,488.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L3650","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,97.7,67.38,302.45,488.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L3650","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,145.47,67.38,302.45,488.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L3650","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,117.24,67.38,302.45,488.75]
["TUFTS - TUFTS POS - HCPCS - L3650","TUFTS","TUFTS POS","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,100.59,67.38,302.45,488.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L3650","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,67.38,67.38,302.45,488.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L3650","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,98.07,67.38,302.45,488.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L3650","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,98.07,67.38,302.45,488.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L3650","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,67.38,67.38,302.45,488.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L3650","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,67.38,67.38,302.45,488.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L3650","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,148.9,67.38,302.45,488.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L3650","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,67.38,67.38,302.45,488.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L3650","BMC HEALTHNET","BMCHN ACO","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,0,67.38,302.45,488.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L3650","BMC HEALTHNET","BMCHN QHP","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,0,67.38,302.45,488.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L3650","BMC HEALTHNET","BMCHN MCO","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,0,67.38,302.45,488.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L3650","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,302.45,67.38,302.45,488.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3650","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,0,67.38,302.45,488.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3650","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,0,67.38,302.45,488.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L3650","BLUE CROSS","BLUE CROSS-PPO","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,98.07,67.38,302.45,488.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L3650","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,98.07,67.38,302.45,488.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3650","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,0,67.38,302.45,488.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L3650","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,79.510000000000005,67.38,302.45,488.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L3650","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,98.07,67.38,302.45,488.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L3650","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,169.54,67.38,302.45,488.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L3650","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,98.07,67.38,302.45,488.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L3650","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",1955,98.07,67.38,302.45,488.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L3670","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,124.38,103.65,465.27,725.75]
["TUFTS - TUFTS PPO - HCPCS - L3670","TUFTS","TUFTS PPO","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,165.53,103.65,465.27,725.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L3670","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,216.35,103.65,465.27,725.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3670","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,0,103.65,465.27,725.75]
["TUFTS - TUFTS SELECT - HCPCS - L3670","TUFTS","TUFTS SELECT","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,154.74,103.65,465.27,725.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3670","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,124.38,103.65,465.27,725.75]
["TUFTS - TUFTS SPIRIT - HCPCS - L3670","TUFTS","TUFTS SPIRIT","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,114.02,103.65,465.27,725.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L3670","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,139.74,103.65,465.27,725.75]
["FALLON - FALLON MEDICAID - HCPCS - L3670","FALLON","FALLON MEDICAID","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,0,103.65,465.27,725.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - L3670","FALLON","FALLON SENIOR PLAN","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,103.65,103.65,465.27,725.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L3670","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,150.29,103.65,465.27,725.75]
["TUFTS - TUFTS HMO - HCPCS - L3670","TUFTS","TUFTS HMO","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,185.69,103.65,465.27,725.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L3670","TUFTS","TUFTS MEDICARE SCO","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,150.29,103.65,465.27,725.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L3670","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,223.78,103.65,465.27,725.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L3670","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,180.35,103.65,465.27,725.75]
["TUFTS - TUFTS POS - HCPCS - L3670","TUFTS","TUFTS POS","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,154.74,103.65,465.27,725.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L3670","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,465.27,103.65,465.27,725.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L3670","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,150.86000000000001,103.65,465.27,725.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L3670","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,150.86000000000001,103.65,465.27,725.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L3670","BMC HEALTHNET","BMCHN QHP","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,0,103.65,465.27,725.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L3670","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,229.05,103.65,465.27,725.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L3670","BMC HEALTHNET","BMCHN ACO","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,0,103.65,465.27,725.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L3670","BMC HEALTHNET","BMCHN MCO","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,0,103.65,465.27,725.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L3670","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,103.65,103.65,465.27,725.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L3670","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,103.65,103.65,465.27,725.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3670","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,0,103.65,465.27,725.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L3670","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,103.65,103.65,465.27,725.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L3670","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,103.65,103.65,465.27,725.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3670","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,0,103.65,465.27,725.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L3670","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,260.8,103.65,465.27,725.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3670","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,0,103.65,465.27,725.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L3670","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,150.86000000000001,103.65,465.27,725.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L3670","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,150.86000000000001,103.65,465.27,725.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L3670","BLUE CROSS","BLUE CROSS-PPO","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,150.86000000000001,103.65,465.27,725.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L3670","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,122.31,103.65,465.27,725.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L3670","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,150.86000000000001,103.65,465.27,725.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L3670","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",2903,150.86000000000001,103.65,465.27,725.75]
["TUFTS - TUFTS PPO - HCPCS - L3760","TUFTS","TUFTS PPO","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,710.69,445.02,1997.57,204.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3760","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,0,445.02,1997.57,204.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3760","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,534.02,445.02,1997.57,204.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L3760","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,534.02,445.02,1997.57,204.75]
["TUFTS - TUFTS SELECT - HCPCS - L3760","TUFTS","TUFTS SELECT","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,664.38,445.02,1997.57,204.75]
["TUFTS - TUFTS SPIRIT - HCPCS - L3760","TUFTS","TUFTS SPIRIT","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,489.52,445.02,1997.57,204.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L3760","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,599.98,445.02,1997.57,204.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L3760","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,928.85,445.02,1997.57,204.75]
["FALLON - FALLON MEDICAID - HCPCS - L3760","FALLON","FALLON MEDICAID","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,0,445.02,1997.57,204.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - L3760","FALLON","FALLON SENIOR PLAN","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,445.02,445.02,1997.57,204.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L3760","TUFTS","TUFTS MEDICARE SCO","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,645.28,445.02,1997.57,204.75]
["TUFTS - TUFTS HMO - HCPCS - L3760","TUFTS","TUFTS HMO","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,797.25,445.02,1997.57,204.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L3760","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,645.28,445.02,1997.57,204.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L3760","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,960.8,445.02,1997.57,204.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L3760","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,774.33,445.02,1997.57,204.75]
["TUFTS - TUFTS POS - HCPCS - L3760","TUFTS","TUFTS POS","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,664.38,445.02,1997.57,204.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L3760","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,647.70000000000005,445.02,1997.57,204.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L3760","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,647.70000000000005,445.02,1997.57,204.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L3760","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,445.02,445.02,1997.57,204.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L3760","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,983.44,445.02,1997.57,204.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L3760","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,445.02,445.02,1997.57,204.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L3760","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,445.02,445.02,1997.57,204.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L3760","BMC HEALTHNET","BMCHN ACO","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,0,445.02,1997.57,204.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L3760","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,445.02,445.02,1997.57,204.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L3760","BMC HEALTHNET","BMCHN QHP","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,0,445.02,1997.57,204.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L3760","BMC HEALTHNET","BMCHN MCO","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,0,445.02,1997.57,204.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L3760","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,1997.57,445.02,1997.57,204.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3760","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,0,445.02,1997.57,204.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L3760","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,647.70000000000005,445.02,1997.57,204.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3760","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,0,445.02,1997.57,204.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L3760","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,647.70000000000005,445.02,1997.57,204.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L3760","BLUE CROSS","BLUE CROSS-PPO","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,647.70000000000005,445.02,1997.57,204.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3760","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,0,445.02,1997.57,204.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L3760","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,1119.76,445.02,1997.57,204.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L3760","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,647.70000000000005,445.02,1997.57,204.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L3760","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,525.12,445.02,1997.57,204.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L3760","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L3760","EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED",819,647.70000000000005,445.02,1997.57,204.75]
["TUFTS - TUFTS PPO - HCPCS - L3762","TUFTS","TUFTS PPO","HCPCS","L3762","RIGID EO WO JOINTS","L3762 - RIGID EO WO JOINTS",57,152.80000000000001,95.68,429.49,14.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L3762","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L3762","RIGID EO WO JOINTS","L3762 - RIGID EO WO JOINTS",57,114.82,95.68,429.49,14.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L3762","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L3762","RIGID EO WO JOINTS","L3762 - RIGID EO WO JOINTS",57,199.71,95.68,429.49,14.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3762","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L3762","RIGID EO WO JOINTS","L3762 - RIGID EO WO JOINTS",57,0,95.68,429.49,14.25]
["TUFTS - TUFTS SELECT - HCPCS - L3762","TUFTS","TUFTS SELECT","HCPCS","L3762","RIGID EO WO JOINTS","L3762 - RIGID EO WO JOINTS",57,142.84,95.68,429.49,14.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3762","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L3762","RIGID EO WO JOINTS","L3762 - RIGID EO WO JOINTS",57,114.82,95.68,429.49,14.25]
["TUFTS - TUFTS SPIRIT - HCPCS - L3762","TUFTS","TUFTS SPIRIT","HCPCS","L3762","RIGID EO WO JOINTS","L3762 - RIGID EO WO JOINTS",57,105.25,95.68,429.49,14.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L3762","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L3762","RIGID EO WO JOINTS","L3762 - RIGID EO WO JOINTS",57,129,95.68,429.49,14.25]
["FALLON - FALLON MEDICAID - HCPCS - L3762","FALLON","FALLON MEDICAID","HCPCS","L3762","RIGID EO WO JOINTS","L3762 - RIGID EO WO JOINTS",57,0,95.68,429.49,14.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - L3762","FALLON","FALLON SENIOR PLAN","HCPCS","L3762","RIGID EO WO JOINTS","L3762 - RIGID EO WO JOINTS",57,95.68,95.68,429.49,14.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L3762","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L3762","RIGID EO WO JOINTS","L3762 - RIGID EO WO JOINTS",57,138.74,95.68,429.49,14.25]
["TUFTS - TUFTS HMO - HCPCS - L3762","TUFTS","TUFTS HMO","HCPCS","L3762","RIGID EO WO JOINTS","L3762 - RIGID EO WO JOINTS",57,171.41,95.68,429.49,14.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L3762","TUFTS","TUFTS MEDICARE SCO","HCPCS","L3762","RIGID EO WO JOINTS","L3762 - RIGID EO WO JOINTS",57,138.74,95.68,429.49,14.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L3762","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L3762","RIGID EO WO JOINTS","L3762 - RIGID EO WO JOINTS",57,206.57,95.68,429.49,14.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L3762","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L3762","RIGID EO WO JOINTS","L3762 - RIGID EO WO JOINTS",57,166.48,95.68,429.49,14.25]
["TUFTS - TUFTS POS - HCPCS - L3762","TUFTS","TUFTS POS","HCPCS","L3762","RIGID EO WO JOINTS","L3762 - RIGID EO WO JOINTS",57,142.84,95.68,429.49,14.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L3762","BMC HEALTHNET","BMCHN QHP","HCPCS","L3762","RIGID EO WO JOINTS","L3762 - RIGID EO WO JOINTS",57,0,95.68,429.49,14.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L3762","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L3762","RIGID EO WO JOINTS","L3762 - RIGID EO WO JOINTS",57,211.44,95.68,429.49,14.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L3762","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L3762","RIGID EO WO JOINTS","L3762 - RIGID EO WO JOINTS",57,429.49,95.68,429.49,14.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L3762","BMC HEALTHNET","BMCHN ACO","HCPCS","L3762","RIGID EO WO JOINTS","L3762 - RIGID EO WO JOINTS",57,0,95.68,429.49,14.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L3762","BMC HEALTHNET","BMCHN MCO","HCPCS","L3762","RIGID EO WO JOINTS","L3762 - RIGID EO WO JOINTS",57,0,95.68,429.49,14.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L3762","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L3762","RIGID EO WO JOINTS","L3762 - RIGID EO WO JOINTS",57,95.68,95.68,429.49,14.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L3762","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L3762","RIGID EO WO JOINTS","L3762 - RIGID EO WO JOINTS",57,95.68,95.68,429.49,14.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3762","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L3762","RIGID EO WO JOINTS","L3762 - RIGID EO WO JOINTS",57,0,95.68,429.49,14.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L3762","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L3762","RIGID EO WO JOINTS","L3762 - RIGID EO WO JOINTS",57,95.68,95.68,429.49,14.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L3762","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L3762","RIGID EO WO JOINTS","L3762 - RIGID EO WO JOINTS",57,95.68,95.68,429.49,14.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L3762","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L3762","RIGID EO WO JOINTS","L3762 - RIGID EO WO JOINTS",57,240.75,95.68,429.49,14.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3762","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L3762","RIGID EO WO JOINTS","L3762 - RIGID EO WO JOINTS",57,0,95.68,429.49,14.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3762","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L3762","RIGID EO WO JOINTS","L3762 - RIGID EO WO JOINTS",57,0,95.68,429.49,14.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L3762","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L3762","RIGID EO WO JOINTS","L3762 - RIGID EO WO JOINTS",57,112.9,95.68,429.49,14.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3807","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,267.02,222.52,998.85,120.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3807","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,0,222.52,998.85,120.75]
["TUFTS - TUFTS PPO - HCPCS - L3807","TUFTS","TUFTS PPO","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,355.37,222.52,998.85,120.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L3807","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,267.02,222.52,998.85,120.75]
["TUFTS - TUFTS SELECT - HCPCS - L3807","TUFTS","TUFTS SELECT","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,332.21,222.52,998.85,120.75]
["TUFTS - TUFTS SPIRIT - HCPCS - L3807","TUFTS","TUFTS SPIRIT","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,244.77,222.52,998.85,120.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L3807","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,300,222.52,998.85,120.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L3807","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,464.46,222.52,998.85,120.75]
["FALLON - FALLON MEDICAID - HCPCS - L3807","FALLON","FALLON MEDICAID","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,0,222.52,998.85,120.75]
["TUFTS - TUFTS HMO - HCPCS - L3807","TUFTS","TUFTS HMO","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,398.65,222.52,998.85,120.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - L3807","FALLON","FALLON SENIOR PLAN","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,222.52,222.52,998.85,120.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L3807","TUFTS","TUFTS MEDICARE SCO","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,322.64999999999998,222.52,998.85,120.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L3807","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,322.64999999999998,222.52,998.85,120.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L3807","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,480.42,222.52,998.85,120.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L3807","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,387.18,222.52,998.85,120.75]
["TUFTS - TUFTS POS - HCPCS - L3807","TUFTS","TUFTS POS","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,332.21,222.52,998.85,120.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L3807","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,222.52,222.52,998.85,120.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L3807","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,222.52,222.52,998.85,120.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L3807","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,323.87,222.52,998.85,120.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L3807","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,323.87,222.52,998.85,120.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L3807","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,222.52,222.52,998.85,120.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L3807","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,491.74,222.52,998.85,120.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L3807","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,222.52,222.52,998.85,120.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L3807","BMC HEALTHNET","BMCHN ACO","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,0,222.52,998.85,120.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L3807","BMC HEALTHNET","BMCHN QHP","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,0,222.52,998.85,120.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L3807","BMC HEALTHNET","BMCHN MCO","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,0,222.52,998.85,120.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L3807","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,998.85,222.52,998.85,120.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3807","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,0,222.52,998.85,120.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3807","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,0,222.52,998.85,120.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3807","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,0,222.52,998.85,120.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L3807","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,323.87,222.52,998.85,120.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L3807","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,559.9,222.52,998.85,120.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L3807","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,323.87,222.52,998.85,120.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L3807","BLUE CROSS","BLUE CROSS-PPO","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,323.87,222.52,998.85,120.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L3807","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,262.57,222.52,998.85,120.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L3807","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,323.87,222.52,998.85,120.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L3807","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED",483,323.87,222.52,998.85,120.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L3808","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,451.13,375.94,1687.5,127.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L3808","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,784.67,375.94,1687.5,127.25]
["TUFTS - TUFTS PPO - HCPCS - L3808","TUFTS","TUFTS PPO","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,600.37,375.94,1687.5,127.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3808","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,0,375.94,1687.5,127.25]
["TUFTS - TUFTS SELECT - HCPCS - L3808","TUFTS","TUFTS SELECT","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,561.25,375.94,1687.5,127.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3808","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,451.13,375.94,1687.5,127.25]
["TUFTS - TUFTS SPIRIT - HCPCS - L3808","TUFTS","TUFTS SPIRIT","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,413.53,375.94,1687.5,127.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L3808","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,506.84,375.94,1687.5,127.25]
["FALLON - FALLON MEDICAID - HCPCS - L3808","FALLON","FALLON MEDICAID","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,0,375.94,1687.5,127.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - L3808","FALLON","FALLON SENIOR PLAN","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,375.94,375.94,1687.5,127.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L3808","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,545.11,375.94,1687.5,127.25]
["TUFTS - TUFTS HMO - HCPCS - L3808","TUFTS","TUFTS HMO","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,673.5,375.94,1687.5,127.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L3808","TUFTS","TUFTS MEDICARE SCO","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,545.11,375.94,1687.5,127.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L3808","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,811.65,375.94,1687.5,127.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L3808","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,654.14,375.94,1687.5,127.25]
["TUFTS - TUFTS POS - HCPCS - L3808","TUFTS","TUFTS POS","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,561.25,375.94,1687.5,127.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L3808","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,547.16999999999996,375.94,1687.5,127.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L3808","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,1687.5,375.94,1687.5,127.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L3808","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,547.16999999999996,375.94,1687.5,127.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L3808","BMC HEALTHNET","BMCHN QHP","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,0,375.94,1687.5,127.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L3808","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,830.78,375.94,1687.5,127.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L3808","BMC HEALTHNET","BMCHN ACO","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,0,375.94,1687.5,127.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L3808","BMC HEALTHNET","BMCHN MCO","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,0,375.94,1687.5,127.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L3808","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,375.94,375.94,1687.5,127.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L3808","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,375.94,375.94,1687.5,127.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3808","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,0,375.94,1687.5,127.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L3808","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,375.94,375.94,1687.5,127.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L3808","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,375.94,375.94,1687.5,127.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L3808","BLUE CROSS","BLUE CROSS-PPO","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,547.16999999999996,375.94,1687.5,127.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3808","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,0,375.94,1687.5,127.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L3808","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,443.61,375.94,1687.5,127.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L3808","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,547.16999999999996,375.94,1687.5,127.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L3808","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,945.94,375.94,1687.5,127.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3808","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,0,375.94,1687.5,127.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L3808","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,547.16999999999996,375.94,1687.5,127.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L3808","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,547.16999999999996,375.94,1687.5,127.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L3808","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L3808","HC EPITRAIN","L3808 - HC EPITRAIN",509,547.16999999999996,375.94,1687.5,127.25]
["TUFTS - TUFTS PPO - HCPCS - L3905","TUFTS","TUFTS PPO","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,1409.34,882.51,3961.32,610.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3905","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,0,882.51,3961.32,610.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3905","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,1059.01,882.51,3961.32,610.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L3905","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,1059.01,882.51,3961.32,610.5]
["TUFTS - TUFTS SELECT - HCPCS - L3905","TUFTS","TUFTS SELECT","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,1317.51,882.51,3961.32,610.5]
["TUFTS - TUFTS SPIRIT - HCPCS - L3905","TUFTS","TUFTS SPIRIT","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,970.76,882.51,3961.32,610.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L3905","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,1189.8,882.51,3961.32,610.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L3905","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,1841.99,882.51,3961.32,610.5]
["FALLON - FALLON MEDICAID - HCPCS - L3905","FALLON","FALLON MEDICAID","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,0,882.51,3961.32,610.5]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L3905","TUFTS","TUFTS MEDICARE SCO","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,1279.6400000000001,882.51,3961.32,610.5]
["FALLON - FALLON SENIOR PLAN - HCPCS - L3905","FALLON","FALLON SENIOR PLAN","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,882.51,882.51,3961.32,610.5]
["TUFTS - TUFTS HMO - HCPCS - L3905","TUFTS","TUFTS HMO","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,1581.02,882.51,3961.32,610.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L3905","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,1279.6400000000001,882.51,3961.32,610.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L3905","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,1905.34,882.51,3961.32,610.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L3905","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,1535.57,882.51,3961.32,610.5]
["TUFTS - TUFTS POS - HCPCS - L3905","TUFTS","TUFTS POS","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,1317.51,882.51,3961.32,610.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L3905","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,882.51,882.51,3961.32,610.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L3905","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,1284.45,882.51,3961.32,610.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L3905","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,1284.45,882.51,3961.32,610.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L3905","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,1950.24,882.51,3961.32,610.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L3905","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,882.51,882.51,3961.32,610.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L3905","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,882.51,882.51,3961.32,610.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L3905","BMC HEALTHNET","BMCHN ACO","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,0,882.51,3961.32,610.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L3905","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,882.51,882.51,3961.32,610.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L3905","BMC HEALTHNET","BMCHN QHP","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,0,882.51,3961.32,610.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L3905","BMC HEALTHNET","BMCHN MCO","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,0,882.51,3961.32,610.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L3905","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,3961.32,882.51,3961.32,610.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3905","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,0,882.51,3961.32,610.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3905","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,0,882.51,3961.32,610.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3905","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,0,882.51,3961.32,610.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L3905","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,1284.45,882.51,3961.32,610.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L3905","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,2220.5700000000002,882.51,3961.32,610.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L3905","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,1284.45,882.51,3961.32,610.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L3905","BLUE CROSS","BLUE CROSS-PPO","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,1284.45,882.51,3961.32,610.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L3905","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,1284.45,882.51,3961.32,610.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L3905","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,1284.45,882.51,3961.32,610.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L3905","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF",2442,1041.3599999999999,882.51,3961.32,610.5]
["TUFTS - TUFTS PPO - HCPCS - L3908","TUFTS","TUFTS PPO","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,116.93,73.22,328.66,35.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L3908","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,87.86,73.22,328.66,35.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L3908","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,152.83000000000001,73.22,328.66,35.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3908","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,0,73.22,328.66,35.75]
["TUFTS - TUFTS SELECT - HCPCS - L3908","TUFTS","TUFTS SELECT","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,109.32,73.22,328.66,35.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3908","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,87.86,73.22,328.66,35.75]
["TUFTS - TUFTS SPIRIT - HCPCS - L3908","TUFTS","TUFTS SPIRIT","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,80.540000000000006,73.22,328.66,35.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L3908","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,98.72,73.22,328.66,35.75]
["FALLON - FALLON MEDICAID - HCPCS - L3908","FALLON","FALLON MEDICAID","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,0,73.22,328.66,35.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L3908","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,106.17,73.22,328.66,35.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - L3908","FALLON","FALLON SENIOR PLAN","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,73.22,73.22,328.66,35.75]
["TUFTS - TUFTS HMO - HCPCS - L3908","TUFTS","TUFTS HMO","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,131.18,73.22,328.66,35.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L3908","TUFTS","TUFTS MEDICARE SCO","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,106.17,73.22,328.66,35.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L3908","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,158.08000000000001,73.22,328.66,35.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L3908","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,127.4,73.22,328.66,35.75]
["TUFTS - TUFTS POS - HCPCS - L3908","TUFTS","TUFTS POS","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,109.32,73.22,328.66,35.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L3908","BMC HEALTHNET","BMCHN QHP","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,0,73.22,328.66,35.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L3908","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,106.57,73.22,328.66,35.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L3908","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,106.57,73.22,328.66,35.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L3908","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,161.81,73.22,328.66,35.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L3908","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,328.66,73.22,328.66,35.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L3908","BMC HEALTHNET","BMCHN ACO","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,0,73.22,328.66,35.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L3908","BMC HEALTHNET","BMCHN MCO","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,0,73.22,328.66,35.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L3908","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,73.22,73.22,328.66,35.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L3908","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,73.22,73.22,328.66,35.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3908","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,0,73.22,328.66,35.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L3908","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,73.22,73.22,328.66,35.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L3908","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,73.22,73.22,328.66,35.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L3908","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,184.24,73.22,328.66,35.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L3908","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,106.57,73.22,328.66,35.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L3908","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,106.57,73.22,328.66,35.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3908","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,0,73.22,328.66,35.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L3908","BLUE CROSS","BLUE CROSS-PPO","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,106.57,73.22,328.66,35.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3908","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,0,73.22,328.66,35.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L3908","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,106.57,73.22,328.66,35.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L3908","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,106.57,73.22,328.66,35.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L3908","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L3908","WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED",143,86.4,73.22,328.66,35.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3967","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,0,1765.23,7923.54,29.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3967","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,2118.2800000000002,1765.23,7923.54,29.25]
["TUFTS - TUFTS PPO - HCPCS - L3967","TUFTS","TUFTS PPO","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,2819,1765.23,7923.54,29.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L3967","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,2118.2800000000002,1765.23,7923.54,29.25]
["TUFTS - TUFTS SELECT - HCPCS - L3967","TUFTS","TUFTS SELECT","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,2635.32,1765.23,7923.54,29.25]
["TUFTS - TUFTS SPIRIT - HCPCS - L3967","TUFTS","TUFTS SPIRIT","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,1941.75,1765.23,7923.54,29.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L3967","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,2379.88,1765.23,7923.54,29.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L3967","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,3684.4,1765.23,7923.54,29.25]
["FALLON - FALLON MEDICAID - HCPCS - L3967","FALLON","FALLON MEDICAID","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,0,1765.23,7923.54,29.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - L3967","FALLON","FALLON SENIOR PLAN","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,1765.23,1765.23,7923.54,29.25]
["TUFTS - TUFTS HMO - HCPCS - L3967","TUFTS","TUFTS HMO","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,3162.38,1765.23,7923.54,29.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L3967","TUFTS","TUFTS MEDICARE SCO","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,2559.58,1765.23,7923.54,29.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L3967","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,2559.58,1765.23,7923.54,29.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L3967","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,3811.13,1765.23,7923.54,29.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L3967","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,3071.5,1765.23,7923.54,29.25]
["TUFTS - TUFTS POS - HCPCS - L3967","TUFTS","TUFTS POS","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,2635.32,1765.23,7923.54,29.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L3967","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,1765.23,1765.23,7923.54,29.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L3967","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,2569.1999999999998,1765.23,7923.54,29.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L3967","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,1765.23,1765.23,7923.54,29.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L3967","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,1765.23,1765.23,7923.54,29.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L3967","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,2569.1999999999998,1765.23,7923.54,29.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L3967","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,3900.95,1765.23,7923.54,29.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L3967","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,1765.23,1765.23,7923.54,29.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L3967","BMC HEALTHNET","BMCHN ACO","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,0,1765.23,7923.54,29.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L3967","BMC HEALTHNET","BMCHN QHP","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,0,1765.23,7923.54,29.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L3967","BMC HEALTHNET","BMCHN MCO","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,0,1765.23,7923.54,29.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L3967","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,7923.54,1765.23,7923.54,29.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3967","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,0,1765.23,7923.54,29.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3967","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,0,1765.23,7923.54,29.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L3967","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,2082.9699999999998,1765.23,7923.54,29.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3967","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,0,1765.23,7923.54,29.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L3967","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,2569.1999999999998,1765.23,7923.54,29.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L3967","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,4441.67,1765.23,7923.54,29.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L3967","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,2569.1999999999998,1765.23,7923.54,29.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L3967","BLUE CROSS","BLUE CROSS-PPO","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,2569.1999999999998,1765.23,7923.54,29.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L3967","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,2569.1999999999998,1765.23,7923.54,29.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L3967","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",117,2569.1999999999998,1765.23,7923.54,29.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L3980","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,453.41,377.84,1695.98,33]
["TUFTS - TUFTS PPO - HCPCS - L3980","TUFTS","TUFTS PPO","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,603.39,377.84,1695.98,33]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L3980","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,788.63,377.84,1695.98,33]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3980","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,0,377.84,1695.98,33]
["TUFTS - TUFTS SELECT - HCPCS - L3980","TUFTS","TUFTS SELECT","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,564.08000000000004,377.84,1695.98,33]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3980","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,453.41,377.84,1695.98,33]
["TUFTS - TUFTS SPIRIT - HCPCS - L3980","TUFTS","TUFTS SPIRIT","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,415.62,377.84,1695.98,33]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L3980","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,509.4,377.84,1695.98,33]
["FALLON - FALLON MEDICAID - HCPCS - L3980","FALLON","FALLON MEDICAID","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,0,377.84,1695.98,33]
["FALLON - FALLON SENIOR PLAN - HCPCS - L3980","FALLON","FALLON SENIOR PLAN","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,377.84,377.84,1695.98,33]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L3980","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,547.87,377.84,1695.98,33]
["TUFTS - TUFTS HMO - HCPCS - L3980","TUFTS","TUFTS HMO","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,676.89,377.84,1695.98,33]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L3980","TUFTS","TUFTS MEDICARE SCO","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,547.87,377.84,1695.98,33]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L3980","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,815.76,377.84,1695.98,33]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L3980","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,657.44,377.84,1695.98,33]
["TUFTS - TUFTS POS - HCPCS - L3980","TUFTS","TUFTS POS","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,564.08000000000004,377.84,1695.98,33]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L3980","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,1695.98,377.84,1695.98,33]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L3980","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,549.92999999999995,377.84,1695.98,33]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L3980","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,549.92999999999995,377.84,1695.98,33]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L3980","BMC HEALTHNET","BMCHN QHP","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,0,377.84,1695.98,33]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L3980","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,834.98,377.84,1695.98,33]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L3980","BMC HEALTHNET","BMCHN ACO","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,0,377.84,1695.98,33]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L3980","BMC HEALTHNET","BMCHN MCO","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,0,377.84,1695.98,33]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L3980","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,377.84,377.84,1695.98,33]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L3980","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,377.84,377.84,1695.98,33]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3980","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,0,377.84,1695.98,33]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L3980","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,377.84,377.84,1695.98,33]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L3980","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,377.84,377.84,1695.98,33]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L3980","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,445.85,377.84,1695.98,33]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3980","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,0,377.84,1695.98,33]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L3980","BLUE CROSS","BLUE CROSS-PPO","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,549.92999999999995,377.84,1695.98,33]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L3980","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,549.92999999999995,377.84,1695.98,33]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L3980","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,950.72,377.84,1695.98,33]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3980","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,0,377.84,1695.98,33]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L3980","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,549.92999999999995,377.84,1695.98,33]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L3980","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,549.92999999999995,377.84,1695.98,33]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L3980","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",132,549.92999999999995,377.84,1695.98,33]
["TUFTS - TUFTS PPO - HCPCS - L3982","TUFTS","TUFTS PPO","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",176,635.97,398.23,1787.56,44]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3982","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",176,0,398.23,1787.56,44]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3982","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",176,477.88,398.23,1787.56,44]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L3982","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",176,477.88,398.23,1787.56,44]
["TUFTS - TUFTS SELECT - HCPCS - L3982","TUFTS","TUFTS SELECT","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",176,594.53,398.23,1787.56,44]
["TUFTS - TUFTS SPIRIT - HCPCS - L3982","TUFTS","TUFTS SPIRIT","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",176,438.05,398.23,1787.56,44]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L3982","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",176,536.89,398.23,1787.56,44]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L3982","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",176,831.2,398.23,1787.56,44]
["FALLON - FALLON MEDICAID - HCPCS - L3982","FALLON","FALLON MEDICAID","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",176,0,398.23,1787.56,44]
["FALLON - FALLON SENIOR PLAN - HCPCS - L3982","FALLON","FALLON SENIOR PLAN","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",176,398.23,398.23,1787.56,44]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L3982","TUFTS","TUFTS MEDICARE SCO","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",176,577.42999999999995,398.23,1787.56,44]
["TUFTS - TUFTS HMO - HCPCS - L3982","TUFTS","TUFTS HMO","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",176,713.43,398.23,1787.56,44]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L3982","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",176,577.42999999999995,398.23,1787.56,44]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L3982","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",176,859.78,398.23,1787.56,44]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L3982","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",176,692.92,398.23,1787.56,44]
["TUFTS - TUFTS POS - HCPCS - L3982","TUFTS","TUFTS POS","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",176,594.53,398.23,1787.56,44]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L3982","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",176,398.23,398.23,1787.56,44]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L3982","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",176,880.04,398.23,1787.56,44]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L3982","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",176,398.23,398.23,1787.56,44]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L3982","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",176,398.23,398.23,1787.56,44]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L3982","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",176,398.23,398.23,1787.56,44]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L3982","BMC HEALTHNET","BMCHN ACO","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",176,0,398.23,1787.56,44]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L3982","BMC HEALTHNET","BMCHN QHP","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",176,0,398.23,1787.56,44]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L3982","BMC HEALTHNET","BMCHN MCO","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",176,0,398.23,1787.56,44]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L3982","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",176,1787.56,398.23,1787.56,44]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3982","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",176,0,398.23,1787.56,44]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L3982","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",176,469.91,398.23,1787.56,44]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3982","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",176,0,398.23,1787.56,44]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3982","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",176,0,398.23,1787.56,44]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L3982","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",176,1002.03,398.23,1787.56,44]
["TUFTS - TUFTS PPO - HCPCS - L4350","TUFTS","TUFTS PPO","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,155.35,97.28,436.66,90]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L4350","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,116.74,97.28,436.66,90]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L4350","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,203.04,97.28,436.66,90]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L4350","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,0,97.28,436.66,90]
["TUFTS - TUFTS SELECT - HCPCS - L4350","TUFTS","TUFTS SELECT","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,145.22999999999999,97.28,436.66,90]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L4350","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,116.74,97.28,436.66,90]
["TUFTS - TUFTS SPIRIT - HCPCS - L4350","TUFTS","TUFTS SPIRIT","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,107.01,97.28,436.66,90]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L4350","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,131.15,97.28,436.66,90]
["FALLON - FALLON MEDICAID - HCPCS - L4350","FALLON","FALLON MEDICAID","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,0,97.28,436.66,90]
["FALLON - FALLON SENIOR PLAN - HCPCS - L4350","FALLON","FALLON SENIOR PLAN","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,97.28,97.28,436.66,90]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L4350","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,141.06,97.28,436.66,90]
["TUFTS - TUFTS HMO - HCPCS - L4350","TUFTS","TUFTS HMO","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,174.28,97.28,436.66,90]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L4350","TUFTS","TUFTS MEDICARE SCO","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,141.06,97.28,436.66,90]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L4350","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,210.03,97.28,436.66,90]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L4350","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,169.27,97.28,436.66,90]
["TUFTS - TUFTS POS - HCPCS - L4350","TUFTS","TUFTS POS","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,145.22999999999999,97.28,436.66,90]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L4350","BMC HEALTHNET","BMCHN QHP","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,0,97.28,436.66,90]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L4350","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,141.58000000000001,97.28,436.66,90]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L4350","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,141.58000000000001,97.28,436.66,90]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L4350","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,214.98,97.28,436.66,90]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L4350","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,436.66,97.28,436.66,90]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L4350","BMC HEALTHNET","BMCHN ACO","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,0,97.28,436.66,90]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L4350","BMC HEALTHNET","BMCHN MCO","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,0,97.28,436.66,90]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L4350","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,97.28,97.28,436.66,90]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L4350","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,97.28,97.28,436.66,90]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L4350","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,0,97.28,436.66,90]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L4350","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,97.28,97.28,436.66,90]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L4350","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,97.28,97.28,436.66,90]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L4350","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,114.79,97.28,436.66,90]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L4350","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,244.78,97.28,436.66,90]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L4350","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,0,97.28,436.66,90]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L4350","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,0,97.28,436.66,90]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L4350","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,141.58000000000001,97.28,436.66,90]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L4350","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,141.58000000000001,97.28,436.66,90]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L4350","BLUE CROSS","BLUE CROSS-PPO","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,141.58000000000001,97.28,436.66,90]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L4350","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,141.58000000000001,97.28,436.66,90]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L4350","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB",360,141.58000000000001,97.28,436.66,90]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L4360","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,415,345.83,1552.36,139.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L4360","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,0,345.83,1552.36,139.25]
["TUFTS - TUFTS PPO - HCPCS - L4360","TUFTS","TUFTS PPO","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,552.29,345.83,1552.36,139.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L4360","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,415,345.83,1552.36,139.25]
["TUFTS - TUFTS SELECT - HCPCS - L4360","TUFTS","TUFTS SELECT","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,516.29999999999995,345.83,1552.36,139.25]
["TUFTS - TUFTS SPIRIT - HCPCS - L4360","TUFTS","TUFTS SPIRIT","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,380.41,345.83,1552.36,139.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L4360","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,466.25,345.83,1552.36,139.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L4360","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,721.83,345.83,1552.36,139.25]
["TUFTS - TUFTS HMO - HCPCS - L4360","TUFTS","TUFTS HMO","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,619.55999999999995,345.83,1552.36,139.25]
["FALLON - FALLON MEDICAID - HCPCS - L4360","FALLON","FALLON MEDICAID","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,0,345.83,1552.36,139.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - L4360","FALLON","FALLON SENIOR PLAN","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,345.83,345.83,1552.36,139.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L4360","TUFTS","TUFTS MEDICARE SCO","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,501.45,345.83,1552.36,139.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L4360","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,501.45,345.83,1552.36,139.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L4360","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,746.65,345.83,1552.36,139.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L4360","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,601.74,345.83,1552.36,139.25]
["TUFTS - TUFTS POS - HCPCS - L4360","TUFTS","TUFTS POS","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,516.29999999999995,345.83,1552.36,139.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L4360","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,345.83,345.83,1552.36,139.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L4360","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,345.83,345.83,1552.36,139.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L4360","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,503.35,345.83,1552.36,139.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L4360","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,345.83,345.83,1552.36,139.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L4360","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,503.35,345.83,1552.36,139.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L4360","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,764.24,345.83,1552.36,139.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L4360","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,345.83,345.83,1552.36,139.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L4360","BMC HEALTHNET","BMCHN ACO","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,0,345.83,1552.36,139.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L4360","BMC HEALTHNET","BMCHN QHP","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,0,345.83,1552.36,139.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L4360","BMC HEALTHNET","BMCHN MCO","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,0,345.83,1552.36,139.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L4360","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,1552.36,345.83,1552.36,139.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L4360","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,0,345.83,1552.36,139.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L4360","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,503.35,345.83,1552.36,139.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L4360","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,0,345.83,1552.36,139.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L4360","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,408.08,345.83,1552.36,139.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L4360","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,503.35,345.83,1552.36,139.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L4360","BLUE CROSS","BLUE CROSS-PPO","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,503.35,345.83,1552.36,139.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L4360","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,0,345.83,1552.36,139.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L4360","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,870.18,345.83,1552.36,139.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L4360","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,503.35,345.83,1552.36,139.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L4360","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB",557,503.35,345.83,1552.36,139.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L4370","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT","L4370 - HC PNEUMATIC FULL LEG SPLINT",107,282.95,235.79,1058.3900000000001,26.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L4370","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT","L4370 - HC PNEUMATIC FULL LEG SPLINT",107,492.15,235.79,1058.3900000000001,26.75]
["TUFTS - TUFTS PPO - HCPCS - L4370","TUFTS","TUFTS PPO","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT","L4370 - HC PNEUMATIC FULL LEG SPLINT",107,376.55,235.79,1058.3900000000001,26.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L4370","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT","L4370 - HC PNEUMATIC FULL LEG SPLINT",107,0,235.79,1058.3900000000001,26.75]
["TUFTS - TUFTS SELECT - HCPCS - L4370","TUFTS","TUFTS SELECT","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT","L4370 - HC PNEUMATIC FULL LEG SPLINT",107,352.02,235.79,1058.3900000000001,26.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L4370","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT","L4370 - HC PNEUMATIC FULL LEG SPLINT",107,282.95,235.79,1058.3900000000001,26.75]
["TUFTS - TUFTS SPIRIT - HCPCS - L4370","TUFTS","TUFTS SPIRIT","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT","L4370 - HC PNEUMATIC FULL LEG SPLINT",107,259.37,235.79,1058.3900000000001,26.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L4370","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT","L4370 - HC PNEUMATIC FULL LEG SPLINT",107,317.89,235.79,1058.3900000000001,26.75]
["FALLON - FALLON MEDICAID - HCPCS - L4370","FALLON","FALLON MEDICAID","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT","L4370 - HC PNEUMATIC FULL LEG SPLINT",107,0,235.79,1058.3900000000001,26.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - L4370","FALLON","FALLON SENIOR PLAN","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT","L4370 - HC PNEUMATIC FULL LEG SPLINT",107,235.79,235.79,1058.3900000000001,26.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L4370","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT","L4370 - HC PNEUMATIC FULL LEG SPLINT",107,341.9,235.79,1058.3900000000001,26.75]
["TUFTS - TUFTS HMO - HCPCS - L4370","TUFTS","TUFTS HMO","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT","L4370 - HC PNEUMATIC FULL LEG SPLINT",107,422.42,235.79,1058.3900000000001,26.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L4370","TUFTS","TUFTS MEDICARE SCO","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT","L4370 - HC PNEUMATIC FULL LEG SPLINT",107,341.9,235.79,1058.3900000000001,26.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L4370","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT","L4370 - HC PNEUMATIC FULL LEG SPLINT",107,509.07,235.79,1058.3900000000001,26.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L4370","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT","L4370 - HC PNEUMATIC FULL LEG SPLINT",107,410.27,235.79,1058.3900000000001,26.75]
["TUFTS - TUFTS POS - HCPCS - L4370","TUFTS","TUFTS POS","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT","L4370 - HC PNEUMATIC FULL LEG SPLINT",107,352.02,235.79,1058.3900000000001,26.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L4370","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT","L4370 - HC PNEUMATIC FULL LEG SPLINT",107,1058.3900000000001,235.79,1058.3900000000001,26.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L4370","BMC HEALTHNET","BMCHN QHP","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT","L4370 - HC PNEUMATIC FULL LEG SPLINT",107,0,235.79,1058.3900000000001,26.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L4370","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT","L4370 - HC PNEUMATIC FULL LEG SPLINT",107,521.07000000000005,235.79,1058.3900000000001,26.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L4370","BMC HEALTHNET","BMCHN ACO","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT","L4370 - HC PNEUMATIC FULL LEG SPLINT",107,0,235.79,1058.3900000000001,26.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L4370","BMC HEALTHNET","BMCHN MCO","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT","L4370 - HC PNEUMATIC FULL LEG SPLINT",107,0,235.79,1058.3900000000001,26.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L4370","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT","L4370 - HC PNEUMATIC FULL LEG SPLINT",107,235.79,235.79,1058.3900000000001,26.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L4370","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT","L4370 - HC PNEUMATIC FULL LEG SPLINT",107,235.79,235.79,1058.3900000000001,26.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L4370","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT","L4370 - HC PNEUMATIC FULL LEG SPLINT",107,0,235.79,1058.3900000000001,26.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L4370","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT","L4370 - HC PNEUMATIC FULL LEG SPLINT",107,235.79,235.79,1058.3900000000001,26.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L4370","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT","L4370 - HC PNEUMATIC FULL LEG SPLINT",107,235.79,235.79,1058.3900000000001,26.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L4370","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT","L4370 - HC PNEUMATIC FULL LEG SPLINT",107,0,235.79,1058.3900000000001,26.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L4370","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT","L4370 - HC PNEUMATIC FULL LEG SPLINT",107,278.23,235.79,1058.3900000000001,26.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L4370","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT","L4370 - HC PNEUMATIC FULL LEG SPLINT",107,593.29,235.79,1058.3900000000001,26.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L4370","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT","L4370 - HC PNEUMATIC FULL LEG SPLINT",107,0,235.79,1058.3900000000001,26.75]
["TUFTS - TUFTS PPO - HCPCS - L4386","TUFTS","TUFTS PPO","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,247.56,155.02000000000001,695.83,41.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L4386","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,0,155.02000000000001,695.83,41.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L4386","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,186.02,155.02000000000001,695.83,41.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L4386","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,186.02,155.02000000000001,695.83,41.25]
["TUFTS - TUFTS SELECT - HCPCS - L4386","TUFTS","TUFTS SELECT","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,231.43,155.02000000000001,695.83,41.25]
["TUFTS - TUFTS SPIRIT - HCPCS - L4386","TUFTS","TUFTS SPIRIT","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,170.52,155.02000000000001,695.83,41.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L4386","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,209,155.02000000000001,695.83,41.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L4386","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,323.57,155.02000000000001,695.83,41.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L4386","TUFTS","TUFTS MEDICARE SCO","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,224.78,155.02000000000001,695.83,41.25]
["FALLON - FALLON MEDICAID - HCPCS - L4386","FALLON","FALLON MEDICAID","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,0,155.02000000000001,695.83,41.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - L4386","FALLON","FALLON SENIOR PLAN","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,155.02000000000001,155.02000000000001,695.83,41.25]
["TUFTS - TUFTS HMO - HCPCS - L4386","TUFTS","TUFTS HMO","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,277.72000000000003,155.02000000000001,695.83,41.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L4386","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,224.78,155.02000000000001,695.83,41.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L4386","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,334.69,155.02000000000001,695.83,41.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L4386","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,269.73,155.02000000000001,695.83,41.25]
["TUFTS - TUFTS POS - HCPCS - L4386","TUFTS","TUFTS POS","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,231.43,155.02000000000001,695.83,41.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L4386","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,155.02000000000001,155.02000000000001,695.83,41.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L4386","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,225.63,155.02000000000001,695.83,41.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L4386","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,342.58,155.02000000000001,695.83,41.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L4386","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,225.63,155.02000000000001,695.83,41.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L4386","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,155.02000000000001,155.02000000000001,695.83,41.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L4386","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,155.02000000000001,155.02000000000001,695.83,41.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L4386","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,155.02000000000001,155.02000000000001,695.83,41.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L4386","BMC HEALTHNET","BMCHN ACO","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,0,155.02000000000001,695.83,41.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L4386","BMC HEALTHNET","BMCHN QHP","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,0,155.02000000000001,695.83,41.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L4386","BMC HEALTHNET","BMCHN MCO","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,0,155.02000000000001,695.83,41.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L4386","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,695.83,155.02000000000001,695.83,41.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L4386","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,0,155.02000000000001,695.83,41.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L4386","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,0,155.02000000000001,695.83,41.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L4386","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,182.92,155.02000000000001,695.83,41.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L4386","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,0,155.02000000000001,695.83,41.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L4386","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,225.63,155.02000000000001,695.83,41.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L4386","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,390.06,155.02000000000001,695.83,41.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L4386","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,225.63,155.02000000000001,695.83,41.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L4386","BLUE CROSS","BLUE CROSS-PPO","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,225.63,155.02000000000001,695.83,41.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L4386","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,225.63,155.02000000000001,695.83,41.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L4386","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB",165,225.63,155.02000000000001,695.83,41.25]
["TUFTS - TUFTS PPO - HCPCS - L4396","TUFTS","TUFTS PPO","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,273.75,171.42,769.43,101.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L4396","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,205.7,171.42,769.43,101.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L4396","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,357.79,171.42,769.43,101.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L4396","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,0,171.42,769.43,101.5]
["TUFTS - TUFTS SELECT - HCPCS - L4396","TUFTS","TUFTS SELECT","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,255.91,171.42,769.43,101.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L4396","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,205.7,171.42,769.43,101.5]
["TUFTS - TUFTS SPIRIT - HCPCS - L4396","TUFTS","TUFTS SPIRIT","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,188.56,171.42,769.43,101.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L4396","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,231.11,171.42,769.43,101.5]
["FALLON - FALLON MEDICAID - HCPCS - L4396","FALLON","FALLON MEDICAID","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,0,171.42,769.43,101.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L4396","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,248.56,171.42,769.43,101.5]
["FALLON - FALLON SENIOR PLAN - HCPCS - L4396","FALLON","FALLON SENIOR PLAN","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,171.42,171.42,769.43,101.5]
["TUFTS - TUFTS HMO - HCPCS - L4396","TUFTS","TUFTS HMO","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,307.08999999999997,171.42,769.43,101.5]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L4396","TUFTS","TUFTS MEDICARE SCO","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,248.56,171.42,769.43,101.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L4396","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,370.1,171.42,769.43,101.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L4396","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,298.27,171.42,769.43,101.5]
["TUFTS - TUFTS POS - HCPCS - L4396","TUFTS","TUFTS POS","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,255.91,171.42,769.43,101.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L4396","BMC HEALTHNET","BMCHN QHP","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,0,171.42,769.43,101.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L4396","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,249.49,171.42,769.43,101.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L4396","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,378.82,171.42,769.43,101.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L4396","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,249.49,171.42,769.43,101.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L4396","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,769.43,171.42,769.43,101.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L4396","BMC HEALTHNET","BMCHN ACO","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,0,171.42,769.43,101.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L4396","BMC HEALTHNET","BMCHN MCO","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,0,171.42,769.43,101.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L4396","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,171.42,171.42,769.43,101.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L4396","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,171.42,171.42,769.43,101.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L4396","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,0,171.42,769.43,101.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L4396","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,171.42,171.42,769.43,101.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L4396","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,171.42,171.42,769.43,101.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L4396","BLUE CROSS","BLUE CROSS-PPO","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,249.49,171.42,769.43,101.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L4396","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,431.33,171.42,769.43,101.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L4396","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,0,171.42,769.43,101.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L4396","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,249.49,171.42,769.43,101.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L4396","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,202.28,171.42,769.43,101.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L4396","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,0,171.42,769.43,101.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L4396","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,249.49,171.42,769.43,101.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L4396","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,249.49,171.42,769.43,101.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L4396","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L4396","STATIC AFO","L4396 - STATIC AFO",406,249.49,171.42,769.43,101.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L4398","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,0,78.92,354.25,101.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L4398","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,94.7,78.92,354.25,101.5]
["TUFTS - TUFTS PPO - HCPCS - L4398","TUFTS","TUFTS PPO","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,126.03,78.92,354.25,101.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L4398","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,94.7,78.92,354.25,101.5]
["TUFTS - TUFTS SELECT - HCPCS - L4398","TUFTS","TUFTS SELECT","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,117.83,78.92,354.25,101.5]
["TUFTS - TUFTS SPIRIT - HCPCS - L4398","TUFTS","TUFTS SPIRIT","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,86.81,78.92,354.25,101.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L4398","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,106.4,78.92,354.25,101.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L4398","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,164.73,78.92,354.25,101.5]
["FALLON - FALLON MEDICAID - HCPCS - L4398","FALLON","FALLON MEDICAID","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,0,78.92,354.25,101.5]
["TUFTS - TUFTS HMO - HCPCS - L4398","TUFTS","TUFTS HMO","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,141.38999999999999,78.92,354.25,101.5]
["FALLON - FALLON SENIOR PLAN - HCPCS - L4398","FALLON","FALLON SENIOR PLAN","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,78.92,78.92,354.25,101.5]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L4398","TUFTS","TUFTS MEDICARE SCO","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,114.43,78.92,354.25,101.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L4398","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,114.43,78.92,354.25,101.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L4398","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,170.39,78.92,354.25,101.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L4398","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,137.32,78.92,354.25,101.5]
["TUFTS - TUFTS POS - HCPCS - L4398","TUFTS","TUFTS POS","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,117.83,78.92,354.25,101.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L4398","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,78.92,78.92,354.25,101.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L4398","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,114.87,78.92,354.25,101.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L4398","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,78.92,78.92,354.25,101.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L4398","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,78.92,78.92,354.25,101.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L4398","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,174.4,78.92,354.25,101.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L4398","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,114.87,78.92,354.25,101.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L4398","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,78.92,78.92,354.25,101.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L4398","BMC HEALTHNET","BMCHN ACO","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,0,78.92,354.25,101.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L4398","BMC HEALTHNET","BMCHN QHP","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,0,78.92,354.25,101.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L4398","BMC HEALTHNET","BMCHN MCO","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,0,78.92,354.25,101.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L4398","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,354.25,78.92,354.25,101.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L4398","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,0,78.92,354.25,101.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L4398","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,0,78.92,354.25,101.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L4398","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,93.13,78.92,354.25,101.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L4398","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,0,78.92,354.25,101.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L4398","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,114.87,78.92,354.25,101.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L4398","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,198.58,78.92,354.25,101.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L4398","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,114.87,78.92,354.25,101.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L4398","BLUE CROSS","BLUE CROSS-PPO","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,114.87,78.92,354.25,101.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L4398","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,114.87,78.92,354.25,101.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L4398","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT",406,114.87,78.92,354.25,101.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L8501","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE","L8501 - TRACHEOSTOMY SPEAKING VALVE",219,192.89,160.74,721.54,54.75]
["TUFTS - TUFTS PPO - HCPCS - L8501","TUFTS","TUFTS PPO","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE","L8501 - TRACHEOSTOMY SPEAKING VALVE",219,256.70999999999998,160.74,721.54,54.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L8501","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE","L8501 - TRACHEOSTOMY SPEAKING VALVE",219,335.51,160.74,721.54,54.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L8501","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE","L8501 - TRACHEOSTOMY SPEAKING VALVE",219,0,160.74,721.54,54.75]
["TUFTS - TUFTS SELECT - HCPCS - L8501","TUFTS","TUFTS SELECT","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE","L8501 - TRACHEOSTOMY SPEAKING VALVE",219,239.98,160.74,721.54,54.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L8501","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE","L8501 - TRACHEOSTOMY SPEAKING VALVE",219,192.89,160.74,721.54,54.75]
["TUFTS - TUFTS SPIRIT - HCPCS - L8501","TUFTS","TUFTS SPIRIT","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE","L8501 - TRACHEOSTOMY SPEAKING VALVE",219,176.81,160.74,721.54,54.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L8501","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE","L8501 - TRACHEOSTOMY SPEAKING VALVE",219,216.71,160.74,721.54,54.75]
["FALLON - FALLON MEDICAID - HCPCS - L8501","FALLON","FALLON MEDICAID","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE","L8501 - TRACHEOSTOMY SPEAKING VALVE",219,0,160.74,721.54,54.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - L8501","FALLON","FALLON SENIOR PLAN","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE","L8501 - TRACHEOSTOMY SPEAKING VALVE",219,160.74,160.74,721.54,54.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L8501","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE","L8501 - TRACHEOSTOMY SPEAKING VALVE",219,233.07,160.74,721.54,54.75]
["TUFTS - TUFTS HMO - HCPCS - L8501","TUFTS","TUFTS HMO","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE","L8501 - TRACHEOSTOMY SPEAKING VALVE",219,287.97000000000003,160.74,721.54,54.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L8501","TUFTS","TUFTS MEDICARE SCO","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE","L8501 - TRACHEOSTOMY SPEAKING VALVE",219,233.07,160.74,721.54,54.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L8501","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE","L8501 - TRACHEOSTOMY SPEAKING VALVE",219,347.04,160.74,721.54,54.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L8501","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE","L8501 - TRACHEOSTOMY SPEAKING VALVE",219,279.69,160.74,721.54,54.75]
["TUFTS - TUFTS POS - HCPCS - L8501","TUFTS","TUFTS POS","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE","L8501 - TRACHEOSTOMY SPEAKING VALVE",219,239.98,160.74,721.54,54.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L8501","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE","L8501 - TRACHEOSTOMY SPEAKING VALVE",219,721.54,160.74,721.54,54.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L8501","BMC HEALTHNET","BMCHN QHP","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE","L8501 - TRACHEOSTOMY SPEAKING VALVE",219,0,160.74,721.54,54.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L8501","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE","L8501 - TRACHEOSTOMY SPEAKING VALVE",219,355.22,160.74,721.54,54.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L8501","BMC HEALTHNET","BMCHN ACO","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE","L8501 - TRACHEOSTOMY SPEAKING VALVE",219,0,160.74,721.54,54.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L8501","BMC HEALTHNET","BMCHN MCO","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE","L8501 - TRACHEOSTOMY SPEAKING VALVE",219,0,160.74,721.54,54.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L8501","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE","L8501 - TRACHEOSTOMY SPEAKING VALVE",219,160.74,160.74,721.54,54.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L8501","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE","L8501 - TRACHEOSTOMY SPEAKING VALVE",219,160.74,160.74,721.54,54.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L8501","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE","L8501 - TRACHEOSTOMY SPEAKING VALVE",219,0,160.74,721.54,54.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L8501","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE","L8501 - TRACHEOSTOMY SPEAKING VALVE",219,160.74,160.74,721.54,54.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L8501","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE","L8501 - TRACHEOSTOMY SPEAKING VALVE",219,160.74,160.74,721.54,54.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L8501","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE","L8501 - TRACHEOSTOMY SPEAKING VALVE",219,0,160.74,721.54,54.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L8501","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE","L8501 - TRACHEOSTOMY SPEAKING VALVE",219,404.45,160.74,721.54,54.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L8501","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE","L8501 - TRACHEOSTOMY SPEAKING VALVE",219,0,160.74,721.54,54.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L8501","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE","L8501 - TRACHEOSTOMY SPEAKING VALVE",219,189.67,160.74,721.54,54.75]
["TUFTS - TUFTS PPO - HCPCS - L8507","TUFTS","TUFTS PPO","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)","L8507 - HC PROLARYNX VOICE (PLUS)",1604,65.510000000000005,41.03,184.14,401]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L8507","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)","L8507 - HC PROLARYNX VOICE (PLUS)",1604,0,41.03,184.14,401]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L8507","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)","L8507 - HC PROLARYNX VOICE (PLUS)",1604,49.24,41.03,184.14,401]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L8507","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)","L8507 - HC PROLARYNX VOICE (PLUS)",1604,49.24,41.03,184.14,401]
["TUFTS - TUFTS SELECT - HCPCS - L8507","TUFTS","TUFTS SELECT","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)","L8507 - HC PROLARYNX VOICE (PLUS)",1604,61.25,41.03,184.14,401]
["TUFTS - TUFTS SPIRIT - HCPCS - L8507","TUFTS","TUFTS SPIRIT","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)","L8507 - HC PROLARYNX VOICE (PLUS)",1604,45.13,41.03,184.14,401]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L8507","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)","L8507 - HC PROLARYNX VOICE (PLUS)",1604,55.32,41.03,184.14,401]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L8507","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)","L8507 - HC PROLARYNX VOICE (PLUS)",1604,85.63,41.03,184.14,401]
["FALLON - FALLON MEDICAID - HCPCS - L8507","FALLON","FALLON MEDICAID","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)","L8507 - HC PROLARYNX VOICE (PLUS)",1604,0,41.03,184.14,401]
["FALLON - FALLON SENIOR PLAN - HCPCS - L8507","FALLON","FALLON SENIOR PLAN","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)","L8507 - HC PROLARYNX VOICE (PLUS)",1604,41.03,41.03,184.14,401]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L8507","TUFTS","TUFTS MEDICARE SCO","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)","L8507 - HC PROLARYNX VOICE (PLUS)",1604,59.49,41.03,184.14,401]
["TUFTS - TUFTS HMO - HCPCS - L8507","TUFTS","TUFTS HMO","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)","L8507 - HC PROLARYNX VOICE (PLUS)",1604,73.5,41.03,184.14,401]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L8507","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)","L8507 - HC PROLARYNX VOICE (PLUS)",1604,59.49,41.03,184.14,401]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L8507","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)","L8507 - HC PROLARYNX VOICE (PLUS)",1604,88.58,41.03,184.14,401]
["TUFTS - TUFTS POS - HCPCS - L8507","TUFTS","TUFTS POS","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)","L8507 - HC PROLARYNX VOICE (PLUS)",1604,61.25,41.03,184.14,401]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L8507","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)","L8507 - HC PROLARYNX VOICE (PLUS)",1604,71.39,41.03,184.14,401]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L8507","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)","L8507 - HC PROLARYNX VOICE (PLUS)",1604,41.03,41.03,184.14,401]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L8507","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)","L8507 - HC PROLARYNX VOICE (PLUS)",1604,90.67,41.03,184.14,401]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L8507","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)","L8507 - HC PROLARYNX VOICE (PLUS)",1604,41.03,41.03,184.14,401]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L8507","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)","L8507 - HC PROLARYNX VOICE (PLUS)",1604,41.03,41.03,184.14,401]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L8507","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)","L8507 - HC PROLARYNX VOICE (PLUS)",1604,41.03,41.03,184.14,401]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L8507","BMC HEALTHNET","BMCHN ACO","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)","L8507 - HC PROLARYNX VOICE (PLUS)",1604,0,41.03,184.14,401]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L8507","BMC HEALTHNET","BMCHN QHP","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)","L8507 - HC PROLARYNX VOICE (PLUS)",1604,0,41.03,184.14,401]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L8507","BMC HEALTHNET","BMCHN MCO","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)","L8507 - HC PROLARYNX VOICE (PLUS)",1604,0,41.03,184.14,401]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L8507","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)","L8507 - HC PROLARYNX VOICE (PLUS)",1604,184.14,41.03,184.14,401]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L8507","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)","L8507 - HC PROLARYNX VOICE (PLUS)",1604,0,41.03,184.14,401]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L8507","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)","L8507 - HC PROLARYNX VOICE (PLUS)",1604,0,41.03,184.14,401]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L8507","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)","L8507 - HC PROLARYNX VOICE (PLUS)",1604,0,41.03,184.14,401]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L8507","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)","L8507 - HC PROLARYNX VOICE (PLUS)",1604,48.42,41.03,184.14,401]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L8507","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)","L8507 - HC PROLARYNX VOICE (PLUS)",1604,103.24,41.03,184.14,401]
["TUFTS - TUFTS PPO - HCPCS - L8509","TUFTS","TUFTS PPO","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,170.87,106.99,480.27,286]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L8509","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,128.38999999999999,106.99,480.27,286]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L8509","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,223.32,106.99,480.27,286]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L8509","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,0,106.99,480.27,286]
["TUFTS - TUFTS SELECT - HCPCS - L8509","TUFTS","TUFTS SELECT","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,159.72999999999999,106.99,480.27,286]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L8509","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,128.38999999999999,106.99,480.27,286]
["TUFTS - TUFTS SPIRIT - HCPCS - L8509","TUFTS","TUFTS SPIRIT","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,117.69,106.99,480.27,286]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L8509","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,144.24,106.99,480.27,286]
["FALLON - FALLON MEDICAID - HCPCS - L8509","FALLON","FALLON MEDICAID","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,0,106.99,480.27,286]
["FALLON - FALLON SENIOR PLAN - HCPCS - L8509","FALLON","FALLON SENIOR PLAN","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,106.99,106.99,480.27,286]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L8509","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,155.13999999999999,106.99,480.27,286]
["TUFTS - TUFTS HMO - HCPCS - L8509","TUFTS","TUFTS HMO","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,191.68,106.99,480.27,286]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L8509","TUFTS","TUFTS MEDICARE SCO","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,155.13999999999999,106.99,480.27,286]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L8509","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,230.99,106.99,480.27,286]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L8509","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,186.16,106.99,480.27,286]
["TUFTS - TUFTS POS - HCPCS - L8509","TUFTS","TUFTS POS","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,159.72999999999999,106.99,480.27,286]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L8509","BMC HEALTHNET","BMCHN QHP","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,0,106.99,480.27,286]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L8509","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,155.72999999999999,106.99,480.27,286]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L8509","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,236.44,106.99,480.27,286]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L8509","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,480.27,106.99,480.27,286]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L8509","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,155.72999999999999,106.99,480.27,286]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L8509","BMC HEALTHNET","BMCHN ACO","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,0,106.99,480.27,286]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L8509","BMC HEALTHNET","BMCHN MCO","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,0,106.99,480.27,286]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L8509","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,106.99,106.99,480.27,286]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L8509","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,106.99,106.99,480.27,286]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L8509","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,0,106.99,480.27,286]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L8509","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,106.99,106.99,480.27,286]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L8509","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,106.99,106.99,480.27,286]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L8509","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,155.72999999999999,106.99,480.27,286]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L8509","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,155.72999999999999,106.99,480.27,286]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L8509","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,269.20999999999998,106.99,480.27,286]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L8509","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,0,106.99,480.27,286]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L8509","BLUE CROSS","BLUE CROSS-PPO","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,155.72999999999999,106.99,480.27,286]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L8509","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,0,106.99,480.27,286]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L8509","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,126.25,106.99,480.27,286]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L8509","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,155.72999999999999,106.99,480.27,286]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L8509","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN",1144,155.72999999999999,106.99,480.27,286]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L8514","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR","L8514 - REPL TRACH PUNCTURE DILATOR",387,110.86,92.38,414.69,96.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L8514","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR","L8514 - REPL TRACH PUNCTURE DILATOR",387,0,92.38,414.69,96.75]
["TUFTS - TUFTS PPO - HCPCS - L8514","TUFTS","TUFTS PPO","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR","L8514 - REPL TRACH PUNCTURE DILATOR",387,147.54,92.38,414.69,96.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L8514","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR","L8514 - REPL TRACH PUNCTURE DILATOR",387,110.86,92.38,414.69,96.75]
["TUFTS - TUFTS SELECT - HCPCS - L8514","TUFTS","TUFTS SELECT","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR","L8514 - REPL TRACH PUNCTURE DILATOR",387,137.91999999999999,92.38,414.69,96.75]
["TUFTS - TUFTS SPIRIT - HCPCS - L8514","TUFTS","TUFTS SPIRIT","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR","L8514 - REPL TRACH PUNCTURE DILATOR",387,101.62,92.38,414.69,96.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L8514","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR","L8514 - REPL TRACH PUNCTURE DILATOR",387,124.55,92.38,414.69,96.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L8514","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR","L8514 - REPL TRACH PUNCTURE DILATOR",387,192.83,92.38,414.69,96.75]
["FALLON - FALLON MEDICAID - HCPCS - L8514","FALLON","FALLON MEDICAID","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR","L8514 - REPL TRACH PUNCTURE DILATOR",387,0,92.38,414.69,96.75]
["TUFTS - TUFTS HMO - HCPCS - L8514","TUFTS","TUFTS HMO","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR","L8514 - REPL TRACH PUNCTURE DILATOR",387,165.51,92.38,414.69,96.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - L8514","FALLON","FALLON SENIOR PLAN","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR","L8514 - REPL TRACH PUNCTURE DILATOR",387,92.38,92.38,414.69,96.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L8514","TUFTS","TUFTS MEDICARE SCO","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR","L8514 - REPL TRACH PUNCTURE DILATOR",387,133.94999999999999,92.38,414.69,96.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L8514","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR","L8514 - REPL TRACH PUNCTURE DILATOR",387,133.94999999999999,92.38,414.69,96.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L8514","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR","L8514 - REPL TRACH PUNCTURE DILATOR",387,199.45,92.38,414.69,96.75]
["TUFTS - TUFTS POS - HCPCS - L8514","TUFTS","TUFTS POS","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR","L8514 - REPL TRACH PUNCTURE DILATOR",387,137.91999999999999,92.38,414.69,96.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L8514","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR","L8514 - REPL TRACH PUNCTURE DILATOR",387,160.74,92.38,414.69,96.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L8514","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR","L8514 - REPL TRACH PUNCTURE DILATOR",387,92.38,92.38,414.69,96.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L8514","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR","L8514 - REPL TRACH PUNCTURE DILATOR",387,92.38,92.38,414.69,96.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L8514","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR","L8514 - REPL TRACH PUNCTURE DILATOR",387,92.38,92.38,414.69,96.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L8514","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR","L8514 - REPL TRACH PUNCTURE DILATOR",387,204.15,92.38,414.69,96.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L8514","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR","L8514 - REPL TRACH PUNCTURE DILATOR",387,92.38,92.38,414.69,96.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L8514","BMC HEALTHNET","BMCHN ACO","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR","L8514 - REPL TRACH PUNCTURE DILATOR",387,0,92.38,414.69,96.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L8514","BMC HEALTHNET","BMCHN QHP","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR","L8514 - REPL TRACH PUNCTURE DILATOR",387,0,92.38,414.69,96.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L8514","BMC HEALTHNET","BMCHN MCO","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR","L8514 - REPL TRACH PUNCTURE DILATOR",387,0,92.38,414.69,96.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L8514","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR","L8514 - REPL TRACH PUNCTURE DILATOR",387,414.69,92.38,414.69,96.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L8514","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR","L8514 - REPL TRACH PUNCTURE DILATOR",387,0,92.38,414.69,96.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L8514","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR","L8514 - REPL TRACH PUNCTURE DILATOR",387,0,92.38,414.69,96.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L8514","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR","L8514 - REPL TRACH PUNCTURE DILATOR",387,0,92.38,414.69,96.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L8514","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR","L8514 - REPL TRACH PUNCTURE DILATOR",387,232.45,92.38,414.69,96.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L8514","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR","L8514 - REPL TRACH PUNCTURE DILATOR",387,109.01,92.38,414.69,96.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L8693","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,1782.68,1485.57,6668.25,365.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L8693","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,3100.71,1485.57,6668.25,365.5]
["TUFTS - TUFTS PPO - HCPCS - L8693","TUFTS","TUFTS PPO","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,2372.4,1485.57,6668.25,365.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L8693","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,0,1485.57,6668.25,365.5]
["TUFTS - TUFTS SELECT - HCPCS - L8693","TUFTS","TUFTS SELECT","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,2217.8200000000002,1485.57,6668.25,365.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L8693","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,1782.68,1485.57,6668.25,365.5]
["TUFTS - TUFTS SPIRIT - HCPCS - L8693","TUFTS","TUFTS SPIRIT","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,1634.13,1485.57,6668.25,365.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L8693","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,2002.85,1485.57,6668.25,365.5]
["FALLON - FALLON MEDICAID - HCPCS - L8693","FALLON","FALLON MEDICAID","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,0,1485.57,6668.25,365.5]
["FALLON - FALLON SENIOR PLAN - HCPCS - L8693","FALLON","FALLON SENIOR PLAN","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,1485.57,1485.57,6668.25,365.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L8693","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,2154.08,1485.57,6668.25,365.5]
["TUFTS - TUFTS HMO - HCPCS - L8693","TUFTS","TUFTS HMO","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,2661.38,1485.57,6668.25,365.5]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - L8693","TUFTS","TUFTS MEDICARE SCO","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,2154.08,1485.57,6668.25,365.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L8693","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,3207.35,1485.57,6668.25,365.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L8693","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,2584.89,1485.57,6668.25,365.5]
["TUFTS - TUFTS POS - HCPCS - L8693","TUFTS","TUFTS POS","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,2217.8200000000002,1485.57,6668.25,365.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L8693","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,2162.1799999999998,1485.57,6668.25,365.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L8693","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,6668.25,1485.57,6668.25,365.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L8693","BMC HEALTHNET","BMCHN QHP","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,0,1485.57,6668.25,365.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L8693","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,3282.93,1485.57,6668.25,365.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L8693","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,2162.1799999999998,1485.57,6668.25,365.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L8693","BMC HEALTHNET","BMCHN ACO","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,0,1485.57,6668.25,365.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L8693","BMC HEALTHNET","BMCHN MCO","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,0,1485.57,6668.25,365.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L8693","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,1485.57,1485.57,6668.25,365.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L8693","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,1485.57,1485.57,6668.25,365.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L8693","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,0,1485.57,6668.25,365.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L8693","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,1485.57,1485.57,6668.25,365.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L8693","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,1485.57,1485.57,6668.25,365.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L8693","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,0,1485.57,6668.25,365.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L8693","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,1752.97,1485.57,6668.25,365.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L8693","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,3737.99,1485.57,6668.25,365.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L8693","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,0,1485.57,6668.25,365.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L8693","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,2162.1799999999998,1485.57,6668.25,365.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L8693","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,2162.1799999999998,1485.57,6668.25,365.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - L8693","BLUE CROSS","BLUE CROSS-PPO","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,2162.1799999999998,1485.57,6668.25,365.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L8693","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,2162.1799999999998,1485.57,6668.25,365.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L8693","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT",1462,2162.1799999999998,1485.57,6668.25,365.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - L8699","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","L8699","HC CARTIFORM 20 X 25 MM DISC","L8699 - HC CARTIFORM 20 X 25 MM DISC",13957,0,0,0,3489.25]
["TUFTS - TUFTS PPO - HCPCS - L8699","TUFTS","TUFTS PPO","HCPCS","L8699","HC CARTIFORM 20 X 25 MM DISC","L8699 - HC CARTIFORM 20 X 25 MM DISC",13957,0,0,0,3489.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L8699","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L8699","HC CARTIFORM 20 X 25 MM DISC","L8699 - HC CARTIFORM 20 X 25 MM DISC",13957,0,0,0,3489.25]
["TUFTS - TUFTS SELECT - HCPCS - L8699","TUFTS","TUFTS SELECT","HCPCS","L8699","HC CARTIFORM 20 X 25 MM DISC","L8699 - HC CARTIFORM 20 X 25 MM DISC",13957,0,0,0,3489.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - L8699","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","L8699","HC CARTIFORM 20 X 25 MM DISC","L8699 - HC CARTIFORM 20 X 25 MM DISC",13957,0,0,0,3489.25]
["FALLON - FALLON MEDICAID - HCPCS - L8699","FALLON","FALLON MEDICAID","HCPCS","L8699","HC CARTIFORM 20 X 25 MM DISC","L8699 - HC CARTIFORM 20 X 25 MM DISC",13957,0,0,0,3489.25]
["TUFTS - TUFTS HMO - HCPCS - L8699","TUFTS","TUFTS HMO","HCPCS","L8699","HC CARTIFORM 20 X 25 MM DISC","L8699 - HC CARTIFORM 20 X 25 MM DISC",13957,0,0,0,3489.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - L8699","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","L8699","HC CARTIFORM 20 X 25 MM DISC","L8699 - HC CARTIFORM 20 X 25 MM DISC",13957,0,0,0,3489.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - L8699","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","L8699","HC CARTIFORM 20 X 25 MM DISC","L8699 - HC CARTIFORM 20 X 25 MM DISC",13957,0,0,0,3489.25]
["TUFTS - TUFTS POS - HCPCS - L8699","TUFTS","TUFTS POS","HCPCS","L8699","HC CARTIFORM 20 X 25 MM DISC","L8699 - HC CARTIFORM 20 X 25 MM DISC",13957,0,0,0,3489.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - L8699","BMC HEALTHNET","BMCHN ACO","HCPCS","L8699","HC CARTIFORM 20 X 25 MM DISC","L8699 - HC CARTIFORM 20 X 25 MM DISC",13957,0,0,0,3489.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - L8699","BMC HEALTHNET","BMCHN QHP","HCPCS","L8699","HC CARTIFORM 20 X 25 MM DISC","L8699 - HC CARTIFORM 20 X 25 MM DISC",13957,0,0,0,3489.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - L8699","BMC HEALTHNET","BMCHN MCO","HCPCS","L8699","HC CARTIFORM 20 X 25 MM DISC","L8699 - HC CARTIFORM 20 X 25 MM DISC",13957,0,0,0,3489.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L8699","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L8699","HC CARTIFORM 20 X 25 MM DISC","L8699 - HC CARTIFORM 20 X 25 MM DISC",13957,0,0,0,3489.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L8699","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L8699","HC CARTIFORM 20 X 25 MM DISC","L8699 - HC CARTIFORM 20 X 25 MM DISC",13957,0,0,0,3489.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L8699","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L8699","HC CARTIFORM 20 X 25 MM DISC","L8699 - HC CARTIFORM 20 X 25 MM DISC",13957,0,0,0,3489.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L8699","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L8699","HC CARTIFORM 20 X 25 MM DISC","L8699 - HC CARTIFORM 20 X 25 MM DISC",13957,0,0,0,3489.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - M0239","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",393,371.52,309.60000000000002,779.02,98.25]
["TUFTS - TUFTS SPIRIT - HCPCS - M0239","TUFTS","TUFTS SPIRIT","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",393,340.56,309.60000000000002,779.02,98.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - M0239","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",393,652.02,309.60000000000002,779.02,98.25]
["FALLON - FALLON MEDICAID - HCPCS - M0239","FALLON","FALLON MEDICAID","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",393,309.60000000000002,309.60000000000002,779.02,98.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - M0239","TUFTS","TUFTS MEDICARE SCO","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",393,448.92,309.60000000000002,779.02,98.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - M0239","FALLON","FALLON SENIOR PLAN","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",393,309.60000000000002,309.60000000000002,779.02,98.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - M0239","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",393,668.43,309.60000000000002,779.02,98.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - M0239","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",393,538.70000000000005,309.60000000000002,779.02,98.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - M0239","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",393,309.60000000000002,309.60000000000002,779.02,98.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - M0239","BMC HEALTHNET","BMCHN QHP","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",393,371.52,309.60000000000002,779.02,98.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - M0239","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",393,518.74,309.60000000000002,779.02,98.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - M0239","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",393,684.18,309.60000000000002,779.02,98.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - M0239","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",393,309.60000000000002,309.60000000000002,779.02,98.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - M0239","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",393,309.60000000000002,309.60000000000002,779.02,98.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - M0239","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",393,518.74,309.60000000000002,779.02,98.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - M0239","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",393,309.60000000000002,309.60000000000002,779.02,98.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - M0239","BMC HEALTHNET","BMCHN ACO","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",393,677.4,309.60000000000002,779.02,98.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - M0239","BMC HEALTHNET","BMCHN MCO","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",393,309.60000000000002,309.60000000000002,779.02,98.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - M0239","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",393,309.60000000000002,309.60000000000002,779.02,98.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - M0239","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",393,365.33,309.60000000000002,779.02,98.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - M0239","BLUE CROSS","BLUE CROSS-PPO","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",393,518.74,309.60000000000002,779.02,98.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - M0239","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",393,365.33,309.60000000000002,779.02,98.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - M0239","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",393,518.74,309.60000000000002,779.02,98.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - M0239","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",393,420.13,309.60000000000002,779.02,98.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - M0239","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",393,518.74,309.60000000000002,779.02,98.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - M0239","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",393,779.02,309.60000000000002,779.02,98.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - M0239","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",393,518.74,309.60000000000002,779.02,98.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - M0239","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",393,518.74,309.60000000000002,779.02,98.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - M0243","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",572,652.02,309.60000000000002,779.02,143]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - M0243","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",572,371.52,309.60000000000002,779.02,143]
["TUFTS - TUFTS SPIRIT - HCPCS - M0243","TUFTS","TUFTS SPIRIT","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",572,340.56,309.60000000000002,779.02,143]
["FALLON - FALLON MEDICAID - HCPCS - M0243","FALLON","FALLON MEDICAID","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",572,309.60000000000002,309.60000000000002,779.02,143]
["FALLON - FALLON SENIOR PLAN - HCPCS - M0243","FALLON","FALLON SENIOR PLAN","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",572,309.60000000000002,309.60000000000002,779.02,143]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - M0243","TUFTS","TUFTS MEDICARE SCO","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",572,448.92,309.60000000000002,779.02,143]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - M0243","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",572,668.43,309.60000000000002,779.02,143]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - M0243","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",572,538.70000000000005,309.60000000000002,779.02,143]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - M0243","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",572,518.74,309.60000000000002,779.02,143]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - M0243","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",572,684.18,309.60000000000002,779.02,143]
["BMC HEALTHNET - BMCHN ACO - HCPCS - M0243","BMC HEALTHNET","BMCHN ACO","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",572,677.4,309.60000000000002,779.02,143]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - M0243","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",572,518.74,309.60000000000002,779.02,143]
["BMC HEALTHNET - BMCHN QHP - HCPCS - M0243","BMC HEALTHNET","BMCHN QHP","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",572,371.52,309.60000000000002,779.02,143]
["BMC HEALTHNET - BMCHN MCO - HCPCS - M0243","BMC HEALTHNET","BMCHN MCO","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",572,309.60000000000002,309.60000000000002,779.02,143]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - M0243","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",572,309.60000000000002,309.60000000000002,779.02,143]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - M0243","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",572,309.60000000000002,309.60000000000002,779.02,143]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - M0243","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",572,309.60000000000002,309.60000000000002,779.02,143]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - M0243","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",572,309.60000000000002,309.60000000000002,779.02,143]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - M0243","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",572,309.60000000000002,309.60000000000002,779.02,143]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - M0243","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",572,779.02,309.60000000000002,779.02,143]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - M0243","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",572,365.33,309.60000000000002,779.02,143]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - M0243","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",572,420.13,309.60000000000002,779.02,143]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - M0243","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",572,365.33,309.60000000000002,779.02,143]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - M0243","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",572,518.74,309.60000000000002,779.02,143]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - M0243","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",572,518.74,309.60000000000002,779.02,143]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - M0243","BLUE CROSS","BLUE CROSS-PPO","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",572,518.74,309.60000000000002,779.02,143]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - M0243","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",572,518.74,309.60000000000002,779.02,143]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - M0243","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",572,518.74,309.60000000000002,779.02,143]
["TUFTS - TUFTS PPO - HCPCS - P9012","TUFTS","TUFTS PPO","HCPCS","P9012","HC CRYOPRECIPITATE UNIT","P9012 - HC CRYOPRECIPITATE UNIT",134,79.010000000000005,64.959999999999994,125.33,33.5]
["TUFTS - TUFTS SELECT - HCPCS - P9012","TUFTS","TUFTS SELECT","HCPCS","P9012","HC CRYOPRECIPITATE UNIT","P9012 - HC CRYOPRECIPITATE UNIT",134,73.86,64.959999999999994,125.33,33.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9012","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","P9012","HC CRYOPRECIPITATE UNIT","P9012 - HC CRYOPRECIPITATE UNIT",134,104.04,64.959999999999994,125.33,33.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9012","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","P9012","HC CRYOPRECIPITATE UNIT","P9012 - HC CRYOPRECIPITATE UNIT",134,106.65,64.959999999999994,125.33,33.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9012","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","P9012","HC CRYOPRECIPITATE UNIT","P9012 - HC CRYOPRECIPITATE UNIT",134,106.65,64.959999999999994,125.33,33.5]
["TUFTS - TUFTS HMO - HCPCS - P9012","TUFTS","TUFTS HMO","HCPCS","P9012","HC CRYOPRECIPITATE UNIT","P9012 - HC CRYOPRECIPITATE UNIT",134,73.86,64.959999999999994,125.33,33.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9012","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","P9012","HC CRYOPRECIPITATE UNIT","P9012 - HC CRYOPRECIPITATE UNIT",134,106.65,64.959999999999994,125.33,33.5]
["TUFTS - TUFTS POS - HCPCS - P9012","TUFTS","TUFTS POS","HCPCS","P9012","HC CRYOPRECIPITATE UNIT","P9012 - HC CRYOPRECIPITATE UNIT",134,73.86,64.959999999999994,125.33,33.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - P9012","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","P9012","HC CRYOPRECIPITATE UNIT","P9012 - HC CRYOPRECIPITATE UNIT",134,64.959999999999994,64.959999999999994,125.33,33.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9012","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","P9012","HC CRYOPRECIPITATE UNIT","P9012 - HC CRYOPRECIPITATE UNIT",134,125.33,64.959999999999994,125.33,33.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9012","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","P9012","HC CRYOPRECIPITATE UNIT","P9012 - HC CRYOPRECIPITATE UNIT",134,64.959999999999994,64.959999999999994,125.33,33.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - P9012","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","P9012","HC CRYOPRECIPITATE UNIT","P9012 - HC CRYOPRECIPITATE UNIT",134,64.959999999999994,64.959999999999994,125.33,33.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9012","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","P9012","HC CRYOPRECIPITATE UNIT","P9012 - HC CRYOPRECIPITATE UNIT",134,64.959999999999994,64.959999999999994,125.33,33.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - P9012","BLUE CROSS","BLUE CROSS-PPO","HCPCS","P9012","HC CRYOPRECIPITATE UNIT","P9012 - HC CRYOPRECIPITATE UNIT",134,64.959999999999994,64.959999999999994,125.33,33.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9012","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","P9012","HC CRYOPRECIPITATE UNIT","P9012 - HC CRYOPRECIPITATE UNIT",134,64.959999999999994,64.959999999999994,125.33,33.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9012","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","P9012","HC CRYOPRECIPITATE UNIT","P9012 - HC CRYOPRECIPITATE UNIT",134,64.959999999999994,64.959999999999994,125.33,33.5]
["TUFTS - TUFTS PPO - HCPCS - P9016","TUFTS","TUFTS PPO","HCPCS","P9016","HC RBC:LEU-RED","P9016 - HC RBC:LEU-RED",576,301.76,243.01,478.65,144]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9016","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","P9016","HC RBC:LEU-RED","P9016 - HC RBC:LEU-RED",576,389.15,243.01,478.65,144]
["TUFTS - TUFTS SELECT - HCPCS - P9016","TUFTS","TUFTS SELECT","HCPCS","P9016","HC RBC:LEU-RED","P9016 - HC RBC:LEU-RED",576,282.10000000000002,243.01,478.65,144]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9016","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","P9016","HC RBC:LEU-RED","P9016 - HC RBC:LEU-RED",576,398.94,243.01,478.65,144]
["TUFTS - TUFTS HMO - HCPCS - P9016","TUFTS","TUFTS HMO","HCPCS","P9016","HC RBC:LEU-RED","P9016 - HC RBC:LEU-RED",576,282.10000000000002,243.01,478.65,144]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9016","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","P9016","HC RBC:LEU-RED","P9016 - HC RBC:LEU-RED",576,398.94,243.01,478.65,144]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9016","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","P9016","HC RBC:LEU-RED","P9016 - HC RBC:LEU-RED",576,398.94,243.01,478.65,144]
["TUFTS - TUFTS POS - HCPCS - P9016","TUFTS","TUFTS POS","HCPCS","P9016","HC RBC:LEU-RED","P9016 - HC RBC:LEU-RED",576,282.10000000000002,243.01,478.65,144]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - P9016","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","P9016","HC RBC:LEU-RED","P9016 - HC RBC:LEU-RED",576,243.01,243.01,478.65,144]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9016","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","P9016","HC RBC:LEU-RED","P9016 - HC RBC:LEU-RED",576,243.01,243.01,478.65,144]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9016","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","P9016","HC RBC:LEU-RED","P9016 - HC RBC:LEU-RED",576,478.65,243.01,478.65,144]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - P9016","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","P9016","HC RBC:LEU-RED","P9016 - HC RBC:LEU-RED",576,243.01,243.01,478.65,144]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9016","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","P9016","HC RBC:LEU-RED","P9016 - HC RBC:LEU-RED",576,243.01,243.01,478.65,144]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - P9016","BLUE CROSS","BLUE CROSS-PPO","HCPCS","P9016","HC RBC:LEU-RED","P9016 - HC RBC:LEU-RED",576,243.01,243.01,478.65,144]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9016","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","P9016","HC RBC:LEU-RED","P9016 - HC RBC:LEU-RED",576,243.01,243.01,478.65,144]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9016","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","P9016","HC RBC:LEU-RED","P9016 - HC RBC:LEU-RED",576,243.01,243.01,478.65,144]
["TUFTS - TUFTS PPO - HCPCS - P9017","TUFTS","TUFTS PPO","HCPCS","P9017","HC FF PLAS: 1 DONOR","P9017 - HC FF PLAS: 1 DONOR",291,137.26,94.07,217.72,72.75]
["TUFTS - TUFTS SELECT - HCPCS - P9017","TUFTS","TUFTS SELECT","HCPCS","P9017","HC FF PLAS: 1 DONOR","P9017 - HC FF PLAS: 1 DONOR",291,128.31,94.07,217.72,72.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9017","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","P9017","HC FF PLAS: 1 DONOR","P9017 - HC FF PLAS: 1 DONOR",291,150.63999999999999,94.07,217.72,72.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9017","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","P9017","HC FF PLAS: 1 DONOR","P9017 - HC FF PLAS: 1 DONOR",291,154.43,94.07,217.72,72.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9017","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","P9017","HC FF PLAS: 1 DONOR","P9017 - HC FF PLAS: 1 DONOR",291,154.43,94.07,217.72,72.75]
["TUFTS - TUFTS HMO - HCPCS - P9017","TUFTS","TUFTS HMO","HCPCS","P9017","HC FF PLAS: 1 DONOR","P9017 - HC FF PLAS: 1 DONOR",291,128.31,94.07,217.72,72.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9017","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","P9017","HC FF PLAS: 1 DONOR","P9017 - HC FF PLAS: 1 DONOR",291,154.43,94.07,217.72,72.75]
["TUFTS - TUFTS POS - HCPCS - P9017","TUFTS","TUFTS POS","HCPCS","P9017","HC FF PLAS: 1 DONOR","P9017 - HC FF PLAS: 1 DONOR",291,128.31,94.07,217.72,72.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9017","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","P9017","HC FF PLAS: 1 DONOR","P9017 - HC FF PLAS: 1 DONOR",291,217.72,94.07,217.72,72.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - P9017","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","P9017","HC FF PLAS: 1 DONOR","P9017 - HC FF PLAS: 1 DONOR",291,94.07,94.07,217.72,72.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9017","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","P9017","HC FF PLAS: 1 DONOR","P9017 - HC FF PLAS: 1 DONOR",291,94.07,94.07,217.72,72.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - P9017","BLUE CROSS","BLUE CROSS-PPO","HCPCS","P9017","HC FF PLAS: 1 DONOR","P9017 - HC FF PLAS: 1 DONOR",291,94.07,94.07,217.72,72.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - P9017","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","P9017","HC FF PLAS: 1 DONOR","P9017 - HC FF PLAS: 1 DONOR",291,94.07,94.07,217.72,72.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9017","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","P9017","HC FF PLAS: 1 DONOR","P9017 - HC FF PLAS: 1 DONOR",291,94.07,94.07,217.72,72.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9017","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","P9017","HC FF PLAS: 1 DONOR","P9017 - HC FF PLAS: 1 DONOR",291,94.07,94.07,217.72,72.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9017","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","P9017","HC FF PLAS: 1 DONOR","P9017 - HC FF PLAS: 1 DONOR",291,94.07,94.07,217.72,72.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9021","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","P9021","HC RBC/UNIT","P9021 - HC RBC/UNIT",323,295.08999999999997,184.28,354.25,80.75]
["TUFTS - TUFTS PPO - HCPCS - P9021","TUFTS","TUFTS PPO","HCPCS","P9021","HC RBC/UNIT","P9021 - HC RBC/UNIT",323,223.33,184.28,354.25,80.75]
["TUFTS - TUFTS SELECT - HCPCS - P9021","TUFTS","TUFTS SELECT","HCPCS","P9021","HC RBC/UNIT","P9021 - HC RBC/UNIT",323,208.77,184.28,354.25,80.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9021","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","P9021","HC RBC/UNIT","P9021 - HC RBC/UNIT",323,302.52,184.28,354.25,80.75]
["TUFTS - TUFTS HMO - HCPCS - P9021","TUFTS","TUFTS HMO","HCPCS","P9021","HC RBC/UNIT","P9021 - HC RBC/UNIT",323,208.77,184.28,354.25,80.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9021","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","P9021","HC RBC/UNIT","P9021 - HC RBC/UNIT",323,302.52,184.28,354.25,80.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9021","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","P9021","HC RBC/UNIT","P9021 - HC RBC/UNIT",323,302.52,184.28,354.25,80.75]
["TUFTS - TUFTS POS - HCPCS - P9021","TUFTS","TUFTS POS","HCPCS","P9021","HC RBC/UNIT","P9021 - HC RBC/UNIT",323,208.77,184.28,354.25,80.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - P9021","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","P9021","HC RBC/UNIT","P9021 - HC RBC/UNIT",323,184.28,184.28,354.25,80.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9021","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","P9021","HC RBC/UNIT","P9021 - HC RBC/UNIT",323,184.28,184.28,354.25,80.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9021","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","P9021","HC RBC/UNIT","P9021 - HC RBC/UNIT",323,354.25,184.28,354.25,80.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - P9021","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","P9021","HC RBC/UNIT","P9021 - HC RBC/UNIT",323,184.28,184.28,354.25,80.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9021","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","P9021","HC RBC/UNIT","P9021 - HC RBC/UNIT",323,184.28,184.28,354.25,80.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - P9021","BLUE CROSS","BLUE CROSS-PPO","HCPCS","P9021","HC RBC/UNIT","P9021 - HC RBC/UNIT",323,184.28,184.28,354.25,80.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9021","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","P9021","HC RBC/UNIT","P9021 - HC RBC/UNIT",323,184.28,184.28,354.25,80.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9021","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","P9021","HC RBC/UNIT","P9021 - HC RBC/UNIT",323,184.28,184.28,354.25,80.75]
["TUFTS - TUFTS PPO - HCPCS - P9034","TUFTS","TUFTS PPO","HCPCS","P9034","HB PLATELETS, PHERESIS","P9034 - HB PLATELETS, PHERESIS",506,504.18,443.29,799.73,126.5]
["TUFTS - TUFTS SELECT - HCPCS - P9034","TUFTS","TUFTS SELECT","HCPCS","P9034","HB PLATELETS, PHERESIS","P9034 - HB PLATELETS, PHERESIS",506,471.32,443.29,799.73,126.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9034","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","P9034","HB PLATELETS, PHERESIS","P9034 - HB PLATELETS, PHERESIS",506,709.89,443.29,799.73,126.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9034","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","P9034","HB PLATELETS, PHERESIS","P9034 - HB PLATELETS, PHERESIS",506,727.76,443.29,799.73,126.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9034","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","P9034","HB PLATELETS, PHERESIS","P9034 - HB PLATELETS, PHERESIS",506,727.76,443.29,799.73,126.5]
["TUFTS - TUFTS HMO - HCPCS - P9034","TUFTS","TUFTS HMO","HCPCS","P9034","HB PLATELETS, PHERESIS","P9034 - HB PLATELETS, PHERESIS",506,471.32,443.29,799.73,126.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9034","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","P9034","HB PLATELETS, PHERESIS","P9034 - HB PLATELETS, PHERESIS",506,727.76,443.29,799.73,126.5]
["TUFTS - TUFTS POS - HCPCS - P9034","TUFTS","TUFTS POS","HCPCS","P9034","HB PLATELETS, PHERESIS","P9034 - HB PLATELETS, PHERESIS",506,471.32,443.29,799.73,126.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - P9034","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","P9034","HB PLATELETS, PHERESIS","P9034 - HB PLATELETS, PHERESIS",506,443.29,443.29,799.73,126.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9034","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","P9034","HB PLATELETS, PHERESIS","P9034 - HB PLATELETS, PHERESIS",506,799.73,443.29,799.73,126.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9034","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","P9034","HB PLATELETS, PHERESIS","P9034 - HB PLATELETS, PHERESIS",506,443.29,443.29,799.73,126.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9034","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","P9034","HB PLATELETS, PHERESIS","P9034 - HB PLATELETS, PHERESIS",506,443.29,443.29,799.73,126.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - P9034","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","P9034","HB PLATELETS, PHERESIS","P9034 - HB PLATELETS, PHERESIS",506,443.29,443.29,799.73,126.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - P9034","BLUE CROSS","BLUE CROSS-PPO","HCPCS","P9034","HB PLATELETS, PHERESIS","P9034 - HB PLATELETS, PHERESIS",506,443.29,443.29,799.73,126.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9034","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","P9034","HB PLATELETS, PHERESIS","P9034 - HB PLATELETS, PHERESIS",506,443.29,443.29,799.73,126.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9034","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","P9034","HB PLATELETS, PHERESIS","P9034 - HB PLATELETS, PHERESIS",506,443.29,443.29,799.73,126.5]
["TUFTS - TUFTS PPO - HCPCS - P9037","TUFTS","TUFTS PPO","HCPCS","P9037","HC PLT:PHER,LEU-RED,IRR/UNIT","P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT",939,1022.99,821.84,1622.67,234.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9037","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","P9037","HC PLT:PHER,LEU-RED,IRR/UNIT","P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT",939,1316.1,821.84,1622.67,234.75]
["TUFTS - TUFTS SELECT - HCPCS - P9037","TUFTS","TUFTS SELECT","HCPCS","P9037","HC PLT:PHER,LEU-RED,IRR/UNIT","P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT",939,956.33,821.84,1622.67,234.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9037","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","P9037","HC PLT:PHER,LEU-RED,IRR/UNIT","P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT",939,1349.22,821.84,1622.67,234.75]
["TUFTS - TUFTS HMO - HCPCS - P9037","TUFTS","TUFTS HMO","HCPCS","P9037","HC PLT:PHER,LEU-RED,IRR/UNIT","P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT",939,956.33,821.84,1622.67,234.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9037","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","P9037","HC PLT:PHER,LEU-RED,IRR/UNIT","P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT",939,1349.22,821.84,1622.67,234.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9037","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","P9037","HC PLT:PHER,LEU-RED,IRR/UNIT","P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT",939,1349.22,821.84,1622.67,234.75]
["TUFTS - TUFTS POS - HCPCS - P9037","TUFTS","TUFTS POS","HCPCS","P9037","HC PLT:PHER,LEU-RED,IRR/UNIT","P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT",939,956.33,821.84,1622.67,234.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - P9037","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","P9037","HC PLT:PHER,LEU-RED,IRR/UNIT","P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT",939,821.84,821.84,1622.67,234.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9037","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","P9037","HC PLT:PHER,LEU-RED,IRR/UNIT","P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT",939,821.84,821.84,1622.67,234.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9037","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","P9037","HC PLT:PHER,LEU-RED,IRR/UNIT","P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT",939,1622.67,821.84,1622.67,234.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - P9037","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","P9037","HC PLT:PHER,LEU-RED,IRR/UNIT","P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT",939,821.84,821.84,1622.67,234.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9037","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","P9037","HC PLT:PHER,LEU-RED,IRR/UNIT","P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT",939,821.84,821.84,1622.67,234.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - P9037","BLUE CROSS","BLUE CROSS-PPO","HCPCS","P9037","HC PLT:PHER,LEU-RED,IRR/UNIT","P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT",939,821.84,821.84,1622.67,234.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9037","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","P9037","HC PLT:PHER,LEU-RED,IRR/UNIT","P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT",939,821.84,821.84,1622.67,234.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9037","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","P9037","HC PLT:PHER,LEU-RED,IRR/UNIT","P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT",939,821.84,821.84,1622.67,234.75]
["TUFTS - TUFTS PPO - HCPCS - P9040","TUFTS","TUFTS PPO","HCPCS","P9040","HC RBC:LEU-RED,IRR/UNIT","P9040 - HC RBC:LEU-RED,IRR/UNIT",523,422.37,336.11,669.97,130.75]
["TUFTS - TUFTS SELECT - HCPCS - P9040","TUFTS","TUFTS SELECT","HCPCS","P9040","HC RBC:LEU-RED,IRR/UNIT","P9040 - HC RBC:LEU-RED,IRR/UNIT",523,394.85,336.11,669.97,130.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9040","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","P9040","HC RBC:LEU-RED,IRR/UNIT","P9040 - HC RBC:LEU-RED,IRR/UNIT",523,538.25,336.11,669.97,130.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9040","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","P9040","HC RBC:LEU-RED,IRR/UNIT","P9040 - HC RBC:LEU-RED,IRR/UNIT",523,551.79999999999995,336.11,669.97,130.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9040","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","P9040","HC RBC:LEU-RED,IRR/UNIT","P9040 - HC RBC:LEU-RED,IRR/UNIT",523,551.79999999999995,336.11,669.97,130.75]
["TUFTS - TUFTS HMO - HCPCS - P9040","TUFTS","TUFTS HMO","HCPCS","P9040","HC RBC:LEU-RED,IRR/UNIT","P9040 - HC RBC:LEU-RED,IRR/UNIT",523,394.85,336.11,669.97,130.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9040","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","P9040","HC RBC:LEU-RED,IRR/UNIT","P9040 - HC RBC:LEU-RED,IRR/UNIT",523,551.79999999999995,336.11,669.97,130.75]
["TUFTS - TUFTS POS - HCPCS - P9040","TUFTS","TUFTS POS","HCPCS","P9040","HC RBC:LEU-RED,IRR/UNIT","P9040 - HC RBC:LEU-RED,IRR/UNIT",523,394.85,336.11,669.97,130.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9040","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","P9040","HC RBC:LEU-RED,IRR/UNIT","P9040 - HC RBC:LEU-RED,IRR/UNIT",523,669.97,336.11,669.97,130.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - P9040","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","P9040","HC RBC:LEU-RED,IRR/UNIT","P9040 - HC RBC:LEU-RED,IRR/UNIT",523,336.11,336.11,669.97,130.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9040","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","P9040","HC RBC:LEU-RED,IRR/UNIT","P9040 - HC RBC:LEU-RED,IRR/UNIT",523,336.11,336.11,669.97,130.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - P9040","BLUE CROSS","BLUE CROSS-PPO","HCPCS","P9040","HC RBC:LEU-RED,IRR/UNIT","P9040 - HC RBC:LEU-RED,IRR/UNIT",523,336.11,336.11,669.97,130.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - P9040","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","P9040","HC RBC:LEU-RED,IRR/UNIT","P9040 - HC RBC:LEU-RED,IRR/UNIT",523,336.11,336.11,669.97,130.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9040","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","P9040","HC RBC:LEU-RED,IRR/UNIT","P9040 - HC RBC:LEU-RED,IRR/UNIT",523,336.11,336.11,669.97,130.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9040","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","P9040","HC RBC:LEU-RED,IRR/UNIT","P9040 - HC RBC:LEU-RED,IRR/UNIT",523,336.11,336.11,669.97,130.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9040","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","P9040","HC RBC:LEU-RED,IRR/UNIT","P9040 - HC RBC:LEU-RED,IRR/UNIT",523,336.11,336.11,669.97,130.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9044","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","P9044","HC CRYOPRECIPITATE REDUCED PLASMA","P9044 - HC CRYOPRECIPITATE REDUCED PLASMA",133,186.87,144.19999999999999,244.67,33.25]
["TUFTS - TUFTS PPO - HCPCS - P9044","TUFTS","TUFTS PPO","HCPCS","P9044","HC CRYOPRECIPITATE REDUCED PLASMA","P9044 - HC CRYOPRECIPITATE REDUCED PLASMA",133,154.25,144.19999999999999,244.67,33.25]
["TUFTS - TUFTS SELECT - HCPCS - P9044","TUFTS","TUFTS SELECT","HCPCS","P9044","HC CRYOPRECIPITATE REDUCED PLASMA","P9044 - HC CRYOPRECIPITATE REDUCED PLASMA",133,144.19999999999999,144.19999999999999,244.67,33.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9044","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","P9044","HC CRYOPRECIPITATE REDUCED PLASMA","P9044 - HC CRYOPRECIPITATE REDUCED PLASMA",133,191.57,144.19999999999999,244.67,33.25]
["TUFTS - TUFTS HMO - HCPCS - P9044","TUFTS","TUFTS HMO","HCPCS","P9044","HC CRYOPRECIPITATE REDUCED PLASMA","P9044 - HC CRYOPRECIPITATE REDUCED PLASMA",133,144.19999999999999,144.19999999999999,244.67,33.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9044","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","P9044","HC CRYOPRECIPITATE REDUCED PLASMA","P9044 - HC CRYOPRECIPITATE REDUCED PLASMA",133,191.57,144.19999999999999,244.67,33.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9044","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","P9044","HC CRYOPRECIPITATE REDUCED PLASMA","P9044 - HC CRYOPRECIPITATE REDUCED PLASMA",133,191.57,144.19999999999999,244.67,33.25]
["TUFTS - TUFTS POS - HCPCS - P9044","TUFTS","TUFTS POS","HCPCS","P9044","HC CRYOPRECIPITATE REDUCED PLASMA","P9044 - HC CRYOPRECIPITATE REDUCED PLASMA",133,144.19999999999999,144.19999999999999,244.67,33.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9044","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","P9044","HC CRYOPRECIPITATE REDUCED PLASMA","P9044 - HC CRYOPRECIPITATE REDUCED PLASMA",133,244.67,144.19999999999999,244.67,33.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - P9045","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",238,62.94,52.45,131.97,59.5]
["TUFTS - TUFTS PPO - HCPCS - P9045","TUFTS","TUFTS PPO","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",238,81.36,52.45,131.97,59.5]
["UNICARE - UNICARE - HCPCS - P9045","UNICARE","UNICARE","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",238,54.43,52.45,131.97,59.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - P9045","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",238,54.43,52.45,131.97,59.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - P9045","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",238,62.94,52.45,131.97,59.5]
["TUFTS - TUFTS SELECT - HCPCS - P9045","TUFTS","TUFTS SELECT","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",238,76.05,52.45,131.97,59.5]
["TUFTS - TUFTS SPIRIT - HCPCS - P9045","TUFTS","TUFTS SPIRIT","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",238,57.7,52.45,131.97,59.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9045","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",238,110.46,52.45,131.97,59.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - P9045","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",238,70.709999999999994,52.45,131.97,59.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9045","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",238,113.24,52.45,131.97,59.5]
["FALLON - FALLON SENIOR PLAN - HCPCS - P9045","FALLON","FALLON SENIOR PLAN","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",238,52.45,52.45,131.97,59.5]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - P9045","TUFTS","TUFTS MEDICARE SCO","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",238,76.05,52.45,131.97,59.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9045","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",238,113.24,52.45,131.97,59.5]
["TUFTS - TUFTS HMO - HCPCS - P9045","TUFTS","TUFTS HMO","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",238,76.05,52.45,131.97,59.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9045","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",238,113.24,52.45,131.97,59.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - P9045","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",238,76.05,52.45,131.97,59.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - P9045","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",238,113.24,52.45,131.97,59.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - P9045","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",238,91.26,52.45,131.97,59.5]
["TUFTS - TUFTS POS - HCPCS - P9045","TUFTS","TUFTS POS","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",238,76.05,52.45,131.97,59.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - P9045","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",238,52.45,52.45,131.97,59.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - P9045","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",238,60.32,52.45,131.97,59.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - P9045","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",238,52.45,52.45,131.97,59.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - P9045","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",238,52.45,52.45,131.97,59.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - P9045","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",238,115.91,52.45,131.97,59.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9045","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",238,129.05000000000001,52.45,131.97,59.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - P9045","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",238,52.45,52.45,131.97,59.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9045","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",238,60.32,52.45,131.97,59.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - P9045","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",238,60.32,52.45,131.97,59.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - P9045","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",238,131.97,52.45,131.97,59.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9045","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",238,60.32,52.45,131.97,59.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - P9045","BLUE CROSS","BLUE CROSS-PPO","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",238,60.32,52.45,131.97,59.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9045","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",238,60.32,52.45,131.97,59.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9045","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",238,60.32,52.45,131.97,59.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - P9045","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",238,61.89,52.45,131.97,59.5]
["TUFTS - TUFTS SELECT - HCPCS - P9047","TUFTS","TUFTS SELECT","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9047","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - P9047","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["TUFTS - TUFTS SPIRIT - HCPCS - P9047","TUFTS","TUFTS SPIRIT","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - P9047","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["TUFTS - TUFTS PPO - HCPCS - P9047","TUFTS","TUFTS PPO","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["UNICARE - UNICARE - HCPCS - P9047","UNICARE","UNICARE","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - P9047","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9047","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - P9047","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - P9047","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - P9047","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - P9047","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["FALLON - FALLON SENIOR PLAN - HCPCS - P9047","FALLON","FALLON SENIOR PLAN","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["TUFTS - TUFTS HMO - HCPCS - P9047","TUFTS","TUFTS HMO","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9047","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - P9047","TUFTS","TUFTS MEDICARE SCO","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9047","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["TUFTS - TUFTS POS - HCPCS - P9047","TUFTS","TUFTS POS","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - P9047","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9047","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - P9047","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - P9047","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - P9047","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9047","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - P9047","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - P9047","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - P9047","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - P9047","BLUE CROSS","BLUE CROSS-PPO","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - P9047","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9047","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9047","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9047","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - P9047","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",279.94,221.64600000000002,107.47,279.94,69.984999999999999]
["TUFTS - TUFTS PPO - HCPCS - P9056","TUFTS","TUFTS PPO","HCPCS","P9056","HC BLOOD, L/R, IRRADIATED","P9056 - HC BLOOD, L/R, IRRADIATED",1619,333.7,311.95,529.32000000000005,404.75]
["TUFTS - TUFTS SELECT - HCPCS - P9056","TUFTS","TUFTS SELECT","HCPCS","P9056","HC BLOOD, L/R, IRRADIATED","P9056 - HC BLOOD, L/R, IRRADIATED",1619,311.95,311.95,529.32000000000005,404.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9056","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","P9056","HC BLOOD, L/R, IRRADIATED","P9056 - HC BLOOD, L/R, IRRADIATED",1619,474.84,311.95,529.32000000000005,404.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9056","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","P9056","HC BLOOD, L/R, IRRADIATED","P9056 - HC BLOOD, L/R, IRRADIATED",1619,486.79,311.95,529.32000000000005,404.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9056","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","P9056","HC BLOOD, L/R, IRRADIATED","P9056 - HC BLOOD, L/R, IRRADIATED",1619,486.79,311.95,529.32000000000005,404.75]
["TUFTS - TUFTS HMO - HCPCS - P9056","TUFTS","TUFTS HMO","HCPCS","P9056","HC BLOOD, L/R, IRRADIATED","P9056 - HC BLOOD, L/R, IRRADIATED",1619,311.95,311.95,529.32000000000005,404.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9056","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","P9056","HC BLOOD, L/R, IRRADIATED","P9056 - HC BLOOD, L/R, IRRADIATED",1619,486.79,311.95,529.32000000000005,404.75]
["TUFTS - TUFTS POS - HCPCS - P9056","TUFTS","TUFTS POS","HCPCS","P9056","HC BLOOD, L/R, IRRADIATED","P9056 - HC BLOOD, L/R, IRRADIATED",1619,311.95,311.95,529.32000000000005,404.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9056","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","P9056","HC BLOOD, L/R, IRRADIATED","P9056 - HC BLOOD, L/R, IRRADIATED",1619,529.32000000000005,311.95,529.32000000000005,404.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9057","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","P9057","HC RBC:LEU RED,FR/DE/WASH,IR","P9057 - HC RBC:LEU RED,FR/DE/WASH,IR",785,472.82,395.89,671.74,196.25]
["TUFTS - TUFTS PPO - HCPCS - P9057","TUFTS","TUFTS PPO","HCPCS","P9057","HC RBC:LEU RED,FR/DE/WASH,IR","P9057 - HC RBC:LEU RED,FR/DE/WASH,IR",785,423.49,395.89,671.74,196.25]
["TUFTS - TUFTS SELECT - HCPCS - P9057","TUFTS","TUFTS SELECT","HCPCS","P9057","HC RBC:LEU RED,FR/DE/WASH,IR","P9057 - HC RBC:LEU RED,FR/DE/WASH,IR",785,395.89,395.89,671.74,196.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9057","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","P9057","HC RBC:LEU RED,FR/DE/WASH,IR","P9057 - HC RBC:LEU RED,FR/DE/WASH,IR",785,484.72,395.89,671.74,196.25]
["TUFTS - TUFTS HMO - HCPCS - P9057","TUFTS","TUFTS HMO","HCPCS","P9057","HC RBC:LEU RED,FR/DE/WASH,IR","P9057 - HC RBC:LEU RED,FR/DE/WASH,IR",785,395.89,395.89,671.74,196.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9057","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","P9057","HC RBC:LEU RED,FR/DE/WASH,IR","P9057 - HC RBC:LEU RED,FR/DE/WASH,IR",785,484.72,395.89,671.74,196.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9057","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","P9057","HC RBC:LEU RED,FR/DE/WASH,IR","P9057 - HC RBC:LEU RED,FR/DE/WASH,IR",785,484.72,395.89,671.74,196.25]
["TUFTS - TUFTS POS - HCPCS - P9057","TUFTS","TUFTS POS","HCPCS","P9057","HC RBC:LEU RED,FR/DE/WASH,IR","P9057 - HC RBC:LEU RED,FR/DE/WASH,IR",785,395.89,395.89,671.74,196.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9057","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","P9057","HC RBC:LEU RED,FR/DE/WASH,IR","P9057 - HC RBC:LEU RED,FR/DE/WASH,IR",785,671.74,395.89,671.74,196.25]
["TUFTS - TUFTS PPO - HCPCS - P9073","TUFTS","TUFTS PPO","HCPCS","P9073","HC PLATELETS PHERESIS PATH REDU","P9073 - HC PLATELETS PHERESIS PATH REDU",889,931.99,821.84,2619.59,222.25]
["TUFTS - TUFTS SELECT - HCPCS - P9073","TUFTS","TUFTS SELECT","HCPCS","P9073","HC PLATELETS PHERESIS PATH REDU","P9073 - HC PLATELETS PHERESIS PATH REDU",889,871.26,821.84,2619.59,222.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9073","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","P9073","HC PLATELETS PHERESIS PATH REDU","P9073 - HC PLATELETS PHERESIS PATH REDU",889,1316.1,821.84,2619.59,222.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9073","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","P9073","HC PLATELETS PHERESIS PATH REDU","P9073 - HC PLATELETS PHERESIS PATH REDU",889,1349.22,821.84,2619.59,222.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9073","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","P9073","HC PLATELETS PHERESIS PATH REDU","P9073 - HC PLATELETS PHERESIS PATH REDU",889,1349.22,821.84,2619.59,222.25]
["TUFTS - TUFTS HMO - HCPCS - P9073","TUFTS","TUFTS HMO","HCPCS","P9073","HC PLATELETS PHERESIS PATH REDU","P9073 - HC PLATELETS PHERESIS PATH REDU",889,1045.51,821.84,2619.59,222.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9073","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","P9073","HC PLATELETS PHERESIS PATH REDU","P9073 - HC PLATELETS PHERESIS PATH REDU",889,1349.22,821.84,2619.59,222.25]
["TUFTS - TUFTS POS - HCPCS - P9073","TUFTS","TUFTS POS","HCPCS","P9073","HC PLATELETS PHERESIS PATH REDU","P9073 - HC PLATELETS PHERESIS PATH REDU",889,871.26,821.84,2619.59,222.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - P9073","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","P9073","HC PLATELETS PHERESIS PATH REDU","P9073 - HC PLATELETS PHERESIS PATH REDU",889,821.84,821.84,2619.59,222.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9073","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","P9073","HC PLATELETS PHERESIS PATH REDU","P9073 - HC PLATELETS PHERESIS PATH REDU",889,2619.59,821.84,2619.59,222.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9073","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","P9073","HC PLATELETS PHERESIS PATH REDU","P9073 - HC PLATELETS PHERESIS PATH REDU",889,821.84,821.84,2619.59,222.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - P9073","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","P9073","HC PLATELETS PHERESIS PATH REDU","P9073 - HC PLATELETS PHERESIS PATH REDU",889,821.84,821.84,2619.59,222.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9073","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","P9073","HC PLATELETS PHERESIS PATH REDU","P9073 - HC PLATELETS PHERESIS PATH REDU",889,821.84,821.84,2619.59,222.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - P9073","BLUE CROSS","BLUE CROSS-PPO","HCPCS","P9073","HC PLATELETS PHERESIS PATH REDU","P9073 - HC PLATELETS PHERESIS PATH REDU",889,821.84,821.84,2619.59,222.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9073","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","P9073","HC PLATELETS PHERESIS PATH REDU","P9073 - HC PLATELETS PHERESIS PATH REDU",889,821.84,821.84,2619.59,222.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9073","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","P9073","HC PLATELETS PHERESIS PATH REDU","P9073 - HC PLATELETS PHERESIS PATH REDU",889,821.84,821.84,2619.59,222.25]
["TUFTS - TUFTS PPO - HCPCS - P9100","TUFTS","TUFTS PPO","HCPCS","P9100","PATHOGEN TEST FOR PLATELETS","P9100 - PATHOGEN TEST FOR PLATELETS",1310,91.31,33.53,256.64,327.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9100","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","P9100","PATHOGEN TEST FOR PLATELETS","P9100 - PATHOGEN TEST FOR PLATELETS",1310,53.7,33.53,256.64,327.5]
["TUFTS - TUFTS SELECT - HCPCS - P9100","TUFTS","TUFTS SELECT","HCPCS","P9100","PATHOGEN TEST FOR PLATELETS","P9100 - PATHOGEN TEST FOR PLATELETS",1310,45.44,33.53,256.64,327.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9100","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","P9100","PATHOGEN TEST FOR PLATELETS","P9100 - PATHOGEN TEST FOR PLATELETS",1310,55.05,33.53,256.64,327.5]
["TUFTS - TUFTS HMO - HCPCS - P9100","TUFTS","TUFTS HMO","HCPCS","P9100","PATHOGEN TEST FOR PLATELETS","P9100 - PATHOGEN TEST FOR PLATELETS",1310,102.43,33.53,256.64,327.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9100","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","P9100","PATHOGEN TEST FOR PLATELETS","P9100 - PATHOGEN TEST FOR PLATELETS",1310,55.05,33.53,256.64,327.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9100","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","P9100","PATHOGEN TEST FOR PLATELETS","P9100 - PATHOGEN TEST FOR PLATELETS",1310,55.05,33.53,256.64,327.5]
["TUFTS - TUFTS POS - HCPCS - P9100","TUFTS","TUFTS POS","HCPCS","P9100","PATHOGEN TEST FOR PLATELETS","P9100 - PATHOGEN TEST FOR PLATELETS",1310,85.36,33.53,256.64,327.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - P9100","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","P9100","PATHOGEN TEST FOR PLATELETS","P9100 - PATHOGEN TEST FOR PLATELETS",1310,33.53,33.53,256.64,327.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9100","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","P9100","PATHOGEN TEST FOR PLATELETS","P9100 - PATHOGEN TEST FOR PLATELETS",1310,256.64,33.53,256.64,327.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9100","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","P9100","PATHOGEN TEST FOR PLATELETS","P9100 - PATHOGEN TEST FOR PLATELETS",1310,33.53,33.53,256.64,327.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - P9100","BLUE CROSS","BLUE CROSS-PPO","HCPCS","P9100","PATHOGEN TEST FOR PLATELETS","P9100 - PATHOGEN TEST FOR PLATELETS",1310,33.53,33.53,256.64,327.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - P9100","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","P9100","PATHOGEN TEST FOR PLATELETS","P9100 - PATHOGEN TEST FOR PLATELETS",1310,33.53,33.53,256.64,327.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9100","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","P9100","PATHOGEN TEST FOR PLATELETS","P9100 - PATHOGEN TEST FOR PLATELETS",1310,33.53,33.53,256.64,327.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9100","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","P9100","PATHOGEN TEST FOR PLATELETS","P9100 - PATHOGEN TEST FOR PLATELETS",1310,33.53,33.53,256.64,327.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9100","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","P9100","PATHOGEN TEST FOR PLATELETS","P9100 - PATHOGEN TEST FOR PLATELETS",1310,33.53,33.53,256.64,327.5]
["UNICARE - UNICARE - HCPCS - P9612","UNICARE","UNICARE","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,5.21,2.2200000000000002,1198.25,22.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - P9612","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,4.34,2.2200000000000002,1198.25,22.5]
["TUFTS - TUFTS PPO - HCPCS - P9612","TUFTS","TUFTS PPO","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,9.09,2.2200000000000002,1198.25,22.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - P9612","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,3.6,2.2200000000000002,1198.25,22.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - P9612","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,2.66,2.2200000000000002,1198.25,22.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - P9612","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,3.6,2.2200000000000002,1198.25,22.5]
["TUFTS - TUFTS SELECT - HCPCS - P9612","TUFTS","TUFTS SELECT","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,4.5199999999999996,2.2200000000000002,1198.25,22.5]
["TUFTS - TUFTS SPIRIT - HCPCS - P9612","TUFTS","TUFTS SPIRIT","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,3.3,2.2200000000000002,1198.25,22.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - HCPCS - P9612","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,2.61,2.2200000000000002,1198.25,22.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9612","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,0,2.2200000000000002,1198.25,22.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - P9612","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,6.32,2.2200000000000002,1198.25,22.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - P9612","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,4.04,2.2200000000000002,1198.25,22.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - HCPCS - P9612","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,3.36,2.2200000000000002,1198.25,22.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9612","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,0,2.2200000000000002,1198.25,22.5]
["FALLON - FALLON MEDICAID - HCPCS - P9612","FALLON","FALLON MEDICAID","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,2.2200000000000002,2.2200000000000002,1198.25,22.5]
["FALLON - FALLON SENIOR PLAN - HCPCS - P9612","FALLON","FALLON SENIOR PLAN","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,3,2.2200000000000002,1198.25,22.5]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - P9612","TUFTS","TUFTS MEDICARE SCO","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,4.3499999999999996,2.2200000000000002,1198.25,22.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9612","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,0,2.2200000000000002,1198.25,22.5]
["TUFTS - TUFTS HMO - HCPCS - P9612","TUFTS","TUFTS HMO","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,10.199999999999999,2.2200000000000002,1198.25,22.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9612","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,0,2.2200000000000002,1198.25,22.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - P9612","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,4.3499999999999996,2.2200000000000002,1198.25,22.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - P9612","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,6.48,2.2200000000000002,1198.25,22.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - P9612","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,5.22,2.2200000000000002,1198.25,22.5]
["TUFTS - TUFTS POS - HCPCS - P9612","TUFTS","TUFTS POS","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,8.5,2.2200000000000002,1198.25,22.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9612","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,25.55,2.2200000000000002,1198.25,22.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - P9612","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,5.27,2.2200000000000002,1198.25,22.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - P9612","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,3,2.2200000000000002,1198.25,22.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - P9612","BMC HEALTHNET","BMCHN QHP","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,2.66,2.2200000000000002,1198.25,22.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - P9612","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,6.63,2.2200000000000002,1198.25,22.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - P9612","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,3,2.2200000000000002,1198.25,22.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - P9612","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,3,2.2200000000000002,1198.25,22.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - P9612","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,3,2.2200000000000002,1198.25,22.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - P9612","BMC HEALTHNET","BMCHN ACO","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,4.8600000000000003,2.2200000000000002,1198.25,22.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - P9612","BMC HEALTHNET","BMCHN MCO","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,2.2200000000000002,2.2200000000000002,1198.25,22.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9612","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,5.27,2.2200000000000002,1198.25,22.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - P9612","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,2.2200000000000002,2.2200000000000002,1198.25,22.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - P9612","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,3.54,2.2200000000000002,1198.25,22.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - P9612","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,2.62,2.2200000000000002,1198.25,22.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - P9612","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,3.01,2.2200000000000002,1198.25,22.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - P9612","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,5.27,2.2200000000000002,1198.25,22.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - P9612","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,7.55,2.2200000000000002,1198.25,22.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9612","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,5.27,2.2200000000000002,1198.25,22.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - P9612","BLUE CROSS","BLUE CROSS-PPO","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,5.27,2.2200000000000002,1198.25,22.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9612","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,5.27,2.2200000000000002,1198.25,22.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9612","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,5.27,2.2200000000000002,1198.25,22.5]
["AETNA - AETNA - HCPCS - P9612","AETNA","AETNA","HCPCS","P9612","CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC",90,1198.25,2.2200000000000002,1198.25,22.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q0091","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR","Q0091 - HC OBTAINING SCREEN PAP SMEAR",83,0,28.83,175.66,20.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q0091","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR","Q0091 - HC OBTAINING SCREEN PAP SMEAR",83,36.159999999999997,28.83,175.66,20.75]
["TUFTS - TUFTS PPO - HCPCS - Q0091","TUFTS","TUFTS PPO","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR","Q0091 - HC OBTAINING SCREEN PAP SMEAR",83,62.49,28.83,175.66,20.75]
["TUFTS - TUFTS SELECT - HCPCS - Q0091","TUFTS","TUFTS SELECT","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR","Q0091 - HC OBTAINING SCREEN PAP SMEAR",83,31.1,28.83,175.66,20.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q0091","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR","Q0091 - HC OBTAINING SCREEN PAP SMEAR",83,37.07,28.83,175.66,20.75]
["FALLON - FALLON MEDICAID - HCPCS - Q0091","FALLON","FALLON MEDICAID","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR","Q0091 - HC OBTAINING SCREEN PAP SMEAR",83,0,28.83,175.66,20.75]
["TUFTS - TUFTS HMO - HCPCS - Q0091","TUFTS","TUFTS HMO","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR","Q0091 - HC OBTAINING SCREEN PAP SMEAR",83,70.099999999999994,28.83,175.66,20.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q0091","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR","Q0091 - HC OBTAINING SCREEN PAP SMEAR",83,37.07,28.83,175.66,20.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q0091","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR","Q0091 - HC OBTAINING SCREEN PAP SMEAR",83,37.07,28.83,175.66,20.75]
["TUFTS - TUFTS POS - HCPCS - Q0091","TUFTS","TUFTS POS","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR","Q0091 - HC OBTAINING SCREEN PAP SMEAR",83,58.42,28.83,175.66,20.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q0091","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR","Q0091 - HC OBTAINING SCREEN PAP SMEAR",83,28.83,28.83,175.66,20.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q0091","BMC HEALTHNET","BMCHN ACO","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR","Q0091 - HC OBTAINING SCREEN PAP SMEAR",83,0,28.83,175.66,20.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q0091","BMC HEALTHNET","BMCHN QHP","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR","Q0091 - HC OBTAINING SCREEN PAP SMEAR",83,0,28.83,175.66,20.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q0091","BMC HEALTHNET","BMCHN MCO","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR","Q0091 - HC OBTAINING SCREEN PAP SMEAR",83,0,28.83,175.66,20.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q0091","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR","Q0091 - HC OBTAINING SCREEN PAP SMEAR",83,175.66,28.83,175.66,20.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q0091","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR","Q0091 - HC OBTAINING SCREEN PAP SMEAR",83,28.83,28.83,175.66,20.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q0091","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR","Q0091 - HC OBTAINING SCREEN PAP SMEAR",83,0,28.83,175.66,20.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q0091","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR","Q0091 - HC OBTAINING SCREEN PAP SMEAR",83,28.83,28.83,175.66,20.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q0091","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR","Q0091 - HC OBTAINING SCREEN PAP SMEAR",83,28.83,28.83,175.66,20.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q0091","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR","Q0091 - HC OBTAINING SCREEN PAP SMEAR",83,0,28.83,175.66,20.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q0091","BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR","Q0091 - HC OBTAINING SCREEN PAP SMEAR",83,28.83,28.83,175.66,20.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q0091","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR","Q0091 - HC OBTAINING SCREEN PAP SMEAR",83,0,28.83,175.66,20.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q0091","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR","Q0091 - HC OBTAINING SCREEN PAP SMEAR",83,28.83,28.83,175.66,20.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q0091","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR","Q0091 - HC OBTAINING SCREEN PAP SMEAR",83,28.83,28.83,175.66,20.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q0111","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,6.49,5.86,127.48,5.75]
["FALLON - FALLON MEDICAID - HCPCS - Q0111","FALLON","FALLON MEDICAID","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,5.41,5.86,127.48,5.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q0111","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,5.41,5.86,127.48,5.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q0111","BMC HEALTHNET","BMCHN QHP","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,6.49,5.86,127.48,5.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q0111","BMC HEALTHNET","BMCHN ACO","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,11.835000000000001,5.86,127.48,5.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q0111","BMC HEALTHNET","BMCHN MCO","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,5.41,5.86,127.48,5.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q0111","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,7.34,5.86,127.48,5.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q0111","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,6.3849999999999998,5.86,127.48,5.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q0111","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,18.14,5.86,127.48,5.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - Q0111","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,31.84,5.86,127.48,5.75]
["TUFTS - TUFTS PPO - HCPCS - Q0111","TUFTS","TUFTS PPO","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,45.36,5.86,127.48,5.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q0111","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,18.14,5.86,127.48,5.75]
["TUFTS - TUFTS SELECT - HCPCS - Q0111","TUFTS","TUFTS SELECT","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,22.58,5.86,127.48,5.75]
["UNICARE - UNICARE - HCPCS - Q0111","UNICARE","UNICARE","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,10.36,5.86,127.48,5.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q0111","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,8.6300000000000008,5.86,127.48,5.75]
["TUFTS - TUFTS SPIRIT - HCPCS - Q0111","TUFTS","TUFTS SPIRIT","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,16.63,5.86,127.48,5.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - HCPCS - Q0111","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,12.74,5.86,127.48,5.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q0111","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,31.57,5.86,127.48,5.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q0111","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,20.38,5.86,127.48,5.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - HCPCS - Q0111","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,16.36,5.86,127.48,5.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q0111","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,32.36,5.86,127.48,5.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - Q0111","FALLON","FALLON SENIOR PLAN","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,15.12,5.86,127.48,5.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q0111","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,21.92,5.86,127.48,5.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q0111","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,32.36,5.86,127.48,5.75]
["TUFTS - TUFTS HMO - HCPCS - Q0111","TUFTS","TUFTS HMO","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,50.9,5.86,127.48,5.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q0111","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,32.36,5.86,127.48,5.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - Q0111","TUFTS","TUFTS MEDICARE SCO","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,21.92,5.86,127.48,5.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q0111","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,32.64,5.86,127.48,5.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q0111","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,26.31,5.86,127.48,5.75]
["TUFTS - TUFTS POS - HCPCS - Q0111","TUFTS","TUFTS POS","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,42.41,5.86,127.48,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q0111","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,27.01,5.86,127.48,5.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q0111","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,33.409999999999997,5.86,127.48,5.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q0111","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,127.48,5.86,127.48,5.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q0111","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,15.12,5.86,127.48,5.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q0111","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,15.12,5.86,127.48,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q0111","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,27.01,5.86,127.48,5.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q0111","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,5.86,5.86,127.48,5.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q0111","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,15.12,5.86,127.48,5.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q0111","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,17.84,5.86,127.48,5.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q0111","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,38.04,5.86,127.48,5.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q0111","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,27.01,5.86,127.48,5.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q0111","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,27.01,5.86,127.48,5.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q0111","BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,27.01,5.86,127.48,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q0111","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,27.01,5.86,127.48,5.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q0111","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS",23,27.01,5.86,127.48,5.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q0114","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,4.32,7.2,82.86,10.25]
["FALLON - FALLON MEDICAID - HCPCS - Q0114","FALLON","FALLON MEDICAID","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,3.6,7.2,82.86,10.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q0114","BMC HEALTHNET","BMCHN MCO","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,3.6,7.2,82.86,10.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q0114","BMC HEALTHNET","BMCHN QHP","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,4.32,7.2,82.86,10.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q0114","BMC HEALTHNET","BMCHN ACO","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,7.875,7.2,82.86,10.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q0114","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,3.6,7.2,82.86,10.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q0114","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,4.8849999999999998,7.2,82.86,10.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q0114","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,4.25,7.2,82.86,10.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q0114","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,11.69,7.2,82.86,10.25]
["TUFTS - TUFTS PPO - HCPCS - Q0114","TUFTS","TUFTS PPO","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,29.48,7.2,82.86,10.25]
["UNICARE - UNICARE - HCPCS - Q0114","UNICARE","UNICARE","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,17.36,7.2,82.86,10.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q0114","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,14.47,7.2,82.86,10.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q0114","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,20.51,7.2,82.86,10.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q0114","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,11.69,7.2,82.86,10.25]
["TUFTS - TUFTS SELECT - HCPCS - Q0114","TUFTS","TUFTS SELECT","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,14.67,7.2,82.86,10.25]
["TUFTS - TUFTS SPIRIT - HCPCS - Q0114","TUFTS","TUFTS SPIRIT","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,10.71,7.2,82.86,10.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - HCPCS - Q0114","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,8.4700000000000006,7.2,82.86,10.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - Q0114","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,20.51,7.2,82.86,10.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q0114","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,13.13,7.2,82.86,10.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - HCPCS - Q0114","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,10.89,7.2,82.86,10.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q0114","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,21.03,7.2,82.86,10.25]
["TUFTS - TUFTS HMO - HCPCS - Q0114","TUFTS","TUFTS HMO","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,33.08,7.2,82.86,10.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - Q0114","FALLON","FALLON SENIOR PLAN","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,9.74,7.2,82.86,10.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - Q0114","TUFTS","TUFTS MEDICARE SCO","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,14.12,7.2,82.86,10.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q0114","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,21.03,7.2,82.86,10.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q0114","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,21.03,7.2,82.86,10.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q0114","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,14.12,7.2,82.86,10.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q0114","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,21.03,7.2,82.86,10.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q0114","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,16.95,7.2,82.86,10.25]
["TUFTS - TUFTS POS - HCPCS - Q0114","TUFTS","TUFTS POS","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,27.56,7.2,82.86,10.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q0114","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,9.74,7.2,82.86,10.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q0114","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,9.74,7.2,82.86,10.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q0114","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,17.79,7.2,82.86,10.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q0114","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,9.74,7.2,82.86,10.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q0114","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,21.52,7.2,82.86,10.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q0114","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,9.81,7.2,82.86,10.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q0114","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,82.86,7.2,82.86,10.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q0114","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,17.79,7.2,82.86,10.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q0114","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,11.49,7.2,82.86,10.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q0114","BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,17.79,7.2,82.86,10.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q0114","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,17.79,7.2,82.86,10.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q0114","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,17.79,7.2,82.86,10.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q0114","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,24.51,7.2,82.86,10.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q0114","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,17.79,7.2,82.86,10.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q0114","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q0114","HC  FERN TEST","Q0114 - HC  FERN TEST",41,17.79,7.2,82.86,10.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q0249","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q0249","HC TOCILIZUMAB FOR COVID-19","Q0249 - HC TOCILIZUMAB FOR COVID-19",9,0,0,0,2.25]
["FALLON - FALLON MEDICAID - HCPCS - Q0249","FALLON","FALLON MEDICAID","HCPCS","Q0249","HC TOCILIZUMAB FOR COVID-19","Q0249 - HC TOCILIZUMAB FOR COVID-19",9,0,0,0,2.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q0249","BMC HEALTHNET","BMCHN QHP","HCPCS","Q0249","HC TOCILIZUMAB FOR COVID-19","Q0249 - HC TOCILIZUMAB FOR COVID-19",9,0,0,0,2.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q0249","BMC HEALTHNET","BMCHN ACO","HCPCS","Q0249","HC TOCILIZUMAB FOR COVID-19","Q0249 - HC TOCILIZUMAB FOR COVID-19",9,0,0,0,2.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q0249","BMC HEALTHNET","BMCHN MCO","HCPCS","Q0249","HC TOCILIZUMAB FOR COVID-19","Q0249 - HC TOCILIZUMAB FOR COVID-19",9,0,0,0,2.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q0249","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q0249","HC TOCILIZUMAB FOR COVID-19","Q0249 - HC TOCILIZUMAB FOR COVID-19",9,0,0,0,2.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q0249","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q0249","HC TOCILIZUMAB FOR COVID-19","Q0249 - HC TOCILIZUMAB FOR COVID-19",9,0,0,0,2.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q0249","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","Q0249","HC TOCILIZUMAB FOR COVID-19","Q0249 - HC TOCILIZUMAB FOR COVID-19",9,0,0,0,2.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q3014","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE","Q3014 - HC TELEHEALTH FACILITY FEE",67,0,26.65,67.06,16.75]
["TUFTS - TUFTS PPO - HCPCS - Q3014","TUFTS","TUFTS PPO","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE","Q3014 - HC TELEHEALTH FACILITY FEE",67,38.6,26.65,67.06,16.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - Q3014","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE","Q3014 - HC TELEHEALTH FACILITY FEE",67,56.12,26.65,67.06,16.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q3014","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE","Q3014 - HC TELEHEALTH FACILITY FEE",67,31.98,26.65,67.06,16.75]
["TUFTS - TUFTS SPIRIT - HCPCS - Q3014","TUFTS","TUFTS SPIRIT","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE","Q3014 - HC TELEHEALTH FACILITY FEE",67,29.32,26.65,67.06,16.75]
["FALLON - FALLON MEDICAID - HCPCS - Q3014","FALLON","FALLON MEDICAID","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE","Q3014 - HC TELEHEALTH FACILITY FEE",67,0,26.65,67.06,16.75]
["FALLON - FALLON SENIOR PLAN - HCPCS - Q3014","FALLON","FALLON SENIOR PLAN","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE","Q3014 - HC TELEHEALTH FACILITY FEE",67,26.65,26.65,67.06,16.75]
["TUFTS - TUFTS HMO - HCPCS - Q3014","TUFTS","TUFTS HMO","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE","Q3014 - HC TELEHEALTH FACILITY FEE",67,38.6,26.65,67.06,16.75]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - Q3014","TUFTS","TUFTS MEDICARE SCO","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE","Q3014 - HC TELEHEALTH FACILITY FEE",67,38.64,26.65,67.06,16.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q3014","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE","Q3014 - HC TELEHEALTH FACILITY FEE",67,57.54,26.65,67.06,16.75]
["TUFTS - TUFTS POS - HCPCS - Q3014","TUFTS","TUFTS POS","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE","Q3014 - HC TELEHEALTH FACILITY FEE",67,38.6,26.65,67.06,16.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q3014","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE","Q3014 - HC TELEHEALTH FACILITY FEE",67,46.37,26.65,67.06,16.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q3014","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE","Q3014 - HC TELEHEALTH FACILITY FEE",67,61.23,26.65,67.06,16.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q3014","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE","Q3014 - HC TELEHEALTH FACILITY FEE",67,58.89,26.65,67.06,16.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q3014","BMC HEALTHNET","BMCHN ACO","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE","Q3014 - HC TELEHEALTH FACILITY FEE",67,0,26.65,67.06,16.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q3014","BMC HEALTHNET","BMCHN QHP","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE","Q3014 - HC TELEHEALTH FACILITY FEE",67,0,26.65,67.06,16.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q3014","BMC HEALTHNET","BMCHN MCO","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE","Q3014 - HC TELEHEALTH FACILITY FEE",67,0,26.65,67.06,16.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q3014","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE","Q3014 - HC TELEHEALTH FACILITY FEE",67,26.65,26.65,67.06,16.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q3014","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE","Q3014 - HC TELEHEALTH FACILITY FEE",67,26.65,26.65,67.06,16.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q3014","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE","Q3014 - HC TELEHEALTH FACILITY FEE",67,26.65,26.65,67.06,16.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q3014","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE","Q3014 - HC TELEHEALTH FACILITY FEE",67,26.65,26.65,67.06,16.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q3014","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE","Q3014 - HC TELEHEALTH FACILITY FEE",67,0,26.65,67.06,16.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q3014","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE","Q3014 - HC TELEHEALTH FACILITY FEE",67,31.45,26.65,67.06,16.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q3014","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE","Q3014 - HC TELEHEALTH FACILITY FEE",67,0,26.65,67.06,16.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q3014","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE","Q3014 - HC TELEHEALTH FACILITY FEE",67,67.06,26.65,67.06,16.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q3014","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE","Q3014 - HC TELEHEALTH FACILITY FEE",67,0,26.65,67.06,16.75]
["TUFTS - TUFTS PPO - HCPCS - Q4100","TUFTS","TUFTS PPO","HCPCS","Q4100","STRAVIX 3X6","Q4100 - STRAVIX 3X6",12079,0,0,0,3019.75]
["TUFTS - TUFTS SELECT - HCPCS - Q4100","TUFTS","TUFTS SELECT","HCPCS","Q4100","STRAVIX 3X6","Q4100 - STRAVIX 3X6",12079,0,0,0,3019.75]
["TUFTS - TUFTS HMO - HCPCS - Q4100","TUFTS","TUFTS HMO","HCPCS","Q4100","STRAVIX 3X6","Q4100 - STRAVIX 3X6",12079,0,0,0,3019.75]
["TUFTS - TUFTS POS - HCPCS - Q4100","TUFTS","TUFTS POS","HCPCS","Q4100","STRAVIX 3X6","Q4100 - STRAVIX 3X6",12079,0,0,0,3019.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q4100","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q4100","STRAVIX 3X6","Q4100 - STRAVIX 3X6",12079,0,0,0,3019.75]
["TUFTS - TUFTS PPO - HCPCS - Q4101","TUFTS","TUFTS PPO","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,0,30.46,76.64,400.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q4101","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,36.549999999999997,30.46,76.64,400.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q4101","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,36.549999999999997,30.46,76.64,400.25]
["TUFTS - TUFTS SELECT - HCPCS - Q4101","TUFTS","TUFTS SELECT","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,0,30.46,76.64,400.25]
["UNICARE - UNICARE - HCPCS - Q4101","UNICARE","UNICARE","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,31.6,30.46,76.64,400.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q4101","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,31.6,30.46,76.64,400.25]
["TUFTS - TUFTS SPIRIT - HCPCS - Q4101","TUFTS","TUFTS SPIRIT","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,33.51,30.46,76.64,400.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q4101","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,0,30.46,76.64,400.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q4101","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,41.07,30.46,76.64,400.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q4101","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,0,30.46,76.64,400.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - Q4101","TUFTS","TUFTS MEDICARE SCO","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,44.17,30.46,76.64,400.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q4101","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,44.17,30.46,76.64,400.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - Q4101","FALLON","FALLON SENIOR PLAN","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,30.46,30.46,76.64,400.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q4101","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,0,30.46,76.64,400.25]
["TUFTS - TUFTS HMO - HCPCS - Q4101","TUFTS","TUFTS HMO","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,0,30.46,76.64,400.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q4101","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,0,30.46,76.64,400.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q4101","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,65.760000000000005,30.46,76.64,400.25]
["TUFTS - TUFTS POS - HCPCS - Q4101","TUFTS","TUFTS POS","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,0,30.46,76.64,400.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q4101","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,53,30.46,76.64,400.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q4101","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,30.46,30.46,76.64,400.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q4101","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,35.03,30.46,76.64,400.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q4101","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,67.31,30.46,76.64,400.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q4101","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,0,30.46,76.64,400.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q4101","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,30.46,30.46,76.64,400.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q4101","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,30.46,30.46,76.64,400.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q4101","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,30.46,30.46,76.64,400.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q4101","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,35.03,30.46,76.64,400.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q4101","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,35.94,30.46,76.64,400.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q4101","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,35.03,30.46,76.64,400.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q4101","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,76.64,30.46,76.64,400.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q4101","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,35.03,30.46,76.64,400.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q4101","BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,35.03,30.46,76.64,400.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q4101","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,35.03,30.46,76.64,400.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q4101","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q4101","APLIGRAF","Q4101 - APLIGRAF",1601,35.03,30.46,76.64,400.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q4102","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,10.6,10.210000000000001,25.69,17.25]
["UNICARE - UNICARE - HCPCS - Q4102","UNICARE","UNICARE","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,10.6,10.210000000000001,25.69,17.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q4102","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,0,10.210000000000001,25.69,17.25]
["TUFTS - TUFTS PPO - HCPCS - Q4102","TUFTS","TUFTS PPO","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,0,10.210000000000001,25.69,17.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q4102","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,12.25,10.210000000000001,25.69,17.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q4102","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,12.25,10.210000000000001,25.69,17.25]
["TUFTS - TUFTS SELECT - HCPCS - Q4102","TUFTS","TUFTS SELECT","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,0,10.210000000000001,25.69,17.25]
["TUFTS - TUFTS SPIRIT - HCPCS - Q4102","TUFTS","TUFTS SPIRIT","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,11.23,10.210000000000001,25.69,17.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q4102","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,13.77,10.210000000000001,25.69,17.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q4102","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,0,10.210000000000001,25.69,17.25]
["TUFTS - TUFTS HMO - HCPCS - Q4102","TUFTS","TUFTS HMO","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,0,10.210000000000001,25.69,17.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - Q4102","FALLON","FALLON SENIOR PLAN","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,10.210000000000001,10.210000000000001,25.69,17.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q4102","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,0,10.210000000000001,25.69,17.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q4102","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,0,10.210000000000001,25.69,17.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q4102","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,14.8,10.210000000000001,25.69,17.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - Q4102","TUFTS","TUFTS MEDICARE SCO","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,14.8,10.210000000000001,25.69,17.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q4102","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,22.04,10.210000000000001,25.69,17.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q4102","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,17.77,10.210000000000001,25.69,17.25]
["TUFTS - TUFTS POS - HCPCS - Q4102","TUFTS","TUFTS POS","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,0,10.210000000000001,25.69,17.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q4102","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,11.74,10.210000000000001,25.69,17.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q4102","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,11.74,10.210000000000001,25.69,17.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q4102","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,22.56,10.210000000000001,25.69,17.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q4102","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,0,10.210000000000001,25.69,17.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q4102","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,10.210000000000001,10.210000000000001,25.69,17.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q4102","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,10.210000000000001,10.210000000000001,25.69,17.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q4102","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,10.210000000000001,10.210000000000001,25.69,17.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q4102","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,10.210000000000001,10.210000000000001,25.69,17.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q4102","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,12.05,10.210000000000001,25.69,17.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q4102","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,25.69,10.210000000000001,25.69,17.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q4102","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,11.74,10.210000000000001,25.69,17.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q4102","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,11.74,10.210000000000001,25.69,17.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q4102","BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,11.74,10.210000000000001,25.69,17.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q4102","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,11.74,10.210000000000001,25.69,17.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q4102","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q4102","OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX",69,11.74,10.210000000000001,25.69,17.25]
["TUFTS - TUFTS PPO - HCPCS - Q4104","TUFTS","TUFTS PPO","HCPCS","Q4104","INTEGRA BMWD","Q4104 - INTEGRA BMWD",7748,0,42.08,56.11,1937]
["TUFTS - TUFTS SELECT - HCPCS - Q4104","TUFTS","TUFTS SELECT","HCPCS","Q4104","INTEGRA BMWD","Q4104 - INTEGRA BMWD",7748,0,42.08,56.11,1937]
["UNICARE - UNICARE - HCPCS - Q4104","UNICARE","UNICARE","HCPCS","Q4104","INTEGRA BMWD","Q4104 - INTEGRA BMWD",7748,42.08,42.08,56.11,1937]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q4104","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q4104","INTEGRA BMWD","Q4104 - INTEGRA BMWD",7748,42.08,42.08,56.11,1937]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q4104","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q4104","INTEGRA BMWD","Q4104 - INTEGRA BMWD",7748,0,42.08,56.11,1937]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q4104","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q4104","INTEGRA BMWD","Q4104 - INTEGRA BMWD",7748,0,42.08,56.11,1937]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q4104","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q4104","INTEGRA BMWD","Q4104 - INTEGRA BMWD",7748,0,42.08,56.11,1937]
["TUFTS - TUFTS HMO - HCPCS - Q4104","TUFTS","TUFTS HMO","HCPCS","Q4104","INTEGRA BMWD","Q4104 - INTEGRA BMWD",7748,0,42.08,56.11,1937]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q4104","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q4104","INTEGRA BMWD","Q4104 - INTEGRA BMWD",7748,0,42.08,56.11,1937]
["TUFTS - TUFTS POS - HCPCS - Q4104","TUFTS","TUFTS POS","HCPCS","Q4104","INTEGRA BMWD","Q4104 - INTEGRA BMWD",7748,0,42.08,56.11,1937]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q4104","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q4104","INTEGRA BMWD","Q4104 - INTEGRA BMWD",7748,0,42.08,56.11,1937]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q4104","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q4104","INTEGRA BMWD","Q4104 - INTEGRA BMWD",7748,56.11,42.08,56.11,1937]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q4104","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q4104","INTEGRA BMWD","Q4104 - INTEGRA BMWD",7748,56.11,42.08,56.11,1937]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q4104","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q4104","INTEGRA BMWD","Q4104 - INTEGRA BMWD",7748,56.11,42.08,56.11,1937]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q4104","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q4104","INTEGRA BMWD","Q4104 - INTEGRA BMWD",7748,56.11,42.08,56.11,1937]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q4104","BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q4104","INTEGRA BMWD","Q4104 - INTEGRA BMWD",7748,56.11,42.08,56.11,1937]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q4104","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q4104","INTEGRA BMWD","Q4104 - INTEGRA BMWD",7748,56.11,42.08,56.11,1937]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q4104","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q4104","INTEGRA BMWD","Q4104 - INTEGRA BMWD",7748,56.11,42.08,56.11,1937]
["TUFTS - TUFTS PPO - HCPCS - Q4107","TUFTS","TUFTS PPO","HCPCS","Q4107","GRAFTJACKET","Q4107 - GRAFTJACKET",2233,0,86.55,110.48,558.25]
["UNICARE - UNICARE - HCPCS - Q4107","UNICARE","UNICARE","HCPCS","Q4107","GRAFTJACKET","Q4107 - GRAFTJACKET",2233,86.55,86.55,110.48,558.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q4107","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q4107","GRAFTJACKET","Q4107 - GRAFTJACKET",2233,86.55,86.55,110.48,558.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q4107","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q4107","GRAFTJACKET","Q4107 - GRAFTJACKET",2233,0,86.55,110.48,558.25]
["TUFTS - TUFTS SELECT - HCPCS - Q4107","TUFTS","TUFTS SELECT","HCPCS","Q4107","GRAFTJACKET","Q4107 - GRAFTJACKET",2233,0,86.55,110.48,558.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q4107","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q4107","GRAFTJACKET","Q4107 - GRAFTJACKET",2233,0,86.55,110.48,558.25]
["TUFTS - TUFTS HMO - HCPCS - Q4107","TUFTS","TUFTS HMO","HCPCS","Q4107","GRAFTJACKET","Q4107 - GRAFTJACKET",2233,0,86.55,110.48,558.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q4107","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q4107","GRAFTJACKET","Q4107 - GRAFTJACKET",2233,0,86.55,110.48,558.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q4107","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q4107","GRAFTJACKET","Q4107 - GRAFTJACKET",2233,0,86.55,110.48,558.25]
["TUFTS - TUFTS POS - HCPCS - Q4107","TUFTS","TUFTS POS","HCPCS","Q4107","GRAFTJACKET","Q4107 - GRAFTJACKET",2233,0,86.55,110.48,558.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q4107","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q4107","GRAFTJACKET","Q4107 - GRAFTJACKET",2233,110.48,86.55,110.48,558.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q4107","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q4107","GRAFTJACKET","Q4107 - GRAFTJACKET",2233,110.48,86.55,110.48,558.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q4107","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q4107","GRAFTJACKET","Q4107 - GRAFTJACKET",2233,0,86.55,110.48,558.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q4107","BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q4107","GRAFTJACKET","Q4107 - GRAFTJACKET",2233,110.48,86.55,110.48,558.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q4107","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q4107","GRAFTJACKET","Q4107 - GRAFTJACKET",2233,110.48,86.55,110.48,558.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q4107","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q4107","GRAFTJACKET","Q4107 - GRAFTJACKET",2233,110.48,86.55,110.48,558.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q4107","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q4107","GRAFTJACKET","Q4107 - GRAFTJACKET",2233,110.48,86.55,110.48,558.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q4107","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q4107","GRAFTJACKET","Q4107 - GRAFTJACKET",2233,110.48,86.55,110.48,558.25]
["TUFTS - TUFTS PPO - HCPCS - Q4112","TUFTS","TUFTS PPO","HCPCS","Q4112","CYMETRA INJECTABLE","Q4112 - CYMETRA INJECTABLE",535,0,904.99,1002.89,133.75]
["TUFTS - TUFTS SELECT - HCPCS - Q4112","TUFTS","TUFTS SELECT","HCPCS","Q4112","CYMETRA INJECTABLE","Q4112 - CYMETRA INJECTABLE",535,0,904.99,1002.89,133.75]
["UNICARE - UNICARE - HCPCS - Q4112","UNICARE","UNICARE","HCPCS","Q4112","CYMETRA INJECTABLE","Q4112 - CYMETRA INJECTABLE",535,904.99,904.99,1002.89,133.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q4112","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q4112","CYMETRA INJECTABLE","Q4112 - CYMETRA INJECTABLE",535,904.99,904.99,1002.89,133.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q4112","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q4112","CYMETRA INJECTABLE","Q4112 - CYMETRA INJECTABLE",535,0,904.99,1002.89,133.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q4112","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q4112","CYMETRA INJECTABLE","Q4112 - CYMETRA INJECTABLE",535,0,904.99,1002.89,133.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q4112","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q4112","CYMETRA INJECTABLE","Q4112 - CYMETRA INJECTABLE",535,0,904.99,1002.89,133.75]
["TUFTS - TUFTS HMO - HCPCS - Q4112","TUFTS","TUFTS HMO","HCPCS","Q4112","CYMETRA INJECTABLE","Q4112 - CYMETRA INJECTABLE",535,0,904.99,1002.89,133.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q4112","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q4112","CYMETRA INJECTABLE","Q4112 - CYMETRA INJECTABLE",535,0,904.99,1002.89,133.75]
["TUFTS - TUFTS POS - HCPCS - Q4112","TUFTS","TUFTS POS","HCPCS","Q4112","CYMETRA INJECTABLE","Q4112 - CYMETRA INJECTABLE",535,0,904.99,1002.89,133.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q4112","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q4112","CYMETRA INJECTABLE","Q4112 - CYMETRA INJECTABLE",535,1002.89,904.99,1002.89,133.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q4112","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q4112","CYMETRA INJECTABLE","Q4112 - CYMETRA INJECTABLE",535,1002.89,904.99,1002.89,133.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q4112","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q4112","CYMETRA INJECTABLE","Q4112 - CYMETRA INJECTABLE",535,0,904.99,1002.89,133.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q4112","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q4112","CYMETRA INJECTABLE","Q4112 - CYMETRA INJECTABLE",535,1002.89,904.99,1002.89,133.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q4112","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q4112","CYMETRA INJECTABLE","Q4112 - CYMETRA INJECTABLE",535,1002.89,904.99,1002.89,133.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q4112","BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q4112","CYMETRA INJECTABLE","Q4112 - CYMETRA INJECTABLE",535,1002.89,904.99,1002.89,133.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q4112","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q4112","CYMETRA INJECTABLE","Q4112 - CYMETRA INJECTABLE",535,1002.89,904.99,1002.89,133.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q4112","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q4112","CYMETRA INJECTABLE","Q4112 - CYMETRA INJECTABLE",535,1002.89,904.99,1002.89,133.75]
["UNICARE - UNICARE - HCPCS - Q4116","UNICARE","UNICARE","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM","Q4116 - HC ALLODERM 8 X 16 MEDIUM",5248,32.29,32.29,35.78,1312]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q4116","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM","Q4116 - HC ALLODERM 8 X 16 MEDIUM",5248,32.29,32.29,35.78,1312]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q4116","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM","Q4116 - HC ALLODERM 8 X 16 MEDIUM",5248,0,32.29,35.78,1312]
["TUFTS - TUFTS PPO - HCPCS - Q4116","TUFTS","TUFTS PPO","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM","Q4116 - HC ALLODERM 8 X 16 MEDIUM",5248,0,32.29,35.78,1312]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q4116","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM","Q4116 - HC ALLODERM 8 X 16 MEDIUM",5248,0,32.29,35.78,1312]
["TUFTS - TUFTS SELECT - HCPCS - Q4116","TUFTS","TUFTS SELECT","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM","Q4116 - HC ALLODERM 8 X 16 MEDIUM",5248,0,32.29,35.78,1312]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q4116","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM","Q4116 - HC ALLODERM 8 X 16 MEDIUM",5248,0,32.29,35.78,1312]
["FALLON - FALLON MEDICAID - HCPCS - Q4116","FALLON","FALLON MEDICAID","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM","Q4116 - HC ALLODERM 8 X 16 MEDIUM",5248,0,32.29,35.78,1312]
["TUFTS - TUFTS HMO - HCPCS - Q4116","TUFTS","TUFTS HMO","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM","Q4116 - HC ALLODERM 8 X 16 MEDIUM",5248,0,32.29,35.78,1312]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q4116","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM","Q4116 - HC ALLODERM 8 X 16 MEDIUM",5248,0,32.29,35.78,1312]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q4116","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM","Q4116 - HC ALLODERM 8 X 16 MEDIUM",5248,0,32.29,35.78,1312]
["TUFTS - TUFTS POS - HCPCS - Q4116","TUFTS","TUFTS POS","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM","Q4116 - HC ALLODERM 8 X 16 MEDIUM",5248,0,32.29,35.78,1312]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q4116","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM","Q4116 - HC ALLODERM 8 X 16 MEDIUM",5248,35.78,32.29,35.78,1312]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q4116","BMC HEALTHNET","BMCHN QHP","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM","Q4116 - HC ALLODERM 8 X 16 MEDIUM",5248,0,32.29,35.78,1312]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q4116","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM","Q4116 - HC ALLODERM 8 X 16 MEDIUM",5248,35.78,32.29,35.78,1312]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q4116","BMC HEALTHNET","BMCHN ACO","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM","Q4116 - HC ALLODERM 8 X 16 MEDIUM",5248,0,32.29,35.78,1312]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q4116","BMC HEALTHNET","BMCHN MCO","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM","Q4116 - HC ALLODERM 8 X 16 MEDIUM",5248,0,32.29,35.78,1312]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q4116","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM","Q4116 - HC ALLODERM 8 X 16 MEDIUM",5248,0,32.29,35.78,1312]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q4116","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM","Q4116 - HC ALLODERM 8 X 16 MEDIUM",5248,0,32.29,35.78,1312]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q4116","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM","Q4116 - HC ALLODERM 8 X 16 MEDIUM",5248,35.78,32.29,35.78,1312]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q4116","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM","Q4116 - HC ALLODERM 8 X 16 MEDIUM",5248,35.78,32.29,35.78,1312]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q4116","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM","Q4116 - HC ALLODERM 8 X 16 MEDIUM",5248,0,32.29,35.78,1312]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q4116","BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM","Q4116 - HC ALLODERM 8 X 16 MEDIUM",5248,35.78,32.29,35.78,1312]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q4116","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM","Q4116 - HC ALLODERM 8 X 16 MEDIUM",5248,0,32.29,35.78,1312]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q4116","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM","Q4116 - HC ALLODERM 8 X 16 MEDIUM",5248,35.78,32.29,35.78,1312]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q4116","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM","Q4116 - HC ALLODERM 8 X 16 MEDIUM",5248,35.78,32.29,35.78,1312]
["TUFTS - TUFTS PPO - HCPCS - Q4124","TUFTS","TUFTS PPO","HCPCS","Q4124","OASIS TRILAYER/1 SQCM","Q4124 - OASIS TRILAYER/1 SQCM",23,0,16.39,16.39,5.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q4124","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q4124","OASIS TRILAYER/1 SQCM","Q4124 - OASIS TRILAYER/1 SQCM",23,0,16.39,16.39,5.75]
["TUFTS - TUFTS SELECT - HCPCS - Q4124","TUFTS","TUFTS SELECT","HCPCS","Q4124","OASIS TRILAYER/1 SQCM","Q4124 - OASIS TRILAYER/1 SQCM",23,0,16.39,16.39,5.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q4124","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q4124","OASIS TRILAYER/1 SQCM","Q4124 - OASIS TRILAYER/1 SQCM",23,0,16.39,16.39,5.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q4124","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q4124","OASIS TRILAYER/1 SQCM","Q4124 - OASIS TRILAYER/1 SQCM",23,0,16.39,16.39,5.75]
["TUFTS - TUFTS POS - HCPCS - Q4124","TUFTS","TUFTS POS","HCPCS","Q4124","OASIS TRILAYER/1 SQCM","Q4124 - OASIS TRILAYER/1 SQCM",23,0,16.39,16.39,5.75]
["FALLON - FALLON MEDICAID - HCPCS - Q4124","FALLON","FALLON MEDICAID","HCPCS","Q4124","OASIS TRILAYER/1 SQCM","Q4124 - OASIS TRILAYER/1 SQCM",23,0,16.39,16.39,5.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q4124","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q4124","OASIS TRILAYER/1 SQCM","Q4124 - OASIS TRILAYER/1 SQCM",23,0,16.39,16.39,5.75]
["TUFTS - TUFTS HMO - HCPCS - Q4124","TUFTS","TUFTS HMO","HCPCS","Q4124","OASIS TRILAYER/1 SQCM","Q4124 - OASIS TRILAYER/1 SQCM",23,0,16.39,16.39,5.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q4124","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q4124","OASIS TRILAYER/1 SQCM","Q4124 - OASIS TRILAYER/1 SQCM",23,0,16.39,16.39,5.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q4124","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q4124","OASIS TRILAYER/1 SQCM","Q4124 - OASIS TRILAYER/1 SQCM",23,0,16.39,16.39,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q4124","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q4124","OASIS TRILAYER/1 SQCM","Q4124 - OASIS TRILAYER/1 SQCM",23,16.39,16.39,16.39,5.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q4124","BMC HEALTHNET","BMCHN ACO","HCPCS","Q4124","OASIS TRILAYER/1 SQCM","Q4124 - OASIS TRILAYER/1 SQCM",23,0,16.39,16.39,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q4124","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q4124","OASIS TRILAYER/1 SQCM","Q4124 - OASIS TRILAYER/1 SQCM",23,16.39,16.39,16.39,5.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q4124","BMC HEALTHNET","BMCHN QHP","HCPCS","Q4124","OASIS TRILAYER/1 SQCM","Q4124 - OASIS TRILAYER/1 SQCM",23,0,16.39,16.39,5.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q4124","BMC HEALTHNET","BMCHN MCO","HCPCS","Q4124","OASIS TRILAYER/1 SQCM","Q4124 - OASIS TRILAYER/1 SQCM",23,0,16.39,16.39,5.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q4124","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q4124","OASIS TRILAYER/1 SQCM","Q4124 - OASIS TRILAYER/1 SQCM",23,0,16.39,16.39,5.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q4124","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q4124","OASIS TRILAYER/1 SQCM","Q4124 - OASIS TRILAYER/1 SQCM",23,0,16.39,16.39,5.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q4124","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","Q4124","OASIS TRILAYER/1 SQCM","Q4124 - OASIS TRILAYER/1 SQCM",23,0,16.39,16.39,5.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q4124","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q4124","OASIS TRILAYER/1 SQCM","Q4124 - OASIS TRILAYER/1 SQCM",23,16.39,16.39,16.39,5.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q4124","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q4124","OASIS TRILAYER/1 SQCM","Q4124 - OASIS TRILAYER/1 SQCM",23,16.39,16.39,16.39,5.75]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q4124","BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q4124","OASIS TRILAYER/1 SQCM","Q4124 - OASIS TRILAYER/1 SQCM",23,16.39,16.39,16.39,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q4124","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q4124","OASIS TRILAYER/1 SQCM","Q4124 - OASIS TRILAYER/1 SQCM",23,16.39,16.39,16.39,5.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q4124","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q4124","OASIS TRILAYER/1 SQCM","Q4124 - OASIS TRILAYER/1 SQCM",23,16.39,16.39,16.39,5.75]
["TUFTS - TUFTS PPO - HCPCS - Q4125","TUFTS","TUFTS PPO","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM","Q4125 - HC AFLEX401 ¿ 40 X 70 MM",4060,0,3.79,3.79,1015]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q4125","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM","Q4125 - HC AFLEX401 ¿ 40 X 70 MM",4060,0,3.79,3.79,1015]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q4125","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM","Q4125 - HC AFLEX401 ¿ 40 X 70 MM",4060,0,3.79,3.79,1015]
["TUFTS - TUFTS SELECT - HCPCS - Q4125","TUFTS","TUFTS SELECT","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM","Q4125 - HC AFLEX401 ¿ 40 X 70 MM",4060,0,3.79,3.79,1015]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q4125","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM","Q4125 - HC AFLEX401 ¿ 40 X 70 MM",4060,0,3.79,3.79,1015]
["FALLON - FALLON MEDICAID - HCPCS - Q4125","FALLON","FALLON MEDICAID","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM","Q4125 - HC AFLEX401 ¿ 40 X 70 MM",4060,0,3.79,3.79,1015]
["TUFTS - TUFTS HMO - HCPCS - Q4125","TUFTS","TUFTS HMO","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM","Q4125 - HC AFLEX401 ¿ 40 X 70 MM",4060,0,3.79,3.79,1015]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q4125","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM","Q4125 - HC AFLEX401 ¿ 40 X 70 MM",4060,0,3.79,3.79,1015]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q4125","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM","Q4125 - HC AFLEX401 ¿ 40 X 70 MM",4060,0,3.79,3.79,1015]
["TUFTS - TUFTS POS - HCPCS - Q4125","TUFTS","TUFTS POS","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM","Q4125 - HC AFLEX401 ¿ 40 X 70 MM",4060,0,3.79,3.79,1015]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q4125","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM","Q4125 - HC AFLEX401 ¿ 40 X 70 MM",4060,3.79,3.79,3.79,1015]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q4125","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM","Q4125 - HC AFLEX401 ¿ 40 X 70 MM",4060,3.79,3.79,3.79,1015]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q4125","BMC HEALTHNET","BMCHN QHP","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM","Q4125 - HC AFLEX401 ¿ 40 X 70 MM",4060,0,3.79,3.79,1015]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q4125","BMC HEALTHNET","BMCHN ACO","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM","Q4125 - HC AFLEX401 ¿ 40 X 70 MM",4060,0,3.79,3.79,1015]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q4125","BMC HEALTHNET","BMCHN MCO","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM","Q4125 - HC AFLEX401 ¿ 40 X 70 MM",4060,0,3.79,3.79,1015]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q4125","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM","Q4125 - HC AFLEX401 ¿ 40 X 70 MM",4060,0,3.79,3.79,1015]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q4125","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM","Q4125 - HC AFLEX401 ¿ 40 X 70 MM",4060,0,3.79,3.79,1015]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q4125","BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM","Q4125 - HC AFLEX401 ¿ 40 X 70 MM",4060,3.79,3.79,3.79,1015]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q4125","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM","Q4125 - HC AFLEX401 ¿ 40 X 70 MM",4060,0,3.79,3.79,1015]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q4125","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM","Q4125 - HC AFLEX401 ¿ 40 X 70 MM",4060,3.79,3.79,3.79,1015]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q4125","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM","Q4125 - HC AFLEX401 ¿ 40 X 70 MM",4060,0,3.79,3.79,1015]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q4125","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM","Q4125 - HC AFLEX401 ¿ 40 X 70 MM",4060,3.79,3.79,3.79,1015]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q4125","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM","Q4125 - HC AFLEX401 ¿ 40 X 70 MM",4060,3.79,3.79,3.79,1015]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q4125","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM","Q4125 - HC AFLEX401 ¿ 40 X 70 MM",4060,3.79,3.79,3.79,1015]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q4130","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q4130","PR STRATTICE TM","Q4130 - PR STRATTICE TM",65718,0,45.89,45.89,16429.5]
["TUFTS - TUFTS PPO - HCPCS - Q4130","TUFTS","TUFTS PPO","HCPCS","Q4130","PR STRATTICE TM","Q4130 - PR STRATTICE TM",65718,0,45.89,45.89,16429.5]
["TUFTS - TUFTS SELECT - HCPCS - Q4130","TUFTS","TUFTS SELECT","HCPCS","Q4130","PR STRATTICE TM","Q4130 - PR STRATTICE TM",65718,0,45.89,45.89,16429.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q4130","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q4130","PR STRATTICE TM","Q4130 - PR STRATTICE TM",65718,0,45.89,45.89,16429.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q4130","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q4130","PR STRATTICE TM","Q4130 - PR STRATTICE TM",65718,0,45.89,45.89,16429.5]
["FALLON - FALLON MEDICAID - HCPCS - Q4130","FALLON","FALLON MEDICAID","HCPCS","Q4130","PR STRATTICE TM","Q4130 - PR STRATTICE TM",65718,0,45.89,45.89,16429.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q4130","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q4130","PR STRATTICE TM","Q4130 - PR STRATTICE TM",65718,0,45.89,45.89,16429.5]
["TUFTS - TUFTS POS - HCPCS - Q4130","TUFTS","TUFTS POS","HCPCS","Q4130","PR STRATTICE TM","Q4130 - PR STRATTICE TM",65718,0,45.89,45.89,16429.5]
["TUFTS - TUFTS HMO - HCPCS - Q4130","TUFTS","TUFTS HMO","HCPCS","Q4130","PR STRATTICE TM","Q4130 - PR STRATTICE TM",65718,0,45.89,45.89,16429.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q4130","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q4130","PR STRATTICE TM","Q4130 - PR STRATTICE TM",65718,0,45.89,45.89,16429.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q4130","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q4130","PR STRATTICE TM","Q4130 - PR STRATTICE TM",65718,45.89,45.89,45.89,16429.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q4130","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q4130","PR STRATTICE TM","Q4130 - PR STRATTICE TM",65718,45.89,45.89,45.89,16429.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q4130","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q4130","PR STRATTICE TM","Q4130 - PR STRATTICE TM",65718,0,45.89,45.89,16429.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q4130","BMC HEALTHNET","BMCHN ACO","HCPCS","Q4130","PR STRATTICE TM","Q4130 - PR STRATTICE TM",65718,0,45.89,45.89,16429.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q4130","BMC HEALTHNET","BMCHN QHP","HCPCS","Q4130","PR STRATTICE TM","Q4130 - PR STRATTICE TM",65718,0,45.89,45.89,16429.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q4130","BMC HEALTHNET","BMCHN MCO","HCPCS","Q4130","PR STRATTICE TM","Q4130 - PR STRATTICE TM",65718,0,45.89,45.89,16429.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q4130","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q4130","PR STRATTICE TM","Q4130 - PR STRATTICE TM",65718,0,45.89,45.89,16429.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q4130","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q4130","PR STRATTICE TM","Q4130 - PR STRATTICE TM",65718,0,45.89,45.89,16429.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q4130","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","Q4130","PR STRATTICE TM","Q4130 - PR STRATTICE TM",65718,0,45.89,45.89,16429.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q4130","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q4130","PR STRATTICE TM","Q4130 - PR STRATTICE TM",65718,45.89,45.89,45.89,16429.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q4130","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q4130","PR STRATTICE TM","Q4130 - PR STRATTICE TM",65718,45.89,45.89,45.89,16429.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q4130","BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q4130","PR STRATTICE TM","Q4130 - PR STRATTICE TM",65718,45.89,45.89,45.89,16429.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q4130","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q4130","PR STRATTICE TM","Q4130 - PR STRATTICE TM",65718,45.89,45.89,45.89,16429.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q4130","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q4130","PR STRATTICE TM","Q4130 - PR STRATTICE TM",65718,45.89,45.89,45.89,16429.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q4132","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q4132","HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM",3754,0,114.63,288.43,938.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q4132","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","Q4132","HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM",3754,137.56,114.63,288.43,938.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q4132","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","Q4132","HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM",3754,137.56,114.63,288.43,938.5]
["TUFTS - TUFTS PPO - HCPCS - Q4132","TUFTS","TUFTS PPO","HCPCS","Q4132","HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM",3754,0,114.63,288.43,938.5]
["TUFTS - TUFTS SELECT - HCPCS - Q4132","TUFTS","TUFTS SELECT","HCPCS","Q4132","HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM",3754,0,114.63,288.43,938.5]
["UNICARE - UNICARE - HCPCS - Q4132","UNICARE","UNICARE","HCPCS","Q4132","HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM",3754,118.95,114.63,288.43,938.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q4132","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q4132","HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM",3754,118.95,114.63,288.43,938.5]
["TUFTS - TUFTS SPIRIT - HCPCS - Q4132","TUFTS","TUFTS SPIRIT","HCPCS","Q4132","HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM",3754,126.09,114.63,288.43,938.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q4132","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","Q4132","HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM",3754,154.54,114.63,288.43,938.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q4132","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q4132","HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM",3754,0,114.63,288.43,938.5]
["TUFTS - TUFTS HMO - HCPCS - Q4132","TUFTS","TUFTS HMO","HCPCS","Q4132","HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM",3754,0,114.63,288.43,938.5]
["FALLON - FALLON SENIOR PLAN - HCPCS - Q4132","FALLON","FALLON SENIOR PLAN","HCPCS","Q4132","HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM",3754,114.63,114.63,288.43,938.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q4132","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","Q4132","HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM",3754,166.21,114.63,288.43,938.5]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - Q4132","TUFTS","TUFTS MEDICARE SCO","HCPCS","Q4132","HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM",3754,166.21,114.63,288.43,938.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q4132","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q4132","HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM",3754,0,114.63,288.43,938.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q4132","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q4132","HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM",3754,0,114.63,288.43,938.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q4132","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","Q4132","HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM",3754,247.49,114.63,288.43,938.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q4132","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","Q4132","HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM",3754,199.46,114.63,288.43,938.5]
["TUFTS - TUFTS POS - HCPCS - Q4132","TUFTS","TUFTS POS","HCPCS","Q4132","HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM",3754,0,114.63,288.43,938.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q4132","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","Q4132","HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM",3754,114.63,114.63,288.43,938.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q4132","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","Q4132","HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM",3754,114.63,114.63,288.43,938.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q4132","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q4132","HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM",3754,131.82,114.63,288.43,938.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q4132","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","Q4132","HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM",3754,114.63,114.63,288.43,938.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q4132","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","Q4132","HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM",3754,253.32,114.63,288.43,938.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q4132","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","Q4132","HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM",3754,114.63,114.63,288.43,938.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q4132","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q4132","HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM",3754,131.82,114.63,288.43,938.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q4132","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q4132","HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM",3754,0,114.63,288.43,938.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q4132","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","Q4132","HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM",3754,135.26,114.63,288.43,938.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q4132","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q4132","HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM",3754,131.82,114.63,288.43,938.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q4132","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q4132","HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM",3754,131.82,114.63,288.43,938.5]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q4132","BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q4132","HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM",3754,131.82,114.63,288.43,938.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q4132","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","Q4132","HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM",3754,288.43,114.63,288.43,938.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q4132","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q4132","HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM",3754,131.82,114.63,288.43,938.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q4132","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q4132","HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM",3754,131.82,114.63,288.43,938.5]
["TUFTS - TUFTS PPO - HCPCS - Q4133","TUFTS","TUFTS PPO","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,0,131.97,332.06,939]
["UNICARE - UNICARE - HCPCS - Q4133","UNICARE","UNICARE","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,136.94999999999999,131.97,332.06,939]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q4133","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,136.94999999999999,131.97,332.06,939]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q4133","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,158.36000000000001,131.97,332.06,939]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q4133","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,158.36000000000001,131.97,332.06,939]
["TUFTS - TUFTS SELECT - HCPCS - Q4133","TUFTS","TUFTS SELECT","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,0,131.97,332.06,939]
["TUFTS - TUFTS SPIRIT - HCPCS - Q4133","TUFTS","TUFTS SPIRIT","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,145.16999999999999,131.97,332.06,939]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q4133","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,0,131.97,332.06,939]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q4133","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,177.92,131.97,332.06,939]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q4133","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,0,131.97,332.06,939]
["FALLON - FALLON SENIOR PLAN - HCPCS - Q4133","FALLON","FALLON SENIOR PLAN","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,131.97,131.97,332.06,939]
["TUFTS - TUFTS POS - HCPCS - Q4133","TUFTS","TUFTS POS","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,0,131.97,332.06,939]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q4133","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,0,131.97,332.06,939]
["TUFTS - TUFTS HMO - HCPCS - Q4133","TUFTS","TUFTS HMO","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,0,131.97,332.06,939]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q4133","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,191.36,131.97,332.06,939]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q4133","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,0,131.97,332.06,939]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - Q4133","TUFTS","TUFTS MEDICARE SCO","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,191.36,131.97,332.06,939]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q4133","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,284.92,131.97,332.06,939]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q4133","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,229.63,131.97,332.06,939]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q4133","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,0,131.97,332.06,939]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q4133","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,151.77000000000001,131.97,332.06,939]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q4133","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,291.64,131.97,332.06,939]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q4133","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,151.77000000000001,131.97,332.06,939]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q4133","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,131.97,131.97,332.06,939]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q4133","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,131.97,131.97,332.06,939]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q4133","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,131.97,131.97,332.06,939]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q4133","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,131.97,131.97,332.06,939]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q4133","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,155.72,131.97,332.06,939]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q4133","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,332.06,131.97,332.06,939]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q4133","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,151.77000000000001,131.97,332.06,939]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q4133","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,151.77000000000001,131.97,332.06,939]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q4133","BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,151.77000000000001,131.97,332.06,939]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q4133","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,151.77000000000001,131.97,332.06,939]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q4133","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",3756,151.77000000000001,131.97,332.06,939]
["TUFTS - TUFTS PPO - HCPCS - Q4196","TUFTS","TUFTS PPO","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,162.6,111.59,280.77999999999997,2261]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q4196","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,133.91,111.59,280.77999999999997,2261]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q4196","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,133.91,111.59,280.77999999999997,2261]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q4196","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,192.05,111.59,280.77999999999997,2261]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q4196","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,0,111.59,280.77999999999997,2261]
["TUFTS - TUFTS SELECT - HCPCS - Q4196","TUFTS","TUFTS SELECT","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,152,111.59,280.77999999999997,2261]
["UNICARE - UNICARE - HCPCS - Q4196","UNICARE","UNICARE","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,115.8,111.59,280.77999999999997,2261]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q4196","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,115.8,111.59,280.77999999999997,2261]
["TUFTS - TUFTS SPIRIT - HCPCS - Q4196","TUFTS","TUFTS SPIRIT","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,122.75,111.59,280.77999999999997,2261]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q4196","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,150.44999999999999,111.59,280.77999999999997,2261]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q4196","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,192.05,111.59,280.77999999999997,2261]
["FALLON - FALLON MEDICAID - HCPCS - Q4196","FALLON","FALLON MEDICAID","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,0,111.59,280.77999999999997,2261]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q4196","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,161.81,111.59,280.77999999999997,2261]
["FALLON - FALLON SENIOR PLAN - HCPCS - Q4196","FALLON","FALLON SENIOR PLAN","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,111.59,111.59,280.77999999999997,2261]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - Q4196","TUFTS","TUFTS MEDICARE SCO","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,161.81,111.59,280.77999999999997,2261]
["TUFTS - TUFTS HMO - HCPCS - Q4196","TUFTS","TUFTS HMO","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,152,111.59,280.77999999999997,2261]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q4196","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,192.05,111.59,280.77999999999997,2261]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q4196","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,192.05,111.59,280.77999999999997,2261]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q4196","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,240.92,111.59,280.77999999999997,2261]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q4196","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,194.17,111.59,280.77999999999997,2261]
["TUFTS - TUFTS POS - HCPCS - Q4196","TUFTS","TUFTS POS","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,152,111.59,280.77999999999997,2261]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q4196","BMC HEALTHNET","BMCHN QHP","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,0,111.59,280.77999999999997,2261]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q4196","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,111.59,111.59,280.77999999999997,2261]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q4196","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,246.6,111.59,280.77999999999997,2261]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q4196","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,111.59,111.59,280.77999999999997,2261]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q4196","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,111.59,111.59,280.77999999999997,2261]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q4196","BMC HEALTHNET","BMCHN ACO","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,0,111.59,280.77999999999997,2261]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q4196","BMC HEALTHNET","BMCHN MCO","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,0,111.59,280.77999999999997,2261]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q4196","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,257.92,111.59,280.77999999999997,2261]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q4196","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,111.59,111.59,280.77999999999997,2261]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q4196","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,0,111.59,280.77999999999997,2261]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q4196","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,131.68,111.59,280.77999999999997,2261]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q4196","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,0,111.59,280.77999999999997,2261]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q4196","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,0,111.59,280.77999999999997,2261]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q4196","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM",9044,280.77999999999997,111.59,280.77999999999997,2261]
["UNICARE - UNICARE - HCPCS - Q9954","UNICARE","UNICARE","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML","Q9954 - ORAL MR CONTRAST, 100 ML",0,12.1,12.1,13.41,0]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q9954","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML","Q9954 - ORAL MR CONTRAST, 100 ML",0,12.1,12.1,13.41,0]
["TUFTS - TUFTS PPO - HCPCS - Q9954","TUFTS","TUFTS PPO","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML","Q9954 - ORAL MR CONTRAST, 100 ML",0,0,12.1,13.41,0]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q9954","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML","Q9954 - ORAL MR CONTRAST, 100 ML",0,0,12.1,13.41,0]
["TUFTS - TUFTS SELECT - HCPCS - Q9954","TUFTS","TUFTS SELECT","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML","Q9954 - ORAL MR CONTRAST, 100 ML",0,0,12.1,13.41,0]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q9954","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML","Q9954 - ORAL MR CONTRAST, 100 ML",0,0,12.1,13.41,0]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q9954","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML","Q9954 - ORAL MR CONTRAST, 100 ML",0,0,12.1,13.41,0]
["FALLON - FALLON MEDICAID - HCPCS - Q9954","FALLON","FALLON MEDICAID","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML","Q9954 - ORAL MR CONTRAST, 100 ML",0,0,12.1,13.41,0]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q9954","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML","Q9954 - ORAL MR CONTRAST, 100 ML",0,0,12.1,13.41,0]
["TUFTS - TUFTS POS - HCPCS - Q9954","TUFTS","TUFTS POS","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML","Q9954 - ORAL MR CONTRAST, 100 ML",0,0,12.1,13.41,0]
["TUFTS - TUFTS HMO - HCPCS - Q9954","TUFTS","TUFTS HMO","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML","Q9954 - ORAL MR CONTRAST, 100 ML",0,0,12.1,13.41,0]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q9954","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML","Q9954 - ORAL MR CONTRAST, 100 ML",0,0,12.1,13.41,0]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q9954","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML","Q9954 - ORAL MR CONTRAST, 100 ML",0,13.41,12.1,13.41,0]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q9954","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML","Q9954 - ORAL MR CONTRAST, 100 ML",0,13.41,12.1,13.41,0]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q9954","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML","Q9954 - ORAL MR CONTRAST, 100 ML",0,0,12.1,13.41,0]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q9954","BMC HEALTHNET","BMCHN ACO","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML","Q9954 - ORAL MR CONTRAST, 100 ML",0,0,12.1,13.41,0]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q9954","BMC HEALTHNET","BMCHN QHP","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML","Q9954 - ORAL MR CONTRAST, 100 ML",0,0,12.1,13.41,0]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q9954","BMC HEALTHNET","BMCHN MCO","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML","Q9954 - ORAL MR CONTRAST, 100 ML",0,0,12.1,13.41,0]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q9954","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML","Q9954 - ORAL MR CONTRAST, 100 ML",0,0,12.1,13.41,0]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q9954","BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML","Q9954 - ORAL MR CONTRAST, 100 ML",0,13.41,12.1,13.41,0]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q9954","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML","Q9954 - ORAL MR CONTRAST, 100 ML",0,0,12.1,13.41,0]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q9954","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML","Q9954 - ORAL MR CONTRAST, 100 ML",0,13.41,12.1,13.41,0]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q9954","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML","Q9954 - ORAL MR CONTRAST, 100 ML",0,0,12.1,13.41,0]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q9954","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML","Q9954 - ORAL MR CONTRAST, 100 ML",0,13.41,12.1,13.41,0]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q9954","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML","Q9954 - ORAL MR CONTRAST, 100 ML",0,13.41,12.1,13.41,0]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q9954","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML","Q9954 - ORAL MR CONTRAST, 100 ML",0,13.41,12.1,13.41,0]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q9956","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,0,31.75,79.89,19]
["TUFTS - TUFTS PPO - HCPCS - Q9956","TUFTS","TUFTS PPO","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,0,31.75,79.89,19]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q9956","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,0,31.75,79.89,19]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q9956","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,38.1,31.75,79.89,19]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q9956","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,38.1,31.75,79.89,19]
["TUFTS - TUFTS SELECT - HCPCS - Q9956","TUFTS","TUFTS SELECT","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,0,31.75,79.89,19]
["UNICARE - UNICARE - HCPCS - Q9956","UNICARE","UNICARE","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,32.950000000000003,31.75,79.89,19]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q9956","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,32.950000000000003,31.75,79.89,19]
["TUFTS - TUFTS SPIRIT - HCPCS - Q9956","TUFTS","TUFTS SPIRIT","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,34.92,31.75,79.89,19]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q9956","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,42.81,31.75,79.89,19]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q9956","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,0,31.75,79.89,19]
["FALLON - FALLON MEDICAID - HCPCS - Q9956","FALLON","FALLON MEDICAID","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,0,31.75,79.89,19]
["TUFTS - TUFTS HMO - HCPCS - Q9956","TUFTS","TUFTS HMO","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,0,31.75,79.89,19]
["FALLON - FALLON SENIOR PLAN - HCPCS - Q9956","FALLON","FALLON SENIOR PLAN","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,31.75,31.75,79.89,19]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q9956","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,0,31.75,79.89,19]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q9956","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,46.04,31.75,79.89,19]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q9956","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,0,31.75,79.89,19]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - Q9956","TUFTS","TUFTS MEDICARE SCO","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,46.04,31.75,79.89,19]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q9956","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,68.55,31.75,79.89,19]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q9956","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,55.25,31.75,79.89,19]
["TUFTS - TUFTS POS - HCPCS - Q9956","TUFTS","TUFTS POS","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,0,31.75,79.89,19]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q9956","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,36.51,31.75,79.89,19]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q9956","BMC HEALTHNET","BMCHN QHP","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,0,31.75,79.89,19]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q9956","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,70.16,31.75,79.89,19]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q9956","BMC HEALTHNET","BMCHN ACO","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,0,31.75,79.89,19]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q9956","BMC HEALTHNET","BMCHN MCO","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,0,31.75,79.89,19]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q9956","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,36.51,31.75,79.89,19]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q9956","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,0,31.75,79.89,19]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q9956","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,31.75,31.75,79.89,19]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q9956","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,31.75,31.75,79.89,19]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q9956","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,31.75,31.75,79.89,19]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q9956","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,31.75,31.75,79.89,19]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q9956","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,0,31.75,79.89,19]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q9956","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,37.47,31.75,79.89,19]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q9956","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,79.89,31.75,79.89,19]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q9956","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,0,31.75,79.89,19]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q9956","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,0,31.75,79.89,19]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q9956","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,36.51,31.75,79.89,19]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q9956","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,36.51,31.75,79.89,19]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q9956","BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,36.51,31.75,79.89,19]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q9956","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,36.51,31.75,79.89,19]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q9956","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",76,36.51,31.75,79.89,19]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q9957","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,57.16,47.63,119.85,104.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q9957","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,0,47.63,119.85,104.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q9957","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,57.16,47.63,119.85,104.25]
["TUFTS - TUFTS PPO - HCPCS - Q9957","TUFTS","TUFTS PPO","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,0,47.63,119.85,104.25]
["UNICARE - UNICARE - HCPCS - Q9957","UNICARE","UNICARE","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,49.42,47.63,119.85,104.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q9957","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,49.42,47.63,119.85,104.25]
["TUFTS - TUFTS SELECT - HCPCS - Q9957","TUFTS","TUFTS SELECT","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,0,47.63,119.85,104.25]
["TUFTS - TUFTS SPIRIT - HCPCS - Q9957","TUFTS","TUFTS SPIRIT","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,52.39,47.63,119.85,104.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q9957","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,0,47.63,119.85,104.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q9957","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,64.209999999999994,47.63,119.85,104.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q9957","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,0,47.63,119.85,104.25]
["FALLON - FALLON MEDICAID - HCPCS - Q9957","FALLON","FALLON MEDICAID","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,0,47.63,119.85,104.25]
["TUFTS - TUFTS POS - HCPCS - Q9957","TUFTS","TUFTS POS","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,0,47.63,119.85,104.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - Q9957","FALLON","FALLON SENIOR PLAN","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,47.63,47.63,119.85,104.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q9957","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,69.06,47.63,119.85,104.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - Q9957","TUFTS","TUFTS MEDICARE SCO","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,69.06,47.63,119.85,104.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q9957","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,0,47.63,119.85,104.25]
["TUFTS - TUFTS HMO - HCPCS - Q9957","TUFTS","TUFTS HMO","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,0,47.63,119.85,104.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q9957","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,0,47.63,119.85,104.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q9957","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,102.83,47.63,119.85,104.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q9957","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,82.88,47.63,119.85,104.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q9957","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,0,47.63,119.85,104.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q9957","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,47.63,47.63,119.85,104.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q9957","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,54.77,47.63,119.85,104.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q9957","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,47.63,47.63,119.85,104.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q9957","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,105.26,47.63,119.85,104.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q9957","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,47.63,47.63,119.85,104.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q9957","BMC HEALTHNET","BMCHN ACO","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,0,47.63,119.85,104.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q9957","BMC HEALTHNET","BMCHN QHP","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,0,47.63,119.85,104.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q9957","BMC HEALTHNET","BMCHN MCO","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,0,47.63,119.85,104.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q9957","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,54.77,47.63,119.85,104.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q9957","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,0,47.63,119.85,104.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q9957","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,47.63,47.63,119.85,104.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q9957","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,56.2,47.63,119.85,104.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q9957","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,54.77,47.63,119.85,104.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q9957","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,54.77,47.63,119.85,104.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q9957","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,0,47.63,119.85,104.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q9957","BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,54.77,47.63,119.85,104.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q9957","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,0,47.63,119.85,104.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q9957","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,119.85,47.63,119.85,104.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q9957","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,54.77,47.63,119.85,104.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q9957","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",417,54.77,47.63,119.85,104.25]
["TUFTS - TUFTS PPO - HCPCS - Q9958","TUFTS","TUFTS PPO","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0,7.0000000000000007E-2,0.18,0.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q9958","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0,7.0000000000000007E-2,0.18,0.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q9958","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0,7.0000000000000007E-2,0.18,0.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q9958","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0.08,7.0000000000000007E-2,0.18,0.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q9958","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0.08,7.0000000000000007E-2,0.18,0.25]
["TUFTS - TUFTS SELECT - HCPCS - Q9958","TUFTS","TUFTS SELECT","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0,7.0000000000000007E-2,0.18,0.25]
["UNICARE - UNICARE - HCPCS - Q9958","UNICARE","UNICARE","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,7.0000000000000007E-2,7.0000000000000007E-2,0.18,0.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q9958","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,7.0000000000000007E-2,7.0000000000000007E-2,0.18,0.25]
["TUFTS - TUFTS SPIRIT - HCPCS - Q9958","TUFTS","TUFTS SPIRIT","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0.08,7.0000000000000007E-2,0.18,0.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q9958","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0.09,7.0000000000000007E-2,0.18,0.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q9958","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0,7.0000000000000007E-2,0.18,0.25]
["FALLON - FALLON MEDICAID - HCPCS - Q9958","FALLON","FALLON MEDICAID","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0,7.0000000000000007E-2,0.18,0.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - Q9958","FALLON","FALLON SENIOR PLAN","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,7.0000000000000007E-2,7.0000000000000007E-2,0.18,0.25]
["TUFTS - TUFTS HMO - HCPCS - Q9958","TUFTS","TUFTS HMO","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0,7.0000000000000007E-2,0.18,0.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q9958","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0,7.0000000000000007E-2,0.18,0.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q9958","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0.1,7.0000000000000007E-2,0.18,0.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q9958","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0,7.0000000000000007E-2,0.18,0.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - Q9958","TUFTS","TUFTS MEDICARE SCO","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0.1,7.0000000000000007E-2,0.18,0.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q9958","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0.15,7.0000000000000007E-2,0.18,0.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q9958","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0.12,7.0000000000000007E-2,0.18,0.25]
["TUFTS - TUFTS POS - HCPCS - Q9958","TUFTS","TUFTS POS","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0,7.0000000000000007E-2,0.18,0.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q9958","BMC HEALTHNET","BMCHN QHP","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0,7.0000000000000007E-2,0.18,0.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q9958","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0.08,7.0000000000000007E-2,0.18,0.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q9958","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0.08,7.0000000000000007E-2,0.18,0.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q9958","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0.15,7.0000000000000007E-2,0.18,0.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q9958","BMC HEALTHNET","BMCHN ACO","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0,7.0000000000000007E-2,0.18,0.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q9958","BMC HEALTHNET","BMCHN MCO","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0,7.0000000000000007E-2,0.18,0.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q9958","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0,7.0000000000000007E-2,0.18,0.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q9958","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,7.0000000000000007E-2,7.0000000000000007E-2,0.18,0.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q9958","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,7.0000000000000007E-2,7.0000000000000007E-2,0.18,0.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q9958","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,7.0000000000000007E-2,7.0000000000000007E-2,0.18,0.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q9958","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,7.0000000000000007E-2,7.0000000000000007E-2,0.18,0.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q9958","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0,7.0000000000000007E-2,0.18,0.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q9958","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0.08,7.0000000000000007E-2,0.18,0.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q9958","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0,7.0000000000000007E-2,0.18,0.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q9958","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0.18,7.0000000000000007E-2,0.18,0.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q9958","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0,7.0000000000000007E-2,0.18,0.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q9958","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0.08,7.0000000000000007E-2,0.18,0.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q9958","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0.08,7.0000000000000007E-2,0.18,0.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q9958","BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0.08,7.0000000000000007E-2,0.18,0.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q9958","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0.08,7.0000000000000007E-2,0.18,0.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q9958","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",1,0.08,7.0000000000000007E-2,0.18,0.25]
["UNICARE - UNICARE - HCPCS - Q9961","UNICARE","UNICARE","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0.25,0.25,0.63,0.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q9961","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0.25,0.25,0.63,0.25]
["TUFTS - TUFTS PPO - HCPCS - Q9961","TUFTS","TUFTS PPO","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0,0.25,0.63,0.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q9961","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0,0.25,0.63,0.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q9961","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0.3,0.25,0.63,0.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q9961","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0.3,0.25,0.63,0.25]
["TUFTS - TUFTS SELECT - HCPCS - Q9961","TUFTS","TUFTS SELECT","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0,0.25,0.63,0.25]
["TUFTS - TUFTS SPIRIT - HCPCS - Q9961","TUFTS","TUFTS SPIRIT","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0.28000000000000003,0.25,0.63,0.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q9961","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0,0.25,0.63,0.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q9961","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0.34,0.25,0.63,0.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q9961","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0,0.25,0.63,0.25]
["FALLON - FALLON MEDICAID - HCPCS - Q9961","FALLON","FALLON MEDICAID","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0,0.25,0.63,0.25]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - Q9961","TUFTS","TUFTS MEDICARE SCO","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0.36,0.25,0.63,0.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q9961","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0.36,0.25,0.63,0.25]
["FALLON - FALLON SENIOR PLAN - HCPCS - Q9961","FALLON","FALLON SENIOR PLAN","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0.25,0.25,0.63,0.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q9961","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0,0.25,0.63,0.25]
["TUFTS - TUFTS POS - HCPCS - Q9961","TUFTS","TUFTS POS","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0,0.25,0.63,0.25]
["TUFTS - TUFTS HMO - HCPCS - Q9961","TUFTS","TUFTS HMO","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0,0.25,0.63,0.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q9961","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0,0.25,0.63,0.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q9961","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0.54,0.25,0.63,0.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q9961","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0.44,0.25,0.63,0.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q9961","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0.25,0.25,0.63,0.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q9961","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0.28999999999999998,0.25,0.63,0.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q9961","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0.55000000000000004,0.25,0.63,0.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q9961","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0,0.25,0.63,0.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q9961","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0.25,0.25,0.63,0.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q9961","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0.25,0.25,0.63,0.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q9961","BMC HEALTHNET","BMCHN ACO","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0,0.25,0.63,0.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q9961","BMC HEALTHNET","BMCHN QHP","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0,0.25,0.63,0.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q9961","BMC HEALTHNET","BMCHN MCO","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0,0.25,0.63,0.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q9961","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0.28999999999999998,0.25,0.63,0.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q9961","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0,0.25,0.63,0.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q9961","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0.25,0.25,0.63,0.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q9961","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0.28999999999999998,0.25,0.63,0.25]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q9961","BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0.28999999999999998,0.25,0.63,0.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q9961","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0,0.25,0.63,0.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q9961","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0.28999999999999998,0.25,0.63,0.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q9961","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0,0.25,0.63,0.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q9961","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0.28999999999999998,0.25,0.63,0.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q9961","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0.63,0.25,0.63,0.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q9961","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0.28999999999999998,0.25,0.63,0.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q9961","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML",1,0.28999999999999998,0.25,0.63,0.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q9963","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["TUFTS - TUFTS PPO - HCPCS - Q9963","TUFTS","TUFTS PPO","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q9963","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q9963","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q9963","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["TUFTS - TUFTS SELECT - HCPCS - Q9963","TUFTS","TUFTS SELECT","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["UNICARE - UNICARE - HCPCS - Q9963","UNICARE","UNICARE","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q9963","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["TUFTS - TUFTS SPIRIT - HCPCS - Q9963","TUFTS","TUFTS SPIRIT","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q9963","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q9963","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["TUFTS - TUFTS HMO - HCPCS - Q9963","TUFTS","TUFTS HMO","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["FALLON - FALLON MEDICAID - HCPCS - Q9963","FALLON","FALLON MEDICAID","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["FALLON - FALLON SENIOR PLAN - HCPCS - Q9963","FALLON","FALLON SENIOR PLAN","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q9963","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q9963","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q9963","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - Q9963","TUFTS","TUFTS MEDICARE SCO","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q9963","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q9963","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["TUFTS - TUFTS POS - HCPCS - Q9963","TUFTS","TUFTS POS","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q9963","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q9963","BMC HEALTHNET","BMCHN QHP","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q9963","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q9963","BMC HEALTHNET","BMCHN ACO","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q9963","BMC HEALTHNET","BMCHN MCO","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q9963","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q9963","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q9963","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q9963","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q9963","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q9963","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q9963","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q9963","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q9963","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q9963","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q9963","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q9963","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q9963","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q9963","BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q9963","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q9963","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML",30.27,30.27,30.27,30.27,7.5674999999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q9966","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q9966","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q9966","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["TUFTS - TUFTS PPO - HCPCS - Q9966","TUFTS","TUFTS PPO","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["UNICARE - UNICARE - HCPCS - Q9966","UNICARE","UNICARE","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q9966","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["TUFTS - TUFTS SELECT - HCPCS - Q9966","TUFTS","TUFTS SELECT","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["TUFTS - TUFTS SPIRIT - HCPCS - Q9966","TUFTS","TUFTS SPIRIT","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q9966","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q9966","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q9966","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["FALLON - FALLON MEDICAID - HCPCS - Q9966","FALLON","FALLON MEDICAID","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["FALLON - FALLON SENIOR PLAN - HCPCS - Q9966","FALLON","FALLON SENIOR PLAN","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["TUFTS - TUFTS POS - HCPCS - Q9966","TUFTS","TUFTS POS","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q9966","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - Q9966","TUFTS","TUFTS MEDICARE SCO","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q9966","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["TUFTS - TUFTS HMO - HCPCS - Q9966","TUFTS","TUFTS HMO","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q9966","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q9966","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q9966","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q9966","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q9966","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q9966","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q9966","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q9966","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q9966","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q9966","BMC HEALTHNET","BMCHN ACO","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q9966","BMC HEALTHNET","BMCHN QHP","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q9966","BMC HEALTHNET","BMCHN MCO","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q9966","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q9966","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q9966","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q9966","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q9966","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q9966","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q9966","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q9966","BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q9966","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q9966","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q9966","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q9966","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",69.63,69.63,34.82,69.63,17.407499999999999]
["UNICARE - UNICARE - HCPCS - Q9967","UNICARE","UNICARE","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.309999999999999,14.75,50.449999999999996,12.612499999999999]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q9967","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.315000000000001,14.75,50.449999999999996,12.612499999999999]
["UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q9967","UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.309999999999999,14.75,50.449999999999996,12.612499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q9967","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q9967","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.319999999999997,14.75,50.449999999999996,12.612499999999999]
["TUFTS - TUFTS SPIRIT - HCPCS - Q9967","TUFTS","TUFTS SPIRIT","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.309999999999999,14.75,50.449999999999996,12.612499999999999]
["TUFTS - TUFTS PPO - HCPCS - Q9967","TUFTS","TUFTS PPO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q9967","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.315000000000001,14.75,50.449999999999996,12.612499999999999]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q9967","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["TUFTS - TUFTS SELECT - HCPCS - Q9967","TUFTS","TUFTS SELECT","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q9967","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - Q9967","TUFTS","TUFTS MEDICARE SCO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.330000000000002,14.75,50.449999999999996,12.612499999999999]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q9967","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.330000000000002,14.75,50.449999999999996,12.612499999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q9967","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.364999999999998,14.75,50.449999999999996,12.612499999999999]
["FALLON - FALLON MEDICAID - HCPCS - Q9967","FALLON","FALLON MEDICAID","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q9967","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q9967","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["TUFTS - TUFTS POS - HCPCS - Q9967","TUFTS","TUFTS POS","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["TUFTS - TUFTS HMO - HCPCS - Q9967","TUFTS","TUFTS HMO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["FALLON - FALLON SENIOR PLAN - HCPCS - Q9967","FALLON","FALLON SENIOR PLAN","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.304999999999996,14.75,50.449999999999996,12.612499999999999]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q9967","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.34,14.75,50.449999999999996,12.612499999999999]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q9967","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.364999999999998,14.75,50.449999999999996,12.612499999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q9967","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.315000000000001,14.75,50.449999999999996,12.612499999999999]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q9967","BMC HEALTHNET","BMCHN ACO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q9967","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.305,14.75,50.449999999999996,12.612499999999999]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q9967","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q9967","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.304999999999996,14.75,50.449999999999996,12.612499999999999]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q9967","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.305,14.75,50.449999999999996,12.612499999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q9967","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.315000000000001,14.75,50.449999999999996,12.612499999999999]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q9967","BMC HEALTHNET","BMCHN MCO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q9967","BMC HEALTHNET","BMCHN QHP","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q9967","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.305,14.75,50.449999999999996,12.612499999999999]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q9967","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q9967","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.38,14.75,50.449999999999996,12.612499999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q9967","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.314999999999998,14.75,50.449999999999996,12.612499999999999]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q9967","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.315000000000001,14.75,50.449999999999996,12.612499999999999]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q9967","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.315000000000001,14.75,50.449999999999996,12.612499999999999]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q9967","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.315000000000001,14.75,50.449999999999996,12.612499999999999]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q9967","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q9967","BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.315000000000001,14.75,50.449999999999996,12.612499999999999]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q9967","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.254999999999999,14.75,50.449999999999996,12.612499999999999]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q9967","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",50.449999999999996,16.315000000000001,14.75,50.449999999999996,12.612499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q9987","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q9987","HC PATHOGEN TEST PLATELETS","Q9987 - HC PATHOGEN TEST PLATELETS",1218,0,0,0,304.5]
["FALLON - FALLON MEDICAID - HCPCS - Q9987","FALLON","FALLON MEDICAID","HCPCS","Q9987","HC PATHOGEN TEST PLATELETS","Q9987 - HC PATHOGEN TEST PLATELETS",1218,0,0,0,304.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - Q9987","BMC HEALTHNET","BMCHN ACO","HCPCS","Q9987","HC PATHOGEN TEST PLATELETS","Q9987 - HC PATHOGEN TEST PLATELETS",1218,0,0,0,304.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - Q9987","BMC HEALTHNET","BMCHN QHP","HCPCS","Q9987","HC PATHOGEN TEST PLATELETS","Q9987 - HC PATHOGEN TEST PLATELETS",1218,0,0,0,304.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - Q9987","BMC HEALTHNET","BMCHN MCO","HCPCS","Q9987","HC PATHOGEN TEST PLATELETS","Q9987 - HC PATHOGEN TEST PLATELETS",1218,0,0,0,304.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q9987","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q9987","HC PATHOGEN TEST PLATELETS","Q9987 - HC PATHOGEN TEST PLATELETS",1218,0,0,0,304.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q9987","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q9987","HC PATHOGEN TEST PLATELETS","Q9987 - HC PATHOGEN TEST PLATELETS",1218,0,0,0,304.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q9987","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","Q9987","HC PATHOGEN TEST PLATELETS","Q9987 - HC PATHOGEN TEST PLATELETS",1218,0,0,0,304.5]
["TUFTS - TUFTS PPO - HCPCS - S2083","TUFTS","TUFTS PPO","HCPCS","S2083","HC ADJUSTMENT GASTRIC BAND","S2083 - HC ADJUSTMENT GASTRIC BAND",211,595.01,317.70999999999998,1198.25,52.75]
["TUFTS - TUFTS SELECT - HCPCS - S2083","TUFTS","TUFTS SELECT","HCPCS","S2083","HC ADJUSTMENT GASTRIC BAND","S2083 - HC ADJUSTMENT GASTRIC BAND",211,317.70999999999998,317.70999999999998,1198.25,52.75]
["TUFTS - TUFTS HMO - HCPCS - S2083","TUFTS","TUFTS HMO","HCPCS","S2083","HC ADJUSTMENT GASTRIC BAND","S2083 - HC ADJUSTMENT GASTRIC BAND",211,595.01,317.70999999999998,1198.25,52.75]
["TUFTS - TUFTS POS - HCPCS - S2083","TUFTS","TUFTS POS","HCPCS","S2083","HC ADJUSTMENT GASTRIC BAND","S2083 - HC ADJUSTMENT GASTRIC BAND",211,595.01,317.70999999999998,1198.25,52.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - S2083","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","S2083","HC ADJUSTMENT GASTRIC BAND","S2083 - HC ADJUSTMENT GASTRIC BAND",211,943.8,317.70999999999998,1198.25,52.75]
["AETNA - AETNA - HCPCS - S2083","AETNA","AETNA","HCPCS","S2083","HC ADJUSTMENT GASTRIC BAND","S2083 - HC ADJUSTMENT GASTRIC BAND",211,1198.25,317.70999999999998,1198.25,52.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - S5100","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","S5100","ADULT DAYCARE SERVICES 15MIN","S5100 - ADULT DAYCARE SERVICES 15MIN",6,0,0,0,1.5]
["FALLON - FALLON MEDICAID - HCPCS - S5100","FALLON","FALLON MEDICAID","HCPCS","S5100","ADULT DAYCARE SERVICES 15MIN","S5100 - ADULT DAYCARE SERVICES 15MIN",6,0,0,0,1.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - S5100","BMC HEALTHNET","BMCHN QHP","HCPCS","S5100","ADULT DAYCARE SERVICES 15MIN","S5100 - ADULT DAYCARE SERVICES 15MIN",6,0,0,0,1.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - S5100","BMC HEALTHNET","BMCHN ACO","HCPCS","S5100","ADULT DAYCARE SERVICES 15MIN","S5100 - ADULT DAYCARE SERVICES 15MIN",6,0,0,0,1.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - S5100","BMC HEALTHNET","BMCHN MCO","HCPCS","S5100","ADULT DAYCARE SERVICES 15MIN","S5100 - ADULT DAYCARE SERVICES 15MIN",6,0,0,0,1.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - S5100","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","S5100","ADULT DAYCARE SERVICES 15MIN","S5100 - ADULT DAYCARE SERVICES 15MIN",6,0,0,0,1.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - S5100","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","S5100","ADULT DAYCARE SERVICES 15MIN","S5100 - ADULT DAYCARE SERVICES 15MIN",6,0,0,0,1.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - S5100","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","S5100","ADULT DAYCARE SERVICES 15MIN","S5100 - ADULT DAYCARE SERVICES 15MIN",6,0,0,0,1.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - S5101","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","S5101","HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)","S5101 - HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)",63,0,0,0,15.75]
["FALLON - FALLON MEDICAID - HCPCS - S5101","FALLON","FALLON MEDICAID","HCPCS","S5101","HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)","S5101 - HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)",63,0,0,0,15.75]
["BMC HEALTHNET - BMCHN ACO - HCPCS - S5101","BMC HEALTHNET","BMCHN ACO","HCPCS","S5101","HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)","S5101 - HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)",63,0,0,0,15.75]
["BMC HEALTHNET - BMCHN QHP - HCPCS - S5101","BMC HEALTHNET","BMCHN QHP","HCPCS","S5101","HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)","S5101 - HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)",63,0,0,0,15.75]
["BMC HEALTHNET - BMCHN MCO - HCPCS - S5101","BMC HEALTHNET","BMCHN MCO","HCPCS","S5101","HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)","S5101 - HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)",63,0,0,0,15.75]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - S5101","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","S5101","HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)","S5101 - HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)",63,0,0,0,15.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - S5101","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","S5101","HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)","S5101 - HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)",63,0,0,0,15.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - S5101","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","S5101","HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)","S5101 - HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)",63,0,0,0,15.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - S5102","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","S5102","HC ADULT DAY HEALTH - COMPLEX PER DIEM","S5102 - HC ADULT DAY HEALTH - COMPLEX PER DIEM",126,0,0,0,31.5]
["FALLON - FALLON MEDICAID - HCPCS - S5102","FALLON","FALLON MEDICAID","HCPCS","S5102","HC ADULT DAY HEALTH - COMPLEX PER DIEM","S5102 - HC ADULT DAY HEALTH - COMPLEX PER DIEM",126,0,0,0,31.5]
["BMC HEALTHNET - BMCHN QHP - HCPCS - S5102","BMC HEALTHNET","BMCHN QHP","HCPCS","S5102","HC ADULT DAY HEALTH - COMPLEX PER DIEM","S5102 - HC ADULT DAY HEALTH - COMPLEX PER DIEM",126,0,0,0,31.5]
["BMC HEALTHNET - BMCHN ACO - HCPCS - S5102","BMC HEALTHNET","BMCHN ACO","HCPCS","S5102","HC ADULT DAY HEALTH - COMPLEX PER DIEM","S5102 - HC ADULT DAY HEALTH - COMPLEX PER DIEM",126,0,0,0,31.5]
["BMC HEALTHNET - BMCHN MCO - HCPCS - S5102","BMC HEALTHNET","BMCHN MCO","HCPCS","S5102","HC ADULT DAY HEALTH - COMPLEX PER DIEM","S5102 - HC ADULT DAY HEALTH - COMPLEX PER DIEM",126,0,0,0,31.5]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - S5102","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","S5102","HC ADULT DAY HEALTH - COMPLEX PER DIEM","S5102 - HC ADULT DAY HEALTH - COMPLEX PER DIEM",126,0,0,0,31.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - S5102","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","S5102","HC ADULT DAY HEALTH - COMPLEX PER DIEM","S5102 - HC ADULT DAY HEALTH - COMPLEX PER DIEM",126,0,0,0,31.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - S5102","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","S5102","HC ADULT DAY HEALTH - COMPLEX PER DIEM","S5102 - HC ADULT DAY HEALTH - COMPLEX PER DIEM",126,0,0,0,31.5]
["TUFTS - TUFTS PPO - HCPCS - S8037","TUFTS","TUFTS PPO","HCPCS","S8037","MRCP","S8037 - MRCP",1440,1341.84,585.76,3771.6,360]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - S8037","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","S8037","MRCP","S8037 - MRCP",1440,0,585.76,3771.6,360]
["TUFTS - TUFTS SELECT - HCPCS - S8037","TUFTS","TUFTS SELECT","HCPCS","S8037","MRCP","S8037 - MRCP",1440,585.76,585.76,3771.6,360]
["FALLON - FALLON MEDICAID - HCPCS - S8037","FALLON","FALLON MEDICAID","HCPCS","S8037","MRCP","S8037 - MRCP",1440,0,585.76,3771.6,360]
["TUFTS - TUFTS HMO - HCPCS - S8037","TUFTS","TUFTS HMO","HCPCS","S8037","MRCP","S8037 - MRCP",1440,1505.27,585.76,3771.6,360]
["TUFTS - TUFTS POS - HCPCS - S8037","TUFTS","TUFTS POS","HCPCS","S8037","MRCP","S8037 - MRCP",1440,1254.4000000000001,585.76,3771.6,360]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - S8037","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","S8037","MRCP","S8037 - MRCP",1440,1396.47,585.76,3771.6,360]
["BMC HEALTHNET - BMCHN ACO - HCPCS - S8037","BMC HEALTHNET","BMCHN ACO","HCPCS","S8037","MRCP","S8037 - MRCP",1440,0,585.76,3771.6,360]
["BMC HEALTHNET - BMCHN QHP - HCPCS - S8037","BMC HEALTHNET","BMCHN QHP","HCPCS","S8037","MRCP","S8037 - MRCP",1440,0,585.76,3771.6,360]
["BMC HEALTHNET - BMCHN MCO - HCPCS - S8037","BMC HEALTHNET","BMCHN MCO","HCPCS","S8037","MRCP","S8037 - MRCP",1440,0,585.76,3771.6,360]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - S8037","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","S8037","MRCP","S8037 - MRCP",1440,3771.6,585.76,3771.6,360]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - S8037","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","S8037","MRCP","S8037 - MRCP",1440,1396.47,585.76,3771.6,360]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - S8037","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","S8037","MRCP","S8037 - MRCP",1440,0,585.76,3771.6,360]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - S8037","BLUE CROSS","BLUE CROSS-PPO","HCPCS","S8037","MRCP","S8037 - MRCP",1440,1396.47,585.76,3771.6,360]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - S8037","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","S8037","MRCP","S8037 - MRCP",1440,0,585.76,3771.6,360]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - S8037","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","S8037","MRCP","S8037 - MRCP",1440,1396.47,585.76,3771.6,360]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - S8037","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","S8037","MRCP","S8037 - MRCP",1440,0,585.76,3771.6,360]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - S8037","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","S8037","MRCP","S8037 - MRCP",1440,1396.47,585.76,3771.6,360]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - S8037","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","S8037","MRCP","S8037 - MRCP",1440,1396.47,585.76,3771.6,360]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - S8037","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","S8037","MRCP","S8037 - MRCP",1440,1396.47,585.76,3771.6,360]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - T2003","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","T2003","HC TRANSPORTATION RATE 1 (1-WAY TRIP)","T2003 - HC TRANSPORTATION RATE 1 (1-WAY TRIP)",25,0,0,0,6.25]
["FALLON - FALLON MEDICAID - HCPCS - T2003","FALLON","FALLON MEDICAID","HCPCS","T2003","HC TRANSPORTATION RATE 1 (1-WAY TRIP)","T2003 - HC TRANSPORTATION RATE 1 (1-WAY TRIP)",25,0,0,0,6.25]
["BMC HEALTHNET - BMCHN QHP - HCPCS - T2003","BMC HEALTHNET","BMCHN QHP","HCPCS","T2003","HC TRANSPORTATION RATE 1 (1-WAY TRIP)","T2003 - HC TRANSPORTATION RATE 1 (1-WAY TRIP)",25,0,0,0,6.25]
["BMC HEALTHNET - BMCHN ACO - HCPCS - T2003","BMC HEALTHNET","BMCHN ACO","HCPCS","T2003","HC TRANSPORTATION RATE 1 (1-WAY TRIP)","T2003 - HC TRANSPORTATION RATE 1 (1-WAY TRIP)",25,0,0,0,6.25]
["BMC HEALTHNET - BMCHN MCO - HCPCS - T2003","BMC HEALTHNET","BMCHN MCO","HCPCS","T2003","HC TRANSPORTATION RATE 1 (1-WAY TRIP)","T2003 - HC TRANSPORTATION RATE 1 (1-WAY TRIP)",25,0,0,0,6.25]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - T2003","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","T2003","HC TRANSPORTATION RATE 1 (1-WAY TRIP)","T2003 - HC TRANSPORTATION RATE 1 (1-WAY TRIP)",25,0,0,0,6.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - T2003","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","T2003","HC TRANSPORTATION RATE 1 (1-WAY TRIP)","T2003 - HC TRANSPORTATION RATE 1 (1-WAY TRIP)",25,0,0,0,6.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - T2003","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","T2003","HC TRANSPORTATION RATE 1 (1-WAY TRIP)","T2003 - HC TRANSPORTATION RATE 1 (1-WAY TRIP)",25,0,0,0,6.25]
["TUFTS - TUFTS PPO - HCPCS - U0001","TUFTS","TUFTS PPO","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",124,115.86,35.909999999999997,325.64,31]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - U0001","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",124,43.09,35.909999999999997,325.64,31]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - U0001","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",124,43.09,35.909999999999997,325.64,31]
["TUFTS - TUFTS SPIRIT - HCPCS - U0001","TUFTS","TUFTS SPIRIT","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",124,39.5,35.909999999999997,325.64,31]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - U0001","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",124,75.63,35.909999999999997,325.64,31]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - U0001","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",124,48.41,35.909999999999997,325.64,31]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - U0001","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",124,52.07,35.909999999999997,325.64,31]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - U0001","TUFTS","TUFTS MEDICARE SCO","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",124,52.07,35.909999999999997,325.64,31]
["FALLON - FALLON SENIOR PLAN - HCPCS - U0001","FALLON","FALLON SENIOR PLAN","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",124,35.909999999999997,35.909999999999997,325.64,31]
["TUFTS - TUFTS HMO - HCPCS - U0001","TUFTS","TUFTS HMO","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",124,139.03,35.909999999999997,325.64,31]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - U0001","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",124,77.53,35.909999999999997,325.64,31]
["TUFTS - TUFTS POS - HCPCS - U0001","TUFTS","TUFTS POS","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",124,115.86,35.909999999999997,325.64,31]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - U0001","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",124,62.48,35.909999999999997,325.64,31]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - U0001","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",124,325.64,35.909999999999997,325.64,31]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - U0001","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",124,41.31,35.909999999999997,325.64,31]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - U0001","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",124,41.31,35.909999999999997,325.64,31]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - U0001","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",124,79.36,35.909999999999997,325.64,31]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - U0001","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",124,35.909999999999997,35.909999999999997,325.64,31]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - U0001","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",124,35.909999999999997,35.909999999999997,325.64,31]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - U0001","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",124,35.909999999999997,35.909999999999997,325.64,31]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - U0001","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",124,42.37,35.909999999999997,325.64,31]
["AETNA - AETNA - HCPCS - U0001","AETNA","AETNA","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",124,35.909999999999997,35.909999999999997,325.64,31]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - U0001","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",124,41.31,35.909999999999997,325.64,31]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - U0001","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",124,90.36,35.909999999999997,325.64,31]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - U0001","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",124,41.31,35.909999999999997,325.64,31]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - U0001","BLUE CROSS","BLUE CROSS-PPO","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",124,41.31,35.909999999999997,325.64,31]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - U0001","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",124,41.31,35.909999999999997,325.64,31]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - U0001","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",124,41.31,35.909999999999997,325.64,31]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - U0002","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,61.57,51.31,465.19,23]
["UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - U0002","UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,108.06,51.31,465.19,23]
["TUFTS - TUFTS PPO - HCPCS - U0002","TUFTS","TUFTS PPO","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,165.5,51.31,465.19,23]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - U0002","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,61.57,51.31,465.19,23]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - U0002","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,61.57,51.31,465.19,23]
["TUFTS - TUFTS SPIRIT - HCPCS - U0002","TUFTS","TUFTS SPIRIT","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,56.44,51.31,465.19,23]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - HCPCS - U0002","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,60.39,51.31,465.19,23]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - U0002","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,69.180000000000007,51.31,465.19,23]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - HCPCS - U0002","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,77.58,51.31,465.19,23]
["FALLON - FALLON MEDICAID - HCPCS - U0002","FALLON","FALLON MEDICAID","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,51.31,51.31,465.19,23]
["FALLON - FALLON SENIOR PLAN - HCPCS - U0002","FALLON","FALLON SENIOR PLAN","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,51.31,51.31,465.19,23]
["TUFTS - TUFTS HMO - HCPCS - U0002","TUFTS","TUFTS HMO","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,198.6,51.31,465.19,23]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - U0002","TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,74.400000000000006,51.31,465.19,23]
["TUFTS - TUFTS MEDICARE SCO - HCPCS - U0002","TUFTS","TUFTS MEDICARE SCO","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,74.400000000000006,51.31,465.19,23]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - U0002","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,110.78,51.31,465.19,23]
["TUFTS - TUFTS POS - HCPCS - U0002","TUFTS","TUFTS POS","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,165.5,51.31,465.19,23]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - U0002","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,89.28,51.31,465.19,23]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - U0002","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,59.02,51.31,465.19,23]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - U0002","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,113.39,51.31,465.19,23]
["BMC HEALTHNET - BMCHN ACO - HCPCS - U0002","BMC HEALTHNET","BMCHN ACO","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,112.27,51.31,465.19,23]
["BMC HEALTHNET - BMCHN QHP - HCPCS - U0002","BMC HEALTHNET","BMCHN QHP","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,61.57,51.31,465.19,23]
["BMC HEALTHNET - BMCHN MCO - HCPCS - U0002","BMC HEALTHNET","BMCHN MCO","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,51.31,51.31,465.19,23]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - U0002","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,465.19,51.31,465.19,23]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - U0002","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,59.02,51.31,465.19,23]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - U0002","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,51.31,51.31,465.19,23]
["ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - U0002","ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,51.31,51.31,465.19,23]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - U0002","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,51.31,51.31,465.19,23]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - U0002","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,51.31,51.31,465.19,23]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - U0002","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,59.02,51.31,465.19,23]
["AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - U0002","AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,60.55,51.31,465.19,23]
["BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - U0002","BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,59.02,51.31,465.19,23]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - U0002","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,129.11000000000001,51.31,465.19,23]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - U0002","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,60.55,51.31,465.19,23]
["BLUE CROSS - BLUE CROSS-PPO - HCPCS - U0002","BLUE CROSS","BLUE CROSS-PPO","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,59.02,51.31,465.19,23]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - U0002","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,69.63,51.31,465.19,23]
["AETNA - AETNA - HCPCS - U0002","AETNA","AETNA","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,51.31,51.31,465.19,23]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - U0002","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,59.02,51.31,465.19,23]
["BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - U0002","BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",92,59.02,51.31,465.19,23]
["TUFTS - TUFTS PPO - HCPCS - V2785","TUFTS","TUFTS PPO","HCPCS","V2785","CORNEAL TISSUE PROCESSING","V2785 - CORNEAL TISSUE PROCESSING",7848,9609.09,5130.87,15242.01,1962]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - V2785","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","V2785","CORNEAL TISSUE PROCESSING","V2785 - CORNEAL TISSUE PROCESSING",7848,0,5130.87,15242.01,1962]
["TUFTS - TUFTS SELECT - HCPCS - V2785","TUFTS","TUFTS SELECT","HCPCS","V2785","CORNEAL TISSUE PROCESSING","V2785 - CORNEAL TISSUE PROCESSING",7848,5130.87,5130.87,15242.01,1962]
["FALLON - FALLON MEDICAID - HCPCS - V2785","FALLON","FALLON MEDICAID","HCPCS","V2785","CORNEAL TISSUE PROCESSING","V2785 - CORNEAL TISSUE PROCESSING",7848,0,5130.87,15242.01,1962]
["TUFTS - TUFTS HMO - HCPCS - V2785","TUFTS","TUFTS HMO","HCPCS","V2785","CORNEAL TISSUE PROCESSING","V2785 - CORNEAL TISSUE PROCESSING",7848,9609.09,5130.87,15242.01,1962]
["TUFTS - TUFTS POS - HCPCS - V2785","TUFTS","TUFTS POS","HCPCS","V2785","CORNEAL TISSUE PROCESSING","V2785 - CORNEAL TISSUE PROCESSING",7848,9609.09,5130.87,15242.01,1962]
["BMC HEALTHNET - BMCHN QHP - HCPCS - V2785","BMC HEALTHNET","BMCHN QHP","HCPCS","V2785","CORNEAL TISSUE PROCESSING","V2785 - CORNEAL TISSUE PROCESSING",7848,0,5130.87,15242.01,1962]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - V2785","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","V2785","CORNEAL TISSUE PROCESSING","V2785 - CORNEAL TISSUE PROCESSING",7848,15242.01,5130.87,15242.01,1962]
["BMC HEALTHNET - BMCHN ACO - HCPCS - V2785","BMC HEALTHNET","BMCHN ACO","HCPCS","V2785","CORNEAL TISSUE PROCESSING","V2785 - CORNEAL TISSUE PROCESSING",7848,0,5130.87,15242.01,1962]
["BMC HEALTHNET - BMCHN MCO - HCPCS - V2785","BMC HEALTHNET","BMCHN MCO","HCPCS","V2785","CORNEAL TISSUE PROCESSING","V2785 - CORNEAL TISSUE PROCESSING",7848,0,5130.87,15242.01,1962]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - V2785","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","V2785","CORNEAL TISSUE PROCESSING","V2785 - CORNEAL TISSUE PROCESSING",7848,0,5130.87,15242.01,1962]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - V2785","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","V2785","CORNEAL TISSUE PROCESSING","V2785 - CORNEAL TISSUE PROCESSING",7848,0,5130.87,15242.01,1962]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - V2785","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","V2785","CORNEAL TISSUE PROCESSING","V2785 - CORNEAL TISSUE PROCESSING",7848,0,5130.87,15242.01,1962]
["TUFTS - TUFTS PPO - HCPCS - V2790","TUFTS","TUFTS PPO","HCPCS","V2790","HC MEMBRANE AMNIOTIC","V2790 - HC MEMBRANE AMNIOTIC",1136,0,0,0,284]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - V2790","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","V2790","HC MEMBRANE AMNIOTIC","V2790 - HC MEMBRANE AMNIOTIC",1136,0,0,0,284]
["TUFTS - TUFTS SELECT - HCPCS - V2790","TUFTS","TUFTS SELECT","HCPCS","V2790","HC MEMBRANE AMNIOTIC","V2790 - HC MEMBRANE AMNIOTIC",1136,0,0,0,284]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - V2790","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","V2790","HC MEMBRANE AMNIOTIC","V2790 - HC MEMBRANE AMNIOTIC",1136,0,0,0,284]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - V2790","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","V2790","HC MEMBRANE AMNIOTIC","V2790 - HC MEMBRANE AMNIOTIC",1136,0,0,0,284]
["TUFTS - TUFTS HMO - HCPCS - V2790","TUFTS","TUFTS HMO","HCPCS","V2790","HC MEMBRANE AMNIOTIC","V2790 - HC MEMBRANE AMNIOTIC",1136,0,0,0,284]
["FALLON - FALLON MEDICAID - HCPCS - V2790","FALLON","FALLON MEDICAID","HCPCS","V2790","HC MEMBRANE AMNIOTIC","V2790 - HC MEMBRANE AMNIOTIC",1136,0,0,0,284]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - V2790","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","V2790","HC MEMBRANE AMNIOTIC","V2790 - HC MEMBRANE AMNIOTIC",1136,0,0,0,284]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - V2790","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","V2790","HC MEMBRANE AMNIOTIC","V2790 - HC MEMBRANE AMNIOTIC",1136,0,0,0,284]
["TUFTS - TUFTS POS - HCPCS - V2790","TUFTS","TUFTS POS","HCPCS","V2790","HC MEMBRANE AMNIOTIC","V2790 - HC MEMBRANE AMNIOTIC",1136,0,0,0,284]
["BMC HEALTHNET - BMCHN ACO - HCPCS - V2790","BMC HEALTHNET","BMCHN ACO","HCPCS","V2790","HC MEMBRANE AMNIOTIC","V2790 - HC MEMBRANE AMNIOTIC",1136,0,0,0,284]
["BMC HEALTHNET - BMCHN QHP - HCPCS - V2790","BMC HEALTHNET","BMCHN QHP","HCPCS","V2790","HC MEMBRANE AMNIOTIC","V2790 - HC MEMBRANE AMNIOTIC",1136,0,0,0,284]
["BMC HEALTHNET - BMCHN MCO - HCPCS - V2790","BMC HEALTHNET","BMCHN MCO","HCPCS","V2790","HC MEMBRANE AMNIOTIC","V2790 - HC MEMBRANE AMNIOTIC",1136,0,0,0,284]
["CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - V2790","CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","V2790","HC MEMBRANE AMNIOTIC","V2790 - HC MEMBRANE AMNIOTIC",1136,0,0,0,284]
["BMC HEALTHNET - BMCHN MEDICAID - HCPCS - V2790","BMC HEALTHNET","BMCHN MEDICAID","HCPCS","V2790","HC MEMBRANE AMNIOTIC","V2790 - HC MEMBRANE AMNIOTIC",1136,0,0,0,284]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - V2790","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","V2790","HC MEMBRANE AMNIOTIC","V2790 - HC MEMBRANE AMNIOTIC",1136,0,0,0,284]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - V2790","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","V2790","HC MEMBRANE AMNIOTIC","V2790 - HC MEMBRANE AMNIOTIC",1136,0,0,0,284]

{"sheet":"Sheet6 (hcpcs)","index":8,"n_rows":2938,"n_cols":4,"rows_kept":2938,"cut":false,"hidden":true,"merged":[]}
["Payer","HCPCS & Description"]
["UNICARE","45378 - COLON CA SCRN NOT HI RSK IND"]
["UNITED HEALTHCARE","45378 - COLON CA SCRN NOT HI RSK IND"]
["TUFTS","45378 - COLON CA SCRN NOT HI RSK IND"]
["HARVARD PILGRIM HEALTH CARE","45378 - COLON CA SCRN NOT HI RSK IND","Row Labels","Count of HCPCS & Description"]
["CIGNA HEALTHCARE","45378 - COLON CA SCRN NOT HI RSK IND","TUFTS",323]
["BLUE CROSS OUT OF STATE","45378 - COLON CA SCRN NOT HI RSK IND","CIGNA HEALTHCARE",321]
["BLUE BENEFIT ADMINISTRATORS","45378 - COLON CA SCRN NOT HI RSK IND","HARVARD PILGRIM HEALTH CARE",242]
["AETNA","45378 - COLON CA SCRN NOT HI RSK IND","UNITED HEALTHCARE",241]
["BLUE CROSS","45378 - COLON CA SCRN NOT HI RSK IND","BLUE CROSS",211]
["UHC COMMUNITY CARE","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","BLUE CROSS OUT OF STATE",200]
["UNITED HEALTHCARE","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","BLUE BENEFIT ADMINISTRATORS",198]
["TUFTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","FALLON",179]
["TUFTS PUBLIC PLANS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","BMC HEALTHNET",179]
["FALLON","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","TUFTS PUBLIC PLANS",177]
["HARVARD PILGRIM HEALTH CARE","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","ALLWAYS HEALTH PARTNERS",161]
["SENIOR WHOLE HEALTH","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","AETNA",85]
["ELDER SERVICE PLAN","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","UHC COMMUNITY CARE",76]
["CIGNA HEALTHCARE","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","SENIOR WHOLE HEALTH",76]
["COMMONWEALTH CARE ALLIANCE","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","ELDER SERVICE PLAN OTHER",76]
["BLUE CROSS OUT OF STATE","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","COMMONWEALTH CARE ALLIANCE",76]
["BMC HEALTHNET","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","ELDER SERVICE PLAN",76]
["ELDER SERVICE PLAN OTHER","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","UNICARE",40]
["ALLWAYS HEALTH PARTNERS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","Grand Total",2937]
["BLUE CROSS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS"]
["AETNA","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS"]
["BLUE BENEFIT ADMINISTRATORS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS"]
["TUFTS","90471 - HC ADMIN PNEUMOCOCCAL VACCINE"]
["UNITED HEALTHCARE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE"]
["HARVARD PILGRIM HEALTH CARE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE"]
["CIGNA HEALTHCARE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE"]
["BLUE CROSS OUT OF STATE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE"]
["BLUE BENEFIT ADMINISTRATORS","90471 - HC ADMIN PNEUMOCOCCAL VACCINE"]
["BLUE CROSS","90471 - HC ADMIN PNEUMOCOCCAL VACCINE"]
["TUFTS","92083 - VISUAL FIELD EXAM,EXTENDED"]
["UNITED HEALTHCARE","92083 - VISUAL FIELD EXAM,EXTENDED"]
["UNICARE","92083 - VISUAL FIELD EXAM,EXTENDED"]
["HARVARD PILGRIM HEALTH CARE","92083 - VISUAL FIELD EXAM,EXTENDED"]
["BLUE CROSS OUT OF STATE","92083 - VISUAL FIELD EXAM,EXTENDED"]
["CIGNA HEALTHCARE","92083 - VISUAL FIELD EXAM,EXTENDED"]
["BLUE CROSS","92083 - VISUAL FIELD EXAM,EXTENDED"]
["BLUE BENEFIT ADMINISTRATORS","92083 - VISUAL FIELD EXAM,EXTENDED"]
["UNITED HEALTHCARE","95800 - HOME SLEEP TEST/TYPE 3 PORTA"]
["TUFTS","95800 - HOME SLEEP TEST/TYPE 3 PORTA"]
["UNICARE","95800 - HOME SLEEP TEST/TYPE 3 PORTA"]
["HARVARD PILGRIM HEALTH CARE","95800 - HOME SLEEP TEST/TYPE 3 PORTA"]
["CIGNA HEALTHCARE","95800 - HOME SLEEP TEST/TYPE 3 PORTA"]
["BLUE CROSS OUT OF STATE","95800 - HOME SLEEP TEST/TYPE 3 PORTA"]
["BLUE BENEFIT ADMINISTRATORS","95800 - HOME SLEEP TEST/TYPE 3 PORTA"]
["BLUE CROSS","95800 - HOME SLEEP TEST/TYPE 3 PORTA"]
["UNITED HEALTHCARE","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME"]
["TUFTS","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME"]
["HARVARD PILGRIM HEALTH CARE","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME"]
["CIGNA HEALTHCARE","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME"]
["BLUE CROSS OUT OF STATE","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME"]
["BLUE BENEFIT ADMINISTRATORS","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME"]
["BLUE CROSS","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME"]
["TUFTS","0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS"]
["UNITED HEALTHCARE","0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS"]
["HARVARD PILGRIM HEALTH CARE","0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS"]
["CIGNA HEALTHCARE","0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS"]
["TUFTS","0399T - PR MYOCARDIAL STRAIN IMAGING"]
["CIGNA HEALTHCARE","0399T - PR MYOCARDIAL STRAIN IMAGING"]
["TUFTS","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA"]
["UNITED HEALTHCARE","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA"]
["HARVARD PILGRIM HEALTH CARE","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA"]
["CIGNA HEALTHCARE","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA"]
["BLUE CROSS OUT OF STATE","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA"]
["BLUE CROSS","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA"]
["BLUE BENEFIT ADMINISTRATORS","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA"]
["AETNA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA"]
["UNITED HEALTHCARE","A4215 - STERILE NEEDLE"]
["TUFTS","A4215 - STERILE NEEDLE"]
["TUFTS PUBLIC PLANS","A4215 - STERILE NEEDLE"]
["HARVARD PILGRIM HEALTH CARE","A4215 - STERILE NEEDLE"]
["CIGNA HEALTHCARE","A4215 - STERILE NEEDLE"]
["BMC HEALTHNET","A4215 - STERILE NEEDLE"]
["FALLON","A4215 - STERILE NEEDLE"]
["ALLWAYS HEALTH PARTNERS","A4215 - STERILE NEEDLE"]
["TUFTS PUBLIC PLANS","A4467 - BELT STRAP SLEEV GRMNT COVER"]
["BMC HEALTHNET","A4467 - BELT STRAP SLEEV GRMNT COVER"]
["FALLON","A4467 - BELT STRAP SLEEV GRMNT COVER"]
["ALLWAYS HEALTH PARTNERS","A4467 - BELT STRAP SLEEV GRMNT COVER"]
["TUFTS PUBLIC PLANS","A4561 - HC PESSARY RUBBER, ANY TYPE"]
["TUFTS","A4561 - HC PESSARY RUBBER, ANY TYPE"]
["UNITED HEALTHCARE","A4561 - HC PESSARY RUBBER, ANY TYPE"]
["UHC COMMUNITY CARE","A4561 - HC PESSARY RUBBER, ANY TYPE"]
["FALLON","A4561 - HC PESSARY RUBBER, ANY TYPE"]
["HARVARD PILGRIM HEALTH CARE","A4561 - HC PESSARY RUBBER, ANY TYPE"]
["SENIOR WHOLE HEALTH","A4561 - HC PESSARY RUBBER, ANY TYPE"]
["BMC HEALTHNET","A4561 - HC PESSARY RUBBER, ANY TYPE"]
["CIGNA HEALTHCARE","A4561 - HC PESSARY RUBBER, ANY TYPE"]
["COMMONWEALTH CARE ALLIANCE","A4561 - HC PESSARY RUBBER, ANY TYPE"]
["ELDER SERVICE PLAN","A4561 - HC PESSARY RUBBER, ANY TYPE"]
["BLUE CROSS OUT OF STATE","A4561 - HC PESSARY RUBBER, ANY TYPE"]
["ELDER SERVICE PLAN OTHER","A4561 - HC PESSARY RUBBER, ANY TYPE"]
["AETNA","A4561 - HC PESSARY RUBBER, ANY TYPE"]
["ALLWAYS HEALTH PARTNERS","A4561 - HC PESSARY RUBBER, ANY TYPE"]
["BLUE CROSS","A4561 - HC PESSARY RUBBER, ANY TYPE"]
["BLUE BENEFIT ADMINISTRATORS","A4561 - HC PESSARY RUBBER, ANY TYPE"]
["TUFTS","A4562 - PESSARY NONRUBBER"]
["UHC COMMUNITY CARE","A4562 - PESSARY NONRUBBER"]
["UNITED HEALTHCARE","A4562 - PESSARY NONRUBBER"]
["TUFTS PUBLIC PLANS","A4562 - PESSARY NONRUBBER"]
["FALLON","A4562 - PESSARY NONRUBBER"]
["HARVARD PILGRIM HEALTH CARE","A4562 - PESSARY NONRUBBER"]
["SENIOR WHOLE HEALTH","A4562 - PESSARY NONRUBBER"]
["BMC HEALTHNET","A4562 - PESSARY NONRUBBER"]
["CIGNA HEALTHCARE","A4562 - PESSARY NONRUBBER"]
["COMMONWEALTH CARE ALLIANCE","A4562 - PESSARY NONRUBBER"]
["ELDER SERVICE PLAN","A4562 - PESSARY NONRUBBER"]
["ELDER SERVICE PLAN OTHER","A4562 - PESSARY NONRUBBER"]
["AETNA","A4562 - PESSARY NONRUBBER"]
["ALLWAYS HEALTH PARTNERS","A4562 - PESSARY NONRUBBER"]
["BLUE CROSS","A4562 - PESSARY NONRUBBER"]
["TUFTS","A4570 - HC MISC SPLINT SUPPLY LV1"]
["TUFTS PUBLIC PLANS","A4570 - HC MISC SPLINT SUPPLY LV1"]
["BMC HEALTHNET","A4570 - HC MISC SPLINT SUPPLY LV1"]
["CIGNA HEALTHCARE","A4570 - HC MISC SPLINT SUPPLY LV1"]
["FALLON","A4570 - HC MISC SPLINT SUPPLY LV1"]
["ALLWAYS HEALTH PARTNERS","A4570 - HC MISC SPLINT SUPPLY LV1"]
["UNITED HEALTHCARE","A4648 - IMPLANTABLE TISSUE MARKER"]
["TUFTS","A4648 - IMPLANTABLE TISSUE MARKER"]
["HARVARD PILGRIM HEALTH CARE","A4648 - IMPLANTABLE TISSUE MARKER"]
["CIGNA HEALTHCARE","A4648 - IMPLANTABLE TISSUE MARKER"]
["UNITED HEALTHCARE","A4725 - DIALYS SOL FLD VOL > 4999CC"]
["TUFTS","A4725 - DIALYS SOL FLD VOL > 4999CC"]
["TUFTS PUBLIC PLANS","A4725 - DIALYS SOL FLD VOL > 4999CC"]
["HARVARD PILGRIM HEALTH CARE","A4725 - DIALYS SOL FLD VOL > 4999CC"]
["BMC HEALTHNET","A4725 - DIALYS SOL FLD VOL > 4999CC"]
["CIGNA HEALTHCARE","A4725 - DIALYS SOL FLD VOL > 4999CC"]
["FALLON","A4725 - DIALYS SOL FLD VOL > 4999CC"]
["ALLWAYS HEALTH PARTNERS","A4725 - DIALYS SOL FLD VOL > 4999CC"]
["TUFTS PUBLIC PLANS","A6209 - FOAM DRSG <=16 SQ IN W/O BDR"]
["TUFTS","A6209 - FOAM DRSG <=16 SQ IN W/O BDR"]
["UNITED HEALTHCARE","A6209 - FOAM DRSG <=16 SQ IN W/O BDR"]
["UHC COMMUNITY CARE","A6209 - FOAM DRSG <=16 SQ IN W/O BDR"]
["FALLON","A6209 - FOAM DRSG <=16 SQ IN W/O BDR"]
["HARVARD PILGRIM HEALTH CARE","A6209 - FOAM DRSG <=16 SQ IN W/O BDR"]
["SENIOR WHOLE HEALTH","A6209 - FOAM DRSG <=16 SQ IN W/O BDR"]
["BMC HEALTHNET","A6209 - FOAM DRSG <=16 SQ IN W/O BDR"]
["CIGNA HEALTHCARE","A6209 - FOAM DRSG <=16 SQ IN W/O BDR"]
["COMMONWEALTH CARE ALLIANCE","A6209 - FOAM DRSG <=16 SQ IN W/O BDR"]
["ELDER SERVICE PLAN","A6209 - FOAM DRSG <=16 SQ IN W/O BDR"]
["BLUE CROSS OUT OF STATE","A6209 - FOAM DRSG <=16 SQ IN W/O BDR"]
["ELDER SERVICE PLAN OTHER","A6209 - FOAM DRSG <=16 SQ IN W/O BDR"]
["ALLWAYS HEALTH PARTNERS","A6209 - FOAM DRSG <=16 SQ IN W/O BDR"]
["BLUE CROSS","A6209 - FOAM DRSG <=16 SQ IN W/O BDR"]
["AETNA","A6209 - FOAM DRSG <=16 SQ IN W/O BDR"]
["BLUE BENEFIT ADMINISTRATORS","A6209 - FOAM DRSG <=16 SQ IN W/O BDR"]
["UHC COMMUNITY CARE","A6258 - TRANSPARENT FILM >16<=48 IN"]
["TUFTS","A6258 - TRANSPARENT FILM >16<=48 IN"]
["UNITED HEALTHCARE","A6258 - TRANSPARENT FILM >16<=48 IN"]
["TUFTS PUBLIC PLANS","A6258 - TRANSPARENT FILM >16<=48 IN"]
["FALLON","A6258 - TRANSPARENT FILM >16<=48 IN"]
["HARVARD PILGRIM HEALTH CARE","A6258 - TRANSPARENT FILM >16<=48 IN"]
["SENIOR WHOLE HEALTH","A6258 - TRANSPARENT FILM >16<=48 IN"]
["ELDER SERVICE PLAN","A6258 - TRANSPARENT FILM >16<=48 IN"]
["COMMONWEALTH CARE ALLIANCE","A6258 - TRANSPARENT FILM >16<=48 IN"]
["ELDER SERVICE PLAN OTHER","A6258 - TRANSPARENT FILM >16<=48 IN"]
["BMC HEALTHNET","A6258 - TRANSPARENT FILM >16<=48 IN"]
["CIGNA HEALTHCARE","A6258 - TRANSPARENT FILM >16<=48 IN"]
["BLUE CROSS OUT OF STATE","A6258 - TRANSPARENT FILM >16<=48 IN"]
["ALLWAYS HEALTH PARTNERS","A6258 - TRANSPARENT FILM >16<=48 IN"]
["AETNA","A6258 - TRANSPARENT FILM >16<=48 IN"]
["BLUE CROSS","A6258 - TRANSPARENT FILM >16<=48 IN"]
["BLUE BENEFIT ADMINISTRATORS","A6258 - TRANSPARENT FILM >16<=48 IN"]
["TUFTS","A6549 - G COMPRESSION STOCKING"]
["TUFTS PUBLIC PLANS","A6549 - G COMPRESSION STOCKING"]
["FALLON","A6549 - G COMPRESSION STOCKING"]
["CIGNA HEALTHCARE","A6549 - G COMPRESSION STOCKING"]
["BMC HEALTHNET","A6549 - G COMPRESSION STOCKING"]
["ALLWAYS HEALTH PARTNERS","A6549 - G COMPRESSION STOCKING"]
["TUFTS PUBLIC PLANS","A6550 - NEG PRES WOUND THER DRSG SET"]
["UNITED HEALTHCARE","A6550 - NEG PRES WOUND THER DRSG SET"]
["TUFTS","A6550 - NEG PRES WOUND THER DRSG SET"]
["UHC COMMUNITY CARE","A6550 - NEG PRES WOUND THER DRSG SET"]
["FALLON","A6550 - NEG PRES WOUND THER DRSG SET"]
["HARVARD PILGRIM HEALTH CARE","A6550 - NEG PRES WOUND THER DRSG SET"]
["SENIOR WHOLE HEALTH","A6550 - NEG PRES WOUND THER DRSG SET"]
["BMC HEALTHNET","A6550 - NEG PRES WOUND THER DRSG SET"]
["CIGNA HEALTHCARE","A6550 - NEG PRES WOUND THER DRSG SET"]
["COMMONWEALTH CARE ALLIANCE","A6550 - NEG PRES WOUND THER DRSG SET"]
["ELDER SERVICE PLAN","A6550 - NEG PRES WOUND THER DRSG SET"]
["ELDER SERVICE PLAN OTHER","A6550 - NEG PRES WOUND THER DRSG SET"]
["ALLWAYS HEALTH PARTNERS","A6550 - NEG PRES WOUND THER DRSG SET"]
["BLUE CROSS","A6550 - NEG PRES WOUND THER DRSG SET"]
["AETNA","A6550 - NEG PRES WOUND THER DRSG SET"]
["UNITED HEALTHCARE","A7520 - TRACH/LARYN TUBE NON-CUFFED"]
["TUFTS","A7520 - TRACH/LARYN TUBE NON-CUFFED"]
["UHC COMMUNITY CARE","A7520 - TRACH/LARYN TUBE NON-CUFFED"]
["TUFTS PUBLIC PLANS","A7520 - TRACH/LARYN TUBE NON-CUFFED"]
["FALLON","A7520 - TRACH/LARYN TUBE NON-CUFFED"]
["HARVARD PILGRIM HEALTH CARE","A7520 - TRACH/LARYN TUBE NON-CUFFED"]
["SENIOR WHOLE HEALTH","A7520 - TRACH/LARYN TUBE NON-CUFFED"]
["BLUE CROSS OUT OF STATE","A7520 - TRACH/LARYN TUBE NON-CUFFED"]
["BMC HEALTHNET","A7520 - TRACH/LARYN TUBE NON-CUFFED"]
["CIGNA HEALTHCARE","A7520 - TRACH/LARYN TUBE NON-CUFFED"]
["COMMONWEALTH CARE ALLIANCE","A7520 - TRACH/LARYN TUBE NON-CUFFED"]
["ELDER SERVICE PLAN","A7520 - TRACH/LARYN TUBE NON-CUFFED"]
["ELDER SERVICE PLAN OTHER","A7520 - TRACH/LARYN TUBE NON-CUFFED"]
["ALLWAYS HEALTH PARTNERS","A7520 - TRACH/LARYN TUBE NON-CUFFED"]
["AETNA","A7520 - TRACH/LARYN TUBE NON-CUFFED"]
["BLUE BENEFIT ADMINISTRATORS","A7520 - TRACH/LARYN TUBE NON-CUFFED"]
["BLUE CROSS","A7520 - TRACH/LARYN TUBE NON-CUFFED"]
["TUFTS","A9500 - TC99M SESTAMIBI"]
["UNITED HEALTHCARE","A9500 - TC99M SESTAMIBI"]
["TUFTS PUBLIC PLANS","A9500 - TC99M SESTAMIBI"]
["HARVARD PILGRIM HEALTH CARE","A9500 - TC99M SESTAMIBI"]
["FALLON","A9500 - TC99M SESTAMIBI"]
["BMC HEALTHNET","A9500 - TC99M SESTAMIBI"]
["CIGNA HEALTHCARE","A9500 - TC99M SESTAMIBI"]
["BLUE CROSS OUT OF STATE","A9500 - TC99M SESTAMIBI"]
["BLUE CROSS","A9500 - TC99M SESTAMIBI"]
["ALLWAYS HEALTH PARTNERS","A9500 - TC99M SESTAMIBI"]
["BLUE BENEFIT ADMINISTRATORS","A9500 - TC99M SESTAMIBI"]
["TUFTS","A9502 - HC TC99M TETROFOSMIN"]
["UNITED HEALTHCARE","A9502 - HC TC99M TETROFOSMIN"]
["TUFTS PUBLIC PLANS","A9502 - HC TC99M TETROFOSMIN"]
["HARVARD PILGRIM HEALTH CARE","A9502 - HC TC99M TETROFOSMIN"]
["FALLON","A9502 - HC TC99M TETROFOSMIN"]
["CIGNA HEALTHCARE","A9502 - HC TC99M TETROFOSMIN"]
["BMC HEALTHNET","A9502 - HC TC99M TETROFOSMIN"]
["BLUE CROSS OUT OF STATE","A9502 - HC TC99M TETROFOSMIN"]
["ALLWAYS HEALTH PARTNERS","A9502 - HC TC99M TETROFOSMIN"]
["BLUE BENEFIT ADMINISTRATORS","A9502 - HC TC99M TETROFOSMIN"]
["BLUE CROSS","A9502 - HC TC99M TETROFOSMIN"]
["UNITED HEALTHCARE","A9503 - TC99M MEDRONATE"]
["TUFTS","A9503 - TC99M MEDRONATE"]
["TUFTS PUBLIC PLANS","A9503 - TC99M MEDRONATE"]
["HARVARD PILGRIM HEALTH CARE","A9503 - TC99M MEDRONATE"]
["FALLON","A9503 - TC99M MEDRONATE"]
["BMC HEALTHNET","A9503 - TC99M MEDRONATE"]
["CIGNA HEALTHCARE","A9503 - TC99M MEDRONATE"]
["BLUE CROSS OUT OF STATE","A9503 - TC99M MEDRONATE"]
["ALLWAYS HEALTH PARTNERS","A9503 - TC99M MEDRONATE"]
["BLUE CROSS","A9503 - TC99M MEDRONATE"]
["BLUE BENEFIT ADMINISTRATORS","A9503 - TC99M MEDRONATE"]
["UNITED HEALTHCARE","A9505 - THALLIUM CHLORIDE PER MCI"]
["TUFTS","A9505 - THALLIUM CHLORIDE PER MCI"]
["TUFTS PUBLIC PLANS","A9505 - THALLIUM CHLORIDE PER MCI"]
["HARVARD PILGRIM HEALTH CARE","A9505 - THALLIUM CHLORIDE PER MCI"]
["FALLON","A9505 - THALLIUM CHLORIDE PER MCI"]
["CIGNA HEALTHCARE","A9505 - THALLIUM CHLORIDE PER MCI"]
["BMC HEALTHNET","A9505 - THALLIUM CHLORIDE PER MCI"]
["BLUE CROSS OUT OF STATE","A9505 - THALLIUM CHLORIDE PER MCI"]
["ALLWAYS HEALTH PARTNERS","A9505 - THALLIUM CHLORIDE PER MCI"]
["BLUE BENEFIT ADMINISTRATORS","A9505 - THALLIUM CHLORIDE PER MCI"]
["BLUE CROSS","A9505 - THALLIUM CHLORIDE PER MCI"]
["TUFTS","A9509 - HC IODINE I-123 PER MCI"]
["UNITED HEALTHCARE","A9509 - HC IODINE I-123 PER MCI"]
["TUFTS PUBLIC PLANS","A9509 - HC IODINE I-123 PER MCI"]
["HARVARD PILGRIM HEALTH CARE","A9509 - HC IODINE I-123 PER MCI"]
["FALLON","A9509 - HC IODINE I-123 PER MCI"]
["BMC HEALTHNET","A9509 - HC IODINE I-123 PER MCI"]
["CIGNA HEALTHCARE","A9509 - HC IODINE I-123 PER MCI"]
["BLUE CROSS OUT OF STATE","A9509 - HC IODINE I-123 PER MCI"]
["ALLWAYS HEALTH PARTNERS","A9509 - HC IODINE I-123 PER MCI"]
["BLUE CROSS","A9509 - HC IODINE I-123 PER MCI"]
["BLUE BENEFIT ADMINISTRATORS","A9509 - HC IODINE I-123 PER MCI"]
["TUFTS","A9512 - TC99M PERTECHNETATE"]
["UNITED HEALTHCARE","A9512 - TC99M PERTECHNETATE"]
["TUFTS PUBLIC PLANS","A9512 - TC99M PERTECHNETATE"]
["HARVARD PILGRIM HEALTH CARE","A9512 - TC99M PERTECHNETATE"]
["FALLON","A9512 - TC99M PERTECHNETATE"]
["CIGNA HEALTHCARE","A9512 - TC99M PERTECHNETATE"]
["BMC HEALTHNET","A9512 - TC99M PERTECHNETATE"]
["ALLWAYS HEALTH PARTNERS","A9512 - TC99M PERTECHNETATE"]
["UNITED HEALTHCARE","A9513 - TECHNETIUM TC-99M MEBROFENIN"]
["TUFTS","A9513 - TECHNETIUM TC-99M MEBROFENIN"]
["TUFTS PUBLIC PLANS","A9513 - TECHNETIUM TC-99M MEBROFENIN"]
["HARVARD PILGRIM HEALTH CARE","A9513 - TECHNETIUM TC-99M MEBROFENIN"]
["FALLON","A9513 - TECHNETIUM TC-99M MEBROFENIN"]
["BMC HEALTHNET","A9513 - TECHNETIUM TC-99M MEBROFENIN"]
["CIGNA HEALTHCARE","A9513 - TECHNETIUM TC-99M MEBROFENIN"]
["BLUE CROSS OUT OF STATE","A9513 - TECHNETIUM TC-99M MEBROFENIN"]
["ALLWAYS HEALTH PARTNERS","A9513 - TECHNETIUM TC-99M MEBROFENIN"]
["BLUE BENEFIT ADMINISTRATORS","A9513 - TECHNETIUM TC-99M MEBROFENIN"]
["AETNA","A9513 - TECHNETIUM TC-99M MEBROFENIN"]
["BLUE CROSS","A9513 - TECHNETIUM TC-99M MEBROFENIN"]
["UNITED HEALTHCARE","A9516 - I123 IODIDE CAP, DX"]
["TUFTS","A9516 - I123 IODIDE CAP, DX"]
["TUFTS PUBLIC PLANS","A9516 - I123 IODIDE CAP, DX"]
["FALLON","A9516 - I123 IODIDE CAP, DX"]
["HARVARD PILGRIM HEALTH CARE","A9516 - I123 IODIDE CAP, DX"]
["BLUE CROSS OUT OF STATE","A9516 - I123 IODIDE CAP, DX"]
["BMC HEALTHNET","A9516 - I123 IODIDE CAP, DX"]
["CIGNA HEALTHCARE","A9516 - I123 IODIDE CAP, DX"]
["ALLWAYS HEALTH PARTNERS","A9516 - I123 IODIDE CAP, DX"]
["BLUE CROSS","A9516 - I123 IODIDE CAP, DX"]
["BLUE BENEFIT ADMINISTRATORS","A9516 - I123 IODIDE CAP, DX"]
["TUFTS","A9517 - I131 IODIDE CAP, RX"]
["UNITED HEALTHCARE","A9517 - I131 IODIDE CAP, RX"]
["TUFTS PUBLIC PLANS","A9517 - I131 IODIDE CAP, RX"]
["HARVARD PILGRIM HEALTH CARE","A9517 - I131 IODIDE CAP, RX"]
["FALLON","A9517 - I131 IODIDE CAP, RX"]
["BMC HEALTHNET","A9517 - I131 IODIDE CAP, RX"]
["CIGNA HEALTHCARE","A9517 - I131 IODIDE CAP, RX"]
["BLUE CROSS OUT OF STATE","A9517 - I131 IODIDE CAP, RX"]
["ALLWAYS HEALTH PARTNERS","A9517 - I131 IODIDE CAP, RX"]
["BLUE BENEFIT ADMINISTRATORS","A9517 - I131 IODIDE CAP, RX"]
["BLUE CROSS","A9517 - I131 IODIDE CAP, RX"]
["TUFTS","A9520 - TECHNETIUMTC-99M SULFUR CLLD"]
["UNITED HEALTHCARE","A9520 - TECHNETIUMTC-99M SULFUR CLLD"]
["TUFTS PUBLIC PLANS","A9520 - TECHNETIUMTC-99M SULFUR CLLD"]
["FALLON","A9520 - TECHNETIUMTC-99M SULFUR CLLD"]
["HARVARD PILGRIM HEALTH CARE","A9520 - TECHNETIUMTC-99M SULFUR CLLD"]
["CIGNA HEALTHCARE","A9520 - TECHNETIUMTC-99M SULFUR CLLD"]
["BMC HEALTHNET","A9520 - TECHNETIUMTC-99M SULFUR CLLD"]
["ALLWAYS HEALTH PARTNERS","A9520 - TECHNETIUMTC-99M SULFUR CLLD"]
["UNITED HEALTHCARE","A9521 - TC99M EXAMETAZIME"]
["TUFTS","A9521 - TC99M EXAMETAZIME"]
["TUFTS PUBLIC PLANS","A9521 - TC99M EXAMETAZIME"]
["HARVARD PILGRIM HEALTH CARE","A9521 - TC99M EXAMETAZIME"]
["FALLON","A9521 - TC99M EXAMETAZIME"]
["BLUE CROSS OUT OF STATE","A9521 - TC99M EXAMETAZIME"]
["BMC HEALTHNET","A9521 - TC99M EXAMETAZIME"]
["CIGNA HEALTHCARE","A9521 - TC99M EXAMETAZIME"]
["ALLWAYS HEALTH PARTNERS","A9521 - TC99M EXAMETAZIME"]
["BLUE CROSS","A9521 - TC99M EXAMETAZIME"]
["BLUE BENEFIT ADMINISTRATORS","A9521 - TC99M EXAMETAZIME"]
["UNITED HEALTHCARE","A9537 - TC99M MEBROFENIN"]
["TUFTS","A9537 - TC99M MEBROFENIN"]
["TUFTS PUBLIC PLANS","A9537 - TC99M MEBROFENIN"]
["HARVARD PILGRIM HEALTH CARE","A9537 - TC99M MEBROFENIN"]
["FALLON","A9537 - TC99M MEBROFENIN"]
["BMC HEALTHNET","A9537 - TC99M MEBROFENIN"]
["CIGNA HEALTHCARE","A9537 - TC99M MEBROFENIN"]
["BLUE CROSS OUT OF STATE","A9537 - TC99M MEBROFENIN"]
["ALLWAYS HEALTH PARTNERS","A9537 - TC99M MEBROFENIN"]
["BLUE BENEFIT ADMINISTRATORS","A9537 - TC99M MEBROFENIN"]
["BLUE CROSS","A9537 - TC99M MEBROFENIN"]
["TUFTS","A9538 - TC99M PYROPHOSPHATE"]
["UNITED HEALTHCARE","A9538 - TC99M PYROPHOSPHATE"]
["TUFTS PUBLIC PLANS","A9538 - TC99M PYROPHOSPHATE"]
["HARVARD PILGRIM HEALTH CARE","A9538 - TC99M PYROPHOSPHATE"]
["FALLON","A9538 - TC99M PYROPHOSPHATE"]
["BMC HEALTHNET","A9538 - TC99M PYROPHOSPHATE"]
["CIGNA HEALTHCARE","A9538 - TC99M PYROPHOSPHATE"]
["BLUE CROSS OUT OF STATE","A9538 - TC99M PYROPHOSPHATE"]
["ALLWAYS HEALTH PARTNERS","A9538 - TC99M PYROPHOSPHATE"]
["BLUE CROSS","A9538 - TC99M PYROPHOSPHATE"]
["BLUE BENEFIT ADMINISTRATORS","A9538 - TC99M PYROPHOSPHATE"]
["TUFTS","A9539 - TC99M PENTETATE"]
["UNITED HEALTHCARE","A9539 - TC99M PENTETATE"]
["TUFTS PUBLIC PLANS","A9539 - TC99M PENTETATE"]
["HARVARD PILGRIM HEALTH CARE","A9539 - TC99M PENTETATE"]
["FALLON","A9539 - TC99M PENTETATE"]
["CIGNA HEALTHCARE","A9539 - TC99M PENTETATE"]
["BMC HEALTHNET","A9539 - TC99M PENTETATE"]
["BLUE CROSS OUT OF STATE","A9539 - TC99M PENTETATE"]
["ALLWAYS HEALTH PARTNERS","A9539 - TC99M PENTETATE"]
["BLUE BENEFIT ADMINISTRATORS","A9539 - TC99M PENTETATE"]
["BLUE CROSS","A9539 - TC99M PENTETATE"]
["UNITED HEALTHCARE","A9540 - TC99M MAA"]
["TUFTS","A9540 - TC99M MAA"]
["TUFTS PUBLIC PLANS","A9540 - TC99M MAA"]
["HARVARD PILGRIM HEALTH CARE","A9540 - TC99M MAA"]
["FALLON","A9540 - TC99M MAA"]
["BMC HEALTHNET","A9540 - TC99M MAA"]
["BLUE CROSS OUT OF STATE","A9540 - TC99M MAA"]
["CIGNA HEALTHCARE","A9540 - TC99M MAA"]
["ALLWAYS HEALTH PARTNERS","A9540 - TC99M MAA"]
["BLUE CROSS","A9540 - TC99M MAA"]
["BLUE BENEFIT ADMINISTRATORS","A9540 - TC99M MAA"]
["UNITED HEALTHCARE","A9541 - TC99M SULFUR COLLOID"]
["TUFTS","A9541 - TC99M SULFUR COLLOID"]
["TUFTS PUBLIC PLANS","A9541 - TC99M SULFUR COLLOID"]
["HARVARD PILGRIM HEALTH CARE","A9541 - TC99M SULFUR COLLOID"]
["FALLON","A9541 - TC99M SULFUR COLLOID"]
["BLUE CROSS OUT OF STATE","A9541 - TC99M SULFUR COLLOID"]
["BMC HEALTHNET","A9541 - TC99M SULFUR COLLOID"]
["CIGNA HEALTHCARE","A9541 - TC99M SULFUR COLLOID"]
["ALLWAYS HEALTH PARTNERS","A9541 - TC99M SULFUR COLLOID"]
["BLUE BENEFIT ADMINISTRATORS","A9541 - TC99M SULFUR COLLOID"]
["BLUE CROSS","A9541 - TC99M SULFUR COLLOID"]
["TUFTS","A9543 - Y90 IBRITUMOMAB, RX"]
["UNITED HEALTHCARE","A9543 - Y90 IBRITUMOMAB, RX"]
["TUFTS PUBLIC PLANS","A9543 - Y90 IBRITUMOMAB, RX"]
["FALLON","A9543 - Y90 IBRITUMOMAB, RX"]
["HARVARD PILGRIM HEALTH CARE","A9543 - Y90 IBRITUMOMAB, RX"]
["BLUE CROSS OUT OF STATE","A9543 - Y90 IBRITUMOMAB, RX"]
["BMC HEALTHNET","A9543 - Y90 IBRITUMOMAB, RX"]
["CIGNA HEALTHCARE","A9543 - Y90 IBRITUMOMAB, RX"]
["ALLWAYS HEALTH PARTNERS","A9543 - Y90 IBRITUMOMAB, RX"]
["BLUE CROSS","A9543 - Y90 IBRITUMOMAB, RX"]
["BLUE BENEFIT ADMINISTRATORS","A9543 - Y90 IBRITUMOMAB, RX"]
["TUFTS","A9547 - IN111 OXYQUINOLINE"]
["UNITED HEALTHCARE","A9547 - IN111 OXYQUINOLINE"]
["TUFTS PUBLIC PLANS","A9547 - IN111 OXYQUINOLINE"]
["HARVARD PILGRIM HEALTH CARE","A9547 - IN111 OXYQUINOLINE"]
["FALLON","A9547 - IN111 OXYQUINOLINE"]
["BLUE CROSS OUT OF STATE","A9547 - IN111 OXYQUINOLINE"]
["CIGNA HEALTHCARE","A9547 - IN111 OXYQUINOLINE"]
["BMC HEALTHNET","A9547 - IN111 OXYQUINOLINE"]
["ALLWAYS HEALTH PARTNERS","A9547 - IN111 OXYQUINOLINE"]
["BLUE BENEFIT ADMINISTRATORS","A9547 - IN111 OXYQUINOLINE"]
["BLUE CROSS","A9547 - IN111 OXYQUINOLINE"]
["TUFTS","A9551 - HC TC99M SUCCIMER/10MCI,DX"]
["UNITED HEALTHCARE","A9551 - HC TC99M SUCCIMER/10MCI,DX"]
["TUFTS PUBLIC PLANS","A9551 - HC TC99M SUCCIMER/10MCI,DX"]
["HARVARD PILGRIM HEALTH CARE","A9551 - HC TC99M SUCCIMER/10MCI,DX"]
["FALLON","A9551 - HC TC99M SUCCIMER/10MCI,DX"]
["BLUE CROSS OUT OF STATE","A9551 - HC TC99M SUCCIMER/10MCI,DX"]
["BMC HEALTHNET","A9551 - HC TC99M SUCCIMER/10MCI,DX"]
["CIGNA HEALTHCARE","A9551 - HC TC99M SUCCIMER/10MCI,DX"]
["BLUE CROSS","A9551 - HC TC99M SUCCIMER/10MCI,DX"]
["ALLWAYS HEALTH PARTNERS","A9551 - HC TC99M SUCCIMER/10MCI,DX"]
["BLUE BENEFIT ADMINISTRATORS","A9551 - HC TC99M SUCCIMER/10MCI,DX"]
["TUFTS","A9552 - F18 FDG"]
["UNITED HEALTHCARE","A9552 - F18 FDG"]
["TUFTS PUBLIC PLANS","A9552 - F18 FDG"]
["HARVARD PILGRIM HEALTH CARE","A9552 - F18 FDG"]
["FALLON","A9552 - F18 FDG"]
["BMC HEALTHNET","A9552 - F18 FDG"]
["BLUE CROSS OUT OF STATE","A9552 - F18 FDG"]
["CIGNA HEALTHCARE","A9552 - F18 FDG"]
["ALLWAYS HEALTH PARTNERS","A9552 - F18 FDG"]
["BLUE BENEFIT ADMINISTRATORS","A9552 - F18 FDG"]
["BLUE CROSS","A9552 - F18 FDG"]
["TUFTS","A9555 - RADIOPHARMACIAL"]
["UNITED HEALTHCARE","A9555 - RADIOPHARMACIAL"]
["TUFTS PUBLIC PLANS","A9555 - RADIOPHARMACIAL"]
["HARVARD PILGRIM HEALTH CARE","A9555 - RADIOPHARMACIAL"]
["FALLON","A9555 - RADIOPHARMACIAL"]
["BLUE CROSS OUT OF STATE","A9555 - RADIOPHARMACIAL"]
["BMC HEALTHNET","A9555 - RADIOPHARMACIAL"]
["CIGNA HEALTHCARE","A9555 - RADIOPHARMACIAL"]
["BLUE CROSS","A9555 - RADIOPHARMACIAL"]
["ALLWAYS HEALTH PARTNERS","A9555 - RADIOPHARMACIAL"]
["BLUE BENEFIT ADMINISTRATORS","A9555 - RADIOPHARMACIAL"]
["TUFTS","A9556 - GA67 GALLIUM"]
["UNITED HEALTHCARE","A9556 - GA67 GALLIUM"]
["TUFTS PUBLIC PLANS","A9556 - GA67 GALLIUM"]
["FALLON","A9556 - GA67 GALLIUM"]
["HARVARD PILGRIM HEALTH CARE","A9556 - GA67 GALLIUM"]
["BLUE CROSS OUT OF STATE","A9556 - GA67 GALLIUM"]
["CIGNA HEALTHCARE","A9556 - GA67 GALLIUM"]
["BMC HEALTHNET","A9556 - GA67 GALLIUM"]
["ALLWAYS HEALTH PARTNERS","A9556 - GA67 GALLIUM"]
["BLUE BENEFIT ADMINISTRATORS","A9556 - GA67 GALLIUM"]
["BLUE CROSS","A9556 - GA67 GALLIUM"]
["UNITED HEALTHCARE","A9557 - TC99M BICISATE"]
["TUFTS","A9557 - TC99M BICISATE"]
["TUFTS PUBLIC PLANS","A9557 - TC99M BICISATE"]
["FALLON","A9557 - TC99M BICISATE"]
["HARVARD PILGRIM HEALTH CARE","A9557 - TC99M BICISATE"]
["BLUE CROSS OUT OF STATE","A9557 - TC99M BICISATE"]
["BMC HEALTHNET","A9557 - TC99M BICISATE"]
["CIGNA HEALTHCARE","A9557 - TC99M BICISATE"]
["ALLWAYS HEALTH PARTNERS","A9557 - TC99M BICISATE"]
["BLUE CROSS","A9557 - TC99M BICISATE"]
["BLUE BENEFIT ADMINISTRATORS","A9557 - TC99M BICISATE"]
["UNITED HEALTHCARE","A9558 - HC XENON133/10MCI"]
["TUFTS","A9558 - HC XENON133/10MCI"]
["TUFTS PUBLIC PLANS","A9558 - HC XENON133/10MCI"]
["HARVARD PILGRIM HEALTH CARE","A9558 - HC XENON133/10MCI"]
["FALLON","A9558 - HC XENON133/10MCI"]
["BLUE CROSS OUT OF STATE","A9558 - HC XENON133/10MCI"]
["BMC HEALTHNET","A9558 - HC XENON133/10MCI"]
["CIGNA HEALTHCARE","A9558 - HC XENON133/10MCI"]
["ALLWAYS HEALTH PARTNERS","A9558 - HC XENON133/10MCI"]
["BLUE BENEFIT ADMINISTRATORS","A9558 - HC XENON133/10MCI"]
["BLUE CROSS","A9558 - HC XENON133/10MCI"]
["TUFTS","A9560 - TC99M LABELED RBC"]
["UNITED HEALTHCARE","A9560 - TC99M LABELED RBC"]
["TUFTS PUBLIC PLANS","A9560 - TC99M LABELED RBC"]
["HARVARD PILGRIM HEALTH CARE","A9560 - TC99M LABELED RBC"]
["FALLON","A9560 - TC99M LABELED RBC"]
["BLUE CROSS OUT OF STATE","A9560 - TC99M LABELED RBC"]
["BMC HEALTHNET","A9560 - TC99M LABELED RBC"]
["CIGNA HEALTHCARE","A9560 - TC99M LABELED RBC"]
["ALLWAYS HEALTH PARTNERS","A9560 - TC99M LABELED RBC"]
["BLUE CROSS","A9560 - TC99M LABELED RBC"]
["BLUE BENEFIT ADMINISTRATORS","A9560 - TC99M LABELED RBC"]
["TUFTS","A9561 - TC99M OXIDRONATE"]
["UNITED HEALTHCARE","A9561 - TC99M OXIDRONATE"]
["TUFTS PUBLIC PLANS","A9561 - TC99M OXIDRONATE"]
["HARVARD PILGRIM HEALTH CARE","A9561 - TC99M OXIDRONATE"]
["FALLON","A9561 - TC99M OXIDRONATE"]
["BLUE CROSS OUT OF STATE","A9561 - TC99M OXIDRONATE"]
["CIGNA HEALTHCARE","A9561 - TC99M OXIDRONATE"]
["BMC HEALTHNET","A9561 - TC99M OXIDRONATE"]
["ALLWAYS HEALTH PARTNERS","A9561 - TC99M OXIDRONATE"]
["BLUE BENEFIT ADMINISTRATORS","A9561 - TC99M OXIDRONATE"]
["BLUE CROSS","A9561 - TC99M OXIDRONATE"]
["UNITED HEALTHCARE","A9562 - TC99M MERTIATIDE"]
["TUFTS","A9562 - TC99M MERTIATIDE"]
["TUFTS PUBLIC PLANS","A9562 - TC99M MERTIATIDE"]
["HARVARD PILGRIM HEALTH CARE","A9562 - TC99M MERTIATIDE"]
["FALLON","A9562 - TC99M MERTIATIDE"]
["BLUE CROSS OUT OF STATE","A9562 - TC99M MERTIATIDE"]
["BMC HEALTHNET","A9562 - TC99M MERTIATIDE"]
["CIGNA HEALTHCARE","A9562 - TC99M MERTIATIDE"]
["ALLWAYS HEALTH PARTNERS","A9562 - TC99M MERTIATIDE"]
["BLUE CROSS","A9562 - TC99M MERTIATIDE"]
["BLUE BENEFIT ADMINISTRATORS","A9562 - TC99M MERTIATIDE"]
["UNITED HEALTHCARE","A9563 - P32 NA PHOSPHATE"]
["TUFTS","A9563 - P32 NA PHOSPHATE"]
["TUFTS PUBLIC PLANS","A9563 - P32 NA PHOSPHATE"]
["HARVARD PILGRIM HEALTH CARE","A9563 - P32 NA PHOSPHATE"]
["FALLON","A9563 - P32 NA PHOSPHATE"]
["BLUE CROSS OUT OF STATE","A9563 - P32 NA PHOSPHATE"]
["BMC HEALTHNET","A9563 - P32 NA PHOSPHATE"]
["CIGNA HEALTHCARE","A9563 - P32 NA PHOSPHATE"]
["ALLWAYS HEALTH PARTNERS","A9563 - P32 NA PHOSPHATE"]
["BLUE BENEFIT ADMINISTRATORS","A9563 - P32 NA PHOSPHATE"]
["BLUE CROSS","A9563 - P32 NA PHOSPHATE"]
["TUFTS","A9569 - TECHNETIUM TC-99M AUTO WBC"]
["UNITED HEALTHCARE","A9569 - TECHNETIUM TC-99M AUTO WBC"]
["TUFTS PUBLIC PLANS","A9569 - TECHNETIUM TC-99M AUTO WBC"]
["FALLON","A9569 - TECHNETIUM TC-99M AUTO WBC"]
["HARVARD PILGRIM HEALTH CARE","A9569 - TECHNETIUM TC-99M AUTO WBC"]
["BLUE CROSS OUT OF STATE","A9569 - TECHNETIUM TC-99M AUTO WBC"]
["BMC HEALTHNET","A9569 - TECHNETIUM TC-99M AUTO WBC"]
["CIGNA HEALTHCARE","A9569 - TECHNETIUM TC-99M AUTO WBC"]
["BLUE CROSS","A9569 - TECHNETIUM TC-99M AUTO WBC"]
["ALLWAYS HEALTH PARTNERS","A9569 - TECHNETIUM TC-99M AUTO WBC"]
["BLUE BENEFIT ADMINISTRATORS","A9569 - TECHNETIUM TC-99M AUTO WBC"]
["TUFTS","A9570 - HC INDIUM IN-111 AUTO WBC"]
["UNITED HEALTHCARE","A9570 - HC INDIUM IN-111 AUTO WBC"]
["TUFTS PUBLIC PLANS","A9570 - HC INDIUM IN-111 AUTO WBC"]
["FALLON","A9570 - HC INDIUM IN-111 AUTO WBC"]
["HARVARD PILGRIM HEALTH CARE","A9570 - HC INDIUM IN-111 AUTO WBC"]
["CIGNA HEALTHCARE","A9570 - HC INDIUM IN-111 AUTO WBC"]
["BMC HEALTHNET","A9570 - HC INDIUM IN-111 AUTO WBC"]
["ALLWAYS HEALTH PARTNERS","A9570 - HC INDIUM IN-111 AUTO WBC"]
["UNITED HEALTHCARE","A9572 - INDIUM IN-111 PENTETREOTIDE"]
["TUFTS","A9572 - INDIUM IN-111 PENTETREOTIDE"]
["TUFTS PUBLIC PLANS","A9572 - INDIUM IN-111 PENTETREOTIDE"]
["FALLON","A9572 - INDIUM IN-111 PENTETREOTIDE"]
["HARVARD PILGRIM HEALTH CARE","A9572 - INDIUM IN-111 PENTETREOTIDE"]
["BLUE CROSS OUT OF STATE","A9572 - INDIUM IN-111 PENTETREOTIDE"]
["BMC HEALTHNET","A9572 - INDIUM IN-111 PENTETREOTIDE"]
["CIGNA HEALTHCARE","A9572 - INDIUM IN-111 PENTETREOTIDE"]
["ALLWAYS HEALTH PARTNERS","A9572 - INDIUM IN-111 PENTETREOTIDE"]
["BLUE BENEFIT ADMINISTRATORS","A9572 - INDIUM IN-111 PENTETREOTIDE"]
["BLUE CROSS","A9572 - INDIUM IN-111 PENTETREOTIDE"]
["UNITED HEALTHCARE","A9575 - INJ GADOTERATE MEGLUMI 0.1ML"]
["TUFTS PUBLIC PLANS","A9575 - INJ GADOTERATE MEGLUMI 0.1ML"]
["TUFTS","A9575 - INJ GADOTERATE MEGLUMI 0.1ML"]
["UHC COMMUNITY CARE","A9575 - INJ GADOTERATE MEGLUMI 0.1ML"]
["UNICARE","A9575 - INJ GADOTERATE MEGLUMI 0.1ML"]
["FALLON","A9575 - INJ GADOTERATE MEGLUMI 0.1ML"]
["HARVARD PILGRIM HEALTH CARE","A9575 - INJ GADOTERATE MEGLUMI 0.1ML"]
["SENIOR WHOLE HEALTH","A9575 - INJ GADOTERATE MEGLUMI 0.1ML"]
["BLUE CROSS OUT OF STATE","A9575 - INJ GADOTERATE MEGLUMI 0.1ML"]
["BMC HEALTHNET","A9575 - INJ GADOTERATE MEGLUMI 0.1ML"]
["CIGNA HEALTHCARE","A9575 - INJ GADOTERATE MEGLUMI 0.1ML"]
["COMMONWEALTH CARE ALLIANCE","A9575 - INJ GADOTERATE MEGLUMI 0.1ML"]
["ELDER SERVICE PLAN","A9575 - INJ GADOTERATE MEGLUMI 0.1ML"]
["ELDER SERVICE PLAN OTHER","A9575 - INJ GADOTERATE MEGLUMI 0.1ML"]
["BLUE CROSS","A9575 - INJ GADOTERATE MEGLUMI 0.1ML"]
["BLUE BENEFIT ADMINISTRATORS","A9575 - INJ GADOTERATE MEGLUMI 0.1ML"]
["AETNA","A9575 - INJ GADOTERATE MEGLUMI 0.1ML"]
["UHC COMMUNITY CARE","A9576 - HC PROHANCE IV CONTRAST PER ML"]
["UNICARE","A9576 - HC PROHANCE IV CONTRAST PER ML"]
["TUFTS","A9576 - HC PROHANCE IV CONTRAST PER ML"]
["UNITED HEALTHCARE","A9576 - HC PROHANCE IV CONTRAST PER ML"]
["TUFTS PUBLIC PLANS","A9576 - HC PROHANCE IV CONTRAST PER ML"]
["FALLON","A9576 - HC PROHANCE IV CONTRAST PER ML"]
["HARVARD PILGRIM HEALTH CARE","A9576 - HC PROHANCE IV CONTRAST PER ML"]
["SENIOR WHOLE HEALTH","A9576 - HC PROHANCE IV CONTRAST PER ML"]
["BLUE CROSS OUT OF STATE","A9576 - HC PROHANCE IV CONTRAST PER ML"]
["ELDER SERVICE PLAN","A9576 - HC PROHANCE IV CONTRAST PER ML"]
["COMMONWEALTH CARE ALLIANCE","A9576 - HC PROHANCE IV CONTRAST PER ML"]
["ELDER SERVICE PLAN OTHER","A9576 - HC PROHANCE IV CONTRAST PER ML"]
["BMC HEALTHNET","A9576 - HC PROHANCE IV CONTRAST PER ML"]
["CIGNA HEALTHCARE","A9576 - HC PROHANCE IV CONTRAST PER ML"]
["BLUE BENEFIT ADMINISTRATORS","A9576 - HC PROHANCE IV CONTRAST PER ML"]
["BLUE CROSS","A9576 - HC PROHANCE IV CONTRAST PER ML"]
["AETNA","A9576 - HC PROHANCE IV CONTRAST PER ML"]
["TUFTS PUBLIC PLANS","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML"]
["TUFTS","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML"]
["UNITED HEALTHCARE","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML"]
["UHC COMMUNITY CARE","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML"]
["UNICARE","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML"]
["FALLON","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML"]
["HARVARD PILGRIM HEALTH CARE","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML"]
["SENIOR WHOLE HEALTH","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML"]
["BLUE CROSS OUT OF STATE","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML"]
["CIGNA HEALTHCARE","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML"]
["BMC HEALTHNET","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML"]
["COMMONWEALTH CARE ALLIANCE","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML"]
["ELDER SERVICE PLAN","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML"]
["ELDER SERVICE PLAN OTHER","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML"]
["BLUE CROSS","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML"]
["BLUE BENEFIT ADMINISTRATORS","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML"]
["AETNA","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML"]
["UNITED HEALTHCARE","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["UHC COMMUNITY CARE","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["UNICARE","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["TUFTS","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["TUFTS PUBLIC PLANS","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["FALLON","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["HARVARD PILGRIM HEALTH CARE","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["SENIOR WHOLE HEALTH","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["BLUE CROSS OUT OF STATE","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["BMC HEALTHNET","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["COMMONWEALTH CARE ALLIANCE","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["ELDER SERVICE PLAN","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["ELDER SERVICE PLAN OTHER","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["CIGNA HEALTHCARE","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["BLUE BENEFIT ADMINISTRATORS","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["BLUE CROSS","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["AETNA","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["UNITED HEALTHCARE","A9580 - HC NA FLUORIDE F-18, DOSE"]
["TUFTS","A9580 - HC NA FLUORIDE F-18, DOSE"]
["TUFTS PUBLIC PLANS","A9580 - HC NA FLUORIDE F-18, DOSE"]
["FALLON","A9580 - HC NA FLUORIDE F-18, DOSE"]
["HARVARD PILGRIM HEALTH CARE","A9580 - HC NA FLUORIDE F-18, DOSE"]
["BMC HEALTHNET","A9580 - HC NA FLUORIDE F-18, DOSE"]
["CIGNA HEALTHCARE","A9580 - HC NA FLUORIDE F-18, DOSE"]
["ALLWAYS HEALTH PARTNERS","A9580 - HC NA FLUORIDE F-18, DOSE"]
["TUFTS PUBLIC PLANS","A9581 - GADOXETATE DISODIUM INJ"]
["TUFTS","A9581 - GADOXETATE DISODIUM INJ"]
["UNITED HEALTHCARE","A9581 - GADOXETATE DISODIUM INJ"]
["UHC COMMUNITY CARE","A9581 - GADOXETATE DISODIUM INJ"]
["UNICARE","A9581 - GADOXETATE DISODIUM INJ"]
["FALLON","A9581 - GADOXETATE DISODIUM INJ"]
["HARVARD PILGRIM HEALTH CARE","A9581 - GADOXETATE DISODIUM INJ"]
["SENIOR WHOLE HEALTH","A9581 - GADOXETATE DISODIUM INJ"]
["BLUE CROSS OUT OF STATE","A9581 - GADOXETATE DISODIUM INJ"]
["BMC HEALTHNET","A9581 - GADOXETATE DISODIUM INJ"]
["CIGNA HEALTHCARE","A9581 - GADOXETATE DISODIUM INJ"]
["COMMONWEALTH CARE ALLIANCE","A9581 - GADOXETATE DISODIUM INJ"]
["ELDER SERVICE PLAN","A9581 - GADOXETATE DISODIUM INJ"]
["ELDER SERVICE PLAN OTHER","A9581 - GADOXETATE DISODIUM INJ"]
["BLUE CROSS","A9581 - GADOXETATE DISODIUM INJ"]
["BLUE BENEFIT ADMINISTRATORS","A9581 - GADOXETATE DISODIUM INJ"]
["AETNA","A9581 - GADOXETATE DISODIUM INJ"]
["TUFTS","A9582 - IODINE I-123 IOBENGUANE"]
["UNITED HEALTHCARE","A9582 - IODINE I-123 IOBENGUANE"]
["TUFTS PUBLIC PLANS","A9582 - IODINE I-123 IOBENGUANE"]
["FALLON","A9582 - IODINE I-123 IOBENGUANE"]
["HARVARD PILGRIM HEALTH CARE","A9582 - IODINE I-123 IOBENGUANE"]
["CIGNA HEALTHCARE","A9582 - IODINE I-123 IOBENGUANE"]
["BMC HEALTHNET","A9582 - IODINE I-123 IOBENGUANE"]
["ALLWAYS HEALTH PARTNERS","A9582 - IODINE I-123 IOBENGUANE"]
["UNITED HEALTHCARE","A9583 - GADOFOSVESET TRISODIUM INJ"]
["UNICARE","A9583 - GADOFOSVESET TRISODIUM INJ"]
["TUFTS","A9583 - GADOFOSVESET TRISODIUM INJ"]
["TUFTS PUBLIC PLANS","A9583 - GADOFOSVESET TRISODIUM INJ"]
["FALLON","A9583 - GADOFOSVESET TRISODIUM INJ"]
["HARVARD PILGRIM HEALTH CARE","A9583 - GADOFOSVESET TRISODIUM INJ"]
["BLUE CROSS OUT OF STATE","A9583 - GADOFOSVESET TRISODIUM INJ"]
["BMC HEALTHNET","A9583 - GADOFOSVESET TRISODIUM INJ"]
["CIGNA HEALTHCARE","A9583 - GADOFOSVESET TRISODIUM INJ"]
["ALLWAYS HEALTH PARTNERS","A9583 - GADOFOSVESET TRISODIUM INJ"]
["BLUE BENEFIT ADMINISTRATORS","A9583 - GADOFOSVESET TRISODIUM INJ"]
["BLUE CROSS","A9583 - GADOFOSVESET TRISODIUM INJ"]
["UNITED HEALTHCARE","A9584 - IODINE I-123 IOFLUPANE"]
["TUFTS","A9584 - IODINE I-123 IOFLUPANE"]
["TUFTS PUBLIC PLANS","A9584 - IODINE I-123 IOFLUPANE"]
["FALLON","A9584 - IODINE I-123 IOFLUPANE"]
["HARVARD PILGRIM HEALTH CARE","A9584 - IODINE I-123 IOFLUPANE"]
["BLUE CROSS OUT OF STATE","A9584 - IODINE I-123 IOFLUPANE"]
["CIGNA HEALTHCARE","A9584 - IODINE I-123 IOFLUPANE"]
["BMC HEALTHNET","A9584 - IODINE I-123 IOFLUPANE"]
["BLUE CROSS","A9584 - IODINE I-123 IOFLUPANE"]
["ALLWAYS HEALTH PARTNERS","A9584 - IODINE I-123 IOFLUPANE"]
["BLUE BENEFIT ADMINISTRATORS","A9584 - IODINE I-123 IOFLUPANE"]
["TUFTS","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE"]
["UNITED HEALTHCARE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE"]
["HARVARD PILGRIM HEALTH CARE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE"]
["BLUE CROSS OUT OF STATE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE"]
["CIGNA HEALTHCARE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE"]
["BLUE BENEFIT ADMINISTRATORS","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE"]
["BLUE CROSS","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE"]
["TUFTS","A9587 - GALLIUM GA-68"]
["UNITED HEALTHCARE","A9587 - GALLIUM GA-68"]
["TUFTS PUBLIC PLANS","A9587 - GALLIUM GA-68"]
["FALLON","A9587 - GALLIUM GA-68"]
["HARVARD PILGRIM HEALTH CARE","A9587 - GALLIUM GA-68"]
["CIGNA HEALTHCARE","A9587 - GALLIUM GA-68"]
["BMC HEALTHNET","A9587 - GALLIUM GA-68"]
["BLUE CROSS OUT OF STATE","A9587 - GALLIUM GA-68"]
["ALLWAYS HEALTH PARTNERS","A9587 - GALLIUM GA-68"]
["BLUE CROSS","A9587 - GALLIUM GA-68"]
["BLUE BENEFIT ADMINISTRATORS","A9587 - GALLIUM GA-68"]
["UNITED HEALTHCARE","A9588 - FLUCICLOVINE F-18"]
["TUFTS","A9588 - FLUCICLOVINE F-18"]
["TUFTS PUBLIC PLANS","A9588 - FLUCICLOVINE F-18"]
["FALLON","A9588 - FLUCICLOVINE F-18"]
["HARVARD PILGRIM HEALTH CARE","A9588 - FLUCICLOVINE F-18"]
["BLUE CROSS OUT OF STATE","A9588 - FLUCICLOVINE F-18"]
["BMC HEALTHNET","A9588 - FLUCICLOVINE F-18"]
["CIGNA HEALTHCARE","A9588 - FLUCICLOVINE F-18"]
["ALLWAYS HEALTH PARTNERS","A9588 - FLUCICLOVINE F-18"]
["BLUE BENEFIT ADMINISTRATORS","A9588 - FLUCICLOVINE F-18"]
["BLUE CROSS","A9588 - FLUCICLOVINE F-18"]
["TUFTS PUBLIC PLANS","A9592 - HC COPPER CU 64 DOTATATE DIAG"]
["FALLON","A9592 - HC COPPER CU 64 DOTATATE DIAG"]
["BMC HEALTHNET","A9592 - HC COPPER CU 64 DOTATATE DIAG"]
["ALLWAYS HEALTH PARTNERS","A9592 - HC COPPER CU 64 DOTATATE DIAG"]
["UNITED HEALTHCARE","A9606 - RADIUM RA223 DICHLORIDE THER"]
["TUFTS","A9606 - RADIUM RA223 DICHLORIDE THER"]
["HARVARD PILGRIM HEALTH CARE","A9606 - RADIUM RA223 DICHLORIDE THER"]
["BLUE CROSS OUT OF STATE","A9606 - RADIUM RA223 DICHLORIDE THER"]
["CIGNA HEALTHCARE","A9606 - RADIUM RA223 DICHLORIDE THER"]
["BLUE CROSS","A9606 - RADIUM RA223 DICHLORIDE THER"]
["BLUE BENEFIT ADMINISTRATORS","A9606 - RADIUM RA223 DICHLORIDE THER"]
["TUFTS","C1713 - HC CORE 10 BONE PLUG"]
["UNITED HEALTHCARE","C1713 - HC CORE 10 BONE PLUG"]
["HARVARD PILGRIM HEALTH CARE","C1713 - HC CORE 10 BONE PLUG"]
["CIGNA HEALTHCARE","C1713 - HC CORE 10 BONE PLUG"]
["TUFTS","C1714 - HC WATHMAN SYS ANTER CURVE"]
["UNITED HEALTHCARE","C1714 - HC WATHMAN SYS ANTER CURVE"]
["HARVARD PILGRIM HEALTH CARE","C1714 - HC WATHMAN SYS ANTER CURVE"]
["CIGNA HEALTHCARE","C1714 - HC WATHMAN SYS ANTER CURVE"]
["UNITED HEALTHCARE","C1715 - BRACHYTHERAPY NEEDLE"]
["TUFTS","C1715 - BRACHYTHERAPY NEEDLE"]
["HARVARD PILGRIM HEALTH CARE","C1715 - BRACHYTHERAPY NEEDLE"]
["CIGNA HEALTHCARE","C1715 - BRACHYTHERAPY NEEDLE"]
["UNITED HEALTHCARE","C1716 - BRACHYTX SOURCE, GOLD 198"]
["TUFTS","C1716 - BRACHYTX SOURCE, GOLD 198"]
["HARVARD PILGRIM HEALTH CARE","C1716 - BRACHYTX SOURCE, GOLD 198"]
["CIGNA HEALTHCARE","C1716 - BRACHYTX SOURCE, GOLD 198"]
["TUFTS","C1717 - HC BRACHYTX, NON-STR,HDR IR-192"]
["UNITED HEALTHCARE","C1717 - HC BRACHYTX, NON-STR,HDR IR-192"]
["HARVARD PILGRIM HEALTH CARE","C1717 - HC BRACHYTX, NON-STR,HDR IR-192"]
["BLUE CROSS OUT OF STATE","C1717 - HC BRACHYTX, NON-STR,HDR IR-192"]
["CIGNA HEALTHCARE","C1717 - HC BRACHYTX, NON-STR,HDR IR-192"]
["BLUE BENEFIT ADMINISTRATORS","C1717 - HC BRACHYTX, NON-STR,HDR IR-192"]
["BLUE CROSS","C1717 - HC BRACHYTX, NON-STR,HDR IR-192"]
["TUFTS","C1719 - BRACHYTX SOUR,NON-HDR IR-192"]
["UNITED HEALTHCARE","C1719 - BRACHYTX SOUR,NON-HDR IR-192"]
["HARVARD PILGRIM HEALTH CARE","C1719 - BRACHYTX SOUR,NON-HDR IR-192"]
["CIGNA HEALTHCARE","C1719 - BRACHYTX SOUR,NON-HDR IR-192"]
["UNITED HEALTHCARE","C1721 - HC ICD,2CH, GEN ONLY, RECALL $0"]
["TUFTS","C1721 - HC ICD,2CH, GEN ONLY, RECALL $0"]
["HARVARD PILGRIM HEALTH CARE","C1721 - HC ICD,2CH, GEN ONLY, RECALL $0"]
["CIGNA HEALTHCARE","C1721 - HC ICD,2CH, GEN ONLY, RECALL $0"]
["UNITED HEALTHCARE","C1722 - HC ICD,1CH, GEN ONLY, RECALL $0"]
["TUFTS","C1722 - HC ICD,1CH, GEN ONLY, RECALL $0"]
["HARVARD PILGRIM HEALTH CARE","C1722 - HC ICD,1CH, GEN ONLY, RECALL $0"]
["CIGNA HEALTHCARE","C1722 - HC ICD,1CH, GEN ONLY, RECALL $0"]
["TUFTS","C1724 - HC CATH, TRANS ATHEREC BURR"]
["UNITED HEALTHCARE","C1724 - HC CATH, TRANS ATHEREC BURR"]
["HARVARD PILGRIM HEALTH CARE","C1724 - HC CATH, TRANS ATHEREC BURR"]
["CIGNA HEALTHCARE","C1724 - HC CATH, TRANS ATHEREC BURR"]
["TUFTS","C1725 - HC SIZING AMPLATZ BALLOON"]
["UNITED HEALTHCARE","C1725 - HC SIZING AMPLATZ BALLOON"]
["HARVARD PILGRIM HEALTH CARE","C1725 - HC SIZING AMPLATZ BALLOON"]
["CIGNA HEALTHCARE","C1725 - HC SIZING AMPLATZ BALLOON"]
["UNITED HEALTHCARE","C1726 - HC CATHETER BALLN LVL 4"]
["TUFTS","C1726 - HC CATHETER BALLN LVL 4"]
["HARVARD PILGRIM HEALTH CARE","C1726 - HC CATHETER BALLN LVL 4"]
["CIGNA HEALTHCARE","C1726 - HC CATHETER BALLN LVL 4"]
["UNITED HEALTHCARE","C1729 - HC CATH; THORA PARA"]
["TUFTS","C1729 - HC CATH; THORA PARA"]
["HARVARD PILGRIM HEALTH CARE","C1729 - HC CATH; THORA PARA"]
["CIGNA HEALTHCARE","C1729 - HC CATH; THORA PARA"]
["TUFTS","C1730 - HC CATH,EP;STEER,DEC(LASSO)"]
["UNITED HEALTHCARE","C1730 - HC CATH,EP;STEER,DEC(LASSO)"]
["HARVARD PILGRIM HEALTH CARE","C1730 - HC CATH,EP;STEER,DEC(LASSO)"]
["CIGNA HEALTHCARE","C1730 - HC CATH,EP;STEER,DEC(LASSO)"]
["TUFTS","C1731 - HC CATH,EP PENTARAY NAV"]
["UNITED HEALTHCARE","C1731 - HC CATH,EP PENTARAY NAV"]
["HARVARD PILGRIM HEALTH CARE","C1731 - HC CATH,EP PENTARAY NAV"]
["CIGNA HEALTHCARE","C1731 - HC CATH,EP PENTARAY NAV"]
["UNITED HEALTHCARE","C1732 - HC CATH,EP DECA NAV"]
["TUFTS","C1732 - HC CATH,EP DECA NAV"]
["HARVARD PILGRIM HEALTH CARE","C1732 - HC CATH,EP DECA NAV"]
["CIGNA HEALTHCARE","C1732 - HC CATH,EP DECA NAV"]
["UNITED HEALTHCARE","C1733 - CATH CRYABL  ARCTIC FRN"]
["TUFTS","C1733 - CATH CRYABL  ARCTIC FRN"]
["HARVARD PILGRIM HEALTH CARE","C1733 - CATH CRYABL  ARCTIC FRN"]
["CIGNA HEALTHCARE","C1733 - CATH CRYABL  ARCTIC FRN"]
["TUFTS","C1750 - HC CATH 2 LUMEN QUINTON"]
["UNITED HEALTHCARE","C1750 - HC CATH 2 LUMEN QUINTON"]
["HARVARD PILGRIM HEALTH CARE","C1750 - HC CATH 2 LUMEN QUINTON"]
["CIGNA HEALTHCARE","C1750 - HC CATH 2 LUMEN QUINTON"]
["TUFTS","C1751 - HC CATH, PACING"]
["UNITED HEALTHCARE","C1751 - HC CATH, PACING"]
["HARVARD PILGRIM HEALTH CARE","C1751 - HC CATH, PACING"]
["CIGNA HEALTHCARE","C1751 - HC CATH, PACING"]
["UNITED HEALTHCARE","C1753 - HC BIOPSY FORC LVL D"]
["TUFTS","C1753 - HC BIOPSY FORC LVL D"]
["HARVARD PILGRIM HEALTH CARE","C1753 - HC BIOPSY FORC LVL D"]
["CIGNA HEALTHCARE","C1753 - HC BIOPSY FORC LVL D"]
["UNITED HEALTHCARE","C1756 - HC PACING WIRE"]
["TUFTS","C1756 - HC PACING WIRE"]
["HARVARD PILGRIM HEALTH CARE","C1756 - HC PACING WIRE"]
["CIGNA HEALTHCARE","C1756 - HC PACING WIRE"]
["TUFTS","C1757 - HC CATH,THROMB/EMB,LVL 2"]
["UNITED HEALTHCARE","C1757 - HC CATH,THROMB/EMB,LVL 2"]
["HARVARD PILGRIM HEALTH CARE","C1757 - HC CATH,THROMB/EMB,LVL 2"]
["CIGNA HEALTHCARE","C1757 - HC CATH,THROMB/EMB,LVL 2"]
["TUFTS","C1759 - HC CATH, ULTRASOUND LVL 2"]
["UNITED HEALTHCARE","C1759 - HC CATH, ULTRASOUND LVL 2"]
["HARVARD PILGRIM HEALTH CARE","C1759 - HC CATH, ULTRASOUND LVL 2"]
["CIGNA HEALTHCARE","C1759 - HC CATH, ULTRASOUND LVL 2"]
["UNITED HEALTHCARE","C1760 - HC CENTRAL LINE KIT"]
["TUFTS","C1760 - HC CENTRAL LINE KIT"]
["HARVARD PILGRIM HEALTH CARE","C1760 - HC CENTRAL LINE KIT"]
["CIGNA HEALTHCARE","C1760 - HC CENTRAL LINE KIT"]
["UNITED HEALTHCARE","C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN"]
["TUFTS","C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN"]
["HARVARD PILGRIM HEALTH CARE","C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN"]
["CIGNA HEALTHCARE","C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN"]
["TUFTS","C1763 - HC SM6X16-STEM HEM"]
["UNITED HEALTHCARE","C1763 - HC SM6X16-STEM HEM"]
["HARVARD PILGRIM HEALTH CARE","C1763 - HC SM6X16-STEM HEM"]
["CIGNA HEALTHCARE","C1763 - HC SM6X16-STEM HEM"]
["UNITED HEALTHCARE","C1764 - HC RECORDER;IMPLANTABLE LOOP"]
["TUFTS","C1764 - HC RECORDER;IMPLANTABLE LOOP"]
["HARVARD PILGRIM HEALTH CARE","C1764 - HC RECORDER;IMPLANTABLE LOOP"]
["CIGNA HEALTHCARE","C1764 - HC RECORDER;IMPLANTABLE LOOP"]
["UNITED HEALTHCARE","C1765 - ADHESION BARRIER"]
["TUFTS","C1765 - ADHESION BARRIER"]
["HARVARD PILGRIM HEALTH CARE","C1765 - ADHESION BARRIER"]
["CIGNA HEALTHCARE","C1765 - ADHESION BARRIER"]
["UNITED HEALTHCARE","C1766 - SHTH INTRO 65CM 15FR 12FR"]
["TUFTS","C1766 - SHTH INTRO 65CM 15FR 12FR"]
["HARVARD PILGRIM HEALTH CARE","C1766 - SHTH INTRO 65CM 15FR 12FR"]
["CIGNA HEALTHCARE","C1766 - SHTH INTRO 65CM 15FR 12FR"]
["TUFTS","C1768 - HC TAVR HEART VALVE KIT"]
["UNITED HEALTHCARE","C1768 - HC TAVR HEART VALVE KIT"]
["HARVARD PILGRIM HEALTH CARE","C1768 - HC TAVR HEART VALVE KIT"]
["CIGNA HEALTHCARE","C1768 - HC TAVR HEART VALVE KIT"]
["UNITED HEALTHCARE","C1769 - GUIDE WIRE"]
["TUFTS","C1769 - GUIDE WIRE"]
["HARVARD PILGRIM HEALTH CARE","C1769 - GUIDE WIRE"]
["CIGNA HEALTHCARE","C1769 - GUIDE WIRE"]
["UNITED HEALTHCARE","C1770 - IMAGING COIL, MR, INSERTABLE"]
["TUFTS","C1770 - IMAGING COIL, MR, INSERTABLE"]
["HARVARD PILGRIM HEALTH CARE","C1770 - IMAGING COIL, MR, INSERTABLE"]
["CIGNA HEALTHCARE","C1770 - IMAGING COIL, MR, INSERTABLE"]
["UNITED HEALTHCARE","C1773 - HC GUIDEWIRE LVL E"]
["TUFTS","C1773 - HC GUIDEWIRE LVL E"]
["HARVARD PILGRIM HEALTH CARE","C1773 - HC GUIDEWIRE LVL E"]
["CIGNA HEALTHCARE","C1773 - HC GUIDEWIRE LVL E"]
["TUFTS","C1776 - HC HEMI-TIB PLATEAU W MENISC"]
["UNITED HEALTHCARE","C1776 - HC HEMI-TIB PLATEAU W MENISC"]
["HARVARD PILGRIM HEALTH CARE","C1776 - HC HEMI-TIB PLATEAU W MENISC"]
["CIGNA HEALTHCARE","C1776 - HC HEMI-TIB PLATEAU W MENISC"]
["UNITED HEALTHCARE","C1777 - HC LEAD,ICD,1COIL"]
["TUFTS","C1777 - HC LEAD,ICD,1COIL"]
["HARVARD PILGRIM HEALTH CARE","C1777 - HC LEAD,ICD,1COIL"]
["CIGNA HEALTHCARE","C1777 - HC LEAD,ICD,1COIL"]
["UNITED HEALTHCARE","C1781 - MESH (IMPLANTABLE)"]
["TUFTS","C1781 - MESH (IMPLANTABLE)"]
["HARVARD PILGRIM HEALTH CARE","C1781 - MESH (IMPLANTABLE)"]
["CIGNA HEALTHCARE","C1781 - MESH (IMPLANTABLE)"]
["UNITED HEALTHCARE","C1784 - HC DES PERIPHERAL STENT"]
["TUFTS","C1784 - HC DES PERIPHERAL STENT"]
["HARVARD PILGRIM HEALTH CARE","C1784 - HC DES PERIPHERAL STENT"]
["CIGNA HEALTHCARE","C1784 - HC DES PERIPHERAL STENT"]
["TUFTS","C1785 - HC PACER;2CH, RECALL $0"]
["UNITED HEALTHCARE","C1785 - HC PACER;2CH, RECALL $0"]
["HARVARD PILGRIM HEALTH CARE","C1785 - HC PACER;2CH, RECALL $0"]
["CIGNA HEALTHCARE","C1785 - HC PACER;2CH, RECALL $0"]
["UNITED HEALTHCARE","C1786 - HC PACER;1CH, RECALL $0"]
["TUFTS","C1786 - HC PACER;1CH, RECALL $0"]
["HARVARD PILGRIM HEALTH CARE","C1786 - HC PACER;1CH, RECALL $0"]
["CIGNA HEALTHCARE","C1786 - HC PACER;1CH, RECALL $0"]
["UNITED HEALTHCARE","C1788 - HC PORTACATH ANY"]
["TUFTS","C1788 - HC PORTACATH ANY"]
["HARVARD PILGRIM HEALTH CARE","C1788 - HC PORTACATH ANY"]
["CIGNA HEALTHCARE","C1788 - HC PORTACATH ANY"]
["UNITED HEALTHCARE","C1817 - HC OCCKYDER;ASD/PFO"]
["TUFTS","C1817 - HC OCCKYDER;ASD/PFO"]
["HARVARD PILGRIM HEALTH CARE","C1817 - HC OCCKYDER;ASD/PFO"]
["CIGNA HEALTHCARE","C1817 - HC OCCKYDER;ASD/PFO"]
["TUFTS","C1821 - HC INTERSPINOUS IMPLANT"]
["UNITED HEALTHCARE","C1821 - HC INTERSPINOUS IMPLANT"]
["HARVARD PILGRIM HEALTH CARE","C1821 - HC INTERSPINOUS IMPLANT"]
["CIGNA HEALTHCARE","C1821 - HC INTERSPINOUS IMPLANT"]
["UNITED HEALTHCARE","C1874 - STENT WALLFLEX SYSTEM"]
["TUFTS","C1874 - STENT WALLFLEX SYSTEM"]
["HARVARD PILGRIM HEALTH CARE","C1874 - STENT WALLFLEX SYSTEM"]
["CIGNA HEALTHCARE","C1874 - STENT WALLFLEX SYSTEM"]
["UNITED HEALTHCARE","C1876 - STENT BILIARY"]
["TUFTS","C1876 - STENT BILIARY"]
["HARVARD PILGRIM HEALTH CARE","C1876 - STENT BILIARY"]
["CIGNA HEALTHCARE","C1876 - STENT BILIARY"]
["UNITED HEALTHCARE","C1880 - IVC FILTERS"]
["TUFTS","C1880 - IVC FILTERS"]
["HARVARD PILGRIM HEALTH CARE","C1880 - IVC FILTERS"]
["CIGNA HEALTHCARE","C1880 - IVC FILTERS"]
["TUFTS","C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0"]
["UNITED HEALTHCARE","C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0"]
["HARVARD PILGRIM HEALTH CARE","C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0"]
["CIGNA HEALTHCARE","C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0"]
["UNITED HEALTHCARE","C1883 - HC ADAPTOR;BI-VENT PACER"]
["TUFTS","C1883 - HC ADAPTOR;BI-VENT PACER"]
["HARVARD PILGRIM HEALTH CARE","C1883 - HC ADAPTOR;BI-VENT PACER"]
["CIGNA HEALTHCARE","C1883 - HC ADAPTOR;BI-VENT PACER"]
["TUFTS","C1884 - EMBOLIZATION PROTECT SYST"]
["UNITED HEALTHCARE","C1884 - EMBOLIZATION PROTECT SYST"]
["HARVARD PILGRIM HEALTH CARE","C1884 - EMBOLIZATION PROTECT SYST"]
["CIGNA HEALTHCARE","C1884 - EMBOLIZATION PROTECT SYST"]
["UNITED HEALTHCARE","C1887 - HC CATH,EP;R-F,30D THERM RMT"]
["TUFTS","C1887 - HC CATH,EP;R-F,30D THERM RMT"]
["HARVARD PILGRIM HEALTH CARE","C1887 - HC CATH,EP;R-F,30D THERM RMT"]
["CIGNA HEALTHCARE","C1887 - HC CATH,EP;R-F,30D THERM RMT"]
["TUFTS","C1892 - HC SHEATH;GUIDING"]
["UNITED HEALTHCARE","C1892 - HC SHEATH;GUIDING"]
["HARVARD PILGRIM HEALTH CARE","C1892 - HC SHEATH;GUIDING"]
["CIGNA HEALTHCARE","C1892 - HC SHEATH;GUIDING"]
["UNITED HEALTHCARE","C1893 - HC DILATOR SHEATH/VISISHEATH"]
["TUFTS","C1893 - HC DILATOR SHEATH/VISISHEATH"]
["HARVARD PILGRIM HEALTH CARE","C1893 - HC DILATOR SHEATH/VISISHEATH"]
["CIGNA HEALTHCARE","C1893 - HC DILATOR SHEATH/VISISHEATH"]
["UNITED HEALTHCARE","C1894 - HC INTRO/SHEATH NON-CARD LV2"]
["TUFTS","C1894 - HC INTRO/SHEATH NON-CARD LV2"]
["HARVARD PILGRIM HEALTH CARE","C1894 - HC INTRO/SHEATH NON-CARD LV2"]
["CIGNA HEALTHCARE","C1894 - HC INTRO/SHEATH NON-CARD LV2"]
["UNITED HEALTHCARE","C1895 - HC ICD LEAD,2COIL"]
["TUFTS","C1895 - HC ICD LEAD,2COIL"]
["HARVARD PILGRIM HEALTH CARE","C1895 - HC ICD LEAD,2COIL"]
["CIGNA HEALTHCARE","C1895 - HC ICD LEAD,2COIL"]
["TUFTS","C1896 - HC SICD PULSE GENERATOR"]
["UNITED HEALTHCARE","C1896 - HC SICD PULSE GENERATOR"]
["HARVARD PILGRIM HEALTH CARE","C1896 - HC SICD PULSE GENERATOR"]
["CIGNA HEALTHCARE","C1896 - HC SICD PULSE GENERATOR"]
["TUFTS","C1898 - HC KIT,PACER;BI-VENT(#6216/8"]
["UNITED HEALTHCARE","C1898 - HC KIT,PACER;BI-VENT(#6216/8"]
["HARVARD PILGRIM HEALTH CARE","C1898 - HC KIT,PACER;BI-VENT(#6216/8"]
["CIGNA HEALTHCARE","C1898 - HC KIT,PACER;BI-VENT(#6216/8"]
["UNITED HEALTHCARE","C1900 - HC INJ;OCTAFLUORO MICRO/1ML"]
["TUFTS","C1900 - HC INJ;OCTAFLUORO MICRO/1ML"]
["HARVARD PILGRIM HEALTH CARE","C1900 - HC INJ;OCTAFLUORO MICRO/1ML"]
["CIGNA HEALTHCARE","C1900 - HC INJ;OCTAFLUORO MICRO/1ML"]
["TUFTS","C2615 - SEALANT, PULMONARY, LIQUID"]
["UNITED HEALTHCARE","C2615 - SEALANT, PULMONARY, LIQUID"]
["HARVARD PILGRIM HEALTH CARE","C2615 - SEALANT, PULMONARY, LIQUID"]
["CIGNA HEALTHCARE","C2615 - SEALANT, PULMONARY, LIQUID"]
["TUFTS","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE"]
["UNITED HEALTHCARE","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE"]
["HARVARD PILGRIM HEALTH CARE","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE"]
["BLUE CROSS OUT OF STATE","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE"]
["CIGNA HEALTHCARE","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE"]
["BLUE CROSS","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE"]
["BLUE BENEFIT ADMINISTRATORS","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE"]
["TUFTS","C2617 - STENT ZIMMON BILIARY"]
["UNITED HEALTHCARE","C2617 - STENT ZIMMON BILIARY"]
["HARVARD PILGRIM HEALTH CARE","C2617 - STENT ZIMMON BILIARY"]
["CIGNA HEALTHCARE","C2617 - STENT ZIMMON BILIARY"]
["TUFTS","C2621 - HC PACER;2CH, W/ BACKUP DEFIB"]
["UNITED HEALTHCARE","C2621 - HC PACER;2CH, W/ BACKUP DEFIB"]
["HARVARD PILGRIM HEALTH CARE","C2621 - HC PACER;2CH, W/ BACKUP DEFIB"]
["CIGNA HEALTHCARE","C2621 - HC PACER;2CH, W/ BACKUP DEFIB"]
["TUFTS","C2623 - CATH TRANSLUMIN DRUG-COAT"]
["UNITED HEALTHCARE","C2623 - CATH TRANSLUMIN DRUG-COAT"]
["HARVARD PILGRIM HEALTH CARE","C2623 - CATH TRANSLUMIN DRUG-COAT"]
["CIGNA HEALTHCARE","C2623 - CATH TRANSLUMIN DRUG-COAT"]
["TUFTS","C2625 - STENT BILIARY COTTON"]
["UNITED HEALTHCARE","C2625 - STENT BILIARY COTTON"]
["HARVARD PILGRIM HEALTH CARE","C2625 - STENT BILIARY COTTON"]
["CIGNA HEALTHCARE","C2625 - STENT BILIARY COTTON"]
["TUFTS","C2628 - HC KIT CATH BRIDGE PRE"]
["UNITED HEALTHCARE","C2628 - HC KIT CATH BRIDGE PRE"]
["HARVARD PILGRIM HEALTH CARE","C2628 - HC KIT CATH BRIDGE PRE"]
["CIGNA HEALTHCARE","C2628 - HC KIT CATH BRIDGE PRE"]
["TUFTS","C2630 - HC CATH;EP CRYOABLATION, 8 MM"]
["UNITED HEALTHCARE","C2630 - HC CATH;EP CRYOABLATION, 8 MM"]
["HARVARD PILGRIM HEALTH CARE","C2630 - HC CATH;EP CRYOABLATION, 8 MM"]
["CIGNA HEALTHCARE","C2630 - HC CATH;EP CRYOABLATION, 8 MM"]
["TUFTS","C2634 - BRACHYTX, NON-STR, HA, I-125"]
["UNITED HEALTHCARE","C2634 - BRACHYTX, NON-STR, HA, I-125"]
["HARVARD PILGRIM HEALTH CARE","C2634 - BRACHYTX, NON-STR, HA, I-125"]
["CIGNA HEALTHCARE","C2634 - BRACHYTX, NON-STR, HA, I-125"]
["TUFTS","C2635 - BRACHYTX, NON-STR, HA, P-103"]
["UNITED HEALTHCARE","C2635 - BRACHYTX, NON-STR, HA, P-103"]
["HARVARD PILGRIM HEALTH CARE","C2635 - BRACHYTX, NON-STR, HA, P-103"]
["BLUE CROSS OUT OF STATE","C2635 - BRACHYTX, NON-STR, HA, P-103"]
["CIGNA HEALTHCARE","C2635 - BRACHYTX, NON-STR, HA, P-103"]
["BLUE CROSS","C2635 - BRACHYTX, NON-STR, HA, P-103"]
["BLUE BENEFIT ADMINISTRATORS","C2635 - BRACHYTX, NON-STR, HA, P-103"]
["TUFTS","C2639 - BRACHYTX, NON-STRANDED,I-125"]
["UNITED HEALTHCARE","C2639 - BRACHYTX, NON-STRANDED,I-125"]
["HARVARD PILGRIM HEALTH CARE","C2639 - BRACHYTX, NON-STRANDED,I-125"]
["BLUE CROSS OUT OF STATE","C2639 - BRACHYTX, NON-STRANDED,I-125"]
["CIGNA HEALTHCARE","C2639 - BRACHYTX, NON-STRANDED,I-125"]
["BLUE CROSS","C2639 - BRACHYTX, NON-STRANDED,I-125"]
["BLUE BENEFIT ADMINISTRATORS","C2639 - BRACHYTX, NON-STRANDED,I-125"]
["TUFTS","C5275 - HC LOW COST SKIN SUBSTITUTE"]
["UNITED HEALTHCARE","C5275 - HC LOW COST SKIN SUBSTITUTE"]
["HARVARD PILGRIM HEALTH CARE","C5275 - HC LOW COST SKIN SUBSTITUTE"]
["BLUE CROSS OUT OF STATE","C5275 - HC LOW COST SKIN SUBSTITUTE"]
["CIGNA HEALTHCARE","C5275 - HC LOW COST SKIN SUBSTITUTE"]
["BLUE CROSS","C5275 - HC LOW COST SKIN SUBSTITUTE"]
["BLUE BENEFIT ADMINISTRATORS","C5275 - HC LOW COST SKIN SUBSTITUTE"]
["AETNA","C5275 - HC LOW COST SKIN SUBSTITUTE"]
["TUFTS","C8908 - HC MRI W/O FOL W/CONT, BREAST,"]
["UNITED HEALTHCARE","C8908 - HC MRI W/O FOL W/CONT, BREAST,"]
["HARVARD PILGRIM HEALTH CARE","C8908 - HC MRI W/O FOL W/CONT, BREAST,"]
["BLUE CROSS OUT OF STATE","C8908 - HC MRI W/O FOL W/CONT, BREAST,"]
["CIGNA HEALTHCARE","C8908 - HC MRI W/O FOL W/CONT, BREAST,"]
["BLUE CROSS","C8908 - HC MRI W/O FOL W/CONT, BREAST,"]
["BLUE BENEFIT ADMINISTRATORS","C8908 - HC MRI W/O FOL W/CONT, BREAST,"]
["TUFTS","C8937 - CAD BREAST MRI"]
["UNITED HEALTHCARE","C8937 - CAD BREAST MRI"]
["HARVARD PILGRIM HEALTH CARE","C8937 - CAD BREAST MRI"]
["CIGNA HEALTHCARE","C8937 - CAD BREAST MRI"]
["TUFTS","C9358 - SURGIMEND, FETAL"]
["UNITED HEALTHCARE","C9358 - SURGIMEND, FETAL"]
["HARVARD PILGRIM HEALTH CARE","C9358 - SURGIMEND, FETAL"]
["BLUE CROSS OUT OF STATE","C9358 - SURGIMEND, FETAL"]
["CIGNA HEALTHCARE","C9358 - SURGIMEND, FETAL"]
["BLUE CROSS","C9358 - SURGIMEND, FETAL"]
["BLUE BENEFIT ADMINISTRATORS","C9358 - SURGIMEND, FETAL"]
["TUFTS","C9728 - PLACE DEVICE/MARKER, NON PRO"]
["UNITED HEALTHCARE","C9728 - PLACE DEVICE/MARKER, NON PRO"]
["HARVARD PILGRIM HEALTH CARE","C9728 - PLACE DEVICE/MARKER, NON PRO"]
["BLUE CROSS OUT OF STATE","C9728 - PLACE DEVICE/MARKER, NON PRO"]
["CIGNA HEALTHCARE","C9728 - PLACE DEVICE/MARKER, NON PRO"]
["BLUE CROSS","C9728 - PLACE DEVICE/MARKER, NON PRO"]
["BLUE BENEFIT ADMINISTRATORS","C9728 - PLACE DEVICE/MARKER, NON PRO"]
["TUFTS","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3"]
["UNITED HEALTHCARE","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3"]
["HARVARD PILGRIM HEALTH CARE","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3"]
["BLUE CROSS OUT OF STATE","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3"]
["CIGNA HEALTHCARE","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3"]
["BLUE CROSS","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3"]
["BLUE BENEFIT ADMINISTRATORS","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3"]
["AETNA","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3"]
["TUFTS","C9803 - HC OP VISIT SPEC COLLECTION SEVERE ACUTE RESP SYDROM COVID-19"]
["CIGNA HEALTHCARE","C9803 - HC OP VISIT SPEC COLLECTION SEVERE ACUTE RESP SYDROM COVID-19"]
["TUFTS","D0150 - COMPREHENSIVE ORAL EXAM 60MIN"]
["CIGNA HEALTHCARE","D0150 - COMPREHENSIVE ORAL EXAM 60MIN"]
["BLUE CROSS OUT OF STATE","D0210 - INTRAORAL - COMPLETE SERIES OF RADIOGRAPHIC IMAGES"]
["BLUE CROSS","D0210 - INTRAORAL - COMPLETE SERIES OF RADIOGRAPHIC IMAGES"]
["BLUE BENEFIT ADMINISTRATORS","D0210 - INTRAORAL - COMPLETE SERIES OF RADIOGRAPHIC IMAGES"]
["BLUE CROSS OUT OF STATE","D0220 - INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE"]
["BLUE CROSS","D0220 - INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE"]
["BLUE BENEFIT ADMINISTRATORS","D0220 - INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE"]
["BLUE CROSS OUT OF STATE","D0230 - INTRAORAL - PERIAPICAL EACH ADDITIONAL RADIOGRAPHIC IMAGE"]
["BLUE CROSS","D0230 - INTRAORAL - PERIAPICAL EACH ADDITIONAL RADIOGRAPHIC IMAGE"]
["BLUE BENEFIT ADMINISTRATORS","D0230 - INTRAORAL - PERIAPICAL EACH ADDITIONAL RADIOGRAPHIC IMAGE"]
["TUFTS","D0240 - INTRAORAL - OCCLUSAL RADIOGRAPHIC IMAGE"]
["CIGNA HEALTHCARE","D0240 - INTRAORAL - OCCLUSAL RADIOGRAPHIC IMAGE"]
["TUFTS","D0250 - HC EXTRA-ORAL - 2D PROJECTION RAD IMAGE CREATED USING A STATIONARY RADIATION SOURCE, AND DETECTOR"]
["CIGNA HEALTHCARE","D0250 - HC EXTRA-ORAL - 2D PROJECTION RAD IMAGE CREATED USING A STATIONARY RADIATION SOURCE, AND DETECTOR"]
["TUFTS","D0251 - HC EXTRA-ORAL POSTERIOR DENTAL RADIOGRAPHIC IMAGE"]
["CIGNA HEALTHCARE","D0251 - HC EXTRA-ORAL POSTERIOR DENTAL RADIOGRAPHIC IMAGE"]
["TUFTS","D0270 - BITEWING - SINGLE RADIOGRAPHIC IMAGE"]
["CIGNA HEALTHCARE","D0270 - BITEWING - SINGLE RADIOGRAPHIC IMAGE"]
["TUFTS","D0272 - BITEWINGS - TWO RADIOGRAPHIC IMAGES"]
["BLUE CROSS OUT OF STATE","D0272 - BITEWINGS - TWO RADIOGRAPHIC IMAGES"]
["CIGNA HEALTHCARE","D0272 - BITEWINGS - TWO RADIOGRAPHIC IMAGES"]
["BLUE CROSS","D0272 - BITEWINGS - TWO RADIOGRAPHIC IMAGES"]
["BLUE BENEFIT ADMINISTRATORS","D0272 - BITEWINGS - TWO RADIOGRAPHIC IMAGES"]
["TUFTS","D0274 - BITEWINGS - FOUR RADIOGRAPHIC IMAGES"]
["BLUE CROSS OUT OF STATE","D0274 - BITEWINGS - FOUR RADIOGRAPHIC IMAGES"]
["CIGNA HEALTHCARE","D0274 - BITEWINGS - FOUR RADIOGRAPHIC IMAGES"]
["BLUE CROSS","D0274 - BITEWINGS - FOUR RADIOGRAPHIC IMAGES"]
["BLUE BENEFIT ADMINISTRATORS","D0274 - BITEWINGS - FOUR RADIOGRAPHIC IMAGES"]
["TUFTS","D0277 - HC VERTICAL BITEWINGS - 7 TO 8 RADIOGRAPHIC IMAGES"]
["CIGNA HEALTHCARE","D0277 - HC VERTICAL BITEWINGS - 7 TO 8 RADIOGRAPHIC IMAGES"]
["TUFTS","D0472 - HC ACCESSION OF TISSUE, GROSS EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN REPORT"]
["CIGNA HEALTHCARE","D0472 - HC ACCESSION OF TISSUE, GROSS EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN REPORT"]
["TUFTS","D0473 - HC ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAM, PREP AND TRANS OF RPT."]
["CIGNA HEALTHCARE","D0473 - HC ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAM, PREP AND TRANS OF RPT."]
["TUFTS","D0474 - HC ACCESSION OF TISSUE, GROSS AND MICRO EXAM, INCL. ASSESS. OF MARGINS FOR DISEASE, PREP., TX OF RPT"]
["CIGNA HEALTHCARE","D0474 - HC ACCESSION OF TISSUE, GROSS AND MICRO EXAM, INCL. ASSESS. OF MARGINS FOR DISEASE, PREP., TX OF RPT"]
["TUFTS","D0480 - HC ACCESSION OF EXFOLIATIVE CYTOLOGIC SMEARS, MICROSCOPIC EXAM, PREP AND TRANS OF RPT"]
["CIGNA HEALTHCARE","D0480 - HC ACCESSION OF EXFOLIATIVE CYTOLOGIC SMEARS, MICROSCOPIC EXAM, PREP AND TRANS OF RPT"]
["TUFTS","D1110 - PROPHYLAXIS - ADULT"]
["BLUE CROSS OUT OF STATE","D1110 - PROPHYLAXIS - ADULT"]
["CIGNA HEALTHCARE","D1110 - PROPHYLAXIS - ADULT"]
["BLUE CROSS","D1110 - PROPHYLAXIS - ADULT"]
["BLUE BENEFIT ADMINISTRATORS","D1110 - PROPHYLAXIS - ADULT"]
["BLUE CROSS OUT OF STATE","D1120 - PROPHYLAXIS - CHILD"]
["BLUE CROSS","D1120 - PROPHYLAXIS - CHILD"]
["BLUE BENEFIT ADMINISTRATORS","D1120 - PROPHYLAXIS - CHILD"]
["BLUE CROSS OUT OF STATE","D1351 - SEALANT - PER TOOTH"]
["BLUE CROSS","D1351 - SEALANT - PER TOOTH"]
["BLUE BENEFIT ADMINISTRATORS","D1351 - SEALANT - PER TOOTH"]
["TUFTS","D1510 - SPACE MAINTAINER - FIXED - UNILATERAL"]
["CIGNA HEALTHCARE","D1510 - SPACE MAINTAINER - FIXED - UNILATERAL"]
["TUFTS","D1516 - SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MAXILLARY"]
["CIGNA HEALTHCARE","D1516 - SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MAXILLARY"]
["TUFTS","D1517 - SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MANDIBULAR"]
["CIGNA HEALTHCARE","D1517 - SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MANDIBULAR"]
["TUFTS","D1575 - HC DISTAL SHOE SPACE MAINTAINER ¿ FIXED ¿ UNILATERAL"]
["CIGNA HEALTHCARE","D1575 - HC DISTAL SHOE SPACE MAINTAINER ¿ FIXED ¿ UNILATERAL"]
["BLUE CROSS OUT OF STATE","D2140 - AMALGAM - ONE SURFACE, PRIMARY OR PERMANENT"]
["BLUE CROSS","D2140 - AMALGAM - ONE SURFACE, PRIMARY OR PERMANENT"]
["BLUE BENEFIT ADMINISTRATORS","D2140 - AMALGAM - ONE SURFACE, PRIMARY OR PERMANENT"]
["BLUE CROSS OUT OF STATE","D2150 - AMALGAM - TWO SURFACES, PRIMARY OR PERMANENT"]
["BLUE CROSS","D2150 - AMALGAM - TWO SURFACES, PRIMARY OR PERMANENT"]
["BLUE BENEFIT ADMINISTRATORS","D2150 - AMALGAM - TWO SURFACES, PRIMARY OR PERMANENT"]
["BLUE CROSS OUT OF STATE","D2160 - AMALGAM - THREE SURFACES, PRIMARY OR PERMANENT"]
["BLUE CROSS","D2160 - AMALGAM - THREE SURFACES, PRIMARY OR PERMANENT"]
["BLUE BENEFIT ADMINISTRATORS","D2160 - AMALGAM - THREE SURFACES, PRIMARY OR PERMANENT"]
["BLUE CROSS OUT OF STATE","D2161 - AMALGAM - FOUR OR MORE SURFACES, PRIMARY OR PERMANENT"]
["BLUE CROSS","D2161 - AMALGAM - FOUR OR MORE SURFACES, PRIMARY OR PERMANENT"]
["BLUE BENEFIT ADMINISTRATORS","D2161 - AMALGAM - FOUR OR MORE SURFACES, PRIMARY OR PERMANENT"]
["BLUE CROSS OUT OF STATE","D2330 - RESIN-BASED COMPOSITE - ONE SURFACE, ANTERIOR"]
["BLUE CROSS","D2330 - RESIN-BASED COMPOSITE - ONE SURFACE, ANTERIOR"]
["BLUE BENEFIT ADMINISTRATORS","D2330 - RESIN-BASED COMPOSITE - ONE SURFACE, ANTERIOR"]
["BLUE CROSS OUT OF STATE","D2331 - RESIN-BASED COMPOSITE - TWO SURFACES, ANTERIOR"]
["BLUE CROSS","D2331 - RESIN-BASED COMPOSITE - TWO SURFACES, ANTERIOR"]
["BLUE BENEFIT ADMINISTRATORS","D2331 - RESIN-BASED COMPOSITE - TWO SURFACES, ANTERIOR"]
["BLUE CROSS OUT OF STATE","D2332 - RESIN-BASED COMPOSITE - THREE SURFACES, ANTERIOR"]
["BLUE CROSS","D2332 - RESIN-BASED COMPOSITE - THREE SURFACES, ANTERIOR"]
["BLUE BENEFIT ADMINISTRATORS","D2332 - RESIN-BASED COMPOSITE - THREE SURFACES, ANTERIOR"]
["BLUE CROSS OUT OF STATE","D2335 - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR)"]
["BLUE CROSS","D2335 - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR)"]
["BLUE BENEFIT ADMINISTRATORS","D2335 - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR)"]
["BLUE CROSS OUT OF STATE","D2390 - RESIN-BASED COMPOSITE CROWN, ANTERIOR"]
["BLUE CROSS","D2390 - RESIN-BASED COMPOSITE CROWN, ANTERIOR"]
["BLUE BENEFIT ADMINISTRATORS","D2390 - RESIN-BASED COMPOSITE CROWN, ANTERIOR"]
["BLUE CROSS OUT OF STATE","D2391 - RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR"]
["BLUE CROSS","D2391 - RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR"]
["BLUE BENEFIT ADMINISTRATORS","D2391 - RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR"]
["BLUE CROSS OUT OF STATE","D2392 - RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR"]
["BLUE CROSS","D2392 - RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR"]
["BLUE BENEFIT ADMINISTRATORS","D2392 - RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR"]
["BLUE CROSS OUT OF STATE","D2393 - RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR"]
["BLUE CROSS","D2393 - RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR"]
["BLUE BENEFIT ADMINISTRATORS","D2393 - RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR"]
["BLUE CROSS OUT OF STATE","D2394 - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR"]
["BLUE CROSS","D2394 - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR"]
["BLUE BENEFIT ADMINISTRATORS","D2394 - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR"]
["BLUE CROSS OUT OF STATE","D2740 - CROWN - PORCELAIN/CERAMIC SUBSTRATE"]
["BLUE CROSS","D2740 - CROWN - PORCELAIN/CERAMIC SUBSTRATE"]
["BLUE BENEFIT ADMINISTRATORS","D2740 - CROWN - PORCELAIN/CERAMIC SUBSTRATE"]
["BLUE CROSS OUT OF STATE","D2930 - PREFABRICATED STAINLESS STEEL CROWN - PRIMARY TOOTH"]
["BLUE CROSS","D2930 - PREFABRICATED STAINLESS STEEL CROWN - PRIMARY TOOTH"]
["BLUE BENEFIT ADMINISTRATORS","D2930 - PREFABRICATED STAINLESS STEEL CROWN - PRIMARY TOOTH"]
["BLUE CROSS OUT OF STATE","D2931 - PREFABRICATED STAINLESS STEEL CROWN - PERMANENT TOOTH"]
["BLUE CROSS","D2931 - PREFABRICATED STAINLESS STEEL CROWN - PERMANENT TOOTH"]
["BLUE BENEFIT ADMINISTRATORS","D2931 - PREFABRICATED STAINLESS STEEL CROWN - PERMANENT TOOTH"]
["BLUE CROSS OUT OF STATE","D2940 - PROTECTIVE RESTORATION"]
["BLUE CROSS","D2940 - PROTECTIVE RESTORATION"]
["BLUE BENEFIT ADMINISTRATORS","D2940 - PROTECTIVE RESTORATION"]
["TUFTS","D2999 - HC UNSPECIFIED RESTORATIVE PROCEDURE, BY REPORT"]
["CIGNA HEALTHCARE","D2999 - HC UNSPECIFIED RESTORATIVE PROCEDURE, BY REPORT"]
["BLUE CROSS OUT OF STATE","D3110 - HC PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION)"]
["BLUE CROSS","D3110 - HC PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION)"]
["BLUE BENEFIT ADMINISTRATORS","D3110 - HC PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION)"]
["BLUE CROSS OUT OF STATE","D3220 - THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) - REMOVAL OF PULP CORONAL TO THE DENTINOCEMENTAL JUNCTION AND APPLICATION OF MEDICAMENT"]
["BLUE CROSS","D3220 - THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) - REMOVAL OF PULP CORONAL TO THE DENTINOCEMENTAL JUNCTION AND APPLICATION OF MEDICAMENT"]
["BLUE BENEFIT ADMINISTRATORS","D3220 - THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) - REMOVAL OF PULP CORONAL TO THE DENTINOCEMENTAL JUNCTION AND APPLICATION OF MEDICAMENT"]
["BLUE CROSS OUT OF STATE","D3310 - ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION)"]
["BLUE CROSS","D3310 - ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION)"]
["BLUE BENEFIT ADMINISTRATORS","D3310 - ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION)"]
["BLUE CROSS OUT OF STATE","D3330 - ENDODONTIC THERAPY, MOLAR (EXCLUDING FINAL RESTORATION)"]
["BLUE CROSS","D3330 - ENDODONTIC THERAPY, MOLAR (EXCLUDING FINAL RESTORATION)"]
["BLUE BENEFIT ADMINISTRATORS","D3330 - ENDODONTIC THERAPY, MOLAR (EXCLUDING FINAL RESTORATION)"]
["TUFTS","D3460 - HC ENDODONTIC ENDOSSEOUS IMPLANT"]
["CIGNA HEALTHCARE","D3460 - HC ENDODONTIC ENDOSSEOUS IMPLANT"]
["TUFTS","D3999 - HC UNSPECIFIED ENDODONTIC PROCEDURE, BY REPORT"]
["CIGNA HEALTHCARE","D3999 - HC UNSPECIFIED ENDODONTIC PROCEDURE, BY REPORT"]
["TUFTS","D4260 - HC OSSEOUS SURGERY FOUR OR MORE CONT. TEETH OR TOOTH BOUNDED SPACES PER QUAD."]
["CIGNA HEALTHCARE","D4260 - HC OSSEOUS SURGERY FOUR OR MORE CONT. TEETH OR TOOTH BOUNDED SPACES PER QUAD."]
["TUFTS","D4263 - HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ FIRST SITE IN QUADRANT"]
["CIGNA HEALTHCARE","D4263 - HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ FIRST SITE IN QUADRANT"]
["TUFTS","D4264 - HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ EACH ADDITIONAL SITE IN QUADRANT"]
["CIGNA HEALTHCARE","D4264 - HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ EACH ADDITIONAL SITE IN QUADRANT"]
["TUFTS","D4270 - HC PEDICLE SOFT TISSUE GRAFT PROCEDURE"]
["CIGNA HEALTHCARE","D4270 - HC PEDICLE SOFT TISSUE GRAFT PROCEDURE"]
["TUFTS","D4273 - HC AUTOGENOUS CONN. TISSUE GRAFT PROC. 1ST TOOTH, IMPLANT, OR EDENTULOUS TOOTH POSITION IN GRAFT"]
["CIGNA HEALTHCARE","D4273 - HC AUTOGENOUS CONN. TISSUE GRAFT PROC. 1ST TOOTH, IMPLANT, OR EDENTULOUS TOOTH POSITION IN GRAFT"]
["TUFTS","D4355 - FULL MOUTH DEBRIDEMENT TO ENABLE COMPREHENSIVE EVALUATION AND DIAGNOSIS"]
["CIGNA HEALTHCARE","D4355 - FULL MOUTH DEBRIDEMENT TO ENABLE COMPREHENSIVE EVALUATION AND DIAGNOSIS"]
["TUFTS","D4381 - HC LOCALIZED DELIVERY - CONTROLLED RELEASE ANTIMICROB. AGENTS TO DISEASED CREVICULAR TISSUE /TOOTH"]
["CIGNA HEALTHCARE","D4381 - HC LOCALIZED DELIVERY - CONTROLLED RELEASE ANTIMICROB. AGENTS TO DISEASED CREVICULAR TISSUE /TOOTH"]
["TUFTS","D5911 - HC FACIAL MOULAGE (SECTIONAL)"]
["CIGNA HEALTHCARE","D5911 - HC FACIAL MOULAGE (SECTIONAL)"]
["TUFTS","D5912 - HC FACIAL MOULAGE (COMPLETE)"]
["CIGNA HEALTHCARE","D5912 - HC FACIAL MOULAGE (COMPLETE)"]
["TUFTS","D5983 - HC RADIATION CARRIER"]
["CIGNA HEALTHCARE","D5983 - HC RADIATION CARRIER"]
["TUFTS","D5984 - HC RADIATION SHIELD"]
["CIGNA HEALTHCARE","D5984 - HC RADIATION SHIELD"]
["TUFTS","D5985 - HC RADIATION CONE LOCATOR"]
["CIGNA HEALTHCARE","D5985 - HC RADIATION CONE LOCATOR"]
["TUFTS","D5987 - HC COMMISSURE SPLINT"]
["CIGNA HEALTHCARE","D5987 - HC COMMISSURE SPLINT"]
["TUFTS","D7140 - EXTRACTION ERUPTED TOOTH/EXR"]
["BLUE CROSS OUT OF STATE","D7140 - EXTRACTION ERUPTED TOOTH/EXR"]
["CIGNA HEALTHCARE","D7140 - EXTRACTION ERUPTED TOOTH/EXR"]
["BLUE CROSS","D7140 - EXTRACTION ERUPTED TOOTH/EXR"]
["BLUE BENEFIT ADMINISTRATORS","D7140 - EXTRACTION ERUPTED TOOTH/EXR"]
["TUFTS","D7210 - EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED"]
["BLUE CROSS OUT OF STATE","D7210 - EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED"]
["CIGNA HEALTHCARE","D7210 - EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED"]
["BLUE CROSS","D7210 - EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED"]
["BLUE BENEFIT ADMINISTRATORS","D7210 - EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED"]
["TUFTS","D7220 - REMOVAL OF IMPACTED TOOTH - SOFT TISSUE"]
["BLUE CROSS OUT OF STATE","D7220 - REMOVAL OF IMPACTED TOOTH - SOFT TISSUE"]
["CIGNA HEALTHCARE","D7220 - REMOVAL OF IMPACTED TOOTH - SOFT TISSUE"]
["BLUE CROSS","D7220 - REMOVAL OF IMPACTED TOOTH - SOFT TISSUE"]
["BLUE BENEFIT ADMINISTRATORS","D7220 - REMOVAL OF IMPACTED TOOTH - SOFT TISSUE"]
["TUFTS","D7230 - REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY"]
["CIGNA HEALTHCARE","D7230 - REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY"]
["BLUE CROSS OUT OF STATE","D7230 - REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY"]
["BLUE CROSS","D7230 - REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY"]
["BLUE BENEFIT ADMINISTRATORS","D7230 - REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY"]
["TUFTS","D7240 - REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY"]
["BLUE CROSS OUT OF STATE","D7240 - REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY"]
["CIGNA HEALTHCARE","D7240 - REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY"]
["BLUE CROSS","D7240 - REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY"]
["BLUE BENEFIT ADMINISTRATORS","D7240 - REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY"]
["TUFTS","D7250 - REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)"]
["BLUE CROSS OUT OF STATE","D7250 - REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)"]
["CIGNA HEALTHCARE","D7250 - REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)"]
["BLUE CROSS","D7250 - REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)"]
["BLUE BENEFIT ADMINISTRATORS","D7250 - REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)"]
["TUFTS","D7260 - HC OROANTRAL FISTULA CLOSURE"]
["CIGNA HEALTHCARE","D7260 - HC OROANTRAL FISTULA CLOSURE"]
["TUFTS","D7261 - PRIMARY CLOSURE OF A SINUS PERFORATION"]
["CIGNA HEALTHCARE","D7261 - PRIMARY CLOSURE OF A SINUS PERFORATION"]
["BLUE CROSS OUT OF STATE","D7310 - ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH SPACES, PER QUADRANT"]
["BLUE CROSS","D7310 - ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH SPACES, PER QUADRANT"]
["BLUE BENEFIT ADMINISTRATORS","D7310 - ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH SPACES, PER QUADRANT"]
["BLUE CROSS OUT OF STATE","D7311 - ALVEOLOPLASTY W/EXTRACT 1-3"]
["BLUE CROSS","D7311 - ALVEOLOPLASTY W/EXTRACT 1-3"]
["BLUE BENEFIT ADMINISTRATORS","D7311 - ALVEOLOPLASTY W/EXTRACT 1-3"]
["BLUE CROSS OUT OF STATE","D7410 - EXCISION OF BENIGN LESION UP TO 1.25 CM"]
["BLUE CROSS","D7410 - EXCISION OF BENIGN LESION UP TO 1.25 CM"]
["BLUE BENEFIT ADMINISTRATORS","D7410 - EXCISION OF BENIGN LESION UP TO 1.25 CM"]
["TUFTS","D7940 - HC OSTEOPLASTY - FOR ORTHOGNATHIC DEFORMITIES"]
["CIGNA HEALTHCARE","D7940 - HC OSTEOPLASTY - FOR ORTHOGNATHIC DEFORMITIES"]
["TUFTS","D9110 - PALLIATIVE (EMERGENCY) TREATMENT OF DENTAL PAIN - MINOR PROCEDURE"]
["CIGNA HEALTHCARE","D9110 - PALLIATIVE (EMERGENCY) TREATMENT OF DENTAL PAIN - MINOR PROCEDURE"]
["TUFTS","D9230 - INHALATION OF NITROUS OXIDE/ANALGESIA, ANXIOLYSIS"]
["CIGNA HEALTHCARE","D9230 - INHALATION OF NITROUS OXIDE/ANALGESIA, ANXIOLYSIS"]
["TUFTS","D9630 - HC DRUGS OR MEDICAMENTS DISPENSED IN THE OFFICE FOR HOME USE"]
["CIGNA HEALTHCARE","D9630 - HC DRUGS OR MEDICAMENTS DISPENSED IN THE OFFICE FOR HOME USE"]
["TUFTS","D9930 - HC TREATMENT OF COMPLICATIONS (POST-SURGICAL) - UNUSUAL CIRCUMSTANCES, BY REPORT"]
["CIGNA HEALTHCARE","D9930 - HC TREATMENT OF COMPLICATIONS (POST-SURGICAL) - UNUSUAL CIRCUMSTANCES, BY REPORT"]
["TUFTS","D9944 - HC OCCLUSAL GUARD ¿ HARD APPLIANCE, FULL ARCH"]
["CIGNA HEALTHCARE","D9944 - HC OCCLUSAL GUARD ¿ HARD APPLIANCE, FULL ARCH"]
["TUFTS","D9951 - OCCLUSAL ADJUSTMENT - LIMITED"]
["CIGNA HEALTHCARE","D9951 - OCCLUSAL ADJUSTMENT - LIMITED"]
["TUFTS","E0191 - PROTECTOR HEEL OR ELBOW"]
["TUFTS PUBLIC PLANS","E0191 - PROTECTOR HEEL OR ELBOW"]
["UHC COMMUNITY CARE","E0191 - PROTECTOR HEEL OR ELBOW"]
["FALLON","E0191 - PROTECTOR HEEL OR ELBOW"]
["SENIOR WHOLE HEALTH","E0191 - PROTECTOR HEEL OR ELBOW"]
["HARVARD PILGRIM HEALTH CARE","E0191 - PROTECTOR HEEL OR ELBOW"]
["BMC HEALTHNET","E0191 - PROTECTOR HEEL OR ELBOW"]
["ELDER SERVICE PLAN","E0191 - PROTECTOR HEEL OR ELBOW"]
["ELDER SERVICE PLAN OTHER","E0191 - PROTECTOR HEEL OR ELBOW"]
["COMMONWEALTH CARE ALLIANCE","E0191 - PROTECTOR HEEL OR ELBOW"]
["AETNA","E0191 - PROTECTOR HEEL OR ELBOW"]
["BLUE CROSS","E0191 - PROTECTOR HEEL OR ELBOW"]
["CIGNA HEALTHCARE","E0191 - PROTECTOR HEEL OR ELBOW"]
["TUFTS","G0101 - CA SCREEN;PELVIC/BREAST EXAM"]
["TUFTS PUBLIC PLANS","G0101 - CA SCREEN;PELVIC/BREAST EXAM"]
["FALLON","G0101 - CA SCREEN;PELVIC/BREAST EXAM"]
["BLUE CROSS OUT OF STATE","G0101 - CA SCREEN;PELVIC/BREAST EXAM"]
["BMC HEALTHNET","G0101 - CA SCREEN;PELVIC/BREAST EXAM"]
["CIGNA HEALTHCARE","G0101 - CA SCREEN;PELVIC/BREAST EXAM"]
["ALLWAYS HEALTH PARTNERS","G0101 - CA SCREEN;PELVIC/BREAST EXAM"]
["BLUE CROSS","G0101 - CA SCREEN;PELVIC/BREAST EXAM"]
["BLUE BENEFIT ADMINISTRATORS","G0101 - CA SCREEN;PELVIC/BREAST EXAM"]
["TUFTS PUBLIC PLANS","G0103 - PSA, TOTAL SCREENING"]
["FALLON","G0103 - PSA, TOTAL SCREENING"]
["BMC HEALTHNET","G0103 - PSA, TOTAL SCREENING"]
["ALLWAYS HEALTH PARTNERS","G0103 - PSA, TOTAL SCREENING"]
["TUFTS","G0103 - PSA, TOTAL SCREENING"]
["UNITED HEALTHCARE","G0103 - PSA, TOTAL SCREENING"]
["UHC COMMUNITY CARE","G0103 - PSA, TOTAL SCREENING"]
["UNICARE","G0103 - PSA, TOTAL SCREENING"]
["HARVARD PILGRIM HEALTH CARE","G0103 - PSA, TOTAL SCREENING"]
["SENIOR WHOLE HEALTH","G0103 - PSA, TOTAL SCREENING"]
["BLUE CROSS OUT OF STATE","G0103 - PSA, TOTAL SCREENING"]
["CIGNA HEALTHCARE","G0103 - PSA, TOTAL SCREENING"]
["COMMONWEALTH CARE ALLIANCE","G0103 - PSA, TOTAL SCREENING"]
["ELDER SERVICE PLAN","G0103 - PSA, TOTAL SCREENING"]
["ELDER SERVICE PLAN OTHER","G0103 - PSA, TOTAL SCREENING"]
["BLUE CROSS","G0103 - PSA, TOTAL SCREENING"]
["BLUE BENEFIT ADMINISTRATORS","G0103 - PSA, TOTAL SCREENING"]
["AETNA","G0103 - PSA, TOTAL SCREENING"]
["TUFTS","G0105 - HC COLORECTAL SCRN; HI RISK IND"]
["UNICARE","G0105 - HC COLORECTAL SCRN; HI RISK IND"]
["UNITED HEALTHCARE","G0105 - HC COLORECTAL SCRN; HI RISK IND"]
["HARVARD PILGRIM HEALTH CARE","G0105 - HC COLORECTAL SCRN; HI RISK IND"]
["BLUE CROSS OUT OF STATE","G0105 - HC COLORECTAL SCRN; HI RISK IND"]
["CIGNA HEALTHCARE","G0105 - HC COLORECTAL SCRN; HI RISK IND"]
["AETNA","G0105 - HC COLORECTAL SCRN; HI RISK IND"]
["BLUE CROSS","G0105 - HC COLORECTAL SCRN; HI RISK IND"]
["BLUE BENEFIT ADMINISTRATORS","G0105 - HC COLORECTAL SCRN; HI RISK IND"]
["UNITED HEALTHCARE","G0108 - DIAB MANAGE TRN  PER INDIV"]
["TUFTS","G0108 - DIAB MANAGE TRN  PER INDIV"]
["HARVARD PILGRIM HEALTH CARE","G0108 - DIAB MANAGE TRN  PER INDIV"]
["CIGNA HEALTHCARE","G0108 - DIAB MANAGE TRN  PER INDIV"]
["BLUE CROSS OUT OF STATE","G0108 - DIAB MANAGE TRN  PER INDIV"]
["BLUE CROSS","G0108 - DIAB MANAGE TRN  PER INDIV"]
["BLUE BENEFIT ADMINISTRATORS","G0108 - DIAB MANAGE TRN  PER INDIV"]
["TUFTS","G0109 - DIAB MANAGE TRN IND/GROUP"]
["UNITED HEALTHCARE","G0109 - DIAB MANAGE TRN IND/GROUP"]
["HARVARD PILGRIM HEALTH CARE","G0109 - DIAB MANAGE TRN IND/GROUP"]
["BLUE CROSS OUT OF STATE","G0109 - DIAB MANAGE TRN IND/GROUP"]
["CIGNA HEALTHCARE","G0109 - DIAB MANAGE TRN IND/GROUP"]
["BLUE CROSS","G0109 - DIAB MANAGE TRN IND/GROUP"]
["BLUE BENEFIT ADMINISTRATORS","G0109 - DIAB MANAGE TRN IND/GROUP"]
["TUFTS","G0127 - TRIM NAIL(S)"]
["UNITED HEALTHCARE","G0127 - TRIM NAIL(S)"]
["TUFTS PUBLIC PLANS","G0127 - TRIM NAIL(S)"]
["HARVARD PILGRIM HEALTH CARE","G0127 - TRIM NAIL(S)"]
["FALLON","G0127 - TRIM NAIL(S)"]
["BLUE CROSS OUT OF STATE","G0127 - TRIM NAIL(S)"]
["CIGNA HEALTHCARE","G0127 - TRIM NAIL(S)"]
["BMC HEALTHNET","G0127 - TRIM NAIL(S)"]
["ALLWAYS HEALTH PARTNERS","G0127 - TRIM NAIL(S)"]
["BLUE CROSS","G0127 - TRIM NAIL(S)"]
["BLUE BENEFIT ADMINISTRATORS","G0127 - TRIM NAIL(S)"]
["TUFTS","G0175 - OPPS SERVICE,SCHED TEAM CONF"]
["TUFTS PUBLIC PLANS","G0175 - OPPS SERVICE,SCHED TEAM CONF"]
["FALLON","G0175 - OPPS SERVICE,SCHED TEAM CONF"]
["BMC HEALTHNET","G0175 - OPPS SERVICE,SCHED TEAM CONF"]
["CIGNA HEALTHCARE","G0175 - OPPS SERVICE,SCHED TEAM CONF"]
["ALLWAYS HEALTH PARTNERS","G0175 - OPPS SERVICE,SCHED TEAM CONF"]
["TUFTS","G0239 - OTH RESP PROC, GROUP"]
["UNITED HEALTHCARE","G0239 - OTH RESP PROC, GROUP"]
["TUFTS PUBLIC PLANS","G0239 - OTH RESP PROC, GROUP"]
["HARVARD PILGRIM HEALTH CARE","G0239 - OTH RESP PROC, GROUP"]
["FALLON","G0239 - OTH RESP PROC, GROUP"]
["BLUE CROSS OUT OF STATE","G0239 - OTH RESP PROC, GROUP"]
["CIGNA HEALTHCARE","G0239 - OTH RESP PROC, GROUP"]
["BMC HEALTHNET","G0239 - OTH RESP PROC, GROUP"]
["ALLWAYS HEALTH PARTNERS","G0239 - OTH RESP PROC, GROUP"]
["BLUE CROSS","G0239 - OTH RESP PROC, GROUP"]
["BLUE BENEFIT ADMINISTRATORS","G0239 - OTH RESP PROC, GROUP"]
["TUFTS","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP"]
["UNITED HEALTHCARE","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP"]
["TUFTS PUBLIC PLANS","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP"]
["HARVARD PILGRIM HEALTH CARE","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP"]
["FALLON","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP"]
["BMC HEALTHNET","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP"]
["BLUE CROSS OUT OF STATE","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP"]
["CIGNA HEALTHCARE","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP"]
["ALLWAYS HEALTH PARTNERS","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP"]
["BLUE CROSS","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP"]
["BLUE BENEFIT ADMINISTRATORS","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP"]
["TUFTS","G0259 - HC INJECT FOR SACROILIAC JOINT"]
["UNITED HEALTHCARE","G0259 - HC INJECT FOR SACROILIAC JOINT"]
["TUFTS PUBLIC PLANS","G0259 - HC INJECT FOR SACROILIAC JOINT"]
["HARVARD PILGRIM HEALTH CARE","G0259 - HC INJECT FOR SACROILIAC JOINT"]
["FALLON","G0259 - HC INJECT FOR SACROILIAC JOINT"]
["CIGNA HEALTHCARE","G0259 - HC INJECT FOR SACROILIAC JOINT"]
["BMC HEALTHNET","G0259 - HC INJECT FOR SACROILIAC JOINT"]
["ALLWAYS HEALTH PARTNERS","G0259 - HC INJECT FOR SACROILIAC JOINT"]
["AETNA","G0259 - HC INJECT FOR SACROILIAC JOINT"]
["TUFTS","G0260 - INJ FOR SACROILIAC JT ANESTH"]
["UNITED HEALTHCARE","G0260 - INJ FOR SACROILIAC JT ANESTH"]
["TUFTS PUBLIC PLANS","G0260 - INJ FOR SACROILIAC JT ANESTH"]
["HARVARD PILGRIM HEALTH CARE","G0260 - INJ FOR SACROILIAC JT ANESTH"]
["FALLON","G0260 - INJ FOR SACROILIAC JT ANESTH"]
["BLUE CROSS OUT OF STATE","G0260 - INJ FOR SACROILIAC JT ANESTH"]
["BMC HEALTHNET","G0260 - INJ FOR SACROILIAC JT ANESTH"]
["CIGNA HEALTHCARE","G0260 - INJ FOR SACROILIAC JT ANESTH"]
["ALLWAYS HEALTH PARTNERS","G0260 - INJ FOR SACROILIAC JT ANESTH"]
["BLUE CROSS","G0260 - INJ FOR SACROILIAC JT ANESTH"]
["BLUE BENEFIT ADMINISTRATORS","G0260 - INJ FOR SACROILIAC JT ANESTH"]
["AETNA","G0260 - INJ FOR SACROILIAC JT ANESTH"]
["TUFTS","G0269 - HC CLOSURE DEVICE PLACEMENT"]
["TUFTS PUBLIC PLANS","G0269 - HC CLOSURE DEVICE PLACEMENT"]
["UNITED HEALTHCARE","G0269 - HC CLOSURE DEVICE PLACEMENT"]
["HARVARD PILGRIM HEALTH CARE","G0269 - HC CLOSURE DEVICE PLACEMENT"]
["FALLON","G0269 - HC CLOSURE DEVICE PLACEMENT"]
["CIGNA HEALTHCARE","G0269 - HC CLOSURE DEVICE PLACEMENT"]
["BMC HEALTHNET","G0269 - HC CLOSURE DEVICE PLACEMENT"]
["ALLWAYS HEALTH PARTNERS","G0269 - HC CLOSURE DEVICE PLACEMENT"]
["UNITED HEALTHCARE","G0270 - MNT SUBS TX FOR CHANGE DX"]
["HARVARD PILGRIM HEALTH CARE","G0270 - MNT SUBS TX FOR CHANGE DX"]
["UNITED HEALTHCARE","G0278 - ILIAC ART ANGIO,CARDIAC CATH"]
["TUFTS","G0278 - ILIAC ART ANGIO,CARDIAC CATH"]
["TUFTS PUBLIC PLANS","G0278 - ILIAC ART ANGIO,CARDIAC CATH"]
["HARVARD PILGRIM HEALTH CARE","G0278 - ILIAC ART ANGIO,CARDIAC CATH"]
["FALLON","G0278 - ILIAC ART ANGIO,CARDIAC CATH"]
["BLUE CROSS OUT OF STATE","G0278 - ILIAC ART ANGIO,CARDIAC CATH"]
["BMC HEALTHNET","G0278 - ILIAC ART ANGIO,CARDIAC CATH"]
["CIGNA HEALTHCARE","G0278 - ILIAC ART ANGIO,CARDIAC CATH"]
["ALLWAYS HEALTH PARTNERS","G0278 - ILIAC ART ANGIO,CARDIAC CATH"]
["BLUE CROSS","G0278 - ILIAC ART ANGIO,CARDIAC CATH"]
["BLUE BENEFIT ADMINISTRATORS","G0278 - ILIAC ART ANGIO,CARDIAC CATH"]
["TUFTS","G0279 - TOMOSYNTHESIS, MAMMO"]
["UHC COMMUNITY CARE","G0279 - TOMOSYNTHESIS, MAMMO"]
["UNITED HEALTHCARE","G0279 - TOMOSYNTHESIS, MAMMO"]
["TUFTS PUBLIC PLANS","G0279 - TOMOSYNTHESIS, MAMMO"]
["FALLON","G0279 - TOMOSYNTHESIS, MAMMO"]
["HARVARD PILGRIM HEALTH CARE","G0279 - TOMOSYNTHESIS, MAMMO"]
["SENIOR WHOLE HEALTH","G0279 - TOMOSYNTHESIS, MAMMO"]
["BLUE CROSS OUT OF STATE","G0279 - TOMOSYNTHESIS, MAMMO"]
["BMC HEALTHNET","G0279 - TOMOSYNTHESIS, MAMMO"]
["CIGNA HEALTHCARE","G0279 - TOMOSYNTHESIS, MAMMO"]
["COMMONWEALTH CARE ALLIANCE","G0279 - TOMOSYNTHESIS, MAMMO"]
["ELDER SERVICE PLAN","G0279 - TOMOSYNTHESIS, MAMMO"]
["ELDER SERVICE PLAN OTHER","G0279 - TOMOSYNTHESIS, MAMMO"]
["BLUE CROSS","G0279 - TOMOSYNTHESIS, MAMMO"]
["BLUE BENEFIT ADMINISTRATORS","G0279 - TOMOSYNTHESIS, MAMMO"]
["AETNA","G0279 - TOMOSYNTHESIS, MAMMO"]
["TUFTS PUBLIC PLANS","G0296 - HC VISIT TO DETERM LDCT ELIG"]
["TUFTS","G0296 - HC VISIT TO DETERM LDCT ELIG"]
["FALLON","G0296 - HC VISIT TO DETERM LDCT ELIG"]
["BLUE CROSS OUT OF STATE","G0296 - HC VISIT TO DETERM LDCT ELIG"]
["BMC HEALTHNET","G0296 - HC VISIT TO DETERM LDCT ELIG"]
["CIGNA HEALTHCARE","G0296 - HC VISIT TO DETERM LDCT ELIG"]
["ALLWAYS HEALTH PARTNERS","G0296 - HC VISIT TO DETERM LDCT ELIG"]
["BLUE CROSS","G0296 - HC VISIT TO DETERM LDCT ELIG"]
["BLUE BENEFIT ADMINISTRATORS","G0296 - HC VISIT TO DETERM LDCT ELIG"]
["TUFTS","G0297 - HC LDCT FOR LUNG CA SCREEN"]
["UNITED HEALTHCARE","G0297 - HC LDCT FOR LUNG CA SCREEN"]
["TUFTS PUBLIC PLANS","G0297 - HC LDCT FOR LUNG CA SCREEN"]
["HARVARD PILGRIM HEALTH CARE","G0297 - HC LDCT FOR LUNG CA SCREEN"]
["FALLON","G0297 - HC LDCT FOR LUNG CA SCREEN"]
["BLUE CROSS OUT OF STATE","G0297 - HC LDCT FOR LUNG CA SCREEN"]
["CIGNA HEALTHCARE","G0297 - HC LDCT FOR LUNG CA SCREEN"]
["BMC HEALTHNET","G0297 - HC LDCT FOR LUNG CA SCREEN"]
["BLUE CROSS","G0297 - HC LDCT FOR LUNG CA SCREEN"]
["ALLWAYS HEALTH PARTNERS","G0297 - HC LDCT FOR LUNG CA SCREEN"]
["BLUE BENEFIT ADMINISTRATORS","G0297 - HC LDCT FOR LUNG CA SCREEN"]
["TUFTS","G0365 - HC VESSEL MAPPING HEMO ACCESS"]
["TUFTS PUBLIC PLANS","G0365 - HC VESSEL MAPPING HEMO ACCESS"]
["FALLON","G0365 - HC VESSEL MAPPING HEMO ACCESS"]
["BMC HEALTHNET","G0365 - HC VESSEL MAPPING HEMO ACCESS"]
["CIGNA HEALTHCARE","G0365 - HC VESSEL MAPPING HEMO ACCESS"]
["ALLWAYS HEALTH PARTNERS","G0365 - HC VESSEL MAPPING HEMO ACCESS"]
["TUFTS","G0378 - HOSPITAL OBSERVATION PER HR"]
["CIGNA HEALTHCARE","G0378 - HOSPITAL OBSERVATION PER HR"]
["TUFTS","G0379 - DIRECT REFER HOSPITAL OBSERV"]
["CIGNA HEALTHCARE","G0379 - DIRECT REFER HOSPITAL OBSERV"]
["TUFTS PUBLIC PLANS","G0389 - ULTRASOUND EXAM AAA SCREEN"]
["FALLON","G0389 - ULTRASOUND EXAM AAA SCREEN"]
["BMC HEALTHNET","G0389 - ULTRASOUND EXAM AAA SCREEN"]
["ALLWAYS HEALTH PARTNERS","G0389 - ULTRASOUND EXAM AAA SCREEN"]
["TUFTS","G0390 - TRAUMA RESPONS W/HOSP CRITI"]
["TUFTS PUBLIC PLANS","G0390 - TRAUMA RESPONS W/HOSP CRITI"]
["UNITED HEALTHCARE","G0390 - TRAUMA RESPONS W/HOSP CRITI"]
["HARVARD PILGRIM HEALTH CARE","G0390 - TRAUMA RESPONS W/HOSP CRITI"]
["FALLON","G0390 - TRAUMA RESPONS W/HOSP CRITI"]
["CIGNA HEALTHCARE","G0390 - TRAUMA RESPONS W/HOSP CRITI"]
["BLUE CROSS OUT OF STATE","G0390 - TRAUMA RESPONS W/HOSP CRITI"]
["BMC HEALTHNET","G0390 - TRAUMA RESPONS W/HOSP CRITI"]
["ALLWAYS HEALTH PARTNERS","G0390 - TRAUMA RESPONS W/HOSP CRITI"]
["BLUE CROSS","G0390 - TRAUMA RESPONS W/HOSP CRITI"]
["BLUE BENEFIT ADMINISTRATORS","G0390 - TRAUMA RESPONS W/HOSP CRITI"]
["BLUE CROSS OUT OF STATE","G0396 - ALCOHOL/SUBS INTERV 15-30MN"]
["TUFTS","G0396 - ALCOHOL/SUBS INTERV 15-30MN"]
["TUFTS PUBLIC PLANS","G0396 - ALCOHOL/SUBS INTERV 15-30MN"]
["FALLON","G0396 - ALCOHOL/SUBS INTERV 15-30MN"]
["BMC HEALTHNET","G0396 - ALCOHOL/SUBS INTERV 15-30MN"]
["CIGNA HEALTHCARE","G0396 - ALCOHOL/SUBS INTERV 15-30MN"]
["ALLWAYS HEALTH PARTNERS","G0396 - ALCOHOL/SUBS INTERV 15-30MN"]
["BLUE CROSS","G0396 - ALCOHOL/SUBS INTERV 15-30MN"]
["BLUE BENEFIT ADMINISTRATORS","G0396 - ALCOHOL/SUBS INTERV 15-30MN"]
["BLUE CROSS OUT OF STATE","G0397 - ALCOHOL/SUBS INTERV >30 MIN"]
["TUFTS","G0397 - ALCOHOL/SUBS INTERV >30 MIN"]
["TUFTS PUBLIC PLANS","G0397 - ALCOHOL/SUBS INTERV >30 MIN"]
["FALLON","G0397 - ALCOHOL/SUBS INTERV >30 MIN"]
["CIGNA HEALTHCARE","G0397 - ALCOHOL/SUBS INTERV >30 MIN"]
["BMC HEALTHNET","G0397 - ALCOHOL/SUBS INTERV >30 MIN"]
["ALLWAYS HEALTH PARTNERS","G0397 - ALCOHOL/SUBS INTERV >30 MIN"]
["BLUE CROSS","G0397 - ALCOHOL/SUBS INTERV >30 MIN"]
["BLUE BENEFIT ADMINISTRATORS","G0397 - ALCOHOL/SUBS INTERV >30 MIN"]
["TUFTS","G0402 - INITIAL PREVENTIVE EXAM"]
["CIGNA HEALTHCARE","G0402 - INITIAL PREVENTIVE EXAM"]
["TUFTS PUBLIC PLANS","G0402 - INITIAL PREVENTIVE EXAM"]
["FALLON","G0402 - INITIAL PREVENTIVE EXAM"]
["BMC HEALTHNET","G0402 - INITIAL PREVENTIVE EXAM"]
["ALLWAYS HEALTH PARTNERS","G0402 - INITIAL PREVENTIVE EXAM"]
["TUFTS PUBLIC PLANS","G0410 - HC GRP PSYCH PARTIAL HOSP 45-50"]
["TUFTS","G0410 - HC GRP PSYCH PARTIAL HOSP 45-50"]
["FALLON","G0410 - HC GRP PSYCH PARTIAL HOSP 45-50"]
["CIGNA HEALTHCARE","G0410 - HC GRP PSYCH PARTIAL HOSP 45-50"]
["BMC HEALTHNET","G0410 - HC GRP PSYCH PARTIAL HOSP 45-50"]
["ALLWAYS HEALTH PARTNERS","G0410 - HC GRP PSYCH PARTIAL HOSP 45-50"]
["TUFTS","G0416 - HC PROSTATE BIOPSY ANY MTHD"]
["UNITED HEALTHCARE","G0416 - HC PROSTATE BIOPSY ANY MTHD"]
["TUFTS PUBLIC PLANS","G0416 - HC PROSTATE BIOPSY ANY MTHD"]
["FALLON","G0416 - HC PROSTATE BIOPSY ANY MTHD"]
["HARVARD PILGRIM HEALTH CARE","G0416 - HC PROSTATE BIOPSY ANY MTHD"]
["BLUE CROSS OUT OF STATE","G0416 - HC PROSTATE BIOPSY ANY MTHD"]
["BMC HEALTHNET","G0416 - HC PROSTATE BIOPSY ANY MTHD"]
["CIGNA HEALTHCARE","G0416 - HC PROSTATE BIOPSY ANY MTHD"]
["ALLWAYS HEALTH PARTNERS","G0416 - HC PROSTATE BIOPSY ANY MTHD"]
["BLUE CROSS","G0416 - HC PROSTATE BIOPSY ANY MTHD"]
["BLUE BENEFIT ADMINISTRATORS","G0416 - HC PROSTATE BIOPSY ANY MTHD"]
["TUFTS","G0420 - HC ED SVC CKD IND PER SESSION"]
["TUFTS PUBLIC PLANS","G0420 - HC ED SVC CKD IND PER SESSION"]
["FALLON","G0420 - HC ED SVC CKD IND PER SESSION"]
["CIGNA HEALTHCARE","G0420 - HC ED SVC CKD IND PER SESSION"]
["BMC HEALTHNET","G0420 - HC ED SVC CKD IND PER SESSION"]
["ALLWAYS HEALTH PARTNERS","G0420 - HC ED SVC CKD IND PER SESSION"]
["TUFTS","G0421 - HC ED SVC CKD GRP PER SESSION"]
["TUFTS PUBLIC PLANS","G0421 - HC ED SVC CKD GRP PER SESSION"]
["FALLON","G0421 - HC ED SVC CKD GRP PER SESSION"]
["BMC HEALTHNET","G0421 - HC ED SVC CKD GRP PER SESSION"]
["CIGNA HEALTHCARE","G0421 - HC ED SVC CKD GRP PER SESSION"]
["ALLWAYS HEALTH PARTNERS","G0421 - HC ED SVC CKD GRP PER SESSION"]
["TUFTS PUBLIC PLANS","G0422 - HC INTENS CARDIAC REHAB W/EXERC"]
["TUFTS","G0422 - HC INTENS CARDIAC REHAB W/EXERC"]
["UNITED HEALTHCARE","G0422 - HC INTENS CARDIAC REHAB W/EXERC"]
["FALLON","G0422 - HC INTENS CARDIAC REHAB W/EXERC"]
["HARVARD PILGRIM HEALTH CARE","G0422 - HC INTENS CARDIAC REHAB W/EXERC"]
["CIGNA HEALTHCARE","G0422 - HC INTENS CARDIAC REHAB W/EXERC"]
["BLUE CROSS OUT OF STATE","G0422 - HC INTENS CARDIAC REHAB W/EXERC"]
["BMC HEALTHNET","G0422 - HC INTENS CARDIAC REHAB W/EXERC"]
["ALLWAYS HEALTH PARTNERS","G0422 - HC INTENS CARDIAC REHAB W/EXERC"]
["BLUE CROSS","G0422 - HC INTENS CARDIAC REHAB W/EXERC"]
["BLUE BENEFIT ADMINISTRATORS","G0422 - HC INTENS CARDIAC REHAB W/EXERC"]
["TUFTS","G0423 - HC INTENS CARDIAC REHAB NO EXER"]
["UNITED HEALTHCARE","G0423 - HC INTENS CARDIAC REHAB NO EXER"]
["TUFTS PUBLIC PLANS","G0423 - HC INTENS CARDIAC REHAB NO EXER"]
["HARVARD PILGRIM HEALTH CARE","G0423 - HC INTENS CARDIAC REHAB NO EXER"]
["FALLON","G0423 - HC INTENS CARDIAC REHAB NO EXER"]
["BLUE CROSS OUT OF STATE","G0423 - HC INTENS CARDIAC REHAB NO EXER"]
["BMC HEALTHNET","G0423 - HC INTENS CARDIAC REHAB NO EXER"]
["CIGNA HEALTHCARE","G0423 - HC INTENS CARDIAC REHAB NO EXER"]
["BLUE CROSS","G0423 - HC INTENS CARDIAC REHAB NO EXER"]
["ALLWAYS HEALTH PARTNERS","G0423 - HC INTENS CARDIAC REHAB NO EXER"]
["BLUE BENEFIT ADMINISTRATORS","G0423 - HC INTENS CARDIAC REHAB NO EXER"]
["UNITED HEALTHCARE","G0424 - PULMONARY REHAB W EXER"]
["TUFTS","G0424 - PULMONARY REHAB W EXER"]
["HARVARD PILGRIM HEALTH CARE","G0424 - PULMONARY REHAB W EXER"]
["BLUE CROSS OUT OF STATE","G0424 - PULMONARY REHAB W EXER"]
["CIGNA HEALTHCARE","G0424 - PULMONARY REHAB W EXER"]
["BLUE CROSS","G0424 - PULMONARY REHAB W EXER"]
["BLUE BENEFIT ADMINISTRATORS","G0424 - PULMONARY REHAB W EXER"]
["TUFTS","G0438 - PPPS, INITIAL VISIT"]
["TUFTS PUBLIC PLANS","G0438 - PPPS, INITIAL VISIT"]
["FALLON","G0438 - PPPS, INITIAL VISIT"]
["BMC HEALTHNET","G0438 - PPPS, INITIAL VISIT"]
["CIGNA HEALTHCARE","G0438 - PPPS, INITIAL VISIT"]
["ALLWAYS HEALTH PARTNERS","G0438 - PPPS, INITIAL VISIT"]
["TUFTS","G0439 - PPPS, SUBSEQ VISIT"]
["TUFTS PUBLIC PLANS","G0439 - PPPS, SUBSEQ VISIT"]
["FALLON","G0439 - PPPS, SUBSEQ VISIT"]
["BMC HEALTHNET","G0439 - PPPS, SUBSEQ VISIT"]
["CIGNA HEALTHCARE","G0439 - PPPS, SUBSEQ VISIT"]
["ALLWAYS HEALTH PARTNERS","G0439 - PPPS, SUBSEQ VISIT"]
["TUFTS PUBLIC PLANS","G0442 - ANNUAL ALCOHOL SCREEN 15 MIN"]
["TUFTS","G0442 - ANNUAL ALCOHOL SCREEN 15 MIN"]
["FALLON","G0442 - ANNUAL ALCOHOL SCREEN 15 MIN"]
["BLUE CROSS OUT OF STATE","G0442 - ANNUAL ALCOHOL SCREEN 15 MIN"]
["BMC HEALTHNET","G0442 - ANNUAL ALCOHOL SCREEN 15 MIN"]
["CIGNA HEALTHCARE","G0442 - ANNUAL ALCOHOL SCREEN 15 MIN"]
["ALLWAYS HEALTH PARTNERS","G0442 - ANNUAL ALCOHOL SCREEN 15 MIN"]
["TUFTS","G0443 - BRIEF ALCOHOL MISUSE COUNSEL"]
["TUFTS PUBLIC PLANS","G0443 - BRIEF ALCOHOL MISUSE COUNSEL"]
["FALLON","G0443 - BRIEF ALCOHOL MISUSE COUNSEL"]
["BLUE CROSS OUT OF STATE","G0443 - BRIEF ALCOHOL MISUSE COUNSEL"]
["BMC HEALTHNET","G0443 - BRIEF ALCOHOL MISUSE COUNSEL"]
["CIGNA HEALTHCARE","G0443 - BRIEF ALCOHOL MISUSE COUNSEL"]
["ALLWAYS HEALTH PARTNERS","G0443 - BRIEF ALCOHOL MISUSE COUNSEL"]
["TUFTS","G0444 - DEPRESSION SCREEN ANNUAL"]
["TUFTS PUBLIC PLANS","G0444 - DEPRESSION SCREEN ANNUAL"]
["FALLON","G0444 - DEPRESSION SCREEN ANNUAL"]
["BMC HEALTHNET","G0444 - DEPRESSION SCREEN ANNUAL"]
["CIGNA HEALTHCARE","G0444 - DEPRESSION SCREEN ANNUAL"]
["ALLWAYS HEALTH PARTNERS","G0444 - DEPRESSION SCREEN ANNUAL"]
["TUFTS","G0445 - HIGH INTEN BEH COUNS STD 30M"]
["TUFTS PUBLIC PLANS","G0445 - HIGH INTEN BEH COUNS STD 30M"]
["FALLON","G0445 - HIGH INTEN BEH COUNS STD 30M"]
["CIGNA HEALTHCARE","G0445 - HIGH INTEN BEH COUNS STD 30M"]
["BMC HEALTHNET","G0445 - HIGH INTEN BEH COUNS STD 30M"]
["ALLWAYS HEALTH PARTNERS","G0445 - HIGH INTEN BEH COUNS STD 30M"]
["TUFTS PUBLIC PLANS","G0446 - INTENS BEHAVE THER CARDIO DX"]
["TUFTS","G0446 - INTENS BEHAVE THER CARDIO DX"]
["FALLON","G0446 - INTENS BEHAVE THER CARDIO DX"]
["BMC HEALTHNET","G0446 - INTENS BEHAVE THER CARDIO DX"]
["CIGNA HEALTHCARE","G0446 - INTENS BEHAVE THER CARDIO DX"]
["ALLWAYS HEALTH PARTNERS","G0446 - INTENS BEHAVE THER CARDIO DX"]
["TUFTS","G0447 - HC BEHAVIOR COUNSEL OBESITY 15M"]
["TUFTS PUBLIC PLANS","G0447 - HC BEHAVIOR COUNSEL OBESITY 15M"]
["FALLON","G0447 - HC BEHAVIOR COUNSEL OBESITY 15M"]
["BMC HEALTHNET","G0447 - HC BEHAVIOR COUNSEL OBESITY 15M"]
["CIGNA HEALTHCARE","G0447 - HC BEHAVIOR COUNSEL OBESITY 15M"]
["ALLWAYS HEALTH PARTNERS","G0447 - HC BEHAVIOR COUNSEL OBESITY 15M"]
["UNITED HEALTHCARE","G0480 - DRUG TEST DEF 1-7 CLASSES"]
["TUFTS","G0480 - DRUG TEST DEF 1-7 CLASSES"]
["TUFTS PUBLIC PLANS","G0480 - DRUG TEST DEF 1-7 CLASSES"]
["UHC COMMUNITY CARE","G0480 - DRUG TEST DEF 1-7 CLASSES"]
["UNICARE","G0480 - DRUG TEST DEF 1-7 CLASSES"]
["FALLON","G0480 - DRUG TEST DEF 1-7 CLASSES"]
["HARVARD PILGRIM HEALTH CARE","G0480 - DRUG TEST DEF 1-7 CLASSES"]
["SENIOR WHOLE HEALTH","G0480 - DRUG TEST DEF 1-7 CLASSES"]
["BLUE CROSS OUT OF STATE","G0480 - DRUG TEST DEF 1-7 CLASSES"]
["BMC HEALTHNET","G0480 - DRUG TEST DEF 1-7 CLASSES"]
["CIGNA HEALTHCARE","G0480 - DRUG TEST DEF 1-7 CLASSES"]
["COMMONWEALTH CARE ALLIANCE","G0480 - DRUG TEST DEF 1-7 CLASSES"]
["ELDER SERVICE PLAN","G0480 - DRUG TEST DEF 1-7 CLASSES"]
["ELDER SERVICE PLAN OTHER","G0480 - DRUG TEST DEF 1-7 CLASSES"]
["BLUE CROSS","G0480 - DRUG TEST DEF 1-7 CLASSES"]
["ALLWAYS HEALTH PARTNERS","G0480 - DRUG TEST DEF 1-7 CLASSES"]
["BLUE BENEFIT ADMINISTRATORS","G0480 - DRUG TEST DEF 1-7 CLASSES"]
["AETNA","G0480 - DRUG TEST DEF 1-7 CLASSES"]
["UNITED HEALTHCARE","G0481 - DRUG TEST DEF 8-14 CLASSES"]
["TUFTS","G0481 - DRUG TEST DEF 8-14 CLASSES"]
["UHC COMMUNITY CARE","G0481 - DRUG TEST DEF 8-14 CLASSES"]
["UNICARE","G0481 - DRUG TEST DEF 8-14 CLASSES"]
["TUFTS PUBLIC PLANS","G0481 - DRUG TEST DEF 8-14 CLASSES"]
["FALLON","G0481 - DRUG TEST DEF 8-14 CLASSES"]
["HARVARD PILGRIM HEALTH CARE","G0481 - DRUG TEST DEF 8-14 CLASSES"]
["SENIOR WHOLE HEALTH","G0481 - DRUG TEST DEF 8-14 CLASSES"]
["ELDER SERVICE PLAN","G0481 - DRUG TEST DEF 8-14 CLASSES"]
["BLUE CROSS OUT OF STATE","G0481 - DRUG TEST DEF 8-14 CLASSES"]
["BMC HEALTHNET","G0481 - DRUG TEST DEF 8-14 CLASSES"]
["CIGNA HEALTHCARE","G0481 - DRUG TEST DEF 8-14 CLASSES"]
["COMMONWEALTH CARE ALLIANCE","G0481 - DRUG TEST DEF 8-14 CLASSES"]
["ELDER SERVICE PLAN OTHER","G0481 - DRUG TEST DEF 8-14 CLASSES"]
["ALLWAYS HEALTH PARTNERS","G0481 - DRUG TEST DEF 8-14 CLASSES"]
["BLUE CROSS","G0481 - DRUG TEST DEF 8-14 CLASSES"]
["BLUE BENEFIT ADMINISTRATORS","G0481 - DRUG TEST DEF 8-14 CLASSES"]
["AETNA","G0481 - DRUG TEST DEF 8-14 CLASSES"]
["BLUE CROSS OUT OF STATE","G0506 - HC COMP ASSESS CARE PLAN CCM SVC"]
["TUFTS PUBLIC PLANS","G0506 - HC COMP ASSESS CARE PLAN CCM SVC"]
["TUFTS","G0506 - HC COMP ASSESS CARE PLAN CCM SVC"]
["UNITED HEALTHCARE","G0506 - HC COMP ASSESS CARE PLAN CCM SVC"]
["HARVARD PILGRIM HEALTH CARE","G0506 - HC COMP ASSESS CARE PLAN CCM SVC"]
["FALLON","G0506 - HC COMP ASSESS CARE PLAN CCM SVC"]
["BMC HEALTHNET","G0506 - HC COMP ASSESS CARE PLAN CCM SVC"]
["CIGNA HEALTHCARE","G0506 - HC COMP ASSESS CARE PLAN CCM SVC"]
["ALLWAYS HEALTH PARTNERS","G0506 - HC COMP ASSESS CARE PLAN CCM SVC"]
["BLUE CROSS","G0506 - HC COMP ASSESS CARE PLAN CCM SVC"]
["BLUE BENEFIT ADMINISTRATORS","G0506 - HC COMP ASSESS CARE PLAN CCM SVC"]
["TUFTS","G0513 - HC PROLONG PREV SVCS, FIRST 30M"]
["UNITED HEALTHCARE","G0513 - HC PROLONG PREV SVCS, FIRST 30M"]
["TUFTS PUBLIC PLANS","G0513 - HC PROLONG PREV SVCS, FIRST 30M"]
["FALLON","G0513 - HC PROLONG PREV SVCS, FIRST 30M"]
["HARVARD PILGRIM HEALTH CARE","G0513 - HC PROLONG PREV SVCS, FIRST 30M"]
["BLUE CROSS OUT OF STATE","G0513 - HC PROLONG PREV SVCS, FIRST 30M"]
["BMC HEALTHNET","G0513 - HC PROLONG PREV SVCS, FIRST 30M"]
["CIGNA HEALTHCARE","G0513 - HC PROLONG PREV SVCS, FIRST 30M"]
["ALLWAYS HEALTH PARTNERS","G0513 - HC PROLONG PREV SVCS, FIRST 30M"]
["BLUE CROSS","G0513 - HC PROLONG PREV SVCS, FIRST 30M"]
["BLUE BENEFIT ADMINISTRATORS","G0513 - HC PROLONG PREV SVCS, FIRST 30M"]
["TUFTS","G0514 - HC PROLONG PREV SVCS, ADDL 30M"]
["UNITED HEALTHCARE","G0514 - HC PROLONG PREV SVCS, ADDL 30M"]
["TUFTS PUBLIC PLANS","G0514 - HC PROLONG PREV SVCS, ADDL 30M"]
["HARVARD PILGRIM HEALTH CARE","G0514 - HC PROLONG PREV SVCS, ADDL 30M"]
["FALLON","G0514 - HC PROLONG PREV SVCS, ADDL 30M"]
["BLUE CROSS OUT OF STATE","G0514 - HC PROLONG PREV SVCS, ADDL 30M"]
["BMC HEALTHNET","G0514 - HC PROLONG PREV SVCS, ADDL 30M"]
["CIGNA HEALTHCARE","G0514 - HC PROLONG PREV SVCS, ADDL 30M"]
["BLUE CROSS","G0514 - HC PROLONG PREV SVCS, ADDL 30M"]
["ALLWAYS HEALTH PARTNERS","G0514 - HC PROLONG PREV SVCS, ADDL 30M"]
["BLUE BENEFIT ADMINISTRATORS","G0514 - HC PROLONG PREV SVCS, ADDL 30M"]
["TUFTS","G2011 - ALCOHOL/SUB ABUSE ASSESS"]
["TUFTS PUBLIC PLANS","G2011 - ALCOHOL/SUB ABUSE ASSESS"]
["FALLON","G2011 - ALCOHOL/SUB ABUSE ASSESS"]
["BMC HEALTHNET","G2011 - ALCOHOL/SUB ABUSE ASSESS"]
["CIGNA HEALTHCARE","G2011 - ALCOHOL/SUB ABUSE ASSESS"]
["BLUE CROSS OUT OF STATE","G2011 - ALCOHOL/SUB ABUSE ASSESS"]
["ALLWAYS HEALTH PARTNERS","G2011 - ALCOHOL/SUB ABUSE ASSESS"]
["BLUE CROSS","G2011 - ALCOHOL/SUB ABUSE ASSESS"]
["BLUE BENEFIT ADMINISTRATORS","G2011 - ALCOHOL/SUB ABUSE ASSESS"]
["TUFTS PUBLIC PLANS","G2012 - HC BRIEF CHECK IN BY MD/QHP"]
["TUFTS","G2012 - HC BRIEF CHECK IN BY MD/QHP"]
["FALLON","G2012 - HC BRIEF CHECK IN BY MD/QHP"]
["BLUE CROSS OUT OF STATE","G2012 - HC BRIEF CHECK IN BY MD/QHP"]
["BMC HEALTHNET","G2012 - HC BRIEF CHECK IN BY MD/QHP"]
["CIGNA HEALTHCARE","G2012 - HC BRIEF CHECK IN BY MD/QHP"]
["BLUE CROSS","G2012 - HC BRIEF CHECK IN BY MD/QHP"]
["ALLWAYS HEALTH PARTNERS","G2012 - HC BRIEF CHECK IN BY MD/QHP"]
["BLUE BENEFIT ADMINISTRATORS","G2012 - HC BRIEF CHECK IN BY MD/QHP"]
["TUFTS PUBLIC PLANS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS"]
["FALLON","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS"]
["BMC HEALTHNET","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS"]
["ALLWAYS HEALTH PARTNERS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS"]
["TUFTS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS"]
["UHC COMMUNITY CARE","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS"]
["UNITED HEALTHCARE","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS"]
["HARVARD PILGRIM HEALTH CARE","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS"]
["SENIOR WHOLE HEALTH","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS"]
["BLUE CROSS OUT OF STATE","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS"]
["CIGNA HEALTHCARE","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS"]
["COMMONWEALTH CARE ALLIANCE","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS"]
["ELDER SERVICE PLAN","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS"]
["ELDER SERVICE PLAN OTHER","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS"]
["BLUE CROSS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS"]
["BLUE BENEFIT ADMINISTRATORS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS"]
["AETNA","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS"]
["TUFTS PUBLIC PLANS","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA"]
["FALLON","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA"]
["BMC HEALTHNET","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA"]
["ALLWAYS HEALTH PARTNERS","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA"]
["TUFTS","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA"]
["UHC COMMUNITY CARE","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA"]
["UNITED HEALTHCARE","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA"]
["HARVARD PILGRIM HEALTH CARE","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA"]
["SENIOR WHOLE HEALTH","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA"]
["BLUE CROSS OUT OF STATE","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA"]
["COMMONWEALTH CARE ALLIANCE","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA"]
["ELDER SERVICE PLAN","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA"]
["ELDER SERVICE PLAN OTHER","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA"]
["CIGNA HEALTHCARE","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA"]
["BLUE CROSS","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA"]
["AETNA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA"]
["BLUE BENEFIT ADMINISTRATORS","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA"]
["TUFTS","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH"]
["UNITED HEALTHCARE","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH"]
["TUFTS PUBLIC PLANS","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH"]
["FALLON","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH"]
["HARVARD PILGRIM HEALTH CARE","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH"]
["BMC HEALTHNET","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH"]
["BLUE CROSS OUT OF STATE","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH"]
["CIGNA HEALTHCARE","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH"]
["ALLWAYS HEALTH PARTNERS","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH"]
["BLUE CROSS","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH"]
["BLUE BENEFIT ADMINISTRATORS","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH"]
["TUFTS PUBLIC PLANS","G2086 - HC OFF BASE OPIOID TX 70MIN"]
["TUFTS","G2086 - HC OFF BASE OPIOID TX 70MIN"]
["FALLON","G2086 - HC OFF BASE OPIOID TX 70MIN"]
["BLUE CROSS OUT OF STATE","G2086 - HC OFF BASE OPIOID TX 70MIN"]
["BMC HEALTHNET","G2086 - HC OFF BASE OPIOID TX 70MIN"]
["CIGNA HEALTHCARE","G2086 - HC OFF BASE OPIOID TX 70MIN"]
["ALLWAYS HEALTH PARTNERS","G2086 - HC OFF BASE OPIOID TX 70MIN"]
["BLUE CROSS","G2086 - HC OFF BASE OPIOID TX 70MIN"]
["BLUE BENEFIT ADMINISTRATORS","G2086 - HC OFF BASE OPIOID TX 70MIN"]
["TUFTS","G2087 - HC OFF BASE OPIOID TX, 60 M"]
["TUFTS PUBLIC PLANS","G2087 - HC OFF BASE OPIOID TX, 60 M"]
["FALLON","G2087 - HC OFF BASE OPIOID TX, 60 M"]
["BLUE CROSS OUT OF STATE","G2087 - HC OFF BASE OPIOID TX, 60 M"]
["BMC HEALTHNET","G2087 - HC OFF BASE OPIOID TX, 60 M"]
["CIGNA HEALTHCARE","G2087 - HC OFF BASE OPIOID TX, 60 M"]
["ALLWAYS HEALTH PARTNERS","G2087 - HC OFF BASE OPIOID TX, 60 M"]
["BLUE CROSS","G2087 - HC OFF BASE OPIOID TX, 60 M"]
["BLUE BENEFIT ADMINISTRATORS","G2087 - HC OFF BASE OPIOID TX, 60 M"]
["TUFTS PUBLIC PLANS","G2088 - HC OFF BASE OPIOID TX, ADD30"]
["FALLON","G2088 - HC OFF BASE OPIOID TX, ADD30"]
["BLUE CROSS OUT OF STATE","G2088 - HC OFF BASE OPIOID TX, ADD30"]
["BMC HEALTHNET","G2088 - HC OFF BASE OPIOID TX, ADD30"]
["BLUE CROSS","G2088 - HC OFF BASE OPIOID TX, ADD30"]
["ALLWAYS HEALTH PARTNERS","G2088 - HC OFF BASE OPIOID TX, ADD30"]
["BLUE BENEFIT ADMINISTRATORS","G2088 - HC OFF BASE OPIOID TX, ADD30"]
["TUFTS PUBLIC PLANS","G2212 - HC PROLONG OUTPT/OFFICE VIS"]
["FALLON","G2212 - HC PROLONG OUTPT/OFFICE VIS"]
["BMC HEALTHNET","G2212 - HC PROLONG OUTPT/OFFICE VIS"]
["ALLWAYS HEALTH PARTNERS","G2212 - HC PROLONG OUTPT/OFFICE VIS"]
["TUFTS PUBLIC PLANS","G2216 - HC HOME SUPPLY INJECT NALOXON"]
["FALLON","G2216 - HC HOME SUPPLY INJECT NALOXON"]
["BMC HEALTHNET","G2216 - HC HOME SUPPLY INJECT NALOXON"]
["ALLWAYS HEALTH PARTNERS","G2216 - HC HOME SUPPLY INJECT NALOXON"]
["TUFTS PUBLIC PLANS","J0702 - HC BETAMETHASONE ACET&SOD PHOSP"]
["TUFTS","J0702 - HC BETAMETHASONE ACET&SOD PHOSP"]
["UNITED HEALTHCARE","J0702 - HC BETAMETHASONE ACET&SOD PHOSP"]
["UNICARE","J0702 - HC BETAMETHASONE ACET&SOD PHOSP"]
["UHC COMMUNITY CARE","J0702 - HC BETAMETHASONE ACET&SOD PHOSP"]
["SENIOR WHOLE HEALTH","J0702 - HC BETAMETHASONE ACET&SOD PHOSP"]
["FALLON","J0702 - HC BETAMETHASONE ACET&SOD PHOSP"]
["HARVARD PILGRIM HEALTH CARE","J0702 - HC BETAMETHASONE ACET&SOD PHOSP"]
["COMMONWEALTH CARE ALLIANCE","J0702 - HC BETAMETHASONE ACET&SOD PHOSP"]
["ELDER SERVICE PLAN","J0702 - HC BETAMETHASONE ACET&SOD PHOSP"]
["BMC HEALTHNET","J0702 - HC BETAMETHASONE ACET&SOD PHOSP"]
["CIGNA HEALTHCARE","J0702 - HC BETAMETHASONE ACET&SOD PHOSP"]
["BLUE CROSS OUT OF STATE","J0702 - HC BETAMETHASONE ACET&SOD PHOSP"]
["ELDER SERVICE PLAN OTHER","J0702 - HC BETAMETHASONE ACET&SOD PHOSP"]
["BLUE CROSS","J0702 - HC BETAMETHASONE ACET&SOD PHOSP"]
["BLUE BENEFIT ADMINISTRATORS","J0702 - HC BETAMETHASONE ACET&SOD PHOSP"]
["AETNA","J0702 - HC BETAMETHASONE ACET&SOD PHOSP"]
["TUFTS PUBLIC PLANS","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)"]
["UNICARE","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)"]
["TUFTS","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)"]
["UNITED HEALTHCARE","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)"]
["UHC COMMUNITY CARE","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)"]
["FALLON","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)"]
["HARVARD PILGRIM HEALTH CARE","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)"]
["SENIOR WHOLE HEALTH","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)"]
["ELDER SERVICE PLAN","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)"]
["COMMONWEALTH CARE ALLIANCE","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)"]
["BLUE CROSS OUT OF STATE","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)"]
["CIGNA HEALTHCARE","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)"]
["BMC HEALTHNET","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)"]
["ELDER SERVICE PLAN OTHER","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)"]
["BLUE CROSS","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)"]
["BLUE BENEFIT ADMINISTRATORS","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)"]
["AETNA","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)"]
["TUFTS","J1250 - HC DOBUTAMINE SDV/250MG"]
["TUFTS PUBLIC PLANS","J1250 - HC DOBUTAMINE SDV/250MG"]
["UNICARE","J1250 - HC DOBUTAMINE SDV/250MG"]
["UNITED HEALTHCARE","J1250 - HC DOBUTAMINE SDV/250MG"]
["UHC COMMUNITY CARE","J1250 - HC DOBUTAMINE SDV/250MG"]
["FALLON","J1250 - HC DOBUTAMINE SDV/250MG"]
["SENIOR WHOLE HEALTH","J1250 - HC DOBUTAMINE SDV/250MG"]
["HARVARD PILGRIM HEALTH CARE","J1250 - HC DOBUTAMINE SDV/250MG"]
["ELDER SERVICE PLAN","J1250 - HC DOBUTAMINE SDV/250MG"]
["BLUE CROSS OUT OF STATE","J1250 - HC DOBUTAMINE SDV/250MG"]
["BMC HEALTHNET","J1250 - HC DOBUTAMINE SDV/250MG"]
["COMMONWEALTH CARE ALLIANCE","J1250 - HC DOBUTAMINE SDV/250MG"]
["CIGNA HEALTHCARE","J1250 - HC DOBUTAMINE SDV/250MG"]
["ELDER SERVICE PLAN OTHER","J1250 - HC DOBUTAMINE SDV/250MG"]
["BLUE BENEFIT ADMINISTRATORS","J1250 - HC DOBUTAMINE SDV/250MG"]
["BLUE CROSS","J1250 - HC DOBUTAMINE SDV/250MG"]
["AETNA","J1250 - HC DOBUTAMINE SDV/250MG"]
["ALLWAYS HEALTH PARTNERS","J1250 - HC DOBUTAMINE SDV/250MG"]
["UNICARE","J2790 - HC IG;RHO D,HUMAN/300MCG"]
["TUFTS","J2790 - HC IG;RHO D,HUMAN/300MCG"]
["UHC COMMUNITY CARE","J2790 - HC IG;RHO D,HUMAN/300MCG"]
["UNITED HEALTHCARE","J2790 - HC IG;RHO D,HUMAN/300MCG"]
["TUFTS PUBLIC PLANS","J2790 - HC IG;RHO D,HUMAN/300MCG"]
["FALLON","J2790 - HC IG;RHO D,HUMAN/300MCG"]
["HARVARD PILGRIM HEALTH CARE","J2790 - HC IG;RHO D,HUMAN/300MCG"]
["SENIOR WHOLE HEALTH","J2790 - HC IG;RHO D,HUMAN/300MCG"]
["ELDER SERVICE PLAN","J2790 - HC IG;RHO D,HUMAN/300MCG"]
["BLUE CROSS OUT OF STATE","J2790 - HC IG;RHO D,HUMAN/300MCG"]
["BMC HEALTHNET","J2790 - HC IG;RHO D,HUMAN/300MCG"]
["CIGNA HEALTHCARE","J2790 - HC IG;RHO D,HUMAN/300MCG"]
["COMMONWEALTH CARE ALLIANCE","J2790 - HC IG;RHO D,HUMAN/300MCG"]
["ELDER SERVICE PLAN OTHER","J2790 - HC IG;RHO D,HUMAN/300MCG"]
["BLUE CROSS","J2790 - HC IG;RHO D,HUMAN/300MCG"]
["AETNA","J2790 - HC IG;RHO D,HUMAN/300MCG"]
["BLUE BENEFIT ADMINISTRATORS","J2790 - HC IG;RHO D,HUMAN/300MCG"]
["UHC COMMUNITY CARE","J3301 - HC TRIAMCINOLONE ACET INJ NOS"]
["UNITED HEALTHCARE","J3301 - HC TRIAMCINOLONE ACET INJ NOS"]
["UNICARE","J3301 - HC TRIAMCINOLONE ACET INJ NOS"]
["TUFTS","J3301 - HC TRIAMCINOLONE ACET INJ NOS"]
["TUFTS PUBLIC PLANS","J3301 - HC TRIAMCINOLONE ACET INJ NOS"]
["SENIOR WHOLE HEALTH","J3301 - HC TRIAMCINOLONE ACET INJ NOS"]
["FALLON","J3301 - HC TRIAMCINOLONE ACET INJ NOS"]
["HARVARD PILGRIM HEALTH CARE","J3301 - HC TRIAMCINOLONE ACET INJ NOS"]
["ELDER SERVICE PLAN OTHER","J3301 - HC TRIAMCINOLONE ACET INJ NOS"]
["COMMONWEALTH CARE ALLIANCE","J3301 - HC TRIAMCINOLONE ACET INJ NOS"]
["CIGNA HEALTHCARE","J3301 - HC TRIAMCINOLONE ACET INJ NOS"]
["BLUE CROSS OUT OF STATE","J3301 - HC TRIAMCINOLONE ACET INJ NOS"]
["ELDER SERVICE PLAN","J3301 - HC TRIAMCINOLONE ACET INJ NOS"]
["BMC HEALTHNET","J3301 - HC TRIAMCINOLONE ACET INJ NOS"]
["BLUE CROSS","J3301 - HC TRIAMCINOLONE ACET INJ NOS"]
["AETNA","J3301 - HC TRIAMCINOLONE ACET INJ NOS"]
["BLUE BENEFIT ADMINISTRATORS","J3301 - HC TRIAMCINOLONE ACET INJ NOS"]
["TUFTS","J3590 - COSTAL CARTILAGE ALLOGRAFT"]
["CIGNA HEALTHCARE","J3590 - COSTAL CARTILAGE ALLOGRAFT"]
["TUFTS","J7307 - HC ETONOGESTREL IMPLANT SYSTEM"]
["UNITED HEALTHCARE","J7307 - HC ETONOGESTREL IMPLANT SYSTEM"]
["HARVARD PILGRIM HEALTH CARE","J7307 - HC ETONOGESTREL IMPLANT SYSTEM"]
["BLUE CROSS OUT OF STATE","J7307 - HC ETONOGESTREL IMPLANT SYSTEM"]
["CIGNA HEALTHCARE","J7307 - HC ETONOGESTREL IMPLANT SYSTEM"]
["BLUE BENEFIT ADMINISTRATORS","J7307 - HC ETONOGESTREL IMPLANT SYSTEM"]
["BLUE CROSS","J7307 - HC ETONOGESTREL IMPLANT SYSTEM"]
["UHC COMMUNITY CARE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE"]
["TUFTS","L0120 - CERV FLEXIBLE NON-ADJUSTABLE"]
["TUFTS PUBLIC PLANS","L0120 - CERV FLEXIBLE NON-ADJUSTABLE"]
["UNITED HEALTHCARE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE"]
["FALLON","L0120 - CERV FLEXIBLE NON-ADJUSTABLE"]
["HARVARD PILGRIM HEALTH CARE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE"]
["SENIOR WHOLE HEALTH","L0120 - CERV FLEXIBLE NON-ADJUSTABLE"]
["ELDER SERVICE PLAN","L0120 - CERV FLEXIBLE NON-ADJUSTABLE"]
["BLUE CROSS OUT OF STATE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE"]
["COMMONWEALTH CARE ALLIANCE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE"]
["ELDER SERVICE PLAN OTHER","L0120 - CERV FLEXIBLE NON-ADJUSTABLE"]
["BMC HEALTHNET","L0120 - CERV FLEXIBLE NON-ADJUSTABLE"]
["CIGNA HEALTHCARE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE"]
["AETNA","L0120 - CERV FLEXIBLE NON-ADJUSTABLE"]
["ALLWAYS HEALTH PARTNERS","L0120 - CERV FLEXIBLE NON-ADJUSTABLE"]
["BLUE CROSS","L0120 - CERV FLEXIBLE NON-ADJUSTABLE"]
["BLUE BENEFIT ADMINISTRATORS","L0120 - CERV FLEXIBLE NON-ADJUSTABLE"]
["TUFTS PUBLIC PLANS","L0140 - CERVICAL SEMI-RIGID ADJUSTAB"]
["TUFTS","L0140 - CERVICAL SEMI-RIGID ADJUSTAB"]
["UNITED HEALTHCARE","L0140 - CERVICAL SEMI-RIGID ADJUSTAB"]
["UHC COMMUNITY CARE","L0140 - CERVICAL SEMI-RIGID ADJUSTAB"]
["FALLON","L0140 - CERVICAL SEMI-RIGID ADJUSTAB"]
["HARVARD PILGRIM HEALTH CARE","L0140 - CERVICAL SEMI-RIGID ADJUSTAB"]
["SENIOR WHOLE HEALTH","L0140 - CERVICAL SEMI-RIGID ADJUSTAB"]
["BMC HEALTHNET","L0140 - CERVICAL SEMI-RIGID ADJUSTAB"]
["CIGNA HEALTHCARE","L0140 - CERVICAL SEMI-RIGID ADJUSTAB"]
["COMMONWEALTH CARE ALLIANCE","L0140 - CERVICAL SEMI-RIGID ADJUSTAB"]
["ELDER SERVICE PLAN","L0140 - CERVICAL SEMI-RIGID ADJUSTAB"]
["ELDER SERVICE PLAN OTHER","L0140 - CERVICAL SEMI-RIGID ADJUSTAB"]
["ALLWAYS HEALTH PARTNERS","L0140 - CERVICAL SEMI-RIGID ADJUSTAB"]
["BLUE CROSS","L0140 - CERVICAL SEMI-RIGID ADJUSTAB"]
["AETNA","L0140 - CERVICAL SEMI-RIGID ADJUSTAB"]
["TUFTS PUBLIC PLANS","L1820 - KO ELAS W/ CONDYLE PADS & JO"]
["TUFTS","L1820 - KO ELAS W/ CONDYLE PADS & JO"]
["UHC COMMUNITY CARE","L1820 - KO ELAS W/ CONDYLE PADS & JO"]
["UNITED HEALTHCARE","L1820 - KO ELAS W/ CONDYLE PADS & JO"]
["FALLON","L1820 - KO ELAS W/ CONDYLE PADS & JO"]
["HARVARD PILGRIM HEALTH CARE","L1820 - KO ELAS W/ CONDYLE PADS & JO"]
["SENIOR WHOLE HEALTH","L1820 - KO ELAS W/ CONDYLE PADS & JO"]
["CIGNA HEALTHCARE","L1820 - KO ELAS W/ CONDYLE PADS & JO"]
["BLUE CROSS OUT OF STATE","L1820 - KO ELAS W/ CONDYLE PADS & JO"]
["ELDER SERVICE PLAN","L1820 - KO ELAS W/ CONDYLE PADS & JO"]
["BMC HEALTHNET","L1820 - KO ELAS W/ CONDYLE PADS & JO"]
["COMMONWEALTH CARE ALLIANCE","L1820 - KO ELAS W/ CONDYLE PADS & JO"]
["ELDER SERVICE PLAN OTHER","L1820 - KO ELAS W/ CONDYLE PADS & JO"]
["BLUE CROSS","L1820 - KO ELAS W/ CONDYLE PADS & JO"]
["ALLWAYS HEALTH PARTNERS","L1820 - KO ELAS W/ CONDYLE PADS & JO"]
["AETNA","L1820 - KO ELAS W/ CONDYLE PADS & JO"]
["BLUE BENEFIT ADMINISTRATORS","L1820 - KO ELAS W/ CONDYLE PADS & JO"]
["TUFTS","L1830 - KO IMMOBILIZER CANVAS LONGIT"]
["TUFTS PUBLIC PLANS","L1830 - KO IMMOBILIZER CANVAS LONGIT"]
["UNITED HEALTHCARE","L1830 - KO IMMOBILIZER CANVAS LONGIT"]
["UHC COMMUNITY CARE","L1830 - KO IMMOBILIZER CANVAS LONGIT"]
["FALLON","L1830 - KO IMMOBILIZER CANVAS LONGIT"]
["HARVARD PILGRIM HEALTH CARE","L1830 - KO IMMOBILIZER CANVAS LONGIT"]
["SENIOR WHOLE HEALTH","L1830 - KO IMMOBILIZER CANVAS LONGIT"]
["BLUE CROSS OUT OF STATE","L1830 - KO IMMOBILIZER CANVAS LONGIT"]
["BMC HEALTHNET","L1830 - KO IMMOBILIZER CANVAS LONGIT"]
["CIGNA HEALTHCARE","L1830 - KO IMMOBILIZER CANVAS LONGIT"]
["COMMONWEALTH CARE ALLIANCE","L1830 - KO IMMOBILIZER CANVAS LONGIT"]
["ELDER SERVICE PLAN","L1830 - KO IMMOBILIZER CANVAS LONGIT"]
["ELDER SERVICE PLAN OTHER","L1830 - KO IMMOBILIZER CANVAS LONGIT"]
["BLUE CROSS","L1830 - KO IMMOBILIZER CANVAS LONGIT"]
["ALLWAYS HEALTH PARTNERS","L1830 - KO IMMOBILIZER CANVAS LONGIT"]
["AETNA","L1830 - KO IMMOBILIZER CANVAS LONGIT"]
["BLUE BENEFIT ADMINISTRATORS","L1830 - KO IMMOBILIZER CANVAS LONGIT"]
["UHC COMMUNITY CARE","L1832 - KO ADJ JNT POS RIGID SUPPORT"]
["TUFTS","L1832 - KO ADJ JNT POS RIGID SUPPORT"]
["TUFTS PUBLIC PLANS","L1832 - KO ADJ JNT POS RIGID SUPPORT"]
["UNITED HEALTHCARE","L1832 - KO ADJ JNT POS RIGID SUPPORT"]
["FALLON","L1832 - KO ADJ JNT POS RIGID SUPPORT"]
["HARVARD PILGRIM HEALTH CARE","L1832 - KO ADJ JNT POS RIGID SUPPORT"]
["SENIOR WHOLE HEALTH","L1832 - KO ADJ JNT POS RIGID SUPPORT"]
["ELDER SERVICE PLAN OTHER","L1832 - KO ADJ JNT POS RIGID SUPPORT"]
["COMMONWEALTH CARE ALLIANCE","L1832 - KO ADJ JNT POS RIGID SUPPORT"]
["BLUE CROSS OUT OF STATE","L1832 - KO ADJ JNT POS RIGID SUPPORT"]
["ELDER SERVICE PLAN","L1832 - KO ADJ JNT POS RIGID SUPPORT"]
["BMC HEALTHNET","L1832 - KO ADJ JNT POS RIGID SUPPORT"]
["CIGNA HEALTHCARE","L1832 - KO ADJ JNT POS RIGID SUPPORT"]
["BLUE CROSS","L1832 - KO ADJ JNT POS RIGID SUPPORT"]
["ALLWAYS HEALTH PARTNERS","L1832 - KO ADJ JNT POS RIGID SUPPORT"]
["AETNA","L1832 - KO ADJ JNT POS RIGID SUPPORT"]
["BLUE BENEFIT ADMINISTRATORS","L1832 - KO ADJ JNT POS RIGID SUPPORT"]
["TUFTS PUBLIC PLANS","L1836 - HC RIGID KO WO JOINTS"]
["UNITED HEALTHCARE","L1836 - HC RIGID KO WO JOINTS"]
["TUFTS","L1836 - HC RIGID KO WO JOINTS"]
["UHC COMMUNITY CARE","L1836 - HC RIGID KO WO JOINTS"]
["FALLON","L1836 - HC RIGID KO WO JOINTS"]
["HARVARD PILGRIM HEALTH CARE","L1836 - HC RIGID KO WO JOINTS"]
["SENIOR WHOLE HEALTH","L1836 - HC RIGID KO WO JOINTS"]
["BMC HEALTHNET","L1836 - HC RIGID KO WO JOINTS"]
["BLUE CROSS OUT OF STATE","L1836 - HC RIGID KO WO JOINTS"]
["CIGNA HEALTHCARE","L1836 - HC RIGID KO WO JOINTS"]
["COMMONWEALTH CARE ALLIANCE","L1836 - HC RIGID KO WO JOINTS"]
["ELDER SERVICE PLAN","L1836 - HC RIGID KO WO JOINTS"]
["ELDER SERVICE PLAN OTHER","L1836 - HC RIGID KO WO JOINTS"]
["ALLWAYS HEALTH PARTNERS","L1836 - HC RIGID KO WO JOINTS"]
["BLUE CROSS","L1836 - HC RIGID KO WO JOINTS"]
["BLUE BENEFIT ADMINISTRATORS","L1836 - HC RIGID KO WO JOINTS"]
["AETNA","L1836 - HC RIGID KO WO JOINTS"]
["TUFTS PUBLIC PLANS","L1902 - AFO ANKLE GAUNTLET"]
["TUFTS","L1902 - AFO ANKLE GAUNTLET"]
["UHC COMMUNITY CARE","L1902 - AFO ANKLE GAUNTLET"]
["UNITED HEALTHCARE","L1902 - AFO ANKLE GAUNTLET"]
["FALLON","L1902 - AFO ANKLE GAUNTLET"]
["HARVARD PILGRIM HEALTH CARE","L1902 - AFO ANKLE GAUNTLET"]
["SENIOR WHOLE HEALTH","L1902 - AFO ANKLE GAUNTLET"]
["ELDER SERVICE PLAN","L1902 - AFO ANKLE GAUNTLET"]
["BLUE CROSS OUT OF STATE","L1902 - AFO ANKLE GAUNTLET"]
["CIGNA HEALTHCARE","L1902 - AFO ANKLE GAUNTLET"]
["BMC HEALTHNET","L1902 - AFO ANKLE GAUNTLET"]
["COMMONWEALTH CARE ALLIANCE","L1902 - AFO ANKLE GAUNTLET"]
["ELDER SERVICE PLAN OTHER","L1902 - AFO ANKLE GAUNTLET"]
["BLUE CROSS","L1902 - AFO ANKLE GAUNTLET"]
["AETNA","L1902 - AFO ANKLE GAUNTLET"]
["ALLWAYS HEALTH PARTNERS","L1902 - AFO ANKLE GAUNTLET"]
["BLUE BENEFIT ADMINISTRATORS","L1902 - AFO ANKLE GAUNTLET"]
["TUFTS","L3260 - AMBULATORY SURGICAL BOOT EAC"]
["TUFTS PUBLIC PLANS","L3260 - AMBULATORY SURGICAL BOOT EAC"]
["FALLON","L3260 - AMBULATORY SURGICAL BOOT EAC"]
["BLUE CROSS OUT OF STATE","L3260 - AMBULATORY SURGICAL BOOT EAC"]
["BMC HEALTHNET","L3260 - AMBULATORY SURGICAL BOOT EAC"]
["CIGNA HEALTHCARE","L3260 - AMBULATORY SURGICAL BOOT EAC"]
["ALLWAYS HEALTH PARTNERS","L3260 - AMBULATORY SURGICAL BOOT EAC"]
["BLUE CROSS","L3260 - AMBULATORY SURGICAL BOOT EAC"]
["BLUE BENEFIT ADMINISTRATORS","L3260 - AMBULATORY SURGICAL BOOT EAC"]
["TUFTS","L3350 - SHOE HEEL WEDGE"]
["TUFTS PUBLIC PLANS","L3350 - SHOE HEEL WEDGE"]
["UNITED HEALTHCARE","L3350 - SHOE HEEL WEDGE"]
["UHC COMMUNITY CARE","L3350 - SHOE HEEL WEDGE"]
["FALLON","L3350 - SHOE HEEL WEDGE"]
["HARVARD PILGRIM HEALTH CARE","L3350 - SHOE HEEL WEDGE"]
["SENIOR WHOLE HEALTH","L3350 - SHOE HEEL WEDGE"]
["BMC HEALTHNET","L3350 - SHOE HEEL WEDGE"]
["CIGNA HEALTHCARE","L3350 - SHOE HEEL WEDGE"]
["COMMONWEALTH CARE ALLIANCE","L3350 - SHOE HEEL WEDGE"]
["ELDER SERVICE PLAN","L3350 - SHOE HEEL WEDGE"]
["ELDER SERVICE PLAN OTHER","L3350 - SHOE HEEL WEDGE"]
["BLUE CROSS","L3350 - SHOE HEEL WEDGE"]
["ALLWAYS HEALTH PARTNERS","L3350 - SHOE HEEL WEDGE"]
["AETNA","L3350 - SHOE HEEL WEDGE"]
["TUFTS PUBLIC PLANS","L3496 - HC STATIC AFO"]
["FALLON","L3496 - HC STATIC AFO"]
["BMC HEALTHNET","L3496 - HC STATIC AFO"]
["ALLWAYS HEALTH PARTNERS","L3496 - HC STATIC AFO"]
["TUFTS PUBLIC PLANS","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN"]
["UHC COMMUNITY CARE","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN"]
["TUFTS","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN"]
["UNITED HEALTHCARE","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN"]
["FALLON","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN"]
["HARVARD PILGRIM HEALTH CARE","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN"]
["SENIOR WHOLE HEALTH","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN"]
["ELDER SERVICE PLAN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN"]
["BLUE CROSS OUT OF STATE","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN"]
["COMMONWEALTH CARE ALLIANCE","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN"]
["ELDER SERVICE PLAN OTHER","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN"]
["BMC HEALTHNET","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN"]
["CIGNA HEALTHCARE","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN"]
["ALLWAYS HEALTH PARTNERS","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN"]
["BLUE CROSS","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN"]
["AETNA","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN"]
["BLUE BENEFIT ADMINISTRATORS","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN"]
["TUFTS PUBLIC PLANS","L3670 - ACROMIO/CLAVICULAR CANVAS&WE"]
["TUFTS","L3670 - ACROMIO/CLAVICULAR CANVAS&WE"]
["UNITED HEALTHCARE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE"]
["UHC COMMUNITY CARE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE"]
["FALLON","L3670 - ACROMIO/CLAVICULAR CANVAS&WE"]
["HARVARD PILGRIM HEALTH CARE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE"]
["SENIOR WHOLE HEALTH","L3670 - ACROMIO/CLAVICULAR CANVAS&WE"]
["CIGNA HEALTHCARE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE"]
["BLUE CROSS OUT OF STATE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE"]
["BMC HEALTHNET","L3670 - ACROMIO/CLAVICULAR CANVAS&WE"]
["COMMONWEALTH CARE ALLIANCE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE"]
["ELDER SERVICE PLAN","L3670 - ACROMIO/CLAVICULAR CANVAS&WE"]
["ELDER SERVICE PLAN OTHER","L3670 - ACROMIO/CLAVICULAR CANVAS&WE"]
["ALLWAYS HEALTH PARTNERS","L3670 - ACROMIO/CLAVICULAR CANVAS&WE"]
["BLUE CROSS","L3670 - ACROMIO/CLAVICULAR CANVAS&WE"]
["BLUE BENEFIT ADMINISTRATORS","L3670 - ACROMIO/CLAVICULAR CANVAS&WE"]
["AETNA","L3670 - ACROMIO/CLAVICULAR CANVAS&WE"]
["TUFTS","L3760 - EO WITHJOINT, PREFABRICATED"]
["TUFTS PUBLIC PLANS","L3760 - EO WITHJOINT, PREFABRICATED"]
["UHC COMMUNITY CARE","L3760 - EO WITHJOINT, PREFABRICATED"]
["UNITED HEALTHCARE","L3760 - EO WITHJOINT, PREFABRICATED"]
["FALLON","L3760 - EO WITHJOINT, PREFABRICATED"]
["HARVARD PILGRIM HEALTH CARE","L3760 - EO WITHJOINT, PREFABRICATED"]
["SENIOR WHOLE HEALTH","L3760 - EO WITHJOINT, PREFABRICATED"]
["BLUE CROSS OUT OF STATE","L3760 - EO WITHJOINT, PREFABRICATED"]
["ELDER SERVICE PLAN","L3760 - EO WITHJOINT, PREFABRICATED"]
["BMC HEALTHNET","L3760 - EO WITHJOINT, PREFABRICATED"]
["COMMONWEALTH CARE ALLIANCE","L3760 - EO WITHJOINT, PREFABRICATED"]
["ELDER SERVICE PLAN OTHER","L3760 - EO WITHJOINT, PREFABRICATED"]
["CIGNA HEALTHCARE","L3760 - EO WITHJOINT, PREFABRICATED"]
["BLUE CROSS","L3760 - EO WITHJOINT, PREFABRICATED"]
["ALLWAYS HEALTH PARTNERS","L3760 - EO WITHJOINT, PREFABRICATED"]
["BLUE BENEFIT ADMINISTRATORS","L3760 - EO WITHJOINT, PREFABRICATED"]
["AETNA","L3760 - EO WITHJOINT, PREFABRICATED"]
["TUFTS","L3762 - RIGID EO WO JOINTS"]
["TUFTS PUBLIC PLANS","L3762 - RIGID EO WO JOINTS"]
["UNITED HEALTHCARE","L3762 - RIGID EO WO JOINTS"]
["UHC COMMUNITY CARE","L3762 - RIGID EO WO JOINTS"]
["FALLON","L3762 - RIGID EO WO JOINTS"]
["HARVARD PILGRIM HEALTH CARE","L3762 - RIGID EO WO JOINTS"]
["SENIOR WHOLE HEALTH","L3762 - RIGID EO WO JOINTS"]
["BMC HEALTHNET","L3762 - RIGID EO WO JOINTS"]
["CIGNA HEALTHCARE","L3762 - RIGID EO WO JOINTS"]
["COMMONWEALTH CARE ALLIANCE","L3762 - RIGID EO WO JOINTS"]
["ELDER SERVICE PLAN","L3762 - RIGID EO WO JOINTS"]
["ELDER SERVICE PLAN OTHER","L3762 - RIGID EO WO JOINTS"]
["BLUE CROSS","L3762 - RIGID EO WO JOINTS"]
["ALLWAYS HEALTH PARTNERS","L3762 - RIGID EO WO JOINTS"]
["AETNA","L3762 - RIGID EO WO JOINTS"]
["UHC COMMUNITY CARE","L3807 - WHFO,NO JOINT, PREFABRICATED"]
["TUFTS PUBLIC PLANS","L3807 - WHFO,NO JOINT, PREFABRICATED"]
["TUFTS","L3807 - WHFO,NO JOINT, PREFABRICATED"]
["UNITED HEALTHCARE","L3807 - WHFO,NO JOINT, PREFABRICATED"]
["FALLON","L3807 - WHFO,NO JOINT, PREFABRICATED"]
["HARVARD PILGRIM HEALTH CARE","L3807 - WHFO,NO JOINT, PREFABRICATED"]
["SENIOR WHOLE HEALTH","L3807 - WHFO,NO JOINT, PREFABRICATED"]
["COMMONWEALTH CARE ALLIANCE","L3807 - WHFO,NO JOINT, PREFABRICATED"]
["ELDER SERVICE PLAN OTHER","L3807 - WHFO,NO JOINT, PREFABRICATED"]
["BLUE CROSS OUT OF STATE","L3807 - WHFO,NO JOINT, PREFABRICATED"]
["ELDER SERVICE PLAN","L3807 - WHFO,NO JOINT, PREFABRICATED"]
["BMC HEALTHNET","L3807 - WHFO,NO JOINT, PREFABRICATED"]
["CIGNA HEALTHCARE","L3807 - WHFO,NO JOINT, PREFABRICATED"]
["ALLWAYS HEALTH PARTNERS","L3807 - WHFO,NO JOINT, PREFABRICATED"]
["BLUE CROSS","L3807 - WHFO,NO JOINT, PREFABRICATED"]
["BLUE BENEFIT ADMINISTRATORS","L3807 - WHFO,NO JOINT, PREFABRICATED"]
["AETNA","L3807 - WHFO,NO JOINT, PREFABRICATED"]
["TUFTS PUBLIC PLANS","L3808 - HC EPITRAIN"]
["UNITED HEALTHCARE","L3808 - HC EPITRAIN"]
["TUFTS","L3808 - HC EPITRAIN"]
["UHC COMMUNITY CARE","L3808 - HC EPITRAIN"]
["FALLON","L3808 - HC EPITRAIN"]
["HARVARD PILGRIM HEALTH CARE","L3808 - HC EPITRAIN"]
["SENIOR WHOLE HEALTH","L3808 - HC EPITRAIN"]
["BLUE CROSS OUT OF STATE","L3808 - HC EPITRAIN"]
["CIGNA HEALTHCARE","L3808 - HC EPITRAIN"]
["BMC HEALTHNET","L3808 - HC EPITRAIN"]
["COMMONWEALTH CARE ALLIANCE","L3808 - HC EPITRAIN"]
["ELDER SERVICE PLAN","L3808 - HC EPITRAIN"]
["ELDER SERVICE PLAN OTHER","L3808 - HC EPITRAIN"]
["BLUE CROSS","L3808 - HC EPITRAIN"]
["ALLWAYS HEALTH PARTNERS","L3808 - HC EPITRAIN"]
["AETNA","L3808 - HC EPITRAIN"]
["BLUE BENEFIT ADMINISTRATORS","L3808 - HC EPITRAIN"]
["TUFTS","L3905 - HC WHO W/NONTORSION JNT(S) CF"]
["TUFTS PUBLIC PLANS","L3905 - HC WHO W/NONTORSION JNT(S) CF"]
["UHC COMMUNITY CARE","L3905 - HC WHO W/NONTORSION JNT(S) CF"]
["UNITED HEALTHCARE","L3905 - HC WHO W/NONTORSION JNT(S) CF"]
["FALLON","L3905 - HC WHO W/NONTORSION JNT(S) CF"]
["HARVARD PILGRIM HEALTH CARE","L3905 - HC WHO W/NONTORSION JNT(S) CF"]
["SENIOR WHOLE HEALTH","L3905 - HC WHO W/NONTORSION JNT(S) CF"]
["ELDER SERVICE PLAN","L3905 - HC WHO W/NONTORSION JNT(S) CF"]
["BLUE CROSS OUT OF STATE","L3905 - HC WHO W/NONTORSION JNT(S) CF"]
["BMC HEALTHNET","L3905 - HC WHO W/NONTORSION JNT(S) CF"]
["COMMONWEALTH CARE ALLIANCE","L3905 - HC WHO W/NONTORSION JNT(S) CF"]
["ELDER SERVICE PLAN OTHER","L3905 - HC WHO W/NONTORSION JNT(S) CF"]
["CIGNA HEALTHCARE","L3905 - HC WHO W/NONTORSION JNT(S) CF"]
["ALLWAYS HEALTH PARTNERS","L3905 - HC WHO W/NONTORSION JNT(S) CF"]
["BLUE CROSS","L3905 - HC WHO W/NONTORSION JNT(S) CF"]
["BLUE BENEFIT ADMINISTRATORS","L3905 - HC WHO W/NONTORSION JNT(S) CF"]
["AETNA","L3905 - HC WHO W/NONTORSION JNT(S) CF"]
["TUFTS","L3908 - WRIST COCK-UP NON-MOLDED"]
["TUFTS PUBLIC PLANS","L3908 - WRIST COCK-UP NON-MOLDED"]
["UNITED HEALTHCARE","L3908 - WRIST COCK-UP NON-MOLDED"]
["UHC COMMUNITY CARE","L3908 - WRIST COCK-UP NON-MOLDED"]
["FALLON","L3908 - WRIST COCK-UP NON-MOLDED"]
["HARVARD PILGRIM HEALTH CARE","L3908 - WRIST COCK-UP NON-MOLDED"]
["SENIOR WHOLE HEALTH","L3908 - WRIST COCK-UP NON-MOLDED"]
["BMC HEALTHNET","L3908 - WRIST COCK-UP NON-MOLDED"]
["BLUE CROSS OUT OF STATE","L3908 - WRIST COCK-UP NON-MOLDED"]
["CIGNA HEALTHCARE","L3908 - WRIST COCK-UP NON-MOLDED"]
["COMMONWEALTH CARE ALLIANCE","L3908 - WRIST COCK-UP NON-MOLDED"]
["ELDER SERVICE PLAN","L3908 - WRIST COCK-UP NON-MOLDED"]
["ELDER SERVICE PLAN OTHER","L3908 - WRIST COCK-UP NON-MOLDED"]
["BLUE CROSS","L3908 - WRIST COCK-UP NON-MOLDED"]
["ALLWAYS HEALTH PARTNERS","L3908 - WRIST COCK-UP NON-MOLDED"]
["BLUE BENEFIT ADMINISTRATORS","L3908 - WRIST COCK-UP NON-MOLDED"]
["AETNA","L3908 - WRIST COCK-UP NON-MOLDED"]
["TUFTS PUBLIC PLANS","L3967 - HC SEWHO AIRPLANE W/O JNTS CF"]
["UHC COMMUNITY CARE","L3967 - HC SEWHO AIRPLANE W/O JNTS CF"]
["TUFTS","L3967 - HC SEWHO AIRPLANE W/O JNTS CF"]
["UNITED HEALTHCARE","L3967 - HC SEWHO AIRPLANE W/O JNTS CF"]
["FALLON","L3967 - HC SEWHO AIRPLANE W/O JNTS CF"]
["HARVARD PILGRIM HEALTH CARE","L3967 - HC SEWHO AIRPLANE W/O JNTS CF"]
["SENIOR WHOLE HEALTH","L3967 - HC SEWHO AIRPLANE W/O JNTS CF"]
["ELDER SERVICE PLAN","L3967 - HC SEWHO AIRPLANE W/O JNTS CF"]
["BLUE CROSS OUT OF STATE","L3967 - HC SEWHO AIRPLANE W/O JNTS CF"]
["COMMONWEALTH CARE ALLIANCE","L3967 - HC SEWHO AIRPLANE W/O JNTS CF"]
["ELDER SERVICE PLAN OTHER","L3967 - HC SEWHO AIRPLANE W/O JNTS CF"]
["BMC HEALTHNET","L3967 - HC SEWHO AIRPLANE W/O JNTS CF"]
["CIGNA HEALTHCARE","L3967 - HC SEWHO AIRPLANE W/O JNTS CF"]
["ALLWAYS HEALTH PARTNERS","L3967 - HC SEWHO AIRPLANE W/O JNTS CF"]
["AETNA","L3967 - HC SEWHO AIRPLANE W/O JNTS CF"]
["BLUE CROSS","L3967 - HC SEWHO AIRPLANE W/O JNTS CF"]
["BLUE BENEFIT ADMINISTRATORS","L3967 - HC SEWHO AIRPLANE W/O JNTS CF"]
["TUFTS PUBLIC PLANS","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL"]
["TUFTS","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL"]
["UNITED HEALTHCARE","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL"]
["UHC COMMUNITY CARE","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL"]
["FALLON","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL"]
["HARVARD PILGRIM HEALTH CARE","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL"]
["SENIOR WHOLE HEALTH","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL"]
["CIGNA HEALTHCARE","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL"]
["BLUE CROSS OUT OF STATE","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL"]
["BMC HEALTHNET","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL"]
["COMMONWEALTH CARE ALLIANCE","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL"]
["ELDER SERVICE PLAN","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL"]
["ELDER SERVICE PLAN OTHER","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL"]
["AETNA","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL"]
["ALLWAYS HEALTH PARTNERS","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL"]
["BLUE CROSS","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL"]
["BLUE BENEFIT ADMINISTRATORS","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL"]
["TUFTS","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL"]
["TUFTS PUBLIC PLANS","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL"]
["UHC COMMUNITY CARE","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL"]
["UNITED HEALTHCARE","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL"]
["FALLON","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL"]
["HARVARD PILGRIM HEALTH CARE","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL"]
["SENIOR WHOLE HEALTH","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL"]
["ELDER SERVICE PLAN","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL"]
["BMC HEALTHNET","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL"]
["COMMONWEALTH CARE ALLIANCE","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL"]
["ELDER SERVICE PLAN OTHER","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL"]
["CIGNA HEALTHCARE","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL"]
["AETNA","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL"]
["ALLWAYS HEALTH PARTNERS","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL"]
["BLUE CROSS","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL"]
["TUFTS","L4350 - ANKLE CONTROL ORTHOSI PREFAB"]
["TUFTS PUBLIC PLANS","L4350 - ANKLE CONTROL ORTHOSI PREFAB"]
["UNITED HEALTHCARE","L4350 - ANKLE CONTROL ORTHOSI PREFAB"]
["UHC COMMUNITY CARE","L4350 - ANKLE CONTROL ORTHOSI PREFAB"]
["FALLON","L4350 - ANKLE CONTROL ORTHOSI PREFAB"]
["HARVARD PILGRIM HEALTH CARE","L4350 - ANKLE CONTROL ORTHOSI PREFAB"]
["SENIOR WHOLE HEALTH","L4350 - ANKLE CONTROL ORTHOSI PREFAB"]
["BMC HEALTHNET","L4350 - ANKLE CONTROL ORTHOSI PREFAB"]
["BLUE CROSS OUT OF STATE","L4350 - ANKLE CONTROL ORTHOSI PREFAB"]
["CIGNA HEALTHCARE","L4350 - ANKLE CONTROL ORTHOSI PREFAB"]
["COMMONWEALTH CARE ALLIANCE","L4350 - ANKLE CONTROL ORTHOSI PREFAB"]
["ELDER SERVICE PLAN","L4350 - ANKLE CONTROL ORTHOSI PREFAB"]
["ELDER SERVICE PLAN OTHER","L4350 - ANKLE CONTROL ORTHOSI PREFAB"]
["AETNA","L4350 - ANKLE CONTROL ORTHOSI PREFAB"]
["BLUE CROSS","L4350 - ANKLE CONTROL ORTHOSI PREFAB"]
["ALLWAYS HEALTH PARTNERS","L4350 - ANKLE CONTROL ORTHOSI PREFAB"]
["BLUE BENEFIT ADMINISTRATORS","L4350 - ANKLE CONTROL ORTHOSI PREFAB"]
["UHC COMMUNITY CARE","L4360 - PNEUMATI WALKING BOOT PREFAB"]
["TUFTS PUBLIC PLANS","L4360 - PNEUMATI WALKING BOOT PREFAB"]
["TUFTS","L4360 - PNEUMATI WALKING BOOT PREFAB"]
["UNITED HEALTHCARE","L4360 - PNEUMATI WALKING BOOT PREFAB"]
["FALLON","L4360 - PNEUMATI WALKING BOOT PREFAB"]
["HARVARD PILGRIM HEALTH CARE","L4360 - PNEUMATI WALKING BOOT PREFAB"]
["SENIOR WHOLE HEALTH","L4360 - PNEUMATI WALKING BOOT PREFAB"]
["COMMONWEALTH CARE ALLIANCE","L4360 - PNEUMATI WALKING BOOT PREFAB"]
["ELDER SERVICE PLAN OTHER","L4360 - PNEUMATI WALKING BOOT PREFAB"]
["BLUE CROSS OUT OF STATE","L4360 - PNEUMATI WALKING BOOT PREFAB"]
["ELDER SERVICE PLAN","L4360 - PNEUMATI WALKING BOOT PREFAB"]
["BMC HEALTHNET","L4360 - PNEUMATI WALKING BOOT PREFAB"]
["CIGNA HEALTHCARE","L4360 - PNEUMATI WALKING BOOT PREFAB"]
["BLUE CROSS","L4360 - PNEUMATI WALKING BOOT PREFAB"]
["ALLWAYS HEALTH PARTNERS","L4360 - PNEUMATI WALKING BOOT PREFAB"]
["AETNA","L4360 - PNEUMATI WALKING BOOT PREFAB"]
["BLUE BENEFIT ADMINISTRATORS","L4360 - PNEUMATI WALKING BOOT PREFAB"]
["TUFTS PUBLIC PLANS","L4370 - HC PNEUMATIC FULL LEG SPLINT"]
["UNITED HEALTHCARE","L4370 - HC PNEUMATIC FULL LEG SPLINT"]
["TUFTS","L4370 - HC PNEUMATIC FULL LEG SPLINT"]
["UHC COMMUNITY CARE","L4370 - HC PNEUMATIC FULL LEG SPLINT"]
["FALLON","L4370 - HC PNEUMATIC FULL LEG SPLINT"]
["HARVARD PILGRIM HEALTH CARE","L4370 - HC PNEUMATIC FULL LEG SPLINT"]
["SENIOR WHOLE HEALTH","L4370 - HC PNEUMATIC FULL LEG SPLINT"]
["CIGNA HEALTHCARE","L4370 - HC PNEUMATIC FULL LEG SPLINT"]
["BMC HEALTHNET","L4370 - HC PNEUMATIC FULL LEG SPLINT"]
["COMMONWEALTH CARE ALLIANCE","L4370 - HC PNEUMATIC FULL LEG SPLINT"]
["ELDER SERVICE PLAN","L4370 - HC PNEUMATIC FULL LEG SPLINT"]
["ELDER SERVICE PLAN OTHER","L4370 - HC PNEUMATIC FULL LEG SPLINT"]
["ALLWAYS HEALTH PARTNERS","L4370 - HC PNEUMATIC FULL LEG SPLINT"]
["AETNA","L4370 - HC PNEUMATIC FULL LEG SPLINT"]
["BLUE CROSS","L4370 - HC PNEUMATIC FULL LEG SPLINT"]
["TUFTS","L4386 - NON-PNEUM WALK BOOT PREFAB"]
["TUFTS PUBLIC PLANS","L4386 - NON-PNEUM WALK BOOT PREFAB"]
["UHC COMMUNITY CARE","L4386 - NON-PNEUM WALK BOOT PREFAB"]
["UNITED HEALTHCARE","L4386 - NON-PNEUM WALK BOOT PREFAB"]
["FALLON","L4386 - NON-PNEUM WALK BOOT PREFAB"]
["HARVARD PILGRIM HEALTH CARE","L4386 - NON-PNEUM WALK BOOT PREFAB"]
["SENIOR WHOLE HEALTH","L4386 - NON-PNEUM WALK BOOT PREFAB"]
["ELDER SERVICE PLAN","L4386 - NON-PNEUM WALK BOOT PREFAB"]
["BLUE CROSS OUT OF STATE","L4386 - NON-PNEUM WALK BOOT PREFAB"]
["BMC HEALTHNET","L4386 - NON-PNEUM WALK BOOT PREFAB"]
["COMMONWEALTH CARE ALLIANCE","L4386 - NON-PNEUM WALK BOOT PREFAB"]
["ELDER SERVICE PLAN OTHER","L4386 - NON-PNEUM WALK BOOT PREFAB"]
["CIGNA HEALTHCARE","L4386 - NON-PNEUM WALK BOOT PREFAB"]
["ALLWAYS HEALTH PARTNERS","L4386 - NON-PNEUM WALK BOOT PREFAB"]
["AETNA","L4386 - NON-PNEUM WALK BOOT PREFAB"]
["BLUE CROSS","L4386 - NON-PNEUM WALK BOOT PREFAB"]
["BLUE BENEFIT ADMINISTRATORS","L4386 - NON-PNEUM WALK BOOT PREFAB"]
["TUFTS","L4396 - STATIC AFO"]
["TUFTS PUBLIC PLANS","L4396 - STATIC AFO"]
["UNITED HEALTHCARE","L4396 - STATIC AFO"]
["UHC COMMUNITY CARE","L4396 - STATIC AFO"]
["FALLON","L4396 - STATIC AFO"]
["HARVARD PILGRIM HEALTH CARE","L4396 - STATIC AFO"]
["SENIOR WHOLE HEALTH","L4396 - STATIC AFO"]
["BMC HEALTHNET","L4396 - STATIC AFO"]
["BLUE CROSS OUT OF STATE","L4396 - STATIC AFO"]
["CIGNA HEALTHCARE","L4396 - STATIC AFO"]
["COMMONWEALTH CARE ALLIANCE","L4396 - STATIC AFO"]
["ELDER SERVICE PLAN","L4396 - STATIC AFO"]
["ELDER SERVICE PLAN OTHER","L4396 - STATIC AFO"]
["BLUE CROSS","L4396 - STATIC AFO"]
["ALLWAYS HEALTH PARTNERS","L4396 - STATIC AFO"]
["AETNA","L4396 - STATIC AFO"]
["BLUE BENEFIT ADMINISTRATORS","L4396 - STATIC AFO"]
["TUFTS PUBLIC PLANS","L4398 - HC FOOT DROP SPLINT RECUMBENT"]
["UHC COMMUNITY CARE","L4398 - HC FOOT DROP SPLINT RECUMBENT"]
["TUFTS","L4398 - HC FOOT DROP SPLINT RECUMBENT"]
["UNITED HEALTHCARE","L4398 - HC FOOT DROP SPLINT RECUMBENT"]
["FALLON","L4398 - HC FOOT DROP SPLINT RECUMBENT"]
["HARVARD PILGRIM HEALTH CARE","L4398 - HC FOOT DROP SPLINT RECUMBENT"]
["SENIOR WHOLE HEALTH","L4398 - HC FOOT DROP SPLINT RECUMBENT"]
["ELDER SERVICE PLAN","L4398 - HC FOOT DROP SPLINT RECUMBENT"]
["BLUE CROSS OUT OF STATE","L4398 - HC FOOT DROP SPLINT RECUMBENT"]
["COMMONWEALTH CARE ALLIANCE","L4398 - HC FOOT DROP SPLINT RECUMBENT"]
["ELDER SERVICE PLAN OTHER","L4398 - HC FOOT DROP SPLINT RECUMBENT"]
["BMC HEALTHNET","L4398 - HC FOOT DROP SPLINT RECUMBENT"]
["CIGNA HEALTHCARE","L4398 - HC FOOT DROP SPLINT RECUMBENT"]
["ALLWAYS HEALTH PARTNERS","L4398 - HC FOOT DROP SPLINT RECUMBENT"]
["AETNA","L4398 - HC FOOT DROP SPLINT RECUMBENT"]
["BLUE CROSS","L4398 - HC FOOT DROP SPLINT RECUMBENT"]
["BLUE BENEFIT ADMINISTRATORS","L4398 - HC FOOT DROP SPLINT RECUMBENT"]
["TUFTS PUBLIC PLANS","L8501 - TRACHEOSTOMY SPEAKING VALVE"]
["TUFTS","L8501 - TRACHEOSTOMY SPEAKING VALVE"]
["UNITED HEALTHCARE","L8501 - TRACHEOSTOMY SPEAKING VALVE"]
["UHC COMMUNITY CARE","L8501 - TRACHEOSTOMY SPEAKING VALVE"]
["FALLON","L8501 - TRACHEOSTOMY SPEAKING VALVE"]
["HARVARD PILGRIM HEALTH CARE","L8501 - TRACHEOSTOMY SPEAKING VALVE"]
["SENIOR WHOLE HEALTH","L8501 - TRACHEOSTOMY SPEAKING VALVE"]
["CIGNA HEALTHCARE","L8501 - TRACHEOSTOMY SPEAKING VALVE"]
["BMC HEALTHNET","L8501 - TRACHEOSTOMY SPEAKING VALVE"]
["COMMONWEALTH CARE ALLIANCE","L8501 - TRACHEOSTOMY SPEAKING VALVE"]
["ELDER SERVICE PLAN","L8501 - TRACHEOSTOMY SPEAKING VALVE"]
["ELDER SERVICE PLAN OTHER","L8501 - TRACHEOSTOMY SPEAKING VALVE"]
["ALLWAYS HEALTH PARTNERS","L8501 - TRACHEOSTOMY SPEAKING VALVE"]
["BLUE CROSS","L8501 - TRACHEOSTOMY SPEAKING VALVE"]
["AETNA","L8501 - TRACHEOSTOMY SPEAKING VALVE"]
["TUFTS","L8507 - HC PROLARYNX VOICE (PLUS)"]
["TUFTS PUBLIC PLANS","L8507 - HC PROLARYNX VOICE (PLUS)"]
["UHC COMMUNITY CARE","L8507 - HC PROLARYNX VOICE (PLUS)"]
["UNITED HEALTHCARE","L8507 - HC PROLARYNX VOICE (PLUS)"]
["FALLON","L8507 - HC PROLARYNX VOICE (PLUS)"]
["HARVARD PILGRIM HEALTH CARE","L8507 - HC PROLARYNX VOICE (PLUS)"]
["SENIOR WHOLE HEALTH","L8507 - HC PROLARYNX VOICE (PLUS)"]
["ELDER SERVICE PLAN","L8507 - HC PROLARYNX VOICE (PLUS)"]
["BMC HEALTHNET","L8507 - HC PROLARYNX VOICE (PLUS)"]
["COMMONWEALTH CARE ALLIANCE","L8507 - HC PROLARYNX VOICE (PLUS)"]
["ELDER SERVICE PLAN OTHER","L8507 - HC PROLARYNX VOICE (PLUS)"]
["CIGNA HEALTHCARE","L8507 - HC PROLARYNX VOICE (PLUS)"]
["ALLWAYS HEALTH PARTNERS","L8507 - HC PROLARYNX VOICE (PLUS)"]
["AETNA","L8507 - HC PROLARYNX VOICE (PLUS)"]
["BLUE CROSS","L8507 - HC PROLARYNX VOICE (PLUS)"]
["TUFTS","L8509 - TRACH-ESOPH VOICE PROS MD IN"]
["TUFTS PUBLIC PLANS","L8509 - TRACH-ESOPH VOICE PROS MD IN"]
["UNITED HEALTHCARE","L8509 - TRACH-ESOPH VOICE PROS MD IN"]
["UHC COMMUNITY CARE","L8509 - TRACH-ESOPH VOICE PROS MD IN"]
["FALLON","L8509 - TRACH-ESOPH VOICE PROS MD IN"]
["HARVARD PILGRIM HEALTH CARE","L8509 - TRACH-ESOPH VOICE PROS MD IN"]
["SENIOR WHOLE HEALTH","L8509 - TRACH-ESOPH VOICE PROS MD IN"]
["BMC HEALTHNET","L8509 - TRACH-ESOPH VOICE PROS MD IN"]
["BLUE CROSS OUT OF STATE","L8509 - TRACH-ESOPH VOICE PROS MD IN"]
["CIGNA HEALTHCARE","L8509 - TRACH-ESOPH VOICE PROS MD IN"]
["COMMONWEALTH CARE ALLIANCE","L8509 - TRACH-ESOPH VOICE PROS MD IN"]
["ELDER SERVICE PLAN","L8509 - TRACH-ESOPH VOICE PROS MD IN"]
["ELDER SERVICE PLAN OTHER","L8509 - TRACH-ESOPH VOICE PROS MD IN"]
["BLUE CROSS","L8509 - TRACH-ESOPH VOICE PROS MD IN"]
["ALLWAYS HEALTH PARTNERS","L8509 - TRACH-ESOPH VOICE PROS MD IN"]
["AETNA","L8509 - TRACH-ESOPH VOICE PROS MD IN"]
["BLUE BENEFIT ADMINISTRATORS","L8509 - TRACH-ESOPH VOICE PROS MD IN"]
["UHC COMMUNITY CARE","L8514 - REPL TRACH PUNCTURE DILATOR"]
["TUFTS PUBLIC PLANS","L8514 - REPL TRACH PUNCTURE DILATOR"]
["TUFTS","L8514 - REPL TRACH PUNCTURE DILATOR"]
["UNITED HEALTHCARE","L8514 - REPL TRACH PUNCTURE DILATOR"]
["FALLON","L8514 - REPL TRACH PUNCTURE DILATOR"]
["HARVARD PILGRIM HEALTH CARE","L8514 - REPL TRACH PUNCTURE DILATOR"]
["SENIOR WHOLE HEALTH","L8514 - REPL TRACH PUNCTURE DILATOR"]
["COMMONWEALTH CARE ALLIANCE","L8514 - REPL TRACH PUNCTURE DILATOR"]
["ELDER SERVICE PLAN OTHER","L8514 - REPL TRACH PUNCTURE DILATOR"]
["ELDER SERVICE PLAN","L8514 - REPL TRACH PUNCTURE DILATOR"]
["BMC HEALTHNET","L8514 - REPL TRACH PUNCTURE DILATOR"]
["CIGNA HEALTHCARE","L8514 - REPL TRACH PUNCTURE DILATOR"]
["ALLWAYS HEALTH PARTNERS","L8514 - REPL TRACH PUNCTURE DILATOR"]
["BLUE CROSS","L8514 - REPL TRACH PUNCTURE DILATOR"]
["AETNA","L8514 - REPL TRACH PUNCTURE DILATOR"]
["TUFTS PUBLIC PLANS","L8693 - HC AUD OSSEO DEV, ABUTMENT"]
["UNITED HEALTHCARE","L8693 - HC AUD OSSEO DEV, ABUTMENT"]
["TUFTS","L8693 - HC AUD OSSEO DEV, ABUTMENT"]
["UHC COMMUNITY CARE","L8693 - HC AUD OSSEO DEV, ABUTMENT"]
["FALLON","L8693 - HC AUD OSSEO DEV, ABUTMENT"]
["HARVARD PILGRIM HEALTH CARE","L8693 - HC AUD OSSEO DEV, ABUTMENT"]
["SENIOR WHOLE HEALTH","L8693 - HC AUD OSSEO DEV, ABUTMENT"]
["BLUE CROSS OUT OF STATE","L8693 - HC AUD OSSEO DEV, ABUTMENT"]
["CIGNA HEALTHCARE","L8693 - HC AUD OSSEO DEV, ABUTMENT"]
["BMC HEALTHNET","L8693 - HC AUD OSSEO DEV, ABUTMENT"]
["COMMONWEALTH CARE ALLIANCE","L8693 - HC AUD OSSEO DEV, ABUTMENT"]
["ELDER SERVICE PLAN","L8693 - HC AUD OSSEO DEV, ABUTMENT"]
["ELDER SERVICE PLAN OTHER","L8693 - HC AUD OSSEO DEV, ABUTMENT"]
["ALLWAYS HEALTH PARTNERS","L8693 - HC AUD OSSEO DEV, ABUTMENT"]
["AETNA","L8693 - HC AUD OSSEO DEV, ABUTMENT"]
["BLUE CROSS","L8693 - HC AUD OSSEO DEV, ABUTMENT"]
["BLUE BENEFIT ADMINISTRATORS","L8693 - HC AUD OSSEO DEV, ABUTMENT"]
["UNITED HEALTHCARE","L8699 - HC CARTIFORM 20 X 25 MM DISC"]
["TUFTS","L8699 - HC CARTIFORM 20 X 25 MM DISC"]
["TUFTS PUBLIC PLANS","L8699 - HC CARTIFORM 20 X 25 MM DISC"]
["FALLON","L8699 - HC CARTIFORM 20 X 25 MM DISC"]
["HARVARD PILGRIM HEALTH CARE","L8699 - HC CARTIFORM 20 X 25 MM DISC"]
["BMC HEALTHNET","L8699 - HC CARTIFORM 20 X 25 MM DISC"]
["CIGNA HEALTHCARE","L8699 - HC CARTIFORM 20 X 25 MM DISC"]
["ALLWAYS HEALTH PARTNERS","L8699 - HC CARTIFORM 20 X 25 MM DISC"]
["UHC COMMUNITY CARE","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING"]
["TUFTS","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING"]
["UNITED HEALTHCARE","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING"]
["FALLON","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING"]
["HARVARD PILGRIM HEALTH CARE","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING"]
["SENIOR WHOLE HEALTH","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING"]
["ELDER SERVICE PLAN","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING"]
["BMC HEALTHNET","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING"]
["BLUE CROSS OUT OF STATE","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING"]
["COMMONWEALTH CARE ALLIANCE","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING"]
["ELDER SERVICE PLAN OTHER","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING"]
["AETNA","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING"]
["BLUE CROSS","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING"]
["ALLWAYS HEALTH PARTNERS","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING"]
["BLUE BENEFIT ADMINISTRATORS","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING"]
["UNITED HEALTHCARE","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG"]
["UHC COMMUNITY CARE","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG"]
["TUFTS","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG"]
["FALLON","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG"]
["HARVARD PILGRIM HEALTH CARE","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG"]
["SENIOR WHOLE HEALTH","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG"]
["BLUE CROSS OUT OF STATE","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG"]
["BMC HEALTHNET","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG"]
["COMMONWEALTH CARE ALLIANCE","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG"]
["ELDER SERVICE PLAN","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG"]
["ELDER SERVICE PLAN OTHER","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG"]
["BLUE CROSS","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG"]
["ALLWAYS HEALTH PARTNERS","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG"]
["AETNA","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG"]
["BLUE BENEFIT ADMINISTRATORS","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG"]
["TUFTS","P9012 - HC CRYOPRECIPITATE UNIT"]
["UNITED HEALTHCARE","P9012 - HC CRYOPRECIPITATE UNIT"]
["HARVARD PILGRIM HEALTH CARE","P9012 - HC CRYOPRECIPITATE UNIT"]
["BLUE CROSS OUT OF STATE","P9012 - HC CRYOPRECIPITATE UNIT"]
["CIGNA HEALTHCARE","P9012 - HC CRYOPRECIPITATE UNIT"]
["BLUE CROSS","P9012 - HC CRYOPRECIPITATE UNIT"]
["BLUE BENEFIT ADMINISTRATORS","P9012 - HC CRYOPRECIPITATE UNIT"]
["TUFTS","P9016 - HC RBC:LEU-RED"]
["UNITED HEALTHCARE","P9016 - HC RBC:LEU-RED"]
["HARVARD PILGRIM HEALTH CARE","P9016 - HC RBC:LEU-RED"]
["BLUE CROSS OUT OF STATE","P9016 - HC RBC:LEU-RED"]
["CIGNA HEALTHCARE","P9016 - HC RBC:LEU-RED"]
["BLUE CROSS","P9016 - HC RBC:LEU-RED"]
["BLUE BENEFIT ADMINISTRATORS","P9016 - HC RBC:LEU-RED"]
["TUFTS","P9017 - HC FF PLAS: 1 DONOR"]
["UNITED HEALTHCARE","P9017 - HC FF PLAS: 1 DONOR"]
["HARVARD PILGRIM HEALTH CARE","P9017 - HC FF PLAS: 1 DONOR"]
["CIGNA HEALTHCARE","P9017 - HC FF PLAS: 1 DONOR"]
["BLUE CROSS OUT OF STATE","P9017 - HC FF PLAS: 1 DONOR"]
["BLUE CROSS","P9017 - HC FF PLAS: 1 DONOR"]
["BLUE BENEFIT ADMINISTRATORS","P9017 - HC FF PLAS: 1 DONOR"]
["UNITED HEALTHCARE","P9021 - HC RBC/UNIT"]
["TUFTS","P9021 - HC RBC/UNIT"]
["HARVARD PILGRIM HEALTH CARE","P9021 - HC RBC/UNIT"]
["BLUE CROSS OUT OF STATE","P9021 - HC RBC/UNIT"]
["CIGNA HEALTHCARE","P9021 - HC RBC/UNIT"]
["BLUE CROSS","P9021 - HC RBC/UNIT"]
["BLUE BENEFIT ADMINISTRATORS","P9021 - HC RBC/UNIT"]
["TUFTS","P9034 - HB PLATELETS, PHERESIS"]
["UNITED HEALTHCARE","P9034 - HB PLATELETS, PHERESIS"]
["HARVARD PILGRIM HEALTH CARE","P9034 - HB PLATELETS, PHERESIS"]
["BLUE CROSS OUT OF STATE","P9034 - HB PLATELETS, PHERESIS"]
["CIGNA HEALTHCARE","P9034 - HB PLATELETS, PHERESIS"]
["BLUE CROSS","P9034 - HB PLATELETS, PHERESIS"]
["BLUE BENEFIT ADMINISTRATORS","P9034 - HB PLATELETS, PHERESIS"]
["TUFTS","P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT"]
["UNITED HEALTHCARE","P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT"]
["HARVARD PILGRIM HEALTH CARE","P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT"]
["BLUE CROSS OUT OF STATE","P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT"]
["CIGNA HEALTHCARE","P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT"]
["BLUE CROSS","P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT"]
["BLUE BENEFIT ADMINISTRATORS","P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT"]
["TUFTS","P9040 - HC RBC:LEU-RED,IRR/UNIT"]
["UNITED HEALTHCARE","P9040 - HC RBC:LEU-RED,IRR/UNIT"]
["HARVARD PILGRIM HEALTH CARE","P9040 - HC RBC:LEU-RED,IRR/UNIT"]
["CIGNA HEALTHCARE","P9040 - HC RBC:LEU-RED,IRR/UNIT"]
["BLUE CROSS OUT OF STATE","P9040 - HC RBC:LEU-RED,IRR/UNIT"]
["BLUE CROSS","P9040 - HC RBC:LEU-RED,IRR/UNIT"]
["BLUE BENEFIT ADMINISTRATORS","P9040 - HC RBC:LEU-RED,IRR/UNIT"]
["UNITED HEALTHCARE","P9044 - HC CRYOPRECIPITATE REDUCED PLASMA"]
["TUFTS","P9044 - HC CRYOPRECIPITATE REDUCED PLASMA"]
["HARVARD PILGRIM HEALTH CARE","P9044 - HC CRYOPRECIPITATE REDUCED PLASMA"]
["CIGNA HEALTHCARE","P9044 - HC CRYOPRECIPITATE REDUCED PLASMA"]
["UHC COMMUNITY CARE","P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["TUFTS","P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["UNICARE","P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["TUFTS PUBLIC PLANS","P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["UNITED HEALTHCARE","P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["FALLON","P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["HARVARD PILGRIM HEALTH CARE","P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["SENIOR WHOLE HEALTH","P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["ELDER SERVICE PLAN","P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["BLUE CROSS OUT OF STATE","P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["COMMONWEALTH CARE ALLIANCE","P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["ELDER SERVICE PLAN OTHER","P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["BMC HEALTHNET","P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["CIGNA HEALTHCARE","P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["BLUE CROSS","P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["BLUE BENEFIT ADMINISTRATORS","P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["AETNA","P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["TUFTS","P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["UNITED HEALTHCARE","P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["UNICARE","P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["UHC COMMUNITY CARE","P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["TUFTS PUBLIC PLANS","P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["SENIOR WHOLE HEALTH","P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["HARVARD PILGRIM HEALTH CARE","P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["FALLON","P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["COMMONWEALTH CARE ALLIANCE","P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["BLUE CROSS OUT OF STATE","P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["BMC HEALTHNET","P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["ELDER SERVICE PLAN","P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["CIGNA HEALTHCARE","P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["ELDER SERVICE PLAN OTHER","P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["AETNA","P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["BLUE CROSS","P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["BLUE BENEFIT ADMINISTRATORS","P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["TUFTS","P9056 - HC BLOOD, L/R, IRRADIATED"]
["UNITED HEALTHCARE","P9056 - HC BLOOD, L/R, IRRADIATED"]
["HARVARD PILGRIM HEALTH CARE","P9056 - HC BLOOD, L/R, IRRADIATED"]
["CIGNA HEALTHCARE","P9056 - HC BLOOD, L/R, IRRADIATED"]
["UNITED HEALTHCARE","P9057 - HC RBC:LEU RED,FR/DE/WASH,IR"]
["TUFTS","P9057 - HC RBC:LEU RED,FR/DE/WASH,IR"]
["HARVARD PILGRIM HEALTH CARE","P9057 - HC RBC:LEU RED,FR/DE/WASH,IR"]
["CIGNA HEALTHCARE","P9057 - HC RBC:LEU RED,FR/DE/WASH,IR"]
["TUFTS","P9073 - HC PLATELETS PHERESIS PATH REDU"]
["UNITED HEALTHCARE","P9073 - HC PLATELETS PHERESIS PATH REDU"]
["HARVARD PILGRIM HEALTH CARE","P9073 - HC PLATELETS PHERESIS PATH REDU"]
["BLUE CROSS OUT OF STATE","P9073 - HC PLATELETS PHERESIS PATH REDU"]
["CIGNA HEALTHCARE","P9073 - HC PLATELETS PHERESIS PATH REDU"]
["BLUE CROSS","P9073 - HC PLATELETS PHERESIS PATH REDU"]
["BLUE BENEFIT ADMINISTRATORS","P9073 - HC PLATELETS PHERESIS PATH REDU"]
["TUFTS","P9100 - PATHOGEN TEST FOR PLATELETS"]
["UNITED HEALTHCARE","P9100 - PATHOGEN TEST FOR PLATELETS"]
["HARVARD PILGRIM HEALTH CARE","P9100 - PATHOGEN TEST FOR PLATELETS"]
["BLUE CROSS OUT OF STATE","P9100 - PATHOGEN TEST FOR PLATELETS"]
["CIGNA HEALTHCARE","P9100 - PATHOGEN TEST FOR PLATELETS"]
["BLUE CROSS","P9100 - PATHOGEN TEST FOR PLATELETS"]
["BLUE BENEFIT ADMINISTRATORS","P9100 - PATHOGEN TEST FOR PLATELETS"]
["UNICARE","P9612 - CATHETERIZE FOR URINE SPEC"]
["TUFTS","P9612 - CATHETERIZE FOR URINE SPEC"]
["UHC COMMUNITY CARE","P9612 - CATHETERIZE FOR URINE SPEC"]
["TUFTS PUBLIC PLANS","P9612 - CATHETERIZE FOR URINE SPEC"]
["UNITED HEALTHCARE","P9612 - CATHETERIZE FOR URINE SPEC"]
["FALLON","P9612 - CATHETERIZE FOR URINE SPEC"]
["HARVARD PILGRIM HEALTH CARE","P9612 - CATHETERIZE FOR URINE SPEC"]
["SENIOR WHOLE HEALTH","P9612 - CATHETERIZE FOR URINE SPEC"]
["CIGNA HEALTHCARE","P9612 - CATHETERIZE FOR URINE SPEC"]
["BLUE CROSS OUT OF STATE","P9612 - CATHETERIZE FOR URINE SPEC"]
["ELDER SERVICE PLAN","P9612 - CATHETERIZE FOR URINE SPEC"]
["BMC HEALTHNET","P9612 - CATHETERIZE FOR URINE SPEC"]
["COMMONWEALTH CARE ALLIANCE","P9612 - CATHETERIZE FOR URINE SPEC"]
["ELDER SERVICE PLAN OTHER","P9612 - CATHETERIZE FOR URINE SPEC"]
["AETNA","P9612 - CATHETERIZE FOR URINE SPEC"]
["ALLWAYS HEALTH PARTNERS","P9612 - CATHETERIZE FOR URINE SPEC"]
["BLUE CROSS","P9612 - CATHETERIZE FOR URINE SPEC"]
["BLUE BENEFIT ADMINISTRATORS","P9612 - CATHETERIZE FOR URINE SPEC"]
["TUFTS PUBLIC PLANS","Q0091 - HC OBTAINING SCREEN PAP SMEAR"]
["UNITED HEALTHCARE","Q0091 - HC OBTAINING SCREEN PAP SMEAR"]
["TUFTS","Q0091 - HC OBTAINING SCREEN PAP SMEAR"]
["FALLON","Q0091 - HC OBTAINING SCREEN PAP SMEAR"]
["HARVARD PILGRIM HEALTH CARE","Q0091 - HC OBTAINING SCREEN PAP SMEAR"]
["BLUE CROSS OUT OF STATE","Q0091 - HC OBTAINING SCREEN PAP SMEAR"]
["BMC HEALTHNET","Q0091 - HC OBTAINING SCREEN PAP SMEAR"]
["CIGNA HEALTHCARE","Q0091 - HC OBTAINING SCREEN PAP SMEAR"]
["BLUE CROSS","Q0091 - HC OBTAINING SCREEN PAP SMEAR"]
["ALLWAYS HEALTH PARTNERS","Q0091 - HC OBTAINING SCREEN PAP SMEAR"]
["BLUE BENEFIT ADMINISTRATORS","Q0091 - HC OBTAINING SCREEN PAP SMEAR"]
["TUFTS PUBLIC PLANS","Q0111 - HC WET MOUNTS W PREPARATIONS"]
["FALLON","Q0111 - HC WET MOUNTS W PREPARATIONS"]
["BMC HEALTHNET","Q0111 - HC WET MOUNTS W PREPARATIONS"]
["ALLWAYS HEALTH PARTNERS","Q0111 - HC WET MOUNTS W PREPARATIONS"]
["UNITED HEALTHCARE","Q0111 - HC WET MOUNTS W PREPARATIONS"]
["TUFTS","Q0111 - HC WET MOUNTS W PREPARATIONS"]
["UHC COMMUNITY CARE","Q0111 - HC WET MOUNTS W PREPARATIONS"]
["UNICARE","Q0111 - HC WET MOUNTS W PREPARATIONS"]
["HARVARD PILGRIM HEALTH CARE","Q0111 - HC WET MOUNTS W PREPARATIONS"]
["SENIOR WHOLE HEALTH","Q0111 - HC WET MOUNTS W PREPARATIONS"]
["BLUE CROSS OUT OF STATE","Q0111 - HC WET MOUNTS W PREPARATIONS"]
["CIGNA HEALTHCARE","Q0111 - HC WET MOUNTS W PREPARATIONS"]
["COMMONWEALTH CARE ALLIANCE","Q0111 - HC WET MOUNTS W PREPARATIONS"]
["ELDER SERVICE PLAN","Q0111 - HC WET MOUNTS W PREPARATIONS"]
["ELDER SERVICE PLAN OTHER","Q0111 - HC WET MOUNTS W PREPARATIONS"]
["AETNA","Q0111 - HC WET MOUNTS W PREPARATIONS"]
["BLUE CROSS","Q0111 - HC WET MOUNTS W PREPARATIONS"]
["BLUE BENEFIT ADMINISTRATORS","Q0111 - HC WET MOUNTS W PREPARATIONS"]
["TUFTS PUBLIC PLANS","Q0114 - HC  FERN TEST"]
["FALLON","Q0114 - HC  FERN TEST"]
["BMC HEALTHNET","Q0114 - HC  FERN TEST"]
["ALLWAYS HEALTH PARTNERS","Q0114 - HC  FERN TEST"]
["UHC COMMUNITY CARE","Q0114 - HC  FERN TEST"]
["TUFTS","Q0114 - HC  FERN TEST"]
["UNICARE","Q0114 - HC  FERN TEST"]
["UNITED HEALTHCARE","Q0114 - HC  FERN TEST"]
["HARVARD PILGRIM HEALTH CARE","Q0114 - HC  FERN TEST"]
["SENIOR WHOLE HEALTH","Q0114 - HC  FERN TEST"]
["COMMONWEALTH CARE ALLIANCE","Q0114 - HC  FERN TEST"]
["ELDER SERVICE PLAN OTHER","Q0114 - HC  FERN TEST"]
["BLUE CROSS OUT OF STATE","Q0114 - HC  FERN TEST"]
["ELDER SERVICE PLAN","Q0114 - HC  FERN TEST"]
["CIGNA HEALTHCARE","Q0114 - HC  FERN TEST"]
["AETNA","Q0114 - HC  FERN TEST"]
["BLUE CROSS","Q0114 - HC  FERN TEST"]
["BLUE BENEFIT ADMINISTRATORS","Q0114 - HC  FERN TEST"]
["TUFTS PUBLIC PLANS","Q0249 - HC TOCILIZUMAB FOR COVID-19"]
["FALLON","Q0249 - HC TOCILIZUMAB FOR COVID-19"]
["BMC HEALTHNET","Q0249 - HC TOCILIZUMAB FOR COVID-19"]
["ALLWAYS HEALTH PARTNERS","Q0249 - HC TOCILIZUMAB FOR COVID-19"]
["TUFTS PUBLIC PLANS","Q3014 - HC TELEHEALTH FACILITY FEE"]
["TUFTS","Q3014 - HC TELEHEALTH FACILITY FEE"]
["UNITED HEALTHCARE","Q3014 - HC TELEHEALTH FACILITY FEE"]
["UHC COMMUNITY CARE","Q3014 - HC TELEHEALTH FACILITY FEE"]
["FALLON","Q3014 - HC TELEHEALTH FACILITY FEE"]
["HARVARD PILGRIM HEALTH CARE","Q3014 - HC TELEHEALTH FACILITY FEE"]
["SENIOR WHOLE HEALTH","Q3014 - HC TELEHEALTH FACILITY FEE"]
["CIGNA HEALTHCARE","Q3014 - HC TELEHEALTH FACILITY FEE"]
["BMC HEALTHNET","Q3014 - HC TELEHEALTH FACILITY FEE"]
["COMMONWEALTH CARE ALLIANCE","Q3014 - HC TELEHEALTH FACILITY FEE"]
["ELDER SERVICE PLAN","Q3014 - HC TELEHEALTH FACILITY FEE"]
["ELDER SERVICE PLAN OTHER","Q3014 - HC TELEHEALTH FACILITY FEE"]
["AETNA","Q3014 - HC TELEHEALTH FACILITY FEE"]
["ALLWAYS HEALTH PARTNERS","Q3014 - HC TELEHEALTH FACILITY FEE"]
["BLUE CROSS","Q3014 - HC TELEHEALTH FACILITY FEE"]
["TUFTS","Q4100 - STRAVIX 3X6"]
["CIGNA HEALTHCARE","Q4100 - STRAVIX 3X6"]
["TUFTS","Q4101 - APLIGRAF"]
["TUFTS PUBLIC PLANS","Q4101 - APLIGRAF"]
["UHC COMMUNITY CARE","Q4101 - APLIGRAF"]
["UNICARE","Q4101 - APLIGRAF"]
["UNITED HEALTHCARE","Q4101 - APLIGRAF"]
["FALLON","Q4101 - APLIGRAF"]
["HARVARD PILGRIM HEALTH CARE","Q4101 - APLIGRAF"]
["SENIOR WHOLE HEALTH","Q4101 - APLIGRAF"]
["ELDER SERVICE PLAN","Q4101 - APLIGRAF"]
["BLUE CROSS OUT OF STATE","Q4101 - APLIGRAF"]
["BMC HEALTHNET","Q4101 - APLIGRAF"]
["CIGNA HEALTHCARE","Q4101 - APLIGRAF"]
["COMMONWEALTH CARE ALLIANCE","Q4101 - APLIGRAF"]
["ELDER SERVICE PLAN OTHER","Q4101 - APLIGRAF"]
["AETNA","Q4101 - APLIGRAF"]
["BLUE CROSS","Q4101 - APLIGRAF"]
["BLUE BENEFIT ADMINISTRATORS","Q4101 - APLIGRAF"]
["UNICARE","Q4102 - OASIS WOUND MATRIX"]
["UNITED HEALTHCARE","Q4102 - OASIS WOUND MATRIX"]
["TUFTS","Q4102 - OASIS WOUND MATRIX"]
["TUFTS PUBLIC PLANS","Q4102 - OASIS WOUND MATRIX"]
["UHC COMMUNITY CARE","Q4102 - OASIS WOUND MATRIX"]
["FALLON","Q4102 - OASIS WOUND MATRIX"]
["HARVARD PILGRIM HEALTH CARE","Q4102 - OASIS WOUND MATRIX"]
["SENIOR WHOLE HEALTH","Q4102 - OASIS WOUND MATRIX"]
["BLUE CROSS OUT OF STATE","Q4102 - OASIS WOUND MATRIX"]
["BMC HEALTHNET","Q4102 - OASIS WOUND MATRIX"]
["CIGNA HEALTHCARE","Q4102 - OASIS WOUND MATRIX"]
["COMMONWEALTH CARE ALLIANCE","Q4102 - OASIS WOUND MATRIX"]
["ELDER SERVICE PLAN","Q4102 - OASIS WOUND MATRIX"]
["ELDER SERVICE PLAN OTHER","Q4102 - OASIS WOUND MATRIX"]
["AETNA","Q4102 - OASIS WOUND MATRIX"]
["BLUE CROSS","Q4102 - OASIS WOUND MATRIX"]
["BLUE BENEFIT ADMINISTRATORS","Q4102 - OASIS WOUND MATRIX"]
["TUFTS","Q4104 - INTEGRA BMWD"]
["UNICARE","Q4104 - INTEGRA BMWD"]
["UNITED HEALTHCARE","Q4104 - INTEGRA BMWD"]
["HARVARD PILGRIM HEALTH CARE","Q4104 - INTEGRA BMWD"]
["CIGNA HEALTHCARE","Q4104 - INTEGRA BMWD"]
["BLUE CROSS OUT OF STATE","Q4104 - INTEGRA BMWD"]
["BLUE CROSS","Q4104 - INTEGRA BMWD"]
["BLUE BENEFIT ADMINISTRATORS","Q4104 - INTEGRA BMWD"]
["TUFTS","Q4107 - GRAFTJACKET"]
["UNICARE","Q4107 - GRAFTJACKET"]
["UNITED HEALTHCARE","Q4107 - GRAFTJACKET"]
["HARVARD PILGRIM HEALTH CARE","Q4107 - GRAFTJACKET"]
["BLUE CROSS OUT OF STATE","Q4107 - GRAFTJACKET"]
["CIGNA HEALTHCARE","Q4107 - GRAFTJACKET"]
["BLUE CROSS","Q4107 - GRAFTJACKET"]
["BLUE BENEFIT ADMINISTRATORS","Q4107 - GRAFTJACKET"]
["TUFTS","Q4112 - CYMETRA INJECTABLE"]
["UNICARE","Q4112 - CYMETRA INJECTABLE"]
["UNITED HEALTHCARE","Q4112 - CYMETRA INJECTABLE"]
["HARVARD PILGRIM HEALTH CARE","Q4112 - CYMETRA INJECTABLE"]
["BLUE CROSS OUT OF STATE","Q4112 - CYMETRA INJECTABLE"]
["CIGNA HEALTHCARE","Q4112 - CYMETRA INJECTABLE"]
["BLUE CROSS","Q4112 - CYMETRA INJECTABLE"]
["BLUE BENEFIT ADMINISTRATORS","Q4112 - CYMETRA INJECTABLE"]
["UNICARE","Q4116 - HC ALLODERM 8 X 16 MEDIUM"]
["UNITED HEALTHCARE","Q4116 - HC ALLODERM 8 X 16 MEDIUM"]
["TUFTS","Q4116 - HC ALLODERM 8 X 16 MEDIUM"]
["TUFTS PUBLIC PLANS","Q4116 - HC ALLODERM 8 X 16 MEDIUM"]
["FALLON","Q4116 - HC ALLODERM 8 X 16 MEDIUM"]
["HARVARD PILGRIM HEALTH CARE","Q4116 - HC ALLODERM 8 X 16 MEDIUM"]
["BLUE CROSS OUT OF STATE","Q4116 - HC ALLODERM 8 X 16 MEDIUM"]
["BMC HEALTHNET","Q4116 - HC ALLODERM 8 X 16 MEDIUM"]
["CIGNA HEALTHCARE","Q4116 - HC ALLODERM 8 X 16 MEDIUM"]
["BLUE CROSS","Q4116 - HC ALLODERM 8 X 16 MEDIUM"]
["ALLWAYS HEALTH PARTNERS","Q4116 - HC ALLODERM 8 X 16 MEDIUM"]
["BLUE BENEFIT ADMINISTRATORS","Q4116 - HC ALLODERM 8 X 16 MEDIUM"]
["TUFTS","Q4124 - OASIS TRILAYER/1 SQCM"]
["TUFTS PUBLIC PLANS","Q4124 - OASIS TRILAYER/1 SQCM"]
["UNITED HEALTHCARE","Q4124 - OASIS TRILAYER/1 SQCM"]
["FALLON","Q4124 - OASIS TRILAYER/1 SQCM"]
["HARVARD PILGRIM HEALTH CARE","Q4124 - OASIS TRILAYER/1 SQCM"]
["CIGNA HEALTHCARE","Q4124 - OASIS TRILAYER/1 SQCM"]
["BLUE CROSS OUT OF STATE","Q4124 - OASIS TRILAYER/1 SQCM"]
["BMC HEALTHNET","Q4124 - OASIS TRILAYER/1 SQCM"]
["ALLWAYS HEALTH PARTNERS","Q4124 - OASIS TRILAYER/1 SQCM"]
["BLUE CROSS","Q4124 - OASIS TRILAYER/1 SQCM"]
["BLUE BENEFIT ADMINISTRATORS","Q4124 - OASIS TRILAYER/1 SQCM"]
["TUFTS","Q4125 - HC AFLEX401 ¿ 40 X 70 MM"]
["UNITED HEALTHCARE","Q4125 - HC AFLEX401 ¿ 40 X 70 MM"]
["TUFTS PUBLIC PLANS","Q4125 - HC AFLEX401 ¿ 40 X 70 MM"]
["FALLON","Q4125 - HC AFLEX401 ¿ 40 X 70 MM"]
["HARVARD PILGRIM HEALTH CARE","Q4125 - HC AFLEX401 ¿ 40 X 70 MM"]
["BLUE CROSS OUT OF STATE","Q4125 - HC AFLEX401 ¿ 40 X 70 MM"]
["BMC HEALTHNET","Q4125 - HC AFLEX401 ¿ 40 X 70 MM"]
["CIGNA HEALTHCARE","Q4125 - HC AFLEX401 ¿ 40 X 70 MM"]
["BLUE CROSS","Q4125 - HC AFLEX401 ¿ 40 X 70 MM"]
["ALLWAYS HEALTH PARTNERS","Q4125 - HC AFLEX401 ¿ 40 X 70 MM"]
["BLUE BENEFIT ADMINISTRATORS","Q4125 - HC AFLEX401 ¿ 40 X 70 MM"]
["TUFTS PUBLIC PLANS","Q4130 - PR STRATTICE TM"]
["TUFTS","Q4130 - PR STRATTICE TM"]
["UNITED HEALTHCARE","Q4130 - PR STRATTICE TM"]
["FALLON","Q4130 - PR STRATTICE TM"]
["HARVARD PILGRIM HEALTH CARE","Q4130 - PR STRATTICE TM"]
["BLUE CROSS OUT OF STATE","Q4130 - PR STRATTICE TM"]
["CIGNA HEALTHCARE","Q4130 - PR STRATTICE TM"]
["BMC HEALTHNET","Q4130 - PR STRATTICE TM"]
["ALLWAYS HEALTH PARTNERS","Q4130 - PR STRATTICE TM"]
["BLUE CROSS","Q4130 - PR STRATTICE TM"]
["BLUE BENEFIT ADMINISTRATORS","Q4130 - PR STRATTICE TM"]
["UNITED HEALTHCARE","Q4132 - HC GRAFIX CORE 5X5CM"]
["TUFTS PUBLIC PLANS","Q4132 - HC GRAFIX CORE 5X5CM"]
["UHC COMMUNITY CARE","Q4132 - HC GRAFIX CORE 5X5CM"]
["TUFTS","Q4132 - HC GRAFIX CORE 5X5CM"]
["UNICARE","Q4132 - HC GRAFIX CORE 5X5CM"]
["FALLON","Q4132 - HC GRAFIX CORE 5X5CM"]
["HARVARD PILGRIM HEALTH CARE","Q4132 - HC GRAFIX CORE 5X5CM"]
["SENIOR WHOLE HEALTH","Q4132 - HC GRAFIX CORE 5X5CM"]
["ELDER SERVICE PLAN","Q4132 - HC GRAFIX CORE 5X5CM"]
["COMMONWEALTH CARE ALLIANCE","Q4132 - HC GRAFIX CORE 5X5CM"]
["BLUE CROSS OUT OF STATE","Q4132 - HC GRAFIX CORE 5X5CM"]
["ELDER SERVICE PLAN OTHER","Q4132 - HC GRAFIX CORE 5X5CM"]
["BMC HEALTHNET","Q4132 - HC GRAFIX CORE 5X5CM"]
["CIGNA HEALTHCARE","Q4132 - HC GRAFIX CORE 5X5CM"]
["AETNA","Q4132 - HC GRAFIX CORE 5X5CM"]
["BLUE CROSS","Q4132 - HC GRAFIX CORE 5X5CM"]
["BLUE BENEFIT ADMINISTRATORS","Q4132 - HC GRAFIX CORE 5X5CM"]
["TUFTS","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["UNICARE","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["TUFTS PUBLIC PLANS","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["UHC COMMUNITY CARE","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["UNITED HEALTHCARE","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["FALLON","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["HARVARD PILGRIM HEALTH CARE","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["SENIOR WHOLE HEALTH","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["CIGNA HEALTHCARE","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["BLUE CROSS OUT OF STATE","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["BMC HEALTHNET","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["COMMONWEALTH CARE ALLIANCE","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["ELDER SERVICE PLAN","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["ELDER SERVICE PLAN OTHER","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["AETNA","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["BLUE CROSS","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["BLUE BENEFIT ADMINISTRATORS","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["TUFTS","Q4196 - HC PURAPLYAM-COM 6X9 CM"]
["TUFTS PUBLIC PLANS","Q4196 - HC PURAPLYAM-COM 6X9 CM"]
["UHC COMMUNITY CARE","Q4196 - HC PURAPLYAM-COM 6X9 CM"]
["UNITED HEALTHCARE","Q4196 - HC PURAPLYAM-COM 6X9 CM"]
["UNICARE","Q4196 - HC PURAPLYAM-COM 6X9 CM"]
["FALLON","Q4196 - HC PURAPLYAM-COM 6X9 CM"]
["HARVARD PILGRIM HEALTH CARE","Q4196 - HC PURAPLYAM-COM 6X9 CM"]
["SENIOR WHOLE HEALTH","Q4196 - HC PURAPLYAM-COM 6X9 CM"]
["BMC HEALTHNET","Q4196 - HC PURAPLYAM-COM 6X9 CM"]
["ELDER SERVICE PLAN","Q4196 - HC PURAPLYAM-COM 6X9 CM"]
["COMMONWEALTH CARE ALLIANCE","Q4196 - HC PURAPLYAM-COM 6X9 CM"]
["CIGNA HEALTHCARE","Q4196 - HC PURAPLYAM-COM 6X9 CM"]
["ELDER SERVICE PLAN OTHER","Q4196 - HC PURAPLYAM-COM 6X9 CM"]
["AETNA","Q4196 - HC PURAPLYAM-COM 6X9 CM"]
["ALLWAYS HEALTH PARTNERS","Q4196 - HC PURAPLYAM-COM 6X9 CM"]
["BLUE CROSS","Q4196 - HC PURAPLYAM-COM 6X9 CM"]
["UNICARE","Q9954 - ORAL MR CONTRAST, 100 ML"]
["TUFTS","Q9954 - ORAL MR CONTRAST, 100 ML"]
["TUFTS PUBLIC PLANS","Q9954 - ORAL MR CONTRAST, 100 ML"]
["UNITED HEALTHCARE","Q9954 - ORAL MR CONTRAST, 100 ML"]
["FALLON","Q9954 - ORAL MR CONTRAST, 100 ML"]
["HARVARD PILGRIM HEALTH CARE","Q9954 - ORAL MR CONTRAST, 100 ML"]
["BLUE CROSS OUT OF STATE","Q9954 - ORAL MR CONTRAST, 100 ML"]
["CIGNA HEALTHCARE","Q9954 - ORAL MR CONTRAST, 100 ML"]
["BMC HEALTHNET","Q9954 - ORAL MR CONTRAST, 100 ML"]
["BLUE CROSS","Q9954 - ORAL MR CONTRAST, 100 ML"]
["ALLWAYS HEALTH PARTNERS","Q9954 - ORAL MR CONTRAST, 100 ML"]
["BLUE BENEFIT ADMINISTRATORS","Q9954 - ORAL MR CONTRAST, 100 ML"]
["UNITED HEALTHCARE","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["TUFTS","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["TUFTS PUBLIC PLANS","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["UHC COMMUNITY CARE","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["UNICARE","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["FALLON","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["HARVARD PILGRIM HEALTH CARE","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["SENIOR WHOLE HEALTH","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["BLUE CROSS OUT OF STATE","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["BMC HEALTHNET","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["CIGNA HEALTHCARE","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["COMMONWEALTH CARE ALLIANCE","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["ELDER SERVICE PLAN","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["ELDER SERVICE PLAN OTHER","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["AETNA","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["BLUE CROSS","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["ALLWAYS HEALTH PARTNERS","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["BLUE BENEFIT ADMINISTRATORS","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["UHC COMMUNITY CARE","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["TUFTS PUBLIC PLANS","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["TUFTS","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["UNICARE","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["UNITED HEALTHCARE","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["FALLON","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["HARVARD PILGRIM HEALTH CARE","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["SENIOR WHOLE HEALTH","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["CIGNA HEALTHCARE","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["COMMONWEALTH CARE ALLIANCE","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["BLUE CROSS OUT OF STATE","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["ELDER SERVICE PLAN","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["BMC HEALTHNET","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["ELDER SERVICE PLAN OTHER","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["AETNA","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["BLUE CROSS","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["ALLWAYS HEALTH PARTNERS","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["BLUE BENEFIT ADMINISTRATORS","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["TUFTS","Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["UNITED HEALTHCARE","Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["TUFTS PUBLIC PLANS","Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["UHC COMMUNITY CARE","Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["UNICARE","Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["FALLON","Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["HARVARD PILGRIM HEALTH CARE","Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["SENIOR WHOLE HEALTH","Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["BMC HEALTHNET","Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["BLUE CROSS OUT OF STATE","Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["CIGNA HEALTHCARE","Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["COMMONWEALTH CARE ALLIANCE","Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["ELDER SERVICE PLAN","Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["ELDER SERVICE PLAN OTHER","Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["AETNA","Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["ALLWAYS HEALTH PARTNERS","Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["BLUE CROSS","Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["BLUE BENEFIT ADMINISTRATORS","Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["UNICARE","Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["TUFTS","Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["TUFTS PUBLIC PLANS","Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["UHC COMMUNITY CARE","Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["UNITED HEALTHCARE","Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["FALLON","Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["HARVARD PILGRIM HEALTH CARE","Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["SENIOR WHOLE HEALTH","Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["ELDER SERVICE PLAN","Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["BLUE CROSS OUT OF STATE","Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["BMC HEALTHNET","Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["CIGNA HEALTHCARE","Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["COMMONWEALTH CARE ALLIANCE","Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["ELDER SERVICE PLAN OTHER","Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["AETNA","Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["BLUE CROSS","Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["ALLWAYS HEALTH PARTNERS","Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["BLUE BENEFIT ADMINISTRATORS","Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["UNITED HEALTHCARE","Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["TUFTS","Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["TUFTS PUBLIC PLANS","Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["UHC COMMUNITY CARE","Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["UNICARE","Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["FALLON","Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["HARVARD PILGRIM HEALTH CARE","Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["SENIOR WHOLE HEALTH","Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["BLUE CROSS OUT OF STATE","Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["BMC HEALTHNET","Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["CIGNA HEALTHCARE","Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["COMMONWEALTH CARE ALLIANCE","Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["ELDER SERVICE PLAN","Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["ELDER SERVICE PLAN OTHER","Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["AETNA","Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["BLUE CROSS","Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["ALLWAYS HEALTH PARTNERS","Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["BLUE BENEFIT ADMINISTRATORS","Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["TUFTS PUBLIC PLANS","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["UHC COMMUNITY CARE","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["TUFTS","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["UNICARE","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["UNITED HEALTHCARE","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["FALLON","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["HARVARD PILGRIM HEALTH CARE","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["SENIOR WHOLE HEALTH","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["ELDER SERVICE PLAN","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["CIGNA HEALTHCARE","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["COMMONWEALTH CARE ALLIANCE","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["BLUE CROSS OUT OF STATE","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["BMC HEALTHNET","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["ELDER SERVICE PLAN OTHER","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["AETNA","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["BLUE CROSS","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["ALLWAYS HEALTH PARTNERS","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["BLUE BENEFIT ADMINISTRATORS","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["UNICARE","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["UHC COMMUNITY CARE","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["TUFTS PUBLIC PLANS","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["TUFTS","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["UNITED HEALTHCARE","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["HARVARD PILGRIM HEALTH CARE","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["FALLON","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["SENIOR WHOLE HEALTH","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["BMC HEALTHNET","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["BLUE CROSS OUT OF STATE","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["ELDER SERVICE PLAN","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["CIGNA HEALTHCARE","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["COMMONWEALTH CARE ALLIANCE","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["ELDER SERVICE PLAN OTHER","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["BLUE CROSS","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["BLUE BENEFIT ADMINISTRATORS","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["AETNA","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["ALLWAYS HEALTH PARTNERS","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["TUFTS PUBLIC PLANS","Q9987 - HC PATHOGEN TEST PLATELETS"]
["FALLON","Q9987 - HC PATHOGEN TEST PLATELETS"]
["BMC HEALTHNET","Q9987 - HC PATHOGEN TEST PLATELETS"]
["ALLWAYS HEALTH PARTNERS","Q9987 - HC PATHOGEN TEST PLATELETS"]
["TUFTS","S2083 - HC ADJUSTMENT GASTRIC BAND"]
["CIGNA HEALTHCARE","S2083 - HC ADJUSTMENT GASTRIC BAND"]
["AETNA","S2083 - HC ADJUSTMENT GASTRIC BAND"]
["TUFTS PUBLIC PLANS","S5100 - ADULT DAYCARE SERVICES 15MIN"]
["FALLON","S5100 - ADULT DAYCARE SERVICES 15MIN"]
["BMC HEALTHNET","S5100 - ADULT DAYCARE SERVICES 15MIN"]
["ALLWAYS HEALTH PARTNERS","S5100 - ADULT DAYCARE SERVICES 15MIN"]
["TUFTS PUBLIC PLANS","S5101 - HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)"]
["FALLON","S5101 - HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)"]
["BMC HEALTHNET","S5101 - HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)"]
["ALLWAYS HEALTH PARTNERS","S5101 - HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)"]
["TUFTS PUBLIC PLANS","S5102 - HC ADULT DAY HEALTH - COMPLEX PER DIEM"]
["FALLON","S5102 - HC ADULT DAY HEALTH - COMPLEX PER DIEM"]
["BMC HEALTHNET","S5102 - HC ADULT DAY HEALTH - COMPLEX PER DIEM"]
["ALLWAYS HEALTH PARTNERS","S5102 - HC ADULT DAY HEALTH - COMPLEX PER DIEM"]
["TUFTS","S8037 - MRCP"]
["TUFTS PUBLIC PLANS","S8037 - MRCP"]
["FALLON","S8037 - MRCP"]
["BLUE CROSS OUT OF STATE","S8037 - MRCP"]
["BMC HEALTHNET","S8037 - MRCP"]
["CIGNA HEALTHCARE","S8037 - MRCP"]
["BLUE CROSS","S8037 - MRCP"]
["ALLWAYS HEALTH PARTNERS","S8037 - MRCP"]
["BLUE BENEFIT ADMINISTRATORS","S8037 - MRCP"]
["TUFTS PUBLIC PLANS","T2003 - HC TRANSPORTATION RATE 1 (1-WAY TRIP)"]
["FALLON","T2003 - HC TRANSPORTATION RATE 1 (1-WAY TRIP)"]
["BMC HEALTHNET","T2003 - HC TRANSPORTATION RATE 1 (1-WAY TRIP)"]
["ALLWAYS HEALTH PARTNERS","T2003 - HC TRANSPORTATION RATE 1 (1-WAY TRIP)"]
["TUFTS","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH"]
["TUFTS PUBLIC PLANS","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH"]
["UHC COMMUNITY CARE","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH"]
["UNITED HEALTHCARE","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH"]
["FALLON","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH"]
["HARVARD PILGRIM HEALTH CARE","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH"]
["SENIOR WHOLE HEALTH","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH"]
["CIGNA HEALTHCARE","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH"]
["BLUE CROSS OUT OF STATE","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH"]
["BMC HEALTHNET","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH"]
["COMMONWEALTH CARE ALLIANCE","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH"]
["ELDER SERVICE PLAN","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH"]
["ELDER SERVICE PLAN OTHER","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH"]
["AETNA","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH"]
["BLUE CROSS","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH"]
["BLUE BENEFIT ADMINISTRATORS","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH"]
["TUFTS PUBLIC PLANS","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP"]
["UNITED HEALTHCARE","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP"]
["TUFTS","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP"]
["UHC COMMUNITY CARE","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP"]
["FALLON","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP"]
["HARVARD PILGRIM HEALTH CARE","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP"]
["SENIOR WHOLE HEALTH","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP"]
["BLUE CROSS OUT OF STATE","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP"]
["BMC HEALTHNET","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP"]
["CIGNA HEALTHCARE","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP"]
["COMMONWEALTH CARE ALLIANCE","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP"]
["ELDER SERVICE PLAN","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP"]
["ELDER SERVICE PLAN OTHER","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP"]
["AETNA","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP"]
["BLUE CROSS","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP"]
["ALLWAYS HEALTH PARTNERS","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP"]
["BLUE BENEFIT ADMINISTRATORS","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP"]
["TUFTS","V2785 - CORNEAL TISSUE PROCESSING"]
["TUFTS PUBLIC PLANS","V2785 - CORNEAL TISSUE PROCESSING"]
["FALLON","V2785 - CORNEAL TISSUE PROCESSING"]
["BMC HEALTHNET","V2785 - CORNEAL TISSUE PROCESSING"]
["CIGNA HEALTHCARE","V2785 - CORNEAL TISSUE PROCESSING"]
["ALLWAYS HEALTH PARTNERS","V2785 - CORNEAL TISSUE PROCESSING"]
["TUFTS","V2790 - HC MEMBRANE AMNIOTIC"]
["TUFTS PUBLIC PLANS","V2790 - HC MEMBRANE AMNIOTIC"]
["UNITED HEALTHCARE","V2790 - HC MEMBRANE AMNIOTIC"]
["FALLON","V2790 - HC MEMBRANE AMNIOTIC"]
["HARVARD PILGRIM HEALTH CARE","V2790 - HC MEMBRANE AMNIOTIC"]
["BMC HEALTHNET","V2790 - HC MEMBRANE AMNIOTIC"]
["CIGNA HEALTHCARE","V2790 - HC MEMBRANE AMNIOTIC"]
["ALLWAYS HEALTH PARTNERS","V2790 - HC MEMBRANE AMNIOTIC"]

{"sheet":"HCPCSPayer&Plan","index":9,"n_rows":48,"n_cols":22,"rows_kept":48,"cut":false,"hidden":true,"merged":[]}
["Payer","Plan","Select Insurance Carrier","AETNA","ALLWAYS HEALTH PARTNERS","BLUE BENEFIT ADMINISTRATORS","BLUE CROSS","BLUE CROSS OUT OF STATE","BMC HEALTHNET","CIGNA HEALTHCARE","COMMONWEALTH CARE ALLIANCE","ELDER SERVICE PLAN","ELDER SERVICE PLAN OTHER","FALLON","HARVARD PILGRIM HEALTH CARE","SENIOR WHOLE HEALTH","TUFTS","TUFTS PUBLIC PLANS","UHC COMMUNITY CARE","UNICARE","UNITED HEALTHCARE"]
["AETNA","AETNA","Select Insurance Plan","Select Insurance Plan","Select Insurance Plan","Select Insurance Plan","Select Insurance Plan","Select Insurance Plan","Select Insurance Plan","Select Insurance Plan","Select Insurance Plan","Select Insurance Plan","Select Insurance Plan","Select Insurance Plan","Select Insurance Plan","Select Insurance Plan","Select Insurance Plan","Select Insurance Plan","Select Insurance Plan","Select Insurance Plan","Select Insurance Plan"]
["AETNA","AETNA-MEDICARE ADVANTAGE",null,{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF($D$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(1:1))),\"\" )","v":"AETNA"},{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(E$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(1:1))),\"\" )","v":"ALLWAYS HLTH ACO"},{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(F$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(1:1))),\"\" )","v":"BLUE BENEFIT ADMIN-PPO"},{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(G$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(1:1))),\"\" )","v":"BLUE CROSS-PPO"},{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(H$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(1:1))),\"\" )","v":"BLUE CROSS OUT OF STATE PPO"},{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(I$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(1:1))),\"\" )","v":"BMC SENIOR CARE OPTIONS"},{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(J$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(1:1))),\"\" )","v":"CIGNA CARELINK"},{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(K$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(1:1))),\"\" )","v":"CCA ONE CARE"},{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(L$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(1:1))),\"\" )","v":"ELEMENT CARE INC"},{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(M$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(1:1))),\"\" )","v":"ELDER SERVICE PLAN OTHER"},{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(N$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(1:1))),\"\" )","v":"FALLON SENIOR PLAN"},{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(O$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(1:1))),\"\" )","v":"HPHC-HARVARD PILGRIM HEALTHCAR"},{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(P$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(1:1))),\"\" )","v":"SENIOR WHOLE HEALTH"},{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(Q$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(1:1))),\"\" )","v":"TUFTS SELECT"},{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(R$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(1:1))),\"\" )","v":"TUFTS PUBLIC UNIFY"},{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(S$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(1:1))),\"\" )","v":"UHC COMMUNITY CARE (EVERCARE)"},{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(T$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(1:1))),\"\" )","v":"UNICARE"},{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(U$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(1:1))),\"\" )","v":"UNITED/HARVARD PILGRIM"}]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO",null,{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF($D$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(2:2))),\"\" )","v":"AETNA-MEDICARE ADVANTAGE"},{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(E$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(2:2))),\"\" )","v":"ALLWAYS HLTH COMM SUBSIDIZED"},null,{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(G$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(2:2))),\"\" )","v":"BLUE CROSS-HMO BLUE"},{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(H$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(2:2))),\"\" )","v":"BLUE CROSS  OUT OF STATE HMO"},{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(I$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(2:2))),\"\" )","v":"BMCHN WELL SENSE"},null,null,{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(L$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(2:2))),\"\" )","v":"NEIGHBORHOOD PACE (ESP EB)"},null,{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(N$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(2:2))),\"\" )","v":"FALLON MEDICAID"},{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(O$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(2:2))),\"\" )","v":"HPHC-HARVARD PILGRIM HPI"},null,{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(Q$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(2:2))),\"\" )","v":"TUFTS POS"},{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(R$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(2:2))),\"\" )","v":"TUFTS PUBLIC DIRECT"},null,{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(T$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(2:2))),\"\" )","v":"UNICARE STATE INDEMNITY PLAN"},{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(U$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(2:2))),\"\" )","v":"UHC-HPHC STUDENT PLAN"}]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED",null,null,null,null,{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(G$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(3:3))),\"\" )","v":"BLUE CROSS-INDEMNITY"},{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(H$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(3:3))),\"\" )","v":"BLUE CROSS OUT OF STATE INDEMNIT"},{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(I$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(3:3))),\"\" )","v":"BMCHN ACO"},null,null,null,null,null,{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(O$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(3:3))),\"\" )","v":"HPHC-HARVARD PILGRIM STRIDE"},null,{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(Q$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(3:3))),\"\" )","v":"TUFTS PPO"},{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(R$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(3:3))),\"\" )","v":"TUFTS PUBLIC DIRECT NON SUBSIDIZ"},null,null,{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(U$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(3:3))),\"\" )","v":"UNITED HEALTHCARE"}]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO",null,null,null,null,{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(G$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"BLUE CROSS-MEDICARE ADVANTAGE"},null,{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(I$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"BMCHN MCO"},null,null,null,null,null,null,null,{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(Q$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"TUFTS HMO"},{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(R$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"TUFTS PUBLIC DIRECT SUBSIDIZED"}]
["BLUE CROSS","BLUE CROSS-PPO",null,null,null,null,null,null,{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(I$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(5:5))),\"\" )","v":"BMCHN MEDICAID"},null,null,null,null,null,null,null,{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(Q$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(5:5))),\"\" )","v":"TUFTS SPIRIT"},{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(R$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(5:5))),\"\" )","v":"TUFTS PUBLIC TOGETHER"}]
["BLUE CROSS","BLUE CROSS-HMO BLUE",null,null,null,null,null,null,{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(I$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(6:6))),\"\" )","v":"BMCHN QHP"},null,null,null,null,null,null,null,{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(Q$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(6:6))),\"\" )","v":"TUFTS MEDICARE SCO"}]
["BLUE CROSS","BLUE CROSS-INDEMNITY",null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(Q$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(7:7))),\"\" )","v":"TUFTS MEDICARE PREFERRED HMO"}]
["BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IFERROR(INDEX($B$2:$B$48, SMALL(IF(V$1=$A$2:$A$48, ROW($A$2:$A$48)-ROW($A$2)+1), ROW(8:8))),\"\" )","v":""}]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT"]
["BMC HEALTHNET","BMC SENIOR CARE OPTIONS"]
["BMC HEALTHNET","BMCHN WELL SENSE"]
["BMC HEALTHNET","BMCHN ACO"]
["BMC HEALTHNET","BMCHN MCO"]
["BMC HEALTHNET","BMCHN MEDICAID"]
["BMC HEALTHNET","BMCHN QHP"]
["CIGNA HEALTHCARE","CIGNA CARELINK"]
["COMMONWEALTH CARE ALLIANCE","CCA ONE CARE"]
["ELDER SERVICE PLAN","ELEMENT CARE INC"]
["ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)"]
["ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER"]
["FALLON","FALLON SENIOR PLAN"]
["FALLON","FALLON MEDICAID"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE"]
["SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH"]
["TUFTS","TUFTS SELECT"]
["TUFTS","TUFTS POS"]
["TUFTS","TUFTS PPO"]
["TUFTS","TUFTS HMO"]
["TUFTS","TUFTS SPIRIT"]
["TUFTS","TUFTS MEDICARE SCO"]
["TUFTS","TUFTS MEDICARE PREFERRED HMO"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER"]
["UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)"]
["UNICARE","UNICARE"]
["UNICARE","UNICARE STATE INDEMNITY PLAN"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN"]
["UNITED HEALTHCARE","UNITED HEALTHCARE"]

{"sheet":"HCPCSPayer&Code&Desc","index":10,"n_rows":2938,"n_cols":22,"rows_kept":2938,"cut":false,"hidden":true,"merged":[]}
["Payer","HCPCS & Description",null,"Select Insurance Carrier","AETNA","ALLWAYS HEALTH PARTNERS","BLUE BENEFIT ADMINISTRATORS","BLUE CROSS","BLUE CROSS OUT OF STATE","BMC HEALTHNET","CIGNA HEALTHCARE","COMMONWEALTH CARE ALLIANCE","ELDER SERVICE PLAN","ELDER SERVICE PLAN OTHER","FALLON","HARVARD PILGRIM HEALTH CARE","SENIOR WHOLE HEALTH","TUFTS","TUFTS PUBLIC PLANS","UHC COMMUNITY CARE","UNICARE","UNITED HEALTHCARE"]
["AETNA","45378 - COLON CA SCRN NOT HI RSK IND",null,"Select HCPCS Code","Select HCPCS Code","Select HCPCS Code","Select HCPCS Code","Select HCPCS Code","Select HCPCS Code","Select HCPCS Code","Select HCPCS Code","Select HCPCS Code","Select HCPCS Code","Select HCPCS Code","Select HCPCS Code","Select HCPCS Code","Select HCPCS Code","Select HCPCS Code","Select HCPCS Code","Select HCPCS Code","Select HCPCS Code","Select HCPCS Code"]
["AETNA","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",null,null,"45378 - COLON CA SCRN NOT HI RSK IND","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","45378 - COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","45378 - COLON CA SCRN NOT HI RSK IND","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","45378 - COLON CA SCRN NOT HI RSK IND","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","45378 - COLON CA SCRN NOT HI RSK IND","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","45378 - COLON CA SCRN NOT HI RSK IND","45378 - COLON CA SCRN NOT HI RSK IND"]
["AETNA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",null,null,"81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","A4215 - STERILE NEEDLE","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","A4215 - STERILE NEEDLE","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","A4561 - HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE","A4215 - STERILE NEEDLE","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","A4561 - HC PESSARY RUBBER, ANY TYPE","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS","A4215 - STERILE NEEDLE","A4561 - HC PESSARY RUBBER, ANY TYPE","92083 - VISUAL FIELD EXAM,EXTENDED","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS"]
["AETNA","A4561 - HC PESSARY RUBBER, ANY TYPE",null,null,"0402T - HC COLLAGEN CROSS-LINKING OF CORNEA","A4467 - BELT STRAP SLEEV GRMNT COVER","90471 - HC ADMIN PNEUMOCOCCAL VACCINE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE","A4467 - BELT STRAP SLEEV GRMNT COVER","90471 - HC ADMIN PNEUMOCOCCAL VACCINE","A4562 - PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER","A4467 - BELT STRAP SLEEV GRMNT COVER","90471 - HC ADMIN PNEUMOCOCCAL VACCINE","A4562 - PESSARY NONRUBBER","90471 - HC ADMIN PNEUMOCOCCAL VACCINE","A4467 - BELT STRAP SLEEV GRMNT COVER","A4562 - PESSARY NONRUBBER","95800 - HOME SLEEP TEST/TYPE 3 PORTA","90471 - HC ADMIN PNEUMOCOCCAL VACCINE"]
["AETNA","A4562 - PESSARY NONRUBBER",null,null,"A4561 - HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE","92083 - VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED","92083 - VISUAL FIELD EXAM,EXTENDED","A4561 - HC PESSARY RUBBER, ANY TYPE","92083 - VISUAL FIELD EXAM,EXTENDED","A6209 - FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR","A6209 - FOAM DRSG <=16 SQ IN W/O BDR","A4561 - HC PESSARY RUBBER, ANY TYPE","92083 - VISUAL FIELD EXAM,EXTENDED","A6209 - FOAM DRSG <=16 SQ IN W/O BDR","92083 - VISUAL FIELD EXAM,EXTENDED","A4561 - HC PESSARY RUBBER, ANY TYPE","A6209 - FOAM DRSG <=16 SQ IN W/O BDR","A9575 - INJ GADOTERATE MEGLUMI 0.1ML","92083 - VISUAL FIELD EXAM,EXTENDED"]
["AETNA","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",null,null,"A4562 - PESSARY NONRUBBER","A4562 - PESSARY NONRUBBER","95800 - HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA","95800 - HOME SLEEP TEST/TYPE 3 PORTA","A4562 - PESSARY NONRUBBER","95800 - HOME SLEEP TEST/TYPE 3 PORTA","A6258 - TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN","A6258 - TRANSPARENT FILM >16<=48 IN","A4562 - PESSARY NONRUBBER","95800 - HOME SLEEP TEST/TYPE 3 PORTA","A6258 - TRANSPARENT FILM >16<=48 IN","95800 - HOME SLEEP TEST/TYPE 3 PORTA","A4562 - PESSARY NONRUBBER","A6258 - TRANSPARENT FILM >16<=48 IN","A9576 - HC PROHANCE IV CONTRAST PER ML","95800 - HOME SLEEP TEST/TYPE 3 PORTA"]
["AETNA","A6258 - TRANSPARENT FILM >16<=48 IN",null,null,"A6209 - FOAM DRSG <=16 SQ IN W/O BDR","A4570 - HC MISC SPLINT SUPPLY LV1","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","A4570 - HC MISC SPLINT SUPPLY LV1","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","A6550 - NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET","A6550 - NEG PRES WOUND THER DRSG SET","A4570 - HC MISC SPLINT SUPPLY LV1","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","A6550 - NEG PRES WOUND THER DRSG SET","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME","A4570 - HC MISC SPLINT SUPPLY LV1","A6550 - NEG PRES WOUND THER DRSG SET","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME"]
["AETNA","A6550 - NEG PRES WOUND THER DRSG SET",null,null,"A6258 - TRANSPARENT FILM >16<=48 IN","A4725 - DIALYS SOL FLD VOL > 4999CC","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA","A4725 - DIALYS SOL FLD VOL > 4999CC","0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS","A7520 - TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED","A7520 - TRACH/LARYN TUBE NON-CUFFED","A4725 - DIALYS SOL FLD VOL > 4999CC","0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS","A7520 - TRACH/LARYN TUBE NON-CUFFED","0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS","A4725 - DIALYS SOL FLD VOL > 4999CC","A7520 - TRACH/LARYN TUBE NON-CUFFED","A9579 - GAD-BASE MR CONTRAST NOS,1ML","0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS"]
["AETNA","A7520 - TRACH/LARYN TUBE NON-CUFFED",null,null,"A6550 - NEG PRES WOUND THER DRSG SET","A6209 - FOAM DRSG <=16 SQ IN W/O BDR","A4561 - HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE","A4561 - HC PESSARY RUBBER, ANY TYPE","A6209 - FOAM DRSG <=16 SQ IN W/O BDR","0399T - PR MYOCARDIAL STRAIN IMAGING","A9575 - INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML","A6209 - FOAM DRSG <=16 SQ IN W/O BDR","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA","A9575 - INJ GADOTERATE MEGLUMI 0.1ML","0399T - PR MYOCARDIAL STRAIN IMAGING","A6209 - FOAM DRSG <=16 SQ IN W/O BDR","A9575 - INJ GADOTERATE MEGLUMI 0.1ML","A9581 - GADOXETATE DISODIUM INJ","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA"]
["AETNA","A9513 - TECHNETIUM TC-99M MEBROFENIN",null,null,"A7520 - TRACH/LARYN TUBE NON-CUFFED","A6258 - TRANSPARENT FILM >16<=48 IN","A6209 - FOAM DRSG <=16 SQ IN W/O BDR","A4562 - PESSARY NONRUBBER","A6209 - FOAM DRSG <=16 SQ IN W/O BDR","A6258 - TRANSPARENT FILM >16<=48 IN","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA","A9576 - HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML","A9576 - HC PROHANCE IV CONTRAST PER ML","A6258 - TRANSPARENT FILM >16<=48 IN","A4215 - STERILE NEEDLE","A9576 - HC PROHANCE IV CONTRAST PER ML","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA","A6258 - TRANSPARENT FILM >16<=48 IN","A9576 - HC PROHANCE IV CONTRAST PER ML","A9583 - GADOFOSVESET TRISODIUM INJ","A4215 - STERILE NEEDLE"]
["AETNA","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",null,null,"A9513 - TECHNETIUM TC-99M MEBROFENIN","A6549 - G COMPRESSION STOCKING","A6258 - TRANSPARENT FILM >16<=48 IN","A6209 - FOAM DRSG <=16 SQ IN W/O BDR","A6258 - TRANSPARENT FILM >16<=48 IN","A6549 - G COMPRESSION STOCKING","A4215 - STERILE NEEDLE","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","A6549 - G COMPRESSION STOCKING","A4561 - HC PESSARY RUBBER, ANY TYPE","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","A4215 - STERILE NEEDLE","A6549 - G COMPRESSION STOCKING","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","G0103 - PSA, TOTAL SCREENING","A4561 - HC PESSARY RUBBER, ANY TYPE"]
["AETNA","A9576 - HC PROHANCE IV CONTRAST PER ML",null,null,"A9575 - INJ GADOTERATE MEGLUMI 0.1ML","A6550 - NEG PRES WOUND THER DRSG SET","A7520 - TRACH/LARYN TUBE NON-CUFFED","A6258 - TRANSPARENT FILM >16<=48 IN","A7520 - TRACH/LARYN TUBE NON-CUFFED","A6550 - NEG PRES WOUND THER DRSG SET","A4561 - HC PESSARY RUBBER, ANY TYPE","A9579 - GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML","A6550 - NEG PRES WOUND THER DRSG SET","A4562 - PESSARY NONRUBBER","A9579 - GAD-BASE MR CONTRAST NOS,1ML","A4561 - HC PESSARY RUBBER, ANY TYPE","A6550 - NEG PRES WOUND THER DRSG SET","A9579 - GAD-BASE MR CONTRAST NOS,1ML","G0105 - HC COLORECTAL SCRN; HI RISK IND","A4562 - PESSARY NONRUBBER"]
["AETNA","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",null,null,"A9576 - HC PROHANCE IV CONTRAST PER ML","A7520 - TRACH/LARYN TUBE NON-CUFFED","A9500 - TC99M SESTAMIBI","A6550 - NEG PRES WOUND THER DRSG SET","A9500 - TC99M SESTAMIBI","A7520 - TRACH/LARYN TUBE NON-CUFFED","A4562 - PESSARY NONRUBBER","A9581 - GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ","A9581 - GADOXETATE DISODIUM INJ","A7520 - TRACH/LARYN TUBE NON-CUFFED","A4648 - IMPLANTABLE TISSUE MARKER","A9581 - GADOXETATE DISODIUM INJ","A4562 - PESSARY NONRUBBER","A7520 - TRACH/LARYN TUBE NON-CUFFED","A9581 - GADOXETATE DISODIUM INJ","G0480 - DRUG TEST DEF 1-7 CLASSES","A4648 - IMPLANTABLE TISSUE MARKER"]
["AETNA","A9579 - GAD-BASE MR CONTRAST NOS,1ML",null,null,"A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","A9500 - TC99M SESTAMIBI","A9502 - HC TC99M TETROFOSMIN","A7520 - TRACH/LARYN TUBE NON-CUFFED","A9502 - HC TC99M TETROFOSMIN","A9500 - TC99M SESTAMIBI","A4570 - HC MISC SPLINT SUPPLY LV1","E0191 - PROTECTOR HEEL OR ELBOW","E0191 - PROTECTOR HEEL OR ELBOW","E0191 - PROTECTOR HEEL OR ELBOW","A9500 - TC99M SESTAMIBI","A4725 - DIALYS SOL FLD VOL > 4999CC","E0191 - PROTECTOR HEEL OR ELBOW","A4570 - HC MISC SPLINT SUPPLY LV1","A9500 - TC99M SESTAMIBI","E0191 - PROTECTOR HEEL OR ELBOW","G0481 - DRUG TEST DEF 8-14 CLASSES","A4725 - DIALYS SOL FLD VOL > 4999CC"]
["AETNA","A9581 - GADOXETATE DISODIUM INJ",null,null,"A9579 - GAD-BASE MR CONTRAST NOS,1ML","A9502 - HC TC99M TETROFOSMIN","A9503 - TC99M MEDRONATE","A9500 - TC99M SESTAMIBI","A9503 - TC99M MEDRONATE","A9502 - HC TC99M TETROFOSMIN","A4648 - IMPLANTABLE TISSUE MARKER","G0103 - PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING","G0103 - PSA, TOTAL SCREENING","A9502 - HC TC99M TETROFOSMIN","A6209 - FOAM DRSG <=16 SQ IN W/O BDR","G0103 - PSA, TOTAL SCREENING","A4648 - IMPLANTABLE TISSUE MARKER","A9502 - HC TC99M TETROFOSMIN","G0103 - PSA, TOTAL SCREENING","J0702 - HC BETAMETHASONE ACET&SOD PHOSP","A6209 - FOAM DRSG <=16 SQ IN W/O BDR"]
["AETNA","C5275 - HC LOW COST SKIN SUBSTITUTE",null,null,"A9581 - GADOXETATE DISODIUM INJ","A9503 - TC99M MEDRONATE","A9505 - THALLIUM CHLORIDE PER MCI","A9502 - HC TC99M TETROFOSMIN","A9505 - THALLIUM CHLORIDE PER MCI","A9503 - TC99M MEDRONATE","A4725 - DIALYS SOL FLD VOL > 4999CC","G0279 - TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO","G0279 - TOMOSYNTHESIS, MAMMO","A9503 - TC99M MEDRONATE","A6258 - TRANSPARENT FILM >16<=48 IN","G0279 - TOMOSYNTHESIS, MAMMO","A4725 - DIALYS SOL FLD VOL > 4999CC","A9503 - TC99M MEDRONATE","G0279 - TOMOSYNTHESIS, MAMMO","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","A6258 - TRANSPARENT FILM >16<=48 IN"]
["AETNA","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3",null,null,"C5275 - HC LOW COST SKIN SUBSTITUTE","A9505 - THALLIUM CHLORIDE PER MCI","A9509 - HC IODINE I-123 PER MCI","A9503 - TC99M MEDRONATE","A9509 - HC IODINE I-123 PER MCI","A9505 - THALLIUM CHLORIDE PER MCI","A6209 - FOAM DRSG <=16 SQ IN W/O BDR","G0480 - DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES","G0480 - DRUG TEST DEF 1-7 CLASSES","A9505 - THALLIUM CHLORIDE PER MCI","A6550 - NEG PRES WOUND THER DRSG SET","G0480 - DRUG TEST DEF 1-7 CLASSES","A6209 - FOAM DRSG <=16 SQ IN W/O BDR","A9505 - THALLIUM CHLORIDE PER MCI","G0480 - DRUG TEST DEF 1-7 CLASSES","J1250 - HC DOBUTAMINE SDV/250MG","A6550 - NEG PRES WOUND THER DRSG SET"]
["AETNA","E0191 - PROTECTOR HEEL OR ELBOW",null,null,"C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3","A9509 - HC IODINE I-123 PER MCI","A9513 - TECHNETIUM TC-99M MEBROFENIN","A9505 - THALLIUM CHLORIDE PER MCI","A9513 - TECHNETIUM TC-99M MEBROFENIN","A9509 - HC IODINE I-123 PER MCI","A6258 - TRANSPARENT FILM >16<=48 IN","G0481 - DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES","A9509 - HC IODINE I-123 PER MCI","A7520 - TRACH/LARYN TUBE NON-CUFFED","G0481 - DRUG TEST DEF 8-14 CLASSES","A6258 - TRANSPARENT FILM >16<=48 IN","A9509 - HC IODINE I-123 PER MCI","G0481 - DRUG TEST DEF 8-14 CLASSES","J2790 - HC IG;RHO D,HUMAN/300MCG","A7520 - TRACH/LARYN TUBE NON-CUFFED"]
["AETNA","G0103 - PSA, TOTAL SCREENING",null,null,"E0191 - PROTECTOR HEEL OR ELBOW","A9512 - TC99M PERTECHNETATE","A9516 - I123 IODIDE CAP, DX","A9509 - HC IODINE I-123 PER MCI","A9516 - I123 IODIDE CAP, DX","A9512 - TC99M PERTECHNETATE","A6549 - G COMPRESSION STOCKING","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS","A9512 - TC99M PERTECHNETATE","A9500 - TC99M SESTAMIBI","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS","A6549 - G COMPRESSION STOCKING","A9512 - TC99M PERTECHNETATE","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS","J3301 - HC TRIAMCINOLONE ACET INJ NOS","A9500 - TC99M SESTAMIBI"]
["AETNA","G0105 - HC COLORECTAL SCRN; HI RISK IND",null,null,"G0103 - PSA, TOTAL SCREENING","A9513 - TECHNETIUM TC-99M MEBROFENIN","A9517 - I131 IODIDE CAP, RX","A9513 - TECHNETIUM TC-99M MEBROFENIN","A9517 - I131 IODIDE CAP, RX","A9513 - TECHNETIUM TC-99M MEBROFENIN","A6550 - NEG PRES WOUND THER DRSG SET","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","A9513 - TECHNETIUM TC-99M MEBROFENIN","A9502 - HC TC99M TETROFOSMIN","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","A6550 - NEG PRES WOUND THER DRSG SET","A9513 - TECHNETIUM TC-99M MEBROFENIN","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","P9045 - HC ALBUMIN (HUMAN) 5% 250ML","A9502 - HC TC99M TETROFOSMIN"]
["AETNA","G0259 - HC INJECT FOR SACROILIAC JOINT",null,null,"G0105 - HC COLORECTAL SCRN; HI RISK IND","A9516 - I123 IODIDE CAP, DX","A9521 - TC99M EXAMETAZIME","A9516 - I123 IODIDE CAP, DX","A9521 - TC99M EXAMETAZIME","A9516 - I123 IODIDE CAP, DX","A7520 - TRACH/LARYN TUBE NON-CUFFED","J0702 - HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP","A9516 - I123 IODIDE CAP, DX","A9503 - TC99M MEDRONATE","J0702 - HC BETAMETHASONE ACET&SOD PHOSP","A7520 - TRACH/LARYN TUBE NON-CUFFED","A9516 - I123 IODIDE CAP, DX","J0702 - HC BETAMETHASONE ACET&SOD PHOSP","P9047 - HC ALBUMIN (HUMAN) 25% 50ML","A9503 - TC99M MEDRONATE"]
["AETNA","G0260 - INJ FOR SACROILIAC JT ANESTH",null,null,"G0259 - HC INJECT FOR SACROILIAC JOINT","A9517 - I131 IODIDE CAP, RX","A9537 - TC99M MEBROFENIN","A9517 - I131 IODIDE CAP, RX","A9537 - TC99M MEBROFENIN","A9517 - I131 IODIDE CAP, RX","A9500 - TC99M SESTAMIBI","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","A9517 - I131 IODIDE CAP, RX","A9505 - THALLIUM CHLORIDE PER MCI","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","A9500 - TC99M SESTAMIBI","A9517 - I131 IODIDE CAP, RX","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","P9612 - CATHETERIZE FOR URINE SPEC","A9505 - THALLIUM CHLORIDE PER MCI"]
["AETNA","G0279 - TOMOSYNTHESIS, MAMMO",null,null,"G0260 - INJ FOR SACROILIAC JT ANESTH","A9520 - TECHNETIUMTC-99M SULFUR CLLD","A9538 - TC99M PYROPHOSPHATE","A9521 - TC99M EXAMETAZIME","A9538 - TC99M PYROPHOSPHATE","A9520 - TECHNETIUMTC-99M SULFUR CLLD","A9502 - HC TC99M TETROFOSMIN","J1250 - HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG","J1250 - HC DOBUTAMINE SDV/250MG","A9520 - TECHNETIUMTC-99M SULFUR CLLD","A9509 - HC IODINE I-123 PER MCI","J1250 - HC DOBUTAMINE SDV/250MG","A9502 - HC TC99M TETROFOSMIN","A9520 - TECHNETIUMTC-99M SULFUR CLLD","J1250 - HC DOBUTAMINE SDV/250MG","Q0111 - HC WET MOUNTS W PREPARATIONS","A9509 - HC IODINE I-123 PER MCI"]
["AETNA","G0480 - DRUG TEST DEF 1-7 CLASSES",null,null,"G0279 - TOMOSYNTHESIS, MAMMO","A9521 - TC99M EXAMETAZIME","A9539 - TC99M PENTETATE","A9537 - TC99M MEBROFENIN","A9539 - TC99M PENTETATE","A9521 - TC99M EXAMETAZIME","A9503 - TC99M MEDRONATE","J2790 - HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG","J2790 - HC IG;RHO D,HUMAN/300MCG","A9521 - TC99M EXAMETAZIME","A9512 - TC99M PERTECHNETATE","J2790 - HC IG;RHO D,HUMAN/300MCG","A9503 - TC99M MEDRONATE","A9521 - TC99M EXAMETAZIME","J2790 - HC IG;RHO D,HUMAN/300MCG","Q0114 - HC  FERN TEST","A9512 - TC99M PERTECHNETATE"]
["AETNA","G0481 - DRUG TEST DEF 8-14 CLASSES",null,null,"G0480 - DRUG TEST DEF 1-7 CLASSES","A9537 - TC99M MEBROFENIN","A9540 - TC99M MAA","A9538 - TC99M PYROPHOSPHATE","A9540 - TC99M MAA","A9537 - TC99M MEBROFENIN","A9505 - THALLIUM CHLORIDE PER MCI","J3301 - HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS","J3301 - HC TRIAMCINOLONE ACET INJ NOS","A9537 - TC99M MEBROFENIN","A9513 - TECHNETIUM TC-99M MEBROFENIN","J3301 - HC TRIAMCINOLONE ACET INJ NOS","A9505 - THALLIUM CHLORIDE PER MCI","A9537 - TC99M MEBROFENIN","J3301 - HC TRIAMCINOLONE ACET INJ NOS","Q4101 - APLIGRAF","A9513 - TECHNETIUM TC-99M MEBROFENIN"]
["AETNA","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",null,null,"G0481 - DRUG TEST DEF 8-14 CLASSES","A9538 - TC99M PYROPHOSPHATE","A9541 - TC99M SULFUR COLLOID","A9539 - TC99M PENTETATE","A9541 - TC99M SULFUR COLLOID","A9538 - TC99M PYROPHOSPHATE","A9509 - HC IODINE I-123 PER MCI","L0120 - CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE","A9538 - TC99M PYROPHOSPHATE","A9516 - I123 IODIDE CAP, DX","L0120 - CERV FLEXIBLE NON-ADJUSTABLE","A9509 - HC IODINE I-123 PER MCI","A9538 - TC99M PYROPHOSPHATE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE","Q4102 - OASIS WOUND MATRIX","A9516 - I123 IODIDE CAP, DX"]
["AETNA","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",null,null,"G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS","A9539 - TC99M PENTETATE","A9543 - Y90 IBRITUMOMAB, RX","A9540 - TC99M MAA","A9543 - Y90 IBRITUMOMAB, RX","A9539 - TC99M PENTETATE","A9512 - TC99M PERTECHNETATE","L0140 - CERVICAL SEMI-RIGID ADJUSTAB","L0140 - CERVICAL SEMI-RIGID ADJUSTAB","L0140 - CERVICAL SEMI-RIGID ADJUSTAB","A9539 - TC99M PENTETATE","A9517 - I131 IODIDE CAP, RX","L0140 - CERVICAL SEMI-RIGID ADJUSTAB","A9512 - TC99M PERTECHNETATE","A9539 - TC99M PENTETATE","L0140 - CERVICAL SEMI-RIGID ADJUSTAB","Q4104 - INTEGRA BMWD","A9517 - I131 IODIDE CAP, RX"]
["AETNA","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",null,null,"G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","A9540 - TC99M MAA","A9547 - IN111 OXYQUINOLINE","A9541 - TC99M SULFUR COLLOID","A9547 - IN111 OXYQUINOLINE","A9540 - TC99M MAA","A9513 - TECHNETIUM TC-99M MEBROFENIN","L1820 - KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO","L1820 - KO ELAS W/ CONDYLE PADS & JO","A9540 - TC99M MAA","A9520 - TECHNETIUMTC-99M SULFUR CLLD","L1820 - KO ELAS W/ CONDYLE PADS & JO","A9513 - TECHNETIUM TC-99M MEBROFENIN","A9540 - TC99M MAA","L1820 - KO ELAS W/ CONDYLE PADS & JO","Q4107 - GRAFTJACKET","A9520 - TECHNETIUMTC-99M SULFUR CLLD"]
["AETNA","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,null,"J0702 - HC BETAMETHASONE ACET&SOD PHOSP","A9541 - TC99M SULFUR COLLOID","A9551 - HC TC99M SUCCIMER/10MCI,DX","A9543 - Y90 IBRITUMOMAB, RX","A9551 - HC TC99M SUCCIMER/10MCI,DX","A9541 - TC99M SULFUR COLLOID","A9516 - I123 IODIDE CAP, DX","L1830 - KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT","L1830 - KO IMMOBILIZER CANVAS LONGIT","A9541 - TC99M SULFUR COLLOID","A9521 - TC99M EXAMETAZIME","L1830 - KO IMMOBILIZER CANVAS LONGIT","A9516 - I123 IODIDE CAP, DX","A9541 - TC99M SULFUR COLLOID","L1830 - KO IMMOBILIZER CANVAS LONGIT","Q4112 - CYMETRA INJECTABLE","A9521 - TC99M EXAMETAZIME"]
["AETNA","J1250 - HC DOBUTAMINE SDV/250MG",null,null,"J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","A9543 - Y90 IBRITUMOMAB, RX","A9552 - F18 FDG","A9547 - IN111 OXYQUINOLINE","A9552 - F18 FDG","A9543 - Y90 IBRITUMOMAB, RX","A9517 - I131 IODIDE CAP, RX","L1832 - KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT","L1832 - KO ADJ JNT POS RIGID SUPPORT","A9543 - Y90 IBRITUMOMAB, RX","A9537 - TC99M MEBROFENIN","L1832 - KO ADJ JNT POS RIGID SUPPORT","A9517 - I131 IODIDE CAP, RX","A9543 - Y90 IBRITUMOMAB, RX","L1832 - KO ADJ JNT POS RIGID SUPPORT","Q4116 - HC ALLODERM 8 X 16 MEDIUM","A9537 - TC99M MEBROFENIN"]
["AETNA","J2790 - HC IG;RHO D,HUMAN/300MCG",null,null,"J1250 - HC DOBUTAMINE SDV/250MG","A9547 - IN111 OXYQUINOLINE","A9555 - RADIOPHARMACIAL","A9551 - HC TC99M SUCCIMER/10MCI,DX","A9555 - RADIOPHARMACIAL","A9547 - IN111 OXYQUINOLINE","A9520 - TECHNETIUMTC-99M SULFUR CLLD","L1836 - HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS","L1836 - HC RIGID KO WO JOINTS","A9547 - IN111 OXYQUINOLINE","A9538 - TC99M PYROPHOSPHATE","L1836 - HC RIGID KO WO JOINTS","A9520 - TECHNETIUMTC-99M SULFUR CLLD","A9547 - IN111 OXYQUINOLINE","L1836 - HC RIGID KO WO JOINTS","Q4132 - HC GRAFIX CORE 5X5CM","A9538 - TC99M PYROPHOSPHATE"]
["AETNA","J3301 - HC TRIAMCINOLONE ACET INJ NOS",null,null,"J2790 - HC IG;RHO D,HUMAN/300MCG","A9551 - HC TC99M SUCCIMER/10MCI,DX","A9556 - GA67 GALLIUM","A9552 - F18 FDG","A9556 - GA67 GALLIUM","A9551 - HC TC99M SUCCIMER/10MCI,DX","A9521 - TC99M EXAMETAZIME","L1902 - AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET","L1902 - AFO ANKLE GAUNTLET","A9551 - HC TC99M SUCCIMER/10MCI,DX","A9539 - TC99M PENTETATE","L1902 - AFO ANKLE GAUNTLET","A9521 - TC99M EXAMETAZIME","A9551 - HC TC99M SUCCIMER/10MCI,DX","L1902 - AFO ANKLE GAUNTLET","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","A9539 - TC99M PENTETATE"]
["AETNA","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",null,null,"J3301 - HC TRIAMCINOLONE ACET INJ NOS","A9552 - F18 FDG","A9557 - TC99M BICISATE","A9555 - RADIOPHARMACIAL","A9557 - TC99M BICISATE","A9552 - F18 FDG","A9537 - TC99M MEBROFENIN","L3350 - SHOE HEEL WEDGE","L3350 - SHOE HEEL WEDGE","L3350 - SHOE HEEL WEDGE","A9552 - F18 FDG","A9540 - TC99M MAA","L3350 - SHOE HEEL WEDGE","A9537 - TC99M MEBROFENIN","A9552 - F18 FDG","L3350 - SHOE HEEL WEDGE","Q4196 - HC PURAPLYAM-COM 6X9 CM","A9540 - TC99M MAA"]
["AETNA","L0140 - CERVICAL SEMI-RIGID ADJUSTAB",null,null,"L0120 - CERV FLEXIBLE NON-ADJUSTABLE","A9555 - RADIOPHARMACIAL","A9558 - HC XENON133/10MCI","A9556 - GA67 GALLIUM","A9558 - HC XENON133/10MCI","A9555 - RADIOPHARMACIAL","A9538 - TC99M PYROPHOSPHATE","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN","A9555 - RADIOPHARMACIAL","A9541 - TC99M SULFUR COLLOID","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN","A9538 - TC99M PYROPHOSPHATE","A9555 - RADIOPHARMACIAL","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN","Q9954 - ORAL MR CONTRAST, 100 ML","A9541 - TC99M SULFUR COLLOID"]
["AETNA","L1820 - KO ELAS W/ CONDYLE PADS & JO",null,null,"L0140 - CERVICAL SEMI-RIGID ADJUSTAB","A9556 - GA67 GALLIUM","A9560 - TC99M LABELED RBC","A9557 - TC99M BICISATE","A9560 - TC99M LABELED RBC","A9556 - GA67 GALLIUM","A9539 - TC99M PENTETATE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE","A9556 - GA67 GALLIUM","A9543 - Y90 IBRITUMOMAB, RX","L3670 - ACROMIO/CLAVICULAR CANVAS&WE","A9539 - TC99M PENTETATE","A9556 - GA67 GALLIUM","L3670 - ACROMIO/CLAVICULAR CANVAS&WE","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML","A9543 - Y90 IBRITUMOMAB, RX"]
["AETNA","L1830 - KO IMMOBILIZER CANVAS LONGIT",null,null,"L1820 - KO ELAS W/ CONDYLE PADS & JO","A9557 - TC99M BICISATE","A9561 - TC99M OXIDRONATE","A9558 - HC XENON133/10MCI","A9561 - TC99M OXIDRONATE","A9557 - TC99M BICISATE","A9540 - TC99M MAA","L3760 - EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED","L3760 - EO WITHJOINT, PREFABRICATED","A9557 - TC99M BICISATE","A9547 - IN111 OXYQUINOLINE","L3760 - EO WITHJOINT, PREFABRICATED","A9540 - TC99M MAA","A9557 - TC99M BICISATE","L3760 - EO WITHJOINT, PREFABRICATED","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML","A9547 - IN111 OXYQUINOLINE"]
["AETNA","L1832 - KO ADJ JNT POS RIGID SUPPORT",null,null,"L1830 - KO IMMOBILIZER CANVAS LONGIT","A9558 - HC XENON133/10MCI","A9562 - TC99M MERTIATIDE","A9560 - TC99M LABELED RBC","A9562 - TC99M MERTIATIDE","A9558 - HC XENON133/10MCI","A9541 - TC99M SULFUR COLLOID","L3762 - RIGID EO WO JOINTS","L3762 - RIGID EO WO JOINTS","L3762 - RIGID EO WO JOINTS","A9558 - HC XENON133/10MCI","A9551 - HC TC99M SUCCIMER/10MCI,DX","L3762 - RIGID EO WO JOINTS","A9541 - TC99M SULFUR COLLOID","A9558 - HC XENON133/10MCI","L3762 - RIGID EO WO JOINTS","Q9958 - HOCM <=149 MG/ML IODINE, 1ML","A9551 - HC TC99M SUCCIMER/10MCI,DX"]
["AETNA","L1836 - HC RIGID KO WO JOINTS",null,null,"L1832 - KO ADJ JNT POS RIGID SUPPORT","A9560 - TC99M LABELED RBC","A9563 - P32 NA PHOSPHATE","A9561 - TC99M OXIDRONATE","A9563 - P32 NA PHOSPHATE","A9560 - TC99M LABELED RBC","A9543 - Y90 IBRITUMOMAB, RX","L3807 - WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED","L3807 - WHFO,NO JOINT, PREFABRICATED","A9560 - TC99M LABELED RBC","A9552 - F18 FDG","L3807 - WHFO,NO JOINT, PREFABRICATED","A9543 - Y90 IBRITUMOMAB, RX","A9560 - TC99M LABELED RBC","L3807 - WHFO,NO JOINT, PREFABRICATED","Q9961 - HOCM 250-299MG/ML IODINE,1ML","A9552 - F18 FDG"]
["AETNA","L1902 - AFO ANKLE GAUNTLET",null,null,"L1836 - HC RIGID KO WO JOINTS","A9561 - TC99M OXIDRONATE","A9569 - TECHNETIUM TC-99M AUTO WBC","A9562 - TC99M MERTIATIDE","A9569 - TECHNETIUM TC-99M AUTO WBC","A9561 - TC99M OXIDRONATE","A9547 - IN111 OXYQUINOLINE","L3808 - HC EPITRAIN","L3808 - HC EPITRAIN","L3808 - HC EPITRAIN","A9561 - TC99M OXIDRONATE","A9555 - RADIOPHARMACIAL","L3808 - HC EPITRAIN","A9547 - IN111 OXYQUINOLINE","A9561 - TC99M OXIDRONATE","L3808 - HC EPITRAIN","Q9963 - HOCM 350-399MG/ML IODINE,1ML","A9555 - RADIOPHARMACIAL"]
["AETNA","L3350 - SHOE HEEL WEDGE",null,null,"L1902 - AFO ANKLE GAUNTLET","A9562 - TC99M MERTIATIDE","A9572 - INDIUM IN-111 PENTETREOTIDE","A9563 - P32 NA PHOSPHATE","A9572 - INDIUM IN-111 PENTETREOTIDE","A9562 - TC99M MERTIATIDE","A9551 - HC TC99M SUCCIMER/10MCI,DX","L3905 - HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF","L3905 - HC WHO W/NONTORSION JNT(S) CF","A9562 - TC99M MERTIATIDE","A9556 - GA67 GALLIUM","L3905 - HC WHO W/NONTORSION JNT(S) CF","A9551 - HC TC99M SUCCIMER/10MCI,DX","A9562 - TC99M MERTIATIDE","L3905 - HC WHO W/NONTORSION JNT(S) CF","Q9966 - LOCM 200-299MG/ML IODINE,1ML","A9556 - GA67 GALLIUM"]
["AETNA","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",null,null,"L3350 - SHOE HEEL WEDGE","A9563 - P32 NA PHOSPHATE","A9575 - INJ GADOTERATE MEGLUMI 0.1ML","A9569 - TECHNETIUM TC-99M AUTO WBC","A9575 - INJ GADOTERATE MEGLUMI 0.1ML","A9563 - P32 NA PHOSPHATE","A9552 - F18 FDG","L3908 - WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED","L3908 - WRIST COCK-UP NON-MOLDED","A9563 - P32 NA PHOSPHATE","A9557 - TC99M BICISATE","L3908 - WRIST COCK-UP NON-MOLDED","A9552 - F18 FDG","A9563 - P32 NA PHOSPHATE","L3908 - WRIST COCK-UP NON-MOLDED","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","A9557 - TC99M BICISATE"]
["AETNA","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",null,null,"L3650 - SHLDER FIG 8 ABDUCT RESTRAIN","A9569 - TECHNETIUM TC-99M AUTO WBC","A9576 - HC PROHANCE IV CONTRAST PER ML","A9572 - INDIUM IN-111 PENTETREOTIDE","A9576 - HC PROHANCE IV CONTRAST PER ML","A9569 - TECHNETIUM TC-99M AUTO WBC","A9555 - RADIOPHARMACIAL","L3967 - HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF","L3967 - HC SEWHO AIRPLANE W/O JNTS CF","A9569 - TECHNETIUM TC-99M AUTO WBC","A9558 - HC XENON133/10MCI","L3967 - HC SEWHO AIRPLANE W/O JNTS CF","A9555 - RADIOPHARMACIAL","A9569 - TECHNETIUM TC-99M AUTO WBC","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",null,"A9558 - HC XENON133/10MCI"]
["AETNA","L3760 - EO WITHJOINT, PREFABRICATED",null,null,"L3670 - ACROMIO/CLAVICULAR CANVAS&WE","A9570 - HC INDIUM IN-111 AUTO WBC","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","A9575 - INJ GADOTERATE MEGLUMI 0.1ML","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","A9570 - HC INDIUM IN-111 AUTO WBC","A9556 - GA67 GALLIUM","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL","A9570 - HC INDIUM IN-111 AUTO WBC","A9560 - TC99M LABELED RBC","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL","A9556 - GA67 GALLIUM","A9570 - HC INDIUM IN-111 AUTO WBC","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",null,"A9560 - TC99M LABELED RBC"]
["AETNA","L3762 - RIGID EO WO JOINTS",null,null,"L3760 - EO WITHJOINT, PREFABRICATED","A9572 - INDIUM IN-111 PENTETREOTIDE","A9579 - GAD-BASE MR CONTRAST NOS,1ML","A9576 - HC PROHANCE IV CONTRAST PER ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML","A9572 - INDIUM IN-111 PENTETREOTIDE","A9557 - TC99M BICISATE","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL","A9572 - INDIUM IN-111 PENTETREOTIDE","A9561 - TC99M OXIDRONATE","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL","A9557 - TC99M BICISATE","A9572 - INDIUM IN-111 PENTETREOTIDE","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",null,"A9561 - TC99M OXIDRONATE"]
["AETNA","L3807 - WHFO,NO JOINT, PREFABRICATED",null,null,"L3762 - RIGID EO WO JOINTS","A9580 - HC NA FLUORIDE F-18, DOSE","A9581 - GADOXETATE DISODIUM INJ","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","A9581 - GADOXETATE DISODIUM INJ","A9575 - INJ GADOTERATE MEGLUMI 0.1ML","A9558 - HC XENON133/10MCI","L4350 - ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB","L4350 - ANKLE CONTROL ORTHOSI PREFAB","A9575 - INJ GADOTERATE MEGLUMI 0.1ML","A9562 - TC99M MERTIATIDE","L4350 - ANKLE CONTROL ORTHOSI PREFAB","A9558 - HC XENON133/10MCI","A9575 - INJ GADOTERATE MEGLUMI 0.1ML","L4350 - ANKLE CONTROL ORTHOSI PREFAB",null,"A9562 - TC99M MERTIATIDE"]
["AETNA","L3808 - HC EPITRAIN",null,null,"L3807 - WHFO,NO JOINT, PREFABRICATED","A9582 - IODINE I-123 IOBENGUANE","A9583 - GADOFOSVESET TRISODIUM INJ","A9579 - GAD-BASE MR CONTRAST NOS,1ML","A9583 - GADOFOSVESET TRISODIUM INJ","A9576 - HC PROHANCE IV CONTRAST PER ML","A9560 - TC99M LABELED RBC","L4360 - PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB","L4360 - PNEUMATI WALKING BOOT PREFAB","A9576 - HC PROHANCE IV CONTRAST PER ML","A9563 - P32 NA PHOSPHATE","L4360 - PNEUMATI WALKING BOOT PREFAB","A9560 - TC99M LABELED RBC","A9576 - HC PROHANCE IV CONTRAST PER ML","L4360 - PNEUMATI WALKING BOOT PREFAB",null,"A9563 - P32 NA PHOSPHATE"]
["AETNA","L3905 - HC WHO W/NONTORSION JNT(S) CF",null,null,"L3808 - HC EPITRAIN","A9583 - GADOFOSVESET TRISODIUM INJ","A9584 - IODINE I-123 IOFLUPANE","A9581 - GADOXETATE DISODIUM INJ","A9584 - IODINE I-123 IOFLUPANE","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","A9561 - TC99M OXIDRONATE","L4370 - HC PNEUMATIC FULL LEG SPLINT","L4370 - HC PNEUMATIC FULL LEG SPLINT","L4370 - HC PNEUMATIC FULL LEG SPLINT","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","A9569 - TECHNETIUM TC-99M AUTO WBC","L4370 - HC PNEUMATIC FULL LEG SPLINT","A9561 - TC99M OXIDRONATE","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","L4370 - HC PNEUMATIC FULL LEG SPLINT",null,"A9569 - TECHNETIUM TC-99M AUTO WBC"]
["AETNA","L3908 - WRIST COCK-UP NON-MOLDED",null,null,"L3905 - HC WHO W/NONTORSION JNT(S) CF","A9584 - IODINE I-123 IOFLUPANE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9583 - GADOFOSVESET TRISODIUM INJ","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9579 - GAD-BASE MR CONTRAST NOS,1ML","A9562 - TC99M MERTIATIDE","L4386 - NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB","L4386 - NON-PNEUM WALK BOOT PREFAB","A9579 - GAD-BASE MR CONTRAST NOS,1ML","A9570 - HC INDIUM IN-111 AUTO WBC","L4386 - NON-PNEUM WALK BOOT PREFAB","A9562 - TC99M MERTIATIDE","A9579 - GAD-BASE MR CONTRAST NOS,1ML","L4386 - NON-PNEUM WALK BOOT PREFAB",null,"A9570 - HC INDIUM IN-111 AUTO WBC"]
["AETNA","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",null,null,"L3908 - WRIST COCK-UP NON-MOLDED","A9587 - GALLIUM GA-68","A9587 - GALLIUM GA-68","A9584 - IODINE I-123 IOFLUPANE","A9587 - GALLIUM GA-68","A9580 - HC NA FLUORIDE F-18, DOSE","A9563 - P32 NA PHOSPHATE","L4396 - STATIC AFO","L4396 - STATIC AFO","L4396 - STATIC AFO","A9580 - HC NA FLUORIDE F-18, DOSE","A9572 - INDIUM IN-111 PENTETREOTIDE","L4396 - STATIC AFO","A9563 - P32 NA PHOSPHATE","A9580 - HC NA FLUORIDE F-18, DOSE","L4396 - STATIC AFO",null,"A9572 - INDIUM IN-111 PENTETREOTIDE"]
["AETNA","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",null,null,"L3967 - HC SEWHO AIRPLANE W/O JNTS CF","A9588 - FLUCICLOVINE F-18","A9588 - FLUCICLOVINE F-18","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","A9588 - FLUCICLOVINE F-18","A9581 - GADOXETATE DISODIUM INJ","A9569 - TECHNETIUM TC-99M AUTO WBC","L4398 - HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT","L4398 - HC FOOT DROP SPLINT RECUMBENT","A9581 - GADOXETATE DISODIUM INJ","A9575 - INJ GADOTERATE MEGLUMI 0.1ML","L4398 - HC FOOT DROP SPLINT RECUMBENT","A9569 - TECHNETIUM TC-99M AUTO WBC","A9581 - GADOXETATE DISODIUM INJ","L4398 - HC FOOT DROP SPLINT RECUMBENT",null,"A9575 - INJ GADOTERATE MEGLUMI 0.1ML"]
["AETNA","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",null,null,"L3980 - HC UPP EXT FX ORTHOSIS HUMERAL","A9592 - HC COPPER CU 64 DOTATATE DIAG","A9606 - RADIUM RA223 DICHLORIDE THER","A9587 - GALLIUM GA-68","A9606 - RADIUM RA223 DICHLORIDE THER","A9582 - IODINE I-123 IOBENGUANE","A9570 - HC INDIUM IN-111 AUTO WBC","L8501 - TRACHEOSTOMY SPEAKING VALVE","L8501 - TRACHEOSTOMY SPEAKING VALVE","L8501 - TRACHEOSTOMY SPEAKING VALVE","A9582 - IODINE I-123 IOBENGUANE","A9576 - HC PROHANCE IV CONTRAST PER ML","L8501 - TRACHEOSTOMY SPEAKING VALVE","A9570 - HC INDIUM IN-111 AUTO WBC","A9582 - IODINE I-123 IOBENGUANE","L8501 - TRACHEOSTOMY SPEAKING VALVE",null,"A9576 - HC PROHANCE IV CONTRAST PER ML"]
["AETNA","L4350 - ANKLE CONTROL ORTHOSI PREFAB",null,null,"L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL","G0101 - CA SCREEN;PELVIC/BREAST EXAM","C1717 - HC BRACHYTX, NON-STR,HDR IR-192","A9588 - FLUCICLOVINE F-18","C1717 - HC BRACHYTX, NON-STR,HDR IR-192","A9583 - GADOFOSVESET TRISODIUM INJ","A9572 - INDIUM IN-111 PENTETREOTIDE","L8507 - HC PROLARYNX VOICE (PLUS)","L8507 - HC PROLARYNX VOICE (PLUS)","L8507 - HC PROLARYNX VOICE (PLUS)","A9583 - GADOFOSVESET TRISODIUM INJ","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","L8507 - HC PROLARYNX VOICE (PLUS)","A9572 - INDIUM IN-111 PENTETREOTIDE","A9583 - GADOFOSVESET TRISODIUM INJ","L8507 - HC PROLARYNX VOICE (PLUS)",null,"A9577 - HC INJ, GADOBENATE DIMEGL 1 ML"]
["AETNA","L4360 - PNEUMATI WALKING BOOT PREFAB",null,null,"L4350 - ANKLE CONTROL ORTHOSI PREFAB","G0103 - PSA, TOTAL SCREENING","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE","A9606 - RADIUM RA223 DICHLORIDE THER","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE","A9584 - IODINE I-123 IOFLUPANE","A9575 - INJ GADOTERATE MEGLUMI 0.1ML","L8509 - TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN","L8509 - TRACH-ESOPH VOICE PROS MD IN","A9584 - IODINE I-123 IOFLUPANE","A9579 - GAD-BASE MR CONTRAST NOS,1ML","L8509 - TRACH-ESOPH VOICE PROS MD IN","A9575 - INJ GADOTERATE MEGLUMI 0.1ML","A9584 - IODINE I-123 IOFLUPANE","L8509 - TRACH-ESOPH VOICE PROS MD IN",null,"A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["AETNA","L4370 - HC PNEUMATIC FULL LEG SPLINT",null,null,"L4360 - PNEUMATI WALKING BOOT PREFAB","G0127 - TRIM NAIL(S)","C2635 - BRACHYTX, NON-STR, HA, P-103","C1717 - HC BRACHYTX, NON-STR,HDR IR-192","C2635 - BRACHYTX, NON-STR, HA, P-103","A9587 - GALLIUM GA-68","A9576 - HC PROHANCE IV CONTRAST PER ML","L8514 - REPL TRACH PUNCTURE DILATOR","L8514 - REPL TRACH PUNCTURE DILATOR","L8514 - REPL TRACH PUNCTURE DILATOR","A9587 - GALLIUM GA-68","A9580 - HC NA FLUORIDE F-18, DOSE","L8514 - REPL TRACH PUNCTURE DILATOR","A9576 - HC PROHANCE IV CONTRAST PER ML","A9587 - GALLIUM GA-68","L8514 - REPL TRACH PUNCTURE DILATOR",null,"A9580 - HC NA FLUORIDE F-18, DOSE"]
["AETNA","L4386 - NON-PNEUM WALK BOOT PREFAB",null,null,"L4370 - HC PNEUMATIC FULL LEG SPLINT","G0175 - OPPS SERVICE,SCHED TEAM CONF","C2639 - BRACHYTX, NON-STRANDED,I-125","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE","C2639 - BRACHYTX, NON-STRANDED,I-125","A9588 - FLUCICLOVINE F-18","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","L8693 - HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT","L8693 - HC AUD OSSEO DEV, ABUTMENT","A9588 - FLUCICLOVINE F-18","A9581 - GADOXETATE DISODIUM INJ","L8693 - HC AUD OSSEO DEV, ABUTMENT","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML","A9588 - FLUCICLOVINE F-18","L8693 - HC AUD OSSEO DEV, ABUTMENT",null,"A9581 - GADOXETATE DISODIUM INJ"]
["AETNA","L4396 - STATIC AFO",null,null,"L4386 - NON-PNEUM WALK BOOT PREFAB","G0239 - OTH RESP PROC, GROUP","C5275 - HC LOW COST SKIN SUBSTITUTE","C2635 - BRACHYTX, NON-STR, HA, P-103","C5275 - HC LOW COST SKIN SUBSTITUTE","A9592 - HC COPPER CU 64 DOTATATE DIAG","A9579 - GAD-BASE MR CONTRAST NOS,1ML","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","A9592 - HC COPPER CU 64 DOTATATE DIAG","A9582 - IODINE I-123 IOBENGUANE","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","A9579 - GAD-BASE MR CONTRAST NOS,1ML","A9592 - HC COPPER CU 64 DOTATATE DIAG","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",null,"A9582 - IODINE I-123 IOBENGUANE"]
["AETNA","L4398 - HC FOOT DROP SPLINT RECUMBENT",null,null,"L4396 - STATIC AFO","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP","C8908 - HC MRI W/O FOL W/CONT, BREAST,","C2639 - BRACHYTX, NON-STRANDED,I-125","C8908 - HC MRI W/O FOL W/CONT, BREAST,","E0191 - PROTECTOR HEEL OR ELBOW","A9580 - HC NA FLUORIDE F-18, DOSE","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","E0191 - PROTECTOR HEEL OR ELBOW","A9583 - GADOFOSVESET TRISODIUM INJ","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","A9580 - HC NA FLUORIDE F-18, DOSE","E0191 - PROTECTOR HEEL OR ELBOW","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",null,"A9583 - GADOFOSVESET TRISODIUM INJ"]
["AETNA","L8501 - TRACHEOSTOMY SPEAKING VALVE",null,null,"L4398 - HC FOOT DROP SPLINT RECUMBENT","G0259 - HC INJECT FOR SACROILIAC JOINT","C9358 - SURGIMEND, FETAL","C5275 - HC LOW COST SKIN SUBSTITUTE","C9358 - SURGIMEND, FETAL","G0101 - CA SCREEN;PELVIC/BREAST EXAM","A9581 - GADOXETATE DISODIUM INJ","P9045 - HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML","P9045 - HC ALBUMIN (HUMAN) 5% 250ML","G0101 - CA SCREEN;PELVIC/BREAST EXAM","A9584 - IODINE I-123 IOFLUPANE","P9045 - HC ALBUMIN (HUMAN) 5% 250ML","A9581 - GADOXETATE DISODIUM INJ","G0101 - CA SCREEN;PELVIC/BREAST EXAM","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",null,"A9584 - IODINE I-123 IOFLUPANE"]
["AETNA","L8507 - HC PROLARYNX VOICE (PLUS)",null,null,"L8501 - TRACHEOSTOMY SPEAKING VALVE","G0260 - INJ FOR SACROILIAC JT ANESTH","C9728 - PLACE DEVICE/MARKER, NON PRO","C8908 - HC MRI W/O FOL W/CONT, BREAST,","C9728 - PLACE DEVICE/MARKER, NON PRO","G0103 - PSA, TOTAL SCREENING","A9582 - IODINE I-123 IOBENGUANE","P9047 - HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML","P9047 - HC ALBUMIN (HUMAN) 25% 50ML","G0103 - PSA, TOTAL SCREENING","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","P9047 - HC ALBUMIN (HUMAN) 25% 50ML","A9582 - IODINE I-123 IOBENGUANE","G0103 - PSA, TOTAL SCREENING","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",null,"A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE"]
["AETNA","L8509 - TRACH-ESOPH VOICE PROS MD IN",null,null,"L8507 - HC PROLARYNX VOICE (PLUS)","G0269 - HC CLOSURE DEVICE PLACEMENT","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3","C9358 - SURGIMEND, FETAL","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3","G0127 - TRIM NAIL(S)","A9583 - GADOFOSVESET TRISODIUM INJ","P9612 - CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC","P9612 - CATHETERIZE FOR URINE SPEC","G0127 - TRIM NAIL(S)","A9587 - GALLIUM GA-68","P9612 - CATHETERIZE FOR URINE SPEC","A9583 - GADOFOSVESET TRISODIUM INJ","G0127 - TRIM NAIL(S)","P9612 - CATHETERIZE FOR URINE SPEC",null,"A9587 - GALLIUM GA-68"]
["AETNA","L8514 - REPL TRACH PUNCTURE DILATOR",null,null,"L8509 - TRACH-ESOPH VOICE PROS MD IN","G0278 - ILIAC ART ANGIO,CARDIAC CATH","D0210 - INTRAORAL - COMPLETE SERIES OF RADIOGRAPHIC IMAGES","C9728 - PLACE DEVICE/MARKER, NON PRO","D0210 - INTRAORAL - COMPLETE SERIES OF RADIOGRAPHIC IMAGES","G0175 - OPPS SERVICE,SCHED TEAM CONF","A9584 - IODINE I-123 IOFLUPANE","Q0111 - HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS","Q0111 - HC WET MOUNTS W PREPARATIONS","G0175 - OPPS SERVICE,SCHED TEAM CONF","A9588 - FLUCICLOVINE F-18","Q0111 - HC WET MOUNTS W PREPARATIONS","A9584 - IODINE I-123 IOFLUPANE","G0175 - OPPS SERVICE,SCHED TEAM CONF","Q0111 - HC WET MOUNTS W PREPARATIONS",null,"A9588 - FLUCICLOVINE F-18"]
["AETNA","L8693 - HC AUD OSSEO DEV, ABUTMENT",null,null,"L8514 - REPL TRACH PUNCTURE DILATOR","G0296 - HC VISIT TO DETERM LDCT ELIG","D0220 - INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3","D0220 - INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE","G0239 - OTH RESP PROC, GROUP","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","Q0114 - HC  FERN TEST","Q0114 - HC  FERN TEST","Q0114 - HC  FERN TEST","G0239 - OTH RESP PROC, GROUP","A9606 - RADIUM RA223 DICHLORIDE THER","Q0114 - HC  FERN TEST","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE","G0239 - OTH RESP PROC, GROUP","Q0114 - HC  FERN TEST",null,"A9606 - RADIUM RA223 DICHLORIDE THER"]
["AETNA","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",null,null,"L8693 - HC AUD OSSEO DEV, ABUTMENT","G0297 - HC LDCT FOR LUNG CA SCREEN","D0230 - INTRAORAL - PERIAPICAL EACH ADDITIONAL RADIOGRAPHIC IMAGE","D0210 - INTRAORAL - COMPLETE SERIES OF RADIOGRAPHIC IMAGES","D0230 - INTRAORAL - PERIAPICAL EACH ADDITIONAL RADIOGRAPHIC IMAGE","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP","A9587 - GALLIUM GA-68","Q3014 - HC TELEHEALTH FACILITY FEE","Q3014 - HC TELEHEALTH FACILITY FEE","Q3014 - HC TELEHEALTH FACILITY FEE","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP","C1713 - HC CORE 10 BONE PLUG","Q3014 - HC TELEHEALTH FACILITY FEE","A9587 - GALLIUM GA-68","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP","Q3014 - HC TELEHEALTH FACILITY FEE",null,"C1713 - HC CORE 10 BONE PLUG"]
["AETNA","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",null,null,"M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","G0365 - HC VESSEL MAPPING HEMO ACCESS","D0272 - BITEWINGS - TWO RADIOGRAPHIC IMAGES","D0220 - INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE","D0272 - BITEWINGS - TWO RADIOGRAPHIC IMAGES","G0259 - HC INJECT FOR SACROILIAC JOINT","A9588 - FLUCICLOVINE F-18","Q4101 - APLIGRAF","Q4101 - APLIGRAF","Q4101 - APLIGRAF","G0259 - HC INJECT FOR SACROILIAC JOINT","C1714 - HC WATHMAN SYS ANTER CURVE","Q4101 - APLIGRAF","A9588 - FLUCICLOVINE F-18","G0259 - HC INJECT FOR SACROILIAC JOINT","Q4101 - APLIGRAF",null,"C1714 - HC WATHMAN SYS ANTER CURVE"]
["AETNA","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",null,null,"M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","G0389 - ULTRASOUND EXAM AAA SCREEN","D0274 - BITEWINGS - FOUR RADIOGRAPHIC IMAGES","D0230 - INTRAORAL - PERIAPICAL EACH ADDITIONAL RADIOGRAPHIC IMAGE","D0274 - BITEWINGS - FOUR RADIOGRAPHIC IMAGES","G0260 - INJ FOR SACROILIAC JT ANESTH","A9606 - RADIUM RA223 DICHLORIDE THER","Q4102 - OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX","Q4102 - OASIS WOUND MATRIX","G0260 - INJ FOR SACROILIAC JT ANESTH","C1715 - BRACHYTHERAPY NEEDLE","Q4102 - OASIS WOUND MATRIX","A9606 - RADIUM RA223 DICHLORIDE THER","G0260 - INJ FOR SACROILIAC JT ANESTH","Q4102 - OASIS WOUND MATRIX",null,"C1715 - BRACHYTHERAPY NEEDLE"]
["AETNA","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",null,null,"P9045 - HC ALBUMIN (HUMAN) 5% 250ML","G0390 - TRAUMA RESPONS W/HOSP CRITI","D1110 - PROPHYLAXIS - ADULT","D0272 - BITEWINGS - TWO RADIOGRAPHIC IMAGES","D1110 - PROPHYLAXIS - ADULT","G0269 - HC CLOSURE DEVICE PLACEMENT","C1713 - HC CORE 10 BONE PLUG","Q4132 - HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM","Q4132 - HC GRAFIX CORE 5X5CM","G0269 - HC CLOSURE DEVICE PLACEMENT","C1716 - BRACHYTX SOURCE, GOLD 198","Q4132 - HC GRAFIX CORE 5X5CM","C1713 - HC CORE 10 BONE PLUG","G0269 - HC CLOSURE DEVICE PLACEMENT","Q4132 - HC GRAFIX CORE 5X5CM",null,"C1716 - BRACHYTX SOURCE, GOLD 198"]
["AETNA","P9612 - CATHETERIZE FOR URINE SPEC",null,null,"P9047 - HC ALBUMIN (HUMAN) 25% 50ML","G0396 - ALCOHOL/SUBS INTERV 15-30MN","D1120 - PROPHYLAXIS - CHILD","D0274 - BITEWINGS - FOUR RADIOGRAPHIC IMAGES","D1120 - PROPHYLAXIS - CHILD","G0278 - ILIAC ART ANGIO,CARDIAC CATH","C1714 - HC WATHMAN SYS ANTER CURVE","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","G0278 - ILIAC ART ANGIO,CARDIAC CATH","C1717 - HC BRACHYTX, NON-STR,HDR IR-192","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","C1714 - HC WATHMAN SYS ANTER CURVE","G0278 - ILIAC ART ANGIO,CARDIAC CATH","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",null,"C1717 - HC BRACHYTX, NON-STR,HDR IR-192"]
["AETNA","Q0111 - HC WET MOUNTS W PREPARATIONS",null,null,"P9612 - CATHETERIZE FOR URINE SPEC","G0397 - ALCOHOL/SUBS INTERV >30 MIN","D1351 - SEALANT - PER TOOTH","D1110 - PROPHYLAXIS - ADULT","D1351 - SEALANT - PER TOOTH","G0279 - TOMOSYNTHESIS, MAMMO","C1715 - BRACHYTHERAPY NEEDLE","Q4196 - HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM","Q4196 - HC PURAPLYAM-COM 6X9 CM","G0279 - TOMOSYNTHESIS, MAMMO","C1719 - BRACHYTX SOUR,NON-HDR IR-192","Q4196 - HC PURAPLYAM-COM 6X9 CM","C1715 - BRACHYTHERAPY NEEDLE","G0279 - TOMOSYNTHESIS, MAMMO","Q4196 - HC PURAPLYAM-COM 6X9 CM",null,"C1719 - BRACHYTX SOUR,NON-HDR IR-192"]
["AETNA","Q0114 - HC  FERN TEST",null,null,"Q0111 - HC WET MOUNTS W PREPARATIONS","G0402 - INITIAL PREVENTIVE EXAM","D2140 - AMALGAM - ONE SURFACE, PRIMARY OR PERMANENT","D1120 - PROPHYLAXIS - CHILD","D2140 - AMALGAM - ONE SURFACE, PRIMARY OR PERMANENT","G0296 - HC VISIT TO DETERM LDCT ELIG","C1716 - BRACHYTX SOURCE, GOLD 198","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML","G0296 - HC VISIT TO DETERM LDCT ELIG","C1721 - HC ICD,2CH, GEN ONLY, RECALL $0","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML","C1716 - BRACHYTX SOURCE, GOLD 198","G0296 - HC VISIT TO DETERM LDCT ELIG","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",null,"C1721 - HC ICD,2CH, GEN ONLY, RECALL $0"]
["AETNA","Q3014 - HC TELEHEALTH FACILITY FEE",null,null,"Q0114 - HC  FERN TEST","G0410 - HC GRP PSYCH PARTIAL HOSP 45-50","D2150 - AMALGAM - TWO SURFACES, PRIMARY OR PERMANENT","D1351 - SEALANT - PER TOOTH","D2150 - AMALGAM - TWO SURFACES, PRIMARY OR PERMANENT","G0297 - HC LDCT FOR LUNG CA SCREEN","C1717 - HC BRACHYTX, NON-STR,HDR IR-192","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML","G0297 - HC LDCT FOR LUNG CA SCREEN","C1722 - HC ICD,1CH, GEN ONLY, RECALL $0","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML","C1717 - HC BRACHYTX, NON-STR,HDR IR-192","G0297 - HC LDCT FOR LUNG CA SCREEN","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",null,"C1722 - HC ICD,1CH, GEN ONLY, RECALL $0"]
["AETNA","Q4101 - APLIGRAF",null,null,"Q3014 - HC TELEHEALTH FACILITY FEE","G0416 - HC PROSTATE BIOPSY ANY MTHD","D2160 - AMALGAM - THREE SURFACES, PRIMARY OR PERMANENT","D2140 - AMALGAM - ONE SURFACE, PRIMARY OR PERMANENT","D2160 - AMALGAM - THREE SURFACES, PRIMARY OR PERMANENT","G0365 - HC VESSEL MAPPING HEMO ACCESS","C1719 - BRACHYTX SOUR,NON-HDR IR-192","Q9958 - HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML","Q9958 - HOCM <=149 MG/ML IODINE, 1ML","G0365 - HC VESSEL MAPPING HEMO ACCESS","C1724 - HC CATH, TRANS ATHEREC BURR","Q9958 - HOCM <=149 MG/ML IODINE, 1ML","C1719 - BRACHYTX SOUR,NON-HDR IR-192","G0365 - HC VESSEL MAPPING HEMO ACCESS","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",null,"C1724 - HC CATH, TRANS ATHEREC BURR"]
["AETNA","Q4102 - OASIS WOUND MATRIX",null,null,"Q4101 - APLIGRAF","G0420 - HC ED SVC CKD IND PER SESSION","D2161 - AMALGAM - FOUR OR MORE SURFACES, PRIMARY OR PERMANENT","D2150 - AMALGAM - TWO SURFACES, PRIMARY OR PERMANENT","D2161 - AMALGAM - FOUR OR MORE SURFACES, PRIMARY OR PERMANENT","G0389 - ULTRASOUND EXAM AAA SCREEN","C1721 - HC ICD,2CH, GEN ONLY, RECALL $0","Q9961 - HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML","Q9961 - HOCM 250-299MG/ML IODINE,1ML","G0389 - ULTRASOUND EXAM AAA SCREEN","C1725 - HC SIZING AMPLATZ BALLOON","Q9961 - HOCM 250-299MG/ML IODINE,1ML","C1721 - HC ICD,2CH, GEN ONLY, RECALL $0","G0389 - ULTRASOUND EXAM AAA SCREEN","Q9961 - HOCM 250-299MG/ML IODINE,1ML",null,"C1725 - HC SIZING AMPLATZ BALLOON"]
["AETNA","Q4132 - HC GRAFIX CORE 5X5CM",null,null,"Q4102 - OASIS WOUND MATRIX","G0421 - HC ED SVC CKD GRP PER SESSION","D2330 - RESIN-BASED COMPOSITE - ONE SURFACE, ANTERIOR","D2160 - AMALGAM - THREE SURFACES, PRIMARY OR PERMANENT","D2330 - RESIN-BASED COMPOSITE - ONE SURFACE, ANTERIOR","G0390 - TRAUMA RESPONS W/HOSP CRITI","C1722 - HC ICD,1CH, GEN ONLY, RECALL $0","Q9963 - HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML","Q9963 - HOCM 350-399MG/ML IODINE,1ML","G0390 - TRAUMA RESPONS W/HOSP CRITI","C1726 - HC CATHETER BALLN LVL 4","Q9963 - HOCM 350-399MG/ML IODINE,1ML","C1722 - HC ICD,1CH, GEN ONLY, RECALL $0","G0390 - TRAUMA RESPONS W/HOSP CRITI","Q9963 - HOCM 350-399MG/ML IODINE,1ML",null,"C1726 - HC CATHETER BALLN LVL 4"]
["AETNA","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",null,null,"Q4132 - HC GRAFIX CORE 5X5CM","G0422 - HC INTENS CARDIAC REHAB W/EXERC","D2331 - RESIN-BASED COMPOSITE - TWO SURFACES, ANTERIOR","D2161 - AMALGAM - FOUR OR MORE SURFACES, PRIMARY OR PERMANENT","D2331 - RESIN-BASED COMPOSITE - TWO SURFACES, ANTERIOR","G0396 - ALCOHOL/SUBS INTERV 15-30MN","C1724 - HC CATH, TRANS ATHEREC BURR","Q9966 - LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML","G0396 - ALCOHOL/SUBS INTERV 15-30MN","C1729 - HC CATH; THORA PARA","Q9966 - LOCM 200-299MG/ML IODINE,1ML","C1724 - HC CATH, TRANS ATHEREC BURR","G0396 - ALCOHOL/SUBS INTERV 15-30MN","Q9966 - LOCM 200-299MG/ML IODINE,1ML",null,"C1729 - HC CATH; THORA PARA"]
["AETNA","Q4196 - HC PURAPLYAM-COM 6X9 CM",null,null,"Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","G0423 - HC INTENS CARDIAC REHAB NO EXER","D2332 - RESIN-BASED COMPOSITE - THREE SURFACES, ANTERIOR","D2330 - RESIN-BASED COMPOSITE - ONE SURFACE, ANTERIOR","D2332 - RESIN-BASED COMPOSITE - THREE SURFACES, ANTERIOR","G0397 - ALCOHOL/SUBS INTERV >30 MIN","C1725 - HC SIZING AMPLATZ BALLOON","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","G0397 - ALCOHOL/SUBS INTERV >30 MIN","C1730 - HC CATH,EP;STEER,DEC(LASSO)","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","C1725 - HC SIZING AMPLATZ BALLOON","G0397 - ALCOHOL/SUBS INTERV >30 MIN","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,"C1730 - HC CATH,EP;STEER,DEC(LASSO)"]
["AETNA","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",null,null,"Q4196 - HC PURAPLYAM-COM 6X9 CM","G0438 - PPPS, INITIAL VISIT","D2335 - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR)","D2331 - RESIN-BASED COMPOSITE - TWO SURFACES, ANTERIOR","D2335 - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR)","G0402 - INITIAL PREVENTIVE EXAM","C1726 - HC CATHETER BALLN LVL 4","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","G0402 - INITIAL PREVENTIVE EXAM","C1731 - HC CATH,EP PENTARAY NAV","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","C1726 - HC CATHETER BALLN LVL 4","G0402 - INITIAL PREVENTIVE EXAM","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",null,"C1731 - HC CATH,EP PENTARAY NAV"]
["AETNA","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",null,null,"Q9956 - HC INJ;OCTAFLUORO MICRO/1ML","G0439 - PPPS, SUBSEQ VISIT","D2390 - RESIN-BASED COMPOSITE CROWN, ANTERIOR","D2332 - RESIN-BASED COMPOSITE - THREE SURFACES, ANTERIOR","D2390 - RESIN-BASED COMPOSITE CROWN, ANTERIOR","G0410 - HC GRP PSYCH PARTIAL HOSP 45-50","C1729 - HC CATH; THORA PARA","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","G0410 - HC GRP PSYCH PARTIAL HOSP 45-50","C1732 - HC CATH,EP DECA NAV","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","C1729 - HC CATH; THORA PARA","G0410 - HC GRP PSYCH PARTIAL HOSP 45-50","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",null,"C1732 - HC CATH,EP DECA NAV"]
["AETNA","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",null,null,"Q9957 - HC INJ;PERFLUTR LIP MIC/1ML","G0442 - ANNUAL ALCOHOL SCREEN 15 MIN","D2391 - RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR","D2335 - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR)","D2391 - RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR","G0416 - HC PROSTATE BIOPSY ANY MTHD","C1730 - HC CATH,EP;STEER,DEC(LASSO)",null,null,null,"G0416 - HC PROSTATE BIOPSY ANY MTHD","C1733 - CATH CRYABL  ARCTIC FRN",null,"C1730 - HC CATH,EP;STEER,DEC(LASSO)","G0416 - HC PROSTATE BIOPSY ANY MTHD",null,null,"C1733 - CATH CRYABL  ARCTIC FRN"]
["AETNA","Q9961 - HOCM 250-299MG/ML IODINE,1ML",null,null,"Q9958 - HOCM <=149 MG/ML IODINE, 1ML","G0443 - BRIEF ALCOHOL MISUSE COUNSEL","D2392 - RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR","D2390 - RESIN-BASED COMPOSITE CROWN, ANTERIOR","D2392 - RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR","G0420 - HC ED SVC CKD IND PER SESSION","C1731 - HC CATH,EP PENTARAY NAV",null,null,null,"G0420 - HC ED SVC CKD IND PER SESSION","C1750 - HC CATH 2 LUMEN QUINTON",null,"C1731 - HC CATH,EP PENTARAY NAV","G0420 - HC ED SVC CKD IND PER SESSION",null,null,"C1750 - HC CATH 2 LUMEN QUINTON"]
["AETNA","Q9963 - HOCM 350-399MG/ML IODINE,1ML",null,null,"Q9961 - HOCM 250-299MG/ML IODINE,1ML","G0444 - DEPRESSION SCREEN ANNUAL","D2393 - RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR","D2391 - RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR","D2393 - RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR","G0421 - HC ED SVC CKD GRP PER SESSION","C1732 - HC CATH,EP DECA NAV",null,null,null,"G0421 - HC ED SVC CKD GRP PER SESSION","C1751 - HC CATH, PACING",null,"C1732 - HC CATH,EP DECA NAV","G0421 - HC ED SVC CKD GRP PER SESSION",null,null,"C1751 - HC CATH, PACING"]
["AETNA","Q9966 - LOCM 200-299MG/ML IODINE,1ML",null,null,"Q9963 - HOCM 350-399MG/ML IODINE,1ML","G0445 - HIGH INTEN BEH COUNS STD 30M","D2394 - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR","D2392 - RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR","D2394 - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR","G0422 - HC INTENS CARDIAC REHAB W/EXERC","C1733 - CATH CRYABL  ARCTIC FRN",null,null,null,"G0422 - HC INTENS CARDIAC REHAB W/EXERC","C1753 - HC BIOPSY FORC LVL D",null,"C1733 - CATH CRYABL  ARCTIC FRN","G0422 - HC INTENS CARDIAC REHAB W/EXERC",null,null,"C1753 - HC BIOPSY FORC LVL D"]
["AETNA","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,null,"Q9966 - LOCM 200-299MG/ML IODINE,1ML","G0446 - INTENS BEHAVE THER CARDIO DX","D2740 - CROWN - PORCELAIN/CERAMIC SUBSTRATE","D2393 - RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR","D2740 - CROWN - PORCELAIN/CERAMIC SUBSTRATE","G0423 - HC INTENS CARDIAC REHAB NO EXER","C1750 - HC CATH 2 LUMEN QUINTON",null,null,null,"G0423 - HC INTENS CARDIAC REHAB NO EXER","C1756 - HC PACING WIRE",null,"C1750 - HC CATH 2 LUMEN QUINTON","G0423 - HC INTENS CARDIAC REHAB NO EXER",null,null,"C1756 - HC PACING WIRE"]
["AETNA","S2083 - HC ADJUSTMENT GASTRIC BAND",null,null,"Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","G0447 - HC BEHAVIOR COUNSEL OBESITY 15M","D2930 - PREFABRICATED STAINLESS STEEL CROWN - PRIMARY TOOTH","D2394 - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR","D2930 - PREFABRICATED STAINLESS STEEL CROWN - PRIMARY TOOTH","G0438 - PPPS, INITIAL VISIT","C1751 - HC CATH, PACING",null,null,null,"G0438 - PPPS, INITIAL VISIT","C1757 - HC CATH,THROMB/EMB,LVL 2",null,"C1751 - HC CATH, PACING","G0438 - PPPS, INITIAL VISIT",null,null,"C1757 - HC CATH,THROMB/EMB,LVL 2"]
["AETNA","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",null,null,"S2083 - HC ADJUSTMENT GASTRIC BAND","G0480 - DRUG TEST DEF 1-7 CLASSES","D2931 - PREFABRICATED STAINLESS STEEL CROWN - PERMANENT TOOTH","D2740 - CROWN - PORCELAIN/CERAMIC SUBSTRATE","D2931 - PREFABRICATED STAINLESS STEEL CROWN - PERMANENT TOOTH","G0439 - PPPS, SUBSEQ VISIT","C1753 - HC BIOPSY FORC LVL D",null,null,null,"G0439 - PPPS, SUBSEQ VISIT","C1759 - HC CATH, ULTRASOUND LVL 2",null,"C1753 - HC BIOPSY FORC LVL D","G0439 - PPPS, SUBSEQ VISIT",null,null,"C1759 - HC CATH, ULTRASOUND LVL 2"]
["AETNA","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",null,null,"U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","G0481 - DRUG TEST DEF 8-14 CLASSES","D2940 - PROTECTIVE RESTORATION","D2930 - PREFABRICATED STAINLESS STEEL CROWN - PRIMARY TOOTH","D2940 - PROTECTIVE RESTORATION","G0442 - ANNUAL ALCOHOL SCREEN 15 MIN","C1756 - HC PACING WIRE",null,null,null,"G0442 - ANNUAL ALCOHOL SCREEN 15 MIN","C1760 - HC CENTRAL LINE KIT",null,"C1756 - HC PACING WIRE","G0442 - ANNUAL ALCOHOL SCREEN 15 MIN",null,null,"C1760 - HC CENTRAL LINE KIT"]
["ALLWAYS HEALTH PARTNERS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",null,null,"U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","G0506 - HC COMP ASSESS CARE PLAN CCM SVC","D3110 - HC PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION)","D2931 - PREFABRICATED STAINLESS STEEL CROWN - PERMANENT TOOTH","D3110 - HC PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION)","G0443 - BRIEF ALCOHOL MISUSE COUNSEL","C1757 - HC CATH,THROMB/EMB,LVL 2",null,null,null,"G0443 - BRIEF ALCOHOL MISUSE COUNSEL","C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN",null,"C1757 - HC CATH,THROMB/EMB,LVL 2","G0443 - BRIEF ALCOHOL MISUSE COUNSEL",null,null,"C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN"]
["ALLWAYS HEALTH PARTNERS","A4215 - STERILE NEEDLE",null,null,null,"G0513 - HC PROLONG PREV SVCS, FIRST 30M","D3220 - THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) - REMOVAL OF PULP CORONAL TO THE DENTINOCEMENTAL JUNCTION AND APPLICATION OF MEDICAMENT","D2940 - PROTECTIVE RESTORATION","D3220 - THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) - REMOVAL OF PULP CORONAL TO THE DENTINOCEMENTAL JUNCTION AND APPLICATION OF MEDICAMENT","G0444 - DEPRESSION SCREEN ANNUAL","C1759 - HC CATH, ULTRASOUND LVL 2",null,null,null,"G0444 - DEPRESSION SCREEN ANNUAL","C1763 - HC SM6X16-STEM HEM",null,"C1759 - HC CATH, ULTRASOUND LVL 2","G0444 - DEPRESSION SCREEN ANNUAL",null,null,"C1763 - HC SM6X16-STEM HEM"]
["ALLWAYS HEALTH PARTNERS","A4467 - BELT STRAP SLEEV GRMNT COVER",null,null,null,"G0514 - HC PROLONG PREV SVCS, ADDL 30M","D3310 - ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION)","D3110 - HC PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION)","D3310 - ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION)","G0445 - HIGH INTEN BEH COUNS STD 30M","C1760 - HC CENTRAL LINE KIT",null,null,null,"G0445 - HIGH INTEN BEH COUNS STD 30M","C1764 - HC RECORDER;IMPLANTABLE LOOP",null,"C1760 - HC CENTRAL LINE KIT","G0445 - HIGH INTEN BEH COUNS STD 30M",null,null,"C1764 - HC RECORDER;IMPLANTABLE LOOP"]
["ALLWAYS HEALTH PARTNERS","A4561 - HC PESSARY RUBBER, ANY TYPE",null,null,null,"G2011 - ALCOHOL/SUB ABUSE ASSESS","D3330 - ENDODONTIC THERAPY, MOLAR (EXCLUDING FINAL RESTORATION)","D3220 - THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) - REMOVAL OF PULP CORONAL TO THE DENTINOCEMENTAL JUNCTION AND APPLICATION OF MEDICAMENT","D3330 - ENDODONTIC THERAPY, MOLAR (EXCLUDING FINAL RESTORATION)","G0446 - INTENS BEHAVE THER CARDIO DX","C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN",null,null,null,"G0446 - INTENS BEHAVE THER CARDIO DX","C1765 - ADHESION BARRIER",null,"C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN","G0446 - INTENS BEHAVE THER CARDIO DX",null,null,"C1765 - ADHESION BARRIER"]
["ALLWAYS HEALTH PARTNERS","A4562 - PESSARY NONRUBBER",null,null,null,"G2012 - HC BRIEF CHECK IN BY MD/QHP","D7140 - EXTRACTION ERUPTED TOOTH/EXR","D3310 - ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION)","D7140 - EXTRACTION ERUPTED TOOTH/EXR","G0447 - HC BEHAVIOR COUNSEL OBESITY 15M","C1763 - HC SM6X16-STEM HEM",null,null,null,"G0447 - HC BEHAVIOR COUNSEL OBESITY 15M","C1766 - SHTH INTRO 65CM 15FR 12FR",null,"C1763 - HC SM6X16-STEM HEM","G0447 - HC BEHAVIOR COUNSEL OBESITY 15M",null,null,"C1766 - SHTH INTRO 65CM 15FR 12FR"]
["ALLWAYS HEALTH PARTNERS","A4570 - HC MISC SPLINT SUPPLY LV1",null,null,null,"G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS","D7210 - EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED","D3330 - ENDODONTIC THERAPY, MOLAR (EXCLUDING FINAL RESTORATION)","D7210 - EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED","G0480 - DRUG TEST DEF 1-7 CLASSES","C1764 - HC RECORDER;IMPLANTABLE LOOP",null,null,null,"G0480 - DRUG TEST DEF 1-7 CLASSES","C1768 - HC TAVR HEART VALVE KIT",null,"C1764 - HC RECORDER;IMPLANTABLE LOOP","G0480 - DRUG TEST DEF 1-7 CLASSES",null,null,"C1768 - HC TAVR HEART VALVE KIT"]
["ALLWAYS HEALTH PARTNERS","A4725 - DIALYS SOL FLD VOL > 4999CC",null,null,null,"G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","D7220 - REMOVAL OF IMPACTED TOOTH - SOFT TISSUE","D7140 - EXTRACTION ERUPTED TOOTH/EXR","D7220 - REMOVAL OF IMPACTED TOOTH - SOFT TISSUE","G0481 - DRUG TEST DEF 8-14 CLASSES","C1765 - ADHESION BARRIER",null,null,null,"G0481 - DRUG TEST DEF 8-14 CLASSES","C1769 - GUIDE WIRE",null,"C1765 - ADHESION BARRIER","G0481 - DRUG TEST DEF 8-14 CLASSES",null,null,"C1769 - GUIDE WIRE"]
["ALLWAYS HEALTH PARTNERS","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",null,null,null,"G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH","D7230 - REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY","D7210 - EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED","D7230 - REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY","G0506 - HC COMP ASSESS CARE PLAN CCM SVC","C1766 - SHTH INTRO 65CM 15FR 12FR",null,null,null,"G0506 - HC COMP ASSESS CARE PLAN CCM SVC","C1770 - IMAGING COIL, MR, INSERTABLE",null,"C1766 - SHTH INTRO 65CM 15FR 12FR","G0506 - HC COMP ASSESS CARE PLAN CCM SVC",null,null,"C1770 - IMAGING COIL, MR, INSERTABLE"]
["ALLWAYS HEALTH PARTNERS","A6258 - TRANSPARENT FILM >16<=48 IN",null,null,null,"G2086 - HC OFF BASE OPIOID TX 70MIN","D7240 - REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY","D7220 - REMOVAL OF IMPACTED TOOTH - SOFT TISSUE","D7240 - REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY","G0513 - HC PROLONG PREV SVCS, FIRST 30M","C1768 - HC TAVR HEART VALVE KIT",null,null,null,"G0513 - HC PROLONG PREV SVCS, FIRST 30M","C1773 - HC GUIDEWIRE LVL E",null,"C1768 - HC TAVR HEART VALVE KIT","G0513 - HC PROLONG PREV SVCS, FIRST 30M",null,null,"C1773 - HC GUIDEWIRE LVL E"]
["ALLWAYS HEALTH PARTNERS","A6549 - G COMPRESSION STOCKING",null,null,null,"G2087 - HC OFF BASE OPIOID TX, 60 M","D7250 - REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)","D7230 - REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY","D7250 - REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)","G0514 - HC PROLONG PREV SVCS, ADDL 30M","C1769 - GUIDE WIRE",null,null,null,"G0514 - HC PROLONG PREV SVCS, ADDL 30M","C1776 - HC HEMI-TIB PLATEAU W MENISC",null,"C1769 - GUIDE WIRE","G0514 - HC PROLONG PREV SVCS, ADDL 30M",null,null,"C1776 - HC HEMI-TIB PLATEAU W MENISC"]
["ALLWAYS HEALTH PARTNERS","A6550 - NEG PRES WOUND THER DRSG SET",null,null,null,"G2088 - HC OFF BASE OPIOID TX, ADD30","D7310 - ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH SPACES, PER QUADRANT","D7240 - REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY","D7310 - ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH SPACES, PER QUADRANT","G2011 - ALCOHOL/SUB ABUSE ASSESS","C1770 - IMAGING COIL, MR, INSERTABLE",null,null,null,"G2011 - ALCOHOL/SUB ABUSE ASSESS","C1777 - HC LEAD,ICD,1COIL",null,"C1770 - IMAGING COIL, MR, INSERTABLE","G2011 - ALCOHOL/SUB ABUSE ASSESS",null,null,"C1777 - HC LEAD,ICD,1COIL"]
["ALLWAYS HEALTH PARTNERS","A7520 - TRACH/LARYN TUBE NON-CUFFED",null,null,null,"G2212 - HC PROLONG OUTPT/OFFICE VIS","D7311 - ALVEOLOPLASTY W/EXTRACT 1-3","D7250 - REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)","D7311 - ALVEOLOPLASTY W/EXTRACT 1-3","G2012 - HC BRIEF CHECK IN BY MD/QHP","C1773 - HC GUIDEWIRE LVL E",null,null,null,"G2012 - HC BRIEF CHECK IN BY MD/QHP","C1781 - MESH (IMPLANTABLE)",null,"C1773 - HC GUIDEWIRE LVL E","G2012 - HC BRIEF CHECK IN BY MD/QHP",null,null,"C1781 - MESH (IMPLANTABLE)"]
["ALLWAYS HEALTH PARTNERS","A9500 - TC99M SESTAMIBI",null,null,null,"G2216 - HC HOME SUPPLY INJECT NALOXON","D7410 - EXCISION OF BENIGN LESION UP TO 1.25 CM","D7310 - ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH SPACES, PER QUADRANT","D7410 - EXCISION OF BENIGN LESION UP TO 1.25 CM","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS","C1776 - HC HEMI-TIB PLATEAU W MENISC",null,null,null,"G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS","C1784 - HC DES PERIPHERAL STENT",null,"C1776 - HC HEMI-TIB PLATEAU W MENISC","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",null,null,"C1784 - HC DES PERIPHERAL STENT"]
["ALLWAYS HEALTH PARTNERS","A9502 - HC TC99M TETROFOSMIN",null,null,null,"J1250 - HC DOBUTAMINE SDV/250MG","G0101 - CA SCREEN;PELVIC/BREAST EXAM","D7311 - ALVEOLOPLASTY W/EXTRACT 1-3","G0101 - CA SCREEN;PELVIC/BREAST EXAM","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","C1777 - HC LEAD,ICD,1COIL",null,null,null,"G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","C1785 - HC PACER;2CH, RECALL $0",null,"C1777 - HC LEAD,ICD,1COIL","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",null,null,"C1785 - HC PACER;2CH, RECALL $0"]
["ALLWAYS HEALTH PARTNERS","A9503 - TC99M MEDRONATE",null,null,null,"L0120 - CERV FLEXIBLE NON-ADJUSTABLE","G0103 - PSA, TOTAL SCREENING","D7410 - EXCISION OF BENIGN LESION UP TO 1.25 CM","G0103 - PSA, TOTAL SCREENING","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH","C1781 - MESH (IMPLANTABLE)",null,null,null,"G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH","C1786 - HC PACER;1CH, RECALL $0",null,"C1781 - MESH (IMPLANTABLE)","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH",null,null,"C1786 - HC PACER;1CH, RECALL $0"]
["ALLWAYS HEALTH PARTNERS","A9505 - THALLIUM CHLORIDE PER MCI",null,null,null,"L0140 - CERVICAL SEMI-RIGID ADJUSTAB","G0105 - HC COLORECTAL SCRN; HI RISK IND","E0191 - PROTECTOR HEEL OR ELBOW","G0105 - HC COLORECTAL SCRN; HI RISK IND","G2086 - HC OFF BASE OPIOID TX 70MIN","C1784 - HC DES PERIPHERAL STENT",null,null,null,"G2086 - HC OFF BASE OPIOID TX 70MIN","C1788 - HC PORTACATH ANY",null,"C1784 - HC DES PERIPHERAL STENT","G2086 - HC OFF BASE OPIOID TX 70MIN",null,null,"C1788 - HC PORTACATH ANY"]
["ALLWAYS HEALTH PARTNERS","A9509 - HC IODINE I-123 PER MCI",null,null,null,"L1820 - KO ELAS W/ CONDYLE PADS & JO","G0108 - DIAB MANAGE TRN  PER INDIV","G0101 - CA SCREEN;PELVIC/BREAST EXAM","G0108 - DIAB MANAGE TRN  PER INDIV","G2087 - HC OFF BASE OPIOID TX, 60 M","C1785 - HC PACER;2CH, RECALL $0",null,null,null,"G2087 - HC OFF BASE OPIOID TX, 60 M","C1817 - HC OCCKYDER;ASD/PFO",null,"C1785 - HC PACER;2CH, RECALL $0","G2087 - HC OFF BASE OPIOID TX, 60 M",null,null,"C1817 - HC OCCKYDER;ASD/PFO"]
["ALLWAYS HEALTH PARTNERS","A9512 - TC99M PERTECHNETATE",null,null,null,"L1830 - KO IMMOBILIZER CANVAS LONGIT","G0109 - DIAB MANAGE TRN IND/GROUP","G0103 - PSA, TOTAL SCREENING","G0109 - DIAB MANAGE TRN IND/GROUP","G2088 - HC OFF BASE OPIOID TX, ADD30","C1786 - HC PACER;1CH, RECALL $0",null,null,null,"G2088 - HC OFF BASE OPIOID TX, ADD30","C1821 - HC INTERSPINOUS IMPLANT",null,"C1786 - HC PACER;1CH, RECALL $0","G2088 - HC OFF BASE OPIOID TX, ADD30",null,null,"C1821 - HC INTERSPINOUS IMPLANT"]
["ALLWAYS HEALTH PARTNERS","A9513 - TECHNETIUM TC-99M MEBROFENIN",null,null,null,"L1832 - KO ADJ JNT POS RIGID SUPPORT","G0127 - TRIM NAIL(S)","G0105 - HC COLORECTAL SCRN; HI RISK IND","G0127 - TRIM NAIL(S)","G2212 - HC PROLONG OUTPT/OFFICE VIS","C1788 - HC PORTACATH ANY",null,null,null,"G2212 - HC PROLONG OUTPT/OFFICE VIS","C1874 - STENT WALLFLEX SYSTEM",null,"C1788 - HC PORTACATH ANY","G2212 - HC PROLONG OUTPT/OFFICE VIS",null,null,"C1874 - STENT WALLFLEX SYSTEM"]
["ALLWAYS HEALTH PARTNERS","A9516 - I123 IODIDE CAP, DX",null,null,null,"L1836 - HC RIGID KO WO JOINTS","G0239 - OTH RESP PROC, GROUP","G0108 - DIAB MANAGE TRN  PER INDIV","G0239 - OTH RESP PROC, GROUP","G2216 - HC HOME SUPPLY INJECT NALOXON","C1817 - HC OCCKYDER;ASD/PFO",null,null,null,"G2216 - HC HOME SUPPLY INJECT NALOXON","C1876 - STENT BILIARY",null,"C1817 - HC OCCKYDER;ASD/PFO","G2216 - HC HOME SUPPLY INJECT NALOXON",null,null,"C1876 - STENT BILIARY"]
["ALLWAYS HEALTH PARTNERS","A9517 - I131 IODIDE CAP, RX",null,null,null,"L1902 - AFO ANKLE GAUNTLET","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP","G0109 - DIAB MANAGE TRN IND/GROUP","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP","J0702 - HC BETAMETHASONE ACET&SOD PHOSP","C1821 - HC INTERSPINOUS IMPLANT",null,null,null,"J0702 - HC BETAMETHASONE ACET&SOD PHOSP","C1880 - IVC FILTERS",null,"C1821 - HC INTERSPINOUS IMPLANT","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",null,null,"C1880 - IVC FILTERS"]
["ALLWAYS HEALTH PARTNERS","A9520 - TECHNETIUMTC-99M SULFUR CLLD",null,null,null,"L3260 - AMBULATORY SURGICAL BOOT EAC","G0260 - INJ FOR SACROILIAC JT ANESTH","G0127 - TRIM NAIL(S)","G0260 - INJ FOR SACROILIAC JT ANESTH","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","C1874 - STENT WALLFLEX SYSTEM",null,null,null,"J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0",null,"C1874 - STENT WALLFLEX SYSTEM","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,null,"C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0"]
["ALLWAYS HEALTH PARTNERS","A9521 - TC99M EXAMETAZIME",null,null,null,"L3350 - SHOE HEEL WEDGE","G0278 - ILIAC ART ANGIO,CARDIAC CATH","G0239 - OTH RESP PROC, GROUP","G0278 - ILIAC ART ANGIO,CARDIAC CATH","J1250 - HC DOBUTAMINE SDV/250MG","C1876 - STENT BILIARY",null,null,null,"J1250 - HC DOBUTAMINE SDV/250MG","C1883 - HC ADAPTOR;BI-VENT PACER",null,"C1876 - STENT BILIARY","J1250 - HC DOBUTAMINE SDV/250MG",null,null,"C1883 - HC ADAPTOR;BI-VENT PACER"]
["ALLWAYS HEALTH PARTNERS","A9537 - TC99M MEBROFENIN",null,null,null,"L3496 - HC STATIC AFO","G0279 - TOMOSYNTHESIS, MAMMO","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP","G0279 - TOMOSYNTHESIS, MAMMO","J2790 - HC IG;RHO D,HUMAN/300MCG","C1880 - IVC FILTERS",null,null,null,"J2790 - HC IG;RHO D,HUMAN/300MCG","C1884 - EMBOLIZATION PROTECT SYST",null,"C1880 - IVC FILTERS","J2790 - HC IG;RHO D,HUMAN/300MCG",null,null,"C1884 - EMBOLIZATION PROTECT SYST"]
["ALLWAYS HEALTH PARTNERS","A9538 - TC99M PYROPHOSPHATE",null,null,null,"L3650 - SHLDER FIG 8 ABDUCT RESTRAIN","G0296 - HC VISIT TO DETERM LDCT ELIG","G0260 - INJ FOR SACROILIAC JT ANESTH","G0296 - HC VISIT TO DETERM LDCT ELIG","J3301 - HC TRIAMCINOLONE ACET INJ NOS","C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0",null,null,null,"J3301 - HC TRIAMCINOLONE ACET INJ NOS","C1887 - HC CATH,EP;R-F,30D THERM RMT",null,"C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0","J3301 - HC TRIAMCINOLONE ACET INJ NOS",null,null,"C1887 - HC CATH,EP;R-F,30D THERM RMT"]
["ALLWAYS HEALTH PARTNERS","A9539 - TC99M PENTETATE",null,null,null,"L3670 - ACROMIO/CLAVICULAR CANVAS&WE","G0297 - HC LDCT FOR LUNG CA SCREEN","G0278 - ILIAC ART ANGIO,CARDIAC CATH","G0297 - HC LDCT FOR LUNG CA SCREEN","L0120 - CERV FLEXIBLE NON-ADJUSTABLE","C1883 - HC ADAPTOR;BI-VENT PACER",null,null,null,"L0120 - CERV FLEXIBLE NON-ADJUSTABLE","C1892 - HC SHEATH;GUIDING",null,"C1883 - HC ADAPTOR;BI-VENT PACER","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",null,null,"C1892 - HC SHEATH;GUIDING"]
["ALLWAYS HEALTH PARTNERS","A9540 - TC99M MAA",null,null,null,"L3760 - EO WITHJOINT, PREFABRICATED","G0390 - TRAUMA RESPONS W/HOSP CRITI","G0279 - TOMOSYNTHESIS, MAMMO","G0390 - TRAUMA RESPONS W/HOSP CRITI","L0140 - CERVICAL SEMI-RIGID ADJUSTAB","C1884 - EMBOLIZATION PROTECT SYST",null,null,null,"L0140 - CERVICAL SEMI-RIGID ADJUSTAB","C1893 - HC DILATOR SHEATH/VISISHEATH",null,"C1884 - EMBOLIZATION PROTECT SYST","L0140 - CERVICAL SEMI-RIGID ADJUSTAB",null,null,"C1893 - HC DILATOR SHEATH/VISISHEATH"]
["ALLWAYS HEALTH PARTNERS","A9541 - TC99M SULFUR COLLOID",null,null,null,"L3762 - RIGID EO WO JOINTS","G0396 - ALCOHOL/SUBS INTERV 15-30MN","G0296 - HC VISIT TO DETERM LDCT ELIG","G0396 - ALCOHOL/SUBS INTERV 15-30MN","L1820 - KO ELAS W/ CONDYLE PADS & JO","C1887 - HC CATH,EP;R-F,30D THERM RMT",null,null,null,"L1820 - KO ELAS W/ CONDYLE PADS & JO","C1894 - HC INTRO/SHEATH NON-CARD LV2",null,"C1887 - HC CATH,EP;R-F,30D THERM RMT","L1820 - KO ELAS W/ CONDYLE PADS & JO",null,null,"C1894 - HC INTRO/SHEATH NON-CARD LV2"]
["ALLWAYS HEALTH PARTNERS","A9543 - Y90 IBRITUMOMAB, RX",null,null,null,"L3807 - WHFO,NO JOINT, PREFABRICATED","G0397 - ALCOHOL/SUBS INTERV >30 MIN","G0297 - HC LDCT FOR LUNG CA SCREEN","G0397 - ALCOHOL/SUBS INTERV >30 MIN","L1830 - KO IMMOBILIZER CANVAS LONGIT","C1892 - HC SHEATH;GUIDING",null,null,null,"L1830 - KO IMMOBILIZER CANVAS LONGIT","C1895 - HC ICD LEAD,2COIL",null,"C1892 - HC SHEATH;GUIDING","L1830 - KO IMMOBILIZER CANVAS LONGIT",null,null,"C1895 - HC ICD LEAD,2COIL"]
["ALLWAYS HEALTH PARTNERS","A9547 - IN111 OXYQUINOLINE",null,null,null,"L3808 - HC EPITRAIN","G0416 - HC PROSTATE BIOPSY ANY MTHD","G0390 - TRAUMA RESPONS W/HOSP CRITI","G0416 - HC PROSTATE BIOPSY ANY MTHD","L1832 - KO ADJ JNT POS RIGID SUPPORT","C1893 - HC DILATOR SHEATH/VISISHEATH",null,null,null,"L1832 - KO ADJ JNT POS RIGID SUPPORT","C1896 - HC SICD PULSE GENERATOR",null,"C1893 - HC DILATOR SHEATH/VISISHEATH","L1832 - KO ADJ JNT POS RIGID SUPPORT",null,null,"C1896 - HC SICD PULSE GENERATOR"]
["ALLWAYS HEALTH PARTNERS","A9551 - HC TC99M SUCCIMER/10MCI,DX",null,null,null,"L3905 - HC WHO W/NONTORSION JNT(S) CF","G0422 - HC INTENS CARDIAC REHAB W/EXERC","G0396 - ALCOHOL/SUBS INTERV 15-30MN","G0422 - HC INTENS CARDIAC REHAB W/EXERC","L1836 - HC RIGID KO WO JOINTS","C1894 - HC INTRO/SHEATH NON-CARD LV2",null,null,null,"L1836 - HC RIGID KO WO JOINTS","C1898 - HC KIT,PACER;BI-VENT(#6216/8",null,"C1894 - HC INTRO/SHEATH NON-CARD LV2","L1836 - HC RIGID KO WO JOINTS",null,null,"C1898 - HC KIT,PACER;BI-VENT(#6216/8"]
["ALLWAYS HEALTH PARTNERS","A9552 - F18 FDG",null,null,null,"L3908 - WRIST COCK-UP NON-MOLDED","G0423 - HC INTENS CARDIAC REHAB NO EXER","G0397 - ALCOHOL/SUBS INTERV >30 MIN","G0423 - HC INTENS CARDIAC REHAB NO EXER","L1902 - AFO ANKLE GAUNTLET","C1895 - HC ICD LEAD,2COIL",null,null,null,"L1902 - AFO ANKLE GAUNTLET","C1900 - HC INJ;OCTAFLUORO MICRO/1ML",null,"C1895 - HC ICD LEAD,2COIL","L1902 - AFO ANKLE GAUNTLET",null,null,"C1900 - HC INJ;OCTAFLUORO MICRO/1ML"]
["ALLWAYS HEALTH PARTNERS","A9555 - RADIOPHARMACIAL",null,null,null,"L3967 - HC SEWHO AIRPLANE W/O JNTS CF","G0424 - PULMONARY REHAB W EXER","G0416 - HC PROSTATE BIOPSY ANY MTHD","G0424 - PULMONARY REHAB W EXER","L3260 - AMBULATORY SURGICAL BOOT EAC","C1896 - HC SICD PULSE GENERATOR",null,null,null,"L3260 - AMBULATORY SURGICAL BOOT EAC","C2615 - SEALANT, PULMONARY, LIQUID",null,"C1896 - HC SICD PULSE GENERATOR","L3260 - AMBULATORY SURGICAL BOOT EAC",null,null,"C2615 - SEALANT, PULMONARY, LIQUID"]
["ALLWAYS HEALTH PARTNERS","A9556 - GA67 GALLIUM",null,null,null,"L3980 - HC UPP EXT FX ORTHOSIS HUMERAL","G0480 - DRUG TEST DEF 1-7 CLASSES","G0422 - HC INTENS CARDIAC REHAB W/EXERC","G0442 - ANNUAL ALCOHOL SCREEN 15 MIN","L3350 - SHOE HEEL WEDGE","C1898 - HC KIT,PACER;BI-VENT(#6216/8",null,null,null,"L3350 - SHOE HEEL WEDGE","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE",null,"C1898 - HC KIT,PACER;BI-VENT(#6216/8","L3350 - SHOE HEEL WEDGE",null,null,"C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE"]
["ALLWAYS HEALTH PARTNERS","A9557 - TC99M BICISATE",null,null,null,"L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL","G0481 - DRUG TEST DEF 8-14 CLASSES","G0423 - HC INTENS CARDIAC REHAB NO EXER","G0443 - BRIEF ALCOHOL MISUSE COUNSEL","L3496 - HC STATIC AFO","C1900 - HC INJ;OCTAFLUORO MICRO/1ML",null,null,null,"L3496 - HC STATIC AFO","C2617 - STENT ZIMMON BILIARY",null,"C1900 - HC INJ;OCTAFLUORO MICRO/1ML","L3496 - HC STATIC AFO",null,null,"C2617 - STENT ZIMMON BILIARY"]
["ALLWAYS HEALTH PARTNERS","A9558 - HC XENON133/10MCI",null,null,null,"L4350 - ANKLE CONTROL ORTHOSI PREFAB","G0506 - HC COMP ASSESS CARE PLAN CCM SVC","G0424 - PULMONARY REHAB W EXER","G0480 - DRUG TEST DEF 1-7 CLASSES","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN","C2615 - SEALANT, PULMONARY, LIQUID",null,null,null,"L3650 - SHLDER FIG 8 ABDUCT RESTRAIN","C2621 - HC PACER;2CH, W/ BACKUP DEFIB",null,"C2615 - SEALANT, PULMONARY, LIQUID","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",null,null,"C2621 - HC PACER;2CH, W/ BACKUP DEFIB"]
["ALLWAYS HEALTH PARTNERS","A9560 - TC99M LABELED RBC",null,null,null,"L4360 - PNEUMATI WALKING BOOT PREFAB","G0513 - HC PROLONG PREV SVCS, FIRST 30M","G0480 - DRUG TEST DEF 1-7 CLASSES","G0481 - DRUG TEST DEF 8-14 CLASSES","L3670 - ACROMIO/CLAVICULAR CANVAS&WE","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE",null,null,null,"L3670 - ACROMIO/CLAVICULAR CANVAS&WE","C2623 - CATH TRANSLUMIN DRUG-COAT",null,"C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",null,null,"C2623 - CATH TRANSLUMIN DRUG-COAT"]
["ALLWAYS HEALTH PARTNERS","A9561 - TC99M OXIDRONATE",null,null,null,"L4370 - HC PNEUMATIC FULL LEG SPLINT","G0514 - HC PROLONG PREV SVCS, ADDL 30M","G0481 - DRUG TEST DEF 8-14 CLASSES","G0506 - HC COMP ASSESS CARE PLAN CCM SVC","L3760 - EO WITHJOINT, PREFABRICATED","C2617 - STENT ZIMMON BILIARY",null,null,null,"L3760 - EO WITHJOINT, PREFABRICATED","C2625 - STENT BILIARY COTTON",null,"C2617 - STENT ZIMMON BILIARY","L3760 - EO WITHJOINT, PREFABRICATED",null,null,"C2625 - STENT BILIARY COTTON"]
["ALLWAYS HEALTH PARTNERS","A9562 - TC99M MERTIATIDE",null,null,null,"L4386 - NON-PNEUM WALK BOOT PREFAB","G2011 - ALCOHOL/SUB ABUSE ASSESS","G0506 - HC COMP ASSESS CARE PLAN CCM SVC","G0513 - HC PROLONG PREV SVCS, FIRST 30M","L3762 - RIGID EO WO JOINTS","C2621 - HC PACER;2CH, W/ BACKUP DEFIB",null,null,null,"L3762 - RIGID EO WO JOINTS","C2628 - HC KIT CATH BRIDGE PRE",null,"C2621 - HC PACER;2CH, W/ BACKUP DEFIB","L3762 - RIGID EO WO JOINTS",null,null,"C2628 - HC KIT CATH BRIDGE PRE"]
["ALLWAYS HEALTH PARTNERS","A9563 - P32 NA PHOSPHATE",null,null,null,"L4396 - STATIC AFO","G2012 - HC BRIEF CHECK IN BY MD/QHP","G0513 - HC PROLONG PREV SVCS, FIRST 30M","G0514 - HC PROLONG PREV SVCS, ADDL 30M","L3807 - WHFO,NO JOINT, PREFABRICATED","C2623 - CATH TRANSLUMIN DRUG-COAT",null,null,null,"L3807 - WHFO,NO JOINT, PREFABRICATED","C2630 - HC CATH;EP CRYOABLATION, 8 MM",null,"C2623 - CATH TRANSLUMIN DRUG-COAT","L3807 - WHFO,NO JOINT, PREFABRICATED",null,null,"C2630 - HC CATH;EP CRYOABLATION, 8 MM"]
["ALLWAYS HEALTH PARTNERS","A9569 - TECHNETIUM TC-99M AUTO WBC",null,null,null,"L4398 - HC FOOT DROP SPLINT RECUMBENT","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS","G0514 - HC PROLONG PREV SVCS, ADDL 30M","G2011 - ALCOHOL/SUB ABUSE ASSESS","L3808 - HC EPITRAIN","C2625 - STENT BILIARY COTTON",null,null,null,"L3808 - HC EPITRAIN","C2634 - BRACHYTX, NON-STR, HA, I-125",null,"C2625 - STENT BILIARY COTTON","L3808 - HC EPITRAIN",null,null,"C2634 - BRACHYTX, NON-STR, HA, I-125"]
["ALLWAYS HEALTH PARTNERS","A9570 - HC INDIUM IN-111 AUTO WBC",null,null,null,"L8501 - TRACHEOSTOMY SPEAKING VALVE","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2011 - ALCOHOL/SUB ABUSE ASSESS","G2012 - HC BRIEF CHECK IN BY MD/QHP","L3905 - HC WHO W/NONTORSION JNT(S) CF","C2628 - HC KIT CATH BRIDGE PRE",null,null,null,"L3905 - HC WHO W/NONTORSION JNT(S) CF","C2635 - BRACHYTX, NON-STR, HA, P-103",null,"C2628 - HC KIT CATH BRIDGE PRE","L3905 - HC WHO W/NONTORSION JNT(S) CF",null,null,"C2635 - BRACHYTX, NON-STR, HA, P-103"]
["ALLWAYS HEALTH PARTNERS","A9572 - INDIUM IN-111 PENTETREOTIDE",null,null,null,"L8507 - HC PROLARYNX VOICE (PLUS)","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH","G2012 - HC BRIEF CHECK IN BY MD/QHP","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS","L3908 - WRIST COCK-UP NON-MOLDED","C2630 - HC CATH;EP CRYOABLATION, 8 MM",null,null,null,"L3908 - WRIST COCK-UP NON-MOLDED","C2639 - BRACHYTX, NON-STRANDED,I-125",null,"C2630 - HC CATH;EP CRYOABLATION, 8 MM","L3908 - WRIST COCK-UP NON-MOLDED",null,null,"C2639 - BRACHYTX, NON-STRANDED,I-125"]
["ALLWAYS HEALTH PARTNERS","A9580 - HC NA FLUORIDE F-18, DOSE",null,null,null,"L8509 - TRACH-ESOPH VOICE PROS MD IN","G2086 - HC OFF BASE OPIOID TX 70MIN","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","L3967 - HC SEWHO AIRPLANE W/O JNTS CF","C2634 - BRACHYTX, NON-STR, HA, I-125",null,null,null,"L3967 - HC SEWHO AIRPLANE W/O JNTS CF","C5275 - HC LOW COST SKIN SUBSTITUTE",null,"C2634 - BRACHYTX, NON-STR, HA, I-125","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",null,null,"C5275 - HC LOW COST SKIN SUBSTITUTE"]
["ALLWAYS HEALTH PARTNERS","A9582 - IODINE I-123 IOBENGUANE",null,null,null,"L8514 - REPL TRACH PUNCTURE DILATOR","G2087 - HC OFF BASE OPIOID TX, 60 M","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL","C2635 - BRACHYTX, NON-STR, HA, P-103",null,null,null,"L3980 - HC UPP EXT FX ORTHOSIS HUMERAL","C8908 - HC MRI W/O FOL W/CONT, BREAST,",null,"C2635 - BRACHYTX, NON-STR, HA, P-103","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",null,null,"C8908 - HC MRI W/O FOL W/CONT, BREAST,"]
["ALLWAYS HEALTH PARTNERS","A9583 - GADOFOSVESET TRISODIUM INJ",null,null,null,"L8693 - HC AUD OSSEO DEV, ABUTMENT","G2088 - HC OFF BASE OPIOID TX, ADD30","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH","G2086 - HC OFF BASE OPIOID TX 70MIN","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL","C2639 - BRACHYTX, NON-STRANDED,I-125",null,null,null,"L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL","C8937 - CAD BREAST MRI",null,"C2639 - BRACHYTX, NON-STRANDED,I-125","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",null,null,"C8937 - CAD BREAST MRI"]
["ALLWAYS HEALTH PARTNERS","A9584 - IODINE I-123 IOFLUPANE",null,null,null,"L8699 - HC CARTIFORM 20 X 25 MM DISC","J0702 - HC BETAMETHASONE ACET&SOD PHOSP","G2086 - HC OFF BASE OPIOID TX 70MIN","G2087 - HC OFF BASE OPIOID TX, 60 M","L4350 - ANKLE CONTROL ORTHOSI PREFAB","C5275 - HC LOW COST SKIN SUBSTITUTE",null,null,null,"L4350 - ANKLE CONTROL ORTHOSI PREFAB","C9358 - SURGIMEND, FETAL",null,"C5275 - HC LOW COST SKIN SUBSTITUTE","L4350 - ANKLE CONTROL ORTHOSI PREFAB",null,null,"C9358 - SURGIMEND, FETAL"]
["ALLWAYS HEALTH PARTNERS","A9587 - GALLIUM GA-68",null,null,null,"M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","G2087 - HC OFF BASE OPIOID TX, 60 M","G2088 - HC OFF BASE OPIOID TX, ADD30","L4360 - PNEUMATI WALKING BOOT PREFAB","C8908 - HC MRI W/O FOL W/CONT, BREAST,",null,null,null,"L4360 - PNEUMATI WALKING BOOT PREFAB","C9728 - PLACE DEVICE/MARKER, NON PRO",null,"C8908 - HC MRI W/O FOL W/CONT, BREAST,","L4360 - PNEUMATI WALKING BOOT PREFAB",null,null,"C9728 - PLACE DEVICE/MARKER, NON PRO"]
["ALLWAYS HEALTH PARTNERS","A9588 - FLUCICLOVINE F-18",null,null,null,"M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","J1250 - HC DOBUTAMINE SDV/250MG","G2088 - HC OFF BASE OPIOID TX, ADD30","J0702 - HC BETAMETHASONE ACET&SOD PHOSP","L4370 - HC PNEUMATIC FULL LEG SPLINT","C8937 - CAD BREAST MRI",null,null,null,"L4370 - HC PNEUMATIC FULL LEG SPLINT","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3",null,"C8937 - CAD BREAST MRI","L4370 - HC PNEUMATIC FULL LEG SPLINT",null,null,"C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3"]
["ALLWAYS HEALTH PARTNERS","A9592 - HC COPPER CU 64 DOTATATE DIAG",null,null,null,"P9612 - CATHETERIZE FOR URINE SPEC","J2790 - HC IG;RHO D,HUMAN/300MCG","J0702 - HC BETAMETHASONE ACET&SOD PHOSP","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","L4386 - NON-PNEUM WALK BOOT PREFAB","C9358 - SURGIMEND, FETAL",null,null,null,"L4386 - NON-PNEUM WALK BOOT PREFAB","E0191 - PROTECTOR HEEL OR ELBOW",null,"C9358 - SURGIMEND, FETAL","L4386 - NON-PNEUM WALK BOOT PREFAB",null,null,"G0103 - PSA, TOTAL SCREENING"]
["ALLWAYS HEALTH PARTNERS","G0101 - CA SCREEN;PELVIC/BREAST EXAM",null,null,null,"Q0091 - HC OBTAINING SCREEN PAP SMEAR","J3301 - HC TRIAMCINOLONE ACET INJ NOS","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)","J1250 - HC DOBUTAMINE SDV/250MG","L4396 - STATIC AFO","C9728 - PLACE DEVICE/MARKER, NON PRO",null,null,null,"L4396 - STATIC AFO","G0103 - PSA, TOTAL SCREENING",null,"C9728 - PLACE DEVICE/MARKER, NON PRO","L4396 - STATIC AFO",null,null,"G0105 - HC COLORECTAL SCRN; HI RISK IND"]
["ALLWAYS HEALTH PARTNERS","G0103 - PSA, TOTAL SCREENING",null,null,null,"Q0111 - HC WET MOUNTS W PREPARATIONS","J7307 - HC ETONOGESTREL IMPLANT SYSTEM","J1250 - HC DOBUTAMINE SDV/250MG","J2790 - HC IG;RHO D,HUMAN/300MCG","L4398 - HC FOOT DROP SPLINT RECUMBENT","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3",null,null,null,"L4398 - HC FOOT DROP SPLINT RECUMBENT","G0105 - HC COLORECTAL SCRN; HI RISK IND",null,"C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3","L4398 - HC FOOT DROP SPLINT RECUMBENT",null,null,"G0108 - DIAB MANAGE TRN  PER INDIV"]
["ALLWAYS HEALTH PARTNERS","G0127 - TRIM NAIL(S)",null,null,null,"Q0114 - HC  FERN TEST","L0120 - CERV FLEXIBLE NON-ADJUSTABLE","J2790 - HC IG;RHO D,HUMAN/300MCG","J3301 - HC TRIAMCINOLONE ACET INJ NOS","L8501 - TRACHEOSTOMY SPEAKING VALVE","C9803 - HC OP VISIT SPEC COLLECTION SEVERE ACUTE RESP SYDROM COVID-19",null,null,null,"L8501 - TRACHEOSTOMY SPEAKING VALVE","G0108 - DIAB MANAGE TRN  PER INDIV",null,"C9803 - HC OP VISIT SPEC COLLECTION SEVERE ACUTE RESP SYDROM COVID-19","L8501 - TRACHEOSTOMY SPEAKING VALVE",null,null,"G0109 - DIAB MANAGE TRN IND/GROUP"]
["ALLWAYS HEALTH PARTNERS","G0175 - OPPS SERVICE,SCHED TEAM CONF",null,null,null,"Q0249 - HC TOCILIZUMAB FOR COVID-19","L1820 - KO ELAS W/ CONDYLE PADS & JO","J3301 - HC TRIAMCINOLONE ACET INJ NOS","J7307 - HC ETONOGESTREL IMPLANT SYSTEM","L8507 - HC PROLARYNX VOICE (PLUS)","D0150 - COMPREHENSIVE ORAL EXAM 60MIN",null,null,null,"L8507 - HC PROLARYNX VOICE (PLUS)","G0109 - DIAB MANAGE TRN IND/GROUP",null,"D0150 - COMPREHENSIVE ORAL EXAM 60MIN","L8507 - HC PROLARYNX VOICE (PLUS)",null,null,"G0127 - TRIM NAIL(S)"]
["ALLWAYS HEALTH PARTNERS","G0239 - OTH RESP PROC, GROUP",null,null,null,"Q3014 - HC TELEHEALTH FACILITY FEE","L1830 - KO IMMOBILIZER CANVAS LONGIT","J7307 - HC ETONOGESTREL IMPLANT SYSTEM","L0120 - CERV FLEXIBLE NON-ADJUSTABLE","L8509 - TRACH-ESOPH VOICE PROS MD IN","D0240 - INTRAORAL - OCCLUSAL RADIOGRAPHIC IMAGE",null,null,null,"L8509 - TRACH-ESOPH VOICE PROS MD IN","G0127 - TRIM NAIL(S)",null,"D0240 - INTRAORAL - OCCLUSAL RADIOGRAPHIC IMAGE","L8509 - TRACH-ESOPH VOICE PROS MD IN",null,null,"G0239 - OTH RESP PROC, GROUP"]
["ALLWAYS HEALTH PARTNERS","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP",null,null,null,"Q4116 - HC ALLODERM 8 X 16 MEDIUM","L1832 - KO ADJ JNT POS RIGID SUPPORT","L0120 - CERV FLEXIBLE NON-ADJUSTABLE","L1820 - KO ELAS W/ CONDYLE PADS & JO","L8514 - REPL TRACH PUNCTURE DILATOR","D0250 - HC EXTRA-ORAL - 2D PROJECTION RAD IMAGE CREATED USING A STATIONARY RADIATION SOURCE, AND DETECTOR",null,null,null,"L8514 - REPL TRACH PUNCTURE DILATOR","G0239 - OTH RESP PROC, GROUP",null,"D0250 - HC EXTRA-ORAL - 2D PROJECTION RAD IMAGE CREATED USING A STATIONARY RADIATION SOURCE, AND DETECTOR","L8514 - REPL TRACH PUNCTURE DILATOR",null,null,"G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP"]
["ALLWAYS HEALTH PARTNERS","G0259 - HC INJECT FOR SACROILIAC JOINT",null,null,null,"Q4124 - OASIS TRILAYER/1 SQCM","L1836 - HC RIGID KO WO JOINTS","L0140 - CERVICAL SEMI-RIGID ADJUSTAB","L1830 - KO IMMOBILIZER CANVAS LONGIT","L8693 - HC AUD OSSEO DEV, ABUTMENT","D0251 - HC EXTRA-ORAL POSTERIOR DENTAL RADIOGRAPHIC IMAGE",null,null,null,"L8693 - HC AUD OSSEO DEV, ABUTMENT","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP",null,"D0251 - HC EXTRA-ORAL POSTERIOR DENTAL RADIOGRAPHIC IMAGE","L8693 - HC AUD OSSEO DEV, ABUTMENT",null,null,"G0259 - HC INJECT FOR SACROILIAC JOINT"]
["ALLWAYS HEALTH PARTNERS","G0260 - INJ FOR SACROILIAC JT ANESTH",null,null,null,"Q4125 - HC AFLEX401 ¿ 40 X 70 MM","L1902 - AFO ANKLE GAUNTLET","L1820 - KO ELAS W/ CONDYLE PADS & JO","L1832 - KO ADJ JNT POS RIGID SUPPORT","L8699 - HC CARTIFORM 20 X 25 MM DISC","D0270 - BITEWING - SINGLE RADIOGRAPHIC IMAGE",null,null,null,"L8699 - HC CARTIFORM 20 X 25 MM DISC","G0259 - HC INJECT FOR SACROILIAC JOINT",null,"D0270 - BITEWING - SINGLE RADIOGRAPHIC IMAGE","L8699 - HC CARTIFORM 20 X 25 MM DISC",null,null,"G0260 - INJ FOR SACROILIAC JT ANESTH"]
["ALLWAYS HEALTH PARTNERS","G0269 - HC CLOSURE DEVICE PLACEMENT",null,null,null,"Q4130 - PR STRATTICE TM","L3260 - AMBULATORY SURGICAL BOOT EAC","L1830 - KO IMMOBILIZER CANVAS LONGIT","L1836 - HC RIGID KO WO JOINTS","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","D0272 - BITEWINGS - TWO RADIOGRAPHIC IMAGES",null,null,null,"M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","G0260 - INJ FOR SACROILIAC JT ANESTH",null,"D0272 - BITEWINGS - TWO RADIOGRAPHIC IMAGES","P9045 - HC ALBUMIN (HUMAN) 5% 250ML",null,null,"G0269 - HC CLOSURE DEVICE PLACEMENT"]
["ALLWAYS HEALTH PARTNERS","G0278 - ILIAC ART ANGIO,CARDIAC CATH",null,null,null,"Q4196 - HC PURAPLYAM-COM 6X9 CM","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN","L1832 - KO ADJ JNT POS RIGID SUPPORT","L1902 - AFO ANKLE GAUNTLET","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","D0274 - BITEWINGS - FOUR RADIOGRAPHIC IMAGES",null,null,null,"M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","G0269 - HC CLOSURE DEVICE PLACEMENT",null,"D0274 - BITEWINGS - FOUR RADIOGRAPHIC IMAGES","P9047 - HC ALBUMIN (HUMAN) 25% 50ML",null,null,"G0270 - MNT SUBS TX FOR CHANGE DX"]
["ALLWAYS HEALTH PARTNERS","G0296 - HC VISIT TO DETERM LDCT ELIG",null,null,null,"Q9954 - ORAL MR CONTRAST, 100 ML","L3670 - ACROMIO/CLAVICULAR CANVAS&WE","L1836 - HC RIGID KO WO JOINTS","L3260 - AMBULATORY SURGICAL BOOT EAC","P9045 - HC ALBUMIN (HUMAN) 5% 250ML","D0277 - HC VERTICAL BITEWINGS - 7 TO 8 RADIOGRAPHIC IMAGES",null,null,null,"P9045 - HC ALBUMIN (HUMAN) 5% 250ML","G0270 - MNT SUBS TX FOR CHANGE DX",null,"D0277 - HC VERTICAL BITEWINGS - 7 TO 8 RADIOGRAPHIC IMAGES","P9612 - CATHETERIZE FOR URINE SPEC",null,null,"G0278 - ILIAC ART ANGIO,CARDIAC CATH"]
["ALLWAYS HEALTH PARTNERS","G0297 - HC LDCT FOR LUNG CA SCREEN",null,null,null,"Q9956 - HC INJ;OCTAFLUORO MICRO/1ML","L3760 - EO WITHJOINT, PREFABRICATED","L1902 - AFO ANKLE GAUNTLET","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN","P9047 - HC ALBUMIN (HUMAN) 25% 50ML","D0472 - HC ACCESSION OF TISSUE, GROSS EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN REPORT",null,null,null,"P9047 - HC ALBUMIN (HUMAN) 25% 50ML","G0278 - ILIAC ART ANGIO,CARDIAC CATH",null,"D0472 - HC ACCESSION OF TISSUE, GROSS EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN REPORT","Q0091 - HC OBTAINING SCREEN PAP SMEAR",null,null,"G0279 - TOMOSYNTHESIS, MAMMO"]
["ALLWAYS HEALTH PARTNERS","G0365 - HC VESSEL MAPPING HEMO ACCESS",null,null,null,"Q9957 - HC INJ;PERFLUTR LIP MIC/1ML","L3807 - WHFO,NO JOINT, PREFABRICATED","L3260 - AMBULATORY SURGICAL BOOT EAC","L3670 - ACROMIO/CLAVICULAR CANVAS&WE","P9612 - CATHETERIZE FOR URINE SPEC","D0473 - HC ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAM, PREP AND TRANS OF RPT.",null,null,null,"P9612 - CATHETERIZE FOR URINE SPEC","G0279 - TOMOSYNTHESIS, MAMMO",null,"D0473 - HC ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAM, PREP AND TRANS OF RPT.","Q0111 - HC WET MOUNTS W PREPARATIONS",null,null,"G0297 - HC LDCT FOR LUNG CA SCREEN"]
["ALLWAYS HEALTH PARTNERS","G0389 - ULTRASOUND EXAM AAA SCREEN",null,null,null,"Q9958 - HOCM <=149 MG/ML IODINE, 1ML","L3808 - HC EPITRAIN","L3350 - SHOE HEEL WEDGE","L3760 - EO WITHJOINT, PREFABRICATED","Q0091 - HC OBTAINING SCREEN PAP SMEAR","D0474 - HC ACCESSION OF TISSUE, GROSS AND MICRO EXAM, INCL. ASSESS. OF MARGINS FOR DISEASE, PREP., TX OF RPT",null,null,null,"Q0091 - HC OBTAINING SCREEN PAP SMEAR","G0297 - HC LDCT FOR LUNG CA SCREEN",null,"D0474 - HC ACCESSION OF TISSUE, GROSS AND MICRO EXAM, INCL. ASSESS. OF MARGINS FOR DISEASE, PREP., TX OF RPT","Q0114 - HC  FERN TEST",null,null,"G0390 - TRAUMA RESPONS W/HOSP CRITI"]
["ALLWAYS HEALTH PARTNERS","G0390 - TRAUMA RESPONS W/HOSP CRITI",null,null,null,"Q9961 - HOCM 250-299MG/ML IODINE,1ML","L3905 - HC WHO W/NONTORSION JNT(S) CF","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN","L3807 - WHFO,NO JOINT, PREFABRICATED","Q0111 - HC WET MOUNTS W PREPARATIONS","D0480 - HC ACCESSION OF EXFOLIATIVE CYTOLOGIC SMEARS, MICROSCOPIC EXAM, PREP AND TRANS OF RPT",null,null,null,"Q0111 - HC WET MOUNTS W PREPARATIONS","G0390 - TRAUMA RESPONS W/HOSP CRITI",null,"D0480 - HC ACCESSION OF EXFOLIATIVE CYTOLOGIC SMEARS, MICROSCOPIC EXAM, PREP AND TRANS OF RPT","Q0249 - HC TOCILIZUMAB FOR COVID-19",null,null,"G0416 - HC PROSTATE BIOPSY ANY MTHD"]
["ALLWAYS HEALTH PARTNERS","G0396 - ALCOHOL/SUBS INTERV 15-30MN",null,null,null,"Q9963 - HOCM 350-399MG/ML IODINE,1ML","L3908 - WRIST COCK-UP NON-MOLDED","L3670 - ACROMIO/CLAVICULAR CANVAS&WE","L3808 - HC EPITRAIN","Q0114 - HC  FERN TEST","D1110 - PROPHYLAXIS - ADULT",null,null,null,"Q0114 - HC  FERN TEST","G0416 - HC PROSTATE BIOPSY ANY MTHD",null,"D1110 - PROPHYLAXIS - ADULT","Q3014 - HC TELEHEALTH FACILITY FEE",null,null,"G0422 - HC INTENS CARDIAC REHAB W/EXERC"]
["ALLWAYS HEALTH PARTNERS","G0397 - ALCOHOL/SUBS INTERV >30 MIN",null,null,null,"Q9966 - LOCM 200-299MG/ML IODINE,1ML","L3967 - HC SEWHO AIRPLANE W/O JNTS CF","L3760 - EO WITHJOINT, PREFABRICATED","L3905 - HC WHO W/NONTORSION JNT(S) CF","Q0249 - HC TOCILIZUMAB FOR COVID-19","D1510 - SPACE MAINTAINER - FIXED - UNILATERAL",null,null,null,"Q0249 - HC TOCILIZUMAB FOR COVID-19","G0422 - HC INTENS CARDIAC REHAB W/EXERC",null,"D1510 - SPACE MAINTAINER - FIXED - UNILATERAL","Q4101 - APLIGRAF",null,null,"G0423 - HC INTENS CARDIAC REHAB NO EXER"]
["ALLWAYS HEALTH PARTNERS","G0402 - INITIAL PREVENTIVE EXAM",null,null,null,"Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL","L3762 - RIGID EO WO JOINTS","L3908 - WRIST COCK-UP NON-MOLDED","Q3014 - HC TELEHEALTH FACILITY FEE","D1516 - SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MAXILLARY",null,null,null,"Q3014 - HC TELEHEALTH FACILITY FEE","G0423 - HC INTENS CARDIAC REHAB NO EXER",null,"D1516 - SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MAXILLARY","Q4102 - OASIS WOUND MATRIX",null,null,"G0424 - PULMONARY REHAB W EXER"]
["ALLWAYS HEALTH PARTNERS","G0410 - HC GRP PSYCH PARTIAL HOSP 45-50",null,null,null,"Q9987 - HC PATHOGEN TEST PLATELETS","L4350 - ANKLE CONTROL ORTHOSI PREFAB","L3807 - WHFO,NO JOINT, PREFABRICATED","L3967 - HC SEWHO AIRPLANE W/O JNTS CF","Q4101 - APLIGRAF","D1517 - SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MANDIBULAR",null,null,null,"Q4101 - APLIGRAF","G0424 - PULMONARY REHAB W EXER",null,"D1517 - SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MANDIBULAR","Q4116 - HC ALLODERM 8 X 16 MEDIUM",null,null,"G0480 - DRUG TEST DEF 1-7 CLASSES"]
["ALLWAYS HEALTH PARTNERS","G0416 - HC PROSTATE BIOPSY ANY MTHD",null,null,null,"S5100 - ADULT DAYCARE SERVICES 15MIN","L4360 - PNEUMATI WALKING BOOT PREFAB","L3808 - HC EPITRAIN","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL","Q4102 - OASIS WOUND MATRIX","D1575 - HC DISTAL SHOE SPACE MAINTAINER ¿ FIXED ¿ UNILATERAL",null,null,null,"Q4102 - OASIS WOUND MATRIX","G0480 - DRUG TEST DEF 1-7 CLASSES",null,"D1575 - HC DISTAL SHOE SPACE MAINTAINER ¿ FIXED ¿ UNILATERAL","Q4124 - OASIS TRILAYER/1 SQCM",null,null,"G0481 - DRUG TEST DEF 8-14 CLASSES"]
["ALLWAYS HEALTH PARTNERS","G0420 - HC ED SVC CKD IND PER SESSION",null,null,null,"S5101 - HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)","L4386 - NON-PNEUM WALK BOOT PREFAB","L3905 - HC WHO W/NONTORSION JNT(S) CF","L4350 - ANKLE CONTROL ORTHOSI PREFAB","Q4116 - HC ALLODERM 8 X 16 MEDIUM","D2999 - HC UNSPECIFIED RESTORATIVE PROCEDURE, BY REPORT",null,null,null,"Q4116 - HC ALLODERM 8 X 16 MEDIUM","G0481 - DRUG TEST DEF 8-14 CLASSES",null,"D2999 - HC UNSPECIFIED RESTORATIVE PROCEDURE, BY REPORT","Q4125 - HC AFLEX401 ¿ 40 X 70 MM",null,null,"G0506 - HC COMP ASSESS CARE PLAN CCM SVC"]
["ALLWAYS HEALTH PARTNERS","G0421 - HC ED SVC CKD GRP PER SESSION",null,null,null,"S5102 - HC ADULT DAY HEALTH - COMPLEX PER DIEM","L4396 - STATIC AFO","L3908 - WRIST COCK-UP NON-MOLDED","L4360 - PNEUMATI WALKING BOOT PREFAB","Q4124 - OASIS TRILAYER/1 SQCM","D3460 - HC ENDODONTIC ENDOSSEOUS IMPLANT",null,null,null,"Q4124 - OASIS TRILAYER/1 SQCM","G0506 - HC COMP ASSESS CARE PLAN CCM SVC",null,"D3460 - HC ENDODONTIC ENDOSSEOUS IMPLANT","Q4130 - PR STRATTICE TM",null,null,"G0513 - HC PROLONG PREV SVCS, FIRST 30M"]
["ALLWAYS HEALTH PARTNERS","G0422 - HC INTENS CARDIAC REHAB W/EXERC",null,null,null,"S8037 - MRCP","L4398 - HC FOOT DROP SPLINT RECUMBENT","L3967 - HC SEWHO AIRPLANE W/O JNTS CF","L4386 - NON-PNEUM WALK BOOT PREFAB","Q4125 - HC AFLEX401 ¿ 40 X 70 MM","D3999 - HC UNSPECIFIED ENDODONTIC PROCEDURE, BY REPORT",null,null,null,"Q4125 - HC AFLEX401 ¿ 40 X 70 MM","G0513 - HC PROLONG PREV SVCS, FIRST 30M",null,"D3999 - HC UNSPECIFIED ENDODONTIC PROCEDURE, BY REPORT","Q4132 - HC GRAFIX CORE 5X5CM",null,null,"G0514 - HC PROLONG PREV SVCS, ADDL 30M"]
["ALLWAYS HEALTH PARTNERS","G0423 - HC INTENS CARDIAC REHAB NO EXER",null,null,null,"T2003 - HC TRANSPORTATION RATE 1 (1-WAY TRIP)","L8509 - TRACH-ESOPH VOICE PROS MD IN","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL","L4396 - STATIC AFO","Q4130 - PR STRATTICE TM","D4260 - HC OSSEOUS SURGERY FOUR OR MORE CONT. TEETH OR TOOTH BOUNDED SPACES PER QUAD.",null,null,null,"Q4130 - PR STRATTICE TM","G0514 - HC PROLONG PREV SVCS, ADDL 30M",null,"D4260 - HC OSSEOUS SURGERY FOUR OR MORE CONT. TEETH OR TOOTH BOUNDED SPACES PER QUAD.","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",null,null,"G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS"]
["ALLWAYS HEALTH PARTNERS","G0438 - PPPS, INITIAL VISIT",null,null,null,"U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","L8693 - HC AUD OSSEO DEV, ABUTMENT","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL","L4398 - HC FOOT DROP SPLINT RECUMBENT","Q4132 - HC GRAFIX CORE 5X5CM","D4263 - HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ FIRST SITE IN QUADRANT",null,null,null,"Q4132 - HC GRAFIX CORE 5X5CM","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",null,"D4263 - HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ FIRST SITE IN QUADRANT","Q4196 - HC PURAPLYAM-COM 6X9 CM",null,null,"G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA"]
["ALLWAYS HEALTH PARTNERS","G0439 - PPPS, SUBSEQ VISIT",null,null,null,"V2785 - CORNEAL TISSUE PROCESSING","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","L4350 - ANKLE CONTROL ORTHOSI PREFAB","L8509 - TRACH-ESOPH VOICE PROS MD IN","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","D4264 - HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ EACH ADDITIONAL SITE IN QUADRANT",null,null,null,"Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",null,"D4264 - HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ EACH ADDITIONAL SITE IN QUADRANT","Q9954 - ORAL MR CONTRAST, 100 ML",null,null,"G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH"]
["ALLWAYS HEALTH PARTNERS","G0442 - ANNUAL ALCOHOL SCREEN 15 MIN",null,null,null,"V2790 - HC MEMBRANE AMNIOTIC","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","L4360 - PNEUMATI WALKING BOOT PREFAB","L8693 - HC AUD OSSEO DEV, ABUTMENT","Q4196 - HC PURAPLYAM-COM 6X9 CM","D4270 - HC PEDICLE SOFT TISSUE GRAFT PROCEDURE",null,null,null,"Q4196 - HC PURAPLYAM-COM 6X9 CM","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH",null,"D4270 - HC PEDICLE SOFT TISSUE GRAFT PROCEDURE","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",null,null,"J0702 - HC BETAMETHASONE ACET&SOD PHOSP"]
["ALLWAYS HEALTH PARTNERS","G0443 - BRIEF ALCOHOL MISUSE COUNSEL",null,null,null,null,"P9012 - HC CRYOPRECIPITATE UNIT","L4370 - HC PNEUMATIC FULL LEG SPLINT","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","Q9954 - ORAL MR CONTRAST, 100 ML","D4273 - HC AUTOGENOUS CONN. TISSUE GRAFT PROC. 1ST TOOTH, IMPLANT, OR EDENTULOUS TOOTH POSITION IN GRAFT",null,null,null,"Q9954 - ORAL MR CONTRAST, 100 ML","J0702 - HC BETAMETHASONE ACET&SOD PHOSP",null,"D4273 - HC AUTOGENOUS CONN. TISSUE GRAFT PROC. 1ST TOOTH, IMPLANT, OR EDENTULOUS TOOTH POSITION IN GRAFT","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",null,null,"J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)"]
["ALLWAYS HEALTH PARTNERS","G0444 - DEPRESSION SCREEN ANNUAL",null,null,null,null,"P9016 - HC RBC:LEU-RED","L4386 - NON-PNEUM WALK BOOT PREFAB","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML","D4355 - FULL MOUTH DEBRIDEMENT TO ENABLE COMPREHENSIVE EVALUATION AND DIAGNOSIS",null,null,null,"Q9956 - HC INJ;OCTAFLUORO MICRO/1ML","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,"D4355 - FULL MOUTH DEBRIDEMENT TO ENABLE COMPREHENSIVE EVALUATION AND DIAGNOSIS","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",null,null,"J1250 - HC DOBUTAMINE SDV/250MG"]
["ALLWAYS HEALTH PARTNERS","G0445 - HIGH INTEN BEH COUNS STD 30M",null,null,null,null,"P9017 - HC FF PLAS: 1 DONOR","L4396 - STATIC AFO","P9012 - HC CRYOPRECIPITATE UNIT","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML","D4381 - HC LOCALIZED DELIVERY - CONTROLLED RELEASE ANTIMICROB. AGENTS TO DISEASED CREVICULAR TISSUE /TOOTH",null,null,null,"Q9957 - HC INJ;PERFLUTR LIP MIC/1ML","J1250 - HC DOBUTAMINE SDV/250MG",null,"D4381 - HC LOCALIZED DELIVERY - CONTROLLED RELEASE ANTIMICROB. AGENTS TO DISEASED CREVICULAR TISSUE /TOOTH","Q9961 - HOCM 250-299MG/ML IODINE,1ML",null,null,"J2790 - HC IG;RHO D,HUMAN/300MCG"]
["ALLWAYS HEALTH PARTNERS","G0446 - INTENS BEHAVE THER CARDIO DX",null,null,null,null,"P9021 - HC RBC/UNIT","L4398 - HC FOOT DROP SPLINT RECUMBENT","P9016 - HC RBC:LEU-RED","Q9958 - HOCM <=149 MG/ML IODINE, 1ML","D5911 - HC FACIAL MOULAGE (SECTIONAL)",null,null,null,"Q9958 - HOCM <=149 MG/ML IODINE, 1ML","J2790 - HC IG;RHO D,HUMAN/300MCG",null,"D5911 - HC FACIAL MOULAGE (SECTIONAL)","Q9963 - HOCM 350-399MG/ML IODINE,1ML",null,null,"J3301 - HC TRIAMCINOLONE ACET INJ NOS"]
["ALLWAYS HEALTH PARTNERS","G0447 - HC BEHAVIOR COUNSEL OBESITY 15M",null,null,null,null,"P9034 - HB PLATELETS, PHERESIS","L8501 - TRACHEOSTOMY SPEAKING VALVE","P9017 - HC FF PLAS: 1 DONOR","Q9961 - HOCM 250-299MG/ML IODINE,1ML","D5912 - HC FACIAL MOULAGE (COMPLETE)",null,null,null,"Q9961 - HOCM 250-299MG/ML IODINE,1ML","J3301 - HC TRIAMCINOLONE ACET INJ NOS",null,"D5912 - HC FACIAL MOULAGE (COMPLETE)","Q9966 - LOCM 200-299MG/ML IODINE,1ML",null,null,"J7307 - HC ETONOGESTREL IMPLANT SYSTEM"]
["ALLWAYS HEALTH PARTNERS","G0480 - DRUG TEST DEF 1-7 CLASSES",null,null,null,null,"P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT","L8507 - HC PROLARYNX VOICE (PLUS)","P9021 - HC RBC/UNIT","Q9963 - HOCM 350-399MG/ML IODINE,1ML","D5983 - HC RADIATION CARRIER",null,null,null,"Q9963 - HOCM 350-399MG/ML IODINE,1ML","J7307 - HC ETONOGESTREL IMPLANT SYSTEM",null,"D5983 - HC RADIATION CARRIER","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,null,"L0120 - CERV FLEXIBLE NON-ADJUSTABLE"]
["ALLWAYS HEALTH PARTNERS","G0481 - DRUG TEST DEF 8-14 CLASSES",null,null,null,null,"P9040 - HC RBC:LEU-RED,IRR/UNIT","L8509 - TRACH-ESOPH VOICE PROS MD IN","P9034 - HB PLATELETS, PHERESIS","Q9966 - LOCM 200-299MG/ML IODINE,1ML","D5984 - HC RADIATION SHIELD",null,null,null,"Q9966 - LOCM 200-299MG/ML IODINE,1ML","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",null,"D5984 - HC RADIATION SHIELD","Q9987 - HC PATHOGEN TEST PLATELETS",null,null,"L0140 - CERVICAL SEMI-RIGID ADJUSTAB"]
["ALLWAYS HEALTH PARTNERS","G0506 - HC COMP ASSESS CARE PLAN CCM SVC",null,null,null,null,"P9045 - HC ALBUMIN (HUMAN) 5% 250ML","L8514 - REPL TRACH PUNCTURE DILATOR","P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","D5985 - HC RADIATION CONE LOCATOR",null,null,null,"Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","L0140 - CERVICAL SEMI-RIGID ADJUSTAB",null,"D5985 - HC RADIATION CONE LOCATOR","S5100 - ADULT DAYCARE SERVICES 15MIN",null,null,"L1820 - KO ELAS W/ CONDYLE PADS & JO"]
["ALLWAYS HEALTH PARTNERS","G0513 - HC PROLONG PREV SVCS, FIRST 30M",null,null,null,null,"P9047 - HC ALBUMIN (HUMAN) 25% 50ML","L8693 - HC AUD OSSEO DEV, ABUTMENT","P9040 - HC RBC:LEU-RED,IRR/UNIT","Q9987 - HC PATHOGEN TEST PLATELETS","D5987 - HC COMMISSURE SPLINT",null,null,null,"Q9987 - HC PATHOGEN TEST PLATELETS","L1820 - KO ELAS W/ CONDYLE PADS & JO",null,"D5987 - HC COMMISSURE SPLINT","S5101 - HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)",null,null,"L1830 - KO IMMOBILIZER CANVAS LONGIT"]
["ALLWAYS HEALTH PARTNERS","G0514 - HC PROLONG PREV SVCS, ADDL 30M",null,null,null,null,"P9073 - HC PLATELETS PHERESIS PATH REDU","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING","P9045 - HC ALBUMIN (HUMAN) 5% 250ML","S5100 - ADULT DAYCARE SERVICES 15MIN","D7140 - EXTRACTION ERUPTED TOOTH/EXR",null,null,null,"S5100 - ADULT DAYCARE SERVICES 15MIN","L1830 - KO IMMOBILIZER CANVAS LONGIT",null,"D7140 - EXTRACTION ERUPTED TOOTH/EXR","S5102 - HC ADULT DAY HEALTH - COMPLEX PER DIEM",null,null,"L1832 - KO ADJ JNT POS RIGID SUPPORT"]
["ALLWAYS HEALTH PARTNERS","G2011 - ALCOHOL/SUB ABUSE ASSESS",null,null,null,null,"P9100 - PATHOGEN TEST FOR PLATELETS","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG","P9047 - HC ALBUMIN (HUMAN) 25% 50ML","S5101 - HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)","D7210 - EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED",null,null,null,"S5101 - HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)","L1832 - KO ADJ JNT POS RIGID SUPPORT",null,"D7210 - EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED","S8037 - MRCP",null,null,"L1836 - HC RIGID KO WO JOINTS"]
["ALLWAYS HEALTH PARTNERS","G2012 - HC BRIEF CHECK IN BY MD/QHP",null,null,null,null,"P9612 - CATHETERIZE FOR URINE SPEC","P9012 - HC CRYOPRECIPITATE UNIT","P9073 - HC PLATELETS PHERESIS PATH REDU","S5102 - HC ADULT DAY HEALTH - COMPLEX PER DIEM","D7220 - REMOVAL OF IMPACTED TOOTH - SOFT TISSUE",null,null,null,"S5102 - HC ADULT DAY HEALTH - COMPLEX PER DIEM","L1836 - HC RIGID KO WO JOINTS",null,"D7220 - REMOVAL OF IMPACTED TOOTH - SOFT TISSUE","T2003 - HC TRANSPORTATION RATE 1 (1-WAY TRIP)",null,null,"L1902 - AFO ANKLE GAUNTLET"]
["ALLWAYS HEALTH PARTNERS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",null,null,null,null,"Q0091 - HC OBTAINING SCREEN PAP SMEAR","P9016 - HC RBC:LEU-RED","P9100 - PATHOGEN TEST FOR PLATELETS","S8037 - MRCP","D7230 - REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY",null,null,null,"S8037 - MRCP","L1902 - AFO ANKLE GAUNTLET",null,"D7230 - REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",null,null,"L3350 - SHOE HEEL WEDGE"]
["ALLWAYS HEALTH PARTNERS","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",null,null,null,null,"Q0111 - HC WET MOUNTS W PREPARATIONS","P9017 - HC FF PLAS: 1 DONOR","P9612 - CATHETERIZE FOR URINE SPEC","T2003 - HC TRANSPORTATION RATE 1 (1-WAY TRIP)","D7240 - REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY",null,null,null,"T2003 - HC TRANSPORTATION RATE 1 (1-WAY TRIP)","L3350 - SHOE HEEL WEDGE",null,"D7240 - REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",null,null,"L3650 - SHLDER FIG 8 ABDUCT RESTRAIN"]
["ALLWAYS HEALTH PARTNERS","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH",null,null,null,null,"Q0114 - HC  FERN TEST","P9021 - HC RBC/UNIT","Q0091 - HC OBTAINING SCREEN PAP SMEAR","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","D7250 - REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)",null,null,null,"U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",null,"D7250 - REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)","V2785 - CORNEAL TISSUE PROCESSING",null,null,"L3670 - ACROMIO/CLAVICULAR CANVAS&WE"]
["ALLWAYS HEALTH PARTNERS","G2086 - HC OFF BASE OPIOID TX 70MIN",null,null,null,null,"Q4101 - APLIGRAF","P9034 - HB PLATELETS, PHERESIS","Q0111 - HC WET MOUNTS W PREPARATIONS","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","D7260 - HC OROANTRAL FISTULA CLOSURE",null,null,null,"U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",null,"D7260 - HC OROANTRAL FISTULA CLOSURE","V2790 - HC MEMBRANE AMNIOTIC",null,null,"L3760 - EO WITHJOINT, PREFABRICATED"]
["ALLWAYS HEALTH PARTNERS","G2087 - HC OFF BASE OPIOID TX, 60 M",null,null,null,null,"Q4102 - OASIS WOUND MATRIX","P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT","Q0114 - HC  FERN TEST","V2785 - CORNEAL TISSUE PROCESSING","D7261 - PRIMARY CLOSURE OF A SINUS PERFORATION",null,null,null,"V2785 - CORNEAL TISSUE PROCESSING","L3760 - EO WITHJOINT, PREFABRICATED",null,"D7261 - PRIMARY CLOSURE OF A SINUS PERFORATION",null,null,null,"L3762 - RIGID EO WO JOINTS"]
["ALLWAYS HEALTH PARTNERS","G2088 - HC OFF BASE OPIOID TX, ADD30",null,null,null,null,"Q4104 - INTEGRA BMWD","P9040 - HC RBC:LEU-RED,IRR/UNIT","Q4101 - APLIGRAF","V2790 - HC MEMBRANE AMNIOTIC","D7940 - HC OSTEOPLASTY - FOR ORTHOGNATHIC DEFORMITIES",null,null,null,"V2790 - HC MEMBRANE AMNIOTIC","L3762 - RIGID EO WO JOINTS",null,"D7940 - HC OSTEOPLASTY - FOR ORTHOGNATHIC DEFORMITIES",null,null,null,"L3807 - WHFO,NO JOINT, PREFABRICATED"]
["ALLWAYS HEALTH PARTNERS","G2212 - HC PROLONG OUTPT/OFFICE VIS",null,null,null,null,"Q4107 - GRAFTJACKET","P9045 - HC ALBUMIN (HUMAN) 5% 250ML","Q4102 - OASIS WOUND MATRIX",null,"D9110 - PALLIATIVE (EMERGENCY) TREATMENT OF DENTAL PAIN - MINOR PROCEDURE",null,null,null,null,"L3807 - WHFO,NO JOINT, PREFABRICATED",null,"D9110 - PALLIATIVE (EMERGENCY) TREATMENT OF DENTAL PAIN - MINOR PROCEDURE",null,null,null,"L3808 - HC EPITRAIN"]
["ALLWAYS HEALTH PARTNERS","G2216 - HC HOME SUPPLY INJECT NALOXON",null,null,null,null,"Q4112 - CYMETRA INJECTABLE","P9047 - HC ALBUMIN (HUMAN) 25% 50ML","Q4104 - INTEGRA BMWD",null,"D9230 - INHALATION OF NITROUS OXIDE/ANALGESIA, ANXIOLYSIS",null,null,null,null,"L3808 - HC EPITRAIN",null,"D9230 - INHALATION OF NITROUS OXIDE/ANALGESIA, ANXIOLYSIS",null,null,null,"L3905 - HC WHO W/NONTORSION JNT(S) CF"]
["ALLWAYS HEALTH PARTNERS","J1250 - HC DOBUTAMINE SDV/250MG",null,null,null,null,"Q4116 - HC ALLODERM 8 X 16 MEDIUM","P9073 - HC PLATELETS PHERESIS PATH REDU","Q4107 - GRAFTJACKET",null,"D9630 - HC DRUGS OR MEDICAMENTS DISPENSED IN THE OFFICE FOR HOME USE",null,null,null,null,"L3905 - HC WHO W/NONTORSION JNT(S) CF",null,"D9630 - HC DRUGS OR MEDICAMENTS DISPENSED IN THE OFFICE FOR HOME USE",null,null,null,"L3908 - WRIST COCK-UP NON-MOLDED"]
["ALLWAYS HEALTH PARTNERS","L0120 - CERV FLEXIBLE NON-ADJUSTABLE",null,null,null,null,"Q4124 - OASIS TRILAYER/1 SQCM","P9100 - PATHOGEN TEST FOR PLATELETS","Q4112 - CYMETRA INJECTABLE",null,"D9930 - HC TREATMENT OF COMPLICATIONS (POST-SURGICAL) - UNUSUAL CIRCUMSTANCES, BY REPORT",null,null,null,null,"L3908 - WRIST COCK-UP NON-MOLDED",null,"D9930 - HC TREATMENT OF COMPLICATIONS (POST-SURGICAL) - UNUSUAL CIRCUMSTANCES, BY REPORT",null,null,null,"L3967 - HC SEWHO AIRPLANE W/O JNTS CF"]
["ALLWAYS HEALTH PARTNERS","L0140 - CERVICAL SEMI-RIGID ADJUSTAB",null,null,null,null,"Q4125 - HC AFLEX401 ¿ 40 X 70 MM","P9612 - CATHETERIZE FOR URINE SPEC","Q4116 - HC ALLODERM 8 X 16 MEDIUM",null,"D9944 - HC OCCLUSAL GUARD ¿ HARD APPLIANCE, FULL ARCH",null,null,null,null,"L3967 - HC SEWHO AIRPLANE W/O JNTS CF",null,"D9944 - HC OCCLUSAL GUARD ¿ HARD APPLIANCE, FULL ARCH",null,null,null,"L3980 - HC UPP EXT FX ORTHOSIS HUMERAL"]
["ALLWAYS HEALTH PARTNERS","L1820 - KO ELAS W/ CONDYLE PADS & JO",null,null,null,null,"Q4130 - PR STRATTICE TM","Q0091 - HC OBTAINING SCREEN PAP SMEAR","Q4124 - OASIS TRILAYER/1 SQCM",null,"D9951 - OCCLUSAL ADJUSTMENT - LIMITED",null,null,null,null,"L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",null,"D9951 - OCCLUSAL ADJUSTMENT - LIMITED",null,null,null,"L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL"]
["ALLWAYS HEALTH PARTNERS","L1830 - KO IMMOBILIZER CANVAS LONGIT",null,null,null,null,"Q4132 - HC GRAFIX CORE 5X5CM","Q0111 - HC WET MOUNTS W PREPARATIONS","Q4125 - HC AFLEX401 ¿ 40 X 70 MM",null,"E0191 - PROTECTOR HEEL OR ELBOW",null,null,null,null,"L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",null,"E0191 - PROTECTOR HEEL OR ELBOW",null,null,null,"L4350 - ANKLE CONTROL ORTHOSI PREFAB"]
["ALLWAYS HEALTH PARTNERS","L1832 - KO ADJ JNT POS RIGID SUPPORT",null,null,null,null,"Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","Q0114 - HC  FERN TEST","Q4130 - PR STRATTICE TM",null,"G0101 - CA SCREEN;PELVIC/BREAST EXAM",null,null,null,null,"L4350 - ANKLE CONTROL ORTHOSI PREFAB",null,"G0101 - CA SCREEN;PELVIC/BREAST EXAM",null,null,null,"L4360 - PNEUMATI WALKING BOOT PREFAB"]
["ALLWAYS HEALTH PARTNERS","L1836 - HC RIGID KO WO JOINTS",null,null,null,null,"Q9954 - ORAL MR CONTRAST, 100 ML","Q3014 - HC TELEHEALTH FACILITY FEE","Q4132 - HC GRAFIX CORE 5X5CM",null,"G0103 - PSA, TOTAL SCREENING",null,null,null,null,"L4360 - PNEUMATI WALKING BOOT PREFAB",null,"G0103 - PSA, TOTAL SCREENING",null,null,null,"L4370 - HC PNEUMATIC FULL LEG SPLINT"]
["ALLWAYS HEALTH PARTNERS","L1902 - AFO ANKLE GAUNTLET",null,null,null,null,"Q9956 - HC INJ;OCTAFLUORO MICRO/1ML","Q4101 - APLIGRAF","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",null,"G0105 - HC COLORECTAL SCRN; HI RISK IND",null,null,null,null,"L4370 - HC PNEUMATIC FULL LEG SPLINT",null,"G0105 - HC COLORECTAL SCRN; HI RISK IND",null,null,null,"L4386 - NON-PNEUM WALK BOOT PREFAB"]
["ALLWAYS HEALTH PARTNERS","L3260 - AMBULATORY SURGICAL BOOT EAC",null,null,null,null,"Q9957 - HC INJ;PERFLUTR LIP MIC/1ML","Q4102 - OASIS WOUND MATRIX","Q9954 - ORAL MR CONTRAST, 100 ML",null,"G0108 - DIAB MANAGE TRN  PER INDIV",null,null,null,null,"L4386 - NON-PNEUM WALK BOOT PREFAB",null,"G0108 - DIAB MANAGE TRN  PER INDIV",null,null,null,"L4396 - STATIC AFO"]
["ALLWAYS HEALTH PARTNERS","L3350 - SHOE HEEL WEDGE",null,null,null,null,"Q9958 - HOCM <=149 MG/ML IODINE, 1ML","Q4104 - INTEGRA BMWD","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",null,"G0109 - DIAB MANAGE TRN IND/GROUP",null,null,null,null,"L4396 - STATIC AFO",null,"G0109 - DIAB MANAGE TRN IND/GROUP",null,null,null,"L4398 - HC FOOT DROP SPLINT RECUMBENT"]
["ALLWAYS HEALTH PARTNERS","L3496 - HC STATIC AFO",null,null,null,null,"Q9961 - HOCM 250-299MG/ML IODINE,1ML","Q4107 - GRAFTJACKET","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",null,"G0127 - TRIM NAIL(S)",null,null,null,null,"L4398 - HC FOOT DROP SPLINT RECUMBENT",null,"G0127 - TRIM NAIL(S)",null,null,null,"L8501 - TRACHEOSTOMY SPEAKING VALVE"]
["ALLWAYS HEALTH PARTNERS","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",null,null,null,null,"Q9963 - HOCM 350-399MG/ML IODINE,1ML","Q4112 - CYMETRA INJECTABLE","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",null,"G0175 - OPPS SERVICE,SCHED TEAM CONF",null,null,null,null,"L8501 - TRACHEOSTOMY SPEAKING VALVE",null,"G0175 - OPPS SERVICE,SCHED TEAM CONF",null,null,null,"L8507 - HC PROLARYNX VOICE (PLUS)"]
["ALLWAYS HEALTH PARTNERS","L3670 - ACROMIO/CLAVICULAR CANVAS&WE",null,null,null,null,"Q9966 - LOCM 200-299MG/ML IODINE,1ML","Q4116 - HC ALLODERM 8 X 16 MEDIUM","Q9961 - HOCM 250-299MG/ML IODINE,1ML",null,"G0239 - OTH RESP PROC, GROUP",null,null,null,null,"L8507 - HC PROLARYNX VOICE (PLUS)",null,"G0239 - OTH RESP PROC, GROUP",null,null,null,"L8509 - TRACH-ESOPH VOICE PROS MD IN"]
["ALLWAYS HEALTH PARTNERS","L3760 - EO WITHJOINT, PREFABRICATED",null,null,null,null,"Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML","Q4124 - OASIS TRILAYER/1 SQCM","Q9963 - HOCM 350-399MG/ML IODINE,1ML",null,"G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP",null,null,null,null,"L8509 - TRACH-ESOPH VOICE PROS MD IN",null,"G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP",null,null,null,"L8514 - REPL TRACH PUNCTURE DILATOR"]
["ALLWAYS HEALTH PARTNERS","L3762 - RIGID EO WO JOINTS",null,null,null,null,"S8037 - MRCP","Q4125 - HC AFLEX401 ¿ 40 X 70 MM","Q9966 - LOCM 200-299MG/ML IODINE,1ML",null,"G0259 - HC INJECT FOR SACROILIAC JOINT",null,null,null,null,"L8514 - REPL TRACH PUNCTURE DILATOR",null,"G0259 - HC INJECT FOR SACROILIAC JOINT",null,null,null,"L8693 - HC AUD OSSEO DEV, ABUTMENT"]
["ALLWAYS HEALTH PARTNERS","L3807 - WHFO,NO JOINT, PREFABRICATED",null,null,null,null,"U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH","Q4130 - PR STRATTICE TM","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,"G0260 - INJ FOR SACROILIAC JT ANESTH",null,null,null,null,"L8693 - HC AUD OSSEO DEV, ABUTMENT",null,"G0260 - INJ FOR SACROILIAC JT ANESTH",null,null,null,"L8699 - HC CARTIFORM 20 X 25 MM DISC"]
["ALLWAYS HEALTH PARTNERS","L3808 - HC EPITRAIN",null,null,null,null,"U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP","Q4132 - HC GRAFIX CORE 5X5CM","S8037 - MRCP",null,"G0269 - HC CLOSURE DEVICE PLACEMENT",null,null,null,null,"L8699 - HC CARTIFORM 20 X 25 MM DISC",null,"G0269 - HC CLOSURE DEVICE PLACEMENT",null,null,null,"M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING"]
["ALLWAYS HEALTH PARTNERS","L3905 - HC WHO W/NONTORSION JNT(S) CF",null,null,null,null,null,"Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",null,"G0278 - ILIAC ART ANGIO,CARDIAC CATH",null,null,null,null,"M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",null,"G0278 - ILIAC ART ANGIO,CARDIAC CATH",null,null,null,"M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG"]
["ALLWAYS HEALTH PARTNERS","L3908 - WRIST COCK-UP NON-MOLDED",null,null,null,null,null,"Q4196 - HC PURAPLYAM-COM 6X9 CM","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",null,"G0279 - TOMOSYNTHESIS, MAMMO",null,null,null,null,"M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",null,"G0279 - TOMOSYNTHESIS, MAMMO",null,null,null,"P9012 - HC CRYOPRECIPITATE UNIT"]
["ALLWAYS HEALTH PARTNERS","L3967 - HC SEWHO AIRPLANE W/O JNTS CF",null,null,null,null,null,"Q9954 - ORAL MR CONTRAST, 100 ML",null,null,"G0296 - HC VISIT TO DETERM LDCT ELIG",null,null,null,null,"P9012 - HC CRYOPRECIPITATE UNIT",null,"G0296 - HC VISIT TO DETERM LDCT ELIG",null,null,null,"P9016 - HC RBC:LEU-RED"]
["ALLWAYS HEALTH PARTNERS","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",null,null,null,null,null,"Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",null,null,"G0297 - HC LDCT FOR LUNG CA SCREEN",null,null,null,null,"P9016 - HC RBC:LEU-RED",null,"G0297 - HC LDCT FOR LUNG CA SCREEN",null,null,null,"P9017 - HC FF PLAS: 1 DONOR"]
["ALLWAYS HEALTH PARTNERS","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",null,null,null,null,null,"Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",null,null,"G0365 - HC VESSEL MAPPING HEMO ACCESS",null,null,null,null,"P9017 - HC FF PLAS: 1 DONOR",null,"G0365 - HC VESSEL MAPPING HEMO ACCESS",null,null,null,"P9021 - HC RBC/UNIT"]
["ALLWAYS HEALTH PARTNERS","L4350 - ANKLE CONTROL ORTHOSI PREFAB",null,null,null,null,null,"Q9958 - HOCM <=149 MG/ML IODINE, 1ML",null,null,"G0378 - HOSPITAL OBSERVATION PER HR",null,null,null,null,"P9021 - HC RBC/UNIT",null,"G0378 - HOSPITAL OBSERVATION PER HR",null,null,null,"P9034 - HB PLATELETS, PHERESIS"]
["ALLWAYS HEALTH PARTNERS","L4360 - PNEUMATI WALKING BOOT PREFAB",null,null,null,null,null,"Q9961 - HOCM 250-299MG/ML IODINE,1ML",null,null,"G0379 - DIRECT REFER HOSPITAL OBSERV",null,null,null,null,"P9034 - HB PLATELETS, PHERESIS",null,"G0379 - DIRECT REFER HOSPITAL OBSERV",null,null,null,"P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT"]
["ALLWAYS HEALTH PARTNERS","L4370 - HC PNEUMATIC FULL LEG SPLINT",null,null,null,null,null,"Q9963 - HOCM 350-399MG/ML IODINE,1ML",null,null,"G0390 - TRAUMA RESPONS W/HOSP CRITI",null,null,null,null,"P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT",null,"G0390 - TRAUMA RESPONS W/HOSP CRITI",null,null,null,"P9040 - HC RBC:LEU-RED,IRR/UNIT"]
["ALLWAYS HEALTH PARTNERS","L4386 - NON-PNEUM WALK BOOT PREFAB",null,null,null,null,null,"Q9966 - LOCM 200-299MG/ML IODINE,1ML",null,null,"G0396 - ALCOHOL/SUBS INTERV 15-30MN",null,null,null,null,"P9040 - HC RBC:LEU-RED,IRR/UNIT",null,"G0396 - ALCOHOL/SUBS INTERV 15-30MN",null,null,null,"P9044 - HC CRYOPRECIPITATE REDUCED PLASMA"]
["ALLWAYS HEALTH PARTNERS","L4396 - STATIC AFO",null,null,null,null,null,"Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,null,"G0397 - ALCOHOL/SUBS INTERV >30 MIN",null,null,null,null,"P9044 - HC CRYOPRECIPITATE REDUCED PLASMA",null,"G0397 - ALCOHOL/SUBS INTERV >30 MIN",null,null,null,"P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["ALLWAYS HEALTH PARTNERS","L4398 - HC FOOT DROP SPLINT RECUMBENT",null,null,null,null,null,"S8037 - MRCP",null,null,"G0402 - INITIAL PREVENTIVE EXAM",null,null,null,null,"P9045 - HC ALBUMIN (HUMAN) 5% 250ML",null,"G0402 - INITIAL PREVENTIVE EXAM",null,null,null,"P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["ALLWAYS HEALTH PARTNERS","L8501 - TRACHEOSTOMY SPEAKING VALVE",null,null,null,null,null,"U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",null,null,"G0410 - HC GRP PSYCH PARTIAL HOSP 45-50",null,null,null,null,"P9047 - HC ALBUMIN (HUMAN) 25% 50ML",null,"G0410 - HC GRP PSYCH PARTIAL HOSP 45-50",null,null,null,"P9056 - HC BLOOD, L/R, IRRADIATED"]
["ALLWAYS HEALTH PARTNERS","L8507 - HC PROLARYNX VOICE (PLUS)",null,null,null,null,null,"U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",null,null,"G0416 - HC PROSTATE BIOPSY ANY MTHD",null,null,null,null,"P9056 - HC BLOOD, L/R, IRRADIATED",null,"G0416 - HC PROSTATE BIOPSY ANY MTHD",null,null,null,"P9057 - HC RBC:LEU RED,FR/DE/WASH,IR"]
["ALLWAYS HEALTH PARTNERS","L8509 - TRACH-ESOPH VOICE PROS MD IN",null,null,null,null,null,null,null,null,"G0420 - HC ED SVC CKD IND PER SESSION",null,null,null,null,"P9057 - HC RBC:LEU RED,FR/DE/WASH,IR",null,"G0420 - HC ED SVC CKD IND PER SESSION",null,null,null,"P9073 - HC PLATELETS PHERESIS PATH REDU"]
["ALLWAYS HEALTH PARTNERS","L8514 - REPL TRACH PUNCTURE DILATOR",null,null,null,null,null,null,null,null,"G0421 - HC ED SVC CKD GRP PER SESSION",null,null,null,null,"P9073 - HC PLATELETS PHERESIS PATH REDU",null,"G0421 - HC ED SVC CKD GRP PER SESSION",null,null,null,"P9100 - PATHOGEN TEST FOR PLATELETS"]
["ALLWAYS HEALTH PARTNERS","L8693 - HC AUD OSSEO DEV, ABUTMENT",null,null,null,null,null,null,null,null,"G0422 - HC INTENS CARDIAC REHAB W/EXERC",null,null,null,null,"P9100 - PATHOGEN TEST FOR PLATELETS",null,"G0422 - HC INTENS CARDIAC REHAB W/EXERC",null,null,null,"P9612 - CATHETERIZE FOR URINE SPEC"]
["ALLWAYS HEALTH PARTNERS","L8699 - HC CARTIFORM 20 X 25 MM DISC",null,null,null,null,null,null,null,null,"G0423 - HC INTENS CARDIAC REHAB NO EXER",null,null,null,null,"P9612 - CATHETERIZE FOR URINE SPEC",null,"G0423 - HC INTENS CARDIAC REHAB NO EXER",null,null,null,"Q0091 - HC OBTAINING SCREEN PAP SMEAR"]
["ALLWAYS HEALTH PARTNERS","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",null,null,null,null,null,null,null,null,"G0424 - PULMONARY REHAB W EXER",null,null,null,null,"Q0091 - HC OBTAINING SCREEN PAP SMEAR",null,"G0424 - PULMONARY REHAB W EXER",null,null,null,"Q0111 - HC WET MOUNTS W PREPARATIONS"]
["ALLWAYS HEALTH PARTNERS","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",null,null,null,null,null,null,null,null,"G0438 - PPPS, INITIAL VISIT",null,null,null,null,"Q0111 - HC WET MOUNTS W PREPARATIONS",null,"G0438 - PPPS, INITIAL VISIT",null,null,null,"Q0114 - HC  FERN TEST"]
["ALLWAYS HEALTH PARTNERS","P9612 - CATHETERIZE FOR URINE SPEC",null,null,null,null,null,null,null,null,"G0439 - PPPS, SUBSEQ VISIT",null,null,null,null,"Q0114 - HC  FERN TEST",null,"G0439 - PPPS, SUBSEQ VISIT",null,null,null,"Q3014 - HC TELEHEALTH FACILITY FEE"]
["ALLWAYS HEALTH PARTNERS","Q0091 - HC OBTAINING SCREEN PAP SMEAR",null,null,null,null,null,null,null,null,"G0442 - ANNUAL ALCOHOL SCREEN 15 MIN",null,null,null,null,"Q3014 - HC TELEHEALTH FACILITY FEE",null,"G0442 - ANNUAL ALCOHOL SCREEN 15 MIN",null,null,null,"Q4101 - APLIGRAF"]
["ALLWAYS HEALTH PARTNERS","Q0111 - HC WET MOUNTS W PREPARATIONS",null,null,null,null,null,null,null,null,"G0443 - BRIEF ALCOHOL MISUSE COUNSEL",null,null,null,null,"Q4101 - APLIGRAF",null,"G0443 - BRIEF ALCOHOL MISUSE COUNSEL",null,null,null,"Q4102 - OASIS WOUND MATRIX"]
["ALLWAYS HEALTH PARTNERS","Q0114 - HC  FERN TEST",null,null,null,null,null,null,null,null,"G0444 - DEPRESSION SCREEN ANNUAL",null,null,null,null,"Q4102 - OASIS WOUND MATRIX",null,"G0444 - DEPRESSION SCREEN ANNUAL",null,null,null,"Q4104 - INTEGRA BMWD"]
["ALLWAYS HEALTH PARTNERS","Q0249 - HC TOCILIZUMAB FOR COVID-19",null,null,null,null,null,null,null,null,"G0445 - HIGH INTEN BEH COUNS STD 30M",null,null,null,null,"Q4104 - INTEGRA BMWD",null,"G0445 - HIGH INTEN BEH COUNS STD 30M",null,null,null,"Q4107 - GRAFTJACKET"]
["ALLWAYS HEALTH PARTNERS","Q3014 - HC TELEHEALTH FACILITY FEE",null,null,null,null,null,null,null,null,"G0446 - INTENS BEHAVE THER CARDIO DX",null,null,null,null,"Q4107 - GRAFTJACKET",null,"G0446 - INTENS BEHAVE THER CARDIO DX",null,null,null,"Q4112 - CYMETRA INJECTABLE"]
["ALLWAYS HEALTH PARTNERS","Q4116 - HC ALLODERM 8 X 16 MEDIUM",null,null,null,null,null,null,null,null,"G0447 - HC BEHAVIOR COUNSEL OBESITY 15M",null,null,null,null,"Q4112 - CYMETRA INJECTABLE",null,"G0447 - HC BEHAVIOR COUNSEL OBESITY 15M",null,null,null,"Q4116 - HC ALLODERM 8 X 16 MEDIUM"]
["ALLWAYS HEALTH PARTNERS","Q4124 - OASIS TRILAYER/1 SQCM",null,null,null,null,null,null,null,null,"G0480 - DRUG TEST DEF 1-7 CLASSES",null,null,null,null,"Q4116 - HC ALLODERM 8 X 16 MEDIUM",null,"G0480 - DRUG TEST DEF 1-7 CLASSES",null,null,null,"Q4124 - OASIS TRILAYER/1 SQCM"]
["ALLWAYS HEALTH PARTNERS","Q4125 - HC AFLEX401 ¿ 40 X 70 MM",null,null,null,null,null,null,null,null,"G0481 - DRUG TEST DEF 8-14 CLASSES",null,null,null,null,"Q4124 - OASIS TRILAYER/1 SQCM",null,"G0481 - DRUG TEST DEF 8-14 CLASSES",null,null,null,"Q4125 - HC AFLEX401 ¿ 40 X 70 MM"]
["ALLWAYS HEALTH PARTNERS","Q4130 - PR STRATTICE TM",null,null,null,null,null,null,null,null,"G0506 - HC COMP ASSESS CARE PLAN CCM SVC",null,null,null,null,"Q4125 - HC AFLEX401 ¿ 40 X 70 MM",null,"G0506 - HC COMP ASSESS CARE PLAN CCM SVC",null,null,null,"Q4130 - PR STRATTICE TM"]
["ALLWAYS HEALTH PARTNERS","Q4196 - HC PURAPLYAM-COM 6X9 CM",null,null,null,null,null,null,null,null,"G0513 - HC PROLONG PREV SVCS, FIRST 30M",null,null,null,null,"Q4130 - PR STRATTICE TM",null,"G0513 - HC PROLONG PREV SVCS, FIRST 30M",null,null,null,"Q4132 - HC GRAFIX CORE 5X5CM"]
["ALLWAYS HEALTH PARTNERS","Q9954 - ORAL MR CONTRAST, 100 ML",null,null,null,null,null,null,null,null,"G0514 - HC PROLONG PREV SVCS, ADDL 30M",null,null,null,null,"Q4132 - HC GRAFIX CORE 5X5CM",null,"G0514 - HC PROLONG PREV SVCS, ADDL 30M",null,null,null,"Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["ALLWAYS HEALTH PARTNERS","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",null,null,null,null,null,null,null,null,"G2011 - ALCOHOL/SUB ABUSE ASSESS",null,null,null,null,"Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",null,"G2011 - ALCOHOL/SUB ABUSE ASSESS",null,null,null,"Q4196 - HC PURAPLYAM-COM 6X9 CM"]
["ALLWAYS HEALTH PARTNERS","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",null,null,null,null,null,null,null,null,"G2012 - HC BRIEF CHECK IN BY MD/QHP",null,null,null,null,"Q4196 - HC PURAPLYAM-COM 6X9 CM",null,"G2012 - HC BRIEF CHECK IN BY MD/QHP",null,null,null,"Q9954 - ORAL MR CONTRAST, 100 ML"]
["ALLWAYS HEALTH PARTNERS","Q9958 - HOCM <=149 MG/ML IODINE, 1ML",null,null,null,null,null,null,null,null,"G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",null,null,null,null,"Q9954 - ORAL MR CONTRAST, 100 ML",null,"G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS",null,null,null,"Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["ALLWAYS HEALTH PARTNERS","Q9961 - HOCM 250-299MG/ML IODINE,1ML",null,null,null,null,null,null,null,null,"G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",null,null,null,null,"Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",null,"G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",null,null,null,"Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["ALLWAYS HEALTH PARTNERS","Q9963 - HOCM 350-399MG/ML IODINE,1ML",null,null,null,null,null,null,null,null,"G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH",null,null,null,null,"Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",null,"G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH",null,null,null,"Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["ALLWAYS HEALTH PARTNERS","Q9966 - LOCM 200-299MG/ML IODINE,1ML",null,null,null,null,null,null,null,null,"G2086 - HC OFF BASE OPIOID TX 70MIN",null,null,null,null,"Q9958 - HOCM <=149 MG/ML IODINE, 1ML",null,"G2086 - HC OFF BASE OPIOID TX 70MIN",null,null,null,"Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["ALLWAYS HEALTH PARTNERS","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,null,null,null,null,null,null,null,"G2087 - HC OFF BASE OPIOID TX, 60 M",null,null,null,null,"Q9961 - HOCM 250-299MG/ML IODINE,1ML",null,"G2087 - HC OFF BASE OPIOID TX, 60 M",null,null,null,"Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["ALLWAYS HEALTH PARTNERS","Q9987 - HC PATHOGEN TEST PLATELETS",null,null,null,null,null,null,null,null,"J0702 - HC BETAMETHASONE ACET&SOD PHOSP",null,null,null,null,"Q9963 - HOCM 350-399MG/ML IODINE,1ML",null,"J0702 - HC BETAMETHASONE ACET&SOD PHOSP",null,null,null,"Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["ALLWAYS HEALTH PARTNERS","S5100 - ADULT DAYCARE SERVICES 15MIN",null,null,null,null,null,null,null,null,"J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,null,null,null,"Q9966 - LOCM 200-299MG/ML IODINE,1ML",null,"J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,null,null,"Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["ALLWAYS HEALTH PARTNERS","S5101 - HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)",null,null,null,null,null,null,null,null,"J1250 - HC DOBUTAMINE SDV/250MG",null,null,null,null,"Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,"J1250 - HC DOBUTAMINE SDV/250MG",null,null,null,"U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH"]
["ALLWAYS HEALTH PARTNERS","S5102 - HC ADULT DAY HEALTH - COMPLEX PER DIEM",null,null,null,null,null,null,null,null,"J2790 - HC IG;RHO D,HUMAN/300MCG",null,null,null,null,"U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",null,"J2790 - HC IG;RHO D,HUMAN/300MCG",null,null,null,"U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP"]
["ALLWAYS HEALTH PARTNERS","S8037 - MRCP",null,null,null,null,null,null,null,null,"J3301 - HC TRIAMCINOLONE ACET INJ NOS",null,null,null,null,"U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",null,"J3301 - HC TRIAMCINOLONE ACET INJ NOS",null,null,null,"V2790 - HC MEMBRANE AMNIOTIC"]
["ALLWAYS HEALTH PARTNERS","T2003 - HC TRANSPORTATION RATE 1 (1-WAY TRIP)",null,null,null,null,null,null,null,null,"J3590 - COSTAL CARTILAGE ALLOGRAFT",null,null,null,null,"V2790 - HC MEMBRANE AMNIOTIC",null,"J3590 - COSTAL CARTILAGE ALLOGRAFT"]
["ALLWAYS HEALTH PARTNERS","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",null,null,null,null,null,null,null,null,"J7307 - HC ETONOGESTREL IMPLANT SYSTEM",null,null,null,null,null,null,"J7307 - HC ETONOGESTREL IMPLANT SYSTEM"]
["ALLWAYS HEALTH PARTNERS","V2785 - CORNEAL TISSUE PROCESSING",null,null,null,null,null,null,null,null,"L0120 - CERV FLEXIBLE NON-ADJUSTABLE",null,null,null,null,null,null,"L0120 - CERV FLEXIBLE NON-ADJUSTABLE"]
["ALLWAYS HEALTH PARTNERS","V2790 - HC MEMBRANE AMNIOTIC",null,null,null,null,null,null,null,null,"L0140 - CERVICAL SEMI-RIGID ADJUSTAB",null,null,null,null,null,null,"L0140 - CERVICAL SEMI-RIGID ADJUSTAB"]
["BLUE BENEFIT ADMINISTRATORS","45378 - COLON CA SCRN NOT HI RSK IND",null,null,null,null,null,null,null,null,"L1820 - KO ELAS W/ CONDYLE PADS & JO",null,null,null,null,null,null,"L1820 - KO ELAS W/ CONDYLE PADS & JO"]
["BLUE BENEFIT ADMINISTRATORS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",null,null,null,null,null,null,null,null,"L1830 - KO IMMOBILIZER CANVAS LONGIT",null,null,null,null,null,null,"L1830 - KO IMMOBILIZER CANVAS LONGIT"]
["BLUE BENEFIT ADMINISTRATORS","90471 - HC ADMIN PNEUMOCOCCAL VACCINE",null,null,null,null,null,null,null,null,"L1832 - KO ADJ JNT POS RIGID SUPPORT",null,null,null,null,null,null,"L1832 - KO ADJ JNT POS RIGID SUPPORT"]
["BLUE BENEFIT ADMINISTRATORS","92083 - VISUAL FIELD EXAM,EXTENDED",null,null,null,null,null,null,null,null,"L1836 - HC RIGID KO WO JOINTS",null,null,null,null,null,null,"L1836 - HC RIGID KO WO JOINTS"]
["BLUE BENEFIT ADMINISTRATORS","95800 - HOME SLEEP TEST/TYPE 3 PORTA",null,null,null,null,null,null,null,null,"L1902 - AFO ANKLE GAUNTLET",null,null,null,null,null,null,"L1902 - AFO ANKLE GAUNTLET"]
["BLUE BENEFIT ADMINISTRATORS","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",null,null,null,null,null,null,null,null,"L3260 - AMBULATORY SURGICAL BOOT EAC",null,null,null,null,null,null,"L3260 - AMBULATORY SURGICAL BOOT EAC"]
["BLUE BENEFIT ADMINISTRATORS","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA",null,null,null,null,null,null,null,null,"L3350 - SHOE HEEL WEDGE",null,null,null,null,null,null,"L3350 - SHOE HEEL WEDGE"]
["BLUE BENEFIT ADMINISTRATORS","A4561 - HC PESSARY RUBBER, ANY TYPE",null,null,null,null,null,null,null,null,"L3650 - SHLDER FIG 8 ABDUCT RESTRAIN",null,null,null,null,null,null,"L3650 - SHLDER FIG 8 ABDUCT RESTRAIN"]
["BLUE BENEFIT ADMINISTRATORS","A6209 - FOAM DRSG <=16 SQ IN W/O BDR",null,null,null,null,null,null,null,null,"L3670 - ACROMIO/CLAVICULAR CANVAS&WE",null,null,null,null,null,null,"L3670 - ACROMIO/CLAVICULAR CANVAS&WE"]
["BLUE BENEFIT ADMINISTRATORS","A6258 - TRANSPARENT FILM >16<=48 IN",null,null,null,null,null,null,null,null,"L3760 - EO WITHJOINT, PREFABRICATED",null,null,null,null,null,null,"L3760 - EO WITHJOINT, PREFABRICATED"]
["BLUE BENEFIT ADMINISTRATORS","A7520 - TRACH/LARYN TUBE NON-CUFFED",null,null,null,null,null,null,null,null,"L3762 - RIGID EO WO JOINTS",null,null,null,null,null,null,"L3762 - RIGID EO WO JOINTS"]
["BLUE BENEFIT ADMINISTRATORS","A9500 - TC99M SESTAMIBI",null,null,null,null,null,null,null,null,"L3807 - WHFO,NO JOINT, PREFABRICATED",null,null,null,null,null,null,"L3807 - WHFO,NO JOINT, PREFABRICATED"]
["BLUE BENEFIT ADMINISTRATORS","A9502 - HC TC99M TETROFOSMIN",null,null,null,null,null,null,null,null,"L3808 - HC EPITRAIN",null,null,null,null,null,null,"L3808 - HC EPITRAIN"]
["BLUE BENEFIT ADMINISTRATORS","A9503 - TC99M MEDRONATE",null,null,null,null,null,null,null,null,"L3905 - HC WHO W/NONTORSION JNT(S) CF",null,null,null,null,null,null,"L3905 - HC WHO W/NONTORSION JNT(S) CF"]
["BLUE BENEFIT ADMINISTRATORS","A9505 - THALLIUM CHLORIDE PER MCI",null,null,null,null,null,null,null,null,"L3908 - WRIST COCK-UP NON-MOLDED",null,null,null,null,null,null,"L3908 - WRIST COCK-UP NON-MOLDED"]
["BLUE BENEFIT ADMINISTRATORS","A9509 - HC IODINE I-123 PER MCI",null,null,null,null,null,null,null,null,"L3967 - HC SEWHO AIRPLANE W/O JNTS CF",null,null,null,null,null,null,"L3967 - HC SEWHO AIRPLANE W/O JNTS CF"]
["BLUE BENEFIT ADMINISTRATORS","A9513 - TECHNETIUM TC-99M MEBROFENIN",null,null,null,null,null,null,null,null,"L3980 - HC UPP EXT FX ORTHOSIS HUMERAL",null,null,null,null,null,null,"L3980 - HC UPP EXT FX ORTHOSIS HUMERAL"]
["BLUE BENEFIT ADMINISTRATORS","A9516 - I123 IODIDE CAP, DX",null,null,null,null,null,null,null,null,"L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL",null,null,null,null,null,null,"L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL"]
["BLUE BENEFIT ADMINISTRATORS","A9517 - I131 IODIDE CAP, RX",null,null,null,null,null,null,null,null,"L4350 - ANKLE CONTROL ORTHOSI PREFAB",null,null,null,null,null,null,"L4350 - ANKLE CONTROL ORTHOSI PREFAB"]
["BLUE BENEFIT ADMINISTRATORS","A9521 - TC99M EXAMETAZIME",null,null,null,null,null,null,null,null,"L4360 - PNEUMATI WALKING BOOT PREFAB",null,null,null,null,null,null,"L4360 - PNEUMATI WALKING BOOT PREFAB"]
["BLUE BENEFIT ADMINISTRATORS","A9537 - TC99M MEBROFENIN",null,null,null,null,null,null,null,null,"L4370 - HC PNEUMATIC FULL LEG SPLINT",null,null,null,null,null,null,"L4370 - HC PNEUMATIC FULL LEG SPLINT"]
["BLUE BENEFIT ADMINISTRATORS","A9538 - TC99M PYROPHOSPHATE",null,null,null,null,null,null,null,null,"L4386 - NON-PNEUM WALK BOOT PREFAB",null,null,null,null,null,null,"L4386 - NON-PNEUM WALK BOOT PREFAB"]
["BLUE BENEFIT ADMINISTRATORS","A9539 - TC99M PENTETATE",null,null,null,null,null,null,null,null,"L4396 - STATIC AFO",null,null,null,null,null,null,"L4396 - STATIC AFO"]
["BLUE BENEFIT ADMINISTRATORS","A9540 - TC99M MAA",null,null,null,null,null,null,null,null,"L4398 - HC FOOT DROP SPLINT RECUMBENT",null,null,null,null,null,null,"L4398 - HC FOOT DROP SPLINT RECUMBENT"]
["BLUE BENEFIT ADMINISTRATORS","A9541 - TC99M SULFUR COLLOID",null,null,null,null,null,null,null,null,"L8501 - TRACHEOSTOMY SPEAKING VALVE",null,null,null,null,null,null,"L8501 - TRACHEOSTOMY SPEAKING VALVE"]
["BLUE BENEFIT ADMINISTRATORS","A9543 - Y90 IBRITUMOMAB, RX",null,null,null,null,null,null,null,null,"L8507 - HC PROLARYNX VOICE (PLUS)",null,null,null,null,null,null,"L8507 - HC PROLARYNX VOICE (PLUS)"]
["BLUE BENEFIT ADMINISTRATORS","A9547 - IN111 OXYQUINOLINE",null,null,null,null,null,null,null,null,"L8509 - TRACH-ESOPH VOICE PROS MD IN",null,null,null,null,null,null,"L8509 - TRACH-ESOPH VOICE PROS MD IN"]
["BLUE BENEFIT ADMINISTRATORS","A9551 - HC TC99M SUCCIMER/10MCI,DX",null,null,null,null,null,null,null,null,"L8514 - REPL TRACH PUNCTURE DILATOR",null,null,null,null,null,null,"L8514 - REPL TRACH PUNCTURE DILATOR"]
["BLUE BENEFIT ADMINISTRATORS","A9552 - F18 FDG",null,null,null,null,null,null,null,null,"L8693 - HC AUD OSSEO DEV, ABUTMENT",null,null,null,null,null,null,"L8693 - HC AUD OSSEO DEV, ABUTMENT"]
["BLUE BENEFIT ADMINISTRATORS","A9555 - RADIOPHARMACIAL",null,null,null,null,null,null,null,null,"L8699 - HC CARTIFORM 20 X 25 MM DISC",null,null,null,null,null,null,"L8699 - HC CARTIFORM 20 X 25 MM DISC"]
["BLUE BENEFIT ADMINISTRATORS","A9556 - GA67 GALLIUM",null,null,null,null,null,null,null,null,"P9012 - HC CRYOPRECIPITATE UNIT",null,null,null,null,null,null,"M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING"]
["BLUE BENEFIT ADMINISTRATORS","A9557 - TC99M BICISATE",null,null,null,null,null,null,null,null,"P9016 - HC RBC:LEU-RED",null,null,null,null,null,null,"M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG"]
["BLUE BENEFIT ADMINISTRATORS","A9558 - HC XENON133/10MCI",null,null,null,null,null,null,null,null,"P9017 - HC FF PLAS: 1 DONOR",null,null,null,null,null,null,"P9012 - HC CRYOPRECIPITATE UNIT"]
["BLUE BENEFIT ADMINISTRATORS","A9560 - TC99M LABELED RBC",null,null,null,null,null,null,null,null,"P9021 - HC RBC/UNIT",null,null,null,null,null,null,"P9016 - HC RBC:LEU-RED"]
["BLUE BENEFIT ADMINISTRATORS","A9561 - TC99M OXIDRONATE",null,null,null,null,null,null,null,null,"P9034 - HB PLATELETS, PHERESIS",null,null,null,null,null,null,"P9017 - HC FF PLAS: 1 DONOR"]
["BLUE BENEFIT ADMINISTRATORS","A9562 - TC99M MERTIATIDE",null,null,null,null,null,null,null,null,"P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT",null,null,null,null,null,null,"P9021 - HC RBC/UNIT"]
["BLUE BENEFIT ADMINISTRATORS","A9563 - P32 NA PHOSPHATE",null,null,null,null,null,null,null,null,"P9040 - HC RBC:LEU-RED,IRR/UNIT",null,null,null,null,null,null,"P9034 - HB PLATELETS, PHERESIS"]
["BLUE BENEFIT ADMINISTRATORS","A9569 - TECHNETIUM TC-99M AUTO WBC",null,null,null,null,null,null,null,null,"P9044 - HC CRYOPRECIPITATE REDUCED PLASMA",null,null,null,null,null,null,"P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT"]
["BLUE BENEFIT ADMINISTRATORS","A9572 - INDIUM IN-111 PENTETREOTIDE",null,null,null,null,null,null,null,null,"P9045 - HC ALBUMIN (HUMAN) 5% 250ML",null,null,null,null,null,null,"P9040 - HC RBC:LEU-RED,IRR/UNIT"]
["BLUE BENEFIT ADMINISTRATORS","A9575 - INJ GADOTERATE MEGLUMI 0.1ML",null,null,null,null,null,null,null,null,"P9047 - HC ALBUMIN (HUMAN) 25% 50ML",null,null,null,null,null,null,"P9044 - HC CRYOPRECIPITATE REDUCED PLASMA"]
["BLUE BENEFIT ADMINISTRATORS","A9576 - HC PROHANCE IV CONTRAST PER ML",null,null,null,null,null,null,null,null,"P9056 - HC BLOOD, L/R, IRRADIATED",null,null,null,null,null,null,"P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["BLUE BENEFIT ADMINISTRATORS","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML",null,null,null,null,null,null,null,null,"P9057 - HC RBC:LEU RED,FR/DE/WASH,IR",null,null,null,null,null,null,"P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["BLUE BENEFIT ADMINISTRATORS","A9579 - GAD-BASE MR CONTRAST NOS,1ML",null,null,null,null,null,null,null,null,"P9073 - HC PLATELETS PHERESIS PATH REDU",null,null,null,null,null,null,"P9056 - HC BLOOD, L/R, IRRADIATED"]
["BLUE BENEFIT ADMINISTRATORS","A9581 - GADOXETATE DISODIUM INJ",null,null,null,null,null,null,null,null,"P9100 - PATHOGEN TEST FOR PLATELETS",null,null,null,null,null,null,"P9057 - HC RBC:LEU RED,FR/DE/WASH,IR"]
["BLUE BENEFIT ADMINISTRATORS","A9583 - GADOFOSVESET TRISODIUM INJ",null,null,null,null,null,null,null,null,"P9612 - CATHETERIZE FOR URINE SPEC",null,null,null,null,null,null,"P9073 - HC PLATELETS PHERESIS PATH REDU"]
["BLUE BENEFIT ADMINISTRATORS","A9584 - IODINE I-123 IOFLUPANE",null,null,null,null,null,null,null,null,"Q0091 - HC OBTAINING SCREEN PAP SMEAR",null,null,null,null,null,null,"P9100 - PATHOGEN TEST FOR PLATELETS"]
["BLUE BENEFIT ADMINISTRATORS","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",null,null,null,null,null,null,null,null,"Q0111 - HC WET MOUNTS W PREPARATIONS",null,null,null,null,null,null,"P9612 - CATHETERIZE FOR URINE SPEC"]
["BLUE BENEFIT ADMINISTRATORS","A9587 - GALLIUM GA-68",null,null,null,null,null,null,null,null,"Q0114 - HC  FERN TEST",null,null,null,null,null,null,"Q0091 - HC OBTAINING SCREEN PAP SMEAR"]
["BLUE BENEFIT ADMINISTRATORS","A9588 - FLUCICLOVINE F-18",null,null,null,null,null,null,null,null,"Q3014 - HC TELEHEALTH FACILITY FEE",null,null,null,null,null,null,"Q0111 - HC WET MOUNTS W PREPARATIONS"]
["BLUE BENEFIT ADMINISTRATORS","A9606 - RADIUM RA223 DICHLORIDE THER",null,null,null,null,null,null,null,null,"Q4100 - STRAVIX 3X6",null,null,null,null,null,null,"Q0114 - HC  FERN TEST"]
["BLUE BENEFIT ADMINISTRATORS","C1717 - HC BRACHYTX, NON-STR,HDR IR-192",null,null,null,null,null,null,null,null,"Q4101 - APLIGRAF",null,null,null,null,null,null,"Q3014 - HC TELEHEALTH FACILITY FEE"]
["BLUE BENEFIT ADMINISTRATORS","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE",null,null,null,null,null,null,null,null,"Q4102 - OASIS WOUND MATRIX",null,null,null,null,null,null,"Q4100 - STRAVIX 3X6"]
["BLUE BENEFIT ADMINISTRATORS","C2635 - BRACHYTX, NON-STR, HA, P-103",null,null,null,null,null,null,null,null,"Q4104 - INTEGRA BMWD",null,null,null,null,null,null,"Q4101 - APLIGRAF"]
["BLUE BENEFIT ADMINISTRATORS","C2639 - BRACHYTX, NON-STRANDED,I-125",null,null,null,null,null,null,null,null,"Q4107 - GRAFTJACKET",null,null,null,null,null,null,"Q4102 - OASIS WOUND MATRIX"]
["BLUE BENEFIT ADMINISTRATORS","C5275 - HC LOW COST SKIN SUBSTITUTE",null,null,null,null,null,null,null,null,"Q4112 - CYMETRA INJECTABLE",null,null,null,null,null,null,"Q4104 - INTEGRA BMWD"]
["BLUE BENEFIT ADMINISTRATORS","C8908 - HC MRI W/O FOL W/CONT, BREAST,",null,null,null,null,null,null,null,null,"Q4116 - HC ALLODERM 8 X 16 MEDIUM",null,null,null,null,null,null,"Q4107 - GRAFTJACKET"]
["BLUE BENEFIT ADMINISTRATORS","C9358 - SURGIMEND, FETAL",null,null,null,null,null,null,null,null,"Q4124 - OASIS TRILAYER/1 SQCM",null,null,null,null,null,null,"Q4112 - CYMETRA INJECTABLE"]
["BLUE BENEFIT ADMINISTRATORS","C9728 - PLACE DEVICE/MARKER, NON PRO",null,null,null,null,null,null,null,null,"Q4125 - HC AFLEX401 ¿ 40 X 70 MM",null,null,null,null,null,null,"Q4116 - HC ALLODERM 8 X 16 MEDIUM"]
["BLUE BENEFIT ADMINISTRATORS","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3",null,null,null,null,null,null,null,null,"Q4130 - PR STRATTICE TM",null,null,null,null,null,null,"Q4124 - OASIS TRILAYER/1 SQCM"]
["BLUE BENEFIT ADMINISTRATORS","D0210 - INTRAORAL - COMPLETE SERIES OF RADIOGRAPHIC IMAGES",null,null,null,null,null,null,null,null,"Q4132 - HC GRAFIX CORE 5X5CM",null,null,null,null,null,null,"Q4125 - HC AFLEX401 ¿ 40 X 70 MM"]
["BLUE BENEFIT ADMINISTRATORS","D0220 - INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE",null,null,null,null,null,null,null,null,"Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",null,null,null,null,null,null,"Q4130 - PR STRATTICE TM"]
["BLUE BENEFIT ADMINISTRATORS","D0230 - INTRAORAL - PERIAPICAL EACH ADDITIONAL RADIOGRAPHIC IMAGE",null,null,null,null,null,null,null,null,"Q4196 - HC PURAPLYAM-COM 6X9 CM",null,null,null,null,null,null,"Q4132 - HC GRAFIX CORE 5X5CM"]
["BLUE BENEFIT ADMINISTRATORS","D0272 - BITEWINGS - TWO RADIOGRAPHIC IMAGES",null,null,null,null,null,null,null,null,"Q9954 - ORAL MR CONTRAST, 100 ML",null,null,null,null,null,null,"Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["BLUE BENEFIT ADMINISTRATORS","D0274 - BITEWINGS - FOUR RADIOGRAPHIC IMAGES",null,null,null,null,null,null,null,null,"Q9956 - HC INJ;OCTAFLUORO MICRO/1ML",null,null,null,null,null,null,"Q4196 - HC PURAPLYAM-COM 6X9 CM"]
["BLUE BENEFIT ADMINISTRATORS","D1110 - PROPHYLAXIS - ADULT",null,null,null,null,null,null,null,null,"Q9957 - HC INJ;PERFLUTR LIP MIC/1ML",null,null,null,null,null,null,"Q9954 - ORAL MR CONTRAST, 100 ML"]
["BLUE BENEFIT ADMINISTRATORS","D1120 - PROPHYLAXIS - CHILD",null,null,null,null,null,null,null,null,"Q9958 - HOCM <=149 MG/ML IODINE, 1ML",null,null,null,null,null,null,"Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["BLUE BENEFIT ADMINISTRATORS","D1351 - SEALANT - PER TOOTH",null,null,null,null,null,null,null,null,"Q9961 - HOCM 250-299MG/ML IODINE,1ML",null,null,null,null,null,null,"Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["BLUE BENEFIT ADMINISTRATORS","D2140 - AMALGAM - ONE SURFACE, PRIMARY OR PERMANENT",null,null,null,null,null,null,null,null,"Q9963 - HOCM 350-399MG/ML IODINE,1ML",null,null,null,null,null,null,"Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["BLUE BENEFIT ADMINISTRATORS","D2150 - AMALGAM - TWO SURFACES, PRIMARY OR PERMANENT",null,null,null,null,null,null,null,null,"Q9966 - LOCM 200-299MG/ML IODINE,1ML",null,null,null,null,null,null,"Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["BLUE BENEFIT ADMINISTRATORS","D2160 - AMALGAM - THREE SURFACES, PRIMARY OR PERMANENT",null,null,null,null,null,null,null,null,"Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,null,null,null,null,null,"Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["BLUE BENEFIT ADMINISTRATORS","D2161 - AMALGAM - FOUR OR MORE SURFACES, PRIMARY OR PERMANENT",null,null,null,null,null,null,null,null,"S2083 - HC ADJUSTMENT GASTRIC BAND",null,null,null,null,null,null,"Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["BLUE BENEFIT ADMINISTRATORS","D2330 - RESIN-BASED COMPOSITE - ONE SURFACE, ANTERIOR",null,null,null,null,null,null,null,null,"S8037 - MRCP",null,null,null,null,null,null,"Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["BLUE BENEFIT ADMINISTRATORS","D2331 - RESIN-BASED COMPOSITE - TWO SURFACES, ANTERIOR",null,null,null,null,null,null,null,null,"U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",null,null,null,null,null,null,"S2083 - HC ADJUSTMENT GASTRIC BAND"]
["BLUE BENEFIT ADMINISTRATORS","D2332 - RESIN-BASED COMPOSITE - THREE SURFACES, ANTERIOR",null,null,null,null,null,null,null,null,"U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",null,null,null,null,null,null,"S8037 - MRCP"]
["BLUE BENEFIT ADMINISTRATORS","D2335 - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR)",null,null,null,null,null,null,null,null,"V2785 - CORNEAL TISSUE PROCESSING",null,null,null,null,null,null,"U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH"]
["BLUE BENEFIT ADMINISTRATORS","D2390 - RESIN-BASED COMPOSITE CROWN, ANTERIOR",null,null,null,null,null,null,null,null,"V2790 - HC MEMBRANE AMNIOTIC",null,null,null,null,null,null,"U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP"]
["BLUE BENEFIT ADMINISTRATORS","D2391 - RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"V2785 - CORNEAL TISSUE PROCESSING"]
["BLUE BENEFIT ADMINISTRATORS","D2392 - RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"V2790 - HC MEMBRANE AMNIOTIC"]
["BLUE BENEFIT ADMINISTRATORS","D2393 - RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR"]
["BLUE BENEFIT ADMINISTRATORS","D2394 - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR"]
["BLUE BENEFIT ADMINISTRATORS","D2740 - CROWN - PORCELAIN/CERAMIC SUBSTRATE"]
["BLUE BENEFIT ADMINISTRATORS","D2930 - PREFABRICATED STAINLESS STEEL CROWN - PRIMARY TOOTH"]
["BLUE BENEFIT ADMINISTRATORS","D2931 - PREFABRICATED STAINLESS STEEL CROWN - PERMANENT TOOTH"]
["BLUE BENEFIT ADMINISTRATORS","D2940 - PROTECTIVE RESTORATION"]
["BLUE BENEFIT ADMINISTRATORS","D3110 - HC PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION)"]
["BLUE BENEFIT ADMINISTRATORS","D3220 - THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) - REMOVAL OF PULP CORONAL TO THE DENTINOCEMENTAL JUNCTION AND APPLICATION OF MEDICAMENT"]
["BLUE BENEFIT ADMINISTRATORS","D3310 - ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION)"]
["BLUE BENEFIT ADMINISTRATORS","D3330 - ENDODONTIC THERAPY, MOLAR (EXCLUDING FINAL RESTORATION)"]
["BLUE BENEFIT ADMINISTRATORS","D7140 - EXTRACTION ERUPTED TOOTH/EXR"]
["BLUE BENEFIT ADMINISTRATORS","D7210 - EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED"]
["BLUE BENEFIT ADMINISTRATORS","D7220 - REMOVAL OF IMPACTED TOOTH - SOFT TISSUE"]
["BLUE BENEFIT ADMINISTRATORS","D7230 - REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY"]
["BLUE BENEFIT ADMINISTRATORS","D7240 - REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY"]
["BLUE BENEFIT ADMINISTRATORS","D7250 - REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)"]
["BLUE BENEFIT ADMINISTRATORS","D7310 - ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH SPACES, PER QUADRANT"]
["BLUE BENEFIT ADMINISTRATORS","D7311 - ALVEOLOPLASTY W/EXTRACT 1-3"]
["BLUE BENEFIT ADMINISTRATORS","D7410 - EXCISION OF BENIGN LESION UP TO 1.25 CM"]
["BLUE BENEFIT ADMINISTRATORS","G0101 - CA SCREEN;PELVIC/BREAST EXAM"]
["BLUE BENEFIT ADMINISTRATORS","G0103 - PSA, TOTAL SCREENING"]
["BLUE BENEFIT ADMINISTRATORS","G0105 - HC COLORECTAL SCRN; HI RISK IND"]
["BLUE BENEFIT ADMINISTRATORS","G0108 - DIAB MANAGE TRN  PER INDIV"]
["BLUE BENEFIT ADMINISTRATORS","G0109 - DIAB MANAGE TRN IND/GROUP"]
["BLUE BENEFIT ADMINISTRATORS","G0127 - TRIM NAIL(S)"]
["BLUE BENEFIT ADMINISTRATORS","G0239 - OTH RESP PROC, GROUP"]
["BLUE BENEFIT ADMINISTRATORS","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP"]
["BLUE BENEFIT ADMINISTRATORS","G0260 - INJ FOR SACROILIAC JT ANESTH"]
["BLUE BENEFIT ADMINISTRATORS","G0278 - ILIAC ART ANGIO,CARDIAC CATH"]
["BLUE BENEFIT ADMINISTRATORS","G0279 - TOMOSYNTHESIS, MAMMO"]
["BLUE BENEFIT ADMINISTRATORS","G0296 - HC VISIT TO DETERM LDCT ELIG"]
["BLUE BENEFIT ADMINISTRATORS","G0297 - HC LDCT FOR LUNG CA SCREEN"]
["BLUE BENEFIT ADMINISTRATORS","G0390 - TRAUMA RESPONS W/HOSP CRITI"]
["BLUE BENEFIT ADMINISTRATORS","G0396 - ALCOHOL/SUBS INTERV 15-30MN"]
["BLUE BENEFIT ADMINISTRATORS","G0397 - ALCOHOL/SUBS INTERV >30 MIN"]
["BLUE BENEFIT ADMINISTRATORS","G0416 - HC PROSTATE BIOPSY ANY MTHD"]
["BLUE BENEFIT ADMINISTRATORS","G0422 - HC INTENS CARDIAC REHAB W/EXERC"]
["BLUE BENEFIT ADMINISTRATORS","G0423 - HC INTENS CARDIAC REHAB NO EXER"]
["BLUE BENEFIT ADMINISTRATORS","G0424 - PULMONARY REHAB W EXER"]
["BLUE BENEFIT ADMINISTRATORS","G0480 - DRUG TEST DEF 1-7 CLASSES"]
["BLUE BENEFIT ADMINISTRATORS","G0481 - DRUG TEST DEF 8-14 CLASSES"]
["BLUE BENEFIT ADMINISTRATORS","G0506 - HC COMP ASSESS CARE PLAN CCM SVC"]
["BLUE BENEFIT ADMINISTRATORS","G0513 - HC PROLONG PREV SVCS, FIRST 30M"]
["BLUE BENEFIT ADMINISTRATORS","G0514 - HC PROLONG PREV SVCS, ADDL 30M"]
["BLUE BENEFIT ADMINISTRATORS","G2011 - ALCOHOL/SUB ABUSE ASSESS"]
["BLUE BENEFIT ADMINISTRATORS","G2012 - HC BRIEF CHECK IN BY MD/QHP"]
["BLUE BENEFIT ADMINISTRATORS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS"]
["BLUE BENEFIT ADMINISTRATORS","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA"]
["BLUE BENEFIT ADMINISTRATORS","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH"]
["BLUE BENEFIT ADMINISTRATORS","G2086 - HC OFF BASE OPIOID TX 70MIN"]
["BLUE BENEFIT ADMINISTRATORS","G2087 - HC OFF BASE OPIOID TX, 60 M"]
["BLUE BENEFIT ADMINISTRATORS","G2088 - HC OFF BASE OPIOID TX, ADD30"]
["BLUE BENEFIT ADMINISTRATORS","J0702 - HC BETAMETHASONE ACET&SOD PHOSP"]
["BLUE BENEFIT ADMINISTRATORS","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)"]
["BLUE BENEFIT ADMINISTRATORS","J1250 - HC DOBUTAMINE SDV/250MG"]
["BLUE BENEFIT ADMINISTRATORS","J2790 - HC IG;RHO D,HUMAN/300MCG"]
["BLUE BENEFIT ADMINISTRATORS","J3301 - HC TRIAMCINOLONE ACET INJ NOS"]
["BLUE BENEFIT ADMINISTRATORS","J7307 - HC ETONOGESTREL IMPLANT SYSTEM"]
["BLUE BENEFIT ADMINISTRATORS","L0120 - CERV FLEXIBLE NON-ADJUSTABLE"]
["BLUE BENEFIT ADMINISTRATORS","L1820 - KO ELAS W/ CONDYLE PADS & JO"]
["BLUE BENEFIT ADMINISTRATORS","L1830 - KO IMMOBILIZER CANVAS LONGIT"]
["BLUE BENEFIT ADMINISTRATORS","L1832 - KO ADJ JNT POS RIGID SUPPORT"]
["BLUE BENEFIT ADMINISTRATORS","L1836 - HC RIGID KO WO JOINTS"]
["BLUE BENEFIT ADMINISTRATORS","L1902 - AFO ANKLE GAUNTLET"]
["BLUE BENEFIT ADMINISTRATORS","L3260 - AMBULATORY SURGICAL BOOT EAC"]
["BLUE BENEFIT ADMINISTRATORS","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN"]
["BLUE BENEFIT ADMINISTRATORS","L3670 - ACROMIO/CLAVICULAR CANVAS&WE"]
["BLUE BENEFIT ADMINISTRATORS","L3760 - EO WITHJOINT, PREFABRICATED"]
["BLUE BENEFIT ADMINISTRATORS","L3807 - WHFO,NO JOINT, PREFABRICATED"]
["BLUE BENEFIT ADMINISTRATORS","L3808 - HC EPITRAIN"]
["BLUE BENEFIT ADMINISTRATORS","L3905 - HC WHO W/NONTORSION JNT(S) CF"]
["BLUE BENEFIT ADMINISTRATORS","L3908 - WRIST COCK-UP NON-MOLDED"]
["BLUE BENEFIT ADMINISTRATORS","L3967 - HC SEWHO AIRPLANE W/O JNTS CF"]
["BLUE BENEFIT ADMINISTRATORS","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL"]
["BLUE BENEFIT ADMINISTRATORS","L4350 - ANKLE CONTROL ORTHOSI PREFAB"]
["BLUE BENEFIT ADMINISTRATORS","L4360 - PNEUMATI WALKING BOOT PREFAB"]
["BLUE BENEFIT ADMINISTRATORS","L4386 - NON-PNEUM WALK BOOT PREFAB"]
["BLUE BENEFIT ADMINISTRATORS","L4396 - STATIC AFO"]
["BLUE BENEFIT ADMINISTRATORS","L4398 - HC FOOT DROP SPLINT RECUMBENT"]
["BLUE BENEFIT ADMINISTRATORS","L8509 - TRACH-ESOPH VOICE PROS MD IN"]
["BLUE BENEFIT ADMINISTRATORS","L8693 - HC AUD OSSEO DEV, ABUTMENT"]
["BLUE BENEFIT ADMINISTRATORS","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING"]
["BLUE BENEFIT ADMINISTRATORS","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG"]
["BLUE BENEFIT ADMINISTRATORS","P9012 - HC CRYOPRECIPITATE UNIT"]
["BLUE BENEFIT ADMINISTRATORS","P9016 - HC RBC:LEU-RED"]
["BLUE BENEFIT ADMINISTRATORS","P9017 - HC FF PLAS: 1 DONOR"]
["BLUE BENEFIT ADMINISTRATORS","P9021 - HC RBC/UNIT"]
["BLUE BENEFIT ADMINISTRATORS","P9034 - HB PLATELETS, PHERESIS"]
["BLUE BENEFIT ADMINISTRATORS","P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT"]
["BLUE BENEFIT ADMINISTRATORS","P9040 - HC RBC:LEU-RED,IRR/UNIT"]
["BLUE BENEFIT ADMINISTRATORS","P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["BLUE BENEFIT ADMINISTRATORS","P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["BLUE BENEFIT ADMINISTRATORS","P9073 - HC PLATELETS PHERESIS PATH REDU"]
["BLUE BENEFIT ADMINISTRATORS","P9100 - PATHOGEN TEST FOR PLATELETS"]
["BLUE BENEFIT ADMINISTRATORS","P9612 - CATHETERIZE FOR URINE SPEC"]
["BLUE BENEFIT ADMINISTRATORS","Q0091 - HC OBTAINING SCREEN PAP SMEAR"]
["BLUE BENEFIT ADMINISTRATORS","Q0111 - HC WET MOUNTS W PREPARATIONS"]
["BLUE BENEFIT ADMINISTRATORS","Q0114 - HC  FERN TEST"]
["BLUE BENEFIT ADMINISTRATORS","Q4101 - APLIGRAF"]
["BLUE BENEFIT ADMINISTRATORS","Q4102 - OASIS WOUND MATRIX"]
["BLUE BENEFIT ADMINISTRATORS","Q4104 - INTEGRA BMWD"]
["BLUE BENEFIT ADMINISTRATORS","Q4107 - GRAFTJACKET"]
["BLUE BENEFIT ADMINISTRATORS","Q4112 - CYMETRA INJECTABLE"]
["BLUE BENEFIT ADMINISTRATORS","Q4116 - HC ALLODERM 8 X 16 MEDIUM"]
["BLUE BENEFIT ADMINISTRATORS","Q4124 - OASIS TRILAYER/1 SQCM"]
["BLUE BENEFIT ADMINISTRATORS","Q4125 - HC AFLEX401 ¿ 40 X 70 MM"]
["BLUE BENEFIT ADMINISTRATORS","Q4130 - PR STRATTICE TM"]
["BLUE BENEFIT ADMINISTRATORS","Q4132 - HC GRAFIX CORE 5X5CM"]
["BLUE BENEFIT ADMINISTRATORS","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["BLUE BENEFIT ADMINISTRATORS","Q9954 - ORAL MR CONTRAST, 100 ML"]
["BLUE BENEFIT ADMINISTRATORS","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["BLUE BENEFIT ADMINISTRATORS","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["BLUE BENEFIT ADMINISTRATORS","Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["BLUE BENEFIT ADMINISTRATORS","Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["BLUE BENEFIT ADMINISTRATORS","Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["BLUE BENEFIT ADMINISTRATORS","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["BLUE BENEFIT ADMINISTRATORS","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["BLUE BENEFIT ADMINISTRATORS","S8037 - MRCP"]
["BLUE BENEFIT ADMINISTRATORS","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH"]
["BLUE BENEFIT ADMINISTRATORS","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP"]
["BLUE CROSS","45378 - COLON CA SCRN NOT HI RSK IND"]
["BLUE CROSS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS"]
["BLUE CROSS","90471 - HC ADMIN PNEUMOCOCCAL VACCINE"]
["BLUE CROSS","92083 - VISUAL FIELD EXAM,EXTENDED"]
["BLUE CROSS","95800 - HOME SLEEP TEST/TYPE 3 PORTA"]
["BLUE CROSS","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME"]
["BLUE CROSS","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA"]
["BLUE CROSS","A4561 - HC PESSARY RUBBER, ANY TYPE"]
["BLUE CROSS","A4562 - PESSARY NONRUBBER"]
["BLUE CROSS","A6209 - FOAM DRSG <=16 SQ IN W/O BDR"]
["BLUE CROSS","A6258 - TRANSPARENT FILM >16<=48 IN"]
["BLUE CROSS","A6550 - NEG PRES WOUND THER DRSG SET"]
["BLUE CROSS","A7520 - TRACH/LARYN TUBE NON-CUFFED"]
["BLUE CROSS","A9500 - TC99M SESTAMIBI"]
["BLUE CROSS","A9502 - HC TC99M TETROFOSMIN"]
["BLUE CROSS","A9503 - TC99M MEDRONATE"]
["BLUE CROSS","A9505 - THALLIUM CHLORIDE PER MCI"]
["BLUE CROSS","A9509 - HC IODINE I-123 PER MCI"]
["BLUE CROSS","A9513 - TECHNETIUM TC-99M MEBROFENIN"]
["BLUE CROSS","A9516 - I123 IODIDE CAP, DX"]
["BLUE CROSS","A9517 - I131 IODIDE CAP, RX"]
["BLUE CROSS","A9521 - TC99M EXAMETAZIME"]
["BLUE CROSS","A9537 - TC99M MEBROFENIN"]
["BLUE CROSS","A9538 - TC99M PYROPHOSPHATE"]
["BLUE CROSS","A9539 - TC99M PENTETATE"]
["BLUE CROSS","A9540 - TC99M MAA"]
["BLUE CROSS","A9541 - TC99M SULFUR COLLOID"]
["BLUE CROSS","A9543 - Y90 IBRITUMOMAB, RX"]
["BLUE CROSS","A9547 - IN111 OXYQUINOLINE"]
["BLUE CROSS","A9551 - HC TC99M SUCCIMER/10MCI,DX"]
["BLUE CROSS","A9552 - F18 FDG"]
["BLUE CROSS","A9555 - RADIOPHARMACIAL"]
["BLUE CROSS","A9556 - GA67 GALLIUM"]
["BLUE CROSS","A9557 - TC99M BICISATE"]
["BLUE CROSS","A9558 - HC XENON133/10MCI"]
["BLUE CROSS","A9560 - TC99M LABELED RBC"]
["BLUE CROSS","A9561 - TC99M OXIDRONATE"]
["BLUE CROSS","A9562 - TC99M MERTIATIDE"]
["BLUE CROSS","A9563 - P32 NA PHOSPHATE"]
["BLUE CROSS","A9569 - TECHNETIUM TC-99M AUTO WBC"]
["BLUE CROSS","A9572 - INDIUM IN-111 PENTETREOTIDE"]
["BLUE CROSS","A9575 - INJ GADOTERATE MEGLUMI 0.1ML"]
["BLUE CROSS","A9576 - HC PROHANCE IV CONTRAST PER ML"]
["BLUE CROSS","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML"]
["BLUE CROSS","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["BLUE CROSS","A9581 - GADOXETATE DISODIUM INJ"]
["BLUE CROSS","A9583 - GADOFOSVESET TRISODIUM INJ"]
["BLUE CROSS","A9584 - IODINE I-123 IOFLUPANE"]
["BLUE CROSS","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE"]
["BLUE CROSS","A9587 - GALLIUM GA-68"]
["BLUE CROSS","A9588 - FLUCICLOVINE F-18"]
["BLUE CROSS","A9606 - RADIUM RA223 DICHLORIDE THER"]
["BLUE CROSS","C1717 - HC BRACHYTX, NON-STR,HDR IR-192"]
["BLUE CROSS","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE"]
["BLUE CROSS","C2635 - BRACHYTX, NON-STR, HA, P-103"]
["BLUE CROSS","C2639 - BRACHYTX, NON-STRANDED,I-125"]
["BLUE CROSS","C5275 - HC LOW COST SKIN SUBSTITUTE"]
["BLUE CROSS","C8908 - HC MRI W/O FOL W/CONT, BREAST,"]
["BLUE CROSS","C9358 - SURGIMEND, FETAL"]
["BLUE CROSS","C9728 - PLACE DEVICE/MARKER, NON PRO"]
["BLUE CROSS","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3"]
["BLUE CROSS","D0210 - INTRAORAL - COMPLETE SERIES OF RADIOGRAPHIC IMAGES"]
["BLUE CROSS","D0220 - INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE"]
["BLUE CROSS","D0230 - INTRAORAL - PERIAPICAL EACH ADDITIONAL RADIOGRAPHIC IMAGE"]
["BLUE CROSS","D0272 - BITEWINGS - TWO RADIOGRAPHIC IMAGES"]
["BLUE CROSS","D0274 - BITEWINGS - FOUR RADIOGRAPHIC IMAGES"]
["BLUE CROSS","D1110 - PROPHYLAXIS - ADULT"]
["BLUE CROSS","D1120 - PROPHYLAXIS - CHILD"]
["BLUE CROSS","D1351 - SEALANT - PER TOOTH"]
["BLUE CROSS","D2140 - AMALGAM - ONE SURFACE, PRIMARY OR PERMANENT"]
["BLUE CROSS","D2150 - AMALGAM - TWO SURFACES, PRIMARY OR PERMANENT"]
["BLUE CROSS","D2160 - AMALGAM - THREE SURFACES, PRIMARY OR PERMANENT"]
["BLUE CROSS","D2161 - AMALGAM - FOUR OR MORE SURFACES, PRIMARY OR PERMANENT"]
["BLUE CROSS","D2330 - RESIN-BASED COMPOSITE - ONE SURFACE, ANTERIOR"]
["BLUE CROSS","D2331 - RESIN-BASED COMPOSITE - TWO SURFACES, ANTERIOR"]
["BLUE CROSS","D2332 - RESIN-BASED COMPOSITE - THREE SURFACES, ANTERIOR"]
["BLUE CROSS","D2335 - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR)"]
["BLUE CROSS","D2390 - RESIN-BASED COMPOSITE CROWN, ANTERIOR"]
["BLUE CROSS","D2391 - RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR"]
["BLUE CROSS","D2392 - RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR"]
["BLUE CROSS","D2393 - RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR"]
["BLUE CROSS","D2394 - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR"]
["BLUE CROSS","D2740 - CROWN - PORCELAIN/CERAMIC SUBSTRATE"]
["BLUE CROSS","D2930 - PREFABRICATED STAINLESS STEEL CROWN - PRIMARY TOOTH"]
["BLUE CROSS","D2931 - PREFABRICATED STAINLESS STEEL CROWN - PERMANENT TOOTH"]
["BLUE CROSS","D2940 - PROTECTIVE RESTORATION"]
["BLUE CROSS","D3110 - HC PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION)"]
["BLUE CROSS","D3220 - THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) - REMOVAL OF PULP CORONAL TO THE DENTINOCEMENTAL JUNCTION AND APPLICATION OF MEDICAMENT"]
["BLUE CROSS","D3310 - ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION)"]
["BLUE CROSS","D3330 - ENDODONTIC THERAPY, MOLAR (EXCLUDING FINAL RESTORATION)"]
["BLUE CROSS","D7140 - EXTRACTION ERUPTED TOOTH/EXR"]
["BLUE CROSS","D7210 - EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED"]
["BLUE CROSS","D7220 - REMOVAL OF IMPACTED TOOTH - SOFT TISSUE"]
["BLUE CROSS","D7230 - REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY"]
["BLUE CROSS","D7240 - REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY"]
["BLUE CROSS","D7250 - REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)"]
["BLUE CROSS","D7310 - ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH SPACES, PER QUADRANT"]
["BLUE CROSS","D7311 - ALVEOLOPLASTY W/EXTRACT 1-3"]
["BLUE CROSS","D7410 - EXCISION OF BENIGN LESION UP TO 1.25 CM"]
["BLUE CROSS","E0191 - PROTECTOR HEEL OR ELBOW"]
["BLUE CROSS","G0101 - CA SCREEN;PELVIC/BREAST EXAM"]
["BLUE CROSS","G0103 - PSA, TOTAL SCREENING"]
["BLUE CROSS","G0105 - HC COLORECTAL SCRN; HI RISK IND"]
["BLUE CROSS","G0108 - DIAB MANAGE TRN  PER INDIV"]
["BLUE CROSS","G0109 - DIAB MANAGE TRN IND/GROUP"]
["BLUE CROSS","G0127 - TRIM NAIL(S)"]
["BLUE CROSS","G0239 - OTH RESP PROC, GROUP"]
["BLUE CROSS","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP"]
["BLUE CROSS","G0260 - INJ FOR SACROILIAC JT ANESTH"]
["BLUE CROSS","G0278 - ILIAC ART ANGIO,CARDIAC CATH"]
["BLUE CROSS","G0279 - TOMOSYNTHESIS, MAMMO"]
["BLUE CROSS","G0296 - HC VISIT TO DETERM LDCT ELIG"]
["BLUE CROSS","G0297 - HC LDCT FOR LUNG CA SCREEN"]
["BLUE CROSS","G0390 - TRAUMA RESPONS W/HOSP CRITI"]
["BLUE CROSS","G0396 - ALCOHOL/SUBS INTERV 15-30MN"]
["BLUE CROSS","G0397 - ALCOHOL/SUBS INTERV >30 MIN"]
["BLUE CROSS","G0416 - HC PROSTATE BIOPSY ANY MTHD"]
["BLUE CROSS","G0422 - HC INTENS CARDIAC REHAB W/EXERC"]
["BLUE CROSS","G0423 - HC INTENS CARDIAC REHAB NO EXER"]
["BLUE CROSS","G0424 - PULMONARY REHAB W EXER"]
["BLUE CROSS","G0480 - DRUG TEST DEF 1-7 CLASSES"]
["BLUE CROSS","G0481 - DRUG TEST DEF 8-14 CLASSES"]
["BLUE CROSS","G0506 - HC COMP ASSESS CARE PLAN CCM SVC"]
["BLUE CROSS","G0513 - HC PROLONG PREV SVCS, FIRST 30M"]
["BLUE CROSS","G0514 - HC PROLONG PREV SVCS, ADDL 30M"]
["BLUE CROSS","G2011 - ALCOHOL/SUB ABUSE ASSESS"]
["BLUE CROSS","G2012 - HC BRIEF CHECK IN BY MD/QHP"]
["BLUE CROSS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS"]
["BLUE CROSS","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA"]
["BLUE CROSS","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH"]
["BLUE CROSS","G2086 - HC OFF BASE OPIOID TX 70MIN"]
["BLUE CROSS","G2087 - HC OFF BASE OPIOID TX, 60 M"]
["BLUE CROSS","G2088 - HC OFF BASE OPIOID TX, ADD30"]
["BLUE CROSS","J0702 - HC BETAMETHASONE ACET&SOD PHOSP"]
["BLUE CROSS","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)"]
["BLUE CROSS","J1250 - HC DOBUTAMINE SDV/250MG"]
["BLUE CROSS","J2790 - HC IG;RHO D,HUMAN/300MCG"]
["BLUE CROSS","J3301 - HC TRIAMCINOLONE ACET INJ NOS"]
["BLUE CROSS","J7307 - HC ETONOGESTREL IMPLANT SYSTEM"]
["BLUE CROSS","L0120 - CERV FLEXIBLE NON-ADJUSTABLE"]
["BLUE CROSS","L0140 - CERVICAL SEMI-RIGID ADJUSTAB"]
["BLUE CROSS","L1820 - KO ELAS W/ CONDYLE PADS & JO"]
["BLUE CROSS","L1830 - KO IMMOBILIZER CANVAS LONGIT"]
["BLUE CROSS","L1832 - KO ADJ JNT POS RIGID SUPPORT"]
["BLUE CROSS","L1836 - HC RIGID KO WO JOINTS"]
["BLUE CROSS","L1902 - AFO ANKLE GAUNTLET"]
["BLUE CROSS","L3260 - AMBULATORY SURGICAL BOOT EAC"]
["BLUE CROSS","L3350 - SHOE HEEL WEDGE"]
["BLUE CROSS","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN"]
["BLUE CROSS","L3670 - ACROMIO/CLAVICULAR CANVAS&WE"]
["BLUE CROSS","L3760 - EO WITHJOINT, PREFABRICATED"]
["BLUE CROSS","L3762 - RIGID EO WO JOINTS"]
["BLUE CROSS","L3807 - WHFO,NO JOINT, PREFABRICATED"]
["BLUE CROSS","L3808 - HC EPITRAIN"]
["BLUE CROSS","L3905 - HC WHO W/NONTORSION JNT(S) CF"]
["BLUE CROSS","L3908 - WRIST COCK-UP NON-MOLDED"]
["BLUE CROSS","L3967 - HC SEWHO AIRPLANE W/O JNTS CF"]
["BLUE CROSS","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL"]
["BLUE CROSS","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL"]
["BLUE CROSS","L4350 - ANKLE CONTROL ORTHOSI PREFAB"]
["BLUE CROSS","L4360 - PNEUMATI WALKING BOOT PREFAB"]
["BLUE CROSS","L4370 - HC PNEUMATIC FULL LEG SPLINT"]
["BLUE CROSS","L4386 - NON-PNEUM WALK BOOT PREFAB"]
["BLUE CROSS","L4396 - STATIC AFO"]
["BLUE CROSS","L4398 - HC FOOT DROP SPLINT RECUMBENT"]
["BLUE CROSS","L8501 - TRACHEOSTOMY SPEAKING VALVE"]
["BLUE CROSS","L8507 - HC PROLARYNX VOICE (PLUS)"]
["BLUE CROSS","L8509 - TRACH-ESOPH VOICE PROS MD IN"]
["BLUE CROSS","L8514 - REPL TRACH PUNCTURE DILATOR"]
["BLUE CROSS","L8693 - HC AUD OSSEO DEV, ABUTMENT"]
["BLUE CROSS","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING"]
["BLUE CROSS","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG"]
["BLUE CROSS","P9012 - HC CRYOPRECIPITATE UNIT"]
["BLUE CROSS","P9016 - HC RBC:LEU-RED"]
["BLUE CROSS","P9017 - HC FF PLAS: 1 DONOR"]
["BLUE CROSS","P9021 - HC RBC/UNIT"]
["BLUE CROSS","P9034 - HB PLATELETS, PHERESIS"]
["BLUE CROSS","P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT"]
["BLUE CROSS","P9040 - HC RBC:LEU-RED,IRR/UNIT"]
["BLUE CROSS","P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["BLUE CROSS","P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["BLUE CROSS","P9073 - HC PLATELETS PHERESIS PATH REDU"]
["BLUE CROSS","P9100 - PATHOGEN TEST FOR PLATELETS"]
["BLUE CROSS","P9612 - CATHETERIZE FOR URINE SPEC"]
["BLUE CROSS","Q0091 - HC OBTAINING SCREEN PAP SMEAR"]
["BLUE CROSS","Q0111 - HC WET MOUNTS W PREPARATIONS"]
["BLUE CROSS","Q0114 - HC  FERN TEST"]
["BLUE CROSS","Q3014 - HC TELEHEALTH FACILITY FEE"]
["BLUE CROSS","Q4101 - APLIGRAF"]
["BLUE CROSS","Q4102 - OASIS WOUND MATRIX"]
["BLUE CROSS","Q4104 - INTEGRA BMWD"]
["BLUE CROSS","Q4107 - GRAFTJACKET"]
["BLUE CROSS","Q4112 - CYMETRA INJECTABLE"]
["BLUE CROSS","Q4116 - HC ALLODERM 8 X 16 MEDIUM"]
["BLUE CROSS","Q4124 - OASIS TRILAYER/1 SQCM"]
["BLUE CROSS","Q4125 - HC AFLEX401 ¿ 40 X 70 MM"]
["BLUE CROSS","Q4130 - PR STRATTICE TM"]
["BLUE CROSS","Q4132 - HC GRAFIX CORE 5X5CM"]
["BLUE CROSS","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["BLUE CROSS","Q4196 - HC PURAPLYAM-COM 6X9 CM"]
["BLUE CROSS","Q9954 - ORAL MR CONTRAST, 100 ML"]
["BLUE CROSS","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["BLUE CROSS","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["BLUE CROSS","Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["BLUE CROSS","Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["BLUE CROSS","Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["BLUE CROSS","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["BLUE CROSS","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["BLUE CROSS","S8037 - MRCP"]
["BLUE CROSS","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH"]
["BLUE CROSS","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP"]
["BLUE CROSS OUT OF STATE","45378 - COLON CA SCRN NOT HI RSK IND"]
["BLUE CROSS OUT OF STATE","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS"]
["BLUE CROSS OUT OF STATE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE"]
["BLUE CROSS OUT OF STATE","92083 - VISUAL FIELD EXAM,EXTENDED"]
["BLUE CROSS OUT OF STATE","95800 - HOME SLEEP TEST/TYPE 3 PORTA"]
["BLUE CROSS OUT OF STATE","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME"]
["BLUE CROSS OUT OF STATE","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA"]
["BLUE CROSS OUT OF STATE","A4561 - HC PESSARY RUBBER, ANY TYPE"]
["BLUE CROSS OUT OF STATE","A6209 - FOAM DRSG <=16 SQ IN W/O BDR"]
["BLUE CROSS OUT OF STATE","A6258 - TRANSPARENT FILM >16<=48 IN"]
["BLUE CROSS OUT OF STATE","A7520 - TRACH/LARYN TUBE NON-CUFFED"]
["BLUE CROSS OUT OF STATE","A9500 - TC99M SESTAMIBI"]
["BLUE CROSS OUT OF STATE","A9502 - HC TC99M TETROFOSMIN"]
["BLUE CROSS OUT OF STATE","A9503 - TC99M MEDRONATE"]
["BLUE CROSS OUT OF STATE","A9505 - THALLIUM CHLORIDE PER MCI"]
["BLUE CROSS OUT OF STATE","A9509 - HC IODINE I-123 PER MCI"]
["BLUE CROSS OUT OF STATE","A9513 - TECHNETIUM TC-99M MEBROFENIN"]
["BLUE CROSS OUT OF STATE","A9516 - I123 IODIDE CAP, DX"]
["BLUE CROSS OUT OF STATE","A9517 - I131 IODIDE CAP, RX"]
["BLUE CROSS OUT OF STATE","A9521 - TC99M EXAMETAZIME"]
["BLUE CROSS OUT OF STATE","A9537 - TC99M MEBROFENIN"]
["BLUE CROSS OUT OF STATE","A9538 - TC99M PYROPHOSPHATE"]
["BLUE CROSS OUT OF STATE","A9539 - TC99M PENTETATE"]
["BLUE CROSS OUT OF STATE","A9540 - TC99M MAA"]
["BLUE CROSS OUT OF STATE","A9541 - TC99M SULFUR COLLOID"]
["BLUE CROSS OUT OF STATE","A9543 - Y90 IBRITUMOMAB, RX"]
["BLUE CROSS OUT OF STATE","A9547 - IN111 OXYQUINOLINE"]
["BLUE CROSS OUT OF STATE","A9551 - HC TC99M SUCCIMER/10MCI,DX"]
["BLUE CROSS OUT OF STATE","A9552 - F18 FDG"]
["BLUE CROSS OUT OF STATE","A9555 - RADIOPHARMACIAL"]
["BLUE CROSS OUT OF STATE","A9556 - GA67 GALLIUM"]
["BLUE CROSS OUT OF STATE","A9557 - TC99M BICISATE"]
["BLUE CROSS OUT OF STATE","A9558 - HC XENON133/10MCI"]
["BLUE CROSS OUT OF STATE","A9560 - TC99M LABELED RBC"]
["BLUE CROSS OUT OF STATE","A9561 - TC99M OXIDRONATE"]
["BLUE CROSS OUT OF STATE","A9562 - TC99M MERTIATIDE"]
["BLUE CROSS OUT OF STATE","A9563 - P32 NA PHOSPHATE"]
["BLUE CROSS OUT OF STATE","A9569 - TECHNETIUM TC-99M AUTO WBC"]
["BLUE CROSS OUT OF STATE","A9572 - INDIUM IN-111 PENTETREOTIDE"]
["BLUE CROSS OUT OF STATE","A9575 - INJ GADOTERATE MEGLUMI 0.1ML"]
["BLUE CROSS OUT OF STATE","A9576 - HC PROHANCE IV CONTRAST PER ML"]
["BLUE CROSS OUT OF STATE","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML"]
["BLUE CROSS OUT OF STATE","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["BLUE CROSS OUT OF STATE","A9581 - GADOXETATE DISODIUM INJ"]
["BLUE CROSS OUT OF STATE","A9583 - GADOFOSVESET TRISODIUM INJ"]
["BLUE CROSS OUT OF STATE","A9584 - IODINE I-123 IOFLUPANE"]
["BLUE CROSS OUT OF STATE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE"]
["BLUE CROSS OUT OF STATE","A9587 - GALLIUM GA-68"]
["BLUE CROSS OUT OF STATE","A9588 - FLUCICLOVINE F-18"]
["BLUE CROSS OUT OF STATE","A9606 - RADIUM RA223 DICHLORIDE THER"]
["BLUE CROSS OUT OF STATE","C1717 - HC BRACHYTX, NON-STR,HDR IR-192"]
["BLUE CROSS OUT OF STATE","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE"]
["BLUE CROSS OUT OF STATE","C2635 - BRACHYTX, NON-STR, HA, P-103"]
["BLUE CROSS OUT OF STATE","C2639 - BRACHYTX, NON-STRANDED,I-125"]
["BLUE CROSS OUT OF STATE","C5275 - HC LOW COST SKIN SUBSTITUTE"]
["BLUE CROSS OUT OF STATE","C8908 - HC MRI W/O FOL W/CONT, BREAST,"]
["BLUE CROSS OUT OF STATE","C9358 - SURGIMEND, FETAL"]
["BLUE CROSS OUT OF STATE","C9728 - PLACE DEVICE/MARKER, NON PRO"]
["BLUE CROSS OUT OF STATE","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3"]
["BLUE CROSS OUT OF STATE","D0210 - INTRAORAL - COMPLETE SERIES OF RADIOGRAPHIC IMAGES"]
["BLUE CROSS OUT OF STATE","D0220 - INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE"]
["BLUE CROSS OUT OF STATE","D0230 - INTRAORAL - PERIAPICAL EACH ADDITIONAL RADIOGRAPHIC IMAGE"]
["BLUE CROSS OUT OF STATE","D0272 - BITEWINGS - TWO RADIOGRAPHIC IMAGES"]
["BLUE CROSS OUT OF STATE","D0274 - BITEWINGS - FOUR RADIOGRAPHIC IMAGES"]
["BLUE CROSS OUT OF STATE","D1110 - PROPHYLAXIS - ADULT"]
["BLUE CROSS OUT OF STATE","D1120 - PROPHYLAXIS - CHILD"]
["BLUE CROSS OUT OF STATE","D1351 - SEALANT - PER TOOTH"]
["BLUE CROSS OUT OF STATE","D2140 - AMALGAM - ONE SURFACE, PRIMARY OR PERMANENT"]
["BLUE CROSS OUT OF STATE","D2150 - AMALGAM - TWO SURFACES, PRIMARY OR PERMANENT"]
["BLUE CROSS OUT OF STATE","D2160 - AMALGAM - THREE SURFACES, PRIMARY OR PERMANENT"]
["BLUE CROSS OUT OF STATE","D2161 - AMALGAM - FOUR OR MORE SURFACES, PRIMARY OR PERMANENT"]
["BLUE CROSS OUT OF STATE","D2330 - RESIN-BASED COMPOSITE - ONE SURFACE, ANTERIOR"]
["BLUE CROSS OUT OF STATE","D2331 - RESIN-BASED COMPOSITE - TWO SURFACES, ANTERIOR"]
["BLUE CROSS OUT OF STATE","D2332 - RESIN-BASED COMPOSITE - THREE SURFACES, ANTERIOR"]
["BLUE CROSS OUT OF STATE","D2335 - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR)"]
["BLUE CROSS OUT OF STATE","D2390 - RESIN-BASED COMPOSITE CROWN, ANTERIOR"]
["BLUE CROSS OUT OF STATE","D2391 - RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR"]
["BLUE CROSS OUT OF STATE","D2392 - RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR"]
["BLUE CROSS OUT OF STATE","D2393 - RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR"]
["BLUE CROSS OUT OF STATE","D2394 - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR"]
["BLUE CROSS OUT OF STATE","D2740 - CROWN - PORCELAIN/CERAMIC SUBSTRATE"]
["BLUE CROSS OUT OF STATE","D2930 - PREFABRICATED STAINLESS STEEL CROWN - PRIMARY TOOTH"]
["BLUE CROSS OUT OF STATE","D2931 - PREFABRICATED STAINLESS STEEL CROWN - PERMANENT TOOTH"]
["BLUE CROSS OUT OF STATE","D2940 - PROTECTIVE RESTORATION"]
["BLUE CROSS OUT OF STATE","D3110 - HC PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION)"]
["BLUE CROSS OUT OF STATE","D3220 - THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) - REMOVAL OF PULP CORONAL TO THE DENTINOCEMENTAL JUNCTION AND APPLICATION OF MEDICAMENT"]
["BLUE CROSS OUT OF STATE","D3310 - ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION)"]
["BLUE CROSS OUT OF STATE","D3330 - ENDODONTIC THERAPY, MOLAR (EXCLUDING FINAL RESTORATION)"]
["BLUE CROSS OUT OF STATE","D7140 - EXTRACTION ERUPTED TOOTH/EXR"]
["BLUE CROSS OUT OF STATE","D7210 - EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED"]
["BLUE CROSS OUT OF STATE","D7220 - REMOVAL OF IMPACTED TOOTH - SOFT TISSUE"]
["BLUE CROSS OUT OF STATE","D7230 - REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY"]
["BLUE CROSS OUT OF STATE","D7240 - REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY"]
["BLUE CROSS OUT OF STATE","D7250 - REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)"]
["BLUE CROSS OUT OF STATE","D7310 - ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH SPACES, PER QUADRANT"]
["BLUE CROSS OUT OF STATE","D7311 - ALVEOLOPLASTY W/EXTRACT 1-3"]
["BLUE CROSS OUT OF STATE","D7410 - EXCISION OF BENIGN LESION UP TO 1.25 CM"]
["BLUE CROSS OUT OF STATE","G0101 - CA SCREEN;PELVIC/BREAST EXAM"]
["BLUE CROSS OUT OF STATE","G0103 - PSA, TOTAL SCREENING"]
["BLUE CROSS OUT OF STATE","G0105 - HC COLORECTAL SCRN; HI RISK IND"]
["BLUE CROSS OUT OF STATE","G0108 - DIAB MANAGE TRN  PER INDIV"]
["BLUE CROSS OUT OF STATE","G0109 - DIAB MANAGE TRN IND/GROUP"]
["BLUE CROSS OUT OF STATE","G0127 - TRIM NAIL(S)"]
["BLUE CROSS OUT OF STATE","G0239 - OTH RESP PROC, GROUP"]
["BLUE CROSS OUT OF STATE","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP"]
["BLUE CROSS OUT OF STATE","G0260 - INJ FOR SACROILIAC JT ANESTH"]
["BLUE CROSS OUT OF STATE","G0278 - ILIAC ART ANGIO,CARDIAC CATH"]
["BLUE CROSS OUT OF STATE","G0279 - TOMOSYNTHESIS, MAMMO"]
["BLUE CROSS OUT OF STATE","G0296 - HC VISIT TO DETERM LDCT ELIG"]
["BLUE CROSS OUT OF STATE","G0297 - HC LDCT FOR LUNG CA SCREEN"]
["BLUE CROSS OUT OF STATE","G0390 - TRAUMA RESPONS W/HOSP CRITI"]
["BLUE CROSS OUT OF STATE","G0396 - ALCOHOL/SUBS INTERV 15-30MN"]
["BLUE CROSS OUT OF STATE","G0397 - ALCOHOL/SUBS INTERV >30 MIN"]
["BLUE CROSS OUT OF STATE","G0416 - HC PROSTATE BIOPSY ANY MTHD"]
["BLUE CROSS OUT OF STATE","G0422 - HC INTENS CARDIAC REHAB W/EXERC"]
["BLUE CROSS OUT OF STATE","G0423 - HC INTENS CARDIAC REHAB NO EXER"]
["BLUE CROSS OUT OF STATE","G0424 - PULMONARY REHAB W EXER"]
["BLUE CROSS OUT OF STATE","G0442 - ANNUAL ALCOHOL SCREEN 15 MIN"]
["BLUE CROSS OUT OF STATE","G0443 - BRIEF ALCOHOL MISUSE COUNSEL"]
["BLUE CROSS OUT OF STATE","G0480 - DRUG TEST DEF 1-7 CLASSES"]
["BLUE CROSS OUT OF STATE","G0481 - DRUG TEST DEF 8-14 CLASSES"]
["BLUE CROSS OUT OF STATE","G0506 - HC COMP ASSESS CARE PLAN CCM SVC"]
["BLUE CROSS OUT OF STATE","G0513 - HC PROLONG PREV SVCS, FIRST 30M"]
["BLUE CROSS OUT OF STATE","G0514 - HC PROLONG PREV SVCS, ADDL 30M"]
["BLUE CROSS OUT OF STATE","G2011 - ALCOHOL/SUB ABUSE ASSESS"]
["BLUE CROSS OUT OF STATE","G2012 - HC BRIEF CHECK IN BY MD/QHP"]
["BLUE CROSS OUT OF STATE","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS"]
["BLUE CROSS OUT OF STATE","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA"]
["BLUE CROSS OUT OF STATE","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH"]
["BLUE CROSS OUT OF STATE","G2086 - HC OFF BASE OPIOID TX 70MIN"]
["BLUE CROSS OUT OF STATE","G2087 - HC OFF BASE OPIOID TX, 60 M"]
["BLUE CROSS OUT OF STATE","G2088 - HC OFF BASE OPIOID TX, ADD30"]
["BLUE CROSS OUT OF STATE","J0702 - HC BETAMETHASONE ACET&SOD PHOSP"]
["BLUE CROSS OUT OF STATE","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)"]
["BLUE CROSS OUT OF STATE","J1250 - HC DOBUTAMINE SDV/250MG"]
["BLUE CROSS OUT OF STATE","J2790 - HC IG;RHO D,HUMAN/300MCG"]
["BLUE CROSS OUT OF STATE","J3301 - HC TRIAMCINOLONE ACET INJ NOS"]
["BLUE CROSS OUT OF STATE","J7307 - HC ETONOGESTREL IMPLANT SYSTEM"]
["BLUE CROSS OUT OF STATE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE"]
["BLUE CROSS OUT OF STATE","L1820 - KO ELAS W/ CONDYLE PADS & JO"]
["BLUE CROSS OUT OF STATE","L1830 - KO IMMOBILIZER CANVAS LONGIT"]
["BLUE CROSS OUT OF STATE","L1832 - KO ADJ JNT POS RIGID SUPPORT"]
["BLUE CROSS OUT OF STATE","L1836 - HC RIGID KO WO JOINTS"]
["BLUE CROSS OUT OF STATE","L1902 - AFO ANKLE GAUNTLET"]
["BLUE CROSS OUT OF STATE","L3260 - AMBULATORY SURGICAL BOOT EAC"]
["BLUE CROSS OUT OF STATE","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN"]
["BLUE CROSS OUT OF STATE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE"]
["BLUE CROSS OUT OF STATE","L3760 - EO WITHJOINT, PREFABRICATED"]
["BLUE CROSS OUT OF STATE","L3807 - WHFO,NO JOINT, PREFABRICATED"]
["BLUE CROSS OUT OF STATE","L3808 - HC EPITRAIN"]
["BLUE CROSS OUT OF STATE","L3905 - HC WHO W/NONTORSION JNT(S) CF"]
["BLUE CROSS OUT OF STATE","L3908 - WRIST COCK-UP NON-MOLDED"]
["BLUE CROSS OUT OF STATE","L3967 - HC SEWHO AIRPLANE W/O JNTS CF"]
["BLUE CROSS OUT OF STATE","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL"]
["BLUE CROSS OUT OF STATE","L4350 - ANKLE CONTROL ORTHOSI PREFAB"]
["BLUE CROSS OUT OF STATE","L4360 - PNEUMATI WALKING BOOT PREFAB"]
["BLUE CROSS OUT OF STATE","L4386 - NON-PNEUM WALK BOOT PREFAB"]
["BLUE CROSS OUT OF STATE","L4396 - STATIC AFO"]
["BLUE CROSS OUT OF STATE","L4398 - HC FOOT DROP SPLINT RECUMBENT"]
["BLUE CROSS OUT OF STATE","L8509 - TRACH-ESOPH VOICE PROS MD IN"]
["BLUE CROSS OUT OF STATE","L8693 - HC AUD OSSEO DEV, ABUTMENT"]
["BLUE CROSS OUT OF STATE","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING"]
["BLUE CROSS OUT OF STATE","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG"]
["BLUE CROSS OUT OF STATE","P9012 - HC CRYOPRECIPITATE UNIT"]
["BLUE CROSS OUT OF STATE","P9016 - HC RBC:LEU-RED"]
["BLUE CROSS OUT OF STATE","P9017 - HC FF PLAS: 1 DONOR"]
["BLUE CROSS OUT OF STATE","P9021 - HC RBC/UNIT"]
["BLUE CROSS OUT OF STATE","P9034 - HB PLATELETS, PHERESIS"]
["BLUE CROSS OUT OF STATE","P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT"]
["BLUE CROSS OUT OF STATE","P9040 - HC RBC:LEU-RED,IRR/UNIT"]
["BLUE CROSS OUT OF STATE","P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["BLUE CROSS OUT OF STATE","P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["BLUE CROSS OUT OF STATE","P9073 - HC PLATELETS PHERESIS PATH REDU"]
["BLUE CROSS OUT OF STATE","P9100 - PATHOGEN TEST FOR PLATELETS"]
["BLUE CROSS OUT OF STATE","P9612 - CATHETERIZE FOR URINE SPEC"]
["BLUE CROSS OUT OF STATE","Q0091 - HC OBTAINING SCREEN PAP SMEAR"]
["BLUE CROSS OUT OF STATE","Q0111 - HC WET MOUNTS W PREPARATIONS"]
["BLUE CROSS OUT OF STATE","Q0114 - HC  FERN TEST"]
["BLUE CROSS OUT OF STATE","Q4101 - APLIGRAF"]
["BLUE CROSS OUT OF STATE","Q4102 - OASIS WOUND MATRIX"]
["BLUE CROSS OUT OF STATE","Q4104 - INTEGRA BMWD"]
["BLUE CROSS OUT OF STATE","Q4107 - GRAFTJACKET"]
["BLUE CROSS OUT OF STATE","Q4112 - CYMETRA INJECTABLE"]
["BLUE CROSS OUT OF STATE","Q4116 - HC ALLODERM 8 X 16 MEDIUM"]
["BLUE CROSS OUT OF STATE","Q4124 - OASIS TRILAYER/1 SQCM"]
["BLUE CROSS OUT OF STATE","Q4125 - HC AFLEX401 ¿ 40 X 70 MM"]
["BLUE CROSS OUT OF STATE","Q4130 - PR STRATTICE TM"]
["BLUE CROSS OUT OF STATE","Q4132 - HC GRAFIX CORE 5X5CM"]
["BLUE CROSS OUT OF STATE","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["BLUE CROSS OUT OF STATE","Q9954 - ORAL MR CONTRAST, 100 ML"]
["BLUE CROSS OUT OF STATE","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["BLUE CROSS OUT OF STATE","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["BLUE CROSS OUT OF STATE","Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["BLUE CROSS OUT OF STATE","Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["BLUE CROSS OUT OF STATE","Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["BLUE CROSS OUT OF STATE","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["BLUE CROSS OUT OF STATE","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["BLUE CROSS OUT OF STATE","S8037 - MRCP"]
["BLUE CROSS OUT OF STATE","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH"]
["BLUE CROSS OUT OF STATE","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP"]
["BMC HEALTHNET","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS"]
["BMC HEALTHNET","A4215 - STERILE NEEDLE"]
["BMC HEALTHNET","A4467 - BELT STRAP SLEEV GRMNT COVER"]
["BMC HEALTHNET","A4561 - HC PESSARY RUBBER, ANY TYPE"]
["BMC HEALTHNET","A4562 - PESSARY NONRUBBER"]
["BMC HEALTHNET","A4570 - HC MISC SPLINT SUPPLY LV1"]
["BMC HEALTHNET","A4725 - DIALYS SOL FLD VOL > 4999CC"]
["BMC HEALTHNET","A6209 - FOAM DRSG <=16 SQ IN W/O BDR"]
["BMC HEALTHNET","A6258 - TRANSPARENT FILM >16<=48 IN"]
["BMC HEALTHNET","A6549 - G COMPRESSION STOCKING"]
["BMC HEALTHNET","A6550 - NEG PRES WOUND THER DRSG SET"]
["BMC HEALTHNET","A7520 - TRACH/LARYN TUBE NON-CUFFED"]
["BMC HEALTHNET","A9500 - TC99M SESTAMIBI"]
["BMC HEALTHNET","A9502 - HC TC99M TETROFOSMIN"]
["BMC HEALTHNET","A9503 - TC99M MEDRONATE"]
["BMC HEALTHNET","A9505 - THALLIUM CHLORIDE PER MCI"]
["BMC HEALTHNET","A9509 - HC IODINE I-123 PER MCI"]
["BMC HEALTHNET","A9512 - TC99M PERTECHNETATE"]
["BMC HEALTHNET","A9513 - TECHNETIUM TC-99M MEBROFENIN"]
["BMC HEALTHNET","A9516 - I123 IODIDE CAP, DX"]
["BMC HEALTHNET","A9517 - I131 IODIDE CAP, RX"]
["BMC HEALTHNET","A9520 - TECHNETIUMTC-99M SULFUR CLLD"]
["BMC HEALTHNET","A9521 - TC99M EXAMETAZIME"]
["BMC HEALTHNET","A9537 - TC99M MEBROFENIN"]
["BMC HEALTHNET","A9538 - TC99M PYROPHOSPHATE"]
["BMC HEALTHNET","A9539 - TC99M PENTETATE"]
["BMC HEALTHNET","A9540 - TC99M MAA"]
["BMC HEALTHNET","A9541 - TC99M SULFUR COLLOID"]
["BMC HEALTHNET","A9543 - Y90 IBRITUMOMAB, RX"]
["BMC HEALTHNET","A9547 - IN111 OXYQUINOLINE"]
["BMC HEALTHNET","A9551 - HC TC99M SUCCIMER/10MCI,DX"]
["BMC HEALTHNET","A9552 - F18 FDG"]
["BMC HEALTHNET","A9555 - RADIOPHARMACIAL"]
["BMC HEALTHNET","A9556 - GA67 GALLIUM"]
["BMC HEALTHNET","A9557 - TC99M BICISATE"]
["BMC HEALTHNET","A9558 - HC XENON133/10MCI"]
["BMC HEALTHNET","A9560 - TC99M LABELED RBC"]
["BMC HEALTHNET","A9561 - TC99M OXIDRONATE"]
["BMC HEALTHNET","A9562 - TC99M MERTIATIDE"]
["BMC HEALTHNET","A9563 - P32 NA PHOSPHATE"]
["BMC HEALTHNET","A9569 - TECHNETIUM TC-99M AUTO WBC"]
["BMC HEALTHNET","A9570 - HC INDIUM IN-111 AUTO WBC"]
["BMC HEALTHNET","A9572 - INDIUM IN-111 PENTETREOTIDE"]
["BMC HEALTHNET","A9575 - INJ GADOTERATE MEGLUMI 0.1ML"]
["BMC HEALTHNET","A9576 - HC PROHANCE IV CONTRAST PER ML"]
["BMC HEALTHNET","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML"]
["BMC HEALTHNET","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["BMC HEALTHNET","A9580 - HC NA FLUORIDE F-18, DOSE"]
["BMC HEALTHNET","A9581 - GADOXETATE DISODIUM INJ"]
["BMC HEALTHNET","A9582 - IODINE I-123 IOBENGUANE"]
["BMC HEALTHNET","A9583 - GADOFOSVESET TRISODIUM INJ"]
["BMC HEALTHNET","A9584 - IODINE I-123 IOFLUPANE"]
["BMC HEALTHNET","A9587 - GALLIUM GA-68"]
["BMC HEALTHNET","A9588 - FLUCICLOVINE F-18"]
["BMC HEALTHNET","A9592 - HC COPPER CU 64 DOTATATE DIAG"]
["BMC HEALTHNET","E0191 - PROTECTOR HEEL OR ELBOW"]
["BMC HEALTHNET","G0101 - CA SCREEN;PELVIC/BREAST EXAM"]
["BMC HEALTHNET","G0103 - PSA, TOTAL SCREENING"]
["BMC HEALTHNET","G0127 - TRIM NAIL(S)"]
["BMC HEALTHNET","G0175 - OPPS SERVICE,SCHED TEAM CONF"]
["BMC HEALTHNET","G0239 - OTH RESP PROC, GROUP"]
["BMC HEALTHNET","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP"]
["BMC HEALTHNET","G0259 - HC INJECT FOR SACROILIAC JOINT"]
["BMC HEALTHNET","G0260 - INJ FOR SACROILIAC JT ANESTH"]
["BMC HEALTHNET","G0269 - HC CLOSURE DEVICE PLACEMENT"]
["BMC HEALTHNET","G0278 - ILIAC ART ANGIO,CARDIAC CATH"]
["BMC HEALTHNET","G0279 - TOMOSYNTHESIS, MAMMO"]
["BMC HEALTHNET","G0296 - HC VISIT TO DETERM LDCT ELIG"]
["BMC HEALTHNET","G0297 - HC LDCT FOR LUNG CA SCREEN"]
["BMC HEALTHNET","G0365 - HC VESSEL MAPPING HEMO ACCESS"]
["BMC HEALTHNET","G0389 - ULTRASOUND EXAM AAA SCREEN"]
["BMC HEALTHNET","G0390 - TRAUMA RESPONS W/HOSP CRITI"]
["BMC HEALTHNET","G0396 - ALCOHOL/SUBS INTERV 15-30MN"]
["BMC HEALTHNET","G0397 - ALCOHOL/SUBS INTERV >30 MIN"]
["BMC HEALTHNET","G0402 - INITIAL PREVENTIVE EXAM"]
["BMC HEALTHNET","G0410 - HC GRP PSYCH PARTIAL HOSP 45-50"]
["BMC HEALTHNET","G0416 - HC PROSTATE BIOPSY ANY MTHD"]
["BMC HEALTHNET","G0420 - HC ED SVC CKD IND PER SESSION"]
["BMC HEALTHNET","G0421 - HC ED SVC CKD GRP PER SESSION"]
["BMC HEALTHNET","G0422 - HC INTENS CARDIAC REHAB W/EXERC"]
["BMC HEALTHNET","G0423 - HC INTENS CARDIAC REHAB NO EXER"]
["BMC HEALTHNET","G0438 - PPPS, INITIAL VISIT"]
["BMC HEALTHNET","G0439 - PPPS, SUBSEQ VISIT"]
["BMC HEALTHNET","G0442 - ANNUAL ALCOHOL SCREEN 15 MIN"]
["BMC HEALTHNET","G0443 - BRIEF ALCOHOL MISUSE COUNSEL"]
["BMC HEALTHNET","G0444 - DEPRESSION SCREEN ANNUAL"]
["BMC HEALTHNET","G0445 - HIGH INTEN BEH COUNS STD 30M"]
["BMC HEALTHNET","G0446 - INTENS BEHAVE THER CARDIO DX"]
["BMC HEALTHNET","G0447 - HC BEHAVIOR COUNSEL OBESITY 15M"]
["BMC HEALTHNET","G0480 - DRUG TEST DEF 1-7 CLASSES"]
["BMC HEALTHNET","G0481 - DRUG TEST DEF 8-14 CLASSES"]
["BMC HEALTHNET","G0506 - HC COMP ASSESS CARE PLAN CCM SVC"]
["BMC HEALTHNET","G0513 - HC PROLONG PREV SVCS, FIRST 30M"]
["BMC HEALTHNET","G0514 - HC PROLONG PREV SVCS, ADDL 30M"]
["BMC HEALTHNET","G2011 - ALCOHOL/SUB ABUSE ASSESS"]
["BMC HEALTHNET","G2012 - HC BRIEF CHECK IN BY MD/QHP"]
["BMC HEALTHNET","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS"]
["BMC HEALTHNET","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA"]
["BMC HEALTHNET","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH"]
["BMC HEALTHNET","G2086 - HC OFF BASE OPIOID TX 70MIN"]
["BMC HEALTHNET","G2087 - HC OFF BASE OPIOID TX, 60 M"]
["BMC HEALTHNET","G2088 - HC OFF BASE OPIOID TX, ADD30"]
["BMC HEALTHNET","G2212 - HC PROLONG OUTPT/OFFICE VIS"]
["BMC HEALTHNET","G2216 - HC HOME SUPPLY INJECT NALOXON"]
["BMC HEALTHNET","J0702 - HC BETAMETHASONE ACET&SOD PHOSP"]
["BMC HEALTHNET","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)"]
["BMC HEALTHNET","J1250 - HC DOBUTAMINE SDV/250MG"]
["BMC HEALTHNET","J2790 - HC IG;RHO D,HUMAN/300MCG"]
["BMC HEALTHNET","J3301 - HC TRIAMCINOLONE ACET INJ NOS"]
["BMC HEALTHNET","L0120 - CERV FLEXIBLE NON-ADJUSTABLE"]
["BMC HEALTHNET","L0140 - CERVICAL SEMI-RIGID ADJUSTAB"]
["BMC HEALTHNET","L1820 - KO ELAS W/ CONDYLE PADS & JO"]
["BMC HEALTHNET","L1830 - KO IMMOBILIZER CANVAS LONGIT"]
["BMC HEALTHNET","L1832 - KO ADJ JNT POS RIGID SUPPORT"]
["BMC HEALTHNET","L1836 - HC RIGID KO WO JOINTS"]
["BMC HEALTHNET","L1902 - AFO ANKLE GAUNTLET"]
["BMC HEALTHNET","L3260 - AMBULATORY SURGICAL BOOT EAC"]
["BMC HEALTHNET","L3350 - SHOE HEEL WEDGE"]
["BMC HEALTHNET","L3496 - HC STATIC AFO"]
["BMC HEALTHNET","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN"]
["BMC HEALTHNET","L3670 - ACROMIO/CLAVICULAR CANVAS&WE"]
["BMC HEALTHNET","L3760 - EO WITHJOINT, PREFABRICATED"]
["BMC HEALTHNET","L3762 - RIGID EO WO JOINTS"]
["BMC HEALTHNET","L3807 - WHFO,NO JOINT, PREFABRICATED"]
["BMC HEALTHNET","L3808 - HC EPITRAIN"]
["BMC HEALTHNET","L3905 - HC WHO W/NONTORSION JNT(S) CF"]
["BMC HEALTHNET","L3908 - WRIST COCK-UP NON-MOLDED"]
["BMC HEALTHNET","L3967 - HC SEWHO AIRPLANE W/O JNTS CF"]
["BMC HEALTHNET","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL"]
["BMC HEALTHNET","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL"]
["BMC HEALTHNET","L4350 - ANKLE CONTROL ORTHOSI PREFAB"]
["BMC HEALTHNET","L4360 - PNEUMATI WALKING BOOT PREFAB"]
["BMC HEALTHNET","L4370 - HC PNEUMATIC FULL LEG SPLINT"]
["BMC HEALTHNET","L4386 - NON-PNEUM WALK BOOT PREFAB"]
["BMC HEALTHNET","L4396 - STATIC AFO"]
["BMC HEALTHNET","L4398 - HC FOOT DROP SPLINT RECUMBENT"]
["BMC HEALTHNET","L8501 - TRACHEOSTOMY SPEAKING VALVE"]
["BMC HEALTHNET","L8507 - HC PROLARYNX VOICE (PLUS)"]
["BMC HEALTHNET","L8509 - TRACH-ESOPH VOICE PROS MD IN"]
["BMC HEALTHNET","L8514 - REPL TRACH PUNCTURE DILATOR"]
["BMC HEALTHNET","L8693 - HC AUD OSSEO DEV, ABUTMENT"]
["BMC HEALTHNET","L8699 - HC CARTIFORM 20 X 25 MM DISC"]
["BMC HEALTHNET","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING"]
["BMC HEALTHNET","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG"]
["BMC HEALTHNET","P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["BMC HEALTHNET","P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["BMC HEALTHNET","P9612 - CATHETERIZE FOR URINE SPEC"]
["BMC HEALTHNET","Q0091 - HC OBTAINING SCREEN PAP SMEAR"]
["BMC HEALTHNET","Q0111 - HC WET MOUNTS W PREPARATIONS"]
["BMC HEALTHNET","Q0114 - HC  FERN TEST"]
["BMC HEALTHNET","Q0249 - HC TOCILIZUMAB FOR COVID-19"]
["BMC HEALTHNET","Q3014 - HC TELEHEALTH FACILITY FEE"]
["BMC HEALTHNET","Q4101 - APLIGRAF"]
["BMC HEALTHNET","Q4102 - OASIS WOUND MATRIX"]
["BMC HEALTHNET","Q4116 - HC ALLODERM 8 X 16 MEDIUM"]
["BMC HEALTHNET","Q4124 - OASIS TRILAYER/1 SQCM"]
["BMC HEALTHNET","Q4125 - HC AFLEX401 ¿ 40 X 70 MM"]
["BMC HEALTHNET","Q4130 - PR STRATTICE TM"]
["BMC HEALTHNET","Q4132 - HC GRAFIX CORE 5X5CM"]
["BMC HEALTHNET","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["BMC HEALTHNET","Q4196 - HC PURAPLYAM-COM 6X9 CM"]
["BMC HEALTHNET","Q9954 - ORAL MR CONTRAST, 100 ML"]
["BMC HEALTHNET","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["BMC HEALTHNET","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["BMC HEALTHNET","Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["BMC HEALTHNET","Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["BMC HEALTHNET","Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["BMC HEALTHNET","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["BMC HEALTHNET","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["BMC HEALTHNET","Q9987 - HC PATHOGEN TEST PLATELETS"]
["BMC HEALTHNET","S5100 - ADULT DAYCARE SERVICES 15MIN"]
["BMC HEALTHNET","S5101 - HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)"]
["BMC HEALTHNET","S5102 - HC ADULT DAY HEALTH - COMPLEX PER DIEM"]
["BMC HEALTHNET","S8037 - MRCP"]
["BMC HEALTHNET","T2003 - HC TRANSPORTATION RATE 1 (1-WAY TRIP)"]
["BMC HEALTHNET","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH"]
["BMC HEALTHNET","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP"]
["BMC HEALTHNET","V2785 - CORNEAL TISSUE PROCESSING"]
["BMC HEALTHNET","V2790 - HC MEMBRANE AMNIOTIC"]
["CIGNA HEALTHCARE","45378 - COLON CA SCRN NOT HI RSK IND"]
["CIGNA HEALTHCARE","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS"]
["CIGNA HEALTHCARE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE"]
["CIGNA HEALTHCARE","92083 - VISUAL FIELD EXAM,EXTENDED"]
["CIGNA HEALTHCARE","95800 - HOME SLEEP TEST/TYPE 3 PORTA"]
["CIGNA HEALTHCARE","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME"]
["CIGNA HEALTHCARE","0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS"]
["CIGNA HEALTHCARE","0399T - PR MYOCARDIAL STRAIN IMAGING"]
["CIGNA HEALTHCARE","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA"]
["CIGNA HEALTHCARE","A4215 - STERILE NEEDLE"]
["CIGNA HEALTHCARE","A4561 - HC PESSARY RUBBER, ANY TYPE"]
["CIGNA HEALTHCARE","A4562 - PESSARY NONRUBBER"]
["CIGNA HEALTHCARE","A4570 - HC MISC SPLINT SUPPLY LV1"]
["CIGNA HEALTHCARE","A4648 - IMPLANTABLE TISSUE MARKER"]
["CIGNA HEALTHCARE","A4725 - DIALYS SOL FLD VOL > 4999CC"]
["CIGNA HEALTHCARE","A6209 - FOAM DRSG <=16 SQ IN W/O BDR"]
["CIGNA HEALTHCARE","A6258 - TRANSPARENT FILM >16<=48 IN"]
["CIGNA HEALTHCARE","A6549 - G COMPRESSION STOCKING"]
["CIGNA HEALTHCARE","A6550 - NEG PRES WOUND THER DRSG SET"]
["CIGNA HEALTHCARE","A7520 - TRACH/LARYN TUBE NON-CUFFED"]
["CIGNA HEALTHCARE","A9500 - TC99M SESTAMIBI"]
["CIGNA HEALTHCARE","A9502 - HC TC99M TETROFOSMIN"]
["CIGNA HEALTHCARE","A9503 - TC99M MEDRONATE"]
["CIGNA HEALTHCARE","A9505 - THALLIUM CHLORIDE PER MCI"]
["CIGNA HEALTHCARE","A9509 - HC IODINE I-123 PER MCI"]
["CIGNA HEALTHCARE","A9512 - TC99M PERTECHNETATE"]
["CIGNA HEALTHCARE","A9513 - TECHNETIUM TC-99M MEBROFENIN"]
["CIGNA HEALTHCARE","A9516 - I123 IODIDE CAP, DX"]
["CIGNA HEALTHCARE","A9517 - I131 IODIDE CAP, RX"]
["CIGNA HEALTHCARE","A9520 - TECHNETIUMTC-99M SULFUR CLLD"]
["CIGNA HEALTHCARE","A9521 - TC99M EXAMETAZIME"]
["CIGNA HEALTHCARE","A9537 - TC99M MEBROFENIN"]
["CIGNA HEALTHCARE","A9538 - TC99M PYROPHOSPHATE"]
["CIGNA HEALTHCARE","A9539 - TC99M PENTETATE"]
["CIGNA HEALTHCARE","A9540 - TC99M MAA"]
["CIGNA HEALTHCARE","A9541 - TC99M SULFUR COLLOID"]
["CIGNA HEALTHCARE","A9543 - Y90 IBRITUMOMAB, RX"]
["CIGNA HEALTHCARE","A9547 - IN111 OXYQUINOLINE"]
["CIGNA HEALTHCARE","A9551 - HC TC99M SUCCIMER/10MCI,DX"]
["CIGNA HEALTHCARE","A9552 - F18 FDG"]
["CIGNA HEALTHCARE","A9555 - RADIOPHARMACIAL"]
["CIGNA HEALTHCARE","A9556 - GA67 GALLIUM"]
["CIGNA HEALTHCARE","A9557 - TC99M BICISATE"]
["CIGNA HEALTHCARE","A9558 - HC XENON133/10MCI"]
["CIGNA HEALTHCARE","A9560 - TC99M LABELED RBC"]
["CIGNA HEALTHCARE","A9561 - TC99M OXIDRONATE"]
["CIGNA HEALTHCARE","A9562 - TC99M MERTIATIDE"]
["CIGNA HEALTHCARE","A9563 - P32 NA PHOSPHATE"]
["CIGNA HEALTHCARE","A9569 - TECHNETIUM TC-99M AUTO WBC"]
["CIGNA HEALTHCARE","A9570 - HC INDIUM IN-111 AUTO WBC"]
["CIGNA HEALTHCARE","A9572 - INDIUM IN-111 PENTETREOTIDE"]
["CIGNA HEALTHCARE","A9575 - INJ GADOTERATE MEGLUMI 0.1ML"]
["CIGNA HEALTHCARE","A9576 - HC PROHANCE IV CONTRAST PER ML"]
["CIGNA HEALTHCARE","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML"]
["CIGNA HEALTHCARE","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["CIGNA HEALTHCARE","A9580 - HC NA FLUORIDE F-18, DOSE"]
["CIGNA HEALTHCARE","A9581 - GADOXETATE DISODIUM INJ"]
["CIGNA HEALTHCARE","A9582 - IODINE I-123 IOBENGUANE"]
["CIGNA HEALTHCARE","A9583 - GADOFOSVESET TRISODIUM INJ"]
["CIGNA HEALTHCARE","A9584 - IODINE I-123 IOFLUPANE"]
["CIGNA HEALTHCARE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE"]
["CIGNA HEALTHCARE","A9587 - GALLIUM GA-68"]
["CIGNA HEALTHCARE","A9588 - FLUCICLOVINE F-18"]
["CIGNA HEALTHCARE","A9606 - RADIUM RA223 DICHLORIDE THER"]
["CIGNA HEALTHCARE","C1713 - HC CORE 10 BONE PLUG"]
["CIGNA HEALTHCARE","C1714 - HC WATHMAN SYS ANTER CURVE"]
["CIGNA HEALTHCARE","C1715 - BRACHYTHERAPY NEEDLE"]
["CIGNA HEALTHCARE","C1716 - BRACHYTX SOURCE, GOLD 198"]
["CIGNA HEALTHCARE","C1717 - HC BRACHYTX, NON-STR,HDR IR-192"]
["CIGNA HEALTHCARE","C1719 - BRACHYTX SOUR,NON-HDR IR-192"]
["CIGNA HEALTHCARE","C1721 - HC ICD,2CH, GEN ONLY, RECALL $0"]
["CIGNA HEALTHCARE","C1722 - HC ICD,1CH, GEN ONLY, RECALL $0"]
["CIGNA HEALTHCARE","C1724 - HC CATH, TRANS ATHEREC BURR"]
["CIGNA HEALTHCARE","C1725 - HC SIZING AMPLATZ BALLOON"]
["CIGNA HEALTHCARE","C1726 - HC CATHETER BALLN LVL 4"]
["CIGNA HEALTHCARE","C1729 - HC CATH; THORA PARA"]
["CIGNA HEALTHCARE","C1730 - HC CATH,EP;STEER,DEC(LASSO)"]
["CIGNA HEALTHCARE","C1731 - HC CATH,EP PENTARAY NAV"]
["CIGNA HEALTHCARE","C1732 - HC CATH,EP DECA NAV"]
["CIGNA HEALTHCARE","C1733 - CATH CRYABL  ARCTIC FRN"]
["CIGNA HEALTHCARE","C1750 - HC CATH 2 LUMEN QUINTON"]
["CIGNA HEALTHCARE","C1751 - HC CATH, PACING"]
["CIGNA HEALTHCARE","C1753 - HC BIOPSY FORC LVL D"]
["CIGNA HEALTHCARE","C1756 - HC PACING WIRE"]
["CIGNA HEALTHCARE","C1757 - HC CATH,THROMB/EMB,LVL 2"]
["CIGNA HEALTHCARE","C1759 - HC CATH, ULTRASOUND LVL 2"]
["CIGNA HEALTHCARE","C1760 - HC CENTRAL LINE KIT"]
["CIGNA HEALTHCARE","C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN"]
["CIGNA HEALTHCARE","C1763 - HC SM6X16-STEM HEM"]
["CIGNA HEALTHCARE","C1764 - HC RECORDER;IMPLANTABLE LOOP"]
["CIGNA HEALTHCARE","C1765 - ADHESION BARRIER"]
["CIGNA HEALTHCARE","C1766 - SHTH INTRO 65CM 15FR 12FR"]
["CIGNA HEALTHCARE","C1768 - HC TAVR HEART VALVE KIT"]
["CIGNA HEALTHCARE","C1769 - GUIDE WIRE"]
["CIGNA HEALTHCARE","C1770 - IMAGING COIL, MR, INSERTABLE"]
["CIGNA HEALTHCARE","C1773 - HC GUIDEWIRE LVL E"]
["CIGNA HEALTHCARE","C1776 - HC HEMI-TIB PLATEAU W MENISC"]
["CIGNA HEALTHCARE","C1777 - HC LEAD,ICD,1COIL"]
["CIGNA HEALTHCARE","C1781 - MESH (IMPLANTABLE)"]
["CIGNA HEALTHCARE","C1784 - HC DES PERIPHERAL STENT"]
["CIGNA HEALTHCARE","C1785 - HC PACER;2CH, RECALL $0"]
["CIGNA HEALTHCARE","C1786 - HC PACER;1CH, RECALL $0"]
["CIGNA HEALTHCARE","C1788 - HC PORTACATH ANY"]
["CIGNA HEALTHCARE","C1817 - HC OCCKYDER;ASD/PFO"]
["CIGNA HEALTHCARE","C1821 - HC INTERSPINOUS IMPLANT"]
["CIGNA HEALTHCARE","C1874 - STENT WALLFLEX SYSTEM"]
["CIGNA HEALTHCARE","C1876 - STENT BILIARY"]
["CIGNA HEALTHCARE","C1880 - IVC FILTERS"]
["CIGNA HEALTHCARE","C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0"]
["CIGNA HEALTHCARE","C1883 - HC ADAPTOR;BI-VENT PACER"]
["CIGNA HEALTHCARE","C1884 - EMBOLIZATION PROTECT SYST"]
["CIGNA HEALTHCARE","C1887 - HC CATH,EP;R-F,30D THERM RMT"]
["CIGNA HEALTHCARE","C1892 - HC SHEATH;GUIDING"]
["CIGNA HEALTHCARE","C1893 - HC DILATOR SHEATH/VISISHEATH"]
["CIGNA HEALTHCARE","C1894 - HC INTRO/SHEATH NON-CARD LV2"]
["CIGNA HEALTHCARE","C1895 - HC ICD LEAD,2COIL"]
["CIGNA HEALTHCARE","C1896 - HC SICD PULSE GENERATOR"]
["CIGNA HEALTHCARE","C1898 - HC KIT,PACER;BI-VENT(#6216/8"]
["CIGNA HEALTHCARE","C1900 - HC INJ;OCTAFLUORO MICRO/1ML"]
["CIGNA HEALTHCARE","C2615 - SEALANT, PULMONARY, LIQUID"]
["CIGNA HEALTHCARE","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE"]
["CIGNA HEALTHCARE","C2617 - STENT ZIMMON BILIARY"]
["CIGNA HEALTHCARE","C2621 - HC PACER;2CH, W/ BACKUP DEFIB"]
["CIGNA HEALTHCARE","C2623 - CATH TRANSLUMIN DRUG-COAT"]
["CIGNA HEALTHCARE","C2625 - STENT BILIARY COTTON"]
["CIGNA HEALTHCARE","C2628 - HC KIT CATH BRIDGE PRE"]
["CIGNA HEALTHCARE","C2630 - HC CATH;EP CRYOABLATION, 8 MM"]
["CIGNA HEALTHCARE","C2634 - BRACHYTX, NON-STR, HA, I-125"]
["CIGNA HEALTHCARE","C2635 - BRACHYTX, NON-STR, HA, P-103"]
["CIGNA HEALTHCARE","C2639 - BRACHYTX, NON-STRANDED,I-125"]
["CIGNA HEALTHCARE","C5275 - HC LOW COST SKIN SUBSTITUTE"]
["CIGNA HEALTHCARE","C8908 - HC MRI W/O FOL W/CONT, BREAST,"]
["CIGNA HEALTHCARE","C8937 - CAD BREAST MRI"]
["CIGNA HEALTHCARE","C9358 - SURGIMEND, FETAL"]
["CIGNA HEALTHCARE","C9728 - PLACE DEVICE/MARKER, NON PRO"]
["CIGNA HEALTHCARE","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3"]
["CIGNA HEALTHCARE","C9803 - HC OP VISIT SPEC COLLECTION SEVERE ACUTE RESP SYDROM COVID-19"]
["CIGNA HEALTHCARE","D0150 - COMPREHENSIVE ORAL EXAM 60MIN"]
["CIGNA HEALTHCARE","D0240 - INTRAORAL - OCCLUSAL RADIOGRAPHIC IMAGE"]
["CIGNA HEALTHCARE","D0250 - HC EXTRA-ORAL - 2D PROJECTION RAD IMAGE CREATED USING A STATIONARY RADIATION SOURCE, AND DETECTOR"]
["CIGNA HEALTHCARE","D0251 - HC EXTRA-ORAL POSTERIOR DENTAL RADIOGRAPHIC IMAGE"]
["CIGNA HEALTHCARE","D0270 - BITEWING - SINGLE RADIOGRAPHIC IMAGE"]
["CIGNA HEALTHCARE","D0272 - BITEWINGS - TWO RADIOGRAPHIC IMAGES"]
["CIGNA HEALTHCARE","D0274 - BITEWINGS - FOUR RADIOGRAPHIC IMAGES"]
["CIGNA HEALTHCARE","D0277 - HC VERTICAL BITEWINGS - 7 TO 8 RADIOGRAPHIC IMAGES"]
["CIGNA HEALTHCARE","D0472 - HC ACCESSION OF TISSUE, GROSS EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN REPORT"]
["CIGNA HEALTHCARE","D0473 - HC ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAM, PREP AND TRANS OF RPT."]
["CIGNA HEALTHCARE","D0474 - HC ACCESSION OF TISSUE, GROSS AND MICRO EXAM, INCL. ASSESS. OF MARGINS FOR DISEASE, PREP., TX OF RPT"]
["CIGNA HEALTHCARE","D0480 - HC ACCESSION OF EXFOLIATIVE CYTOLOGIC SMEARS, MICROSCOPIC EXAM, PREP AND TRANS OF RPT"]
["CIGNA HEALTHCARE","D1110 - PROPHYLAXIS - ADULT"]
["CIGNA HEALTHCARE","D1510 - SPACE MAINTAINER - FIXED - UNILATERAL"]
["CIGNA HEALTHCARE","D1516 - SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MAXILLARY"]
["CIGNA HEALTHCARE","D1517 - SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MANDIBULAR"]
["CIGNA HEALTHCARE","D1575 - HC DISTAL SHOE SPACE MAINTAINER ¿ FIXED ¿ UNILATERAL"]
["CIGNA HEALTHCARE","D2999 - HC UNSPECIFIED RESTORATIVE PROCEDURE, BY REPORT"]
["CIGNA HEALTHCARE","D3460 - HC ENDODONTIC ENDOSSEOUS IMPLANT"]
["CIGNA HEALTHCARE","D3999 - HC UNSPECIFIED ENDODONTIC PROCEDURE, BY REPORT"]
["CIGNA HEALTHCARE","D4260 - HC OSSEOUS SURGERY FOUR OR MORE CONT. TEETH OR TOOTH BOUNDED SPACES PER QUAD."]
["CIGNA HEALTHCARE","D4263 - HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ FIRST SITE IN QUADRANT"]
["CIGNA HEALTHCARE","D4264 - HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ EACH ADDITIONAL SITE IN QUADRANT"]
["CIGNA HEALTHCARE","D4270 - HC PEDICLE SOFT TISSUE GRAFT PROCEDURE"]
["CIGNA HEALTHCARE","D4273 - HC AUTOGENOUS CONN. TISSUE GRAFT PROC. 1ST TOOTH, IMPLANT, OR EDENTULOUS TOOTH POSITION IN GRAFT"]
["CIGNA HEALTHCARE","D4355 - FULL MOUTH DEBRIDEMENT TO ENABLE COMPREHENSIVE EVALUATION AND DIAGNOSIS"]
["CIGNA HEALTHCARE","D4381 - HC LOCALIZED DELIVERY - CONTROLLED RELEASE ANTIMICROB. AGENTS TO DISEASED CREVICULAR TISSUE /TOOTH"]
["CIGNA HEALTHCARE","D5911 - HC FACIAL MOULAGE (SECTIONAL)"]
["CIGNA HEALTHCARE","D5912 - HC FACIAL MOULAGE (COMPLETE)"]
["CIGNA HEALTHCARE","D5983 - HC RADIATION CARRIER"]
["CIGNA HEALTHCARE","D5984 - HC RADIATION SHIELD"]
["CIGNA HEALTHCARE","D5985 - HC RADIATION CONE LOCATOR"]
["CIGNA HEALTHCARE","D5987 - HC COMMISSURE SPLINT"]
["CIGNA HEALTHCARE","D7140 - EXTRACTION ERUPTED TOOTH/EXR"]
["CIGNA HEALTHCARE","D7210 - EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED"]
["CIGNA HEALTHCARE","D7220 - REMOVAL OF IMPACTED TOOTH - SOFT TISSUE"]
["CIGNA HEALTHCARE","D7230 - REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY"]
["CIGNA HEALTHCARE","D7240 - REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY"]
["CIGNA HEALTHCARE","D7250 - REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)"]
["CIGNA HEALTHCARE","D7260 - HC OROANTRAL FISTULA CLOSURE"]
["CIGNA HEALTHCARE","D7261 - PRIMARY CLOSURE OF A SINUS PERFORATION"]
["CIGNA HEALTHCARE","D7940 - HC OSTEOPLASTY - FOR ORTHOGNATHIC DEFORMITIES"]
["CIGNA HEALTHCARE","D9110 - PALLIATIVE (EMERGENCY) TREATMENT OF DENTAL PAIN - MINOR PROCEDURE"]
["CIGNA HEALTHCARE","D9230 - INHALATION OF NITROUS OXIDE/ANALGESIA, ANXIOLYSIS"]
["CIGNA HEALTHCARE","D9630 - HC DRUGS OR MEDICAMENTS DISPENSED IN THE OFFICE FOR HOME USE"]
["CIGNA HEALTHCARE","D9930 - HC TREATMENT OF COMPLICATIONS (POST-SURGICAL) - UNUSUAL CIRCUMSTANCES, BY REPORT"]
["CIGNA HEALTHCARE","D9944 - HC OCCLUSAL GUARD ¿ HARD APPLIANCE, FULL ARCH"]
["CIGNA HEALTHCARE","D9951 - OCCLUSAL ADJUSTMENT - LIMITED"]
["CIGNA HEALTHCARE","E0191 - PROTECTOR HEEL OR ELBOW"]
["CIGNA HEALTHCARE","G0101 - CA SCREEN;PELVIC/BREAST EXAM"]
["CIGNA HEALTHCARE","G0103 - PSA, TOTAL SCREENING"]
["CIGNA HEALTHCARE","G0105 - HC COLORECTAL SCRN; HI RISK IND"]
["CIGNA HEALTHCARE","G0108 - DIAB MANAGE TRN  PER INDIV"]
["CIGNA HEALTHCARE","G0109 - DIAB MANAGE TRN IND/GROUP"]
["CIGNA HEALTHCARE","G0127 - TRIM NAIL(S)"]
["CIGNA HEALTHCARE","G0175 - OPPS SERVICE,SCHED TEAM CONF"]
["CIGNA HEALTHCARE","G0239 - OTH RESP PROC, GROUP"]
["CIGNA HEALTHCARE","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP"]
["CIGNA HEALTHCARE","G0259 - HC INJECT FOR SACROILIAC JOINT"]
["CIGNA HEALTHCARE","G0260 - INJ FOR SACROILIAC JT ANESTH"]
["CIGNA HEALTHCARE","G0269 - HC CLOSURE DEVICE PLACEMENT"]
["CIGNA HEALTHCARE","G0278 - ILIAC ART ANGIO,CARDIAC CATH"]
["CIGNA HEALTHCARE","G0279 - TOMOSYNTHESIS, MAMMO"]
["CIGNA HEALTHCARE","G0296 - HC VISIT TO DETERM LDCT ELIG"]
["CIGNA HEALTHCARE","G0297 - HC LDCT FOR LUNG CA SCREEN"]
["CIGNA HEALTHCARE","G0365 - HC VESSEL MAPPING HEMO ACCESS"]
["CIGNA HEALTHCARE","G0378 - HOSPITAL OBSERVATION PER HR"]
["CIGNA HEALTHCARE","G0379 - DIRECT REFER HOSPITAL OBSERV"]
["CIGNA HEALTHCARE","G0390 - TRAUMA RESPONS W/HOSP CRITI"]
["CIGNA HEALTHCARE","G0396 - ALCOHOL/SUBS INTERV 15-30MN"]
["CIGNA HEALTHCARE","G0397 - ALCOHOL/SUBS INTERV >30 MIN"]
["CIGNA HEALTHCARE","G0402 - INITIAL PREVENTIVE EXAM"]
["CIGNA HEALTHCARE","G0410 - HC GRP PSYCH PARTIAL HOSP 45-50"]
["CIGNA HEALTHCARE","G0416 - HC PROSTATE BIOPSY ANY MTHD"]
["CIGNA HEALTHCARE","G0420 - HC ED SVC CKD IND PER SESSION"]
["CIGNA HEALTHCARE","G0421 - HC ED SVC CKD GRP PER SESSION"]
["CIGNA HEALTHCARE","G0422 - HC INTENS CARDIAC REHAB W/EXERC"]
["CIGNA HEALTHCARE","G0423 - HC INTENS CARDIAC REHAB NO EXER"]
["CIGNA HEALTHCARE","G0424 - PULMONARY REHAB W EXER"]
["CIGNA HEALTHCARE","G0438 - PPPS, INITIAL VISIT"]
["CIGNA HEALTHCARE","G0439 - PPPS, SUBSEQ VISIT"]
["CIGNA HEALTHCARE","G0442 - ANNUAL ALCOHOL SCREEN 15 MIN"]
["CIGNA HEALTHCARE","G0443 - BRIEF ALCOHOL MISUSE COUNSEL"]
["CIGNA HEALTHCARE","G0444 - DEPRESSION SCREEN ANNUAL"]
["CIGNA HEALTHCARE","G0445 - HIGH INTEN BEH COUNS STD 30M"]
["CIGNA HEALTHCARE","G0446 - INTENS BEHAVE THER CARDIO DX"]
["CIGNA HEALTHCARE","G0447 - HC BEHAVIOR COUNSEL OBESITY 15M"]
["CIGNA HEALTHCARE","G0480 - DRUG TEST DEF 1-7 CLASSES"]
["CIGNA HEALTHCARE","G0481 - DRUG TEST DEF 8-14 CLASSES"]
["CIGNA HEALTHCARE","G0506 - HC COMP ASSESS CARE PLAN CCM SVC"]
["CIGNA HEALTHCARE","G0513 - HC PROLONG PREV SVCS, FIRST 30M"]
["CIGNA HEALTHCARE","G0514 - HC PROLONG PREV SVCS, ADDL 30M"]
["CIGNA HEALTHCARE","G2011 - ALCOHOL/SUB ABUSE ASSESS"]
["CIGNA HEALTHCARE","G2012 - HC BRIEF CHECK IN BY MD/QHP"]
["CIGNA HEALTHCARE","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS"]
["CIGNA HEALTHCARE","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA"]
["CIGNA HEALTHCARE","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH"]
["CIGNA HEALTHCARE","G2086 - HC OFF BASE OPIOID TX 70MIN"]
["CIGNA HEALTHCARE","G2087 - HC OFF BASE OPIOID TX, 60 M"]
["CIGNA HEALTHCARE","J0702 - HC BETAMETHASONE ACET&SOD PHOSP"]
["CIGNA HEALTHCARE","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)"]
["CIGNA HEALTHCARE","J1250 - HC DOBUTAMINE SDV/250MG"]
["CIGNA HEALTHCARE","J2790 - HC IG;RHO D,HUMAN/300MCG"]
["CIGNA HEALTHCARE","J3301 - HC TRIAMCINOLONE ACET INJ NOS"]
["CIGNA HEALTHCARE","J3590 - COSTAL CARTILAGE ALLOGRAFT"]
["CIGNA HEALTHCARE","J7307 - HC ETONOGESTREL IMPLANT SYSTEM"]
["CIGNA HEALTHCARE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE"]
["CIGNA HEALTHCARE","L0140 - CERVICAL SEMI-RIGID ADJUSTAB"]
["CIGNA HEALTHCARE","L1820 - KO ELAS W/ CONDYLE PADS & JO"]
["CIGNA HEALTHCARE","L1830 - KO IMMOBILIZER CANVAS LONGIT"]
["CIGNA HEALTHCARE","L1832 - KO ADJ JNT POS RIGID SUPPORT"]
["CIGNA HEALTHCARE","L1836 - HC RIGID KO WO JOINTS"]
["CIGNA HEALTHCARE","L1902 - AFO ANKLE GAUNTLET"]
["CIGNA HEALTHCARE","L3260 - AMBULATORY SURGICAL BOOT EAC"]
["CIGNA HEALTHCARE","L3350 - SHOE HEEL WEDGE"]
["CIGNA HEALTHCARE","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN"]
["CIGNA HEALTHCARE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE"]
["CIGNA HEALTHCARE","L3760 - EO WITHJOINT, PREFABRICATED"]
["CIGNA HEALTHCARE","L3762 - RIGID EO WO JOINTS"]
["CIGNA HEALTHCARE","L3807 - WHFO,NO JOINT, PREFABRICATED"]
["CIGNA HEALTHCARE","L3808 - HC EPITRAIN"]
["CIGNA HEALTHCARE","L3905 - HC WHO W/NONTORSION JNT(S) CF"]
["CIGNA HEALTHCARE","L3908 - WRIST COCK-UP NON-MOLDED"]
["CIGNA HEALTHCARE","L3967 - HC SEWHO AIRPLANE W/O JNTS CF"]
["CIGNA HEALTHCARE","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL"]
["CIGNA HEALTHCARE","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL"]
["CIGNA HEALTHCARE","L4350 - ANKLE CONTROL ORTHOSI PREFAB"]
["CIGNA HEALTHCARE","L4360 - PNEUMATI WALKING BOOT PREFAB"]
["CIGNA HEALTHCARE","L4370 - HC PNEUMATIC FULL LEG SPLINT"]
["CIGNA HEALTHCARE","L4386 - NON-PNEUM WALK BOOT PREFAB"]
["CIGNA HEALTHCARE","L4396 - STATIC AFO"]
["CIGNA HEALTHCARE","L4398 - HC FOOT DROP SPLINT RECUMBENT"]
["CIGNA HEALTHCARE","L8501 - TRACHEOSTOMY SPEAKING VALVE"]
["CIGNA HEALTHCARE","L8507 - HC PROLARYNX VOICE (PLUS)"]
["CIGNA HEALTHCARE","L8509 - TRACH-ESOPH VOICE PROS MD IN"]
["CIGNA HEALTHCARE","L8514 - REPL TRACH PUNCTURE DILATOR"]
["CIGNA HEALTHCARE","L8693 - HC AUD OSSEO DEV, ABUTMENT"]
["CIGNA HEALTHCARE","L8699 - HC CARTIFORM 20 X 25 MM DISC"]
["CIGNA HEALTHCARE","P9012 - HC CRYOPRECIPITATE UNIT"]
["CIGNA HEALTHCARE","P9016 - HC RBC:LEU-RED"]
["CIGNA HEALTHCARE","P9017 - HC FF PLAS: 1 DONOR"]
["CIGNA HEALTHCARE","P9021 - HC RBC/UNIT"]
["CIGNA HEALTHCARE","P9034 - HB PLATELETS, PHERESIS"]
["CIGNA HEALTHCARE","P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT"]
["CIGNA HEALTHCARE","P9040 - HC RBC:LEU-RED,IRR/UNIT"]
["CIGNA HEALTHCARE","P9044 - HC CRYOPRECIPITATE REDUCED PLASMA"]
["CIGNA HEALTHCARE","P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["CIGNA HEALTHCARE","P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["CIGNA HEALTHCARE","P9056 - HC BLOOD, L/R, IRRADIATED"]
["CIGNA HEALTHCARE","P9057 - HC RBC:LEU RED,FR/DE/WASH,IR"]
["CIGNA HEALTHCARE","P9073 - HC PLATELETS PHERESIS PATH REDU"]
["CIGNA HEALTHCARE","P9100 - PATHOGEN TEST FOR PLATELETS"]
["CIGNA HEALTHCARE","P9612 - CATHETERIZE FOR URINE SPEC"]
["CIGNA HEALTHCARE","Q0091 - HC OBTAINING SCREEN PAP SMEAR"]
["CIGNA HEALTHCARE","Q0111 - HC WET MOUNTS W PREPARATIONS"]
["CIGNA HEALTHCARE","Q0114 - HC  FERN TEST"]
["CIGNA HEALTHCARE","Q3014 - HC TELEHEALTH FACILITY FEE"]
["CIGNA HEALTHCARE","Q4100 - STRAVIX 3X6"]
["CIGNA HEALTHCARE","Q4101 - APLIGRAF"]
["CIGNA HEALTHCARE","Q4102 - OASIS WOUND MATRIX"]
["CIGNA HEALTHCARE","Q4104 - INTEGRA BMWD"]
["CIGNA HEALTHCARE","Q4107 - GRAFTJACKET"]
["CIGNA HEALTHCARE","Q4112 - CYMETRA INJECTABLE"]
["CIGNA HEALTHCARE","Q4116 - HC ALLODERM 8 X 16 MEDIUM"]
["CIGNA HEALTHCARE","Q4124 - OASIS TRILAYER/1 SQCM"]
["CIGNA HEALTHCARE","Q4125 - HC AFLEX401 ¿ 40 X 70 MM"]
["CIGNA HEALTHCARE","Q4130 - PR STRATTICE TM"]
["CIGNA HEALTHCARE","Q4132 - HC GRAFIX CORE 5X5CM"]
["CIGNA HEALTHCARE","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["CIGNA HEALTHCARE","Q4196 - HC PURAPLYAM-COM 6X9 CM"]
["CIGNA HEALTHCARE","Q9954 - ORAL MR CONTRAST, 100 ML"]
["CIGNA HEALTHCARE","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["CIGNA HEALTHCARE","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["CIGNA HEALTHCARE","Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["CIGNA HEALTHCARE","Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["CIGNA HEALTHCARE","Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["CIGNA HEALTHCARE","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["CIGNA HEALTHCARE","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["CIGNA HEALTHCARE","S2083 - HC ADJUSTMENT GASTRIC BAND"]
["CIGNA HEALTHCARE","S8037 - MRCP"]
["CIGNA HEALTHCARE","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH"]
["CIGNA HEALTHCARE","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP"]
["CIGNA HEALTHCARE","V2785 - CORNEAL TISSUE PROCESSING"]
["CIGNA HEALTHCARE","V2790 - HC MEMBRANE AMNIOTIC"]
["COMMONWEALTH CARE ALLIANCE","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS"]
["COMMONWEALTH CARE ALLIANCE","A4561 - HC PESSARY RUBBER, ANY TYPE"]
["COMMONWEALTH CARE ALLIANCE","A4562 - PESSARY NONRUBBER"]
["COMMONWEALTH CARE ALLIANCE","A6209 - FOAM DRSG <=16 SQ IN W/O BDR"]
["COMMONWEALTH CARE ALLIANCE","A6258 - TRANSPARENT FILM >16<=48 IN"]
["COMMONWEALTH CARE ALLIANCE","A6550 - NEG PRES WOUND THER DRSG SET"]
["COMMONWEALTH CARE ALLIANCE","A7520 - TRACH/LARYN TUBE NON-CUFFED"]
["COMMONWEALTH CARE ALLIANCE","A9575 - INJ GADOTERATE MEGLUMI 0.1ML"]
["COMMONWEALTH CARE ALLIANCE","A9576 - HC PROHANCE IV CONTRAST PER ML"]
["COMMONWEALTH CARE ALLIANCE","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML"]
["COMMONWEALTH CARE ALLIANCE","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["COMMONWEALTH CARE ALLIANCE","A9581 - GADOXETATE DISODIUM INJ"]
["COMMONWEALTH CARE ALLIANCE","E0191 - PROTECTOR HEEL OR ELBOW"]
["COMMONWEALTH CARE ALLIANCE","G0103 - PSA, TOTAL SCREENING"]
["COMMONWEALTH CARE ALLIANCE","G0279 - TOMOSYNTHESIS, MAMMO"]
["COMMONWEALTH CARE ALLIANCE","G0480 - DRUG TEST DEF 1-7 CLASSES"]
["COMMONWEALTH CARE ALLIANCE","G0481 - DRUG TEST DEF 8-14 CLASSES"]
["COMMONWEALTH CARE ALLIANCE","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS"]
["COMMONWEALTH CARE ALLIANCE","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA"]
["COMMONWEALTH CARE ALLIANCE","J0702 - HC BETAMETHASONE ACET&SOD PHOSP"]
["COMMONWEALTH CARE ALLIANCE","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)"]
["COMMONWEALTH CARE ALLIANCE","J1250 - HC DOBUTAMINE SDV/250MG"]
["COMMONWEALTH CARE ALLIANCE","J2790 - HC IG;RHO D,HUMAN/300MCG"]
["COMMONWEALTH CARE ALLIANCE","J3301 - HC TRIAMCINOLONE ACET INJ NOS"]
["COMMONWEALTH CARE ALLIANCE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE"]
["COMMONWEALTH CARE ALLIANCE","L0140 - CERVICAL SEMI-RIGID ADJUSTAB"]
["COMMONWEALTH CARE ALLIANCE","L1820 - KO ELAS W/ CONDYLE PADS & JO"]
["COMMONWEALTH CARE ALLIANCE","L1830 - KO IMMOBILIZER CANVAS LONGIT"]
["COMMONWEALTH CARE ALLIANCE","L1832 - KO ADJ JNT POS RIGID SUPPORT"]
["COMMONWEALTH CARE ALLIANCE","L1836 - HC RIGID KO WO JOINTS"]
["COMMONWEALTH CARE ALLIANCE","L1902 - AFO ANKLE GAUNTLET"]
["COMMONWEALTH CARE ALLIANCE","L3350 - SHOE HEEL WEDGE"]
["COMMONWEALTH CARE ALLIANCE","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN"]
["COMMONWEALTH CARE ALLIANCE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE"]
["COMMONWEALTH CARE ALLIANCE","L3760 - EO WITHJOINT, PREFABRICATED"]
["COMMONWEALTH CARE ALLIANCE","L3762 - RIGID EO WO JOINTS"]
["COMMONWEALTH CARE ALLIANCE","L3807 - WHFO,NO JOINT, PREFABRICATED"]
["COMMONWEALTH CARE ALLIANCE","L3808 - HC EPITRAIN"]
["COMMONWEALTH CARE ALLIANCE","L3905 - HC WHO W/NONTORSION JNT(S) CF"]
["COMMONWEALTH CARE ALLIANCE","L3908 - WRIST COCK-UP NON-MOLDED"]
["COMMONWEALTH CARE ALLIANCE","L3967 - HC SEWHO AIRPLANE W/O JNTS CF"]
["COMMONWEALTH CARE ALLIANCE","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL"]
["COMMONWEALTH CARE ALLIANCE","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL"]
["COMMONWEALTH CARE ALLIANCE","L4350 - ANKLE CONTROL ORTHOSI PREFAB"]
["COMMONWEALTH CARE ALLIANCE","L4360 - PNEUMATI WALKING BOOT PREFAB"]
["COMMONWEALTH CARE ALLIANCE","L4370 - HC PNEUMATIC FULL LEG SPLINT"]
["COMMONWEALTH CARE ALLIANCE","L4386 - NON-PNEUM WALK BOOT PREFAB"]
["COMMONWEALTH CARE ALLIANCE","L4396 - STATIC AFO"]
["COMMONWEALTH CARE ALLIANCE","L4398 - HC FOOT DROP SPLINT RECUMBENT"]
["COMMONWEALTH CARE ALLIANCE","L8501 - TRACHEOSTOMY SPEAKING VALVE"]
["COMMONWEALTH CARE ALLIANCE","L8507 - HC PROLARYNX VOICE (PLUS)"]
["COMMONWEALTH CARE ALLIANCE","L8509 - TRACH-ESOPH VOICE PROS MD IN"]
["COMMONWEALTH CARE ALLIANCE","L8514 - REPL TRACH PUNCTURE DILATOR"]
["COMMONWEALTH CARE ALLIANCE","L8693 - HC AUD OSSEO DEV, ABUTMENT"]
["COMMONWEALTH CARE ALLIANCE","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING"]
["COMMONWEALTH CARE ALLIANCE","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG"]
["COMMONWEALTH CARE ALLIANCE","P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["COMMONWEALTH CARE ALLIANCE","P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["COMMONWEALTH CARE ALLIANCE","P9612 - CATHETERIZE FOR URINE SPEC"]
["COMMONWEALTH CARE ALLIANCE","Q0111 - HC WET MOUNTS W PREPARATIONS"]
["COMMONWEALTH CARE ALLIANCE","Q0114 - HC  FERN TEST"]
["COMMONWEALTH CARE ALLIANCE","Q3014 - HC TELEHEALTH FACILITY FEE"]
["COMMONWEALTH CARE ALLIANCE","Q4101 - APLIGRAF"]
["COMMONWEALTH CARE ALLIANCE","Q4102 - OASIS WOUND MATRIX"]
["COMMONWEALTH CARE ALLIANCE","Q4132 - HC GRAFIX CORE 5X5CM"]
["COMMONWEALTH CARE ALLIANCE","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["COMMONWEALTH CARE ALLIANCE","Q4196 - HC PURAPLYAM-COM 6X9 CM"]
["COMMONWEALTH CARE ALLIANCE","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["COMMONWEALTH CARE ALLIANCE","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["COMMONWEALTH CARE ALLIANCE","Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["COMMONWEALTH CARE ALLIANCE","Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["COMMONWEALTH CARE ALLIANCE","Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["COMMONWEALTH CARE ALLIANCE","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["COMMONWEALTH CARE ALLIANCE","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["COMMONWEALTH CARE ALLIANCE","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH"]
["COMMONWEALTH CARE ALLIANCE","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP"]
["ELDER SERVICE PLAN","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS"]
["ELDER SERVICE PLAN","A4561 - HC PESSARY RUBBER, ANY TYPE"]
["ELDER SERVICE PLAN","A4562 - PESSARY NONRUBBER"]
["ELDER SERVICE PLAN","A6209 - FOAM DRSG <=16 SQ IN W/O BDR"]
["ELDER SERVICE PLAN","A6258 - TRANSPARENT FILM >16<=48 IN"]
["ELDER SERVICE PLAN","A6550 - NEG PRES WOUND THER DRSG SET"]
["ELDER SERVICE PLAN","A7520 - TRACH/LARYN TUBE NON-CUFFED"]
["ELDER SERVICE PLAN","A9575 - INJ GADOTERATE MEGLUMI 0.1ML"]
["ELDER SERVICE PLAN","A9576 - HC PROHANCE IV CONTRAST PER ML"]
["ELDER SERVICE PLAN","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML"]
["ELDER SERVICE PLAN","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["ELDER SERVICE PLAN","A9581 - GADOXETATE DISODIUM INJ"]
["ELDER SERVICE PLAN","E0191 - PROTECTOR HEEL OR ELBOW"]
["ELDER SERVICE PLAN","G0103 - PSA, TOTAL SCREENING"]
["ELDER SERVICE PLAN","G0279 - TOMOSYNTHESIS, MAMMO"]
["ELDER SERVICE PLAN","G0480 - DRUG TEST DEF 1-7 CLASSES"]
["ELDER SERVICE PLAN","G0481 - DRUG TEST DEF 8-14 CLASSES"]
["ELDER SERVICE PLAN","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS"]
["ELDER SERVICE PLAN","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA"]
["ELDER SERVICE PLAN","J0702 - HC BETAMETHASONE ACET&SOD PHOSP"]
["ELDER SERVICE PLAN","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)"]
["ELDER SERVICE PLAN","J1250 - HC DOBUTAMINE SDV/250MG"]
["ELDER SERVICE PLAN","J2790 - HC IG;RHO D,HUMAN/300MCG"]
["ELDER SERVICE PLAN","J3301 - HC TRIAMCINOLONE ACET INJ NOS"]
["ELDER SERVICE PLAN","L0120 - CERV FLEXIBLE NON-ADJUSTABLE"]
["ELDER SERVICE PLAN","L0140 - CERVICAL SEMI-RIGID ADJUSTAB"]
["ELDER SERVICE PLAN","L1820 - KO ELAS W/ CONDYLE PADS & JO"]
["ELDER SERVICE PLAN","L1830 - KO IMMOBILIZER CANVAS LONGIT"]
["ELDER SERVICE PLAN","L1832 - KO ADJ JNT POS RIGID SUPPORT"]
["ELDER SERVICE PLAN","L1836 - HC RIGID KO WO JOINTS"]
["ELDER SERVICE PLAN","L1902 - AFO ANKLE GAUNTLET"]
["ELDER SERVICE PLAN","L3350 - SHOE HEEL WEDGE"]
["ELDER SERVICE PLAN","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN"]
["ELDER SERVICE PLAN","L3670 - ACROMIO/CLAVICULAR CANVAS&WE"]
["ELDER SERVICE PLAN","L3760 - EO WITHJOINT, PREFABRICATED"]
["ELDER SERVICE PLAN","L3762 - RIGID EO WO JOINTS"]
["ELDER SERVICE PLAN","L3807 - WHFO,NO JOINT, PREFABRICATED"]
["ELDER SERVICE PLAN","L3808 - HC EPITRAIN"]
["ELDER SERVICE PLAN","L3905 - HC WHO W/NONTORSION JNT(S) CF"]
["ELDER SERVICE PLAN","L3908 - WRIST COCK-UP NON-MOLDED"]
["ELDER SERVICE PLAN","L3967 - HC SEWHO AIRPLANE W/O JNTS CF"]
["ELDER SERVICE PLAN","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL"]
["ELDER SERVICE PLAN","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL"]
["ELDER SERVICE PLAN","L4350 - ANKLE CONTROL ORTHOSI PREFAB"]
["ELDER SERVICE PLAN","L4360 - PNEUMATI WALKING BOOT PREFAB"]
["ELDER SERVICE PLAN","L4370 - HC PNEUMATIC FULL LEG SPLINT"]
["ELDER SERVICE PLAN","L4386 - NON-PNEUM WALK BOOT PREFAB"]
["ELDER SERVICE PLAN","L4396 - STATIC AFO"]
["ELDER SERVICE PLAN","L4398 - HC FOOT DROP SPLINT RECUMBENT"]
["ELDER SERVICE PLAN","L8501 - TRACHEOSTOMY SPEAKING VALVE"]
["ELDER SERVICE PLAN","L8507 - HC PROLARYNX VOICE (PLUS)"]
["ELDER SERVICE PLAN","L8509 - TRACH-ESOPH VOICE PROS MD IN"]
["ELDER SERVICE PLAN","L8514 - REPL TRACH PUNCTURE DILATOR"]
["ELDER SERVICE PLAN","L8693 - HC AUD OSSEO DEV, ABUTMENT"]
["ELDER SERVICE PLAN","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING"]
["ELDER SERVICE PLAN","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG"]
["ELDER SERVICE PLAN","P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["ELDER SERVICE PLAN","P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["ELDER SERVICE PLAN","P9612 - CATHETERIZE FOR URINE SPEC"]
["ELDER SERVICE PLAN","Q0111 - HC WET MOUNTS W PREPARATIONS"]
["ELDER SERVICE PLAN","Q0114 - HC  FERN TEST"]
["ELDER SERVICE PLAN","Q3014 - HC TELEHEALTH FACILITY FEE"]
["ELDER SERVICE PLAN","Q4101 - APLIGRAF"]
["ELDER SERVICE PLAN","Q4102 - OASIS WOUND MATRIX"]
["ELDER SERVICE PLAN","Q4132 - HC GRAFIX CORE 5X5CM"]
["ELDER SERVICE PLAN","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["ELDER SERVICE PLAN","Q4196 - HC PURAPLYAM-COM 6X9 CM"]
["ELDER SERVICE PLAN","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["ELDER SERVICE PLAN","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["ELDER SERVICE PLAN","Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["ELDER SERVICE PLAN","Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["ELDER SERVICE PLAN","Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["ELDER SERVICE PLAN","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["ELDER SERVICE PLAN","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["ELDER SERVICE PLAN","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH"]
["ELDER SERVICE PLAN","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP"]
["ELDER SERVICE PLAN OTHER","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS"]
["ELDER SERVICE PLAN OTHER","A4561 - HC PESSARY RUBBER, ANY TYPE"]
["ELDER SERVICE PLAN OTHER","A4562 - PESSARY NONRUBBER"]
["ELDER SERVICE PLAN OTHER","A6209 - FOAM DRSG <=16 SQ IN W/O BDR"]
["ELDER SERVICE PLAN OTHER","A6258 - TRANSPARENT FILM >16<=48 IN"]
["ELDER SERVICE PLAN OTHER","A6550 - NEG PRES WOUND THER DRSG SET"]
["ELDER SERVICE PLAN OTHER","A7520 - TRACH/LARYN TUBE NON-CUFFED"]
["ELDER SERVICE PLAN OTHER","A9575 - INJ GADOTERATE MEGLUMI 0.1ML"]
["ELDER SERVICE PLAN OTHER","A9576 - HC PROHANCE IV CONTRAST PER ML"]
["ELDER SERVICE PLAN OTHER","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML"]
["ELDER SERVICE PLAN OTHER","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["ELDER SERVICE PLAN OTHER","A9581 - GADOXETATE DISODIUM INJ"]
["ELDER SERVICE PLAN OTHER","E0191 - PROTECTOR HEEL OR ELBOW"]
["ELDER SERVICE PLAN OTHER","G0103 - PSA, TOTAL SCREENING"]
["ELDER SERVICE PLAN OTHER","G0279 - TOMOSYNTHESIS, MAMMO"]
["ELDER SERVICE PLAN OTHER","G0480 - DRUG TEST DEF 1-7 CLASSES"]
["ELDER SERVICE PLAN OTHER","G0481 - DRUG TEST DEF 8-14 CLASSES"]
["ELDER SERVICE PLAN OTHER","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS"]
["ELDER SERVICE PLAN OTHER","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA"]
["ELDER SERVICE PLAN OTHER","J0702 - HC BETAMETHASONE ACET&SOD PHOSP"]
["ELDER SERVICE PLAN OTHER","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)"]
["ELDER SERVICE PLAN OTHER","J1250 - HC DOBUTAMINE SDV/250MG"]
["ELDER SERVICE PLAN OTHER","J2790 - HC IG;RHO D,HUMAN/300MCG"]
["ELDER SERVICE PLAN OTHER","J3301 - HC TRIAMCINOLONE ACET INJ NOS"]
["ELDER SERVICE PLAN OTHER","L0120 - CERV FLEXIBLE NON-ADJUSTABLE"]
["ELDER SERVICE PLAN OTHER","L0140 - CERVICAL SEMI-RIGID ADJUSTAB"]
["ELDER SERVICE PLAN OTHER","L1820 - KO ELAS W/ CONDYLE PADS & JO"]
["ELDER SERVICE PLAN OTHER","L1830 - KO IMMOBILIZER CANVAS LONGIT"]
["ELDER SERVICE PLAN OTHER","L1832 - KO ADJ JNT POS RIGID SUPPORT"]
["ELDER SERVICE PLAN OTHER","L1836 - HC RIGID KO WO JOINTS"]
["ELDER SERVICE PLAN OTHER","L1902 - AFO ANKLE GAUNTLET"]
["ELDER SERVICE PLAN OTHER","L3350 - SHOE HEEL WEDGE"]
["ELDER SERVICE PLAN OTHER","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN"]
["ELDER SERVICE PLAN OTHER","L3670 - ACROMIO/CLAVICULAR CANVAS&WE"]
["ELDER SERVICE PLAN OTHER","L3760 - EO WITHJOINT, PREFABRICATED"]
["ELDER SERVICE PLAN OTHER","L3762 - RIGID EO WO JOINTS"]
["ELDER SERVICE PLAN OTHER","L3807 - WHFO,NO JOINT, PREFABRICATED"]
["ELDER SERVICE PLAN OTHER","L3808 - HC EPITRAIN"]
["ELDER SERVICE PLAN OTHER","L3905 - HC WHO W/NONTORSION JNT(S) CF"]
["ELDER SERVICE PLAN OTHER","L3908 - WRIST COCK-UP NON-MOLDED"]
["ELDER SERVICE PLAN OTHER","L3967 - HC SEWHO AIRPLANE W/O JNTS CF"]
["ELDER SERVICE PLAN OTHER","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL"]
["ELDER SERVICE PLAN OTHER","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL"]
["ELDER SERVICE PLAN OTHER","L4350 - ANKLE CONTROL ORTHOSI PREFAB"]
["ELDER SERVICE PLAN OTHER","L4360 - PNEUMATI WALKING BOOT PREFAB"]
["ELDER SERVICE PLAN OTHER","L4370 - HC PNEUMATIC FULL LEG SPLINT"]
["ELDER SERVICE PLAN OTHER","L4386 - NON-PNEUM WALK BOOT PREFAB"]
["ELDER SERVICE PLAN OTHER","L4396 - STATIC AFO"]
["ELDER SERVICE PLAN OTHER","L4398 - HC FOOT DROP SPLINT RECUMBENT"]
["ELDER SERVICE PLAN OTHER","L8501 - TRACHEOSTOMY SPEAKING VALVE"]
["ELDER SERVICE PLAN OTHER","L8507 - HC PROLARYNX VOICE (PLUS)"]
["ELDER SERVICE PLAN OTHER","L8509 - TRACH-ESOPH VOICE PROS MD IN"]
["ELDER SERVICE PLAN OTHER","L8514 - REPL TRACH PUNCTURE DILATOR"]
["ELDER SERVICE PLAN OTHER","L8693 - HC AUD OSSEO DEV, ABUTMENT"]
["ELDER SERVICE PLAN OTHER","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING"]
["ELDER SERVICE PLAN OTHER","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG"]
["ELDER SERVICE PLAN OTHER","P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["ELDER SERVICE PLAN OTHER","P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["ELDER SERVICE PLAN OTHER","P9612 - CATHETERIZE FOR URINE SPEC"]
["ELDER SERVICE PLAN OTHER","Q0111 - HC WET MOUNTS W PREPARATIONS"]
["ELDER SERVICE PLAN OTHER","Q0114 - HC  FERN TEST"]
["ELDER SERVICE PLAN OTHER","Q3014 - HC TELEHEALTH FACILITY FEE"]
["ELDER SERVICE PLAN OTHER","Q4101 - APLIGRAF"]
["ELDER SERVICE PLAN OTHER","Q4102 - OASIS WOUND MATRIX"]
["ELDER SERVICE PLAN OTHER","Q4132 - HC GRAFIX CORE 5X5CM"]
["ELDER SERVICE PLAN OTHER","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["ELDER SERVICE PLAN OTHER","Q4196 - HC PURAPLYAM-COM 6X9 CM"]
["ELDER SERVICE PLAN OTHER","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["ELDER SERVICE PLAN OTHER","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["ELDER SERVICE PLAN OTHER","Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["ELDER SERVICE PLAN OTHER","Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["ELDER SERVICE PLAN OTHER","Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["ELDER SERVICE PLAN OTHER","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["ELDER SERVICE PLAN OTHER","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["ELDER SERVICE PLAN OTHER","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH"]
["ELDER SERVICE PLAN OTHER","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP"]
["FALLON","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS"]
["FALLON","A4215 - STERILE NEEDLE"]
["FALLON","A4467 - BELT STRAP SLEEV GRMNT COVER"]
["FALLON","A4561 - HC PESSARY RUBBER, ANY TYPE"]
["FALLON","A4562 - PESSARY NONRUBBER"]
["FALLON","A4570 - HC MISC SPLINT SUPPLY LV1"]
["FALLON","A4725 - DIALYS SOL FLD VOL > 4999CC"]
["FALLON","A6209 - FOAM DRSG <=16 SQ IN W/O BDR"]
["FALLON","A6258 - TRANSPARENT FILM >16<=48 IN"]
["FALLON","A6549 - G COMPRESSION STOCKING"]
["FALLON","A6550 - NEG PRES WOUND THER DRSG SET"]
["FALLON","A7520 - TRACH/LARYN TUBE NON-CUFFED"]
["FALLON","A9500 - TC99M SESTAMIBI"]
["FALLON","A9502 - HC TC99M TETROFOSMIN"]
["FALLON","A9503 - TC99M MEDRONATE"]
["FALLON","A9505 - THALLIUM CHLORIDE PER MCI"]
["FALLON","A9509 - HC IODINE I-123 PER MCI"]
["FALLON","A9512 - TC99M PERTECHNETATE"]
["FALLON","A9513 - TECHNETIUM TC-99M MEBROFENIN"]
["FALLON","A9516 - I123 IODIDE CAP, DX"]
["FALLON","A9517 - I131 IODIDE CAP, RX"]
["FALLON","A9520 - TECHNETIUMTC-99M SULFUR CLLD"]
["FALLON","A9521 - TC99M EXAMETAZIME"]
["FALLON","A9537 - TC99M MEBROFENIN"]
["FALLON","A9538 - TC99M PYROPHOSPHATE"]
["FALLON","A9539 - TC99M PENTETATE"]
["FALLON","A9540 - TC99M MAA"]
["FALLON","A9541 - TC99M SULFUR COLLOID"]
["FALLON","A9543 - Y90 IBRITUMOMAB, RX"]
["FALLON","A9547 - IN111 OXYQUINOLINE"]
["FALLON","A9551 - HC TC99M SUCCIMER/10MCI,DX"]
["FALLON","A9552 - F18 FDG"]
["FALLON","A9555 - RADIOPHARMACIAL"]
["FALLON","A9556 - GA67 GALLIUM"]
["FALLON","A9557 - TC99M BICISATE"]
["FALLON","A9558 - HC XENON133/10MCI"]
["FALLON","A9560 - TC99M LABELED RBC"]
["FALLON","A9561 - TC99M OXIDRONATE"]
["FALLON","A9562 - TC99M MERTIATIDE"]
["FALLON","A9563 - P32 NA PHOSPHATE"]
["FALLON","A9569 - TECHNETIUM TC-99M AUTO WBC"]
["FALLON","A9570 - HC INDIUM IN-111 AUTO WBC"]
["FALLON","A9572 - INDIUM IN-111 PENTETREOTIDE"]
["FALLON","A9575 - INJ GADOTERATE MEGLUMI 0.1ML"]
["FALLON","A9576 - HC PROHANCE IV CONTRAST PER ML"]
["FALLON","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML"]
["FALLON","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["FALLON","A9580 - HC NA FLUORIDE F-18, DOSE"]
["FALLON","A9581 - GADOXETATE DISODIUM INJ"]
["FALLON","A9582 - IODINE I-123 IOBENGUANE"]
["FALLON","A9583 - GADOFOSVESET TRISODIUM INJ"]
["FALLON","A9584 - IODINE I-123 IOFLUPANE"]
["FALLON","A9587 - GALLIUM GA-68"]
["FALLON","A9588 - FLUCICLOVINE F-18"]
["FALLON","A9592 - HC COPPER CU 64 DOTATATE DIAG"]
["FALLON","E0191 - PROTECTOR HEEL OR ELBOW"]
["FALLON","G0101 - CA SCREEN;PELVIC/BREAST EXAM"]
["FALLON","G0103 - PSA, TOTAL SCREENING"]
["FALLON","G0127 - TRIM NAIL(S)"]
["FALLON","G0175 - OPPS SERVICE,SCHED TEAM CONF"]
["FALLON","G0239 - OTH RESP PROC, GROUP"]
["FALLON","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP"]
["FALLON","G0259 - HC INJECT FOR SACROILIAC JOINT"]
["FALLON","G0260 - INJ FOR SACROILIAC JT ANESTH"]
["FALLON","G0269 - HC CLOSURE DEVICE PLACEMENT"]
["FALLON","G0278 - ILIAC ART ANGIO,CARDIAC CATH"]
["FALLON","G0279 - TOMOSYNTHESIS, MAMMO"]
["FALLON","G0296 - HC VISIT TO DETERM LDCT ELIG"]
["FALLON","G0297 - HC LDCT FOR LUNG CA SCREEN"]
["FALLON","G0365 - HC VESSEL MAPPING HEMO ACCESS"]
["FALLON","G0389 - ULTRASOUND EXAM AAA SCREEN"]
["FALLON","G0390 - TRAUMA RESPONS W/HOSP CRITI"]
["FALLON","G0396 - ALCOHOL/SUBS INTERV 15-30MN"]
["FALLON","G0397 - ALCOHOL/SUBS INTERV >30 MIN"]
["FALLON","G0402 - INITIAL PREVENTIVE EXAM"]
["FALLON","G0410 - HC GRP PSYCH PARTIAL HOSP 45-50"]
["FALLON","G0416 - HC PROSTATE BIOPSY ANY MTHD"]
["FALLON","G0420 - HC ED SVC CKD IND PER SESSION"]
["FALLON","G0421 - HC ED SVC CKD GRP PER SESSION"]
["FALLON","G0422 - HC INTENS CARDIAC REHAB W/EXERC"]
["FALLON","G0423 - HC INTENS CARDIAC REHAB NO EXER"]
["FALLON","G0438 - PPPS, INITIAL VISIT"]
["FALLON","G0439 - PPPS, SUBSEQ VISIT"]
["FALLON","G0442 - ANNUAL ALCOHOL SCREEN 15 MIN"]
["FALLON","G0443 - BRIEF ALCOHOL MISUSE COUNSEL"]
["FALLON","G0444 - DEPRESSION SCREEN ANNUAL"]
["FALLON","G0445 - HIGH INTEN BEH COUNS STD 30M"]
["FALLON","G0446 - INTENS BEHAVE THER CARDIO DX"]
["FALLON","G0447 - HC BEHAVIOR COUNSEL OBESITY 15M"]
["FALLON","G0480 - DRUG TEST DEF 1-7 CLASSES"]
["FALLON","G0481 - DRUG TEST DEF 8-14 CLASSES"]
["FALLON","G0506 - HC COMP ASSESS CARE PLAN CCM SVC"]
["FALLON","G0513 - HC PROLONG PREV SVCS, FIRST 30M"]
["FALLON","G0514 - HC PROLONG PREV SVCS, ADDL 30M"]
["FALLON","G2011 - ALCOHOL/SUB ABUSE ASSESS"]
["FALLON","G2012 - HC BRIEF CHECK IN BY MD/QHP"]
["FALLON","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS"]
["FALLON","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA"]
["FALLON","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH"]
["FALLON","G2086 - HC OFF BASE OPIOID TX 70MIN"]
["FALLON","G2087 - HC OFF BASE OPIOID TX, 60 M"]
["FALLON","G2088 - HC OFF BASE OPIOID TX, ADD30"]
["FALLON","G2212 - HC PROLONG OUTPT/OFFICE VIS"]
["FALLON","G2216 - HC HOME SUPPLY INJECT NALOXON"]
["FALLON","J0702 - HC BETAMETHASONE ACET&SOD PHOSP"]
["FALLON","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)"]
["FALLON","J1250 - HC DOBUTAMINE SDV/250MG"]
["FALLON","J2790 - HC IG;RHO D,HUMAN/300MCG"]
["FALLON","J3301 - HC TRIAMCINOLONE ACET INJ NOS"]
["FALLON","L0120 - CERV FLEXIBLE NON-ADJUSTABLE"]
["FALLON","L0140 - CERVICAL SEMI-RIGID ADJUSTAB"]
["FALLON","L1820 - KO ELAS W/ CONDYLE PADS & JO"]
["FALLON","L1830 - KO IMMOBILIZER CANVAS LONGIT"]
["FALLON","L1832 - KO ADJ JNT POS RIGID SUPPORT"]
["FALLON","L1836 - HC RIGID KO WO JOINTS"]
["FALLON","L1902 - AFO ANKLE GAUNTLET"]
["FALLON","L3260 - AMBULATORY SURGICAL BOOT EAC"]
["FALLON","L3350 - SHOE HEEL WEDGE"]
["FALLON","L3496 - HC STATIC AFO"]
["FALLON","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN"]
["FALLON","L3670 - ACROMIO/CLAVICULAR CANVAS&WE"]
["FALLON","L3760 - EO WITHJOINT, PREFABRICATED"]
["FALLON","L3762 - RIGID EO WO JOINTS"]
["FALLON","L3807 - WHFO,NO JOINT, PREFABRICATED"]
["FALLON","L3808 - HC EPITRAIN"]
["FALLON","L3905 - HC WHO W/NONTORSION JNT(S) CF"]
["FALLON","L3908 - WRIST COCK-UP NON-MOLDED"]
["FALLON","L3967 - HC SEWHO AIRPLANE W/O JNTS CF"]
["FALLON","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL"]
["FALLON","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL"]
["FALLON","L4350 - ANKLE CONTROL ORTHOSI PREFAB"]
["FALLON","L4360 - PNEUMATI WALKING BOOT PREFAB"]
["FALLON","L4370 - HC PNEUMATIC FULL LEG SPLINT"]
["FALLON","L4386 - NON-PNEUM WALK BOOT PREFAB"]
["FALLON","L4396 - STATIC AFO"]
["FALLON","L4398 - HC FOOT DROP SPLINT RECUMBENT"]
["FALLON","L8501 - TRACHEOSTOMY SPEAKING VALVE"]
["FALLON","L8507 - HC PROLARYNX VOICE (PLUS)"]
["FALLON","L8509 - TRACH-ESOPH VOICE PROS MD IN"]
["FALLON","L8514 - REPL TRACH PUNCTURE DILATOR"]
["FALLON","L8693 - HC AUD OSSEO DEV, ABUTMENT"]
["FALLON","L8699 - HC CARTIFORM 20 X 25 MM DISC"]
["FALLON","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING"]
["FALLON","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG"]
["FALLON","P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["FALLON","P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["FALLON","P9612 - CATHETERIZE FOR URINE SPEC"]
["FALLON","Q0091 - HC OBTAINING SCREEN PAP SMEAR"]
["FALLON","Q0111 - HC WET MOUNTS W PREPARATIONS"]
["FALLON","Q0114 - HC  FERN TEST"]
["FALLON","Q0249 - HC TOCILIZUMAB FOR COVID-19"]
["FALLON","Q3014 - HC TELEHEALTH FACILITY FEE"]
["FALLON","Q4101 - APLIGRAF"]
["FALLON","Q4102 - OASIS WOUND MATRIX"]
["FALLON","Q4116 - HC ALLODERM 8 X 16 MEDIUM"]
["FALLON","Q4124 - OASIS TRILAYER/1 SQCM"]
["FALLON","Q4125 - HC AFLEX401 ¿ 40 X 70 MM"]
["FALLON","Q4130 - PR STRATTICE TM"]
["FALLON","Q4132 - HC GRAFIX CORE 5X5CM"]
["FALLON","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["FALLON","Q4196 - HC PURAPLYAM-COM 6X9 CM"]
["FALLON","Q9954 - ORAL MR CONTRAST, 100 ML"]
["FALLON","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["FALLON","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["FALLON","Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["FALLON","Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["FALLON","Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["FALLON","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["FALLON","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["FALLON","Q9987 - HC PATHOGEN TEST PLATELETS"]
["FALLON","S5100 - ADULT DAYCARE SERVICES 15MIN"]
["FALLON","S5101 - HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)"]
["FALLON","S5102 - HC ADULT DAY HEALTH - COMPLEX PER DIEM"]
["FALLON","S8037 - MRCP"]
["FALLON","T2003 - HC TRANSPORTATION RATE 1 (1-WAY TRIP)"]
["FALLON","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH"]
["FALLON","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP"]
["FALLON","V2785 - CORNEAL TISSUE PROCESSING"]
["FALLON","V2790 - HC MEMBRANE AMNIOTIC"]
["HARVARD PILGRIM HEALTH CARE","45378 - COLON CA SCRN NOT HI RSK IND"]
["HARVARD PILGRIM HEALTH CARE","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS"]
["HARVARD PILGRIM HEALTH CARE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE"]
["HARVARD PILGRIM HEALTH CARE","92083 - VISUAL FIELD EXAM,EXTENDED"]
["HARVARD PILGRIM HEALTH CARE","95800 - HOME SLEEP TEST/TYPE 3 PORTA"]
["HARVARD PILGRIM HEALTH CARE","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME"]
["HARVARD PILGRIM HEALTH CARE","0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS"]
["HARVARD PILGRIM HEALTH CARE","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA"]
["HARVARD PILGRIM HEALTH CARE","A4215 - STERILE NEEDLE"]
["HARVARD PILGRIM HEALTH CARE","A4561 - HC PESSARY RUBBER, ANY TYPE"]
["HARVARD PILGRIM HEALTH CARE","A4562 - PESSARY NONRUBBER"]
["HARVARD PILGRIM HEALTH CARE","A4648 - IMPLANTABLE TISSUE MARKER"]
["HARVARD PILGRIM HEALTH CARE","A4725 - DIALYS SOL FLD VOL > 4999CC"]
["HARVARD PILGRIM HEALTH CARE","A6209 - FOAM DRSG <=16 SQ IN W/O BDR"]
["HARVARD PILGRIM HEALTH CARE","A6258 - TRANSPARENT FILM >16<=48 IN"]
["HARVARD PILGRIM HEALTH CARE","A6550 - NEG PRES WOUND THER DRSG SET"]
["HARVARD PILGRIM HEALTH CARE","A7520 - TRACH/LARYN TUBE NON-CUFFED"]
["HARVARD PILGRIM HEALTH CARE","A9500 - TC99M SESTAMIBI"]
["HARVARD PILGRIM HEALTH CARE","A9502 - HC TC99M TETROFOSMIN"]
["HARVARD PILGRIM HEALTH CARE","A9503 - TC99M MEDRONATE"]
["HARVARD PILGRIM HEALTH CARE","A9505 - THALLIUM CHLORIDE PER MCI"]
["HARVARD PILGRIM HEALTH CARE","A9509 - HC IODINE I-123 PER MCI"]
["HARVARD PILGRIM HEALTH CARE","A9512 - TC99M PERTECHNETATE"]
["HARVARD PILGRIM HEALTH CARE","A9513 - TECHNETIUM TC-99M MEBROFENIN"]
["HARVARD PILGRIM HEALTH CARE","A9516 - I123 IODIDE CAP, DX"]
["HARVARD PILGRIM HEALTH CARE","A9517 - I131 IODIDE CAP, RX"]
["HARVARD PILGRIM HEALTH CARE","A9520 - TECHNETIUMTC-99M SULFUR CLLD"]
["HARVARD PILGRIM HEALTH CARE","A9521 - TC99M EXAMETAZIME"]
["HARVARD PILGRIM HEALTH CARE","A9537 - TC99M MEBROFENIN"]
["HARVARD PILGRIM HEALTH CARE","A9538 - TC99M PYROPHOSPHATE"]
["HARVARD PILGRIM HEALTH CARE","A9539 - TC99M PENTETATE"]
["HARVARD PILGRIM HEALTH CARE","A9540 - TC99M MAA"]
["HARVARD PILGRIM HEALTH CARE","A9541 - TC99M SULFUR COLLOID"]
["HARVARD PILGRIM HEALTH CARE","A9543 - Y90 IBRITUMOMAB, RX"]
["HARVARD PILGRIM HEALTH CARE","A9547 - IN111 OXYQUINOLINE"]
["HARVARD PILGRIM HEALTH CARE","A9551 - HC TC99M SUCCIMER/10MCI,DX"]
["HARVARD PILGRIM HEALTH CARE","A9552 - F18 FDG"]
["HARVARD PILGRIM HEALTH CARE","A9555 - RADIOPHARMACIAL"]
["HARVARD PILGRIM HEALTH CARE","A9556 - GA67 GALLIUM"]
["HARVARD PILGRIM HEALTH CARE","A9557 - TC99M BICISATE"]
["HARVARD PILGRIM HEALTH CARE","A9558 - HC XENON133/10MCI"]
["HARVARD PILGRIM HEALTH CARE","A9560 - TC99M LABELED RBC"]
["HARVARD PILGRIM HEALTH CARE","A9561 - TC99M OXIDRONATE"]
["HARVARD PILGRIM HEALTH CARE","A9562 - TC99M MERTIATIDE"]
["HARVARD PILGRIM HEALTH CARE","A9563 - P32 NA PHOSPHATE"]
["HARVARD PILGRIM HEALTH CARE","A9569 - TECHNETIUM TC-99M AUTO WBC"]
["HARVARD PILGRIM HEALTH CARE","A9570 - HC INDIUM IN-111 AUTO WBC"]
["HARVARD PILGRIM HEALTH CARE","A9572 - INDIUM IN-111 PENTETREOTIDE"]
["HARVARD PILGRIM HEALTH CARE","A9575 - INJ GADOTERATE MEGLUMI 0.1ML"]
["HARVARD PILGRIM HEALTH CARE","A9576 - HC PROHANCE IV CONTRAST PER ML"]
["HARVARD PILGRIM HEALTH CARE","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML"]
["HARVARD PILGRIM HEALTH CARE","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["HARVARD PILGRIM HEALTH CARE","A9580 - HC NA FLUORIDE F-18, DOSE"]
["HARVARD PILGRIM HEALTH CARE","A9581 - GADOXETATE DISODIUM INJ"]
["HARVARD PILGRIM HEALTH CARE","A9582 - IODINE I-123 IOBENGUANE"]
["HARVARD PILGRIM HEALTH CARE","A9583 - GADOFOSVESET TRISODIUM INJ"]
["HARVARD PILGRIM HEALTH CARE","A9584 - IODINE I-123 IOFLUPANE"]
["HARVARD PILGRIM HEALTH CARE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE"]
["HARVARD PILGRIM HEALTH CARE","A9587 - GALLIUM GA-68"]
["HARVARD PILGRIM HEALTH CARE","A9588 - FLUCICLOVINE F-18"]
["HARVARD PILGRIM HEALTH CARE","A9606 - RADIUM RA223 DICHLORIDE THER"]
["HARVARD PILGRIM HEALTH CARE","C1713 - HC CORE 10 BONE PLUG"]
["HARVARD PILGRIM HEALTH CARE","C1714 - HC WATHMAN SYS ANTER CURVE"]
["HARVARD PILGRIM HEALTH CARE","C1715 - BRACHYTHERAPY NEEDLE"]
["HARVARD PILGRIM HEALTH CARE","C1716 - BRACHYTX SOURCE, GOLD 198"]
["HARVARD PILGRIM HEALTH CARE","C1717 - HC BRACHYTX, NON-STR,HDR IR-192"]
["HARVARD PILGRIM HEALTH CARE","C1719 - BRACHYTX SOUR,NON-HDR IR-192"]
["HARVARD PILGRIM HEALTH CARE","C1721 - HC ICD,2CH, GEN ONLY, RECALL $0"]
["HARVARD PILGRIM HEALTH CARE","C1722 - HC ICD,1CH, GEN ONLY, RECALL $0"]
["HARVARD PILGRIM HEALTH CARE","C1724 - HC CATH, TRANS ATHEREC BURR"]
["HARVARD PILGRIM HEALTH CARE","C1725 - HC SIZING AMPLATZ BALLOON"]
["HARVARD PILGRIM HEALTH CARE","C1726 - HC CATHETER BALLN LVL 4"]
["HARVARD PILGRIM HEALTH CARE","C1729 - HC CATH; THORA PARA"]
["HARVARD PILGRIM HEALTH CARE","C1730 - HC CATH,EP;STEER,DEC(LASSO)"]
["HARVARD PILGRIM HEALTH CARE","C1731 - HC CATH,EP PENTARAY NAV"]
["HARVARD PILGRIM HEALTH CARE","C1732 - HC CATH,EP DECA NAV"]
["HARVARD PILGRIM HEALTH CARE","C1733 - CATH CRYABL  ARCTIC FRN"]
["HARVARD PILGRIM HEALTH CARE","C1750 - HC CATH 2 LUMEN QUINTON"]
["HARVARD PILGRIM HEALTH CARE","C1751 - HC CATH, PACING"]
["HARVARD PILGRIM HEALTH CARE","C1753 - HC BIOPSY FORC LVL D"]
["HARVARD PILGRIM HEALTH CARE","C1756 - HC PACING WIRE"]
["HARVARD PILGRIM HEALTH CARE","C1757 - HC CATH,THROMB/EMB,LVL 2"]
["HARVARD PILGRIM HEALTH CARE","C1759 - HC CATH, ULTRASOUND LVL 2"]
["HARVARD PILGRIM HEALTH CARE","C1760 - HC CENTRAL LINE KIT"]
["HARVARD PILGRIM HEALTH CARE","C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN"]
["HARVARD PILGRIM HEALTH CARE","C1763 - HC SM6X16-STEM HEM"]
["HARVARD PILGRIM HEALTH CARE","C1764 - HC RECORDER;IMPLANTABLE LOOP"]
["HARVARD PILGRIM HEALTH CARE","C1765 - ADHESION BARRIER"]
["HARVARD PILGRIM HEALTH CARE","C1766 - SHTH INTRO 65CM 15FR 12FR"]
["HARVARD PILGRIM HEALTH CARE","C1768 - HC TAVR HEART VALVE KIT"]
["HARVARD PILGRIM HEALTH CARE","C1769 - GUIDE WIRE"]
["HARVARD PILGRIM HEALTH CARE","C1770 - IMAGING COIL, MR, INSERTABLE"]
["HARVARD PILGRIM HEALTH CARE","C1773 - HC GUIDEWIRE LVL E"]
["HARVARD PILGRIM HEALTH CARE","C1776 - HC HEMI-TIB PLATEAU W MENISC"]
["HARVARD PILGRIM HEALTH CARE","C1777 - HC LEAD,ICD,1COIL"]
["HARVARD PILGRIM HEALTH CARE","C1781 - MESH (IMPLANTABLE)"]
["HARVARD PILGRIM HEALTH CARE","C1784 - HC DES PERIPHERAL STENT"]
["HARVARD PILGRIM HEALTH CARE","C1785 - HC PACER;2CH, RECALL $0"]
["HARVARD PILGRIM HEALTH CARE","C1786 - HC PACER;1CH, RECALL $0"]
["HARVARD PILGRIM HEALTH CARE","C1788 - HC PORTACATH ANY"]
["HARVARD PILGRIM HEALTH CARE","C1817 - HC OCCKYDER;ASD/PFO"]
["HARVARD PILGRIM HEALTH CARE","C1821 - HC INTERSPINOUS IMPLANT"]
["HARVARD PILGRIM HEALTH CARE","C1874 - STENT WALLFLEX SYSTEM"]
["HARVARD PILGRIM HEALTH CARE","C1876 - STENT BILIARY"]
["HARVARD PILGRIM HEALTH CARE","C1880 - IVC FILTERS"]
["HARVARD PILGRIM HEALTH CARE","C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0"]
["HARVARD PILGRIM HEALTH CARE","C1883 - HC ADAPTOR;BI-VENT PACER"]
["HARVARD PILGRIM HEALTH CARE","C1884 - EMBOLIZATION PROTECT SYST"]
["HARVARD PILGRIM HEALTH CARE","C1887 - HC CATH,EP;R-F,30D THERM RMT"]
["HARVARD PILGRIM HEALTH CARE","C1892 - HC SHEATH;GUIDING"]
["HARVARD PILGRIM HEALTH CARE","C1893 - HC DILATOR SHEATH/VISISHEATH"]
["HARVARD PILGRIM HEALTH CARE","C1894 - HC INTRO/SHEATH NON-CARD LV2"]
["HARVARD PILGRIM HEALTH CARE","C1895 - HC ICD LEAD,2COIL"]
["HARVARD PILGRIM HEALTH CARE","C1896 - HC SICD PULSE GENERATOR"]
["HARVARD PILGRIM HEALTH CARE","C1898 - HC KIT,PACER;BI-VENT(#6216/8"]
["HARVARD PILGRIM HEALTH CARE","C1900 - HC INJ;OCTAFLUORO MICRO/1ML"]
["HARVARD PILGRIM HEALTH CARE","C2615 - SEALANT, PULMONARY, LIQUID"]
["HARVARD PILGRIM HEALTH CARE","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE"]
["HARVARD PILGRIM HEALTH CARE","C2617 - STENT ZIMMON BILIARY"]
["HARVARD PILGRIM HEALTH CARE","C2621 - HC PACER;2CH, W/ BACKUP DEFIB"]
["HARVARD PILGRIM HEALTH CARE","C2623 - CATH TRANSLUMIN DRUG-COAT"]
["HARVARD PILGRIM HEALTH CARE","C2625 - STENT BILIARY COTTON"]
["HARVARD PILGRIM HEALTH CARE","C2628 - HC KIT CATH BRIDGE PRE"]
["HARVARD PILGRIM HEALTH CARE","C2630 - HC CATH;EP CRYOABLATION, 8 MM"]
["HARVARD PILGRIM HEALTH CARE","C2634 - BRACHYTX, NON-STR, HA, I-125"]
["HARVARD PILGRIM HEALTH CARE","C2635 - BRACHYTX, NON-STR, HA, P-103"]
["HARVARD PILGRIM HEALTH CARE","C2639 - BRACHYTX, NON-STRANDED,I-125"]
["HARVARD PILGRIM HEALTH CARE","C5275 - HC LOW COST SKIN SUBSTITUTE"]
["HARVARD PILGRIM HEALTH CARE","C8908 - HC MRI W/O FOL W/CONT, BREAST,"]
["HARVARD PILGRIM HEALTH CARE","C8937 - CAD BREAST MRI"]
["HARVARD PILGRIM HEALTH CARE","C9358 - SURGIMEND, FETAL"]
["HARVARD PILGRIM HEALTH CARE","C9728 - PLACE DEVICE/MARKER, NON PRO"]
["HARVARD PILGRIM HEALTH CARE","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3"]
["HARVARD PILGRIM HEALTH CARE","E0191 - PROTECTOR HEEL OR ELBOW"]
["HARVARD PILGRIM HEALTH CARE","G0103 - PSA, TOTAL SCREENING"]
["HARVARD PILGRIM HEALTH CARE","G0105 - HC COLORECTAL SCRN; HI RISK IND"]
["HARVARD PILGRIM HEALTH CARE","G0108 - DIAB MANAGE TRN  PER INDIV"]
["HARVARD PILGRIM HEALTH CARE","G0109 - DIAB MANAGE TRN IND/GROUP"]
["HARVARD PILGRIM HEALTH CARE","G0127 - TRIM NAIL(S)"]
["HARVARD PILGRIM HEALTH CARE","G0239 - OTH RESP PROC, GROUP"]
["HARVARD PILGRIM HEALTH CARE","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP"]
["HARVARD PILGRIM HEALTH CARE","G0259 - HC INJECT FOR SACROILIAC JOINT"]
["HARVARD PILGRIM HEALTH CARE","G0260 - INJ FOR SACROILIAC JT ANESTH"]
["HARVARD PILGRIM HEALTH CARE","G0269 - HC CLOSURE DEVICE PLACEMENT"]
["HARVARD PILGRIM HEALTH CARE","G0270 - MNT SUBS TX FOR CHANGE DX"]
["HARVARD PILGRIM HEALTH CARE","G0278 - ILIAC ART ANGIO,CARDIAC CATH"]
["HARVARD PILGRIM HEALTH CARE","G0279 - TOMOSYNTHESIS, MAMMO"]
["HARVARD PILGRIM HEALTH CARE","G0297 - HC LDCT FOR LUNG CA SCREEN"]
["HARVARD PILGRIM HEALTH CARE","G0390 - TRAUMA RESPONS W/HOSP CRITI"]
["HARVARD PILGRIM HEALTH CARE","G0416 - HC PROSTATE BIOPSY ANY MTHD"]
["HARVARD PILGRIM HEALTH CARE","G0422 - HC INTENS CARDIAC REHAB W/EXERC"]
["HARVARD PILGRIM HEALTH CARE","G0423 - HC INTENS CARDIAC REHAB NO EXER"]
["HARVARD PILGRIM HEALTH CARE","G0424 - PULMONARY REHAB W EXER"]
["HARVARD PILGRIM HEALTH CARE","G0480 - DRUG TEST DEF 1-7 CLASSES"]
["HARVARD PILGRIM HEALTH CARE","G0481 - DRUG TEST DEF 8-14 CLASSES"]
["HARVARD PILGRIM HEALTH CARE","G0506 - HC COMP ASSESS CARE PLAN CCM SVC"]
["HARVARD PILGRIM HEALTH CARE","G0513 - HC PROLONG PREV SVCS, FIRST 30M"]
["HARVARD PILGRIM HEALTH CARE","G0514 - HC PROLONG PREV SVCS, ADDL 30M"]
["HARVARD PILGRIM HEALTH CARE","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS"]
["HARVARD PILGRIM HEALTH CARE","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA"]
["HARVARD PILGRIM HEALTH CARE","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH"]
["HARVARD PILGRIM HEALTH CARE","J0702 - HC BETAMETHASONE ACET&SOD PHOSP"]
["HARVARD PILGRIM HEALTH CARE","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)"]
["HARVARD PILGRIM HEALTH CARE","J1250 - HC DOBUTAMINE SDV/250MG"]
["HARVARD PILGRIM HEALTH CARE","J2790 - HC IG;RHO D,HUMAN/300MCG"]
["HARVARD PILGRIM HEALTH CARE","J3301 - HC TRIAMCINOLONE ACET INJ NOS"]
["HARVARD PILGRIM HEALTH CARE","J7307 - HC ETONOGESTREL IMPLANT SYSTEM"]
["HARVARD PILGRIM HEALTH CARE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE"]
["HARVARD PILGRIM HEALTH CARE","L0140 - CERVICAL SEMI-RIGID ADJUSTAB"]
["HARVARD PILGRIM HEALTH CARE","L1820 - KO ELAS W/ CONDYLE PADS & JO"]
["HARVARD PILGRIM HEALTH CARE","L1830 - KO IMMOBILIZER CANVAS LONGIT"]
["HARVARD PILGRIM HEALTH CARE","L1832 - KO ADJ JNT POS RIGID SUPPORT"]
["HARVARD PILGRIM HEALTH CARE","L1836 - HC RIGID KO WO JOINTS"]
["HARVARD PILGRIM HEALTH CARE","L1902 - AFO ANKLE GAUNTLET"]
["HARVARD PILGRIM HEALTH CARE","L3350 - SHOE HEEL WEDGE"]
["HARVARD PILGRIM HEALTH CARE","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN"]
["HARVARD PILGRIM HEALTH CARE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE"]
["HARVARD PILGRIM HEALTH CARE","L3760 - EO WITHJOINT, PREFABRICATED"]
["HARVARD PILGRIM HEALTH CARE","L3762 - RIGID EO WO JOINTS"]
["HARVARD PILGRIM HEALTH CARE","L3807 - WHFO,NO JOINT, PREFABRICATED"]
["HARVARD PILGRIM HEALTH CARE","L3808 - HC EPITRAIN"]
["HARVARD PILGRIM HEALTH CARE","L3905 - HC WHO W/NONTORSION JNT(S) CF"]
["HARVARD PILGRIM HEALTH CARE","L3908 - WRIST COCK-UP NON-MOLDED"]
["HARVARD PILGRIM HEALTH CARE","L3967 - HC SEWHO AIRPLANE W/O JNTS CF"]
["HARVARD PILGRIM HEALTH CARE","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL"]
["HARVARD PILGRIM HEALTH CARE","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL"]
["HARVARD PILGRIM HEALTH CARE","L4350 - ANKLE CONTROL ORTHOSI PREFAB"]
["HARVARD PILGRIM HEALTH CARE","L4360 - PNEUMATI WALKING BOOT PREFAB"]
["HARVARD PILGRIM HEALTH CARE","L4370 - HC PNEUMATIC FULL LEG SPLINT"]
["HARVARD PILGRIM HEALTH CARE","L4386 - NON-PNEUM WALK BOOT PREFAB"]
["HARVARD PILGRIM HEALTH CARE","L4396 - STATIC AFO"]
["HARVARD PILGRIM HEALTH CARE","L4398 - HC FOOT DROP SPLINT RECUMBENT"]
["HARVARD PILGRIM HEALTH CARE","L8501 - TRACHEOSTOMY SPEAKING VALVE"]
["HARVARD PILGRIM HEALTH CARE","L8507 - HC PROLARYNX VOICE (PLUS)"]
["HARVARD PILGRIM HEALTH CARE","L8509 - TRACH-ESOPH VOICE PROS MD IN"]
["HARVARD PILGRIM HEALTH CARE","L8514 - REPL TRACH PUNCTURE DILATOR"]
["HARVARD PILGRIM HEALTH CARE","L8693 - HC AUD OSSEO DEV, ABUTMENT"]
["HARVARD PILGRIM HEALTH CARE","L8699 - HC CARTIFORM 20 X 25 MM DISC"]
["HARVARD PILGRIM HEALTH CARE","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING"]
["HARVARD PILGRIM HEALTH CARE","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG"]
["HARVARD PILGRIM HEALTH CARE","P9012 - HC CRYOPRECIPITATE UNIT"]
["HARVARD PILGRIM HEALTH CARE","P9016 - HC RBC:LEU-RED"]
["HARVARD PILGRIM HEALTH CARE","P9017 - HC FF PLAS: 1 DONOR"]
["HARVARD PILGRIM HEALTH CARE","P9021 - HC RBC/UNIT"]
["HARVARD PILGRIM HEALTH CARE","P9034 - HB PLATELETS, PHERESIS"]
["HARVARD PILGRIM HEALTH CARE","P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT"]
["HARVARD PILGRIM HEALTH CARE","P9040 - HC RBC:LEU-RED,IRR/UNIT"]
["HARVARD PILGRIM HEALTH CARE","P9044 - HC CRYOPRECIPITATE REDUCED PLASMA"]
["HARVARD PILGRIM HEALTH CARE","P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["HARVARD PILGRIM HEALTH CARE","P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["HARVARD PILGRIM HEALTH CARE","P9056 - HC BLOOD, L/R, IRRADIATED"]
["HARVARD PILGRIM HEALTH CARE","P9057 - HC RBC:LEU RED,FR/DE/WASH,IR"]
["HARVARD PILGRIM HEALTH CARE","P9073 - HC PLATELETS PHERESIS PATH REDU"]
["HARVARD PILGRIM HEALTH CARE","P9100 - PATHOGEN TEST FOR PLATELETS"]
["HARVARD PILGRIM HEALTH CARE","P9612 - CATHETERIZE FOR URINE SPEC"]
["HARVARD PILGRIM HEALTH CARE","Q0091 - HC OBTAINING SCREEN PAP SMEAR"]
["HARVARD PILGRIM HEALTH CARE","Q0111 - HC WET MOUNTS W PREPARATIONS"]
["HARVARD PILGRIM HEALTH CARE","Q0114 - HC  FERN TEST"]
["HARVARD PILGRIM HEALTH CARE","Q3014 - HC TELEHEALTH FACILITY FEE"]
["HARVARD PILGRIM HEALTH CARE","Q4101 - APLIGRAF"]
["HARVARD PILGRIM HEALTH CARE","Q4102 - OASIS WOUND MATRIX"]
["HARVARD PILGRIM HEALTH CARE","Q4104 - INTEGRA BMWD"]
["HARVARD PILGRIM HEALTH CARE","Q4107 - GRAFTJACKET"]
["HARVARD PILGRIM HEALTH CARE","Q4112 - CYMETRA INJECTABLE"]
["HARVARD PILGRIM HEALTH CARE","Q4116 - HC ALLODERM 8 X 16 MEDIUM"]
["HARVARD PILGRIM HEALTH CARE","Q4124 - OASIS TRILAYER/1 SQCM"]
["HARVARD PILGRIM HEALTH CARE","Q4125 - HC AFLEX401 ¿ 40 X 70 MM"]
["HARVARD PILGRIM HEALTH CARE","Q4130 - PR STRATTICE TM"]
["HARVARD PILGRIM HEALTH CARE","Q4132 - HC GRAFIX CORE 5X5CM"]
["HARVARD PILGRIM HEALTH CARE","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["HARVARD PILGRIM HEALTH CARE","Q4196 - HC PURAPLYAM-COM 6X9 CM"]
["HARVARD PILGRIM HEALTH CARE","Q9954 - ORAL MR CONTRAST, 100 ML"]
["HARVARD PILGRIM HEALTH CARE","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["HARVARD PILGRIM HEALTH CARE","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["HARVARD PILGRIM HEALTH CARE","Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["HARVARD PILGRIM HEALTH CARE","Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["HARVARD PILGRIM HEALTH CARE","Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["HARVARD PILGRIM HEALTH CARE","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["HARVARD PILGRIM HEALTH CARE","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["HARVARD PILGRIM HEALTH CARE","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH"]
["HARVARD PILGRIM HEALTH CARE","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP"]
["HARVARD PILGRIM HEALTH CARE","V2790 - HC MEMBRANE AMNIOTIC"]
["SENIOR WHOLE HEALTH","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS"]
["SENIOR WHOLE HEALTH","A4561 - HC PESSARY RUBBER, ANY TYPE"]
["SENIOR WHOLE HEALTH","A4562 - PESSARY NONRUBBER"]
["SENIOR WHOLE HEALTH","A6209 - FOAM DRSG <=16 SQ IN W/O BDR"]
["SENIOR WHOLE HEALTH","A6258 - TRANSPARENT FILM >16<=48 IN"]
["SENIOR WHOLE HEALTH","A6550 - NEG PRES WOUND THER DRSG SET"]
["SENIOR WHOLE HEALTH","A7520 - TRACH/LARYN TUBE NON-CUFFED"]
["SENIOR WHOLE HEALTH","A9575 - INJ GADOTERATE MEGLUMI 0.1ML"]
["SENIOR WHOLE HEALTH","A9576 - HC PROHANCE IV CONTRAST PER ML"]
["SENIOR WHOLE HEALTH","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML"]
["SENIOR WHOLE HEALTH","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["SENIOR WHOLE HEALTH","A9581 - GADOXETATE DISODIUM INJ"]
["SENIOR WHOLE HEALTH","E0191 - PROTECTOR HEEL OR ELBOW"]
["SENIOR WHOLE HEALTH","G0103 - PSA, TOTAL SCREENING"]
["SENIOR WHOLE HEALTH","G0279 - TOMOSYNTHESIS, MAMMO"]
["SENIOR WHOLE HEALTH","G0480 - DRUG TEST DEF 1-7 CLASSES"]
["SENIOR WHOLE HEALTH","G0481 - DRUG TEST DEF 8-14 CLASSES"]
["SENIOR WHOLE HEALTH","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS"]
["SENIOR WHOLE HEALTH","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA"]
["SENIOR WHOLE HEALTH","J0702 - HC BETAMETHASONE ACET&SOD PHOSP"]
["SENIOR WHOLE HEALTH","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)"]
["SENIOR WHOLE HEALTH","J1250 - HC DOBUTAMINE SDV/250MG"]
["SENIOR WHOLE HEALTH","J2790 - HC IG;RHO D,HUMAN/300MCG"]
["SENIOR WHOLE HEALTH","J3301 - HC TRIAMCINOLONE ACET INJ NOS"]
["SENIOR WHOLE HEALTH","L0120 - CERV FLEXIBLE NON-ADJUSTABLE"]
["SENIOR WHOLE HEALTH","L0140 - CERVICAL SEMI-RIGID ADJUSTAB"]
["SENIOR WHOLE HEALTH","L1820 - KO ELAS W/ CONDYLE PADS & JO"]
["SENIOR WHOLE HEALTH","L1830 - KO IMMOBILIZER CANVAS LONGIT"]
["SENIOR WHOLE HEALTH","L1832 - KO ADJ JNT POS RIGID SUPPORT"]
["SENIOR WHOLE HEALTH","L1836 - HC RIGID KO WO JOINTS"]
["SENIOR WHOLE HEALTH","L1902 - AFO ANKLE GAUNTLET"]
["SENIOR WHOLE HEALTH","L3350 - SHOE HEEL WEDGE"]
["SENIOR WHOLE HEALTH","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN"]
["SENIOR WHOLE HEALTH","L3670 - ACROMIO/CLAVICULAR CANVAS&WE"]
["SENIOR WHOLE HEALTH","L3760 - EO WITHJOINT, PREFABRICATED"]
["SENIOR WHOLE HEALTH","L3762 - RIGID EO WO JOINTS"]
["SENIOR WHOLE HEALTH","L3807 - WHFO,NO JOINT, PREFABRICATED"]
["SENIOR WHOLE HEALTH","L3808 - HC EPITRAIN"]
["SENIOR WHOLE HEALTH","L3905 - HC WHO W/NONTORSION JNT(S) CF"]
["SENIOR WHOLE HEALTH","L3908 - WRIST COCK-UP NON-MOLDED"]
["SENIOR WHOLE HEALTH","L3967 - HC SEWHO AIRPLANE W/O JNTS CF"]
["SENIOR WHOLE HEALTH","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL"]
["SENIOR WHOLE HEALTH","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL"]
["SENIOR WHOLE HEALTH","L4350 - ANKLE CONTROL ORTHOSI PREFAB"]
["SENIOR WHOLE HEALTH","L4360 - PNEUMATI WALKING BOOT PREFAB"]
["SENIOR WHOLE HEALTH","L4370 - HC PNEUMATIC FULL LEG SPLINT"]
["SENIOR WHOLE HEALTH","L4386 - NON-PNEUM WALK BOOT PREFAB"]
["SENIOR WHOLE HEALTH","L4396 - STATIC AFO"]
["SENIOR WHOLE HEALTH","L4398 - HC FOOT DROP SPLINT RECUMBENT"]
["SENIOR WHOLE HEALTH","L8501 - TRACHEOSTOMY SPEAKING VALVE"]
["SENIOR WHOLE HEALTH","L8507 - HC PROLARYNX VOICE (PLUS)"]
["SENIOR WHOLE HEALTH","L8509 - TRACH-ESOPH VOICE PROS MD IN"]
["SENIOR WHOLE HEALTH","L8514 - REPL TRACH PUNCTURE DILATOR"]
["SENIOR WHOLE HEALTH","L8693 - HC AUD OSSEO DEV, ABUTMENT"]
["SENIOR WHOLE HEALTH","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING"]
["SENIOR WHOLE HEALTH","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG"]
["SENIOR WHOLE HEALTH","P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["SENIOR WHOLE HEALTH","P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["SENIOR WHOLE HEALTH","P9612 - CATHETERIZE FOR URINE SPEC"]
["SENIOR WHOLE HEALTH","Q0111 - HC WET MOUNTS W PREPARATIONS"]
["SENIOR WHOLE HEALTH","Q0114 - HC  FERN TEST"]
["SENIOR WHOLE HEALTH","Q3014 - HC TELEHEALTH FACILITY FEE"]
["SENIOR WHOLE HEALTH","Q4101 - APLIGRAF"]
["SENIOR WHOLE HEALTH","Q4102 - OASIS WOUND MATRIX"]
["SENIOR WHOLE HEALTH","Q4132 - HC GRAFIX CORE 5X5CM"]
["SENIOR WHOLE HEALTH","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["SENIOR WHOLE HEALTH","Q4196 - HC PURAPLYAM-COM 6X9 CM"]
["SENIOR WHOLE HEALTH","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["SENIOR WHOLE HEALTH","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["SENIOR WHOLE HEALTH","Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["SENIOR WHOLE HEALTH","Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["SENIOR WHOLE HEALTH","Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["SENIOR WHOLE HEALTH","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["SENIOR WHOLE HEALTH","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["SENIOR WHOLE HEALTH","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH"]
["SENIOR WHOLE HEALTH","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP"]
["TUFTS","45378 - COLON CA SCRN NOT HI RSK IND"]
["TUFTS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS"]
["TUFTS","90471 - HC ADMIN PNEUMOCOCCAL VACCINE"]
["TUFTS","92083 - VISUAL FIELD EXAM,EXTENDED"]
["TUFTS","95800 - HOME SLEEP TEST/TYPE 3 PORTA"]
["TUFTS","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME"]
["TUFTS","0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS"]
["TUFTS","0399T - PR MYOCARDIAL STRAIN IMAGING"]
["TUFTS","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA"]
["TUFTS","A4215 - STERILE NEEDLE"]
["TUFTS","A4561 - HC PESSARY RUBBER, ANY TYPE"]
["TUFTS","A4562 - PESSARY NONRUBBER"]
["TUFTS","A4570 - HC MISC SPLINT SUPPLY LV1"]
["TUFTS","A4648 - IMPLANTABLE TISSUE MARKER"]
["TUFTS","A4725 - DIALYS SOL FLD VOL > 4999CC"]
["TUFTS","A6209 - FOAM DRSG <=16 SQ IN W/O BDR"]
["TUFTS","A6258 - TRANSPARENT FILM >16<=48 IN"]
["TUFTS","A6549 - G COMPRESSION STOCKING"]
["TUFTS","A6550 - NEG PRES WOUND THER DRSG SET"]
["TUFTS","A7520 - TRACH/LARYN TUBE NON-CUFFED"]
["TUFTS","A9500 - TC99M SESTAMIBI"]
["TUFTS","A9502 - HC TC99M TETROFOSMIN"]
["TUFTS","A9503 - TC99M MEDRONATE"]
["TUFTS","A9505 - THALLIUM CHLORIDE PER MCI"]
["TUFTS","A9509 - HC IODINE I-123 PER MCI"]
["TUFTS","A9512 - TC99M PERTECHNETATE"]
["TUFTS","A9513 - TECHNETIUM TC-99M MEBROFENIN"]
["TUFTS","A9516 - I123 IODIDE CAP, DX"]
["TUFTS","A9517 - I131 IODIDE CAP, RX"]
["TUFTS","A9520 - TECHNETIUMTC-99M SULFUR CLLD"]
["TUFTS","A9521 - TC99M EXAMETAZIME"]
["TUFTS","A9537 - TC99M MEBROFENIN"]
["TUFTS","A9538 - TC99M PYROPHOSPHATE"]
["TUFTS","A9539 - TC99M PENTETATE"]
["TUFTS","A9540 - TC99M MAA"]
["TUFTS","A9541 - TC99M SULFUR COLLOID"]
["TUFTS","A9543 - Y90 IBRITUMOMAB, RX"]
["TUFTS","A9547 - IN111 OXYQUINOLINE"]
["TUFTS","A9551 - HC TC99M SUCCIMER/10MCI,DX"]
["TUFTS","A9552 - F18 FDG"]
["TUFTS","A9555 - RADIOPHARMACIAL"]
["TUFTS","A9556 - GA67 GALLIUM"]
["TUFTS","A9557 - TC99M BICISATE"]
["TUFTS","A9558 - HC XENON133/10MCI"]
["TUFTS","A9560 - TC99M LABELED RBC"]
["TUFTS","A9561 - TC99M OXIDRONATE"]
["TUFTS","A9562 - TC99M MERTIATIDE"]
["TUFTS","A9563 - P32 NA PHOSPHATE"]
["TUFTS","A9569 - TECHNETIUM TC-99M AUTO WBC"]
["TUFTS","A9570 - HC INDIUM IN-111 AUTO WBC"]
["TUFTS","A9572 - INDIUM IN-111 PENTETREOTIDE"]
["TUFTS","A9575 - INJ GADOTERATE MEGLUMI 0.1ML"]
["TUFTS","A9576 - HC PROHANCE IV CONTRAST PER ML"]
["TUFTS","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML"]
["TUFTS","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["TUFTS","A9580 - HC NA FLUORIDE F-18, DOSE"]
["TUFTS","A9581 - GADOXETATE DISODIUM INJ"]
["TUFTS","A9582 - IODINE I-123 IOBENGUANE"]
["TUFTS","A9583 - GADOFOSVESET TRISODIUM INJ"]
["TUFTS","A9584 - IODINE I-123 IOFLUPANE"]
["TUFTS","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE"]
["TUFTS","A9587 - GALLIUM GA-68"]
["TUFTS","A9588 - FLUCICLOVINE F-18"]
["TUFTS","A9606 - RADIUM RA223 DICHLORIDE THER"]
["TUFTS","C1713 - HC CORE 10 BONE PLUG"]
["TUFTS","C1714 - HC WATHMAN SYS ANTER CURVE"]
["TUFTS","C1715 - BRACHYTHERAPY NEEDLE"]
["TUFTS","C1716 - BRACHYTX SOURCE, GOLD 198"]
["TUFTS","C1717 - HC BRACHYTX, NON-STR,HDR IR-192"]
["TUFTS","C1719 - BRACHYTX SOUR,NON-HDR IR-192"]
["TUFTS","C1721 - HC ICD,2CH, GEN ONLY, RECALL $0"]
["TUFTS","C1722 - HC ICD,1CH, GEN ONLY, RECALL $0"]
["TUFTS","C1724 - HC CATH, TRANS ATHEREC BURR"]
["TUFTS","C1725 - HC SIZING AMPLATZ BALLOON"]
["TUFTS","C1726 - HC CATHETER BALLN LVL 4"]
["TUFTS","C1729 - HC CATH; THORA PARA"]
["TUFTS","C1730 - HC CATH,EP;STEER,DEC(LASSO)"]
["TUFTS","C1731 - HC CATH,EP PENTARAY NAV"]
["TUFTS","C1732 - HC CATH,EP DECA NAV"]
["TUFTS","C1733 - CATH CRYABL  ARCTIC FRN"]
["TUFTS","C1750 - HC CATH 2 LUMEN QUINTON"]
["TUFTS","C1751 - HC CATH, PACING"]
["TUFTS","C1753 - HC BIOPSY FORC LVL D"]
["TUFTS","C1756 - HC PACING WIRE"]
["TUFTS","C1757 - HC CATH,THROMB/EMB,LVL 2"]
["TUFTS","C1759 - HC CATH, ULTRASOUND LVL 2"]
["TUFTS","C1760 - HC CENTRAL LINE KIT"]
["TUFTS","C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN"]
["TUFTS","C1763 - HC SM6X16-STEM HEM"]
["TUFTS","C1764 - HC RECORDER;IMPLANTABLE LOOP"]
["TUFTS","C1765 - ADHESION BARRIER"]
["TUFTS","C1766 - SHTH INTRO 65CM 15FR 12FR"]
["TUFTS","C1768 - HC TAVR HEART VALVE KIT"]
["TUFTS","C1769 - GUIDE WIRE"]
["TUFTS","C1770 - IMAGING COIL, MR, INSERTABLE"]
["TUFTS","C1773 - HC GUIDEWIRE LVL E"]
["TUFTS","C1776 - HC HEMI-TIB PLATEAU W MENISC"]
["TUFTS","C1777 - HC LEAD,ICD,1COIL"]
["TUFTS","C1781 - MESH (IMPLANTABLE)"]
["TUFTS","C1784 - HC DES PERIPHERAL STENT"]
["TUFTS","C1785 - HC PACER;2CH, RECALL $0"]
["TUFTS","C1786 - HC PACER;1CH, RECALL $0"]
["TUFTS","C1788 - HC PORTACATH ANY"]
["TUFTS","C1817 - HC OCCKYDER;ASD/PFO"]
["TUFTS","C1821 - HC INTERSPINOUS IMPLANT"]
["TUFTS","C1874 - STENT WALLFLEX SYSTEM"]
["TUFTS","C1876 - STENT BILIARY"]
["TUFTS","C1880 - IVC FILTERS"]
["TUFTS","C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0"]
["TUFTS","C1883 - HC ADAPTOR;BI-VENT PACER"]
["TUFTS","C1884 - EMBOLIZATION PROTECT SYST"]
["TUFTS","C1887 - HC CATH,EP;R-F,30D THERM RMT"]
["TUFTS","C1892 - HC SHEATH;GUIDING"]
["TUFTS","C1893 - HC DILATOR SHEATH/VISISHEATH"]
["TUFTS","C1894 - HC INTRO/SHEATH NON-CARD LV2"]
["TUFTS","C1895 - HC ICD LEAD,2COIL"]
["TUFTS","C1896 - HC SICD PULSE GENERATOR"]
["TUFTS","C1898 - HC KIT,PACER;BI-VENT(#6216/8"]
["TUFTS","C1900 - HC INJ;OCTAFLUORO MICRO/1ML"]
["TUFTS","C2615 - SEALANT, PULMONARY, LIQUID"]
["TUFTS","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE"]
["TUFTS","C2617 - STENT ZIMMON BILIARY"]
["TUFTS","C2621 - HC PACER;2CH, W/ BACKUP DEFIB"]
["TUFTS","C2623 - CATH TRANSLUMIN DRUG-COAT"]
["TUFTS","C2625 - STENT BILIARY COTTON"]
["TUFTS","C2628 - HC KIT CATH BRIDGE PRE"]
["TUFTS","C2630 - HC CATH;EP CRYOABLATION, 8 MM"]
["TUFTS","C2634 - BRACHYTX, NON-STR, HA, I-125"]
["TUFTS","C2635 - BRACHYTX, NON-STR, HA, P-103"]
["TUFTS","C2639 - BRACHYTX, NON-STRANDED,I-125"]
["TUFTS","C5275 - HC LOW COST SKIN SUBSTITUTE"]
["TUFTS","C8908 - HC MRI W/O FOL W/CONT, BREAST,"]
["TUFTS","C8937 - CAD BREAST MRI"]
["TUFTS","C9358 - SURGIMEND, FETAL"]
["TUFTS","C9728 - PLACE DEVICE/MARKER, NON PRO"]
["TUFTS","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3"]
["TUFTS","C9803 - HC OP VISIT SPEC COLLECTION SEVERE ACUTE RESP SYDROM COVID-19"]
["TUFTS","D0150 - COMPREHENSIVE ORAL EXAM 60MIN"]
["TUFTS","D0240 - INTRAORAL - OCCLUSAL RADIOGRAPHIC IMAGE"]
["TUFTS","D0250 - HC EXTRA-ORAL - 2D PROJECTION RAD IMAGE CREATED USING A STATIONARY RADIATION SOURCE, AND DETECTOR"]
["TUFTS","D0251 - HC EXTRA-ORAL POSTERIOR DENTAL RADIOGRAPHIC IMAGE"]
["TUFTS","D0270 - BITEWING - SINGLE RADIOGRAPHIC IMAGE"]
["TUFTS","D0272 - BITEWINGS - TWO RADIOGRAPHIC IMAGES"]
["TUFTS","D0274 - BITEWINGS - FOUR RADIOGRAPHIC IMAGES"]
["TUFTS","D0277 - HC VERTICAL BITEWINGS - 7 TO 8 RADIOGRAPHIC IMAGES"]
["TUFTS","D0472 - HC ACCESSION OF TISSUE, GROSS EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN REPORT"]
["TUFTS","D0473 - HC ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAM, PREP AND TRANS OF RPT."]
["TUFTS","D0474 - HC ACCESSION OF TISSUE, GROSS AND MICRO EXAM, INCL. ASSESS. OF MARGINS FOR DISEASE, PREP., TX OF RPT"]
["TUFTS","D0480 - HC ACCESSION OF EXFOLIATIVE CYTOLOGIC SMEARS, MICROSCOPIC EXAM, PREP AND TRANS OF RPT"]
["TUFTS","D1110 - PROPHYLAXIS - ADULT"]
["TUFTS","D1510 - SPACE MAINTAINER - FIXED - UNILATERAL"]
["TUFTS","D1516 - SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MAXILLARY"]
["TUFTS","D1517 - SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MANDIBULAR"]
["TUFTS","D1575 - HC DISTAL SHOE SPACE MAINTAINER ¿ FIXED ¿ UNILATERAL"]
["TUFTS","D2999 - HC UNSPECIFIED RESTORATIVE PROCEDURE, BY REPORT"]
["TUFTS","D3460 - HC ENDODONTIC ENDOSSEOUS IMPLANT"]
["TUFTS","D3999 - HC UNSPECIFIED ENDODONTIC PROCEDURE, BY REPORT"]
["TUFTS","D4260 - HC OSSEOUS SURGERY FOUR OR MORE CONT. TEETH OR TOOTH BOUNDED SPACES PER QUAD."]
["TUFTS","D4263 - HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ FIRST SITE IN QUADRANT"]
["TUFTS","D4264 - HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ EACH ADDITIONAL SITE IN QUADRANT"]
["TUFTS","D4270 - HC PEDICLE SOFT TISSUE GRAFT PROCEDURE"]
["TUFTS","D4273 - HC AUTOGENOUS CONN. TISSUE GRAFT PROC. 1ST TOOTH, IMPLANT, OR EDENTULOUS TOOTH POSITION IN GRAFT"]
["TUFTS","D4355 - FULL MOUTH DEBRIDEMENT TO ENABLE COMPREHENSIVE EVALUATION AND DIAGNOSIS"]
["TUFTS","D4381 - HC LOCALIZED DELIVERY - CONTROLLED RELEASE ANTIMICROB. AGENTS TO DISEASED CREVICULAR TISSUE /TOOTH"]
["TUFTS","D5911 - HC FACIAL MOULAGE (SECTIONAL)"]
["TUFTS","D5912 - HC FACIAL MOULAGE (COMPLETE)"]
["TUFTS","D5983 - HC RADIATION CARRIER"]
["TUFTS","D5984 - HC RADIATION SHIELD"]
["TUFTS","D5985 - HC RADIATION CONE LOCATOR"]
["TUFTS","D5987 - HC COMMISSURE SPLINT"]
["TUFTS","D7140 - EXTRACTION ERUPTED TOOTH/EXR"]
["TUFTS","D7210 - EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED"]
["TUFTS","D7220 - REMOVAL OF IMPACTED TOOTH - SOFT TISSUE"]
["TUFTS","D7230 - REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY"]
["TUFTS","D7240 - REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY"]
["TUFTS","D7250 - REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)"]
["TUFTS","D7260 - HC OROANTRAL FISTULA CLOSURE"]
["TUFTS","D7261 - PRIMARY CLOSURE OF A SINUS PERFORATION"]
["TUFTS","D7940 - HC OSTEOPLASTY - FOR ORTHOGNATHIC DEFORMITIES"]
["TUFTS","D9110 - PALLIATIVE (EMERGENCY) TREATMENT OF DENTAL PAIN - MINOR PROCEDURE"]
["TUFTS","D9230 - INHALATION OF NITROUS OXIDE/ANALGESIA, ANXIOLYSIS"]
["TUFTS","D9630 - HC DRUGS OR MEDICAMENTS DISPENSED IN THE OFFICE FOR HOME USE"]
["TUFTS","D9930 - HC TREATMENT OF COMPLICATIONS (POST-SURGICAL) - UNUSUAL CIRCUMSTANCES, BY REPORT"]
["TUFTS","D9944 - HC OCCLUSAL GUARD ¿ HARD APPLIANCE, FULL ARCH"]
["TUFTS","D9951 - OCCLUSAL ADJUSTMENT - LIMITED"]
["TUFTS","E0191 - PROTECTOR HEEL OR ELBOW"]
["TUFTS","G0101 - CA SCREEN;PELVIC/BREAST EXAM"]
["TUFTS","G0103 - PSA, TOTAL SCREENING"]
["TUFTS","G0105 - HC COLORECTAL SCRN; HI RISK IND"]
["TUFTS","G0108 - DIAB MANAGE TRN  PER INDIV"]
["TUFTS","G0109 - DIAB MANAGE TRN IND/GROUP"]
["TUFTS","G0127 - TRIM NAIL(S)"]
["TUFTS","G0175 - OPPS SERVICE,SCHED TEAM CONF"]
["TUFTS","G0239 - OTH RESP PROC, GROUP"]
["TUFTS","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP"]
["TUFTS","G0259 - HC INJECT FOR SACROILIAC JOINT"]
["TUFTS","G0260 - INJ FOR SACROILIAC JT ANESTH"]
["TUFTS","G0269 - HC CLOSURE DEVICE PLACEMENT"]
["TUFTS","G0278 - ILIAC ART ANGIO,CARDIAC CATH"]
["TUFTS","G0279 - TOMOSYNTHESIS, MAMMO"]
["TUFTS","G0296 - HC VISIT TO DETERM LDCT ELIG"]
["TUFTS","G0297 - HC LDCT FOR LUNG CA SCREEN"]
["TUFTS","G0365 - HC VESSEL MAPPING HEMO ACCESS"]
["TUFTS","G0378 - HOSPITAL OBSERVATION PER HR"]
["TUFTS","G0379 - DIRECT REFER HOSPITAL OBSERV"]
["TUFTS","G0390 - TRAUMA RESPONS W/HOSP CRITI"]
["TUFTS","G0396 - ALCOHOL/SUBS INTERV 15-30MN"]
["TUFTS","G0397 - ALCOHOL/SUBS INTERV >30 MIN"]
["TUFTS","G0402 - INITIAL PREVENTIVE EXAM"]
["TUFTS","G0410 - HC GRP PSYCH PARTIAL HOSP 45-50"]
["TUFTS","G0416 - HC PROSTATE BIOPSY ANY MTHD"]
["TUFTS","G0420 - HC ED SVC CKD IND PER SESSION"]
["TUFTS","G0421 - HC ED SVC CKD GRP PER SESSION"]
["TUFTS","G0422 - HC INTENS CARDIAC REHAB W/EXERC"]
["TUFTS","G0423 - HC INTENS CARDIAC REHAB NO EXER"]
["TUFTS","G0424 - PULMONARY REHAB W EXER"]
["TUFTS","G0438 - PPPS, INITIAL VISIT"]
["TUFTS","G0439 - PPPS, SUBSEQ VISIT"]
["TUFTS","G0442 - ANNUAL ALCOHOL SCREEN 15 MIN"]
["TUFTS","G0443 - BRIEF ALCOHOL MISUSE COUNSEL"]
["TUFTS","G0444 - DEPRESSION SCREEN ANNUAL"]
["TUFTS","G0445 - HIGH INTEN BEH COUNS STD 30M"]
["TUFTS","G0446 - INTENS BEHAVE THER CARDIO DX"]
["TUFTS","G0447 - HC BEHAVIOR COUNSEL OBESITY 15M"]
["TUFTS","G0480 - DRUG TEST DEF 1-7 CLASSES"]
["TUFTS","G0481 - DRUG TEST DEF 8-14 CLASSES"]
["TUFTS","G0506 - HC COMP ASSESS CARE PLAN CCM SVC"]
["TUFTS","G0513 - HC PROLONG PREV SVCS, FIRST 30M"]
["TUFTS","G0514 - HC PROLONG PREV SVCS, ADDL 30M"]
["TUFTS","G2011 - ALCOHOL/SUB ABUSE ASSESS"]
["TUFTS","G2012 - HC BRIEF CHECK IN BY MD/QHP"]
["TUFTS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS"]
["TUFTS","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA"]
["TUFTS","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH"]
["TUFTS","G2086 - HC OFF BASE OPIOID TX 70MIN"]
["TUFTS","G2087 - HC OFF BASE OPIOID TX, 60 M"]
["TUFTS","J0702 - HC BETAMETHASONE ACET&SOD PHOSP"]
["TUFTS","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)"]
["TUFTS","J1250 - HC DOBUTAMINE SDV/250MG"]
["TUFTS","J2790 - HC IG;RHO D,HUMAN/300MCG"]
["TUFTS","J3301 - HC TRIAMCINOLONE ACET INJ NOS"]
["TUFTS","J3590 - COSTAL CARTILAGE ALLOGRAFT"]
["TUFTS","J7307 - HC ETONOGESTREL IMPLANT SYSTEM"]
["TUFTS","L0120 - CERV FLEXIBLE NON-ADJUSTABLE"]
["TUFTS","L0140 - CERVICAL SEMI-RIGID ADJUSTAB"]
["TUFTS","L1820 - KO ELAS W/ CONDYLE PADS & JO"]
["TUFTS","L1830 - KO IMMOBILIZER CANVAS LONGIT"]
["TUFTS","L1832 - KO ADJ JNT POS RIGID SUPPORT"]
["TUFTS","L1836 - HC RIGID KO WO JOINTS"]
["TUFTS","L1902 - AFO ANKLE GAUNTLET"]
["TUFTS","L3260 - AMBULATORY SURGICAL BOOT EAC"]
["TUFTS","L3350 - SHOE HEEL WEDGE"]
["TUFTS","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN"]
["TUFTS","L3670 - ACROMIO/CLAVICULAR CANVAS&WE"]
["TUFTS","L3760 - EO WITHJOINT, PREFABRICATED"]
["TUFTS","L3762 - RIGID EO WO JOINTS"]
["TUFTS","L3807 - WHFO,NO JOINT, PREFABRICATED"]
["TUFTS","L3808 - HC EPITRAIN"]
["TUFTS","L3905 - HC WHO W/NONTORSION JNT(S) CF"]
["TUFTS","L3908 - WRIST COCK-UP NON-MOLDED"]
["TUFTS","L3967 - HC SEWHO AIRPLANE W/O JNTS CF"]
["TUFTS","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL"]
["TUFTS","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL"]
["TUFTS","L4350 - ANKLE CONTROL ORTHOSI PREFAB"]
["TUFTS","L4360 - PNEUMATI WALKING BOOT PREFAB"]
["TUFTS","L4370 - HC PNEUMATIC FULL LEG SPLINT"]
["TUFTS","L4386 - NON-PNEUM WALK BOOT PREFAB"]
["TUFTS","L4396 - STATIC AFO"]
["TUFTS","L4398 - HC FOOT DROP SPLINT RECUMBENT"]
["TUFTS","L8501 - TRACHEOSTOMY SPEAKING VALVE"]
["TUFTS","L8507 - HC PROLARYNX VOICE (PLUS)"]
["TUFTS","L8509 - TRACH-ESOPH VOICE PROS MD IN"]
["TUFTS","L8514 - REPL TRACH PUNCTURE DILATOR"]
["TUFTS","L8693 - HC AUD OSSEO DEV, ABUTMENT"]
["TUFTS","L8699 - HC CARTIFORM 20 X 25 MM DISC"]
["TUFTS","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING"]
["TUFTS","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG"]
["TUFTS","P9012 - HC CRYOPRECIPITATE UNIT"]
["TUFTS","P9016 - HC RBC:LEU-RED"]
["TUFTS","P9017 - HC FF PLAS: 1 DONOR"]
["TUFTS","P9021 - HC RBC/UNIT"]
["TUFTS","P9034 - HB PLATELETS, PHERESIS"]
["TUFTS","P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT"]
["TUFTS","P9040 - HC RBC:LEU-RED,IRR/UNIT"]
["TUFTS","P9044 - HC CRYOPRECIPITATE REDUCED PLASMA"]
["TUFTS","P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["TUFTS","P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["TUFTS","P9056 - HC BLOOD, L/R, IRRADIATED"]
["TUFTS","P9057 - HC RBC:LEU RED,FR/DE/WASH,IR"]
["TUFTS","P9073 - HC PLATELETS PHERESIS PATH REDU"]
["TUFTS","P9100 - PATHOGEN TEST FOR PLATELETS"]
["TUFTS","P9612 - CATHETERIZE FOR URINE SPEC"]
["TUFTS","Q0091 - HC OBTAINING SCREEN PAP SMEAR"]
["TUFTS","Q0111 - HC WET MOUNTS W PREPARATIONS"]
["TUFTS","Q0114 - HC  FERN TEST"]
["TUFTS","Q3014 - HC TELEHEALTH FACILITY FEE"]
["TUFTS","Q4100 - STRAVIX 3X6"]
["TUFTS","Q4101 - APLIGRAF"]
["TUFTS","Q4102 - OASIS WOUND MATRIX"]
["TUFTS","Q4104 - INTEGRA BMWD"]
["TUFTS","Q4107 - GRAFTJACKET"]
["TUFTS","Q4112 - CYMETRA INJECTABLE"]
["TUFTS","Q4116 - HC ALLODERM 8 X 16 MEDIUM"]
["TUFTS","Q4124 - OASIS TRILAYER/1 SQCM"]
["TUFTS","Q4125 - HC AFLEX401 ¿ 40 X 70 MM"]
["TUFTS","Q4130 - PR STRATTICE TM"]
["TUFTS","Q4132 - HC GRAFIX CORE 5X5CM"]
["TUFTS","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["TUFTS","Q4196 - HC PURAPLYAM-COM 6X9 CM"]
["TUFTS","Q9954 - ORAL MR CONTRAST, 100 ML"]
["TUFTS","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["TUFTS","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["TUFTS","Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["TUFTS","Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["TUFTS","Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["TUFTS","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["TUFTS","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["TUFTS","S2083 - HC ADJUSTMENT GASTRIC BAND"]
["TUFTS","S8037 - MRCP"]
["TUFTS","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH"]
["TUFTS","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP"]
["TUFTS","V2785 - CORNEAL TISSUE PROCESSING"]
["TUFTS","V2790 - HC MEMBRANE AMNIOTIC"]
["TUFTS PUBLIC PLANS","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS"]
["TUFTS PUBLIC PLANS","A4215 - STERILE NEEDLE"]
["TUFTS PUBLIC PLANS","A4467 - BELT STRAP SLEEV GRMNT COVER"]
["TUFTS PUBLIC PLANS","A4561 - HC PESSARY RUBBER, ANY TYPE"]
["TUFTS PUBLIC PLANS","A4562 - PESSARY NONRUBBER"]
["TUFTS PUBLIC PLANS","A4570 - HC MISC SPLINT SUPPLY LV1"]
["TUFTS PUBLIC PLANS","A4725 - DIALYS SOL FLD VOL > 4999CC"]
["TUFTS PUBLIC PLANS","A6209 - FOAM DRSG <=16 SQ IN W/O BDR"]
["TUFTS PUBLIC PLANS","A6258 - TRANSPARENT FILM >16<=48 IN"]
["TUFTS PUBLIC PLANS","A6549 - G COMPRESSION STOCKING"]
["TUFTS PUBLIC PLANS","A6550 - NEG PRES WOUND THER DRSG SET"]
["TUFTS PUBLIC PLANS","A7520 - TRACH/LARYN TUBE NON-CUFFED"]
["TUFTS PUBLIC PLANS","A9500 - TC99M SESTAMIBI"]
["TUFTS PUBLIC PLANS","A9502 - HC TC99M TETROFOSMIN"]
["TUFTS PUBLIC PLANS","A9503 - TC99M MEDRONATE"]
["TUFTS PUBLIC PLANS","A9505 - THALLIUM CHLORIDE PER MCI"]
["TUFTS PUBLIC PLANS","A9509 - HC IODINE I-123 PER MCI"]
["TUFTS PUBLIC PLANS","A9512 - TC99M PERTECHNETATE"]
["TUFTS PUBLIC PLANS","A9513 - TECHNETIUM TC-99M MEBROFENIN"]
["TUFTS PUBLIC PLANS","A9516 - I123 IODIDE CAP, DX"]
["TUFTS PUBLIC PLANS","A9517 - I131 IODIDE CAP, RX"]
["TUFTS PUBLIC PLANS","A9520 - TECHNETIUMTC-99M SULFUR CLLD"]
["TUFTS PUBLIC PLANS","A9521 - TC99M EXAMETAZIME"]
["TUFTS PUBLIC PLANS","A9537 - TC99M MEBROFENIN"]
["TUFTS PUBLIC PLANS","A9538 - TC99M PYROPHOSPHATE"]
["TUFTS PUBLIC PLANS","A9539 - TC99M PENTETATE"]
["TUFTS PUBLIC PLANS","A9540 - TC99M MAA"]
["TUFTS PUBLIC PLANS","A9541 - TC99M SULFUR COLLOID"]
["TUFTS PUBLIC PLANS","A9543 - Y90 IBRITUMOMAB, RX"]
["TUFTS PUBLIC PLANS","A9547 - IN111 OXYQUINOLINE"]
["TUFTS PUBLIC PLANS","A9551 - HC TC99M SUCCIMER/10MCI,DX"]
["TUFTS PUBLIC PLANS","A9552 - F18 FDG"]
["TUFTS PUBLIC PLANS","A9555 - RADIOPHARMACIAL"]
["TUFTS PUBLIC PLANS","A9556 - GA67 GALLIUM"]
["TUFTS PUBLIC PLANS","A9557 - TC99M BICISATE"]
["TUFTS PUBLIC PLANS","A9558 - HC XENON133/10MCI"]
["TUFTS PUBLIC PLANS","A9560 - TC99M LABELED RBC"]
["TUFTS PUBLIC PLANS","A9561 - TC99M OXIDRONATE"]
["TUFTS PUBLIC PLANS","A9562 - TC99M MERTIATIDE"]
["TUFTS PUBLIC PLANS","A9563 - P32 NA PHOSPHATE"]
["TUFTS PUBLIC PLANS","A9569 - TECHNETIUM TC-99M AUTO WBC"]
["TUFTS PUBLIC PLANS","A9570 - HC INDIUM IN-111 AUTO WBC"]
["TUFTS PUBLIC PLANS","A9572 - INDIUM IN-111 PENTETREOTIDE"]
["TUFTS PUBLIC PLANS","A9575 - INJ GADOTERATE MEGLUMI 0.1ML"]
["TUFTS PUBLIC PLANS","A9576 - HC PROHANCE IV CONTRAST PER ML"]
["TUFTS PUBLIC PLANS","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML"]
["TUFTS PUBLIC PLANS","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["TUFTS PUBLIC PLANS","A9580 - HC NA FLUORIDE F-18, DOSE"]
["TUFTS PUBLIC PLANS","A9581 - GADOXETATE DISODIUM INJ"]
["TUFTS PUBLIC PLANS","A9582 - IODINE I-123 IOBENGUANE"]
["TUFTS PUBLIC PLANS","A9583 - GADOFOSVESET TRISODIUM INJ"]
["TUFTS PUBLIC PLANS","A9584 - IODINE I-123 IOFLUPANE"]
["TUFTS PUBLIC PLANS","A9587 - GALLIUM GA-68"]
["TUFTS PUBLIC PLANS","A9588 - FLUCICLOVINE F-18"]
["TUFTS PUBLIC PLANS","A9592 - HC COPPER CU 64 DOTATATE DIAG"]
["TUFTS PUBLIC PLANS","E0191 - PROTECTOR HEEL OR ELBOW"]
["TUFTS PUBLIC PLANS","G0101 - CA SCREEN;PELVIC/BREAST EXAM"]
["TUFTS PUBLIC PLANS","G0103 - PSA, TOTAL SCREENING"]
["TUFTS PUBLIC PLANS","G0127 - TRIM NAIL(S)"]
["TUFTS PUBLIC PLANS","G0175 - OPPS SERVICE,SCHED TEAM CONF"]
["TUFTS PUBLIC PLANS","G0239 - OTH RESP PROC, GROUP"]
["TUFTS PUBLIC PLANS","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP"]
["TUFTS PUBLIC PLANS","G0259 - HC INJECT FOR SACROILIAC JOINT"]
["TUFTS PUBLIC PLANS","G0260 - INJ FOR SACROILIAC JT ANESTH"]
["TUFTS PUBLIC PLANS","G0269 - HC CLOSURE DEVICE PLACEMENT"]
["TUFTS PUBLIC PLANS","G0278 - ILIAC ART ANGIO,CARDIAC CATH"]
["TUFTS PUBLIC PLANS","G0279 - TOMOSYNTHESIS, MAMMO"]
["TUFTS PUBLIC PLANS","G0296 - HC VISIT TO DETERM LDCT ELIG"]
["TUFTS PUBLIC PLANS","G0297 - HC LDCT FOR LUNG CA SCREEN"]
["TUFTS PUBLIC PLANS","G0365 - HC VESSEL MAPPING HEMO ACCESS"]
["TUFTS PUBLIC PLANS","G0389 - ULTRASOUND EXAM AAA SCREEN"]
["TUFTS PUBLIC PLANS","G0390 - TRAUMA RESPONS W/HOSP CRITI"]
["TUFTS PUBLIC PLANS","G0396 - ALCOHOL/SUBS INTERV 15-30MN"]
["TUFTS PUBLIC PLANS","G0397 - ALCOHOL/SUBS INTERV >30 MIN"]
["TUFTS PUBLIC PLANS","G0402 - INITIAL PREVENTIVE EXAM"]
["TUFTS PUBLIC PLANS","G0410 - HC GRP PSYCH PARTIAL HOSP 45-50"]
["TUFTS PUBLIC PLANS","G0416 - HC PROSTATE BIOPSY ANY MTHD"]
["TUFTS PUBLIC PLANS","G0420 - HC ED SVC CKD IND PER SESSION"]
["TUFTS PUBLIC PLANS","G0421 - HC ED SVC CKD GRP PER SESSION"]
["TUFTS PUBLIC PLANS","G0422 - HC INTENS CARDIAC REHAB W/EXERC"]
["TUFTS PUBLIC PLANS","G0423 - HC INTENS CARDIAC REHAB NO EXER"]
["TUFTS PUBLIC PLANS","G0438 - PPPS, INITIAL VISIT"]
["TUFTS PUBLIC PLANS","G0439 - PPPS, SUBSEQ VISIT"]
["TUFTS PUBLIC PLANS","G0442 - ANNUAL ALCOHOL SCREEN 15 MIN"]
["TUFTS PUBLIC PLANS","G0443 - BRIEF ALCOHOL MISUSE COUNSEL"]
["TUFTS PUBLIC PLANS","G0444 - DEPRESSION SCREEN ANNUAL"]
["TUFTS PUBLIC PLANS","G0445 - HIGH INTEN BEH COUNS STD 30M"]
["TUFTS PUBLIC PLANS","G0446 - INTENS BEHAVE THER CARDIO DX"]
["TUFTS PUBLIC PLANS","G0447 - HC BEHAVIOR COUNSEL OBESITY 15M"]
["TUFTS PUBLIC PLANS","G0480 - DRUG TEST DEF 1-7 CLASSES"]
["TUFTS PUBLIC PLANS","G0481 - DRUG TEST DEF 8-14 CLASSES"]
["TUFTS PUBLIC PLANS","G0506 - HC COMP ASSESS CARE PLAN CCM SVC"]
["TUFTS PUBLIC PLANS","G0513 - HC PROLONG PREV SVCS, FIRST 30M"]
["TUFTS PUBLIC PLANS","G0514 - HC PROLONG PREV SVCS, ADDL 30M"]
["TUFTS PUBLIC PLANS","G2011 - ALCOHOL/SUB ABUSE ASSESS"]
["TUFTS PUBLIC PLANS","G2012 - HC BRIEF CHECK IN BY MD/QHP"]
["TUFTS PUBLIC PLANS","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS"]
["TUFTS PUBLIC PLANS","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA"]
["TUFTS PUBLIC PLANS","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH"]
["TUFTS PUBLIC PLANS","G2086 - HC OFF BASE OPIOID TX 70MIN"]
["TUFTS PUBLIC PLANS","G2087 - HC OFF BASE OPIOID TX, 60 M"]
["TUFTS PUBLIC PLANS","G2088 - HC OFF BASE OPIOID TX, ADD30"]
["TUFTS PUBLIC PLANS","G2212 - HC PROLONG OUTPT/OFFICE VIS"]
["TUFTS PUBLIC PLANS","G2216 - HC HOME SUPPLY INJECT NALOXON"]
["TUFTS PUBLIC PLANS","J0702 - HC BETAMETHASONE ACET&SOD PHOSP"]
["TUFTS PUBLIC PLANS","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)"]
["TUFTS PUBLIC PLANS","J1250 - HC DOBUTAMINE SDV/250MG"]
["TUFTS PUBLIC PLANS","J2790 - HC IG;RHO D,HUMAN/300MCG"]
["TUFTS PUBLIC PLANS","J3301 - HC TRIAMCINOLONE ACET INJ NOS"]
["TUFTS PUBLIC PLANS","L0120 - CERV FLEXIBLE NON-ADJUSTABLE"]
["TUFTS PUBLIC PLANS","L0140 - CERVICAL SEMI-RIGID ADJUSTAB"]
["TUFTS PUBLIC PLANS","L1820 - KO ELAS W/ CONDYLE PADS & JO"]
["TUFTS PUBLIC PLANS","L1830 - KO IMMOBILIZER CANVAS LONGIT"]
["TUFTS PUBLIC PLANS","L1832 - KO ADJ JNT POS RIGID SUPPORT"]
["TUFTS PUBLIC PLANS","L1836 - HC RIGID KO WO JOINTS"]
["TUFTS PUBLIC PLANS","L1902 - AFO ANKLE GAUNTLET"]
["TUFTS PUBLIC PLANS","L3260 - AMBULATORY SURGICAL BOOT EAC"]
["TUFTS PUBLIC PLANS","L3350 - SHOE HEEL WEDGE"]
["TUFTS PUBLIC PLANS","L3496 - HC STATIC AFO"]
["TUFTS PUBLIC PLANS","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN"]
["TUFTS PUBLIC PLANS","L3670 - ACROMIO/CLAVICULAR CANVAS&WE"]
["TUFTS PUBLIC PLANS","L3760 - EO WITHJOINT, PREFABRICATED"]
["TUFTS PUBLIC PLANS","L3762 - RIGID EO WO JOINTS"]
["TUFTS PUBLIC PLANS","L3807 - WHFO,NO JOINT, PREFABRICATED"]
["TUFTS PUBLIC PLANS","L3808 - HC EPITRAIN"]
["TUFTS PUBLIC PLANS","L3905 - HC WHO W/NONTORSION JNT(S) CF"]
["TUFTS PUBLIC PLANS","L3908 - WRIST COCK-UP NON-MOLDED"]
["TUFTS PUBLIC PLANS","L3967 - HC SEWHO AIRPLANE W/O JNTS CF"]
["TUFTS PUBLIC PLANS","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL"]
["TUFTS PUBLIC PLANS","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL"]
["TUFTS PUBLIC PLANS","L4350 - ANKLE CONTROL ORTHOSI PREFAB"]
["TUFTS PUBLIC PLANS","L4360 - PNEUMATI WALKING BOOT PREFAB"]
["TUFTS PUBLIC PLANS","L4370 - HC PNEUMATIC FULL LEG SPLINT"]
["TUFTS PUBLIC PLANS","L4386 - NON-PNEUM WALK BOOT PREFAB"]
["TUFTS PUBLIC PLANS","L4396 - STATIC AFO"]
["TUFTS PUBLIC PLANS","L4398 - HC FOOT DROP SPLINT RECUMBENT"]
["TUFTS PUBLIC PLANS","L8501 - TRACHEOSTOMY SPEAKING VALVE"]
["TUFTS PUBLIC PLANS","L8507 - HC PROLARYNX VOICE (PLUS)"]
["TUFTS PUBLIC PLANS","L8509 - TRACH-ESOPH VOICE PROS MD IN"]
["TUFTS PUBLIC PLANS","L8514 - REPL TRACH PUNCTURE DILATOR"]
["TUFTS PUBLIC PLANS","L8693 - HC AUD OSSEO DEV, ABUTMENT"]
["TUFTS PUBLIC PLANS","L8699 - HC CARTIFORM 20 X 25 MM DISC"]
["TUFTS PUBLIC PLANS","P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["TUFTS PUBLIC PLANS","P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["TUFTS PUBLIC PLANS","P9612 - CATHETERIZE FOR URINE SPEC"]
["TUFTS PUBLIC PLANS","Q0091 - HC OBTAINING SCREEN PAP SMEAR"]
["TUFTS PUBLIC PLANS","Q0111 - HC WET MOUNTS W PREPARATIONS"]
["TUFTS PUBLIC PLANS","Q0114 - HC  FERN TEST"]
["TUFTS PUBLIC PLANS","Q0249 - HC TOCILIZUMAB FOR COVID-19"]
["TUFTS PUBLIC PLANS","Q3014 - HC TELEHEALTH FACILITY FEE"]
["TUFTS PUBLIC PLANS","Q4101 - APLIGRAF"]
["TUFTS PUBLIC PLANS","Q4102 - OASIS WOUND MATRIX"]
["TUFTS PUBLIC PLANS","Q4116 - HC ALLODERM 8 X 16 MEDIUM"]
["TUFTS PUBLIC PLANS","Q4124 - OASIS TRILAYER/1 SQCM"]
["TUFTS PUBLIC PLANS","Q4125 - HC AFLEX401 ¿ 40 X 70 MM"]
["TUFTS PUBLIC PLANS","Q4130 - PR STRATTICE TM"]
["TUFTS PUBLIC PLANS","Q4132 - HC GRAFIX CORE 5X5CM"]
["TUFTS PUBLIC PLANS","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["TUFTS PUBLIC PLANS","Q4196 - HC PURAPLYAM-COM 6X9 CM"]
["TUFTS PUBLIC PLANS","Q9954 - ORAL MR CONTRAST, 100 ML"]
["TUFTS PUBLIC PLANS","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["TUFTS PUBLIC PLANS","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["TUFTS PUBLIC PLANS","Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["TUFTS PUBLIC PLANS","Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["TUFTS PUBLIC PLANS","Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["TUFTS PUBLIC PLANS","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["TUFTS PUBLIC PLANS","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["TUFTS PUBLIC PLANS","Q9987 - HC PATHOGEN TEST PLATELETS"]
["TUFTS PUBLIC PLANS","S5100 - ADULT DAYCARE SERVICES 15MIN"]
["TUFTS PUBLIC PLANS","S5101 - HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)"]
["TUFTS PUBLIC PLANS","S5102 - HC ADULT DAY HEALTH - COMPLEX PER DIEM"]
["TUFTS PUBLIC PLANS","S8037 - MRCP"]
["TUFTS PUBLIC PLANS","T2003 - HC TRANSPORTATION RATE 1 (1-WAY TRIP)"]
["TUFTS PUBLIC PLANS","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH"]
["TUFTS PUBLIC PLANS","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP"]
["TUFTS PUBLIC PLANS","V2785 - CORNEAL TISSUE PROCESSING"]
["TUFTS PUBLIC PLANS","V2790 - HC MEMBRANE AMNIOTIC"]
["UHC COMMUNITY CARE","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS"]
["UHC COMMUNITY CARE","A4561 - HC PESSARY RUBBER, ANY TYPE"]
["UHC COMMUNITY CARE","A4562 - PESSARY NONRUBBER"]
["UHC COMMUNITY CARE","A6209 - FOAM DRSG <=16 SQ IN W/O BDR"]
["UHC COMMUNITY CARE","A6258 - TRANSPARENT FILM >16<=48 IN"]
["UHC COMMUNITY CARE","A6550 - NEG PRES WOUND THER DRSG SET"]
["UHC COMMUNITY CARE","A7520 - TRACH/LARYN TUBE NON-CUFFED"]
["UHC COMMUNITY CARE","A9575 - INJ GADOTERATE MEGLUMI 0.1ML"]
["UHC COMMUNITY CARE","A9576 - HC PROHANCE IV CONTRAST PER ML"]
["UHC COMMUNITY CARE","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML"]
["UHC COMMUNITY CARE","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["UHC COMMUNITY CARE","A9581 - GADOXETATE DISODIUM INJ"]
["UHC COMMUNITY CARE","E0191 - PROTECTOR HEEL OR ELBOW"]
["UHC COMMUNITY CARE","G0103 - PSA, TOTAL SCREENING"]
["UHC COMMUNITY CARE","G0279 - TOMOSYNTHESIS, MAMMO"]
["UHC COMMUNITY CARE","G0480 - DRUG TEST DEF 1-7 CLASSES"]
["UHC COMMUNITY CARE","G0481 - DRUG TEST DEF 8-14 CLASSES"]
["UHC COMMUNITY CARE","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS"]
["UHC COMMUNITY CARE","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA"]
["UHC COMMUNITY CARE","J0702 - HC BETAMETHASONE ACET&SOD PHOSP"]
["UHC COMMUNITY CARE","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)"]
["UHC COMMUNITY CARE","J1250 - HC DOBUTAMINE SDV/250MG"]
["UHC COMMUNITY CARE","J2790 - HC IG;RHO D,HUMAN/300MCG"]
["UHC COMMUNITY CARE","J3301 - HC TRIAMCINOLONE ACET INJ NOS"]
["UHC COMMUNITY CARE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE"]
["UHC COMMUNITY CARE","L0140 - CERVICAL SEMI-RIGID ADJUSTAB"]
["UHC COMMUNITY CARE","L1820 - KO ELAS W/ CONDYLE PADS & JO"]
["UHC COMMUNITY CARE","L1830 - KO IMMOBILIZER CANVAS LONGIT"]
["UHC COMMUNITY CARE","L1832 - KO ADJ JNT POS RIGID SUPPORT"]
["UHC COMMUNITY CARE","L1836 - HC RIGID KO WO JOINTS"]
["UHC COMMUNITY CARE","L1902 - AFO ANKLE GAUNTLET"]
["UHC COMMUNITY CARE","L3350 - SHOE HEEL WEDGE"]
["UHC COMMUNITY CARE","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN"]
["UHC COMMUNITY CARE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE"]
["UHC COMMUNITY CARE","L3760 - EO WITHJOINT, PREFABRICATED"]
["UHC COMMUNITY CARE","L3762 - RIGID EO WO JOINTS"]
["UHC COMMUNITY CARE","L3807 - WHFO,NO JOINT, PREFABRICATED"]
["UHC COMMUNITY CARE","L3808 - HC EPITRAIN"]
["UHC COMMUNITY CARE","L3905 - HC WHO W/NONTORSION JNT(S) CF"]
["UHC COMMUNITY CARE","L3908 - WRIST COCK-UP NON-MOLDED"]
["UHC COMMUNITY CARE","L3967 - HC SEWHO AIRPLANE W/O JNTS CF"]
["UHC COMMUNITY CARE","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL"]
["UHC COMMUNITY CARE","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL"]
["UHC COMMUNITY CARE","L4350 - ANKLE CONTROL ORTHOSI PREFAB"]
["UHC COMMUNITY CARE","L4360 - PNEUMATI WALKING BOOT PREFAB"]
["UHC COMMUNITY CARE","L4370 - HC PNEUMATIC FULL LEG SPLINT"]
["UHC COMMUNITY CARE","L4386 - NON-PNEUM WALK BOOT PREFAB"]
["UHC COMMUNITY CARE","L4396 - STATIC AFO"]
["UHC COMMUNITY CARE","L4398 - HC FOOT DROP SPLINT RECUMBENT"]
["UHC COMMUNITY CARE","L8501 - TRACHEOSTOMY SPEAKING VALVE"]
["UHC COMMUNITY CARE","L8507 - HC PROLARYNX VOICE (PLUS)"]
["UHC COMMUNITY CARE","L8509 - TRACH-ESOPH VOICE PROS MD IN"]
["UHC COMMUNITY CARE","L8514 - REPL TRACH PUNCTURE DILATOR"]
["UHC COMMUNITY CARE","L8693 - HC AUD OSSEO DEV, ABUTMENT"]
["UHC COMMUNITY CARE","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING"]
["UHC COMMUNITY CARE","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG"]
["UHC COMMUNITY CARE","P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["UHC COMMUNITY CARE","P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["UHC COMMUNITY CARE","P9612 - CATHETERIZE FOR URINE SPEC"]
["UHC COMMUNITY CARE","Q0111 - HC WET MOUNTS W PREPARATIONS"]
["UHC COMMUNITY CARE","Q0114 - HC  FERN TEST"]
["UHC COMMUNITY CARE","Q3014 - HC TELEHEALTH FACILITY FEE"]
["UHC COMMUNITY CARE","Q4101 - APLIGRAF"]
["UHC COMMUNITY CARE","Q4102 - OASIS WOUND MATRIX"]
["UHC COMMUNITY CARE","Q4132 - HC GRAFIX CORE 5X5CM"]
["UHC COMMUNITY CARE","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["UHC COMMUNITY CARE","Q4196 - HC PURAPLYAM-COM 6X9 CM"]
["UHC COMMUNITY CARE","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["UHC COMMUNITY CARE","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["UHC COMMUNITY CARE","Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["UHC COMMUNITY CARE","Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["UHC COMMUNITY CARE","Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["UHC COMMUNITY CARE","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["UHC COMMUNITY CARE","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["UHC COMMUNITY CARE","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH"]
["UHC COMMUNITY CARE","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP"]
["UNICARE","45378 - COLON CA SCRN NOT HI RSK IND"]
["UNICARE","92083 - VISUAL FIELD EXAM,EXTENDED"]
["UNICARE","95800 - HOME SLEEP TEST/TYPE 3 PORTA"]
["UNICARE","A9575 - INJ GADOTERATE MEGLUMI 0.1ML"]
["UNICARE","A9576 - HC PROHANCE IV CONTRAST PER ML"]
["UNICARE","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML"]
["UNICARE","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["UNICARE","A9581 - GADOXETATE DISODIUM INJ"]
["UNICARE","A9583 - GADOFOSVESET TRISODIUM INJ"]
["UNICARE","G0103 - PSA, TOTAL SCREENING"]
["UNICARE","G0105 - HC COLORECTAL SCRN; HI RISK IND"]
["UNICARE","G0480 - DRUG TEST DEF 1-7 CLASSES"]
["UNICARE","G0481 - DRUG TEST DEF 8-14 CLASSES"]
["UNICARE","J0702 - HC BETAMETHASONE ACET&SOD PHOSP"]
["UNICARE","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)"]
["UNICARE","J1250 - HC DOBUTAMINE SDV/250MG"]
["UNICARE","J2790 - HC IG;RHO D,HUMAN/300MCG"]
["UNICARE","J3301 - HC TRIAMCINOLONE ACET INJ NOS"]
["UNICARE","P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["UNICARE","P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["UNICARE","P9612 - CATHETERIZE FOR URINE SPEC"]
["UNICARE","Q0111 - HC WET MOUNTS W PREPARATIONS"]
["UNICARE","Q0114 - HC  FERN TEST"]
["UNICARE","Q4101 - APLIGRAF"]
["UNICARE","Q4102 - OASIS WOUND MATRIX"]
["UNICARE","Q4104 - INTEGRA BMWD"]
["UNICARE","Q4107 - GRAFTJACKET"]
["UNICARE","Q4112 - CYMETRA INJECTABLE"]
["UNICARE","Q4116 - HC ALLODERM 8 X 16 MEDIUM"]
["UNICARE","Q4132 - HC GRAFIX CORE 5X5CM"]
["UNICARE","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["UNICARE","Q4196 - HC PURAPLYAM-COM 6X9 CM"]
["UNICARE","Q9954 - ORAL MR CONTRAST, 100 ML"]
["UNICARE","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["UNICARE","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["UNICARE","Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["UNICARE","Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["UNICARE","Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["UNICARE","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["UNICARE","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["UNITED HEALTHCARE","45378 - COLON CA SCRN NOT HI RSK IND"]
["UNITED HEALTHCARE","81170 - PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS"]
["UNITED HEALTHCARE","90471 - HC ADMIN PNEUMOCOCCAL VACCINE"]
["UNITED HEALTHCARE","92083 - VISUAL FIELD EXAM,EXTENDED"]
["UNITED HEALTHCARE","95800 - HOME SLEEP TEST/TYPE 3 PORTA"]
["UNITED HEALTHCARE","0042T - HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME"]
["UNITED HEALTHCARE","0278T - HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS"]
["UNITED HEALTHCARE","0402T - HC COLLAGEN CROSS-LINKING OF CORNEA"]
["UNITED HEALTHCARE","A4215 - STERILE NEEDLE"]
["UNITED HEALTHCARE","A4561 - HC PESSARY RUBBER, ANY TYPE"]
["UNITED HEALTHCARE","A4562 - PESSARY NONRUBBER"]
["UNITED HEALTHCARE","A4648 - IMPLANTABLE TISSUE MARKER"]
["UNITED HEALTHCARE","A4725 - DIALYS SOL FLD VOL > 4999CC"]
["UNITED HEALTHCARE","A6209 - FOAM DRSG <=16 SQ IN W/O BDR"]
["UNITED HEALTHCARE","A6258 - TRANSPARENT FILM >16<=48 IN"]
["UNITED HEALTHCARE","A6550 - NEG PRES WOUND THER DRSG SET"]
["UNITED HEALTHCARE","A7520 - TRACH/LARYN TUBE NON-CUFFED"]
["UNITED HEALTHCARE","A9500 - TC99M SESTAMIBI"]
["UNITED HEALTHCARE","A9502 - HC TC99M TETROFOSMIN"]
["UNITED HEALTHCARE","A9503 - TC99M MEDRONATE"]
["UNITED HEALTHCARE","A9505 - THALLIUM CHLORIDE PER MCI"]
["UNITED HEALTHCARE","A9509 - HC IODINE I-123 PER MCI"]
["UNITED HEALTHCARE","A9512 - TC99M PERTECHNETATE"]
["UNITED HEALTHCARE","A9513 - TECHNETIUM TC-99M MEBROFENIN"]
["UNITED HEALTHCARE","A9516 - I123 IODIDE CAP, DX"]
["UNITED HEALTHCARE","A9517 - I131 IODIDE CAP, RX"]
["UNITED HEALTHCARE","A9520 - TECHNETIUMTC-99M SULFUR CLLD"]
["UNITED HEALTHCARE","A9521 - TC99M EXAMETAZIME"]
["UNITED HEALTHCARE","A9537 - TC99M MEBROFENIN"]
["UNITED HEALTHCARE","A9538 - TC99M PYROPHOSPHATE"]
["UNITED HEALTHCARE","A9539 - TC99M PENTETATE"]
["UNITED HEALTHCARE","A9540 - TC99M MAA"]
["UNITED HEALTHCARE","A9541 - TC99M SULFUR COLLOID"]
["UNITED HEALTHCARE","A9543 - Y90 IBRITUMOMAB, RX"]
["UNITED HEALTHCARE","A9547 - IN111 OXYQUINOLINE"]
["UNITED HEALTHCARE","A9551 - HC TC99M SUCCIMER/10MCI,DX"]
["UNITED HEALTHCARE","A9552 - F18 FDG"]
["UNITED HEALTHCARE","A9555 - RADIOPHARMACIAL"]
["UNITED HEALTHCARE","A9556 - GA67 GALLIUM"]
["UNITED HEALTHCARE","A9557 - TC99M BICISATE"]
["UNITED HEALTHCARE","A9558 - HC XENON133/10MCI"]
["UNITED HEALTHCARE","A9560 - TC99M LABELED RBC"]
["UNITED HEALTHCARE","A9561 - TC99M OXIDRONATE"]
["UNITED HEALTHCARE","A9562 - TC99M MERTIATIDE"]
["UNITED HEALTHCARE","A9563 - P32 NA PHOSPHATE"]
["UNITED HEALTHCARE","A9569 - TECHNETIUM TC-99M AUTO WBC"]
["UNITED HEALTHCARE","A9570 - HC INDIUM IN-111 AUTO WBC"]
["UNITED HEALTHCARE","A9572 - INDIUM IN-111 PENTETREOTIDE"]
["UNITED HEALTHCARE","A9575 - INJ GADOTERATE MEGLUMI 0.1ML"]
["UNITED HEALTHCARE","A9576 - HC PROHANCE IV CONTRAST PER ML"]
["UNITED HEALTHCARE","A9577 - HC INJ, GADOBENATE DIMEGL 1 ML"]
["UNITED HEALTHCARE","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["UNITED HEALTHCARE","A9580 - HC NA FLUORIDE F-18, DOSE"]
["UNITED HEALTHCARE","A9581 - GADOXETATE DISODIUM INJ"]
["UNITED HEALTHCARE","A9582 - IODINE I-123 IOBENGUANE"]
["UNITED HEALTHCARE","A9583 - GADOFOSVESET TRISODIUM INJ"]
["UNITED HEALTHCARE","A9584 - IODINE I-123 IOFLUPANE"]
["UNITED HEALTHCARE","A9586 - HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE"]
["UNITED HEALTHCARE","A9587 - GALLIUM GA-68"]
["UNITED HEALTHCARE","A9588 - FLUCICLOVINE F-18"]
["UNITED HEALTHCARE","A9606 - RADIUM RA223 DICHLORIDE THER"]
["UNITED HEALTHCARE","C1713 - HC CORE 10 BONE PLUG"]
["UNITED HEALTHCARE","C1714 - HC WATHMAN SYS ANTER CURVE"]
["UNITED HEALTHCARE","C1715 - BRACHYTHERAPY NEEDLE"]
["UNITED HEALTHCARE","C1716 - BRACHYTX SOURCE, GOLD 198"]
["UNITED HEALTHCARE","C1717 - HC BRACHYTX, NON-STR,HDR IR-192"]
["UNITED HEALTHCARE","C1719 - BRACHYTX SOUR,NON-HDR IR-192"]
["UNITED HEALTHCARE","C1721 - HC ICD,2CH, GEN ONLY, RECALL $0"]
["UNITED HEALTHCARE","C1722 - HC ICD,1CH, GEN ONLY, RECALL $0"]
["UNITED HEALTHCARE","C1724 - HC CATH, TRANS ATHEREC BURR"]
["UNITED HEALTHCARE","C1725 - HC SIZING AMPLATZ BALLOON"]
["UNITED HEALTHCARE","C1726 - HC CATHETER BALLN LVL 4"]
["UNITED HEALTHCARE","C1729 - HC CATH; THORA PARA"]
["UNITED HEALTHCARE","C1730 - HC CATH,EP;STEER,DEC(LASSO)"]
["UNITED HEALTHCARE","C1731 - HC CATH,EP PENTARAY NAV"]
["UNITED HEALTHCARE","C1732 - HC CATH,EP DECA NAV"]
["UNITED HEALTHCARE","C1733 - CATH CRYABL  ARCTIC FRN"]
["UNITED HEALTHCARE","C1750 - HC CATH 2 LUMEN QUINTON"]
["UNITED HEALTHCARE","C1751 - HC CATH, PACING"]
["UNITED HEALTHCARE","C1753 - HC BIOPSY FORC LVL D"]
["UNITED HEALTHCARE","C1756 - HC PACING WIRE"]
["UNITED HEALTHCARE","C1757 - HC CATH,THROMB/EMB,LVL 2"]
["UNITED HEALTHCARE","C1759 - HC CATH, ULTRASOUND LVL 2"]
["UNITED HEALTHCARE","C1760 - HC CENTRAL LINE KIT"]
["UNITED HEALTHCARE","C1762 - HC NERVE - CONNEVTIVE TISSUE, HUMAN"]
["UNITED HEALTHCARE","C1763 - HC SM6X16-STEM HEM"]
["UNITED HEALTHCARE","C1764 - HC RECORDER;IMPLANTABLE LOOP"]
["UNITED HEALTHCARE","C1765 - ADHESION BARRIER"]
["UNITED HEALTHCARE","C1766 - SHTH INTRO 65CM 15FR 12FR"]
["UNITED HEALTHCARE","C1768 - HC TAVR HEART VALVE KIT"]
["UNITED HEALTHCARE","C1769 - GUIDE WIRE"]
["UNITED HEALTHCARE","C1770 - IMAGING COIL, MR, INSERTABLE"]
["UNITED HEALTHCARE","C1773 - HC GUIDEWIRE LVL E"]
["UNITED HEALTHCARE","C1776 - HC HEMI-TIB PLATEAU W MENISC"]
["UNITED HEALTHCARE","C1777 - HC LEAD,ICD,1COIL"]
["UNITED HEALTHCARE","C1781 - MESH (IMPLANTABLE)"]
["UNITED HEALTHCARE","C1784 - HC DES PERIPHERAL STENT"]
["UNITED HEALTHCARE","C1785 - HC PACER;2CH, RECALL $0"]
["UNITED HEALTHCARE","C1786 - HC PACER;1CH, RECALL $0"]
["UNITED HEALTHCARE","C1788 - HC PORTACATH ANY"]
["UNITED HEALTHCARE","C1817 - HC OCCKYDER;ASD/PFO"]
["UNITED HEALTHCARE","C1821 - HC INTERSPINOUS IMPLANT"]
["UNITED HEALTHCARE","C1874 - STENT WALLFLEX SYSTEM"]
["UNITED HEALTHCARE","C1876 - STENT BILIARY"]
["UNITED HEALTHCARE","C1880 - IVC FILTERS"]
["UNITED HEALTHCARE","C1882 - HC ICD,BI-VENT, GEN ONLY, RECALL $0"]
["UNITED HEALTHCARE","C1883 - HC ADAPTOR;BI-VENT PACER"]
["UNITED HEALTHCARE","C1884 - EMBOLIZATION PROTECT SYST"]
["UNITED HEALTHCARE","C1887 - HC CATH,EP;R-F,30D THERM RMT"]
["UNITED HEALTHCARE","C1892 - HC SHEATH;GUIDING"]
["UNITED HEALTHCARE","C1893 - HC DILATOR SHEATH/VISISHEATH"]
["UNITED HEALTHCARE","C1894 - HC INTRO/SHEATH NON-CARD LV2"]
["UNITED HEALTHCARE","C1895 - HC ICD LEAD,2COIL"]
["UNITED HEALTHCARE","C1896 - HC SICD PULSE GENERATOR"]
["UNITED HEALTHCARE","C1898 - HC KIT,PACER;BI-VENT(#6216/8"]
["UNITED HEALTHCARE","C1900 - HC INJ;OCTAFLUORO MICRO/1ML"]
["UNITED HEALTHCARE","C2615 - SEALANT, PULMONARY, LIQUID"]
["UNITED HEALTHCARE","C2616 - HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE"]
["UNITED HEALTHCARE","C2617 - STENT ZIMMON BILIARY"]
["UNITED HEALTHCARE","C2621 - HC PACER;2CH, W/ BACKUP DEFIB"]
["UNITED HEALTHCARE","C2623 - CATH TRANSLUMIN DRUG-COAT"]
["UNITED HEALTHCARE","C2625 - STENT BILIARY COTTON"]
["UNITED HEALTHCARE","C2628 - HC KIT CATH BRIDGE PRE"]
["UNITED HEALTHCARE","C2630 - HC CATH;EP CRYOABLATION, 8 MM"]
["UNITED HEALTHCARE","C2634 - BRACHYTX, NON-STR, HA, I-125"]
["UNITED HEALTHCARE","C2635 - BRACHYTX, NON-STR, HA, P-103"]
["UNITED HEALTHCARE","C2639 - BRACHYTX, NON-STRANDED,I-125"]
["UNITED HEALTHCARE","C5275 - HC LOW COST SKIN SUBSTITUTE"]
["UNITED HEALTHCARE","C8908 - HC MRI W/O FOL W/CONT, BREAST,"]
["UNITED HEALTHCARE","C8937 - CAD BREAST MRI"]
["UNITED HEALTHCARE","C9358 - SURGIMEND, FETAL"]
["UNITED HEALTHCARE","C9728 - PLACE DEVICE/MARKER, NON PRO"]
["UNITED HEALTHCARE","C9739 - HC CYSTOSCOPY PROSTATIC IMP 1-3"]
["UNITED HEALTHCARE","G0103 - PSA, TOTAL SCREENING"]
["UNITED HEALTHCARE","G0105 - HC COLORECTAL SCRN; HI RISK IND"]
["UNITED HEALTHCARE","G0108 - DIAB MANAGE TRN  PER INDIV"]
["UNITED HEALTHCARE","G0109 - DIAB MANAGE TRN IND/GROUP"]
["UNITED HEALTHCARE","G0127 - TRIM NAIL(S)"]
["UNITED HEALTHCARE","G0239 - OTH RESP PROC, GROUP"]
["UNITED HEALTHCARE","G0257 - HC UNSCHED DIALYSIS ESRD PT HOSP"]
["UNITED HEALTHCARE","G0259 - HC INJECT FOR SACROILIAC JOINT"]
["UNITED HEALTHCARE","G0260 - INJ FOR SACROILIAC JT ANESTH"]
["UNITED HEALTHCARE","G0269 - HC CLOSURE DEVICE PLACEMENT"]
["UNITED HEALTHCARE","G0270 - MNT SUBS TX FOR CHANGE DX"]
["UNITED HEALTHCARE","G0278 - ILIAC ART ANGIO,CARDIAC CATH"]
["UNITED HEALTHCARE","G0279 - TOMOSYNTHESIS, MAMMO"]
["UNITED HEALTHCARE","G0297 - HC LDCT FOR LUNG CA SCREEN"]
["UNITED HEALTHCARE","G0390 - TRAUMA RESPONS W/HOSP CRITI"]
["UNITED HEALTHCARE","G0416 - HC PROSTATE BIOPSY ANY MTHD"]
["UNITED HEALTHCARE","G0422 - HC INTENS CARDIAC REHAB W/EXERC"]
["UNITED HEALTHCARE","G0423 - HC INTENS CARDIAC REHAB NO EXER"]
["UNITED HEALTHCARE","G0424 - PULMONARY REHAB W EXER"]
["UNITED HEALTHCARE","G0480 - DRUG TEST DEF 1-7 CLASSES"]
["UNITED HEALTHCARE","G0481 - DRUG TEST DEF 8-14 CLASSES"]
["UNITED HEALTHCARE","G0506 - HC COMP ASSESS CARE PLAN CCM SVC"]
["UNITED HEALTHCARE","G0513 - HC PROLONG PREV SVCS, FIRST 30M"]
["UNITED HEALTHCARE","G0514 - HC PROLONG PREV SVCS, ADDL 30M"]
["UNITED HEALTHCARE","G2023 - SPECIMEN COLLECTION FOR  CORONAVIRUS"]
["UNITED HEALTHCARE","G2024 - SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA"]
["UNITED HEALTHCARE","G2066 - HC INTERROGATION EVAL REMOTE </30 D TECH"]
["UNITED HEALTHCARE","J0702 - HC BETAMETHASONE ACET&SOD PHOSP"]
["UNITED HEALTHCARE","J1030 - PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)"]
["UNITED HEALTHCARE","J1250 - HC DOBUTAMINE SDV/250MG"]
["UNITED HEALTHCARE","J2790 - HC IG;RHO D,HUMAN/300MCG"]
["UNITED HEALTHCARE","J3301 - HC TRIAMCINOLONE ACET INJ NOS"]
["UNITED HEALTHCARE","J7307 - HC ETONOGESTREL IMPLANT SYSTEM"]
["UNITED HEALTHCARE","L0120 - CERV FLEXIBLE NON-ADJUSTABLE"]
["UNITED HEALTHCARE","L0140 - CERVICAL SEMI-RIGID ADJUSTAB"]
["UNITED HEALTHCARE","L1820 - KO ELAS W/ CONDYLE PADS & JO"]
["UNITED HEALTHCARE","L1830 - KO IMMOBILIZER CANVAS LONGIT"]
["UNITED HEALTHCARE","L1832 - KO ADJ JNT POS RIGID SUPPORT"]
["UNITED HEALTHCARE","L1836 - HC RIGID KO WO JOINTS"]
["UNITED HEALTHCARE","L1902 - AFO ANKLE GAUNTLET"]
["UNITED HEALTHCARE","L3350 - SHOE HEEL WEDGE"]
["UNITED HEALTHCARE","L3650 - SHLDER FIG 8 ABDUCT RESTRAIN"]
["UNITED HEALTHCARE","L3670 - ACROMIO/CLAVICULAR CANVAS&WE"]
["UNITED HEALTHCARE","L3760 - EO WITHJOINT, PREFABRICATED"]
["UNITED HEALTHCARE","L3762 - RIGID EO WO JOINTS"]
["UNITED HEALTHCARE","L3807 - WHFO,NO JOINT, PREFABRICATED"]
["UNITED HEALTHCARE","L3808 - HC EPITRAIN"]
["UNITED HEALTHCARE","L3905 - HC WHO W/NONTORSION JNT(S) CF"]
["UNITED HEALTHCARE","L3908 - WRIST COCK-UP NON-MOLDED"]
["UNITED HEALTHCARE","L3967 - HC SEWHO AIRPLANE W/O JNTS CF"]
["UNITED HEALTHCARE","L3980 - HC UPP EXT FX ORTHOSIS HUMERAL"]
["UNITED HEALTHCARE","L3982 - HC UPPER EXT FX ORTHOSIS RAD/UL"]
["UNITED HEALTHCARE","L4350 - ANKLE CONTROL ORTHOSI PREFAB"]
["UNITED HEALTHCARE","L4360 - PNEUMATI WALKING BOOT PREFAB"]
["UNITED HEALTHCARE","L4370 - HC PNEUMATIC FULL LEG SPLINT"]
["UNITED HEALTHCARE","L4386 - NON-PNEUM WALK BOOT PREFAB"]
["UNITED HEALTHCARE","L4396 - STATIC AFO"]
["UNITED HEALTHCARE","L4398 - HC FOOT DROP SPLINT RECUMBENT"]
["UNITED HEALTHCARE","L8501 - TRACHEOSTOMY SPEAKING VALVE"]
["UNITED HEALTHCARE","L8507 - HC PROLARYNX VOICE (PLUS)"]
["UNITED HEALTHCARE","L8509 - TRACH-ESOPH VOICE PROS MD IN"]
["UNITED HEALTHCARE","L8514 - REPL TRACH PUNCTURE DILATOR"]
["UNITED HEALTHCARE","L8693 - HC AUD OSSEO DEV, ABUTMENT"]
["UNITED HEALTHCARE","L8699 - HC CARTIFORM 20 X 25 MM DISC"]
["UNITED HEALTHCARE","M0239 - HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING"]
["UNITED HEALTHCARE","M0243 - HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG"]
["UNITED HEALTHCARE","P9012 - HC CRYOPRECIPITATE UNIT"]
["UNITED HEALTHCARE","P9016 - HC RBC:LEU-RED"]
["UNITED HEALTHCARE","P9017 - HC FF PLAS: 1 DONOR"]
["UNITED HEALTHCARE","P9021 - HC RBC/UNIT"]
["UNITED HEALTHCARE","P9034 - HB PLATELETS, PHERESIS"]
["UNITED HEALTHCARE","P9037 - HC PLT:PHER,LEU-RED,IRR/UNIT"]
["UNITED HEALTHCARE","P9040 - HC RBC:LEU-RED,IRR/UNIT"]
["UNITED HEALTHCARE","P9044 - HC CRYOPRECIPITATE REDUCED PLASMA"]
["UNITED HEALTHCARE","P9045 - HC ALBUMIN (HUMAN) 5% 250ML"]
["UNITED HEALTHCARE","P9047 - HC ALBUMIN (HUMAN) 25% 50ML"]
["UNITED HEALTHCARE","P9056 - HC BLOOD, L/R, IRRADIATED"]
["UNITED HEALTHCARE","P9057 - HC RBC:LEU RED,FR/DE/WASH,IR"]
["UNITED HEALTHCARE","P9073 - HC PLATELETS PHERESIS PATH REDU"]
["UNITED HEALTHCARE","P9100 - PATHOGEN TEST FOR PLATELETS"]
["UNITED HEALTHCARE","P9612 - CATHETERIZE FOR URINE SPEC"]
["UNITED HEALTHCARE","Q0091 - HC OBTAINING SCREEN PAP SMEAR"]
["UNITED HEALTHCARE","Q0111 - HC WET MOUNTS W PREPARATIONS"]
["UNITED HEALTHCARE","Q0114 - HC  FERN TEST"]
["UNITED HEALTHCARE","Q3014 - HC TELEHEALTH FACILITY FEE"]
["UNITED HEALTHCARE","Q4101 - APLIGRAF"]
["UNITED HEALTHCARE","Q4102 - OASIS WOUND MATRIX"]
["UNITED HEALTHCARE","Q4104 - INTEGRA BMWD"]
["UNITED HEALTHCARE","Q4107 - GRAFTJACKET"]
["UNITED HEALTHCARE","Q4112 - CYMETRA INJECTABLE"]
["UNITED HEALTHCARE","Q4116 - HC ALLODERM 8 X 16 MEDIUM"]
["UNITED HEALTHCARE","Q4124 - OASIS TRILAYER/1 SQCM"]
["UNITED HEALTHCARE","Q4125 - HC AFLEX401 ¿ 40 X 70 MM"]
["UNITED HEALTHCARE","Q4130 - PR STRATTICE TM"]
["UNITED HEALTHCARE","Q4132 - HC GRAFIX CORE 5X5CM"]
["UNITED HEALTHCARE","Q4133 - HC GRAFIX STRAVIX PRIME PL (5CMX5CM)"]
["UNITED HEALTHCARE","Q4196 - HC PURAPLYAM-COM 6X9 CM"]
["UNITED HEALTHCARE","Q9954 - ORAL MR CONTRAST, 100 ML"]
["UNITED HEALTHCARE","Q9956 - HC INJ;OCTAFLUORO MICRO/1ML"]
["UNITED HEALTHCARE","Q9957 - HC INJ;PERFLUTR LIP MIC/1ML"]
["UNITED HEALTHCARE","Q9958 - HOCM <=149 MG/ML IODINE, 1ML"]
["UNITED HEALTHCARE","Q9961 - HOCM 250-299MG/ML IODINE,1ML"]
["UNITED HEALTHCARE","Q9963 - HOCM 350-399MG/ML IODINE,1ML"]
["UNITED HEALTHCARE","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["UNITED HEALTHCARE","Q9967 - HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML"]
["UNITED HEALTHCARE","U0001 - HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH"]
["UNITED HEALTHCARE","U0002 - HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP"]
["UNITED HEALTHCARE","V2790 - HC MEMBRANE AMNIOTIC"]

{"sheet":"HCPCSCombo","index":11,"n_rows":327,"n_cols":16,"rows_kept":327,"cut":false,"hidden":true,"merged":[]}
[]
[]
[null,null,null,null,null,null,null,null,null,null,"CB Payer Link","Payer Content","CB Plan Link","Plan Content","CB BC Link","BC Content"]
[null,null,null,null,null,null,null,null,null,1,1,{"$f":"TRANSPOSE(HCPCSPayPln[#Headers])","v":"Select Insurance Carrier"},1,{"$f":"INDEX('HCPCSPayer&Plan'!C2:U2,,$K$4)","v":"Select Insurance Plan"},1,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D2:V2,,$K$4)","v":"Select HCPCS Code"}]
[null,null,null,null,null,null,null,null,null,2,null,"AETNA",null,{"$f":"INDEX('HCPCSPayer&Plan'!C3:U3,,$K$4)","v":0},null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D3:V3,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,3,null,"ALLWAYS HEALTH PARTNERS",null,{"$f":"INDEX('HCPCSPayer&Plan'!C4:U4,,$K$4)","v":0},null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D4:V4,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,4,null,"BLUE BENEFIT ADMINISTRATORS",null,{"$f":"INDEX('HCPCSPayer&Plan'!C5:U5,,$K$4)","v":0},null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D5:V5,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,5,null,"BLUE CROSS",null,{"$f":"INDEX('HCPCSPayer&Plan'!C6:U6,,$K$4)","v":0},null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D6:V6,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,6,null,"BLUE CROSS OUT OF STATE",null,{"$f":"INDEX('HCPCSPayer&Plan'!C7:U7,,$K$4)","v":0},null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D7:V7,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,7,null,"BMC HEALTHNET",null,{"$f":"INDEX('HCPCSPayer&Plan'!C8:U8,,$K$4)","v":0},null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D8:V8,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,8,null,"CIGNA HEALTHCARE",null,{"$f":"INDEX('HCPCSPayer&Plan'!C9:U9,,$K$4)","v":0},null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D9:V9,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,9,null,"COMMONWEALTH CARE ALLIANCE",null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D10:V10,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,10,null,"ELDER SERVICE PLAN",null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D11:V11,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,11,null,"ELDER SERVICE PLAN OTHER",null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D12:V12,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,12,null,"FALLON",null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D13:V13,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,13,null,"HARVARD PILGRIM HEALTH CARE",null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D14:V14,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,14,null,"SENIOR WHOLE HEALTH",null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D15:V15,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,15,null,"TUFTS",null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D16:V16,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,16,null,"TUFTS PUBLIC PLANS",null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D17:V17,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,17,null,"UHC COMMUNITY CARE",null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D18:V18,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,18,null,"UNICARE",null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D19:V19,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,19,null,"UNITED HEALTHCARE",null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D20:V20,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D21:V21,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D22:V22,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D23:V23,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D24:V24,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D25:V25,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D26:V26,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D27:V27,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D28:V28,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D29:V29,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D30:V30,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D31:V31,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D32:V32,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D33:V33,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D34:V34,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D35:V35,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D36:V36,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D37:V37,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D38:V38,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D39:V39,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D40:V40,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D41:V41,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D42:V42,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D43:V43,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D44:V44,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D45:V45,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D46:V46,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D47:V47,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D48:V48,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D49:V49,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D50:V50,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D51:V51,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D52:V52,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D53:V53,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D54:V54,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D55:V55,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D56:V56,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D57:V57,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D58:V58,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D59:V59,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D60:V60,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D61:V61,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D62:V62,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D63:V63,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D64:V64,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D65:V65,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D66:V66,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D67:V67,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D68:V68,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D69:V69,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D70:V70,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D71:V71,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D72:V72,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D73:V73,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D74:V74,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D75:V75,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D76:V76,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D77:V77,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D78:V78,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D79:V79,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D80:V80,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D81:V81,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D82:V82,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D83:V83,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D84:V84,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D85:V85,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D86:V86,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D87:V87,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D88:V88,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D89:V89,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D90:V90,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D91:V91,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D92:V92,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D93:V93,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D94:V94,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D95:V95,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D96:V96,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D97:V97,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D98:V98,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D99:V99,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D100:V100,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D101:V101,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D102:V102,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D103:V103,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D104:V104,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D105:V105,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D106:V106,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D107:V107,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D108:V108,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D109:V109,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D110:V110,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D111:V111,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D112:V112,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D113:V113,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D114:V114,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D115:V115,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D116:V116,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D117:V117,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D118:V118,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D119:V119,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D120:V120,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D121:V121,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D122:V122,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D123:V123,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D124:V124,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D125:V125,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D126:V126,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D127:V127,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D128:V128,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D129:V129,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D130:V130,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D131:V131,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D132:V132,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D133:V133,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D134:V134,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D135:V135,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D136:V136,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D137:V137,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D138:V138,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D139:V139,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D140:V140,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D141:V141,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D142:V142,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D143:V143,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D144:V144,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D145:V145,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D146:V146,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D147:V147,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D148:V148,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D149:V149,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D150:V150,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D151:V151,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D152:V152,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D153:V153,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D154:V154,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D155:V155,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D156:V156,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D157:V157,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D158:V158,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D159:V159,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D160:V160,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D161:V161,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D162:V162,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D163:V163,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D164:V164,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D165:V165,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D166:V166,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D167:V167,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D168:V168,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D169:V169,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D170:V170,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D171:V171,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D172:V172,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D173:V173,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D174:V174,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D175:V175,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D176:V176,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D177:V177,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D178:V178,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D179:V179,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D180:V180,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D181:V181,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D182:V182,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D183:V183,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D184:V184,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D185:V185,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D186:V186,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D187:V187,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D188:V188,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D189:V189,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D190:V190,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D191:V191,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D192:V192,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D193:V193,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D194:V194,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D195:V195,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D196:V196,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D197:V197,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D198:V198,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D199:V199,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D200:V200,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D201:V201,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D202:V202,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D203:V203,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D204:V204,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D205:V205,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D206:V206,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D207:V207,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D208:V208,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D209:V209,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D210:V210,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D211:V211,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D212:V212,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D213:V213,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D214:V214,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D215:V215,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D216:V216,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D217:V217,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D218:V218,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D219:V219,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D220:V220,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D221:V221,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D222:V222,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D223:V223,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D224:V224,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D225:V225,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D226:V226,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D227:V227,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D228:V228,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D229:V229,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D230:V230,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D231:V231,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D232:V232,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D233:V233,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D234:V234,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D235:V235,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D236:V236,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D237:V237,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D238:V238,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D239:V239,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D240:V240,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D241:V241,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D242:V242,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D243:V243,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D244:V244,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D245:V245,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D246:V246,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D247:V247,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D248:V248,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D249:V249,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D250:V250,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D251:V251,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D252:V252,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D253:V253,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D254:V254,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D255:V255,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D256:V256,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D257:V257,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D258:V258,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D259:V259,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D260:V260,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D261:V261,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D262:V262,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D263:V263,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D264:V264,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D265:V265,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D266:V266,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D267:V267,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D268:V268,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D269:V269,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D270:V270,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D271:V271,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D272:V272,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D273:V273,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D274:V274,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D275:V275,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D276:V276,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D277:V277,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D278:V278,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D279:V279,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D280:V280,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D281:V281,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D282:V282,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D283:V283,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D284:V284,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D285:V285,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D286:V286,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D287:V287,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D288:V288,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D289:V289,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D290:V290,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D291:V291,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D292:V292,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D293:V293,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D294:V294,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D295:V295,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D296:V296,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D297:V297,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D298:V298,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D299:V299,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D300:V300,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D301:V301,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D302:V302,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D303:V303,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D304:V304,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D305:V305,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D306:V306,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D307:V307,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D308:V308,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D309:V309,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D310:V310,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D311:V311,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D312:V312,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D313:V313,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D314:V314,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D315:V315,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D316:V316,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D317:V317,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D318:V318,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D319:V319,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D320:V320,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D321:V321,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D322:V322,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D323:V323,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D324:V324,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('HCPCSPayer&Code&Desc'!D325:V325,,$K$4)","v":0}]

{"sheet":"HCPCS Table","index":12,"n_rows":7351,"n_cols":14,"rows_kept":4500,"cut":true,"hidden":true,"merged":[],"bounds":{"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0}}
["IP/OP","Payer - Plan - Bill Type - Bill Code","Payer","Plan","Bill Type","Bill Code","Billing Description","CPT Mod","Gross Charge Amount","Payer Charge Amount","Minimum Charge Amount","Maximum Charge Amount","Self-Pay Charge","Duplicate"]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - 0042T"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",null,767,0,1452,1452,191.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - 0278T"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","0278T","HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS",null,77,943.8,286.31,943.8,19.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - 0278T"},"TUFTS","TUFTS SELECT","HCPCS","0278T","HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS",null,77,317.70999999999998,286.31,943.8,19.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - 0399T"},"TUFTS","TUFTS PPO","HCPCS","0399T","PR MYOCARDIAL STRAIN IMAGING",null,1022,0,null,null,255.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - 0402T"},"TUFTS","TUFTS POS","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA",null,2880,7467.76,1198.25,11845.41,720,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - 0402T"},"TUFTS","TUFTS SELECT","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA",null,2880,3987.49,1198.25,11845.41,720,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA - HCPCS - 45378"},"AETNA","AETNA","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND",null,1672,1500.85,1020.59,3264.67,418,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - 81170"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",null,798,300,159,2909.77,199.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - 81170"},"TUFTS","TUFTS POS","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",null,798,967.76,159,2909.77,199.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - 81170"},"TUFTS","TUFTS PPO","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",null,798,1035.23,159,2909.77,199.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - 81170"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",null,798,265.99,159,2909.77,199.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - 81170"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",null,798,754.86,159,2909.77,199.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - 81170"},"BMC HEALTHNET","BMCHN QHP","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",null,798,265.99,159,2909.77,199.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A4215"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A4215","STERILE NEEDLE",null,433,0,null,null,108.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - A4215"},"FALLON","FALLON MEDICAID","HCPCS","A4215","STERILE NEEDLE",null,433,0,null,null,108.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A4215"},"TUFTS","TUFTS POS","HCPCS","A4215","STERILE NEEDLE",null,433,0,null,null,108.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A4215"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A4215","STERILE NEEDLE",null,433,0,null,null,108.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - A4215"},"BMC HEALTHNET","BMCHN QHP","HCPCS","A4215","STERILE NEEDLE",null,433,0,null,null,108.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A4561"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE",null,108,0,23.18,58.33,27,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A4561"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE",null,108,40.33,23.18,58.33,27,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A4561"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE",null,108,58.33,23.18,58.33,27,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - A4561"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE",null,108,33.729999999999997,23.18,58.33,27,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A4561"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE",null,108,51.23,23.18,58.33,27,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A4562"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A4562","PESSARY NONRUBBER",null,64,0,57.71,145.21,16,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A4562"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","A4562","PESSARY NONRUBBER",null,64,68.099999999999994,57.71,145.21,16,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A4562"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","A4562","PESSARY NONRUBBER",null,64,145.21,57.71,145.21,16,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - A4570"},"FALLON","FALLON MEDICAID","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1",null,40,0,19.010000000000002,107.35,10,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A4648"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A4648","IMPLANTABLE TISSUE MARKER",null,281,0,null,null,70.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - A4725"},"TUFTS","TUFTS HMO","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC",null,87,0,null,null,21.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A4725"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC",null,87,0,null,null,21.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A6209"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR",null,163,8.68,8.68,21.84,40.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - A6209"},"FALLON","FALLON SENIOR PLAN","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR",null,163,8.68,8.68,21.84,40.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A6209"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR",null,163,11.7,8.68,21.84,40.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A6209"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR",null,163,10.42,8.68,21.84,40.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A6209"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR",null,163,10.24,8.68,21.84,40.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - A6209"},"BMC HEALTHNET","BMCHN ACO","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR",null,163,0,8.68,21.84,40.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A6209"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR",null,163,19.18,8.68,21.84,40.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A6258"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN",null,83,8.6999999999999993,5,12.58,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - A6258"},"TUFTS","TUFTS SELECT","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN",null,83,0,5,12.58,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A6258"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN",null,83,7.28,5,12.58,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A6258"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN",null,83,7.28,5,12.58,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A6549"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A6549","G COMPRESSION STOCKING",null,37,0,null,null,9.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A6550"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A6550","NEG PRES WOUND THER DRSG SET",null,4,0,25.71,64.69,1,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A6550"},"TUFTS","TUFTS PPO","HCPCS","A6550","NEG PRES WOUND THER DRSG SET",null,4,0,25.71,64.69,1,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - A6550"},"TUFTS","TUFTS SELECT","HCPCS","A6550","NEG PRES WOUND THER DRSG SET",null,4,0,25.71,64.69,1,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - A6550"},"TUFTS","TUFTS SPIRIT","HCPCS","A6550","NEG PRES WOUND THER DRSG SET",null,4,28.28,25.71,64.69,1,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - A7520"},"FALLON","FALLON SENIOR PLAN","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED",null,1173,55.16,55.16,138.79,293.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - A7520"},"TUFTS","TUFTS SPIRIT","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED",null,1173,60.68,55.16,138.79,293.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A7520"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED",null,1173,0,55.16,138.79,293.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9500"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9500","TC99M SESTAMIBI",null,274,0,463.42,463.42,68.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9500"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9500","TC99M SESTAMIBI",null,274,0,463.42,463.42,68.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9500"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9500","TC99M SESTAMIBI",null,274,463.42,463.42,463.42,68.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9500"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9500","TC99M SESTAMIBI",null,274,463.42,463.42,463.42,68.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - A9502"},"FALLON","FALLON MEDICAID","HCPCS","A9502","HC TC99M TETROFOSMIN",null,140,0,278.27,278.27,35,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - A9502"},"TUFTS","TUFTS HMO","HCPCS","A9502","HC TC99M TETROFOSMIN",null,140,0,278.27,278.27,35,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9502"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9502","HC TC99M TETROFOSMIN",null,140,278.27,278.27,278.27,35,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9502"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9502","HC TC99M TETROFOSMIN",null,140,278.27,278.27,278.27,35,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - A9502"},"BMC HEALTHNET","BMCHN ACO","HCPCS","A9502","HC TC99M TETROFOSMIN",null,140,0,278.27,278.27,35,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9503"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9503","TC99M MEDRONATE",null,23,0,37.119999999999997,37.119999999999997,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - A9503"},"TUFTS","TUFTS HMO","HCPCS","A9503","TC99M MEDRONATE",null,23,0,37.119999999999997,37.119999999999997,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A9509"},"TUFTS","TUFTS POS","HCPCS","A9509","HC IODINE I-123 PER MCI",null,95,0,5163.91,5163.91,23.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A9509"},"TUFTS","TUFTS PPO","HCPCS","A9509","HC IODINE I-123 PER MCI",null,95,0,5163.91,5163.91,23.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - A9509"},"TUFTS","TUFTS SELECT","HCPCS","A9509","HC IODINE I-123 PER MCI",null,95,0,5163.91,5163.91,23.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9512"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9512","TC99M PERTECHNETATE",null,1,0,null,null,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9513"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN",null,320,441.49,294.27999999999997,1097.56,80,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9513"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN",null,320,1097.56,294.27999999999997,1097.56,80,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - A9513"},"TUFTS","TUFTS HMO","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN",null,320,438.05,294.27999999999997,1097.56,80,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9513"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN",null,320,329.72,294.27999999999997,1097.56,80,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9513"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN",null,320,329.72,294.27999999999997,1097.56,80,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9513"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN",null,320,329.72,294.27999999999997,1097.56,80,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9516"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9516","I123 IODIDE CAP, DX",null,192,0,516.39,516.39,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - A9516"},"TUFTS","TUFTS HMO","HCPCS","A9516","I123 IODIDE CAP, DX",null,192,0,516.39,516.39,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9516"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9516","I123 IODIDE CAP, DX",null,192,0,516.39,516.39,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9516"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9516","I123 IODIDE CAP, DX",null,192,0,516.39,516.39,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9516"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9516","I123 IODIDE CAP, DX",null,192,516.39,516.39,516.39,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9516"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9516","I123 IODIDE CAP, DX",null,192,516.39,516.39,516.39,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9516"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9516","I123 IODIDE CAP, DX",null,192,516.39,516.39,516.39,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9517"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9517","I131 IODIDE CAP, RX",null,437,0,30.1,101.94,109.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9520"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD",null,1951,0,null,null,487.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9520"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD",null,1951,0,null,null,487.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9520"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD",null,1951,0,null,null,487.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9521"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9521","TC99M EXAMETAZIME",null,360,0,4157.3,4157.3,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9537"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9537","TC99M MEBROFENIN",null,138,0,157.94999999999999,157.94999999999999,34.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9537"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9537","TC99M MEBROFENIN",null,138,157.94999999999999,157.94999999999999,157.94999999999999,34.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9538"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9538","TC99M PYROPHOSPHATE",null,111,0,114.21,114.21,27.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9538"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9538","TC99M PYROPHOSPHATE",null,111,114.21,114.21,114.21,27.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9538"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9538","TC99M PYROPHOSPHATE",null,111,114.21,114.21,114.21,27.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9539"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9539","TC99M PENTETATE",null,668,0,89.47,89.47,167,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A9539"},"TUFTS","TUFTS POS","HCPCS","A9539","TC99M PENTETATE",null,668,0,89.47,89.47,167,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9540"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9540","TC99M MAA",null,1831,85.66,85.66,85.66,457.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - A9541"},"BMC HEALTHNET","BMCHN MCO","HCPCS","A9541","TC99M SULFUR COLLOID",null,120,0,152.69,152.69,30,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9543"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9543","Y90 IBRITUMOMAB, RX",null,66322,139963.56,72400.97,217685.7,16580.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - A9543"},"BMC HEALTHNET","BMCHN MCO","HCPCS","A9543","Y90 IBRITUMOMAB, RX",null,66322,0,72400.97,217685.7,16580.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9547"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9547","IN111 OXYQUINOLINE",null,440,0,5105.7299999999996,5105.7299999999996,110,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9547"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9547","IN111 OXYQUINOLINE",null,440,5105.7299999999996,5105.7299999999996,5105.7299999999996,110,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9547"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9547","IN111 OXYQUINOLINE",null,440,5105.7299999999996,5105.7299999999996,5105.7299999999996,110,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9552"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9552","F18 FDG",null,972,0,1166.46,1166.46,243,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - A9552"},"TUFTS","TUFTS SELECT","HCPCS","A9552","F18 FDG",null,972,0,1166.46,1166.46,243,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9552"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9552","F18 FDG",null,972,1166.46,1166.46,1166.46,243,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9552"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9552","F18 FDG",null,972,1166.46,1166.46,1166.46,243,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9555"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9555","RADIOPHARMACIAL",null,1065,0,1604.08,1604.08,266.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9555"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9555","RADIOPHARMACIAL",null,1065,0,1604.08,1604.08,266.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - A9555"},"BMC HEALTHNET","BMCHN QHP","HCPCS","A9555","RADIOPHARMACIAL",null,1065,0,1604.08,1604.08,266.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9556"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9556","GA67 GALLIUM",null,20,0,311.94,311.94,5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - A9556"},"TUFTS","TUFTS SELECT","HCPCS","A9556","GA67 GALLIUM",null,20,0,311.94,311.94,5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9557"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9557","TC99M BICISATE",null,239,0,1062.44,1062.44,59.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9557"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9557","TC99M BICISATE",null,239,0,1062.44,1062.44,59.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9557"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9557","TC99M BICISATE",null,239,0,1062.44,1062.44,59.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9557"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9557","TC99M BICISATE",null,239,0,1062.44,1062.44,59.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9557"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9557","TC99M BICISATE",null,239,1062.44,1062.44,1062.44,59.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9558"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9558","HC XENON133/10MCI",null,23,0,108.88,108.88,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9558"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9558","HC XENON133/10MCI",null,23,0,108.88,108.88,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A9560"},"TUFTS","TUFTS POS","HCPCS","A9560","TC99M LABELED RBC",null,246,0,266.7,266.7,61.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9560"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9560","TC99M LABELED RBC",null,246,266.7,266.7,266.7,61.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9561"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9561","TC99M OXIDRONATE",null,127,0,125.64,125.64,31.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9562"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9562","TC99M MERTIATIDE",null,1237,0,2212.25,2212.25,309.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - A9562"},"BMC HEALTHNET","BMCHN QHP","HCPCS","A9562","TC99M MERTIATIDE",null,1237,0,2212.25,2212.25,309.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9563"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9563","P32 NA PHOSPHATE",null,0,535.17999999999995,535.17999999999995,3182.68,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9563"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9563","P32 NA PHOSPHATE",null,0,535.17999999999995,535.17999999999995,3182.68,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - A9563"},"TUFTS","TUFTS SELECT","HCPCS","A9563","P32 NA PHOSPHATE",null,0,1058.54,535.17999999999995,3182.68,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9563"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9563","P32 NA PHOSPHATE",null,0,870.53,535.17999999999995,3182.68,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9570"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC",null,6395,0,null,null,1598.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9570"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC",null,6395,0,null,null,1598.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - A9570"},"FALLON","FALLON MEDICAID","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC",null,6395,0,null,null,1598.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - A9570"},"BMC HEALTHNET","BMCHN ACO","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC",null,6395,0,null,null,1598.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A9572"},"TUFTS","TUFTS PPO","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE",null,131,0,16207.01,16207.01,32.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9575"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML",null,8,0,0.18,0.45,2,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9575"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML",null,8,0.21,0.18,0.45,2,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9575"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML",null,8,0.21,0.18,0.45,2,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9575"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML",null,8,0.21,0.18,0.45,2,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A9576"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML",null,5,1.5,1.5,3.77,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9576"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML",null,5,0,1.5,3.77,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - A9576"},"TUFTS","TUFTS HMO","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML",null,5,0,1.5,3.77,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A9576"},"TUFTS","TUFTS POS","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML",null,5,0,1.5,3.77,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9576"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML",null,5,3.76,1.5,3.77,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9576"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML",null,5,3.76,1.5,3.77,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A9576"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML",null,5,3.31,1.5,3.77,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9577"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML",null,21,5.03,1.81,5.03,5.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - A9579"},"TUFTS","TUFTS SELECT","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML",null,5,0,1.53,4.38,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A9579"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML",null,5,3.38,1.53,4.38,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9580"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE",null,158,0,null,null,39.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - A9580"},"BMC HEALTHNET","BMCHN QHP","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE",null,158,0,null,null,39.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9581"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9581","GADOXETATE DISODIUM INJ",null,99,0,14.76,37.14,24.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9581"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9581","GADOXETATE DISODIUM INJ",null,99,16.97,14.76,37.14,24.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9582"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9582","IODINE I-123 IOBENGUANE",null,10370,0,null,null,2592.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - A9582"},"BMC HEALTHNET","BMCHN MCO","HCPCS","A9582","IODINE I-123 IOBENGUANE",null,10370,0,null,null,2592.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - A9583"},"UNICARE","UNICARE","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ",null,13,19.260000000000002,19.260000000000002,21.34,3.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9583"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ",null,13,0,19.260000000000002,21.34,3.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A9584"},"TUFTS","TUFTS POS","HCPCS","A9584","IODINE I-123 IOFLUPANE",null,2729,0,3235.55,3235.55,682.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A9584"},"TUFTS","TUFTS PPO","HCPCS","A9584","IODINE I-123 IOFLUPANE",null,2729,0,3235.55,3235.55,682.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9584"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9584","IODINE I-123 IOFLUPANE",null,2729,3235.55,3235.55,3235.55,682.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - A9584"},"BMC HEALTHNET","BMCHN QHP","HCPCS","A9584","IODINE I-123 IOFLUPANE",null,2729,0,3235.55,3235.55,682.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9586"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",null,4402,3746.06,3746.06,7452.46,1100.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9587"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9587","GALLIUM GA-68",null,12985,84.97,84.97,113.78,3246.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - A9587"},"BMC HEALTHNET","BMCHN ACO","HCPCS","A9587","GALLIUM GA-68",null,12985,0,84.97,113.78,3246.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9588"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9588","FLUCICLOVINE F-18",null,15438,525.05999999999995,525.05999999999995,703.05,3859.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - A9588"},"BMC HEALTHNET","BMCHN MCO","HCPCS","A9588","FLUCICLOVINE F-18",null,15438,0,525.05999999999995,703.05,3859.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9592"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9592","HC COPPER CU 64 DOTATATE DIAG",null,5634,0,null,null,1408.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - A9592"},"BMC HEALTHNET","BMCHN MCO","HCPCS","A9592","HC COPPER CU 64 DOTATATE DIAG",null,5634,0,null,null,1408.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9606"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER",null,493,378.21,198.62,597.20000000000005,123.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1713"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1713","HC CORE 10 BONE PLUG",null,4568,0,null,null,1142,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1714"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1714","HC WATHMAN SYS ANTER CURVE",null,6114,0,null,null,1528.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C1714"},"TUFTS","TUFTS POS","HCPCS","C1714","HC WATHMAN SYS ANTER CURVE",null,6114,0,null,null,1528.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1716"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1716","BRACHYTX SOURCE, GOLD 198",null,0,200.39,168.52,506.68,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C1716"},"TUFTS","TUFTS HMO","HCPCS","C1716","BRACHYTX SOURCE, GOLD 198",null,0,202.22,168.52,506.68,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1717"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192",null,607,1411.01,469.29,1411.01,151.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C1717"},"TUFTS","TUFTS POS","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192",null,607,469.29,469.29,1411.01,151.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - C1717"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192",null,607,836.69,469.29,1411.01,151.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C1719"},"TUFTS","TUFTS HMO","HCPCS","C1719","BRACHYTX SOUR,NON-HDR IR-192",null,95,142.63,108.35,357.35,23.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C1719"},"TUFTS","TUFTS PPO","HCPCS","C1719","BRACHYTX SOUR,NON-HDR IR-192",null,95,127.14,108.35,357.35,23.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1721"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1721","HC ICD,2CH, GEN ONLY, RECALL $0",null,39674,0,null,null,9918.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1724"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1724","HC CATH, TRANS ATHEREC BURR",null,7410,0,null,null,1852.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1724"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1724","HC CATH, TRANS ATHEREC BURR",null,7410,0,null,null,1852.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C1724"},"TUFTS","TUFTS POS","HCPCS","C1724","HC CATH, TRANS ATHEREC BURR",null,7410,0,null,null,1852.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C1724"},"TUFTS","TUFTS PPO","HCPCS","C1724","HC CATH, TRANS ATHEREC BURR",null,7410,0,null,null,1852.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1725"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1725","HC SIZING AMPLATZ BALLOON",null,1693,0,null,null,423.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1725"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1725","HC SIZING AMPLATZ BALLOON",null,1693,0,null,null,423.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1726"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1726","HC CATHETER BALLN LVL 4",null,387,0,null,null,96.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C1726"},"TUFTS","TUFTS HMO","HCPCS","C1726","HC CATHETER BALLN LVL 4",null,387,0,null,null,96.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1729"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1729","HC CATH; THORA PARA",null,2283,0,null,null,570.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C1729"},"TUFTS","TUFTS PPO","HCPCS","C1729","HC CATH; THORA PARA",null,2283,0,null,null,570.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1730"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1730","HC CATH,EP;STEER,DEC(LASSO)",null,2283,0,null,null,570.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1732"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1732","HC CATH,EP DECA NAV",null,7766,0,null,null,1941.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1732"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1732","HC CATH,EP DECA NAV",null,7766,0,null,null,1941.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1732"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1732","HC CATH,EP DECA NAV",null,7766,0,null,null,1941.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1732"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1732","HC CATH,EP DECA NAV",null,7766,0,null,null,1941.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C1732"},"TUFTS","TUFTS SELECT","HCPCS","C1732","HC CATH,EP DECA NAV",null,7766,0,null,null,1941.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1733"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1733","CATH CRYABL  ARCTIC FRN",null,10475,0,null,null,2618.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1750"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1750","HC CATH 2 LUMEN QUINTON",null,1693,0,null,null,423.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C1750"},"TUFTS","TUFTS POS","HCPCS","C1750","HC CATH 2 LUMEN QUINTON",null,1693,0,null,null,423.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C1753"},"TUFTS","TUFTS HMO","HCPCS","C1753","HC BIOPSY FORC LVL D",null,3947,0,null,null,986.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1756"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1756","HC PACING WIRE",null,1438,0,null,null,359.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C1756"},"TUFTS","TUFTS POS","HCPCS","C1756","HC PACING WIRE",null,1438,0,null,null,359.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1757"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1757","HC CATH,THROMB/EMB,LVL 2",null,15822,0,null,null,3955.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1760"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1760","HC CENTRAL LINE KIT",null,1799,0,null,null,449.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1762"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1762","HC NERVE - CONNEVTIVE TISSUE, HUMAN",null,12010,0,null,null,3002.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C1762"},"TUFTS","TUFTS POS","HCPCS","C1762","HC NERVE - CONNEVTIVE TISSUE, HUMAN",null,12010,0,null,null,3002.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1763"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1763","HC SM6X16-STEM HEM",null,2242,0,null,null,560.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C1764"},"TUFTS","TUFTS POS","HCPCS","C1764","HC RECORDER;IMPLANTABLE LOOP",null,8983,0,null,null,2245.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1765"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1765","ADHESION BARRIER",null,569,0,null,null,142.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C1768"},"TUFTS","TUFTS HMO","HCPCS","C1768","HC TAVR HEART VALVE KIT",null,76125,0,null,null,19031.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C1768"},"TUFTS","TUFTS POS","HCPCS","C1768","HC TAVR HEART VALVE KIT",null,76125,0,null,null,19031.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1769"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1769","GUIDE WIRE",null,4759,0,null,null,1189.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C1769"},"TUFTS","TUFTS HMO","HCPCS","C1769","GUIDE WIRE",null,4759,0,null,null,1189.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1770"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1770","IMAGING COIL, MR, INSERTABLE",null,3667,0,null,null,916.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1773"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1773","HC GUIDEWIRE LVL E",null,2163,0,null,null,540.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1773"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1773","HC GUIDEWIRE LVL E",null,2163,0,null,null,540.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C1773"},"TUFTS","TUFTS PPO","HCPCS","C1773","HC GUIDEWIRE LVL E",null,2163,0,null,null,540.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C1776"},"TUFTS","TUFTS PPO","HCPCS","C1776","HC HEMI-TIB PLATEAU W MENISC",null,21721,0,null,null,5430.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1777"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1777","HC LEAD,ICD,1COIL",null,13038,0,null,null,3259.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1777"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1777","HC LEAD,ICD,1COIL",null,13038,0,null,null,3259.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1777"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1777","HC LEAD,ICD,1COIL",null,13038,0,null,null,3259.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1784"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1784","HC DES PERIPHERAL STENT",null,2734,0,null,null,683.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1784"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1784","HC DES PERIPHERAL STENT",null,2734,0,null,null,683.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C1784"},"TUFTS","TUFTS POS","HCPCS","C1784","HC DES PERIPHERAL STENT",null,2734,0,null,null,683.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1785"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1785","HC PACER;2CH, RECALL $0",null,12546,0,null,null,3136.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1788"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1788","HC PORTACATH ANY",null,540,0,null,null,135,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C1817"},"TUFTS","TUFTS HMO","HCPCS","C1817","HC OCCKYDER;ASD/PFO",null,9668,0,null,null,2417,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C1817"},"TUFTS","TUFTS PPO","HCPCS","C1817","HC OCCKYDER;ASD/PFO",null,9668,0,null,null,2417,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1821"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1821","HC INTERSPINOUS IMPLANT",null,9770,0,null,null,2442.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C1821"},"TUFTS","TUFTS POS","HCPCS","C1821","HC INTERSPINOUS IMPLANT",null,9770,0,null,null,2442.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1874"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1874","STENT WALLFLEX SYSTEM",null,8879,0,null,null,2219.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C1874"},"TUFTS","TUFTS POS","HCPCS","C1874","STENT WALLFLEX SYSTEM",null,8879,0,null,null,2219.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1876"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1876","STENT BILIARY",null,11691,0,null,null,2922.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1880"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1880","IVC FILTERS",null,7726,0,null,null,1931.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C1880"},"TUFTS","TUFTS HMO","HCPCS","C1880","IVC FILTERS",null,7726,0,null,null,1931.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C1880"},"TUFTS","TUFTS PPO","HCPCS","C1880","IVC FILTERS",null,7726,0,null,null,1931.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1882"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1882","HC ICD,BI-VENT, GEN ONLY, RECALL $0",null,53226,0,null,null,13306.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C1883"},"TUFTS","TUFTS HMO","HCPCS","C1883","HC ADAPTOR;BI-VENT PACER",null,1257,0,null,null,314.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1884"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1884","EMBOLIZATION PROTECT SYST",null,31469,0,null,null,7867.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1887"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1887","HC CATH,EP;R-F,30D THERM RMT",null,3731,0,null,null,932.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1887"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1887","HC CATH,EP;R-F,30D THERM RMT",null,3731,0,null,null,932.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1893"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1893","HC DILATOR SHEATH/VISISHEATH",null,406,0,null,null,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1893"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1893","HC DILATOR SHEATH/VISISHEATH",null,406,0,null,null,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1894"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1894","HC INTRO/SHEATH NON-CARD LV2",null,252,0,null,null,63,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1895"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1895","HC ICD LEAD,2COIL",null,13382,0,null,null,3345.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C1898"},"TUFTS","TUFTS SELECT","HCPCS","C1898","HC KIT,PACER;BI-VENT(#6216/8",null,1575,0,null,null,393.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C1900"},"TUFTS","TUFTS POS","HCPCS","C1900","HC INJ;OCTAFLUORO MICRO/1ML",null,8293,0,null,null,2073.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C1900"},"TUFTS","TUFTS PPO","HCPCS","C1900","HC INJ;OCTAFLUORO MICRO/1ML",null,8293,0,null,null,2073.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C2616"},"TUFTS","TUFTS HMO","HCPCS","C2616","HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE",null,60393,30614.639999999999,25512.2,76706.740000000005,15098.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - C2616"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","C2616","HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE",null,60393,47839.61,25512.2,76706.740000000005,15098.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C2617"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C2617","STENT ZIMMON BILIARY",null,638,0,null,null,159.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C2617"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C2617","STENT ZIMMON BILIARY",null,638,0,null,null,159.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C2617"},"TUFTS","TUFTS POS","HCPCS","C2617","STENT ZIMMON BILIARY",null,638,0,null,null,159.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C2617"},"TUFTS","TUFTS SELECT","HCPCS","C2617","STENT ZIMMON BILIARY",null,638,0,null,null,159.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C2623"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C2623","CATH TRANSLUMIN DRUG-COAT",null,2837,0,null,null,709.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C2623"},"TUFTS","TUFTS POS","HCPCS","C2623","CATH TRANSLUMIN DRUG-COAT",null,2837,0,null,null,709.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C2625"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C2625","STENT BILIARY COTTON",null,246,0,null,null,61.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C2625"},"TUFTS","TUFTS SELECT","HCPCS","C2625","STENT BILIARY COTTON",null,246,0,null,null,61.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C2628"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C2628","HC KIT CATH BRIDGE PRE",null,2308,0,null,null,577,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C2628"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C2628","HC KIT CATH BRIDGE PRE",null,2308,0,null,null,577,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C2630"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C2630","HC CATH;EP CRYOABLATION, 8 MM",null,4966,0,null,null,1241.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C2635"},"TUFTS","TUFTS PPO","HCPCS","C2635","BRACHYTX, NON-STR, HA, P-103",null,0,86.29,78.03,242.54,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - C2635"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","C2635","BRACHYTX, NON-STR, HA, P-103",null,0,78.03,78.03,242.54,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C2639"},"TUFTS","TUFTS POS","HCPCS","C2639","BRACHYTX, NON-STRANDED,I-125",null,47,52.85,52.85,100.75,11.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C2639"},"TUFTS","TUFTS SELECT","HCPCS","C2639","BRACHYTX, NON-STRANDED,I-125",null,47,52.85,52.85,100.75,11.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C5275"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C5275","HC LOW COST SKIN SUBSTITUTE",null,743,1042.56,684.11,2032.26,185.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C8908"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C8908","HC MRI W/O FOL W/CONT, BREAST,",null,579,4299.8,664.1,4299.8,144.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C8908"},"TUFTS","TUFTS POS","HCPCS","C8908","HC MRI W/O FOL W/CONT, BREAST,",null,579,1430.06,664.1,4299.8,144.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C8937"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C8937","CAD BREAST MRI",null,331,0,null,null,82.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C8937"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C8937","CAD BREAST MRI",null,331,0,null,null,82.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C9358"},"TUFTS","TUFTS HMO","HCPCS","C9358","SURGIMEND, FETAL",null,8526,0,24.42,24.42,2131.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C9358"},"TUFTS","TUFTS POS","HCPCS","C9358","SURGIMEND, FETAL",null,8526,0,24.42,24.42,2131.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - C9358"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","C9358","SURGIMEND, FETAL",null,8526,24.42,24.42,24.42,2131.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C9728"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C9728","PLACE DEVICE/MARKER, NON PRO",null,1957,2510.1799999999998,2227.36,7098.97,489.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C9728"},"TUFTS","TUFTS PPO","HCPCS","C9728","PLACE DEVICE/MARKER, NON PRO",null,1957,4475.4399999999996,2227.36,7098.97,489.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - C9728"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","C9728","PLACE DEVICE/MARKER, NON PRO",null,1957,3429.66,2227.36,7098.97,489.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA - HCPCS - C9739"},"AETNA","AETNA","HCPCS","C9739","HC CYSTOSCOPY PROSTATIC IMP 1-3",null,6035,2166.09,2166.09,15242.01,1508.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - C9739"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","C9739","HC CYSTOSCOPY PROSTATIC IMP 1-3",null,6035,6751.98,2166.09,15242.01,1508.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D0150"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D0150","COMPREHENSIVE ORAL EXAM 60MIN",null,265,4066.77,1275.99,4066.77,66.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - D0150"},"TUFTS","TUFTS HMO","HCPCS","D0150","COMPREHENSIVE ORAL EXAM 60MIN",null,265,2396.69,1275.99,4066.77,66.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D0210"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D0210","INTRAORAL - COMPLETE SERIES OF RADIOGRAPHIC IMAGES",null,165,120.47,120.47,120.47,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D0220"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D0220","INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE",null,165,23.78,23.78,23.78,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D0230"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D0230","INTRAORAL - PERIAPICAL EACH ADDITIONAL RADIOGRAPHIC IMAGE",null,110,21.35,21.35,21.35,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - D0230"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","D0230","INTRAORAL - PERIAPICAL EACH ADDITIONAL RADIOGRAPHIC IMAGE",null,110,21.35,21.35,21.35,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D0230"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D0230","INTRAORAL - PERIAPICAL EACH ADDITIONAL RADIOGRAPHIC IMAGE",null,110,21.35,21.35,21.35,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D0230"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D0230","INTRAORAL - PERIAPICAL EACH ADDITIONAL RADIOGRAPHIC IMAGE",null,110,21.35,21.35,21.35,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - D0240"},"TUFTS","TUFTS PPO","HCPCS","D0240","INTRAORAL - OCCLUSAL RADIOGRAPHIC IMAGE",null,836,2563.83,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - D0270"},"TUFTS","TUFTS HMO","HCPCS","D0270","BITEWING - SINGLE RADIOGRAPHIC IMAGE",null,836,2396.69,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D0274"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D0274","BITEWINGS - FOUR RADIOGRAPHIC IMAGES",null,836,4066.77,1182.5,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - D0274"},"TUFTS","TUFTS PPO","HCPCS","D0274","BITEWINGS - FOUR RADIOGRAPHIC IMAGES",null,836,2563.83,1182.5,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D0274"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D0274","BITEWINGS - FOUR RADIOGRAPHIC IMAGES",null,836,1182.5,1182.5,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - D0472"},"TUFTS","TUFTS PPO","HCPCS","D0472","HC ACCESSION OF TISSUE, GROSS EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN REPORT",null,110,3900.57,1941.26,6187.11,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - D0473"},"TUFTS","TUFTS HMO","HCPCS","D0473","HC ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAM, PREP AND TRANS OF RPT.",null,110,3646.27,1941.26,6187.11,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - D0474"},"TUFTS","TUFTS HMO","HCPCS","D0474","HC ACCESSION OF TISSUE, GROSS AND MICRO EXAM, INCL. ASSESS. OF MARGINS FOR DISEASE, PREP., TX OF RPT",null,110,3646.27,1941.26,6187.11,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D1120"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D1120","PROPHYLAXIS - CHILD",null,110,57.92,57.92,57.92,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D1351"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D1351","SEALANT - PER TOOTH",null,110,45.91,45.91,45.91,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D1351"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D1351","SEALANT - PER TOOTH",null,110,45.91,45.91,45.91,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D1510"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D1510","SPACE MAINTAINER - FIXED - UNILATERAL",null,836,4066.77,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D1517"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D1517","SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MANDIBULAR",null,1451,0,null,null,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2140"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D2140","AMALGAM - ONE SURFACE, PRIMARY OR PERMANENT",null,110,98.66,98.66,98.66,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2140"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D2140","AMALGAM - ONE SURFACE, PRIMARY OR PERMANENT",null,110,98.66,98.66,98.66,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2150"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","D2150","AMALGAM - TWO SURFACES, PRIMARY OR PERMANENT",null,110,126.81,126.81,126.81,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2161"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","D2161","AMALGAM - FOUR OR MORE SURFACES, PRIMARY OR PERMANENT",null,110,187.9,187.9,187.9,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2330"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D2330","RESIN-BASED COMPOSITE - ONE SURFACE, ANTERIOR",null,110,121.33,121.33,121.33,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2335"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D2335","RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR)",null,110,223.88,223.88,223.88,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2390"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D2390","RESIN-BASED COMPOSITE CROWN, ANTERIOR",null,110,248.14,248.14,248.14,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2391"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","D2391","RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR",null,110,141.69,141.69,141.69,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2391"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D2391","RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR",null,110,141.69,141.69,141.69,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2393"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D2393","RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR",null,110,230.94,230.94,230.94,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2393"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D2393","RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR",null,110,230.94,230.94,230.94,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2393"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D2393","RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR",null,110,230.94,230.94,230.94,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2740"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D2740","CROWN - PORCELAIN/CERAMIC SUBSTRATE",null,110,1036.53,1036.53,1036.53,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2930"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D2930","PREFABRICATED STAINLESS STEEL CROWN - PRIMARY TOOTH",null,110,228.61,228.61,228.61,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - D2999"},"TUFTS","TUFTS HMO","HCPCS","D2999","HC UNSPECIFIED RESTORATIVE PROCEDURE, BY REPORT",null,1451,2396.69,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D3220"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D3220","THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) - REMOVAL OF PULP CORONAL TO THE DENTINOCEMENTAL JUNCTION AND APPLICATION OF MEDICAMENT",null,110,141.69,141.69,141.69,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D3310"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D3310","ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION)",null,110,587.95000000000005,587.95000000000005,587.95000000000005,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D3330"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D3330","ENDODONTIC THERAPY, MOLAR (EXCLUDING FINAL RESTORATION)",null,110,894.85,894.85,894.85,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - D3999"},"TUFTS","TUFTS SELECT","HCPCS","D3999","HC UNSPECIFIED ENDODONTIC PROCEDURE, BY REPORT",null,1451,1275.99,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - D4264"},"TUFTS","TUFTS POS","HCPCS","D4264","HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ EACH ADDITIONAL SITE IN QUADRANT",null,1451,2396.69,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - D4270"},"TUFTS","TUFTS PPO","HCPCS","D4270","HC PEDICLE SOFT TISSUE GRAFT PROCEDURE",null,1451,2563.83,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - D4355"},"TUFTS","TUFTS SELECT","HCPCS","D4355","FULL MOUTH DEBRIDEMENT TO ENABLE COMPREHENSIVE EVALUATION AND DIAGNOSIS",null,836,1275.99,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - D5984"},"TUFTS","TUFTS PPO","HCPCS","D5984","HC RADIATION SHIELD",null,1451,2563.83,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - D5985"},"TUFTS","TUFTS HMO","HCPCS","D5985","HC RADIATION CONE LOCATOR",null,1451,2396.69,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D7140"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D7140","EXTRACTION ERUPTED TOOTH/EXR",null,836,1510.05,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - D7210"},"TUFTS","TUFTS PPO","HCPCS","D7210","EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED",null,836,2563.83,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D7210"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D7210","EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED",null,836,1510.05,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D7220"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D7220","REMOVAL OF IMPACTED TOOTH - SOFT TISSUE",null,836,1510.05,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D7220"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D7220","REMOVAL OF IMPACTED TOOTH - SOFT TISSUE",null,836,1510.05,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D7230"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D7230","REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY",null,836,1510.05,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D7240"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D7240","REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY",null,836,1510.05,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D7240"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D7240","REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY",null,836,1510.05,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - D7250"},"TUFTS","TUFTS POS","HCPCS","D7250","REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)",null,836,2396.69,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D7250"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D7250","REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)",null,836,1510.05,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - D7260"},"TUFTS","TUFTS PPO","HCPCS","D7260","HC OROANTRAL FISTULA CLOSURE",null,1081,2563.83,1275.99,4066.77,270.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D7410"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D7410","EXCISION OF BENIGN LESION UP TO 1.25 CM",null,110,692.83,692.83,692.83,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - D7410"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","D7410","EXCISION OF BENIGN LESION UP TO 1.25 CM",null,110,692.83,692.83,692.83,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - D7940"},"TUFTS","TUFTS SELECT","HCPCS","D7940","HC OSTEOPLASTY - FOR ORTHOGNATHIC DEFORMITIES",null,1451,1275.99,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D9230"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D9230","INHALATION OF NITROUS OXIDE/ANALGESIA, ANXIOLYSIS",null,110,0,null,null,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - D9951"},"TUFTS","TUFTS HMO","HCPCS","D9951","OCCLUSAL ADJUSTMENT - LIMITED",null,1350,2396.69,1275.99,4066.77,337.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - D9951"},"TUFTS","TUFTS SELECT","HCPCS","D9951","OCCLUSAL ADJUSTMENT - LIMITED",null,1350,1275.99,1275.99,4066.77,337.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - E0191"},"FALLON","FALLON SENIOR PLAN","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","NU",321,11.61,11.61,52.13,80.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - E0191"},"FALLON","FALLON SENIOR PLAN","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","RR",321,1.2,11.61,52.13,80.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - E0191"},"TUFTS","TUFTS PPO","HCPCS","E0191","PROTECTOR HEEL OR ELBOW",null,321,18.55,11.61,52.13,80.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - E0191"},"TUFTS","TUFTS SPIRIT","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","UE",321,9.5299999999999994,11.61,52.13,80.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - E0191"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","RR",321,1.44,11.61,52.13,80.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - E0191"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","UE",321,21.79,11.61,52.13,80.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0101"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0101","CA SCREEN;PELVIC/BREAST EXAM",null,148,128.29,18.010000000000002,128.29,37,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0103"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0103","PSA, TOTAL SCREENING",null,93,44.13,16.78,181.16,23.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0103"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0103","PSA, TOTAL SCREENING",null,93,0,16.78,181.16,23.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0103"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0103","PSA, TOTAL SCREENING",null,93,41.5,16.78,181.16,23.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0103"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0103","PSA, TOTAL SCREENING",null,93,16.78,16.78,181.16,23.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - G0103"},"BMC HEALTHNET","BMCHN QHP","HCPCS","G0103","PSA, TOTAL SCREENING",null,93,20.14,16.78,181.16,23.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - G0105"},"UNICARE","UNICARE","HCPCS","G0105","HC COLORECTAL SCRN; HI RISK IND",null,1152,1020.59,1020.59,3264.67,288,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - G0105"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","G0105","HC COLORECTAL SCRN; HI RISK IND",null,1152,1020.59,1020.59,3264.67,288,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0105"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0105","HC COLORECTAL SCRN; HI RISK IND",null,1152,1250.94,1020.59,3264.67,288,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0105"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0105","HC COLORECTAL SCRN; HI RISK IND",null,1152,1250.94,1020.59,3264.67,288,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0105"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0105","HC COLORECTAL SCRN; HI RISK IND",null,1152,1250.94,1020.59,3264.67,288,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - G0108"},"TUFTS","TUFTS SELECT","HCPCS","G0108","DIAB MANAGE TRN  PER INDIV",null,425,72.41,72.41,230.78,106.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0108"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0108","DIAB MANAGE TRN  PER INDIV",null,425,136.19,72.41,230.78,106.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0108"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0108","DIAB MANAGE TRN  PER INDIV",null,425,136.19,72.41,230.78,106.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0108"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0108","DIAB MANAGE TRN  PER INDIV",null,425,136.19,72.41,230.78,106.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0109"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0109","DIAB MANAGE TRN IND/GROUP",null,267,37.520000000000003,32.64,134.25,66.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0127"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0127","TRIM NAIL(S)",null,189,117.73,93.87,317.35000000000002,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0127"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0127","TRIM NAIL(S)",null,189,317.35000000000002,93.87,317.35000000000002,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0127"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0127","TRIM NAIL(S)",null,189,0,93.87,317.35000000000002,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0127"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0127","TRIM NAIL(S)",null,189,93.87,93.87,317.35000000000002,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0175"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0175","OPPS SERVICE,SCHED TEAM CONF",null,565,2035.73,638.73,2035.73,141.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - G0175"},"TUFTS","TUFTS SELECT","HCPCS","G0175","OPPS SERVICE,SCHED TEAM CONF",null,565,638.73,638.73,2035.73,141.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - G0239"},"TUFTS","TUFTS POS","HCPCS","G0239","OTH RESP PROC, GROUP",null,99,124.19,53.94,373.41,24.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0257"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP",null,911,1027.32,1027.32,3651.55,227.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0257"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP",null,911,1027.32,1027.32,3651.55,227.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - G0257"},"BMC HEALTHNET","BMCHN MCO","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP",null,911,0,1027.32,3651.55,227.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - G0259"},"TUFTS","TUFTS POS","HCPCS","G0259","HC INJECT FOR SACROILIAC JOINT",null,1513,0,1198.25,1198.25,378.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA - HCPCS - G0259"},"AETNA","AETNA","HCPCS","G0259","HC INJECT FOR SACROILIAC JOINT",null,1513,1198.25,1198.25,1198.25,378.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0260"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH",null,817,1292.83,1005.62,3474.13,204.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - G0260"},"TUFTS","TUFTS PPO","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH",null,817,2190.21,1005.62,3474.13,204.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - G0260"},"BMC HEALTHNET","BMCHN ACO","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH",null,817,0,1005.62,3474.13,204.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0269"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0269","HC CLOSURE DEVICE PLACEMENT",null,200,0,null,null,50,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0278"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH",null,3138,0,34.229999999999997,34.229999999999997,784.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - G0278"},"TUFTS","TUFTS POS","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH",null,3138,0,34.229999999999997,34.229999999999997,784.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0278"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH",null,3138,34.229999999999997,34.229999999999997,34.229999999999997,784.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - G0278"},"BMC HEALTHNET","BMCHN MCO","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH",null,3138,0,34.229999999999997,34.229999999999997,784.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - G0278"},"BMC HEALTHNET","BMCHN QHP","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH",null,3138,0,34.229999999999997,34.229999999999997,784.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - G0279"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","G0279","TOMOSYNTHESIS, MAMMO",null,55,30.09,30.09,295.68,13.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0279"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0279","TOMOSYNTHESIS, MAMMO",null,55,51.68,30.09,295.68,13.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0279"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0279","TOMOSYNTHESIS, MAMMO",null,55,51.68,30.09,295.68,13.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - G0296"},"FALLON","FALLON MEDICAID","HCPCS","G0296","HC VISIT TO DETERM LDCT ELIG",null,118,0,102.62,660.74,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - G0296"},"TUFTS","TUFTS HMO","HCPCS","G0296","HC VISIT TO DETERM LDCT ELIG",null,118,263.7,102.62,660.74,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - G0296"},"TUFTS","TUFTS POS","HCPCS","G0296","HC VISIT TO DETERM LDCT ELIG",null,118,219.75,102.62,660.74,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0296"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0296","HC VISIT TO DETERM LDCT ELIG",null,118,0,102.62,660.74,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0296"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0296","HC VISIT TO DETERM LDCT ELIG",null,118,128.29,102.62,660.74,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0297"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN",null,1437,801.26,107.22,801.26,359.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - G0365"},"TUFTS","TUFTS HMO","HCPCS","G0365","HC VESSEL MAPPING HEMO ACCESS",null,498,510.97,272.02999999999997,867.01,124.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - G0365"},"BMC HEALTHNET","BMCHN MCO","HCPCS","G0365","HC VESSEL MAPPING HEMO ACCESS",null,498,0,272.02999999999997,867.01,124.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0365"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0365","HC VESSEL MAPPING HEMO ACCESS",null,498,0,272.02999999999997,867.01,124.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - G0365"},"BMC HEALTHNET","BMCHN QHP","HCPCS","G0365","HC VESSEL MAPPING HEMO ACCESS",null,498,0,272.02999999999997,867.01,124.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - G0379"},"TUFTS","TUFTS SELECT","HCPCS","G0379","DIRECT REFER HOSPITAL OBSERV",null,752,874.54,874.54,2787.3,188,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0390"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI",null,3274,1587.59,1579.83,5035.18,818.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - 90471"},"TUFTS","TUFTS PPO","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE",null,64,217.91,76.22,345.64,16,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - 90471"},"TUFTS","TUFTS SELECT","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE",null,64,108.45,76.22,345.64,16,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - 90471"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE",null,64,76.22,76.22,345.64,16,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - 90471"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE",null,64,76.22,76.22,345.64,16,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - 90471"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE",null,64,76.22,76.22,345.64,16,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - G0390"},"BMC HEALTHNET","BMCHN ACO","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI",null,3274,0,1579.83,5035.18,818.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0396"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN",null,42,336.32,56.05,336.32,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0396"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN",null,42,0,56.05,336.32,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0396"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN",null,42,56.05,56.05,336.32,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - G0396"},"BMC HEALTHNET","BMCHN ACO","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN",null,42,0,56.05,336.32,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - G0396"},"BMC HEALTHNET","BMCHN MCO","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN",null,42,0,56.05,336.32,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - G0397"},"FALLON","FALLON MEDICAID","HCPCS","G0397","ALCOHOL/SUBS INTERV >30 MIN",null,118,0,128.29,815.89,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - G0397"},"TUFTS","TUFTS SELECT","HCPCS","G0397","ALCOHOL/SUBS INTERV >30 MIN",null,118,144.46,128.29,815.89,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0397"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0397","ALCOHOL/SUBS INTERV >30 MIN",null,118,128.29,128.29,815.89,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - G0397"},"BMC HEALTHNET","BMCHN MCO","HCPCS","G0397","ALCOHOL/SUBS INTERV >30 MIN",null,118,0,128.29,815.89,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - G0397"},"BMC HEALTHNET","BMCHN QHP","HCPCS","G0397","ALCOHOL/SUBS INTERV >30 MIN",null,118,0,128.29,815.89,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - G0402"},"TUFTS","TUFTS HMO","HCPCS","G0402","INITIAL PREVENTIVE EXAM",null,168,0,208.89,1179.72,42,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - G0402"},"TUFTS","TUFTS POS","HCPCS","G0402","INITIAL PREVENTIVE EXAM",null,168,392.36,208.89,1179.72,42,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0402"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0402","INITIAL PREVENTIVE EXAM",null,168,0,208.89,1179.72,42,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0410"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0410","HC GRP PSYCH PARTIAL HOSP 45-50",null,220,0,null,null,55,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0416"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD",null,425,592.04,360.63,2456.98,106.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - G0416"},"TUFTS","TUFTS POS","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD",null,425,817.15,360.63,2456.98,106.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0416"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD",null,425,360.63,360.63,2456.98,106.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - G0416"},"BMC HEALTHNET","BMCHN ACO","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD",null,425,0,360.63,2456.98,106.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - G0416"},"BMC HEALTHNET","BMCHN MCO","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD",null,425,0,360.63,2456.98,106.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - G0420"},"TUFTS","TUFTS POS","HCPCS","G0420","HC ED SVC CKD IND PER SESSION",null,156,347.3,184.9,589.33000000000004,39,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0420"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0420","HC ED SVC CKD IND PER SESSION",null,156,0,184.9,589.33000000000004,39,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0421"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0421","HC ED SVC CKD GRP PER SESSION",null,37,0,42.72,136.13999999999999,9.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0422"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC",null,169,0,198.42,637.79,42.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0422"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC",null,169,198.42,198.42,637.79,42.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0422"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC",null,169,198.42,198.42,637.79,42.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0423"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER",null,169,255.09,198.42,637.79,42.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0423"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER",null,169,0,198.42,637.79,42.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0423"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER",null,169,198.42,198.42,637.79,42.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0424"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G0424","PULMONARY REHAB W EXER",null,284,120.69,93.87,343.09,71,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - G0424"},"TUFTS","TUFTS POS","HCPCS","G0424","PULMONARY REHAB W EXER",null,284,202.19,93.87,343.09,71,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - G0438"},"TUFTS","TUFTS HMO","HCPCS","G0438","PPPS, INITIAL VISIT",null,547,38.93,34.03,61.76,136.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0438"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0438","PPPS, INITIAL VISIT",null,547,0,34.03,61.76,136.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - G0439"},"FALLON","FALLON MEDICAID","HCPCS","G0439","PPPS, SUBSEQ VISIT",null,327,0,34.03,61.76,81.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0442"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0442","ANNUAL ALCOHOL SCREEN 15 MIN",null,42,0,13.34,33.6,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0443"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0443","BRIEF ALCOHOL MISUSE COUNSEL",null,118,33.04,18.52,33.6,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0444"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0444","DEPRESSION SCREEN ANNUAL",null,42,0,8.9,16.149999999999999,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - G0444"},"BMC HEALTHNET","BMCHN QHP","HCPCS","G0444","DEPRESSION SCREEN ANNUAL",null,42,0,8.9,16.149999999999999,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - G0445"},"TUFTS","TUFTS PPO","HCPCS","G0445","HIGH INTEN BEH COUNS STD 30M",null,118,10.18,8.9,16.149999999999999,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0445"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0445","HIGH INTEN BEH COUNS STD 30M",null,118,0,8.9,16.149999999999999,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0445"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0445","HIGH INTEN BEH COUNS STD 30M",null,118,0,8.9,16.149999999999999,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0447"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0447","HC BEHAVIOR COUNSEL OBESITY 15M",null,118,0,18.52,33.6,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - G0480"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES",null,254,173.18,59.69,973.54,63.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - G0480"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES",null,254,114.43,59.69,973.54,63.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - G0480"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES",null,254,199.11,59.69,973.54,63.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - G0480"},"TUFTS","TUFTS PPO","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES",null,254,346.36,59.69,973.54,63.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - G0480"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES",null,254,287.93,59.69,973.54,63.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - G0481"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES",null,192,156.59,91.84,1332.11,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - G0481"},"FALLON","FALLON MEDICAID","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES",null,192,91.84,91.84,1332.11,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0481"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES",null,192,286.56,91.84,1332.11,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - G0481"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES",null,192,394.01,91.84,1332.11,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0506"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC",null,62,0,110.9,110.9,15.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - G0506"},"TUFTS","TUFTS HMO","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC",null,62,0,110.9,110.9,15.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0506"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC",null,62,0,110.9,110.9,15.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0506"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC",null,62,0,110.9,110.9,15.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0506"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC",null,62,0,110.9,110.9,15.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - G0506"},"BMC HEALTHNET","BMCHN MCO","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC",null,62,0,110.9,110.9,15.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0513"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M",null,84,148.6,148.6,148.6,21,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0514"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M",null,84,0,148.6,148.6,21,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - G2011"},"FALLON","FALLON MEDICAID","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS",null,35,0,28.83,133.88,8.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G2011"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS",null,35,28.83,28.83,133.88,8.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - G2012"},"FALLON","FALLON MEDICAID","HCPCS","G2012","HC BRIEF CHECK IN BY MD/QHP",null,42,0,31.78,31.78,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - G2012"},"TUFTS","TUFTS PPO","HCPCS","G2012","HC BRIEF CHECK IN BY MD/QHP",null,42,0,31.78,31.78,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - G2012"},"TUFTS","TUFTS SELECT","HCPCS","G2012","HC BRIEF CHECK IN BY MD/QHP",null,42,0,31.78,31.78,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - G2023"},"UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS",null,31,49.41,23.46,212.71,7.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - G2023"},"FALLON","FALLON MEDICAID","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","CG",31,44.27,23.46,212.71,7.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - G2023"},"TUFTS","TUFTS SPIRIT","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS",null,31,25.81,23.46,212.71,7.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - G2023"},"BMC HEALTHNET","BMCHN MCO","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","CG",31,44.27,23.46,212.71,7.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - G2023"},"BMC HEALTHNET","BMCHN QHP","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","CG",31,53.12,23.46,212.71,7.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - G2024"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",null,33,25.46,25.46,230.84,8.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - G2024"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",null,33,36.92,25.46,230.84,8.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - G2024"},"TUFTS","TUFTS SPIRIT","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",null,33,28.01,25.46,230.84,8.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - HCPCS - G2024"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",null,33,38.5,25.46,230.84,8.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G2024"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",null,33,34.549999999999997,25.46,230.84,8.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G2066"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH",null,165,78.260000000000005,58.35,370.47,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - G2066"},"TUFTS","TUFTS PPO","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH",null,165,131.81,58.35,370.47,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - G2086"},"TUFTS","TUFTS POS","HCPCS","G2086","HC OFF BASE OPIOID TX 70MIN",null,194,46.18,46.18,211.43,48.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G2086"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G2086","HC OFF BASE OPIOID TX 70MIN",null,194,211.43,46.18,211.43,48.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - G2086"},"BMC HEALTHNET","BMCHN QHP","HCPCS","G2086","HC OFF BASE OPIOID TX 70MIN",null,194,0,46.18,211.43,48.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G2087"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G2087","HC OFF BASE OPIOID TX, 60 M",null,194,0,46.18,211.43,48.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G2088"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G2088","HC OFF BASE OPIOID TX, ADD30",null,45,82.11,82.11,82.11,11.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G2088"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G2088","HC OFF BASE OPIOID TX, ADD30",null,45,82.11,82.11,82.11,11.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - G2088"},"BMC HEALTHNET","BMCHN QHP","HCPCS","G2088","HC OFF BASE OPIOID TX, ADD30",null,45,0,82.11,82.11,11.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G2212"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G2212","HC PROLONG OUTPT/OFFICE VIS",null,188,0,null,null,47,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L0120"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE",null,25,53.67,24.86,111.59,6.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - L0120"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE",null,25,36.049999999999997,24.86,111.59,6.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L0120"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE",null,25,36.19,24.86,111.59,6.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - L0120"},"BMC HEALTHNET","BMCHN MCO","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE",null,25,0,24.86,111.59,6.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L0140"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB",null,189,93.02,77.52,347.97,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L0140"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB",null,189,104.51,77.52,347.97,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L0140"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB",null,189,0,77.52,347.97,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L1820"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO",null,159,171.11,142.59,640.03,39.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L1820"},"UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO",null,159,297.62,142.59,640.03,39.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - L1820"},"TUFTS","TUFTS SELECT","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO",null,159,212.87,142.59,640.03,39.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - L1820"},"BMC HEALTHNET","BMCHN MCO","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO",null,159,0,142.59,640.03,39.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - L1820"},"BMC HEALTHNET","BMCHN QHP","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO",null,159,0,142.59,640.03,39.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - L1830"},"FALLON","FALLON SENIOR PLAN","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT",null,78,81.95,81.95,367.86,19.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L1832"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT",null,1523,877.44,743.59,3337.75,380.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L1832"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT",null,1523,0,743.59,3337.75,380.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - L1832"},"BMC HEALTHNET","BMCHN QHP","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT",null,1523,0,743.59,3337.75,380.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - L1836"},"FALLON","FALLON MEDICAID","HCPCS","L1836","HC RIGID KO WO JOINTS",null,209,0,130.47999999999999,585.70000000000005,52.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L1836"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L1836","HC RIGID KO WO JOINTS",null,209,288.35000000000002,130.47999999999999,585.70000000000005,52.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L1902"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L1902","AFO ANKLE GAUNTLET",null,219,185.98,86.14,386.65,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L1902"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L1902","AFO ANKLE GAUNTLET",null,219,149.88,86.14,386.65,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L1902"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","L1902","AFO ANKLE GAUNTLET",null,219,125.37,86.14,386.65,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L1902"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L1902","AFO ANKLE GAUNTLET",null,219,125.37,86.14,386.65,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - L1902"},"BMC HEALTHNET","BMCHN QHP","HCPCS","L1902","AFO ANKLE GAUNTLET",null,219,0,86.14,386.65,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - L3260"},"TUFTS","TUFTS HMO","HCPCS","L3260","AMBULATORY SURGICAL BOOT EAC",null,279,142.85,31.12,357.96,69.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - L3260"},"TUFTS","TUFTS POS","HCPCS","L3260","AMBULATORY SURGICAL BOOT EAC",null,279,119.04,31.12,357.96,69.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - L3260"},"TUFTS","TUFTS SELECT","HCPCS","L3260","AMBULATORY SURGICAL BOOT EAC",null,279,63.38,31.12,357.96,69.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3260"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L3260","AMBULATORY SURGICAL BOOT EAC",null,279,0,31.12,357.96,69.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3260"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L3260","AMBULATORY SURGICAL BOOT EAC",null,279,0,31.12,357.96,69.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - L3260"},"BMC HEALTHNET","BMCHN ACO","HCPCS","L3260","AMBULATORY SURGICAL BOOT EAC",null,279,0,31.12,357.96,69.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3350"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L3350","SHOE HEEL WEDGE",null,41,26.89,22.41,100.59,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - L3350"},"TUFTS","TUFTS PPO","HCPCS","L3350","SHOE HEEL WEDGE",null,41,35.79,22.41,100.59,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L3350"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L3350","SHOE HEEL WEDGE",null,41,56.39,22.41,100.59,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3496"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L3496","HC STATIC AFO",null,406,0,null,null,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - L3496"},"BMC HEALTHNET","BMCHN MCO","HCPCS","L3496","HC STATIC AFO",null,406,0,null,null,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L3650"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN",null,1955,80.86,67.38,302.45,488.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L3650"},"UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN",null,1955,140.63999999999999,67.38,302.45,488.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L3650"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN",null,1955,67.38,67.38,302.45,488.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - L3650"},"TUFTS","TUFTS POS","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN",null,1955,100.59,67.38,302.45,488.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L3650"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN",null,1955,98.07,67.38,302.45,488.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - L3670"},"BMC HEALTHNET","BMCHN MCO","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE",null,2903,0,103.65,465.27,725.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L3760"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L3760","EO WITHJOINT, PREFABRICATED",null,819,445.02,445.02,1997.57,204.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L3760"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L3760","EO WITHJOINT, PREFABRICATED",null,819,445.02,445.02,1997.57,204.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - L3760"},"TUFTS","TUFTS SPIRIT","HCPCS","L3760","EO WITHJOINT, PREFABRICATED",null,819,489.52,445.02,1997.57,204.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L3760"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L3760","EO WITHJOINT, PREFABRICATED",null,819,647.70000000000005,445.02,1997.57,204.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - L3760"},"BMC HEALTHNET","BMCHN MCO","HCPCS","L3760","EO WITHJOINT, PREFABRICATED",null,819,0,445.02,1997.57,204.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L3762"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L3762","RIGID EO WO JOINTS",null,57,114.82,95.68,429.49,14.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3762"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L3762","RIGID EO WO JOINTS",null,57,114.82,95.68,429.49,14.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - L3762"},"FALLON","FALLON SENIOR PLAN","HCPCS","L3762","RIGID EO WO JOINTS",null,57,95.68,95.68,429.49,14.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - L3762"},"TUFTS","TUFTS HMO","HCPCS","L3762","RIGID EO WO JOINTS",null,57,171.41,95.68,429.49,14.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - L3762"},"TUFTS","TUFTS SELECT","HCPCS","L3762","RIGID EO WO JOINTS",null,57,142.84,95.68,429.49,14.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3762"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L3762","RIGID EO WO JOINTS",null,57,0,95.68,429.49,14.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L3807"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED",null,483,222.52,222.52,998.85,120.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L3807"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED",null,483,387.18,222.52,998.85,120.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - L3807"},"TUFTS","TUFTS POS","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED",null,483,332.21,222.52,998.85,120.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - L3807"},"TUFTS","TUFTS SELECT","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED",null,483,332.21,222.52,998.85,120.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L3807"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED",null,483,323.87,222.52,998.85,120.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L3807"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED",null,483,559.9,222.52,998.85,120.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L3808"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L3808","HC EPITRAIN",null,509,375.94,375.94,1687.5,127.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L3808"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L3808","HC EPITRAIN",null,509,375.94,375.94,1687.5,127.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - L3808"},"TUFTS","TUFTS SELECT","HCPCS","L3808","HC EPITRAIN",null,509,561.25,375.94,1687.5,127.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L3808"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L3808","HC EPITRAIN",null,509,506.84,375.94,1687.5,127.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3808"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L3808","HC EPITRAIN",null,509,0,375.94,1687.5,127.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - L3808"},"BMC HEALTHNET","BMCHN ACO","HCPCS","L3808","HC EPITRAIN",null,509,0,375.94,1687.5,127.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L3905"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF",null,2442,1905.34,882.51,3961.32,610.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L3905"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF",null,2442,1279.6400000000001,882.51,3961.32,610.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - L3905"},"TUFTS","TUFTS SPIRIT","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF",null,2442,970.76,882.51,3961.32,610.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L3905"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF",null,2442,1041.3599999999999,882.51,3961.32,610.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3905"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF",null,2442,0,882.51,3961.32,610.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3905"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF",null,2442,0,882.51,3961.32,610.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L3905"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF",null,2442,1284.45,882.51,3961.32,610.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L3905"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF",null,2442,1284.45,882.51,3961.32,610.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - L3905"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF",null,2442,1284.45,882.51,3961.32,610.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3908"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L3908","WRIST COCK-UP NON-MOLDED",null,143,87.86,73.22,328.66,35.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - L3908"},"TUFTS","TUFTS HMO","HCPCS","L3908","WRIST COCK-UP NON-MOLDED",null,143,131.18,73.22,328.66,35.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - 92083"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED",null,461,224.25,68.75,607.84,115.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - 92083"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED",null,461,607.84,68.75,607.84,115.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3967"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF",null,117,2118.2800000000002,1765.23,7923.54,29.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - L3967"},"TUFTS","TUFTS POS","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF",null,117,2635.32,1765.23,7923.54,29.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - L3967"},"BMC HEALTHNET","BMCHN QHP","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF",null,117,0,1765.23,7923.54,29.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - L3980"},"TUFTS","TUFTS POS","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL",null,132,564.08000000000004,377.84,1695.98,33,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3980"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL",null,132,0,377.84,1695.98,33,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L3980"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL",null,132,950.72,377.84,1695.98,33,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - L3980"},"BMC HEALTHNET","BMCHN ACO","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL",null,132,0,377.84,1695.98,33,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3980"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL",null,132,0,377.84,1695.98,33,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - L3982"},"FALLON","FALLON SENIOR PLAN","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL",null,176,398.23,398.23,1787.56,44,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L3982"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL",null,176,469.91,398.23,1787.56,44,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L4350"},"UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB",null,360,203.04,97.28,436.66,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L4350"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB",null,360,436.66,97.28,436.66,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - L4350"},"TUFTS","TUFTS POS","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB",null,360,145.22999999999999,97.28,436.66,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - L4350"},"TUFTS","TUFTS PPO","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB",null,360,155.35,97.28,436.66,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L4350"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB",null,360,0,97.28,436.66,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L4350"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB",null,360,141.58000000000001,97.28,436.66,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L4350"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB",null,360,244.78,97.28,436.66,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L4360"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB",null,557,345.83,345.83,1552.36,139.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - L4360"},"TUFTS","TUFTS PPO","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB",null,557,552.29,345.83,1552.36,139.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L4360"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB",null,557,0,345.83,1552.36,139.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L4360"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB",null,557,503.35,345.83,1552.36,139.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L4370"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT",null,107,282.95,235.79,1058.3900000000001,26.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L4370"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT",null,107,235.79,235.79,1058.3900000000001,26.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L4370"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT",null,107,521.07000000000005,235.79,1058.3900000000001,26.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L4386"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB",null,165,695.83,155.02000000000001,695.83,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L4386"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB",null,165,155.02000000000001,155.02000000000001,695.83,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L4386"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB",null,165,155.02000000000001,155.02000000000001,695.83,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L4386"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB",null,165,334.69,155.02000000000001,695.83,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L4386"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB",null,165,269.73,155.02000000000001,695.83,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L4396"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L4396","STATIC AFO",null,406,171.42,171.42,769.43,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L4396"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L4396","STATIC AFO",null,406,0,171.42,769.43,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L4396"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L4396","STATIC AFO",null,406,249.49,171.42,769.43,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - L4396"},"BMC HEALTHNET","BMCHN MCO","HCPCS","L4396","STATIC AFO",null,406,0,171.42,769.43,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L4398"},"UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT",null,406,164.73,78.92,354.25,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L4398"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT",null,406,106.4,78.92,354.25,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - L8501"},"BMC HEALTHNET","BMCHN MCO","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE",null,219,0,160.74,721.54,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L8507"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)",null,1604,49.24,41.03,184.14,401,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L8507"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)",null,1604,184.14,41.03,184.14,401,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - L8507"},"FALLON","FALLON SENIOR PLAN","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)",null,1604,41.03,41.03,184.14,401,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L8507"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)",null,1604,0,41.03,184.14,401,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L8509"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN",null,1144,106.99,106.99,480.27,286,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - L8509"},"FALLON","FALLON MEDICAID","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN",null,1144,0,106.99,480.27,286,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L8509"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN",null,1144,144.24,106.99,480.27,286,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L8509"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN",null,1144,236.44,106.99,480.27,286,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - L8514"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR",null,387,133.94999999999999,92.38,414.69,96.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - L8514"},"TUFTS","TUFTS PPO","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR",null,387,147.54,92.38,414.69,96.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L8514"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR",null,387,0,92.38,414.69,96.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L8693"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT",null,1462,1485.57,1485.57,6668.25,365.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L8693"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT",null,1462,1485.57,1485.57,6668.25,365.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L8693"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT",null,1462,0,1485.57,6668.25,365.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L8693"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT",null,1462,2162.1799999999998,1485.57,6668.25,365.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - L8699"},"BMC HEALTHNET","BMCHN QHP","HCPCS","L8699","HC CARTIFORM 20 X 25 MM DISC",null,13957,0,null,null,3489.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - M0239"},"FALLON","FALLON SENIOR PLAN","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",null,393,309.60000000000002,309.60000000000002,779.02,98.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - M0239"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",null,393,518.74,309.60000000000002,779.02,98.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - M0239"},"BMC HEALTHNET","BMCHN QHP","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",null,393,371.52,309.60000000000002,779.02,98.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - M0243"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",null,572,538.70000000000005,309.60000000000002,779.02,143,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - M0243"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",null,572,518.74,309.60000000000002,779.02,143,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9012"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","P9012","HC CRYOPRECIPITATE UNIT",null,134,106.65,64.959999999999994,125.33,33.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9016"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","P9016","HC RBC:LEU-RED",null,576,398.94,243.01,478.65,144,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - P9016"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","P9016","HC RBC:LEU-RED",null,576,243.01,243.01,478.65,144,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9017"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","P9017","HC FF PLAS: 1 DONOR",null,291,154.43,94.07,217.72,72.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - P9017"},"TUFTS","TUFTS SELECT","HCPCS","P9017","HC FF PLAS: 1 DONOR",null,291,128.31,94.07,217.72,72.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9021"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","P9021","HC RBC/UNIT",null,323,184.28,184.28,354.25,80.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9021"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","P9021","HC RBC/UNIT",null,323,184.28,184.28,354.25,80.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9021"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","P9021","HC RBC/UNIT",null,323,184.28,184.28,354.25,80.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9034"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","P9034","HB PLATELETS, PHERESIS",null,506,727.76,443.29,799.73,126.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9034"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","P9034","HB PLATELETS, PHERESIS",null,506,799.73,443.29,799.73,126.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - P9037"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","P9037","HC PLT:PHER,LEU-RED,IRR/UNIT",null,939,821.84,821.84,1622.67,234.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9040"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","P9040","HC RBC:LEU-RED,IRR/UNIT",null,523,551.79999999999995,336.11,669.97,130.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - P9040"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","P9040","HC RBC:LEU-RED,IRR/UNIT",null,523,336.11,336.11,669.97,130.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9044"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","P9044","HC CRYOPRECIPITATE REDUCED PLASMA",null,133,244.67,144.19999999999999,244.67,33.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - P9045"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML",null,238,62.94,52.45,131.97,59.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - P9045"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML",null,238,52.45,52.45,131.97,59.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - P9045"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML",null,238,70.709999999999994,52.45,131.97,59.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9057"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","P9057","HC RBC:LEU RED,FR/DE/WASH,IR",null,785,472.82,395.89,671.74,196.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9073"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","P9073","HC PLATELETS PHERESIS PATH REDU",null,889,1349.22,821.84,2619.59,222.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9100"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","P9100","PATHOGEN TEST FOR PLATELETS",null,1310,256.64,33.53,256.64,327.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - P9100"},"TUFTS","TUFTS POS","HCPCS","P9100","PATHOGEN TEST FOR PLATELETS",null,1310,85.36,33.53,256.64,327.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - P9100"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","P9100","PATHOGEN TEST FOR PLATELETS",null,1310,33.53,33.53,256.64,327.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - P9612"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","P9612","CATHETERIZE FOR URINE SPEC",null,90,4.34,2.2200000000000002,1198.25,22.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - P9612"},"UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","P9612","CATHETERIZE FOR URINE SPEC",null,90,6.32,2.2200000000000002,1198.25,22.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9612"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","P9612","CATHETERIZE FOR URINE SPEC",null,90,0,2.2200000000000002,1198.25,22.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - P9612"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","P9612","CATHETERIZE FOR URINE SPEC",null,90,6.48,2.2200000000000002,1198.25,22.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - P9612"},"TUFTS","TUFTS PPO","HCPCS","P9612","CATHETERIZE FOR URINE SPEC",null,90,9.09,2.2200000000000002,1198.25,22.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA - HCPCS - P9612"},"AETNA","AETNA","HCPCS","P9612","CATHETERIZE FOR URINE SPEC",null,90,1198.25,2.2200000000000002,1198.25,22.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q0091"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR",null,83,28.83,28.83,175.66,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q0111"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS",null,23,15.12,5.86,127.48,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q0111"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS",null,23,32.36,5.86,127.48,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q0111"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS",null,23,32.64,5.86,127.48,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q0111"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS",null,23,21.92,5.86,127.48,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - Q0111"},"TUFTS","TUFTS POS","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS",null,23,42.41,5.86,127.48,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q0111"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS",null,23,20.38,5.86,127.48,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q0111"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS",null,23,12.98,5.86,127.48,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q0111"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS",null,23,0,5.86,127.48,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q0114"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q0114","HC  FERN TEST",null,41,21.03,7.2,82.86,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q0114"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","Q0114","HC  FERN TEST",null,41,9.74,7.2,82.86,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - Q0114"},"FALLON","FALLON MEDICAID","HCPCS","Q0114","HC  FERN TEST",null,41,0,7.2,82.86,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - Q0114"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","Q0114","HC  FERN TEST",null,41,14.12,7.2,82.86,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - Q0114"},"TUFTS","TUFTS SELECT","HCPCS","Q0114","HC  FERN TEST",null,41,14.67,7.2,82.86,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - Q0114"},"TUFTS","TUFTS SPIRIT","HCPCS","Q0114","HC  FERN TEST",null,41,10.71,7.2,82.86,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q0114"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","Q0114","HC  FERN TEST",null,41,11.49,7.2,82.86,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q0114"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q0114","HC  FERN TEST",null,41,17.79,7.2,82.86,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - Q0114"},"BMC HEALTHNET","BMCHN QHP","HCPCS","Q0114","HC  FERN TEST",null,41,0,7.2,82.86,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q0249"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","Q0249","HC TOCILIZUMAB FOR COVID-19",null,9,0,null,null,2.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q0249"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q0249","HC TOCILIZUMAB FOR COVID-19",null,9,0,null,null,2.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - Q3014"},"TUFTS","TUFTS HMO","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE",null,67,38.6,26.65,67.06,16.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - Q3014"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE",null,67,38.64,26.65,67.06,16.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q3014"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE",null,67,0,26.65,67.06,16.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q3014"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE",null,67,67.06,26.65,67.06,16.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q4101"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","Q4101","APLIGRAF",null,1601,36.549999999999997,30.46,76.64,400.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - Q4101"},"UNICARE","UNICARE","HCPCS","Q4101","APLIGRAF",null,1601,31.6,30.46,76.64,400.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q4101"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q4101","APLIGRAF",null,1601,0,30.46,76.64,400.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - Q4101"},"TUFTS","TUFTS POS","HCPCS","Q4101","APLIGRAF",null,1601,0,30.46,76.64,400.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q4101"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","Q4101","APLIGRAF",null,1601,67.31,30.46,76.64,400.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q4102"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","Q4102","OASIS WOUND MATRIX",null,69,10.210000000000001,10.210000000000001,25.69,17.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - Q4102"},"FALLON","FALLON SENIOR PLAN","HCPCS","Q4102","OASIS WOUND MATRIX",null,69,10.210000000000001,10.210000000000001,25.69,17.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - Q4102"},"TUFTS","TUFTS SPIRIT","HCPCS","Q4102","OASIS WOUND MATRIX",null,69,11.23,10.210000000000001,25.69,17.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q4102"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","Q4102","OASIS WOUND MATRIX",null,69,12.05,10.210000000000001,25.69,17.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q4102"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q4102","OASIS WOUND MATRIX",null,69,11.74,10.210000000000001,25.69,17.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q4102"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","Q4102","OASIS WOUND MATRIX",null,69,22.56,10.210000000000001,25.69,17.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q4104"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q4104","INTEGRA BMWD",null,7748,0,42.08,56.11,1937,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - Q4104"},"TUFTS","TUFTS PPO","HCPCS","Q4104","INTEGRA BMWD",null,7748,0,42.08,56.11,1937,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q4104"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q4104","INTEGRA BMWD",null,7748,56.11,42.08,56.11,1937,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - Q4107"},"UNICARE","UNICARE","HCPCS","Q4107","GRAFTJACKET",null,2233,86.55,86.55,110.48,558.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q4107"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q4107","GRAFTJACKET",null,2233,0,86.55,110.48,558.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q4112"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q4112","CYMETRA INJECTABLE",null,535,1002.89,904.99,1002.89,133.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q4116"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM",null,5248,0,32.29,35.78,1312,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - Q4116"},"TUFTS","TUFTS POS","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM",null,5248,0,32.29,35.78,1312,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q4116"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM",null,5248,35.78,32.29,35.78,1312,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q4124"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q4124","OASIS TRILAYER/1 SQCM",null,23,0,16.39,16.39,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q4124"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q4124","OASIS TRILAYER/1 SQCM",null,23,0,16.39,16.39,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q4125"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM",null,4060,3.79,3.79,3.79,1015,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - Q4125"},"BMC HEALTHNET","BMCHN MCO","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM",null,4060,0,3.79,3.79,1015,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q4125"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM",null,4060,0,3.79,3.79,1015,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q4130"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q4130","PR STRATTICE TM",null,65718,0,45.89,45.89,16429.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - Q4130"},"TUFTS","TUFTS PPO","HCPCS","Q4130","PR STRATTICE TM",null,65718,0,45.89,45.89,16429.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q4130"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q4130","PR STRATTICE TM",null,65718,45.89,45.89,45.89,16429.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q4132"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","Q4132","HC GRAFIX CORE 5X5CM",null,3754,137.56,114.63,288.43,938.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q4132"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q4132","HC GRAFIX CORE 5X5CM",null,3754,118.95,114.63,288.43,938.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q4132"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","Q4132","HC GRAFIX CORE 5X5CM",null,3754,166.21,114.63,288.43,938.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q4132"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q4132","HC GRAFIX CORE 5X5CM",null,3754,131.82,114.63,288.43,938.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q4132"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q4132","HC GRAFIX CORE 5X5CM",null,3754,131.82,114.63,288.43,938.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q4133"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",null,3756,0,131.97,332.06,939,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q4133"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",null,3756,131.97,131.97,332.06,939,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - Q4133"},"TUFTS","TUFTS SPIRIT","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",null,3756,145.16999999999999,131.97,332.06,939,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q4133"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",null,3756,151.77000000000001,131.97,332.06,939,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q4133"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",null,3756,291.64,131.97,332.06,939,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q4196"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM",null,9044,133.91,111.59,280.77999999999997,2261,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q4196"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM",null,9044,133.91,111.59,280.77999999999997,2261,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q4196"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM",null,9044,111.59,111.59,280.77999999999997,2261,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q4196"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM",null,9044,161.81,111.59,280.77999999999997,2261,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - Q4196"},"TUFTS","TUFTS POS","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM",null,9044,152,111.59,280.77999999999997,2261,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - Q4196"},"TUFTS","TUFTS PPO","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM",null,9044,162.6,111.59,280.77999999999997,2261,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - Q9954"},"FALLON","FALLON MEDICAID","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML",null,0,0,12.1,13.41,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - Q9954"},"TUFTS","TUFTS HMO","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML",null,0,0,12.1,13.41,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q9954"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML",null,0,0,12.1,13.41,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q9954"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML",null,0,13.41,12.1,13.41,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q9954"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML",null,0,13.41,12.1,13.41,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - Q9954"},"BMC HEALTHNET","BMCHN MCO","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML",null,0,0,12.1,13.41,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q9956"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML",null,76,36.51,31.75,79.89,19,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q9956"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML",null,76,36.51,31.75,79.89,19,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - Q9956"},"BMC HEALTHNET","BMCHN QHP","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML",null,76,0,31.75,79.89,19,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - Q9957"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML",null,417,69.06,47.63,119.85,104.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - Q9957"},"TUFTS","TUFTS POS","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML",null,417,0,47.63,119.85,104.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q9957"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML",null,417,56.2,47.63,119.85,104.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q9958"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML",null,1,0.08,7.0000000000000007E-2,0.18,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q9958"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML",null,1,0,7.0000000000000007E-2,0.18,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - Q9958"},"FALLON","FALLON MEDICAID","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML",null,1,0,7.0000000000000007E-2,0.18,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q9958"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML",null,1,0,7.0000000000000007E-2,0.18,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q9958"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML",null,1,0.15,7.0000000000000007E-2,0.18,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q9958"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML",null,1,0.12,7.0000000000000007E-2,0.18,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q9958"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML",null,1,0,7.0000000000000007E-2,0.18,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q9958"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML",null,1,0.08,7.0000000000000007E-2,0.18,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - Q9958"},"BMC HEALTHNET","BMCHN ACO","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML",null,1,0,7.0000000000000007E-2,0.18,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q9961"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML",null,1,0.25,0.25,0.63,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q9961"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML",null,1,0,0.25,0.63,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q9961"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML",null,1,0,0.25,0.63,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - Q9961"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML",null,1,0.36,0.25,0.63,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q9961"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML",null,1,0,0.25,0.63,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q9961"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML",null,1,0.28999999999999998,0.25,0.63,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q9987"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q9987","HC PATHOGEN TEST PLATELETS",null,1218,0,null,null,304.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - Q9987"},"BMC HEALTHNET","BMCHN ACO","HCPCS","Q9987","HC PATHOGEN TEST PLATELETS",null,1218,0,null,null,304.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - S5100"},"BMC HEALTHNET","BMCHN MCO","HCPCS","S5100","ADULT DAYCARE SERVICES 15MIN",null,6,0,null,null,1.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - S5102"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","S5102","HC ADULT DAY HEALTH - COMPLEX PER DIEM",null,126,0,null,null,31.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - S5102"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","S5102","HC ADULT DAY HEALTH - COMPLEX PER DIEM",null,126,0,null,null,31.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - S8037"},"TUFTS","TUFTS PPO","HCPCS","S8037","MRCP",null,1440,1341.84,585.76,3771.6,360,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - S8037"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","S8037","MRCP",null,1440,0,585.76,3771.6,360,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - S8037"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","S8037","MRCP",null,1440,0,585.76,3771.6,360,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - T2003"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","T2003","HC TRANSPORTATION RATE 1 (1-WAY TRIP)",null,25,0,null,null,6.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - U0001"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",null,124,43.09,35.909999999999997,325.64,31,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - U0001"},"TUFTS","TUFTS SPIRIT","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",null,124,39.5,35.909999999999997,325.64,31,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - U0001"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",null,124,90.36,35.909999999999997,325.64,31,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - U0002"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",null,92,61.57,51.31,465.19,23,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - U0002"},"UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",null,92,108.06,51.31,465.19,23,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - U0002"},"FALLON","FALLON SENIOR PLAN","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",null,92,51.31,51.31,465.19,23,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - U0002"},"TUFTS","TUFTS POS","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",null,92,165.5,51.31,465.19,23,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - U0002"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",null,92,129.11000000000001,51.31,465.19,23,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - U0002"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",null,92,113.39,51.31,465.19,23,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - V2785"},"TUFTS","TUFTS POS","HCPCS","V2785","CORNEAL TISSUE PROCESSING",null,7848,9609.09,5130.87,15242.01,1962,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - V2785"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","V2785","CORNEAL TISSUE PROCESSING",null,7848,0,5130.87,15242.01,1962,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - V2790"},"TUFTS","TUFTS POS","HCPCS","V2790","HC MEMBRANE AMNIOTIC",null,1136,0,null,null,284,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - 0042T"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",null,767,0,1452,1452,191.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - 0042T"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",null,767,0,1452,1452,191.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - 0042T"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",null,767,1452,1452,1452,191.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - 0042T"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",null,767,1452,1452,1452,191.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - 0399T"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","0399T","PR MYOCARDIAL STRAIN IMAGING",null,1022,0,null,null,255.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA - HCPCS - 0402T"},"AETNA","AETNA","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA",null,2880,1198.25,1198.25,11845.41,720,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - 0402T"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA",null,2880,3044.16,1198.25,11845.41,720,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - 95800"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA",null,205,228.32,228.32,1412.44,51.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - 45378"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND",null,1672,3264.67,1020.59,3264.67,418,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - 92083"},"TUFTS","TUFTS POS","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED",null,461,358.22,68.75,607.84,115.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - 92083"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED",null,461,178.83,68.75,607.84,115.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - 81170"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",null,798,360,159,2909.77,199.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - 81170"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",null,798,360,159,2909.77,199.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - 81170"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",null,798,647.70000000000005,159,2909.77,199.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - 81170"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",null,798,435,159,2909.77,199.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - 81170"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",null,798,404.46,159,2909.77,199.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - 81170"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",null,798,548.09,159,2909.77,199.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - 81170"},"BMC HEALTHNET","BMCHN MCO","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",null,798,221.66,159,2909.77,199.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - 81170"},"BMC HEALTHNET","BMCHN ACO","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",null,798,484.99,159,2909.77,199.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - 95800"},"TUFTS","TUFTS POS","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA",null,205,469.76,228.32,1412.44,51.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - 95800"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA",null,205,228.32,228.32,1412.44,51.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - 45378"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND",null,1672,1608.22,1020.59,3264.67,418,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - 45378"},"TUFTS","TUFTS HMO","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND",null,1672,2057.7399999999998,1020.59,3264.67,418,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - 45378"},"TUFTS","TUFTS PPO","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND",null,1672,2058.16,1020.59,3264.67,418,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - 45378"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND",null,1672,1250.94,1020.59,3264.67,418,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A4215"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A4215","STERILE NEEDLE",null,433,0,null,null,108.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - A4215"},"BMC HEALTHNET","BMCHN MCO","HCPCS","A4215","STERILE NEEDLE",null,433,0,null,null,108.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A4467"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A4467","BELT STRAP SLEEV GRMNT COVER",null,151,0,null,null,37.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A4561"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE",null,108,27.82,23.18,58.33,27,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A4561"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE",null,108,0,23.18,58.33,27,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A4561"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE",null,108,33.729999999999997,23.18,58.33,27,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A4562"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A4562","PESSARY NONRUBBER",null,64,0,57.71,145.21,16,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A4562"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","A4562","PESSARY NONRUBBER",null,64,57.71,57.71,145.21,16,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A4562"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","A4562","PESSARY NONRUBBER",null,64,57.71,57.71,145.21,16,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A4562"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","A4562","PESSARY NONRUBBER",null,64,100.42,57.71,145.21,16,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A4562"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","A4562","PESSARY NONRUBBER",null,64,83.68,57.71,145.21,16,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - A4562"},"TUFTS","TUFTS SELECT","HCPCS","A4562","PESSARY NONRUBBER",null,64,0,57.71,145.21,16,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A4562"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","A4562","PESSARY NONRUBBER",null,64,127.53,57.71,145.21,16,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A4570"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1",null,40,107.35,19.010000000000002,107.35,10,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A4570"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1",null,40,0,19.010000000000002,107.35,10,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A4570"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1",null,40,0,19.010000000000002,107.35,10,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A4570"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1",null,40,0,19.010000000000002,107.35,10,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A4725"},"TUFTS","TUFTS PPO","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC",null,87,0,null,null,21.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A6209"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR",null,163,10.42,8.68,21.84,40.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A6209"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR",null,163,8.68,8.68,21.84,40.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A6209"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR",null,163,15.1,8.68,21.84,40.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A6209"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR",null,163,12.59,8.68,21.84,40.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A6209"},"TUFTS","TUFTS POS","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR",null,163,0,8.68,21.84,40.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A6209"},"TUFTS","TUFTS PPO","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR",null,163,0,8.68,21.84,40.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A6258"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN",null,83,6,5,12.58,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - A6258"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN",null,83,7.25,5,12.58,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A6258"},"TUFTS","TUFTS PPO","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN",null,83,0,5,12.58,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - A6549"},"TUFTS","TUFTS HMO","HCPCS","A6549","G COMPRESSION STOCKING",null,37,0,null,null,9.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A6549"},"TUFTS","TUFTS POS","HCPCS","A6549","G COMPRESSION STOCKING",null,37,0,null,null,9.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A6549"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A6549","G COMPRESSION STOCKING",null,37,0,null,null,9.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A6550"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","A6550","NEG PRES WOUND THER DRSG SET",null,4,25.71,25.71,64.69,1,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - A6550"},"FALLON","FALLON MEDICAID","HCPCS","A6550","NEG PRES WOUND THER DRSG SET",null,4,0,25.71,64.69,1,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A7520"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED",null,1173,95.98,55.16,138.79,293.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - A7520"},"TUFTS","TUFTS HMO","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED",null,1173,0,55.16,138.79,293.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A7520"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED",null,1173,80.290000000000006,55.16,138.79,293.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - A7520"},"BMC HEALTHNET","BMCHN MCO","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED",null,1173,0,55.16,138.79,293.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - A9500"},"FALLON","FALLON MEDICAID","HCPCS","A9500","TC99M SESTAMIBI",null,274,0,463.42,463.42,68.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A9500"},"TUFTS","TUFTS PPO","HCPCS","A9500","TC99M SESTAMIBI",null,274,0,463.42,463.42,68.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9500"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9500","TC99M SESTAMIBI",null,274,463.42,463.42,463.42,68.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9502"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9502","HC TC99M TETROFOSMIN",null,140,0,278.27,278.27,35,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9502"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9502","HC TC99M TETROFOSMIN",null,140,278.27,278.27,278.27,35,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9503"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9503","TC99M MEDRONATE",null,23,0,37.119999999999997,37.119999999999997,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - A9503"},"BMC HEALTHNET","BMCHN ACO","HCPCS","A9503","TC99M MEDRONATE",null,23,0,37.119999999999997,37.119999999999997,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - A9505"},"FALLON","FALLON MEDICAID","HCPCS","A9505","THALLIUM CHLORIDE PER MCI",null,23,0,395.74,395.74,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9505"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9505","THALLIUM CHLORIDE PER MCI",null,23,0,395.74,395.74,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9505"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9505","THALLIUM CHLORIDE PER MCI",null,23,395.74,395.74,395.74,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9505"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9505","THALLIUM CHLORIDE PER MCI",null,23,395.74,395.74,395.74,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - A9505"},"BMC HEALTHNET","BMCHN QHP","HCPCS","A9505","THALLIUM CHLORIDE PER MCI",null,23,0,395.74,395.74,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9509"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9509","HC IODINE I-123 PER MCI",null,95,5163.91,5163.91,5163.91,23.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9509"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9509","HC IODINE I-123 PER MCI",null,95,5163.91,5163.91,5163.91,23.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9512"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9512","TC99M PERTECHNETATE",null,1,0,null,null,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - A9512"},"FALLON","FALLON MEDICAID","HCPCS","A9512","TC99M PERTECHNETATE",null,1,0,null,null,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A9512"},"TUFTS","TUFTS PPO","HCPCS","A9512","TC99M PERTECHNETATE",null,1,0,null,null,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9512"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9512","TC99M PERTECHNETATE",null,1,0,null,null,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9513"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN",null,320,441.49,294.27999999999997,1097.56,80,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - A9513"},"FALLON","FALLON MEDICAID","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN",null,320,0,294.27999999999997,1097.56,80,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9513"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN",null,320,441.49,294.27999999999997,1097.56,80,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - A9513"},"TUFTS","TUFTS SELECT","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN",null,320,365.04,294.27999999999997,1097.56,80,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9513"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN",null,320,0,294.27999999999997,1097.56,80,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA - HCPCS - A9513"},"AETNA","AETNA","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN",null,320,294.27999999999997,294.27999999999997,1097.56,80,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - A9513"},"BMC HEALTHNET","BMCHN MCO","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN",null,320,0,294.27999999999997,1097.56,80,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9516"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9516","I123 IODIDE CAP, DX",null,192,516.39,516.39,516.39,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9517"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9517","I131 IODIDE CAP, RX",null,437,101.94,30.1,101.94,109.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9517"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9517","I131 IODIDE CAP, RX",null,437,101.94,30.1,101.94,109.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9517"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9517","I131 IODIDE CAP, RX",null,437,101.94,30.1,101.94,109.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9520"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD",null,1951,0,null,null,487.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A9520"},"TUFTS","TUFTS POS","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD",null,1951,0,null,null,487.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - A9520"},"TUFTS","TUFTS SELECT","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD",null,1951,0,null,null,487.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - A9520"},"BMC HEALTHNET","BMCHN QHP","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD",null,1951,0,null,null,487.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - A9521"},"TUFTS","TUFTS SELECT","HCPCS","A9521","TC99M EXAMETAZIME",null,360,0,4157.3,4157.3,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9521"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9521","TC99M EXAMETAZIME",null,360,0,4157.3,4157.3,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - A9521"},"BMC HEALTHNET","BMCHN QHP","HCPCS","A9521","TC99M EXAMETAZIME",null,360,0,4157.3,4157.3,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - A9538"},"BMC HEALTHNET","BMCHN ACO","HCPCS","A9538","TC99M PYROPHOSPHATE",null,111,0,114.21,114.21,27.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9538"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9538","TC99M PYROPHOSPHATE",null,111,0,114.21,114.21,27.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9539"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9539","TC99M PENTETATE",null,668,89.47,89.47,89.47,167,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - A9539"},"BMC HEALTHNET","BMCHN MCO","HCPCS","A9539","TC99M PENTETATE",null,668,0,89.47,89.47,167,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9540"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9540","TC99M MAA",null,1831,0,85.66,85.66,457.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - A9540"},"BMC HEALTHNET","BMCHN ACO","HCPCS","A9540","TC99M MAA",null,1831,0,85.66,85.66,457.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9540"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9540","TC99M MAA",null,1831,0,85.66,85.66,457.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - A9541"},"FALLON","FALLON MEDICAID","HCPCS","A9541","TC99M SULFUR COLLOID",null,120,0,152.69,152.69,30,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A9541"},"TUFTS","TUFTS POS","HCPCS","A9541","TC99M SULFUR COLLOID",null,120,0,152.69,152.69,30,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - A9541"},"TUFTS","TUFTS SELECT","HCPCS","A9541","TC99M SULFUR COLLOID",null,120,0,152.69,152.69,30,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - A9541"},"BMC HEALTHNET","BMCHN QHP","HCPCS","A9541","TC99M SULFUR COLLOID",null,120,0,152.69,152.69,30,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - A9543"},"TUFTS","TUFTS HMO","HCPCS","A9543","Y90 IBRITUMOMAB, RX",null,66322,86881.16,72400.97,217685.7,16580.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9543"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9543","Y90 IBRITUMOMAB, RX",null,66322,139963.56,72400.97,217685.7,16580.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9547"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9547","IN111 OXYQUINOLINE",null,440,0,5105.7299999999996,5105.7299999999996,110,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9547"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9547","IN111 OXYQUINOLINE",null,440,0,5105.7299999999996,5105.7299999999996,110,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9547"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9547","IN111 OXYQUINOLINE",null,440,0,5105.7299999999996,5105.7299999999996,110,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - A9547"},"TUFTS","TUFTS HMO","HCPCS","A9547","IN111 OXYQUINOLINE",null,440,0,5105.7299999999996,5105.7299999999996,110,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9551"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX",null,154,0,1711.56,1711.56,38.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9552"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9552","F18 FDG",null,972,0,1166.46,1166.46,243,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9552"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9552","F18 FDG",null,972,0,1166.46,1166.46,243,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A9555"},"TUFTS","TUFTS PPO","HCPCS","A9555","RADIOPHARMACIAL",null,1065,0,1604.08,1604.08,266.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9555"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9555","RADIOPHARMACIAL",null,1065,1604.08,1604.08,1604.08,266.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9556"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9556","GA67 GALLIUM",null,20,0,311.94,311.94,5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A9556"},"TUFTS","TUFTS PPO","HCPCS","A9556","GA67 GALLIUM",null,20,0,311.94,311.94,5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9556"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9556","GA67 GALLIUM",null,20,311.94,311.94,311.94,5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9556"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9556","GA67 GALLIUM",null,20,0,311.94,311.94,5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - A9557"},"FALLON","FALLON MEDICAID","HCPCS","A9557","TC99M BICISATE",null,239,0,1062.44,1062.44,59.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9557"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9557","TC99M BICISATE",null,239,0,1062.44,1062.44,59.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A9557"},"TUFTS","TUFTS POS","HCPCS","A9557","TC99M BICISATE",null,239,0,1062.44,1062.44,59.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - A9557"},"TUFTS","TUFTS SELECT","HCPCS","A9557","TC99M BICISATE",null,239,0,1062.44,1062.44,59.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9557"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9557","TC99M BICISATE",null,239,1062.44,1062.44,1062.44,59.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - A9557"},"BMC HEALTHNET","BMCHN ACO","HCPCS","A9557","TC99M BICISATE",null,239,0,1062.44,1062.44,59.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - A9557"},"BMC HEALTHNET","BMCHN MCO","HCPCS","A9557","TC99M BICISATE",null,239,0,1062.44,1062.44,59.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9558"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9558","HC XENON133/10MCI",null,23,0,108.88,108.88,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9558"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9558","HC XENON133/10MCI",null,23,0,108.88,108.88,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - A9560"},"FALLON","FALLON MEDICAID","HCPCS","A9560","TC99M LABELED RBC",null,246,0,266.7,266.7,61.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - A9560"},"TUFTS","TUFTS HMO","HCPCS","A9560","TC99M LABELED RBC",null,246,0,266.7,266.7,61.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - A9560"},"BMC HEALTHNET","BMCHN MCO","HCPCS","A9560","TC99M LABELED RBC",null,246,0,266.7,266.7,61.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - A9560"},"BMC HEALTHNET","BMCHN QHP","HCPCS","A9560","TC99M LABELED RBC",null,246,0,266.7,266.7,61.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9561"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9561","TC99M OXIDRONATE",null,127,0,125.64,125.64,31.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9561"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9561","TC99M OXIDRONATE",null,127,0,125.64,125.64,31.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A9561"},"TUFTS","TUFTS PPO","HCPCS","A9561","TC99M OXIDRONATE",null,127,0,125.64,125.64,31.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9561"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9561","TC99M OXIDRONATE",null,127,0,125.64,125.64,31.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9561"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9561","TC99M OXIDRONATE",null,127,0,125.64,125.64,31.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9561"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9561","TC99M OXIDRONATE",null,127,125.64,125.64,125.64,31.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - A9561"},"BMC HEALTHNET","BMCHN MCO","HCPCS","A9561","TC99M OXIDRONATE",null,127,0,125.64,125.64,31.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9563"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9563","P32 NA PHOSPHATE",null,0,535.17999999999995,535.17999999999995,3182.68,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9563"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9563","P32 NA PHOSPHATE",null,0,535.17999999999995,535.17999999999995,3182.68,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9563"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9563","P32 NA PHOSPHATE",null,0,0,535.17999999999995,3182.68,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9569"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC",null,5086,0,4157.3,4157.3,1271.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9569"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC",null,5086,0,4157.3,4157.3,1271.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9569"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC",null,5086,4157.3,4157.3,4157.3,1271.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9569"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC",null,5086,4157.3,4157.3,4157.3,1271.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9569"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC",null,5086,4157.3,4157.3,4157.3,1271.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - A9569"},"BMC HEALTHNET","BMCHN ACO","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC",null,5086,0,4157.3,4157.3,1271.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - A9570"},"TUFTS","TUFTS HMO","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC",null,6395,0,null,null,1598.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A9570"},"TUFTS","TUFTS POS","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC",null,6395,0,null,null,1598.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A9570"},"TUFTS","TUFTS PPO","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC",null,6395,0,null,null,1598.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9570"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC",null,6395,0,null,null,1598.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9572"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE",null,131,0,16207.01,16207.01,32.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9572"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE",null,131,0,16207.01,16207.01,32.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9572"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE",null,131,0,16207.01,16207.01,32.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9572"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE",null,131,0,16207.01,16207.01,32.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9572"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE",null,131,16207.01,16207.01,16207.01,32.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - A9575"},"UNICARE","UNICARE","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML",null,8,0.19,0.18,0.45,2,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A9575"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML",null,8,0.18,0.18,0.45,2,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A9575"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML",null,8,0.39,0.18,0.45,2,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A9575"},"TUFTS","TUFTS PPO","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML",null,8,0,0.18,0.45,2,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A9576"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML",null,5,1.5,1.5,3.77,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9576"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML",null,5,0,1.5,3.77,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A9576"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML",null,5,2.1800000000000002,1.5,3.77,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - A9577"},"TUFTS","TUFTS SPIRIT","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML",null,21,1.99,1.81,5.03,5.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - A9579"},"UNICARE","UNICARE","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML",null,5,1.58,1.53,4.38,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9579"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML",null,5,0,1.53,4.38,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9579"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML",null,5,0,1.53,4.38,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A9579"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML",null,5,1.53,1.53,4.38,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9579"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML",null,5,0,1.53,4.38,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A9579"},"TUFTS","TUFTS POS","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML",null,5,0,1.53,4.38,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A9580"},"TUFTS","TUFTS POS","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE",null,158,0,null,null,39.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - A9580"},"BMC HEALTHNET","BMCHN ACO","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE",null,158,0,null,null,39.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A9581"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","A9581","GADOXETATE DISODIUM INJ",null,99,17.71,14.76,37.14,24.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - A9581"},"UNICARE","UNICARE","HCPCS","A9581","GADOXETATE DISODIUM INJ",null,99,15.32,14.76,37.14,24.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9581"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9581","GADOXETATE DISODIUM INJ",null,99,0,14.76,37.14,24.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - A9581"},"TUFTS","TUFTS HMO","HCPCS","A9581","GADOXETATE DISODIUM INJ",null,99,0,14.76,37.14,24.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A9581"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","A9581","GADOXETATE DISODIUM INJ",null,99,17.420000000000002,14.76,37.14,24.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9581"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9581","GADOXETATE DISODIUM INJ",null,99,16.97,14.76,37.14,24.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A9581"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","A9581","GADOXETATE DISODIUM INJ",null,99,32.619999999999997,14.76,37.14,24.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9581"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9581","GADOXETATE DISODIUM INJ",null,99,16.97,14.76,37.14,24.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9582"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9582","IODINE I-123 IOBENGUANE",null,10370,0,null,null,2592.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9582"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9582","IODINE I-123 IOBENGUANE",null,10370,0,null,null,2592.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9582"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9582","IODINE I-123 IOBENGUANE",null,10370,0,null,null,2592.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - A9582"},"BMC HEALTHNET","BMCHN QHP","HCPCS","A9582","IODINE I-123 IOBENGUANE",null,10370,0,null,null,2592.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9583"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ",null,13,0,19.260000000000002,21.34,3.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9583"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ",null,13,21.34,19.260000000000002,21.34,3.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - A9584"},"FALLON","FALLON MEDICAID","HCPCS","A9584","IODINE I-123 IOFLUPANE",null,2729,0,3235.55,3235.55,682.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - A9584"},"TUFTS","TUFTS SELECT","HCPCS","A9584","IODINE I-123 IOFLUPANE",null,2729,0,3235.55,3235.55,682.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9586"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",null,4402,5015.9399999999996,3746.06,7452.46,1100.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - A9588"},"TUFTS","TUFTS HMO","HCPCS","A9588","FLUCICLOVINE F-18",null,15438,0,525.05999999999995,703.05,3859.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9588"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9588","FLUCICLOVINE F-18",null,15438,525.05999999999995,525.05999999999995,703.05,3859.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9588"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9588","FLUCICLOVINE F-18",null,15438,0,525.05999999999995,703.05,3859.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9592"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9592","HC COPPER CU 64 DOTATATE DIAG",null,5634,0,null,null,1408.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9606"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER",null,493,378.21,198.62,597.20000000000005,123.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1713"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1713","HC CORE 10 BONE PLUG",null,4568,0,null,null,1142,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C1714"},"TUFTS","TUFTS PPO","HCPCS","C1714","HC WATHMAN SYS ANTER CURVE",null,6114,0,null,null,1528.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1715"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1715","BRACHYTHERAPY NEEDLE",null,21,0,null,null,5.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C1715"},"TUFTS","TUFTS POS","HCPCS","C1715","BRACHYTHERAPY NEEDLE",null,21,0,null,null,5.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1716"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1716","BRACHYTX SOURCE, GOLD 198",null,0,200.39,168.52,506.68,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - C1717"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192",null,607,836.69,469.29,1411.01,151.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1721"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1721","HC ICD,2CH, GEN ONLY, RECALL $0",null,39674,0,null,null,9918.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C1721"},"TUFTS","TUFTS PPO","HCPCS","C1721","HC ICD,2CH, GEN ONLY, RECALL $0",null,39674,0,null,null,9918.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1724"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1724","HC CATH, TRANS ATHEREC BURR",null,7410,0,null,null,1852.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1725"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1725","HC SIZING AMPLATZ BALLOON",null,1693,0,null,null,423.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C1726"},"TUFTS","TUFTS PPO","HCPCS","C1726","HC CATHETER BALLN LVL 4",null,387,0,null,null,96.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C1729"},"TUFTS","TUFTS SELECT","HCPCS","C1729","HC CATH; THORA PARA",null,2283,0,null,null,570.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1730"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1730","HC CATH,EP;STEER,DEC(LASSO)",null,2283,0,null,null,570.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C1730"},"TUFTS","TUFTS SELECT","HCPCS","C1730","HC CATH,EP;STEER,DEC(LASSO)",null,2283,0,null,null,570.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1731"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1731","HC CATH,EP PENTARAY NAV",null,3847,0,null,null,961.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C1731"},"TUFTS","TUFTS PPO","HCPCS","C1731","HC CATH,EP PENTARAY NAV",null,3847,0,null,null,961.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C1732"},"TUFTS","TUFTS HMO","HCPCS","C1732","HC CATH,EP DECA NAV",null,7766,0,null,null,1941.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1751"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1751","HC CATH, PACING",null,1438,0,null,null,359.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1751"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1751","HC CATH, PACING",null,1438,0,null,null,359.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1756"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1756","HC PACING WIRE",null,1438,0,null,null,359.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1756"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1756","HC PACING WIRE",null,1438,0,null,null,359.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C1757"},"TUFTS","TUFTS PPO","HCPCS","C1757","HC CATH,THROMB/EMB,LVL 2",null,15822,0,null,null,3955.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1760"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1760","HC CENTRAL LINE KIT",null,1799,0,null,null,449.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1763"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1763","HC SM6X16-STEM HEM",null,2242,0,null,null,560.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C1763"},"TUFTS","TUFTS POS","HCPCS","C1763","HC SM6X16-STEM HEM",null,2242,0,null,null,560.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1764"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1764","HC RECORDER;IMPLANTABLE LOOP",null,8983,0,null,null,2245.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1766"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1766","SHTH INTRO 65CM 15FR 12FR",null,2619,0,null,null,654.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1766"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1766","SHTH INTRO 65CM 15FR 12FR",null,2619,0,null,null,654.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C1770"},"TUFTS","TUFTS SELECT","HCPCS","C1770","IMAGING COIL, MR, INSERTABLE",null,3667,0,null,null,916.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C1773"},"TUFTS","TUFTS HMO","HCPCS","C1773","HC GUIDEWIRE LVL E",null,2163,0,null,null,540.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1776"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1776","HC HEMI-TIB PLATEAU W MENISC",null,21721,0,null,null,5430.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C1776"},"TUFTS","TUFTS HMO","HCPCS","C1776","HC HEMI-TIB PLATEAU W MENISC",null,21721,0,null,null,5430.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1777"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1777","HC LEAD,ICD,1COIL",null,13038,0,null,null,3259.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1781"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1781","MESH (IMPLANTABLE)",null,36449,0,null,null,9112.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1781"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1781","MESH (IMPLANTABLE)",null,36449,0,null,null,9112.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1784"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1784","HC DES PERIPHERAL STENT",null,2734,0,null,null,683.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1785"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1785","HC PACER;2CH, RECALL $0",null,12546,0,null,null,3136.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1786"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1786","HC PACER;1CH, RECALL $0",null,23460,0,null,null,5865,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1821"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1821","HC INTERSPINOUS IMPLANT",null,9770,0,null,null,2442.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1821"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1821","HC INTERSPINOUS IMPLANT",null,9770,0,null,null,2442.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C1821"},"TUFTS","TUFTS PPO","HCPCS","C1821","HC INTERSPINOUS IMPLANT",null,9770,0,null,null,2442.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C1876"},"TUFTS","TUFTS SELECT","HCPCS","C1876","STENT BILIARY",null,11691,0,null,null,2922.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C1880"},"TUFTS","TUFTS POS","HCPCS","C1880","IVC FILTERS",null,7726,0,null,null,1931.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C1883"},"TUFTS","TUFTS PPO","HCPCS","C1883","HC ADAPTOR;BI-VENT PACER",null,1257,0,null,null,314.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1894"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1894","HC INTRO/SHEATH NON-CARD LV2",null,252,0,null,null,63,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1898"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1898","HC KIT,PACER;BI-VENT(#6216/8",null,1575,0,null,null,393.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - C2616"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","C2616","HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE",null,60393,47839.61,25512.2,76706.740000000005,15098.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C2621"},"TUFTS","TUFTS POS","HCPCS","C2621","HC PACER;2CH, W/ BACKUP DEFIB",null,21692,0,null,null,5423,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C2623"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C2623","CATH TRANSLUMIN DRUG-COAT",null,2837,0,null,null,709.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C2628"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C2628","HC KIT CATH BRIDGE PRE",null,2308,0,null,null,577,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C2628"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C2628","HC KIT CATH BRIDGE PRE",null,2308,0,null,null,577,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C2630"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C2630","HC CATH;EP CRYOABLATION, 8 MM",null,4966,0,null,null,1241.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C2630"},"TUFTS","TUFTS PPO","HCPCS","C2630","HC CATH;EP CRYOABLATION, 8 MM",null,4966,0,null,null,1241.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - C2635"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","C2635","BRACHYTX, NON-STR, HA, P-103",null,0,78.03,78.03,242.54,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - C2635"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","C2635","BRACHYTX, NON-STR, HA, P-103",null,0,78.03,78.03,242.54,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C2639"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C2639","BRACHYTX, NON-STRANDED,I-125",null,47,61.32,52.85,100.75,11.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C2639"},"TUFTS","TUFTS HMO","HCPCS","C2639","BRACHYTX, NON-STRANDED,I-125",null,47,52.85,52.85,100.75,11.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - C2639"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","C2639","BRACHYTX, NON-STRANDED,I-125",null,47,100.75,52.85,100.75,11.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - C2639"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","C2639","BRACHYTX, NON-STRANDED,I-125",null,47,100.75,52.85,100.75,11.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - C2639"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","C2639","BRACHYTX, NON-STRANDED,I-125",null,47,100.75,52.85,100.75,11.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C5275"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C5275","HC LOW COST SKIN SUBSTITUTE",null,743,1016.97,684.11,2032.26,185.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C5275"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C5275","HC LOW COST SKIN SUBSTITUTE",null,743,1042.56,684.11,2032.26,185.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA - HCPCS - C5275"},"AETNA","AETNA","HCPCS","C5275","HC LOW COST SKIN SUBSTITUTE",null,743,1500.85,684.11,2032.26,185.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - C5275"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","C5275","HC LOW COST SKIN SUBSTITUTE",null,743,810.95,684.11,2032.26,185.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - C5275"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","C5275","HC LOW COST SKIN SUBSTITUTE",null,743,810.95,684.11,2032.26,185.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C8908"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C8908","HC MRI W/O FOL W/CONT, BREAST,",null,579,664.1,664.1,4299.8,144.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C8908"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C8908","HC MRI W/O FOL W/CONT, BREAST,",null,579,664.1,664.1,4299.8,144.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C8908"},"TUFTS","TUFTS PPO","HCPCS","C8908","HC MRI W/O FOL W/CONT, BREAST,",null,579,1529.76,664.1,4299.8,144.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C8908"},"TUFTS","TUFTS SELECT","HCPCS","C8908","HC MRI W/O FOL W/CONT, BREAST,",null,579,667.78,664.1,4299.8,144.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C8937"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C8937","CAD BREAST MRI",null,331,0,null,null,82.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C9358"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C9358","SURGIMEND, FETAL",null,8526,0,24.42,24.42,2131.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C9728"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C9728","PLACE DEVICE/MARKER, NON PRO",null,1957,2573.36,2227.36,7098.97,489.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C9728"},"TUFTS","TUFTS POS","HCPCS","C9728","PLACE DEVICE/MARKER, NON PRO",null,1957,4183.66,2227.36,7098.97,489.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - C9728"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","C9728","PLACE DEVICE/MARKER, NON PRO",null,1957,3429.66,2227.36,7098.97,489.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C9739"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C9739","HC CYSTOSCOPY PROSTATIC IMP 1-3",null,6035,7812.32,2166.09,15242.01,1508.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C9739"},"TUFTS","TUFTS HMO","HCPCS","C9739","HC CYSTOSCOPY PROSTATIC IMP 1-3",null,6035,9609.09,2166.09,15242.01,1508.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - C9739"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","C9739","HC CYSTOSCOPY PROSTATIC IMP 1-3",null,6035,6751.98,2166.09,15242.01,1508.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C9803"},"TUFTS","TUFTS HMO","HCPCS","C9803","HC OP VISIT SPEC COLLECTION SEVERE ACUTE RESP SYDROM COVID-19",null,35,105.24,87.7,246.49,8.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C9803"},"TUFTS","TUFTS POS","HCPCS","C9803","HC OP VISIT SPEC COLLECTION SEVERE ACUTE RESP SYDROM COVID-19",null,35,87.7,87.7,246.49,8.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - D0150"},"TUFTS","TUFTS PPO","HCPCS","D0150","COMPREHENSIVE ORAL EXAM 60MIN",null,265,2563.83,1275.99,4066.77,66.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D0210"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D0210","INTRAORAL - COMPLETE SERIES OF RADIOGRAPHIC IMAGES",null,165,120.47,120.47,120.47,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D0210"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D0210","INTRAORAL - COMPLETE SERIES OF RADIOGRAPHIC IMAGES",null,165,120.47,120.47,120.47,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D0210"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D0210","INTRAORAL - COMPLETE SERIES OF RADIOGRAPHIC IMAGES",null,165,120.47,120.47,120.47,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - D0220"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","D0220","INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE",null,165,23.78,23.78,23.78,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D0250"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D0250","HC EXTRA-ORAL - 2D PROJECTION RAD IMAGE CREATED USING A STATIONARY RADIATION SOURCE, AND DETECTOR",null,1451,4066.77,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D0251"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D0251","HC EXTRA-ORAL POSTERIOR DENTAL RADIOGRAPHIC IMAGE",null,119,0,null,null,29.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D0270"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D0270","BITEWING - SINGLE RADIOGRAPHIC IMAGE",null,836,4066.77,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - D0270"},"TUFTS","TUFTS POS","HCPCS","D0270","BITEWING - SINGLE RADIOGRAPHIC IMAGE",null,836,2396.69,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - D0270"},"TUFTS","TUFTS PPO","HCPCS","D0270","BITEWING - SINGLE RADIOGRAPHIC IMAGE",null,836,2563.83,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - D0272"},"TUFTS","TUFTS HMO","HCPCS","D0272","BITEWINGS - TWO RADIOGRAPHIC IMAGES",null,836,2396.69,1182.5,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D0272"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D0272","BITEWINGS - TWO RADIOGRAPHIC IMAGES",null,836,1182.5,1182.5,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D0272"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D0272","BITEWINGS - TWO RADIOGRAPHIC IMAGES",null,836,1182.5,1182.5,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - D0472"},"TUFTS","TUFTS SELECT","HCPCS","D0472","HC ACCESSION OF TISSUE, GROSS EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN REPORT",null,110,1941.26,1941.26,6187.11,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - D0480"},"TUFTS","TUFTS SELECT","HCPCS","D0480","HC ACCESSION OF EXFOLIATIVE CYTOLOGIC SMEARS, MICROSCOPIC EXAM, PREP AND TRANS OF RPT",null,110,1941.26,1941.26,6187.11,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D1110"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D1110","PROPHYLAXIS - ADULT",null,110,163.22999999999999,51.21,163.22999999999999,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D1110"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D1110","PROPHYLAXIS - ADULT",null,110,84.56,51.21,163.22999999999999,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - D1110"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","D1110","PROPHYLAXIS - ADULT",null,110,84.56,51.21,163.22999999999999,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D1110"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D1110","PROPHYLAXIS - ADULT",null,110,84.56,51.21,163.22999999999999,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - D1120"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","D1120","PROPHYLAXIS - CHILD",null,110,57.92,57.92,57.92,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - D1510"},"TUFTS","TUFTS PPO","HCPCS","D1510","SPACE MAINTAINER - FIXED - UNILATERAL",null,836,2563.83,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - D1516"},"TUFTS","TUFTS HMO","HCPCS","D1516","SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MAXILLARY",null,1350,0,null,null,337.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - D1575"},"TUFTS","TUFTS HMO","HCPCS","D1575","HC DISTAL SHOE SPACE MAINTAINER ¿ FIXED ¿ UNILATERAL",null,1451,3237.33,1723.54,5493.21,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - D1575"},"TUFTS","TUFTS POS","HCPCS","D1575","HC DISTAL SHOE SPACE MAINTAINER ¿ FIXED ¿ UNILATERAL",null,1451,3237.33,1723.54,5493.21,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2330"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D2330","RESIN-BASED COMPOSITE - ONE SURFACE, ANTERIOR",null,110,121.33,121.33,121.33,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2331"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D2331","RESIN-BASED COMPOSITE - TWO SURFACES, ANTERIOR",null,110,154.99,154.99,154.99,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2332"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D2332","RESIN-BASED COMPOSITE - THREE SURFACES, ANTERIOR",null,110,189.47,189.47,189.47,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2391"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D2391","RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR",null,110,141.69,141.69,141.69,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2394"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D2394","RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR",null,110,282.64,282.64,282.64,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2394"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D2394","RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR",null,110,282.64,282.64,282.64,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2394"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D2394","RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR",null,110,282.64,282.64,282.64,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2740"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D2740","CROWN - PORCELAIN/CERAMIC SUBSTRATE",null,110,1036.53,1036.53,1036.53,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2930"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D2930","PREFABRICATED STAINLESS STEEL CROWN - PRIMARY TOOTH",null,110,228.61,228.61,228.61,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2931"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D2931","PREFABRICATED STAINLESS STEEL CROWN - PERMANENT TOOTH",null,110,259.95,259.95,259.95,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2940"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D2940","PROTECTIVE RESTORATION",null,110,87.67,87.67,87.67,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - D2999"},"TUFTS","TUFTS POS","HCPCS","D2999","HC UNSPECIFIED RESTORATIVE PROCEDURE, BY REPORT",null,1451,2396.69,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - D2999"},"TUFTS","TUFTS PPO","HCPCS","D2999","HC UNSPECIFIED RESTORATIVE PROCEDURE, BY REPORT",null,1451,2563.83,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D3110"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D3110","HC PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION)",null,110,68.89,68.89,68.89,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D3110"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D3110","HC PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION)",null,110,68.89,68.89,68.89,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D3110"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D3110","HC PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION)",null,110,68.89,68.89,68.89,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D3220"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D3220","THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) - REMOVAL OF PULP CORONAL TO THE DENTINOCEMENTAL JUNCTION AND APPLICATION OF MEDICAMENT",null,110,141.69,141.69,141.69,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D3310"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D3310","ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION)",null,110,587.95000000000005,587.95000000000005,587.95000000000005,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D3330"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D3330","ENDODONTIC THERAPY, MOLAR (EXCLUDING FINAL RESTORATION)",null,110,894.85,894.85,894.85,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - D3460"},"TUFTS","TUFTS POS","HCPCS","D3460","HC ENDODONTIC ENDOSSEOUS IMPLANT",null,1451,2396.69,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - D3999"},"TUFTS","TUFTS PPO","HCPCS","D3999","HC UNSPECIFIED ENDODONTIC PROCEDURE, BY REPORT",null,1451,2563.83,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - D4260"},"TUFTS","TUFTS POS","HCPCS","D4260","HC OSSEOUS SURGERY FOUR OR MORE CONT. TEETH OR TOOTH BOUNDED SPACES PER QUAD.",null,1451,2396.69,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D4263"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D4263","HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ FIRST SITE IN QUADRANT",null,1451,4066.77,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D4264"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D4264","HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ EACH ADDITIONAL SITE IN QUADRANT",null,1451,4066.77,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D4355"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D4355","FULL MOUTH DEBRIDEMENT TO ENABLE COMPREHENSIVE EVALUATION AND DIAGNOSIS",null,836,4066.77,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - D4355"},"TUFTS","TUFTS HMO","HCPCS","D4355","FULL MOUTH DEBRIDEMENT TO ENABLE COMPREHENSIVE EVALUATION AND DIAGNOSIS",null,836,2396.69,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D5912"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D5912","HC FACIAL MOULAGE (COMPLETE)",null,1451,4066.77,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - D5912"},"TUFTS","TUFTS HMO","HCPCS","D5912","HC FACIAL MOULAGE (COMPLETE)",null,1451,2396.69,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - D5912"},"TUFTS","TUFTS PPO","HCPCS","D5912","HC FACIAL MOULAGE (COMPLETE)",null,1451,2563.83,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - D5983"},"TUFTS","TUFTS SELECT","HCPCS","D5983","HC RADIATION CARRIER",null,1451,1275.99,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - D7140"},"TUFTS","TUFTS SELECT","HCPCS","D7140","EXTRACTION ERUPTED TOOTH/EXR",null,836,1275.99,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - D7210"},"TUFTS","TUFTS POS","HCPCS","D7210","EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED",null,836,2396.69,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - D7210"},"TUFTS","TUFTS SELECT","HCPCS","D7210","EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED",null,836,1275.99,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - D7220"},"TUFTS","TUFTS SELECT","HCPCS","D7220","REMOVAL OF IMPACTED TOOTH - SOFT TISSUE",null,836,1275.99,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D7240"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D7240","REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY",null,836,1510.05,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D7240"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D7240","REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY",null,836,1510.05,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D7240"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D7240","REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY",null,836,1510.05,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - D7250"},"TUFTS","TUFTS PPO","HCPCS","D7250","REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)",null,836,2563.83,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - D7250"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","D7250","REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)",null,836,1510.05,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D7250"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D7250","REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)",null,836,1510.05,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D7250"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D7250","REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)",null,836,1510.05,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - D7261"},"TUFTS","TUFTS PPO","HCPCS","D7261","PRIMARY CLOSURE OF A SINUS PERFORATION",null,836,2563.83,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - D7261"},"TUFTS","TUFTS SELECT","HCPCS","D7261","PRIMARY CLOSURE OF A SINUS PERFORATION",null,836,1275.99,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D7310"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D7310","ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH SPACES, PER QUADRANT",null,110,230.94,230.94,230.94,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D7311"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D7311","ALVEOLOPLASTY W/EXTRACT 1-3",null,110,202.78,202.78,202.78,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D7410"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D7410","EXCISION OF BENIGN LESION UP TO 1.25 CM",null,110,692.83,692.83,692.83,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D7410"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D7410","EXCISION OF BENIGN LESION UP TO 1.25 CM",null,110,692.83,692.83,692.83,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - D9930"},"TUFTS","TUFTS POS","HCPCS","D9930","HC TREATMENT OF COMPLICATIONS (POST-SURGICAL) - UNUSUAL CIRCUMSTANCES, BY REPORT",null,1451,2396.69,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - E0191"},"FALLON","FALLON SENIOR PLAN","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","UE",321,8.66,11.61,52.13,80.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - E0191"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","RR",321,2.09,11.61,52.13,80.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - E0191"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","NU",321,13.7,11.61,52.13,80.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - E0191"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","NU",321,25.66,11.61,52.13,80.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - G0101"},"FALLON","FALLON MEDICAID","HCPCS","G0101","CA SCREEN;PELVIC/BREAST EXAM",null,148,0,18.010000000000002,128.29,37,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0101"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0101","CA SCREEN;PELVIC/BREAST EXAM",null,148,0,18.010000000000002,128.29,37,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0101"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0101","CA SCREEN;PELVIC/BREAST EXAM",null,148,128.29,18.010000000000002,128.29,37,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - G0103"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","G0103","PSA, TOTAL SCREENING",null,93,37.200000000000003,16.78,181.16,23.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - G0103"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","G0103","PSA, TOTAL SCREENING",null,93,25.23,16.78,181.16,23.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - G0103"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","G0103","PSA, TOTAL SCREENING",null,93,19.309999999999999,16.78,181.16,23.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0103"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0103","PSA, TOTAL SCREENING",null,93,44.13,16.78,181.16,23.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - G0103"},"TUFTS","TUFTS HMO","HCPCS","G0103","PSA, TOTAL SCREENING",null,93,72.3,16.78,181.16,23.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - G0103"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","G0103","PSA, TOTAL SCREENING",null,93,28,16.78,181.16,23.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - G0103"},"TUFTS","TUFTS PPO","HCPCS","G0103","PSA, TOTAL SCREENING",null,93,64.45,16.78,181.16,23.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - G0103"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","G0103","PSA, TOTAL SCREENING",null,93,22.79,16.78,181.16,23.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0103"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0103","PSA, TOTAL SCREENING",null,93,41.5,16.78,181.16,23.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - G0103"},"BMC HEALTHNET","BMCHN MCO","HCPCS","G0103","PSA, TOTAL SCREENING",null,93,16.78,16.78,181.16,23.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - G0103"},"BMC HEALTHNET","BMCHN ACO","HCPCS","G0103","PSA, TOTAL SCREENING",null,93,36.71,16.78,181.16,23.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0105"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0105","HC COLORECTAL SCRN; HI RISK IND",null,1152,3264.67,1020.59,3264.67,288,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA - HCPCS - G0105"},"AETNA","AETNA","HCPCS","G0105","HC COLORECTAL SCRN; HI RISK IND",null,1152,1500.85,1020.59,3264.67,288,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0108"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0108","DIAB MANAGE TRN  PER INDIV",null,425,230.78,72.41,230.78,106.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0108"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0108","DIAB MANAGE TRN  PER INDIV",null,425,121.38,72.41,230.78,106.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0108"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0108","DIAB MANAGE TRN  PER INDIV",null,425,121.38,72.41,230.78,106.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - G0108"},"TUFTS","TUFTS HMO","HCPCS","G0108","DIAB MANAGE TRN  PER INDIV",null,425,136.01,72.41,230.78,106.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0108"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0108","DIAB MANAGE TRN  PER INDIV",null,425,136.19,72.41,230.78,106.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0127"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0127","TRIM NAIL(S)",null,189,120.69,93.87,317.35000000000002,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - G0127"},"TUFTS","TUFTS PPO","HCPCS","G0127","TRIM NAIL(S)",null,189,200.07,93.87,317.35000000000002,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0127"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0127","TRIM NAIL(S)",null,189,0,93.87,317.35000000000002,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0127"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0127","TRIM NAIL(S)",null,189,93.87,93.87,317.35000000000002,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - G0175"},"TUFTS","TUFTS POS","HCPCS","G0175","OPPS SERVICE,SCHED TEAM CONF",null,565,1199.72,638.73,2035.73,141.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - G0175"},"BMC HEALTHNET","BMCHN MCO","HCPCS","G0175","OPPS SERVICE,SCHED TEAM CONF",null,565,0,638.73,2035.73,141.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0239"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0239","OTH RESP PROC, GROUP",null,99,67.64,53.94,373.41,24.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0239"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0239","OTH RESP PROC, GROUP",null,99,69.349999999999994,53.94,373.41,24.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - G0239"},"TUFTS","TUFTS HMO","HCPCS","G0239","OTH RESP PROC, GROUP",null,99,149.03,53.94,373.41,24.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0239"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0239","OTH RESP PROC, GROUP",null,99,53.94,53.94,373.41,24.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0239"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0239","OTH RESP PROC, GROUP",null,99,53.94,53.94,373.41,24.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - G0257"},"BMC HEALTHNET","BMCHN ACO","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP",null,911,0,1027.32,3651.55,227.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0259"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0259","HC INJECT FOR SACROILIAC JOINT",null,1513,0,1198.25,1198.25,378.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - G0259"},"TUFTS","TUFTS PPO","HCPCS","G0259","HC INJECT FOR SACROILIAC JOINT",null,1513,0,1198.25,1198.25,378.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0259"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0259","HC INJECT FOR SACROILIAC JOINT",null,1513,0,1198.25,1198.25,378.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - G0259"},"BMC HEALTHNET","BMCHN ACO","HCPCS","G0259","HC INJECT FOR SACROILIAC JOINT",null,1513,0,1198.25,1198.25,378.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0259"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0259","HC INJECT FOR SACROILIAC JOINT",null,1513,0,1198.25,1198.25,378.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - G0260"},"TUFTS","TUFTS SELECT","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH",null,817,1090.04,1005.62,3474.13,204.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0260"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH",null,817,1005.62,1005.62,3474.13,204.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0260"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH",null,817,1005.62,1005.62,3474.13,204.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - G0260"},"BMC HEALTHNET","BMCHN MCO","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH",null,817,0,1005.62,3474.13,204.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - G0260"},"BMC HEALTHNET","BMCHN QHP","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH",null,817,0,1005.62,3474.13,204.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - G0269"},"FALLON","FALLON MEDICAID","HCPCS","G0269","HC CLOSURE DEVICE PLACEMENT",null,200,0,null,null,50,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - G0278"},"FALLON","FALLON MEDICAID","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH",null,3138,0,34.229999999999997,34.229999999999997,784.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0278"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH",null,3138,0,34.229999999999997,34.229999999999997,784.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0278"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH",null,3138,0,34.229999999999997,34.229999999999997,784.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0278"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH",null,3138,34.229999999999997,34.229999999999997,34.229999999999997,784.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0279"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0279","TOMOSYNTHESIS, MAMMO",null,55,31.88,30.09,295.68,13.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0279"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G0279","TOMOSYNTHESIS, MAMMO",null,55,32.69,30.09,295.68,13.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - G0279"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","G0279","TOMOSYNTHESIS, MAMMO",null,55,35.51,30.09,295.68,13.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0279"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0279","TOMOSYNTHESIS, MAMMO",null,55,51.68,30.09,295.68,13.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0297"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN",null,1437,107.22,107.22,801.26,359.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0297"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN",null,1437,178.43,107.22,801.26,359.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0297"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN",null,1437,178.43,107.22,801.26,359.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - G0297"},"BMC HEALTHNET","BMCHN ACO","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN",null,1437,0,107.22,801.26,359.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0365"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0365","HC VESSEL MAPPING HEMO ACCESS",null,498,0,272.02999999999997,867.01,124.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - G0378"},"TUFTS","TUFTS HMO","HCPCS","G0378","HOSPITAL OBSERVATION PER HR",null,319,0,null,null,79.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - G0379"},"TUFTS","TUFTS PPO","HCPCS","G0379","DIRECT REFER HOSPITAL OBSERV",null,752,1757.21,874.54,2787.3,188,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0389"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0389","ULTRASOUND EXAM AAA SCREEN",null,544,0,null,null,136,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0389"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0389","ULTRASOUND EXAM AAA SCREEN",null,544,0,null,null,136,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0390"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI",null,3274,0,1579.83,5035.18,818.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - G0390"},"TUFTS","TUFTS POS","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI",null,3274,2967.4,1579.83,5035.18,818.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0390"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI",null,3274,0,1579.83,5035.18,818.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0390"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI",null,3274,1587.59,1579.83,5035.18,818.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0396"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN",null,42,56.05,56.05,336.32,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - G0397"},"TUFTS","TUFTS PPO","HCPCS","G0397","ALCOHOL/SUBS INTERV >30 MIN",null,118,290.27999999999997,128.29,815.89,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0397"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0397","ALCOHOL/SUBS INTERV >30 MIN",null,118,0,128.29,815.89,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0397"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0397","ALCOHOL/SUBS INTERV >30 MIN",null,118,128.29,128.29,815.89,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0402"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0402","INITIAL PREVENTIVE EXAM",null,168,0,208.89,1179.72,42,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0402"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0402","INITIAL PREVENTIVE EXAM",null,168,0,208.89,1179.72,42,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - G0402"},"BMC HEALTHNET","BMCHN MCO","HCPCS","G0402","INITIAL PREVENTIVE EXAM",null,168,0,208.89,1179.72,42,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - G0410"},"BMC HEALTHNET","BMCHN QHP","HCPCS","G0410","HC GRP PSYCH PARTIAL HOSP 45-50",null,220,0,null,null,55,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - G0416"},"TUFTS","TUFTS HMO","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD",null,425,980.58,360.63,2456.98,106.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - G0416"},"TUFTS","TUFTS SELECT","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD",null,425,435.04,360.63,2456.98,106.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0416"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD",null,425,0,360.63,2456.98,106.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0416"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD",null,425,360.63,360.63,2456.98,106.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0416"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD",null,425,360.63,360.63,2456.98,106.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0420"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0420","HC ED SVC CKD IND PER SESSION",null,156,589.33000000000004,184.9,589.33000000000004,39,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0420"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0420","HC ED SVC CKD IND PER SESSION",null,156,0,184.9,589.33000000000004,39,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0423"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER",null,169,637.79,198.42,637.79,42.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - G0423"},"TUFTS","TUFTS HMO","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER",null,169,375.87,198.42,637.79,42.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - G0423"},"TUFTS","TUFTS SELECT","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER",null,169,200.11,198.42,637.79,42.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0424"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0424","PULMONARY REHAB W EXER",null,284,117.73,93.87,343.09,71,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - G0424"},"TUFTS","TUFTS HMO","HCPCS","G0424","PULMONARY REHAB W EXER",null,284,202.19,93.87,343.09,71,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - G0424"},"TUFTS","TUFTS SELECT","HCPCS","G0424","PULMONARY REHAB W EXER",null,284,107.65,93.87,343.09,71,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0424"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0424","PULMONARY REHAB W EXER",null,284,93.87,93.87,343.09,71,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0438"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0438","PPPS, INITIAL VISIT",null,547,0,34.03,61.76,136.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - G0439"},"TUFTS","TUFTS PPO","HCPCS","G0439","PPPS, SUBSEQ VISIT",null,327,38.93,34.03,61.76,81.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - G0439"},"TUFTS","TUFTS SELECT","HCPCS","G0439","PPPS, SUBSEQ VISIT",null,327,34.03,34.03,61.76,81.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0442"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0442","ANNUAL ALCOHOL SCREEN 15 MIN",null,42,13.34,13.34,33.6,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - G0443"},"BMC HEALTHNET","BMCHN ACO","HCPCS","G0443","BRIEF ALCOHOL MISUSE COUNSEL",null,118,0,18.52,33.6,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0443"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0443","BRIEF ALCOHOL MISUSE COUNSEL",null,118,0,18.52,33.6,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - G0443"},"BMC HEALTHNET","BMCHN QHP","HCPCS","G0443","BRIEF ALCOHOL MISUSE COUNSEL",null,118,0,18.52,33.6,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - G0444"},"FALLON","FALLON MEDICAID","HCPCS","G0444","DEPRESSION SCREEN ANNUAL",null,42,0,8.9,16.149999999999999,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0445"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0445","HIGH INTEN BEH COUNS STD 30M",null,118,0,8.9,16.149999999999999,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - G0480"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES",null,254,137.32,59.69,973.54,63.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - G0480"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES",null,254,137.32,59.69,973.54,63.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - G0480"},"FALLON","FALLON SENIOR PLAN","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES",null,254,114.43,59.69,973.54,63.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - G0480"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES",null,254,165.92,59.69,973.54,63.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - HCPCS - G0480"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES",null,254,70.260000000000005,59.69,973.54,63.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0480"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES",null,254,71.63,59.69,973.54,63.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0480"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES",null,254,209.48,59.69,973.54,63.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0481"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES",null,192,329.78,91.84,1332.11,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - G0481"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES",null,192,338.08,91.84,1332.11,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - G0481"},"TUFTS","TUFTS PPO","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES",null,192,473.93,91.84,1332.11,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - G0481"},"TUFTS","TUFTS SELECT","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES",null,192,235.87,91.84,1332.11,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - G0481"},"TUFTS","TUFTS SPIRIT","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES",null,192,172.25,91.84,1332.11,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0481"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES",null,192,108.37,91.84,1332.11,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0481"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES",null,192,286.56,91.84,1332.11,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0506"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC",null,62,110.9,110.9,110.9,15.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0513"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M",null,84,0,148.6,148.6,21,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0513"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M",null,84,0,148.6,148.6,21,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0513"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M",null,84,148.6,148.6,148.6,21,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - G0513"},"BMC HEALTHNET","BMCHN ACO","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M",null,84,0,148.6,148.6,21,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - G0514"},"TUFTS","TUFTS PPO","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M",null,84,0,148.6,148.6,21,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - G0514"},"TUFTS","TUFTS SELECT","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M",null,84,0,148.6,148.6,21,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0514"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M",null,84,0,148.6,148.6,21,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0514"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M",null,84,148.6,148.6,148.6,21,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0514"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M",null,84,148.6,148.6,148.6,21,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - G2011"},"TUFTS","TUFTS HMO","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS",null,35,78.89,28.83,133.88,8.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - G2011"},"TUFTS","TUFTS POS","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS",null,35,78.89,28.83,133.88,8.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - G2011"},"TUFTS","TUFTS SELECT","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS",null,35,42.01,28.83,133.88,8.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G2011"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS",null,35,0,28.83,133.88,8.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - G2011"},"BMC HEALTHNET","BMCHN MCO","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS",null,35,0,28.83,133.88,8.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - G2012"},"TUFTS","TUFTS POS","HCPCS","G2012","HC BRIEF CHECK IN BY MD/QHP",null,42,0,31.78,31.78,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G2012"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G2012","HC BRIEF CHECK IN BY MD/QHP",null,42,31.78,31.78,31.78,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G2023"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS",null,31,212.71,23.46,212.71,7.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - G2023"},"FALLON","FALLON SENIOR PLAN","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS",null,31,23.46,23.46,212.71,7.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - G2023"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS",null,31,34.020000000000003,23.46,212.71,7.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - G2023"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS",null,31,34.020000000000003,23.46,212.71,7.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - G2023"},"TUFTS","TUFTS PPO","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS",null,31,75.680000000000007,23.46,212.71,7.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - G2023"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS",null,31,26.99,23.46,212.71,7.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G2023"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS",null,31,26.99,23.46,212.71,7.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - G2023"},"BMC HEALTHNET","BMCHN QHP","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS",null,31,28.15,23.46,212.71,7.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - G2024"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",null,33,44.3,25.46,230.84,8.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G2024"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","CG",33,54.6,25.46,230.84,8.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G2024"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",null,33,29.29,25.46,230.84,8.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G2024"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",null,33,29.29,25.46,230.84,8.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - G2066"},"FALLON","FALLON MEDICAID","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH",null,165,0,58.35,370.47,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G2066"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH",null,165,58.35,58.35,370.47,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - G2066"},"BMC HEALTHNET","BMCHN ACO","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH",null,165,0,58.35,370.47,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G2087"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G2087","HC OFF BASE OPIOID TX, 60 M",null,194,211.43,46.18,211.43,48.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - G2087"},"BMC HEALTHNET","BMCHN QHP","HCPCS","G2087","HC OFF BASE OPIOID TX, 60 M",null,194,0,46.18,211.43,48.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G2088"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G2088","HC OFF BASE OPIOID TX, ADD30",null,45,82.11,82.11,82.11,11.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - G2216"},"FALLON","FALLON MEDICAID","HCPCS","G2216","HC HOME SUPPLY INJECT NALOXON",null,118,0,null,null,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - L0120"},"TUFTS","TUFTS HMO","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE",null,25,44.54,24.86,111.59,6.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L0120"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE",null,25,33.520000000000003,24.86,111.59,6.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - L0120"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE",null,25,36.19,24.86,111.59,6.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - L0140"},"TUFTS","TUFTS PPO","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB",null,189,123.8,77.52,347.97,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L0140"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB",null,189,0,77.52,347.97,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - L1820"},"TUFTS","TUFTS SPIRIT","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO",null,159,156.85,142.59,640.03,39.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L1820"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO",null,159,192.24,142.59,640.03,39.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L1820"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO",null,159,207.54,142.59,640.03,39.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - L1820"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO",null,159,207.54,142.59,640.03,39.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L1820"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO",null,159,207.54,142.59,640.03,39.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - L1820"},"BMC HEALTHNET","BMCHN ACO","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO",null,159,0,142.59,640.03,39.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L1830"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT",null,78,98.34,81.95,367.86,19.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L1830"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT",null,78,81.95,81.95,367.86,19.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L1830"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT",null,78,176.93,81.95,367.86,19.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - L1830"},"TUFTS","TUFTS HMO","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT",null,78,146.82,81.95,367.86,19.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L1830"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT",null,78,118.83,81.95,367.86,19.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L1830"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT",null,78,181.1,81.95,367.86,19.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L1832"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT",null,1523,1002.51,743.59,3337.75,380.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L1832"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT",null,1523,1082.26,743.59,3337.75,380.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L1836"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L1836","HC RIGID KO WO JOINTS",null,209,130.47999999999999,130.47999999999999,585.70000000000005,52.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - L1836"},"TUFTS","TUFTS SPIRIT","HCPCS","L1836","HC RIGID KO WO JOINTS",null,209,143.53,130.47999999999999,585.70000000000005,52.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L1836"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","L1836","HC RIGID KO WO JOINTS",null,209,189.91,130.47999999999999,585.70000000000005,52.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L1836"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L1836","HC RIGID KO WO JOINTS",null,209,328.31,130.47999999999999,585.70000000000005,52.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L1902"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L1902","AFO ANKLE GAUNTLET",null,219,86.14,86.14,386.65,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L1902"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L1902","AFO ANKLE GAUNTLET",null,219,86.14,86.14,386.65,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L1902"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L1902","AFO ANKLE GAUNTLET",null,219,86.14,86.14,386.65,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L1902"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L1902","AFO ANKLE GAUNTLET",null,219,124.9,86.14,386.65,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L1902"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L1902","AFO ANKLE GAUNTLET",null,219,116.13,86.14,386.65,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L1902"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L1902","AFO ANKLE GAUNTLET",null,219,0,86.14,386.65,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L1902"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L1902","AFO ANKLE GAUNTLET",null,219,125.37,86.14,386.65,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - L3260"},"TUFTS","TUFTS PPO","HCPCS","L3260","AMBULATORY SURGICAL BOOT EAC",null,279,127.35,31.12,357.96,69.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L3350"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L3350","SHOE HEEL WEDGE",null,41,22.41,22.41,100.59,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L3350"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L3350","SHOE HEEL WEDGE",null,41,22.41,22.41,100.59,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L3350"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L3350","SHOE HEEL WEDGE",null,41,48.38,22.41,100.59,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3350"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L3350","SHOE HEEL WEDGE",null,41,0,22.41,100.59,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - L3496"},"BMC HEALTHNET","BMCHN QHP","HCPCS","L3496","HC STATIC AFO",null,406,0,null,null,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L3650"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN",null,1955,67.38,67.38,302.45,488.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3650"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN",null,1955,0,67.38,302.45,488.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L3650"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN",null,1955,98.07,67.38,302.45,488.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - L3650"},"BMC HEALTHNET","BMCHN MCO","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN",null,1955,0,67.38,302.45,488.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - L3670"},"TUFTS","TUFTS POS","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE",null,2903,154.74,103.65,465.27,725.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - L3670"},"TUFTS","TUFTS SPIRIT","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE",null,2903,114.02,103.65,465.27,725.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L3670"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE",null,2903,150.86000000000001,103.65,465.27,725.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - L3670"},"BMC HEALTHNET","BMCHN QHP","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE",null,2903,0,103.65,465.27,725.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L3760"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L3760","EO WITHJOINT, PREFABRICATED",null,819,445.02,445.02,1997.57,204.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L3760"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L3760","EO WITHJOINT, PREFABRICATED",null,819,445.02,445.02,1997.57,204.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3760"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L3760","EO WITHJOINT, PREFABRICATED",null,819,0,445.02,1997.57,204.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3760"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L3760","EO WITHJOINT, PREFABRICATED",null,819,0,445.02,1997.57,204.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L3760"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L3760","EO WITHJOINT, PREFABRICATED",null,819,647.70000000000005,445.02,1997.57,204.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - L3762"},"FALLON","FALLON MEDICAID","HCPCS","L3762","RIGID EO WO JOINTS",null,57,0,95.68,429.49,14.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L3762"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L3762","RIGID EO WO JOINTS",null,57,240.75,95.68,429.49,14.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L3807"},"UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED",null,483,464.46,222.52,998.85,120.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L3807"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED",null,483,480.42,222.52,998.85,120.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L3807"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED",null,483,262.57,222.52,998.85,120.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3807"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED",null,483,0,222.52,998.85,120.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L3808"},"UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L3808","HC EPITRAIN",null,509,784.67,375.94,1687.5,127.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - L3808"},"FALLON","FALLON MEDICAID","HCPCS","L3808","HC EPITRAIN",null,509,0,375.94,1687.5,127.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L3808"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L3808","HC EPITRAIN",null,509,545.11,375.94,1687.5,127.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3808"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L3808","HC EPITRAIN",null,509,0,375.94,1687.5,127.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L3808"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L3808","HC EPITRAIN",null,509,547.16999999999996,375.94,1687.5,127.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3808"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L3808","HC EPITRAIN",null,509,0,375.94,1687.5,127.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - L3808"},"BMC HEALTHNET","BMCHN QHP","HCPCS","L3808","HC EPITRAIN",null,509,0,375.94,1687.5,127.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L3905"},"UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF",null,2442,1841.99,882.51,3961.32,610.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L3905"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF",null,2442,1284.45,882.51,3961.32,610.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L3905"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF",null,2442,1284.45,882.51,3961.32,610.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - L3905"},"BMC HEALTHNET","BMCHN ACO","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF",null,2442,0,882.51,3961.32,610.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L3905"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF",null,2442,1950.24,882.51,3961.32,610.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - L3905"},"BMC HEALTHNET","BMCHN MCO","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF",null,2442,0,882.51,3961.32,610.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - L3908"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","L3908","WRIST COCK-UP NON-MOLDED",null,143,106.17,73.22,328.66,35.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - L3908"},"TUFTS","TUFTS PPO","HCPCS","L3908","WRIST COCK-UP NON-MOLDED",null,143,116.93,73.22,328.66,35.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - L3908"},"TUFTS","TUFTS SPIRIT","HCPCS","L3908","WRIST COCK-UP NON-MOLDED",null,143,80.540000000000006,73.22,328.66,35.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L3908"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L3908","WRIST COCK-UP NON-MOLDED",null,143,106.57,73.22,328.66,35.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L3908"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L3908","WRIST COCK-UP NON-MOLDED",null,143,106.57,73.22,328.66,35.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - L3908"},"BMC HEALTHNET","BMCHN ACO","HCPCS","L3908","WRIST COCK-UP NON-MOLDED",null,143,0,73.22,328.66,35.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3967"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF",null,117,0,1765.23,7923.54,29.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3967"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF",null,117,0,1765.23,7923.54,29.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L3967"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF",null,117,2569.1999999999998,1765.23,7923.54,29.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L3980"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL",null,132,377.84,377.84,1695.98,33,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L3980"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL",null,132,815.76,377.84,1695.98,33,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - L3980"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL",null,132,547.87,377.84,1695.98,33,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L3980"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL",null,132,509.4,377.84,1695.98,33,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3982"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL",null,176,477.88,398.23,1787.56,44,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3982"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL",null,176,0,398.23,1787.56,44,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - L4350"},"TUFTS","TUFTS HMO","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB",null,360,174.28,97.28,436.66,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L4350"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB",null,360,131.15,97.28,436.66,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L4350"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB",null,360,141.58000000000001,97.28,436.66,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L4350"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB",null,360,141.58000000000001,97.28,436.66,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L4350"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB",null,360,214.98,97.28,436.66,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L4360"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB",null,557,415,345.83,1552.36,139.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L4360"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB",null,557,746.65,345.83,1552.36,139.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L4360"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB",null,557,501.45,345.83,1552.36,139.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - L4360"},"TUFTS","TUFTS SELECT","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB",null,557,516.29999999999995,345.83,1552.36,139.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L4360"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB",null,557,408.08,345.83,1552.36,139.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L4360"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB",null,557,503.35,345.83,1552.36,139.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L4360"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB",null,557,764.24,345.83,1552.36,139.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - L4360"},"BMC HEALTHNET","BMCHN MCO","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB",null,557,0,345.83,1552.36,139.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L4360"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB",null,557,0,345.83,1552.36,139.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L4370"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT",null,107,235.79,235.79,1058.3900000000001,26.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - L4370"},"TUFTS","TUFTS SPIRIT","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT",null,107,259.37,235.79,1058.3900000000001,26.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L4370"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT",null,107,278.23,235.79,1058.3900000000001,26.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - L4386"},"TUFTS","TUFTS SELECT","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB",null,165,231.43,155.02000000000001,695.83,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - L4386"},"BMC HEALTHNET","BMCHN QHP","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB",null,165,0,155.02000000000001,695.83,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L4396"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L4396","STATIC AFO",null,406,202.28,171.42,769.43,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L4396"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L4396","STATIC AFO",null,406,249.49,171.42,769.43,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - L4396"},"BMC HEALTHNET","BMCHN QHP","HCPCS","L4396","STATIC AFO",null,406,0,171.42,769.43,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L4398"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT",null,406,94.7,78.92,354.25,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L4398"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT",null,406,78.92,78.92,354.25,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L4398"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT",null,406,137.32,78.92,354.25,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L4398"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT",null,406,0,78.92,354.25,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L4398"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT",null,406,114.87,78.92,354.25,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L4398"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT",null,406,114.87,78.92,354.25,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - L4398"},"BMC HEALTHNET","BMCHN ACO","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT",null,406,0,78.92,354.25,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L4398"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT",null,406,0,78.92,354.25,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L8501"},"UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE",null,219,335.51,160.74,721.54,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - L8501"},"TUFTS","TUFTS SELECT","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE",null,219,239.98,160.74,721.54,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - L8501"},"BMC HEALTHNET","BMCHN ACO","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE",null,219,0,160.74,721.54,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L8501"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE",null,219,355.22,160.74,721.54,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L8507"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)",null,1604,49.24,41.03,184.14,401,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L8507"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)",null,1604,41.03,41.03,184.14,401,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - L8507"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)",null,1604,59.49,41.03,184.14,401,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L8507"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)",null,1604,48.42,41.03,184.14,401,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L8507"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)",null,1604,0,41.03,184.14,401,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L8509"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN",null,1144,106.99,106.99,480.27,286,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L8509"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN",null,1144,155.72999999999999,106.99,480.27,286,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L8509"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN",null,1144,155.72999999999999,106.99,480.27,286,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L8514"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR",null,387,110.86,92.38,414.69,96.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L8514"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR",null,387,199.45,92.38,414.69,96.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L8514"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR",null,387,232.45,92.38,414.69,96.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L8693"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT",null,1462,1485.57,1485.57,6668.25,365.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L8693"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT",null,1462,2162.1799999999998,1485.57,6668.25,365.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L8693"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT",null,1462,3282.93,1485.57,6668.25,365.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - L8693"},"BMC HEALTHNET","BMCHN MCO","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT",null,1462,0,1485.57,6668.25,365.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L8693"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT",null,1462,0,1485.57,6668.25,365.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - L8693"},"BMC HEALTHNET","BMCHN QHP","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT",null,1462,0,1485.57,6668.25,365.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L8699"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L8699","HC CARTIFORM 20 X 25 MM DISC",null,13957,0,null,null,3489.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - M0239"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",null,393,309.60000000000002,309.60000000000002,779.02,98.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - M0239"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",null,393,365.33,309.60000000000002,779.02,98.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - M0243"},"FALLON","FALLON MEDICAID","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",null,572,309.60000000000002,309.60000000000002,779.02,143,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - M0243"},"FALLON","FALLON SENIOR PLAN","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",null,572,309.60000000000002,309.60000000000002,779.02,143,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - M0243"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",null,572,518.74,309.60000000000002,779.02,143,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - M0243"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",null,572,518.74,309.60000000000002,779.02,143,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - M0243"},"BMC HEALTHNET","BMCHN MCO","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",null,572,309.60000000000002,309.60000000000002,779.02,143,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9012"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","P9012","HC CRYOPRECIPITATE UNIT",null,134,104.04,64.959999999999994,125.33,33.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9012"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","P9012","HC CRYOPRECIPITATE UNIT",null,134,106.65,64.959999999999994,125.33,33.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9012"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","P9012","HC CRYOPRECIPITATE UNIT",null,134,106.65,64.959999999999994,125.33,33.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - P9012"},"TUFTS","TUFTS PPO","HCPCS","P9012","HC CRYOPRECIPITATE UNIT",null,134,79.010000000000005,64.959999999999994,125.33,33.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9016"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","P9016","HC RBC:LEU-RED",null,576,243.01,243.01,478.65,144,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - P9017"},"TUFTS","TUFTS HMO","HCPCS","P9017","HC FF PLAS: 1 DONOR",null,291,128.31,94.07,217.72,72.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9017"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","P9017","HC FF PLAS: 1 DONOR",null,291,94.07,94.07,217.72,72.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - P9021"},"TUFTS","TUFTS PPO","HCPCS","P9021","HC RBC/UNIT",null,323,223.33,184.28,354.25,80.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - P9021"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","P9021","HC RBC/UNIT",null,323,184.28,184.28,354.25,80.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - P9034"},"TUFTS","TUFTS SELECT","HCPCS","P9034","HB PLATELETS, PHERESIS",null,506,471.32,443.29,799.73,126.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - P9034"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","P9034","HB PLATELETS, PHERESIS",null,506,443.29,443.29,799.73,126.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9034"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","P9034","HB PLATELETS, PHERESIS",null,506,443.29,443.29,799.73,126.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9034"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","P9034","HB PLATELETS, PHERESIS",null,506,443.29,443.29,799.73,126.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - P9037"},"TUFTS","TUFTS HMO","HCPCS","P9037","HC PLT:PHER,LEU-RED,IRR/UNIT",null,939,956.33,821.84,1622.67,234.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9037"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","P9037","HC PLT:PHER,LEU-RED,IRR/UNIT",null,939,821.84,821.84,1622.67,234.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9040"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","P9040","HC RBC:LEU-RED,IRR/UNIT",null,523,551.79999999999995,336.11,669.97,130.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - P9040"},"TUFTS","TUFTS HMO","HCPCS","P9040","HC RBC:LEU-RED,IRR/UNIT",null,523,394.85,336.11,669.97,130.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - P9040"},"TUFTS","TUFTS SELECT","HCPCS","P9040","HC RBC:LEU-RED,IRR/UNIT",null,523,394.85,336.11,669.97,130.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9040"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","P9040","HC RBC:LEU-RED,IRR/UNIT",null,523,336.11,336.11,669.97,130.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - P9040"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","P9040","HC RBC:LEU-RED,IRR/UNIT",null,523,336.11,336.11,669.97,130.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9040"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","P9040","HC RBC:LEU-RED,IRR/UNIT",null,523,336.11,336.11,669.97,130.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9044"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","P9044","HC CRYOPRECIPITATE REDUCED PLASMA",null,133,191.57,144.19999999999999,244.67,33.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - P9044"},"TUFTS","TUFTS SELECT","HCPCS","P9044","HC CRYOPRECIPITATE REDUCED PLASMA",null,133,144.19999999999999,144.19999999999999,244.67,33.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - P9045"},"UNICARE","UNICARE","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML",null,238,54.43,52.45,131.97,59.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - P9045"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML",null,238,52.45,52.45,131.97,59.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9045"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML",null,238,113.24,52.45,131.97,59.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9045"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML",null,238,60.32,52.45,131.97,59.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - P9045"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML",null,238,115.91,52.45,131.97,59.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9056"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","P9056","HC BLOOD, L/R, IRRADIATED",null,1619,529.32000000000005,311.95,529.32000000000005,404.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9056"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","P9056","HC BLOOD, L/R, IRRADIATED",null,1619,486.79,311.95,529.32000000000005,404.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - P9057"},"TUFTS","TUFTS HMO","HCPCS","P9057","HC RBC:LEU RED,FR/DE/WASH,IR",null,785,395.89,395.89,671.74,196.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - P9073"},"TUFTS","TUFTS HMO","HCPCS","P9073","HC PLATELETS PHERESIS PATH REDU",null,889,1045.51,821.84,2619.59,222.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - P9073"},"TUFTS","TUFTS POS","HCPCS","P9073","HC PLATELETS PHERESIS PATH REDU",null,889,871.26,821.84,2619.59,222.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9073"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","P9073","HC PLATELETS PHERESIS PATH REDU",null,889,821.84,821.84,2619.59,222.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9073"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","P9073","HC PLATELETS PHERESIS PATH REDU",null,889,821.84,821.84,2619.59,222.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - P9073"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","P9073","HC PLATELETS PHERESIS PATH REDU",null,889,821.84,821.84,2619.59,222.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9073"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","P9073","HC PLATELETS PHERESIS PATH REDU",null,889,821.84,821.84,2619.59,222.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9073"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","P9073","HC PLATELETS PHERESIS PATH REDU",null,889,821.84,821.84,2619.59,222.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - P9100"},"TUFTS","TUFTS PPO","HCPCS","P9100","PATHOGEN TEST FOR PLATELETS",null,1310,91.31,33.53,256.64,327.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9612"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","P9612","CATHETERIZE FOR URINE SPEC",null,90,0,2.2200000000000002,1198.25,22.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9612"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","P9612","CATHETERIZE FOR URINE SPEC",null,90,25.55,2.2200000000000002,1198.25,22.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - HCPCS - P9612"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","HCPCS","P9612","CATHETERIZE FOR URINE SPEC",null,90,2.61,2.2200000000000002,1198.25,22.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q0091"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR",null,83,0,28.83,175.66,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - Q0111"},"UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS",null,23,31.84,5.86,127.48,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q0111"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS",null,23,5.86,5.86,127.48,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q0111"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS",null,23,15.12,5.86,127.48,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - HCPCS - Q0111"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS",null,23,16.36,5.86,127.48,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q0111"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS",null,23,0,5.86,127.48,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q0111"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS",null,23,27.01,5.86,127.48,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q0111"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS",null,23,10.82,5.86,127.48,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q0111"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS",null,23,0,5.86,127.48,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q0114"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q0114","HC  FERN TEST",null,41,14.47,7.2,82.86,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q0114"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q0114","HC  FERN TEST",null,41,82.86,7.2,82.86,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q0114"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","Q0114","HC  FERN TEST",null,41,9.74,7.2,82.86,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q0114"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","Q0114","HC  FERN TEST",null,41,9.81,7.2,82.86,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - Q0249"},"BMC HEALTHNET","BMCHN QHP","HCPCS","Q0249","HC TOCILIZUMAB FOR COVID-19",null,9,0,null,null,2.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q3014"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE",null,67,26.65,26.65,67.06,16.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - Q3014"},"FALLON","FALLON MEDICAID","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE",null,67,0,26.65,67.06,16.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - Q3014"},"BMC HEALTHNET","BMCHN QHP","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE",null,67,0,26.65,67.06,16.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q4101"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q4101","APLIGRAF",null,1601,31.6,30.46,76.64,400.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q4101"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","Q4101","APLIGRAF",null,1601,30.46,30.46,76.64,400.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q4101"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","Q4101","APLIGRAF",null,1601,30.46,30.46,76.64,400.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q4101"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q4101","APLIGRAF",null,1601,0,30.46,76.64,400.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - Q4101"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","Q4101","APLIGRAF",null,1601,44.17,30.46,76.64,400.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - Q4101"},"TUFTS","TUFTS SELECT","HCPCS","Q4101","APLIGRAF",null,1601,0,30.46,76.64,400.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - Q4102"},"UNICARE","UNICARE","HCPCS","Q4102","OASIS WOUND MATRIX",null,69,10.6,10.210000000000001,25.69,17.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q4102"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","Q4102","OASIS WOUND MATRIX",null,69,10.210000000000001,10.210000000000001,25.69,17.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q4102"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","Q4102","OASIS WOUND MATRIX",null,69,10.210000000000001,10.210000000000001,25.69,17.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q4102"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q4102","OASIS WOUND MATRIX",null,69,0,10.210000000000001,25.69,17.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q4102"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","Q4102","OASIS WOUND MATRIX",null,69,22.04,10.210000000000001,25.69,17.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - Q4102"},"TUFTS","TUFTS POS","HCPCS","Q4102","OASIS WOUND MATRIX",null,69,0,10.210000000000001,25.69,17.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - Q4104"},"TUFTS","TUFTS HMO","HCPCS","Q4104","INTEGRA BMWD",null,7748,0,42.08,56.11,1937,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q4104"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q4104","INTEGRA BMWD",null,7748,56.11,42.08,56.11,1937,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q4104"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q4104","INTEGRA BMWD",null,7748,56.11,42.08,56.11,1937,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q4107"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q4107","GRAFTJACKET",null,2233,0,86.55,110.48,558.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q4107"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q4107","GRAFTJACKET",null,2233,110.48,86.55,110.48,558.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - Q4112"},"UNICARE","UNICARE","HCPCS","Q4112","CYMETRA INJECTABLE",null,535,904.99,904.99,1002.89,133.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q4112"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q4112","CYMETRA INJECTABLE",null,535,0,904.99,1002.89,133.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q4112"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q4112","CYMETRA INJECTABLE",null,535,0,904.99,1002.89,133.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - Q4112"},"TUFTS","TUFTS POS","HCPCS","Q4112","CYMETRA INJECTABLE",null,535,0,904.99,1002.89,133.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q4116"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM",null,5248,0,32.29,35.78,1312,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - Q4116"},"FALLON","FALLON MEDICAID","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM",null,5248,0,32.29,35.78,1312,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - Q4116"},"TUFTS","TUFTS HMO","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM",null,5248,0,32.29,35.78,1312,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q4116"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM",null,5248,0,32.29,35.78,1312,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - Q4124"},"FALLON","FALLON MEDICAID","HCPCS","Q4124","OASIS TRILAYER/1 SQCM",null,23,0,16.39,16.39,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q4125"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM",null,4060,0,3.79,3.79,1015,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q4125"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM",null,4060,0,3.79,3.79,1015,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q4125"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM",null,4060,0,3.79,3.79,1015,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q4130"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q4130","PR STRATTICE TM",null,65718,0,45.89,45.89,16429.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q4130"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q4130","PR STRATTICE TM",null,65718,45.89,45.89,45.89,16429.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - Q4130"},"BMC HEALTHNET","BMCHN QHP","HCPCS","Q4130","PR STRATTICE TM",null,65718,0,45.89,45.89,16429.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - Q4132"},"FALLON","FALLON SENIOR PLAN","HCPCS","Q4132","HC GRAFIX CORE 5X5CM",null,3754,114.63,114.63,288.43,938.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q4132"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q4132","HC GRAFIX CORE 5X5CM",null,3754,0,114.63,288.43,938.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q4132"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q4132","HC GRAFIX CORE 5X5CM",null,3754,131.82,114.63,288.43,938.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q4133"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",null,3756,0,131.97,332.06,939,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q4133"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",null,3756,0,131.97,332.06,939,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - Q4133"},"TUFTS","TUFTS PPO","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",null,3756,0,131.97,332.06,939,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q4196"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM",null,9044,192.05,111.59,280.77999999999997,2261,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - Q9954"},"BMC HEALTHNET","BMCHN QHP","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML",null,0,0,12.1,13.41,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q9956"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML",null,76,31.75,31.75,79.89,19,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - Q9956"},"FALLON","FALLON SENIOR PLAN","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML",null,76,31.75,31.75,79.89,19,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q9956"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML",null,76,0,31.75,79.89,19,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q9956"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML",null,76,36.51,31.75,79.89,19,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q9956"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML",null,76,79.89,31.75,79.89,19,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q9956"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML",null,76,36.51,31.75,79.89,19,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - Q9957"},"UNICARE","UNICARE","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML",null,417,49.42,47.63,119.85,104.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q9957"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML",null,417,49.42,47.63,119.85,104.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q9957"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML",null,417,47.63,47.63,119.85,104.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q9957"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML",null,417,47.63,47.63,119.85,104.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - Q9957"},"FALLON","FALLON MEDICAID","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML",null,417,0,47.63,119.85,104.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q9957"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML",null,417,102.83,47.63,119.85,104.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - Q9957"},"TUFTS","TUFTS HMO","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML",null,417,0,47.63,119.85,104.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - Q9957"},"TUFTS","TUFTS SPIRIT","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML",null,417,52.39,47.63,119.85,104.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q9957"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML",null,417,64.209999999999994,47.63,119.85,104.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q9957"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML",null,417,54.77,47.63,119.85,104.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q9958"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML",null,1,0,7.0000000000000007E-2,0.18,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q9958"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML",null,1,0,7.0000000000000007E-2,0.18,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q9958"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML",null,1,0.08,7.0000000000000007E-2,0.18,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q9958"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML",null,1,0.08,7.0000000000000007E-2,0.18,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q9958"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML",null,1,0.15,7.0000000000000007E-2,0.18,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - Q9961"},"UNICARE","UNICARE","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML",null,1,0.25,0.25,0.63,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q9961"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML",null,1,0.25,0.25,0.63,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q9961"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML",null,1,0.54,0.25,0.63,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - Q9961"},"TUFTS","TUFTS PPO","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML",null,1,0,0.25,0.63,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - Q9961"},"TUFTS","TUFTS SELECT","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML",null,1,0,0.25,0.63,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q9961"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML",null,1,0.28999999999999998,0.25,0.63,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q9961"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML",null,1,0.28999999999999998,0.25,0.63,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q9961"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML",null,1,0.28999999999999998,0.25,0.63,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q9961"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML",null,1,0.63,0.25,0.63,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q9987"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q9987","HC PATHOGEN TEST PLATELETS",null,1218,0,null,null,304.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - Q9987"},"BMC HEALTHNET","BMCHN MCO","HCPCS","Q9987","HC PATHOGEN TEST PLATELETS",null,1218,0,null,null,304.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - S5100"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","S5100","ADULT DAYCARE SERVICES 15MIN",null,6,0,null,null,1.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - S5100"},"BMC HEALTHNET","BMCHN QHP","HCPCS","S5100","ADULT DAYCARE SERVICES 15MIN",null,6,0,null,null,1.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - S5101"},"BMC HEALTHNET","BMCHN QHP","HCPCS","S5101","HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)",null,63,0,null,null,15.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - S5102"},"BMC HEALTHNET","BMCHN QHP","HCPCS","S5102","HC ADULT DAY HEALTH - COMPLEX PER DIEM",null,126,0,null,null,31.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - U0001"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",null,124,35.909999999999997,35.909999999999997,325.64,31,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA - HCPCS - U0001"},"AETNA","AETNA","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",null,124,35.909999999999997,35.909999999999997,325.64,31,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - U0001"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",null,124,41.31,35.909999999999997,325.64,31,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - U0001"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",null,124,41.31,35.909999999999997,325.64,31,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - U0002"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",null,92,61.57,51.31,465.19,23,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - U0002"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",null,92,51.31,51.31,465.19,23,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - U0002"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",null,92,51.31,51.31,465.19,23,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - U0002"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",null,92,74.400000000000006,51.31,465.19,23,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - U0002"},"TUFTS","TUFTS SPIRIT","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",null,92,56.44,51.31,465.19,23,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - U0002"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",null,92,61.57,51.31,465.19,23,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - U0002"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",null,92,60.55,51.31,465.19,23,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA - HCPCS - U0002"},"AETNA","AETNA","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",null,92,51.31,51.31,465.19,23,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - U0002"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",null,92,59.02,51.31,465.19,23,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - U0002"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",null,92,59.02,51.31,465.19,23,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - V2785"},"TUFTS","TUFTS HMO","HCPCS","V2785","CORNEAL TISSUE PROCESSING",null,7848,9609.09,5130.87,15242.01,1962,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - V2785"},"BMC HEALTHNET","BMCHN MCO","HCPCS","V2785","CORNEAL TISSUE PROCESSING",null,7848,0,5130.87,15242.01,1962,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - V2785"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","V2785","CORNEAL TISSUE PROCESSING",null,7848,0,5130.87,15242.01,1962,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - V2790"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","V2790","HC MEMBRANE AMNIOTIC",null,1136,0,null,null,284,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - V2790"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","V2790","HC MEMBRANE AMNIOTIC",null,1136,0,null,null,284,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - V2790"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","V2790","HC MEMBRANE AMNIOTIC",null,1136,0,null,null,284,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - 0042T"},"TUFTS","TUFTS HMO","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",null,767,0,1452,1452,191.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - 0042T"},"TUFTS","TUFTS PPO","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",null,767,0,1452,1452,191.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - 0402T"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA",null,2880,3435.75,1198.25,11845.41,720,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - 0402T"},"TUFTS","TUFTS HMO","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA",null,2880,7467.76,1198.25,11845.41,720,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - 0402T"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA",null,2880,3044.16,1198.25,11845.41,720,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - G0481"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES",null,192,227.06,91.84,1332.11,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0481"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES",null,192,124.63,91.84,1332.11,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0481"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES",null,192,286.56,91.84,1332.11,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0481"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES",null,192,286.56,91.84,1332.11,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - G0481"},"BMC HEALTHNET","BMCHN ACO","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES",null,192,200.95,91.84,1332.11,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0506"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC",null,62,0,110.9,110.9,15.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - G0506"},"TUFTS","TUFTS PPO","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC",null,62,0,110.9,110.9,15.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0513"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M",null,84,148.6,148.6,148.6,21,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - G0513"},"BMC HEALTHNET","BMCHN QHP","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M",null,84,0,148.6,148.6,21,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0514"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M",null,84,0,148.6,148.6,21,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G2011"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS",null,35,0,28.83,133.88,8.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G2011"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS",null,35,28.83,28.83,133.88,8.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G2011"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS",null,35,28.83,28.83,133.88,8.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G2011"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS",null,35,28.83,28.83,133.88,8.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G2012"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G2012","HC BRIEF CHECK IN BY MD/QHP",null,42,31.78,31.78,31.78,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - G2012"},"BMC HEALTHNET","BMCHN ACO","HCPCS","G2012","HC BRIEF CHECK IN BY MD/QHP",null,42,0,31.78,31.78,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G2023"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS",null,31,26.99,23.46,212.71,7.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - G2023"},"BMC HEALTHNET","BMCHN MCO","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS",null,31,23.46,23.46,212.71,7.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - G2024"},"TUFTS","TUFTS POS","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",null,33,82.13,25.46,230.84,8.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G2024"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","CG",33,55.52,25.46,230.84,8.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G2024"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","CG",33,62.79,25.46,230.84,8.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G2024"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",null,33,29.29,25.46,230.84,8.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G2024"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",null,33,29.29,25.46,230.84,8.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G2024"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",null,33,29.29,25.46,230.84,8.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - G2024"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",null,33,29.29,25.46,230.84,8.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - G2024"},"BMC HEALTHNET","BMCHN ACO","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","CG",33,101.24,25.46,230.84,8.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - G2066"},"TUFTS","TUFTS HMO","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH",null,165,147.85,58.35,370.47,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G2066"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH",null,165,58.35,58.35,370.47,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G2066"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH",null,165,0,58.35,370.47,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - G2086"},"TUFTS","TUFTS PPO","HCPCS","G2086","HC OFF BASE OPIOID TX 70MIN",null,194,46.18,46.18,211.43,48.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G2086"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G2086","HC OFF BASE OPIOID TX 70MIN",null,194,0,46.18,211.43,48.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - G2086"},"BMC HEALTHNET","BMCHN ACO","HCPCS","G2086","HC OFF BASE OPIOID TX 70MIN",null,194,0,46.18,211.43,48.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G2086"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G2086","HC OFF BASE OPIOID TX 70MIN",null,194,211.43,46.18,211.43,48.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - G2087"},"TUFTS","TUFTS POS","HCPCS","G2087","HC OFF BASE OPIOID TX, 60 M",null,194,46.18,46.18,211.43,48.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - G2087"},"TUFTS","TUFTS PPO","HCPCS","G2087","HC OFF BASE OPIOID TX, 60 M",null,194,46.18,46.18,211.43,48.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G2087"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G2087","HC OFF BASE OPIOID TX, 60 M",null,194,211.43,46.18,211.43,48.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G2087"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G2087","HC OFF BASE OPIOID TX, 60 M",null,194,211.43,46.18,211.43,48.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G2212"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G2212","HC PROLONG OUTPT/OFFICE VIS",null,188,0,null,null,47,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - G2212"},"BMC HEALTHNET","BMCHN ACO","HCPCS","G2212","HC PROLONG OUTPT/OFFICE VIS",null,188,0,null,null,47,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G2216"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G2216","HC HOME SUPPLY INJECT NALOXON",null,118,0,null,null,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L0120"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE",null,25,24.86,24.86,111.59,6.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - L0120"},"TUFTS","TUFTS SPIRIT","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE",null,25,27.35,24.86,111.59,6.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L0140"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB",null,189,77.52,77.52,347.97,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - L0140"},"TUFTS","TUFTS HMO","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB",null,189,138.88999999999999,77.52,347.97,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - L0140"},"TUFTS","TUFTS SPIRIT","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB",null,189,85.27,77.52,347.97,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L0140"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB",null,189,171.31,77.52,347.97,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L1820"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO",null,159,142.59,142.59,640.03,39.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L1820"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO",null,159,142.59,142.59,640.03,39.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L1820"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO",null,159,307.85000000000002,142.59,640.03,39.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - L1820"},"TUFTS","TUFTS PPO","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO",null,159,227.71,142.59,640.03,39.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L1820"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO",null,159,207.54,142.59,640.03,39.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - L1830"},"FALLON","FALLON MEDICAID","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT",null,78,0,81.95,367.86,19.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L1830"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT",null,78,142.59,81.95,367.86,19.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - L1830"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT",null,78,118.83,81.95,367.86,19.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - L1830"},"TUFTS","TUFTS SELECT","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT",null,78,122.35,81.95,367.86,19.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - L1830"},"TUFTS","TUFTS SPIRIT","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT",null,78,90.14,81.95,367.86,19.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - 92083"},"TUFTS","TUFTS PPO","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED",null,461,383.21,68.75,607.84,115.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - 92083"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED",null,461,178.83,68.75,607.84,115.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L1830"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT",null,78,119.28,81.95,367.86,19.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - L1830"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT",null,78,119.28,81.95,367.86,19.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L1832"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT",null,1523,892.31,743.59,3337.75,380.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L1832"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT",null,1523,1605.41,743.59,3337.75,380.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - L1832"},"TUFTS","TUFTS POS","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT",null,1523,1110.1199999999999,743.59,3337.75,380.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L1832"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT",null,1523,1082.26,743.59,3337.75,380.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - L1832"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT",null,1523,1082.26,743.59,3337.75,380.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - L1836"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","L1836","HC RIGID KO WO JOINTS",null,209,189.2,130.47999999999999,585.70000000000005,52.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - L1836"},"TUFTS","TUFTS POS","HCPCS","L1836","HC RIGID KO WO JOINTS",null,209,194.81,130.47999999999999,585.70000000000005,52.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L1836"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L1836","HC RIGID KO WO JOINTS",null,209,175.91,130.47999999999999,585.70000000000005,52.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L1836"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L1836","HC RIGID KO WO JOINTS",null,209,189.91,130.47999999999999,585.70000000000005,52.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - L1836"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","L1836","HC RIGID KO WO JOINTS",null,209,189.91,130.47999999999999,585.70000000000005,52.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - L1836"},"BMC HEALTHNET","BMCHN MCO","HCPCS","L1836","HC RIGID KO WO JOINTS",null,209,0,130.47999999999999,585.70000000000005,52.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - L1902"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","L1902","AFO ANKLE GAUNTLET",null,219,124.9,86.14,386.65,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - L1902"},"TUFTS","TUFTS POS","HCPCS","L1902","AFO ANKLE GAUNTLET",null,219,128.6,86.14,386.65,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L3260"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L3260","AMBULATORY SURGICAL BOOT EAC",null,279,31.12,31.12,357.96,69.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L3350"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L3350","SHOE HEEL WEDGE",null,41,22.41,22.41,100.59,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L3350"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L3350","SHOE HEEL WEDGE",null,41,22.41,22.41,100.59,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L3350"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L3350","SHOE HEEL WEDGE",null,41,32.49,22.41,100.59,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - L3350"},"TUFTS","TUFTS SELECT","HCPCS","L3350","SHOE HEEL WEDGE",null,41,33.450000000000003,22.41,100.59,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - L3496"},"FALLON","FALLON MEDICAID","HCPCS","L3496","HC STATIC AFO",null,406,0,null,null,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - L3496"},"BMC HEALTHNET","BMCHN ACO","HCPCS","L3496","HC STATIC AFO",null,406,0,null,null,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3496"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L3496","HC STATIC AFO",null,406,0,null,null,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3650"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN",null,1955,80.86,67.38,302.45,488.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L3650"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN",null,1955,67.38,67.38,302.45,488.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L3650"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN",null,1955,169.54,67.38,302.45,488.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - L3650"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN",null,1955,98.07,67.38,302.45,488.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - L3650"},"BMC HEALTHNET","BMCHN QHP","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN",null,1955,0,67.38,302.45,488.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3670"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE",null,2903,124.38,103.65,465.27,725.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L3670"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE",null,2903,465.27,103.65,465.27,725.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - L3670"},"TUFTS","TUFTS PPO","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE",null,2903,165.53,103.65,465.27,725.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3670"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE",null,2903,0,103.65,465.27,725.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L3670"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE",null,2903,122.31,103.65,465.27,725.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L3670"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE",null,2903,150.86000000000001,103.65,465.27,725.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - L3670"},"BMC HEALTHNET","BMCHN ACO","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE",null,2903,0,103.65,465.27,725.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3670"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE",null,2903,0,103.65,465.27,725.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3760"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L3760","EO WITHJOINT, PREFABRICATED",null,819,534.02,445.02,1997.57,204.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L3760"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L3760","EO WITHJOINT, PREFABRICATED",null,819,774.33,445.02,1997.57,204.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L3760"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L3760","EO WITHJOINT, PREFABRICATED",null,819,525.12,445.02,1997.57,204.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L3760"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L3760","EO WITHJOINT, PREFABRICATED",null,819,647.70000000000005,445.02,1997.57,204.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L3762"},"UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L3762","RIGID EO WO JOINTS",null,57,199.71,95.68,429.49,14.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L3762"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L3762","RIGID EO WO JOINTS",null,57,429.49,95.68,429.49,14.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L3762"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L3762","RIGID EO WO JOINTS",null,57,95.68,95.68,429.49,14.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L3762"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L3762","RIGID EO WO JOINTS",null,57,138.74,95.68,429.49,14.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3807"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED",null,483,267.02,222.52,998.85,120.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L3807"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED",null,483,323.87,222.52,998.85,120.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L3808"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L3808","HC EPITRAIN",null,509,547.16999999999996,375.94,1687.5,127.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L3905"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF",null,2442,1059.01,882.51,3961.32,610.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L3905"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF",null,2442,882.51,882.51,3961.32,610.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3905"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF",null,2442,0,882.51,3961.32,610.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L3908"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L3908","WRIST COCK-UP NON-MOLDED",null,143,87.86,73.22,328.66,35.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L3908"},"UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L3908","WRIST COCK-UP NON-MOLDED",null,143,152.83000000000001,73.22,328.66,35.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L3908"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L3908","WRIST COCK-UP NON-MOLDED",null,143,98.72,73.22,328.66,35.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3908"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L3908","WRIST COCK-UP NON-MOLDED",null,143,0,73.22,328.66,35.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - L3908"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","L3908","WRIST COCK-UP NON-MOLDED",null,143,106.57,73.22,328.66,35.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L3967"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF",null,117,3071.5,1765.23,7923.54,29.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - L3967"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF",null,117,2559.58,1765.23,7923.54,29.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L3967"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF",null,117,2379.88,1765.23,7923.54,29.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L3967"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF",null,117,2082.9699999999998,1765.23,7923.54,29.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L3980"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL",null,132,1695.98,377.84,1695.98,33,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L3980"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL",null,132,377.84,377.84,1695.98,33,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - L3980"},"FALLON","FALLON MEDICAID","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL",null,132,0,377.84,1695.98,33,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - L3980"},"TUFTS","TUFTS SELECT","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL",null,132,564.08000000000004,377.84,1695.98,33,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - L3980"},"TUFTS","TUFTS SPIRIT","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL",null,132,415.62,377.84,1695.98,33,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L3982"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL",null,176,859.78,398.23,1787.56,44,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - L3982"},"TUFTS","TUFTS HMO","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL",null,176,713.43,398.23,1787.56,44,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L4350"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB",null,360,97.28,97.28,436.66,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - L4350"},"FALLON","FALLON MEDICAID","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB",null,360,0,97.28,436.66,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - L4350"},"FALLON","FALLON SENIOR PLAN","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB",null,360,97.28,97.28,436.66,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L4350"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB",null,360,114.79,97.28,436.66,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L4350"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB",null,360,141.58000000000001,97.28,436.66,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - L4350"},"BMC HEALTHNET","BMCHN QHP","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB",null,360,0,97.28,436.66,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - L4360"},"TUFTS","TUFTS SPIRIT","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB",null,557,380.41,345.83,1552.36,139.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L4360"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB",null,557,503.35,345.83,1552.36,139.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - L4360"},"BMC HEALTHNET","BMCHN ACO","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB",null,557,0,345.83,1552.36,139.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L4370"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT",null,107,282.95,235.79,1058.3900000000001,26.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L4370"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT",null,107,235.79,235.79,1058.3900000000001,26.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - L4370"},"FALLON","FALLON SENIOR PLAN","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT",null,107,235.79,235.79,1058.3900000000001,26.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L4370"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT",null,107,509.07,235.79,1058.3900000000001,26.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L4370"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT",null,107,0,235.79,1058.3900000000001,26.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - L4370"},"BMC HEALTHNET","BMCHN MCO","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT",null,107,0,235.79,1058.3900000000001,26.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L4386"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB",null,165,186.02,155.02000000000001,695.83,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L4386"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB",null,165,186.02,155.02000000000001,695.83,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - L4386"},"TUFTS","TUFTS PPO","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB",null,165,247.56,155.02000000000001,695.83,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L4386"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB",null,165,209,155.02000000000001,695.83,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L4386"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB",null,165,225.63,155.02000000000001,695.83,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L4386"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB",null,165,390.06,155.02000000000001,695.83,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L4396"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L4396","STATIC AFO",null,406,205.7,171.42,769.43,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L4396"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L4396","STATIC AFO",null,406,205.7,171.42,769.43,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L4396"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L4396","STATIC AFO",null,406,769.43,171.42,769.43,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - L4396"},"TUFTS","TUFTS POS","HCPCS","L4396","STATIC AFO",null,406,255.91,171.42,769.43,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - L4396"},"TUFTS","TUFTS SPIRIT","HCPCS","L4396","STATIC AFO",null,406,188.56,171.42,769.43,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L4396"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","L4396","STATIC AFO",null,406,249.49,171.42,769.43,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L4396"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L4396","STATIC AFO",null,406,378.82,171.42,769.43,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L4398"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT",null,406,78.92,78.92,354.25,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L4398"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT",null,406,114.87,78.92,354.25,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L8501"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE",null,219,721.54,160.74,721.54,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - L8501"},"FALLON","FALLON SENIOR PLAN","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE",null,219,160.74,160.74,721.54,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L8501"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE",null,219,0,160.74,721.54,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - L8507"},"FALLON","FALLON MEDICAID","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)",null,1604,0,41.03,184.14,401,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L8507"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)",null,1604,71.39,41.03,184.14,401,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L8507"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)",null,1604,59.49,41.03,184.14,401,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L8507"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)",null,1604,90.67,41.03,184.14,401,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L8509"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN",null,1144,128.38999999999999,106.99,480.27,286,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - L8509"},"FALLON","FALLON SENIOR PLAN","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN",null,1144,106.99,106.99,480.27,286,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L8509"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN",null,1144,155.13999999999999,106.99,480.27,286,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L8509"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN",null,1144,0,106.99,480.27,286,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L8509"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN",null,1144,155.72999999999999,106.99,480.27,286,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - L8509"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN",null,1144,155.72999999999999,106.99,480.27,286,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - L8514"},"TUFTS","TUFTS SELECT","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR",null,387,137.91999999999999,92.38,414.69,96.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L8514"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR",null,387,204.15,92.38,414.69,96.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L8693"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT",null,1462,2154.08,1485.57,6668.25,365.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L8693"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT",null,1462,2002.85,1485.57,6668.25,365.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - L8693"},"BMC HEALTHNET","BMCHN ACO","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT",null,1462,0,1485.57,6668.25,365.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - L8699"},"FALLON","FALLON MEDICAID","HCPCS","L8699","HC CARTIFORM 20 X 25 MM DISC",null,13957,0,null,null,3489.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - L8699"},"TUFTS","TUFTS HMO","HCPCS","L8699","HC CARTIFORM 20 X 25 MM DISC",null,13957,0,null,null,3489.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - L8699"},"BMC HEALTHNET","BMCHN ACO","HCPCS","L8699","HC CARTIFORM 20 X 25 MM DISC",null,13957,0,null,null,3489.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - M0239"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",null,393,518.74,309.60000000000002,779.02,98.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - M0239"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",null,393,518.74,309.60000000000002,779.02,98.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - M0239"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",null,393,518.74,309.60000000000002,779.02,98.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - M0239"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",null,393,518.74,309.60000000000002,779.02,98.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - M0243"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",null,572,371.52,309.60000000000002,779.02,143,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - M0243"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",null,572,668.43,309.60000000000002,779.02,143,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - M0243"},"TUFTS","TUFTS SPIRIT","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",null,572,340.56,309.60000000000002,779.02,143,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - M0243"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",null,572,518.74,309.60000000000002,779.02,143,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - M0243"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",null,572,518.74,309.60000000000002,779.02,143,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - M0243"},"BMC HEALTHNET","BMCHN QHP","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",null,572,371.52,309.60000000000002,779.02,143,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9012"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","P9012","HC CRYOPRECIPITATE UNIT",null,134,64.959999999999994,64.959999999999994,125.33,33.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9012"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","P9012","HC CRYOPRECIPITATE UNIT",null,134,64.959999999999994,64.959999999999994,125.33,33.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9012"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","P9012","HC CRYOPRECIPITATE UNIT",null,134,64.959999999999994,64.959999999999994,125.33,33.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9016"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","P9016","HC RBC:LEU-RED",null,576,243.01,243.01,478.65,144,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9016"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","P9016","HC RBC:LEU-RED",null,576,243.01,243.01,478.65,144,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9017"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","P9017","HC FF PLAS: 1 DONOR",null,291,94.07,94.07,217.72,72.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9021"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","P9021","HC RBC/UNIT",null,323,302.52,184.28,354.25,80.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9021"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","P9021","HC RBC/UNIT",null,323,302.52,184.28,354.25,80.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - P9021"},"TUFTS","TUFTS POS","HCPCS","P9021","HC RBC/UNIT",null,323,208.77,184.28,354.25,80.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - P9034"},"TUFTS","TUFTS HMO","HCPCS","P9034","HB PLATELETS, PHERESIS",null,506,471.32,443.29,799.73,126.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - P9034"},"TUFTS","TUFTS POS","HCPCS","P9034","HB PLATELETS, PHERESIS",null,506,471.32,443.29,799.73,126.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9037"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","P9037","HC PLT:PHER,LEU-RED,IRR/UNIT",null,939,1349.22,821.84,1622.67,234.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9037"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","P9037","HC PLT:PHER,LEU-RED,IRR/UNIT",null,939,1349.22,821.84,1622.67,234.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - P9037"},"TUFTS","TUFTS POS","HCPCS","P9037","HC PLT:PHER,LEU-RED,IRR/UNIT",null,939,956.33,821.84,1622.67,234.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - P9037"},"TUFTS","TUFTS SELECT","HCPCS","P9037","HC PLT:PHER,LEU-RED,IRR/UNIT",null,939,956.33,821.84,1622.67,234.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9037"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","P9037","HC PLT:PHER,LEU-RED,IRR/UNIT",null,939,821.84,821.84,1622.67,234.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - P9037"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","P9037","HC PLT:PHER,LEU-RED,IRR/UNIT",null,939,821.84,821.84,1622.67,234.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9040"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","P9040","HC RBC:LEU-RED,IRR/UNIT",null,523,551.79999999999995,336.11,669.97,130.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9040"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","P9040","HC RBC:LEU-RED,IRR/UNIT",null,523,336.11,336.11,669.97,130.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - P9044"},"TUFTS","TUFTS PPO","HCPCS","P9044","HC CRYOPRECIPITATE REDUCED PLASMA",null,133,154.25,144.19999999999999,244.67,33.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - P9045"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML",null,238,62.94,52.45,131.97,59.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9045"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML",null,238,110.46,52.45,131.97,59.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - P9045"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML",null,238,113.24,52.45,131.97,59.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - P9045"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML",null,238,76.05,52.45,131.97,59.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9045"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML",null,238,60.32,52.45,131.97,59.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - P9045"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML",null,238,60.32,52.45,131.97,59.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - P9056"},"TUFTS","TUFTS HMO","HCPCS","P9056","HC BLOOD, L/R, IRRADIATED",null,1619,311.95,311.95,529.32000000000005,404.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9057"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","P9057","HC RBC:LEU RED,FR/DE/WASH,IR",null,785,671.74,395.89,671.74,196.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9073"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","P9073","HC PLATELETS PHERESIS PATH REDU",null,889,1349.22,821.84,2619.59,222.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - P9100"},"TUFTS","TUFTS SELECT","HCPCS","P9100","PATHOGEN TEST FOR PLATELETS",null,1310,45.44,33.53,256.64,327.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - P9100"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","P9100","PATHOGEN TEST FOR PLATELETS",null,1310,33.53,33.53,256.64,327.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9100"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","P9100","PATHOGEN TEST FOR PLATELETS",null,1310,33.53,33.53,256.64,327.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - P9612"},"UNICARE","UNICARE","HCPCS","P9612","CATHETERIZE FOR URINE SPEC",null,90,5.21,2.2200000000000002,1198.25,22.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - P9612"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","P9612","CATHETERIZE FOR URINE SPEC",null,90,3,2.2200000000000002,1198.25,22.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - P9612"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","P9612","CATHETERIZE FOR URINE SPEC",null,90,3,2.2200000000000002,1198.25,22.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - P9612"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","P9612","CATHETERIZE FOR URINE SPEC",null,90,5.22,2.2200000000000002,1198.25,22.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - HCPCS - P9612"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","HCPCS","P9612","CATHETERIZE FOR URINE SPEC",null,90,3.36,2.2200000000000002,1198.25,22.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - P9612"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","P9612","CATHETERIZE FOR URINE SPEC",null,90,2.66,2.2200000000000002,1198.25,22.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - P9612"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","P9612","CATHETERIZE FOR URINE SPEC",null,90,5.27,2.2200000000000002,1198.25,22.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - Q0091"},"FALLON","FALLON MEDICAID","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR",null,83,0,28.83,175.66,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q0091"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR",null,83,28.83,28.83,175.66,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - Q0111"},"TUFTS","TUFTS HMO","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS",null,23,50.9,5.86,127.48,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - Q0111"},"TUFTS","TUFTS SELECT","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS",null,23,22.58,5.86,127.48,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q0111"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS",null,23,27.01,5.86,127.48,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - Q0114"},"UNICARE","UNICARE","HCPCS","Q0114","HC  FERN TEST",null,41,17.36,7.2,82.86,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - Q0114"},"FALLON","FALLON SENIOR PLAN","HCPCS","Q0114","HC  FERN TEST",null,41,9.74,7.2,82.86,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - Q0114"},"TUFTS","TUFTS HMO","HCPCS","Q0114","HC  FERN TEST",null,41,33.08,7.2,82.86,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - Q0114"},"TUFTS","TUFTS PPO","HCPCS","Q0114","HC  FERN TEST",null,41,29.48,7.2,82.86,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - Q0114"},"BMC HEALTHNET","BMCHN MCO","HCPCS","Q0114","HC  FERN TEST",null,41,7.2,7.2,82.86,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - Q0114"},"BMC HEALTHNET","BMCHN QHP","HCPCS","Q0114","HC  FERN TEST",null,41,8.64,7.2,82.86,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - Q0249"},"FALLON","FALLON MEDICAID","HCPCS","Q0249","HC TOCILIZUMAB FOR COVID-19",null,9,0,null,null,2.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q3014"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE",null,67,31.98,26.65,67.06,16.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q3014"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE",null,67,26.65,26.65,67.06,16.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q3014"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE",null,67,46.37,26.65,67.06,16.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - Q3014"},"TUFTS","TUFTS PPO","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE",null,67,38.6,26.65,67.06,16.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - Q4100"},"TUFTS","TUFTS HMO","HCPCS","Q4100","STRAVIX 3X6",null,12079,0,null,null,3019.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q4101"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q4101","APLIGRAF",null,1601,0,30.46,76.64,400.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - Q4101"},"TUFTS","TUFTS SPIRIT","HCPCS","Q4101","APLIGRAF",null,1601,33.51,30.46,76.64,400.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q4101"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q4101","APLIGRAF",null,1601,35.03,30.46,76.64,400.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q4101"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q4101","APLIGRAF",null,1601,35.03,30.46,76.64,400.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q4101"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q4101","APLIGRAF",null,1601,35.03,30.46,76.64,400.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q4102"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","Q4102","OASIS WOUND MATRIX",null,69,12.25,10.210000000000001,25.69,17.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q4102"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q4102","OASIS WOUND MATRIX",null,69,0,10.210000000000001,25.69,17.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - Q4102"},"TUFTS","TUFTS SELECT","HCPCS","Q4102","OASIS WOUND MATRIX",null,69,0,10.210000000000001,25.69,17.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q4102"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q4102","OASIS WOUND MATRIX",null,69,11.74,10.210000000000001,25.69,17.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q4104"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q4104","INTEGRA BMWD",null,7748,56.11,42.08,56.11,1937,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q4104"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q4104","INTEGRA BMWD",null,7748,56.11,42.08,56.11,1937,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q4107"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q4107","GRAFTJACKET",null,2233,110.48,86.55,110.48,558.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q4112"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q4112","CYMETRA INJECTABLE",null,535,1002.89,904.99,1002.89,133.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q4112"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q4112","CYMETRA INJECTABLE",null,535,1002.89,904.99,1002.89,133.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q4112"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q4112","CYMETRA INJECTABLE",null,535,1002.89,904.99,1002.89,133.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - Q4116"},"UNICARE","UNICARE","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM",null,5248,32.29,32.29,35.78,1312,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q4116"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM",null,5248,35.78,32.29,35.78,1312,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q4124"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","Q4124","OASIS TRILAYER/1 SQCM",null,23,0,16.39,16.39,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - Q4124"},"BMC HEALTHNET","BMCHN ACO","HCPCS","Q4124","OASIS TRILAYER/1 SQCM",null,23,0,16.39,16.39,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q4124"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q4124","OASIS TRILAYER/1 SQCM",null,23,16.39,16.39,16.39,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q4125"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM",null,4060,0,3.79,3.79,1015,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q4125"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM",null,4060,3.79,3.79,3.79,1015,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q4130"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q4130","PR STRATTICE TM",null,65718,0,45.89,45.89,16429.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q4130"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q4130","PR STRATTICE TM",null,65718,45.89,45.89,45.89,16429.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q4130"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q4130","PR STRATTICE TM",null,65718,45.89,45.89,45.89,16429.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q4130"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q4130","PR STRATTICE TM",null,65718,45.89,45.89,45.89,16429.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - Q4130"},"BMC HEALTHNET","BMCHN MCO","HCPCS","Q4130","PR STRATTICE TM",null,65718,0,45.89,45.89,16429.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q4132"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q4132","HC GRAFIX CORE 5X5CM",null,3754,0,114.63,288.43,938.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q4132"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q4132","HC GRAFIX CORE 5X5CM",null,3754,131.82,114.63,288.43,938.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q4133"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",null,3756,158.36000000000001,131.97,332.06,939,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q4133"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",null,3756,136.94999999999999,131.97,332.06,939,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q4133"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",null,3756,229.63,131.97,332.06,939,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q4133"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",null,3756,177.92,131.97,332.06,939,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q4133"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",null,3756,151.77000000000001,131.97,332.06,939,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q4196"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM",null,9044,0,111.59,280.77999999999997,2261,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q4196"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM",null,9044,0,111.59,280.77999999999997,2261,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - Q4196"},"BMC HEALTHNET","BMCHN QHP","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM",null,9044,0,111.59,280.77999999999997,2261,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q9954"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML",null,0,0,12.1,13.41,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q9956"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML",null,76,31.75,31.75,79.89,19,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q9956"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML",null,76,0,31.75,79.89,19,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - Q9956"},"TUFTS","TUFTS HMO","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML",null,76,0,31.75,79.89,19,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - Q9956"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML",null,76,46.04,31.75,79.89,19,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - Q9956"},"TUFTS","TUFTS POS","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML",null,76,0,31.75,79.89,19,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q9956"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML",null,76,0,31.75,79.89,19,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q9957"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML",null,417,0,47.63,119.85,104.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q9957"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML",null,417,47.63,47.63,119.85,104.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q9957"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML",null,417,0,47.63,119.85,104.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q9957"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML",null,417,54.77,47.63,119.85,104.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q9958"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML",null,1,7.0000000000000007E-2,7.0000000000000007E-2,0.18,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q9958"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML",null,1,0,7.0000000000000007E-2,0.18,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q9958"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML",null,1,7.0000000000000007E-2,7.0000000000000007E-2,0.18,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - Q9958"},"FALLON","FALLON SENIOR PLAN","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML",null,1,7.0000000000000007E-2,7.0000000000000007E-2,0.18,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - Q9958"},"TUFTS","TUFTS PPO","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML",null,1,0,7.0000000000000007E-2,0.18,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q9958"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML",null,1,0,7.0000000000000007E-2,0.18,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q9958"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML",null,1,0.08,7.0000000000000007E-2,0.18,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q9961"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML",null,1,0.3,0.25,0.63,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q9961"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML",null,1,0,0.25,0.63,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q9961"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML",null,1,0.34,0.25,0.63,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q9961"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML",null,1,0,0.25,0.63,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - S2083"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","S2083","HC ADJUSTMENT GASTRIC BAND",null,211,943.8,317.70999999999998,1198.25,52.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - S5100"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","S5100","ADULT DAYCARE SERVICES 15MIN",null,6,0,null,null,1.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - S5100"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","S5100","ADULT DAYCARE SERVICES 15MIN",null,6,0,null,null,1.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - S5101"},"FALLON","FALLON MEDICAID","HCPCS","S5101","HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)",null,63,0,null,null,15.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - S5101"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","S5101","HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)",null,63,0,null,null,15.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - S5101"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","S5101","HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)",null,63,0,null,null,15.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - S5102"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","S5102","HC ADULT DAY HEALTH - COMPLEX PER DIEM",null,126,0,null,null,31.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - S8037"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","S8037","MRCP",null,1440,0,585.76,3771.6,360,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - S8037"},"BMC HEALTHNET","BMCHN MCO","HCPCS","S8037","MRCP",null,1440,0,585.76,3771.6,360,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - U0001"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",null,124,35.909999999999997,35.909999999999997,325.64,31,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - U0001"},"FALLON","FALLON SENIOR PLAN","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",null,124,35.909999999999997,35.909999999999997,325.64,31,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - U0001"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",null,124,62.48,35.909999999999997,325.64,31,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - U0001"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",null,124,41.31,35.909999999999997,325.64,31,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - U0002"},"BMC HEALTHNET","BMCHN MCO","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",null,92,51.31,51.31,465.19,23,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - U0002"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",null,92,51.31,51.31,465.19,23,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - V2785"},"FALLON","FALLON MEDICAID","HCPCS","V2785","CORNEAL TISSUE PROCESSING",null,7848,0,5130.87,15242.01,1962,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - V2785"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","V2785","CORNEAL TISSUE PROCESSING",null,7848,0,5130.87,15242.01,1962,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - V2790"},"BMC HEALTHNET","BMCHN ACO","HCPCS","V2790","HC MEMBRANE AMNIOTIC",null,1136,0,null,null,284,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - 0042T"},"TUFTS","TUFTS SELECT","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",null,767,0,1452,1452,191.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - 0278T"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","0278T","HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS",null,77,293.52,286.31,943.8,19.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - 0278T"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","0278T","HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS",null,77,293.52,286.31,943.8,19.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - 0278T"},"TUFTS","TUFTS PPO","HCPCS","0278T","HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS",null,77,595.01,286.31,943.8,19.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - 0402T"},"TUFTS","TUFTS PPO","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA",null,2880,7467.76,1198.25,11845.41,720,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - 95800"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA",null,205,286.31,228.32,1412.44,51.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - 95800"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA",null,205,228.32,228.32,1412.44,51.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - A4215"},"TUFTS","TUFTS SELECT","HCPCS","A4215","STERILE NEEDLE",null,433,0,null,null,108.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A4215"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A4215","STERILE NEEDLE",null,433,0,null,null,108.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A4215"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A4215","STERILE NEEDLE",null,433,0,null,null,108.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A4215"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A4215","STERILE NEEDLE",null,433,0,null,null,108.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A4467"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A4467","BELT STRAP SLEEV GRMNT COVER",null,151,0,null,null,37.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - A4561"},"FALLON","FALLON MEDICAID","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE",null,108,0,23.18,58.33,27,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - A4561"},"TUFTS","TUFTS HMO","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE",null,108,0,23.18,58.33,27,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A4561"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE",null,108,31.25,23.18,58.33,27,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A4561"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE",null,108,0,23.18,58.33,27,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A4561"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE",null,108,33.729999999999997,23.18,58.33,27,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A4562"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","A4562","PESSARY NONRUBBER",null,64,69.25,57.71,145.21,16,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A4562"},"TUFTS","TUFTS PPO","HCPCS","A4562","PESSARY NONRUBBER",null,64,0,57.71,145.21,16,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - A4562"},"TUFTS","TUFTS SPIRIT","HCPCS","A4562","PESSARY NONRUBBER",null,64,63.48,57.71,145.21,16,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A4562"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A4562","PESSARY NONRUBBER",null,64,0,57.71,145.21,16,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - A4562"},"BMC HEALTHNET","BMCHN ACO","HCPCS","A4562","PESSARY NONRUBBER",null,64,0,57.71,145.21,16,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - A4570"},"BMC HEALTHNET","BMCHN ACO","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1",null,40,0,19.010000000000002,107.35,10,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A4648"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A4648","IMPLANTABLE TISSUE MARKER",null,281,0,null,null,70.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A4648"},"TUFTS","TUFTS PPO","HCPCS","A4648","IMPLANTABLE TISSUE MARKER",null,281,0,null,null,70.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A4725"},"TUFTS","TUFTS POS","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC",null,87,0,null,null,21.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - A4725"},"BMC HEALTHNET","BMCHN ACO","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC",null,87,0,null,null,21.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A6209"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR",null,163,18.739999999999998,8.68,21.84,40.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - A6209"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR",null,163,12.59,8.68,21.84,40.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A6209"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR",null,163,0,8.68,21.84,40.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A6209"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR",null,163,12.63,8.68,21.84,40.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - A6209"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR",null,163,12.63,8.68,21.84,40.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A6258"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN",null,83,0,5,12.58,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - A6258"},"TUFTS","TUFTS HMO","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN",null,83,0,5,12.58,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A6258"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN",null,83,7.25,5,12.58,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A6258"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN",null,83,0,5,12.58,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - A6549"},"FALLON","FALLON MEDICAID","HCPCS","A6549","G COMPRESSION STOCKING",null,37,0,null,null,9.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - A6549"},"TUFTS","TUFTS SELECT","HCPCS","A6549","G COMPRESSION STOCKING",null,37,0,null,null,9.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - A6549"},"BMC HEALTHNET","BMCHN MCO","HCPCS","A6549","G COMPRESSION STOCKING",null,37,0,null,null,9.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - A6549"},"BMC HEALTHNET","BMCHN QHP","HCPCS","A6549","G COMPRESSION STOCKING",null,37,0,null,null,9.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A6550"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","A6550","NEG PRES WOUND THER DRSG SET",null,4,30.85,25.71,64.69,1,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - A6550"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","A6550","NEG PRES WOUND THER DRSG SET",null,4,37.28,25.71,64.69,1,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A6550"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A6550","NEG PRES WOUND THER DRSG SET",null,4,0,25.71,64.69,1,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A6550"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","A6550","NEG PRES WOUND THER DRSG SET",null,4,64.69,25.71,64.69,1,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A7520"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED",null,1173,0,55.16,138.79,293.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A7520"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED",null,1173,55.16,55.16,138.79,293.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - A7520"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED",null,1173,79.98,55.16,138.79,293.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A7520"},"TUFTS","TUFTS POS","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED",null,1173,0,55.16,138.79,293.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A7520"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED",null,1173,80.290000000000006,55.16,138.79,293.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A7520"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED",null,1173,80.290000000000006,55.16,138.79,293.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9500"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9500","TC99M SESTAMIBI",null,274,0,463.42,463.42,68.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9500"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9500","TC99M SESTAMIBI",null,274,0,463.42,463.42,68.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - A9500"},"BMC HEALTHNET","BMCHN ACO","HCPCS","A9500","TC99M SESTAMIBI",null,274,0,463.42,463.42,68.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9502"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9502","HC TC99M TETROFOSMIN",null,140,0,278.27,278.27,35,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9502"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9502","HC TC99M TETROFOSMIN",null,140,278.27,278.27,278.27,35,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - A9502"},"BMC HEALTHNET","BMCHN QHP","HCPCS","A9502","HC TC99M TETROFOSMIN",null,140,0,278.27,278.27,35,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9503"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9503","TC99M MEDRONATE",null,23,0,37.119999999999997,37.119999999999997,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9503"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9503","TC99M MEDRONATE",null,23,0,37.119999999999997,37.119999999999997,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - A9503"},"FALLON","FALLON MEDICAID","HCPCS","A9503","TC99M MEDRONATE",null,23,0,37.119999999999997,37.119999999999997,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9503"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9503","TC99M MEDRONATE",null,23,0,37.119999999999997,37.119999999999997,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - A9503"},"BMC HEALTHNET","BMCHN MCO","HCPCS","A9503","TC99M MEDRONATE",null,23,0,37.119999999999997,37.119999999999997,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9505"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9505","THALLIUM CHLORIDE PER MCI",null,23,0,395.74,395.74,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9505"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9505","THALLIUM CHLORIDE PER MCI",null,23,0,395.74,395.74,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - A9505"},"TUFTS","TUFTS SELECT","HCPCS","A9505","THALLIUM CHLORIDE PER MCI",null,23,0,395.74,395.74,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9505"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9505","THALLIUM CHLORIDE PER MCI",null,23,0,395.74,395.74,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9505"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9505","THALLIUM CHLORIDE PER MCI",null,23,0,395.74,395.74,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9505"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9505","THALLIUM CHLORIDE PER MCI",null,23,0,395.74,395.74,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - A9512"},"TUFTS","TUFTS SELECT","HCPCS","A9512","TC99M PERTECHNETATE",null,1,0,null,null,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9512"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9512","TC99M PERTECHNETATE",null,1,0,null,null,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9512"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9512","TC99M PERTECHNETATE",null,1,0,null,null,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9513"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN",null,320,329.72,294.27999999999997,1097.56,80,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9513"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN",null,320,329.72,294.27999999999997,1097.56,80,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A9516"},"TUFTS","TUFTS POS","HCPCS","A9516","I123 IODIDE CAP, DX",null,192,0,516.39,516.39,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - A9516"},"BMC HEALTHNET","BMCHN MCO","HCPCS","A9516","I123 IODIDE CAP, DX",null,192,0,516.39,516.39,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - A9517"},"FALLON","FALLON MEDICAID","HCPCS","A9517","I131 IODIDE CAP, RX",null,437,0,30.1,101.94,109.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9517"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9517","I131 IODIDE CAP, RX",null,437,101.94,30.1,101.94,109.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9520"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD",null,1951,0,null,null,487.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - A9521"},"BMC HEALTHNET","BMCHN MCO","HCPCS","A9521","TC99M EXAMETAZIME",null,360,0,4157.3,4157.3,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9537"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9537","TC99M MEBROFENIN",null,138,0,157.94999999999999,157.94999999999999,34.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9537"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9537","TC99M MEBROFENIN",null,138,0,157.94999999999999,157.94999999999999,34.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9538"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9538","TC99M PYROPHOSPHATE",null,111,0,114.21,114.21,27.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9538"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9538","TC99M PYROPHOSPHATE",null,111,0,114.21,114.21,27.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - A9538"},"BMC HEALTHNET","BMCHN MCO","HCPCS","A9538","TC99M PYROPHOSPHATE",null,111,0,114.21,114.21,27.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9539"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9539","TC99M PENTETATE",null,668,0,89.47,89.47,167,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9539"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9539","TC99M PENTETATE",null,668,0,89.47,89.47,167,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9539"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9539","TC99M PENTETATE",null,668,0,89.47,89.47,167,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9539"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9539","TC99M PENTETATE",null,668,89.47,89.47,89.47,167,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - A9539"},"BMC HEALTHNET","BMCHN ACO","HCPCS","A9539","TC99M PENTETATE",null,668,0,89.47,89.47,167,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A9540"},"TUFTS","TUFTS POS","HCPCS","A9540","TC99M MAA",null,1831,0,85.66,85.66,457.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - A9540"},"TUFTS","TUFTS SELECT","HCPCS","A9540","TC99M MAA",null,1831,0,85.66,85.66,457.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9540"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9540","TC99M MAA",null,1831,0,85.66,85.66,457.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9540"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9540","TC99M MAA",null,1831,85.66,85.66,85.66,457.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9541"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9541","TC99M SULFUR COLLOID",null,120,0,152.69,152.69,30,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A9541"},"TUFTS","TUFTS PPO","HCPCS","A9541","TC99M SULFUR COLLOID",null,120,0,152.69,152.69,30,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9541"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9541","TC99M SULFUR COLLOID",null,120,152.69,152.69,152.69,30,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A9543"},"TUFTS","TUFTS POS","HCPCS","A9543","Y90 IBRITUMOMAB, RX",null,66322,72400.97,72400.97,217685.7,16580.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A9543"},"TUFTS","TUFTS PPO","HCPCS","A9543","Y90 IBRITUMOMAB, RX",null,66322,77447.320000000007,72400.97,217685.7,16580.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - A9547"},"FALLON","FALLON MEDICAID","HCPCS","A9547","IN111 OXYQUINOLINE",null,440,0,5105.7299999999996,5105.7299999999996,110,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9547"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9547","IN111 OXYQUINOLINE",null,440,5105.7299999999996,5105.7299999999996,5105.7299999999996,110,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9547"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9547","IN111 OXYQUINOLINE",null,440,5105.7299999999996,5105.7299999999996,5105.7299999999996,110,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9547"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9547","IN111 OXYQUINOLINE",null,440,5105.7299999999996,5105.7299999999996,5105.7299999999996,110,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9547"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9547","IN111 OXYQUINOLINE",null,440,5105.7299999999996,5105.7299999999996,5105.7299999999996,110,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - A9547"},"BMC HEALTHNET","BMCHN ACO","HCPCS","A9547","IN111 OXYQUINOLINE",null,440,0,5105.7299999999996,5105.7299999999996,110,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - A9547"},"BMC HEALTHNET","BMCHN MCO","HCPCS","A9547","IN111 OXYQUINOLINE",null,440,0,5105.7299999999996,5105.7299999999996,110,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9551"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX",null,154,0,1711.56,1711.56,38.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9551"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX",null,154,1711.56,1711.56,1711.56,38.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9552"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9552","F18 FDG",null,972,1166.46,1166.46,1166.46,243,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - A9552"},"BMC HEALTHNET","BMCHN MCO","HCPCS","A9552","F18 FDG",null,972,0,1166.46,1166.46,243,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9555"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9555","RADIOPHARMACIAL",null,1065,0,1604.08,1604.08,266.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9555"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9555","RADIOPHARMACIAL",null,1065,1604.08,1604.08,1604.08,266.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9556"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9556","GA67 GALLIUM",null,20,0,311.94,311.94,5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - A9556"},"TUFTS","TUFTS HMO","HCPCS","A9556","GA67 GALLIUM",null,20,0,311.94,311.94,5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9556"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9556","GA67 GALLIUM",null,20,0,311.94,311.94,5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9557"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9557","TC99M BICISATE",null,239,0,1062.44,1062.44,59.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9557"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9557","TC99M BICISATE",null,239,1062.44,1062.44,1062.44,59.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - A9558"},"FALLON","FALLON MEDICAID","HCPCS","A9558","HC XENON133/10MCI",null,23,0,108.88,108.88,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - A9558"},"TUFTS","TUFTS HMO","HCPCS","A9558","HC XENON133/10MCI",null,23,0,108.88,108.88,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A9558"},"TUFTS","TUFTS PPO","HCPCS","A9558","HC XENON133/10MCI",null,23,0,108.88,108.88,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9558"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9558","HC XENON133/10MCI",null,23,108.88,108.88,108.88,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9560"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9560","TC99M LABELED RBC",null,246,0,266.7,266.7,61.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A9560"},"TUFTS","TUFTS PPO","HCPCS","A9560","TC99M LABELED RBC",null,246,0,266.7,266.7,61.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9560"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9560","TC99M LABELED RBC",null,246,266.7,266.7,266.7,61.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9560"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9560","TC99M LABELED RBC",null,246,266.7,266.7,266.7,61.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9560"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9560","TC99M LABELED RBC",null,246,266.7,266.7,266.7,61.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9561"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9561","TC99M OXIDRONATE",null,127,125.64,125.64,125.64,31.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9562"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9562","TC99M MERTIATIDE",null,1237,0,2212.25,2212.25,309.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A9562"},"TUFTS","TUFTS PPO","HCPCS","A9562","TC99M MERTIATIDE",null,1237,0,2212.25,2212.25,309.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A9563"},"TUFTS","TUFTS POS","HCPCS","A9563","P32 NA PHOSPHATE",null,0,1058.54,535.17999999999995,3182.68,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - A9570"},"BMC HEALTHNET","BMCHN QHP","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC",null,6395,0,null,null,1598.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9572"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE",null,131,0,16207.01,16207.01,32.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9572"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE",null,131,16207.01,16207.01,16207.01,32.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9575"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML",null,8,0,0.18,0.45,2,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A9576"},"TUFTS","TUFTS PPO","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML",null,5,0,1.5,3.77,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A9577"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML",null,21,2.17,1.81,5.03,5.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - A9577"},"FALLON","FALLON SENIOR PLAN","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML",null,21,1.81,1.81,5.03,5.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A9577"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML",null,21,2.62,1.81,5.03,5.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A9579"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML",null,5,1.53,1.53,4.38,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9579"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML",null,5,4.38,1.53,4.38,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9579"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML",null,5,4.38,1.53,4.38,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - A9581"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","A9581","GADOXETATE DISODIUM INJ",null,99,15.32,14.76,37.14,24.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A9581"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","A9581","GADOXETATE DISODIUM INJ",null,99,31.87,14.76,37.14,24.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - A9581"},"TUFTS","TUFTS SELECT","HCPCS","A9581","GADOXETATE DISODIUM INJ",null,99,0,14.76,37.14,24.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9583"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ",null,13,21.34,19.260000000000002,21.34,3.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9584"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9584","IODINE I-123 IOFLUPANE",null,2729,3235.55,3235.55,3235.55,682.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9587"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9587","GALLIUM GA-68",null,12985,0,84.97,113.78,3246.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9587"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9587","GALLIUM GA-68",null,12985,0,84.97,113.78,3246.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9588"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9588","FLUCICLOVINE F-18",null,15438,525.05999999999995,525.05999999999995,703.05,3859.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9606"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER",null,493,378.21,198.62,597.20000000000005,123.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1716"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1716","BRACHYTX SOURCE, GOLD 198",null,0,200.39,168.52,506.68,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C1717"},"TUFTS","TUFTS HMO","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192",null,607,563.15,469.29,1411.01,151.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1724"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1724","HC CATH, TRANS ATHEREC BURR",null,7410,0,null,null,1852.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C1726"},"TUFTS","TUFTS POS","HCPCS","C1726","HC CATHETER BALLN LVL 4",null,387,0,null,null,96.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1731"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1731","HC CATH,EP PENTARAY NAV",null,3847,0,null,null,961.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1750"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1750","HC CATH 2 LUMEN QUINTON",null,1693,0,null,null,423.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1753"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1753","HC BIOPSY FORC LVL D",null,3947,0,null,null,986.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C1753"},"TUFTS","TUFTS SELECT","HCPCS","C1753","HC BIOPSY FORC LVL D",null,3947,0,null,null,986.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C1757"},"TUFTS","TUFTS POS","HCPCS","C1757","HC CATH,THROMB/EMB,LVL 2",null,15822,0,null,null,3955.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1759"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1759","HC CATH, ULTRASOUND LVL 2",null,6295,0,null,null,1573.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1760"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1760","HC CENTRAL LINE KIT",null,1799,0,null,null,449.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1762"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1762","HC NERVE - CONNEVTIVE TISSUE, HUMAN",null,12010,0,null,null,3002.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C1762"},"TUFTS","TUFTS SELECT","HCPCS","C1762","HC NERVE - CONNEVTIVE TISSUE, HUMAN",null,12010,0,null,null,3002.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C1768"},"TUFTS","TUFTS PPO","HCPCS","C1768","HC TAVR HEART VALVE KIT",null,76125,0,null,null,19031.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C1769"},"TUFTS","TUFTS SELECT","HCPCS","C1769","GUIDE WIRE",null,4759,0,null,null,1189.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1770"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1770","IMAGING COIL, MR, INSERTABLE",null,3667,0,null,null,916.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C1777"},"TUFTS","TUFTS SELECT","HCPCS","C1777","HC LEAD,ICD,1COIL",null,13038,0,null,null,3259.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1781"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1781","MESH (IMPLANTABLE)",null,36449,0,null,null,9112.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1786"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1786","HC PACER;1CH, RECALL $0",null,23460,0,null,null,5865,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1788"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1788","HC PORTACATH ANY",null,540,0,null,null,135,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C1882"},"TUFTS","TUFTS HMO","HCPCS","C1882","HC ICD,BI-VENT, GEN ONLY, RECALL $0",null,53226,0,null,null,13306.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C1884"},"TUFTS","TUFTS SELECT","HCPCS","C1884","EMBOLIZATION PROTECT SYST",null,31469,0,null,null,7867.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C1892"},"TUFTS","TUFTS HMO","HCPCS","C1892","HC SHEATH;GUIDING",null,340,0,null,null,85,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C1895"},"TUFTS","TUFTS SELECT","HCPCS","C1895","HC ICD LEAD,2COIL",null,13382,0,null,null,3345.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - C2616"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","C2616","HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE",null,60393,47839.61,25512.2,76706.740000000005,15098.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C2623"},"TUFTS","TUFTS PPO","HCPCS","C2623","CATH TRANSLUMIN DRUG-COAT",null,2837,0,null,null,709.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C2634"},"TUFTS","TUFTS POS","HCPCS","C2634","BRACHYTX, NON-STR, HA, I-125",null,0,232.45,232.45,698.88,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - C2639"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","C2639","BRACHYTX, NON-STRANDED,I-125",null,47,100.75,52.85,100.75,11.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - C8908"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","C8908","HC MRI W/O FOL W/CONT, BREAST,",null,579,1105.27,664.1,4299.8,144.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C9358"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C9358","SURGIMEND, FETAL",null,8526,0,24.42,24.42,2131.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - C9358"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","C9358","SURGIMEND, FETAL",null,8526,24.42,24.42,24.42,2131.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - C9358"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","C9358","SURGIMEND, FETAL",null,8526,24.42,24.42,24.42,2131.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C9739"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C9739","HC CYSTOSCOPY PROSTATIC IMP 1-3",null,6035,15242.01,2166.09,15242.01,1508.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - C9739"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","C9739","HC CYSTOSCOPY PROSTATIC IMP 1-3",null,6035,6751.98,2166.09,15242.01,1508.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D0272"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D0272","BITEWINGS - TWO RADIOGRAPHIC IMAGES",null,836,1182.5,1182.5,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D0274"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D0274","BITEWINGS - FOUR RADIOGRAPHIC IMAGES",null,836,1182.5,1182.5,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - D0474"},"TUFTS","TUFTS PPO","HCPCS","D0474","HC ACCESSION OF TISSUE, GROSS AND MICRO EXAM, INCL. ASSESS. OF MARGINS FOR DISEASE, PREP., TX OF RPT",null,110,3900.57,1941.26,6187.11,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - D0474"},"TUFTS","TUFTS SELECT","HCPCS","D0474","HC ACCESSION OF TISSUE, GROSS AND MICRO EXAM, INCL. ASSESS. OF MARGINS FOR DISEASE, PREP., TX OF RPT",null,110,1941.26,1941.26,6187.11,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - D1110"},"TUFTS","TUFTS SELECT","HCPCS","D1110","PROPHYLAXIS - ADULT",null,110,51.21,51.21,163.22999999999999,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - D1351"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","D1351","SEALANT - PER TOOTH",null,110,45.91,45.91,45.91,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2150"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D2150","AMALGAM - TWO SURFACES, PRIMARY OR PERMANENT",null,110,126.81,126.81,126.81,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2160"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D2160","AMALGAM - THREE SURFACES, PRIMARY OR PERMANENT",null,110,153.4,153.4,153.4,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2330"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D2330","RESIN-BASED COMPOSITE - ONE SURFACE, ANTERIOR",null,110,121.33,121.33,121.33,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2331"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D2331","RESIN-BASED COMPOSITE - TWO SURFACES, ANTERIOR",null,110,154.99,154.99,154.99,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2392"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","D2392","RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR",null,110,186.31,186.31,186.31,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2393"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D2393","RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR",null,110,230.94,230.94,230.94,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2394"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D2394","RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR",null,110,282.64,282.64,282.64,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2930"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","D2930","PREFABRICATED STAINLESS STEEL CROWN - PRIMARY TOOTH",null,110,228.61,228.61,228.61,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D3460"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D3460","HC ENDODONTIC ENDOSSEOUS IMPLANT",null,1451,4066.77,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - D4263"},"TUFTS","TUFTS HMO","HCPCS","D4263","HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ FIRST SITE IN QUADRANT",null,1451,2396.69,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D4381"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D4381","HC LOCALIZED DELIVERY - CONTROLLED RELEASE ANTIMICROB. AGENTS TO DISEASED CREVICULAR TISSUE /TOOTH",null,1451,4066.77,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - 81170"},"FALLON","FALLON MEDICAID","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",null,798,221.66,159,2909.77,199.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - 81170"},"TUFTS","TUFTS SPIRIT","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",null,798,330,159,2909.77,199.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - 81170"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",null,798,354,159,2909.77,199.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - 90471"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE",null,64,76.22,76.22,345.64,16,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - D4381"},"TUFTS","TUFTS SELECT","HCPCS","D4381","HC LOCALIZED DELIVERY - CONTROLLED RELEASE ANTIMICROB. AGENTS TO DISEASED CREVICULAR TISSUE /TOOTH",null,1451,1275.99,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - D5985"},"TUFTS","TUFTS POS","HCPCS","D5985","HC RADIATION CONE LOCATOR",null,1451,2396.69,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - D5987"},"TUFTS","TUFTS POS","HCPCS","D5987","HC COMMISSURE SPLINT",null,1451,2396.69,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - D7220"},"TUFTS","TUFTS PPO","HCPCS","D7220","REMOVAL OF IMPACTED TOOTH - SOFT TISSUE",null,836,2563.83,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - D7230"},"TUFTS","TUFTS PPO","HCPCS","D7230","REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY",null,836,2563.83,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - D7240"},"TUFTS","TUFTS HMO","HCPCS","D7240","REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY",null,836,2396.69,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - D7260"},"TUFTS","TUFTS HMO","HCPCS","D7260","HC OROANTRAL FISTULA CLOSURE",null,1081,2396.69,1275.99,4066.77,270.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D7310"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D7310","ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH SPACES, PER QUADRANT",null,110,230.94,230.94,230.94,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D9630"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D9630","HC DRUGS OR MEDICAMENTS DISPENSED IN THE OFFICE FOR HOME USE",null,110,3340.65,591.51,3340.65,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - E0191"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","NU",321,11.61,11.61,52.13,80.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - E0191"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","UE",321,18.7,11.61,52.13,80.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - G0101"},"TUFTS","TUFTS HMO","HCPCS","G0101","CA SCREEN;PELVIC/BREAST EXAM",null,148,24.73,18.010000000000002,128.29,37,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - G0103"},"UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","G0103","PSA, TOTAL SCREENING",null,93,40.67,16.78,181.16,23.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - G0103"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","G0103","PSA, TOTAL SCREENING",null,93,28,16.78,181.16,23.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - HCPCS - G0103"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","HCPCS","G0103","PSA, TOTAL SCREENING",null,93,19.75,16.78,181.16,23.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0103"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0103","PSA, TOTAL SCREENING",null,93,41.5,16.78,181.16,23.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - G0108"},"TUFTS","TUFTS PPO","HCPCS","G0108","DIAB MANAGE TRN  PER INDIV",null,425,145.49,72.41,230.78,106.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0109"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0109","DIAB MANAGE TRN IND/GROUP",null,267,37.520000000000003,32.64,134.25,66.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - G0127"},"FALLON","FALLON MEDICAID","HCPCS","G0127","TRIM NAIL(S)",null,189,0,93.87,317.35000000000002,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - G0260"},"FALLON","FALLON MEDICAID","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH",null,817,0,1005.62,3474.13,204.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0269"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0269","HC CLOSURE DEVICE PLACEMENT",null,200,0,null,null,50,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0270"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0270","MNT SUBS TX FOR CHANGE DX",null,86,69.08,69.08,70.819999999999993,21.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0270"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G0270","MNT SUBS TX FOR CHANGE DX",null,86,70.819999999999993,69.08,70.819999999999993,21.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - G0279"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","G0279","TOMOSYNTHESIS, MAMMO",null,55,30.09,30.09,295.68,13.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0279"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0279","TOMOSYNTHESIS, MAMMO",null,55,51.68,30.09,295.68,13.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0296"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0296","HC VISIT TO DETERM LDCT ELIG",null,118,128.29,102.62,660.74,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0297"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN",null,1437,178.43,107.22,801.26,359.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - G0378"},"TUFTS","TUFTS POS","HCPCS","G0378","HOSPITAL OBSERVATION PER HR",null,319,0,null,null,79.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - G0378"},"TUFTS","TUFTS SELECT","HCPCS","G0378","HOSPITAL OBSERVATION PER HR",null,319,0,null,null,79.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0390"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI",null,3274,0,1579.83,5035.18,818.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0410"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0410","HC GRP PSYCH PARTIAL HOSP 45-50",null,220,0,null,null,55,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - G0421"},"TUFTS","TUFTS PPO","HCPCS","G0421","HC ED SVC CKD GRP PER SESSION",null,37,85.83,42.72,136.13999999999999,9.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0421"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0421","HC ED SVC CKD GRP PER SESSION",null,37,0,42.72,136.13999999999999,9.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0422"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC",null,169,0,198.42,637.79,42.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - G0423"},"TUFTS","TUFTS POS","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER",null,169,375.87,198.42,637.79,42.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0423"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER",null,169,0,198.42,637.79,42.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - G0439"},"TUFTS","TUFTS POS","HCPCS","G0439","PPPS, SUBSEQ VISIT",null,327,38.93,34.03,61.76,81.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - G0442"},"BMC HEALTHNET","BMCHN ACO","HCPCS","G0442","ANNUAL ALCOHOL SCREEN 15 MIN",null,42,0,13.34,33.6,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0443"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0443","BRIEF ALCOHOL MISUSE COUNSEL",null,118,33.6,18.52,33.6,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0445"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0445","HIGH INTEN BEH COUNS STD 30M",null,118,16.149999999999999,8.9,16.149999999999999,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0446"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0446","INTENS BEHAVE THER CARDIO DX",null,42,0,8.9,16.149999999999999,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - G0447"},"TUFTS","TUFTS POS","HCPCS","G0447","HC BEHAVIOR COUNSEL OBESITY 15M",null,118,21.18,18.52,33.6,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0447"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0447","HC BEHAVIOR COUNSEL OBESITY 15M",null,118,0,18.52,33.6,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - G0480"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES",null,254,114.43,59.69,973.54,63.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0480"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES",null,254,209.48,59.69,973.54,63.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0480"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES",null,254,209.48,59.69,973.54,63.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - G0481"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES",null,192,236.98,91.84,1332.11,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - 81170"},"UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",null,798,631.79999999999995,159,2909.77,199.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - 81170"},"FALLON","FALLON SENIOR PLAN","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",null,798,300,159,2909.77,199.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - 81170"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",null,798,548.09,159,2909.77,199.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - 45378"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND",null,1672,1020.59,1020.59,3264.67,418,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - A4467"},"FALLON","FALLON MEDICAID","HCPCS","A4467","BELT STRAP SLEEV GRMNT COVER",null,151,0,null,null,37.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - A4561"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE",null,108,23.18,23.18,58.33,27,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A4562"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A4562","PESSARY NONRUBBER",null,64,0,57.71,145.21,16,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A4562"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","A4562","PESSARY NONRUBBER",null,64,57.71,57.71,145.21,16,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A4648"},"TUFTS","TUFTS POS","HCPCS","A4648","IMPLANTABLE TISSUE MARKER",null,281,0,null,null,70.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A4725"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC",null,87,0,null,null,21.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A6209"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR",null,163,12.63,8.68,21.84,40.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A6209"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR",null,163,12.63,8.68,21.84,40.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - A6258"},"FALLON","FALLON MEDICAID","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN",null,83,0,5,12.58,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - A6258"},"TUFTS","TUFTS SPIRIT","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN",null,83,5.5,5,12.58,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A6258"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN",null,83,7.28,5,12.58,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A6258"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN",null,83,12.58,5,12.58,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A6549"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A6549","G COMPRESSION STOCKING",null,37,0,null,null,9.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A6550"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","A6550","NEG PRES WOUND THER DRSG SET",null,4,37.28,25.71,64.69,1,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - A6550"},"BMC HEALTHNET","BMCHN QHP","HCPCS","A6550","NEG PRES WOUND THER DRSG SET",null,4,0,25.71,64.69,1,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A7520"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED",null,1173,0,55.16,138.79,293.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - A9500"},"TUFTS","TUFTS HMO","HCPCS","A9500","TC99M SESTAMIBI",null,274,0,463.42,463.42,68.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - A9500"},"TUFTS","TUFTS SELECT","HCPCS","A9500","TC99M SESTAMIBI",null,274,0,463.42,463.42,68.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9502"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9502","HC TC99M TETROFOSMIN",null,140,0,278.27,278.27,35,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9505"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9505","THALLIUM CHLORIDE PER MCI",null,23,395.74,395.74,395.74,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - A9509"},"TUFTS","TUFTS HMO","HCPCS","A9509","HC IODINE I-123 PER MCI",null,95,0,5163.91,5163.91,23.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9512"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9512","TC99M PERTECHNETATE",null,1,0,null,null,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9513"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN",null,320,0,294.27999999999997,1097.56,80,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9513"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN",null,320,329.72,294.27999999999997,1097.56,80,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9516"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9516","I123 IODIDE CAP, DX",null,192,516.39,516.39,516.39,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9516"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9516","I123 IODIDE CAP, DX",null,192,516.39,516.39,516.39,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - A9517"},"TUFTS","TUFTS HMO","HCPCS","A9517","I131 IODIDE CAP, RX",null,437,36.119999999999997,30.1,101.94,109.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A9517"},"TUFTS","TUFTS POS","HCPCS","A9517","I131 IODIDE CAP, RX",null,437,30.1,30.1,101.94,109.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - A9537"},"BMC HEALTHNET","BMCHN MCO","HCPCS","A9537","TC99M MEBROFENIN",null,138,0,157.94999999999999,157.94999999999999,34.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9538"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9538","TC99M PYROPHOSPHATE",null,111,0,114.21,114.21,27.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - A9539"},"TUFTS","TUFTS HMO","HCPCS","A9539","TC99M PENTETATE",null,668,0,89.47,89.47,167,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9539"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9539","TC99M PENTETATE",null,668,0,89.47,89.47,167,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9540"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9540","TC99M MAA",null,1831,0,85.66,85.66,457.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9540"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9540","TC99M MAA",null,1831,85.66,85.66,85.66,457.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9541"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9541","TC99M SULFUR COLLOID",null,120,0,152.69,152.69,30,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9543"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9543","Y90 IBRITUMOMAB, RX",null,66322,97558.58,72400.97,217685.7,16580.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9543"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9543","Y90 IBRITUMOMAB, RX",null,66322,139963.56,72400.97,217685.7,16580.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - A9547"},"BMC HEALTHNET","BMCHN QHP","HCPCS","A9547","IN111 OXYQUINOLINE",null,440,0,5105.7299999999996,5105.7299999999996,110,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9551"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX",null,154,0,1711.56,1711.56,38.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - A9551"},"BMC HEALTHNET","BMCHN ACO","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX",null,154,0,1711.56,1711.56,38.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9552"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9552","F18 FDG",null,972,0,1166.46,1166.46,243,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9552"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9552","F18 FDG",null,972,1166.46,1166.46,1166.46,243,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - A9555"},"TUFTS","TUFTS HMO","HCPCS","A9555","RADIOPHARMACIAL",null,1065,0,1604.08,1604.08,266.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - A9555"},"BMC HEALTHNET","BMCHN ACO","HCPCS","A9555","RADIOPHARMACIAL",null,1065,0,1604.08,1604.08,266.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9556"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9556","GA67 GALLIUM",null,20,311.94,311.94,311.94,5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9557"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9557","TC99M BICISATE",null,239,0,1062.44,1062.44,59.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9560"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9560","TC99M LABELED RBC",null,246,0,266.7,266.7,61.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9561"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9561","TC99M OXIDRONATE",null,127,0,125.64,125.64,31.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9562"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9562","TC99M MERTIATIDE",null,1237,0,2212.25,2212.25,309.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9562"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9562","TC99M MERTIATIDE",null,1237,2212.25,2212.25,2212.25,309.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - A9562"},"BMC HEALTHNET","BMCHN ACO","HCPCS","A9562","TC99M MERTIATIDE",null,1237,0,2212.25,2212.25,309.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A9563"},"TUFTS","TUFTS PPO","HCPCS","A9563","P32 NA PHOSPHATE",null,0,1132.32,535.17999999999995,3182.68,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9569"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC",null,5086,0,4157.3,4157.3,1271.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - A9570"},"BMC HEALTHNET","BMCHN MCO","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC",null,6395,0,null,null,1598.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9572"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE",null,131,16207.01,16207.01,16207.01,32.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A9575"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML",null,8,0.21,0.18,0.45,2,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A9575"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML",null,8,0.4,0.18,0.45,2,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9576"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML",null,5,0,1.5,3.77,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A9576"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML",null,5,2.61,1.5,3.77,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A9577"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML",null,21,1.81,1.81,5.03,5.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A9579"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML",null,5,1.84,1.53,4.38,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A9579"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML",null,5,3.85,1.53,4.38,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A9581"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","A9581","GADOXETATE DISODIUM INJ",null,99,17.71,14.76,37.14,24.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - A9581"},"TUFTS","TUFTS SPIRIT","HCPCS","A9581","GADOXETATE DISODIUM INJ",null,99,16.239999999999998,14.76,37.14,24.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9582"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9582","IODINE I-123 IOBENGUANE",null,10370,0,null,null,2592.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9582"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9582","IODINE I-123 IOBENGUANE",null,10370,0,null,null,2592.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - A9583"},"TUFTS","TUFTS SELECT","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ",null,13,0,19.260000000000002,21.34,3.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9583"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ",null,13,0,19.260000000000002,21.34,3.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9586"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",null,4402,3746.06,3746.06,7452.46,1100.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A9587"},"TUFTS","TUFTS POS","HCPCS","A9587","GALLIUM GA-68",null,12985,0,84.97,113.78,3246.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9587"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9587","GALLIUM GA-68",null,12985,84.97,84.97,113.78,3246.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9588"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9588","FLUCICLOVINE F-18",null,15438,703.05,525.05999999999995,703.05,3859.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9606"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER",null,493,378.21,198.62,597.20000000000005,123.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1715"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1715","BRACHYTHERAPY NEEDLE",null,21,0,null,null,5.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C1715"},"TUFTS","TUFTS HMO","HCPCS","C1715","BRACHYTHERAPY NEEDLE",null,21,0,null,null,5.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1717"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192",null,607,554.13,469.29,1411.01,151.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1719"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1719","BRACHYTX SOUR,NON-HDR IR-192",null,95,108.35,108.35,357.35,23.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C1719"},"TUFTS","TUFTS POS","HCPCS","C1719","BRACHYTX SOUR,NON-HDR IR-192",null,95,118.86,108.35,357.35,23.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1721"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1721","HC ICD,2CH, GEN ONLY, RECALL $0",null,39674,0,null,null,9918.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1726"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1726","HC CATHETER BALLN LVL 4",null,387,0,null,null,96.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1733"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1733","CATH CRYABL  ARCTIC FRN",null,10475,0,null,null,2618.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C1751"},"TUFTS","TUFTS HMO","HCPCS","C1751","HC CATH, PACING",null,1438,0,null,null,359.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1759"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1759","HC CATH, ULTRASOUND LVL 2",null,6295,0,null,null,1573.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1764"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1764","HC RECORDER;IMPLANTABLE LOOP",null,8983,0,null,null,2245.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C1766"},"TUFTS","TUFTS HMO","HCPCS","C1766","SHTH INTRO 65CM 15FR 12FR",null,2619,0,null,null,654.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1768"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1768","HC TAVR HEART VALVE KIT",null,76125,0,null,null,19031.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1777"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1777","HC LEAD,ICD,1COIL",null,13038,0,null,null,3259.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1786"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1786","HC PACER;1CH, RECALL $0",null,23460,0,null,null,5865,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1817"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1817","HC OCCKYDER;ASD/PFO",null,9668,0,null,null,2417,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1874"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1874","STENT WALLFLEX SYSTEM",null,8879,0,null,null,2219.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1880"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1880","IVC FILTERS",null,7726,0,null,null,1931.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1883"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1883","HC ADAPTOR;BI-VENT PACER",null,1257,0,null,null,314.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C1883"},"TUFTS","TUFTS SELECT","HCPCS","C1883","HC ADAPTOR;BI-VENT PACER",null,1257,0,null,null,314.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C1884"},"TUFTS","TUFTS PPO","HCPCS","C1884","EMBOLIZATION PROTECT SYST",null,31469,0,null,null,7867.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1892"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1892","HC SHEATH;GUIDING",null,340,0,null,null,85,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C1894"},"TUFTS","TUFTS POS","HCPCS","C1894","HC INTRO/SHEATH NON-CARD LV2",null,252,0,null,null,63,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1896"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1896","HC SICD PULSE GENERATOR",null,10912,0,null,null,2728,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1896"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1896","HC SICD PULSE GENERATOR",null,10912,0,null,null,2728,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C1900"},"TUFTS","TUFTS HMO","HCPCS","C1900","HC INJ;OCTAFLUORO MICRO/1ML",null,8293,0,null,null,2073.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C2616"},"TUFTS","TUFTS POS","HCPCS","C2616","HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE",null,60393,25512.2,25512.2,76706.740000000005,15098.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C2621"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C2621","HC PACER;2CH, W/ BACKUP DEFIB",null,21692,0,null,null,5423,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C2625"},"TUFTS","TUFTS HMO","HCPCS","C2625","STENT BILIARY COTTON",null,246,0,null,null,61.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C2628"},"TUFTS","TUFTS SELECT","HCPCS","C2628","HC KIT CATH BRIDGE PRE",null,2308,0,null,null,577,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C2634"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C2634","BRACHYTX, NON-STR, HA, I-125",null,0,313.02999999999997,232.45,698.88,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C2634"},"TUFTS","TUFTS HMO","HCPCS","C2634","BRACHYTX, NON-STR, HA, I-125",null,0,278.94,232.45,698.88,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C2635"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C2635","BRACHYTX, NON-STR, HA, P-103",null,0,97.01,78.03,242.54,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C8908"},"TUFTS","TUFTS HMO","HCPCS","C8908","HC MRI W/O FOL W/CONT, BREAST,",null,579,1716.08,664.1,4299.8,144.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - C8908"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","C8908","HC MRI W/O FOL W/CONT, BREAST,",null,579,1105.27,664.1,4299.8,144.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C9358"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C9358","SURGIMEND, FETAL",null,8526,0,24.42,24.42,2131.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C9728"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C9728","PLACE DEVICE/MARKER, NON PRO",null,1957,2573.36,2227.36,7098.97,489.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - C9739"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","C9739","HC CYSTOSCOPY PROSTATIC IMP 1-3",null,6035,6751.98,2166.09,15242.01,1508.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C9803"},"TUFTS","TUFTS PPO","HCPCS","C9803","HC OP VISIT SPEC COLLECTION SEVERE ACUTE RESP SYDROM COVID-19",null,35,87.7,87.7,246.49,8.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D0210"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D0210","INTRAORAL - COMPLETE SERIES OF RADIOGRAPHIC IMAGES",null,165,120.47,120.47,120.47,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - D0240"},"TUFTS","TUFTS POS","HCPCS","D0240","INTRAORAL - OCCLUSAL RADIOGRAPHIC IMAGE",null,836,2396.69,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D0474"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D0474","HC ACCESSION OF TISSUE, GROSS AND MICRO EXAM, INCL. ASSESS. OF MARGINS FOR DISEASE, PREP., TX OF RPT",null,110,6187.11,1941.26,6187.11,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D1110"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D1110","PROPHYLAXIS - ADULT",null,110,84.56,51.21,163.22999999999999,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - D1510"},"TUFTS","TUFTS HMO","HCPCS","D1510","SPACE MAINTAINER - FIXED - UNILATERAL",null,836,2396.69,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - D1517"},"TUFTS","TUFTS HMO","HCPCS","D1517","SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MANDIBULAR",null,1451,0,null,null,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2161"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D2161","AMALGAM - FOUR OR MORE SURFACES, PRIMARY OR PERMANENT",null,110,187.9,187.9,187.9,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2332"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D2332","RESIN-BASED COMPOSITE - THREE SURFACES, ANTERIOR",null,110,189.47,189.47,189.47,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2391"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D2391","RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR",null,110,141.69,141.69,141.69,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2392"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D2392","RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR",null,110,186.31,186.31,186.31,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2931"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D2931","PREFABRICATED STAINLESS STEEL CROWN - PERMANENT TOOTH",null,110,259.95,259.95,259.95,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D3330"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D3330","ENDODONTIC THERAPY, MOLAR (EXCLUDING FINAL RESTORATION)",null,110,894.85,894.85,894.85,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - D4264"},"TUFTS","TUFTS HMO","HCPCS","D4264","HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ EACH ADDITIONAL SITE IN QUADRANT",null,1451,2396.69,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - D4264"},"TUFTS","TUFTS SELECT","HCPCS","D4264","HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ EACH ADDITIONAL SITE IN QUADRANT",null,1451,1275.99,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - D5983"},"TUFTS","TUFTS POS","HCPCS","D5983","HC RADIATION CARRIER",null,1451,2396.69,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - D5984"},"TUFTS","TUFTS POS","HCPCS","D5984","HC RADIATION SHIELD",null,1451,2396.69,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - D7140"},"TUFTS","TUFTS PPO","HCPCS","D7140","EXTRACTION ERUPTED TOOTH/EXR",null,836,2563.83,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - D7210"},"TUFTS","TUFTS HMO","HCPCS","D7210","EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED",null,836,2396.69,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - D7240"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","D7240","REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY",null,836,1510.05,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D7261"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D7261","PRIMARY CLOSURE OF A SINUS PERFORATION",null,836,4066.77,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D7311"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D7311","ALVEOLOPLASTY W/EXTRACT 1-3",null,110,202.78,202.78,202.78,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - D9230"},"TUFTS","TUFTS POS","HCPCS","D9230","INHALATION OF NITROUS OXIDE/ANALGESIA, ANXIOLYSIS",null,110,0,null,null,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - D9951"},"TUFTS","TUFTS POS","HCPCS","D9951","OCCLUSAL ADJUSTMENT - LIMITED",null,1350,2396.69,1275.99,4066.77,337.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - D9951"},"TUFTS","TUFTS PPO","HCPCS","D9951","OCCLUSAL ADJUSTMENT - LIMITED",null,1350,2563.83,1275.99,4066.77,337.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - E0191"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","NU",321,25.07,11.61,52.13,80.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - E0191"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","RR",321,1.62,11.61,52.13,80.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - E0191"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","UE",321,19.14,11.61,52.13,80.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - G0101"},"TUFTS","TUFTS PPO","HCPCS","G0101","CA SCREEN;PELVIC/BREAST EXAM",null,148,20.6,18.010000000000002,128.29,37,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - G0103"},"FALLON","FALLON MEDICAID","HCPCS","G0103","PSA, TOTAL SCREENING",null,93,0,16.78,181.16,23.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - G0103"},"TUFTS","TUFTS SELECT","HCPCS","G0103","PSA, TOTAL SCREENING",null,93,32.07,16.78,181.16,23.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0103"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0103","PSA, TOTAL SCREENING",null,93,41.5,16.78,181.16,23.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - G0103"},"BMC HEALTHNET","BMCHN MCO","HCPCS","G0103","PSA, TOTAL SCREENING",null,93,0,16.78,181.16,23.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0108"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0108","DIAB MANAGE TRN  PER INDIV",null,425,136.19,72.41,230.78,106.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0109"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0109","DIAB MANAGE TRN IND/GROUP",null,267,33.46,32.64,134.25,66.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0127"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0127","TRIM NAIL(S)",null,189,93.87,93.87,317.35000000000002,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0239"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0239","OTH RESP PROC, GROUP",null,99,373.41,53.94,373.41,24.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0257"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP",null,911,1320.72,1027.32,3651.55,227.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0257"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP",null,911,0,1027.32,3651.55,227.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0257"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP",null,911,1027.32,1027.32,3651.55,227.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0257"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP",null,911,1027.32,1027.32,3651.55,227.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0260"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH",null,817,3474.13,1005.62,3474.13,204.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - G0269"},"TUFTS","TUFTS POS","HCPCS","G0269","HC CLOSURE DEVICE PLACEMENT",null,200,0,null,null,50,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - G0269"},"BMC HEALTHNET","BMCHN QHP","HCPCS","G0269","HC CLOSURE DEVICE PLACEMENT",null,200,0,null,null,50,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - G0279"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","G0279","TOMOSYNTHESIS, MAMMO",null,55,36.11,30.09,295.68,13.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - G0279"},"TUFTS","TUFTS HMO","HCPCS","G0279","TOMOSYNTHESIS, MAMMO",null,55,118.02,30.09,295.68,13.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - G0279"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","G0279","TOMOSYNTHESIS, MAMMO",null,55,40.57,30.09,295.68,13.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0297"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN",null,1437,107.22,107.22,801.26,359.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - G0297"},"TUFTS","TUFTS PPO","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN",null,1437,285.07,107.22,801.26,359.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0389"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0389","ULTRASOUND EXAM AAA SCREEN",null,544,0,null,null,136,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0390"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI",null,3274,0,1579.83,5035.18,818.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0396"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN",null,42,0,56.05,336.32,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0396"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN",null,42,46.72,56.05,336.32,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - G0397"},"BMC HEALTHNET","BMCHN ACO","HCPCS","G0397","ALCOHOL/SUBS INTERV >30 MIN",null,118,0,128.29,815.89,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - G0402"},"FALLON","FALLON MEDICAID","HCPCS","G0402","INITIAL PREVENTIVE EXAM",null,168,0,208.89,1179.72,42,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - G0402"},"TUFTS","TUFTS PPO","HCPCS","G0402","INITIAL PREVENTIVE EXAM",null,168,0,208.89,1179.72,42,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - G0410"},"TUFTS","TUFTS SELECT","HCPCS","G0410","HC GRP PSYCH PARTIAL HOSP 45-50",null,220,0,null,null,55,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0410"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0410","HC GRP PSYCH PARTIAL HOSP 45-50",null,220,0,null,null,55,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0420"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0420","HC ED SVC CKD IND PER SESSION",null,156,0,184.9,589.33000000000004,39,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0422"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC",null,169,255.09,198.42,637.79,42.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0422"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC",null,169,0,198.42,637.79,42.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0423"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER",null,169,198.42,198.42,637.79,42.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - G0439"},"BMC HEALTHNET","BMCHN MCO","HCPCS","G0439","PPPS, SUBSEQ VISIT",null,327,0,34.03,61.76,81.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - G0442"},"TUFTS","TUFTS HMO","HCPCS","G0442","ANNUAL ALCOHOL SCREEN 15 MIN",null,42,21.18,13.34,33.6,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0442"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0442","ANNUAL ALCOHOL SCREEN 15 MIN",null,42,0,13.34,33.6,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - G0447"},"FALLON","FALLON MEDICAID","HCPCS","G0447","HC BEHAVIOR COUNSEL OBESITY 15M",null,118,0,18.52,33.6,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - G0447"},"TUFTS","TUFTS SELECT","HCPCS","G0447","HC BEHAVIOR COUNSEL OBESITY 15M",null,118,18.52,18.52,33.6,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - G0480"},"FALLON","FALLON MEDICAID","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES",null,254,59.69,59.69,973.54,63.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - G0480"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES",null,254,247.05,59.69,973.54,63.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - G0481"},"UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES",null,192,329.78,91.84,1332.11,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - G0481"},"TUFTS","TUFTS HMO","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES",null,192,531.64,91.84,1332.11,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - G0506"},"FALLON","FALLON MEDICAID","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC",null,62,0,110.9,110.9,15.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0513"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M",null,84,0,148.6,148.6,21,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0513"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M",null,84,148.6,148.6,148.6,21,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0514"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M",null,84,148.6,148.6,148.6,21,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - G2012"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","G2012","HC BRIEF CHECK IN BY MD/QHP",null,42,31.78,31.78,31.78,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - G2023"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS",null,31,23.46,23.46,212.71,7.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - HCPCS - G2023"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS",null,31,35.47,23.46,212.71,7.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - G2024"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",null,33,30.55,25.46,230.84,8.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - G2024"},"TUFTS","TUFTS PPO","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",null,33,82.13,25.46,230.84,8.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - G2024"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",null,33,34.33,25.46,230.84,8.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G2066"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH",null,165,80.23,58.35,370.47,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G2066"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH",null,165,80.23,58.35,370.47,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - G2086"},"TUFTS","TUFTS HMO","HCPCS","G2086","HC OFF BASE OPIOID TX 70MIN",null,194,55.42,46.18,211.43,48.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - G2086"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","G2086","HC OFF BASE OPIOID TX 70MIN",null,194,211.43,46.18,211.43,48.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G2088"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G2088","HC OFF BASE OPIOID TX, ADD30",null,45,0,82.11,82.11,11.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G2088"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G2088","HC OFF BASE OPIOID TX, ADD30",null,45,0,82.11,82.11,11.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L0120"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE",null,25,24.86,24.86,111.59,6.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L0120"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE",null,25,24.86,24.86,111.59,6.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L0140"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB",null,189,93.02,77.52,347.97,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L0140"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB",null,189,0,77.52,347.97,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L1820"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO",null,159,142.59,142.59,640.03,39.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L1830"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT",null,78,81.95,81.95,367.86,19.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L1832"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT",null,1523,743.59,743.59,3337.75,380.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L1832"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT",null,1523,1078.21,743.59,3337.75,380.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - L1832"},"BMC HEALTHNET","BMCHN ACO","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT",null,1523,0,743.59,3337.75,380.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L1836"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L1836","HC RIGID KO WO JOINTS",null,209,0,130.47999999999999,585.70000000000005,52.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - L1902"},"TUFTS","TUFTS PPO","HCPCS","L1902","AFO ANKLE GAUNTLET",null,219,137.56,86.14,386.65,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L1902"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L1902","AFO ANKLE GAUNTLET",null,219,216.75,86.14,386.65,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L3260"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L3260","AMBULATORY SURGICAL BOOT EAC",null,279,31.12,31.12,357.96,69.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - L3350"},"TUFTS","TUFTS SPIRIT","HCPCS","L3350","SHOE HEEL WEDGE",null,41,24.65,22.41,100.59,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3496"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L3496","HC STATIC AFO",null,406,0,null,null,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - L3650"},"FALLON","FALLON MEDICAID","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN",null,1955,0,67.38,302.45,488.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L3650"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN",null,1955,90.84,67.38,302.45,488.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L3650"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN",null,1955,148.9,67.38,302.45,488.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - L3670"},"TUFTS","TUFTS SELECT","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE",null,2903,154.74,103.65,465.27,725.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L3670"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE",null,2903,150.86000000000001,103.65,465.27,725.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - 92083"},"TUFTS","TUFTS SELECT","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED",null,461,190.72,68.75,607.84,115.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - 92083"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED",null,461,178.83,68.75,607.84,115.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L3762"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L3762","RIGID EO WO JOINTS",null,57,95.68,95.68,429.49,14.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - L3762"},"TUFTS","TUFTS PPO","HCPCS","L3762","RIGID EO WO JOINTS",null,57,152.80000000000001,95.68,429.49,14.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3762"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L3762","RIGID EO WO JOINTS",null,57,0,95.68,429.49,14.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - L3807"},"TUFTS","TUFTS HMO","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED",null,483,398.65,222.52,998.85,120.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L3807"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED",null,483,300,222.52,998.85,120.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3807"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED",null,483,0,222.52,998.85,120.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L3808"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L3808","HC EPITRAIN",null,509,547.16999999999996,375.94,1687.5,127.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L3905"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF",null,2442,1059.01,882.51,3961.32,610.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - L3905"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF",null,2442,1279.6400000000001,882.51,3961.32,610.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - L3905"},"TUFTS","TUFTS PPO","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF",null,2442,1409.34,882.51,3961.32,610.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L3908"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L3908","WRIST COCK-UP NON-MOLDED",null,143,73.22,73.22,328.66,35.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - L3908"},"FALLON","FALLON SENIOR PLAN","HCPCS","L3908","WRIST COCK-UP NON-MOLDED",null,143,73.22,73.22,328.66,35.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - L3967"},"TUFTS","TUFTS SELECT","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF",null,117,2635.32,1765.23,7923.54,29.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L3967"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF",null,117,2569.1999999999998,1765.23,7923.54,29.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L3980"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL",null,132,453.41,377.84,1695.98,33,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L3980"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL",null,132,445.85,377.84,1695.98,33,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - L3982"},"TUFTS","TUFTS SELECT","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL",null,176,594.53,398.23,1787.56,44,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3982"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL",null,176,0,398.23,1787.56,44,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L4350"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB",null,360,97.28,97.28,436.66,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L4350"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB",null,360,0,97.28,436.66,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L4360"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB",null,557,466.25,345.83,1552.36,139.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - L4370"},"FALLON","FALLON MEDICAID","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT",null,107,0,235.79,1058.3900000000001,26.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L4370"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT",null,107,0,235.79,1058.3900000000001,26.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - L4386"},"FALLON","FALLON SENIOR PLAN","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB",null,165,155.02000000000001,155.02000000000001,695.83,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - L4386"},"TUFTS","TUFTS SPIRIT","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB",null,165,170.52,155.02000000000001,695.83,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L4386"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB",null,165,225.63,155.02000000000001,695.83,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L4386"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB",null,165,0,155.02000000000001,695.83,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L4396"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L4396","STATIC AFO",null,406,231.11,171.42,769.43,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - L4398"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT",null,406,114.43,78.92,354.25,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - L4398"},"TUFTS","TUFTS SELECT","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT",null,406,117.83,78.92,354.25,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - L8501"},"FALLON","FALLON MEDICAID","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE",null,219,0,160.74,721.54,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L8501"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE",null,219,347.04,160.74,721.54,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L8501"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE",null,219,0,160.74,721.54,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L8501"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE",null,219,0,160.74,721.54,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L8509"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN",null,1144,186.16,106.99,480.27,286,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L8514"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR",null,387,92.38,92.38,414.69,96.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - L8514"},"BMC HEALTHNET","BMCHN ACO","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR",null,387,0,92.38,414.69,96.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L8693"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT",null,1462,1782.68,1485.57,6668.25,365.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - L8699"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","L8699","HC CARTIFORM 20 X 25 MM DISC",null,13957,0,null,null,3489.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L8699"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L8699","HC CARTIFORM 20 X 25 MM DISC",null,13957,0,null,null,3489.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - M0239"},"FALLON","FALLON MEDICAID","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",null,393,309.60000000000002,309.60000000000002,779.02,98.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - M0239"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",null,393,448.92,309.60000000000002,779.02,98.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - M0239"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",null,393,518.74,309.60000000000002,779.02,98.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - M0243"},"UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",null,572,652.02,309.60000000000002,779.02,143,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - P9012"},"TUFTS","TUFTS SELECT","HCPCS","P9012","HC CRYOPRECIPITATE UNIT",null,134,73.86,64.959999999999994,125.33,33.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - P9012"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","P9012","HC CRYOPRECIPITATE UNIT",null,134,64.959999999999994,64.959999999999994,125.33,33.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9021"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","P9021","HC RBC/UNIT",null,323,295.08999999999997,184.28,354.25,80.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - P9037"},"TUFTS","TUFTS PPO","HCPCS","P9037","HC PLT:PHER,LEU-RED,IRR/UNIT",null,939,1022.99,821.84,1622.67,234.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9040"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","P9040","HC RBC:LEU-RED,IRR/UNIT",null,523,336.11,336.11,669.97,130.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - P9045"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML",null,238,54.43,52.45,131.97,59.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - P9057"},"TUFTS","TUFTS POS","HCPCS","P9057","HC RBC:LEU RED,FR/DE/WASH,IR",null,785,395.89,395.89,671.74,196.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - P9100"},"TUFTS","TUFTS HMO","HCPCS","P9100","PATHOGEN TEST FOR PLATELETS",null,1310,102.43,33.53,256.64,327.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - P9612"},"FALLON","FALLON SENIOR PLAN","HCPCS","P9612","CATHETERIZE FOR URINE SPEC",null,90,3,2.2200000000000002,1198.25,22.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - P9612"},"TUFTS","TUFTS HMO","HCPCS","P9612","CATHETERIZE FOR URINE SPEC",null,90,10.199999999999999,2.2200000000000002,1198.25,22.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q0091"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR",null,83,37.07,28.83,175.66,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q0091"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR",null,83,37.07,28.83,175.66,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - Q0091"},"TUFTS","TUFTS PPO","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR",null,83,62.49,28.83,175.66,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - Q0091"},"BMC HEALTHNET","BMCHN QHP","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR",null,83,0,28.83,175.66,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - Q0111"},"FALLON","FALLON MEDICAID","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS",null,23,0,5.86,127.48,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q0111"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS",null,23,12.77,5.86,127.48,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q0111"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS",null,23,27.01,5.86,127.48,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - Q0111"},"BMC HEALTHNET","BMCHN MCO","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS",null,23,10.82,5.86,127.48,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q0114"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","Q0114","HC  FERN TEST",null,41,14.12,7.2,82.86,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q0114"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q0114","HC  FERN TEST",null,41,17.79,7.2,82.86,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q0114"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","Q0114","HC  FERN TEST",null,41,21.52,7.2,82.86,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q0249"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q0249","HC TOCILIZUMAB FOR COVID-19",null,9,0,null,null,2.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q4102"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q4102","OASIS WOUND MATRIX",null,69,0,10.210000000000001,25.69,17.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - Q4102"},"TUFTS","TUFTS HMO","HCPCS","Q4102","OASIS WOUND MATRIX",null,69,0,10.210000000000001,25.69,17.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q4102"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","Q4102","OASIS WOUND MATRIX",null,69,25.69,10.210000000000001,25.69,17.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - Q4104"},"TUFTS","TUFTS SELECT","HCPCS","Q4104","INTEGRA BMWD",null,7748,0,42.08,56.11,1937,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - Q4112"},"TUFTS","TUFTS PPO","HCPCS","Q4112","CYMETRA INJECTABLE",null,535,0,904.99,1002.89,133.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q4116"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM",null,5248,0,32.29,35.78,1312,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - Q4116"},"BMC HEALTHNET","BMCHN MCO","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM",null,5248,0,32.29,35.78,1312,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q4124"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q4124","OASIS TRILAYER/1 SQCM",null,23,0,16.39,16.39,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - Q4125"},"FALLON","FALLON MEDICAID","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM",null,4060,0,3.79,3.79,1015,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - Q4125"},"TUFTS","TUFTS SELECT","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM",null,4060,0,3.79,3.79,1015,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - Q4130"},"TUFTS","TUFTS POS","HCPCS","Q4130","PR STRATTICE TM",null,65718,0,45.89,45.89,16429.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - Q4132"},"UNICARE","UNICARE","HCPCS","Q4132","HC GRAFIX CORE 5X5CM",null,3754,118.95,114.63,288.43,938.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - Q4132"},"TUFTS","TUFTS SELECT","HCPCS","Q4132","HC GRAFIX CORE 5X5CM",null,3754,0,114.63,288.43,938.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q4132"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","Q4132","HC GRAFIX CORE 5X5CM",null,3754,154.54,114.63,288.43,938.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q4133"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",null,3756,0,131.97,332.06,939,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q4133"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",null,3756,151.77000000000001,131.97,332.06,939,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q4196"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM",null,9044,192.05,111.59,280.77999999999997,2261,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - Q4196"},"TUFTS","TUFTS HMO","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM",null,9044,152,111.59,280.77999999999997,2261,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q9954"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML",null,0,0,12.1,13.41,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q9956"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML",null,76,38.1,31.75,79.89,19,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q9956"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML",null,76,31.75,31.75,79.89,19,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q9956"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML",null,76,36.51,31.75,79.89,19,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q9956"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML",null,76,70.16,31.75,79.89,19,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q9957"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML",null,417,57.16,47.63,119.85,104.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q9958"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML",null,1,0.08,7.0000000000000007E-2,0.18,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q9961"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML",null,1,0.25,0.25,0.63,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q9987"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q9987","HC PATHOGEN TEST PLATELETS",null,1218,0,null,null,304.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - S5100"},"BMC HEALTHNET","BMCHN ACO","HCPCS","S5100","ADULT DAYCARE SERVICES 15MIN",null,6,0,null,null,1.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - S8037"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","S8037","MRCP",null,1440,1396.47,585.76,3771.6,360,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - U0001"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",null,124,41.31,35.909999999999997,325.64,31,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - U0002"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",null,92,69.180000000000007,51.31,465.19,23,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - U0002"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",null,92,59.02,51.31,465.19,23,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - V2790"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","V2790","HC MEMBRANE AMNIOTIC",null,1136,0,null,null,284,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - 0042T"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",null,767,0,1452,1452,191.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - 0402T"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA",null,2880,11845.41,1198.25,11845.41,720,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - 95800"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA",null,205,293.2,228.32,1412.44,51.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - 95800"},"TUFTS","TUFTS HMO","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA",null,205,563.71,228.32,1412.44,51.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - 95800"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA",null,205,228.32,228.32,1412.44,51.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - 95800"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA",null,205,228.32,228.32,1412.44,51.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A4215"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A4215","STERILE NEEDLE",null,433,0,null,null,108.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A4561"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE",null,108,23.18,23.18,58.33,27,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - A4561"},"TUFTS","TUFTS SELECT","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE",null,108,0,23.18,58.33,27,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A4561"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE",null,108,33.729999999999997,23.18,58.33,27,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A4562"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","A4562","PESSARY NONRUBBER",null,64,57.71,57.71,145.21,16,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A4570"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1",null,40,0,19.010000000000002,107.35,10,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - A4570"},"BMC HEALTHNET","BMCHN QHP","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1",null,40,0,19.010000000000002,107.35,10,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A4725"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC",null,87,0,null,null,21.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A6209"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR",null,163,8.68,8.68,21.84,40.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A6209"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR",null,163,12.63,8.68,21.84,40.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - A6258"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN",null,83,5,5,12.58,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A6258"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN",null,83,10.8,5,12.58,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - A6258"},"BMC HEALTHNET","BMCHN QHP","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN",null,83,0,5,12.58,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A6549"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A6549","G COMPRESSION STOCKING",null,37,0,null,null,9.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - A6550"},"FALLON","FALLON SENIOR PLAN","HCPCS","A6550","NEG PRES WOUND THER DRSG SET",null,4,25.71,25.71,64.69,1,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A6550"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","A6550","NEG PRES WOUND THER DRSG SET",null,4,44.74,25.71,64.69,1,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A7520"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED",null,1173,0,55.16,138.79,293.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A7520"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED",null,1173,55.16,55.16,138.79,293.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A7520"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED",null,1173,66.19,55.16,138.79,293.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - A7520"},"BMC HEALTHNET","BMCHN QHP","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED",null,1173,0,55.16,138.79,293.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9500"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9500","TC99M SESTAMIBI",null,274,0,463.42,463.42,68.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9502"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9502","HC TC99M TETROFOSMIN",null,140,0,278.27,278.27,35,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9502"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9502","HC TC99M TETROFOSMIN",null,140,0,278.27,278.27,35,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9503"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9503","TC99M MEDRONATE",null,23,0,37.119999999999997,37.119999999999997,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9503"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9503","TC99M MEDRONATE",null,23,37.119999999999997,37.119999999999997,37.119999999999997,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - A9505"},"BMC HEALTHNET","BMCHN ACO","HCPCS","A9505","THALLIUM CHLORIDE PER MCI",null,23,0,395.74,395.74,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9509"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9509","HC IODINE I-123 PER MCI",null,95,5163.91,5163.91,5163.91,23.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - A9509"},"BMC HEALTHNET","BMCHN MCO","HCPCS","A9509","HC IODINE I-123 PER MCI",null,95,0,5163.91,5163.91,23.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9512"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9512","TC99M PERTECHNETATE",null,1,0,null,null,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - A9516"},"BMC HEALTHNET","BMCHN QHP","HCPCS","A9516","I123 IODIDE CAP, DX",null,192,0,516.39,516.39,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9517"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9517","I131 IODIDE CAP, RX",null,437,62.66,30.1,101.94,109.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A9517"},"TUFTS","TUFTS PPO","HCPCS","A9517","I131 IODIDE CAP, RX",null,437,32.200000000000003,30.1,101.94,109.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - A9517"},"BMC HEALTHNET","BMCHN QHP","HCPCS","A9517","I131 IODIDE CAP, RX",null,437,0,30.1,101.94,109.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9521"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9521","TC99M EXAMETAZIME",null,360,0,4157.3,4157.3,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A9521"},"TUFTS","TUFTS POS","HCPCS","A9521","TC99M EXAMETAZIME",null,360,0,4157.3,4157.3,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A9537"},"TUFTS","TUFTS PPO","HCPCS","A9537","TC99M MEBROFENIN",null,138,0,157.94999999999999,157.94999999999999,34.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9538"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9538","TC99M PYROPHOSPHATE",null,111,114.21,114.21,114.21,27.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9539"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9539","TC99M PENTETATE",null,668,89.47,89.47,89.47,167,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9539"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9539","TC99M PENTETATE",null,668,89.47,89.47,89.47,167,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9541"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9541","TC99M SULFUR COLLOID",null,120,0,152.69,152.69,30,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9541"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9541","TC99M SULFUR COLLOID",null,120,152.69,152.69,152.69,30,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - A9541"},"BMC HEALTHNET","BMCHN ACO","HCPCS","A9541","TC99M SULFUR COLLOID",null,120,0,152.69,152.69,30,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9543"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9543","Y90 IBRITUMOMAB, RX",null,66322,139963.56,72400.97,217685.7,16580.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9547"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9547","IN111 OXYQUINOLINE",null,440,0,5105.7299999999996,5105.7299999999996,110,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9547"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9547","IN111 OXYQUINOLINE",null,440,0,5105.7299999999996,5105.7299999999996,110,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9552"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9552","F18 FDG",null,972,0,1166.46,1166.46,243,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - A9552"},"BMC HEALTHNET","BMCHN QHP","HCPCS","A9552","F18 FDG",null,972,0,1166.46,1166.46,243,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9556"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9556","GA67 GALLIUM",null,20,0,311.94,311.94,5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9556"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9556","GA67 GALLIUM",null,20,311.94,311.94,311.94,5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - 81170"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",null,798,331.82,159,2909.77,199.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - 81170"},"TUFTS","TUFTS SELECT","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",null,798,451.91,159,2909.77,199.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A9558"},"TUFTS","TUFTS POS","HCPCS","A9558","HC XENON133/10MCI",null,23,0,108.88,108.88,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9560"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9560","TC99M LABELED RBC",null,246,0,266.7,266.7,61.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9560"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9560","TC99M LABELED RBC",null,246,266.7,266.7,266.7,61.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9560"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9560","TC99M LABELED RBC",null,246,266.7,266.7,266.7,61.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9569"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC",null,5086,4157.3,4157.3,4157.3,1271.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - A9569"},"BMC HEALTHNET","BMCHN QHP","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC",null,5086,0,4157.3,4157.3,1271.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - A9575"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML",null,8,0.26,0.18,0.45,2,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9575"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML",null,8,0.21,0.18,0.45,2,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9576"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML",null,5,3.76,1.5,3.77,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A9577"},"TUFTS","TUFTS POS","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML",null,21,0,1.81,5.03,5.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9577"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML",null,21,5.03,1.81,5.03,5.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9579"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML",null,5,0,1.53,4.38,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9580"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE",null,158,0,null,null,39.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9581"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9581","GADOXETATE DISODIUM INJ",null,99,16.97,14.76,37.14,24.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - A9582"},"TUFTS","TUFTS SELECT","HCPCS","A9582","IODINE I-123 IOBENGUANE",null,10370,0,null,null,2592.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9583"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ",null,13,21.34,19.260000000000002,21.34,3.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9584"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9584","IODINE I-123 IOFLUPANE",null,2729,0,3235.55,3235.55,682.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9584"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9584","IODINE I-123 IOFLUPANE",null,2729,0,3235.55,3235.55,682.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9584"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9584","IODINE I-123 IOFLUPANE",null,2729,0,3235.55,3235.55,682.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - A9587"},"TUFTS","TUFTS HMO","HCPCS","A9587","GALLIUM GA-68",null,12985,0,84.97,113.78,3246.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9587"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9587","GALLIUM GA-68",null,12985,84.97,84.97,113.78,3246.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - A9588"},"TUFTS","TUFTS SELECT","HCPCS","A9588","FLUCICLOVINE F-18",null,15438,0,525.05999999999995,703.05,3859.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9606"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER",null,493,247.36,198.62,597.20000000000005,123.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9606"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER",null,493,378.21,198.62,597.20000000000005,123.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - C1717"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192",null,607,836.69,469.29,1411.01,151.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1722"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1722","HC ICD,1CH, GEN ONLY, RECALL $0",null,43645,0,null,null,10911.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C1724"},"TUFTS","TUFTS HMO","HCPCS","C1724","HC CATH, TRANS ATHEREC BURR",null,7410,0,null,null,1852.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1725"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1725","HC SIZING AMPLATZ BALLOON",null,1693,0,null,null,423.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1731"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1731","HC CATH,EP PENTARAY NAV",null,3847,0,null,null,961.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C1732"},"TUFTS","TUFTS PPO","HCPCS","C1732","HC CATH,EP DECA NAV",null,7766,0,null,null,1941.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1751"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1751","HC CATH, PACING",null,1438,0,null,null,359.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C1756"},"TUFTS","TUFTS HMO","HCPCS","C1756","HC PACING WIRE",null,1438,0,null,null,359.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1762"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1762","HC NERVE - CONNEVTIVE TISSUE, HUMAN",null,12010,0,null,null,3002.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C1763"},"TUFTS","TUFTS SELECT","HCPCS","C1763","HC SM6X16-STEM HEM",null,2242,0,null,null,560.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1765"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1765","ADHESION BARRIER",null,569,0,null,null,142.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1768"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1768","HC TAVR HEART VALVE KIT",null,76125,0,null,null,19031.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1770"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1770","IMAGING COIL, MR, INSERTABLE",null,3667,0,null,null,916.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C1770"},"TUFTS","TUFTS POS","HCPCS","C1770","IMAGING COIL, MR, INSERTABLE",null,3667,0,null,null,916.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1781"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1781","MESH (IMPLANTABLE)",null,36449,0,null,null,9112.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C1784"},"TUFTS","TUFTS HMO","HCPCS","C1784","HC DES PERIPHERAL STENT",null,2734,0,null,null,683.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1785"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1785","HC PACER;2CH, RECALL $0",null,12546,0,null,null,3136.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C1817"},"TUFTS","TUFTS POS","HCPCS","C1817","HC OCCKYDER;ASD/PFO",null,9668,0,null,null,2417,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C1874"},"TUFTS","TUFTS HMO","HCPCS","C1874","STENT WALLFLEX SYSTEM",null,8879,0,null,null,2219.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1876"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1876","STENT BILIARY",null,11691,0,null,null,2922.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1883"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1883","HC ADAPTOR;BI-VENT PACER",null,1257,0,null,null,314.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1883"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1883","HC ADAPTOR;BI-VENT PACER",null,1257,0,null,null,314.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1892"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1892","HC SHEATH;GUIDING",null,340,0,null,null,85,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C1892"},"TUFTS","TUFTS SELECT","HCPCS","C1892","HC SHEATH;GUIDING",null,340,0,null,null,85,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C1893"},"TUFTS","TUFTS POS","HCPCS","C1893","HC DILATOR SHEATH/VISISHEATH",null,406,0,null,null,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C1894"},"TUFTS","TUFTS HMO","HCPCS","C1894","HC INTRO/SHEATH NON-CARD LV2",null,252,0,null,null,63,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1895"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1895","HC ICD LEAD,2COIL",null,13382,0,null,null,3345.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C1898"},"TUFTS","TUFTS PPO","HCPCS","C1898","HC KIT,PACER;BI-VENT(#6216/8",null,1575,0,null,null,393.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - 90471"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE",null,64,76.22,76.22,345.64,16,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C2617"},"TUFTS","TUFTS HMO","HCPCS","C2617","STENT ZIMMON BILIARY",null,638,0,null,null,159.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C2621"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C2621","HC PACER;2CH, W/ BACKUP DEFIB",null,21692,0,null,null,5423,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C2623"},"TUFTS","TUFTS HMO","HCPCS","C2623","CATH TRANSLUMIN DRUG-COAT",null,2837,0,null,null,709.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C2625"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C2625","STENT BILIARY COTTON",null,246,0,null,null,61.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C2625"},"TUFTS","TUFTS PPO","HCPCS","C2625","STENT BILIARY COTTON",null,246,0,null,null,61.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C5275"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C5275","HC LOW COST SKIN SUBSTITUTE",null,743,2032.26,684.11,2032.26,185.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - C5275"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","C5275","HC LOW COST SKIN SUBSTITUTE",null,743,810.95,684.11,2032.26,185.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - C8908"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","C8908","HC MRI W/O FOL W/CONT, BREAST,",null,579,1105.27,664.1,4299.8,144.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C9728"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C9728","PLACE DEVICE/MARKER, NON PRO",null,1957,2573.36,2227.36,7098.97,489.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C9739"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C9739","HC CYSTOSCOPY PROSTATIC IMP 1-3",null,6035,7812.32,2166.09,15242.01,1508.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C9739"},"TUFTS","TUFTS PPO","HCPCS","C9739","HC CYSTOSCOPY PROSTATIC IMP 1-3",null,6035,9609.09,2166.09,15242.01,1508.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D0220"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D0220","INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE",null,165,23.78,23.78,23.78,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D0230"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D0230","INTRAORAL - PERIAPICAL EACH ADDITIONAL RADIOGRAPHIC IMAGE",null,110,21.35,21.35,21.35,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D0272"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D0272","BITEWINGS - TWO RADIOGRAPHIC IMAGES",null,836,4066.77,1182.5,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D0272"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D0272","BITEWINGS - TWO RADIOGRAPHIC IMAGES",null,836,1182.5,1182.5,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - D0480"},"TUFTS","TUFTS HMO","HCPCS","D0480","HC ACCESSION OF EXFOLIATIVE CYTOLOGIC SMEARS, MICROSCOPIC EXAM, PREP AND TRANS OF RPT",null,110,3646.27,1941.26,6187.11,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D1120"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D1120","PROPHYLAXIS - CHILD",null,110,57.92,57.92,57.92,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2140"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D2140","AMALGAM - ONE SURFACE, PRIMARY OR PERMANENT",null,110,98.66,98.66,98.66,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2140"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D2140","AMALGAM - ONE SURFACE, PRIMARY OR PERMANENT",null,110,98.66,98.66,98.66,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2332"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D2332","RESIN-BASED COMPOSITE - THREE SURFACES, ANTERIOR",null,110,189.47,189.47,189.47,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2332"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","D2332","RESIN-BASED COMPOSITE - THREE SURFACES, ANTERIOR",null,110,189.47,189.47,189.47,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2390"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","D2390","RESIN-BASED COMPOSITE CROWN, ANTERIOR",null,110,248.14,248.14,248.14,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2393"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","D2393","RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR",null,110,230.94,230.94,230.94,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2930"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D2930","PREFABRICATED STAINLESS STEEL CROWN - PRIMARY TOOTH",null,110,228.61,228.61,228.61,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2940"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D2940","PROTECTIVE RESTORATION",null,110,87.67,87.67,87.67,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D3310"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D3310","ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION)",null,110,587.95000000000005,587.95000000000005,587.95000000000005,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D3999"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D3999","HC UNSPECIFIED ENDODONTIC PROCEDURE, BY REPORT",null,1451,4066.77,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - D4264"},"TUFTS","TUFTS PPO","HCPCS","D4264","HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ EACH ADDITIONAL SITE IN QUADRANT",null,1451,2563.83,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D4270"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D4270","HC PEDICLE SOFT TISSUE GRAFT PROCEDURE",null,1451,4066.77,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - D5911"},"TUFTS","TUFTS HMO","HCPCS","D5911","HC FACIAL MOULAGE (SECTIONAL)",null,1451,2396.69,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - D5912"},"TUFTS","TUFTS SELECT","HCPCS","D5912","HC FACIAL MOULAGE (COMPLETE)",null,1451,1275.99,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - D5984"},"TUFTS","TUFTS SELECT","HCPCS","D5984","HC RADIATION SHIELD",null,1451,1275.99,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - D5985"},"TUFTS","TUFTS SELECT","HCPCS","D5985","HC RADIATION CONE LOCATOR",null,1451,1275.99,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D7210"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D7210","EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED",null,836,1510.05,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D7220"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D7220","REMOVAL OF IMPACTED TOOTH - SOFT TISSUE",null,836,4066.77,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D7230"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D7230","REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY",null,836,4066.77,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - D7230"},"TUFTS","TUFTS POS","HCPCS","D7230","REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY",null,836,2396.69,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - D7310"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","D7310","ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH SPACES, PER QUADRANT",null,110,230.94,230.94,230.94,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - D9110"},"TUFTS","TUFTS HMO","HCPCS","D9110","PALLIATIVE (EMERGENCY) TREATMENT OF DENTAL PAIN - MINOR PROCEDURE",null,110,0,null,null,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - E0191"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","UE",321,8.66,11.61,52.13,80.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - E0191"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","RR",321,1.74,11.61,52.13,80.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0101"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0101","CA SCREEN;PELVIC/BREAST EXAM",null,148,128.29,18.010000000000002,128.29,37,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - G0103"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","G0103","PSA, TOTAL SCREENING",null,93,23.17,16.78,181.16,23.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - G0103"},"TUFTS","TUFTS POS","HCPCS","G0103","PSA, TOTAL SCREENING",null,93,60.25,16.78,181.16,23.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - G0103"},"BMC HEALTHNET","BMCHN QHP","HCPCS","G0103","PSA, TOTAL SCREENING",null,93,0,16.78,181.16,23.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0127"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0127","TRIM NAIL(S)",null,189,120.69,93.87,317.35000000000002,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - G0127"},"TUFTS","TUFTS HMO","HCPCS","G0127","TRIM NAIL(S)",null,189,187.02,93.87,317.35000000000002,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - G0127"},"BMC HEALTHNET","BMCHN QHP","HCPCS","G0127","TRIM NAIL(S)",null,189,0,93.87,317.35000000000002,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - G0175"},"BMC HEALTHNET","BMCHN QHP","HCPCS","G0175","OPPS SERVICE,SCHED TEAM CONF",null,565,0,638.73,2035.73,141.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0239"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0239","OTH RESP PROC, GROUP",null,99,0,53.94,373.41,24.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0257"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP",null,911,1027.32,1027.32,3651.55,227.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - G0260"},"TUFTS","TUFTS POS","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH",null,817,2047.41,1005.62,3474.13,204.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0260"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH",null,817,0,1005.62,3474.13,204.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - G0269"},"TUFTS","TUFTS SELECT","HCPCS","G0269","HC CLOSURE DEVICE PLACEMENT",null,200,0,null,null,50,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0278"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH",null,3138,34.229999999999997,34.229999999999997,34.229999999999997,784.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - G0279"},"TUFTS","TUFTS SELECT","HCPCS","G0279","TOMOSYNTHESIS, MAMMO",null,55,44.81,30.09,295.68,13.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - G0279"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","G0279","TOMOSYNTHESIS, MAMMO",null,55,66.5,30.09,295.68,13.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0296"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0296","HC VISIT TO DETERM LDCT ELIG",null,118,0,102.62,660.74,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0297"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN",null,1437,107.22,107.22,801.26,359.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0297"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN",null,1437,178.43,107.22,801.26,359.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0390"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI",null,3274,0,1579.83,5035.18,818.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - G0396"},"TUFTS","TUFTS POS","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN",null,42,111.85,56.05,336.32,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - G0402"},"BMC HEALTHNET","BMCHN ACO","HCPCS","G0402","INITIAL PREVENTIVE EXAM",null,168,0,208.89,1179.72,42,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0410"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0410","HC GRP PSYCH PARTIAL HOSP 45-50",null,220,0,null,null,55,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0416"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD",null,425,2456.98,360.63,2456.98,106.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - G0420"},"BMC HEALTHNET","BMCHN ACO","HCPCS","G0420","HC ED SVC CKD IND PER SESSION",null,156,0,184.9,589.33000000000004,39,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - G0421"},"FALLON","FALLON MEDICAID","HCPCS","G0421","HC ED SVC CKD GRP PER SESSION",null,37,0,42.72,136.13999999999999,9.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0423"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER",null,169,198.42,198.42,637.79,42.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0423"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER",null,169,198.42,198.42,637.79,42.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - G0438"},"FALLON","FALLON MEDICAID","HCPCS","G0438","PPPS, INITIAL VISIT",null,547,0,34.03,61.76,136.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0439"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0439","PPPS, SUBSEQ VISIT",null,327,0,34.03,61.76,81.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - G0442"},"TUFTS","TUFTS PPO","HCPCS","G0442","ANNUAL ALCOHOL SCREEN 15 MIN",null,42,21.18,13.34,33.6,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - G0442"},"TUFTS","TUFTS SELECT","HCPCS","G0442","ANNUAL ALCOHOL SCREEN 15 MIN",null,42,18.52,13.34,33.6,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - G0445"},"FALLON","FALLON MEDICAID","HCPCS","G0445","HIGH INTEN BEH COUNS STD 30M",null,118,0,8.9,16.149999999999999,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - G0445"},"TUFTS","TUFTS HMO","HCPCS","G0445","HIGH INTEN BEH COUNS STD 30M",null,118,10.18,8.9,16.149999999999999,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - G0446"},"TUFTS","TUFTS HMO","HCPCS","G0446","INTENS BEHAVE THER CARDIO DX",null,42,10.18,8.9,16.149999999999999,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - G0480"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES",null,254,117.65,59.69,973.54,63.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - G0480"},"TUFTS","TUFTS HMO","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES",null,254,388.52,59.69,973.54,63.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0480"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES",null,254,209.48,59.69,973.54,63.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - HCPCS - G0481"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES",null,192,108.1,91.84,1332.11,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0481"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES",null,192,286.56,91.84,1332.11,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0506"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC",null,62,110.9,110.9,110.9,15.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0513"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M",null,84,0,148.6,148.6,21,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - G0514"},"TUFTS","TUFTS POS","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M",null,84,0,148.6,148.6,21,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0514"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M",null,84,0,148.6,148.6,21,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G2011"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS",null,35,133.88,28.83,133.88,8.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G2011"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS",null,35,28.83,28.83,133.88,8.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - 92083"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED",null,461,178.83,68.75,607.84,115.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - P9016"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","P9016","HC RBC:LEU-RED",null,576,243.01,243.01,478.65,144,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9017"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","P9017","HC FF PLAS: 1 DONOR",null,291,94.07,94.07,217.72,72.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9017"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","P9017","HC FF PLAS: 1 DONOR",null,291,94.07,94.07,217.72,72.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - P9040"},"TUFTS","TUFTS POS","HCPCS","P9040","HC RBC:LEU-RED,IRR/UNIT",null,523,394.85,336.11,669.97,130.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9045"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML",null,238,129.05000000000001,52.45,131.97,59.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - P9057"},"TUFTS","TUFTS PPO","HCPCS","P9057","HC RBC:LEU RED,FR/DE/WASH,IR",null,785,423.49,395.89,671.74,196.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - P9612"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","P9612","CATHETERIZE FOR URINE SPEC",null,90,3,2.2200000000000002,1198.25,22.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - P9612"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","P9612","CATHETERIZE FOR URINE SPEC",null,90,3.01,2.2200000000000002,1198.25,22.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - P9612"},"BMC HEALTHNET","BMCHN ACO","HCPCS","P9612","CATHETERIZE FOR URINE SPEC",null,90,4.8600000000000003,2.2200000000000002,1198.25,22.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - P9612"},"BMC HEALTHNET","BMCHN QHP","HCPCS","P9612","CATHETERIZE FOR URINE SPEC",null,90,2.66,2.2200000000000002,1198.25,22.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q0091"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR",null,83,36.159999999999997,28.83,175.66,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - Q0091"},"TUFTS","TUFTS POS","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR",null,83,58.42,28.83,175.66,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - Q0111"},"UNICARE","UNICARE","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS",null,23,10.36,5.86,127.48,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q0111"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS",null,23,27.01,5.86,127.48,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - Q0111"},"BMC HEALTHNET","BMCHN QHP","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS",null,23,12.98,5.86,127.48,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q0114"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q0114","HC  FERN TEST",null,41,21.03,7.2,82.86,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q0114"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q0114","HC  FERN TEST",null,41,8.64,7.2,82.86,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q0114"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q0114","HC  FERN TEST",null,41,17.79,7.2,82.86,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q0114"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q0114","HC  FERN TEST",null,41,17.79,7.2,82.86,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q3014"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE",null,67,0,26.65,67.06,16.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q3014"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE",null,67,58.89,26.65,67.06,16.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q4101"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q4101","APLIGRAF",null,1601,35.03,30.46,76.64,400.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q4101"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","Q4101","APLIGRAF",null,1601,76.64,30.46,76.64,400.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q4102"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q4102","OASIS WOUND MATRIX",null,69,11.74,10.210000000000001,25.69,17.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - Q4104"},"UNICARE","UNICARE","HCPCS","Q4104","INTEGRA BMWD",null,7748,42.08,42.08,56.11,1937,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - Q4107"},"TUFTS","TUFTS SELECT","HCPCS","Q4107","GRAFTJACKET",null,2233,0,86.55,110.48,558.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q4112"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q4112","CYMETRA INJECTABLE",null,535,904.99,904.99,1002.89,133.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - Q4116"},"TUFTS","TUFTS SELECT","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM",null,5248,0,32.29,35.78,1312,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q4125"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM",null,4060,0,3.79,3.79,1015,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q4125"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM",null,4060,3.79,3.79,3.79,1015,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q4130"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q4130","PR STRATTICE TM",null,65718,0,45.89,45.89,16429.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q4132"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","Q4132","HC GRAFIX CORE 5X5CM",null,3754,114.63,114.63,288.43,938.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - Q4132"},"TUFTS","TUFTS HMO","HCPCS","Q4132","HC GRAFIX CORE 5X5CM",null,3754,0,114.63,288.43,938.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q4133"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",null,3756,158.36000000000001,131.97,332.06,939,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - Q4133"},"UNICARE","UNICARE","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",null,3756,136.94999999999999,131.97,332.06,939,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - Q4196"},"FALLON","FALLON MEDICAID","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM",null,9044,0,111.59,280.77999999999997,2261,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q4196"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM",null,9044,280.77999999999997,111.59,280.77999999999997,2261,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - Q9956"},"TUFTS","TUFTS SPIRIT","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML",null,76,34.92,31.75,79.89,19,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q9956"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML",null,76,0,31.75,79.89,19,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q9957"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML",null,417,54.77,47.63,119.85,104.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q9957"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML",null,417,0,47.63,119.85,104.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q9958"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML",null,1,0,7.0000000000000007E-2,0.18,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q9961"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML",null,1,0.25,0.25,0.63,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q9961"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML",null,1,0.28999999999999998,0.25,0.63,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - S8037"},"TUFTS","TUFTS SELECT","HCPCS","S8037","MRCP",null,1440,585.76,585.76,3771.6,360,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - S8037"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","S8037","MRCP",null,1440,1396.47,585.76,3771.6,360,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - S8037"},"BMC HEALTHNET","BMCHN QHP","HCPCS","S8037","MRCP",null,1440,0,585.76,3771.6,360,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - T2003"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","T2003","HC TRANSPORTATION RATE 1 (1-WAY TRIP)",null,25,0,null,null,6.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - U0001"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",null,124,325.64,35.909999999999997,325.64,31,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - U0001"},"TUFTS","TUFTS HMO","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",null,124,139.03,35.909999999999997,325.64,31,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - U0001"},"TUFTS","TUFTS PPO","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",null,124,115.86,35.909999999999997,325.64,31,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - U0001"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",null,124,79.36,35.909999999999997,325.64,31,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - HCPCS - U0002"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",null,92,77.58,51.31,465.19,23,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - V2790"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","V2790","HC MEMBRANE AMNIOTIC",null,1136,0,null,null,284,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - V2790"},"TUFTS","TUFTS PPO","HCPCS","V2790","HC MEMBRANE AMNIOTIC",null,1136,0,null,null,284,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - 0278T"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","0278T","HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS",null,77,293.52,286.31,943.8,19.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - 0278T"},"TUFTS","TUFTS HMO","HCPCS","0278T","HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS",null,77,595.01,286.31,943.8,19.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - 0402T"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA",null,2880,3522.21,1198.25,11845.41,720,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - 0402T"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA",null,2880,3044.16,1198.25,11845.41,720,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - 81170"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",null,798,548.09,159,2909.77,199.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - 45378"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND",null,1672,1250.94,1020.59,3264.67,418,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G2012"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G2012","HC BRIEF CHECK IN BY MD/QHP",null,42,0,31.78,31.78,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - G2023"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS",null,31,40.82,23.46,212.71,7.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - G2023"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS",null,31,27.68,23.46,212.71,7.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - G2023"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS",null,31,59.03,23.46,212.71,7.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - G2024"},"FALLON","FALLON MEDICAID","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","CG",33,46.27,25.46,230.84,8.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - G2024"},"BMC HEALTHNET","BMCHN ACO","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",null,33,55.71,25.46,230.84,8.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G2066"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH",null,165,370.47,58.35,370.47,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G2086"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G2086","HC OFF BASE OPIOID TX 70MIN",null,194,211.43,46.18,211.43,48.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G2087"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G2087","HC OFF BASE OPIOID TX, 60 M",null,194,211.43,46.18,211.43,48.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - L0120"},"TUFTS","TUFTS SELECT","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE",null,25,37.119999999999997,24.86,111.59,6.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L0140"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB",null,189,347.97,77.52,347.97,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L0140"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB",null,189,167.37,77.52,347.97,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L0140"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB",null,189,91.47,77.52,347.97,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L0140"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB",null,189,0,77.52,347.97,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - L1820"},"FALLON","FALLON MEDICAID","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO",null,159,0,142.59,640.03,39.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L1820"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO",null,159,207.54,142.59,640.03,39.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L1830"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT",null,78,0,81.95,367.86,19.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L1830"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT",null,78,0,81.95,367.86,19.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - L1832"},"FALLON","FALLON SENIOR PLAN","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT",null,1523,743.59,743.59,3337.75,380.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L1832"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT",null,1523,1293.8499999999999,743.59,3337.75,380.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L1832"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT",null,1523,1082.26,743.59,3337.75,380.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L1836"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L1836","HC RIGID KO WO JOINTS",null,209,0,130.47999999999999,585.70000000000005,52.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - L1902"},"TUFTS","TUFTS SPIRIT","HCPCS","L1902","AFO ANKLE GAUNTLET",null,219,94.75,86.14,386.65,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - L1902"},"BMC HEALTHNET","BMCHN ACO","HCPCS","L1902","AFO ANKLE GAUNTLET",null,219,0,86.14,386.65,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - L3350"},"BMC HEALTHNET","BMCHN ACO","HCPCS","L3350","SHOE HEEL WEDGE",null,41,0,22.41,100.59,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3496"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L3496","HC STATIC AFO",null,406,0,null,null,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L3650"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN",null,1955,98.07,67.38,302.45,488.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L3670"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE",null,2903,103.65,103.65,465.27,725.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - L3670"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE",null,2903,150.29,103.65,465.27,725.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3670"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE",null,2903,0,103.65,465.27,725.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3762"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L3762","RIGID EO WO JOINTS",null,57,0,95.68,429.49,14.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L3762"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L3762","RIGID EO WO JOINTS",null,57,211.44,95.68,429.49,14.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L3807"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED",null,483,222.52,222.52,998.85,120.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L3808"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L3808","HC EPITRAIN",null,509,375.94,375.94,1687.5,127.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - L3808"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","L3808","HC EPITRAIN",null,509,545.11,375.94,1687.5,127.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3808"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L3808","HC EPITRAIN",null,509,0,375.94,1687.5,127.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L3905"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF",null,2442,882.51,882.51,3961.32,610.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - L3905"},"FALLON","FALLON MEDICAID","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF",null,2442,0,882.51,3961.32,610.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - L3905"},"BMC HEALTHNET","BMCHN QHP","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF",null,2442,0,882.51,3961.32,610.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - L3908"},"FALLON","FALLON MEDICAID","HCPCS","L3908","WRIST COCK-UP NON-MOLDED",null,143,0,73.22,328.66,35.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - L3908"},"TUFTS","TUFTS SELECT","HCPCS","L3908","WRIST COCK-UP NON-MOLDED",null,143,109.32,73.22,328.66,35.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L3967"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF",null,117,1765.23,1765.23,7923.54,29.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3967"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF",null,117,0,1765.23,7923.54,29.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L3967"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF",null,117,3900.95,1765.23,7923.54,29.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L3980"},"UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL",null,132,788.63,377.84,1695.98,33,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3980"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL",null,132,0,377.84,1695.98,33,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L3982"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL",null,176,1787.56,398.23,1787.56,44,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L3982"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL",null,176,398.23,398.23,1787.56,44,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - L3982"},"BMC HEALTHNET","BMCHN MCO","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL",null,176,0,398.23,1787.56,44,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L4350"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB",null,360,141.58000000000001,97.28,436.66,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L4370"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT",null,107,235.79,235.79,1058.3900000000001,26.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - L4370"},"BMC HEALTHNET","BMCHN QHP","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT",null,107,0,235.79,1058.3900000000001,26.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L4386"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB",null,165,225.63,155.02000000000001,695.83,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - L4386"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB",null,165,225.63,155.02000000000001,695.83,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L8501"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE",null,219,192.89,160.74,721.54,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L8501"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE",null,219,160.74,160.74,721.54,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - L8501"},"BMC HEALTHNET","BMCHN QHP","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE",null,219,0,160.74,721.54,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L8507"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)",null,1604,41.03,41.03,184.14,401,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - L8509"},"TUFTS","TUFTS SELECT","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN",null,1144,159.72999999999999,106.99,480.27,286,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L8509"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN",null,1144,0,106.99,480.27,286,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L8509"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN",null,1144,269.20999999999998,106.99,480.27,286,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L8514"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR",null,387,414.69,92.38,414.69,96.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L8514"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR",null,387,133.94999999999999,92.38,414.69,96.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L8693"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT",null,1462,1782.68,1485.57,6668.25,365.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - L8693"},"FALLON","FALLON SENIOR PLAN","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT",null,1462,1485.57,1485.57,6668.25,365.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - L8693"},"TUFTS","TUFTS SELECT","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT",null,1462,2217.8200000000002,1485.57,6668.25,365.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L8693"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT",null,1462,2162.1799999999998,1485.57,6668.25,365.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - L8699"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","L8699","HC CARTIFORM 20 X 25 MM DISC",null,13957,0,null,null,3489.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L8699"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L8699","HC CARTIFORM 20 X 25 MM DISC",null,13957,0,null,null,3489.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - M0239"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",null,393,538.70000000000005,309.60000000000002,779.02,98.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - P9012"},"TUFTS","TUFTS POS","HCPCS","P9012","HC CRYOPRECIPITATE UNIT",null,134,73.86,64.959999999999994,125.33,33.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9016"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","P9016","HC RBC:LEU-RED",null,576,398.94,243.01,478.65,144,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A4215"},"TUFTS","TUFTS PPO","HCPCS","A4215","STERILE NEEDLE",null,433,0,null,null,108.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - A4467"},"BMC HEALTHNET","BMCHN MCO","HCPCS","A4467","BELT STRAP SLEEV GRMNT COVER",null,151,0,null,null,37.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - A4561"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE",null,108,33.61,23.18,58.33,27,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A4561"},"TUFTS","TUFTS POS","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE",null,108,0,23.18,58.33,27,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A4561"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE",null,108,0,23.18,58.33,27,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A4570"},"TUFTS","TUFTS PPO","HCPCS","A4570","HC MISC SPLINT SUPPLY LV1",null,40,38.19,19.010000000000002,107.35,10,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A4725"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC",null,87,0,null,null,21.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - A4725"},"BMC HEALTHNET","BMCHN MCO","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC",null,87,0,null,null,21.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - A6258"},"FALLON","FALLON SENIOR PLAN","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN",null,83,5,5,12.58,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A6258"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN",null,83,7.28,5,12.58,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A6550"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A6550","NEG PRES WOUND THER DRSG SET",null,4,0,25.71,64.69,1,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A6550"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A6550","NEG PRES WOUND THER DRSG SET",null,4,0,25.71,64.69,1,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A6550"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A6550","NEG PRES WOUND THER DRSG SET",null,4,0,25.71,64.69,1,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A7520"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED",null,1173,119.09,55.16,138.79,293.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A7520"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED",null,1173,80.290000000000006,55.16,138.79,293.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9500"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9500","TC99M SESTAMIBI",null,274,463.42,463.42,463.42,68.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - A9502"},"TUFTS","TUFTS SELECT","HCPCS","A9502","HC TC99M TETROFOSMIN",null,140,0,278.27,278.27,35,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9502"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9502","HC TC99M TETROFOSMIN",null,140,278.27,278.27,278.27,35,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9503"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9503","TC99M MEDRONATE",null,23,37.119999999999997,37.119999999999997,37.119999999999997,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9505"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9505","THALLIUM CHLORIDE PER MCI",null,23,0,395.74,395.74,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9509"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9509","HC IODINE I-123 PER MCI",null,95,5163.91,5163.91,5163.91,23.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9509"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9509","HC IODINE I-123 PER MCI",null,95,0,5163.91,5163.91,23.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9516"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9516","I123 IODIDE CAP, DX",null,192,0,516.39,516.39,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A9516"},"TUFTS","TUFTS PPO","HCPCS","A9516","I123 IODIDE CAP, DX",null,192,0,516.39,516.39,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9517"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9517","I131 IODIDE CAP, RX",null,437,101.94,30.1,101.94,109.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - A9517"},"BMC HEALTHNET","BMCHN ACO","HCPCS","A9517","I131 IODIDE CAP, RX",null,437,0,30.1,101.94,109.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9521"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9521","TC99M EXAMETAZIME",null,360,0,4157.3,4157.3,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9521"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9521","TC99M EXAMETAZIME",null,360,0,4157.3,4157.3,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9537"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9537","TC99M MEBROFENIN",null,138,0,157.94999999999999,157.94999999999999,34.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9537"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9537","TC99M MEBROFENIN",null,138,157.94999999999999,157.94999999999999,157.94999999999999,34.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9538"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9538","TC99M PYROPHOSPHATE",null,111,0,114.21,114.21,27.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A9538"},"TUFTS","TUFTS POS","HCPCS","A9538","TC99M PYROPHOSPHATE",null,111,0,114.21,114.21,27.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - A9539"},"FALLON","FALLON MEDICAID","HCPCS","A9539","TC99M PENTETATE",null,668,0,89.47,89.47,167,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9539"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9539","TC99M PENTETATE",null,668,0,89.47,89.47,167,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9540"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9540","TC99M MAA",null,1831,0,85.66,85.66,457.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9540"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9540","TC99M MAA",null,1831,85.66,85.66,85.66,457.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9541"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9541","TC99M SULFUR COLLOID",null,120,152.69,152.69,152.69,30,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - A9543"},"TUFTS","TUFTS SELECT","HCPCS","A9543","Y90 IBRITUMOMAB, RX",null,66322,72400.97,72400.97,217685.7,16580.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9551"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX",null,154,0,1711.56,1711.56,38.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9551"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX",null,154,0,1711.56,1711.56,38.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9555"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9555","RADIOPHARMACIAL",null,1065,0,1604.08,1604.08,266.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9555"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9555","RADIOPHARMACIAL",null,1065,1604.08,1604.08,1604.08,266.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - A9556"},"BMC HEALTHNET","BMCHN MCO","HCPCS","A9556","GA67 GALLIUM",null,20,0,311.94,311.94,5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - A9556"},"BMC HEALTHNET","BMCHN QHP","HCPCS","A9556","GA67 GALLIUM",null,20,0,311.94,311.94,5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9557"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9557","TC99M BICISATE",null,239,1062.44,1062.44,1062.44,59.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9558"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9558","HC XENON133/10MCI",null,23,108.88,108.88,108.88,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - A9560"},"BMC HEALTHNET","BMCHN ACO","HCPCS","A9560","TC99M LABELED RBC",null,246,0,266.7,266.7,61.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A9561"},"TUFTS","TUFTS POS","HCPCS","A9561","TC99M OXIDRONATE",null,127,0,125.64,125.64,31.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - A9561"},"BMC HEALTHNET","BMCHN ACO","HCPCS","A9561","TC99M OXIDRONATE",null,127,0,125.64,125.64,31.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A9562"},"TUFTS","TUFTS POS","HCPCS","A9562","TC99M MERTIATIDE",null,1237,0,2212.25,2212.25,309.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9562"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9562","TC99M MERTIATIDE",null,1237,2212.25,2212.25,2212.25,309.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9562"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9562","TC99M MERTIATIDE",null,1237,0,2212.25,2212.25,309.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - A9563"},"BMC HEALTHNET","BMCHN QHP","HCPCS","A9563","P32 NA PHOSPHATE",null,0,0,535.17999999999995,3182.68,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - A9569"},"FALLON","FALLON MEDICAID","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC",null,5086,0,4157.3,4157.3,1271.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - A9569"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC",null,5086,0,4157.3,4157.3,1271.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9569"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC",null,5086,0,4157.3,4157.3,1271.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9572"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE",null,131,16207.01,16207.01,16207.01,32.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A9575"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML",null,8,0.22,0.18,0.45,2,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - A9575"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML",null,8,0.24,0.18,0.45,2,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - A9575"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML",null,8,0.45,0.18,0.45,2,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9576"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML",null,5,3.76,1.5,3.77,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A9577"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML",null,21,3.15,1.81,5.03,5.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9577"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML",null,21,5.03,1.81,5.03,5.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - A9579"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML",null,5,1.58,1.53,4.38,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A9579"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML",null,5,2.2200000000000002,1.53,4.38,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - A9579"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML",null,5,2.2200000000000002,1.53,4.38,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9579"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML",null,5,4.38,1.53,4.38,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A9581"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","A9581","GADOXETATE DISODIUM INJ",null,99,14.76,14.76,37.14,24.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A9581"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","A9581","GADOXETATE DISODIUM INJ",null,99,25.68,14.76,37.14,24.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9582"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9582","IODINE I-123 IOBENGUANE",null,10370,0,null,null,2592.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - A9583"},"BMC HEALTHNET","BMCHN ACO","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ",null,13,0,19.260000000000002,21.34,3.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9584"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9584","IODINE I-123 IOFLUPANE",null,2729,0,3235.55,3235.55,682.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9587"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9587","GALLIUM GA-68",null,12985,113.78,84.97,113.78,3246.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A9588"},"TUFTS","TUFTS PPO","HCPCS","A9588","FLUCICLOVINE F-18",null,15438,0,525.05999999999995,703.05,3859.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - A9588"},"BMC HEALTHNET","BMCHN QHP","HCPCS","A9588","FLUCICLOVINE F-18",null,15438,0,525.05999999999995,703.05,3859.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - A9592"},"BMC HEALTHNET","BMCHN ACO","HCPCS","A9592","HC COPPER CU 64 DOTATATE DIAG",null,5634,0,null,null,1408.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1714"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1714","HC WATHMAN SYS ANTER CURVE",null,6114,0,null,null,1528.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1716"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1716","BRACHYTX SOURCE, GOLD 198",null,0,200.39,168.52,506.68,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C1721"},"TUFTS","TUFTS SELECT","HCPCS","C1721","HC ICD,2CH, GEN ONLY, RECALL $0",null,39674,0,null,null,9918.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C1722"},"TUFTS","TUFTS PPO","HCPCS","C1722","HC ICD,1CH, GEN ONLY, RECALL $0",null,43645,0,null,null,10911.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1726"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1726","HC CATHETER BALLN LVL 4",null,387,0,null,null,96.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1726"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1726","HC CATHETER BALLN LVL 4",null,387,0,null,null,96.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1729"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1729","HC CATH; THORA PARA",null,2283,0,null,null,570.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1731"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1731","HC CATH,EP PENTARAY NAV",null,3847,0,null,null,961.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1733"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1733","CATH CRYABL  ARCTIC FRN",null,10475,0,null,null,2618.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1750"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1750","HC CATH 2 LUMEN QUINTON",null,1693,0,null,null,423.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1751"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1751","HC CATH, PACING",null,1438,0,null,null,359.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C1751"},"TUFTS","TUFTS SELECT","HCPCS","C1751","HC CATH, PACING",null,1438,0,null,null,359.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1757"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1757","HC CATH,THROMB/EMB,LVL 2",null,15822,0,null,null,3955.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1763"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1763","HC SM6X16-STEM HEM",null,2242,0,null,null,560.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C1765"},"TUFTS","TUFTS SELECT","HCPCS","C1765","ADHESION BARRIER",null,569,0,null,null,142.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C1766"},"TUFTS","TUFTS POS","HCPCS","C1766","SHTH INTRO 65CM 15FR 12FR",null,2619,0,null,null,654.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1773"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1773","HC GUIDEWIRE LVL E",null,2163,0,null,null,540.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1785"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1785","HC PACER;2CH, RECALL $0",null,12546,0,null,null,3136.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C1786"},"TUFTS","TUFTS PPO","HCPCS","C1786","HC PACER;1CH, RECALL $0",null,23460,0,null,null,5865,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1788"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1788","HC PORTACATH ANY",null,540,0,null,null,135,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C1821"},"TUFTS","TUFTS HMO","HCPCS","C1821","HC INTERSPINOUS IMPLANT",null,9770,0,null,null,2442.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C1874"},"TUFTS","TUFTS SELECT","HCPCS","C1874","STENT WALLFLEX SYSTEM",null,8879,0,null,null,2219.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C1882"},"TUFTS","TUFTS POS","HCPCS","C1882","HC ICD,BI-VENT, GEN ONLY, RECALL $0",null,53226,0,null,null,13306.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C1884"},"TUFTS","TUFTS POS","HCPCS","C1884","EMBOLIZATION PROTECT SYST",null,31469,0,null,null,7867.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1894"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1894","HC INTRO/SHEATH NON-CARD LV2",null,252,0,null,null,63,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C1895"},"TUFTS","TUFTS POS","HCPCS","C1895","HC ICD LEAD,2COIL",null,13382,0,null,null,3345.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1900"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1900","HC INJ;OCTAFLUORO MICRO/1ML",null,8293,0,null,null,2073.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C2628"},"TUFTS","TUFTS HMO","HCPCS","C2628","HC KIT CATH BRIDGE PRE",null,2308,0,null,null,577,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C2630"},"TUFTS","TUFTS POS","HCPCS","C2630","HC CATH;EP CRYOABLATION, 8 MM",null,4966,0,null,null,1241.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C2634"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C2634","BRACHYTX, NON-STR, HA, I-125",null,0,313.02999999999997,232.45,698.88,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - C2639"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","C2639","BRACHYTX, NON-STRANDED,I-125",null,47,100.75,52.85,100.75,11.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - C5275"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","C5275","HC LOW COST SKIN SUBSTITUTE",null,743,810.95,684.11,2032.26,185.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C8937"},"TUFTS","TUFTS PPO","HCPCS","C8937","CAD BREAST MRI",null,331,0,null,null,82.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - C9728"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","C9728","PLACE DEVICE/MARKER, NON PRO",null,1957,3429.66,2227.36,7098.97,489.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - D0210"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","D0210","INTRAORAL - COMPLETE SERIES OF RADIOGRAPHIC IMAGES",null,165,120.47,120.47,120.47,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - D0240"},"TUFTS","TUFTS SELECT","HCPCS","D0240","INTRAORAL - OCCLUSAL RADIOGRAPHIC IMAGE",null,836,1275.99,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D0274"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D0274","BITEWINGS - FOUR RADIOGRAPHIC IMAGES",null,836,1182.5,1182.5,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - D0277"},"TUFTS","TUFTS HMO","HCPCS","D0277","HC VERTICAL BITEWINGS - 7 TO 8 RADIOGRAPHIC IMAGES",null,1451,2396.69,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - D0473"},"TUFTS","TUFTS SELECT","HCPCS","D0473","HC ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAM, PREP AND TRANS OF RPT.",null,110,1941.26,1941.26,6187.11,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - D1110"},"TUFTS","TUFTS PPO","HCPCS","D1110","PROPHYLAXIS - ADULT",null,110,102.91,51.21,163.22999999999999,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - D1517"},"TUFTS","TUFTS POS","HCPCS","D1517","SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MANDIBULAR",null,1451,0,null,null,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2160"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D2160","AMALGAM - THREE SURFACES, PRIMARY OR PERMANENT",null,110,153.4,153.4,153.4,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2161"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D2161","AMALGAM - FOUR OR MORE SURFACES, PRIMARY OR PERMANENT",null,110,187.9,187.9,187.9,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2161"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D2161","AMALGAM - FOUR OR MORE SURFACES, PRIMARY OR PERMANENT",null,110,187.9,187.9,187.9,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2391"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D2391","RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR",null,110,141.69,141.69,141.69,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2392"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D2392","RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR",null,110,186.31,186.31,186.31,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2931"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","D2931","PREFABRICATED STAINLESS STEEL CROWN - PERMANENT TOOTH",null,110,259.95,259.95,259.95,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D3110"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D3110","HC PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION)",null,110,68.89,68.89,68.89,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D3220"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D3220","THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) - REMOVAL OF PULP CORONAL TO THE DENTINOCEMENTAL JUNCTION AND APPLICATION OF MEDICAMENT",null,110,141.69,141.69,141.69,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - D4263"},"TUFTS","TUFTS POS","HCPCS","D4263","HC BONE REPLACEMENT GRAFT ¿ RETAINED NATURAL TOOTH ¿ FIRST SITE IN QUADRANT",null,1451,2396.69,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - D7140"},"TUFTS","TUFTS POS","HCPCS","D7140","EXTRACTION ERUPTED TOOTH/EXR",null,836,2396.69,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D7210"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D7210","EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED",null,836,1510.05,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - D7220"},"TUFTS","TUFTS HMO","HCPCS","D7220","REMOVAL OF IMPACTED TOOTH - SOFT TISSUE",null,836,2396.69,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - D7220"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","D7220","REMOVAL OF IMPACTED TOOTH - SOFT TISSUE",null,836,1510.05,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - 90471"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE",null,64,129,76.22,345.64,16,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - 90471"},"TUFTS","TUFTS HMO","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE",null,64,203.7,76.22,345.64,16,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D7310"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D7310","ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH SPACES, PER QUADRANT",null,110,230.94,230.94,230.94,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - D7311"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","D7311","ALVEOLOPLASTY W/EXTRACT 1-3",null,110,202.78,202.78,202.78,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - D9930"},"TUFTS","TUFTS PPO","HCPCS","D9930","HC TREATMENT OF COMPLICATIONS (POST-SURGICAL) - UNUSUAL CIRCUMSTANCES, BY REPORT",null,1451,2563.83,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D9944"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D9944","HC OCCLUSAL GUARD ¿ HARD APPLIANCE, FULL ARCH",null,51,0,null,null,12.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - E0191"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","RR",321,1.2,11.61,52.13,80.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - E0191"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","RR",321,2.59,11.61,52.13,80.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - E0191"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","NU",321,15.65,11.61,52.13,80.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0101"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0101","CA SCREEN;PELVIC/BREAST EXAM",null,148,0,18.010000000000002,128.29,37,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - G0103"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","G0103","PSA, TOTAL SCREENING",null,93,33.6,16.78,181.16,23.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0103"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0103","PSA, TOTAL SCREENING",null,93,19.8,16.78,181.16,23.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - G0105"},"TUFTS","TUFTS PPO","HCPCS","G0105","HC COLORECTAL SCRN; HI RISK IND",null,1152,2058.16,1020.59,3264.67,288,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0109"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0109","DIAB MANAGE TRN IND/GROUP",null,267,37.520000000000003,32.64,134.25,66.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0127"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0127","TRIM NAIL(S)",null,189,93.87,93.87,317.35000000000002,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0127"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0127","TRIM NAIL(S)",null,189,93.87,93.87,317.35000000000002,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - G0239"},"TUFTS","TUFTS SELECT","HCPCS","G0239","OTH RESP PROC, GROUP",null,99,66.12,53.94,373.41,24.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0239"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0239","OTH RESP PROC, GROUP",null,99,0,53.94,373.41,24.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0239"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0239","OTH RESP PROC, GROUP",null,99,53.94,53.94,373.41,24.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0259"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0259","HC INJECT FOR SACROILIAC JOINT",null,1513,0,1198.25,1198.25,378.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0260"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH",null,817,1005.62,1005.62,3474.13,204.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0260"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH",null,817,1005.62,1005.62,3474.13,204.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0270"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0270","MNT SUBS TX FOR CHANGE DX",null,86,70.819999999999993,69.08,70.819999999999993,21.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0278"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH",null,3138,0,34.229999999999997,34.229999999999997,784.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - G0279"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","G0279","TOMOSYNTHESIS, MAMMO",null,55,43.63,30.09,295.68,13.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0296"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0296","HC VISIT TO DETERM LDCT ELIG",null,118,0,102.62,660.74,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0296"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0296","HC VISIT TO DETERM LDCT ELIG",null,118,128.29,102.62,660.74,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0297"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN",null,1437,0,107.22,801.26,359.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0365"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0365","HC VESSEL MAPPING HEMO ACCESS",null,498,867.01,272.02999999999997,867.01,124.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - G0365"},"TUFTS","TUFTS SELECT","HCPCS","G0365","HC VESSEL MAPPING HEMO ACCESS",null,498,272.02999999999997,272.02999999999997,867.01,124.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - G0389"},"BMC HEALTHNET","BMCHN ACO","HCPCS","G0389","ULTRASOUND EXAM AAA SCREEN",null,544,0,null,null,136,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0390"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI",null,3274,1587.59,1579.83,5035.18,818.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - G0390"},"BMC HEALTHNET","BMCHN MCO","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI",null,3274,0,1579.83,5035.18,818.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0396"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN",null,42,56.05,56.05,336.32,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - G0402"},"TUFTS","TUFTS POS","HCPCS","G0402","INITIAL PREVENTIVE EXAM",null,168,0,208.89,1179.72,42,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - G0402"},"BMC HEALTHNET","BMCHN QHP","HCPCS","G0402","INITIAL PREVENTIVE EXAM",null,168,0,208.89,1179.72,42,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0422"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC",null,169,637.79,198.42,637.79,42.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0422"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC",null,169,0,198.42,637.79,42.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - G0422"},"BMC HEALTHNET","BMCHN MCO","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC",null,169,0,198.42,637.79,42.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0423"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER",null,169,255.09,198.42,637.79,42.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0442"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0442","ANNUAL ALCOHOL SCREEN 15 MIN",null,42,33.6,13.34,33.6,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - G0442"},"BMC HEALTHNET","BMCHN QHP","HCPCS","G0442","ANNUAL ALCOHOL SCREEN 15 MIN",null,42,0,13.34,33.6,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - G0445"},"BMC HEALTHNET","BMCHN QHP","HCPCS","G0445","HIGH INTEN BEH COUNS STD 30M",null,118,0,8.9,16.149999999999999,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - G0446"},"TUFTS","TUFTS POS","HCPCS","G0446","INTENS BEHAVE THER CARDIO DX",null,42,10.18,8.9,16.149999999999999,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - G0447"},"TUFTS","TUFTS PPO","HCPCS","G0447","HC BEHAVIOR COUNSEL OBESITY 15M",null,118,21.18,18.52,33.6,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - G0447"},"BMC HEALTHNET","BMCHN QHP","HCPCS","G0447","HC BEHAVIOR COUNSEL OBESITY 15M",null,118,0,18.52,33.6,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - G0480"},"TUFTS","TUFTS SELECT","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES",null,254,172.38,59.69,973.54,63.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - G0481"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES",null,192,227.06,91.84,1332.11,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - G0481"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES",null,192,184.78,91.84,1332.11,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0506"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC",null,62,0,110.9,110.9,15.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0506"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC",null,62,110.9,110.9,110.9,15.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - G0513"},"TUFTS","TUFTS HMO","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M",null,84,0,148.6,148.6,21,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0513"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M",null,84,148.6,148.6,148.6,21,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0514"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M",null,84,148.6,148.6,148.6,21,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G2011"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS",null,35,28.83,28.83,133.88,8.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - G2012"},"BMC HEALTHNET","BMCHN MCO","HCPCS","G2012","HC BRIEF CHECK IN BY MD/QHP",null,42,0,31.78,31.78,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - HCPCS - G2023"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","CG",31,52.11,23.46,212.71,7.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - G2023"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS",null,31,31.63,23.46,212.71,7.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G2023"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS",null,31,26.99,23.46,212.71,7.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - G2024"},"UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",null,33,53.62,25.46,230.84,8.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G2024"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",null,33,30.04,25.46,230.84,8.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G2066"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH",null,165,58.35,58.35,370.47,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G2086"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G2086","HC OFF BASE OPIOID TX 70MIN",null,194,0,46.18,211.43,48.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - G2087"},"FALLON","FALLON MEDICAID","HCPCS","G2087","HC OFF BASE OPIOID TX, 60 M",null,194,0,46.18,211.43,48.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - G2087"},"BMC HEALTHNET","BMCHN ACO","HCPCS","G2087","HC OFF BASE OPIOID TX, 60 M",null,194,0,46.18,211.43,48.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G2212"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G2212","HC PROLONG OUTPT/OFFICE VIS",null,188,0,null,null,47,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L0120"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE",null,25,36.19,24.86,111.59,6.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L0140"},"UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB",null,189,161.80000000000001,77.52,347.97,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - L0140"},"BMC HEALTHNET","BMCHN MCO","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB",null,189,0,77.52,347.97,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L1820"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO",null,159,640.03,142.59,640.03,39.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L1820"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO",null,159,0,142.59,640.03,39.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - L1830"},"TUFTS","TUFTS PPO","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT",null,78,130.88,81.95,367.86,19.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L1830"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT",null,78,0,81.95,367.86,19.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L1832"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT",null,1523,3337.75,743.59,3337.75,380.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - L1832"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT",null,1523,1078.21,743.59,3337.75,380.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L1832"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT",null,1523,1082.26,743.59,3337.75,380.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L1836"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L1836","HC RIGID KO WO JOINTS",null,209,130.47999999999999,130.47999999999999,585.70000000000005,52.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L1836"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L1836","HC RIGID KO WO JOINTS",null,209,130.47999999999999,130.47999999999999,585.70000000000005,52.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - L1902"},"FALLON","FALLON MEDICAID","HCPCS","L1902","AFO ANKLE GAUNTLET",null,219,0,86.14,386.65,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - L1902"},"TUFTS","TUFTS SELECT","HCPCS","L1902","AFO ANKLE GAUNTLET",null,219,128.6,86.14,386.65,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3260"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L3260","AMBULATORY SURGICAL BOOT EAC",null,279,0,31.12,357.96,69.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - L3260"},"BMC HEALTHNET","BMCHN MCO","HCPCS","L3260","AMBULATORY SURGICAL BOOT EAC",null,279,0,31.12,357.96,69.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - L3350"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","L3350","SHOE HEEL WEDGE",null,41,32.49,22.41,100.59,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L3650"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN",null,1955,302.45,67.38,302.45,488.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L3650"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN",null,1955,0,67.38,302.45,488.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L3650"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN",null,1955,98.07,67.38,302.45,488.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L3670"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE",null,2903,180.35,103.65,465.27,725.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L3760"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L3760","EO WITHJOINT, PREFABRICATED",null,819,534.02,445.02,1997.57,204.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - L3760"},"FALLON","FALLON SENIOR PLAN","HCPCS","L3760","EO WITHJOINT, PREFABRICATED",null,819,445.02,445.02,1997.57,204.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L3760"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L3760","EO WITHJOINT, PREFABRICATED",null,819,645.28,445.02,1997.57,204.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - L3762"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","L3762","RIGID EO WO JOINTS",null,57,95.68,95.68,429.49,14.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L3807"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED",null,483,222.52,222.52,998.85,120.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - L3807"},"TUFTS","TUFTS PPO","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED",null,483,355.37,222.52,998.85,120.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L3807"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED",null,483,323.87,222.52,998.85,120.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L3905"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF",null,2442,882.51,882.51,3961.32,610.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - L3905"},"TUFTS","TUFTS SELECT","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF",null,2442,1317.51,882.51,3961.32,610.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L3908"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","L3908","WRIST COCK-UP NON-MOLDED",null,143,106.57,73.22,328.66,35.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L3908"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L3908","WRIST COCK-UP NON-MOLDED",null,143,184.24,73.22,328.66,35.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L3967"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF",null,117,4441.67,1765.23,7923.54,29.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - L3967"},"BMC HEALTHNET","BMCHN ACO","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF",null,117,0,1765.23,7923.54,29.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L3980"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL",null,132,549.92999999999995,377.84,1695.98,33,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L3980"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL",null,132,549.92999999999995,377.84,1695.98,33,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - L3982"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL",null,176,577.42999999999995,398.23,1787.56,44,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L3982"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL",null,176,880.04,398.23,1787.56,44,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L4350"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB",null,360,0,97.28,436.66,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L4360"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB",null,557,345.83,345.83,1552.36,139.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L4370"},"UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT",null,107,492.15,235.79,1058.3900000000001,26.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L4370"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT",null,107,317.89,235.79,1058.3900000000001,26.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - L4386"},"TUFTS","TUFTS HMO","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB",null,165,277.72000000000003,155.02000000000001,695.83,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - L4386"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB",null,165,224.78,155.02000000000001,695.83,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - L4396"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","L4396","STATIC AFO",null,406,249.49,171.42,769.43,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L4396"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L4396","STATIC AFO",null,406,249.49,171.42,769.43,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L4398"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT",null,406,198.58,78.92,354.25,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L8501"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE",null,219,160.74,160.74,721.54,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - L8507"},"BMC HEALTHNET","BMCHN MCO","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)",null,1604,0,41.03,184.14,401,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L8509"},"UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN",null,1144,223.32,106.99,480.27,286,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L8509"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN",null,1144,155.72999999999999,106.99,480.27,286,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - L8509"},"BMC HEALTHNET","BMCHN MCO","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN",null,1144,0,106.99,480.27,286,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L8514"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR",null,387,124.55,92.38,414.69,96.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - L8693"},"TUFTS","TUFTS SPIRIT","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT",null,1462,1634.13,1485.57,6668.25,365.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L8699"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L8699","HC CARTIFORM 20 X 25 MM DISC",null,13957,0,null,null,3489.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - M0239"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",null,393,365.33,309.60000000000002,779.02,98.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - M0243"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",null,572,365.33,309.60000000000002,779.02,143,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - M0243"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",null,572,365.33,309.60000000000002,779.02,143,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - P9021"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","P9021","HC RBC/UNIT",null,323,184.28,184.28,354.25,80.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - P9021"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","P9021","HC RBC/UNIT",null,323,184.28,184.28,354.25,80.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9037"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","P9037","HC PLT:PHER,LEU-RED,IRR/UNIT",null,939,1349.22,821.84,1622.67,234.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9040"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","P9040","HC RBC:LEU-RED,IRR/UNIT",null,523,669.97,336.11,669.97,130.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - P9045"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML",null,238,52.45,52.45,131.97,59.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9045"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML",null,238,60.32,52.45,131.97,59.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - P9056"},"TUFTS","TUFTS POS","HCPCS","P9056","HC BLOOD, L/R, IRRADIATED",null,1619,311.95,311.95,529.32000000000005,404.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9057"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","P9057","HC RBC:LEU RED,FR/DE/WASH,IR",null,785,484.72,395.89,671.74,196.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9073"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","P9073","HC PLATELETS PHERESIS PATH REDU",null,889,2619.59,821.84,2619.59,222.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - P9073"},"TUFTS","TUFTS SELECT","HCPCS","P9073","HC PLATELETS PHERESIS PATH REDU",null,889,871.26,821.84,2619.59,222.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9100"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","P9100","PATHOGEN TEST FOR PLATELETS",null,1310,33.53,33.53,256.64,327.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - P9612"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","P9612","CATHETERIZE FOR URINE SPEC",null,90,3,2.2200000000000002,1198.25,22.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - P9612"},"TUFTS","TUFTS POS","HCPCS","P9612","CATHETERIZE FOR URINE SPEC",null,90,8.5,2.2200000000000002,1198.25,22.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - P9612"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","P9612","CATHETERIZE FOR URINE SPEC",null,90,2.62,2.2200000000000002,1198.25,22.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - Q0091"},"BMC HEALTHNET","BMCHN ACO","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR",null,83,0,28.83,175.66,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - Q0091"},"BMC HEALTHNET","BMCHN MCO","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR",null,83,0,28.83,175.66,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q0111"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS",null,23,26.31,5.86,127.48,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q0114"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q0114","HC  FERN TEST",null,41,7.2,7.2,82.86,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - Q3014"},"UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE",null,67,56.12,26.65,67.06,16.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - Q3014"},"TUFTS","TUFTS SPIRIT","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE",null,67,29.32,26.65,67.06,16.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - Q4100"},"TUFTS","TUFTS SELECT","HCPCS","Q4100","STRAVIX 3X6",null,12079,0,null,null,3019.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q4101"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","Q4101","APLIGRAF",null,1601,30.46,30.46,76.64,400.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q4102"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","Q4102","OASIS WOUND MATRIX",null,69,12.25,10.210000000000001,25.69,17.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q4104"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q4104","INTEGRA BMWD",null,7748,0,42.08,56.11,1937,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q4104"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q4104","INTEGRA BMWD",null,7748,56.11,42.08,56.11,1937,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q4107"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q4107","GRAFTJACKET",null,2233,86.55,86.55,110.48,558.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q4107"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q4107","GRAFTJACKET",null,2233,110.48,86.55,110.48,558.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q4112"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q4112","CYMETRA INJECTABLE",null,535,1002.89,904.99,1002.89,133.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q4116"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM",null,5248,35.78,32.29,35.78,1312,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q4124"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q4124","OASIS TRILAYER/1 SQCM",null,23,16.39,16.39,16.39,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q4130"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q4130","PR STRATTICE TM",null,65718,45.89,45.89,45.89,16429.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - Q4132"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","Q4132","HC GRAFIX CORE 5X5CM",null,3754,166.21,114.63,288.43,938.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q4132"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","Q4132","HC GRAFIX CORE 5X5CM",null,3754,288.43,114.63,288.43,938.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - Q4133"},"TUFTS","TUFTS SELECT","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",null,3756,0,131.97,332.06,939,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - Q4196"},"UNICARE","UNICARE","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM",null,9044,115.8,111.59,280.77999999999997,2261,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q4196"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM",null,9044,194.17,111.59,280.77999999999997,2261,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q4196"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM",null,9044,150.44999999999999,111.59,280.77999999999997,2261,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - Q4196"},"BMC HEALTHNET","BMCHN MCO","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM",null,9044,0,111.59,280.77999999999997,2261,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q9954"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML",null,0,13.41,12.1,13.41,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q9954"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML",null,0,13.41,12.1,13.41,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q9956"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML",null,76,32.950000000000003,31.75,79.89,19,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - Q9956"},"FALLON","FALLON MEDICAID","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML",null,76,0,31.75,79.89,19,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q9956"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML",null,76,42.81,31.75,79.89,19,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q9956"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML",null,76,0,31.75,79.89,19,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q9957"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML",null,417,54.77,47.63,119.85,104.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - Q9957"},"BMC HEALTHNET","BMCHN ACO","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML",null,417,0,47.63,119.85,104.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q9961"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML",null,1,0,0.25,0.63,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - S2083"},"TUFTS","TUFTS POS","HCPCS","S2083","HC ADJUSTMENT GASTRIC BAND",null,211,595.01,317.70999999999998,1198.25,52.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - S5102"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","S5102","HC ADULT DAY HEALTH - COMPLEX PER DIEM",null,126,0,null,null,31.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - S8037"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","S8037","MRCP",null,1440,1396.47,585.76,3771.6,360,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - U0001"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",null,124,41.31,35.909999999999997,325.64,31,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - U0002"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",null,92,51.31,51.31,465.19,23,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - U0002"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",null,92,59.02,51.31,465.19,23,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - V2785"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","V2785","CORNEAL TISSUE PROCESSING",null,7848,0,5130.87,15242.01,1962,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - 0399T"},"TUFTS","TUFTS SELECT","HCPCS","0399T","PR MYOCARDIAL STRAIN IMAGING",null,1022,0,null,null,255.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - 0402T"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA",null,2880,3044.16,1198.25,11845.41,720,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - 95800"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS",95800,"HOME SLEEP TEST/TYPE 3 PORTA",null,205,293.52,228.32,1412.44,51.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - 81170"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",null,798,300,159,2909.77,199.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - 92083"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED",null,461,229.89,68.75,607.84,115.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - 45378"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND",null,1672,1608.22,1020.59,3264.67,418,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - 45378"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND",null,1672,1250.94,1020.59,3264.67,418,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A4467"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A4467","BELT STRAP SLEEV GRMNT COVER",null,151,0,null,null,37.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A4561"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE",null,108,33.61,23.18,58.33,27,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - A4561"},"BMC HEALTHNET","BMCHN ACO","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE",null,108,0,23.18,58.33,27,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A4562"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A4562","PESSARY NONRUBBER",null,64,0,57.71,145.21,16,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - A4562"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","A4562","PESSARY NONRUBBER",null,64,83.68,57.71,145.21,16,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A4648"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A4648","IMPLANTABLE TISSUE MARKER",null,281,0,null,null,70.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - A4648"},"TUFTS","TUFTS HMO","HCPCS","A4648","IMPLANTABLE TISSUE MARKER",null,281,0,null,null,70.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A6209"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR",null,163,0,8.68,21.84,40.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - A6209"},"TUFTS","TUFTS SPIRIT","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR",null,163,9.5500000000000007,8.68,21.84,40.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - A6258"},"BMC HEALTHNET","BMCHN MCO","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN",null,83,0,5,12.58,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A6550"},"TUFTS","TUFTS POS","HCPCS","A6550","NEG PRES WOUND THER DRSG SET",null,4,0,25.71,64.69,1,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A6550"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","A6550","NEG PRES WOUND THER DRSG SET",null,4,30.85,25.71,64.69,1,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - A6550"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","A6550","NEG PRES WOUND THER DRSG SET",null,4,56.82,25.71,64.69,1,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A7520"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A7520","TRACH/LARYN TUBE NON-CUFFED",null,1173,80.290000000000006,55.16,138.79,293.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9500"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9500","TC99M SESTAMIBI",null,274,463.42,463.42,463.42,68.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9502"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9502","HC TC99M TETROFOSMIN",null,140,0,278.27,278.27,35,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9505"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9505","THALLIUM CHLORIDE PER MCI",null,23,0,395.74,395.74,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9505"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9505","THALLIUM CHLORIDE PER MCI",null,23,395.74,395.74,395.74,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9509"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9509","HC IODINE I-123 PER MCI",null,95,0,5163.91,5163.91,23.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A9513"},"TUFTS","TUFTS PPO","HCPCS","A9513","TECHNETIUM TC-99M MEBROFENIN",null,320,390.48,294.27999999999997,1097.56,80,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9516"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9516","I123 IODIDE CAP, DX",null,192,0,516.39,516.39,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9516"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9516","I123 IODIDE CAP, DX",null,192,516.39,516.39,516.39,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9517"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9517","I131 IODIDE CAP, RX",null,437,0,30.1,101.94,109.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9537"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9537","TC99M MEBROFENIN",null,138,0,157.94999999999999,157.94999999999999,34.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A9537"},"TUFTS","TUFTS POS","HCPCS","A9537","TC99M MEBROFENIN",null,138,0,157.94999999999999,157.94999999999999,34.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9537"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9537","TC99M MEBROFENIN",null,138,157.94999999999999,157.94999999999999,157.94999999999999,34.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9538"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9538","TC99M PYROPHOSPHATE",null,111,0,114.21,114.21,27.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - A9539"},"BMC HEALTHNET","BMCHN QHP","HCPCS","A9539","TC99M PENTETATE",null,668,0,89.47,89.47,167,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9540"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9540","TC99M MAA",null,1831,0,85.66,85.66,457.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9541"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9541","TC99M SULFUR COLLOID",null,120,152.69,152.69,152.69,30,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9543"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9543","Y90 IBRITUMOMAB, RX",null,66322,97558.58,72400.97,217685.7,16580.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9543"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9543","Y90 IBRITUMOMAB, RX",null,66322,139963.56,72400.97,217685.7,16580.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - A9547"},"TUFTS","TUFTS SELECT","HCPCS","A9547","IN111 OXYQUINOLINE",null,440,0,5105.7299999999996,5105.7299999999996,110,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - A9551"},"FALLON","FALLON MEDICAID","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX",null,154,0,1711.56,1711.56,38.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A9551"},"TUFTS","TUFTS PPO","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX",null,154,0,1711.56,1711.56,38.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9552"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9552","F18 FDG",null,972,0,1166.46,1166.46,243,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9552"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9552","F18 FDG",null,972,0,1166.46,1166.46,243,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - A9555"},"FALLON","FALLON MEDICAID","HCPCS","A9555","RADIOPHARMACIAL",null,1065,0,1604.08,1604.08,266.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9555"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9555","RADIOPHARMACIAL",null,1065,0,1604.08,1604.08,266.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9556"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9556","GA67 GALLIUM",null,20,311.94,311.94,311.94,5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - A9558"},"TUFTS","TUFTS SELECT","HCPCS","A9558","HC XENON133/10MCI",null,23,0,108.88,108.88,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - A9558"},"BMC HEALTHNET","BMCHN ACO","HCPCS","A9558","HC XENON133/10MCI",null,23,0,108.88,108.88,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - A9558"},"BMC HEALTHNET","BMCHN MCO","HCPCS","A9558","HC XENON133/10MCI",null,23,0,108.88,108.88,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9561"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9561","TC99M OXIDRONATE",null,127,125.64,125.64,125.64,31.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9562"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9562","TC99M MERTIATIDE",null,1237,2212.25,2212.25,2212.25,309.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A9569"},"TUFTS","TUFTS POS","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC",null,5086,0,4157.3,4157.3,1271.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9569"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC",null,5086,0,4157.3,4157.3,1271.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9570"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC",null,6395,0,null,null,1598.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - A9572"},"FALLON","FALLON MEDICAID","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE",null,131,0,16207.01,16207.01,32.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - A9575"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML",null,8,0.22,0.18,0.45,2,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - A9575"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML",null,8,0.18,0.18,0.45,2,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9575"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML",null,8,0,0.18,0.45,2,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - A9575"},"TUFTS","TUFTS SPIRIT","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML",null,8,0.2,0.18,0.45,2,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - A9576"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML",null,5,1.5,1.5,3.77,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - A9577"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML",null,21,2.17,1.81,5.03,5.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9577"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML",null,21,0,1.81,5.03,5.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - A9577"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML",null,21,2.14,1.81,5.03,5.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - A9579"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML",null,5,3.3,1.53,4.38,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A9579"},"TUFTS","TUFTS PPO","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML",null,5,0,1.53,4.38,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9580"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE",null,158,0,null,null,39.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A9580"},"TUFTS","TUFTS PPO","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE",null,158,0,null,null,39.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - A9581"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","A9581","GADOXETATE DISODIUM INJ",null,99,21.4,14.76,37.14,24.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - A9582"},"FALLON","FALLON MEDICAID","HCPCS","A9582","IODINE I-123 IOBENGUANE",null,10370,0,null,null,2592.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9586"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",null,4402,5015.9399999999996,3746.06,7452.46,1100.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - A9586"},"TUFTS","TUFTS SELECT","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",null,4402,4392.1499999999996,3746.06,7452.46,1100.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A9587"},"TUFTS","TUFTS PPO","HCPCS","A9587","GALLIUM GA-68",null,12985,0,84.97,113.78,3246.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - A9588"},"FALLON","FALLON MEDICAID","HCPCS","A9588","FLUCICLOVINE F-18",null,15438,0,525.05999999999995,703.05,3859.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9588"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9588","FLUCICLOVINE F-18",null,15438,0,525.05999999999995,703.05,3859.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9588"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9588","FLUCICLOVINE F-18",null,15438,525.05999999999995,525.05999999999995,703.05,3859.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A9592"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A9592","HC COPPER CU 64 DOTATATE DIAG",null,5634,0,null,null,1408.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9606"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER",null,493,247.36,198.62,597.20000000000005,123.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C1713"},"TUFTS","TUFTS POS","HCPCS","C1713","HC CORE 10 BONE PLUG",null,4568,0,null,null,1142,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C1713"},"TUFTS","TUFTS PPO","HCPCS","C1713","HC CORE 10 BONE PLUG",null,4568,0,null,null,1142,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1719"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1719","BRACHYTX SOUR,NON-HDR IR-192",null,95,357.35,108.35,357.35,23.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C1724"},"TUFTS","TUFTS SELECT","HCPCS","C1724","HC CATH, TRANS ATHEREC BURR",null,7410,0,null,null,1852.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1729"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1729","HC CATH; THORA PARA",null,2283,0,null,null,570.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1733"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1733","CATH CRYABL  ARCTIC FRN",null,10475,0,null,null,2618.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1753"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1753","HC BIOPSY FORC LVL D",null,3947,0,null,null,986.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C1759"},"TUFTS","TUFTS POS","HCPCS","C1759","HC CATH, ULTRASOUND LVL 2",null,6295,0,null,null,1573.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C1763"},"TUFTS","TUFTS HMO","HCPCS","C1763","HC SM6X16-STEM HEM",null,2242,0,null,null,560.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1764"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1764","HC RECORDER;IMPLANTABLE LOOP",null,8983,0,null,null,2245.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1765"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1765","ADHESION BARRIER",null,569,0,null,null,142.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1765"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1765","ADHESION BARRIER",null,569,0,null,null,142.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C1776"},"TUFTS","TUFTS SELECT","HCPCS","C1776","HC HEMI-TIB PLATEAU W MENISC",null,21721,0,null,null,5430.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1784"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1784","HC DES PERIPHERAL STENT",null,2734,0,null,null,683.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1786"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1786","HC PACER;1CH, RECALL $0",null,23460,0,null,null,5865,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C1786"},"TUFTS","TUFTS POS","HCPCS","C1786","HC PACER;1CH, RECALL $0",null,23460,0,null,null,5865,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1876"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1876","STENT BILIARY",null,11691,0,null,null,2922.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1880"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1880","IVC FILTERS",null,7726,0,null,null,1931.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1884"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1884","EMBOLIZATION PROTECT SYST",null,31469,0,null,null,7867.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C1887"},"TUFTS","TUFTS POS","HCPCS","C1887","HC CATH,EP;R-F,30D THERM RMT",null,3731,0,null,null,932.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C1896"},"TUFTS","TUFTS SELECT","HCPCS","C1896","HC SICD PULSE GENERATOR",null,10912,0,null,null,2728,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C1898"},"TUFTS","TUFTS POS","HCPCS","C1898","HC KIT,PACER;BI-VENT(#6216/8",null,1575,0,null,null,393.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C2616"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C2616","HC BRACHYTHERAPY, NON STRANDED YTTRIUM-90 MICROSPHERE",null,60393,76706.740000000005,25512.2,76706.740000000005,15098.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C2617"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C2617","STENT ZIMMON BILIARY",null,638,0,null,null,159.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C2623"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C2623","CATH TRANSLUMIN DRUG-COAT",null,2837,0,null,null,709.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C2635"},"TUFTS","TUFTS POS","HCPCS","C2635","BRACHYTX, NON-STR, HA, P-103",null,0,80.66,78.03,242.54,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C2639"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C2639","BRACHYTX, NON-STRANDED,I-125",null,47,89.68,52.85,100.75,11.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C2639"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C2639","BRACHYTX, NON-STRANDED,I-125",null,47,61.32,52.85,100.75,11.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C9728"},"TUFTS","TUFTS HMO","HCPCS","C9728","PLACE DEVICE/MARKER, NON PRO",null,1957,4183.66,2227.36,7098.97,489.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - C9739"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","C9739","HC CYSTOSCOPY PROSTATIC IMP 1-3",null,6035,6751.98,2166.09,15242.01,1508.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - D0251"},"TUFTS","TUFTS PPO","HCPCS","D0251","HC EXTRA-ORAL POSTERIOR DENTAL RADIOGRAPHIC IMAGE",null,119,0,null,null,29.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - D0272"},"TUFTS","TUFTS PPO","HCPCS","D0272","BITEWINGS - TWO RADIOGRAPHIC IMAGES",null,836,2563.83,1182.5,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D0274"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D0274","BITEWINGS - FOUR RADIOGRAPHIC IMAGES",null,836,1182.5,1182.5,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D0274"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D0274","BITEWINGS - FOUR RADIOGRAPHIC IMAGES",null,836,1182.5,1182.5,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D1110"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D1110","PROPHYLAXIS - ADULT",null,110,84.56,51.21,163.22999999999999,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - D1516"},"TUFTS","TUFTS PPO","HCPCS","D1516","SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MAXILLARY",null,1350,0,null,null,337.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D2161"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D2161","AMALGAM - FOUR OR MORE SURFACES, PRIMARY OR PERMANENT",null,110,187.9,187.9,187.9,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D2330"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D2330","RESIN-BASED COMPOSITE - ONE SURFACE, ANTERIOR",null,110,121.33,121.33,121.33,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - D2331"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","D2331","RESIN-BASED COMPOSITE - TWO SURFACES, ANTERIOR",null,110,154.99,154.99,154.99,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2390"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D2390","RESIN-BASED COMPOSITE CROWN, ANTERIOR",null,110,248.14,248.14,248.14,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2393"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D2393","RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR",null,110,230.94,230.94,230.94,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2394"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D2394","RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR",null,110,282.64,282.64,282.64,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D3110"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D3110","HC PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION)",null,110,68.89,68.89,68.89,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - D3110"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","D3110","HC PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION)",null,110,68.89,68.89,68.89,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - D3330"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","D3330","ENDODONTIC THERAPY, MOLAR (EXCLUDING FINAL RESTORATION)",null,110,894.85,894.85,894.85,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - D4273"},"TUFTS","TUFTS POS","HCPCS","D4273","HC AUTOGENOUS CONN. TISSUE GRAFT PROC. 1ST TOOTH, IMPLANT, OR EDENTULOUS TOOTH POSITION IN GRAFT",null,1451,2396.69,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D5985"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D5985","HC RADIATION CONE LOCATOR",null,1451,4066.77,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - D5987"},"TUFTS","TUFTS SELECT","HCPCS","D5987","HC COMMISSURE SPLINT",null,1451,1275.99,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D7230"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D7230","REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY",null,836,1510.05,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D7230"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D7230","REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY",null,836,1510.05,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - D7261"},"TUFTS","TUFTS HMO","HCPCS","D7261","PRIMARY CLOSURE OF A SINUS PERFORATION",null,836,2396.69,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D7311"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D7311","ALVEOLOPLASTY W/EXTRACT 1-3",null,110,202.78,202.78,202.78,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - D9230"},"TUFTS","TUFTS HMO","HCPCS","D9230","INHALATION OF NITROUS OXIDE/ANALGESIA, ANXIOLYSIS",null,110,0,null,null,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - D9630"},"TUFTS","TUFTS POS","HCPCS","D9630","HC DRUGS OR MEDICAMENTS DISPENSED IN THE OFFICE FOR HOME USE",null,110,1111.03,591.51,3340.65,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - E0191"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","RR",321,1.44,11.61,52.13,80.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - E0191"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","NU",321,11.61,11.61,52.13,80.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - E0191"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","UE",321,12.56,11.61,52.13,80.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - E0191"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","RR",321,1.74,11.61,52.13,80.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - E0191"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","NU",321,29.21,11.61,52.13,80.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - G0103"},"FALLON","FALLON SENIOR PLAN","HCPCS","G0103","PSA, TOTAL SCREENING",null,93,19.309999999999999,16.78,181.16,23.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0103"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0103","PSA, TOTAL SCREENING",null,93,22.77,16.78,181.16,23.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0103"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0103","PSA, TOTAL SCREENING",null,93,41.5,16.78,181.16,23.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - G0105"},"TUFTS","TUFTS HMO","HCPCS","G0105","HC COLORECTAL SCRN; HI RISK IND",null,1152,2057.7399999999998,1020.59,3264.67,288,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0109"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0109","DIAB MANAGE TRN IND/GROUP",null,267,37.520000000000003,32.64,134.25,66.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - G0127"},"TUFTS","TUFTS POS","HCPCS","G0127","TRIM NAIL(S)",null,189,187.02,93.87,317.35000000000002,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0175"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0175","OPPS SERVICE,SCHED TEAM CONF",null,565,0,638.73,2035.73,141.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - G0257"},"FALLON","FALLON MEDICAID","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP",null,911,0,1027.32,3651.55,227.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - G0257"},"TUFTS","TUFTS PPO","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP",null,911,2302.06,1027.32,3651.55,227.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - G0259"},"BMC HEALTHNET","BMCHN QHP","HCPCS","G0259","HC INJECT FOR SACROILIAC JOINT",null,1513,0,1198.25,1198.25,378.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0260"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0260","INJ FOR SACROILIAC JT ANESTH",null,817,1292.83,1005.62,3474.13,204.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0269"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0269","HC CLOSURE DEVICE PLACEMENT",null,200,0,null,null,50,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0269"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0269","HC CLOSURE DEVICE PLACEMENT",null,200,0,null,null,50,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0279"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0279","TOMOSYNTHESIS, MAMMO",null,55,51.68,30.09,295.68,13.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - G0297"},"FALLON","FALLON MEDICAID","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN",null,1437,0,107.22,801.26,359.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - G0297"},"TUFTS","TUFTS HMO","HCPCS","G0297","HC LDCT FOR LUNG CA SCREEN",null,1437,319.77999999999997,107.22,801.26,359.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - G0365"},"BMC HEALTHNET","BMCHN ACO","HCPCS","G0365","HC VESSEL MAPPING HEMO ACCESS",null,498,0,272.02999999999997,867.01,124.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0390"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI",null,3274,5035.18,1579.83,5035.18,818.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - G0396"},"TUFTS","TUFTS HMO","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN",null,42,134.22,56.05,336.32,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0397"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0397","ALCOHOL/SUBS INTERV >30 MIN",null,118,92.48,128.29,815.89,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - G0410"},"TUFTS","TUFTS HMO","HCPCS","G0410","HC GRP PSYCH PARTIAL HOSP 45-50",null,220,0,null,null,55,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0416"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD",null,425,0,360.63,2456.98,106.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G0416"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD",null,425,360.63,360.63,2456.98,106.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - G0421"},"TUFTS","TUFTS HMO","HCPCS","G0421","HC ED SVC CKD GRP PER SESSION",null,37,80.23,42.72,136.13999999999999,9.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0421"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0421","HC ED SVC CKD GRP PER SESSION",null,37,0,42.72,136.13999999999999,9.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - G0422"},"BMC HEALTHNET","BMCHN ACO","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC",null,169,0,198.42,637.79,42.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - G0423"},"FALLON","FALLON MEDICAID","HCPCS","G0423","HC INTENS CARDIAC REHAB NO EXER",null,169,0,198.42,637.79,42.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0424"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0424","PULMONARY REHAB W EXER",null,284,93.87,93.87,343.09,71,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - G0424"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","G0424","PULMONARY REHAB W EXER",null,284,93.87,93.87,343.09,71,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - G0438"},"TUFTS","TUFTS SELECT","HCPCS","G0438","PPPS, INITIAL VISIT",null,547,34.03,34.03,61.76,136.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G0438"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G0438","PPPS, INITIAL VISIT",null,547,0,34.03,61.76,136.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - G0439"},"BMC HEALTHNET","BMCHN ACO","HCPCS","G0439","PPPS, SUBSEQ VISIT",null,327,0,34.03,61.76,81.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - G0443"},"BMC HEALTHNET","BMCHN MCO","HCPCS","G0443","BRIEF ALCOHOL MISUSE COUNSEL",null,118,0,18.52,33.6,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0444"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0444","DEPRESSION SCREEN ANNUAL",null,42,0,8.9,16.149999999999999,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - G0446"},"TUFTS","TUFTS PPO","HCPCS","G0446","INTENS BEHAVE THER CARDIO DX",null,42,10.18,8.9,16.149999999999999,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0480"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES",null,254,240.99,59.69,973.54,63.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0480"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES",null,254,247.05,59.69,973.54,63.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - G0480"},"BMC HEALTHNET","BMCHN QHP","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES",null,254,71.63,59.69,973.54,63.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0481"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES",null,192,286.56,91.84,1332.11,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - G0481"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES",null,192,346.05,91.84,1332.11,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - G0513"},"FALLON","FALLON MEDICAID","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M",null,84,0,148.6,148.6,21,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0513"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0513","HC PROLONG PREV SVCS, FIRST 30M",null,84,148.6,148.6,148.6,21,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0514"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0514","HC PROLONG PREV SVCS, ADDL 30M",null,84,0,148.6,148.6,21,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - G2011"},"TUFTS","TUFTS PPO","HCPCS","G2011","ALCOHOL/SUB ABUSE ASSESS",null,35,84.4,28.83,133.88,8.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G2012"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G2012","HC BRIEF CHECK IN BY MD/QHP",null,42,0,31.78,31.78,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G2012"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G2012","HC BRIEF CHECK IN BY MD/QHP",null,42,31.78,31.78,31.78,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G2012"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G2012","HC BRIEF CHECK IN BY MD/QHP",null,42,31.78,31.78,31.78,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G2023"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","CG",31,60.07,23.46,212.71,7.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - G2023"},"BMC HEALTHNET","BMCHN ACO","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS",null,31,51.33,23.46,212.71,7.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - HCPCS - G2024"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",null,33,29.97,25.46,230.84,8.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - G2024"},"BMC HEALTHNET","BMCHN MCO","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA","CG",33,46.27,25.46,230.84,8.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - G2066"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH",null,165,58.35,58.35,370.47,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G2066"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH",null,165,58.35,58.35,370.47,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - G2087"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","G2087","HC OFF BASE OPIOID TX, 60 M",null,194,211.43,46.18,211.43,48.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G2212"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G2212","HC PROLONG OUTPT/OFFICE VIS",null,188,0,null,null,47,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G2216"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G2216","HC HOME SUPPLY INJECT NALOXON",null,118,0,null,null,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L0120"},"UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE",null,25,51.89,24.86,111.59,6.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L0120"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE",null,25,36.19,24.86,111.59,6.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - L0140"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB",null,189,112.4,77.52,347.97,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - L1820"},"FALLON","FALLON SENIOR PLAN","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO",null,159,142.59,142.59,640.03,39.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L1830"},"UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT",null,78,171.05,81.95,367.86,19.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - L1830"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT",null,78,119.28,81.95,367.86,19.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - L1830"},"BMC HEALTHNET","BMCHN ACO","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT",null,78,0,81.95,367.86,19.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - L1832"},"TUFTS","TUFTS PPO","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT",null,1523,1187.49,743.59,3337.75,380.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - L1832"},"TUFTS","TUFTS SELECT","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT",null,1523,1110.1199999999999,743.59,3337.75,380.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - L1836"},"TUFTS","TUFTS HMO","HCPCS","L1836","HC RIGID KO WO JOINTS",null,209,233.77,130.47999999999999,585.70000000000005,52.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - L1836"},"BMC HEALTHNET","BMCHN QHP","HCPCS","L1836","HC RIGID KO WO JOINTS",null,209,0,130.47999999999999,585.70000000000005,52.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - L3260"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","L3260","AMBULATORY SURGICAL BOOT EAC",null,279,31.12,31.12,357.96,69.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3260"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L3260","AMBULATORY SURGICAL BOOT EAC",null,279,0,31.12,357.96,69.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - L3350"},"FALLON","FALLON SENIOR PLAN","HCPCS","L3350","SHOE HEEL WEDGE",null,41,22.41,22.41,100.59,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L3350"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L3350","SHOE HEEL WEDGE",null,41,30.21,22.41,100.59,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - L3650"},"FALLON","FALLON SENIOR PLAN","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN",null,1955,67.38,67.38,302.45,488.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - L3650"},"TUFTS","TUFTS SPIRIT","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN",null,1955,74.12,67.38,302.45,488.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - L3670"},"FALLON","FALLON SENIOR PLAN","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE",null,2903,103.65,103.65,465.27,725.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L3670"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE",null,2903,150.86000000000001,103.65,465.27,725.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L3760"},"UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L3760","EO WITHJOINT, PREFABRICATED",null,819,928.85,445.02,1997.57,204.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L3762"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L3762","RIGID EO WO JOINTS",null,57,166.48,95.68,429.49,14.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L3807"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED",null,483,0,222.52,998.85,120.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3807"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED",null,483,0,222.52,998.85,120.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L3808"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L3808","HC EPITRAIN",null,509,945.94,375.94,1687.5,127.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - L3905"},"FALLON","FALLON SENIOR PLAN","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF",null,2442,882.51,882.51,3961.32,610.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L3908"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L3908","WRIST COCK-UP NON-MOLDED",null,143,106.57,73.22,328.66,35.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L3967"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF",null,117,2118.2800000000002,1765.23,7923.54,29.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - L3967"},"FALLON","FALLON SENIOR PLAN","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF",null,117,1765.23,1765.23,7923.54,29.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L3980"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL",null,132,377.84,377.84,1695.98,33,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L3980"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL",null,132,549.92999999999995,377.84,1695.98,33,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L3982"},"UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL",null,176,831.2,398.23,1787.56,44,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L4350"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB",null,360,116.74,97.28,436.66,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L4350"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB",null,360,210.03,97.28,436.66,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L4360"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB",null,557,1552.36,345.83,1552.36,139.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L4360"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB",null,557,345.83,345.83,1552.36,139.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L4360"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB",null,557,0,345.83,1552.36,139.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L4360"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB",null,557,870.18,345.83,1552.36,139.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L4370"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L4370","HC PNEUMATIC FULL LEG SPLINT",null,107,1058.3900000000001,235.79,1058.3900000000001,26.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L4396"},"UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L4396","STATIC AFO",null,406,357.79,171.42,769.43,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - L4396"},"TUFTS","TUFTS PPO","HCPCS","L4396","STATIC AFO",null,406,273.75,171.42,769.43,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L4398"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT",null,406,94.7,78.92,354.25,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L4398"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT",null,406,93.13,78.92,354.25,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L4398"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT",null,406,174.4,78.92,354.25,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L8501"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE",null,219,404.45,160.74,721.54,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L8507"},"UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)",null,1604,85.63,41.03,184.14,401,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L8507"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)",null,1604,0,41.03,184.14,401,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - L8507"},"BMC HEALTHNET","BMCHN ACO","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)",null,1604,0,41.03,184.14,401,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - L8509"},"TUFTS","TUFTS PPO","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN",null,1144,170.87,106.99,480.27,286,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - L8509"},"TUFTS","TUFTS SPIRIT","HCPCS","L8509","TRACH-ESOPH VOICE PROS MD IN",null,1144,117.69,106.99,480.27,286,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - L8514"},"BMC HEALTHNET","BMCHN MCO","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR",null,387,0,92.38,414.69,96.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L8693"},"UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT",null,1462,3100.71,1485.57,6668.25,365.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L8693"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT",null,1462,2162.1799999999998,1485.57,6668.25,365.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L8693"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT",null,1462,3737.99,1485.57,6668.25,365.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - M0239"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",null,393,420.13,309.60000000000002,779.02,98.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - M0243"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",null,572,420.13,309.60000000000002,779.02,143,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - P9012"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","P9012","HC CRYOPRECIPITATE UNIT",null,134,64.959999999999994,64.959999999999994,125.33,33.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - P9016"},"TUFTS","TUFTS PPO","HCPCS","P9016","HC RBC:LEU-RED",null,576,301.76,243.01,478.65,144,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9021"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","P9021","HC RBC/UNIT",null,323,302.52,184.28,354.25,80.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9034"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","P9034","HB PLATELETS, PHERESIS",null,506,709.89,443.29,799.73,126.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9037"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","P9037","HC PLT:PHER,LEU-RED,IRR/UNIT",null,939,821.84,821.84,1622.67,234.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9045"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML",null,238,113.24,52.45,131.97,59.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - P9045"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML",null,238,61.89,52.45,131.97,59.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9045"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML",null,238,60.32,52.45,131.97,59.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9073"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","P9073","HC PLATELETS PHERESIS PATH REDU",null,889,1349.22,821.84,2619.59,222.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9100"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","P9100","PATHOGEN TEST FOR PLATELETS",null,1310,55.05,33.53,256.64,327.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - P9612"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","P9612","CATHETERIZE FOR URINE SPEC",null,90,7.55,2.2200000000000002,1198.25,22.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9612"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","P9612","CATHETERIZE FOR URINE SPEC",null,90,5.27,2.2200000000000002,1198.25,22.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q0111"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS",null,23,18.14,5.86,127.48,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q0111"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS",null,23,8.6300000000000008,5.86,127.48,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q0111"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS",null,23,27.01,5.86,127.48,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - Q0111"},"BMC HEALTHNET","BMCHN ACO","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS",null,23,23.67,5.86,127.48,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - Q0114"},"BMC HEALTHNET","BMCHN MCO","HCPCS","Q0114","HC  FERN TEST",null,41,0,7.2,82.86,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q3014"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE",null,67,26.65,26.65,67.06,16.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - Q4100"},"TUFTS","TUFTS POS","HCPCS","Q4100","STRAVIX 3X6",null,12079,0,null,null,3019.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q4101"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q4101","APLIGRAF",null,1601,0,30.46,76.64,400.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q4101"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q4101","APLIGRAF",null,1601,35.03,30.46,76.64,400.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q4102"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q4102","OASIS WOUND MATRIX",null,69,10.6,10.210000000000001,25.69,17.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q4102"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","Q4102","OASIS WOUND MATRIX",null,69,17.77,10.210000000000001,25.69,17.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q4102"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q4102","OASIS WOUND MATRIX",null,69,11.74,10.210000000000001,25.69,17.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q4104"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q4104","INTEGRA BMWD",null,7748,56.11,42.08,56.11,1937,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q4107"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q4107","GRAFTJACKET",null,2233,0,86.55,110.48,558.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q4112"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q4112","CYMETRA INJECTABLE",null,535,1002.89,904.99,1002.89,133.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q4124"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q4124","OASIS TRILAYER/1 SQCM",null,23,0,16.39,16.39,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - Q4124"},"TUFTS","TUFTS POS","HCPCS","Q4124","OASIS TRILAYER/1 SQCM",null,23,0,16.39,16.39,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q4124"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q4124","OASIS TRILAYER/1 SQCM",null,23,16.39,16.39,16.39,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q4125"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM",null,4060,0,3.79,3.79,1015,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - Q4130"},"TUFTS","TUFTS HMO","HCPCS","Q4130","PR STRATTICE TM",null,65718,0,45.89,45.89,16429.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q4132"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","Q4132","HC GRAFIX CORE 5X5CM",null,3754,114.63,114.63,288.43,938.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - Q4132"},"TUFTS","TUFTS POS","HCPCS","Q4132","HC GRAFIX CORE 5X5CM",null,3754,0,114.63,288.43,938.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q4132"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","Q4132","HC GRAFIX CORE 5X5CM",null,3754,253.32,114.63,288.43,938.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q4133"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",null,3756,155.72,131.97,332.06,939,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q4196"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM",null,9044,115.8,111.59,280.77999999999997,2261,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q9954"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML",null,0,0,12.1,13.41,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - Q9954"},"TUFTS","TUFTS PPO","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML",null,0,0,12.1,13.41,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - Q9956"},"TUFTS","TUFTS PPO","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML",null,76,0,31.75,79.89,19,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q9957"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML",null,417,0,47.63,119.85,104.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - Q9957"},"TUFTS","TUFTS PPO","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML",null,417,0,47.63,119.85,104.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q9957"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML",null,417,105.26,47.63,119.85,104.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - Q9958"},"UNICARE","UNICARE","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML",null,1,7.0000000000000007E-2,7.0000000000000007E-2,0.18,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q9958"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML",null,1,7.0000000000000007E-2,7.0000000000000007E-2,0.18,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - Q9958"},"TUFTS","TUFTS HMO","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML",null,1,0,7.0000000000000007E-2,0.18,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q9961"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML",null,1,0,0.25,0.63,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q9961"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML",null,1,0.28999999999999998,0.25,0.63,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - Q9987"},"FALLON","FALLON MEDICAID","HCPCS","Q9987","HC PATHOGEN TEST PLATELETS",null,1218,0,null,null,304.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA - HCPCS - S2083"},"AETNA","AETNA","HCPCS","S2083","HC ADJUSTMENT GASTRIC BAND",null,211,1198.25,317.70999999999998,1198.25,52.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - S8037"},"TUFTS","TUFTS POS","HCPCS","S8037","MRCP",null,1440,1254.4000000000001,585.76,3771.6,360,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - T2003"},"BMC HEALTHNET","BMCHN MCO","HCPCS","T2003","HC TRANSPORTATION RATE 1 (1-WAY TRIP)",null,25,0,null,null,6.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - U0001"},"TUFTS","TUFTS POS","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",null,124,115.86,35.909999999999997,325.64,31,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - U0002"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",null,92,59.02,51.31,465.19,23,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - 0042T"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","0042T","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME",null,767,1452,1452,1452,191.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - 0278T"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","0278T","HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS",null,77,286.31,286.31,943.8,19.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - 0402T"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","0402T","HC COLLAGEN CROSS-LINKING OF CORNEA",null,2880,3522.21,1198.25,11845.41,720,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C2617"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C2617","STENT ZIMMON BILIARY",null,638,0,null,null,159.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C2625"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C2625","STENT BILIARY COTTON",null,246,0,null,null,61.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C2630"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C2630","HC CATH;EP CRYOABLATION, 8 MM",null,4966,0,null,null,1241.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C2630"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C2630","HC CATH;EP CRYOABLATION, 8 MM",null,4966,0,null,null,1241.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C2635"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C2635","BRACHYTX, NON-STR, HA, P-103",null,0,97.01,78.03,242.54,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C2635"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C2635","BRACHYTX, NON-STR, HA, P-103",null,0,97.01,78.03,242.54,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - C2635"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","C2635","BRACHYTX, NON-STR, HA, P-103",null,0,78.03,78.03,242.54,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C5275"},"TUFTS","TUFTS SELECT","HCPCS","C5275","HC LOW COST SKIN SUBSTITUTE",null,743,684.11,684.11,2032.26,185.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - C5275"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","C5275","HC LOW COST SKIN SUBSTITUTE",null,743,810.95,684.11,2032.26,185.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C9728"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C9728","PLACE DEVICE/MARKER, NON PRO",null,1957,7098.97,2227.36,7098.97,489.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C9803"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C9803","HC OP VISIT SPEC COLLECTION SEVERE ACUTE RESP SYDROM COVID-19",null,35,246.49,87.7,246.49,8.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - D0250"},"TUFTS","TUFTS POS","HCPCS","D0250","HC EXTRA-ORAL - 2D PROJECTION RAD IMAGE CREATED USING A STATIONARY RADIATION SOURCE, AND DETECTOR",null,1451,2396.69,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - D0251"},"TUFTS","TUFTS SELECT","HCPCS","D0251","HC EXTRA-ORAL POSTERIOR DENTAL RADIOGRAPHIC IMAGE",null,119,0,null,null,29.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D0274"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D0274","BITEWINGS - FOUR RADIOGRAPHIC IMAGES",null,836,1182.5,1182.5,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D0472"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D0472","HC ACCESSION OF TISSUE, GROSS EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN REPORT",null,110,6187.11,1941.26,6187.11,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - D1351"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","D1351","SEALANT - PER TOOTH",null,110,45.91,45.91,45.91,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - D1517"},"TUFTS","TUFTS PPO","HCPCS","D1517","SPACE MAINTAINER ¿ FIXED ¿ BILATERAL, MANDIBULAR",null,1451,0,null,null,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2150"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D2150","AMALGAM - TWO SURFACES, PRIMARY OR PERMANENT",null,110,126.81,126.81,126.81,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D2160"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D2160","AMALGAM - THREE SURFACES, PRIMARY OR PERMANENT",null,110,153.4,153.4,153.4,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2331"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D2331","RESIN-BASED COMPOSITE - TWO SURFACES, ANTERIOR",null,110,154.99,154.99,154.99,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - D2390"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","D2390","RESIN-BASED COMPOSITE CROWN, ANTERIOR",null,110,248.14,248.14,248.14,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D2392"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D2392","RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR",null,110,186.31,186.31,186.31,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D2740"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D2740","CROWN - PORCELAIN/CERAMIC SUBSTRATE",null,110,1036.53,1036.53,1036.53,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D2999"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D2999","HC UNSPECIFIED RESTORATIVE PROCEDURE, BY REPORT",null,1451,4066.77,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D3310"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D3310","ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION)",null,110,587.95000000000005,587.95000000000005,587.95000000000005,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - D3460"},"TUFTS","TUFTS SELECT","HCPCS","D3460","HC ENDODONTIC ENDOSSEOUS IMPLANT",null,1451,1275.99,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - D4260"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","D4260","HC OSSEOUS SURGERY FOUR OR MORE CONT. TEETH OR TOOTH BOUNDED SPACES PER QUAD.",null,1451,4066.77,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - D4273"},"TUFTS","TUFTS HMO","HCPCS","D4273","HC AUTOGENOUS CONN. TISSUE GRAFT PROC. 1ST TOOTH, IMPLANT, OR EDENTULOUS TOOTH POSITION IN GRAFT",null,1451,2396.69,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - D4273"},"TUFTS","TUFTS SELECT","HCPCS","D4273","HC AUTOGENOUS CONN. TISSUE GRAFT PROC. 1ST TOOTH, IMPLANT, OR EDENTULOUS TOOTH POSITION IN GRAFT",null,1451,1275.99,1275.99,4066.77,362.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - D7220"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","D7220","REMOVAL OF IMPACTED TOOTH - SOFT TISSUE",null,836,1510.05,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - D7220"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","D7220","REMOVAL OF IMPACTED TOOTH - SOFT TISSUE",null,836,1510.05,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - D7250"},"TUFTS","TUFTS SELECT","HCPCS","D7250","REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)",null,836,1275.99,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D7250"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D7250","REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)",null,836,1510.05,1275.99,4066.77,209,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - D7310"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","D7310","ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH SPACES, PER QUADRANT",null,110,230.94,230.94,230.94,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - D7410"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","D7410","EXCISION OF BENIGN LESION UP TO 1.25 CM",null,110,692.83,692.83,692.83,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - D9630"},"TUFTS","TUFTS PPO","HCPCS","D9630","HC DRUGS OR MEDICAMENTS DISPENSED IN THE OFFICE FOR HOME USE",null,110,1188.52,591.51,3340.65,27.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - E0191"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","RR",321,1.2,11.61,52.13,80.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - E0191"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","NU",321,16.829999999999998,11.61,52.13,80.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - E0191"},"TUFTS","TUFTS SELECT","HCPCS","E0191","PROTECTOR HEEL OR ELBOW",null,321,17.34,11.61,52.13,80.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - E0191"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","E0191","PROTECTOR HEEL OR ELBOW","UE",321,10.220000000000001,11.61,52.13,80.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0103"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0103","PSA, TOTAL SCREENING",null,93,43.05,16.78,181.16,23.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - G0103"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","G0103","PSA, TOTAL SCREENING",null,93,41.69,16.78,181.16,23.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0105"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G0105","HC COLORECTAL SCRN; HI RISK IND",null,1152,1608.22,1020.59,3264.67,288,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - G0108"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","G0108","DIAB MANAGE TRN  PER INDIV",null,425,118.4,72.41,230.78,106.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - G0108"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","G0108","DIAB MANAGE TRN  PER INDIV",null,425,136.19,72.41,230.78,106.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - G0109"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","G0109","DIAB MANAGE TRN IND/GROUP",null,267,37.520000000000003,32.64,134.25,66.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G0127"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G0127","TRIM NAIL(S)",null,189,93.87,93.87,317.35000000000002,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - G0239"},"TUFTS","TUFTS PPO","HCPCS","G0239","OTH RESP PROC, GROUP",null,99,132.85,53.94,373.41,24.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G0239"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G0239","OTH RESP PROC, GROUP",null,99,53.94,53.94,373.41,24.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - G0257"},"TUFTS","TUFTS HMO","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP",null,911,2151.9699999999998,1027.32,3651.55,227.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0257"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0257","HC UNSCHED DIALYSIS ESRD PT HOSP",null,911,0,1027.32,3651.55,227.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0259"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0259","HC INJECT FOR SACROILIAC JOINT",null,1513,0,1198.25,1198.25,378.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - G0259"},"FALLON","FALLON MEDICAID","HCPCS","G0259","HC INJECT FOR SACROILIAC JOINT",null,1513,0,1198.25,1198.25,378.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - G0269"},"BMC HEALTHNET","BMCHN ACO","HCPCS","G0269","HC CLOSURE DEVICE PLACEMENT",null,200,0,null,null,50,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - G0278"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","G0278","ILIAC ART ANGIO,CARDIAC CATH",null,3138,0,34.229999999999997,34.229999999999997,784.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - G0279"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","G0279","TOMOSYNTHESIS, MAMMO",null,55,36.11,30.09,295.68,13.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0279"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0279","TOMOSYNTHESIS, MAMMO",null,55,295.68,30.09,295.68,13.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - G0279"},"TUFTS","TUFTS PPO","HCPCS","G0279","TOMOSYNTHESIS, MAMMO",null,55,105.2,30.09,295.68,13.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0296"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0296","HC VISIT TO DETERM LDCT ELIG",null,118,660.74,102.62,660.74,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - G0296"},"BMC HEALTHNET","BMCHN MCO","HCPCS","G0296","HC VISIT TO DETERM LDCT ELIG",null,118,0,102.62,660.74,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - G0365"},"TUFTS","TUFTS POS","HCPCS","G0365","HC VESSEL MAPPING HEMO ACCESS",null,498,510.97,272.02999999999997,867.01,124.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0379"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0379","DIRECT REFER HOSPITAL OBSERV",null,752,2787.3,874.54,2787.3,188,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - G0390"},"TUFTS","TUFTS PPO","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI",null,3274,3174.35,1579.83,5035.18,818.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - G0390"},"BMC HEALTHNET","BMCHN QHP","HCPCS","G0390","TRAUMA RESPONS W/HOSP CRITI",null,3274,0,1579.83,5035.18,818.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0396"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN",null,42,56.05,56.05,336.32,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0396"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN",null,42,0,56.05,336.32,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - G0396"},"BMC HEALTHNET","BMCHN QHP","HCPCS","G0396","ALCOHOL/SUBS INTERV 15-30MN",null,42,0,56.05,336.32,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - G0402"},"TUFTS","TUFTS SELECT","HCPCS","G0402","INITIAL PREVENTIVE EXAM",null,168,208.89,208.89,1179.72,42,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - G0410"},"FALLON","FALLON MEDICAID","HCPCS","G0410","HC GRP PSYCH PARTIAL HOSP 45-50",null,220,0,null,null,55,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G0416"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G0416","HC PROSTATE BIOPSY ANY MTHD",null,425,0,360.63,2456.98,106.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - G0420"},"TUFTS","TUFTS HMO","HCPCS","G0420","HC ED SVC CKD IND PER SESSION",null,156,347.3,184.9,589.33000000000004,39,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - G0422"},"FALLON","FALLON MEDICAID","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC",null,169,0,198.42,637.79,42.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0422"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0422","HC INTENS CARDIAC REHAB W/EXERC",null,169,255.09,198.42,637.79,42.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - G0424"},"TUFTS","TUFTS PPO","HCPCS","G0424","PULMONARY REHAB W EXER",null,284,216.3,93.87,343.09,71,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - G0438"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","G0438","PPPS, INITIAL VISIT",null,547,61.76,34.03,61.76,136.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G0438"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G0438","PPPS, INITIAL VISIT",null,547,0,34.03,61.76,136.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - G0442"},"BMC HEALTHNET","BMCHN MCO","HCPCS","G0442","ANNUAL ALCOHOL SCREEN 15 MIN",null,42,0,13.34,33.6,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - G0444"},"TUFTS","TUFTS HMO","HCPCS","G0444","DEPRESSION SCREEN ANNUAL",null,42,10.18,8.9,16.149999999999999,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G0444"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G0444","DEPRESSION SCREEN ANNUAL",null,42,0,8.9,16.149999999999999,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - G0446"},"FALLON","FALLON MEDICAID","HCPCS","G0446","INTENS BEHAVE THER CARDIO DX",null,42,0,8.9,16.149999999999999,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - G0480"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES",null,254,247.05,59.69,973.54,63.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - G0480"},"TUFTS","TUFTS SPIRIT","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES",null,254,125.87,59.69,973.54,63.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - G0480"},"BMC HEALTHNET","BMCHN MCO","HCPCS","G0480","DRUG TEST DEF 1-7 CLASSES",null,254,59.69,59.69,973.54,63.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - G0481"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES",null,192,160.99,91.84,1332.11,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - G0481"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","G0481","DRUG TEST DEF 8-14 CLASSES",null,192,338.08,91.84,1332.11,48,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G0506"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC",null,62,110.9,110.9,110.9,15.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - G0506"},"BMC HEALTHNET","BMCHN QHP","HCPCS","G0506","HC COMP ASSESS CARE PLAN CCM SVC",null,62,0,110.9,110.9,15.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - 92083"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED",null,461,68.75,68.75,607.84,115.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - 92083"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS",92083,"VISUAL FIELD EXAM,EXTENDED",null,461,178.83,68.75,607.84,115.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - G2012"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","G2012","HC BRIEF CHECK IN BY MD/QHP",null,42,0,31.78,31.78,10.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - G2023"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS",null,31,28.15,23.46,212.71,7.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - G2023"},"TUFTS","TUFTS HMO","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS",null,31,90.81,23.46,212.71,7.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - G2023"},"BMC HEALTHNET","BMCHN ACO","HCPCS","G2023","SPECIMEN COLLECTION FOR  CORONAVIRUS","CG",31,96.86,23.46,212.71,7.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - G2024"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",null,33,29.29,25.46,230.84,8.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - G2024"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","G2024","SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA",null,33,25.46,25.46,230.84,8.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - G2066"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH",null,165,0,58.35,370.47,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - G2066"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH",null,165,0,58.35,370.47,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - G2066"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","G2066","HC INTERROGATION EVAL REMOTE </30 D TECH",null,165,58.35,58.35,370.47,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - G2087"},"BMC HEALTHNET","BMCHN MCO","HCPCS","G2087","HC OFF BASE OPIOID TX, 60 M",null,194,0,46.18,211.43,48.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - G2088"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","G2088","HC OFF BASE OPIOID TX, ADD30",null,45,82.11,82.11,82.11,11.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - G2088"},"BMC HEALTHNET","BMCHN MCO","HCPCS","G2088","HC OFF BASE OPIOID TX, ADD30",null,45,0,82.11,82.11,11.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - G2216"},"BMC HEALTHNET","BMCHN MCO","HCPCS","G2216","HC HOME SUPPLY INJECT NALOXON",null,118,0,null,null,29.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L0120"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE",null,25,24.86,24.86,111.59,6.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L0120"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE",null,25,43.26,24.86,111.59,6.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - L0120"},"BMC HEALTHNET","BMCHN ACO","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE",null,25,0,24.86,111.59,6.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - L0120"},"BMC HEALTHNET","BMCHN QHP","HCPCS","L0120","CERV FLEXIBLE NON-ADJUSTABLE",null,25,0,24.86,111.59,6.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - L0140"},"FALLON","FALLON MEDICAID","HCPCS","L0140","CERVICAL SEMI-RIGID ADJUSTAB",null,189,0,77.52,347.97,47.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L1820"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L1820","KO ELAS W/ CONDYLE PADS & JO",null,159,0,142.59,640.03,39.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L1830"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT",null,78,98.34,81.95,367.86,19.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - L1830"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT",null,78,110.48,81.95,367.86,19.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L1830"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT",null,78,119.28,81.95,367.86,19.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - L1830"},"BMC HEALTHNET","BMCHN QHP","HCPCS","L1830","KO IMMOBILIZER CANVAS LONGIT",null,78,0,81.95,367.86,19.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - L1832"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT",null,1523,743.59,743.59,3337.75,380.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L1832"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L1832","KO ADJ JNT POS RIGID SUPPORT",null,1523,1082.26,743.59,3337.75,380.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - L1836"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","L1836","HC RIGID KO WO JOINTS",null,209,156.58000000000001,130.47999999999999,585.70000000000005,52.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - L1836"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","L1836","HC RIGID KO WO JOINTS",null,209,585.70000000000005,130.47999999999999,585.70000000000005,52.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L1836"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L1836","HC RIGID KO WO JOINTS",null,209,189.2,130.47999999999999,585.70000000000005,52.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L1836"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L1836","HC RIGID KO WO JOINTS",null,209,0,130.47999999999999,585.70000000000005,52.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - L1902"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","L1902","AFO ANKLE GAUNTLET",null,219,101.65,86.14,386.65,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L1902"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L1902","AFO ANKLE GAUNTLET",null,219,0,86.14,386.65,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - L3350"},"FALLON","FALLON MEDICAID","HCPCS","L3350","SHOE HEEL WEDGE",null,41,0,22.41,100.59,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - L3350"},"BMC HEALTHNET","BMCHN MCO","HCPCS","L3350","SHOE HEEL WEDGE",null,41,0,22.41,100.59,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - L3650"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","L3650","SHLDER FIG 8 ABDUCT RESTRAIN",null,1955,97.7,67.38,302.45,488.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L3670"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L3670","ACROMIO/CLAVICULAR CANVAS&WE",null,2903,260.8,103.65,465.27,725.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - L3760"},"TUFTS","TUFTS POS","HCPCS","L3760","EO WITHJOINT, PREFABRICATED",null,819,664.38,445.02,1997.57,204.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L3760"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L3760","EO WITHJOINT, PREFABRICATED",null,819,647.70000000000005,445.02,1997.57,204.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - L3760"},"BMC HEALTHNET","BMCHN ACO","HCPCS","L3760","EO WITHJOINT, PREFABRICATED",null,819,0,445.02,1997.57,204.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L3762"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L3762","RIGID EO WO JOINTS",null,57,206.57,95.68,429.49,14.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - L3762"},"TUFTS","TUFTS POS","HCPCS","L3762","RIGID EO WO JOINTS",null,57,142.84,95.68,429.49,14.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - L3762"},"BMC HEALTHNET","BMCHN QHP","HCPCS","L3762","RIGID EO WO JOINTS",null,57,0,95.68,429.49,14.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - L3807"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED",null,483,323.87,222.52,998.85,120.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - L3807"},"BMC HEALTHNET","BMCHN QHP","HCPCS","L3807","WHFO,NO JOINT, PREFABRICATED",null,483,0,222.52,998.85,120.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - L3808"},"TUFTS","TUFTS PPO","HCPCS","L3808","HC EPITRAIN",null,509,600.37,375.94,1687.5,127.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L3808"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","L3808","HC EPITRAIN",null,509,547.16999999999996,375.94,1687.5,127.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L3905"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L3905","HC WHO W/NONTORSION JNT(S) CF",null,2442,1284.45,882.51,3961.32,610.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - L3908"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","L3908","WRIST COCK-UP NON-MOLDED",null,143,0,73.22,328.66,35.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - L3908"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","L3908","WRIST COCK-UP NON-MOLDED",null,143,0,73.22,328.66,35.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - L3967"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF",null,117,3811.13,1765.23,7923.54,29.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - L3967"},"TUFTS","TUFTS HMO","HCPCS","L3967","HC SEWHO AIRPLANE W/O JNTS CF",null,117,3162.38,1765.23,7923.54,29.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - L3980"},"TUFTS","TUFTS HMO","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL",null,132,676.89,377.84,1695.98,33,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - L3980"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL",null,132,549.92999999999995,377.84,1695.98,33,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - L3980"},"BMC HEALTHNET","BMCHN QHP","HCPCS","L3980","HC UPP EXT FX ORTHOSIS HUMERAL",null,132,0,377.84,1695.98,33,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - L3982"},"TUFTS","TUFTS SPIRIT","HCPCS","L3982","HC UPPER EXT FX ORTHOSIS RAD/UL",null,176,438.05,398.23,1787.56,44,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - L4350"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB",null,360,141.06,97.28,436.66,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - L4350"},"TUFTS","TUFTS SPIRIT","HCPCS","L4350","ANKLE CONTROL ORTHOSI PREFAB",null,360,107.01,97.28,436.66,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - L4360"},"TUFTS","TUFTS POS","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB",null,557,516.29999999999995,345.83,1552.36,139.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - L4360"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","L4360","PNEUMATI WALKING BOOT PREFAB",null,557,0,345.83,1552.36,139.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED HEALTHCARE - HCPCS - L4386"},"UNITED HEALTHCARE","UNITED HEALTHCARE","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB",null,165,323.57,155.02000000000001,695.83,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - L4386"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB",null,165,0,155.02000000000001,695.83,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - L4386"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB",null,165,225.63,155.02000000000001,695.83,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - L4386"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","L4386","NON-PNEUM WALK BOOT PREFAB",null,165,342.58,155.02000000000001,695.83,41.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - L4396"},"FALLON","FALLON MEDICAID","HCPCS","L4396","STATIC AFO",null,406,0,171.42,769.43,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - L4396"},"TUFTS","TUFTS SELECT","HCPCS","L4396","STATIC AFO",null,406,255.91,171.42,769.43,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - L4396"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","L4396","STATIC AFO",null,406,431.33,171.42,769.43,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L4398"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT",null,406,78.92,78.92,354.25,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - L4398"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT",null,406,114.43,78.92,354.25,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - L4398"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","L4398","HC FOOT DROP SPLINT RECUMBENT",null,406,114.87,78.92,354.25,101.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - L8501"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE",null,219,192.89,160.74,721.54,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - L8501"},"TUFTS","TUFTS SPIRIT","HCPCS","L8501","TRACHEOSTOMY SPEAKING VALVE",null,219,176.81,160.74,721.54,54.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - L8507"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)",null,1604,41.03,41.03,184.14,401,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L8507"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L8507","HC PROLARYNX VOICE (PLUS)",null,1604,41.03,41.03,184.14,401,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - L8514"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR",null,387,92.38,92.38,414.69,96.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - L8514"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","L8514","REPL TRACH PUNCTURE DILATOR",null,387,160.74,92.38,414.69,96.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - L8693"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT",null,1462,2154.08,1485.57,6668.25,365.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - L8693"},"TUFTS","TUFTS POS","HCPCS","L8693","HC AUD OSSEO DEV, ABUTMENT",null,1462,2217.8200000000002,1485.57,6668.25,365.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - M0239"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",null,393,309.60000000000002,309.60000000000002,779.02,98.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - M0239"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","M0239","HC INTRAVENOUS INFUSION, BAMLANIVIMAB-XXXX, INCLUDES INFUSION AND POST ADMINISTRATION MONITORING",null,393,309.60000000000002,309.60000000000002,779.02,98.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - M0243"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","M0243","HC INJECTION, CASIRIVIMAB AND IMDEVIMAB, 2400 MG",null,572,448.92,309.60000000000002,779.02,143,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - P9012"},"TUFTS","TUFTS HMO","HCPCS","P9012","HC CRYOPRECIPITATE UNIT",null,134,73.86,64.959999999999994,125.33,33.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9016"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","P9016","HC RBC:LEU-RED",null,576,478.65,243.01,478.65,144,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - P9017"},"TUFTS","TUFTS PPO","HCPCS","P9017","HC FF PLAS: 1 DONOR",null,291,137.26,94.07,217.72,72.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9021"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","P9021","HC RBC/UNIT",null,323,354.25,184.28,354.25,80.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9034"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","P9034","HB PLATELETS, PHERESIS",null,506,443.29,443.29,799.73,126.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9037"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","P9037","HC PLT:PHER,LEU-RED,IRR/UNIT",null,939,1622.67,821.84,1622.67,234.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - P9044"},"TUFTS","TUFTS HMO","HCPCS","P9044","HC CRYOPRECIPITATE REDUCED PLASMA",null,133,144.19999999999999,144.19999999999999,244.67,33.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - P9045"},"TUFTS","TUFTS SELECT","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML",null,238,76.05,52.45,131.97,59.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - P9045"},"TUFTS","TUFTS SPIRIT","HCPCS","P9045","HC ALBUMIN (HUMAN) 5% 250ML",null,238,57.7,52.45,131.97,59.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - P9073"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","P9073","HC PLATELETS PHERESIS PATH REDU",null,889,821.84,821.84,2619.59,222.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9100"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","P9100","PATHOGEN TEST FOR PLATELETS",null,1310,53.7,33.53,256.64,327.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - P9612"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","P9612","CATHETERIZE FOR URINE SPEC",null,90,3.54,2.2200000000000002,1198.25,22.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q0091"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q0091","HC OBTAINING SCREEN PAP SMEAR",null,83,28.83,28.83,175.66,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q0111"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS",null,23,14.68,5.86,127.48,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q0111"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","Q0111","HC WET MOUNTS W PREPARATIONS",null,23,38.04,5.86,127.48,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q0114"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","Q0114","HC  FERN TEST",null,41,11.69,7.2,82.86,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q0114"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","Q0114","HC  FERN TEST",null,41,16.95,7.2,82.86,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q0114"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q0114","HC  FERN TEST",null,41,0,7.2,82.86,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q0114"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q0114","HC  FERN TEST",null,41,17.79,7.2,82.86,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - Q0114"},"BMC HEALTHNET","BMCHN ACO","HCPCS","Q0114","HC  FERN TEST",null,41,15.75,7.2,82.86,10.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q3014"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","Q3014","HC TELEHEALTH FACILITY FEE",null,67,57.54,26.65,67.06,16.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q4101"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","Q4101","APLIGRAF",null,1601,41.07,30.46,76.64,400.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q4101"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q4101","APLIGRAF",null,1601,35.03,30.46,76.64,400.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - Q4112"},"TUFTS","TUFTS HMO","HCPCS","Q4112","CYMETRA INJECTABLE",null,535,0,904.99,1002.89,133.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - Q4116"},"TUFTS","TUFTS PPO","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM",null,5248,0,32.29,35.78,1312,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q4116"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q4116","HC ALLODERM 8 X 16 MEDIUM",null,5248,35.78,32.29,35.78,1312,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q4124"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q4124","OASIS TRILAYER/1 SQCM",null,23,0,16.39,16.39,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q4124"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q4124","OASIS TRILAYER/1 SQCM",null,23,16.39,16.39,16.39,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q4125"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q4125","HC AFLEX401 ¿ 40 X 70 MM",null,4060,3.79,3.79,3.79,1015,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q4130"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","Q4130","PR STRATTICE TM",null,65718,0,45.89,45.89,16429.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q4132"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","Q4132","HC GRAFIX CORE 5X5CM",null,3754,114.63,114.63,288.43,938.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q4133"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",null,3756,131.97,131.97,332.06,939,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q4133"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","Q4133","HC GRAFIX STRAVIX PRIME PL (5CMX5CM)",null,3756,284.92,131.97,332.06,939,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q4196"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM",null,9044,111.59,111.59,280.77999999999997,2261,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q4196"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM",null,9044,240.92,111.59,280.77999999999997,2261,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q4196"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","Q4196","HC PURAPLYAM-COM 6X9 CM",null,9044,246.6,111.59,280.77999999999997,2261,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q9954"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q9954","ORAL MR CONTRAST, 100 ML",null,0,0,12.1,13.41,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q9956"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML",null,76,0,31.75,79.89,19,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q9956"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","Q9956","HC INJ;OCTAFLUORO MICRO/1ML",null,76,46.04,31.75,79.89,19,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q9957"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","Q9957","HC INJ;PERFLUTR LIP MIC/1ML",null,417,57.16,47.63,119.85,104.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q9958"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML",null,1,0.08,7.0000000000000007E-2,0.18,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q9958"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML",null,1,7.0000000000000007E-2,7.0000000000000007E-2,0.18,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - Q9958"},"BMC HEALTHNET","BMCHN MCO","HCPCS","Q9958","HOCM <=149 MG/ML IODINE, 1ML",null,1,0,7.0000000000000007E-2,0.18,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - Q9961"},"FALLON","FALLON SENIOR PLAN","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML",null,1,0.25,0.25,0.63,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q9961"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML",null,1,0.36,0.25,0.63,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - Q9961"},"BMC HEALTHNET","BMCHN ACO","HCPCS","Q9961","HOCM 250-299MG/ML IODINE,1ML",null,1,0,0.25,0.63,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - S2083"},"TUFTS","TUFTS SELECT","HCPCS","S2083","HC ADJUSTMENT GASTRIC BAND",null,211,317.70999999999998,317.70999999999998,1198.25,52.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - S5101"},"BMC HEALTHNET","BMCHN MCO","HCPCS","S5101","HC ADULT DAY HEALTH COMPLEX - 3 HOUR (IN PERSON)",null,63,0,null,null,15.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - S5102"},"FALLON","FALLON MEDICAID","HCPCS","S5102","HC ADULT DAY HEALTH - COMPLEX PER DIEM",null,126,0,null,null,31.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - S8037"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","S8037","MRCP",null,1440,1396.47,585.76,3771.6,360,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - U0001"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",null,124,43.09,35.909999999999997,325.64,31,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - U0001"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","U0001","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",null,124,52.07,35.909999999999997,325.64,31,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - U0002"},"TUFTS","TUFTS HMO","HCPCS","U0002","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL-ARUP",null,92,198.6,51.31,465.19,23,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - V2785"},"BMC HEALTHNET","BMCHN ACO","HCPCS","V2785","CORNEAL TISSUE PROCESSING",null,7848,0,5130.87,15242.01,1962,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - V2790"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","V2790","HC MEMBRANE AMNIOTIC",null,1136,0,null,null,284,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - V2790"},"BMC HEALTHNET","BMCHN QHP","HCPCS","V2790","HC MEMBRANE AMNIOTIC",null,1136,0,null,null,284,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - J1250"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,17.55,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - J1250"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,44.41,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - J1250"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,44.41,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - J2790"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG",null,186.95,0,74.3,186.95,46.737499999999997,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - J3301"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,157.52000000000001,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - J3301"},"UNICARE","UNICARE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,40.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - J3301"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,40.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - J3301"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,62.07,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - J3301"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,11.87,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - J3301"},"FALLON","FALLON SENIOR PLAN","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,40.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - J3301"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,3.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - J3301"},"TUFTS","TUFTS HMO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,40.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - J3301"},"TUFTS","TUFTS POS","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,3.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - J3301"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,11.87,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - J3301"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,11.87,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - J3301"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,62.07,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - J3301"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,28.21,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - J3590"},"TUFTS","TUFTS POS","HCPCS","J3590","COSTAL CARTILAGE ALLOGRAFT",null,3907.79,576,576,3907.79,976.94749999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - J3590"},"TUFTS","TUFTS SELECT","HCPCS","J3590","COSTAL CARTILAGE ALLOGRAFT",null,3907.79,2672.09,576,3907.79,976.94749999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - J7307"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM",null,3487,3162.8,3162.8,3487,871.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - J7307"},"TUFTS","TUFTS PPO","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM",null,3487,3487,3162.8,3487,871.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9047"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,270.35000000000002,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9047"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,214.93,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - P9047"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,214.93,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - P9047"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,214.93,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - P9047"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,214.93,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - P9047"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,270.35000000000002,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9047"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,270.35000000000002,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - P9047"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,107.47,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - P9047"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,235.54,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q9963"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML",null,30.27,30.27,30.27,30.27,7.5674999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q9963"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML",null,30.27,30.27,30.27,30.27,7.5674999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q9963"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML",null,30.27,30.27,30.27,30.27,7.5674999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q9966"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML",null,69.63,69.63,34.82,69.63,17.407499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q9966"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML",null,69.63,69.63,34.82,69.63,17.407499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q9967"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.12,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q9967"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.12,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q9967"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q9967"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q9967"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,14.75,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q9967"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.15,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - Q9967"},"TUFTS","TUFTS POS","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - Q9967"},"TUFTS","TUFTS PPO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q9967"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,50.45,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q9967"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,32.33,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q9967"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,32.33,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - Q9967"},"BMC HEALTHNET","BMCHN ACO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q9967"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,14.75,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C2615"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C2615","SEALANT, PULMONARY, LIQUID",null,1447.7,748.44,748.44,1447.7,361.92500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C2615"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C2615","SEALANT, PULMONARY, LIQUID",null,1447.7,748.44,748.44,1447.7,361.92500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C2615"},"TUFTS","TUFTS SELECT","HCPCS","C2615","SEALANT, PULMONARY, LIQUID",null,1447.7,1447.7,748.44,1447.7,361.92500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - J0702"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,116.03,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - J0702"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,132.62,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - J0702"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,132.62,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - J0702"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,116.03,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - J1030"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,26.88,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - J1030"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.6,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - J1030"},"TUFTS","TUFTS POS","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.6,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - J1030"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.59,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - J1030"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.59,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - J1030"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.6,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - J1250"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,17.55,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - J1250"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,17.55,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - J1250"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,18.62,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - J1250"},"TUFTS","TUFTS HMO","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,17.55,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - J1250"},"TUFTS","TUFTS SPIRIT","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,18.62,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - J1250"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,44.41,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - A4561"},"TUFTS","TUFTS SPIRIT","HCPCS","A4561","HC PESSARY RUBBER, ANY TYPE",null,108,25.5,23.18,58.33,27,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - A4562"},"FALLON","FALLON MEDICAID","HCPCS","A4562","PESSARY NONRUBBER",null,64,0,57.71,145.21,16,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - A4562"},"TUFTS","TUFTS HMO","HCPCS","A4562","PESSARY NONRUBBER",null,64,0,57.71,145.21,16,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A4562"},"TUFTS","TUFTS POS","HCPCS","A4562","PESSARY NONRUBBER",null,64,0,57.71,145.21,16,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A4725"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A4725","DIALYS SOL FLD VOL > 4999CC",null,87,0,null,null,21.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A6209"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR",null,163,0,8.68,21.84,40.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A6209"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR",null,163,12.63,8.68,21.84,40.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A6209"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A6209","FOAM DRSG <=16 SQ IN W/O BDR",null,163,12.63,8.68,21.84,40.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - A6258"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","A6258","TRANSPARENT FILM >16<=48 IN",null,83,0,5,12.58,20.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - A6549"},"BMC HEALTHNET","BMCHN ACO","HCPCS","A6549","G COMPRESSION STOCKING",null,37,0,null,null,9.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - A6550"},"TUFTS","TUFTS HMO","HCPCS","A6550","NEG PRES WOUND THER DRSG SET",null,4,0,25.71,64.69,1,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - A9500"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","A9500","TC99M SESTAMIBI",null,274,0,463.42,463.42,68.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9500"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9500","TC99M SESTAMIBI",null,274,0,463.42,463.42,68.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9502"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9502","HC TC99M TETROFOSMIN",null,140,278.27,278.27,278.27,35,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9503"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9503","TC99M MEDRONATE",null,23,37.119999999999997,37.119999999999997,37.119999999999997,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9503"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9503","TC99M MEDRONATE",null,23,37.119999999999997,37.119999999999997,37.119999999999997,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9505"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9505","THALLIUM CHLORIDE PER MCI",null,23,395.74,395.74,395.74,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - A9509"},"FALLON","FALLON MEDICAID","HCPCS","A9509","HC IODINE I-123 PER MCI",null,95,0,5163.91,5163.91,23.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9509"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9509","HC IODINE I-123 PER MCI",null,95,5163.91,5163.91,5163.91,23.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A9512"},"TUFTS","TUFTS POS","HCPCS","A9512","TC99M PERTECHNETATE",null,1,0,null,null,0.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9517"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9517","I131 IODIDE CAP, RX",null,437,101.94,30.1,101.94,109.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - A9520"},"FALLON","FALLON MEDICAID","HCPCS","A9520","TECHNETIUMTC-99M SULFUR CLLD",null,1951,0,null,null,487.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - A9521"},"FALLON","FALLON MEDICAID","HCPCS","A9521","TC99M EXAMETAZIME",null,360,0,4157.3,4157.3,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - A9521"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","A9521","TC99M EXAMETAZIME",null,360,4157.3,4157.3,4157.3,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - A9521"},"BMC HEALTHNET","BMCHN ACO","HCPCS","A9521","TC99M EXAMETAZIME",null,360,0,4157.3,4157.3,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9521"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9521","TC99M EXAMETAZIME",null,360,4157.3,4157.3,4157.3,90,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - A9537"},"FALLON","FALLON MEDICAID","HCPCS","A9537","TC99M MEBROFENIN",null,138,0,157.94999999999999,157.94999999999999,34.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - A9538"},"TUFTS","TUFTS HMO","HCPCS","A9538","TC99M PYROPHOSPHATE",null,111,0,114.21,114.21,27.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - A9538"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","A9538","TC99M PYROPHOSPHATE",null,111,114.21,114.21,114.21,27.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A9540"},"TUFTS","TUFTS PPO","HCPCS","A9540","TC99M MAA",null,1831,0,85.66,85.66,457.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - A9541"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","A9541","TC99M SULFUR COLLOID",null,120,0,152.69,152.69,30,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A9547"},"TUFTS","TUFTS PPO","HCPCS","A9547","IN111 OXYQUINOLINE",null,440,0,5105.7299999999996,5105.7299999999996,110,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9551"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX",null,154,0,1711.56,1711.56,38.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9551"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9551","HC TC99M SUCCIMER/10MCI,DX",null,154,1711.56,1711.56,1711.56,38.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9552"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9552","F18 FDG",null,972,0,1166.46,1166.46,243,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - A9552"},"BMC HEALTHNET","BMCHN ACO","HCPCS","A9552","F18 FDG",null,972,0,1166.46,1166.46,243,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - A9555"},"BMC HEALTHNET","BMCHN MCO","HCPCS","A9555","RADIOPHARMACIAL",null,1065,0,1604.08,1604.08,266.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9556"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9556","GA67 GALLIUM",null,20,311.94,311.94,311.94,5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - A9557"},"BMC HEALTHNET","BMCHN QHP","HCPCS","A9557","TC99M BICISATE",null,239,0,1062.44,1062.44,59.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9558"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9558","HC XENON133/10MCI",null,23,0,108.88,108.88,5.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9560"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9560","TC99M LABELED RBC",null,246,0,266.7,266.7,61.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9561"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9561","TC99M OXIDRONATE",null,127,0,125.64,125.64,31.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9562"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9562","TC99M MERTIATIDE",null,1237,0,2212.25,2212.25,309.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - A9562"},"TUFTS","TUFTS SELECT","HCPCS","A9562","TC99M MERTIATIDE",null,1237,0,2212.25,2212.25,309.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - A9563"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","A9563","P32 NA PHOSPHATE",null,0,870.53,535.17999999999995,3182.68,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - A9569"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","A9569","TECHNETIUM TC-99M AUTO WBC",null,5086,0,4157.3,4157.3,1271.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - 81170"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",null,798,300.79000000000002,159,2909.77,199.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - 81170"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS",81170,"PR ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS",null,798,548.09,159,2909.77,199.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9570"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9570","HC INDIUM IN-111 AUTO WBC",null,6395,0,null,null,1598.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - A9572"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE",null,131,0,16207.01,16207.01,32.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - A9572"},"BMC HEALTHNET","BMCHN ACO","HCPCS","A9572","INDIUM IN-111 PENTETREOTIDE",null,131,0,16207.01,16207.01,32.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - A9575"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","A9575","INJ GADOTERATE MEGLUMI 0.1ML",null,8,0.31,0.18,0.45,2,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9576"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML",null,5,0,1.5,3.77,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9576"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9576","HC PROHANCE IV CONTRAST PER ML",null,5,3.76,1.5,3.77,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - A9577"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","A9577","HC INJ, GADOBENATE DIMEGL 1 ML",null,21,5.03,1.81,5.03,5.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - A9579"},"FALLON","FALLON SENIOR PLAN","HCPCS","A9579","GAD-BASE MR CONTRAST NOS,1ML",null,5,1.53,1.53,4.38,1.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - A9580"},"TUFTS","TUFTS SELECT","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE",null,158,0,null,null,39.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - A9580"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","A9580","HC NA FLUORIDE F-18, DOSE",null,158,0,null,null,39.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9581"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9581","GADOXETATE DISODIUM INJ",null,99,16.97,14.76,37.14,24.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A9582"},"TUFTS","TUFTS PPO","HCPCS","A9582","IODINE I-123 IOBENGUANE",null,10370,0,null,null,2592.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - A9583"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ",null,13,21.34,19.260000000000002,21.34,3.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - A9583"},"BMC HEALTHNET","BMCHN MCO","HCPCS","A9583","GADOFOSVESET TRISODIUM INJ",null,13,0,19.260000000000002,21.34,3.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - A9584"},"BMC HEALTHNET","BMCHN ACO","HCPCS","A9584","IODINE I-123 IOFLUPANE",null,2729,0,3235.55,3235.55,682.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - A9586"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",null,4402,7452.46,3746.06,7452.46,1100.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - A9586"},"TUFTS","TUFTS POS","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",null,4402,4392.1499999999996,3746.06,7452.46,1100.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A9586"},"TUFTS","TUFTS PPO","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",null,4402,4698.29,3746.06,7452.46,1100.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - A9586"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","A9586","HCFLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE",null,4402,3746.06,3746.06,7452.46,1100.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - A9587"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","A9587","GALLIUM GA-68",null,12985,113.78,84.97,113.78,3246.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - A9588"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","A9588","FLUCICLOVINE F-18",null,15438,525.05999999999995,525.05999999999995,703.05,3859.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - A9606"},"TUFTS","TUFTS PPO","HCPCS","A9606","RADIUM RA223 DICHLORIDE THER",null,493,212.47,198.62,597.20000000000005,123.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C1713"},"TUFTS","TUFTS SELECT","HCPCS","C1713","HC CORE 10 BONE PLUG",null,4568,0,null,null,1142,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C1716"},"TUFTS","TUFTS POS","HCPCS","C1716","BRACHYTX SOURCE, GOLD 198",null,0,168.52,168.52,506.68,0,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1717"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192",null,607,554.13,469.29,1411.01,151.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C1717"},"TUFTS","TUFTS SELECT","HCPCS","C1717","HC BRACHYTX, NON-STR,HDR IR-192",null,607,469.29,469.29,1411.01,151.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1721"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1721","HC ICD,2CH, GEN ONLY, RECALL $0",null,39674,0,null,null,9918.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1722"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1722","HC ICD,1CH, GEN ONLY, RECALL $0",null,43645,0,null,null,10911.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C1730"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C1730","HC CATH,EP;STEER,DEC(LASSO)",null,2283,0,null,null,570.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1730"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1730","HC CATH,EP;STEER,DEC(LASSO)",null,2283,0,null,null,570.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C1750"},"TUFTS","TUFTS SELECT","HCPCS","C1750","HC CATH 2 LUMEN QUINTON",null,1693,0,null,null,423.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1756"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1756","HC PACING WIRE",null,1438,0,null,null,359.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C1759"},"TUFTS","TUFTS SELECT","HCPCS","C1759","HC CATH, ULTRASOUND LVL 2",null,6295,0,null,null,1573.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C1760"},"TUFTS","TUFTS PPO","HCPCS","C1760","HC CENTRAL LINE KIT",null,1799,0,null,null,449.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1764"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1764","HC RECORDER;IMPLANTABLE LOOP",null,8983,0,null,null,2245.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C1764"},"TUFTS","TUFTS SELECT","HCPCS","C1764","HC RECORDER;IMPLANTABLE LOOP",null,8983,0,null,null,2245.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1768"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1768","HC TAVR HEART VALVE KIT",null,76125,0,null,null,19031.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C1770"},"TUFTS","TUFTS PPO","HCPCS","C1770","IMAGING COIL, MR, INSERTABLE",null,3667,0,null,null,916.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1776"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1776","HC HEMI-TIB PLATEAU W MENISC",null,21721,0,null,null,5430.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C1777"},"TUFTS","TUFTS POS","HCPCS","C1777","HC LEAD,ICD,1COIL",null,13038,0,null,null,3259.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C1786"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C1786","HC PACER;1CH, RECALL $0",null,23460,0,null,null,5865,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C1788"},"TUFTS","TUFTS HMO","HCPCS","C1788","HC PORTACATH ANY",null,540,0,null,null,135,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C1821"},"TUFTS","TUFTS SELECT","HCPCS","C1821","HC INTERSPINOUS IMPLANT",null,9770,0,null,null,2442.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C1882"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C1882","HC ICD,BI-VENT, GEN ONLY, RECALL $0",null,53226,0,null,null,13306.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C1884"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C1884","EMBOLIZATION PROTECT SYST",null,31469,0,null,null,7867.25,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C1892"},"TUFTS","TUFTS POS","HCPCS","C1892","HC SHEATH;GUIDING",null,340,0,null,null,85,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C1894"},"TUFTS","TUFTS SELECT","HCPCS","C1894","HC INTRO/SHEATH NON-CARD LV2",null,252,0,null,null,63,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C1895"},"TUFTS","TUFTS PPO","HCPCS","C1895","HC ICD LEAD,2COIL",null,13382,0,null,null,3345.5,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C1898"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C1898","HC KIT,PACER;BI-VENT(#6216/8",null,1575,0,null,null,393.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C1898"},"TUFTS","TUFTS HMO","HCPCS","C1898","HC KIT,PACER;BI-VENT(#6216/8",null,1575,0,null,null,393.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - 90471"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS",90471,"HC ADMIN PNEUMOCOCCAL VACCINE",null,64,129,76.22,345.64,16,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - P9047"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,107.47,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - P9047"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,214.93,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - P9047"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,235.54,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - P9047"},"TUFTS","TUFTS SELECT","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,235.54,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - P9047"},"TUFTS","TUFTS SPIRIT","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,279.94,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - P9047"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,214.93,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9047"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,107.47,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9047"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,235.54,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - P9047"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,214.93,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - P9047"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,214.93,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q9963"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML",null,30.27,30.27,30.27,30.27,7.5674999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q9966"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML",null,69.63,69.63,34.82,69.63,17.407499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q9966"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML",null,69.63,69.63,34.82,69.63,17.407499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q9967"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,50.45,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q9967"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,32.33,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q9967"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,14.75,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q9967"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,14.75,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q9967"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.1,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q9967"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,32.33,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - Q9967"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,50.45,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - Q9967"},"TUFTS","TUFTS POS","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - Q9967"},"TUFTS","TUFTS PPO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,32.33,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q9967"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,32.33,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q9967"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.12,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q9967"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.12,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q9967"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,50.45,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - Q9967"},"BMC HEALTHNET","BMCHN MCO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C2615"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C2615","SEALANT, PULMONARY, LIQUID",null,1447.7,1447.7,748.44,1447.7,361.92500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C2615"},"TUFTS","TUFTS HMO","HCPCS","C2615","SEALANT, PULMONARY, LIQUID",null,1447.7,841.81,748.44,1447.7,361.92500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - C2615"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","C2615","SEALANT, PULMONARY, LIQUID",null,1447.7,841.81,748.44,1447.7,361.92500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - C2615"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","C2615","SEALANT, PULMONARY, LIQUID",null,1447.7,1447.7,748.44,1447.7,361.92500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C2615"},"TUFTS","TUFTS PPO","HCPCS","C2615","SEALANT, PULMONARY, LIQUID",null,1447.7,1447.7,748.44,1447.7,361.92500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - J0702"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,118.27,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - J0702"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,118.27,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - J1030"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.59,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - J1030"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.59,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - J1030"},"TUFTS","TUFTS POS","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.59,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - J1030"},"TUFTS","TUFTS SPIRIT","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.6,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - J1030"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.6,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - J0702"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,132.62,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - J0702"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,116.03,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - J0702"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,132.62,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - J0702"},"FALLON","FALLON SENIOR PLAN","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,132.62,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - J0702"},"TUFTS","TUFTS PPO","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,116.03,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - J0702"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,118.27,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - J0702"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,116.03,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - J1030"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,26.88,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - J1030"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.59,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - J1030"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.59,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - J1030"},"TUFTS","TUFTS SELECT","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.6,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - J1030"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.6,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - J1250"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,44.41,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - J1250"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,17.55,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - J1250"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,17.55,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - J1250"},"TUFTS","TUFTS POS","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,17.55,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - J1250"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,44.41,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - J1250"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,44.41,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - J1250"},"BMC HEALTHNET","BMCHN MCO","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,44.41,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - J1250"},"BMC HEALTHNET","BMCHN QHP","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,44.41,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - J2790"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG",null,186.95,0,74.3,186.95,46.737499999999997,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - J3301"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,40.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - J3301"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,62.07,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - J3301"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,11.87,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - J3301"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,62.07,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - J3301"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,62.07,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - J3301"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,3.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - J3301"},"TUFTS","TUFTS PPO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,31.05,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - J3301"},"TUFTS","TUFTS SPIRIT","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,40.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - J3301"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,62.07,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - J3301"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,31.05,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - J3301"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,62.07,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - J3301"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,40.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - J3301"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,11.87,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - J1250"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,17.55,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - J1250"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,17.55,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - J1250"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,17.55,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - J1250"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,44.41,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - J1250"},"BMC HEALTHNET","BMCHN ACO","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,44.41,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - J1250"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,18.62,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - J2790"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG",null,186.95,0,74.3,186.95,46.737499999999997,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - J3301"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,28.21,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - J3301"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,157.52000000000001,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - J3301"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,3.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - J3301"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,31.05,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - J3301"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,3.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - J3301"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,31.05,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - J3301"},"FALLON","FALLON SENIOR PLAN","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,3.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - J3301"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,157.52000000000001,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - J3301"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,157.52000000000001,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - J3301"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,157.52000000000001,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - J3301"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,31.05,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - J3301"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,62.07,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - J3301"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,11.87,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - J3590"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","J3590","COSTAL CARTILAGE ALLOGRAFT",null,3907.79,2672.09,576,3907.79,976.94749999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - J3590"},"TUFTS","TUFTS PPO","HCPCS","J3590","COSTAL CARTILAGE ALLOGRAFT",null,3907.79,576,576,3907.79,976.94749999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - J7307"},"TUFTS","TUFTS HMO","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM",null,3487,3487,3162.8,3487,871.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - J7307"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM",null,3487,3162.8,3162.8,3487,871.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9047"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,279.94,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - P9047"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,279.94,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - P9047"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,235.54,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - P9047"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,270.35000000000002,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - P9047"},"TUFTS","TUFTS POS","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,270.35000000000002,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - P9047"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,279.94,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9047"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,279.94,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - P9047"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,270.35000000000002,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - J3590"},"TUFTS","TUFTS POS","HCPCS","J3590","COSTAL CARTILAGE ALLOGRAFT",null,3907.79,576,576,3907.79,976.94749999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - J7307"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM",null,3487,3487,3162.8,3487,871.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - P9047"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,107.47,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - P9047"},"UNICARE","UNICARE","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,270.35000000000002,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - P9047"},"FALLON","FALLON SENIOR PLAN","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,107.47,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - P9047"},"FALLON","FALLON SENIOR PLAN","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,235.54,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - P9047"},"TUFTS","TUFTS HMO","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,235.54,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - P9047"},"TUFTS","TUFTS PPO","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,270.35000000000002,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9047"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,214.93,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - P9047"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,107.47,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - Q9966"},"FALLON","FALLON MEDICAID","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML",null,69.63,69.63,34.82,69.63,17.407499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - Q9966"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML",null,69.63,69.63,34.82,69.63,17.407499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q9966"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML",null,69.63,69.63,34.82,69.63,17.407499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - Q9966"},"BMC HEALTHNET","BMCHN ACO","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML",null,69.63,69.63,34.82,69.63,17.407499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - Q9967"},"UNICARE","UNICARE","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.11,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q9967"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q9967"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.1,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - Q9967"},"FALLON","FALLON MEDICAID","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - Q9967"},"FALLON","FALLON SENIOR PLAN","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,14.75,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - Q9967"},"TUFTS","TUFTS HMO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q9967"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,14.75,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - Q9967"},"TUFTS","TUFTS SELECT","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,14.75,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q9967"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q9967"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,32.33,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q9963"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML",null,30.27,30.27,30.27,30.27,7.5674999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q9963"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML",null,30.27,30.27,30.27,30.27,7.5674999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - Q9963"},"BMC HEALTHNET","BMCHN QHP","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML",null,30.27,30.27,30.27,30.27,7.5674999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - Q9966"},"TUFTS","TUFTS POS","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML",null,69.63,69.63,34.82,69.63,17.407499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q9967"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,50.45,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q9967"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,50.45,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - Q9967"},"FALLON","FALLON MEDICAID","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,50.45,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q9967"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q9967"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,32.33,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - Q9967"},"TUFTS","TUFTS HMO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,14.75,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - Q9967"},"TUFTS","TUFTS PPO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q9967"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,32.33,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q9967"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q9967"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,32.33,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - Q9967"},"BMC HEALTHNET","BMCHN ACO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - Q9967"},"BMC HEALTHNET","BMCHN QHP","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q9967"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,32.33,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q9967"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.12,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - Q9967"},"BMC HEALTHNET","BMCHN QHP","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,32.33,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - C2615"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","C2615","SEALANT, PULMONARY, LIQUID",null,1447.7,1447.7,748.44,1447.7,361.92500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - J0702"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,116.03,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - J0702"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,116.03,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - J0702"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,116.03,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - J0702"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,118.27,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - J0702"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,132.62,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - J0702"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,132.62,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - J1030"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.59,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - J1030"},"UNICARE","UNICARE","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.6,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - J1030"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.59,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - J1030"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.59,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - J1030"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,26.88,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - J1250"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,44.41,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - J1250"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,44.41,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - J1250"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,18.62,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - J1250"},"TUFTS","TUFTS SELECT","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,18.62,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - J1250"},"TUFTS","TUFTS SELECT","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,17.55,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - J1250"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,18.62,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - J1250"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,17.55,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - J2790"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG",null,186.95,0,74.3,186.95,46.737499999999997,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - J2790"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG",null,186.95,0,74.3,186.95,46.737499999999997,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - J3301"},"UNICARE","UNICARE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,157.52000000000001,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - J3301"},"UNICARE","UNICARE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,62.07,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - J3301"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,11.87,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - J3301"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,3.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - J3301"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,62.07,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - J3301"},"TUFTS","TUFTS POS","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,40.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - J3301"},"TUFTS","TUFTS SELECT","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,157.52000000000001,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - J3301"},"TUFTS","TUFTS SELECT","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,62.07,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - J3301"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,62.07,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - J3301"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,40.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - J3301"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,28.21,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - J3301"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,28.21,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - J3301"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,40.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - J3301"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,28.21,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - J7307"},"TUFTS","TUFTS POS","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM",null,3487,3162.8,3162.8,3487,871.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - J7307"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM",null,3487,3162.8,3162.8,3487,871.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - J7307"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM",null,3487,3487,3162.8,3487,871.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - P9047"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,235.54,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9047"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,235.54,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - P9047"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,279.94,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - P9047"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,235.54,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9047"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,107.47,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - P9047"},"TUFTS","TUFTS POS","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,107.47,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - P9047"},"TUFTS","TUFTS SELECT","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,279.94,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9047"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,279.94,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9047"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,270.35000000000002,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q9963"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML",null,30.27,30.27,30.27,30.27,7.5674999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q9966"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML",null,69.63,69.63,34.82,69.63,17.407499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q9967"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.12,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - Q9967"},"UNICARE","UNICARE","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,32.33,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q9967"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,32.33,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q9967"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.1,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q9967"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,32.33,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q9967"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - Q9967"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.15,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - Q9967"},"TUFTS","TUFTS POS","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,50.45,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - Q9967"},"TUFTS","TUFTS SPIRIT","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,14.75,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q9967"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,14.75,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q9967"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.12,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q9967"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,14.75,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q9967"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,32.33,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - Q9967"},"BMC HEALTHNET","BMCHN QHP","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - J0702"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,132.62,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - J0702"},"FALLON","FALLON SENIOR PLAN","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,118.27,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - J0702"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,116.03,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - J1030"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,26.88,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - J1030"},"TUFTS","TUFTS SPIRIT","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,26.88,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - J1030"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,26.88,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - J1030"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,26.88,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - J1250"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,17.55,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - J1250"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,44.41,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - J1250"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,18.62,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - J0702"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,132.62,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - J0702"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,116.03,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - J0702"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,132.62,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - J0702"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,116.03,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - J0702"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,132.62,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - J0702"},"TUFTS","TUFTS HMO","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,116.03,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - J0702"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,118.27,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - J0702"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,116.03,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - J0702"},"TUFTS","TUFTS POS","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,118.27,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - J0702"},"TUFTS","TUFTS SELECT","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,132.62,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - J0702"},"TUFTS","TUFTS SPIRIT","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,116.03,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - J0702"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,132.62,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - J0702"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,116.03,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - J0702"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,118.27,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - J0702"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,118.27,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - J0702"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,116.03,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - J0702"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,116.03,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - J0702"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,132.62,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - J0702"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,116.03,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - J1030"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.59,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - J1030"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,26.88,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - J1030"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,26.88,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - J1030"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,26.88,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - J1030"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,26.88,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - J1030"},"TUFTS","TUFTS HMO","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.6,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - J1030"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.6,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - J1030"},"TUFTS","TUFTS POS","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,26.88,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - J1030"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.59,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - J1030"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,26.88,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - J1030"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,26.88,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - J1030"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.59,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - J1250"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,17.55,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - J1250"},"UNICARE","UNICARE","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,18.62,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - J1250"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,44.41,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - J1250"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,17.55,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - J1250"},"FALLON","FALLON MEDICAID","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,44.41,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - J1250"},"FALLON","FALLON SENIOR PLAN","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,44.41,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - J1250"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,44.41,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - J1250"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,44.41,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - J1250"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,44.41,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - J1250"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,18.62,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - J1250"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,17.55,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - J1250"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,17.55,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - J1250"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,17.55,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - J1250"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,44.41,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - J1250"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,44.41,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - J1250"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,18.62,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - J1250"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,18.62,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - J1250"},"TUFTS","TUFTS HMO","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,44.41,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - J1250"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,17.55,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - J1250"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,18.62,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - J1250"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,18.62,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - J1250"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,17.55,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - J2790"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG",null,186.95,0,74.3,186.95,46.737499999999997,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - J2790"},"TUFTS","TUFTS PPO","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG",null,186.95,0,74.3,186.95,46.737499999999997,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - J2790"},"TUFTS","TUFTS SPIRIT","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG",null,186.95,0,74.3,186.95,46.737499999999997,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - J2790"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG",null,186.95,0,74.3,186.95,46.737499999999997,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - J3301"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,11.87,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - J3301"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,11.87,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - J3301"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,157.52000000000001,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - J3301"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,157.52000000000001,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - J3301"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,40.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - J3301"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,28.21,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - J3301"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,31.05,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - J3301"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,157.52000000000001,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - J3301"},"TUFTS","TUFTS HMO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,28.21,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - J3301"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,40.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - J3301"},"TUFTS","TUFTS POS","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,62.07,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - J3301"},"TUFTS","TUFTS SELECT","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,31.05,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - J3301"},"TUFTS","TUFTS SELECT","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,11.87,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - J3301"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,40.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - J3301"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,157.52000000000001,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - J3301"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,62.07,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - J3301"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,40.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - J3301"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,62.07,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - J3301"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,31.05,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - J3301"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,157.52000000000001,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - J3301"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,40.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - J3301"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,3.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - J3301"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,31.05,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - J3590"},"TUFTS","TUFTS HMO","HCPCS","J3590","COSTAL CARTILAGE ALLOGRAFT",null,3907.79,576,576,3907.79,976.94749999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - J3590"},"TUFTS","TUFTS PPO","HCPCS","J3590","COSTAL CARTILAGE ALLOGRAFT",null,3907.79,2672.09,576,3907.79,976.94749999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - J7307"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM",null,3487,3162.8,3162.8,3487,871.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - J7307"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM",null,3487,3487,3162.8,3487,871.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - J7307"},"TUFTS","TUFTS HMO","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM",null,3487,3162.8,3162.8,3487,871.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9047"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,107.47,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - P9047"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,107.47,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - P9047"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,214.93,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - P9047"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,235.54,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - P9047"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,270.35000000000002,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9047"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,279.94,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - P9047"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,107.47,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - P9047"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,235.54,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - P9047"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,214.93,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - P9047"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,270.35000000000002,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - P9047"},"TUFTS","TUFTS HMO","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,270.35000000000002,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - P9047"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,107.47,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - P9047"},"TUFTS","TUFTS POS","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,214.93,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - P9047"},"TUFTS","TUFTS PPO","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,214.93,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - P9047"},"TUFTS","TUFTS SELECT","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,107.47,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - P9047"},"TUFTS","TUFTS SELECT","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,214.93,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - P9047"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,214.93,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - P9047"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,107.47,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9047"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,235.54,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - P9047"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,270.35000000000002,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - P9047"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,214.93,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - P9047"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,270.35000000000002,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - P9047"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,214.93,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - P9047"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,270.35000000000002,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - P9047"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,235.54,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - J2790"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG",null,186.95,0,74.3,186.95,46.737499999999997,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - J2790"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG",null,186.95,0,74.3,186.95,46.737499999999997,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - J2790"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG",null,186.95,0,74.3,186.95,46.737499999999997,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - J3301"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,62.07,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - J3301"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,3.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - J3301"},"UNICARE","UNICARE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,3.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - J3301"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,11.87,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - J3301"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,28.21,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - J3301"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,157.52000000000001,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - J3301"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,62.07,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - J3301"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,40.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - J3301"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,40.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - J3301"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,11.87,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - J3301"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,62.07,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - J3301"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,3.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - J3301"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,157.52000000000001,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - J3301"},"FALLON","FALLON SENIOR PLAN","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,157.52000000000001,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - J3301"},"FALLON","FALLON SENIOR PLAN","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,62.07,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - J3301"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,40.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - J3301"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,11.87,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - J3301"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,3.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - J3301"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,157.52000000000001,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - J3301"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,28.21,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - J3301"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,157.52000000000001,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - J3301"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,62.07,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - J3301"},"TUFTS","TUFTS POS","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,157.52000000000001,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - J3301"},"TUFTS","TUFTS PPO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,28.21,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - J3301"},"TUFTS","TUFTS SPIRIT","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,31.05,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - J3301"},"TUFTS","TUFTS SPIRIT","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,28.21,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - J3301"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,157.52000000000001,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - J3301"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,3.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - J3301"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,28.21,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - J3301"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,62.07,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - J3301"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,28.21,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - J3301"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,3.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - J3590"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","J3590","COSTAL CARTILAGE ALLOGRAFT",null,3907.79,576,576,3907.79,976.94749999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - J3590"},"TUFTS","TUFTS HMO","HCPCS","J3590","COSTAL CARTILAGE ALLOGRAFT",null,3907.79,2672.09,576,3907.79,976.94749999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - J7307"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM",null,3487,3487,3162.8,3487,871.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - J7307"},"TUFTS","TUFTS PPO","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM",null,3487,3162.8,3162.8,3487,871.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - J7307"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM",null,3487,3162.8,3162.8,3487,871.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - J7307"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM",null,3487,3162.8,3162.8,3487,871.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - J7307"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM",null,3487,3162.8,3162.8,3487,871.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - J7307"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM",null,3487,3162.8,3162.8,3487,871.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - P9047"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,214.93,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - P9047"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,235.54,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - P9047"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,270.35000000000002,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - P9047"},"UNICARE","UNICARE","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,279.94,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9047"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,279.94,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9047"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,214.93,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - P9047"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,235.54,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9047"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,270.35000000000002,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - P9047"},"FALLON","FALLON SENIOR PLAN","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,214.93,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9047"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,214.93,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - P9047"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,279.94,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - P9047"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,279.94,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - P9047"},"TUFTS","TUFTS SELECT","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,270.35000000000002,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - P9047"},"TUFTS","TUFTS SPIRIT","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,107.47,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - P9047"},"TUFTS","TUFTS SPIRIT","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,214.93,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - P9047"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,279.94,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9047"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,235.54,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - P9047"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,279.94,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - P9047"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,235.54,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q9963"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML",null,30.27,30.27,30.27,30.27,7.5674999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q9963"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML",null,30.27,30.27,30.27,30.27,7.5674999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q9963"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML",null,30.27,30.27,30.27,30.27,7.5674999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q9963"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML",null,30.27,30.27,30.27,30.27,7.5674999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q9963"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML",null,30.27,30.27,30.27,30.27,7.5674999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q9963"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML",null,30.27,30.27,30.27,30.27,7.5674999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q9963"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML",null,30.27,30.27,30.27,30.27,7.5674999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q9963"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML",null,30.27,30.27,30.27,30.27,7.5674999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - Q9963"},"TUFTS","TUFTS POS","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML",null,30.27,30.27,30.27,30.27,7.5674999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - Q9963"},"TUFTS","TUFTS PPO","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML",null,30.27,30.27,30.27,30.27,7.5674999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q9963"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML",null,30.27,30.27,30.27,30.27,7.5674999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q9963"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML",null,30.27,30.27,30.27,30.27,7.5674999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - Q9966"},"UNICARE","UNICARE","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML",null,69.63,69.63,34.82,69.63,17.407499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q9966"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML",null,69.63,69.63,34.82,69.63,17.407499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - Q9966"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML",null,69.63,69.63,34.82,69.63,17.407499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - Q9966"},"TUFTS","TUFTS HMO","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML",null,69.63,69.63,34.82,69.63,17.407499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q9966"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML",null,69.63,69.63,34.82,69.63,17.407499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q9966"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML",null,69.63,69.63,34.82,69.63,17.407499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q9966"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML",null,69.63,69.63,34.82,69.63,17.407499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - Q9967"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,32.33,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - Q9967"},"UNICARE","UNICARE","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.11,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - Q9967"},"UNICARE","UNICARE","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,50.45,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q9967"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.11,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q9967"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.11,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q9967"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.1,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q9967"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,50.45,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - Q9967"},"FALLON","FALLON MEDICAID","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,14.75,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - Q9967"},"FALLON","FALLON SENIOR PLAN","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.1,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - Q9967"},"FALLON","FALLON SENIOR PLAN","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,32.33,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q9967"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q9967"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,50.45,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q9967"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,50.45,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q9967"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,14.75,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - Q9967"},"TUFTS","TUFTS SELECT","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q9967"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.13,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q9967"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,14.75,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q9967"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.12,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q9967"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,50.45,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q9967"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,50.45,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q9967"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.12,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q9967"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.12,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - Q9967"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,50.45,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q9967"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,32.33,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q9963"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML",null,30.27,30.27,30.27,30.27,7.5674999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q9966"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML",null,69.63,69.63,34.82,69.63,17.407499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q9966"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML",null,69.63,69.63,34.82,69.63,17.407499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - Q9966"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML",null,69.63,69.63,34.82,69.63,17.407499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q9966"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML",null,69.63,69.63,34.82,69.63,17.407499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q9966"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML",null,69.63,69.63,34.82,69.63,17.407499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q9967"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,32.33,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q9967"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.1,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q9967"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.1,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q9967"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,50.45,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - Q9967"},"FALLON","FALLON SENIOR PLAN","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,50.45,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q9967"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,32.33,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - Q9967"},"TUFTS","TUFTS HMO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,32.33,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - Q9967"},"TUFTS","TUFTS POS","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,32.33,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q9967"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.13,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q9967"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q9967"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,50.45,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q9967"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q9967"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,14.75,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - HCPCS - Q9967"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,32.33,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q9967"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.12,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q9967"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.12,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - Q9967"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,14.75,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q9967"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,50.45,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q9967"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.12,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q9967"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.25,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q9967"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,32.33,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - Q9967"},"BMC HEALTHNET","BMCHN ACO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,14.75,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q9967"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.12,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q9967"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.22,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q9967"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,14.75,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q9967"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,32.33,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - Q9967"},"BMC HEALTHNET","BMCHN MCO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,50.45,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - Q9967"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - Q9967"},"BMC HEALTHNET","BMCHN QHP","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - Q9967"},"BMC HEALTHNET","BMCHN QHP","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,50.45,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - C2615"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","C2615","SEALANT, PULMONARY, LIQUID",null,1447.7,841.81,748.44,1447.7,361.92500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C2615"},"TUFTS","TUFTS SELECT","HCPCS","C2615","SEALANT, PULMONARY, LIQUID",null,1447.7,841.81,748.44,1447.7,361.92500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - C2615"},"TUFTS","TUFTS SELECT","HCPCS","C2615","SEALANT, PULMONARY, LIQUID",null,1447.7,748.44,748.44,1447.7,361.92500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - J0702"},"UNICARE","UNICARE","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,118.27,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - J0702"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,132.62,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - J0702"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,132.62,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - J0702"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,116.03,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - J0702"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,118.27,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - J0702"},"TUFTS","TUFTS PPO","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,132.62,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - J0702"},"TUFTS","TUFTS SELECT","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,118.27,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - J0702"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,116.03,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - J0702"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,132.62,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - J0702"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,118.27,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - J0702"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,132.62,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - J0702"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,118.27,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - J0702"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,132.62,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - J1030"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.6,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - J1030"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,26.88,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - J1030"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.6,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - J1030"},"FALLON","FALLON SENIOR PLAN","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.59,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - J1030"},"FALLON","FALLON SENIOR PLAN","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.6,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - J1030"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.6,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - J1030"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.6,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - J1030"},"TUFTS","TUFTS PPO","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.6,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - J1030"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.6,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - J1030"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.59,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - J1250"},"UNICARE","UNICARE","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,44.41,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - J1250"},"UNICARE","UNICARE","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,17.55,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - J1250"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,17.55,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - J1250"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,17.55,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - J1250"},"FALLON","FALLON MEDICAID","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,17.55,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - J1250"},"FALLON","FALLON SENIOR PLAN","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,17.55,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - J1250"},"TUFTS","TUFTS SELECT","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,44.41,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - J1250"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,44.41,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - J1250"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,18.62,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - J1250"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,44.41,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - J1250"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,18.62,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - J1250"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,17.55,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - J1250"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,18.62,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - J1250"},"BMC HEALTHNET","BMCHN MCO","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,18.62,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - J2790"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG",null,186.95,0,74.3,186.95,46.737499999999997,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - J2790"},"FALLON","FALLON SENIOR PLAN","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG",null,186.95,0,74.3,186.95,46.737499999999997,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - J2790"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG",null,186.95,0,74.3,186.95,46.737499999999997,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - J2790"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG",null,186.95,0,74.3,186.95,46.737499999999997,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - J2790"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG",null,186.95,0,74.3,186.95,46.737499999999997,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - J2790"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG",null,186.95,0,74.3,186.95,46.737499999999997,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - J2790"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG",null,186.95,0,74.3,186.95,46.737499999999997,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - J3301"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,157.52000000000001,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - J3301"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,28.21,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - J3301"},"UNICARE","UNICARE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,11.87,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - J3301"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,31.05,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - J3301"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,3.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - J3301"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,28.21,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - J3301"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,31.05,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - J3301"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,40.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - J3301"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,40.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - J3301"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,3.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - J3301"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,157.52000000000001,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - J3301"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,28.21,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - J3301"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,3.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - J3301"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,11.87,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - J3301"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,28.21,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - J3301"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,31.05,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - J3301"},"TUFTS","TUFTS POS","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,31.05,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - J3301"},"TUFTS","TUFTS SELECT","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,3.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - J3301"},"TUFTS","TUFTS SPIRIT","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,3.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - J3301"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,11.87,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - J3301"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,157.52000000000001,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - J3301"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,11.87,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - J3301"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,3.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - J3301"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,11.87,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - J3301"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,157.52000000000001,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - J3301"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,31.05,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - J3301"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,11.87,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - J3590"},"TUFTS","TUFTS HMO","HCPCS","J3590","COSTAL CARTILAGE ALLOGRAFT",null,3907.79,576,576,3907.79,976.94749999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - J3590"},"TUFTS","TUFTS POS","HCPCS","J3590","COSTAL CARTILAGE ALLOGRAFT",null,3907.79,2672.09,576,3907.79,976.94749999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - J3590"},"TUFTS","TUFTS SELECT","HCPCS","J3590","COSTAL CARTILAGE ALLOGRAFT",null,3907.79,576,576,3907.79,976.94749999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - J7307"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM",null,3487,3487,3162.8,3487,871.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - J7307"},"TUFTS","TUFTS SELECT","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM",null,3487,3487,3162.8,3487,871.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - J7307"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM",null,3487,3487,3162.8,3487,871.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - P9047"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,279.94,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - P9047"},"UNICARE","UNICARE","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,235.54,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - P9047"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,279.94,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - P9047"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,107.47,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - P9047"},"FALLON","FALLON SENIOR PLAN","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,279.94,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - P9047"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,270.35000000000002,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - P9047"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,270.35000000000002,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - P9047"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,279.94,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - P9047"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,107.47,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - P9047"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,235.54,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - P9047"},"TUFTS","TUFTS PPO","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,235.54,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9047"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,279.94,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - P9047"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,107.47,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - P9047"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,214.93,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - P9047"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,235.54,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - P9047"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,270.35000000000002,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - P9047"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,279.94,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - P9047"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,279.94,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q9963"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML",null,30.27,30.27,30.27,30.27,7.5674999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - Q9963"},"FALLON","FALLON MEDICAID","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML",null,30.27,30.27,30.27,30.27,7.5674999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q9963"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML",null,30.27,30.27,30.27,30.27,7.5674999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - Q9963"},"TUFTS","TUFTS SELECT","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML",null,30.27,30.27,30.27,30.27,7.5674999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q9963"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML",null,30.27,30.27,30.27,30.27,7.5674999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q9963"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML",null,30.27,30.27,30.27,30.27,7.5674999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - Q9963"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","Q9963","HOCM 350-399MG/ML IODINE,1ML",null,30.27,30.27,30.27,30.27,7.5674999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - Q9966"},"BMC HEALTHNET","BMCHN MCO","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML",null,69.63,69.63,34.82,69.63,17.407499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - Q9966"},"BMC HEALTHNET","BMCHN QHP","HCPCS","Q9966","LOCM 200-299MG/ML IODINE,1ML",null,69.63,69.63,34.82,69.63,17.407499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - Q9967"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.12,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q9967"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,50.45,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE STATE INDEMNITY PLAN - HCPCS - Q9967"},"UNICARE","UNICARE STATE INDEMNITY PLAN","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,14.75,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - Q9967"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,50.45,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - Q9967"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - Q9967"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - Q9967"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.1,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - Q9967"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.1,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - Q9967"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.1,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - Q9967"},"FALLON","FALLON MEDICAID","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON MEDICAID - HCPCS - Q9967"},"FALLON","FALLON MEDICAID","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,32.33,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - Q9967"},"FALLON","FALLON SENIOR PLAN","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.1,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - Q9967"},"FALLON","FALLON SENIOR PLAN","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.1,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q9967"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,50.45,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - Q9967"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,14.75,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q9967"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - Q9967"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,14.75,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - Q9967"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,32.33,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - Q9967"},"TUFTS","TUFTS HMO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q9967"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.15,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - Q9967"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.15,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - Q9967"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.15,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - Q9967"},"TUFTS","TUFTS SELECT","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - Q9967"},"TUFTS","TUFTS SELECT","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - Q9967"},"TUFTS","TUFTS SELECT","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,32.33,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - Q9967"},"TUFTS","TUFTS SPIRIT","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.11,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - Q9967"},"TUFTS","TUFTS SPIRIT","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.11,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - Q9967"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.13,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q9967"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - HCPCS - Q9967"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,14.75,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q9967"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,14.75,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - Q9967"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,32.33,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - HCPCS - Q9967"},"ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - Q9967"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.12,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - Q9967"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,32.33,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - Q9967"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.12,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - Q9967"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.12,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - Q9967"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.25,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN ACO - HCPCS - Q9967"},"BMC HEALTHNET","BMCHN ACO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,50.45,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - Q9967"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,0.12,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MCO - HCPCS - Q9967"},"BMC HEALTHNET","BMCHN MCO","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,32.33,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN QHP - HCPCS - Q9967"},"BMC HEALTHNET","BMCHN QHP","HCPCS","Q9967","HC CONTRAST;NON-IONIC  (OTPIRAY) 200ML",null,50.45,14.75,14.75,50.45,12.612500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - C2615"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","C2615","SEALANT, PULMONARY, LIQUID",null,1447.7,1447.7,748.44,1447.7,361.92500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - C2615"},"TUFTS","TUFTS HMO","HCPCS","C2615","SEALANT, PULMONARY, LIQUID",null,1447.7,1447.7,748.44,1447.7,361.92500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - C2615"},"TUFTS","TUFTS POS","HCPCS","C2615","SEALANT, PULMONARY, LIQUID",null,1447.7,841.81,748.44,1447.7,361.92500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - C2615"},"TUFTS","TUFTS PPO","HCPCS","C2615","SEALANT, PULMONARY, LIQUID",null,1447.7,841.81,748.44,1447.7,361.92500000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - J0702"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,116.03,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - J0702"},"UNICARE","UNICARE","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,132.62,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - J0702"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,118.27,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - HCPCS - J0702"},"ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,118.27,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - J0702"},"FALLON","FALLON SENIOR PLAN","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,116.03,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - J0702"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,118.27,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - J0702"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,132.62,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - J0702"},"TUFTS","TUFTS HMO","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,118.27,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - J0702"},"TUFTS","TUFTS HMO","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,132.62,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - J0702"},"TUFTS","TUFTS SPIRIT","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,132.62,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - J0702"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,116.03,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - J0702"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,132.62,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - J0702"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","J0702","HC BETAMETHASONE ACET&SOD PHOSP",null,132.62,132.62,116.03,132.62,33.155000000000001,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - J1030"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.6,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - J1030"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.59,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - J1030"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.6,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - J1030"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.6,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - J1030"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,26.88,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - J1030"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.59,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - J1030"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,26.88,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - J1030"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.6,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - J1030"},"TUFTS","TUFTS HMO","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.59,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - J1030"},"TUFTS","TUFTS HMO","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,26.88,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - J1030"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.59,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - J1030"},"TUFTS","TUFTS PPO","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.59,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SELECT - HCPCS - J1030"},"TUFTS","TUFTS SELECT","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,26.88,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - J1030"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.59,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - J1030"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.59,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - J1030"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.6,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - J1030"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,26.88,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - J1030"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,23.59,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - J1030"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","J1030","PATIENT SUPPLIED METHYLPREDNISOLONE ¿ (DEPO)",null,26.88,26.88,23.59,26.88,6.72,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - HCPCS - J1250"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,18.62,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - J1250"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,44.41,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - J1250"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,18.62,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - J1250"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,44.41,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - J1250"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,44.41,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - HCPCS - J1250"},"ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,44.41,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - HCPCS - J1250"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,44.41,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - J1250"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,17.55,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - J1250"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,44.41,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - J1250"},"TUFTS","TUFTS PPO","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,44.41,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - J1250"},"TUFTS","TUFTS PPO","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,17.55,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-INDEMNITY - HCPCS - J1250"},"BLUE CROSS","BLUE CROSS-INDEMNITY","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,17.55,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-PPO - HCPCS - J1250"},"BLUE CROSS","BLUE CROSS-PPO","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,18.62,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - HCPCS - J1250"},"BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,44.41,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMCHN MEDICAID - HCPCS - J1250"},"BMC HEALTHNET","BMCHN MEDICAID","HCPCS","J1250","HC DOBUTAMINE SDV/250MG",null,44.41,18.62,17.55,44.41,11.102499999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - J2790"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG",null,186.95,0,74.3,186.95,46.737499999999997,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - J2790"},"UNICARE","UNICARE","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG",null,186.95,0,74.3,186.95,46.737499999999997,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - J2790"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG",null,186.95,0,74.3,186.95,46.737499999999997,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - J2790"},"TUFTS","TUFTS HMO","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG",null,186.95,0,74.3,186.95,46.737499999999997,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - J2790"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","J2790","HC IG;RHO D,HUMAN/300MCG",null,186.95,0,74.3,186.95,46.737499999999997,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - J3301"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,11.87,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNICARE - UNICARE - HCPCS - J3301"},"UNICARE","UNICARE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,31.05,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - J3301"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,157.52000000000001,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - HCPCS - J3301"},"UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,62.07,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - J3301"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,3.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - J3301"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,31.05,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"CIGNA HEALTHCARE - CIGNA CARELINK - HCPCS - J3301"},"CIGNA HEALTHCARE","CIGNA CARELINK","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,62.07,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - J3301"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,28.21,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"FALLON - FALLON SENIOR PLAN - HCPCS - J3301"},"FALLON","FALLON SENIOR PLAN","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,31.05,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - HCPCS - J3301"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,31.05,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - HCPCS - J3301"},"SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,40.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - J3301"},"TUFTS","TUFTS HMO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,11.87,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS HMO - HCPCS - J3301"},"TUFTS","TUFTS HMO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,3.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - J3301"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,62.07,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE PREFERRED HMO - HCPCS - J3301"},"TUFTS","TUFTS MEDICARE PREFERRED HMO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,11.87,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - J3301"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,31.05,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - J3301"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,40.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS MEDICARE SCO - HCPCS - J3301"},"TUFTS","TUFTS MEDICARE SCO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,3.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - J3301"},"TUFTS","TUFTS POS","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,28.21,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS PPO - HCPCS - J3301"},"TUFTS","TUFTS PPO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,3.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - J3301"},"TUFTS","TUFTS SPIRIT","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,62.07,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS SPIRIT - HCPCS - J3301"},"TUFTS","TUFTS SPIRIT","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,11.87,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - HCPCS - J3301"},"TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,28.21,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - J3301"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,157.52000000000001,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"AETNA - AETNA-MEDICARE ADVANTAGE - HCPCS - J3301"},"AETNA","AETNA-MEDICARE ADVANTAGE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,3.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - J3301"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,62.07,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS - BLUE CROSS-HMO BLUE - HCPCS - J3301"},"BLUE CROSS","BLUE CROSS-HMO BLUE","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,31.05,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - HCPCS - J3301"},"BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,28.21,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - HCPCS - J3301"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,40.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BMC HEALTHNET - BMC SENIOR CARE OPTIONS - HCPCS - J3301"},"BMC HEALTHNET","BMC SENIOR CARE OPTIONS","HCPCS","J3301","HC TRIAMCINOLONE ACET INJ NOS",null,157.52000000000001,3.11,3.11,157.52000000000001,39.380000000000003,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"TUFTS - TUFTS POS - HCPCS - J3590"},"TUFTS","TUFTS POS","HCPCS","J3590","COSTAL CARTILAGE ALLOGRAFT",null,3907.79,3907.79,576,3907.79,976.94749999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - J7307"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM",null,3487,3487,3162.8,3487,871.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - HCPCS - J7307"},"HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","HCPCS","J7307","HC ETONOGESTREL IMPLANT SYSTEM",null,3487,3162.8,3162.8,3487,871.75,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - HCPCS - P9047"},"UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,214.93,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9047"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,107.47,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - HCPCS - P9047"},"UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,235.54,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - HCPCS - P9047"},"COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,235.54,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"ELDER SERVICE PLAN - ELEMENT CARE INC - HCPCS - P9047"},"ELDER SERVICE PLAN","ELEMENT CARE INC","HCPCS","P9047","HC ALBUMIN (HUMAN) 25% 50ML",null,279.94,270.35000000000002,107.47,279.94,69.984999999999999,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - HCPCS - 45378"},"BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND",null,1672,1250.94,1020.59,3264.67,418,1]
["OUTPATIENT",{"$f":"CONCATENATE(HCPCS[[#This Row],[Payer]],\" - \",HCPCS[[#This Row],[Plan]],\" - \",HCPCS[[#This Row],[Bill Type]],\" - \",HCPCS[[#This Row],[Bill Code]])","v":"BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - HCPCS - 45378"},"BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","HCPCS",45378,"COLON CA SCRN NOT HI RSK IND",null,1672,1250.94,1020.59,3264.67,418,1]

{"sheet":"CPT Pivot","index":13,"n_rows":79783,"n_cols":7,"rows_kept":4500,"cut":true,"hidden":true,"merged":[],"bounds":{"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0}}
["Bill Code","(All)"]
[]
["Row Labels","Sum of Duplicate","Average of Gross Charge Amount","Average of Payer Charge Amount","Average of Minimum Charge Amount","Average of Maximum Charge Amount","Average of Self-Pay Charge"]
["UNICARE - UNICARE - CPT - 90686",8,66.930000000000007,62.792500000000004,59.699999999999996,66.930000000000007,16.732500000000002]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90686",8,66.930000000000007,62.792499999999997,59.699999999999996,66.930000000000007,16.732500000000002]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90686",8,66.930000000000007,62.792499999999997,59.699999999999996,66.930000000000007,16.732500000000002]
["TUFTS - TUFTS PPO - CPT - 90686",8,66.930000000000007,62.792500000000004,59.699999999999996,66.930000000000007,16.732500000000002]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 90686",8,66.930000000000007,62.792499999999997,59.699999999999996,66.930000000000007,16.732500000000002]
["TUFTS - TUFTS SELECT - CPT - 90686",8,66.930000000000007,62.792499999999997,59.699999999999996,66.930000000000007,16.732500000000002]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90686",8,66.930000000000007,62.79249999999999,59.699999999999996,66.930000000000007,16.732500000000002]
["TUFTS - TUFTS SPIRIT - CPT - 90686",8,66.930000000000007,62.792500000000004,59.699999999999996,66.930000000000007,16.732500000000002]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 90686",8,66.930000000000007,62.792500000000004,59.699999999999996,66.930000000000007,16.732500000000002]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 90686",8,66.930000000000007,62.792500000000004,59.699999999999996,66.930000000000007,16.732500000000002]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 90686",8,66.930000000000007,62.79249999999999,59.699999999999996,66.930000000000007,16.732500000000002]
["TUFTS - TUFTS HMO - CPT - 90686",8,66.930000000000007,62.792500000000004,59.699999999999996,66.930000000000007,16.732500000000002]
["TUFTS - TUFTS POS - CPT - 90686",8,66.930000000000007,62.792499999999997,59.699999999999996,66.930000000000007,16.732500000000002]
["TUFTS - TUFTS MEDICARE SCO - CPT - 90686",8,66.930000000000007,62.792499999999997,59.699999999999996,66.930000000000007,16.732500000000002]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 90686",8,66.930000000000007,62.792500000000004,59.699999999999996,66.930000000000007,16.732500000000002]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 90686",8,66.930000000000007,62.792499999999997,59.699999999999996,66.930000000000007,16.732500000000002]
["FALLON - FALLON SENIOR PLAN - CPT - 90686",8,66.930000000000007,62.792499999999997,59.699999999999996,66.930000000000007,16.732500000000002]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 90686",8,66.930000000000007,62.792499999999997,59.699999999999996,66.930000000000007,16.732500000000002]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90686",8,66.930000000000007,62.792499999999997,59.699999999999996,66.930000000000007,16.732500000000002]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90686",8,66.930000000000007,62.792500000000004,59.699999999999996,66.930000000000007,16.732500000000002]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 90686",8,66.930000000000007,62.792499999999997,59.699999999999996,66.930000000000007,16.732500000000002]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 90686",8,66.930000000000007,62.792499999999997,59.699999999999996,66.930000000000007,16.732500000000002]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90686",8,66.930000000000007,62.792500000000004,59.699999999999996,66.930000000000007,16.732500000000002]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 90686",8,66.930000000000007,62.792500000000004,59.699999999999996,66.930000000000007,16.732500000000002]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90686",8,66.930000000000007,62.792499999999997,59.699999999999996,66.930000000000007,16.732500000000002]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 90686",8,66.930000000000007,62.792499999999997,59.699999999999996,66.930000000000007,16.732500000000002]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90686",8,66.930000000000007,62.792499999999997,59.699999999999996,66.930000000000007,16.732500000000002]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90686",8,66.930000000000007,62.792499999999997,59.699999999999996,66.930000000000007,16.732500000000002]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 90686",8,66.930000000000007,62.792500000000004,59.699999999999996,66.930000000000007,16.732500000000002]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90686",8,66.930000000000007,62.792499999999997,59.699999999999996,66.930000000000007,16.732500000000002]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 90686",8,66.930000000000007,62.792499999999997,59.699999999999996,66.930000000000007,16.732500000000002]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 90686",8,66.930000000000007,62.792499999999997,59.699999999999996,66.930000000000007,16.732500000000002]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 90686",8,66.930000000000007,62.792499999999997,59.699999999999996,66.930000000000007,16.732500000000002]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90686",8,66.930000000000007,62.792500000000004,59.699999999999996,66.930000000000007,16.732500000000002]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 90686",8,66.930000000000007,62.792499999999997,59.699999999999996,66.930000000000007,16.732500000000002]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90715",7,163.03,145.40857142857141,121.14999999999999,163.03,40.7575]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90715",7,163.03,145.40857142857141,121.14999999999999,163.03,40.7575]
["TUFTS - TUFTS SPIRIT - CPT - 90715",7,163.03,145.40857142857141,121.14999999999999,163.03,40.7575]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 90715",7,163.03,145.40857142857141,121.14999999999999,163.03,40.7575]
["TUFTS - TUFTS PPO - CPT - 90715",7,163.03,145.40857142857143,121.14999999999999,163.03,40.7575]
["TUFTS - TUFTS SELECT - CPT - 90715",7,163.03,145.40857142857141,121.14999999999999,163.03,40.7575]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90715",7,163.03,145.40857142857141,121.14999999999999,163.03,40.7575]
["UNICARE - UNICARE - CPT - 90715",7,163.03,145.40857142857141,121.14999999999999,163.03,40.7575]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 90715",7,163.03,145.40857142857141,121.14999999999999,163.03,40.7575]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 90715",7,163.03,145.40857142857141,121.14999999999999,163.03,40.7575]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 90715",7,163.03,145.40857142857143,121.14999999999999,163.03,40.7575]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90715",7,163.03,145.40857142857143,121.14999999999999,163.03,40.7575]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 90715",7,163.03,145.40857142857141,121.14999999999999,163.03,40.7575]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90715",7,163.03,145.40857142857141,121.14999999999999,163.03,40.7575]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 90715",7,163.03,145.40857142857141,121.14999999999999,163.03,40.7575]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 90715",7,163.03,145.40857142857143,121.14999999999999,163.03,40.7575]
["TUFTS - TUFTS MEDICARE SCO - CPT - 90715",7,163.03,145.40857142857141,121.14999999999999,163.03,40.7575]
["FALLON - FALLON SENIOR PLAN - CPT - 90715",7,163.03,145.40857142857141,121.14999999999999,163.03,40.7575]
["TUFTS - TUFTS HMO - CPT - 90715",7,163.03,145.40857142857141,121.14999999999999,163.03,40.7575]
["TUFTS - TUFTS POS - CPT - 90715",7,163.03,145.40857142857143,121.14999999999999,163.03,40.7575]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90715",7,163.03,145.40857142857141,121.14999999999999,163.03,40.7575]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 90715",7,163.03,145.40857142857141,121.14999999999999,163.03,40.7575]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90715",7,163.03,145.40857142857141,121.14999999999999,163.03,40.7575]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 90715",7,163.03,145.40857142857141,121.14999999999999,163.03,40.7575]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 90715",7,163.03,145.40857142857141,121.14999999999999,163.03,40.7575]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90715",7,163.03,145.40857142857141,121.14999999999999,163.03,40.7575]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90715",7,163.03,145.40857142857141,121.14999999999999,163.03,40.7575]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 90715",7,163.03,145.40857142857143,121.14999999999999,163.03,40.7575]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90715",7,163.03,145.40857142857143,121.14999999999999,163.03,40.7575]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 90715",7,163.03,145.40857142857141,121.14999999999999,163.03,40.7575]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90715",7,163.03,145.40857142857141,121.14999999999999,163.03,40.7575]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 90715",7,163.03,145.40857142857141,121.14999999999999,163.03,40.7575]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 90715",7,163.03,145.40857142857141,121.14999999999999,163.03,40.7575]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 90715",7,163.03,145.40857142857141,121.14999999999999,163.03,40.7575]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90698",5,355.01,290.48799999999994,160.24,355.01,88.752499999999998]
["TUFTS - TUFTS PPO - CPT - 90700",5,87.75,83.441999999999993,70.77,87.75,21.9375]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90698",5,355.01,290.488,160.24,355.01,88.752499999999998]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 90698",5,355.01,290.48799999999994,160.24,355.01,88.752499999999998]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90700",5,87.75,83.442000000000007,70.77,87.75,21.9375]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 90700",5,87.75,83.442000000000007,70.77,87.75,21.9375]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 90700",5,87.75,83.442000000000007,70.77,87.75,21.9375]
["TUFTS - TUFTS SELECT - CPT - 90698",5,355.01,290.488,160.24,355.01,88.752499999999998]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90700",5,87.75,83.442000000000007,70.77,87.75,21.9375]
["TUFTS - TUFTS SELECT - CPT - 90700",5,87.75,83.442000000000007,70.77,87.75,21.9375]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90698",5,355.01,290.48799999999994,160.24,355.01,88.752499999999998]
["TUFTS - TUFTS PPO - CPT - 90698",5,355.01,290.48799999999994,160.24,355.01,88.752499999999998]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 90698",5,355.01,290.48799999999994,160.24,355.01,88.752499999999998]
["UNICARE - UNICARE - CPT - 90698",5,355.01,290.488,160.24,355.01,88.752499999999998]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90700",5,87.75,83.442000000000007,70.77,87.75,21.9375]
["UNICARE - UNICARE - CPT - 90700",5,87.75,83.441999999999993,70.77,87.75,21.9375]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90698",5,355.01,290.488,160.24,355.01,88.752499999999998]
["TUFTS - TUFTS HMO - CPT - 90698",5,355.01,290.48799999999994,160.24,355.01,88.752499999999998]
["FALLON - FALLON MEDICAID - CPT - 90698",5,355.01,290.48799999999994,160.24,355.01,88.752499999999998]
["FALLON - FALLON MEDICAID - CPT - 90700",5,87.75,83.441999999999993,70.77,87.75,21.9375]
["TUFTS - TUFTS HMO - CPT - 90700",5,87.75,83.442000000000007,70.77,87.75,21.9375]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90698",5,355.01,290.48799999999994,160.24,355.01,88.752499999999998]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90700",5,87.75,83.442000000000007,70.77,87.75,21.9375]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90700",5,87.75,83.441999999999993,70.77,87.75,21.9375]
["TUFTS - TUFTS POS - CPT - 90700",5,87.75,83.442000000000007,70.77,87.75,21.9375]
["TUFTS - TUFTS POS - CPT - 90698",5,355.01,290.48799999999994,160.24,355.01,88.752499999999998]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90698",5,355.01,290.48799999999994,160.24,355.01,88.752499999999998]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90700",5,87.75,83.442000000000007,70.77,87.75,21.9375]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90700",5,87.75,83.442000000000007,70.77,87.75,21.9375]
["BMC HEALTHNET - BMCHN MCO - CPT - 90700",5,87.75,83.442000000000007,70.77,87.75,21.9375]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90700",5,87.75,83.441999999999993,70.77,87.75,21.9375]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 90698",5,355.01,290.48799999999994,160.24,355.01,88.752499999999998]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90700",5,87.75,83.442000000000007,70.77,87.75,21.9375]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 90700",5,87.75,83.442000000000007,70.77,87.75,21.9375]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90698",5,355.01,290.488,160.24,355.01,88.752499999999998]
["BMC HEALTHNET - BMCHN QHP - CPT - 90698",5,355.01,290.488,160.24,355.01,88.752499999999998]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90698",5,355.01,290.48799999999994,160.24,355.01,88.752499999999998]
["BMC HEALTHNET - BMCHN QHP - CPT - 90700",5,87.75,83.442000000000007,70.77,87.75,21.9375]
["BMC HEALTHNET - BMCHN MCO - CPT - 90698",5,355.01,290.48799999999994,160.24,355.01,88.752499999999998]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90698",5,355.01,290.488,160.24,355.01,88.752499999999998]
["BMC HEALTHNET - BMCHN ACO - CPT - 90700",5,87.75,83.442000000000007,70.77,87.75,21.9375]
["BMC HEALTHNET - BMCHN ACO - CPT - 90698",5,355.01,290.48799999999994,160.24,355.01,88.752499999999998]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 90698",5,355.01,290.48799999999994,160.24,355.01,88.752499999999998]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90698",5,355.01,290.488,160.24,355.01,88.752499999999998]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 90698",5,355.01,290.48799999999994,160.24,355.01,88.752499999999998]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 90700",5,87.75,83.441999999999993,70.77,87.75,21.9375]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90700",5,87.75,83.442000000000007,70.77,87.75,21.9375]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 90698",5,355.01,290.488,160.24,355.01,88.752499999999998]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 90700",5,87.75,83.442000000000007,70.77,87.75,21.9375]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90700",5,87.75,83.441999999999993,70.77,87.75,21.9375]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 90698",5,355.01,290.488,160.24,355.01,88.752499999999998]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 90700",5,87.75,83.441999999999993,70.77,87.75,21.9375]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90698",5,355.01,290.488,160.24,355.01,88.752499999999998]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 90700",5,87.75,83.442000000000007,70.77,87.75,21.9375]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90648",4,355.01,135.465,35.97,355.01,88.752499999999998]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90648",4,355.01,135.465,35.97,355.01,88.752499999999998]
["TUFTS - TUFTS SPIRIT - CPT - 90746",4,217.1,200.7775,175.53,217.1,54.274999999999999]
["UNICARE - UNICARE - CPT - 90648",4,355.01,135.465,35.97,355.01,88.752499999999998]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90746",4,217.1,200.7775,175.53,217.1,54.274999999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 90648",4,355.01,135.465,35.97,355.01,88.752499999999998]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 90632",4,266.16000000000003,254.69499999999999,244.66,266.16000000000003,66.540000000000006]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 90632",4,266.16000000000003,254.69499999999999,244.66,266.16000000000003,66.540000000000006]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 90648",4,355.01,135.465,35.97,355.01,88.752499999999998]
["TUFTS - TUFTS PPO - CPT - 90746",4,217.1,200.7775,175.53,217.1,54.274999999999999]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 90746",4,217.1,200.7775,175.53,217.1,54.274999999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 90632",4,266.16000000000003,254.69499999999996,244.66,266.16000000000003,66.540000000000006]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90632",4,266.16000000000003,254.69499999999999,244.66,266.16000000000003,66.540000000000006]
["UNICARE - UNICARE - CPT - 90746",4,217.1,200.7775,175.53,217.1,54.274999999999999]
["TUFTS - TUFTS PPO - CPT - 90648",4,355.01,135.465,35.97,355.01,88.752499999999998]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90632",4,266.16000000000003,254.69499999999999,244.66,266.16000000000003,66.540000000000006]
["TUFTS - TUFTS SELECT - CPT - 90632",4,266.16000000000003,254.69499999999999,244.66,266.16000000000003,66.540000000000006]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90648",4,355.01,135.465,35.97,355.01,88.752499999999998]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90746",4,217.1,200.7775,175.53,217.1,54.274999999999999]
["TUFTS - TUFTS SPIRIT - CPT - 90632",4,266.16000000000003,254.69499999999999,244.66,266.16000000000003,66.540000000000006]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90632",4,266.16000000000003,254.69500000000002,244.66,266.16000000000003,66.540000000000006]
["TUFTS - TUFTS SELECT - CPT - 90648",4,355.01,135.465,35.97,355.01,88.752499999999998]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 90746",4,217.1,200.7775,175.53,217.1,54.274999999999999]
["TUFTS - TUFTS PPO - CPT - 90632",4,266.16000000000003,254.69500000000002,244.66,266.16000000000003,66.540000000000006]
["UNICARE - UNICARE - CPT - 90632",4,266.16000000000003,254.69499999999999,244.66,266.16000000000003,66.540000000000006]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 90746",4,217.1,200.7775,175.53,217.1,54.274999999999999]
["TUFTS - TUFTS SELECT - CPT - 90746",4,217.1,200.7775,175.53,217.1,54.274999999999999]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90746",4,217.1,200.7775,175.53,217.1,54.274999999999999]
["TUFTS - TUFTS MEDICARE SCO - CPT - 90632",4,266.16000000000003,254.69499999999999,244.66,266.16000000000003,66.540000000000006]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 90632",4,266.16000000000003,254.69499999999996,244.66,266.16000000000003,66.540000000000006]
["TUFTS - TUFTS POS - CPT - 90632",4,266.16000000000003,254.69499999999999,244.66,266.16000000000003,66.540000000000006]
["FALLON - FALLON SENIOR PLAN - CPT - 90746",4,217.1,200.7775,175.53,217.1,54.274999999999999]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 90746",4,217.1,200.7775,175.53,217.1,54.274999999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90632",4,266.16000000000003,254.69499999999999,244.66,266.16000000000003,66.540000000000006]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90746",4,217.1,200.7775,175.53,217.1,54.274999999999999]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 90746",4,217.1,200.7775,175.53,217.1,54.274999999999999]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 90632",4,266.16000000000003,254.69499999999999,244.66,266.16000000000003,66.540000000000006]
["TUFTS - TUFTS HMO - CPT - 90632",4,266.16000000000003,254.69499999999999,244.66,266.16000000000003,66.540000000000006]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 90632",4,266.16000000000003,254.69499999999999,244.66,266.16000000000003,66.540000000000006]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90632",4,266.16000000000003,254.69499999999996,244.66,266.16000000000003,66.540000000000006]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 90746",4,217.1,200.7775,175.53,217.1,54.274999999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90648",4,355.01,135.465,35.97,355.01,88.752499999999998]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 90746",4,217.1,200.7775,175.53,217.1,54.274999999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90746",4,217.1,200.7775,175.53,217.1,54.274999999999999]
["TUFTS - TUFTS MEDICARE SCO - CPT - 90746",4,217.1,200.7775,175.53,217.1,54.274999999999999]
["FALLON - FALLON SENIOR PLAN - CPT - 90632",4,266.16000000000003,254.69499999999999,244.66,266.16000000000003,66.540000000000006]
["TUFTS - TUFTS POS - CPT - 90648",4,355.01,135.465,35.97,355.01,88.752499999999998]
["FALLON - FALLON MEDICAID - CPT - 90648",4,355.01,135.465,35.97,355.01,88.752499999999998]
["TUFTS - TUFTS HMO - CPT - 90746",4,217.1,200.7775,175.53,217.1,54.274999999999999]
["TUFTS - TUFTS HMO - CPT - 90648",4,355.01,135.465,35.97,355.01,88.752499999999998]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90648",4,355.01,135.465,35.97,355.01,88.752499999999998]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 90632",4,266.16000000000003,254.69499999999999,244.66,266.16000000000003,66.540000000000006]
["TUFTS - TUFTS POS - CPT - 90746",4,217.1,200.7775,175.53,217.1,54.274999999999999]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 90746",4,217.1,200.7775,175.53,217.1,54.274999999999999]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 90648",4,355.01,135.465,35.97,355.01,88.752499999999998]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 90746",4,217.1,200.7775,175.53,217.1,54.274999999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90632",4,266.16000000000003,254.69499999999999,244.66,266.16000000000003,66.540000000000006]
["BMC HEALTHNET - BMCHN ACO - CPT - 90648",4,355.01,135.465,35.97,355.01,88.752499999999998]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90648",4,355.01,135.465,35.97,355.01,88.752499999999998]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90632",4,266.16000000000003,254.69499999999999,244.66,266.16000000000003,66.540000000000006]
["BMC HEALTHNET - BMCHN QHP - CPT - 90648",4,355.01,135.465,35.97,355.01,88.752499999999998]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90648",4,355.01,135.465,35.97,355.01,88.752499999999998]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90746",4,217.1,200.7775,175.53,217.1,54.274999999999999]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 90632",4,266.16000000000003,254.69499999999999,244.66,266.16000000000003,66.540000000000006]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90746",4,217.1,200.7775,175.53,217.1,54.274999999999999]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 90746",4,217.1,200.7775,175.53,217.1,54.274999999999999]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90632",4,266.16000000000003,254.69499999999999,244.66,266.16000000000003,66.540000000000006]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 90632",4,266.16000000000003,254.69499999999999,244.66,266.16000000000003,66.540000000000006]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90648",4,355.01,135.465,35.97,355.01,88.752499999999998]
["BMC HEALTHNET - BMCHN MCO - CPT - 90648",4,355.01,135.465,35.97,355.01,88.752499999999998]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 90632",4,266.16000000000003,254.69499999999999,244.66,266.16000000000003,66.540000000000006]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 90632",4,266.16000000000003,254.69499999999999,244.66,266.16000000000003,66.540000000000006]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90632",4,266.16000000000003,254.69499999999999,244.66,266.16000000000003,66.540000000000006]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90648",4,355.01,135.465,35.97,355.01,88.752499999999998]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90746",4,217.1,200.7775,175.53,217.1,54.274999999999999]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 90746",4,217.1,200.7775,175.53,217.1,54.274999999999999]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90746",4,217.1,200.7775,175.53,217.1,54.274999999999999]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 90746",4,217.1,200.7775,175.53,217.1,54.274999999999999]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90632",4,266.16000000000003,254.69499999999999,244.66,266.16000000000003,66.540000000000006]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90648",4,355.01,135.465,35.97,355.01,88.752499999999998]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 90632",4,266.16000000000003,254.69499999999999,244.66,266.16000000000003,66.540000000000006]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90746",4,217.1,200.7775,175.53,217.1,54.274999999999999]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 90746",4,217.1,200.7775,175.53,217.1,54.274999999999999]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 90648",4,355.01,135.465,35.97,355.01,88.752499999999998]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 90648",4,355.01,135.465,35.97,355.01,88.752499999999998]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90746",4,217.1,200.7775,175.53,217.1,54.274999999999999]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 90648",4,355.01,135.465,35.97,355.01,88.752499999999998]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90648",4,355.01,135.465,35.97,355.01,88.752499999999998]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 90632",4,266.16000000000003,254.69499999999999,244.66,266.16000000000003,66.540000000000006]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 90632",4,266.16000000000003,254.69499999999999,244.66,266.16000000000003,66.540000000000006]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 90648",4,355.01,135.465,35.97,355.01,88.752499999999998]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 90632",4,266.16000000000003,254.69499999999999,244.66,266.16000000000003,66.540000000000006]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 90746",4,217.1,200.7775,175.53,217.1,54.274999999999999]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90632",4,266.16000000000003,254.69499999999999,244.66,266.16000000000003,66.540000000000006]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 90746",4,217.1,200.7775,175.53,217.1,54.274999999999999]
["TUFTS - TUFTS PPO - CPT - 90620",3,613.46,218.25,204.03,613.46,153.36500000000001]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90740",3,350.28,144.89333333333335,0.18000000000000002,350.28,87.57]
["TUFTS - TUFTS SELECT - CPT - 90734",3,464.28,412.11999999999995,362.95,464.28,116.07]
["TUFTS - TUFTS SPIRIT - CPT - 90675",3,1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90740",3,350.28,144.89333333333332,0.18000000000000002,350.28,87.57]
["TUFTS - TUFTS PPO - CPT - 90734",3,464.28,412.12000000000006,362.95,464.28,116.07]
["UNICARE - UNICARE - CPT - 90734",3,464.28,412.11999999999995,362.95,464.28,116.07]
["TUFTS - TUFTS SPIRIT - CPT - 90740",3,350.28,144.89333333333332,0.18000000000000002,350.28,87.57]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90675",3,1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["TUFTS - TUFTS PPO - CPT - 90740",3,350.28,144.89333333333335,0.18000000000000002,350.28,87.57]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90675",3,1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 90675",3,1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90675",3,1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 90740",3,350.28,144.89333333333332,0.18000000000000002,350.28,87.57]
["UNICARE - UNICARE - CPT - 90675",3,1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90740",3,350.28,144.89333333333332,0.18000000000000002,350.28,87.57]
["UNICARE - UNICARE - CPT - 90740",3,350.28,144.89333333333335,0.18000000000000002,350.28,87.57]
["TUFTS - TUFTS SELECT - CPT - 90620",3,613.46,204.03,204.03,613.46,153.36500000000001]
["TUFTS - TUFTS SELECT - CPT - 90740",3,350.28,144.89333333333332,0.18000000000000002,350.28,87.57]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 90675",3,1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90734",3,464.28,412.11999999999995,362.95,464.28,116.07]
["TUFTS - TUFTS PPO - CPT - 90675",3,1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90620",3,613.46,314.44,204.03,613.46,153.36500000000001]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 90740",3,350.28,144.89333333333332,0.18000000000000002,350.28,87.57]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90734",3,464.28,412.11999999999995,362.95,464.28,116.07]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 90675",3,1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90620",3,613.46,314.44,204.03,613.46,153.36500000000001]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 90740",3,350.28,144.89333333333335,0.18000000000000002,350.28,87.57]
["TUFTS - TUFTS SELECT - CPT - 90675",3,1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90734",3,464.28,412.11999999999995,362.95,464.28,116.07]
["TUFTS - TUFTS POS - CPT - 90740",3,350.28,144.89333333333332,0.18000000000000002,350.28,87.57]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 90740",3,350.28,144.89333333333332,0.18000000000000002,350.28,87.57]
["TUFTS - TUFTS HMO - CPT - 90675",3,1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["FALLON - FALLON SENIOR PLAN - CPT - 90675",3,1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["TUFTS - TUFTS POS - CPT - 90675",3,1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["FALLON - FALLON SENIOR PLAN - CPT - 90740",3,350.28,144.89333333333332,0.18000000000000002,350.28,87.57]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 90740",3,350.28,144.89333333333332,0.18000000000000002,350.28,87.57]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90620",3,613.46,314.44,204.03,613.46,153.36500000000001]
["TUFTS - TUFTS HMO - CPT - 90740",3,350.28,144.89333333333335,0.18000000000000002,350.28,87.57]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90675",3,1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["TUFTS - TUFTS MEDICARE SCO - CPT - 90740",3,350.28,144.89333333333332,0.18000000000000002,350.28,87.57]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90734",3,464.28,412.11999999999995,362.95,464.28,116.07]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 90740",3,350.28,144.89333333333332,0.18000000000000002,350.28,87.57]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90740",3,350.28,144.89333333333332,0.18000000000000002,350.28,87.57]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 90675",3,1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90620",3,613.46,314.44,204.03,613.46,153.36500000000001]
["TUFTS - TUFTS HMO - CPT - 90620",3,613.46,244.84,204.03,613.46,153.36500000000001]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90675",3,1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["TUFTS - TUFTS HMO - CPT - 90734",3,464.28,412.11999999999995,362.95,464.28,116.07]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 90675",3,1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 90675",3,1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90734",3,464.28,412.12000000000006,362.95,464.28,116.07]
["TUFTS - TUFTS MEDICARE SCO - CPT - 90675",3,1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90740",3,350.28,144.89333333333332,0.18000000000000002,350.28,87.57]
["TUFTS - TUFTS POS - CPT - 90620",3,613.46,204.03,204.03,613.46,153.36500000000001]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 90675",3,1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 90740",3,350.28,144.89333333333332,0.18000000000000002,350.28,87.57]
["TUFTS - TUFTS POS - CPT - 90734",3,464.28,412.12000000000006,362.95,464.28,116.07]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 90675",3,1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 90740",3,350.28,144.89333333333332,0.18000000000000002,350.28,87.57]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 90740",3,350.28,144.89333333333332,0.18000000000000002,350.28,87.57]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90740",3,350.28,144.89333333333332,0.18000000000000002,350.28,87.57]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90740",3,350.28,144.89333333333332,0.18000000000000002,350.28,87.57]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90734",3,464.28,412.12000000000006,362.95,464.28,116.07]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 90740",3,350.28,144.89333333333332,0.18000000000000002,350.28,87.57]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90740",3,350.28,144.89333333333332,0.18000000000000002,350.28,87.57]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90675",3,1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 90675",3,1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90675",3,1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90620",3,613.46,247.18999999999997,204.03,613.46,153.36500000000001]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90734",3,464.28,412.11999999999995,362.95,464.28,116.07]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 90740",3,350.28,144.89333333333335,0.18000000000000002,350.28,87.57]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90620",3,613.46,247.18999999999997,204.03,613.46,153.36500000000001]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90675",3,1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 90675",3,1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90675",3,1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 90675",3,1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90620",3,613.46,247.18999999999997,204.03,613.46,153.36500000000001]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90734",3,464.28,412.12000000000006,362.95,464.28,116.07]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90620",3,613.46,613.46,204.03,613.46,153.36500000000001]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90734",3,464.28,412.11999999999995,362.95,464.28,116.07]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90740",3,350.28,144.89333333333332,0.18000000000000002,350.28,87.57]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90740",3,350.28,144.89333333333332,0.18000000000000002,350.28,87.57]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90740",3,350.28,144.89333333333332,0.18000000000000002,350.28,87.57]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 90675",3,1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 90675",3,1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90675",3,1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 90740",3,350.28,144.89333333333332,0.18000000000000002,350.28,87.57]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 90740",3,350.28,144.89333333333332,0.18000000000000002,350.28,87.57]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 90620",3,613.46,247.18999999999997,204.03,613.46,153.36500000000001]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90734",3,464.28,412.12000000000006,362.95,464.28,116.07]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 90675",3,1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90620",3,613.46,247.18999999999997,204.03,613.46,153.36500000000001]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 90740",3,350.28,144.89333333333332,0.18000000000000002,350.28,87.57]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90734",3,464.28,412.11999999999995,362.95,464.28,116.07]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 90734",3,464.28,412.11999999999995,362.95,464.28,116.07]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 90675",3,1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 90740",3,350.28,144.89333333333332,0.18000000000000002,350.28,87.57]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 90620",3,613.46,247.18999999999997,204.03,613.46,153.36500000000001]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 90734",3,464.28,412.11999999999995,362.95,464.28,116.07]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90675",3,1370.91,1157.5266666666666,905.04,1370.91,342.72750000000002]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90620",3,613.46,247.18999999999997,204.03,613.46,153.36500000000001]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 90672",2,81.53,80.009999999999991,78.489999999999995,81.53,20.3825]
["TUFTS - TUFTS SPIRIT - CPT - 83001",2,93,20.440000000000001,16.95,208.59,23.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 83001",2,93,22.3,16.95,208.59,23.25]
["TUFTS - TUFTS SPIRIT - CPT - 84295",2,25,5.29,4.3899999999999997,54.04,6.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 82043",2,27,12.17,5.28,64.88,6.75]
["TUFTS - TUFTS SPIRIT - CPT - 84443",2,84,18.48,15.33,188.7,21]
["TUFTS - TUFTS SELECT - CPT - 90651",2,898.26,864.33500000000004,830.41,898.26,224.565]
["TUFTS - TUFTS SPIRIT - CPT - 84450",2,26,5.7,4.72,58.08,6.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 86803",2,58,17.12,13.01,160.13,14.5]
["TUFTS - TUFTS SPIRIT - CPT - 84460",2,27,5.83,4.83,59.46,6.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90371",2,473.09,370.26499999999999,267.44,473.09,118.27249999999999]
["TUFTS - TUFTS SPIRIT - CPT - 84478",2,29,6.31,5.24,64.44,7.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 84132",2,24,10.02,4.2,51.64,6]
["TUFTS - TUFTS SPIRIT - CPT - 84520",2,21,4.3499999999999996,3.61,44.34,5.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 87801",2,310,84.24,64.03,787.98,77.5]
["TUFTS - TUFTS SPIRIT - CPT - 84550",2,24,4.97,4.12,50.7,6]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 82274",2,159,19.100000000000001,14.51,178.59,39.75]
["TUFTS - TUFTS SPIRIT - CPT - 84703",2,37,8.27,6.86,84.49,9.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 84443",2,84,20.16,15.33,188.7,21]
["TUFTS - TUFTS SPIRIT - CPT - 85014",2,12,2.61,2.16,26.61,3]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 90674",2,72.349999999999994,72.34,72.33,72.349999999999994,18.087499999999999]
["TUFTS - TUFTS SPIRIT - CPT - 85018",2,12,2.61,2.16,26.61,3]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90670",2,749.99,725.45,700.91,749.99,187.4975]
["TUFTS - TUFTS SPIRIT - CPT - 85025",2,40,8.5500000000000007,7.09,87.22,10]
["TUFTS - TUFTS SPIRIT - CPT - 83986",2,20,3.94,3.27,40.229999999999997,5]
["TUFTS - TUFTS SPIRIT - CPT - 85576",2,311,27.4,19.59,243.68,77.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 82951",2,64,27.1,11.74,144.52000000000001,16]
["TUFTS - TUFTS SPIRIT - CPT - 85610",2,21,4.72,3.58,44.06,5.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 86308",2,24,10.91,4.72,58.08,6]
["TUFTS - TUFTS SPIRIT - CPT - 86308",2,24,5.7,4.72,58.08,6]
["TUFTS - TUFTS SPIRIT - CPT - 82150",2,33,7.13,5.91,72.75,8.25]
["TUFTS - TUFTS SPIRIT - CPT - 86618",2,191,18.73,15.53,191.1,47.75]
["TUFTS - TUFTS SPIRIT - CPT - 82570",2,26,5.7,4.72,58.08,6.5]
["TUFTS - TUFTS SPIRIT - CPT - 86701",2,44,9.7799999999999994,8.11,99.73,11]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 81003",2,12,2.7,2.0499999999999998,25.23,3]
["TUFTS - TUFTS SPIRIT - CPT - 86780",2,61,14.56,12.07,148.63999999999999,15.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 82565",2,26,6.14,4.68,57.51,6.5]
["TUFTS - TUFTS SPIRIT - CPT - 86803",2,58,15.7,13.01,160.13,14.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 83721",2,44,12.6,8.6999999999999993,107.11,11]
["TUFTS - TUFTS SPIRIT - CPT - 87077",2,27,8.89,7.18,90.64,6.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 85018",2,12,2.84,2.16,26.61,3]
["TUFTS - TUFTS SPIRIT - CPT - 87210",2,23,6.4,4.3,56.49,5.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 87633",2,820,500.14,291.7,4678.75,205]
["TUFTS - TUFTS SPIRIT - CPT - 87338",2,102,15.82,13.12,161.52000000000001,25.5]
["TUFTS - TUFTS SPIRIT - CPT - 82952",2,15,4.3099999999999996,3.58,43.98,3.75]
["TUFTS - TUFTS SPIRIT - CPT - 87389",2,111,26.49,21.97,270.29000000000002,27.75]
["TUFTS - TUFTS SPIRIT - CPT - 83002",2,93,20.37,16.89,207.81,23.25]
["TUFTS - TUFTS SPIRIT - CPT - 87449",2,57,13.18,10.94,134.54,14.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90714",2,63.91,61.674999999999997,59.44,63.91,15.977499999999999]
["TUFTS - TUFTS SPIRIT - CPT - 87502",2,269,105.38,77.11,958.3,67.25]
["TUFTS - TUFTS SPIRIT - CPT - 83880",2,169,43.19,30.96,384.74,42.25]
["TUFTS - TUFTS SPIRIT - CPT - 87631",2,504,156.88999999999999,103.92,1440.32,126]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 80053",2,375,22.24,9.6300000000000008,118.56,93.75]
["TUFTS - TUFTS SPIRIT - CPT - 87633",2,820,458.46,291.7,4678.75,205]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 82435",2,24,9.69,4.2,51.64,6]
["TUFTS - TUFTS SPIRIT - CPT - 87801",2,310,77.22,64.03,787.98,77.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 83520",2,63,36.369999999999997,12.76,167.51,15.75]
["TUFTS - TUFTS SPIRIT - CPT - 87880",2,57,18.18,12.21,160.29,14.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 84520",2,21,8.32,3.61,44.34,5.25]
["TUFTS - TUFTS SPIRIT - CPT - 87899",2,94,17.68,11.87,155.81,23.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 87389",2,111,50.71,21.97,270.29000000000002,27.75]
["TUFTS - TUFTS SPIRIT - CPT - 90371",2,473.09,370.26499999999999,267.44,473.09,118.27249999999999]
["TUFTS - TUFTS SPIRIT - CPT - 82042",2,26,8.56,5.75,75.44,6.5]
["TUFTS - TUFTS PPO - CPT - 90732",2,383.29,320.21000000000004,257.13,383.29,95.822500000000005]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 87449",2,57,14.38,10.94,134.54,14.25]
["TUFTS - TUFTS SPIRIT - CPT - 90670",2,749.99,725.45,700.91,749.99,187.4975]
["TUFTS - TUFTS SPIRIT - CPT - 82565",2,26,5.63,4.68,57.51,6.5]
["TUFTS - TUFTS SPIRIT - CPT - 90672",2,81.53,80.009999999999991,78.489999999999995,81.53,20.3825]
["TUFTS - TUFTS SPIRIT - CPT - 82947",2,21,4.32,3.58,44.06,5.25]
["TUFTS - TUFTS SPIRIT - CPT - 90674",2,72.349999999999994,72.34,72.33,72.349999999999994,18.087499999999999]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 80053",2,375,12.67,9.6300000000000008,118.56,93.75]
["TUFTS - TUFTS SPIRIT - CPT - 82310",2,26,5.68,4.71,57.87,6.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 82043",2,27,6.94,5.28,64.88,6.75]
["TUFTS - TUFTS SPIRIT - CPT - 82330",2,69,15.05,12.47,153.49,17.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 82435",2,24,5.52,4.2,51.64,6]
["TUFTS - TUFTS SPIRIT - CPT - 90694",2,180.47,180.42500000000001,180.38,180.47,45.1175]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 82951",2,64,15.44,11.74,144.52000000000001,16]
["TUFTS - TUFTS SPIRIT - CPT - 90714",2,63.91,61.674999999999997,59.44,63.91,15.977499999999999]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 83520",2,63,20.72,12.76,167.51,15.75]
["TUFTS - TUFTS PPO - CPT - 90739",2,411.21,307.27999999999997,411.21,411.21,102.80249999999999]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 84132",2,24,5.71,4.2,51.64,6]
["TUFTS - TUFTS SPIRIT - CPT - 90732",2,383.29,320.21000000000004,257.13,383.29,95.822500000000005]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 84520",2,21,4.74,3.61,44.34,5.25]
["TUFTS - TUFTS SPIRIT - CPT - 90739",2,411.21,277.70999999999998,411.21,411.21,102.80249999999999]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 86308",2,24,6.22,4.72,58.08,6]
["TUFTS - TUFTS SPIRIT - CPT - 82374",2,25,5.37,4.46,54.82,6.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 87389",2,111,28.9,21.97,270.29000000000002,27.75]
["TUFTS - TUFTS SPIRIT - CPT - 82435",2,24,5.0599999999999996,4.2,51.64,6]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 90371",2,473.09,370.26499999999999,267.44,473.09,118.27249999999999]
["TUFTS - TUFTS SPIRIT - CPT - 90756",2,67.58,67.58,67.58,67.58,16.895]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 90714",2,63.91,61.674999999999997,59.44,63.91,15.977499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 36415",2,26,1.3049999999999999,2.2200000000000002,25.55,6.5]
["TUFTS - TUFTS SPIRIT - CPT - 82985",2,73,18.440000000000001,13.75,169.26,18.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 81178",2,175,60.204999999999998,102.3,1328.77,43.75]
["TUFTS - TUFTS PPO - CPT - 90714",2,63.91,61.674999999999997,59.44,63.91,15.977499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 81179",2,175,60.204999999999998,102.3,1328.77,43.75]
["UNICARE - UNICARE - CPT - 90756",2,67.58,67.58,67.58,67.58,16.895]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 81180",2,175,60.204999999999998,102.3,1328.77,43.75]
["TUFTS - TUFTS PPO - CPT - 90670",2,749.99,725.45,700.91,749.99,187.4975]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 81206",2,684,88.015000000000001,149.56,1840.58,171]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90739",2,411.21,273.63,411.21,411.21,102.80249999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 81207",2,287,77.754999999999995,132.12,1625.92,71.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90651",2,898.26,864.33500000000004,830.41,898.26,224.565]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 81210",2,492,76.27,129.6,1701.28,123]
["TUFTS - TUFTS SPIRIT - CPT - 80069",2,218,9.5500000000000007,7.92,97.49,54.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 81235",2,1038,141.13499999999999,239.82,3148.12,259.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90750",2,540.45000000000005,404.48500000000001,268.52,540.45000000000005,135.11250000000001]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 81240",2,434,28.565000000000001,48.54,637.1,108.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 81003",2,12,4.74,2.0499999999999998,25.23,3]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 81241",2,434,32.805,55.74,711.6,108.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 82274",2,159,33.53,14.51,178.59,39.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 81256",2,434,35.085000000000001,59.62,733.73,108.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 82565",2,26,10.78,4.68,57.51,6.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 81261",2,737,106.285,180.6,2222.63,184.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 83001",2,93,39.130000000000003,16.95,208.59,23.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 81270",2,434,49.21,83.62,1029.05,108.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 83721",2,44,22.11,8.6999999999999993,107.11,11]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 81271",2,175,60.204999999999998,102.3,1328.77,43.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 84443",2,84,35.380000000000003,15.33,188.7,21]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 81274",2,175,120.77,205.22,2665.65,43.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 85018",2,12,4.99,2.16,26.61,3]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 81275",2,534,84.025000000000006,142.78,1874.37,133.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 86803",2,58,30.05,13.01,160.13,14.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 81291",2,434,28.414999999999999,48.28,633.76,108.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 87633",2,820,877.74,291.7,4678.75,205]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 81301",2,534,155.44,264.13,3380.71,133.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 90756",2,67.58,67.58,67.58,67.58,16.895]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 81305",2,223,77.075000000000003,130.97,1701.28,55.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90674",2,72.349999999999994,72.34,72.33,72.349999999999994,18.087499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 81315",2,675,111.285,189.1,2327.29,168.75]
["TUFTS - TUFTS SPIRIT - CPT - 84157",2,20,4.4000000000000004,3.35,41.16,5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 81329",2,174,60.204999999999998,102.3,1328.77,43.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 87631",2,504,171.16,103.92,1440.32,126]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 81342",2,534,108.16500000000001,183.8,2261.92,133.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 87899",2,94,19.28,11.87,155.81,23.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 81430",2,2063,706.57500000000005,1625,15761.12,515.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 90672",2,81.53,80.009999999999991,78.489999999999995,81.53,20.3825]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 81431",2,863,295.49,679.57,6591.3,215.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 90694",2,180.47,180.42500000000001,180.38,180.47,45.1175]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 81596",2,92,31.72,53.9,700.23,23]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 90739",2,411.21,284.26499999999999,411.21,411.21,102.80249999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 82075",2,86,13.045,16.53,291,21.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 80048",2,226,10.15,7.71,94.96,56.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 82962",2,12,1.425,2.42,31.83,3]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 80069",2,218,10.42,7.92,97.49,54.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 84145",2,99,14.385,24.44,300.82,24.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 82040",2,26,5.94,4.51,55.55,6.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 87150",2,460,18.84,32.01,393.99,115]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 82247",2,26,6.02,4.57,56.28,6.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 87493",2,120,18.84,32.01,393.99,30]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 82330",2,69,16.420000000000002,12.47,153.49,17.25]
["TUFTS - TUFTS PPO - CPT - 90672",2,81.53,80.009999999999991,78.489999999999995,81.53,20.3825]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 82523",2,62,22.42,17.05,209.77,15.5]
["TUFTS - TUFTS PPO - CPT - 90750",2,540.45000000000005,404.48500000000001,268.52,540.45000000000005,135.11250000000001]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 82947",2,21,4.72,3.58,44.06,5.25]
["TUFTS - TUFTS PPO - CPT - 90756",2,67.58,67.58,67.58,67.58,16.895]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 82977",2,36,8.64,6.57,80.86,9]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 80048",2,226,11.41,7.71,94.96,56.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 83036",2,49,11.65,8.86,109.06,12.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 80051",2,91,9.4499999999999993,6.4,78.7,22.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 83655",2,58,14.53,11.05,135.91999999999999,14.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 80053",2,375,14.24,9.6300000000000008,118.56,93.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 83986",2,20,4.3,3.27,40.229999999999997,5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 80061",2,131,18.05,12.21,150.31,32.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 84157",2,20,4.8,3.35,41.16,5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 80069",2,218,11.7,7.92,97.49,54.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 84460",2,27,6.36,4.83,59.46,6.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 80178",2,34,8.91,6.03,74.22,8.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 84703",2,37,9.02,6.86,84.49,9.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 81003",2,12,3.03,2.0499999999999998,25.23,3]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 85576",2,311,29.89,19.59,243.68,77.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 82010",2,40,11.01,7.46,91.78,10]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 86701",2,44,10.67,8.11,99.73,11]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 82040",2,26,6.67,4.51,55.55,6.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 87210",2,23,6.98,4.3,56.49,5.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 82042",2,26,10.49,5.75,75.44,6.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 87502",2,269,114.96,77.11,958.3,67.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 82043",2,27,7.79,5.28,64.88,6.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 87880",2,57,19.84,12.21,160.29,14.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 82150",2,33,8.74,5.91,72.75,8.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 90670",2,749.99,725.45,700.91,749.99,187.4975]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 82247",2,26,6.77,4.57,56.28,6.5]
["TUFTS - TUFTS SELECT - CPT - 90672",2,81.53,80.009999999999991,78.489999999999995,81.53,20.3825]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 82271",2,15,7.17,3.93,51.64,3.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 90732",2,383.29,320.21000000000004,257.13,383.29,95.822500000000005]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 82274",2,159,21.46,14.51,178.59,39.75]
["UNICARE - UNICARE - CPT - 90371",2,473.09,370.26499999999999,267.44,473.09,118.27249999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 82310",2,26,6.96,4.71,57.87,6.5]
["UNICARE - UNICARE - CPT - 90672",2,81.53,80.009999999999991,78.489999999999995,81.53,20.3825]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 82330",2,69,18.440000000000001,12.47,153.49,17.25]
["UNICARE - UNICARE - CPT - 90694",2,180.47,180.42500000000001,180.38,180.47,45.1175]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 82374",2,25,6.58,4.46,54.82,6.25]
["TUFTS - TUFTS SELECT - CPT - 90732",2,383.29,320.21000000000004,257.13,383.29,95.822500000000005]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 82435",2,24,6.2,4.2,51.64,6]
["TUFTS - TUFTS SPIRIT - CPT - 83036",2,49,10.68,8.86,109.06,12.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 82465",2,23,5.86,3.97,48.83,5.75]
["TUFTS - TUFTS SELECT - CPT - 90739",2,411.21,300.65499999999997,411.21,411.21,102.80249999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 82523",2,62,25.18,17.05,209.77,15.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90674",2,72.349999999999994,72.34,72.33,72.349999999999994,18.087499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 82550",2,33,8.7799999999999994,5.94,73.12,8.25]
["TUFTS - TUFTS SELECT - CPT - 90750",2,540.45000000000005,404.48500000000001,268.52,540.45000000000005,135.11250000000001]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 82565",2,26,6.9,4.68,57.51,6.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90732",2,383.29,320.21000000000004,257.13,383.29,95.822500000000005]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 82570",2,26,6.98,4.72,58.08,6.5]
["TUFTS - TUFTS SELECT - CPT - 99496",2,827,104.44499999999999,194.55,1179.72,206.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 82947",2,21,5.3,3.58,44.06,5.25]
["TUFTS - TUFTS SPIRIT - CPT - 80048",2,226,9.31,7.71,94.96,56.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 82950",2,25,6.4,4.33,53.31,6.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90672",2,81.53,80.009999999999991,78.489999999999995,81.53,20.3825]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 82951",2,64,17.350000000000001,11.74,144.52000000000001,16]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90694",2,180.47,180.42500000000001,180.38,180.47,45.1175]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 82952",2,15,5.28,3.58,43.98,3.75]
["TUFTS - TUFTS SPIRIT - CPT - 80178",2,34,7.27,6.03,74.22,8.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 82977",2,36,9.7100000000000009,6.57,80.86,9]
["TUFTS - TUFTS SPIRIT - CPT - 84075",2,26,5.7,4.72,58.08,6.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 82985",2,73,22.6,13.75,169.26,18.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 80048",2,226,17.82,7.71,94.96,56.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 83001",2,93,25.05,16.95,208.59,23.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 80069",2,218,18.28,7.92,97.49,54.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 83002",2,93,24.97,16.89,207.81,23.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 82040",2,26,10.42,4.51,55.55,6.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 83036",2,49,13.09,8.86,109.06,12.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 82247",2,26,10.57,4.57,56.28,6.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 83516",2,55,15.54,10.52,129.47999999999999,13.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 82330",2,69,28.81,12.47,153.49,17.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 83520",2,63,23.28,12.76,167.51,15.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 82523",2,62,39.340000000000003,17.05,209.77,15.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 83605",2,54,15.6,9.75,119.99,13.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 82947",2,21,8.2799999999999994,3.58,44.06,5.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 83655",2,58,16.329999999999998,11.05,135.91999999999999,14.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 82977",2,36,15.16,6.57,80.86,9]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 83718",2,41,11.04,7.48,91.95,10.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 83036",2,49,20.45,8.86,109.06,12.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 83721",2,44,14.16,8.6999999999999993,107.11,11]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 83655",2,58,25.5,11.05,135.91999999999999,14.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 83880",2,169,52.93,30.96,384.74,42.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 83986",2,20,7.54,3.27,40.229999999999997,5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 83986",2,20,4.83,3.27,40.229999999999997,5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 84157",2,20,8.42,3.35,41.16,5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 84075",2,26,6.98,4.72,58.08,6.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 84460",2,27,11.16,4.83,59.46,6.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 84132",2,24,6.42,4.2,51.64,6]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 84703",2,37,15.84,6.86,84.49,9.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 84155",2,20,4.95,3.35,41.16,5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 85576",2,311,52.46,19.59,243.68,77.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 84157",2,20,5.39,3.35,41.16,5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 86701",2,44,18.72,8.11,99.73,11]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 84295",2,25,6.48,4.3899999999999997,54.04,6.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 87210",2,23,12.26,4.3,56.49,5.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 84443",2,84,22.65,15.33,188.7,21]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 87502",2,269,201.75,77.11,958.3,67.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 84450",2,26,6.98,4.72,58.08,6.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 87880",2,57,34.81,12.21,160.29,14.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 84460",2,27,7.15,4.83,59.46,6.75]
["TUFTS - TUFTS SPIRIT - CPT - 82010",2,40,8.99,7.46,91.78,10]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 84478",2,29,7.74,5.24,64.44,7.25]
["TUFTS - TUFTS SPIRIT - CPT - 84132",2,24,5.24,4.2,51.64,6]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 84520",2,21,5.33,3.61,44.34,5.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90670",2,749.99,725.45,700.91,749.99,187.4975]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 84550",2,24,6.09,4.12,50.7,6]
["TUFTS - TUFTS SPIRIT - CPT - 82043",2,27,6.36,5.28,64.88,6.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 84703",2,37,10.14,6.86,84.49,9.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90714",2,63.91,61.674999999999997,59.44,63.91,15.977499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 85014",2,12,3.2,2.16,26.61,3]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 87389",2,111,28.9,21.97,270.29000000000002,27.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 85018",2,12,3.2,2.16,26.61,3]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 87502",2,269,114.96,77.11,958.3,67.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 85025",2,40,10.48,7.09,87.22,10]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 87633",2,820,500.14,291.7,4678.75,205]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 85576",2,311,33.58,19.59,243.68,77.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 87880",2,57,19.84,12.21,160.29,14.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 85610",2,21,5.78,3.58,44.06,5.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 90371",2,473.09,370.26499999999999,267.44,473.09,118.27249999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 86308",2,24,6.98,4.72,58.08,6]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 90670",2,749.99,725.45,700.91,749.99,187.4975]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 86618",2,191,22.96,15.53,191.1,47.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 90674",2,72.349999999999994,72.34,72.33,72.349999999999994,18.087499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 86701",2,44,11.99,8.11,99.73,11]
["TUFTS - TUFTS PPO - CPT - 90674",2,72.349999999999994,72.34,72.33,72.349999999999994,18.087499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 86780",2,61,17.850000000000001,12.07,148.63999999999999,15.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 90714",2,63.91,61.674999999999997,59.44,63.91,15.977499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 86803",2,58,19.239999999999998,13.01,160.13,14.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 90732",2,383.29,320.21000000000004,257.13,383.29,95.822500000000005]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 87077",2,27,10.89,7.18,90.64,6.75]
["TUFTS - TUFTS SPIRIT - CPT - 82950",2,25,5.22,4.33,53.31,6.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 87210",2,23,7.85,4.3,56.49,5.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 90756",2,67.58,67.58,67.58,67.58,16.895]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 87338",2,102,19.39,13.12,161.52000000000001,25.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 80051",2,91,8.41,6.4,78.7,22.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 87389",2,111,32.46,21.97,270.29000000000002,27.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 80061",2,131,16.07,12.21,150.31,32.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 87449",2,57,16.149999999999999,10.94,134.54,14.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 80178",2,34,7.93,6.03,74.22,8.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 87502",2,269,129.16,77.11,958.3,67.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 82010",2,40,9.8000000000000007,7.46,91.78,10]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 87631",2,504,192.29,103.92,1440.32,126]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 82042",2,26,9.34,5.75,75.44,6.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 87633",2,820,561.9,291.7,4678.75,205]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 82150",2,33,7.78,5.91,72.75,8.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 87801",2,310,94.64,64.03,787.98,77.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 82271",2,15,6.38,3.93,51.64,3.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 87880",2,57,22.29,12.21,160.29,14.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 82310",2,26,6.19,4.71,57.87,6.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 87899",2,94,21.67,11.87,155.81,23.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 82374",2,25,5.86,4.46,54.82,6.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 90371",2,473.09,370.26499999999999,267.44,473.09,118.27249999999999]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 82465",2,23,5.22,3.97,48.83,5.75]
["TUFTS - TUFTS PPO - CPT - 98966",2,36,19.3,38.6,108.49,9]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 82550",2,33,7.81,5.94,73.12,8.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 90670",2,749.99,725.45,700.91,749.99,187.4975]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 82570",2,26,6.22,4.72,58.08,6.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 90672",2,81.53,80.009999999999991,78.489999999999995,81.53,20.3825]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 82950",2,25,5.7,4.33,53.31,6.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 90674",2,72.349999999999994,72.34,72.33,72.349999999999994,18.087499999999999]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 82952",2,15,4.7,3.58,43.98,3.75]
["TUFTS - TUFTS SPIRIT - CPT - 82465",2,23,4.78,3.97,48.83,5.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 82985",2,73,20.11,13.75,169.26,18.25]
["TUFTS - TUFTS PPO - CPT - 98967",2,72,19.3,38.6,108.49,18]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 83002",2,93,22.22,16.89,207.81,23.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 90694",2,180.47,180.42500000000001,180.38,180.47,45.1175]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 83516",2,55,13.84,10.52,129.47999999999999,13.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 90714",2,63.91,61.674999999999997,59.44,63.91,15.977499999999999]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 83605",2,54,13.88,9.75,119.99,13.5]
["TUFTS - TUFTS PPO - CPT - 98968",2,106,19.3,38.6,108.49,26.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 83718",2,41,9.83,7.48,91.95,10.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 90732",2,383.29,320.21000000000004,257.13,383.29,95.822500000000005]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 83880",2,169,47.11,30.96,384.74,42.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 90739",2,411.21,293.98,411.21,411.21,102.80249999999999]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 84075",2,26,6.22,4.72,58.08,6.5]
["TUFTS - TUFTS SPIRIT - CPT - 82523",2,62,20.55,17.05,209.77,15.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 84155",2,20,4.4000000000000004,3.35,41.16,5]
["TUFTS - TUFTS PPO - CPT - 99473",2,36,40.844999999999999,36.99,229.62,9]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 84295",2,25,5.77,4.3899999999999997,54.04,6.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 90756",2,67.58,67.58,67.58,67.58,16.895]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 84450",2,26,6.22,4.72,58.08,6.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 36415",2,26,1.33,2.2200000000000002,25.55,6.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 84478",2,29,6.89,5.24,64.44,7.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81178",2,175,61.38,102.3,1328.77,43.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 84550",2,24,5.42,4.12,50.7,6]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81179",2,175,61.38,102.3,1328.77,43.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 85014",2,12,2.84,2.16,26.61,3]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81180",2,175,61.38,102.3,1328.77,43.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 85025",2,40,9.32,7.09,87.22,10]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81206",2,684,89.734999999999999,149.56,1840.58,171]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 85610",2,21,5.15,3.58,44.06,5.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81207",2,287,79.27,132.12,1625.92,71.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 86618",2,191,20.440000000000001,15.53,191.1,47.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81210",2,492,77.760000000000005,129.6,1701.28,123]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 86780",2,61,15.89,12.07,148.63999999999999,15.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81235",2,1038,143.88999999999999,239.82,3148.12,259.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 87077",2,27,9.6999999999999993,7.18,90.64,6.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81240",2,434,29.125,48.54,637.1,108.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 87338",2,102,17.260000000000002,13.12,161.52000000000001,25.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81241",2,434,33.445,55.74,711.6,108.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 87449",2,57,14.38,10.94,134.54,14.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81256",2,434,35.770000000000003,59.62,733.73,108.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 87631",2,504,171.16,103.92,1440.32,126]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81261",2,737,108.36,180.6,2222.63,184.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 87801",2,310,84.24,64.03,787.98,77.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81270",2,434,50.17,83.62,1029.05,108.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 87899",2,94,19.28,11.87,155.81,23.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81271",2,175,61.38,102.3,1328.77,43.75]
["TUFTS - TUFTS SELECT - CPT - 90670",2,749.99,725.45,700.91,749.99,187.4975]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81274",2,175,123.13,205.22,2665.65,43.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 90672",2,81.53,80.009999999999991,78.489999999999995,81.53,20.3825]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81275",2,534,85.67,142.78,1874.37,133.5]
["TUFTS - TUFTS SPIRIT - CPT - 82951",2,64,14.16,11.74,144.52000000000001,16]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81291",2,434,28.97,48.28,633.76,108.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 90694",2,180.47,180.42500000000001,180.38,180.47,45.1175]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81301",2,534,158.47999999999999,264.13,3380.71,133.5]
["TUFTS - TUFTS SELECT - CPT - 90674",2,72.349999999999994,72.34,72.33,72.349999999999994,18.087499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81305",2,223,78.58,130.97,1701.28,55.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 90739",2,411.21,284.26499999999999,411.21,411.21,102.80249999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81315",2,675,113.46,189.1,2327.29,168.75]
["TUFTS - TUFTS SPIRIT - CPT - 82977",2,36,7.92,6.57,80.86,9]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81329",2,174,61.38,102.3,1328.77,43.5]
["TUFTS - TUFTS PPO - CPT - 90371",2,473.09,370.26499999999999,267.44,473.09,118.27249999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81342",2,534,110.28,183.8,2261.92,133.5]
["UNICARE - UNICARE - CPT - 90670",2,749.99,725.45,700.91,749.99,187.4975]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81430",2,2063,720.38499999999999,1625,15761.12,515.75]
["UNICARE - UNICARE - CPT - 90674",2,72.349999999999994,72.34,72.33,72.349999999999994,18.087499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81431",2,863,301.26499999999999,679.57,6591.3,215.75]
["TUFTS - TUFTS PPO - CPT - 90651",2,898.26,864.33500000000004,830.41,898.26,224.565]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81596",2,92,32.340000000000003,53.9,700.23,23]
["TUFTS - TUFTS SELECT - CPT - 90714",2,63.91,61.674999999999997,59.44,63.91,15.977499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 82075",2,86,13.3,16.53,291,21.5]
["UNICARE - UNICARE - CPT - 90714",2,63.91,61.674999999999997,59.44,63.91,15.977499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 82962",2,12,1.45,2.42,31.83,3]
["UNICARE - UNICARE - CPT - 90732",2,383.29,320.21000000000004,257.13,383.29,95.822500000000005]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 84145",2,99,14.664999999999999,24.44,300.82,24.75]
["UNICARE - UNICARE - CPT - 90739",2,411.21,273.63,411.21,411.21,102.80249999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 87150",2,460,19.204999999999998,32.01,393.99,115]
["TUFTS - TUFTS SPIRIT - CPT - 83516",2,55,12.68,10.52,129.47999999999999,13.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 87493",2,120,19.204999999999998,32.01,393.99,30]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90371",2,473.09,370.26499999999999,267.44,473.09,118.27249999999999]
["TUFTS - TUFTS PPO - CPT - 99495",2,439,209.86,194.55,1179.72,109.75]
["TUFTS - TUFTS SPIRIT - CPT - 83520",2,63,19,12.76,167.51,15.75]
["TUFTS - TUFTS PPO - CPT - 99496",2,827,209.86,194.55,1179.72,206.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90672",2,81.53,80.009999999999991,78.489999999999995,81.53,20.3825]
["TUFTS - TUFTS SELECT - CPT - 90371",2,473.09,370.26499999999999,267.44,473.09,118.27249999999999]
["TUFTS - TUFTS SPIRIT - CPT - 83605",2,54,12.73,9.75,119.99,13.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 80048",2,226,10.15,7.71,94.96,56.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90694",2,180.47,180.42500000000001,180.38,180.47,45.1175]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 80051",2,91,8.41,6.4,78.7,22.75]
["TUFTS - TUFTS SELECT - CPT - 90756",2,67.58,67.58,67.58,67.58,16.895]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 80053",2,375,12.67,9.6300000000000008,118.56,93.75]
["TUFTS - TUFTS SELECT - CPT - 99495",2,439,104.44499999999999,194.55,1179.72,109.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 80061",2,131,16.07,12.21,150.31,32.75]
["TUFTS - TUFTS SPIRIT - CPT - 83655",2,58,13.32,11.05,135.91999999999999,14.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 80069",2,218,10.42,7.92,97.49,54.5]
["TUFTS - TUFTS SPIRIT - CPT - 83718",2,41,9.01,7.48,91.95,10.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 80178",2,34,7.93,6.03,74.22,8.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90756",2,67.58,67.58,67.58,67.58,16.895]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 81003",2,12,2.7,2.0499999999999998,25.23,3]
["TUFTS - TUFTS SPIRIT - CPT - 83721",2,44,11.55,8.6999999999999993,107.11,11]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 82010",2,40,9.8000000000000007,7.46,91.78,10]
["TUFTS - TUFTS SPIRIT - CPT - 80051",2,91,7.71,6.4,78.7,22.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 82040",2,26,5.94,4.51,55.55,6.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90670",2,749.99,725.45,700.91,749.99,187.4975]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 82042",2,26,9.34,5.75,75.44,6.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90674",2,72.349999999999994,72.34,72.33,72.349999999999994,18.087499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 82043",2,27,6.94,5.28,64.88,6.75]
["TUFTS - TUFTS SPIRIT - CPT - 80053",2,375,11.62,9.6300000000000008,118.56,93.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 82150",2,33,7.78,5.91,72.75,8.25]
["TUFTS - TUFTS SPIRIT - CPT - 80061",2,131,14.73,12.21,150.31,32.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 82247",2,26,6.02,4.57,56.28,6.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90714",2,63.91,61.674999999999997,59.44,63.91,15.977499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 82271",2,15,6.38,3.93,51.64,3.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90732",2,383.29,320.21000000000004,257.13,383.29,95.822500000000005]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 82274",2,159,19.100000000000001,14.51,178.59,39.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90739",2,411.21,323.81,411.21,411.21,102.80249999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 82310",2,26,6.19,4.71,57.87,6.5]
["TUFTS - TUFTS SPIRIT - CPT - 81003",2,12,2.48,2.0499999999999998,25.23,3]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 82330",2,69,16.420000000000002,12.47,153.49,17.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90756",2,67.58,67.58,67.58,67.58,16.895]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 82374",2,25,5.86,4.46,54.82,6.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 80051",2,91,14.76,6.4,78.7,22.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 82435",2,24,5.52,4.2,51.64,6]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 80061",2,131,28.2,12.21,150.31,32.75]
["TUFTS - TUFTS SPIRIT - CPT - 82550",2,33,7.16,5.94,73.12,8.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 80178",2,34,13.92,6.03,74.22,8.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90750",2,540.45000000000005,404.48500000000001,268.52,540.45000000000005,135.11250000000001]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 82010",2,40,17.21,7.46,91.78,10]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 82550",2,33,7.81,5.94,73.12,8.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 82042",2,26,16.38,5.75,75.44,6.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 82565",2,26,6.14,4.68,57.51,6.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 82150",2,33,13.65,5.91,72.75,8.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 82570",2,26,6.22,4.72,58.08,6.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 82271",2,15,11.2,3.93,51.64,3.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 82947",2,21,4.72,3.58,44.06,5.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 82310",2,26,10.87,4.71,57.87,6.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 82950",2,25,5.7,4.33,53.31,6.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 82374",2,25,10.28,4.46,54.82,6.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 82951",2,64,15.44,11.74,144.52000000000001,16]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 82465",2,23,9.16,3.97,48.83,5.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 82952",2,15,4.7,3.58,43.98,3.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 82550",2,33,13.71,5.94,73.12,8.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 82977",2,36,8.64,6.57,80.86,9]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 82570",2,26,10.91,4.72,58.08,6.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 82985",2,73,20.11,13.75,169.26,18.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 82950",2,25,10,4.33,53.31,6.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 83001",2,93,22.3,16.95,208.59,23.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 82952",2,15,8.26,3.58,43.98,3.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 83002",2,93,22.22,16.89,207.81,23.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 82985",2,73,35.299999999999997,13.75,169.26,18.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 83036",2,49,11.65,8.86,109.06,12.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 83002",2,93,39,16.89,207.81,23.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 83516",2,55,13.84,10.52,129.47999999999999,13.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 83516",2,55,24.28,10.52,129.47999999999999,13.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 83520",2,63,20.72,12.76,167.51,15.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 83605",2,54,24.37,9.75,119.99,13.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 83605",2,54,13.88,9.75,119.99,13.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 83718",2,41,17.25,7.48,91.95,10.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 83655",2,58,14.53,11.05,135.91999999999999,14.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 83880",2,169,82.68,30.96,384.74,42.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 83718",2,41,9.83,7.48,91.95,10.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 84075",2,26,10.91,4.72,58.08,6.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 83721",2,44,12.6,8.6999999999999993,107.11,11]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 84155",2,20,7.73,3.35,41.16,5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 83880",2,169,47.11,30.96,384.74,42.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 84295",2,25,10.130000000000001,4.3899999999999997,54.04,6.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 83986",2,20,4.3,3.27,40.229999999999997,5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 84450",2,26,10.91,4.72,58.08,6.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 84075",2,26,6.22,4.72,58.08,6.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 84478",2,29,12.09,5.24,64.44,7.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 84132",2,24,5.71,4.2,51.64,6]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 84550",2,24,9.52,4.12,50.7,6]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 84155",2,20,4.4000000000000004,3.35,41.16,5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 85014",2,12,4.99,2.16,26.61,3]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 84157",2,20,4.8,3.35,41.16,5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 85025",2,40,16.36,7.09,87.22,10]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 84295",2,25,5.77,4.3899999999999997,54.04,6.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 85610",2,21,9.0299999999999994,3.58,44.06,5.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 84443",2,84,20.16,15.33,188.7,21]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 86618",2,191,35.869999999999997,15.53,191.1,47.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 84450",2,26,6.22,4.72,58.08,6.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 86780",2,61,27.88,12.07,148.63999999999999,15.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 84460",2,27,6.36,4.83,59.46,6.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 87077",2,27,17.02,7.18,90.64,6.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 84478",2,29,6.89,5.24,64.44,7.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 87338",2,102,30.28,13.12,161.52000000000001,25.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90732",2,383.29,320.21000000000004,257.13,383.29,95.822500000000005]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 87449",2,57,25.23,10.94,134.54,14.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90739",2,411.21,323.81,411.21,411.21,102.80249999999999]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 87631",2,504,300.38,103.92,1440.32,126]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 84703",2,37,9.02,6.86,84.49,9.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 87801",2,310,147.84,64.03,787.98,77.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 85014",2,12,2.84,2.16,26.61,3]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 87899",2,94,33.840000000000003,11.87,155.81,23.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 85018",2,12,2.84,2.16,26.61,3]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 90674",2,72.349999999999994,72.34,72.33,72.349999999999994,18.087499999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 85025",2,40,9.32,7.09,87.22,10]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 90694",2,180.47,180.42500000000001,180.38,180.47,45.1175]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 85576",2,311,29.89,19.59,243.68,77.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90371",2,473.09,370.26499999999999,267.44,473.09,118.27249999999999]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 85610",2,21,5.15,3.58,44.06,5.25]
["TUFTS - TUFTS SPIRIT - CPT - 82040",2,26,5.44,4.51,55.55,6.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 86308",2,24,6.22,4.72,58.08,6]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90651",2,898.26,864.33500000000004,830.41,898.26,224.565]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 86618",2,191,20.440000000000001,15.53,191.1,47.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90672",2,81.53,80.009999999999991,78.489999999999995,81.53,20.3825]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 86701",2,44,10.67,8.11,99.73,11]
["TUFTS - TUFTS SPIRIT - CPT - 84155",2,20,4.04,3.35,41.16,5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 86780",2,61,15.89,12.07,148.63999999999999,15.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90694",2,180.47,180.42500000000001,180.38,180.47,45.1175]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 86803",2,58,17.12,13.01,160.13,14.5]
["TUFTS - TUFTS SPIRIT - CPT - 82247",2,26,5.52,4.57,56.28,6.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 87077",2,27,9.6999999999999993,7.18,90.64,6.75]
["TUFTS - TUFTS SPIRIT - CPT - 82271",2,15,5.85,3.93,51.64,3.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 87210",2,23,6.98,4.3,56.49,5.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 87338",2,102,17.260000000000002,13.12,161.52000000000001,25.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 84520",2,21,4.74,3.61,44.34,5.25]
["TUFTS - TUFTS SPIRIT - CPT - 82274",2,159,17.510000000000002,14.51,178.59,39.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 84550",2,24,5.42,4.12,50.7,6]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 82465",2,23,5.22,3.97,48.83,5.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90756",2,67.58,67.58,67.58,67.58,16.895]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 82523",2,62,22.42,17.05,209.77,15.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 90756",2,67.58,67.58,67.58,67.58,16.895]
["FALLON - FALLON SENIOR PLAN - CPT - 82465",2,23,4.3499999999999996,3.97,48.83,5.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 87210",2,23,8.44,4.3,56.49,5.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 80048",2,226,12.27,7.71,94.96,56.5]
["FALLON - FALLON SENIOR PLAN - CPT - 82523",2,62,18.68,17.05,209.77,15.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 83880",2,169,56.93,30.96,384.74,42.25]
["FALLON - FALLON SENIOR PLAN - CPT - 82550",2,33,6.51,5.94,73.12,8.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 90732",2,383.29,320.21000000000004,257.13,383.29,95.822500000000005]
["FALLON - FALLON SENIOR PLAN - CPT - 82565",2,26,5.12,4.68,57.51,6.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 83036",2,49,14.08,8.86,109.06,12.25]
["FALLON - FALLON SENIOR PLAN - CPT - 82570",2,26,5.18,4.72,58.08,6.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 82010",2,40,11.85,7.46,91.78,10]
["FALLON - FALLON SENIOR PLAN - CPT - 82947",2,21,3.93,3.58,44.06,5.25]
["TUFTS - TUFTS MEDICARE SCO - CPT - 87801",2,310,101.79,64.03,787.98,77.5]
["FALLON - FALLON SENIOR PLAN - CPT - 82950",2,25,4.75,4.33,53.31,6.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 87502",2,269,166.69,77.11,958.3,67.25]
["FALLON - FALLON SENIOR PLAN - CPT - 82951",2,64,12.87,11.74,144.52000000000001,16]
["FALLON - FALLON MEDICAID - CPT - 81235",2,1038,119.91,239.82,3148.12,259.5]
["FALLON - FALLON SENIOR PLAN - CPT - 82952",2,15,3.92,3.58,43.98,3.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82330",2,69,19.84,12.47,153.49,17.25]
["FALLON - FALLON SENIOR PLAN - CPT - 82977",2,36,7.2,6.57,80.86,9]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 84460",2,27,7.69,4.83,59.46,6.75]
["FALLON - FALLON SENIOR PLAN - CPT - 82985",2,73,16.760000000000002,13.75,169.26,18.25]
["FALLON - FALLON MEDICAID - CPT - 81261",2,737,90.3,180.6,2222.63,184.25]
["FALLON - FALLON SENIOR PLAN - CPT - 83001",2,93,18.579999999999998,16.95,208.59,23.25]
["TUFTS - TUFTS MEDICARE SCO - CPT - 82570",2,26,7.51,4.72,58.08,6.5]
["FALLON - FALLON SENIOR PLAN - CPT - 83002",2,93,18.52,16.89,207.81,23.25]
["TUFTS - TUFTS MEDICARE SCO - CPT - 85025",2,40,11.27,7.09,87.22,10]
["FALLON - FALLON SENIOR PLAN - CPT - 83036",2,49,9.7100000000000009,8.86,109.06,12.25]
["FALLON - FALLON MEDICAID - CPT - 81301",2,534,132.065,264.13,3380.71,133.5]
["FALLON - FALLON SENIOR PLAN - CPT - 83516",2,55,11.53,10.52,129.47999999999999,13.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 86701",2,44,15.47,8.11,99.73,11]
["FALLON - FALLON SENIOR PLAN - CPT - 83520",2,63,17.27,12.76,167.51,15.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 90670",2,749.99,725.45,700.91,749.99,187.4975]
["FALLON - FALLON SENIOR PLAN - CPT - 83605",2,54,11.57,9.75,119.99,13.5]
["FALLON - FALLON MEDICAID - CPT - 81206",2,684,74.78,149.56,1840.58,171]
["FALLON - FALLON SENIOR PLAN - CPT - 83655",2,58,12.11,11.05,135.91999999999999,14.5]
["TUFTS - TUFTS HMO - CPT - 90750",2,540.45000000000005,404.48500000000001,268.52,540.45000000000005,135.11250000000001]
["FALLON - FALLON SENIOR PLAN - CPT - 83718",2,41,8.19,7.48,91.95,10.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82040",2,26,7.18,4.51,55.55,6.5]
["FALLON - FALLON SENIOR PLAN - CPT - 83721",2,44,10.5,8.6999999999999993,107.11,11]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82947",2,21,5.7,3.58,44.06,5.25]
["FALLON - FALLON SENIOR PLAN - CPT - 83880",2,169,39.26,30.96,384.74,42.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 83986",2,20,5.19,3.27,40.229999999999997,5]
["FALLON - FALLON SENIOR PLAN - CPT - 83986",2,20,3.58,3.27,40.229999999999997,5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 85576",2,311,36.119999999999997,19.59,243.68,77.75]
["FALLON - FALLON SENIOR PLAN - CPT - 84075",2,26,5.18,4.72,58.08,6.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 87880",2,57,23.97,12.21,160.29,14.25]
["FALLON - FALLON SENIOR PLAN - CPT - 84132",2,24,4.76,4.2,51.64,6]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 90756",2,67.58,67.58,67.58,67.58,16.895]
["FALLON - FALLON SENIOR PLAN - CPT - 84155",2,20,3.67,3.35,41.16,5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 82310",2,26,7.48,4.71,57.87,6.5]
["FALLON - FALLON SENIOR PLAN - CPT - 84157",2,20,4,3.35,41.16,5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 83002",2,93,26.85,16.89,207.81,23.25]
["FALLON - FALLON SENIOR PLAN - CPT - 84295",2,25,4.8099999999999996,4.3899999999999997,54.04,6.25]
["TUFTS - TUFTS MEDICARE SCO - CPT - 84450",2,26,7.51,4.72,58.08,6.5]
["FALLON - FALLON SENIOR PLAN - CPT - 84443",2,84,16.8,15.33,188.7,21]
["TUFTS - TUFTS MEDICARE SCO - CPT - 87077",2,27,11.72,7.18,90.64,6.75]
["FALLON - FALLON SENIOR PLAN - CPT - 84450",2,26,5.18,4.72,58.08,6.5]
["FALLON - FALLON SENIOR PLAN - CPT - 82310",2,26,5.16,4.71,57.87,6.5]
["FALLON - FALLON SENIOR PLAN - CPT - 84460",2,27,5.3,4.83,59.46,6.75]
["TUFTS - TUFTS POS - CPT - 90672",2,81.53,80.009999999999991,78.489999999999995,81.53,20.3825]
["FALLON - FALLON SENIOR PLAN - CPT - 84478",2,29,5.74,5.24,64.44,7.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 85576",2,311,43.34,19.59,243.68,77.75]
["FALLON - FALLON SENIOR PLAN - CPT - 84520",2,21,3.95,3.61,44.34,5.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 87210",2,23,10.130000000000001,4.3,56.49,5.75]
["FALLON - FALLON SENIOR PLAN - CPT - 84550",2,24,4.5199999999999996,4.12,50.7,6]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 87880",2,57,28.76,12.21,160.29,14.25]
["FALLON - FALLON SENIOR PLAN - CPT - 84703",2,37,7.52,6.86,84.49,9.25]
["FALLON - FALLON MEDICAID - CPT - 36415",2,26,1.1100000000000001,2.2200000000000002,25.55,6.5]
["FALLON - FALLON SENIOR PLAN - CPT - 85014",2,12,2.37,2.16,26.61,3]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 86308",2,24,5.18,4.72,58.08,6]
["FALLON - FALLON SENIOR PLAN - CPT - 85018",2,12,2.37,2.16,26.61,3]
["TUFTS - TUFTS HMO - CPT - 90674",2,72.349999999999994,72.34,72.33,72.349999999999994,18.087499999999999]
["FALLON - FALLON SENIOR PLAN - CPT - 85025",2,40,7.77,7.09,87.22,10]
["FALLON - FALLON SENIOR PLAN - CPT - 82150",2,33,6.48,5.91,72.75,8.25]
["FALLON - FALLON SENIOR PLAN - CPT - 85576",2,311,24.91,19.59,243.68,77.75]
["TUFTS - TUFTS HMO - CPT - 98968",2,106,23.16,38.6,108.49,26.5]
["FALLON - FALLON SENIOR PLAN - CPT - 85610",2,21,4.29,3.58,44.06,5.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 80069",2,218,12.59,7.92,97.49,54.5]
["FALLON - FALLON SENIOR PLAN - CPT - 86308",2,24,5.18,4.72,58.08,6]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82247",2,26,7.28,4.57,56.28,6.5]
["FALLON - FALLON SENIOR PLAN - CPT - 86618",2,191,17.03,15.53,191.1,47.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82523",2,62,27.09,17.05,209.77,15.5]
["FALLON - FALLON SENIOR PLAN - CPT - 86701",2,44,8.89,8.11,99.73,11]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82977",2,36,10.44,6.57,80.86,9]
["FALLON - FALLON SENIOR PLAN - CPT - 86780",2,61,13.24,12.07,148.63999999999999,15.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 83655",2,58,17.559999999999999,11.05,135.91999999999999,14.5]
["FALLON - FALLON SENIOR PLAN - CPT - 86803",2,58,14.27,13.01,160.13,14.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 84157",2,20,5.8,3.35,41.16,5]
["FALLON - FALLON SENIOR PLAN - CPT - 87077",2,27,8.08,7.18,90.64,6.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 84703",2,37,10.9,6.86,84.49,9.25]
["FALLON - FALLON SENIOR PLAN - CPT - 87210",2,23,5.82,4.3,56.49,5.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 86701",2,44,12.89,8.11,99.73,11]
["FALLON - FALLON SENIOR PLAN - CPT - 87338",2,102,14.38,13.12,161.52000000000001,25.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 87502",2,269,138.91,77.11,958.3,67.25]
["FALLON - FALLON SENIOR PLAN - CPT - 87389",2,111,24.08,21.97,270.29000000000002,27.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 90670",2,749.99,725.45,700.91,749.99,187.4975]
["FALLON - FALLON SENIOR PLAN - CPT - 87449",2,57,11.98,10.94,134.54,14.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 90732",2,383.29,320.21000000000004,257.13,383.29,95.822500000000005]
["FALLON - FALLON SENIOR PLAN - CPT - 87502",2,269,95.8,77.11,958.3,67.25]
["TUFTS - TUFTS MEDICARE SCO - CPT - 80061",2,131,19.420000000000002,12.21,150.31,32.75]
["FALLON - FALLON SENIOR PLAN - CPT - 87631",2,504,142.63,103.92,1440.32,126]
["TUFTS - TUFTS MEDICARE SCO - CPT - 82150",2,33,9.4,5.91,72.75,8.25]
["FALLON - FALLON SENIOR PLAN - CPT - 87633",2,820,416.78,291.7,4678.75,205]
["TUFTS - TUFTS MEDICARE SCO - CPT - 82465",2,23,6.31,3.97,48.83,5.75]
["FALLON - FALLON SENIOR PLAN - CPT - 87801",2,310,70.2,64.03,787.98,77.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 82952",2,15,5.68,3.58,43.98,3.75]
["FALLON - FALLON SENIOR PLAN - CPT - 87880",2,57,16.53,12.21,160.29,14.25]
["TUFTS - TUFTS MEDICARE SCO - CPT - 83605",2,54,16.78,9.75,119.99,13.5]
["FALLON - FALLON SENIOR PLAN - CPT - 87899",2,94,16.07,11.87,155.81,23.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 84155",2,20,5.32,3.35,41.16,5]
["FALLON - FALLON SENIOR PLAN - CPT - 90371",2,473.09,370.26499999999999,267.44,473.09,118.27249999999999]
["TUFTS - TUFTS MEDICARE SCO - CPT - 84550",2,24,6.55,4.12,50.7,6]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 87389",2,111,24.08,21.97,270.29000000000002,27.75]
["TUFTS - TUFTS MEDICARE SCO - CPT - 86618",2,191,24.69,15.53,191.1,47.75]
["FALLON - FALLON SENIOR PLAN - CPT - 90670",2,749.99,725.45,700.91,749.99,187.4975]
["TUFTS - TUFTS MEDICARE SCO - CPT - 87449",2,57,17.37,10.94,134.54,14.25]
["FALLON - FALLON SENIOR PLAN - CPT - 90672",2,81.53,80.009999999999991,78.489999999999995,81.53,20.3825]
["FALLON - FALLON MEDICAID - CPT - 81274",2,175,102.61,205.22,2665.65,43.75]
["FALLON - FALLON SENIOR PLAN - CPT - 90674",2,72.349999999999994,72.34,72.33,72.349999999999994,18.087499999999999]
["FALLON - FALLON MEDICAID - CPT - 81291",2,434,24.14,48.28,633.76,108.5]
["FALLON - FALLON MEDICAID - CPT - 82075",2,86,11.085000000000001,16.53,291,21.5]
["FALLON - FALLON MEDICAID - CPT - 81305",2,223,65.484999999999999,130.97,1701.28,55.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 87449",2,57,11.98,10.94,134.54,14.25]
["FALLON - FALLON MEDICAID - CPT - 81342",2,534,91.9,183.8,2261.92,133.5]
["FALLON - FALLON SENIOR PLAN - CPT - 90694",2,180.47,180.42500000000001,180.38,180.47,45.1175]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 85018",2,12,4.12,2.16,26.61,3]
["FALLON - FALLON SENIOR PLAN - CPT - 90714",2,63.91,61.674999999999997,59.44,63.91,15.977499999999999]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 86308",2,24,9.01,4.72,58.08,6]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 87502",2,269,95.8,77.11,958.3,67.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 86803",2,58,24.83,13.01,160.13,14.5]
["FALLON - FALLON SENIOR PLAN - CPT - 90732",2,383.29,320.21000000000004,257.13,383.29,95.822500000000005]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 87389",2,111,41.9,21.97,270.29000000000002,27.75]
["FALLON - FALLON SENIOR PLAN - CPT - 90739",2,411.21,271.15499999999997,411.21,411.21,102.80249999999999]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 87633",2,820,725.2,291.7,4678.75,205]
["FALLON - FALLON MEDICAID - CPT - 82962",2,12,1.21,2.42,31.83,3]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 90371",2,473.09,370.26499999999999,267.44,473.09,118.27249999999999]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 87631",2,504,142.63,103.92,1440.32,126]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 90674",2,72.349999999999994,72.34,72.33,72.349999999999994,18.087499999999999]
["FALLON - FALLON SENIOR PLAN - CPT - 90756",2,67.58,67.58,67.58,67.58,16.895]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 90714",2,63.91,61.674999999999997,59.44,63.91,15.977499999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90371",2,473.09,370.26499999999999,267.44,473.09,118.27249999999999]
["FALLON - FALLON SENIOR PLAN - CPT - 82040",2,26,4.95,4.51,55.55,6.5]
["FALLON - FALLON MEDICAID - CPT - 84145",2,99,12.22,24.44,300.82,24.75]
["FALLON - FALLON SENIOR PLAN - CPT - 82042",2,26,7.78,5.75,75.44,6.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 87633",2,820,416.78,291.7,4678.75,205]
["TUFTS - TUFTS HMO - CPT - 90670",2,749.99,725.45,700.91,749.99,187.4975]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 87801",2,310,70.2,64.03,787.98,77.5]
["FALLON - FALLON MEDICAID - CPT - 81207",2,287,66.06,132.12,1625.92,71.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90651",2,898.26,864.33500000000004,830.41,898.26,224.565]
["FALLON - FALLON MEDICAID - CPT - 81240",2,434,24.27,48.54,637.1,108.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90670",2,749.99,725.45,700.91,749.99,187.4975]
["FALLON - FALLON SENIOR PLAN - CPT - 82247",2,26,5.0199999999999996,4.57,56.28,6.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90672",2,81.53,80.009999999999991,78.489999999999995,81.53,20.3825]
["TUFTS - TUFTS HMO - CPT - 98966",2,36,23.16,38.6,108.49,9]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90674",2,72.349999999999994,72.34,72.33,72.349999999999994,18.087499999999999]
["TUFTS - TUFTS HMO - CPT - 99495",2,439,235.41499999999999,194.55,1179.72,109.75]
["FALLON - FALLON MEDICAID - CPT - 87150",2,460,16.004999999999999,32.01,393.99,115]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 80053",2,375,15.31,9.6300000000000008,118.56,93.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 87880",2,57,16.53,12.21,160.29,14.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 81003",2,12,3.26,2.0499999999999998,25.23,3]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90694",2,180.47,180.42500000000001,180.38,180.47,45.1175]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82043",2,27,8.3800000000000008,5.28,64.88,6.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 87899",2,94,16.07,11.87,155.81,23.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82274",2,159,23.08,14.51,178.59,39.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 90371",2,473.09,370.26499999999999,267.44,473.09,118.27249999999999]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82435",2,24,6.67,4.2,51.64,6]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90714",2,63.91,61.674999999999997,59.44,63.91,15.977499999999999]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82565",2,26,7.42,4.68,57.51,6.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 86618",2,191,17.03,15.53,191.1,47.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82951",2,64,18.66,11.74,144.52000000000001,16]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90732",2,383.29,320.21000000000004,257.13,383.29,95.822500000000005]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 83001",2,93,26.94,16.95,208.59,23.25]
["FALLON - FALLON MEDICAID - CPT - 87493",2,120,16.004999999999999,32.01,393.99,30]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 83520",2,63,25.04,12.76,167.51,15.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90739",2,411.21,323.81,411.21,411.21,102.80249999999999]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 83721",2,44,15.23,8.6999999999999993,107.11,11]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 87077",2,27,8.08,7.18,90.64,6.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 84132",2,24,6.9,4.2,51.64,6]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 90670",2,749.99,725.45,700.91,749.99,187.4975]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 84443",2,84,24.36,15.33,188.7,21]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90750",2,540.45000000000005,404.48500000000001,268.52,540.45000000000005,135.11250000000001]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 84520",2,21,5.73,3.61,44.34,5.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90756",2,67.58,67.58,67.58,67.58,16.895]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 85018",2,12,3.44,2.16,26.61,3]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90371",2,473.09,370.26499999999999,267.44,473.09,118.27249999999999]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 86308",2,24,7.51,4.72,58.08,6]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 87210",2,23,5.82,4.3,56.49,5.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 86803",2,58,20.69,13.01,160.13,14.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 90672",2,81.53,80.009999999999991,78.489999999999995,81.53,20.3825]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 87389",2,111,34.92,21.97,270.29000000000002,27.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 90674",2,72.349999999999994,72.34,72.33,72.349999999999994,18.087499999999999]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 87633",2,820,604.33000000000004,291.7,4678.75,205]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90651",2,898.26,864.33500000000004,830.41,898.26,224.565]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 90371",2,473.09,370.26499999999999,267.44,473.09,118.27249999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90670",2,749.99,725.45,700.91,749.99,187.4975]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 90674",2,72.349999999999994,72.34,72.33,72.349999999999994,18.087499999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90672",2,81.53,80.009999999999991,78.489999999999995,81.53,20.3825]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 90714",2,63.91,61.674999999999997,59.44,63.91,15.977499999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90674",2,72.349999999999994,72.34,72.33,72.349999999999994,18.087499999999999]
["FALLON - FALLON SENIOR PLAN - CPT - 82274",2,159,15.92,14.51,178.59,39.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 87338",2,102,14.38,13.12,161.52000000000001,25.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 80051",2,91,10.16,6.4,78.7,22.75]
["FALLON - FALLON SENIOR PLAN - CPT - 80048",2,226,8.4600000000000009,7.71,94.96,56.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 80178",2,34,9.58,6.03,74.22,8.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90694",2,180.47,180.42500000000001,180.38,180.47,45.1175]
["TUFTS - TUFTS MEDICARE SCO - CPT - 82042",2,26,11.28,5.75,75.44,6.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 86701",2,44,8.89,8.11,99.73,11]
["TUFTS - TUFTS MEDICARE SCO - CPT - 82271",2,15,7.71,3.93,51.64,3.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 90694",2,180.47,180.42500000000001,180.38,180.47,45.1175]
["TUFTS - TUFTS MEDICARE SCO - CPT - 82374",2,25,7.08,4.46,54.82,6.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90714",2,63.91,61.674999999999997,59.44,63.91,15.977499999999999]
["TUFTS - TUFTS MEDICARE SCO - CPT - 82550",2,33,9.44,5.94,73.12,8.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 90714",2,63.91,61.674999999999997,59.44,63.91,15.977499999999999]
["TUFTS - TUFTS MEDICARE SCO - CPT - 82950",2,25,6.89,4.33,53.31,6.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90732",2,383.29,320.21000000000004,257.13,383.29,95.822500000000005]
["TUFTS - TUFTS MEDICARE SCO - CPT - 82985",2,73,24.3,13.75,169.26,18.25]
["FALLON - FALLON SENIOR PLAN - CPT - 80051",2,91,7.01,6.4,78.7,22.75]
["TUFTS - TUFTS MEDICARE SCO - CPT - 83516",2,55,16.72,10.52,129.47999999999999,13.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90739",2,411.21,323.81,411.21,411.21,102.80249999999999]
["TUFTS - TUFTS MEDICARE SCO - CPT - 83718",2,41,11.88,7.48,91.95,10.25]
["FALLON - FALLON SENIOR PLAN - CPT - 80053",2,375,10.56,9.6300000000000008,118.56,93.75]
["TUFTS - TUFTS MEDICARE SCO - CPT - 84075",2,26,7.51,4.72,58.08,6.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 86780",2,61,13.24,12.07,148.63999999999999,15.25]
["TUFTS - TUFTS MEDICARE SCO - CPT - 84295",2,25,6.97,4.3899999999999997,54.04,6.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90750",2,540.45000000000005,404.48500000000001,268.52,540.45000000000005,135.11250000000001]
["TUFTS - TUFTS MEDICARE SCO - CPT - 84478",2,29,8.32,5.24,64.44,7.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90756",2,67.58,67.58,67.58,67.58,16.895]
["TUFTS - TUFTS MEDICARE SCO - CPT - 85014",2,12,3.44,2.16,26.61,3]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 80048",2,226,18.27,7.71,94.96,56.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 85610",2,21,6.22,3.58,44.06,5.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 80051",2,91,15.13,6.4,78.7,22.75]
["TUFTS - TUFTS MEDICARE SCO - CPT - 86780",2,61,19.2,12.07,148.63999999999999,15.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 80053",2,375,22.8,9.6300000000000008,118.56,93.75]
["TUFTS - TUFTS MEDICARE SCO - CPT - 87338",2,102,20.85,13.12,161.52000000000001,25.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 80061",2,131,28.91,12.21,150.31,32.75]
["TUFTS - TUFTS MEDICARE SCO - CPT - 87631",2,504,206.81,103.92,1440.32,126]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 80069",2,218,18.739999999999998,7.92,97.49,54.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 87899",2,94,23.3,11.87,155.81,23.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 80178",2,34,14.27,6.03,74.22,8.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 90672",2,81.53,80.009999999999991,78.489999999999995,81.53,20.3825]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 81003",2,12,4.8600000000000003,2.0499999999999998,25.23,3]
["TUFTS - TUFTS MEDICARE SCO - CPT - 90694",2,180.47,180.42500000000001,180.38,180.47,45.1175]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 82010",2,40,17.64,7.46,91.78,10]
["TUFTS - TUFTS MEDICARE SCO - CPT - 90739",2,411.21,300.65499999999997,411.21,411.21,102.80249999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 82040",2,26,10.69,4.51,55.55,6.5]
["TUFTS - TUFTS POS - CPT - 90371",2,473.09,370.26499999999999,267.44,473.09,118.27249999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 82042",2,26,16.8,5.75,75.44,6.5]
["TUFTS - TUFTS POS - CPT - 90651",2,898.26,864.33500000000004,830.41,898.26,224.565]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 82043",2,27,12.48,5.28,64.88,6.75]
["FALLON - FALLON SENIOR PLAN - CPT - 82435",2,24,4.5999999999999996,4.2,51.64,6]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 82150",2,33,13.99,5.91,72.75,8.25]
["TUFTS - TUFTS POS - CPT - 90714",2,63.91,61.674999999999997,59.44,63.91,15.977499999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 82247",2,26,10.84,4.57,56.28,6.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 85014",2,12,4.12,2.16,26.61,3]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 82271",2,15,11.49,3.93,51.64,3.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 85025",2,40,13.52,7.09,87.22,10]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 82274",2,159,34.369999999999997,14.51,178.59,39.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 85610",2,21,7.46,3.58,44.06,5.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 82310",2,26,11.14,4.71,57.87,6.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 86618",2,191,29.63,15.53,191.1,47.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 82330",2,69,29.54,12.47,153.49,17.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 86780",2,61,23.04,12.07,148.63999999999999,15.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 82374",2,25,10.54,4.46,54.82,6.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 87077",2,27,14.06,7.18,90.64,6.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 82435",2,24,9.93,4.2,51.64,6]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 87338",2,102,25.02,13.12,161.52000000000001,25.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 82465",2,23,9.39,3.97,48.83,5.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 87449",2,57,20.85,10.94,134.54,14.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 82523",2,62,40.33,17.05,209.77,15.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 87631",2,504,248.18,103.92,1440.32,126]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 82550",2,33,14.06,5.94,73.12,8.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 87801",2,310,122.15,64.03,787.98,77.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 82565",2,26,11.05,4.68,57.51,6.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 87899",2,94,27.96,11.87,155.81,23.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 82570",2,26,11.18,4.72,58.08,6.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 90756",2,67.58,67.58,67.58,67.58,16.895]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 82947",2,21,8.48,3.58,44.06,5.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 90672",2,81.53,80.009999999999991,78.489999999999995,81.53,20.3825]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 82950",2,25,10.26,4.33,53.31,6.25]
["FALLON - FALLON SENIOR PLAN - CPT - 82010",2,40,8.17,7.46,91.78,10]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 82951",2,64,27.79,11.74,144.52000000000001,16]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 90694",2,180.47,180.42500000000001,180.38,180.47,45.1175]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 82952",2,15,8.4600000000000009,3.58,43.98,3.75]
["FALLON - FALLON MEDICAID - CPT - 81178",2,175,51.15,102.3,1328.77,43.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 82977",2,36,15.54,6.57,80.86,9]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 90739",2,411.21,319.65999999999997,411.21,411.21,102.80249999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 82985",2,73,36.18,13.75,169.26,18.25]
["FALLON - FALLON MEDICAID - CPT - 81179",2,175,51.15,102.3,1328.77,43.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 83001",2,93,40.11,16.95,208.59,23.25]
["TUFTS - TUFTS HMO - CPT - 90371",2,473.09,370.26499999999999,267.44,473.09,118.27249999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 83002",2,93,39.979999999999997,16.89,207.81,23.25]
["FALLON - FALLON MEDICAID - CPT - 81180",2,175,51.15,102.3,1328.77,43.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 83036",2,49,20.96,8.86,109.06,12.25]
["TUFTS - TUFTS HMO - CPT - 90651",2,898.26,864.33500000000004,830.41,898.26,224.565]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 83516",2,55,24.89,10.52,129.47999999999999,13.75]
["TUFTS - TUFTS HMO - CPT - 90672",2,81.53,80.009999999999991,78.489999999999995,81.53,20.3825]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 83520",2,63,37.29,12.76,167.51,15.75]
["FALLON - FALLON SENIOR PLAN - CPT - 82043",2,27,5.78,5.28,64.88,6.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 83605",2,54,24.98,9.75,119.99,13.5]
["FALLON - FALLON MEDICAID - CPT - 81210",2,492,64.8,129.6,1701.28,123]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 83655",2,58,26.15,11.05,135.91999999999999,14.5]
["TUFTS - TUFTS HMO - CPT - 90714",2,63.91,61.674999999999997,59.44,63.91,15.977499999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 83718",2,41,17.68,7.48,91.95,10.25]
["TUFTS - TUFTS HMO - CPT - 90732",2,383.29,320.21000000000004,257.13,383.29,95.822500000000005]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 83721",2,44,22.67,8.6999999999999993,107.11,11]
["TUFTS - TUFTS HMO - CPT - 90739",2,411.21,300.65499999999997,411.21,411.21,102.80249999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 83880",2,169,84.76,30.96,384.74,42.25]
["FALLON - FALLON MEDICAID - CPT - 81241",2,434,27.87,55.74,711.6,108.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 83986",2,20,7.73,3.27,40.229999999999997,5]
["TUFTS - TUFTS HMO - CPT - 90756",2,67.58,67.58,67.58,67.58,16.895]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 84075",2,26,11.18,4.72,58.08,6.5]
["TUFTS - TUFTS HMO - CPT - 98967",2,72,23.16,38.6,108.49,18]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 84132",2,24,10.28,4.2,51.64,6]
["TUFTS - TUFTS HMO - CPT - 99473",2,36,49.015000000000001,36.99,229.62,9]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 84155",2,20,7.92,3.35,41.16,5]
["TUFTS - TUFTS HMO - CPT - 99496",2,827,235.41499999999999,194.55,1179.72,206.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 84157",2,20,8.64,3.35,41.16,5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 80051",2,91,10.16,6.4,78.7,22.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 84295",2,25,10.38,4.3899999999999997,54.04,6.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 80061",2,131,19.420000000000002,12.21,150.31,32.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 84443",2,84,36.270000000000003,15.33,188.7,21]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 80178",2,34,9.58,6.03,74.22,8.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 84450",2,26,11.18,4.72,58.08,6.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82010",2,40,11.85,7.46,91.78,10]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 84460",2,27,11.44,4.83,59.46,6.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82042",2,26,11.28,5.75,75.44,6.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 84478",2,29,12.39,5.24,64.44,7.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82150",2,33,9.4,5.91,72.75,8.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 84520",2,21,8.5299999999999994,3.61,44.34,5.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82271",2,15,7.71,3.93,51.64,3.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 84550",2,24,9.76,4.12,50.7,6]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82310",2,26,7.48,4.71,57.87,6.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 84703",2,37,16.239999999999998,6.86,84.49,9.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82374",2,25,7.08,4.46,54.82,6.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 85014",2,12,5.12,2.16,26.61,3]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82465",2,23,6.31,3.97,48.83,5.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 85018",2,12,5.12,2.16,26.61,3]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82550",2,33,9.44,5.94,73.12,8.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 85025",2,40,16.78,7.09,87.22,10]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82570",2,26,7.51,4.72,58.08,6.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 85576",2,311,53.78,19.59,243.68,77.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82950",2,25,6.89,4.33,53.31,6.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 85610",2,21,9.26,3.58,44.06,5.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82952",2,15,5.68,3.58,43.98,3.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 86308",2,24,11.18,4.72,58.08,6]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82985",2,73,24.3,13.75,169.26,18.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 86618",2,191,36.770000000000003,15.53,191.1,47.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 83002",2,93,26.85,16.89,207.81,23.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 86701",2,44,19.190000000000001,8.11,99.73,11]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 83516",2,55,16.72,10.52,129.47999999999999,13.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 86780",2,61,28.59,12.07,148.63999999999999,15.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 83605",2,54,16.78,9.75,119.99,13.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 86803",2,58,30.81,13.01,160.13,14.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 83718",2,41,11.88,7.48,91.95,10.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 87077",2,27,17.440000000000001,7.18,90.64,6.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 83880",2,169,56.93,30.96,384.74,42.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 87210",2,23,12.57,4.3,56.49,5.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 84075",2,26,7.51,4.72,58.08,6.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 87338",2,102,31.05,13.12,161.52000000000001,25.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 84155",2,20,5.32,3.35,41.16,5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 87389",2,111,51.99,21.97,270.29000000000002,27.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 84295",2,25,6.97,4.3899999999999997,54.04,6.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 87449",2,57,25.86,10.94,134.54,14.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 84450",2,26,7.51,4.72,58.08,6.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 87502",2,269,206.83,77.11,958.3,67.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 84478",2,29,8.32,5.24,64.44,7.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 87631",2,504,307.94,103.92,1440.32,126]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 84550",2,24,6.55,4.12,50.7,6]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 87633",2,820,899.83,291.7,4678.75,205]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 85014",2,12,3.44,2.16,26.61,3]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 87801",2,310,151.56,64.03,787.98,77.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 85025",2,40,11.27,7.09,87.22,10]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 87880",2,57,35.69,12.21,160.29,14.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 85610",2,21,6.22,3.58,44.06,5.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 87899",2,94,34.700000000000003,11.87,155.81,23.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 86618",2,191,24.69,15.53,191.1,47.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 90371",2,473.09,370.26499999999999,267.44,473.09,118.27249999999999]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 86780",2,61,19.2,12.07,148.63999999999999,15.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 90732",2,383.29,320.21000000000004,257.13,383.29,95.822500000000005]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 87077",2,27,11.72,7.18,90.64,6.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 90670",2,749.99,725.45,700.91,749.99,187.4975]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 87338",2,102,20.85,13.12,161.52000000000001,25.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 90672",2,81.53,80.009999999999991,78.489999999999995,81.53,20.3825]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 87449",2,57,17.37,10.94,134.54,14.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 90674",2,72.349999999999994,72.34,72.33,72.349999999999994,18.087499999999999]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 87631",2,504,206.81,103.92,1440.32,126]
["FALLON - FALLON SENIOR PLAN - CPT - 80061",2,131,13.39,12.21,150.31,32.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 87801",2,310,101.79,64.03,787.98,77.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 90739",2,411.21,271.15499999999997,411.21,411.21,102.80249999999999]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 87899",2,94,23.3,11.87,155.81,23.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 90694",2,180.47,180.42500000000001,180.38,180.47,45.1175]
["FALLON - FALLON MEDICAID - CPT - 81256",2,434,29.81,59.62,733.73,108.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 90714",2,63.91,61.674999999999997,59.44,63.91,15.977499999999999]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 90672",2,81.53,80.009999999999991,78.489999999999995,81.53,20.3825]
["FALLON - FALLON SENIOR PLAN - CPT - 80069",2,218,8.68,7.92,97.49,54.5]
["FALLON - FALLON SENIOR PLAN - CPT - 82271",2,15,5.32,3.93,51.64,3.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 90732",2,383.29,320.21000000000004,257.13,383.29,95.822500000000005]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 90694",2,180.47,180.42500000000001,180.38,180.47,45.1175]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 90739",2,411.21,347.125,411.21,411.21,102.80249999999999]
["FALLON - FALLON MEDICAID - CPT - 81270",2,434,41.81,83.62,1029.05,108.5]
["FALLON - FALLON SENIOR PLAN - CPT - 80178",2,34,6.61,6.03,74.22,8.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 90739",2,411.21,300.65499999999997,411.21,411.21,102.80249999999999]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 86803",2,58,14.27,13.01,160.13,14.5]
["FALLON - FALLON MEDICAID - CPT - 81271",2,175,51.15,102.3,1328.77,43.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 90756",2,67.58,67.58,67.58,67.58,16.895]
["TUFTS - TUFTS MEDICARE SCO - CPT - 80048",2,226,12.27,7.71,94.96,56.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 80048",2,226,14.72,7.71,94.96,56.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 80053",2,375,15.31,9.6300000000000008,118.56,93.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 80051",2,91,12.2,6.4,78.7,22.75]
["TUFTS - TUFTS MEDICARE SCO - CPT - 80069",2,218,12.59,7.92,97.49,54.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 80053",2,375,18.37,9.6300000000000008,118.56,93.75]
["TUFTS - TUFTS MEDICARE SCO - CPT - 81003",2,12,3.26,2.0499999999999998,25.23,3]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 80061",2,131,23.3,12.21,150.31,32.75]
["TUFTS - TUFTS MEDICARE SCO - CPT - 82040",2,26,7.18,4.51,55.55,6.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 80069",2,218,15.1,7.92,97.49,54.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 82043",2,27,8.3800000000000008,5.28,64.88,6.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 80178",2,34,11.5,6.03,74.22,8.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 82247",2,26,7.28,4.57,56.28,6.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 81003",2,12,3.92,2.0499999999999998,25.23,3]
["TUFTS - TUFTS MEDICARE SCO - CPT - 82274",2,159,23.08,14.51,178.59,39.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 82010",2,40,14.22,7.46,91.78,10]
["TUFTS - TUFTS MEDICARE SCO - CPT - 82330",2,69,19.84,12.47,153.49,17.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 82040",2,26,8.61,4.51,55.55,6.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 82435",2,24,6.67,4.2,51.64,6]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 82042",2,26,13.54,5.75,75.44,6.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 82523",2,62,27.09,17.05,209.77,15.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 82043",2,27,10.06,5.28,64.88,6.75]
["TUFTS - TUFTS MEDICARE SCO - CPT - 82565",2,26,7.42,4.68,57.51,6.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 82150",2,33,11.28,5.91,72.75,8.25]
["TUFTS - TUFTS MEDICARE SCO - CPT - 82947",2,21,5.7,3.58,44.06,5.25]
["FALLON - FALLON SENIOR PLAN - CPT - 81003",2,12,2.25,2.0499999999999998,25.23,3]
["TUFTS - TUFTS MEDICARE SCO - CPT - 82951",2,64,18.66,11.74,144.52000000000001,16]
["TUFTS - TUFTS POS - CPT - 90750",2,540.45000000000005,404.48500000000001,268.52,540.45000000000005,135.11250000000001]
["TUFTS - TUFTS MEDICARE SCO - CPT - 82977",2,36,10.44,6.57,80.86,9]
["TUFTS - TUFTS POS - CPT - 98966",2,36,19.3,38.6,108.49,9]
["TUFTS - TUFTS MEDICARE SCO - CPT - 83001",2,93,26.94,16.95,208.59,23.25]
["TUFTS - TUFTS POS - CPT - 98968",2,106,19.3,38.6,108.49,26.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 83036",2,49,14.08,8.86,109.06,12.25]
["TUFTS - TUFTS POS - CPT - 99495",2,439,196.18,194.55,1179.72,109.75]
["TUFTS - TUFTS MEDICARE SCO - CPT - 83520",2,63,25.04,12.76,167.51,15.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 82374",2,25,8.49,4.46,54.82,6.25]
["TUFTS - TUFTS MEDICARE SCO - CPT - 83655",2,58,17.559999999999999,11.05,135.91999999999999,14.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 82435",2,24,8,4.2,51.64,6]
["TUFTS - TUFTS MEDICARE SCO - CPT - 83721",2,44,15.23,8.6999999999999993,107.11,11]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 82465",2,23,7.57,3.97,48.83,5.75]
["TUFTS - TUFTS MEDICARE SCO - CPT - 83986",2,20,5.19,3.27,40.229999999999997,5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 82523",2,62,32.5,17.05,209.77,15.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 84132",2,24,6.9,4.2,51.64,6]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 82550",2,33,11.33,5.94,73.12,8.25]
["TUFTS - TUFTS MEDICARE SCO - CPT - 84157",2,20,5.8,3.35,41.16,5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 82565",2,26,8.91,4.68,57.51,6.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 84443",2,84,24.36,15.33,188.7,21]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 82570",2,26,9.01,4.72,58.08,6.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 84460",2,27,7.69,4.83,59.46,6.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 82947",2,21,6.84,3.58,44.06,5.25]
["TUFTS - TUFTS MEDICARE SCO - CPT - 84520",2,21,5.73,3.61,44.34,5.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 82950",2,25,8.27,4.33,53.31,6.25]
["TUFTS - TUFTS MEDICARE SCO - CPT - 84703",2,37,10.9,6.86,84.49,9.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 82951",2,64,22.39,11.74,144.52000000000001,16]
["TUFTS - TUFTS MEDICARE SCO - CPT - 85018",2,12,3.44,2.16,26.61,3]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 82952",2,15,6.82,3.58,43.98,3.75]
["TUFTS - TUFTS MEDICARE SCO - CPT - 85576",2,311,36.119999999999997,19.59,243.68,77.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 82977",2,36,12.53,6.57,80.86,9]
["TUFTS - TUFTS MEDICARE SCO - CPT - 86308",2,24,7.51,4.72,58.08,6]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 82985",2,73,29.16,13.75,169.26,18.25]
["TUFTS - TUFTS MEDICARE SCO - CPT - 86701",2,44,12.89,8.11,99.73,11]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 83001",2,93,32.33,16.95,208.59,23.25]
["TUFTS - TUFTS MEDICARE SCO - CPT - 86803",2,58,20.69,13.01,160.13,14.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 83002",2,93,32.22,16.89,207.81,23.25]
["TUFTS - TUFTS MEDICARE SCO - CPT - 87210",2,23,8.44,4.3,56.49,5.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 83036",2,49,16.899999999999999,8.86,109.06,12.25]
["TUFTS - TUFTS MEDICARE SCO - CPT - 87389",2,111,34.92,21.97,270.29000000000002,27.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 83516",2,55,20.059999999999999,10.52,129.47999999999999,13.75]
["TUFTS - TUFTS MEDICARE SCO - CPT - 87502",2,269,138.91,77.11,958.3,67.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 83520",2,63,30.05,12.76,167.51,15.75]
["TUFTS - TUFTS MEDICARE SCO - CPT - 87633",2,820,604.33000000000004,291.7,4678.75,205]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 83605",2,54,20.13,9.75,119.99,13.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 87880",2,57,23.97,12.21,160.29,14.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 83655",2,58,21.07,11.05,135.91999999999999,14.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 90371",2,473.09,370.26499999999999,267.44,473.09,118.27249999999999]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 83718",2,41,14.25,7.48,91.95,10.25]
["TUFTS - TUFTS MEDICARE SCO - CPT - 90670",2,749.99,725.45,700.91,749.99,187.4975]
["TUFTS - TUFTS POS - CPT - 90732",2,383.29,320.21000000000004,257.13,383.29,95.822500000000005]
["TUFTS - TUFTS MEDICARE SCO - CPT - 90674",2,72.349999999999994,72.34,72.33,72.349999999999994,18.087499999999999]
["TUFTS - TUFTS POS - CPT - 90739",2,411.21,300.65499999999997,411.21,411.21,102.80249999999999]
["FALLON - FALLON MEDICAID - CPT - 81275",2,534,71.39,142.78,1874.37,133.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 83986",2,20,6.23,3.27,40.229999999999997,5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 90714",2,63.91,61.674999999999997,59.44,63.91,15.977499999999999]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 84075",2,26,9.01,4.72,58.08,6.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 90732",2,383.29,320.21000000000004,257.13,383.29,95.822500000000005]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 84132",2,24,8.2799999999999994,4.2,51.64,6]
["FALLON - FALLON SENIOR PLAN - CPT - 82330",2,69,13.68,12.47,153.49,17.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 84155",2,20,6.39,3.35,41.16,5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 90756",2,67.58,67.58,67.58,67.58,16.895]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 84157",2,20,6.96,3.35,41.16,5]
["FALLON - FALLON SENIOR PLAN - CPT - 82374",2,25,4.88,4.46,54.82,6.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 84295",2,25,8.3699999999999992,4.3899999999999997,54.04,6.25]
["FALLON - FALLON MEDICAID - CPT - 81315",2,675,94.55,189.1,2327.29,168.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 84443",2,84,29.23,15.33,188.7,21]
["TUFTS - TUFTS POS - CPT - 90670",2,749.99,725.45,700.91,749.99,187.4975]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 84450",2,26,9.01,4.72,58.08,6.5]
["TUFTS - TUFTS POS - CPT - 90674",2,72.349999999999994,72.34,72.33,72.349999999999994,18.087499999999999]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 84460",2,27,9.2200000000000006,4.83,59.46,6.75]
["FALLON - FALLON MEDICAID - CPT - 81329",2,174,51.15,102.3,1328.77,43.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 84478",2,29,9.99,5.24,64.44,7.25]
["FALLON - FALLON MEDICAID - CPT - 81430",2,2063,600.32000000000005,1625,15761.12,515.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 84520",2,21,6.87,3.61,44.34,5.25]
["FALLON - FALLON MEDICAID - CPT - 81431",2,863,251.05500000000001,679.57,6591.3,215.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 84550",2,24,7.86,4.12,50.7,6]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 84703",2,37,13.08,6.86,84.49,9.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 83721",2,44,18.27,8.6999999999999993,107.11,11]
["FALLON - FALLON MEDICAID - CPT - 81596",2,92,26.95,53.9,700.23,23]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 83880",2,169,68.31,30.96,384.74,42.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 82247",2,26,8.73,4.57,56.28,6.5]
["TUFTS - TUFTS POS - CPT - 90756",2,67.58,67.58,67.58,67.58,16.895]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 82271",2,15,9.26,3.93,51.64,3.75]
["TUFTS - TUFTS POS - CPT - 98967",2,72,19.3,38.6,108.49,18]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 82274",2,159,27.7,14.51,178.59,39.75]
["TUFTS - TUFTS POS - CPT - 99473",2,36,40.844999999999999,36.99,229.62,9]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 82310",2,26,8.98,4.71,57.87,6.5]
["TUFTS - TUFTS POS - CPT - 99496",2,827,196.18,194.55,1179.72,206.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 82330",2,69,23.8,12.47,153.49,17.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 90756",2,67.58,67.58,67.58,67.58,16.895]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90840",2,92,116.655,147.96,147.96,23]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 83721",2,44,10.5,8.6999999999999993,107.11,11]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 87077",2,27,8.08,7.18,90.64,6.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90849",2,121,129.095,22.66,214.2,30.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 82271",2,15,4.46,3.93,51.64,3.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90853",2,121,81.034999999999997,22.66,128.29,30.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 83002",2,93,18.52,16.89,207.81,23.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90867",2,390,445.31500000000005,423.72,2582.75,97.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 81003",2,12,2.25,2.0499999999999998,25.23,3]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90876",2,1070,184.94499999999999,235.11,235.11,267.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 87633",2,820,416.78,291.7,4678.75,205]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90882",2,218,150.83000000000001,158.44,894.84,54.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 84295",2,25,6.6,4.3899999999999997,54.04,6.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90887",2,231,144.72499999999999,183.64,183.64,57.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 84450",2,26,5.18,4.72,58.08,6.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 80048",2,226,18.7,7.71,94.96,56.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 84450",2,26,5.18,4.72,58.08,6.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 80051",2,91,15.49,6.4,78.7,22.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90833",2,27,122.435,155.30000000000001,155.30000000000001,6.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 80053",2,375,23.34,9.6300000000000008,118.56,93.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 82565",2,26,5.12,4.68,57.51,6.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 80061",2,131,29.59,12.21,150.31,32.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 85018",2,12,2.37,2.16,26.61,3]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 80069",2,218,19.18,7.92,97.49,54.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90838",2,27,204.655,260.17,260.17,6.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 80178",2,34,14.61,6.03,74.22,8.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 82985",2,73,20.68,13.75,169.26,18.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 81003",2,12,4.97,2.0499999999999998,25.23,3]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 86803",2,58,15.95,13.01,160.13,14.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 82010",2,40,18.05,7.46,91.78,10]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 83002",2,93,18.52,16.89,207.81,23.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 82040",2,26,10.94,4.51,55.55,6.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 82570",2,26,5.18,4.72,58.08,6.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 82042",2,26,17.190000000000001,5.75,75.44,6.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 83880",2,169,39.26,30.96,384.74,42.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 82043",2,27,12.77,5.28,64.88,6.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 85025",2,40,7.77,7.09,87.22,10]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 82150",2,33,14.32,5.91,72.75,8.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 87801",2,310,70.2,64.03,787.98,77.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 82247",2,26,11.09,4.57,56.28,6.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90670",2,749.99,725.45,700.91,749.99,187.4975]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 82271",2,15,11.76,3.93,51.64,3.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 82274",2,159,15.92,14.51,178.59,39.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 82274",2,159,35.18,14.51,178.59,39.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 83001",2,93,18.579999999999998,16.95,208.59,23.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 82310",2,26,11.4,4.71,57.87,6.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 84443",2,84,16.8,15.33,188.7,21]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 82330",2,69,30.23,12.47,153.49,17.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 86803",2,58,14.27,13.01,160.13,14.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 82374",2,25,10.78,4.46,54.82,6.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 90674",2,72.349999999999994,72.34,72.33,72.349999999999994,18.087499999999999]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 82435",2,24,10.17,4.2,51.64,6]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 80178",2,34,9.07,6.03,74.22,8.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 82465",2,23,9.61,3.97,48.83,5.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 82550",2,33,8.93,5.94,73.12,8.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 82523",2,62,41.28,17.05,209.77,15.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 83718",2,41,11.24,7.48,91.95,10.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 82550",2,33,14.39,5.94,73.12,8.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 85014",2,12,3.25,2.16,26.61,3]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 82565",2,26,11.31,4.68,57.51,6.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 87880",2,57,15.71,12.21,160.29,14.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 82570",2,26,11.45,4.72,58.08,6.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 82570",2,26,5.18,4.72,58.08,6.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 82947",2,21,8.68,3.58,44.06,5.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 83880",2,169,39.26,30.96,384.74,42.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 82950",2,25,10.5,4.33,53.31,6.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90739",2,411.21,280.98500000000001,411.21,411.21,102.80249999999999]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 82951",2,64,28.44,11.74,144.52000000000001,16]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 82952",2,15,3.92,3.58,43.98,3.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 82952",2,15,8.66,3.58,43.98,3.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 83605",2,54,11.57,9.75,119.99,13.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 82977",2,36,15.91,6.57,80.86,9]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 84155",2,20,3.67,3.35,41.16,5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 82985",2,73,37.04,13.75,169.26,18.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 84550",2,24,4.5199999999999996,4.12,50.7,6]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 83001",2,93,41.06,16.95,208.59,23.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 86618",2,191,17.03,15.53,191.1,47.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 83002",2,93,40.93,16.89,207.81,23.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 87449",2,57,11.98,10.94,134.54,14.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 83036",2,49,21.46,8.86,109.06,12.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90756",2,67.58,67.58,67.58,67.58,16.895]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 83516",2,55,25.48,10.52,129.47999999999999,13.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90834",2,164,163.995,40.369999999999997,214.2,41]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 83520",2,63,38.159999999999997,12.76,167.51,15.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 80053",2,375,10.56,9.6300000000000008,118.56,93.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 83605",2,54,25.57,9.75,119.99,13.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 82043",2,27,5.78,5.28,64.88,6.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 83655",2,58,26.76,11.05,135.91999999999999,14.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 82435",2,24,4.5999999999999996,4.2,51.64,6]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 83718",2,41,18.100000000000001,7.48,91.95,10.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 82951",2,64,12.87,11.74,144.52000000000001,16]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 83721",2,44,23.2,8.6999999999999993,107.11,11]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 83520",2,63,17.27,12.76,167.51,15.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 83880",2,169,86.76,30.96,384.74,42.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 84132",2,24,4.76,4.2,51.64,6]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 83986",2,20,7.91,3.27,40.229999999999997,5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 84520",2,21,3.95,3.61,44.34,5.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 84075",2,26,11.45,4.72,58.08,6.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 86308",2,24,5.18,4.72,58.08,6]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 84132",2,24,10.52,4.2,51.64,6]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 87389",2,111,24.08,21.97,270.29000000000002,27.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 84155",2,20,8.11,3.35,41.16,5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 90371",2,473.09,370.26499999999999,267.44,473.09,118.27249999999999]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 84157",2,20,8.84,3.35,41.16,5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 90714",2,63.91,61.674999999999997,59.44,63.91,15.977499999999999]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 84295",2,25,10.63,4.3899999999999997,54.04,6.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 80051",2,91,9.6199999999999992,6.4,78.7,22.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 84443",2,84,37.130000000000003,15.33,188.7,21]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 82042",2,26,7.1,5.75,75.44,6.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 84450",2,26,11.45,4.72,58.08,6.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 82374",2,25,6.7,4.46,54.82,6.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 84460",2,27,11.71,4.83,59.46,6.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 82950",2,25,6.51,4.33,53.31,6.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 84478",2,29,12.68,5.24,64.44,7.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 83516",2,55,15.71,10.52,129.47999999999999,13.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 84520",2,21,8.73,3.61,44.34,5.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 84075",2,26,7.1,4.72,58.08,6.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 84550",2,24,9.99,4.12,50.7,6]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 84478",2,29,7.88,5.24,64.44,7.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 84703",2,37,16.62,6.86,84.49,9.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 86308",2,24,7.1,4.72,58.08,6]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 85014",2,12,5.24,2.16,26.61,3]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 87389",2,111,30.84,21.97,270.29000000000002,27.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 85018",2,12,5.24,2.16,26.61,3]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 90670",2,749.99,725.45,700.91,749.99,187.4975]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 85025",2,40,17.170000000000002,7.09,87.22,10]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 90732",2,383.29,320.21000000000004,257.13,383.29,95.822500000000005]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 85576",2,311,55.05,19.59,243.68,77.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 82952",2,15,3.92,3.58,43.98,3.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 85610",2,21,9.48,3.58,44.06,5.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 83605",2,54,11.57,9.75,119.99,13.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 86308",2,24,11.45,4.72,58.08,6]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 84155",2,20,3.67,3.35,41.16,5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 86618",2,191,37.630000000000003,15.53,191.1,47.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 84550",2,24,4.5199999999999996,4.12,50.7,6]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 86701",2,44,19.649999999999999,8.11,99.73,11]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 82550",2,33,6.51,5.94,73.12,8.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 86780",2,61,29.26,12.07,148.63999999999999,15.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 82950",2,25,4.75,4.33,53.31,6.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 86803",2,58,31.53,13.01,160.13,14.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 82985",2,73,16.760000000000002,13.75,169.26,18.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 87077",2,27,17.86,7.18,90.64,6.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 83516",2,55,11.53,10.52,129.47999999999999,13.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 87210",2,23,12.86,4.3,56.49,5.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 83718",2,41,8.19,7.48,91.95,10.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 87338",2,102,31.78,13.12,161.52000000000001,25.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 84075",2,26,5.18,4.72,58.08,6.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 87389",2,111,53.21,21.97,270.29000000000002,27.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 84295",2,25,4.8099999999999996,4.3899999999999997,54.04,6.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 87449",2,57,26.47,10.94,134.54,14.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 84478",2,29,5.74,5.24,64.44,7.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 87502",2,269,211.71,77.11,958.3,67.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 85014",2,12,2.37,2.16,26.61,3]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 87631",2,504,315.2,103.92,1440.32,126]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 85610",2,21,4.29,3.58,44.06,5.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 87633",2,820,921.03,291.7,4678.75,205]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 86780",2,61,13.24,12.07,148.63999999999999,15.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 87801",2,310,155.13,64.03,787.98,77.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 87338",2,102,14.38,13.12,161.52000000000001,25.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 87880",2,57,36.53,12.21,160.29,14.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 87631",2,504,142.63,103.92,1440.32,126]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 87899",2,94,35.51,11.87,155.81,23.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 87899",2,94,16.07,11.87,155.81,23.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 90371",2,473.09,370.26499999999999,267.44,473.09,118.27249999999999]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 90672",2,81.53,80.009999999999991,78.489999999999995,81.53,20.3825]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90756",2,67.58,67.58,67.58,67.58,16.895]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 90694",2,180.47,180.42500000000001,180.38,180.47,45.1175]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 90670",2,749.99,725.45,700.91,749.99,187.4975]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 90739",2,411.21,271.15499999999997,411.21,411.21,102.80249999999999]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 90672",2,81.53,80.009999999999991,78.489999999999995,81.53,20.3825]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 80048",2,226,8.4600000000000009,7.71,94.96,56.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 90674",2,72.349999999999994,72.34,72.33,72.349999999999994,18.087499999999999]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 80069",2,218,8.68,7.92,97.49,54.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90732",2,383.29,320.21000000000004,257.13,383.29,95.822500000000005]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 82040",2,26,4.95,4.51,55.55,6.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90371",2,473.09,370.26499999999999,267.44,473.09,118.27249999999999]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 82247",2,26,5.0199999999999996,4.57,56.28,6.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 90694",2,180.47,180.42500000000001,180.38,180.47,45.1175]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 82330",2,69,13.68,12.47,153.49,17.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 90714",2,63.91,61.674999999999997,59.44,63.91,15.977499999999999]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 82523",2,62,18.68,17.05,209.77,15.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90714",2,63.91,61.674999999999997,59.44,63.91,15.977499999999999]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 82947",2,21,3.93,3.58,44.06,5.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 90732",2,383.29,320.21000000000004,257.13,383.29,95.822500000000005]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 82977",2,36,7.2,6.57,80.86,9]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 90739",2,411.21,350.46500000000003,411.21,411.21,102.80249999999999]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 83036",2,49,9.7100000000000009,8.86,109.06,12.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90739",2,411.21,280.98500000000001,411.21,411.21,102.80249999999999]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 83655",2,58,12.11,11.05,135.91999999999999,14.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90674",2,72.349999999999994,72.34,72.33,72.349999999999994,18.087499999999999]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 83986",2,20,3.58,3.27,40.229999999999997,5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 90756",2,67.58,67.58,67.58,67.58,16.895]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 84157",2,20,4,3.35,41.16,5]
["BMC HEALTHNET - BMCHN ACO - CPT - 36415",2,26,2.4300000000000002,2.2200000000000002,25.55,6.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 84460",2,27,5.3,4.83,59.46,6.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 81178",2,175,111.91500000000001,102.3,1328.77,43.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 84703",2,37,7.52,6.86,84.49,9.25]
["BMC HEALTHNET - BMCHN ACO - CPT - 81179",2,175,111.91500000000001,102.3,1328.77,43.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 85576",2,311,24.91,19.59,243.68,77.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 81180",2,175,111.91500000000001,102.3,1328.77,43.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 86701",2,44,8.89,8.11,99.73,11]
["BMC HEALTHNET - BMCHN ACO - CPT - 81206",2,684,163.62,149.56,1840.58,171]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 87210",2,23,5.82,4.3,56.49,5.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 81207",2,287,144.54,132.12,1625.92,71.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 87502",2,269,95.8,77.11,958.3,67.25]
["BMC HEALTHNET - BMCHN ACO - CPT - 81210",2,492,141.78,129.6,1701.28,123]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 87880",2,57,16.53,12.21,160.29,14.25]
["BMC HEALTHNET - BMCHN ACO - CPT - 81235",2,1038,262.36500000000001,239.82,3148.12,259.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 90670",2,749.99,725.45,700.91,749.99,187.4975]
["BMC HEALTHNET - BMCHN ACO - CPT - 81240",2,434,53.104999999999997,48.54,637.1,108.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90651",2,898.26,864.33500000000004,830.41,898.26,224.565]
["BMC HEALTHNET - BMCHN ACO - CPT - 81241",2,434,60.98,55.74,711.6,108.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 90732",2,383.29,320.21000000000004,257.13,383.29,95.822500000000005]
["BMC HEALTHNET - BMCHN ACO - CPT - 81256",2,434,65.224999999999994,59.62,733.73,108.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 90756",2,67.58,67.58,67.58,67.58,16.895]
["BMC HEALTHNET - BMCHN ACO - CPT - 81261",2,737,197.57499999999999,180.6,2222.63,184.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 80061",2,131,18.37,12.21,150.31,32.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 81270",2,434,91.48,83.62,1029.05,108.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 82010",2,40,11.21,7.46,91.78,10]
["BMC HEALTHNET - BMCHN ACO - CPT - 81271",2,175,111.91500000000001,102.3,1328.77,43.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 82150",2,33,8.89,5.91,72.75,8.25]
["BMC HEALTHNET - BMCHN ACO - CPT - 81274",2,175,224.51,205.22,2665.65,43.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 82310",2,26,7.08,4.71,57.87,6.5]
["BMC HEALTHNET - BMCHN ACO - CPT - 81275",2,534,156.19999999999999,142.78,1874.37,133.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 82465",2,23,5.97,3.97,48.83,5.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 81291",2,434,52.82,48.28,633.76,108.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 82570",2,26,7.1,4.72,58.08,6.5]
["BMC HEALTHNET - BMCHN ACO - CPT - 81301",2,534,288.95999999999998,264.13,3380.71,133.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 82952",2,15,3.95,3.58,43.98,3.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 81305",2,223,143.28,130.97,1701.28,55.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 83002",2,93,25.4,16.89,207.81,23.25]
["BMC HEALTHNET - BMCHN ACO - CPT - 81315",2,675,206.875,189.1,2327.29,168.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 83605",2,54,14.65,9.75,119.99,13.5]
["BMC HEALTHNET - BMCHN ACO - CPT - 81329",2,174,111.91500000000001,102.3,1328.77,43.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 83880",2,169,46.56,30.96,384.74,42.25]
["BMC HEALTHNET - BMCHN ACO - CPT - 81342",2,534,201.07499999999999,183.8,2261.92,133.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 84155",2,20,5.03,3.35,41.16,5]
["BMC HEALTHNET - BMCHN ACO - CPT - 81430",2,2063,1313.5,1625,15761.12,515.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 84450",2,26,7.1,4.72,58.08,6.5]
["BMC HEALTHNET - BMCHN ACO - CPT - 81431",2,863,549.30999999999995,679.57,6591.3,215.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 84550",2,24,6.2,4.12,50.7,6]
["BMC HEALTHNET - BMCHN ACO - CPT - 81596",2,92,58.965000000000003,53.9,700.23,23]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 85576",2,311,29.47,19.59,243.68,77.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 82075",2,86,24.254999999999999,16.53,291,21.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 86701",2,44,12.19,8.11,99.73,11]
["BMC HEALTHNET - BMCHN ACO - CPT - 82962",2,12,2.645,2.42,31.83,3]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 87210",2,23,5.86,4.3,56.49,5.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 84145",2,99,26.734999999999999,24.44,300.82,24.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 87502",2,269,77.11,77.11,958.3,67.25]
["BMC HEALTHNET - BMCHN ACO - CPT - 87150",2,460,35.020000000000003,32.01,393.99,115]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 90371",2,473.09,370.26499999999999,267.44,473.09,118.27249999999999]
["BMC HEALTHNET - BMCHN ACO - CPT - 87493",2,120,35.020000000000003,32.01,393.99,30]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 90674",2,72.349999999999994,72.34,72.33,72.349999999999994,18.087499999999999]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 85610",2,21,4.29,3.58,44.06,5.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 90714",2,63.91,61.674999999999997,59.44,63.91,15.977499999999999]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90672",2,81.53,80.009999999999991,78.489999999999995,81.53,20.3825]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90846",2,238,176.11500000000001,44.81,214.2,59.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90651",2,898.26,864.33500000000004,830.41,898.26,224.565]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 82950",2,25,4.75,4.33,53.31,6.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90670",2,749.99,725.45,700.91,749.99,187.4975]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 82985",2,73,16.760000000000002,13.75,169.26,18.25]
["BMC HEALTHNET - BMCHN MCO - CPT - 36415",2,26,1.1100000000000001,2.2200000000000002,25.55,6.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 83516",2,55,11.53,10.52,129.47999999999999,13.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 81178",2,175,51.15,102.3,1328.77,43.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 83718",2,41,8.19,7.48,91.95,10.25]
["BMC HEALTHNET - BMCHN MCO - CPT - 81179",2,175,51.15,102.3,1328.77,43.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 84075",2,26,5.18,4.72,58.08,6.5]
["BMC HEALTHNET - BMCHN MCO - CPT - 81180",2,175,51.15,102.3,1328.77,43.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 84295",2,25,4.8099999999999996,4.3899999999999997,54.04,6.25]
["BMC HEALTHNET - BMCHN MCO - CPT - 81206",2,684,74.78,149.56,1840.58,171]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 84478",2,29,5.74,5.24,64.44,7.25]
["BMC HEALTHNET - BMCHN MCO - CPT - 81207",2,287,66.06,132.12,1625.92,71.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 85014",2,12,2.37,2.16,26.61,3]
["BMC HEALTHNET - BMCHN MCO - CPT - 81210",2,492,64.8,129.6,1701.28,123]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 82523",2,62,18.68,17.05,209.77,15.5]
["BMC HEALTHNET - BMCHN MCO - CPT - 81235",2,1038,119.91,239.82,3148.12,259.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 82565",2,26,5.12,4.68,57.51,6.5]
["BMC HEALTHNET - BMCHN MCO - CPT - 81240",2,434,24.27,48.54,637.1,108.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 82947",2,21,3.93,3.58,44.06,5.25]
["BMC HEALTHNET - BMCHN MCO - CPT - 81241",2,434,27.87,55.74,711.6,108.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 82951",2,64,12.87,11.74,144.52000000000001,16]
["BMC HEALTHNET - BMCHN MCO - CPT - 81256",2,434,29.81,59.62,733.73,108.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 82977",2,36,7.2,6.57,80.86,9]
["BMC HEALTHNET - BMCHN MCO - CPT - 81261",2,737,90.3,180.6,2222.63,184.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 83001",2,93,18.579999999999998,16.95,208.59,23.25]
["BMC HEALTHNET - BMCHN MCO - CPT - 81270",2,434,41.81,83.62,1029.05,108.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 83036",2,49,9.7100000000000009,8.86,109.06,12.25]
["BMC HEALTHNET - BMCHN MCO - CPT - 81271",2,175,51.15,102.3,1328.77,43.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 83520",2,63,17.27,12.76,167.51,15.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 81274",2,175,102.61,205.22,2665.65,43.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 83655",2,58,12.11,11.05,135.91999999999999,14.5]
["BMC HEALTHNET - BMCHN MCO - CPT - 81275",2,534,71.39,142.78,1874.37,133.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 83721",2,44,10.5,8.6999999999999993,107.11,11]
["BMC HEALTHNET - BMCHN MCO - CPT - 81291",2,434,24.14,48.28,633.76,108.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 83986",2,20,3.58,3.27,40.229999999999997,5]
["BMC HEALTHNET - BMCHN MCO - CPT - 81301",2,534,132.065,264.13,3380.71,133.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 84132",2,24,4.76,4.2,51.64,6]
["BMC HEALTHNET - BMCHN MCO - CPT - 81305",2,223,65.484999999999999,130.97,1701.28,55.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 84157",2,20,4,3.35,41.16,5]
["BMC HEALTHNET - BMCHN MCO - CPT - 81315",2,675,94.55,189.1,2327.29,168.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 84443",2,84,16.8,15.33,188.7,21]
["BMC HEALTHNET - BMCHN MCO - CPT - 81329",2,174,51.15,102.3,1328.77,43.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 84460",2,27,5.3,4.83,59.46,6.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 81342",2,534,91.9,183.8,2261.92,133.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 84520",2,21,3.95,3.61,44.34,5.25]
["BMC HEALTHNET - BMCHN MCO - CPT - 81430",2,2063,600.32000000000005,1625,15761.12,515.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 84703",2,37,7.52,6.86,84.49,9.25]
["BMC HEALTHNET - BMCHN MCO - CPT - 81431",2,863,251.05500000000001,679.57,6591.3,215.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 85018",2,12,2.37,2.16,26.61,3]
["BMC HEALTHNET - BMCHN MCO - CPT - 81596",2,92,26.95,53.9,700.23,23]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 85576",2,311,24.91,19.59,243.68,77.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 82075",2,86,11.085000000000001,16.53,291,21.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 86308",2,24,5.18,4.72,58.08,6]
["BMC HEALTHNET - BMCHN MCO - CPT - 82962",2,12,1.21,2.42,31.83,3]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 86701",2,44,8.89,8.11,99.73,11]
["BMC HEALTHNET - BMCHN MCO - CPT - 84145",2,99,12.22,24.44,300.82,24.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 86803",2,58,14.27,13.01,160.13,14.5]
["BMC HEALTHNET - BMCHN MCO - CPT - 87150",2,460,16.004999999999999,32.01,393.99,115]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 87210",2,23,5.82,4.3,56.49,5.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 87493",2,120,16.004999999999999,32.01,393.99,30]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 87389",2,111,24.08,21.97,270.29000000000002,27.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90672",2,81.53,80.009999999999991,78.489999999999995,81.53,20.3825]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 87502",2,269,95.8,77.11,958.3,67.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90674",2,72.349999999999994,72.34,72.33,72.349999999999994,18.087499999999999]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 87633",2,820,416.78,291.7,4678.75,205]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90750",2,540.45000000000005,404.48500000000001,268.52,540.45000000000005,135.11250000000001]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 87880",2,57,16.53,12.21,160.29,14.25]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 36415",2,26,1.1100000000000001,2.2200000000000002,25.55,6.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 90371",2,473.09,370.26499999999999,267.44,473.09,118.27249999999999]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 81178",2,175,51.15,102.3,1328.77,43.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 90670",2,749.99,725.45,700.91,749.99,187.4975]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 81179",2,175,51.15,102.3,1328.77,43.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 90674",2,72.349999999999994,72.34,72.33,72.349999999999994,18.087499999999999]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 81180",2,175,51.15,102.3,1328.77,43.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90371",2,473.09,370.26499999999999,267.44,473.09,118.27249999999999]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 81206",2,684,74.78,149.56,1840.58,171]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 90714",2,63.91,61.674999999999997,59.44,63.91,15.977499999999999]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 81207",2,287,66.06,132.12,1625.92,71.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 90732",2,383.29,320.21000000000004,257.13,383.29,95.822500000000005]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 81210",2,492,64.8,129.6,1701.28,123]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90836",2,27,154.76,196.74,196.74,6.75]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 81235",2,1038,119.91,239.82,3148.12,259.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 90756",2,67.58,67.58,67.58,67.58,16.895]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 81240",2,434,24.27,48.54,637.1,108.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 80051",2,91,7.01,6.4,78.7,22.75]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 81241",2,434,27.87,55.74,711.6,108.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 80061",2,131,13.39,12.21,150.31,32.75]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 81256",2,434,29.81,59.62,733.73,108.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 80178",2,34,6.61,6.03,74.22,8.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 81261",2,737,90.3,180.6,2222.63,184.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 82010",2,40,8.17,7.46,91.78,10]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 81270",2,434,41.81,83.62,1029.05,108.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 82042",2,26,7.78,5.75,75.44,6.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 81271",2,175,51.15,102.3,1328.77,43.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 82150",2,33,6.48,5.91,72.75,8.25]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 81274",2,175,102.61,205.22,2665.65,43.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 82271",2,15,5.32,3.93,51.64,3.75]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 81275",2,534,71.39,142.78,1874.37,133.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 82310",2,26,5.16,4.71,57.87,6.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 81291",2,434,24.14,48.28,633.76,108.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 82374",2,25,4.88,4.46,54.82,6.25]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 81301",2,534,132.065,264.13,3380.71,133.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 82465",2,23,4.3499999999999996,3.97,48.83,5.75]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 81305",2,223,65.484999999999999,130.97,1701.28,55.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 82550",2,33,6.51,5.94,73.12,8.25]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 81315",2,675,94.55,189.1,2327.29,168.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 82570",2,26,5.18,4.72,58.08,6.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 81329",2,174,51.15,102.3,1328.77,43.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 82950",2,25,4.75,4.33,53.31,6.25]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 81342",2,534,91.9,183.8,2261.92,133.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 82952",2,15,3.92,3.58,43.98,3.75]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 81430",2,2063,600.32000000000005,1625,15761.12,515.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 82985",2,73,16.760000000000002,13.75,169.26,18.25]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 81431",2,863,251.05500000000001,679.57,6591.3,215.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 83002",2,93,18.52,16.89,207.81,23.25]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 81596",2,92,26.95,53.9,700.23,23]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 83516",2,55,11.53,10.52,129.47999999999999,13.75]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 82075",2,86,11.085000000000001,16.53,291,21.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 83605",2,54,11.57,9.75,119.99,13.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 82962",2,12,1.21,2.42,31.83,3]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 83718",2,41,8.19,7.48,91.95,10.25]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 84145",2,99,12.22,24.44,300.82,24.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 83880",2,169,39.26,30.96,384.74,42.25]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 87150",2,460,16.004999999999999,32.01,393.99,115]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 84075",2,26,5.18,4.72,58.08,6.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 87493",2,120,16.004999999999999,32.01,393.99,30]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 84155",2,20,3.67,3.35,41.16,5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90371",2,473.09,370.26499999999999,267.44,473.09,118.27249999999999]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 84295",2,25,4.8099999999999996,4.3899999999999997,54.04,6.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90694",2,180.47,180.42500000000001,180.38,180.47,45.1175]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 84450",2,26,5.18,4.72,58.08,6.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90694",2,180.47,180.42500000000001,180.38,180.47,45.1175]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 84478",2,29,5.74,5.24,64.44,7.25]
["BMC HEALTHNET - BMCHN QHP - CPT - 36415",2,26,1.33,2.2200000000000002,25.55,6.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 84550",2,24,4.5199999999999996,4.12,50.7,6]
["BMC HEALTHNET - BMCHN QHP - CPT - 81178",2,175,61.38,102.3,1328.77,43.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 85014",2,12,2.37,2.16,26.61,3]
["BMC HEALTHNET - BMCHN QHP - CPT - 81179",2,175,61.38,102.3,1328.77,43.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 85025",2,40,7.77,7.09,87.22,10]
["BMC HEALTHNET - BMCHN QHP - CPT - 81180",2,175,61.38,102.3,1328.77,43.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 85610",2,21,4.29,3.58,44.06,5.25]
["BMC HEALTHNET - BMCHN QHP - CPT - 81206",2,684,89.734999999999999,149.56,1840.58,171]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 86618",2,191,17.03,15.53,191.1,47.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 81207",2,287,79.27,132.12,1625.92,71.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 86780",2,61,13.24,12.07,148.63999999999999,15.25]
["BMC HEALTHNET - BMCHN QHP - CPT - 81210",2,492,77.760000000000005,129.6,1701.28,123]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 87077",2,27,8.08,7.18,90.64,6.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 81235",2,1038,143.88999999999999,239.82,3148.12,259.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 87338",2,102,14.38,13.12,161.52000000000001,25.5]
["BMC HEALTHNET - BMCHN QHP - CPT - 81240",2,434,29.125,48.54,637.1,108.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 87449",2,57,11.98,10.94,134.54,14.25]
["BMC HEALTHNET - BMCHN QHP - CPT - 81241",2,434,33.445,55.74,711.6,108.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 87631",2,504,142.63,103.92,1440.32,126]
["BMC HEALTHNET - BMCHN QHP - CPT - 81256",2,434,35.770000000000003,59.62,733.73,108.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 87801",2,310,70.2,64.03,787.98,77.5]
["BMC HEALTHNET - BMCHN QHP - CPT - 81261",2,737,108.36,180.6,2222.63,184.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 87899",2,94,16.07,11.87,155.81,23.5]
["BMC HEALTHNET - BMCHN QHP - CPT - 81270",2,434,50.17,83.62,1029.05,108.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90732",2,383.29,320.21000000000004,257.13,383.29,95.822500000000005]
["BMC HEALTHNET - BMCHN QHP - CPT - 81271",2,175,61.38,102.3,1328.77,43.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 90672",2,81.53,80.009999999999991,78.489999999999995,81.53,20.3825]
["BMC HEALTHNET - BMCHN QHP - CPT - 81274",2,175,123.13,205.22,2665.65,43.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90837",2,165,192.7,40.369999999999997,214.2,41.25]
["BMC HEALTHNET - BMCHN QHP - CPT - 81275",2,534,85.67,142.78,1874.37,133.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 90694",2,180.47,180.42500000000001,180.38,180.47,45.1175]
["BMC HEALTHNET - BMCHN QHP - CPT - 81291",2,434,28.97,48.28,633.76,108.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90670",2,749.99,725.45,700.91,749.99,187.4975]
["BMC HEALTHNET - BMCHN QHP - CPT - 81301",2,534,158.47999999999999,264.13,3380.71,133.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 90739",2,411.21,271.15499999999997,411.21,411.21,102.80249999999999]
["BMC HEALTHNET - BMCHN QHP - CPT - 81305",2,223,78.58,130.97,1701.28,55.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90672",2,81.53,80.009999999999991,78.489999999999995,81.53,20.3825]
["BMC HEALTHNET - BMCHN QHP - CPT - 81315",2,675,113.46,189.1,2327.29,168.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 80048",2,226,11.6,7.71,94.96,56.5]
["BMC HEALTHNET - BMCHN QHP - CPT - 81329",2,174,61.38,102.3,1328.77,43.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 80053",2,375,14.49,9.6300000000000008,118.56,93.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 81342",2,534,110.28,183.8,2261.92,133.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 80069",2,218,11.91,7.92,97.49,54.5]
["BMC HEALTHNET - BMCHN QHP - CPT - 81430",2,2063,720.38499999999999,1625,15761.12,515.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 81003",2,12,3.08,2.0499999999999998,25.23,3]
["BMC HEALTHNET - BMCHN QHP - CPT - 81431",2,863,301.26499999999999,679.57,6591.3,215.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 82040",2,26,6.79,4.51,55.55,6.5]
["BMC HEALTHNET - BMCHN QHP - CPT - 81596",2,92,32.340000000000003,53.9,700.23,23]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 82043",2,27,7.41,5.28,64.88,6.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 82075",2,86,13.3,16.53,291,21.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 82247",2,26,6.88,4.57,56.28,6.5]
["BMC HEALTHNET - BMCHN QHP - CPT - 82962",2,12,1.45,2.42,31.83,3]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 82274",2,159,20.329999999999998,14.51,178.59,39.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 84145",2,99,14.664999999999999,24.44,300.82,24.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 82330",2,69,18.760000000000002,12.47,153.49,17.25]
["BMC HEALTHNET - BMCHN QHP - CPT - 87150",2,460,19.204999999999998,32.01,393.99,115]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 82435",2,24,6.31,4.2,51.64,6]
["BMC HEALTHNET - BMCHN QHP - CPT - 87493",2,120,19.204999999999998,32.01,393.99,30]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 82523",2,62,17.5,17.05,209.77,15.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90750",2,540.45000000000005,404.48500000000001,268.52,540.45000000000005,135.11250000000001]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 82565",2,26,7.03,4.68,57.51,6.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90714",2,63.91,61.674999999999997,59.44,63.91,15.977499999999999]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 82947",2,21,5.39,3.58,44.06,5.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90651",2,898.26,864.33500000000004,830.41,898.26,224.565]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 82951",2,64,17.66,11.74,144.52000000000001,16]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90371",2,473.09,370.26499999999999,267.44,473.09,118.27249999999999]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 82977",2,36,9.8800000000000008,6.57,80.86,9]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90756",2,67.58,67.58,67.58,67.58,16.895]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 83001",2,93,25.49,16.95,208.59,23.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90732",2,383.29,320.21000000000004,257.13,383.29,95.822500000000005]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 83036",2,49,13.32,8.86,109.06,12.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90785",2,27,25.814999999999998,32.82,32.82,6.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 83520",2,63,17.760000000000002,12.76,167.51,15.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90651",2,898.26,864.33500000000004,830.41,898.26,224.565]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 83655",2,58,16.61,11.05,135.91999999999999,14.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90670",2,749.99,725.45,700.91,749.99,187.4975]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 83721",2,44,12.59,8.6999999999999993,107.11,11]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90672",2,81.53,80.009999999999991,78.489999999999995,81.53,20.3825]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 83986",2,20,4.91,3.27,40.229999999999997,5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90674",2,72.349999999999994,72.34,72.33,72.349999999999994,18.087499999999999]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 84132",2,24,6.31,4.2,51.64,6]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90791",2,165,192.97,40.369999999999997,214.2,41.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 84157",2,20,5.03,3.35,41.16,5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90739",2,411.21,280.98500000000001,411.21,411.21,102.80249999999999]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 84443",2,84,23.05,15.33,188.7,21]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90792",2,165,204.19,40.369999999999997,214.2,41.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 84460",2,27,7.27,4.83,59.46,6.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90714",2,63.91,61.674999999999997,59.44,63.91,15.977499999999999]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 84520",2,21,5.42,3.61,44.34,5.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90714",2,63.91,61.674999999999997,59.44,63.91,15.977499999999999]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 84703",2,37,10.32,6.86,84.49,9.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90750",2,540.45000000000005,404.48500000000001,268.52,540.45000000000005,135.11250000000001]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 85018",2,12,3.25,2.16,26.61,3]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90732",2,383.29,320.21000000000004,257.13,383.29,95.822500000000005]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 85610",2,21,5.39,3.58,44.06,5.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90832",2,125,149.77499999999998,31.86,214.2,31.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 86618",2,191,19.600000000000001,15.53,191.1,47.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90739",2,411.21,366.88,411.21,411.21,102.80249999999999]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 86780",2,61,18.16,12.07,148.63999999999999,15.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90694",2,180.47,180.42500000000001,180.38,180.47,45.1175]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 87077",2,27,7.18,7.18,90.64,6.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 90756",2,67.58,67.58,67.58,67.58,16.895]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 87338",2,102,15.74,13.12,161.52000000000001,25.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 80051",2,91,7.01,6.4,78.7,22.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 87449",2,57,15.71,10.94,134.54,14.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 80061",2,131,13.39,12.21,150.31,32.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 87631",2,504,103.92,103.92,1440.32,126]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 80178",2,34,6.61,6.03,74.22,8.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 87899",2,94,15.71,11.87,155.81,23.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 82010",2,40,8.17,7.46,91.78,10]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90674",2,72.349999999999994,72.34,72.33,72.349999999999994,18.087499999999999]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 82042",2,26,7.78,5.75,75.44,6.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 90672",2,81.53,80.009999999999991,78.489999999999995,81.53,20.3825]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 82150",2,33,6.48,5.91,72.75,8.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90839",2,153,196.315,40.369999999999997,214.2,38.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 82271",2,15,5.32,3.93,51.64,3.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 90694",2,180.47,180.42500000000001,180.38,180.47,45.1175]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 82310",2,26,5.16,4.71,57.87,6.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90845",2,153,168.5,40.369999999999997,214.2,38.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 82374",2,25,4.88,4.46,54.82,6.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 90739",2,411.21,271.15499999999997,411.21,411.21,102.80249999999999]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 82465",2,23,4.3499999999999996,3.97,48.83,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90847",2,281,179.01999999999998,44.81,214.2,70.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 82550",2,33,6.51,5.94,73.12,8.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 80048",2,226,8.4600000000000009,7.71,94.96,56.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 85025",2,40,7.77,7.09,87.22,10]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 80053",2,375,10.56,9.6300000000000008,118.56,93.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90750",2,540.45000000000005,404.48500000000001,268.52,540.45000000000005,135.11250000000001]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 80069",2,218,8.68,7.92,97.49,54.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90756",2,67.58,67.58,67.58,67.58,16.895]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 81003",2,12,2.25,2.0499999999999998,25.23,3]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 98966",2,36,54.244999999999997,38.6,108.49,9]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 82040",2,26,4.95,4.51,55.55,6.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 98967",2,72,54.244999999999997,38.6,108.49,18]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 82043",2,27,5.78,5.28,64.88,6.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 98968",2,106,54.244999999999997,38.6,108.49,26.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 82247",2,26,5.0199999999999996,4.57,56.28,6.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 99473",2,36,114.81,36.99,229.62,9]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 82274",2,159,15.92,14.51,178.59,39.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 99495",2,439,589.86,194.55,1179.72,109.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 82330",2,69,13.68,12.47,153.49,17.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 99496",2,827,589.86,194.55,1179.72,206.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 82435",2,24,4.5999999999999996,4.2,51.64,6]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 80048",2,226,8.4600000000000009,7.71,94.96,56.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 82523",2,62,18.68,17.05,209.77,15.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 80051",2,91,7.01,6.4,78.7,22.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 82565",2,26,5.12,4.68,57.51,6.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 80053",2,375,10.56,9.6300000000000008,118.56,93.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 82947",2,21,3.93,3.58,44.06,5.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 80061",2,131,13.39,12.21,150.31,32.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 82951",2,64,12.87,11.74,144.52000000000001,16]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 80069",2,218,8.68,7.92,97.49,54.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 82977",2,36,7.2,6.57,80.86,9]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 80178",2,34,6.61,6.03,74.22,8.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 83001",2,93,18.579999999999998,16.95,208.59,23.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 81003",2,12,2.25,2.0499999999999998,25.23,3]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 83036",2,49,9.7100000000000009,8.86,109.06,12.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 82010",2,40,8.17,7.46,91.78,10]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 83520",2,63,17.27,12.76,167.51,15.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 82040",2,26,4.95,4.51,55.55,6.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 83655",2,58,12.11,11.05,135.91999999999999,14.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 82042",2,26,7.78,5.75,75.44,6.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 83721",2,44,10.5,8.6999999999999993,107.11,11]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 82043",2,27,5.78,5.28,64.88,6.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 83986",2,20,3.58,3.27,40.229999999999997,5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 82150",2,33,6.48,5.91,72.75,8.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 84132",2,24,4.76,4.2,51.64,6]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 82247",2,26,5.0199999999999996,4.57,56.28,6.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 84157",2,20,4,3.35,41.16,5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 82271",2,15,5.32,3.93,51.64,3.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 84443",2,84,16.8,15.33,188.7,21]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 82274",2,159,15.92,14.51,178.59,39.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 84460",2,27,5.3,4.83,59.46,6.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 82310",2,26,5.16,4.71,57.87,6.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 84520",2,21,3.95,3.61,44.34,5.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 82330",2,69,13.68,12.47,153.49,17.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 84703",2,37,7.52,6.86,84.49,9.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 82374",2,25,4.88,4.46,54.82,6.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 85018",2,12,2.37,2.16,26.61,3]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 82435",2,24,4.5999999999999996,4.2,51.64,6]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 82465",2,23,4.3499999999999996,3.97,48.83,5.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 85576",2,311,24.91,19.59,243.68,77.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 90651",2,898.26,864.33500000000004,830.41,898.26,224.565]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 82985",2,73,42.17,13.75,169.26,18.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 83655",2,58,14.29,11.05,135.91999999999999,14.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 86803",2,58,16.84,13.01,160.13,14.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 86780",2,61,33.31,12.07,148.63999999999999,15.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 87077",2,27,9.5299999999999994,7.18,90.64,6.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 83605",2,54,13.65,9.75,119.99,13.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 87210",2,23,6.87,4.3,56.49,5.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 82271",2,15,13.39,3.93,51.64,3.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 87338",2,102,16.97,13.12,161.52000000000001,25.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 84295",2,25,12.1,4.3899999999999997,54.04,6.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 87389",2,111,28.41,21.97,270.29000000000002,27.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 90672",2,81.53,80.009999999999991,78.489999999999995,81.53,20.3825]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 87449",2,57,14.14,10.94,134.54,14.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90739",2,411.21,280.98500000000001,411.21,411.21,102.80249999999999]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 87502",2,269,113.04,77.11,958.3,67.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 82330",2,69,16.14,12.47,153.49,17.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 87631",2,504,168.3,103.92,1440.32,126]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 80178",2,34,16.63,6.03,74.22,8.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 87633",2,820,491.8,291.7,4678.75,205]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 82550",2,33,16.38,5.94,73.12,8.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 87801",2,310,82.84,64.03,787.98,77.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 83718",2,41,20.61,7.48,91.95,10.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 87880",2,57,19.510000000000002,12.21,160.29,14.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 85014",2,12,5.96,2.16,26.61,3]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 87899",2,94,18.96,11.87,155.81,23.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 87631",2,504,358.89,103.92,1440.32,126]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 90371",2,473.09,370.26499999999999,267.44,473.09,118.27249999999999]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 90739",2,411.21,370.53999999999996,411.21,411.21,102.80249999999999]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 82947",2,21,4.6399999999999997,3.58,44.06,5.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90714",2,63.91,61.674999999999997,59.44,63.91,15.977499999999999]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 90670",2,749.99,725.45,700.91,749.99,187.4975]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90756",2,67.58,67.58,67.58,67.58,16.895]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 90672",2,81.53,80.009999999999991,78.489999999999995,81.53,20.3825]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90674",2,72.349999999999994,72.34,72.33,72.349999999999994,18.087499999999999]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 90674",2,72.349999999999994,72.34,72.33,72.349999999999994,18.087499999999999]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90732",2,383.29,320.21000000000004,257.13,383.29,95.822500000000005]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 84132",2,24,5.62,4.2,51.64,6]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 80051",2,91,17.64,6.4,78.7,22.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 80053",2,375,12.46,9.6300000000000008,118.56,93.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 87801",2,310,176.64,64.03,787.98,77.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 82951",2,64,15.19,11.74,144.52000000000001,16]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 80053",2,375,26.57,9.6300000000000008,118.56,93.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 82985",2,73,19.78,13.75,169.26,18.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 86780",2,61,15.62,12.07,148.63999999999999,15.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 99153",1,55,0,28.2,28.2,13.75]
["TUFTS - TUFTS PPO - CPT - 86707",1,56,46.21,10.55,129.88999999999999,14]
["TUFTS - TUFTS PPO - CPT - 86817",1,296,366.24,78.42,1029.42,74]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 54220",1,1009,499.64,388.64,3264.67,252.25]
["TUFTS - TUFTS PPO - CPT - 87150",1,460,140.16999999999999,32.01,393.99,115]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 40530",1,3896,4229.1400000000003,1500.85,7703.8,974]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 21048",1,6641,8596.73,1500.85,8596.73,1660.25]
["TUFTS - TUFTS PPO - CPT - 87507",1,588,1664.59,291.7,4678.75,147]
["TUFTS - TUFTS PPO - CPT - 87901",1,675,1028.22,112.85,2890.09,168.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 97116",1,139,48.21,48.21,191.22,34.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 67912",1,3788,3435.75,1990.62,11845.41,947]
["TUFTS - TUFTS PPO - CPT - 88368",1,699,874.55,129.21,2458.16,174.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 86789",1,79,30.31,13.13,161.6,19.75]
["TUFTS - TUFTS PPO - CPT - 76776",1,1458,474.37,147.96,1333.33,364.5]
["TUFTS - TUFTS PPO - CPT - 90837",1,165,46.18,40.369999999999997,214.2,41.25]
["TUFTS - TUFTS PPO - CPT - 90853",1,121,25.93,22.66,128.29,30.25]
["UNICARE - UNICARE - CPT - 86705",1,60,28.57,10.74,132.21,15]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 43201",1,2394,1010.64,1010.64,3264.67,598.5]
["TUFTS - TUFTS PPO - CPT - 92310",1,20,116.57,58.01,751.68,5]
["TUFTS - TUFTS PPO - CPT - 92556",1,181,119.77,53.94,336.64,45.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 26116",1,4035,2607.12,1500.85,7703.8,1008.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 43249",1,1743,2811.55,1010.64,3264.67,435.75]
["TUFTS - TUFTS PPO - CPT - 92924",1,10821,23407.53,12498.68,37129.18,2705.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 87660",1,157,46.92,18.29,225.1,39.25]
["TUFTS - TUFTS PPO - CPT - 93295",1,545,159.34,78.260000000000005,447.87,136.25]
["TUFTS - TUFTS PPO - CPT - 93321",1,224,0,51.85,225.94,56]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 31820",1,3301,4335.57,1098.98,4335.57,825.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 42725",1,7214,8596.73,1500.85,8596.73,1803.5]
["TUFTS - TUFTS PPO - CPT - 93788",1,123,383.21,126.22,1077.0999999999999,30.75]
["TUFTS - TUFTS PPO - CPT - 93892",1,3107,397.63,188.94,1117.6500000000001,776.75]
["TUFTS - TUFTS PPO - CPT - 94003",1,602,1706.43,300.91000000000003,4796.37,150.5]
["UNICARE - UNICARE - CPT - 78582",1,3009,629.03,524.19000000000005,5502.59,752.25]
["TUFTS - TUFTS PPO - CPT - 95117",1,86,137.81,63.62,218.59,21.5]
["UNICARE - UNICARE - CPT - 93880",1,2300,360.83,300.69,2134.23,575]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 45337",1,1099,420.29,420.29,3264.67,274.75]
["TUFTS - TUFTS PPO - CPT - 95940",1,854,0,80.3,80.3,213.5]
["TUFTS - TUFTS PPO - CPT - 95983",1,57,318.01,62.4,504.44,14.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 87075",1,41,19.149999999999999,8.64,106.25,10.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 94450",1,390,117.36,117.36,1412.44,97.5]
["TUFTS - TUFTS PPO - CPT - 96417",1,316,217.91,100.35,612.48,79]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 27372",1,3089,4507.8100000000004,2531.06,15242.01,772.25]
["TUFTS - TUFTS PPO - CPT - 97156",1,378,81.69,56.05,129.58000000000001,94.5]
["TUFTS - TUFTS PPO - CPT - 76817",1,974,456.92,147.96,1284.3,243.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 65205",1,337,224.25,178.83,943.8,84.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 67505",1,385,597.09,476.13,2032.26,96.25]
["TUFTS - TUFTS PPO - CPT - 76820",1,387,419.73,147.96,1179.76,96.75]
["TUFTS - TUFTS PPO - CPT - 76821",1,921,453.34,147.96,1274.24,230.25]
["TUFTS - TUFTS SELECT - CPT - 10010",1,436,0,204.55,1198.25,109]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90633",1,118.96,118.96,118.96,118.96,29.74]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 81207",1,287,305.02999999999997,132.12,1625.92,71.75]
["TUFTS - TUFTS SELECT - CPT - 11426",1,2987,2593.31,1500.85,7703.8,746.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 86850",1,87,20.58,5.25,501.09,21.75]
["TUFTS - TUFTS SELECT - CPT - 11922",1,371,0,73.66,1198.25,92.75]
["TUFTS - TUFTS SELECT - CPT - 12018",1,260,2593.31,296.32,7703.8,65]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 36415",1,26,0,2.2200000000000002,25.55,6.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 44364",1,2394,2882.31,1013.38,7703.8,598.5]
["TUFTS - TUFTS SELECT - CPT - 15277",1,2192,684.11,684.11,3344.2,548]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 76506",1,1185,193.63,147.96,1274.24,296.25]
["TUFTS - TUFTS SELECT - CPT - 17311",1,2913,684.11,684.11,2032.26,728.25]
["TUFTS - TUFTS SELECT - CPT - 19100",1,709,684.11,684.11,2672.73,177.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 91034",1,968,982.93,764.57,4807.5,242]
["UNICARE - UNICARE - CPT - 76828",1,425,171.11,142.59,1307.74,106.25]
["TUFTS - TUFTS SELECT - CPT - 21025",1,5755,2593.31,1500.85,8596.73,1438.75]
["TUFTS - TUFTS SELECT - CPT - 21083",1,4030,5730.6,3747.12,17023.61,1007.5]
["TUFTS - TUFTS SELECT - CPT - 21235",1,2622,5130.87,2531.06,15242.01,655.5]
["UNICARE - UNICARE - CPT - 86701",1,44,21.56,8.11,99.73,11]
["UNICARE - UNICARE - CPT - 87902",1,437,199.7,112.85,2890.09,109.25]
["TUFTS - TUFTS SELECT - CPT - 23505",1,1738,1098.98,1098.98,3264.67,434.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 29882",1,4072,2306.5300000000002,1990.62,7703.8,1018]
["TUFTS - TUFTS SELECT - CPT - 25535",1,3469,1098.98,378,3264.67,867.25]
["TUFTS - TUFTS SELECT - CPT - 26011",1,1418,1098.98,1098.98,3264.67,354.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 77316",1,909,160.66,160.66,2582.9899999999998,227.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 81210",1,492,265.29000000000002,129.6,1701.28,123]
["TUFTS - TUFTS SELECT - CPT - 27328",1,4466,3987.49,1990.62,11845.41,1116.5]
["TUFTS - TUFTS SELECT - CPT - 27605",1,2895,1098.98,1098.98,3264.67,723.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 87510",1,157,40.56,18.29,225.1,39.25]
["TUFTS - TUFTS SELECT - CPT - 28220",1,2837,1098.98,1098.98,3264.67,709.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 95908",1,582,282.57,282.57,1457.53,145.5]
["TUFTS - TUFTS SELECT - CPT - 28570",1,321,1098.98,378,3264.67,80.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 15050",1,3469,1016.97,684.11,2032.26,867.25]
["TUFTS - TUFTS SELECT - CPT - 29730",1,199,239.79,226.08,764.24,49.75]
["TUFTS - TUFTS SELECT - CPT - 30580",1,6512,3987.49,2166.09,11845.41,1628]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 30300",1,993,224.25,178.83,943.8,248.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 37237",1,7580,0,525.59,1198.25,1895]
["TUFTS - TUFTS SELECT - CPT - 32550",1,4154,2593.31,1500.85,7703.8,1038.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 46050",1,756,1568.74,684.11,2032.26,189]
["TUFTS - TUFTS SELECT - CPT - 33244",1,6372,2593.31,2166.09,7703.8,1593]
["TUFTS - TUFTS SELECT - CPT - 36013",1,998,0,299.61,1198.25,249.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 69020",1,1130,1220.0899999999999,317.70999999999998,1250.8,282.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 73720",1,5507,664.1,664.1,4299.8,1376.75]
["TUFTS - TUFTS SELECT - CPT - 36570",1,4122,2593.31,1990.62,7703.8,1030.5]
["TUFTS - TUFTS SELECT - CPT - 36591",1,192,190.66,178.83,607.66,48]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 82523",1,62,48.59,17.05,209.77,15.5]
["TUFTS - TUFTS SELECT - CPT - 37230",1,16686,21120.9,2166.09,62742.78,4171.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 85260",1,91,41.89,16.329999999999998,200.93,22.75]
["TUFTS - TUFTS SELECT - CPT - 38220",1,1103,1098.98,1098.98,3264.67,275.75]
["TUFTS - TUFTS SELECT - CPT - 40840",1,6641,2593.31,1500.85,8596.73,1660.25]
["TUFTS - TUFTS SELECT - CPT - 41113",1,2737,2593.31,1500.85,7703.8,684.25]
["TUFTS - TUFTS SELECT - CPT - 41820",1,4466,3987.49,1198.25,11845.41,1116.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 81252",1,153,212.96,101.12,254.44,38.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 82379",1,52,35.53,14.65,189.43,13]
["TUFTS - TUFTS SELECT - CPT - 43236",1,1347,1098.98,1010.64,3264.67,336.75]
["TUFTS - TUFTS SELECT - CPT - 43265",1,4415,2593.31,1500.85,8736.31,1103.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 0505T",1,14877,18787.919999999998,2166.09,18787.919999999998,3719.25]
["TUFTS - TUFTS SELECT - CPT - 45300",1,794,1098.98,420.29,3264.67,198.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 19350",1,2893,5471.79,2166.09,11845.41,723.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 26650",1,4072,5097.42,1500.85,7703.8,1018]
["TUFTS - TUFTS SELECT - CPT - 47000",1,1304,1098.98,1098.98,3264.67,326]
["TUFTS - TUFTS SELECT - CPT - 47554",1,5522,3987.49,1990.62,11845.41,1380.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 41018",1,2007,2485.42,1098.98,3264.67,501.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 43212",1,4077,8736.31,1098.98,8736.31,1019.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 51728",1,2386,1213.9000000000001,944.22,3176.09,596.5]
["TUFTS - TUFTS SELECT - CPT - 51728",1,2386,996.53,944.22,3176.09,596.5]
["TUFTS - TUFTS SELECT - CPT - 54050",1,794,317.70999999999998,317.70999999999998,943.8,198.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 68801",1,830,751.68,171.09,751.68,207.5]
["TUFTS - TUFTS SELECT - CPT - 56606",1,230,0,72.959999999999994,1198.25,57.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 76873",1,1622,193.63,147.96,1373.56,405.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 78458",1,547,608.36,239.64,4270.45,136.75]
["TUFTS - TUFTS SELECT - CPT - 59000",1,634,684.11,684.11,2032.26,158.5]
["TUFTS - TUFTS SELECT - CPT - 61624",1,8320,5130.87,2890.31,15242.01,2080]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 87253",1,100,48.47,18.43,226.77,25]
["TUFTS - TUFTS SELECT - CPT - 64402",1,581,684.11,310.58,2032.26,145.25]
["UNICARE - UNICARE - CPT - 74363",1,1534,589.28,221.67,589.28,383.5]
["UNICARE - UNICARE - CPT - 76831",1,1228,183.41,152.84,2653.95,307]
["TUFTS - TUFTS SELECT - CPT - 64653",1,401,684.11,415.61,2032.26,100.25]
["TUFTS - TUFTS SELECT - CPT - 65205",1,337,317.70999999999998,178.83,943.8,84.25]
["TUFTS - TUFTS SELECT - CPT - 65430",1,804,317.70999999999998,317.70999999999998,943.8,201]
["UNICARE - UNICARE - CPT - 82585",1,29,14.09,7.96,137.13999999999999,7.25]
["UNICARE - UNICARE - CPT - 83785",1,109,59.7,22.44,276.16000000000003,27.25]
["TUFTS - TUFTS SELECT - CPT - 67108",1,5769,5130.87,2531.06,15242.01,1442.25]
["TUFTS - TUFTS SELECT - CPT - 67343",1,2949,2593.31,2531.06,7703.8,737.25]
["UNICARE - UNICARE - CPT - 86900",1,87,7.25,2.73,923.73,21.75]
["TUFTS - TUFTS SELECT - CPT - 67973",1,2949,3987.49,1990.62,11845.41,737.25]
["UNICARE - UNICARE - CPT - 92524",1,459,279.74,185.85,592.32000000000005,114.75]
["UNICARE - UNICARE - CPT - 93299",1,165,80.650000000000006,65.5,369.9,41.25]
["TUFTS - TUFTS SELECT - CPT - 70300",1,141,123.67,81.93,796.29,35.25]
["TUFTS - TUFTS SELECT - CPT - 70496",1,4798,375.85,347.19,2420.09,1199.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 44361",1,1332,1013.38,1013.38,7703.8,333]
["TUFTS - TUFTS SELECT - CPT - 72114",1,606,202.64,125.38,1304.76,151.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 70491",1,2545,445.9,347.19,2420.09,636.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 73501",1,251,72.290000000000006,72.290000000000006,801.26,62.75]
["TUFTS - TUFTS SELECT - CPT - 73092",1,267,196.1,72.290000000000006,1262.6600000000001,66.75]
["TUFTS - TUFTS SELECT - CPT - 73592",1,319,124.44,72.290000000000006,801.26,79.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 78012",1,782,167.19,167.19,3840.32,195.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 78278",1,3311,373.93,373.93,4270.45,827.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 80201",1,46,24.12,10.88,133.80000000000001,11.5]
["TUFTS - TUFTS SELECT - CPT - 75563",1,5514,1210.76,861.13,7795.97,1378.5]
["TUFTS - TUFTS SELECT - CPT - 75810",1,4288,2747.37,827.44,17690.02,1072]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 84630",1,55,23.03,10.39,127.81,13.75]
["TUFTS - TUFTS SELECT - CPT - 76513",1,869,203.1,147.96,1307.74,217.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 87077",1,27,10.57,7.18,90.64,6.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 87517",1,213,86.65,39.07,480.84,53.25]
["TUFTS - TUFTS SELECT - CPT - 76998",1,606,0,108,183.41,151.5]
["TUFTS - TUFTS SELECT - CPT - 77067",1,378,176.6,107.96,1165.46,94.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 95905",1,161,178.47,178.47,1036.18,40.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 97110",1,192,54.69,51.98,193.61,48]
["TUFTS - TUFTS SELECT - CPT - 77789",1,978,220.78,143.49,1421.57,244.5]
["TUFTS - TUFTS SELECT - CPT - 78070",1,1430,663.23,310.3,4270.45,357.5]
["TUFTS - TUFTS SELECT - CPT - 78491",1,3492,2598.5500000000002,1212.54,16731.72,873]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 19284",1,383,0,128.53,1198.25,95.75]
["TUFTS - TUFTS SELECT - CPT - 78807",1,3227,809.27,425.49,5210.82,806.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 24670",1,2004,474.04,378,3264.67,501]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 27040",1,2043,2607.12,1098.98,3264.67,510.75]
["TUFTS - TUFTS SELECT - CPT - 81025",1,32,12.96,6.36,83.47,8]
["TUFTS - TUFTS SELECT - CPT - 81271",1,175,206.36,102.3,1328.77,43.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 33212",1,11115,10135.48,1990.62,31200.07,2778.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 36252",1,4429,5563.04,1500.85,11845.41,1107.25]
["TUFTS - TUFTS SELECT - CPT - 82540",1,23,8.08,4.2300000000000004,52,5.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 41820",1,4466,4229.1400000000003,1198.25,11845.41,1116.5]
["TUFTS - TUFTS SELECT - CPT - 83010",1,63,21.92,11.47,141.18,15.75]
["TUFTS - TUFTS SELECT - CPT - 83550",1,44,15.24,7.97,98.14,11]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 50434",1,1457,3297.53,1098.98,3380.52,364.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 55250",1,2985,3297.53,1098.98,3380.52,746.25]
["TUFTS - TUFTS SELECT - CPT - 84307",1,515,31.86,16.670000000000002,205.12,128.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 64616",1,795,521.19000000000005,415.61,2032.26,198.75]
["TUFTS - TUFTS SELECT - CPT - 84597",1,149,23.93,12.52,154.06,37.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 67041",1,5769,6899.74,2354.5,15242.01,1442.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 70491",1,2545,347.19,347.19,2420.09,636.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 70555",1,1185,396.79,396.79,2653.95,296.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 73100",1,313,107.22,72.290000000000006,801.26,78.25]
["TUFTS - TUFTS SELECT - CPT - 86431",1,27,9.89,5.17,63.66,6.75]
["TUFTS - TUFTS SELECT - CPT - 86645",1,71,29.38,15.37,189.15,17.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 77290",1,4635,553.85,369.25,3892.44,1158.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 80145",1,91,81.23,38.57,206.18,22.75]
["TUFTS - TUFTS SELECT - CPT - 86923",1,142,204.99,190.34,1319.88,35.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 82040",1,26,12.87,4.51,55.55,6.5]
["TUFTS - TUFTS SELECT - CPT - 87254",1,98,34.1,12.44,219.59,24.5]
["TUFTS - TUFTS SELECT - CPT - 87391",1,87,32.99,16.18,212.42,21.75]
["TUFTS - TUFTS SELECT - CPT - 87486",1,127,61.19,32.01,393.99,31.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 86615",1,174,30.85,12.03,148.07,43.5]
["TUFTS - TUFTS SELECT - CPT - 88160",1,182,31.1,22.57,200.27,45.5]
["TUFTS - TUFTS SELECT - CPT - 88187",1,158,59.25,49.74,381.48,39.5]
["TUFTS - TUFTS SELECT - CPT - 88361",1,475,381.77,194.53,2458.16,118.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 92133",1,226,117.73,68.75,562.35,56.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 92579",1,249,286.31,158,1391.25,62.25]
["TUFTS - TUFTS SELECT - CPT - 90713",1,80.760000000000005,80.760000000000005,80.760000000000005,80.760000000000005,20.190000000000001]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 94727",1,207,286.31,117.36,1412.44,51.75]
["TUFTS - TUFTS SELECT - CPT - 91122",1,1102,420.07,388.64,2372.37,275.5]
["TUFTS - TUFTS SELECT - CPT - 92025",1,189,99.57,93.87,317.35000000000002,47.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 81180",1,175,288.52,102.3,1328.77,43.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 82017",1,83,35.53,14.65,189.43,20.75]
["TUFTS - TUFTS SELECT - CPT - 92585",1,639,457.32,326.83,2582.75,159.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 84446",1,69,29.86,12.94,159.19,17.25]
["TUFTS - TUFTS SELECT - CPT - 92621",1,95,0,46.73,46.73,23.75]
["TUFTS - TUFTS SELECT - CPT - 93271",1,170,202.57,126.22,1144.02,42.5]
["TUFTS - TUFTS PPO - CPT - 86328",1,203,145.91,45.23,410.13,50.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 88230",1,424,245.33,47.5,1307.74,106]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 0523T",1,2178,0,null,null,544.5]
["TUFTS - TUFTS SELECT - CPT - 93622",1,1561,0,524.51,5170.4799999999996,390.25]
["TUFTS - TUFTS SELECT - CPT - 93656",1,25096,21120.9,2531.06,62742.78,6274]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 19081",1,1351,2672.73,1098.98,3264.67,337.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 21445",1,7214,8596.73,2166.09,11845.41,1803.5]
["TUFTS - TUFTS SELECT - CPT - 94762",1,228,250.1,228.32,1412.44,57]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 26700",1,2298,485.97,317.70999999999998,943.8,574.5]
["TUFTS - TUFTS SELECT - CPT - 95816",1,1832,457.32,282.57,2582.75,458]
["TUFTS - TUFTS SELECT - CPT - 95907",1,473,250.1,178.47,797.09,118.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 32553",1,1590,2573.36,1198.25,7703.8,397.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 36589",1,1072,1338.6,684.11,2032.26,268]
["TUFTS - TUFTS SELECT - CPT - 96160",1,42,50.95,50.95,162.4,10.5]
["TUFTS - TUFTS SELECT - CPT - 96417",1,316,108.45,100.35,612.48,79]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 43762",1,357,499.64,388.64,3264.67,89.25]
["TUFTS - TUFTS SELECT - CPT - 97164",1,262,98.19,98.19,365.72,65.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 50561",1,6035,7812.32,1098.98,7812.32,1508.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 57107",1,3863,4588.18,1500.85,15242.01,965.75]
["TUFTS - TUFTS SELECT - CPT - 99381",1,320,33.74,33.74,253.27,80]
["TUFTS - TUFTS SELECT - CPT - 99396",1,403,33.74,33.74,256.38,100.75]
["TUFTS - TUFTS SELECT - CPT - 99473",1,36,0,36.99,229.62,9]
["TUFTS - TUFTS SPIRIT - CPT - 80169",1,310,15.1,10.01,154.22,77.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 68760",1,385,612.12,476.13,2032.26,96.25]
["TUFTS - TUFTS SPIRIT - CPT - 81000",1,17,4.42,2.97,39.04,4.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 73620",1,267,107.22,72.290000000000006,801.26,66.75]
["TUFTS - TUFTS SPIRIT - CPT - 81329",1,174,150.69999999999999,102.3,1328.77,43.5]
["TUFTS - TUFTS SPIRIT - CPT - 81405",1,629,331.49,301.35000000000002,758.26,157.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 78018",1,2963,783.95,425.49,5068.46,740.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 78645",1,3070,783.95,345.6,5427.23,767.5]
["TUFTS - TUFTS SPIRIT - CPT - 82656",1,55,12.68,10.52,129.47999999999999,13.75]
["TUFTS - TUFTS SPIRIT - CPT - 82785",1,82,18.11,15.01,184.75,20.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 83050",1,37,17.7,6.69,82.45,9.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 83921",1,80,45.79,15.67,205.7,20]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 85280",1,97,46.42,17.649999999999999,217.27,24.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 86710",1,35,32.51,12.36,152.1,8.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 86910",1,67,76.709999999999994,74.83,76.709999999999994,16.75]
["TUFTS - TUFTS SPIRIT - CPT - 84591",1,58,18.77,12.6,165.43,14.5]
["TUFTS - TUFTS SPIRIT - CPT - 85027",1,33,7.12,5.9,72.55,8.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 91200",1,301,293.52,219.65,700.05,75.25]
["UNICARE - UNICARE - CPT - 75559",1,4821,711.62,593.02,5285.52,1205.25]
["TUFTS - TUFTS SPIRIT - CPT - 86235",1,81,19.72,16.36,201.29,20.25]
["TUFTS - TUFTS SPIRIT - CPT - 86403",1,269,12.69,9.2899999999999991,114.93,67.25]
["UNICARE - UNICARE - CPT - 77077",1,389,86.75,72.290000000000006,1262.6600000000001,97.25]
["TUFTS - TUFTS PPO - CPT - 77386",1,4559,2233.7800000000002,523.85,6278.62,1139.75]
["UNICARE - UNICARE - CPT - 78226",1,3070,516.96,430.8,4270.45,767.5]
["UNICARE - UNICARE - CPT - 79445",1,1061,460.18,303.64999999999998,2756.08,265.25]
["TUFTS - TUFTS SPIRIT - CPT - 87150",1,460,38.6,32.01,393.99,115]
["TUFTS - TUFTS SPIRIT - CPT - 87184",1,35,8.23,6.29,77.400000000000006,8.75]
["UNICARE - UNICARE - CPT - 82595",1,33,15.71,5.9,72.55,8.25]
["TUFTS - TUFTS SPIRIT - CPT - 87517",1,213,47.12,39.07,480.84,53.25]
["UNICARE - UNICARE - CPT - 83916",1,97,48.79,20.239999999999998,265.61,24.25]
["TUFTS - TUFTS SPIRIT - CPT - 87799",1,307,47.12,39.07,480.84,76.75]
["TUFTS - TUFTS SPIRIT - CPT - 90673",1,127,44.67,40.61,177.04,31.75]
["UNICARE - UNICARE - CPT - 85301",1,52,26.24,9.86,121.37,13]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 33361",1,9196,0,3373.74,3373.74,2299]
["UNICARE - UNICARE - CPT - 86645",1,71,34.68,15.37,189.15,17.75]
["UNICARE - UNICARE - CPT - 86777",1,180,34.94,13.13,161.6,45]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 78805",1,1274,0,425.49,11326.05,318.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 80175",1,64,14.23,12.09,148.84,16]
["UNICARE - UNICARE - CPT - 88143",1,101,49.2,18.48,228.72,25.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 81218",1,551,259.70999999999998,159,2715.49,137.75]
["UNICARE - UNICARE - CPT - 92555",1,165,70.92,53.94,336.64,41.25]
["UNICARE - UNICARE - CPT - 93271",1,170,151.46,126.22,1144.02,42.5]
["UNICARE - UNICARE - CPT - 93303",1,1861,484.39,403.66,4775.3,465.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 82365",1,120,13.84,11.76,144.81,30]
["UNICARE - UNICARE - CPT - 95806",1,422,408.6,228.32,1412.44,105.5]
["UNICARE - UNICARE - CPT - 97116",1,139,48.21,48.21,191.22,34.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 83021",1,91,19.39,16.47,202.68,22.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 43244",1,2267,1010.64,1010.64,7703.8,566.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 83873",1,84,18.47,15.69,193.18,21]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 45381",1,1897,1020.59,1020.59,3264.67,474.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 84270",1,105,23.33,19.82,243.97,26.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 70336",1,3454,567.87,396.79,2642.66,863.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 71100",1,116,72.290000000000006,72.290000000000006,801.26,29]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 85290",1,82,17.54,14.9,183.36,20.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 85652",1,14,2.9,2.46,30.24,3.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 74262",1,5902,445.9,347.19,2420.09,1475.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 86353",1,327,52.64,44.72,550.37,81.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 75984",1,1061,173.86,140.21,208.63,265.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 76946",1,304,111.15,27.24,133.38,76]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 86709",1,56,12.09,10.27,126.43,14]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 86807",1,183,68.400000000000006,54.29,762.87,45.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 86886",1,315,5.56,4.72,1267.31,78.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 78804",1,5251,1071.19,1071.19,14762.31,1312.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 80339",1,104,29.98,7.53,48.46,26]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 87327",1,57,12.88,10.94,134.82,14.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 87532",1,38,37.68,32.01,393.99,9.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 82962",1,12,4.74,2.42,31.83,3]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 87906",1,2063,138.19999999999999,56.44,1445.09,515.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 84305",1,82,34.19,19.399999999999999,238.75,20.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 85025",1,40,15.72,7.09,87.22,10]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 93668",1,87,0,99.57,317.35000000000002,21.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 96116",1,412,0,423.72,2582.75,103]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 86701",1,44,17.97,8.11,99.73,11]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 86807",1,183,80.040000000000006,54.29,762.87,45.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 99606",1,43,0,null,null,10.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 87556",1,129,52.68,32.01,404.26,32.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 80169",1,310,18.510000000000002,10.01,154.22,77.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 81206",1,684,221.05,149.56,1840.58,171]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 92568",1,79,59.1,53.94,326.01,19.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 93307",1,1065,403.66,387.2,2940.06,266.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 93350",1,1869,403.66,403.66,4775.3,467.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 94200",1,192,71.61,71.61,847.64,48]
["TUFTS - TUFTS PPO - CPT - 78605",1,721,1957.69,489.45,5502.59,180.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 96374",1,254,65.72,65.72,917.77,63.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 99397",1,427,235.27,33.74,282.32,106.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 82962",1,12,4.42,2.42,31.83,3]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11303",1,570,661.45,317.70999999999998,943.8,142.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 83825",1,80,21.92,14.83,182.55,20]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 84144",1,104,28.12,19.03,234.27,26]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 14060",1,5231,3262.11,1990.62,11845.41,1307.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 17264",1,1065,661.45,317.70999999999998,1198.25,266.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 85027",1,33,8.7200000000000006,5.9,72.55,8.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 85230",1,91,24.13,16.329999999999998,200.93,22.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 85652",1,14,3.64,2.46,30.24,3.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 86235",1,81,24.17,16.36,201.29,20.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 86317",1,72,20.21,13.67,168.24,18]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 25076",1,2041,2607.12,1990.62,11845.41,510.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 26645",1,2976,2489.31,1098.98,3264.67,744]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 86738",1,32,17.850000000000001,12.07,148.63999999999999,8]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 86788",1,88,22.72,15.37,189.15,22]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 28515",1,1084,474.04,317.70999999999998,1198.25,271]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 29355",1,357,496.13,395.63,1308.22,89.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 87276",1,57,21.67,11.87,155.81,14.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 32550",1,4154,5586.35,1500.85,7703.8,1038.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 87632",1,504,293.99,157.59,2395.92,126]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 88147",1,78,68.16,15.61,490.34,19.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 36576",1,2426,2303.1799999999998,1098.98,3264.67,606.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 37183",1,15672,8867.69,2397.88,11845.41,3918]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 80186",1,46,18.98,12.55,154.51,11.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 41017",1,3301,4229.1400000000003,1098.98,4335.57,825.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 81218",1,551,333.62,159,2715.49,137.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 42808",1,3197,4229.1400000000003,1500.85,7703.8,799.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 43259",1,2333,2811.55,1010.64,7703.8,583.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 82340",1,31,8.32,5.5,67.7,7.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 45390",1,1378,2063.44,1098.98,3264.67,344.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 82941",1,85,24.31,16.079999999999998,197.91,21.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 83002",1,93,25.54,16.89,207.81,23.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 51798",1,181,117.73,93.87,347.12,45.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 56740",1,3544,4475.54,1990.62,11845.41,886]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 84153",1,93,25.37,16.78,206.51,23.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 59812",1,2302,4475.54,2354.5,11845.41,575.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 84466",1,64,17.600000000000001,11.64,143.30000000000001,16]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 85048",1,12,3.49,2.31,28.49,3]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 65222",1,449,224.25,178.83,943.8,112.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 65800",1,1284,3633.78,1098.98,3725.22,321]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 86256",1,53,16.62,10.99,135.27000000000001,13.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 86331",1,57,16.53,10.93,134.44999999999999,14.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 86481",1,127,111.72,73.89,969.95,31.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 86698",1,28,17.239999999999998,11.4,140.32,7]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 72050",1,504,193.63,125.38,1304.76,126]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 86787",1,101,17.77,11.75,144.6,25.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 73202",1,3140,347.19,347.19,2420.09,785]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 87205",1,23,5.88,3.89,47.89,5.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 87276",1,57,17.95,11.87,155.81,14.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 75870",1,2426,1882.14,780.65,11330.17,606.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 76391",1,838,396.79,396.79,2653.95,209.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 87880",1,57,18.46,12.21,160.29,14.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 88172",1,166,25.57,16.91,1400.17,41.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 77770",1,1716,1212.82,523.85,8624.5,429]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 45349",1,2215,0,1098.98,3264.67,553.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 80158",1,91,42.25,16.46,202.6,22.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 80329",1,235,10.74,10.74,111.18,58.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 81050",1,15,7.67,2.74,35.29,3.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 80195",1,35,15.04,10.01,154.22,8.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 80353",1,71,0,18.37,118.27,17.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 82607",1,75,35.28,13.75,169.26,18.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 83070",1,25,11.1,4.33,53.31,6.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81403",1,659,0,185.2,466,164.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 84439",1,46,21.1,8.2200000000000006,101.2,11.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 82390",1,52,11.76,9.8000000000000007,120.52,13]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 82540",1,23,5.08,4.2300000000000004,52,5.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 86359",1,57,88.28,15.71,423.58,14.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 86787",1,101,30.14,11.75,144.6,25.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 83550",1,44,9.56,7.97,98.14,11]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 83918",1,62,20.93,17.440000000000001,228.93,15.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 87653",1,129,82.11,32.01,393.99,32.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 84307",1,515,20,16.670000000000002,205.12,128.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 88344",1,423,577.51,159.9,2519.54,105.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 84540",1,25,5.2,4.33,53.96,6.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 85306",1,69,16.78,13.98,172.07,17.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 85397",1,207,27.36,22.8,299.31,51.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 86021",1,72,16.489999999999998,13.74,169.1,18]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 86382",1,324,18.52,15.43,189.88,81]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 93567",1,448,0,130.85,130.85,112]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 86652",1,66,14.44,12.03,148.07,16.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 86702",1,82,14.8,12.33,151.72999999999999,20.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 95120",1,232,159.55000000000001,18.04,163.57,58]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 86923",1,142,0,190.34,1319.88,35.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 96040",1,231,98.67,33.74,122.29,57.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 96405",1,90,125.83,100.35,612.48,22.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 87391",1,87,19.420000000000002,16.18,212.42,21.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 87506",1,334,233.62,157.59,2550.8000000000002,83.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 81256",1,434,137.65,59.62,733.73,108.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 81304",1,183,315.89999999999998,150,377.43,45.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 82104",1,64,30.45,13.2,162.37,16]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 82810",1,52,20.58,7.96,98.14,13]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 83014",1,40,16.55,7.17,88.24,10]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 97014",1,80,0,28.92,37.4,20]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 84630",1,55,23.99,10.39,127.81,13.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 85384",1,43,20.47,7.75,96.06,10.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 85670",1,29,12.15,5.26,64.72,7.25]
["TUFTS - TUFTS PPO - CPT - 81291",1,434,225.48,48.28,633.76,108.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 80438",1,65,60.49,45.99,565.98,16.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 87015",1,34,14.07,6.09,74.989999999999995,8.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 81301",1,534,418.27,264.13,3380.71,133.5]
["TUFTS - TUFTS PPO - CPT - 86340",1,73,60.22,13.75,169.26,18.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 0126T",1,650,69.349999999999994,67.64,69.349999999999994,162.5]
["TUFTS - TUFTS PPO - CPT - 81430",1,2063,5607.43,1625,15761.12,515.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 82553",1,38,13.86,10.54,129.69,9.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 82585",1,29,16.97,7.96,137.13999999999999,7.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 12056",1,477,678.1,527.46,2032.26,119.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 83540",1,33,7.76,5.9,72.63,8.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 83695",1,63,17.18,11.81,145.38,15.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 84134",1,72,17.510000000000002,13.31,163.76,18]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 20527",1,454,534.30999999999995,317.70999999999998,1198.25,113.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 84436",1,35,8.24,6.27,77.11,8.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 21550",1,1972,2672.73,1098.98,3264.67,493]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 23655",1,1986,2551.96,1098.98,3264.67,496.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 85461",1,34,11.23,6.92,90.76,8.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 86003",1,22,6.26,4.76,58.53,5.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 27337",1,3207,4621.25,1990.62,11845.41,801.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 86609",1,48,15.46,11.75,144.6,12]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 28630",1,275,485.97,317.70999999999998,1198.25,68.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 29807",1,10676,11074.87,1990.62,11845.41,2669]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 86880",1,142,6.47,4.91,366.72,35.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 87118",1,55,17.53,10.79,141.71,13.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 33270",1,53692,43021.64,1990.62,62742.78,13423]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 36227",1,1026,0,292.08999999999997,1198.25,256.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 36471",1,783,678.1,521.32000000000005,1661.52,195.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 37220",1,7580,9090.86,2166.09,25611.61,1895]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 87660",1,157,24.06,18.29,225.1,39.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 40510",1,2787,4335.57,1500.85,7703.8,696.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 42505",1,7214,8596.73,2166.09,11845.41,1803.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 43240",1,3048,5488.65,1010.64,11845.41,762]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 43255",1,2170,2882.31,1010.64,7703.8,542.5]
["TUFTS - TUFTS PPO - CPT - 82747",1,76,69.150000000000006,15.8,194.37,19]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 81235",1,1038,389.5,239.82,3148.12,259.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 47536",1,1033,5726.94,1098.98,5726.94,258.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 50684",1,375,0,127.07,1198.25,93.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 82104",1,64,17.350000000000001,13.2,162.37,16]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 82175",1,92,22.76,17.3,212.95,23]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 82507",1,134,33.36,25.37,312.11,33.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 82731",1,318,77.290000000000006,28.7,723.09,79.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 82810",1,52,11.72,7.96,98.14,13]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 64451",1,794,1292.83,1005.99,3474.13,198.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 83918",1,62,28.32,17.440000000000001,228.93,15.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 83993",1,95,23.56,17.91,220.45,23.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 84302",1,25,5.83,4.43,54.53,6.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 67901",1,2949,3522.21,2354.5,15242.01,737.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 84630",1,55,13.67,10.39,127.81,13.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 70260",1,446,193.63,125.38,1274.24,111.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 71120",1,298,107.22,72.290000000000006,801.26,74.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 86146",1,197,30.54,18.87,285.7,49.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 86317",1,72,17.989999999999998,13.67,168.24,18]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 74021",1,381,193.63,147.96,1026.3599999999999,95.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 74248",1,1832,0,99.33,99.33,458]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 86774",1,83,17.760000000000002,12.77,166.08,20.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 76801",1,1206,193.63,147.96,1274.24,301.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 87110",1,25,23.52,17.87,219.96,6.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 77021",1,3686,0,567.87,838.57,921.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 78020",1,765,0,119.46,179.88,191.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 78445",1,1640,608.36,239.64,4231.53,410]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 78650",1,3153,2115.7600000000002,345.6,12480.42,788.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 87900",1,600,156.41999999999999,118.9,1463.3,150]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 88264",1,519,173.53,113.7,1414.07,129.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 81311",1,4795,638.61,218.55,2868.9,1198.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 82232",1,81,38.799999999999997,14.76,181.61,20.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 92934",1,8975,0,4148.71,4148.71,2243.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 83070",1,25,11.38,4.33,53.31,6.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 93453",1,10776,5460.91,2531.06,7703.8,2694]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 93890",1,2670,497.78,201.8,1975.52,667.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 85250",1,95,45.68,17.37,213.81,23.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 86256",1,53,28.91,10.99,135.27000000000001,13.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 95910",1,919,544.74,282.57,1457.53,229.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 95962",1,676,0,236.55,236.55,169]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 96415",1,139,129,100.35,612.48,34.75]
["UNICARE - UNICARE - CPT - 72040",1,383,86.75,72.290000000000006,801.26,95.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 87522",1,213,102.77,39.07,480.84,53.25]
["UNICARE - UNICARE - CPT - 72141",1,3650,711.62,396.79,2653.95,912.5]
["UNICARE - UNICARE - CPT - 73120",1,267,86.75,72.290000000000006,1262.6600000000001,66.75]
["UNICARE - UNICARE - CPT - 73206",1,3440,633.36,347.19,2420.09,860]
["UNICARE - UNICARE - CPT - 73565",1,353,86.75,72.290000000000006,801.26,88.25]
["UNICARE - UNICARE - CPT - 29807",1,10676,3666.54,1990.62,11845.41,2669]
["UNICARE - UNICARE - CPT - 43246",1,1937,1010.64,1010.64,7703.8,484.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 93005",1,153,120.69,47.27,562.35,38.25]
["UNICARE - UNICARE - CPT - 45332",1,1341,420.29,420.29,2115.37,335.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 93655",1,3836,0,1065.1099999999999,1198.25,959]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 93980",1,1568,242.91,188.94,1117.6500000000001,392]
["UNICARE - UNICARE - CPT - 64484",1,403,995.78,128.04,1198.25,100.75]
["UNICARE - UNICARE - CPT - 64510",1,1071,995.78,829.82,3264.67,267.75]
["UNICARE - UNICARE - CPT - 70300",1,141,164.02,81.93,796.29,35.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 96368",1,90,0,53.54,53.54,22.5]
["UNICARE - UNICARE - CPT - 71130",1,348,86.75,72.290000000000006,801.26,87]
["FALLON - FALLON MEDICAID - CPT - 84445",1,244,46.39,46.39,570.91,61]
["FALLON - FALLON MEDICAID - CPT - 84597",1,149,12.52,12.52,154.06,37.25]
["TUFTS - TUFTS MEDICARE SCO - CPT - 84144",1,104,30.25,19.03,234.27,26]
["FALLON - FALLON MEDICAID - CPT - 85576",1,311,19.59,19.59,243.68,77.75]
["TUFTS - TUFTS HMO - CPT - 95979",1,427,0,null,null,106.75]
["TUFTS - TUFTS POS - CPT - 28153",1,3938,4856.75,1990.62,7703.8,984.5]
["FALLON - FALLON MEDICAID - CPT - 86609",1,48,11.75,11.75,144.6,12]
["FALLON - FALLON MEDICAID - CPT - 86664",1,37,13.95,13.95,171.71,9.25]
["TUFTS - TUFTS HMO - CPT - 76825",1,2097,2172.86,160.47,5444.31,524.25]
["FALLON - FALLON MEDICAID - CPT - 86812",1,119,23.54,23.54,289.69,29.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 86625",1,16,19.02,11.97,147.33000000000001,4]
["TUFTS - TUFTS POS - CPT - 43245",1,1449,4856.75,1010.64,7703.8,362.25]
["FALLON - FALLON MEDICAID - CPT - 87220",1,23,3.89,3.89,47.89,5.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 86707",1,56,11.57,10.55,129.88999999999999,14]
["TUFTS - TUFTS PPO - CPT - 76377",1,742,0,64.89,64.89,185.5]
["TUFTS - TUFTS HMO - CPT - 43202",1,1154,2057.7399999999998,1010.64,3264.67,288.5]
["TUFTS - TUFTS HMO - CPT - 44384",1,4118,9609.09,1500.85,15242.01,1029.5]
["TUFTS - TUFTS HMO - CPT - 80366",1,56,31.93,12.43,80,14]
["FALLON - FALLON MEDICAID - CPT - 91112",1,5914,0,1278.93,4318.55,1478.5]
["TUFTS - TUFTS HMO - CPT - 92587",1,457,932.8,107.3,2337.23,114.25]
["FALLON - FALLON MEDICAID - CPT - 96112",1,341,0,194.05,618.47,85.25]
["TUFTS - TUFTS MEDICARE SCO - CPT - 82677",1,90,35.06,22.05,271.39,22.5]
["TUFTS - TUFTS POS - CPT - 12056",1,477,1281.21,527.46,2032.26,119.25]
["FALLON - FALLON MEDICAID - CPT - 99495",1,439,0,194.55,1179.72,109.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 86735",1,65,13.05,11.9,146.47999999999999,16.25]
["TUFTS - TUFTS POS - CPT - 77074",1,653,433.94,125.38,1304.76,163.25]
["TUFTS - TUFTS POS - CPT - 85027",1,33,24.13,5.9,72.55,8.25]
["FALLON - FALLON SENIOR PLAN - CPT - 81240",1,434,65.69,48.54,637.1,108.5]
["TUFTS - TUFTS PPO - CPT - 25680",1,321,4856.75,378,7703.8,80.25]
["FALLON - FALLON SENIOR PLAN - CPT - 81430",1,2063,1625,1625,15761.12,515.75]
["FALLON - FALLON SENIOR PLAN - CPT - 82139",1,98,16.87,14.65,189.43,24.5]
["FALLON - FALLON SENIOR PLAN - CPT - 82232",1,81,16.18,14.76,181.61,20.25]
["TUFTS - TUFTS HMO - CPT - 44366",1,1998,4856.75,1013.38,7703.8,499.5]
["FALLON - FALLON SENIOR PLAN - CPT - 82747",1,76,17.649999999999999,15.8,194.37,19]
["FALLON - FALLON SENIOR PLAN - CPT - 82945",1,21,3.93,3.58,44.06,5.25]
["FALLON - FALLON SENIOR PLAN - CPT - 83021",1,91,18.059999999999999,16.47,202.68,22.75]
["TUFTS - TUFTS HMO - CPT - 82570",1,26,23.18,4.72,58.08,6.5]
["TUFTS - TUFTS HMO - CPT - 86331",1,57,53.66,10.93,134.44999999999999,14.25]
["FALLON - FALLON SENIOR PLAN - CPT - 84182",1,264,29.21,21.58,283.38,66]
["TUFTS - TUFTS HMO - CPT - 95962",1,676,0,236.55,236.55,169]
["FALLON - FALLON SENIOR PLAN - CPT - 85046",1,141,5.57,5.08,62.56,35.25]
["FALLON - FALLON SENIOR PLAN - CPT - 85245",1,180,22.94,20.92,257.5,45]
["TUFTS - TUFTS MEDICARE SCO - CPT - 82104",1,64,20.97,13.2,162.37,16]
["TUFTS - TUFTS MEDICARE SCO - CPT - 86235",1,81,26,16.36,201.29,20.25]
["FALLON - FALLON SENIOR PLAN - CPT - 86376",1,70,14.55,13.27,163.31,17.5]
["TUFTS - TUFTS POS - CPT - 25505",1,3521,2058.17,1098.98,3264.67,880.25]
["FALLON - FALLON SENIOR PLAN - CPT - 86652",1,66,13.19,12.03,148.07,16.5]
["TUFTS - TUFTS POS - CPT - 36479",1,2062,0,336.67,1198.25,515.5]
["TUFTS - TUFTS POS - CPT - 59897",1,356,1281.21,684.11,2032.26,89]
["TUFTS - TUFTS POS - CPT - 69433",1,1031,2058.17,818.07,3264.67,257.75]
["TUFTS - TUFTS POS - CPT - 72128",1,2005,434.94,193.63,1307.74,501.25]
["FALLON - FALLON SENIOR PLAN - CPT - 87254",1,98,19.559999999999999,12.44,219.59,24.5]
["FALLON - FALLON SENIOR PLAN - CPT - 87480",1,157,20.05,18.29,225.1,39.25]
["TUFTS - TUFTS POS - CPT - 87430",1,57,54.22,12.42,163.02000000000001,14.25]
["TUFTS - TUFTS POS - CPT - 93880",1,2300,709.8,300.69,2134.23,575]
["FALLON - FALLON SENIOR PLAN - CPT - 88274",1,172,42.38,31.76,411.07,43]
["TUFTS - TUFTS PPO - CPT - 15241",1,870,0,275.18,1990.62,217.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 0523T",1,2178,0,null,null,544.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 10140",1,1453,2672.73,1098.98,3264.67,363.25]
["TUFTS - TUFTS PPO - CPT - 45350",1,1509,2058.16,1098.98,3264.67,377.25]
["TUFTS - TUFTS PPO - CPT - 75825",1,4288,11095.41,827.44,31186.53,1072]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11606",1,2452,2672.73,1500.85,7703.8,613]
["TUFTS - TUFTS HMO - CPT - 31605",1,254,2057.7399999999998,346.18,3264.67,63.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 12013",1,476,380.96,296.32,3264.67,119]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 12051",1,1324,678.1,527.46,2032.26,331]
["TUFTS - TUFTS HMO - CPT - 49450",1,803,1281.21,684.11,2032.26,200.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 14041",1,6040,3344.2,1990.62,11845.41,1510]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 15828",1,5109,5972.07,1990.62,7703.8,1277.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 17003",1,34,0,6.04,1198.25,8.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 17263",1,995,380.96,296.32,1198.25,248.75]
["TUFTS - TUFTS HMO - CPT - 75736",1,4288,19614.62,1894.5,49146.35,1072]
["TUFTS - TUFTS HMO - CPT - 77001",1,1131,0,149.06,149.06,282.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 20605",1,311,534.30999999999995,317.70999999999998,1198.25,77.75]
["TUFTS - TUFTS HMO - CPT - 83662",1,31,84.74,17.25,212.3,7.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 21337",1,3896,4335.57,1500.85,7703.8,974]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 21451",1,4870,2485.42,2148.08,11845.41,1217.5]
["TUFTS - TUFTS HMO - CPT - 87899",1,94,62.19,11.87,155.81,23.5]
["TUFTS - TUFTS HMO - CPT - 92592",1,67,55.4,24.58,138.81,16.75]
["TUFTS - TUFTS HMO - CPT - 93287",1,315,0,52.71,52.71,78.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 25071",1,3254,2672.73,1990.62,11845.41,813.5]
["TUFTS - TUFTS HMO - CPT - 99483",1,359,43.73,31.86,102.42,89.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 81178",1,175,198.65,102.3,1328.77,43.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 83921",1,80,30.75,15.67,205.7,20]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 86807",1,183,114.04,54.29,762.87,45.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 87341",1,51,14.98,9.42,115.95,12.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 27603",1,3573,4621.25,1500.85,7703.8,893.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 27840",1,2813,485.97,378,3264.67,703.25]
["TUFTS - TUFTS MEDICARE SCO - CPT - 86160",1,61,17.399999999999999,10.94,134.62,15.25]
["TUFTS - TUFTS MEDICARE SCO - CPT - 87799",1,307,62.12,39.07,480.84,76.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 29405",1,459,508.62,395.63,1308.22,114.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 30000",1,933,445.06,346.18,2032.26,233.25]
["TUFTS - TUFTS POS - CPT - 25065",1,2043,2058.17,1098.98,3264.67,510.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 31530",1,2128,2660.67,1500.85,7703.8,532]
["TUFTS - TUFTS POS - CPT - 31525",1,2091,2058.17,1098.98,3264.67,522.75]
["TUFTS - TUFTS POS - CPT - 37237",1,7580,0,525.59,1198.25,1895]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 33224",1,10670,13864.17,1098.98,16591.07,2667.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 33231",1,34636,43021.64,1990.62,62742.78,8659]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 33286",1,892,1250.8,972.93,3264.67,223]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 36410",1,78,0,23.16,96.14,19.5]
["TUFTS - TUFTS POS - CPT - 65750",1,5769,9609.09,2531.06,15242.01,1442.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 36558",1,3308,5132.74,1098.98,5132.74,827]
["TUFTS - TUFTS POS - CPT - 73503",1,311,423.79,135.91,1274.24,77.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 37197",1,4034,5132.74,1098.98,5132.74,1008.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 37226",1,15672,18787.919999999998,2166.09,18787.919999999998,3918]
["TUFTS - TUFTS POS - CPT - 83050",1,37,27.42,6.69,82.45,9.25]
["TUFTS - TUFTS POS - CPT - 85379",1,51,37.979999999999997,9.2799999999999994,114.2,12.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 40820",1,3301,4335.57,1098.98,4335.57,825.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 41116",1,3197,4335.57,1098.98,4335.57,799.25]
["TUFTS - TUFTS POS - CPT - 92584",1,492,469.76,211.54,1412.44,123]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 42808",1,3197,4335.57,1500.85,7703.8,799.25]
["TUFTS - TUFTS POS - CPT - 95249",1,134,187.02,93.87,562.35,33.5]
["TUFTS - TUFTS POS - CPT - 99406",1,83,95.7,50.95,287.77999999999997,20.75]
["TUFTS - TUFTS PPO - CPT - 11104",1,272,595.01,296.32,1198.25,68]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 44391",1,1406,2115.37,1020.59,3264.67,351.5]
["TUFTS - TUFTS PPO - CPT - 25635",1,3159,2058.16,1098.98,3264.67,789.75]
["TUFTS - TUFTS PPO - CPT - 27323",1,2043,2058.16,1098.98,3264.67,510.75]
["TUFTS - TUFTS PPO - CPT - 31611",1,4242,7467.76,1990.62,11845.41,1060.5]
["TUFTS - TUFTS PPO - CPT - 38500",1,4095,4856.75,1500.85,7703.8,1023.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 49321",1,7189,8930.2099999999991,2166.09,11845.41,1797.25]
["TUFTS - TUFTS PPO - CPT - 45332",1,1341,1281.21,420.29,2115.37,335.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 50688",1,2246,3380.52,1098.98,3380.52,561.5]
["TUFTS - TUFTS HMO - CPT - 22870",1,2523,0,311.33,1198.25,630.75]
["TUFTS - TUFTS HMO - CPT - 25650",1,2305,595.01,317.70999999999998,943.8,576.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 54700",1,2985,3380.52,1500.85,7703.8,746.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 57020",1,4336,4588.18,1500.85,7703.8,1084]
["TUFTS - TUFTS HMO - CPT - 33016",1,2070,4856.75,1500.85,7703.8,517.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 58301",1,531,358.24,278.66000000000003,1198.25,132.75]
["TUFTS - TUFTS HMO - CPT - 36596",1,1461,4856.75,1198.25,7703.8,365.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 59414",1,3553,4588.18,3965.45,13969.53,888.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 62323",1,1153,1292.83,829.82,3264.67,288.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 64418",1,575,1292.83,310.58,2032.26,143.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 64450",1,529,1292.83,310.58,2032.26,132.25]
["TUFTS - TUFTS HMO - CPT - 50431",1,844,1871.78,944.22,3176.09,211]
["TUFTS - TUFTS HMO - CPT - 55876",1,1783,4856.75,1198.25,7703.8,445.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 65220",1,326,751.68,317.70999999999998,943.8,81.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 65756",1,5769,7073.38,2531.06,15242.01,1442.25]
["TUFTS - TUFTS HMO - CPT - 66179",1,6814,10732.28,2166.09,17023.61,1703.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 67031",1,2732,1071.25,833.27,3264.67,683]
["TUFTS - TUFTS HMO - CPT - 70460",1,2057,965.87,347.19,2420.09,514.25]
["TUFTS - TUFTS HMO - CPT - 72147",1,4142,1710.37,637.16,4285.49,1035.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 67921",1,2132,3522.21,1990.62,11845.41,533]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 68530",1,385,612.12,476.13,2032.26,96.25]
["TUFTS - TUFTS HMO - CPT - 76942",1,1935,0,51.61,133.38,483.75]
["TUFTS - TUFTS HMO - CPT - 77370",1,938,588.29,160.66,1474.02,234.5]
["TUFTS - TUFTS HMO - CPT - 78071",1,3400,1704.36,239.64,4270.45,850]
["TUFTS - TUFTS HMO - CPT - 81240",1,434,254.28,48.54,637.1,108.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 71120",1,298,107.22,72.290000000000006,801.26,74.5]
["TUFTS - TUFTS HMO - CPT - 82668",1,91,84.22,17.14,210.99,22.75]
["TUFTS - TUFTS HMO - CPT - 85045",1,22,17.89,3.64,44.83,5.5]
["TUFTS - TUFTS HMO - CPT - 85055",1,141,138.35,15.07,346.67,35.25]
["TUFTS - TUFTS HMO - CPT - 86615",1,174,59.09,12.03,148.07,43.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 73522",1,282,193.63,72.290000000000006,1274.24,70.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 74160",1,2716,347.19,347.19,2420.09,679]
["TUFTS - TUFTS HMO - CPT - 88368",1,699,981.08,129.21,2458.16,174.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 75557",1,3484,396.79,396.79,2653.95,871]
["TUFTS - TUFTS HMO - CPT - 92556",1,181,134.36000000000001,53.94,336.64,45.25]
["TUFTS - TUFTS HMO - CPT - 93285",1,369,147.85,41.48,370.47,92.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 76377",1,742,0,64.89,64.89,185.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 76776",1,1458,193.63,147.96,1333.33,364.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 76813",1,1182,193.63,98.34,1274.24,295.5]
["TUFTS - TUFTS HMO - CPT - 96375",1,101,128.82,63.62,218.59,25.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 77067",1,378,171.19,107.96,1165.46,94.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 77080",1,913,193.63,119.6,1198.1400000000001,228.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 77412",1,2143,386.3,204.55,2711.86,535.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 78014",1,2283,608.36,310.3,4270.45,570.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 78195",1,3404,783.95,393.08,5427.23,851]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 85379",1,51,14.76,9.2799999999999994,114.2,12.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 86666",1,77,14.76,9.2799999999999994,114.2,19.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 78835",1,1832,0,375.38,375.38,458]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 80150",1,124,36.159999999999997,13.75,169.26,31]
["TUFTS - TUFTS MEDICARE SCO - CPT - 80201",1,46,17.28,10.88,133.80000000000001,11.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 81276",1,3198,280.20999999999998,142.78,1874.37,799.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 81241",1,434,158.41,55.74,711.6,108.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 84210",1,53,21,10.7,140.4,13.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 82042",1,26,16.8,5.75,75.44,6.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 86060",1,36,10.59,6.66,81.96,9]
["FALLON - FALLON MEDICAID - CPT - 83825",1,80,14.83,14.83,182.55,20]
["TUFTS - TUFTS MEDICARE SCO - CPT - 87591",1,129,50.88,32.01,393.99,32.25]
["TUFTS - TUFTS MEDICARE SCO - CPT - 89060",1,63,10.63,6.52,80.290000000000006,15.75]
["TUFTS - TUFTS POS - CPT - 11982",1,734,595.01,317.70999999999998,1198.25,183.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 83605",1,54,28.48,9.75,119.99,13.5]
["TUFTS - TUFTS POS - CPT - 15936",1,1858,7467.76,2166.09,11845.41,464.5]
["TUFTS - TUFTS POS - CPT - 20983",1,8897,4856.75,1500.85,11074.87,2224.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 84307",1,515,43.85,16.670000000000002,205.12,128.75]
["TUFTS - TUFTS POS - CPT - 25600",1,2371,595.01,317.70999999999998,1198.25,592.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 84681",1,100,49.94,18.989999999999998,233.69,25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 85305",1,56,27.85,10.59,130.34,14]
["TUFTS - TUFTS POS - CPT - 31552",1,6641,9609.09,2354.5,15242.01,1660.25]
["TUFTS - TUFTS POS - CPT - 36225",1,4429,9609.09,1500.85,15242.01,1107.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 86382",1,324,40.57,15.43,189.88,81]
["TUFTS - TUFTS POS - CPT - 38208",1,1015,1281.21,643.03,2032.26,253.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 86692",1,143,41.17,15.66,192.69,35.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 86777",1,180,34.520000000000003,13.13,161.6,45]
["TUFTS - TUFTS POS - CPT - 46601",1,483,595.01,178.83,1198.25,120.75]
["TUFTS - TUFTS POS - CPT - 49411",1,1473,4856.75,1198.25,7703.8,368.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 87209",1,91,43.12,16.399999999999999,201.74,22.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 87272",1,57,28.76,10.94,134.54,14.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 87390",1,87,51.95,17.78,233.33,21.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 87633",1,820,999.81,291.7,4678.75,205]
["TUFTS - TUFTS POS - CPT - 67040",1,5769,9609.09,2531.06,15242.01,1442.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 88152",1,36,59.67,13.16,268.05,9]
["TUFTS - TUFTS POS - CPT - 72130",1,3004,804.9,347.19,2420.09,751]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 88365",1,523,312.47000000000003,110.4,1369.2,130.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90461",1,78,64.510000000000005,23.77,75.739999999999995,19.5]
["TUFTS - TUFTS POS - CPT - 76881",1,1154,443.45,147.96,1333.33,288.5]
["TUFTS - TUFTS POS - CPT - 77084",1,4166,994.25,396.79,2989.41,1041.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 92018",1,2949,3522.21,486.48,3522.21,737.25]
["TUFTS - TUFTS POS - CPT - 81179",1,175,441.93,102.3,1328.77,43.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 92555",1,165,69.349999999999994,53.94,336.64,41.25]
["TUFTS - TUFTS POS - CPT - 82595",1,33,24.13,5.9,72.55,8.25]
["TUFTS - TUFTS POS - CPT - 83986",1,20,13.38,3.27,40.229999999999997,5]
["TUFTS - TUFTS POS - CPT - 86161",1,58,44.78,10.94,134.62,14.5]
["TUFTS - TUFTS POS - CPT - 86580",1,55,66.290000000000006,6.04,199.34,13.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 93351",1,2162,1074.08,756.94,4775.3,540.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 93461",1,13863,5460.91,2531.06,7703.8,3465.75]
["TUFTS - TUFTS POS - CPT - 88356",1,836,216.37,67.040000000000006,683.56,209]
["TUFTS - TUFTS POS - CPT - 91034",1,968,1598.87,764.57,4807.5,242]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 93931",1,1540,242.91,188.94,1169.49,385]
["TUFTS - TUFTS POS - CPT - 93278",1,85,187.02,47.27,562.35,21.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 94664",1,219,413.66,40.020000000000003,1630.85,54.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 95170",1,78,81.78,63.62,218.59,19.5]
["TUFTS - TUFTS POS - CPT - 95971",1,200,380.48,197.39,1144.02,50]
["TUFTS - TUFTS POS - CPT - 97537",1,148,122.03,53.3,207.05,37]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 95933",1,430,229.89,127.32,719.1,107.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 96116",1,412,544.74,423.72,2582.75,103]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 96127",1,51,69.349999999999994,53.94,183.88,12.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 96521",1,629,404.12,314.33999999999997,1054.69,157.25]
["TUFTS - TUFTS PPO - CPT - 19380",1,5998,9609.09,2354.5,15242.01,1499.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 99152",1,101,0,29.88,29.88,25.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 10061",1,1357,678.1,317.70999999999998,1198.25,339.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11000",1,475,1042.56,317.70999999999998,1198.25,118.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11106",1,484,678.1,317.70999999999998,1198.25,121]
["TUFTS - TUFTS PPO - CPT - 29075",1,481,824.75,395.63,1308.22,120.25]
["TUFTS - TUFTS PPO - CPT - 31552",1,6641,9609.09,2354.5,15242.01,1660.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11755",1,600,1250.8,684.11,2032.26,150]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 12005",1,763,678.1,527.46,3264.67,190.75]
["TUFTS - TUFTS PPO - CPT - 40816",1,3197,4856.75,1500.85,7703.8,799.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 14000",1,3904,3344.2,1500.85,7703.8,976]
["TUFTS - TUFTS PPO - CPT - 45347",1,1444,2058.16,1098.98,8736.31,361]
["TUFTS - TUFTS PPO - CPT - 49010",1,4688,7467.76,2166.09,11845.41,1172]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 17111",1,657,380.96,296.32,1198.25,164.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 19081",1,1351,2672.73,1098.98,3264.67,337.75]
["TUFTS - TUFTS HMO - CPT - 22515",1,11021,0,554.91,1198.25,2755.25]
["TUFTS - TUFTS HMO - CPT - 23450",1,8897,9609.09,2354.5,15242.01,2224.25]
["TUFTS - TUFTS HMO - CPT - 24670",1,2004,2057.7399999999998,378,3264.67,501]
["TUFTS - TUFTS HMO - CPT - 26951",1,4072,4856.75,1500.85,7703.8,1018]
["TUFTS - TUFTS HMO - CPT - 27246",1,2950,2057.7399999999998,378,3264.67,737.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 21932",1,3570,4621.25,1500.85,7703.8,892.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 22903",1,3338,4621.25,1990.62,11845.41,834.5]
["TUFTS - TUFTS HMO - CPT - 29075",1,481,770.98,395.63,1308.22,120.25]
["TUFTS - TUFTS HMO - CPT - 30300",1,993,595.01,178.83,943.8,248.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 25116",1,1528,5097.42,2166.09,11845.41,382]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 25675",1,325,485.97,378,3264.67,81.25]
["TUFTS - TUFTS HMO - CPT - 36002",1,818,595.01,317.70999999999998,1338.6,204.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 27048",1,1528,4621.25,1990.62,11845.41,382]
["TUFTS - TUFTS HMO - CPT - 36585",1,3308,4856.75,1990.62,7703.8,827]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 27339",1,4466,4621.25,1990.62,11845.41,1116.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 27816",1,2193,485.97,378,3264.67,548.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 28220",1,2837,2551.96,1098.98,3264.67,709.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 28232",1,2895,2551.96,1098.98,3264.67,723.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 29240",1,329,229.89,162.21,516.99,82.25]
["TUFTS - TUFTS HMO - CPT - 44377",1,2469,4856.75,1013.38,7703.8,617.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 29823",1,4886,5097.42,1990.62,11845.41,1221.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 31237",1,2091,2660.67,1500.85,7703.8,522.75]
["TUFTS - TUFTS HMO - CPT - 49406",1,2105,4856.75,1500.85,7703.8,526.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 31624",1,1637,2660.67,1098.98,3264.67,409.25]
["TUFTS - TUFTS HMO - CPT - 53854",1,2677,4856.75,1500.85,7703.8,669.25]
["TUFTS - TUFTS HMO - CPT - 56821",1,891,595.01,317.70999999999998,1198.25,222.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 33271",1,11405,10390.549999999999,1990.62,31200.07,2851.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 36140",1,794,0,223.07,1198.25,198.5]
["TUFTS - TUFTS HMO - CPT - 64416",1,523,2057.7399999999998,310.58,3264.67,130.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 36513",1,1867,826.68,643.03,2792.38,466.75]
["TUFTS - TUFTS HMO - CPT - 65756",1,5769,9609.09,2531.06,15242.01,1442.25]
["TUFTS - TUFTS HMO - CPT - 66850",1,3062,9609.09,2531.06,15242.01,765.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 37221",1,15672,18787.919999999998,2166.09,37129.18,3918]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 37242",1,15195,18787.919999999998,1990.62,37129.18,3798.75]
["TUFTS - TUFTS HMO - CPT - 69433",1,1031,2057.7399999999998,818.07,3264.67,257.75]
["TUFTS - TUFTS HMO - CPT - 70450",1,1569,508.55,193.63,1274.24,392.25]
["TUFTS - TUFTS HMO - CPT - 70543",1,5365,1878.64,664.1,4707.1099999999997,1341.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 41113",1,2737,4335.57,1500.85,7703.8,684.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 42335",1,3350,4335.57,1990.62,11845.41,837.5]
["TUFTS - TUFTS HMO - CPT - 73600",1,279,339.91,72.290000000000006,851.68,69.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 43220",1,2226,2882.31,1010.64,3264.67,556.5]
["TUFTS - TUFTS HMO - CPT - 75571",1,153,260.43,32.409999999999997,652.5,38.25]
["TUFTS - TUFTS HMO - CPT - 76380",1,1566,319.77999999999997,81.93,801.26,391.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 45005",1,1178,2115.37,1500.85,7703.8,294.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 45347",1,1444,8736.31,1098.98,8736.31,361]
["TUFTS - TUFTS HMO - CPT - 77373",1,13470,8191.59,2909.47,20524.84,3367.5]
["TUFTS - TUFTS HMO - CPT - 78315",1,3304,1704.36,394.65,4270.45,826]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 47552",1,3075,5726.94,1500.85,7703.8,768.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 49185",1,862,1250.8,972.93,3264.67,215.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 50389",1,928,1213.9000000000001,944.22,3264.67,232]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 51703",1,611,293.52,228.32,1198.25,152.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 51729",1,2602,1213.9000000000001,944.22,3176.09,650.5]
["TUFTS - TUFTS HMO - CPT - 82550",1,33,29.18,5.94,73.12,8.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 56440",1,2365,4588.18,1500.85,7703.8,591.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 56740",1,3544,4588.18,1990.62,11845.41,886]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 57505",1,709,1204.81,937.16,3264.67,177.25]
["TUFTS - TUFTS HMO - CPT - 85260",1,91,80.2,16.329999999999998,200.93,22.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 59200",1,356,589.41,317.70999999999998,1198.25,89]
["TUFTS - TUFTS HMO - CPT - 86485",1,60,111.97,10.72,280.56,15]
["TUFTS - TUFTS HMO - CPT - 86735",1,65,58.46,11.9,146.47999999999999,16.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 64435",1,643,1292.83,310.58,2032.26,160.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 64569",1,8974,11618.83,1500.85,11618.83,2243.5]
["TUFTS - TUFTS HMO - CPT - 87536",1,279,381.27,77.09,955.28,69.75]
["TUFTS - TUFTS HMO - CPT - 87880",1,57,63.98,12.21,160.29,14.25]
["TUFTS - TUFTS HMO - CPT - 88237",1,425,569.16999999999996,54.81,1426.13,106.25]
["TUFTS - TUFTS HMO - CPT - 90713",1,80.760000000000005,80.760000000000005,80.760000000000005,80.760000000000005,20.190000000000001]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 67028",1,770,622.61,484.3,2032.26,192.5]
["TUFTS - TUFTS HMO - CPT - 91065",1,470,563.71,228.32,1412.44,117.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 67228",1,7345,1071.25,833.27,3264.67,1836.25]
["TUFTS - TUFTS HMO - CPT - 92605",1,402,344.76,152.96,863.86,100.5]
["TUFTS - TUFTS HMO - CPT - 92925",1,11269,0,4148.71,4148.71,2817.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 68440",1,427,612.12,476.13,2032.26,106.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 69420",1,955,445.06,346.18,2032.26,238.75]
["TUFTS - TUFTS HMO - CPT - 93797",1,274,451.04,74.930000000000007,1130.1600000000001,68.5]
["TUFTS - TUFTS HMO - CPT - 94644",1,226,429.87,178.83,1077.0999999999999,56.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 71046",1,284,107.22,81.93,801.26,71]
["TUFTS - TUFTS HMO - CPT - 95885",1,280,0,112.2,112.2,70]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 72120",1,169,193.63,72.290000000000006,1102.33,42.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 72197",1,5507,664.1,664.1,4707.1099999999997,1376.75]
["TUFTS - TUFTS HMO - CPT - 97154",1,378,81.69,56.05,129.58000000000001,94.5]
["TUFTS - TUFTS HMO - CPT - 99214",1,327,46.32,33.74,190.85,81.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 73720",1,5507,664.1,664.1,4299.8,1376.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 74150",1,1978,193.63,193.63,1307.74,494.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 74328",1,325,0,215.23,215.23,81.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 75635",1,4210,347.19,265.3,2420.09,1052.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 75741",1,4288,4546.0600000000004,827.44,31186.53,1072]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82436",1,26,8.34,4.59,56.85,6.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82731",1,318,93.39,28.7,723.09,79.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 76801",1,1206,193.63,147.96,1274.24,301.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 76827",1,580,193.63,147.96,1423.04,145]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 85210",1,65,18.82,11.84,145.74,16.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 85303",1,62,20.07,12.62,155.28,15.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 77307",1,1070,553.85,369.25,3236.35,267.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 86707",1,56,16.78,10.55,129.88999999999999,14]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 78071",1,3400,608.36,239.64,4270.45,850]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 78300",1,658,608.36,394.65,4270.45,164.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 87538",1,326,50.88,32.01,393.99,81.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 87799",1,307,62.12,39.07,480.84,76.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 90653",1,79,86.32,59.53,149.79,19.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 80187",1,91,58.53,27.11,144.88999999999999,22.75]
["TUFTS - TUFTS MEDICARE SCO - CPT - 81275",1,534,280.20999999999998,142.78,1874.37,133.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 81342",1,534,292.18,183.8,2261.92,133.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 82180",1,49,14.34,9.01,110.9,12.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 81342",1,534,483.36,183.8,2261.92,133.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 83498",1,130,39.4,24.78,305.02,32.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 82330",1,69,36.44,12.47,153.49,17.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 82507",1,134,66.69,25.37,312.11,33.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 85300",1,57,17.18,10.81,133.03,14.25]
["TUFTS - TUFTS MEDICARE SCO - CPT - 86161",1,58,17.399999999999999,10.94,134.62,14.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 83516",1,55,30.74,10.52,129.47999999999999,13.75]
["TUFTS - TUFTS MEDICARE SCO - CPT - 86765",1,102,18.68,11.75,144.6,25.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 83945",1,62,31.2,11.74,144.81,15.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 84270",1,105,52.14,19.82,243.97,26.25]
["TUFTS - TUFTS MEDICARE SCO - CPT - 87532",1,38,50.88,32.01,393.99,9.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 84480",1,71,34,12.94,159.19,17.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 85290",1,82,39.19,14.9,183.36,20.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 85303",1,62,33.18,12.62,155.28,15.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 85670",1,29,13.84,5.26,64.72,7.25]
["TUFTS - TUFTS POS - CPT - 11770",1,2987,7467.76,1990.62,11845.41,746.75]
["TUFTS - TUFTS POS - CPT - 15003",1,1421,0,113.61,1198.25,355.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 86631",1,52,28.37,10.79,132.78,13]
["TUFTS - TUFTS POS - CPT - 17261",1,709,595.01,296.32,1198.25,177.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 86778",1,72,34.57,13.14,161.72,18]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 86901",1,87,69.349999999999994,2.73,348.71,21.75]
["TUFTS - TUFTS POS - CPT - 21933",1,5650,7467.76,1990.62,11845.41,1412.5]
["TUFTS - TUFTS POS - CPT - 22902",1,2024,4856.75,1500.85,7703.8,506]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 87340",1,51,24.79,9.42,115.95,12.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 87490",1,100,49.12,18.29,226.32,25]
["TUFTS - TUFTS POS - CPT - 27306",1,4106,7467.76,1990.62,11845.41,1026.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 88112",1,320,110.07,37.81,557.29999999999995,80]
["TUFTS - TUFTS POS - CPT - 28515",1,1084,595.01,317.70999999999998,1198.25,271]
["TUFTS - TUFTS POS - CPT - 29580",1,328,450.38,226.08,764.24,82]
["TUFTS - TUFTS POS - CPT - 30100",1,939,2058.17,1098.98,3264.67,234.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90653",1,79,102.47,59.53,149.79,19.75]
["TUFTS - TUFTS POS - CPT - 33228",1,10670,3954.83,1990.62,62742.78,2667.5]
["TUFTS - TUFTS POS - CPT - 33273",1,4700,4856.75,1990.62,7703.8,1175]
["TUFTS - TUFTS POS - CPT - 36248",1,389,0,121.05,1500.85,97.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 92311",1,523,751.68,93.14,1538.47,130.75]
["TUFTS - TUFTS POS - CPT - 37215",1,8331,4856.75,1990.62,7703.8,2082.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 92621",1,95,0,46.73,46.73,23.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 92944",1,5075,0,6373.27,6373.27,1268.75]
["TUFTS - TUFTS POS - CPT - 41825",1,4030,2058.17,1098.98,4335.57,1007.5]
["TUFTS - TUFTS POS - CPT - 43229",1,3385,4856.75,1500.85,7703.8,846.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 93456",1,10614,5460.91,2531.06,7703.8,2653.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 93567",1,448,0,130.85,130.85,112]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 93591",1,12027,29835.33,2574.12,62742.78,3006.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 93923",1,381,293.52,211.22,1412.44,95.25]
["TUFTS - TUFTS POS - CPT - 50433",1,1900,2058.17,1098.98,3380.52,475]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 94375",1,345,544.74,117.36,2363.2800000000002,86.25]
["TUFTS - TUFTS POS - CPT - 54220",1,1009,2058.17,388.64,3264.67,252.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 95149",1,78,129,100.35,345.64,19.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 95806",1,422,293.52,228.32,1412.44,105.5]
["TUFTS - TUFTS POS - CPT - 62302",1,877,2058.17,1098.98,3264.67,219.25]
["TUFTS - TUFTS POS - CPT - 64494",1,399,0,127.95,1198.25,99.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 96105",1,448,230.32,162.37,917.01,112]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 96375",1,101,81.78,63.62,218.59,25.25]
["TUFTS - TUFTS POS - CPT - 67141",1,427,1281.21,476.13,2032.26,106.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 97802",1,165,81.7,57.12,182.04,41.25]
["TUFTS - TUFTS POS - CPT - 68840",1,1137,595.01,317.70999999999998,1198.25,284.25]
["TUFTS - TUFTS POS - CPT - 70336",1,3454,878.92,396.79,2642.66,863.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 80299",1,718,40.24,13.77,180.75,179.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 81180",1,175,295.77999999999997,102.3,1328.77,43.75]
["TUFTS - TUFTS POS - CPT - 73202",1,3140,804.9,347.19,2420.09,785]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 81401",1,678,295.77999999999997,137,344.72,169.5]
["TUFTS - TUFTS POS - CPT - 74445",1,490,584.30999999999995,147.96,1756.83,122.5]
["TUFTS - TUFTS POS - CPT - 75831",1,4288,10372.290000000001,780.65,31186.53,1072]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 82378",1,95,40.93,17.3,212.87,23.75]
["TUFTS - TUFTS POS - CPT - 76802",1,634,0,45.03,118.01,158.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 82746",1,73,31.74,13.41,165.06,18.25]
["TUFTS - TUFTS POS - CPT - 77402",1,1675,472.79,143.49,1421.57,418.75]
["TUFTS - TUFTS POS - CPT - 77790",1,846,0,69.3,69.3,211.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 84105",1,26,12.48,4.72,58.16,6.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 84182",1,264,63.06,21.58,283.38,66]
["TUFTS - TUFTS POS - CPT - 80280",1,67,68.739999999999995,38.57,206.18,16.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 85004",1,22,13.97,5.9,72.55,5.5]
["TUFTS - TUFTS POS - CPT - 82024",1,185,144.19999999999999,35.229999999999997,433.56,46.25]
["TUFTS - TUFTS POS - CPT - 82585",1,29,45.62,7.96,137.13999999999999,7.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 86160",1,61,25.91,10.94,134.62,15.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 86335",1,138,63.37,26.77,329.47,34.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 86360",1,69,101.43,18.87,527.5,17.25]
["TUFTS - TUFTS POS - CPT - 85301",1,52,40.369999999999997,9.86,121.37,13]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 86744",1,46,34.520000000000003,12.03,155.08000000000001,11.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 86777",1,180,31.07,13.13,161.6,45]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 87075",1,41,20.45,8.64,106.25,10.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 87207",1,281,12.93,5.47,67.33,70.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 87260",1,57,31.15,10.94,139.96,14.25]
["TUFTS - TUFTS POS - CPT - 87385",1,46,44.75,10.94,134.54,11.5]
["TUFTS - TUFTS POS - CPT - 87906",1,2063,480.62,56.44,1445.09,515.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 87660",1,157,43.29,18.29,225.1,39.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 88280",1,149,72.260000000000005,24.73,324.62,37.25]
["TUFTS - TUFTS POS - CPT - 90839",1,153,46.18,40.369999999999997,214.2,38.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 77063",1,100,52.36,26.06,295.68,25]
["TUFTS - TUFTS POS - CPT - 92521",1,543,415.8,221.37,705.55,135.75]
["TUFTS - TUFTS POS - CPT - 92597",1,348,390.83,178.94,1175.1199999999999,87]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 81222",1,762,757.02,435.07,1094.72,190.5]
["TUFTS - TUFTS POS - CPT - 93260",1,56,123.21,62.4,209.07,14]
["TUFTS - TUFTS POS - CPT - 93610",1,8754,15821.72,4616.53,47572.639999999999,2188.5]
["TUFTS - TUFTS POS - CPT - 93660",1,1399,1598.87,545.01,4807.5,349.75]
["TUFTS - TUFTS POS - CPT - 93990",1,2030,371.71,188.94,1117.6500000000001,507.5]
["FALLON - FALLON MEDICAID - CPT - 62329",1,794,0,1005.99,3264.67,198.5]
["FALLON - FALLON MEDICAID - CPT - 69090",1,104,0,68.89,943.8,26]
["TUFTS - TUFTS POS - CPT - 95962",1,676,0,236.55,236.55,169]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 83010",1,63,21.89,11.47,141.18,15.75]
["TUFTS - TUFTS POS - CPT - 97157",1,378,81.69,56.05,129.58000000000001,94.5]
["TUFTS - TUFTS POS - CPT - 97760",1,189,180.68,60.33,306.58999999999997,47.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 84145",1,99,47.36,24.44,300.82,24.75]
["FALLON - FALLON MEDICAID - CPT - 80076",1,224,7.46,7.46,91.78,56]
["TUFTS - TUFTS PPO - CPT - 11056",1,171,320.41000000000003,171.09,1198.25,42.75]
["TUFTS - TUFTS PPO - CPT - 11601",1,1146,1281.21,684.11,2032.26,286.5]
["FALLON - FALLON MEDICAID - CPT - 80175",1,64,12.09,12.09,148.84,16]
["TUFTS - TUFTS PPO - CPT - 13122",1,661,0,213.81,1198.25,165.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 86300",1,96,36.21,18.989999999999998,233.69,24]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 86615",1,174,22.95,12.03,148.07,43.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 86638",1,63,21.09,11.06,136.13,15.75]
["TUFTS - TUFTS PPO - CPT - 21080",1,3209,10732.28,3747.12,17023.61,802.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 86850",1,87,17,5.25,501.09,21.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 87040",1,51,17.96,9.41,115.87,12.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 87181",1,25,8.27,3.54,53.31,6.25]
["TUFTS - TUFTS PPO - CPT - 25500",1,1908,595.01,317.70999999999998,1198.25,477]
["TUFTS - TUFTS PPO - CPT - 27238",1,3509,2058.16,1098.98,3264.67,877.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 87507",1,588,725.2,291.7,4678.75,147]
["TUFTS - TUFTS PPO - CPT - 28230",1,2895,2058.16,1098.98,3264.67,723.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 88165",1,52,73.459999999999994,13.16,409.48,13]
["FALLON - FALLON MEDICAID - CPT - 80354",1,86,0,19.329999999999998,147.9,21.5]
["TUFTS - TUFTS PPO - CPT - 31613",1,3197,4856.75,1500.85,7703.8,799.25]
["TUFTS - TUFTS PPO - CPT - 31632",1,378,0,120.16,1500.85,94.5]
["TUFTS - TUFTS PPO - CPT - 33222",1,2594,2058.16,1098.98,3344.2,648.5]
["TUFTS - TUFTS PPO - CPT - 36475",1,3421,7467.76,1990.62,11845.41,855.25]
["TUFTS - TUFTS PPO - CPT - 64447",1,509,1281.21,310.58,2032.26,127.25]
["TUFTS - TUFTS PPO - CPT - 36904",1,7857,4856.75,2354.5,9090.86,1964.25]
["TUFTS - TUFTS PPO - CPT - 64771",1,1959,4856.75,1500.85,7703.8,489.75]
["TUFTS - TUFTS PPO - CPT - 40810",1,2094,2058.16,1098.98,4335.57,523.5]
["TUFTS - TUFTS PPO - CPT - 41822",1,2007,2058.16,1098.98,3264.67,501.75]
["TUFTS - TUFTS PPO - CPT - 67930",1,2721,2058.16,1098.98,3522.21,680.25]
["TUFTS - TUFTS PPO - CPT - 69209",1,198,320.41000000000003,93.87,1198.25,49.5]
["TUFTS - TUFTS PPO - CPT - 44394",1,1971,4856.75,1020.59,7703.8,492.75]
["TUFTS - TUFTS PPO - CPT - 45384",1,2086,2058.16,1020.59,3264.67,521.5]
["TUFTS - TUFTS PPO - CPT - 72190",1,416,392.56,72.290000000000006,1103.3900000000001,104]
["TUFTS - TUFTS PPO - CPT - 50387",1,2635,2058.16,1098.98,3380.52,658.75]
["TUFTS - TUFTS PPO - CPT - 73592",1,319,285.07,72.290000000000006,801.26,79.75]
["TUFTS - TUFTS PPO - CPT - 56420",1,706,2058.16,278.66000000000003,3264.67,176.5]
["TUFTS - TUFTS HMO - CPT - 11000",1,475,595.01,317.70999999999998,1198.25,118.75]
["TUFTS - TUFTS HMO - CPT - 11301",1,389,320.41000000000003,171.09,508.23,97.25]
["TUFTS - TUFTS PPO - CPT - 62369",1,476,2058.16,470.91,3264.67,119]
["TUFTS - TUFTS HMO - CPT - 11621",1,860,1281.21,684.11,2032.26,215]
["TUFTS - TUFTS PPO - CPT - 64635",1,2471,2058.16,1098.98,3264.67,617.75]
["TUFTS - TUFTS PPO - CPT - 66185",1,3062,4856.75,1500.85,7703.8,765.5]
["TUFTS - TUFTS HMO - CPT - 12044",1,1648,1281.21,684.11,2032.26,412]
["TUFTS - TUFTS PPO - CPT - 67318",1,2949,7467.76,2166.09,11845.41,737.25]
["TUFTS - TUFTS HMO - CPT - 14061",1,6450,7467.76,1990.62,11845.41,1612.5]
["TUFTS - TUFTS PPO - CPT - 69200",1,454,595.01,178.83,943.8,113.5]
["TUFTS - TUFTS PPO - CPT - 70481",1,3060,861.01,347.19,2420.09,765]
["TUFTS - TUFTS HMO - CPT - 17271",1,858,595.01,296.32,1198.25,214.5]
["TUFTS - TUFTS HMO - CPT - 19318",1,8148,7467.76,2166.09,11845.41,2037]
["TUFTS - TUFTS PPO - CPT - 73503",1,311,453.34,135.91,1274.24,77.75]
["TUFTS - TUFTS HMO - CPT - 20950",1,860,595.01,317.70999999999998,1250.8,215]
["TUFTS - TUFTS PPO - CPT - 75563",1,5514,2773.62,861.13,7795.97,1378.5]
["TUFTS - TUFTS PPO - CPT - 75898",1,1421,4902.28,173.86,13779.11,355.25]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 86609",1,48,11.75,11.75,144.6,12]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 82787",1,19,9.36,5.07,89.99,4.75]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 80198",1,71,12.9,12.9,158.69999999999999,17.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 83789",1,91,44.14,17.809999999999999,233.86,22.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 95992",1,283,0,80.59,256.86,70.75]
["CIGNA HEALTHCARE - CIGNA - CPT - 86800",1,51,66.760000000000005,14.51,178.59,12.75]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 87425",1,57,29.14,10.94,134.54,14.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 84520",1,21,9.2200000000000006,3.61,44.34,5.25]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 19316",1,7790,0,2166.09,11845.41,1947.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 85611",1,21,9.2200000000000006,3.6,44.26,5.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 86157",1,38,18.45,7.35,90.48,9.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 44369",1,2282,7703.8,1013.38,7703.8,570.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 77062",1,483,1706.13,207.16,1706.13,120.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 86682",1,104,29.65,11.87,146.03,26]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 86707",1,56,26.35,10.55,129.88999999999999,14]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 81256",1,434,65.36,59.62,733.73,108.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 87081",1,34,15.16,6.04,74.42,8.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 82652",1,191,35.119999999999997,35.119999999999997,432.18,47.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 87207",1,281,34.94,5.47,67.33,70.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 87490",1,100,45.46,18.29,226.32,25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 87532",1,38,79.05,32.01,393.99,9.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 87632",1,504,481.55,157.59,2395.92,126]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 28039",1,2723,11845.41,1198.25,11845.41,680.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 64640",1,1297,3264.67,1098.98,3264.67,324.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 88331",1,299,190.34,34.96,1369.2,74.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 84450",1,26,58.08,4.72,58.08,6.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 70310",1,364,303.20999999999998,136.68,2574.88,91]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 70460",1,2057,577.83000000000004,347.19,2420.09,514.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 85461",1,34,9.36,6.92,90.76,8.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 89050",1,25,4.72,4.3099999999999996,53.02,6.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 92132",1,186,93.87,68.75,562.35,46.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 92260",1,92,53.94,53.94,341.01,23]
["BMC HEALTHNET - BMCHN MCO - CPT - 87798",1,129,32.01,32.01,393.99,32.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 92577",1,286,764.57,158,3800.82,71.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 85651",1,20,3.24,3.24,41.45,5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 99172",1,72,0,39.39,39.39,18]
["BMC HEALTHNET - BMCHN QHP - CPT - 80186",1,46,15.06,12.55,154.51,11.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 93287",1,315,52.71,52.71,52.71,78.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 93306",1,2511,835.47,403.66,4775.3,627.75]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 84480",1,71,28.04,12.94,159.19,17.75]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 87081",1,34,11.41,6.04,74.42,8.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 93656",1,25096,32266.99,2531.06,62742.78,6274]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 93926",1,1905,188.94,188.94,1169.49,476.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 21501",1,2480,7703.8,1500.85,7703.8,620]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 95076",1,629,764.57,764.57,2713.03,157.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 45307",1,2802,3264.67,1098.98,4536.32,700.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 55700",1,1826,3264.67,1098.98,3380.52,456.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 95909",1,697,423.72,282.57,1457.53,174.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 95937",1,364,228.32,228.32,1412.44,91]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 81235",1,1038,3148.12,239.82,3148.12,259.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 96366",1,100,63.62,63.62,218.59,25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 87556",1,129,404.26,32.01,404.26,32.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 96567",1,645,296.32,296.32,983.48,161.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 97154",1,378,56.05,56.05,129.58000000000001,94.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 97811",1,41,63.62,63.62,63.62,10.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 99156",1,101,190.51,190.51,190.51,25.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 87350",1,55,11.53,10.51,129.4,13.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 81304",1,183,150,150,377.43,45.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 10180",1,3570,3994.03,1500.85,7703.8,892.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11303",1,570,527.46,317.70999999999998,943.8,142.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 86762",1,70,19.739999999999998,13.13,161.6,17.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11621",1,860,972.93,684.11,2032.26,215]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 85027",1,33,6.47,5.9,72.55,8.25]
["BMC HEALTHNET - BMCHN MCO - CPT - 85250",1,95,17.37,17.37,213.81,23.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 12053",1,1677,527.46,527.46,2032.26,419.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 13121",1,2517,810.95,684.11,2032.26,629.25]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 64624",1,2182,0,1198.25,7703.8,545.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 80168",1,75,14.9,14.9,183.36,18.75]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 82670",1,139,25.48,25.48,313.62,34.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 17271",1,858,296.32,296.32,1198.25,214.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 19350",1,2893,4729.13,2166.09,11845.41,723.25]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 92941",1,10821,0,1657.51,37129.18,2705.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 20610",1,381,415.61,317.70999999999998,1198.25,95.25]
["BMC HEALTHNET - BMCHN QHP - CPT - 82810",1,52,9.5500000000000007,7.96,98.14,13]
["BMC HEALTHNET - BMCHN QHP - CPT - 84597",1,149,15.02,12.52,154.06,37.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 21461",1,7214,7429.92,2166.09,11845.41,1803.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 22513",1,8897,9571.73,1990.62,17023.61,2224.25]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 81050",1,15,7.61,2.74,35.29,3.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 24605",1,2026,2205.59,1500.85,7703.8,506.5]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 86902",1,87,5.24,4.6900000000000004,2272.4699999999998,21.75]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 87899",1,94,29.14,11.87,155.81,23.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 26060",1,3045,2205.59,1500.85,7703.8,761.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 27047",1,2794,3994.03,1500.85,7703.8,698.5]
["CIGNA HEALTHCARE - CIGNA - CPT - 87299",1,92,51.64,11.9,156.22,23]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11421",1,1103,3264.67,972.93,3264.67,275.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 27814",1,8554,9571.73,1990.62,11845.41,2138.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 28010",1,2895,2205.59,1098.98,3264.67,723.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 28296",1,3939,4405.5600000000004,1990.62,11845.41,984.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 28046",1,3438,11845.41,1990.62,11845.41,859.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 29440",1,199,226.08,226.08,764.24,49.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 37195",1,346,3264.67,484.3,3264.67,86.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 45382",1,2540,3264.67,1020.59,3264.67,635]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 31570",1,4112,4602.58,1500.85,7703.8,1028]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 31630",1,4368,4602.58,1500.85,7703.8,1092]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 67800",1,808,2032.26,476.13,2032.26,202]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 72120",1,169,1102.33,72.290000000000006,1102.33,42.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 33264",1,34636,51483.43,1990.62,62742.78,8659]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 77399",1,346,1474.02,160.66,1474.02,86.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 36248",1,389,121.05,121.05,1500.85,97.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 81309",1,223,1468.89,274.83,1468.89,55.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 36556",1,1461,1836.61,1098.98,3264.67,365.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 86593",1,23,49.48,4.0199999999999996,49.48,5.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 87624",1,110,393.99,32.01,393.99,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 37222",1,7580,459.91,459.91,1198.25,1895]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 38241",1,5269,2094.1799999999998,2094.1799999999998,15242.01,1317.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 95249",1,134,562.35,93.87,562.35,33.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 99406",1,83,287.77999999999997,50.95,287.77999999999997,20.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 41251",1,310,346.18,346.18,2032.26,77.5]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 84540",1,25,12.07,4.33,53.96,6.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 42815",1,7214,7429.92,2354.5,15242.01,1803.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 43237",1,1797,2491.1,1010.64,3264.67,449.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 82747",1,76,17.649999999999999,15.8,194.37,19]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 85046",1,141,5.57,5.08,62.56,35.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 44404",1,1378,1645.44,1098.98,3264.67,344.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 80185",1,66,13.25,12.09,148.84,16.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 45347",1,1444,7550.56,1098.98,8736.31,361]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 46607",1,930,1645.44,1098.98,3264.67,232.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 87186",1,43,8.65,7.88,97,10.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 80177",1,174,18.18,12.09,148.84,43.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 81315",1,675,284.38,189.1,2327.29,168.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 51102",1,2441,2921.68,1098.98,3380.52,610.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 51705",1,391,388.64,388.64,1338.81,97.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 88142",1,101,27.79,18.48,227.42,25.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 82677",1,90,24.18,22.05,271.39,22.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 56501",1,2598,2601.27,1098.98,3344.2,649.5]
["BMC HEALTHNET - BMCHN MCO - CPT - 83002",1,93,16.89,16.89,207.81,23.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 57510",1,3553,3965.45,1098.98,4588.18,888.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 58674",1,15505,13001.07,2354.5,37129.18,3876.25]
["BMC HEALTHNET - BMCHN MCO - CPT - 86698",1,28,11.4,11.4,140.32,7]
["BMC HEALTHNET - BMCHN MCO - CPT - 87186",1,43,7.88,7.88,97,10.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 62369",1,476,470.91,470.91,3264.67,119]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 64415",1,503,1284.45,310.58,3264.67,125.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 64520",1,1153,1284.45,829.82,3264.67,288.25]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 37182",1,6320,0,2031.06,11845.41,1580]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 81221",1,434,0,97.22,244.62,108.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 82530",1,82,15.24,15.24,187.56,20.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 82941",1,85,16.079999999999998,16.079999999999998,197.91,21.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 66984",1,2878,3219.62,2574.12,7703.8,719.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 67101",1,3007,3219.62,2166.09,11845.41,751.75]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 86663",1,37,11.97,11.97,147.33000000000001,9.25]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 86817",1,296,78.42,78.42,1029.42,74]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 68340",1,2721,3044.16,2166.09,11845.41,680.25]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 95951",1,1693,0,1629.7,9203.9699999999993,423.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 70030",1,275,81.93,72.290000000000006,801.26,68.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 70380",1,392,81.93,72.290000000000006,932.7,98]
["BMC HEALTHNET - BMCHN QHP - CPT - 81276",1,3198,171.34,142.78,1874.37,799.5]
["BMC HEALTHNET - BMCHN QHP - CPT - 82384",1,122,27.65,23.04,283.54000000000002,30.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 72110",1,462,147.96,125.38,1304.76,115.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 72133",1,2997,577.83000000000004,347.19,2420.09,749.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 72191",1,4023,577.83000000000004,347.19,2420.09,1005.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 86625",1,16,14.36,11.97,147.33000000000001,4]
["BMC HEALTHNET - BMCHN QHP - CPT - 87140",1,28,6.1,5.08,62.56,7]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 73700",1,1997,322.25,193.63,1274.24,499.25]
["BMC HEALTHNET - BMCHN QHP - CPT - 93668",1,87,0,99.57,317.35000000000002,21.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 74712",1,2754,660.39,303.5,1954.21,688.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 75571",1,153,178.43,32.409999999999997,652.5,38.25]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 83090",1,84,27.19,15.39,189.43,21]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 85048",1,12,4.21,2.31,28.49,3]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 76519",1,781,147.96,147.96,1208.5,195.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 76816",1,1146,147.96,98.34,1179.76,286.5]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 87511",1,109,51.5,32.01,393.99,27.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 77014",1,1088,345.55,161,345.55,272]
["CIGNA HEALTHCARE - CIGNA - CPT - 82104",1,64,65.13,13.2,162.37,16]
["CIGNA HEALTHCARE - CIGNA - CPT - 83835",1,83,76.34,15.46,190.17,20.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 77761",1,3426,1495.83,523.85,6278.62,856.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 77778",1,7167,2027.78,1212.82,8624.5,1791.75]
["CIGNA HEALTHCARE - CIGNA - CPT - 87172",1,23,19.239999999999998,3.89,47.89,5.75]
["CIGNA HEALTHCARE - CIGNA - CPT - 87400",1,57,51.64,10.94,137.06,14.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 10140",1,1453,3264.67,1098.98,3264.67,363.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 79445",1,1061,303.64999999999998,303.64999999999998,2756.08,265.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 13121",1,2517,2032.26,684.11,2032.26,629.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 81002",1,12,6.59,2.57,33.79,3]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 81221",1,434,177.86,97.22,244.62,108.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 23540",1,1217,3264.67,378,3264.67,304.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 25660",1,325,3264.67,378,3264.67,81.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 82175",1,92,42.81,17.3,212.95,23]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 82306",1,146,66.540000000000006,27.01,332.37,36.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 31577",1,1156,2032.26,649.07000000000005,2032.26,289]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 82810",1,52,19.760000000000002,7.96,98.14,13]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 37186",1,1951,0,603,1198.25,487.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 83497",1,62,28.98,11.76,144.81,15.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 41006",1,1709,3264.67,1098.98,3264.67,427.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 84145",1,99,60.6,24.44,300.82,24.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 84244",1,106,49.4,20.059999999999999,246.86,26.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 49329",1,7452,17023.61,1198.25,17023.61,1863]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 54060",1,2325,3264.67,1098.98,3344.2,581.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 85270",1,91,40.18,16.329999999999998,200.93,22.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 85576",1,311,34.94,19.59,243.68,77.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 66180",1,5769,11845.41,2354.5,11845.41,1442.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 86340",1,73,34.26,13.75,169.26,18.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 68720",1,4867,11845.41,2166.09,11845.41,1216.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 72148",1,3598,2653.95,396.79,2653.95,899.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 86744",1,46,29.65,12.03,155.08000000000001,11.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 86850",1,87,67.040000000000006,5.25,501.09,21.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 76945",1,1925,0,111.15,174.71,481.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 87185",1,25,10.55,3.54,53.31,6.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 78453",1,1924,13344.86,1360.45,13344.86,481]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 81241",1,434,711.6,55.74,711.6,108.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 87556",1,129,79.05,32.01,404.26,32.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 87635",1,153,59.02,51.31,465.19,38.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 87912",1,675,581.03,112.85,2890.09,168.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 85305",1,56,130.34,10.59,130.34,14]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 86617",1,27,173.95,14.13,173.95,6.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 89050",1,25,10.55,4.3099999999999996,53.02,6.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 70547",1,4407,660.39,396.79,2653.95,1101.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 88369",1,154,0,100.56,162.36000000000001,38.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90840",1,92,147.96,147.96,147.96,23]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 92586",1,417,1412.44,141.86000000000001,1412.44,104.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 93286",1,237,0,52.71,52.71,59.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 92521",1,543,281.64999999999998,221.37,705.55,135.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 92538",1,584,228.32,228.32,1610.39,146]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 95990",1,457,1636.93,484.3,1636.93,114.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 96900",1,100,185.72,53.94,185.72,25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 92953",1,798,884.17,884.17,5007.9799999999996,199.5]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 82175",1,92,48.25,17.3,212.95,23]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 93285",1,369,62.4,41.48,370.47,92.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 93459",1,11307,4719.71,2531.06,7703.8,2826.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 93530",1,2897,4719.71,2531.06,7703.8,724.25]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 86807",1,183,100.63,54.29,762.87,45.75]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 87116",1,54,27.46,9.86,121.29,13.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 93980",1,1568,188.94,188.94,1117.6500000000001,392]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 94640",1,330,321.77,40.020000000000003,1630.85,82.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 82542",1,926,24.09,17.8,233.69,231.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 95707",1,377,407.35,407.35,2582.75,94.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 84165",1,63,10.74,9.8000000000000007,120.52,15.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 86431",1,27,5.67,5.17,63.66,6.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 95930",1,205,228.32,228.32,1412.44,51.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 96121",1,412,187.64,187.64,187.64,103]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 78258",1,2202,464.88,373.93,4270.45,550.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 81271",1,175,137,102.3,1328.77,43.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 81402",1,434,150.33000000000001,150.33000000000001,378.26,108.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 97152",1,378,56.05,56.05,129.58000000000001,94.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 97802",1,165,84.13,57.12,182.04,41.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 85306",1,69,15.32,13.98,172.07,17.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 99284",1,2183,605.19000000000005,352.73,3681.98,545.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 87172",1,23,4.2699999999999996,3.89,47.89,5.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 87797",1,31,30.03,22.19,291.27999999999997,7.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11200",1,559,296.32,296.32,1198.25,139.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11402",1,876,972.93,684.11,2032.26,219]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 83695",1,63,17.760000000000002,11.81,145.38,15.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 84166",1,99,24.46,16.260000000000002,200.15,24.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 12031",1,1177,527.46,527.46,2032.26,294.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 86813",1,266,79.56,52.9,651.04,66.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 14302",1,1598,548.05999999999995,548.05999999999995,1198.25,399.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 15630",1,2701,2601.27,1990.62,11845.41,675.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 81271",1,175,137,102.3,1328.77,43.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 82175",1,92,42.81,17.3,212.95,23]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 19282",1,362,125.12,125.12,1198.25,90.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 82626",1,122,57.32,23.05,283.74,30.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 20240",1,3570,3994.03,1500.85,7703.8,892.5]
["BMC HEALTHNET - BMCHN MCO - CPT - 82379",1,52,15.39,14.65,189.43,13]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 21079",1,3209,3747.12,3747.12,17023.61,802.25]
["BMC HEALTHNET - BMCHN MCO - CPT - 84080",1,71,13.48,13.48,166,17.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 84165",1,63,9.8000000000000007,9.8000000000000007,120.52,15.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 23350",1,637,126.08,126.08,1198.25,159.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 23600",1,1217,378,378,3264.67,304.25]
["BMC HEALTHNET - BMCHN MCO - CPT - 86580",1,55,6.04,6.04,199.34,13.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 86694",1,34,13.13,13.13,161.6,8.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 25660",1,325,378,378,3264.67,81.25]
["BMC HEALTHNET - BMCHN MCO - CPT - 87255",1,168,30.89,30.89,380.17,42]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 26770",1,1939,378,317.70999999999998,943.8,484.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 27306",1,4106,4405.5600000000004,1990.62,11845.41,1026.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 27372",1,3089,3994.03,2531.06,15242.01,772.25]
["BMC HEALTHNET - BMCHN MCO - CPT - 96130",1,341,0,71.41,293.52,85.25]
["BMC HEALTHNET - BMCHN MCO - CPT - 96164",1,36,0,43.97,129.58000000000001,9]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 28234",1,2895,2205.59,1098.98,3264.67,723.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 28525",1,3970,4405.5600000000004,1990.62,11845.41,992.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 74245",1,1698,0,228.79,2347.71,424.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 80354",1,86,0,19.329999999999998,147.9,21.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 31231",1,598,275.37,275.37,1500.85,149.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 81599",1,916,0,null,null,229]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 31628",1,1449,4602.58,1500.85,7703.8,362.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 33206",1,10670,16591.07,2531.06,37129.18,2667.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 83721",1,44,8.6999999999999993,8.6999999999999993,107.11,11]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 83970",1,206,37.65,37.65,463.35,51.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 36223",1,4429,7349.8,1500.85,15242.01,1107.25]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 85461",1,34,6.92,6.92,90.76,8.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 36558",1,3308,4436.09,1098.98,5132.74,827]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 36591",1,192,178.83,178.83,607.66,48]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 86807",1,183,58.11,54.29,762.87,45.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 37191",1,4893,7349.8,1990.62,17023.61,1223.25]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 87186",1,43,7.88,7.88,97,10.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 38221",1,1103,2309.9699999999998,1098.98,3264.67,275.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 40520",1,4029,3747.12,1500.85,7703.8,1007.25]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 89320",1,118,10.99,10.99,135.27000000000001,29.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 96131",1,341,0,198.96,198.96,85.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 42180",1,589,818.07,684.11,2032.26,147.25]
["BMC HEALTHNET - BMCHN QHP - CPT - 11922",1,371,0,73.66,1198.25,92.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 43200",1,1154,1278.93,1010.64,3264.67,288.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 43259",1,2333,2491.1,1010.64,7703.8,583.25]
["BMC HEALTHNET - BMCHN QHP - CPT - 81254",1,51,0,35,88.07,12.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 81403",1,659,0,185.2,466,164.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 45337",1,1099,1645.44,420.29,3264.67,274.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 45915",1,1494,1645.44,1098.98,3264.67,373.5]
["BMC HEALTHNET - BMCHN QHP - CPT - 83655",1,58,13.26,11.05,135.91999999999999,14.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 47537",1,698,1278.93,684.11,2032.26,174.5]
["BMC HEALTHNET - BMCHN QHP - CPT - 84430",1,58,12.73,10.61,130.62,14.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 49427",1,341,112.93,112.93,1198.25,85.25]
["BMC HEALTHNET - BMCHN QHP - CPT - 85705",1,35,10.55,8.7899999999999991,108.13,8.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 51710",1,803,944.22,944.22,3176.09,200.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 52285",1,834,944.22,944.22,7703.8,208.5]
["BMC HEALTHNET - BMCHN QHP - CPT - 86900",1,87,3.28,2.73,923.73,21.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 87269",1,57,13.13,10.94,135.27000000000001,14.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 57160",1,368,278.66000000000003,278.66000000000003,943.8,92]
["BMC HEALTHNET - BMCHN QHP - CPT - 87912",1,675,281.81,112.85,2890.09,168.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 59015",1,1037,937.16,684.11,2032.26,259.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 61640",1,4698,1156.06,1156.06,1156.06,1174.5]
["BMC HEALTHNET - BMCHN QHP - CPT - 97755",1,177,0,64.09,238.69,44.25]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 80048",1,226,16.72,7.71,94.96,56.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 64490",1,1071,1284.45,829.82,4375.87,267.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 64505",1,647,415.61,310.58,1198.25,161.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 64635",1,2471,2739.86,1098.98,3264.67,617.75]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 83002",1,93,36.619999999999997,16.89,207.81,23.25]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 84244",1,106,43.49,20.059999999999999,246.86,26.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 66183",1,5769,6113.35,1990.62,17023.61,1442.25]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 85049",1,23,8.83,4.09,50.21,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 67311",1,2949,3044.16,1990.62,11845.41,737.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 67550",1,4867,4996.58,2166.09,11845.41,1216.75]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 86778",1,72,28.47,13.14,161.72,18]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 87106",1,51,20.399999999999999,9.41,115.87,12.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 69100",1,410,346.18,346.18,2032.26,102.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 69801",1,2094,2148.08,2148.08,15242.01,523.5]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 88304",1,191,55.2,55.2,557.29999999999995,47.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 70544",1,4409,660.39,396.79,2653.95,1102.25]
["CIGNA HEALTHCARE - CIGNA - CPT - 80202",1,67,61.05,12.35,151.97999999999999,16.75]
["CIGNA HEALTHCARE - CIGNA - CPT - 82575",1,48,42.59,8.6199999999999992,106.17,12]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 72157",1,5001,1105.27,664.1,4707.1099999999997,1250.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 73030",1,294,81.93,72.290000000000006,801.26,73.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 73060",1,279,81.93,72.290000000000006,801.26,69.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 73610",1,319,81.93,72.290000000000006,851.68,79.75]
["CIGNA HEALTHCARE - CIGNA - CPT - 85730",1,31,27.06,5.48,67.41,7.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 74176",1,2117,660.39,396.79,2562.5700000000002,529.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 74450",1,375,303.20999999999998,267.85000000000002,2562.5700000000002,93.75]
["CIGNA HEALTHCARE - CIGNA - CPT - 87046",1,48,10.64,6,105.97,12]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 75805",1,636,1438.22,321.11,12540.99,159]
["CIGNA HEALTHCARE - CIGNA - CPT - 87899",1,94,51.64,11.87,155.81,23.5]
["CIGNA HEALTHCARE - CIGNA - CPT - 88348",1,2244,1153.07,165.6,5742.72,561]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 76813",1,1182,147.96,98.34,1274.24,295.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 76831",1,1228,303.20999999999998,152.84,2653.95,307]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11770",1,2987,11845.41,1990.62,11845.41,746.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 77301",1,16122,3429.66,1340.75,14341.71,4030.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 15276",1,191,0,62.43,1198.25,47.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 17261",1,709,943.8,296.32,1198.25,177.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 19020",1,2335,7703.8,1500.85,7703.8,583.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 78315",1,3304,464.88,394.65,4270.45,826]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 78580",1,2102,464.88,315.47000000000003,4270.45,525.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 22514",1,22040,17023.61,1990.62,17023.61,5510]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 23525",1,321,3264.67,378,3264.67,80.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 80299",1,718,34.26,13.77,180.75,179.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 81000",1,17,7.24,2.97,39.04,4.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 27256",1,325,7703.8,378,7703.8,81.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 81308",1,223,346.55,301.35000000000002,1610.68,55.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 29105",1,459,764.24,226.08,764.24,114.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 30100",1,939,3264.67,1098.98,3264.67,234.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 82390",1,52,24.37,9.8000000000000007,120.52,13]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 82565",1,26,11.86,4.68,57.51,6.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 33273",1,4700,7703.8,1990.62,7703.8,1175]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 83030",1,42,19.760000000000002,7.94,104.21,10.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 36481",1,2753,0,826.81,1198.25,688.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 83789",1,91,44.14,17.809999999999999,233.86,22.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 84134",1,72,32.94,13.31,163.76,18]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 38792",1,444,2063.4,593.65,2063.4,111]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 84445",1,244,114.62,46.39,570.91,61]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 43229",1,3385,7703.8,1500.85,7703.8,846.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 43248",1,1449,7703.8,1010.64,7703.8,362.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 85576",1,311,34.94,19.59,243.68,77.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 86300",1,96,46.77,18.989999999999998,233.69,24]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 47001",1,786,0,258.39,1198.25,196.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 86611",1,61,23.06,9.2799999999999994,114.2,15.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 51703",1,611,797.09,228.32,1198.25,152.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 54220",1,1009,3264.67,388.64,3264.67,252.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 86813",1,266,131.09,52.9,651.04,66.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 87106",1,51,23.06,9.41,115.87,12.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 62273",1,1153,3264.67,1005.62,3264.67,288.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 64400",1,531,2032.26,310.58,2032.26,132.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 87498",1,322,79.05,32.01,393.99,80.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 65782",1,4867,11845.41,2354.5,11845.41,1216.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 87912",1,675,581.03,112.85,2890.09,168.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 67107",1,5769,15242.01,2354.5,15242.01,1442.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 88302",1,180,42.24,36.799999999999997,310.36,45]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 69300",1,3350,11845.41,1990.62,11845.41,837.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 70260",1,446,1274.24,125.38,1274.24,111.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 71270",1,3035,577.83000000000004,347.19,2420.09,758.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90738",1,479,351.57,53.59,929.69,119.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 73110",1,360,801.26,72.290000000000006,801.26,90]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 73723",1,5151,4299.8,664.1,4299.8,1287.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 92201",1,71,88.54,88.54,320.3,17.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 76000",1,492,2487.79,130.34,2487.79,123]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 92526",1,361,213.94,181.53,578.54,90.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 92585",1,639,423.72,326.83,2582.75,159.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 92594",1,167,47.48,24.58,138.81,41.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 77768",1,2180,2711.86,143.49,2711.86,545]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 93279",1,448,62.4,41.48,370.47,112]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 93287",1,315,52.71,52.71,52.71,78.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 93351",1,2162,835.47,756.94,4775.3,540.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 81000",1,17,39.04,2.97,39.04,4.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 93619",1,5212,8560.41,2531.06,9904.74,1303]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 82164",1,71,163.96,13.32,163.96,17.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 82747",1,76,194.37,15.8,194.37,19]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 94617",1,276,178.83,178.83,1085.78,69]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 95120",1,232,24.95,18.04,163.57,58]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 84520",1,21,44.34,3.61,44.34,5.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 85549",1,91,210.55,17.100000000000001,210.55,22.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 95913",1,1506,764.57,282.57,2677.27,376.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 86638",1,63,136.13,11.06,136.13,15.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 96121",1,412,187.64,187.64,187.64,103]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 96369",1,289,314.33999999999997,314.33999999999997,1054.69,72.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 87385",1,46,134.54,10.94,134.54,11.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 87506",1,334,2550.8000000000002,157.59,2550.8000000000002,83.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 87801",1,310,787.98,64.03,787.98,77.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 76828",1,425,147.96,142.59,1307.74,106.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 99281",1,492,117.1,116.13,1429.96,123]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90832",1,125,102.42,31.86,214.2,31.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 92012",1,265,101.85,31.68,194.55,66.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 80177",1,174,29.28,12.09,148.84,43.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 92590",1,167,308.48,54.62,308.48,41.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 81254",1,51,77.349999999999994,35,88.07,12.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 81291",1,434,144.38999999999999,48.28,633.76,108.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 93580",1,19898,62742.78,2574.12,62742.78,4974.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 93926",1,1905,1169.49,188.94,1169.49,476.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 82365",1,120,28.51,11.76,144.81,30]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 72198",1,4469,1376.16,547.75,3526.9,1117.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 82627",1,110,49.13,20.28,249.67,27.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 83003",1,81,36.840000000000003,15.21,187.11,20.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 96370",1,57,218.59,63.62,218.59,14.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 97760",1,189,306.58999999999997,60.33,306.58999999999997,47.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 84156",1,20,8.11,3.35,41.16,5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 84403",1,124,57.04,23.55,289.82,31]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 84432",1,79,35.49,14.65,180.3,19.75]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 82270",1,17,8.26,3.24,42.47,4.25]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 82705",1,25,12.95,4.6500000000000004,57.22,6.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 85397",1,207,68.2,22.8,299.31,51.75]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 84155",1,20,9.32,3.35,41.16,5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 86328",1,203,99.95,45.23,410.13,50.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 86635",1,42,25.35,10.47,128.83000000000001,10.5]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 86353",1,327,124.66,44.72,550.37,81.75]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 86705",1,60,29.95,10.74,132.21,15]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 87015",1,34,14.76,6.09,74.989999999999995,8.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 87045",1,48,20.86,8.6199999999999992,105.97,12]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 87798",1,129,66.22,32.01,393.99,32.25]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 88164",1,52,26.86,10.82,145.38,13]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 80169",1,310,13.73,10.01,154.22,77.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 87535",1,359,77.540000000000006,32.01,393.99,89.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 81270",1,434,91.66,83.62,1029.05,108.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 88271",1,373,47.34,19.54,240.42,93.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 74018",1,232,81.93,81.93,801.26,58]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 77280",1,1590,356.14,160.66,1474.02,397.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 77317",1,1185,926.01,369.25,3892.44,296.25]
["BMC HEALTHNET - BMCHN ACO - CPT - 61642",1,3302,0,812.01,812.01,825.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 77407",1,2226,645.86,143.49,1819.55,556.5]
["BMC HEALTHNET - BMCHN ACO - CPT - 80177",1,174,26.45,12.09,148.84,43.5]
["BMC HEALTHNET - BMCHN ACO - CPT - 80329",1,235,0,10.74,111.18,58.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 86738",1,32,13.24,12.07,148.63999999999999,8]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 87102",1,42,8.41,7.67,94.39,10.5]
["BMC HEALTHNET - BMCHN ACO - CPT - 81363",1,455,327.19,149.54,1963.05,113.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 82040",1,26,9.8699999999999992,4.51,55.55,6.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 89320",1,118,12.31,10.99,135.27000000000001,29.5]
["BMC HEALTHNET - BMCHN ACO - CPT - 82523",1,62,37.31,17.05,209.77,15.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 80177",1,174,13.25,12.09,148.84,43.5]
["BMC HEALTHNET - BMCHN ACO - CPT - 82728",1,67,27.2,12.43,153.04,16.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 83519",1,115,29.73,13.59,178.43,28.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 83874",1,62,25.77,11.78,145.01,15.5]
["BMC HEALTHNET - BMCHN ACO - CPT - 83916",1,97,44.29,20.239999999999998,265.61,24.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 83690",1,35,6.89,6.29,77.400000000000006,8.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 84166",1,99,17.829999999999998,16.260000000000002,200.15,24.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 84481",1,83,33.83,15.46,190.17,20.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 85245",1,180,45.77,20.92,257.5,45]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 86255",1,35,12.05,10.99,135.27000000000001,8.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 86141",1,63,25.84,11.81,145.38,15.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 86757",1,117,19.350000000000001,17.66,217.35,29.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 87153",1,447,115.36,115.36,1294.94,111.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 87253",1,100,20.2,18.43,226.77,25]
["BMC HEALTHNET - BMCHN ACO - CPT - 86665",1,37,36.21,16.55,203.74,9.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 80186",1,46,30.96,12.55,154.51,11.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 36415",1,26,3,2.2200000000000002,25.55,6.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 81311",1,4795,297.86,218.55,2868.9,1198.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 87184",1,35,13.76,6.29,77.400000000000006,8.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 87385",1,46,23.94,10.94,134.54,11.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 81218",1,551,546.11,159,2715.49,137.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 87538",1,326,70.040000000000006,32.01,393.99,81.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 84442",1,92,20.28,13.48,166,23]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 85004",1,22,8.8699999999999992,5.9,72.55,5.5]
["BMC HEALTHNET - BMCHN ACO - CPT - 89051",1,28,10.98,5.0199999999999996,61.83,7]
["BMC HEALTHNET - BMCHN ACO - CPT - 90912",1,260,0,108.42,1370.62,65]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 86777",1,180,19.739999999999998,13.13,161.6,45]
["BMC HEALTHNET - BMCHN ACO - CPT - 96161",1,42,0,50.95,162.4,10.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 87391",1,87,24.2,16.18,212.42,21.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 87799",1,307,58.76,39.07,480.84,76.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 0012A",1,59,56.78,28.39,124.23,14.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 74712",1,2754,660.39,303.5,1954.21,688.5]
["BMC HEALTHNET - BMCHN MCO - CPT - 43257",1,3148,0,1990.62,7703.8,787]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 81308",1,223,301.35000000000002,301.35000000000002,1610.68,55.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 82017",1,83,16.87,14.65,189.43,20.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 80156",1,72,13.28,13.28,163.47,18]
["BMC HEALTHNET - BMCHN MCO - CPT - 80320",1,235,0,16.89,108.78,58.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 83789",1,91,24.11,17.809999999999999,233.86,22.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 81254",1,51,0,35,88.07,12.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 84482",1,73,15.76,14.38,176.92,18.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 85611",1,21,3.94,3.6,44.26,5.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 74430",1,608,507.47,267.85000000000002,3645.22,152]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 28825",1,2883,4405.5600000000004,1500.85,7703.8,720.75]
["AETNA - AETNA - CPT - 23600",1,1217,1198.25,378,3264.67,304.25]
["AETNA - AETNA - CPT - 24066",1,3449,1500.85,1500.85,7703.8,862.25]
["AETNA - AETNA - CPT - 25075",1,2428,1500.85,1500.85,7703.8,607]
["AETNA - AETNA - CPT - 26011",1,1418,1198.25,1098.98,3264.67,354.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 49010",1,4688,2316.04,2166.09,11845.41,1172]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 62305",1,899,1161.71,1098.98,3264.67,224.75]
["AETNA - AETNA - CPT - 27520",1,2263,1198.25,378,3264.67,565.75]
["AETNA - AETNA - CPT - 27614",1,3449,1500.85,1500.85,7703.8,862.25]
["AETNA - AETNA - CPT - 27786",1,2195,1198.25,378,3264.67,548.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 99498",1,283,180.79,180.79,180.79,70.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 46505",1,1495,1645.44,1198.25,7703.8,373.75]
["AETNA - AETNA - CPT - 29827",1,10676,2354.5,2354.5,15242.01,2669]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11646",1,3063,3994.03,1500.85,7703.8,765.75]
["AETNA - AETNA - CPT - 31578",1,2091,1500.85,1500.85,7703.8,522.75]
["AETNA - AETNA - CPT - 31628",1,1449,1500.85,1500.85,7703.8,362.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 21440",1,3620,3747.12,1990.62,11845.41,905]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 31611",1,4242,3747.12,1990.62,11845.41,1060.5]
["AETNA - AETNA - CPT - 36014",1,1055,1198.25,373.73,1198.25,263.75]
["AETNA - AETNA - CPT - 36221",1,4429,1500.85,1500.85,15242.01,1107.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 88184",1,256,360.63,68.739999999999995,2458.16,64]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 92977",1,437,484.3,484.3,3021.28,109.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 83735",1,34,16.86,6.11,75.150000000000006,8.5]
["AETNA - AETNA - CPT - 37186",1,1951,1198.25,603,1198.25,487.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 37197",1,4034,4436.09,1098.98,5132.74,1008.5]
["AETNA - AETNA - CPT - 38222",1,1103,1198.25,1098.98,3264.67,275.75]
["AETNA - AETNA - CPT - 40520",1,4029,1500.85,1500.85,7703.8,1007.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 88313",1,483,42.24,29.44,366.72,120.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 23625",1,2021,2205.59,1500.85,7703.8,505.25]
["AETNA - AETNA - CPT - 42330",1,2094,1198.25,1198.25,7703.8,523.5]
["AETNA - AETNA - CPT - 42826",1,3197,2166.09,2166.09,11845.41,799.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 93285",1,369,62.4,41.48,370.47,92.25]
["AETNA - AETNA - CPT - 43261",1,2794,1500.85,1500.85,7703.8,698.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11421",1,1103,972.93,972.93,3264.67,275.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 28190",1,1023,972.93,972.93,3264.67,255.75]
["AETNA - AETNA - CPT - 45340",1,1341,1198.25,737.96,3264.67,335.25]
["AETNA - AETNA - CPT - 46020",1,2694,1990.62,1990.62,11845.41,673.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 66600",1,5769,6113.35,1990.62,11845.41,1442.25]
["AETNA - AETNA - CPT - 47542",1,934,1198.25,335.84,1198.25,233.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 77373",1,13470,4864.47,2909.47,20524.84,3367.5]
["AETNA - AETNA - CPT - 49440",1,1695,1500.85,1010.64,3264.67,423.75]
["AETNA - AETNA - CPT - 51702",1,228,1198.25,178.83,1198.25,57]
["AETNA - AETNA - CPT - 51728",1,2386,1198.25,944.22,3176.09,596.5]
["AETNA - AETNA - CPT - 53620",1,2441,1198.25,944.22,11845.41,610.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 82009",1,24,11.37,4.12,50.7,6]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 86376",1,70,36.61,13.27,163.31,17.5]
["AETNA - AETNA - CPT - 57500",1,589,1198.25,937.16,3264.67,147.25]
["AETNA - AETNA - CPT - 58558",1,3031,1990.62,1775.68,7703.8,757.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 32557",1,836,1836.61,1098.98,3264.67,209]
["AETNA - AETNA - CPT - 62305",1,899,1500.85,1098.98,3264.67,224.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 64418",1,575,1005.62,310.58,2032.26,143.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 70320",1,498,303.20999999999998,136.68,2060.09,124.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 73221",1,3843,660.39,396.79,2653.95,960.75]
["AETNA - AETNA - CPT - 64771",1,1959,1500.85,1500.85,7703.8,489.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 86905",1,87,360.63,3.49,2229.4299999999998,21.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 88172",1,166,190.34,16.91,1400.17,41.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 99205",1,698,408.29,33.74,408.29,174.5]
["AETNA - AETNA - CPT - 67108",1,5769,2531.06,2531.06,15242.01,1442.25]
["AETNA - AETNA - CPT - 67343",1,2949,2531.06,2531.06,7703.8,737.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 37220",1,7580,7856.99,2166.09,25611.61,1895]
["AETNA - AETNA - CPT - 68115",1,2949,1500.85,1098.98,3522.21,737.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 87281",1,57,27.01,10.94,134.54,14.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 87538",1,326,79.05,32.01,393.99,81.5]
["AETNA - AETNA - CPT - 93609",1,2513,2531.06,884.46,5539.84,628.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 0012A",1,59,33.5,28.39,124.23,14.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 96158",1,81,126.4,36.44,126.4,20.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 80280",1,67,45.51,38.57,206.18,16.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11620",1,930,2309.9699999999998,1098.98,3264.67,232.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 21453",1,5309,7429.92,1990.62,11845.41,1327.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 81363",1,455,238.83,149.54,1963.05,113.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 82075",1,86,35.4,16.53,291,21.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 82103",1,65,15.86,12.26,150.88,16.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 36556",1,1461,1836.61,1098.98,3264.67,365.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 43191",1,2394,2491.1,1098.98,3264.67,598.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 82728",1,67,16.079999999999998,12.43,153.04,16.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 83050",1,37,9.68,6.69,82.45,9.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 65280",1,5769,6113.35,2166.09,11845.41,1442.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 83916",1,97,32.32,20.239999999999998,265.61,24.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 73564",1,422,147.96,72.290000000000006,1103.3900000000001,105.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 76816",1,1146,147.96,98.34,1179.76,286.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 84482",1,73,18.600000000000001,14.38,176.92,18.25]
["AETNA - AETNA - CPT - 11422",1,1039,1198.25,1098.98,3264.67,259.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 84466",1,64,28.98,11.64,143.30000000000001,16]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 86304",1,100,46.77,18.989999999999998,233.69,25]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 86331",1,57,14.14,10.93,134.44999999999999,14.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 92286",1,615,178.83,125.6,1077.0999999999999,153.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 86612",1,83,15.22,11.77,144.88999999999999,20.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 93786",1,283,178.83,126.22,1077.0999999999999,70.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 99284",1,2183,605.19000000000005,352.73,3681.98,545.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 81450",1,2132,1911.13,561.19000000000005,7366.77,533]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 82626",1,122,63.58,23.05,283.74,30.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 86778",1,72,36.26,13.14,161.72,18]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 87350",1,55,13.61,10.51,129.4,13.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 10061",1,1357,527.46,317.70999999999998,1198.25,339.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 87641",1,129,41.41,32.01,393.99,32.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 20950",1,860,972.93,317.70999999999998,1250.8,215]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 27086",1,1141,2309.9699999999998,1098.98,3264.67,285.25]
["AETNA - AETNA - CPT - 11720",1,165,1198.25,93.87,1198.25,41.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 36416",1,22,0,5.27,5.27,5.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 43277",1,2980,4743.7,1990.62,7703.8,745]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 49418",1,4154,4949.6400000000003,1098.98,5726.94,1038.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 80055",1,264,51.46,41.91,536.66999999999996,66]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 80162",1,66,14.29,12.11,149,16.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 80354",1,86,0,19.329999999999998,147.9,21.5]
["AETNA - AETNA - CPT - 11900",1,243,1198.25,171.09,1198.25,60.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 81257",1,455,0,102.26,257.31,113.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 77014",1,1088,345.55,161,345.55,272]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 81207",1,287,326.74,132.12,1625.92,71.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 82270",1,17,3.82,3.24,42.47,4.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 82553",1,38,12.44,10.54,129.69,9.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 87305",1,272,27.01,10.94,134.54,68]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 95869",1,372,228.32,178.47,1310.18,93]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 83605",1,54,11.5,9.75,119.99,13.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11446",1,2492,3994.03,1500.85,7703.8,623]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 84133",1,23,4.6399999999999997,3.93,48.38,5.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 84311",1,32,7.53,6.38,79.27,8]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 27808",1,2302,378,378,3264.67,575.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 29581",1,174,226.08,226.08,943.8,43.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 33227",1,7357,12434.24,1990.62,62742.78,1839.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 43236",1,1347,1278.93,1010.64,3264.67,336.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 85732",1,33,6.96,5.9,72.55,8.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 50684",1,375,127.07,127.07,1198.25,93.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 65778",1,2051,1355.74,1098.98,3264.67,512.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 68340",1,2721,3044.16,2166.09,11845.41,680.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 87116",1,54,24.37,9.86,121.29,13.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 86807",1,183,68.569999999999993,54.29,762.87,45.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 86920",1,142,0,14.72,1319.88,35.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 91122",1,1102,388.64,388.64,2372.37,275.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 92607",1,518,325.64,166.37,939.63,129.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 87389",1,111,25.92,21.97,270.29000000000002,27.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 93925",1,2895,387.2,300.69,2134.23,723.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 87581",1,127,37.770000000000003,32.01,393.99,31.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 88141",1,96,25.81,21.87,100.38,24]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 88165",1,52,36.799999999999997,13.16,409.48,13]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11311",1,484,296.32,171.09,508.23,121]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 94645",1,72,0,44.22,44.22,18]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 95951",1,1693,0,1629.7,9203.9699999999993,423.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 96139",1,341,0,101.73,101.73,85.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 99354",1,384,0,null,null,96]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 24675",1,3187,2205.59,1098.98,3264.67,796.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - G0465",1,2187,0,null,null,546.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 28045",1,3490,3994.03,1990.62,11845.41,872.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 58321",1,402,0,458.47,2032.26,100.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 64451",1,794,0,1005.99,3474.13,198.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 36470",1,657,527.46,521.32000000000005,1661.52,164.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 36572",1,955,1041.23,1041.23,3264.67,238.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 81161",1,366,0,141.12,2706.08,91.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 43253",1,2228,2491.1,1990.62,7703.8,557]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 81302",1,559,0,527.87,1328.23,139.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 46250",1,3599,3920.63,1990.62,11845.41,899.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 54700",1,2985,2921.68,1500.85,7703.8,746.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 58559",1,6172,6928.79,1500.85,8016.91,1543]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 61623",1,15195,16237.9,2398.64,18787.919999999998,3798.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 82728",1,67,16.87,12.43,153.04,16.75]
["AETNA - AETNA - CPT - 14000",1,3904,1500.85,1500.85,7703.8,976]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 68020",1,1212,1355.74,684.11,2032.26,303]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 70470",1,2070,577.83000000000004,347.19,2420.09,517.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 84134",1,72,18.059999999999999,13.31,163.76,18]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 74230",1,872,147.96,147.96,1536.95,218]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 84484",1,49,12.5,9.2100000000000009,120.92,12.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 85025",1,40,9.6199999999999992,7.09,87.22,10]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 78264",1,2744,464.88,373.93,4270.45,686]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 80345",1,95,44.14,16.41,105.68,23.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 86162",1,98,25.16,18.54,228.19,24.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 86353",1,327,60.69,44.72,550.37,81.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 84442",1,92,33.590000000000003,13.48,166,23]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 86692",1,143,21.25,15.66,192.69,35.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 86485",1,60,42.24,10.72,280.56,15]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 86774",1,83,18.32,12.77,166.08,20.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 87081",1,34,8.1999999999999993,6.04,74.42,8.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 87103",1,46,20.52,12.37,198.48,11.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 87207",1,281,7.42,5.47,67.33,70.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 87490",1,100,24.82,18.29,226.32,25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 93292",1,290,62.4,62.4,370.47,72.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 87632",1,504,264.18,157.59,2395.92,126]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 95148",1,78,100.35,100.35,345.64,19.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 88262",1,492,154.29,113.7,1399.23,123]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 90723",1,306.57,306.57,306.57,306.57,76.642499999999998]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 99496",1,827,194.55,194.55,1179.72,206.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 81254",1,51,88.07,35,88.07,12.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 96171",1,56,0,68.86,68.86,14]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 97755",1,177,0,64.09,238.69,44.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 84597",1,149,34.520000000000003,12.52,154.06,37.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 85307",1,69,38.549999999999997,13.98,172.07,17.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 86905",1,87,9.64,3.49,2229.4299999999998,21.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 87496",1,41,88.29,32.01,393.99,10.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 87798",1,129,88.29,32.01,393.99,32.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11620",1,930,2309.9699999999998,1098.98,3264.67,232.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11755",1,600,972.93,684.11,2032.26,150]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 17003",1,34,6.04,6.04,1198.25,8.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 19283",1,766,972.93,317.70999999999998,1500.85,191.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 14000",1,3904,2601.27,1500.85,7703.8,976]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 15120",1,4152,4645.3599999999997,1500.85,7703.8,1038]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 26990",1,3970,4405.5600000000004,1098.98,5097.42,992.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 17111",1,657,296.32,296.32,1198.25,164.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 29515",1,378,226.08,226.08,764.24,94.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 36011",1,1206,387.04,387.04,1198.25,301.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 20551",1,324,415.61,317.70999999999998,1198.25,81]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 20982",1,6499,9571.73,1198.25,11074.87,1624.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 21026",1,6641,7429.92,1500.85,8596.73,1660.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 21407",1,7214,7429.92,2354.5,15242.01,1803.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 45385",1,2371,1645.44,1020.59,3264.67,592.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 22510",1,9073,4405.5600000000004,2397.88,7703.8,2268.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 23545",1,1738,378,378,3264.67,434.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 58555",1,3031,3965.45,1098.98,4588.18,757.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 24675",1,3187,2205.59,1098.98,3264.67,796.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 65093",1,4867,4996.58,1990.62,11845.41,1216.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 67515",1,706,476.13,476.13,2032.26,176.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 26750",1,1413,378,317.70999999999998,943.8,353.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 27324",1,3449,3994.03,1098.98,4621.25,862.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 73600",1,279,81.93,72.290000000000006,851.68,69.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 27760",1,2337,378,378,3264.67,584.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 76827",1,580,147.96,147.96,1423.04,145]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 77435",1,2386,2684.18,2684.18,2684.18,596.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 28825",1,2883,4405.5600000000004,1500.85,7703.8,720.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 29355",1,357,395.63,395.63,1308.22,89.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 82390",1,52,24.37,9.8000000000000007,120.52,13]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 82960",1,29,13.83,5.52,67.86,7.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 83935",1,34,15.16,6.22,76.540000000000006,8.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 86328",1,203,52.03,45.23,410.13,50.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 31653",1,2800,4602.58,1500.85,17023.61,700]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 86922",1,142,190.34,55.2,1356.56,35.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 33270",1,53692,51483.43,1990.62,62742.78,13423]
["AETNA - AETNA - CPT - 21407",1,7214,2354.5,2354.5,15242.01,1803.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 95711",1,377,407.35,407.35,2582.75,94.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 36500",1,1371,453.05,453.05,1198.25,342.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 36569",1,1461,1836.61,1198.25,7703.8,365.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 10160",1,729,527.46,317.70999999999998,1198.25,182.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 37212",1,3354,4436.09,1098.98,5132.74,838.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 13131",1,2113,527.46,527.46,2032.26,528.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 37242",1,15195,16237.9,1990.62,37129.18,3798.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 38550",1,4650,4729.13,1990.62,11845.41,1162.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 41006",1,1709,2148.08,1098.98,3264.67,427.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 41100",1,852,818.07,818.07,3264.67,213]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 28630",1,275,378,317.70999999999998,1198.25,68.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 29882",1,4072,4405.5600000000004,1990.62,7703.8,1018]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 43200",1,1154,1278.93,1010.64,3264.67,288.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 43253",1,2228,2491.1,1990.62,7703.8,557]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 37215",1,8331,2506.5500000000002,1990.62,7703.8,2082.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 44380",1,1441,1278.93,1013.38,3264.67,360.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 42842",1,7214,7429.92,3987.49,11845.41,1803.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 45380",1,2000,1645.44,1020.59,3264.67,500]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 46083",1,821,388.64,317.70999999999998,1198.25,205.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 47535",1,4625,4949.6400000000003,1098.98,5726.94,1156.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 59025",1,373,278.66000000000003,278.66000000000003,951.58,93.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 61626",1,15195,16237.9,2398.64,18787.919999999998,3798.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 51102",1,2441,2921.68,1098.98,3380.52,610.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67840",1,1231,1355.74,1098.98,3264.67,307.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 53620",1,2441,944.22,944.22,11845.41,610.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 87106",1,51,23.06,9.41,115.87,12.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 87536",1,279,192.36,77.09,955.28,69.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 87900",1,600,294.47000000000003,118.9,1463.3,150]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 88262",1,492,281.29000000000002,113.7,1399.23,123]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 58323",1,219,278.66000000000003,278.66000000000003,2032.26,54.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 59414",1,3553,3965.45,3965.45,13969.53,888.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 91111",1,3770,1278.93,1278.93,7945.14,942.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 92311",1,523,584.69000000000005,93.14,1538.47,130.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 64445",1,1153,1005.62,310.58,3264.67,288.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 92938",1,8975,6373.27,6373.27,6373.27,2243.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 64653",1,401,415.61,415.61,2032.26,100.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 65210",1,496,584.69000000000005,317.70999999999998,943.8,124]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 93922",1,888,178.83,178.83,1077.0999999999999,222]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 94762",1,228,228.32,228.32,1412.44,57]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 67028",1,770,484.3,484.3,2032.26,192.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 67105",1,4946,833.27,833.27,3264.67,1236.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 67400",1,4867,4996.58,1990.62,11845.41,1216.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 67917",1,3727,3044.16,2166.09,11845.41,931.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 67971",1,2949,3044.16,1990.62,11845.41,737.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 99497",1,300,128.29,128.29,439.53,75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 70140",1,288,81.93,72.290000000000006,801.26,72]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 70200",1,416,147.96,72.290000000000006,1103.3900000000001,104]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 70481",1,3060,577.83000000000004,347.19,2420.09,765]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 12041",1,1204,527.46,317.70999999999998,1198.25,301]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 15260",1,3002,2601.27,1500.85,7703.8,750.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 72128",1,2005,322.25,193.63,1307.74,501.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 19288",1,469,160.32,160.32,1198.25,117.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 73092",1,267,147.96,72.290000000000006,1262.6600000000001,66.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 73592",1,319,81.93,72.290000000000006,801.26,79.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 22903",1,3338,3994.03,1990.62,11845.41,834.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 23450",1,8897,9571.73,2354.5,15242.01,2224.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 24670",1,2004,378,378,3264.67,501]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 27048",1,1528,3994.03,1990.62,11845.41,382]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 75825",1,4288,3473.84,827.44,31186.53,1072]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 27759",1,16080,17992.57,2166.09,20818.13,4020]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 29105",1,459,226.08,226.08,764.24,114.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 76811",1,1767,303.20999999999998,227.73,2433.2600000000002,441.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 30903",1,621,178.83,178.83,1198.25,155.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 77012",1,1201,160.13999999999999,160.13999999999999,535.08000000000004,300.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 77076",1,162,147.96,125.38,1421,40.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 36216",1,2108,676.88,676.88,1500.85,527]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 36512",1,1867,2094.1799999999998,1500.85,7279.25,466.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 78071",1,3400,464.88,239.64,4270.45,850]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 37242",1,15195,16237.9,1990.62,37129.18,3798.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 78452",1,4705,3521.28,1360.45,14762.31,1176.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 78830",1,1615,3492.18,2115.7600000000002,14691.07,403.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 42450",1,7214,7429.92,1500.85,8596.73,1803.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 44364",1,2394,2491.1,1013.38,7703.8,598.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 81179",1,175,157.55000000000001,102.3,1328.77,43.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 81257",1,455,187.08,102.26,257.31,113.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 81271",1,175,157.55000000000001,102.3,1328.77,43.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 82010",1,40,18.45,7.46,91.78,10]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 52000",1,945,944.22,944.22,3264.67,236.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 82271",1,15,9.8800000000000008,3.93,51.64,3.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 57105",1,3805,3965.45,1500.85,7703.8,951.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 82656",1,55,26.35,10.52,129.47999999999999,13.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 82952",1,15,8.57,3.58,43.98,3.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 64505",1,647,415.61,310.58,1198.25,161.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 65220",1,326,584.69000000000005,317.70999999999998,943.8,81.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 84132",1,24,10.55,4.2,51.64,6]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 84425",1,102,48.09,19.37,238.34,25.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 67880",1,2874,3044.16,1990.62,11845.41,718.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 67966",1,2949,3044.16,1990.62,11845.41,737.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 70260",1,446,147.96,125.38,1274.24,111.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 71100",1,116,81.93,72.290000000000006,801.26,29]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 72050",1,504,147.96,125.38,1304.76,126]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 86328",1,203,52.03,45.23,410.13,50.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 73723",1,5151,1105.27,664.1,4299.8,1287.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 74185",1,4461,1380.99,549.66999999999996,3539.25,1115.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 75842",1,6836,5755.52,780.65,49146.35,1709]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 86807",1,183,143.61000000000001,54.29,762.87,45.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 76819",1,852,147.96,147.96,1333.33,213]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 87177",1,44,19.760000000000002,8.1199999999999992,99.89,11]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 87276",1,57,29.65,11.87,155.81,14.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 78315",1,3304,464.88,394.65,4270.45,826]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 78598",1,2826,599.04999999999995,524.19000000000005,5502.59,706.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 87801",1,310,158.1,64.03,787.98,77.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 88143",1,101,45.46,18.48,228.72,25.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 82024",1,185,86.95,35.229999999999997,433.56,46.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 88363",1,51,22.57,12.3,200.27,12.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 82507",1,134,62.58,25.37,312.11,33.5]
["AETNA - AETNA - CPT - 15002",1,1752,1500.85,684.11,3344.2,438]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 90832",1,125,214.2,31.86,214.2,31.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 90913",1,260,60.18,60.18,1370.62,65]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 91035",1,2485,764.57,764.57,4807.5,621.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 85384",1,43,19.100000000000001,7.75,96.06,10.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 86481",1,127,182.47,73.89,969.95,31.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 92537",1,660,228.32,228.32,1610.39,165]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 92577",1,286,764.57,158,3800.82,71.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 87220",1,23,9.8800000000000008,3.89,47.89,5.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 92928",1,14515,16237.9,12498.68,37129.18,3628.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 87880",1,57,30.3,12.21,160.29,14.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 88342",1,336,190.34,36.799999999999997,1705.48,84]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 93351",1,2162,835.47,756.94,4775.3,540.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 93459",1,11307,4719.71,2531.06,7703.8,2826.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 92136",1,442,178.83,68.75,607.84,110.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 92287",1,236,178.83,125.6,1077.0999999999999,59]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 92603",1,259,228.32,228.32,1412.44,64.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 93278",1,85,93.87,47.27,562.35,21.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 95117",1,86,63.62,63.62,218.59,21.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 93464",1,845,427.95,427.95,427.95,211.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 94150",1,182,228.32,71.61,1332.19,45.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 94729",1,268,122.48,117.36,140.83000000000001,67]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 95700",1,377,407.35,407.35,2582.75,94.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 96125",1,504,273.64999999999998,273.64999999999998,273.64999999999998,126]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 96156",1,101,126.4,36.44,126.4,25.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 96413",1,754,484.3,484.3,3098.76,188.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 97116",1,139,75.650000000000006,48.21,191.22,34.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 99495",1,439,194.55,194.55,1179.72,109.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 80145",1,91,97.05,38.57,206.18,22.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 99213",1,214,123.78,33.74,123.78,53.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 99407",1,107,56.05,50.95,287.77999999999997,26.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 0012A",1,59,65.31,28.39,124.23,14.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 82656",1,55,29.01,10.52,129.47999999999999,13.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11310",1,334,296.32,171.09,508.23,83.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11404",1,1972,2309.9699999999998,1098.98,3264.67,493]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11604",1,1656,972.93,972.93,7703.8,414]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 85049",1,23,11.27,4.09,50.21,5.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 12007",1,1144,296.32,296.32,7703.8,286]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 86635",1,42,28.86,10.47,128.83000000000001,10.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 86705",1,60,29.62,10.74,132.21,15]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 15260",1,3002,2601.27,1500.85,7703.8,750.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 15830",1,8148,8254.4500000000007,1990.62,11845.41,2037]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 87535",1,359,88.29,32.01,393.99,89.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 19081",1,1351,2309.9699999999998,1098.98,3264.67,337.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - U0004",1,150,251.62,100,906.74,37.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11305",1,246,296.32,171.09,508.23,61.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 20930",1,2590,270.92,270.92,1198.25,647.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11721",1,187,93.87,93.87,1198.25,46.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 14061",1,6450,2601.27,1990.62,11845.41,1612.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 15272",1,133,42.82,42.82,1198.25,33.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 17004",1,1004,527.46,317.70999999999998,1198.25,251]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 20610",1,381,415.61,317.70999999999998,1198.25,95.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 24640",1,720,378,317.70999999999998,943.8,180]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 21325",1,3350,3747.12,2166.09,11845.41,837.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 25560",1,1903,378,317.70999999999998,1198.25,475.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 25000",1,2568,2205.59,1990.62,11845.41,642]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 25680",1,321,378,378,7703.8,80.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 27323",1,2043,2309.9699999999998,1098.98,3264.67,510.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 27501",1,3811,378,378,7703.8,952.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 28192",1,2407,2309.9699999999998,1500.85,7703.8,601.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 29126",1,373,178.83,178.83,607.84,93.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 28465",1,9088,9571.73,1990.62,11845.41,2272]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 31613",1,3197,3747.12,1500.85,7703.8,799.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 29280",1,224,53.94,53.94,194.97,56]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 30140",1,3301,3747.12,1500.85,7703.8,825.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 30580",1,6512,7429.92,2166.09,11845.41,1628]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 36620",1,366,108.25,108.25,1198.25,91.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 31652",1,3928,4602.58,1500.85,17023.61,982]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 32551",1,1299,1836.61,1500.85,7703.8,324.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 33221",1,18441,29689.62,1990.62,62742.78,4610.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 42720",1,3349,3747.12,1098.98,4335.57,837.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 43245",1,1449,2491.1,1010.64,7703.8,362.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 36245",1,1858,588.04999999999995,588.04999999999995,1500.85,464.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 45384",1,2086,1645.44,1020.59,3264.67,521.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 36566",1,6569,7349.8,1990.62,11845.41,1642.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 36600",1,171,178.83,169.87,541.4,42.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 51736",1,219,178.83,178.83,624.73,54.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 55000",1,636,972.93,684.11,2032.26,159]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 56405",1,840,458.47,458.47,3264.67,210]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 59300",1,3412,3965.45,1098.98,4588.18,853]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 40842",1,6641,7429.92,1990.62,11845.41,1660.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 62329",1,794,1005.99,1005.99,3264.67,198.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 64774",1,1959,2739.86,1500.85,7703.8,489.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 65135",1,4867,4996.58,1500.85,7703.8,1216.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 66250",1,2949,3044.16,1500.85,7703.8,737.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 43250",1,1459,2491.1,1010.64,7703.8,364.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 43754",1,374,423.72,317.70999999999998,1198.25,93.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 69110",1,2858,3994.03,1098.98,4621.25,714.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 70548",1,4688,1105.27,637.16,4285.49,1172]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 45389",1,1378,7550.56,1098.98,8736.31,344.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 72159",1,4562,1426,567.59,3654.63,1140.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 47536",1,1033,4949.6400000000003,1098.98,5726.94,258.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 49406",1,2105,2309.9699999999998,1500.85,7703.8,526.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 75561",1,4658,1105.27,664.1,4299.8,1164.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 75870",1,2426,1438.22,780.65,11330.17,606.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 51797",1,835,263.05,263.05,1198.25,208.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 77011",1,2190,345.46,345.46,535.08000000000004,547.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 54161",1,2601,2921.68,1500.85,7703.8,650.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 57061",1,2365,3965.45,1098.98,4588.18,591.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 78429",1,1832,3961.48,2367.3000000000002,16731.72,458]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 57510",1,3553,3965.45,1098.98,4588.18,888.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 59414",1,3553,3965.45,3965.45,13969.53,888.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 61626",1,15195,16237.9,2398.64,18787.919999999998,3798.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 61885",1,28075,31416.26,1500.85,62742.78,7018.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 82542",1,926,44.14,17.8,233.69,231.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 82952",1,15,8.57,3.58,43.98,3.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 64505",1,647,415.61,310.58,1198.25,161.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 84311",1,32,15.81,6.38,79.27,8]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 65105",1,4867,4996.58,2166.09,11845.41,1216.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 65779",1,4466,4996.58,1098.98,6423.61,1116.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 86382",1,324,38.200000000000003,15.43,189.88,81]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 86696",1,77,43.48,17.66,217.35,19.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 86709",1,56,25.69,10.27,126.43,14]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 92570",1,207,228.32,59.1,785.13,51.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 87486",1,127,79.05,32.01,393.99,31.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 87532",1,38,79.05,32.01,393.99,9.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 88291",1,563,64.5,21.78,99.36,140.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 90636",1,123,150.25,74.239999999999995,150.25,30.75]
["AETNA - AETNA - CPT - 21445",1,7214,2166.09,2166.09,11845.41,1803.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 66711",1,3062,3219.62,1500.85,7703.8,765.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 67105",1,4946,833.27,833.27,3264.67,1236.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 92562",1,215,228.32,59.1,1274.6400000000001,53.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 92978",1,821,646.49,646.49,646.49,205.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 67971",1,2949,3044.16,1990.62,11845.41,737.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 68335",1,4867,4996.58,2166.09,11845.41,1216.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 93926",1,1905,188.94,188.94,1169.49,476.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 70300",1,141,81.93,81.93,796.29,35.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 95710",1,723,781.56,781.56,4577.47,180.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 70496",1,4798,577.83000000000004,347.19,2420.09,1199.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 72052",1,650,147.96,125.38,1304.76,162.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 72114",1,606,147.96,125.38,1304.76,151.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 72146",1,3654,660.39,396.79,2653.95,913.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 73120",1,267,147.96,72.290000000000006,1262.6600000000001,66.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 99497",1,300,128.29,128.29,439.53,75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 73564",1,422,147.96,72.290000000000006,1103.3900000000001,105.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11422",1,1039,2309.9699999999998,1098.98,3264.67,259.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 74330",1,418,306.10000000000002,306.10000000000002,306.10000000000002,104.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 74450",1,375,303.20999999999998,267.85000000000002,2562.5700000000002,93.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 15260",1,3002,2601.27,1500.85,7703.8,750.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 19001",1,163,53.07,53.07,1198.25,40.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 76380",1,1566,81.93,81.93,801.26,391.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 76805",1,1417,147.96,147.96,1361.54,354.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 21920",1,2043,2309.9699999999998,1098.98,3264.67,510.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 76981",1,174,141.28,141.28,996.77,43.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 24670",1,2004,378,378,3264.67,501]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 26650",1,4072,4405.5600000000004,1500.85,7703.8,1018]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 27043",1,1528,3994.03,1990.62,11845.41,382]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 77523",1,1883,3104.64,1400.79,13219.58,470.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 28525",1,3970,4405.5600000000004,1990.62,11845.41,992.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 29131",1,260,93.87,93.87,317.35000000000002,65]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 31032",1,7214,7429.92,2166.09,11845.41,1803.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 78814",1,3583,3939.92,2059.9699999999998,16731.72,895.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 80198",1,71,31.63,12.9,158.69999999999999,17.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 33286",1,892,972.93,972.93,3264.67,223]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 81222",1,762,795.12,435.07,1094.72,190.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 36598",1,275,314.33999999999997,314.33999999999997,1500.85,68.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 37221",1,15672,16237.9,2166.09,37129.18,3918]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 82088",1,196,92.23,37.17,457.49,49]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 82164",1,71,32.94,13.32,163.96,17.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 82374",1,25,11.2,4.46,54.82,6.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 82705",1,25,11.2,4.6500000000000004,57.22,6.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 44604",1,1472,2644.98,2644.98,2644.98,368]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 83010",1,63,28.32,11.47,141.18,15.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 83915",1,54,25.04,10.17,125.2,13.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 49082",1,836,1278.93,1098.98,3264.67,209]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 83916",1,97,50.07,20.239999999999998,265.61,24.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 49180",1,1304,2309.9699999999998,1098.98,3264.67,326]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 83918",1,62,42.81,17.440000000000001,228.93,15.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 49320",1,6902,7718.14,1990.62,11845.41,1725.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 83921",1,80,38.869999999999997,15.67,205.7,20]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 49324",1,6897,7718.14,2166.09,17023.61,1724.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 83930",1,33,15.16,6.03,74.22,8.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 49406",1,2105,2309.9699999999998,1500.85,7703.8,526.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 83935",1,34,15.16,6.22,76.540000000000006,8.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 49411",1,1473,2001.68,1198.25,7703.8,368.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 83937",1,143,67.19,27.23,335.1,35.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 49422",1,4214,4436.09,1098.98,5703.04,1053.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 83945",1,62,28.98,11.74,144.81,15.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 49424",1,290,94.18,94.18,1198.25,72.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 83970",1,206,92.89,37.65,463.35,51.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 49440",1,1695,2491.1,1010.64,3264.67,423.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 83986",1,20,7.9,3.27,40.229999999999997,5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 49446",1,1743,2491.1,1010.64,3264.67,435.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 83992",1,71,79.05,15.16,162.9,17.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 49451",1,691,1278.93,684.11,2032.26,172.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 83993",1,95,44.14,17.91,220.45,23.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 49460",1,1116,1278.93,684.11,2032.26,279]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84075",1,26,11.86,4.72,58.08,6.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 49570",1,4625,4949.6400000000003,2166.09,11845.41,1156.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84080",1,71,33.590000000000003,13.48,166,17.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 50382",1,2635,2921.68,1198.25,11845.41,658.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84100",1,25,10.55,4.32,53.23,6.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 50386",1,1312,2921.68,1098.98,3756.12,328]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84105",1,26,11.86,4.72,58.16,6.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 50389",1,928,944.22,944.22,3264.67,232]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84132",1,24,10.55,4.2,51.64,6]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 50430",1,829,944.22,944.22,3176.09,207.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84133",1,23,9.8800000000000008,3.93,48.38,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 50432",1,3162,2921.68,1098.98,3380.52,790.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84134",1,72,32.94,13.31,163.76,18]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 50434",1,1457,2921.68,1098.98,3380.52,364.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84144",1,104,46.77,19.03,234.27,26]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 50436",1,2677,2921.68,1098.98,3380.52,669.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84145",1,99,60.6,24.44,300.82,24.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 50561",1,6035,6751.98,1098.98,7812.32,1508.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84146",1,97,43.48,17.670000000000002,217.56,24.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 50593",1,12512,13001.07,2397.88,15242.01,3128]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84153",1,93,41.5,16.78,206.51,23.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 50688",1,2246,2921.68,1098.98,3380.52,561.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84155",1,20,8.57,3.35,41.16,5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 50694",1,1971,4915.28,1098.98,5687.17,492.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84156",1,20,8.57,3.35,41.16,5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 51100",1,351,388.64,317.70999999999998,1198.25,87.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84157",1,20,8.57,3.35,41.16,5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 51600",1,329,110.49,110.49,110.49,82.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84163",1,72,34.26,13.74,169.1,18]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 51700",1,492,388.64,388.64,1338.81,123]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84165",1,63,34.94,9.8000000000000007,120.52,15.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 51702",1,228,178.83,178.83,1198.25,57]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84166",1,99,34.94,16.260000000000002,200.15,24.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 51705",1,391,388.64,388.64,1338.81,97.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84182",1,264,34.94,21.58,283.38,66]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 51720",1,600,388.64,388.64,1338.81,150]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84202",1,23,32.28,13.09,161.07,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 51726",1,2050,388.64,388.64,2518.29,512.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84206",1,86,48.75,19.72,258.88,21.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 51728",1,2386,944.22,944.22,3176.09,596.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84207",1,130,63.24,25.63,315.49,32.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 51736",1,219,178.83,178.83,624.73,54.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84210",1,53,26.35,10.7,140.4,13.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 51784",1,1471,228.32,228.32,797.09,367.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84244",1,106,49.4,20.059999999999999,246.86,26.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 51797",1,835,263.05,263.05,1198.25,208.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84255",1,123,57.32,23.29,286.64,30.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 52000",1,945,944.22,944.22,3264.67,236.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84270",1,105,48.75,19.82,243.97,26.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 52224",1,3451,2921.68,1500.85,7703.8,862.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84295",1,25,10.55,4.3899999999999997,54.04,6.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 52281",1,2072,2921.68,1500.85,7703.8,518]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84300",1,25,11.2,4.43,54.53,6.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 52310",1,2072,2921.68,1500.85,7703.8,518]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84302",1,25,11.2,4.43,54.53,6.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 52351",1,3553,2921.68,1990.62,7703.8,888.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84305",1,82,48.09,19.399999999999999,238.75,20.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 53450",1,4463,2921.68,1098.98,3380.52,1115.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84307",1,515,41.5,16.670000000000002,205.12,128.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 53620",1,2441,944.22,944.22,11845.41,610.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84311",1,32,15.81,6.38,79.27,8]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 54001",1,2635,2921.68,1500.85,7703.8,658.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84376",1,27,12.51,5.0199999999999996,61.7,6.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 54055",1,2598,2601.27,1098.98,3344.2,649.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84402",1,123,57.32,23.24,285.98,30.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 54060",1,2325,2601.27,1098.98,3344.2,581.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84403",1,124,57.97,23.55,289.82,31]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 54100",1,1972,2309.9699999999998,1098.98,3264.67,493]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84425",1,102,48.09,19.37,238.34,25.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 54150",1,2776,2921.68,1098.98,3380.52,694]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84430",1,58,26.35,10.61,130.62,14.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 54162",1,2614,2921.68,1500.85,7703.8,653.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84432",1,79,36.24,14.65,180.3,19.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 54200",1,625,388.64,388.64,2032.26,156.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84436",1,35,15.81,6.27,77.11,8.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 54231",1,2441,388.64,388.64,11845.41,610.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84439",1,46,20.420000000000002,8.2200000000000006,101.2,11.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 54450",1,430,388.64,388.64,3264.67,107.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84442",1,92,33.590000000000003,13.48,166,23]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 54600",1,2614,2921.68,2166.09,11845.41,653.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84443",1,84,38.200000000000003,15.33,188.7,21]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 55000",1,636,972.93,684.11,2032.26,159]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84445",1,244,114.62,46.39,570.91,61]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 55120",1,2611,2921.68,1500.85,7703.8,652.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84446",1,69,32.28,12.94,159.19,17.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 55400",1,4530,4915.28,1098.98,5687.17,1132.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84450",1,26,11.86,4.72,58.08,6.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 55700",1,1826,2921.68,1098.98,3380.52,456.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84460",1,27,11.86,4.83,59.46,6.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 56405",1,840,458.47,458.47,3264.67,210]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84466",1,64,28.98,11.64,143.30000000000001,16]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 56440",1,2365,3965.45,1500.85,7703.8,591.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84478",1,29,13.18,5.24,64.44,7.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 56501",1,2598,2601.27,1098.98,3344.2,649.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84479",1,33,14.49,5.9,72.55,8.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 56605",1,635,937.16,684.11,2032.26,158.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84480",1,71,32.28,12.94,159.19,17.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 56620",1,3543,3965.45,2354.5,15242.01,885.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84481",1,83,38.200000000000003,15.46,190.17,20.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 56740",1,3544,3965.45,1990.62,11845.41,886]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84482",1,73,35.57,14.38,176.92,18.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 56820",1,665,278.66000000000003,278.66000000000003,1198.25,166.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84484",1,49,23.06,9.2100000000000009,120.92,12.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 57020",1,4336,3965.45,1500.85,7703.8,1084]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84520",1,21,9.2200000000000006,3.61,44.34,5.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 57061",1,2365,3965.45,1098.98,4588.18,591.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84540",1,25,10.55,4.33,53.96,6.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 57105",1,3805,3965.45,1500.85,7703.8,951.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84550",1,24,9.8800000000000008,4.12,50.7,6]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 57135",1,3553,3965.45,1500.85,7703.8,888.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84560",1,25,10.55,4.33,53.31,6.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 57156",1,406,458.47,458.47,2032.26,101.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84590",1,56,26.35,10.59,130.34,14]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 57170",1,375,278.66000000000003,241,768.13,93.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84591",1,58,30.96,12.6,165.43,14.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 57200",1,3715,3965.45,1098.98,4588.18,928.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84597",1,149,30.96,12.52,154.06,37.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 57410",1,3544,3965.45,1500.85,7703.8,886]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84630",1,55,25.69,10.39,127.81,13.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 57420",1,702,458.47,458.47,2032.26,175.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84681",1,100,46.77,18.989999999999998,233.69,25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 57452",1,711,278.66000000000003,278.66000000000003,1500.85,177.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84702",1,75,34.26,13.74,169.1,18.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 57455",1,861,458.47,458.47,2032.26,215.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84703",1,37,17.12,6.86,84.49,9.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 57460",1,2365,3965.45,1098.98,4588.18,591.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85004",1,22,14.49,5.9,72.55,5.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 57500",1,589,937.16,937.16,3264.67,147.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85014",1,12,5.27,2.16,26.61,3]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 57510",1,3553,3965.45,1098.98,4588.18,888.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85018",1,12,5.27,2.16,26.61,3]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 57520",1,3553,3965.45,1500.85,7703.8,888.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85025",1,40,17.79,7.09,87.22,10]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 57558",1,2365,3965.45,1990.62,7703.8,591.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85027",1,33,14.49,5.9,72.55,8.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 58100",1,683,278.66000000000003,278.66000000000003,1198.25,170.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85045",1,22,9.2200000000000006,3.64,44.83,5.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 58120",1,2365,3965.45,1098.98,4588.18,591.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85046",1,141,12.51,5.08,62.56,35.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 58300",1,387,132.08000000000001,132.08000000000001,1198.25,96.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85048",1,12,5.93,2.31,28.49,3]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 58321",1,402,458.47,458.47,2032.26,100.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85049",1,23,9.8800000000000008,4.09,50.21,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 58323",1,219,278.66000000000003,278.66000000000003,2032.26,54.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85055",1,141,65.22,15.07,346.67,35.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 58345",1,3412,3965.45,1098.98,4588.18,853]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85060",1,79,47.41,15.64,183.73,19.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 58558",1,3031,3965.45,1775.68,7703.8,757.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85210",1,65,28.98,11.84,145.74,16.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 58561",1,7714,6928.79,1990.62,11845.41,1928.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85220",1,90,39.53,16.100000000000001,198.11,22.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 58565",1,6134,6928.79,1990.62,11845.41,1533.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85230",1,91,40.18,16.329999999999998,200.93,22.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 58674",1,15505,13001.07,2354.5,37129.18,3876.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85240",1,91,40.18,16.329999999999998,200.93,22.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 59000",1,634,937.16,684.11,2032.26,158.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85245",1,180,52.04,20.92,257.5,45]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 59020",1,546,278.66000000000003,278.66000000000003,951.58,136.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85246",1,200,52.04,20.92,257.5,50]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 59160",1,2200,3965.45,1990.62,7703.8,550]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85250",1,95,42.81,17.37,213.81,23.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 59300",1,3412,3965.45,1098.98,4588.18,853]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85260",1,91,40.18,16.329999999999998,200.93,22.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 59409",1,6397,3965.45,1198.25,13969.53,1599.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85270",1,91,40.18,16.329999999999998,200.93,22.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 59414",1,3553,3965.45,3965.45,13969.53,888.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85280",1,97,43.48,17.649999999999999,217.27,24.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 59820",1,2772,3965.45,2354.5,11845.41,693]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85290",1,82,36.89,14.9,183.36,20.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 59840",1,2365,3965.45,2354.5,11845.41,591.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85300",1,57,27.01,10.81,133.03,14.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 59870",1,3675,3965.45,2354.5,11845.41,918.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85301",1,52,24.37,9.86,121.37,13]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 60100",1,592,972.93,684.11,2032.26,148]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85302",1,58,27.01,10.96,134.82,14.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 60300",1,709,972.93,684.11,2032.26,177.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85303",1,62,30.96,12.62,155.28,15.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 61050",1,390,415.61,415.61,3264.67,97.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85305",1,56,26.35,10.59,130.34,14]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 61070",1,661,1005.62,684.11,2032.26,165.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85306",1,69,34.26,13.98,172.07,17.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 61624",1,8320,2890.31,2890.31,15242.01,2080]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85307",1,69,34.26,13.98,172.07,17.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 61640",1,4698,1156.06,1156.06,1156.06,1174.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85347",1,21,9.8800000000000008,3.89,47.81,5.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 61642",1,3302,812.01,812.01,812.01,825.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85366",1,38,146.9,10.33,780.44,9.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 61650",1,3730,1377.69,1377.69,1377.69,932.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85378",1,36,17.79,7.18,94.31,9]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 61885",1,28075,31416.26,1500.85,62742.78,7018.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85379",1,51,23.06,9.2799999999999994,114.2,12.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 62264",1,1734,1284.45,1098.98,3264.67,433.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85384",1,43,19.100000000000001,7.75,96.06,10.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 62269",1,2006,2309.9699999999998,1098.98,3264.67,501.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85397",1,207,56.65,22.8,299.31,51.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 62272",1,647,1005.62,1005.62,3264.67,161.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85461",1,34,17.12,6.92,90.76,8.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 62284",1,645,219.52,219.52,1198.25,161.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85520",1,138,29.65,11.94,146.97,34.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 62304",1,862,1161.71,1098.98,3264.67,215.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85549",1,91,42.16,17.100000000000001,210.55,22.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 62320",1,1071,1005.62,829.82,3264.67,267.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85576",1,311,34.94,19.59,243.68,77.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 62322",1,1153,1005.62,829.82,3264.67,288.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85610",1,21,8.57,3.58,44.06,5.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 62324",1,1211,1284.45,829.82,3264.67,302.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85611",1,21,9.2200000000000006,3.6,44.26,5.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 62327",1,1153,1284.45,829.82,3264.67,288.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85613",1,13,21.73,8.23,107.56,3.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 62329",1,794,1005.99,1005.99,3264.67,198.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85651",1,20,7.9,3.24,41.45,5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 62367",1,476,470.91,470.91,3264.67,119]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85652",1,14,5.93,2.46,30.24,3.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 62369",1,476,470.91,470.91,3264.67,119]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85660",1,28,12.51,5.0199999999999996,61.83,7]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 63650",1,7397,10041.84,1500.85,11618.83,1849.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85670",1,29,13.18,5.26,64.72,7.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 63662",1,4823,4836.26,1098.98,6217.49,1205.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85705",1,35,21.73,8.7899999999999991,108.13,8.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64405",1,611,415.61,310.58,2032.26,152.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85730",1,31,13.83,5.48,67.41,7.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64415",1,503,1284.45,310.58,3264.67,125.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85732",1,33,14.49,5.9,72.55,8.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64417",1,548,1284.45,310.58,2032.26,137]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85810",1,58,26.35,10.65,130.99,14.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64420",1,531,1005.62,310.58,2032.26,132.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86003",1,22,11.86,4.76,58.53,5.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64425",1,736,1005.62,310.58,2032.26,184]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86021",1,72,34.26,13.74,169.1,18]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64435",1,643,1005.62,310.58,2032.26,160.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86022",1,265,41.5,16.760000000000002,206.23,66.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64447",1,509,1005.62,310.58,2032.26,127.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86038",1,175,27.01,11.02,135.68,43.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64451",1,794,1005.99,1005.99,3474.13,198.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86039",1,170,25.04,10.18,125.28,42.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64455",1,350,415.61,310.58,1198.25,87.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86060",1,36,16.47,6.66,81.96,9]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64462",1,824,124.9,124.9,1198.25,206]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86140",1,106,11.86,4.72,58.08,26.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64483",1,1153,1284.45,829.82,3264.67,288.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86141",1,63,28.98,11.81,145.38,15.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64486",1,423,136.02000000000001,136.02000000000001,1500.85,105.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86146",1,197,57.32,18.87,285.7,49.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64490",1,1071,1284.45,829.82,4375.87,267.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86147",1,83,57.32,18.87,285.7,20.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64492",1,442,149.56,149.56,1198.25,110.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86157",1,38,18.45,7.35,90.48,9.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64494",1,399,127.95,127.95,1198.25,99.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86160",1,61,27.01,10.94,134.62,15.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64505",1,647,415.61,310.58,1198.25,161.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86161",1,58,27.01,10.94,134.62,14.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64520",1,1153,1284.45,829.82,3264.67,288.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86162",1,98,46.11,18.54,228.19,24.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64561",1,9071,10041.84,1098.98,11618.83,2267.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86200",1,63,28.98,11.81,145.38,15.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64585",1,4823,4836.26,1098.98,6217.49,1205.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86235",1,81,40.18,16.36,201.29,20.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64611",1,760,415.61,317.70999999999998,1198.25,190]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86255",1,35,34.94,10.99,135.27000000000001,8.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64615",1,648,415.61,415.61,2032.26,162]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86256",1,53,34.94,10.99,135.27000000000001,13.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64617",1,842,415.61,415.61,2032.26,210.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86300",1,96,46.77,18.989999999999998,233.69,24]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64624",1,2182,2767.2,1198.25,7703.8,545.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86301",1,100,46.77,18.989999999999998,233.69,25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64633",1,2657,2739.86,1098.98,3264.67,664.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86304",1,100,46.77,18.989999999999998,233.69,25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64635",1,2471,2739.86,1098.98,3264.67,617.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86308",1,24,11.86,4.72,58.08,6]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64640",1,1297,1284.45,1098.98,3264.67,324.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86316",1,93,46.77,18.989999999999998,233.69,23.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64643",1,531,179.6,179.6,1198.25,132.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86317",1,72,33.590000000000003,13.67,168.24,18]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64645",1,609,207.02,207.02,1198.25,152.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86328",1,203,52.03,45.23,410.13,50.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64647",1,988,1005.62,684.11,2032.26,247]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86331",1,57,27.01,10.93,134.44999999999999,14.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64653",1,401,415.61,415.61,2032.26,100.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86334",1,80,34.94,20.39,250.85,20]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64721",1,3269,2739.86,1500.85,7703.8,817.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86335",1,138,34.94,26.77,329.47,34.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64774",1,1959,2739.86,1500.85,7703.8,489.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86336",1,76,34.909999999999997,14.22,174.97,19]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 65101",1,4867,4996.58,1990.62,11845.41,1216.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86340",1,73,34.26,13.75,169.26,18.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 65105",1,4867,4996.58,2166.09,11845.41,1216.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86341",1,96,44.79,18.05,228.64,24]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 65135",1,4867,4996.58,1500.85,7703.8,1216.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86353",1,327,110.68,44.72,550.37,81.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 65205",1,337,178.83,178.83,943.8,84.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86355",1,412,84.99,15.71,423.58,103]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 65220",1,326,584.69000000000005,317.70999999999998,943.8,81.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86357",1,412,84.99,15.71,423.58,103]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 65265",1,3062,3219.62,2166.09,11845.41,765.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86359",1,57,84.99,15.71,423.58,14.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 65285",1,5769,6113.35,2166.09,11845.41,1442.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86360",1,69,106.06,18.87,527.5,17.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 65400",1,4626,1355.74,1098.98,3264.67,1156.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86376",1,70,32.94,13.27,163.31,17.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 65426",1,3671,3044.16,2354.5,15242.01,917.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86382",1,324,38.200000000000003,15.43,189.88,81]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 65435",1,1108,1355.74,1098.98,3264.67,277]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86403",1,269,23.06,9.2899999999999991,114.93,67.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 65730",1,5769,6113.35,2531.06,15242.01,1442.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86431",1,27,12.51,5.17,63.66,6.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 65755",1,5769,6113.35,2531.06,15242.01,1442.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86480",1,93,139.66,56.54,695.83,23.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 65770",1,10801,16518.79,2531.06,19112.91,2700.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86481",1,127,182.47,73.89,969.95,31.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 65779",1,4466,4996.58,1098.98,6423.61,1116.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86485",1,60,42.24,10.72,280.56,15]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 65782",1,4867,4996.58,2354.5,11845.41,1216.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86580",1,55,7.88,6.04,199.34,13.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 65815",1,3062,3219.62,1500.85,7703.8,765.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86592",1,28,9.8800000000000008,3.89,47.89,7]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 65855",1,2309,833.27,833.27,3264.67,577.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86593",1,23,9.8800000000000008,4.0199999999999996,49.48,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 65865",1,3062,3219.62,1098.98,3725.22,765.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86606",1,71,34.26,13.74,169.1,17.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 65875",1,3062,3219.62,2166.09,11845.41,765.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86609",1,48,28.98,11.75,144.6,12]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 66020",1,2051,3219.62,1098.98,3725.22,512.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86611",1,61,23.06,9.2799999999999994,114.2,15.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 66170",1,3062,3219.62,2166.09,11845.41,765.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86612",1,83,28.98,11.77,144.88999999999999,20.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 66179",1,6814,6113.35,2166.09,17023.61,1703.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86615",1,174,29.65,12.03,148.07,43.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 66183",1,5769,6113.35,1990.62,17023.61,1442.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86617",1,27,34.909999999999997,14.13,173.95,6.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 66250",1,2949,3044.16,1500.85,7703.8,737.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86618",1,191,38.200000000000003,15.53,191.1,47.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 66625",1,2878,3219.62,1990.62,11845.41,719.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86622",1,79,20.420000000000002,8.15,100.26,19.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 66710",1,3098,3044.16,1500.85,7703.8,774.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86625",1,16,29.65,11.97,147.33000000000001,4]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 66761",1,1822,833.27,833.27,3264.67,455.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86631",1,52,27.01,10.79,132.78,13]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 66821",1,2391,833.27,833.27,3264.67,597.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86632",1,53,28.32,11.57,142.36000000000001,13.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 66840",1,3062,3219.62,2166.09,11845.41,765.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86635",1,42,25.69,10.47,128.83000000000001,10.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 66852",1,5769,6113.35,2166.09,11845.41,1442.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86638",1,63,27.67,11.06,136.13,15.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 66982",1,2305,3219.62,2574.12,7703.8,576.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86644",1,72,32.28,13.13,161.6,18]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 66985",1,3062,3219.62,2398.64,7703.8,765.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86645",1,71,38.200000000000003,15.37,189.15,17.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67005",1,3062,3219.62,2166.09,11845.41,765.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86648",1,83,34.26,13.39,170.69,20.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67015",1,4446,3219.62,1098.98,3725.22,1111.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86652",1,66,29.65,12.03,148.07,16.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67031",1,2732,833.27,833.27,3264.67,683]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86654",1,28,29.65,12.03,148.07,7]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67039",1,5679,6113.35,2531.06,15242.01,1419.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86658",1,70,29.65,11.88,146.19,17.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67041",1,5769,6113.35,2354.5,15242.01,1442.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86663",1,37,29.65,11.97,147.33000000000001,9.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67101",1,3007,3219.62,2166.09,11845.41,751.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86664",1,37,34.26,13.95,171.71,9.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67107",1,5769,6113.35,2354.5,15242.01,1442.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86665",1,37,40.85,16.55,203.74,9.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67110",1,5928,3219.62,3219.62,11845.41,1482]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86666",1,77,23.06,9.2799999999999994,114.2,19.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67120",1,2878,3219.62,1500.85,7703.8,719.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86677",1,66,32.94,13.23,164.61,16.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67141",1,427,476.13,476.13,2032.26,106.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86682",1,104,29.65,11.87,146.03,26]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67210",1,3854,833.27,833.27,3264.67,963.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86689",1,52,43.48,17.66,217.35,13]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67221",1,1654,833.27,684.11,2032.26,413.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86692",1,143,38.869999999999997,15.66,192.69,35.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67311",1,2949,3044.16,1990.62,11845.41,737.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86694",1,34,32.28,13.13,161.6,8.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67314",1,2949,3044.16,2166.09,11845.41,737.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86695",1,66,29.65,12.03,148.07,16.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67318",1,2949,3044.16,2166.09,11845.41,737.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86696",1,77,43.48,17.66,217.35,19.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67332",1,3426,821.24,821.24,2166.09,856.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86698",1,28,28.32,11.4,140.32,7]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67345",1,426,476.13,476.13,2032.26,106.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86701",1,44,19.760000000000002,8.11,99.73,11]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67405",1,2949,3044.16,2166.09,11845.41,737.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86702",1,82,30.3,12.33,151.72999999999999,20.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67414",1,4867,4996.58,2354.5,11845.41,1216.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86703",1,50,30.96,12.5,153.85,12.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67505",1,385,476.13,476.13,2032.26,96.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86704",1,61,27.01,10.99,135.27000000000001,15.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67550",1,4867,4996.58,2166.09,11845.41,1216.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86705",1,60,26.35,10.74,132.21,15]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67710",1,1108,1355.74,1098.98,3264.67,277]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86706",1,52,24.37,9.8000000000000007,120.52,13]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67800",1,808,476.13,476.13,2032.26,202]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86707",1,56,26.35,10.55,129.88999999999999,14]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67805",1,1303,476.13,476.13,2032.26,325.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86708",1,58,27.67,11.3,139.02000000000001,14.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67810",1,695,476.13,476.13,2032.26,173.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86709",1,56,25.69,10.27,126.43,14]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67825",1,953,476.13,476.13,2032.26,238.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86710",1,35,30.3,12.36,152.1,8.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67850",1,1201,1355.74,1098.98,3264.67,300.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86735",1,65,29.65,11.9,146.47999999999999,16.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67880",1,2874,3044.16,1990.62,11845.41,718.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86738",1,32,29.65,12.07,148.63999999999999,8]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67900",1,2949,3044.16,2166.09,11845.41,737.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86744",1,46,29.65,12.03,155.08000000000001,11.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67902",1,4867,4996.58,2354.5,15242.01,1216.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86747",1,26,33.590000000000003,12.77,168.81,6.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67904",1,2949,3044.16,2166.09,11845.41,737.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86753",1,42,27.67,11.3,139.02000000000001,10.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67912",1,3788,3044.16,1990.62,11845.41,947]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86757",1,117,43.48,17.66,217.35,29.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67921",1,2132,3044.16,1990.62,11845.41,533]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86762",1,70,32.28,13.13,161.6,17.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67924",1,2880,3044.16,2166.09,11845.41,720]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86765",1,102,28.98,11.75,144.6,25.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67935",1,2721,3044.16,1500.85,7703.8,680.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86769",1,203,48.46,42.13,382.01,50.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67966",1,2949,3044.16,1990.62,11845.41,737.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86774",1,83,33.590000000000003,12.77,166.08,20.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67973",1,2949,3044.16,1990.62,11845.41,737.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86777",1,180,32.28,13.13,161.6,45]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 68100",1,1108,3044.16,1098.98,3522.21,277]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86778",1,72,32.28,13.14,161.72,18]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 68115",1,2949,3044.16,1098.98,3522.21,737.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86780",1,61,29.65,12.07,148.63999999999999,15.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 68320",1,2949,3044.16,2166.09,11845.41,737.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86787",1,101,28.98,11.75,144.6,25.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 68335",1,4867,4996.58,2166.09,11845.41,1216.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86788",1,88,38.200000000000003,15.37,189.15,22]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 68362",1,2949,3044.16,1500.85,7703.8,737.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86789",1,79,32.28,13.13,161.6,19.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 68530",1,385,476.13,476.13,2032.26,96.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86790",1,32,28.98,11.75,144.6,8]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 68720",1,4867,4996.58,2166.09,11845.41,1216.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86800",1,51,35.57,14.51,178.59,12.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 68760",1,385,476.13,476.13,2032.26,96.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86803",1,58,32.28,13.01,160.13,14.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 68801",1,830,584.69000000000005,171.09,751.68,207.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86807",1,183,143.61000000000001,54.29,762.87,45.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 68811",1,2949,3044.16,1098.98,3522.21,737.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86812",1,119,57.97,23.54,289.69,29.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 68816",1,2949,3044.16,1500.85,7703.8,737.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86813",1,266,131.09,52.9,651.04,66.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 69000",1,937,972.93,317.70999999999998,1250.8,234.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86817",1,296,194.34,78.42,1029.42,74]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 69020",1,1130,972.93,317.70999999999998,1250.8,282.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86850",1,87,67.040000000000006,5.25,501.09,21.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 69100",1,410,346.18,346.18,2032.26,102.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86860",1,142,190.34,23.92,1356.56,35.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 69110",1,2858,3994.03,1098.98,4621.25,714.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86870",1,209,360.63,57.04,2437.5300000000002,52.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 69200",1,454,178.83,178.83,943.8,113.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86880",1,142,42.24,4.91,366.72,35.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 69210",1,254,93.87,93.87,1198.25,63.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86886",1,315,190.34,4.72,1267.31,78.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 69222",1,1084,818.07,818.07,3264.67,271]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86900",1,87,140.04,2.73,923.73,21.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 69420",1,955,346.18,346.18,2032.26,238.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86901",1,87,42.24,2.73,348.71,21.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 69436",1,2007,2148.08,1990.62,7703.8,501.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86902",1,87,360.63,4.6900000000000004,2272.4699999999998,21.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 69540",1,2094,2148.08,1098.98,3264.67,523.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86905",1,87,360.63,3.49,2229.4299999999998,21.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 69631",1,7489,7429.92,2354.5,15242.01,1872.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86920",1,142,190.34,14.72,1319.88,35.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 70010",1,569,507.47,308.97000000000003,4577.43,142.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86922",1,142,190.34,55.2,1356.56,35.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 70100",1,338,81.93,72.290000000000006,801.26,84.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86923",1,142,190.34,190.34,1319.88,35.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 70130",1,546,147.96,72.290000000000006,1103.3900000000001,136.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 87015",1,34,15.16,6.09,74.989999999999995,8.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 70150",1,402,147.96,72.290000000000006,1274.24,100.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 87040",1,51,23.06,9.41,115.87,12.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 70200",1,416,147.96,72.290000000000006,1103.3900000000001,104]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 87045",1,48,21.08,8.6199999999999992,105.97,12]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 87046",1,48,21.08,6,105.97,12]
["Grand Total",82841,1527.9205382600469,1474.8340644124851,539.82118839487964,3514.2073619378007,381.98013456501172]

{"sheet":"Average Table - CPT","index":14,"n_rows":79780,"n_cols":12,"rows_kept":4500,"cut":true,"hidden":true,"merged":[],"bounds":{"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0}}
["Payer - Plan - Bill Type - Bill Code","Payer","Plan","Bill Type","Bill Code","Bill Code Description","CPT & Description","Gross Charge Amount","Payer Charge Amount","Minimum Charge Amount","Maximum Charge Amount","Self-Pay Charge"]
["AETNA - AETNA - CPT - 10004","AETNA","AETNA","CPT","10004","HC FNA BX W/O IMG GDN EA ADDL","10004 - HC FNA BX W/O IMG GDN EA ADDL",435,1198.25,107.47,1198.25,108.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 10004","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","10004","HC FNA BX W/O IMG GDN EA ADDL","10004 - HC FNA BX W/O IMG GDN EA ADDL",435,107.47,107.47,1198.25,108.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 10004","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","10004","HC FNA BX W/O IMG GDN EA ADDL","10004 - HC FNA BX W/O IMG GDN EA ADDL",435,107.47,107.47,1198.25,108.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 10004","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","10004","HC FNA BX W/O IMG GDN EA ADDL","10004 - HC FNA BX W/O IMG GDN EA ADDL",435,107.47,107.47,1198.25,108.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 10004","BLUE CROSS","BLUE CROSS-PPO","CPT","10004","HC FNA BX W/O IMG GDN EA ADDL","10004 - HC FNA BX W/O IMG GDN EA ADDL",435,107.47,107.47,1198.25,108.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 10004","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","10004","HC FNA BX W/O IMG GDN EA ADDL","10004 - HC FNA BX W/O IMG GDN EA ADDL",435,107.47,107.47,1198.25,108.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 10004","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","10004","HC FNA BX W/O IMG GDN EA ADDL","10004 - HC FNA BX W/O IMG GDN EA ADDL",435,107.47,107.47,1198.25,108.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 10004","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","10004","HC FNA BX W/O IMG GDN EA ADDL","10004 - HC FNA BX W/O IMG GDN EA ADDL",435,107.47,107.47,1198.25,108.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 10004","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","10004","HC FNA BX W/O IMG GDN EA ADDL","10004 - HC FNA BX W/O IMG GDN EA ADDL",435,0,107.47,1198.25,108.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 10004","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","10004","HC FNA BX W/O IMG GDN EA ADDL","10004 - HC FNA BX W/O IMG GDN EA ADDL",435,0,107.47,1198.25,108.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 10004","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","10004","HC FNA BX W/O IMG GDN EA ADDL","10004 - HC FNA BX W/O IMG GDN EA ADDL",435,0,107.47,1198.25,108.75]
["TUFTS - TUFTS HMO - CPT - 10004","TUFTS","TUFTS HMO","CPT","10004","HC FNA BX W/O IMG GDN EA ADDL","10004 - HC FNA BX W/O IMG GDN EA ADDL",435,0,107.47,1198.25,108.75]
["TUFTS - TUFTS POS - CPT - 10004","TUFTS","TUFTS POS","CPT","10004","HC FNA BX W/O IMG GDN EA ADDL","10004 - HC FNA BX W/O IMG GDN EA ADDL",435,0,107.47,1198.25,108.75]
["TUFTS - TUFTS PPO - CPT - 10004","TUFTS","TUFTS PPO","CPT","10004","HC FNA BX W/O IMG GDN EA ADDL","10004 - HC FNA BX W/O IMG GDN EA ADDL",435,0,107.47,1198.25,108.75]
["TUFTS - TUFTS SELECT - CPT - 10004","TUFTS","TUFTS SELECT","CPT","10004","HC FNA BX W/O IMG GDN EA ADDL","10004 - HC FNA BX W/O IMG GDN EA ADDL",435,0,107.47,1198.25,108.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 10004","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","10004","HC FNA BX W/O IMG GDN EA ADDL","10004 - HC FNA BX W/O IMG GDN EA ADDL",435,0,107.47,1198.25,108.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 10004","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","10004","HC FNA BX W/O IMG GDN EA ADDL","10004 - HC FNA BX W/O IMG GDN EA ADDL",435,0,107.47,1198.25,108.75]
["AETNA - AETNA - CPT - 10005","AETNA","AETNA","CPT","10005","HC FNA BX W/US GDN 1ST LES","10005 - HC FNA BX W/US GDN 1ST LES",892,1198.25,684.11,2032.26,223]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 10005","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","10005","HC FNA BX W/US GDN 1ST LES","10005 - HC FNA BX W/US GDN 1ST LES",892,972.93,684.11,2032.26,223]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 10005","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","10005","HC FNA BX W/US GDN 1ST LES","10005 - HC FNA BX W/US GDN 1ST LES",892,972.93,684.11,2032.26,223]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 10005","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","10005","HC FNA BX W/US GDN 1ST LES","10005 - HC FNA BX W/US GDN 1ST LES",892,972.93,684.11,2032.26,223]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 10005","BLUE CROSS","BLUE CROSS-PPO","CPT","10005","HC FNA BX W/US GDN 1ST LES","10005 - HC FNA BX W/US GDN 1ST LES",892,972.93,684.11,2032.26,223]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 10005","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","10005","HC FNA BX W/US GDN 1ST LES","10005 - HC FNA BX W/US GDN 1ST LES",892,972.93,684.11,2032.26,223]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 10005","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","10005","HC FNA BX W/US GDN 1ST LES","10005 - HC FNA BX W/US GDN 1ST LES",892,972.93,684.11,2032.26,223]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 10005","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","10005","HC FNA BX W/US GDN 1ST LES","10005 - HC FNA BX W/US GDN 1ST LES",892,972.93,684.11,2032.26,223]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 10005","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","10005","HC FNA BX W/US GDN 1ST LES","10005 - HC FNA BX W/US GDN 1ST LES",892,2032.26,684.11,2032.26,223]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 10005","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","10005","HC FNA BX W/US GDN 1ST LES","10005 - HC FNA BX W/US GDN 1ST LES",892,1250.8,684.11,2032.26,223]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 10005","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","10005","HC FNA BX W/US GDN 1ST LES","10005 - HC FNA BX W/US GDN 1ST LES",892,1250.8,684.11,2032.26,223]
["TUFTS - TUFTS HMO - CPT - 10005","TUFTS","TUFTS HMO","CPT","10005","HC FNA BX W/US GDN 1ST LES","10005 - HC FNA BX W/US GDN 1ST LES",892,1281.21,684.11,2032.26,223]
["TUFTS - TUFTS POS - CPT - 10005","TUFTS","TUFTS POS","CPT","10005","HC FNA BX W/US GDN 1ST LES","10005 - HC FNA BX W/US GDN 1ST LES",892,1281.21,684.11,2032.26,223]
["TUFTS - TUFTS PPO - CPT - 10005","TUFTS","TUFTS PPO","CPT","10005","HC FNA BX W/US GDN 1ST LES","10005 - HC FNA BX W/US GDN 1ST LES",892,1281.21,684.11,2032.26,223]
["TUFTS - TUFTS SELECT - CPT - 10005","TUFTS","TUFTS SELECT","CPT","10005","HC FNA BX W/US GDN 1ST LES","10005 - HC FNA BX W/US GDN 1ST LES",892,684.11,684.11,2032.26,223]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 10005","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","10005","HC FNA BX W/US GDN 1ST LES","10005 - HC FNA BX W/US GDN 1ST LES",892,1220.0899999999999,684.11,2032.26,223]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 10005","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","10005","HC FNA BX W/US GDN 1ST LES","10005 - HC FNA BX W/US GDN 1ST LES",892,1250.8,684.11,2032.26,223]
["AETNA - AETNA - CPT - 10006","AETNA","AETNA","CPT","10006","HC FNA BX W/US GDN EA ADDL","10006 - HC FNA BX W/US GDN EA ADDL",435,1198.25,122.2,1198.25,108.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 10006","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","10006","HC FNA BX W/US GDN EA ADDL","10006 - HC FNA BX W/US GDN EA ADDL",435,122.2,122.2,1198.25,108.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 10006","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","10006","HC FNA BX W/US GDN EA ADDL","10006 - HC FNA BX W/US GDN EA ADDL",435,122.2,122.2,1198.25,108.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 10006","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","10006","HC FNA BX W/US GDN EA ADDL","10006 - HC FNA BX W/US GDN EA ADDL",435,122.2,122.2,1198.25,108.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 10006","BLUE CROSS","BLUE CROSS-PPO","CPT","10006","HC FNA BX W/US GDN EA ADDL","10006 - HC FNA BX W/US GDN EA ADDL",435,122.2,122.2,1198.25,108.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 10006","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","10006","HC FNA BX W/US GDN EA ADDL","10006 - HC FNA BX W/US GDN EA ADDL",435,122.2,122.2,1198.25,108.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 10006","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","10006","HC FNA BX W/US GDN EA ADDL","10006 - HC FNA BX W/US GDN EA ADDL",435,122.2,122.2,1198.25,108.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 10006","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","10006","HC FNA BX W/US GDN EA ADDL","10006 - HC FNA BX W/US GDN EA ADDL",435,122.2,122.2,1198.25,108.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 10006","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","10006","HC FNA BX W/US GDN EA ADDL","10006 - HC FNA BX W/US GDN EA ADDL",435,0,122.2,1198.25,108.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 10006","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","10006","HC FNA BX W/US GDN EA ADDL","10006 - HC FNA BX W/US GDN EA ADDL",435,0,122.2,1198.25,108.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 10006","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","10006","HC FNA BX W/US GDN EA ADDL","10006 - HC FNA BX W/US GDN EA ADDL",435,0,122.2,1198.25,108.75]
["TUFTS - TUFTS HMO - CPT - 10006","TUFTS","TUFTS HMO","CPT","10006","HC FNA BX W/US GDN EA ADDL","10006 - HC FNA BX W/US GDN EA ADDL",435,0,122.2,1198.25,108.75]
["TUFTS - TUFTS POS - CPT - 10006","TUFTS","TUFTS POS","CPT","10006","HC FNA BX W/US GDN EA ADDL","10006 - HC FNA BX W/US GDN EA ADDL",435,0,122.2,1198.25,108.75]
["TUFTS - TUFTS PPO - CPT - 10006","TUFTS","TUFTS PPO","CPT","10006","HC FNA BX W/US GDN EA ADDL","10006 - HC FNA BX W/US GDN EA ADDL",435,0,122.2,1198.25,108.75]
["TUFTS - TUFTS SELECT - CPT - 10006","TUFTS","TUFTS SELECT","CPT","10006","HC FNA BX W/US GDN EA ADDL","10006 - HC FNA BX W/US GDN EA ADDL",435,0,122.2,1198.25,108.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 10006","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","10006","HC FNA BX W/US GDN EA ADDL","10006 - HC FNA BX W/US GDN EA ADDL",435,0,122.2,1198.25,108.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 10006","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","10006","HC FNA BX W/US GDN EA ADDL","10006 - HC FNA BX W/US GDN EA ADDL",435,0,122.2,1198.25,108.75]
["AETNA - AETNA - CPT - 10007","AETNA","AETNA","CPT","10007","HC FNA BX W/FLUOR GDN 1ST LES","10007 - HC FNA BX W/FLUOR GDN 1ST LES",892,1198.25,684.11,2032.26,223]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 10007","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","10007","HC FNA BX W/FLUOR GDN 1ST LES","10007 - HC FNA BX W/FLUOR GDN 1ST LES",892,972.93,684.11,2032.26,223]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 10007","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","10007","HC FNA BX W/FLUOR GDN 1ST LES","10007 - HC FNA BX W/FLUOR GDN 1ST LES",892,972.93,684.11,2032.26,223]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 10007","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","10007","HC FNA BX W/FLUOR GDN 1ST LES","10007 - HC FNA BX W/FLUOR GDN 1ST LES",892,972.93,684.11,2032.26,223]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 10007","BLUE CROSS","BLUE CROSS-PPO","CPT","10007","HC FNA BX W/FLUOR GDN 1ST LES","10007 - HC FNA BX W/FLUOR GDN 1ST LES",892,972.93,684.11,2032.26,223]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 10007","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","10007","HC FNA BX W/FLUOR GDN 1ST LES","10007 - HC FNA BX W/FLUOR GDN 1ST LES",892,972.93,684.11,2032.26,223]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 10007","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","10007","HC FNA BX W/FLUOR GDN 1ST LES","10007 - HC FNA BX W/FLUOR GDN 1ST LES",892,972.93,684.11,2032.26,223]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 10007","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","10007","HC FNA BX W/FLUOR GDN 1ST LES","10007 - HC FNA BX W/FLUOR GDN 1ST LES",892,972.93,684.11,2032.26,223]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 10007","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","10007","HC FNA BX W/FLUOR GDN 1ST LES","10007 - HC FNA BX W/FLUOR GDN 1ST LES",892,2032.26,684.11,2032.26,223]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 10007","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","10007","HC FNA BX W/FLUOR GDN 1ST LES","10007 - HC FNA BX W/FLUOR GDN 1ST LES",892,1250.8,684.11,2032.26,223]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 10007","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","10007","HC FNA BX W/FLUOR GDN 1ST LES","10007 - HC FNA BX W/FLUOR GDN 1ST LES",892,1250.8,684.11,2032.26,223]
["TUFTS - TUFTS HMO - CPT - 10007","TUFTS","TUFTS HMO","CPT","10007","HC FNA BX W/FLUOR GDN 1ST LES","10007 - HC FNA BX W/FLUOR GDN 1ST LES",892,1281.21,684.11,2032.26,223]
["TUFTS - TUFTS POS - CPT - 10007","TUFTS","TUFTS POS","CPT","10007","HC FNA BX W/FLUOR GDN 1ST LES","10007 - HC FNA BX W/FLUOR GDN 1ST LES",892,1281.21,684.11,2032.26,223]
["TUFTS - TUFTS PPO - CPT - 10007","TUFTS","TUFTS PPO","CPT","10007","HC FNA BX W/FLUOR GDN 1ST LES","10007 - HC FNA BX W/FLUOR GDN 1ST LES",892,1281.21,684.11,2032.26,223]
["TUFTS - TUFTS SELECT - CPT - 10007","TUFTS","TUFTS SELECT","CPT","10007","HC FNA BX W/FLUOR GDN 1ST LES","10007 - HC FNA BX W/FLUOR GDN 1ST LES",892,684.11,684.11,2032.26,223]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 10007","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","10007","HC FNA BX W/FLUOR GDN 1ST LES","10007 - HC FNA BX W/FLUOR GDN 1ST LES",892,1220.0899999999999,684.11,2032.26,223]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 10007","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","10007","HC FNA BX W/FLUOR GDN 1ST LES","10007 - HC FNA BX W/FLUOR GDN 1ST LES",892,1250.8,684.11,2032.26,223]
["AETNA - AETNA - CPT - 10008","AETNA","AETNA","CPT","10008","HC FNA BX W/FLUOR GDN EA ADDL","10008 - HC FNA BX W/FLUOR GDN EA ADDL",436,1198.25,151.03,1198.25,109]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 10008","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","10008","HC FNA BX W/FLUOR GDN EA ADDL","10008 - HC FNA BX W/FLUOR GDN EA ADDL",436,151.03,151.03,1198.25,109]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 10008","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","10008","HC FNA BX W/FLUOR GDN EA ADDL","10008 - HC FNA BX W/FLUOR GDN EA ADDL",436,151.03,151.03,1198.25,109]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 10008","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","10008","HC FNA BX W/FLUOR GDN EA ADDL","10008 - HC FNA BX W/FLUOR GDN EA ADDL",436,151.03,151.03,1198.25,109]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 10008","BLUE CROSS","BLUE CROSS-PPO","CPT","10008","HC FNA BX W/FLUOR GDN EA ADDL","10008 - HC FNA BX W/FLUOR GDN EA ADDL",436,151.03,151.03,1198.25,109]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 10008","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","10008","HC FNA BX W/FLUOR GDN EA ADDL","10008 - HC FNA BX W/FLUOR GDN EA ADDL",436,151.03,151.03,1198.25,109]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 10008","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","10008","HC FNA BX W/FLUOR GDN EA ADDL","10008 - HC FNA BX W/FLUOR GDN EA ADDL",436,151.03,151.03,1198.25,109]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 10008","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","10008","HC FNA BX W/FLUOR GDN EA ADDL","10008 - HC FNA BX W/FLUOR GDN EA ADDL",436,151.03,151.03,1198.25,109]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 10008","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","10008","HC FNA BX W/FLUOR GDN EA ADDL","10008 - HC FNA BX W/FLUOR GDN EA ADDL",436,0,151.03,1198.25,109]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 10008","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","10008","HC FNA BX W/FLUOR GDN EA ADDL","10008 - HC FNA BX W/FLUOR GDN EA ADDL",436,0,151.03,1198.25,109]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 10008","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","10008","HC FNA BX W/FLUOR GDN EA ADDL","10008 - HC FNA BX W/FLUOR GDN EA ADDL",436,0,151.03,1198.25,109]
["TUFTS - TUFTS HMO - CPT - 10008","TUFTS","TUFTS HMO","CPT","10008","HC FNA BX W/FLUOR GDN EA ADDL","10008 - HC FNA BX W/FLUOR GDN EA ADDL",436,0,151.03,1198.25,109]
["TUFTS - TUFTS POS - CPT - 10008","TUFTS","TUFTS POS","CPT","10008","HC FNA BX W/FLUOR GDN EA ADDL","10008 - HC FNA BX W/FLUOR GDN EA ADDL",436,0,151.03,1198.25,109]
["TUFTS - TUFTS PPO - CPT - 10008","TUFTS","TUFTS PPO","CPT","10008","HC FNA BX W/FLUOR GDN EA ADDL","10008 - HC FNA BX W/FLUOR GDN EA ADDL",436,0,151.03,1198.25,109]
["TUFTS - TUFTS SELECT - CPT - 10008","TUFTS","TUFTS SELECT","CPT","10008","HC FNA BX W/FLUOR GDN EA ADDL","10008 - HC FNA BX W/FLUOR GDN EA ADDL",436,0,151.03,1198.25,109]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 10008","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","10008","HC FNA BX W/FLUOR GDN EA ADDL","10008 - HC FNA BX W/FLUOR GDN EA ADDL",436,0,151.03,1198.25,109]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 10008","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","10008","HC FNA BX W/FLUOR GDN EA ADDL","10008 - HC FNA BX W/FLUOR GDN EA ADDL",436,0,151.03,1198.25,109]
["AETNA - AETNA - CPT - 10009","AETNA","AETNA","CPT","10009","HC FNA BX W/CT GDN 1ST LES","10009 - HC FNA BX W/CT GDN 1ST LES",892,1198.25,684.11,2032.26,223]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 10009","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","10009","HC FNA BX W/CT GDN 1ST LES","10009 - HC FNA BX W/CT GDN 1ST LES",892,972.93,684.11,2032.26,223]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 10009","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","10009","HC FNA BX W/CT GDN 1ST LES","10009 - HC FNA BX W/CT GDN 1ST LES",892,972.93,684.11,2032.26,223]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 10009","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","10009","HC FNA BX W/CT GDN 1ST LES","10009 - HC FNA BX W/CT GDN 1ST LES",892,972.93,684.11,2032.26,223]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 10009","BLUE CROSS","BLUE CROSS-PPO","CPT","10009","HC FNA BX W/CT GDN 1ST LES","10009 - HC FNA BX W/CT GDN 1ST LES",892,972.93,684.11,2032.26,223]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 10009","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","10009","HC FNA BX W/CT GDN 1ST LES","10009 - HC FNA BX W/CT GDN 1ST LES",892,972.93,684.11,2032.26,223]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 10009","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","10009","HC FNA BX W/CT GDN 1ST LES","10009 - HC FNA BX W/CT GDN 1ST LES",892,972.93,684.11,2032.26,223]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 10009","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","10009","HC FNA BX W/CT GDN 1ST LES","10009 - HC FNA BX W/CT GDN 1ST LES",892,972.93,684.11,2032.26,223]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 10009","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","10009","HC FNA BX W/CT GDN 1ST LES","10009 - HC FNA BX W/CT GDN 1ST LES",892,2032.26,684.11,2032.26,223]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 10009","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","10009","HC FNA BX W/CT GDN 1ST LES","10009 - HC FNA BX W/CT GDN 1ST LES",892,1250.8,684.11,2032.26,223]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 10009","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","10009","HC FNA BX W/CT GDN 1ST LES","10009 - HC FNA BX W/CT GDN 1ST LES",892,1250.8,684.11,2032.26,223]
["TUFTS - TUFTS HMO - CPT - 10009","TUFTS","TUFTS HMO","CPT","10009","HC FNA BX W/CT GDN 1ST LES","10009 - HC FNA BX W/CT GDN 1ST LES",892,1281.21,684.11,2032.26,223]
["TUFTS - TUFTS POS - CPT - 10009","TUFTS","TUFTS POS","CPT","10009","HC FNA BX W/CT GDN 1ST LES","10009 - HC FNA BX W/CT GDN 1ST LES",892,1281.21,684.11,2032.26,223]
["TUFTS - TUFTS PPO - CPT - 10009","TUFTS","TUFTS PPO","CPT","10009","HC FNA BX W/CT GDN 1ST LES","10009 - HC FNA BX W/CT GDN 1ST LES",892,1281.21,684.11,2032.26,223]
["TUFTS - TUFTS SELECT - CPT - 10009","TUFTS","TUFTS SELECT","CPT","10009","HC FNA BX W/CT GDN 1ST LES","10009 - HC FNA BX W/CT GDN 1ST LES",892,684.11,684.11,2032.26,223]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 10009","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","10009","HC FNA BX W/CT GDN 1ST LES","10009 - HC FNA BX W/CT GDN 1ST LES",892,1220.0899999999999,684.11,2032.26,223]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 10009","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","10009","HC FNA BX W/CT GDN 1ST LES","10009 - HC FNA BX W/CT GDN 1ST LES",892,1250.8,684.11,2032.26,223]
["AETNA - AETNA - CPT - 10010","AETNA","AETNA","CPT","10010","HC FNA BX W/CT GDN EA ADDL","10010 - HC FNA BX W/CT GDN EA ADDL",436,1198.25,204.55,1198.25,109]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 10010","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","10010","HC FNA BX W/CT GDN EA ADDL","10010 - HC FNA BX W/CT GDN EA ADDL",436,204.55,204.55,1198.25,109]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 10010","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","10010","HC FNA BX W/CT GDN EA ADDL","10010 - HC FNA BX W/CT GDN EA ADDL",436,204.55,204.55,1198.25,109]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 10010","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","10010","HC FNA BX W/CT GDN EA ADDL","10010 - HC FNA BX W/CT GDN EA ADDL",436,204.55,204.55,1198.25,109]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 10010","BLUE CROSS","BLUE CROSS-PPO","CPT","10010","HC FNA BX W/CT GDN EA ADDL","10010 - HC FNA BX W/CT GDN EA ADDL",436,204.55,204.55,1198.25,109]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 10010","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","10010","HC FNA BX W/CT GDN EA ADDL","10010 - HC FNA BX W/CT GDN EA ADDL",436,204.55,204.55,1198.25,109]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 10010","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","10010","HC FNA BX W/CT GDN EA ADDL","10010 - HC FNA BX W/CT GDN EA ADDL",436,204.55,204.55,1198.25,109]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 10010","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","10010","HC FNA BX W/CT GDN EA ADDL","10010 - HC FNA BX W/CT GDN EA ADDL",436,204.55,204.55,1198.25,109]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 10010","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","10010","HC FNA BX W/CT GDN EA ADDL","10010 - HC FNA BX W/CT GDN EA ADDL",436,0,204.55,1198.25,109]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 10010","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","10010","HC FNA BX W/CT GDN EA ADDL","10010 - HC FNA BX W/CT GDN EA ADDL",436,0,204.55,1198.25,109]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 10010","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","10010","HC FNA BX W/CT GDN EA ADDL","10010 - HC FNA BX W/CT GDN EA ADDL",436,0,204.55,1198.25,109]
["TUFTS - TUFTS HMO - CPT - 10010","TUFTS","TUFTS HMO","CPT","10010","HC FNA BX W/CT GDN EA ADDL","10010 - HC FNA BX W/CT GDN EA ADDL",436,0,204.55,1198.25,109]
["TUFTS - TUFTS POS - CPT - 10010","TUFTS","TUFTS POS","CPT","10010","HC FNA BX W/CT GDN EA ADDL","10010 - HC FNA BX W/CT GDN EA ADDL",436,0,204.55,1198.25,109]
["TUFTS - TUFTS PPO - CPT - 10010","TUFTS","TUFTS PPO","CPT","10010","HC FNA BX W/CT GDN EA ADDL","10010 - HC FNA BX W/CT GDN EA ADDL",436,0,204.55,1198.25,109]
["TUFTS - TUFTS SELECT - CPT - 10010","TUFTS","TUFTS SELECT","CPT","10010","HC FNA BX W/CT GDN EA ADDL","10010 - HC FNA BX W/CT GDN EA ADDL",436,0,204.55,1198.25,109]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 10010","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","10010","HC FNA BX W/CT GDN EA ADDL","10010 - HC FNA BX W/CT GDN EA ADDL",436,0,204.55,1198.25,109]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 10010","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","10010","HC FNA BX W/CT GDN EA ADDL","10010 - HC FNA BX W/CT GDN EA ADDL",436,0,204.55,1198.25,109]
["AETNA - AETNA - CPT - 10011","AETNA","AETNA","CPT","10011","HC FNA BX W/MR GDN 1ST LES","10011 - HC FNA BX W/MR GDN 1ST LES",892,1198.25,684.11,2032.26,223]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 10011","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","10011","HC FNA BX W/MR GDN 1ST LES","10011 - HC FNA BX W/MR GDN 1ST LES",892,972.93,684.11,2032.26,223]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 10011","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","10011","HC FNA BX W/MR GDN 1ST LES","10011 - HC FNA BX W/MR GDN 1ST LES",892,972.93,684.11,2032.26,223]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 10011","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","10011","HC FNA BX W/MR GDN 1ST LES","10011 - HC FNA BX W/MR GDN 1ST LES",892,972.93,684.11,2032.26,223]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 10011","BLUE CROSS","BLUE CROSS-PPO","CPT","10011","HC FNA BX W/MR GDN 1ST LES","10011 - HC FNA BX W/MR GDN 1ST LES",892,972.93,684.11,2032.26,223]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 10011","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","10011","HC FNA BX W/MR GDN 1ST LES","10011 - HC FNA BX W/MR GDN 1ST LES",892,972.93,684.11,2032.26,223]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 10011","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","10011","HC FNA BX W/MR GDN 1ST LES","10011 - HC FNA BX W/MR GDN 1ST LES",892,972.93,684.11,2032.26,223]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 10011","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","10011","HC FNA BX W/MR GDN 1ST LES","10011 - HC FNA BX W/MR GDN 1ST LES",892,972.93,684.11,2032.26,223]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 10011","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","10011","HC FNA BX W/MR GDN 1ST LES","10011 - HC FNA BX W/MR GDN 1ST LES",892,2032.26,684.11,2032.26,223]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 10011","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","10011","HC FNA BX W/MR GDN 1ST LES","10011 - HC FNA BX W/MR GDN 1ST LES",892,1250.8,684.11,2032.26,223]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 10011","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","10011","HC FNA BX W/MR GDN 1ST LES","10011 - HC FNA BX W/MR GDN 1ST LES",892,1250.8,684.11,2032.26,223]
["TUFTS - TUFTS HMO - CPT - 10011","TUFTS","TUFTS HMO","CPT","10011","HC FNA BX W/MR GDN 1ST LES","10011 - HC FNA BX W/MR GDN 1ST LES",892,1281.21,684.11,2032.26,223]
["TUFTS - TUFTS POS - CPT - 10011","TUFTS","TUFTS POS","CPT","10011","HC FNA BX W/MR GDN 1ST LES","10011 - HC FNA BX W/MR GDN 1ST LES",892,1281.21,684.11,2032.26,223]
["TUFTS - TUFTS PPO - CPT - 10011","TUFTS","TUFTS PPO","CPT","10011","HC FNA BX W/MR GDN 1ST LES","10011 - HC FNA BX W/MR GDN 1ST LES",892,1281.21,684.11,2032.26,223]
["TUFTS - TUFTS SELECT - CPT - 10011","TUFTS","TUFTS SELECT","CPT","10011","HC FNA BX W/MR GDN 1ST LES","10011 - HC FNA BX W/MR GDN 1ST LES",892,684.11,684.11,2032.26,223]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 10011","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","10011","HC FNA BX W/MR GDN 1ST LES","10011 - HC FNA BX W/MR GDN 1ST LES",892,1220.0899999999999,684.11,2032.26,223]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 10011","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","10011","HC FNA BX W/MR GDN 1ST LES","10011 - HC FNA BX W/MR GDN 1ST LES",892,1250.8,684.11,2032.26,223]
["AETNA - AETNA - CPT - 10012","AETNA","AETNA","CPT","10012","HC FNA BX W/MR GDN EA ADDL","10012 - HC FNA BX W/MR GDN EA ADDL",436,1198.25,1198.25,1198.25,109]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 10012","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","10012","HC FNA BX W/MR GDN EA ADDL","10012 - HC FNA BX W/MR GDN EA ADDL",436,0,1198.25,1198.25,109]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 10012","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","10012","HC FNA BX W/MR GDN EA ADDL","10012 - HC FNA BX W/MR GDN EA ADDL",436,0,1198.25,1198.25,109]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 10012","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","10012","HC FNA BX W/MR GDN EA ADDL","10012 - HC FNA BX W/MR GDN EA ADDL",436,0,1198.25,1198.25,109]
["TUFTS - TUFTS HMO - CPT - 10012","TUFTS","TUFTS HMO","CPT","10012","HC FNA BX W/MR GDN EA ADDL","10012 - HC FNA BX W/MR GDN EA ADDL",436,0,1198.25,1198.25,109]
["TUFTS - TUFTS POS - CPT - 10012","TUFTS","TUFTS POS","CPT","10012","HC FNA BX W/MR GDN EA ADDL","10012 - HC FNA BX W/MR GDN EA ADDL",436,0,1198.25,1198.25,109]
["TUFTS - TUFTS PPO - CPT - 10012","TUFTS","TUFTS PPO","CPT","10012","HC FNA BX W/MR GDN EA ADDL","10012 - HC FNA BX W/MR GDN EA ADDL",436,0,1198.25,1198.25,109]
["TUFTS - TUFTS SELECT - CPT - 10012","TUFTS","TUFTS SELECT","CPT","10012","HC FNA BX W/MR GDN EA ADDL","10012 - HC FNA BX W/MR GDN EA ADDL",436,0,1198.25,1198.25,109]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 10012","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","10012","HC FNA BX W/MR GDN EA ADDL","10012 - HC FNA BX W/MR GDN EA ADDL",436,0,1198.25,1198.25,109]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 10012","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","10012","HC FNA BX W/MR GDN EA ADDL","10012 - HC FNA BX W/MR GDN EA ADDL",436,0,1198.25,1198.25,109]
["AETNA - AETNA - CPT - 10021","AETNA","AETNA","CPT","10021","FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE","10021 - FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE",538,1198.25,317.70999999999998,1198.25,134.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 10021","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","10021","FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE","10021 - FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE",538,527.46,317.70999999999998,1198.25,134.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 10021","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","10021","FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE","10021 - FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE",538,527.46,317.70999999999998,1198.25,134.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 10021","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","10021","FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE","10021 - FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE",538,527.46,317.70999999999998,1198.25,134.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 10021","BLUE CROSS","BLUE CROSS-PPO","CPT","10021","FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE","10021 - FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE",538,527.46,317.70999999999998,1198.25,134.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 10021","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","10021","FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE","10021 - FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE",538,527.46,317.70999999999998,1198.25,134.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 10021","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","10021","FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE","10021 - FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE",538,527.46,317.70999999999998,1198.25,134.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 10021","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","10021","FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE","10021 - FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE",538,527.46,317.70999999999998,1198.25,134.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 10021","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","10021","FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE","10021 - FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE",538,943.8,317.70999999999998,1198.25,134.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 10021","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","10021","FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE","10021 - FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE",538,678.1,317.70999999999998,1198.25,134.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 10021","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","10021","FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE","10021 - FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE",538,678.1,317.70999999999998,1198.25,134.5]
["TUFTS - TUFTS HMO - CPT - 10021","TUFTS","TUFTS HMO","CPT","10021","FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE","10021 - FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE",538,595.01,317.70999999999998,1198.25,134.5]
["TUFTS - TUFTS POS - CPT - 10021","TUFTS","TUFTS POS","CPT","10021","FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE","10021 - FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE",538,595.01,317.70999999999998,1198.25,134.5]
["TUFTS - TUFTS PPO - CPT - 10021","TUFTS","TUFTS PPO","CPT","10021","FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE","10021 - FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE",538,595.01,317.70999999999998,1198.25,134.5]
["TUFTS - TUFTS SELECT - CPT - 10021","TUFTS","TUFTS SELECT","CPT","10021","FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE","10021 - FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE",538,317.70999999999998,317.70999999999998,1198.25,134.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 10021","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","10021","FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE","10021 - FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE",538,661.45,317.70999999999998,1198.25,134.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 10021","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","10021","FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE","10021 - FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE",538,678.1,317.70999999999998,1198.25,134.5]
["AETNA - AETNA - CPT - 10030","AETNA","AETNA","CPT","10030","IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE","10030 - IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE",1149,1500.85,317.70999999999998,1500.85,287.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 10030","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","10030","IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE","10030 - IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE",1149,972.93,317.70999999999998,1500.85,287.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 10030","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","10030","IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE","10030 - IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE",1149,972.93,317.70999999999998,1500.85,287.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 10030","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","10030","IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE","10030 - IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE",1149,972.93,317.70999999999998,1500.85,287.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 10030","BLUE CROSS","BLUE CROSS-PPO","CPT","10030","IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE","10030 - IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE",1149,972.93,317.70999999999998,1500.85,287.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 10030","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","10030","IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE","10030 - IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE",1149,972.93,317.70999999999998,1500.85,287.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 10030","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","10030","IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE","10030 - IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE",1149,972.93,317.70999999999998,1500.85,287.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 10030","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","10030","IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE","10030 - IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE",1149,972.93,317.70999999999998,1500.85,287.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 10030","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","10030","IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE","10030 - IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE",1149,943.8,317.70999999999998,1500.85,287.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 10030","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","10030","IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE","10030 - IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE",1149,1250.8,317.70999999999998,1500.85,287.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 10030","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","10030","IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE","10030 - IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE",1149,1250.8,317.70999999999998,1500.85,287.25]
["TUFTS - TUFTS HMO - CPT - 10030","TUFTS","TUFTS HMO","CPT","10030","IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE","10030 - IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE",1149,595.01,317.70999999999998,1500.85,287.25]
["TUFTS - TUFTS POS - CPT - 10030","TUFTS","TUFTS POS","CPT","10030","IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE","10030 - IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE",1149,595.01,317.70999999999998,1500.85,287.25]
["TUFTS - TUFTS PPO - CPT - 10030","TUFTS","TUFTS PPO","CPT","10030","IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE","10030 - IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE",1149,595.01,317.70999999999998,1500.85,287.25]
["TUFTS - TUFTS SELECT - CPT - 10030","TUFTS","TUFTS SELECT","CPT","10030","IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE","10030 - IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE",1149,317.70999999999998,317.70999999999998,1500.85,287.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 10030","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","10030","IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE","10030 - IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE",1149,1220.0899999999999,317.70999999999998,1500.85,287.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 10030","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","10030","IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE","10030 - IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE",1149,1250.8,317.70999999999998,1500.85,287.25]
["AETNA - AETNA - CPT - 10035","AETNA","AETNA","CPT","10035","HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION","10035 - HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION",930,1500.85,972.93,3264.67,232.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 10035","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","10035","HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION","10035 - HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION",930,972.93,972.93,3264.67,232.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 10035","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","10035","HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION","10035 - HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION",930,972.93,972.93,3264.67,232.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 10035","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","10035","HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION","10035 - HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION",930,972.93,972.93,3264.67,232.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 10035","BLUE CROSS","BLUE CROSS-PPO","CPT","10035","HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION","10035 - HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION",930,972.93,972.93,3264.67,232.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 10035","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","10035","HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION","10035 - HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION",930,972.93,972.93,3264.67,232.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 10035","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","10035","HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION","10035 - HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION",930,972.93,972.93,3264.67,232.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 10035","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","10035","HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION","10035 - HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION",930,972.93,972.93,3264.67,232.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 10035","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","10035","HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION","10035 - HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION",930,3264.67,972.93,3264.67,232.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 10035","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","10035","HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION","10035 - HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION",930,1250.8,972.93,3264.67,232.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 10035","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","10035","HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION","10035 - HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION",930,1250.8,972.93,3264.67,232.5]
["TUFTS - TUFTS HMO - CPT - 10035","TUFTS","TUFTS HMO","CPT","10035","HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION","10035 - HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION",930,2057.7399999999998,972.93,3264.67,232.5]
["TUFTS - TUFTS POS - CPT - 10035","TUFTS","TUFTS POS","CPT","10035","HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION","10035 - HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION",930,2058.17,972.93,3264.67,232.5]
["TUFTS - TUFTS PPO - CPT - 10035","TUFTS","TUFTS PPO","CPT","10035","HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION","10035 - HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION",930,2058.16,972.93,3264.67,232.5]
["TUFTS - TUFTS SELECT - CPT - 10035","TUFTS","TUFTS SELECT","CPT","10035","HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION","10035 - HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION",930,1098.98,972.93,3264.67,232.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 10035","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","10035","HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION","10035 - HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION",930,1220.0899999999999,972.93,3264.67,232.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 10035","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","10035","HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION","10035 - HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION",930,1250.8,972.93,3264.67,232.5]
["AETNA - AETNA - CPT - 10036","AETNA","AETNA","CPT","10036","HC PERQ DEV SOFT TISS ADD IMAG","10036 - HC PERQ DEV SOFT TISS ADD IMAG",861,1198.25,107.09,1198.25,215.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 10036","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","10036","HC PERQ DEV SOFT TISS ADD IMAG","10036 - HC PERQ DEV SOFT TISS ADD IMAG",861,107.09,107.09,1198.25,215.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 10036","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","10036","HC PERQ DEV SOFT TISS ADD IMAG","10036 - HC PERQ DEV SOFT TISS ADD IMAG",861,107.09,107.09,1198.25,215.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 10036","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","10036","HC PERQ DEV SOFT TISS ADD IMAG","10036 - HC PERQ DEV SOFT TISS ADD IMAG",861,107.09,107.09,1198.25,215.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 10036","BLUE CROSS","BLUE CROSS-PPO","CPT","10036","HC PERQ DEV SOFT TISS ADD IMAG","10036 - HC PERQ DEV SOFT TISS ADD IMAG",861,107.09,107.09,1198.25,215.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 10036","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","10036","HC PERQ DEV SOFT TISS ADD IMAG","10036 - HC PERQ DEV SOFT TISS ADD IMAG",861,107.09,107.09,1198.25,215.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 10036","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","10036","HC PERQ DEV SOFT TISS ADD IMAG","10036 - HC PERQ DEV SOFT TISS ADD IMAG",861,107.09,107.09,1198.25,215.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 10036","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","10036","HC PERQ DEV SOFT TISS ADD IMAG","10036 - HC PERQ DEV SOFT TISS ADD IMAG",861,107.09,107.09,1198.25,215.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 10036","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","10036","HC PERQ DEV SOFT TISS ADD IMAG","10036 - HC PERQ DEV SOFT TISS ADD IMAG",861,0,107.09,1198.25,215.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 10036","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","10036","HC PERQ DEV SOFT TISS ADD IMAG","10036 - HC PERQ DEV SOFT TISS ADD IMAG",861,0,107.09,1198.25,215.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 10036","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","10036","HC PERQ DEV SOFT TISS ADD IMAG","10036 - HC PERQ DEV SOFT TISS ADD IMAG",861,0,107.09,1198.25,215.25]
["TUFTS - TUFTS HMO - CPT - 10036","TUFTS","TUFTS HMO","CPT","10036","HC PERQ DEV SOFT TISS ADD IMAG","10036 - HC PERQ DEV SOFT TISS ADD IMAG",861,0,107.09,1198.25,215.25]
["TUFTS - TUFTS POS - CPT - 10036","TUFTS","TUFTS POS","CPT","10036","HC PERQ DEV SOFT TISS ADD IMAG","10036 - HC PERQ DEV SOFT TISS ADD IMAG",861,0,107.09,1198.25,215.25]
["TUFTS - TUFTS PPO - CPT - 10036","TUFTS","TUFTS PPO","CPT","10036","HC PERQ DEV SOFT TISS ADD IMAG","10036 - HC PERQ DEV SOFT TISS ADD IMAG",861,0,107.09,1198.25,215.25]
["TUFTS - TUFTS SELECT - CPT - 10036","TUFTS","TUFTS SELECT","CPT","10036","HC PERQ DEV SOFT TISS ADD IMAG","10036 - HC PERQ DEV SOFT TISS ADD IMAG",861,0,107.09,1198.25,215.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 10036","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","10036","HC PERQ DEV SOFT TISS ADD IMAG","10036 - HC PERQ DEV SOFT TISS ADD IMAG",861,0,107.09,1198.25,215.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 10036","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","10036","HC PERQ DEV SOFT TISS ADD IMAG","10036 - HC PERQ DEV SOFT TISS ADD IMAG",861,0,107.09,1198.25,215.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 10040","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","10040","ACNE SURGERY","10040 - ACNE SURGERY",681,0,171.09,508.23,170.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 10040","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","10040","ACNE SURGERY","10040 - ACNE SURGERY",681,0,171.09,508.23,170.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 10040","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","10040","ACNE SURGERY","10040 - ACNE SURGERY",681,296.32,171.09,508.23,170.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 10040","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","10040","ACNE SURGERY","10040 - ACNE SURGERY",681,296.32,171.09,508.23,170.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 10040","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","10040","ACNE SURGERY","10040 - ACNE SURGERY",681,296.32,171.09,508.23,170.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 10040","BLUE CROSS","BLUE CROSS-PPO","CPT","10040","ACNE SURGERY","10040 - ACNE SURGERY",681,296.32,171.09,508.23,170.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 10040","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","10040","ACNE SURGERY","10040 - ACNE SURGERY",681,296.32,171.09,508.23,170.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 10040","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","10040","ACNE SURGERY","10040 - ACNE SURGERY",681,296.32,171.09,508.23,170.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 10040","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","10040","ACNE SURGERY","10040 - ACNE SURGERY",681,296.32,171.09,508.23,170.25]
["BMC HEALTHNET - BMCHN ACO - CPT - 10040","BMC HEALTHNET","BMCHN ACO","CPT","10040","ACNE SURGERY","10040 - ACNE SURGERY",681,0,171.09,508.23,170.25]
["BMC HEALTHNET - BMCHN MCO - CPT - 10040","BMC HEALTHNET","BMCHN MCO","CPT","10040","ACNE SURGERY","10040 - ACNE SURGERY",681,0,171.09,508.23,170.25]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 10040","BMC HEALTHNET","BMCHN MEDICAID","CPT","10040","ACNE SURGERY","10040 - ACNE SURGERY",681,0,171.09,508.23,170.25]
["BMC HEALTHNET - BMCHN QHP - CPT - 10040","BMC HEALTHNET","BMCHN QHP","CPT","10040","ACNE SURGERY","10040 - ACNE SURGERY",681,0,171.09,508.23,170.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 10040","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","10040","ACNE SURGERY","10040 - ACNE SURGERY",681,508.23,171.09,508.23,170.25]
["FALLON - FALLON MEDICAID - CPT - 10040","FALLON","FALLON MEDICAID","CPT","10040","ACNE SURGERY","10040 - ACNE SURGERY",681,0,171.09,508.23,170.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 10040","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","10040","ACNE SURGERY","10040 - ACNE SURGERY",681,380.96,171.09,508.23,170.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 10040","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","10040","ACNE SURGERY","10040 - ACNE SURGERY",681,380.96,171.09,508.23,170.25]
["TUFTS - TUFTS HMO - CPT - 10040","TUFTS","TUFTS HMO","CPT","10040","ACNE SURGERY","10040 - ACNE SURGERY",681,320.41000000000003,171.09,508.23,170.25]
["TUFTS - TUFTS POS - CPT - 10040","TUFTS","TUFTS POS","CPT","10040","ACNE SURGERY","10040 - ACNE SURGERY",681,320.41000000000003,171.09,508.23,170.25]
["TUFTS - TUFTS PPO - CPT - 10040","TUFTS","TUFTS PPO","CPT","10040","ACNE SURGERY","10040 - ACNE SURGERY",681,320.41000000000003,171.09,508.23,170.25]
["TUFTS - TUFTS SELECT - CPT - 10040","TUFTS","TUFTS SELECT","CPT","10040","ACNE SURGERY","10040 - ACNE SURGERY",681,171.09,171.09,508.23,170.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 10040","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","10040","ACNE SURGERY","10040 - ACNE SURGERY",681,0,171.09,508.23,170.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 10040","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","10040","ACNE SURGERY","10040 - ACNE SURGERY",681,0,171.09,508.23,170.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 10040","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","10040","ACNE SURGERY","10040 - ACNE SURGERY",681,371.6,171.09,508.23,170.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 10040","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","10040","ACNE SURGERY","10040 - ACNE SURGERY",681,380.96,171.09,508.23,170.25]
["AETNA - AETNA - CPT - 10060","AETNA","AETNA","CPT","10060","INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE","10060 - INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE",729,1198.25,296.32,1198.25,182.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 10060","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","10060","INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE","10060 - INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE",729,296.32,296.32,1198.25,182.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 10060","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","10060","INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE","10060 - INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE",729,296.32,296.32,1198.25,182.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 10060","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","10060","INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE","10060 - INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE",729,296.32,296.32,1198.25,182.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 10060","BLUE CROSS","BLUE CROSS-PPO","CPT","10060","INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE","10060 - INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE",729,296.32,296.32,1198.25,182.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 10060","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","10060","INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE","10060 - INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE",729,296.32,296.32,1198.25,182.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 10060","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","10060","INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE","10060 - INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE",729,296.32,296.32,1198.25,182.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 10060","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","10060","INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE","10060 - INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE",729,296.32,296.32,1198.25,182.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 10060","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","10060","INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE","10060 - INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE",729,943.8,296.32,1198.25,182.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 10060","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","10060","INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE","10060 - INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE",729,380.96,296.32,1198.25,182.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 10060","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","10060","INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE","10060 - INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE",729,380.96,296.32,1198.25,182.25]
["TUFTS - TUFTS HMO - CPT - 10060","TUFTS","TUFTS HMO","CPT","10060","INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE","10060 - INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE",729,595.01,296.32,1198.25,182.25]
["TUFTS - TUFTS POS - CPT - 10060","TUFTS","TUFTS POS","CPT","10060","INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE","10060 - INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE",729,595.01,296.32,1198.25,182.25]
["TUFTS - TUFTS PPO - CPT - 10060","TUFTS","TUFTS PPO","CPT","10060","INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE","10060 - INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE",729,595.01,296.32,1198.25,182.25]
["TUFTS - TUFTS SELECT - CPT - 10060","TUFTS","TUFTS SELECT","CPT","10060","INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE","10060 - INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE",729,317.70999999999998,296.32,1198.25,182.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 10060","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","10060","INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE","10060 - INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE",729,371.6,296.32,1198.25,182.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 10060","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","10060","INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE","10060 - INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE",729,380.96,296.32,1198.25,182.25]
["AETNA - AETNA - CPT - 10061","AETNA","AETNA","CPT","10061","INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE","10061 - INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE",1357,1198.25,317.70999999999998,1198.25,339.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 10061","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","10061","INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE","10061 - INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE",1357,527.46,317.70999999999998,1198.25,339.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 10061","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","10061","INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE","10061 - INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE",1357,527.46,317.70999999999998,1198.25,339.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 10061","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","10061","INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE","10061 - INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE",1357,527.46,317.70999999999998,1198.25,339.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 10061","BLUE CROSS","BLUE CROSS-PPO","CPT","10061","INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE","10061 - INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE",1357,527.46,317.70999999999998,1198.25,339.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 10061","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","10061","INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE","10061 - INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE",1357,527.46,317.70999999999998,1198.25,339.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 10061","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","10061","INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE","10061 - INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE",1357,527.46,317.70999999999998,1198.25,339.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 10061","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","10061","INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE","10061 - INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE",1357,527.46,317.70999999999998,1198.25,339.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 10061","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","10061","INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE","10061 - INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE",1357,943.8,317.70999999999998,1198.25,339.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 10061","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","10061","INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE","10061 - INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE",1357,678.1,317.70999999999998,1198.25,339.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 10061","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","10061","INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE","10061 - INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE",1357,678.1,317.70999999999998,1198.25,339.25]
["TUFTS - TUFTS HMO - CPT - 10061","TUFTS","TUFTS HMO","CPT","10061","INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE","10061 - INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE",1357,595.01,317.70999999999998,1198.25,339.25]
["TUFTS - TUFTS POS - CPT - 10061","TUFTS","TUFTS POS","CPT","10061","INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE","10061 - INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE",1357,595.01,317.70999999999998,1198.25,339.25]
["TUFTS - TUFTS PPO - CPT - 10061","TUFTS","TUFTS PPO","CPT","10061","INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE","10061 - INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE",1357,595.01,317.70999999999998,1198.25,339.25]
["TUFTS - TUFTS SELECT - CPT - 10061","TUFTS","TUFTS SELECT","CPT","10061","INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE","10061 - INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE",1357,317.70999999999998,317.70999999999998,1198.25,339.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 10061","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","10061","INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE","10061 - INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE",1357,661.45,317.70999999999998,1198.25,339.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 10061","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","10061","INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE","10061 - INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE",1357,678.1,317.70999999999998,1198.25,339.25]
["AETNA - AETNA - CPT - 10080","AETNA","AETNA","CPT","10080","INCISION & DRAINAGE PILONIDAL CYST SIMPLE","10080 - INCISION & DRAINAGE PILONIDAL CYST SIMPLE",783,1198.25,972.93,3264.67,195.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 10080","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","10080","INCISION & DRAINAGE PILONIDAL CYST SIMPLE","10080 - INCISION & DRAINAGE PILONIDAL CYST SIMPLE",783,972.93,972.93,3264.67,195.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 10080","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","10080","INCISION & DRAINAGE PILONIDAL CYST SIMPLE","10080 - INCISION & DRAINAGE PILONIDAL CYST SIMPLE",783,972.93,972.93,3264.67,195.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 10080","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","10080","INCISION & DRAINAGE PILONIDAL CYST SIMPLE","10080 - INCISION & DRAINAGE PILONIDAL CYST SIMPLE",783,972.93,972.93,3264.67,195.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 10080","BLUE CROSS","BLUE CROSS-PPO","CPT","10080","INCISION & DRAINAGE PILONIDAL CYST SIMPLE","10080 - INCISION & DRAINAGE PILONIDAL CYST SIMPLE",783,972.93,972.93,3264.67,195.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 10080","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","10080","INCISION & DRAINAGE PILONIDAL CYST SIMPLE","10080 - INCISION & DRAINAGE PILONIDAL CYST SIMPLE",783,972.93,972.93,3264.67,195.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 10080","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","10080","INCISION & DRAINAGE PILONIDAL CYST SIMPLE","10080 - INCISION & DRAINAGE PILONIDAL CYST SIMPLE",783,972.93,972.93,3264.67,195.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 10080","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","10080","INCISION & DRAINAGE PILONIDAL CYST SIMPLE","10080 - INCISION & DRAINAGE PILONIDAL CYST SIMPLE",783,972.93,972.93,3264.67,195.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 10080","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","10080","INCISION & DRAINAGE PILONIDAL CYST SIMPLE","10080 - INCISION & DRAINAGE PILONIDAL CYST SIMPLE",783,3264.67,972.93,3264.67,195.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 10080","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","10080","INCISION & DRAINAGE PILONIDAL CYST SIMPLE","10080 - INCISION & DRAINAGE PILONIDAL CYST SIMPLE",783,1250.8,972.93,3264.67,195.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 10080","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","10080","INCISION & DRAINAGE PILONIDAL CYST SIMPLE","10080 - INCISION & DRAINAGE PILONIDAL CYST SIMPLE",783,1250.8,972.93,3264.67,195.75]
["TUFTS - TUFTS HMO - CPT - 10080","TUFTS","TUFTS HMO","CPT","10080","INCISION & DRAINAGE PILONIDAL CYST SIMPLE","10080 - INCISION & DRAINAGE PILONIDAL CYST SIMPLE",783,2057.7399999999998,972.93,3264.67,195.75]
["TUFTS - TUFTS POS - CPT - 10080","TUFTS","TUFTS POS","CPT","10080","INCISION & DRAINAGE PILONIDAL CYST SIMPLE","10080 - INCISION & DRAINAGE PILONIDAL CYST SIMPLE",783,2058.17,972.93,3264.67,195.75]
["TUFTS - TUFTS PPO - CPT - 10080","TUFTS","TUFTS PPO","CPT","10080","INCISION & DRAINAGE PILONIDAL CYST SIMPLE","10080 - INCISION & DRAINAGE PILONIDAL CYST SIMPLE",783,2058.16,972.93,3264.67,195.75]
["TUFTS - TUFTS SELECT - CPT - 10080","TUFTS","TUFTS SELECT","CPT","10080","INCISION & DRAINAGE PILONIDAL CYST SIMPLE","10080 - INCISION & DRAINAGE PILONIDAL CYST SIMPLE",783,1098.98,972.93,3264.67,195.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 10080","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","10080","INCISION & DRAINAGE PILONIDAL CYST SIMPLE","10080 - INCISION & DRAINAGE PILONIDAL CYST SIMPLE",783,1220.0899999999999,972.93,3264.67,195.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 10080","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","10080","INCISION & DRAINAGE PILONIDAL CYST SIMPLE","10080 - INCISION & DRAINAGE PILONIDAL CYST SIMPLE",783,1250.8,972.93,3264.67,195.75]
["AETNA - AETNA - CPT - 10081","AETNA","AETNA","CPT","10081","INCISION & DRAINAGE PILONIDAL CYST COMPLICATED","10081 - INCISION & DRAINAGE PILONIDAL CYST COMPLICATED",1356,1198.25,972.93,3264.67,339]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 10081","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","10081","INCISION & DRAINAGE PILONIDAL CYST COMPLICATED","10081 - INCISION & DRAINAGE PILONIDAL CYST COMPLICATED",1356,972.93,972.93,3264.67,339]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 10081","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","10081","INCISION & DRAINAGE PILONIDAL CYST COMPLICATED","10081 - INCISION & DRAINAGE PILONIDAL CYST COMPLICATED",1356,972.93,972.93,3264.67,339]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 10081","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","10081","INCISION & DRAINAGE PILONIDAL CYST COMPLICATED","10081 - INCISION & DRAINAGE PILONIDAL CYST COMPLICATED",1356,972.93,972.93,3264.67,339]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 10081","BLUE CROSS","BLUE CROSS-PPO","CPT","10081","INCISION & DRAINAGE PILONIDAL CYST COMPLICATED","10081 - INCISION & DRAINAGE PILONIDAL CYST COMPLICATED",1356,972.93,972.93,3264.67,339]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 10081","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","10081","INCISION & DRAINAGE PILONIDAL CYST COMPLICATED","10081 - INCISION & DRAINAGE PILONIDAL CYST COMPLICATED",1356,972.93,972.93,3264.67,339]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 10081","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","10081","INCISION & DRAINAGE PILONIDAL CYST COMPLICATED","10081 - INCISION & DRAINAGE PILONIDAL CYST COMPLICATED",1356,972.93,972.93,3264.67,339]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 10081","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","10081","INCISION & DRAINAGE PILONIDAL CYST COMPLICATED","10081 - INCISION & DRAINAGE PILONIDAL CYST COMPLICATED",1356,972.93,972.93,3264.67,339]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 10081","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","10081","INCISION & DRAINAGE PILONIDAL CYST COMPLICATED","10081 - INCISION & DRAINAGE PILONIDAL CYST COMPLICATED",1356,3264.67,972.93,3264.67,339]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 10081","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","10081","INCISION & DRAINAGE PILONIDAL CYST COMPLICATED","10081 - INCISION & DRAINAGE PILONIDAL CYST COMPLICATED",1356,1250.8,972.93,3264.67,339]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 10081","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","10081","INCISION & DRAINAGE PILONIDAL CYST COMPLICATED","10081 - INCISION & DRAINAGE PILONIDAL CYST COMPLICATED",1356,1250.8,972.93,3264.67,339]
["TUFTS - TUFTS HMO - CPT - 10081","TUFTS","TUFTS HMO","CPT","10081","INCISION & DRAINAGE PILONIDAL CYST COMPLICATED","10081 - INCISION & DRAINAGE PILONIDAL CYST COMPLICATED",1356,2057.7399999999998,972.93,3264.67,339]
["TUFTS - TUFTS POS - CPT - 10081","TUFTS","TUFTS POS","CPT","10081","INCISION & DRAINAGE PILONIDAL CYST COMPLICATED","10081 - INCISION & DRAINAGE PILONIDAL CYST COMPLICATED",1356,2058.17,972.93,3264.67,339]
["TUFTS - TUFTS PPO - CPT - 10081","TUFTS","TUFTS PPO","CPT","10081","INCISION & DRAINAGE PILONIDAL CYST COMPLICATED","10081 - INCISION & DRAINAGE PILONIDAL CYST COMPLICATED",1356,2058.16,972.93,3264.67,339]
["TUFTS - TUFTS SELECT - CPT - 10081","TUFTS","TUFTS SELECT","CPT","10081","INCISION & DRAINAGE PILONIDAL CYST COMPLICATED","10081 - INCISION & DRAINAGE PILONIDAL CYST COMPLICATED",1356,1098.98,972.93,3264.67,339]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 10081","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","10081","INCISION & DRAINAGE PILONIDAL CYST COMPLICATED","10081 - INCISION & DRAINAGE PILONIDAL CYST COMPLICATED",1356,1220.0899999999999,972.93,3264.67,339]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 10081","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","10081","INCISION & DRAINAGE PILONIDAL CYST COMPLICATED","10081 - INCISION & DRAINAGE PILONIDAL CYST COMPLICATED",1356,1250.8,972.93,3264.67,339]
["AETNA - AETNA - CPT - 10120","AETNA","AETNA","CPT","10120","INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE","10120 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE",715,1198.25,317.70999999999998,1198.25,178.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 10120","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","10120","INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE","10120 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE",715,527.46,317.70999999999998,1198.25,178.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 10120","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","10120","INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE","10120 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE",715,527.46,317.70999999999998,1198.25,178.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 10120","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","10120","INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE","10120 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE",715,527.46,317.70999999999998,1198.25,178.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 10120","BLUE CROSS","BLUE CROSS-PPO","CPT","10120","INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE","10120 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE",715,527.46,317.70999999999998,1198.25,178.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 10120","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","10120","INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE","10120 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE",715,527.46,317.70999999999998,1198.25,178.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 10120","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","10120","INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE","10120 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE",715,527.46,317.70999999999998,1198.25,178.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 10120","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","10120","INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE","10120 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE",715,527.46,317.70999999999998,1198.25,178.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 10120","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","10120","INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE","10120 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE",715,943.8,317.70999999999998,1198.25,178.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 10120","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","10120","INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE","10120 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE",715,678.1,317.70999999999998,1198.25,178.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 10120","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","10120","INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE","10120 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE",715,678.1,317.70999999999998,1198.25,178.75]
["TUFTS - TUFTS HMO - CPT - 10120","TUFTS","TUFTS HMO","CPT","10120","INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE","10120 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE",715,595.01,317.70999999999998,1198.25,178.75]
["TUFTS - TUFTS POS - CPT - 10120","TUFTS","TUFTS POS","CPT","10120","INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE","10120 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE",715,595.01,317.70999999999998,1198.25,178.75]
["TUFTS - TUFTS PPO - CPT - 10120","TUFTS","TUFTS PPO","CPT","10120","INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE","10120 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE",715,595.01,317.70999999999998,1198.25,178.75]
["TUFTS - TUFTS SELECT - CPT - 10120","TUFTS","TUFTS SELECT","CPT","10120","INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE","10120 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE",715,317.70999999999998,317.70999999999998,1198.25,178.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 10120","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","10120","INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE","10120 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE",715,661.45,317.70999999999998,1198.25,178.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 10120","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","10120","INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE","10120 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE",715,678.1,317.70999999999998,1198.25,178.75]
["AETNA - AETNA - CPT - 10121","AETNA","AETNA","CPT","10121","INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL","10121 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL",1972,1500.85,1098.98,3264.67,493]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 10121","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","10121","INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL","10121 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL",1972,2309.9699999999998,1098.98,3264.67,493]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 10121","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","10121","INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL","10121 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL",1972,2309.9699999999998,1098.98,3264.67,493]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 10121","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","10121","INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL","10121 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL",1972,2309.9699999999998,1098.98,3264.67,493]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 10121","BLUE CROSS","BLUE CROSS-PPO","CPT","10121","INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL","10121 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL",1972,2309.9699999999998,1098.98,3264.67,493]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 10121","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","10121","INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL","10121 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL",1972,2309.9699999999998,1098.98,3264.67,493]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 10121","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","10121","INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL","10121 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL",1972,2309.9699999999998,1098.98,3264.67,493]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 10121","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","10121","INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL","10121 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL",1972,2309.9699999999998,1098.98,3264.67,493]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 10121","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","10121","INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL","10121 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL",1972,3264.67,1098.98,3264.67,493]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 10121","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","10121","INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL","10121 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL",1972,2672.73,1098.98,3264.67,493]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 10121","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","10121","INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL","10121 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL",1972,2672.73,1098.98,3264.67,493]
["TUFTS - TUFTS HMO - CPT - 10121","TUFTS","TUFTS HMO","CPT","10121","INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL","10121 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL",1972,2057.7399999999998,1098.98,3264.67,493]
["TUFTS - TUFTS POS - CPT - 10121","TUFTS","TUFTS POS","CPT","10121","INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL","10121 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL",1972,2058.17,1098.98,3264.67,493]
["TUFTS - TUFTS PPO - CPT - 10121","TUFTS","TUFTS PPO","CPT","10121","INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL","10121 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL",1972,2058.16,1098.98,3264.67,493]
["TUFTS - TUFTS SELECT - CPT - 10121","TUFTS","TUFTS SELECT","CPT","10121","INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL","10121 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL",1972,1098.98,1098.98,3264.67,493]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 10121","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","10121","INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL","10121 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL",1972,2607.12,1098.98,3264.67,493]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 10121","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","10121","INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL","10121 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL",1972,2672.73,1098.98,3264.67,493]
["AETNA - AETNA - CPT - 10140","AETNA","AETNA","CPT","10140","I&D HEMATOMA SEROMA/FLUID COLLECTION","10140 - I&D HEMATOMA SEROMA/FLUID COLLECTION",1453,1198.25,1098.98,3264.67,363.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 10140","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","10140","I&D HEMATOMA SEROMA/FLUID COLLECTION","10140 - I&D HEMATOMA SEROMA/FLUID COLLECTION",1453,2309.9699999999998,1098.98,3264.67,363.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 10140","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","10140","I&D HEMATOMA SEROMA/FLUID COLLECTION","10140 - I&D HEMATOMA SEROMA/FLUID COLLECTION",1453,2309.9699999999998,1098.98,3264.67,363.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 10140","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","10140","I&D HEMATOMA SEROMA/FLUID COLLECTION","10140 - I&D HEMATOMA SEROMA/FLUID COLLECTION",1453,2309.9699999999998,1098.98,3264.67,363.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 10140","BLUE CROSS","BLUE CROSS-PPO","CPT","10140","I&D HEMATOMA SEROMA/FLUID COLLECTION","10140 - I&D HEMATOMA SEROMA/FLUID COLLECTION",1453,2309.9699999999998,1098.98,3264.67,363.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 10140","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","10140","I&D HEMATOMA SEROMA/FLUID COLLECTION","10140 - I&D HEMATOMA SEROMA/FLUID COLLECTION",1453,2309.9699999999998,1098.98,3264.67,363.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 10140","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","10140","I&D HEMATOMA SEROMA/FLUID COLLECTION","10140 - I&D HEMATOMA SEROMA/FLUID COLLECTION",1453,2309.9699999999998,1098.98,3264.67,363.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 10140","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","10140","I&D HEMATOMA SEROMA/FLUID COLLECTION","10140 - I&D HEMATOMA SEROMA/FLUID COLLECTION",1453,2309.9699999999998,1098.98,3264.67,363.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 10140","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","10140","I&D HEMATOMA SEROMA/FLUID COLLECTION","10140 - I&D HEMATOMA SEROMA/FLUID COLLECTION",1453,3264.67,1098.98,3264.67,363.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 10140","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","10140","I&D HEMATOMA SEROMA/FLUID COLLECTION","10140 - I&D HEMATOMA SEROMA/FLUID COLLECTION",1453,2672.73,1098.98,3264.67,363.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 10140","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","10140","I&D HEMATOMA SEROMA/FLUID COLLECTION","10140 - I&D HEMATOMA SEROMA/FLUID COLLECTION",1453,2672.73,1098.98,3264.67,363.25]
["TUFTS - TUFTS HMO - CPT - 10140","TUFTS","TUFTS HMO","CPT","10140","I&D HEMATOMA SEROMA/FLUID COLLECTION","10140 - I&D HEMATOMA SEROMA/FLUID COLLECTION",1453,2057.7399999999998,1098.98,3264.67,363.25]
["TUFTS - TUFTS POS - CPT - 10140","TUFTS","TUFTS POS","CPT","10140","I&D HEMATOMA SEROMA/FLUID COLLECTION","10140 - I&D HEMATOMA SEROMA/FLUID COLLECTION",1453,2058.17,1098.98,3264.67,363.25]
["TUFTS - TUFTS PPO - CPT - 10140","TUFTS","TUFTS PPO","CPT","10140","I&D HEMATOMA SEROMA/FLUID COLLECTION","10140 - I&D HEMATOMA SEROMA/FLUID COLLECTION",1453,2058.16,1098.98,3264.67,363.25]
["TUFTS - TUFTS SELECT - CPT - 10140","TUFTS","TUFTS SELECT","CPT","10140","I&D HEMATOMA SEROMA/FLUID COLLECTION","10140 - I&D HEMATOMA SEROMA/FLUID COLLECTION",1453,1098.98,1098.98,3264.67,363.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 10140","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","10140","I&D HEMATOMA SEROMA/FLUID COLLECTION","10140 - I&D HEMATOMA SEROMA/FLUID COLLECTION",1453,2607.12,1098.98,3264.67,363.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 10140","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","10140","I&D HEMATOMA SEROMA/FLUID COLLECTION","10140 - I&D HEMATOMA SEROMA/FLUID COLLECTION",1453,2672.73,1098.98,3264.67,363.25]
["AETNA - AETNA - CPT - 10160","AETNA","AETNA","CPT","10160","PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST",729,1198.25,317.70999999999998,1198.25,182.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 10160","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","10160","PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST",729,527.46,317.70999999999998,1198.25,182.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 10160","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","10160","PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST",729,527.46,317.70999999999998,1198.25,182.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 10160","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","10160","PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST",729,527.46,317.70999999999998,1198.25,182.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 10160","BLUE CROSS","BLUE CROSS-PPO","CPT","10160","PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST",729,527.46,317.70999999999998,1198.25,182.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 10160","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","10160","PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST",729,527.46,317.70999999999998,1198.25,182.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 10160","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","10160","PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST",729,527.46,317.70999999999998,1198.25,182.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 10160","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","10160","PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST",729,527.46,317.70999999999998,1198.25,182.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 10160","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","10160","PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST",729,943.8,317.70999999999998,1198.25,182.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 10160","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","10160","PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST",729,678.1,317.70999999999998,1198.25,182.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 10160","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","10160","PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST",729,678.1,317.70999999999998,1198.25,182.25]
["TUFTS - TUFTS HMO - CPT - 10160","TUFTS","TUFTS HMO","CPT","10160","PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST",729,595.01,317.70999999999998,1198.25,182.25]
["TUFTS - TUFTS POS - CPT - 10160","TUFTS","TUFTS POS","CPT","10160","PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST",729,595.01,317.70999999999998,1198.25,182.25]
["TUFTS - TUFTS PPO - CPT - 10160","TUFTS","TUFTS PPO","CPT","10160","PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST",729,595.01,317.70999999999998,1198.25,182.25]
["TUFTS - TUFTS SELECT - CPT - 10160","TUFTS","TUFTS SELECT","CPT","10160","PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST",729,317.70999999999998,317.70999999999998,1198.25,182.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 10160","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","10160","PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST",729,661.45,317.70999999999998,1198.25,182.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 10160","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","10160","PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST",729,678.1,317.70999999999998,1198.25,182.25]
["AETNA - AETNA - CPT - 10180","AETNA","AETNA","CPT","10180","HC COMPLEX DRAINAGE, WOUND","10180 - HC COMPLEX DRAINAGE, WOUND",3570,1500.85,1500.85,7703.8,892.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 10180","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","10180","HC COMPLEX DRAINAGE, WOUND","10180 - HC COMPLEX DRAINAGE, WOUND",3570,3994.03,1500.85,7703.8,892.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 10180","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","10180","HC COMPLEX DRAINAGE, WOUND","10180 - HC COMPLEX DRAINAGE, WOUND",3570,3994.03,1500.85,7703.8,892.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 10180","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","10180","HC COMPLEX DRAINAGE, WOUND","10180 - HC COMPLEX DRAINAGE, WOUND",3570,3994.03,1500.85,7703.8,892.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 10180","BLUE CROSS","BLUE CROSS-PPO","CPT","10180","HC COMPLEX DRAINAGE, WOUND","10180 - HC COMPLEX DRAINAGE, WOUND",3570,3994.03,1500.85,7703.8,892.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 10180","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","10180","HC COMPLEX DRAINAGE, WOUND","10180 - HC COMPLEX DRAINAGE, WOUND",3570,3994.03,1500.85,7703.8,892.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 10180","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","10180","HC COMPLEX DRAINAGE, WOUND","10180 - HC COMPLEX DRAINAGE, WOUND",3570,3994.03,1500.85,7703.8,892.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 10180","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","10180","HC COMPLEX DRAINAGE, WOUND","10180 - HC COMPLEX DRAINAGE, WOUND",3570,3994.03,1500.85,7703.8,892.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 10180","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","10180","HC COMPLEX DRAINAGE, WOUND","10180 - HC COMPLEX DRAINAGE, WOUND",3570,7703.8,1500.85,7703.8,892.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 10180","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","10180","HC COMPLEX DRAINAGE, WOUND","10180 - HC COMPLEX DRAINAGE, WOUND",3570,4621.25,1500.85,7703.8,892.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 10180","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","10180","HC COMPLEX DRAINAGE, WOUND","10180 - HC COMPLEX DRAINAGE, WOUND",3570,4621.25,1500.85,7703.8,892.5]
["TUFTS - TUFTS HMO - CPT - 10180","TUFTS","TUFTS HMO","CPT","10180","HC COMPLEX DRAINAGE, WOUND","10180 - HC COMPLEX DRAINAGE, WOUND",3570,4856.75,1500.85,7703.8,892.5]
["TUFTS - TUFTS POS - CPT - 10180","TUFTS","TUFTS POS","CPT","10180","HC COMPLEX DRAINAGE, WOUND","10180 - HC COMPLEX DRAINAGE, WOUND",3570,4856.75,1500.85,7703.8,892.5]
["TUFTS - TUFTS PPO - CPT - 10180","TUFTS","TUFTS PPO","CPT","10180","HC COMPLEX DRAINAGE, WOUND","10180 - HC COMPLEX DRAINAGE, WOUND",3570,4856.75,1500.85,7703.8,892.5]
["TUFTS - TUFTS SELECT - CPT - 10180","TUFTS","TUFTS SELECT","CPT","10180","HC COMPLEX DRAINAGE, WOUND","10180 - HC COMPLEX DRAINAGE, WOUND",3570,2593.31,1500.85,7703.8,892.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 10180","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","10180","HC COMPLEX DRAINAGE, WOUND","10180 - HC COMPLEX DRAINAGE, WOUND",3570,4507.8100000000004,1500.85,7703.8,892.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 10180","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","10180","HC COMPLEX DRAINAGE, WOUND","10180 - HC COMPLEX DRAINAGE, WOUND",3570,4621.25,1500.85,7703.8,892.5]
["AETNA - AETNA - CPT - 11000","AETNA","AETNA","CPT","11000","DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF","11000 - DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF",475,1198.25,317.70999999999998,1198.25,118.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11000","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11000","DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF","11000 - DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF",475,810.95,317.70999999999998,1198.25,118.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11000","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11000","DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF","11000 - DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF",475,810.95,317.70999999999998,1198.25,118.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11000","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11000","DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF","11000 - DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF",475,810.95,317.70999999999998,1198.25,118.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11000","BLUE CROSS","BLUE CROSS-PPO","CPT","11000","DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF","11000 - DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF",475,810.95,317.70999999999998,1198.25,118.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11000","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11000","DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF","11000 - DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF",475,810.95,317.70999999999998,1198.25,118.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11000","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11000","DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF","11000 - DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF",475,810.95,317.70999999999998,1198.25,118.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11000","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11000","DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF","11000 - DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF",475,810.95,317.70999999999998,1198.25,118.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11000","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11000","DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF","11000 - DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF",475,943.8,317.70999999999998,1198.25,118.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11000","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11000","DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF","11000 - DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF",475,1042.56,317.70999999999998,1198.25,118.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11000","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11000","DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF","11000 - DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF",475,1042.56,317.70999999999998,1198.25,118.75]
["TUFTS - TUFTS HMO - CPT - 11000","TUFTS","TUFTS HMO","CPT","11000","DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF","11000 - DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF",475,595.01,317.70999999999998,1198.25,118.75]
["TUFTS - TUFTS POS - CPT - 11000","TUFTS","TUFTS POS","CPT","11000","DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF","11000 - DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF",475,595.01,317.70999999999998,1198.25,118.75]
["TUFTS - TUFTS PPO - CPT - 11000","TUFTS","TUFTS PPO","CPT","11000","DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF","11000 - DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF",475,595.01,317.70999999999998,1198.25,118.75]
["TUFTS - TUFTS SELECT - CPT - 11000","TUFTS","TUFTS SELECT","CPT","11000","DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF","11000 - DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF",475,317.70999999999998,317.70999999999998,1198.25,118.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11000","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11000","DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF","11000 - DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF",475,1016.97,317.70999999999998,1198.25,118.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11000","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11000","DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF","11000 - DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF",475,1042.56,317.70999999999998,1198.25,118.75]
["AETNA - AETNA - CPT - 11010","AETNA","AETNA","CPT","11010","HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ","11010 - HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ",2161,1500.85,684.11,2032.26,540.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11010","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11010","HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ","11010 - HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ",2161,972.93,684.11,2032.26,540.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11010","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11010","HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ","11010 - HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ",2161,972.93,684.11,2032.26,540.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11010","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11010","HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ","11010 - HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ",2161,972.93,684.11,2032.26,540.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11010","BLUE CROSS","BLUE CROSS-PPO","CPT","11010","HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ","11010 - HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ",2161,972.93,684.11,2032.26,540.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11010","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11010","HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ","11010 - HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ",2161,972.93,684.11,2032.26,540.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11010","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11010","HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ","11010 - HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ",2161,972.93,684.11,2032.26,540.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11010","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11010","HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ","11010 - HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ",2161,972.93,684.11,2032.26,540.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11010","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11010","HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ","11010 - HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ",2161,2032.26,684.11,2032.26,540.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11010","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11010","HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ","11010 - HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ",2161,1250.8,684.11,2032.26,540.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11010","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11010","HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ","11010 - HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ",2161,1250.8,684.11,2032.26,540.25]
["TUFTS - TUFTS HMO - CPT - 11010","TUFTS","TUFTS HMO","CPT","11010","HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ","11010 - HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ",2161,1281.21,684.11,2032.26,540.25]
["TUFTS - TUFTS POS - CPT - 11010","TUFTS","TUFTS POS","CPT","11010","HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ","11010 - HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ",2161,1281.21,684.11,2032.26,540.25]
["TUFTS - TUFTS PPO - CPT - 11010","TUFTS","TUFTS PPO","CPT","11010","HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ","11010 - HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ",2161,1281.21,684.11,2032.26,540.25]
["TUFTS - TUFTS SELECT - CPT - 11010","TUFTS","TUFTS SELECT","CPT","11010","HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ","11010 - HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ",2161,684.11,684.11,2032.26,540.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11010","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11010","HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ","11010 - HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ",2161,1220.0899999999999,684.11,2032.26,540.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11010","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11010","HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ","11010 - HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ",2161,1250.8,684.11,2032.26,540.25]
["AETNA - AETNA - CPT - 11012","AETNA","AETNA","CPT","11012","HC DBRDMT FX&/DISLC SUBQ T/M/F BONE","11012 - HC DBRDMT FX&/DISLC SUBQ T/M/F BONE",3490,1500.85,684.11,4621.25,872.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11012","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11012","HC DBRDMT FX&/DISLC SUBQ T/M/F BONE","11012 - HC DBRDMT FX&/DISLC SUBQ T/M/F BONE",3490,3994.03,684.11,4621.25,872.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11012","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11012","HC DBRDMT FX&/DISLC SUBQ T/M/F BONE","11012 - HC DBRDMT FX&/DISLC SUBQ T/M/F BONE",3490,3994.03,684.11,4621.25,872.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11012","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11012","HC DBRDMT FX&/DISLC SUBQ T/M/F BONE","11012 - HC DBRDMT FX&/DISLC SUBQ T/M/F BONE",3490,3994.03,684.11,4621.25,872.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11012","BLUE CROSS","BLUE CROSS-PPO","CPT","11012","HC DBRDMT FX&/DISLC SUBQ T/M/F BONE","11012 - HC DBRDMT FX&/DISLC SUBQ T/M/F BONE",3490,3994.03,684.11,4621.25,872.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11012","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11012","HC DBRDMT FX&/DISLC SUBQ T/M/F BONE","11012 - HC DBRDMT FX&/DISLC SUBQ T/M/F BONE",3490,3994.03,684.11,4621.25,872.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11012","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11012","HC DBRDMT FX&/DISLC SUBQ T/M/F BONE","11012 - HC DBRDMT FX&/DISLC SUBQ T/M/F BONE",3490,3994.03,684.11,4621.25,872.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11012","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11012","HC DBRDMT FX&/DISLC SUBQ T/M/F BONE","11012 - HC DBRDMT FX&/DISLC SUBQ T/M/F BONE",3490,3994.03,684.11,4621.25,872.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11012","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11012","HC DBRDMT FX&/DISLC SUBQ T/M/F BONE","11012 - HC DBRDMT FX&/DISLC SUBQ T/M/F BONE",3490,2032.26,684.11,4621.25,872.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11012","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11012","HC DBRDMT FX&/DISLC SUBQ T/M/F BONE","11012 - HC DBRDMT FX&/DISLC SUBQ T/M/F BONE",3490,4621.25,684.11,4621.25,872.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11012","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11012","HC DBRDMT FX&/DISLC SUBQ T/M/F BONE","11012 - HC DBRDMT FX&/DISLC SUBQ T/M/F BONE",3490,4621.25,684.11,4621.25,872.5]
["TUFTS - TUFTS HMO - CPT - 11012","TUFTS","TUFTS HMO","CPT","11012","HC DBRDMT FX&/DISLC SUBQ T/M/F BONE","11012 - HC DBRDMT FX&/DISLC SUBQ T/M/F BONE",3490,1281.21,684.11,4621.25,872.5]
["TUFTS - TUFTS POS - CPT - 11012","TUFTS","TUFTS POS","CPT","11012","HC DBRDMT FX&/DISLC SUBQ T/M/F BONE","11012 - HC DBRDMT FX&/DISLC SUBQ T/M/F BONE",3490,1281.21,684.11,4621.25,872.5]
["TUFTS - TUFTS PPO - CPT - 11012","TUFTS","TUFTS PPO","CPT","11012","HC DBRDMT FX&/DISLC SUBQ T/M/F BONE","11012 - HC DBRDMT FX&/DISLC SUBQ T/M/F BONE",3490,1281.21,684.11,4621.25,872.5]
["TUFTS - TUFTS SELECT - CPT - 11012","TUFTS","TUFTS SELECT","CPT","11012","HC DBRDMT FX&/DISLC SUBQ T/M/F BONE","11012 - HC DBRDMT FX&/DISLC SUBQ T/M/F BONE",3490,684.11,684.11,4621.25,872.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11012","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11012","HC DBRDMT FX&/DISLC SUBQ T/M/F BONE","11012 - HC DBRDMT FX&/DISLC SUBQ T/M/F BONE",3490,4507.8100000000004,684.11,4621.25,872.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11012","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11012","HC DBRDMT FX&/DISLC SUBQ T/M/F BONE","11012 - HC DBRDMT FX&/DISLC SUBQ T/M/F BONE",3490,4621.25,684.11,4621.25,872.5]
["AETNA - AETNA - CPT - 11042","AETNA","AETNA","CPT","11042","DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<","11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<",473,1500.85,317.70999999999998,1500.85,118.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11042","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11042","DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<","11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<",473,527.46,317.70999999999998,1500.85,118.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11042","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11042","DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<","11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<",473,527.46,317.70999999999998,1500.85,118.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11042","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11042","DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<","11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<",473,527.46,317.70999999999998,1500.85,118.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11042","BLUE CROSS","BLUE CROSS-PPO","CPT","11042","DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<","11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<",473,527.46,317.70999999999998,1500.85,118.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11042","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11042","DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<","11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<",473,527.46,317.70999999999998,1500.85,118.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11042","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11042","DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<","11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<",473,527.46,317.70999999999998,1500.85,118.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11042","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11042","DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<","11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<",473,527.46,317.70999999999998,1500.85,118.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11042","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11042","DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<","11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<",473,943.8,317.70999999999998,1500.85,118.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11042","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11042","DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<","11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<",473,678.1,317.70999999999998,1500.85,118.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11042","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11042","DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<","11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<",473,678.1,317.70999999999998,1500.85,118.25]
["TUFTS - TUFTS HMO - CPT - 11042","TUFTS","TUFTS HMO","CPT","11042","DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<","11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<",473,595.01,317.70999999999998,1500.85,118.25]
["TUFTS - TUFTS POS - CPT - 11042","TUFTS","TUFTS POS","CPT","11042","DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<","11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<",473,595.01,317.70999999999998,1500.85,118.25]
["TUFTS - TUFTS PPO - CPT - 11042","TUFTS","TUFTS PPO","CPT","11042","DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<","11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<",473,595.01,317.70999999999998,1500.85,118.25]
["TUFTS - TUFTS SELECT - CPT - 11042","TUFTS","TUFTS SELECT","CPT","11042","DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<","11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<",473,317.70999999999998,317.70999999999998,1500.85,118.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11042","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11042","DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<","11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<",473,661.45,317.70999999999998,1500.85,118.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11042","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11042","DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<","11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<",473,678.1,317.70999999999998,1500.85,118.25]
["AETNA - AETNA - CPT - 11043","AETNA","AETNA","CPT","11043","DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<","11043 - DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<",1202,1500.85,317.70999999999998,1500.85,300.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11043","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11043","DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<","11043 - DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<",1202,810.95,317.70999999999998,1500.85,300.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11043","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11043","DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<","11043 - DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<",1202,810.95,317.70999999999998,1500.85,300.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11043","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11043","DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<","11043 - DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<",1202,810.95,317.70999999999998,1500.85,300.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11043","BLUE CROSS","BLUE CROSS-PPO","CPT","11043","DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<","11043 - DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<",1202,810.95,317.70999999999998,1500.85,300.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11043","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11043","DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<","11043 - DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<",1202,810.95,317.70999999999998,1500.85,300.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11043","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11043","DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<","11043 - DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<",1202,810.95,317.70999999999998,1500.85,300.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11043","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11043","DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<","11043 - DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<",1202,810.95,317.70999999999998,1500.85,300.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11043","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11043","DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<","11043 - DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<",1202,943.8,317.70999999999998,1500.85,300.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11043","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11043","DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<","11043 - DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<",1202,1042.56,317.70999999999998,1500.85,300.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11043","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11043","DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<","11043 - DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<",1202,1042.56,317.70999999999998,1500.85,300.5]
["TUFTS - TUFTS HMO - CPT - 11043","TUFTS","TUFTS HMO","CPT","11043","DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<","11043 - DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<",1202,595.01,317.70999999999998,1500.85,300.5]
["TUFTS - TUFTS POS - CPT - 11043","TUFTS","TUFTS POS","CPT","11043","DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<","11043 - DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<",1202,595.01,317.70999999999998,1500.85,300.5]
["TUFTS - TUFTS PPO - CPT - 11043","TUFTS","TUFTS PPO","CPT","11043","DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<","11043 - DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<",1202,595.01,317.70999999999998,1500.85,300.5]
["TUFTS - TUFTS SELECT - CPT - 11043","TUFTS","TUFTS SELECT","CPT","11043","DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<","11043 - DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<",1202,317.70999999999998,317.70999999999998,1500.85,300.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11043","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11043","DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<","11043 - DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<",1202,1016.97,317.70999999999998,1500.85,300.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11043","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11043","DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<","11043 - DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<",1202,1042.56,317.70999999999998,1500.85,300.5]
["AETNA - AETNA - CPT - 11044","AETNA","AETNA","CPT","11044","DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<","11044 - DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<",1795,1500.85,1500.85,7703.8,448.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11044","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11044","DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<","11044 - DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<",1795,2309.9699999999998,1500.85,7703.8,448.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11044","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11044","DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<","11044 - DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<",1795,2309.9699999999998,1500.85,7703.8,448.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11044","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11044","DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<","11044 - DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<",1795,2309.9699999999998,1500.85,7703.8,448.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11044","BLUE CROSS","BLUE CROSS-PPO","CPT","11044","DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<","11044 - DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<",1795,2309.9699999999998,1500.85,7703.8,448.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11044","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11044","DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<","11044 - DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<",1795,2309.9699999999998,1500.85,7703.8,448.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11044","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11044","DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<","11044 - DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<",1795,2309.9699999999998,1500.85,7703.8,448.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11044","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11044","DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<","11044 - DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<",1795,2309.9699999999998,1500.85,7703.8,448.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11044","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11044","DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<","11044 - DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<",1795,7703.8,1500.85,7703.8,448.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11044","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11044","DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<","11044 - DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<",1795,2672.73,1500.85,7703.8,448.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11044","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11044","DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<","11044 - DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<",1795,2672.73,1500.85,7703.8,448.75]
["TUFTS - TUFTS HMO - CPT - 11044","TUFTS","TUFTS HMO","CPT","11044","DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<","11044 - DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<",1795,4856.75,1500.85,7703.8,448.75]
["TUFTS - TUFTS POS - CPT - 11044","TUFTS","TUFTS POS","CPT","11044","DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<","11044 - DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<",1795,4856.75,1500.85,7703.8,448.75]
["TUFTS - TUFTS PPO - CPT - 11044","TUFTS","TUFTS PPO","CPT","11044","DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<","11044 - DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<",1795,4856.75,1500.85,7703.8,448.75]
["TUFTS - TUFTS SELECT - CPT - 11044","TUFTS","TUFTS SELECT","CPT","11044","DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<","11044 - DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<",1795,2593.31,1500.85,7703.8,448.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11044","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11044","DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<","11044 - DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<",1795,2607.12,1500.85,7703.8,448.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11044","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11044","DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<","11044 - DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<",1795,2672.73,1500.85,7703.8,448.75]
["AETNA - AETNA - CPT - 11045","AETNA","AETNA","CPT","11045","DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM","11045 - DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM",206,1198.25,65.06,1198.25,51.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11045","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11045","DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM","11045 - DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM",206,65.06,65.06,1198.25,51.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11045","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11045","DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM","11045 - DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM",206,65.06,65.06,1198.25,51.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11045","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11045","DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM","11045 - DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM",206,65.06,65.06,1198.25,51.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11045","BLUE CROSS","BLUE CROSS-PPO","CPT","11045","DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM","11045 - DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM",206,65.06,65.06,1198.25,51.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11045","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11045","DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM","11045 - DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM",206,65.06,65.06,1198.25,51.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11045","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11045","DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM","11045 - DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM",206,65.06,65.06,1198.25,51.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11045","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11045","DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM","11045 - DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM",206,65.06,65.06,1198.25,51.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11045","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11045","DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM","11045 - DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM",206,0,65.06,1198.25,51.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11045","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11045","DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM","11045 - DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM",206,0,65.06,1198.25,51.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11045","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11045","DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM","11045 - DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM",206,0,65.06,1198.25,51.5]
["TUFTS - TUFTS HMO - CPT - 11045","TUFTS","TUFTS HMO","CPT","11045","DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM","11045 - DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM",206,0,65.06,1198.25,51.5]
["TUFTS - TUFTS POS - CPT - 11045","TUFTS","TUFTS POS","CPT","11045","DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM","11045 - DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM",206,0,65.06,1198.25,51.5]
["TUFTS - TUFTS PPO - CPT - 11045","TUFTS","TUFTS PPO","CPT","11045","DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM","11045 - DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM",206,0,65.06,1198.25,51.5]
["TUFTS - TUFTS SELECT - CPT - 11045","TUFTS","TUFTS SELECT","CPT","11045","DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM","11045 - DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM",206,0,65.06,1198.25,51.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11045","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11045","DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM","11045 - DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM",206,0,65.06,1198.25,51.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11045","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11045","DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM","11045 - DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM",206,0,65.06,1198.25,51.5]
["AETNA - AETNA - CPT - 11046","AETNA","AETNA","CPT","11046","DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM","11046 - DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM",420,1198.25,138.07,1198.25,105]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11046","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11046","DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM","11046 - DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM",420,138.07,138.07,1198.25,105]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11046","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11046","DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM","11046 - DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM",420,138.07,138.07,1198.25,105]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11046","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11046","DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM","11046 - DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM",420,138.07,138.07,1198.25,105]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11046","BLUE CROSS","BLUE CROSS-PPO","CPT","11046","DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM","11046 - DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM",420,138.07,138.07,1198.25,105]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11046","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11046","DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM","11046 - DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM",420,138.07,138.07,1198.25,105]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11046","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11046","DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM","11046 - DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM",420,138.07,138.07,1198.25,105]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11046","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11046","DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM","11046 - DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM",420,138.07,138.07,1198.25,105]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11046","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11046","DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM","11046 - DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM",420,0,138.07,1198.25,105]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11046","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11046","DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM","11046 - DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM",420,0,138.07,1198.25,105]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11046","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11046","DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM","11046 - DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM",420,0,138.07,1198.25,105]
["TUFTS - TUFTS HMO - CPT - 11046","TUFTS","TUFTS HMO","CPT","11046","DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM","11046 - DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM",420,0,138.07,1198.25,105]
["TUFTS - TUFTS POS - CPT - 11046","TUFTS","TUFTS POS","CPT","11046","DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM","11046 - DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM",420,0,138.07,1198.25,105]
["TUFTS - TUFTS PPO - CPT - 11046","TUFTS","TUFTS PPO","CPT","11046","DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM","11046 - DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM",420,0,138.07,1198.25,105]
["TUFTS - TUFTS SELECT - CPT - 11046","TUFTS","TUFTS SELECT","CPT","11046","DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM","11046 - DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM",420,0,138.07,1198.25,105]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11046","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11046","DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM","11046 - DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM",420,0,138.07,1198.25,105]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11046","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11046","DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM","11046 - DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM",420,0,138.07,1198.25,105]
["AETNA - AETNA - CPT - 11047","AETNA","AETNA","CPT","11047","DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM","11047 - DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM",742,1198.25,244.48,1198.25,185.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11047","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11047","DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM","11047 - DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM",742,244.48,244.48,1198.25,185.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11047","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11047","DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM","11047 - DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM",742,244.48,244.48,1198.25,185.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11047","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11047","DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM","11047 - DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM",742,244.48,244.48,1198.25,185.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11047","BLUE CROSS","BLUE CROSS-PPO","CPT","11047","DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM","11047 - DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM",742,244.48,244.48,1198.25,185.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11047","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11047","DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM","11047 - DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM",742,244.48,244.48,1198.25,185.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11047","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11047","DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM","11047 - DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM",742,244.48,244.48,1198.25,185.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11047","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11047","DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM","11047 - DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM",742,244.48,244.48,1198.25,185.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11047","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11047","DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM","11047 - DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM",742,0,244.48,1198.25,185.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11047","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11047","DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM","11047 - DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM",742,0,244.48,1198.25,185.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11047","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11047","DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM","11047 - DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM",742,0,244.48,1198.25,185.5]
["TUFTS - TUFTS HMO - CPT - 11047","TUFTS","TUFTS HMO","CPT","11047","DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM","11047 - DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM",742,0,244.48,1198.25,185.5]
["TUFTS - TUFTS POS - CPT - 11047","TUFTS","TUFTS POS","CPT","11047","DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM","11047 - DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM",742,0,244.48,1198.25,185.5]
["TUFTS - TUFTS PPO - CPT - 11047","TUFTS","TUFTS PPO","CPT","11047","DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM","11047 - DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM",742,0,244.48,1198.25,185.5]
["TUFTS - TUFTS SELECT - CPT - 11047","TUFTS","TUFTS SELECT","CPT","11047","DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM","11047 - DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM",742,0,244.48,1198.25,185.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11047","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11047","DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM","11047 - DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM",742,0,244.48,1198.25,185.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11047","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11047","DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM","11047 - DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM",742,0,244.48,1198.25,185.5]
["AETNA - AETNA - CPT - 11055","AETNA","AETNA","CPT","11055","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1","11055 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1",148,1198.25,296.32,1198.25,37]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11055","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11055","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1","11055 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1",148,296.32,296.32,1198.25,37]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11055","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11055","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1","11055 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1",148,296.32,296.32,1198.25,37]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11055","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11055","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1","11055 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1",148,296.32,296.32,1198.25,37]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11055","BLUE CROSS","BLUE CROSS-PPO","CPT","11055","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1","11055 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1",148,296.32,296.32,1198.25,37]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11055","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11055","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1","11055 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1",148,296.32,296.32,1198.25,37]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11055","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11055","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1","11055 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1",148,296.32,296.32,1198.25,37]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11055","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11055","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1","11055 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1",148,296.32,296.32,1198.25,37]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11055","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11055","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1","11055 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1",148,943.8,296.32,1198.25,37]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11055","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11055","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1","11055 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1",148,380.96,296.32,1198.25,37]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11055","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11055","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1","11055 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1",148,380.96,296.32,1198.25,37]
["TUFTS - TUFTS HMO - CPT - 11055","TUFTS","TUFTS HMO","CPT","11055","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1","11055 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1",148,595.01,296.32,1198.25,37]
["TUFTS - TUFTS POS - CPT - 11055","TUFTS","TUFTS POS","CPT","11055","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1","11055 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1",148,595.01,296.32,1198.25,37]
["TUFTS - TUFTS PPO - CPT - 11055","TUFTS","TUFTS PPO","CPT","11055","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1","11055 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1",148,595.01,296.32,1198.25,37]
["TUFTS - TUFTS SELECT - CPT - 11055","TUFTS","TUFTS SELECT","CPT","11055","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1","11055 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1",148,317.70999999999998,296.32,1198.25,37]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11055","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11055","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1","11055 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1",148,371.6,296.32,1198.25,37]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11055","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11055","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1","11055 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1",148,380.96,296.32,1198.25,37]
["AETNA - AETNA - CPT - 11056","AETNA","AETNA","CPT","11056","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4","11056 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4",171,1198.25,171.09,1198.25,42.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11056","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11056","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4","11056 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4",171,296.32,171.09,1198.25,42.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11056","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11056","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4","11056 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4",171,296.32,171.09,1198.25,42.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11056","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11056","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4","11056 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4",171,296.32,171.09,1198.25,42.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11056","BLUE CROSS","BLUE CROSS-PPO","CPT","11056","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4","11056 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4",171,296.32,171.09,1198.25,42.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11056","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11056","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4","11056 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4",171,296.32,171.09,1198.25,42.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11056","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11056","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4","11056 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4",171,296.32,171.09,1198.25,42.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11056","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11056","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4","11056 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4",171,296.32,171.09,1198.25,42.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11056","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11056","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4","11056 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4",171,508.23,171.09,1198.25,42.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11056","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11056","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4","11056 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4",171,380.96,171.09,1198.25,42.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11056","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11056","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4","11056 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4",171,380.96,171.09,1198.25,42.75]
["TUFTS - TUFTS HMO - CPT - 11056","TUFTS","TUFTS HMO","CPT","11056","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4","11056 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4",171,320.41000000000003,171.09,1198.25,42.75]
["TUFTS - TUFTS POS - CPT - 11056","TUFTS","TUFTS POS","CPT","11056","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4","11056 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4",171,320.41000000000003,171.09,1198.25,42.75]
["TUFTS - TUFTS PPO - CPT - 11056","TUFTS","TUFTS PPO","CPT","11056","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4","11056 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4",171,320.41000000000003,171.09,1198.25,42.75]
["TUFTS - TUFTS SELECT - CPT - 11056","TUFTS","TUFTS SELECT","CPT","11056","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4","11056 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4",171,171.09,171.09,1198.25,42.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11056","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11056","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4","11056 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4",171,371.6,171.09,1198.25,42.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11056","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11056","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4","11056 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4",171,380.96,171.09,1198.25,42.75]
["AETNA - AETNA - CPT - 11057","AETNA","AETNA","CPT","11057","PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4","11057 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4",273,1198.25,296.32,1198.25,68.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11057","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11057","PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4","11057 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4",273,296.32,296.32,1198.25,68.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11057","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11057","PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4","11057 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4",273,296.32,296.32,1198.25,68.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11057","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11057","PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4","11057 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4",273,296.32,296.32,1198.25,68.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11057","BLUE CROSS","BLUE CROSS-PPO","CPT","11057","PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4","11057 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4",273,296.32,296.32,1198.25,68.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11057","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11057","PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4","11057 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4",273,296.32,296.32,1198.25,68.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11057","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11057","PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4","11057 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4",273,296.32,296.32,1198.25,68.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11057","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11057","PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4","11057 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4",273,296.32,296.32,1198.25,68.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11057","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11057","PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4","11057 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4",273,943.8,296.32,1198.25,68.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11057","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11057","PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4","11057 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4",273,380.96,296.32,1198.25,68.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11057","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11057","PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4","11057 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4",273,380.96,296.32,1198.25,68.25]
["TUFTS - TUFTS HMO - CPT - 11057","TUFTS","TUFTS HMO","CPT","11057","PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4","11057 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4",273,595.01,296.32,1198.25,68.25]
["TUFTS - TUFTS POS - CPT - 11057","TUFTS","TUFTS POS","CPT","11057","PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4","11057 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4",273,595.01,296.32,1198.25,68.25]
["TUFTS - TUFTS PPO - CPT - 11057","TUFTS","TUFTS PPO","CPT","11057","PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4","11057 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4",273,595.01,296.32,1198.25,68.25]
["TUFTS - TUFTS SELECT - CPT - 11057","TUFTS","TUFTS SELECT","CPT","11057","PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4","11057 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4",273,317.70999999999998,296.32,1198.25,68.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11057","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11057","PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4","11057 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4",273,371.6,296.32,1198.25,68.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11057","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11057","PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4","11057 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4",273,380.96,296.32,1198.25,68.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11101","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11101","BIOPSY SKIN SUBQ&/MUCOUS MEMBRANE EA ADDL LESN","11101 - BIOPSY SKIN SUBQ&/MUCOUS MEMBRANE EA ADDL LESN",191,0,0,0,47.75]
["TUFTS - TUFTS HMO - CPT - 11101","TUFTS","TUFTS HMO","CPT","11101","BIOPSY SKIN SUBQ&/MUCOUS MEMBRANE EA ADDL LESN","11101 - BIOPSY SKIN SUBQ&/MUCOUS MEMBRANE EA ADDL LESN",191,0,0,0,47.75]
["TUFTS - TUFTS POS - CPT - 11101","TUFTS","TUFTS POS","CPT","11101","BIOPSY SKIN SUBQ&/MUCOUS MEMBRANE EA ADDL LESN","11101 - BIOPSY SKIN SUBQ&/MUCOUS MEMBRANE EA ADDL LESN",191,0,0,0,47.75]
["TUFTS - TUFTS PPO - CPT - 11101","TUFTS","TUFTS PPO","CPT","11101","BIOPSY SKIN SUBQ&/MUCOUS MEMBRANE EA ADDL LESN","11101 - BIOPSY SKIN SUBQ&/MUCOUS MEMBRANE EA ADDL LESN",191,0,0,0,47.75]
["TUFTS - TUFTS SELECT - CPT - 11101","TUFTS","TUFTS SELECT","CPT","11101","BIOPSY SKIN SUBQ&/MUCOUS MEMBRANE EA ADDL LESN","11101 - BIOPSY SKIN SUBQ&/MUCOUS MEMBRANE EA ADDL LESN",191,0,0,0,47.75]
["AETNA - AETNA - CPT - 11102","AETNA","AETNA","CPT","11102","HC TANGNTL BX SKIN SINGLE LES","11102 - HC TANGNTL BX SKIN SINGLE LES",272,1198.25,296.32,1198.25,68]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11102","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11102","HC TANGNTL BX SKIN SINGLE LES","11102 - HC TANGNTL BX SKIN SINGLE LES",272,296.32,296.32,1198.25,68]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11102","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11102","HC TANGNTL BX SKIN SINGLE LES","11102 - HC TANGNTL BX SKIN SINGLE LES",272,296.32,296.32,1198.25,68]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11102","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11102","HC TANGNTL BX SKIN SINGLE LES","11102 - HC TANGNTL BX SKIN SINGLE LES",272,296.32,296.32,1198.25,68]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11102","BLUE CROSS","BLUE CROSS-PPO","CPT","11102","HC TANGNTL BX SKIN SINGLE LES","11102 - HC TANGNTL BX SKIN SINGLE LES",272,296.32,296.32,1198.25,68]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11102","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11102","HC TANGNTL BX SKIN SINGLE LES","11102 - HC TANGNTL BX SKIN SINGLE LES",272,296.32,296.32,1198.25,68]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11102","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11102","HC TANGNTL BX SKIN SINGLE LES","11102 - HC TANGNTL BX SKIN SINGLE LES",272,296.32,296.32,1198.25,68]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11102","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11102","HC TANGNTL BX SKIN SINGLE LES","11102 - HC TANGNTL BX SKIN SINGLE LES",272,296.32,296.32,1198.25,68]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11102","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11102","HC TANGNTL BX SKIN SINGLE LES","11102 - HC TANGNTL BX SKIN SINGLE LES",272,943.8,296.32,1198.25,68]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11102","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11102","HC TANGNTL BX SKIN SINGLE LES","11102 - HC TANGNTL BX SKIN SINGLE LES",272,380.96,296.32,1198.25,68]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11102","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11102","HC TANGNTL BX SKIN SINGLE LES","11102 - HC TANGNTL BX SKIN SINGLE LES",272,380.96,296.32,1198.25,68]
["TUFTS - TUFTS HMO - CPT - 11102","TUFTS","TUFTS HMO","CPT","11102","HC TANGNTL BX SKIN SINGLE LES","11102 - HC TANGNTL BX SKIN SINGLE LES",272,595.01,296.32,1198.25,68]
["TUFTS - TUFTS POS - CPT - 11102","TUFTS","TUFTS POS","CPT","11102","HC TANGNTL BX SKIN SINGLE LES","11102 - HC TANGNTL BX SKIN SINGLE LES",272,595.01,296.32,1198.25,68]
["TUFTS - TUFTS PPO - CPT - 11102","TUFTS","TUFTS PPO","CPT","11102","HC TANGNTL BX SKIN SINGLE LES","11102 - HC TANGNTL BX SKIN SINGLE LES",272,595.01,296.32,1198.25,68]
["TUFTS - TUFTS SELECT - CPT - 11102","TUFTS","TUFTS SELECT","CPT","11102","HC TANGNTL BX SKIN SINGLE LES","11102 - HC TANGNTL BX SKIN SINGLE LES",272,317.70999999999998,296.32,1198.25,68]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11102","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11102","HC TANGNTL BX SKIN SINGLE LES","11102 - HC TANGNTL BX SKIN SINGLE LES",272,371.6,296.32,1198.25,68]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11102","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11102","HC TANGNTL BX SKIN SINGLE LES","11102 - HC TANGNTL BX SKIN SINGLE LES",272,380.96,296.32,1198.25,68]
["AETNA - AETNA - CPT - 11103","AETNA","AETNA","CPT","11103","HC TANGNTL BX SKIN EA SEP/ADDL","11103 - HC TANGNTL BX SKIN EA SEP/ADDL",133,1198.25,57.32,1198.25,33.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11103","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11103","HC TANGNTL BX SKIN EA SEP/ADDL","11103 - HC TANGNTL BX SKIN EA SEP/ADDL",133,57.32,57.32,1198.25,33.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11103","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11103","HC TANGNTL BX SKIN EA SEP/ADDL","11103 - HC TANGNTL BX SKIN EA SEP/ADDL",133,57.32,57.32,1198.25,33.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11103","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11103","HC TANGNTL BX SKIN EA SEP/ADDL","11103 - HC TANGNTL BX SKIN EA SEP/ADDL",133,57.32,57.32,1198.25,33.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11103","BLUE CROSS","BLUE CROSS-PPO","CPT","11103","HC TANGNTL BX SKIN EA SEP/ADDL","11103 - HC TANGNTL BX SKIN EA SEP/ADDL",133,57.32,57.32,1198.25,33.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11103","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11103","HC TANGNTL BX SKIN EA SEP/ADDL","11103 - HC TANGNTL BX SKIN EA SEP/ADDL",133,57.32,57.32,1198.25,33.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11103","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11103","HC TANGNTL BX SKIN EA SEP/ADDL","11103 - HC TANGNTL BX SKIN EA SEP/ADDL",133,57.32,57.32,1198.25,33.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11103","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11103","HC TANGNTL BX SKIN EA SEP/ADDL","11103 - HC TANGNTL BX SKIN EA SEP/ADDL",133,57.32,57.32,1198.25,33.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11103","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11103","HC TANGNTL BX SKIN EA SEP/ADDL","11103 - HC TANGNTL BX SKIN EA SEP/ADDL",133,0,57.32,1198.25,33.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11103","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11103","HC TANGNTL BX SKIN EA SEP/ADDL","11103 - HC TANGNTL BX SKIN EA SEP/ADDL",133,0,57.32,1198.25,33.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11103","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11103","HC TANGNTL BX SKIN EA SEP/ADDL","11103 - HC TANGNTL BX SKIN EA SEP/ADDL",133,0,57.32,1198.25,33.25]
["TUFTS - TUFTS HMO - CPT - 11103","TUFTS","TUFTS HMO","CPT","11103","HC TANGNTL BX SKIN EA SEP/ADDL","11103 - HC TANGNTL BX SKIN EA SEP/ADDL",133,0,57.32,1198.25,33.25]
["TUFTS - TUFTS POS - CPT - 11103","TUFTS","TUFTS POS","CPT","11103","HC TANGNTL BX SKIN EA SEP/ADDL","11103 - HC TANGNTL BX SKIN EA SEP/ADDL",133,0,57.32,1198.25,33.25]
["TUFTS - TUFTS PPO - CPT - 11103","TUFTS","TUFTS PPO","CPT","11103","HC TANGNTL BX SKIN EA SEP/ADDL","11103 - HC TANGNTL BX SKIN EA SEP/ADDL",133,0,57.32,1198.25,33.25]
["TUFTS - TUFTS SELECT - CPT - 11103","TUFTS","TUFTS SELECT","CPT","11103","HC TANGNTL BX SKIN EA SEP/ADDL","11103 - HC TANGNTL BX SKIN EA SEP/ADDL",133,0,57.32,1198.25,33.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11103","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11103","HC TANGNTL BX SKIN EA SEP/ADDL","11103 - HC TANGNTL BX SKIN EA SEP/ADDL",133,0,57.32,1198.25,33.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11103","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11103","HC TANGNTL BX SKIN EA SEP/ADDL","11103 - HC TANGNTL BX SKIN EA SEP/ADDL",133,0,57.32,1198.25,33.25]
["AETNA - AETNA - CPT - 11104","AETNA","AETNA","CPT","11104","HC PUNCH BX SKIN SINGLE LESION","11104 - HC PUNCH BX SKIN SINGLE LESION",272,1198.25,296.32,1198.25,68]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11104","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11104","HC PUNCH BX SKIN SINGLE LESION","11104 - HC PUNCH BX SKIN SINGLE LESION",272,296.32,296.32,1198.25,68]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11104","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11104","HC PUNCH BX SKIN SINGLE LESION","11104 - HC PUNCH BX SKIN SINGLE LESION",272,296.32,296.32,1198.25,68]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11104","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11104","HC PUNCH BX SKIN SINGLE LESION","11104 - HC PUNCH BX SKIN SINGLE LESION",272,296.32,296.32,1198.25,68]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11104","BLUE CROSS","BLUE CROSS-PPO","CPT","11104","HC PUNCH BX SKIN SINGLE LESION","11104 - HC PUNCH BX SKIN SINGLE LESION",272,296.32,296.32,1198.25,68]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11104","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11104","HC PUNCH BX SKIN SINGLE LESION","11104 - HC PUNCH BX SKIN SINGLE LESION",272,296.32,296.32,1198.25,68]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11104","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11104","HC PUNCH BX SKIN SINGLE LESION","11104 - HC PUNCH BX SKIN SINGLE LESION",272,296.32,296.32,1198.25,68]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11104","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11104","HC PUNCH BX SKIN SINGLE LESION","11104 - HC PUNCH BX SKIN SINGLE LESION",272,296.32,296.32,1198.25,68]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11104","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11104","HC PUNCH BX SKIN SINGLE LESION","11104 - HC PUNCH BX SKIN SINGLE LESION",272,943.8,296.32,1198.25,68]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11104","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11104","HC PUNCH BX SKIN SINGLE LESION","11104 - HC PUNCH BX SKIN SINGLE LESION",272,380.96,296.32,1198.25,68]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11104","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11104","HC PUNCH BX SKIN SINGLE LESION","11104 - HC PUNCH BX SKIN SINGLE LESION",272,380.96,296.32,1198.25,68]
["TUFTS - TUFTS HMO - CPT - 11104","TUFTS","TUFTS HMO","CPT","11104","HC PUNCH BX SKIN SINGLE LESION","11104 - HC PUNCH BX SKIN SINGLE LESION",272,595.01,296.32,1198.25,68]
["TUFTS - TUFTS POS - CPT - 11104","TUFTS","TUFTS POS","CPT","11104","HC PUNCH BX SKIN SINGLE LESION","11104 - HC PUNCH BX SKIN SINGLE LESION",272,595.01,296.32,1198.25,68]
["TUFTS - TUFTS PPO - CPT - 11104","TUFTS","TUFTS PPO","CPT","11104","HC PUNCH BX SKIN SINGLE LESION","11104 - HC PUNCH BX SKIN SINGLE LESION",272,595.01,296.32,1198.25,68]
["TUFTS - TUFTS SELECT - CPT - 11104","TUFTS","TUFTS SELECT","CPT","11104","HC PUNCH BX SKIN SINGLE LESION","11104 - HC PUNCH BX SKIN SINGLE LESION",272,317.70999999999998,296.32,1198.25,68]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11104","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11104","HC PUNCH BX SKIN SINGLE LESION","11104 - HC PUNCH BX SKIN SINGLE LESION",272,371.6,296.32,1198.25,68]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11104","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11104","HC PUNCH BX SKIN SINGLE LESION","11104 - HC PUNCH BX SKIN SINGLE LESION",272,380.96,296.32,1198.25,68]
["AETNA - AETNA - CPT - 11105","AETNA","AETNA","CPT","11105","HC PUNCH BX SKIN EA SEP/ADDL","11105 - HC PUNCH BX SKIN EA SEP/ADDL",133,1198.25,67.709999999999994,1198.25,33.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11105","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11105","HC PUNCH BX SKIN EA SEP/ADDL","11105 - HC PUNCH BX SKIN EA SEP/ADDL",133,67.709999999999994,67.709999999999994,1198.25,33.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11105","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11105","HC PUNCH BX SKIN EA SEP/ADDL","11105 - HC PUNCH BX SKIN EA SEP/ADDL",133,67.709999999999994,67.709999999999994,1198.25,33.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11105","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11105","HC PUNCH BX SKIN EA SEP/ADDL","11105 - HC PUNCH BX SKIN EA SEP/ADDL",133,67.709999999999994,67.709999999999994,1198.25,33.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11105","BLUE CROSS","BLUE CROSS-PPO","CPT","11105","HC PUNCH BX SKIN EA SEP/ADDL","11105 - HC PUNCH BX SKIN EA SEP/ADDL",133,67.709999999999994,67.709999999999994,1198.25,33.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11105","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11105","HC PUNCH BX SKIN EA SEP/ADDL","11105 - HC PUNCH BX SKIN EA SEP/ADDL",133,67.709999999999994,67.709999999999994,1198.25,33.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11105","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11105","HC PUNCH BX SKIN EA SEP/ADDL","11105 - HC PUNCH BX SKIN EA SEP/ADDL",133,67.709999999999994,67.709999999999994,1198.25,33.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11105","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11105","HC PUNCH BX SKIN EA SEP/ADDL","11105 - HC PUNCH BX SKIN EA SEP/ADDL",133,67.709999999999994,67.709999999999994,1198.25,33.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11105","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11105","HC PUNCH BX SKIN EA SEP/ADDL","11105 - HC PUNCH BX SKIN EA SEP/ADDL",133,0,67.709999999999994,1198.25,33.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11105","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11105","HC PUNCH BX SKIN EA SEP/ADDL","11105 - HC PUNCH BX SKIN EA SEP/ADDL",133,0,67.709999999999994,1198.25,33.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11105","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11105","HC PUNCH BX SKIN EA SEP/ADDL","11105 - HC PUNCH BX SKIN EA SEP/ADDL",133,0,67.709999999999994,1198.25,33.25]
["TUFTS - TUFTS HMO - CPT - 11105","TUFTS","TUFTS HMO","CPT","11105","HC PUNCH BX SKIN EA SEP/ADDL","11105 - HC PUNCH BX SKIN EA SEP/ADDL",133,0,67.709999999999994,1198.25,33.25]
["TUFTS - TUFTS POS - CPT - 11105","TUFTS","TUFTS POS","CPT","11105","HC PUNCH BX SKIN EA SEP/ADDL","11105 - HC PUNCH BX SKIN EA SEP/ADDL",133,0,67.709999999999994,1198.25,33.25]
["TUFTS - TUFTS PPO - CPT - 11105","TUFTS","TUFTS PPO","CPT","11105","HC PUNCH BX SKIN EA SEP/ADDL","11105 - HC PUNCH BX SKIN EA SEP/ADDL",133,0,67.709999999999994,1198.25,33.25]
["TUFTS - TUFTS SELECT - CPT - 11105","TUFTS","TUFTS SELECT","CPT","11105","HC PUNCH BX SKIN EA SEP/ADDL","11105 - HC PUNCH BX SKIN EA SEP/ADDL",133,0,67.709999999999994,1198.25,33.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11105","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11105","HC PUNCH BX SKIN EA SEP/ADDL","11105 - HC PUNCH BX SKIN EA SEP/ADDL",133,0,67.709999999999994,1198.25,33.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11105","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11105","HC PUNCH BX SKIN EA SEP/ADDL","11105 - HC PUNCH BX SKIN EA SEP/ADDL",133,0,67.709999999999994,1198.25,33.25]
["AETNA - AETNA - CPT - 11106","AETNA","AETNA","CPT","11106","HC INCAL BX SKN SINGLE LES","11106 - HC INCAL BX SKN SINGLE LES",484,1198.25,317.70999999999998,1198.25,121]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11106","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11106","HC INCAL BX SKN SINGLE LES","11106 - HC INCAL BX SKN SINGLE LES",484,527.46,317.70999999999998,1198.25,121]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11106","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11106","HC INCAL BX SKN SINGLE LES","11106 - HC INCAL BX SKN SINGLE LES",484,527.46,317.70999999999998,1198.25,121]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11106","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11106","HC INCAL BX SKN SINGLE LES","11106 - HC INCAL BX SKN SINGLE LES",484,527.46,317.70999999999998,1198.25,121]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11106","BLUE CROSS","BLUE CROSS-PPO","CPT","11106","HC INCAL BX SKN SINGLE LES","11106 - HC INCAL BX SKN SINGLE LES",484,527.46,317.70999999999998,1198.25,121]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11106","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11106","HC INCAL BX SKN SINGLE LES","11106 - HC INCAL BX SKN SINGLE LES",484,527.46,317.70999999999998,1198.25,121]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11106","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11106","HC INCAL BX SKN SINGLE LES","11106 - HC INCAL BX SKN SINGLE LES",484,527.46,317.70999999999998,1198.25,121]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11106","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11106","HC INCAL BX SKN SINGLE LES","11106 - HC INCAL BX SKN SINGLE LES",484,527.46,317.70999999999998,1198.25,121]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11106","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11106","HC INCAL BX SKN SINGLE LES","11106 - HC INCAL BX SKN SINGLE LES",484,943.8,317.70999999999998,1198.25,121]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11106","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11106","HC INCAL BX SKN SINGLE LES","11106 - HC INCAL BX SKN SINGLE LES",484,678.1,317.70999999999998,1198.25,121]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11106","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11106","HC INCAL BX SKN SINGLE LES","11106 - HC INCAL BX SKN SINGLE LES",484,678.1,317.70999999999998,1198.25,121]
["TUFTS - TUFTS HMO - CPT - 11106","TUFTS","TUFTS HMO","CPT","11106","HC INCAL BX SKN SINGLE LES","11106 - HC INCAL BX SKN SINGLE LES",484,595.01,317.70999999999998,1198.25,121]
["TUFTS - TUFTS POS - CPT - 11106","TUFTS","TUFTS POS","CPT","11106","HC INCAL BX SKN SINGLE LES","11106 - HC INCAL BX SKN SINGLE LES",484,595.01,317.70999999999998,1198.25,121]
["TUFTS - TUFTS PPO - CPT - 11106","TUFTS","TUFTS PPO","CPT","11106","HC INCAL BX SKN SINGLE LES","11106 - HC INCAL BX SKN SINGLE LES",484,595.01,317.70999999999998,1198.25,121]
["TUFTS - TUFTS SELECT - CPT - 11106","TUFTS","TUFTS SELECT","CPT","11106","HC INCAL BX SKN SINGLE LES","11106 - HC INCAL BX SKN SINGLE LES",484,317.70999999999998,317.70999999999998,1198.25,121]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11106","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11106","HC INCAL BX SKN SINGLE LES","11106 - HC INCAL BX SKN SINGLE LES",484,661.45,317.70999999999998,1198.25,121]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11106","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11106","HC INCAL BX SKN SINGLE LES","11106 - HC INCAL BX SKN SINGLE LES",484,678.1,317.70999999999998,1198.25,121]
["AETNA - AETNA - CPT - 11107","AETNA","AETNA","CPT","11107","HC INCAL BX SKN EA SEP/ADDL","11107 - HC INCAL BX SKN EA SEP/ADDL",236,1198.25,80.709999999999994,1198.25,59]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11107","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11107","HC INCAL BX SKN EA SEP/ADDL","11107 - HC INCAL BX SKN EA SEP/ADDL",236,80.709999999999994,80.709999999999994,1198.25,59]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11107","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11107","HC INCAL BX SKN EA SEP/ADDL","11107 - HC INCAL BX SKN EA SEP/ADDL",236,80.709999999999994,80.709999999999994,1198.25,59]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11107","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11107","HC INCAL BX SKN EA SEP/ADDL","11107 - HC INCAL BX SKN EA SEP/ADDL",236,80.709999999999994,80.709999999999994,1198.25,59]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11107","BLUE CROSS","BLUE CROSS-PPO","CPT","11107","HC INCAL BX SKN EA SEP/ADDL","11107 - HC INCAL BX SKN EA SEP/ADDL",236,80.709999999999994,80.709999999999994,1198.25,59]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11107","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11107","HC INCAL BX SKN EA SEP/ADDL","11107 - HC INCAL BX SKN EA SEP/ADDL",236,80.709999999999994,80.709999999999994,1198.25,59]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11107","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11107","HC INCAL BX SKN EA SEP/ADDL","11107 - HC INCAL BX SKN EA SEP/ADDL",236,80.709999999999994,80.709999999999994,1198.25,59]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11107","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11107","HC INCAL BX SKN EA SEP/ADDL","11107 - HC INCAL BX SKN EA SEP/ADDL",236,80.709999999999994,80.709999999999994,1198.25,59]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11107","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11107","HC INCAL BX SKN EA SEP/ADDL","11107 - HC INCAL BX SKN EA SEP/ADDL",236,0,80.709999999999994,1198.25,59]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11107","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11107","HC INCAL BX SKN EA SEP/ADDL","11107 - HC INCAL BX SKN EA SEP/ADDL",236,0,80.709999999999994,1198.25,59]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11107","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11107","HC INCAL BX SKN EA SEP/ADDL","11107 - HC INCAL BX SKN EA SEP/ADDL",236,0,80.709999999999994,1198.25,59]
["TUFTS - TUFTS HMO - CPT - 11107","TUFTS","TUFTS HMO","CPT","11107","HC INCAL BX SKN EA SEP/ADDL","11107 - HC INCAL BX SKN EA SEP/ADDL",236,0,80.709999999999994,1198.25,59]
["TUFTS - TUFTS POS - CPT - 11107","TUFTS","TUFTS POS","CPT","11107","HC INCAL BX SKN EA SEP/ADDL","11107 - HC INCAL BX SKN EA SEP/ADDL",236,0,80.709999999999994,1198.25,59]
["TUFTS - TUFTS PPO - CPT - 11107","TUFTS","TUFTS PPO","CPT","11107","HC INCAL BX SKN EA SEP/ADDL","11107 - HC INCAL BX SKN EA SEP/ADDL",236,0,80.709999999999994,1198.25,59]
["TUFTS - TUFTS SELECT - CPT - 11107","TUFTS","TUFTS SELECT","CPT","11107","HC INCAL BX SKN EA SEP/ADDL","11107 - HC INCAL BX SKN EA SEP/ADDL",236,0,80.709999999999994,1198.25,59]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11107","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11107","HC INCAL BX SKN EA SEP/ADDL","11107 - HC INCAL BX SKN EA SEP/ADDL",236,0,80.709999999999994,1198.25,59]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11107","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11107","HC INCAL BX SKN EA SEP/ADDL","11107 - HC INCAL BX SKN EA SEP/ADDL",236,0,80.709999999999994,1198.25,59]
["AETNA - AETNA - CPT - 11200","AETNA","AETNA","CPT","11200","REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15","11200 - REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15",559,1198.25,296.32,1198.25,139.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11200","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11200","REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15","11200 - REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15",559,296.32,296.32,1198.25,139.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11200","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11200","REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15","11200 - REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15",559,296.32,296.32,1198.25,139.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11200","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11200","REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15","11200 - REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15",559,296.32,296.32,1198.25,139.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11200","BLUE CROSS","BLUE CROSS-PPO","CPT","11200","REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15","11200 - REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15",559,296.32,296.32,1198.25,139.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11200","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11200","REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15","11200 - REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15",559,296.32,296.32,1198.25,139.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11200","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11200","REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15","11200 - REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15",559,296.32,296.32,1198.25,139.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11200","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11200","REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15","11200 - REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15",559,296.32,296.32,1198.25,139.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11200","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11200","REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15","11200 - REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15",559,943.8,296.32,1198.25,139.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11200","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11200","REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15","11200 - REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15",559,380.96,296.32,1198.25,139.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11200","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11200","REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15","11200 - REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15",559,380.96,296.32,1198.25,139.75]
["TUFTS - TUFTS HMO - CPT - 11200","TUFTS","TUFTS HMO","CPT","11200","REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15","11200 - REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15",559,595.01,296.32,1198.25,139.75]
["TUFTS - TUFTS POS - CPT - 11200","TUFTS","TUFTS POS","CPT","11200","REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15","11200 - REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15",559,595.01,296.32,1198.25,139.75]
["TUFTS - TUFTS PPO - CPT - 11200","TUFTS","TUFTS PPO","CPT","11200","REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15","11200 - REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15",559,595.01,296.32,1198.25,139.75]
["TUFTS - TUFTS SELECT - CPT - 11200","TUFTS","TUFTS SELECT","CPT","11200","REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15","11200 - REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15",559,317.70999999999998,296.32,1198.25,139.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11200","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11200","REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15","11200 - REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15",559,371.6,296.32,1198.25,139.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11200","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11200","REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15","11200 - REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15",559,380.96,296.32,1198.25,139.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11300","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11300","SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<","11300 - SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<",232,296.32,171.09,508.23,58]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11300","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11300","SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<","11300 - SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<",232,296.32,171.09,508.23,58]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11300","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11300","SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<","11300 - SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<",232,296.32,171.09,508.23,58]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11300","BLUE CROSS","BLUE CROSS-PPO","CPT","11300","SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<","11300 - SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<",232,296.32,171.09,508.23,58]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11300","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11300","SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<","11300 - SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<",232,296.32,171.09,508.23,58]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11300","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11300","SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<","11300 - SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<",232,296.32,171.09,508.23,58]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11300","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11300","SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<","11300 - SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<",232,296.32,171.09,508.23,58]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11300","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11300","SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<","11300 - SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<",232,508.23,171.09,508.23,58]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11300","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11300","SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<","11300 - SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<",232,380.96,171.09,508.23,58]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11300","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11300","SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<","11300 - SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<",232,380.96,171.09,508.23,58]
["TUFTS - TUFTS HMO - CPT - 11300","TUFTS","TUFTS HMO","CPT","11300","SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<","11300 - SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<",232,320.41000000000003,171.09,508.23,58]
["TUFTS - TUFTS POS - CPT - 11300","TUFTS","TUFTS POS","CPT","11300","SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<","11300 - SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<",232,320.41000000000003,171.09,508.23,58]
["TUFTS - TUFTS PPO - CPT - 11300","TUFTS","TUFTS PPO","CPT","11300","SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<","11300 - SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<",232,320.41000000000003,171.09,508.23,58]
["TUFTS - TUFTS SELECT - CPT - 11300","TUFTS","TUFTS SELECT","CPT","11300","SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<","11300 - SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<",232,171.09,171.09,508.23,58]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11300","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11300","SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<","11300 - SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<",232,371.6,171.09,508.23,58]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11300","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11300","SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<","11300 - SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<",232,380.96,171.09,508.23,58]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11301","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11301","SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM","11301 - SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM",389,296.32,171.09,508.23,97.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11301","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11301","SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM","11301 - SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM",389,296.32,171.09,508.23,97.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11301","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11301","SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM","11301 - SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM",389,296.32,171.09,508.23,97.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11301","BLUE CROSS","BLUE CROSS-PPO","CPT","11301","SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM","11301 - SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM",389,296.32,171.09,508.23,97.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11301","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11301","SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM","11301 - SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM",389,296.32,171.09,508.23,97.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11301","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11301","SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM","11301 - SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM",389,296.32,171.09,508.23,97.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11301","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11301","SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM","11301 - SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM",389,296.32,171.09,508.23,97.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11301","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11301","SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM","11301 - SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM",389,508.23,171.09,508.23,97.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11301","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11301","SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM","11301 - SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM",389,380.96,171.09,508.23,97.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11301","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11301","SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM","11301 - SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM",389,380.96,171.09,508.23,97.25]
["TUFTS - TUFTS HMO - CPT - 11301","TUFTS","TUFTS HMO","CPT","11301","SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM","11301 - SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM",389,320.41000000000003,171.09,508.23,97.25]
["TUFTS - TUFTS POS - CPT - 11301","TUFTS","TUFTS POS","CPT","11301","SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM","11301 - SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM",389,320.41000000000003,171.09,508.23,97.25]
["TUFTS - TUFTS PPO - CPT - 11301","TUFTS","TUFTS PPO","CPT","11301","SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM","11301 - SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM",389,320.41000000000003,171.09,508.23,97.25]
["TUFTS - TUFTS SELECT - CPT - 11301","TUFTS","TUFTS SELECT","CPT","11301","SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM","11301 - SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM",389,171.09,171.09,508.23,97.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11301","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11301","SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM","11301 - SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM",389,371.6,171.09,508.23,97.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11301","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11301","SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM","11301 - SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM",389,380.96,171.09,508.23,97.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11302","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11302","SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM","11302 - SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM",484,296.32,171.09,508.23,121]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11302","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11302","SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM","11302 - SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM",484,296.32,171.09,508.23,121]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11302","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11302","SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM","11302 - SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM",484,296.32,171.09,508.23,121]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11302","BLUE CROSS","BLUE CROSS-PPO","CPT","11302","SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM","11302 - SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM",484,296.32,171.09,508.23,121]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11302","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11302","SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM","11302 - SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM",484,296.32,171.09,508.23,121]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11302","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11302","SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM","11302 - SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM",484,296.32,171.09,508.23,121]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11302","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11302","SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM","11302 - SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM",484,296.32,171.09,508.23,121]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11302","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11302","SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM","11302 - SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM",484,508.23,171.09,508.23,121]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11302","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11302","SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM","11302 - SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM",484,380.96,171.09,508.23,121]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11302","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11302","SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM","11302 - SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM",484,380.96,171.09,508.23,121]
["TUFTS - TUFTS HMO - CPT - 11302","TUFTS","TUFTS HMO","CPT","11302","SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM","11302 - SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM",484,320.41000000000003,171.09,508.23,121]
["TUFTS - TUFTS POS - CPT - 11302","TUFTS","TUFTS POS","CPT","11302","SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM","11302 - SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM",484,320.41000000000003,171.09,508.23,121]
["TUFTS - TUFTS PPO - CPT - 11302","TUFTS","TUFTS PPO","CPT","11302","SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM","11302 - SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM",484,320.41000000000003,171.09,508.23,121]
["TUFTS - TUFTS SELECT - CPT - 11302","TUFTS","TUFTS SELECT","CPT","11302","SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM","11302 - SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM",484,171.09,171.09,508.23,121]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11302","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11302","SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM","11302 - SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM",484,371.6,171.09,508.23,121]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11302","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11302","SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM","11302 - SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM",484,380.96,171.09,508.23,121]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11303","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11303","SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM","11303 - SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM",570,527.46,317.70999999999998,943.8,142.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11303","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11303","SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM","11303 - SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM",570,527.46,317.70999999999998,943.8,142.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11303","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11303","SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM","11303 - SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM",570,527.46,317.70999999999998,943.8,142.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11303","BLUE CROSS","BLUE CROSS-PPO","CPT","11303","SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM","11303 - SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM",570,527.46,317.70999999999998,943.8,142.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11303","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11303","SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM","11303 - SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM",570,527.46,317.70999999999998,943.8,142.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11303","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11303","SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM","11303 - SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM",570,527.46,317.70999999999998,943.8,142.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11303","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11303","SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM","11303 - SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM",570,527.46,317.70999999999998,943.8,142.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11303","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11303","SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM","11303 - SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM",570,943.8,317.70999999999998,943.8,142.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11303","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11303","SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM","11303 - SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM",570,678.1,317.70999999999998,943.8,142.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11303","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11303","SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM","11303 - SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM",570,678.1,317.70999999999998,943.8,142.5]
["TUFTS - TUFTS HMO - CPT - 11303","TUFTS","TUFTS HMO","CPT","11303","SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM","11303 - SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM",570,595.01,317.70999999999998,943.8,142.5]
["TUFTS - TUFTS POS - CPT - 11303","TUFTS","TUFTS POS","CPT","11303","SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM","11303 - SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM",570,595.01,317.70999999999998,943.8,142.5]
["TUFTS - TUFTS PPO - CPT - 11303","TUFTS","TUFTS PPO","CPT","11303","SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM","11303 - SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM",570,595.01,317.70999999999998,943.8,142.5]
["TUFTS - TUFTS SELECT - CPT - 11303","TUFTS","TUFTS SELECT","CPT","11303","SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM","11303 - SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM",570,317.70999999999998,317.70999999999998,943.8,142.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11303","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11303","SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM","11303 - SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM",570,661.45,317.70999999999998,943.8,142.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11303","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11303","SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM","11303 - SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM",570,678.1,317.70999999999998,943.8,142.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11305","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11305","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<","11305 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<",246,296.32,171.09,508.23,61.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11305","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11305","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<","11305 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<",246,296.32,171.09,508.23,61.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11305","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11305","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<","11305 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<",246,296.32,171.09,508.23,61.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11305","BLUE CROSS","BLUE CROSS-PPO","CPT","11305","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<","11305 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<",246,296.32,171.09,508.23,61.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11305","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11305","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<","11305 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<",246,296.32,171.09,508.23,61.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11305","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11305","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<","11305 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<",246,296.32,171.09,508.23,61.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11305","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11305","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<","11305 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<",246,296.32,171.09,508.23,61.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11305","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11305","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<","11305 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<",246,508.23,171.09,508.23,61.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11305","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11305","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<","11305 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<",246,380.96,171.09,508.23,61.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11305","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11305","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<","11305 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<",246,380.96,171.09,508.23,61.5]
["TUFTS - TUFTS HMO - CPT - 11305","TUFTS","TUFTS HMO","CPT","11305","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<","11305 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<",246,320.41000000000003,171.09,508.23,61.5]
["TUFTS - TUFTS POS - CPT - 11305","TUFTS","TUFTS POS","CPT","11305","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<","11305 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<",246,320.41000000000003,171.09,508.23,61.5]
["TUFTS - TUFTS PPO - CPT - 11305","TUFTS","TUFTS PPO","CPT","11305","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<","11305 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<",246,320.41000000000003,171.09,508.23,61.5]
["TUFTS - TUFTS SELECT - CPT - 11305","TUFTS","TUFTS SELECT","CPT","11305","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<","11305 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<",246,171.09,171.09,508.23,61.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11305","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11305","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<","11305 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<",246,371.6,171.09,508.23,61.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11305","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11305","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<","11305 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<",246,380.96,171.09,508.23,61.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11306","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11306","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM","11306 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM",405,296.32,171.09,508.23,101.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11306","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11306","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM","11306 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM",405,296.32,171.09,508.23,101.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11306","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11306","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM","11306 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM",405,296.32,171.09,508.23,101.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11306","BLUE CROSS","BLUE CROSS-PPO","CPT","11306","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM","11306 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM",405,296.32,171.09,508.23,101.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11306","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11306","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM","11306 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM",405,296.32,171.09,508.23,101.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11306","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11306","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM","11306 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM",405,296.32,171.09,508.23,101.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11306","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11306","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM","11306 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM",405,296.32,171.09,508.23,101.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11306","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11306","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM","11306 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM",405,508.23,171.09,508.23,101.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11306","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11306","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM","11306 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM",405,380.96,171.09,508.23,101.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11306","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11306","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM","11306 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM",405,380.96,171.09,508.23,101.25]
["TUFTS - TUFTS HMO - CPT - 11306","TUFTS","TUFTS HMO","CPT","11306","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM","11306 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM",405,320.41000000000003,171.09,508.23,101.25]
["TUFTS - TUFTS POS - CPT - 11306","TUFTS","TUFTS POS","CPT","11306","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM","11306 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM",405,320.41000000000003,171.09,508.23,101.25]
["TUFTS - TUFTS PPO - CPT - 11306","TUFTS","TUFTS PPO","CPT","11306","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM","11306 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM",405,320.41000000000003,171.09,508.23,101.25]
["TUFTS - TUFTS SELECT - CPT - 11306","TUFTS","TUFTS SELECT","CPT","11306","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM","11306 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM",405,171.09,171.09,508.23,101.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11306","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11306","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM","11306 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM",405,371.6,171.09,508.23,101.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11306","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11306","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM","11306 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM",405,380.96,171.09,508.23,101.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11307","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11307","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM","11307 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM",487,296.32,171.09,508.23,121.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11307","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11307","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM","11307 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM",487,296.32,171.09,508.23,121.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11307","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11307","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM","11307 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM",487,296.32,171.09,508.23,121.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11307","BLUE CROSS","BLUE CROSS-PPO","CPT","11307","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM","11307 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM",487,296.32,171.09,508.23,121.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11307","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11307","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM","11307 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM",487,296.32,171.09,508.23,121.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11307","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11307","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM","11307 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM",487,296.32,171.09,508.23,121.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11307","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11307","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM","11307 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM",487,296.32,171.09,508.23,121.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11307","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11307","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM","11307 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM",487,508.23,171.09,508.23,121.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11307","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11307","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM","11307 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM",487,380.96,171.09,508.23,121.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11307","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11307","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM","11307 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM",487,380.96,171.09,508.23,121.75]
["TUFTS - TUFTS HMO - CPT - 11307","TUFTS","TUFTS HMO","CPT","11307","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM","11307 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM",487,320.41000000000003,171.09,508.23,121.75]
["TUFTS - TUFTS POS - CPT - 11307","TUFTS","TUFTS POS","CPT","11307","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM","11307 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM",487,320.41000000000003,171.09,508.23,121.75]
["TUFTS - TUFTS PPO - CPT - 11307","TUFTS","TUFTS PPO","CPT","11307","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM","11307 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM",487,320.41000000000003,171.09,508.23,121.75]
["TUFTS - TUFTS SELECT - CPT - 11307","TUFTS","TUFTS SELECT","CPT","11307","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM","11307 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM",487,171.09,171.09,508.23,121.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11307","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11307","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM","11307 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM",487,371.6,171.09,508.23,121.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11307","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11307","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM","11307 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM",487,380.96,171.09,508.23,121.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11308","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11308","SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM","11308 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM",557,527.46,317.70999999999998,943.8,139.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11308","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11308","SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM","11308 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM",557,527.46,317.70999999999998,943.8,139.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11308","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11308","SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM","11308 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM",557,527.46,317.70999999999998,943.8,139.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11308","BLUE CROSS","BLUE CROSS-PPO","CPT","11308","SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM","11308 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM",557,527.46,317.70999999999998,943.8,139.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11308","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11308","SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM","11308 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM",557,527.46,317.70999999999998,943.8,139.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11308","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11308","SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM","11308 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM",557,527.46,317.70999999999998,943.8,139.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11308","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11308","SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM","11308 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM",557,527.46,317.70999999999998,943.8,139.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11308","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11308","SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM","11308 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM",557,943.8,317.70999999999998,943.8,139.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11308","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11308","SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM","11308 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM",557,678.1,317.70999999999998,943.8,139.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11308","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11308","SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM","11308 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM",557,678.1,317.70999999999998,943.8,139.25]
["TUFTS - TUFTS HMO - CPT - 11308","TUFTS","TUFTS HMO","CPT","11308","SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM","11308 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM",557,595.01,317.70999999999998,943.8,139.25]
["TUFTS - TUFTS POS - CPT - 11308","TUFTS","TUFTS POS","CPT","11308","SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM","11308 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM",557,595.01,317.70999999999998,943.8,139.25]
["TUFTS - TUFTS PPO - CPT - 11308","TUFTS","TUFTS PPO","CPT","11308","SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM","11308 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM",557,595.01,317.70999999999998,943.8,139.25]
["TUFTS - TUFTS SELECT - CPT - 11308","TUFTS","TUFTS SELECT","CPT","11308","SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM","11308 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM",557,317.70999999999998,317.70999999999998,943.8,139.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11308","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11308","SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM","11308 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM",557,661.45,317.70999999999998,943.8,139.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11308","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11308","SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM","11308 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM",557,678.1,317.70999999999998,943.8,139.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11310","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11310","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<","11310 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<",334,296.32,171.09,508.23,83.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11310","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11310","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<","11310 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<",334,296.32,171.09,508.23,83.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11310","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11310","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<","11310 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<",334,296.32,171.09,508.23,83.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11310","BLUE CROSS","BLUE CROSS-PPO","CPT","11310","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<","11310 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<",334,296.32,171.09,508.23,83.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11310","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11310","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<","11310 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<",334,296.32,171.09,508.23,83.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11310","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11310","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<","11310 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<",334,296.32,171.09,508.23,83.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11310","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11310","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<","11310 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<",334,296.32,171.09,508.23,83.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11310","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11310","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<","11310 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<",334,508.23,171.09,508.23,83.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11310","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11310","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<","11310 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<",334,380.96,171.09,508.23,83.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11310","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11310","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<","11310 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<",334,380.96,171.09,508.23,83.5]
["TUFTS - TUFTS HMO - CPT - 11310","TUFTS","TUFTS HMO","CPT","11310","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<","11310 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<",334,320.41000000000003,171.09,508.23,83.5]
["TUFTS - TUFTS POS - CPT - 11310","TUFTS","TUFTS POS","CPT","11310","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<","11310 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<",334,320.41000000000003,171.09,508.23,83.5]
["TUFTS - TUFTS PPO - CPT - 11310","TUFTS","TUFTS PPO","CPT","11310","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<","11310 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<",334,320.41000000000003,171.09,508.23,83.5]
["TUFTS - TUFTS SELECT - CPT - 11310","TUFTS","TUFTS SELECT","CPT","11310","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<","11310 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<",334,171.09,171.09,508.23,83.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11310","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11310","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<","11310 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<",334,371.6,171.09,508.23,83.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11310","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11310","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<","11310 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<",334,380.96,171.09,508.23,83.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11311","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11311","SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM","11311 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM",484,296.32,171.09,508.23,121]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11311","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11311","SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM","11311 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM",484,296.32,171.09,508.23,121]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11311","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11311","SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM","11311 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM",484,296.32,171.09,508.23,121]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11311","BLUE CROSS","BLUE CROSS-PPO","CPT","11311","SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM","11311 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM",484,296.32,171.09,508.23,121]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11311","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11311","SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM","11311 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM",484,296.32,171.09,508.23,121]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11311","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11311","SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM","11311 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM",484,296.32,171.09,508.23,121]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11311","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11311","SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM","11311 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM",484,296.32,171.09,508.23,121]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11311","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11311","SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM","11311 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM",484,508.23,171.09,508.23,121]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11311","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11311","SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM","11311 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM",484,380.96,171.09,508.23,121]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11311","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11311","SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM","11311 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM",484,380.96,171.09,508.23,121]
["TUFTS - TUFTS HMO - CPT - 11311","TUFTS","TUFTS HMO","CPT","11311","SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM","11311 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM",484,320.41000000000003,171.09,508.23,121]
["TUFTS - TUFTS POS - CPT - 11311","TUFTS","TUFTS POS","CPT","11311","SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM","11311 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM",484,320.41000000000003,171.09,508.23,121]
["TUFTS - TUFTS PPO - CPT - 11311","TUFTS","TUFTS PPO","CPT","11311","SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM","11311 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM",484,320.41000000000003,171.09,508.23,121]
["TUFTS - TUFTS SELECT - CPT - 11311","TUFTS","TUFTS SELECT","CPT","11311","SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM","11311 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM",484,171.09,171.09,508.23,121]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11311","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11311","SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM","11311 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM",484,371.6,171.09,508.23,121]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11311","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11311","SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM","11311 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM",484,380.96,171.09,508.23,121]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11312","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11312","SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM","11312 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM",559,527.46,317.70999999999998,943.8,139.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11312","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11312","SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM","11312 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM",559,527.46,317.70999999999998,943.8,139.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11312","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11312","SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM","11312 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM",559,527.46,317.70999999999998,943.8,139.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11312","BLUE CROSS","BLUE CROSS-PPO","CPT","11312","SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM","11312 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM",559,527.46,317.70999999999998,943.8,139.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11312","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11312","SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM","11312 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM",559,527.46,317.70999999999998,943.8,139.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11312","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11312","SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM","11312 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM",559,527.46,317.70999999999998,943.8,139.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11312","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11312","SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM","11312 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM",559,527.46,317.70999999999998,943.8,139.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11312","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11312","SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM","11312 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM",559,943.8,317.70999999999998,943.8,139.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11312","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11312","SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM","11312 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM",559,678.1,317.70999999999998,943.8,139.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11312","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11312","SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM","11312 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM",559,678.1,317.70999999999998,943.8,139.75]
["TUFTS - TUFTS HMO - CPT - 11312","TUFTS","TUFTS HMO","CPT","11312","SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM","11312 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM",559,595.01,317.70999999999998,943.8,139.75]
["TUFTS - TUFTS POS - CPT - 11312","TUFTS","TUFTS POS","CPT","11312","SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM","11312 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM",559,595.01,317.70999999999998,943.8,139.75]
["TUFTS - TUFTS PPO - CPT - 11312","TUFTS","TUFTS PPO","CPT","11312","SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM","11312 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM",559,595.01,317.70999999999998,943.8,139.75]
["TUFTS - TUFTS SELECT - CPT - 11312","TUFTS","TUFTS SELECT","CPT","11312","SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM","11312 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM",559,317.70999999999998,317.70999999999998,943.8,139.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11312","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11312","SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM","11312 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM",559,661.45,317.70999999999998,943.8,139.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11312","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11312","SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM","11312 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM",559,678.1,317.70999999999998,943.8,139.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11313","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11313","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM","11313 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM",750,527.46,317.70999999999998,943.8,187.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11313","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11313","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM","11313 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM",750,527.46,317.70999999999998,943.8,187.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11313","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11313","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM","11313 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM",750,527.46,317.70999999999998,943.8,187.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11313","BLUE CROSS","BLUE CROSS-PPO","CPT","11313","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM","11313 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM",750,527.46,317.70999999999998,943.8,187.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11313","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11313","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM","11313 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM",750,527.46,317.70999999999998,943.8,187.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11313","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11313","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM","11313 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM",750,527.46,317.70999999999998,943.8,187.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11313","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11313","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM","11313 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM",750,527.46,317.70999999999998,943.8,187.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11313","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11313","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM","11313 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM",750,943.8,317.70999999999998,943.8,187.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11313","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11313","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM","11313 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM",750,678.1,317.70999999999998,943.8,187.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11313","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11313","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM","11313 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM",750,678.1,317.70999999999998,943.8,187.5]
["TUFTS - TUFTS HMO - CPT - 11313","TUFTS","TUFTS HMO","CPT","11313","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM","11313 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM",750,595.01,317.70999999999998,943.8,187.5]
["TUFTS - TUFTS POS - CPT - 11313","TUFTS","TUFTS POS","CPT","11313","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM","11313 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM",750,595.01,317.70999999999998,943.8,187.5]
["TUFTS - TUFTS PPO - CPT - 11313","TUFTS","TUFTS PPO","CPT","11313","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM","11313 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM",750,595.01,317.70999999999998,943.8,187.5]
["TUFTS - TUFTS SELECT - CPT - 11313","TUFTS","TUFTS SELECT","CPT","11313","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM","11313 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM",750,317.70999999999998,317.70999999999998,943.8,187.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11313","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11313","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM","11313 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM",750,661.45,317.70999999999998,943.8,187.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11313","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11313","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM","11313 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM",750,678.1,317.70999999999998,943.8,187.5]
["AETNA - AETNA - CPT - 11400","AETNA","AETNA","CPT","11400","EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<","11400 - EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<",611,1198.25,684.11,2032.26,152.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11400","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11400","EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<","11400 - EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<",611,972.93,684.11,2032.26,152.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11400","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11400","EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<","11400 - EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<",611,972.93,684.11,2032.26,152.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11400","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11400","EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<","11400 - EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<",611,972.93,684.11,2032.26,152.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11400","BLUE CROSS","BLUE CROSS-PPO","CPT","11400","EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<","11400 - EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<",611,972.93,684.11,2032.26,152.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11400","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11400","EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<","11400 - EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<",611,972.93,684.11,2032.26,152.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11400","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11400","EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<","11400 - EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<",611,972.93,684.11,2032.26,152.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11400","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11400","EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<","11400 - EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<",611,972.93,684.11,2032.26,152.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11400","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11400","EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<","11400 - EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<",611,2032.26,684.11,2032.26,152.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11400","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11400","EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<","11400 - EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<",611,1250.8,684.11,2032.26,152.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11400","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11400","EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<","11400 - EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<",611,1250.8,684.11,2032.26,152.75]
["TUFTS - TUFTS HMO - CPT - 11400","TUFTS","TUFTS HMO","CPT","11400","EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<","11400 - EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<",611,1281.21,684.11,2032.26,152.75]
["TUFTS - TUFTS POS - CPT - 11400","TUFTS","TUFTS POS","CPT","11400","EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<","11400 - EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<",611,1281.21,684.11,2032.26,152.75]
["TUFTS - TUFTS PPO - CPT - 11400","TUFTS","TUFTS PPO","CPT","11400","EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<","11400 - EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<",611,1281.21,684.11,2032.26,152.75]
["TUFTS - TUFTS SELECT - CPT - 11400","TUFTS","TUFTS SELECT","CPT","11400","EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<","11400 - EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<",611,684.11,684.11,2032.26,152.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11400","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11400","EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<","11400 - EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<",611,1220.0899999999999,684.11,2032.26,152.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11400","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11400","EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<","11400 - EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<",611,1250.8,684.11,2032.26,152.75]
["AETNA - AETNA - CPT - 11401","AETNA","AETNA","CPT","11401","EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM","11401 - EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM",798,1198.25,527.46,2032.26,199.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11401","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11401","EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM","11401 - EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM",798,527.46,527.46,2032.26,199.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11401","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11401","EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM","11401 - EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM",798,527.46,527.46,2032.26,199.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11401","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11401","EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM","11401 - EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM",798,527.46,527.46,2032.26,199.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11401","BLUE CROSS","BLUE CROSS-PPO","CPT","11401","EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM","11401 - EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM",798,527.46,527.46,2032.26,199.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11401","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11401","EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM","11401 - EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM",798,527.46,527.46,2032.26,199.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11401","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11401","EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM","11401 - EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM",798,527.46,527.46,2032.26,199.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11401","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11401","EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM","11401 - EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM",798,527.46,527.46,2032.26,199.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11401","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11401","EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM","11401 - EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM",798,2032.26,527.46,2032.26,199.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11401","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11401","EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM","11401 - EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM",798,678.1,527.46,2032.26,199.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11401","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11401","EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM","11401 - EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM",798,678.1,527.46,2032.26,199.5]
["TUFTS - TUFTS HMO - CPT - 11401","TUFTS","TUFTS HMO","CPT","11401","EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM","11401 - EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM",798,1281.21,527.46,2032.26,199.5]
["TUFTS - TUFTS POS - CPT - 11401","TUFTS","TUFTS POS","CPT","11401","EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM","11401 - EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM",798,1281.21,527.46,2032.26,199.5]
["TUFTS - TUFTS PPO - CPT - 11401","TUFTS","TUFTS PPO","CPT","11401","EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM","11401 - EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM",798,1281.21,527.46,2032.26,199.5]
["TUFTS - TUFTS SELECT - CPT - 11401","TUFTS","TUFTS SELECT","CPT","11401","EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM","11401 - EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM",798,684.11,527.46,2032.26,199.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11401","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11401","EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM","11401 - EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM",798,661.45,527.46,2032.26,199.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11401","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11401","EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM","11401 - EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM",798,678.1,527.46,2032.26,199.5]
["AETNA - AETNA - CPT - 11402","AETNA","AETNA","CPT","11402","EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM","11402 - EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM",876,1198.25,684.11,2032.26,219]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11402","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11402","EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM","11402 - EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM",876,972.93,684.11,2032.26,219]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11402","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11402","EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM","11402 - EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM",876,972.93,684.11,2032.26,219]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11402","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11402","EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM","11402 - EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM",876,972.93,684.11,2032.26,219]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11402","BLUE CROSS","BLUE CROSS-PPO","CPT","11402","EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM","11402 - EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM",876,972.93,684.11,2032.26,219]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11402","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11402","EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM","11402 - EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM",876,972.93,684.11,2032.26,219]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11402","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11402","EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM","11402 - EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM",876,972.93,684.11,2032.26,219]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11402","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11402","EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM","11402 - EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM",876,972.93,684.11,2032.26,219]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11402","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11402","EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM","11402 - EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM",876,2032.26,684.11,2032.26,219]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11402","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11402","EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM","11402 - EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM",876,1250.8,684.11,2032.26,219]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11402","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11402","EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM","11402 - EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM",876,1250.8,684.11,2032.26,219]
["TUFTS - TUFTS HMO - CPT - 11402","TUFTS","TUFTS HMO","CPT","11402","EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM","11402 - EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM",876,1281.21,684.11,2032.26,219]
["TUFTS - TUFTS POS - CPT - 11402","TUFTS","TUFTS POS","CPT","11402","EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM","11402 - EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM",876,1281.21,684.11,2032.26,219]
["TUFTS - TUFTS PPO - CPT - 11402","TUFTS","TUFTS PPO","CPT","11402","EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM","11402 - EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM",876,1281.21,684.11,2032.26,219]
["TUFTS - TUFTS SELECT - CPT - 11402","TUFTS","TUFTS SELECT","CPT","11402","EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM","11402 - EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM",876,684.11,684.11,2032.26,219]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11402","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11402","EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM","11402 - EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM",876,1220.0899999999999,684.11,2032.26,219]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11402","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11402","EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM","11402 - EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM",876,1250.8,684.11,2032.26,219]
["AETNA - AETNA - CPT - 11403","AETNA","AETNA","CPT","11403","EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<","11403 - EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<",1130,1198.25,972.93,3264.67,282.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11403","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11403","EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<","11403 - EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<",1130,972.93,972.93,3264.67,282.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11403","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11403","EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<","11403 - EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<",1130,972.93,972.93,3264.67,282.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11403","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11403","EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<","11403 - EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<",1130,972.93,972.93,3264.67,282.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11403","BLUE CROSS","BLUE CROSS-PPO","CPT","11403","EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<","11403 - EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<",1130,972.93,972.93,3264.67,282.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11403","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11403","EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<","11403 - EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<",1130,972.93,972.93,3264.67,282.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11403","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11403","EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<","11403 - EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<",1130,972.93,972.93,3264.67,282.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11403","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11403","EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<","11403 - EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<",1130,972.93,972.93,3264.67,282.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11403","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11403","EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<","11403 - EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<",1130,3264.67,972.93,3264.67,282.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11403","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11403","EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<","11403 - EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<",1130,1250.8,972.93,3264.67,282.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11403","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11403","EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<","11403 - EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<",1130,1250.8,972.93,3264.67,282.5]
["TUFTS - TUFTS HMO - CPT - 11403","TUFTS","TUFTS HMO","CPT","11403","EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<","11403 - EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<",1130,2057.7399999999998,972.93,3264.67,282.5]
["TUFTS - TUFTS POS - CPT - 11403","TUFTS","TUFTS POS","CPT","11403","EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<","11403 - EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<",1130,2058.17,972.93,3264.67,282.5]
["TUFTS - TUFTS PPO - CPT - 11403","TUFTS","TUFTS PPO","CPT","11403","EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<","11403 - EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<",1130,2058.16,972.93,3264.67,282.5]
["TUFTS - TUFTS SELECT - CPT - 11403","TUFTS","TUFTS SELECT","CPT","11403","EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<","11403 - EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<",1130,1098.98,972.93,3264.67,282.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11403","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11403","EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<","11403 - EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<",1130,1220.0899999999999,972.93,3264.67,282.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11403","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11403","EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<","11403 - EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<",1130,1250.8,972.93,3264.67,282.5]
["AETNA - AETNA - CPT - 11404","AETNA","AETNA","CPT","11404","EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM","11404 - EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM",1972,1198.25,1098.98,3264.67,493]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11404","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11404","EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM","11404 - EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM",1972,2309.9699999999998,1098.98,3264.67,493]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11404","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11404","EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM","11404 - EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM",1972,2309.9699999999998,1098.98,3264.67,493]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11404","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11404","EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM","11404 - EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM",1972,2309.9699999999998,1098.98,3264.67,493]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11404","BLUE CROSS","BLUE CROSS-PPO","CPT","11404","EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM","11404 - EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM",1972,2309.9699999999998,1098.98,3264.67,493]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11404","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11404","EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM","11404 - EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM",1972,2309.9699999999998,1098.98,3264.67,493]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11404","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11404","EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM","11404 - EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM",1972,2309.9699999999998,1098.98,3264.67,493]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11404","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11404","EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM","11404 - EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM",1972,2309.9699999999998,1098.98,3264.67,493]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11404","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11404","EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM","11404 - EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM",1972,3264.67,1098.98,3264.67,493]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11404","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11404","EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM","11404 - EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM",1972,2672.73,1098.98,3264.67,493]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11404","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11404","EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM","11404 - EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM",1972,2672.73,1098.98,3264.67,493]
["TUFTS - TUFTS HMO - CPT - 11404","TUFTS","TUFTS HMO","CPT","11404","EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM","11404 - EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM",1972,2057.7399999999998,1098.98,3264.67,493]
["TUFTS - TUFTS POS - CPT - 11404","TUFTS","TUFTS POS","CPT","11404","EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM","11404 - EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM",1972,2058.17,1098.98,3264.67,493]
["TUFTS - TUFTS PPO - CPT - 11404","TUFTS","TUFTS PPO","CPT","11404","EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM","11404 - EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM",1972,2058.16,1098.98,3264.67,493]
["TUFTS - TUFTS SELECT - CPT - 11404","TUFTS","TUFTS SELECT","CPT","11404","EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM","11404 - EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM",1972,1098.98,1098.98,3264.67,493]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11404","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11404","EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM","11404 - EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM",1972,2607.12,1098.98,3264.67,493]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11404","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11404","EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM","11404 - EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM",1972,2672.73,1098.98,3264.67,493]
["AETNA - AETNA - CPT - 11406","AETNA","AETNA","CPT","11406","EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM","11406 - EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM",1873,1500.85,1500.85,7703.8,468.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11406","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11406","EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM","11406 - EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM",1873,2309.9699999999998,1500.85,7703.8,468.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11406","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11406","EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM","11406 - EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM",1873,2309.9699999999998,1500.85,7703.8,468.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11406","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11406","EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM","11406 - EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM",1873,2309.9699999999998,1500.85,7703.8,468.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11406","BLUE CROSS","BLUE CROSS-PPO","CPT","11406","EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM","11406 - EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM",1873,2309.9699999999998,1500.85,7703.8,468.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11406","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11406","EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM","11406 - EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM",1873,2309.9699999999998,1500.85,7703.8,468.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11406","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11406","EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM","11406 - EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM",1873,2309.9699999999998,1500.85,7703.8,468.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11406","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11406","EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM","11406 - EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM",1873,2309.9699999999998,1500.85,7703.8,468.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11406","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11406","EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM","11406 - EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM",1873,7703.8,1500.85,7703.8,468.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11406","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11406","EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM","11406 - EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM",1873,2672.73,1500.85,7703.8,468.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11406","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11406","EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM","11406 - EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM",1873,2672.73,1500.85,7703.8,468.25]
["TUFTS - TUFTS HMO - CPT - 11406","TUFTS","TUFTS HMO","CPT","11406","EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM","11406 - EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM",1873,4856.75,1500.85,7703.8,468.25]
["TUFTS - TUFTS POS - CPT - 11406","TUFTS","TUFTS POS","CPT","11406","EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM","11406 - EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM",1873,4856.75,1500.85,7703.8,468.25]
["TUFTS - TUFTS PPO - CPT - 11406","TUFTS","TUFTS PPO","CPT","11406","EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM","11406 - EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM",1873,4856.75,1500.85,7703.8,468.25]
["TUFTS - TUFTS SELECT - CPT - 11406","TUFTS","TUFTS SELECT","CPT","11406","EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM","11406 - EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM",1873,2593.31,1500.85,7703.8,468.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11406","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11406","EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM","11406 - EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM",1873,2607.12,1500.85,7703.8,468.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11406","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11406","EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM","11406 - EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM",1873,2672.73,1500.85,7703.8,468.25]
["AETNA - AETNA - CPT - 11420","AETNA","AETNA","CPT","11420","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<","11420 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<",1103,1500.85,1098.98,3264.67,275.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11420","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11420","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<","11420 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<",1103,2309.9699999999998,1098.98,3264.67,275.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11420","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11420","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<","11420 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<",1103,2309.9699999999998,1098.98,3264.67,275.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11420","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11420","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<","11420 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<",1103,2309.9699999999998,1098.98,3264.67,275.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11420","BLUE CROSS","BLUE CROSS-PPO","CPT","11420","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<","11420 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<",1103,2309.9699999999998,1098.98,3264.67,275.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11420","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11420","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<","11420 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<",1103,2309.9699999999998,1098.98,3264.67,275.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11420","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11420","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<","11420 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<",1103,2309.9699999999998,1098.98,3264.67,275.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11420","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11420","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<","11420 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<",1103,2309.9699999999998,1098.98,3264.67,275.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11420","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11420","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<","11420 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<",1103,3264.67,1098.98,3264.67,275.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11420","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11420","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<","11420 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<",1103,2672.73,1098.98,3264.67,275.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11420","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11420","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<","11420 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<",1103,2672.73,1098.98,3264.67,275.75]
["TUFTS - TUFTS HMO - CPT - 11420","TUFTS","TUFTS HMO","CPT","11420","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<","11420 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<",1103,2057.7399999999998,1098.98,3264.67,275.75]
["TUFTS - TUFTS POS - CPT - 11420","TUFTS","TUFTS POS","CPT","11420","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<","11420 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<",1103,2058.17,1098.98,3264.67,275.75]
["TUFTS - TUFTS PPO - CPT - 11420","TUFTS","TUFTS PPO","CPT","11420","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<","11420 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<",1103,2058.16,1098.98,3264.67,275.75]
["TUFTS - TUFTS SELECT - CPT - 11420","TUFTS","TUFTS SELECT","CPT","11420","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<","11420 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<",1103,1098.98,1098.98,3264.67,275.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11420","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11420","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<","11420 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<",1103,2607.12,1098.98,3264.67,275.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11420","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11420","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<","11420 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<",1103,2672.73,1098.98,3264.67,275.75]
["AETNA - AETNA - CPT - 11421","AETNA","AETNA","CPT","11421","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM","11421 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM",1103,1500.85,972.93,3264.67,275.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11421","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11421","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM","11421 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM",1103,972.93,972.93,3264.67,275.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11421","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11421","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM","11421 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM",1103,972.93,972.93,3264.67,275.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11421","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11421","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM","11421 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM",1103,972.93,972.93,3264.67,275.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11421","BLUE CROSS","BLUE CROSS-PPO","CPT","11421","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM","11421 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM",1103,972.93,972.93,3264.67,275.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11421","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11421","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM","11421 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM",1103,972.93,972.93,3264.67,275.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11421","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11421","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM","11421 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM",1103,972.93,972.93,3264.67,275.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11421","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11421","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM","11421 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM",1103,972.93,972.93,3264.67,275.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11421","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11421","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM","11421 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM",1103,3264.67,972.93,3264.67,275.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11421","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11421","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM","11421 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM",1103,1250.8,972.93,3264.67,275.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11421","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11421","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM","11421 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM",1103,1250.8,972.93,3264.67,275.75]
["TUFTS - TUFTS HMO - CPT - 11421","TUFTS","TUFTS HMO","CPT","11421","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM","11421 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM",1103,2057.7399999999998,972.93,3264.67,275.75]
["TUFTS - TUFTS POS - CPT - 11421","TUFTS","TUFTS POS","CPT","11421","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM","11421 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM",1103,2058.17,972.93,3264.67,275.75]
["TUFTS - TUFTS PPO - CPT - 11421","TUFTS","TUFTS PPO","CPT","11421","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM","11421 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM",1103,2058.16,972.93,3264.67,275.75]
["TUFTS - TUFTS SELECT - CPT - 11421","TUFTS","TUFTS SELECT","CPT","11421","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM","11421 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM",1103,1098.98,972.93,3264.67,275.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11421","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11421","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM","11421 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM",1103,1220.0899999999999,972.93,3264.67,275.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11421","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11421","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM","11421 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM",1103,1250.8,972.93,3264.67,275.75]
["AETNA - AETNA - CPT - 11422","AETNA","AETNA","CPT","11422","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM","11422 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM",1039,1198.25,1098.98,3264.67,259.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11422","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11422","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM","11422 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM",1039,2309.9699999999998,1098.98,3264.67,259.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11422","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11422","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM","11422 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM",1039,2309.9699999999998,1098.98,3264.67,259.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11422","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11422","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM","11422 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM",1039,2309.9699999999998,1098.98,3264.67,259.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11422","BLUE CROSS","BLUE CROSS-PPO","CPT","11422","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM","11422 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM",1039,2309.9699999999998,1098.98,3264.67,259.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11422","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11422","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM","11422 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM",1039,2309.9699999999998,1098.98,3264.67,259.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11422","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11422","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM","11422 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM",1039,2309.9699999999998,1098.98,3264.67,259.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11422","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11422","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM","11422 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM",1039,2309.9699999999998,1098.98,3264.67,259.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11422","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11422","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM","11422 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM",1039,3264.67,1098.98,3264.67,259.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11422","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11422","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM","11422 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM",1039,2672.73,1098.98,3264.67,259.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11422","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11422","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM","11422 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM",1039,2672.73,1098.98,3264.67,259.75]
["TUFTS - TUFTS HMO - CPT - 11422","TUFTS","TUFTS HMO","CPT","11422","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM","11422 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM",1039,2057.7399999999998,1098.98,3264.67,259.75]
["TUFTS - TUFTS POS - CPT - 11422","TUFTS","TUFTS POS","CPT","11422","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM","11422 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM",1039,2058.17,1098.98,3264.67,259.75]
["TUFTS - TUFTS PPO - CPT - 11422","TUFTS","TUFTS PPO","CPT","11422","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM","11422 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM",1039,2058.16,1098.98,3264.67,259.75]
["TUFTS - TUFTS SELECT - CPT - 11422","TUFTS","TUFTS SELECT","CPT","11422","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM","11422 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM",1039,1098.98,1098.98,3264.67,259.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11422","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11422","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM","11422 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM",1039,2607.12,1098.98,3264.67,259.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11422","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11422","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM","11422 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM",1039,2672.73,1098.98,3264.67,259.75]
["AETNA - AETNA - CPT - 11423","AETNA","AETNA","CPT","11423","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM","11423 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM",1972,1198.25,1198.25,7703.8,493]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11423","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11423","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM","11423 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM",1972,2309.9699999999998,1198.25,7703.8,493]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11423","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11423","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM","11423 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM",1972,2309.9699999999998,1198.25,7703.8,493]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11423","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11423","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM","11423 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM",1972,2309.9699999999998,1198.25,7703.8,493]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11423","BLUE CROSS","BLUE CROSS-PPO","CPT","11423","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM","11423 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM",1972,2309.9699999999998,1198.25,7703.8,493]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11423","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11423","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM","11423 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM",1972,2309.9699999999998,1198.25,7703.8,493]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11423","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11423","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM","11423 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM",1972,2309.9699999999998,1198.25,7703.8,493]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11423","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11423","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM","11423 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM",1972,2309.9699999999998,1198.25,7703.8,493]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11423","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11423","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM","11423 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM",1972,7703.8,1198.25,7703.8,493]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11423","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11423","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM","11423 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM",1972,2672.73,1198.25,7703.8,493]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11423","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11423","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM","11423 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM",1972,2672.73,1198.25,7703.8,493]
["TUFTS - TUFTS HMO - CPT - 11423","TUFTS","TUFTS HMO","CPT","11423","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM","11423 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM",1972,4856.75,1198.25,7703.8,493]
["TUFTS - TUFTS POS - CPT - 11423","TUFTS","TUFTS POS","CPT","11423","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM","11423 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM",1972,4856.75,1198.25,7703.8,493]
["TUFTS - TUFTS PPO - CPT - 11423","TUFTS","TUFTS PPO","CPT","11423","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM","11423 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM",1972,4856.75,1198.25,7703.8,493]
["TUFTS - TUFTS SELECT - CPT - 11423","TUFTS","TUFTS SELECT","CPT","11423","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM","11423 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM",1972,2593.31,1198.25,7703.8,493]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11423","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11423","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM","11423 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM",1972,2607.12,1198.25,7703.8,493]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11423","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11423","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM","11423 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM",1972,2672.73,1198.25,7703.8,493]
["AETNA - AETNA - CPT - 11424","AETNA","AETNA","CPT","11424","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM","11424 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM",1972,1500.85,1500.85,7703.8,493]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11424","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11424","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM","11424 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM",1972,2309.9699999999998,1500.85,7703.8,493]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11424","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11424","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM","11424 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM",1972,2309.9699999999998,1500.85,7703.8,493]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11424","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11424","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM","11424 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM",1972,2309.9699999999998,1500.85,7703.8,493]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11424","BLUE CROSS","BLUE CROSS-PPO","CPT","11424","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM","11424 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM",1972,2309.9699999999998,1500.85,7703.8,493]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11424","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11424","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM","11424 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM",1972,2309.9699999999998,1500.85,7703.8,493]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11424","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11424","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM","11424 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM",1972,2309.9699999999998,1500.85,7703.8,493]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11424","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11424","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM","11424 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM",1972,2309.9699999999998,1500.85,7703.8,493]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11424","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11424","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM","11424 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM",1972,7703.8,1500.85,7703.8,493]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11424","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11424","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM","11424 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM",1972,2672.73,1500.85,7703.8,493]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11424","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11424","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM","11424 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM",1972,2672.73,1500.85,7703.8,493]
["TUFTS - TUFTS HMO - CPT - 11424","TUFTS","TUFTS HMO","CPT","11424","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM","11424 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM",1972,4856.75,1500.85,7703.8,493]
["TUFTS - TUFTS POS - CPT - 11424","TUFTS","TUFTS POS","CPT","11424","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM","11424 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM",1972,4856.75,1500.85,7703.8,493]
["TUFTS - TUFTS PPO - CPT - 11424","TUFTS","TUFTS PPO","CPT","11424","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM","11424 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM",1972,4856.75,1500.85,7703.8,493]
["TUFTS - TUFTS SELECT - CPT - 11424","TUFTS","TUFTS SELECT","CPT","11424","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM","11424 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM",1972,2593.31,1500.85,7703.8,493]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11424","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11424","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM","11424 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM",1972,2607.12,1500.85,7703.8,493]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11424","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11424","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM","11424 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM",1972,2672.73,1500.85,7703.8,493]
["AETNA - AETNA - CPT - 11426","AETNA","AETNA","CPT","11426","EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM","11426 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM",2987,1500.85,1500.85,7703.8,746.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11426","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11426","EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM","11426 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM",2987,3994.03,1500.85,7703.8,746.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11426","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11426","EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM","11426 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM",2987,3994.03,1500.85,7703.8,746.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11426","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11426","EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM","11426 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM",2987,3994.03,1500.85,7703.8,746.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11426","BLUE CROSS","BLUE CROSS-PPO","CPT","11426","EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM","11426 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM",2987,3994.03,1500.85,7703.8,746.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11426","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11426","EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM","11426 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM",2987,3994.03,1500.85,7703.8,746.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11426","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11426","EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM","11426 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM",2987,3994.03,1500.85,7703.8,746.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11426","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11426","EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM","11426 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM",2987,3994.03,1500.85,7703.8,746.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11426","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11426","EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM","11426 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM",2987,7703.8,1500.85,7703.8,746.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11426","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11426","EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM","11426 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM",2987,4621.25,1500.85,7703.8,746.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11426","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11426","EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM","11426 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM",2987,4621.25,1500.85,7703.8,746.75]
["TUFTS - TUFTS HMO - CPT - 11426","TUFTS","TUFTS HMO","CPT","11426","EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM","11426 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM",2987,4856.75,1500.85,7703.8,746.75]
["TUFTS - TUFTS POS - CPT - 11426","TUFTS","TUFTS POS","CPT","11426","EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM","11426 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM",2987,4856.75,1500.85,7703.8,746.75]
["TUFTS - TUFTS PPO - CPT - 11426","TUFTS","TUFTS PPO","CPT","11426","EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM","11426 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM",2987,4856.75,1500.85,7703.8,746.75]
["TUFTS - TUFTS SELECT - CPT - 11426","TUFTS","TUFTS SELECT","CPT","11426","EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM","11426 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM",2987,2593.31,1500.85,7703.8,746.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11426","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11426","EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM","11426 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM",2987,4507.8100000000004,1500.85,7703.8,746.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11426","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11426","EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM","11426 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM",2987,4621.25,1500.85,7703.8,746.75]
["AETNA - AETNA - CPT - 11440","AETNA","AETNA","CPT","11440","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<","11440 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<",792,1500.85,684.11,2032.26,198]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11440","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11440","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<","11440 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<",792,972.93,684.11,2032.26,198]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11440","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11440","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<","11440 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<",792,972.93,684.11,2032.26,198]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11440","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11440","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<","11440 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<",792,972.93,684.11,2032.26,198]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11440","BLUE CROSS","BLUE CROSS-PPO","CPT","11440","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<","11440 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<",792,972.93,684.11,2032.26,198]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11440","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11440","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<","11440 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<",792,972.93,684.11,2032.26,198]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11440","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11440","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<","11440 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<",792,972.93,684.11,2032.26,198]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11440","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11440","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<","11440 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<",792,972.93,684.11,2032.26,198]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11440","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11440","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<","11440 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<",792,2032.26,684.11,2032.26,198]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11440","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11440","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<","11440 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<",792,1250.8,684.11,2032.26,198]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11440","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11440","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<","11440 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<",792,1250.8,684.11,2032.26,198]
["TUFTS - TUFTS HMO - CPT - 11440","TUFTS","TUFTS HMO","CPT","11440","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<","11440 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<",792,1281.21,684.11,2032.26,198]
["TUFTS - TUFTS POS - CPT - 11440","TUFTS","TUFTS POS","CPT","11440","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<","11440 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<",792,1281.21,684.11,2032.26,198]
["TUFTS - TUFTS PPO - CPT - 11440","TUFTS","TUFTS PPO","CPT","11440","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<","11440 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<",792,1281.21,684.11,2032.26,198]
["TUFTS - TUFTS SELECT - CPT - 11440","TUFTS","TUFTS SELECT","CPT","11440","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<","11440 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<",792,684.11,684.11,2032.26,198]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11440","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11440","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<","11440 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<",792,1220.0899999999999,684.11,2032.26,198]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11440","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11440","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<","11440 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<",792,1250.8,684.11,2032.26,198]
["AETNA - AETNA - CPT - 11441","AETNA","AETNA","CPT","11441","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM","11441 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM",1009,1500.85,684.11,2032.26,252.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11441","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11441","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM","11441 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM",1009,972.93,684.11,2032.26,252.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11441","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11441","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM","11441 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM",1009,972.93,684.11,2032.26,252.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11441","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11441","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM","11441 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM",1009,972.93,684.11,2032.26,252.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11441","BLUE CROSS","BLUE CROSS-PPO","CPT","11441","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM","11441 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM",1009,972.93,684.11,2032.26,252.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11441","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11441","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM","11441 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM",1009,972.93,684.11,2032.26,252.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11441","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11441","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM","11441 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM",1009,972.93,684.11,2032.26,252.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11441","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11441","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM","11441 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM",1009,972.93,684.11,2032.26,252.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11441","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11441","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM","11441 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM",1009,2032.26,684.11,2032.26,252.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11441","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11441","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM","11441 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM",1009,1250.8,684.11,2032.26,252.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11441","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11441","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM","11441 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM",1009,1250.8,684.11,2032.26,252.25]
["TUFTS - TUFTS HMO - CPT - 11441","TUFTS","TUFTS HMO","CPT","11441","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM","11441 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM",1009,1281.21,684.11,2032.26,252.25]
["TUFTS - TUFTS POS - CPT - 11441","TUFTS","TUFTS POS","CPT","11441","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM","11441 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM",1009,1281.21,684.11,2032.26,252.25]
["TUFTS - TUFTS PPO - CPT - 11441","TUFTS","TUFTS PPO","CPT","11441","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM","11441 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM",1009,1281.21,684.11,2032.26,252.25]
["TUFTS - TUFTS SELECT - CPT - 11441","TUFTS","TUFTS SELECT","CPT","11441","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM","11441 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM",1009,684.11,684.11,2032.26,252.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11441","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11441","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM","11441 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM",1009,1220.0899999999999,684.11,2032.26,252.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11441","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11441","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM","11441 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM",1009,1250.8,684.11,2032.26,252.25]
["AETNA - AETNA - CPT - 11442","AETNA","AETNA","CPT","11442","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM","11442 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM",1046,1198.25,972.93,3264.67,261.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11442","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11442","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM","11442 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM",1046,972.93,972.93,3264.67,261.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11442","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11442","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM","11442 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM",1046,972.93,972.93,3264.67,261.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11442","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11442","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM","11442 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM",1046,972.93,972.93,3264.67,261.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11442","BLUE CROSS","BLUE CROSS-PPO","CPT","11442","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM","11442 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM",1046,972.93,972.93,3264.67,261.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11442","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11442","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM","11442 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM",1046,972.93,972.93,3264.67,261.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11442","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11442","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM","11442 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM",1046,972.93,972.93,3264.67,261.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11442","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11442","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM","11442 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM",1046,972.93,972.93,3264.67,261.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11442","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11442","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM","11442 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM",1046,3264.67,972.93,3264.67,261.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11442","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11442","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM","11442 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM",1046,1250.8,972.93,3264.67,261.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11442","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11442","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM","11442 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM",1046,1250.8,972.93,3264.67,261.5]
["TUFTS - TUFTS HMO - CPT - 11442","TUFTS","TUFTS HMO","CPT","11442","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM","11442 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM",1046,2057.7399999999998,972.93,3264.67,261.5]
["TUFTS - TUFTS POS - CPT - 11442","TUFTS","TUFTS POS","CPT","11442","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM","11442 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM",1046,2058.17,972.93,3264.67,261.5]
["TUFTS - TUFTS PPO - CPT - 11442","TUFTS","TUFTS PPO","CPT","11442","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM","11442 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM",1046,2058.16,972.93,3264.67,261.5]
["TUFTS - TUFTS SELECT - CPT - 11442","TUFTS","TUFTS SELECT","CPT","11442","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM","11442 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM",1046,1098.98,972.93,3264.67,261.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11442","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11442","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM","11442 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM",1046,1220.0899999999999,972.93,3264.67,261.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11442","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11442","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM","11442 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM",1046,1250.8,972.93,3264.67,261.5]
["AETNA - AETNA - CPT - 11443","AETNA","AETNA","CPT","11443","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM","11443 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM",1375,1198.25,1098.98,3264.67,343.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11443","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11443","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM","11443 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM",1375,2309.9699999999998,1098.98,3264.67,343.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11443","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11443","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM","11443 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM",1375,2309.9699999999998,1098.98,3264.67,343.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11443","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11443","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM","11443 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM",1375,2309.9699999999998,1098.98,3264.67,343.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11443","BLUE CROSS","BLUE CROSS-PPO","CPT","11443","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM","11443 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM",1375,2309.9699999999998,1098.98,3264.67,343.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11443","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11443","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM","11443 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM",1375,2309.9699999999998,1098.98,3264.67,343.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11443","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11443","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM","11443 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM",1375,2309.9699999999998,1098.98,3264.67,343.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11443","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11443","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM","11443 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM",1375,2309.9699999999998,1098.98,3264.67,343.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11443","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11443","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM","11443 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM",1375,3264.67,1098.98,3264.67,343.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11443","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11443","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM","11443 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM",1375,2672.73,1098.98,3264.67,343.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11443","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11443","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM","11443 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM",1375,2672.73,1098.98,3264.67,343.75]
["TUFTS - TUFTS HMO - CPT - 11443","TUFTS","TUFTS HMO","CPT","11443","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM","11443 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM",1375,2057.7399999999998,1098.98,3264.67,343.75]
["TUFTS - TUFTS POS - CPT - 11443","TUFTS","TUFTS POS","CPT","11443","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM","11443 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM",1375,2058.17,1098.98,3264.67,343.75]
["TUFTS - TUFTS PPO - CPT - 11443","TUFTS","TUFTS PPO","CPT","11443","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM","11443 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM",1375,2058.16,1098.98,3264.67,343.75]
["TUFTS - TUFTS SELECT - CPT - 11443","TUFTS","TUFTS SELECT","CPT","11443","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM","11443 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM",1375,1098.98,1098.98,3264.67,343.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11443","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11443","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM","11443 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM",1375,2607.12,1098.98,3264.67,343.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11443","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11443","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM","11443 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM",1375,2672.73,1098.98,3264.67,343.75]
["AETNA - AETNA - CPT - 11444","AETNA","AETNA","CPT","11444","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM","11444 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM",1752,1198.25,1098.98,3264.67,438]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11444","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11444","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM","11444 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM",1752,2309.9699999999998,1098.98,3264.67,438]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11444","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11444","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM","11444 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM",1752,2309.9699999999998,1098.98,3264.67,438]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11444","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11444","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM","11444 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM",1752,2309.9699999999998,1098.98,3264.67,438]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11444","BLUE CROSS","BLUE CROSS-PPO","CPT","11444","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM","11444 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM",1752,2309.9699999999998,1098.98,3264.67,438]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11444","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11444","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM","11444 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM",1752,2309.9699999999998,1098.98,3264.67,438]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11444","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11444","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM","11444 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM",1752,2309.9699999999998,1098.98,3264.67,438]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11444","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11444","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM","11444 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM",1752,2309.9699999999998,1098.98,3264.67,438]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11444","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11444","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM","11444 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM",1752,3264.67,1098.98,3264.67,438]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11444","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11444","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM","11444 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM",1752,2672.73,1098.98,3264.67,438]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11444","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11444","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM","11444 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM",1752,2672.73,1098.98,3264.67,438]
["TUFTS - TUFTS HMO - CPT - 11444","TUFTS","TUFTS HMO","CPT","11444","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM","11444 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM",1752,2057.7399999999998,1098.98,3264.67,438]
["TUFTS - TUFTS POS - CPT - 11444","TUFTS","TUFTS POS","CPT","11444","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM","11444 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM",1752,2058.17,1098.98,3264.67,438]
["TUFTS - TUFTS PPO - CPT - 11444","TUFTS","TUFTS PPO","CPT","11444","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM","11444 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM",1752,2058.16,1098.98,3264.67,438]
["TUFTS - TUFTS SELECT - CPT - 11444","TUFTS","TUFTS SELECT","CPT","11444","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM","11444 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM",1752,1098.98,1098.98,3264.67,438]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11444","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11444","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM","11444 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM",1752,2607.12,1098.98,3264.67,438]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11444","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11444","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM","11444 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM",1752,2672.73,1098.98,3264.67,438]
["AETNA - AETNA - CPT - 11446","AETNA","AETNA","CPT","11446","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM","11446 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM",2492,1500.85,1500.85,7703.8,623]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11446","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11446","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM","11446 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM",2492,3994.03,1500.85,7703.8,623]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11446","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11446","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM","11446 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM",2492,3994.03,1500.85,7703.8,623]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11446","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11446","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM","11446 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM",2492,3994.03,1500.85,7703.8,623]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11446","BLUE CROSS","BLUE CROSS-PPO","CPT","11446","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM","11446 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM",2492,3994.03,1500.85,7703.8,623]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11446","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11446","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM","11446 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM",2492,3994.03,1500.85,7703.8,623]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11446","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11446","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM","11446 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM",2492,3994.03,1500.85,7703.8,623]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11446","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11446","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM","11446 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM",2492,3994.03,1500.85,7703.8,623]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11446","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11446","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM","11446 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM",2492,7703.8,1500.85,7703.8,623]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11446","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11446","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM","11446 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM",2492,4621.25,1500.85,7703.8,623]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11446","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11446","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM","11446 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM",2492,4621.25,1500.85,7703.8,623]
["TUFTS - TUFTS HMO - CPT - 11446","TUFTS","TUFTS HMO","CPT","11446","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM","11446 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM",2492,4856.75,1500.85,7703.8,623]
["TUFTS - TUFTS POS - CPT - 11446","TUFTS","TUFTS POS","CPT","11446","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM","11446 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM",2492,4856.75,1500.85,7703.8,623]
["TUFTS - TUFTS PPO - CPT - 11446","TUFTS","TUFTS PPO","CPT","11446","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM","11446 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM",2492,4856.75,1500.85,7703.8,623]
["TUFTS - TUFTS SELECT - CPT - 11446","TUFTS","TUFTS SELECT","CPT","11446","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM","11446 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM",2492,2593.31,1500.85,7703.8,623]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11446","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11446","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM","11446 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM",2492,4507.8100000000004,1500.85,7703.8,623]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11446","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11446","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM","11446 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM",2492,4621.25,1500.85,7703.8,623]
["AETNA - AETNA - CPT - 11450","AETNA","AETNA","CPT","11450","EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR","11450 - EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR",2778,1500.85,1500.85,7703.8,694.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11450","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11450","EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR","11450 - EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR",2778,3994.03,1500.85,7703.8,694.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11450","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11450","EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR","11450 - EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR",2778,3994.03,1500.85,7703.8,694.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11450","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11450","EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR","11450 - EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR",2778,3994.03,1500.85,7703.8,694.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11450","BLUE CROSS","BLUE CROSS-PPO","CPT","11450","EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR","11450 - EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR",2778,3994.03,1500.85,7703.8,694.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11450","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11450","EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR","11450 - EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR",2778,3994.03,1500.85,7703.8,694.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11450","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11450","EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR","11450 - EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR",2778,3994.03,1500.85,7703.8,694.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11450","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11450","EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR","11450 - EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR",2778,3994.03,1500.85,7703.8,694.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11450","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11450","EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR","11450 - EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR",2778,7703.8,1500.85,7703.8,694.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11450","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11450","EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR","11450 - EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR",2778,4621.25,1500.85,7703.8,694.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11450","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11450","EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR","11450 - EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR",2778,4621.25,1500.85,7703.8,694.5]
["TUFTS - TUFTS HMO - CPT - 11450","TUFTS","TUFTS HMO","CPT","11450","EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR","11450 - EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR",2778,4856.75,1500.85,7703.8,694.5]
["TUFTS - TUFTS POS - CPT - 11450","TUFTS","TUFTS POS","CPT","11450","EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR","11450 - EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR",2778,4856.75,1500.85,7703.8,694.5]
["TUFTS - TUFTS PPO - CPT - 11450","TUFTS","TUFTS PPO","CPT","11450","EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR","11450 - EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR",2778,4856.75,1500.85,7703.8,694.5]
["TUFTS - TUFTS SELECT - CPT - 11450","TUFTS","TUFTS SELECT","CPT","11450","EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR","11450 - EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR",2778,2593.31,1500.85,7703.8,694.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11450","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11450","EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR","11450 - EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR",2778,4507.8100000000004,1500.85,7703.8,694.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11450","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11450","EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR","11450 - EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR",2778,4621.25,1500.85,7703.8,694.5]
["AETNA - AETNA - CPT - 11463","AETNA","AETNA","CPT","11463","EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR","11463 - EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR",2490,1500.85,1500.85,7703.8,622.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11463","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11463","EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR","11463 - EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR",2490,3994.03,1500.85,7703.8,622.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11463","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11463","EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR","11463 - EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR",2490,3994.03,1500.85,7703.8,622.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11463","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11463","EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR","11463 - EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR",2490,3994.03,1500.85,7703.8,622.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11463","BLUE CROSS","BLUE CROSS-PPO","CPT","11463","EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR","11463 - EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR",2490,3994.03,1500.85,7703.8,622.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11463","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11463","EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR","11463 - EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR",2490,3994.03,1500.85,7703.8,622.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11463","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11463","EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR","11463 - EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR",2490,3994.03,1500.85,7703.8,622.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11463","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11463","EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR","11463 - EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR",2490,3994.03,1500.85,7703.8,622.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11463","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11463","EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR","11463 - EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR",2490,7703.8,1500.85,7703.8,622.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11463","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11463","EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR","11463 - EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR",2490,4621.25,1500.85,7703.8,622.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11463","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11463","EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR","11463 - EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR",2490,4621.25,1500.85,7703.8,622.5]
["TUFTS - TUFTS HMO - CPT - 11463","TUFTS","TUFTS HMO","CPT","11463","EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR","11463 - EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR",2490,4856.75,1500.85,7703.8,622.5]
["TUFTS - TUFTS POS - CPT - 11463","TUFTS","TUFTS POS","CPT","11463","EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR","11463 - EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR",2490,4856.75,1500.85,7703.8,622.5]
["TUFTS - TUFTS PPO - CPT - 11463","TUFTS","TUFTS PPO","CPT","11463","EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR","11463 - EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR",2490,4856.75,1500.85,7703.8,622.5]
["TUFTS - TUFTS SELECT - CPT - 11463","TUFTS","TUFTS SELECT","CPT","11463","EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR","11463 - EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR",2490,2593.31,1500.85,7703.8,622.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11463","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11463","EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR","11463 - EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR",2490,4507.8100000000004,1500.85,7703.8,622.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11463","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11463","EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR","11463 - EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR",2490,4621.25,1500.85,7703.8,622.5]
["AETNA - AETNA - CPT - 11470","AETNA","AETNA","CPT","11470","EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR","11470 - EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR",2987,1500.85,1500.85,7703.8,746.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11470","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11470","EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR","11470 - EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR",2987,3994.03,1500.85,7703.8,746.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11470","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11470","EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR","11470 - EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR",2987,3994.03,1500.85,7703.8,746.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11470","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11470","EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR","11470 - EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR",2987,3994.03,1500.85,7703.8,746.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11470","BLUE CROSS","BLUE CROSS-PPO","CPT","11470","EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR","11470 - EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR",2987,3994.03,1500.85,7703.8,746.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11470","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11470","EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR","11470 - EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR",2987,3994.03,1500.85,7703.8,746.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11470","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11470","EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR","11470 - EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR",2987,3994.03,1500.85,7703.8,746.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11470","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11470","EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR","11470 - EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR",2987,3994.03,1500.85,7703.8,746.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11470","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11470","EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR","11470 - EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR",2987,7703.8,1500.85,7703.8,746.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11470","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11470","EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR","11470 - EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR",2987,4621.25,1500.85,7703.8,746.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11470","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11470","EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR","11470 - EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR",2987,4621.25,1500.85,7703.8,746.75]
["TUFTS - TUFTS HMO - CPT - 11470","TUFTS","TUFTS HMO","CPT","11470","EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR","11470 - EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR",2987,4856.75,1500.85,7703.8,746.75]
["TUFTS - TUFTS POS - CPT - 11470","TUFTS","TUFTS POS","CPT","11470","EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR","11470 - EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR",2987,4856.75,1500.85,7703.8,746.75]
["TUFTS - TUFTS PPO - CPT - 11470","TUFTS","TUFTS PPO","CPT","11470","EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR","11470 - EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR",2987,4856.75,1500.85,7703.8,746.75]
["TUFTS - TUFTS SELECT - CPT - 11470","TUFTS","TUFTS SELECT","CPT","11470","EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR","11470 - EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR",2987,2593.31,1500.85,7703.8,746.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11470","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11470","EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR","11470 - EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR",2987,4507.8100000000004,1500.85,7703.8,746.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11470","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11470","EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR","11470 - EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR",2987,4621.25,1500.85,7703.8,746.75]
["AETNA - AETNA - CPT - 11600","AETNA","AETNA","CPT","11600","HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG","11600 - HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG",870,1198.25,972.93,3264.67,217.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11600","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11600","HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG","11600 - HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG",870,972.93,972.93,3264.67,217.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11600","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11600","HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG","11600 - HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG",870,972.93,972.93,3264.67,217.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11600","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11600","HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG","11600 - HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG",870,972.93,972.93,3264.67,217.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11600","BLUE CROSS","BLUE CROSS-PPO","CPT","11600","HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG","11600 - HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG",870,972.93,972.93,3264.67,217.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11600","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11600","HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG","11600 - HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG",870,972.93,972.93,3264.67,217.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11600","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11600","HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG","11600 - HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG",870,972.93,972.93,3264.67,217.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11600","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11600","HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG","11600 - HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG",870,972.93,972.93,3264.67,217.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11600","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11600","HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG","11600 - HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG",870,3264.67,972.93,3264.67,217.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11600","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11600","HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG","11600 - HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG",870,1250.8,972.93,3264.67,217.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11600","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11600","HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG","11600 - HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG",870,1250.8,972.93,3264.67,217.5]
["TUFTS - TUFTS HMO - CPT - 11600","TUFTS","TUFTS HMO","CPT","11600","HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG","11600 - HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG",870,2057.7399999999998,972.93,3264.67,217.5]
["TUFTS - TUFTS POS - CPT - 11600","TUFTS","TUFTS POS","CPT","11600","HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG","11600 - HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG",870,2058.17,972.93,3264.67,217.5]
["TUFTS - TUFTS PPO - CPT - 11600","TUFTS","TUFTS PPO","CPT","11600","HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG","11600 - HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG",870,2058.16,972.93,3264.67,217.5]
["TUFTS - TUFTS SELECT - CPT - 11600","TUFTS","TUFTS SELECT","CPT","11600","HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG","11600 - HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG",870,1098.98,972.93,3264.67,217.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11600","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11600","HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG","11600 - HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG",870,1220.0899999999999,972.93,3264.67,217.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11600","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11600","HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG","11600 - HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG",870,1250.8,972.93,3264.67,217.5]
["AETNA - AETNA - CPT - 11601","AETNA","AETNA","CPT","11601","EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM","11601 - EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM",1146,1198.25,684.11,2032.26,286.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11601","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11601","EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM","11601 - EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM",1146,972.93,684.11,2032.26,286.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11601","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11601","EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM","11601 - EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM",1146,972.93,684.11,2032.26,286.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11601","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11601","EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM","11601 - EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM",1146,972.93,684.11,2032.26,286.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11601","BLUE CROSS","BLUE CROSS-PPO","CPT","11601","EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM","11601 - EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM",1146,972.93,684.11,2032.26,286.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11601","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11601","EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM","11601 - EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM",1146,972.93,684.11,2032.26,286.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11601","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11601","EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM","11601 - EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM",1146,972.93,684.11,2032.26,286.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11601","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11601","EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM","11601 - EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM",1146,972.93,684.11,2032.26,286.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11601","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11601","EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM","11601 - EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM",1146,2032.26,684.11,2032.26,286.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11601","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11601","EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM","11601 - EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM",1146,1250.8,684.11,2032.26,286.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11601","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11601","EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM","11601 - EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM",1146,1250.8,684.11,2032.26,286.5]
["TUFTS - TUFTS HMO - CPT - 11601","TUFTS","TUFTS HMO","CPT","11601","EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM","11601 - EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM",1146,1281.21,684.11,2032.26,286.5]
["TUFTS - TUFTS POS - CPT - 11601","TUFTS","TUFTS POS","CPT","11601","EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM","11601 - EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM",1146,1281.21,684.11,2032.26,286.5]
["TUFTS - TUFTS PPO - CPT - 11601","TUFTS","TUFTS PPO","CPT","11601","EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM","11601 - EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM",1146,1281.21,684.11,2032.26,286.5]
["TUFTS - TUFTS SELECT - CPT - 11601","TUFTS","TUFTS SELECT","CPT","11601","EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM","11601 - EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM",1146,684.11,684.11,2032.26,286.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11601","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11601","EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM","11601 - EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM",1146,1220.0899999999999,684.11,2032.26,286.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11601","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11601","EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM","11601 - EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM",1146,1250.8,684.11,2032.26,286.5]
["AETNA - AETNA - CPT - 11602","AETNA","AETNA","CPT","11602","EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM","11602 - EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM",1262,1198.25,527.46,2032.26,315.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11602","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11602","EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM","11602 - EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM",1262,527.46,527.46,2032.26,315.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11602","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11602","EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM","11602 - EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM",1262,527.46,527.46,2032.26,315.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11602","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11602","EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM","11602 - EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM",1262,527.46,527.46,2032.26,315.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11602","BLUE CROSS","BLUE CROSS-PPO","CPT","11602","EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM","11602 - EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM",1262,527.46,527.46,2032.26,315.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11602","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11602","EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM","11602 - EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM",1262,527.46,527.46,2032.26,315.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11602","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11602","EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM","11602 - EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM",1262,527.46,527.46,2032.26,315.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11602","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11602","EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM","11602 - EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM",1262,527.46,527.46,2032.26,315.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11602","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11602","EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM","11602 - EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM",1262,2032.26,527.46,2032.26,315.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11602","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11602","EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM","11602 - EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM",1262,678.1,527.46,2032.26,315.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11602","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11602","EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM","11602 - EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM",1262,678.1,527.46,2032.26,315.5]
["TUFTS - TUFTS HMO - CPT - 11602","TUFTS","TUFTS HMO","CPT","11602","EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM","11602 - EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM",1262,1281.21,527.46,2032.26,315.5]
["TUFTS - TUFTS POS - CPT - 11602","TUFTS","TUFTS POS","CPT","11602","EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM","11602 - EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM",1262,1281.21,527.46,2032.26,315.5]
["TUFTS - TUFTS PPO - CPT - 11602","TUFTS","TUFTS PPO","CPT","11602","EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM","11602 - EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM",1262,1281.21,527.46,2032.26,315.5]
["TUFTS - TUFTS SELECT - CPT - 11602","TUFTS","TUFTS SELECT","CPT","11602","EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM","11602 - EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM",1262,684.11,527.46,2032.26,315.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11602","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11602","EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM","11602 - EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM",1262,661.45,527.46,2032.26,315.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11602","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11602","EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM","11602 - EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM",1262,678.1,527.46,2032.26,315.5]
["AETNA - AETNA - CPT - 11603","AETNA","AETNA","CPT","11603","EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<","11603 - EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<",1505,1198.25,972.93,3264.67,376.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11603","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11603","EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<","11603 - EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<",1505,972.93,972.93,3264.67,376.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11603","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11603","EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<","11603 - EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<",1505,972.93,972.93,3264.67,376.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11603","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11603","EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<","11603 - EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<",1505,972.93,972.93,3264.67,376.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11603","BLUE CROSS","BLUE CROSS-PPO","CPT","11603","EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<","11603 - EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<",1505,972.93,972.93,3264.67,376.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11603","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11603","EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<","11603 - EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<",1505,972.93,972.93,3264.67,376.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11603","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11603","EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<","11603 - EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<",1505,972.93,972.93,3264.67,376.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11603","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11603","EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<","11603 - EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<",1505,972.93,972.93,3264.67,376.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11603","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11603","EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<","11603 - EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<",1505,3264.67,972.93,3264.67,376.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11603","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11603","EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<","11603 - EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<",1505,1250.8,972.93,3264.67,376.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11603","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11603","EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<","11603 - EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<",1505,1250.8,972.93,3264.67,376.25]
["TUFTS - TUFTS HMO - CPT - 11603","TUFTS","TUFTS HMO","CPT","11603","EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<","11603 - EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<",1505,2057.7399999999998,972.93,3264.67,376.25]
["TUFTS - TUFTS POS - CPT - 11603","TUFTS","TUFTS POS","CPT","11603","EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<","11603 - EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<",1505,2058.17,972.93,3264.67,376.25]
["TUFTS - TUFTS PPO - CPT - 11603","TUFTS","TUFTS PPO","CPT","11603","EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<","11603 - EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<",1505,2058.16,972.93,3264.67,376.25]
["TUFTS - TUFTS SELECT - CPT - 11603","TUFTS","TUFTS SELECT","CPT","11603","EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<","11603 - EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<",1505,1098.98,972.93,3264.67,376.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11603","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11603","EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<","11603 - EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<",1505,1220.0899999999999,972.93,3264.67,376.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11603","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11603","EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<","11603 - EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<",1505,1250.8,972.93,3264.67,376.25]
["AETNA - AETNA - CPT - 11604","AETNA","AETNA","CPT","11604","EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM","11604 - EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM",1656,1500.85,972.93,7703.8,414]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11604","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11604","EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM","11604 - EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM",1656,972.93,972.93,7703.8,414]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11604","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11604","EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM","11604 - EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM",1656,972.93,972.93,7703.8,414]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11604","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11604","EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM","11604 - EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM",1656,972.93,972.93,7703.8,414]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11604","BLUE CROSS","BLUE CROSS-PPO","CPT","11604","EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM","11604 - EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM",1656,972.93,972.93,7703.8,414]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11604","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11604","EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM","11604 - EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM",1656,972.93,972.93,7703.8,414]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11604","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11604","EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM","11604 - EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM",1656,972.93,972.93,7703.8,414]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11604","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11604","EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM","11604 - EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM",1656,972.93,972.93,7703.8,414]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11604","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11604","EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM","11604 - EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM",1656,7703.8,972.93,7703.8,414]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11604","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11604","EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM","11604 - EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM",1656,1250.8,972.93,7703.8,414]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11604","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11604","EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM","11604 - EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM",1656,1250.8,972.93,7703.8,414]
["TUFTS - TUFTS HMO - CPT - 11604","TUFTS","TUFTS HMO","CPT","11604","EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM","11604 - EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM",1656,4856.75,972.93,7703.8,414]
["TUFTS - TUFTS POS - CPT - 11604","TUFTS","TUFTS POS","CPT","11604","EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM","11604 - EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM",1656,4856.75,972.93,7703.8,414]
["TUFTS - TUFTS PPO - CPT - 11604","TUFTS","TUFTS PPO","CPT","11604","EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM","11604 - EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM",1656,4856.75,972.93,7703.8,414]
["TUFTS - TUFTS SELECT - CPT - 11604","TUFTS","TUFTS SELECT","CPT","11604","EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM","11604 - EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM",1656,2593.31,972.93,7703.8,414]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11604","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11604","EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM","11604 - EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM",1656,1220.0899999999999,972.93,7703.8,414]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11604","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11604","EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM","11604 - EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM",1656,1250.8,972.93,7703.8,414]
["AETNA - AETNA - CPT - 11606","AETNA","AETNA","CPT","11606","EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM","11606 - EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM",2452,1500.85,1500.85,7703.8,613]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11606","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11606","EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM","11606 - EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM",2452,2309.9699999999998,1500.85,7703.8,613]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11606","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11606","EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM","11606 - EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM",2452,2309.9699999999998,1500.85,7703.8,613]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11606","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11606","EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM","11606 - EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM",2452,2309.9699999999998,1500.85,7703.8,613]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11606","BLUE CROSS","BLUE CROSS-PPO","CPT","11606","EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM","11606 - EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM",2452,2309.9699999999998,1500.85,7703.8,613]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11606","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11606","EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM","11606 - EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM",2452,2309.9699999999998,1500.85,7703.8,613]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11606","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11606","EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM","11606 - EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM",2452,2309.9699999999998,1500.85,7703.8,613]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11606","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11606","EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM","11606 - EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM",2452,2309.9699999999998,1500.85,7703.8,613]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11606","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11606","EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM","11606 - EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM",2452,7703.8,1500.85,7703.8,613]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11606","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11606","EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM","11606 - EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM",2452,2672.73,1500.85,7703.8,613]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11606","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11606","EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM","11606 - EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM",2452,2672.73,1500.85,7703.8,613]
["TUFTS - TUFTS HMO - CPT - 11606","TUFTS","TUFTS HMO","CPT","11606","EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM","11606 - EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM",2452,4856.75,1500.85,7703.8,613]
["TUFTS - TUFTS POS - CPT - 11606","TUFTS","TUFTS POS","CPT","11606","EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM","11606 - EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM",2452,4856.75,1500.85,7703.8,613]
["TUFTS - TUFTS PPO - CPT - 11606","TUFTS","TUFTS PPO","CPT","11606","EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM","11606 - EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM",2452,4856.75,1500.85,7703.8,613]
["TUFTS - TUFTS SELECT - CPT - 11606","TUFTS","TUFTS SELECT","CPT","11606","EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM","11606 - EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM",2452,2593.31,1500.85,7703.8,613]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11606","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11606","EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM","11606 - EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM",2452,2607.12,1500.85,7703.8,613]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11606","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11606","EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM","11606 - EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM",2452,2672.73,1500.85,7703.8,613]
["AETNA - AETNA - CPT - 11620","AETNA","AETNA","CPT","11620","EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<","11620 - EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<",930,1198.25,1098.98,3264.67,232.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11620","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11620","EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<","11620 - EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<",930,2309.9699999999998,1098.98,3264.67,232.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11620","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11620","EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<","11620 - EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<",930,2309.9699999999998,1098.98,3264.67,232.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11620","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11620","EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<","11620 - EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<",930,2309.9699999999998,1098.98,3264.67,232.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11620","BLUE CROSS","BLUE CROSS-PPO","CPT","11620","EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<","11620 - EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<",930,2309.9699999999998,1098.98,3264.67,232.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11620","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11620","EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<","11620 - EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<",930,2309.9699999999998,1098.98,3264.67,232.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11620","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11620","EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<","11620 - EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<",930,2309.9699999999998,1098.98,3264.67,232.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11620","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11620","EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<","11620 - EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<",930,2309.9699999999998,1098.98,3264.67,232.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11620","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11620","EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<","11620 - EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<",930,3264.67,1098.98,3264.67,232.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11620","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11620","EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<","11620 - EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<",930,2672.73,1098.98,3264.67,232.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11620","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11620","EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<","11620 - EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<",930,2672.73,1098.98,3264.67,232.5]
["TUFTS - TUFTS HMO - CPT - 11620","TUFTS","TUFTS HMO","CPT","11620","EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<","11620 - EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<",930,2057.7399999999998,1098.98,3264.67,232.5]
["TUFTS - TUFTS POS - CPT - 11620","TUFTS","TUFTS POS","CPT","11620","EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<","11620 - EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<",930,2058.17,1098.98,3264.67,232.5]
["TUFTS - TUFTS PPO - CPT - 11620","TUFTS","TUFTS PPO","CPT","11620","EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<","11620 - EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<",930,2058.16,1098.98,3264.67,232.5]
["TUFTS - TUFTS SELECT - CPT - 11620","TUFTS","TUFTS SELECT","CPT","11620","EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<","11620 - EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<",930,1098.98,1098.98,3264.67,232.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11620","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11620","EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<","11620 - EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<",930,2607.12,1098.98,3264.67,232.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11620","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11620","EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<","11620 - EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<",930,2672.73,1098.98,3264.67,232.5]
["AETNA - AETNA - CPT - 11621","AETNA","AETNA","CPT","11621","HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM","11621 - HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM",860,1198.25,684.11,2032.26,215]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11621","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11621","HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM","11621 - HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM",860,972.93,684.11,2032.26,215]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11621","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11621","HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM","11621 - HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM",860,972.93,684.11,2032.26,215]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11621","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11621","HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM","11621 - HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM",860,972.93,684.11,2032.26,215]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11621","BLUE CROSS","BLUE CROSS-PPO","CPT","11621","HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM","11621 - HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM",860,972.93,684.11,2032.26,215]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11621","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11621","HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM","11621 - HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM",860,972.93,684.11,2032.26,215]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11621","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11621","HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM","11621 - HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM",860,972.93,684.11,2032.26,215]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11621","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11621","HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM","11621 - HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM",860,972.93,684.11,2032.26,215]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11621","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11621","HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM","11621 - HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM",860,2032.26,684.11,2032.26,215]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11621","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11621","HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM","11621 - HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM",860,1250.8,684.11,2032.26,215]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11621","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11621","HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM","11621 - HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM",860,1250.8,684.11,2032.26,215]
["TUFTS - TUFTS HMO - CPT - 11621","TUFTS","TUFTS HMO","CPT","11621","HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM","11621 - HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM",860,1281.21,684.11,2032.26,215]
["TUFTS - TUFTS POS - CPT - 11621","TUFTS","TUFTS POS","CPT","11621","HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM","11621 - HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM",860,1281.21,684.11,2032.26,215]
["TUFTS - TUFTS PPO - CPT - 11621","TUFTS","TUFTS PPO","CPT","11621","HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM","11621 - HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM",860,1281.21,684.11,2032.26,215]
["TUFTS - TUFTS SELECT - CPT - 11621","TUFTS","TUFTS SELECT","CPT","11621","HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM","11621 - HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM",860,684.11,684.11,2032.26,215]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11621","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11621","HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM","11621 - HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM",860,1220.0899999999999,684.11,2032.26,215]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11621","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11621","HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM","11621 - HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM",860,1250.8,684.11,2032.26,215]
["AETNA - AETNA - CPT - 11622","AETNA","AETNA","CPT","11622","EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM","11622 - EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM",1324,1198.25,972.93,3264.67,331]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11622","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11622","EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM","11622 - EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM",1324,972.93,972.93,3264.67,331]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11622","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11622","EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM","11622 - EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM",1324,972.93,972.93,3264.67,331]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11622","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11622","EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM","11622 - EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM",1324,972.93,972.93,3264.67,331]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11622","BLUE CROSS","BLUE CROSS-PPO","CPT","11622","EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM","11622 - EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM",1324,972.93,972.93,3264.67,331]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11622","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11622","EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM","11622 - EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM",1324,972.93,972.93,3264.67,331]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11622","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11622","EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM","11622 - EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM",1324,972.93,972.93,3264.67,331]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11622","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11622","EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM","11622 - EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM",1324,972.93,972.93,3264.67,331]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11622","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11622","EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM","11622 - EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM",1324,3264.67,972.93,3264.67,331]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11622","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11622","EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM","11622 - EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM",1324,1250.8,972.93,3264.67,331]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11622","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11622","EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM","11622 - EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM",1324,1250.8,972.93,3264.67,331]
["TUFTS - TUFTS HMO - CPT - 11622","TUFTS","TUFTS HMO","CPT","11622","EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM","11622 - EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM",1324,2057.7399999999998,972.93,3264.67,331]
["TUFTS - TUFTS POS - CPT - 11622","TUFTS","TUFTS POS","CPT","11622","EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM","11622 - EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM",1324,2058.17,972.93,3264.67,331]
["TUFTS - TUFTS PPO - CPT - 11622","TUFTS","TUFTS PPO","CPT","11622","EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM","11622 - EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM",1324,2058.16,972.93,3264.67,331]
["TUFTS - TUFTS SELECT - CPT - 11622","TUFTS","TUFTS SELECT","CPT","11622","EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM","11622 - EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM",1324,1098.98,972.93,3264.67,331]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11622","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11622","EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM","11622 - EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM",1324,1220.0899999999999,972.93,3264.67,331]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11622","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11622","EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM","11622 - EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM",1324,1250.8,972.93,3264.67,331]
["AETNA - AETNA - CPT - 11623","AETNA","AETNA","CPT","11623","EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<","11623 - EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<",1637,1198.25,1098.98,3264.67,409.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11623","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11623","EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<","11623 - EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<",1637,2309.9699999999998,1098.98,3264.67,409.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11623","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11623","EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<","11623 - EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<",1637,2309.9699999999998,1098.98,3264.67,409.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11623","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11623","EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<","11623 - EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<",1637,2309.9699999999998,1098.98,3264.67,409.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11623","BLUE CROSS","BLUE CROSS-PPO","CPT","11623","EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<","11623 - EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<",1637,2309.9699999999998,1098.98,3264.67,409.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11623","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11623","EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<","11623 - EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<",1637,2309.9699999999998,1098.98,3264.67,409.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11623","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11623","EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<","11623 - EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<",1637,2309.9699999999998,1098.98,3264.67,409.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11623","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11623","EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<","11623 - EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<",1637,2309.9699999999998,1098.98,3264.67,409.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11623","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11623","EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<","11623 - EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<",1637,3264.67,1098.98,3264.67,409.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11623","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11623","EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<","11623 - EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<",1637,2672.73,1098.98,3264.67,409.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11623","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11623","EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<","11623 - EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<",1637,2672.73,1098.98,3264.67,409.25]
["TUFTS - TUFTS HMO - CPT - 11623","TUFTS","TUFTS HMO","CPT","11623","EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<","11623 - EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<",1637,2057.7399999999998,1098.98,3264.67,409.25]
["TUFTS - TUFTS POS - CPT - 11623","TUFTS","TUFTS POS","CPT","11623","EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<","11623 - EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<",1637,2058.17,1098.98,3264.67,409.25]
["TUFTS - TUFTS PPO - CPT - 11623","TUFTS","TUFTS PPO","CPT","11623","EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<","11623 - EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<",1637,2058.16,1098.98,3264.67,409.25]
["TUFTS - TUFTS SELECT - CPT - 11623","TUFTS","TUFTS SELECT","CPT","11623","EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<","11623 - EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<",1637,1098.98,1098.98,3264.67,409.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11623","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11623","EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<","11623 - EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<",1637,2607.12,1098.98,3264.67,409.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11623","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11623","EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<","11623 - EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<",1637,2672.73,1098.98,3264.67,409.25]
["AETNA - AETNA - CPT - 11624","AETNA","AETNA","CPT","11624","EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM","11624 - EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM",1856,1500.85,1500.85,7703.8,464]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11624","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11624","EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM","11624 - EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM",1856,2309.9699999999998,1500.85,7703.8,464]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11624","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11624","EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM","11624 - EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM",1856,2309.9699999999998,1500.85,7703.8,464]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11624","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11624","EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM","11624 - EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM",1856,2309.9699999999998,1500.85,7703.8,464]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11624","BLUE CROSS","BLUE CROSS-PPO","CPT","11624","EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM","11624 - EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM",1856,2309.9699999999998,1500.85,7703.8,464]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11624","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11624","EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM","11624 - EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM",1856,2309.9699999999998,1500.85,7703.8,464]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11624","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11624","EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM","11624 - EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM",1856,2309.9699999999998,1500.85,7703.8,464]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11624","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11624","EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM","11624 - EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM",1856,2309.9699999999998,1500.85,7703.8,464]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11624","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11624","EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM","11624 - EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM",1856,7703.8,1500.85,7703.8,464]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11624","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11624","EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM","11624 - EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM",1856,2672.73,1500.85,7703.8,464]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11624","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11624","EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM","11624 - EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM",1856,2672.73,1500.85,7703.8,464]
["TUFTS - TUFTS HMO - CPT - 11624","TUFTS","TUFTS HMO","CPT","11624","EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM","11624 - EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM",1856,4856.75,1500.85,7703.8,464]
["TUFTS - TUFTS POS - CPT - 11624","TUFTS","TUFTS POS","CPT","11624","EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM","11624 - EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM",1856,4856.75,1500.85,7703.8,464]
["TUFTS - TUFTS PPO - CPT - 11624","TUFTS","TUFTS PPO","CPT","11624","EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM","11624 - EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM",1856,4856.75,1500.85,7703.8,464]
["TUFTS - TUFTS SELECT - CPT - 11624","TUFTS","TUFTS SELECT","CPT","11624","EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM","11624 - EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM",1856,2593.31,1500.85,7703.8,464]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11624","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11624","EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM","11624 - EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM",1856,2607.12,1500.85,7703.8,464]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11624","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11624","EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM","11624 - EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM",1856,2672.73,1500.85,7703.8,464]
["AETNA - AETNA - CPT - 11626","AETNA","AETNA","CPT","11626","EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM","11626 - EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM",2987,1500.85,1500.85,7703.8,746.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11626","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11626","EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM","11626 - EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM",2987,3994.03,1500.85,7703.8,746.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11626","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11626","EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM","11626 - EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM",2987,3994.03,1500.85,7703.8,746.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11626","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11626","EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM","11626 - EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM",2987,3994.03,1500.85,7703.8,746.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11626","BLUE CROSS","BLUE CROSS-PPO","CPT","11626","EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM","11626 - EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM",2987,3994.03,1500.85,7703.8,746.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11626","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11626","EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM","11626 - EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM",2987,3994.03,1500.85,7703.8,746.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11626","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11626","EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM","11626 - EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM",2987,3994.03,1500.85,7703.8,746.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11626","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11626","EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM","11626 - EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM",2987,3994.03,1500.85,7703.8,746.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11626","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11626","EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM","11626 - EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM",2987,7703.8,1500.85,7703.8,746.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11626","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11626","EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM","11626 - EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM",2987,4621.25,1500.85,7703.8,746.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11626","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11626","EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM","11626 - EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM",2987,4621.25,1500.85,7703.8,746.75]
["TUFTS - TUFTS HMO - CPT - 11626","TUFTS","TUFTS HMO","CPT","11626","EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM","11626 - EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM",2987,4856.75,1500.85,7703.8,746.75]
["TUFTS - TUFTS POS - CPT - 11626","TUFTS","TUFTS POS","CPT","11626","EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM","11626 - EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM",2987,4856.75,1500.85,7703.8,746.75]
["TUFTS - TUFTS PPO - CPT - 11626","TUFTS","TUFTS PPO","CPT","11626","EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM","11626 - EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM",2987,4856.75,1500.85,7703.8,746.75]
["TUFTS - TUFTS SELECT - CPT - 11626","TUFTS","TUFTS SELECT","CPT","11626","EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM","11626 - EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM",2987,2593.31,1500.85,7703.8,746.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11626","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11626","EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM","11626 - EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM",2987,4507.8100000000004,1500.85,7703.8,746.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11626","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11626","EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM","11626 - EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM",2987,4621.25,1500.85,7703.8,746.75]
["AETNA - AETNA - CPT - 11640","AETNA","AETNA","CPT","11640","EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<","11640 - EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<",967,1500.85,684.11,2032.26,241.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11640","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11640","EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<","11640 - EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<",967,972.93,684.11,2032.26,241.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11640","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11640","EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<","11640 - EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<",967,972.93,684.11,2032.26,241.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11640","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11640","EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<","11640 - EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<",967,972.93,684.11,2032.26,241.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11640","BLUE CROSS","BLUE CROSS-PPO","CPT","11640","EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<","11640 - EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<",967,972.93,684.11,2032.26,241.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11640","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11640","EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<","11640 - EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<",967,972.93,684.11,2032.26,241.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11640","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11640","EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<","11640 - EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<",967,972.93,684.11,2032.26,241.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11640","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11640","EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<","11640 - EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<",967,972.93,684.11,2032.26,241.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11640","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11640","EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<","11640 - EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<",967,2032.26,684.11,2032.26,241.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11640","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11640","EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<","11640 - EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<",967,1250.8,684.11,2032.26,241.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11640","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11640","EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<","11640 - EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<",967,1250.8,684.11,2032.26,241.75]
["TUFTS - TUFTS HMO - CPT - 11640","TUFTS","TUFTS HMO","CPT","11640","EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<","11640 - EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<",967,1281.21,684.11,2032.26,241.75]
["TUFTS - TUFTS POS - CPT - 11640","TUFTS","TUFTS POS","CPT","11640","EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<","11640 - EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<",967,1281.21,684.11,2032.26,241.75]
["TUFTS - TUFTS PPO - CPT - 11640","TUFTS","TUFTS PPO","CPT","11640","EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<","11640 - EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<",967,1281.21,684.11,2032.26,241.75]
["TUFTS - TUFTS SELECT - CPT - 11640","TUFTS","TUFTS SELECT","CPT","11640","EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<","11640 - EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<",967,684.11,684.11,2032.26,241.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11640","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11640","EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<","11640 - EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<",967,1220.0899999999999,684.11,2032.26,241.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11640","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11640","EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<","11640 - EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<",967,1250.8,684.11,2032.26,241.75]
["AETNA - AETNA - CPT - 11642","AETNA","AETNA","CPT","11642","HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL","11642 - HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL",870,1500.85,684.11,2032.26,217.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11642","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11642","HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL","11642 - HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL",870,972.93,684.11,2032.26,217.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11642","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11642","HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL","11642 - HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL",870,972.93,684.11,2032.26,217.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11642","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11642","HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL","11642 - HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL",870,972.93,684.11,2032.26,217.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11642","BLUE CROSS","BLUE CROSS-PPO","CPT","11642","HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL","11642 - HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL",870,972.93,684.11,2032.26,217.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11642","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11642","HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL","11642 - HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL",870,972.93,684.11,2032.26,217.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11642","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11642","HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL","11642 - HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL",870,972.93,684.11,2032.26,217.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11642","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11642","HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL","11642 - HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL",870,972.93,684.11,2032.26,217.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11642","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11642","HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL","11642 - HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL",870,2032.26,684.11,2032.26,217.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11642","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11642","HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL","11642 - HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL",870,1250.8,684.11,2032.26,217.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11642","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11642","HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL","11642 - HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL",870,1250.8,684.11,2032.26,217.5]
["TUFTS - TUFTS HMO - CPT - 11642","TUFTS","TUFTS HMO","CPT","11642","HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL","11642 - HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL",870,1281.21,684.11,2032.26,217.5]
["TUFTS - TUFTS POS - CPT - 11642","TUFTS","TUFTS POS","CPT","11642","HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL","11642 - HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL",870,1281.21,684.11,2032.26,217.5]
["TUFTS - TUFTS PPO - CPT - 11642","TUFTS","TUFTS PPO","CPT","11642","HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL","11642 - HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL",870,1281.21,684.11,2032.26,217.5]
["TUFTS - TUFTS SELECT - CPT - 11642","TUFTS","TUFTS SELECT","CPT","11642","HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL","11642 - HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL",870,684.11,684.11,2032.26,217.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11642","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11642","HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL","11642 - HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL",870,1220.0899999999999,684.11,2032.26,217.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11642","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11642","HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL","11642 - HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL",870,1250.8,684.11,2032.26,217.5]
["AETNA - AETNA - CPT - 11643","AETNA","AETNA","CPT","11643","EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<","11643 - EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<",1786,1500.85,1098.98,3264.67,446.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11643","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11643","EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<","11643 - EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<",1786,2309.9699999999998,1098.98,3264.67,446.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11643","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11643","EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<","11643 - EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<",1786,2309.9699999999998,1098.98,3264.67,446.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11643","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11643","EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<","11643 - EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<",1786,2309.9699999999998,1098.98,3264.67,446.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11643","BLUE CROSS","BLUE CROSS-PPO","CPT","11643","EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<","11643 - EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<",1786,2309.9699999999998,1098.98,3264.67,446.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11643","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11643","EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<","11643 - EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<",1786,2309.9699999999998,1098.98,3264.67,446.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11643","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11643","EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<","11643 - EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<",1786,2309.9699999999998,1098.98,3264.67,446.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11643","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11643","EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<","11643 - EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<",1786,2309.9699999999998,1098.98,3264.67,446.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11643","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11643","EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<","11643 - EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<",1786,3264.67,1098.98,3264.67,446.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11643","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11643","EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<","11643 - EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<",1786,2672.73,1098.98,3264.67,446.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11643","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11643","EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<","11643 - EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<",1786,2672.73,1098.98,3264.67,446.5]
["TUFTS - TUFTS HMO - CPT - 11643","TUFTS","TUFTS HMO","CPT","11643","EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<","11643 - EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<",1786,2057.7399999999998,1098.98,3264.67,446.5]
["TUFTS - TUFTS POS - CPT - 11643","TUFTS","TUFTS POS","CPT","11643","EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<","11643 - EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<",1786,2058.17,1098.98,3264.67,446.5]
["TUFTS - TUFTS PPO - CPT - 11643","TUFTS","TUFTS PPO","CPT","11643","EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<","11643 - EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<",1786,2058.16,1098.98,3264.67,446.5]
["TUFTS - TUFTS SELECT - CPT - 11643","TUFTS","TUFTS SELECT","CPT","11643","EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<","11643 - EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<",1786,1098.98,1098.98,3264.67,446.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11643","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11643","EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<","11643 - EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<",1786,2607.12,1098.98,3264.67,446.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11643","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11643","EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<","11643 - EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<",1786,2672.73,1098.98,3264.67,446.5]
["AETNA - AETNA - CPT - 11644","AETNA","AETNA","CPT","11644","EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM","11644 - EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM",2210,1500.85,1500.85,7703.8,552.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11644","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11644","EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM","11644 - EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM",2210,2309.9699999999998,1500.85,7703.8,552.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11644","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11644","EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM","11644 - EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM",2210,2309.9699999999998,1500.85,7703.8,552.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11644","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11644","EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM","11644 - EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM",2210,2309.9699999999998,1500.85,7703.8,552.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11644","BLUE CROSS","BLUE CROSS-PPO","CPT","11644","EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM","11644 - EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM",2210,2309.9699999999998,1500.85,7703.8,552.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11644","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11644","EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM","11644 - EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM",2210,2309.9699999999998,1500.85,7703.8,552.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11644","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11644","EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM","11644 - EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM",2210,2309.9699999999998,1500.85,7703.8,552.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11644","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11644","EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM","11644 - EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM",2210,2309.9699999999998,1500.85,7703.8,552.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11644","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11644","EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM","11644 - EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM",2210,7703.8,1500.85,7703.8,552.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11644","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11644","EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM","11644 - EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM",2210,2672.73,1500.85,7703.8,552.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11644","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11644","EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM","11644 - EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM",2210,2672.73,1500.85,7703.8,552.5]
["TUFTS - TUFTS HMO - CPT - 11644","TUFTS","TUFTS HMO","CPT","11644","EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM","11644 - EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM",2210,4856.75,1500.85,7703.8,552.5]
["TUFTS - TUFTS POS - CPT - 11644","TUFTS","TUFTS POS","CPT","11644","EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM","11644 - EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM",2210,4856.75,1500.85,7703.8,552.5]
["TUFTS - TUFTS PPO - CPT - 11644","TUFTS","TUFTS PPO","CPT","11644","EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM","11644 - EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM",2210,4856.75,1500.85,7703.8,552.5]
["TUFTS - TUFTS SELECT - CPT - 11644","TUFTS","TUFTS SELECT","CPT","11644","EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM","11644 - EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM",2210,2593.31,1500.85,7703.8,552.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11644","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11644","EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM","11644 - EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM",2210,2607.12,1500.85,7703.8,552.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11644","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11644","EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM","11644 - EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM",2210,2672.73,1500.85,7703.8,552.5]
["AETNA - AETNA - CPT - 11646","AETNA","AETNA","CPT","11646","EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM","11646 - EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM",3063,1500.85,1500.85,7703.8,765.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11646","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11646","EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM","11646 - EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM",3063,3994.03,1500.85,7703.8,765.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11646","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11646","EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM","11646 - EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM",3063,3994.03,1500.85,7703.8,765.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11646","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11646","EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM","11646 - EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM",3063,3994.03,1500.85,7703.8,765.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11646","BLUE CROSS","BLUE CROSS-PPO","CPT","11646","EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM","11646 - EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM",3063,3994.03,1500.85,7703.8,765.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11646","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11646","EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM","11646 - EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM",3063,3994.03,1500.85,7703.8,765.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11646","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11646","EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM","11646 - EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM",3063,3994.03,1500.85,7703.8,765.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11646","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11646","EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM","11646 - EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM",3063,3994.03,1500.85,7703.8,765.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11646","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11646","EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM","11646 - EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM",3063,7703.8,1500.85,7703.8,765.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11646","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11646","EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM","11646 - EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM",3063,4621.25,1500.85,7703.8,765.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11646","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11646","EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM","11646 - EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM",3063,4621.25,1500.85,7703.8,765.75]
["TUFTS - TUFTS HMO - CPT - 11646","TUFTS","TUFTS HMO","CPT","11646","EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM","11646 - EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM",3063,4856.75,1500.85,7703.8,765.75]
["TUFTS - TUFTS POS - CPT - 11646","TUFTS","TUFTS POS","CPT","11646","EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM","11646 - EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM",3063,4856.75,1500.85,7703.8,765.75]
["TUFTS - TUFTS PPO - CPT - 11646","TUFTS","TUFTS PPO","CPT","11646","EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM","11646 - EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM",3063,4856.75,1500.85,7703.8,765.75]
["TUFTS - TUFTS SELECT - CPT - 11646","TUFTS","TUFTS SELECT","CPT","11646","EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM","11646 - EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM",3063,2593.31,1500.85,7703.8,765.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11646","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11646","EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM","11646 - EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM",3063,4507.8100000000004,1500.85,7703.8,765.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11646","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11646","EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM","11646 - EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM",3063,4621.25,1500.85,7703.8,765.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11719","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11719","TRIMMING NONDYSTROPHIC NAILS ANY NUMBER","11719 - TRIMMING NONDYSTROPHIC NAILS ANY NUMBER",106,93.87,93.87,508.23,26.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11719","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11719","TRIMMING NONDYSTROPHIC NAILS ANY NUMBER","11719 - TRIMMING NONDYSTROPHIC NAILS ANY NUMBER",106,93.87,93.87,508.23,26.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11719","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11719","TRIMMING NONDYSTROPHIC NAILS ANY NUMBER","11719 - TRIMMING NONDYSTROPHIC NAILS ANY NUMBER",106,93.87,93.87,508.23,26.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11719","BLUE CROSS","BLUE CROSS-PPO","CPT","11719","TRIMMING NONDYSTROPHIC NAILS ANY NUMBER","11719 - TRIMMING NONDYSTROPHIC NAILS ANY NUMBER",106,93.87,93.87,508.23,26.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11719","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11719","TRIMMING NONDYSTROPHIC NAILS ANY NUMBER","11719 - TRIMMING NONDYSTROPHIC NAILS ANY NUMBER",106,93.87,93.87,508.23,26.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11719","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11719","TRIMMING NONDYSTROPHIC NAILS ANY NUMBER","11719 - TRIMMING NONDYSTROPHIC NAILS ANY NUMBER",106,93.87,93.87,508.23,26.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11719","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11719","TRIMMING NONDYSTROPHIC NAILS ANY NUMBER","11719 - TRIMMING NONDYSTROPHIC NAILS ANY NUMBER",106,93.87,93.87,508.23,26.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11719","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11719","TRIMMING NONDYSTROPHIC NAILS ANY NUMBER","11719 - TRIMMING NONDYSTROPHIC NAILS ANY NUMBER",106,508.23,93.87,508.23,26.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11719","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11719","TRIMMING NONDYSTROPHIC NAILS ANY NUMBER","11719 - TRIMMING NONDYSTROPHIC NAILS ANY NUMBER",106,120.69,93.87,508.23,26.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11719","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11719","TRIMMING NONDYSTROPHIC NAILS ANY NUMBER","11719 - TRIMMING NONDYSTROPHIC NAILS ANY NUMBER",106,120.69,93.87,508.23,26.5]
["TUFTS - TUFTS HMO - CPT - 11719","TUFTS","TUFTS HMO","CPT","11719","TRIMMING NONDYSTROPHIC NAILS ANY NUMBER","11719 - TRIMMING NONDYSTROPHIC NAILS ANY NUMBER",106,320.41000000000003,93.87,508.23,26.5]
["TUFTS - TUFTS POS - CPT - 11719","TUFTS","TUFTS POS","CPT","11719","TRIMMING NONDYSTROPHIC NAILS ANY NUMBER","11719 - TRIMMING NONDYSTROPHIC NAILS ANY NUMBER",106,320.41000000000003,93.87,508.23,26.5]
["TUFTS - TUFTS PPO - CPT - 11719","TUFTS","TUFTS PPO","CPT","11719","TRIMMING NONDYSTROPHIC NAILS ANY NUMBER","11719 - TRIMMING NONDYSTROPHIC NAILS ANY NUMBER",106,320.41000000000003,93.87,508.23,26.5]
["TUFTS - TUFTS SELECT - CPT - 11719","TUFTS","TUFTS SELECT","CPT","11719","TRIMMING NONDYSTROPHIC NAILS ANY NUMBER","11719 - TRIMMING NONDYSTROPHIC NAILS ANY NUMBER",106,171.09,93.87,508.23,26.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11719","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11719","TRIMMING NONDYSTROPHIC NAILS ANY NUMBER","11719 - TRIMMING NONDYSTROPHIC NAILS ANY NUMBER",106,117.73,93.87,508.23,26.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11719","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11719","TRIMMING NONDYSTROPHIC NAILS ANY NUMBER","11719 - TRIMMING NONDYSTROPHIC NAILS ANY NUMBER",106,120.69,93.87,508.23,26.5]
["AETNA - AETNA - CPT - 11720","AETNA","AETNA","CPT","11720","DEBRIDEMENT NAIL ANY METHOD 1-5","11720 - DEBRIDEMENT NAIL ANY METHOD 1-5",165,1198.25,93.87,1198.25,41.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11720","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11720","DEBRIDEMENT NAIL ANY METHOD 1-5","11720 - DEBRIDEMENT NAIL ANY METHOD 1-5",165,93.87,93.87,1198.25,41.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11720","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11720","DEBRIDEMENT NAIL ANY METHOD 1-5","11720 - DEBRIDEMENT NAIL ANY METHOD 1-5",165,93.87,93.87,1198.25,41.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11720","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11720","DEBRIDEMENT NAIL ANY METHOD 1-5","11720 - DEBRIDEMENT NAIL ANY METHOD 1-5",165,93.87,93.87,1198.25,41.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11720","BLUE CROSS","BLUE CROSS-PPO","CPT","11720","DEBRIDEMENT NAIL ANY METHOD 1-5","11720 - DEBRIDEMENT NAIL ANY METHOD 1-5",165,93.87,93.87,1198.25,41.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11720","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11720","DEBRIDEMENT NAIL ANY METHOD 1-5","11720 - DEBRIDEMENT NAIL ANY METHOD 1-5",165,93.87,93.87,1198.25,41.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11720","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11720","DEBRIDEMENT NAIL ANY METHOD 1-5","11720 - DEBRIDEMENT NAIL ANY METHOD 1-5",165,93.87,93.87,1198.25,41.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11720","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11720","DEBRIDEMENT NAIL ANY METHOD 1-5","11720 - DEBRIDEMENT NAIL ANY METHOD 1-5",165,93.87,93.87,1198.25,41.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11720","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11720","DEBRIDEMENT NAIL ANY METHOD 1-5","11720 - DEBRIDEMENT NAIL ANY METHOD 1-5",165,508.23,93.87,1198.25,41.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11720","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11720","DEBRIDEMENT NAIL ANY METHOD 1-5","11720 - DEBRIDEMENT NAIL ANY METHOD 1-5",165,120.69,93.87,1198.25,41.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11720","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11720","DEBRIDEMENT NAIL ANY METHOD 1-5","11720 - DEBRIDEMENT NAIL ANY METHOD 1-5",165,120.69,93.87,1198.25,41.25]
["TUFTS - TUFTS HMO - CPT - 11720","TUFTS","TUFTS HMO","CPT","11720","DEBRIDEMENT NAIL ANY METHOD 1-5","11720 - DEBRIDEMENT NAIL ANY METHOD 1-5",165,320.41000000000003,93.87,1198.25,41.25]
["TUFTS - TUFTS POS - CPT - 11720","TUFTS","TUFTS POS","CPT","11720","DEBRIDEMENT NAIL ANY METHOD 1-5","11720 - DEBRIDEMENT NAIL ANY METHOD 1-5",165,320.41000000000003,93.87,1198.25,41.25]
["TUFTS - TUFTS PPO - CPT - 11720","TUFTS","TUFTS PPO","CPT","11720","DEBRIDEMENT NAIL ANY METHOD 1-5","11720 - DEBRIDEMENT NAIL ANY METHOD 1-5",165,320.41000000000003,93.87,1198.25,41.25]
["TUFTS - TUFTS SELECT - CPT - 11720","TUFTS","TUFTS SELECT","CPT","11720","DEBRIDEMENT NAIL ANY METHOD 1-5","11720 - DEBRIDEMENT NAIL ANY METHOD 1-5",165,171.09,93.87,1198.25,41.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11720","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11720","DEBRIDEMENT NAIL ANY METHOD 1-5","11720 - DEBRIDEMENT NAIL ANY METHOD 1-5",165,117.73,93.87,1198.25,41.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11720","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11720","DEBRIDEMENT NAIL ANY METHOD 1-5","11720 - DEBRIDEMENT NAIL ANY METHOD 1-5",165,120.69,93.87,1198.25,41.25]
["AETNA - AETNA - CPT - 11721","AETNA","AETNA","CPT","11721","DEBRIDEMENT NAIL ANY METHOD 6/>","11721 - DEBRIDEMENT NAIL ANY METHOD 6/>",187,1198.25,93.87,1198.25,46.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11721","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11721","DEBRIDEMENT NAIL ANY METHOD 6/>","11721 - DEBRIDEMENT NAIL ANY METHOD 6/>",187,93.87,93.87,1198.25,46.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11721","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11721","DEBRIDEMENT NAIL ANY METHOD 6/>","11721 - DEBRIDEMENT NAIL ANY METHOD 6/>",187,93.87,93.87,1198.25,46.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11721","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11721","DEBRIDEMENT NAIL ANY METHOD 6/>","11721 - DEBRIDEMENT NAIL ANY METHOD 6/>",187,93.87,93.87,1198.25,46.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11721","BLUE CROSS","BLUE CROSS-PPO","CPT","11721","DEBRIDEMENT NAIL ANY METHOD 6/>","11721 - DEBRIDEMENT NAIL ANY METHOD 6/>",187,93.87,93.87,1198.25,46.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11721","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11721","DEBRIDEMENT NAIL ANY METHOD 6/>","11721 - DEBRIDEMENT NAIL ANY METHOD 6/>",187,93.87,93.87,1198.25,46.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11721","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11721","DEBRIDEMENT NAIL ANY METHOD 6/>","11721 - DEBRIDEMENT NAIL ANY METHOD 6/>",187,93.87,93.87,1198.25,46.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11721","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11721","DEBRIDEMENT NAIL ANY METHOD 6/>","11721 - DEBRIDEMENT NAIL ANY METHOD 6/>",187,93.87,93.87,1198.25,46.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11721","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11721","DEBRIDEMENT NAIL ANY METHOD 6/>","11721 - DEBRIDEMENT NAIL ANY METHOD 6/>",187,508.23,93.87,1198.25,46.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11721","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11721","DEBRIDEMENT NAIL ANY METHOD 6/>","11721 - DEBRIDEMENT NAIL ANY METHOD 6/>",187,120.69,93.87,1198.25,46.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11721","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11721","DEBRIDEMENT NAIL ANY METHOD 6/>","11721 - DEBRIDEMENT NAIL ANY METHOD 6/>",187,120.69,93.87,1198.25,46.75]
["TUFTS - TUFTS HMO - CPT - 11721","TUFTS","TUFTS HMO","CPT","11721","DEBRIDEMENT NAIL ANY METHOD 6/>","11721 - DEBRIDEMENT NAIL ANY METHOD 6/>",187,320.41000000000003,93.87,1198.25,46.75]
["TUFTS - TUFTS POS - CPT - 11721","TUFTS","TUFTS POS","CPT","11721","DEBRIDEMENT NAIL ANY METHOD 6/>","11721 - DEBRIDEMENT NAIL ANY METHOD 6/>",187,320.41000000000003,93.87,1198.25,46.75]
["TUFTS - TUFTS PPO - CPT - 11721","TUFTS","TUFTS PPO","CPT","11721","DEBRIDEMENT NAIL ANY METHOD 6/>","11721 - DEBRIDEMENT NAIL ANY METHOD 6/>",187,320.41000000000003,93.87,1198.25,46.75]
["TUFTS - TUFTS SELECT - CPT - 11721","TUFTS","TUFTS SELECT","CPT","11721","DEBRIDEMENT NAIL ANY METHOD 6/>","11721 - DEBRIDEMENT NAIL ANY METHOD 6/>",187,171.09,93.87,1198.25,46.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11721","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11721","DEBRIDEMENT NAIL ANY METHOD 6/>","11721 - DEBRIDEMENT NAIL ANY METHOD 6/>",187,117.73,93.87,1198.25,46.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11721","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11721","DEBRIDEMENT NAIL ANY METHOD 6/>","11721 - DEBRIDEMENT NAIL ANY METHOD 6/>",187,120.69,93.87,1198.25,46.75]
["AETNA - AETNA - CPT - 11730","AETNA","AETNA","CPT","11730","AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1","11730 - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1",383,1198.25,296.32,1198.25,95.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11730","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11730","AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1","11730 - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1",383,296.32,296.32,1198.25,95.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11730","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11730","AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1","11730 - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1",383,296.32,296.32,1198.25,95.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11730","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11730","AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1","11730 - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1",383,296.32,296.32,1198.25,95.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11730","BLUE CROSS","BLUE CROSS-PPO","CPT","11730","AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1","11730 - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1",383,296.32,296.32,1198.25,95.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11730","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11730","AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1","11730 - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1",383,296.32,296.32,1198.25,95.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11730","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11730","AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1","11730 - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1",383,296.32,296.32,1198.25,95.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11730","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11730","AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1","11730 - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1",383,296.32,296.32,1198.25,95.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11730","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11730","AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1","11730 - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1",383,943.8,296.32,1198.25,95.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11730","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11730","AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1","11730 - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1",383,380.96,296.32,1198.25,95.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11730","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11730","AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1","11730 - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1",383,380.96,296.32,1198.25,95.75]
["TUFTS - TUFTS HMO - CPT - 11730","TUFTS","TUFTS HMO","CPT","11730","AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1","11730 - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1",383,595.01,296.32,1198.25,95.75]
["TUFTS - TUFTS POS - CPT - 11730","TUFTS","TUFTS POS","CPT","11730","AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1","11730 - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1",383,595.01,296.32,1198.25,95.75]
["TUFTS - TUFTS PPO - CPT - 11730","TUFTS","TUFTS PPO","CPT","11730","AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1","11730 - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1",383,595.01,296.32,1198.25,95.75]
["TUFTS - TUFTS SELECT - CPT - 11730","TUFTS","TUFTS SELECT","CPT","11730","AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1","11730 - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1",383,317.70999999999998,296.32,1198.25,95.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11730","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11730","AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1","11730 - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1",383,371.6,296.32,1198.25,95.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11730","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11730","AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1","11730 - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1",383,380.96,296.32,1198.25,95.75]
["AETNA - AETNA - CPT - 11732","AETNA","AETNA","CPT","11732","AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL","11732 - AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL",155,1198.25,43.37,1198.25,38.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11732","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11732","AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL","11732 - AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL",155,43.37,43.37,1198.25,38.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11732","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11732","AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL","11732 - AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL",155,43.37,43.37,1198.25,38.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11732","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11732","AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL","11732 - AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL",155,43.37,43.37,1198.25,38.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11732","BLUE CROSS","BLUE CROSS-PPO","CPT","11732","AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL","11732 - AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL",155,43.37,43.37,1198.25,38.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11732","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11732","AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL","11732 - AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL",155,43.37,43.37,1198.25,38.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11732","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11732","AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL","11732 - AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL",155,43.37,43.37,1198.25,38.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11732","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11732","AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL","11732 - AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL",155,43.37,43.37,1198.25,38.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11732","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11732","AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL","11732 - AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL",155,0,43.37,1198.25,38.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11732","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11732","AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL","11732 - AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL",155,0,43.37,1198.25,38.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11732","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11732","AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL","11732 - AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL",155,0,43.37,1198.25,38.75]
["TUFTS - TUFTS HMO - CPT - 11732","TUFTS","TUFTS HMO","CPT","11732","AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL","11732 - AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL",155,0,43.37,1198.25,38.75]
["TUFTS - TUFTS POS - CPT - 11732","TUFTS","TUFTS POS","CPT","11732","AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL","11732 - AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL",155,0,43.37,1198.25,38.75]
["TUFTS - TUFTS PPO - CPT - 11732","TUFTS","TUFTS PPO","CPT","11732","AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL","11732 - AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL",155,0,43.37,1198.25,38.75]
["TUFTS - TUFTS SELECT - CPT - 11732","TUFTS","TUFTS SELECT","CPT","11732","AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL","11732 - AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL",155,0,43.37,1198.25,38.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11732","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11732","AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL","11732 - AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL",155,0,43.37,1198.25,38.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11732","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11732","AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL","11732 - AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL",155,0,43.37,1198.25,38.75]
["AETNA - AETNA - CPT - 11740","AETNA","AETNA","CPT","11740","EVACUATION SUBUNGUAL HEMATOMA","11740 - EVACUATION SUBUNGUAL HEMATOMA",246,1198.25,178.83,1198.25,61.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11740","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11740","EVACUATION SUBUNGUAL HEMATOMA","11740 - EVACUATION SUBUNGUAL HEMATOMA",246,178.83,178.83,1198.25,61.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11740","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11740","EVACUATION SUBUNGUAL HEMATOMA","11740 - EVACUATION SUBUNGUAL HEMATOMA",246,178.83,178.83,1198.25,61.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11740","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11740","EVACUATION SUBUNGUAL HEMATOMA","11740 - EVACUATION SUBUNGUAL HEMATOMA",246,178.83,178.83,1198.25,61.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11740","BLUE CROSS","BLUE CROSS-PPO","CPT","11740","EVACUATION SUBUNGUAL HEMATOMA","11740 - EVACUATION SUBUNGUAL HEMATOMA",246,178.83,178.83,1198.25,61.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11740","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11740","EVACUATION SUBUNGUAL HEMATOMA","11740 - EVACUATION SUBUNGUAL HEMATOMA",246,178.83,178.83,1198.25,61.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11740","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11740","EVACUATION SUBUNGUAL HEMATOMA","11740 - EVACUATION SUBUNGUAL HEMATOMA",246,178.83,178.83,1198.25,61.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11740","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11740","EVACUATION SUBUNGUAL HEMATOMA","11740 - EVACUATION SUBUNGUAL HEMATOMA",246,178.83,178.83,1198.25,61.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11740","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11740","EVACUATION SUBUNGUAL HEMATOMA","11740 - EVACUATION SUBUNGUAL HEMATOMA",246,943.8,178.83,1198.25,61.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11740","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11740","EVACUATION SUBUNGUAL HEMATOMA","11740 - EVACUATION SUBUNGUAL HEMATOMA",246,229.89,178.83,1198.25,61.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11740","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11740","EVACUATION SUBUNGUAL HEMATOMA","11740 - EVACUATION SUBUNGUAL HEMATOMA",246,229.89,178.83,1198.25,61.5]
["TUFTS - TUFTS HMO - CPT - 11740","TUFTS","TUFTS HMO","CPT","11740","EVACUATION SUBUNGUAL HEMATOMA","11740 - EVACUATION SUBUNGUAL HEMATOMA",246,595.01,178.83,1198.25,61.5]
["TUFTS - TUFTS POS - CPT - 11740","TUFTS","TUFTS POS","CPT","11740","EVACUATION SUBUNGUAL HEMATOMA","11740 - EVACUATION SUBUNGUAL HEMATOMA",246,595.01,178.83,1198.25,61.5]
["TUFTS - TUFTS PPO - CPT - 11740","TUFTS","TUFTS PPO","CPT","11740","EVACUATION SUBUNGUAL HEMATOMA","11740 - EVACUATION SUBUNGUAL HEMATOMA",246,595.01,178.83,1198.25,61.5]
["TUFTS - TUFTS SELECT - CPT - 11740","TUFTS","TUFTS SELECT","CPT","11740","EVACUATION SUBUNGUAL HEMATOMA","11740 - EVACUATION SUBUNGUAL HEMATOMA",246,317.70999999999998,178.83,1198.25,61.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11740","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11740","EVACUATION SUBUNGUAL HEMATOMA","11740 - EVACUATION SUBUNGUAL HEMATOMA",246,224.25,178.83,1198.25,61.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11740","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11740","EVACUATION SUBUNGUAL HEMATOMA","11740 - EVACUATION SUBUNGUAL HEMATOMA",246,229.89,178.83,1198.25,61.5]
["AETNA - AETNA - CPT - 11750","AETNA","AETNA","CPT","11750","EXCISION NAIL MATRIX PERMANENT REMOVAL","11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL",1315,1198.25,527.46,2032.26,328.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11750","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11750","EXCISION NAIL MATRIX PERMANENT REMOVAL","11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL",1315,527.46,527.46,2032.26,328.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11750","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11750","EXCISION NAIL MATRIX PERMANENT REMOVAL","11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL",1315,527.46,527.46,2032.26,328.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11750","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11750","EXCISION NAIL MATRIX PERMANENT REMOVAL","11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL",1315,527.46,527.46,2032.26,328.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11750","BLUE CROSS","BLUE CROSS-PPO","CPT","11750","EXCISION NAIL MATRIX PERMANENT REMOVAL","11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL",1315,527.46,527.46,2032.26,328.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11750","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11750","EXCISION NAIL MATRIX PERMANENT REMOVAL","11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL",1315,527.46,527.46,2032.26,328.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11750","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11750","EXCISION NAIL MATRIX PERMANENT REMOVAL","11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL",1315,527.46,527.46,2032.26,328.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11750","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11750","EXCISION NAIL MATRIX PERMANENT REMOVAL","11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL",1315,527.46,527.46,2032.26,328.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11750","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11750","EXCISION NAIL MATRIX PERMANENT REMOVAL","11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL",1315,2032.26,527.46,2032.26,328.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11750","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11750","EXCISION NAIL MATRIX PERMANENT REMOVAL","11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL",1315,678.1,527.46,2032.26,328.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11750","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11750","EXCISION NAIL MATRIX PERMANENT REMOVAL","11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL",1315,678.1,527.46,2032.26,328.75]
["TUFTS - TUFTS HMO - CPT - 11750","TUFTS","TUFTS HMO","CPT","11750","EXCISION NAIL MATRIX PERMANENT REMOVAL","11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL",1315,1281.21,527.46,2032.26,328.75]
["TUFTS - TUFTS POS - CPT - 11750","TUFTS","TUFTS POS","CPT","11750","EXCISION NAIL MATRIX PERMANENT REMOVAL","11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL",1315,1281.21,527.46,2032.26,328.75]
["TUFTS - TUFTS PPO - CPT - 11750","TUFTS","TUFTS PPO","CPT","11750","EXCISION NAIL MATRIX PERMANENT REMOVAL","11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL",1315,1281.21,527.46,2032.26,328.75]
["TUFTS - TUFTS SELECT - CPT - 11750","TUFTS","TUFTS SELECT","CPT","11750","EXCISION NAIL MATRIX PERMANENT REMOVAL","11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL",1315,684.11,527.46,2032.26,328.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11750","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11750","EXCISION NAIL MATRIX PERMANENT REMOVAL","11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL",1315,661.45,527.46,2032.26,328.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11750","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11750","EXCISION NAIL MATRIX PERMANENT REMOVAL","11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL",1315,678.1,527.46,2032.26,328.75]
["AETNA - AETNA - CPT - 11755","AETNA","AETNA","CPT","11755","BIOPSY NAIL UNIT SEPARATE PROCEDURE","11755 - BIOPSY NAIL UNIT SEPARATE PROCEDURE",600,1198.25,684.11,2032.26,150]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11755","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11755","BIOPSY NAIL UNIT SEPARATE PROCEDURE","11755 - BIOPSY NAIL UNIT SEPARATE PROCEDURE",600,972.93,684.11,2032.26,150]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11755","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11755","BIOPSY NAIL UNIT SEPARATE PROCEDURE","11755 - BIOPSY NAIL UNIT SEPARATE PROCEDURE",600,972.93,684.11,2032.26,150]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11755","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11755","BIOPSY NAIL UNIT SEPARATE PROCEDURE","11755 - BIOPSY NAIL UNIT SEPARATE PROCEDURE",600,972.93,684.11,2032.26,150]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11755","BLUE CROSS","BLUE CROSS-PPO","CPT","11755","BIOPSY NAIL UNIT SEPARATE PROCEDURE","11755 - BIOPSY NAIL UNIT SEPARATE PROCEDURE",600,972.93,684.11,2032.26,150]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11755","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11755","BIOPSY NAIL UNIT SEPARATE PROCEDURE","11755 - BIOPSY NAIL UNIT SEPARATE PROCEDURE",600,972.93,684.11,2032.26,150]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11755","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11755","BIOPSY NAIL UNIT SEPARATE PROCEDURE","11755 - BIOPSY NAIL UNIT SEPARATE PROCEDURE",600,972.93,684.11,2032.26,150]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11755","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11755","BIOPSY NAIL UNIT SEPARATE PROCEDURE","11755 - BIOPSY NAIL UNIT SEPARATE PROCEDURE",600,972.93,684.11,2032.26,150]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11755","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11755","BIOPSY NAIL UNIT SEPARATE PROCEDURE","11755 - BIOPSY NAIL UNIT SEPARATE PROCEDURE",600,2032.26,684.11,2032.26,150]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11755","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11755","BIOPSY NAIL UNIT SEPARATE PROCEDURE","11755 - BIOPSY NAIL UNIT SEPARATE PROCEDURE",600,1250.8,684.11,2032.26,150]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11755","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11755","BIOPSY NAIL UNIT SEPARATE PROCEDURE","11755 - BIOPSY NAIL UNIT SEPARATE PROCEDURE",600,1250.8,684.11,2032.26,150]
["TUFTS - TUFTS HMO - CPT - 11755","TUFTS","TUFTS HMO","CPT","11755","BIOPSY NAIL UNIT SEPARATE PROCEDURE","11755 - BIOPSY NAIL UNIT SEPARATE PROCEDURE",600,1281.21,684.11,2032.26,150]
["TUFTS - TUFTS POS - CPT - 11755","TUFTS","TUFTS POS","CPT","11755","BIOPSY NAIL UNIT SEPARATE PROCEDURE","11755 - BIOPSY NAIL UNIT SEPARATE PROCEDURE",600,1281.21,684.11,2032.26,150]
["TUFTS - TUFTS PPO - CPT - 11755","TUFTS","TUFTS PPO","CPT","11755","BIOPSY NAIL UNIT SEPARATE PROCEDURE","11755 - BIOPSY NAIL UNIT SEPARATE PROCEDURE",600,1281.21,684.11,2032.26,150]
["TUFTS - TUFTS SELECT - CPT - 11755","TUFTS","TUFTS SELECT","CPT","11755","BIOPSY NAIL UNIT SEPARATE PROCEDURE","11755 - BIOPSY NAIL UNIT SEPARATE PROCEDURE",600,684.11,684.11,2032.26,150]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11755","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11755","BIOPSY NAIL UNIT SEPARATE PROCEDURE","11755 - BIOPSY NAIL UNIT SEPARATE PROCEDURE",600,1220.0899999999999,684.11,2032.26,150]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11755","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11755","BIOPSY NAIL UNIT SEPARATE PROCEDURE","11755 - BIOPSY NAIL UNIT SEPARATE PROCEDURE",600,1250.8,684.11,2032.26,150]
["AETNA - AETNA - CPT - 11760","AETNA","AETNA","CPT","11760","REPAIR NAIL BED","11760 - REPAIR NAIL BED",1035,1198.25,317.70999999999998,1198.25,258.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11760","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11760","REPAIR NAIL BED","11760 - REPAIR NAIL BED",1035,810.95,317.70999999999998,1198.25,258.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11760","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11760","REPAIR NAIL BED","11760 - REPAIR NAIL BED",1035,810.95,317.70999999999998,1198.25,258.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11760","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11760","REPAIR NAIL BED","11760 - REPAIR NAIL BED",1035,810.95,317.70999999999998,1198.25,258.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11760","BLUE CROSS","BLUE CROSS-PPO","CPT","11760","REPAIR NAIL BED","11760 - REPAIR NAIL BED",1035,810.95,317.70999999999998,1198.25,258.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11760","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11760","REPAIR NAIL BED","11760 - REPAIR NAIL BED",1035,810.95,317.70999999999998,1198.25,258.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11760","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11760","REPAIR NAIL BED","11760 - REPAIR NAIL BED",1035,810.95,317.70999999999998,1198.25,258.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11760","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11760","REPAIR NAIL BED","11760 - REPAIR NAIL BED",1035,810.95,317.70999999999998,1198.25,258.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11760","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11760","REPAIR NAIL BED","11760 - REPAIR NAIL BED",1035,943.8,317.70999999999998,1198.25,258.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11760","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11760","REPAIR NAIL BED","11760 - REPAIR NAIL BED",1035,1042.56,317.70999999999998,1198.25,258.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11760","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11760","REPAIR NAIL BED","11760 - REPAIR NAIL BED",1035,1042.56,317.70999999999998,1198.25,258.75]
["TUFTS - TUFTS HMO - CPT - 11760","TUFTS","TUFTS HMO","CPT","11760","REPAIR NAIL BED","11760 - REPAIR NAIL BED",1035,595.01,317.70999999999998,1198.25,258.75]
["TUFTS - TUFTS POS - CPT - 11760","TUFTS","TUFTS POS","CPT","11760","REPAIR NAIL BED","11760 - REPAIR NAIL BED",1035,595.01,317.70999999999998,1198.25,258.75]
["TUFTS - TUFTS PPO - CPT - 11760","TUFTS","TUFTS PPO","CPT","11760","REPAIR NAIL BED","11760 - REPAIR NAIL BED",1035,595.01,317.70999999999998,1198.25,258.75]
["TUFTS - TUFTS SELECT - CPT - 11760","TUFTS","TUFTS SELECT","CPT","11760","REPAIR NAIL BED","11760 - REPAIR NAIL BED",1035,317.70999999999998,317.70999999999998,1198.25,258.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11760","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11760","REPAIR NAIL BED","11760 - REPAIR NAIL BED",1035,1016.97,317.70999999999998,1198.25,258.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11760","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11760","REPAIR NAIL BED","11760 - REPAIR NAIL BED",1035,1042.56,317.70999999999998,1198.25,258.75]
["AETNA - AETNA - CPT - 11765","AETNA","AETNA","CPT","11765","WEDGE EXCISION SKIN NAIL FOLD","11765 - WEDGE EXCISION SKIN NAIL FOLD",704,1198.25,317.70999999999998,1198.25,176]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11765","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11765","WEDGE EXCISION SKIN NAIL FOLD","11765 - WEDGE EXCISION SKIN NAIL FOLD",704,527.46,317.70999999999998,1198.25,176]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11765","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11765","WEDGE EXCISION SKIN NAIL FOLD","11765 - WEDGE EXCISION SKIN NAIL FOLD",704,527.46,317.70999999999998,1198.25,176]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11765","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11765","WEDGE EXCISION SKIN NAIL FOLD","11765 - WEDGE EXCISION SKIN NAIL FOLD",704,527.46,317.70999999999998,1198.25,176]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11765","BLUE CROSS","BLUE CROSS-PPO","CPT","11765","WEDGE EXCISION SKIN NAIL FOLD","11765 - WEDGE EXCISION SKIN NAIL FOLD",704,527.46,317.70999999999998,1198.25,176]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11765","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11765","WEDGE EXCISION SKIN NAIL FOLD","11765 - WEDGE EXCISION SKIN NAIL FOLD",704,527.46,317.70999999999998,1198.25,176]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11765","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11765","WEDGE EXCISION SKIN NAIL FOLD","11765 - WEDGE EXCISION SKIN NAIL FOLD",704,527.46,317.70999999999998,1198.25,176]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11765","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11765","WEDGE EXCISION SKIN NAIL FOLD","11765 - WEDGE EXCISION SKIN NAIL FOLD",704,527.46,317.70999999999998,1198.25,176]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11765","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11765","WEDGE EXCISION SKIN NAIL FOLD","11765 - WEDGE EXCISION SKIN NAIL FOLD",704,943.8,317.70999999999998,1198.25,176]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11765","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11765","WEDGE EXCISION SKIN NAIL FOLD","11765 - WEDGE EXCISION SKIN NAIL FOLD",704,678.1,317.70999999999998,1198.25,176]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11765","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11765","WEDGE EXCISION SKIN NAIL FOLD","11765 - WEDGE EXCISION SKIN NAIL FOLD",704,678.1,317.70999999999998,1198.25,176]
["TUFTS - TUFTS HMO - CPT - 11765","TUFTS","TUFTS HMO","CPT","11765","WEDGE EXCISION SKIN NAIL FOLD","11765 - WEDGE EXCISION SKIN NAIL FOLD",704,595.01,317.70999999999998,1198.25,176]
["TUFTS - TUFTS POS - CPT - 11765","TUFTS","TUFTS POS","CPT","11765","WEDGE EXCISION SKIN NAIL FOLD","11765 - WEDGE EXCISION SKIN NAIL FOLD",704,595.01,317.70999999999998,1198.25,176]
["TUFTS - TUFTS PPO - CPT - 11765","TUFTS","TUFTS PPO","CPT","11765","WEDGE EXCISION SKIN NAIL FOLD","11765 - WEDGE EXCISION SKIN NAIL FOLD",704,595.01,317.70999999999998,1198.25,176]
["TUFTS - TUFTS SELECT - CPT - 11765","TUFTS","TUFTS SELECT","CPT","11765","WEDGE EXCISION SKIN NAIL FOLD","11765 - WEDGE EXCISION SKIN NAIL FOLD",704,317.70999999999998,317.70999999999998,1198.25,176]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11765","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11765","WEDGE EXCISION SKIN NAIL FOLD","11765 - WEDGE EXCISION SKIN NAIL FOLD",704,661.45,317.70999999999998,1198.25,176]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11765","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11765","WEDGE EXCISION SKIN NAIL FOLD","11765 - WEDGE EXCISION SKIN NAIL FOLD",704,678.1,317.70999999999998,1198.25,176]
["AETNA - AETNA - CPT - 11770","AETNA","AETNA","CPT","11770","EXCISION PILONIDAL CYST/SINUS SIMPLE","11770 - EXCISION PILONIDAL CYST/SINUS SIMPLE",2987,1990.62,1990.62,11845.41,746.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11770","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11770","EXCISION PILONIDAL CYST/SINUS SIMPLE","11770 - EXCISION PILONIDAL CYST/SINUS SIMPLE",2987,3994.03,1990.62,11845.41,746.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11770","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11770","EXCISION PILONIDAL CYST/SINUS SIMPLE","11770 - EXCISION PILONIDAL CYST/SINUS SIMPLE",2987,3994.03,1990.62,11845.41,746.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11770","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11770","EXCISION PILONIDAL CYST/SINUS SIMPLE","11770 - EXCISION PILONIDAL CYST/SINUS SIMPLE",2987,3994.03,1990.62,11845.41,746.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11770","BLUE CROSS","BLUE CROSS-PPO","CPT","11770","EXCISION PILONIDAL CYST/SINUS SIMPLE","11770 - EXCISION PILONIDAL CYST/SINUS SIMPLE",2987,3994.03,1990.62,11845.41,746.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11770","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11770","EXCISION PILONIDAL CYST/SINUS SIMPLE","11770 - EXCISION PILONIDAL CYST/SINUS SIMPLE",2987,3994.03,1990.62,11845.41,746.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11770","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11770","EXCISION PILONIDAL CYST/SINUS SIMPLE","11770 - EXCISION PILONIDAL CYST/SINUS SIMPLE",2987,3994.03,1990.62,11845.41,746.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11770","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11770","EXCISION PILONIDAL CYST/SINUS SIMPLE","11770 - EXCISION PILONIDAL CYST/SINUS SIMPLE",2987,3994.03,1990.62,11845.41,746.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11770","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11770","EXCISION PILONIDAL CYST/SINUS SIMPLE","11770 - EXCISION PILONIDAL CYST/SINUS SIMPLE",2987,11845.41,1990.62,11845.41,746.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11770","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11770","EXCISION PILONIDAL CYST/SINUS SIMPLE","11770 - EXCISION PILONIDAL CYST/SINUS SIMPLE",2987,4621.25,1990.62,11845.41,746.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11770","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11770","EXCISION PILONIDAL CYST/SINUS SIMPLE","11770 - EXCISION PILONIDAL CYST/SINUS SIMPLE",2987,4621.25,1990.62,11845.41,746.75]
["TUFTS - TUFTS HMO - CPT - 11770","TUFTS","TUFTS HMO","CPT","11770","EXCISION PILONIDAL CYST/SINUS SIMPLE","11770 - EXCISION PILONIDAL CYST/SINUS SIMPLE",2987,7467.76,1990.62,11845.41,746.75]
["TUFTS - TUFTS POS - CPT - 11770","TUFTS","TUFTS POS","CPT","11770","EXCISION PILONIDAL CYST/SINUS SIMPLE","11770 - EXCISION PILONIDAL CYST/SINUS SIMPLE",2987,7467.76,1990.62,11845.41,746.75]
["TUFTS - TUFTS PPO - CPT - 11770","TUFTS","TUFTS PPO","CPT","11770","EXCISION PILONIDAL CYST/SINUS SIMPLE","11770 - EXCISION PILONIDAL CYST/SINUS SIMPLE",2987,7467.76,1990.62,11845.41,746.75]
["TUFTS - TUFTS SELECT - CPT - 11770","TUFTS","TUFTS SELECT","CPT","11770","EXCISION PILONIDAL CYST/SINUS SIMPLE","11770 - EXCISION PILONIDAL CYST/SINUS SIMPLE",2987,3987.49,1990.62,11845.41,746.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11770","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11770","EXCISION PILONIDAL CYST/SINUS SIMPLE","11770 - EXCISION PILONIDAL CYST/SINUS SIMPLE",2987,4507.8100000000004,1990.62,11845.41,746.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11770","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11770","EXCISION PILONIDAL CYST/SINUS SIMPLE","11770 - EXCISION PILONIDAL CYST/SINUS SIMPLE",2987,4621.25,1990.62,11845.41,746.75]
["AETNA - AETNA - CPT - 11772","AETNA","AETNA","CPT","11772","EXCISION PILONIDAL CYST/SINUS COMPLICATED","11772 - EXCISION PILONIDAL CYST/SINUS COMPLICATED",4398,1990.62,1990.62,11845.41,1099.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11772","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11772","EXCISION PILONIDAL CYST/SINUS COMPLICATED","11772 - EXCISION PILONIDAL CYST/SINUS COMPLICATED",4398,3994.03,1990.62,11845.41,1099.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11772","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11772","EXCISION PILONIDAL CYST/SINUS COMPLICATED","11772 - EXCISION PILONIDAL CYST/SINUS COMPLICATED",4398,3994.03,1990.62,11845.41,1099.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11772","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11772","EXCISION PILONIDAL CYST/SINUS COMPLICATED","11772 - EXCISION PILONIDAL CYST/SINUS COMPLICATED",4398,3994.03,1990.62,11845.41,1099.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11772","BLUE CROSS","BLUE CROSS-PPO","CPT","11772","EXCISION PILONIDAL CYST/SINUS COMPLICATED","11772 - EXCISION PILONIDAL CYST/SINUS COMPLICATED",4398,3994.03,1990.62,11845.41,1099.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11772","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11772","EXCISION PILONIDAL CYST/SINUS COMPLICATED","11772 - EXCISION PILONIDAL CYST/SINUS COMPLICATED",4398,3994.03,1990.62,11845.41,1099.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11772","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11772","EXCISION PILONIDAL CYST/SINUS COMPLICATED","11772 - EXCISION PILONIDAL CYST/SINUS COMPLICATED",4398,3994.03,1990.62,11845.41,1099.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11772","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11772","EXCISION PILONIDAL CYST/SINUS COMPLICATED","11772 - EXCISION PILONIDAL CYST/SINUS COMPLICATED",4398,3994.03,1990.62,11845.41,1099.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11772","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11772","EXCISION PILONIDAL CYST/SINUS COMPLICATED","11772 - EXCISION PILONIDAL CYST/SINUS COMPLICATED",4398,11845.41,1990.62,11845.41,1099.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11772","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11772","EXCISION PILONIDAL CYST/SINUS COMPLICATED","11772 - EXCISION PILONIDAL CYST/SINUS COMPLICATED",4398,4621.25,1990.62,11845.41,1099.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11772","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11772","EXCISION PILONIDAL CYST/SINUS COMPLICATED","11772 - EXCISION PILONIDAL CYST/SINUS COMPLICATED",4398,4621.25,1990.62,11845.41,1099.5]
["TUFTS - TUFTS HMO - CPT - 11772","TUFTS","TUFTS HMO","CPT","11772","EXCISION PILONIDAL CYST/SINUS COMPLICATED","11772 - EXCISION PILONIDAL CYST/SINUS COMPLICATED",4398,7467.76,1990.62,11845.41,1099.5]
["TUFTS - TUFTS POS - CPT - 11772","TUFTS","TUFTS POS","CPT","11772","EXCISION PILONIDAL CYST/SINUS COMPLICATED","11772 - EXCISION PILONIDAL CYST/SINUS COMPLICATED",4398,7467.76,1990.62,11845.41,1099.5]
["TUFTS - TUFTS PPO - CPT - 11772","TUFTS","TUFTS PPO","CPT","11772","EXCISION PILONIDAL CYST/SINUS COMPLICATED","11772 - EXCISION PILONIDAL CYST/SINUS COMPLICATED",4398,7467.76,1990.62,11845.41,1099.5]
["TUFTS - TUFTS SELECT - CPT - 11772","TUFTS","TUFTS SELECT","CPT","11772","EXCISION PILONIDAL CYST/SINUS COMPLICATED","11772 - EXCISION PILONIDAL CYST/SINUS COMPLICATED",4398,3987.49,1990.62,11845.41,1099.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11772","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11772","EXCISION PILONIDAL CYST/SINUS COMPLICATED","11772 - EXCISION PILONIDAL CYST/SINUS COMPLICATED",4398,4507.8100000000004,1990.62,11845.41,1099.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11772","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11772","EXCISION PILONIDAL CYST/SINUS COMPLICATED","11772 - EXCISION PILONIDAL CYST/SINUS COMPLICATED",4398,4621.25,1990.62,11845.41,1099.5]
["AETNA - AETNA - CPT - 11900","AETNA","AETNA","CPT","11900","INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS","11900 - INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS",243,1198.25,171.09,1198.25,60.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11900","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11900","INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS","11900 - INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS",243,296.32,171.09,1198.25,60.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11900","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11900","INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS","11900 - INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS",243,296.32,171.09,1198.25,60.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11900","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11900","INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS","11900 - INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS",243,296.32,171.09,1198.25,60.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11900","BLUE CROSS","BLUE CROSS-PPO","CPT","11900","INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS","11900 - INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS",243,296.32,171.09,1198.25,60.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11900","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11900","INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS","11900 - INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS",243,296.32,171.09,1198.25,60.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11900","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11900","INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS","11900 - INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS",243,296.32,171.09,1198.25,60.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11900","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11900","INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS","11900 - INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS",243,296.32,171.09,1198.25,60.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11900","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11900","INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS","11900 - INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS",243,508.23,171.09,1198.25,60.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11900","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11900","INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS","11900 - INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS",243,380.96,171.09,1198.25,60.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11900","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11900","INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS","11900 - INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS",243,380.96,171.09,1198.25,60.75]
["TUFTS - TUFTS HMO - CPT - 11900","TUFTS","TUFTS HMO","CPT","11900","INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS","11900 - INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS",243,320.41000000000003,171.09,1198.25,60.75]
["TUFTS - TUFTS POS - CPT - 11900","TUFTS","TUFTS POS","CPT","11900","INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS","11900 - INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS",243,320.41000000000003,171.09,1198.25,60.75]
["TUFTS - TUFTS PPO - CPT - 11900","TUFTS","TUFTS PPO","CPT","11900","INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS","11900 - INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS",243,320.41000000000003,171.09,1198.25,60.75]
["TUFTS - TUFTS SELECT - CPT - 11900","TUFTS","TUFTS SELECT","CPT","11900","INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS","11900 - INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS",243,171.09,171.09,1198.25,60.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11900","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11900","INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS","11900 - INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS",243,371.6,171.09,1198.25,60.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11900","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11900","INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS","11900 - INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS",243,380.96,171.09,1198.25,60.75]
["AETNA - AETNA - CPT - 11901","AETNA","AETNA","CPT","11901","INJECTION INTRALESIONAL >7 LESIONS","11901 - INJECTION INTRALESIONAL >7 LESIONS",375,1198.25,171.09,1198.25,93.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11901","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11901","INJECTION INTRALESIONAL >7 LESIONS","11901 - INJECTION INTRALESIONAL >7 LESIONS",375,296.32,171.09,1198.25,93.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11901","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11901","INJECTION INTRALESIONAL >7 LESIONS","11901 - INJECTION INTRALESIONAL >7 LESIONS",375,296.32,171.09,1198.25,93.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11901","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11901","INJECTION INTRALESIONAL >7 LESIONS","11901 - INJECTION INTRALESIONAL >7 LESIONS",375,296.32,171.09,1198.25,93.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11901","BLUE CROSS","BLUE CROSS-PPO","CPT","11901","INJECTION INTRALESIONAL >7 LESIONS","11901 - INJECTION INTRALESIONAL >7 LESIONS",375,296.32,171.09,1198.25,93.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11901","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11901","INJECTION INTRALESIONAL >7 LESIONS","11901 - INJECTION INTRALESIONAL >7 LESIONS",375,296.32,171.09,1198.25,93.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11901","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11901","INJECTION INTRALESIONAL >7 LESIONS","11901 - INJECTION INTRALESIONAL >7 LESIONS",375,296.32,171.09,1198.25,93.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11901","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11901","INJECTION INTRALESIONAL >7 LESIONS","11901 - INJECTION INTRALESIONAL >7 LESIONS",375,296.32,171.09,1198.25,93.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11901","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11901","INJECTION INTRALESIONAL >7 LESIONS","11901 - INJECTION INTRALESIONAL >7 LESIONS",375,508.23,171.09,1198.25,93.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11901","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11901","INJECTION INTRALESIONAL >7 LESIONS","11901 - INJECTION INTRALESIONAL >7 LESIONS",375,380.96,171.09,1198.25,93.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11901","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11901","INJECTION INTRALESIONAL >7 LESIONS","11901 - INJECTION INTRALESIONAL >7 LESIONS",375,380.96,171.09,1198.25,93.75]
["TUFTS - TUFTS HMO - CPT - 11901","TUFTS","TUFTS HMO","CPT","11901","INJECTION INTRALESIONAL >7 LESIONS","11901 - INJECTION INTRALESIONAL >7 LESIONS",375,320.41000000000003,171.09,1198.25,93.75]
["TUFTS - TUFTS POS - CPT - 11901","TUFTS","TUFTS POS","CPT","11901","INJECTION INTRALESIONAL >7 LESIONS","11901 - INJECTION INTRALESIONAL >7 LESIONS",375,320.41000000000003,171.09,1198.25,93.75]
["TUFTS - TUFTS PPO - CPT - 11901","TUFTS","TUFTS PPO","CPT","11901","INJECTION INTRALESIONAL >7 LESIONS","11901 - INJECTION INTRALESIONAL >7 LESIONS",375,320.41000000000003,171.09,1198.25,93.75]
["TUFTS - TUFTS SELECT - CPT - 11901","TUFTS","TUFTS SELECT","CPT","11901","INJECTION INTRALESIONAL >7 LESIONS","11901 - INJECTION INTRALESIONAL >7 LESIONS",375,171.09,171.09,1198.25,93.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11901","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11901","INJECTION INTRALESIONAL >7 LESIONS","11901 - INJECTION INTRALESIONAL >7 LESIONS",375,371.6,171.09,1198.25,93.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11901","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11901","INJECTION INTRALESIONAL >7 LESIONS","11901 - INJECTION INTRALESIONAL >7 LESIONS",375,380.96,171.09,1198.25,93.75]
["AETNA - AETNA - CPT - 11921","AETNA","AETNA","CPT","11921","HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM","11921 - HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM",740,1198.25,684.11,2032.26,185]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11921","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11921","HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM","11921 - HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM",740,810.95,684.11,2032.26,185]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11921","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11921","HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM","11921 - HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM",740,810.95,684.11,2032.26,185]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11921","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11921","HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM","11921 - HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM",740,810.95,684.11,2032.26,185]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11921","BLUE CROSS","BLUE CROSS-PPO","CPT","11921","HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM","11921 - HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM",740,810.95,684.11,2032.26,185]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11921","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11921","HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM","11921 - HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM",740,810.95,684.11,2032.26,185]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11921","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11921","HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM","11921 - HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM",740,810.95,684.11,2032.26,185]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11921","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11921","HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM","11921 - HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM",740,810.95,684.11,2032.26,185]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11921","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11921","HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM","11921 - HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM",740,2032.26,684.11,2032.26,185]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11921","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11921","HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM","11921 - HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM",740,1042.56,684.11,2032.26,185]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11921","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11921","HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM","11921 - HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM",740,1042.56,684.11,2032.26,185]
["TUFTS - TUFTS HMO - CPT - 11921","TUFTS","TUFTS HMO","CPT","11921","HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM","11921 - HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM",740,1281.21,684.11,2032.26,185]
["TUFTS - TUFTS POS - CPT - 11921","TUFTS","TUFTS POS","CPT","11921","HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM","11921 - HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM",740,1281.21,684.11,2032.26,185]
["TUFTS - TUFTS PPO - CPT - 11921","TUFTS","TUFTS PPO","CPT","11921","HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM","11921 - HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM",740,1281.21,684.11,2032.26,185]
["TUFTS - TUFTS SELECT - CPT - 11921","TUFTS","TUFTS SELECT","CPT","11921","HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM","11921 - HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM",740,684.11,684.11,2032.26,185]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11921","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11921","HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM","11921 - HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM",740,1016.97,684.11,2032.26,185]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11921","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11921","HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM","11921 - HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM",740,1042.56,684.11,2032.26,185]
["AETNA - AETNA - CPT - 11922","AETNA","AETNA","CPT","11922","HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",371,1198.25,73.66,1198.25,92.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 11922","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","11922","HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",371,0,73.66,1198.25,92.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 11922","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","11922","HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",371,0,73.66,1198.25,92.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11922","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11922","HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",371,73.66,73.66,1198.25,92.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11922","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11922","HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",371,73.66,73.66,1198.25,92.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11922","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11922","HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",371,73.66,73.66,1198.25,92.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11922","BLUE CROSS","BLUE CROSS-PPO","CPT","11922","HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",371,73.66,73.66,1198.25,92.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11922","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11922","HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",371,73.66,73.66,1198.25,92.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11922","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11922","HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",371,73.66,73.66,1198.25,92.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11922","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11922","HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",371,73.66,73.66,1198.25,92.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 11922","BMC HEALTHNET","BMCHN ACO","CPT","11922","HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",371,0,73.66,1198.25,92.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 11922","BMC HEALTHNET","BMCHN MCO","CPT","11922","HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",371,0,73.66,1198.25,92.75]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 11922","BMC HEALTHNET","BMCHN MEDICAID","CPT","11922","HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",371,0,73.66,1198.25,92.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 11922","BMC HEALTHNET","BMCHN QHP","CPT","11922","HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",371,0,73.66,1198.25,92.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11922","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11922","HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",371,0,73.66,1198.25,92.75]
["FALLON - FALLON MEDICAID - CPT - 11922","FALLON","FALLON MEDICAID","CPT","11922","HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",371,0,73.66,1198.25,92.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11922","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11922","HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",371,0,73.66,1198.25,92.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11922","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11922","HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",371,0,73.66,1198.25,92.75]
["TUFTS - TUFTS HMO - CPT - 11922","TUFTS","TUFTS HMO","CPT","11922","HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",371,0,73.66,1198.25,92.75]
["TUFTS - TUFTS POS - CPT - 11922","TUFTS","TUFTS POS","CPT","11922","HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",371,0,73.66,1198.25,92.75]
["TUFTS - TUFTS PPO - CPT - 11922","TUFTS","TUFTS PPO","CPT","11922","HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",371,0,73.66,1198.25,92.75]
["TUFTS - TUFTS SELECT - CPT - 11922","TUFTS","TUFTS SELECT","CPT","11922","HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",371,0,73.66,1198.25,92.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 11922","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","11922","HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",371,0,73.66,1198.25,92.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 11922","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","11922","HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",371,0,73.66,1198.25,92.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11922","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11922","HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",371,0,73.66,1198.25,92.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11922","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11922","HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",371,0,73.66,1198.25,92.75]
["AETNA - AETNA - CPT - 11976","AETNA","AETNA","CPT","11976","REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES","11976 - REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES",742,1198.25,684.11,2032.26,185.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11976","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11976","REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES","11976 - REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES",742,972.93,684.11,2032.26,185.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11976","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11976","REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES","11976 - REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES",742,972.93,684.11,2032.26,185.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11976","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11976","REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES","11976 - REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES",742,972.93,684.11,2032.26,185.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11976","BLUE CROSS","BLUE CROSS-PPO","CPT","11976","REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES","11976 - REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES",742,972.93,684.11,2032.26,185.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11976","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11976","REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES","11976 - REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES",742,972.93,684.11,2032.26,185.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11976","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11976","REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES","11976 - REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES",742,972.93,684.11,2032.26,185.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11976","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11976","REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES","11976 - REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES",742,972.93,684.11,2032.26,185.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11976","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11976","REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES","11976 - REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES",742,2032.26,684.11,2032.26,185.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11976","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11976","REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES","11976 - REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES",742,1250.8,684.11,2032.26,185.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11976","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11976","REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES","11976 - REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES",742,1250.8,684.11,2032.26,185.5]
["TUFTS - TUFTS HMO - CPT - 11976","TUFTS","TUFTS HMO","CPT","11976","REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES","11976 - REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES",742,1281.21,684.11,2032.26,185.5]
["TUFTS - TUFTS POS - CPT - 11976","TUFTS","TUFTS POS","CPT","11976","REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES","11976 - REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES",742,1281.21,684.11,2032.26,185.5]
["TUFTS - TUFTS PPO - CPT - 11976","TUFTS","TUFTS PPO","CPT","11976","REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES","11976 - REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES",742,1281.21,684.11,2032.26,185.5]
["TUFTS - TUFTS SELECT - CPT - 11976","TUFTS","TUFTS SELECT","CPT","11976","REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES","11976 - REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES",742,684.11,684.11,2032.26,185.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11976","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11976","REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES","11976 - REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES",742,1220.0899999999999,684.11,2032.26,185.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11976","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11976","REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES","11976 - REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES",742,1250.8,684.11,2032.26,185.5]
["AETNA - AETNA - CPT - 11980","AETNA","AETNA","CPT","11980","SUBCUTANEOUS HORMONE PELLET IMPLANTATION","11980 - SUBCUTANEOUS HORMONE PELLET IMPLANTATION",619,1198.25,317.70999999999998,1198.25,154.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11980","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11980","SUBCUTANEOUS HORMONE PELLET IMPLANTATION","11980 - SUBCUTANEOUS HORMONE PELLET IMPLANTATION",619,584.69000000000005,317.70999999999998,1198.25,154.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11980","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11980","SUBCUTANEOUS HORMONE PELLET IMPLANTATION","11980 - SUBCUTANEOUS HORMONE PELLET IMPLANTATION",619,584.69000000000005,317.70999999999998,1198.25,154.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11980","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11980","SUBCUTANEOUS HORMONE PELLET IMPLANTATION","11980 - SUBCUTANEOUS HORMONE PELLET IMPLANTATION",619,584.69000000000005,317.70999999999998,1198.25,154.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11980","BLUE CROSS","BLUE CROSS-PPO","CPT","11980","SUBCUTANEOUS HORMONE PELLET IMPLANTATION","11980 - SUBCUTANEOUS HORMONE PELLET IMPLANTATION",619,584.69000000000005,317.70999999999998,1198.25,154.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11980","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11980","SUBCUTANEOUS HORMONE PELLET IMPLANTATION","11980 - SUBCUTANEOUS HORMONE PELLET IMPLANTATION",619,584.69000000000005,317.70999999999998,1198.25,154.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11980","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11980","SUBCUTANEOUS HORMONE PELLET IMPLANTATION","11980 - SUBCUTANEOUS HORMONE PELLET IMPLANTATION",619,584.69000000000005,317.70999999999998,1198.25,154.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11980","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11980","SUBCUTANEOUS HORMONE PELLET IMPLANTATION","11980 - SUBCUTANEOUS HORMONE PELLET IMPLANTATION",619,584.69000000000005,317.70999999999998,1198.25,154.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11980","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11980","SUBCUTANEOUS HORMONE PELLET IMPLANTATION","11980 - SUBCUTANEOUS HORMONE PELLET IMPLANTATION",619,943.8,317.70999999999998,1198.25,154.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11980","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11980","SUBCUTANEOUS HORMONE PELLET IMPLANTATION","11980 - SUBCUTANEOUS HORMONE PELLET IMPLANTATION",619,751.68,317.70999999999998,1198.25,154.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11980","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11980","SUBCUTANEOUS HORMONE PELLET IMPLANTATION","11980 - SUBCUTANEOUS HORMONE PELLET IMPLANTATION",619,751.68,317.70999999999998,1198.25,154.75]
["TUFTS - TUFTS HMO - CPT - 11980","TUFTS","TUFTS HMO","CPT","11980","SUBCUTANEOUS HORMONE PELLET IMPLANTATION","11980 - SUBCUTANEOUS HORMONE PELLET IMPLANTATION",619,595.01,317.70999999999998,1198.25,154.75]
["TUFTS - TUFTS POS - CPT - 11980","TUFTS","TUFTS POS","CPT","11980","SUBCUTANEOUS HORMONE PELLET IMPLANTATION","11980 - SUBCUTANEOUS HORMONE PELLET IMPLANTATION",619,595.01,317.70999999999998,1198.25,154.75]
["TUFTS - TUFTS PPO - CPT - 11980","TUFTS","TUFTS PPO","CPT","11980","SUBCUTANEOUS HORMONE PELLET IMPLANTATION","11980 - SUBCUTANEOUS HORMONE PELLET IMPLANTATION",619,595.01,317.70999999999998,1198.25,154.75]
["TUFTS - TUFTS SELECT - CPT - 11980","TUFTS","TUFTS SELECT","CPT","11980","SUBCUTANEOUS HORMONE PELLET IMPLANTATION","11980 - SUBCUTANEOUS HORMONE PELLET IMPLANTATION",619,317.70999999999998,317.70999999999998,1198.25,154.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11980","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11980","SUBCUTANEOUS HORMONE PELLET IMPLANTATION","11980 - SUBCUTANEOUS HORMONE PELLET IMPLANTATION",619,733.22,317.70999999999998,1198.25,154.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11980","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11980","SUBCUTANEOUS HORMONE PELLET IMPLANTATION","11980 - SUBCUTANEOUS HORMONE PELLET IMPLANTATION",619,751.68,317.70999999999998,1198.25,154.75]
["AETNA - AETNA - CPT - 11981","AETNA","AETNA","CPT","11981","INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11981 - INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",616,1198.25,178.83,1198.25,154]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11981","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11981","INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11981 - INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",616,178.83,178.83,1198.25,154]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11981","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11981","INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11981 - INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",616,178.83,178.83,1198.25,154]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11981","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11981","INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11981 - INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",616,178.83,178.83,1198.25,154]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11981","BLUE CROSS","BLUE CROSS-PPO","CPT","11981","INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11981 - INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",616,178.83,178.83,1198.25,154]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11981","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11981","INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11981 - INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",616,178.83,178.83,1198.25,154]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11981","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11981","INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11981 - INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",616,178.83,178.83,1198.25,154]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11981","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11981","INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11981 - INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",616,178.83,178.83,1198.25,154]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11981","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11981","INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11981 - INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",616,943.8,178.83,1198.25,154]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11981","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11981","INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11981 - INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",616,229.89,178.83,1198.25,154]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11981","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11981","INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11981 - INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",616,229.89,178.83,1198.25,154]
["TUFTS - TUFTS HMO - CPT - 11981","TUFTS","TUFTS HMO","CPT","11981","INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11981 - INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",616,595.01,178.83,1198.25,154]
["TUFTS - TUFTS POS - CPT - 11981","TUFTS","TUFTS POS","CPT","11981","INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11981 - INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",616,595.01,178.83,1198.25,154]
["TUFTS - TUFTS PPO - CPT - 11981","TUFTS","TUFTS PPO","CPT","11981","INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11981 - INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",616,595.01,178.83,1198.25,154]
["TUFTS - TUFTS SELECT - CPT - 11981","TUFTS","TUFTS SELECT","CPT","11981","INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11981 - INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",616,317.70999999999998,178.83,1198.25,154]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11981","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11981","INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11981 - INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",616,224.25,178.83,1198.25,154]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11981","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11981","INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11981 - INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",616,229.89,178.83,1198.25,154]
["AETNA - AETNA - CPT - 11982","AETNA","AETNA","CPT","11982","REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11982 - REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",734,1198.25,317.70999999999998,1198.25,183.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11982","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11982","REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11982 - REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",734,584.69000000000005,317.70999999999998,1198.25,183.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11982","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11982","REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11982 - REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",734,584.69000000000005,317.70999999999998,1198.25,183.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11982","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11982","REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11982 - REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",734,584.69000000000005,317.70999999999998,1198.25,183.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11982","BLUE CROSS","BLUE CROSS-PPO","CPT","11982","REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11982 - REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",734,584.69000000000005,317.70999999999998,1198.25,183.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11982","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11982","REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11982 - REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",734,584.69000000000005,317.70999999999998,1198.25,183.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11982","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11982","REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11982 - REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",734,584.69000000000005,317.70999999999998,1198.25,183.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11982","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11982","REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11982 - REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",734,584.69000000000005,317.70999999999998,1198.25,183.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11982","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11982","REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11982 - REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",734,943.8,317.70999999999998,1198.25,183.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11982","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11982","REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11982 - REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",734,751.68,317.70999999999998,1198.25,183.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11982","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11982","REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11982 - REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",734,751.68,317.70999999999998,1198.25,183.5]
["TUFTS - TUFTS HMO - CPT - 11982","TUFTS","TUFTS HMO","CPT","11982","REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11982 - REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",734,595.01,317.70999999999998,1198.25,183.5]
["TUFTS - TUFTS POS - CPT - 11982","TUFTS","TUFTS POS","CPT","11982","REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11982 - REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",734,595.01,317.70999999999998,1198.25,183.5]
["TUFTS - TUFTS PPO - CPT - 11982","TUFTS","TUFTS PPO","CPT","11982","REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11982 - REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",734,595.01,317.70999999999998,1198.25,183.5]
["TUFTS - TUFTS SELECT - CPT - 11982","TUFTS","TUFTS SELECT","CPT","11982","REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11982 - REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",734,317.70999999999998,317.70999999999998,1198.25,183.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11982","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11982","REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11982 - REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",734,733.22,317.70999999999998,1198.25,183.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11982","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11982","REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11982 - REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",734,751.68,317.70999999999998,1198.25,183.5]
["AETNA - AETNA - CPT - 11983","AETNA","AETNA","CPT","11983","RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT","11983 - RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT",1269,1198.25,317.70999999999998,1198.25,317.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11983","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","11983","RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT","11983 - RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT",1269,584.69000000000005,317.70999999999998,1198.25,317.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11983","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","11983","RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT","11983 - RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT",1269,584.69000000000005,317.70999999999998,1198.25,317.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11983","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","11983","RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT","11983 - RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT",1269,584.69000000000005,317.70999999999998,1198.25,317.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 11983","BLUE CROSS","BLUE CROSS-PPO","CPT","11983","RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT","11983 - RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT",1269,584.69000000000005,317.70999999999998,1198.25,317.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11983","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","11983","RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT","11983 - RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT",1269,584.69000000000005,317.70999999999998,1198.25,317.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11983","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","11983","RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT","11983 - RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT",1269,584.69000000000005,317.70999999999998,1198.25,317.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11983","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","11983","RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT","11983 - RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT",1269,584.69000000000005,317.70999999999998,1198.25,317.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11983","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","11983","RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT","11983 - RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT",1269,943.8,317.70999999999998,1198.25,317.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11983","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","11983","RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT","11983 - RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT",1269,751.68,317.70999999999998,1198.25,317.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11983","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","11983","RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT","11983 - RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT",1269,751.68,317.70999999999998,1198.25,317.25]
["TUFTS - TUFTS HMO - CPT - 11983","TUFTS","TUFTS HMO","CPT","11983","RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT","11983 - RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT",1269,595.01,317.70999999999998,1198.25,317.25]
["TUFTS - TUFTS POS - CPT - 11983","TUFTS","TUFTS POS","CPT","11983","RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT","11983 - RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT",1269,595.01,317.70999999999998,1198.25,317.25]
["TUFTS - TUFTS PPO - CPT - 11983","TUFTS","TUFTS PPO","CPT","11983","RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT","11983 - RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT",1269,595.01,317.70999999999998,1198.25,317.25]
["TUFTS - TUFTS SELECT - CPT - 11983","TUFTS","TUFTS SELECT","CPT","11983","RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT","11983 - RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT",1269,317.70999999999998,317.70999999999998,1198.25,317.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11983","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","11983","RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT","11983 - RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT",1269,733.22,317.70999999999998,1198.25,317.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11983","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","11983","RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT","11983 - RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT",1269,751.68,317.70999999999998,1198.25,317.25]
["AETNA - AETNA - CPT - 12001","AETNA","AETNA","CPT","12001","SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<","12001 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<",343,1198.25,296.32,1198.25,85.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 12001","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","12001","SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<","12001 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<",343,296.32,296.32,1198.25,85.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 12001","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","12001","SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<","12001 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<",343,296.32,296.32,1198.25,85.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 12001","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","12001","SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<","12001 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<",343,296.32,296.32,1198.25,85.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 12001","BLUE CROSS","BLUE CROSS-PPO","CPT","12001","SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<","12001 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<",343,296.32,296.32,1198.25,85.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 12001","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","12001","SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<","12001 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<",343,296.32,296.32,1198.25,85.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 12001","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","12001","SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<","12001 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<",343,296.32,296.32,1198.25,85.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 12001","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","12001","SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<","12001 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<",343,296.32,296.32,1198.25,85.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 12001","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","12001","SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<","12001 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<",343,943.8,296.32,1198.25,85.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 12001","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","12001","SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<","12001 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<",343,380.96,296.32,1198.25,85.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 12001","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","12001","SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<","12001 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<",343,380.96,296.32,1198.25,85.75]
["TUFTS - TUFTS HMO - CPT - 12001","TUFTS","TUFTS HMO","CPT","12001","SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<","12001 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<",343,595.01,296.32,1198.25,85.75]
["TUFTS - TUFTS POS - CPT - 12001","TUFTS","TUFTS POS","CPT","12001","SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<","12001 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<",343,595.01,296.32,1198.25,85.75]
["TUFTS - TUFTS PPO - CPT - 12001","TUFTS","TUFTS PPO","CPT","12001","SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<","12001 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<",343,595.01,296.32,1198.25,85.75]
["TUFTS - TUFTS SELECT - CPT - 12001","TUFTS","TUFTS SELECT","CPT","12001","SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<","12001 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<",343,317.70999999999998,296.32,1198.25,85.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 12001","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","12001","SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<","12001 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<",343,371.6,296.32,1198.25,85.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 12001","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","12001","SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<","12001 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<",343,380.96,296.32,1198.25,85.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 12002","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","12002","SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM","12002 - SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM",454,296.32,296.32,943.8,113.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 12002","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","12002","SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM","12002 - SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM",454,296.32,296.32,943.8,113.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 12002","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","12002","SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM","12002 - SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM",454,296.32,296.32,943.8,113.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 12002","BLUE CROSS","BLUE CROSS-PPO","CPT","12002","SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM","12002 - SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM",454,296.32,296.32,943.8,113.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 12002","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","12002","SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM","12002 - SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM",454,296.32,296.32,943.8,113.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 12002","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","12002","SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM","12002 - SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM",454,296.32,296.32,943.8,113.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 12002","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","12002","SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM","12002 - SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM",454,296.32,296.32,943.8,113.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 12002","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","12002","SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM","12002 - SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM",454,943.8,296.32,943.8,113.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 12002","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","12002","SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM","12002 - SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM",454,380.96,296.32,943.8,113.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 12002","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","12002","SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM","12002 - SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM",454,380.96,296.32,943.8,113.5]
["TUFTS - TUFTS HMO - CPT - 12002","TUFTS","TUFTS HMO","CPT","12002","SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM","12002 - SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM",454,595.01,296.32,943.8,113.5]
["TUFTS - TUFTS POS - CPT - 12002","TUFTS","TUFTS POS","CPT","12002","SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM","12002 - SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM",454,595.01,296.32,943.8,113.5]
["TUFTS - TUFTS PPO - CPT - 12002","TUFTS","TUFTS PPO","CPT","12002","SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM","12002 - SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM",454,595.01,296.32,943.8,113.5]
["TUFTS - TUFTS SELECT - CPT - 12002","TUFTS","TUFTS SELECT","CPT","12002","SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM","12002 - SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM",454,317.70999999999998,296.32,943.8,113.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 12002","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","12002","SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM","12002 - SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM",454,371.6,296.32,943.8,113.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 12002","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","12002","SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM","12002 - SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM",454,380.96,296.32,943.8,113.5]
["AETNA - AETNA - CPT - 12004","AETNA","AETNA","CPT","12004","SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM","12004 - SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM",565,1198.25,296.32,3264.67,141.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 12004","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","12004","SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM","12004 - SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM",565,296.32,296.32,3264.67,141.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 12004","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","12004","SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM","12004 - SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM",565,296.32,296.32,3264.67,141.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 12004","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","12004","SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM","12004 - SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM",565,296.32,296.32,3264.67,141.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 12004","BLUE CROSS","BLUE CROSS-PPO","CPT","12004","SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM","12004 - SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM",565,296.32,296.32,3264.67,141.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 12004","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","12004","SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM","12004 - SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM",565,296.32,296.32,3264.67,141.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 12004","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","12004","SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM","12004 - SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM",565,296.32,296.32,3264.67,141.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 12004","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","12004","SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM","12004 - SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM",565,296.32,296.32,3264.67,141.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 12004","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","12004","SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM","12004 - SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM",565,3264.67,296.32,3264.67,141.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 12004","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","12004","SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM","12004 - SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM",565,380.96,296.32,3264.67,141.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 12004","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","12004","SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM","12004 - SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM",565,380.96,296.32,3264.67,141.25]
["TUFTS - TUFTS HMO - CPT - 12004","TUFTS","TUFTS HMO","CPT","12004","SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM","12004 - SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM",565,2057.7399999999998,296.32,3264.67,141.25]
["TUFTS - TUFTS POS - CPT - 12004","TUFTS","TUFTS POS","CPT","12004","SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM","12004 - SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM",565,2058.17,296.32,3264.67,141.25]
["TUFTS - TUFTS PPO - CPT - 12004","TUFTS","TUFTS PPO","CPT","12004","SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM","12004 - SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM",565,2058.16,296.32,3264.67,141.25]
["TUFTS - TUFTS SELECT - CPT - 12004","TUFTS","TUFTS SELECT","CPT","12004","SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM","12004 - SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM",565,1098.98,296.32,3264.67,141.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 12004","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","12004","SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM","12004 - SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM",565,371.6,296.32,3264.67,141.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 12004","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","12004","SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM","12004 - SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM",565,380.96,296.32,3264.67,141.25]
["AETNA - AETNA - CPT - 12005","AETNA","AETNA","CPT","12005","SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM","12005 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM",763,1500.85,527.46,3264.67,190.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 12005","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","12005","SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM","12005 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM",763,527.46,527.46,3264.67,190.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 12005","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","12005","SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM","12005 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM",763,527.46,527.46,3264.67,190.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 12005","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","12005","SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM","12005 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM",763,527.46,527.46,3264.67,190.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 12005","BLUE CROSS","BLUE CROSS-PPO","CPT","12005","SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM","12005 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM",763,527.46,527.46,3264.67,190.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 12005","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","12005","SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM","12005 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM",763,527.46,527.46,3264.67,190.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 12005","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","12005","SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM","12005 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM",763,527.46,527.46,3264.67,190.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 12005","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","12005","SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM","12005 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM",763,527.46,527.46,3264.67,190.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 12005","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","12005","SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM","12005 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM",763,3264.67,527.46,3264.67,190.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 12005","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","12005","SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM","12005 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM",763,678.1,527.46,3264.67,190.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 12005","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","12005","SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM","12005 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM",763,678.1,527.46,3264.67,190.75]
["TUFTS - TUFTS HMO - CPT - 12005","TUFTS","TUFTS HMO","CPT","12005","SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM","12005 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM",763,2057.7399999999998,527.46,3264.67,190.75]
["TUFTS - TUFTS POS - CPT - 12005","TUFTS","TUFTS POS","CPT","12005","SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM","12005 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM",763,2058.17,527.46,3264.67,190.75]
["TUFTS - TUFTS PPO - CPT - 12005","TUFTS","TUFTS PPO","CPT","12005","SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM","12005 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM",763,2058.16,527.46,3264.67,190.75]
["TUFTS - TUFTS SELECT - CPT - 12005","TUFTS","TUFTS SELECT","CPT","12005","SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM","12005 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM",763,1098.98,527.46,3264.67,190.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 12005","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","12005","SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM","12005 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM",763,661.45,527.46,3264.67,190.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 12005","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","12005","SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM","12005 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM",763,678.1,527.46,3264.67,190.75]
["AETNA - AETNA - CPT - 12006","AETNA","AETNA","CPT","12006","SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM","12006 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM",930,1500.85,527.46,7703.8,232.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 12006","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","12006","SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM","12006 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM",930,527.46,527.46,7703.8,232.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 12006","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","12006","SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM","12006 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM",930,527.46,527.46,7703.8,232.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 12006","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","12006","SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM","12006 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM",930,527.46,527.46,7703.8,232.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 12006","BLUE CROSS","BLUE CROSS-PPO","CPT","12006","SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM","12006 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM",930,527.46,527.46,7703.8,232.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 12006","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","12006","SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM","12006 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM",930,527.46,527.46,7703.8,232.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 12006","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","12006","SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM","12006 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM",930,527.46,527.46,7703.8,232.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 12006","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","12006","SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM","12006 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM",930,527.46,527.46,7703.8,232.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 12006","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","12006","SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM","12006 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM",930,7703.8,527.46,7703.8,232.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 12011","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","12011","SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<","12011 - SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<",428,380.96,296.32,3264.67,107]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 12015","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","12015","SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM","12015 - SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM",754,296.32,296.32,1198.25,188.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 12015","BLUE CROSS","BLUE CROSS-PPO","CPT","12015","SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM","12015 - SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM",754,296.32,296.32,1198.25,188.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 12017","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","12017","HC RESUPERF WND FACE 20.1-30 CM","12017 - HC RESUPERF WND FACE 20.1-30 CM",477,661.45,527.46,7703.8,119.25]
["TUFTS - TUFTS SELECT - CPT - 12020","TUFTS","TUFTS SELECT","CPT","12020","TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE","12020 - TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE",1435,684.11,684.11,2032.26,358.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 12034","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","12034","REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM","12034 - REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM",1588,678.1,527.46,2032.26,397]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 12035","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","12035","REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM","12035 - REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM",1839,678.1,527.46,2032.26,459.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 12037","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","12037","REPAIR INTERMEDIATE S/A/T/E >30.0 CM","12037 - REPAIR INTERMEDIATE S/A/T/E >30.0 CM",2514,3262.11,684.11,3344.2,628.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 12044","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","12044","REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM","12044 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM",1648,1042.56,684.11,2032.26,412]
["AETNA - AETNA - CPT - 12047","AETNA","AETNA","CPT","12047","REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM","12047 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM",2627,1500.85,684.11,3344.2,656.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 12051","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","12051","REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<","12051 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<",1324,678.1,527.46,2032.26,331]
["AETNA - AETNA - CPT - 12054","AETNA","AETNA","CPT","12054","REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM","12054 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM",1758,1500.85,317.70999999999998,1500.85,439.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 12057","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","12057","HC LAYR CLOS WND FACE,FACIAL >30 CM","12057 - HC LAYR CLOS WND FACE,FACIAL >30 CM",477,527.46,527.46,2032.26,119.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 13100","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","13100","REPAIR COMPLEX TRUNK 1.1-2.5 CM","13100 - REPAIR COMPLEX TRUNK 1.1-2.5 CM",1793,1042.56,684.11,2032.26,448.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 13121","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","13121","REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM","13121 - REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM",2517,810.95,684.11,2032.26,629.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 13131","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","13131","REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM","13131 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM",2113,527.46,527.46,2032.26,528.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 13151","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","13151","REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM","13151 - REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM",2426,810.95,684.11,2032.26,606.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 13160","BLUE CROSS","BLUE CROSS-PPO","CPT","13160","SECONDARY CLOSURE SURG WOUND/DEHSN EXTSV/COMPLIC","13160 - SECONDARY CLOSURE SURG WOUND/DEHSN EXTSV/COMPLIC",6205,2601.27,1500.85,7703.8,1551.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 14001","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","14001","ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM","14001 - ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM",5072,2601.27,1990.62,11845.41,1268]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 14021","BLUE CROSS","BLUE CROSS-PPO","CPT","14021","ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM","14021 - ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM",5587,2601.27,1990.62,11845.41,1396.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 14060","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","14060","ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<","14060 - ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<",5231,2601.27,1990.62,11845.41,1307.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 14061","BLUE CROSS","BLUE CROSS-PPO","CPT","14061","ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM","14061 - ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM",6450,2601.27,1990.62,11845.41,1612.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 14302","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","14302","ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM/<","14302 - ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM/<",1598,548.05999999999995,548.05999999999995,1198.25,399.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 15003","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","15003","HC WOUND PREP, PED, TRK/ARM/LG ADDL 100 CM","15003 - HC WOUND PREP, PED, TRK/ARM/LG ADDL 100 CM",1421,113.61,113.61,1198.25,355.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 15100","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","15100","HC SKIN SPLT GRFT TRNK/ARM/LEG","15100 - HC SKIN SPLT GRFT TRNK/ARM/LEG",2354,2601.27,1500.85,7703.8,588.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 15240","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","15240","FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20 CM/<","15240 - FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20 CM/<",6235,3344.2,1990.62,11845.41,1558.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 15241","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","15241","FTH/GT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA20CM/<","15241 - FTH/GT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA20CM/<",870,275.18,275.18,1990.62,217.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 15271","BLUE CROSS","BLUE CROSS-PPO","CPT","15271","APP SKN SUB GRFT T/A/L AREA/100SCM /<1ST 25","15271 - APP SKN SUB GRFT T/A/L AREA/100SCM /<1ST 25",2356,2601.27,1098.98,3344.2,589]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 15274","BLUE CROSS","BLUE CROSS-PPO","CPT","15274","HC APP SKN SUB GRFT T/A/L AREA/>100SCM ADL 100SCM","15274 - HC APP SKN SUB GRFT T/A/L AREA/>100SCM ADL 100SCM",2594,114.44,114.44,1198.25,648.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 15277","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","15277","HC SUB GRFT F/S/N/H/F/G/M/D />100SCM 1ST 100SCM","15277 - HC SUB GRFT F/S/N/H/F/G/M/D />100SCM 1ST 100SCM",2192,2032.26,684.11,3344.2,548]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 15620","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","15620","DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F","15620 - DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F",2535,3344.2,2166.09,11845.41,633.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 15731","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","15731","FOREHEAD FLAP W/VASC PEDICLE","15731 - FOREHEAD FLAP W/VASC PEDICLE",5186,4645.3599999999997,1990.62,7703.8,1296.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 15771","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","15771","HC GRFG AUTOL FAT LIPO 50 CC/<","15771 - HC GRFG AUTOL FAT LIPO 50 CC/<",3778,5972.07,2166.09,11845.41,944.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 15772","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","15772","HC GRFG AUTOL FAT LIPO EA ADDL","15772 - HC GRFG AUTOL FAT LIPO EA ADDL",1889,0,349.94,1198.25,472.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 15820","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","15820","HC REVISION OF LOWER EYELID","15820 - HC REVISION OF LOWER EYELID",2527,2601.27,1990.62,7703.8,631.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 15821","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","15821","HC REV LOWER EYELID EXTEN FAT PAD","15821 - HC REV LOWER EYELID EXTEN FAT PAD",2527,2601.27,1990.62,7703.8,631.75]
["TUFTS - TUFTS HMO - CPT - 15823","TUFTS","TUFTS HMO","CPT","15823","HC REV UPPER EYELID W EXCESS SKIN","15823 - HC REV UPPER EYELID W EXCESS SKIN",2414,7467.76,2354.5,11845.41,603.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 15830","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","15830","HC EXCISE EXCESS SKIN TISSUE,ABDOMEN","15830 - HC EXCISE EXCESS SKIN TISSUE,ABDOMEN",8148,9316.2900000000009,1990.62,11845.41,2037]
["AETNA - AETNA - CPT - 15850","AETNA","AETNA","CPT","15850","REMOVE SUTURES SAME SURGEON","15850 - REMOVE SUTURES SAME SURGEON",773,1198.25,317.70999999999998,1198.25,193.25]
["TUFTS - TUFTS POS - CPT - 15851","TUFTS","TUFTS POS","CPT","15851","REMOVE SUTURES DIFF SURGEON","15851 - REMOVE SUTURES DIFF SURGEON",2527,595.01,317.70999999999998,3344.2,631.75]
["AETNA - AETNA - CPT - 16020","AETNA","AETNA","CPT","16020","DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL","16020 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL",417,1198.25,296.32,1198.25,104.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 17000","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","17000","DESTRUCTION PREMALIGNANT LESION 1ST","17000 - DESTRUCTION PREMALIGNANT LESION 1ST",430,296.32,171.09,1198.25,107.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 17004","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","17004","DESTRUCTION PREMALIGNANT LESION 15/>","17004 - DESTRUCTION PREMALIGNANT LESION 15/>",1004,527.46,317.70999999999998,1198.25,251]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 17107","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","17107","DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM","17107 - DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM",2675,810.95,317.70999999999998,1198.25,668.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 17110","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","17110","DESTRUCTION BENIGN LESIONS UP TO 14","17110 - DESTRUCTION BENIGN LESIONS UP TO 14",536,296.32,171.09,1198.25,134]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 17260","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","17260","DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<","17260 - DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<",536,296.32,296.32,1198.25,134]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 17262","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","17262","DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM","17262 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM",899,296.32,296.32,1198.25,224.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 17263","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","17263","DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM","17263 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM",995,943.8,296.32,1198.25,248.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 17281","BLUE CROSS","BLUE CROSS-PPO","CPT","17281","DESTRUCTION OF SKIN LESIONS","17281 - DESTRUCTION OF SKIN LESIONS",510,527.46,317.70999999999998,1198.25,127.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 17312","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","17312","MOHS,  ADDL STAGE, HEAD/NECK/HAND/FEET/GENTIAL","17312 - MOHS,  ADDL STAGE, HEAD/NECK/HAND/FEET/GENTIAL",1547,499.91,499.91,1198.25,386.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 17312","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","17312","MOHS,  ADDL STAGE, HEAD/NECK/HAND/FEET/GENTIAL","17312 - MOHS,  ADDL STAGE, HEAD/NECK/HAND/FEET/GENTIAL",1547,0,499.91,1198.25,386.75]
["AETNA - AETNA - CPT - 19000","AETNA","AETNA","CPT","19000","PUNCTURE ASPIRATION CYST BREAST","19000 - PUNCTURE ASPIRATION CYST BREAST",709,1198.25,684.11,2032.26,177.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 19000","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","19000","PUNCTURE ASPIRATION CYST BREAST","19000 - PUNCTURE ASPIRATION CYST BREAST",709,972.93,684.11,2032.26,177.25]
["TUFTS - TUFTS SELECT - CPT - 19020","TUFTS","TUFTS SELECT","CPT","19020","MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP","19020 - MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP",2335,2593.31,1500.85,7703.8,583.75]
["TUFTS - TUFTS PPO - CPT - 19082","TUFTS","TUFTS PPO","CPT","19082","BX BREAST W/DEVICE ADDL LESION STEREOTACT GUID","19082 - BX BREAST W/DEVICE ADDL LESION STEREOTACT GUID",646,0,209.09,1198.25,161.5]
["TUFTS - TUFTS PPO - CPT - 19086","TUFTS","TUFTS PPO","CPT","19086","BX BREAST W/DEVICE ADDL LESION MAGNET RES GUID","19086 - BX BREAST W/DEVICE ADDL LESION MAGNET RES GUID",660,0,227.08,1198.25,165]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 19100","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","19100","BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX","19100 - BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX",709,2607.12,684.11,2672.73,177.25]
["TUFTS - TUFTS SELECT - CPT - 19125","TUFTS","TUFTS SELECT","CPT","19125","HC EXCISE BREAST LES W XRAY MARKER","19125 - HC EXCISE BREAST LES W XRAY MARKER",4228,2593.31,1990.62,7703.8,1057]
["TUFTS - TUFTS SELECT - CPT - 19283","TUFTS","TUFTS SELECT","CPT","19283","PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GDNCE","19283 - PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GDNCE",766,317.70999999999998,317.70999999999998,1500.85,191.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 19285","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","19285","PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG","19285 - PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG",650,1250.8,317.70999999999998,1500.85,162.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 19287","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","19287","PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID","19287 - PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID",1056,1220.0899999999999,317.70999999999998,1990.62,264]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 19301","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","19301","HC PR MASTECTOMY, PARTIAL","19301 - HC PR MASTECTOMY, PARTIAL",4228,5337.47,1990.62,11845.41,1057]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 19328","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","19328","HC REMOVAL OF BREAST IMPLANT","19328 - HC REMOVAL OF BREAST IMPLANT",4228,3264.67,1098.98,6079.77,1057]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 19350","BLUE CROSS","BLUE CROSS-PPO","CPT","19350","NIPPLE/AREOLA RECONSTRUCTION","19350 - NIPPLE/AREOLA RECONSTRUCTION",2893,4729.13,2166.09,11845.41,723.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 19499","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","19499","PR TOMO GUIDED PLACEMENT OF BREAST LOCALIZATION DEVICE","19499 - PR TOMO GUIDED PLACEMENT OF BREAST LOCALIZATION DEVICE",4071,11845.41,1198.25,11845.41,1017.75]
["TUFTS - TUFTS PPO - CPT - 20102","TUFTS","TUFTS PPO","CPT","20102","HC EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK","20102 - HC EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK",2354,2058.16,1098.98,3344.2,588.5]
["TUFTS - TUFTS PPO - CPT - 20205","TUFTS","TUFTS PPO","CPT","20205","BIOPSY,MUSCLE,DEEP","20205 - BIOPSY,MUSCLE,DEEP",1972,7467.76,1990.62,11845.41,493]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 20220","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","20220","HC BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL","20220 - HC BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL",1103,2607.12,1098.98,3264.67,275.75]
["TUFTS - TUFTS SELECT - CPT - 20240","TUFTS","TUFTS SELECT","CPT","20240","HC BIOPSY BONE OPEN SUPERFICIAL","20240 - HC BIOPSY BONE OPEN SUPERFICIAL",3570,2593.31,1500.85,7703.8,892.5]
["TUFTS - TUFTS SELECT - CPT - 20501","TUFTS","TUFTS SELECT","CPT","20501","HC INJECTION SINUS TRACT DIAGNOSTIC","20501 - HC INJECTION SINUS TRACT DIAGNOSTIC",262,0,93.24,1198.25,65.5]
["TUFTS - TUFTS HMO - CPT - 20520","TUFTS","TUFTS HMO","CPT","20520","REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE","20520 - REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE",1125,1281.21,684.11,2672.73,281.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 20527","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","20527","INJECTION ENZYME PALMAR FASCIAL CORD","20527 - INJECTION ENZYME PALMAR FASCIAL CORD",454,521.19000000000005,317.70999999999998,1198.25,113.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 20551","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","20551","INJECTION SINGLE TENDON ORIGIN/INSERTION","20551 - INJECTION SINGLE TENDON ORIGIN/INSERTION",324,521.19000000000005,317.70999999999998,1198.25,81]
["TUFTS - TUFTS POS - CPT - 20553","TUFTS","TUFTS POS","CPT","20553","INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES","20553 - INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES",324,595.01,317.70999999999998,1198.25,81]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 20605","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","20605","ARTHROCENTESIS ASPIR&/INJECTION INTERM JT/BURS","20605 - ARTHROCENTESIS ASPIR&/INJECTION INTERM JT/BURS",311,534.30999999999995,317.70999999999998,1198.25,77.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 20612","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","20612","ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ","20612 - ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ",316,415.61,317.70999999999998,1198.25,79]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 20650","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","20650","HC INSERT AND REMOVE BONE PIN","20650 - HC INSERT AND REMOVE BONE PIN",4072,4405.5600000000004,1990.62,11845.41,1018]
["TUFTS - TUFTS SELECT - CPT - 20650","TUFTS","TUFTS SELECT","CPT","20650","HC INSERT AND REMOVE BONE PIN","20650 - HC INSERT AND REMOVE BONE PIN",4072,3987.49,1990.62,11845.41,1018]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 20690","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","20690","HC APPLY BONE FIXATION DEVICE","20690 - HC APPLY BONE FIXATION DEVICE",9361,10803,1500.85,11074.87,2340.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 20982","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","20982","HC ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE","20982 - HC ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE",6499,11074.87,1198.25,11074.87,1624.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 21011","BLUE CROSS","BLUE CROSS-PPO","CPT","21011","EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ <2CM","21011 - EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ <2CM",1996,2309.9699999999998,1098.98,3264.67,499]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 21013","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","21013","EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL <2CM","21013 - EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL <2CM",3106,2309.9699999999998,1098.98,3264.67,776.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 21026","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","21026","HC EXCISION OF FACIAL BONE(S)","21026 - HC EXCISION OF FACIAL BONE(S)",6641,7429.92,1500.85,8596.73,1660.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 21029","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","21029","HC CONTOUR OF FACE BONE LESION","21029 - HC CONTOUR OF FACE BONE LESION",3896,3747.12,1500.85,11845.41,974]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 21031","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","21031","HC EXCISION TORUS MANDIBULARIS","21031 - HC EXCISION TORUS MANDIBULARIS",3301,3747.12,1198.25,7703.8,825.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 21040","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","21040","HC EXCISION BENIGN TUMORE MANDIBLE","21040 - HC EXCISION BENIGN TUMORE MANDIBLE",3209,3747.12,1500.85,7703.8,802.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 21046","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","21046","HC EXCISION,BEN TUMOR,MANDIBLE,INTRA-ORAL","21046 - HC EXCISION,BEN TUMOR,MANDIBLE,INTRA-ORAL",5309,7429.92,1500.85,8596.73,1327.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 21070","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","21070","HC REMV CORONOID PROCESS","21070 - HC REMV CORONOID PROCESS",7214,7429.92,1990.62,11845.41,1803.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 21076","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","21076","HC PREP FACE/ORAL PROST OBTURATOR","21076 - HC PREP FACE/ORAL PROST OBTURATOR",3209,2148.08,2148.08,17023.61,802.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 21080","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","21080","HC PREP FACE/ORAL PROST FINL OBTURATOR","21080 - HC PREP FACE/ORAL PROST FINL OBTURATOR",3209,3747.12,3747.12,17023.61,802.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 21085","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","21085","HC IMPRESSION & PREPARATION ORAL SURGICAL SPLINT","21085 - HC IMPRESSION & PREPARATION ORAL SURGICAL SPLINT",691,445.06,346.18,17023.61,172.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 21198","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","21198","HC OSTEOTOMY, MANDIBLE","21198 - HC OSTEOTOMY, MANDIBLE",7214,7429.92,1990.62,11845.41,1803.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 21215","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","21215","HC MANDIBLE GRAFT","21215 - HC MANDIBLE GRAFT",7214,7429.92,2531.06,15242.01,1803.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 21240","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","21240","HC ARTHROPLASTY TMJ","21240 - HC ARTHROPLASTY TMJ",7214,7429.92,2166.09,11845.41,1803.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 21244","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","21244","HC RECONSTR MANDIBLE,BONE PLATE","21244 - HC RECONSTR MANDIBLE,BONE PLATE",7214,7429.92,2531.06,15242.01,1803.5]
["TUFTS - TUFTS POS - CPT - 21310","TUFTS","TUFTS POS","CPT","21310","CLOSED TREATMENT NASAL FRACTURE W/O MANIPULATION","21310 - CLOSED TREATMENT NASAL FRACTURE W/O MANIPULATION",323,4856.75,378,7703.8,80.75]
["TUFTS - TUFTS HMO - CPT - 21320","TUFTS","TUFTS HMO","CPT","21320","CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION","21320 - CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION",2094,4856.75,1500.85,7703.8,523.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 21337","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","21337","HC CLOSED RX NASAL SEPTAL FRACTURE","21337 - HC CLOSED RX NASAL SEPTAL FRACTURE",3896,3747.12,1500.85,7703.8,974]
["TUFTS - TUFTS PPO - CPT - 21400","TUFTS","TUFTS PPO","CPT","21400","HC CLOSED RX FX ORBIT","21400 - HC CLOSED RX FX ORBIT",658,4856.75,818.07,7703.8,164.5]
["TUFTS - TUFTS POS - CPT - 21421","TUFTS","TUFTS POS","CPT","21421","HC CLOSED RX LEFORTE I+WIRES","21421 - HC CLOSED RX LEFORTE I+WIRES",3350,7467.76,2166.09,11845.41,837.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 21440","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","21440","HC DENTAL RIDGE FX","21440 - HC DENTAL RIDGE FX",3620,3747.12,1990.62,11845.41,905]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 21450","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","21450","HC CLOSED RX MANDIBLE FX","21450 - HC CLOSED RX MANDIBLE FX",658,1051.71,818.07,11845.41,164.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 21453","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","21453","HC CLOSED RX MANDIBLE FX+DENTAL FIX","21453 - HC CLOSED RX MANDIBLE FX+DENTAL FIX",5309,8385.69,1990.62,11845.41,1327.25]
["TUFTS - TUFTS HMO - CPT - 21470","TUFTS","TUFTS HMO","CPT","21470","HC OPEN RX MANDIBLE CONDYLE FX,COMPL","21470 - HC OPEN RX MANDIBLE CONDYLE FX,COMPL",7214,9609.09,2354.5,15242.01,1803.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 21501","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","21501","I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX","21501 - I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX",2480,4621.25,1500.85,7703.8,620]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 21555","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","21555","EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM","21555 - EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM",2366,2672.73,1500.85,7703.8,591.5]
["TUFTS - TUFTS POS - CPT - 21556","TUFTS","TUFTS POS","CPT","21556","EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM","21556 - EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM",4117,4856.75,1500.85,7703.8,1029.25]
["TUFTS - TUFTS HMO - CPT - 21925","TUFTS","TUFTS HMO","CPT","21925","HC BIOPSY SOFT TISSUE BACK,DEEP","21925 - HC BIOPSY SOFT TISSUE BACK,DEEP",2043,4856.75,1500.85,7703.8,510.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 21932","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","21932","HC EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM","21932 - HC EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM",3570,4621.25,1500.85,7703.8,892.5]
["TUFTS - TUFTS PPO - CPT - 22310","TUFTS","TUFTS PPO","CPT","22310","CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING","22310 - CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING",1336,2058.16,378,3264.67,334]
["AETNA - AETNA - CPT - 22513","AETNA","AETNA","CPT","22513","HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION","22513 - HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION",8897,1990.62,1990.62,17023.61,2224.25]
["TUFTS - TUFTS HMO - CPT - 22513","TUFTS","TUFTS HMO","CPT","22513","HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION","22513 - HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION",8897,10732.28,1990.62,17023.61,2224.25]
["TUFTS - TUFTS SELECT - CPT - 22854","TUFTS","TUFTS SELECT","CPT","22854","HC INSJ BIOMCHN DEV VRT CORPECTOMY DEFECT W/ARTHRD","22854 - HC INSJ BIOMCHN DEV VRT CORPECTOMY DEFECT W/ARTHRD",660,0,842.2,1198.25,165]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 22870","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","22870","HC INSJ STABLJ DEV W/O DCMPRN LUMBAR SECOND LEVEL","22870 - HC INSJ STABLJ DEV W/O DCMPRN LUMBAR SECOND LEVEL",2523,0,311.33,1198.25,630.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 22903","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","22903","HC EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3+CM","22903 - HC EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3+CM",3338,4621.25,1990.62,11845.41,834.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 23065","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","23065","HC BIOPSY SOFT TISSUE SHOULDER SUPERFICIAL","23065 - HC BIOPSY SOFT TISSUE SHOULDER SUPERFICIAL",2043,2607.12,1098.98,3264.67,510.75]
["TUFTS - TUFTS SELECT - CPT - 23073","TUFTS","TUFTS SELECT","CPT","23073","HC EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/>","23073 - HC EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/>",1528,3987.49,1990.62,11845.41,382]
["AETNA - AETNA - CPT - 23330","AETNA","AETNA","CPT","23330","REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS","23330 - REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS",930,1198.25,972.93,3264.67,232.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 23330","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","23330","REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS","23330 - REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS",930,1250.8,972.93,3264.67,232.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 23500","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","23500","CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION","23500 - CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION",1217,474.04,378,3264.67,304.25]
["TUFTS - TUFTS PPO - CPT - 23505","TUFTS","TUFTS PPO","CPT","23505","CLSD TX CLAVICULAR FRACTURE W/MANIPULATION","23505 - CLSD TX CLAVICULAR FRACTURE W/MANIPULATION",1738,2058.16,1098.98,3264.67,434.5]
["AETNA - AETNA - CPT - 23570","AETNA","AETNA","CPT","23570","CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION","23570 - CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION",1217,1198.25,378,3264.67,304.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 23575","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","23575","CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION","23575 - CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION",1738,2551.96,1098.98,3264.67,434.5]
["TUFTS - TUFTS SELECT - CPT - 23605","TUFTS","TUFTS SELECT","CPT","23605","CLTX PROX HUMRL FX W/MANJ W/WO SKELETAL TRACJ","23605 - CLTX PROX HUMRL FX W/MANJ W/WO SKELETAL TRACJ",2021,2593.31,1500.85,7703.8,505.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 23655","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","23655","HC CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES","23655 - HC CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES",1986,2205.59,1098.98,3264.67,496.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 24066","BLUE CROSS","BLUE CROSS-PPO","CPT","24066","HC BX ARM/ELBOW SOFT TISSUE,DEEP","24066 - HC BX ARM/ELBOW SOFT TISSUE,DEEP",3449,3994.03,1500.85,7703.8,862.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 24075","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","24075","EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM","24075 - EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM",1972,2309.9699999999998,1500.85,7703.8,493]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 24075","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","24075","EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM","24075 - EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM",1972,2607.12,1500.85,7703.8,493]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 24220","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","24220","HC INJECTION ELBOW ARTHROGRAPHY","24220 - HC INJECTION ELBOW ARTHROGRAPHY",637,167.43,167.43,1198.25,159.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 24505","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","24505","CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ","24505 - CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ",1738,2205.59,1098.98,3264.67,434.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 24535","BLUE CROSS","BLUE CROSS-PPO","CPT","24535","CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ","24535 - CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ",1738,2205.59,1098.98,3264.67,434.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 24560","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","24560","CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ","24560 - CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ",1217,378,378,3264.67,304.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 24576","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","24576","CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ","24576 - CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ",2327,378,378,3264.67,581.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 24605","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","24605","HC TX ELBOW DISLOC W/ANESTH","24605 - HC TX ELBOW DISLOC W/ANESTH",2026,2205.59,1500.85,7703.8,506.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 24640","BLUE CROSS","BLUE CROSS-PPO","CPT","24640","CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ","24640 - CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ",720,378,317.70999999999998,943.8,180]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 24655","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","24655","CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION","24655 - CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION",3067,2205.59,1098.98,3264.67,766.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 24675","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","24675","CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ","24675 - CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ",3187,2205.59,1098.98,3264.67,796.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 25065","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","25065","HC BIOPSY FOREARM SOFT TISSUES,SUPERFIC","25065 - HC BIOPSY FOREARM SOFT TISSUES,SUPERFIC",2043,2309.9699999999998,1098.98,3264.67,510.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 25071","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","25071","EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/>","25071 - EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/>",3254,2309.9699999999998,1990.62,11845.41,813.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 25076","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","25076","EXC FOREARM TUM DEEP < 3 CM","25076 - EXC FOREARM TUM DEEP < 3 CM",2041,2309.9699999999998,1990.62,11845.41,510.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 25112","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","25112","EXCISION GANGLION WRIST DORSAL/VOLAR RECURRENT","25112 - EXCISION GANGLION WRIST DORSAL/VOLAR RECURRENT",4070,2205.59,2166.09,11845.41,1017.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 25248","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","25248","HC REMOVE FOREARM/WRIST FOREIGN BODY","25248 - HC REMOVE FOREARM/WRIST FOREIGN BODY",2026,2551.96,1500.85,7703.8,506.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 25505","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","25505","CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION","25505 - CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION",3521,3264.67,1098.98,3264.67,880.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 25530","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","25530","CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION","25530 - CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION",1808,378,317.70999999999998,1198.25,452]
["AETNA - AETNA - CPT - 25565","AETNA","AETNA","CPT","25565","CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ","25565 - CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ",3607,1500.85,1500.85,7703.8,901.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 25605","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","25605","CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF","25605 - CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF",3956,2551.96,1098.98,3264.67,989]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 25622","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","25622","CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ","25622 - CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ",2123,485.97,317.70999999999998,943.8,530.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 25630","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","25630","CLTX CARPAL BONE FX W/O MANJ EACH BONE","25630 - CLTX CARPAL BONE FX W/O MANJ EACH BONE",2151,378,317.70999999999998,1198.25,537.75]
["TUFTS - TUFTS POS - CPT - 25660","TUFTS","TUFTS POS","CPT","25660","CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MANJ","25660 - CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MANJ",325,2058.17,378,3264.67,81.25]
["TUFTS - TUFTS HMO - CPT - 25680","TUFTS","TUFTS HMO","CPT","25680","HC CLOSED RX NAVIC/LUNATE FX/DISLOC","25680 - HC CLOSED RX NAVIC/LUNATE FX/DISLOC",321,4856.75,378,7703.8,80.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 25690","BLUE CROSS","BLUE CROSS-PPO","CPT","25690","CLOSED TX LUNATE DISLOCATION W/MANIPULATION","25690 - CLOSED TX LUNATE DISLOCATION W/MANIPULATION",2026,2205.59,1098.98,3264.67,506.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 26011","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","26011","DRAINAGE FINGER ABSCESS COMPLICATED","26011 - DRAINAGE FINGER ABSCESS COMPLICATED",1418,2672.73,1098.98,3264.67,354.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 26080","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","26080","HC EXPLORE/TREAT INTERPHALANGEAL JT,EA","26080 - HC EXPLORE/TREAT INTERPHALANGEAL JT,EA",2016,2205.59,2166.09,11845.41,504]
["TUFTS - TUFTS HMO - CPT - 26113","TUFTS","TUFTS HMO","CPT","26113","EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5CM/>","26113 - EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5CM/>",4200,7467.76,1990.62,11845.41,1050]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 26116","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","26116","EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM","26116 - EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM",4035,2672.73,1500.85,7703.8,1008.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 26410","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","26410","HC REPAIR EXTEN TENDON,DORSUM HAND,EA","26410 - HC REPAIR EXTEN TENDON,DORSUM HAND,EA",2026,11845.41,1990.62,11845.41,506.5]
["TUFTS - TUFTS POS - CPT - 26418","TUFTS","TUFTS POS","CPT","26418","HC REPAIR EXTEN TENDON,DORSUM FINGER,EA","26418 - HC REPAIR EXTEN TENDON,DORSUM FINGER,EA",3693,7467.76,2166.09,11845.41,923.25]
["TUFTS - TUFTS HMO - CPT - 26535","TUFTS","TUFTS HMO","CPT","26535","HC ARTHROPLASTY I-P JT","26535 - HC ARTHROPLASTY I-P JT",3781,9609.09,2354.5,15242.01,945.25]
["TUFTS - TUFTS HMO - CPT - 26641","TUFTS","TUFTS HMO","CPT","26641","CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ","26641 - CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ",2528,595.01,317.70999999999998,943.8,632]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 26650","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","26650","HC PRQ SKEL FIXATION CARP/MTCRPL FX DISLOCATE THUMB","26650 - HC PRQ SKEL FIXATION CARP/MTCRPL FX DISLOCATE THUMB",4072,4972.29,1500.85,7703.8,1018]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 26725","BLUE CROSS","BLUE CROSS-PPO","CPT","26725","CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA","26725 - CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA",2335,378,378,3264.67,583.75]
["TUFTS - TUFTS SELECT - CPT - 26725","TUFTS","TUFTS SELECT","CPT","26725","CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA","26725 - CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA",2335,1098.98,378,3264.67,583.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 26755","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","26755","CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA","26755 - CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA",2102,378,317.70999999999998,943.8,525.5]
["TUFTS - TUFTS SELECT - CPT - 26765","TUFTS","TUFTS SELECT","CPT","26765","HC OPEN TX DISTAL PHALANGEAL FRACTURE EACH","26765 - HC OPEN TX DISTAL PHALANGEAL FRACTURE EACH",3938,3987.49,2166.09,11845.41,984.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 26990","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","26990","HC INCIS/DRAIN PELVIS/HIP,DEEP ABCESS","26990 - HC INCIS/DRAIN PELVIS/HIP,DEEP ABCESS",3970,4405.5600000000004,1098.98,5097.42,992.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 27040","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","27040","HC BX SOFT TISSUES,PELV/HIP,SUPERFICL","27040 - HC BX SOFT TISSUES,PELV/HIP,SUPERFICL",2043,2309.9699999999998,1098.98,3264.67,510.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 27048","BLUE CROSS","BLUE CROSS-PPO","CPT","27048","EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC <5CM","27048 - EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC <5CM",1528,3994.03,1990.62,11845.41,382]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 27087","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","27087","REMOVAL FOREIGN BODY PELVIS/HIP DEEP","27087 - REMOVAL FOREIGN BODY PELVIS/HIP DEEP",4826,11845.41,1990.62,11845.41,1206.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 27093","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","27093","HC INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA","27093 - HC INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA",533,173.01,173.01,1198.25,133.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 27200","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","27200","HC CLOSED TREATMENT COCCYGEAL FRACTURE","27200 - HC CLOSED TREATMENT COCCYGEAL FRACTURE",1431,378,317.70999999999998,1198.25,357.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 27220","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","27220","CLTX ACETABULUM HIP/SOCKT FX W/O MANJ","27220 - CLTX ACETABULUM HIP/SOCKT FX W/O MANJ",4008,378,378,2032.26,1002]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 27246","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","27246","CLTX GREATER TROCHANTERIC FX W/O MANJ","27246 - CLTX GREATER TROCHANTERIC FX W/O MANJ",2950,485.97,378,3264.67,737.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 27252","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","27252","HC TX HIP DISLOC W/ANESTH","27252 - HC TX HIP DISLOC W/ANESTH",2025,2205.59,1500.85,7703.8,506.25]
["TUFTS - TUFTS HMO - CPT - 27265","TUFTS","TUFTS HMO","CPT","27265","CLTX POST HIP ARTHRP DISLC W/O ANES","27265 - CLTX POST HIP ARTHRP DISLC W/O ANES",3055,2057.7399999999998,378,3264.67,763.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 27301","BLUE CROSS","BLUE CROSS-PPO","CPT","27301","HC INCIS/DRAIN THIGH/KNEE ABSCESS,DEEP","27301 - HC INCIS/DRAIN THIGH/KNEE ABSCESS,DEEP",3449,3994.03,1990.62,11845.41,862.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 27324","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","27324","HC BX THIGH/KNEE SOFT TISSUES,DEEP","27324 - HC BX THIGH/KNEE SOFT TISSUES,DEEP",3449,3994.03,1098.98,4621.25,862.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 27328","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","27328","HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM","27328 - HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM",4466,3994.03,1990.62,11845.41,1116.5]
["AETNA - AETNA - CPT - 27337","AETNA","AETNA","CPT","27337","EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/>","27337 - EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/>",3207,1990.62,1990.62,11845.41,801.75]
["TUFTS - TUFTS PPO - CPT - 27370","TUFTS","TUFTS PPO","CPT","27370","INJ ARTHRO KNEE","27370 - INJ ARTHRO KNEE",399,0,0,0,99.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 27502","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","27502","CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ","27502 - CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ",5928,2205.59,1500.85,7703.8,1482]
["AETNA - AETNA - CPT - 27520","AETNA","AETNA","CPT","27520","CLOSED TX PATELLAR FRACTURE W/O MANIPULATION","27520 - CLOSED TX PATELLAR FRACTURE W/O MANIPULATION",2263,1198.25,378,3264.67,565.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 27520","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","27520","CLOSED TX PATELLAR FRACTURE W/O MANIPULATION","27520 - CLOSED TX PATELLAR FRACTURE W/O MANIPULATION",2263,485.97,378,3264.67,565.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 27532","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","27532","HC CLTX TIBIAL FX PROXIMAL W/WO MANJ W/SKEL TRACJ","27532 - HC CLTX TIBIAL FX PROXIMAL W/WO MANJ W/SKEL TRACJ",4413,4972.29,1098.98,5097.42,1103.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 27603","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","27603","HC DRAIN LOWER LEG DEEP ABSC/HEMATOMA","27603 - HC DRAIN LOWER LEG DEEP ABSC/HEMATOMA",3573,3994.03,1500.85,7703.8,893.25]
["AETNA - AETNA - CPT - 27613","AETNA","AETNA","CPT","27613","HC BX LOW LEG SOFT TISSUE,SUPERFICIAL","27613 - HC BX LOW LEG SOFT TISSUE,SUPERFICIAL",2043,1198.25,1098.98,3264.67,510.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 27614","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","27614","HC BX LOW LEG SOFT TISSUE,DEEP","27614 - HC BX LOW LEG SOFT TISSUE,DEEP",3449,4621.25,1500.85,7703.8,862.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 27634","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","27634","HC EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5+CM","27634 - HC EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5+CM",3570,11845.41,1990.62,11845.41,892.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 27750","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","27750","CLTX TIBIAL SHAFT FX W/O MANIPULATION","27750 - CLTX TIBIAL SHAFT FX W/O MANIPULATION",2433,378,378,3264.67,608.25]
["AETNA - AETNA - CPT - 27759","AETNA","AETNA","CPT","27759","HC TREAT TIBIAL SHAFT FX, INTRAMED IMPLANT","27759 - HC TREAT TIBIAL SHAFT FX, INTRAMED IMPLANT",16080,2166.09,2166.09,20818.13,4020]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 27767","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","27767","HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANIP","27767 - HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANIP",2180,378,317.70999999999998,1198.25,545]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 27780","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","27780","CLTX PROX FIBULA/SHFT FX W/O MANJ","27780 - CLTX PROX FIBULA/SHFT FX W/O MANJ",2135,378,378,3264.67,533.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 27788","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","27788","CLTX DSTL FIBULAR FX LAT MALLS W/MANJ","27788 - CLTX DSTL FIBULAR FX LAT MALLS W/MANJ",2964,378,378,3264.67,741]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 27810","BLUE CROSS","BLUE CROSS-PPO","CPT","27810","CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ","27810 - CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ",3285,2205.59,1098.98,3264.67,821.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 27816","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","27816","CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION","27816 - CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION",2193,378,378,3264.67,548.25]
["TUFTS - TUFTS POS - CPT - 27824","TUFTS","TUFTS POS","CPT","27824","CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ","27824 - CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ",2325,2058.17,378,3264.67,581.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 27840","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","27840","CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA","27840 - CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA",2813,378,378,3264.67,703.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 28010","BLUE CROSS","BLUE CROSS-PPO","CPT","28010","TENOTOMY PERCUTANEOUS TOE SINGLE TENDON","28010 - TENOTOMY PERCUTANEOUS TOE SINGLE TENDON",2895,2205.59,1098.98,3264.67,723.75]
["TUFTS - TUFTS PPO - CPT - 28011","TUFTS","TUFTS PPO","CPT","28011","HC INCISION OF TOE TENDONS","28011 - HC INCISION OF TOE TENDONS",2020,4856.75,1990.62,7703.8,505]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 28043","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","28043","EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM","28043 - EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM",2008,2309.9699999999998,1500.85,7703.8,502]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 28045","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","28045","HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC <1.5CM","28045 - HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC <1.5CM",3490,3994.03,1990.62,11845.41,872.5]
["TUFTS - TUFTS SELECT - CPT - 28046","TUFTS","TUFTS SELECT","CPT","28046","HC RESECT FOOT/TOE TUMOR < 3 CM","28046 - HC RESECT FOOT/TOE TUMOR < 3 CM",3438,3987.49,1990.62,11845.41,859.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 28150","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","28150","HC REMOVAL OF SINGLE TOE,EACH","28150 - HC REMOVAL OF SINGLE TOE,EACH",3938,4405.5600000000004,1990.62,7703.8,984.5]
["TUFTS - TUFTS POS - CPT - 28190","TUFTS","TUFTS POS","CPT","28190","REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS","28190 - REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS",1023,2058.17,972.93,3264.67,255.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 28222","BLUE CROSS","BLUE CROSS-PPO","CPT","28222","HC TENOLYSIS FLEXOR FOOT MULTIPLE TENDONS","28222 - HC TENOLYSIS FLEXOR FOOT MULTIPLE TENDONS",3970,4405.5600000000004,1098.98,5097.42,992.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 28232","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","28232","TX OPEN TENDON FLEXOR TOE 1 TENDON SPX","28232 - TX OPEN TENDON FLEXOR TOE 1 TENDON SPX",2895,2205.59,1098.98,3264.67,723.75]
["AETNA - AETNA - CPT - 28308","AETNA","AETNA","CPT","28308","OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA","28308 - OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA",2861,1500.85,1500.85,7703.8,715.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 28400","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","28400","CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION","28400 - CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION",1743,378,378,3264.67,435.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 28435","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","28435","CLOSED TX TALUS FRACTURE W/MANIPULATION","28435 - CLOSED TX TALUS FRACTURE W/MANIPULATION",1918,2551.96,1500.85,7703.8,479.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 28455","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","28455","TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ","28455 - TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ",1989,2205.59,1098.98,3264.67,497.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 28470","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","28470","CLOSED TX METATARSAL FRACTURE W/O MANIPULATION","28470 - CLOSED TX METATARSAL FRACTURE W/O MANIPULATION",1468,378,317.70999999999998,1198.25,367]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 28495","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","28495","CLTX FX GRT TOE PHLX/PHLG W/MANJ","28495 - CLTX FX GRT TOE PHLX/PHLG W/MANJ",1159,485.97,317.70999999999998,1198.25,289.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 28510","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","28510","CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ","28510 - CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ",914,378,317.70999999999998,1198.25,228.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 28530","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","28530","HC CLOSED RX SESAMOID BONE FX","28530 - HC CLOSED RX SESAMOID BONE FX",321,378,317.70999999999998,1198.25,80.25]
["AETNA - AETNA - CPT - 28570","AETNA","AETNA","CPT","28570","HC CLOSED RX TALOTARSAL DISLOC","28570 - HC CLOSED RX TALOTARSAL DISLOC",321,1198.25,378,3264.67,80.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 28660","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","28660","HC CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES","28660 - HC CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES",323,485.97,317.70999999999998,1198.25,80.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 28825","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","28825","HC AMP,TOE;INTERPHAL JT","28825 - HC AMP,TOE;INTERPHAL JT",2883,7703.8,1500.85,7703.8,720.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 29086","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","29086","HC APPLY CAST,FINGER (CONTRACTURE)","29086 - HC APPLY CAST,FINGER (CONTRACTURE)",203,226.08,226.08,764.24,50.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 29125","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","29125","APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC","29125 - APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC",304,229.89,178.83,607.84,76]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 29126","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","29126","APPLICATION SHORT ARM SPLINT DYNAMIC","29126 - APPLICATION SHORT ARM SPLINT DYNAMIC",373,229.89,178.83,607.84,93.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 29200","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","29200","STRAPPING THORAX","29200 - STRAPPING THORAX",302,290.64,226.08,740.26,75.5]
["AETNA - AETNA - CPT - 29345","AETNA","AETNA","CPT","29345","APPLICATION LONG LEG CAST THIGH-TOE","29345 - APPLICATION LONG LEG CAST THIGH-TOE",776,1198.25,395.63,1308.22,194]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 29365","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","29365","APPLICATION CYLINDER CAST THIGH ANKLE","29365 - APPLICATION CYLINDER CAST THIGH ANKLE",675,395.63,395.63,1308.22,168.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 29405","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","29405","APPLICATION SHORT LEG CAST BELOW KNEE-TOE","29405 - APPLICATION SHORT LEG CAST BELOW KNEE-TOE",459,508.62,395.63,1308.22,114.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 29450","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","29450","APPL CLUBFOOT CAST MOLDING/MANJ LONG/SHORT LEG","29450 - APPL CLUBFOOT CAST MOLDING/MANJ LONG/SHORT LEG",866,764.24,226.08,764.24,216.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 29515","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","29515","APPLICATION SHORT LEG SPLINT CALF FOOT","29515 - APPLICATION SHORT LEG SPLINT CALF FOOT",378,290.64,226.08,764.24,94.5]
["TUFTS - TUFTS PPO - CPT - 29540","TUFTS","TUFTS PPO","CPT","29540","STRAPPING ANKLE &/FOOT","29540 - STRAPPING ANKLE &/FOOT",198,466.68,226.08,740.26,49.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 29580","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","29580","STRAPPING UNNA BOOT","29580 - STRAPPING UNNA BOOT",328,290.64,226.08,764.24,82]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 29581","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","29581","APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT","29581 - APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT",174,290.64,226.08,943.8,43.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 29705","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","29705","HC REMV/REVISN FULL ARM/LEG CAST","29705 - HC REMV/REVISN FULL ARM/LEG CAST",354,508.62,395.63,1274.1099999999999,88.5]
["UNICARE - UNICARE - CPT - 29807","UNICARE","UNICARE","CPT","29807","HC SHLDR ARTHROSCOP,SURG,REPAIR,SLAP LESION","29807 - HC SHLDR ARTHROSCOP,SURG,REPAIR,SLAP LESION",10676,3666.54,1990.62,11845.41,2669]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 29827","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","29827","HC SHLDR ARTHROSCOP,SURG,W/ROTAT CUFF REPR","29827 - HC SHLDR ARTHROSCOP,SURG,W/ROTAT CUFF REPR",10676,15242.01,2354.5,15242.01,2669]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 29881","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","29881","HC KNEE SCOPE SINGLE MENISCECTOMY","29881 - HC KNEE SCOPE SINGLE MENISCECTOMY",4072,4405.5600000000004,2166.09,7703.8,1018]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 29888","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","29888","HC KNEE SCOPE,AID ANT CRUCIATE REPAIR","29888 - HC KNEE SCOPE,AID ANT CRUCIATE REPAIR",8897,9571.73,1990.62,11845.41,2224.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 30100","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","30100","HC BIOPSY INTRANASAL","30100 - HC BIOPSY INTRANASAL",939,2148.08,1098.98,3264.67,234.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 30117","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","30117","EXCISION/DESTRUCTION INTRANASAL LESION INT APPR","30117 - EXCISION/DESTRUCTION INTRANASAL LESION INT APPR",2646,3747.12,1990.62,11845.41,661.5]
["AETNA - AETNA - CPT - 30140","AETNA","AETNA","CPT","30140","HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL","30140 - HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL",3301,1500.85,1500.85,7703.8,825.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 30220","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","30220","INSERTION NASAL SEPTAL PROSTHESIS BUTTON","30220 - INSERTION NASAL SEPTAL PROSTHESIS BUTTON",2094,2485.42,1990.62,7703.8,523.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 30465","BLUE CROSS","BLUE CROSS-PPO","CPT","30465","REPAIR NASAL VESTIBULAR STENOSIS","30465 - REPAIR NASAL VESTIBULAR STENOSIS",7658,7429.92,2531.06,15242.01,1914.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 30560","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","30560","HC RELEASE OF NASAL ADHESIONS","30560 - HC RELEASE OF NASAL ADHESIONS",731,818.07,818.07,7703.8,182.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 30801","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","30801","ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC","30801 - ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC",1076,2148.08,1098.98,3264.67,269]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 30901","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","30901","CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE","30901 - CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE",435,178.83,178.83,1198.25,108.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 30903","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","30903","CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX","30903 - CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX",621,229.89,178.83,1198.25,155.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 31032","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","31032","HC EXPLOR MAXILL SINUS,RMV POLYPS","31032 - HC EXPLOR MAXILL SINUS,RMV POLYPS",7214,7429.92,2166.09,11845.41,1803.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 31237","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","31237","NASAL/SINUS NDSC SURG W/BX POLYPECT/DBRDMT SPX","31237 - NASAL/SINUS NDSC SURG W/BX POLYPECT/DBRDMT SPX",2091,2299.54,1500.85,7703.8,522.75]
["TUFTS - TUFTS SELECT - CPT - 31239","TUFTS","TUFTS SELECT","CPT","31239","HC NASAL/SINUS ENDOSCOPY SURG","31239 - HC NASAL/SINUS ENDOSCOPY SURG",4562,3987.49,2166.09,11845.41,1140.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 31500","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","31500","HC INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE","31500 - HC INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE",840,1130.24,346.18,1198.25,210]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 31505","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","31505","LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX","31505 - LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX",383,943.8,275.37,943.8,95.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 31510","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","31510","HC LARYNGOSCOPY,INDIRECT WITH BIOPSY","31510 - HC LARYNGOSCOPY,INDIRECT WITH BIOPSY",4562,5325.37,1500.85,7703.8,1140.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 31552","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","31552","HC LARYNGOPLASTY LARYNGEAL STEN W/O STENT 12 YRS>","31552 - HC LARYNGOPLASTY LARYNGEAL STEN W/O STENT 12 YRS>",6641,8596.73,2354.5,15242.01,1660.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 31570","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","31570","HC LARYNGOSCOPY,DIRCT,INJ VOCAL CORD","31570 - HC LARYNGOSCOPY,DIRCT,INJ VOCAL CORD",4112,5325.37,1500.85,7703.8,1028]
["AETNA - AETNA - CPT - 31572","AETNA","AETNA","CPT","31572","HC LARYNGOSCOPY FLEXIBLE ABLATJ DESTJ LESION(S) UNI","31572 - HC LARYNGOSCOPY FLEXIBLE ABLATJ DESTJ LESION(S) UNI",3233,1500.85,1500.85,7703.8,808.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 31574","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","31574","HC LARYNGOSCOPY FLEXIBLE W/INJECTION AGMNTJ UNI","31574 - HC LARYNGOSCOPY FLEXIBLE W/INJECTION AGMNTJ UNI",2056,2299.54,1500.85,7703.8,514]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 31576","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","31576","LARYNGOSCOPY FLEXIBLE FIBEROPTIC W/BIOPSY","31576 - LARYNGOSCOPY FLEXIBLE FIBEROPTIC W/BIOPSY",2091,2595.35,1500.85,7703.8,522.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 31579","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","31579","LARYNGOSCOPY FLX/RGD FIBOPT W/STROBOSCOPY","31579 - LARYNGOSCOPY FLX/RGD FIBOPT W/STROBOSCOPY",1103,2032.26,649.07000000000005,2032.26,275.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 31611","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","31611","CONSTJ TRACHEOESOPHGL FSTL&INSJ SP PROSTH","31611 - CONSTJ TRACHEOESOPHGL FSTL&INSJ SP PROSTH",4242,3747.12,1990.62,11845.41,1060.5]
["TUFTS - TUFTS SELECT - CPT - 31615","TUFTS","TUFTS SELECT","CPT","31615","TRACHEOBRNCHSC THRU EST TRACHS INC","31615 - TRACHEOBRNCHSC THRU EST TRACHS INC",998,1098.98,818.07,3264.67,249.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 31623","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","31623","BRNCHSC BRUSHING/PROTECTED BRUSHINGS","31623 - BRNCHSC BRUSHING/PROTECTED BRUSHINGS",2128,2299.54,1098.98,3264.67,532]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 31626","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","31626","HC BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT","31626 - HC BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT",8573,8644.68,1990.62,10002.24,2143.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 31628","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","31628","BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX 1 LOBE","31628 - BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX 1 LOBE",1449,5194.6400000000003,1500.85,7703.8,362.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 31632","BLUE CROSS","BLUE CROSS-PPO","CPT","31632","HC BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE","31632 - HC BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE",378,120.16,120.16,1500.85,94.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 31645","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","31645","HC BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE 1ST","31645 - HC BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE 1ST",1637,3264.67,1098.98,3264.67,409.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 31645","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","31645","HC BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE 1ST","31645 - HC BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE 1ST",1637,2660.67,1098.98,3264.67,409.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 31653","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","31653","HC BRONCH EBUS SAMPLING 3 OR MORE NODES","31653 - HC BRONCH EBUS SAMPLING 3 OR MORE NODES",2800,4602.58,1500.85,17023.61,700]
["TUFTS - TUFTS SELECT - CPT - 31820","TUFTS","TUFTS SELECT","CPT","31820","HC SURG CLOSURE TRACH/FISTULA","31820 - HC SURG CLOSURE TRACH/FISTULA",3301,1098.98,1098.98,4335.57,825.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 32550","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","32550","HC INS TUNN PLEURAL CATH W/U","32550 - HC INS TUNN PLEURAL CATH W/U",4154,4949.6400000000003,1500.85,7703.8,1038.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 32551","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","32551","TUBE THORACOSTOMY INCLUDES WATER SEAL","32551 - TUBE THORACOSTOMY INCLUDES WATER SEAL",1299,1836.61,1500.85,7703.8,324.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 32554","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","32554","THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING","32554 - THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING",836,1305.74,1041.23,3264.67,209]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 32554","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","32554","THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING","32554 - THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING",836,1338.6,1041.23,3264.67,209]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 32994","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","32994","HC ABLATION THER 1+ PULM TUMORS PREQ CRYOABLATION","32994 - HC ABLATION THER 1+ PULM TUMORS PREQ CRYOABLATION",1343,7718.14,2166.09,15242.01,335.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 33015","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","33015","TUBE PERICARDIOSTOMY","33015 - TUBE PERICARDIOSTOMY",3850,0,3987.49,11845.41,962.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 33206","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","33206","HC INS NEW/RPLCMT PRM PACEMAKR W/TRANS ELTRD ATRIAL","33206 - HC INS NEW/RPLCMT PRM PACEMAKR W/TRANS ELTRD ATRIAL",10670,13864.17,2531.06,37129.18,2667.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 33208","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","33208","HC INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT","33208 - HC INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT",10670,13864.17,2531.06,31200.07,2667.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 33212","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","33212","HC INS PM PLS GEN W/EXIST SINGLE LEAD","33212 - HC INS PM PLS GEN W/EXIST SINGLE LEAD",11115,12434.24,1990.62,31200.07,2778.75]
["TUFTS - TUFTS HMO - CPT - 33215","TUFTS","TUFTS HMO","CPT","33215","HC RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE","33215 - HC RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE",2275,2057.7399999999998,1098.98,5132.74,568.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 33217","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","33217","HC INSJ 2 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB","33217 - HC INSJ 2 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB",7357,10390.549999999999,2166.09,31200.07,1839.25]
["TUFTS - TUFTS POS - CPT - 33221","TUFTS","TUFTS POS","CPT","33221","HC INS PACEMAKER PULSE GEN ONLY W/EXIST MULT LEADS","33221 - HC INS PACEMAKER PULSE GEN ONLY W/EXIST MULT LEADS",18441,3954.83,1990.62,62742.78,4610.25]
["TUFTS - TUFTS POS - CPT - 33225","TUFTS","TUFTS POS","CPT","33225","HC INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN","33225 - HC INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN",3408,0,1173.46,2166.09,852]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 33226","BLUE CROSS","BLUE CROSS-PPO","CPT","33226","HC RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD","33226 - HC RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD",3654,4436.09,1098.98,5132.74,913.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 33228","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","33228","HC REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS","33228 - HC REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS",10670,13864.17,1990.62,62742.78,2667.5]
["TUFTS - TUFTS PPO - CPT - 33233","TUFTS","TUFTS PPO","CPT","33233","HC REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY","33233 - HC REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY",7357,2058.16,1098.98,12434.24,1839.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 33235","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","33235","HC RMVL TRANSVNS PM ELTRD DUAL LEAD SYS","33235 - HC RMVL TRANSVNS PM ELTRD DUAL LEAD SYS",4756,6758.81,2166.09,7703.8,1189]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 33240","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","33240","HC INSJ IMPLNTBL DEFIB PULSE GEN W/1 EXISTING LD","33240 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/1 EXISTING LD",25757,30868.73,2531.06,62742.78,6439.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 33244","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","33244","HC RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ","33244 - HC RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ",6372,6758.81,2166.09,7703.8,1593]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 33263","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","33263","HC RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD","33263 - HC RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD",25757,30868.73,1990.62,62742.78,6439.25]
["TUFTS - TUFTS HMO - CPT - 33270","TUFTS","TUFTS HMO","CPT","33270","INS/RPLCMNT PERM SUBQ IMPLTBL DFB W/SUBQ ELTRD","33270 - INS/RPLCMNT PERM SUBQ IMPLTBL DFB W/SUBQ ELTRD",53692,39555.230000000003,1990.62,62742.78,13423]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 33273","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","33273","REPOS PREVIOUSLY IMPLANTED SUBQ IMPLANTABLE DFB","33273 - REPOS PREVIOUSLY IMPLANTED SUBQ IMPLANTABLE DFB",4700,6758.81,1990.62,7703.8,1175]
["AETNA - AETNA - CPT - 33285","AETNA","AETNA","CPT","33285","HC INSJ SUBQ CAR RHYTHM MNTR","33285 - HC INSJ SUBQ CAR RHYTHM MNTR",11393,1198.25,1198.25,25611.61,2848.25]
["TUFTS - TUFTS POS - CPT - 33289","TUFTS","TUFTS POS","CPT","33289","HC TCAT IMPL WRLS P-ART PRS SNR L-T HEMODYN MNTR","33289 - HC TCAT IMPL WRLS P-ART PRS SNR L-T HEMODYN MNTR",45145,3954.83,2531.06,62742.78,11286.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 33967","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","33967","HC PERC INS IAB","33967 - HC PERC INS IAB",1979,645.88,645.88,26020.16,494.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 36000","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","36000","INTRODUCTION NEEDLE/INTRACATHETER VEIN","36000 - INTRODUCTION NEEDLE/INTRACATHETER VEIN",73,23.16,23.16,23.16,18.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 36005","BLUE CROSS","BLUE CROSS-PPO","CPT","36005","HC NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH","36005 - HC NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH",366,119.48,119.48,1198.25,91.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 36010","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","36010","HC INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA","36010 - HC INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA",928,271.81,271.81,1198.25,232]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 36014","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","36014","HC SLCTV CATHETER PLMT LEFT/RIGHT PULMONARY ARTERY","36014 - HC SLCTV CATHETER PLMT LEFT/RIGHT PULMONARY ARTERY",1055,373.73,373.73,1198.25,263.75]
["AETNA - AETNA - CPT - 36140","AETNA","AETNA","CPT","36140","HC INTRO NEEDLE/INTRACATH EXTREMITY ARTERY","36140 - HC INTRO NEEDLE/INTRACATH EXTREMITY ARTERY",794,1198.25,223.07,1198.25,198.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 36200","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","36200","HC INTRODUCTION CATHETER AORTA","36200 - HC INTRODUCTION CATHETER AORTA",1183,343.93,343.93,1500.85,295.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 36217","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","36217","HC SLCTV CATHJ 3RD+ ORD SLCTV THRC/BRCH/CPHLC BRNCH","36217 - HC SLCTV CATHJ 3RD+ ORD SLCTV THRC/BRCH/CPHLC BRNCH",2514,811.77,811.77,1500.85,628.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 36218","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","36218","HC SLCTV CATHJ EA 2ND+ ORD THRC/BRCH/CPHLC BRNCH","36218 - HC SLCTV CATHJ EA 2ND+ ORD THRC/BRCH/CPHLC BRNCH",401,128.88,128.88,1500.85,100.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 36222","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","36222","HC SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART","36222 - HC SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART",4429,15242.01,1500.85,15242.01,1107.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 36223","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","36223","HC SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART","36223 - HC SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART",4429,9216.9500000000007,1500.85,15242.01,1107.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 36227","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","36227","HC SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC","36227 - HC SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC",1026,292.08999999999997,292.08999999999997,1198.25,256.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 36228","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","36228","HC SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT","36228 - HC SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT",2088,0,602.42999999999995,1198.25,522]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 36246","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","36246","HC SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH","36246 - HC SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH",2072,0,628.98,1500.85,518]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 36251","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","36251","HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UN","36251 - HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UN",4429,4436.09,1500.85,11845.41,1107.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 36254","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","36254","HC SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I","36254 - HC SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I",4429,4436.09,1500.85,11845.41,1107.25]
["TUFTS - TUFTS PPO - CPT - 36410","TUFTS","TUFTS PPO","CPT","36410","VNPNXR 3 YEARS/> PHYS/QHP SKILL","36410 - VNPNXR 3 YEARS/> PHYS/QHP SKILL",78,0,23.16,96.14,19.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 36415","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT","36415","COLLECTION VENOUS BLOOD VENIPUNCTURE","36415 - COLLECTION VENOUS BLOOD VENIPUNCTURE",26,4.04,2.2200000000000002,25.55,6.5]
["FALLON - FALLON MEDICAID - CPT - 36416","FALLON","FALLON MEDICAID","CPT","36416","HC COLLECTION CAPILLARY BLOOD SPECIMEN","36416 - HC COLLECTION CAPILLARY BLOOD SPECIMEN",22,0,5.27,5.27,5.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 36470","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","36470","NJX SCLEROSING SOLUTION SINGLE VEIN","36470 - NJX SCLEROSING SOLUTION SINGLE VEIN",657,678.1,521.32000000000005,1661.52,164.25]
["AETNA - AETNA - CPT - 36473","AETNA","AETNA","CPT","36473","HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM 1ST VEIN","36473 - HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM 1ST VEIN",4122,1990.62,1990.62,11845.41,1030.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 36474","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","36474","HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM SBSQ VEINS","36474 - HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM SBSQ VEINS",2062,218.48,218.48,1198.25,515.5]
["TUFTS - TUFTS HMO - CPT - 36479","TUFTS","TUFTS HMO","CPT","36479","HC ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS","36479 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS",2062,0,336.67,1198.25,515.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 36481","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","36481","HC PERC PORTAL VEIN CATH","36481 - HC PERC PORTAL VEIN CATH",2753,826.81,826.81,1198.25,688.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 36483","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","36483","HC ENDOVEN ABLTI THER CHEM ADHESIVE SBSQ VEIN","36483 - HC ENDOVEN ABLTI THER CHEM ADHESIVE SBSQ VEIN",3423,0,218.56,1198.25,855.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 36511","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","36511","HC THER APHERESIS,WHITE BLOOD CELLS","36511 - HC THER APHERESIS,WHITE BLOOD CELLS",1867,2692.27,1500.85,7279.25,466.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 36522","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","36522","PHOTOPHERESIS EXTRACORPOREAL","36522 - PHOTOPHERESIS EXTRACORPOREAL",7093,8468.68,1500.85,20857.57,1773.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 36555","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","36555","HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y","36555 - HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y",1359,2361.15,1098.98,3264.67,339.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 36561","BLUE CROSS","BLUE CROSS-PPO","CPT","36561","HC INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>","36561 - HC INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>",4034,4436.09,1990.62,7703.8,1008.5]
["TUFTS - TUFTS HMO - CPT - 36565","TUFTS","TUFTS HMO","CPT","36565","HC INSJ TUN VAD REQ 2 CATH 2 SITS W/O SUBQ PORT/PMP","36565 - HC INSJ TUN VAD REQ 2 CATH 2 SITS W/O SUBQ PORT/PMP",4122,4856.75,1990.62,7703.8,1030.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 36568","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","36568","HC INS PICC;W/O PMP/PRT;<5YR","36568 - HC INS PICC;W/O PMP/PRT;<5YR",1461,1338.6,1041.23,7703.8,365.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 36571","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","36571","HC INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>","36571 - HC INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>",4122,4436.09,1990.62,7703.8,1030.5]
["TUFTS - TUFTS POS - CPT - 36573","TUFTS","TUFTS POS","CPT","36573","HC INSJ PICC RS&I 5 YR+","36573 - HC INSJ PICC RS&I 5 YR+",1683,4856.75,1198.25,7703.8,420.75]
["TUFTS - TUFTS HMO - CPT - 36576","TUFTS","TUFTS HMO","CPT","36576","HC RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT","36576 - HC RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT",2426,2057.7399999999998,1098.98,3264.67,606.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 36580","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","36580","HC REPL CVC,NON_TUN;5/+YO","36580 - HC REPL CVC,NON_TUN;5/+YO",1461,1836.61,1198.25,7703.8,365.25]
["TUFTS - TUFTS PPO - CPT - 36584","TUFTS","TUFTS PPO","CPT","36584","RPLCMT COMPL PRPH CVC W/O SUBQ PORT/PMP","36584 - RPLCMT COMPL PRPH CVC W/O SUBQ PORT/PMP",1461,4856.75,1198.25,7703.8,365.25]
["TUFTS - TUFTS POS - CPT - 36589","TUFTS","TUFTS POS","CPT","36589","RMVL TUN CVC W/O SUBQ PORT/PMP","36589 - RMVL TUN CVC W/O SUBQ PORT/PMP",1072,1281.21,684.11,2032.26,268]
["TUFTS - TUFTS PPO - CPT - 36590","TUFTS","TUFTS PPO","CPT","36590","HC RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ","36590 - HC RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ",1588,2058.16,1041.23,3264.67,397]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 36593","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","36593","DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH","36593 - DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH",492,607.33000000000004,484.3,1705.01,123]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 36595","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","36595","HC MECH REMOV PERICATH OBSTR CV DEV VIA VEN ACCESS","36595 - HC MECH REMOV PERICATH OBSTR CV DEV VIA VEN ACCESS",4214,4436.09,2166.09,11845.41,1053.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 36598","BMC HEALTHNET","BMCHN MEDICAID","CPT","36598","HC CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT","36598 - HC CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT",275,0,314.33999999999997,1500.85,68.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 36620","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","36620","HC INSERT CATH,ART,PERCUT,SHORTTERM","36620 - HC INSERT CATH,ART,PERCUT,SHORTTERM",366,108.25,108.25,1198.25,91.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 36903","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","36903","HC INTRO CATH DIALYSIS CIRCUIT W/TCAT PLMT IV STENT","36903 - HC INTRO CATH DIALYSIS CIRCUIT W/TCAT PLMT IV STENT",15870,18787.919999999998,2531.06,18787.919999999998,3967.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 36904","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","36904","HC PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH","36904 - HC PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH",7857,7856.99,2354.5,9090.86,1964.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 36906","BLUE CROSS","BLUE CROSS-PPO","CPT","36906","HC PERQ THRMBC/NFS DIAL CIRCUIT TCAT PLMT IV STENT","36906 - HC PERQ THRMBC/NFS DIAL CIRCUIT TCAT PLMT IV STENT",24055,25785.9,2531.06,37129.18,6013.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 37182","BMC HEALTHNET","BMCHN MCO","CPT","37182","HC INSJ TRANSVNS INTRAHEPATC PORTOSYSIC SHUNT","37182 - HC INSJ TRANSVNS INTRAHEPATC PORTOSYSIC SHUNT",6320,0,2031.06,11845.41,1580]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 37184","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","37184","HC PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST","37184 - HC PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST",5624,7856.99,2397.88,15242.01,1406]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 37186","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","37186","HC SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL","37186 - HC SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL",1951,603,603,1198.25,487.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 37188","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","37188","PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX","37188 - PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX",5624,4436.09,2397.88,15242.01,1406]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 37193","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","37193","HC RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I","37193 - HC RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I",4034,4436.09,1990.62,11845.41,1008.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 37197","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","37197","HC PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING","37197 - HC PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING",4034,4436.09,1098.98,5132.74,1008.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 37212","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","37212","HC THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX","37212 - HC THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX",3354,4436.09,1098.98,5132.74,838.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 37214","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","37214","HC CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL","37214 - HC CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL",3308,1836.61,1098.98,3264.67,827]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 37215","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","37215","HC TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ","37215 - HC TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ",8331,2506.5500000000002,1990.62,7703.8,2082.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 37222","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","37222","HC REVASC;ILIAC,EAAD,TRN ANG","37222 - HC REVASC;ILIAC,EAAD,TRN ANG",7580,459.91,459.91,1198.25,1895]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 37223","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","37223","HC REVASC;ILIAC,EAAD,TRN STN","37223 - HC REVASC;ILIAC,EAAD,TRN STN",7051,526.34,526.34,1198.25,1762.75]
["TUFTS - TUFTS HMO - CPT - 37226","TUFTS","TUFTS HMO","CPT","37226","HC REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL","37226 - HC REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL",15672,7467.76,2166.09,18787.919999999998,3918]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 37229","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","37229","HC REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL","37229 - HC REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL",16686,25785.9,2166.09,62742.78,4171.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 37230","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","37230","HC REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL","37230 - HC REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL",16686,25785.9,2166.09,62742.78,4171.5]
["TUFTS - TUFTS POS - CPT - 37232","TUFTS","TUFTS POS","CPT","37232","HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL","37232 - HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL",7580,0,497.3,1198.25,1895]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 37236","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","37236","OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL","37236 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL",15672,16237.9,1990.62,18787.919999999998,3918]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 37239","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","37239","OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL","37239 - OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL",7580,376.39,376.39,1198.25,1895]
["TUFTS - TUFTS PPO - CPT - 37241","TUFTS","TUFTS PPO","CPT","37241","VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I","37241 - VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I",15195,4856.75,1990.62,18787.919999999998,3798.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 37246","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","37246","HC TRLUML BAL ANGIO 1ST ART","37246 - HC TRLUML BAL ANGIO 1ST ART",7857,9090.86,2531.06,11845.41,1964.25]
["TUFTS - TUFTS HMO - CPT - 37247","TUFTS","TUFTS HMO","CPT","37247","HC TRLUML BAL ANGIO ADD ART","37247 - HC TRLUML BAL ANGIO ADD ART",3929,0,422.81,1198.25,982.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 37252","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","37252","INTRAVSC US DURNG DX EVAL &/OR THERPUTC INTRVNTN INCL RAD S&I; 1ST NONCRNRY VES","37252 - INTRAVSC US DURNG DX EVAL &/OR THERPUTC INTRVNTN INCL RAD S&I; 1ST NONCRNRY VES",652,225.25,225.25,1198.25,163]
["TUFTS - TUFTS HMO - CPT - 38200","TUFTS","TUFTS HMO","CPT","38200","HC INJ PROC SPLENOPORTO","38200 - HC INJ PROC SPLENOPORTO",1095,0,1198.25,1198.25,273.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 38208","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","38208","HC TRNSPL PREP HEMATOP PROGEN THAW PREV HRV PER DNR","38208 - HC TRNSPL PREP HEMATOP PROGEN THAW PREV HRV PER DNR",1015,643.03,643.03,2032.26,253.75]
["TUFTS - TUFTS HMO - CPT - 38220","TUFTS","TUFTS HMO","CPT","38220","MARROW ASPIRATION ONLY","38220 - MARROW ASPIRATION ONLY",1103,2057.7399999999998,1098.98,3264.67,275.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 38241","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","38241","TRNSPLJ AUTOLOGOUS HEMATOPOIETIC CELLS PER DONOR","38241 - TRNSPLJ AUTOLOGOUS HEMATOPOIETIC CELLS PER DONOR",5269,2626.18,2094.1799999999998,15242.01,1317.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 38500","BLUE CROSS","BLUE CROSS-PPO","CPT","38500","HC BIOPSY/EXCISION, LYMPH NODE(S)","38500 - HC BIOPSY/EXCISION, LYMPH NODE(S)",4095,4729.13,1500.85,7703.8,1023.75]
["TUFTS - TUFTS POS - CPT - 38505","TUFTS","TUFTS POS","CPT","38505","BX/EXC LYMPH NODE NEEDLE SUPERFICIAL","38505 - BX/EXC LYMPH NODE NEEDLE SUPERFICIAL",1209,2058.17,1098.98,3264.67,302.25]
["TUFTS - TUFTS HMO - CPT - 38531","TUFTS","TUFTS HMO","CPT","38531","HC OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES","38531 - HC OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES",4334,7467.76,1500.85,11845.41,1083.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 38790","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","38790","HC INJECTION PROCEDURE LYMPHANGIOGRAPHY","38790 - HC INJECTION PROCEDURE LYMPHANGIOGRAPHY",644,208.28,208.28,1198.25,161]
["TUFTS - TUFTS SELECT - CPT - 40490","TUFTS","TUFTS SELECT","CPT","40490","BIOPSY OF LIP","40490 - BIOPSY OF LIP",573,684.11,346.18,2032.26,143.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 40520","BLUE CROSS","BLUE CROSS-PPO","CPT","40520","HC PARTIAL EXCISION OF LIP","40520 - HC PARTIAL EXCISION OF LIP",4029,3747.12,1500.85,7703.8,1007.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 40530","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","40530","HC PARTIAL REMOVAL OF LIP,>1/4","40530 - HC PARTIAL REMOVAL OF LIP,>1/4",3896,4335.57,1500.85,7703.8,974]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 40652","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","40652","HC REPAIR LIP,<1/2 VERT HEIGHT","40652 - HC REPAIR LIP,<1/2 VERT HEIGHT",658,1025.9000000000001,818.07,11845.41,164.5]
["TUFTS - TUFTS HMO - CPT - 40804","TUFTS","TUFTS HMO","CPT","40804","HC REM FB,MOUTH;SIMP","40804 - HC REM FB,MOUTH;SIMP",1058,320.41000000000003,171.09,1644.19,264.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 40806","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","40806","INCISION OF LIP FOLD","40806 - INCISION OF LIP FOLD",667,818.07,684.11,2032.26,166.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 40810","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","40810","EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR","40810 - EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR",2094,3747.12,1098.98,4335.57,523.5]
["TUFTS - TUFTS POS - CPT - 40814","TUFTS","TUFTS POS","CPT","40814","HC EXCIS MOUTH MUCOSA/SUB,COMPLX REPR","40814 - HC EXCIS MOUTH MUCOSA/SUB,COMPLX REPR",3197,4856.75,1500.85,7703.8,799.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 40820","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","40820","HC DESTRUC MOUTH LESION/SCAR","40820 - HC DESTRUC MOUTH LESION/SCAR",3301,3747.12,1098.98,4335.57,825.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 40831","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","40831","HC REPAIR MOUTH LACERATION,>2.5 CM","40831 - HC REPAIR MOUTH LACERATION,>2.5 CM",691,818.07,818.07,3264.67,172.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 40842","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","40842","HC RECONSTRUC MOUTH POSTER,UNILAT","40842 - HC RECONSTRUC MOUTH POSTER,UNILAT",6641,7429.92,1990.62,11845.41,1660.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 41007","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","41007","HC I&D MOUTH/TONG INTRA,SUBMENTAL","41007 - HC I&D MOUTH/TONG INTRA,SUBMENTAL",1921,2148.08,1098.98,3264.67,480.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 41009","BLUE CROSS","BLUE CROSS-PPO","CPT","41009","HC I&D MOUTH/TONG INTRA, MASTICATOR","41009 - HC I&D MOUTH/TONG INTRA, MASTICATOR",2270,818.07,684.11,2032.26,567.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 41010","BLUE CROSS","BLUE CROSS-PPO","CPT","41010","INCISION LINGUAL FRENUM FRENOTOMY","41010 - INCISION LINGUAL FRENUM FRENOTOMY",870,2148.08,1098.98,3264.67,217.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 41100","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","41100","BIOPSY TONGUE ANTERIOR TWO-THIRDS","41100 - BIOPSY TONGUE ANTERIOR TWO-THIRDS",852,818.07,818.07,3264.67,213]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 41105","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","41105","HC BIOPSY TONGUE,POSTER 1/3","41105 - HC BIOPSY TONGUE,POSTER 1/3",2618,3747.12,1500.85,7703.8,654.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 41110","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","41110","EXCISION LESION TONGUE W/O CLOSURE","41110 - EXCISION LESION TONGUE W/O CLOSURE",2094,3747.12,1098.98,4335.57,523.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 41113","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","41113","HC EXCIS TONGUE LESN,POST 1/3","41113 - HC EXCIS TONGUE LESN,POST 1/3",2737,3747.12,1500.85,7703.8,684.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 41250","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","41250","HC RLAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG","41250 - HC RLAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG",1199,178.83,178.83,7703.8,299.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 41251","BLUE CROSS","BLUE CROSS-PPO","CPT","41251","HC REPAIR TONGUE LACER,POST 1/3","41251 - HC REPAIR TONGUE LACER,POST 1/3",310,346.18,346.18,2032.26,77.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 41800","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","41800","HC DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS","41800 - HC DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS",1148,178.83,178.83,3264.67,287]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 41822","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","41822","EXCIS FIBROUS TUBER,DENTOALV","41822 - EXCIS FIBROUS TUBER,DENTOALV",2007,3264.67,1098.98,3264.67,501.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 41825","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","41825","EXCISION OF GUM LESION","41825 - EXCISION OF GUM LESION",4030,3747.12,1098.98,4335.57,1007.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 41850","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","41850","TREATMENT OF GUM LESION","41850 - TREATMENT OF GUM LESION",1993,2485.42,1098.98,3264.67,498.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 41874","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","41874","HC REPAIR TOOTH SOCKET","41874 - HC REPAIR TOOTH SOCKET",3996,4335.57,1198.25,7703.8,999]
["AETNA - AETNA - CPT - 42104","AETNA","AETNA","CPT","42104","EXC LESION PALATE UVULA W/O CLOSURE","42104 - EXC LESION PALATE UVULA W/O CLOSURE",2094,1500.85,1500.85,7703.8,523.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 42120","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","42120","HC RESCJ PALATE/EXTENSIVE RESCJ LESION","42120 - HC RESCJ PALATE/EXTENSIVE RESCJ LESION",6512,7429.92,2166.09,11845.41,1628]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 42180","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","42180","HC REPAIR PALATE LACER <2 CM","42180 - HC REPAIR PALATE LACER <2 CM",589,818.07,684.11,2032.26,147.25]
["TUFTS - TUFTS HMO - CPT - 42299","TUFTS","TUFTS HMO","CPT","42299","HC PALATE/UVULA SURGERY UNLISTED","42299 - HC PALATE/UVULA SURGERY UNLISTED",268,595.01,317.70999999999998,943.8,67]
["TUFTS - TUFTS SELECT - CPT - 42330","TUFTS","TUFTS SELECT","CPT","42330","SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL","42330 - SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL",2094,2593.31,1198.25,7703.8,523.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 42408","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","42408","HC EXCISION SUBLING SALIVARY CYST","42408 - HC EXCISION SUBLING SALIVARY CYST",3896,4229.1400000000003,1990.62,11845.41,974]
["TUFTS - TUFTS SELECT - CPT - 42415","TUFTS","TUFTS SELECT","CPT","42415","HC EXC PAROTD,LAT LOBE,DISSECT 5TH NERV","42415 - HC EXC PAROTD,LAT LOBE,DISSECT 5TH NERV",7214,5130.87,2531.06,15242.01,1803.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 42505","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","42505","HC REPAIR SALIVARY DUCT COMPLICATED","42505 - HC REPAIR SALIVARY DUCT COMPLICATED",7214,7429.92,2166.09,11845.41,1803.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 42720","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","42720","HC INC/DRAIN RETROPHARYNG ABSCESS,ORAL","42720 - HC INC/DRAIN RETROPHARYNG ABSCESS,ORAL",3349,4335.57,1098.98,4335.57,837.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 42725","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","42725","HC INC/DRAIN RETROPHARYNG ABSCESS,EXT","42725 - HC INC/DRAIN RETROPHARYNG ABSCESS,EXT",7214,8596.73,1500.85,8596.73,1803.5]
["TUFTS - TUFTS SELECT - CPT - 42804","TUFTS","TUFTS SELECT","CPT","42804","BIOPSY NASOPHARYNX VISIBLE LESION SIMPLE","42804 - BIOPSY NASOPHARYNX VISIBLE LESION SIMPLE",2094,1098.98,1098.98,4335.57,523.5]
["TUFTS - TUFTS HMO - CPT - 42810","TUFTS","TUFTS HMO","CPT","42810","EXC BRANCHIAL CLEFT CYST CONFINED SKN&SUBQ TIS","42810 - EXC BRANCHIAL CLEFT CYST CONFINED SKN&SUBQ TIS",3197,7467.76,1990.62,11845.41,799.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 42826","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","42826","TONSILLECTOMY ONE-HALF AGE 12/>","42826 - TONSILLECTOMY ONE-HALF AGE 12/>",3197,4335.57,2166.09,11845.41,799.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 42842","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","42842","HC RAD RESEC TONSIL/PILLARS","42842 - HC RAD RESEC TONSIL/PILLARS",7214,8596.73,3987.49,11845.41,1803.5]
["TUFTS - TUFTS SELECT - CPT - 43191","TUFTS","TUFTS SELECT","CPT","43191","HC ESOPHAGOSCOPY RIGID TRANSORAL DIAGNOSTIC BRUSH","43191 - HC ESOPHAGOSCOPY RIGID TRANSORAL DIAGNOSTIC BRUSH",2394,1098.98,1098.98,3264.67,598.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 43193","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","43193","HC ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY","43193 - HC ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY",2317,2811.55,1198.25,7703.8,579.25]
["TUFTS - TUFTS HMO - CPT - 43198","TUFTS","TUFTS HMO","CPT","43198","ESOPHAGOSCOPY FLEXIBLE TRANSNASAL WITH BIOPSY","43198 - ESOPHAGOSCOPY FLEXIBLE TRANSNASAL WITH BIOPSY",1154,2057.7399999999998,1098.98,3264.67,288.5]
["TUFTS - TUFTS HMO - CPT - 43202","TUFTS","TUFTS HMO","CPT","43202","ESPHGSC RGD/FLX W/BIOPSY SINGLE/MULTIPLE","43202 - ESPHGSC RGD/FLX W/BIOPSY SINGLE/MULTIPLE",1154,2057.7399999999998,1010.64,3264.67,288.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 43220","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","43220","HC ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM","43220 - HC ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM",2226,2491.1,1010.64,3264.67,556.5]
["TUFTS - TUFTS HMO - CPT - 43220","TUFTS","TUFTS HMO","CPT","43220","HC ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM","43220 - HC ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM",2226,2057.7399999999998,1010.64,3264.67,556.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 43235","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","43235","HC UPPER GI NDSC DX W/WO COLLECTION SPECIMEN","43235 - HC UPPER GI NDSC DX W/WO COLLECTION SPECIMEN",1123,1644.19,1010.64,3264.67,280.75]
["TUFTS - TUFTS POS - CPT - 43236","TUFTS","TUFTS POS","CPT","43236","HC UPPER GI NDSC W/SUBMUCOSAL INJECTION","43236 - HC UPPER GI NDSC W/SUBMUCOSAL INJECTION",1347,2058.17,1010.64,3264.67,336.75]
["AETNA - AETNA - CPT - 43238","AETNA","AETNA","CPT","43238","HC UPR GI NDSC TNDSC US FINE NDL ASPIR/BX ESOPH","43238 - HC UPR GI NDSC TNDSC US FINE NDL ASPIR/BX ESOPH",2244,1500.85,1010.64,3264.67,561]
["TUFTS - TUFTS SELECT - CPT - 43239","TUFTS","TUFTS SELECT","CPT","43239","HC UPPER NDSC BIOPSY SINGLE/MULTIPLE","43239 - HC UPPER NDSC BIOPSY SINGLE/MULTIPLE",1322,1098.98,1010.64,3264.67,330.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 43242","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","43242","HC UPPER GI NDSC ULTRASOUND GUIDED BIOPSY","43242 - HC UPPER GI NDSC ULTRASOUND GUIDED BIOPSY",3252,2491.1,1010.64,7703.8,813]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 43244","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","43244","HC UPR GI NDSC BAND LIG ESOPHGL&/GSTR VARICES","43244 - HC UPR GI NDSC BAND LIG ESOPHGL&/GSTR VARICES",2267,2491.1,1010.64,7703.8,566.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 43246","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","43246","HC UPR GI NDSC PLMT PRQ GASTROSTOMY TUBE","43246 - HC UPR GI NDSC PLMT PRQ GASTROSTOMY TUBE",1937,7703.8,1010.64,7703.8,484.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 43248","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","43248","HC UPR GI NDSC INSJ GUIDE WIRE DILAT ESOPHAGUS","43248 - HC UPR GI NDSC INSJ GUIDE WIRE DILAT ESOPHAGUS",1449,1603.82,1010.64,7703.8,362.25]
["TUFTS - TUFTS POS - CPT - 43250","TUFTS","TUFTS POS","CPT","43250","HC UPR GI NDSC RMVL LESION HOT BX/BIPOLAR CAUTERY","43250 - HC UPR GI NDSC RMVL LESION HOT BX/BIPOLAR CAUTERY",1459,4856.75,1010.64,7703.8,364.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 43255","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","43255","HC UPR GI NDSC CONTROL BLEEDING ANY METHOD","43255 - HC UPR GI NDSC CONTROL BLEEDING ANY METHOD",2170,2491.1,1010.64,7703.8,542.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 43257","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","43257","HC UPR GI NDSC DLVR THERMAL NRG SPHNCTR/CARDIA","43257 - HC UPR GI NDSC DLVR THERMAL NRG SPHNCTR/CARDIA",3148,4743.7,1990.62,7703.8,787]
["TUFTS - TUFTS PPO - CPT - 43259","TUFTS","TUFTS PPO","CPT","43259","HC UPPER GI NDSC W/NDSC ULTRASOUND EXAM","43259 - HC UPPER GI NDSC W/NDSC ULTRASOUND EXAM",2333,4856.75,1010.64,7703.8,583.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 43262","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","43262","HC ERCP W/SPHINCTEROTOMY/PAPILLOTOMY","43262 - HC ERCP W/SPHINCTEROTOMY/PAPILLOTOMY",3285,5488.65,1500.85,7703.8,821.25]
["TUFTS - TUFTS PPO - CPT - 43265","TUFTS","TUFTS PPO","CPT","43265","HC ERCP W/DSTRJ LITHOTRIPSY CALCULI ANY METHOD","43265 - HC ERCP W/DSTRJ LITHOTRIPSY CALCULI ANY METHOD",4415,4856.75,1500.85,8736.31,1103.75]
["TUFTS - TUFTS POS - CPT - 43270","TUFTS","TUFTS POS","CPT","43270","HC EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE","43270 - HC EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE",1824,7467.76,1990.62,11845.41,456]
["TUFTS - TUFTS HMO - CPT - 43274","TUFTS","TUFTS HMO","CPT","43274","HC ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT","43274 - HC ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT",3592,4856.75,1990.62,8736.31,898]
["TUFTS - TUFTS SELECT - CPT - 43277","TUFTS","TUFTS SELECT","CPT","43277","HC ERCP BALLOON DILATE BILIARY/PANC DUCT/AMPULLA EA","43277 - HC ERCP BALLOON DILATE BILIARY/PANC DUCT/AMPULLA EA",2980,2593.31,1990.62,7703.8,745]
["TUFTS - TUFTS PPO - CPT - 43450","TUFTS","TUFTS PPO","CPT","43450","HC DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS","43450 - HC DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS",1115,2058.16,1098.98,3264.67,278.75]
["TUFTS - TUFTS POS - CPT - 43752","TUFTS","TUFTS POS","CPT","43752","HC PLACEMENT NG/OG TUBE BY PHYSICIAN","43752 - HC PLACEMENT NG/OG TUBE BY PHYSICIAN",306,595.01,317.70999999999998,1500.85,76.5]
["TUFTS - TUFTS PPO - CPT - 43762","TUFTS","TUFTS PPO","CPT","43762","HC RPLC GTUBE NO REVJ TRC","43762 - HC RPLC GTUBE NO REVJ TRC",357,2058.16,388.64,3264.67,89.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 43763","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","43763","HC RPLC GTUBE REVJ GSTRST TRC","43763 - HC RPLC GTUBE REVJ GSTRST TRC",357,3264.67,388.64,3264.67,89.25]
["TUFTS - TUFTS POS - CPT - 44238","TUFTS","TUFTS POS","CPT","44238","HC LAPAROSCOPE PROC INTESTINE","44238 - HC LAPAROSCOPE PROC INTESTINE",7452,10732.28,2609.9699999999998,17023.61,1863]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 44361","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","44361","HC ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY","44361 - HC ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY",1332,2882.31,1013.38,7703.8,333]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 44369","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","44369","HC ENTEROSCOPY > 2ND PRTN ABLTJ LESION","44369 - HC ENTEROSCOPY > 2ND PRTN ABLTJ LESION",2282,2491.1,1013.38,7703.8,570.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 44376","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","44376","HC ENTEROSC >2ND PRTN W/ILEUM W/WO COLLJ SPEC SPX","44376 - HC ENTEROSC >2ND PRTN W/ILEUM W/WO COLLJ SPEC SPX",2337,2491.1,1013.38,3264.67,584.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 44378","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","44378","HC ENTEROSCOPY > 2ND PRTN ILEUM CONTROL BLEEDING","44378 - HC ENTEROSCOPY > 2ND PRTN ILEUM CONTROL BLEEDING",3165,2882.31,1013.38,7703.8,791.25]
["BMC HEALTHNET - BMCHN QHP - CPT - 44381","BMC HEALTHNET","BMCHN QHP","CPT","44381","HC ILEOSCOPY STOMA W/BALLOON DILATION","44381 - HC ILEOSCOPY STOMA W/BALLOON DILATION",1487,0,1198.25,15242.01,371.75]
["AETNA - AETNA - CPT - 44384","AETNA","AETNA","CPT","44384","ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT","44384 - ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT",4118,1500.85,1500.85,15242.01,1029.5]
["AETNA - AETNA - CPT - 44388","AETNA","AETNA","CPT","44388","HC COLONOSCOPY STOMA DX W/WO COLLJ SPEC SPX","44388 - HC COLONOSCOPY STOMA DX W/WO COLLJ SPEC SPX",1284,1198.25,1020.59,3264.67,321]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 44388","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","44388","HC COLONOSCOPY STOMA DX W/WO COLLJ SPEC SPX","44388 - HC COLONOSCOPY STOMA DX W/WO COLLJ SPEC SPX",1284,1020.59,1020.59,3264.67,321]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 44394","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","44394","HC COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE","44394 - HC COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE",1971,7703.8,1020.59,7703.8,492.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 44405","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","44405","HC COLONOSCOPY STOMA W/BALLOON DILATION","44405 - HC COLONOSCOPY STOMA W/BALLOON DILATION",1378,1645.44,1098.98,3264.67,344.5]
["BMC HEALTHNET - BMCHN ACO - CPT - 44604","BMC HEALTHNET","BMCHN ACO","CPT","44604","HC SUTURE LRG INTEST","44604 - HC SUTURE LRG INTEST",1472,0,2644.98,2644.98,368]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 44705","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","44705","PREPARE FECAL MICROBIOTA FOR INSTILLATION","44705 - PREPARE FECAL MICROBIOTA FOR INSTILLATION",260,185.27,185.27,1198.25,65]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 45005","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","45005","HC I&D RECTAL SUBMUCOSAL ABSCESS","45005 - HC I&D RECTAL SUBMUCOSAL ABSCESS",1178,1645.44,1500.85,7703.8,294.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 45305","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","45305","HC PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE","45305 - HC PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE",1341,2115.37,737.96,3264.67,335.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 45307","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","45307","HC PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY","45307 - HC PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY",2802,4424.96,1098.98,4536.32,700.5]
["UNICARE - UNICARE - CPT - 45331","UNICARE","UNICARE","CPT","45331","HC COLON CA SCREEN;BARIUM ENEMA","45331 - HC COLON CA SCREEN;BARIUM ENEMA",794,420.29,420.29,3264.67,198.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 45334","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","45334","HC SIGMOIDOSCOPY FLX CONTROL BLEEDING","45334 - HC SIGMOIDOSCOPY FLX CONTROL BLEEDING",1262,1645.44,737.96,3264.67,315.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 45335","BLUE CROSS","BLUE CROSS-PPO","CPT","45335","HC SGMDSC FLX DIRED SBMCSL NJX ANY SBST","45335 - HC SGMDSC FLX DIRED SBMCSL NJX ANY SBST",715,1250.94,420.29,2032.26,178.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 45338","BLUE CROSS","BLUE CROSS-PPO","CPT","45338","HC SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ","45338 - HC SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ",1092,1645.44,737.96,3264.67,273]
["UNICARE - UNICARE - CPT - 45341","UNICARE","UNICARE","CPT","45341","HC SIGMOIDOSCOPY FLX NDSC US XM","45341 - HC SIGMOIDOSCOPY FLX NDSC US XM",1206,737.96,737.96,3264.67,301.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 45346","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","45346","HC SIGMOIDOSCOPY FLX ABLATION TUMOR POLYP/OTH LES","45346 - HC SIGMOIDOSCOPY FLX ABLATION TUMOR POLYP/OTH LES",1406,2115.37,1098.98,3264.67,351.5]
["TUFTS - TUFTS SELECT - CPT - 45347","TUFTS","TUFTS SELECT","CPT","45347","HC SIGMOIDOSCOPY FLX PLACEMENT OF ENDOSCOPIC STENT","45347 - HC SIGMOIDOSCOPY FLX PLACEMENT OF ENDOSCOPIC STENT",1444,1098.98,1098.98,8736.31,361]
["TUFTS - TUFTS HMO - CPT - 45379","TUFTS","TUFTS HMO","CPT","45379","HC COLSC FLX PROX SPLENIC FLXR RMVL FB","45379 - HC COLSC FLX PROX SPLENIC FLXR RMVL FB",2094,2057.7399999999998,1020.59,3264.67,523.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 45380","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","45380","COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2000,2115.37,1020.59,3264.67,500]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 45382","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","45382","HC COLSC FLX PROX SPLENIC FLXR CTRL BLD","45382 - HC COLSC FLX PROX SPLENIC FLXR CTRL BLD",2540,1645.44,1020.59,3264.67,635]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 45386","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","45386","HC COLSC FLX PROX SPLENIC FLXR DILAT BALO 1/> STRI","45386 - HC COLSC FLX PROX SPLENIC FLXR DILAT BALO 1/> STRI",2054,2063.44,1020.59,3264.67,513.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 45390","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","45390","HC COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION","45390 - HC COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION",1378,0,1098.98,3264.67,344.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 45390","BMC HEALTHNET","BMCHN MEDICAID","CPT","45390","HC COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION","45390 - HC COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION",1378,0,1098.98,3264.67,344.5]
["TUFTS - TUFTS PPO - CPT - 45398","TUFTS","TUFTS PPO","CPT","45398","HC COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S)","45398 - HC COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S)",1378,2058.16,1098.98,3264.67,344.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 45910","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","45910","HC DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL","45910 - HC DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL",2442,2063.44,1098.98,3264.67,610.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 46020","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","46020","PLACEMENT ON SETON","46020 - PLACEMENT ON SETON",2694,11845.41,1990.62,11845.41,673.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 46040","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","46040","I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX","46040 - I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX",3165,1645.44,1645.44,11845.41,791.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 46083","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","46083","INCISION THROMBOSED HEMORRHOID EXTERNAL","46083 - INCISION THROMBOSED HEMORRHOID EXTERNAL",821,388.64,317.70999999999998,1198.25,205.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 46221","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","46221","HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS","46221 - HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS",1473,1608.22,1098.98,3264.67,368.25]
["TUFTS - TUFTS SELECT - CPT - 46255","TUFTS","TUFTS SELECT","CPT","46255","HC HEMORRHOIDECTOMY,INT/EXT,1 COLUMN/GROUP","46255 - HC HEMORRHOIDECTOMY,INT/EXT,1 COLUMN/GROUP",4466,3987.49,1990.62,11845.41,1116.5]
["TUFTS - TUFTS HMO - CPT - 46505","TUFTS","TUFTS HMO","CPT","46505","CHEMODENERVATION ANAL SPHINCTER","46505 - CHEMODENERVATION ANAL SPHINCTER",1495,4856.75,1198.25,7703.8,373.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 46601","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","46601","HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT","46601 - HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT",483,229.89,178.83,1198.25,120.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 46607","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","46607","HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT W/BX","46607 - HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT W/BX",930,2063.44,1098.98,3264.67,232.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 46610","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","46610","HC ANOSCOPY W/RMVL LESION CAUTERY","46610 - HC ANOSCOPY W/RMVL LESION CAUTERY",3476,3920.63,1098.98,4536.32,869]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 46900","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","46900","DSTRJ LESION ANUS SIMPLE CHEMICAL","46900 - DSTRJ LESION ANUS SIMPLE CHEMICAL",1062,527.46,317.70999999999998,1198.25,265.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 46922","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","46922","HC SURG EXCISION OF ANAL LESION(S)","46922 - HC SURG EXCISION OF ANAL LESION(S)",3487,3920.63,1098.98,4536.32,871.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 47000","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","47000","HEARING AID EXAMINATION & SELECTION MONAURAL","47000 - HEARING AID EXAMINATION & SELECTION MONAURAL",1304,2309.9699999999998,1098.98,3264.67,326]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 47382","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","47382","HC ABLTJ 1/> LVR TUM PRQ RF","47382 - HC ABLTJ 1/> LVR TUM PRQ RF",5817,7718.14,2166.09,15242.01,1454.25]
["TUFTS - TUFTS POS - CPT - 47399","TUFTS","TUFTS POS","CPT","47399","HC ABL,ALCOHOL,1/+ LIVER TUM","47399 - HC ABL,ALCOHOL,1/+ LIVER TUM",2899,1281.21,684.11,2032.26,724.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 47533","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","47533","PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL","47533 - PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL",2142,4949.6400000000003,1098.98,5726.94,535.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 47534","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","47534","PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I INT-EXT","47534 - PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I INT-EXT",2811,4949.6400000000003,1098.98,5726.94,702.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 47535","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","47535","HC CONV EXT BIL DRG CATH TO INT-EXT BIL DRG CATH","47535 - HC CONV EXT BIL DRG CATH TO INT-EXT BIL DRG CATH",4625,5726.94,1098.98,5726.94,1156.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 47552","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","47552","HC BILIARY ENDO PRQ T-TUBE DX W/COLLECT SPEC BRUSH","47552 - HC BILIARY ENDO PRQ T-TUBE DX W/COLLECT SPEC BRUSH",3075,4949.6400000000003,1500.85,7703.8,768.75]
["TUFTS - TUFTS SELECT - CPT - 47552","TUFTS","TUFTS SELECT","CPT","47552","HC BILIARY ENDO PRQ T-TUBE DX W/COLLECT SPEC BRUSH","47552 - HC BILIARY ENDO PRQ T-TUBE DX W/COLLECT SPEC BRUSH",3075,2593.31,1500.85,7703.8,768.75]
["AETNA - AETNA - CPT - 47556","AETNA","AETNA","CPT","47556","HC BILIARY NDSC PRQ T-TUBE DILAT STRIX W/STENT","47556 - HC BILIARY NDSC PRQ T-TUBE DILAT STRIX W/STENT",7058,1990.62,1990.62,15242.01,1764.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 48102","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","48102","HC BIOPSY PANCREA PERCUTANEOUS NEEDLE","48102 - HC BIOPSY PANCREA PERCUTANEOUS NEEDLE",1810,2672.73,1098.98,3264.67,452.5]
["TUFTS - TUFTS SELECT - CPT - 49180","TUFTS","TUFTS SELECT","CPT","49180","BX ABDL/RETROPERITONEAL MASS PRQ NEEDLE","49180 - BX ABDL/RETROPERITONEAL MASS PRQ NEEDLE",1304,1098.98,1098.98,3264.67,326]
["TUFTS - TUFTS PPO - CPT - 49185","TUFTS","TUFTS PPO","CPT","49185","SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID","49185 - SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID",862,2058.16,972.93,3264.67,215.5]
["TUFTS - TUFTS PPO - CPT - 49324","TUFTS","TUFTS PPO","CPT","49324","HC LAP INSERTION TUNNELED INTRAPERITONEAL CATHETER","49324 - HC LAP INSERTION TUNNELED INTRAPERITONEAL CATHETER",6897,10732.28,2166.09,17023.61,1724.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 49406","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","49406","IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ","49406 - IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ",2105,2309.9699999999998,1500.85,7703.8,526.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 49411","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","49411","INTERSTITIAL DEV PLMT RADIATION THERAPY 1/MLT","49411 - INTERSTITIAL DEV PLMT RADIATION THERAPY 1/MLT",1473,2001.68,1198.25,7703.8,368.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 49423","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","49423","HC EXCHNG ABSC/CST DRG CATH RAD GID SPX","49423 - HC EXCHNG ABSC/CST DRG CATH RAD GID SPX",2394,2491.1,1098.98,3264.67,598.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 49424","BLUE CROSS","BLUE CROSS-PPO","CPT","49424","HC INJ CONT ABS/CY EVAL","49424 - HC INJ CONT ABS/CY EVAL",290,94.18,94.18,1198.25,72.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 49440","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","49440","INSERT GASTROSTOMY TUBE PERCUTANEOUS","49440 - INSERT GASTROSTOMY TUBE PERCUTANEOUS",1695,2491.1,1010.64,3264.67,423.75]
["UNICARE - UNICARE - CPT - 49446","UNICARE","UNICARE","CPT","49446","HC CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERQ","49446 - HC CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERQ",1743,1010.64,1010.64,3264.67,435.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 49452","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","49452","HC PERC REPL GAST_JEJ TUBE,W","49452 - HC PERC REPL GAST_JEJ TUBE,W",1060,1644.19,684.11,2032.26,265]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 49460","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","49460","HC FIX G/COLON TUBE W/DEVICE","49460 - HC FIX G/COLON TUBE W/DEVICE",1116,1603.82,684.11,2032.26,279]
["TUFTS - TUFTS SELECT - CPT - 49570","TUFTS","TUFTS SELECT","CPT","49570","HC REPAIR EPIGASTRIC HERNIA,REDUC","49570 - HC REPAIR EPIGASTRIC HERNIA,REDUC",4625,3987.49,2166.09,11845.41,1156.25]
["AETNA - AETNA - CPT - 50387","AETNA","AETNA","CPT","50387","HC RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH","50387 - HC RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH",2635,1198.25,1098.98,3380.52,658.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 50387","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","50387","HC RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH","50387 - HC RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH",2635,3380.52,1098.98,3380.52,658.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 50431","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","50431","HC NJX ANTGRD NPHRSTGRM &/OR URTRGRM COMPL DIAG INCL IMG GUI RAD S&I; EXSTNG ACCES","50431 - HC NJX ANTGRD NPHRSTGRM &/OR URTRGRM COMPL DIAG INCL IMG GUI RAD S&I; EXSTNG ACCES",844,944.22,944.22,3176.09,211]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 50433","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","50433","PLACEMENT NEPHROURETERAL CATH PRQ NEW ACCESS RAD S&I","50433 - PLACEMENT NEPHROURETERAL CATH PRQ NEW ACCESS RAD S&I",1900,2921.68,1098.98,3380.52,475]
["AETNA - AETNA - CPT - 50435","AETNA","AETNA","CPT","50435","EXCHANGE NEPHROSTOMY CATHETER PRQ W/IMAGE GUIDE RAD S&I","50435 - EXCHANGE NEPHROSTOMY CATHETER PRQ W/IMAGE GUIDE RAD S&I",708,1198.25,1098.98,3380.52,177]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 50437","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","50437","HC DILAT XST TRC NEW ACCESS RCS","50437 - HC DILAT XST TRC NEW ACCESS RCS",4504,4915.28,1098.98,5687.17,1126]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 50593","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","50593","HC ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY","50593 - HC ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY",12512,13001.07,2397.88,15242.01,3128]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 50688","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","50688","CHNG URTROST TUBE/XTRNLLY ACCESSIBLE STENT ILEAL","50688 - CHNG URTROST TUBE/XTRNLLY ACCESSIBLE STENT ILEAL",2246,2921.68,1098.98,3380.52,561.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 50693","BLUE CROSS","BLUE CROSS-PPO","CPT","50693","PLACEMENT URETERAL STENT PRQ WITH PRE-EXISTING NEPHROSTOMY TRACT","50693 - PLACEMENT URETERAL STENT PRQ WITH PRE-EXISTING NEPHROSTOMY TRACT",1524,2921.68,1098.98,3380.52,381]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 51102","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","51102","HC ASP BLADDER;W/INS SUPRAPU","51102 - HC ASP BLADDER;W/INS SUPRAPU",2441,2921.68,1098.98,3380.52,610.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 51600","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","51600","NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPY","51600 - NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPY",329,110.49,110.49,110.49,82.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 51700","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","51700","BLDR IRRIGATION SMPL LAVAGE &/INSTLJ","51700 - BLDR IRRIGATION SMPL LAVAGE &/INSTLJ",492,388.64,388.64,1338.81,123]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 51703","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","51703","INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED","51703 - INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED",611,228.32,228.32,1198.25,152.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 51710","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","51710","CHANGE CYSTOSTOMY TUBE COMPLICATED","51710 - CHANGE CYSTOSTOMY TUBE COMPLICATED",803,3176.09,944.22,3176.09,200.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 51720","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","51720","BLADDER INSTILLATION ANTICARCINOGENIC AGENT","51720 - BLADDER INSTILLATION ANTICARCINOGENIC AGENT",600,388.64,388.64,1338.81,150]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 51728","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","51728","COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES","51728 - COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES",2386,944.22,944.22,3176.09,596.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 51729","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","51729","COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL","51729 - COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL",2602,1184.0999999999999,944.22,3176.09,650.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 51741","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","51741","COMPLEX UROFLOMETRY","51741 - COMPLEX UROFLOMETRY",243,228.32,228.32,779.81,60.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 51785","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","51785","NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ","51785 - NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ",1793,388.64,388.64,1338.81,448.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 52000","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","52000","CYSTOURETHROSCOPY","52000 - CYSTOURETHROSCOPY",945,944.22,944.22,3264.67,236.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 52224","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","52224","CYSTO W/REMOVAL OF LESIONS SMALL","52224 - CYSTO W/REMOVAL OF LESIONS SMALL",3451,7703.8,1500.85,7703.8,862.75]
["TUFTS - TUFTS POS - CPT - 52281","TUFTS","TUFTS POS","CPT","52281","CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS","52281 - CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS",2072,4856.75,1500.85,7703.8,518]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 52332","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","52332","HC CYSTOSCOPY, INSERT URETERAL STENT","52332 - HC CYSTOSCOPY, INSERT URETERAL STENT",4393,5687.17,1500.85,7703.8,1098.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 52356","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","52356","HC CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT","52356 - HC CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT",6500,7812.32,2166.09,17023.61,1625]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 53600","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","53600","DILAT URETHRAL STRIX DILATOR MALE 1ST","53600 - DILAT URETHRAL STRIX DILATOR MALE 1ST",476,388.64,388.64,2032.26,119]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 53899","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","53899","HC URETERAL DILATION","53899 - HC URETERAL DILATION",1999,943.8,317.70999999999998,1198.25,499.75]
["TUFTS - TUFTS POS - CPT - 54050","TUFTS","TUFTS POS","CPT","54050","DSTRJ LESION PENIS SIMPLE CHEMICAL","54050 - DSTRJ LESION PENIS SIMPLE CHEMICAL",794,595.01,317.70999999999998,943.8,198.5]
["TUFTS - TUFTS HMO - CPT - 54060","TUFTS","TUFTS HMO","CPT","54060","HC DESTR PENIS LESN,SIMPL,SURG EXCIS","54060 - HC DESTR PENIS LESN,SIMPL,SURG EXCIS",2325,2057.7399999999998,1098.98,3344.2,581.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 54100","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","54100","BIOPSY PENIS SEPARATE PROCEDURE","54100 - BIOPSY PENIS SEPARATE PROCEDURE",1972,2672.73,1098.98,3264.67,493]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 54115","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","54115","HC REMV FOR.BODY DEEP PENILE TISS","54115 - HC REMV FOR.BODY DEEP PENILE TISS",3570,4507.8100000000004,1098.98,4621.25,892.5]
["TUFTS - TUFTS POS - CPT - 54162","TUFTS","TUFTS POS","CPT","54162","HC LYSIS/EXCIS,PENILE POSTCIRCUM ADHESIONS","54162 - HC LYSIS/EXCIS,PENILE POSTCIRCUM ADHESIONS",2614,4856.75,1500.85,7703.8,653.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 54231","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","54231","DYNAMIC CAVERNOSOMETRY NJX VASOACTIVE DRUGS","54231 - DYNAMIC CAVERNOSOMETRY NJX VASOACTIVE DRUGS",2441,388.64,388.64,11845.41,610.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 54235","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","54235","NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT","54235 - NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT",550,388.64,388.64,1338.81,137.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 54450","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","54450","FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING","54450 - FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING",430,499.64,388.64,3264.67,107.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 54600","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","54600","HC REDUCE TESTIS TORSION","54600 - HC REDUCE TESTIS TORSION",2614,3380.52,2166.09,11845.41,653.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 55100","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","55100","DRAIN SCROTAL WALL ABS","55100 - DRAIN SCROTAL WALL ABS",1256,2607.12,1098.98,3264.67,314]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 55400","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","55400","HC REPAIR OF SPERM DUCT","55400 - HC REPAIR OF SPERM DUCT",4530,0,1098.98,5687.17,1132.5]
["TUFTS - TUFTS SELECT - CPT - 55700","TUFTS","TUFTS SELECT","CPT","55700","PROSTATE NEEDLE BIOPSY ANY APPROACH","55700 - PROSTATE NEEDLE BIOPSY ANY APPROACH",1826,1098.98,1098.98,3380.52,456.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 56420","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","56420","I&D OF BARTHOLINS GLAND ABSCESS","56420 - I&D OF BARTHOLINS GLAND ABSCESS",706,278.66000000000003,278.66000000000003,3264.67,176.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 56440","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","56440","MARSUPIALIZATION BARTHOLINS GLAND CYST","56440 - MARSUPIALIZATION BARTHOLINS GLAND CYST",2365,3965.45,1500.85,7703.8,591.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 56515","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","56515","DESTRUCTION LESIONS VULVA EXTENSIVE","56515 - DESTRUCTION LESIONS VULVA EXTENSIVE",2598,3344.2,1990.62,11845.41,649.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 56606","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","56606","BIOPSY VULVA/PERINEUM EACH ADDL LESION","56606 - BIOPSY VULVA/PERINEUM EACH ADDL LESION",230,72.959999999999994,72.959999999999994,1198.25,57.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 56700","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","56700","HC PARTIAL REMOVAL OF HYMEN","56700 - HC PARTIAL REMOVAL OF HYMEN",3863,3965.45,1098.98,4588.18,965.75]
["TUFTS - TUFTS HMO - CPT - 56820","TUFTS","TUFTS HMO","CPT","56820","COLPOSCOPY VULVA","56820 - COLPOSCOPY VULVA",665,595.01,278.66000000000003,1198.25,166.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 56821","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","56821","COLPOSCOPY VULVA W/BIOPSY","56821 - COLPOSCOPY VULVA W/BIOPSY",891,943.8,317.70999999999998,1198.25,222.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 57023","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","57023","HC I & D VAG HEMATOMA NON-OB","57023 - HC I & D VAG HEMATOMA NON-OB",3438,7703.8,1198.25,7703.8,859.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 57105","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","57105","HC BIOPSY OF VAGINA","57105 - HC BIOPSY OF VAGINA",3805,3965.45,1500.85,7703.8,951.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 57155","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","57155","HC OR INSERTION OF T&O","57155 - HC OR INSERTION OF T&O",3411,4588.18,1500.85,11815.28,852.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 57156","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","57156","HC INSERTION OF CYLINDER","57156 - HC INSERTION OF CYLINDER",406,589.41,458.47,2032.26,101.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 57170","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","57170","DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS","57170 - DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS",375,358.24,241,768.13,93.75]
["TUFTS - TUFTS SELECT - CPT - 57210","TUFTS","TUFTS SELECT","CPT","57210","HC REPAIR VAGINA/PERINEUM","57210 - HC REPAIR VAGINA/PERINEUM",3715,2593.31,1500.85,7703.8,928.75]
["TUFTS - TUFTS PPO - CPT - 57415","TUFTS","TUFTS PPO","CPT","57415","HC REMOVAL VAGINAL FOR.BODY W ANESTH","57415 - HC REMOVAL VAGINAL FOR.BODY W ANESTH",3715,2058.16,1098.98,4588.18,928.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 57452","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","57452","COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA","57452 - COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA",711,349.45,278.66000000000003,1500.85,177.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 57455","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","57455","COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX","57455 - COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX",861,574.94000000000005,458.47,2032.26,215.25]
["TUFTS - TUFTS SELECT - CPT - 57460","TUFTS","TUFTS SELECT","CPT","57460","COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX","57460 - COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX",2365,1098.98,1098.98,4588.18,591.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 57500","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","57500","BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX","57500 - BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX",589,1204.81,937.16,3264.67,147.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 57511","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","57511","HC CRYOCAUTERY OF CERVIX","57511 - HC CRYOCAUTERY OF CERVIX",409,589.41,317.70999999999998,1198.25,102.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 57522","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","57522","CONIZATION CERVIX W/WO D&C RPR ELTRD EXC","57522 - CONIZATION CERVIX W/WO D&C RPR ELTRD EXC",4911,4475.54,1098.98,4588.18,1227.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 57800","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","57800","DILATION CERVICAL CANAL INSTRUMENTAL SPX","57800 - DILATION CERVICAL CANAL INSTRUMENTAL SPX",2365,3965.45,1098.98,4588.18,591.25]
["AETNA - AETNA - CPT - 58145","AETNA","AETNA","CPT","58145","MYOMECTOMY 1-4 MYOMAS 250 GM/< VAGINAL APPR","58145 - MYOMECTOMY 1-4 MYOMAS 250 GM/< VAGINAL APPR",4218,2354.5,2354.5,15242.01,1054.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 58145","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","58145","MYOMECTOMY 1-4 MYOMAS 250 GM/< VAGINAL APPR","58145 - MYOMECTOMY 1-4 MYOMAS 250 GM/< VAGINAL APPR",4218,4475.54,2354.5,15242.01,1054.5]
["TUFTS - TUFTS SELECT - CPT - 58301","TUFTS","TUFTS SELECT","CPT","58301","REMOVAL INTRAUTERINE DEVICE IUD","58301 - REMOVAL INTRAUTERINE DEVICE IUD",531,317.70999999999998,278.66000000000003,1198.25,132.75]
["TUFTS - TUFTS PPO - CPT - 58323","TUFTS","TUFTS PPO","CPT","58323","SPERM WASHING ARTIFICIAL INSEMINATION","58323 - SPERM WASHING ARTIFICIAL INSEMINATION",219,1281.21,278.66000000000003,2032.26,54.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 58345","BMC HEALTHNET","BMCHN QHP","CPT","58345","HC REOPEN FALLOPIAN TUBE, TRANSCERV CATH","58345 - HC REOPEN FALLOPIAN TUBE, TRANSCERV CATH",3412,0,1098.98,4588.18,853]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 58345","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","58345","HC REOPEN FALLOPIAN TUBE, TRANSCERV CATH","58345 - HC REOPEN FALLOPIAN TUBE, TRANSCERV CATH",3412,4588.18,1098.98,4588.18,853]
["TUFTS - TUFTS PPO - CPT - 58558","TUFTS","TUFTS PPO","CPT","58558","HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C","58558 - HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C",3031,4856.75,1775.68,7703.8,757.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 58565","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","58565","HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS","58565 - HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS",6134,6928.79,1990.62,11845.41,1533.5]
["AETNA - AETNA - CPT - 58579","AETNA","AETNA","CPT","58579","HC UNLISTED HYSTEROSCOPY PROCEDURE UTERUS","58579 - HC UNLISTED HYSTEROSCOPY PROCEDURE UTERUS",242,1990.62,1990.62,11845.41,60.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 58925","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","58925","HC OVARIAN CYSTECTOMY UNI/BI","58925 - HC OVARIAN CYSTECTOMY UNI/BI",6172,8016.91,2354.5,15242.01,1543]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 59020","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","59020","FETAL CONTRACTION STRESS TEST","59020 - FETAL CONTRACTION STRESS TEST",546,278.66000000000003,278.66000000000003,951.58,136.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 59160","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","59160","CURETTAGE POSTPARTUM","59160 - CURETTAGE POSTPARTUM",2200,4588.18,1990.62,7703.8,550]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 59320","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","59320","CERCLAGE CERVIX PREGNANCY VAGINAL","59320 - CERCLAGE CERVIX PREGNANCY VAGINAL",2365,3965.45,1098.98,4588.18,591.25]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 59412","BMC HEALTHNET","BMCHN MEDICAID","CPT","59412","EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS","59412 - EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS",2365,0,3965.45,13969.53,591.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 59812","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","59812","TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL","59812 - TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL",2302,3965.45,2354.5,11845.41,575.5]
["TUFTS - TUFTS POS - CPT - 59820","TUFTS","TUFTS POS","CPT","59820","TX MISSED ABORTION FIRST TRIMESTER SURGICAL","59820 - TX MISSED ABORTION FIRST TRIMESTER SURGICAL",2772,7467.76,2354.5,11845.41,693]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 59870","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","59870","UTERINE EVACUATION & CURETTAGE HYDATIDIFORM MOLE","59870 - UTERINE EVACUATION & CURETTAGE HYDATIDIFORM MOLE",3675,3965.45,2354.5,11845.41,918.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 59897","BMC HEALTHNET","BMCHN MCO","CPT","59897","HC FETAL INVAS PX W/ US","59897 - HC FETAL INVAS PX W/ US",356,0,684.11,2032.26,89]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 60300","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","60300","HB ASPIRATION AND/OR INJECTION THYROID CYST","60300 - HB ASPIRATION AND/OR INJECTION THYROID CYST",709,972.93,684.11,2032.26,177.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 61050","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","61050","HC CISTERNAL/C1-2 PUNCTURE","61050 - HC CISTERNAL/C1-2 PUNCTURE",390,3264.67,415.61,3264.67,97.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 61055","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","61055","HC CISTERNAL/LATERAL C1-C2 PUNCTURE W/INJECTION","61055 - HC CISTERNAL/LATERAL C1-C2 PUNCTURE W/INJECTION",390,415.61,415.61,3264.67,97.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 61624","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","61624","HC TCAT PERMANENT OCCLUSION/EMBOLIZATION PRQ CNS","61624 - HC TCAT PERMANENT OCCLUSION/EMBOLIZATION PRQ CNS",8320,2890.31,2890.31,15242.01,2080]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 61640","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","61640","HC PERC BAL DIL CRAN VASO;IN","61640 - HC PERC BAL DIL CRAN VASO;IN",4698,1156.06,1156.06,1156.06,1174.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 61641","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","61641","HC BALLOON DIALT INTRACRAN VASOSPASM, ADD SAME FAM","61641 - HC BALLOON DIALT INTRACRAN VASOSPASM, ADD SAME FAM",5444,406.01,406.01,406.01,1361]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 61645","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","61645","HC PERQ ARTERIAL TRANSLUMINAL M-THROMBECTOMY & OR INFUSION","61645 - HC PERQ ARTERIAL TRANSLUMINAL M-THROMBECTOMY & OR INFUSION",5444,0,2084.5,15242.01,1361]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 61885","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","61885","HC IMP STIM,CRANIAL,SUBQ,1 ARRAY","61885 - HC IMP STIM,CRANIAL,SUBQ,1 ARRAY",28075,31416.26,1500.85,62742.78,7018.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 62252","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","62252","HC REPRGRMG PROGRAMMABLE CEREBROSPINAL SHUNT","62252 - HC REPRGRMG PROGRAMMABLE CEREBROSPINAL SHUNT",275,590.54,317.70999999999998,943.8,68.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 62269","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","62269","HC BIO,SPINAL CORD,PERC NEED","62269 - HC BIO,SPINAL CORD,PERC NEED",2006,2309.9699999999998,1098.98,3264.67,501.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 62273","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","62273","HC INJECTION EPIDURAL BLOOD/CLOT PATCH","62273 - HC INJECTION EPIDURAL BLOOD/CLOT PATCH",1153,1005.62,1005.62,3264.67,288.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 62304","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","62304","MYELOGRAPHY VIA LUMBAR INJECT RS&I LUMBOSACRAL","62304 - MYELOGRAPHY VIA LUMBAR INJECT RS&I LUMBOSACRAL",862,1161.71,1098.98,3264.67,215.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 62305","BLUE CROSS","BLUE CROSS-PPO","CPT","62305","MYELOGRAPHY VIA LUMBAR INJECTION RS&I 2+ REGIONS","62305 - MYELOGRAPHY VIA LUMBAR INJECTION RS&I 2+ REGIONS",899,1161.71,1098.98,3264.67,224.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 62322","BLUE CROSS","BLUE CROSS-PPO","CPT","62322","HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1153,1005.62,829.82,3264.67,288.25]
["UNICARE - UNICARE - CPT - 62323","UNICARE","UNICARE","CPT","62323","HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1153,995.78,829.82,3264.67,288.25]
["TUFTS - TUFTS SELECT - CPT - 62324","TUFTS","TUFTS SELECT","CPT","62324","HC NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN.","62324 - HC NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN.",1211,1098.98,829.82,3264.67,302.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 62329","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","62329","HC THER SPI PNXR CSF FLUOR/CT","62329 - HC THER SPI PNXR CSF FLUOR/CT",794,1005.99,1005.99,3264.67,198.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 62329","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","62329","HC THER SPI PNXR CSF FLUOR/CT","62329 - HC THER SPI PNXR CSF FLUOR/CT",794,1292.83,1005.99,3264.67,198.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 62367","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","62367","ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL","62367 - ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL",476,3264.67,470.91,3264.67,119]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 62370","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","62370","ELEC ANLYS IMPLT ITHCL/EDRL PMP W/REPR PHYS/QHP","62370 - ELEC ANLYS IMPLT ITHCL/EDRL PMP W/REPR PHYS/QHP",476,470.91,470.91,3264.67,119]
["TUFTS - TUFTS HMO - CPT - 63662","TUFTS","TUFTS HMO","CPT","63662","HC REMOVE SPINAL NEUROSTIM ELECTRODE PLATE/PADDLE, INCL FLUORO","63662 - HC REMOVE SPINAL NEUROSTIM ELECTRODE PLATE/PADDLE, INCL FLUORO",4823,2057.7399999999998,1098.98,6217.49,1205.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 64400","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","64400","NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH","64400 - NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH",531,534.30999999999995,310.58,2032.26,132.75]
["UNICARE - UNICARE - CPT - 64405","UNICARE","UNICARE","CPT","64405","INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV","64405 - INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV",611,372.7,310.58,2032.26,152.75]
["AETNA - AETNA - CPT - 64416","AETNA","AETNA","CPT","64416","HC INJ,ANES;CONT INF B PLEX","64416 - HC INJ,ANES;CONT INF B PLEX",523,1198.25,310.58,3264.67,130.75]
["TUFTS - TUFTS SELECT - CPT - 64417","TUFTS","TUFTS SELECT","CPT","64417","INJECTION ANESTHETIC AGENT AXILLARY NERVE","64417 - INJECTION ANESTHETIC AGENT AXILLARY NERVE",548,684.11,310.58,2032.26,137]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 64421","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","64421","MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES","64421 - MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES",1153,1651.29,773.72,3264.67,288.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 64430","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","64430","HC INJ,ANES;PUDEND NER","64430 - HC INJ,ANES;PUDEND NER",1153,1284.45,310.58,3264.67,288.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 64445","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","64445","INJECTION ANESTHETIC AGENT SCIATIC NRV SINGLE","64445 - INJECTION ANESTHETIC AGENT SCIATIC NRV SINGLE",1153,1005.62,310.58,3264.67,288.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64450","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","64450","INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH","64450 - INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH",529,1005.62,310.58,2032.26,132.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64454","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","64454","HC NJX AA&/STRD GNCLR NRV BRNCH","64454 - HC NJX AA&/STRD GNCLR NRV BRNCH",794,1005.99,1005.99,3474.13,198.5]
["UNICARE - UNICARE - CPT - 64455","UNICARE","UNICARE","CPT","64455","NJX ANES&/STEROID PLANTAR COMMON DIGITAL NERVE","64455 - NJX ANES&/STEROID PLANTAR COMMON DIGITAL NERVE",350,372.7,310.58,1198.25,87.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 64462","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","64462","HC PVB,THORAC;2ND & ANY ADD¿L INJECT SITE(S) INCLUD IMAGE GUIDE WHEN PERFORMED","64462 - HC PVB,THORAC;2ND & ANY ADD¿L INJECT SITE(S) INCLUD IMAGE GUIDE WHEN PERFORMED",824,124.9,124.9,1198.25,206]
["TUFTS - TUFTS HMO - CPT - 64484","TUFTS","TUFTS HMO","CPT","64484","NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC EA LV","64484 - NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC EA LV",403,0,128.04,1198.25,100.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 64486","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","64486","TAP BLOCK UNILATERAL BY INJECTION(S)","64486 - TAP BLOCK UNILATERAL BY INJECTION(S)",423,136.02000000000001,136.02000000000001,1500.85,105.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 64490","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","64490","NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL","64490 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL",1071,1284.45,829.82,4375.87,267.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 64494","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","64494","NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL","64494 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL",399,127.95,127.95,1198.25,99.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64494","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","64494","NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL","64494 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL",399,127.95,127.95,1198.25,99.75]
["TUFTS - TUFTS POS - CPT - 64505","TUFTS","TUFTS POS","CPT","64505","INJECTION ANES AGENT SPHENOPALATINE GANGLION","64505 - INJECTION ANES AGENT SPHENOPALATINE GANGLION",647,595.01,310.58,1198.25,161.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 64520","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","64520","INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC","64520 - INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC",1153,1284.45,829.82,3264.67,288.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 64569","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","64569","HC REVISE/REPLACE CRANIAL NERVE STIM ELECTRODE/CONNECT PULSE GEN","64569 - HC REVISE/REPLACE CRANIAL NERVE STIM ELECTRODE/CONNECT PULSE GEN",8974,11333.61,1500.85,11618.83,2243.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64600","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","64600","INJECTION TREATMENT OF NERVE","64600 - INJECTION TREATMENT OF NERVE",1211,1284.45,1098.98,3264.67,302.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 64612","BLUE CROSS","BLUE CROSS-PPO","CPT","64612","CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL","64612 - CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL",1247,415.61,415.61,2032.26,311.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 64616","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","64616","CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA","64616 - CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA",795,534.30999999999995,415.61,2032.26,198.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 64624","BLUE CROSS","BLUE CROSS-PPO","CPT","64624","HC DSTRJ NULYT AGT GNCLR NRV","64624 - HC DSTRJ NULYT AGT GNCLR NRV",2182,2767.2,1198.25,7703.8,545.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 64632","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","64632","DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE","64632 - DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE",522,415.61,317.70999999999998,1198.25,130.5]
["TUFTS - TUFTS SELECT - CPT - 64634","TUFTS","TUFTS SELECT","CPT","64634","HC DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA","64634 - HC DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA",536,0,167.4,1198.25,134]
["TUFTS - TUFTS PPO - CPT - 64636","TUFTS","TUFTS PPO","CPT","64636","DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL","64636 - DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL",433,0,146.83000000000001,1198.25,108.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 64642","BLUE CROSS","BLUE CROSS-PPO","CPT","64642","CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE","64642 - CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE",792,1005.62,684.11,2032.26,198]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 64645","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","64645","CHEMODENERVATION 1 EXTREMITY EA ADDL 5/> MUSCLES","64645 - CHEMODENERVATION 1 EXTREMITY EA ADDL 5/> MUSCLES",609,0,207.02,1198.25,152.25]
["TUFTS - TUFTS SELECT - CPT - 64646","TUFTS","TUFTS SELECT","CPT","64646","CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES","64646 - CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES",856,684.11,684.11,2032.26,214]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 64680","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","64680","HC DES,NEURO;CELIAC PLEX,WWO","64680 - HC DES,NEURO;CELIAC PLEX,WWO",2657,1651.29,1284.45,7703.8,664.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 64771","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","64771","HC TRANSECT OTHER CRAN N,EXTRADURAL","64771 - HC TRANSECT OTHER CRAN N,EXTRADURAL",1959,3170.12,1500.85,7703.8,489.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 64774","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","64774","HC EXCISE CUTANEOUS NEUROMA","64774 - HC EXCISE CUTANEOUS NEUROMA",1959,3092.3,1500.85,7703.8,489.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 65103","BLUE CROSS","BLUE CROSS-PPO","CPT","65103","HC REMOVE EYE/INSERT IMPLANT","65103 - HC REMOVE EYE/INSERT IMPLANT",4867,4996.58,1990.62,11845.41,1216.75]
["TUFTS - TUFTS HMO - CPT - 65135","TUFTS","TUFTS HMO","CPT","65135","HC INSJ OC IMPLT AFTER ENCL MUSC X ATTACHED","65135 - HC INSJ OC IMPLT AFTER ENCL MUSC X ATTACHED",4867,4856.75,1500.85,7703.8,1216.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 65175","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","65175","HC REMOVAL OF OCULAR IMPLANT","65175 - HC REMOVAL OF OCULAR IMPLANT",4867,5781.24,1098.98,5781.24,1216.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 65210","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","65210","HC RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR","65210 - HC RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR",496,584.69000000000005,317.70999999999998,943.8,124]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 65265","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","65265","HC REMOVE FOREIGN BODY FROM EYE","65265 - HC REMOVE FOREIGN BODY FROM EYE",3062,3725.22,2166.09,11845.41,765.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 65285","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","65285","HC RPR LAC CORN&/SCLRA PERF W/REPOS/RESCJ UVEAL T","65285 - HC RPR LAC CORN&/SCLRA PERF W/REPOS/RESCJ UVEAL T",5769,6113.35,2166.09,11845.41,1442.25]
["TUFTS - TUFTS PPO - CPT - 65400","TUFTS","TUFTS PPO","CPT","65400","EXCISION LESION CORNEA XCP PTERYGIUM","65400 - EXCISION LESION CORNEA XCP PTERYGIUM",4626,2058.16,1098.98,3264.67,1156.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 65435","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","65435","RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION","65435 - RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION",1108,1355.74,1098.98,3264.67,277]
["TUFTS - TUFTS PPO - CPT - 65730","TUFTS","TUFTS PPO","CPT","65730","HC KERATOPLASTY PENTRG EXCEPT APHAKIA/PSEUDOPHAKIA","65730 - HC KERATOPLASTY PENTRG EXCEPT APHAKIA/PSEUDOPHAKIA",5769,9609.09,2531.06,15242.01,1442.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 65756","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","65756","HC CORNEAL TRNSPL ENDOTHELIAL","65756 - HC CORNEAL TRNSPL ENDOTHELIAL",5769,6113.35,2531.06,15242.01,1442.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 65778","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","65778","PLACE AMNIOTIC MEMB OCULAR SURFACE SELF RETAIN","65778 - PLACE AMNIOTIC MEMB OCULAR SURFACE SELF RETAIN",2051,1355.74,1098.98,3264.67,512.75]
["TUFTS - TUFTS SELECT - CPT - 65779","TUFTS","TUFTS SELECT","CPT","65779","HC PLACE AMNIOTIC MEMBRANE OCULAR SURFACE WOUND HEALING, SUTURED","65779 - HC PLACE AMNIOTIC MEMBRANE OCULAR SURFACE WOUND HEALING, SUTURED",4466,1098.98,1098.98,6423.61,1116.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 65780","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","65780","HC OCULAR RECONST TRANSPLANT","65780 - HC OCULAR RECONST TRANSPLANT",4867,5781.24,2354.5,11845.41,1216.75]
["TUFTS - TUFTS HMO - CPT - 65820","TUFTS","TUFTS HMO","CPT","65820","HC RELIEVE INNER EYE PRESSURE","65820 - HC RELIEVE INNER EYE PRESSURE",5769,4856.75,1198.25,7703.8,1442.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 65855","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","65855","TRABECULOPLASTY LASER SURG 1/> SESSIONS","65855 - TRABECULOPLASTY LASER SURG 1/> SESSIONS",2309,833.27,833.27,3264.67,577.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 65865","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","65865","HC INCISE INNER EYE ADHESIONS","65865 - HC INCISE INNER EYE ADHESIONS",3062,3264.67,1098.98,3725.22,765.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 65920","BLUE CROSS","BLUE CROSS-PPO","CPT","65920","HC REMOVE IMPLANT OF EYE","65920 - HC REMOVE IMPLANT OF EYE",3062,3219.62,2531.06,15242.01,765.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 66030","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","66030","HC INJECTION TREATMENT OF EYE","66030 - HC INJECTION TREATMENT OF EYE",3062,3725.22,1098.98,3725.22,765.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 66172","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","66172","HC INCISION OF EYE","66172 - HC INCISION OF EYE",3062,3725.22,2166.09,11845.41,765.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 66180","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","66180","HC AQUEOUS SHUNT EYE W/GRAFT","66180 - HC AQUEOUS SHUNT EYE W/GRAFT",5769,6113.35,2354.5,11845.41,1442.25]
["TUFTS - TUFTS HMO - CPT - 66250","TUFTS","TUFTS HMO","CPT","66250","HC FOLLOW-UP SURGERY OF EYE","66250 - HC FOLLOW-UP SURGERY OF EYE",2949,4856.75,1500.85,7703.8,737.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 66625","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","66625","HC REMV IRIS PERIPH FOR GLAUCOMA","66625 - HC REMV IRIS PERIPH FOR GLAUCOMA",2878,3725.22,1990.62,11845.41,719.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 66711","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","66711","HC ECP CILIARY BODY DESTRUCTION","66711 - HC ECP CILIARY BODY DESTRUCTION",3062,3725.22,1500.85,7703.8,765.5]
["TUFTS - TUFTS POS - CPT - 66762","TUFTS","TUFTS POS","CPT","66762","IRIDOPLASTY PHOTOCOAGULATION 1/> SESSIONS","66762 - IRIDOPLASTY PHOTOCOAGULATION 1/> SESSIONS",3256,2058.17,833.27,3264.67,814]
["TUFTS - TUFTS HMO - CPT - 66825","TUFTS","TUFTS HMO","CPT","66825","HC REPOSITION INTRAOCULAR LENS","66825 - HC REPOSITION INTRAOCULAR LENS",3062,7467.76,2166.09,11845.41,765.5]
["AETNA - AETNA - CPT - 66852","AETNA","AETNA","CPT","66852","HC RMVL LENS MATERIAL PARS PLANA W/WO VITRECTOMY","66852 - HC RMVL LENS MATERIAL PARS PLANA W/WO VITRECTOMY",5769,2166.09,2166.09,11845.41,1442.25]
["TUFTS - TUFTS PPO - CPT - 66982","TUFTS","TUFTS PPO","CPT","66982","REMV CATARACT EXTRACAP,INSERT LENS,COMP","66982 - REMV CATARACT EXTRACAP,INSERT LENS,COMP",2305,4856.75,2574.12,7703.8,576.25]
["TUFTS - TUFTS POS - CPT - 66985","TUFTS","TUFTS POS","CPT","66985","INSERT LENS PROSTHESIS ONLY","66985 - INSERT LENS PROSTHESIS ONLY",3062,4856.75,2398.64,7703.8,765.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 67005","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","67005","HC RMVL VITREOUS ANT APPR PARTIAL REMOVAL","67005 - HC RMVL VITREOUS ANT APPR PARTIAL REMOVAL",3062,3219.62,2166.09,11845.41,765.5]
["TUFTS - TUFTS SELECT - CPT - 67028","TUFTS","TUFTS SELECT","CPT","67028","INTRAVITREAL NJX PHARMACOLOGIC AGT SPX","67028 - INTRAVITREAL NJX PHARMACOLOGIC AGT SPX",770,684.11,484.3,2032.26,192.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 67031","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","67031","SEVERING VITREOUS STRANS LASER 1/> STAGES","67031 - SEVERING VITREOUS STRANS LASER 1/> STAGES",2732,1071.25,833.27,3264.67,683]
["TUFTS - TUFTS HMO - CPT - 67039","TUFTS","TUFTS HMO","CPT","67039","HC VITRECTOMY,FOCAL LASER RX RETINA","67039 - HC VITRECTOMY,FOCAL LASER RX RETINA",5679,9609.09,2531.06,15242.01,1419.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 67101","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","67101","HC RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID CRTX","67101 - HC RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID CRTX",3007,3633.78,2166.09,11845.41,751.75]
["AETNA - AETNA - CPT - 67105","AETNA","AETNA","CPT","67105","RPR RETINAL DTCHMNT 1/> SES PC W/WO DRG SUBRETI","67105 - RPR RETINAL DTCHMNT 1/> SES PC W/WO DRG SUBRETI",4946,2354.5,833.27,3264.67,1236.5]
["TUFTS - TUFTS POS - CPT - 67108","TUFTS","TUFTS POS","CPT","67108","HC RPR RETINAL DTCHMNT W/VITRECTOMY ANY METH","67108 - HC RPR RETINAL DTCHMNT W/VITRECTOMY ANY METH",5769,9609.09,2531.06,15242.01,1442.25]
["TUFTS - TUFTS POS - CPT - 67113","TUFTS","TUFTS POS","CPT","67113","HC REPAIR COMPLEX RETINA DETACH VITRECTOMY & MEMB PEEL","67113 - HC REPAIR COMPLEX RETINA DETACH VITRECTOMY & MEMB PEEL",5420,10732.28,2354.5,17023.61,1355]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 67145","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","67145","PROPH RTA DTCHMNT W/O DRG 1/> SESS","67145 - PROPH RTA DTCHMNT W/O DRG 1/> SESS",3819,833.27,833.27,3264.67,954.75]
["TUFTS - TUFTS SELECT - CPT - 67210","TUFTS","TUFTS SELECT","CPT","67210","DSTRJ LOCLZD LES RETINA 1/> SESS PC","67210 - DSTRJ LOCLZD LES RETINA 1/> SESS PC",3854,1098.98,833.27,3264.67,963.5]
["TUFTS - TUFTS HMO - CPT - 67299","TUFTS","TUFTS HMO","CPT","67299","EYE SURG POST SGMT PROC UNLISTED","67299 - EYE SURG POST SGMT PROC UNLISTED",3062,1281.21,684.11,2032.26,765.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 67312","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","67312","HC STRABISMUS RECESSION/RESCJ 2 HRZNTL MUSC","67312 - HC STRABISMUS RECESSION/RESCJ 2 HRZNTL MUSC",4867,4996.58,2166.09,11845.41,1216.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 67316","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","67316","HC STRABISMUS RECESSION/RESCJ 2/MORE VER MUSC","67316 - HC STRABISMUS RECESSION/RESCJ 2/MORE VER MUSC",2949,3522.21,2166.09,11845.41,737.25]
["AETNA - AETNA - CPT - 67332","AETNA","AETNA","CPT","67332","HC STRABISMUS SCARRING EO MUSC/RSTCV MYOPATHY ADD-ON","67332 - HC STRABISMUS SCARRING EO MUSC/RSTCV MYOPATHY ADD-ON",3426,2166.09,821.24,2166.09,856.5]
["TUFTS - TUFTS POS - CPT - 67345","TUFTS","TUFTS POS","CPT","67345","HC DESTROY NERVE OF EYE MUSCLE","67345 - HC DESTROY NERVE OF EYE MUSCLE",426,1281.21,476.13,2032.26,106.5]
["TUFTS - TUFTS HMO - CPT - 67400","TUFTS","TUFTS HMO","CPT","67400","HC EXPLORE/BIOPSY EYE SOCKET","67400 - HC EXPLORE/BIOPSY EYE SOCKET",4867,7467.76,1990.62,11845.41,1216.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 67414","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","67414","HC EXPLR/DECOMPRESS EYE SOCKET","67414 - HC EXPLR/DECOMPRESS EYE SOCKET",4867,4996.58,2354.5,11845.41,1216.75]
["TUFTS - TUFTS PPO - CPT - 67515","TUFTS","TUFTS PPO","CPT","67515","INJECTION MEDICATION/OTHER SUBST TENON CAPSULE","67515 - INJECTION MEDICATION/OTHER SUBST TENON CAPSULE",706,1281.21,476.13,2032.26,176.5]
["TUFTS - TUFTS POS - CPT - 67550","TUFTS","TUFTS POS","CPT","67550","HC INSERT EYE SOCKET IMPLANT","67550 - HC INSERT EYE SOCKET IMPLANT",4867,7467.76,2166.09,11845.41,1216.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 67800","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","67800","EXCISION CHALAZION SINGLE","67800 - EXCISION CHALAZION SINGLE",808,476.13,476.13,2032.26,202]
["TUFTS - TUFTS SELECT - CPT - 67805","TUFTS","TUFTS SELECT","CPT","67805","EXCISION CHALAZION MULTIPLE DIFFERENT LIDS","67805 - EXCISION CHALAZION MULTIPLE DIFFERENT LIDS",1303,684.11,476.13,2032.26,325.75]
["TUFTS - TUFTS PPO - CPT - 67808","TUFTS","TUFTS PPO","CPT","67808","HC REMOVE EYELID LESION(S)","67808 - HC REMOVE EYELID LESION(S)",2949,4856.75,1500.85,7703.8,737.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 67825","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","67825","CORRECTION TRICHIASIS EPILATION OTH/THAN FORCEPS","67825 - CORRECTION TRICHIASIS EPILATION OTH/THAN FORCEPS",953,612.12,476.13,2032.26,238.25]
["AETNA - AETNA - CPT - 67875","AETNA","AETNA","CPT","67875","TEMPORARY CLOSURE EYELIDS SUTURE","67875 - TEMPORARY CLOSURE EYELIDS SUTURE",1212,1198.25,1098.98,3264.67,303]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 67880","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","67880","HC REVISION OF EYELID","67880 - HC REVISION OF EYELID",2874,3522.21,1990.62,11845.41,718.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 67900","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","67900","HC REPAIR BROW DEFECT","67900 - HC REPAIR BROW DEFECT",2949,3522.21,2166.09,11845.41,737.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 67904","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","67904","HC RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT XTRNL","67904 - HC RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT XTRNL",2949,3044.16,2166.09,11845.41,737.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 67911","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","67911","HC CORRECT LID RETRACTN","67911 - HC CORRECT LID RETRACTN",2721,11845.41,1990.62,11845.41,680.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 67917","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","67917","REPAIR ECTROPION EXTENSIVE","67917 - REPAIR ECTROPION EXTENSIVE",3727,3435.75,2166.09,11845.41,931.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 67930","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","67930","HC SUTURE EYELID WOUND,PARTIAL THICK","67930 - HC SUTURE EYELID WOUND,PARTIAL THICK",2721,3044.16,1098.98,3522.21,680.25]
["TUFTS - TUFTS PPO - CPT - 67961","TUFTS","TUFTS PPO","CPT","67961","HC REVISION OF EYELID,< 1/4 LID MARGIN","67961 - HC REVISION OF EYELID,< 1/4 LID MARGIN",4464,7467.76,1990.62,11845.41,1116]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 67961","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","67961","HC REVISION OF EYELID,< 1/4 LID MARGIN","67961 - HC REVISION OF EYELID,< 1/4 LID MARGIN",4464,3522.21,1990.62,11845.41,1116]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 68100","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","68100","HC BIOPSY OF CONJUNCTIVA","68100 - HC BIOPSY OF CONJUNCTIVA",1108,3044.16,1098.98,3522.21,277]
["TUFTS - TUFTS SELECT - CPT - 68110","TUFTS","TUFTS SELECT","CPT","68110","EXCISION LESION CONJUNCTIVA </1 CM","68110 - EXCISION LESION CONJUNCTIVA </1 CM",2058,2593.31,1500.85,7703.8,514.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 68200","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","68200","SUBCONJUNCTIVAL INJECTION","68200 - SUBCONJUNCTIVAL INJECTION",273,178.83,178.83,624.73,68.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 68340","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","68340","HC DIVISION OF SYMBLEPHARON","68340 - HC DIVISION OF SYMBLEPHARON",2721,3044.16,2166.09,11845.41,680.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 68362","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","68362","HC CONJUNCTIVAL FLAP TOTAL","68362 - HC CONJUNCTIVAL FLAP TOTAL",2949,3044.16,1500.85,7703.8,737.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 68530","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","68530","HC CLEARANCE OF TEAR DUCT","68530 - HC CLEARANCE OF TEAR DUCT",385,476.13,476.13,2032.26,96.25]
["TUFTS - TUFTS SELECT - CPT - 68720","TUFTS","TUFTS SELECT","CPT","68720","HC CREATE TEAR SAC DRAIN","68720 - HC CREATE TEAR SAC DRAIN",4867,3987.49,2166.09,11845.41,1216.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 68761","BLUE CROSS","BLUE CROSS-PPO","CPT","68761","CLSR LACRIMAL PUNCTUM PLUG EACH","68761 - CLSR LACRIMAL PUNCTUM PLUG EACH",924,476.13,476.13,2032.26,231]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 68810","BLUE CROSS","BLUE CROSS-PPO","CPT","68810","HC PROBE NASOLACRIMAL DUCT","68810 - HC PROBE NASOLACRIMAL DUCT",264,476.13,476.13,2032.26,66]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 68811","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","68811","HC PROBE NASOLACRIMAL DUCT","68811 - HC PROBE NASOLACRIMAL DUCT",2949,3522.21,1098.98,3522.21,737.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 69000","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","69000","DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE","69000 - DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE",937,972.93,317.70999999999998,1250.8,234.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 69020","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","69020","DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS","69020 - DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS",1130,972.93,317.70999999999998,1250.8,282.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 69105","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","69105","BIOPSY EXTERNAL AUDITORY CANAL","69105 - BIOPSY EXTERNAL AUDITORY CANAL",2094,3264.67,1098.98,3264.67,523.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 69145","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","69145","EXCISION SOFT TIS LES EXTERNAL AUDITORY CANAL","69145 - EXCISION SOFT TIS LES EXTERNAL AUDITORY CANAL",1972,3994.03,1500.85,7703.8,493]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 69209","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","69209","RMVL IMPACTED CERUMEN USING IRRIGATION/LAVAGE,UNILATERAL","69209 - RMVL IMPACTED CERUMEN USING IRRIGATION/LAVAGE,UNILATERAL",198,93.87,93.87,1198.25,49.5]
["TUFTS - TUFTS HMO - CPT - 69220","TUFTS","TUFTS HMO","CPT","69220","DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE","69220 - DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE",487,320.41000000000003,171.09,508.23,121.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 69420","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","69420","MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ","69420 - MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ",955,346.18,346.18,2032.26,238.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 69436","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","69436","HC CREATE EARDRUM OPENING,GEN ANESTH","69436 - HC CREATE EARDRUM OPENING,GEN ANESTH",2007,2148.08,1990.62,7703.8,501.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 69501","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","69501","MASTOIDECTOMY,SIMPLE","69501 - MASTOIDECTOMY,SIMPLE",643,7429.92,2531.06,15242.01,160.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 69801","BLUE CROSS","BLUE CROSS-PPO","CPT","69801","LABYRINTHOTOMY TRANSCANAL","69801 - LABYRINTHOTOMY TRANSCANAL",2094,2148.08,2148.08,15242.01,523.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 70010","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","70010","HC CHG MYELOGRAPHY POST FOSSA","70010 - HC CHG MYELOGRAPHY POST FOSSA",569,507.47,308.97000000000003,4577.43,142.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 70030","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","70030","HC CHG RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY","70030 - HC CHG RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY",275,107.22,72.290000000000006,801.26,68.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 70140","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","70140","HC CHG RADEX FACIAL BONES < 3 VIEWS","70140 - HC CHG RADEX FACIAL BONES < 3 VIEWS",288,107.22,72.290000000000006,801.26,72]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 70150","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","70150","HC CHG RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS","70150 - HC CHG RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS",402,147.96,72.290000000000006,1274.24,100.5]
["TUFTS - TUFTS POS - CPT - 70200","TUFTS","TUFTS POS","CPT","70200","HC CHG RADEX ORBITS COMPLETE MINIMUM 4 VIEWS","70200 - HC CHG RADEX ORBITS COMPLETE MINIMUM 4 VIEWS",416,366.97,72.290000000000006,1103.3900000000001,104]
["TUFTS - TUFTS PPO - CPT - 70250","TUFTS","TUFTS PPO","CPT","70250","RADIOLOGIC EXAMINATION SKULL 4/> VIEWS","70250 - RADIOLOGIC EXAMINATION SKULL 4/> VIEWS",355,392.56,72.290000000000006,1103.3900000000001,88.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 70300","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","70300","RADIOLOGIC EXAMINATION TEETH 1 VIEW","70300 - RADIOLOGIC EXAMINATION TEETH 1 VIEW",141,136.68,81.93,796.29,35.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 70320","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","70320","RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH","70320 - RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH",498,303.20999999999998,136.68,2060.09,124.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 70336","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","70336","HC CHG MRI TEMPOROMANDIBULAR JOINT","70336 - HC CHG MRI TEMPOROMANDIBULAR JOINT",3454,660.39,396.79,2642.66,863.5]
["TUFTS - TUFTS HMO - CPT - 70350","TUFTS","TUFTS HMO","CPT","70350","HC CHG CEPHALOGRAM ORTHODONTIC","70350 - HC CHG CEPHALOGRAM ORTHODONTIC",209,319.77999999999997,72.290000000000006,801.26,52.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 70360","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","70360","HC CHG RADIOLOGIC EXAMINATION NECK SOFT TISSUE","70360 - HC CHG RADIOLOGIC EXAMINATION NECK SOFT TISSUE",255,107.22,72.290000000000006,801.26,63.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 70390","BLUE CROSS","BLUE CROSS-PPO","CPT","70390","HC SIALOGRAPHY","70390 - HC SIALOGRAPHY",971,303.20999999999998,173.86,2562.5700000000002,242.75]
["UNICARE - UNICARE - CPT - 70460","UNICARE","UNICARE","CPT","70460","HC CHG CT HEAD/BRAIN W/CONTRAST MATERIAL","70460 - HC CHG CT HEAD/BRAIN W/CONTRAST MATERIAL",2057,535.08000000000004,347.19,2420.09,514.25]
["TUFTS - TUFTS PPO - CPT - 70470","TUFTS","TUFTS PPO","CPT","70470","HC CHG CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL","70470 - HC CHG CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL",2070,861.01,347.19,2420.09,517.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 70481","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","70481","HC CHG CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL","70481 - HC CHG CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL",3060,347.19,347.19,2420.09,765]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 70488","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","70488","HC CHG CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL","70488 - HC CHG CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL",3151,347.19,347.19,2420.09,787.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 70490","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","70490","HC CHG CT SOFT TISSUE NECK W/O CONTRAST MATERIAL","70490 - HC CHG CT SOFT TISSUE NECK W/O CONTRAST MATERIAL",2110,322.25,193.63,1274.24,527.5]
["TUFTS - TUFTS SELECT - CPT - 70496","TUFTS","TUFTS SELECT","CPT","70496","HC CHG CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST","70496 - HC CHG CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST",4798,375.85,347.19,2420.09,1199.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 70540","BLUE CROSS","BLUE CROSS-PPO","CPT","70540","HC CHG MRI ORBIT FACE &/NECK W/O CONTRAST","70540 - HC CHG MRI ORBIT FACE &/NECK W/O CONTRAST",3898,660.39,396.79,2653.95,974.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 70543","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","70543","HC CHG MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL","70543 - HC CHG MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL",5365,1105.27,664.1,4707.1099999999997,1341.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 70545","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","70545","HC CHG MRA HEAD W/CONTRAST MATERIAL","70545 - HC CHG MRA HEAD W/CONTRAST MATERIAL",4315,664.1,637.16,4285.49,1078.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 70547","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","70547","HC CHG MRA NECK W/O CONTRST MATERIAL","70547 - HC CHG MRA NECK W/O CONTRST MATERIAL",4407,593.02,396.79,2653.95,1101.75]
["TUFTS - TUFTS PPO - CPT - 70549","TUFTS","TUFTS PPO","CPT","70549","HC MRA,NECK;W/WO","70549 - HC MRA,NECK;W/WO",6668,1529.76,664.1,4299.8,1667]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 70552","BLUE CROSS","BLUE CROSS-PPO","CPT","70552","HC CHG MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL","70552 - HC CHG MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL",4596,1105.27,637.16,4285.49,1149]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 71023","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","71023","XR CHEST 2V W FLUORO","71023 - XR CHEST 2V W FLUORO",596,130.34,130.34,156.41,149]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 71046","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","71046","HC CHG RADIOLOGIC EXAM CHEST 2 VIEWS","71046 - HC CHG RADIOLOGIC EXAM CHEST 2 VIEWS",284,81.93,81.93,801.26,71]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 71100","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","71100","HC CHG X-RAY RIBS 2VW UNILAT","71100 - HC CHG X-RAY RIBS 2VW UNILAT",116,107.22,72.290000000000006,801.26,29]
["TUFTS - TUFTS SELECT - CPT - 71110","TUFTS","TUFTS SELECT","CPT","71110","HC CHG RADEX RIBS BILATERAL 3 VIEWS","71110 - HC CHG RADEX RIBS BILATERAL 3 VIEWS",387,197.9,72.290000000000006,1274.24,96.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 71130","BLUE CROSS","BLUE CROSS-PPO","CPT","71130","HC CHG RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS","71130 - HC CHG RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS",348,81.93,72.290000000000006,801.26,87]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 71130","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","71130","HC CHG RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS","71130 - HC CHG RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS",348,801.26,72.290000000000006,801.26,87]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 71275","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","71275","HC CHG CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST","71275 - HC CHG CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST",3800,2420.09,347.19,2420.09,950]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 71550","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","71550","HC CHG MRI CHEST W/O CONTRAST MATERIAL","71550 - HC CHG MRI CHEST W/O CONTRAST MATERIAL",4542,396.79,396.79,2653.95,1135.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 71552","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","71552","HC CHG MRI CHEST W/O & W/CONTRAST MATERIAL","71552 - HC CHG MRI CHEST W/O & W/CONTRAST MATERIAL",6316,1105.27,664.1,4707.1099999999997,1579]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 72050","BLUE CROSS","BLUE CROSS-PPO","CPT","72050","HC CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS","72050 - HC CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS",504,147.96,125.38,1304.76,126]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 72052","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","72052","HC CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS","72052 - HC CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS",650,147.96,125.38,1304.76,162.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 72070","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","72070","HC CHG RADEX SPINE THORACIC 2 VIEWS","72070 - HC CHG RADEX SPINE THORACIC 2 VIEWS",319,72.290000000000006,72.290000000000006,1262.6600000000001,79.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 72080","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","72080","HC CHG RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS","72080 - HC CHG RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS",353,81.93,72.290000000000006,801.26,88.25]
["TUFTS - TUFTS PPO - CPT - 72082","TUFTS","TUFTS PPO","CPT","72082","XRAY EXAM ENTIRE SPINE INCLUDING SKULL, CERV AND SACRAL SPINE; 2 OR 3 VIEWS","72082 - XRAY EXAM ENTIRE SPINE INCLUDING SKULL, CERV AND SACRAL SPINE; 2 OR 3 VIEWS",385,453.34,125.38,1274.24,96.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 72084","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","72084","X-RAY EXAM ENTIRE SPI 6/> VW","72084 - X-RAY EXAM ENTIRE SPI 6/> VW",162,193.63,147.96,1677.11,40.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 72110","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","72110","HC CHG RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS","72110 - HC CHG RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS",462,1304.76,125.38,1304.76,115.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 72125","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","72125","HC CHG CT CERVICAL SPINE W/O CONTRAST MATERIAL","72125 - HC CHG CT CERVICAL SPINE W/O CONTRAST MATERIAL",2037,322.25,193.63,1307.74,509.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 72127","BLUE CROSS","BLUE CROSS-PPO","CPT","72127","HC CT,C SPINE;W/WO","72127 - HC CT,C SPINE;W/WO",2974,577.83000000000004,347.19,2420.09,743.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 72130","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","72130","HC CT,T SPINE;W/WO","72130 - HC CT,T SPINE;W/WO",3004,577.83000000000004,347.19,2420.09,751]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 72132","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","72132","HC CHG CT LUMBAR SPINE W/CONTRAST MATERIAL","72132 - HC CHG CT LUMBAR SPINE W/CONTRAST MATERIAL",2494,1105.27,445.9,4285.49,623.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 72133","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","72133","HC CT,L SPINE;W/WO","72133 - HC CT,L SPINE;W/WO",2997,527.99,347.19,2420.09,749.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 72142","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","72142","HC CHG MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL","72142 - HC CHG MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL",4685,664.1,637.16,4299.8,1171.25]
["TUFTS - TUFTS PPO - CPT - 72148","TUFTS","TUFTS PPO","CPT","72148","HC CHG MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL","72148 - HC CHG MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL",3598,944.21,396.79,2653.95,899.5]
["TUFTS - TUFTS HMO - CPT - 72149","TUFTS","TUFTS HMO","CPT","72149","HC CHG MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL","72149 - HC CHG MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL",4538,1716.08,637.16,4299.8,1134.5]
["TUFTS - TUFTS PPO - CPT - 72157","TUFTS","TUFTS PPO","CPT","72157","HC CHG MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL","72157 - HC CHG MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL",5001,1674.68,664.1,4707.1099999999997,1250.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 72190","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","72190","HC CHG RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS","72190 - HC CHG RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS",416,193.63,72.290000000000006,1103.3900000000001,104]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 72191","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","72191","HC CHG CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST","72191 - HC CHG CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST",4023,2420.09,347.19,2420.09,1005.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 72193","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","72193","HC CHG CT PELVIS W/CONTRAST MATERIAL","72193 - HC CHG CT PELVIS W/CONTRAST MATERIAL",2361,577.83000000000004,347.19,2420.09,590.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 72196","BLUE CROSS","BLUE CROSS-PPO","CPT","72196","HC CHG MRI PELVIS W/CONTRAST MATERIAL","72196 - HC CHG MRI PELVIS W/CONTRAST MATERIAL",4533,1105.27,637.16,4285.49,1133.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 72197","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","72197","HC CHG MRI PELVIS W/O & W/CONTRAST MATERIAL","72197 - HC CHG MRI PELVIS W/O & W/CONTRAST MATERIAL",5507,1105.27,664.1,4707.1099999999997,1376.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 72200","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","72200","X-RAY EXAM SI JOINTS","72200 - X-RAY EXAM SI JOINTS",162,193.63,72.290000000000006,1209.52,40.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 72240","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","72240","HC CHG MYELOGRAPHY CERVICAL RS&I","72240 - HC CHG MYELOGRAPHY CERVICAL RS&I",1230,1190.5,308.97000000000003,7066.23,307.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 73000","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","73000","ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R","73000 - ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R",279,81.93,72.290000000000006,801.26,69.75]
["TUFTS - TUFTS HMO - CPT - 73010","TUFTS","TUFTS HMO","CPT","73010","HC CHG RADEX SCAPULA COMPLETE","73010 - HC CHG RADEX SCAPULA COMPLETE",308,439.96,72.290000000000006,1102.33,77]
["TUFTS - TUFTS POS - CPT - 73050","TUFTS","TUFTS POS","CPT","73050","HC CHG RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ","73050 - HC CHG RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ",392,266.48,72.290000000000006,801.26,98]
["UNICARE - UNICARE - CPT - 73060","UNICARE","UNICARE","CPT","73060","HC CHG RADEX HUMERUS MINIMUM 2 VIEWS","73060 - HC CHG RADEX HUMERUS MINIMUM 2 VIEWS",279,86.75,72.290000000000006,801.26,69.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 73080","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","73080","HC CHG RADEX ELBOW COMPLETE MINIMUM 3 VIEWS","73080 - HC CHG RADEX ELBOW COMPLETE MINIMUM 3 VIEWS",323,81.93,72.290000000000006,851.68,80.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 73100","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","73100","XTRNL ECG & 48 HR RECORDING","73100 - XTRNL ECG & 48 HR RECORDING",313,801.26,72.290000000000006,801.26,78.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 73130","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","73130","HC CHG RADEX HAND MINIMUM 3 VIEWS","73130 - HC CHG RADEX HAND MINIMUM 3 VIEWS",310,81.93,72.290000000000006,851.68,77.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 73130","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","73130","HC CHG RADEX HAND MINIMUM 3 VIEWS","73130 - HC CHG RADEX HAND MINIMUM 3 VIEWS",310,107.22,72.290000000000006,851.68,77.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 73201","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","73201","HC CHG CT UPPER EXTREMITY W/CONTRAST MATERIAL","73201 - HC CHG CT UPPER EXTREMITY W/CONTRAST MATERIAL",2448,1105.27,445.9,4285.49,612]
["TUFTS - TUFTS SELECT - CPT - 73218","TUFTS","TUFTS SELECT","CPT","73218","HC CHG MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL","73218 - HC CHG MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL",4023,412.18,396.79,2653.95,1005.75]
["TUFTS - TUFTS POS - CPT - 73219","TUFTS","TUFTS POS","CPT","73219","HC CHG MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL","73219 - HC CHG MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL",4445,1430.06,637.16,4299.8,1111.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 73222","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","73222","HC CHG MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL","73222 - HC CHG MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL",4142,1190.5,637.16,6980.89,1035.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 73225","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","73225","HC CHG MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL","73225 - HC CHG MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL",4357,664.1,551.97,3554.09,1089.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 73502","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","73502","XRAY EXAM OF HIP UNILATERAL W/PELVIS WHEN PERFORMED; 2-3 VIEWS","73502 - XRAY EXAM OF HIP UNILATERAL W/PELVIS WHEN PERFORMED; 2-3 VIEWS",251,801.26,72.290000000000006,801.26,62.75]
["UNICARE - UNICARE - CPT - 73521","UNICARE","UNICARE","CPT","73521","XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; 2 VIEWS","73521 - XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; 2 VIEWS",236,86.75,72.290000000000006,1274.24,59]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 73551","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","73551","XRAY EXAM FEMUR; 1 VIEW","73551 - XRAY EXAM FEMUR; 1 VIEW",163,81.93,72.290000000000006,801.26,40.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 73560","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","73560","HC CHG RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS","73560 - HC CHG RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS",302,81.93,72.290000000000006,801.26,75.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 73562","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","73562","HC CHG RADIOLOGIC EXAMINATION KNEE 3 VIEWS","73562 - HC CHG RADIOLOGIC EXAMINATION KNEE 3 VIEWS",364,72.290000000000006,72.290000000000006,801.26,91]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 73590","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","73590","HC CHG RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS","73590 - HC CHG RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS",262,107.22,72.290000000000006,801.26,65.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 73600","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","73600","HC CHG RADIOLOGIC EXAMINATION ANKLE 2 VIEWS","73600 - HC CHG RADIOLOGIC EXAMINATION ANKLE 2 VIEWS",279,81.93,72.290000000000006,851.68,69.75]
["TUFTS - TUFTS SELECT - CPT - 73630","TUFTS","TUFTS SELECT","CPT","73630","HC CHG RADEX FOOT COMPLETE MINIMUM 3 VIEWS","73630 - HC CHG RADEX FOOT COMPLETE MINIMUM 3 VIEWS",304,124.44,72.290000000000006,801.26,76]
["TUFTS - TUFTS HMO - CPT - 73660","TUFTS","TUFTS HMO","CPT","73660","HC CHG RADEX TOE MINIMUM 2 VIEWS","73660 - HC CHG RADEX TOE MINIMUM 2 VIEWS",294,319.77999999999997,72.290000000000006,801.26,73.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 73701","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","73701","HC CHG CT LOWER EXTREMITY W/CONTRAST MATERIAL","73701 - HC CHG CT LOWER EXTREMITY W/CONTRAST MATERIAL",2480,347.19,347.19,2420.09,620]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 73702","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","73702","HC CHG CT LOWER EXTREMITY W/O & W/CONTRAST MATRL","73702 - HC CHG CT LOWER EXTREMITY W/O & W/CONTRAST MATRL",3135,577.83000000000004,347.19,2420.09,783.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 73720","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","73720","HC CHG MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR","73720 - HC CHG MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR",5507,1105.27,664.1,4299.8,1376.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 73722","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","73722","HC CHG MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL","73722 - HC CHG MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL",4265,1981.37,637.16,6980.89,1066.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 73722","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","73722","HC CHG MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL","73722 - HC CHG MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL",4265,1190.5,637.16,6980.89,1066.25]
["TUFTS - TUFTS SELECT - CPT - 73725","TUFTS","TUFTS SELECT","CPT","73725","HC MRA,LE,W/O","73725 - HC MRA,LE,W/O",4484,809.58,664.1,5212.7700000000004,1121]
["TUFTS - TUFTS SELECT - CPT - 74021","TUFTS","TUFTS SELECT","CPT","74021","HC XRAY ABD 3+ VIEWS","74021 - HC XRAY ABD 3+ VIEWS",381,159.4,147.96,1026.3599999999999,95.25]
["TUFTS - TUFTS PPO - CPT - 74160","TUFTS","TUFTS PPO","CPT","74160","HC CHG CT ABDOMEN W/CONTRAST MATERIAL","74160 - HC CHG CT ABDOMEN W/CONTRAST MATERIAL",2716,861.01,347.19,2420.09,679]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 74175","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","74175","HC CHG CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST","74175 - HC CHG CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST",4281,577.83000000000004,347.19,2420.09,1070.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 74177","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","74177","HC CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL","74177 - HC CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL",3344,664.1,639.20000000000005,4115.74,836]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 74181","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","74181","HC CHG MRI ABDOMEN W/O CONTRAST MATERIAL","74181 - HC CHG MRI ABDOMEN W/O CONTRAST MATERIAL",3605,660.39,396.79,2653.95,901.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 74183","BLUE CROSS","BLUE CROSS-PPO","CPT","74183","HC CHG MRI ABDOMEN W/O & W/CONTRAST MATERIAL","74183 - HC CHG MRI ABDOMEN W/O & W/CONTRAST MATERIAL",5524,1105.27,664.1,4707.1099999999997,1381]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 74221","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","74221","HC X-RAY XM ESOPHAGUS 2CNTRST","74221 - HC X-RAY XM ESOPHAGUS 2CNTRST",232,229.65,229.65,1738.9,58]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 74240","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","74240","HC XRAY UPPER GI TRACT","74240 - HC XRAY UPPER GI TRACT",797,265.3,148.44,1899.39,199.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 74246","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","74246","HC XRAY UPPER GI AIR CONTRAST","74246 - HC XRAY UPPER GI AIR CONTRAST",843,347.19,148.44,1899.39,210.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 74248","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","74248","HC X-RAY SM INT F-THRU STD","74248 - HC X-RAY SM INT F-THRU STD",1832,0,99.33,99.33,458]
["TUFTS - TUFTS HMO - CPT - 74249","TUFTS","TUFTS HMO","CPT","74249","XR UGI W AIR CON SM BOWEL","74249 - XR UGI W AIR CON SM BOWEL",1833,904.38,228.79,2266.0300000000002,458.25]
["TUFTS - TUFTS HMO - CPT - 74261","TUFTS","TUFTS HMO","CPT","74261","HC CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST","74261 - HC CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST",5060,467.78,182.03,1172.0999999999999,1265]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 74270","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","74270","HC CHG RADEX COLON BARIUM ENEMA W/WO KUB","74270 - HC CHG RADEX COLON BARIUM ENEMA W/WO KUB",1493,347.19,148.44,1899.39,373.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 74280","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","74280","HC CHG RADEX COLON W/SPEC HI DNS BARIUM W/WO GLUCAGON","74280 - HC CHG RADEX COLON W/SPEC HI DNS BARIUM W/WO GLUCAGON",2072,265.3,228.79,2136.63,518]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 74328","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","74328","HC ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I","74328 - HC ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I",325,0,215.23,215.23,81.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 74360","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","74360","HC CHG INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I","74360 - HC CHG INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I",349,0,213.77,272.52999999999997,87.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 74363","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","74363","HC CHG PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I","74363 - HC CHG PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I",1534,221.67,221.67,589.28,383.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 74425","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","74425","UROGRAPHY ANTEGRADE RS&I","74425 - UROGRAPHY ANTEGRADE RS&I",375,507.47,267.85000000000002,4285.49,93.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 74450","BLUE CROSS","BLUE CROSS-PPO","CPT","74450","URETHROCYSTOGRAPHY RETROGRADE RS&I","74450 - URETHROCYSTOGRAPHY RETROGRADE RS&I",375,303.20999999999998,267.85000000000002,2562.5700000000002,93.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 74455","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","74455","URETHROCYSTOGRAPHY VOIDING RS&I","74455 - URETHROCYSTOGRAPHY VOIDING RS&I",823,303.20999999999998,267.85000000000002,2653.95,205.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 74740","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","74740","HC CHG HYSTEROSALPINGOGRAPHY RS&I","74740 - HC CHG HYSTEROSALPINGOGRAPHY RS&I",792,303.20999999999998,303.20999999999998,2562.5700000000002,198]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 75561","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","75561","HC CHG CARDIAC MRI W/WO CONTRAST & FURTHER SEQ","75561 - HC CHG CARDIAC MRI W/WO CONTRAST & FURTHER SEQ",4658,1105.27,664.1,4299.8,1164.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 75565","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","75565","HC CHG CARDIAC MRI FOR VELOCITY FLOW MAPPING","75565 - HC CHG CARDIAC MRI FOR VELOCITY FLOW MAPPING",619,186.53,186.53,186.53,154.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 75574","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","75574","HC CHG CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST","75574 - HC CHG CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST",4340,347.19,347.19,2420.09,1085]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 75605","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","75605","HC CHG AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I","75605 - HC CHG AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I",4288,5755.52,1894.5,49146.35,1072]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 75625","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","75625","HC CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I","75625 - HC CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I",7093,4546.0600000000004,1894.5,31186.53,1773.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 75635","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","75635","HC CHG CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP","75635 - HC CHG CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP",4210,265.3,265.3,2420.09,1052.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 75710","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","75710","HC CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I","75710 - HC CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I",6293,4546.0600000000004,1894.5,31186.53,1573.25]
["TUFTS - TUFTS PPO - CPT - 75731","TUFTS","TUFTS PPO","CPT","75731","HC ANGIO ADRENAL UNILAT SELECT","75731 - HC ANGIO ADRENAL UNILAT SELECT",4214,6087.94,1438.22,17111.73,1053.5]
["TUFTS - TUFTS HMO - CPT - 75733","TUFTS","TUFTS HMO","CPT","75733","HC ANGIO ADRENAL BILAT SELECT","75733 - HC ANGIO ADRENAL BILAT SELECT",4214,12446.74,632.41999999999996,31186.53,1053.5]
["TUFTS - TUFTS PPO - CPT - 75741","TUFTS","TUFTS PPO","CPT","75741","HC CHG ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I","75741 - HC CHG ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I",4288,11095.41,827.44,31186.53,1072]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 75774","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","75774","HC CHG ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I","75774 - HC CHG ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I",1462,0,135.78,992.93,365.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 75805","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","75805","HC LYMPH VES X-RAY TRUNK UNI","75805 - HC LYMPH VES X-RAY TRUNK UNI",636,1438.22,321.11,12540.99,159]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 75810","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","75810","HC CHG SPLENOPORTOGRAPY RS&I","75810 - HC CHG SPLENOPORTOGRAPY RS&I",4288,1882.14,827.44,17690.02,1072]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 75822","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","75822","HC CHG VENOGRAPHY EXTREMITY BILATERAL RS&I","75822 - HC CHG VENOGRAPHY EXTREMITY BILATERAL RS&I",1532,1438.22,677.24,13161.5,383]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 75825","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","75825","HC CHG VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I","75825 - HC CHG VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I",4288,4546.0600000000004,827.44,31186.53,1072]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 75833","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","75833","HC CHG VENOGRAM RENAL BILAT","75833 - HC CHG VENOGRAM RENAL BILAT",4122,3473.84,827.44,31186.53,1030.5]
["TUFTS - TUFTS SELECT - CPT - 75860","TUFTS","TUFTS SELECT","CPT","75860","HC CHG VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I","75860 - HC CHG VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I",1532,4415.3500000000004,780.65,28429.96,383]
["TUFTS - TUFTS HMO - CPT - 75885","TUFTS","TUFTS HMO","CPT","75885","HC CHG PERCUT XHEPATIC PORTO+DYNAMIC","75885 - HC CHG PERCUT XHEPATIC PORTO+DYNAMIC",4122,12446.74,1894.5,31186.53,1030.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 75889","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","75889","HC HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I","75889 - HC HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I",3742,3473.84,1894.5,31186.53,935.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 75894","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","75894","HC CHG TRANSCATHETER EMBOLIZATION ANY METH RS&I","75894 - HC CHG TRANSCATHETER EMBOLIZATION ANY METH RS&I",2196,0,491.07,1917.42,549]
["TUFTS - TUFTS HMO - CPT - 75898","TUFTS","TUFTS HMO","CPT","75898","HC CHG ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS","75898 - HC CHG ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS",1421,5499.32,173.86,13779.11,355.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 75989","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","75989","RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I","75989 - RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I",1182,130.61000000000001,130.61000000000001,130.61000000000001,295.5]
["TUFTS - TUFTS PPO - CPT - 76001","TUFTS","TUFTS PPO","CPT","76001","HC FLUOROSCOPY SPX >1 HOUR PHYS/QHP TIME","76001 - HC FLUOROSCOPY SPX >1 HOUR PHYS/QHP TIME",325,0,0,0,81.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 76010","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","76010","HC CHG RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD","76010 - HC CHG RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD",249,107.22,72.290000000000006,801.26,62.25]
["TUFTS - TUFTS HMO - CPT - 76098","TUFTS","TUFTS HMO","CPT","76098","HC CHG RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN","76098 - HC CHG RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN",864,1907.75,321.11,4780.03,216]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 76380","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","76380","HC CHG CT LIMITED/LOCALIZED FOLLOW UP STUDY","76380 - HC CHG CT LIMITED/LOCALIZED FOLLOW UP STUDY",1566,107.22,81.93,801.26,391.5]
["TUFTS - TUFTS SELECT - CPT - 76391","TUFTS","TUFTS SELECT","CPT","76391","HC MAGNETIC RESONANCE ELASTOGRAPHY","76391 - HC MAGNETIC RESONANCE ELASTOGRAPHY",838,412.18,396.79,2653.95,209.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 76497","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","76497","HC CTGUIDE,SOFT TISS ABL","76497 - HC CTGUIDE,SOFT TISS ABL",561,0,107.22,801.26,140.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 76506","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","76506","HC CHG ECHOENCEPHALOGRAPHY REAL TIME IMAGING","76506 - HC CHG ECHOENCEPHALOGRAPHY REAL TIME IMAGING",1185,147.96,147.96,1274.24,296.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 76512","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","76512","OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN","76512 - OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN",867,193.63,147.96,1274.24,216.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 76514","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","76514","OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI","76514 - OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI",141,27.45,22.57,270.45999999999998,35.25]
["TUFTS - TUFTS HMO - CPT - 76529","TUFTS","TUFTS HMO","CPT","76529","OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION","76529 - OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION",738,328.98,81.93,824.29,184.5]
["TUFTS - TUFTS PPO - CPT - 76604","TUFTS","TUFTS PPO","CPT","76604","HC CHG US CHEST REAL TIME W/IMAGE DOCUMENTATION","76604 - HC CHG US CHEST REAL TIME W/IMAGE DOCUMENTATION",829,453.34,147.96,1274.24,207.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 76642","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","76642","US BREAST UNI REAL TIME WITH IMAGE LIMITED","76642 - US BREAST UNI REAL TIME WITH IMAGE LIMITED",471,107.22,81.93,932.7,117.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 76705","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","76705","ULTRASOUND ABDOMINAL REAL TIME W/IMAGE LIMITED","76705 - ULTRASOUND ABDOMINAL REAL TIME W/IMAGE LIMITED",1024,147.96,147.96,1333.33,256]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 76775","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","76775","US RETROPERITONEAL REAL TIME W/IMAGE LIMITED","76775 - US RETROPERITONEAL REAL TIME W/IMAGE LIMITED",1029,193.63,147.96,1307.74,257.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 76800","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","76800","HC CHG ULTRASOUND SPINAL CANAL & CONTENTS","76800 - HC CHG ULTRASOUND SPINAL CANAL & CONTENTS",1268,147.96,147.96,1208.5,317]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 76805","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","76805","US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION","76805 - US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION",1417,147.96,147.96,1361.54,354.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 76811","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","76811","US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION","76811 - US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION",1767,303.20999999999998,227.73,2433.2600000000002,441.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 76812","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","76812","US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT","76812 - US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT",2021,228.8,152.84,228.8,505.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 76814","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","76814","US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION","76814 - US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION",770,0,59.73,118.01,192.5]
["UNICARE - UNICARE - CPT - 76817","UNICARE","UNICARE","CPT","76817","US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG","76817 - US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG",974,183.41,147.96,1284.3,243.5]
["TUFTS - TUFTS PPO - CPT - 76818","TUFTS","TUFTS PPO","CPT","76818","FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING","76818 - FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING",1172,474.37,147.96,1333.33,293]
["TUFTS - TUFTS PPO - CPT - 76820","TUFTS","TUFTS PPO","CPT","76820","DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY","76820 - DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY",387,419.73,147.96,1179.76,96.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 76826","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","76826","ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD","76826 - ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD",1251,396.79,142.59,3012.56,312.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 76828","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","76828","DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT","76828 - DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT",425,147.96,142.59,1307.74,106.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 76831","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","76831","SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER","76831 - SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER",1228,303.20999999999998,152.84,2653.95,307]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 76870","BLUE CROSS","BLUE CROSS-PPO","CPT","76870","ULTRASOUND SCROTUM & CONTENTS","76870 - ULTRASOUND SCROTUM & CONTENTS",1177,147.96,147.96,1307.74,294.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 76872","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","76872","ULTRASOUND TRANSRECTAL","76872 - ULTRASOUND TRANSRECTAL",1256,147.96,147.96,1333.33,314]
["UNICARE - UNICARE - CPT - 76881","UNICARE","UNICARE","CPT","76881","US EXTREMITY NON-VASC REAL-TIME IMG COMPL","76881 - US EXTREMITY NON-VASC REAL-TIME IMG COMPL",1154,183.41,147.96,1333.33,288.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 76886","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","76886","HC US EXAM INFANT HIPS STATIC","76886 - HC US EXAM INFANT HIPS STATIC",118,152.84,81.93,862.97,29.5]
["TUFTS - TUFTS HMO - CPT - 76940","TUFTS","TUFTS HMO","CPT","76940","HC CHG US &MNTR PARENCHYMAL TISSUE ABLATION","76940 - HC CHG US &MNTR PARENCHYMAL TISSUE ABLATION",1446,0,111.15,293.17,361.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 76946","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","76946","US GUIDANCE AMNIOCENTESIS RS&I","76946 - US GUIDANCE AMNIOCENTESIS RS&I",304,0,27.24,133.38,76]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 76979","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","76979","HC US TRGT DYN MBUBB EA ADDL","76979 - HC US TRGT DYN MBUBB EA ADDL",456,370.63,370.63,370.63,114]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 76981","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","76981","HC USE PARENCHYMA","76981 - HC USE PARENCHYMA",174,193.63,141.28,996.77,43.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 76983","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","76983","HC USE EA ADDL TARGET LESION","76983 - HC USE EA ADDL TARGET LESION",174,119.71,119.71,119.71,43.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 77002","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","77002","HC CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON","77002 - HC CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON",691,152.75,152.75,152.75,172.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 77011","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","77011","HC CHG CT GUIDANCE STEREOTACTIC LOCALIZATION","77011 - HC CHG CT GUIDANCE STEREOTACTIC LOCALIZATION",2190,345.46,345.46,535.08000000000004,547.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 77013","BLUE CROSS","BLUE CROSS-PPO","CPT","77013","HC CHG CT GUIDANCE &MONITORING VISC TISS ABLATION","77013 - HC CHG CT GUIDANCE &MONITORING VISC TISS ABLATION",1822,962.03,318.45,962.03,455.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 77021","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","77021","HC MRGUIDE,NEED PLACE","77021 - HC MRGUIDE,NEED PLACE",3686,838.57,567.87,838.57,921.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 77048","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","77048","HC MRI BREAST C-+ W/CAD UNI","77048 - HC MRI BREAST C-+ W/CAD UNI",594,1313.44,664.1,4775.95,148.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 77061","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","77061","DIGITAL BREAST TOMOSYNTHESIS UNILATERAL","77061 - DIGITAL BREAST TOMOSYNTHESIS UNILATERAL",383,241.35,161.88,1397.73,95.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 77063","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT","77063","SCREENING DIGITAL BREAST TOMOSYNTHESIS BI","77063 - SCREENING DIGITAL BREAST TOMOSYNTHESIS BI",100,40.57,26.06,295.68,25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 77065","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","77065","HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",812,163.16999999999999,92.17,1102.04,203]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 77066","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","77066","HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",1041,249.66,114.75,1410.44,260.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 77067","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","77067","HC SCR MAMM CAD, BI","77067 - HC SCR MAMM CAD, BI",378,107.96,107.96,1165.46,94.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 77073","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","77073","HC CHG BONE LENGTH STUDIES","77073 - HC CHG BONE LENGTH STUDIES",371,147.96,72.290000000000006,1102.33,92.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 77074","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","77074","HC CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED","77074 - HC CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED",653,125.38,125.38,1304.76,163.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 77076","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","77076","HC X-RAYS BONE SURVEY INFANT","77076 - HC X-RAYS BONE SURVEY INFANT",162,193.63,125.38,1421,40.5]
["TUFTS - TUFTS PPO - CPT - 77081","TUFTS","TUFTS PPO","CPT","77081","DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL","77081 - DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL",262,283.3,72.38,796.29,65.5]
["UNICARE - UNICARE - CPT - 77084","UNICARE","UNICARE","CPT","77084","HC CHG BONE MARROW BLOOD SUPPLY","77084 - HC CHG BONE MARROW BLOOD SUPPLY",4166,681.44,396.79,2989.41,1041.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 77280","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","77280","HC SIM SIMPLE","77280 - HC SIM SIMPLE",1590,356.14,160.66,1474.02,397.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 77295","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","77295","HC COMPUTER GEN PLAN  3D","77295 - HC COMPUTER GEN PLAN  3D",3774,3429.66,1340.75,14341.71,943.5]
["TUFTS - TUFTS POS - CPT - 77295","TUFTS","TUFTS POS","CPT","77295","HC COMPUTER GEN PLAN  3D","77295 - HC COMPUTER GEN PLAN  3D",3774,4769.8900000000003,1340.75,14341.71,943.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 77301","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","77301","HC IMRT PLAN","77301 - HC IMRT PLAN",16122,2051.29,1340.75,14341.71,4030.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 77317","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","77317","BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL","77317 - BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL",1185,553.85,369.25,3892.44,296.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 77321","BLUE CROSS","BLUE CROSS-PPO","CPT","77321","HC SPEC PORT PLAN INCLUDES ELECTRONS","77321 - HC SPEC PORT PLAN INCLUDES ELECTRONS",965,926.01,369.25,3892.44,241.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 77331","BLUE CROSS","BLUE CROSS-PPO","CPT","77331","HC SPEC DOSI","77331 - HC SPEC DOSI",1015,356.14,160.66,1474.02,253.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 77334","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","77334","HC TX DEVICES COMP","77334 - HC TX DEVICES COMP",1239,926.01,269.72000000000003,3892.44,309.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 77336","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","77336","HC MED PHYSICS CONSULT/WK","77336 - HC MED PHYSICS CONSULT/WK",357,213.01,160.66,1474.02,89.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 77370","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","77370","HC SPEC MED PHYSICS CONSULT","77370 - HC SPEC MED PHYSICS CONSULT",938,160.66,160.66,1474.02,234.5]
["TUFTS - TUFTS SELECT - CPT - 77373","TUFTS","TUFTS SELECT","CPT","77373","HC SRS FRACTIONATED 1-5 BODY; 2-5 CRANIAL","77373 - HC SRS FRACTIONATED 1-5 BODY; 2-5 CRANIAL",13470,3187.64,2909.47,20524.84,3367.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 77387","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","77387","GUIDANCE FOR LOCLZJ TARGET VOL FOR RADJ TX DLVR","77387 - GUIDANCE FOR LOCLZJ TARGET VOL FOR RADJ TX DLVR",648,315.13,111.15,315.13,162]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 77402","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","77402","HC TX DEL =>1 MEV SIMPLE","77402 - HC TX DEL =>1 MEV SIMPLE",1675,201.34,143.49,1421.57,418.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 77412","BLUE CROSS","BLUE CROSS-PPO","CPT","77412","HC TX DEL =>1 MEV - COMPLEX","77412 - HC TX DEL =>1 MEV - COMPLEX",2143,645.86,204.55,2711.86,535.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 77470","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","77470","HC SPEC TX PROC/CONCURRENT CHEMO","77470 - HC SPEC TX PROC/CONCURRENT CHEMO",1304,6278.62,548.11,6278.62,326]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 77520","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","77520","PROTON BEAM DEL,SIMPLE","77520 - PROTON BEAM DEL,SIMPLE",787,1495.83,894.66,6278.62,196.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 77761","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","77761","HC BRACHY INCAV SMP","77761 - HC BRACHY INCAV SMP",3426,1495.83,523.85,6278.62,856.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 77763","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","77763","HC BRACHY INCAV CMP","77763 - HC BRACHY INCAV CMP",5993,2027.78,523.85,8077.76,1498.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 77763","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","77763","HC BRACHY INCAV CMP","77763 - HC BRACHY INCAV CMP",5993,1212.82,523.85,8077.76,1498.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 77770","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","77770","HC HDR RDNCL NTRSTL/1ST","77770 - HC HDR RDNCL NTRSTL/1ST",1716,523.85,523.85,8624.5,429]
["UNICARE - UNICARE - CPT - 77772","UNICARE","UNICARE","CPT","77772","HC HDR RDNCL NTRSTL/12+","77772 - HC HDR RDNCL NTRSTL/12+",4931,628.62,523.85,8624.5,1232.75]
["TUFTS - TUFTS POS - CPT - 77789","TUFTS","TUFTS POS","CPT","77789","HC BRACHY SURF APP","77789 - HC BRACHY SURF APP",978,472.79,143.49,1421.57,244.5]
["TUFTS - TUFTS PPO - CPT - 77799","TUFTS","TUFTS PPO","CPT","77799","HC UNLIST BRACHY","77799 - HC UNLIST BRACHY",2586,552.62,241.24,1553.29,646.5]
["UNICARE - UNICARE - CPT - 78014","UNICARE","UNICARE","CPT","78014","HC CHG THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS","78014 - HC CHG THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS",2283,372.36,310.3,4270.45,570.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 78020","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","78020","HC CHG THYROID CARCINOMA METASTASES UPTAKE","78020 - HC CHG THYROID CARCINOMA METASTASES UPTAKE",765,0,119.46,179.88,191.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 78071","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","78071","HC CHG PARATHYROID PLANAR IMAGING W/WO SUBTRACTION","78071 - HC CHG PARATHYROID PLANAR IMAGING W/WO SUBTRACTION",3400,4270.45,239.64,4270.45,850]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 78104","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","78104","HC CHG BONE MARROW IMAGING WHOLE BODY","78104 - HC CHG BONE MARROW IMAGING WHOLE BODY",2302,464.88,393.08,4270.45,575.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 78104","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","78104","HC CHG BONE MARROW IMAGING WHOLE BODY","78104 - HC CHG BONE MARROW IMAGING WHOLE BODY",2302,393.08,393.08,4270.45,575.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 78216","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","78216","HC LIVER&SPLEEN IM;W/FLO","78216 - HC LIVER&SPLEEN IM;W/FLO",1086,464.88,430.8,4270.45,271.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 78226","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","78226","HC CHG HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER","78226 - HC CHG HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER",3070,430.8,430.8,4270.45,767.5]
["UNICARE - UNICARE - CPT - 78258","UNICARE","UNICARE","CPT","78258","HC CHG ESOPHAGEAL MOTILITY","78258 - HC CHG ESOPHAGEAL MOTILITY",2202,448.72,373.93,4270.45,550.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 78264","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","78264","HC CHG GASTRIC EMPTYING IMAGING STUDY","78264 - HC CHG GASTRIC EMPTYING IMAGING STUDY",2744,608.36,373.93,4270.45,686]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 78300","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","78300","HC CHG BONE IMAGING, LIMITED AREA","78300 - HC CHG BONE IMAGING, LIMITED AREA",658,464.88,394.65,4270.45,164.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 78305","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","78305","HC BONE&/JOINT IM;MULT","78305 - HC BONE&/JOINT IM;MULT",2225,464.88,394.65,4270.45,556.25]
["UNICARE - UNICARE - CPT - 78306","UNICARE","UNICARE","CPT","78306","HC CHG BONE &/JOINT IMAGING WHOLE BODY","78306 - HC CHG BONE &/JOINT IMAGING WHOLE BODY",2372,473.58,394.65,4270.45,593]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 78428","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","78428","HC CHG CARDIAC SHUNT DETECTION","78428 - HC CHG CARDIAC SHUNT DETECTION",1736,434.6,434.6,4270.45,434]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 78431","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","78431","HC MYOCRD IMG PET RST&STRS CT","78431 - HC MYOCRD IMG PET RST&STRS CT",2857,6178.34,3873.11,12028.4,714.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 78433","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","78433","HC MYOCRD IMG PET 2RTRACER CT","78433 - HC MYOCRD IMG PET 2RTRACER CT",3491,7550.99,4733.6099999999997,14700.77,872.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 78445","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","78445","HC CHG NONCARDIAC VASCULAR FLOW IMAGING","78445 - HC CHG NONCARDIAC VASCULAR FLOW IMAGING",1640,608.36,239.64,4231.53,410]
["TUFTS - TUFTS SELECT - CPT - 78453","TUFTS","TUFTS SELECT","CPT","78453","HC MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS","78453 - HC MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS",1924,2072.54,1360.45,13344.86,481]
["TUFTS - TUFTS HMO - CPT - 78458","TUFTS","TUFTS HMO","CPT","78458","HC VEN THROMBOSIS IMAGES BILAT","78458 - HC VEN THROMBOSIS IMAGES BILAT",547,1704.36,239.64,4270.45,136.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 78491","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","78491","HC CHG MYOCRD IMAGE PET PERFUS SINGLE STUDY REST/STRESS","78491 - HC CHG MYOCRD IMAGE PET PERFUS SINGLE STUDY REST/STRESS",3492,3939.92,1212.54,16731.72,873]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 78492","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","78492","HC CHG MYOCRD IMAGE PET PERFUS MULTPL STUDY REST/STRESS","78492 - HC CHG MYOCRD IMAGE PET PERFUS MULTPL STUDY REST/STRESS",3274,16731.72,1212.54,16731.72,818.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 78580","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","78580","HC CHG PULMONARY PERFUSION IMAGING PARTICULATE","78580 - HC CHG PULMONARY PERFUSION IMAGING PARTICULATE",2102,464.88,315.47000000000003,4270.45,525.5]
["UNICARE - UNICARE - CPT - 78597","UNICARE","UNICARE","CPT","78597","HC CHG QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING","78597 - HC CHG QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING",1840,378.56,315.47000000000003,4270.45,460]
["TUFTS - TUFTS PPO - CPT - 78605","TUFTS","TUFTS PPO","CPT","78605","HC BRAIN IMAGE 4+ VIEWS","78605 - HC BRAIN IMAGE 4+ VIEWS",721,1957.69,489.45,5502.59,180.25]
["TUFTS - TUFTS POS - CPT - 78608","TUFTS","TUFTS POS","CPT","78608","HC CHG BRAIN IMAGING PET METABOLIC EVALUATION","78608 - HC CHG BRAIN IMAGING PET METABOLIC EVALUATION",3899,5564.78,1895.18,16731.72,974.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 78645","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","78645","HC CHG CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ","78645 - HC CHG CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ",3070,599.04999999999995,345.6,5427.23,767.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 78707","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","78707","HC CHG KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/O RX","78707 - HC CHG KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/O RX",2180,783.95,370.89,5502.59,545]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 78708","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","78708","HC CHG RENAL FLOW/FUNCT IMAGE,PHARM RX","78708 - HC CHG RENAL FLOW/FUNCT IMAGE,PHARM RX",702,418.55,418.55,5502.59,175.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 78800","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","78800","HC NM RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR: LIMITED AREA","78800 - HC NM RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR: LIMITED AREA",1784,464.88,425.49,4270.45,446]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 78804","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","78804","HC RP TUM LOC/RP DIS;BODY,2/","78804 - HC RP TUM LOC/RP DIS;BODY,2/",5251,1616.75,1071.19,14762.31,1312.75]
["TUFTS - TUFTS HMO - CPT - 78804","TUFTS","TUFTS HMO","CPT","78804","HC RP TUM LOC/RP DIS;BODY,2/","78804 - HC RP TUM LOC/RP DIS;BODY,2/",5251,5891.73,1071.19,14762.31,1312.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 78807","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","78807","NM INFLAM LOCAL W SPECT","78807 - NM INFLAM LOCAL W SPECT",3227,0,425.49,5210.82,806.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 78815","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","78815","HC CHG PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH","78815 - HC CHG PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH",4921,3939.92,2059.9699999999998,16731.72,1230.25]
["TUFTS - TUFTS SELECT - CPT - 78816","TUFTS","TUFTS SELECT","CPT","78816","HC CHG PET IMAGING FOR CT ATTENUATION WHOLE BODY","78816 - HC CHG PET IMAGING FOR CT ATTENUATION WHOLE BODY",6151,2598.5500000000002,2059.9699999999998,16731.72,1537.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 78830","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","78830","HC RP LOCLZJ TUM SPECT W/CT 1","78830 - HC RP LOCLZJ TUM SPECT W/CT 1",1615,2115.7600000000002,2115.7600000000002,14691.07,403.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 79005","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","79005","HC CHG RP THERAPY ORAL ADMINISTRATION","79005 - HC CHG RP THERAPY ORAL ADMINISTRATION",1223,303.64999999999998,303.64999999999998,2756.08,305.75]
["TUFTS - TUFTS PPO - CPT - 79101","TUFTS","TUFTS PPO","CPT","79101","HC CHG RP THERAPY INTRAVENOUS ADMINISTRATION","79101 - HC CHG RP THERAPY INTRAVENOUS ADMINISTRATION",1381,980.55,303.64999999999998,2756.08,345.25]
["TUFTS - TUFTS PPO - CPT - 79445","TUFTS","TUFTS PPO","CPT","79445","HC CHG RP THERAPY INTRA-ARTERIAL PARTICULATE ADMN","79445 - HC CHG RP THERAPY INTRA-ARTERIAL PARTICULATE ADMN",1061,980.55,303.64999999999998,2756.08,265.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 80048","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","80048","HC CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - HC CHG BASIC METABOLIC PANEL CALCIUM TOTAL",226,10.15,7.71,94.96,56.5]
["TUFTS - TUFTS POS - CPT - 80051","TUFTS","TUFTS POS","CPT","80051","HC CHG ELECTROLYTE PANEL","80051 - HC CHG ELECTROLYTE PANEL",91,26.17,6.4,78.7,22.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 80053","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","80053","HC CHG COMPREHENSIVE METABOLIC PANEL","80053 - HC CHG COMPREHENSIVE METABOLIC PANEL",375,11.36,9.6300000000000008,118.56,93.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 80055","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","80055","HC CHG OBSTETRIC PANEL","80055 - HC CHG OBSTETRIC PANEL",264,56.42,41.91,536.66999999999996,66]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 80061","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","80061","HC CHG LIPID PANEL","80061 - HC CHG LIPID PANEL",131,29.59,12.21,150.31,32.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 80061","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","80061","HC CHG LIPID PANEL","80061 - HC CHG LIPID PANEL",131,35.69,12.21,150.31,32.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 80069","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","80069","HC CHG RENAL FUNCTION PANEL","80069 - HC CHG RENAL FUNCTION PANEL",218,23.14,7.92,97.49,54.5]
["TUFTS - TUFTS SELECT - CPT - 80074","TUFTS","TUFTS SELECT","CPT","80074","HC CHG ACUTE HEPATITIS PANEL","80074 - HC CHG ACUTE HEPATITIS PANEL",391,83.06,43.45,534.79999999999995,97.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 80076","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","80076","HC CHG HEPATIC FUNCTION PANEL","80076 - HC CHG HEPATIC FUNCTION PANEL",224,18.45,7.46,91.78,56]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 80145","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT","80145","HC DRUG ASSAY ADALIMUMAB","80145 - HC DRUG ASSAY ADALIMUMAB",91,38.57,38.57,206.18,22.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 80150","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","80150","HC AMIKACIN","80150 - HC AMIKACIN",124,169.26,13.75,169.26,31]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 80156","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","80156","HC CHG DRUG ASSAY CARBAMAZEPINE TOTAL","80156 - HC CHG DRUG ASSAY CARBAMAZEPINE TOTAL",72,32.94,13.28,163.47,18]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 80156","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","80156","HC CHG DRUG ASSAY CARBAMAZEPINE TOTAL","80156 - HC CHG DRUG ASSAY CARBAMAZEPINE TOTAL",72,15.63,13.28,163.47,18]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 80158","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","80158","HC CHG DRUG ASSAY CYCLOSPORINE","80158 - HC CHG DRUG ASSAY CYCLOSPORINE",91,21.66,16.46,202.6,22.75]
["FALLON - FALLON MEDICAID - CPT - 80162","FALLON","FALLON MEDICAID","CPT","80162","HC CHG DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL","80162 - HC CHG DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL",66,12.11,12.11,149,16.5]
["TUFTS - TUFTS POS - CPT - 80164","TUFTS","TUFTS POS","CPT","80164","HC CHG DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL","80164 - HC CHG DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL",67,50.55,12.35,151.97999999999999,16.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 80168","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","80168","HC CHG DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE","80168 - HC CHG DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE",75,183.36,14.9,183.36,18.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 80168","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","80168","HC CHG DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE","80168 - HC CHG DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE",75,23.69,14.9,183.36,18.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 80170","BMC HEALTHNET","BMCHN MCO","CPT","80170","HC CHG DRUG SCREEN QUANTITATIVE GENTAMICIN","80170 - HC CHG DRUG SCREEN QUANTITATIVE GENTAMICIN",82,14.94,14.94,183.85,20.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 80170","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","80170","HC CHG DRUG SCREEN QUANTITATIVE GENTAMICIN","80170 - HC CHG DRUG SCREEN QUANTITATIVE GENTAMICIN",82,34.5,14.94,183.85,20.5]
["TUFTS - TUFTS PPO - CPT - 80171","TUFTS","TUFTS PPO","CPT","80171","DRUG SCREEN QUANTITATIVE GABAPENTIN","80171 - DRUG SCREEN QUANTITATIVE GABAPENTIN",83,74.78,16.010000000000002,210.18,20.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 80175","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","80175","DRUG SCREEN QUANTITATIVE LAMOTRIGINE","80175 - DRUG SCREEN QUANTITATIVE LAMOTRIGINE",64,16.41,12.09,148.84,16]
["TUFTS - TUFTS MEDICARE SCO - CPT - 80177","TUFTS","TUFTS MEDICARE SCO","CPT","80177","DRUG SCREEN QUANTITATIVE LEVETIRACETAM","80177 - DRUG SCREEN QUANTITATIVE LEVETIRACETAM",174,19.21,12.09,148.84,43.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 80178","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","80178","HC CHG DRUG SCREEN QUANTITATIVE LITHIUM","80178 - HC CHG DRUG SCREEN QUANTITATIVE LITHIUM",34,15.16,6.03,74.22,8.5]
["TUFTS - TUFTS PPO - CPT - 80178","TUFTS","TUFTS PPO","CPT","80178","HC CHG DRUG SCREEN QUANTITATIVE LITHIUM","80178 - HC CHG DRUG SCREEN QUANTITATIVE LITHIUM",34,26.4,6.03,74.22,8.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 80184","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT","80184","HC CHG DRUG SCREEN QUANTITATIVE PHENOBARBITAL","80184 - HC CHG DRUG SCREEN QUANTITATIVE PHENOBARBITAL",46,20.63,11.3,148.35,11.5]
["FALLON - FALLON SENIOR PLAN - CPT - 80185","FALLON","FALLON SENIOR PLAN","CPT","80185","HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL","80185 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL",66,13.25,12.09,148.84,16.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 80186","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","80186","HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN FREE","80186 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN FREE",46,30.96,12.55,154.51,11.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 80186","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","80186","HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN FREE","80186 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN FREE",46,32.200000000000003,12.55,154.51,11.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 80195","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","80195","HC CHG DRUG SCREEN QUANTITATIVE SIROLIMUS","80195 - HC CHG DRUG SCREEN QUANTITATIVE SIROLIMUS",35,32.950000000000003,10.01,154.22,8.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 80197","BMC HEALTHNET","BMCHN ACO","CPT","80197","HC CHG DRUG SCREEN QUANTITATIVE TACROLIMUS","80197 - HC CHG DRUG SCREEN QUANTITATIVE TACROLIMUS",36,27.42,10.01,154.22,9]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 80198","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","80198","HC Q;THEOPHYLLINE","80198 - HC Q;THEOPHYLLINE",71,33.92,12.9,158.69999999999999,17.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 80201","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","80201","HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE","80201 - HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE",46,27.01,10.88,133.80000000000001,11.5]
["TUFTS - TUFTS SPIRIT - CPT - 80201","TUFTS","TUFTS SPIRIT","CPT","80201","HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE","80201 - HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE",46,13.11,10.88,133.80000000000001,11.5]
["TUFTS - TUFTS POS - CPT - 80202","TUFTS","TUFTS POS","CPT","80202","HC CHG DRUG SCREEN QUANTITATIVE VANCOMYCIN","80202 - HC CHG DRUG SCREEN QUANTITATIVE VANCOMYCIN",67,50.55,12.35,151.97999999999999,16.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 80203","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","80203","DRUG SCREEN QUANTITATIVE ZONISAMIDE","80203 - DRUG SCREEN QUANTITATIVE ZONISAMIDE",64,23.06,12.09,148.84,16]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 80203","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","80203","DRUG SCREEN QUANTITATIVE ZONISAMIDE","80203 - DRUG SCREEN QUANTITATIVE ZONISAMIDE",64,31.8,12.09,148.84,16]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 80235","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","80235","HC DRUG ASSAY LACOSAMIDE","80235 - HC DRUG ASSAY LACOSAMIDE",67,32.53,27.11,144.88999999999999,16.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 80299","BLUE CROSS","BLUE CROSS-PPO","CPT","80299","HC INFLIXIMAB DRUG CONC. AND ANTI-INFLIXIMAB AB","80299 - HC INFLIXIMAB DRUG CONC. AND ANTI-INFLIXIMAB AB",718,34.26,13.77,180.75,179.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 80299","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","80299","HC INFLIXIMAB DRUG CONC. AND ANTI-INFLIXIMAB AB","80299 - HC INFLIXIMAB DRUG CONC. AND ANTI-INFLIXIMAB AB",718,27.03,13.77,180.75,179.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 80306","BLUE CROSS","BLUE CROSS-PPO","CPT","80306","HC DRUG TEST PRSMV INSTRMNT","80306 - HC DRUG TEST PRSMV INSTRMNT",192,32.94,11.89,145.87,48]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 80307","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","80307","HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS","80307 - HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS",762,55.97,47.55,572.91,190.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 80307","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","80307","HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS","80307 - HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS",762,94.4,47.55,572.91,190.5]
["BMC HEALTHNET - BMCHN MCO - CPT - 80329","BMC HEALTHNET","BMCHN MCO","CPT","80329","DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2","80329 - DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2",235,0,10.74,111.18,58.75]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 80345","BMC HEALTHNET","BMCHN MEDICAID","CPT","80345","HC CHG DRUG SCREENING BARBITURATES","80345 - HC CHG DRUG SCREENING BARBITURATES",95,0,16.41,105.68,23.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 80353","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","80353","HC CHG DRUG SCREENING COCAINE","80353 - HC CHG DRUG SCREENING COCAINE",71,44.14,18.37,118.27,17.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 80353","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","80353","HC CHG DRUG SCREENING COCAINE","80353 - HC CHG DRUG SCREENING COCAINE",71,30.65,18.37,118.27,17.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 80361","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","80361","HC CHG DRUG SCREENING OPIATES 1 OR MORE","80361 - HC CHG DRUG SCREENING OPIATES 1 OR MORE",102,44.14,25.61,164.9,25.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 80366","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","80366","HC CHG DRUG SCREENING PREGABALIN","80366 - HC CHG DRUG SCREENING PREGABALIN",56,44.14,12.43,80,14]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 80438","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","80438","HC CHG TRH STIM PANEL 1 HR","80438 - HC CHG TRH STIM PANEL 1 HR",65,54.13,45.99,565.98,16.25]
["BMC HEALTHNET - BMCHN MCO - CPT - 81000","BMC HEALTHNET","BMCHN MCO","CPT","81000","URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY","81000 - URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY",17,2.97,2.97,39.04,4.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 81001","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","81001","URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY","81001 - URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY",17,7.98,2.9,35.659999999999997,4.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 81001","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","81001","URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY","81001 - URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY",17,4.3499999999999996,2.9,35.659999999999997,4.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 81002","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","81002","URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP","81002 - URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP",12,3.48,2.57,33.79,3]
["TUFTS - TUFTS HMO - CPT - 81003","TUFTS","TUFTS HMO","CPT","81003","URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY","81003 - URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY",12,10.06,2.0499999999999998,25.23,3]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 81003","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","81003","URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY","81003 - URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY",12,4.74,2.0499999999999998,25.23,3]
["CIGNA HEALTHCARE - CIGNA - CPT - 81025","CIGNA HEALTHCARE","CIGNA","CPT","81025","URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS","81025 - URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS",32,28.49,6.36,83.47,8]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 81025","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","81025","URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS","81025 - URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS",32,7.49,6.36,83.47,8]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 81050","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","81050","HC CHG VOLUME MEASUREMENT TIMED COLLECTION EACH","81050 - HC CHG VOLUME MEASUREMENT TIMED COLLECTION EACH",15,4.12,2.74,35.29,3.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 81161","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","81161","HC DMD DUPLICATION/DELETION ANALYSIS","81161 - HC DMD DUPLICATION/DELETION ANALYSIS",366,602.36,141.12,2706.08,91.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 81178","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","81178","HC CHG ATXN1 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","81178 - HC CHG ATXN1 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES",175,137,102.3,1328.77,43.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 81179","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","81179","HC CHG ATXN2 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","81179 - HC CHG ATXN2 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES",175,157.55000000000001,102.3,1328.77,43.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 81179","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","81179","HC CHG ATXN2 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","81179 - HC CHG ATXN2 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES",175,295.77999999999997,102.3,1328.77,43.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 81206","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","81206","HC CHG BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE","81206 - HC CHG BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE",684,362.33,149.56,1840.58,171]
["UNICARE - UNICARE - CPT - 81206","UNICARE","UNICARE","CPT","81206","HC CHG BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE","81206 - HC CHG BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE",684,397.27,149.56,1840.58,171]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 81210","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","81210","HC CHG BRAF GENE ANALYSIS V600 VARIANT(S)","81210 - HC CHG BRAF GENE ANALYSIS V600 VARIANT(S)",492,320.82,129.6,1701.28,123]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 81210","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","81210","HC CHG BRAF GENE ANALYSIS V600 VARIANT(S)","81210 - HC CHG BRAF GENE ANALYSIS V600 VARIANT(S)",492,265.29000000000002,129.6,1701.28,123]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 81218","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","81218","HC CEBPA GENE ANALYSIS FULL GENE SEQUENC","81218 - HC CEBPA GENE ANALYSIS FULL GENE SEQUENC",551,546.11,159,2715.49,137.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 81220","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","81220","HC CHG CFTR GENE ANALYSIS COMMON VARIANTS","81220 - HC CHG CFTR GENE ANALYSIS COMMON VARIANTS",847,1201.7,411.25,1400.52,211.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 81221","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","81221","HC CHG CFTR GENE ANALYSIS KNOWN FAMILIAL VARIANTS","81221 - HC CHG CFTR GENE ANALYSIS KNOWN FAMILIAL VARIANTS",434,116.66,97.22,244.62,108.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 81222","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","81222","HC GEN CYSTIC FIBROSIS DEL/DUP","81222 - HC GEN CYSTIC FIBROSIS DEL/DUP",762,939.32,435.07,1094.72,190.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 81223","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","81223","HC CFTR GENE ANALYSIS FULL GENE SEQUENCE","81223 - HC CFTR GENE ANALYSIS FULL GENE SEQUENCE",1523,912.38,499,1255.58,380.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 81235","BLUE CROSS","BLUE CROSS-PPO","CPT","81235","HC CHG EGFR GENE ANALYSIS COMMON VARIANTS","81235 - HC CHG EGFR GENE ANALYSIS COMMON VARIANTS",1038,593.54,239.82,3148.12,259.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 81235","TUFTS","TUFTS MEDICARE SCO","CPT","81235","HC CHG EGFR GENE ANALYSIS COMMON VARIANTS","81235 - HC CHG EGFR GENE ANALYSIS COMMON VARIANTS",1038,470.64,239.82,3148.12,259.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 81240","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","81240","HC CHG F2 GENE ANALYSIS 20210G >A VARIANT","81240 - HC CHG F2 GENE ANALYSIS 20210G >A VARIANT",434,119.9,48.54,637.1,108.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 81241","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","81241","HC CHG F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT","81241 - HC CHG F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT",434,711.6,55.74,711.6,108.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 81243","BLUE CROSS","BLUE CROSS-PPO","CPT","81243","HC CHG FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES","81243 - HC CHG FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES",434,104.09,57.04,371.04,108.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 81252","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","81252","HC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCEHC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCE","81252 - HC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCEHC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCE",153,185.12,101.12,254.44,38.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 81253","BLUE CROSS","BLUE CROSS-PPO","CPT","81253","HC CHG GJB2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS","81253 - HC CHG GJB2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS",153,112.64,61.52,154.80000000000001,38.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 81254","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT","81254","HC CHG GJB6 GENE ANALYSIS COMMON VARIANTS","81254 - HC CHG GJB6 GENE ANALYSIS COMMON VARIANTS",51,35,35,88.07,12.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 81256","BMC HEALTHNET","BMCHN QHP","CPT","81256","HC CHG HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS","81256 - HC CHG HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS",434,35.770000000000003,59.62,733.73,108.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 81257","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","81257","HC CHG HBA1/HBA2 ANALYSIS FOR COMMON DELETIONS/VARIANT","81257 - HC CHG HBA1/HBA2 ANALYSIS FOR COMMON DELETIONS/VARIANT",455,122.71,102.26,257.31,113.75]
["FALLON - FALLON SENIOR PLAN - CPT - 81259","FALLON","FALLON SENIOR PLAN","CPT","81259","HC HBA1/HBA2 GENE ANALYSIS FULL GENE SEQUENCE","81259 - HC HBA1/HBA2 GENE ANALYSIS FULL GENE SEQUENCE",629,600,443.32,5819.55,157.25]
["BMC HEALTHNET - BMCHN ACO - CPT - 81261","BMC HEALTHNET","BMCHN ACO","CPT","81261","IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED; PRO/TECH","81261 - IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED; PRO/TECH",737,197.57499999999999,180.6,2222.63,184.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 81269","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","81269","HC HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIENTS","81269 - HC HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIENTS",455,447.28,149.54,1963.05,113.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 81270","BMC HEALTHNET","BMCHN ACO","CPT","81270","HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT","81270 - HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT",434,91.48,83.62,1029.05,108.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 81270","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","81270","HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT","81270 - HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT",434,132.91,83.62,1029.05,108.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 81271","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","81271","HC HTT GENE ANALYSIS DECTECT ABNORMAL ALLELES","81271 - HC HTT GENE ANALYSIS DECTECT ABNORMAL ALLELES",175,198.65,102.3,1328.77,43.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 81272","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","81272","HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS","81272 - HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS",660,711.41,159,3195.92,165]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 81274","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","81274","HC HTT GENE ANALYSIS CHARACTERIZATION ALLELES","81274 - HC HTT GENE ANALYSIS CHARACTERIZATION ALLELES",175,593.36,205.22,2665.65,43.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 81275","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","81275","HC CHG KRAS GENE ANALYSIS VARIANTS IN EXON 2","81275 - HC CHG KRAS GENE ANALYSIS VARIANTS IN EXON 2",534,353.1,142.78,1874.37,133.5]
["BMC HEALTHNET - BMCHN QHP - CPT - 81276","BMC HEALTHNET","BMCHN QHP","CPT","81276","HC CHG KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)","81276 - HC CHG KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)",3198,171.34,142.78,1874.37,799.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81276","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","81276","HC CHG KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)","81276 - HC CHG KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)",3198,171.34,142.78,1874.37,799.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 81288","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","81288","MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS","81288 - MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS",1882,351.77,142.1,1865.32,470.5]
["BMC HEALTHNET - BMCHN MCO - CPT - 81291","BMC HEALTHNET","BMCHN MCO","CPT","81291","HC CHG MTHFR GENE ANALYSIS COMMON VARIANTS","81291 - HC CHG MTHFR GENE ANALYSIS COMMON VARIANTS",434,24.14,48.28,633.76,108.5]
["BMC HEALTHNET - BMCHN ACO - CPT - 81301","BMC HEALTHNET","BMCHN ACO","CPT","81301","HC CHG MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF","81301 - HC CHG MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF",534,288.95999999999998,264.13,3380.71,133.5]
["TUFTS - TUFTS SPIRIT - CPT - 81301","TUFTS","TUFTS SPIRIT","CPT","81301","HC CHG MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF","81301 - HC CHG MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF",534,383.42,264.13,3380.71,133.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 81304","BLUE CROSS","BLUE CROSS-PPO","CPT","81304","HC MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT","81304 - HC MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT",183,274.04000000000002,150,377.43,45.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 81304","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","81304","HC MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT","81304 - HC MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT",183,315.89999999999998,150,377.43,45.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 81307","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","81307","HC PALB2 GENE FULL GENE SEQ","81307 - HC PALB2 GENE FULL GENE SEQ",223,610.74,282.88,1511.93,55.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 81308","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","81308","HC PALB2 GENE KNOWN FAMIL VRNT","81308 - HC PALB2 GENE KNOWN FAMIL VRNT",223,346.55,301.35000000000002,1610.68,55.75]
["TUFTS - TUFTS HMO - CPT - 81309","TUFTS","TUFTS HMO","CPT","81309","HC PIK3CA GENE TRGT SEQ ALYS","81309 - HC PIK3CA GENE TRGT SEQ ALYS",223,587.75,274.83,1468.89,55.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 81311","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","81311","HC CHG NRAS GENE ANALYSIS VARIANTS IN EXON 2&3","81311 - HC CHG NRAS GENE ANALYSIS VARIANTS IN EXON 2&3",4795,540.84,218.55,2868.9,1198.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 81315","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","81315","HC PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT","81315 - HC PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT",675,467.72,189.1,2327.29,168.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 81329","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","81329","HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS","81329 - HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS",174,161.66,102.3,1328.77,43.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 81329","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","81329","HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS","81329 - HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS",174,60.204999999999998,102.3,1328.77,43.5]
["FALLON - FALLON MEDICAID - CPT - 81342","FALLON","FALLON MEDICAID","CPT","81342","TRG@ GENE REARRANGEMENT ANALYSIS; PRO/TECH","81342 - TRG@ GENE REARRANGEMENT ANALYSIS; PRO/TECH",534,91.9,183.8,2261.92,133.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 81342","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","81342","TRG@ GENE REARRANGEMENT ANALYSIS; PRO/TECH","81342 - TRG@ GENE REARRANGEMENT ANALYSIS; PRO/TECH",534,471.49,183.8,2261.92,133.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81350","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","81350","HC CHG UGT1A1 GENE ANALYSIS COMMON VARIANTS","81350 - HC CHG UGT1A1 GENE ANALYSIS COMMON VARIANTS",815,0,234,588.79,203.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 81364","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","81364","HC HBB FULL GENE SEQUENCE","81364 - HC HBB FULL GENE SEQUENCE",629,282.99,239.82,3148.12,157.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 81364","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","81364","HC HBB FULL GENE SEQUENCE","81364 - HC HBB FULL GENE SEQUENCE",629,683.57,239.82,3148.12,157.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81401","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","81401","HC CHG, MOLECULAR PATHOLOGY PROCEDURE LEVEL 2","81401 - HC CHG, MOLECULAR PATHOLOGY PROCEDURE LEVEL 2",678,0,137,344.72,169.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 81402","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","81402","HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 3","81402 - HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 3",434,180.4,150.33000000000001,378.26,108.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 81404","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","81404","VHL (EG, VON HIPPEL-LINDAUFAMILIAL CANCER SYNDROME, FULL GENE SEQ VWF PRO/TECH","81404 - VHL (EG, VON HIPPEL-LINDAUFAMILIAL CANCER SYNDROME, FULL GENE SEQ VWF PRO/TECH",629,502.63,274.83,691.53,157.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 81405","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","81405","HC MOPATH PROCEDURE LEVEL 6","81405 - HC MOPATH PROCEDURE LEVEL 6",629,0,301.35000000000002,758.26,157.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 81406","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","81406","HC CHG MOLECULAR PATHOLOGY PROCEDURE LEVEL 7","81406 - HC CHG MOLECULAR PATHOLOGY PROCEDURE LEVEL 7",584,492.21,282.88,711.78,146]
["FALLON - FALLON MEDICAID - CPT - 81430","FALLON","FALLON MEDICAID","CPT","81430","HC CHG HEARING LOSS GENOMIC SEQUENCE ANALYSIS 60 GENES","81430 - HC CHG HEARING LOSS GENOMIC SEQUENCE ANALYSIS 60 GENES",2063,600.32000000000005,1625,15761.12,515.75]
["TUFTS - TUFTS SELECT - CPT - 81430","TUFTS","TUFTS SELECT","CPT","81430","HC CHG HEARING LOSS GENOMIC SEQUENCE ANALYSIS 60 GENES","81430 - HC CHG HEARING LOSS GENOMIC SEQUENCE ANALYSIS 60 GENES",2063,2447.8000000000002,1625,15761.12,515.75]
["FALLON - FALLON SENIOR PLAN - CPT - 81450","FALLON","FALLON SENIOR PLAN","CPT","81450","HC CHG GENOMIC SEQ ANALYS DNA&RNA ANALYS 5-50 GENE","81450 - HC CHG GENOMIC SEQ ANALYS DNA&RNA ANALYS 5-50 GENE",2132,759.53,561.19000000000005,7366.77,533]
["BMC HEALTHNET - BMCHN MCO - CPT - 81479","BMC HEALTHNET","BMCHN MCO","CPT","81479","HC CHG UNLISTED MOLELCULAR PATHOLOGY PROCEDURE","81479 - HC CHG UNLISTED MOLELCULAR PATHOLOGY PROCEDURE",1744,0,100.02,100.02,436]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 81542","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","81542","HC ONC PROSTATE MRNA 22 CNT GEN","81542 - HC ONC PROSTATE MRNA 22 CNT GEN",92,0,0,0,23]
["TUFTS - TUFTS SPIRIT - CPT - 81542","TUFTS","TUFTS SPIRIT","CPT","81542","HC ONC PROSTATE MRNA 22 CNT GEN","81542 - HC ONC PROSTATE MRNA 22 CNT GEN",92,0,0,0,23]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 82009","BMC HEALTHNET","BMCHN WELL SENSE","CPT","82009","HC CHG KETONE BODIES SERUM QUALITATIVE","82009 - HC CHG KETONE BODIES SERUM QUALITATIVE",24,11.5,4.12,50.7,6]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 82009","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","82009","HC CHG KETONE BODIES SERUM QUALITATIVE","82009 - HC CHG KETONE BODIES SERUM QUALITATIVE",24,4.8499999999999996,4.12,50.7,6]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 82010","BMC HEALTHNET","BMCHN WELL SENSE","CPT","82010","HC CHG KETONE BODIES SERUM QUANTITATIVE","82010 - HC CHG KETONE BODIES SERUM QUANTITATIVE",40,20.77,7.46,91.78,10]
["FALLON - FALLON MEDICAID - CPT - 82017","FALLON","FALLON MEDICAID","CPT","82017","HC CHG ACYLCARNITINES QUANTIATIVE EACH SPECIMEN","82017 - HC CHG ACYLCARNITINES QUANTIATIVE EACH SPECIMEN",83,15.39,14.65,189.43,20.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 82024","BLUE CROSS","BLUE CROSS-PPO","CPT","82024","HC CHG ADRENOCORTICOTROPIC HORMONE ACTH","82024 - HC CHG ADRENOCORTICOTROPIC HORMONE ACTH",185,86.95,35.229999999999997,433.56,46.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 82024","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","82024","HC CHG ADRENOCORTICOTROPIC HORMONE ACTH","82024 - HC CHG ADRENOCORTICOTROPIC HORMONE ACTH",185,42.28,35.229999999999997,433.56,46.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82040","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","82040","HC CHG ALBUMIN SERUM PLASMA/WHOLE BLOOD","82040 - HC CHG ALBUMIN SERUM PLASMA/WHOLE BLOOD",26,7.18,4.51,55.55,6.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82042","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","82042","HC CHG ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN","82042 - HC CHG ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN",26,11.28,5.75,75.44,6.5]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 82043","BMC HEALTHNET","BMCHN WELL SENSE","CPT","82043","HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE","82043 - HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE",27,10.69,5.28,64.88,6.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 82075","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","82075","HC CHG ASSAY OF ALCOHOL BREATH","82075 - HC CHG ASSAY OF ALCOHOL BREATH",86,64.77,16.53,291,21.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 82085","BLUE CROSS","BLUE CROSS-PPO","CPT","82085","HC CHG ASSAY OF ALDOLASE","82085 - HC CHG ASSAY OF ALDOLASE",48,21.73,8.86,109.06,12]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 82085","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT","82085","HC CHG ASSAY OF ALDOLASE","82085 - HC CHG ASSAY OF ALDOLASE",48,9.7100000000000009,8.86,109.06,12]
["TUFTS - TUFTS SELECT - CPT - 82088","TUFTS","TUFTS SELECT","CPT","82088","HC CHG ASSAY OF ALDOSTERONE","82088 - HC CHG ASSAY OF ALDOSTERONE",196,71.05,37.17,457.49,49]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82103","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","82103","HC CHG ALPHA-1-ANTITRYPSIN TOTAL","82103 - HC CHG ALPHA-1-ANTITRYPSIN TOTAL",65,19.489999999999998,12.26,150.88,16.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 82103","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","82103","HC CHG ALPHA-1-ANTITRYPSIN TOTAL","82103 - HC CHG ALPHA-1-ANTITRYPSIN TOTAL",65,32.229999999999997,12.26,150.88,16.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 82104","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","82104","HC CHG ALPHA-1-ANTITRYPSIN PHENOTYPE","82104 - HC CHG ALPHA-1-ANTITRYPSIN PHENOTYPE",64,17.350000000000001,13.2,162.37,16]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 82139","BLUE CROSS","BLUE CROSS-PPO","CPT","82139","HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE","82139 - HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE",98,38.200000000000003,14.65,189.43,24.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 82139","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","82139","HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE","82139 - HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE",98,29.35,14.65,189.43,24.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 82140","BLUE CROSS","BLUE CROSS-PPO","CPT","82140","HC CHG ASSAY OF AMMONIA","82140 - HC CHG ASSAY OF AMMONIA",72,32.94,13.29,163.55000000000001,18]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 82150","BMC HEALTHNET","BMCHN MEDICAID","CPT","82150","HC CHG ASSAY OF AMYLASE","82150 - HC CHG ASSAY OF AMYLASE",33,5.91,5.91,72.75,8.25]
["TUFTS - TUFTS SPIRIT - CPT - 82150","TUFTS","TUFTS SPIRIT","CPT","82150","HC CHG ASSAY OF AMYLASE","82150 - HC CHG ASSAY OF AMYLASE",33,7.13,5.91,72.75,8.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82157","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","82157","HC CHG ANDROSTENEDIONE","82157 - HC CHG ANDROSTENEDIONE",141,42.46,26.7,328.66,35.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 82164","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT","82164","HC CHG ANGIOTENSIN I-CONVERTING ENZYME","82164 - HC CHG ANGIOTENSIN I-CONVERTING ENZYME",71,19.68,13.32,163.96,17.75]
["TUFTS - TUFTS POS - CPT - 82172","TUFTS","TUFTS POS","CPT","82172","HC CHG APOLIPOPROTEIN EACH","82172 - HC CHG APOLIPOPROTEIN EACH",146,68.03,15.58,204.55,36.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 82175","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","82175","HC CHG ASSAY OF ARSENIC","82175 - HC CHG ASSAY OF ARSENIC",92,33.01,17.3,212.95,23]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 82180","BMC HEALTHNET","BMCHN MEDICAID","CPT","82180","HC CHG ASSAY OF ASCORBIC ACID BLOOD","82180 - HC CHG ASSAY OF ASCORBIC ACID BLOOD",49,9.01,9.01,110.9,12.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 82180","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","82180","HC CHG ASSAY OF ASCORBIC ACID BLOOD","82180 - HC CHG ASSAY OF ASCORBIC ACID BLOOD",49,10.81,9.01,110.9,12.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 82247","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","82247","HC CHG BILIRUBIN TOTAL","82247 - HC CHG BILIRUBIN TOTAL",26,11.2,4.57,56.28,6.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 82247","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","82247","HC CHG BILIRUBIN TOTAL","82247 - HC CHG BILIRUBIN TOTAL",26,13.36,4.57,56.28,6.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 82248","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","82248","HC CHG BILIRUBIN DIRECT","82248 - HC CHG BILIRUBIN DIRECT",26,6.88,4.57,56.28,6.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 82248","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT","82248","HC CHG BILIRUBIN DIRECT","82248 - HC CHG BILIRUBIN DIRECT",26,6.77,4.57,56.28,6.5]
["TUFTS - TUFTS PPO - CPT - 82270","TUFTS","TUFTS PPO","CPT","82270","HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER","82270 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER",17,15.11,3.24,42.47,4.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82271","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","82271","HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES","82271 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES",15,7.71,3.93,51.64,3.75]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 82274","BMC HEALTHNET","BMCHN WELL SENSE","CPT","82274","HC CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3","82274 - HC CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3",159,27.58,14.51,178.59,39.75]
["TUFTS - TUFTS SELECT - CPT - 82306","TUFTS","TUFTS SELECT","CPT","82306","HC CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED","82306 - HC CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED",146,51.62,27.01,332.37,36.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 82308","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","82308","HC CHG CALCITONIN","82308 - HC CHG CALCITONIN",128,60.6,24.44,300.82,32]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 82308","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","82308","HC CHG CALCITONIN","82308 - HC CHG CALCITONIN",128,32.15,24.44,300.82,32]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 82330","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","82330","HC CHG CALCIUM IONIZED","82330 - HC CHG CALCIUM IONIZED",69,16.14,12.47,153.49,17.25]
["TUFTS - TUFTS POS - CPT - 82330","TUFTS","TUFTS POS","CPT","82330","HC CHG CALCIUM IONIZED","82330 - HC CHG CALCIUM IONIZED",69,51.05,12.47,153.49,17.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 82340","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","82340","HC Q;KID STONE, UR CALCIUM","82340 - HC Q;KID STONE, UR CALCIUM",31,67.7,5.5,67.7,7.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 82365","BLUE CROSS","BLUE CROSS-PPO","CPT","82365","HC CHG CALCULUS INFRARED SPECTROSCOPY","82365 - HC CHG CALCULUS INFRARED SPECTROSCOPY",120,28.98,11.76,144.81,30]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 82374","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","82374","HC CHG CARBON DIOXIDE BICARBONATE","82374 - HC CHG CARBON DIOXIDE BICARBONATE",25,11.2,4.46,54.82,6.25]
["TUFTS - TUFTS SPIRIT - CPT - 82374","TUFTS","TUFTS SPIRIT","CPT","82374","HC CHG CARBON DIOXIDE BICARBONATE","82374 - HC CHG CARBON DIOXIDE BICARBONATE",25,5.37,4.46,54.82,6.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 82378","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","82378","HC CHG CARCINOEMBRYONIC ANTIGEN CEA","82378 - HC CHG CARCINOEMBRYONIC ANTIGEN CEA",95,22.37,17.3,212.87,23.75]
["TUFTS - TUFTS POS - CPT - 82378","TUFTS","TUFTS POS","CPT","82378","HC CHG CARCINOEMBRYONIC ANTIGEN CEA","82378 - HC CHG CARCINOEMBRYONIC ANTIGEN CEA",95,70.8,17.3,212.87,23.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 82379","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","82379","HC CRL;CARNITINE","82379 - HC CRL;CARNITINE",52,18.16,14.65,189.43,13]
["TUFTS - TUFTS POS - CPT - 82379","TUFTS","TUFTS POS","CPT","82379","HC CRL;CARNITINE","82379 - HC CRL;CARNITINE",52,63,14.65,189.43,13]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 82390","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","82390","HC CHG CERULOPLASMIN","82390 - HC CHG CERULOPLASMIN",52,24.37,9.8000000000000007,120.52,13]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 82390","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","82390","HC CHG CERULOPLASMIN","82390 - HC CHG CERULOPLASMIN",52,22.62,9.8000000000000007,120.52,13]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 82397","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","82397","HC CHEMILUMINESCENT ASSAY","82397 - HC CHEMILUMINESCENT ASSAY",718,31.63,12.88,158.54,179.5]
["TUFTS - TUFTS POS - CPT - 82435","TUFTS","TUFTS POS","CPT","82435","HC CHG CHLORIDE BLD","82435 - HC CHG CHLORIDE BLD",24,17.170000000000002,4.2,51.64,6]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 82436","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","82436","HC CHG CHLORIDE URINE","82436 - HC CHG CHLORIDE URINE",26,11.2,4.59,56.85,6.5]
["TUFTS - TUFTS POS - CPT - 82436","TUFTS","TUFTS POS","CPT","82436","HC CHG CHLORIDE URINE","82436 - HC CHG CHLORIDE URINE",26,18.91,4.59,56.85,6.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 82438","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","82438","HC CHG CHLORIDE OTHER SOURCE","82438 - HC CHG CHLORIDE OTHER SOURCE",25,5.35,4.46,54.82,6.25]
["FALLON - FALLON MEDICAID - CPT - 82465","FALLON","FALLON MEDICAID","CPT","82465","CHOLESTEROL SERUM/WHOLE BLOOD TOTAL","82465 - CHOLESTEROL SERUM/WHOLE BLOOD TOTAL",23,3.97,3.97,48.83,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 82495","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","82495","HC CHG ASSAY OF CHROMIUM","82495 - HC CHG ASSAY OF CHROMIUM",98,45.46,18.5,227.7,24.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 82495","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","82495","HC CHG ASSAY OF CHROMIUM","82495 - HC CHG ASSAY OF CHROMIUM",98,48.64,18.5,227.7,24.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 82523","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","82523","HC CHG COLLAGEN CROSS LINKS ANY METHOD","82523 - HC CHG COLLAGEN CROSS LINKS ANY METHOD",62,22.04,17.05,209.77,15.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 82525","BLUE CROSS","BLUE CROSS-PPO","CPT","82525","HC CHG ASSAY OF COPPER","82525 - HC CHG ASSAY OF COPPER",62,28.32,11.32,139.30000000000001,15.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 82525","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","82525","HC CHG ASSAY OF COPPER","82525 - HC CHG ASSAY OF COPPER",62,25.1,11.32,139.30000000000001,15.5]
["FALLON - FALLON MEDICAID - CPT - 82530","FALLON","FALLON MEDICAID","CPT","82530","HC CHG CORTISOL FREE","82530 - HC CHG CORTISOL FREE",82,15.24,15.24,187.56,20.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 82530","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","82530","HC CHG CORTISOL FREE","82530 - HC CHG CORTISOL FREE",82,18.29,15.24,187.56,20.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 82540","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","82540","HC CHG ASSAY OF CREATINE","82540 - HC CHG ASSAY OF CREATINE",23,10.55,4.2300000000000004,52,5.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 82542","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","82542","HC CHG COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC","82542 - HC CHG COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC",926,28.43,17.8,233.69,231.5]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 82542","BMC HEALTHNET","BMCHN WELL SENSE","CPT","82542","HC CHG COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC","82542 - HC CHG COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC",926,34.450000000000003,17.8,233.69,231.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 82550","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","82550","HC CHG CREATINE KINASE TOTAL","82550 - HC CHG CREATINE KINASE TOTAL",33,14.49,5.94,73.12,8.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 82553","BLUE CROSS","BLUE CROSS-PPO","CPT","82553","HC CHG CREATINE KINASE MB FRACTION ONLY","82553 - HC CHG CREATINE KINASE MB FRACTION ONLY",38,26.35,10.54,129.69,9.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 82553","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","82553","HC CHG CREATINE KINASE MB FRACTION ONLY","82553 - HC CHG CREATINE KINASE MB FRACTION ONLY",38,27.02,10.54,129.69,9.5]
["FALLON - FALLON MEDICAID - CPT - 82565","FALLON","FALLON MEDICAID","CPT","82565","HC CHG CREATININE BLOOD","82565 - HC CHG CREATININE BLOOD",26,4.68,4.68,57.51,6.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82570","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","82570","HC CHG CREATININE OTHER SOURCE","82570 - HC CHG CREATININE OTHER SOURCE",26,7.51,4.72,58.08,6.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 82575","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","82575","HC CHG CREATININE CLEARANCE","82575 - HC CHG CREATININE CLEARANCE",48,21.08,8.6199999999999992,106.17,12]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 82585","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","82585","HC CHG ASSAY OF CRYOFIBRN","82585 - HC CHG ASSAY OF CRYOFIBRN",29,7.96,7.96,137.13999999999999,7.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 82595","BLUE CROSS","BLUE CROSS-PPO","CPT","82595","HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE","82595 - HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE",33,14.49,5.9,72.55,8.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 82607","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","82607","HC CHG CYANOCOBALAMIN VITAMIN B-12","82607 - HC CHG CYANOCOBALAMIN VITAMIN B-12",75,16.22,13.75,169.26,18.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 82607","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","82607","HC CHG CYANOCOBALAMIN VITAMIN B-12","82607 - HC CHG CYANOCOBALAMIN VITAMIN B-12",75,31.76,13.75,169.26,18.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82626","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","82626","HC CHG DEHYDROEPIANDROSTERONE","82626 - HC CHG DEHYDROEPIANDROSTERONE",122,36.64,23.05,283.74,30.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 82627","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","82627","HC CHG DEHYDROEPIANDROSTERONE-SULFATE","82627 - HC CHG DEHYDROEPIANDROSTERONE-SULFATE",110,50.07,20.28,249.67,27.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82627","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","82627","HC CHG DEHYDROEPIANDROSTERONE-SULFATE","82627 - HC CHG DEHYDROEPIANDROSTERONE-SULFATE",110,32.229999999999997,20.28,249.67,27.5]
["UNICARE - UNICARE - CPT - 82652","UNICARE","UNICARE","CPT","82652","HC CHG 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED","82652 - HC CHG 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED",191,93.43,35.119999999999997,432.18,47.75]
["FALLON - FALLON MEDICAID - CPT - 82656","FALLON","FALLON MEDICAID","CPT","82656","HC CHG ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN","82656 - HC CHG ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN",55,10.52,10.52,129.47999999999999,13.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 82657","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","82657","HC CHG NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA","82657 - HC CHG NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA",1263,40.85,16.47,215.03,315.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 82668","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","82668","HC CHG ASSAY OF ERYTHROPOIETIN","82668 - HC CHG ASSAY OF ERYTHROPOIETIN",91,42.16,17.14,210.99,22.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 82670","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","82670","HC CHG ASSAY OF ESTRADIOL","82670 - HC CHG ASSAY OF ESTRADIOL",139,32.97,25.48,313.62,34.75]
["TUFTS - TUFTS POS - CPT - 82670","TUFTS","TUFTS POS","CPT","82670","HC CHG ASSAY OF ESTRADIOL","82670 - HC CHG ASSAY OF ESTRADIOL",139,104.3,25.48,313.62,34.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 82693","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","82693","HC CHG ASSAY OF ETHYLENE GLYCOL","82693 - HC CHG ASSAY OF ETHYLENE GLYCOL",72,16.04,13.59,167.3,18]
["FALLON - FALLON MEDICAID - CPT - 82693","FALLON","FALLON MEDICAID","CPT","82693","HC CHG ASSAY OF ETHYLENE GLYCOL","82693 - HC CHG ASSAY OF ETHYLENE GLYCOL",72,13.59,13.59,167.3,18]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 82705","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","82705","HC CHG FAT/LIPIDS FECES QUALITATIVE","82705 - HC CHG FAT/LIPIDS FECES QUALITATIVE",25,11.2,4.6500000000000004,57.22,6.25]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 82728","BMC HEALTHNET","BMCHN MEDICAID","CPT","82728","HC CHG ASSAY OF FERRITIN","82728 - HC CHG ASSAY OF FERRITIN",67,12.43,12.43,153.04,16.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 82731","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","82731","HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN","82731 - HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN",318,76,28.7,723.09,79.5]
["TUFTS - TUFTS POS - CPT - 82731","TUFTS","TUFTS POS","CPT","82731","HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN","82731 - HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN",318,240.5,28.7,723.09,79.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 82746","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","82746","HC CHG ASSAY OF FOLIC ACID SERUM","82746 - HC CHG ASSAY OF FOLIC ACID SERUM",73,14.7,13.41,165.06,18.25]
["FALLON - FALLON MEDICAID - CPT - 82747","FALLON","FALLON MEDICAID","CPT","82747","HC CHG ASSAY OF FOLIC ACID RBC","82747 - HC CHG ASSAY OF FOLIC ACID RBC",76,15.8,15.8,194.37,19]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 82784","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","82784","HC CHG ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH","82784 - HC CHG ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH",37,21.08,8.48,104.38,9.25]
["BMC HEALTHNET - BMCHN QHP - CPT - 82785","BMC HEALTHNET","BMCHN QHP","CPT","82785","HC CHG ASSAY OF GAMMAGLOBULIN IGE","82785 - HC CHG ASSAY OF GAMMAGLOBULIN IGE",82,18.010000000000002,15.01,184.75,20.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 82787","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","82787","HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES","82787 - HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES",19,9.4600000000000009,5.07,89.99,4.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 82787","BMC HEALTHNET","BMCHN QHP","CPT","82787","HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES","82787 - HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES",19,8.77,5.07,89.99,4.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 82803","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","82803","HC CHG BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3","82803 - HC CHG BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3",97,30.76,19.260000000000002,252.81,24.25]
["FALLON - FALLON MEDICAID - CPT - 82805","FALLON","FALLON MEDICAID","CPT","82805","HC CHG GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY","82805 - HC CHG GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY",141,58.2,38.92,764.01,35.25]
["BMC HEALTHNET - BMCHN ACO - CPT - 82810","BMC HEALTHNET","BMCHN ACO","CPT","82810","HC BLOOD GASSES O2 SAT ONLY","82810 - HC BLOOD GASSES O2 SAT ONLY",52,17.420000000000002,7.96,98.14,13]
["FALLON - FALLON MEDICAID - CPT - 82810","FALLON","FALLON MEDICAID","CPT","82810","HC BLOOD GASSES O2 SAT ONLY","82810 - HC BLOOD GASSES O2 SAT ONLY",52,7.96,7.96,98.14,13]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82941","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","82941","HC CHG ASSAY OF GASTRIN","82941 - HC CHG ASSAY OF GASTRIN",85,25.56,16.079999999999998,197.91,21.25]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 82945","CIGNA HEALTHCARE","CIGNA PPO","CPT","82945","HC CHG GLUCOSE BODY FLUID OTHER THAN BLOOD","82945 - HC CHG GLUCOSE BODY FLUID OTHER THAN BLOOD",21,9.98,3.58,44.06,5.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 82947","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","82947","HC CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP","82947 - HC CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP",21,4.6399999999999997,3.58,44.06,5.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 82950","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","82950","HC CHG GLUCOSE POST GLUCOSE DOSE","82950 - HC CHG GLUCOSE POST GLUCOSE DOSE",25,11.95,4.33,53.31,6.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 82950","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT","82950","HC CHG GLUCOSE POST GLUCOSE DOSE","82950 - HC CHG GLUCOSE POST GLUCOSE DOSE",25,6.55,4.33,53.31,6.25]
["FALLON - FALLON MEDICAID - CPT - 82951","FALLON","FALLON MEDICAID","CPT","82951","HC CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS","82951 - HC CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS",64,11.74,11.74,144.52000000000001,16]
["BMC HEALTHNET - BMCHN MCO - CPT - 82952","BMC HEALTHNET","BMCHN MCO","CPT","82952","HC CHG GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS","82952 - HC CHG GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS",15,3.58,3.58,43.98,3.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 82960","BMC HEALTHNET","BMCHN QHP","CPT","82960","HC CHG GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN","82960 - HC CHG GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN",29,6.62,5.52,67.86,7.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82960","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","82960","HC CHG GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN","82960 - HC CHG GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN",29,8.77,5.52,67.86,7.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 82977","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","82977","HC CHG ASSAY OF GGT","82977 - HC CHG ASSAY OF GGT",36,16.47,6.57,80.86,9]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 82977","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT","82977","HC CHG ASSAY OF GGT","82977 - HC CHG ASSAY OF GGT",36,9.93,6.57,80.86,9]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 82985","BLUE CROSS","BLUE CROSS-PPO","CPT","82985","HC CHG ASSAY OF GLYCATED PROTEIN","82985 - HC CHG ASSAY OF GLYCATED PROTEIN",73,34.26,13.75,169.26,18.25]
["CIGNA HEALTHCARE - CIGNA - CPT - 83001","CIGNA HEALTHCARE","CIGNA","CPT","83001","HC CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE","83001 - HC CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE",93,83.75,16.95,208.59,23.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 83001","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","83001","HC CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE","83001 - HC CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE",93,39.130000000000003,16.95,208.59,23.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 83002","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","83002","HC CHG GONADOTROPIN LUTEINIZING HORMONE","83002 - HC CHG GONADOTROPIN LUTEINIZING HORMONE",93,26.85,16.89,207.81,23.25]
["FALLON - FALLON MEDICAID - CPT - 83003","FALLON","FALLON MEDICAID","CPT","83003","HC CHG ASSAY OF GROWTH HORMONE HUMAN","83003 - HC CHG ASSAY OF GROWTH HORMONE HUMAN",81,15.21,15.21,187.11,20.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 83010","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","83010","HC CHG ASSAY OF HAPTOGLOBIN, QUANT","83010 - HC CHG ASSAY OF HAPTOGLOBIN, QUANT",63,17.25,11.47,141.18,15.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 83013","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","83013","HC H PYLORI (C-13) BREATH","83013 - HC H PYLORI (C-13) BREATH",180,148.86000000000001,61.44,756.15,45]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 83013","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT","83013","HC H PYLORI (C-13) BREATH","83013 - HC H PYLORI (C-13) BREATH",180,92.9,61.44,756.15,45]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 83014","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","83014","HC H PYLORI DRUG ADMIN","83014 - HC H PYLORI DRUG ADMIN",40,16.55,7.17,88.24,10]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 83020","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","83020","HC CHG HEMOGLOBIN ELECTROPHORESIS","83020 - HC CHG HEMOGLOBIN ELECTROPHORESIS",63,144.52000000000001,11.74,144.52000000000001,15.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 83021","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","83021","HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY","83021 - HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY",91,19.39,16.47,202.68,22.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 83030","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","83030","HC CHG HEMOGLOBIN F FETAL CHEMICAL","83030 - HC CHG HEMOGLOBIN F FETAL CHEMICAL",42,11.34,7.94,104.21,10.5]
["BMC HEALTHNET - BMCHN QHP - CPT - 83036","BMC HEALTHNET","BMCHN QHP","CPT","83036","HEMOGLOBIN GLYCOSYLATED A1C","83036 - HEMOGLOBIN GLYCOSYLATED A1C",49,10.63,8.86,109.06,12.25]
["BMC HEALTHNET - BMCHN MCO - CPT - 83050","BMC HEALTHNET","BMCHN MCO","CPT","83050","HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE","83050 - HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE",37,6.69,6.69,82.45,9.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 83050","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","83050","HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE","83050 - HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE",37,17.27,6.69,82.45,9.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 83070","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","83070","HC CHG ASSAY OF HEMOSIDERIN QUALITATIVE","83070 - HC CHG ASSAY OF HEMOSIDERIN QUALITATIVE",25,10.26,4.33,53.31,6.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 83070","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","83070","HC CHG ASSAY OF HEMOSIDERIN QUALITATIVE","83070 - HC CHG ASSAY OF HEMOSIDERIN QUALITATIVE",25,10,4.33,53.31,6.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 83497","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","83497","HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA","83497 - HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA",62,28.98,11.76,144.81,15.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 83497","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","83497","HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA","83497 - HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA",62,13.84,11.76,144.81,15.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 83498","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","83498","HC CHG ASSAY OF HYDROXYPROGESTERONE 17-D","83498 - HC CHG ASSAY OF HYDROXYPROGESTERONE 17-D",130,37.270000000000003,24.78,305.02,32.5]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 83516","BMC HEALTHNET","BMCHN WELL SENSE","CPT","83516","HC CRL;TTG AB,IGA","83516 - HC CRL;TTG AB,IGA",55,22.66,10.52,129.47999999999999,13.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 83519","BMC HEALTHNET","BMCHN MCO","CPT","83519","HC CHG IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","83519 - HC CHG IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY",115,13.59,13.59,178.43,28.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 83519","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","83519","HC CHG IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","83519 - HC CHG IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY",115,38.75,13.59,178.43,28.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 83520","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","83520","HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE","83520 - HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE",63,30.05,12.76,167.51,15.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 83525","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","83525","HC CHG ASSAY OF INSULIN TOTAL","83525 - HC CHG ASSAY OF INSULIN TOTAL",57,12.28,10.43,128.30000000000001,14.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 83540","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","83540","HC CHG ASSAY OF IRON","83540 - HC CHG ASSAY OF IRON",33,8.8800000000000008,5.9,72.63,8.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 83550","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","83550","HC CHG IRON BINDING CAPACITY","83550 - HC CHG IRON BINDING CAPACITY",44,20.96,7.97,98.14,11]
["BMC HEALTHNET - BMCHN MCO - CPT - 83605","BMC HEALTHNET","BMCHN MCO","CPT","83605","HC CHG ASSAY OF LACTATE","83605 - HC CHG ASSAY OF LACTATE",54,9.75,9.75,119.99,13.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 83605","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","83605","HC CHG ASSAY OF LACTATE","83605 - HC CHG ASSAY OF LACTATE",54,24.37,9.75,119.99,13.5]
["TUFTS - TUFTS POS - CPT - 83615","TUFTS","TUFTS POS","CPT","83615","HC CHG LACTATE DEHYDROGENASE LDH","83615 - HC CHG LACTATE DEHYDROGENASE LDH",31,22.55,5.5,67.78,7.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 83630","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT","83630","HC CHG LACTOFERRIN FECAL QUALITATIVE","83630 - HC CHG LACTOFERRIN FECAL QUALITATIVE",112,27.08,17.91,220.45,28]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 83655","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","83655","HC CHG ASSAY OF LEAD","83655 - HC CHG ASSAY OF LEAD",58,16.61,11.05,135.91999999999999,14.5]
["TUFTS - TUFTS HMO - CPT - 83662","TUFTS","TUFTS HMO","CPT","83662","HC L/S RATIO, FOAM STABILITY","83662 - HC L/S RATIO, FOAM STABILITY",31,84.74,17.25,212.3,7.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 83690","BMC HEALTHNET","BMCHN QHP","CPT","83690","HC CHG ASSAY OF LIPASE","83690 - HC CHG ASSAY OF LIPASE",35,7.55,6.29,77.400000000000006,8.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 83690","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","83690","HC CHG ASSAY OF LIPASE","83690 - HC CHG ASSAY OF LIPASE",35,11.99,6.29,77.400000000000006,8.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 83695","BMC HEALTHNET","BMCHN QHP","CPT","83695","HC CHG LIPOPROTEIN (A)","83695 - HC CHG LIPOPROTEIN (A)",63,14.17,11.81,145.38,15.75]
["FALLON - FALLON MEDICAID - CPT - 83718","FALLON","FALLON MEDICAID","CPT","83718","HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL","83718 - HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL",41,7.48,7.48,91.95,10.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 83721","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","83721","HC CRL;DIRECT LDL","83721 - HC CRL;DIRECT LDL",44,22.67,8.6999999999999993,107.11,11]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 83721","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","83721","HC CRL;DIRECT LDL","83721 - HC CRL;DIRECT LDL",44,12.6,8.6999999999999993,107.11,11]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 83785","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","83785","HC CHG, ASSAY OF MANGANESE","83785 - HC CHG, ASSAY OF MANGANESE",109,31.45,22.44,276.16000000000003,27.25]
["TUFTS - TUFTS SELECT - CPT - 83785","TUFTS","TUFTS SELECT","CPT","83785","HC CHG, ASSAY OF MANGANESE","83785 - HC CHG, ASSAY OF MANGANESE",109,42.89,22.44,276.16000000000003,27.25]
["CIGNA HEALTHCARE - CIGNA - CPT - 83789","CIGNA HEALTHCARE","CIGNA","CPT","83789","HC CHG MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA","83789 - HC CHG MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA",91,81.39,17.809999999999999,233.86,22.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 83825","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","83825","HC CHG ASSAY OF MERCURY QUANTITATIVE","83825 - HC CHG ASSAY OF MERCURY QUANTITATIVE",80,22.3,14.83,182.55,20]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 83835","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","83835","HC CHG METANEPHRINES","83835 - HC CHG METANEPHRINES",83,38.200000000000003,15.46,190.17,20.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 83873","BMC HEALTHNET","BMCHN QHP","CPT","83873","HC CHG MYELIN BASIC PROTEIN CEREBROSPINAL FLUID","83873 - HC CHG MYELIN BASIC PROTEIN CEREBROSPINAL FLUID",84,18.829999999999998,15.69,193.18,21]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 83873","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","83873","HC CHG MYELIN BASIC PROTEIN CEREBROSPINAL FLUID","83873 - HC CHG MYELIN BASIC PROTEIN CEREBROSPINAL FLUID",84,29.93,15.69,193.18,21]
["TUFTS - TUFTS MEDICARE SCO - CPT - 83874","TUFTS","TUFTS MEDICARE SCO","CPT","83874","HC CHG MYOGLOBIN","83874 - HC CHG MYOGLOBIN",62,18.73,11.78,145.01,15.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 83880","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","83880","HC CHG NATRIURETIC PEPTIDE","83880 - HC CHG NATRIURETIC PEPTIDE",169,46.33,30.96,384.74,42.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 83883","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","83883","HC NEPHELOMETRY, EACH ANALYTE","83883 - HC NEPHELOMETRY, EACH ANALYTE",57,29.36,12.41,152.63,14.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 83915","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","83915","HC CHG ASSAY OF NUCLEOTIDASE 5'-","83915 - HC CHG ASSAY OF NUCLEOTIDASE 5'-",54,25.04,10.17,125.2,13.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 83915","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","83915","HC CHG ASSAY OF NUCLEOTIDASE 5'-","83915 - HC CHG ASSAY OF NUCLEOTIDASE 5'-",54,26.75,10.17,125.2,13.5]
["TUFTS - TUFTS SELECT - CPT - 83916","TUFTS","TUFTS SELECT","CPT","83916","HC CHG OLIGOCLONAL IMMUNE","83916 - HC CHG OLIGOCLONAL IMMUNE",97,41.25,20.239999999999998,265.61,24.25]
["CIGNA HEALTHCARE - CIGNA - CPT - 83918","CIGNA HEALTHCARE","CIGNA","CPT","83918","HC CHG ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN","83918 - HC CHG ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN",62,74.180000000000007,17.440000000000001,228.93,15.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 83921","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","83921","HC CHG ORGANIC ACID 1 QUANTITATIVE","83921 - HC CHG ORGANIC ACID 1 QUANTITATIVE",80,21.26,15.67,205.7,20]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 83921","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","83921","HC CHG ORGANIC ACID 1 QUANTITATIVE","83921 - HC CHG ORGANIC ACID 1 QUANTITATIVE",80,25.45,15.67,205.7,20]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 83930","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","83930","HC Q;OSMOLALITY,SER","83930 - HC Q;OSMOLALITY,SER",33,7.93,6.03,74.22,8.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 83935","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","83935","HC CHG ASSAY OF OSMOLALITY URINE","83935 - HC CHG ASSAY OF OSMOLALITY URINE",34,11.87,6.22,76.540000000000006,8.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 83937","TUFTS","TUFTS MEDICARE SCO","CPT","83937","HC CHG ASSAY OF OSTEOCALCIN","83937 - HC CHG ASSAY OF OSTEOCALCIN",143,43.28,27.23,335.1,35.75]
["CIGNA HEALTHCARE - CIGNA - CPT - 83945","CIGNA HEALTHCARE","CIGNA","CPT","83945","HC CHG ASSAY OF OXALATE","83945 - HC CHG ASSAY OF OXALATE",62,58.04,11.74,144.81,15.5]
["TUFTS - TUFTS SPIRIT - CPT - 83945","TUFTS","TUFTS SPIRIT","CPT","83945","HC CHG ASSAY OF OXALATE","83945 - HC CHG ASSAY OF OXALATE",62,15.9,11.74,144.81,15.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 83986","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","83986","HC CHG PH BODY FLUID NOT ELSEWHERE SPECIFIED","83986 - HC CHG PH BODY FLUID NOT ELSEWHERE SPECIFIED",20,7.9,3.27,40.229999999999997,5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 83986","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","83986","HC CHG PH BODY FLUID NOT ELSEWHERE SPECIFIED","83986 - HC CHG PH BODY FLUID NOT ELSEWHERE SPECIFIED",20,4.3,3.27,40.229999999999997,5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 83993","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","83993","HC CHG ASSAY OF CALPROTECTIN FECAL","83993 - HC CHG ASSAY OF CALPROTECTIN FECAL",95,21.13,17.91,220.45,23.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 84075","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","84075","HC CHG ASSAY OF PHOSPHATASE ALKALINE","84075 - HC CHG ASSAY OF PHOSPHATASE ALKALINE",26,6.41,4.72,58.08,6.5]
["TUFTS - TUFTS SELECT - CPT - 84075","TUFTS","TUFTS SELECT","CPT","84075","HC CHG ASSAY OF PHOSPHATASE ALKALINE","84075 - HC CHG ASSAY OF PHOSPHATASE ALKALINE",26,9.02,4.72,58.08,6.5]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 84080","BMC HEALTHNET","BMCHN WELL SENSE","CPT","84080","HC CHG ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES","84080 - HC CHG ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES",71,29.23,13.48,166,17.75]
["TUFTS - TUFTS SELECT - CPT - 84080","TUFTS","TUFTS SELECT","CPT","84080","HC CHG ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES","84080 - HC CHG ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES",71,25.78,13.48,166,17.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 84100","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","84100","HC CHG ASSAY OF PHOSPHORUS INORGANIC","84100 - HC CHG ASSAY OF PHOSPHORUS INORGANIC",25,11.1,4.32,53.23,6.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 84105","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","84105","HC CHG ASSAY OF PHOSPHORUS INORGANIC URINE","84105 - HC CHG ASSAY OF PHOSPHORUS INORGANIC URINE",26,12.48,4.72,58.16,6.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 84132","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","84132","HC CHG POTASSIUM SERUM PLASMA/WHOLE BLOOD","84132 - HC CHG POTASSIUM SERUM PLASMA/WHOLE BLOOD",24,10.52,4.2,51.64,6]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 84133","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","84133","HC CHG POTASSIUM URINE","84133 - HC CHG POTASSIUM URINE",23,9.8800000000000008,3.93,48.38,5.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 84134","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","84134","HC CHG PREALBUMIN","84134 - HC CHG PREALBUMIN",72,18.059999999999999,13.31,163.76,18]
["TUFTS - TUFTS SELECT - CPT - 84134","TUFTS","TUFTS SELECT","CPT","84134","HC CHG PREALBUMIN","84134 - HC CHG PREALBUMIN",72,25.43,13.31,163.76,18]
["CIGNA HEALTHCARE - CIGNA - CPT - 84144","CIGNA HEALTHCARE","CIGNA","CPT","84144","HC CHG ASSAY OF PROGESTERONE","84144 - HC CHG ASSAY OF PROGESTERONE",104,93.98,19.03,234.27,26]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 84145","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","84145","HC CHG PROCALCITONIN (PCT)","84145 - HC CHG PROCALCITONIN (PCT)",99,58.77,24.44,300.82,24.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 84146","BMC HEALTHNET","BMCHN MCO","CPT","84146","HC CHG ASSAY OF PROLACTIN","84146 - HC CHG ASSAY OF PROLACTIN",97,17.670000000000002,17.670000000000002,217.56,24.25]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 84153","BMC HEALTHNET","BMCHN WELL SENSE","CPT","84153","HC CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL","84153 - HC CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL",93,28.68,16.78,206.51,23.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84155","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","84155","HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD","84155 - HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD",20,8.57,3.35,41.16,5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 84155","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","84155","HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD","84155 - HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD",20,3.67,3.35,41.16,5]
["FALLON - FALLON SENIOR PLAN - CPT - 84156","FALLON","FALLON SENIOR PLAN","CPT","84156","HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY URINE","84156 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY URINE",20,3.67,3.35,41.16,5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 84157","TUFTS","TUFTS MEDICARE SCO","CPT","84157","HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC","84157 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC",20,5.8,3.35,41.16,5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 84163","BMC HEALTHNET","BMCHN MEDICAID","CPT","84163","HC CHG PREGNANCY-ASSOCIATED PLASMA PROTEIN-A","84163 - HC CHG PREGNANCY-ASSOCIATED PLASMA PROTEIN-A",72,13.74,13.74,169.1,18]
["FALLON - FALLON SENIOR PLAN - CPT - 84165","FALLON","FALLON SENIOR PLAN","CPT","84165","HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM","84165 - HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM",63,10.74,9.8000000000000007,120.52,15.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 84166","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","84166","HC CHG PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI","84166 - HC CHG PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI",99,34.94,16.260000000000002,200.15,24.75]
["FALLON - FALLON SENIOR PLAN - CPT - 84166","FALLON","FALLON SENIOR PLAN","CPT","84166","HC CHG PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI","84166 - HC CHG PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI",99,17.829999999999998,16.260000000000002,200.15,24.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 84182","BMC HEALTHNET","BMCHN ACO","CPT","84182","HC CHG PROTEIN, WESTERN BLOT TEST, W BAND","84182 - HC CHG PROTEIN, WESTERN BLOT TEST, W BAND",264,47.22,21.58,283.38,66]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 84202","CIGNA HEALTHCARE","CIGNA PPO","CPT","84202","HC Q;ERYTH PROTPOR","84202 - HC Q;ERYTH PROTPOR",23,36.479999999999997,13.09,161.07,5.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 84206","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","84206","HC CHG ASSAY OF PROINSULIN","84206 - HC CHG ASSAY OF PROINSULIN",86,24.43,19.72,258.88,21.5]
["TUFTS - TUFTS SPIRIT - CPT - 84206","TUFTS","TUFTS SPIRIT","CPT","84206","HC CHG ASSAY OF PROINSULIN","84206 - HC CHG ASSAY OF PROINSULIN",86,29.36,19.72,258.88,21.5]
["UNICARE - UNICARE - CPT - 84207","UNICARE","UNICARE","CPT","84207","HC CHG ASSAY OF PYRIDOXAL PHOSPHATE","84207 - HC CHG ASSAY OF PYRIDOXAL PHOSPHATE",130,65.95,25.63,315.49,32.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 84210","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","84210","HC CHG ASSAY OF PYRUVATE","84210 - HC CHG ASSAY OF PYRUVATE",53,25.2,10.7,140.4,13.25]
["TUFTS - TUFTS PPO - CPT - 84244","TUFTS","TUFTS PPO","CPT","84244","HC CHG ASSAY OF RENIN","84244 - HC CHG ASSAY OF RENIN",106,87.83,20.059999999999999,246.86,26.5]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 84255","BMC HEALTHNET","BMCHN WELL SENSE","CPT","84255","HC CHG ASSAY OF SELENIUM","84255 - HC CHG ASSAY OF SELENIUM",123,50.46,23.29,286.64,30.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 84270","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","84270","HC CHG ASSAY OF SEX HORMONE BINDING GLOBULIN","84270 - HC CHG ASSAY OF SEX HORMONE BINDING GLOBULIN",105,48.75,19.82,243.97,26.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 84295","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","84295","HC CHG SODIUM SERUM PLASMA OR WHOLE BLOOD","84295 - HC CHG SODIUM SERUM PLASMA OR WHOLE BLOOD",25,10.55,4.3899999999999997,54.04,6.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 84295","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT","84295","HC CHG SODIUM SERUM PLASMA OR WHOLE BLOOD","84295 - HC CHG SODIUM SERUM PLASMA OR WHOLE BLOOD",25,4.8099999999999996,4.3899999999999997,54.04,6.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 84300","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","84300","HC CHG ASSAY OF URINE SODIUM","84300 - HC CHG ASSAY OF URINE SODIUM",25,11.66,4.43,54.53,6.25]
["UNICARE - UNICARE - CPT - 84300","UNICARE","UNICARE","CPT","84300","HC CHG ASSAY OF URINE SODIUM","84300 - HC CHG ASSAY OF URINE SODIUM",25,11.8,4.43,54.53,6.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 84305","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","84305","HC CHG ASSAY OF SOMATOMEDIN","84305 - HC CHG ASSAY OF SOMATOMEDIN",82,23.18,19.399999999999999,238.75,20.5]
["TUFTS - TUFTS SPIRIT - CPT - 84305","TUFTS","TUFTS SPIRIT","CPT","84305","HC CHG ASSAY OF SOMATOMEDIN","84305 - HC CHG ASSAY OF SOMATOMEDIN",82,23.39,19.399999999999999,238.75,20.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 84307","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","84307","HC CHG ASSAY OF SOMATOSTATIN","84307 - HC CHG ASSAY OF SOMATOSTATIN",515,18.28,16.670000000000002,205.12,128.75]
["TUFTS - TUFTS HMO - CPT - 84311","TUFTS","TUFTS HMO","CPT","84311","HC CHG SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED","84311 - HC CHG SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED",32,31.63,6.38,79.27,8]
["BMC HEALTHNET - BMCHN MCO - CPT - 84376","BMC HEALTHNET","BMCHN MCO","CPT","84376","HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC","84376 - HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC",27,5.0199999999999996,5.0199999999999996,61.7,6.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 84376","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","84376","HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC","84376 - HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC",27,11.58,5.0199999999999996,61.7,6.75]
["UNICARE - UNICARE - CPT - 84402","UNICARE","UNICARE","CPT","84402","HC CHG ASSAY OF TESTOSTERONE FREE","84402 - HC CHG ASSAY OF TESTOSTERONE FREE",123,61.8,23.24,285.98,30.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 84403","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","84403","HC CHG ASSAY OF TESTOSTERONE TOTAL","84403 - HC CHG ASSAY OF TESTOSTERONE TOTAL",124,27.72,23.55,289.82,31]
["FALLON - FALLON MEDICAID - CPT - 84425","FALLON","FALLON MEDICAID","CPT","84425","HC CHG ASSAY OF THIAMINE-VITAMIN B-1","84425 - HC CHG ASSAY OF THIAMINE-VITAMIN B-1",102,19.37,19.37,238.34,25.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 84430","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","84430","HC CHG ASSAY OF THIOCYANATE","84430 - HC CHG ASSAY OF THIOCYANATE",58,25.11,10.61,130.62,14.5]
["BMC HEALTHNET - BMCHN MCO - CPT - 84432","BMC HEALTHNET","BMCHN MCO","CPT","84432","HC CHG ASSAY OF THYROGLOBULIN","84432 - HC CHG ASSAY OF THYROGLOBULIN",79,14.65,14.65,180.3,19.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 84432","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","84432","HC CHG ASSAY OF THYROGLOBULIN","84432 - HC CHG ASSAY OF THYROGLOBULIN",79,23.29,14.65,180.3,19.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84439","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","84439","HC CHG ASSAY OF FREE THYROXINE","84439 - HC CHG ASSAY OF FREE THYROXINE",46,20.420000000000002,8.2200000000000006,101.2,11.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 84439","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","84439","HC CHG ASSAY OF FREE THYROXINE","84439 - HC CHG ASSAY OF FREE THYROXINE",46,9.67,8.2200000000000006,101.2,11.5]
["TUFTS - TUFTS PPO - CPT - 84442","TUFTS","TUFTS PPO","CPT","84442","HC CHG ASSAY OF THYROXINE BNDNG GLOBULIN","84442 - HC CHG ASSAY OF THYROXINE BNDNG GLOBULIN",92,59.06,13.48,166,23]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 84443","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","84443","HC CHG ASSAY OF THYROID STIMULATING HORMONE TSH","84443 - HC CHG ASSAY OF THYROID STIMULATING HORMONE TSH",84,36.270000000000003,15.33,188.7,21]
["BMC HEALTHNET - BMCHN MCO - CPT - 84445","BMC HEALTHNET","BMCHN MCO","CPT","84445","HC CHG THYROID STIMULATING IMMUNE GLOBULINS TSI","84445 - HC CHG THYROID STIMULATING IMMUNE GLOBULINS TSI",244,46.39,46.39,570.91,61]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 84445","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","84445","HC CHG THYROID STIMULATING IMMUNE GLOBULINS TSI","84445 - HC CHG THYROID STIMULATING IMMUNE GLOBULINS TSI",244,61.03,46.39,570.91,61]
["BMC HEALTHNET - BMCHN MCO - CPT - 84446","BMC HEALTHNET","BMCHN MCO","CPT","84446","HC CHG ASSAY OF TOCOPHEROL ALPHA VITAMIN E","84446 - HC CHG ASSAY OF TOCOPHEROL ALPHA VITAMIN E",69,12.94,12.94,159.19,17.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 84450","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","84450","HC CHG TRANSFERASE ASPARTATE AMINO AST SGOT","84450 - HC CHG TRANSFERASE ASPARTATE AMINO AST SGOT",26,7.1,4.72,58.08,6.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84460","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","84460","HC CHG TRANSFERASE ALANINE AMINO (ALT) (SGPT)","84460 - HC CHG TRANSFERASE ALANINE AMINO (ALT) (SGPT)",27,11.86,4.83,59.46,6.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 84460","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","84460","HC CHG TRANSFERASE ALANINE AMINO (ALT) (SGPT)","84460 - HC CHG TRANSFERASE ALANINE AMINO (ALT) (SGPT)",27,5.68,4.83,59.46,6.75]
["TUFTS - TUFTS SELECT - CPT - 84466","TUFTS","TUFTS SELECT","CPT","84466","HC CHG ASSAY OF L7383TRANSFERRIN","84466 - HC CHG ASSAY OF L7383TRANSFERRIN",64,22.26,11.64,143.30000000000001,16]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 84478","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","84478","HC CHG ASSAY OF TRIGLYCERIDES","84478 - HC CHG ASSAY OF TRIGLYCERIDES",29,12.39,5.24,64.44,7.25]
["BMC HEALTHNET - BMCHN MCO - CPT - 84479","BMC HEALTHNET","BMCHN MCO","CPT","84479","HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO","84479 - HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO",33,5.9,5.9,72.55,8.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 84479","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","84479","HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO","84479 - HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO",33,7.76,5.9,72.55,8.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84481","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","84481","HC CHG ASSAY OF TRIIODOTHYRONINE T3 FREE","84481 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 FREE",83,38.200000000000003,15.46,190.17,20.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 84482","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","84482","HC CHG TRIIODOTHYRONINE T3 REVERSE","84482 - HC CHG TRIIODOTHYRONINE T3 REVERSE",73,34.83,14.38,176.92,18.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 84482","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT","84482","HC CHG TRIIODOTHYRONINE T3 REVERSE","84482 - HC CHG TRIIODOTHYRONINE T3 REVERSE",73,21.74,14.38,176.92,18.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 84484","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","84484","HC CHG ASSAY OF TROPONIN QUANTITATIVE","84484 - HC CHG ASSAY OF TROPONIN QUANTITATIVE",49,26.92,9.2100000000000009,120.92,12.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 84484","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","84484","HC CHG ASSAY OF TROPONIN QUANTITATIVE","84484 - HC CHG ASSAY OF TROPONIN QUANTITATIVE",49,19.91,9.2100000000000009,120.92,12.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 84520","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","84520","HC CHG ASSAY OF UREA NITROGEN QUANTITATIVE","84520 - HC CHG ASSAY OF UREA NITROGEN QUANTITATIVE",21,8.32,3.61,44.34,5.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84550","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","84550","HC CHG ASSAY OF BLOOD/URIC ACID","84550 - HC CHG ASSAY OF BLOOD/URIC ACID",24,9.8800000000000008,4.12,50.7,6]
["TUFTS - TUFTS POS - CPT - 84550","TUFTS","TUFTS POS","CPT","84550","HC CHG ASSAY OF BLOOD/URIC ACID","84550 - HC CHG ASSAY OF BLOOD/URIC ACID",24,16.86,4.12,50.7,6]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84560","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","84560","HC CHG ASSAY OF URIC ACID OTHER SOURCE","84560 - HC CHG ASSAY OF URIC ACID OTHER SOURCE",25,10.55,4.33,53.31,6.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 84590","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","84590","HC CHG ASSAY OF VITAMIN A","84590 - HC CHG ASSAY OF VITAMIN A",56,25.66,10.59,130.34,14]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 84590","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","84590","HC CHG ASSAY OF VITAMIN A","84590 - HC CHG ASSAY OF VITAMIN A",56,12.71,10.59,130.34,14]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 84591","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","84591","HC CHG ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED","84591 - HC CHG ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED",58,36.83,12.6,165.43,14.5]
["TUFTS - TUFTS SELECT - CPT - 84597","TUFTS","TUFTS SELECT","CPT","84597","HC CHG ASSAY OF VITAMIN K","84597 - HC CHG ASSAY OF VITAMIN K",149,23.93,12.52,154.06,37.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 84630","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","84630","HC CHG ASSAY OF ZINC","84630 - HC CHG ASSAY OF ZINC",55,12.23,10.39,127.81,13.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84681","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","84681","HC CHG ASSAY OF C-PEPTIDE","84681 - HC CHG ASSAY OF C-PEPTIDE",100,46.77,18.989999999999998,233.69,25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 84702","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","84702","HC HCG TUMOR MARKER","84702 - HC HCG TUMOR MARKER",75,33.26,13.74,169.1,18.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 84702","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","84702","HC HCG TUMOR MARKER","84702 - HC HCG TUMOR MARKER",75,30.45,13.74,169.1,18.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 85004","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","85004","HC AUTO DIFF","85004 - HC AUTO DIFF",22,8.01,5.9,72.55,5.5]
["TUFTS - TUFTS POS - CPT - 85004","TUFTS","TUFTS POS","CPT","85004","HC AUTO DIFF","85004 - HC AUTO DIFF",22,24.13,5.9,72.55,5.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 85014","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","85014","HC CHG BLOOD COUNT HEMATOCRIT","85014 - HC CHG BLOOD COUNT HEMATOCRIT",12,2.37,2.16,26.61,3]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 85018","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","85018","POC;HEMOGLOBIN","85018 - POC;HEMOGLOBIN",12,5.12,2.16,26.61,3]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 85018","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","85018","POC;HEMOGLOBIN","85018 - POC;HEMOGLOBIN",12,2.59,2.16,26.61,3]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 85025","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","85025","HC CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC","85025 - HC CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC",40,16.78,7.09,87.22,10]
["BMC HEALTHNET - BMCHN MCO - CPT - 85027","BMC HEALTHNET","BMCHN MCO","CPT","85027","HC CHG BLOOD COUNT COMPLETE AUTOMATED","85027 - HC CHG BLOOD COUNT COMPLETE AUTOMATED",33,5.9,5.9,72.55,8.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 85045","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","85045","HC CHG BLOOD COUNT RETICULOCYTE AUTOMATED","85045 - HC CHG BLOOD COUNT RETICULOCYTE AUTOMATED",22,4.28,3.64,44.83,5.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85046","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","85046","HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS","85046 - HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS",141,12.51,5.08,62.56,35.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 85046","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","85046","HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS","85046 - HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS",141,5.98,5.08,62.56,35.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 85048","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","85048","HC CHG BLOOD COUNT LEUKOCYTE WBC AUTOMATED","85048 - HC CHG BLOOD COUNT LEUKOCYTE WBC AUTOMATED",12,5.15,2.31,28.49,3]
["TUFTS - TUFTS HMO - CPT - 85049","TUFTS","TUFTS HMO","CPT","85049","HC CHG BLOOD COUNT PLATELET AUTOMATED","85049 - HC CHG BLOOD COUNT PLATELET AUTOMATED",23,20.04,4.09,50.21,5.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 85055","BMC HEALTHNET","BMCHN QHP","CPT","85055","HC CHG RETICULATED PLATELET ASSAY","85055 - HC CHG RETICULATED PLATELET ASSAY",141,31.69,15.07,346.67,35.25]
["CIGNA HEALTHCARE - CIGNA - CPT - 85060","CIGNA HEALTHCARE","CIGNA","CPT","85060","HC BL SMEAR W/O DIFF WBC COUNT","85060 - HC BL SMEAR W/O DIFF WBC COUNT",79,106.17,15.64,183.73,19.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 85210","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","85210","HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC","85210 - HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC",65,22.59,11.84,145.74,16.25]
["BMC HEALTHNET - BMCHN QHP - CPT - 85220","BMC HEALTHNET","BMCHN QHP","CPT","85220","HC CHG CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR","85220 - HC CHG CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR",90,19.32,16.100000000000001,198.11,22.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 85230","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","85230","HC CHG CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR","85230 - HC CHG CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR",91,17.899999999999999,16.329999999999998,200.93,22.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 85240","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","85240","HC CHG CLOTTING FACTOR VIII AHG 1 STAGE","85240 - HC CHG CLOTTING FACTOR VIII AHG 1 STAGE",91,40.18,16.329999999999998,200.93,22.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 85240","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","85240","HC CHG CLOTTING FACTOR VIII AHG 1 STAGE","85240 - HC CHG CLOTTING FACTOR VIII AHG 1 STAGE",91,38.65,16.329999999999998,200.93,22.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 85245","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","85245","HC CHG CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT","85245 - HC CHG CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT",180,46.41,20.92,257.5,45]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 85246","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","85246","HC CHG CLOTTING FACTOR VIII VW FACTOR ANTIGEN","85246 - HC CHG CLOTTING FACTOR VIII VW FACTOR ANTIGEN",200,39.92,20.92,257.5,50]
["FALLON - FALLON SENIOR PLAN - CPT - 85250","FALLON","FALLON SENIOR PLAN","CPT","85250","HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS","85250 - HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS",95,19.04,17.37,213.81,23.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 85250","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","85250","HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS","85250 - HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS",95,33.130000000000003,17.37,213.81,23.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 85270","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","85270","HC CHG CLOTTING FACTOR XI PTA","85270 - HC CHG CLOTTING FACTOR XI PTA",91,40.18,16.329999999999998,200.93,22.75]
["TUFTS - TUFTS MEDICARE SCO - CPT - 85270","TUFTS","TUFTS MEDICARE SCO","CPT","85270","HC CHG CLOTTING FACTOR XI PTA","85270 - HC CHG CLOTTING FACTOR XI PTA",91,25.95,16.329999999999998,200.93,22.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 85280","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","85280","HC CHG CLOTTING FACTOR XII HAGEMAN","85280 - HC CHG CLOTTING FACTOR XII HAGEMAN",97,43.48,17.649999999999999,217.27,24.25]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 85290","CIGNA HEALTHCARE","CIGNA PPO","CPT","85290","HC CHG CLOTTING FACTOR XIII FIBRIN STABILIZING","85290 - HC CHG CLOTTING FACTOR XIII FIBRIN STABILIZING",82,41.54,14.9,183.36,20.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 85290","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","85290","HC CHG CLOTTING FACTOR XIII FIBRIN STABILIZING","85290 - HC CHG CLOTTING FACTOR XIII FIBRIN STABILIZING",82,33.04,14.9,183.36,20.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 85300","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","85300","HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY","85300 - HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY",57,20.62,10.81,133.03,14.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 85301","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","85301","HC CHG CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY","85301 - HC CHG CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY",52,25.93,9.86,121.37,13]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 85302","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","85302","HC CHG CLOTTING INHIBITORS PROTEIN C ANTIGEN","85302 - HC CHG CLOTTING INHIBITORS PROTEIN C ANTIGEN",58,12.01,10.96,134.82,14.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 85303","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","85303","HC CHG CLOTTING INHIBITORS PROTEIN C ACTIVITY","85303 - HC CHG CLOTTING INHIBITORS PROTEIN C ACTIVITY",62,30.96,12.62,155.28,15.5]
["TUFTS - TUFTS POS - CPT - 85303","TUFTS","TUFTS POS","CPT","85303","HC CHG CLOTTING INHIBITORS PROTEIN C ACTIVITY","85303 - HC CHG CLOTTING INHIBITORS PROTEIN C ACTIVITY",62,51.63,12.62,155.28,15.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 85305","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","85305","HC CHG CLOTTING INHIBITORS PROTEIN S TOTAL","85305 - HC CHG CLOTTING INHIBITORS PROTEIN S TOTAL",56,23.45,10.59,130.34,14]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 85307","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","85307","HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY","85307 - HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY",69,34.26,13.98,172.07,17.25]
["TUFTS - TUFTS HMO - CPT - 85307","TUFTS","TUFTS HMO","CPT","85307","HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY","85307 - HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY",69,68.680000000000007,13.98,172.07,17.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 85347","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","85347","HC CHG COAGULATION TIME ACTIVATED","85347 - HC CHG COAGULATION TIME ACTIVATED",21,4.28,3.89,47.81,5.25]
["TUFTS - TUFTS SPIRIT - CPT - 85347","TUFTS","TUFTS SPIRIT","CPT","85347","HC CHG COAGULATION TIME ACTIVATED","85347 - HC CHG COAGULATION TIME ACTIVATED",21,4.71,3.89,47.81,5.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 85366","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","85366","HC CHG FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ","85366 - HC CHG FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ",38,69.97,10.33,780.44,9.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 85378","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","85378","HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN","85378 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN",36,20.99,7.18,94.31,9]
["FALLON - FALLON MEDICAID - CPT - 85379","FALLON","FALLON MEDICAID","CPT","85379","HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE","85379 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE",51,9.2799999999999994,9.2799999999999994,114.2,12.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 85379","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","85379","HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE","85379 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE",51,20.59,9.2799999999999994,114.2,12.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 85397","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","85397","HC CHG CLOTTING FUNCTION ACTIVITY NOS, EA ANALYT","85397 - HC CHG CLOTTING FUNCTION ACTIVITY NOS, EA ANALYT",207,56.65,22.8,299.31,51.75]
["TUFTS - TUFTS POS - CPT - 85397","TUFTS","TUFTS POS","CPT","85397","HC CHG CLOTTING FUNCTION ACTIVITY NOS, EA ANALYT","85397 - HC CHG CLOTTING FUNCTION ACTIVITY NOS, EA ANALYT",207,99.56,22.8,299.31,51.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 85461","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","85461","HC CHG HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE","85461 - HC CHG HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE",34,9.1,6.92,90.76,8.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 85520","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","85520","HC CHG HEPARIN ASSAY","85520 - HC CHG HEPARIN ASSAY",138,22.78,11.94,146.97,34.5]
["TUFTS - TUFTS HMO - CPT - 85549","TUFTS","TUFTS HMO","CPT","85549","HC CHG MURAMIDASE","85549 - HC CHG MURAMIDASE",91,84.02,17.100000000000001,210.55,22.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 85576","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","85576","HC CHG PLATELET AGGREGATION IN VITRO EACH AGENT","85576 - HC CHG PLATELET AGGREGATION IN VITRO EACH AGENT",311,24.91,19.59,243.68,77.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 85610","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","85610","POC;INR","85610 - POC;INR",21,8.57,3.58,44.06,5.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 85610","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","85610","POC;INR","85610 - POC;INR",21,4.21,3.58,44.06,5.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 85611","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","85611","HC CHG PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH","85611 - HC CHG PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH",21,7.98,3.6,44.26,5.25]
["FALLON - FALLON MEDICAID - CPT - 85613","FALLON","FALLON MEDICAID","CPT","85613","HC CHG RUSSELL VIPER VENOM DILUTED","85613 - HC CHG RUSSELL VIPER VENOM DILUTED",13,8.74,8.23,107.56,3.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 85613","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","85613","HC CHG RUSSELL VIPER VENOM DILUTED","85613 - HC CHG RUSSELL VIPER VENOM DILUTED",13,12.13,8.23,107.56,3.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 85651","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","85651","SEDIMENTATION RATE RBC NON-AUTOMATED","85651 - SEDIMENTATION RATE RBC NON-AUTOMATED",20,7.43,3.24,41.45,5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 85652","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","85652","HC CHG SEDIMENTATION RATE RBC AUTOMATED","85652 - HC CHG SEDIMENTATION RATE RBC AUTOMATED",14,3.92,2.46,30.24,3.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 85660","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","85660","HC CHG SICKLING RBC REDUCTION","85660 - HC CHG SICKLING RBC REDUCTION",28,5.51,5.0199999999999996,61.83,7]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 85670","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","85670","HC CHG THROMBIN TIME PLASMA","85670 - HC CHG THROMBIN TIME PLASMA",29,13.18,5.26,64.72,7.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 85705","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","85705","HC CHG THROMBOPLASTIN INHIBITION TISSUE","85705 - HC CHG THROMBOPLASTIN INHIBITION TISSUE",35,20.79,8.7899999999999991,108.13,8.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 85705","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","85705","HC CHG THROMBOPLASTIN INHIBITION TISSUE","85705 - HC CHG THROMBOPLASTIN INHIBITION TISSUE",35,14.15,8.7899999999999991,108.13,8.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 85730","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","85730","HC CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD","85730 - HC CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD",31,10.46,5.48,67.41,7.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 85732","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","85732","HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA","85732 - HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA",33,7.76,5.9,72.55,8.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 85810","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","85810","HC CHG VISCOSITY","85810 - HC CHG VISCOSITY",58,11.67,10.65,130.99,14.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 86003","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","86003","HC CHG ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN","86003 - HC CHG ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN",22,11.86,4.76,58.53,5.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 86021","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","86021","HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES","86021 - HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES",72,17.760000000000002,13.74,169.1,18]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 86021","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","86021","HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES","86021 - HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES",72,30.45,13.74,169.1,18]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 86022","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","86022","HC CRL;SEROTONIN RLS ASSAY","86022 - HC CRL;SEROTONIN RLS ASSAY",265,31.96,16.760000000000002,206.23,66.25]
["TUFTS - TUFTS SELECT - CPT - 86038","TUFTS","TUFTS SELECT","CPT","86038","HC CHG ANTINUCLEAR ANTIBODIES ANA","86038 - HC CHG ANTINUCLEAR ANTIBODIES ANA",175,21.07,11.02,135.68,43.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 86039","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","86039","HC CHG ANTINUCLEAR ANTIBODIES ANA TITER","86039 - HC CHG ANTINUCLEAR ANTIBODIES ANA TITER",170,11.16,10.18,125.28,42.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 86039","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","86039","HC CHG ANTINUCLEAR ANTIBODIES ANA TITER","86039 - HC CHG ANTINUCLEAR ANTIBODIES ANA TITER",170,13.39,10.18,125.28,42.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 86140","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","86140","C-REACTIVE PROTEIN","86140 - C-REACTIVE PROTEIN",106,11.45,4.72,58.08,26.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 86140","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","86140","C-REACTIVE PROTEIN","86140 - C-REACTIVE PROTEIN",106,10.48,4.72,58.08,26.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 86141","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT","86141","HC CRL;CARDIO CRP","86141 - HC CRL;CARDIO CRP",63,17.86,11.81,145.38,15.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 86141","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","86141","HC CRL;CARDIO CRP","86141 - HC CRL;CARDIO CRP",63,26.2,11.81,145.38,15.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 86147","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","86147","HC Q;CARDLIP AB;IGG,IGM,IGA","86147 - HC Q;CARDLIP AB;IGG,IGM,IGA",83,57.32,18.87,285.7,20.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 86147","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","86147","HC Q;CARDLIP AB;IGG,IGM,IGA","86147 - HC Q;CARDLIP AB;IGG,IGM,IGA",83,53.6,18.87,285.7,20.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 86157","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","86157","HC CHG COLD AGGLUTININ TITER","86157 - HC CHG COLD AGGLUTININ TITER",38,8.06,7.35,90.48,9.5]
["TUFTS - TUFTS POS - CPT - 86160","TUFTS","TUFTS POS","CPT","86160","HC CHG COMPLEMENT ANTIGEN EACH COMPONENT","86160 - HC CHG COMPLEMENT ANTIGEN EACH COMPONENT",61,44.78,10.94,134.62,15.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 86161","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","86161","HC CHG COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT","86161 - HC CHG COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT",58,26.52,10.94,134.62,14.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 86161","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","86161","HC CHG COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT","86161 - HC CHG COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT",58,24.29,10.94,134.62,14.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 86162","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","86162","HC CHG COMPLEMENT TOTAL HEMOLYTIC","86162 - HC CHG COMPLEMENT TOTAL HEMOLYTIC",98,22.25,18.54,228.19,24.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 86200","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","86200","HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY","86200 - HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY",63,13.9,11.81,145.38,15.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 86235","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","86235","HC CHG EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD","86235 - HC CHG EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD",81,36.28,16.36,201.29,20.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 86255","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","86255","HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY","86255 - HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY",35,12.97,10.99,135.27000000000001,8.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 86256","BMC HEALTHNET","BMCHN MCO","CPT","86256","HC CHG FLUORESCENT ANTIBODY; TITER","86256 - HC CHG FLUORESCENT ANTIBODY; TITER",53,10.99,10.99,135.27000000000001,13.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 86256","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","86256","HC CHG FLUORESCENT ANTIBODY; TITER","86256 - HC CHG FLUORESCENT ANTIBODY; TITER",53,20.97,10.99,135.27000000000001,13.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 86300","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","86300","HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3","86300 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3",96,43.83,18.989999999999998,233.69,24]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 86301","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","86301","HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9","86301 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9",100,22.35,18.989999999999998,233.69,25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 86304","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","86304","HC CRL;CA-125","86304 - HC CRL;CA-125",100,46.77,18.989999999999998,233.69,25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 86308","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","86308","HC CHG HETEROPHILE ANTIBODIES SCREEN","86308 - HC CHG HETEROPHILE ANTIBODIES SCREEN",24,11.86,4.72,58.08,6]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 86308","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","86308","HC CHG HETEROPHILE ANTIBODIES SCREEN","86308 - HC CHG HETEROPHILE ANTIBODIES SCREEN",24,10.48,4.72,58.08,6]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 86316","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","86316","HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE","86316 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE",93,22.79,18.989999999999998,233.69,23.25]
["BMC HEALTHNET - BMCHN MCO - CPT - 86317","BMC HEALTHNET","BMCHN MCO","CPT","86317","HC IMMUNOASSAY,INFECT AGENT,QUANT","86317 - HC IMMUNOASSAY,INFECT AGENT,QUANT",72,13.67,13.67,168.24,18]
["FALLON - FALLON MEDICAID - CPT - 86328","FALLON","FALLON MEDICAID","CPT","86328","IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY; CORONAVIRUS 2","86328 - IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY; CORONAVIRUS 2",203,45.23,45.23,410.13,50.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 86331","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","86331","HC CHG IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY","86331 - HC CHG IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY",57,27.01,10.93,134.44999999999999,14.25]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 86334","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","86334","HC CHG IMMUNOFIXJ ELECTROPHORESIS SERUM","86334 - HC CHG IMMUNOFIXJ ELECTROPHORESIS SERUM",80,30.65,20.39,250.85,20]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 86335","BLUE CROSS","BLUE CROSS-PPO","CPT","86335","HC CHG IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS","86335 - HC CHG IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS",138,34.94,26.77,329.47,34.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 86336","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","86336","HC CHG INHIBIN A","86336 - HC CHG INHIBIN A",76,34.909999999999997,14.22,174.97,19]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 86340","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","86340","HC CHG INTRINSIC FACTOR ANTIBODIES","86340 - HC CHG INTRINSIC FACTOR ANTIBODIES",73,18.66,13.75,169.26,18.25]
["TUFTS - TUFTS SELECT - CPT - 86340","TUFTS","TUFTS SELECT","CPT","86340","HC CHG INTRINSIC FACTOR ANTIBODIES","86340 - HC CHG INTRINSIC FACTOR ANTIBODIES",73,26.29,13.75,169.26,18.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 86341","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","86341","HC CHG ISLET CELL ANTIBODY","86341 - HC CHG ISLET CELL ANTIBODY",96,228.64,18.05,228.64,24]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 86353","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","86353","HC CHG LYMPHOCYTE TRANSFORMATION","86353 - HC CHG LYMPHOCYTE TRANSFORMATION",327,117.6,44.72,550.37,81.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 86355","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","86355","HC B CELLS TOTAL COUNT","86355 - HC B CELLS TOTAL COUNT",412,84.99,15.71,423.58,103]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 86355","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","86355","HC B CELLS TOTAL COUNT","86355 - HC B CELLS TOTAL COUNT",412,81.459999999999994,15.71,423.58,103]
["BMC HEALTHNET - BMCHN MCO - CPT - 86357","BMC HEALTHNET","BMCHN MCO","CPT","86357","HC NK CELLS, TOTAL COUNT","86357 - HC NK CELLS, TOTAL COUNT",412,34.42,15.71,423.58,103]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 86359","BMC HEALTHNET","BMCHN WELL SENSE","CPT","86359","HC CHG T CELLS TOTAL COUNT","86359 - HC CHG T CELLS TOTAL COUNT",57,22.66,15.71,423.58,14.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 86360","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","86360","HC CHG T CELLS ABSOLUTE CD4&CD8 COUNT RATIO","86360 - HC CHG T CELLS ABSOLUTE CD4&CD8 COUNT RATIO",69,118.21,18.87,527.5,17.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 86360","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT","86360","HC CHG T CELLS ABSOLUTE CD4&CD8 COUNT RATIO","86360 - HC CHG T CELLS ABSOLUTE CD4&CD8 COUNT RATIO",69,64.8,18.87,527.5,17.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 86376","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","86376","HC CHG MICROSOMAL ANTIBODIES EACH","86376 - HC CHG MICROSOMAL ANTIBODIES EACH",70,25.32,13.27,163.31,17.5]
["TUFTS - TUFTS HMO - CPT - 86382","TUFTS","TUFTS HMO","CPT","86382","HC CHG NEUTRALIZATION TEST VIRAL","86382 - HC CHG NEUTRALIZATION TEST VIRAL",324,75.790000000000006,15.43,189.88,81]
["BMC HEALTHNET - BMCHN QHP - CPT - 86403","BMC HEALTHNET","BMCHN QHP","CPT","86403","HC CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY","86403 - HC CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY",269,11.15,9.2899999999999991,114.93,67.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 86431","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","86431","HC CHG RHEUMATOID FACTOR QUANTITATIVE","86431 - HC CHG RHEUMATOID FACTOR QUANTITATIVE",27,13.6,5.17,63.66,6.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 86480","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","86480","HC CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON","86480 - HC CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON",93,155.94999999999999,56.54,695.83,23.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 86480","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","86480","HC CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON","86480 - HC CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON",93,74.38,56.54,695.83,23.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 86481","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","86481","HC TB TEST CELL MEDIATED ANTIGEN RESPONSE, ENUM GAMMA INTERFRON T-CELL","86481 - HC TB TEST CELL MEDIATED ANTIGEN RESPONSE, ENUM GAMMA INTERFRON T-CELL",127,86.97,73.89,969.95,31.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 86486","BMC HEALTHNET","BMCHN QHP","CPT","86486","SKIN TEST UNLISTED ANTIGEN EACH","86486 - SKIN TEST UNLISTED ANTIGEN EACH",34,4.91,4.09,199.34,8.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 86580","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","86580","SKIN TEST TUBERCULOSIS INTRADERMAL","86580 - SKIN TEST TUBERCULOSIS INTRADERMAL",55,7.11,6.04,199.34,13.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 86592","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","86592","HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL","86592 - HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL",28,10,3.89,47.89,7]
["TUFTS - TUFTS HMO - CPT - 86593","TUFTS","TUFTS HMO","CPT","86593","HC SYPHILIS;QN","86593 - HC SYPHILIS;QN",23,19.75,4.0199999999999996,49.48,5.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 86606","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","86606","HC CHG ANTIBODY ASPERGILLUS","86606 - HC CHG ANTIBODY ASPERGILLUS",71,34.26,13.74,169.1,17.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 86609","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","86609","HC CHG ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED","86609 - HC CHG ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED",48,12.88,11.75,144.6,12]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 86611","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","86611","HC BARTONELLA, ANTIBODY","86611 - HC BARTONELLA, ANTIBODY",61,25.61,9.2799999999999994,114.2,15.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 86612","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","86612","HC CHG BLASTOMYCES ANTIBODY","86612 - HC CHG BLASTOMYCES ANTIBODY",83,15.22,11.77,144.88999999999999,20.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 86612","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","86612","HC CHG BLASTOMYCES ANTIBODY","86612 - HC CHG BLASTOMYCES ANTIBODY",83,32.46,11.77,144.88999999999999,20.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 86615","BMC HEALTHNET","BMCHN MCO","CPT","86615","HC Q;BORDTLLA AB;IGG,IGA","86615 - HC Q;BORDTLLA AB;IGG,IGA",174,12.03,12.03,148.07,43.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 86617","BLUE CROSS","BLUE CROSS-PPO","CPT","86617","HC CHG ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST","86617 - HC CHG ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST",27,34.909999999999997,14.13,173.95,6.75]
["TUFTS - TUFTS HMO - CPT - 86617","TUFTS","TUFTS HMO","CPT","86617","HC CHG ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST","86617 - HC CHG ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST",27,69.430000000000007,14.13,173.95,6.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 86618","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","86618","HC Q;LYME AB INDEX CNS INFEC","86618 - HC Q;LYME AB INDEX CNS INFEC",191,20.440000000000001,15.53,191.1,47.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 86622","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","86622","HC CHG ANTIBODY BRUCELLA","86622 - HC CHG ANTIBODY BRUCELLA",79,8.93,8.15,100.26,19.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 86625","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","86625","HC CAMPYLOBACTER, ANTIBODY","86625 - HC CAMPYLOBACTER, ANTIBODY",16,28.33,11.97,147.33000000000001,4]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 86631","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","86631","HC CHG, CHLAMYDIA, ANTIBODY","86631 - HC CHG, CHLAMYDIA, ANTIBODY",52,12.73,10.79,132.78,13]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 86631","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","86631","HC CHG, CHLAMYDIA, ANTIBODY","86631 - HC CHG, CHLAMYDIA, ANTIBODY",52,27.67,10.79,132.78,13]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86635","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","86635","HC CHG ANTIBODY COCCIDIOIDES","86635 - HC CHG ANTIBODY COCCIDIOIDES",42,25.69,10.47,128.83000000000001,10.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 86635","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","86635","HC CHG ANTIBODY COCCIDIOIDES","86635 - HC CHG ANTIBODY COCCIDIOIDES",42,25.69,10.47,128.83000000000001,10.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 86638","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","86638","HC CHG, Q FEVER ANTIBODY","86638 - HC CHG, Q FEVER ANTIBODY",63,12.12,11.06,136.13,15.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 86638","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","86638","HC CHG, Q FEVER ANTIBODY","86638 - HC CHG, Q FEVER ANTIBODY",63,13.02,11.06,136.13,15.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 86645","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","86645","HC CHG ANTIBODY CYTOMEGALOVIRUS CMV IGM","86645 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV IGM",71,38.200000000000003,15.37,189.15,17.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 86645","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","86645","HC CHG ANTIBODY CYTOMEGALOVIRUS CMV IGM","86645 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV IGM",71,36.380000000000003,15.37,189.15,17.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 86648","BMC HEALTHNET","BMCHN MCO","CPT","86648","HC CHG ANTIBODY DIPHTHERIA","86648 - HC CHG ANTIBODY DIPHTHERIA",83,13.87,13.39,170.69,20.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 86652","BMC HEALTHNET","BMCHN ACO","CPT","86652","HC CHG, ENCEPHAL ANTIBODY EAST EQU","86652 - HC CHG, ENCEPHAL ANTIBODY EAST EQU",66,26.32,12.03,148.07,16.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86654","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","86654","CHG ANTIBODY ENCEPHALITIS WESTRN EQUINE","86654 - CHG ANTIBODY ENCEPHALITIS WESTRN EQUINE",28,29.65,12.03,148.07,7]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 86654","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","86654","CHG ANTIBODY ENCEPHALITIS WESTRN EQUINE","86654 - CHG ANTIBODY ENCEPHALITIS WESTRN EQUINE",28,31.63,12.03,148.07,7]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 86658","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","86658","HC CHG ENTEROVIRUS ANTIBODY","86658 - HC CHG ENTEROVIRUS ANTIBODY",70,13.03,11.88,146.19,17.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 86663","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","86663","HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA","86663 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA",37,28.33,11.97,147.33000000000001,9.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 86664","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","86664","HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA","86664 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA",37,38.47,13.95,171.71,9.25]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 86665","CIGNA HEALTHCARE","CIGNA PPO","CPT","86665","HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA","86665 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA",37,36.340000000000003,16.55,203.74,9.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86666","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","86666","HC CHG ANTIBODY EHRLICHIA","86666 - HC CHG ANTIBODY EHRLICHIA",77,23.06,9.2799999999999994,114.2,19.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 86677","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","86677","HC CHG ANTIBODY HELICOBACTER PYLORI","86677 - HC CHG ANTIBODY HELICOBACTER PYLORI",66,32.94,13.23,164.61,16.5]
["UNICARE - UNICARE - CPT - 86677","UNICARE","UNICARE","CPT","86677","HC CHG ANTIBODY HELICOBACTER PYLORI","86677 - HC CHG ANTIBODY HELICOBACTER PYLORI",66,35.229999999999997,13.23,164.61,16.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 86682","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","86682","HC Q;CYSTICERCUS AB,BLOT","86682 - HC Q;CYSTICERCUS AB,BLOT",104,28.09,11.87,146.03,26]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 86689","BMC HEALTHNET","BMCHN WELL SENSE","CPT","86689","HC HTLV/HIV CONFIRMATORY TEST","86689 - HC HTLV/HIV CONFIRMATORY TEST",52,38.25,17.66,217.35,13]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 86692","CIGNA HEALTHCARE","CIGNA PPO","CPT","86692","HC CHG ANTIBODY HEP DELTA AGENT","86692 - HC CHG ANTIBODY HEP DELTA AGENT",143,42.99,15.66,192.69,35.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 86692","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","86692","HC CHG ANTIBODY HEP DELTA AGENT","86692 - HC CHG ANTIBODY HEP DELTA AGENT",143,40.159999999999997,15.66,192.69,35.75]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 86694","CIGNA HEALTHCARE","CIGNA PPO","CPT","86694","HC CHG ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST","86694 - HC CHG ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST",34,36.590000000000003,13.13,161.6,8.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86695","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","86695","HC CHG ANTIBODY HERPES SMPLX TYPE 1","86695 - HC CHG ANTIBODY HERPES SMPLX TYPE 1",66,29.65,12.03,148.07,16.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86696","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","86696","HC CHG ANTIBODY HERPES SMPLX TYPE 2","86696 - HC CHG ANTIBODY HERPES SMPLX TYPE 2",77,43.48,17.66,217.35,19.25]
["UNICARE - UNICARE - CPT - 86696","UNICARE","UNICARE","CPT","86696","HC CHG ANTIBODY HERPES SMPLX TYPE 2","86696 - HC CHG ANTIBODY HERPES SMPLX TYPE 2",77,46.99,17.66,217.35,19.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 86698","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","86698","HC CHG ANTIBODY HISTOPLASMA","86698 - HC CHG ANTIBODY HISTOPLASMA",28,29.77,11.4,140.32,7]
["CIGNA HEALTHCARE - CIGNA - CPT - 86701","CIGNA HEALTHCARE","CIGNA","CPT","86701","HC HIV-1","86701 - HC HIV-1",44,40.020000000000003,8.11,99.73,11]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 86702","CIGNA HEALTHCARE","CIGNA PPO","CPT","86702","HC QL/SEMI MULT AB;HIV2","86702 - HC QL/SEMI MULT AB;HIV2",82,26.84,12.33,151.72999999999999,20.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86703","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","86703","HC HIV 1/2 ANTIBODY","86703 - HC HIV 1/2 ANTIBODY",50,30.96,12.5,153.85,12.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 86704","BMC HEALTHNET","BMCHN MEDICAID","CPT","86704","HC CHG HEPATITIS B CORE ANTIBODY HBCAB TOTAL","86704 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB TOTAL",61,10.99,10.99,135.27000000000001,15.25]
["UNICARE - UNICARE - CPT - 86704","UNICARE","UNICARE","CPT","86704","HC CHG HEPATITIS B CORE ANTIBODY HBCAB TOTAL","86704 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB TOTAL",61,29.27,10.99,135.27000000000001,15.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 86706","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","86706","HC CHG HEPATITIS B SURF ANTIBODY HBSAB","86706 - HC CHG HEPATITIS B SURF ANTIBODY HBSAB",52,13.3,9.8000000000000007,120.52,13]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 86706","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","86706","HC CHG HEPATITIS B SURF ANTIBODY HBSAB","86706 - HC CHG HEPATITIS B SURF ANTIBODY HBSAB",52,10.74,9.8000000000000007,120.52,13]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 86707","CIGNA HEALTHCARE","CIGNA PPO","CPT","86707","HC CHG HEPATITIS BE ANTIBODY HBEAB","86707 - HC CHG HEPATITIS BE ANTIBODY HBEAB",56,29.39,10.55,129.88999999999999,14]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 86708","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","86708","HC CHG HEPATITIS A ANTIBODY HAAB","86708 - HC CHG HEPATITIS A ANTIBODY HAAB",58,27.67,11.3,139.02000000000001,14.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 86709","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","86709","HC CHG HEPATITIS ANTIBODY HAAB IGM ANTIBODY","86709 - HC CHG HEPATITIS ANTIBODY HAAB IGM ANTIBODY",56,25.69,10.27,126.43,14]
["UNICARE - UNICARE - CPT - 86709","UNICARE","UNICARE","CPT","86709","HC CHG HEPATITIS ANTIBODY HAAB IGM ANTIBODY","86709 - HC CHG HEPATITIS ANTIBODY HAAB IGM ANTIBODY",56,27.32,10.27,126.43,14]
["BMC HEALTHNET - BMCHN QHP - CPT - 86710","BMC HEALTHNET","BMCHN QHP","CPT","86710","HC INFLUENZA VIRUS","86710 - HC INFLUENZA VIRUS",35,14.83,12.36,152.1,8.75]
["TUFTS - TUFTS PPO - CPT - 86735","TUFTS","TUFTS PPO","CPT","86735","HC CHG ANTIBODY MUMPS","86735 - HC CHG ANTIBODY MUMPS",65,52.11,11.9,146.47999999999999,16.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 86738","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","86738","HC CHG ANTIBODY MYCOPLSM","86738 - HC CHG ANTIBODY MYCOPLSM",32,16.38,12.07,148.63999999999999,8]
["BMC HEALTHNET - BMCHN ACO - CPT - 86744","BMC HEALTHNET","BMCHN ACO","CPT","86744","HC CHG ANTIBODY NOCARDIA","86744 - HC CHG ANTIBODY NOCARDIA",46,26.32,12.03,155.08000000000001,11.5]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 86744","CIGNA HEALTHCARE","CIGNA PPO","CPT","86744","HC CHG ANTIBODY NOCARDIA","86744 - HC CHG ANTIBODY NOCARDIA",46,23.67,12.03,155.08000000000001,11.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 86747","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","86747","HC CHG ANTIBODY PARVOVIRUS","86747 - HC CHG ANTIBODY PARVOVIRUS",26,36.06,12.77,168.81,6.5]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 86753","CIGNA HEALTHCARE","CIGNA PPO","CPT","86753","HC CHG ANTIBODY PROTOZOA NES","86753 - HC CHG ANTIBODY PROTOZOA NES",42,23.67,11.3,139.02000000000001,10.5]
["UNICARE - UNICARE - CPT - 86753","UNICARE","UNICARE","CPT","86753","HC CHG ANTIBODY PROTOZOA NES","86753 - HC CHG ANTIBODY PROTOZOA NES",42,22.57,11.3,139.02000000000001,10.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 86762","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","86762","HC CHG ANTIBODY RUBELLA","86762 - HC CHG ANTIBODY RUBELLA",70,36.21,13.13,161.6,17.5]
["TUFTS - TUFTS PPO - CPT - 86762","TUFTS","TUFTS PPO","CPT","86762","HC CHG ANTIBODY RUBELLA","86762 - HC CHG ANTIBODY RUBELLA",70,57.49,13.13,161.6,17.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 86765","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","86765","HC CHG ANTIBODY RUBEOLA","86765 - HC CHG ANTIBODY RUBEOLA",102,15.46,11.75,144.6,25.5]
["BMC HEALTHNET - BMCHN MCO - CPT - 86769","BMC HEALTHNET","BMCHN MCO","CPT","86769","ANTIBODY; SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2","86769 - ANTIBODY; SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2",203,42.13,42.13,382.01,50.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 86774","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","86774","HC CHG ANTIBODY TETANUS","86774 - HC CHG ANTIBODY TETANUS",83,14.8,12.77,166.08,20.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 86777","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","86777","HC CHG ANTIBODY TOXOPLASMA","86777 - HC CHG ANTIBODY TOXOPLASMA",180,31.07,13.13,161.6,45]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 86777","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","86777","HC CHG ANTIBODY TOXOPLASMA","86777 - HC CHG ANTIBODY TOXOPLASMA",180,20.87,13.13,161.6,45]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 86778","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","86778","HC Q;TOXOPLASMA IGM,AB","86778 - HC Q;TOXOPLASMA IGM,AB",72,31.11,13.14,161.72,18]
["BMC HEALTHNET - BMCHN MCO - CPT - 86780","BMC HEALTHNET","BMCHN MCO","CPT","86780","HC CHG ANTIBODY TREPONEMA PALLIDUM","86780 - HC CHG ANTIBODY TREPONEMA PALLIDUM",61,12.07,12.07,148.63999999999999,15.25]
["TUFTS - TUFTS HMO - CPT - 86787","TUFTS","TUFTS HMO","CPT","86787","HC CHG ANTIBODY VARICELLA-ZOSTER","86787 - HC CHG ANTIBODY VARICELLA-ZOSTER",101,57.72,11.75,144.6,25.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 86788","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","86788","HC CHG ANTIBODY WEST NILE VIRUS IGM","86788 - HC CHG ANTIBODY WEST NILE VIRUS IGM",88,42.4,15.37,189.15,22]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 86788","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","86788","HC CHG ANTIBODY WEST NILE VIRUS IGM","86788 - HC CHG ANTIBODY WEST NILE VIRUS IGM",88,20.22,15.37,189.15,22]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 86789","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","86789","HC CHG ANTIBODY WEST NILE VIRUS","86789 - HC CHG ANTIBODY WEST NILE VIRUS",79,17.27,13.13,161.6,19.75]
["TUFTS - TUFTS PPO - CPT - 86790","TUFTS","TUFTS PPO","CPT","86790","HC CHG ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED","86790 - HC CHG ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED",32,51.45,11.75,144.6,8]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 86800","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","86800","HC CHG THYROGLOBULIN ANTIBODY","86800 - HC CHG THYROGLOBULIN ANTIBODY",51,34.35,14.51,178.59,12.75]
["FALLON - FALLON SENIOR PLAN - CPT - 86803","FALLON","FALLON SENIOR PLAN","CPT","86803","HC CHG HEPATITIS C ANTIBODY","86803 - HC CHG HEPATITIS C ANTIBODY",58,14.27,13.01,160.13,14.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 86807","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","86807","HC CHG SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH","86807 - HC CHG SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH",183,143.61000000000001,54.29,762.87,45.75]
["TUFTS - TUFTS SELECT - CPT - 86807","TUFTS","TUFTS SELECT","CPT","86807","HC CHG SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH","86807 - HC CHG SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH",183,118.48,54.29,762.87,45.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 86813","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","86813","HC CHG HLA TYPING A/B/C MULTIPLE ANTIGENS","86813 - HC CHG HLA TYPING A/B/C MULTIPLE ANTIGENS",266,62.42,52.9,651.04,66.5]
["TUFTS - TUFTS PPO - CPT - 86813","TUFTS","TUFTS PPO","CPT","86813","HC CHG HLA TYPING A/B/C MULTIPLE ANTIGENS","86813 - HC CHG HLA TYPING A/B/C MULTIPLE ANTIGENS",266,231.62,52.9,651.04,66.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 86817","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT","86817","HC CHG HLA TYPING DR/DQ MULTIPLE ANTIGENS","86817 - HC CHG HLA TYPING DR/DQ MULTIPLE ANTIGENS",296,143.1,78.42,1029.42,74]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 86850","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","86850","HC CHG ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE","86850 - HC CHG ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE",87,110.07,5.25,501.09,21.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 86860","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","86860","HC CHG ANTIBODY ELUTION RBC EACH ELUTION","86860 - HC CHG ANTIBODY ELUTION RBC EACH ELUTION",142,1356.56,23.92,1356.56,35.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 86870","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","86870","HC CHG ANTIBODY ID RBC ANTIBODIES EA PANEL EA SERUM TQ","86870 - HC CHG ANTIBODY ID RBC ANTIBODIES EA PANEL EA SERUM TQ",209,0,57.04,2437.5300000000002,52.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 86886","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","86886","HC CHG ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER","86886 - HC CHG ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER",315,5.57,4.72,1267.31,78.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 86886","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","86886","HC CHG ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER","86886 - HC CHG ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER",315,312.47000000000003,4.72,1267.31,78.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 86900","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","86900","HC CHG BLOOD TYPING SEROLOGIC ABO","86900 - HC CHG BLOOD TYPING SEROLOGIC ABO",87,3.22,2.73,923.73,21.75]
["TUFTS - TUFTS PPO - CPT - 86900","TUFTS","TUFTS PPO","CPT","86900","HC CHG BLOOD TYPING SEROLOGIC ABO","86900 - HC CHG BLOOD TYPING SEROLOGIC ABO",87,328.64,2.73,923.73,21.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 86901","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","86901","HC CHG BLOOD TYPING SEROLOGIC RH (D)","86901 - HC CHG BLOOD TYPING SEROLOGIC RH (D)",87,3.59,2.73,348.71,21.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 86902","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","86902","HC CHG BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH","86902 - HC CHG BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH",87,11.05,4.6900000000000004,2272.4699999999998,21.75]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 86905","BMC HEALTHNET","BMCHN MEDICAID","CPT","86905","HC CHG BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH","86905 - HC CHG BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH",87,3.49,3.49,2229.4299999999998,21.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 86910","BMC HEALTHNET","BMCHN ACO","CPT","86910","HC CHG BLOOD TYPING PATERNITY INDIV ABO RH&MN","86910 - HC CHG BLOOD TYPING PATERNITY INDIV ABO RH&MN",67,0,74.83,76.709999999999994,16.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 86922","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","86922","HC CHG COMPATIBILITY EACH UNIT ANTIGLOBULIN","86922 - HC CHG COMPATIBILITY EACH UNIT ANTIGLOBULIN",142,1356.56,55.2,1356.56,35.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 86923","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","86923","HC CHG COMPATIBILITY EACH UNIT ELECTRONIC","86923 - HC CHG COMPATIBILITY EACH UNIT ELECTRONIC",142,0,190.34,1319.88,35.5]
["TUFTS - TUFTS SELECT - CPT - 87015","TUFTS","TUFTS SELECT","CPT","87015","HC CHG CONCENTRATION INFECTIOUS AGENTS","87015 - HC CHG CONCENTRATION INFECTIOUS AGENTS",34,11.64,6.09,74.989999999999995,8.5]
["CIGNA HEALTHCARE - CIGNA - CPT - 87040","CIGNA HEALTHCARE","CIGNA","CPT","87040","HC CHG CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES","87040 - HC CHG CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES",51,46.54,9.41,115.87,12.75]
["FALLON - FALLON MEDICAID - CPT - 87045","FALLON","FALLON MEDICAID","CPT","87045","HC CHG CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL","87045 - HC CHG CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL",48,8.6199999999999992,8.6199999999999992,105.97,12]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 87045","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","87045","HC CHG CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL","87045 - HC CHG CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL",48,11.33,8.6199999999999992,105.97,12]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 87046","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","87046","HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA","87046 - HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA",48,11.33,6,105.97,12]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 87070","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","87070","CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL","87070 - CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL",43,15,7.86,96.71,10.75]
["TUFTS - TUFTS MEDICARE SCO - CPT - 87075","TUFTS","TUFTS MEDICARE SCO","CPT","87075","HC CHG CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID","87075 - HC CHG CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID",41,13.73,8.64,106.25,10.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 87076","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","87076","HC CHG CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL","87076 - HC CHG CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL",27,9.5299999999999994,7.18,90.64,6.75]
["TUFTS - TUFTS SPIRIT - CPT - 87076","TUFTS","TUFTS SPIRIT","CPT","87076","HC CHG CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL","87076 - HC CHG CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL",27,8.89,7.18,90.64,6.75]
["CIGNA HEALTHCARE - CIGNA - CPT - 87077","CIGNA HEALTHCARE","CIGNA","CPT","87077","HC CHG CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL","87077 - HC CHG CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL",27,23.56,7.18,90.64,6.75]
["FALLON - FALLON MEDICAID - CPT - 87081","FALLON","FALLON MEDICAID","CPT","87081","HC CULT,BACT,SCR,H PYLORI","87081 - HC CULT,BACT,SCR,H PYLORI",34,6.04,6.04,74.42,8.5]
["TUFTS - TUFTS POS - CPT - 87086","TUFTS","TUFTS POS","CPT","87086","HC CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE","87086 - HC CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE",41,30.12,7.36,90.56,10.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 87086","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","87086","HC CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE","87086 - HC CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE",41,9.68,7.36,90.56,10.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 87102","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","87102","HC CHG CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD","87102 - HC CHG CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD",42,9.92,7.67,94.39,10.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 87102","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","87102","HC CHG CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD","87102 - HC CHG CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD",42,9.1999999999999993,7.67,94.39,10.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 87103","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT","87103","HC CHG CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD","87103 - HC CHG CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD",46,22.86,12.37,198.48,11.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 87106","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","87106","HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST","87106 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST",51,24.76,9.41,115.87,12.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 87107","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","87107","HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD","87107 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD",51,23.06,9.41,115.87,12.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 87110","BMC HEALTHNET","BMCHN QHP","CPT","87110","HC CHG CULTURE, CHLAMYDIA","87110 - HC CHG CULTURE, CHLAMYDIA",25,21.44,17.87,219.96,6.25]
["TUFTS - TUFTS PPO - CPT - 87110","TUFTS","TUFTS PPO","CPT","87110","HC CHG CULTURE, CHLAMYDIA","87110 - HC CHG CULTURE, CHLAMYDIA",25,78.260000000000005,17.87,219.96,6.25]
["TUFTS - TUFTS MEDICARE SCO - CPT - 87116","TUFTS","TUFTS MEDICARE SCO","CPT","87116","HC CHG CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL","87116 - HC CHG CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL",54,15.66,9.86,121.29,13.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 87118","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT","87118","HC CHG CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL","87118 - HC CHG CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL",55,16.309999999999999,10.79,141.71,13.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 87118","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","87118","HC CHG CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL","87118 - HC CHG CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL",55,17.53,10.79,141.71,13.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 87140","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT","87140","HC CHG CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM","87140 - HC CHG CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM",28,7.68,5.08,62.56,7]
["FALLON - FALLON MEDICAID - CPT - 87149","FALLON","FALLON MEDICAID","CPT","87149","HC CHG CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM","87149 - HC CHG CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM",100,18.29,18.29,225.1,25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 87150","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","87150","HC CHG CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM","87150 - HC CHG CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM",460,19.204999999999998,32.01,393.99,115]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 87153","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","87153","HC Q;BACT ID,PHENO,SEQ","87153 - HC Q;BACT ID,PHENO,SEQ",447,1294.94,115.36,1294.94,111.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 87172","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","87172","HC CHG PINWORM EXAMINATION","87172 - HC CHG PINWORM EXAMINATION",23,9.8800000000000008,3.89,47.89,5.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 87176","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","87176","HC CHG HOMOGENIZATION TISSUE CULTURE","87176 - HC CHG HOMOGENIZATION TISSUE CULTURE",29,13.18,5.36,66.02,7.25]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 87176","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","87176","HC CHG HOMOGENIZATION TISSUE CULTURE","87176 - HC CHG HOMOGENIZATION TISSUE CULTURE",29,11.9,5.36,66.02,7.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 87177","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","87177","HC CHG OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID","87177 - HC CHG OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID",44,9.56,8.1199999999999992,99.89,11]
["TUFTS - TUFTS SELECT - CPT - 87181","TUFTS","TUFTS SELECT","CPT","87181","HC CHG SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ","87181 - HC CHG SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ",25,8.2799999999999994,3.54,53.31,6.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 87184","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","87184","HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD","87184 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD",35,7.48,6.29,77.400000000000006,8.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 87184","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","87184","HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD","87184 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD",35,13.94,6.29,77.400000000000006,8.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 87186","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","87186","HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ","87186 - HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ",43,19.12,7.88,97,10.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 87186","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","87186","HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ","87186 - HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ",43,17.489999999999998,7.88,97,10.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 87188","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","87188","HC CHG SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT","87188 - HC CHG SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT",81,15.93,6.06,74.58,20.25]
["TUFTS - TUFTS SELECT - CPT - 87205","TUFTS","TUFTS SELECT","CPT","87205","HC CHG SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL","87205 - HC CHG SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL",23,7.44,3.89,47.89,5.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 87206","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","87206","HC CHG SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT","87206 - HC CHG SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT",27,5.39,4.91,60.48,6.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 87207","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","87207","SMR PRIM SRC SPEC STAIN BODIES/PARASITS","87207 - SMR PRIM SRC SPEC STAIN BODIES/PARASITS",281,15.07,5.47,67.33,70.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 87207","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","87207","SMR PRIM SRC SPEC STAIN BODIES/PARASITS","87207 - SMR PRIM SRC SPEC STAIN BODIES/PARASITS",281,5.99,5.47,67.33,70.25]
["UNICARE - UNICARE - CPT - 87209","UNICARE","UNICARE","CPT","87209","HC CHG SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS","87209 - HC CHG SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS",91,43.58,16.399999999999999,201.74,22.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 87210","BMC HEALTHNET","BMCHN MCO","CPT","87210","SMR PRIM SRC WET MOUNT NFCT AGT","87210 - SMR PRIM SRC WET MOUNT NFCT AGT",23,4.3,4.3,56.49,5.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 87210","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","87210","SMR PRIM SRC WET MOUNT NFCT AGT","87210 - SMR PRIM SRC WET MOUNT NFCT AGT",23,12.26,4.3,56.49,5.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 87252","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","87252","HC CHG VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT","87252 - HC CHG VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT",172,32.270000000000003,23.78,292.58999999999997,43]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 87252","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","87252","HC CHG VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT","87252 - HC CHG VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT",172,27.99,23.78,292.58999999999997,43]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 87253","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","87253","HC CHG VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE","87253 - HC CHG VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE",100,27.71,18.43,226.77,25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 87254","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","87254","HC CHG VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA","87254 - HC CHG VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA",98,44.14,12.44,219.59,24.5]
["BMC HEALTHNET - BMCHN MCO - CPT - 87255","BMC HEALTHNET","BMCHN MCO","CPT","87255","HC CHG VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC","87255 - HC CHG VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC",168,30.89,30.89,380.17,42]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 87260","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","87260","HC CHG IAADI ADENOVIRUS","87260 - HC CHG IAADI ADENOVIRUS",57,15.71,10.94,139.96,14.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 87269","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","87269","HC CHG IAADI GIARDIA","87269 - HC CHG IAADI GIARDIA",57,27.01,10.94,135.27000000000001,14.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 87269","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","87269","HC CHG IAADI GIARDIA","87269 - HC CHG IAADI GIARDIA",57,16.329999999999998,10.94,135.27000000000001,14.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 87275","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","87275","HC CHG IAADI INFLUENZA B VIRUS","87275 - HC CHG IAADI INFLUENZA B VIRUS",57,14.45,10.94,134.54,14.25]
["CIGNA HEALTHCARE - CIGNA - CPT - 87275","CIGNA HEALTHCARE","CIGNA","CPT","87275","HC CHG IAADI INFLUENZA B VIRUS","87275 - HC CHG IAADI INFLUENZA B VIRUS",57,51.64,10.94,134.54,14.25]
["CIGNA HEALTHCARE - CIGNA - CPT - 87276","CIGNA HEALTHCARE","CIGNA","CPT","87276","HC CHG IAADI INFFLUENZA A VIRUS","87276 - HC CHG IAADI INFFLUENZA A VIRUS",57,51.64,11.87,155.81,14.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 87279","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","87279","HC CHG IAADI PARAINFLUENZA VIRUS EACH TYPE","87279 - HC CHG IAADI PARAINFLUENZA VIRUS EACH TYPE",57,30.3,12.14,159.36000000000001,14.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 87281","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","87281","HC CHG IAADI PNEUMOCUSTIS CARINII","87281 - HC CHG IAADI PNEUMOCUSTIS CARINII",57,27.01,10.94,134.54,14.25]
["FALLON - FALLON MEDICAID - CPT - 87281","FALLON","FALLON MEDICAID","CPT","87281","HC CHG IAADI PNEUMOCUSTIS CARINII","87281 - HC CHG IAADI PNEUMOCUSTIS CARINII",57,10.94,10.94,134.54,14.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 87299","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","87299","HC CHG AG DETECTION NOS, FLUOR","87299 - HC CHG AG DETECTION NOS, FLUOR",92,35.58,11.9,156.22,23]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 87299","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","87299","HC CHG AG DETECTION NOS, FLUOR","87299 - HC CHG AG DETECTION NOS, FLUOR",92,19.32,11.9,156.22,23]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 87324","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","87324","HC CHG IAAD IA CLOSTRIDIUM DIFFICILE TOXIN","87324 - HC CHG IAAD IA CLOSTRIDIUM DIFFICILE TOXIN",57,14.85,10.94,134.54,14.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 87327","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","87327","HC CHG IAAD IA CRYPTOCOCCUS NEOFORMANS","87327 - HC CHG IAAD IA CRYPTOCOCCUS NEOFORMANS",57,27.01,10.94,134.82,14.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 87327","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","87327","HC CHG IAAD IA CRYPTOCOCCUS NEOFORMANS","87327 - HC CHG IAAD IA CRYPTOCOCCUS NEOFORMANS",57,16.100000000000001,10.94,134.82,14.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 87338","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","87338","HC CHG IAAD IA HPYLORI STOOL","87338 - HC CHG IAAD IA HPYLORI STOOL",102,38.340000000000003,13.12,161.52000000000001,25.5]
["CIGNA HEALTHCARE - CIGNA - CPT - 87340","CIGNA HEALTHCARE","CIGNA","CPT","87340","HC CHG IAAD IA HEPATITIS B SURFACE ANTIGEN","87340 - HC CHG IAAD IA HEPATITIS B SURFACE ANTIGEN",51,46.54,9.42,115.95,12.75]
["CIGNA HEALTHCARE - CIGNA - CPT - 87341","CIGNA HEALTHCARE","CIGNA","CPT","87341","HC CHG IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION","87341 - HC CHG IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION",51,46.54,9.42,115.95,12.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 87350","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","87350","HC CHG IAAD IA HEPATITIS BE ANTIGEN","87350 - HC CHG IAAD IA HEPATITIS BE ANTIGEN",55,25.69,10.51,129.4,13.75]
["TUFTS - TUFTS PPO - CPT - 87350","TUFTS","TUFTS PPO","CPT","87350","HC CHG IAAD IA HEPATITIS BE ANTIGEN","87350 - HC CHG IAAD IA HEPATITIS BE ANTIGEN",55,46.04,10.51,129.4,13.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 87385","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","87385","HC CHG IAAD IA HISTOPLASM CAPSULATUM","87385 - HC CHG IAAD IA HISTOPLASM CAPSULATUM",46,15.9,10.94,134.54,11.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 87389","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","87389","HC CHG IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE","87389 - HC CHG IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE",111,53.21,21.97,270.29000000000002,27.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 87389","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","87389","HC CHG IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE","87389 - HC CHG IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE",111,62.61,21.97,270.29000000000002,27.75]
["TUFTS - TUFTS HMO - CPT - 87390","TUFTS","TUFTS HMO","CPT","87390","HC CHG IAAD IA HIV-1","87390 - HC CHG IAAD IA HIV-1",87,93.12,17.78,233.33,21.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 87391","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","87391","HC CHG IAAD IA HIV-2","87391 - HC CHG IAAD IA HIV-2",87,24.2,16.18,212.42,21.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 87400","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","87400","HC CHG IAAD IA INFLUENZA A/B EACH","87400 - HC CHG IAAD IA INFLUENZA A/B EACH",57,14.13,10.94,137.06,14.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 87420","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","87420","HC CHG IAAD IA RESPIRATORY SYNCTIAL VIRUS","87420 - HC CHG IAAD IA RESPIRATORY SYNCTIAL VIRUS",57,35,10.94,136.04,14.25]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 87425","CIGNA HEALTHCARE","CIGNA PPO","CPT","87425","HC CHG IAAD IA ROTAVIRUS","87425 - HC CHG IAAD IA ROTAVIRUS",57,29.14,10.94,134.54,14.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 87425","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","87425","HC CHG IAAD IA ROTAVIRUS","87425 - HC CHG IAAD IA ROTAVIRUS",57,28.05,10.94,134.54,14.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 87426","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","87426","SARSCOV CORONAVIRUS AG IA","87426 - SARSCOV CORONAVIRUS AG IA",100,42.4,10.94,88.9,25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 87430","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","87430","HC CHG IAAD IA STREPTOCOCCUS GROUP A","87430 - HC CHG IAAD IA STREPTOCOCCUS GROUP A",57,36.29,12.42,163.02000000000001,14.25]
["TUFTS - TUFTS SPIRIT - CPT - 87449","TUFTS","TUFTS SPIRIT","CPT","87449","HC AG DET,ENZ IMM;OTH,EA","87449 - HC AG DET,ENZ IMM;OTH,EA",57,13.18,10.94,134.54,14.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 87480","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","87480","HC CHG IADNA CANDIDA SPECIES DIRECT PROBE TQ","87480 - HC CHG IADNA CANDIDA SPECIES DIRECT PROBE TQ",157,43.29,18.29,225.1,39.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 87481","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","87481","HC CHG CANDIDA, DNA, AMP PROBE","87481 - HC CHG CANDIDA, DNA, AMP PROBE",124,84.18,32.01,393.99,31]
["BMC HEALTHNET - BMCHN ACO - CPT - 87486","BMC HEALTHNET","BMCHN ACO","CPT","87486","HC CHG IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ","87486 - HC CHG IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ",127,70.040000000000006,32.01,393.99,31.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 87486","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","87486","HC CHG IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ","87486 - HC CHG IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ",127,42.11,32.01,393.99,31.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 87491","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","87491","HC CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ","87491 - HC CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ",129,79.05,32.01,393.99,32.25]
["TUFTS - TUFTS SPIRIT - CPT - 87491","TUFTS","TUFTS SPIRIT","CPT","87491","HC CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ","87491 - HC CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ",129,38.6,32.01,393.99,32.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 87493","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","87493","HC CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE","87493 - HC CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE",120,19.204999999999998,32.01,393.99,30]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 87496","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","87496","HC ARUP;CYTOMEG VIR PCR,CSF","87496 - HC ARUP;CYTOMEG VIR PCR,CSF",41,61.06,32.01,393.99,10.25]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 87497","BMC HEALTHNET","BMCHN MEDICAID","CPT","87497","HC CHG IADNA CYTOMEGALOVIRUS QUANTIFICATION","87497 - HC CHG IADNA CYTOMEGALOVIRUS QUANTIFICATION",384,39.07,39.07,480.84,96]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 87497","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","87497","HC CHG IADNA CYTOMEGALOVIRUS QUANTIFICATION","87497 - HC CHG IADNA CYTOMEGALOVIRUS QUANTIFICATION",384,102.77,39.07,480.84,96]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 87498","BMC HEALTHNET","BMCHN MEDICAID","CPT","87498","HC CHG IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP","87498 - HC CHG IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP",322,32.01,32.01,393.99,80.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 87502","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT","87502","HC Q;FLU AG DET,MULT TYP,2,2","87502 - HC Q;FLU AG DET,MULT TYP,2,2",269,129.16,77.11,958.3,67.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 87505","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","87505","HC CHG NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN","87505 - HC CHG NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN",181,289.19,103.92,1440.15,45.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 87505","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","87505","HC CHG NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN","87505 - HC CHG NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN",181,270.18,103.92,1440.15,45.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 87507","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","87507","HC IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25","87507 - HC IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25",588,940.7,291.7,4678.75,147]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 87507","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","87507","HC IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25","87507 - HC IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25",588,975.27,291.7,4678.75,147]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 87511","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","87511","HC CHG GARDNER VAG, DNA  AMP PROBE","87511 - HC CHG GARDNER VAG, DNA  AMP PROBE",109,79.05,32.01,393.99,27.25]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 87511","BMC HEALTHNET","BMCHN WELL SENSE","CPT","87511","HC CHG GARDNER VAG, DNA  AMP PROBE","87511 - HC CHG GARDNER VAG, DNA  AMP PROBE",109,51.5,32.01,393.99,27.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 87517","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","87517","HC CHG IADNA HEPATITIS B VIRUS QUANTIFICATION","87517 - HC CHG IADNA HEPATITIS B VIRUS QUANTIFICATION",213,42.84,39.07,480.84,53.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 87522","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","87522","HC ARUP;HEP C VIR RNA QN","87522 - HC ARUP;HEP C VIR RNA QN",213,92.49,39.07,480.84,53.25]
["BMC HEALTHNET - BMCHN MCO - CPT - 87529","BMC HEALTHNET","BMCHN MCO","CPT","87529","HC CHG IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ","87529 - HC CHG IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ",140,32.01,32.01,393.99,35]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 87529","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","87529","HC CHG IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ","87529 - HC CHG IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ",140,82.11,32.01,393.99,35]
["BMC HEALTHNET - BMCHN MCO - CPT - 87532","BMC HEALTHNET","BMCHN MCO","CPT","87532","HC CHG IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ","87532 - HC CHG IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ",38,32.01,32.01,393.99,9.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 87535","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","87535","HC CHG IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ","87535 - HC CHG IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ",359,35.090000000000003,32.01,393.99,89.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 87536","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","87536","HC CHG IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION","87536 - HC CHG IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION",279,192.36,77.09,955.28,69.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 87538","BLUE CROSS","BLUE CROSS-PPO","CPT","87538","HC HIV-2 PROBE&REVRSE TRNSCRIPJ","87538 - HC HIV-2 PROBE&REVRSE TRNSCRIPJ",326,79.05,32.01,393.99,81.5]
["BMC HEALTHNET - BMCHN ACO - CPT - 87556","BMC HEALTHNET","BMCHN ACO","CPT","87556","HC CHG IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB","87556 - HC CHG IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB",129,70.040000000000006,32.01,404.26,32.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 87556","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","87556","HC CHG IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB","87556 - HC CHG IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB",129,89.99,32.01,404.26,32.25]
["TUFTS - TUFTS MEDICARE SCO - CPT - 87563","TUFTS","TUFTS MEDICARE SCO","CPT","87563","HC M. GENITALIUM AMP PROBE","87563 - HC M. GENITALIUM AMP PROBE",129,50.88,35.090000000000003,187.56,32.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 87581","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","87581","HC CHG IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ","87581 - HC CHG IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ",127,35.090000000000003,32.01,393.99,31.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 87591","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","87591","HC CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ","87591 - HC CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ",129,75.760000000000005,32.01,393.99,32.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 87624","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","87624","IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES","87624 - IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES",110,37.68,32.01,393.99,27.5]
["FALLON - FALLON MEDICAID - CPT - 87631","FALLON","FALLON MEDICAID","CPT","87631","HC INFLUENZA A/B,RSV PCR","87631 - HC INFLUENZA A/B,RSV PCR",504,117.02,103.92,1440.32,126]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 87632","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","87632","HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 6-11 TARGETS","87632 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 6-11 TARGETS",504,481.89,157.59,2395.92,126]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 87633","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","87633","HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET","87633 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET",820,1048.7,291.7,4678.75,205]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 87635","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","87635","HC SARS-COV-2 COVID-19 AMP PRB","87635 - HC SARS-COV-2 COVID-19 AMP PRB",153,59.02,51.31,465.19,38.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 87636","BLUE CROSS","BLUE CROSS-PPO","CPT","87636","HC SARSCOV2 & INF A&B AMP PRB","87636 - HC SARSCOV2 & INF A&B AMP PRB",378,164.02,142.63,358.89,94.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 87636","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","87636","HC SARSCOV2 & INF A&B AMP PRB","87636 - HC SARSCOV2 & INF A&B AMP PRB",378,307.94,142.63,358.89,94.5]
["BMC HEALTHNET - BMCHN QHP - CPT - 87641","BMC HEALTHNET","BMCHN QHP","CPT","87641","HC CHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ","87641 - HC CHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ",129,38.409999999999997,32.01,393.99,32.25]
["TUFTS - TUFTS PPO - CPT - 87641","TUFTS","TUFTS PPO","CPT","87641","HC CHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ","87641 - HC CHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ",129,140.16999999999999,32.01,393.99,32.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 87653","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","87653","HC CHG IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ","87653 - HC CHG IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ",129,393.99,32.01,393.99,32.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 87660","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","87660","HC CHG IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ","87660 - HC CHG IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ",157,45.46,18.29,225.1,39.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 87660","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","87660","HC CHG IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ","87660 - HC CHG IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ",157,46.92,18.29,225.1,39.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 87797","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","87797","HC CHG DETECT AGENT NOS, DNA, DIR","87797 - HC CHG DETECT AGENT NOS, DNA, DIR",31,30.11,22.19,291.27999999999997,7.75]
["TUFTS - TUFTS SELECT - CPT - 87797","TUFTS","TUFTS SELECT","CPT","87797","HC CHG DETECT AGENT NOS, DNA, DIR","87797 - HC CHG DETECT AGENT NOS, DNA, DIR",31,45.24,22.19,291.27999999999997,7.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 87799","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","87799","HC CHG IADNA NOS QUANTIFICATION EACH ORGANISM","87799 - HC CHG IADNA NOS QUANTIFICATION EACH ORGANISM",307,96.84,39.07,480.84,76.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 87799","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","87799","HC CHG IADNA NOS QUANTIFICATION EACH ORGANISM","87799 - HC CHG IADNA NOS QUANTIFICATION EACH ORGANISM",307,102.77,39.07,480.84,76.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 87801","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","87801","HC CHG DETECT AGENT, MULT ORGS, DNA  AMP","87801 - HC CHG DETECT AGENT, MULT ORGS, DNA  AMP",310,155.13,64.03,787.98,77.5]
["BMC HEALTHNET - BMCHN ACO - CPT - 87880","BMC HEALTHNET","BMCHN ACO","CPT","87880","IAADIADOO STREPTOCOCCUS GROUP A","87880 - IAADIADOO STREPTOCOCCUS GROUP A",57,26.72,12.21,160.29,14.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 87899","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","87899","HC MALARIA ANTIGEN","87899 - HC MALARIA ANTIGEN",94,16.11,11.87,155.81,23.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 87899","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","87899","HC MALARIA ANTIGEN","87899 - HC MALARIA ANTIGEN",94,34.700000000000003,11.87,155.81,23.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 87900","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","87900","HC CHG NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION","87900 - HC CHG NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION",600,263.70999999999998,118.9,1463.3,150]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 87901","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","87901","HC CHG NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEAS","87901 - HC CHG NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEAS",675,447.96,112.85,2890.09,168.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 87902","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","87902","HC CHG NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS","87902 - HC CHG NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS",437,581.03,112.85,2890.09,109.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 87906","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT","87906","HC Q;HIV1 GENO","87906 - HC Q;HIV1 GENO",2063,128.72999999999999,56.44,1445.09,515.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 87912","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","87912","HC CHG NFCT AGENT GENOTYPE HEPATITIS B VIRUS","87912 - HC CHG NFCT AGENT GENOTYPE HEPATITIS B VIRUS",675,581.03,112.85,2890.09,168.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 88104","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","88104","HC CHG CYTOPATH FLUIDS SMEAR, INTERP","88104 - HC CHG CYTOPATH FLUIDS SMEAR, INTERP",218,36.39,30.84,366.72,54.5]
["BMC HEALTHNET - BMCHN MCO - CPT - 88108","BMC HEALTHNET","BMCHN MCO","CPT","88108","HC CHG CYTP CONCENTRATION SMEARS & INTERPRETATION","88108 - HC CHG CYTP CONCENTRATION SMEARS & INTERPRETATION",224,39.479999999999997,39.479999999999997,366.72,56]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 88108","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","88108","HC CHG CYTP CONCENTRATION SMEARS & INTERPRETATION","88108 - HC CHG CYTP CONCENTRATION SMEARS & INTERPRETATION",224,67.64,39.479999999999997,366.72,56]
["TUFTS - TUFTS POS - CPT - 88141","TUFTS","TUFTS POS","CPT","88141","HC CYTOPATH CERV/VAG INTEPRET","88141 - HC CYTOPATH CERV/VAG INTEPRET",96,0,21.87,100.38,24]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 88142","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","88142","CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN","88142 - CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN",101,45.46,18.48,227.42,25.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 88143","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","88143","HC CHG CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS","88143 - HC CHG CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS",101,49.74,18.48,228.72,25.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 88147","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","88147","HC CHG CYTOPATH SMEAR CERV/VAG AUTOMATED","88147 - HC CHG CYTOPATH SMEAR CERV/VAG AUTOMATED",78,59.66,15.61,490.34,19.5]
["TUFTS - TUFTS POS - CPT - 88147","TUFTS","TUFTS POS","CPT","88147","HC CHG CYTOPATH SMEAR CERV/VAG AUTOMATED","88147 - HC CHG CYTOPATH SMEAR CERV/VAG AUTOMATED",78,163.08000000000001,15.61,490.34,19.5]
["TUFTS - TUFTS SELECT - CPT - 88152","TUFTS","TUFTS SELECT","CPT","88152","HC CHG CYTOPATH SMEAR CERV/VAG,AUTO REDO","88152 - HC CHG CYTOPATH SMEAR CERV/VAG,AUTO REDO",36,41.63,13.16,268.05,9]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 88160","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","88160","HC CHG CYTP SMRS ANY OTH SRC SCR&INTERPJ","88160 - HC CHG CYTP SMRS ANY OTH SRC SCR&INTERPJ",182,28.75,22.57,200.27,45.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 88164","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT","88164","HC CHG CYTOPATH TBS CERV/VAG MANUAL","88164 - HC CHG CYTOPATH TBS CERV/VAG MANUAL",52,15.12,10.82,145.38,13]
["TUFTS - TUFTS PPO - CPT - 88164","TUFTS","TUFTS PPO","CPT","88164","HC CHG CYTOPATH TBS CERV/VAG MANUAL","88164 - HC CHG CYTOPATH TBS CERV/VAG MANUAL",52,51.72,10.82,145.38,13]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 88165","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","88165","HC CHG CYTP SLIDES C/V MNL SCR&RESCR PHYS SUPV","88165 - HC CHG CYTP SLIDES C/V MNL SCR&RESCR PHYS SUPV",52,37.43,13.16,409.48,13]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 88173","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","88173","CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT","88173 - CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT",441,110.07,56.76,557.29999999999995,110.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 88184","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT","88184","HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST","88184 - HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST",256,103.93,68.739999999999995,2458.16,64]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 88185","BMC HEALTHNET","BMCHN WELL SENSE","CPT","88185","HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA","88185 - HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA",158,35.42,35.42,62.22,39.5]
["TUFTS - TUFTS PPO - CPT - 88187","TUFTS","TUFTS PPO","CPT","88187","FLOWCYTOMETRY/READ, 2-8 MARKERS","88187 - FLOWCYTOMETRY/READ, 2-8 MARKERS",158,135.72,49.74,381.48,39.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 88230","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","88230","HC CHG TISS CUL NON-NEO DISORDERS LYMPHOCYTE","88230 - HC CHG TISS CUL NON-NEO DISORDERS LYMPHOCYTE",424,47.5,47.5,1307.74,106]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 88235","BLUE CROSS","BLUE CROSS-PPO","CPT","88235","HC CHG TISSUE CULTURE, PLACENTA","88235 - HC CHG TISSUE CULTURE, PLACENTA",594,332.02,120.58,1653.19,148.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 88237","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","88237","HC CHG TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS","88237 - HC CHG TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS",425,285.25,54.81,1426.13,106.25]
["BMC HEALTHNET - BMCHN QHP - CPT - 88262","BMC HEALTHNET","BMCHN QHP","CPT","88262","HC CHG CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING","88262 - HC CHG CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING",492,136.44,113.7,1399.23,123]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 88262","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","88262","HC CHG CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING","88262 - HC CHG CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING",492,181.96,113.7,1399.23,123]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 88264","BMC HEALTHNET","BMCHN WELL SENSE","CPT","88264","HC CHG CHRMSM ANALYZE 20-25 CELLS","88264 - HC CHG CHRMSM ANALYZE 20-25 CELLS",519,237.7,113.7,1414.07,129.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 88271","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","88271","HC CHG MOLECULAR CYTOGENETICS DNA PROBE EACH","88271 - HC CHG MOLECULAR CYTOGENETICS DNA PROBE EACH",373,29.38,19.54,240.42,93.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 88274","BLUE CROSS","BLUE CROSS-PPO","CPT","88274","HC CHG MOLECULAR CYTOGENETICS INTERPHASE ISH 25-99 CLL","88274 - HC CHG MOLECULAR CYTOGENETICS INTERPHASE ISH 25-99 CLL",172,78.400000000000006,31.76,411.07,43]
["BMC HEALTHNET - BMCHN MCO - CPT - 88275","BMC HEALTHNET","BMCHN MCO","CPT","88275","HC CHG MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL","88275 - HC CHG MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL",373,37.82,37.82,496.49,93.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 88275","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","88275","HC CHG MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL","88275 - HC CHG MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL",373,107.81,37.82,496.49,93.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 88280","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","88280","HC CHG CHROMOSOME KARYOTYPE STUDY","88280 - HC CHG CHROMOSOME KARYOTYPE STUDY",149,48.53,24.73,324.62,37.25]
["TUFTS - TUFTS HMO - CPT - 88291","TUFTS","TUFTS HMO","CPT","88291","HC CHG CYTOGENETICS&MOLEC CYTOGENETICS INTERP&REP","88291 - HC CHG CYTOGENETICS&MOLEC CYTOGENETICS INTERP&REP",563,0,21.78,99.36,140.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 88304","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","88304","HC CHG LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM","88304 - HC CHG LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM",191,67.040000000000006,55.2,557.29999999999995,47.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 88305","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","88305","CELL BLCK","88305 - CELL BLCK",331,110.07,67.040000000000006,557.29999999999995,82.75]
["TUFTS - TUFTS POS - CPT - 88307","TUFTS","TUFTS POS","CPT","88307","HC CHG LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM","88307 - HC CHG LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM",757,656.89,73.599999999999994,1975.12,189.25]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 88313","CIGNA HEALTHCARE","CIGNA PPO","CPT","88313","HC CHG SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT","88313 - HC CHG SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT",483,140.94,29.44,366.72,120.75]
["BMC HEALTHNET - BMCHN WELL SENSE - CPT - 88314","BMC HEALTHNET","BMCHN WELL SENSE","CPT","88314","HC HISTOCHEMICAL STAIN","88314 - HC HISTOCHEMICAL STAIN",239,71.760000000000005,69.39,143.9,59.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 88329","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","88329","HC CHG PATHOLOGY CONSULTATION DURING SURGERY","88329 - HC CHG PATHOLOGY CONSULTATION DURING SURGERY",110,42.24,42.24,364.6,27.5]
["TUFTS - TUFTS PPO - CPT - 88331","TUFTS","TUFTS PPO","CPT","88331","PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC","88331 - PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC",299,487.13,34.96,1369.2,74.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 88342","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","88342","HC CHG IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE","88342 - HC CHG IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE",336,190.34,36.799999999999997,1705.48,84]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 88346","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","88346","HC CHG IMMUNOFLUORESCENCE PER SPEC 1ST SINGL ANTB STAIN","88346 - HC CHG IMMUNOFLUORESCENCE PER SPEC 1ST SINGL ANTB STAIN",327,592.04,84.87,2458.16,81.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 88350","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","88350","IMMUNOFLUORESCENCE PER SPEC ADD SINGL ANTB STAIN","88350 - IMMUNOFLUORESCENCE PER SPEC ADD SINGL ANTB STAIN",389,99.67,99.67,103.96,97.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 88361","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","88361","HC CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST","88361 - HC CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST",475,592.04,194.53,2458.16,118.75]
["TUFTS - TUFTS POS - CPT - 88362","TUFTS","TUFTS POS","CPT","88362","HC NERVE TEASING PREPARATIONS","88362 - HC NERVE TEASING PREPARATIONS",670,1765.64,184,5308.75,167.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 88364","BLUE CROSS","BLUE CROSS-PPO","CPT","88364","IN SITU HYBRIDIZATION EA ADDL PROBE STAIN","88364 - IN SITU HYBRIDIZATION EA ADDL PROBE STAIN",221,201.48,133.29,201.48,55.25]
["FALLON - FALLON MEDICAID - CPT - 88368","FALLON","FALLON MEDICAID","CPT","88368","HC CHG M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL","88368 - HC CHG M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL",699,129.21,129.21,2458.16,174.75]
["TUFTS - TUFTS HMO - CPT - 88380","TUFTS","TUFTS HMO","CPT","88380","HC CHG MICRODISSECTION PREP IDENTIFIED TARGET LASER","88380 - HC CHG MICRODISSECTION PREP IDENTIFIED TARGET LASER",3123,0,28.59,161.54,780.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 89050","BMC HEALTHNET","BMCHN ACO","CPT","89050","HC CHG CELL COUNT MISCELLANEOUS BODY FLUIDS","89050 - HC CHG CELL COUNT MISCELLANEOUS BODY FLUIDS",25,9.43,4.3099999999999996,53.02,6.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 89051","BLUE CROSS","BLUE CROSS-PPO","CPT","89051","HC CHG CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT","89051 - HC CHG CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT",28,12.51,5.0199999999999996,61.83,7]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 89051","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","89051","HC CHG CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT","89051 - HC CHG CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT",28,6.02,5.0199999999999996,61.83,7]
["CIGNA HEALTHCARE - CIGNA PPO - CPT - 89060","CIGNA HEALTHCARE","CIGNA PPO","CPT","89060","HC CHG CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID","89060 - HC CHG CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID",63,18.170000000000002,6.52,80.290000000000006,15.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 89320","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","89320","SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT","89320 - SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT",118,17.850000000000001,10.99,135.27000000000001,29.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 89320","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","89320","SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT","89320 - SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT",118,28.91,10.99,135.27000000000001,29.5]
["TUFTS - TUFTS PPO - CPT - 90389","TUFTS","TUFTS PPO","CPT","90389","HC US SCREENING SAAAVE MCR","90389 - HC US SCREENING SAAAVE MCR",544,620.82000000000005,123.13,1744.97,136]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90472","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","90472","IMADM PRQ ID SUBQ/IM NJXS EA VACCINE","90472 - IMADM PRQ ID SUBQ/IM NJXS EA VACCINE",64,25.32,25.32,25.32,16]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90473","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","90473","IMADM INTRANSL/ORAL 1 VACCINE","90473 - IMADM INTRANSL/ORAL 1 VACCINE",64,129,108.45,345.64,16]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90621","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","90621","MENB-FHBP RECOMBNT LIPOPROTEIN VACC 2/3 DOSE IM","90621 - MENB-FHBP RECOMBNT LIPOPROTEIN VACC 2/3 DOSE IM",444,262.89999999999998,146.87,441.59,111]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90625","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","90625","HC  CHOLERA VACCINE ADULT 1 DOSE LIVE FOR ORAL USE","90625 - HC  CHOLERA VACCINE ADULT 1 DOSE LIVE FOR ORAL USE",749.23,749.23,749.23,749.23,187.3075]
["TUFTS - TUFTS PPO - CPT - 90636","TUFTS","TUFTS PPO","CPT","90636","HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM","90636 - HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM",123,0,74.239999999999995,150.25,30.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90648","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","90648","HC HIB VACCINE, PRP-T, IM,DPH","90648 - HC HIB VACCINE, PRP-T, IM,DPH",355.01,135.465,35.97,355.01,88.752499999999998]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 90653","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT","90653","HC IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE","90653 - HC IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE",79,80.260000000000005,59.53,149.79,19.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 90662","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","90662","INFLUENZA VACCINE CELL CULT PRSRV FREE IM FLUZONE HIGH DOSE","90662 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM FLUZONE HIGH DOSE",129,70.13,60.98,244.17,32.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 90670","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","90670","CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH","90670 - CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH",749.99,725.45,700.91,749.99,187.4975]
["TUFTS - TUFTS SELECT - CPT - 90672","TUFTS","TUFTS SELECT","CPT","90672","CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST","90672 - CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST",81.53,80.009999999999991,78.489999999999995,81.53,20.3825]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 90673","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","90673","INFLUENZA VACCINE CELL CULT PRSRV FREE IM","90673 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM",127,47.92,40.61,177.04,31.75]
["TUFTS - TUFTS POS - CPT - 90674","TUFTS","TUFTS POS","CPT","90674","HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE","90674 - HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",72.349999999999994,72.34,72.33,72.349999999999994,18.087499999999999]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 90686","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","90686","HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE","90686 - HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",66.930000000000007,62.792500000000004,59.699999999999996,66.930000000000007,16.732500000000002]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90690","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","90690","CR BUILD ONLY - TYPHOID VACCINE, ORAL,TRAVEL","90690 - CR BUILD ONLY - TYPHOID VACCINE, ORAL,TRAVEL",234.33,234.33,234.33,234.33,58.582500000000003]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 90691","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","90691","CR BUILD ONLY - TYPHOID VACCINE, IM,TRAVEL","90691 - CR BUILD ONLY - TYPHOID VACCINE, IM,TRAVEL",359.7,359.7,359.7,359.7,89.924999999999997]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90694","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","90694","HC VACC AIIV4 NO PRSRV 0.5ML IM","90694 - HC VACC AIIV4 NO PRSRV 0.5ML IM",180.47,180.42500000000001,180.38,180.47,45.1175]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90698","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","90698","CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH","90698 - CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",355.01,290.48799999999994,160.24,355.01,88.752499999999998]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90707","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","90707","CR BUILD ONLY - MMR VIRUS IMMUNIZATION, SUBCUT,TRAVEL,PEDI","90707 - CR BUILD ONLY - MMR VIRUS IMMUNIZATION, SUBCUT,TRAVEL,PEDI",280.73,280.73,280.73,280.73,70.182500000000005]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 90714","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","90714","CR BUILD ONLY - TD VACCINE NO PRSRV >/= 7 YO, IM,DPH","90714 - CR BUILD ONLY - TD VACCINE NO PRSRV >/= 7 YO, IM,DPH",63.91,61.674999999999997,59.44,63.91,15.977499999999999]
["TUFTS - TUFTS POS - CPT - 90715","TUFTS","TUFTS POS","CPT","90715","CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH","90715 - CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",163.03,145.40857142857143,121.14999999999999,163.03,40.7575]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90717","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","90717","YELLOW FEVER VACCINE SUBQ","90717 - YELLOW FEVER VACCINE SUBQ",578.47,578.47,578.47,578.47,144.61750000000001]
["TUFTS - TUFTS POS - CPT - 90723","TUFTS","TUFTS POS","CPT","90723","CR BUILD ONLY - DTAP/HEPB/IPV VACCINE,IM,DPH","90723 - CR BUILD ONLY - DTAP/HEPB/IPV VACCINE,IM,DPH",306.57,306.57,306.57,306.57,76.642499999999998]
["TUFTS - TUFTS PPO - CPT - 90734","TUFTS","TUFTS PPO","CPT","90734","CR BUILD ONLY - MENINGOCOCCAL VACCINE, IM,TRAVEL","90734 - CR BUILD ONLY - MENINGOCOCCAL VACCINE, IM,TRAVEL",464.28,412.12000000000006,362.95,464.28,116.07]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90738","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","90738","HC JAPANESE ENCEPH VACC, INACTIVATED, IM,TRAVEL","90738 - HC JAPANESE ENCEPH VACC, INACTIVATED, IM,TRAVEL",479,447.2,53.59,929.69,119.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90740","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","90740","HC HEP B VACCINE,DIAL/IMMUNOSUP, IM","90740 - HC HEP B VACCINE,DIAL/IMMUNOSUP, IM",350.28,144.89333333333332,0.18000000000000002,350.28,87.57]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90744","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","90744","CR BUILD ONLY - HEP B VACCINE,PED/ADOL,IM,DPH","90744 - CR BUILD ONLY - HEP B VACCINE,PED/ADOL,IM,DPH",87.01,87.01,87.01,87.01,21.752500000000001]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 90746","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","90746","CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL","90746 - CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL",217.1,200.7775,175.53,217.1,54.274999999999999]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90750","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","90750","HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX","90750 - HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX",540.45000000000005,404.48500000000001,268.52,540.45000000000005,135.11250000000001]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90785","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","90785","PSYCHOTHERAPY COMPLEX INTERACTIVE","90785 - PSYCHOTHERAPY COMPLEX INTERACTIVE",27,32.82,32.82,32.82,6.75]
["TUFTS - TUFTS PPO - CPT - 90792","TUFTS","TUFTS PPO","CPT","90792","PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES","90792 - PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES",165,46.18,40.369999999999997,214.2,41.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90833","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","90833","PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 30 MIN","90833 - PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 30 MIN",27,155.30000000000001,155.30000000000001,155.30000000000001,6.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90840","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","90840","HC PSYCHOTHERAPY FOR CRISIS EACH ADDL 30 MINUTES","90840 - HC PSYCHOTHERAPY FOR CRISIS EACH ADDL 30 MINUTES",92,147.96,147.96,147.96,23]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 90845","BMC HEALTHNET","BMCHN MEDICAID","CPT","90845","PSYCHOANALYSIS","90845 - PSYCHOANALYSIS",153,0,40.369999999999997,214.2,38.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90847","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","90847","FAMILY PSYCHOTHERAPY W/PATIENT PRESENT","90847 - FAMILY PSYCHOTHERAPY W/PATIENT PRESENT",281,214.2,44.81,214.2,70.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90867","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","90867","HC TRANSCRANIAL MAGNETIC STIMULATION TREATMENT,PLANNING","90867 - HC TRANSCRANIAL MAGNETIC STIMULATION TREATMENT,PLANNING",390,423.72,423.72,2582.75,97.5]
["TUFTS - TUFTS HMO - CPT - 90882","TUFTS","TUFTS HMO","CPT","90882","HC ENVIRONMENTAL IVNTJ MGMT PURPOSES PSYC PT","90882 - HC ENVIRONMENTAL IVNTJ MGMT PURPOSES PSYC PT",218,357.12,158.44,894.84,54.5]
["TUFTS - TUFTS SELECT - CPT - 90901","TUFTS","TUFTS SELECT","CPT","90901","HC BIOFEEDBACK TRAINING, ANY MODALITY","90901 - HC BIOFEEDBACK TRAINING, ANY MODALITY",260,86.03,85.76,485.85,65]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90913","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","90913","HC BFB TRAINING EA ADDL 15 MIN","90913 - HC BFB TRAINING EA ADDL 15 MIN",260,60.18,60.18,1370.62,65]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 91010","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","91010","ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT","91010 - ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT",906,4807.5,764.57,4807.5,226.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 91034","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","91034","GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT","91034 - GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT",968,958.8,764.57,4807.5,242]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 91065","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","91065","BREATH HYDROGEN TEST","91065 - BREATH HYDROGEN TEST",470,228.32,228.32,1412.44,117.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 91110","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","91110","GI IMAG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R","91110 - GI IMAG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R",4594,1603.82,1278.93,7945.14,1148.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 91112","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","91112","GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP","91112 - GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP",5914,0,1278.93,4318.55,1478.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 91200","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","91200","HC LIVER ELASTOGRAPHY W/O IMAG W/I&R","91200 - HC LIVER ELASTOGRAPHY W/O IMAG W/I&R",301,293.52,219.65,700.05,75.25]
["TUFTS - TUFTS HMO - CPT - 92012","TUFTS","TUFTS HMO","CPT","92012","OPHTH MEDICAL XM&EVAL INTERMEDIATE ESTAB PT","92012 - OPHTH MEDICAL XM&EVAL INTERMEDIATE ESTAB PT",265,43.48,31.68,194.55,66.25]
["TUFTS - TUFTS SELECT - CPT - 92015","TUFTS","TUFTS SELECT","CPT","92015","DETERMINATION REFRACTIVE STATE","92015 - DETERMINATION REFRACTIVE STATE",94,0,42.5,47.23,23.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 92020","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","92020","GONIOSCOPY SEPARATE PROCEDURE","92020 - GONIOSCOPY SEPARATE PROCEDURE",192,178.83,68.75,587.33000000000004,48]
["UNICARE - UNICARE - CPT - 92065","UNICARE","UNICARE","CPT","92065","ORTHOPTIC &/PLEOPTIC TRAINING W/MEDICAL DIRECTJ","92065 - ORTHOPTIC &/PLEOPTIC TRAINING W/MEDICAL DIRECTJ",269,82.5,68.75,344.19,67.25]
["TUFTS - TUFTS PPO - CPT - 92071","TUFTS","TUFTS PPO","CPT","92071","FIT CONTACT LENS TX OCULAR SURFACE DISEASE","92071 - FIT CONTACT LENS TX OCULAR SURFACE DISEASE",108,0,82.25,229.89,27]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 92132","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","92132","CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI","92132 - CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI",186,120.69,68.75,562.35,46.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 92132","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","92132","CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI","92132 - CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI",186,120.69,68.75,562.35,46.5]
["TUFTS - TUFTS HMO - CPT - 92136","TUFTS","TUFTS HMO","CPT","92136","OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL","92136 - OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL",442,358.22,68.75,607.84,110.5]
["TUFTS - TUFTS POS - CPT - 92226","TUFTS","TUFTS POS","CPT","92226","OPHTHALMOSCPY EXTENDED RETINAL DRAWING I&R SBS","92226 - OPHTHALMOSCPY EXTENDED RETINAL DRAWING I&R SBS",95,269.06,68.75,456.55,23.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 92240","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","92240","INDOCYANINE GREEN ANGIOGRAPHY W/INTERP & REPOR","92240 - INDOCYANINE GREEN ANGIOGRAPHY W/INTERP & REPOR",1248,544.74,172.1,2582.75,312]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 92260","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","92260","OPHTHALMODYNAMOMETRY","92260 - OPHTHALMODYNAMOMETRY",92,69.349999999999994,53.94,341.01,23]
["TUFTS - TUFTS PPO - CPT - 92265","TUFTS","TUFTS PPO","CPT","92265","NEEDLE OCULOGRAPHY 1/ XOC MUSC 1/BOTH EYE W/I&R","92265 - NEEDLE OCULOGRAPHY 1/ XOC MUSC 1/BOTH EYE W/I&R",420,200.07,68.75,562.35,105]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 92274","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","92274","HC MULTIFOCAL ERG W/I&R","92274 - HC MULTIFOCAL ERG W/I&R",210,293.52,228.32,797.09,52.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 92284","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","92284","DARK ADAPTATION XM W/INTERPRETATION & REPORT","92284 - DARK ADAPTATION XM W/INTERPRETATION & REPORT",302,584.69000000000005,125.6,2664.1,75.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 92286","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","92286","ANT SGM IMAGING W/MICROSCOPY ENDOTHELIAL ANALY","92286 - ANT SGM IMAGING W/MICROSCOPY ENDOTHELIAL ANALY",615,229.89,125.6,1077.0999999999999,153.75]
["TUFTS - TUFTS POS - CPT - 92311","TUFTS","TUFTS POS","CPT","92311","HC CONTACT LENS FIT, APHAKIA UNILAT","92311 - HC CONTACT LENS FIT, APHAKIA UNILAT",523,906.67,93.14,1538.47,130.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 92312","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","92312","HC CONTACT LENS FIT,APHAKIA BILAT","92312 - HC CONTACT LENS FIT,APHAKIA BILAT",163,178.83,93.14,587.33000000000004,40.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 92502","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","92502","HC EAR AND THROAT EXAMINATION","92502 - HC EAR AND THROAT EXAMINATION",658,818.07,789.53,2516.34,164.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 92520","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","92520","LARYNGEAL FUNCTION STUDIES","92520 - LARYNGEAL FUNCTION STUDIES",206,178.83,178.83,1047.6300000000001,51.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 92522","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","92522","EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE","92522 - EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE",440,226.86,179.09,570.79,110]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 92523","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","92523","EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION","92523 - EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION",912,486.27,279.74,1188.2,228]
["TUFTS - TUFTS POS - CPT - 92526","TUFTS","TUFTS POS","CPT","92526","TX SWALLOWING DYSFUNCTION&/ORAL FUNCJ FEEDING","92526 - TX SWALLOWING DYSFUNCTION&/ORAL FUNCJ FEEDING",361,340.95,181.53,578.54,90.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 92538","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","92538","CALORIC VEST BILATERAL MONOTHERMAL","92538 - CALORIC VEST BILATERAL MONOTHERMAL",584,293.52,228.32,1610.39,146]
["TUFTS - TUFTS POS - CPT - 92541","TUFTS","TUFTS POS","CPT","92541","SPONTANEOUS NYSTAGMUS TEST","92541 - SPONTANEOUS NYSTAGMUS TEST",150,358.22,178.83,1077.0999999999999,37.5]
["TUFTS - TUFTS POS - CPT - 92545","TUFTS","TUFTS POS","CPT","92545","OSCILLATING TRACKING TEST W/RECORDING","92545 - OSCILLATING TRACKING TEST W/RECORDING",163,469.76,228.32,1412.44,40.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 92552","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","92552","PURE TONE AUDIOMETRY AIR ONLY","92552 - PURE TONE AUDIOMETRY AIR ONLY",159,178.83,40.869999999999997,997.99,39.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 92553","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","92553","PURE TONE AUDIOMETRY AIR & BONE","92553 - PURE TONE AUDIOMETRY AIR & BONE",246,293.52,40.869999999999997,1391.25,61.5]
["TUFTS - TUFTS PPO - CPT - 92556","TUFTS","TUFTS PPO","CPT","92556","SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ","92556 - SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ",181,119.77,53.94,336.64,45.25]
["TUFTS - TUFTS SELECT - CPT - 92562","TUFTS","TUFTS SELECT","CPT","92562","LOUDNESS BALANCE BINAURAL/MONAURAL","92562 - LOUDNESS BALANCE BINAURAL/MONAURAL",215,225.69,59.1,1274.6400000000001,53.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 92565","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","92565","STENGER TEST PURE TONE","92565 - STENGER TEST PURE TONE",102,69.349999999999994,53.94,336.64,25.5]
["TUFTS - TUFTS HMO - CPT - 92567","TUFTS","TUFTS HMO","CPT","92567","TYMPANOMETRY","92567 - TYMPANOMETRY",110,134.36000000000001,53.94,336.64,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 92572","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","92572","STAGGERED SPONDAIC WORD","92572 - STAGGERED SPONDAIC WORD",178,228.32,59.1,1412.44,44.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 92577","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","92577","STENGER TEST SPEECH","92577 - STENGER TEST SPEECH",286,764.57,158,3800.82,71.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 92582","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","92582","CONDITIONING PLAY AUDIOMETRY","92582 - CONDITIONING PLAY AUDIOMETRY",347,1391.25,158,1391.25,86.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 92585","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","92585","AUDITORY EVOKED POTENTIALS COMPREHENSIVE","92585 - AUDITORY EVOKED POTENTIALS COMPREHENSIVE",639,544.74,326.83,2582.75,159.75]
["TUFTS - TUFTS PPO - CPT - 92587","TUFTS","TUFTS PPO","CPT","92587","DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD","92587 - DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD",457,831.53,107.3,2337.23,114.25]
["TUFTS - TUFTS POS - CPT - 92588","TUFTS","TUFTS POS","CPT","92588","DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL","92588 - DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL",457,777.33,107.3,2337.23,114.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 92592","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","92592","HEARING AID CHECK MONAURAL","92592 - HEARING AID CHECK MONAURAL",67,49.9,24.58,138.81,16.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 92597","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","92597","EVAL&/FITG VOICE PROSTC DEV SUPLMNT ORAL SPEEC","92597 - EVAL&/FITG VOICE PROSTC DEV SUPLMNT ORAL SPEEC",348,1175.1199999999999,178.94,1175.1199999999999,87]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 92602","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","92602","HC REPROGRAM COCHLEAR IMPLT <7","92602 - HC REPROGRAM COCHLEAR IMPLT <7",203,228.32,228.32,1412.44,50.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 92604","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","92604","HC DX ANAL COCHLEAR IMP, PT >7 YRS, REPROG","92604 - HC DX ANAL COCHLEAR IMP, PT >7 YRS, REPROG",208,228.32,228.32,1412.44,52]
["TUFTS - TUFTS PPO - CPT - 92607","TUFTS","TUFTS PPO","CPT","92607","RX SP-GENRATJ AUGMNT&COMUNICAJ DEV 1ST HR","92607 - RX SP-GENRATJ AUGMNT&COMUNICAJ DEV 1ST HR",518,334.3,166.37,939.63,129.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 92612","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","92612","FLX FIBOPT NDSC EVAL SWLNG C/V REC","92612 - FLX FIBOPT NDSC EVAL SWLNG C/V REC",338,167.41,167.41,970.97,84.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 92621","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","92621","EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN","92621 - EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN",95,0,46.73,46.73,23.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 92627","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","92627","HC EVAL AUDITORY REHAB STATUS, EA ADD 15","92627 - HC EVAL AUDITORY REHAB STATUS, EA ADD 15",208,0,44.13,44.13,52]
["BMC HEALTHNET - BMCHN ACO - CPT - 92633","BMC HEALTHNET","BMCHN ACO","CPT","92633","HC AUD REH POSTLING HEARLOSS","92633 - HC AUD REH POSTLING HEARLOSS",208,0,0,0,52]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 92924","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","92924","HC PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH","92924 - HC PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH",10821,16237.9,12498.68,37129.18,2705.25]
["TUFTS - TUFTS PPO - CPT - 92925","TUFTS","TUFTS PPO","CPT","92925","HC ATHER MAJOR/BRANCH EA ADD","92925 - HC ATHER MAJOR/BRANCH EA ADD",11269,0,4148.71,4148.71,2817.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 92933","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","92933","HC PRQ TRLUML CORONRY STENT/ATH/ANGIO ONE ART/BRNCH","92933 - HC PRQ TRLUML CORONRY STENT/ATH/ANGIO ONE ART/BRNCH",16686,25785.9,3954.83,62742.78,4171.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 92937","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","92937","HC PRQ TRLUML CORONARY BYP GRFT REVASC ONE VESSEL","92937 - HC PRQ TRLUML CORONARY BYP GRFT REVASC ONE VESSEL",14735,18787.919999999998,12498.68,37129.18,3683.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 92943","BLUE CROSS","BLUE CROSS-PPO","CPT","92943","HC PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL","92943 - HC PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL",10821,16237.9,12498.68,37129.18,2705.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 92944","BLUE CROSS","BLUE CROSS-PPO","CPT","92944","PRQ TRLUML CORONRY CHRNIC OCCLUS REVASC ADDL VSL","92944 - PRQ TRLUML CORONRY CHRNIC OCCLUS REVASC ADDL VSL",5075,6373.27,6373.27,6373.27,1268.75]
["TUFTS - TUFTS SELECT - CPT - 92953","TUFTS","TUFTS SELECT","CPT","92953","HC TEMPORARY TRANSCUTANEOUS PACING","92953 - HC TEMPORARY TRANSCUTANEOUS PACING",798,886.73,884.17,5007.9799999999996,199.5]
["TUFTS - TUFTS POS - CPT - 92977","TUFTS","TUFTS POS","CPT","92977","HC THROMBOLYSIS,CORONARY,IV INFUSN","92977 - HC THROMBOLYSIS,CORONARY,IV INFUSN",437,1004.82,484.3,3021.28,109.25]
["TUFTS - TUFTS POS - CPT - 92978","TUFTS","TUFTS POS","CPT","92978","HC ENDOLUMINAL CORONARY IVUS OCT I&R INITIAL VESSEL","92978 - HC ENDOLUMINAL CORONARY IVUS OCT I&R INITIAL VESSEL",821,0,646.49,646.49,205.25]
["TUFTS - TUFTS HMO - CPT - 92990","TUFTS","TUFTS HMO","CPT","92990","PRQ BALLOON VALVULOPLASTY PULMONARY VALVE","92990 - PRQ BALLOON VALVULOPLASTY PULMONARY VALVE",10820,16146.45,8621.5499999999993,25611.61,2705]
["TUFTS - TUFTS PPO - CPT - 92990","TUFTS","TUFTS PPO","CPT","92990","PRQ BALLOON VALVULOPLASTY PULMONARY VALVE","92990 - PRQ BALLOON VALVULOPLASTY PULMONARY VALVE",10820,16146.45,8621.5499999999993,25611.61,2705]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 93225","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","93225","HC XTRNL ECG & 48 HR RECORDING","93225 - HC XTRNL ECG & 48 HR RECORDING",245,126.22,126.22,1077.0999999999999,61.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 93270","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","93270","XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS","93270 - XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS",84,80.23,62.4,370.47,21]
["UNICARE - UNICARE - CPT - 93278","UNICARE","UNICARE","CPT","93278","SIGNAL AVERAGED ELECTROCARDIOGRAPHY W/WO ECG","93278 - SIGNAL AVERAGED ELECTROCARDIOGRAPHY W/WO ECG",85,56.72,47.27,562.35,21.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 93281","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","93281","PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER","93281 - PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER",604,62.4,41.48,370.47,151]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 93282","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","93282","PROGRAM EVAL IMPLANTABLE IN PERSN 1 LD CARD/DFB","93282 - PROGRAM EVAL IMPLANTABLE IN PERSN 1 LD CARD/DFB",558,370.47,62.4,370.47,139.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 93285","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","93285","PROGRAM EVAL IMPLANTABLE DEV IN PRSN ILR SYSTEM","93285 - PROGRAM EVAL IMPLANTABLE DEV IN PRSN ILR SYSTEM",369,80.23,41.48,370.47,92.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 93286","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","93286","HC PERI-PX EVAL&PROGRAM IN PRSN PACEMAKER SYSTEM","93286 - HC PERI-PX EVAL&PROGRAM IN PRSN PACEMAKER SYSTEM",237,0,52.71,52.71,59.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 93288","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","93288","INTERROGATION EVAL IN PERSON 1/DUAL/MLT LEAD PM","93288 - INTERROGATION EVAL IN PERSON 1/DUAL/MLT LEAD PM",334,62.4,41.48,370.47,83.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 93293","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","93293","HC TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL","93293 - HC TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL",56,62.4,62.4,370.47,14]
["UNICARE - UNICARE - CPT - 93293","UNICARE","UNICARE","CPT","93293","HC TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL","93293 - HC TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL",56,80.650000000000006,62.4,370.47,14]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 93296","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","93296","HC REM INTERROG EVL PM/IDS","93296 - HC REM INTERROG EVL PM/IDS",57,62.4,62.4,370.47,14.25]
["TUFTS - TUFTS PPO - CPT - 93299","TUFTS","TUFTS PPO","CPT","93299","INTERROGATION EVAL REMOTE </30 D TECH REVIEW","93299 - INTERROGATION EVAL REMOTE </30 D TECH REVIEW",165,131.6,65.5,369.9,41.25]
["TUFTS - TUFTS HMO - CPT - 93307","TUFTS","TUFTS HMO","CPT","93307","HC ECHO HEART XTHORACIC,COMPLETE, W/O DOPPLER  WITH CONTRAST","93307 - HC ECHO HEART XTHORACIC,COMPLETE, W/O DOPPLER  WITH CONTRAST",1065,1173.3699999999999,387.2,2940.06,266.25]
["TUFTS - TUFTS POS - CPT - 93308","TUFTS","TUFTS POS","CPT","93308","HC ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD WITH CONTRAST","93308 - HC ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD WITH CONTRAST",897,774.2,188.28,2327.8200000000002,224.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 93313","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","93313","HC ECHO R-T 2D W/PROBE PLACEMENT ONLY","93313 - HC ECHO R-T 2D W/PROBE PLACEMENT ONLY",1031,1074.08,756.94,5016.9799999999996,257.75]
["TUFTS - TUFTS POS - CPT - 93318","TUFTS","TUFTS POS","CPT","93318","HC ECHO TRANSEOPHAG MONTR CARDIAC PUMP FUNCTJ","93318 - HC ECHO TRANSEOPHAG MONTR CARDIAC PUMP FUNCTJ",1153,1724.6,756.94,5185.51,288.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 93321","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","93321","HC DOP ECHOCARD PULSE WAVE W/SPECTRAL F-UP/LMTD STD","93321 - HC DOP ECHOCARD PULSE WAVE W/SPECTRAL F-UP/LMTD STD",224,51.85,51.85,225.94,56]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 93350","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","93350","HC ECHO HEART XTHORACIC, STRESS/REST WITH CONTRAST","93350 - HC ECHO HEART XTHORACIC, STRESS/REST WITH CONTRAST",1869,1047.71,403.66,4775.3,467.25]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 93356","BMC HEALTHNET","BMCHN MEDICAID","CPT","93356","HC MYOCRD STRAIN IMG SPCKL TRCK","93356 - HC MYOCRD STRAIN IMG SPCKL TRCK",1869,0,0,0,467.25]
["AETNA - AETNA - CPT - 93452","AETNA","AETNA","CPT","93452","HC L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - HC L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",8230,2531.06,2531.06,7703.8,2057.5]
["TUFTS - TUFTS HMO - CPT - 93453","TUFTS","TUFTS HMO","CPT","93453","HC R & L HRT CATH W/NJX L VENTRICULOG IMG S&I","93453 - HC R & L HRT CATH W/NJX L VENTRICULOG IMG S&I",10776,4856.75,2531.06,7703.8,2694]
["TUFTS - TUFTS HMO - CPT - 93456","TUFTS","TUFTS HMO","CPT","93456","HC CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I","93456 - HC CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I",10614,4856.75,2531.06,7703.8,2653.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 93458","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","93458","HC CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I","93458 - HC CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I",10240,4719.71,2531.06,7703.8,2560]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 93459","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","93459","HC CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I","93459 - HC CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I",11307,4719.71,2531.06,7703.8,2826.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 93462","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","93462","HC LEFT HEART CATH BY TRANSEPTAL PUNCTURE","93462 - HC LEFT HEART CATH BY TRANSEPTAL PUNCTURE",6104,0,524.49,5396.16,1526]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 93464","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","93464","HC PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU","93464 - HC PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU",845,0,427.95,427.95,211.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 93530","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","93530","RHC CNGNITL ANMLES","93530 - RHC CNGNITL ANMLES",2897,4719.71,2531.06,7703.8,724.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 93533","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","93533","CMBN R HRT T-SEPTAL L HRT CATHJ SEPTAL OPNG CGEN","93533 - CMBN R HRT T-SEPTAL L HRT CATHJ SEPTAL OPNG CGEN",3361,5460.91,2531.06,11845.41,840.25]
["TUFTS - TUFTS POS - CPT - 93565","TUFTS","TUFTS POS","CPT","93565","HC NJX SEL L VENT/ATRIAL ANGIO HRT CATH W/S&I","93565 - HC NJX SEL L VENT/ATRIAL ANGIO HRT CATH W/S&I",401,0,112.05,112.05,100.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 93566","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","93566","HC NJX SEL R VENT/ATRIAL ANGIO HRT CATH W/S&I","93566 - HC NJX SEL R VENT/ATRIAL ANGIO HRT CATH W/S&I",397,0,115.44,115.44,99.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 93568","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","93568","HC NJX PULMONARY ANGIO HRT CATH W/S&I","93568 - HC NJX PULMONARY ANGIO HRT CATH W/S&I",411,0,118.04,118.04,102.75]
["TUFTS - TUFTS SELECT - CPT - 93580","TUFTS","TUFTS SELECT","CPT","93580","PRQ TCAT CLSR CGEN INTRATRL COMUNICAJ W/IMPLT","93580 - PRQ TCAT CLSR CGEN INTRATRL COMUNICAJ W/IMPLT",19898,21120.9,2574.12,62742.78,4974.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 93590","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","93590","HC PERQ TRANSCATH CLS PARAVALVR LEAK 1 MITRAL VALVE","93590 - HC PERQ TRANSCATH CLS PARAVALVR LEAK 1 MITRAL VALVE",24055,25785.9,2574.12,62742.78,6013.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 93592","BLUE CROSS","BLUE CROSS-PPO","CPT","93592","HC PERQ TRANSCATH CLS PARAVALVR LEAK EACH OCCLS DEV","93592 - HC PERQ TRANSCATH CLS PARAVALVR LEAK EACH OCCLS DEV",12027,975.19,975.19,1198.25,3006.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 93610","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","93610","HC INTRA-ATRIAL PACING","93610 - HC INTRA-ATRIAL PACING",8754,9904.74,4616.53,47572.639999999999,2188.5]
["AETNA - AETNA - CPT - 93620","AETNA","AETNA","CPT","93620","HC COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION","93620 - HC COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION",8184,2531.06,2531.06,9904.74,2046]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 93622","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","93622","HC COMPRE ELECTROPHYSIOL XM W/LEFT VENTR PACNG/REC","93622 - HC COMPRE ELECTROPHYSIOL XM W/LEFT VENTR PACNG/REC",1561,0,524.51,5170.4799999999996,390.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 93642","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","93642","HC EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS","93642 - HC EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS",3473,1543.9,1318.95,9798.84,868.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 93644","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","93644","HC EPHYS EVAL SUBQ IMPLANTABLE DEFIBRILLATOR","93644 - HC EPHYS EVAL SUBQ IMPLANTABLE DEFIBRILLATOR",382,0,138.5,138.5,95.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 93654","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","93654","HC COMPRE EP EVAL TX VT","93654 - HC COMPRE EP EVAL TX VT",16142,62742.78,2531.06,62742.78,4035.5]
["TUFTS - TUFTS POS - CPT - 93655","TUFTS","TUFTS POS","CPT","93655","HC ICAR CATHETER ABLATION ARRHYTHMIA ADD ON","93655 - HC ICAR CATHETER ABLATION ARRHYTHMIA ADD ON",3836,0,1065.1099999999999,1198.25,959]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 93657","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","93657","HC ABLATE L/R ATRIAL FIBRIL W/ISOLATED PULM VEIN","93657 - HC ABLATE L/R ATRIAL FIBRIL W/ISOLATED PULM VEIN",3838,1063.23,1063.23,1198.25,959.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 93662","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","93662","INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I","93662 - INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I",1277,3767.18,426.19,4520.62,319.25]
["TUFTS - TUFTS POS - CPT - 93750","TUFTS","TUFTS POS","CPT","93750","HC INTERROGATION VAD IN PERSON","93750 - HC INTERROGATION VAD IN PERSON",146,380.48,197.39,1144.02,36.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 93786","BMC HEALTHNET","BMCHN MEDICAID","CPT","93786","BL BLD PRESS W/TAPE&/DISK 24/> HR REC ONL","93786 - BL BLD PRESS W/TAPE&/DISK 24/> HR REC ONL",283,0,126.22,1077.0999999999999,70.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 93797","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","93797","SP CARD REHAB MAINTAIN","93797 - SP CARD REHAB MAINTAIN",274,1130.1600000000001,74.930000000000007,1130.1600000000001,68.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 93882","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","93882","HC DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY","93882 - HC DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY",1667,236.95,188.94,1204.79,416.75]
["UNICARE - UNICARE - CPT - 93886","UNICARE","UNICARE","CPT","93886","TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL","93886 - TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL",3426,360.83,300.69,2134.23,856.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 93893","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","93893","HC TRANSCRAN DOPP INTRACRAN, EMBOLI W/INJ","93893 - HC TRANSCRAN DOPP INTRACRAN, EMBOLI W/INJ",3150,188.94,188.79,1066.22,787.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 93895","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","93895","HC CAROTID INTIMA MEDIA & CAROTID ATHEROMA EVAL BI","93895 - HC CAROTID INTIMA MEDIA & CAROTID ATHEROMA EVAL BI",731,224.25,224.25,229.89,182.75]
["TUFTS - TUFTS SELECT - CPT - 93923","TUFTS","TUFTS SELECT","CPT","93923","NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS","93923 - NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS",381,250.1,211.22,1412.44,95.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 93926","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","93926","HC DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY","93926 - HC DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY",1905,188.94,188.94,1169.49,476.25]
["TUFTS - TUFTS HMO - CPT - 93931","TUFTS","TUFTS HMO","CPT","93931","DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY","93931 - DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY",1540,466.74,188.94,1169.49,385]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 93971","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","93971","HC DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY","93971 - HC DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY",1373,300.69,188.94,1169.49,343.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 93976","BLUE CROSS","BLUE CROSS-PPO","CPT","93976","HC DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RORGN LMT","93976 - HC DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RORGN LMT",1992,188.94,188.94,1378.16,498]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 93980","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","93980","DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL","93980 - DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL",1568,188.94,188.94,1117.6500000000001,392]
["BMC HEALTHNET - BMCHN MCO - CPT - 93985","BMC HEALTHNET","BMCHN MCO","CPT","93985","DUP-SCAN HEMO COMPL BI STD","93985 - DUP-SCAN HEMO COMPL BI STD",348,0,375.05,2134.23,87]
["BMC HEALTHNET - BMCHN MCO - CPT - 93986","BMC HEALTHNET","BMCHN MCO","CPT","93986","DUP-SCAN HEMO COMPL UNI STD","93986 - DUP-SCAN HEMO COMPL UNI STD",168,0,180.4,1117.6500000000001,42]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 94010","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","94010","SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ","94010 - SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ",301,228.32,117.36,1412.44,75.25]
["TUFTS - TUFTS POS - CPT - 94010","TUFTS","TUFTS POS","CPT","94010","SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ","94010 - SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ",301,469.76,117.36,1412.44,75.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 94070","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","94070","BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT","94070 - BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT",492,531.36,340.14,2582.75,123]
["TUFTS - TUFTS SELECT - CPT - 94200","TUFTS","TUFTS SELECT","CPT","94200","HC MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ","94200 - HC MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ",192,150.09,71.61,847.64,48]
["UNICARE - UNICARE - CPT - 94453","UNICARE","UNICARE","CPT","94453","HC HAST W/OXYGEN TITRATE","94453 - HC HAST W/OXYGEN TITRATE",163,140.83000000000001,117.36,1077.0999999999999,40.75]
["TUFTS - TUFTS HMO - CPT - 94617","TUFTS","TUFTS HMO","CPT","94617","HC EXERCISE TEST FOR BRONCHOSPASM","94617 - HC EXERCISE TEST FOR BRONCHOSPASM",276,433.33,178.83,1085.78,69]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 94621","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","94621","HC PULMONARY STRESS TESTING COMPLEX","94621 - HC PULMONARY STRESS TESTING COMPLEX",802,544.74,340.14,2582.75,200.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 94644","BMC HEALTHNET","BMCHN MEDICAID","CPT","94644","CONTINUOUS INHALATION TREATMENT 1ST HR","94644 - CONTINUOUS INHALATION TREATMENT 1ST HR",226,0,178.83,1077.0999999999999,56.5]
["TUFTS - TUFTS HMO - CPT - 94645","TUFTS","TUFTS HMO","CPT","94645","CONTINUOUS INHALATION TREATMENT EA ADDL HR","94645 - CONTINUOUS INHALATION TREATMENT EA ADDL HR",72,0,44.22,44.22,18]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 94667","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","94667","HC CHEST WALL MANIPULATION,INITIAL","94667 - HC CHEST WALL MANIPULATION,INITIAL",207,178.83,40.020000000000003,1012.66,51.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 94690","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","94690","O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX","94690 - O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX",252,321.69,53.94,321.69,63]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 94727","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","94727","HC GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&VOL","94727 - HC GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&VOL",207,228.32,117.36,1412.44,51.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 94761","BLUE CROSS","BLUE CROSS-PPO","CPT","94761","MEASURE BLOOD OXYGEN LEVEL","94761 - MEASURE BLOOD OXYGEN LEVEL",189,11.22,11.22,11.22,47.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 94772","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","94772","CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT","94772 - CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT",895,764.57,764.57,4558.4799999999996,223.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 95004","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","95004","PERCUTANEOUS TESTS W/ALLERGENIC EXTRACTS","95004 - PERCUTANEOUS TESTS W/ALLERGENIC EXTRACTS",102,73.91,73.91,3612.37,25.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 95017","BLUE CROSS","BLUE CROSS-PPO","CPT","95017","ALLG TSTG PERQ & IC VENOMS IMMED REACT W/ I&R","95017 - ALLG TSTG PERQ & IC VENOMS IMMED REACT W/ I&R",62,53.94,48.89,155.82,15.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 95044","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","95044","PATCH/APPLICATION TEST SPECIFY NUMBER TESTS","95044 - PATCH/APPLICATION TEST SPECIFY NUMBER TESTS",232,1970.71,73.91,3612.37,58]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 95076","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","95076","INGESTION CHALLENGE TEST INITIAL 120 MINUTES","95076 - INGESTION CHALLENGE TEST INITIAL 120 MINUTES",629,982.93,764.57,2713.03,157.25]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 95120","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","95120","PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX","95120 - PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX",232,0,18.04,163.57,58]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 95144","BLUE CROSS","BLUE CROSS-PPO","CPT","95144","PREPJ& ANTIGEN PRV ALLERGEN IMMUNOTHERAPY 1 DO","95144 - PREPJ& ANTIGEN PRV ALLERGEN IMMUNOTHERAPY 1 DO",78,63.62,63.62,218.59,19.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 95146","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","95146","PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 2 INSECT","95146 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 2 INSECT",183,63.62,63.62,259.07,45.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 95148","BLUE CROSS","BLUE CROSS-PPO","CPT","95148","PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 4 INSECT","95148 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 4 INSECT",78,100.35,100.35,345.64,19.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 95165","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","95165","PREPJ& ALLERGEN IMMUNOTHERAPY 1/MLT ANTIGEN","95165 - PREPJ& ALLERGEN IMMUNOTHERAPY 1/MLT ANTIGEN",99,63.62,63.62,218.59,24.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 95249","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","95249","HC CONT GLUC MONITORING PATIENT PROVIDED EQUIPMENT","95249 - HC CONT GLUC MONITORING PATIENT PROVIDED EQUIPMENT",134,120.69,93.87,562.35,33.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 95700","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","95700","HC EEG CONT REC W/VID EEG TECH","95700 - HC EEG CONT REC W/VID EEG TECH",377,407.35,407.35,2582.75,94.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 95707","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","95707","HC EEG W/O VID 2-12HR CONT MNTR","95707 - HC EEG W/O VID 2-12HR CONT MNTR",377,2582.75,407.35,2582.75,94.25]
["TUFTS - TUFTS HMO - CPT - 95708","TUFTS","TUFTS HMO","CPT","95708","HC EEG WO VID EA 12-26HR UNMNTR","95708 - HC EEG WO VID EA 12-26HR UNMNTR",723,1826.84,781.56,4577.47,180.75]
["TUFTS - TUFTS PPO - CPT - 95711","TUFTS","TUFTS PPO","CPT","95711","HC VEEG 2-12 HR UNMONITORED","95711 - HC VEEG 2-12 HR UNMONITORED",377,918.88,407.35,2582.75,94.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 95782","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","95782","POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND","95782 - POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND",5308,5229.46,1532.92,5229.46,1327]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 95803","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","95803","ACTIGRAPHY TESTING RECORDING ANALYSIS I&R","95803 - ACTIGRAPHY TESTING RECORDING ANALYSIS I&R",905,117.73,93.87,615.09,226.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 95806","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","95806","SLEEP STUDY, UNATTENDED, SIMUL RECORD HR/O2 SAT/RESP FLOW/RESP EFF","95806 - SLEEP STUDY, UNATTENDED, SIMUL RECORD HR/O2 SAT/RESP FLOW/RESP EFF",422,228.32,228.32,1412.44,105.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 95811","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","95811","POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND","95811 - POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND",3214,9266.61,1440.46,9266.61,803.5]
["TUFTS - TUFTS POS - CPT - 95812","TUFTS","TUFTS POS","CPT","95812","ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN","95812 - ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN",1995,858.98,340.5,2582.75,498.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 95816","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","95816","ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY","95816 - ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY",1832,423.72,282.57,2582.75,458]
["TUFTS - TUFTS POS - CPT - 95831","TUFTS","TUFTS POS","CPT","95831","MUSCLE TESTING EXTREMITY OR TRUNK","95831 - MUSCLE TESTING EXTREMITY OR TRUNK",73,45.98,24.48,138.24,18.25]
["TUFTS - TUFTS PPO - CPT - 95860","TUFTS","TUFTS PPO","CPT","95860","NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS","95860 - NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS",497,368.65,178.83,1036.18,124.25]
["TUFTS - TUFTS HMO - CPT - 95861","TUFTS","TUFTS HMO","CPT","95861","NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS","95861 - NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS",726,429.87,178.83,1077.0999999999999,181.5]
["UNICARE - UNICARE - CPT - 95864","UNICARE","UNICARE","CPT","95864","NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS","95864 - NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS",939,371.29,228.32,1412.44,234.75]
["TUFTS - TUFTS POS - CPT - 95867","TUFTS","TUFTS POS","CPT","95867","NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI","95867 - NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI",486,469.76,228.32,1412.44,121.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 95869","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","95869","NEEDLE EMG THRC PARASPI MUSC EXCLUDING T1/T12","95869 - NEEDLE EMG THRC PARASPI MUSC EXCLUDING T1/T12",372,293.52,178.47,1310.18,93]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 95873","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","95873","ELECTRICAL STIMULATION GUID W/CHEMODENERVATION","95873 - ELECTRICAL STIMULATION GUID W/CHEMODENERVATION",360,0,147.08000000000001,147.08000000000001,90]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 95885","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","95885","NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED","95885 - NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED",280,0,112.2,112.2,70]
["TUFTS - TUFTS HMO - CPT - 95887","TUFTS","TUFTS HMO","CPT","95887","NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION","95887 - NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION",389,0,117.85,117.85,97.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 95908","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","95908","MOTOR &/SENS 3-4 NRV CNDJ PRECONF ELTRODE LIMB","95908 - MOTOR &/SENS 3-4 NRV CNDJ PRECONF ELTRODE LIMB",582,423.72,282.57,1457.53,145.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 95910","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","95910","MOTOR &/SENS 7-8 NRV CNDJ PRECONF ELTRODE LIMB","95910 - MOTOR &/SENS 7-8 NRV CNDJ PRECONF ELTRODE LIMB",919,544.74,282.57,1457.53,229.75]
["TUFTS - TUFTS SELECT - CPT - 95912","TUFTS","TUFTS SELECT","CPT","95912","MOTOR &/SENS 11-12 NRV CNDJ PRECONF ELTRODE LIMB","95912 - MOTOR &/SENS 11-12 NRV CNDJ PRECONF ELTRODE LIMB",1302,840.01,282.57,2677.27,325.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 95913","BLUE CROSS","BLUE CROSS-PPO","CPT","95913","MOTOR &/SENS 13/> NRV CNDJ PRECONF ELTRODE LIMB","95913 - MOTOR &/SENS 13/> NRV CNDJ PRECONF ELTRODE LIMB",1506,764.57,282.57,2677.27,376.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 95925","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","95925","HC SOMATOSENSORY TEST,UPPER LIMBS","95925 - HC SOMATOSENSORY TEST,UPPER LIMBS",433,544.74,423.72,2582.75,108.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 95930","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","95930","HC VISUAL EP TESTING CNS EXCEPT GLAUCOMA W/I&R","95930 - HC VISUAL EP TESTING CNS EXCEPT GLAUCOMA W/I&R",205,228.32,228.32,1412.44,51.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 95933","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","95933","ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST","95933 - ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST",430,229.89,127.32,719.1,107.5]
["BMC HEALTHNET - BMCHN MCO - CPT - 95953","BMC HEALTHNET","BMCHN MCO","CPT","95953","LOCALIZE CEREBRAL SEIZURE CPTR PORTABLE EEG","95953 - LOCALIZE CEREBRAL SEIZURE CPTR PORTABLE EEG",2165,0,811.7,4584.1899999999996,541.25]
["TUFTS - TUFTS POS - CPT - 95953","TUFTS","TUFTS POS","CPT","95953","LOCALIZE CEREBRAL SEIZURE CPTR PORTABLE EEG","95953 - LOCALIZE CEREBRAL SEIZURE CPTR PORTABLE EEG",2165,1524.6,811.7,4584.1899999999996,541.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 95962","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","95962","HC FUNCJAL CORT & SUBCORT MAPG PHYS/QHP ATTND ADDL HR","95962 - HC FUNCJAL CORT & SUBCORT MAPG PHYS/QHP ATTND ADDL HR",676,236.55,236.55,236.55,169]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 95966","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","95966","HC MEG,EVOKED MAGNET FIELDS, SINGLE MODAL","95966 - HC MEG,EVOKED MAGNET FIELDS, SINGLE MODAL",1353,0,1532.92,9266.61,338.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 95977","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","95977","HC ALYS CPLX CN NPGT PRGRMG","95977 - HC ALYS CPLX CN NPGT PRGRMG",181,197.39,197.39,645.61,45.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 95977","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","95977","HC ALYS CPLX CN NPGT PRGRMG","95977 - HC ALYS CPLX CN NPGT PRGRMG",181,253.77,197.39,645.61,45.25]
["TUFTS - TUFTS POS - CPT - 95984","TUFTS","TUFTS POS","CPT","95984","HC ALYS BRN NPGT PRGRMG ADDL 15","95984 - HC ALYS BRN NPGT PRGRMG ADDL 15",57,0,108.7,108.7,14.25]
["TUFTS - TUFTS SELECT - CPT - 95992","TUFTS","TUFTS SELECT","CPT","95992","CANALITH REPOSITIONING PROCEDURE","95992 - CANALITH REPOSITIONING PROCEDURE",283,80.59,80.59,256.86,70.75]
["TUFTS - TUFTS SELECT - CPT - 96040","TUFTS","TUFTS SELECT","CPT","96040","MEDICAL GENETICS COUNSELING EACH 30 MINUTES","96040 - MEDICAL GENETICS COUNSELING EACH 30 MINUTES",231,33.74,33.74,122.29,57.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 96112","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","96112","HC DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR","96112 - HC DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR",341,228.32,194.05,618.47,85.25]
["TUFTS - TUFTS PPO - CPT - 96113","TUFTS","TUFTS PPO","CPT","96113","HC DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN","96113 - HC DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN",170,0,141.36000000000001,141.36000000000001,42.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 96121","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","96121","HC NEUROBEHAVIORAL STATUS XM PHYS/QHP EA ADDL HOUR","96121 - HC NEUROBEHAVIORAL STATUS XM PHYS/QHP EA ADDL HOUR",412,187.64,187.64,187.64,103]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 96125","BMC HEALTHNET","BMCHN MEDICAID","CPT","96125","STANDARDIZED COGNITIVE PERFORMANCE TESTING","96125 - STANDARDIZED COGNITIVE PERFORMANCE TESTING",504,0,273.64999999999998,273.64999999999998,126]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 96130","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","96130","HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR","96130 - HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR",341,286.31,71.41,293.52,85.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 96132","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","96132","HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR","96132 - HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR",341,228.32,71.41,293.52,85.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 96132","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","96132","HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR","96132 - HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR",341,286.31,71.41,293.52,85.25]
["TUFTS - TUFTS POS - CPT - 96137","TUFTS","TUFTS POS","CPT","96137","HC PSYCL/NRPSYCL TST PHYS/QHP 2+ TST EA ADDL 30 MIN","96137 - HC PSYCL/NRPSYCL TST PHYS/QHP 2+ TST EA ADDL 30 MIN",341,0,46.29,46.29,85.25]
["BMC HEALTHNET - BMCHN ACO - CPT - 96138","BMC HEALTHNET","BMCHN ACO","CPT","96138","HC PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN","96138 - HC PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN",341,0,28.83,129.58000000000001,85.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 96146","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","96146","HC PSYCL/NRPSYCL TST ELEC PLATFORM AUTO RESULT","96146 - HC PSYCL/NRPSYCL TST ELEC PLATFORM AUTO RESULT",341,0,36.159999999999997,129.58000000000001,85.25]
["TUFTS - TUFTS HMO - CPT - 96156","TUFTS","TUFTS HMO","CPT","96156","HC HLTH BHV ASSMT/REASSESSMENT","96156 - HC HLTH BHV ASSMT/REASSESSMENT",101,36.44,36.44,126.4,25.25]
["BMC HEALTHNET - BMCHN ACO - CPT - 96159","BMC HEALTHNET","BMCHN ACO","CPT","96159","HC HLTH BHV IVNTJ INDIV EA ADDL","96159 - HC HLTH BHV IVNTJ INDIV EA ADDL",41,0,49.89,49.89,10.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 96160","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","96160","PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM","96160 - PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM",42,56.05,50.95,162.4,10.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 96164","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","96164","HC HLTH BHV IVNTJ GRP 1ST 30","96164 - HC HLTH BHV IVNTJ GRP 1ST 30",36,43.97,43.97,129.58000000000001,9]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 96167","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","96167","HC HLTH BHV IVNTJ FAM 1ST 30","96167 - HC HLTH BHV IVNTJ FAM 1ST 30",36,0,43.97,129.58000000000001,9]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 96168","BMC HEALTHNET","BMCHN MEDICAID","CPT","96168","HC HLTH BHV IVNTJ FAM EA ADDL","96168 - HC HLTH BHV IVNTJ FAM EA ADDL",19,0,55.01,55.01,4.75]
["TUFTS - TUFTS SELECT - CPT - 96360","TUFTS","TUFTS SELECT","CPT","96360","IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR","96360 - IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR",363,308.91000000000003,132.85,984.54,90.75]
["TUFTS - TUFTS PPO - CPT - 96361","TUFTS","TUFTS PPO","CPT","96361","IV INFUSION HYDRATION EACH ADDITIONAL HOUR","96361 - IV INFUSION HYDRATION EACH ADDITIONAL HOUR",110,137.81,63.62,218.59,27.5]
["TUFTS - TUFTS HMO - CPT - 96367","TUFTS","TUFTS HMO","CPT","96367","IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR","96367 - IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR",144,203.7,100.35,345.64,36]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 96371","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","96371","HC SUBQ INFUSION ADDITIONAL PUMP INFUSION SITE","96371 - HC SUBQ INFUSION ADDITIONAL PUMP INFUSION SITE",405,100.35,100.35,345.64,101.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 96374","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","96374","THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG","96374 - THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG",254,314.33999999999997,65.72,917.77,63.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 96374","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","96374","THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG","96374 - THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG",254,65.72,65.72,917.77,63.5]
["TUFTS - TUFTS POS - CPT - 96401","TUFTS","TUFTS POS","CPT","96401","CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-NEO","96401 - CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-NEO",338,203.7,100.35,612.48,84.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 96405","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","96405","HC INTRALESIONAL CHEMO ADMIN,<8 LESN","96405 - HC INTRALESIONAL CHEMO ADMIN,<8 LESN",90,100.35,100.35,612.48,22.5]
["TUFTS - TUFTS POS - CPT - 96409","TUFTS","TUFTS POS","CPT","96409","CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG","96409 - CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG",498,621.57000000000005,314.33999999999997,1868.91,124.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 96416","BLUE CROSS","BLUE CROSS-PPO","CPT","96416","CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP","96416 - CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP",754,484.3,484.3,3098.76,188.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 96521","BLUE CROSS","BLUE CROSS-PPO","CPT","96521","REFILLING & MAINTENANCE PORTABLE PUMP","96521 - REFILLING & MAINTENANCE PORTABLE PUMP",629,314.33999999999997,314.33999999999997,1054.69,157.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 96523","BLUE CROSS","BLUE CROSS-PPO","CPT","96523","IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST","96523 - IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST",141,93.87,93.87,562.35,35.25]
["BMC HEALTHNET - BMCHN MCO - CPT - 96567","BMC HEALTHNET","BMCHN MCO","CPT","96567","PDT XTRNL APPL LIGHT DSTR LES SKN BY ACTIVJ RX","96567 - PDT XTRNL APPL LIGHT DSTR LES SKN BY ACTIVJ RX",645,0,296.32,983.48,161.25]
["TUFTS - TUFTS HMO - CPT - 97010","TUFTS","TUFTS HMO","CPT","97010","HC APPLICATION MODALITY 1/> AREAS HOT/COLD PACKS","97010 - HC APPLICATION MODALITY 1/> AREAS HOT/COLD PACKS",31,24.1,8.8800000000000008,40.869999999999997,7.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 97014","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","97014","HC APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED","97014 - HC APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED",80,0,28.92,37.4,20]
["TUFTS - TUFTS HMO - CPT - 97033","TUFTS","TUFTS HMO","CPT","97033","APPL MODALITY 1/> AREAS IONTOPHORESIS EA 15 MIN","97033 - APPL MODALITY 1/> AREAS IONTOPHORESIS EA 15 MIN",162,78.23,35.64,132.72999999999999,40.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 97110","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","97110","THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES","97110 - THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES",192,193.61,51.98,193.61,48]
["UNICARE - UNICARE - CPT - 97116","UNICARE","UNICARE","CPT","97116","HC THER PX 1/> AREAS EA 15 MIN GAIT TRAINJ W/STAIR","97116 - HC THER PX 1/> AREAS EA 15 MIN GAIT TRAINJ W/STAIR",139,48.21,48.21,191.22,34.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 97130","BMC HEALTHNET","BMCHN QHP","CPT","97130","HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTE","97130 - HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTE",65,0,55.85,55.85,16.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 97151","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","97151","HC BHV ID ASSMT BY PHYS/QHP","97151 - HC BHV ID ASSMT BY PHYS/QHP",378,56.05,56.05,129.58000000000001,94.5]
["TUFTS - TUFTS SELECT - CPT - 97152","TUFTS","TUFTS SELECT","CPT","97152","HC BHV ID SUPRT ASSMT BY 1 TECH","97152 - HC BHV ID SUPRT ASSMT BY 1 TECH",378,71.41,56.05,129.58000000000001,94.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 97153","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","97153","HC ADAPTIVE BEHAVIOR TX BY TECH","97153 - HC ADAPTIVE BEHAVIOR TX BY TECH",378,56.05,56.05,129.58000000000001,94.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 97156","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","97156","HC FAM ADAPT BHV TX GDN PHY/QHP","97156 - HC FAM ADAPT BHV TX GDN PHY/QHP",378,0,56.05,129.58000000000001,94.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 97156","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","97156","HC FAM ADAPT BHV TX GDN PHY/QHP","97156 - HC FAM ADAPT BHV TX GDN PHY/QHP",378,70.3,56.05,129.58000000000001,94.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 97157","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","97157","HC MULT FAM ADAPT BHV TX GDN","97157 - HC MULT FAM ADAPT BHV TX GDN",378,72.069999999999993,56.05,129.58000000000001,94.5]
["TUFTS - TUFTS PPO - CPT - 97164","TUFTS","TUFTS PPO","CPT","97164","HC PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS","97164 - HC PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS",262,230.56,98.19,365.72,65.5]
["TUFTS - TUFTS POS - CPT - 97165","TUFTS","TUFTS POS","CPT","97165","HC OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS","97165 - HC OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS",366,291.7,155.29,494.96,91.5]
["TUFTS - TUFTS PPO - CPT - 97168","TUFTS","TUFTS PPO","CPT","97168","HC OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS","97168 - HC OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS",262,251.6,107.16,399.1,65.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 97535","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","97535","HC SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES","97535 - HC SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES",172,86.01,58.39,217.46,43]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 97598","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","97598","DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM","97598 - DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM",625,27.27,27.27,1198.25,156.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 97598","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","97598","DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM","97598 - DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM",625,0,27.27,1198.25,156.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 97750","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","97750","HC PHYSICAL PERFORMANCE TEST/MEAS W/REPRT EA 15 MIN","97750 - HC PHYSICAL PERFORMANCE TEST/MEAS W/REPRT EA 15 MIN",165,87.89,58.95,227.31,41.25]
["TUFTS - TUFTS PPO - CPT - 97760","TUFTS","TUFTS PPO","CPT","97760","ORTHOTIC MGMT&TRAINJ UXTR LXTR&/TRNK EA 15","97760 - ORTHOTIC MGMT&TRAINJ UXTR LXTR&/TRNK EA 15",189,193.29,60.33,306.58999999999997,47.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 97802","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","97802","MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI","97802 - MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI",165,84.13,57.12,182.04,41.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 97810","BLUE CROSS","BLUE CROSS-PPO","CPT","97810","HC ACUPUNCTURE 1/> NDLES W/O ELEC STIMJ INIT 15 MIN","97810 - HC ACUPUNCTURE 1/> NDLES W/O ELEC STIMJ INIT 15 MIN",55,75.78,75.78,75.78,13.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 98960","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","98960","HC EDUCATION&TRAINING SELF-MGMT NONPHYS 1 PT","98960 - HC EDUCATION&TRAINING SELF-MGMT NONPHYS 1 PT",135,72.41,72.41,72.41,33.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 99151","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","99151","HC MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS","99151 - HC MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS",110,0,61.58,61.58,27.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 99152","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","99152","HC MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS","99152 - HC MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS",101,29.88,29.88,29.88,25.25]
["BMC HEALTHNET - BMCHN QHP - CPT - 99155","BMC HEALTHNET","BMCHN QHP","CPT","99155","HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS","99155 - HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS",101,0,215.6,215.6,25.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 99156","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","99156","HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS","99156 - HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS",101,190.51,190.51,190.51,25.25]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 99157","BMC HEALTHNET","BMCHN MEDICAID","CPT","99157","HC MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS","99157 - HC MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS",55,0,156.06,156.06,13.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 99201","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","99201","OFFICE OUTPATIENT NEW 10 MINUTES","99201 - OFFICE OUTPATIENT NEW 10 MINUTES",109,77.44,33.74,108.49,27.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 99203","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","99203","OFFICE OUTPATIENT NEW 30 MINUTES","99203 - OFFICE OUTPATIENT NEW 30 MINUTES",322,184.8,33.74,184.8,80.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 99211","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","99211","ESTABLISHED PATIENT - PHARM - LEVEL 1","99211 - ESTABLISHED PATIENT - PHARM - LEVEL 1",90,77.44,22.32,108.49,22.5]
["TUFTS - TUFTS PPO - CPT - 99212","TUFTS","TUFTS PPO","CPT","99212","ESTABLISHED PATIENT - PHARM - LEVEL 2","99212 - ESTABLISHED PATIENT - PHARM - LEVEL 2",113,38.6,33.74,108.49,28.25]
["UNICARE - UNICARE - CPT - 99281","UNICARE","UNICARE","CPT","99281","HC ED VAWA W/MSAECK","99281 - HC ED VAWA W/MSAECK",492,139.36000000000001,116.13,1429.96,123]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 99282","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","99282","HC EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY","99282 - HC EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY",792,116.13,116.13,1936.24,198]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 99292","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","99292","CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN","99292 - CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN",1377,268.83,268.83,268.83,344.25]
["FALLON - FALLON MEDICAID - CPT - 99355","FALLON","FALLON MEDICAID","CPT","99355","PROLNG SVC OFFICE O/P DIR CONTACT EA 30 MINUTES","99355 - PROLNG SVC OFFICE O/P DIR CONTACT EA 30 MINUTES",375,0,0,0,93.75]
["TUFTS - TUFTS SELECT - CPT - 99359","TUFTS","TUFTS SELECT","CPT","99359","PROLONGED SERV,NO CONTCT,EA ADD 30 MIN","99359 - PROLONGED SERV,NO CONTCT,EA ADD 30 MIN",84,0,0,0,21]
["TUFTS - TUFTS PPO - CPT - 99384","TUFTS","TUFTS PPO","CPT","99384","INITIAL PREVENTIVE MEDICINE NEW PT AGE 12-17 YR","99384 - INITIAL PREVENTIVE MEDICINE NEW PT AGE 12-17 YR",427,38.6,33.74,286.88,106.75]
["UNICARE - UNICARE - CPT - 99386","UNICARE","UNICARE","CPT","99386","INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS","99386 - INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS",497,335.53,33.74,335.53,124.25]
["TUFTS - TUFTS POS - CPT - 99394","TUFTS","TUFTS POS","CPT","99394","PERIODIC PREVENTIVE MED EST PATIENT 12-17YRS","99394 - PERIODIC PREVENTIVE MED EST PATIENT 12-17YRS",360,38.6,33.74,229.61,90]
["UNICARE - UNICARE - CPT - 99403","UNICARE","UNICARE","CPT","99403","HC PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 45 MIN","99403 - HC PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 45 MIN",312,233.09,34.03,233.09,78]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 99406","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","99406","TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES","99406 - TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES",83,0,50.95,287.77999999999997,20.75]
["TUFTS - TUFTS POS - CPT - 99407","TUFTS","TUFTS POS","CPT","99407","TOBACCO USE CESSATION INTENSIVE >10 MINUTES","99407 - TOBACCO USE CESSATION INTENSIVE >10 MINUTES",107,95.7,50.95,287.77999999999997,26.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 99454","BMC HEALTHNET","BMCHN QHP","CPT","99454","HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D",55,0,62.4,209.07,13.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 99454","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","99454","HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D",55,209.07,62.4,209.07,13.75]
["FALLON - FALLON MEDICAID - CPT - 99454","FALLON","FALLON MEDICAID","CPT","99454","HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D",55,0,62.4,209.07,13.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 99454","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","99454","HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D",55,80.23,62.4,209.07,13.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 99454","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","99454","HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D",55,80.23,62.4,209.07,13.75]
["TUFTS - TUFTS HMO - CPT - 99454","TUFTS","TUFTS HMO","CPT","99454","HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D",55,123.21,62.4,209.07,13.75]
["TUFTS - TUFTS POS - CPT - 99454","TUFTS","TUFTS POS","CPT","99454","HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D",55,123.21,62.4,209.07,13.75]
["TUFTS - TUFTS PPO - CPT - 99454","TUFTS","TUFTS PPO","CPT","99454","HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D",55,131.81,62.4,209.07,13.75]
["TUFTS - TUFTS SELECT - CPT - 99454","TUFTS","TUFTS SELECT","CPT","99454","HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D",55,65.599999999999994,62.4,209.07,13.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 99454","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","99454","HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D",55,0,62.4,209.07,13.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 99454","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","99454","HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D",55,0,62.4,209.07,13.75]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 99454","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","99454","HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D",55,78.260000000000005,62.4,209.07,13.75]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 99454","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","99454","HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D",55,80.23,62.4,209.07,13.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 99456","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","99456","WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS","99456 - WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS",348,0,0,0,87]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 99456","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","99456","WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS","99456 - WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS",348,0,0,0,87]
["BMC HEALTHNET - BMCHN ACO - CPT - 99456","BMC HEALTHNET","BMCHN ACO","CPT","99456","WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS","99456 - WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS",348,0,0,0,87]
["BMC HEALTHNET - BMCHN MCO - CPT - 99456","BMC HEALTHNET","BMCHN MCO","CPT","99456","WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS","99456 - WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS",348,0,0,0,87]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 99456","BMC HEALTHNET","BMCHN MEDICAID","CPT","99456","WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS","99456 - WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS",348,0,0,0,87]
["BMC HEALTHNET - BMCHN QHP - CPT - 99456","BMC HEALTHNET","BMCHN QHP","CPT","99456","WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS","99456 - WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS",348,0,0,0,87]
["FALLON - FALLON MEDICAID - CPT - 99456","FALLON","FALLON MEDICAID","CPT","99456","WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS","99456 - WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS",348,0,0,0,87]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 99456","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","99456","WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS","99456 - WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS",348,0,0,0,87]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 99456","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","99456","WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS","99456 - WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS",348,0,0,0,87]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 99473","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,0,36.99,229.62,9]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 99473","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,0,36.99,229.62,9]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 99473","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,36.99,36.99,229.62,9]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 99473","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,36.99,36.99,229.62,9]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 99473","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,36.99,36.99,229.62,9]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 99473","BLUE CROSS","BLUE CROSS-PPO","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,36.99,36.99,229.62,9]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 99473","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,36.99,36.99,229.62,9]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 99473","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,36.99,36.99,229.62,9]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 99473","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,36.99,36.99,229.62,9]
["BMC HEALTHNET - BMCHN ACO - CPT - 99473","BMC HEALTHNET","BMCHN ACO","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,0,36.99,229.62,9]
["BMC HEALTHNET - BMCHN MCO - CPT - 99473","BMC HEALTHNET","BMCHN MCO","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,0,36.99,229.62,9]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 99473","BMC HEALTHNET","BMCHN MEDICAID","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,0,36.99,229.62,9]
["BMC HEALTHNET - BMCHN QHP - CPT - 99473","BMC HEALTHNET","BMCHN QHP","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,0,36.99,229.62,9]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 99473","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,114.81,36.99,229.62,9]
["FALLON - FALLON MEDICAID - CPT - 99473","FALLON","FALLON MEDICAID","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,0,36.99,229.62,9]
["TUFTS - TUFTS HMO - CPT - 99473","TUFTS","TUFTS HMO","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,49.015000000000001,36.99,229.62,9]
["TUFTS - TUFTS POS - CPT - 99473","TUFTS","TUFTS POS","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,40.844999999999999,36.99,229.62,9]
["TUFTS - TUFTS PPO - CPT - 99473","TUFTS","TUFTS PPO","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,40.844999999999999,36.99,229.62,9]
["TUFTS - TUFTS SELECT - CPT - 99473","TUFTS","TUFTS SELECT","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,0,36.99,229.62,9]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 99473","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,0,36.99,229.62,9]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 99473","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","99473","HC SELF-MEAS BP PT EDUCAJ/TRAIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",36,0,36.99,229.62,9]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 99483","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","99483","HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT","99483 - HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT",359,102.42,31.86,102.42,89.75]
["TUFTS - TUFTS HMO - CPT - 99483","TUFTS","TUFTS HMO","CPT","99483","HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT","99483 - HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT",359,43.73,31.86,102.42,89.75]
["TUFTS - TUFTS POS - CPT - 99483","TUFTS","TUFTS POS","CPT","99483","HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT","99483 - HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT",359,36.44,31.86,102.42,89.75]
["TUFTS - TUFTS PPO - CPT - 99483","TUFTS","TUFTS PPO","CPT","99483","HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT","99483 - HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT",359,36.44,31.86,102.42,89.75]
["TUFTS - TUFTS SELECT - CPT - 99483","TUFTS","TUFTS SELECT","CPT","99483","HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT","99483 - HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT",359,31.86,31.86,102.42,89.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 99495","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,0,194.55,1179.72,109.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 99495","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,0,194.55,1179.72,109.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 99495","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,194.55,194.55,1179.72,109.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 99495","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,194.55,194.55,1179.72,109.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 99495","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,194.55,194.55,1179.72,109.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 99495","BLUE CROSS","BLUE CROSS-PPO","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,194.55,194.55,1179.72,109.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 99495","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,194.55,194.55,1179.72,109.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 99495","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,194.55,194.55,1179.72,109.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 99495","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,194.55,194.55,1179.72,109.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 99495","BMC HEALTHNET","BMCHN ACO","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,0,194.55,1179.72,109.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 99495","BMC HEALTHNET","BMCHN MCO","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,0,194.55,1179.72,109.75]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 99495","BMC HEALTHNET","BMCHN MEDICAID","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,0,194.55,1179.72,109.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 99495","BMC HEALTHNET","BMCHN QHP","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,0,194.55,1179.72,109.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 99495","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,589.86,194.55,1179.72,109.75]
["FALLON - FALLON MEDICAID - CPT - 99495","FALLON","FALLON MEDICAID","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,0,194.55,1179.72,109.75]
["TUFTS - TUFTS HMO - CPT - 99495","TUFTS","TUFTS HMO","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,235.41499999999999,194.55,1179.72,109.75]
["TUFTS - TUFTS POS - CPT - 99495","TUFTS","TUFTS POS","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,196.18,194.55,1179.72,109.75]
["TUFTS - TUFTS PPO - CPT - 99495","TUFTS","TUFTS PPO","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,209.86,194.55,1179.72,109.75]
["TUFTS - TUFTS SELECT - CPT - 99495","TUFTS","TUFTS SELECT","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,104.44499999999999,194.55,1179.72,109.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 99495","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,0,194.55,1179.72,109.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 99495","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",439,0,194.55,1179.72,109.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 99496","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,0,194.55,1179.72,206.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 99496","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,0,194.55,1179.72,206.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 99496","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,194.55,194.55,1179.72,206.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 99496","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,194.55,194.55,1179.72,206.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 99496","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,194.55,194.55,1179.72,206.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 99496","BLUE CROSS","BLUE CROSS-PPO","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,194.55,194.55,1179.72,206.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 99496","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,194.55,194.55,1179.72,206.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 99496","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,194.55,194.55,1179.72,206.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 99496","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,194.55,194.55,1179.72,206.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 99496","BMC HEALTHNET","BMCHN ACO","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,0,194.55,1179.72,206.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 99496","BMC HEALTHNET","BMCHN MCO","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,0,194.55,1179.72,206.75]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 99496","BMC HEALTHNET","BMCHN MEDICAID","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,0,194.55,1179.72,206.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 99496","BMC HEALTHNET","BMCHN QHP","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,0,194.55,1179.72,206.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 99496","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,589.86,194.55,1179.72,206.75]
["FALLON - FALLON MEDICAID - CPT - 99496","FALLON","FALLON MEDICAID","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,0,194.55,1179.72,206.75]
["TUFTS - TUFTS HMO - CPT - 99496","TUFTS","TUFTS HMO","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,235.41499999999999,194.55,1179.72,206.75]
["TUFTS - TUFTS POS - CPT - 99496","TUFTS","TUFTS POS","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,196.18,194.55,1179.72,206.75]
["TUFTS - TUFTS PPO - CPT - 99496","TUFTS","TUFTS PPO","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,209.86,194.55,1179.72,206.75]
["TUFTS - TUFTS SELECT - CPT - 99496","TUFTS","TUFTS SELECT","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,104.44499999999999,194.55,1179.72,206.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 99496","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,0,194.55,1179.72,206.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 99496","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","99496","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",827,0,194.55,1179.72,206.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 99497","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,0,128.29,439.53,75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 99497","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,0,128.29,439.53,75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 99497","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,128.29,128.29,439.53,75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 99497","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,128.29,128.29,439.53,75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 99497","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,128.29,128.29,439.53,75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 99497","BLUE CROSS","BLUE CROSS-PPO","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,128.29,128.29,439.53,75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 99497","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,128.29,128.29,439.53,75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 99497","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,128.29,128.29,439.53,75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 99497","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,128.29,128.29,439.53,75]
["BMC HEALTHNET - BMCHN ACO - CPT - 99497","BMC HEALTHNET","BMCHN ACO","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,0,128.29,439.53,75]
["BMC HEALTHNET - BMCHN MCO - CPT - 99497","BMC HEALTHNET","BMCHN MCO","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,0,128.29,439.53,75]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 99497","BMC HEALTHNET","BMCHN MEDICAID","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,0,128.29,439.53,75]
["BMC HEALTHNET - BMCHN QHP - CPT - 99497","BMC HEALTHNET","BMCHN QHP","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,0,128.29,439.53,75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 99497","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,439.53,128.29,439.53,75]
["FALLON - FALLON MEDICAID - CPT - 99497","FALLON","FALLON MEDICAID","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,0,128.29,439.53,75]
["TUFTS - TUFTS HMO - CPT - 99497","TUFTS","TUFTS HMO","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,259.04000000000002,128.29,439.53,75]
["TUFTS - TUFTS POS - CPT - 99497","TUFTS","TUFTS POS","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,259.04000000000002,128.29,439.53,75]
["TUFTS - TUFTS PPO - CPT - 99497","TUFTS","TUFTS PPO","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,277.10000000000002,128.29,439.53,75]
["TUFTS - TUFTS SELECT - CPT - 99497","TUFTS","TUFTS SELECT","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,137.91,128.29,439.53,75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 99497","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,0,128.29,439.53,75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 99497","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",300,0,128.29,439.53,75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 99498","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","99498","HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS",283,180.79,180.79,180.79,70.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 99498","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","99498","HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS",283,180.79,180.79,180.79,70.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 99498","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","99498","HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS",283,180.79,180.79,180.79,70.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 99498","BLUE CROSS","BLUE CROSS-PPO","CPT","99498","HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS",283,180.79,180.79,180.79,70.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 99498","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","99498","HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS",283,180.79,180.79,180.79,70.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 99498","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","99498","HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS",283,180.79,180.79,180.79,70.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 99498","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","99498","HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS",283,180.79,180.79,180.79,70.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 99498","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","99498","HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS",283,0,180.79,180.79,70.75]
["TUFTS - TUFTS HMO - CPT - 99498","TUFTS","TUFTS HMO","CPT","99498","HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS",283,0,180.79,180.79,70.75]
["TUFTS - TUFTS POS - CPT - 99498","TUFTS","TUFTS POS","CPT","99498","HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS",283,0,180.79,180.79,70.75]
["TUFTS - TUFTS PPO - CPT - 99498","TUFTS","TUFTS PPO","CPT","99498","HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS",283,0,180.79,180.79,70.75]
["TUFTS - TUFTS SELECT - CPT - 99498","TUFTS","TUFTS SELECT","CPT","99498","HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS",283,0,180.79,180.79,70.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 99605","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","99605","MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM",62,0,0,0,15.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 99605","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","99605","MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM",62,0,0,0,15.5]
["BMC HEALTHNET - BMCHN ACO - CPT - 99605","BMC HEALTHNET","BMCHN ACO","CPT","99605","MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM",62,0,0,0,15.5]
["BMC HEALTHNET - BMCHN MCO - CPT - 99605","BMC HEALTHNET","BMCHN MCO","CPT","99605","MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM",62,0,0,0,15.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 99605","BMC HEALTHNET","BMCHN MEDICAID","CPT","99605","MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM",62,0,0,0,15.5]
["BMC HEALTHNET - BMCHN QHP - CPT - 99605","BMC HEALTHNET","BMCHN QHP","CPT","99605","MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM",62,0,0,0,15.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 99605","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","99605","MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM",62,0,0,0,15.5]
["FALLON - FALLON MEDICAID - CPT - 99605","FALLON","FALLON MEDICAID","CPT","99605","MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM",62,0,0,0,15.5]
["TUFTS - TUFTS HMO - CPT - 99605","TUFTS","TUFTS HMO","CPT","99605","MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM",62,0,0,0,15.5]
["TUFTS - TUFTS POS - CPT - 99605","TUFTS","TUFTS POS","CPT","99605","MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM",62,0,0,0,15.5]
["TUFTS - TUFTS PPO - CPT - 99605","TUFTS","TUFTS PPO","CPT","99605","MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM",62,0,0,0,15.5]
["TUFTS - TUFTS SELECT - CPT - 99605","TUFTS","TUFTS SELECT","CPT","99605","MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM",62,0,0,0,15.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 99605","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","99605","MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM",62,0,0,0,15.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 99605","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","99605","MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM",62,0,0,0,15.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 99606","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","99606","MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM",43,0,0,0,10.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 99606","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","99606","MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM",43,0,0,0,10.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 99606","BMC HEALTHNET","BMCHN ACO","CPT","99606","MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM",43,0,0,0,10.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 99606","BMC HEALTHNET","BMCHN MCO","CPT","99606","MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM",43,0,0,0,10.75]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 99606","BMC HEALTHNET","BMCHN MEDICAID","CPT","99606","MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM",43,0,0,0,10.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 99606","BMC HEALTHNET","BMCHN QHP","CPT","99606","MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM",43,0,0,0,10.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 99606","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","99606","MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM",43,0,0,0,10.75]
["FALLON - FALLON MEDICAID - CPT - 99606","FALLON","FALLON MEDICAID","CPT","99606","MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM",43,0,0,0,10.75]
["TUFTS - TUFTS HMO - CPT - 99606","TUFTS","TUFTS HMO","CPT","99606","MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM",43,0,0,0,10.75]
["TUFTS - TUFTS POS - CPT - 99606","TUFTS","TUFTS POS","CPT","99606","MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM",43,0,0,0,10.75]
["TUFTS - TUFTS PPO - CPT - 99606","TUFTS","TUFTS PPO","CPT","99606","MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM",43,0,0,0,10.75]
["TUFTS - TUFTS SELECT - CPT - 99606","TUFTS","TUFTS SELECT","CPT","99606","MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM",43,0,0,0,10.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 99606","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","99606","MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM",43,0,0,0,10.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 99606","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","99606","MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM",43,0,0,0,10.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 99607","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","99607","MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM",32,0,0,0,8]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 99607","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","99607","MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM",32,0,0,0,8]
["BMC HEALTHNET - BMCHN ACO - CPT - 99607","BMC HEALTHNET","BMCHN ACO","CPT","99607","MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM",32,0,0,0,8]
["BMC HEALTHNET - BMCHN MCO - CPT - 99607","BMC HEALTHNET","BMCHN MCO","CPT","99607","MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM",32,0,0,0,8]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 99607","BMC HEALTHNET","BMCHN MEDICAID","CPT","99607","MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM",32,0,0,0,8]
["BMC HEALTHNET - BMCHN QHP - CPT - 99607","BMC HEALTHNET","BMCHN QHP","CPT","99607","MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM",32,0,0,0,8]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 99607","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","99607","MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM",32,0,0,0,8]
["FALLON - FALLON MEDICAID - CPT - 99607","FALLON","FALLON MEDICAID","CPT","99607","MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM",32,0,0,0,8]
["TUFTS - TUFTS HMO - CPT - 99607","TUFTS","TUFTS HMO","CPT","99607","MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM",32,0,0,0,8]
["TUFTS - TUFTS POS - CPT - 99607","TUFTS","TUFTS POS","CPT","99607","MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM",32,0,0,0,8]
["TUFTS - TUFTS PPO - CPT - 99607","TUFTS","TUFTS PPO","CPT","99607","MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM",32,0,0,0,8]
["TUFTS - TUFTS SELECT - CPT - 99607","TUFTS","TUFTS SELECT","CPT","99607","MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM",32,0,0,0,8]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 99607","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","99607","MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM",32,0,0,0,8]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 99607","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","99607","MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM",32,0,0,0,8]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 0001A","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,19.989999999999998,16.940000000000001,74.13,14.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 0001A","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,39.979999999999997,16.940000000000001,74.13,14.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 0001A","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,45.98,16.940000000000001,74.13,14.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 0001A","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,38.97,16.940000000000001,74.13,14.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 0001A","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,38.97,16.940000000000001,74.13,14.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 0001A","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,38.97,16.940000000000001,74.13,14.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 0001A","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,42.62,16.940000000000001,74.13,14.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 0001A","BLUE CROSS","BLUE CROSS-PPO","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,38.97,16.940000000000001,74.13,14.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 0001A","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,38.97,16.940000000000001,74.13,14.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 0001A","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,38.97,16.940000000000001,74.13,14.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 0001A","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,38.97,16.940000000000001,74.13,14.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 0001A","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,37.44,16.940000000000001,74.13,14.5]
["BMC HEALTHNET - BMCHN ACO - CPT - 0001A","BMC HEALTHNET","BMCHN ACO","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,74.13,16.940000000000001,74.13,14.5]
["BMC HEALTHNET - BMCHN MCO - CPT - 0001A","BMC HEALTHNET","BMCHN MCO","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,33.880000000000003,16.940000000000001,74.13,14.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 0001A","BMC HEALTHNET","BMCHN MEDICAID","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,33.880000000000003,16.940000000000001,74.13,14.5]
["BMC HEALTHNET - BMCHN QHP - CPT - 0001A","BMC HEALTHNET","BMCHN QHP","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,40.659999999999997,16.940000000000001,74.13,14.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 0001A","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,16.940000000000001,16.940000000000001,74.13,14.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 0001A","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,16.940000000000001,16.940000000000001,74.13,14.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 0001A","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,16.940000000000001,16.940000000000001,74.13,14.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 0001A","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,16.940000000000001,16.940000000000001,74.13,14.5]
["FALLON - FALLON MEDICAID - CPT - 0001A","FALLON","FALLON MEDICAID","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,33.880000000000003,16.940000000000001,74.13,14.5]
["FALLON - FALLON SENIOR PLAN - CPT - 0001A","FALLON","FALLON SENIOR PLAN","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,16.940000000000001,16.940000000000001,74.13,14.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 0001A","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,36.57,16.940000000000001,74.13,14.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 0001A","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,29.48,16.940000000000001,74.13,14.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 0001A","TUFTS","TUFTS MEDICARE SCO","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,24.56,16.940000000000001,74.13,14.5]
["TUFTS - TUFTS SPIRIT - CPT - 0001A","TUFTS","TUFTS SPIRIT","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,18.63,16.940000000000001,74.13,14.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 0001A","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,20.329999999999998,16.940000000000001,74.13,14.5]
["UNICARE - UNICARE - CPT - 0001A","UNICARE","UNICARE","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,33.89,16.940000000000001,74.13,14.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 0001A","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,33.89,16.940000000000001,74.13,14.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 0001A","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",58,35.68,16.940000000000001,74.13,14.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 0002A","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,33.5,28.39,124.23,14.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 0002A","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,67,28.39,124.23,14.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 0002A","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,77.05,28.39,124.23,14.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 0002A","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,65.31,28.39,124.23,14.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 0002A","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,65.31,28.39,124.23,14.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 0002A","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,65.31,28.39,124.23,14.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 0002A","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,71.430000000000007,28.39,124.23,14.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 0002A","BLUE CROSS","BLUE CROSS-PPO","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,65.31,28.39,124.23,14.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 0002A","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,65.31,28.39,124.23,14.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 0002A","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,65.31,28.39,124.23,14.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 0002A","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,65.31,28.39,124.23,14.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 0002A","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,62.74,28.39,124.23,14.5]
["BMC HEALTHNET - BMCHN ACO - CPT - 0002A","BMC HEALTHNET","BMCHN ACO","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,124.23,28.39,124.23,14.5]
["BMC HEALTHNET - BMCHN MCO - CPT - 0002A","BMC HEALTHNET","BMCHN MCO","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,56.78,28.39,124.23,14.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 0002A","BMC HEALTHNET","BMCHN MEDICAID","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,56.78,28.39,124.23,14.5]
["BMC HEALTHNET - BMCHN QHP - CPT - 0002A","BMC HEALTHNET","BMCHN QHP","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,68.14,28.39,124.23,14.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 0002A","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,28.39,28.39,124.23,14.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 0002A","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,28.39,28.39,124.23,14.5]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 0002A","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,28.39,28.39,124.23,14.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 0002A","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,28.39,28.39,124.23,14.5]
["FALLON - FALLON MEDICAID - CPT - 0002A","FALLON","FALLON MEDICAID","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,56.78,28.39,124.23,14.5]
["FALLON - FALLON SENIOR PLAN - CPT - 0002A","FALLON","FALLON SENIOR PLAN","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,28.39,28.39,124.23,14.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 0002A","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,61.29,28.39,124.23,14.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 0002A","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,49.4,28.39,124.23,14.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - 0002A","TUFTS","TUFTS MEDICARE SCO","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,41.17,28.39,124.23,14.5]
["TUFTS - TUFTS SPIRIT - CPT - 0002A","TUFTS","TUFTS SPIRIT","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,31.23,28.39,124.23,14.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 0002A","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,34.07,28.39,124.23,14.5]
["UNICARE - UNICARE - CPT - 0002A","UNICARE","UNICARE","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,56.79,28.39,124.23,14.5]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 0002A","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,56.79,28.39,124.23,14.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 0002A","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",58,59.79,28.39,124.23,14.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 0011A","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,19.989999999999998,16.940000000000001,74.13,14.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 0011A","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,39.979999999999997,16.940000000000001,74.13,14.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 0011A","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,45.98,16.940000000000001,74.13,14.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 0011A","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,38.97,16.940000000000001,74.13,14.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 0011A","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,38.97,16.940000000000001,74.13,14.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 0011A","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,38.97,16.940000000000001,74.13,14.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 0011A","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,42.62,16.940000000000001,74.13,14.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 0011A","BLUE CROSS","BLUE CROSS-PPO","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,38.97,16.940000000000001,74.13,14.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 0011A","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,38.97,16.940000000000001,74.13,14.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 0011A","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,38.97,16.940000000000001,74.13,14.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 0011A","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,38.97,16.940000000000001,74.13,14.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 0011A","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,37.44,16.940000000000001,74.13,14.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 0011A","BMC HEALTHNET","BMCHN ACO","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,74.13,16.940000000000001,74.13,14.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 0011A","BMC HEALTHNET","BMCHN MCO","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,33.880000000000003,16.940000000000001,74.13,14.75]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 0011A","BMC HEALTHNET","BMCHN MEDICAID","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,33.880000000000003,16.940000000000001,74.13,14.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 0011A","BMC HEALTHNET","BMCHN QHP","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,40.659999999999997,16.940000000000001,74.13,14.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 0011A","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,16.940000000000001,16.940000000000001,74.13,14.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 0011A","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,16.940000000000001,16.940000000000001,74.13,14.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 0011A","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,16.940000000000001,16.940000000000001,74.13,14.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 0011A","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,16.940000000000001,16.940000000000001,74.13,14.75]
["FALLON - FALLON MEDICAID - CPT - 0011A","FALLON","FALLON MEDICAID","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,33.880000000000003,16.940000000000001,74.13,14.75]
["FALLON - FALLON SENIOR PLAN - CPT - 0011A","FALLON","FALLON SENIOR PLAN","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,16.940000000000001,16.940000000000001,74.13,14.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 0011A","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,36.57,16.940000000000001,74.13,14.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 0011A","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,29.48,16.940000000000001,74.13,14.75]
["TUFTS - TUFTS MEDICARE SCO - CPT - 0011A","TUFTS","TUFTS MEDICARE SCO","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,24.56,16.940000000000001,74.13,14.75]
["TUFTS - TUFTS SPIRIT - CPT - 0011A","TUFTS","TUFTS SPIRIT","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,18.63,16.940000000000001,74.13,14.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 0011A","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,20.329999999999998,16.940000000000001,74.13,14.75]
["UNICARE - UNICARE - CPT - 0011A","UNICARE","UNICARE","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,33.89,16.940000000000001,74.13,14.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 0011A","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,33.89,16.940000000000001,74.13,14.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 0011A","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",59,35.68,16.940000000000001,74.13,14.75]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 0012A","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,33.5,28.39,124.23,14.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 0012A","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,67,28.39,124.23,14.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 0012A","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,77.05,28.39,124.23,14.75]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 0012A","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,65.31,28.39,124.23,14.75]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 0012A","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,65.31,28.39,124.23,14.75]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 0012A","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,65.31,28.39,124.23,14.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 0012A","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,71.430000000000007,28.39,124.23,14.75]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 0012A","BLUE CROSS","BLUE CROSS-PPO","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,65.31,28.39,124.23,14.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 0012A","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,65.31,28.39,124.23,14.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 0012A","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,65.31,28.39,124.23,14.75]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 0012A","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,65.31,28.39,124.23,14.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 0012A","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,62.74,28.39,124.23,14.75]
["BMC HEALTHNET - BMCHN ACO - CPT - 0012A","BMC HEALTHNET","BMCHN ACO","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,124.23,28.39,124.23,14.75]
["BMC HEALTHNET - BMCHN MCO - CPT - 0012A","BMC HEALTHNET","BMCHN MCO","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,56.78,28.39,124.23,14.75]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - 0012A","BMC HEALTHNET","BMCHN MEDICAID","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,56.78,28.39,124.23,14.75]
["BMC HEALTHNET - BMCHN QHP - CPT - 0012A","BMC HEALTHNET","BMCHN QHP","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,68.14,28.39,124.23,14.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 0012A","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,28.39,28.39,124.23,14.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 0012A","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,28.39,28.39,124.23,14.75]
["ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 0012A","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,28.39,28.39,124.23,14.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 0012A","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,28.39,28.39,124.23,14.75]
["FALLON - FALLON MEDICAID - CPT - 0012A","FALLON","FALLON MEDICAID","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,56.78,28.39,124.23,14.75]
["FALLON - FALLON SENIOR PLAN - CPT - 0012A","FALLON","FALLON SENIOR PLAN","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,28.39,28.39,124.23,14.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 0012A","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,61.29,28.39,124.23,14.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 0012A","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,49.4,28.39,124.23,14.75]
["TUFTS - TUFTS MEDICARE SCO - CPT - 0012A","TUFTS","TUFTS MEDICARE SCO","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,41.17,28.39,124.23,14.75]
["TUFTS - TUFTS SPIRIT - CPT - 0012A","TUFTS","TUFTS SPIRIT","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,31.23,28.39,124.23,14.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 0012A","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,34.07,28.39,124.23,14.75]
["UNICARE - UNICARE - CPT - 0012A","UNICARE","UNICARE","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,56.79,28.39,124.23,14.75]
["UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 0012A","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,56.79,28.39,124.23,14.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 0012A","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",59,59.79,28.39,124.23,14.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 0106T","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","0106T","HC QUANT SENSORY TEST, PER EXTREMITY, TOUCH STIMULI","0106T - HC QUANT SENSORY TEST, PER EXTREMITY, TOUCH STIMULI",49,69.349999999999994,67.64,69.349999999999994,12.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 0106T","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","0106T","HC QUANT SENSORY TEST, PER EXTREMITY, TOUCH STIMULI","0106T - HC QUANT SENSORY TEST, PER EXTREMITY, TOUCH STIMULI",49,69.349999999999994,67.64,69.349999999999994,12.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 0106T","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","0106T","HC QUANT SENSORY TEST, PER EXTREMITY, TOUCH STIMULI","0106T - HC QUANT SENSORY TEST, PER EXTREMITY, TOUCH STIMULI",49,67.64,67.64,69.349999999999994,12.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 0106T","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","0106T","HC QUANT SENSORY TEST, PER EXTREMITY, TOUCH STIMULI","0106T - HC QUANT SENSORY TEST, PER EXTREMITY, TOUCH STIMULI",49,69.349999999999994,67.64,69.349999999999994,12.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 0126T","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","0126T","HC COMMON CAROTID INTIMA-MEDIA THICK FOR AHD/CHD RISK ASSESS","0126T - HC COMMON CAROTID INTIMA-MEDIA THICK FOR AHD/CHD RISK ASSESS",650,69.349999999999994,67.64,69.349999999999994,162.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 0126T","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","0126T","HC COMMON CAROTID INTIMA-MEDIA THICK FOR AHD/CHD RISK ASSESS","0126T - HC COMMON CAROTID INTIMA-MEDIA THICK FOR AHD/CHD RISK ASSESS",650,69.349999999999994,67.64,69.349999999999994,162.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 0126T","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","0126T","HC COMMON CAROTID INTIMA-MEDIA THICK FOR AHD/CHD RISK ASSESS","0126T - HC COMMON CAROTID INTIMA-MEDIA THICK FOR AHD/CHD RISK ASSESS",650,67.64,67.64,69.349999999999994,162.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 0126T","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","0126T","HC COMMON CAROTID INTIMA-MEDIA THICK FOR AHD/CHD RISK ASSESS","0126T - HC COMMON CAROTID INTIMA-MEDIA THICK FOR AHD/CHD RISK ASSESS",650,69.349999999999994,67.64,69.349999999999994,162.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 0159T","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","0159T","HC COMPUTER AIDED DETECTION BREAST MRI","0159T - HC COMPUTER AIDED DETECTION BREAST MRI",331,0,0,0,82.75]
["TUFTS - TUFTS HMO - CPT - 0159T","TUFTS","TUFTS HMO","CPT","0159T","HC COMPUTER AIDED DETECTION BREAST MRI","0159T - HC COMPUTER AIDED DETECTION BREAST MRI",331,0,0,0,82.75]
["TUFTS - TUFTS POS - CPT - 0159T","TUFTS","TUFTS POS","CPT","0159T","HC COMPUTER AIDED DETECTION BREAST MRI","0159T - HC COMPUTER AIDED DETECTION BREAST MRI",331,0,0,0,82.75]
["TUFTS - TUFTS PPO - CPT - 0159T","TUFTS","TUFTS PPO","CPT","0159T","HC COMPUTER AIDED DETECTION BREAST MRI","0159T - HC COMPUTER AIDED DETECTION BREAST MRI",331,0,0,0,82.75]
["TUFTS - TUFTS SELECT - CPT - 0159T","TUFTS","TUFTS SELECT","CPT","0159T","HC COMPUTER AIDED DETECTION BREAST MRI","0159T - HC COMPUTER AIDED DETECTION BREAST MRI",331,0,0,0,82.75]
["AETNA - AETNA - CPT - 0191T","AETNA","AETNA","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",5769,1990.62,1990.62,17023.61,1442.25]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 0191T","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",5769,6113.35,1990.62,17023.61,1442.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 0191T","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",5769,6113.35,1990.62,17023.61,1442.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 0191T","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",5769,6113.35,1990.62,17023.61,1442.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 0191T","BLUE CROSS","BLUE CROSS-PPO","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",5769,6113.35,1990.62,17023.61,1442.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 0191T","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",5769,6113.35,1990.62,17023.61,1442.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 0191T","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",5769,6113.35,1990.62,17023.61,1442.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 0191T","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",5769,6113.35,1990.62,17023.61,1442.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 0191T","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",5769,17023.61,1990.62,17023.61,1442.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 0191T","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",5769,7073.38,1990.62,17023.61,1442.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 0191T","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",5769,7073.38,1990.62,17023.61,1442.25]
["TUFTS - TUFTS HMO - CPT - 0191T","TUFTS","TUFTS HMO","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",5769,10732.28,1990.62,17023.61,1442.25]
["TUFTS - TUFTS POS - CPT - 0191T","TUFTS","TUFTS POS","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",5769,10732.28,1990.62,17023.61,1442.25]
["TUFTS - TUFTS PPO - CPT - 0191T","TUFTS","TUFTS PPO","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",5769,10732.28,1990.62,17023.61,1442.25]
["TUFTS - TUFTS SELECT - CPT - 0191T","TUFTS","TUFTS SELECT","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",5769,5730.6,1990.62,17023.61,1442.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 0191T","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",5769,6899.74,1990.62,17023.61,1442.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 0191T","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",5769,7073.38,1990.62,17023.61,1442.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 0202U","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",1355,0,0,0,338.75]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 0202U","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",1355,0,0,0,338.75]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 0202U","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",1355,0,0,0,338.75]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 0202U","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",1355,0,0,0,338.75]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 0202U","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",1355,0,0,0,338.75]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 0202U","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",1355,0,0,0,338.75]
["FALLON - FALLON SENIOR PLAN - CPT - 0202U","FALLON","FALLON SENIOR PLAN","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",1355,0,0,0,338.75]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 0202U","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",1355,0,0,0,338.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 0202U","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",1355,0,0,0,338.75]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 0202U","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",1355,0,0,0,338.75]
["TUFTS - TUFTS MEDICARE SCO - CPT - 0202U","TUFTS","TUFTS MEDICARE SCO","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",1355,0,0,0,338.75]
["TUFTS - TUFTS SPIRIT - CPT - 0202U","TUFTS","TUFTS SPIRIT","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",1355,0,0,0,338.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 0202U","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",1355,0,0,0,338.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 0202U","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",1355,0,0,0,338.75]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 0202U","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",1355,0,0,0,338.75]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 0202U","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",1355,0,0,0,338.75]
["AETNA - AETNA - CPT - 0207T","AETNA","AETNA","CPT","0207T","HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL","0207T - HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL",85,1198.25,117.73,1198.25,21.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 0207T","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","0207T","HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL","0207T - HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL",85,120.69,117.73,1198.25,21.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 0207T","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","0207T","HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL","0207T - HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL",85,120.69,117.73,1198.25,21.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 0207T","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","0207T","HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL","0207T - HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL",85,117.73,117.73,1198.25,21.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 0207T","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","0207T","HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL","0207T - HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL",85,120.69,117.73,1198.25,21.25]
["AETNA - AETNA - CPT - 0234T","AETNA","AETNA","CPT","0234T","HC TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA","0234T - HC TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA",9897,1990.62,1990.62,18787.919999999998,2474.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 0234T","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","0234T","HC TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA","0234T - HC TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA",9897,18787.919999999998,1990.62,18787.919999999998,2474.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 0234T","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","0234T","HC TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA","0234T - HC TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA",9897,18787.919999999998,1990.62,18787.919999999998,2474.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 0234T","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","0234T","HC TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA","0234T - HC TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA",9897,18326.71,1990.62,18787.919999999998,2474.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 0234T","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","0234T","HC TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA","0234T - HC TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA",9897,18787.919999999998,1990.62,18787.919999999998,2474.25]
["AETNA - AETNA - CPT - 0236T","AETNA","AETNA","CPT","0236T","HC TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA","0236T - HC TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA",3620,1990.62,1990.62,18787.919999999998,905]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 0236T","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","0236T","HC TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA","0236T - HC TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA",3620,18787.919999999998,1990.62,18787.919999999998,905]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 0236T","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","0236T","HC TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA","0236T - HC TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA",3620,18787.919999999998,1990.62,18787.919999999998,905]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 0236T","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","0236T","HC TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA","0236T - HC TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA",3620,18326.71,1990.62,18787.919999999998,905]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 0236T","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","0236T","HC TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA","0236T - HC TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA",3620,18787.919999999998,1990.62,18787.919999999998,905]
["AETNA - AETNA - CPT - 0237T","AETNA","AETNA","CPT","0237T","HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL","0237T - HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL",3620,1990.62,1990.62,18787.919999999998,905]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 0237T","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","0237T","HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL","0237T - HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL",3620,18787.919999999998,1990.62,18787.919999999998,905]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 0237T","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","0237T","HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL","0237T - HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL",3620,18787.919999999998,1990.62,18787.919999999998,905]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 0237T","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","0237T","HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL","0237T - HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL",3620,18326.71,1990.62,18787.919999999998,905]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 0237T","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","0237T","HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL","0237T - HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL",3620,18787.919999999998,1990.62,18787.919999999998,905]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 0238T","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","0238T","HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA",15225,25785.9,25785.9,29835.33,3806.25]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 0238T","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","0238T","HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA",15225,25785.9,25785.9,29835.33,3806.25]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 0238T","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","0238T","HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA",15225,25785.9,25785.9,29835.33,3806.25]
["BLUE CROSS - BLUE CROSS-PPO - CPT - 0238T","BLUE CROSS","BLUE CROSS-PPO","CPT","0238T","HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA",15225,25785.9,25785.9,29835.33,3806.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 0238T","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","0238T","HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA",15225,25785.9,25785.9,29835.33,3806.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 0238T","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","0238T","HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA",15225,25785.9,25785.9,29835.33,3806.25]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 0238T","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","0238T","HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA",15225,25785.9,25785.9,29835.33,3806.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 0238T","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","0238T","HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA",15225,29835.33,25785.9,29835.33,3806.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 0238T","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","0238T","HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA",15225,29835.33,25785.9,29835.33,3806.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 0238T","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","0238T","HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA",15225,29102.92,25785.9,29835.33,3806.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 0238T","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","0238T","HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA",15225,29835.33,25785.9,29835.33,3806.25]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 0241U","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT","0241U - HC NFCT DS VIR RESP RNA 4 TRGT",229,168.3,142.63,358.89,57.25]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 0241U","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT","0241U - HC NFCT DS VIR RESP RNA 4 TRGT",229,358.89,142.63,358.89,57.25]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 0241U","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT","0241U - HC NFCT DS VIR RESP RNA 4 TRGT",229,315.2,142.63,358.89,57.25]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 0241U","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT","0241U - HC NFCT DS VIR RESP RNA 4 TRGT",229,142.63,142.63,358.89,57.25]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 0241U","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT","0241U - HC NFCT DS VIR RESP RNA 4 TRGT",229,142.63,142.63,358.89,57.25]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 0241U","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT","0241U - HC NFCT DS VIR RESP RNA 4 TRGT",229,142.63,142.63,358.89,57.25]
["FALLON - FALLON SENIOR PLAN - CPT - 0241U","FALLON","FALLON SENIOR PLAN","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT","0241U - HC NFCT DS VIR RESP RNA 4 TRGT",229,142.63,142.63,358.89,57.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 0241U","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT","0241U - HC NFCT DS VIR RESP RNA 4 TRGT",229,307.94,142.63,358.89,57.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 0241U","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT","0241U - HC NFCT DS VIR RESP RNA 4 TRGT",229,248.18,142.63,358.89,57.25]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 0241U","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT","0241U - HC NFCT DS VIR RESP RNA 4 TRGT",229,206.81,142.63,358.89,57.25]
["TUFTS - TUFTS MEDICARE SCO - CPT - 0241U","TUFTS","TUFTS MEDICARE SCO","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT","0241U - HC NFCT DS VIR RESP RNA 4 TRGT",229,206.81,142.63,358.89,57.25]
["TUFTS - TUFTS SPIRIT - CPT - 0241U","TUFTS","TUFTS SPIRIT","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT","0241U - HC NFCT DS VIR RESP RNA 4 TRGT",229,156.88999999999999,142.63,358.89,57.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 0241U","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT","0241U - HC NFCT DS VIR RESP RNA 4 TRGT",229,192.29,142.63,358.89,57.25]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 0241U","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT","0241U - HC NFCT DS VIR RESP RNA 4 TRGT",229,171.16,142.63,358.89,57.25]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 0241U","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT","0241U - HC NFCT DS VIR RESP RNA 4 TRGT",229,171.16,142.63,358.89,57.25]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 0241U","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT","0241U - HC NFCT DS VIR RESP RNA 4 TRGT",229,300.38,142.63,358.89,57.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 0346T","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","0346T","ULTRASOUND ELASTOGRAPHY","0346T - ULTRASOUND ELASTOGRAPHY",1279,0,0,0,319.75]
["TUFTS - TUFTS HMO - CPT - 0346T","TUFTS","TUFTS HMO","CPT","0346T","ULTRASOUND ELASTOGRAPHY","0346T - ULTRASOUND ELASTOGRAPHY",1279,0,0,0,319.75]
["TUFTS - TUFTS POS - CPT - 0346T","TUFTS","TUFTS POS","CPT","0346T","ULTRASOUND ELASTOGRAPHY","0346T - ULTRASOUND ELASTOGRAPHY",1279,0,0,0,319.75]
["TUFTS - TUFTS PPO - CPT - 0346T","TUFTS","TUFTS PPO","CPT","0346T","ULTRASOUND ELASTOGRAPHY","0346T - ULTRASOUND ELASTOGRAPHY",1279,0,0,0,319.75]
["TUFTS - TUFTS SELECT - CPT - 0346T","TUFTS","TUFTS SELECT","CPT","0346T","ULTRASOUND ELASTOGRAPHY","0346T - ULTRASOUND ELASTOGRAPHY",1279,0,0,0,319.75]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 0362T","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","0362T","HC BHV ID SUPRT ASSMT EA 15 MIN","0362T - HC BHV ID SUPRT ASSMT EA 15 MIN",378,61.23,33.74,61.23,94.5]
["TUFTS - TUFTS HMO - CPT - 0362T","TUFTS","TUFTS HMO","CPT","0362T","HC BHV ID SUPRT ASSMT EA 15 MIN","0362T - HC BHV ID SUPRT ASSMT EA 15 MIN",378,38.6,33.74,61.23,94.5]
["TUFTS - TUFTS POS - CPT - 0362T","TUFTS","TUFTS POS","CPT","0362T","HC BHV ID SUPRT ASSMT EA 15 MIN","0362T - HC BHV ID SUPRT ASSMT EA 15 MIN",378,38.6,33.74,61.23,94.5]
["TUFTS - TUFTS PPO - CPT - 0362T","TUFTS","TUFTS PPO","CPT","0362T","HC BHV ID SUPRT ASSMT EA 15 MIN","0362T - HC BHV ID SUPRT ASSMT EA 15 MIN",378,38.6,33.74,61.23,94.5]
["TUFTS - TUFTS SELECT - CPT - 0362T","TUFTS","TUFTS SELECT","CPT","0362T","HC BHV ID SUPRT ASSMT EA 15 MIN","0362T - HC BHV ID SUPRT ASSMT EA 15 MIN",378,33.74,33.74,61.23,94.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 0373T","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","0373T","HC ADAPT BHV TX EA 15 MIN","0373T - HC ADAPT BHV TX EA 15 MIN",378,61.23,33.74,61.23,94.5]
["TUFTS - TUFTS HMO - CPT - 0373T","TUFTS","TUFTS HMO","CPT","0373T","HC ADAPT BHV TX EA 15 MIN","0373T - HC ADAPT BHV TX EA 15 MIN",378,38.6,33.74,61.23,94.5]
["TUFTS - TUFTS POS - CPT - 0373T","TUFTS","TUFTS POS","CPT","0373T","HC ADAPT BHV TX EA 15 MIN","0373T - HC ADAPT BHV TX EA 15 MIN",378,38.6,33.74,61.23,94.5]
["TUFTS - TUFTS PPO - CPT - 0373T","TUFTS","TUFTS PPO","CPT","0373T","HC ADAPT BHV TX EA 15 MIN","0373T - HC ADAPT BHV TX EA 15 MIN",378,38.6,33.74,61.23,94.5]
["TUFTS - TUFTS SELECT - CPT - 0373T","TUFTS","TUFTS SELECT","CPT","0373T","HC ADAPT BHV TX EA 15 MIN","0373T - HC ADAPT BHV TX EA 15 MIN",378,33.74,33.74,61.23,94.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 0482T","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","0482T","ABSOLUTE QUAN MYOCARD BLD FLO PET STRESS & REST","0482T - ABSOLUTE QUAN MYOCARD BLD FLO PET STRESS & REST",1350,0,0,0,337.5]
["TUFTS - TUFTS HMO - CPT - 0482T","TUFTS","TUFTS HMO","CPT","0482T","ABSOLUTE QUAN MYOCARD BLD FLO PET STRESS & REST","0482T - ABSOLUTE QUAN MYOCARD BLD FLO PET STRESS & REST",1350,0,0,0,337.5]
["TUFTS - TUFTS POS - CPT - 0482T","TUFTS","TUFTS POS","CPT","0482T","ABSOLUTE QUAN MYOCARD BLD FLO PET STRESS & REST","0482T - ABSOLUTE QUAN MYOCARD BLD FLO PET STRESS & REST",1350,0,0,0,337.5]
["TUFTS - TUFTS PPO - CPT - 0482T","TUFTS","TUFTS PPO","CPT","0482T","ABSOLUTE QUAN MYOCARD BLD FLO PET STRESS & REST","0482T - ABSOLUTE QUAN MYOCARD BLD FLO PET STRESS & REST",1350,0,0,0,337.5]
["TUFTS - TUFTS SELECT - CPT - 0482T","TUFTS","TUFTS SELECT","CPT","0482T","ABSOLUTE QUAN MYOCARD BLD FLO PET STRESS & REST","0482T - ABSOLUTE QUAN MYOCARD BLD FLO PET STRESS & REST",1350,0,0,0,337.5]
["AETNA - AETNA - CPT - 0505T","AETNA","AETNA","CPT","0505T","HC EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR","0505T - HC EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR",14877,2166.09,2166.09,18787.919999999998,3719.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 0505T","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","0505T","HC EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR","0505T - HC EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR",14877,18787.919999999998,2166.09,18787.919999999998,3719.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 0505T","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","0505T","HC EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR","0505T - HC EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR",14877,18787.919999999998,2166.09,18787.919999999998,3719.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 0505T","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","0505T","HC EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR","0505T - HC EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR",14877,18326.71,2166.09,18787.919999999998,3719.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 0505T","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","0505T","HC EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR","0505T - HC EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR",14877,18787.919999999998,2166.09,18787.919999999998,3719.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 0509T","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","0509T","HC PATTERN ERG W/I&R","0509T - HC PATTERN ERG W/I&R",210,797.09,250.1,797.09,52.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 0509T","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","0509T","HC PATTERN ERG W/I&R","0509T - HC PATTERN ERG W/I&R",210,293.52,250.1,797.09,52.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 0509T","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","0509T","HC PATTERN ERG W/I&R","0509T - HC PATTERN ERG W/I&R",210,293.52,250.1,797.09,52.5]
["TUFTS - TUFTS HMO - CPT - 0509T","TUFTS","TUFTS HMO","CPT","0509T","HC PATTERN ERG W/I&R","0509T - HC PATTERN ERG W/I&R",210,469.76,250.1,797.09,52.5]
["TUFTS - TUFTS POS - CPT - 0509T","TUFTS","TUFTS POS","CPT","0509T","HC PATTERN ERG W/I&R","0509T - HC PATTERN ERG W/I&R",210,469.76,250.1,797.09,52.5]
["TUFTS - TUFTS PPO - CPT - 0509T","TUFTS","TUFTS PPO","CPT","0509T","HC PATTERN ERG W/I&R","0509T - HC PATTERN ERG W/I&R",210,502.51,250.1,797.09,52.5]
["TUFTS - TUFTS SELECT - CPT - 0509T","TUFTS","TUFTS SELECT","CPT","0509T","HC PATTERN ERG W/I&R","0509T - HC PATTERN ERG W/I&R",210,250.1,250.1,797.09,52.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 0509T","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","0509T","HC PATTERN ERG W/I&R","0509T - HC PATTERN ERG W/I&R",210,286.31,250.1,797.09,52.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 0509T","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","0509T","HC PATTERN ERG W/I&R","0509T - HC PATTERN ERG W/I&R",210,293.52,250.1,797.09,52.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 0523T","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","0523T","HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING","0523T - HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING",2178,0,0,0,544.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 0523T","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","0523T","HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING","0523T - HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING",2178,0,0,0,544.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 0523T","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","0523T","HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING","0523T - HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING",2178,0,0,0,544.5]
["TUFTS - TUFTS HMO - CPT - 0523T","TUFTS","TUFTS HMO","CPT","0523T","HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING","0523T - HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING",2178,0,0,0,544.5]
["TUFTS - TUFTS POS - CPT - 0523T","TUFTS","TUFTS POS","CPT","0523T","HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING","0523T - HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING",2178,0,0,0,544.5]
["TUFTS - TUFTS PPO - CPT - 0523T","TUFTS","TUFTS PPO","CPT","0523T","HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING","0523T - HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING",2178,0,0,0,544.5]
["TUFTS - TUFTS SELECT - CPT - 0523T","TUFTS","TUFTS SELECT","CPT","0523T","HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING","0523T - HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING",2178,0,0,0,544.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 0523T","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","0523T","HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING","0523T - HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING",2178,0,0,0,544.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 0523T","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","0523T","HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING","0523T - HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING",2178,0,0,0,544.5]
["AETNA - AETNA - CPT - 0524T","AETNA","AETNA","CPT","0524T","HC EV CATHETER DIR CHEM ABLTJ INCMPTNT XTR VEIN","0524T - HC EV CATHETER DIR CHEM ABLTJ INCMPTNT XTR VEIN",4065,1990.62,1990.62,5703.04,1016.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 0524T","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","0524T","HC EV CATHETER DIR CHEM ABLTJ INCMPTNT XTR VEIN","0524T - HC EV CATHETER DIR CHEM ABLTJ INCMPTNT XTR VEIN",4065,5703.04,1990.62,5703.04,1016.25]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 0524T","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","0524T","HC EV CATHETER DIR CHEM ABLTJ INCMPTNT XTR VEIN","0524T - HC EV CATHETER DIR CHEM ABLTJ INCMPTNT XTR VEIN",4065,5703.04,1990.62,5703.04,1016.25]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 0524T","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","0524T","HC EV CATHETER DIR CHEM ABLTJ INCMPTNT XTR VEIN","0524T - HC EV CATHETER DIR CHEM ABLTJ INCMPTNT XTR VEIN",4065,5563.04,1990.62,5703.04,1016.25]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 0524T","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","0524T","HC EV CATHETER DIR CHEM ABLTJ INCMPTNT XTR VEIN","0524T - HC EV CATHETER DIR CHEM ABLTJ INCMPTNT XTR VEIN",4065,5703.04,1990.62,5703.04,1016.25]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 0540T","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","0540T","HC CAR-T CLL ADMN AUTOLOGOUS","0540T - HC CAR-T CLL ADMN AUTOLOGOUS",451,1748.74,548.67999999999995,1748.74,112.75]
["TUFTS - TUFTS HMO - CPT - 0540T","TUFTS","TUFTS HMO","CPT","0540T","HC CAR-T CLL ADMN AUTOLOGOUS","0540T - HC CAR-T CLL ADMN AUTOLOGOUS",451,1030.5899999999999,548.67999999999995,1748.74,112.75]
["TUFTS - TUFTS POS - CPT - 0540T","TUFTS","TUFTS POS","CPT","0540T","HC CAR-T CLL ADMN AUTOLOGOUS","0540T - HC CAR-T CLL ADMN AUTOLOGOUS",451,1030.5899999999999,548.67999999999995,1748.74,112.75]
["TUFTS - TUFTS PPO - CPT - 0540T","TUFTS","TUFTS PPO","CPT","0540T","HC CAR-T CLL ADMN AUTOLOGOUS","0540T - HC CAR-T CLL ADMN AUTOLOGOUS",451,1102.46,548.67999999999995,1748.74,112.75]
["TUFTS - TUFTS SELECT - CPT - 0540T","TUFTS","TUFTS SELECT","CPT","0540T","HC CAR-T CLL ADMN AUTOLOGOUS","0540T - HC CAR-T CLL ADMN AUTOLOGOUS",451,548.67999999999995,548.67999999999995,1748.74,112.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - G0399","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",206,0,286.31,1634.89,51.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - G0399","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",206,0,286.31,1634.89,51.5]
["BMC HEALTHNET - BMCHN ACO - CPT - G0399","BMC HEALTHNET","BMCHN ACO","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",206,0,286.31,1634.89,51.5]
["BMC HEALTHNET - BMCHN MCO - CPT - G0399","BMC HEALTHNET","BMCHN MCO","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",206,0,286.31,1634.89,51.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - G0399","BMC HEALTHNET","BMCHN MEDICAID","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",206,0,286.31,1634.89,51.5]
["BMC HEALTHNET - BMCHN QHP - CPT - G0399","BMC HEALTHNET","BMCHN QHP","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",206,0,286.31,1634.89,51.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - G0399","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",206,1634.89,286.31,1634.89,51.5]
["FALLON - FALLON MEDICAID - CPT - G0399","FALLON","FALLON MEDICAID","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",206,0,286.31,1634.89,51.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - G0399","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",206,293.52,286.31,1634.89,51.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - G0399","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",206,293.52,286.31,1634.89,51.5]
["TUFTS - TUFTS HMO - CPT - G0399","TUFTS","TUFTS HMO","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",206,652.5,286.31,1634.89,51.5]
["TUFTS - TUFTS POS - CPT - G0399","TUFTS","TUFTS POS","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",206,543.75,286.31,1634.89,51.5]
["TUFTS - TUFTS PPO - CPT - G0399","TUFTS","TUFTS PPO","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",206,581.65,286.31,1634.89,51.5]
["TUFTS - TUFTS SELECT - CPT - G0399","TUFTS","TUFTS SELECT","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",206,543.75,286.31,1634.89,51.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - G0399","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",206,0,286.31,1634.89,51.5]
["UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - G0399","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",206,286.31,286.31,1634.89,51.5]
["UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - G0399","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",206,293.52,286.31,1634.89,51.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - G0465","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","G0465","HC AUTOLOG PRP DIAB WOUND ULCER","G0465 - HC AUTOLOG PRP DIAB WOUND ULCER",2187,0,0,0,546.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - G0465","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","G0465","HC AUTOLOG PRP DIAB WOUND ULCER","G0465 - HC AUTOLOG PRP DIAB WOUND ULCER",2187,0,0,0,546.75]
["BMC HEALTHNET - BMCHN ACO - CPT - G0465","BMC HEALTHNET","BMCHN ACO","CPT","G0465","HC AUTOLOG PRP DIAB WOUND ULCER","G0465 - HC AUTOLOG PRP DIAB WOUND ULCER",2187,0,0,0,546.75]
["BMC HEALTHNET - BMCHN MCO - CPT - G0465","BMC HEALTHNET","BMCHN MCO","CPT","G0465","HC AUTOLOG PRP DIAB WOUND ULCER","G0465 - HC AUTOLOG PRP DIAB WOUND ULCER",2187,0,0,0,546.75]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - G0465","BMC HEALTHNET","BMCHN MEDICAID","CPT","G0465","HC AUTOLOG PRP DIAB WOUND ULCER","G0465 - HC AUTOLOG PRP DIAB WOUND ULCER",2187,0,0,0,546.75]
["BMC HEALTHNET - BMCHN QHP - CPT - G0465","BMC HEALTHNET","BMCHN QHP","CPT","G0465","HC AUTOLOG PRP DIAB WOUND ULCER","G0465 - HC AUTOLOG PRP DIAB WOUND ULCER",2187,0,0,0,546.75]
["FALLON - FALLON MEDICAID - CPT - G0465","FALLON","FALLON MEDICAID","CPT","G0465","HC AUTOLOG PRP DIAB WOUND ULCER","G0465 - HC AUTOLOG PRP DIAB WOUND ULCER",2187,0,0,0,546.75]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - G0465","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","G0465","HC AUTOLOG PRP DIAB WOUND ULCER","G0465 - HC AUTOLOG PRP DIAB WOUND ULCER",2187,0,0,0,546.75]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - G2215","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","G2215","HC HOME SUPPLY NASAL NALOXONE","G2215 - HC HOME SUPPLY NASAL NALOXONE",118,0,0,0,29.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - G2215","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","G2215","HC HOME SUPPLY NASAL NALOXONE","G2215 - HC HOME SUPPLY NASAL NALOXONE",118,0,0,0,29.5]
["BMC HEALTHNET - BMCHN ACO - CPT - G2215","BMC HEALTHNET","BMCHN ACO","CPT","G2215","HC HOME SUPPLY NASAL NALOXONE","G2215 - HC HOME SUPPLY NASAL NALOXONE",118,0,0,0,29.5]
["BMC HEALTHNET - BMCHN MCO - CPT - G2215","BMC HEALTHNET","BMCHN MCO","CPT","G2215","HC HOME SUPPLY NASAL NALOXONE","G2215 - HC HOME SUPPLY NASAL NALOXONE",118,0,0,0,29.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - G2215","BMC HEALTHNET","BMCHN MEDICAID","CPT","G2215","HC HOME SUPPLY NASAL NALOXONE","G2215 - HC HOME SUPPLY NASAL NALOXONE",118,0,0,0,29.5]
["BMC HEALTHNET - BMCHN QHP - CPT - G2215","BMC HEALTHNET","BMCHN QHP","CPT","G2215","HC HOME SUPPLY NASAL NALOXONE","G2215 - HC HOME SUPPLY NASAL NALOXONE",118,0,0,0,29.5]
["FALLON - FALLON MEDICAID - CPT - G2215","FALLON","FALLON MEDICAID","CPT","G2215","HC HOME SUPPLY NASAL NALOXONE","G2215 - HC HOME SUPPLY NASAL NALOXONE",118,0,0,0,29.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - G2215","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","G2215","HC HOME SUPPLY NASAL NALOXONE","G2215 - HC HOME SUPPLY NASAL NALOXONE",118,0,0,0,29.5]
["AETNA - AETNA-MEDICARE ADVANTAGE - CPT - U0004","AETNA","AETNA-MEDICARE ADVANTAGE","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,118,100,906.74,37.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - U0004","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,118,100,906.74,37.5]
["ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - U0004","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,135.69999999999999,100,906.74,37.5]
["BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - U0004","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,115.01,100,906.74,37.5]
["BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - U0004","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,115.01,100,906.74,37.5]
["BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - U0004","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,115.01,100,906.74,37.5]
["BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - U0004","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,251.62,100,906.74,37.5]
["BLUE CROSS - BLUE CROSS-PPO - CPT - U0004","BLUE CROSS","BLUE CROSS-PPO","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,115.01,100,906.74,37.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - U0004","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,115.01,100,906.74,37.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - U0004","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,115.01,100,906.74,37.5]
["BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - U0004","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,115.01,100,906.74,37.5]
["BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - U0004","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,220.99,100,906.74,37.5]
["BMC HEALTHNET - BMCHN ACO - CPT - U0004","BMC HEALTHNET","BMCHN ACO","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,218.8,100,906.74,37.5]
["BMC HEALTHNET - BMCHN MCO - CPT - U0004","BMC HEALTHNET","BMCHN MCO","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,100,100,906.74,37.5]
["BMC HEALTHNET - BMCHN MEDICAID - CPT - U0004","BMC HEALTHNET","BMCHN MEDICAID","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,100,100,906.74,37.5]
["BMC HEALTHNET - BMCHN QHP - CPT - U0004","BMC HEALTHNET","BMCHN QHP","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,120,100,906.74,37.5]
["CIGNA HEALTHCARE - CIGNA CARELINK - CPT - U0004","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,906.74,100,906.74,37.5]
["COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - U0004","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,100,100,906.74,37.5]
["ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - U0004","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,100,100,906.74,37.5]
["ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - U0004","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,100,100,906.74,37.5]
["FALLON - FALLON MEDICAID - CPT - U0004","FALLON","FALLON MEDICAID","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,100,100,906.74,37.5]
["FALLON - FALLON SENIOR PLAN - CPT - U0004","FALLON","FALLON SENIOR PLAN","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,100,100,906.74,37.5]
["HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - U0004","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,215.9,100,906.74,37.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - U0004","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,174,100,906.74,37.5]
["TUFTS - TUFTS HMO - CPT - U0004","TUFTS","TUFTS HMO","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,387.12,100,906.74,37.5]
["TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - U0004","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,145,100,906.74,37.5]
["TUFTS - TUFTS MEDICARE SCO - CPT - U0004","TUFTS","TUFTS MEDICARE SCO","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,145,100,906.74,37.5]
["TUFTS - TUFTS POS - CPT - U0004","TUFTS","TUFTS POS","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,322.60000000000002,100,906.74,37.5]
["TUFTS - TUFTS PPO - CPT - U0004","TUFTS","TUFTS PPO","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,322.60000000000002,100,906.74,37.5]
["TUFTS - TUFTS SPIRIT - CPT - U0004","TUFTS","TUFTS SPIRIT","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,110,100,906.74,37.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - U0004","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,117.7,100,906.74,37.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - U0004","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,134.82,100,906.74,37.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - U0004","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,151.19999999999999,100,906.74,37.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - U0004","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,120,100,906.74,37.5]
["TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - U0004","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,120,100,906.74,37.5]
["UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - U0004","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,120,100,906.74,37.5]
["UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - U0004","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",150,210.6,100,906.74,37.5]

{"sheet":"Sheet6 (cpt)","index":15,"n_rows":79780,"n_cols":17,"rows_kept":4500,"cut":true,"hidden":true,"merged":[],"bounds":{"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0}}
["Payer","Plan","Bill Code","Bill Code Description","CPT & Description",null,null,null,null,null,"Plan","Bill Code",null,"Payer","CPT & Description",null,"*Select Insurance Carrier"]
["AETNA","AETNA","10004","HC FNA BX W/O IMG GDN EA ADDL","10004 - HC FNA BX W/O IMG GDN EA ADDL",null,null,null,null,null,"AETNA","10004",null,"AETNA","10004 - HC FNA BX W/O IMG GDN EA ADDL",null,"AETNA"]
["AETNA","AETNA","10005","HC FNA BX W/US GDN 1ST LES","10005 - HC FNA BX W/US GDN 1ST LES",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","10004",null,"AETNA","10005 - HC FNA BX W/US GDN 1ST LES",null,"AETNA2"]
["AETNA","AETNA","10006","HC FNA BX W/US GDN EA ADDL","10006 - HC FNA BX W/US GDN EA ADDL",null,null,null,null,null,"BLUE CROSS-HMO BLUE","10004",null,"AETNA","10006 - HC FNA BX W/US GDN EA ADDL",null,"ALLWAYS HEALTH PARTNERS"]
["AETNA","AETNA","10007","HC FNA BX W/FLUOR GDN 1ST LES","10007 - HC FNA BX W/FLUOR GDN 1ST LES",null,null,null,null,null,"BLUE CROSS-INDEMNITY","10004",null,"AETNA","10007 - HC FNA BX W/FLUOR GDN 1ST LES",null,"ALLWAYS HEALTH PARTNERS2"]
["AETNA","AETNA","10008","HC FNA BX W/FLUOR GDN EA ADDL","10008 - HC FNA BX W/FLUOR GDN EA ADDL",null,null,null,null,null,"BLUE CROSS-PPO","10004",null,"AETNA","10008 - HC FNA BX W/FLUOR GDN EA ADDL",null,"BLUE BENEFIT ADMINISTRATORS"]
["AETNA","AETNA","10009","HC FNA BX W/CT GDN 1ST LES","10009 - HC FNA BX W/CT GDN 1ST LES",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","10004",null,"AETNA","10009 - HC FNA BX W/CT GDN 1ST LES",null,"BLUE BENEFIT ADMINISTRATORS2"]
["AETNA","AETNA","10010","HC FNA BX W/CT GDN EA ADDL","10010 - HC FNA BX W/CT GDN EA ADDL",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","10004",null,"AETNA","10010 - HC FNA BX W/CT GDN EA ADDL",null,"BLUE CROSS"]
["AETNA","AETNA","10011","HC FNA BX W/MR GDN 1ST LES","10011 - HC FNA BX W/MR GDN 1ST LES",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","10004",null,"AETNA","10011 - HC FNA BX W/MR GDN 1ST LES",null,"BLUE CROSS OUT OF STATE"]
["AETNA","AETNA","10012","HC FNA BX W/MR GDN EA ADDL","10012 - HC FNA BX W/MR GDN EA ADDL",null,null,null,null,null,"CIGNA CARELINK","10004",null,"AETNA","10012 - HC FNA BX W/MR GDN EA ADDL",null,"BLUE CROSS OUT OF STATE2"]
["AETNA","AETNA","10021","FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE","10021 - FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","10004",null,"AETNA","10021 - FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE",null,"BLUE CROSS2"]
["AETNA","AETNA","10030","IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE","10030 - IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","10004",null,"AETNA","10030 - IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE",null,"BMC HEALTHNET"]
["AETNA","AETNA","10035","HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION","10035 - HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION",null,null,null,null,null,"TUFTS HMO","10004",null,"AETNA","10035 - HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION",null,"BMC HEALTHNET2"]
["AETNA","AETNA","10036","HC PERQ DEV SOFT TISS ADD IMAG","10036 - HC PERQ DEV SOFT TISS ADD IMAG",null,null,null,null,null,"TUFTS POS","10004",null,"AETNA","10036 - HC PERQ DEV SOFT TISS ADD IMAG",null,"CIGNA HEALTHCARE"]
["AETNA","AETNA","10060","INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE","10060 - INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE",null,null,null,null,null,"TUFTS PPO","10004",null,"AETNA","10060 - INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE",null,"CIGNA HEALTHCARE2"]
["AETNA","AETNA","10061","INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE","10061 - INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE",null,null,null,null,null,"TUFTS SELECT","10004",null,"AETNA","10061 - INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE",null,"COMMONWEALTH CARE ALLIANCE"]
["AETNA","AETNA","10080","INCISION & DRAINAGE PILONIDAL CYST SIMPLE","10080 - INCISION & DRAINAGE PILONIDAL CYST SIMPLE",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","10004",null,"AETNA","10080 - INCISION & DRAINAGE PILONIDAL CYST SIMPLE",null,"COMMONWEALTH CARE ALLIANCE2"]
["AETNA","AETNA","10081","INCISION & DRAINAGE PILONIDAL CYST COMPLICATED","10081 - INCISION & DRAINAGE PILONIDAL CYST COMPLICATED",null,null,null,null,null,"UNITED/HARVARD PILGRIM","10004",null,"AETNA","10081 - INCISION & DRAINAGE PILONIDAL CYST COMPLICATED",null,"ELDER SERVICE PLAN"]
["AETNA","AETNA","10120","INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE","10120 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE",null,null,null,null,null,"AETNA","10005",null,"AETNA","10120 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE",null,"ELDER SERVICE PLAN OTHER"]
["AETNA","AETNA","10121","INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL","10121 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","10005",null,"AETNA","10121 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL",null,"ELDER SERVICE PLAN OTHER2"]
["AETNA","AETNA","10140","I&D HEMATOMA SEROMA/FLUID COLLECTION","10140 - I&D HEMATOMA SEROMA/FLUID COLLECTION",null,null,null,null,null,"BLUE CROSS-HMO BLUE","10005",null,"AETNA","10140 - I&D HEMATOMA SEROMA/FLUID COLLECTION",null,"ELDER SERVICE PLAN2"]
["AETNA","AETNA","10160","PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST",null,null,null,null,null,"BLUE CROSS-INDEMNITY","10005",null,"AETNA","10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST",null,"FALLON"]
["AETNA","AETNA","10180","HC COMPLEX DRAINAGE, WOUND","10180 - HC COMPLEX DRAINAGE, WOUND",null,null,null,null,null,"BLUE CROSS-PPO","10005",null,"AETNA","10180 - HC COMPLEX DRAINAGE, WOUND",null,"FALLON2"]
["AETNA","AETNA","11000","DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF","11000 - DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","10005",null,"AETNA","11000 - DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF",null,"HARVARD PILGRIM HEALTH CARE"]
["AETNA","AETNA","11010","HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ","11010 - HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","10005",null,"AETNA","11010 - HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ",null,"HARVARD PILGRIM HEALTH CARE2"]
["AETNA","AETNA","11012","HC DBRDMT FX&/DISLC SUBQ T/M/F BONE","11012 - HC DBRDMT FX&/DISLC SUBQ T/M/F BONE",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","10005",null,"AETNA","11012 - HC DBRDMT FX&/DISLC SUBQ T/M/F BONE",null,"SENIOR WHOLE HEALTH"]
["AETNA","AETNA","11042","DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<","11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<",null,null,null,null,null,"CIGNA CARELINK","10005",null,"AETNA","11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<",null,"SENIOR WHOLE HEALTH2"]
["AETNA","AETNA","11043","DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<","11043 - DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","10005",null,"AETNA","11043 - DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<",null,"TUFTS"]
["AETNA","AETNA","11044","DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<","11044 - DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","10005",null,"AETNA","11044 - DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<",null,"TUFTS PUBLIC PLANS"]
["AETNA","AETNA","11045","DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM","11045 - DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM",null,null,null,null,null,"TUFTS HMO","10005",null,"AETNA","11045 - DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM",null,"TUFTS PUBLIC PLANS2"]
["AETNA","AETNA","11046","DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM","11046 - DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM",null,null,null,null,null,"TUFTS POS","10005",null,"AETNA","11046 - DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM",null,"TUFTS2"]
["AETNA","AETNA","11047","DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM","11047 - DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM",null,null,null,null,null,"TUFTS PPO","10005",null,"AETNA","11047 - DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM",null,"UHC COMMUNITY CARE"]
["AETNA","AETNA","11055","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1","11055 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1",null,null,null,null,null,"TUFTS SELECT","10005",null,"AETNA","11055 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1",null,"UHC COMMUNITY CARE2"]
["AETNA","AETNA","11056","PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4","11056 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","10005",null,"AETNA","11056 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4",null,"UNICARE"]
["AETNA","AETNA","11057","PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4","11057 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4",null,null,null,null,null,"UNITED/HARVARD PILGRIM","10005",null,"AETNA","11057 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4",null,"UNICARE2"]
["AETNA","AETNA","11102","HC TANGNTL BX SKIN SINGLE LES","11102 - HC TANGNTL BX SKIN SINGLE LES",null,null,null,null,null,"AETNA","10006",null,"AETNA","11102 - HC TANGNTL BX SKIN SINGLE LES",null,"UNITED HEALTHCARE"]
["AETNA","AETNA","11103","HC TANGNTL BX SKIN EA SEP/ADDL","11103 - HC TANGNTL BX SKIN EA SEP/ADDL",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","10006",null,"AETNA","11103 - HC TANGNTL BX SKIN EA SEP/ADDL",null,"UNITED HEALTHCARE2"]
["AETNA","AETNA","11104","HC PUNCH BX SKIN SINGLE LESION","11104 - HC PUNCH BX SKIN SINGLE LESION",null,null,null,null,null,"BLUE CROSS-HMO BLUE","10006",null,"AETNA","11104 - HC PUNCH BX SKIN SINGLE LESION"]
["AETNA","AETNA","11105","HC PUNCH BX SKIN EA SEP/ADDL","11105 - HC PUNCH BX SKIN EA SEP/ADDL",null,null,null,null,null,"BLUE CROSS-INDEMNITY","10006",null,"AETNA","11105 - HC PUNCH BX SKIN EA SEP/ADDL"]
["AETNA","AETNA","11106","HC INCAL BX SKN SINGLE LES","11106 - HC INCAL BX SKN SINGLE LES",null,null,null,null,null,"BLUE CROSS-PPO","10006",null,"AETNA","11106 - HC INCAL BX SKN SINGLE LES"]
["AETNA","AETNA","11107","HC INCAL BX SKN EA SEP/ADDL","11107 - HC INCAL BX SKN EA SEP/ADDL",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","10006",null,"AETNA","11107 - HC INCAL BX SKN EA SEP/ADDL"]
["AETNA","AETNA","11200","REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15","11200 - REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","10006",null,"AETNA","11200 - REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15"]
["AETNA","AETNA","11400","EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<","11400 - EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","10006",null,"AETNA","11400 - EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<"]
["AETNA","AETNA","11401","EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM","11401 - EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM",null,null,null,null,null,"CIGNA CARELINK","10006",null,"AETNA","11401 - EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM"]
["AETNA","AETNA","11402","EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM","11402 - EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","10006",null,"AETNA","11402 - EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM"]
["AETNA","AETNA","11403","EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<","11403 - EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","10006",null,"AETNA","11403 - EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<"]
["AETNA","AETNA","11404","EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM","11404 - EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM",null,null,null,null,null,"TUFTS HMO","10006",null,"AETNA","11404 - EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM"]
["AETNA","AETNA","11406","EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM","11406 - EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM",null,null,null,null,null,"TUFTS POS","10006",null,"AETNA","11406 - EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM"]
["AETNA","AETNA","11420","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<","11420 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<",null,null,null,null,null,"TUFTS PPO","10006",null,"AETNA","11420 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<"]
["AETNA","AETNA","11421","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM","11421 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM",null,null,null,null,null,"TUFTS SELECT","10006",null,"AETNA","11421 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM"]
["AETNA","AETNA","11422","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM","11422 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","10006",null,"AETNA","11422 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM"]
["AETNA","AETNA","11423","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM","11423 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM",null,null,null,null,null,"UNITED/HARVARD PILGRIM","10006",null,"AETNA","11423 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM"]
["AETNA","AETNA","11424","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM","11424 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM",null,null,null,null,null,"AETNA","10007",null,"AETNA","11424 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM"]
["AETNA","AETNA","11426","EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM","11426 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","10007",null,"AETNA","11426 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM"]
["AETNA","AETNA","11440","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<","11440 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<",null,null,null,null,null,"BLUE CROSS-HMO BLUE","10007",null,"AETNA","11440 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<"]
["AETNA","AETNA","11441","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM","11441 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM",null,null,null,null,null,"BLUE CROSS-INDEMNITY","10007",null,"AETNA","11441 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM"]
["AETNA","AETNA","11442","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM","11442 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM",null,null,null,null,null,"BLUE CROSS-PPO","10007",null,"AETNA","11442 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM"]
["AETNA","AETNA","11443","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM","11443 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","10007",null,"AETNA","11443 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM"]
["AETNA","AETNA","11444","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM","11444 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","10007",null,"AETNA","11444 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM"]
["AETNA","AETNA","11446","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM","11446 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","10007",null,"AETNA","11446 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM"]
["AETNA","AETNA","11450","EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR","11450 - EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR",null,null,null,null,null,"CIGNA CARELINK","10007",null,"AETNA","11450 - EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR"]
["AETNA","AETNA","11463","EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR","11463 - EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","10007",null,"AETNA","11463 - EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR"]
["AETNA","AETNA","11470","EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR","11470 - EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","10007",null,"AETNA","11470 - EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR"]
["AETNA","AETNA","11600","HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG","11600 - HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG",null,null,null,null,null,"TUFTS HMO","10007",null,"AETNA","11600 - HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG"]
["AETNA","AETNA","11601","EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM","11601 - EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM",null,null,null,null,null,"TUFTS POS","10007",null,"AETNA","11601 - EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM"]
["AETNA","AETNA","11602","EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM","11602 - EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM",null,null,null,null,null,"TUFTS PPO","10007",null,"AETNA","11602 - EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM"]
["AETNA","AETNA","11603","EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<","11603 - EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<",null,null,null,null,null,"TUFTS SELECT","10007",null,"AETNA","11603 - EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<"]
["AETNA","AETNA","11604","EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM","11604 - EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","10007",null,"AETNA","11604 - EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM"]
["AETNA","AETNA","11606","EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM","11606 - EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM",null,null,null,null,null,"UNITED/HARVARD PILGRIM","10007",null,"AETNA","11606 - EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM"]
["AETNA","AETNA","11620","EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<","11620 - EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<",null,null,null,null,null,"AETNA","10008",null,"AETNA","11620 - EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<"]
["AETNA","AETNA","11621","HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM","11621 - HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","10008",null,"AETNA","11621 - HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM"]
["AETNA","AETNA","11622","EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM","11622 - EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM",null,null,null,null,null,"BLUE CROSS-HMO BLUE","10008",null,"AETNA","11622 - EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM"]
["AETNA","AETNA","11623","EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<","11623 - EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<",null,null,null,null,null,"BLUE CROSS-INDEMNITY","10008",null,"AETNA","11623 - EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<"]
["AETNA","AETNA","11624","EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM","11624 - EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM",null,null,null,null,null,"BLUE CROSS-PPO","10008",null,"AETNA","11624 - EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM"]
["AETNA","AETNA","11626","EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM","11626 - EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","10008",null,"AETNA","11626 - EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM"]
["AETNA","AETNA","11640","EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<","11640 - EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","10008",null,"AETNA","11640 - EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<"]
["AETNA","AETNA","11642","HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL","11642 - HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","10008",null,"AETNA","11642 - HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL"]
["AETNA","AETNA","11643","EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<","11643 - EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<",null,null,null,null,null,"CIGNA CARELINK","10008",null,"AETNA","11643 - EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<"]
["AETNA","AETNA","11644","EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM","11644 - EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","10008",null,"AETNA","11644 - EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM"]
["AETNA","AETNA","11646","EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM","11646 - EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","10008",null,"AETNA","11646 - EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM"]
["AETNA","AETNA","11720","DEBRIDEMENT NAIL ANY METHOD 1-5","11720 - DEBRIDEMENT NAIL ANY METHOD 1-5",null,null,null,null,null,"TUFTS HMO","10008",null,"AETNA","11720 - DEBRIDEMENT NAIL ANY METHOD 1-5"]
["AETNA","AETNA","11721","DEBRIDEMENT NAIL ANY METHOD 6/>","11721 - DEBRIDEMENT NAIL ANY METHOD 6/>",null,null,null,null,null,"TUFTS POS","10008",null,"AETNA","11721 - DEBRIDEMENT NAIL ANY METHOD 6/>"]
["AETNA","AETNA","11730","AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1","11730 - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1",null,null,null,null,null,"TUFTS PPO","10008",null,"AETNA","11730 - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1"]
["AETNA","AETNA","11732","AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL","11732 - AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL",null,null,null,null,null,"TUFTS SELECT","10008",null,"AETNA","11732 - AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL"]
["AETNA","AETNA","11740","EVACUATION SUBUNGUAL HEMATOMA","11740 - EVACUATION SUBUNGUAL HEMATOMA",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","10008",null,"AETNA","11740 - EVACUATION SUBUNGUAL HEMATOMA"]
["AETNA","AETNA","11750","EXCISION NAIL MATRIX PERMANENT REMOVAL","11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL",null,null,null,null,null,"UNITED/HARVARD PILGRIM","10008",null,"AETNA","11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL"]
["AETNA","AETNA","11755","BIOPSY NAIL UNIT SEPARATE PROCEDURE","11755 - BIOPSY NAIL UNIT SEPARATE PROCEDURE",null,null,null,null,null,"AETNA","10009",null,"AETNA","11755 - BIOPSY NAIL UNIT SEPARATE PROCEDURE"]
["AETNA","AETNA","11760","REPAIR NAIL BED","11760 - REPAIR NAIL BED",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","10009",null,"AETNA","11760 - REPAIR NAIL BED"]
["AETNA","AETNA","11765","WEDGE EXCISION SKIN NAIL FOLD","11765 - WEDGE EXCISION SKIN NAIL FOLD",null,null,null,null,null,"BLUE CROSS-HMO BLUE","10009",null,"AETNA","11765 - WEDGE EXCISION SKIN NAIL FOLD"]
["AETNA","AETNA","11770","EXCISION PILONIDAL CYST/SINUS SIMPLE","11770 - EXCISION PILONIDAL CYST/SINUS SIMPLE",null,null,null,null,null,"BLUE CROSS-INDEMNITY","10009",null,"AETNA","11770 - EXCISION PILONIDAL CYST/SINUS SIMPLE"]
["AETNA","AETNA","11772","EXCISION PILONIDAL CYST/SINUS COMPLICATED","11772 - EXCISION PILONIDAL CYST/SINUS COMPLICATED",null,null,null,null,null,"BLUE CROSS-PPO","10009",null,"AETNA","11772 - EXCISION PILONIDAL CYST/SINUS COMPLICATED"]
["AETNA","AETNA","11900","INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS","11900 - INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","10009",null,"AETNA","11900 - INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS"]
["AETNA","AETNA","11901","INJECTION INTRALESIONAL >7 LESIONS","11901 - INJECTION INTRALESIONAL >7 LESIONS",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","10009",null,"AETNA","11901 - INJECTION INTRALESIONAL >7 LESIONS"]
["AETNA","AETNA","11921","HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM","11921 - HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","10009",null,"AETNA","11921 - HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM"]
["AETNA","AETNA","11922","HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",null,null,null,null,null,"CIGNA CARELINK","10009",null,"AETNA","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM"]
["AETNA","AETNA","11976","REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES","11976 - REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","10009",null,"AETNA","11976 - REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES"]
["AETNA","AETNA","11980","SUBCUTANEOUS HORMONE PELLET IMPLANTATION","11980 - SUBCUTANEOUS HORMONE PELLET IMPLANTATION",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","10009",null,"AETNA","11980 - SUBCUTANEOUS HORMONE PELLET IMPLANTATION"]
["AETNA","AETNA","11981","INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11981 - INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",null,null,null,null,null,"TUFTS HMO","10009",null,"AETNA","11981 - INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT"]
["AETNA","AETNA","11982","REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11982 - REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",null,null,null,null,null,"TUFTS POS","10009",null,"AETNA","11982 - REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT"]
["AETNA","AETNA","11983","RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT","11983 - RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT",null,null,null,null,null,"TUFTS PPO","10009",null,"AETNA","11983 - RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT"]
["AETNA","AETNA","12001","SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<","12001 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<",null,null,null,null,null,"TUFTS SELECT","10009",null,"AETNA","12001 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<"]
["AETNA","AETNA","12004","SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM","12004 - SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","10009",null,"AETNA","12004 - SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM"]
["AETNA","AETNA","12005","SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM","12005 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM",null,null,null,null,null,"UNITED/HARVARD PILGRIM","10009",null,"AETNA","12005 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM"]
["AETNA","AETNA","12006","SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM","12006 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM",null,null,null,null,null,"AETNA","10010",null,"AETNA","12006 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM"]
["AETNA","AETNA","12007","SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM","12007 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","10010",null,"AETNA","12007 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM"]
["AETNA","AETNA","12014","SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM","12014 - SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM",null,null,null,null,null,"BLUE CROSS-HMO BLUE","10010",null,"AETNA","12014 - SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM"]
["AETNA","AETNA","12015","SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM","12015 - SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM",null,null,null,null,null,"BLUE CROSS-INDEMNITY","10010",null,"AETNA","12015 - SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM"]
["AETNA","AETNA","12016","SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM","12016 - SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM",null,null,null,null,null,"BLUE CROSS-PPO","10010",null,"AETNA","12016 - SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM"]
["AETNA","AETNA","12017","HC RESUPERF WND FACE 20.1-30 CM","12017 - HC RESUPERF WND FACE 20.1-30 CM",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","10010",null,"AETNA","12017 - HC RESUPERF WND FACE 20.1-30 CM"]
["AETNA","AETNA","12018","HC RESUPERF WND FACE >30 CM","12018 - HC RESUPERF WND FACE >30 CM",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","10010",null,"AETNA","12018 - HC RESUPERF WND FACE >30 CM"]
["AETNA","AETNA","12020","TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE","12020 - TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","10010",null,"AETNA","12020 - TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE"]
["AETNA","AETNA","12021","TX SUPERFICIAL WOUND DEHISCENCE W/PACKING","12021 - TX SUPERFICIAL WOUND DEHISCENCE W/PACKING",null,null,null,null,null,"CIGNA CARELINK","10010",null,"AETNA","12021 - TX SUPERFICIAL WOUND DEHISCENCE W/PACKING"]
["AETNA","AETNA","12031","REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<","12031 - REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","10010",null,"AETNA","12031 - REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<"]
["AETNA","AETNA","12032","REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM","12032 - REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","10010",null,"AETNA","12032 - REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM"]
["AETNA","AETNA","12034","REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM","12034 - REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM",null,null,null,null,null,"TUFTS HMO","10010",null,"AETNA","12034 - REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM"]
["AETNA","AETNA","12035","REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM","12035 - REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM",null,null,null,null,null,"TUFTS POS","10010",null,"AETNA","12035 - REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM"]
["AETNA","AETNA","12036","HC LAYR CLOS WND TRUNK, ARM, LEG 20.1-30 CM","12036 - HC LAYR CLOS WND TRUNK, ARM, LEG 20.1-30 CM",null,null,null,null,null,"TUFTS PPO","10010",null,"AETNA","12036 - HC LAYR CLOS WND TRUNK, ARM, LEG 20.1-30 CM"]
["AETNA","AETNA","12037","REPAIR INTERMEDIATE S/A/T/E >30.0 CM","12037 - REPAIR INTERMEDIATE S/A/T/E >30.0 CM",null,null,null,null,null,"TUFTS SELECT","10010",null,"AETNA","12037 - REPAIR INTERMEDIATE S/A/T/E >30.0 CM"]
["AETNA","AETNA","12041","REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<","12041 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","10010",null,"AETNA","12041 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<"]
["AETNA","AETNA","12042","REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM","12042 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM",null,null,null,null,null,"UNITED/HARVARD PILGRIM","10010",null,"AETNA","12042 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM"]
["AETNA","AETNA","12044","REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM","12044 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM",null,null,null,null,null,"AETNA","10011",null,"AETNA","12044 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM"]
["AETNA","AETNA","12045","HC LAYR CLOS WND REST BODY 12.6-20 CM","12045 - HC LAYR CLOS WND REST BODY 12.6-20 CM",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","10011",null,"AETNA","12045 - HC LAYR CLOS WND REST BODY 12.6-20 CM"]
["AETNA","AETNA","12046","HC LAYR CLOS WND REST BODY 20.1-30 CM","12046 - HC LAYR CLOS WND REST BODY 20.1-30 CM",null,null,null,null,null,"BLUE CROSS-HMO BLUE","10011",null,"AETNA","12046 - HC LAYR CLOS WND REST BODY 20.1-30 CM"]
["AETNA","AETNA","12047","REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM","12047 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM",null,null,null,null,null,"BLUE CROSS-INDEMNITY","10011",null,"AETNA","12047 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM"]
["AETNA","AETNA","12051","REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<","12051 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<",null,null,null,null,null,"BLUE CROSS-PPO","10011",null,"AETNA","12051 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<"]
["AETNA","AETNA","12052","REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM","12052 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","10011",null,"AETNA","12052 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM"]
["AETNA","AETNA","12053","REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM","12053 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","10011",null,"AETNA","12053 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM"]
["AETNA","AETNA","12054","REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM","12054 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","10011",null,"AETNA","12054 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM"]
["AETNA","AETNA","12055","REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM","12055 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM",null,null,null,null,null,"CIGNA CARELINK","10011",null,"AETNA","12055 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM"]
["AETNA","AETNA","12056","HC LAYR CLOS WND FACE,FACIAL 20.1-30 CM","12056 - HC LAYR CLOS WND FACE,FACIAL 20.1-30 CM",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","10011",null,"AETNA","12056 - HC LAYR CLOS WND FACE,FACIAL 20.1-30 CM"]
["AETNA","AETNA","12057","HC LAYR CLOS WND FACE,FACIAL >30 CM","12057 - HC LAYR CLOS WND FACE,FACIAL >30 CM",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","10011",null,"AETNA","12057 - HC LAYR CLOS WND FACE,FACIAL >30 CM"]
["AETNA","AETNA","13100","REPAIR COMPLEX TRUNK 1.1-2.5 CM","13100 - REPAIR COMPLEX TRUNK 1.1-2.5 CM",null,null,null,null,null,"TUFTS HMO","10011",null,"AETNA","13100 - REPAIR COMPLEX TRUNK 1.1-2.5 CM"]
["AETNA","AETNA","13101","REPAIR COMPLEX TRUNK 2.6-7.5 CM","13101 - REPAIR COMPLEX TRUNK 2.6-7.5 CM",null,null,null,null,null,"TUFTS POS","10011",null,"AETNA","13101 - REPAIR COMPLEX TRUNK 2.6-7.5 CM"]
["AETNA","AETNA","13102","REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<","13102 - REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<",null,null,null,null,null,"TUFTS PPO","10011",null,"AETNA","13102 - REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<"]
["AETNA","AETNA","13120","REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM","13120 - REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM",null,null,null,null,null,"TUFTS SELECT","10011",null,"AETNA","13120 - REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM"]
["AETNA","AETNA","13121","REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM","13121 - REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","10011",null,"AETNA","13121 - REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM"]
["AETNA","AETNA","13122","REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<","13122 - REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<",null,null,null,null,null,"UNITED/HARVARD PILGRIM","10011",null,"AETNA","13122 - REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<"]
["AETNA","AETNA","13131","REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM","13131 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM",null,null,null,null,null,"AETNA","10012",null,"AETNA","13131 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM"]
["AETNA","AETNA","13132","REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM","13132 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM",null,null,null,null,null,"CIGNA CARELINK","10012",null,"AETNA","13132 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM"]
["AETNA","AETNA","13133","REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<","13133 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","10012",null,"AETNA","13133 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<"]
["AETNA","AETNA","13151","REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM","13151 - REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","10012",null,"AETNA","13151 - REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM"]
["AETNA","AETNA","13152","REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM","13152 - REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM",null,null,null,null,null,"TUFTS HMO","10012",null,"AETNA","13152 - REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM"]
["AETNA","AETNA","13160","SECONDARY CLOSURE SURG WOUND/DEHSN EXTSV/COMPLIC","13160 - SECONDARY CLOSURE SURG WOUND/DEHSN EXTSV/COMPLIC",null,null,null,null,null,"TUFTS POS","10012",null,"AETNA","13160 - SECONDARY CLOSURE SURG WOUND/DEHSN EXTSV/COMPLIC"]
["AETNA","AETNA","14000","ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<","14000 - ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<",null,null,null,null,null,"TUFTS PPO","10012",null,"AETNA","14000 - ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<"]
["AETNA","AETNA","14001","ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM","14001 - ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM",null,null,null,null,null,"TUFTS SELECT","10012",null,"AETNA","14001 - ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM"]
["AETNA","AETNA","14020","ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<","14020 - ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","10012",null,"AETNA","14020 - ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<"]
["AETNA","AETNA","14021","ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM","14021 - ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM",null,null,null,null,null,"UNITED/HARVARD PILGRIM","10012",null,"AETNA","14021 - ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM"]
["AETNA","AETNA","14040","ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<","14040 - ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<",null,null,null,null,null,"AETNA","10021",null,"AETNA","14040 - ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<"]
["AETNA","AETNA","14041","ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM","14041 - ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","10021",null,"AETNA","14041 - ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM"]
["AETNA","AETNA","14060","ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<","14060 - ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<",null,null,null,null,null,"BLUE CROSS-HMO BLUE","10021",null,"AETNA","14060 - ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<"]
["AETNA","AETNA","14061","ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM","14061 - ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM",null,null,null,null,null,"BLUE CROSS-INDEMNITY","10021",null,"AETNA","14061 - ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM"]
["AETNA","AETNA","14301","ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM","14301 - ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM",null,null,null,null,null,"BLUE CROSS-PPO","10021",null,"AETNA","14301 - ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM"]
["AETNA","AETNA","14302","ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM/<","14302 - ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM/<",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","10021",null,"AETNA","14302 - ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM/<"]
["AETNA","AETNA","15002","PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT","15002 - PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","10021",null,"AETNA","15002 - PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT"]
["AETNA","AETNA","15003","HC WOUND PREP, PED, TRK/ARM/LG ADDL 100 CM","15003 - HC WOUND PREP, PED, TRK/ARM/LG ADDL 100 CM",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","10021",null,"AETNA","15003 - HC WOUND PREP, PED, TRK/ARM/LG ADDL 100 CM"]
["AETNA","AETNA","15004","PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT","15004 - PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT",null,null,null,null,null,"CIGNA CARELINK","10021",null,"AETNA","15004 - PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT"]
["AETNA","AETNA","15050","PINCH GRAFT 1/MLT SM ULCER TIP/OTH AREA 2CM","15050 - PINCH GRAFT 1/MLT SM ULCER TIP/OTH AREA 2CM",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","10021",null,"AETNA","15050 - PINCH GRAFT 1/MLT SM ULCER TIP/OTH AREA 2CM"]
["AETNA","AETNA","15100","HC SKIN SPLT GRFT TRNK/ARM/LEG","15100 - HC SKIN SPLT GRFT TRNK/ARM/LEG",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","10021",null,"AETNA","15100 - HC SKIN SPLT GRFT TRNK/ARM/LEG"]
["AETNA","AETNA","15120","HB SPLIT GRFT,HEAD,FAC,HAND,FEET <100 SQCM","15120 - HB SPLIT GRFT,HEAD,FAC,HAND,FEET <100 SQCM",null,null,null,null,null,"TUFTS HMO","10021",null,"AETNA","15120 - HB SPLIT GRFT,HEAD,FAC,HAND,FEET <100 SQCM"]
["AETNA","AETNA","15220","HC FULL THICK GRFT SCALP, ARM, LEG, <20SQC","15220 - HC FULL THICK GRFT SCALP, ARM, LEG, <20SQC",null,null,null,null,null,"TUFTS POS","10021",null,"AETNA","15220 - HC FULL THICK GRFT SCALP, ARM, LEG, <20SQC"]
["AETNA","AETNA","15240","FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20 CM/<","15240 - FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20 CM/<",null,null,null,null,null,"TUFTS PPO","10021",null,"AETNA","15240 - FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20 CM/<"]
["AETNA","AETNA","15241","FTH/GT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA20CM/<","15241 - FTH/GT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA20CM/<",null,null,null,null,null,"TUFTS SELECT","10021",null,"AETNA","15241 - FTH/GT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA20CM/<"]
["AETNA","AETNA","15260","FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/<","15260 - FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/<",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","10021",null,"AETNA","15260 - FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/<"]
["AETNA","AETNA","15271","APP SKN SUB GRFT T/A/L AREA/100SCM /<1ST 25","15271 - APP SKN SUB GRFT T/A/L AREA/100SCM /<1ST 25",null,null,null,null,null,"UNITED/HARVARD PILGRIM","10021",null,"AETNA","15271 - APP SKN SUB GRFT T/A/L AREA/100SCM /<1ST 25"]
["AETNA","AETNA","15272","APP SKN SUB GRFT T/A/L AREA/100SCM EA ADL 25SC","15272 - APP SKN SUB GRFT T/A/L AREA/100SCM EA ADL 25SC",null,null,null,null,null,"AETNA","10030",null,"AETNA","15272 - APP SKN SUB GRFT T/A/L AREA/100SCM EA ADL 25SC"]
["AETNA","AETNA","15273","HC APP SKN SUB GRFT T/A/L AREA/>100SCM 1ST 100SCM","15273 - HC APP SKN SUB GRFT T/A/L AREA/>100SCM 1ST 100SCM",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","10030",null,"AETNA","15273 - HC APP SKN SUB GRFT T/A/L AREA/>100SCM 1ST 100SCM"]
["AETNA","AETNA","15274","HC APP SKN SUB GRFT T/A/L AREA/>100SCM ADL 100SCM","15274 - HC APP SKN SUB GRFT T/A/L AREA/>100SCM ADL 100SCM",null,null,null,null,null,"BLUE CROSS-HMO BLUE","10030",null,"AETNA","15274 - HC APP SKN SUB GRFT T/A/L AREA/>100SCM ADL 100SCM"]
["AETNA","AETNA","15275","SUB GRFT F/S/N/H/F/G/M/D <100SCM 1ST 25 SCM","15275 - SUB GRFT F/S/N/H/F/G/M/D <100SCM 1ST 25 SCM",null,null,null,null,null,"BLUE CROSS-INDEMNITY","10030",null,"AETNA","15275 - SUB GRFT F/S/N/H/F/G/M/D <100SCM 1ST 25 SCM"]
["AETNA","AETNA","15276","SUB GRFT F/S/N/H/F/G/M/D <100SCM EA ADDL 25 SCM","15276 - SUB GRFT F/S/N/H/F/G/M/D <100SCM EA ADDL 25 SCM",null,null,null,null,null,"BLUE CROSS-PPO","10030",null,"AETNA","15276 - SUB GRFT F/S/N/H/F/G/M/D <100SCM EA ADDL 25 SCM"]
["AETNA","AETNA","15277","HC SUB GRFT F/S/N/H/F/G/M/D />100SCM 1ST 100SCM","15277 - HC SUB GRFT F/S/N/H/F/G/M/D />100SCM 1ST 100SCM",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","10030",null,"AETNA","15277 - HC SUB GRFT F/S/N/H/F/G/M/D />100SCM 1ST 100SCM"]
["AETNA","AETNA","15278","HC SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM ADL 100SQ CM","15278 - HC SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM ADL 100SQ CM",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","10030",null,"AETNA","15278 - HC SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM ADL 100SQ CM"]
["AETNA","AETNA","15620","DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F","15620 - DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","10030",null,"AETNA","15620 - DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F"]
["AETNA","AETNA","15630","HC DELAY/SECTN FLAP LID,NOS,EAR,LIP","15630 - HC DELAY/SECTN FLAP LID,NOS,EAR,LIP",null,null,null,null,null,"CIGNA CARELINK","10030",null,"AETNA","15630 - HC DELAY/SECTN FLAP LID,NOS,EAR,LIP"]
["AETNA","AETNA","15731","FOREHEAD FLAP W/VASC PEDICLE","15731 - FOREHEAD FLAP W/VASC PEDICLE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","10030",null,"AETNA","15731 - FOREHEAD FLAP W/VASC PEDICLE"]
["AETNA","AETNA","15733","HC MUSC MYOQ/FSCQ FLAP HEAD&NECK W/NAMED VASC PEDCL","15733 - HC MUSC MYOQ/FSCQ FLAP HEAD&NECK W/NAMED VASC PEDCL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","10030",null,"AETNA","15733 - HC MUSC MYOQ/FSCQ FLAP HEAD&NECK W/NAMED VASC PEDCL"]
["AETNA","AETNA","15769","HC GRFG AUTOL SOFT TISS DIR EXC","15769 - HC GRFG AUTOL SOFT TISS DIR EXC",null,null,null,null,null,"TUFTS HMO","10030",null,"AETNA","15769 - HC GRFG AUTOL SOFT TISS DIR EXC"]
["AETNA","AETNA","15771","HC GRFG AUTOL FAT LIPO 50 CC/<","15771 - HC GRFG AUTOL FAT LIPO 50 CC/<",null,null,null,null,null,"TUFTS POS","10030",null,"AETNA","15771 - HC GRFG AUTOL FAT LIPO 50 CC/<"]
["AETNA","AETNA","15772","HC GRFG AUTOL FAT LIPO EA ADDL","15772 - HC GRFG AUTOL FAT LIPO EA ADDL",null,null,null,null,null,"TUFTS PPO","10030",null,"AETNA","15772 - HC GRFG AUTOL FAT LIPO EA ADDL"]
["AETNA","AETNA","15773","GRFG AUTOL FAT LIPO 25 CC/<","15773 - GRFG AUTOL FAT LIPO 25 CC/<",null,null,null,null,null,"TUFTS SELECT","10030",null,"AETNA","15773 - GRFG AUTOL FAT LIPO 25 CC/<"]
["AETNA","AETNA","15774","HC GFRG AUTOL FAT LIPO EA ADDL","15774 - HC GFRG AUTOL FAT LIPO EA ADDL",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","10030",null,"AETNA","15774 - HC GFRG AUTOL FAT LIPO EA ADDL"]
["AETNA","AETNA","15820","HC REVISION OF LOWER EYELID","15820 - HC REVISION OF LOWER EYELID",null,null,null,null,null,"UNITED/HARVARD PILGRIM","10030",null,"AETNA","15820 - HC REVISION OF LOWER EYELID"]
["AETNA","AETNA","15821","HC REV LOWER EYELID EXTEN FAT PAD","15821 - HC REV LOWER EYELID EXTEN FAT PAD",null,null,null,null,null,"AETNA","10035",null,"AETNA","15821 - HC REV LOWER EYELID EXTEN FAT PAD"]
["AETNA","AETNA","15822","BLEPHAROPLASTY UPPER EYELID","15822 - BLEPHAROPLASTY UPPER EYELID",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","10035",null,"AETNA","15822 - BLEPHAROPLASTY UPPER EYELID"]
["AETNA","AETNA","15823","HC REV UPPER EYELID W EXCESS SKIN","15823 - HC REV UPPER EYELID W EXCESS SKIN",null,null,null,null,null,"BLUE CROSS-HMO BLUE","10035",null,"AETNA","15823 - HC REV UPPER EYELID W EXCESS SKIN"]
["AETNA","AETNA","15828","HC RHYTIDECTOMY CHEEK CHIN & NECK","15828 - HC RHYTIDECTOMY CHEEK CHIN & NECK",null,null,null,null,null,"BLUE CROSS-INDEMNITY","10035",null,"AETNA","15828 - HC RHYTIDECTOMY CHEEK CHIN & NECK"]
["AETNA","AETNA","15830","HC EXCISE EXCESS SKIN TISSUE,ABDOMEN","15830 - HC EXCISE EXCESS SKIN TISSUE,ABDOMEN",null,null,null,null,null,"BLUE CROSS-PPO","10035",null,"AETNA","15830 - HC EXCISE EXCESS SKIN TISSUE,ABDOMEN"]
["AETNA","AETNA","15832","HC EXCISE EXCESS SKIN TISSUE,THIGH","15832 - HC EXCISE EXCESS SKIN TISSUE,THIGH",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","10035",null,"AETNA","15832 - HC EXCISE EXCESS SKIN TISSUE,THIGH"]
["AETNA","AETNA","15839","EXCISION EXCESSIVE SKIN & SUBQ TISSUE OTHER AREA","15839 - EXCISION EXCESSIVE SKIN & SUBQ TISSUE OTHER AREA",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","10035",null,"AETNA","15839 - EXCISION EXCESSIVE SKIN & SUBQ TISSUE OTHER AREA"]
["AETNA","AETNA","15850","REMOVE SUTURES SAME SURGEON","15850 - REMOVE SUTURES SAME SURGEON",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","10035",null,"AETNA","15850 - REMOVE SUTURES SAME SURGEON"]
["AETNA","AETNA","15851","REMOVE SUTURES DIFF SURGEON","15851 - REMOVE SUTURES DIFF SURGEON",null,null,null,null,null,"CIGNA CARELINK","10035",null,"AETNA","15851 - REMOVE SUTURES DIFF SURGEON"]
["AETNA","AETNA","15852","HC DRESSING CHANGE,NOT FOR BURN","15852 - HC DRESSING CHANGE,NOT FOR BURN",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","10035",null,"AETNA","15852 - HC DRESSING CHANGE,NOT FOR BURN"]
["AETNA","AETNA","15936","HC EXC SACR HCESS ULC W MUSC FLAP CLO","15936 - HC EXC SACR HCESS ULC W MUSC FLAP CLO",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","10035",null,"AETNA","15936 - HC EXC SACR HCESS ULC W MUSC FLAP CLO"]
["AETNA","AETNA","16020","DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL","16020 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL",null,null,null,null,null,"TUFTS HMO","10035",null,"AETNA","16020 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL"]
["AETNA","AETNA","16025","DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM","16025 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM",null,null,null,null,null,"TUFTS POS","10035",null,"AETNA","16025 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM"]
["AETNA","AETNA","16030","DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE","16030 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE",null,null,null,null,null,"TUFTS PPO","10035",null,"AETNA","16030 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE"]
["AETNA","AETNA","17000","DESTRUCTION PREMALIGNANT LESION 1ST","17000 - DESTRUCTION PREMALIGNANT LESION 1ST",null,null,null,null,null,"TUFTS SELECT","10035",null,"AETNA","17000 - DESTRUCTION PREMALIGNANT LESION 1ST"]
["AETNA","AETNA","17003","DESTRUCTION PREMALIGNANT LESION 2-14 EA","17003 - DESTRUCTION PREMALIGNANT LESION 2-14 EA",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","10035",null,"AETNA","17003 - DESTRUCTION PREMALIGNANT LESION 2-14 EA"]
["AETNA","AETNA","17004","DESTRUCTION PREMALIGNANT LESION 15/>","17004 - DESTRUCTION PREMALIGNANT LESION 15/>",null,null,null,null,null,"UNITED/HARVARD PILGRIM","10035",null,"AETNA","17004 - DESTRUCTION PREMALIGNANT LESION 15/>"]
["AETNA","AETNA","17106","DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM","17106 - DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM",null,null,null,null,null,"AETNA","10036",null,"AETNA","17106 - DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM"]
["AETNA","AETNA","17107","DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM","17107 - DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","10036",null,"AETNA","17107 - DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM"]
["AETNA","AETNA","17108","DSTRJ CUTANEOUS VASCULAR LESIONS >50.0 SQ CM","17108 - DSTRJ CUTANEOUS VASCULAR LESIONS >50.0 SQ CM",null,null,null,null,null,"BLUE CROSS-HMO BLUE","10036",null,"AETNA","17108 - DSTRJ CUTANEOUS VASCULAR LESIONS >50.0 SQ CM"]
["AETNA","AETNA","17110","DESTRUCTION BENIGN LESIONS UP TO 14","17110 - DESTRUCTION BENIGN LESIONS UP TO 14",null,null,null,null,null,"BLUE CROSS-INDEMNITY","10036",null,"AETNA","17110 - DESTRUCTION BENIGN LESIONS UP TO 14"]
["AETNA","AETNA","17111","DESTRUCTION BENIGN LESIONS 15/>","17111 - DESTRUCTION BENIGN LESIONS 15/>",null,null,null,null,null,"BLUE CROSS-PPO","10036",null,"AETNA","17111 - DESTRUCTION BENIGN LESIONS 15/>"]
["AETNA","AETNA","17250","CHEMICAL CAUTERIZATION GRANULATION TISSUE","17250 - CHEMICAL CAUTERIZATION GRANULATION TISSUE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","10036",null,"AETNA","17250 - CHEMICAL CAUTERIZATION GRANULATION TISSUE"]
["AETNA","AETNA","17260","DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<","17260 - DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","10036",null,"AETNA","17260 - DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<"]
["AETNA","AETNA","17261","DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM","17261 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","10036",null,"AETNA","17261 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM"]
["AETNA","AETNA","17262","DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM","17262 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM",null,null,null,null,null,"CIGNA CARELINK","10036",null,"AETNA","17262 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM"]
["AETNA","AETNA","17263","DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM","17263 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","10036",null,"AETNA","17263 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM"]
["AETNA","AETNA","17264","DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM","17264 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","10036",null,"AETNA","17264 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM"]
["AETNA","AETNA","17271","DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM","17271 - DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM",null,null,null,null,null,"TUFTS HMO","10036",null,"AETNA","17271 - DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM"]
["AETNA","AETNA","17280","HC DESTR MALIG FACE,NOSE,LIP <0.6 CM","17280 - HC DESTR MALIG FACE,NOSE,LIP <0.6 CM",null,null,null,null,null,"TUFTS POS","10036",null,"AETNA","17280 - HC DESTR MALIG FACE,NOSE,LIP <0.6 CM"]
["AETNA","AETNA","17281","DESTRUCTION OF SKIN LESIONS","17281 - DESTRUCTION OF SKIN LESIONS",null,null,null,null,null,"TUFTS PPO","10036",null,"AETNA","17281 - DESTRUCTION OF SKIN LESIONS"]
["AETNA","AETNA","17311","MOHS MICROGRAPHIC H/N/H/F/G 1ST STAGE 5 BLOCKS","17311 - MOHS MICROGRAPHIC H/N/H/F/G 1ST STAGE 5 BLOCKS",null,null,null,null,null,"TUFTS SELECT","10036",null,"AETNA","17311 - MOHS MICROGRAPHIC H/N/H/F/G 1ST STAGE 5 BLOCKS"]
["AETNA","AETNA","17312","MOHS,  ADDL STAGE, HEAD/NECK/HAND/FEET/GENTIAL","17312 - MOHS,  ADDL STAGE, HEAD/NECK/HAND/FEET/GENTIAL",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","10036",null,"AETNA","17312 - MOHS,  ADDL STAGE, HEAD/NECK/HAND/FEET/GENTIAL"]
["AETNA","AETNA","17313","MOHS TRUNK/ARM/LEG 1ST STAGE 5 BLOCKS","17313 - MOHS TRUNK/ARM/LEG 1ST STAGE 5 BLOCKS",null,null,null,null,null,"UNITED/HARVARD PILGRIM","10036",null,"AETNA","17313 - MOHS TRUNK/ARM/LEG 1ST STAGE 5 BLOCKS"]
["AETNA","AETNA","17314","MOHS TRUNK/ARM/LEG EA STAGE AFTER 1ST STAGE","17314 - MOHS TRUNK/ARM/LEG EA STAGE AFTER 1ST STAGE",null,null,null,null,null,"ALLWAYS HLTH ACO","10040",null,"AETNA","17314 - MOHS TRUNK/ARM/LEG EA STAGE AFTER 1ST STAGE"]
["AETNA","AETNA","17315","MOHS TRUNK/ARM/LEG EA ADDL BLOCK ANY STAGE","17315 - MOHS TRUNK/ARM/LEG EA ADDL BLOCK ANY STAGE",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","10040",null,"AETNA","17315 - MOHS TRUNK/ARM/LEG EA ADDL BLOCK ANY STAGE"]
["AETNA","AETNA","17999","PR PRE OPERATIVE LASER HAIR REMOVAL FOR GENITAL AFFIRMATION SURGERY","17999 - PR PRE OPERATIVE LASER HAIR REMOVAL FOR GENITAL AFFIRMATION SURGERY",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","10040",null,"AETNA","17999 - PR PRE OPERATIVE LASER HAIR REMOVAL FOR GENITAL AFFIRMATION SURGERY"]
["AETNA","AETNA","19000","PUNCTURE ASPIRATION CYST BREAST","19000 - PUNCTURE ASPIRATION CYST BREAST",null,null,null,null,null,"BLUE CROSS-HMO BLUE","10040",null,"AETNA","19000 - PUNCTURE ASPIRATION CYST BREAST"]
["AETNA","AETNA","19001","HC CY ASP BREAST;EA ADD","19001 - HC CY ASP BREAST;EA ADD",null,null,null,null,null,"BLUE CROSS-INDEMNITY","10040",null,"AETNA","19001 - HC CY ASP BREAST;EA ADD"]
["AETNA","AETNA","19020","MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP","19020 - MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP",null,null,null,null,null,"BLUE CROSS-PPO","10040",null,"AETNA","19020 - MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP"]
["AETNA","AETNA","19081","BX BREAST W/DEVICE 1ST LESION STEREOTACTIC GUID","19081 - BX BREAST W/DEVICE 1ST LESION STEREOTACTIC GUID",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","10040",null,"AETNA","19081 - BX BREAST W/DEVICE 1ST LESION STEREOTACTIC GUID"]
["AETNA","AETNA","19082","BX BREAST W/DEVICE ADDL LESION STEREOTACT GUID","19082 - BX BREAST W/DEVICE ADDL LESION STEREOTACT GUID",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","10040",null,"AETNA","19082 - BX BREAST W/DEVICE ADDL LESION STEREOTACT GUID"]
["AETNA","AETNA","19083","BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID","19083 - BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","10040",null,"AETNA","19083 - BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID"]
["AETNA","AETNA","19084","BX BREAST W/DEVICE ADDL LESION ULTRASOUND GUID","19084 - BX BREAST W/DEVICE ADDL LESION ULTRASOUND GUID",null,null,null,null,null,"BMCHN ACO","10040",null,"AETNA","19084 - BX BREAST W/DEVICE ADDL LESION ULTRASOUND GUID"]
["AETNA","AETNA","19085","BX BREAST W/DEVICE 1ST LESION MAGNETIC RES GUID","19085 - BX BREAST W/DEVICE 1ST LESION MAGNETIC RES GUID",null,null,null,null,null,"BMCHN MCO","10040",null,"AETNA","19085 - BX BREAST W/DEVICE 1ST LESION MAGNETIC RES GUID"]
["AETNA","AETNA","19086","BX BREAST W/DEVICE ADDL LESION MAGNET RES GUID","19086 - BX BREAST W/DEVICE ADDL LESION MAGNET RES GUID",null,null,null,null,null,"BMCHN MEDICAID","10040",null,"AETNA","19086 - BX BREAST W/DEVICE ADDL LESION MAGNET RES GUID"]
["AETNA","AETNA","19100","BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX","19100 - BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX",null,null,null,null,null,"BMCHN QHP","10040",null,"AETNA","19100 - BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX"]
["AETNA","AETNA","19120","EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION","19120 - EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION",null,null,null,null,null,"CIGNA CARELINK","10040",null,"AETNA","19120 - EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION"]
["AETNA","AETNA","19125","HC EXCISE BREAST LES W XRAY MARKER","19125 - HC EXCISE BREAST LES W XRAY MARKER",null,null,null,null,null,"FALLON MEDICAID","10040",null,"AETNA","19125 - HC EXCISE BREAST LES W XRAY MARKER"]
["AETNA","AETNA","19281","PERQ DEVICE PLACEMENT BREAST LOC 1ST LES W/GDNCE","19281 - PERQ DEVICE PLACEMENT BREAST LOC 1ST LES W/GDNCE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","10040",null,"AETNA","19281 - PERQ DEVICE PLACEMENT BREAST LOC 1ST LES W/GDNCE"]
["AETNA","AETNA","19282","PERQ DEVICE PLACEMT BREAST LOC EA LESION W/GDNCE","19282 - PERQ DEVICE PLACEMT BREAST LOC EA LESION W/GDNCE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","10040",null,"AETNA","19282 - PERQ DEVICE PLACEMT BREAST LOC EA LESION W/GDNCE"]
["AETNA","AETNA","19283","PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GDNCE","19283 - PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GDNCE",null,null,null,null,null,"TUFTS HMO","10040",null,"AETNA","19283 - PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GDNCE"]
["AETNA","AETNA","19284","HC PERQ BREAST LOC DEVICE PLACEMT EA LESION STRTCTC","19284 - HC PERQ BREAST LOC DEVICE PLACEMT EA LESION STRTCTC",null,null,null,null,null,"TUFTS POS","10040",null,"AETNA","19284 - HC PERQ BREAST LOC DEVICE PLACEMT EA LESION STRTCTC"]
["AETNA","AETNA","19285","PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG","19285 - PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG",null,null,null,null,null,"TUFTS PPO","10040",null,"AETNA","19285 - PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG"]
["AETNA","AETNA","19286","PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE","19286 - PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE",null,null,null,null,null,"TUFTS SELECT","10040",null,"AETNA","19286 - PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE"]
["AETNA","AETNA","19287","PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID","19287 - PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID",null,null,null,null,null,"TUFTS PUBLIC DIRECT","10040",null,"AETNA","19287 - PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID"]
["AETNA","AETNA","19288","PERQ BREAST LOC DEVICE PLACEMT ADD LESIO MR GUID","19288 - PERQ BREAST LOC DEVICE PLACEMT ADD LESIO MR GUID",null,null,null,null,null,"TUFTS PUBLIC TOGETHER","10040",null,"AETNA","19288 - PERQ BREAST LOC DEVICE PLACEMT ADD LESIO MR GUID"]
["AETNA","AETNA","19301","HC PR MASTECTOMY, PARTIAL","19301 - HC PR MASTECTOMY, PARTIAL",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","10040",null,"AETNA","19301 - HC PR MASTECTOMY, PARTIAL"]
["AETNA","AETNA","19316","SUSPENSION OF BREAST","19316 - SUSPENSION OF BREAST",null,null,null,null,null,"UNITED/HARVARD PILGRIM","10040",null,"AETNA","19316 - SUSPENSION OF BREAST"]
["AETNA","AETNA","19318","HC REDUCTION OF LARGE BREAST","19318 - HC REDUCTION OF LARGE BREAST",null,null,null,null,null,"AETNA","10060",null,"AETNA","19318 - HC REDUCTION OF LARGE BREAST"]
["AETNA","AETNA","19328","HC REMOVAL OF BREAST IMPLANT","19328 - HC REMOVAL OF BREAST IMPLANT",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","10060",null,"AETNA","19328 - HC REMOVAL OF BREAST IMPLANT"]
["AETNA","AETNA","19340","INSERT BREAST PROS IMMED AFTER EXCIS","19340 - INSERT BREAST PROS IMMED AFTER EXCIS",null,null,null,null,null,"BLUE CROSS-HMO BLUE","10060",null,"AETNA","19340 - INSERT BREAST PROS IMMED AFTER EXCIS"]
["AETNA","AETNA","19350","NIPPLE/AREOLA RECONSTRUCTION","19350 - NIPPLE/AREOLA RECONSTRUCTION",null,null,null,null,null,"BLUE CROSS-INDEMNITY","10060",null,"AETNA","19350 - NIPPLE/AREOLA RECONSTRUCTION"]
["AETNA","AETNA","19355","HC CORRECT INVERTED NIPPLE(S)","19355 - HC CORRECT INVERTED NIPPLE(S)",null,null,null,null,null,"BLUE CROSS-PPO","10060",null,"AETNA","19355 - HC CORRECT INVERTED NIPPLE(S)"]
["AETNA","AETNA","19380","REVISION RECONSTRUCTED BREAST","19380 - REVISION RECONSTRUCTED BREAST",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","10060",null,"AETNA","19380 - REVISION RECONSTRUCTED BREAST"]
["AETNA","AETNA","19499","PR TOMO GUIDED PLACEMENT OF BREAST LOCALIZATION DEVICE","19499 - PR TOMO GUIDED PLACEMENT OF BREAST LOCALIZATION DEVICE",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","10060",null,"AETNA","19499 - PR TOMO GUIDED PLACEMENT OF BREAST LOCALIZATION DEVICE"]
["AETNA","AETNA","20103","EXPLORATION PENETRATING WOUND SPX EXTREMITY","20103 - EXPLORATION PENETRATING WOUND SPX EXTREMITY",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","10060",null,"AETNA","20103 - EXPLORATION PENETRATING WOUND SPX EXTREMITY"]
["AETNA","AETNA","20200","HC MUSCLE BIOPSY","20200 - HC MUSCLE BIOPSY",null,null,null,null,null,"CIGNA CARELINK","10060",null,"AETNA","20200 - HC MUSCLE BIOPSY"]
["AETNA","AETNA","20205","BIOPSY,MUSCLE,DEEP","20205 - BIOPSY,MUSCLE,DEEP",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","10060",null,"AETNA","20205 - BIOPSY,MUSCLE,DEEP"]
["AETNA","AETNA","20206","BIOPSY MUSCLE PERCUTANEOUS NEEDLE","20206 - BIOPSY MUSCLE PERCUTANEOUS NEEDLE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","10060",null,"AETNA","20206 - BIOPSY MUSCLE PERCUTANEOUS NEEDLE"]
["AETNA","AETNA","20220","HC BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL","20220 - HC BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL",null,null,null,null,null,"TUFTS HMO","10060",null,"AETNA","20220 - HC BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL"]
["AETNA","AETNA","20225","HC BIOPSY BONE TROCAR/NEEDLE DEEP","20225 - HC BIOPSY BONE TROCAR/NEEDLE DEEP",null,null,null,null,null,"TUFTS POS","10060",null,"AETNA","20225 - HC BIOPSY BONE TROCAR/NEEDLE DEEP"]
["AETNA","AETNA","20240","HC BIOPSY BONE OPEN SUPERFICIAL","20240 - HC BIOPSY BONE OPEN SUPERFICIAL",null,null,null,null,null,"TUFTS PPO","10060",null,"AETNA","20240 - HC BIOPSY BONE OPEN SUPERFICIAL"]
["AETNA","AETNA","20245","BIOPSY BONE OPEN DEEP","20245 - BIOPSY BONE OPEN DEEP",null,null,null,null,null,"TUFTS SELECT","10060",null,"AETNA","20245 - BIOPSY BONE OPEN DEEP"]
["AETNA","AETNA","20501","HC INJECTION SINUS TRACT DIAGNOSTIC","20501 - HC INJECTION SINUS TRACT DIAGNOSTIC",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","10060",null,"AETNA","20501 - HC INJECTION SINUS TRACT DIAGNOSTIC"]
["AETNA","AETNA","20520","REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE","20520 - REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE",null,null,null,null,null,"UNITED/HARVARD PILGRIM","10060",null,"AETNA","20520 - REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE"]
["AETNA","AETNA","20525","RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP","20525 - RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP",null,null,null,null,null,"AETNA","10061",null,"AETNA","20525 - RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP"]
["AETNA","AETNA","20526","INJECTION THERAPEUTIC CARPAL TUNNEL","20526 - INJECTION THERAPEUTIC CARPAL TUNNEL",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","10061",null,"AETNA","20526 - INJECTION THERAPEUTIC CARPAL TUNNEL"]
["AETNA","AETNA","20527","INJECTION ENZYME PALMAR FASCIAL CORD","20527 - INJECTION ENZYME PALMAR FASCIAL CORD",null,null,null,null,null,"BLUE CROSS-HMO BLUE","10061",null,"AETNA","20527 - INJECTION ENZYME PALMAR FASCIAL CORD"]
["AETNA","AETNA","20550","INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS","20550 - INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS",null,null,null,null,null,"BLUE CROSS-INDEMNITY","10061",null,"AETNA","20550 - INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS"]
["AETNA","AETNA","20551","INJECTION SINGLE TENDON ORIGIN/INSERTION","20551 - INJECTION SINGLE TENDON ORIGIN/INSERTION",null,null,null,null,null,"BLUE CROSS-PPO","10061",null,"AETNA","20551 - INJECTION SINGLE TENDON ORIGIN/INSERTION"]
["AETNA","AETNA","20552","INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES","20552 - INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","10061",null,"AETNA","20552 - INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES"]
["AETNA","AETNA","20553","INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES","20553 - INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","10061",null,"AETNA","20553 - INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES"]
["AETNA","AETNA","20600","ARTHROCENTESIS ASPIR&/INJECTION SMALL JT/BURSA","20600 - ARTHROCENTESIS ASPIR&/INJECTION SMALL JT/BURSA",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","10061",null,"AETNA","20600 - ARTHROCENTESIS ASPIR&/INJECTION SMALL JT/BURSA"]
["AETNA","AETNA","20604","HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT","20604 - HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT",null,null,null,null,null,"CIGNA CARELINK","10061",null,"AETNA","20604 - HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT"]
["AETNA","AETNA","20605","ARTHROCENTESIS ASPIR&/INJECTION INTERM JT/BURS","20605 - ARTHROCENTESIS ASPIR&/INJECTION INTERM JT/BURS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","10061",null,"AETNA","20605 - ARTHROCENTESIS ASPIR&/INJECTION INTERM JT/BURS"]
["AETNA","AETNA","20606","HC PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US","20606 - HC PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","10061",null,"AETNA","20606 - HC PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US"]
["AETNA","AETNA","20610","ARTHROCENTESIS ASPIR&/INJECTION MAJOR JT/BURSA","20610 - ARTHROCENTESIS ASPIR&/INJECTION MAJOR JT/BURSA",null,null,null,null,null,"TUFTS HMO","10061",null,"AETNA","20610 - ARTHROCENTESIS ASPIR&/INJECTION MAJOR JT/BURSA"]
["AETNA","AETNA","20611","HC PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US","20611 - HC PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US",null,null,null,null,null,"TUFTS POS","10061",null,"AETNA","20611 - HC PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US"]
["AETNA","AETNA","20612","ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ","20612 - ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ",null,null,null,null,null,"TUFTS PPO","10061",null,"AETNA","20612 - ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ"]
["AETNA","AETNA","20615","ASPIRATION & INJECTION TREATMENT BONE CYST","20615 - ASPIRATION & INJECTION TREATMENT BONE CYST",null,null,null,null,null,"TUFTS SELECT","10061",null,"AETNA","20615 - ASPIRATION & INJECTION TREATMENT BONE CYST"]
["AETNA","AETNA","20650","HC INSERT AND REMOVE BONE PIN","20650 - HC INSERT AND REMOVE BONE PIN",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","10061",null,"AETNA","20650 - HC INSERT AND REMOVE BONE PIN"]
["AETNA","AETNA","20670","REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE","20670 - REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE",null,null,null,null,null,"UNITED/HARVARD PILGRIM","10061",null,"AETNA","20670 - REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE"]
["AETNA","AETNA","20680","REMOVAL IMPLANT DEEP","20680 - REMOVAL IMPLANT DEEP",null,null,null,null,null,"AETNA","10080",null,"AETNA","20680 - REMOVAL IMPLANT DEEP"]
["AETNA","AETNA","20690","HC APPLY BONE FIXATION DEVICE","20690 - HC APPLY BONE FIXATION DEVICE",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","10080",null,"AETNA","20690 - HC APPLY BONE FIXATION DEVICE"]
["AETNA","AETNA","20930","HC ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED","20930 - HC ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED",null,null,null,null,null,"BLUE CROSS-HMO BLUE","10080",null,"AETNA","20930 - HC ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED"]
["AETNA","AETNA","20950","HC RECORD FLUID PRESSURE,MUSCLE","20950 - HC RECORD FLUID PRESSURE,MUSCLE",null,null,null,null,null,"BLUE CROSS-INDEMNITY","10080",null,"AETNA","20950 - HC RECORD FLUID PRESSURE,MUSCLE"]
["AETNA","AETNA","20982","HC ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE","20982 - HC ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE",null,null,null,null,null,"BLUE CROSS-PPO","10080",null,"AETNA","20982 - HC ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE"]
["AETNA","AETNA","20983","HC ABLATJ BONE TUMOR CRYO PERQ W/IMG GDN WHEN PRFMD","20983 - HC ABLATJ BONE TUMOR CRYO PERQ W/IMG GDN WHEN PRFMD",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","10080",null,"AETNA","20983 - HC ABLATJ BONE TUMOR CRYO PERQ W/IMG GDN WHEN PRFMD"]
["AETNA","AETNA","20999","PR PLACEMENT OF ANTIBIOTIC BEADS","20999 - PR PLACEMENT OF ANTIBIOTIC BEADS",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","10080",null,"AETNA","20999 - PR PLACEMENT OF ANTIBIOTIC BEADS"]
["AETNA","AETNA","21011","EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ <2CM","21011 - EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ <2CM",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","10080",null,"AETNA","21011 - EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ <2CM"]
["AETNA","AETNA","21012","EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/>","21012 - EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/>",null,null,null,null,null,"CIGNA CARELINK","10080",null,"AETNA","21012 - EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/>"]
["AETNA","AETNA","21013","EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL <2CM","21013 - EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL <2CM",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","10080",null,"AETNA","21013 - EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL <2CM"]
["AETNA","AETNA","21014","EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/>","21014 - EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/>",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","10080",null,"AETNA","21014 - EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/>"]
["AETNA","AETNA","21025","HC EXCISION OF BONE, LOWER JAW","21025 - HC EXCISION OF BONE, LOWER JAW",null,null,null,null,null,"TUFTS HMO","10080",null,"AETNA","21025 - HC EXCISION OF BONE, LOWER JAW"]
["AETNA","AETNA","21026","HC EXCISION OF FACIAL BONE(S)","21026 - HC EXCISION OF FACIAL BONE(S)",null,null,null,null,null,"TUFTS POS","10080",null,"AETNA","21026 - HC EXCISION OF FACIAL BONE(S)"]
["AETNA","AETNA","21029","HC CONTOUR OF FACE BONE LESION","21029 - HC CONTOUR OF FACE BONE LESION",null,null,null,null,null,"TUFTS PPO","10080",null,"AETNA","21029 - HC CONTOUR OF FACE BONE LESION"]
["AETNA","AETNA","21030","HC EXC BENIGN TUMOR/CYST MAXL/ZYGOMA ENCL & CURTG","21030 - HC EXC BENIGN TUMOR/CYST MAXL/ZYGOMA ENCL & CURTG",null,null,null,null,null,"TUFTS SELECT","10080",null,"AETNA","21030 - HC EXC BENIGN TUMOR/CYST MAXL/ZYGOMA ENCL & CURTG"]
["AETNA","AETNA","21031","HC EXCISION TORUS MANDIBULARIS","21031 - HC EXCISION TORUS MANDIBULARIS",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","10080",null,"AETNA","21031 - HC EXCISION TORUS MANDIBULARIS"]
["AETNA","AETNA","21032","HC EXCISION,MAXILLARY TORUS PALATINUS","21032 - HC EXCISION,MAXILLARY TORUS PALATINUS",null,null,null,null,null,"UNITED/HARVARD PILGRIM","10080",null,"AETNA","21032 - HC EXCISION,MAXILLARY TORUS PALATINUS"]
["AETNA","AETNA","21040","HC EXCISION BENIGN TUMORE MANDIBLE","21040 - HC EXCISION BENIGN TUMORE MANDIBLE",null,null,null,null,null,"AETNA","10081",null,"AETNA","21040 - HC EXCISION BENIGN TUMORE MANDIBLE"]
["AETNA","AETNA","21044","HC REMV MALIG JAW BONE LESION","21044 - HC REMV MALIG JAW BONE LESION",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","10081",null,"AETNA","21044 - HC REMV MALIG JAW BONE LESION"]
["AETNA","AETNA","21046","HC EXCISION,BEN TUMOR,MANDIBLE,INTRA-ORAL","21046 - HC EXCISION,BEN TUMOR,MANDIBLE,INTRA-ORAL",null,null,null,null,null,"BLUE CROSS-HMO BLUE","10081",null,"AETNA","21046 - HC EXCISION,BEN TUMOR,MANDIBLE,INTRA-ORAL"]
["AETNA","AETNA","21047","HC EXCISION,BEN TUMOR,MANDIBLE,EXTRA-ORAL","21047 - HC EXCISION,BEN TUMOR,MANDIBLE,EXTRA-ORAL",null,null,null,null,null,"BLUE CROSS-INDEMNITY","10081",null,"AETNA","21047 - HC EXCISION,BEN TUMOR,MANDIBLE,EXTRA-ORAL"]
["AETNA","AETNA","21048","HC EXCISION,BEN TUMOR,MAXILLA,INTRA-ORAL","21048 - HC EXCISION,BEN TUMOR,MAXILLA,INTRA-ORAL",null,null,null,null,null,"BLUE CROSS-PPO","10081",null,"AETNA","21048 - HC EXCISION,BEN TUMOR,MAXILLA,INTRA-ORAL"]
["AETNA","AETNA","21070","HC REMV CORONOID PROCESS","21070 - HC REMV CORONOID PROCESS",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","10081",null,"AETNA","21070 - HC REMV CORONOID PROCESS"]
["AETNA","AETNA","21073","HC MANIPULATION TMJ THERAPEUTIC REQUIRE ANESTHESIA","21073 - HC MANIPULATION TMJ THERAPEUTIC REQUIRE ANESTHESIA",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","10081",null,"AETNA","21073 - HC MANIPULATION TMJ THERAPEUTIC REQUIRE ANESTHESIA"]
["AETNA","AETNA","21110","APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC","21110 - APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","10081",null,"AETNA","21110 - APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC"]
["AETNA","AETNA","21121","HC RECONST CHIN SLIDE SINGL OSTEOTOMY","21121 - HC RECONST CHIN SLIDE SINGL OSTEOTOMY",null,null,null,null,null,"CIGNA CARELINK","10081",null,"AETNA","21121 - HC RECONST CHIN SLIDE SINGL OSTEOTOMY"]
["AETNA","AETNA","21198","HC OSTEOTOMY, MANDIBLE","21198 - HC OSTEOTOMY, MANDIBLE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","10081",null,"AETNA","21198 - HC OSTEOTOMY, MANDIBLE"]
["AETNA","AETNA","21208","HC AUGMENT FACIAL BONES","21208 - HC AUGMENT FACIAL BONES",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","10081",null,"AETNA","21208 - HC AUGMENT FACIAL BONES"]
["AETNA","AETNA","21215","HC MANDIBLE GRAFT","21215 - HC MANDIBLE GRAFT",null,null,null,null,null,"TUFTS HMO","10081",null,"AETNA","21215 - HC MANDIBLE GRAFT"]
["AETNA","AETNA","21235","HC GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR","21235 - HC GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR",null,null,null,null,null,"TUFTS POS","10081",null,"AETNA","21235 - HC GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR"]
["AETNA","AETNA","21240","HC ARTHROPLASTY TMJ","21240 - HC ARTHROPLASTY TMJ",null,null,null,null,null,"TUFTS PPO","10081",null,"AETNA","21240 - HC ARTHROPLASTY TMJ"]
["AETNA","AETNA","21243","HC ARTHROPLASTY TMJ+PROSTHESIS","21243 - HC ARTHROPLASTY TMJ+PROSTHESIS",null,null,null,null,null,"TUFTS SELECT","10081",null,"AETNA","21243 - HC ARTHROPLASTY TMJ+PROSTHESIS"]
["AETNA","AETNA","21244","HC RECONSTR MANDIBLE,BONE PLATE","21244 - HC RECONSTR MANDIBLE,BONE PLATE",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","10081",null,"AETNA","21244 - HC RECONSTR MANDIBLE,BONE PLATE"]
["AETNA","AETNA","21248","HC RECONSTR JAW,PART-ENDO IMPLNT","21248 - HC RECONSTR JAW,PART-ENDO IMPLNT",null,null,null,null,null,"UNITED/HARVARD PILGRIM","10081",null,"AETNA","21248 - HC RECONSTR JAW,PART-ENDO IMPLNT"]
["AETNA","AETNA","21310","CLOSED TREATMENT NASAL FRACTURE W/O MANIPULATION","21310 - CLOSED TREATMENT NASAL FRACTURE W/O MANIPULATION",null,null,null,null,null,"AETNA","10120",null,"AETNA","21310 - CLOSED TREATMENT NASAL FRACTURE W/O MANIPULATION"]
["AETNA","AETNA","21315","CLOSED TX NASAL FRACTURE W/O STABILIZATION","21315 - CLOSED TX NASAL FRACTURE W/O STABILIZATION",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","10120",null,"AETNA","21315 - CLOSED TX NASAL FRACTURE W/O STABILIZATION"]
["AETNA","AETNA","21320","CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION","21320 - CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION",null,null,null,null,null,"BLUE CROSS-HMO BLUE","10120",null,"AETNA","21320 - CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION"]
["AETNA","AETNA","21325","HC OPEN RX NOSE FRACTURE","21325 - HC OPEN RX NOSE FRACTURE",null,null,null,null,null,"BLUE CROSS-INDEMNITY","10120",null,"AETNA","21325 - HC OPEN RX NOSE FRACTURE"]
["AETNA","AETNA","21337","HC CLOSED RX NASAL SEPTAL FRACTURE","21337 - HC CLOSED RX NASAL SEPTAL FRACTURE",null,null,null,null,null,"BLUE CROSS-PPO","10120",null,"AETNA","21337 - HC CLOSED RX NASAL SEPTAL FRACTURE"]
["AETNA","AETNA","21365","HC OPEN RX COMPLX CHEEK BONE FRAC","21365 - HC OPEN RX COMPLX CHEEK BONE FRAC",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","10120",null,"AETNA","21365 - HC OPEN RX COMPLX CHEEK BONE FRAC"]
["AETNA","AETNA","21390","HC REPAIR EYE BLOWOUT,PERIORB+IMPLNT","21390 - HC REPAIR EYE BLOWOUT,PERIORB+IMPLNT",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","10120",null,"AETNA","21390 - HC REPAIR EYE BLOWOUT,PERIORB+IMPLNT"]
["AETNA","AETNA","21400","HC CLOSED RX FX ORBIT","21400 - HC CLOSED RX FX ORBIT",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","10120",null,"AETNA","21400 - HC CLOSED RX FX ORBIT"]
["AETNA","AETNA","21407","HC OPEN RX FX ORBIT W IMPLANT","21407 - HC OPEN RX FX ORBIT W IMPLANT",null,null,null,null,null,"CIGNA CARELINK","10120",null,"AETNA","21407 - HC OPEN RX FX ORBIT W IMPLANT"]
["AETNA","AETNA","21421","HC CLOSED RX LEFORTE I+WIRES","21421 - HC CLOSED RX LEFORTE I+WIRES",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","10120",null,"AETNA","21421 - HC CLOSED RX LEFORTE I+WIRES"]
["AETNA","AETNA","21440","HC DENTAL RIDGE FX","21440 - HC DENTAL RIDGE FX",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","10120",null,"AETNA","21440 - HC DENTAL RIDGE FX"]
["AETNA","AETNA","21445","HC OPEN RX DENTAL RIDGE FX","21445 - HC OPEN RX DENTAL RIDGE FX",null,null,null,null,null,"TUFTS HMO","10120",null,"AETNA","21445 - HC OPEN RX DENTAL RIDGE FX"]
["AETNA","AETNA","21450","HC CLOSED RX MANDIBLE FX","21450 - HC CLOSED RX MANDIBLE FX",null,null,null,null,null,"TUFTS POS","10120",null,"AETNA","21450 - HC CLOSED RX MANDIBLE FX"]
["AETNA","AETNA","21451","CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION","21451 - CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION",null,null,null,null,null,"TUFTS PPO","10120",null,"AETNA","21451 - CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION"]
["AETNA","AETNA","21453","HC CLOSED RX MANDIBLE FX+DENTAL FIX","21453 - HC CLOSED RX MANDIBLE FX+DENTAL FIX",null,null,null,null,null,"TUFTS SELECT","10120",null,"AETNA","21453 - HC CLOSED RX MANDIBLE FX+DENTAL FIX"]
["AETNA","AETNA","21461","HC OPEN RX MANDIBLE FX","21461 - HC OPEN RX MANDIBLE FX",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","10120",null,"AETNA","21461 - HC OPEN RX MANDIBLE FX"]
["AETNA","AETNA","21462","HC OPEN RX MANDIBLE FX+DENTAL FIX","21462 - HC OPEN RX MANDIBLE FX+DENTAL FIX",null,null,null,null,null,"UNITED/HARVARD PILGRIM","10120",null,"AETNA","21462 - HC OPEN RX MANDIBLE FX+DENTAL FIX"]
["AETNA","AETNA","21470","HC OPEN RX MANDIBLE CONDYLE FX,COMPL","21470 - HC OPEN RX MANDIBLE CONDYLE FX,COMPL",null,null,null,null,null,"AETNA","10121",null,"AETNA","21470 - HC OPEN RX MANDIBLE CONDYLE FX,COMPL"]
["AETNA","AETNA","21480","CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ","21480 - CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","10121",null,"AETNA","21480 - CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ"]
["AETNA","AETNA","21501","I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX","21501 - I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX",null,null,null,null,null,"BLUE CROSS-HMO BLUE","10121",null,"AETNA","21501 - I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX"]
["AETNA","AETNA","21550","BIOPSY SOFT TISSUE NECK/THORAX","21550 - BIOPSY SOFT TISSUE NECK/THORAX",null,null,null,null,null,"BLUE CROSS-INDEMNITY","10121",null,"AETNA","21550 - BIOPSY SOFT TISSUE NECK/THORAX"]
["AETNA","AETNA","21552","EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>","21552 - EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>",null,null,null,null,null,"BLUE CROSS-PPO","10121",null,"AETNA","21552 - EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>"]
["AETNA","AETNA","21554","EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/>","21554 - EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/>",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","10121",null,"AETNA","21554 - EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/>"]
["AETNA","AETNA","21555","EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM","21555 - EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","10121",null,"AETNA","21555 - EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM"]
["AETNA","AETNA","21556","EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM","21556 - EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","10121",null,"AETNA","21556 - EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM"]
["AETNA","AETNA","21920","HC BIOPSY SOFT TISSUE BACK,SUPERF","21920 - HC BIOPSY SOFT TISSUE BACK,SUPERF",null,null,null,null,null,"CIGNA CARELINK","10121",null,"AETNA","21920 - HC BIOPSY SOFT TISSUE BACK,SUPERF"]
["AETNA","AETNA","21925","HC BIOPSY SOFT TISSUE BACK,DEEP","21925 - HC BIOPSY SOFT TISSUE BACK,DEEP",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","10121",null,"AETNA","21925 - HC BIOPSY SOFT TISSUE BACK,DEEP"]
["AETNA","AETNA","21930","EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM","21930 - EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","10121",null,"AETNA","21930 - EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM"]
["AETNA","AETNA","21931","EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/>","21931 - EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/>",null,null,null,null,null,"TUFTS HMO","10121",null,"AETNA","21931 - EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/>"]
["AETNA","AETNA","21932","HC EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM","21932 - HC EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM",null,null,null,null,null,"TUFTS POS","10121",null,"AETNA","21932 - HC EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM"]
["AETNA","AETNA","21933","EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>","21933 - EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>",null,null,null,null,null,"TUFTS PPO","10121",null,"AETNA","21933 - EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>"]
["AETNA","AETNA","22310","CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING","22310 - CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING",null,null,null,null,null,"TUFTS SELECT","10121",null,"AETNA","22310 - CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING"]
["AETNA","AETNA","22510","PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC","22510 - PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","10121",null,"AETNA","22510 - PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC"]
["AETNA","AETNA","22511","PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL","22511 - PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL",null,null,null,null,null,"UNITED/HARVARD PILGRIM","10121",null,"AETNA","22511 - PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL"]
["AETNA","AETNA","22512","HC VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL","22512 - HC VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL",null,null,null,null,null,"AETNA","10140",null,"AETNA","22512 - HC VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL"]
["AETNA","AETNA","22513","HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION","22513 - HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","10140",null,"AETNA","22513 - HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION"]
["AETNA","AETNA","22514","PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR","22514 - PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR",null,null,null,null,null,"BLUE CROSS-HMO BLUE","10140",null,"AETNA","22514 - PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR"]
["AETNA","AETNA","22515","PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH","22515 - PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH",null,null,null,null,null,"BLUE CROSS-INDEMNITY","10140",null,"AETNA","22515 - PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH"]
["AETNA","AETNA","22854","HC INSJ BIOMCHN DEV VRT CORPECTOMY DEFECT W/ARTHRD","22854 - HC INSJ BIOMCHN DEV VRT CORPECTOMY DEFECT W/ARTHRD",null,null,null,null,null,"BLUE CROSS-PPO","10140",null,"AETNA","22854 - HC INSJ BIOMCHN DEV VRT CORPECTOMY DEFECT W/ARTHRD"]
["AETNA","AETNA","22869","HC INSJ STABLJ DEV W/O DCMPRN LUMBAR SINGLE LEVEL","22869 - HC INSJ STABLJ DEV W/O DCMPRN LUMBAR SINGLE LEVEL",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","10140",null,"AETNA","22869 - HC INSJ STABLJ DEV W/O DCMPRN LUMBAR SINGLE LEVEL"]
["AETNA","AETNA","22870","HC INSJ STABLJ DEV W/O DCMPRN LUMBAR SECOND LEVEL","22870 - HC INSJ STABLJ DEV W/O DCMPRN LUMBAR SECOND LEVEL",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","10140",null,"AETNA","22870 - HC INSJ STABLJ DEV W/O DCMPRN LUMBAR SECOND LEVEL"]
["AETNA","AETNA","22901","HC EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL 5+CM","22901 - HC EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL 5+CM",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","10140",null,"AETNA","22901 - HC EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL 5+CM"]
["AETNA","AETNA","22902","HC EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM","22902 - HC EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM",null,null,null,null,null,"CIGNA CARELINK","10140",null,"AETNA","22902 - HC EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM"]
["AETNA","AETNA","22903","HC EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3+CM","22903 - HC EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3+CM",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","10140",null,"AETNA","22903 - HC EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3+CM"]
["AETNA","AETNA","23031","HC DRAIN INFECT SHOULDER BURSA","23031 - HC DRAIN INFECT SHOULDER BURSA",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","10140",null,"AETNA","23031 - HC DRAIN INFECT SHOULDER BURSA"]
["AETNA","AETNA","23065","HC BIOPSY SOFT TISSUE SHOULDER SUPERFICIAL","23065 - HC BIOPSY SOFT TISSUE SHOULDER SUPERFICIAL",null,null,null,null,null,"TUFTS HMO","10140",null,"AETNA","23065 - HC BIOPSY SOFT TISSUE SHOULDER SUPERFICIAL"]
["AETNA","AETNA","23066","HC BIOPSY SOFT TISSUE SHOULDER DEEP","23066 - HC BIOPSY SOFT TISSUE SHOULDER DEEP",null,null,null,null,null,"TUFTS POS","10140",null,"AETNA","23066 - HC BIOPSY SOFT TISSUE SHOULDER DEEP"]
["AETNA","AETNA","23071","EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/>","23071 - EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/>",null,null,null,null,null,"TUFTS PPO","10140",null,"AETNA","23071 - EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/>"]
["AETNA","AETNA","23073","HC EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/>","23073 - HC EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/>",null,null,null,null,null,"TUFTS SELECT","10140",null,"AETNA","23073 - HC EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/>"]
["AETNA","AETNA","23075","EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM","23075 - EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","10140",null,"AETNA","23075 - EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM"]
["AETNA","AETNA","23076","HC EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM","23076 - HC EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM",null,null,null,null,null,"UNITED/HARVARD PILGRIM","10140",null,"AETNA","23076 - HC EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM"]
["AETNA","AETNA","23330","REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS","23330 - REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS",null,null,null,null,null,"AETNA","10160",null,"AETNA","23330 - REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS"]
["AETNA","AETNA","23350","HC INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI ARTHG","23350 - HC INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI ARTHG",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","10160",null,"AETNA","23350 - HC INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI ARTHG"]
["AETNA","AETNA","23450","HC REPAIR SHOULDER CAPSULE,ANTERIOR","23450 - HC REPAIR SHOULDER CAPSULE,ANTERIOR",null,null,null,null,null,"BLUE CROSS-HMO BLUE","10160",null,"AETNA","23450 - HC REPAIR SHOULDER CAPSULE,ANTERIOR"]
["AETNA","AETNA","23500","CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION","23500 - CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION",null,null,null,null,null,"BLUE CROSS-INDEMNITY","10160",null,"AETNA","23500 - CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION"]
["AETNA","AETNA","23505","CLSD TX CLAVICULAR FRACTURE W/MANIPULATION","23505 - CLSD TX CLAVICULAR FRACTURE W/MANIPULATION",null,null,null,null,null,"BLUE CROSS-PPO","10160",null,"AETNA","23505 - CLSD TX CLAVICULAR FRACTURE W/MANIPULATION"]
["AETNA","AETNA","23525","HC CLOSED RX STERN-CLAV DISLOC,MANIP","23525 - HC CLOSED RX STERN-CLAV DISLOC,MANIP",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","10160",null,"AETNA","23525 - HC CLOSED RX STERN-CLAV DISLOC,MANIP"]
["AETNA","AETNA","23540","CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION","23540 - CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","10160",null,"AETNA","23540 - CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION"]
["AETNA","AETNA","23545","CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION","23545 - CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","10160",null,"AETNA","23545 - CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION"]
["AETNA","AETNA","23570","CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION","23570 - CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION",null,null,null,null,null,"CIGNA CARELINK","10160",null,"AETNA","23570 - CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION"]
["AETNA","AETNA","23575","CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION","23575 - CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","10160",null,"AETNA","23575 - CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION"]
["AETNA","AETNA","23600","CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION","23600 - CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","10160",null,"AETNA","23600 - CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION"]
["AETNA","AETNA","23605","CLTX PROX HUMRL FX W/MANJ W/WO SKELETAL TRACJ","23605 - CLTX PROX HUMRL FX W/MANJ W/WO SKELETAL TRACJ",null,null,null,null,null,"TUFTS HMO","10160",null,"AETNA","23605 - CLTX PROX HUMRL FX W/MANJ W/WO SKELETAL TRACJ"]
["AETNA","AETNA","23620","CLTX GREATER HUMERAL TUBEROSITY FX W/O MANJ","23620 - CLTX GREATER HUMERAL TUBEROSITY FX W/O MANJ",null,null,null,null,null,"TUFTS POS","10160",null,"AETNA","23620 - CLTX GREATER HUMERAL TUBEROSITY FX W/O MANJ"]
["AETNA","AETNA","23625","CLTX GRTER HUMERAL TUBEROSITY FX W/MANIPULATION","23625 - CLTX GRTER HUMERAL TUBEROSITY FX W/MANIPULATION",null,null,null,null,null,"TUFTS PPO","10160",null,"AETNA","23625 - CLTX GRTER HUMERAL TUBEROSITY FX W/MANIPULATION"]
["AETNA","AETNA","23650","CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES","23650 - CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES",null,null,null,null,null,"TUFTS SELECT","10160",null,"AETNA","23650 - CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES"]
["AETNA","AETNA","23655","HC CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES","23655 - HC CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","10160",null,"AETNA","23655 - HC CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES"]
["AETNA","AETNA","23665","CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ","23665 - CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ",null,null,null,null,null,"UNITED/HARVARD PILGRIM","10160",null,"AETNA","23665 - CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ"]
["AETNA","AETNA","24065","HC BX ARM/ELBOW SOFT TISSUE,SUPERFICIAL","24065 - HC BX ARM/ELBOW SOFT TISSUE,SUPERFICIAL",null,null,null,null,null,"AETNA","10180",null,"AETNA","24065 - HC BX ARM/ELBOW SOFT TISSUE,SUPERFICIAL"]
["AETNA","AETNA","24066","HC BX ARM/ELBOW SOFT TISSUE,DEEP","24066 - HC BX ARM/ELBOW SOFT TISSUE,DEEP",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","10180",null,"AETNA","24066 - HC BX ARM/ELBOW SOFT TISSUE,DEEP"]
["AETNA","AETNA","24071","EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/>","24071 - EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/>",null,null,null,null,null,"BLUE CROSS-HMO BLUE","10180",null,"AETNA","24071 - EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/>"]
["AETNA","AETNA","24075","EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM","24075 - EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM",null,null,null,null,null,"BLUE CROSS-INDEMNITY","10180",null,"AETNA","24075 - EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM"]
["AETNA","AETNA","24076","HC EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM","24076 - HC EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM",null,null,null,null,null,"BLUE CROSS-PPO","10180",null,"AETNA","24076 - HC EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM"]
["AETNA","AETNA","24201","HC REMOVAL ARM/ELBOW F.B.,DEEP","24201 - HC REMOVAL ARM/ELBOW F.B.,DEEP",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","10180",null,"AETNA","24201 - HC REMOVAL ARM/ELBOW F.B.,DEEP"]
["AETNA","AETNA","24220","HC INJECTION ELBOW ARTHROGRAPHY","24220 - HC INJECTION ELBOW ARTHROGRAPHY",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","10180",null,"AETNA","24220 - HC INJECTION ELBOW ARTHROGRAPHY"]
["AETNA","AETNA","24357","HC REPAIR ELBOW PERC","24357 - HC REPAIR ELBOW PERC",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","10180",null,"AETNA","24357 - HC REPAIR ELBOW PERC"]
["AETNA","AETNA","24500","CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION","24500 - CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION",null,null,null,null,null,"CIGNA CARELINK","10180",null,"AETNA","24500 - CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION"]
["AETNA","AETNA","24505","CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ","24505 - CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","10180",null,"AETNA","24505 - CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ"]
["AETNA","AETNA","24530","CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ","24530 - CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","10180",null,"AETNA","24530 - CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ"]
["AETNA","AETNA","24535","CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ","24535 - CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ",null,null,null,null,null,"TUFTS HMO","10180",null,"AETNA","24535 - CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ"]
["AETNA","AETNA","24560","CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ","24560 - CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ",null,null,null,null,null,"TUFTS POS","10180",null,"AETNA","24560 - CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ"]
["AETNA","AETNA","24565","CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/MANJ","24565 - CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/MANJ",null,null,null,null,null,"TUFTS PPO","10180",null,"AETNA","24565 - CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/MANJ"]
["AETNA","AETNA","24576","CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ","24576 - CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ",null,null,null,null,null,"TUFTS SELECT","10180",null,"AETNA","24576 - CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ"]
["AETNA","AETNA","24577","CLTX HUMERAL CONDYLAR FX MEDIAL/LATERAL W/MANJ","24577 - CLTX HUMERAL CONDYLAR FX MEDIAL/LATERAL W/MANJ",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","10180",null,"AETNA","24577 - CLTX HUMERAL CONDYLAR FX MEDIAL/LATERAL W/MANJ"]
["AETNA","AETNA","24600","TREATMENT CLOSED ELBOW DISLOCATION W/O ANES","24600 - TREATMENT CLOSED ELBOW DISLOCATION W/O ANES",null,null,null,null,null,"UNITED/HARVARD PILGRIM","10180",null,"AETNA","24600 - TREATMENT CLOSED ELBOW DISLOCATION W/O ANES"]
["AETNA","AETNA","24605","HC TX ELBOW DISLOC W/ANESTH","24605 - HC TX ELBOW DISLOC W/ANESTH",null,null,null,null,null,"AETNA","11000",null,"AETNA","24605 - HC TX ELBOW DISLOC W/ANESTH"]
["AETNA","AETNA","24620","HC CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ","24620 - HC CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11000",null,"AETNA","24620 - HC CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ"]
["AETNA","AETNA","24650","CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION","24650 - CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11000",null,"AETNA","24650 - CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION"]
["AETNA","AETNA","24655","CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION","24655 - CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11000",null,"AETNA","24655 - CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION"]
["AETNA","AETNA","24670","CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ","24670 - CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ",null,null,null,null,null,"BLUE CROSS-PPO","11000",null,"AETNA","24670 - CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ"]
["AETNA","AETNA","24675","CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ","24675 - CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11000",null,"AETNA","24675 - CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ"]
["AETNA","AETNA","25000","HC INCISION EXTENSOR TENDON SHEATH WRIST","25000 - HC INCISION EXTENSOR TENDON SHEATH WRIST",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11000",null,"AETNA","25000 - HC INCISION EXTENSOR TENDON SHEATH WRIST"]
["AETNA","AETNA","25031","HC DRAINAGE OF FOREARM BURSA","25031 - HC DRAINAGE OF FOREARM BURSA",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11000",null,"AETNA","25031 - HC DRAINAGE OF FOREARM BURSA"]
["AETNA","AETNA","25065","HC BIOPSY FOREARM SOFT TISSUES,SUPERFIC","25065 - HC BIOPSY FOREARM SOFT TISSUES,SUPERFIC",null,null,null,null,null,"CIGNA CARELINK","11000",null,"AETNA","25065 - HC BIOPSY FOREARM SOFT TISSUES,SUPERFIC"]
["AETNA","AETNA","25066","HC BIOPSY FOREARM SOFT TISSUES,DEEP","25066 - HC BIOPSY FOREARM SOFT TISSUES,DEEP",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11000",null,"AETNA","25066 - HC BIOPSY FOREARM SOFT TISSUES,DEEP"]
["AETNA","AETNA","25071","EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/>","25071 - EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/>",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11000",null,"AETNA","25071 - EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/>"]
["AETNA","AETNA","25073","HC  EXC TUMOR SFT TISS FOREARM&//WRIST SUBFASC 3+CM","25073 - HC  EXC TUMOR SFT TISS FOREARM&//WRIST SUBFASC 3+CM",null,null,null,null,null,"TUFTS HMO","11000",null,"AETNA","25073 - HC  EXC TUMOR SFT TISS FOREARM&//WRIST SUBFASC 3+CM"]
["AETNA","AETNA","25075","EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM","25075 - EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM",null,null,null,null,null,"TUFTS POS","11000",null,"AETNA","25075 - EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM"]
["AETNA","AETNA","25076","EXC FOREARM TUM DEEP < 3 CM","25076 - EXC FOREARM TUM DEEP < 3 CM",null,null,null,null,null,"TUFTS PPO","11000",null,"AETNA","25076 - EXC FOREARM TUM DEEP < 3 CM"]
["AETNA","AETNA","25111","EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY","25111 - EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY",null,null,null,null,null,"TUFTS SELECT","11000",null,"AETNA","25111 - EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY"]
["AETNA","AETNA","25112","EXCISION GANGLION WRIST DORSAL/VOLAR RECURRENT","25112 - EXCISION GANGLION WRIST DORSAL/VOLAR RECURRENT",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11000",null,"AETNA","25112 - EXCISION GANGLION WRIST DORSAL/VOLAR RECURRENT"]
["AETNA","AETNA","25116","RAD EXCIS WRIST SYNOV/TENDON,EXTEN","25116 - RAD EXCIS WRIST SYNOV/TENDON,EXTEN",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11000",null,"AETNA","25116 - RAD EXCIS WRIST SYNOV/TENDON,EXTEN"]
["AETNA","AETNA","25246","HC INJECTION WRIST ARTHROGRAPHY","25246 - HC INJECTION WRIST ARTHROGRAPHY",null,null,null,null,null,"AETNA","11010",null,"AETNA","25246 - HC INJECTION WRIST ARTHROGRAPHY"]
["AETNA","AETNA","25248","HC REMOVE FOREARM/WRIST FOREIGN BODY","25248 - HC REMOVE FOREARM/WRIST FOREIGN BODY",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11010",null,"AETNA","25248 - HC REMOVE FOREARM/WRIST FOREIGN BODY"]
["AETNA","AETNA","25500","CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION","25500 - CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11010",null,"AETNA","25500 - CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION"]
["AETNA","AETNA","25505","CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION","25505 - CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11010",null,"AETNA","25505 - CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION"]
["AETNA","AETNA","25520","HC CLOSED RX RADIAL SHAFT FX W/DISLOCATION","25520 - HC CLOSED RX RADIAL SHAFT FX W/DISLOCATION",null,null,null,null,null,"BLUE CROSS-PPO","11010",null,"AETNA","25520 - HC CLOSED RX RADIAL SHAFT FX W/DISLOCATION"]
["AETNA","AETNA","25530","CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION","25530 - CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11010",null,"AETNA","25530 - CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION"]
["AETNA","AETNA","25535","CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION","25535 - CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11010",null,"AETNA","25535 - CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION"]
["AETNA","AETNA","25560","CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MAN","25560 - CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MAN",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11010",null,"AETNA","25560 - CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MAN"]
["AETNA","AETNA","25565","CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ","25565 - CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ",null,null,null,null,null,"CIGNA CARELINK","11010",null,"AETNA","25565 - CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ"]
["AETNA","AETNA","25600","CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ","25600 - CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11010",null,"AETNA","25600 - CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ"]
["AETNA","AETNA","25605","CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF","25605 - CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11010",null,"AETNA","25605 - CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF"]
["AETNA","AETNA","25606","HC TREAT FX DISTAL RADIAL","25606 - HC TREAT FX DISTAL RADIAL",null,null,null,null,null,"TUFTS HMO","11010",null,"AETNA","25606 - HC TREAT FX DISTAL RADIAL"]
["AETNA","AETNA","25624","CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ","25624 - CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ",null,null,null,null,null,"TUFTS POS","11010",null,"AETNA","25624 - CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ"]
["AETNA","AETNA","25630","CLTX CARPAL BONE FX W/O MANJ EACH BONE","25630 - CLTX CARPAL BONE FX W/O MANJ EACH BONE",null,null,null,null,null,"TUFTS PPO","11010",null,"AETNA","25630 - CLTX CARPAL BONE FX W/O MANJ EACH BONE"]
["AETNA","AETNA","25635","CLTX CARPAL BONE FX W/MANJ EACH BONE","25635 - CLTX CARPAL BONE FX W/MANJ EACH BONE",null,null,null,null,null,"TUFTS SELECT","11010",null,"AETNA","25635 - CLTX CARPAL BONE FX W/MANJ EACH BONE"]
["AETNA","AETNA","25660","CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MANJ","25660 - CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MANJ",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11010",null,"AETNA","25660 - CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MANJ"]
["AETNA","AETNA","25675","CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ","25675 - CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11010",null,"AETNA","25675 - CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ"]
["AETNA","AETNA","25680","HC CLOSED RX NAVIC/LUNATE FX/DISLOC","25680 - HC CLOSED RX NAVIC/LUNATE FX/DISLOC",null,null,null,null,null,"AETNA","11012",null,"AETNA","25680 - HC CLOSED RX NAVIC/LUNATE FX/DISLOC"]
["AETNA","AETNA","25690","CLOSED TX LUNATE DISLOCATION W/MANIPULATION","25690 - CLOSED TX LUNATE DISLOCATION W/MANIPULATION",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11012",null,"AETNA","25690 - CLOSED TX LUNATE DISLOCATION W/MANIPULATION"]
["AETNA","AETNA","26011","DRAINAGE FINGER ABSCESS COMPLICATED","26011 - DRAINAGE FINGER ABSCESS COMPLICATED",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11012",null,"AETNA","26011 - DRAINAGE FINGER ABSCESS COMPLICATED"]
["AETNA","AETNA","26055","TENDON SHEATH INCISION","26055 - TENDON SHEATH INCISION",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11012",null,"AETNA","26055 - TENDON SHEATH INCISION"]
["AETNA","AETNA","26060","HC INCIS PERCUT FINGER TENDON,SINGLE,EA","26060 - HC INCIS PERCUT FINGER TENDON,SINGLE,EA",null,null,null,null,null,"BLUE CROSS-PPO","11012",null,"AETNA","26060 - HC INCIS PERCUT FINGER TENDON,SINGLE,EA"]
["AETNA","AETNA","26080","HC EXPLORE/TREAT INTERPHALANGEAL JT,EA","26080 - HC EXPLORE/TREAT INTERPHALANGEAL JT,EA",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11012",null,"AETNA","26080 - HC EXPLORE/TREAT INTERPHALANGEAL JT,EA"]
["AETNA","AETNA","26111","HC EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5+CM","26111 - HC EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5+CM",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11012",null,"AETNA","26111 - HC EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5+CM"]
["AETNA","AETNA","26113","EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5CM/>","26113 - EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5CM/>",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11012",null,"AETNA","26113 - EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5CM/>"]
["AETNA","AETNA","26115","EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM","26115 - EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM",null,null,null,null,null,"CIGNA CARELINK","11012",null,"AETNA","26115 - EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM"]
["AETNA","AETNA","26116","EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM","26116 - EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11012",null,"AETNA","26116 - EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM"]
["AETNA","AETNA","26160","EXC LES TDN SHTH/JT CAPSL HAND/FNGR","26160 - EXC LES TDN SHTH/JT CAPSL HAND/FNGR",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11012",null,"AETNA","26160 - EXC LES TDN SHTH/JT CAPSL HAND/FNGR"]
["AETNA","AETNA","26236","HC PR PART REMV BONE,DISTAL PHALANX","26236 - HC PR PART REMV BONE,DISTAL PHALANX",null,null,null,null,null,"TUFTS HMO","11012",null,"AETNA","26236 - HC PR PART REMV BONE,DISTAL PHALANX"]
["AETNA","AETNA","26341","MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD","26341 - MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD",null,null,null,null,null,"TUFTS POS","11012",null,"AETNA","26341 - MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD"]
["AETNA","AETNA","26410","HC REPAIR EXTEN TENDON,DORSUM HAND,EA","26410 - HC REPAIR EXTEN TENDON,DORSUM HAND,EA",null,null,null,null,null,"TUFTS PPO","11012",null,"AETNA","26410 - HC REPAIR EXTEN TENDON,DORSUM HAND,EA"]
["AETNA","AETNA","26418","HC REPAIR EXTEN TENDON,DORSUM FINGER,EA","26418 - HC REPAIR EXTEN TENDON,DORSUM FINGER,EA",null,null,null,null,null,"TUFTS SELECT","11012",null,"AETNA","26418 - HC REPAIR EXTEN TENDON,DORSUM FINGER,EA"]
["AETNA","AETNA","26432","CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING","26432 - CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11012",null,"AETNA","26432 - CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING"]
["AETNA","AETNA","26535","HC ARTHROPLASTY I-P JT","26535 - HC ARTHROPLASTY I-P JT",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11012",null,"AETNA","26535 - HC ARTHROPLASTY I-P JT"]
["AETNA","AETNA","26605","CLTX METACARPAL FX W/MANIPULATION EACH BONE","26605 - CLTX METACARPAL FX W/MANIPULATION EACH BONE",null,null,null,null,null,"AETNA","11042",null,"AETNA","26605 - CLTX METACARPAL FX W/MANIPULATION EACH BONE"]
["AETNA","AETNA","26645","CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ","26645 - CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11042",null,"AETNA","26645 - CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ"]
["AETNA","AETNA","26650","HC PRQ SKEL FIXATION CARP/MTCRPL FX DISLOCATE THUMB","26650 - HC PRQ SKEL FIXATION CARP/MTCRPL FX DISLOCATE THUMB",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11042",null,"AETNA","26650 - HC PRQ SKEL FIXATION CARP/MTCRPL FX DISLOCATE THUMB"]
["AETNA","AETNA","26720","CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA","26720 - CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11042",null,"AETNA","26720 - CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA"]
["AETNA","AETNA","26725","CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA","26725 - CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA",null,null,null,null,null,"BLUE CROSS-PPO","11042",null,"AETNA","26725 - CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA"]
["AETNA","AETNA","26740","CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ","26740 - CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11042",null,"AETNA","26740 - CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ"]
["AETNA","AETNA","26742","CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ","26742 - CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11042",null,"AETNA","26742 - CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ"]
["AETNA","AETNA","26765","HC OPEN TX DISTAL PHALANGEAL FRACTURE EACH","26765 - HC OPEN TX DISTAL PHALANGEAL FRACTURE EACH",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11042",null,"AETNA","26765 - HC OPEN TX DISTAL PHALANGEAL FRACTURE EACH"]
["AETNA","AETNA","26951","HC AMPUTATION FINGER/THUMB","26951 - HC AMPUTATION FINGER/THUMB",null,null,null,null,null,"CIGNA CARELINK","11042",null,"AETNA","26951 - HC AMPUTATION FINGER/THUMB"]
["AETNA","AETNA","26990","HC INCIS/DRAIN PELVIS/HIP,DEEP ABCESS","26990 - HC INCIS/DRAIN PELVIS/HIP,DEEP ABCESS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11042",null,"AETNA","26990 - HC INCIS/DRAIN PELVIS/HIP,DEEP ABCESS"]
["AETNA","AETNA","27040","HC BX SOFT TISSUES,PELV/HIP,SUPERFICL","27040 - HC BX SOFT TISSUES,PELV/HIP,SUPERFICL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11042",null,"AETNA","27040 - HC BX SOFT TISSUES,PELV/HIP,SUPERFICL"]
["AETNA","AETNA","27041","HC BX SOFT TISSUES,PELV/HIP,DEEP","27041 - HC BX SOFT TISSUES,PELV/HIP,DEEP",null,null,null,null,null,"TUFTS HMO","11042",null,"AETNA","27041 - HC BX SOFT TISSUES,PELV/HIP,DEEP"]
["AETNA","AETNA","27043","EXCISION TUMOR SOFT TISSUE PELVIS&HIP SUBQ 3+CM","27043 - EXCISION TUMOR SOFT TISSUE PELVIS&HIP SUBQ 3+CM",null,null,null,null,null,"TUFTS POS","11042",null,"AETNA","27043 - EXCISION TUMOR SOFT TISSUE PELVIS&HIP SUBQ 3+CM"]
["AETNA","AETNA","27047","EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ <3CM","27047 - EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ <3CM",null,null,null,null,null,"TUFTS PPO","11042",null,"AETNA","27047 - EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ <3CM"]
["AETNA","AETNA","27048","EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC <5CM","27048 - EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC <5CM",null,null,null,null,null,"TUFTS SELECT","11042",null,"AETNA","27048 - EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC <5CM"]
["AETNA","AETNA","27086","RMVL FOREIGN BODY PELVIS/HIP SUBCUTANEOUS TISS","27086 - RMVL FOREIGN BODY PELVIS/HIP SUBCUTANEOUS TISS",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11042",null,"AETNA","27086 - RMVL FOREIGN BODY PELVIS/HIP SUBCUTANEOUS TISS"]
["AETNA","AETNA","27087","REMOVAL FOREIGN BODY PELVIS/HIP DEEP","27087 - REMOVAL FOREIGN BODY PELVIS/HIP DEEP",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11042",null,"AETNA","27087 - REMOVAL FOREIGN BODY PELVIS/HIP DEEP"]
["AETNA","AETNA","27093","HC INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA","27093 - HC INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA",null,null,null,null,null,"AETNA","11043",null,"AETNA","27093 - HC INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA"]
["AETNA","AETNA","27096","INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA","27096 - INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11043",null,"AETNA","27096 - INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA"]
["AETNA","AETNA","27197","HC CLSD TX PELVIC RING FX W/O MANIPULATION","27197 - HC CLSD TX PELVIC RING FX W/O MANIPULATION",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11043",null,"AETNA","27197 - HC CLSD TX PELVIC RING FX W/O MANIPULATION"]
["AETNA","AETNA","27200","HC CLOSED TREATMENT COCCYGEAL FRACTURE","27200 - HC CLOSED TREATMENT COCCYGEAL FRACTURE",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11043",null,"AETNA","27200 - HC CLOSED TREATMENT COCCYGEAL FRACTURE"]
["AETNA","AETNA","27230","CLTX FEM FX PROX END NCK W/O MANJ","27230 - CLTX FEM FX PROX END NCK W/O MANJ",null,null,null,null,null,"BLUE CROSS-PPO","11043",null,"AETNA","27230 - CLTX FEM FX PROX END NCK W/O MANJ"]
["AETNA","AETNA","27238","CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ","27238 - CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11043",null,"AETNA","27238 - CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ"]
["AETNA","AETNA","27246","CLTX GREATER TROCHANTERIC FX W/O MANJ","27246 - CLTX GREATER TROCHANTERIC FX W/O MANJ",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11043",null,"AETNA","27246 - CLTX GREATER TROCHANTERIC FX W/O MANJ"]
["AETNA","AETNA","27250","CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA","27250 - CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11043",null,"AETNA","27250 - CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA"]
["AETNA","AETNA","27252","HC TX HIP DISLOC W/ANESTH","27252 - HC TX HIP DISLOC W/ANESTH",null,null,null,null,null,"CIGNA CARELINK","11043",null,"AETNA","27252 - HC TX HIP DISLOC W/ANESTH"]
["AETNA","AETNA","27256","TX SPONTAN HIP DISLC ABDCT SPLNT/TRCJ W/O ANES","27256 - TX SPONTAN HIP DISLC ABDCT SPLNT/TRCJ W/O ANES",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11043",null,"AETNA","27256 - TX SPONTAN HIP DISLC ABDCT SPLNT/TRCJ W/O ANES"]
["AETNA","AETNA","27257","HC TX HIPDISLOC ABDCT WMANP","27257 - HC TX HIPDISLOC ABDCT WMANP",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11043",null,"AETNA","27257 - HC TX HIPDISLOC ABDCT WMANP"]
["AETNA","AETNA","27265","CLTX POST HIP ARTHRP DISLC W/O ANES","27265 - CLTX POST HIP ARTHRP DISLC W/O ANES",null,null,null,null,null,"TUFTS HMO","11043",null,"AETNA","27265 - CLTX POST HIP ARTHRP DISLC W/O ANES"]
["AETNA","AETNA","27266","HC CLOSED RX POST HIP FIX DISLOC,ANESTH","27266 - HC CLOSED RX POST HIP FIX DISLOC,ANESTH",null,null,null,null,null,"TUFTS POS","11043",null,"AETNA","27266 - HC CLOSED RX POST HIP FIX DISLOC,ANESTH"]
["AETNA","AETNA","27299","PR HIP ABDUCTOR REPAIR","27299 - PR HIP ABDUCTOR REPAIR",null,null,null,null,null,"TUFTS PPO","11043",null,"AETNA","27299 - PR HIP ABDUCTOR REPAIR"]
["AETNA","AETNA","27301","HC INCIS/DRAIN THIGH/KNEE ABSCESS,DEEP","27301 - HC INCIS/DRAIN THIGH/KNEE ABSCESS,DEEP",null,null,null,null,null,"TUFTS SELECT","11043",null,"AETNA","27301 - HC INCIS/DRAIN THIGH/KNEE ABSCESS,DEEP"]
["AETNA","AETNA","27306","HC INCISION OF THIGH TENDON","27306 - HC INCISION OF THIGH TENDON",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11043",null,"AETNA","27306 - HC INCISION OF THIGH TENDON"]
["AETNA","AETNA","27323","HC BX THIGH/KNEE SOFT TISSUES,SUPERF","27323 - HC BX THIGH/KNEE SOFT TISSUES,SUPERF",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11043",null,"AETNA","27323 - HC BX THIGH/KNEE SOFT TISSUES,SUPERF"]
["AETNA","AETNA","27324","HC BX THIGH/KNEE SOFT TISSUES,DEEP","27324 - HC BX THIGH/KNEE SOFT TISSUES,DEEP",null,null,null,null,null,"AETNA","11044",null,"AETNA","27324 - HC BX THIGH/KNEE SOFT TISSUES,DEEP"]
["AETNA","AETNA","27327","EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ <3CM","27327 - EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ <3CM",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11044",null,"AETNA","27327 - EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ <3CM"]
["AETNA","AETNA","27328","HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM","27328 - HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11044",null,"AETNA","27328 - HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM"]
["AETNA","AETNA","27337","EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/>","27337 - EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/>",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11044",null,"AETNA","27337 - EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/>"]
["AETNA","AETNA","27339","HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC 5+ CM","27339 - HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC 5+ CM",null,null,null,null,null,"BLUE CROSS-PPO","11044",null,"AETNA","27339 - HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC 5+ CM"]
["AETNA","AETNA","27369","HC NJX CNTRST KNE ARTHG/CT/MRI","27369 - HC NJX CNTRST KNE ARTHG/CT/MRI",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11044",null,"AETNA","27369 - HC NJX CNTRST KNE ARTHG/CT/MRI"]
["AETNA","AETNA","27372","REMOVAL FOREIGN BODY DEEP THIGH/KNEE","27372 - REMOVAL FOREIGN BODY DEEP THIGH/KNEE",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11044",null,"AETNA","27372 - REMOVAL FOREIGN BODY DEEP THIGH/KNEE"]
["AETNA","AETNA","27500","CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION","27500 - CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11044",null,"AETNA","27500 - CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION"]
["AETNA","AETNA","27501","CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANJ","27501 - CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANJ",null,null,null,null,null,"CIGNA CARELINK","11044",null,"AETNA","27501 - CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANJ"]
["AETNA","AETNA","27502","CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ","27502 - CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11044",null,"AETNA","27502 - CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ"]
["AETNA","AETNA","27508","CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ","27508 - CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11044",null,"AETNA","27508 - CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ"]
["AETNA","AETNA","27520","CLOSED TX PATELLAR FRACTURE W/O MANIPULATION","27520 - CLOSED TX PATELLAR FRACTURE W/O MANIPULATION",null,null,null,null,null,"TUFTS HMO","11044",null,"AETNA","27520 - CLOSED TX PATELLAR FRACTURE W/O MANIPULATION"]
["AETNA","AETNA","27530","CLTX TIBIAL FX PROXIMAL W/O MANIPULATION","27530 - CLTX TIBIAL FX PROXIMAL W/O MANIPULATION",null,null,null,null,null,"TUFTS POS","11044",null,"AETNA","27530 - CLTX TIBIAL FX PROXIMAL W/O MANIPULATION"]
["AETNA","AETNA","27532","HC CLTX TIBIAL FX PROXIMAL W/WO MANJ W/SKEL TRACJ","27532 - HC CLTX TIBIAL FX PROXIMAL W/WO MANJ W/SKEL TRACJ",null,null,null,null,null,"TUFTS PPO","11044",null,"AETNA","27532 - HC CLTX TIBIAL FX PROXIMAL W/WO MANJ W/SKEL TRACJ"]
["AETNA","AETNA","27538","CLTX INTERCONDYLAR SPI&/TUBRST FX KNE W/WO MAN","27538 - CLTX INTERCONDYLAR SPI&/TUBRST FX KNE W/WO MAN",null,null,null,null,null,"TUFTS SELECT","11044",null,"AETNA","27538 - CLTX INTERCONDYLAR SPI&/TUBRST FX KNE W/WO MAN"]
["AETNA","AETNA","27550","CLOSED TX KNEE DISLOCATION W/O ANESTHESIA","27550 - CLOSED TX KNEE DISLOCATION W/O ANESTHESIA",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11044",null,"AETNA","27550 - CLOSED TX KNEE DISLOCATION W/O ANESTHESIA"]
["AETNA","AETNA","27560","CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA","27560 - CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11044",null,"AETNA","27560 - CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA"]
["AETNA","AETNA","27603","HC DRAIN LOWER LEG DEEP ABSC/HEMATOMA","27603 - HC DRAIN LOWER LEG DEEP ABSC/HEMATOMA",null,null,null,null,null,"AETNA","11045",null,"AETNA","27603 - HC DRAIN LOWER LEG DEEP ABSC/HEMATOMA"]
["AETNA","AETNA","27605","TENOTOMY PRQ ACHILLES TENDON SPX LOCAL ANES","27605 - TENOTOMY PRQ ACHILLES TENDON SPX LOCAL ANES",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11045",null,"AETNA","27605 - TENOTOMY PRQ ACHILLES TENDON SPX LOCAL ANES"]
["AETNA","AETNA","27613","HC BX LOW LEG SOFT TISSUE,SUPERFICIAL","27613 - HC BX LOW LEG SOFT TISSUE,SUPERFICIAL",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11045",null,"AETNA","27613 - HC BX LOW LEG SOFT TISSUE,SUPERFICIAL"]
["AETNA","AETNA","27614","HC BX LOW LEG SOFT TISSUE,DEEP","27614 - HC BX LOW LEG SOFT TISSUE,DEEP",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11045",null,"AETNA","27614 - HC BX LOW LEG SOFT TISSUE,DEEP"]
["AETNA","AETNA","27618","EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM","27618 - EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM",null,null,null,null,null,"BLUE CROSS-PPO","11045",null,"AETNA","27618 - EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM"]
["AETNA","AETNA","27632","EXCISION TUMOR SOFT TISSUE LEG/ANKLE SUBQ 3 CM/>","27632 - EXCISION TUMOR SOFT TISSUE LEG/ANKLE SUBQ 3 CM/>",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11045",null,"AETNA","27632 - EXCISION TUMOR SOFT TISSUE LEG/ANKLE SUBQ 3 CM/>"]
["AETNA","AETNA","27634","HC EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5+CM","27634 - HC EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5+CM",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11045",null,"AETNA","27634 - HC EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5+CM"]
["AETNA","AETNA","27648","HC INJECTION ANKLE ARTHROGRAPHY","27648 - HC INJECTION ANKLE ARTHROGRAPHY",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11045",null,"AETNA","27648 - HC INJECTION ANKLE ARTHROGRAPHY"]
["AETNA","AETNA","27685","HC LENGTH/SHORT LEG/ANKL TENDON,SINGLE","27685 - HC LENGTH/SHORT LEG/ANKL TENDON,SINGLE",null,null,null,null,null,"CIGNA CARELINK","11045",null,"AETNA","27685 - HC LENGTH/SHORT LEG/ANKL TENDON,SINGLE"]
["AETNA","AETNA","27750","CLTX TIBIAL SHAFT FX W/O MANIPULATION","27750 - CLTX TIBIAL SHAFT FX W/O MANIPULATION",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11045",null,"AETNA","27750 - CLTX TIBIAL SHAFT FX W/O MANIPULATION"]
["AETNA","AETNA","27752","CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ","27752 - CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11045",null,"AETNA","27752 - CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ"]
["AETNA","AETNA","27759","HC TREAT TIBIAL SHAFT FX, INTRAMED IMPLANT","27759 - HC TREAT TIBIAL SHAFT FX, INTRAMED IMPLANT",null,null,null,null,null,"TUFTS HMO","11045",null,"AETNA","27759 - HC TREAT TIBIAL SHAFT FX, INTRAMED IMPLANT"]
["AETNA","AETNA","27760","CLTX MEDIAL MALLEOLUS FX W/O MANIPULATION","27760 - CLTX MEDIAL MALLEOLUS FX W/O MANIPULATION",null,null,null,null,null,"TUFTS POS","11045",null,"AETNA","27760 - CLTX MEDIAL MALLEOLUS FX W/O MANIPULATION"]
["AETNA","AETNA","27762","CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ","27762 - CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ",null,null,null,null,null,"TUFTS PPO","11045",null,"AETNA","27762 - CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ"]
["AETNA","AETNA","27767","HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANIP","27767 - HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANIP",null,null,null,null,null,"TUFTS SELECT","11045",null,"AETNA","27767 - HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANIP"]
["AETNA","AETNA","27768","HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ","27768 - HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11045",null,"AETNA","27768 - HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ"]
["AETNA","AETNA","27780","CLTX PROX FIBULA/SHFT FX W/O MANJ","27780 - CLTX PROX FIBULA/SHFT FX W/O MANJ",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11045",null,"AETNA","27780 - CLTX PROX FIBULA/SHFT FX W/O MANJ"]
["AETNA","AETNA","27781","CLTX PROX FIBULA/SHFT FX W/MANJ","27781 - CLTX PROX FIBULA/SHFT FX W/MANJ",null,null,null,null,null,"AETNA","11046",null,"AETNA","27781 - CLTX PROX FIBULA/SHFT FX W/MANJ"]
["AETNA","AETNA","27786","CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ","27786 - CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11046",null,"AETNA","27786 - CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ"]
["AETNA","AETNA","27788","CLTX DSTL FIBULAR FX LAT MALLS W/MANJ","27788 - CLTX DSTL FIBULAR FX LAT MALLS W/MANJ",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11046",null,"AETNA","27788 - CLTX DSTL FIBULAR FX LAT MALLS W/MANJ"]
["AETNA","AETNA","27808","CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ","27808 - CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11046",null,"AETNA","27808 - CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ"]
["AETNA","AETNA","27810","CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ","27810 - CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ",null,null,null,null,null,"BLUE CROSS-PPO","11046",null,"AETNA","27810 - CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ"]
["AETNA","AETNA","27814","HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE","27814 - HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11046",null,"AETNA","27814 - HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE"]
["AETNA","AETNA","27816","CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION","27816 - CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11046",null,"AETNA","27816 - CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION"]
["AETNA","AETNA","27818","CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION","27818 - CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11046",null,"AETNA","27818 - CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION"]
["AETNA","AETNA","27824","CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ","27824 - CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ",null,null,null,null,null,"CIGNA CARELINK","11046",null,"AETNA","27824 - CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ"]
["AETNA","AETNA","27825","CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ","27825 - CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11046",null,"AETNA","27825 - CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ"]
["AETNA","AETNA","27830","CLTX PROX TIBFIB JT DISLC W/O ANES","27830 - CLTX PROX TIBFIB JT DISLC W/O ANES",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11046",null,"AETNA","27830 - CLTX PROX TIBFIB JT DISLC W/O ANES"]
["AETNA","AETNA","27840","CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA","27840 - CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA",null,null,null,null,null,"TUFTS HMO","11046",null,"AETNA","27840 - CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA"]
["AETNA","AETNA","27870","HC ARTHRODESIS,ANKLE,OPEN","27870 - HC ARTHRODESIS,ANKLE,OPEN",null,null,null,null,null,"TUFTS POS","11046",null,"AETNA","27870 - HC ARTHRODESIS,ANKLE,OPEN"]
["AETNA","AETNA","28010","TENOTOMY PERCUTANEOUS TOE SINGLE TENDON","28010 - TENOTOMY PERCUTANEOUS TOE SINGLE TENDON",null,null,null,null,null,"TUFTS PPO","11046",null,"AETNA","28010 - TENOTOMY PERCUTANEOUS TOE SINGLE TENDON"]
["AETNA","AETNA","28011","HC INCISION OF TOE TENDONS","28011 - HC INCISION OF TOE TENDONS",null,null,null,null,null,"TUFTS SELECT","11046",null,"AETNA","28011 - HC INCISION OF TOE TENDONS"]
["AETNA","AETNA","28022","HC ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT","28022 - HC ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11046",null,"AETNA","28022 - HC ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT"]
["AETNA","AETNA","28039","EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>","28039 - EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11046",null,"AETNA","28039 - EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>"]
["AETNA","AETNA","28041","HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5+CM","28041 - HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5+CM",null,null,null,null,null,"AETNA","11047",null,"AETNA","28041 - HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5+CM"]
["AETNA","AETNA","28043","EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM","28043 - EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11047",null,"AETNA","28043 - EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM"]
["AETNA","AETNA","28045","HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC <1.5CM","28045 - HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC <1.5CM",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11047",null,"AETNA","28045 - HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC <1.5CM"]
["AETNA","AETNA","28046","HC RESECT FOOT/TOE TUMOR < 3 CM","28046 - HC RESECT FOOT/TOE TUMOR < 3 CM",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11047",null,"AETNA","28046 - HC RESECT FOOT/TOE TUMOR < 3 CM"]
["AETNA","AETNA","28090","HC REMOVAL OF FOOT LESION","28090 - HC REMOVAL OF FOOT LESION",null,null,null,null,null,"BLUE CROSS-PPO","11047",null,"AETNA","28090 - HC REMOVAL OF FOOT LESION"]
["AETNA","AETNA","28124","PARTIAL REMOVAL OF TOE","28124 - PARTIAL REMOVAL OF TOE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11047",null,"AETNA","28124 - PARTIAL REMOVAL OF TOE"]
["AETNA","AETNA","28150","HC REMOVAL OF SINGLE TOE,EACH","28150 - HC REMOVAL OF SINGLE TOE,EACH",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11047",null,"AETNA","28150 - HC REMOVAL OF SINGLE TOE,EACH"]
["AETNA","AETNA","28153","HC RESEC HEAD OF PHALANX,TOE","28153 - HC RESEC HEAD OF PHALANX,TOE",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11047",null,"AETNA","28153 - HC RESEC HEAD OF PHALANX,TOE"]
["AETNA","AETNA","28190","REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS","28190 - REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS",null,null,null,null,null,"CIGNA CARELINK","11047",null,"AETNA","28190 - REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS"]
["AETNA","AETNA","28192","REMOVAL FOREIGN BODY FOOT DEEP","28192 - REMOVAL FOREIGN BODY FOOT DEEP",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11047",null,"AETNA","28192 - REMOVAL FOREIGN BODY FOOT DEEP"]
["AETNA","AETNA","28220","HC RELEASE FLEX FOOT TENDON,SINGLE","28220 - HC RELEASE FLEX FOOT TENDON,SINGLE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11047",null,"AETNA","28220 - HC RELEASE FLEX FOOT TENDON,SINGLE"]
["AETNA","AETNA","28222","HC TENOLYSIS FLEXOR FOOT MULTIPLE TENDONS","28222 - HC TENOLYSIS FLEXOR FOOT MULTIPLE TENDONS",null,null,null,null,null,"TUFTS HMO","11047",null,"AETNA","28222 - HC TENOLYSIS FLEXOR FOOT MULTIPLE TENDONS"]
["AETNA","AETNA","28230","TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPX","28230 - TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPX",null,null,null,null,null,"TUFTS POS","11047",null,"AETNA","28230 - TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPX"]
["AETNA","AETNA","28232","TX OPEN TENDON FLEXOR TOE 1 TENDON SPX","28232 - TX OPEN TENDON FLEXOR TOE 1 TENDON SPX",null,null,null,null,null,"TUFTS PPO","11047",null,"AETNA","28232 - TX OPEN TENDON FLEXOR TOE 1 TENDON SPX"]
["AETNA","AETNA","28234","TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON","28234 - TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON",null,null,null,null,null,"TUFTS SELECT","11047",null,"AETNA","28234 - TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON"]
["AETNA","AETNA","28285","CORRECTION HAMMERTOE","28285 - CORRECTION HAMMERTOE",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11047",null,"AETNA","28285 - CORRECTION HAMMERTOE"]
["AETNA","AETNA","28296","HC CORRJ HALLUX VALGUS W/SESMDC W/DIST METAR OSTEOT","28296 - HC CORRJ HALLUX VALGUS W/SESMDC W/DIST METAR OSTEOT",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11047",null,"AETNA","28296 - HC CORRJ HALLUX VALGUS W/SESMDC W/DIST METAR OSTEOT"]
["AETNA","AETNA","28308","OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA","28308 - OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA",null,null,null,null,null,"AETNA","11055",null,"AETNA","28308 - OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA"]
["AETNA","AETNA","28400","CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION","28400 - CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11055",null,"AETNA","28400 - CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION"]
["AETNA","AETNA","28405","CLOSED TX CALCANEAL FRACTURE W/MANIPULATION","28405 - CLOSED TX CALCANEAL FRACTURE W/MANIPULATION",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11055",null,"AETNA","28405 - CLOSED TX CALCANEAL FRACTURE W/MANIPULATION"]
["AETNA","AETNA","28430","CLOSED TX TALUS FRACTURE W/O MANIPULATION","28430 - CLOSED TX TALUS FRACTURE W/O MANIPULATION",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11055",null,"AETNA","28430 - CLOSED TX TALUS FRACTURE W/O MANIPULATION"]
["AETNA","AETNA","28435","CLOSED TX TALUS FRACTURE W/MANIPULATION","28435 - CLOSED TX TALUS FRACTURE W/MANIPULATION",null,null,null,null,null,"BLUE CROSS-PPO","11055",null,"AETNA","28435 - CLOSED TX TALUS FRACTURE W/MANIPULATION"]
["AETNA","AETNA","28450","TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ","28450 - TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11055",null,"AETNA","28450 - TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ"]
["AETNA","AETNA","28455","TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ","28455 - TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11055",null,"AETNA","28455 - TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ"]
["AETNA","AETNA","28465","HC TREAT MIDFOOT FRACTURE EACH","28465 - HC TREAT MIDFOOT FRACTURE EACH",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11055",null,"AETNA","28465 - HC TREAT MIDFOOT FRACTURE EACH"]
["AETNA","AETNA","28470","CLOSED TX METATARSAL FRACTURE W/O MANIPULATION","28470 - CLOSED TX METATARSAL FRACTURE W/O MANIPULATION",null,null,null,null,null,"CIGNA CARELINK","11055",null,"AETNA","28470 - CLOSED TX METATARSAL FRACTURE W/O MANIPULATION"]
["AETNA","AETNA","28475","CLTX METAR FX W/MANJ","28475 - CLTX METAR FX W/MANJ",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11055",null,"AETNA","28475 - CLTX METAR FX W/MANJ"]
["AETNA","AETNA","28490","CLTX FX GRT TOE PHLX/PHLG W/O MANJ","28490 - CLTX FX GRT TOE PHLX/PHLG W/O MANJ",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11055",null,"AETNA","28490 - CLTX FX GRT TOE PHLX/PHLG W/O MANJ"]
["AETNA","AETNA","28495","CLTX FX GRT TOE PHLX/PHLG W/MANJ","28495 - CLTX FX GRT TOE PHLX/PHLG W/MANJ",null,null,null,null,null,"TUFTS HMO","11055",null,"AETNA","28495 - CLTX FX GRT TOE PHLX/PHLG W/MANJ"]
["AETNA","AETNA","28510","CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ","28510 - CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ",null,null,null,null,null,"TUFTS POS","11055",null,"AETNA","28510 - CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ"]
["AETNA","AETNA","28515","CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ","28515 - CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ",null,null,null,null,null,"TUFTS PPO","11055",null,"AETNA","28515 - CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ"]
["AETNA","AETNA","28525","HC OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE","28525 - HC OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE",null,null,null,null,null,"TUFTS SELECT","11055",null,"AETNA","28525 - HC OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE"]
["AETNA","AETNA","28530","HC CLOSED RX SESAMOID BONE FX","28530 - HC CLOSED RX SESAMOID BONE FX",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11055",null,"AETNA","28530 - HC CLOSED RX SESAMOID BONE FX"]
["AETNA","AETNA","28540","CLTX TARSAL DISLC OTH/THN TALOTARSAL W/O ANES","28540 - CLTX TARSAL DISLC OTH/THN TALOTARSAL W/O ANES",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11055",null,"AETNA","28540 - CLTX TARSAL DISLC OTH/THN TALOTARSAL W/O ANES"]
["AETNA","AETNA","28570","HC CLOSED RX TALOTARSAL DISLOC","28570 - HC CLOSED RX TALOTARSAL DISLOC",null,null,null,null,null,"AETNA","11056",null,"AETNA","28570 - HC CLOSED RX TALOTARSAL DISLOC"]
["AETNA","AETNA","28600","CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES","28600 - CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11056",null,"AETNA","28600 - CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES"]
["AETNA","AETNA","28630","CLOSED RX MT-PHAL TOE DISLOCATION","28630 - CLOSED RX MT-PHAL TOE DISLOCATION",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11056",null,"AETNA","28630 - CLOSED RX MT-PHAL TOE DISLOCATION"]
["AETNA","AETNA","28660","HC CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES","28660 - HC CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11056",null,"AETNA","28660 - HC CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES"]
["AETNA","AETNA","28825","HC AMP,TOE;INTERPHAL JT","28825 - HC AMP,TOE;INTERPHAL JT",null,null,null,null,null,"BLUE CROSS-PPO","11056",null,"AETNA","28825 - HC AMP,TOE;INTERPHAL JT"]
["AETNA","AETNA","28899","CHEILECTOMY LESSER MPJ W/ IMPLANT","28899 - CHEILECTOMY LESSER MPJ W/ IMPLANT",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11056",null,"AETNA","28899 - CHEILECTOMY LESSER MPJ W/ IMPLANT"]
["AETNA","AETNA","29345","APPLICATION LONG LEG CAST THIGH-TOE","29345 - APPLICATION LONG LEG CAST THIGH-TOE",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11056",null,"AETNA","29345 - APPLICATION LONG LEG CAST THIGH-TOE"]
["AETNA","AETNA","29804","HC TMJ ARTHROSCOPY/SURGERY","29804 - HC TMJ ARTHROSCOPY/SURGERY",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11056",null,"AETNA","29804 - HC TMJ ARTHROSCOPY/SURGERY"]
["AETNA","AETNA","29807","HC SHLDR ARTHROSCOP,SURG,REPAIR,SLAP LESION","29807 - HC SHLDR ARTHROSCOP,SURG,REPAIR,SLAP LESION",null,null,null,null,null,"CIGNA CARELINK","11056",null,"AETNA","29807 - HC SHLDR ARTHROSCOP,SURG,REPAIR,SLAP LESION"]
["AETNA","AETNA","29823","HC SHLDR ARTHROSCOP,EXTEN DEBRIDE 3+","29823 - HC SHLDR ARTHROSCOP,EXTEN DEBRIDE 3+",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11056",null,"AETNA","29823 - HC SHLDR ARTHROSCOP,EXTEN DEBRIDE 3+"]
["AETNA","AETNA","29827","HC SHLDR ARTHROSCOP,SURG,W/ROTAT CUFF REPR","29827 - HC SHLDR ARTHROSCOP,SURG,W/ROTAT CUFF REPR",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11056",null,"AETNA","29827 - HC SHLDR ARTHROSCOP,SURG,W/ROTAT CUFF REPR"]
["AETNA","AETNA","29881","HC KNEE SCOPE SINGLE MENISCECTOMY","29881 - HC KNEE SCOPE SINGLE MENISCECTOMY",null,null,null,null,null,"TUFTS HMO","11056",null,"AETNA","29881 - HC KNEE SCOPE SINGLE MENISCECTOMY"]
["AETNA","AETNA","29882","HC KNEE SCOPE,MED OR LAT MENIS REPAIR","29882 - HC KNEE SCOPE,MED OR LAT MENIS REPAIR",null,null,null,null,null,"TUFTS POS","11056",null,"AETNA","29882 - HC KNEE SCOPE,MED OR LAT MENIS REPAIR"]
["AETNA","AETNA","29888","HC KNEE SCOPE,AID ANT CRUCIATE REPAIR","29888 - HC KNEE SCOPE,AID ANT CRUCIATE REPAIR",null,null,null,null,null,"TUFTS PPO","11056",null,"AETNA","29888 - HC KNEE SCOPE,AID ANT CRUCIATE REPAIR"]
["AETNA","AETNA","30000","DRAINAGE ABSCESS/HEMATOMA NASAL INT APPROACH","30000 - DRAINAGE ABSCESS/HEMATOMA NASAL INT APPROACH",null,null,null,null,null,"TUFTS SELECT","11056",null,"AETNA","30000 - DRAINAGE ABSCESS/HEMATOMA NASAL INT APPROACH"]
["AETNA","AETNA","30020","DRAINAGE ABSCESS/HEMATOMA NASAL SEPTUM","30020 - DRAINAGE ABSCESS/HEMATOMA NASAL SEPTUM",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11056",null,"AETNA","30020 - DRAINAGE ABSCESS/HEMATOMA NASAL SEPTUM"]
["AETNA","AETNA","30100","HC BIOPSY INTRANASAL","30100 - HC BIOPSY INTRANASAL",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11056",null,"AETNA","30100 - HC BIOPSY INTRANASAL"]
["AETNA","AETNA","30110","EXCISION NASAL POLYP SIMPLE","30110 - EXCISION NASAL POLYP SIMPLE",null,null,null,null,null,"AETNA","11057",null,"AETNA","30110 - EXCISION NASAL POLYP SIMPLE"]
["AETNA","AETNA","30117","EXCISION/DESTRUCTION INTRANASAL LESION INT APPR","30117 - EXCISION/DESTRUCTION INTRANASAL LESION INT APPR",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11057",null,"AETNA","30117 - EXCISION/DESTRUCTION INTRANASAL LESION INT APPR"]
["AETNA","AETNA","30130","HC EXCISION TURBINATE","30130 - HC EXCISION TURBINATE",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11057",null,"AETNA","30130 - HC EXCISION TURBINATE"]
["AETNA","AETNA","30140","HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL","30140 - HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11057",null,"AETNA","30140 - HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL"]
["AETNA","AETNA","30220","INSERTION NASAL SEPTAL PROSTHESIS BUTTON","30220 - INSERTION NASAL SEPTAL PROSTHESIS BUTTON",null,null,null,null,null,"BLUE CROSS-PPO","11057",null,"AETNA","30220 - INSERTION NASAL SEPTAL PROSTHESIS BUTTON"]
["AETNA","AETNA","30420","HC RECONSTR NOSE+MAJ SEPTAL REPAIR","30420 - HC RECONSTR NOSE+MAJ SEPTAL REPAIR",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11057",null,"AETNA","30420 - HC RECONSTR NOSE+MAJ SEPTAL REPAIR"]
["AETNA","AETNA","30465","REPAIR NASAL VESTIBULAR STENOSIS","30465 - REPAIR NASAL VESTIBULAR STENOSIS",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11057",null,"AETNA","30465 - REPAIR NASAL VESTIBULAR STENOSIS"]
["AETNA","AETNA","30520","HC REPAIR OF NASAL SEPTUM","30520 - HC REPAIR OF NASAL SEPTUM",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11057",null,"AETNA","30520 - HC REPAIR OF NASAL SEPTUM"]
["AETNA","AETNA","30560","HC RELEASE OF NASAL ADHESIONS","30560 - HC RELEASE OF NASAL ADHESIONS",null,null,null,null,null,"CIGNA CARELINK","11057",null,"AETNA","30560 - HC RELEASE OF NASAL ADHESIONS"]
["AETNA","AETNA","30580","HC REPAIR FISTULA OROMAXILLARY","30580 - HC REPAIR FISTULA OROMAXILLARY",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11057",null,"AETNA","30580 - HC REPAIR FISTULA OROMAXILLARY"]
["AETNA","AETNA","30600","HC REPAIR ORO-NASAL FISTULA","30600 - HC REPAIR ORO-NASAL FISTULA",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11057",null,"AETNA","30600 - HC REPAIR ORO-NASAL FISTULA"]
["AETNA","AETNA","30801","ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC","30801 - ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC",null,null,null,null,null,"TUFTS HMO","11057",null,"AETNA","30801 - ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC"]
["AETNA","AETNA","30802","ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL","30802 - ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL",null,null,null,null,null,"TUFTS POS","11057",null,"AETNA","30802 - ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL"]
["AETNA","AETNA","30901","CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE","30901 - CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE",null,null,null,null,null,"TUFTS PPO","11057",null,"AETNA","30901 - CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE"]
["AETNA","AETNA","30903","CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX","30903 - CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX",null,null,null,null,null,"TUFTS SELECT","11057",null,"AETNA","30903 - CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX"]
["AETNA","AETNA","30905","CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST","30905 - CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11057",null,"AETNA","30905 - CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST"]
["AETNA","AETNA","30906","CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ","30906 - CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11057",null,"AETNA","30906 - CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ"]
["AETNA","AETNA","30930","HC THER FX NASAL INF TURBINATE","30930 - HC THER FX NASAL INF TURBINATE",null,null,null,null,null,"CIGNA CARELINK","11101",null,"AETNA","30930 - HC THER FX NASAL INF TURBINATE"]
["AETNA","AETNA","31032","HC EXPLOR MAXILL SINUS,RMV POLYPS","31032 - HC EXPLOR MAXILL SINUS,RMV POLYPS",null,null,null,null,null,"TUFTS HMO","11101",null,"AETNA","31032 - HC EXPLOR MAXILL SINUS,RMV POLYPS"]
["AETNA","AETNA","31231","NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX","31231 - NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX",null,null,null,null,null,"TUFTS POS","11101",null,"AETNA","31231 - NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX"]
["AETNA","AETNA","31237","NASAL/SINUS NDSC SURG W/BX POLYPECT/DBRDMT SPX","31237 - NASAL/SINUS NDSC SURG W/BX POLYPECT/DBRDMT SPX",null,null,null,null,null,"TUFTS PPO","11101",null,"AETNA","31237 - NASAL/SINUS NDSC SURG W/BX POLYPECT/DBRDMT SPX"]
["AETNA","AETNA","31238","NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMRRG","31238 - NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMRRG",null,null,null,null,null,"TUFTS SELECT","11101",null,"AETNA","31238 - NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMRRG"]
["AETNA","AETNA","31239","HC NASAL/SINUS ENDOSCOPY SURG","31239 - HC NASAL/SINUS ENDOSCOPY SURG",null,null,null,null,null,"AETNA","11102",null,"AETNA","31239 - HC NASAL/SINUS ENDOSCOPY SURG"]
["AETNA","AETNA","31256","HC EXPLORATION MAXILLARY SINUS","31256 - HC EXPLORATION MAXILLARY SINUS",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11102",null,"AETNA","31256 - HC EXPLORATION MAXILLARY SINUS"]
["AETNA","AETNA","31267","HC NASAL/SINUS ENDOSCOPY,RMV TISS MAXILL SINUS","31267 - HC NASAL/SINUS ENDOSCOPY,RMV TISS MAXILL SINUS",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11102",null,"AETNA","31267 - HC NASAL/SINUS ENDOSCOPY,RMV TISS MAXILL SINUS"]
["AETNA","AETNA","31500","HC INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE","31500 - HC INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11102",null,"AETNA","31500 - HC INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE"]
["AETNA","AETNA","31502","TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT","31502 - TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT",null,null,null,null,null,"BLUE CROSS-PPO","11102",null,"AETNA","31502 - TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT"]
["AETNA","AETNA","31510","HC LARYNGOSCOPY,INDIRECT WITH BIOPSY","31510 - HC LARYNGOSCOPY,INDIRECT WITH BIOPSY",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11102",null,"AETNA","31510 - HC LARYNGOSCOPY,INDIRECT WITH BIOPSY"]
["AETNA","AETNA","31511","HC LARYNGOSCOPY,INDIRECT+REMV FOR.BODY","31511 - HC LARYNGOSCOPY,INDIRECT+REMV FOR.BODY",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11102",null,"AETNA","31511 - HC LARYNGOSCOPY,INDIRECT+REMV FOR.BODY"]
["AETNA","AETNA","31525","HC LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN","31525 - HC LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11102",null,"AETNA","31525 - HC LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN"]
["AETNA","AETNA","31530","HC LARYNGOSCOPY,DIRCT,OP,F.B. REMVL","31530 - HC LARYNGOSCOPY,DIRCT,OP,F.B. REMVL",null,null,null,null,null,"CIGNA CARELINK","11102",null,"AETNA","31530 - HC LARYNGOSCOPY,DIRCT,OP,F.B. REMVL"]
["AETNA","AETNA","31552","HC LARYNGOPLASTY LARYNGEAL STEN W/O STENT 12 YRS>","31552 - HC LARYNGOPLASTY LARYNGEAL STEN W/O STENT 12 YRS>",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11102",null,"AETNA","31552 - HC LARYNGOPLASTY LARYNGEAL STEN W/O STENT 12 YRS>"]
["AETNA","AETNA","31570","HC LARYNGOSCOPY,DIRCT,INJ VOCAL CORD","31570 - HC LARYNGOSCOPY,DIRCT,INJ VOCAL CORD",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11102",null,"AETNA","31570 - HC LARYNGOSCOPY,DIRCT,INJ VOCAL CORD"]
["AETNA","AETNA","31571","LARGSC W/NJX VOCAL CORD THER W/MICRO/TELESCOPE","31571 - LARGSC W/NJX VOCAL CORD THER W/MICRO/TELESCOPE",null,null,null,null,null,"TUFTS HMO","11102",null,"AETNA","31571 - LARGSC W/NJX VOCAL CORD THER W/MICRO/TELESCOPE"]
["AETNA","AETNA","31572","HC LARYNGOSCOPY FLEXIBLE ABLATJ DESTJ LESION(S) UNI","31572 - HC LARYNGOSCOPY FLEXIBLE ABLATJ DESTJ LESION(S) UNI",null,null,null,null,null,"TUFTS POS","11102",null,"AETNA","31572 - HC LARYNGOSCOPY FLEXIBLE ABLATJ DESTJ LESION(S) UNI"]
["AETNA","AETNA","31573","HC LARYNGOSCOPY FLEXIBLE THERAPEUTIC INJECTION UNI","31573 - HC LARYNGOSCOPY FLEXIBLE THERAPEUTIC INJECTION UNI",null,null,null,null,null,"TUFTS PPO","11102",null,"AETNA","31573 - HC LARYNGOSCOPY FLEXIBLE THERAPEUTIC INJECTION UNI"]
["AETNA","AETNA","31574","HC LARYNGOSCOPY FLEXIBLE W/INJECTION AGMNTJ UNI","31574 - HC LARYNGOSCOPY FLEXIBLE W/INJECTION AGMNTJ UNI",null,null,null,null,null,"TUFTS SELECT","11102",null,"AETNA","31574 - HC LARYNGOSCOPY FLEXIBLE W/INJECTION AGMNTJ UNI"]
["AETNA","AETNA","31575","LARYNGOSCOPY FLEXIBLE FIBEROPTIC DIAGNOSTIC","31575 - LARYNGOSCOPY FLEXIBLE FIBEROPTIC DIAGNOSTIC",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11102",null,"AETNA","31575 - LARYNGOSCOPY FLEXIBLE FIBEROPTIC DIAGNOSTIC"]
["AETNA","AETNA","31576","LARYNGOSCOPY FLEXIBLE FIBEROPTIC W/BIOPSY","31576 - LARYNGOSCOPY FLEXIBLE FIBEROPTIC W/BIOPSY",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11102",null,"AETNA","31576 - LARYNGOSCOPY FLEXIBLE FIBEROPTIC W/BIOPSY"]
["AETNA","AETNA","31577","LARYNGOSCOPY FLX FIBEROPTIC RMVL FOREIGN BODY","31577 - LARYNGOSCOPY FLX FIBEROPTIC RMVL FOREIGN BODY",null,null,null,null,null,"AETNA","11103",null,"AETNA","31577 - LARYNGOSCOPY FLX FIBEROPTIC RMVL FOREIGN BODY"]
["AETNA","AETNA","31578","LARYNGOSCOPY FLEXIBLE FIBEROPTIC REMOVAL LESION","31578 - LARYNGOSCOPY FLEXIBLE FIBEROPTIC REMOVAL LESION",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11103",null,"AETNA","31578 - LARYNGOSCOPY FLEXIBLE FIBEROPTIC REMOVAL LESION"]
["AETNA","AETNA","31579","LARYNGOSCOPY FLX/RGD FIBOPT W/STROBOSCOPY","31579 - LARYNGOSCOPY FLX/RGD FIBOPT W/STROBOSCOPY",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11103",null,"AETNA","31579 - LARYNGOSCOPY FLX/RGD FIBOPT W/STROBOSCOPY"]
["AETNA","AETNA","31599","SML WITH EXCISION OF TRACHEAL/SUBGLOTTIC STENOSIS","31599 - SML WITH EXCISION OF TRACHEAL/SUBGLOTTIC STENOSIS",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11103",null,"AETNA","31599 - SML WITH EXCISION OF TRACHEAL/SUBGLOTTIC STENOSIS"]
["AETNA","AETNA","31603","HC TRACHEOSTOMY,EMERG,XTRACH","31603 - HC TRACHEOSTOMY,EMERG,XTRACH",null,null,null,null,null,"BLUE CROSS-PPO","11103",null,"AETNA","31603 - HC TRACHEOSTOMY,EMERG,XTRACH"]
["AETNA","AETNA","31605","HC TRACHEOSTOMY,EMERG,CRICOTHYROID","31605 - HC TRACHEOSTOMY,EMERG,CRICOTHYROID",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11103",null,"AETNA","31605 - HC TRACHEOSTOMY,EMERG,CRICOTHYROID"]
["AETNA","AETNA","31611","CONSTJ TRACHEOESOPHGL FSTL&INSJ SP PROSTH","31611 - CONSTJ TRACHEOESOPHGL FSTL&INSJ SP PROSTH",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11103",null,"AETNA","31611 - CONSTJ TRACHEOESOPHGL FSTL&INSJ SP PROSTH"]
["AETNA","AETNA","31613","TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION","31613 - TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11103",null,"AETNA","31613 - TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION"]
["AETNA","AETNA","31615","TRACHEOBRNCHSC THRU EST TRACHS INC","31615 - TRACHEOBRNCHSC THRU EST TRACHS INC",null,null,null,null,null,"CIGNA CARELINK","11103",null,"AETNA","31615 - TRACHEOBRNCHSC THRU EST TRACHS INC"]
["AETNA","AETNA","31622","BRNCHSC INCL FLUOR GID DX W/CELL WASHG SPX","31622 - BRNCHSC INCL FLUOR GID DX W/CELL WASHG SPX",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11103",null,"AETNA","31622 - BRNCHSC INCL FLUOR GID DX W/CELL WASHG SPX"]
["AETNA","AETNA","31623","BRNCHSC BRUSHING/PROTECTED BRUSHINGS","31623 - BRNCHSC BRUSHING/PROTECTED BRUSHINGS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11103",null,"AETNA","31623 - BRNCHSC BRUSHING/PROTECTED BRUSHINGS"]
["AETNA","AETNA","31624","BRNCHSC W/BRNCL ALVEOLAR LAVAGE","31624 - BRNCHSC W/BRNCL ALVEOLAR LAVAGE",null,null,null,null,null,"TUFTS HMO","11103",null,"AETNA","31624 - BRNCHSC W/BRNCL ALVEOLAR LAVAGE"]
["AETNA","AETNA","31625","BRONCHOSCOPY BRONCHIAL/ENDOBRNCL BX 1+ SITES","31625 - BRONCHOSCOPY BRONCHIAL/ENDOBRNCL BX 1+ SITES",null,null,null,null,null,"TUFTS POS","11103",null,"AETNA","31625 - BRONCHOSCOPY BRONCHIAL/ENDOBRNCL BX 1+ SITES"]
["AETNA","AETNA","31626","HC BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT","31626 - HC BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT",null,null,null,null,null,"TUFTS PPO","11103",null,"AETNA","31626 - HC BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT"]
["AETNA","AETNA","31628","BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX 1 LOBE","31628 - BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX 1 LOBE",null,null,null,null,null,"TUFTS SELECT","11103",null,"AETNA","31628 - BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX 1 LOBE"]
["AETNA","AETNA","31629","HC BRONCHOSCOPY NEEDLE BX TRACHEA MAIN STEM&/BRON","31629 - HC BRONCHOSCOPY NEEDLE BX TRACHEA MAIN STEM&/BRON",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11103",null,"AETNA","31629 - HC BRONCHOSCOPY NEEDLE BX TRACHEA MAIN STEM&/BRON"]
["AETNA","AETNA","31630","HC BRONCHOSCOPY,TRACH/BRONCH DILATN","31630 - HC BRONCHOSCOPY,TRACH/BRONCH DILATN",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11103",null,"AETNA","31630 - HC BRONCHOSCOPY,TRACH/BRONCH DILATN"]
["AETNA","AETNA","31632","HC BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE","31632 - HC BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE",null,null,null,null,null,"AETNA","11104",null,"AETNA","31632 - HC BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE"]
["AETNA","AETNA","31635","HC BRONCHOSCOPY W/REMOVAL FOREIGN BODY","31635 - HC BRONCHOSCOPY W/REMOVAL FOREIGN BODY",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11104",null,"AETNA","31635 - HC BRONCHOSCOPY W/REMOVAL FOREIGN BODY"]
["AETNA","AETNA","31640","HC BRONCHOSCOPY,EXCIS LESN","31640 - HC BRONCHOSCOPY,EXCIS LESN",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11104",null,"AETNA","31640 - HC BRONCHOSCOPY,EXCIS LESN"]
["AETNA","AETNA","31645","HC BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE 1ST","31645 - HC BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE 1ST",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11104",null,"AETNA","31645 - HC BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE 1ST"]
["AETNA","AETNA","31646","HC BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE SBSQ","31646 - HC BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE SBSQ",null,null,null,null,null,"BLUE CROSS-PPO","11104",null,"AETNA","31646 - HC BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE SBSQ"]
["AETNA","AETNA","31652","HC BRNCHSC EBUS GUIDED SAMPL 1/2 NODE STATION/STRUX","31652 - HC BRNCHSC EBUS GUIDED SAMPL 1/2 NODE STATION/STRUX",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11104",null,"AETNA","31652 - HC BRNCHSC EBUS GUIDED SAMPL 1/2 NODE STATION/STRUX"]
["AETNA","AETNA","31653","HC BRONCH EBUS SAMPLING 3 OR MORE NODES","31653 - HC BRONCH EBUS SAMPLING 3 OR MORE NODES",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11104",null,"AETNA","31653 - HC BRONCH EBUS SAMPLING 3 OR MORE NODES"]
["AETNA","AETNA","31720","HC CATHETER ASPIRATION NASOTRACHEAL SPX","31720 - HC CATHETER ASPIRATION NASOTRACHEAL SPX",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11104",null,"AETNA","31720 - HC CATHETER ASPIRATION NASOTRACHEAL SPX"]
["AETNA","AETNA","31820","HC SURG CLOSURE TRACH/FISTULA","31820 - HC SURG CLOSURE TRACH/FISTULA",null,null,null,null,null,"CIGNA CARELINK","11104",null,"AETNA","31820 - HC SURG CLOSURE TRACH/FISTULA"]
["AETNA","AETNA","32400","HC BIOPSY PLEURA PERCUTANEOUS NEEDLE","32400 - HC BIOPSY PLEURA PERCUTANEOUS NEEDLE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11104",null,"AETNA","32400 - HC BIOPSY PLEURA PERCUTANEOUS NEEDLE"]
["AETNA","AETNA","32405","HC BIOPSY LUNG/MEDIASTINUM PERCUTANEOUS NEEDLE","32405 - HC BIOPSY LUNG/MEDIASTINUM PERCUTANEOUS NEEDLE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11104",null,"AETNA","32405 - HC BIOPSY LUNG/MEDIASTINUM PERCUTANEOUS NEEDLE"]
["AETNA","AETNA","32550","HC INS TUNN PLEURAL CATH W/U","32550 - HC INS TUNN PLEURAL CATH W/U",null,null,null,null,null,"TUFTS HMO","11104",null,"AETNA","32550 - HC INS TUNN PLEURAL CATH W/U"]
["AETNA","AETNA","32551","TUBE THORACOSTOMY INCLUDES WATER SEAL","32551 - TUBE THORACOSTOMY INCLUDES WATER SEAL",null,null,null,null,null,"TUFTS POS","11104",null,"AETNA","32551 - TUBE THORACOSTOMY INCLUDES WATER SEAL"]
["AETNA","AETNA","32552","HC REMOVAL OF LUNG CATHETER","32552 - HC REMOVAL OF LUNG CATHETER",null,null,null,null,null,"TUFTS PPO","11104",null,"AETNA","32552 - HC REMOVAL OF LUNG CATHETER"]
["AETNA","AETNA","32553","HC PLMT NTRSTL DEV RADJ THX GID PRQ INTRATHRC 1/MLT","32553 - HC PLMT NTRSTL DEV RADJ THX GID PRQ INTRATHRC 1/MLT",null,null,null,null,null,"TUFTS SELECT","11104",null,"AETNA","32553 - HC PLMT NTRSTL DEV RADJ THX GID PRQ INTRATHRC 1/MLT"]
["AETNA","AETNA","32554","THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING","32554 - THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11104",null,"AETNA","32554 - THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING"]
["AETNA","AETNA","32555","THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING","32555 - THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11104",null,"AETNA","32555 - THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING"]
["AETNA","AETNA","32556","PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING","32556 - PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING",null,null,null,null,null,"AETNA","11105",null,"AETNA","32556 - PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING"]
["AETNA","AETNA","32557","PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING","32557 - PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11105",null,"AETNA","32557 - PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING"]
["AETNA","AETNA","32994","HC ABLATION THER 1+ PULM TUMORS PREQ CRYOABLATION","32994 - HC ABLATION THER 1+ PULM TUMORS PREQ CRYOABLATION",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11105",null,"AETNA","32994 - HC ABLATION THER 1+ PULM TUMORS PREQ CRYOABLATION"]
["AETNA","AETNA","32998","HC ABLATION PULMONARY TUMOR PERQ RADIOFREQUENCY UNI","32998 - HC ABLATION PULMONARY TUMOR PERQ RADIOFREQUENCY UNI",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11105",null,"AETNA","32998 - HC ABLATION PULMONARY TUMOR PERQ RADIOFREQUENCY UNI"]
["AETNA","AETNA","33016","HC PERICARDIOCENTESIS W/IMAGING","33016 - HC PERICARDIOCENTESIS W/IMAGING",null,null,null,null,null,"BLUE CROSS-PPO","11105",null,"AETNA","33016 - HC PERICARDIOCENTESIS W/IMAGING"]
["AETNA","AETNA","33206","HC INS NEW/RPLCMT PRM PACEMAKR W/TRANS ELTRD ATRIAL","33206 - HC INS NEW/RPLCMT PRM PACEMAKR W/TRANS ELTRD ATRIAL",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11105",null,"AETNA","33206 - HC INS NEW/RPLCMT PRM PACEMAKR W/TRANS ELTRD ATRIAL"]
["AETNA","AETNA","33207","HC INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR","33207 - HC INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11105",null,"AETNA","33207 - HC INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR"]
["AETNA","AETNA","33208","HC INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT","33208 - HC INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11105",null,"AETNA","33208 - HC INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT"]
["AETNA","AETNA","33210","HC INSJ/RPLCMT TEMP TRANSVNS 1CHMBR ELTRD/PM CATH","33210 - HC INSJ/RPLCMT TEMP TRANSVNS 1CHMBR ELTRD/PM CATH",null,null,null,null,null,"CIGNA CARELINK","11105",null,"AETNA","33210 - HC INSJ/RPLCMT TEMP TRANSVNS 1CHMBR ELTRD/PM CATH"]
["AETNA","AETNA","33212","HC INS PM PLS GEN W/EXIST SINGLE LEAD","33212 - HC INS PM PLS GEN W/EXIST SINGLE LEAD",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11105",null,"AETNA","33212 - HC INS PM PLS GEN W/EXIST SINGLE LEAD"]
["AETNA","AETNA","33213","HC INS PACEMAKER PULSE GEN ONLY W/EXIST DUAL LEADS","33213 - HC INS PACEMAKER PULSE GEN ONLY W/EXIST DUAL LEADS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11105",null,"AETNA","33213 - HC INS PACEMAKER PULSE GEN ONLY W/EXIST DUAL LEADS"]
["AETNA","AETNA","33214","HC UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS","33214 - HC UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS",null,null,null,null,null,"TUFTS HMO","11105",null,"AETNA","33214 - HC UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS"]
["AETNA","AETNA","33215","HC RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE","33215 - HC RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE",null,null,null,null,null,"TUFTS POS","11105",null,"AETNA","33215 - HC RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE"]
["AETNA","AETNA","33216","HC INSJ 1 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB","33216 - HC INSJ 1 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB",null,null,null,null,null,"TUFTS PPO","11105",null,"AETNA","33216 - HC INSJ 1 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB"]
["AETNA","AETNA","33217","HC INSJ 2 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB","33217 - HC INSJ 2 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB",null,null,null,null,null,"TUFTS SELECT","11105",null,"AETNA","33217 - HC INSJ 2 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB"]
["AETNA","AETNA","33221","HC INS PACEMAKER PULSE GEN ONLY W/EXIST MULT LEADS","33221 - HC INS PACEMAKER PULSE GEN ONLY W/EXIST MULT LEADS",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11105",null,"AETNA","33221 - HC INS PACEMAKER PULSE GEN ONLY W/EXIST MULT LEADS"]
["AETNA","AETNA","33222","HC RELOCATION OF SKIN POCKET FOR PACEMAKER","33222 - HC RELOCATION OF SKIN POCKET FOR PACEMAKER",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11105",null,"AETNA","33222 - HC RELOCATION OF SKIN POCKET FOR PACEMAKER"]
["AETNA","AETNA","33223","HC RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR","33223 - HC RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR",null,null,null,null,null,"AETNA","11106",null,"AETNA","33223 - HC RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR"]
["AETNA","AETNA","33224","HC INSJ ELTRD CAR VEN SYS ATTCH PREV PM/DFB PLS GEN","33224 - HC INSJ ELTRD CAR VEN SYS ATTCH PREV PM/DFB PLS GEN",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11106",null,"AETNA","33224 - HC INSJ ELTRD CAR VEN SYS ATTCH PREV PM/DFB PLS GEN"]
["AETNA","AETNA","33225","HC INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN","33225 - HC INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11106",null,"AETNA","33225 - HC INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN"]
["AETNA","AETNA","33226","HC RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD","33226 - HC RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11106",null,"AETNA","33226 - HC RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD"]
["AETNA","AETNA","33227","HC REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD","33227 - HC REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD",null,null,null,null,null,"BLUE CROSS-PPO","11106",null,"AETNA","33227 - HC REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD"]
["AETNA","AETNA","33228","HC REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS","33228 - HC REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11106",null,"AETNA","33228 - HC REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS"]
["AETNA","AETNA","33229","HC REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD","33229 - HC REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11106",null,"AETNA","33229 - HC REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD"]
["AETNA","AETNA","33230","HC INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST DUAL LEADS","33230 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST DUAL LEADS",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11106",null,"AETNA","33230 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST DUAL LEADS"]
["AETNA","AETNA","33231","HC INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST MULTILEADS","33231 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST MULTILEADS",null,null,null,null,null,"CIGNA CARELINK","11106",null,"AETNA","33231 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST MULTILEADS"]
["AETNA","AETNA","33233","HC REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY","33233 - HC REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11106",null,"AETNA","33233 - HC REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY"]
["AETNA","AETNA","33234","HC RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR/VENTR","33234 - HC RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR/VENTR",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11106",null,"AETNA","33234 - HC RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR/VENTR"]
["AETNA","AETNA","33235","HC RMVL TRANSVNS PM ELTRD DUAL LEAD SYS","33235 - HC RMVL TRANSVNS PM ELTRD DUAL LEAD SYS",null,null,null,null,null,"TUFTS HMO","11106",null,"AETNA","33235 - HC RMVL TRANSVNS PM ELTRD DUAL LEAD SYS"]
["AETNA","AETNA","33240","HC INSJ IMPLNTBL DEFIB PULSE GEN W/1 EXISTING LD","33240 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/1 EXISTING LD",null,null,null,null,null,"TUFTS POS","11106",null,"AETNA","33240 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/1 EXISTING LD"]
["AETNA","AETNA","33241","HC REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY","33241 - HC REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY",null,null,null,null,null,"TUFTS PPO","11106",null,"AETNA","33241 - HC REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY"]
["AETNA","AETNA","33244","HC RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ","33244 - HC RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ",null,null,null,null,null,"TUFTS SELECT","11106",null,"AETNA","33244 - HC RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ"]
["AETNA","AETNA","33249","HC INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR","33249 - HC INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11106",null,"AETNA","33249 - HC INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR"]
["AETNA","AETNA","33262","HC RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD","33262 - HC RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11106",null,"AETNA","33262 - HC RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD"]
["AETNA","AETNA","33263","HC RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD","33263 - HC RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD",null,null,null,null,null,"AETNA","11107",null,"AETNA","33263 - HC RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD"]
["AETNA","AETNA","33264","HC EXCHNG ICD GEN MULTI SYST","33264 - HC EXCHNG ICD GEN MULTI SYST",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11107",null,"AETNA","33264 - HC EXCHNG ICD GEN MULTI SYST"]
["AETNA","AETNA","33270","INS/RPLCMNT PERM SUBQ IMPLTBL DFB W/SUBQ ELTRD","33270 - INS/RPLCMNT PERM SUBQ IMPLTBL DFB W/SUBQ ELTRD",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11107",null,"AETNA","33270 - INS/RPLCMNT PERM SUBQ IMPLTBL DFB W/SUBQ ELTRD"]
["AETNA","AETNA","33271","INSJ OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE","33271 - INSJ OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11107",null,"AETNA","33271 - INSJ OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE"]
["AETNA","AETNA","33273","REPOS PREVIOUSLY IMPLANTED SUBQ IMPLANTABLE DFB","33273 - REPOS PREVIOUSLY IMPLANTED SUBQ IMPLANTABLE DFB",null,null,null,null,null,"BLUE CROSS-PPO","11107",null,"AETNA","33273 - REPOS PREVIOUSLY IMPLANTED SUBQ IMPLANTABLE DFB"]
["AETNA","AETNA","33274","HC TCAT INSJ/RPL PERM LDLS PM","33274 - HC TCAT INSJ/RPL PERM LDLS PM",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11107",null,"AETNA","33274 - HC TCAT INSJ/RPL PERM LDLS PM"]
["AETNA","AETNA","33275","HC TCAT RMVL PERM LDLS PM","33275 - HC TCAT RMVL PERM LDLS PM",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11107",null,"AETNA","33275 - HC TCAT RMVL PERM LDLS PM"]
["AETNA","AETNA","33285","HC INSJ SUBQ CAR RHYTHM MNTR","33285 - HC INSJ SUBQ CAR RHYTHM MNTR",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11107",null,"AETNA","33285 - HC INSJ SUBQ CAR RHYTHM MNTR"]
["AETNA","AETNA","33286","HC RMVL SUBQ CAR RHYTHM MNTR","33286 - HC RMVL SUBQ CAR RHYTHM MNTR",null,null,null,null,null,"CIGNA CARELINK","11107",null,"AETNA","33286 - HC RMVL SUBQ CAR RHYTHM MNTR"]
["AETNA","AETNA","33289","HC TCAT IMPL WRLS P-ART PRS SNR L-T HEMODYN MNTR","33289 - HC TCAT IMPL WRLS P-ART PRS SNR L-T HEMODYN MNTR",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11107",null,"AETNA","33289 - HC TCAT IMPL WRLS P-ART PRS SNR L-T HEMODYN MNTR"]
["AETNA","AETNA","33968","HC REM AORTIC ASSIST DEV PRQ","33968 - HC REM AORTIC ASSIST DEV PRQ",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11107",null,"AETNA","33968 - HC REM AORTIC ASSIST DEV PRQ"]
["AETNA","AETNA","36002","HC INJECTION RX EXTREMITY PSEUDOANEURYSM","36002 - HC INJECTION RX EXTREMITY PSEUDOANEURYSM",null,null,null,null,null,"TUFTS HMO","11107",null,"AETNA","36002 - HC INJECTION RX EXTREMITY PSEUDOANEURYSM"]
["AETNA","AETNA","36005","HC NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH","36005 - HC NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH",null,null,null,null,null,"TUFTS POS","11107",null,"AETNA","36005 - HC NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH"]
["AETNA","AETNA","36010","HC INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA","36010 - HC INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA",null,null,null,null,null,"TUFTS PPO","11107",null,"AETNA","36010 - HC INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA"]
["AETNA","AETNA","36011","HC SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH","36011 - HC SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH",null,null,null,null,null,"TUFTS SELECT","11107",null,"AETNA","36011 - HC SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH"]
["AETNA","AETNA","36012","HC SLCTV CATH PLMT VEN SYS 2ND ORDER/> SLCTV BRANC","36012 - HC SLCTV CATH PLMT VEN SYS 2ND ORDER/> SLCTV BRANC",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11107",null,"AETNA","36012 - HC SLCTV CATH PLMT VEN SYS 2ND ORDER/> SLCTV BRANC"]
["AETNA","AETNA","36013","HC INTRO CATHETER RIGHT HEART/MAIN PULMONARY ARTERY","36013 - HC INTRO CATHETER RIGHT HEART/MAIN PULMONARY ARTERY",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11107",null,"AETNA","36013 - HC INTRO CATHETER RIGHT HEART/MAIN PULMONARY ARTERY"]
["AETNA","AETNA","36014","HC SLCTV CATHETER PLMT LEFT/RIGHT PULMONARY ARTERY","36014 - HC SLCTV CATHETER PLMT LEFT/RIGHT PULMONARY ARTERY",null,null,null,null,null,"AETNA","11200",null,"AETNA","36014 - HC SLCTV CATHETER PLMT LEFT/RIGHT PULMONARY ARTERY"]
["AETNA","AETNA","36015","HC SLCTV CATH PLMT SEGMENTAL/SUBSEGMENTAL PULM ART","36015 - HC SLCTV CATH PLMT SEGMENTAL/SUBSEGMENTAL PULM ART",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11200",null,"AETNA","36015 - HC SLCTV CATH PLMT SEGMENTAL/SUBSEGMENTAL PULM ART"]
["AETNA","AETNA","36140","HC INTRO NEEDLE/INTRACATH EXTREMITY ARTERY","36140 - HC INTRO NEEDLE/INTRACATH EXTREMITY ARTERY",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11200",null,"AETNA","36140 - HC INTRO NEEDLE/INTRACATH EXTREMITY ARTERY"]
["AETNA","AETNA","36160","HC INTRO NEEDLE/INTRACATH AORTIC TRANSLUMBAR","36160 - HC INTRO NEEDLE/INTRACATH AORTIC TRANSLUMBAR",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11200",null,"AETNA","36160 - HC INTRO NEEDLE/INTRACATH AORTIC TRANSLUMBAR"]
["AETNA","AETNA","36200","HC INTRODUCTION CATHETER AORTA","36200 - HC INTRODUCTION CATHETER AORTA",null,null,null,null,null,"BLUE CROSS-PPO","11200",null,"AETNA","36200 - HC INTRODUCTION CATHETER AORTA"]
["AETNA","AETNA","36215","HC SLCTV CATHJ EA 1ST ORD THRC/BRCH/CPHLC BRNCH","36215 - HC SLCTV CATHJ EA 1ST ORD THRC/BRCH/CPHLC BRNCH",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11200",null,"AETNA","36215 - HC SLCTV CATHJ EA 1ST ORD THRC/BRCH/CPHLC BRNCH"]
["AETNA","AETNA","36216","HC SLCTV CATHJ 1ST 2ND ORD THRC/BRCH/CPHLC BRNCH","36216 - HC SLCTV CATHJ 1ST 2ND ORD THRC/BRCH/CPHLC BRNCH",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11200",null,"AETNA","36216 - HC SLCTV CATHJ 1ST 2ND ORD THRC/BRCH/CPHLC BRNCH"]
["AETNA","AETNA","36217","HC SLCTV CATHJ 3RD+ ORD SLCTV THRC/BRCH/CPHLC BRNCH","36217 - HC SLCTV CATHJ 3RD+ ORD SLCTV THRC/BRCH/CPHLC BRNCH",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11200",null,"AETNA","36217 - HC SLCTV CATHJ 3RD+ ORD SLCTV THRC/BRCH/CPHLC BRNCH"]
["AETNA","AETNA","36218","HC SLCTV CATHJ EA 2ND+ ORD THRC/BRCH/CPHLC BRNCH","36218 - HC SLCTV CATHJ EA 2ND+ ORD THRC/BRCH/CPHLC BRNCH",null,null,null,null,null,"CIGNA CARELINK","11200",null,"AETNA","36218 - HC SLCTV CATHJ EA 2ND+ ORD THRC/BRCH/CPHLC BRNCH"]
["AETNA","AETNA","36221","HC NONSLCTV CATH THOR AORTA ANGIO INTR/XTRCRANL ART","36221 - HC NONSLCTV CATH THOR AORTA ANGIO INTR/XTRCRANL ART",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11200",null,"AETNA","36221 - HC NONSLCTV CATH THOR AORTA ANGIO INTR/XTRCRANL ART"]
["AETNA","AETNA","36222","HC SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART","36222 - HC SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11200",null,"AETNA","36222 - HC SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART"]
["AETNA","AETNA","36223","HC SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART","36223 - HC SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART",null,null,null,null,null,"TUFTS HMO","11200",null,"AETNA","36223 - HC SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART"]
["AETNA","AETNA","36224","HC SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART","36224 - HC SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART",null,null,null,null,null,"TUFTS POS","11200",null,"AETNA","36224 - HC SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART"]
["AETNA","AETNA","36225","HC SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY","36225 - HC SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY",null,null,null,null,null,"TUFTS PPO","11200",null,"AETNA","36225 - HC SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY"]
["AETNA","AETNA","36226","HC SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY","36226 - HC SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY",null,null,null,null,null,"TUFTS SELECT","11200",null,"AETNA","36226 - HC SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY"]
["AETNA","AETNA","36227","HC SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC","36227 - HC SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11200",null,"AETNA","36227 - HC SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC"]
["AETNA","AETNA","36228","HC SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT","36228 - HC SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11200",null,"AETNA","36228 - HC SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT"]
["AETNA","AETNA","36245","HC SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH","36245 - HC SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11300",null,"AETNA","36245 - HC SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH"]
["AETNA","AETNA","36246","HC SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH","36246 - HC SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11300",null,"AETNA","36246 - HC SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH"]
["AETNA","AETNA","36247","HC SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH","36247 - HC SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11300",null,"AETNA","36247 - HC SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH"]
["AETNA","AETNA","36248","HC SLCTV CATHJ EA 2ND+ ORD ABDL PEL/LXTR ART BRNCH","36248 - HC SLCTV CATHJ EA 2ND+ ORD ABDL PEL/LXTR ART BRNCH",null,null,null,null,null,"BLUE CROSS-PPO","11300",null,"AETNA","36248 - HC SLCTV CATHJ EA 2ND+ ORD ABDL PEL/LXTR ART BRNCH"]
["AETNA","AETNA","36251","HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UN","36251 - HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UN",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11300",null,"AETNA","36251 - HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UN"]
["AETNA","AETNA","36252","HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BIL","36252 - HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BIL",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11300",null,"AETNA","36252 - HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BIL"]
["AETNA","AETNA","36253","HC SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I","36253 - HC SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11300",null,"AETNA","36253 - HC SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I"]
["AETNA","AETNA","36254","HC SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I","36254 - HC SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I",null,null,null,null,null,"CIGNA CARELINK","11300",null,"AETNA","36254 - HC SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I"]
["AETNA","AETNA-MEDICARE ADVANTAGE","36415","COLLECTION VENOUS BLOOD VENIPUNCTURE","36415 - COLLECTION VENOUS BLOOD VENIPUNCTURE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11300",null,"AETNA","36415 - COLLECTION VENOUS BLOOD VENIPUNCTURE"]
["AETNA","AETNA","36430","TRANSFUSION BLOOD/BLOOD COMPONENTS","36430 - TRANSFUSION BLOOD/BLOOD COMPONENTS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11300",null,"AETNA","36430 - TRANSFUSION BLOOD/BLOOD COMPONENTS"]
["AETNA","AETNA","36455","HC EXCHANGE TRANSFUION, OTHR","36455 - HC EXCHANGE TRANSFUION, OTHR",null,null,null,null,null,"TUFTS HMO","11300",null,"AETNA","36455 - HC EXCHANGE TRANSFUION, OTHR"]
["AETNA","AETNA","36470","NJX SCLEROSING SOLUTION SINGLE VEIN","36470 - NJX SCLEROSING SOLUTION SINGLE VEIN",null,null,null,null,null,"TUFTS POS","11300",null,"AETNA","36470 - NJX SCLEROSING SOLUTION SINGLE VEIN"]
["AETNA","AETNA","36471","NJX SCLEROSING SOLUTION MULTIPLE VEINS SAME LEG","36471 - NJX SCLEROSING SOLUTION MULTIPLE VEINS SAME LEG",null,null,null,null,null,"TUFTS PPO","11300",null,"AETNA","36471 - NJX SCLEROSING SOLUTION MULTIPLE VEINS SAME LEG"]
["AETNA","AETNA","36473","HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM 1ST VEIN","36473 - HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM 1ST VEIN",null,null,null,null,null,"TUFTS SELECT","11300",null,"AETNA","36473 - HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM 1ST VEIN"]
["AETNA","AETNA","36474","HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM SBSQ VEINS","36474 - HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM SBSQ VEINS",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11300",null,"AETNA","36474 - HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM SBSQ VEINS"]
["AETNA","AETNA","36475","HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN","36475 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11300",null,"AETNA","36475 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN"]
["AETNA","AETNA","36476","HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS","36476 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11301",null,"AETNA","36476 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS"]
["AETNA","AETNA","36478","HC ENDOVENOUS LASER, 1ST VEIN","36478 - HC ENDOVENOUS LASER, 1ST VEIN",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11301",null,"AETNA","36478 - HC ENDOVENOUS LASER, 1ST VEIN"]
["AETNA","AETNA","36479","HC ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS","36479 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11301",null,"AETNA","36479 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS"]
["AETNA","AETNA","36481","HC PERC PORTAL VEIN CATH","36481 - HC PERC PORTAL VEIN CATH",null,null,null,null,null,"BLUE CROSS-PPO","11301",null,"AETNA","36481 - HC PERC PORTAL VEIN CATH"]
["AETNA","AETNA","36482","HC ENDOVEN ABLTI THER CHEM ADHESIVE 1ST VEIN","36482 - HC ENDOVEN ABLTI THER CHEM ADHESIVE 1ST VEIN",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11301",null,"AETNA","36482 - HC ENDOVEN ABLTI THER CHEM ADHESIVE 1ST VEIN"]
["AETNA","AETNA","36483","HC ENDOVEN ABLTI THER CHEM ADHESIVE SBSQ VEIN","36483 - HC ENDOVEN ABLTI THER CHEM ADHESIVE SBSQ VEIN",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11301",null,"AETNA","36483 - HC ENDOVEN ABLTI THER CHEM ADHESIVE SBSQ VEIN"]
["AETNA","AETNA","36500","HC VEN CATHJ SLCTV ORGAN BLD SAMPLING","36500 - HC VEN CATHJ SLCTV ORGAN BLD SAMPLING",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11301",null,"AETNA","36500 - HC VEN CATHJ SLCTV ORGAN BLD SAMPLING"]
["AETNA","AETNA","36511","HC THER APHERESIS,WHITE BLOOD CELLS","36511 - HC THER APHERESIS,WHITE BLOOD CELLS",null,null,null,null,null,"CIGNA CARELINK","11301",null,"AETNA","36511 - HC THER APHERESIS,WHITE BLOOD CELLS"]
["AETNA","AETNA","36512","THERAPEUTIC APHERESIS RED BLOOD CELLS","36512 - THERAPEUTIC APHERESIS RED BLOOD CELLS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11301",null,"AETNA","36512 - THERAPEUTIC APHERESIS RED BLOOD CELLS"]
["AETNA","AETNA","36513","THERAPEUTIC APHERESIS PLATELETS","36513 - THERAPEUTIC APHERESIS PLATELETS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11301",null,"AETNA","36513 - THERAPEUTIC APHERESIS PLATELETS"]
["AETNA","AETNA","36514","THERAPEUTIC APHERESIS PLASMA PHERESIS","36514 - THERAPEUTIC APHERESIS PLASMA PHERESIS",null,null,null,null,null,"TUFTS HMO","11301",null,"AETNA","36514 - THERAPEUTIC APHERESIS PLASMA PHERESIS"]
["AETNA","AETNA","36522","PHOTOPHERESIS EXTRACORPOREAL","36522 - PHOTOPHERESIS EXTRACORPOREAL",null,null,null,null,null,"TUFTS POS","11301",null,"AETNA","36522 - PHOTOPHERESIS EXTRACORPOREAL"]
["AETNA","AETNA","36555","HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y","36555 - HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y",null,null,null,null,null,"TUFTS PPO","11301",null,"AETNA","36555 - HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y"]
["AETNA","AETNA","36556","HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/>","36556 - HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/>",null,null,null,null,null,"TUFTS SELECT","11301",null,"AETNA","36556 - HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/>"]
["AETNA","AETNA","36558","HC INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>","36558 - HC INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11301",null,"AETNA","36558 - HC INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>"]
["AETNA","AETNA","36560","HC INSJ TUNNELED CTR VAD W/SUBQ PORT UNDER 5 YR","36560 - HC INSJ TUNNELED CTR VAD W/SUBQ PORT UNDER 5 YR",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11301",null,"AETNA","36560 - HC INSJ TUNNELED CTR VAD W/SUBQ PORT UNDER 5 YR"]
["AETNA","AETNA","36561","HC INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>","36561 - HC INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11302",null,"AETNA","36561 - HC INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>"]
["AETNA","AETNA","36565","HC INSJ TUN VAD REQ 2 CATH 2 SITS W/O SUBQ PORT/PMP","36565 - HC INSJ TUN VAD REQ 2 CATH 2 SITS W/O SUBQ PORT/PMP",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11302",null,"AETNA","36565 - HC INSJ TUN VAD REQ 2 CATH 2 SITS W/O SUBQ PORT/PMP"]
["AETNA","AETNA","36566","HC INSJ TUN VAD REQ 2 CATH 2 SITS W/SUBQ PORT","36566 - HC INSJ TUN VAD REQ 2 CATH 2 SITS W/SUBQ PORT",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11302",null,"AETNA","36566 - HC INSJ TUN VAD REQ 2 CATH 2 SITS W/SUBQ PORT"]
["AETNA","AETNA","36568","HC INS PICC;W/O PMP/PRT;<5YR","36568 - HC INS PICC;W/O PMP/PRT;<5YR",null,null,null,null,null,"BLUE CROSS-PPO","11302",null,"AETNA","36568 - HC INS PICC;W/O PMP/PRT;<5YR"]
["AETNA","AETNA","36569","INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/>","36569 - INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/>",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11302",null,"AETNA","36569 - INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/>"]
["AETNA","AETNA","36570","HC INSJ PRPH CTR VAD W/SUBQ PORT UNDER 5 YR","36570 - HC INSJ PRPH CTR VAD W/SUBQ PORT UNDER 5 YR",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11302",null,"AETNA","36570 - HC INSJ PRPH CTR VAD W/SUBQ PORT UNDER 5 YR"]
["AETNA","AETNA","36571","HC INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>","36571 - HC INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11302",null,"AETNA","36571 - HC INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>"]
["AETNA","AETNA","36572","HC INSJ PICC RS&I <5 YR","36572 - HC INSJ PICC RS&I <5 YR",null,null,null,null,null,"CIGNA CARELINK","11302",null,"AETNA","36572 - HC INSJ PICC RS&I <5 YR"]
["AETNA","AETNA","36573","HC INSJ PICC RS&I 5 YR+","36573 - HC INSJ PICC RS&I 5 YR+",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11302",null,"AETNA","36573 - HC INSJ PICC RS&I 5 YR+"]
["AETNA","AETNA","36575","HC RTUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP","36575 - HC RTUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11302",null,"AETNA","36575 - HC RTUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP"]
["AETNA","AETNA","36576","HC RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT","36576 - HC RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT",null,null,null,null,null,"TUFTS HMO","11302",null,"AETNA","36576 - HC RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT"]
["AETNA","AETNA","36578","HC RPLCMT CATH CTR VAD SUBQ PORT/PMP","36578 - HC RPLCMT CATH CTR VAD SUBQ PORT/PMP",null,null,null,null,null,"TUFTS POS","11302",null,"AETNA","36578 - HC RPLCMT CATH CTR VAD SUBQ PORT/PMP"]
["AETNA","AETNA","36580","HC REPL CVC,NON_TUN;5/+YO","36580 - HC REPL CVC,NON_TUN;5/+YO",null,null,null,null,null,"TUFTS PPO","11302",null,"AETNA","36580 - HC REPL CVC,NON_TUN;5/+YO"]
["AETNA","AETNA","36581","RPLCMT COMPL TUN CVC W/O SUBQ PORT/PMP","36581 - RPLCMT COMPL TUN CVC W/O SUBQ PORT/PMP",null,null,null,null,null,"TUFTS SELECT","11302",null,"AETNA","36581 - RPLCMT COMPL TUN CVC W/O SUBQ PORT/PMP"]
["AETNA","AETNA","36582","HC RPLCMT COMPL TUN CTR VAD W/SUBQ PORT","36582 - HC RPLCMT COMPL TUN CTR VAD W/SUBQ PORT",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11302",null,"AETNA","36582 - HC RPLCMT COMPL TUN CTR VAD W/SUBQ PORT"]
["AETNA","AETNA","36584","RPLCMT COMPL PRPH CVC W/O SUBQ PORT/PMP","36584 - RPLCMT COMPL PRPH CVC W/O SUBQ PORT/PMP",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11302",null,"AETNA","36584 - RPLCMT COMPL PRPH CVC W/O SUBQ PORT/PMP"]
["AETNA","AETNA","36585","HC RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT","36585 - HC RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11303",null,"AETNA","36585 - HC RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT"]
["AETNA","AETNA","36589","RMVL TUN CVC W/O SUBQ PORT/PMP","36589 - RMVL TUN CVC W/O SUBQ PORT/PMP",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11303",null,"AETNA","36589 - RMVL TUN CVC W/O SUBQ PORT/PMP"]
["AETNA","AETNA","36590","HC RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ","36590 - HC RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11303",null,"AETNA","36590 - HC RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ"]
["AETNA","AETNA","36593","DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH","36593 - DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH",null,null,null,null,null,"BLUE CROSS-PPO","11303",null,"AETNA","36593 - DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH"]
["AETNA","AETNA","36595","HC MECH REMOV PERICATH OBSTR CV DEV VIA VEN ACCESS","36595 - HC MECH REMOV PERICATH OBSTR CV DEV VIA VEN ACCESS",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11303",null,"AETNA","36595 - HC MECH REMOV PERICATH OBSTR CV DEV VIA VEN ACCESS"]
["AETNA","AETNA","36596","HC MCHNL RMVL INTRAL OBSTR CV DEV THRU DEV LUMEN","36596 - HC MCHNL RMVL INTRAL OBSTR CV DEV THRU DEV LUMEN",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11303",null,"AETNA","36596 - HC MCHNL RMVL INTRAL OBSTR CV DEV THRU DEV LUMEN"]
["AETNA","AETNA","36598","HC CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT","36598 - HC CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11303",null,"AETNA","36598 - HC CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT"]
["AETNA","AETNA","36620","HC INSERT CATH,ART,PERCUT,SHORTTERM","36620 - HC INSERT CATH,ART,PERCUT,SHORTTERM",null,null,null,null,null,"CIGNA CARELINK","11303",null,"AETNA","36620 - HC INSERT CATH,ART,PERCUT,SHORTTERM"]
["AETNA","AETNA","36680","HC PLACEMENT NEEDLE INTRAOSSEOUS INFUSION","36680 - HC PLACEMENT NEEDLE INTRAOSSEOUS INFUSION",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11303",null,"AETNA","36680 - HC PLACEMENT NEEDLE INTRAOSSEOUS INFUSION"]
["AETNA","AETNA","36901","HC INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR S&I","36901 - HC INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR S&I",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11303",null,"AETNA","36901 - HC INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR S&I"]
["AETNA","AETNA","36902","HC INTRO CATH DIALYSIS CIRCUIT W/TRLUML BALO ANGIOP","36902 - HC INTRO CATH DIALYSIS CIRCUIT W/TRLUML BALO ANGIOP",null,null,null,null,null,"TUFTS HMO","11303",null,"AETNA","36902 - HC INTRO CATH DIALYSIS CIRCUIT W/TRLUML BALO ANGIOP"]
["AETNA","AETNA","36903","HC INTRO CATH DIALYSIS CIRCUIT W/TCAT PLMT IV STENT","36903 - HC INTRO CATH DIALYSIS CIRCUIT W/TCAT PLMT IV STENT",null,null,null,null,null,"TUFTS POS","11303",null,"AETNA","36903 - HC INTRO CATH DIALYSIS CIRCUIT W/TCAT PLMT IV STENT"]
["AETNA","AETNA","36904","HC PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH","36904 - HC PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH",null,null,null,null,null,"TUFTS PPO","11303",null,"AETNA","36904 - HC PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH"]
["AETNA","AETNA","36905","HC PERQ THRMBC/NFS DIAL CIRCUIT TRLUML BALO ANGIOP","36905 - HC PERQ THRMBC/NFS DIAL CIRCUIT TRLUML BALO ANGIOP",null,null,null,null,null,"TUFTS SELECT","11303",null,"AETNA","36905 - HC PERQ THRMBC/NFS DIAL CIRCUIT TRLUML BALO ANGIOP"]
["AETNA","AETNA","36906","HC PERQ THRMBC/NFS DIAL CIRCUIT TCAT PLMT IV STENT","36906 - HC PERQ THRMBC/NFS DIAL CIRCUIT TCAT PLMT IV STENT",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11303",null,"AETNA","36906 - HC PERQ THRMBC/NFS DIAL CIRCUIT TCAT PLMT IV STENT"]
["AETNA","AETNA","36907","HC TRLUML BAL ANGIO CTR DIAL","36907 - HC TRLUML BAL ANGIO CTR DIAL",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11303",null,"AETNA","36907 - HC TRLUML BAL ANGIO CTR DIAL"]
["AETNA","AETNA","36908","HC STENT PLMT CENTRAL DIAYLSIS SEG PFRMD DIAL CIR","36908 - HC STENT PLMT CENTRAL DIAYLSIS SEG PFRMD DIAL CIR",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11305",null,"AETNA","36908 - HC STENT PLMT CENTRAL DIAYLSIS SEG PFRMD DIAL CIR"]
["AETNA","AETNA","37183","HC REVJ TRANSVNS INTRAHEPATIC PORTOSYSTEMIC SHUNT","37183 - HC REVJ TRANSVNS INTRAHEPATIC PORTOSYSTEMIC SHUNT",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11305",null,"AETNA","37183 - HC REVJ TRANSVNS INTRAHEPATIC PORTOSYSTEMIC SHUNT"]
["AETNA","AETNA","37184","HC PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST","37184 - HC PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11305",null,"AETNA","37184 - HC PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST"]
["AETNA","AETNA","37185","PRIM PRQ TRLUML MCHNL THRMBC SBSQ VSL","37185 - PRIM PRQ TRLUML MCHNL THRMBC SBSQ VSL",null,null,null,null,null,"BLUE CROSS-PPO","11305",null,"AETNA","37185 - PRIM PRQ TRLUML MCHNL THRMBC SBSQ VSL"]
["AETNA","AETNA","37186","HC SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL","37186 - HC SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11305",null,"AETNA","37186 - HC SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL"]
["AETNA","AETNA","37187","PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN","37187 - PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11305",null,"AETNA","37187 - PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN"]
["AETNA","AETNA","37188","PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX","37188 - PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11305",null,"AETNA","37188 - PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX"]
["AETNA","AETNA","37191","HC INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I","37191 - HC INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I",null,null,null,null,null,"CIGNA CARELINK","11305",null,"AETNA","37191 - HC INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I"]
["AETNA","AETNA","37192","HC REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I","37192 - HC REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11305",null,"AETNA","37192 - HC REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I"]
["AETNA","AETNA","37193","HC RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I","37193 - HC RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11305",null,"AETNA","37193 - HC RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I"]
["AETNA","AETNA","37197","HC PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING","37197 - HC PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING",null,null,null,null,null,"TUFTS HMO","11305",null,"AETNA","37197 - HC PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING"]
["AETNA","AETNA","37200","HC TRANSCATHETER BIOPSY","37200 - HC TRANSCATHETER BIOPSY",null,null,null,null,null,"TUFTS POS","11305",null,"AETNA","37200 - HC TRANSCATHETER BIOPSY"]
["AETNA","AETNA","37211","HC THROMBOLYSIS ARTERIAL INFUSION ICRA RS&I INIT TX","37211 - HC THROMBOLYSIS ARTERIAL INFUSION ICRA RS&I INIT TX",null,null,null,null,null,"TUFTS PPO","11305",null,"AETNA","37211 - HC THROMBOLYSIS ARTERIAL INFUSION ICRA RS&I INIT TX"]
["AETNA","AETNA","37212","HC THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX","37212 - HC THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX",null,null,null,null,null,"TUFTS SELECT","11305",null,"AETNA","37212 - HC THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX"]
["AETNA","AETNA","37213","HC THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX","37213 - HC THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11305",null,"AETNA","37213 - HC THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX"]
["AETNA","AETNA","37214","HC CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL","37214 - HC CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11305",null,"AETNA","37214 - HC CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL"]
["AETNA","AETNA","37215","HC TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ","37215 - HC TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11306",null,"AETNA","37215 - HC TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ"]
["AETNA","AETNA","37216","HC TCAT IV STENT CRV CRTD ART W/O EMBOLIC PROTECJ [37216]","37216 - HC TCAT IV STENT CRV CRTD ART W/O EMBOLIC PROTECJ [37216]",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11306",null,"AETNA","37216 - HC TCAT IV STENT CRV CRTD ART W/O EMBOLIC PROTECJ [37216]"]
["AETNA","AETNA","37220","HC REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL","37220 - HC REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11306",null,"AETNA","37220 - HC REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL"]
["AETNA","AETNA","37221","HC REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOPLSTY","37221 - HC REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOPLSTY",null,null,null,null,null,"BLUE CROSS-PPO","11306",null,"AETNA","37221 - HC REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOPLSTY"]
["AETNA","AETNA","37222","HC REVASC;ILIAC,EAAD,TRN ANG","37222 - HC REVASC;ILIAC,EAAD,TRN ANG",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11306",null,"AETNA","37222 - HC REVASC;ILIAC,EAAD,TRN ANG"]
["AETNA","AETNA","37223","HC REVASC;ILIAC,EAAD,TRN STN","37223 - HC REVASC;ILIAC,EAAD,TRN STN",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11306",null,"AETNA","37223 - HC REVASC;ILIAC,EAAD,TRN STN"]
["AETNA","AETNA","37224","HC REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI","37224 - HC REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11306",null,"AETNA","37224 - HC REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI"]
["AETNA","AETNA","37225","HC REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL","37225 - HC REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL",null,null,null,null,null,"CIGNA CARELINK","11306",null,"AETNA","37225 - HC REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL"]
["AETNA","AETNA","37226","HC REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL","37226 - HC REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11306",null,"AETNA","37226 - HC REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL"]
["AETNA","AETNA","37227","HC REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL","37227 - HC REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11306",null,"AETNA","37227 - HC REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL"]
["AETNA","AETNA","37228","HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI","37228 - HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI",null,null,null,null,null,"TUFTS HMO","11306",null,"AETNA","37228 - HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI"]
["AETNA","AETNA","37229","HC REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL","37229 - HC REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL",null,null,null,null,null,"TUFTS POS","11306",null,"AETNA","37229 - HC REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL"]
["AETNA","AETNA","37230","HC REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL","37230 - HC REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL",null,null,null,null,null,"TUFTS PPO","11306",null,"AETNA","37230 - HC REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL"]
["AETNA","AETNA","37231","HC REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP SM VSL","37231 - HC REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP SM VSL",null,null,null,null,null,"TUFTS SELECT","11306",null,"AETNA","37231 - HC REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP SM VSL"]
["AETNA","AETNA","37232","HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL","37232 - HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11306",null,"AETNA","37232 - HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL"]
["AETNA","AETNA","37233","HC REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA VSL","37233 - HC REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA VSL",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11306",null,"AETNA","37233 - HC REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA VSL"]
["AETNA","AETNA","37236","OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL","37236 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11307",null,"AETNA","37236 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL"]
["AETNA","AETNA","37237","OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL","37237 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11307",null,"AETNA","37237 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL"]
["AETNA","AETNA","37238","OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST","37238 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11307",null,"AETNA","37238 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST"]
["AETNA","AETNA","37239","OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL","37239 - OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL",null,null,null,null,null,"BLUE CROSS-PPO","11307",null,"AETNA","37239 - OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL"]
["AETNA","AETNA","37241","VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I","37241 - VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11307",null,"AETNA","37241 - VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I"]
["AETNA","AETNA","37242","VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I","37242 - VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11307",null,"AETNA","37242 - VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I"]
["AETNA","AETNA","37243","VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT","37243 - VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11307",null,"AETNA","37243 - VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT"]
["AETNA","AETNA","37244","VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE","37244 - VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE",null,null,null,null,null,"CIGNA CARELINK","11307",null,"AETNA","37244 - VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE"]
["AETNA","AETNA","37246","HC TRLUML BAL ANGIO 1ST ART","37246 - HC TRLUML BAL ANGIO 1ST ART",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11307",null,"AETNA","37246 - HC TRLUML BAL ANGIO 1ST ART"]
["AETNA","AETNA","37247","HC TRLUML BAL ANGIO ADD ART","37247 - HC TRLUML BAL ANGIO ADD ART",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11307",null,"AETNA","37247 - HC TRLUML BAL ANGIO ADD ART"]
["AETNA","AETNA","37248","HC TRLUML BAL ANGIO 1ST VEIN","37248 - HC TRLUML BAL ANGIO 1ST VEIN",null,null,null,null,null,"TUFTS HMO","11307",null,"AETNA","37248 - HC TRLUML BAL ANGIO 1ST VEIN"]
["AETNA","AETNA","37249","HC TRLUML BAL ANGIO ADD VEIN","37249 - HC TRLUML BAL ANGIO ADD VEIN",null,null,null,null,null,"TUFTS POS","11307",null,"AETNA","37249 - HC TRLUML BAL ANGIO ADD VEIN"]
["AETNA","AETNA","37252","INTRAVSC US DURNG DX EVAL &/OR THERPUTC INTRVNTN INCL RAD S&I; 1ST NONCRNRY VES","37252 - INTRAVSC US DURNG DX EVAL &/OR THERPUTC INTRVNTN INCL RAD S&I; 1ST NONCRNRY VES",null,null,null,null,null,"TUFTS PPO","11307",null,"AETNA","37252 - INTRAVSC US DURNG DX EVAL &/OR THERPUTC INTRVNTN INCL RAD S&I; 1ST NONCRNRY VES"]
["AETNA","AETNA","37253","HC INTVASC US NONCORON ADD","37253 - HC INTVASC US NONCORON ADD",null,null,null,null,null,"TUFTS SELECT","11307",null,"AETNA","37253 - HC INTVASC US NONCORON ADD"]
["AETNA","AETNA","37609","HC TEMPORAL ARTERY LIGATN OR BX","37609 - HC TEMPORAL ARTERY LIGATN OR BX",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11307",null,"AETNA","37609 - HC TEMPORAL ARTERY LIGATN OR BX"]
["AETNA","AETNA","37799","UNLISTED PROCEDURE,VASCULAR SURGERY","37799 - UNLISTED PROCEDURE,VASCULAR SURGERY",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11307",null,"AETNA","37799 - UNLISTED PROCEDURE,VASCULAR SURGERY"]
["AETNA","AETNA","38200","HC INJ PROC SPLENOPORTO","38200 - HC INJ PROC SPLENOPORTO",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11308",null,"AETNA","38200 - HC INJ PROC SPLENOPORTO"]
["AETNA","AETNA","38220","MARROW ASPIRATION ONLY","38220 - MARROW ASPIRATION ONLY",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11308",null,"AETNA","38220 - MARROW ASPIRATION ONLY"]
["AETNA","AETNA","38221","BONE MARROW BIOPSY NEEDLE/TROCAR","38221 - BONE MARROW BIOPSY NEEDLE/TROCAR",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11308",null,"AETNA","38221 - BONE MARROW BIOPSY NEEDLE/TROCAR"]
["AETNA","AETNA","38222","HC DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS","38222 - HC DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS",null,null,null,null,null,"BLUE CROSS-PPO","11308",null,"AETNA","38222 - HC DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS"]
["AETNA","AETNA","38241","TRNSPLJ AUTOLOGOUS HEMATOPOIETIC CELLS PER DONOR","38241 - TRNSPLJ AUTOLOGOUS HEMATOPOIETIC CELLS PER DONOR",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11308",null,"AETNA","38241 - TRNSPLJ AUTOLOGOUS HEMATOPOIETIC CELLS PER DONOR"]
["AETNA","AETNA","38300","DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL","38300 - DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11308",null,"AETNA","38300 - DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL"]
["AETNA","AETNA","38500","HC BIOPSY/EXCISION, LYMPH NODE(S)","38500 - HC BIOPSY/EXCISION, LYMPH NODE(S)",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11308",null,"AETNA","38500 - HC BIOPSY/EXCISION, LYMPH NODE(S)"]
["AETNA","AETNA","38505","BX/EXC LYMPH NODE NEEDLE SUPERFICIAL","38505 - BX/EXC LYMPH NODE NEEDLE SUPERFICIAL",null,null,null,null,null,"CIGNA CARELINK","11308",null,"AETNA","38505 - BX/EXC LYMPH NODE NEEDLE SUPERFICIAL"]
["AETNA","AETNA","38510","HC BX/REMV,LYMPH NODE,DEEP CERV","38510 - HC BX/REMV,LYMPH NODE,DEEP CERV",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11308",null,"AETNA","38510 - HC BX/REMV,LYMPH NODE,DEEP CERV"]
["AETNA","AETNA","38531","HC OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES","38531 - HC OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11308",null,"AETNA","38531 - HC OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES"]
["AETNA","AETNA","38542","HC EXPLORE DEEP NODE(S), NECK","38542 - HC EXPLORE DEEP NODE(S), NECK",null,null,null,null,null,"TUFTS HMO","11308",null,"AETNA","38542 - HC EXPLORE DEEP NODE(S), NECK"]
["AETNA","AETNA","38550","HC REMOVAL CYST HYGROMA","38550 - HC REMOVAL CYST HYGROMA",null,null,null,null,null,"TUFTS POS","11308",null,"AETNA","38550 - HC REMOVAL CYST HYGROMA"]
["AETNA","AETNA","38790","HC INJECTION PROCEDURE LYMPHANGIOGRAPHY","38790 - HC INJECTION PROCEDURE LYMPHANGIOGRAPHY",null,null,null,null,null,"TUFTS PPO","11308",null,"AETNA","38790 - HC INJECTION PROCEDURE LYMPHANGIOGRAPHY"]
["AETNA","AETNA","38792","HC INJ PROC;SENTINAL NODE ID","38792 - HC INJ PROC;SENTINAL NODE ID",null,null,null,null,null,"TUFTS SELECT","11308",null,"AETNA","38792 - HC INJ PROC;SENTINAL NODE ID"]
["AETNA","AETNA","40500","HC LIP SHAVE","40500 - HC LIP SHAVE",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11308",null,"AETNA","40500 - HC LIP SHAVE"]
["AETNA","AETNA","40510","EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR","40510 - EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11308",null,"AETNA","40510 - EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR"]
["AETNA","AETNA","40520","HC PARTIAL EXCISION OF LIP","40520 - HC PARTIAL EXCISION OF LIP",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11310",null,"AETNA","40520 - HC PARTIAL EXCISION OF LIP"]
["AETNA","AETNA","40525","HC FULL THICK EXCIS LIP,RECON W FLAP","40525 - HC FULL THICK EXCIS LIP,RECON W FLAP",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11310",null,"AETNA","40525 - HC FULL THICK EXCIS LIP,RECON W FLAP"]
["AETNA","AETNA","40530","HC PARTIAL REMOVAL OF LIP,>1/4","40530 - HC PARTIAL REMOVAL OF LIP,>1/4",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11310",null,"AETNA","40530 - HC PARTIAL REMOVAL OF LIP,>1/4"]
["AETNA","AETNA","40650","HC REPAIR LIP,FULL THICK,VERMILION","40650 - HC REPAIR LIP,FULL THICK,VERMILION",null,null,null,null,null,"BLUE CROSS-PPO","11310",null,"AETNA","40650 - HC REPAIR LIP,FULL THICK,VERMILION"]
["AETNA","AETNA","40652","HC REPAIR LIP,<1/2 VERT HEIGHT","40652 - HC REPAIR LIP,<1/2 VERT HEIGHT",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11310",null,"AETNA","40652 - HC REPAIR LIP,<1/2 VERT HEIGHT"]
["AETNA","AETNA","40654","HC REPAIR LIP,>1/2 VERT HEIGHT","40654 - HC REPAIR LIP,>1/2 VERT HEIGHT",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11310",null,"AETNA","40654 - HC REPAIR LIP,>1/2 VERT HEIGHT"]
["AETNA","AETNA","40801","DRG ABSC CST HMTMA VESTIBULE MOUTH COMP","40801 - DRG ABSC CST HMTMA VESTIBULE MOUTH COMP",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11310",null,"AETNA","40801 - DRG ABSC CST HMTMA VESTIBULE MOUTH COMP"]
["AETNA","AETNA","40805","HC REMOVAL FOREIGN BODY,MOUTH,COMPLEX","40805 - HC REMOVAL FOREIGN BODY,MOUTH,COMPLEX",null,null,null,null,null,"CIGNA CARELINK","11310",null,"AETNA","40805 - HC REMOVAL FOREIGN BODY,MOUTH,COMPLEX"]
["AETNA","AETNA","40806","INCISION OF LIP FOLD","40806 - INCISION OF LIP FOLD",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11310",null,"AETNA","40806 - INCISION OF LIP FOLD"]
["AETNA","AETNA","40808","BIOPSY VESTIBULE MOUTH","40808 - BIOPSY VESTIBULE MOUTH",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11310",null,"AETNA","40808 - BIOPSY VESTIBULE MOUTH"]
["AETNA","AETNA","40810","EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR","40810 - EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR",null,null,null,null,null,"TUFTS HMO","11310",null,"AETNA","40810 - EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR"]
["AETNA","AETNA","40812","EXC LES MUCOSA & SBMCSL VESTIBULE SMPL RPR","40812 - EXC LES MUCOSA & SBMCSL VESTIBULE SMPL RPR",null,null,null,null,null,"TUFTS POS","11310",null,"AETNA","40812 - EXC LES MUCOSA & SBMCSL VESTIBULE SMPL RPR"]
["AETNA","AETNA","40814","HC EXCIS MOUTH MUCOSA/SUB,COMPLX REPR","40814 - HC EXCIS MOUTH MUCOSA/SUB,COMPLX REPR",null,null,null,null,null,"TUFTS PPO","11310",null,"AETNA","40814 - HC EXCIS MOUTH MUCOSA/SUB,COMPLX REPR"]
["AETNA","AETNA","40816","EXC LES MUCOSA&SBMCSL VESTIBULE CPLX EXC MUSC","40816 - EXC LES MUCOSA&SBMCSL VESTIBULE CPLX EXC MUSC",null,null,null,null,null,"TUFTS SELECT","11310",null,"AETNA","40816 - EXC LES MUCOSA&SBMCSL VESTIBULE CPLX EXC MUSC"]
["AETNA","AETNA","40819","EXC FRENUM LABIAL/BUCCAL","40819 - EXC FRENUM LABIAL/BUCCAL",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11310",null,"AETNA","40819 - EXC FRENUM LABIAL/BUCCAL"]
["AETNA","AETNA","40820","HC DESTRUC MOUTH LESION/SCAR","40820 - HC DESTRUC MOUTH LESION/SCAR",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11310",null,"AETNA","40820 - HC DESTRUC MOUTH LESION/SCAR"]
["AETNA","AETNA","40831","HC REPAIR MOUTH LACERATION,>2.5 CM","40831 - HC REPAIR MOUTH LACERATION,>2.5 CM",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11311",null,"AETNA","40831 - HC REPAIR MOUTH LACERATION,>2.5 CM"]
["AETNA","AETNA","40840","HC RECONSTRUC MOUTH ANTERIOR","40840 - HC RECONSTRUC MOUTH ANTERIOR",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11311",null,"AETNA","40840 - HC RECONSTRUC MOUTH ANTERIOR"]
["AETNA","AETNA","40842","HC RECONSTRUC MOUTH POSTER,UNILAT","40842 - HC RECONSTRUC MOUTH POSTER,UNILAT",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11311",null,"AETNA","40842 - HC RECONSTRUC MOUTH POSTER,UNILAT"]
["AETNA","AETNA","40845","HC RECONSTRUC MOUTH COMPLEX","40845 - HC RECONSTRUC MOUTH COMPLEX",null,null,null,null,null,"BLUE CROSS-PPO","11311",null,"AETNA","40845 - HC RECONSTRUC MOUTH COMPLEX"]
["AETNA","AETNA","41006","HC INTRAORAL I&D TONGUE/FLOOR SUBLNGL DP SPRMLHYD","41006 - HC INTRAORAL I&D TONGUE/FLOOR SUBLNGL DP SPRMLHYD",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11311",null,"AETNA","41006 - HC INTRAORAL I&D TONGUE/FLOOR SUBLNGL DP SPRMLHYD"]
["AETNA","AETNA","41007","HC I&D MOUTH/TONG INTRA,SUBMENTAL","41007 - HC I&D MOUTH/TONG INTRA,SUBMENTAL",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11311",null,"AETNA","41007 - HC I&D MOUTH/TONG INTRA,SUBMENTAL"]
["AETNA","AETNA","41008","HC I&D MOUTH/TONG INTRA,SUBMANDIBULAR","41008 - HC I&D MOUTH/TONG INTRA,SUBMANDIBULAR",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11311",null,"AETNA","41008 - HC I&D MOUTH/TONG INTRA,SUBMANDIBULAR"]
["AETNA","AETNA","41009","HC I&D MOUTH/TONG INTRA, MASTICATOR","41009 - HC I&D MOUTH/TONG INTRA, MASTICATOR",null,null,null,null,null,"CIGNA CARELINK","11311",null,"AETNA","41009 - HC I&D MOUTH/TONG INTRA, MASTICATOR"]
["AETNA","AETNA","41010","INCISION LINGUAL FRENUM FRENOTOMY","41010 - INCISION LINGUAL FRENUM FRENOTOMY",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11311",null,"AETNA","41010 - INCISION LINGUAL FRENUM FRENOTOMY"]
["AETNA","AETNA","41016","HC MOUTH/TONG EXTRA,SUBMENTAL","41016 - HC MOUTH/TONG EXTRA,SUBMENTAL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11311",null,"AETNA","41016 - HC MOUTH/TONG EXTRA,SUBMENTAL"]
["AETNA","AETNA","41017","HC XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB","41017 - HC XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB",null,null,null,null,null,"TUFTS HMO","11311",null,"AETNA","41017 - HC XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB"]
["AETNA","AETNA","41018","HC I&D MOUTH/TONG EXTRA,MASTICATOR","41018 - HC I&D MOUTH/TONG EXTRA,MASTICATOR",null,null,null,null,null,"TUFTS POS","11311",null,"AETNA","41018 - HC I&D MOUTH/TONG EXTRA,MASTICATOR"]
["AETNA","AETNA","41100","BIOPSY TONGUE ANTERIOR TWO-THIRDS","41100 - BIOPSY TONGUE ANTERIOR TWO-THIRDS",null,null,null,null,null,"TUFTS PPO","11311",null,"AETNA","41100 - BIOPSY TONGUE ANTERIOR TWO-THIRDS"]
["AETNA","AETNA","41105","HC BIOPSY TONGUE,POSTER 1/3","41105 - HC BIOPSY TONGUE,POSTER 1/3",null,null,null,null,null,"TUFTS SELECT","11311",null,"AETNA","41105 - HC BIOPSY TONGUE,POSTER 1/3"]
["AETNA","AETNA","41108","BIOPSY FLOOR MOUTH","41108 - BIOPSY FLOOR MOUTH",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11311",null,"AETNA","41108 - BIOPSY FLOOR MOUTH"]
["AETNA","AETNA","41110","EXCISION LESION TONGUE W/O CLOSURE","41110 - EXCISION LESION TONGUE W/O CLOSURE",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11311",null,"AETNA","41110 - EXCISION LESION TONGUE W/O CLOSURE"]
["AETNA","AETNA","41112","EXC LES TONGUE W/CLSR ANTERIOR TWO-THIRDS","41112 - EXC LES TONGUE W/CLSR ANTERIOR TWO-THIRDS",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11312",null,"AETNA","41112 - EXC LES TONGUE W/CLSR ANTERIOR TWO-THIRDS"]
["AETNA","AETNA","41113","HC EXCIS TONGUE LESN,POST 1/3","41113 - HC EXCIS TONGUE LESN,POST 1/3",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11312",null,"AETNA","41113 - HC EXCIS TONGUE LESN,POST 1/3"]
["AETNA","AETNA","41115","EXCIISION LINGUAL FRENUM FRENECTOMY","41115 - EXCIISION LINGUAL FRENUM FRENECTOMY",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11312",null,"AETNA","41115 - EXCIISION LINGUAL FRENUM FRENECTOMY"]
["AETNA","AETNA","41116","EXCISION LESION FLOOR MOUTH","41116 - EXCISION LESION FLOOR MOUTH",null,null,null,null,null,"BLUE CROSS-PPO","11312",null,"AETNA","41116 - EXCISION LESION FLOOR MOUTH"]
["AETNA","AETNA","41120","HC PART REMOVAL TONGUE,<1/2","41120 - HC PART REMOVAL TONGUE,<1/2",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11312",null,"AETNA","41120 - HC PART REMOVAL TONGUE,<1/2"]
["AETNA","AETNA","41250","HC RLAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG","41250 - HC RLAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11312",null,"AETNA","41250 - HC RLAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG"]
["AETNA","AETNA","41251","HC REPAIR TONGUE LACER,POST 1/3","41251 - HC REPAIR TONGUE LACER,POST 1/3",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11312",null,"AETNA","41251 - HC REPAIR TONGUE LACER,POST 1/3"]
["AETNA","AETNA","41252","HC REPAIR TONGUE LACER,2.6 CM+/COMPLX","41252 - HC REPAIR TONGUE LACER,2.6 CM+/COMPLX",null,null,null,null,null,"CIGNA CARELINK","11312",null,"AETNA","41252 - HC REPAIR TONGUE LACER,2.6 CM+/COMPLX"]
["AETNA","AETNA","41800","HC DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS","41800 - HC DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11312",null,"AETNA","41800 - HC DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS"]
["AETNA","AETNA","41820","HC EXCISION, GUM, EACH QUADRANT","41820 - HC EXCISION, GUM, EACH QUADRANT",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11312",null,"AETNA","41820 - HC EXCISION, GUM, EACH QUADRANT"]
["AETNA","AETNA","41821","HC EXCISION OF GUM FLAP","41821 - HC EXCISION OF GUM FLAP",null,null,null,null,null,"TUFTS HMO","11312",null,"AETNA","41821 - HC EXCISION OF GUM FLAP"]
["AETNA","AETNA","41822","EXCIS FIBROUS TUBER,DENTOALV","41822 - EXCIS FIBROUS TUBER,DENTOALV",null,null,null,null,null,"TUFTS POS","11312",null,"AETNA","41822 - EXCIS FIBROUS TUBER,DENTOALV"]
["AETNA","AETNA","41823","HC EXCIS OSSEOUS TUBER,DENTOALV","41823 - HC EXCIS OSSEOUS TUBER,DENTOALV",null,null,null,null,null,"TUFTS PPO","11312",null,"AETNA","41823 - HC EXCIS OSSEOUS TUBER,DENTOALV"]
["AETNA","AETNA","41825","EXCISION OF GUM LESION","41825 - EXCISION OF GUM LESION",null,null,null,null,null,"TUFTS SELECT","11312",null,"AETNA","41825 - EXCISION OF GUM LESION"]
["AETNA","AETNA","41826","HC EXCIS DENTOALV LESN,SIMPL REPR","41826 - HC EXCIS DENTOALV LESN,SIMPL REPR",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11312",null,"AETNA","41826 - HC EXCIS DENTOALV LESN,SIMPL REPR"]
["AETNA","AETNA","41830","HC REMOVAL OF GUM TISSUE","41830 - HC REMOVAL OF GUM TISSUE",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11312",null,"AETNA","41830 - HC REMOVAL OF GUM TISSUE"]
["AETNA","AETNA","41850","TREATMENT OF GUM LESION","41850 - TREATMENT OF GUM LESION",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11313",null,"AETNA","41850 - TREATMENT OF GUM LESION"]
["AETNA","AETNA","41874","HC REPAIR TOOTH SOCKET","41874 - HC REPAIR TOOTH SOCKET",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11313",null,"AETNA","41874 - HC REPAIR TOOTH SOCKET"]
["AETNA","AETNA","41899","HC SUR REM TOOTH&BONE","41899 - HC SUR REM TOOTH&BONE",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11313",null,"AETNA","41899 - HC SUR REM TOOTH&BONE"]
["AETNA","AETNA","42000","HC DRAINAGE ABSCESS PALATE UVULA","42000 - HC DRAINAGE ABSCESS PALATE UVULA",null,null,null,null,null,"BLUE CROSS-PPO","11313",null,"AETNA","42000 - HC DRAINAGE ABSCESS PALATE UVULA"]
["AETNA","AETNA","42100","BIOPSY PALATE UVULA","42100 - BIOPSY PALATE UVULA",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11313",null,"AETNA","42100 - BIOPSY PALATE UVULA"]
["AETNA","AETNA","42104","EXC LESION PALATE UVULA W/O CLOSURE","42104 - EXC LESION PALATE UVULA W/O CLOSURE",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11313",null,"AETNA","42104 - EXC LESION PALATE UVULA W/O CLOSURE"]
["AETNA","AETNA","42106","EXC LESION PALATE UVULA W/SMPL PRIM CLOSURE","42106 - EXC LESION PALATE UVULA W/SMPL PRIM CLOSURE",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11313",null,"AETNA","42106 - EXC LESION PALATE UVULA W/SMPL PRIM CLOSURE"]
["AETNA","AETNA","42120","HC RESCJ PALATE/EXTENSIVE RESCJ LESION","42120 - HC RESCJ PALATE/EXTENSIVE RESCJ LESION",null,null,null,null,null,"CIGNA CARELINK","11313",null,"AETNA","42120 - HC RESCJ PALATE/EXTENSIVE RESCJ LESION"]
["AETNA","AETNA","42140","HC UVULECTOMY EXCISION UVULA","42140 - HC UVULECTOMY EXCISION UVULA",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11313",null,"AETNA","42140 - HC UVULECTOMY EXCISION UVULA"]
["AETNA","AETNA","42160","HC DESTRUC LESN PALATE/UVULVA","42160 - HC DESTRUC LESN PALATE/UVULVA",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11313",null,"AETNA","42160 - HC DESTRUC LESN PALATE/UVULVA"]
["AETNA","AETNA","42180","HC REPAIR PALATE LACER <2 CM","42180 - HC REPAIR PALATE LACER <2 CM",null,null,null,null,null,"TUFTS HMO","11313",null,"AETNA","42180 - HC REPAIR PALATE LACER <2 CM"]
["AETNA","AETNA","42210","HC RECONST CLEFT PALATE,BONE GRFT","42210 - HC RECONST CLEFT PALATE,BONE GRFT",null,null,null,null,null,"TUFTS POS","11313",null,"AETNA","42210 - HC RECONST CLEFT PALATE,BONE GRFT"]
["AETNA","AETNA","42330","SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL","42330 - SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL",null,null,null,null,null,"TUFTS PPO","11313",null,"AETNA","42330 - SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL"]
["AETNA","AETNA","42335","HC REMOVAL SUBMAND STONE,COMPLICATED","42335 - HC REMOVAL SUBMAND STONE,COMPLICATED",null,null,null,null,null,"TUFTS SELECT","11313",null,"AETNA","42335 - HC REMOVAL SUBMAND STONE,COMPLICATED"]
["AETNA","AETNA","42400","BIOPSY SALIVARY GLAND NEEDLE","42400 - BIOPSY SALIVARY GLAND NEEDLE",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11313",null,"AETNA","42400 - BIOPSY SALIVARY GLAND NEEDLE"]
["AETNA","AETNA","42405","BIOPSY SALIVARY GLAND INCISIONAL","42405 - BIOPSY SALIVARY GLAND INCISIONAL",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11313",null,"AETNA","42405 - BIOPSY SALIVARY GLAND INCISIONAL"]
["AETNA","AETNA","42408","HC EXCISION SUBLING SALIVARY CYST","42408 - HC EXCISION SUBLING SALIVARY CYST",null,null,null,null,null,"AETNA","11400",null,"AETNA","42408 - HC EXCISION SUBLING SALIVARY CYST"]
["AETNA","AETNA","42415","HC EXC PAROTD,LAT LOBE,DISSECT 5TH NERV","42415 - HC EXC PAROTD,LAT LOBE,DISSECT 5TH NERV",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11400",null,"AETNA","42415 - HC EXC PAROTD,LAT LOBE,DISSECT 5TH NERV"]
["AETNA","AETNA","42440","HC EXCISION SUBMAXILLARY GLAND","42440 - HC EXCISION SUBMAXILLARY GLAND",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11400",null,"AETNA","42440 - HC EXCISION SUBMAXILLARY GLAND"]
["AETNA","AETNA","42450","HC EXCISION SUBLINGUAL GLAND","42450 - HC EXCISION SUBLINGUAL GLAND",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11400",null,"AETNA","42450 - HC EXCISION SUBLINGUAL GLAND"]
["AETNA","AETNA","42500","HC PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY PRIM","42500 - HC PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY PRIM",null,null,null,null,null,"BLUE CROSS-PPO","11400",null,"AETNA","42500 - HC PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY PRIM"]
["AETNA","AETNA","42505","HC REPAIR SALIVARY DUCT COMPLICATED","42505 - HC REPAIR SALIVARY DUCT COMPLICATED",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11400",null,"AETNA","42505 - HC REPAIR SALIVARY DUCT COMPLICATED"]
["AETNA","AETNA","42699","SIAOENDOSCOPY","42699 - SIAOENDOSCOPY",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11400",null,"AETNA","42699 - SIAOENDOSCOPY"]
["AETNA","AETNA","42700","I&D ABSCESS PERITONSILLAR","42700 - I&D ABSCESS PERITONSILLAR",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11400",null,"AETNA","42700 - I&D ABSCESS PERITONSILLAR"]
["AETNA","AETNA","42720","HC INC/DRAIN RETROPHARYNG ABSCESS,ORAL","42720 - HC INC/DRAIN RETROPHARYNG ABSCESS,ORAL",null,null,null,null,null,"CIGNA CARELINK","11400",null,"AETNA","42720 - HC INC/DRAIN RETROPHARYNG ABSCESS,ORAL"]
["AETNA","AETNA","42725","HC INC/DRAIN RETROPHARYNG ABSCESS,EXT","42725 - HC INC/DRAIN RETROPHARYNG ABSCESS,EXT",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11400",null,"AETNA","42725 - HC INC/DRAIN RETROPHARYNG ABSCESS,EXT"]
["AETNA","AETNA","42800","BIOPSY OROPHARYNX","42800 - BIOPSY OROPHARYNX",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11400",null,"AETNA","42800 - BIOPSY OROPHARYNX"]
["AETNA","AETNA","42804","BIOPSY NASOPHARYNX VISIBLE LESION SIMPLE","42804 - BIOPSY NASOPHARYNX VISIBLE LESION SIMPLE",null,null,null,null,null,"TUFTS HMO","11400",null,"AETNA","42804 - BIOPSY NASOPHARYNX VISIBLE LESION SIMPLE"]
["AETNA","AETNA","42808","EXCISION/DESTRUCTION LESION PHARYNX ANY METHOD","42808 - EXCISION/DESTRUCTION LESION PHARYNX ANY METHOD",null,null,null,null,null,"TUFTS POS","11400",null,"AETNA","42808 - EXCISION/DESTRUCTION LESION PHARYNX ANY METHOD"]
["AETNA","AETNA","42809","REMOVAL FOREIGN BODY PHARYNX","42809 - REMOVAL FOREIGN BODY PHARYNX",null,null,null,null,null,"TUFTS PPO","11400",null,"AETNA","42809 - REMOVAL FOREIGN BODY PHARYNX"]
["AETNA","AETNA","42810","EXC BRANCHIAL CLEFT CYST CONFINED SKN&SUBQ TIS","42810 - EXC BRANCHIAL CLEFT CYST CONFINED SKN&SUBQ TIS",null,null,null,null,null,"TUFTS SELECT","11400",null,"AETNA","42810 - EXC BRANCHIAL CLEFT CYST CONFINED SKN&SUBQ TIS"]
["AETNA","AETNA","42815","HC EXCISION BRANC CLFT CYST,DEEP","42815 - HC EXCISION BRANC CLFT CYST,DEEP",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11400",null,"AETNA","42815 - HC EXCISION BRANC CLFT CYST,DEEP"]
["AETNA","AETNA","42826","TONSILLECTOMY ONE-HALF AGE 12/>","42826 - TONSILLECTOMY ONE-HALF AGE 12/>",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11400",null,"AETNA","42826 - TONSILLECTOMY ONE-HALF AGE 12/>"]
["AETNA","AETNA","42960","HC CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE","42960 - HC CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE",null,null,null,null,null,"AETNA","11401",null,"AETNA","42960 - HC CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE"]
["AETNA","AETNA","42970","HC CTRL NASOPHARYNGEAL HEMRRG SMPL W/PST NSL PACKS","42970 - HC CTRL NASOPHARYNGEAL HEMRRG SMPL W/PST NSL PACKS",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11401",null,"AETNA","42970 - HC CTRL NASOPHARYNGEAL HEMRRG SMPL W/PST NSL PACKS"]
["AETNA","AETNA","43191","HC ESOPHAGOSCOPY RIGID TRANSORAL DIAGNOSTIC BRUSH","43191 - HC ESOPHAGOSCOPY RIGID TRANSORAL DIAGNOSTIC BRUSH",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11401",null,"AETNA","43191 - HC ESOPHAGOSCOPY RIGID TRANSORAL DIAGNOSTIC BRUSH"]
["AETNA","AETNA","43193","HC ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY","43193 - HC ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11401",null,"AETNA","43193 - HC ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY"]
["AETNA","AETNA","43195","HC ESOPHAGOSCOPY RIGID TRANSORAL BALLOON DILATION","43195 - HC ESOPHAGOSCOPY RIGID TRANSORAL BALLOON DILATION",null,null,null,null,null,"BLUE CROSS-PPO","11401",null,"AETNA","43195 - HC ESOPHAGOSCOPY RIGID TRANSORAL BALLOON DILATION"]
["AETNA","AETNA","43197","HC ESOPHAGOSCOPY FLEXIBLE TRANSNASAL DIAGNOSTIC","43197 - HC ESOPHAGOSCOPY FLEXIBLE TRANSNASAL DIAGNOSTIC",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11401",null,"AETNA","43197 - HC ESOPHAGOSCOPY FLEXIBLE TRANSNASAL DIAGNOSTIC"]
["AETNA","AETNA","43198","ESOPHAGOSCOPY FLEXIBLE TRANSNASAL WITH BIOPSY","43198 - ESOPHAGOSCOPY FLEXIBLE TRANSNASAL WITH BIOPSY",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11401",null,"AETNA","43198 - ESOPHAGOSCOPY FLEXIBLE TRANSNASAL WITH BIOPSY"]
["AETNA","AETNA","43200","ESPHGSC RGD/FLX DX W/WO COLLJ SPEC BR/WA SPX","43200 - ESPHGSC RGD/FLX DX W/WO COLLJ SPEC BR/WA SPX",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11401",null,"AETNA","43200 - ESPHGSC RGD/FLX DX W/WO COLLJ SPEC BR/WA SPX"]
["AETNA","AETNA","43201","HC ESOPHAGOSCOPY FLEXIBLE TRANSORAL W SUBMUCOUS INJ","43201 - HC ESOPHAGOSCOPY FLEXIBLE TRANSORAL W SUBMUCOUS INJ",null,null,null,null,null,"CIGNA CARELINK","11401",null,"AETNA","43201 - HC ESOPHAGOSCOPY FLEXIBLE TRANSORAL W SUBMUCOUS INJ"]
["AETNA","AETNA","43202","ESPHGSC RGD/FLX W/BIOPSY SINGLE/MULTIPLE","43202 - ESPHGSC RGD/FLX W/BIOPSY SINGLE/MULTIPLE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11401",null,"AETNA","43202 - ESPHGSC RGD/FLX W/BIOPSY SINGLE/MULTIPLE"]
["AETNA","AETNA","43212","HC ESOPHAGOSCOPY TRANSORAL STENT PLACEMENT","43212 - HC ESOPHAGOSCOPY TRANSORAL STENT PLACEMENT",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11401",null,"AETNA","43212 - HC ESOPHAGOSCOPY TRANSORAL STENT PLACEMENT"]
["AETNA","AETNA","43215","HC ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY","43215 - HC ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY",null,null,null,null,null,"TUFTS HMO","11401",null,"AETNA","43215 - HC ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY"]
["AETNA","AETNA","43220","HC ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM","43220 - HC ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM",null,null,null,null,null,"TUFTS POS","11401",null,"AETNA","43220 - HC ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM"]
["AETNA","AETNA","43229","HC ESOPHAGOSCOPY FLEX TRANSORAL LESION ABLATION","43229 - HC ESOPHAGOSCOPY FLEX TRANSORAL LESION ABLATION",null,null,null,null,null,"TUFTS PPO","11401",null,"AETNA","43229 - HC ESOPHAGOSCOPY FLEX TRANSORAL LESION ABLATION"]
["AETNA","AETNA","43231","HC ESPHGSC RGD/FLX W/NDSC ULTRASOUND EXAMINATION","43231 - HC ESPHGSC RGD/FLX W/NDSC ULTRASOUND EXAMINATION",null,null,null,null,null,"TUFTS SELECT","11401",null,"AETNA","43231 - HC ESPHGSC RGD/FLX W/NDSC ULTRASOUND EXAMINATION"]
["AETNA","AETNA","43232","HC ESPHGSC RGD/FLX W/TNDSC US-GID FINE NDL ASPIR/BX","43232 - HC ESPHGSC RGD/FLX W/TNDSC US-GID FINE NDL ASPIR/BX",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11401",null,"AETNA","43232 - HC ESPHGSC RGD/FLX W/TNDSC US-GID FINE NDL ASPIR/BX"]
["AETNA","AETNA","43235","HC UPPER GI NDSC DX W/WO COLLECTION SPECIMEN","43235 - HC UPPER GI NDSC DX W/WO COLLECTION SPECIMEN",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11401",null,"AETNA","43235 - HC UPPER GI NDSC DX W/WO COLLECTION SPECIMEN"]
["AETNA","AETNA","43236","HC UPPER GI NDSC W/SUBMUCOSAL INJECTION","43236 - HC UPPER GI NDSC W/SUBMUCOSAL INJECTION",null,null,null,null,null,"AETNA","11402",null,"AETNA","43236 - HC UPPER GI NDSC W/SUBMUCOSAL INJECTION"]
["AETNA","AETNA","43237","UPR GI NDSC & US NDSC EXAM LMTD ESOPHAGUS","43237 - UPR GI NDSC & US NDSC EXAM LMTD ESOPHAGUS",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11402",null,"AETNA","43237 - UPR GI NDSC & US NDSC EXAM LMTD ESOPHAGUS"]
["AETNA","AETNA","43238","HC UPR GI NDSC TNDSC US FINE NDL ASPIR/BX ESOPH","43238 - HC UPR GI NDSC TNDSC US FINE NDL ASPIR/BX ESOPH",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11402",null,"AETNA","43238 - HC UPR GI NDSC TNDSC US FINE NDL ASPIR/BX ESOPH"]
["AETNA","AETNA","43239","HC UPPER NDSC BIOPSY SINGLE/MULTIPLE","43239 - HC UPPER NDSC BIOPSY SINGLE/MULTIPLE",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11402",null,"AETNA","43239 - HC UPPER NDSC BIOPSY SINGLE/MULTIPLE"]
["AETNA","AETNA","43240","HC UPR GI NDSC TRANSMURAL DRAINAGE PSEUDOCYST","43240 - HC UPR GI NDSC TRANSMURAL DRAINAGE PSEUDOCYST",null,null,null,null,null,"BLUE CROSS-PPO","11402",null,"AETNA","43240 - HC UPR GI NDSC TRANSMURAL DRAINAGE PSEUDOCYST"]
["AETNA","AETNA","43241","HC UPR GI NDSC TNDSC INTRALUMINAL TUBE/CATH PLMT","43241 - HC UPR GI NDSC TNDSC INTRALUMINAL TUBE/CATH PLMT",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11402",null,"AETNA","43241 - HC UPR GI NDSC TNDSC INTRALUMINAL TUBE/CATH PLMT"]
["AETNA","AETNA","43242","HC UPPER GI NDSC ULTRASOUND GUIDED BIOPSY","43242 - HC UPPER GI NDSC ULTRASOUND GUIDED BIOPSY",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11402",null,"AETNA","43242 - HC UPPER GI NDSC ULTRASOUND GUIDED BIOPSY"]
["AETNA","AETNA","43243","HC UPR GI NDSC NJX SCLEROSIS ESOPHGL&/GSTR VARICE","43243 - HC UPR GI NDSC NJX SCLEROSIS ESOPHGL&/GSTR VARICE",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11402",null,"AETNA","43243 - HC UPR GI NDSC NJX SCLEROSIS ESOPHGL&/GSTR VARICE"]
["AETNA","AETNA","43244","HC UPR GI NDSC BAND LIG ESOPHGL&/GSTR VARICES","43244 - HC UPR GI NDSC BAND LIG ESOPHGL&/GSTR VARICES",null,null,null,null,null,"CIGNA CARELINK","11402",null,"AETNA","43244 - HC UPR GI NDSC BAND LIG ESOPHGL&/GSTR VARICES"]
["AETNA","AETNA","43245","HC UPR GI NDSC DILAT GSTR OUTLET FOR OBSTRCJ","43245 - HC UPR GI NDSC DILAT GSTR OUTLET FOR OBSTRCJ",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11402",null,"AETNA","43245 - HC UPR GI NDSC DILAT GSTR OUTLET FOR OBSTRCJ"]
["AETNA","AETNA","43246","HC UPR GI NDSC PLMT PRQ GASTROSTOMY TUBE","43246 - HC UPR GI NDSC PLMT PRQ GASTROSTOMY TUBE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11402",null,"AETNA","43246 - HC UPR GI NDSC PLMT PRQ GASTROSTOMY TUBE"]
["AETNA","AETNA","43247","HC UPPER GI NDSC W/FOREIGN BODY REMOVAL","43247 - HC UPPER GI NDSC W/FOREIGN BODY REMOVAL",null,null,null,null,null,"TUFTS HMO","11402",null,"AETNA","43247 - HC UPPER GI NDSC W/FOREIGN BODY REMOVAL"]
["AETNA","AETNA","43248","HC UPR GI NDSC INSJ GUIDE WIRE DILAT ESOPHAGUS","43248 - HC UPR GI NDSC INSJ GUIDE WIRE DILAT ESOPHAGUS",null,null,null,null,null,"TUFTS POS","11402",null,"AETNA","43248 - HC UPR GI NDSC INSJ GUIDE WIRE DILAT ESOPHAGUS"]
["AETNA","AETNA","43249","HC UPR GI NDSC BALLOON DILAT ESOPH <30 MM DIAM","43249 - HC UPR GI NDSC BALLOON DILAT ESOPH <30 MM DIAM",null,null,null,null,null,"TUFTS PPO","11402",null,"AETNA","43249 - HC UPR GI NDSC BALLOON DILAT ESOPH <30 MM DIAM"]
["AETNA","AETNA","43250","HC UPR GI NDSC RMVL LESION HOT BX/BIPOLAR CAUTERY","43250 - HC UPR GI NDSC RMVL LESION HOT BX/BIPOLAR CAUTERY",null,null,null,null,null,"TUFTS SELECT","11402",null,"AETNA","43250 - HC UPR GI NDSC RMVL LESION HOT BX/BIPOLAR CAUTERY"]
["AETNA","AETNA","43251","HC UPR GI NDSC RMVL TUM POLYP/OTH LES SNARE TQ","43251 - HC UPR GI NDSC RMVL TUM POLYP/OTH LES SNARE TQ",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11402",null,"AETNA","43251 - HC UPR GI NDSC RMVL TUM POLYP/OTH LES SNARE TQ"]
["AETNA","AETNA","43253","HC EGD US GUIDED TRANSMURAL INJXN/FIDUCIAL MARKER E","43253 - HC EGD US GUIDED TRANSMURAL INJXN/FIDUCIAL MARKER E",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11402",null,"AETNA","43253 - HC EGD US GUIDED TRANSMURAL INJXN/FIDUCIAL MARKER E"]
["AETNA","AETNA","43254","HC EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION","43254 - HC EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION",null,null,null,null,null,"AETNA","11403",null,"AETNA","43254 - HC EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION"]
["AETNA","AETNA","43255","HC UPR GI NDSC CONTROL BLEEDING ANY METHOD","43255 - HC UPR GI NDSC CONTROL BLEEDING ANY METHOD",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11403",null,"AETNA","43255 - HC UPR GI NDSC CONTROL BLEEDING ANY METHOD"]
["AETNA","AETNA","43257","HC UPR GI NDSC DLVR THERMAL NRG SPHNCTR/CARDIA","43257 - HC UPR GI NDSC DLVR THERMAL NRG SPHNCTR/CARDIA",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11403",null,"AETNA","43257 - HC UPR GI NDSC DLVR THERMAL NRG SPHNCTR/CARDIA"]
["AETNA","AETNA","43259","HC UPPER GI NDSC W/NDSC ULTRASOUND EXAM","43259 - HC UPPER GI NDSC W/NDSC ULTRASOUND EXAM",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11403",null,"AETNA","43259 - HC UPPER GI NDSC W/NDSC ULTRASOUND EXAM"]
["AETNA","AETNA","43260","HC ERCP DX W/WO COLLJ SPEC BRUSHING/WASHING SPX","43260 - HC ERCP DX W/WO COLLJ SPEC BRUSHING/WASHING SPX",null,null,null,null,null,"BLUE CROSS-PPO","11403",null,"AETNA","43260 - HC ERCP DX W/WO COLLJ SPEC BRUSHING/WASHING SPX"]
["AETNA","AETNA","43261","HC ERCP W/BIOPSY SINGLE/MULTIPLE","43261 - HC ERCP W/BIOPSY SINGLE/MULTIPLE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11403",null,"AETNA","43261 - HC ERCP W/BIOPSY SINGLE/MULTIPLE"]
["AETNA","AETNA","43262","HC ERCP W/SPHINCTEROTOMY/PAPILLOTOMY","43262 - HC ERCP W/SPHINCTEROTOMY/PAPILLOTOMY",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11403",null,"AETNA","43262 - HC ERCP W/SPHINCTEROTOMY/PAPILLOTOMY"]
["AETNA","AETNA","43264","HC ERCP W/RMVCALCULI BILIARY&/PANCREATIC DUCTS","43264 - HC ERCP W/RMVCALCULI BILIARY&/PANCREATIC DUCTS",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11403",null,"AETNA","43264 - HC ERCP W/RMVCALCULI BILIARY&/PANCREATIC DUCTS"]
["AETNA","AETNA","43265","HC ERCP W/DSTRJ LITHOTRIPSY CALCULI ANY METHOD","43265 - HC ERCP W/DSTRJ LITHOTRIPSY CALCULI ANY METHOD",null,null,null,null,null,"CIGNA CARELINK","11403",null,"AETNA","43265 - HC ERCP W/DSTRJ LITHOTRIPSY CALCULI ANY METHOD"]
["AETNA","AETNA","43266","HC EGD ENDOSCOPIC STENT PLACEMENT W/WIRE& DILATION","43266 - HC EGD ENDOSCOPIC STENT PLACEMENT W/WIRE& DILATION",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11403",null,"AETNA","43266 - HC EGD ENDOSCOPIC STENT PLACEMENT W/WIRE& DILATION"]
["AETNA","AETNA","43270","HC EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE","43270 - HC EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11403",null,"AETNA","43270 - HC EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE"]
["AETNA","AETNA","43273","HC ENDOSCOPIC PAPILLA CANNULATION BILE PANCREATIC","43273 - HC ENDOSCOPIC PAPILLA CANNULATION BILE PANCREATIC",null,null,null,null,null,"TUFTS HMO","11403",null,"AETNA","43273 - HC ENDOSCOPIC PAPILLA CANNULATION BILE PANCREATIC"]
["AETNA","AETNA","43274","HC ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT","43274 - HC ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT",null,null,null,null,null,"TUFTS POS","11403",null,"AETNA","43274 - HC ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT"]
["AETNA","AETNA","43275","HC ERCP REMOVE FOREIGN BODY/STENT BILIARY/PANC DUCT","43275 - HC ERCP REMOVE FOREIGN BODY/STENT BILIARY/PANC DUCT",null,null,null,null,null,"TUFTS PPO","11403",null,"AETNA","43275 - HC ERCP REMOVE FOREIGN BODY/STENT BILIARY/PANC DUCT"]
["AETNA","AETNA","43276","HC ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE","43276 - HC ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE",null,null,null,null,null,"TUFTS SELECT","11403",null,"AETNA","43276 - HC ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE"]
["AETNA","AETNA","43277","HC ERCP BALLOON DILATE BILIARY/PANC DUCT/AMPULLA EA","43277 - HC ERCP BALLOON DILATE BILIARY/PANC DUCT/AMPULLA EA",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11403",null,"AETNA","43277 - HC ERCP BALLOON DILATE BILIARY/PANC DUCT/AMPULLA EA"]
["AETNA","AETNA","43278","HC ERCP LESION ABLATE W/DILATE","43278 - HC ERCP LESION ABLATE W/DILATE",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11403",null,"AETNA","43278 - HC ERCP LESION ABLATE W/DILATE"]
["AETNA","AETNA","43450","HC DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS","43450 - HC DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS",null,null,null,null,null,"AETNA","11404",null,"AETNA","43450 - HC DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS"]
["AETNA","AETNA","43752","HC PLACEMENT NG/OG TUBE BY PHYSICIAN","43752 - HC PLACEMENT NG/OG TUBE BY PHYSICIAN",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11404",null,"AETNA","43752 - HC PLACEMENT NG/OG TUBE BY PHYSICIAN"]
["AETNA","AETNA","43753","GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE","43753 - GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11404",null,"AETNA","43753 - GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE"]
["AETNA","AETNA","43754","HC GASTRIC INTUBAT DX W/ASPIRATION SINGLE SPECIME","43754 - HC GASTRIC INTUBAT DX W/ASPIRATION SINGLE SPECIME",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11404",null,"AETNA","43754 - HC GASTRIC INTUBAT DX W/ASPIRATION SINGLE SPECIME"]
["AETNA","AETNA","43761","REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO","43761 - REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO",null,null,null,null,null,"BLUE CROSS-PPO","11404",null,"AETNA","43761 - REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO"]
["AETNA","AETNA","43762","HC RPLC GTUBE NO REVJ TRC","43762 - HC RPLC GTUBE NO REVJ TRC",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11404",null,"AETNA","43762 - HC RPLC GTUBE NO REVJ TRC"]
["AETNA","AETNA","43763","HC RPLC GTUBE REVJ GSTRST TRC","43763 - HC RPLC GTUBE REVJ GSTRST TRC",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11404",null,"AETNA","43763 - HC RPLC GTUBE REVJ GSTRST TRC"]
["AETNA","AETNA","43999","ENDOSCOPIC ENDOLUMINAL GASTRIC PLICATION","43999 - ENDOSCOPIC ENDOLUMINAL GASTRIC PLICATION",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11404",null,"AETNA","43999 - ENDOSCOPIC ENDOLUMINAL GASTRIC PLICATION"]
["AETNA","AETNA","44180","HC LAP, SURG ENTEROLYSIS","44180 - HC LAP, SURG ENTEROLYSIS",null,null,null,null,null,"CIGNA CARELINK","11404",null,"AETNA","44180 - HC LAP, SURG ENTEROLYSIS"]
["AETNA","AETNA","44360","HC ENDOSCOPY UPPER SMALL INTESTINE","44360 - HC ENDOSCOPY UPPER SMALL INTESTINE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11404",null,"AETNA","44360 - HC ENDOSCOPY UPPER SMALL INTESTINE"]
["AETNA","AETNA","44361","HC ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY","44361 - HC ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11404",null,"AETNA","44361 - HC ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY"]
["AETNA","AETNA","44363","HC ENTEROSCOPY > 2ND PRTN W/RMVL FOREIGN BODY","44363 - HC ENTEROSCOPY > 2ND PRTN W/RMVL FOREIGN BODY",null,null,null,null,null,"TUFTS HMO","11404",null,"AETNA","44363 - HC ENTEROSCOPY > 2ND PRTN W/RMVL FOREIGN BODY"]
["AETNA","AETNA","44364","HC ENTEROSCOPY > 2ND PRTN W/RMVL LESION SNARE.","44364 - HC ENTEROSCOPY > 2ND PRTN W/RMVL LESION SNARE.",null,null,null,null,null,"TUFTS POS","11404",null,"AETNA","44364 - HC ENTEROSCOPY > 2ND PRTN W/RMVL LESION SNARE."]
["AETNA","AETNA","44366","HC ENTEROSCOPY > 2ND PRTN W/CONTROL BLEEDING","44366 - HC ENTEROSCOPY > 2ND PRTN W/CONTROL BLEEDING",null,null,null,null,null,"TUFTS PPO","11404",null,"AETNA","44366 - HC ENTEROSCOPY > 2ND PRTN W/CONTROL BLEEDING"]
["AETNA","AETNA","44369","HC ENTEROSCOPY > 2ND PRTN ABLTJ LESION","44369 - HC ENTEROSCOPY > 2ND PRTN ABLTJ LESION",null,null,null,null,null,"TUFTS SELECT","11404",null,"AETNA","44369 - HC ENTEROSCOPY > 2ND PRTN ABLTJ LESION"]
["AETNA","AETNA","44376","HC ENTEROSC >2ND PRTN W/ILEUM W/WO COLLJ SPEC SPX","44376 - HC ENTEROSC >2ND PRTN W/ILEUM W/WO COLLJ SPEC SPX",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11404",null,"AETNA","44376 - HC ENTEROSC >2ND PRTN W/ILEUM W/WO COLLJ SPEC SPX"]
["AETNA","AETNA","44377","HC ENTEROSC >2ND PRTN W/ILEUM W/BX SINGLE/MULTIPLE","44377 - HC ENTEROSC >2ND PRTN W/ILEUM W/BX SINGLE/MULTIPLE",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11404",null,"AETNA","44377 - HC ENTEROSC >2ND PRTN W/ILEUM W/BX SINGLE/MULTIPLE"]
["AETNA","AETNA","44378","HC ENTEROSCOPY > 2ND PRTN ILEUM CONTROL BLEEDING","44378 - HC ENTEROSCOPY > 2ND PRTN ILEUM CONTROL BLEEDING",null,null,null,null,null,"AETNA","11406",null,"AETNA","44378 - HC ENTEROSCOPY > 2ND PRTN ILEUM CONTROL BLEEDING"]
["AETNA","AETNA","44380","HC ILEOSCOPY STOMA DX W/WO COLLJ SPEC BR/WA SPX","44380 - HC ILEOSCOPY STOMA DX W/WO COLLJ SPEC BR/WA SPX",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11406",null,"AETNA","44380 - HC ILEOSCOPY STOMA DX W/WO COLLJ SPEC BR/WA SPX"]
["AETNA","AETNA","44381","HC ILEOSCOPY STOMA W/BALLOON DILATION","44381 - HC ILEOSCOPY STOMA W/BALLOON DILATION",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11406",null,"AETNA","44381 - HC ILEOSCOPY STOMA W/BALLOON DILATION"]
["AETNA","AETNA","44382","HC ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE","44382 - HC ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11406",null,"AETNA","44382 - HC ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE"]
["AETNA","AETNA","44384","ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT","44384 - ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT",null,null,null,null,null,"BLUE CROSS-PPO","11406",null,"AETNA","44384 - ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT"]
["AETNA","AETNA","44385","HC NDSC EVAL INTSTINAL POUCH DX W/WO COLLJ SPEC SPX","44385 - HC NDSC EVAL INTSTINAL POUCH DX W/WO COLLJ SPEC SPX",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11406",null,"AETNA","44385 - HC NDSC EVAL INTSTINAL POUCH DX W/WO COLLJ SPEC SPX"]
["AETNA","AETNA","44386","NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE","44386 - NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11406",null,"AETNA","44386 - NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE"]
["AETNA","AETNA","44388","HC COLONOSCOPY STOMA DX W/WO COLLJ SPEC SPX","44388 - HC COLONOSCOPY STOMA DX W/WO COLLJ SPEC SPX",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11406",null,"AETNA","44388 - HC COLONOSCOPY STOMA DX W/WO COLLJ SPEC SPX"]
["AETNA","AETNA","44389","HC COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE","44389 - HC COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE",null,null,null,null,null,"CIGNA CARELINK","11406",null,"AETNA","44389 - HC COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE"]
["AETNA","AETNA","44391","HC COLONOSCOPY STOMA CONTROL BLEEDING","44391 - HC COLONOSCOPY STOMA CONTROL BLEEDING",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11406",null,"AETNA","44391 - HC COLONOSCOPY STOMA CONTROL BLEEDING"]
["AETNA","AETNA","44394","HC COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE","44394 - HC COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11406",null,"AETNA","44394 - HC COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE"]
["AETNA","AETNA","44404","HC COLONOSCOPY STOMA W/SUBMUCOSAL INJECTION","44404 - HC COLONOSCOPY STOMA W/SUBMUCOSAL INJECTION",null,null,null,null,null,"TUFTS HMO","11406",null,"AETNA","44404 - HC COLONOSCOPY STOMA W/SUBMUCOSAL INJECTION"]
["AETNA","AETNA","44405","HC COLONOSCOPY STOMA W/BALLOON DILATION","44405 - HC COLONOSCOPY STOMA W/BALLOON DILATION",null,null,null,null,null,"TUFTS POS","11406",null,"AETNA","44405 - HC COLONOSCOPY STOMA W/BALLOON DILATION"]
["AETNA","AETNA","44406","HR COLONOSCOPY STOMA W/ENDOSCOPIC ULTRASOUND EXAM","44406 - HR COLONOSCOPY STOMA W/ENDOSCOPIC ULTRASOUND EXAM",null,null,null,null,null,"TUFTS PPO","11406",null,"AETNA","44406 - HR COLONOSCOPY STOMA W/ENDOSCOPIC ULTRASOUND EXAM"]
["AETNA","AETNA","44705","PREPARE FECAL MICROBIOTA FOR INSTILLATION","44705 - PREPARE FECAL MICROBIOTA FOR INSTILLATION",null,null,null,null,null,"TUFTS SELECT","11406",null,"AETNA","44705 - PREPARE FECAL MICROBIOTA FOR INSTILLATION"]
["AETNA","AETNA","44799","PR DILATION OF ILEOSTOMY STRICTURE","44799 - PR DILATION OF ILEOSTOMY STRICTURE",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11406",null,"AETNA","44799 - PR DILATION OF ILEOSTOMY STRICTURE"]
["AETNA","AETNA","44970","HC LAPAROSCOPIC APPENDECTOMY","44970 - HC LAPAROSCOPIC APPENDECTOMY",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11406",null,"AETNA","44970 - HC LAPAROSCOPIC APPENDECTOMY"]
["AETNA","AETNA","45005","HC I&D RECTAL SUBMUCOSAL ABSCESS","45005 - HC I&D RECTAL SUBMUCOSAL ABSCESS",null,null,null,null,null,"AETNA","11420",null,"AETNA","45005 - HC I&D RECTAL SUBMUCOSAL ABSCESS"]
["AETNA","AETNA","45190","HC DESTRUCT,RECTAL TUMOR,TRANSANAL APPROACH","45190 - HC DESTRUCT,RECTAL TUMOR,TRANSANAL APPROACH",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11420",null,"AETNA","45190 - HC DESTRUCT,RECTAL TUMOR,TRANSANAL APPROACH"]
["AETNA","AETNA","45300","PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX","45300 - PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11420",null,"AETNA","45300 - PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX"]
["AETNA","AETNA","45305","HC PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE","45305 - HC PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11420",null,"AETNA","45305 - HC PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE"]
["AETNA","AETNA","45307","HC PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY","45307 - HC PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY",null,null,null,null,null,"BLUE CROSS-PPO","11420",null,"AETNA","45307 - HC PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY"]
["AETNA","AETNA","45317","HC PROCTOSIGMOIDOSCOPY BLEED","45317 - HC PROCTOSIGMOIDOSCOPY BLEED",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11420",null,"AETNA","45317 - HC PROCTOSIGMOIDOSCOPY BLEED"]
["AETNA","AETNA","45330","HC SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD","45330 - HC SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11420",null,"AETNA","45330 - HC SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD"]
["AETNA","AETNA","45331","HC COLON CA SCREEN;BARIUM ENEMA","45331 - HC COLON CA SCREEN;BARIUM ENEMA",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11420",null,"AETNA","45331 - HC COLON CA SCREEN;BARIUM ENEMA"]
["AETNA","AETNA","45332","HC SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY","45332 - HC SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY",null,null,null,null,null,"CIGNA CARELINK","11420",null,"AETNA","45332 - HC SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY"]
["AETNA","AETNA","45333","HC SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS","45333 - HC SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11420",null,"AETNA","45333 - HC SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS"]
["AETNA","AETNA","45334","HC SIGMOIDOSCOPY FLX CONTROL BLEEDING","45334 - HC SIGMOIDOSCOPY FLX CONTROL BLEEDING",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11420",null,"AETNA","45334 - HC SIGMOIDOSCOPY FLX CONTROL BLEEDING"]
["AETNA","AETNA","45335","HC SGMDSC FLX DIRED SBMCSL NJX ANY SBST","45335 - HC SGMDSC FLX DIRED SBMCSL NJX ANY SBST",null,null,null,null,null,"TUFTS HMO","11420",null,"AETNA","45335 - HC SGMDSC FLX DIRED SBMCSL NJX ANY SBST"]
["AETNA","AETNA","45337","HC SGMDSC FLX DCMPRN VOLVULUS ANY METHOD","45337 - HC SGMDSC FLX DCMPRN VOLVULUS ANY METHOD",null,null,null,null,null,"TUFTS POS","11420",null,"AETNA","45337 - HC SGMDSC FLX DCMPRN VOLVULUS ANY METHOD"]
["AETNA","AETNA","45338","HC SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ","45338 - HC SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ",null,null,null,null,null,"TUFTS PPO","11420",null,"AETNA","45338 - HC SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ"]
["AETNA","AETNA","45340","HC SIGMOIDOSCOPY FLX DILAT BALO 1/MORE STRIXS","45340 - HC SIGMOIDOSCOPY FLX DILAT BALO 1/MORE STRIXS",null,null,null,null,null,"TUFTS SELECT","11420",null,"AETNA","45340 - HC SIGMOIDOSCOPY FLX DILAT BALO 1/MORE STRIXS"]
["AETNA","AETNA","45341","HC SIGMOIDOSCOPY FLX NDSC US XM","45341 - HC SIGMOIDOSCOPY FLX NDSC US XM",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11420",null,"AETNA","45341 - HC SIGMOIDOSCOPY FLX NDSC US XM"]
["AETNA","AETNA","45342","HC SIGMOIDOSCOPY FLX TNDSC US GID NDL ASPIR/BX","45342 - HC SIGMOIDOSCOPY FLX TNDSC US GID NDL ASPIR/BX",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11420",null,"AETNA","45342 - HC SIGMOIDOSCOPY FLX TNDSC US GID NDL ASPIR/BX"]
["AETNA","AETNA","45346","HC SIGMOIDOSCOPY FLX ABLATION TUMOR POLYP/OTH LES","45346 - HC SIGMOIDOSCOPY FLX ABLATION TUMOR POLYP/OTH LES",null,null,null,null,null,"AETNA","11421",null,"AETNA","45346 - HC SIGMOIDOSCOPY FLX ABLATION TUMOR POLYP/OTH LES"]
["AETNA","AETNA","45347","HC SIGMOIDOSCOPY FLX PLACEMENT OF ENDOSCOPIC STENT","45347 - HC SIGMOIDOSCOPY FLX PLACEMENT OF ENDOSCOPIC STENT",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11421",null,"AETNA","45347 - HC SIGMOIDOSCOPY FLX PLACEMENT OF ENDOSCOPIC STENT"]
["AETNA","AETNA","45349","SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION","45349 - SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11421",null,"AETNA","45349 - SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION"]
["AETNA","AETNA","45350","HC SIGMOIDOSCOPY FLX WITH WITH BAND LIGATION(S)","45350 - HC SIGMOIDOSCOPY FLX WITH WITH BAND LIGATION(S)",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11421",null,"AETNA","45350 - HC SIGMOIDOSCOPY FLX WITH WITH BAND LIGATION(S)"]
["AETNA","AETNA","45379","HC COLSC FLX PROX SPLENIC FLXR RMVL FB","45379 - HC COLSC FLX PROX SPLENIC FLXR RMVL FB",null,null,null,null,null,"BLUE CROSS-PPO","11421",null,"AETNA","45379 - HC COLSC FLX PROX SPLENIC FLXR RMVL FB"]
["AETNA","AETNA","45380","COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11421",null,"AETNA","45380 - COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["AETNA","AETNA","45381","HC COLSC FLX PROX SPLENIC FLXR SBMCSL NJX","45381 - HC COLSC FLX PROX SPLENIC FLXR SBMCSL NJX",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11421",null,"AETNA","45381 - HC COLSC FLX PROX SPLENIC FLXR SBMCSL NJX"]
["AETNA","AETNA","45382","HC COLSC FLX PROX SPLENIC FLXR CTRL BLD","45382 - HC COLSC FLX PROX SPLENIC FLXR CTRL BLD",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11421",null,"AETNA","45382 - HC COLSC FLX PROX SPLENIC FLXR CTRL BLD"]
["AETNA","AETNA","45384","HC COLSC FLX PROX SPLENIC FLXR RMVL LES CAUT","45384 - HC COLSC FLX PROX SPLENIC FLXR RMVL LES CAUT",null,null,null,null,null,"CIGNA CARELINK","11421",null,"AETNA","45384 - HC COLSC FLX PROX SPLENIC FLXR RMVL LES CAUT"]
["AETNA","AETNA","45385","HC COLSC FLX PROX SPLENIC FLXR RMVL LES SNARE TQ","45385 - HC COLSC FLX PROX SPLENIC FLXR RMVL LES SNARE TQ",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11421",null,"AETNA","45385 - HC COLSC FLX PROX SPLENIC FLXR RMVL LES SNARE TQ"]
["AETNA","AETNA","45386","HC COLSC FLX PROX SPLENIC FLXR DILAT BALO 1/> STRI","45386 - HC COLSC FLX PROX SPLENIC FLXR DILAT BALO 1/> STRI",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11421",null,"AETNA","45386 - HC COLSC FLX PROX SPLENIC FLXR DILAT BALO 1/> STRI"]
["AETNA","AETNA","45388","HC COLONOSCOPY FLX ABLATION TUMOR POLYP/OTHER LES","45388 - HC COLONOSCOPY FLX ABLATION TUMOR POLYP/OTHER LES",null,null,null,null,null,"TUFTS HMO","11421",null,"AETNA","45388 - HC COLONOSCOPY FLX ABLATION TUMOR POLYP/OTHER LES"]
["AETNA","AETNA","45389","HC COLONOSCOPY FLX WITH ENDOSCOPIC STENT PLACEMENT","45389 - HC COLONOSCOPY FLX WITH ENDOSCOPIC STENT PLACEMENT",null,null,null,null,null,"TUFTS POS","11421",null,"AETNA","45389 - HC COLONOSCOPY FLX WITH ENDOSCOPIC STENT PLACEMENT"]
["AETNA","AETNA","45390","HC COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION","45390 - HC COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION",null,null,null,null,null,"TUFTS PPO","11421",null,"AETNA","45390 - HC COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION"]
["AETNA","AETNA","45391","HC COLSC FLX PROX SPLENIC FLXR NDSC US XM","45391 - HC COLSC FLX PROX SPLENIC FLXR NDSC US XM",null,null,null,null,null,"TUFTS SELECT","11421",null,"AETNA","45391 - HC COLSC FLX PROX SPLENIC FLXR NDSC US XM"]
["AETNA","AETNA","45392","HC COLSC FLX PROX SPLENIC FLXR US GID NDL ASPIR/BX","45392 - HC COLSC FLX PROX SPLENIC FLXR US GID NDL ASPIR/BX",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11421",null,"AETNA","45392 - HC COLSC FLX PROX SPLENIC FLXR US GID NDL ASPIR/BX"]
["AETNA","AETNA","45398","HC COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S)","45398 - HC COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S)",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11421",null,"AETNA","45398 - HC COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S)"]
["AETNA","AETNA","45910","HC DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL","45910 - HC DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL",null,null,null,null,null,"AETNA","11422",null,"AETNA","45910 - HC DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL"]
["AETNA","AETNA","45915","HC REMV RECTAL OBSTR:FECES/F.B. W ANEST","45915 - HC REMV RECTAL OBSTR:FECES/F.B. W ANEST",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11422",null,"AETNA","45915 - HC REMV RECTAL OBSTR:FECES/F.B. W ANEST"]
["AETNA","AETNA","46020","PLACEMENT ON SETON","46020 - PLACEMENT ON SETON",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11422",null,"AETNA","46020 - PLACEMENT ON SETON"]
["AETNA","AETNA","46030","REMOVAL OF RECTAL MARKER","46030 - REMOVAL OF RECTAL MARKER",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11422",null,"AETNA","46030 - REMOVAL OF RECTAL MARKER"]
["AETNA","AETNA","46040","I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX","46040 - I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX",null,null,null,null,null,"BLUE CROSS-PPO","11422",null,"AETNA","46040 - I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX"]
["AETNA","AETNA","46050","I&D PERIANAL ABSCESS SUPERFICIAL","46050 - I&D PERIANAL ABSCESS SUPERFICIAL",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11422",null,"AETNA","46050 - I&D PERIANAL ABSCESS SUPERFICIAL"]
["AETNA","AETNA","46060","I&D ISCHIORCT/INTRAMURAL ABSC W/WO SETON","46060 - I&D ISCHIORCT/INTRAMURAL ABSC W/WO SETON",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11422",null,"AETNA","46060 - I&D ISCHIORCT/INTRAMURAL ABSC W/WO SETON"]
["AETNA","AETNA","46083","INCISION THROMBOSED HEMORRHOID EXTERNAL","46083 - INCISION THROMBOSED HEMORRHOID EXTERNAL",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11422",null,"AETNA","46083 - INCISION THROMBOSED HEMORRHOID EXTERNAL"]
["AETNA","AETNA","46220","EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS","46220 - EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS",null,null,null,null,null,"CIGNA CARELINK","11422",null,"AETNA","46220 - EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS"]
["AETNA","AETNA","46221","HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS","46221 - HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11422",null,"AETNA","46221 - HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS"]
["AETNA","AETNA","46250","HC HEMORRHOIDECTOMY,EXTERNAL, 2+ COLUMNS/GROUPS","46250 - HC HEMORRHOIDECTOMY,EXTERNAL, 2+ COLUMNS/GROUPS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11422",null,"AETNA","46250 - HC HEMORRHOIDECTOMY,EXTERNAL, 2+ COLUMNS/GROUPS"]
["AETNA","AETNA","46255","HC HEMORRHOIDECTOMY,INT/EXT,1 COLUMN/GROUP","46255 - HC HEMORRHOIDECTOMY,INT/EXT,1 COLUMN/GROUP",null,null,null,null,null,"TUFTS HMO","11422",null,"AETNA","46255 - HC HEMORRHOIDECTOMY,INT/EXT,1 COLUMN/GROUP"]
["AETNA","AETNA","46260","HC HEMORRHOIDECTOMY INT & XTRNL 2/> COLUMN/GRO","46260 - HC HEMORRHOIDECTOMY INT & XTRNL 2/> COLUMN/GRO",null,null,null,null,null,"TUFTS POS","11422",null,"AETNA","46260 - HC HEMORRHOIDECTOMY INT & XTRNL 2/> COLUMN/GRO"]
["AETNA","AETNA","46320","HC EXCISION THROMBOSED HEMORRHOID, EXTERNAL","46320 - HC EXCISION THROMBOSED HEMORRHOID, EXTERNAL",null,null,null,null,null,"TUFTS PPO","11422",null,"AETNA","46320 - HC EXCISION THROMBOSED HEMORRHOID, EXTERNAL"]
["AETNA","AETNA","46505","CHEMODENERVATION ANAL SPHINCTER","46505 - CHEMODENERVATION ANAL SPHINCTER",null,null,null,null,null,"TUFTS SELECT","11422",null,"AETNA","46505 - CHEMODENERVATION ANAL SPHINCTER"]
["AETNA","AETNA","46600","ANOSCOPY DX W/WO COLLJ SPEC BR/WA SPX","46600 - ANOSCOPY DX W/WO COLLJ SPEC BR/WA SPX",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11422",null,"AETNA","46600 - ANOSCOPY DX W/WO COLLJ SPEC BR/WA SPX"]
["AETNA","AETNA","46601","HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT","46601 - HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11422",null,"AETNA","46601 - HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT"]
["AETNA","AETNA","46604","HC ANOSCOPY,W/DILATION","46604 - HC ANOSCOPY,W/DILATION",null,null,null,null,null,"AETNA","11423",null,"AETNA","46604 - HC ANOSCOPY,W/DILATION"]
["AETNA","AETNA","46606","ANOSCOPY W/BX SINGLE/MULTIPLE","46606 - ANOSCOPY W/BX SINGLE/MULTIPLE",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11423",null,"AETNA","46606 - ANOSCOPY W/BX SINGLE/MULTIPLE"]
["AETNA","AETNA","46607","HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT W/BX","46607 - HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT W/BX",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11423",null,"AETNA","46607 - HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT W/BX"]
["AETNA","AETNA","46608","HC ANOSCOPY,REMOVE FOREIGN BODY","46608 - HC ANOSCOPY,REMOVE FOREIGN BODY",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11423",null,"AETNA","46608 - HC ANOSCOPY,REMOVE FOREIGN BODY"]
["AETNA","AETNA","46610","HC ANOSCOPY W/RMVL LESION CAUTERY","46610 - HC ANOSCOPY W/RMVL LESION CAUTERY",null,null,null,null,null,"BLUE CROSS-PPO","11423",null,"AETNA","46610 - HC ANOSCOPY W/RMVL LESION CAUTERY"]
["AETNA","AETNA","46615","ANOSCOPY ABLATION LESION","46615 - ANOSCOPY ABLATION LESION",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11423",null,"AETNA","46615 - ANOSCOPY ABLATION LESION"]
["AETNA","AETNA","46900","DSTRJ LESION ANUS SIMPLE CHEMICAL","46900 - DSTRJ LESION ANUS SIMPLE CHEMICAL",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11423",null,"AETNA","46900 - DSTRJ LESION ANUS SIMPLE CHEMICAL"]
["AETNA","AETNA","46910","DSTRJ LESION ANUS SMPL ELTRDSICCATION","46910 - DSTRJ LESION ANUS SMPL ELTRDSICCATION",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11423",null,"AETNA","46910 - DSTRJ LESION ANUS SMPL ELTRDSICCATION"]
["AETNA","AETNA","46916","DSTRJ LESION ANUS SIMPLE CRYOSURGERY","46916 - DSTRJ LESION ANUS SIMPLE CRYOSURGERY",null,null,null,null,null,"CIGNA CARELINK","11423",null,"AETNA","46916 - DSTRJ LESION ANUS SIMPLE CRYOSURGERY"]
["AETNA","AETNA","46922","HC SURG EXCISION OF ANAL LESION(S)","46922 - HC SURG EXCISION OF ANAL LESION(S)",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11423",null,"AETNA","46922 - HC SURG EXCISION OF ANAL LESION(S)"]
["AETNA","AETNA","46924","DSTRJ LESION ANUS EXTENSIVE","46924 - DSTRJ LESION ANUS EXTENSIVE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11423",null,"AETNA","46924 - DSTRJ LESION ANUS EXTENSIVE"]
["AETNA","AETNA","47000","HEARING AID EXAMINATION & SELECTION MONAURAL","47000 - HEARING AID EXAMINATION & SELECTION MONAURAL",null,null,null,null,null,"TUFTS HMO","11423",null,"AETNA","47000 - HEARING AID EXAMINATION & SELECTION MONAURAL"]
["AETNA","AETNA","47001","HC BIO,LIVER AT OTH PROC","47001 - HC BIO,LIVER AT OTH PROC",null,null,null,null,null,"TUFTS POS","11423",null,"AETNA","47001 - HC BIO,LIVER AT OTH PROC"]
["AETNA","AETNA","47382","HC ABLTJ 1/> LVR TUM PRQ RF","47382 - HC ABLTJ 1/> LVR TUM PRQ RF",null,null,null,null,null,"TUFTS PPO","11423",null,"AETNA","47382 - HC ABLTJ 1/> LVR TUM PRQ RF"]
["AETNA","AETNA","47383","HC ABLATION 1/> LIVER TUMOR PERQ CRYOABLATION","47383 - HC ABLATION 1/> LIVER TUMOR PERQ CRYOABLATION",null,null,null,null,null,"TUFTS SELECT","11423",null,"AETNA","47383 - HC ABLATION 1/> LIVER TUMOR PERQ CRYOABLATION"]
["AETNA","AETNA","47531","NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS","47531 - NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11423",null,"AETNA","47531 - NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS"]
["AETNA","AETNA","47532","NJX CHOLANGIO PRQ W/IMG GID RS&I NEW ACCESS","47532 - NJX CHOLANGIO PRQ W/IMG GID RS&I NEW ACCESS",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11423",null,"AETNA","47532 - NJX CHOLANGIO PRQ W/IMG GID RS&I NEW ACCESS"]
["AETNA","AETNA","47533","PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL","47533 - PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL",null,null,null,null,null,"AETNA","11424",null,"AETNA","47533 - PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL"]
["AETNA","AETNA","47534","PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I INT-EXT","47534 - PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I INT-EXT",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11424",null,"AETNA","47534 - PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I INT-EXT"]
["AETNA","AETNA","47535","HC CONV EXT BIL DRG CATH TO INT-EXT BIL DRG CATH","47535 - HC CONV EXT BIL DRG CATH TO INT-EXT BIL DRG CATH",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11424",null,"AETNA","47535 - HC CONV EXT BIL DRG CATH TO INT-EXT BIL DRG CATH"]
["AETNA","AETNA","47536","EXCHANGE BILIARY DRG CATHETER PRQ W/IMAGE GUID RAD S&I","47536 - EXCHANGE BILIARY DRG CATHETER PRQ W/IMAGE GUID RAD S&I",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11424",null,"AETNA","47536 - EXCHANGE BILIARY DRG CATHETER PRQ W/IMAGE GUID RAD S&I"]
["AETNA","AETNA","47537","REMOVAL BILIARY DRG CATHETER REQ FLUOR GUID RAD S&I","47537 - REMOVAL BILIARY DRG CATHETER REQ FLUOR GUID RAD S&I",null,null,null,null,null,"BLUE CROSS-PPO","11424",null,"AETNA","47537 - REMOVAL BILIARY DRG CATHETER REQ FLUOR GUID RAD S&I"]
["AETNA","AETNA","47538","HC PERQ PLMTBIL DUCTSTNT EX","47538 - HC PERQ PLMTBIL DUCTSTNT EX",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11424",null,"AETNA","47538 - HC PERQ PLMTBIL DUCTSTNT EX"]
["AETNA","AETNA","47542","BALLOON DILAT BILIARY DUCT/AMPULLA PRQ EACH DUCT","47542 - BALLOON DILAT BILIARY DUCT/AMPULLA PRQ EACH DUCT",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11424",null,"AETNA","47542 - BALLOON DILAT BILIARY DUCT/AMPULLA PRQ EACH DUCT"]
["AETNA","AETNA","47552","HC BILIARY ENDO PRQ T-TUBE DX W/COLLECT SPEC BRUSH","47552 - HC BILIARY ENDO PRQ T-TUBE DX W/COLLECT SPEC BRUSH",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11424",null,"AETNA","47552 - HC BILIARY ENDO PRQ T-TUBE DX W/COLLECT SPEC BRUSH"]
["AETNA","AETNA","47554","HC BILIARY ENDOSCOPY,PERCUT,W/REM, STONE(S)","47554 - HC BILIARY ENDOSCOPY,PERCUT,W/REM, STONE(S)",null,null,null,null,null,"CIGNA CARELINK","11424",null,"AETNA","47554 - HC BILIARY ENDOSCOPY,PERCUT,W/REM, STONE(S)"]
["AETNA","AETNA","47555","HC BIL ENDO,PERC;DIL W/O STE","47555 - HC BIL ENDO,PERC;DIL W/O STE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11424",null,"AETNA","47555 - HC BIL ENDO,PERC;DIL W/O STE"]
["AETNA","AETNA","47556","HC BILIARY NDSC PRQ T-TUBE DILAT STRIX W/STENT","47556 - HC BILIARY NDSC PRQ T-TUBE DILAT STRIX W/STENT",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11424",null,"AETNA","47556 - HC BILIARY NDSC PRQ T-TUBE DILAT STRIX W/STENT"]
["AETNA","AETNA","48102","HC BIOPSY PANCREA PERCUTANEOUS NEEDLE","48102 - HC BIOPSY PANCREA PERCUTANEOUS NEEDLE",null,null,null,null,null,"TUFTS HMO","11424",null,"AETNA","48102 - HC BIOPSY PANCREA PERCUTANEOUS NEEDLE"]
["AETNA","AETNA","49010","HC EXPLORATORY RETROPERITONEAL","49010 - HC EXPLORATORY RETROPERITONEAL",null,null,null,null,null,"TUFTS POS","11424",null,"AETNA","49010 - HC EXPLORATORY RETROPERITONEAL"]
["AETNA","AETNA","49082","ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE","49082 - ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE",null,null,null,null,null,"TUFTS PPO","11424",null,"AETNA","49082 - ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE"]
["AETNA","AETNA","49083","ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE","49083 - ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE",null,null,null,null,null,"TUFTS SELECT","11424",null,"AETNA","49083 - ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE"]
["AETNA","AETNA","49180","BX ABDL/RETROPERITONEAL MASS PRQ NEEDLE","49180 - BX ABDL/RETROPERITONEAL MASS PRQ NEEDLE",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11424",null,"AETNA","49180 - BX ABDL/RETROPERITONEAL MASS PRQ NEEDLE"]
["AETNA","AETNA","49185","SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID","49185 - SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11424",null,"AETNA","49185 - SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID"]
["AETNA","AETNA","49320","HC LAP,DIAGNOSTIC ABDOMEN","49320 - HC LAP,DIAGNOSTIC ABDOMEN",null,null,null,null,null,"AETNA","11426",null,"AETNA","49320 - HC LAP,DIAGNOSTIC ABDOMEN"]
["AETNA","AETNA","49321","HC LAP,DX SURGICAL ABD W/BIOPSY","49321 - HC LAP,DX SURGICAL ABD W/BIOPSY",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11426",null,"AETNA","49321 - HC LAP,DX SURGICAL ABD W/BIOPSY"]
["AETNA","AETNA","49324","HC LAP INSERTION TUNNELED INTRAPERITONEAL CATHETER","49324 - HC LAP INSERTION TUNNELED INTRAPERITONEAL CATHETER",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11426",null,"AETNA","49324 - HC LAP INSERTION TUNNELED INTRAPERITONEAL CATHETER"]
["AETNA","AETNA","49329","HC LAPARO PROC ABDM/PER/OMENT","49329 - HC LAPARO PROC ABDM/PER/OMENT",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11426",null,"AETNA","49329 - HC LAPARO PROC ABDM/PER/OMENT"]
["AETNA","AETNA","49405","IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ","49405 - IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ",null,null,null,null,null,"BLUE CROSS-PPO","11426",null,"AETNA","49405 - IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ"]
["AETNA","AETNA","49406","IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ","49406 - IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11426",null,"AETNA","49406 - IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ"]
["AETNA","AETNA","49407","IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL","49407 - IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11426",null,"AETNA","49407 - IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL"]
["AETNA","AETNA","49411","INTERSTITIAL DEV PLMT RADIATION THERAPY 1/MLT","49411 - INTERSTITIAL DEV PLMT RADIATION THERAPY 1/MLT",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11426",null,"AETNA","49411 - INTERSTITIAL DEV PLMT RADIATION THERAPY 1/MLT"]
["AETNA","AETNA","49418","INSJ INTRAPERITONEAL CATHETER W/IMG GID","49418 - INSJ INTRAPERITONEAL CATHETER W/IMG GID",null,null,null,null,null,"CIGNA CARELINK","11426",null,"AETNA","49418 - INSJ INTRAPERITONEAL CATHETER W/IMG GID"]
["AETNA","AETNA","49422","REMOVE TUNNELED IP CATH","49422 - REMOVE TUNNELED IP CATH",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11426",null,"AETNA","49422 - REMOVE TUNNELED IP CATH"]
["AETNA","AETNA","49423","HC EXCHNG ABSC/CST DRG CATH RAD GID SPX","49423 - HC EXCHNG ABSC/CST DRG CATH RAD GID SPX",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11426",null,"AETNA","49423 - HC EXCHNG ABSC/CST DRG CATH RAD GID SPX"]
["AETNA","AETNA","49424","HC INJ CONT ABS/CY EVAL","49424 - HC INJ CONT ABS/CY EVAL",null,null,null,null,null,"TUFTS HMO","11426",null,"AETNA","49424 - HC INJ CONT ABS/CY EVAL"]
["AETNA","AETNA","49427","HC INJ PROC EXIST VP SHUNT","49427 - HC INJ PROC EXIST VP SHUNT",null,null,null,null,null,"TUFTS POS","11426",null,"AETNA","49427 - HC INJ PROC EXIST VP SHUNT"]
["AETNA","AETNA","49440","INSERT GASTROSTOMY TUBE PERCUTANEOUS","49440 - INSERT GASTROSTOMY TUBE PERCUTANEOUS",null,null,null,null,null,"TUFTS PPO","11426",null,"AETNA","49440 - INSERT GASTROSTOMY TUBE PERCUTANEOUS"]
["AETNA","AETNA","49441","HC INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ","49441 - HC INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ",null,null,null,null,null,"TUFTS SELECT","11426",null,"AETNA","49441 - HC INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ"]
["AETNA","AETNA","49446","HC CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERQ","49446 - HC CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERQ",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11426",null,"AETNA","49446 - HC CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERQ"]
["AETNA","AETNA","49450","HC REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS","49450 - HC REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11426",null,"AETNA","49450 - HC REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS"]
["AETNA","AETNA","49451","HC PERC REPL DUD/JEJ TUBE,W/","49451 - HC PERC REPL DUD/JEJ TUBE,W/",null,null,null,null,null,"AETNA","11440",null,"AETNA","49451 - HC PERC REPL DUD/JEJ TUBE,W/"]
["AETNA","AETNA","49452","HC PERC REPL GAST_JEJ TUBE,W","49452 - HC PERC REPL GAST_JEJ TUBE,W",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11440",null,"AETNA","49452 - HC PERC REPL GAST_JEJ TUBE,W"]
["AETNA","AETNA","49460","HC FIX G/COLON TUBE W/DEVICE","49460 - HC FIX G/COLON TUBE W/DEVICE",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11440",null,"AETNA","49460 - HC FIX G/COLON TUBE W/DEVICE"]
["AETNA","AETNA","49465","HC CONTRAST INJECTION PERQ RADIOLOGIC EVAL GI TUBE","49465 - HC CONTRAST INJECTION PERQ RADIOLOGIC EVAL GI TUBE",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11440",null,"AETNA","49465 - HC CONTRAST INJECTION PERQ RADIOLOGIC EVAL GI TUBE"]
["AETNA","AETNA","49570","HC REPAIR EPIGASTRIC HERNIA,REDUC","49570 - HC REPAIR EPIGASTRIC HERNIA,REDUC",null,null,null,null,null,"BLUE CROSS-PPO","11440",null,"AETNA","49570 - HC REPAIR EPIGASTRIC HERNIA,REDUC"]
["AETNA","AETNA","50200","RENAL BIOPSY PRQ TROCAR/NEEDLE","50200 - RENAL BIOPSY PRQ TROCAR/NEEDLE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11440",null,"AETNA","50200 - RENAL BIOPSY PRQ TROCAR/NEEDLE"]
["AETNA","AETNA","50382","HC RMVL & RPLCMT INTLY DWELLING URETERAL STENT PRQ","50382 - HC RMVL & RPLCMT INTLY DWELLING URETERAL STENT PRQ",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11440",null,"AETNA","50382 - HC RMVL & RPLCMT INTLY DWELLING URETERAL STENT PRQ"]
["AETNA","AETNA","50385","HC REMOVE & REPLACE INDWELL URETERAL STENT TRURTHRL","50385 - HC REMOVE & REPLACE INDWELL URETERAL STENT TRURTHRL",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11440",null,"AETNA","50385 - HC REMOVE & REPLACE INDWELL URETERAL STENT TRURTHRL"]
["AETNA","AETNA","50386","HC REM URET STENT,TRANS,W/O","50386 - HC REM URET STENT,TRANS,W/O",null,null,null,null,null,"CIGNA CARELINK","11440",null,"AETNA","50386 - HC REM URET STENT,TRANS,W/O"]
["AETNA","AETNA","50387","HC RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH","50387 - HC RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11440",null,"AETNA","50387 - HC RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH"]
["AETNA","AETNA","50389","HC RMVL NFROS TUBE REQ FLUORO GUIDANCE","50389 - HC RMVL NFROS TUBE REQ FLUORO GUIDANCE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11440",null,"AETNA","50389 - HC RMVL NFROS TUBE REQ FLUORO GUIDANCE"]
["AETNA","AETNA","50390","ASPIR &/NJX RENAL CYST/PELVIS NEEDLE PRQ","50390 - ASPIR &/NJX RENAL CYST/PELVIS NEEDLE PRQ",null,null,null,null,null,"TUFTS HMO","11440",null,"AETNA","50390 - ASPIR &/NJX RENAL CYST/PELVIS NEEDLE PRQ"]
["AETNA","AETNA","50430","HC NJX PX ANTEGRDE NFROSGRM &/URTRGRM NEW ACCESS","50430 - HC NJX PX ANTEGRDE NFROSGRM &/URTRGRM NEW ACCESS",null,null,null,null,null,"TUFTS POS","11440",null,"AETNA","50430 - HC NJX PX ANTEGRDE NFROSGRM &/URTRGRM NEW ACCESS"]
["AETNA","AETNA","50431","HC NJX ANTGRD NPHRSTGRM &/OR URTRGRM COMPL DIAG INCL IMG GUI RAD S&I; EXSTNG ACCES","50431 - HC NJX ANTGRD NPHRSTGRM &/OR URTRGRM COMPL DIAG INCL IMG GUI RAD S&I; EXSTNG ACCES",null,null,null,null,null,"TUFTS PPO","11440",null,"AETNA","50431 - HC NJX ANTGRD NPHRSTGRM &/OR URTRGRM COMPL DIAG INCL IMG GUI RAD S&I; EXSTNG ACCES"]
["AETNA","AETNA","50432","HC PLACEMENT NEPHROSTOMY CATH PRQ NEW ACCESS RAD S&I","50432 - HC PLACEMENT NEPHROSTOMY CATH PRQ NEW ACCESS RAD S&I",null,null,null,null,null,"TUFTS SELECT","11440",null,"AETNA","50432 - HC PLACEMENT NEPHROSTOMY CATH PRQ NEW ACCESS RAD S&I"]
["AETNA","AETNA","50433","PLACEMENT NEPHROURETERAL CATH PRQ NEW ACCESS RAD S&I","50433 - PLACEMENT NEPHROURETERAL CATH PRQ NEW ACCESS RAD S&I",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11440",null,"AETNA","50433 - PLACEMENT NEPHROURETERAL CATH PRQ NEW ACCESS RAD S&I"]
["AETNA","AETNA","50434","CONVERT NEPHROSTOMY CATH TO NEPHROURTRL CATH PRQ","50434 - CONVERT NEPHROSTOMY CATH TO NEPHROURTRL CATH PRQ",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11440",null,"AETNA","50434 - CONVERT NEPHROSTOMY CATH TO NEPHROURTRL CATH PRQ"]
["AETNA","AETNA","50435","EXCHANGE NEPHROSTOMY CATHETER PRQ W/IMAGE GUIDE RAD S&I","50435 - EXCHANGE NEPHROSTOMY CATHETER PRQ W/IMAGE GUIDE RAD S&I",null,null,null,null,null,"AETNA","11441",null,"AETNA","50435 - EXCHANGE NEPHROSTOMY CATHETER PRQ W/IMAGE GUIDE RAD S&I"]
["AETNA","AETNA","50436","HC DILAT XST TRC NDURLGC PX","50436 - HC DILAT XST TRC NDURLGC PX",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11441",null,"AETNA","50436 - HC DILAT XST TRC NDURLGC PX"]
["AETNA","AETNA","50437","HC DILAT XST TRC NEW ACCESS RCS","50437 - HC DILAT XST TRC NEW ACCESS RCS",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11441",null,"AETNA","50437 - HC DILAT XST TRC NEW ACCESS RCS"]
["AETNA","AETNA","50561","HC RENAL ENDOSCOPY,REMV FB/STONE","50561 - HC RENAL ENDOSCOPY,REMV FB/STONE",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11441",null,"AETNA","50561 - HC RENAL ENDOSCOPY,REMV FB/STONE"]
["AETNA","AETNA","50592","HC ABLTJ 1/> RENAL TUMOR PRQ UNI RADIOFREQUENCY","50592 - HC ABLTJ 1/> RENAL TUMOR PRQ UNI RADIOFREQUENCY",null,null,null,null,null,"BLUE CROSS-PPO","11441",null,"AETNA","50592 - HC ABLTJ 1/> RENAL TUMOR PRQ UNI RADIOFREQUENCY"]
["AETNA","AETNA","50593","HC ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY","50593 - HC ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11441",null,"AETNA","50593 - HC ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY"]
["AETNA","AETNA","50684","INJ PX URETEROGRAPHY/URETEROPYLOGRAPHY CATH","50684 - INJ PX URETEROGRAPHY/URETEROPYLOGRAPHY CATH",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11441",null,"AETNA","50684 - INJ PX URETEROGRAPHY/URETEROPYLOGRAPHY CATH"]
["AETNA","AETNA","50688","CHNG URTROST TUBE/XTRNLLY ACCESSIBLE STENT ILEAL","50688 - CHNG URTROST TUBE/XTRNLLY ACCESSIBLE STENT ILEAL",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11441",null,"AETNA","50688 - CHNG URTROST TUBE/XTRNLLY ACCESSIBLE STENT ILEAL"]
["AETNA","AETNA","50693","PLACEMENT URETERAL STENT PRQ WITH PRE-EXISTING NEPHROSTOMY TRACT","50693 - PLACEMENT URETERAL STENT PRQ WITH PRE-EXISTING NEPHROSTOMY TRACT",null,null,null,null,null,"CIGNA CARELINK","11441",null,"AETNA","50693 - PLACEMENT URETERAL STENT PRQ WITH PRE-EXISTING NEPHROSTOMY TRACT"]
["AETNA","AETNA","50694","PLACEMENT URETERAL STENT PRQ NEW ACESS WITHOUT SEP NEPHROSTOMY CATH","50694 - PLACEMENT URETERAL STENT PRQ NEW ACESS WITHOUT SEP NEPHROSTOMY CATH",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11441",null,"AETNA","50694 - PLACEMENT URETERAL STENT PRQ NEW ACESS WITHOUT SEP NEPHROSTOMY CATH"]
["AETNA","AETNA","50695","HC PLMT URET STNTW/SEP NEPH","50695 - HC PLMT URET STNTW/SEP NEPH",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11441",null,"AETNA","50695 - HC PLMT URET STNTW/SEP NEPH"]
["AETNA","AETNA","51100","HC ASPIRATION BLADDER NEEDLE","51100 - HC ASPIRATION BLADDER NEEDLE",null,null,null,null,null,"TUFTS HMO","11441",null,"AETNA","51100 - HC ASPIRATION BLADDER NEEDLE"]
["AETNA","AETNA","51102","HC ASP BLADDER;W/INS SUPRAPU","51102 - HC ASP BLADDER;W/INS SUPRAPU",null,null,null,null,null,"TUFTS POS","11441",null,"AETNA","51102 - HC ASP BLADDER;W/INS SUPRAPU"]
["AETNA","AETNA","51700","BLDR IRRIGATION SMPL LAVAGE &/INSTLJ","51700 - BLDR IRRIGATION SMPL LAVAGE &/INSTLJ",null,null,null,null,null,"TUFTS PPO","11441",null,"AETNA","51700 - BLDR IRRIGATION SMPL LAVAGE &/INSTLJ"]
["AETNA","AETNA","51701","INSJ NON-NDWELLG BLADDER CATHETER","51701 - INSJ NON-NDWELLG BLADDER CATHETER",null,null,null,null,null,"TUFTS SELECT","11441",null,"AETNA","51701 - INSJ NON-NDWELLG BLADDER CATHETER"]
["AETNA","AETNA","51702","INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE","51702 - INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11441",null,"AETNA","51702 - INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE"]
["AETNA","AETNA","51703","INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED","51703 - INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11441",null,"AETNA","51703 - INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED"]
["AETNA","AETNA","51705","CHANGE CYSTOSTOMY TUBE SIMPLE","51705 - CHANGE CYSTOSTOMY TUBE SIMPLE",null,null,null,null,null,"AETNA","11442",null,"AETNA","51705 - CHANGE CYSTOSTOMY TUBE SIMPLE"]
["AETNA","AETNA","51710","CHANGE CYSTOSTOMY TUBE COMPLICATED","51710 - CHANGE CYSTOSTOMY TUBE COMPLICATED",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11442",null,"AETNA","51710 - CHANGE CYSTOSTOMY TUBE COMPLICATED"]
["AETNA","AETNA","51720","BLADDER INSTILLATION ANTICARCINOGENIC AGENT","51720 - BLADDER INSTILLATION ANTICARCINOGENIC AGENT",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11442",null,"AETNA","51720 - BLADDER INSTILLATION ANTICARCINOGENIC AGENT"]
["AETNA","AETNA","51725","SIMPLE CYSTOMETROGRAM","51725 - SIMPLE CYSTOMETROGRAM",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11442",null,"AETNA","51725 - SIMPLE CYSTOMETROGRAM"]
["AETNA","AETNA","51726","BLADDER PRESSURE MEASUREMENT DURING FILLING","51726 - BLADDER PRESSURE MEASUREMENT DURING FILLING",null,null,null,null,null,"BLUE CROSS-PPO","11442",null,"AETNA","51726 - BLADDER PRESSURE MEASUREMENT DURING FILLING"]
["AETNA","AETNA","51727","COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE","51727 - COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11442",null,"AETNA","51727 - COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE"]
["AETNA","AETNA","51728","COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES","51728 - COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11442",null,"AETNA","51728 - COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES"]
["AETNA","AETNA","51729","COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL","51729 - COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11442",null,"AETNA","51729 - COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL"]
["AETNA","AETNA","51785","NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ","51785 - NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ",null,null,null,null,null,"CIGNA CARELINK","11442",null,"AETNA","51785 - NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ"]
["AETNA","AETNA","51797","VOID PRESSURE STUDIES INTRAABDOMINAL","51797 - VOID PRESSURE STUDIES INTRAABDOMINAL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11442",null,"AETNA","51797 - VOID PRESSURE STUDIES INTRAABDOMINAL"]
["AETNA","AETNA","52000","CYSTOURETHROSCOPY","52000 - CYSTOURETHROSCOPY",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11442",null,"AETNA","52000 - CYSTOURETHROSCOPY"]
["AETNA","AETNA","52005","HC CYSTOURETHROSCOPY,URETER CATHETER","52005 - HC CYSTOURETHROSCOPY,URETER CATHETER",null,null,null,null,null,"TUFTS HMO","11442",null,"AETNA","52005 - HC CYSTOURETHROSCOPY,URETER CATHETER"]
["AETNA","AETNA","52224","CYSTO W/REMOVAL OF LESIONS SMALL","52224 - CYSTO W/REMOVAL OF LESIONS SMALL",null,null,null,null,null,"TUFTS POS","11442",null,"AETNA","52224 - CYSTO W/REMOVAL OF LESIONS SMALL"]
["AETNA","AETNA","52234","HC CYSTO W/REMOVAL OF TUMORS SMALL","52234 - HC CYSTO W/REMOVAL OF TUMORS SMALL",null,null,null,null,null,"TUFTS PPO","11442",null,"AETNA","52234 - HC CYSTO W/REMOVAL OF TUMORS SMALL"]
["AETNA","AETNA","52281","CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS","52281 - CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS",null,null,null,null,null,"TUFTS SELECT","11442",null,"AETNA","52281 - CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS"]
["AETNA","AETNA","52285","HC CYSTOSCOPY AND TREATMENT","52285 - HC CYSTOSCOPY AND TREATMENT",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11442",null,"AETNA","52285 - HC CYSTOSCOPY AND TREATMENT"]
["AETNA","AETNA","52310","CYSTO W/SIMPLE REMOVAL STONE & STENT","52310 - CYSTO W/SIMPLE REMOVAL STONE & STENT",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11442",null,"AETNA","52310 - CYSTO W/SIMPLE REMOVAL STONE & STENT"]
["AETNA","AETNA","52332","HC CYSTOSCOPY, INSERT URETERAL STENT","52332 - HC CYSTOSCOPY, INSERT URETERAL STENT",null,null,null,null,null,"AETNA","11443",null,"AETNA","52332 - HC CYSTOSCOPY, INSERT URETERAL STENT"]
["AETNA","AETNA","52351","HC CYSTO/URETERO/PYELOSCOPY, DX","52351 - HC CYSTO/URETERO/PYELOSCOPY, DX",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11443",null,"AETNA","52351 - HC CYSTO/URETERO/PYELOSCOPY, DX"]
["AETNA","AETNA","52356","HC CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT","52356 - HC CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11443",null,"AETNA","52356 - HC CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT"]
["AETNA","AETNA","53450","HC REVISION OF URETHRA","53450 - HC REVISION OF URETHRA",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11443",null,"AETNA","53450 - HC REVISION OF URETHRA"]
["AETNA","AETNA","53600","DILAT URETHRAL STRIX DILATOR MALE 1ST","53600 - DILAT URETHRAL STRIX DILATOR MALE 1ST",null,null,null,null,null,"BLUE CROSS-PPO","11443",null,"AETNA","53600 - DILAT URETHRAL STRIX DILATOR MALE 1ST"]
["AETNA","AETNA","53620","DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE 1ST","53620 - DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE 1ST",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11443",null,"AETNA","53620 - DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE 1ST"]
["AETNA","AETNA","53660","HC DILATION OF URETHRA","53660 - HC DILATION OF URETHRA",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11443",null,"AETNA","53660 - HC DILATION OF URETHRA"]
["AETNA","AETNA","53854","HC TRURL DSTRJ PRST8 TISS RF WV THERMOTHERAPY","53854 - HC TRURL DSTRJ PRST8 TISS RF WV THERMOTHERAPY",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11443",null,"AETNA","53854 - HC TRURL DSTRJ PRST8 TISS RF WV THERMOTHERAPY"]
["AETNA","AETNA","53899","HC URETERAL DILATION","53899 - HC URETERAL DILATION",null,null,null,null,null,"CIGNA CARELINK","11443",null,"AETNA","53899 - HC URETERAL DILATION"]
["AETNA","AETNA","54001","HC SLITTING OF PREPUCE","54001 - HC SLITTING OF PREPUCE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11443",null,"AETNA","54001 - HC SLITTING OF PREPUCE"]
["AETNA","AETNA","54060","HC DESTR PENIS LESN,SIMPL,SURG EXCIS","54060 - HC DESTR PENIS LESN,SIMPL,SURG EXCIS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11443",null,"AETNA","54060 - HC DESTR PENIS LESN,SIMPL,SURG EXCIS"]
["AETNA","AETNA","54065","DSTRJ LESION PENIS EXTENSIVE","54065 - DSTRJ LESION PENIS EXTENSIVE",null,null,null,null,null,"TUFTS HMO","11443",null,"AETNA","54065 - DSTRJ LESION PENIS EXTENSIVE"]
["AETNA","AETNA","54100","BIOPSY PENIS SEPARATE PROCEDURE","54100 - BIOPSY PENIS SEPARATE PROCEDURE",null,null,null,null,null,"TUFTS POS","11443",null,"AETNA","54100 - BIOPSY PENIS SEPARATE PROCEDURE"]
["AETNA","AETNA","54115","HC REMV FOR.BODY DEEP PENILE TISS","54115 - HC REMV FOR.BODY DEEP PENILE TISS",null,null,null,null,null,"TUFTS PPO","11443",null,"AETNA","54115 - HC REMV FOR.BODY DEEP PENILE TISS"]
["AETNA","AETNA","54150","CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK","54150 - CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK",null,null,null,null,null,"TUFTS SELECT","11443",null,"AETNA","54150 - CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK"]
["AETNA","AETNA","54161","HC CIRCUM 28 DAYS OR OLDER","54161 - HC CIRCUM 28 DAYS OR OLDER",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11443",null,"AETNA","54161 - HC CIRCUM 28 DAYS OR OLDER"]
["AETNA","AETNA","54162","HC LYSIS/EXCIS,PENILE POSTCIRCUM ADHESIONS","54162 - HC LYSIS/EXCIS,PENILE POSTCIRCUM ADHESIONS",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11443",null,"AETNA","54162 - HC LYSIS/EXCIS,PENILE POSTCIRCUM ADHESIONS"]
["AETNA","AETNA","54164","FRENULOTOMY PENIS","54164 - FRENULOTOMY PENIS",null,null,null,null,null,"AETNA","11444",null,"AETNA","54164 - FRENULOTOMY PENIS"]
["AETNA","AETNA","54220","IRRIGATION CORPORA CAVERNOSA PRIAPISM","54220 - IRRIGATION CORPORA CAVERNOSA PRIAPISM",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11444",null,"AETNA","54220 - IRRIGATION CORPORA CAVERNOSA PRIAPISM"]
["AETNA","AETNA","54450","FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING","54450 - FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11444",null,"AETNA","54450 - FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING"]
["AETNA","AETNA","54520","HC REMOVAL OF TESTIS","54520 - HC REMOVAL OF TESTIS",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11444",null,"AETNA","54520 - HC REMOVAL OF TESTIS"]
["AETNA","AETNA","54600","HC REDUCE TESTIS TORSION","54600 - HC REDUCE TESTIS TORSION",null,null,null,null,null,"BLUE CROSS-PPO","11444",null,"AETNA","54600 - HC REDUCE TESTIS TORSION"]
["AETNA","AETNA","54700","I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE","54700 - I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11444",null,"AETNA","54700 - I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE"]
["AETNA","AETNA","55100","DRAIN SCROTAL WALL ABS","55100 - DRAIN SCROTAL WALL ABS",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11444",null,"AETNA","55100 - DRAIN SCROTAL WALL ABS"]
["AETNA","AETNA","55120","HB REMOVAL OF SCROTAL FOR BODY","55120 - HB REMOVAL OF SCROTAL FOR BODY",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11444",null,"AETNA","55120 - HB REMOVAL OF SCROTAL FOR BODY"]
["AETNA","AETNA","55250","VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS","55250 - VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS",null,null,null,null,null,"CIGNA CARELINK","11444",null,"AETNA","55250 - VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS"]
["AETNA","AETNA","55400","HC REPAIR OF SPERM DUCT","55400 - HC REPAIR OF SPERM DUCT",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11444",null,"AETNA","55400 - HC REPAIR OF SPERM DUCT"]
["AETNA","AETNA","55520","HC REMOVAL OF SPERM CORD LESION","55520 - HC REMOVAL OF SPERM CORD LESION",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11444",null,"AETNA","55520 - HC REMOVAL OF SPERM CORD LESION"]
["AETNA","AETNA","55700","PROSTATE NEEDLE BIOPSY ANY APPROACH","55700 - PROSTATE NEEDLE BIOPSY ANY APPROACH",null,null,null,null,null,"TUFTS HMO","11444",null,"AETNA","55700 - PROSTATE NEEDLE BIOPSY ANY APPROACH"]
["AETNA","AETNA","55876","PLMT INTERSTITIAL DEV RADIAT TX PROSTATE 1/MULT","55876 - PLMT INTERSTITIAL DEV RADIAT TX PROSTATE 1/MULT",null,null,null,null,null,"TUFTS POS","11444",null,"AETNA","55876 - PLMT INTERSTITIAL DEV RADIAT TX PROSTATE 1/MULT"]
["AETNA","AETNA","55899","UNLISTED PROCEDURE MALE GENITAL SYSTEM","55899 - UNLISTED PROCEDURE MALE GENITAL SYSTEM",null,null,null,null,null,"TUFTS PPO","11444",null,"AETNA","55899 - UNLISTED PROCEDURE MALE GENITAL SYSTEM"]
["AETNA","AETNA","56405","I&D VULVA/PERINEAL ABSCESS","56405 - I&D VULVA/PERINEAL ABSCESS",null,null,null,null,null,"TUFTS SELECT","11444",null,"AETNA","56405 - I&D VULVA/PERINEAL ABSCESS"]
["AETNA","AETNA","56420","I&D OF BARTHOLINS GLAND ABSCESS","56420 - I&D OF BARTHOLINS GLAND ABSCESS",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11444",null,"AETNA","56420 - I&D OF BARTHOLINS GLAND ABSCESS"]
["AETNA","AETNA","56440","MARSUPIALIZATION BARTHOLINS GLAND CYST","56440 - MARSUPIALIZATION BARTHOLINS GLAND CYST",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11444",null,"AETNA","56440 - MARSUPIALIZATION BARTHOLINS GLAND CYST"]
["AETNA","AETNA","56442","HYMENOTOMY","56442 - HYMENOTOMY",null,null,null,null,null,"AETNA","11446",null,"AETNA","56442 - HYMENOTOMY"]
["AETNA","AETNA","56501","DESTRUCTION LESIONS VULVA SIMPLE","56501 - DESTRUCTION LESIONS VULVA SIMPLE",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11446",null,"AETNA","56501 - DESTRUCTION LESIONS VULVA SIMPLE"]
["AETNA","AETNA","56515","DESTRUCTION LESIONS VULVA EXTENSIVE","56515 - DESTRUCTION LESIONS VULVA EXTENSIVE",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11446",null,"AETNA","56515 - DESTRUCTION LESIONS VULVA EXTENSIVE"]
["AETNA","AETNA","56605","BIOPSY VULVA/PERINEUM 1 LESION SPX","56605 - BIOPSY VULVA/PERINEUM 1 LESION SPX",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11446",null,"AETNA","56605 - BIOPSY VULVA/PERINEUM 1 LESION SPX"]
["AETNA","AETNA","56606","BIOPSY VULVA/PERINEUM EACH ADDL LESION","56606 - BIOPSY VULVA/PERINEUM EACH ADDL LESION",null,null,null,null,null,"BLUE CROSS-PPO","11446",null,"AETNA","56606 - BIOPSY VULVA/PERINEUM EACH ADDL LESION"]
["AETNA","AETNA","56620","HC PART SIMPLE REMV VULVA","56620 - HC PART SIMPLE REMV VULVA",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11446",null,"AETNA","56620 - HC PART SIMPLE REMV VULVA"]
["AETNA","AETNA","56700","HC PARTIAL REMOVAL OF HYMEN","56700 - HC PARTIAL REMOVAL OF HYMEN",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11446",null,"AETNA","56700 - HC PARTIAL REMOVAL OF HYMEN"]
["AETNA","AETNA","56740","HC EXCIS BARTHOLIN GLAND/CYST","56740 - HC EXCIS BARTHOLIN GLAND/CYST",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11446",null,"AETNA","56740 - HC EXCIS BARTHOLIN GLAND/CYST"]
["AETNA","AETNA","56820","COLPOSCOPY VULVA","56820 - COLPOSCOPY VULVA",null,null,null,null,null,"CIGNA CARELINK","11446",null,"AETNA","56820 - COLPOSCOPY VULVA"]
["AETNA","AETNA","56821","COLPOSCOPY VULVA W/BIOPSY","56821 - COLPOSCOPY VULVA W/BIOPSY",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11446",null,"AETNA","56821 - COLPOSCOPY VULVA W/BIOPSY"]
["AETNA","AETNA","57020","COLPOCENTESIS SEPARATE PROCEDURE","57020 - COLPOCENTESIS SEPARATE PROCEDURE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11446",null,"AETNA","57020 - COLPOCENTESIS SEPARATE PROCEDURE"]
["AETNA","AETNA","57023","HC I & D VAG HEMATOMA NON-OB","57023 - HC I & D VAG HEMATOMA NON-OB",null,null,null,null,null,"TUFTS HMO","11446",null,"AETNA","57023 - HC I & D VAG HEMATOMA NON-OB"]
["AETNA","AETNA","57061","DESTRUCTION VAGINAL LESIONS SIMPLE","57061 - DESTRUCTION VAGINAL LESIONS SIMPLE",null,null,null,null,null,"TUFTS POS","11446",null,"AETNA","57061 - DESTRUCTION VAGINAL LESIONS SIMPLE"]
["AETNA","AETNA","57100","BIOPSY VAGINAL MUCOSA SIMPLE","57100 - BIOPSY VAGINAL MUCOSA SIMPLE",null,null,null,null,null,"TUFTS PPO","11446",null,"AETNA","57100 - BIOPSY VAGINAL MUCOSA SIMPLE"]
["AETNA","AETNA","57105","HC BIOPSY OF VAGINA","57105 - HC BIOPSY OF VAGINA",null,null,null,null,null,"TUFTS SELECT","11446",null,"AETNA","57105 - HC BIOPSY OF VAGINA"]
["AETNA","AETNA","57107","REMOVE VAGINA TISSUE PART","57107 - REMOVE VAGINA TISSUE PART",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11446",null,"AETNA","57107 - REMOVE VAGINA TISSUE PART"]
["AETNA","AETNA","57135","HC EXCIS VAGINAL CYST/TUMOR","57135 - HC EXCIS VAGINAL CYST/TUMOR",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11446",null,"AETNA","57135 - HC EXCIS VAGINAL CYST/TUMOR"]
["AETNA","AETNA","57155","HC OR INSERTION OF T&O","57155 - HC OR INSERTION OF T&O",null,null,null,null,null,"AETNA","11450",null,"AETNA","57155 - HC OR INSERTION OF T&O"]
["AETNA","AETNA","57156","HC INSERTION OF CYLINDER","57156 - HC INSERTION OF CYLINDER",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11450",null,"AETNA","57156 - HC INSERTION OF CYLINDER"]
["AETNA","AETNA","57200","HC COLPORRHAPHY, SUTURE VAGINAL INJURY, NON-OB","57200 - HC COLPORRHAPHY, SUTURE VAGINAL INJURY, NON-OB",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11450",null,"AETNA","57200 - HC COLPORRHAPHY, SUTURE VAGINAL INJURY, NON-OB"]
["AETNA","AETNA","57210","HC REPAIR VAGINA/PERINEUM","57210 - HC REPAIR VAGINA/PERINEUM",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11450",null,"AETNA","57210 - HC REPAIR VAGINA/PERINEUM"]
["AETNA","AETNA","57410","HC PELVIC EXAMINATION W ANESTH","57410 - HC PELVIC EXAMINATION W ANESTH",null,null,null,null,null,"BLUE CROSS-PPO","11450",null,"AETNA","57410 - HC PELVIC EXAMINATION W ANESTH"]
["AETNA","AETNA","57415","HC REMOVAL VAGINAL FOR.BODY W ANESTH","57415 - HC REMOVAL VAGINAL FOR.BODY W ANESTH",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11450",null,"AETNA","57415 - HC REMOVAL VAGINAL FOR.BODY W ANESTH"]
["AETNA","AETNA","57420","COLPOSCOPY ENTIRE VAGINA W/CERVIX IF PRESENT","57420 - COLPOSCOPY ENTIRE VAGINA W/CERVIX IF PRESENT",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11450",null,"AETNA","57420 - COLPOSCOPY ENTIRE VAGINA W/CERVIX IF PRESENT"]
["AETNA","AETNA","57421","COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX","57421 - COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11450",null,"AETNA","57421 - COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX"]
["AETNA","AETNA","57452","COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA","57452 - COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA",null,null,null,null,null,"CIGNA CARELINK","11450",null,"AETNA","57452 - COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA"]
["AETNA","AETNA","57454","COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE","57454 - COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11450",null,"AETNA","57454 - COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE"]
["AETNA","AETNA","57455","COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX","57455 - COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11450",null,"AETNA","57455 - COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX"]
["AETNA","AETNA","57456","COLPOSCOPY CERVIX ENDOCERVICAL CURETTAGE","57456 - COLPOSCOPY CERVIX ENDOCERVICAL CURETTAGE",null,null,null,null,null,"TUFTS HMO","11450",null,"AETNA","57456 - COLPOSCOPY CERVIX ENDOCERVICAL CURETTAGE"]
["AETNA","AETNA","57460","COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX","57460 - COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX",null,null,null,null,null,"TUFTS POS","11450",null,"AETNA","57460 - COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX"]
["AETNA","AETNA","57461","COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX","57461 - COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX",null,null,null,null,null,"TUFTS PPO","11450",null,"AETNA","57461 - COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX"]
["AETNA","AETNA","57500","BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX","57500 - BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX",null,null,null,null,null,"TUFTS SELECT","11450",null,"AETNA","57500 - BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX"]
["AETNA","AETNA","57505","ENDOCERVICAL CURETTAGE W/DILATION & CURETTAGE","57505 - ENDOCERVICAL CURETTAGE W/DILATION & CURETTAGE",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11450",null,"AETNA","57505 - ENDOCERVICAL CURETTAGE W/DILATION & CURETTAGE"]
["AETNA","AETNA","57510","HC CAUTERIZATION,CERVIX,ELECTRO/THERMAL","57510 - HC CAUTERIZATION,CERVIX,ELECTRO/THERMAL",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11450",null,"AETNA","57510 - HC CAUTERIZATION,CERVIX,ELECTRO/THERMAL"]
["AETNA","AETNA","57511","HC CRYOCAUTERY OF CERVIX","57511 - HC CRYOCAUTERY OF CERVIX",null,null,null,null,null,"AETNA","11463",null,"AETNA","57511 - HC CRYOCAUTERY OF CERVIX"]
["AETNA","AETNA","57520","HC CONIZATION CERVIX, KNIFE/LASER","57520 - HC CONIZATION CERVIX, KNIFE/LASER",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11463",null,"AETNA","57520 - HC CONIZATION CERVIX, KNIFE/LASER"]
["AETNA","AETNA","57522","CONIZATION CERVIX W/WO D&C RPR ELTRD EXC","57522 - CONIZATION CERVIX W/WO D&C RPR ELTRD EXC",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11463",null,"AETNA","57522 - CONIZATION CERVIX W/WO D&C RPR ELTRD EXC"]
["AETNA","AETNA","57558","DILATION & CURETTAGE CERVICAL STUMP","57558 - DILATION & CURETTAGE CERVICAL STUMP",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11463",null,"AETNA","57558 - DILATION & CURETTAGE CERVICAL STUMP"]
["AETNA","AETNA","57800","DILATION CERVICAL CANAL INSTRUMENTAL SPX","57800 - DILATION CERVICAL CANAL INSTRUMENTAL SPX",null,null,null,null,null,"BLUE CROSS-PPO","11463",null,"AETNA","57800 - DILATION CERVICAL CANAL INSTRUMENTAL SPX"]
["AETNA","AETNA","58100","ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX","58100 - ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11463",null,"AETNA","58100 - ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX"]
["AETNA","AETNA","58110","ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY","58110 - ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11463",null,"AETNA","58110 - ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY"]
["AETNA","AETNA","58120","DILATION & CURETTAGE DX&/THER NONOBSTETRIC","58120 - DILATION & CURETTAGE DX&/THER NONOBSTETRIC",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11463",null,"AETNA","58120 - DILATION & CURETTAGE DX&/THER NONOBSTETRIC"]
["AETNA","AETNA","58145","MYOMECTOMY 1-4 MYOMAS 250 GM/< VAGINAL APPR","58145 - MYOMECTOMY 1-4 MYOMAS 250 GM/< VAGINAL APPR",null,null,null,null,null,"CIGNA CARELINK","11463",null,"AETNA","58145 - MYOMECTOMY 1-4 MYOMAS 250 GM/< VAGINAL APPR"]
["AETNA","AETNA","58300","INSERTION INTRAUTERINE DEVICE IUD","58300 - INSERTION INTRAUTERINE DEVICE IUD",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11463",null,"AETNA","58300 - INSERTION INTRAUTERINE DEVICE IUD"]
["AETNA","AETNA","58301","REMOVAL INTRAUTERINE DEVICE IUD","58301 - REMOVAL INTRAUTERINE DEVICE IUD",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11463",null,"AETNA","58301 - REMOVAL INTRAUTERINE DEVICE IUD"]
["AETNA","AETNA","58340","CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI","58340 - CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI",null,null,null,null,null,"TUFTS HMO","11463",null,"AETNA","58340 - CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI"]
["AETNA","AETNA","58345","HC REOPEN FALLOPIAN TUBE, TRANSCERV CATH","58345 - HC REOPEN FALLOPIAN TUBE, TRANSCERV CATH",null,null,null,null,null,"TUFTS POS","11463",null,"AETNA","58345 - HC REOPEN FALLOPIAN TUBE, TRANSCERV CATH"]
["AETNA","AETNA","58555","HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE","58555 - HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE",null,null,null,null,null,"TUFTS PPO","11463",null,"AETNA","58555 - HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE"]
["AETNA","AETNA","58558","HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C","58558 - HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C",null,null,null,null,null,"TUFTS SELECT","11463",null,"AETNA","58558 - HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C"]
["AETNA","AETNA","58559","HC HYSTEROSCOPY LYSIS INTRAUTERINE ADHESIONS","58559 - HC HYSTEROSCOPY LYSIS INTRAUTERINE ADHESIONS",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11463",null,"AETNA","58559 - HC HYSTEROSCOPY LYSIS INTRAUTERINE ADHESIONS"]
["AETNA","AETNA","58561","HC HYSTEROSCOPY,RMV MYOMA","58561 - HC HYSTEROSCOPY,RMV MYOMA",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11463",null,"AETNA","58561 - HC HYSTEROSCOPY,RMV MYOMA"]
["AETNA","AETNA","58562","HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY","58562 - HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY",null,null,null,null,null,"AETNA","11470",null,"AETNA","58562 - HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY"]
["AETNA","AETNA","58565","HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS","58565 - HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11470",null,"AETNA","58565 - HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS"]
["AETNA","AETNA","58579","HC UNLISTED HYSTEROSCOPY PROCEDURE UTERUS","58579 - HC UNLISTED HYSTEROSCOPY PROCEDURE UTERUS",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11470",null,"AETNA","58579 - HC UNLISTED HYSTEROSCOPY PROCEDURE UTERUS"]
["AETNA","AETNA","58674","HC LAPS ABLTJ UTERINE FIBROIDS","58674 - HC LAPS ABLTJ UTERINE FIBROIDS",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11470",null,"AETNA","58674 - HC LAPS ABLTJ UTERINE FIBROIDS"]
["AETNA","AETNA","58925","HC OVARIAN CYSTECTOMY UNI/BI","58925 - HC OVARIAN CYSTECTOMY UNI/BI",null,null,null,null,null,"BLUE CROSS-PPO","11470",null,"AETNA","58925 - HC OVARIAN CYSTECTOMY UNI/BI"]
["AETNA","AETNA","58999","HC GENITAL SURG PROC, FEMALE UNLISTED","58999 - HC GENITAL SURG PROC, FEMALE UNLISTED",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11470",null,"AETNA","58999 - HC GENITAL SURG PROC, FEMALE UNLISTED"]
["AETNA","AETNA","59000","AMNIOCENTESIS DIAGNOSIC","59000 - AMNIOCENTESIS DIAGNOSIC",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11470",null,"AETNA","59000 - AMNIOCENTESIS DIAGNOSIC"]
["AETNA","AETNA","59160","CURETTAGE POSTPARTUM","59160 - CURETTAGE POSTPARTUM",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11470",null,"AETNA","59160 - CURETTAGE POSTPARTUM"]
["AETNA","AETNA","59200","INSERTION CERVICAL DILATOR SEPARATE PROCEDURE","59200 - INSERTION CERVICAL DILATOR SEPARATE PROCEDURE",null,null,null,null,null,"CIGNA CARELINK","11470",null,"AETNA","59200 - INSERTION CERVICAL DILATOR SEPARATE PROCEDURE"]
["AETNA","AETNA","59300","HC EPISIOTOMY/VAG RPR OTH/THN ATTENDING","59300 - HC EPISIOTOMY/VAG RPR OTH/THN ATTENDING",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11470",null,"AETNA","59300 - HC EPISIOTOMY/VAG RPR OTH/THN ATTENDING"]
["AETNA","AETNA","59320","CERCLAGE CERVIX PREGNANCY VAGINAL","59320 - CERCLAGE CERVIX PREGNANCY VAGINAL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11470",null,"AETNA","59320 - CERCLAGE CERVIX PREGNANCY VAGINAL"]
["AETNA","AETNA","59409","HC VAGINAL DELIVERY ONLY","59409 - HC VAGINAL DELIVERY ONLY",null,null,null,null,null,"TUFTS HMO","11470",null,"AETNA","59409 - HC VAGINAL DELIVERY ONLY"]
["AETNA","AETNA","59812","TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL","59812 - TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL",null,null,null,null,null,"TUFTS POS","11470",null,"AETNA","59812 - TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL"]
["AETNA","AETNA","59820","TX MISSED ABORTION FIRST TRIMESTER SURGICAL","59820 - TX MISSED ABORTION FIRST TRIMESTER SURGICAL",null,null,null,null,null,"TUFTS PPO","11470",null,"AETNA","59820 - TX MISSED ABORTION FIRST TRIMESTER SURGICAL"]
["AETNA","AETNA","59821","TX MISSED ABORTION SECOND TRIMESTER SURGICAL","59821 - TX MISSED ABORTION SECOND TRIMESTER SURGICAL",null,null,null,null,null,"TUFTS SELECT","11470",null,"AETNA","59821 - TX MISSED ABORTION SECOND TRIMESTER SURGICAL"]
["AETNA","AETNA","59840","INDUCED ABORTION DILATION AND CURETTAGE","59840 - INDUCED ABORTION DILATION AND CURETTAGE",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11470",null,"AETNA","59840 - INDUCED ABORTION DILATION AND CURETTAGE"]
["AETNA","AETNA","59841","INDUCED ABORTION DILATION & EVAUCATION","59841 - INDUCED ABORTION DILATION & EVAUCATION",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11470",null,"AETNA","59841 - INDUCED ABORTION DILATION & EVAUCATION"]
["AETNA","AETNA","59870","UTERINE EVACUATION & CURETTAGE HYDATIDIFORM MOLE","59870 - UTERINE EVACUATION & CURETTAGE HYDATIDIFORM MOLE",null,null,null,null,null,"AETNA","11600",null,"AETNA","59870 - UTERINE EVACUATION & CURETTAGE HYDATIDIFORM MOLE"]
["AETNA","AETNA","59871","REMOVAL CERCLAGE SUTURE UNDER ANESTHESIA","59871 - REMOVAL CERCLAGE SUTURE UNDER ANESTHESIA",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11600",null,"AETNA","59871 - REMOVAL CERCLAGE SUTURE UNDER ANESTHESIA"]
["AETNA","AETNA","59897","HC FETAL INVAS PX W/ US","59897 - HC FETAL INVAS PX W/ US",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11600",null,"AETNA","59897 - HC FETAL INVAS PX W/ US"]
["AETNA","AETNA","60100","BIOPSY THYROID PERCUTANEOUS CORE NEEDLE","60100 - BIOPSY THYROID PERCUTANEOUS CORE NEEDLE",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11600",null,"AETNA","60100 - BIOPSY THYROID PERCUTANEOUS CORE NEEDLE"]
["AETNA","AETNA","60220","HC THYROID LOBECTOMY,UNILAT","60220 - HC THYROID LOBECTOMY,UNILAT",null,null,null,null,null,"BLUE CROSS-PPO","11600",null,"AETNA","60220 - HC THYROID LOBECTOMY,UNILAT"]
["AETNA","AETNA","60300","HB ASPIRATION AND/OR INJECTION THYROID CYST","60300 - HB ASPIRATION AND/OR INJECTION THYROID CYST",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11600",null,"AETNA","60300 - HB ASPIRATION AND/OR INJECTION THYROID CYST"]
["AETNA","AETNA","60500","HC EXPLORE PARATHYROID GLANDS","60500 - HC EXPLORE PARATHYROID GLANDS",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11600",null,"AETNA","60500 - HC EXPLORE PARATHYROID GLANDS"]
["AETNA","AETNA","61050","HC CISTERNAL/C1-2 PUNCTURE","61050 - HC CISTERNAL/C1-2 PUNCTURE",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11600",null,"AETNA","61050 - HC CISTERNAL/C1-2 PUNCTURE"]
["AETNA","AETNA","61055","HC CISTERNAL/LATERAL C1-C2 PUNCTURE W/INJECTION","61055 - HC CISTERNAL/LATERAL C1-C2 PUNCTURE W/INJECTION",null,null,null,null,null,"CIGNA CARELINK","11600",null,"AETNA","61055 - HC CISTERNAL/LATERAL C1-C2 PUNCTURE W/INJECTION"]
["AETNA","AETNA","61070","HC PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX","61070 - HC PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11600",null,"AETNA","61070 - HC PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX"]
["AETNA","AETNA","61623","HC EVASC TEMP BALLOON ARTL OCCLUSION HEAD/NECK","61623 - HC EVASC TEMP BALLOON ARTL OCCLUSION HEAD/NECK",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11600",null,"AETNA","61623 - HC EVASC TEMP BALLOON ARTL OCCLUSION HEAD/NECK"]
["AETNA","AETNA","61626","HC TCAT PERMANT OCCLUSION/EMBOLIZATION PRQ NON-CNS","61626 - HC TCAT PERMANT OCCLUSION/EMBOLIZATION PRQ NON-CNS",null,null,null,null,null,"TUFTS HMO","11600",null,"AETNA","61626 - HC TCAT PERMANT OCCLUSION/EMBOLIZATION PRQ NON-CNS"]
["AETNA","AETNA","61645","HC PERQ ARTERIAL TRANSLUMINAL M-THROMBECTOMY & OR INFUSION","61645 - HC PERQ ARTERIAL TRANSLUMINAL M-THROMBECTOMY & OR INFUSION",null,null,null,null,null,"TUFTS POS","11600",null,"AETNA","61645 - HC PERQ ARTERIAL TRANSLUMINAL M-THROMBECTOMY & OR INFUSION"]
["AETNA","AETNA","61885","HC IMP STIM,CRANIAL,SUBQ,1 ARRAY","61885 - HC IMP STIM,CRANIAL,SUBQ,1 ARRAY",null,null,null,null,null,"TUFTS PPO","11600",null,"AETNA","61885 - HC IMP STIM,CRANIAL,SUBQ,1 ARRAY"]
["AETNA","AETNA","62264","HC PRQ LYSIS EPIDURAL ADHESIONS MULT SESSIONS 1 DAY","62264 - HC PRQ LYSIS EPIDURAL ADHESIONS MULT SESSIONS 1 DAY",null,null,null,null,null,"TUFTS SELECT","11600",null,"AETNA","62264 - HC PRQ LYSIS EPIDURAL ADHESIONS MULT SESSIONS 1 DAY"]
["AETNA","AETNA","62268","HC PERCUTANEOUS ASPIRATION SPINAL CORD CYST/SYRINX","62268 - HC PERCUTANEOUS ASPIRATION SPINAL CORD CYST/SYRINX",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11600",null,"AETNA","62268 - HC PERCUTANEOUS ASPIRATION SPINAL CORD CYST/SYRINX"]
["AETNA","AETNA","62269","HC BIO,SPINAL CORD,PERC NEED","62269 - HC BIO,SPINAL CORD,PERC NEED",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11600",null,"AETNA","62269 - HC BIO,SPINAL CORD,PERC NEED"]
["AETNA","AETNA","62270","SPINAL PUNCTURE LUMBAR DIAGNOSTIC","62270 - SPINAL PUNCTURE LUMBAR DIAGNOSTIC",null,null,null,null,null,"AETNA","11601",null,"AETNA","62270 - SPINAL PUNCTURE LUMBAR DIAGNOSTIC"]
["AETNA","AETNA","62272","HC SPINAL PUNCTURE THER DRAIN CEREBROSPINAL FLUID","62272 - HC SPINAL PUNCTURE THER DRAIN CEREBROSPINAL FLUID",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11601",null,"AETNA","62272 - HC SPINAL PUNCTURE THER DRAIN CEREBROSPINAL FLUID"]
["AETNA","AETNA","62273","HC INJECTION EPIDURAL BLOOD/CLOT PATCH","62273 - HC INJECTION EPIDURAL BLOOD/CLOT PATCH",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11601",null,"AETNA","62273 - HC INJECTION EPIDURAL BLOOD/CLOT PATCH"]
["AETNA","AETNA","62284","HC INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR","62284 - HC INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11601",null,"AETNA","62284 - HC INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR"]
["AETNA","AETNA","62302","MYELOGRAPHY VIA LUMBAR INJECTION RS&I CERVICAL","62302 - MYELOGRAPHY VIA LUMBAR INJECTION RS&I CERVICAL",null,null,null,null,null,"BLUE CROSS-PPO","11601",null,"AETNA","62302 - MYELOGRAPHY VIA LUMBAR INJECTION RS&I CERVICAL"]
["AETNA","AETNA","62304","MYELOGRAPHY VIA LUMBAR INJECT RS&I LUMBOSACRAL","62304 - MYELOGRAPHY VIA LUMBAR INJECT RS&I LUMBOSACRAL",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11601",null,"AETNA","62304 - MYELOGRAPHY VIA LUMBAR INJECT RS&I LUMBOSACRAL"]
["AETNA","AETNA","62305","MYELOGRAPHY VIA LUMBAR INJECTION RS&I 2+ REGIONS","62305 - MYELOGRAPHY VIA LUMBAR INJECTION RS&I 2+ REGIONS",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11601",null,"AETNA","62305 - MYELOGRAPHY VIA LUMBAR INJECTION RS&I 2+ REGIONS"]
["AETNA","AETNA","62320","HC NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN","62320 - HC NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11601",null,"AETNA","62320 - HC NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN"]
["AETNA","AETNA","62321","HR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN","62321 - HR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN",null,null,null,null,null,"CIGNA CARELINK","11601",null,"AETNA","62321 - HR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN"]
["AETNA","AETNA","62322","HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11601",null,"AETNA","62322 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["AETNA","AETNA","62323","HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11601",null,"AETNA","62323 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["AETNA","AETNA","62324","HC NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN.","62324 - HC NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN.",null,null,null,null,null,"TUFTS HMO","11601",null,"AETNA","62324 - HC NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN."]
["AETNA","AETNA","62326","HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62326 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",null,null,null,null,null,"TUFTS POS","11601",null,"AETNA","62326 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["AETNA","AETNA","62327","HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62327 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",null,null,null,null,null,"TUFTS PPO","11601",null,"AETNA","62327 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["AETNA","AETNA","62328","HC DX LMBR SPI PNXR W/FLUOR/CT","62328 - HC DX LMBR SPI PNXR W/FLUOR/CT",null,null,null,null,null,"TUFTS SELECT","11601",null,"AETNA","62328 - HC DX LMBR SPI PNXR W/FLUOR/CT"]
["AETNA","AETNA","62329","HC THER SPI PNXR CSF FLUOR/CT","62329 - HC THER SPI PNXR CSF FLUOR/CT",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11601",null,"AETNA","62329 - HC THER SPI PNXR CSF FLUOR/CT"]
["AETNA","AETNA","62365","HC REMOVE INFUSN DEVICE/PUMP","62365 - HC REMOVE INFUSN DEVICE/PUMP",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11601",null,"AETNA","62365 - HC REMOVE INFUSN DEVICE/PUMP"]
["AETNA","AETNA","62367","ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL","62367 - ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL",null,null,null,null,null,"AETNA","11602",null,"AETNA","62367 - ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL"]
["AETNA","AETNA","62368","ELECT ANALYS IMPLT ITHCL/EDRL PUMP W/REPRGRMG","62368 - ELECT ANALYS IMPLT ITHCL/EDRL PUMP W/REPRGRMG",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11602",null,"AETNA","62368 - ELECT ANALYS IMPLT ITHCL/EDRL PUMP W/REPRGRMG"]
["AETNA","AETNA","62370","ELEC ANLYS IMPLT ITHCL/EDRL PMP W/REPR PHYS/QHP","62370 - ELEC ANLYS IMPLT ITHCL/EDRL PMP W/REPR PHYS/QHP",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11602",null,"AETNA","62370 - ELEC ANLYS IMPLT ITHCL/EDRL PMP W/REPR PHYS/QHP"]
["AETNA","AETNA","63650","HC PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL","63650 - HC PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11602",null,"AETNA","63650 - HC PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL"]
["AETNA","AETNA","63661","HC RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR","63661 - HC RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR",null,null,null,null,null,"BLUE CROSS-PPO","11602",null,"AETNA","63661 - HC RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR"]
["AETNA","AETNA","63662","HC REMOVE SPINAL NEUROSTIM ELECTRODE PLATE/PADDLE, INCL FLUORO","63662 - HC REMOVE SPINAL NEUROSTIM ELECTRODE PLATE/PADDLE, INCL FLUORO",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11602",null,"AETNA","63662 - HC REMOVE SPINAL NEUROSTIM ELECTRODE PLATE/PADDLE, INCL FLUORO"]
["AETNA","AETNA","64400","NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH","64400 - NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11602",null,"AETNA","64400 - NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH"]
["AETNA","AETNA","64405","INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV","64405 - INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11602",null,"AETNA","64405 - INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV"]
["AETNA","AETNA","64408","HC INJ,ANES;VAGUS NER","64408 - HC INJ,ANES;VAGUS NER",null,null,null,null,null,"CIGNA CARELINK","11602",null,"AETNA","64408 - HC INJ,ANES;VAGUS NER"]
["AETNA","AETNA","64415","SINGLE NERVE BLOCK INJECTION ARM NERVE","64415 - SINGLE NERVE BLOCK INJECTION ARM NERVE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11602",null,"AETNA","64415 - SINGLE NERVE BLOCK INJECTION ARM NERVE"]
["AETNA","AETNA","64416","HC INJ,ANES;CONT INF B PLEX","64416 - HC INJ,ANES;CONT INF B PLEX",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11602",null,"AETNA","64416 - HC INJ,ANES;CONT INF B PLEX"]
["AETNA","AETNA","64417","INJECTION ANESTHETIC AGENT AXILLARY NERVE","64417 - INJECTION ANESTHETIC AGENT AXILLARY NERVE",null,null,null,null,null,"TUFTS HMO","11602",null,"AETNA","64417 - INJECTION ANESTHETIC AGENT AXILLARY NERVE"]
["AETNA","AETNA","64418","INJECTION ANESTHETIC AGENT SUPRASCAPULAR NERVE","64418 - INJECTION ANESTHETIC AGENT SUPRASCAPULAR NERVE",null,null,null,null,null,"TUFTS POS","11602",null,"AETNA","64418 - INJECTION ANESTHETIC AGENT SUPRASCAPULAR NERVE"]
["AETNA","AETNA","64420","INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE","64420 - INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE",null,null,null,null,null,"TUFTS PPO","11602",null,"AETNA","64420 - INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE"]
["AETNA","AETNA","64421","MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES","64421 - MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES",null,null,null,null,null,"TUFTS SELECT","11602",null,"AETNA","64421 - MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES"]
["AETNA","AETNA","64425","INJECTION ANES ILIOINGUINAL ILIOHYPOGASTRIC NRVS","64425 - INJECTION ANES ILIOINGUINAL ILIOHYPOGASTRIC NRVS",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11602",null,"AETNA","64425 - INJECTION ANES ILIOINGUINAL ILIOHYPOGASTRIC NRVS"]
["AETNA","AETNA","64430","HC INJ,ANES;PUDEND NER","64430 - HC INJ,ANES;PUDEND NER",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11602",null,"AETNA","64430 - HC INJ,ANES;PUDEND NER"]
["AETNA","AETNA","64435","INJECTION ANESTHETIC PARACERVICAL UTERINE NERVE","64435 - INJECTION ANESTHETIC PARACERVICAL UTERINE NERVE",null,null,null,null,null,"AETNA","11603",null,"AETNA","64435 - INJECTION ANESTHETIC PARACERVICAL UTERINE NERVE"]
["AETNA","AETNA","64445","INJECTION ANESTHETIC AGENT SCIATIC NRV SINGLE","64445 - INJECTION ANESTHETIC AGENT SCIATIC NRV SINGLE",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11603",null,"AETNA","64445 - INJECTION ANESTHETIC AGENT SCIATIC NRV SINGLE"]
["AETNA","AETNA","64450","INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH","64450 - INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11603",null,"AETNA","64450 - INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH"]
["AETNA","AETNA","64451","HC NJX AA&/STRD NRV NRVTG SI JT","64451 - HC NJX AA&/STRD NRV NRVTG SI JT",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11603",null,"AETNA","64451 - HC NJX AA&/STRD NRV NRVTG SI JT"]
["AETNA","AETNA","64454","HC NJX AA&/STRD GNCLR NRV BRNCH","64454 - HC NJX AA&/STRD GNCLR NRV BRNCH",null,null,null,null,null,"BLUE CROSS-PPO","11603",null,"AETNA","64454 - HC NJX AA&/STRD GNCLR NRV BRNCH"]
["AETNA","AETNA","64455","NJX ANES&/STEROID PLANTAR COMMON DIGITAL NERVE","64455 - NJX ANES&/STEROID PLANTAR COMMON DIGITAL NERVE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11603",null,"AETNA","64455 - NJX ANES&/STEROID PLANTAR COMMON DIGITAL NERVE"]
["AETNA","AETNA","64461","HC PVB,THORACIC;SINGLE INJECTION SITE INCLUDING IMAGING GUIDANCE WHEN PERFORMED","64461 - HC PVB,THORACIC;SINGLE INJECTION SITE INCLUDING IMAGING GUIDANCE WHEN PERFORMED",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11603",null,"AETNA","64461 - HC PVB,THORACIC;SINGLE INJECTION SITE INCLUDING IMAGING GUIDANCE WHEN PERFORMED"]
["AETNA","AETNA","64462","HC PVB,THORAC;2ND & ANY ADD¿L INJECT SITE(S) INCLUD IMAGE GUIDE WHEN PERFORMED","64462 - HC PVB,THORAC;2ND & ANY ADD¿L INJECT SITE(S) INCLUD IMAGE GUIDE WHEN PERFORMED",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11603",null,"AETNA","64462 - HC PVB,THORAC;2ND & ANY ADD¿L INJECT SITE(S) INCLUD IMAGE GUIDE WHEN PERFORMED"]
["AETNA","AETNA","64479","HC INJECT ANES/STEROID FORAMEN CERV/THORACIC W IMG GUIDE ,1 LEVEL","64479 - HC INJECT ANES/STEROID FORAMEN CERV/THORACIC W IMG GUIDE ,1 LEVEL",null,null,null,null,null,"CIGNA CARELINK","11603",null,"AETNA","64479 - HC INJECT ANES/STEROID FORAMEN CERV/THORACIC W IMG GUIDE ,1 LEVEL"]
["AETNA","AETNA","64483","NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL","64483 - NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11603",null,"AETNA","64483 - NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL"]
["AETNA","AETNA","64484","NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC EA LV","64484 - NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC EA LV",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11603",null,"AETNA","64484 - NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC EA LV"]
["AETNA","AETNA","64486","TAP BLOCK UNILATERAL BY INJECTION(S)","64486 - TAP BLOCK UNILATERAL BY INJECTION(S)",null,null,null,null,null,"TUFTS HMO","11603",null,"AETNA","64486 - TAP BLOCK UNILATERAL BY INJECTION(S)"]
["AETNA","AETNA","64488","HC TAP BLOCK BILATERAL BY INJECTION(S)","64488 - HC TAP BLOCK BILATERAL BY INJECTION(S)",null,null,null,null,null,"TUFTS POS","11603",null,"AETNA","64488 - HC TAP BLOCK BILATERAL BY INJECTION(S)"]
["AETNA","AETNA","64490","NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL","64490 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL",null,null,null,null,null,"TUFTS PPO","11603",null,"AETNA","64490 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL"]
["AETNA","AETNA","64491","NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL","64491 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL",null,null,null,null,null,"TUFTS SELECT","11603",null,"AETNA","64491 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL"]
["AETNA","AETNA","64492","NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL","64492 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11603",null,"AETNA","64492 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL"]
["AETNA","AETNA","64493","NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL","64493 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11603",null,"AETNA","64493 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL"]
["AETNA","AETNA","64494","NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL","64494 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL",null,null,null,null,null,"AETNA","11604",null,"AETNA","64494 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL"]
["AETNA","AETNA","64495","NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL","64495 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11604",null,"AETNA","64495 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL"]
["AETNA","AETNA","64505","INJECTION ANES AGENT SPHENOPALATINE GANGLION","64505 - INJECTION ANES AGENT SPHENOPALATINE GANGLION",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11604",null,"AETNA","64505 - INJECTION ANES AGENT SPHENOPALATINE GANGLION"]
["AETNA","AETNA","64510","NJX ANES STELLATE GANGLION CRV SYMPATHETIC","64510 - NJX ANES STELLATE GANGLION CRV SYMPATHETIC",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11604",null,"AETNA","64510 - NJX ANES STELLATE GANGLION CRV SYMPATHETIC"]
["AETNA","AETNA","64520","INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC","64520 - INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC",null,null,null,null,null,"BLUE CROSS-PPO","11604",null,"AETNA","64520 - INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC"]
["AETNA","AETNA","64530","INJX ANES CELIAC PLEXUS W/WO RADIOLOGIC MONITRNG","64530 - INJX ANES CELIAC PLEXUS W/WO RADIOLOGIC MONITRNG",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11604",null,"AETNA","64530 - INJX ANES CELIAC PLEXUS W/WO RADIOLOGIC MONITRNG"]
["AETNA","AETNA","64561","IMPLANT NEUROELECTRODES","64561 - IMPLANT NEUROELECTRODES",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11604",null,"AETNA","64561 - IMPLANT NEUROELECTRODES"]
["AETNA","AETNA","64569","HC REVISE/REPLACE CRANIAL NERVE STIM ELECTRODE/CONNECT PULSE GEN","64569 - HC REVISE/REPLACE CRANIAL NERVE STIM ELECTRODE/CONNECT PULSE GEN",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11604",null,"AETNA","64569 - HC REVISE/REPLACE CRANIAL NERVE STIM ELECTRODE/CONNECT PULSE GEN"]
["AETNA","AETNA","64585","REVISE/REMOVE NEUROELECTRODE","64585 - REVISE/REMOVE NEUROELECTRODE",null,null,null,null,null,"CIGNA CARELINK","11604",null,"AETNA","64585 - REVISE/REMOVE NEUROELECTRODE"]
["AETNA","AETNA","64600","INJECTION TREATMENT OF NERVE","64600 - INJECTION TREATMENT OF NERVE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11604",null,"AETNA","64600 - INJECTION TREATMENT OF NERVE"]
["AETNA","AETNA","64611","CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS","64611 - CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11604",null,"AETNA","64611 - CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS"]
["AETNA","AETNA","64612","CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL","64612 - CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL",null,null,null,null,null,"TUFTS HMO","11604",null,"AETNA","64612 - CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL"]
["AETNA","AETNA","64615","CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE","64615 - CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE",null,null,null,null,null,"TUFTS POS","11604",null,"AETNA","64615 - CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE"]
["AETNA","AETNA","64616","CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA","64616 - CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA",null,null,null,null,null,"TUFTS PPO","11604",null,"AETNA","64616 - CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA"]
["AETNA","AETNA","64617","CHEMODENERVATION MUSCLE LARYNX UNILAT W/EMG","64617 - CHEMODENERVATION MUSCLE LARYNX UNILAT W/EMG",null,null,null,null,null,"TUFTS SELECT","11604",null,"AETNA","64617 - CHEMODENERVATION MUSCLE LARYNX UNILAT W/EMG"]
["AETNA","AETNA","64620","HC DEST,INTERCOSTAL,NEUROLYTIC","64620 - HC DEST,INTERCOSTAL,NEUROLYTIC",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11604",null,"AETNA","64620 - HC DEST,INTERCOSTAL,NEUROLYTIC"]
["AETNA","AETNA","64624","HC DSTRJ NULYT AGT GNCLR NRV","64624 - HC DSTRJ NULYT AGT GNCLR NRV",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11604",null,"AETNA","64624 - HC DSTRJ NULYT AGT GNCLR NRV"]
["AETNA","AETNA","64625","HC RF ABLTJ NRV NRVTG SI JT","64625 - HC RF ABLTJ NRV NRVTG SI JT",null,null,null,null,null,"AETNA","11606",null,"AETNA","64625 - HC RF ABLTJ NRV NRVTG SI JT"]
["AETNA","AETNA","64632","DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE","64632 - DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11606",null,"AETNA","64632 - DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE"]
["AETNA","AETNA","64633","DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA","64633 - DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11606",null,"AETNA","64633 - DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA"]
["AETNA","AETNA","64634","HC DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA","64634 - HC DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11606",null,"AETNA","64634 - HC DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA"]
["AETNA","AETNA","64635","DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL","64635 - DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL",null,null,null,null,null,"BLUE CROSS-PPO","11606",null,"AETNA","64635 - DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL"]
["AETNA","AETNA","64636","DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL","64636 - DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11606",null,"AETNA","64636 - DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL"]
["AETNA","AETNA","64640","DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE","64640 - DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11606",null,"AETNA","64640 - DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE"]
["AETNA","AETNA","64642","CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE","64642 - CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11606",null,"AETNA","64642 - CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE"]
["AETNA","AETNA","64643","CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE","64643 - CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE",null,null,null,null,null,"CIGNA CARELINK","11606",null,"AETNA","64643 - CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE"]
["AETNA","AETNA","64644","CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES","64644 - CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11606",null,"AETNA","64644 - CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES"]
["AETNA","AETNA","64645","CHEMODENERVATION 1 EXTREMITY EA ADDL 5/> MUSCLES","64645 - CHEMODENERVATION 1 EXTREMITY EA ADDL 5/> MUSCLES",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11606",null,"AETNA","64645 - CHEMODENERVATION 1 EXTREMITY EA ADDL 5/> MUSCLES"]
["AETNA","AETNA","64646","CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES","64646 - CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES",null,null,null,null,null,"TUFTS HMO","11606",null,"AETNA","64646 - CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES"]
["AETNA","AETNA","64647","CHEMODENERVATION OF TRUNK 6 OR MORE MUSCLES","64647 - CHEMODENERVATION OF TRUNK 6 OR MORE MUSCLES",null,null,null,null,null,"TUFTS POS","11606",null,"AETNA","64647 - CHEMODENERVATION OF TRUNK 6 OR MORE MUSCLES"]
["AETNA","AETNA","64650","CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE","64650 - CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE",null,null,null,null,null,"TUFTS PPO","11606",null,"AETNA","64650 - CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE"]
["AETNA","AETNA","64653","CHEMODENERVATION ECCRINE GLANDS OTH AREA PER DAY","64653 - CHEMODENERVATION ECCRINE GLANDS OTH AREA PER DAY",null,null,null,null,null,"TUFTS SELECT","11606",null,"AETNA","64653 - CHEMODENERVATION ECCRINE GLANDS OTH AREA PER DAY"]
["AETNA","AETNA","64680","HC DES,NEURO;CELIAC PLEX,WWO","64680 - HC DES,NEURO;CELIAC PLEX,WWO",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11606",null,"AETNA","64680 - HC DES,NEURO;CELIAC PLEX,WWO"]
["AETNA","AETNA","64721","NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE","64721 - NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11606",null,"AETNA","64721 - NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE"]
["AETNA","AETNA","64771","HC TRANSECT OTHER CRAN N,EXTRADURAL","64771 - HC TRANSECT OTHER CRAN N,EXTRADURAL",null,null,null,null,null,"AETNA","11620",null,"AETNA","64771 - HC TRANSECT OTHER CRAN N,EXTRADURAL"]
["AETNA","AETNA","64774","HC EXCISE CUTANEOUS NEUROMA","64774 - HC EXCISE CUTANEOUS NEUROMA",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11620",null,"AETNA","64774 - HC EXCISE CUTANEOUS NEUROMA"]
["AETNA","AETNA","64999","PR SACROCOCCYGEAL JOINT INJECTION AND GANGLION OF IMPAR BLOCK","64999 - PR SACROCOCCYGEAL JOINT INJECTION AND GANGLION OF IMPAR BLOCK",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11620",null,"AETNA","64999 - PR SACROCOCCYGEAL JOINT INJECTION AND GANGLION OF IMPAR BLOCK"]
["AETNA","AETNA","65093","HC REVISE EYE WITH IMPLANT","65093 - HC REVISE EYE WITH IMPLANT",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11620",null,"AETNA","65093 - HC REVISE EYE WITH IMPLANT"]
["AETNA","AETNA","65101","HC REMOVAL OF EYE","65101 - HC REMOVAL OF EYE",null,null,null,null,null,"BLUE CROSS-PPO","11620",null,"AETNA","65101 - HC REMOVAL OF EYE"]
["AETNA","AETNA","65103","HC REMOVE EYE/INSERT IMPLANT","65103 - HC REMOVE EYE/INSERT IMPLANT",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11620",null,"AETNA","65103 - HC REMOVE EYE/INSERT IMPLANT"]
["AETNA","AETNA","65105","HC REMOVE EYE/ATTACH IMPLANT","65105 - HC REMOVE EYE/ATTACH IMPLANT",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11620",null,"AETNA","65105 - HC REMOVE EYE/ATTACH IMPLANT"]
["AETNA","AETNA","65130","HC INSERT OCULAR IMPLANT","65130 - HC INSERT OCULAR IMPLANT",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11620",null,"AETNA","65130 - HC INSERT OCULAR IMPLANT"]
["AETNA","AETNA","65135","HC INSJ OC IMPLT AFTER ENCL MUSC X ATTACHED","65135 - HC INSJ OC IMPLT AFTER ENCL MUSC X ATTACHED",null,null,null,null,null,"CIGNA CARELINK","11620",null,"AETNA","65135 - HC INSJ OC IMPLT AFTER ENCL MUSC X ATTACHED"]
["AETNA","AETNA","65175","HC REMOVAL OF OCULAR IMPLANT","65175 - HC REMOVAL OF OCULAR IMPLANT",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11620",null,"AETNA","65175 - HC REMOVAL OF OCULAR IMPLANT"]
["AETNA","AETNA","65265","HC REMOVE FOREIGN BODY FROM EYE","65265 - HC REMOVE FOREIGN BODY FROM EYE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11620",null,"AETNA","65265 - HC REMOVE FOREIGN BODY FROM EYE"]
["AETNA","AETNA","65280","HC REPAIR OF EYE WOUND","65280 - HC REPAIR OF EYE WOUND",null,null,null,null,null,"TUFTS HMO","11620",null,"AETNA","65280 - HC REPAIR OF EYE WOUND"]
["AETNA","AETNA","65285","HC RPR LAC CORN&/SCLRA PERF W/REPOS/RESCJ UVEAL T","65285 - HC RPR LAC CORN&/SCLRA PERF W/REPOS/RESCJ UVEAL T",null,null,null,null,null,"TUFTS POS","11620",null,"AETNA","65285 - HC RPR LAC CORN&/SCLRA PERF W/REPOS/RESCJ UVEAL T"]
["AETNA","AETNA","65286","RPR LAC APPL TISSUE GLUE WOUND CORNEA&/SCLERA","65286 - RPR LAC APPL TISSUE GLUE WOUND CORNEA&/SCLERA",null,null,null,null,null,"TUFTS PPO","11620",null,"AETNA","65286 - RPR LAC APPL TISSUE GLUE WOUND CORNEA&/SCLERA"]
["AETNA","AETNA","65400","EXCISION LESION CORNEA XCP PTERYGIUM","65400 - EXCISION LESION CORNEA XCP PTERYGIUM",null,null,null,null,null,"TUFTS SELECT","11620",null,"AETNA","65400 - EXCISION LESION CORNEA XCP PTERYGIUM"]
["AETNA","AETNA","65420","HC REMOVAL OF EYE LESION","65420 - HC REMOVAL OF EYE LESION",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11620",null,"AETNA","65420 - HC REMOVAL OF EYE LESION"]
["AETNA","AETNA","65426","EXCISION/TRANSPOSITION PTERYGIUM W/GRAFG","65426 - EXCISION/TRANSPOSITION PTERYGIUM W/GRAFG",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11620",null,"AETNA","65426 - EXCISION/TRANSPOSITION PTERYGIUM W/GRAFG"]
["AETNA","AETNA","65435","RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION","65435 - RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION",null,null,null,null,null,"AETNA","11621",null,"AETNA","65435 - RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION"]
["AETNA","AETNA","65436","RMVL CORNEAL EPITHELIUM W/APPL CHELATING AGENT","65436 - RMVL CORNEAL EPITHELIUM W/APPL CHELATING AGENT",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11621",null,"AETNA","65436 - RMVL CORNEAL EPITHELIUM W/APPL CHELATING AGENT"]
["AETNA","AETNA","65730","HC KERATOPLASTY PENTRG EXCEPT APHAKIA/PSEUDOPHAKIA","65730 - HC KERATOPLASTY PENTRG EXCEPT APHAKIA/PSEUDOPHAKIA",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11621",null,"AETNA","65730 - HC KERATOPLASTY PENTRG EXCEPT APHAKIA/PSEUDOPHAKIA"]
["AETNA","AETNA","65750","HC KERATOPLASTY PENETRAING APHAKIA","65750 - HC KERATOPLASTY PENETRAING APHAKIA",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11621",null,"AETNA","65750 - HC KERATOPLASTY PENETRAING APHAKIA"]
["AETNA","AETNA","65755","HC KERATOPLASTY PENETRATING PSEUDOPHAKIA","65755 - HC KERATOPLASTY PENETRATING PSEUDOPHAKIA",null,null,null,null,null,"BLUE CROSS-PPO","11621",null,"AETNA","65755 - HC KERATOPLASTY PENETRATING PSEUDOPHAKIA"]
["AETNA","AETNA","65756","HC CORNEAL TRNSPL ENDOTHELIAL","65756 - HC CORNEAL TRNSPL ENDOTHELIAL",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11621",null,"AETNA","65756 - HC CORNEAL TRNSPL ENDOTHELIAL"]
["AETNA","AETNA","65770","HC REVISE CORNEA WITH IMPLANT","65770 - HC REVISE CORNEA WITH IMPLANT",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11621",null,"AETNA","65770 - HC REVISE CORNEA WITH IMPLANT"]
["AETNA","AETNA","65778","PLACE AMNIOTIC MEMB OCULAR SURFACE SELF RETAIN","65778 - PLACE AMNIOTIC MEMB OCULAR SURFACE SELF RETAIN",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11621",null,"AETNA","65778 - PLACE AMNIOTIC MEMB OCULAR SURFACE SELF RETAIN"]
["AETNA","AETNA","65779","HC PLACE AMNIOTIC MEMBRANE OCULAR SURFACE WOUND HEALING, SUTURED","65779 - HC PLACE AMNIOTIC MEMBRANE OCULAR SURFACE WOUND HEALING, SUTURED",null,null,null,null,null,"CIGNA CARELINK","11621",null,"AETNA","65779 - HC PLACE AMNIOTIC MEMBRANE OCULAR SURFACE WOUND HEALING, SUTURED"]
["AETNA","AETNA","65780","HC OCULAR RECONST TRANSPLANT","65780 - HC OCULAR RECONST TRANSPLANT",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11621",null,"AETNA","65780 - HC OCULAR RECONST TRANSPLANT"]
["AETNA","AETNA","65782","HC OCCULAR SURFACE RECONSTRUCTION LIMBAL AUTOGRAFT","65782 - HC OCCULAR SURFACE RECONSTRUCTION LIMBAL AUTOGRAFT",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11621",null,"AETNA","65782 - HC OCCULAR SURFACE RECONSTRUCTION LIMBAL AUTOGRAFT"]
["AETNA","AETNA","65800","PARACENTSIS ANT CHAMB EYE ASPIR AQUEOUS SPX","65800 - PARACENTSIS ANT CHAMB EYE ASPIR AQUEOUS SPX",null,null,null,null,null,"TUFTS HMO","11621",null,"AETNA","65800 - PARACENTSIS ANT CHAMB EYE ASPIR AQUEOUS SPX"]
["AETNA","AETNA","65815","HC DRAINAGE OF EYE","65815 - HC DRAINAGE OF EYE",null,null,null,null,null,"TUFTS POS","11621",null,"AETNA","65815 - HC DRAINAGE OF EYE"]
["AETNA","AETNA","65820","HC RELIEVE INNER EYE PRESSURE","65820 - HC RELIEVE INNER EYE PRESSURE",null,null,null,null,null,"TUFTS PPO","11621",null,"AETNA","65820 - HC RELIEVE INNER EYE PRESSURE"]
["AETNA","AETNA","65855","TRABECULOPLASTY LASER SURG 1/> SESSIONS","65855 - TRABECULOPLASTY LASER SURG 1/> SESSIONS",null,null,null,null,null,"TUFTS SELECT","11621",null,"AETNA","65855 - TRABECULOPLASTY LASER SURG 1/> SESSIONS"]
["AETNA","AETNA","65860","SEVERING ADHESIONS ANTERIOR SEGMENT LASER SPX","65860 - SEVERING ADHESIONS ANTERIOR SEGMENT LASER SPX",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11621",null,"AETNA","65860 - SEVERING ADHESIONS ANTERIOR SEGMENT LASER SPX"]
["AETNA","AETNA","65865","HC INCISE INNER EYE ADHESIONS","65865 - HC INCISE INNER EYE ADHESIONS",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11621",null,"AETNA","65865 - HC INCISE INNER EYE ADHESIONS"]
["AETNA","AETNA","65870","HC SEVERING ADS ANT SEG INCAL SPX ANT SYNECHIAE","65870 - HC SEVERING ADS ANT SEG INCAL SPX ANT SYNECHIAE",null,null,null,null,null,"AETNA","11622",null,"AETNA","65870 - HC SEVERING ADS ANT SEG INCAL SPX ANT SYNECHIAE"]
["AETNA","AETNA","65875","HC SEVERING ADS ANT SEG INCAL SPX POST SYNECHIAE","65875 - HC SEVERING ADS ANT SEG INCAL SPX POST SYNECHIAE",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11622",null,"AETNA","65875 - HC SEVERING ADS ANT SEG INCAL SPX POST SYNECHIAE"]
["AETNA","AETNA","65920","HC REMOVE IMPLANT OF EYE","65920 - HC REMOVE IMPLANT OF EYE",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11622",null,"AETNA","65920 - HC REMOVE IMPLANT OF EYE"]
["AETNA","AETNA","66020","INJX ANTERIOR CHAMBER EYE AIR/LIQUID SPX","66020 - INJX ANTERIOR CHAMBER EYE AIR/LIQUID SPX",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11622",null,"AETNA","66020 - INJX ANTERIOR CHAMBER EYE AIR/LIQUID SPX"]
["AETNA","AETNA","66030","HC INJECTION TREATMENT OF EYE","66030 - HC INJECTION TREATMENT OF EYE",null,null,null,null,null,"BLUE CROSS-PPO","11622",null,"AETNA","66030 - HC INJECTION TREATMENT OF EYE"]
["AETNA","AETNA","66170","HC GLAUCOMA SURGERY","66170 - HC GLAUCOMA SURGERY",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11622",null,"AETNA","66170 - HC GLAUCOMA SURGERY"]
["AETNA","AETNA","66172","HC INCISION OF EYE","66172 - HC INCISION OF EYE",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11622",null,"AETNA","66172 - HC INCISION OF EYE"]
["AETNA","AETNA","66179","HC AQUEOUS SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT","66179 - HC AQUEOUS SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11622",null,"AETNA","66179 - HC AQUEOUS SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT"]
["AETNA","AETNA","66180","HC AQUEOUS SHUNT EYE W/GRAFT","66180 - HC AQUEOUS SHUNT EYE W/GRAFT",null,null,null,null,null,"CIGNA CARELINK","11622",null,"AETNA","66180 - HC AQUEOUS SHUNT EYE W/GRAFT"]
["AETNA","AETNA","66183","HC INSERT ANT DRAINAGE DEVICE","66183 - HC INSERT ANT DRAINAGE DEVICE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11622",null,"AETNA","66183 - HC INSERT ANT DRAINAGE DEVICE"]
["AETNA","AETNA","66185","HC REVISE AQUEOUS SHUNT EYE","66185 - HC REVISE AQUEOUS SHUNT EYE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11622",null,"AETNA","66185 - HC REVISE AQUEOUS SHUNT EYE"]
["AETNA","AETNA","66250","HC FOLLOW-UP SURGERY OF EYE","66250 - HC FOLLOW-UP SURGERY OF EYE",null,null,null,null,null,"TUFTS HMO","11622",null,"AETNA","66250 - HC FOLLOW-UP SURGERY OF EYE"]
["AETNA","AETNA","66600","HC REMOVE IRIS AND LESION","66600 - HC REMOVE IRIS AND LESION",null,null,null,null,null,"TUFTS POS","11622",null,"AETNA","66600 - HC REMOVE IRIS AND LESION"]
["AETNA","AETNA","66625","HC REMV IRIS PERIPH FOR GLAUCOMA","66625 - HC REMV IRIS PERIPH FOR GLAUCOMA",null,null,null,null,null,"TUFTS PPO","11622",null,"AETNA","66625 - HC REMV IRIS PERIPH FOR GLAUCOMA"]
["AETNA","AETNA","66682","HC REPAIR IRIS & CILIARY BODY","66682 - HC REPAIR IRIS & CILIARY BODY",null,null,null,null,null,"TUFTS SELECT","11622",null,"AETNA","66682 - HC REPAIR IRIS & CILIARY BODY"]
["AETNA","AETNA","66710","CILIARY BODY DSTRJ CYCLOPHOTOCOAG TRANSSCERAL","66710 - CILIARY BODY DSTRJ CYCLOPHOTOCOAG TRANSSCERAL",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11622",null,"AETNA","66710 - CILIARY BODY DSTRJ CYCLOPHOTOCOAG TRANSSCERAL"]
["AETNA","AETNA","66711","HC ECP CILIARY BODY DESTRUCTION","66711 - HC ECP CILIARY BODY DESTRUCTION",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11622",null,"AETNA","66711 - HC ECP CILIARY BODY DESTRUCTION"]
["AETNA","AETNA","66761","IRIDOTOMY/IRRIDECTOMY LASER SURG PER SESSION","66761 - IRIDOTOMY/IRRIDECTOMY LASER SURG PER SESSION",null,null,null,null,null,"AETNA","11623",null,"AETNA","66761 - IRIDOTOMY/IRRIDECTOMY LASER SURG PER SESSION"]
["AETNA","AETNA","66762","IRIDOPLASTY PHOTOCOAGULATION 1/> SESSIONS","66762 - IRIDOPLASTY PHOTOCOAGULATION 1/> SESSIONS",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11623",null,"AETNA","66762 - IRIDOPLASTY PHOTOCOAGULATION 1/> SESSIONS"]
["AETNA","AETNA","66821","POST-CATARACT LASER SURGERY","66821 - POST-CATARACT LASER SURGERY",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11623",null,"AETNA","66821 - POST-CATARACT LASER SURGERY"]
["AETNA","AETNA","66825","HC REPOSITION INTRAOCULAR LENS","66825 - HC REPOSITION INTRAOCULAR LENS",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11623",null,"AETNA","66825 - HC REPOSITION INTRAOCULAR LENS"]
["AETNA","AETNA","66840","HC RMVL LENS MATERIAL ASPIR TQ 1/> STAGES","66840 - HC RMVL LENS MATERIAL ASPIR TQ 1/> STAGES",null,null,null,null,null,"BLUE CROSS-PPO","11623",null,"AETNA","66840 - HC RMVL LENS MATERIAL ASPIR TQ 1/> STAGES"]
["AETNA","AETNA","66850","HC RMVL LENS MATERIAL PHACOFRAGMENTATION ASPIR","66850 - HC RMVL LENS MATERIAL PHACOFRAGMENTATION ASPIR",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11623",null,"AETNA","66850 - HC RMVL LENS MATERIAL PHACOFRAGMENTATION ASPIR"]
["AETNA","AETNA","66852","HC RMVL LENS MATERIAL PARS PLANA W/WO VITRECTOMY","66852 - HC RMVL LENS MATERIAL PARS PLANA W/WO VITRECTOMY",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11623",null,"AETNA","66852 - HC RMVL LENS MATERIAL PARS PLANA W/WO VITRECTOMY"]
["AETNA","AETNA","66940","HC EXTRACTION OF LENS","66940 - HC EXTRACTION OF LENS",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11623",null,"AETNA","66940 - HC EXTRACTION OF LENS"]
["AETNA","AETNA","66982","REMV CATARACT EXTRACAP,INSERT LENS,COMP","66982 - REMV CATARACT EXTRACAP,INSERT LENS,COMP",null,null,null,null,null,"CIGNA CARELINK","11623",null,"AETNA","66982 - REMV CATARACT EXTRACAP,INSERT LENS,COMP"]
["AETNA","AETNA","66984","REMV CATARACT EXTRACAP,INSERT LENS","66984 - REMV CATARACT EXTRACAP,INSERT LENS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11623",null,"AETNA","66984 - REMV CATARACT EXTRACAP,INSERT LENS"]
["AETNA","AETNA","66985","INSERT LENS PROSTHESIS ONLY","66985 - INSERT LENS PROSTHESIS ONLY",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11623",null,"AETNA","66985 - INSERT LENS PROSTHESIS ONLY"]
["AETNA","AETNA","66986","HC EXCHANGE LENS PROSTHESIS","66986 - HC EXCHANGE LENS PROSTHESIS",null,null,null,null,null,"TUFTS HMO","11623",null,"AETNA","66986 - HC EXCHANGE LENS PROSTHESIS"]
["AETNA","AETNA","67005","HC RMVL VITREOUS ANT APPR PARTIAL REMOVAL","67005 - HC RMVL VITREOUS ANT APPR PARTIAL REMOVAL",null,null,null,null,null,"TUFTS POS","11623",null,"AETNA","67005 - HC RMVL VITREOUS ANT APPR PARTIAL REMOVAL"]
["AETNA","AETNA","67010","HC RMVL VITREOUS ANT APPR SUBTOT RMVL MECH VITRECT","67010 - HC RMVL VITREOUS ANT APPR SUBTOT RMVL MECH VITRECT",null,null,null,null,null,"TUFTS PPO","11623",null,"AETNA","67010 - HC RMVL VITREOUS ANT APPR SUBTOT RMVL MECH VITRECT"]
["AETNA","AETNA","67015","ASPIRATION/RELEASE VITREOUS SUBRETINAL/CHOROIDAL","67015 - ASPIRATION/RELEASE VITREOUS SUBRETINAL/CHOROIDAL",null,null,null,null,null,"TUFTS SELECT","11623",null,"AETNA","67015 - ASPIRATION/RELEASE VITREOUS SUBRETINAL/CHOROIDAL"]
["AETNA","AETNA","67028","INTRAVITREAL NJX PHARMACOLOGIC AGT SPX","67028 - INTRAVITREAL NJX PHARMACOLOGIC AGT SPX",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11623",null,"AETNA","67028 - INTRAVITREAL NJX PHARMACOLOGIC AGT SPX"]
["AETNA","AETNA","67031","SEVERING VITREOUS STRANS LASER 1/> STAGES","67031 - SEVERING VITREOUS STRANS LASER 1/> STAGES",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11623",null,"AETNA","67031 - SEVERING VITREOUS STRANS LASER 1/> STAGES"]
["AETNA","AETNA","67036","HC VITRECTOMY,MECHANICAL","67036 - HC VITRECTOMY,MECHANICAL",null,null,null,null,null,"AETNA","11624",null,"AETNA","67036 - HC VITRECTOMY,MECHANICAL"]
["AETNA","AETNA","67039","HC VITRECTOMY,FOCAL LASER RX RETINA","67039 - HC VITRECTOMY,FOCAL LASER RX RETINA",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11624",null,"AETNA","67039 - HC VITRECTOMY,FOCAL LASER RX RETINA"]
["AETNA","AETNA","67040","HC LASER TREATMENT OF RETINA","67040 - HC LASER TREATMENT OF RETINA",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11624",null,"AETNA","67040 - HC LASER TREATMENT OF RETINA"]
["AETNA","AETNA","67041","HC VIT FOR MACULAR PUCKER","67041 - HC VIT FOR MACULAR PUCKER",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11624",null,"AETNA","67041 - HC VIT FOR MACULAR PUCKER"]
["AETNA","AETNA","67042","HC VIT FOR MACULAR HOLE","67042 - HC VIT FOR MACULAR HOLE",null,null,null,null,null,"BLUE CROSS-PPO","11624",null,"AETNA","67042 - HC VIT FOR MACULAR HOLE"]
["AETNA","AETNA","67101","HC RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID CRTX","67101 - HC RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID CRTX",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11624",null,"AETNA","67101 - HC RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID CRTX"]
["AETNA","AETNA","67105","RPR RETINAL DTCHMNT 1/> SES PC W/WO DRG SUBRETI","67105 - RPR RETINAL DTCHMNT 1/> SES PC W/WO DRG SUBRETI",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11624",null,"AETNA","67105 - RPR RETINAL DTCHMNT 1/> SES PC W/WO DRG SUBRETI"]
["AETNA","AETNA","67107","HC REPAIR RETINAL DETACHMENT SCLERAL BUCKLING","67107 - HC REPAIR RETINAL DETACHMENT SCLERAL BUCKLING",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11624",null,"AETNA","67107 - HC REPAIR RETINAL DETACHMENT SCLERAL BUCKLING"]
["AETNA","AETNA","67108","HC RPR RETINAL DTCHMNT W/VITRECTOMY ANY METH","67108 - HC RPR RETINAL DTCHMNT W/VITRECTOMY ANY METH",null,null,null,null,null,"CIGNA CARELINK","11624",null,"AETNA","67108 - HC RPR RETINAL DTCHMNT W/VITRECTOMY ANY METH"]
["AETNA","AETNA","67113","HC REPAIR COMPLEX RETINA DETACH VITRECTOMY & MEMB PEEL","67113 - HC REPAIR COMPLEX RETINA DETACH VITRECTOMY & MEMB PEEL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11624",null,"AETNA","67113 - HC REPAIR COMPLEX RETINA DETACH VITRECTOMY & MEMB PEEL"]
["AETNA","AETNA","67120","HC REMV POST EYE IMPLNT MATER,EXTRAOCUL","67120 - HC REMV POST EYE IMPLNT MATER,EXTRAOCUL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11624",null,"AETNA","67120 - HC REMV POST EYE IMPLNT MATER,EXTRAOCUL"]
["AETNA","AETNA","67121","HC REMOVE EYE IMPLANT MATERIAL","67121 - HC REMOVE EYE IMPLANT MATERIAL",null,null,null,null,null,"TUFTS HMO","11624",null,"AETNA","67121 - HC REMOVE EYE IMPLANT MATERIAL"]
["AETNA","AETNA","67141","HC PROPH RTA DTCHMNT CRTX DTHRM","67141 - HC PROPH RTA DTCHMNT CRTX DTHRM",null,null,null,null,null,"TUFTS POS","11624",null,"AETNA","67141 - HC PROPH RTA DTCHMNT CRTX DTHRM"]
["AETNA","AETNA","67145","PROPH RTA DTCHMNT W/O DRG 1/> SESS","67145 - PROPH RTA DTCHMNT W/O DRG 1/> SESS",null,null,null,null,null,"TUFTS PPO","11624",null,"AETNA","67145 - PROPH RTA DTCHMNT W/O DRG 1/> SESS"]
["AETNA","AETNA","67210","DSTRJ LOCLZD LES RETINA 1/> SESS PC","67210 - DSTRJ LOCLZD LES RETINA 1/> SESS PC",null,null,null,null,null,"TUFTS SELECT","11624",null,"AETNA","67210 - DSTRJ LOCLZD LES RETINA 1/> SESS PC"]
["AETNA","AETNA","67220","DSTRJ LES CHOROID PC 1/> SESS","67220 - DSTRJ LES CHOROID PC 1/> SESS",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11624",null,"AETNA","67220 - DSTRJ LES CHOROID PC 1/> SESS"]
["AETNA","AETNA","67221","DSTRJ LESION CHOROID PHOTODYNAMIC THERAPY","67221 - DSTRJ LESION CHOROID PHOTODYNAMIC THERAPY",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11624",null,"AETNA","67221 - DSTRJ LESION CHOROID PHOTODYNAMIC THERAPY"]
["AETNA","AETNA","67228","EXTENSIVE RETINOPATHY 1/> SESS PHOTOCOAGULATION","67228 - EXTENSIVE RETINOPATHY 1/> SESS PHOTOCOAGULATION",null,null,null,null,null,"AETNA","11626",null,"AETNA","67228 - EXTENSIVE RETINOPATHY 1/> SESS PHOTOCOAGULATION"]
["AETNA","AETNA","67311","HC STRABISMUS RECESSION/RESCJ 1 HRZNTL MUSC","67311 - HC STRABISMUS RECESSION/RESCJ 1 HRZNTL MUSC",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11626",null,"AETNA","67311 - HC STRABISMUS RECESSION/RESCJ 1 HRZNTL MUSC"]
["AETNA","AETNA","67312","HC STRABISMUS RECESSION/RESCJ 2 HRZNTL MUSC","67312 - HC STRABISMUS RECESSION/RESCJ 2 HRZNTL MUSC",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11626",null,"AETNA","67312 - HC STRABISMUS RECESSION/RESCJ 2 HRZNTL MUSC"]
["AETNA","AETNA","67314","HC STRABISMUS RECESSION/RESCJ 1 VER MUSC","67314 - HC STRABISMUS RECESSION/RESCJ 1 VER MUSC",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11626",null,"AETNA","67314 - HC STRABISMUS RECESSION/RESCJ 1 VER MUSC"]
["AETNA","AETNA","67316","HC STRABISMUS RECESSION/RESCJ 2/MORE VER MUSC","67316 - HC STRABISMUS RECESSION/RESCJ 2/MORE VER MUSC",null,null,null,null,null,"BLUE CROSS-PPO","11626",null,"AETNA","67316 - HC STRABISMUS RECESSION/RESCJ 2/MORE VER MUSC"]
["AETNA","AETNA","67318","HC STRABISMUS ANY SUPERIOR OBLIQUE MUSCLE","67318 - HC STRABISMUS ANY SUPERIOR OBLIQUE MUSCLE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11626",null,"AETNA","67318 - HC STRABISMUS ANY SUPERIOR OBLIQUE MUSCLE"]
["AETNA","AETNA","67320","HC TRANSPOSITION PROCEDURE EXTRAOCULAR MUSC ADD-ON","67320 - HC TRANSPOSITION PROCEDURE EXTRAOCULAR MUSC ADD-ON",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11626",null,"AETNA","67320 - HC TRANSPOSITION PROCEDURE EXTRAOCULAR MUSC ADD-ON"]
["AETNA","AETNA","67332","HC STRABISMUS SCARRING EO MUSC/RSTCV MYOPATHY ADD-ON","67332 - HC STRABISMUS SCARRING EO MUSC/RSTCV MYOPATHY ADD-ON",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11626",null,"AETNA","67332 - HC STRABISMUS SCARRING EO MUSC/RSTCV MYOPATHY ADD-ON"]
["AETNA","AETNA","67343","HC RELEASE EYE TISSUE","67343 - HC RELEASE EYE TISSUE",null,null,null,null,null,"CIGNA CARELINK","11626",null,"AETNA","67343 - HC RELEASE EYE TISSUE"]
["AETNA","AETNA","67345","HC DESTROY NERVE OF EYE MUSCLE","67345 - HC DESTROY NERVE OF EYE MUSCLE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11626",null,"AETNA","67345 - HC DESTROY NERVE OF EYE MUSCLE"]
["AETNA","AETNA","67400","HC EXPLORE/BIOPSY EYE SOCKET","67400 - HC EXPLORE/BIOPSY EYE SOCKET",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11626",null,"AETNA","67400 - HC EXPLORE/BIOPSY EYE SOCKET"]
["AETNA","AETNA","67405","HC EXPLORE/DRAIN EYE SOCKET","67405 - HC EXPLORE/DRAIN EYE SOCKET",null,null,null,null,null,"TUFTS HMO","11626",null,"AETNA","67405 - HC EXPLORE/DRAIN EYE SOCKET"]
["AETNA","AETNA","67412","HC EXPLORE/TREAT EYE SOCKET","67412 - HC EXPLORE/TREAT EYE SOCKET",null,null,null,null,null,"TUFTS POS","11626",null,"AETNA","67412 - HC EXPLORE/TREAT EYE SOCKET"]
["AETNA","AETNA","67414","HC EXPLR/DECOMPRESS EYE SOCKET","67414 - HC EXPLR/DECOMPRESS EYE SOCKET",null,null,null,null,null,"TUFTS PPO","11626",null,"AETNA","67414 - HC EXPLR/DECOMPRESS EYE SOCKET"]
["AETNA","AETNA","67420","HC EXPLORE/TREAT EYE SOCKET","67420 - HC EXPLORE/TREAT EYE SOCKET",null,null,null,null,null,"TUFTS SELECT","11626",null,"AETNA","67420 - HC EXPLORE/TREAT EYE SOCKET"]
["AETNA","AETNA","67505","HC INJECT/TREAT EYE SOCKET","67505 - HC INJECT/TREAT EYE SOCKET",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11626",null,"AETNA","67505 - HC INJECT/TREAT EYE SOCKET"]
["AETNA","AETNA","67515","INJECTION MEDICATION/OTHER SUBST TENON CAPSULE","67515 - INJECTION MEDICATION/OTHER SUBST TENON CAPSULE",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11626",null,"AETNA","67515 - INJECTION MEDICATION/OTHER SUBST TENON CAPSULE"]
["AETNA","AETNA","67550","HC INSERT EYE SOCKET IMPLANT","67550 - HC INSERT EYE SOCKET IMPLANT",null,null,null,null,null,"AETNA","11640",null,"AETNA","67550 - HC INSERT EYE SOCKET IMPLANT"]
["AETNA","AETNA","67700","BLEPHAROTOMY DRAINAGE ABSCESS EYELID","67700 - BLEPHAROTOMY DRAINAGE ABSCESS EYELID",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11640",null,"AETNA","67700 - BLEPHAROTOMY DRAINAGE ABSCESS EYELID"]
["AETNA","AETNA","67710","SEVERING TARSORRHAPHY","67710 - SEVERING TARSORRHAPHY",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11640",null,"AETNA","67710 - SEVERING TARSORRHAPHY"]
["AETNA","AETNA","67715","HC CANTHOTOMY SEPARATE PROCEDURE","67715 - HC CANTHOTOMY SEPARATE PROCEDURE",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11640",null,"AETNA","67715 - HC CANTHOTOMY SEPARATE PROCEDURE"]
["AETNA","AETNA","67800","EXCISION CHALAZION SINGLE","67800 - EXCISION CHALAZION SINGLE",null,null,null,null,null,"BLUE CROSS-PPO","11640",null,"AETNA","67800 - EXCISION CHALAZION SINGLE"]
["AETNA","AETNA","67801","EXCISION CHALAZION MULTIPLE SAME LID","67801 - EXCISION CHALAZION MULTIPLE SAME LID",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11640",null,"AETNA","67801 - EXCISION CHALAZION MULTIPLE SAME LID"]
["AETNA","AETNA","67805","EXCISION CHALAZION MULTIPLE DIFFERENT LIDS","67805 - EXCISION CHALAZION MULTIPLE DIFFERENT LIDS",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11640",null,"AETNA","67805 - EXCISION CHALAZION MULTIPLE DIFFERENT LIDS"]
["AETNA","AETNA","67808","HC REMOVE EYELID LESION(S)","67808 - HC REMOVE EYELID LESION(S)",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11640",null,"AETNA","67808 - HC REMOVE EYELID LESION(S)"]
["AETNA","AETNA","67810","INCISIONAL BIOPSY EYELID SKIN & LID MARGIN","67810 - INCISIONAL BIOPSY EYELID SKIN & LID MARGIN",null,null,null,null,null,"CIGNA CARELINK","11640",null,"AETNA","67810 - INCISIONAL BIOPSY EYELID SKIN & LID MARGIN"]
["AETNA","AETNA","67840","EXC LESION EYELID W/O CLSR/W/SIMPLE DIR CLOSURE","67840 - EXC LESION EYELID W/O CLSR/W/SIMPLE DIR CLOSURE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11640",null,"AETNA","67840 - EXC LESION EYELID W/O CLSR/W/SIMPLE DIR CLOSURE"]
["AETNA","AETNA","67850","HC DESTRUC EYELID LESN, <1 CM","67850 - HC DESTRUC EYELID LESN, <1 CM",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11640",null,"AETNA","67850 - HC DESTRUC EYELID LESN, <1 CM"]
["AETNA","AETNA","67875","TEMPORARY CLOSURE EYELIDS SUTURE","67875 - TEMPORARY CLOSURE EYELIDS SUTURE",null,null,null,null,null,"TUFTS HMO","11640",null,"AETNA","67875 - TEMPORARY CLOSURE EYELIDS SUTURE"]
["AETNA","AETNA","67880","HC REVISION OF EYELID","67880 - HC REVISION OF EYELID",null,null,null,null,null,"TUFTS POS","11640",null,"AETNA","67880 - HC REVISION OF EYELID"]
["AETNA","AETNA","67882","HC REVISION EYELID,XPOSITN TARSAL PLATE","67882 - HC REVISION EYELID,XPOSITN TARSAL PLATE",null,null,null,null,null,"TUFTS PPO","11640",null,"AETNA","67882 - HC REVISION EYELID,XPOSITN TARSAL PLATE"]
["AETNA","AETNA","67900","HC REPAIR BROW DEFECT","67900 - HC REPAIR BROW DEFECT",null,null,null,null,null,"TUFTS SELECT","11640",null,"AETNA","67900 - HC REPAIR BROW DEFECT"]
["AETNA","AETNA","67901","HC RPR BLEPHAROPTOSIS FRONTALIS MUSC SUTR/OTH MATRL","67901 - HC RPR BLEPHAROPTOSIS FRONTALIS MUSC SUTR/OTH MATRL",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11640",null,"AETNA","67901 - HC RPR BLEPHAROPTOSIS FRONTALIS MUSC SUTR/OTH MATRL"]
["AETNA","AETNA","67902","HC RPR BLEPHAROPT FRONTALIS MUSC AUTOL FASCAL SLING","67902 - HC RPR BLEPHAROPT FRONTALIS MUSC AUTOL FASCAL SLING",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11640",null,"AETNA","67902 - HC RPR BLEPHAROPT FRONTALIS MUSC AUTOL FASCAL SLING"]
["AETNA","AETNA","67903","HC RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT INTERNAL","67903 - HC RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT INTERNAL",null,null,null,null,null,"AETNA","11642",null,"AETNA","67903 - HC RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT INTERNAL"]
["AETNA","AETNA","67904","HC RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT XTRNL","67904 - HC RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT XTRNL",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11642",null,"AETNA","67904 - HC RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT XTRNL"]
["AETNA","AETNA","67911","HC CORRECT LID RETRACTN","67911 - HC CORRECT LID RETRACTN",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11642",null,"AETNA","67911 - HC CORRECT LID RETRACTN"]
["AETNA","AETNA","67912","CORRJ LAGOPHTHALMOS IMPLTJ UPR EYELID LID LOAD","67912 - CORRJ LAGOPHTHALMOS IMPLTJ UPR EYELID LID LOAD",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11642",null,"AETNA","67912 - CORRJ LAGOPHTHALMOS IMPLTJ UPR EYELID LID LOAD"]
["AETNA","AETNA","67917","REPAIR ECTROPION EXTENSIVE","67917 - REPAIR ECTROPION EXTENSIVE",null,null,null,null,null,"BLUE CROSS-PPO","11642",null,"AETNA","67917 - REPAIR ECTROPION EXTENSIVE"]
["AETNA","AETNA","67921","HC FIX ENTROPION,SUTURE","67921 - HC FIX ENTROPION,SUTURE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11642",null,"AETNA","67921 - HC FIX ENTROPION,SUTURE"]
["AETNA","AETNA","67923","HC REPAIR ENTROPION EXCISION TARSAL WEDGE","67923 - HC REPAIR ENTROPION EXCISION TARSAL WEDGE",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11642",null,"AETNA","67923 - HC REPAIR ENTROPION EXCISION TARSAL WEDGE"]
["AETNA","AETNA","67924","HC FIX ENTROPION,EXTENSV LID REPAIR","67924 - HC FIX ENTROPION,EXTENSV LID REPAIR",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11642",null,"AETNA","67924 - HC FIX ENTROPION,EXTENSV LID REPAIR"]
["AETNA","AETNA","67930","HC SUTURE EYELID WOUND,PARTIAL THICK","67930 - HC SUTURE EYELID WOUND,PARTIAL THICK",null,null,null,null,null,"CIGNA CARELINK","11642",null,"AETNA","67930 - HC SUTURE EYELID WOUND,PARTIAL THICK"]
["AETNA","AETNA","67935","HC SUTURE EYELID WOUND,FULL THICK","67935 - HC SUTURE EYELID WOUND,FULL THICK",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11642",null,"AETNA","67935 - HC SUTURE EYELID WOUND,FULL THICK"]
["AETNA","AETNA","67961","HC REVISION OF EYELID,< 1/4 LID MARGIN","67961 - HC REVISION OF EYELID,< 1/4 LID MARGIN",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11642",null,"AETNA","67961 - HC REVISION OF EYELID,< 1/4 LID MARGIN"]
["AETNA","AETNA","67966","HC EXCISION & REPAIR EYELID ONE-FOURTH LID MARGIN","67966 - HC EXCISION & REPAIR EYELID ONE-FOURTH LID MARGIN",null,null,null,null,null,"TUFTS HMO","11642",null,"AETNA","67966 - HC EXCISION & REPAIR EYELID ONE-FOURTH LID MARGIN"]
["AETNA","AETNA","67971","HC RCNSTJ EYELID FULL THICKNESS </TWO-THIRDS 1 STG","67971 - HC RCNSTJ EYELID FULL THICKNESS </TWO-THIRDS 1 STG",null,null,null,null,null,"TUFTS POS","11642",null,"AETNA","67971 - HC RCNSTJ EYELID FULL THICKNESS </TWO-THIRDS 1 STG"]
["AETNA","AETNA","67973","HC RCNSTJ EYELID FULL THICKNESS LOWER EYELID 1 STG","67973 - HC RCNSTJ EYELID FULL THICKNESS LOWER EYELID 1 STG",null,null,null,null,null,"TUFTS PPO","11642",null,"AETNA","67973 - HC RCNSTJ EYELID FULL THICKNESS LOWER EYELID 1 STG"]
["AETNA","AETNA","68020","HC INCISE/DRAIN CONJUNCTIVA","68020 - HC INCISE/DRAIN CONJUNCTIVA",null,null,null,null,null,"TUFTS SELECT","11642",null,"AETNA","68020 - HC INCISE/DRAIN CONJUNCTIVA"]
["AETNA","AETNA","68100","HC BIOPSY OF CONJUNCTIVA","68100 - HC BIOPSY OF CONJUNCTIVA",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11642",null,"AETNA","68100 - HC BIOPSY OF CONJUNCTIVA"]
["AETNA","AETNA","68110","EXCISION LESION CONJUNCTIVA </1 CM","68110 - EXCISION LESION CONJUNCTIVA </1 CM",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11642",null,"AETNA","68110 - EXCISION LESION CONJUNCTIVA </1 CM"]
["AETNA","AETNA","68115","HC REMOVE EYELID LINING LESION","68115 - HC REMOVE EYELID LINING LESION",null,null,null,null,null,"AETNA","11643",null,"AETNA","68115 - HC REMOVE EYELID LINING LESION"]
["AETNA","AETNA","68320","HC CONJUNCTIVOPLASTY W/GRF/XTNSV REARRANGEMENT","68320 - HC CONJUNCTIVOPLASTY W/GRF/XTNSV REARRANGEMENT",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11643",null,"AETNA","68320 - HC CONJUNCTIVOPLASTY W/GRF/XTNSV REARRANGEMENT"]
["AETNA","AETNA","68325","HC CONJUNCTIVOPLASTY W/BUCCAL MUC MEMB GRAFT","68325 - HC CONJUNCTIVOPLASTY W/BUCCAL MUC MEMB GRAFT",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11643",null,"AETNA","68325 - HC CONJUNCTIVOPLASTY W/BUCCAL MUC MEMB GRAFT"]
["AETNA","AETNA","68335","HC RPR SYMBLEPHARON FR GRF CJNC/BUCCAL MUC MEMB","68335 - HC RPR SYMBLEPHARON FR GRF CJNC/BUCCAL MUC MEMB",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11643",null,"AETNA","68335 - HC RPR SYMBLEPHARON FR GRF CJNC/BUCCAL MUC MEMB"]
["AETNA","AETNA","68340","HC DIVISION OF SYMBLEPHARON","68340 - HC DIVISION OF SYMBLEPHARON",null,null,null,null,null,"BLUE CROSS-PPO","11643",null,"AETNA","68340 - HC DIVISION OF SYMBLEPHARON"]
["AETNA","AETNA","68362","HC CONJUNCTIVAL FLAP TOTAL","68362 - HC CONJUNCTIVAL FLAP TOTAL",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11643",null,"AETNA","68362 - HC CONJUNCTIVAL FLAP TOTAL"]
["AETNA","AETNA","68440","HC INCISE TEAR DUCT OPENING","68440 - HC INCISE TEAR DUCT OPENING",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11643",null,"AETNA","68440 - HC INCISE TEAR DUCT OPENING"]
["AETNA","AETNA","68530","HC CLEARANCE OF TEAR DUCT","68530 - HC CLEARANCE OF TEAR DUCT",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11643",null,"AETNA","68530 - HC CLEARANCE OF TEAR DUCT"]
["AETNA","AETNA","68700","HC REPAIR TEAR DUCTS","68700 - HC REPAIR TEAR DUCTS",null,null,null,null,null,"CIGNA CARELINK","11643",null,"AETNA","68700 - HC REPAIR TEAR DUCTS"]
["AETNA","AETNA","68720","HC CREATE TEAR SAC DRAIN","68720 - HC CREATE TEAR SAC DRAIN",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11643",null,"AETNA","68720 - HC CREATE TEAR SAC DRAIN"]
["AETNA","AETNA","68750","HC CREATE TEAR DUCT DRAIN","68750 - HC CREATE TEAR DUCT DRAIN",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11643",null,"AETNA","68750 - HC CREATE TEAR DUCT DRAIN"]
["AETNA","AETNA","68760","HC CLOSE TEAR DUCT OPENING","68760 - HC CLOSE TEAR DUCT OPENING",null,null,null,null,null,"TUFTS HMO","11643",null,"AETNA","68760 - HC CLOSE TEAR DUCT OPENING"]
["AETNA","AETNA","68761","CLSR LACRIMAL PUNCTUM PLUG EACH","68761 - CLSR LACRIMAL PUNCTUM PLUG EACH",null,null,null,null,null,"TUFTS POS","11643",null,"AETNA","68761 - CLSR LACRIMAL PUNCTUM PLUG EACH"]
["AETNA","AETNA","68810","HC PROBE NASOLACRIMAL DUCT","68810 - HC PROBE NASOLACRIMAL DUCT",null,null,null,null,null,"TUFTS PPO","11643",null,"AETNA","68810 - HC PROBE NASOLACRIMAL DUCT"]
["AETNA","AETNA","68811","HC PROBE NASOLACRIMAL DUCT","68811 - HC PROBE NASOLACRIMAL DUCT",null,null,null,null,null,"TUFTS SELECT","11643",null,"AETNA","68811 - HC PROBE NASOLACRIMAL DUCT"]
["AETNA","AETNA","68815","HC PROBE NASOLAC DUCT,INSERT TUBE/STENT","68815 - HC PROBE NASOLAC DUCT,INSERT TUBE/STENT",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11643",null,"AETNA","68815 - HC PROBE NASOLAC DUCT,INSERT TUBE/STENT"]
["AETNA","AETNA","68816","HC PROBE NL DUCT W/BALLOON","68816 - HC PROBE NL DUCT W/BALLOON",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11643",null,"AETNA","68816 - HC PROBE NL DUCT W/BALLOON"]
["AETNA","AETNA","68840","HC EXPLORE LACRIMAL CANALICULI","68840 - HC EXPLORE LACRIMAL CANALICULI",null,null,null,null,null,"AETNA","11644",null,"AETNA","68840 - HC EXPLORE LACRIMAL CANALICULI"]
["AETNA","AETNA","69000","DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE","69000 - DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11644",null,"AETNA","69000 - DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE"]
["AETNA","AETNA","69005","DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX","69005 - DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11644",null,"AETNA","69005 - DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX"]
["AETNA","AETNA","69020","DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS","69020 - DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11644",null,"AETNA","69020 - DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS"]
["AETNA","AETNA","69110","HC REMOVAL EXTERNAL EAR,PARTIAL","69110 - HC REMOVAL EXTERNAL EAR,PARTIAL",null,null,null,null,null,"BLUE CROSS-PPO","11644",null,"AETNA","69110 - HC REMOVAL EXTERNAL EAR,PARTIAL"]
["AETNA","AETNA","69145","EXCISION SOFT TIS LES EXTERNAL AUDITORY CANAL","69145 - EXCISION SOFT TIS LES EXTERNAL AUDITORY CANAL",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11644",null,"AETNA","69145 - EXCISION SOFT TIS LES EXTERNAL AUDITORY CANAL"]
["AETNA","AETNA","69209","RMVL IMPACTED CERUMEN USING IRRIGATION/LAVAGE,UNILATERAL","69209 - RMVL IMPACTED CERUMEN USING IRRIGATION/LAVAGE,UNILATERAL",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11644",null,"AETNA","69209 - RMVL IMPACTED CERUMEN USING IRRIGATION/LAVAGE,UNILATERAL"]
["AETNA","AETNA","69210","RMVL IMPACTED CERUMEN SPX 1/BOTH EARS","69210 - RMVL IMPACTED CERUMEN SPX 1/BOTH EARS",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11644",null,"AETNA","69210 - RMVL IMPACTED CERUMEN SPX 1/BOTH EARS"]
["AETNA","AETNA","69222","DEBRIDEMENT MASTOIDECTOMY CAVITY CMPLX","69222 - DEBRIDEMENT MASTOIDECTOMY CAVITY CMPLX",null,null,null,null,null,"CIGNA CARELINK","11644",null,"AETNA","69222 - DEBRIDEMENT MASTOIDECTOMY CAVITY CMPLX"]
["AETNA","AETNA","69300","HC OTOPLASTY PROTRUDING EAR W WO SIZE RDCTJ","69300 - HC OTOPLASTY PROTRUDING EAR W WO SIZE RDCTJ",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11644",null,"AETNA","69300 - HC OTOPLASTY PROTRUDING EAR W WO SIZE RDCTJ"]
["AETNA","AETNA","69420","MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ","69420 - MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11644",null,"AETNA","69420 - MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ"]
["AETNA","AETNA","69433","TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA","69433 - TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA",null,null,null,null,null,"TUFTS HMO","11644",null,"AETNA","69433 - TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA"]
["AETNA","AETNA","69436","HC CREATE EARDRUM OPENING,GEN ANESTH","69436 - HC CREATE EARDRUM OPENING,GEN ANESTH",null,null,null,null,null,"TUFTS POS","11644",null,"AETNA","69436 - HC CREATE EARDRUM OPENING,GEN ANESTH"]
["AETNA","AETNA","69501","MASTOIDECTOMY,SIMPLE","69501 - MASTOIDECTOMY,SIMPLE",null,null,null,null,null,"TUFTS PPO","11644",null,"AETNA","69501 - MASTOIDECTOMY,SIMPLE"]
["AETNA","AETNA","69540","HC REMV AURAL POLYP","69540 - HC REMV AURAL POLYP",null,null,null,null,null,"TUFTS SELECT","11644",null,"AETNA","69540 - HC REMV AURAL POLYP"]
["AETNA","AETNA","69620","MYRINGOPLASTY","69620 - MYRINGOPLASTY",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11644",null,"AETNA","69620 - MYRINGOPLASTY"]
["AETNA","AETNA","69631","HC TYMPANOPLASTY","69631 - HC TYMPANOPLASTY",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11644",null,"AETNA","69631 - HC TYMPANOPLASTY"]
["AETNA","AETNA","69801","LABYRINTHOTOMY TRANSCANAL","69801 - LABYRINTHOTOMY TRANSCANAL",null,null,null,null,null,"AETNA","11646",null,"AETNA","69801 - LABYRINTHOTOMY TRANSCANAL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","77063","SCREENING DIGITAL BREAST TOMOSYNTHESIS BI","77063 - SCREENING DIGITAL BREAST TOMOSYNTHESIS BI",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11646",null,"AETNA","77063 - SCREENING DIGITAL BREAST TOMOSYNTHESIS BI"]
["AETNA","AETNA-MEDICARE ADVANTAGE","77065","HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11646",null,"AETNA","77065 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["AETNA","AETNA-MEDICARE ADVANTAGE","77066","HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11646",null,"AETNA","77066 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["AETNA","AETNA-MEDICARE ADVANTAGE","77067","HC SCR MAMM CAD, BI","77067 - HC SCR MAMM CAD, BI",null,null,null,null,null,"BLUE CROSS-PPO","11646",null,"AETNA","77067 - HC SCR MAMM CAD, BI"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80048","HC CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - HC CHG BASIC METABOLIC PANEL CALCIUM TOTAL",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11646",null,"AETNA","80048 - HC CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80051","HC CHG ELECTROLYTE PANEL","80051 - HC CHG ELECTROLYTE PANEL",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11646",null,"AETNA","80051 - HC CHG ELECTROLYTE PANEL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80053","HC CHG COMPREHENSIVE METABOLIC PANEL","80053 - HC CHG COMPREHENSIVE METABOLIC PANEL",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11646",null,"AETNA","80053 - HC CHG COMPREHENSIVE METABOLIC PANEL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80055","HC CHG OBSTETRIC PANEL","80055 - HC CHG OBSTETRIC PANEL",null,null,null,null,null,"CIGNA CARELINK","11646",null,"AETNA","80055 - HC CHG OBSTETRIC PANEL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80061","HC CHG LIPID PANEL","80061 - HC CHG LIPID PANEL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11646",null,"AETNA","80061 - HC CHG LIPID PANEL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80069","HC CHG RENAL FUNCTION PANEL","80069 - HC CHG RENAL FUNCTION PANEL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11646",null,"AETNA","80069 - HC CHG RENAL FUNCTION PANEL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80074","HC CHG ACUTE HEPATITIS PANEL","80074 - HC CHG ACUTE HEPATITIS PANEL",null,null,null,null,null,"TUFTS HMO","11646",null,"AETNA","80074 - HC CHG ACUTE HEPATITIS PANEL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80076","HC CHG HEPATIC FUNCTION PANEL","80076 - HC CHG HEPATIC FUNCTION PANEL",null,null,null,null,null,"TUFTS POS","11646",null,"AETNA","80076 - HC CHG HEPATIC FUNCTION PANEL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80145","HC DRUG ASSAY ADALIMUMAB","80145 - HC DRUG ASSAY ADALIMUMAB",null,null,null,null,null,"TUFTS PPO","11646",null,"AETNA","80145 - HC DRUG ASSAY ADALIMUMAB"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80150","HC AMIKACIN","80150 - HC AMIKACIN",null,null,null,null,null,"TUFTS SELECT","11646",null,"AETNA","80150 - HC AMIKACIN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80156","HC CHG DRUG ASSAY CARBAMAZEPINE TOTAL","80156 - HC CHG DRUG ASSAY CARBAMAZEPINE TOTAL",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11646",null,"AETNA","80156 - HC CHG DRUG ASSAY CARBAMAZEPINE TOTAL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80158","HC CHG DRUG ASSAY CYCLOSPORINE","80158 - HC CHG DRUG ASSAY CYCLOSPORINE",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11646",null,"AETNA","80158 - HC CHG DRUG ASSAY CYCLOSPORINE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80162","HC CHG DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL","80162 - HC CHG DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11719",null,"AETNA","80162 - HC CHG DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80164","HC CHG DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL","80164 - HC CHG DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11719",null,"AETNA","80164 - HC CHG DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80168","HC CHG DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE","80168 - HC CHG DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11719",null,"AETNA","80168 - HC CHG DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80169","DRUG SCREEN QUANTITATIVE EVEROLIMUS","80169 - DRUG SCREEN QUANTITATIVE EVEROLIMUS",null,null,null,null,null,"BLUE CROSS-PPO","11719",null,"AETNA","80169 - DRUG SCREEN QUANTITATIVE EVEROLIMUS"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80170","HC CHG DRUG SCREEN QUANTITATIVE GENTAMICIN","80170 - HC CHG DRUG SCREEN QUANTITATIVE GENTAMICIN",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11719",null,"AETNA","80170 - HC CHG DRUG SCREEN QUANTITATIVE GENTAMICIN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80171","DRUG SCREEN QUANTITATIVE GABAPENTIN","80171 - DRUG SCREEN QUANTITATIVE GABAPENTIN",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11719",null,"AETNA","80171 - DRUG SCREEN QUANTITATIVE GABAPENTIN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80175","DRUG SCREEN QUANTITATIVE LAMOTRIGINE","80175 - DRUG SCREEN QUANTITATIVE LAMOTRIGINE",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11719",null,"AETNA","80175 - DRUG SCREEN QUANTITATIVE LAMOTRIGINE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80177","DRUG SCREEN QUANTITATIVE LEVETIRACETAM","80177 - DRUG SCREEN QUANTITATIVE LEVETIRACETAM",null,null,null,null,null,"CIGNA CARELINK","11719",null,"AETNA","80177 - DRUG SCREEN QUANTITATIVE LEVETIRACETAM"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80178","HC CHG DRUG SCREEN QUANTITATIVE LITHIUM","80178 - HC CHG DRUG SCREEN QUANTITATIVE LITHIUM",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11719",null,"AETNA","80178 - HC CHG DRUG SCREEN QUANTITATIVE LITHIUM"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80184","HC CHG DRUG SCREEN QUANTITATIVE PHENOBARBITAL","80184 - HC CHG DRUG SCREEN QUANTITATIVE PHENOBARBITAL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11719",null,"AETNA","80184 - HC CHG DRUG SCREEN QUANTITATIVE PHENOBARBITAL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80185","HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL","80185 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL",null,null,null,null,null,"TUFTS HMO","11719",null,"AETNA","80185 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80186","HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN FREE","80186 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN FREE",null,null,null,null,null,"TUFTS POS","11719",null,"AETNA","80186 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN FREE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80187","HC DRUG ASSAY POSACONAZOLE","80187 - HC DRUG ASSAY POSACONAZOLE",null,null,null,null,null,"TUFTS PPO","11719",null,"AETNA","80187 - HC DRUG ASSAY POSACONAZOLE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80195","HC CHG DRUG SCREEN QUANTITATIVE SIROLIMUS","80195 - HC CHG DRUG SCREEN QUANTITATIVE SIROLIMUS",null,null,null,null,null,"TUFTS SELECT","11719",null,"AETNA","80195 - HC CHG DRUG SCREEN QUANTITATIVE SIROLIMUS"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80197","HC CHG DRUG SCREEN QUANTITATIVE TACROLIMUS","80197 - HC CHG DRUG SCREEN QUANTITATIVE TACROLIMUS",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11719",null,"AETNA","80197 - HC CHG DRUG SCREEN QUANTITATIVE TACROLIMUS"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80198","HC Q;THEOPHYLLINE","80198 - HC Q;THEOPHYLLINE",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11719",null,"AETNA","80198 - HC Q;THEOPHYLLINE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80201","HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE","80201 - HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE",null,null,null,null,null,"AETNA","11720",null,"AETNA","80201 - HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80202","HC CHG DRUG SCREEN QUANTITATIVE VANCOMYCIN","80202 - HC CHG DRUG SCREEN QUANTITATIVE VANCOMYCIN",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11720",null,"AETNA","80202 - HC CHG DRUG SCREEN QUANTITATIVE VANCOMYCIN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80203","DRUG SCREEN QUANTITATIVE ZONISAMIDE","80203 - DRUG SCREEN QUANTITATIVE ZONISAMIDE",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11720",null,"AETNA","80203 - DRUG SCREEN QUANTITATIVE ZONISAMIDE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80230","HC DRUG ASSAY INFLIXIMAB","80230 - HC DRUG ASSAY INFLIXIMAB",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11720",null,"AETNA","80230 - HC DRUG ASSAY INFLIXIMAB"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80235","HC DRUG ASSAY LACOSAMIDE","80235 - HC DRUG ASSAY LACOSAMIDE",null,null,null,null,null,"BLUE CROSS-PPO","11720",null,"AETNA","80235 - HC DRUG ASSAY LACOSAMIDE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80280","HC DRUG ASSAY VEDOLIZUMAB","80280 - HC DRUG ASSAY VEDOLIZUMAB",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11720",null,"AETNA","80280 - HC DRUG ASSAY VEDOLIZUMAB"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80285","HC DRUG ASSAY VORICONAZOLE","80285 - HC DRUG ASSAY VORICONAZOLE",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11720",null,"AETNA","80285 - HC DRUG ASSAY VORICONAZOLE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80299","HC INFLIXIMAB DRUG CONC. AND ANTI-INFLIXIMAB AB","80299 - HC INFLIXIMAB DRUG CONC. AND ANTI-INFLIXIMAB AB",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11720",null,"AETNA","80299 - HC INFLIXIMAB DRUG CONC. AND ANTI-INFLIXIMAB AB"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80306","HC DRUG TEST PRSMV INSTRMNT","80306 - HC DRUG TEST PRSMV INSTRMNT",null,null,null,null,null,"CIGNA CARELINK","11720",null,"AETNA","80306 - HC DRUG TEST PRSMV INSTRMNT"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80307","HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS","80307 - HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11720",null,"AETNA","80307 - HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS"]
["AETNA","AETNA-MEDICARE ADVANTAGE","80438","HC CHG TRH STIM PANEL 1 HR","80438 - HC CHG TRH STIM PANEL 1 HR",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11720",null,"AETNA","80438 - HC CHG TRH STIM PANEL 1 HR"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81000","URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY","81000 - URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY",null,null,null,null,null,"TUFTS HMO","11720",null,"AETNA","81000 - URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81001","URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY","81001 - URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY",null,null,null,null,null,"TUFTS POS","11720",null,"AETNA","81001 - URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81002","URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP","81002 - URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP",null,null,null,null,null,"TUFTS PPO","11720",null,"AETNA","81002 - URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81003","URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY","81003 - URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY",null,null,null,null,null,"TUFTS SELECT","11720",null,"AETNA","81003 - URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81015","HC CHG URINALYSIS MICROSCOPIC ONLY","81015 - HC CHG URINALYSIS MICROSCOPIC ONLY",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11720",null,"AETNA","81015 - HC CHG URINALYSIS MICROSCOPIC ONLY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81025","URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS","81025 - URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11720",null,"AETNA","81025 - URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81050","HC CHG VOLUME MEASUREMENT TIMED COLLECTION EACH","81050 - HC CHG VOLUME MEASUREMENT TIMED COLLECTION EACH",null,null,null,null,null,"AETNA","11721",null,"AETNA","81050 - HC CHG VOLUME MEASUREMENT TIMED COLLECTION EACH"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81161","HC DMD DUPLICATION/DELETION ANALYSIS","81161 - HC DMD DUPLICATION/DELETION ANALYSIS",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11721",null,"AETNA","81161 - HC DMD DUPLICATION/DELETION ANALYSIS"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81178","HC CHG ATXN1 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","81178 - HC CHG ATXN1 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11721",null,"AETNA","81178 - HC CHG ATXN1 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81179","HC CHG ATXN2 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","81179 - HC CHG ATXN2 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11721",null,"AETNA","81179 - HC CHG ATXN2 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81180","HC CHG ATXN3 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","81180 - HC CHG ATXN3 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES",null,null,null,null,null,"BLUE CROSS-PPO","11721",null,"AETNA","81180 - HC CHG ATXN3 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81206","HC CHG BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE","81206 - HC CHG BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11721",null,"AETNA","81206 - HC CHG BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81207","HC Q;P190 BCR-ABL 1","81207 - HC Q;P190 BCR-ABL 1",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11721",null,"AETNA","81207 - HC Q;P190 BCR-ABL 1"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81210","HC CHG BRAF GENE ANALYSIS V600 VARIANT(S)","81210 - HC CHG BRAF GENE ANALYSIS V600 VARIANT(S)",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11721",null,"AETNA","81210 - HC CHG BRAF GENE ANALYSIS V600 VARIANT(S)"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81218","HC CEBPA GENE ANALYSIS FULL GENE SEQUENC","81218 - HC CEBPA GENE ANALYSIS FULL GENE SEQUENC",null,null,null,null,null,"CIGNA CARELINK","11721",null,"AETNA","81218 - HC CEBPA GENE ANALYSIS FULL GENE SEQUENC"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81220","HC CHG CFTR GENE ANALYSIS COMMON VARIANTS","81220 - HC CHG CFTR GENE ANALYSIS COMMON VARIANTS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11721",null,"AETNA","81220 - HC CHG CFTR GENE ANALYSIS COMMON VARIANTS"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81221","HC CHG CFTR GENE ANALYSIS KNOWN FAMILIAL VARIANTS","81221 - HC CHG CFTR GENE ANALYSIS KNOWN FAMILIAL VARIANTS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11721",null,"AETNA","81221 - HC CHG CFTR GENE ANALYSIS KNOWN FAMILIAL VARIANTS"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81222","HC GEN CYSTIC FIBROSIS DEL/DUP","81222 - HC GEN CYSTIC FIBROSIS DEL/DUP",null,null,null,null,null,"TUFTS HMO","11721",null,"AETNA","81222 - HC GEN CYSTIC FIBROSIS DEL/DUP"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81223","HC CFTR GENE ANALYSIS FULL GENE SEQUENCE","81223 - HC CFTR GENE ANALYSIS FULL GENE SEQUENCE",null,null,null,null,null,"TUFTS POS","11721",null,"AETNA","81223 - HC CFTR GENE ANALYSIS FULL GENE SEQUENCE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81229","HC CYTOG ALYS CHRML ABNR SNPCGH","81229 - HC CYTOG ALYS CHRML ABNR SNPCGH",null,null,null,null,null,"TUFTS PPO","11721",null,"AETNA","81229 - HC CYTOG ALYS CHRML ABNR SNPCGH"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81235","HC CHG EGFR GENE ANALYSIS COMMON VARIANTS","81235 - HC CHG EGFR GENE ANALYSIS COMMON VARIANTS",null,null,null,null,null,"TUFTS SELECT","11721",null,"AETNA","81235 - HC CHG EGFR GENE ANALYSIS COMMON VARIANTS"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81240","HC CHG F2 GENE ANALYSIS 20210G >A VARIANT","81240 - HC CHG F2 GENE ANALYSIS 20210G >A VARIANT",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11721",null,"AETNA","81240 - HC CHG F2 GENE ANALYSIS 20210G >A VARIANT"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81241","HC CHG F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT","81241 - HC CHG F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11721",null,"AETNA","81241 - HC CHG F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81243","HC CHG FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES","81243 - HC CHG FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES",null,null,null,null,null,"AETNA","11730",null,"AETNA","81243 - HC CHG FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81252","HC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCEHC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCE","81252 - HC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCEHC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCE",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11730",null,"AETNA","81252 - HC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCEHC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81253","HC CHG GJB2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS","81253 - HC CHG GJB2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11730",null,"AETNA","81253 - HC CHG GJB2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81254","HC CHG GJB6 GENE ANALYSIS COMMON VARIANTS","81254 - HC CHG GJB6 GENE ANALYSIS COMMON VARIANTS",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11730",null,"AETNA","81254 - HC CHG GJB6 GENE ANALYSIS COMMON VARIANTS"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81256","HC CHG HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS","81256 - HC CHG HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS",null,null,null,null,null,"BLUE CROSS-PPO","11730",null,"AETNA","81256 - HC CHG HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81257","HC CHG HBA1/HBA2 ANALYSIS FOR COMMON DELETIONS/VARIANT","81257 - HC CHG HBA1/HBA2 ANALYSIS FOR COMMON DELETIONS/VARIANT",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11730",null,"AETNA","81257 - HC CHG HBA1/HBA2 ANALYSIS FOR COMMON DELETIONS/VARIANT"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81259","HC HBA1/HBA2 GENE ANALYSIS FULL GENE SEQUENCE","81259 - HC HBA1/HBA2 GENE ANALYSIS FULL GENE SEQUENCE",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11730",null,"AETNA","81259 - HC HBA1/HBA2 GENE ANALYSIS FULL GENE SEQUENCE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81261","IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED; PRO/TECH","81261 - IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED; PRO/TECH",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11730",null,"AETNA","81261 - IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED; PRO/TECH"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81269","HC HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIENTS","81269 - HC HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIENTS",null,null,null,null,null,"CIGNA CARELINK","11730",null,"AETNA","81269 - HC HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIENTS"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81270","HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT","81270 - HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11730",null,"AETNA","81270 - HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81271","HC HTT GENE ANALYSIS DECTECT ABNORMAL ALLELES","81271 - HC HTT GENE ANALYSIS DECTECT ABNORMAL ALLELES",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11730",null,"AETNA","81271 - HC HTT GENE ANALYSIS DECTECT ABNORMAL ALLELES"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81272","HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS","81272 - HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS",null,null,null,null,null,"TUFTS HMO","11730",null,"AETNA","81272 - HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81274","HC HTT GENE ANALYSIS CHARACTERIZATION ALLELES","81274 - HC HTT GENE ANALYSIS CHARACTERIZATION ALLELES",null,null,null,null,null,"TUFTS POS","11730",null,"AETNA","81274 - HC HTT GENE ANALYSIS CHARACTERIZATION ALLELES"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81275","HC CHG KRAS GENE ANALYSIS VARIANTS IN EXON 2","81275 - HC CHG KRAS GENE ANALYSIS VARIANTS IN EXON 2",null,null,null,null,null,"TUFTS PPO","11730",null,"AETNA","81275 - HC CHG KRAS GENE ANALYSIS VARIANTS IN EXON 2"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81276","HC CHG KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)","81276 - HC CHG KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)",null,null,null,null,null,"TUFTS SELECT","11730",null,"AETNA","81276 - HC CHG KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81277","HC CYTOGENOMIC NEO MICRORA ALYS","81277 - HC CYTOGENOMIC NEO MICRORA ALYS",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11730",null,"AETNA","81277 - HC CYTOGENOMIC NEO MICRORA ALYS"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81288","MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS","81288 - MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11730",null,"AETNA","81288 - MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81291","HC CHG MTHFR GENE ANALYSIS COMMON VARIANTS","81291 - HC CHG MTHFR GENE ANALYSIS COMMON VARIANTS",null,null,null,null,null,"AETNA","11732",null,"AETNA","81291 - HC CHG MTHFR GENE ANALYSIS COMMON VARIANTS"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81301","HC CHG MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF","81301 - HC CHG MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11732",null,"AETNA","81301 - HC CHG MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81302","HC Q;RETT SYN ANLY","81302 - HC Q;RETT SYN ANLY",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11732",null,"AETNA","81302 - HC Q;RETT SYN ANLY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81304","HC MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT","81304 - HC MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11732",null,"AETNA","81304 - HC MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81305","HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT","81305 - HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT",null,null,null,null,null,"BLUE CROSS-PPO","11732",null,"AETNA","81305 - HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81307","HC PALB2 GENE FULL GENE SEQ","81307 - HC PALB2 GENE FULL GENE SEQ",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11732",null,"AETNA","81307 - HC PALB2 GENE FULL GENE SEQ"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81308","HC PALB2 GENE KNOWN FAMIL VRNT","81308 - HC PALB2 GENE KNOWN FAMIL VRNT",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11732",null,"AETNA","81308 - HC PALB2 GENE KNOWN FAMIL VRNT"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81309","HC PIK3CA GENE TRGT SEQ ALYS","81309 - HC PIK3CA GENE TRGT SEQ ALYS",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11732",null,"AETNA","81309 - HC PIK3CA GENE TRGT SEQ ALYS"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81311","HC CHG NRAS GENE ANALYSIS VARIANTS IN EXON 2&3","81311 - HC CHG NRAS GENE ANALYSIS VARIANTS IN EXON 2&3",null,null,null,null,null,"CIGNA CARELINK","11732",null,"AETNA","81311 - HC CHG NRAS GENE ANALYSIS VARIANTS IN EXON 2&3"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81315","HC PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT","81315 - HC PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11732",null,"AETNA","81315 - HC PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81329","HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS","81329 - HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11732",null,"AETNA","81329 - HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81331","HC PRADER-WILLI/ANGELMAN","81331 - HC PRADER-WILLI/ANGELMAN",null,null,null,null,null,"TUFTS HMO","11732",null,"AETNA","81331 - HC PRADER-WILLI/ANGELMAN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81342","TRG@ GENE REARRANGEMENT ANALYSIS; PRO/TECH","81342 - TRG@ GENE REARRANGEMENT ANALYSIS; PRO/TECH",null,null,null,null,null,"TUFTS POS","11732",null,"AETNA","81342 - TRG@ GENE REARRANGEMENT ANALYSIS; PRO/TECH"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81350","HC CHG UGT1A1 GENE ANALYSIS COMMON VARIANTS","81350 - HC CHG UGT1A1 GENE ANALYSIS COMMON VARIANTS",null,null,null,null,null,"TUFTS PPO","11732",null,"AETNA","81350 - HC CHG UGT1A1 GENE ANALYSIS COMMON VARIANTS"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81363","HC HBB DUPLICATION/DELETION VARIANTS","81363 - HC HBB DUPLICATION/DELETION VARIANTS",null,null,null,null,null,"TUFTS SELECT","11732",null,"AETNA","81363 - HC HBB DUPLICATION/DELETION VARIANTS"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81364","HC HBB FULL GENE SEQUENCE","81364 - HC HBB FULL GENE SEQUENCE",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11732",null,"AETNA","81364 - HC HBB FULL GENE SEQUENCE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81401","HC CHG, MOLECULAR PATHOLOGY PROCEDURE LEVEL 2","81401 - HC CHG, MOLECULAR PATHOLOGY PROCEDURE LEVEL 2",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11732",null,"AETNA","81401 - HC CHG, MOLECULAR PATHOLOGY PROCEDURE LEVEL 2"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81402","HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 3","81402 - HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 3",null,null,null,null,null,"AETNA","11740",null,"AETNA","81402 - HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 3"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81403","SEQ & EXON 13 SEQ, IF PERFORMED KRAS (EG, CARCINOMA), GENE ANALYSIS, PRO/TECH","81403 - SEQ & EXON 13 SEQ, IF PERFORMED KRAS (EG, CARCINOMA), GENE ANALYSIS, PRO/TECH",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11740",null,"AETNA","81403 - SEQ & EXON 13 SEQ, IF PERFORMED KRAS (EG, CARCINOMA), GENE ANALYSIS, PRO/TECH"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81404","VHL (EG, VON HIPPEL-LINDAUFAMILIAL CANCER SYNDROME, FULL GENE SEQ VWF PRO/TECH","81404 - VHL (EG, VON HIPPEL-LINDAUFAMILIAL CANCER SYNDROME, FULL GENE SEQ VWF PRO/TECH",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11740",null,"AETNA","81404 - VHL (EG, VON HIPPEL-LINDAUFAMILIAL CANCER SYNDROME, FULL GENE SEQ VWF PRO/TECH"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81405","HC MOPATH PROCEDURE LEVEL 6","81405 - HC MOPATH PROCEDURE LEVEL 6",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11740",null,"AETNA","81405 - HC MOPATH PROCEDURE LEVEL 6"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81406","HC CHG MOLECULAR PATHOLOGY PROCEDURE LEVEL 7","81406 - HC CHG MOLECULAR PATHOLOGY PROCEDURE LEVEL 7",null,null,null,null,null,"BLUE CROSS-PPO","11740",null,"AETNA","81406 - HC CHG MOLECULAR PATHOLOGY PROCEDURE LEVEL 7"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81430","HC CHG HEARING LOSS GENOMIC SEQUENCE ANALYSIS 60 GENES","81430 - HC CHG HEARING LOSS GENOMIC SEQUENCE ANALYSIS 60 GENES",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11740",null,"AETNA","81430 - HC CHG HEARING LOSS GENOMIC SEQUENCE ANALYSIS 60 GENES"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81431","HC CHG HEARING LOSS DUP/DEL ANALYSIS","81431 - HC CHG HEARING LOSS DUP/DEL ANALYSIS",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11740",null,"AETNA","81431 - HC CHG HEARING LOSS DUP/DEL ANALYSIS"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81450","HC CHG GENOMIC SEQ ANALYS DNA&RNA ANALYS 5-50 GENE","81450 - HC CHG GENOMIC SEQ ANALYS DNA&RNA ANALYS 5-50 GENE",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11740",null,"AETNA","81450 - HC CHG GENOMIC SEQ ANALYS DNA&RNA ANALYS 5-50 GENE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81522","HC ONC BREAST MRNA 12 GENES","81522 - HC ONC BREAST MRNA 12 GENES",null,null,null,null,null,"CIGNA CARELINK","11740",null,"AETNA","81522 - HC ONC BREAST MRNA 12 GENES"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81542","HC ONC PROSTATE MRNA 22 CNT GEN","81542 - HC ONC PROSTATE MRNA 22 CNT GEN",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11740",null,"AETNA","81542 - HC ONC PROSTATE MRNA 22 CNT GEN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","81596","HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR","81596 - HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11740",null,"AETNA","81596 - HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82009","HC CHG KETONE BODIES SERUM QUALITATIVE","82009 - HC CHG KETONE BODIES SERUM QUALITATIVE",null,null,null,null,null,"TUFTS HMO","11740",null,"AETNA","82009 - HC CHG KETONE BODIES SERUM QUALITATIVE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82010","HC CHG KETONE BODIES SERUM QUANTITATIVE","82010 - HC CHG KETONE BODIES SERUM QUANTITATIVE",null,null,null,null,null,"TUFTS POS","11740",null,"AETNA","82010 - HC CHG KETONE BODIES SERUM QUANTITATIVE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82017","HC CHG ACYLCARNITINES QUANTIATIVE EACH SPECIMEN","82017 - HC CHG ACYLCARNITINES QUANTIATIVE EACH SPECIMEN",null,null,null,null,null,"TUFTS PPO","11740",null,"AETNA","82017 - HC CHG ACYLCARNITINES QUANTIATIVE EACH SPECIMEN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82024","HC CHG ADRENOCORTICOTROPIC HORMONE ACTH","82024 - HC CHG ADRENOCORTICOTROPIC HORMONE ACTH",null,null,null,null,null,"TUFTS SELECT","11740",null,"AETNA","82024 - HC CHG ADRENOCORTICOTROPIC HORMONE ACTH"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82040","HC CHG ALBUMIN SERUM PLASMA/WHOLE BLOOD","82040 - HC CHG ALBUMIN SERUM PLASMA/WHOLE BLOOD",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11740",null,"AETNA","82040 - HC CHG ALBUMIN SERUM PLASMA/WHOLE BLOOD"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82042","HC CHG ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN","82042 - HC CHG ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11740",null,"AETNA","82042 - HC CHG ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82043","HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE","82043 - HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE",null,null,null,null,null,"AETNA","11750",null,"AETNA","82043 - HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82075","HC CHG ASSAY OF ALCOHOL BREATH","82075 - HC CHG ASSAY OF ALCOHOL BREATH",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11750",null,"AETNA","82075 - HC CHG ASSAY OF ALCOHOL BREATH"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82085","HC CHG ASSAY OF ALDOLASE","82085 - HC CHG ASSAY OF ALDOLASE",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11750",null,"AETNA","82085 - HC CHG ASSAY OF ALDOLASE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82088","HC CHG ASSAY OF ALDOSTERONE","82088 - HC CHG ASSAY OF ALDOSTERONE",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11750",null,"AETNA","82088 - HC CHG ASSAY OF ALDOSTERONE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82103","HC CHG ALPHA-1-ANTITRYPSIN TOTAL","82103 - HC CHG ALPHA-1-ANTITRYPSIN TOTAL",null,null,null,null,null,"BLUE CROSS-PPO","11750",null,"AETNA","82103 - HC CHG ALPHA-1-ANTITRYPSIN TOTAL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82104","HC CHG ALPHA-1-ANTITRYPSIN PHENOTYPE","82104 - HC CHG ALPHA-1-ANTITRYPSIN PHENOTYPE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11750",null,"AETNA","82104 - HC CHG ALPHA-1-ANTITRYPSIN PHENOTYPE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82105","HC CHG ALPHA-FETOPROTEIN SERUM","82105 - HC CHG ALPHA-FETOPROTEIN SERUM",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11750",null,"AETNA","82105 - HC CHG ALPHA-FETOPROTEIN SERUM"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82139","HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE","82139 - HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11750",null,"AETNA","82139 - HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82140","HC CHG ASSAY OF AMMONIA","82140 - HC CHG ASSAY OF AMMONIA",null,null,null,null,null,"CIGNA CARELINK","11750",null,"AETNA","82140 - HC CHG ASSAY OF AMMONIA"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82150","HC CHG ASSAY OF AMYLASE","82150 - HC CHG ASSAY OF AMYLASE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11750",null,"AETNA","82150 - HC CHG ASSAY OF AMYLASE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82157","HC CHG ANDROSTENEDIONE","82157 - HC CHG ANDROSTENEDIONE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11750",null,"AETNA","82157 - HC CHG ANDROSTENEDIONE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82164","HC CHG ANGIOTENSIN I-CONVERTING ENZYME","82164 - HC CHG ANGIOTENSIN I-CONVERTING ENZYME",null,null,null,null,null,"TUFTS HMO","11750",null,"AETNA","82164 - HC CHG ANGIOTENSIN I-CONVERTING ENZYME"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82172","HC CHG APOLIPOPROTEIN EACH","82172 - HC CHG APOLIPOPROTEIN EACH",null,null,null,null,null,"TUFTS POS","11750",null,"AETNA","82172 - HC CHG APOLIPOPROTEIN EACH"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82175","HC CHG ASSAY OF ARSENIC","82175 - HC CHG ASSAY OF ARSENIC",null,null,null,null,null,"TUFTS PPO","11750",null,"AETNA","82175 - HC CHG ASSAY OF ARSENIC"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82180","HC CHG ASSAY OF ASCORBIC ACID BLOOD","82180 - HC CHG ASSAY OF ASCORBIC ACID BLOOD",null,null,null,null,null,"TUFTS SELECT","11750",null,"AETNA","82180 - HC CHG ASSAY OF ASCORBIC ACID BLOOD"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82232","HC CHG BETA-2 MICROGLOBULIN","82232 - HC CHG BETA-2 MICROGLOBULIN",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11750",null,"AETNA","82232 - HC CHG BETA-2 MICROGLOBULIN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82247","HC CHG BILIRUBIN TOTAL","82247 - HC CHG BILIRUBIN TOTAL",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11750",null,"AETNA","82247 - HC CHG BILIRUBIN TOTAL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82248","HC CHG BILIRUBIN DIRECT","82248 - HC CHG BILIRUBIN DIRECT",null,null,null,null,null,"AETNA","11755",null,"AETNA","82248 - HC CHG BILIRUBIN DIRECT"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82270","HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER","82270 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11755",null,"AETNA","82270 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82271","HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES","82271 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11755",null,"AETNA","82271 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82274","HC CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3","82274 - HC CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11755",null,"AETNA","82274 - HC CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82306","HC CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED","82306 - HC CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED",null,null,null,null,null,"BLUE CROSS-PPO","11755",null,"AETNA","82306 - HC CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82308","HC CHG CALCITONIN","82308 - HC CHG CALCITONIN",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11755",null,"AETNA","82308 - HC CHG CALCITONIN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82310","HC CHG CALCIUM TOTAL","82310 - HC CHG CALCIUM TOTAL",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11755",null,"AETNA","82310 - HC CHG CALCIUM TOTAL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82330","HC CHG CALCIUM IONIZED","82330 - HC CHG CALCIUM IONIZED",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11755",null,"AETNA","82330 - HC CHG CALCIUM IONIZED"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82340","HC Q;KID STONE, UR CALCIUM","82340 - HC Q;KID STONE, UR CALCIUM",null,null,null,null,null,"CIGNA CARELINK","11755",null,"AETNA","82340 - HC Q;KID STONE, UR CALCIUM"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82365","HC CHG CALCULUS INFRARED SPECTROSCOPY","82365 - HC CHG CALCULUS INFRARED SPECTROSCOPY",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11755",null,"AETNA","82365 - HC CHG CALCULUS INFRARED SPECTROSCOPY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82374","HC CHG CARBON DIOXIDE BICARBONATE","82374 - HC CHG CARBON DIOXIDE BICARBONATE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11755",null,"AETNA","82374 - HC CHG CARBON DIOXIDE BICARBONATE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82375","HC CHG CARBOXYHEMOGLOBIN QUANTITATIVE","82375 - HC CHG CARBOXYHEMOGLOBIN QUANTITATIVE",null,null,null,null,null,"TUFTS HMO","11755",null,"AETNA","82375 - HC CHG CARBOXYHEMOGLOBIN QUANTITATIVE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82378","HC CHG CARCINOEMBRYONIC ANTIGEN CEA","82378 - HC CHG CARCINOEMBRYONIC ANTIGEN CEA",null,null,null,null,null,"TUFTS POS","11755",null,"AETNA","82378 - HC CHG CARCINOEMBRYONIC ANTIGEN CEA"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82379","HC CRL;CARNITINE","82379 - HC CRL;CARNITINE",null,null,null,null,null,"TUFTS PPO","11755",null,"AETNA","82379 - HC CRL;CARNITINE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82384","HC CHG CATECHOLAMINES FRACTIONATED","82384 - HC CHG CATECHOLAMINES FRACTIONATED",null,null,null,null,null,"TUFTS SELECT","11755",null,"AETNA","82384 - HC CHG CATECHOLAMINES FRACTIONATED"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82390","HC CHG CERULOPLASMIN","82390 - HC CHG CERULOPLASMIN",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11755",null,"AETNA","82390 - HC CHG CERULOPLASMIN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82397","HC CHEMILUMINESCENT ASSAY","82397 - HC CHEMILUMINESCENT ASSAY",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11755",null,"AETNA","82397 - HC CHEMILUMINESCENT ASSAY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82435","HC CHG CHLORIDE BLD","82435 - HC CHG CHLORIDE BLD",null,null,null,null,null,"AETNA","11760",null,"AETNA","82435 - HC CHG CHLORIDE BLD"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82436","HC CHG CHLORIDE URINE","82436 - HC CHG CHLORIDE URINE",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11760",null,"AETNA","82436 - HC CHG CHLORIDE URINE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82438","HC CHG CHLORIDE OTHER SOURCE","82438 - HC CHG CHLORIDE OTHER SOURCE",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11760",null,"AETNA","82438 - HC CHG CHLORIDE OTHER SOURCE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82465","CHOLESTEROL SERUM/WHOLE BLOOD TOTAL","82465 - CHOLESTEROL SERUM/WHOLE BLOOD TOTAL",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11760",null,"AETNA","82465 - CHOLESTEROL SERUM/WHOLE BLOOD TOTAL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82495","HC CHG ASSAY OF CHROMIUM","82495 - HC CHG ASSAY OF CHROMIUM",null,null,null,null,null,"BLUE CROSS-PPO","11760",null,"AETNA","82495 - HC CHG ASSAY OF CHROMIUM"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82507","HC CHG ASSAY OF CITRATE","82507 - HC CHG ASSAY OF CITRATE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11760",null,"AETNA","82507 - HC CHG ASSAY OF CITRATE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82523","HC CHG COLLAGEN CROSS LINKS ANY METHOD","82523 - HC CHG COLLAGEN CROSS LINKS ANY METHOD",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11760",null,"AETNA","82523 - HC CHG COLLAGEN CROSS LINKS ANY METHOD"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82525","HC CHG ASSAY OF COPPER","82525 - HC CHG ASSAY OF COPPER",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11760",null,"AETNA","82525 - HC CHG ASSAY OF COPPER"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82530","HC CHG CORTISOL FREE","82530 - HC CHG CORTISOL FREE",null,null,null,null,null,"CIGNA CARELINK","11760",null,"AETNA","82530 - HC CHG CORTISOL FREE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82533","HC CHG CORTISOL TOTAL","82533 - HC CHG CORTISOL TOTAL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11760",null,"AETNA","82533 - HC CHG CORTISOL TOTAL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82540","HC CHG ASSAY OF CREATINE","82540 - HC CHG ASSAY OF CREATINE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11760",null,"AETNA","82540 - HC CHG ASSAY OF CREATINE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82542","HC CHG COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC","82542 - HC CHG COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC",null,null,null,null,null,"TUFTS HMO","11760",null,"AETNA","82542 - HC CHG COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82550","HC CHG CREATINE KINASE TOTAL","82550 - HC CHG CREATINE KINASE TOTAL",null,null,null,null,null,"TUFTS POS","11760",null,"AETNA","82550 - HC CHG CREATINE KINASE TOTAL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82553","HC CHG CREATINE KINASE MB FRACTION ONLY","82553 - HC CHG CREATINE KINASE MB FRACTION ONLY",null,null,null,null,null,"TUFTS PPO","11760",null,"AETNA","82553 - HC CHG CREATINE KINASE MB FRACTION ONLY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82565","HC CHG CREATININE BLOOD","82565 - HC CHG CREATININE BLOOD",null,null,null,null,null,"TUFTS SELECT","11760",null,"AETNA","82565 - HC CHG CREATININE BLOOD"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82570","HC CHG CREATININE OTHER SOURCE","82570 - HC CHG CREATININE OTHER SOURCE",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11760",null,"AETNA","82570 - HC CHG CREATININE OTHER SOURCE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82575","HC CHG CREATININE CLEARANCE","82575 - HC CHG CREATININE CLEARANCE",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11760",null,"AETNA","82575 - HC CHG CREATININE CLEARANCE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82585","HC CHG ASSAY OF CRYOFIBRN","82585 - HC CHG ASSAY OF CRYOFIBRN",null,null,null,null,null,"AETNA","11765",null,"AETNA","82585 - HC CHG ASSAY OF CRYOFIBRN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82595","HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE","82595 - HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11765",null,"AETNA","82595 - HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82607","HC CHG CYANOCOBALAMIN VITAMIN B-12","82607 - HC CHG CYANOCOBALAMIN VITAMIN B-12",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11765",null,"AETNA","82607 - HC CHG CYANOCOBALAMIN VITAMIN B-12"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82626","HC CHG DEHYDROEPIANDROSTERONE","82626 - HC CHG DEHYDROEPIANDROSTERONE",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11765",null,"AETNA","82626 - HC CHG DEHYDROEPIANDROSTERONE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82627","HC CHG DEHYDROEPIANDROSTERONE-SULFATE","82627 - HC CHG DEHYDROEPIANDROSTERONE-SULFATE",null,null,null,null,null,"BLUE CROSS-PPO","11765",null,"AETNA","82627 - HC CHG DEHYDROEPIANDROSTERONE-SULFATE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82652","HC CHG 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED","82652 - HC CHG 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11765",null,"AETNA","82652 - HC CHG 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82656","HC CHG ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN","82656 - HC CHG ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11765",null,"AETNA","82656 - HC CHG ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82657","HC CHG NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA","82657 - HC CHG NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11765",null,"AETNA","82657 - HC CHG NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82668","HC CHG ASSAY OF ERYTHROPOIETIN","82668 - HC CHG ASSAY OF ERYTHROPOIETIN",null,null,null,null,null,"CIGNA CARELINK","11765",null,"AETNA","82668 - HC CHG ASSAY OF ERYTHROPOIETIN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82670","HC CHG ASSAY OF ESTRADIOL","82670 - HC CHG ASSAY OF ESTRADIOL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11765",null,"AETNA","82670 - HC CHG ASSAY OF ESTRADIOL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82677","HC CHG ASSAY OF ESTRIOL","82677 - HC CHG ASSAY OF ESTRIOL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11765",null,"AETNA","82677 - HC CHG ASSAY OF ESTRIOL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82693","HC CHG ASSAY OF ETHYLENE GLYCOL","82693 - HC CHG ASSAY OF ETHYLENE GLYCOL",null,null,null,null,null,"TUFTS HMO","11765",null,"AETNA","82693 - HC CHG ASSAY OF ETHYLENE GLYCOL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82705","HC CHG FAT/LIPIDS FECES QUALITATIVE","82705 - HC CHG FAT/LIPIDS FECES QUALITATIVE",null,null,null,null,null,"TUFTS POS","11765",null,"AETNA","82705 - HC CHG FAT/LIPIDS FECES QUALITATIVE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82728","HC CHG ASSAY OF FERRITIN","82728 - HC CHG ASSAY OF FERRITIN",null,null,null,null,null,"TUFTS PPO","11765",null,"AETNA","82728 - HC CHG ASSAY OF FERRITIN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82731","HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN","82731 - HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN",null,null,null,null,null,"TUFTS SELECT","11765",null,"AETNA","82731 - HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82746","HC CHG ASSAY OF FOLIC ACID SERUM","82746 - HC CHG ASSAY OF FOLIC ACID SERUM",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11765",null,"AETNA","82746 - HC CHG ASSAY OF FOLIC ACID SERUM"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82747","HC CHG ASSAY OF FOLIC ACID RBC","82747 - HC CHG ASSAY OF FOLIC ACID RBC",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11765",null,"AETNA","82747 - HC CHG ASSAY OF FOLIC ACID RBC"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82784","HC CHG ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH","82784 - HC CHG ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH",null,null,null,null,null,"AETNA","11770",null,"AETNA","82784 - HC CHG ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82785","HC CHG ASSAY OF GAMMAGLOBULIN IGE","82785 - HC CHG ASSAY OF GAMMAGLOBULIN IGE",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11770",null,"AETNA","82785 - HC CHG ASSAY OF GAMMAGLOBULIN IGE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82787","HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES","82787 - HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11770",null,"AETNA","82787 - HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82803","HC CHG BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3","82803 - HC CHG BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11770",null,"AETNA","82803 - HC CHG BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82805","HC CHG GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY","82805 - HC CHG GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY",null,null,null,null,null,"BLUE CROSS-PPO","11770",null,"AETNA","82805 - HC CHG GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82810","HC BLOOD GASSES O2 SAT ONLY","82810 - HC BLOOD GASSES O2 SAT ONLY",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11770",null,"AETNA","82810 - HC BLOOD GASSES O2 SAT ONLY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82941","HC CHG ASSAY OF GASTRIN","82941 - HC CHG ASSAY OF GASTRIN",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11770",null,"AETNA","82941 - HC CHG ASSAY OF GASTRIN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82945","HC CHG GLUCOSE BODY FLUID OTHER THAN BLOOD","82945 - HC CHG GLUCOSE BODY FLUID OTHER THAN BLOOD",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11770",null,"AETNA","82945 - HC CHG GLUCOSE BODY FLUID OTHER THAN BLOOD"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82947","HC CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP","82947 - HC CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP",null,null,null,null,null,"CIGNA CARELINK","11770",null,"AETNA","82947 - HC CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82950","HC CHG GLUCOSE POST GLUCOSE DOSE","82950 - HC CHG GLUCOSE POST GLUCOSE DOSE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11770",null,"AETNA","82950 - HC CHG GLUCOSE POST GLUCOSE DOSE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82951","HC CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS","82951 - HC CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11770",null,"AETNA","82951 - HC CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82952","HC CHG GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS","82952 - HC CHG GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS",null,null,null,null,null,"TUFTS HMO","11770",null,"AETNA","82952 - HC CHG GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82960","HC CHG GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN","82960 - HC CHG GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN",null,null,null,null,null,"TUFTS POS","11770",null,"AETNA","82960 - HC CHG GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82962","HC GLUCOMETER - PHARM","82962 - HC GLUCOMETER - PHARM",null,null,null,null,null,"TUFTS PPO","11770",null,"AETNA","82962 - HC GLUCOMETER - PHARM"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82977","HC CHG ASSAY OF GGT","82977 - HC CHG ASSAY OF GGT",null,null,null,null,null,"TUFTS SELECT","11770",null,"AETNA","82977 - HC CHG ASSAY OF GGT"]
["AETNA","AETNA-MEDICARE ADVANTAGE","82985","HC CHG ASSAY OF GLYCATED PROTEIN","82985 - HC CHG ASSAY OF GLYCATED PROTEIN",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11770",null,"AETNA","82985 - HC CHG ASSAY OF GLYCATED PROTEIN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83001","HC CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE","83001 - HC CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11770",null,"AETNA","83001 - HC CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83002","HC CHG GONADOTROPIN LUTEINIZING HORMONE","83002 - HC CHG GONADOTROPIN LUTEINIZING HORMONE",null,null,null,null,null,"AETNA","11772",null,"AETNA","83002 - HC CHG GONADOTROPIN LUTEINIZING HORMONE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83003","HC CHG ASSAY OF GROWTH HORMONE HUMAN","83003 - HC CHG ASSAY OF GROWTH HORMONE HUMAN",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11772",null,"AETNA","83003 - HC CHG ASSAY OF GROWTH HORMONE HUMAN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83010","HC CHG ASSAY OF HAPTOGLOBIN, QUANT","83010 - HC CHG ASSAY OF HAPTOGLOBIN, QUANT",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11772",null,"AETNA","83010 - HC CHG ASSAY OF HAPTOGLOBIN, QUANT"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83013","HC H PYLORI (C-13) BREATH","83013 - HC H PYLORI (C-13) BREATH",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11772",null,"AETNA","83013 - HC H PYLORI (C-13) BREATH"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83014","HC H PYLORI DRUG ADMIN","83014 - HC H PYLORI DRUG ADMIN",null,null,null,null,null,"BLUE CROSS-PPO","11772",null,"AETNA","83014 - HC H PYLORI DRUG ADMIN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83020","HC CHG HEMOGLOBIN ELECTROPHORESIS","83020 - HC CHG HEMOGLOBIN ELECTROPHORESIS",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11772",null,"AETNA","83020 - HC CHG HEMOGLOBIN ELECTROPHORESIS"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83021","HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY","83021 - HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11772",null,"AETNA","83021 - HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83030","HC CHG HEMOGLOBIN F FETAL CHEMICAL","83030 - HC CHG HEMOGLOBIN F FETAL CHEMICAL",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11772",null,"AETNA","83030 - HC CHG HEMOGLOBIN F FETAL CHEMICAL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83036","HEMOGLOBIN GLYCOSYLATED A1C","83036 - HEMOGLOBIN GLYCOSYLATED A1C",null,null,null,null,null,"CIGNA CARELINK","11772",null,"AETNA","83036 - HEMOGLOBIN GLYCOSYLATED A1C"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83050","HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE","83050 - HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11772",null,"AETNA","83050 - HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83070","HC CHG ASSAY OF HEMOSIDERIN QUALITATIVE","83070 - HC CHG ASSAY OF HEMOSIDERIN QUALITATIVE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11772",null,"AETNA","83070 - HC CHG ASSAY OF HEMOSIDERIN QUALITATIVE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83090","HC CHG ASSAY OF HOMOCYSTEINE","83090 - HC CHG ASSAY OF HOMOCYSTEINE",null,null,null,null,null,"TUFTS HMO","11772",null,"AETNA","83090 - HC CHG ASSAY OF HOMOCYSTEINE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83497","HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA","83497 - HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA",null,null,null,null,null,"TUFTS POS","11772",null,"AETNA","83497 - HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83498","HC CHG ASSAY OF HYDROXYPROGESTERONE 17-D","83498 - HC CHG ASSAY OF HYDROXYPROGESTERONE 17-D",null,null,null,null,null,"TUFTS PPO","11772",null,"AETNA","83498 - HC CHG ASSAY OF HYDROXYPROGESTERONE 17-D"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83516","HC CRL;TTG AB,IGA","83516 - HC CRL;TTG AB,IGA",null,null,null,null,null,"TUFTS SELECT","11772",null,"AETNA","83516 - HC CRL;TTG AB,IGA"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83519","HC CHG IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","83519 - HC CHG IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11772",null,"AETNA","83519 - HC CHG IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83520","HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE","83520 - HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11772",null,"AETNA","83520 - HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83525","HC CHG ASSAY OF INSULIN TOTAL","83525 - HC CHG ASSAY OF INSULIN TOTAL",null,null,null,null,null,"AETNA","11900",null,"AETNA","83525 - HC CHG ASSAY OF INSULIN TOTAL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83540","HC CHG ASSAY OF IRON","83540 - HC CHG ASSAY OF IRON",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11900",null,"AETNA","83540 - HC CHG ASSAY OF IRON"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83550","HC CHG IRON BINDING CAPACITY","83550 - HC CHG IRON BINDING CAPACITY",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11900",null,"AETNA","83550 - HC CHG IRON BINDING CAPACITY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83605","HC CHG ASSAY OF LACTATE","83605 - HC CHG ASSAY OF LACTATE",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11900",null,"AETNA","83605 - HC CHG ASSAY OF LACTATE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83615","HC CHG LACTATE DEHYDROGENASE LDH","83615 - HC CHG LACTATE DEHYDROGENASE LDH",null,null,null,null,null,"BLUE CROSS-PPO","11900",null,"AETNA","83615 - HC CHG LACTATE DEHYDROGENASE LDH"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83630","HC CHG LACTOFERRIN FECAL QUALITATIVE","83630 - HC CHG LACTOFERRIN FECAL QUALITATIVE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11900",null,"AETNA","83630 - HC CHG LACTOFERRIN FECAL QUALITATIVE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83655","HC CHG ASSAY OF LEAD","83655 - HC CHG ASSAY OF LEAD",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11900",null,"AETNA","83655 - HC CHG ASSAY OF LEAD"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83662","HC L/S RATIO, FOAM STABILITY","83662 - HC L/S RATIO, FOAM STABILITY",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11900",null,"AETNA","83662 - HC L/S RATIO, FOAM STABILITY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83690","HC CHG ASSAY OF LIPASE","83690 - HC CHG ASSAY OF LIPASE",null,null,null,null,null,"CIGNA CARELINK","11900",null,"AETNA","83690 - HC CHG ASSAY OF LIPASE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83695","HC CHG LIPOPROTEIN (A)","83695 - HC CHG LIPOPROTEIN (A)",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11900",null,"AETNA","83695 - HC CHG LIPOPROTEIN (A)"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83718","HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL","83718 - HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11900",null,"AETNA","83718 - HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83721","HC CRL;DIRECT LDL","83721 - HC CRL;DIRECT LDL",null,null,null,null,null,"TUFTS HMO","11900",null,"AETNA","83721 - HC CRL;DIRECT LDL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83735","HC CHG ASSAY OF MAGNESIUM","83735 - HC CHG ASSAY OF MAGNESIUM",null,null,null,null,null,"TUFTS POS","11900",null,"AETNA","83735 - HC CHG ASSAY OF MAGNESIUM"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83785","HC CHG, ASSAY OF MANGANESE","83785 - HC CHG, ASSAY OF MANGANESE",null,null,null,null,null,"TUFTS PPO","11900",null,"AETNA","83785 - HC CHG, ASSAY OF MANGANESE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83789","HC CHG MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA","83789 - HC CHG MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA",null,null,null,null,null,"TUFTS SELECT","11900",null,"AETNA","83789 - HC CHG MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83825","HC CHG ASSAY OF MERCURY QUANTITATIVE","83825 - HC CHG ASSAY OF MERCURY QUANTITATIVE",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11900",null,"AETNA","83825 - HC CHG ASSAY OF MERCURY QUANTITATIVE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83835","HC CHG METANEPHRINES","83835 - HC CHG METANEPHRINES",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11900",null,"AETNA","83835 - HC CHG METANEPHRINES"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83873","HC CHG MYELIN BASIC PROTEIN CEREBROSPINAL FLUID","83873 - HC CHG MYELIN BASIC PROTEIN CEREBROSPINAL FLUID",null,null,null,null,null,"AETNA","11901",null,"AETNA","83873 - HC CHG MYELIN BASIC PROTEIN CEREBROSPINAL FLUID"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83874","HC CHG MYOGLOBIN","83874 - HC CHG MYOGLOBIN",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11901",null,"AETNA","83874 - HC CHG MYOGLOBIN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83880","HC CHG NATRIURETIC PEPTIDE","83880 - HC CHG NATRIURETIC PEPTIDE",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11901",null,"AETNA","83880 - HC CHG NATRIURETIC PEPTIDE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83883","HC NEPHELOMETRY, EACH ANALYTE","83883 - HC NEPHELOMETRY, EACH ANALYTE",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11901",null,"AETNA","83883 - HC NEPHELOMETRY, EACH ANALYTE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83915","HC CHG ASSAY OF NUCLEOTIDASE 5'-","83915 - HC CHG ASSAY OF NUCLEOTIDASE 5'-",null,null,null,null,null,"BLUE CROSS-PPO","11901",null,"AETNA","83915 - HC CHG ASSAY OF NUCLEOTIDASE 5'-"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83916","HC CHG OLIGOCLONAL IMMUNE","83916 - HC CHG OLIGOCLONAL IMMUNE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11901",null,"AETNA","83916 - HC CHG OLIGOCLONAL IMMUNE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83918","HC CHG ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN","83918 - HC CHG ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11901",null,"AETNA","83918 - HC CHG ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83921","HC CHG ORGANIC ACID 1 QUANTITATIVE","83921 - HC CHG ORGANIC ACID 1 QUANTITATIVE",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11901",null,"AETNA","83921 - HC CHG ORGANIC ACID 1 QUANTITATIVE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83930","HC Q;OSMOLALITY,SER","83930 - HC Q;OSMOLALITY,SER",null,null,null,null,null,"CIGNA CARELINK","11901",null,"AETNA","83930 - HC Q;OSMOLALITY,SER"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83935","HC CHG ASSAY OF OSMOLALITY URINE","83935 - HC CHG ASSAY OF OSMOLALITY URINE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11901",null,"AETNA","83935 - HC CHG ASSAY OF OSMOLALITY URINE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83937","HC CHG ASSAY OF OSTEOCALCIN","83937 - HC CHG ASSAY OF OSTEOCALCIN",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11901",null,"AETNA","83937 - HC CHG ASSAY OF OSTEOCALCIN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83945","HC CHG ASSAY OF OXALATE","83945 - HC CHG ASSAY OF OXALATE",null,null,null,null,null,"TUFTS HMO","11901",null,"AETNA","83945 - HC CHG ASSAY OF OXALATE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83970","HC CHG ASSAY OF PARATHORMONE","83970 - HC CHG ASSAY OF PARATHORMONE",null,null,null,null,null,"TUFTS POS","11901",null,"AETNA","83970 - HC CHG ASSAY OF PARATHORMONE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83986","HC CHG PH BODY FLUID NOT ELSEWHERE SPECIFIED","83986 - HC CHG PH BODY FLUID NOT ELSEWHERE SPECIFIED",null,null,null,null,null,"TUFTS PPO","11901",null,"AETNA","83986 - HC CHG PH BODY FLUID NOT ELSEWHERE SPECIFIED"]
["AETNA","AETNA-MEDICARE ADVANTAGE","83993","HC CHG ASSAY OF CALPROTECTIN FECAL","83993 - HC CHG ASSAY OF CALPROTECTIN FECAL",null,null,null,null,null,"TUFTS SELECT","11901",null,"AETNA","83993 - HC CHG ASSAY OF CALPROTECTIN FECAL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84075","HC CHG ASSAY OF PHOSPHATASE ALKALINE","84075 - HC CHG ASSAY OF PHOSPHATASE ALKALINE",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11901",null,"AETNA","84075 - HC CHG ASSAY OF PHOSPHATASE ALKALINE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84080","HC CHG ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES","84080 - HC CHG ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11901",null,"AETNA","84080 - HC CHG ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84100","HC CHG ASSAY OF PHOSPHORUS INORGANIC","84100 - HC CHG ASSAY OF PHOSPHORUS INORGANIC",null,null,null,null,null,"AETNA","11921",null,"AETNA","84100 - HC CHG ASSAY OF PHOSPHORUS INORGANIC"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84105","HC CHG ASSAY OF PHOSPHORUS INORGANIC URINE","84105 - HC CHG ASSAY OF PHOSPHORUS INORGANIC URINE",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11921",null,"AETNA","84105 - HC CHG ASSAY OF PHOSPHORUS INORGANIC URINE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84132","HC CHG POTASSIUM SERUM PLASMA/WHOLE BLOOD","84132 - HC CHG POTASSIUM SERUM PLASMA/WHOLE BLOOD",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11921",null,"AETNA","84132 - HC CHG POTASSIUM SERUM PLASMA/WHOLE BLOOD"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84133","HC CHG POTASSIUM URINE","84133 - HC CHG POTASSIUM URINE",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11921",null,"AETNA","84133 - HC CHG POTASSIUM URINE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84134","HC CHG PREALBUMIN","84134 - HC CHG PREALBUMIN",null,null,null,null,null,"BLUE CROSS-PPO","11921",null,"AETNA","84134 - HC CHG PREALBUMIN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84144","HC CHG ASSAY OF PROGESTERONE","84144 - HC CHG ASSAY OF PROGESTERONE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11921",null,"AETNA","84144 - HC CHG ASSAY OF PROGESTERONE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84145","HC CHG PROCALCITONIN (PCT)","84145 - HC CHG PROCALCITONIN (PCT)",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11921",null,"AETNA","84145 - HC CHG PROCALCITONIN (PCT)"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84146","HC CHG ASSAY OF PROLACTIN","84146 - HC CHG ASSAY OF PROLACTIN",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11921",null,"AETNA","84146 - HC CHG ASSAY OF PROLACTIN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84153","HC CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL","84153 - HC CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL",null,null,null,null,null,"CIGNA CARELINK","11921",null,"AETNA","84153 - HC CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84155","HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD","84155 - HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11921",null,"AETNA","84155 - HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84156","HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY URINE","84156 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY URINE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11921",null,"AETNA","84156 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY URINE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84157","HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC","84157 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC",null,null,null,null,null,"TUFTS HMO","11921",null,"AETNA","84157 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84163","HC CHG PREGNANCY-ASSOCIATED PLASMA PROTEIN-A","84163 - HC CHG PREGNANCY-ASSOCIATED PLASMA PROTEIN-A",null,null,null,null,null,"TUFTS POS","11921",null,"AETNA","84163 - HC CHG PREGNANCY-ASSOCIATED PLASMA PROTEIN-A"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84165","HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM","84165 - HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM",null,null,null,null,null,"TUFTS PPO","11921",null,"AETNA","84165 - HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84166","HC CHG PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI","84166 - HC CHG PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI",null,null,null,null,null,"TUFTS SELECT","11921",null,"AETNA","84166 - HC CHG PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84182","HC CHG PROTEIN, WESTERN BLOT TEST, W BAND","84182 - HC CHG PROTEIN, WESTERN BLOT TEST, W BAND",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11921",null,"AETNA","84182 - HC CHG PROTEIN, WESTERN BLOT TEST, W BAND"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84202","HC Q;ERYTH PROTPOR","84202 - HC Q;ERYTH PROTPOR",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11921",null,"AETNA","84202 - HC Q;ERYTH PROTPOR"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84206","HC CHG ASSAY OF PROINSULIN","84206 - HC CHG ASSAY OF PROINSULIN",null,null,null,null,null,"AETNA","11922",null,"AETNA","84206 - HC CHG ASSAY OF PROINSULIN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84207","HC CHG ASSAY OF PYRIDOXAL PHOSPHATE","84207 - HC CHG ASSAY OF PYRIDOXAL PHOSPHATE",null,null,null,null,null,"ALLWAYS HLTH ACO","11922",null,"AETNA","84207 - HC CHG ASSAY OF PYRIDOXAL PHOSPHATE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84210","HC CHG ASSAY OF PYRUVATE","84210 - HC CHG ASSAY OF PYRUVATE",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","11922",null,"AETNA","84210 - HC CHG ASSAY OF PYRUVATE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84244","HC CHG ASSAY OF RENIN","84244 - HC CHG ASSAY OF RENIN",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11922",null,"AETNA","84244 - HC CHG ASSAY OF RENIN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84255","HC CHG ASSAY OF SELENIUM","84255 - HC CHG ASSAY OF SELENIUM",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11922",null,"AETNA","84255 - HC CHG ASSAY OF SELENIUM"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84270","HC CHG ASSAY OF SEX HORMONE BINDING GLOBULIN","84270 - HC CHG ASSAY OF SEX HORMONE BINDING GLOBULIN",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11922",null,"AETNA","84270 - HC CHG ASSAY OF SEX HORMONE BINDING GLOBULIN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84295","HC CHG SODIUM SERUM PLASMA OR WHOLE BLOOD","84295 - HC CHG SODIUM SERUM PLASMA OR WHOLE BLOOD",null,null,null,null,null,"BLUE CROSS-PPO","11922",null,"AETNA","84295 - HC CHG SODIUM SERUM PLASMA OR WHOLE BLOOD"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84300","HC CHG ASSAY OF URINE SODIUM","84300 - HC CHG ASSAY OF URINE SODIUM",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11922",null,"AETNA","84300 - HC CHG ASSAY OF URINE SODIUM"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84302","HC CHG ASSAY OF SODIUM OTHER SOURCE","84302 - HC CHG ASSAY OF SODIUM OTHER SOURCE",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11922",null,"AETNA","84302 - HC CHG ASSAY OF SODIUM OTHER SOURCE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84305","HC CHG ASSAY OF SOMATOMEDIN","84305 - HC CHG ASSAY OF SOMATOMEDIN",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11922",null,"AETNA","84305 - HC CHG ASSAY OF SOMATOMEDIN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84307","HC CHG ASSAY OF SOMATOSTATIN","84307 - HC CHG ASSAY OF SOMATOSTATIN",null,null,null,null,null,"BMCHN ACO","11922",null,"AETNA","84307 - HC CHG ASSAY OF SOMATOSTATIN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84311","HC CHG SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED","84311 - HC CHG SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED",null,null,null,null,null,"BMCHN MCO","11922",null,"AETNA","84311 - HC CHG SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84376","HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC","84376 - HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC",null,null,null,null,null,"BMCHN MEDICAID","11922",null,"AETNA","84376 - HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84402","HC CHG ASSAY OF TESTOSTERONE FREE","84402 - HC CHG ASSAY OF TESTOSTERONE FREE",null,null,null,null,null,"BMCHN QHP","11922",null,"AETNA","84402 - HC CHG ASSAY OF TESTOSTERONE FREE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84403","HC CHG ASSAY OF TESTOSTERONE TOTAL","84403 - HC CHG ASSAY OF TESTOSTERONE TOTAL",null,null,null,null,null,"CIGNA CARELINK","11922",null,"AETNA","84403 - HC CHG ASSAY OF TESTOSTERONE TOTAL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84425","HC CHG ASSAY OF THIAMINE-VITAMIN B-1","84425 - HC CHG ASSAY OF THIAMINE-VITAMIN B-1",null,null,null,null,null,"FALLON MEDICAID","11922",null,"AETNA","84425 - HC CHG ASSAY OF THIAMINE-VITAMIN B-1"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84430","HC CHG ASSAY OF THIOCYANATE","84430 - HC CHG ASSAY OF THIOCYANATE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11922",null,"AETNA","84430 - HC CHG ASSAY OF THIOCYANATE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84432","HC CHG ASSAY OF THYROGLOBULIN","84432 - HC CHG ASSAY OF THYROGLOBULIN",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11922",null,"AETNA","84432 - HC CHG ASSAY OF THYROGLOBULIN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84436","HC CHG ASSAY OF THYROXINE TOTAL","84436 - HC CHG ASSAY OF THYROXINE TOTAL",null,null,null,null,null,"TUFTS HMO","11922",null,"AETNA","84436 - HC CHG ASSAY OF THYROXINE TOTAL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84439","HC CHG ASSAY OF FREE THYROXINE","84439 - HC CHG ASSAY OF FREE THYROXINE",null,null,null,null,null,"TUFTS POS","11922",null,"AETNA","84439 - HC CHG ASSAY OF FREE THYROXINE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84442","HC CHG ASSAY OF THYROXINE BNDNG GLOBULIN","84442 - HC CHG ASSAY OF THYROXINE BNDNG GLOBULIN",null,null,null,null,null,"TUFTS PPO","11922",null,"AETNA","84442 - HC CHG ASSAY OF THYROXINE BNDNG GLOBULIN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84443","HC CHG ASSAY OF THYROID STIMULATING HORMONE TSH","84443 - HC CHG ASSAY OF THYROID STIMULATING HORMONE TSH",null,null,null,null,null,"TUFTS SELECT","11922",null,"AETNA","84443 - HC CHG ASSAY OF THYROID STIMULATING HORMONE TSH"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84445","HC CHG THYROID STIMULATING IMMUNE GLOBULINS TSI","84445 - HC CHG THYROID STIMULATING IMMUNE GLOBULINS TSI",null,null,null,null,null,"TUFTS PUBLIC DIRECT","11922",null,"AETNA","84445 - HC CHG THYROID STIMULATING IMMUNE GLOBULINS TSI"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84446","HC CHG ASSAY OF TOCOPHEROL ALPHA VITAMIN E","84446 - HC CHG ASSAY OF TOCOPHEROL ALPHA VITAMIN E",null,null,null,null,null,"TUFTS PUBLIC TOGETHER","11922",null,"AETNA","84446 - HC CHG ASSAY OF TOCOPHEROL ALPHA VITAMIN E"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84450","HC CHG TRANSFERASE ASPARTATE AMINO AST SGOT","84450 - HC CHG TRANSFERASE ASPARTATE AMINO AST SGOT",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11922",null,"AETNA","84450 - HC CHG TRANSFERASE ASPARTATE AMINO AST SGOT"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84460","HC CHG TRANSFERASE ALANINE AMINO (ALT) (SGPT)","84460 - HC CHG TRANSFERASE ALANINE AMINO (ALT) (SGPT)",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11922",null,"AETNA","84460 - HC CHG TRANSFERASE ALANINE AMINO (ALT) (SGPT)"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84466","HC CHG ASSAY OF L7383TRANSFERRIN","84466 - HC CHG ASSAY OF L7383TRANSFERRIN",null,null,null,null,null,"AETNA","11976",null,"AETNA","84466 - HC CHG ASSAY OF L7383TRANSFERRIN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84478","HC CHG ASSAY OF TRIGLYCERIDES","84478 - HC CHG ASSAY OF TRIGLYCERIDES",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11976",null,"AETNA","84478 - HC CHG ASSAY OF TRIGLYCERIDES"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84479","HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO","84479 - HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11976",null,"AETNA","84479 - HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84480","HC CHG ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3","84480 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11976",null,"AETNA","84480 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84481","HC CHG ASSAY OF TRIIODOTHYRONINE T3 FREE","84481 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 FREE",null,null,null,null,null,"BLUE CROSS-PPO","11976",null,"AETNA","84481 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 FREE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84482","HC CHG TRIIODOTHYRONINE T3 REVERSE","84482 - HC CHG TRIIODOTHYRONINE T3 REVERSE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11976",null,"AETNA","84482 - HC CHG TRIIODOTHYRONINE T3 REVERSE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84484","HC CHG ASSAY OF TROPONIN QUANTITATIVE","84484 - HC CHG ASSAY OF TROPONIN QUANTITATIVE",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11976",null,"AETNA","84484 - HC CHG ASSAY OF TROPONIN QUANTITATIVE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84520","HC CHG ASSAY OF UREA NITROGEN QUANTITATIVE","84520 - HC CHG ASSAY OF UREA NITROGEN QUANTITATIVE",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11976",null,"AETNA","84520 - HC CHG ASSAY OF UREA NITROGEN QUANTITATIVE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84540","HC CHG ASSAY OF UREA NITROGEN URINE","84540 - HC CHG ASSAY OF UREA NITROGEN URINE",null,null,null,null,null,"CIGNA CARELINK","11976",null,"AETNA","84540 - HC CHG ASSAY OF UREA NITROGEN URINE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84550","HC CHG ASSAY OF BLOOD/URIC ACID","84550 - HC CHG ASSAY OF BLOOD/URIC ACID",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11976",null,"AETNA","84550 - HC CHG ASSAY OF BLOOD/URIC ACID"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84560","HC CHG ASSAY OF URIC ACID OTHER SOURCE","84560 - HC CHG ASSAY OF URIC ACID OTHER SOURCE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11976",null,"AETNA","84560 - HC CHG ASSAY OF URIC ACID OTHER SOURCE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84590","HC CHG ASSAY OF VITAMIN A","84590 - HC CHG ASSAY OF VITAMIN A",null,null,null,null,null,"TUFTS HMO","11976",null,"AETNA","84590 - HC CHG ASSAY OF VITAMIN A"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84591","HC CHG ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED","84591 - HC CHG ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED",null,null,null,null,null,"TUFTS POS","11976",null,"AETNA","84591 - HC CHG ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84597","HC CHG ASSAY OF VITAMIN K","84597 - HC CHG ASSAY OF VITAMIN K",null,null,null,null,null,"TUFTS PPO","11976",null,"AETNA","84597 - HC CHG ASSAY OF VITAMIN K"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84630","HC CHG ASSAY OF ZINC","84630 - HC CHG ASSAY OF ZINC",null,null,null,null,null,"TUFTS SELECT","11976",null,"AETNA","84630 - HC CHG ASSAY OF ZINC"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84681","HC CHG ASSAY OF C-PEPTIDE","84681 - HC CHG ASSAY OF C-PEPTIDE",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11976",null,"AETNA","84681 - HC CHG ASSAY OF C-PEPTIDE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84702","HC HCG TUMOR MARKER","84702 - HC HCG TUMOR MARKER",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11976",null,"AETNA","84702 - HC HCG TUMOR MARKER"]
["AETNA","AETNA-MEDICARE ADVANTAGE","84703","HC GONAD,CHOR(HCG);QL","84703 - HC GONAD,CHOR(HCG);QL",null,null,null,null,null,"AETNA","11980",null,"AETNA","84703 - HC GONAD,CHOR(HCG);QL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85004","HC AUTO DIFF","85004 - HC AUTO DIFF",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11980",null,"AETNA","85004 - HC AUTO DIFF"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85014","HC CHG BLOOD COUNT HEMATOCRIT","85014 - HC CHG BLOOD COUNT HEMATOCRIT",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11980",null,"AETNA","85014 - HC CHG BLOOD COUNT HEMATOCRIT"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85018","POC;HEMOGLOBIN","85018 - POC;HEMOGLOBIN",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11980",null,"AETNA","85018 - POC;HEMOGLOBIN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85025","HC CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC","85025 - HC CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC",null,null,null,null,null,"BLUE CROSS-PPO","11980",null,"AETNA","85025 - HC CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85027","HC CHG BLOOD COUNT COMPLETE AUTOMATED","85027 - HC CHG BLOOD COUNT COMPLETE AUTOMATED",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11980",null,"AETNA","85027 - HC CHG BLOOD COUNT COMPLETE AUTOMATED"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85045","HC CHG BLOOD COUNT RETICULOCYTE AUTOMATED","85045 - HC CHG BLOOD COUNT RETICULOCYTE AUTOMATED",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11980",null,"AETNA","85045 - HC CHG BLOOD COUNT RETICULOCYTE AUTOMATED"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85046","HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS","85046 - HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11980",null,"AETNA","85046 - HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85048","HC CHG BLOOD COUNT LEUKOCYTE WBC AUTOMATED","85048 - HC CHG BLOOD COUNT LEUKOCYTE WBC AUTOMATED",null,null,null,null,null,"CIGNA CARELINK","11980",null,"AETNA","85048 - HC CHG BLOOD COUNT LEUKOCYTE WBC AUTOMATED"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85049","HC CHG BLOOD COUNT PLATELET AUTOMATED","85049 - HC CHG BLOOD COUNT PLATELET AUTOMATED",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11980",null,"AETNA","85049 - HC CHG BLOOD COUNT PLATELET AUTOMATED"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85055","HC CHG RETICULATED PLATELET ASSAY","85055 - HC CHG RETICULATED PLATELET ASSAY",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11980",null,"AETNA","85055 - HC CHG RETICULATED PLATELET ASSAY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85210","HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC","85210 - HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC",null,null,null,null,null,"TUFTS HMO","11980",null,"AETNA","85210 - HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85220","HC CHG CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR","85220 - HC CHG CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR",null,null,null,null,null,"TUFTS POS","11980",null,"AETNA","85220 - HC CHG CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85230","HC CHG CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR","85230 - HC CHG CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR",null,null,null,null,null,"TUFTS PPO","11980",null,"AETNA","85230 - HC CHG CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85240","HC CHG CLOTTING FACTOR VIII AHG 1 STAGE","85240 - HC CHG CLOTTING FACTOR VIII AHG 1 STAGE",null,null,null,null,null,"TUFTS SELECT","11980",null,"AETNA","85240 - HC CHG CLOTTING FACTOR VIII AHG 1 STAGE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85245","HC CHG CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT","85245 - HC CHG CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11980",null,"AETNA","85245 - HC CHG CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85246","HC CHG CLOTTING FACTOR VIII VW FACTOR ANTIGEN","85246 - HC CHG CLOTTING FACTOR VIII VW FACTOR ANTIGEN",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11980",null,"AETNA","85246 - HC CHG CLOTTING FACTOR VIII VW FACTOR ANTIGEN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85250","HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS","85250 - HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS",null,null,null,null,null,"AETNA","11981",null,"AETNA","85250 - HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85260","HC CHG CLOTTING FACTOR X STUART-PROWER","85260 - HC CHG CLOTTING FACTOR X STUART-PROWER",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11981",null,"AETNA","85260 - HC CHG CLOTTING FACTOR X STUART-PROWER"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85270","HC CHG CLOTTING FACTOR XI PTA","85270 - HC CHG CLOTTING FACTOR XI PTA",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11981",null,"AETNA","85270 - HC CHG CLOTTING FACTOR XI PTA"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85280","HC CHG CLOTTING FACTOR XII HAGEMAN","85280 - HC CHG CLOTTING FACTOR XII HAGEMAN",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11981",null,"AETNA","85280 - HC CHG CLOTTING FACTOR XII HAGEMAN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85290","HC CHG CLOTTING FACTOR XIII FIBRIN STABILIZING","85290 - HC CHG CLOTTING FACTOR XIII FIBRIN STABILIZING",null,null,null,null,null,"BLUE CROSS-PPO","11981",null,"AETNA","85290 - HC CHG CLOTTING FACTOR XIII FIBRIN STABILIZING"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85300","HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY","85300 - HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11981",null,"AETNA","85300 - HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85301","HC CHG CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY","85301 - HC CHG CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11981",null,"AETNA","85301 - HC CHG CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85302","HC CHG CLOTTING INHIBITORS PROTEIN C ANTIGEN","85302 - HC CHG CLOTTING INHIBITORS PROTEIN C ANTIGEN",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11981",null,"AETNA","85302 - HC CHG CLOTTING INHIBITORS PROTEIN C ANTIGEN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85303","HC CHG CLOTTING INHIBITORS PROTEIN C ACTIVITY","85303 - HC CHG CLOTTING INHIBITORS PROTEIN C ACTIVITY",null,null,null,null,null,"CIGNA CARELINK","11981",null,"AETNA","85303 - HC CHG CLOTTING INHIBITORS PROTEIN C ACTIVITY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85305","HC CHG CLOTTING INHIBITORS PROTEIN S TOTAL","85305 - HC CHG CLOTTING INHIBITORS PROTEIN S TOTAL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11981",null,"AETNA","85305 - HC CHG CLOTTING INHIBITORS PROTEIN S TOTAL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85306","HC CHG CLOTTING INHIBITORS PROTEIN S FREE","85306 - HC CHG CLOTTING INHIBITORS PROTEIN S FREE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11981",null,"AETNA","85306 - HC CHG CLOTTING INHIBITORS PROTEIN S FREE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85307","HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY","85307 - HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY",null,null,null,null,null,"TUFTS HMO","11981",null,"AETNA","85307 - HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85347","HC CHG COAGULATION TIME ACTIVATED","85347 - HC CHG COAGULATION TIME ACTIVATED",null,null,null,null,null,"TUFTS POS","11981",null,"AETNA","85347 - HC CHG COAGULATION TIME ACTIVATED"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85366","HC CHG FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ","85366 - HC CHG FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ",null,null,null,null,null,"TUFTS PPO","11981",null,"AETNA","85366 - HC CHG FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85378","HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN","85378 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN",null,null,null,null,null,"TUFTS SELECT","11981",null,"AETNA","85378 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85379","HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE","85379 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11981",null,"AETNA","85379 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85384","HC CHG FIBRINOGEN ACTIVITY","85384 - HC CHG FIBRINOGEN ACTIVITY",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11981",null,"AETNA","85384 - HC CHG FIBRINOGEN ACTIVITY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85397","HC CHG CLOTTING FUNCTION ACTIVITY NOS, EA ANALYT","85397 - HC CHG CLOTTING FUNCTION ACTIVITY NOS, EA ANALYT",null,null,null,null,null,"AETNA","11982",null,"AETNA","85397 - HC CHG CLOTTING FUNCTION ACTIVITY NOS, EA ANALYT"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85461","HC CHG HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE","85461 - HC CHG HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11982",null,"AETNA","85461 - HC CHG HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85520","HC CHG HEPARIN ASSAY","85520 - HC CHG HEPARIN ASSAY",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11982",null,"AETNA","85520 - HC CHG HEPARIN ASSAY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85549","HC CHG MURAMIDASE","85549 - HC CHG MURAMIDASE",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11982",null,"AETNA","85549 - HC CHG MURAMIDASE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85576","HC CHG PLATELET AGGREGATION IN VITRO EACH AGENT","85576 - HC CHG PLATELET AGGREGATION IN VITRO EACH AGENT",null,null,null,null,null,"BLUE CROSS-PPO","11982",null,"AETNA","85576 - HC CHG PLATELET AGGREGATION IN VITRO EACH AGENT"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85610","POC;INR","85610 - POC;INR",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11982",null,"AETNA","85610 - POC;INR"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85611","HC CHG PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH","85611 - HC CHG PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11982",null,"AETNA","85611 - HC CHG PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85613","HC CHG RUSSELL VIPER VENOM DILUTED","85613 - HC CHG RUSSELL VIPER VENOM DILUTED",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11982",null,"AETNA","85613 - HC CHG RUSSELL VIPER VENOM DILUTED"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85651","SEDIMENTATION RATE RBC NON-AUTOMATED","85651 - SEDIMENTATION RATE RBC NON-AUTOMATED",null,null,null,null,null,"CIGNA CARELINK","11982",null,"AETNA","85651 - SEDIMENTATION RATE RBC NON-AUTOMATED"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85652","HC CHG SEDIMENTATION RATE RBC AUTOMATED","85652 - HC CHG SEDIMENTATION RATE RBC AUTOMATED",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11982",null,"AETNA","85652 - HC CHG SEDIMENTATION RATE RBC AUTOMATED"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85660","HC CHG SICKLING RBC REDUCTION","85660 - HC CHG SICKLING RBC REDUCTION",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11982",null,"AETNA","85660 - HC CHG SICKLING RBC REDUCTION"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85670","HC CHG THROMBIN TIME PLASMA","85670 - HC CHG THROMBIN TIME PLASMA",null,null,null,null,null,"TUFTS HMO","11982",null,"AETNA","85670 - HC CHG THROMBIN TIME PLASMA"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85705","HC CHG THROMBOPLASTIN INHIBITION TISSUE","85705 - HC CHG THROMBOPLASTIN INHIBITION TISSUE",null,null,null,null,null,"TUFTS POS","11982",null,"AETNA","85705 - HC CHG THROMBOPLASTIN INHIBITION TISSUE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85730","HC CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD","85730 - HC CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD",null,null,null,null,null,"TUFTS PPO","11982",null,"AETNA","85730 - HC CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85732","HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA","85732 - HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA",null,null,null,null,null,"TUFTS SELECT","11982",null,"AETNA","85732 - HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA"]
["AETNA","AETNA-MEDICARE ADVANTAGE","85810","HC CHG VISCOSITY","85810 - HC CHG VISCOSITY",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11982",null,"AETNA","85810 - HC CHG VISCOSITY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86003","HC CHG ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN","86003 - HC CHG ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11982",null,"AETNA","86003 - HC CHG ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86021","HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES","86021 - HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES",null,null,null,null,null,"AETNA","11983",null,"AETNA","86021 - HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86022","HC CRL;SEROTONIN RLS ASSAY","86022 - HC CRL;SEROTONIN RLS ASSAY",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","11983",null,"AETNA","86022 - HC CRL;SEROTONIN RLS ASSAY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86038","HC CHG ANTINUCLEAR ANTIBODIES ANA","86038 - HC CHG ANTINUCLEAR ANTIBODIES ANA",null,null,null,null,null,"BLUE CROSS-HMO BLUE","11983",null,"AETNA","86038 - HC CHG ANTINUCLEAR ANTIBODIES ANA"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86039","HC CHG ANTINUCLEAR ANTIBODIES ANA TITER","86039 - HC CHG ANTINUCLEAR ANTIBODIES ANA TITER",null,null,null,null,null,"BLUE CROSS-INDEMNITY","11983",null,"AETNA","86039 - HC CHG ANTINUCLEAR ANTIBODIES ANA TITER"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86060","HC CHG ANTISTREPTOLYSIN O TITER","86060 - HC CHG ANTISTREPTOLYSIN O TITER",null,null,null,null,null,"BLUE CROSS-PPO","11983",null,"AETNA","86060 - HC CHG ANTISTREPTOLYSIN O TITER"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86140","C-REACTIVE PROTEIN","86140 - C-REACTIVE PROTEIN",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","11983",null,"AETNA","86140 - C-REACTIVE PROTEIN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86141","HC CRL;CARDIO CRP","86141 - HC CRL;CARDIO CRP",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","11983",null,"AETNA","86141 - HC CRL;CARDIO CRP"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86146","HC CRL;BETA-2 GLYCPRTN 1 AB","86146 - HC CRL;BETA-2 GLYCPRTN 1 AB",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","11983",null,"AETNA","86146 - HC CRL;BETA-2 GLYCPRTN 1 AB"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86147","HC Q;CARDLIP AB;IGG,IGM,IGA","86147 - HC Q;CARDLIP AB;IGG,IGM,IGA",null,null,null,null,null,"CIGNA CARELINK","11983",null,"AETNA","86147 - HC Q;CARDLIP AB;IGG,IGM,IGA"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86157","HC CHG COLD AGGLUTININ TITER","86157 - HC CHG COLD AGGLUTININ TITER",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","11983",null,"AETNA","86157 - HC CHG COLD AGGLUTININ TITER"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86160","HC CHG COMPLEMENT ANTIGEN EACH COMPONENT","86160 - HC CHG COMPLEMENT ANTIGEN EACH COMPONENT",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","11983",null,"AETNA","86160 - HC CHG COMPLEMENT ANTIGEN EACH COMPONENT"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86161","HC CHG COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT","86161 - HC CHG COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT",null,null,null,null,null,"TUFTS HMO","11983",null,"AETNA","86161 - HC CHG COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86162","HC CHG COMPLEMENT TOTAL HEMOLYTIC","86162 - HC CHG COMPLEMENT TOTAL HEMOLYTIC",null,null,null,null,null,"TUFTS POS","11983",null,"AETNA","86162 - HC CHG COMPLEMENT TOTAL HEMOLYTIC"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86200","HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY","86200 - HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY",null,null,null,null,null,"TUFTS PPO","11983",null,"AETNA","86200 - HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86235","HC CHG EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD","86235 - HC CHG EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD",null,null,null,null,null,"TUFTS SELECT","11983",null,"AETNA","86235 - HC CHG EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86255","HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY","86255 - HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","11983",null,"AETNA","86255 - HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86256","HC CHG FLUORESCENT ANTIBODY; TITER","86256 - HC CHG FLUORESCENT ANTIBODY; TITER",null,null,null,null,null,"UNITED/HARVARD PILGRIM","11983",null,"AETNA","86256 - HC CHG FLUORESCENT ANTIBODY; TITER"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86300","HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3","86300 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3",null,null,null,null,null,"AETNA","12001",null,"AETNA","86300 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86301","HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9","86301 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","12001",null,"AETNA","86301 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86304","HC CRL;CA-125","86304 - HC CRL;CA-125",null,null,null,null,null,"BLUE CROSS-HMO BLUE","12001",null,"AETNA","86304 - HC CRL;CA-125"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86308","HC CHG HETEROPHILE ANTIBODIES SCREEN","86308 - HC CHG HETEROPHILE ANTIBODIES SCREEN",null,null,null,null,null,"BLUE CROSS-INDEMNITY","12001",null,"AETNA","86308 - HC CHG HETEROPHILE ANTIBODIES SCREEN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86316","HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE","86316 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE",null,null,null,null,null,"BLUE CROSS-PPO","12001",null,"AETNA","86316 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86317","HC IMMUNOASSAY,INFECT AGENT,QUANT","86317 - HC IMMUNOASSAY,INFECT AGENT,QUANT",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","12001",null,"AETNA","86317 - HC IMMUNOASSAY,INFECT AGENT,QUANT"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86328","IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY; CORONAVIRUS 2","86328 - IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY; CORONAVIRUS 2",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","12001",null,"AETNA","86328 - IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY; CORONAVIRUS 2"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86331","HC CHG IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY","86331 - HC CHG IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","12001",null,"AETNA","86331 - HC CHG IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86334","HC CHG IMMUNOFIXJ ELECTROPHORESIS SERUM","86334 - HC CHG IMMUNOFIXJ ELECTROPHORESIS SERUM",null,null,null,null,null,"CIGNA CARELINK","12001",null,"AETNA","86334 - HC CHG IMMUNOFIXJ ELECTROPHORESIS SERUM"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86335","HC CHG IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS","86335 - HC CHG IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","12001",null,"AETNA","86335 - HC CHG IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86336","HC CHG INHIBIN A","86336 - HC CHG INHIBIN A",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","12001",null,"AETNA","86336 - HC CHG INHIBIN A"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86340","HC CHG INTRINSIC FACTOR ANTIBODIES","86340 - HC CHG INTRINSIC FACTOR ANTIBODIES",null,null,null,null,null,"TUFTS HMO","12001",null,"AETNA","86340 - HC CHG INTRINSIC FACTOR ANTIBODIES"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86341","HC CHG ISLET CELL ANTIBODY","86341 - HC CHG ISLET CELL ANTIBODY",null,null,null,null,null,"TUFTS POS","12001",null,"AETNA","86341 - HC CHG ISLET CELL ANTIBODY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86353","HC CHG LYMPHOCYTE TRANSFORMATION","86353 - HC CHG LYMPHOCYTE TRANSFORMATION",null,null,null,null,null,"TUFTS PPO","12001",null,"AETNA","86353 - HC CHG LYMPHOCYTE TRANSFORMATION"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86355","HC B CELLS TOTAL COUNT","86355 - HC B CELLS TOTAL COUNT",null,null,null,null,null,"TUFTS SELECT","12001",null,"AETNA","86355 - HC B CELLS TOTAL COUNT"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86357","HC NK CELLS, TOTAL COUNT","86357 - HC NK CELLS, TOTAL COUNT",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","12001",null,"AETNA","86357 - HC NK CELLS, TOTAL COUNT"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86359","HC CHG T CELLS TOTAL COUNT","86359 - HC CHG T CELLS TOTAL COUNT",null,null,null,null,null,"UNITED/HARVARD PILGRIM","12001",null,"AETNA","86359 - HC CHG T CELLS TOTAL COUNT"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86360","HC CHG T CELLS ABSOLUTE CD4&CD8 COUNT RATIO","86360 - HC CHG T CELLS ABSOLUTE CD4&CD8 COUNT RATIO",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","12002",null,"AETNA","86360 - HC CHG T CELLS ABSOLUTE CD4&CD8 COUNT RATIO"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86376","HC CHG MICROSOMAL ANTIBODIES EACH","86376 - HC CHG MICROSOMAL ANTIBODIES EACH",null,null,null,null,null,"BLUE CROSS-HMO BLUE","12002",null,"AETNA","86376 - HC CHG MICROSOMAL ANTIBODIES EACH"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86382","HC CHG NEUTRALIZATION TEST VIRAL","86382 - HC CHG NEUTRALIZATION TEST VIRAL",null,null,null,null,null,"BLUE CROSS-INDEMNITY","12002",null,"AETNA","86382 - HC CHG NEUTRALIZATION TEST VIRAL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86403","HC CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY","86403 - HC CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY",null,null,null,null,null,"BLUE CROSS-PPO","12002",null,"AETNA","86403 - HC CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86431","HC CHG RHEUMATOID FACTOR QUANTITATIVE","86431 - HC CHG RHEUMATOID FACTOR QUANTITATIVE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","12002",null,"AETNA","86431 - HC CHG RHEUMATOID FACTOR QUANTITATIVE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86480","HC CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON","86480 - HC CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","12002",null,"AETNA","86480 - HC CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86481","HC TB TEST CELL MEDIATED ANTIGEN RESPONSE, ENUM GAMMA INTERFRON T-CELL","86481 - HC TB TEST CELL MEDIATED ANTIGEN RESPONSE, ENUM GAMMA INTERFRON T-CELL",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","12002",null,"AETNA","86481 - HC TB TEST CELL MEDIATED ANTIGEN RESPONSE, ENUM GAMMA INTERFRON T-CELL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86592","HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL","86592 - HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL",null,null,null,null,null,"CIGNA CARELINK","12002",null,"AETNA","86592 - HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86593","HC SYPHILIS;QN","86593 - HC SYPHILIS;QN",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","12002",null,"AETNA","86593 - HC SYPHILIS;QN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86606","HC CHG ANTIBODY ASPERGILLUS","86606 - HC CHG ANTIBODY ASPERGILLUS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","12002",null,"AETNA","86606 - HC CHG ANTIBODY ASPERGILLUS"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86609","HC CHG ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED","86609 - HC CHG ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED",null,null,null,null,null,"TUFTS HMO","12002",null,"AETNA","86609 - HC CHG ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86611","HC BARTONELLA, ANTIBODY","86611 - HC BARTONELLA, ANTIBODY",null,null,null,null,null,"TUFTS POS","12002",null,"AETNA","86611 - HC BARTONELLA, ANTIBODY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86612","HC CHG BLASTOMYCES ANTIBODY","86612 - HC CHG BLASTOMYCES ANTIBODY",null,null,null,null,null,"TUFTS PPO","12002",null,"AETNA","86612 - HC CHG BLASTOMYCES ANTIBODY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86615","HC Q;BORDTLLA AB;IGG,IGA","86615 - HC Q;BORDTLLA AB;IGG,IGA",null,null,null,null,null,"TUFTS SELECT","12002",null,"AETNA","86615 - HC Q;BORDTLLA AB;IGG,IGA"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86617","HC CHG ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST","86617 - HC CHG ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","12002",null,"AETNA","86617 - HC CHG ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86618","HC Q;LYME AB INDEX CNS INFEC","86618 - HC Q;LYME AB INDEX CNS INFEC",null,null,null,null,null,"UNITED/HARVARD PILGRIM","12002",null,"AETNA","86618 - HC Q;LYME AB INDEX CNS INFEC"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86622","HC CHG ANTIBODY BRUCELLA","86622 - HC CHG ANTIBODY BRUCELLA",null,null,null,null,null,"AETNA","12004",null,"AETNA","86622 - HC CHG ANTIBODY BRUCELLA"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86625","HC CAMPYLOBACTER, ANTIBODY","86625 - HC CAMPYLOBACTER, ANTIBODY",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","12004",null,"AETNA","86625 - HC CAMPYLOBACTER, ANTIBODY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86631","HC CHG, CHLAMYDIA, ANTIBODY","86631 - HC CHG, CHLAMYDIA, ANTIBODY",null,null,null,null,null,"BLUE CROSS-HMO BLUE","12004",null,"AETNA","86631 - HC CHG, CHLAMYDIA, ANTIBODY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86632","HC CHG CHLAMYDIA, IGM ANTIBODY","86632 - HC CHG CHLAMYDIA, IGM ANTIBODY",null,null,null,null,null,"BLUE CROSS-INDEMNITY","12004",null,"AETNA","86632 - HC CHG CHLAMYDIA, IGM ANTIBODY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86635","HC CHG ANTIBODY COCCIDIOIDES","86635 - HC CHG ANTIBODY COCCIDIOIDES",null,null,null,null,null,"BLUE CROSS-PPO","12004",null,"AETNA","86635 - HC CHG ANTIBODY COCCIDIOIDES"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86638","HC CHG, Q FEVER ANTIBODY","86638 - HC CHG, Q FEVER ANTIBODY",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","12004",null,"AETNA","86638 - HC CHG, Q FEVER ANTIBODY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86644","HC CHG ANTIBODY CYTOMEGALOVIRUS CMV","86644 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","12004",null,"AETNA","86644 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86645","HC CHG ANTIBODY CYTOMEGALOVIRUS CMV IGM","86645 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV IGM",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","12004",null,"AETNA","86645 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV IGM"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86648","HC CHG ANTIBODY DIPHTHERIA","86648 - HC CHG ANTIBODY DIPHTHERIA",null,null,null,null,null,"CIGNA CARELINK","12004",null,"AETNA","86648 - HC CHG ANTIBODY DIPHTHERIA"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86652","HC CHG, ENCEPHAL ANTIBODY EAST EQU","86652 - HC CHG, ENCEPHAL ANTIBODY EAST EQU",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","12004",null,"AETNA","86652 - HC CHG, ENCEPHAL ANTIBODY EAST EQU"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86654","CHG ANTIBODY ENCEPHALITIS WESTRN EQUINE","86654 - CHG ANTIBODY ENCEPHALITIS WESTRN EQUINE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","12004",null,"AETNA","86654 - CHG ANTIBODY ENCEPHALITIS WESTRN EQUINE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86658","HC CHG ENTEROVIRUS ANTIBODY","86658 - HC CHG ENTEROVIRUS ANTIBODY",null,null,null,null,null,"TUFTS HMO","12004",null,"AETNA","86658 - HC CHG ENTEROVIRUS ANTIBODY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86663","HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA","86663 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA",null,null,null,null,null,"TUFTS POS","12004",null,"AETNA","86663 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86664","HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA","86664 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA",null,null,null,null,null,"TUFTS PPO","12004",null,"AETNA","86664 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86665","HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA","86665 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA",null,null,null,null,null,"TUFTS SELECT","12004",null,"AETNA","86665 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86666","HC CHG ANTIBODY EHRLICHIA","86666 - HC CHG ANTIBODY EHRLICHIA",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","12004",null,"AETNA","86666 - HC CHG ANTIBODY EHRLICHIA"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86677","HC CHG ANTIBODY HELICOBACTER PYLORI","86677 - HC CHG ANTIBODY HELICOBACTER PYLORI",null,null,null,null,null,"UNITED/HARVARD PILGRIM","12004",null,"AETNA","86677 - HC CHG ANTIBODY HELICOBACTER PYLORI"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86682","HC Q;CYSTICERCUS AB,BLOT","86682 - HC Q;CYSTICERCUS AB,BLOT",null,null,null,null,null,"AETNA","12005",null,"AETNA","86682 - HC Q;CYSTICERCUS AB,BLOT"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86689","HC HTLV/HIV CONFIRMATORY TEST","86689 - HC HTLV/HIV CONFIRMATORY TEST",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","12005",null,"AETNA","86689 - HC HTLV/HIV CONFIRMATORY TEST"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86692","HC CHG ANTIBODY HEP DELTA AGENT","86692 - HC CHG ANTIBODY HEP DELTA AGENT",null,null,null,null,null,"BLUE CROSS-HMO BLUE","12005",null,"AETNA","86692 - HC CHG ANTIBODY HEP DELTA AGENT"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86694","HC CHG ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST","86694 - HC CHG ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST",null,null,null,null,null,"BLUE CROSS-INDEMNITY","12005",null,"AETNA","86694 - HC CHG ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86695","HC CHG ANTIBODY HERPES SMPLX TYPE 1","86695 - HC CHG ANTIBODY HERPES SMPLX TYPE 1",null,null,null,null,null,"BLUE CROSS-PPO","12005",null,"AETNA","86695 - HC CHG ANTIBODY HERPES SMPLX TYPE 1"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86696","HC CHG ANTIBODY HERPES SMPLX TYPE 2","86696 - HC CHG ANTIBODY HERPES SMPLX TYPE 2",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","12005",null,"AETNA","86696 - HC CHG ANTIBODY HERPES SMPLX TYPE 2"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86698","HC CHG ANTIBODY HISTOPLASMA","86698 - HC CHG ANTIBODY HISTOPLASMA",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","12005",null,"AETNA","86698 - HC CHG ANTIBODY HISTOPLASMA"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86701","HC HIV-1","86701 - HC HIV-1",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","12005",null,"AETNA","86701 - HC HIV-1"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86702","HC QL/SEMI MULT AB;HIV2","86702 - HC QL/SEMI MULT AB;HIV2",null,null,null,null,null,"CIGNA CARELINK","12005",null,"AETNA","86702 - HC QL/SEMI MULT AB;HIV2"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86703","HC HIV 1/2 ANTIBODY","86703 - HC HIV 1/2 ANTIBODY",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","12005",null,"AETNA","86703 - HC HIV 1/2 ANTIBODY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86704","HC CHG HEPATITIS B CORE ANTIBODY HBCAB TOTAL","86704 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB TOTAL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","12005",null,"AETNA","86704 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB TOTAL"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86705","HC CHG HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY","86705 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY",null,null,null,null,null,"TUFTS HMO","12005",null,"AETNA","86705 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86706","HC CHG HEPATITIS B SURF ANTIBODY HBSAB","86706 - HC CHG HEPATITIS B SURF ANTIBODY HBSAB",null,null,null,null,null,"TUFTS POS","12005",null,"AETNA","86706 - HC CHG HEPATITIS B SURF ANTIBODY HBSAB"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86707","HC CHG HEPATITIS BE ANTIBODY HBEAB","86707 - HC CHG HEPATITIS BE ANTIBODY HBEAB",null,null,null,null,null,"TUFTS PPO","12005",null,"AETNA","86707 - HC CHG HEPATITIS BE ANTIBODY HBEAB"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86708","HC CHG HEPATITIS A ANTIBODY HAAB","86708 - HC CHG HEPATITIS A ANTIBODY HAAB",null,null,null,null,null,"TUFTS SELECT","12005",null,"AETNA","86708 - HC CHG HEPATITIS A ANTIBODY HAAB"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86709","HC CHG HEPATITIS ANTIBODY HAAB IGM ANTIBODY","86709 - HC CHG HEPATITIS ANTIBODY HAAB IGM ANTIBODY",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","12005",null,"AETNA","86709 - HC CHG HEPATITIS ANTIBODY HAAB IGM ANTIBODY"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86710","HC INFLUENZA VIRUS","86710 - HC INFLUENZA VIRUS",null,null,null,null,null,"UNITED/HARVARD PILGRIM","12005",null,"AETNA","86710 - HC INFLUENZA VIRUS"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86735","HC CHG ANTIBODY MUMPS","86735 - HC CHG ANTIBODY MUMPS",null,null,null,null,null,"AETNA","12006",null,"AETNA","86735 - HC CHG ANTIBODY MUMPS"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86738","HC CHG ANTIBODY MYCOPLSM","86738 - HC CHG ANTIBODY MYCOPLSM",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","12006",null,"AETNA","86738 - HC CHG ANTIBODY MYCOPLSM"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86744","HC CHG ANTIBODY NOCARDIA","86744 - HC CHG ANTIBODY NOCARDIA",null,null,null,null,null,"BLUE CROSS-HMO BLUE","12006",null,"AETNA","86744 - HC CHG ANTIBODY NOCARDIA"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86747","HC CHG ANTIBODY PARVOVIRUS","86747 - HC CHG ANTIBODY PARVOVIRUS",null,null,null,null,null,"BLUE CROSS-INDEMNITY","12006",null,"AETNA","86747 - HC CHG ANTIBODY PARVOVIRUS"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86753","HC CHG ANTIBODY PROTOZOA NES","86753 - HC CHG ANTIBODY PROTOZOA NES",null,null,null,null,null,"BLUE CROSS-PPO","12006",null,"AETNA","86753 - HC CHG ANTIBODY PROTOZOA NES"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86757","HC CHG, RICKETTSIA","86757 - HC CHG, RICKETTSIA",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","12006",null,"AETNA","86757 - HC CHG, RICKETTSIA"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86762","HC CHG ANTIBODY RUBELLA","86762 - HC CHG ANTIBODY RUBELLA",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","12006",null,"AETNA","86762 - HC CHG ANTIBODY RUBELLA"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86765","HC CHG ANTIBODY RUBEOLA","86765 - HC CHG ANTIBODY RUBEOLA",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","12006",null,"AETNA","86765 - HC CHG ANTIBODY RUBEOLA"]
["AETNA","AETNA-MEDICARE ADVANTAGE","86769","ANTIBODY; SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2","86769 - ANTIBODY; SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2",null,null,null,null,null,"CIGNA CARELINK","12006",null,"AETNA","86769 - ANTIBODY; SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2"]
["AETNA","AETNA-MEDICARE ADVANTAGE","87103","HC CHG CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD","87103 - HC CHG CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","12011",null,"AETNA","87103 - HC CHG CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD"]
["AETNA","AETNA-MEDICARE ADVANTAGE","87350","HC CHG IAAD IA HEPATITIS BE ANTIGEN","87350 - HC CHG IAAD IA HEPATITIS BE ANTIGEN",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","12015",null,"AETNA","87350 - HC CHG IAAD IA HEPATITIS BE ANTIGEN"]
["AETNA","AETNA-MEDICARE ADVANTAGE","87390","HC CHG IAAD IA HIV-1","87390 - HC CHG IAAD IA HIV-1",null,null,null,null,null,"BLUE CROSS-PPO","12015",null,"AETNA","87390 - HC CHG IAAD IA HIV-1"]
["AETNA","AETNA-MEDICARE ADVANTAGE","87661","IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH","87661 - IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","12017",null,"AETNA","87797 - HC CHG DETECT AGENT NOS, DNA, DIR"]
["AETNA","AETNA-MEDICARE ADVANTAGE","90653","HC IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE","90653 - HC IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE",null,null,null,null,null,"TUFTS SELECT","12020",null,"AETNA","90662 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM FLUZONE HIGH DOSE"]
["AETNA","AETNA-MEDICARE ADVANTAGE","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","12034",null,"AETNA","0207T - HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","21248","HC RECONSTR JAW,PART-ENDO IMPLNT","21248 - HC RECONSTR JAW,PART-ENDO IMPLNT",null,null,null,null,null,"UNITED/HARVARD PILGRIM","12035",null,"ALLWAYS HEALTH PARTNERS","36415 - COLLECTION VENOUS BLOOD VENIPUNCTURE"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","44381","HC ILEOSCOPY STOMA W/BALLOON DILATION","44381 - HC ILEOSCOPY STOMA W/BALLOON DILATION",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","12037",null,"ALLWAYS HEALTH PARTNERS","61650 - ENDOVASCULAR INTRACRANIAL PROLNG ADMN RX AGENT; INITIAL VASCULAR TERRITORY"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","61651","ENDOVASCULAR INTRACRANIAL PROLNG ADMN RX AGENT; EACH ADD¿L VASCULAR TERRITORY","61651 - ENDOVASCULAR INTRACRANIAL PROLNG ADMN RX AGENT; EACH ADD¿L VASCULAR TERRITORY",null,null,null,null,null,"UNITED/HARVARD PILGRIM","12044",null,"ALLWAYS HEALTH PARTNERS","80202 - HC CHG DRUG SCREEN QUANTITATIVE VANCOMYCIN"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","77790","HC BRACHY , SUP. HANDLING, LOADING","77790 - HC BRACHY , SUP. HANDLING, LOADING",null,null,null,null,null,"AETNA","12047",null,"ALLWAYS HEALTH PARTNERS","81229 - HC CYTOG ALYS CHRML ABNR SNPCGH"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","80158","HC CHG DRUG ASSAY CYCLOSPORINE","80158 - HC CHG DRUG ASSAY CYCLOSPORINE",null,null,null,null,null,"UNITED/HARVARD PILGRIM","12051",null,"ALLWAYS HEALTH PARTNERS","81401 - HC CHG, MOLECULAR PATHOLOGY PROCEDURE LEVEL 2"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","80202","HC CHG DRUG SCREEN QUANTITATIVE VANCOMYCIN","80202 - HC CHG DRUG SCREEN QUANTITATIVE VANCOMYCIN",null,null,null,null,null,"AETNA","12054",null,"ALLWAYS HEALTH PARTNERS","82248 - HC CHG BILIRUBIN DIRECT"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","81180","HC CHG ATXN3 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","81180 - HC CHG ATXN3 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","12057",null,"ALLWAYS HEALTH PARTNERS","82785 - HC CHG ASSAY OF GAMMAGLOBULIN IGE"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","81243","HC CHG FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES","81243 - HC CHG FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","13100",null,"ALLWAYS HEALTH PARTNERS","83050 - HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","81403","SEQ & EXON 13 SEQ, IF PERFORMED KRAS (EG, CARCINOMA), GENE ANALYSIS, PRO/TECH","81403 - SEQ & EXON 13 SEQ, IF PERFORMED KRAS (EG, CARCINOMA), GENE ANALYSIS, PRO/TECH",null,null,null,null,null,"BLUE CROSS-INDEMNITY","13121",null,"ALLWAYS HEALTH PARTNERS","84210 - HC CHG ASSAY OF PYRUVATE"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","82043","HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE","82043 - HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE",null,null,null,null,null,"BLUE CROSS-HMO BLUE","13131",null,"ALLWAYS HEALTH PARTNERS","84550 - HC CHG ASSAY OF BLOOD/URIC ACID"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","82365","HC CHG CALCULUS INFRARED SPECTROSCOPY","82365 - HC CHG CALCULUS INFRARED SPECTROSCOPY",null,null,null,null,null,"BLUE CROSS-INDEMNITY","13151",null,"ALLWAYS HEALTH PARTNERS","85652 - HC CHG SEDIMENTATION RATE RBC AUTOMATED"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","82540","HC CHG ASSAY OF CREATINE","82540 - HC CHG ASSAY OF CREATINE",null,null,null,null,null,"BLUE CROSS-PPO","13160",null,"ALLWAYS HEALTH PARTNERS","86336 - HC CHG INHIBIN A"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","82670","HC CHG ASSAY OF ESTRADIOL","82670 - HC CHG ASSAY OF ESTRADIOL",null,null,null,null,null,"BLUE CROSS-INDEMNITY","14001",null,"ALLWAYS HEALTH PARTNERS","86645 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV IGM"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","82951","HC CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS","82951 - HC CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS",null,null,null,null,null,"BLUE CROSS-PPO","14021",null,"ALLWAYS HEALTH PARTNERS","86769 - ANTIBODY; SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","83550","HC CHG IRON BINDING CAPACITY","83550 - HC CHG IRON BINDING CAPACITY",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","14060",null,"ALLWAYS HEALTH PARTNERS","87176 - HC CHG HOMOGENIZATION TISSUE CULTURE"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","83718","HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL","83718 - HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL",null,null,null,null,null,"BLUE CROSS-PPO","14061",null,"ALLWAYS HEALTH PARTNERS","87255 - HC CHG VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","83937","HC CHG ASSAY OF OSTEOCALCIN","83937 - HC CHG ASSAY OF OSTEOCALCIN",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","14302",null,"ALLWAYS HEALTH PARTNERS","87502 - HC Q;FLU AG DET,MULT TYP,2,2"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","84146","HC CHG ASSAY OF PROLACTIN","84146 - HC CHG ASSAY OF PROLACTIN",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","15003",null,"ALLWAYS HEALTH PARTNERS","87801 - HC CHG DETECT AGENT, MULT ORGS, DNA  AMP"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","84436","HC CHG ASSAY OF THYROXINE TOTAL","84436 - HC CHG ASSAY OF THYROXINE TOTAL",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","15100",null,"ALLWAYS HEALTH PARTNERS","90913 - HC BFB TRAINING EA ADDL 15 MIN"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","85018","POC;HEMOGLOBIN","85018 - POC;HEMOGLOBIN",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","15240",null,"ALLWAYS HEALTH PARTNERS","97014 - HC APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","85046","HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS","85046 - HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS",null,null,null,null,null,"BLUE CROSS-HMO BLUE","15241",null,"ALLWAYS HEALTH PARTNERS","97157 - HC MULT FAM ADAPT BHV TX GDN"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","85302","HC CHG CLOTTING INHIBITORS PROTEIN C ANTIGEN","85302 - HC CHG CLOTTING INHIBITORS PROTEIN C ANTIGEN",null,null,null,null,null,"BLUE CROSS-PPO","15271",null,"ALLWAYS HEALTH PARTNERS","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","86003","HC CHG ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN","86003 - HC CHG ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN",null,null,null,null,null,"BLUE CROSS-PPO","15274",null,"BLUE BENEFIT ADMINISTRATORS","11303 - SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","86335","HC CHG IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS","86335 - HC CHG IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS",null,null,null,null,null,"CIGNA CARELINK","15277",null,"BLUE BENEFIT ADMINISTRATORS","11760 - REPAIR NAIL BED"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","86592","HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL","86592 - HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","15620",null,"BLUE BENEFIT ADMINISTRATORS","12042 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","86644","HC CHG ANTIBODY CYTOMEGALOVIRUS CMV","86644 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","15731",null,"BLUE BENEFIT ADMINISTRATORS","14060 - ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","86710","HC INFLUENZA VIRUS","86710 - HC INFLUENZA VIRUS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","15771",null,"BLUE BENEFIT ADMINISTRATORS","17250 - CHEMICAL CAUTERIZATION GRANULATION TISSUE"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","86769","ANTIBODY; SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2","86769 - ANTIBODY; SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","15772",null,"BLUE BENEFIT ADMINISTRATORS","19081 - BX BREAST W/DEVICE 1ST LESION STEREOTACTIC GUID"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","86910","HC CHG BLOOD TYPING PATERNITY INDIV ABO RH&MN","86910 - HC CHG BLOOD TYPING PATERNITY INDIV ABO RH&MN",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","15820",null,"BLUE BENEFIT ADMINISTRATORS","20606 - HC PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","87046","HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA","87046 - HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","15821",null,"BLUE BENEFIT ADMINISTRATORS","21014 - EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/>"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","87176","HC CHG HOMOGENIZATION TISSUE CULTURE","87176 - HC CHG HOMOGENIZATION TISSUE CULTURE",null,null,null,null,null,"TUFTS HMO","15823",null,"BLUE BENEFIT ADMINISTRATORS","21440 - HC DENTAL RIDGE FX"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","87281","HC CHG IAADI PNEUMOCUSTIS CARINII","87281 - HC CHG IAADI PNEUMOCUSTIS CARINII",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","15830",null,"BLUE BENEFIT ADMINISTRATORS","23540 - CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","87449","HC AG DET,ENZ IMM;OTH,EA","87449 - HC AG DET,ENZ IMM;OTH,EA",null,null,null,null,null,"AETNA","15850",null,"BLUE BENEFIT ADMINISTRATORS","25000 - HC INCISION EXTENSOR TENDON SHEATH WRIST"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","87511","HC CHG GARDNER VAG, DNA  AMP PROBE","87511 - HC CHG GARDNER VAG, DNA  AMP PROBE",null,null,null,null,null,"TUFTS POS","15851",null,"BLUE BENEFIT ADMINISTRATORS","25675 - CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","87899","HC MALARIA ANTIGEN","87899 - HC MALARIA ANTIGEN",null,null,null,null,null,"AETNA","16020",null,"BLUE BENEFIT ADMINISTRATORS","27257 - HC TX HIPDISLOC ABDCT WMANP"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","88264","HC CHG CHRMSM ANALYZE 20-25 CELLS","88264 - HC CHG CHRMSM ANALYZE 20-25 CELLS",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","17000",null,"BLUE BENEFIT ADMINISTRATORS","28041 - HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5+CM"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","90698","CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH","90698 - CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,null,null,null,null,"BLUE CROSS-HMO BLUE","17004",null,"BLUE BENEFIT ADMINISTRATORS","28515 - CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","92633","HC AUD REH POSTLING HEARLOSS","92633 - HC AUD REH POSTLING HEARLOSS",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","17107",null,"BLUE BENEFIT ADMINISTRATORS","29540 - STRAPPING ANKLE &/FOOT"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","96105","ASSESSMENT PHASIA W/INTERP & REPORT PER HOUR","96105 - ASSESSMENT PHASIA W/INTERP & REPORT PER HOUR",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","17110",null,"BLUE BENEFIT ADMINISTRATORS","31237 - NASAL/SINUS NDSC SURG W/BX POLYPECT/DBRDMT SPX"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","96168","HC HLTH BHV IVNTJ FAM EA ADDL","96168 - HC HLTH BHV IVNTJ FAM EA ADDL",null,null,null,null,null,"BLUE CROSS-INDEMNITY","17260",null,"BLUE BENEFIT ADMINISTRATORS","32405 - HC BIOPSY LUNG/MEDIASTINUM PERCUTANEOUS NEEDLE"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","97537","HC COMMUNITY/WORK REINTEGRATION TRAINJ EA 15 MIN","97537 - HC COMMUNITY/WORK REINTEGRATION TRAINJ EA 15 MIN",null,null,null,null,null,"BLUE CROSS-HMO BLUE","17262",null,"BLUE BENEFIT ADMINISTRATORS","33233 - HC REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY"]
["ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","99358","HC PROLONGED SERV,NO CONTACT,1ST HR","99358 - HC PROLONGED SERV,NO CONTACT,1ST HR",null,null,null,null,null,"CIGNA CARELINK","17263",null,"BLUE BENEFIT ADMINISTRATORS","36005 - HC NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","10010","HC FNA BX W/CT GDN EA ADDL","10010 - HC FNA BX W/CT GDN EA ADDL",null,null,null,null,null,"BLUE CROSS-PPO","17281",null,"BLUE BENEFIT ADMINISTRATORS","36572 - HC INSJ PICC RS&I <5 YR"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","11107","HC INCAL BX SKN EA SEP/ADDL","11107 - HC INCAL BX SKN EA SEP/ADDL",null,null,null,null,null,"BLUE CROSS-INDEMNITY","17312",null,"BLUE BENEFIT ADMINISTRATORS","37186 - HC SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","11312","SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM","11312 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","17312",null,"BLUE BENEFIT ADMINISTRATORS","37214 - HC CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","12021","TX SUPERFICIAL WOUND DEHISCENCE W/PACKING","12021 - TX SUPERFICIAL WOUND DEHISCENCE W/PACKING",null,null,null,null,null,"AETNA","19000",null,"BLUE BENEFIT ADMINISTRATORS","41007 - HC I&D MOUTH/TONG INTRA,SUBMENTAL"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","12032","REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM","12032 - REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM",null,null,null,null,null,"BLUE CROSS-HMO BLUE","19000",null,"BLUE BENEFIT ADMINISTRATORS","41009 - HC I&D MOUTH/TONG INTRA, MASTICATOR"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","15220","HC FULL THICK GRFT SCALP, ARM, LEG, <20SQC","15220 - HC FULL THICK GRFT SCALP, ARM, LEG, <20SQC",null,null,null,null,null,"TUFTS SELECT","19020",null,"BLUE BENEFIT ADMINISTRATORS","42700 - I&D ABSCESS PERITONSILLAR"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","16000","HC INITIAL RX BURN(S) 1ST DEGREE","16000 - HC INITIAL RX BURN(S) 1ST DEGREE",null,null,null,null,null,"TUFTS PPO","19082",null,"BLUE BENEFIT ADMINISTRATORS","43241 - HC UPR GI NDSC TNDSC INTRALUMINAL TUBE/CATH PLMT"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","20526","INJECTION THERAPEUTIC CARPAL TUNNEL","20526 - INJECTION THERAPEUTIC CARPAL TUNNEL",null,null,null,null,null,"TUFTS PPO","19086",null,"BLUE BENEFIT ADMINISTRATORS","45317 - HC PROCTOSIGMOIDOSCOPY BLEED"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","20950","HC RECORD FLUID PRESSURE,MUSCLE","20950 - HC RECORD FLUID PRESSURE,MUSCLE",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","19100",null,"BLUE BENEFIT ADMINISTRATORS","45382 - HC COLSC FLX PROX SPLENIC FLXR CTRL BLD"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","21243","HC ARTHROPLASTY TMJ+PROSTHESIS","21243 - HC ARTHROPLASTY TMJ+PROSTHESIS",null,null,null,null,null,"TUFTS SELECT","19125",null,"BLUE BENEFIT ADMINISTRATORS","46900 - DSTRJ LESION ANUS SIMPLE CHEMICAL"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","23073","HC EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/>","23073 - HC EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/>",null,null,null,null,null,"TUFTS SELECT","19283",null,"BLUE BENEFIT ADMINISTRATORS","50385 - HC REMOVE & REPLACE INDWELL URETERAL STENT TRURTHRL"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","24577","CLTX HUMERAL CONDYLAR FX MEDIAL/LATERAL W/MANJ","24577 - CLTX HUMERAL CONDYLAR FX MEDIAL/LATERAL W/MANJ",null,null,null,null,null,"UNITED/HARVARD PILGRIM","19285",null,"BLUE BENEFIT ADMINISTRATORS","51729 - COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","25624","CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ","25624 - CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","19287",null,"BLUE BENEFIT ADMINISTRATORS","54200 - INJECTION PEYRONIE DISEASE"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","26742","CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ","26742 - CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","19301",null,"BLUE BENEFIT ADMINISTRATORS","57105 - HC BIOPSY OF VAGINA"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","27618","EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM","27618 - EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM",null,null,null,null,null,"CIGNA CARELINK","19328",null,"BLUE BENEFIT ADMINISTRATORS","59200 - INSERTION CERVICAL DILATOR SEPARATE PROCEDURE"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","28041","HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5+CM","28041 - HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5+CM",null,null,null,null,null,"BLUE CROSS-PPO","19350",null,"BLUE BENEFIT ADMINISTRATORS","62252 - HC REPRGRMG PROGRAMMABLE CEREBROSPINAL SHUNT"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","29445","HC APPLICATION RIGID TOTAL CONTACT LEG CAST","29445 - HC APPLICATION RIGID TOTAL CONTACT LEG CAST",null,null,null,null,null,"CIGNA CARELINK","19499",null,"BLUE BENEFIT ADMINISTRATORS","64494 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","30520","HC REPAIR OF NASAL SEPTUM","30520 - HC REPAIR OF NASAL SEPTUM",null,null,null,null,null,"TUFTS PPO","20102",null,"BLUE BENEFIT ADMINISTRATORS","64771 - HC TRANSECT OTHER CRAN N,EXTRADURAL"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","31640","HC BRONCHOSCOPY,EXCIS LESN","31640 - HC BRONCHOSCOPY,EXCIS LESN",null,null,null,null,null,"TUFTS PPO","20205",null,"BLUE BENEFIT ADMINISTRATORS","66625 - HC REMV IRIS PERIPH FOR GLAUCOMA"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","33226","HC RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD","33226 - HC RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","20220",null,"BLUE BENEFIT ADMINISTRATORS","67210 - DSTRJ LOCLZD LES RETINA 1/> SESS PC"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","36013","HC INTRO CATHETER RIGHT HEART/MAIN PULMONARY ARTERY","36013 - HC INTRO CATHETER RIGHT HEART/MAIN PULMONARY ARTERY",null,null,null,null,null,"TUFTS SELECT","20240",null,"BLUE BENEFIT ADMINISTRATORS","67875 - TEMPORARY CLOSURE EYELIDS SUTURE"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","36473","HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM 1ST VEIN","36473 - HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM 1ST VEIN",null,null,null,null,null,"TUFTS SELECT","20501",null,"BLUE BENEFIT ADMINISTRATORS","68750 - HC CREATE TEAR DUCT DRAIN"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","36522","PHOTOPHERESIS EXTRACORPOREAL","36522 - PHOTOPHERESIS EXTRACORPOREAL",null,null,null,null,null,"TUFTS HMO","20520",null,"BLUE BENEFIT ADMINISTRATORS","69105 - BIOPSY EXTERNAL AUDITORY CANAL"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","37212","HC THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX","37212 - HC THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","20527",null,"BLUE BENEFIT ADMINISTRATORS","70498 - HC CHG CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","38206","HC BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ AUTOL","38206 - HC BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ AUTOL",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","20551",null,"BLUE BENEFIT ADMINISTRATORS","72050 - HC CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","40810","EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR","40810 - EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR",null,null,null,null,null,"TUFTS POS","20553",null,"BLUE BENEFIT ADMINISTRATORS","72158 - HC CHG MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","42415","HC EXC PAROTD,LAT LOBE,DISSECT 5TH NERV","42415 - HC EXC PAROTD,LAT LOBE,DISSECT 5TH NERV",null,null,null,null,null,"UNITED/HARVARD PILGRIM","20605",null,"BLUE BENEFIT ADMINISTRATORS","73565 - HC CHG RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","43261","HC ERCP W/BIOPSY SINGLE/MULTIPLE","43261 - HC ERCP W/BIOPSY SINGLE/MULTIPLE",null,null,null,null,null,"BLUE CROSS-INDEMNITY","20612",null,"BLUE BENEFIT ADMINISTRATORS","74420 - X-RAY URINARY TRACT EXAM WITH CONTRAST MATERIAL"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","44384","ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT","44384 - ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","20650",null,"BLUE BENEFIT ADMINISTRATORS","75803 - HC LYPMH VESSEL XRAY ARM/LEG"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","44970","HC LAPAROSCOPIC APPENDECTOMY","44970 - HC LAPAROSCOPIC APPENDECTOMY",null,null,null,null,null,"TUFTS SELECT","20650",null,"BLUE BENEFIT ADMINISTRATORS","75870 - VENOGRAM SUPER SAG SINUS"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","46604","HC ANOSCOPY,W/DILATION","46604 - HC ANOSCOPY,W/DILATION",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","20690",null,"BLUE BENEFIT ADMINISTRATORS","76817 - US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","50200","RENAL BIOPSY PRQ TROCAR/NEEDLE","50200 - RENAL BIOPSY PRQ TROCAR/NEEDLE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","20982",null,"BLUE BENEFIT ADMINISTRATORS","77077 - HC CHG JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","51725","SIMPLE CYSTOMETROGRAM","51725 - SIMPLE CYSTOMETROGRAM",null,null,null,null,null,"BLUE CROSS-PPO","21011",null,"BLUE BENEFIT ADMINISTRATORS","77412 - HC TX DEL =>1 MEV - COMPLEX"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","54100","BIOPSY PENIS SEPARATE PROCEDURE","54100 - BIOPSY PENIS SEPARATE PROCEDURE",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","21013",null,"BLUE BENEFIT ADMINISTRATORS","78215 - HC CHG LIVER & SPLEEN IMAGING STATIC ONLY"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","57454","COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE","57454 - COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","21026",null,"BLUE BENEFIT ADMINISTRATORS","78831 - HC NM LOCLZJ TUM SPECT 2 AREAS"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","58300","INSERTION INTRAUTERINE DEVICE IUD","58300 - INSERTION INTRAUTERINE DEVICE IUD",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","21029",null,"BLUE BENEFIT ADMINISTRATORS","80158 - HC CHG DRUG ASSAY CYCLOSPORINE"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","59841","INDUCED ABORTION DILATION & EVAUCATION","59841 - INDUCED ABORTION DILATION & EVAUCATION",null,null,null,null,null,"BLUE CROSS-HMO BLUE","21031",null,"BLUE BENEFIT ADMINISTRATORS","80366 - HC CHG DRUG SCREENING PREGABALIN"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","62322","HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","21040",null,"BLUE BENEFIT ADMINISTRATORS","81269 - HC HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIENTS"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","64488","HC TAP BLOCK BILATERAL BY INJECTION(S)","64488 - HC TAP BLOCK BILATERAL BY INJECTION(S)",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","21046",null,"BLUE BENEFIT ADMINISTRATORS","82017 - HC CHG ACYLCARNITINES QUANTIATIVE EACH SPECIMEN"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","65210","HC RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR","65210 - HC RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR",null,null,null,null,null,"BLUE CROSS-INDEMNITY","21070",null,"BLUE BENEFIT ADMINISTRATORS","82540 - HC CHG ASSAY OF CREATINE"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","66179","HC AQUEOUS SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT","66179 - HC AQUEOUS SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","21076",null,"BLUE BENEFIT ADMINISTRATORS","82952 - HC CHG GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","67041","HC VIT FOR MACULAR PUCKER","67041 - HC VIT FOR MACULAR PUCKER",null,null,null,null,null,"BLUE CROSS-INDEMNITY","21080",null,"BLUE BENEFIT ADMINISTRATORS","83662 - HC L/S RATIO, FOAM STABILITY"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","67917","REPAIR ECTROPION EXTENSIVE","67917 - REPAIR ECTROPION EXTENSIVE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","21085",null,"BLUE BENEFIT ADMINISTRATORS","84307 - HC CHG ASSAY OF SOMATOSTATIN"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","70030","HC CHG RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY","70030 - HC CHG RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","21198",null,"BLUE BENEFIT ADMINISTRATORS","85300 - HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","70487","HC CHG CT MAXILLOFACIAL W/CONTRAST MATERIAL","70487 - HC CHG CT MAXILLOFACIAL W/CONTRAST MATERIAL",null,null,null,null,null,"BLUE CROSS-INDEMNITY","21215",null,"BLUE BENEFIT ADMINISTRATORS","86038 - HC CHG ANTINUCLEAR ANTIBODIES ANA"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","71275","HC CHG CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST","71275 - HC CHG CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST",null,null,null,null,null,"BLUE CROSS-HMO BLUE","21240",null,"BLUE BENEFIT ADMINISTRATORS","86376 - HC CHG MICROSOMAL ANTIBODIES EACH"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","72159","HC MRA,SPINE,W/WO","72159 - HC MRA,SPINE,W/WO",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","21244",null,"BLUE BENEFIT ADMINISTRATORS","86696 - HC CHG ANTIBODY HERPES SMPLX TYPE 2"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","73523","XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; MINIMUM 5 VIEWS","73523 - XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; MINIMUM 5 VIEWS",null,null,null,null,null,"TUFTS POS","21310",null,"BLUE BENEFIT ADMINISTRATORS","87040 - HC CHG CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","74175","HC CHG CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST","74175 - HC CHG CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST",null,null,null,null,null,"TUFTS HMO","21320",null,"BLUE BENEFIT ADMINISTRATORS","87210 - SMR PRIM SRC WET MOUNT NFCT AGT"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","74420","X-RAY URINARY TRACT EXAM WITH CONTRAST MATERIAL","74420 - X-RAY URINARY TRACT EXAM WITH CONTRAST MATERIAL",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","21337",null,"BLUE BENEFIT ADMINISTRATORS","87426 - SARSCOV CORONAVIRUS AG IA"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","76080","HC CHG RADEX ABSCESS/FISTULA/SINUS TRACT RS&I","76080 - HC CHG RADEX ABSCESS/FISTULA/SINUS TRACT RS&I",null,null,null,null,null,"TUFTS PPO","21400",null,"BLUE BENEFIT ADMINISTRATORS","88161 - HC CHG CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","76812","US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT","76812 - US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT",null,null,null,null,null,"TUFTS POS","21421",null,"BLUE BENEFIT ADMINISTRATORS","88341 - IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","76826","ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD","76826 - ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","21440",null,"BLUE BENEFIT ADMINISTRATORS","88364 - IN SITU HYBRIDIZATION EA ADDL PROBE STAIN"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","77061","DIGITAL BREAST TOMOSYNTHESIS UNILATERAL","77061 - DIGITAL BREAST TOMOSYNTHESIS UNILATERAL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","21450",null,"BLUE BENEFIT ADMINISTRATORS","90698 - CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","77373","HC SRS FRACTIONATED 1-5 BODY; 2-5 CRANIAL","77373 - HC SRS FRACTIONATED 1-5 BODY; 2-5 CRANIAL",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","21453",null,"BLUE BENEFIT ADMINISTRATORS","90913 - HC BFB TRAINING EA ADDL 15 MIN"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","78305","HC BONE&/JOINT IM;MULT","78305 - HC BONE&/JOINT IM;MULT",null,null,null,null,null,"TUFTS HMO","21470",null,"BLUE BENEFIT ADMINISTRATORS","92285 - XTRNL OCULAR PHOTOG W/I&R DOCMT MEDICAL PROGRE"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","78740","HC URETERAL REFLUX","78740 - HC URETERAL REFLUX",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","21501",null,"BLUE BENEFIT ADMINISTRATORS","92558 - EVOKED OTOACOUSTIC EMISSIONS SCREEN AUTO ANALYS"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","81025","URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS","81025 - URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","21555",null,"BLUE BENEFIT ADMINISTRATORS","93017 - HC CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","81253","HC CHG GJB2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS","81253 - HC CHG GJB2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS",null,null,null,null,null,"TUFTS POS","21556",null,"BLUE BENEFIT ADMINISTRATORS","93293 - HC TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","81403","SEQ & EXON 13 SEQ, IF PERFORMED KRAS (EG, CARCINOMA), GENE ANALYSIS, PRO/TECH","81403 - SEQ & EXON 13 SEQ, IF PERFORMED KRAS (EG, CARCINOMA), GENE ANALYSIS, PRO/TECH",null,null,null,null,null,"TUFTS HMO","21925",null,"BLUE BENEFIT ADMINISTRATORS","93463 - HC DRUG ADMIN & HEMODYNMIC MEAS"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","82435","HC CHG CHLORIDE BLD","82435 - HC CHG CHLORIDE BLD",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","21932",null,"BLUE BENEFIT ADMINISTRATORS","93893 - HC TRANSCRAN DOPP INTRACRAN, EMBOLI W/INJ"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","82803","HC CHG BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3","82803 - HC CHG BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3",null,null,null,null,null,"TUFTS PPO","22310",null,"BLUE BENEFIT ADMINISTRATORS","94664 - HC DEMO/EVAL INHALER/NEBULIZER - PHARM"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","83921","HC CHG ORGANIC ACID 1 QUANTITATIVE","83921 - HC CHG ORGANIC ACID 1 QUANTITATIVE",null,null,null,null,null,"AETNA","22513",null,"BLUE BENEFIT ADMINISTRATORS","95816 - ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","84100","HC CHG ASSAY OF PHOSPHORUS INORGANIC","84100 - HC CHG ASSAY OF PHOSPHORUS INORGANIC",null,null,null,null,null,"TUFTS HMO","22513",null,"BLUE BENEFIT ADMINISTRATORS","95868 - NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","84590","HC CHG ASSAY OF VITAMIN A","84590 - HC CHG ASSAY OF VITAMIN A",null,null,null,null,null,"TUFTS SELECT","22854",null,"BLUE BENEFIT ADMINISTRATORS","96136 - HC PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","85300","HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY","85300 - HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","22870",null,"BLUE BENEFIT ADMINISTRATORS","96401 - CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-NEO"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","86341","HC CHG ISLET CELL ANTIBODY","86341 - HC CHG ISLET CELL ANTIBODY",null,null,null,null,null,"UNITED/HARVARD PILGRIM","22903",null,"BLUE BENEFIT ADMINISTRATORS","97760 - ORTHOTIC MGMT&TRAINJ UXTR LXTR&/TRNK EA 15"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","86654","CHG ANTIBODY ENCEPHALITIS WESTRN EQUINE","86654 - CHG ANTIBODY ENCEPHALITIS WESTRN EQUINE",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","23065",null,"BLUE BENEFIT ADMINISTRATORS","99283 - HC EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","86880","HC CHG ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM","86880 - HC CHG ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM",null,null,null,null,null,"TUFTS SELECT","23073",null,"BLUE CROSS","11046 - DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","87186","HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ","87186 - HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ",null,null,null,null,null,"AETNA","23330",null,"BLUE CROSS","11441 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","87276","HC CHG IAADI INFFLUENZA A VIRUS","87276 - HC CHG IAADI INFFLUENZA A VIRUS",null,null,null,null,null,"UNITED/HARVARD PILGRIM","23330",null,"BLUE CROSS","11622 - EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","87635","HC SARS-COV-2 COVID-19 AMP PRB","87635 - HC SARS-COV-2 COVID-19 AMP PRB",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","23500",null,"BLUE CROSS","12037 - REPAIR INTERMEDIATE S/A/T/E >30.0 CM"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","87902","HC CHG NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS","87902 - HC CHG NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS",null,null,null,null,null,"TUFTS PPO","23505",null,"BLUE CROSS","13101 - REPAIR COMPLEX TRUNK 2.6-7.5 CM"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","88363","HC CHG EXAM & SELECT ARCHIVE TISSUE MOLECULAR ANALYSI","88363 - HC CHG EXAM & SELECT ARCHIVE TISSUE MOLECULAR ANALYSI",null,null,null,null,null,"AETNA","23570",null,"BLUE CROSS","15839 - EXCISION EXCESSIVE SKIN & SUBQ TISSUE OTHER AREA"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","90675","CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL","90675 - CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,null,null,null,null,"UNITED/HARVARD PILGRIM","23575",null,"BLUE CROSS","19001 - HC CY ASP BREAST;EA ADD"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","90838","PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 60 MIN","90838 - PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 60 MIN",null,null,null,null,null,"TUFTS SELECT","23605",null,"BLUE CROSS","20206 - BIOPSY MUSCLE PERCUTANEOUS NEEDLE"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","92270","ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT","92270 - ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","23655",null,"BLUE CROSS","21198 - HC OSTEOTOMY, MANDIBLE"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","92587","DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD","92587 - DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD",null,null,null,null,null,"BLUE CROSS-PPO","24066",null,"BLUE CROSS","23066 - HC BIOPSY SOFT TISSUE SHOULDER DEEP"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","92934","HC PRQ TRLUML CORONARY STENT/ATH/ANGIO ADDL BRANCH","92934 - HC PRQ TRLUML CORONARY STENT/ATH/ANGIO ADDL BRANCH",null,null,null,null,null,"BLUE CROSS-INDEMNITY","24075",null,"BLUE CROSS","24530 - CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","92978","HC ENDOLUMINAL CORONARY IVUS OCT I&R INITIAL VESSEL","92978 - HC ENDOLUMINAL CORONARY IVUS OCT I&R INITIAL VESSEL",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","24075",null,"BLUE CROSS","24670 - CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","93457","HC CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I","93457 - HC CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","24220",null,"BLUE CROSS","26645 - CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","93892","HC TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT","93892 - HC TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","24505",null,"BLUE CROSS","27560 - CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","94640","PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT","94640 - PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT",null,null,null,null,null,"BLUE CROSS-PPO","24535",null,"BLUE CROSS","28022 - HC ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","94772","CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT","94772 - CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT",null,null,null,null,null,"BLUE CROSS-HMO BLUE","24560",null,"BLUE CROSS","28232 - TX OPEN TENDON FLEXOR TOE 1 TENDON SPX"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","95713","HC VEEG 2-12 HR CONT MNTR","95713 - HC VEEG 2-12 HR CONT MNTR",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","24576",null,"BLUE CROSS","29130 - APPLICATION FINGER SPLINT STATIC"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","95971","ELEC ALYS NSTIM PLS GEN SMPL SC/PERPH W/PRGRMG","95971 - ELEC ALYS NSTIM PLS GEN SMPL SC/PERPH W/PRGRMG",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","24605",null,"BLUE CROSS","31032 - HC EXPLOR MAXILL SINUS,RMV POLYPS"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","96165","HC HLTH BHV IVNTJ GRP EA ADDL","96165 - HC HLTH BHV IVNTJ GRP EA ADDL",null,null,null,null,null,"BLUE CROSS-PPO","24640",null,"BLUE CROSS","31624 - BRNCHSC W/BRNCL ALVEOLAR LAVAGE"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","96900","ACTINOTHERAPY ULTRAVIOLET LIGHT","96900 - ACTINOTHERAPY ULTRAVIOLET LIGHT",null,null,null,null,null,"BLUE CROSS-INDEMNITY","24655",null,"BLUE CROSS","33212 - HC INS PM PLS GEN W/EXIST SINGLE LEAD"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","97597","DEBRIDEMENT OPEN WOUND 20 SQ CM/<","97597 - DEBRIDEMENT OPEN WOUND 20 SQ CM/<",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","24675",null,"BLUE CROSS","36000 - INTRODUCTION NEEDLE/INTRACATHETER VEIN"]
["BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","25065",null,"BLUE CROSS","36500 - HC VEN CATHJ SLCTV ORGAN BLD SAMPLING"]
["BLUE CROSS","BLUE CROSS-PPO","10011","HC FNA BX W/MR GDN 1ST LES","10011 - HC FNA BX W/MR GDN 1ST LES",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","25071",null,"BLUE CROSS","36598 - HC CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","11042","DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<","11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","25076",null,"BLUE CROSS","37246 - HC TRLUML BAL ANGIO 1ST ART"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","11104","HC PUNCH BX SKIN SINGLE LESION","11104 - HC PUNCH BX SKIN SINGLE LESION",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","25112",null,"BLUE CROSS","40801 - DRG ABSC CST HMTMA VESTIBULE MOUTH COMP"]
["BLUE CROSS","BLUE CROSS-PPO","11401","EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM","11401 - EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","25248",null,"BLUE CROSS","42330 - SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","11440","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<","11440 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<",null,null,null,null,null,"CIGNA CARELINK","25505",null,"BLUE CROSS","43215 - HC ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","11602","EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM","11602 - EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","25530",null,"BLUE CROSS","43270 - HC EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","11719","TRIMMING NONDYSTROPHIC NAILS ANY NUMBER","11719 - TRIMMING NONDYSTROPHIC NAILS ANY NUMBER",null,null,null,null,null,"AETNA","25565",null,"BLUE CROSS","45305 - HC PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","11921","HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM","11921 - HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","25605",null,"BLUE CROSS","46260 - HC HEMORRHOIDECTOMY INT & XTRNL 2/> COLUMN/GRO"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","12006","SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM","12006 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","25622",null,"BLUE CROSS","48102 - HC BIOPSY PANCREA PERCUTANEOUS NEEDLE"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","12020","TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE","12020 - TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE",null,null,null,null,null,"BLUE CROSS-HMO BLUE","25630",null,"BLUE CROSS","50200 - RENAL BIOPSY PRQ TROCAR/NEEDLE"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","12057","HC LAYR CLOS WND FACE,FACIAL >30 CM","12057 - HC LAYR CLOS WND FACE,FACIAL >30 CM",null,null,null,null,null,"TUFTS POS","25660",null,"BLUE CROSS","54050 - DSTRJ LESION PENIS SIMPLE CHEMICAL"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","13152","REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM","13152 - REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM",null,null,null,null,null,"TUFTS HMO","25680",null,"BLUE CROSS","56605 - BIOPSY VULVA/PERINEUM 1 LESION SPX"]
["BLUE CROSS","BLUE CROSS-PPO","14001","ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM","14001 - ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM",null,null,null,null,null,"BLUE CROSS-PPO","25690",null,"BLUE CROSS","57061 - DESTRUCTION VAGINAL LESIONS SIMPLE"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","15100","HC SKIN SPLT GRFT TRNK/ARM/LEG","15100 - HC SKIN SPLT GRFT TRNK/ARM/LEG",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","26011",null,"BLUE CROSS","58323 - SPERM WASHING ARTIFICIAL INSEMINATION"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","15630","HC DELAY/SECTN FLAP LID,NOS,EAR,LIP","15630 - HC DELAY/SECTN FLAP LID,NOS,EAR,LIP",null,null,null,null,null,"BLUE CROSS-INDEMNITY","26080",null,"BLUE CROSS","61651 - ENDOVASCULAR INTRACRANIAL PROLNG ADMN RX AGENT; EACH ADD¿L VASCULAR TERRITORY"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","15832","HC EXCISE EXCESS SKIN TISSUE,THIGH","15832 - HC EXCISE EXCESS SKIN TISSUE,THIGH",null,null,null,null,null,"TUFTS HMO","26113",null,"BLUE CROSS","64445 - INJECTION ANESTHETIC AGENT SCIATIC NRV SINGLE"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","17003","DESTRUCTION PREMALIGNANT LESION 2-14 EA","17003 - DESTRUCTION PREMALIGNANT LESION 2-14 EA",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","26116",null,"BLUE CROSS","64624 - HC DSTRJ NULYT AGT GNCLR NRV"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","19000","PUNCTURE ASPIRATION CYST BREAST","19000 - PUNCTURE ASPIRATION CYST BREAST",null,null,null,null,null,"CIGNA CARELINK","26410",null,"BLUE CROSS","66250 - HC FOLLOW-UP SURGERY OF EYE"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","19085","BX BREAST W/DEVICE 1ST LESION MAGNETIC RES GUID","19085 - BX BREAST W/DEVICE 1ST LESION MAGNETIC RES GUID",null,null,null,null,null,"TUFTS POS","26418",null,"BLUE CROSS","67028 - INTRAVITREAL NJX PHARMACOLOGIC AGT SPX"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","19287","PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID","19287 - PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID",null,null,null,null,null,"TUFTS HMO","26535",null,"BLUE CROSS","67414 - HC EXPLR/DECOMPRESS EYE SOCKET"]
["BLUE CROSS","BLUE CROSS-PPO","20220","HC BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL","20220 - HC BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL",null,null,null,null,null,"TUFTS HMO","26641",null,"BLUE CROSS","68700 - HC REPAIR TEAR DUCTS"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","20600","ARTHROCENTESIS ASPIR&/INJECTION SMALL JT/BURSA","20600 - ARTHROCENTESIS ASPIR&/INJECTION SMALL JT/BURSA",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","26650",null,"BLUE CROSS","70140 - HC CHG RADEX FACIAL BONES < 3 VIEWS"]
["BLUE CROSS","BLUE CROSS-PPO","21013","EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL <2CM","21013 - EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL <2CM",null,null,null,null,null,"BLUE CROSS-PPO","26725",null,"BLUE CROSS","71120 - HC CHG RADEX STERNUM MINIMUM 2 VIEWS"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","21029","HC CONTOUR OF FACE BONE LESION","21029 - HC CONTOUR OF FACE BONE LESION",null,null,null,null,null,"TUFTS SELECT","26725",null,"BLUE CROSS","72020 - HC CHG RADEX SPINE 1 VIEW SPECIFY LEVEL"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","21121","HC RECONST CHIN SLIDE SINGL OSTEOTOMY","21121 - HC RECONST CHIN SLIDE SINGL OSTEOTOMY",null,null,null,null,null,"BLUE CROSS-INDEMNITY","26755",null,"BLUE CROSS","73050 - HC CHG RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ"]
["BLUE CROSS","BLUE CROSS-PPO","21310","CLOSED TREATMENT NASAL FRACTURE W/O MANIPULATION","21310 - CLOSED TREATMENT NASAL FRACTURE W/O MANIPULATION",null,null,null,null,null,"TUFTS SELECT","26765",null,"BLUE CROSS","73551 - XRAY EXAM FEMUR; 1 VIEW"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","21550","BIOPSY SOFT TISSUE NECK/THORAX","21550 - BIOPSY SOFT TISSUE NECK/THORAX",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","26990",null,"BLUE CROSS","74363 - HC CHG PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I"]
["BLUE CROSS","BLUE CROSS-PPO","21920","HC BIOPSY SOFT TISSUE BACK,SUPERF","21920 - HC BIOPSY SOFT TISSUE BACK,SUPERF",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","27040",null,"BLUE CROSS","75574 - HC CHG CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST"]
["BLUE CROSS","BLUE CROSS-PPO","23071","EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/>","23071 - EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/>",null,null,null,null,null,"BLUE CROSS-PPO","27048",null,"BLUE CROSS","76705 - ULTRASOUND ABDOMINAL REAL TIME W/IMAGE LIMITED"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","23575","CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION","23575 - CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION",null,null,null,null,null,"CIGNA CARELINK","27087",null,"BLUE CROSS","76942 - US GUIDANCE NEEDLE PLACEMENT RS&I"]
["BLUE CROSS","BLUE CROSS-PPO","23650","CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES","23650 - CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","27093",null,"BLUE CROSS","77021 - HC MRGUIDE,NEED PLACE"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","24565","CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/MANJ","24565 - CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/MANJ",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","27200",null,"BLUE CROSS","77402 - HC TX DEL =>1 MEV SIMPLE"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","24620","HC CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ","24620 - HC CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","27220",null,"BLUE CROSS","77771 - HC HDR RDNCL NTRSTL/2-12"]
["BLUE CROSS","BLUE CROSS-PPO","25248","HC REMOVE FOREARM/WRIST FOREIGN BODY","25248 - HC REMOVE FOREARM/WRIST FOREIGN BODY",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","27246",null,"BLUE CROSS","78645 - HC CHG CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","25622","CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ","25622 - CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","27252",null,"BLUE CROSS","80145 - HC DRUG ASSAY ADALIMUMAB"]
["BLUE CROSS","BLUE CROSS-PPO","26160","EXC LES TDN SHTH/JT CAPSL HAND/FNGR","26160 - EXC LES TDN SHTH/JT CAPSL HAND/FNGR",null,null,null,null,null,"TUFTS HMO","27265",null,"BLUE CROSS","81218 - HC CEBPA GENE ANALYSIS FULL GENE SEQUENC"]
["BLUE CROSS","BLUE CROSS-PPO","26650","HC PRQ SKEL FIXATION CARP/MTCRPL FX DISLOCATE THUMB","26650 - HC PRQ SKEL FIXATION CARP/MTCRPL FX DISLOCATE THUMB",null,null,null,null,null,"BLUE CROSS-PPO","27301",null,"BLUE CROSS","81309 - HC PIK3CA GENE TRGT SEQ ALYS"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","27048","EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC <5CM","27048 - EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC <5CM",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","27324",null,"BLUE CROSS","82340 - HC Q;KID STONE, UR CALCIUM"]
["BLUE CROSS","BLUE CROSS-PPO","27250","CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA","27250 - CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","27328",null,"BLUE CROSS","82668 - HC CHG ASSAY OF ERYTHROPOIETIN"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","27265","CLTX POST HIP ARTHRP DISLC W/O ANES","27265 - CLTX POST HIP ARTHRP DISLC W/O ANES",null,null,null,null,null,"AETNA","27337",null,"BLUE CROSS","82787 - HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","27532","HC CLTX TIBIAL FX PROXIMAL W/WO MANJ W/SKEL TRACJ","27532 - HC CLTX TIBIAL FX PROXIMAL W/WO MANJ W/SKEL TRACJ",null,null,null,null,null,"TUFTS PPO","27370",null,"BLUE CROSS","83916 - HC CHG OLIGOCLONAL IMMUNE"]
["BLUE CROSS","BLUE CROSS-PPO","27767","HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANIP","27767 - HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANIP",null,null,null,null,null,"BLUE CROSS-HMO BLUE","27502",null,"BLUE CROSS","84460 - HC CHG TRANSFERASE ALANINE AMINO (ALT) (SGPT)"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","27824","CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ","27824 - CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ",null,null,null,null,null,"AETNA","27520",null,"BLUE CROSS","85230 - HC CHG CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR"]
["BLUE CROSS","BLUE CROSS-PPO","28010","TENOTOMY PERCUTANEOUS TOE SINGLE TENDON","28010 - TENOTOMY PERCUTANEOUS TOE SINGLE TENDON",null,null,null,null,null,"UNITED/HARVARD PILGRIM","27520",null,"BLUE CROSS","85347 - HC CHG COAGULATION TIME ACTIVATED"]
["BLUE CROSS","BLUE CROSS-PPO","28153","HC RESEC HEAD OF PHALANX,TOE","28153 - HC RESEC HEAD OF PHALANX,TOE",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","27532",null,"BLUE CROSS","86161 - HC CHG COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT"]
["BLUE CROSS","BLUE CROSS-PPO","28470","CLOSED TX METATARSAL FRACTURE W/O MANIPULATION","28470 - CLOSED TX METATARSAL FRACTURE W/O MANIPULATION",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","27603",null,"BLUE CROSS","86664 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA"]
["BLUE CROSS","BLUE CROSS-PPO","28630","CLOSED RX MT-PHAL TOE DISLOCATION","28630 - CLOSED RX MT-PHAL TOE DISLOCATION",null,null,null,null,null,"AETNA","27613",null,"BLUE CROSS","86780 - HC CHG ANTIBODY TREPONEMA PALLIDUM"]
["BLUE CROSS","BLUE CROSS-PPO","29131","APPLICATION FINGER SPLINT DYNAMIC","29131 - APPLICATION FINGER SPLINT DYNAMIC",null,null,null,null,null,"UNITED/HARVARD PILGRIM","27614",null,"BLUE CROSS","87088 - HC CHG CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","29530","STRAPPING KNEE","29530 - STRAPPING KNEE",null,null,null,null,null,"CIGNA CARELINK","27634",null,"BLUE CROSS","87341 - HC CHG IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION"]
["BLUE CROSS","BLUE CROSS-PPO","29882","HC KNEE SCOPE,MED OR LAT MENIS REPAIR","29882 - HC KNEE SCOPE,MED OR LAT MENIS REPAIR",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","27750",null,"BLUE CROSS","87640 - HC CHG IADNA S AUREUS AMPLIFIED PROBE TQ"]
["BLUE CROSS","BLUE CROSS-PPO","30300","REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE","30300 - REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE",null,null,null,null,null,"AETNA","27759",null,"BLUE CROSS","88188 - FLOWCYTOMETRY/READ, 9-15 MARKERS"]
["BLUE CROSS","BLUE CROSS-PPO","31239","HC NASAL/SINUS ENDOSCOPY SURG","31239 - HC NASAL/SINUS ENDOSCOPY SURG",null,null,null,null,null,"BLUE CROSS-INDEMNITY","27767",null,"BLUE CROSS","90621 - MENB-FHBP RECOMBNT LIPOPROTEIN VACC 2/3 DOSE IM"]
["BLUE CROSS","BLUE CROSS-PPO","31570","HC LARYNGOSCOPY,DIRCT,INJ VOCAL CORD","31570 - HC LARYNGOSCOPY,DIRCT,INJ VOCAL CORD",null,null,null,null,null,"BLUE CROSS-HMO BLUE","27780",null,"BLUE CROSS","90740 - HC HEP B VACCINE,DIAL/IMMUNOSUP, IM"]
["BLUE CROSS","BLUE CROSS-PPO","31625","BRONCHOSCOPY BRONCHIAL/ENDOBRNCL BX 1+ SITES","31625 - BRONCHOSCOPY BRONCHIAL/ENDOBRNCL BX 1+ SITES",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","27788",null,"BLUE CROSS","92081 - VISUAL FIELD XM UNI/BI W/INTERPRETJ LIMITED EXAM"]
["BLUE CROSS","BLUE CROSS-PPO","31653","HC BRONCH EBUS SAMPLING 3 OR MORE NODES","31653 - HC BRONCH EBUS SAMPLING 3 OR MORE NODES",null,null,null,null,null,"BLUE CROSS-PPO","27810",null,"BLUE CROSS","92522 - EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE"]
["BLUE CROSS","BLUE CROSS-PPO","32555","THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING","32555 - THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING",null,null,null,null,null,"BLUE CROSS-INDEMNITY","27816",null,"BLUE CROSS","92585 - AUDITORY EVOKED POTENTIALS COMPREHENSIVE"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","33217","HC INSJ 2 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB","33217 - HC INSJ 2 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB",null,null,null,null,null,"TUFTS POS","27824",null,"BLUE CROSS","92960 - HC CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL"]
["BLUE CROSS","BLUE CROSS-PPO","33235","HC RMVL TRANSVNS PM ELTRD DUAL LEAD SYS","33235 - HC RMVL TRANSVNS PM ELTRD DUAL LEAD SYS",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","27840",null,"BLUE CROSS","93318 - HC ECHO TRANSEOPHAG MONTR CARDIAC PUMP FUNCTJ"]
["BLUE CROSS","BLUE CROSS-PPO","33274","HC TCAT INSJ/RPL PERM LDLS PM","33274 - HC TCAT INSJ/RPL PERM LDLS PM",null,null,null,null,null,"BLUE CROSS-PPO","28010",null,"BLUE CROSS","93580 - PRQ TCAT CLSR CGEN INTRATRL COMUNICAJ W/IMPLT"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","36002","HC INJECTION RX EXTREMITY PSEUDOANEURYSM","36002 - HC INJECTION RX EXTREMITY PSEUDOANEURYSM",null,null,null,null,null,"TUFTS PPO","28011",null,"BLUE CROSS","93786 - BL BLD PRESS W/TAPE&/DISK 24/> HR REC ONL"]
["BLUE CROSS","BLUE CROSS-PPO","36226","HC SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY","36226 - HC SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","28043",null,"BLUE CROSS","95018 - ALLG TEST PERQ & IC DRUG/BIOL IMMED REACT W/ I&R"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","36248","HC SLCTV CATHJ EA 2ND+ ORD ABDL PEL/LXTR ART BRNCH","36248 - HC SLCTV CATHJ EA 2ND+ ORD ABDL PEL/LXTR ART BRNCH",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","28045",null,"BLUE CROSS","95170 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY WHL INSE"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","36416","HC COLLECTION CAPILLARY BLOOD SPECIMEN","36416 - HC COLLECTION CAPILLARY BLOOD SPECIMEN",null,null,null,null,null,"TUFTS SELECT","28046",null,"BLUE CROSS","95819 - ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","36483","HC ENDOVEN ABLTI THER CHEM ADHESIVE SBSQ VEIN","36483 - HC ENDOVEN ABLTI THER CHEM ADHESIVE SBSQ VEIN",null,null,null,null,null,"BLUE CROSS-HMO BLUE","28150",null,"BLUE CROSS","95962 - HC FUNCJAL CORT & SUBCORT MAPG PHYS/QHP ATTND ADDL HR"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","36569","INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/>","36569 - INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/>",null,null,null,null,null,"TUFTS POS","28190",null,"BLUE CROSS","96367 - IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","36590","HC RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ","36590 - HC RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ",null,null,null,null,null,"BLUE CROSS-PPO","28222",null,"BLUE CROSS","97153 - HC ADAPTIVE BEHAVIOR TX BY TECH"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","36902","HC INTRO CATH DIALYSIS CIRCUIT W/TRLUML BALO ANGIOP","36902 - HC INTRO CATH DIALYSIS CIRCUIT W/TRLUML BALO ANGIOP",null,null,null,null,null,"BLUE CROSS-INDEMNITY","28232",null,"BLUE CROSS","97813 - HC ACUPUNCT W/ ELEC STIMUL 15 MIN"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","37213","HC THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX","37213 - HC THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX",null,null,null,null,null,"AETNA","28308",null,"BLUE CROSS OUT OF STATE","10120 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","37223","HC REVASC;ILIAC,EAAD,TRN STN","37223 - HC REVASC;ILIAC,EAAD,TRN STN",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","28400",null,"BLUE CROSS OUT OF STATE","11107 - HC INCAL BX SKN EA SEP/ADDL"]
["BLUE CROSS","BLUE CROSS-PPO","37244","VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE","37244 - VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","28435",null,"BLUE CROSS OUT OF STATE","11730 - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","38207","HC TRNSPL PREPJ HEMATOP PROGEN CELLS CRYOPRSRV STOR","38207 - HC TRNSPL PREPJ HEMATOP PROGEN CELLS CRYOPRSRV STOR",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","28455",null,"BLUE CROSS OUT OF STATE","12014 - SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","38790","HC INJECTION PROCEDURE LYMPHANGIOGRAPHY","38790 - HC INJECTION PROCEDURE LYMPHANGIOGRAPHY",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","28470",null,"BLUE CROSS OUT OF STATE","14001 - ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM"]
["BLUE CROSS","BLUE CROSS-PPO","40812","EXC LES MUCOSA & SBMCSL VESTIBULE SMPL RPR","40812 - EXC LES MUCOSA & SBMCSL VESTIBULE SMPL RPR",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","28495",null,"BLUE CROSS OUT OF STATE","17106 - DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM"]
["BLUE CROSS","BLUE CROSS-PPO","40819","EXC FRENUM LABIAL/BUCCAL","40819 - EXC FRENUM LABIAL/BUCCAL",null,null,null,null,null,"BLUE CROSS-HMO BLUE","28510",null,"BLUE CROSS OUT OF STATE","17263 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","41112","EXC LES TONGUE W/CLSR ANTERIOR TWO-THIRDS","41112 - EXC LES TONGUE W/CLSR ANTERIOR TWO-THIRDS",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","28530",null,"BLUE CROSS OUT OF STATE","20552 - INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","41820","HC EXCISION, GUM, EACH QUADRANT","41820 - HC EXCISION, GUM, EACH QUADRANT",null,null,null,null,null,"AETNA","28570",null,"BLUE CROSS OUT OF STATE","21032 - HC EXCISION,MAXILLARY TORUS PALATINUS"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","42400","BIOPSY SALIVARY GLAND NEEDLE","42400 - BIOPSY SALIVARY GLAND NEEDLE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","28660",null,"BLUE CROSS OUT OF STATE","22514 - PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR"]
["BLUE CROSS","BLUE CROSS-PPO","42450","HC EXCISION SUBLINGUAL GLAND","42450 - HC EXCISION SUBLINGUAL GLAND",null,null,null,null,null,"CIGNA CARELINK","28825",null,"BLUE CROSS OUT OF STATE","23350 - HC INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI ARTHG"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","43200","ESPHGSC RGD/FLX DX W/WO COLLJ SPEC BR/WA SPX","43200 - ESPHGSC RGD/FLX DX W/WO COLLJ SPEC BR/WA SPX",null,null,null,null,null,"BLUE CROSS-INDEMNITY","29086",null,"BLUE CROSS OUT OF STATE","25624 - CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","43240","HC UPR GI NDSC TRANSMURAL DRAINAGE PSEUDOCYST","43240 - HC UPR GI NDSC TRANSMURAL DRAINAGE PSEUDOCYST",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","29125",null,"BLUE CROSS OUT OF STATE","26775 - HC CLTX IPHAL JT DISLC W/MANJ REQ ANES"]
["BLUE CROSS","BLUE CROSS-PPO","43245","HC UPR GI NDSC DILAT GSTR OUTLET FOR OBSTRCJ","43245 - HC UPR GI NDSC DILAT GSTR OUTLET FOR OBSTRCJ",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","29126",null,"BLUE CROSS OUT OF STATE","27238 - CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ"]
["BLUE CROSS","BLUE CROSS-PPO","43265","HC ERCP W/DSTRJ LITHOTRIPSY CALCULI ANY METHOD","43265 - HC ERCP W/DSTRJ LITHOTRIPSY CALCULI ANY METHOD",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","29200",null,"BLUE CROSS OUT OF STATE","27808 - CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ"]
["BLUE CROSS","BLUE CROSS-PPO","43761","REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO","43761 - REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO",null,null,null,null,null,"AETNA","29345",null,"BLUE CROSS OUT OF STATE","28470 - CLOSED TX METATARSAL FRACTURE W/O MANIPULATION"]
["BLUE CROSS","BLUE CROSS-PPO","44377","HC ENTEROSC >2ND PRTN W/ILEUM W/BX SINGLE/MULTIPLE","44377 - HC ENTEROSC >2ND PRTN W/ILEUM W/BX SINGLE/MULTIPLE",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","29365",null,"BLUE CROSS OUT OF STATE","29450 - APPL CLUBFOOT CAST MOLDING/MANJ LONG/SHORT LEG"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","44394","HC COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE","44394 - HC COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE",null,null,null,null,null,"UNITED/HARVARD PILGRIM","29405",null,"BLUE CROSS OUT OF STATE","30465 - REPAIR NASAL VESTIBULAR STENOSIS"]
["BLUE CROSS","BLUE CROSS-PPO","45334","HC SIGMOIDOSCOPY FLX CONTROL BLEEDING","45334 - HC SIGMOIDOSCOPY FLX CONTROL BLEEDING",null,null,null,null,null,"CIGNA CARELINK","29450",null,"BLUE CROSS OUT OF STATE","31653 - HC BRONCH EBUS SAMPLING 3 OR MORE NODES"]
["BLUE CROSS","BLUE CROSS-PPO","45379","HC COLSC FLX PROX SPLENIC FLXR RMVL FB","45379 - HC COLSC FLX PROX SPLENIC FLXR RMVL FB",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","29515",null,"BLUE CROSS OUT OF STATE","33227 - HC REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","46050","I&D PERIANAL ABSCESS SUPERFICIAL","46050 - I&D PERIANAL ABSCESS SUPERFICIAL",null,null,null,null,null,"TUFTS PPO","29540",null,"BLUE CROSS OUT OF STATE","36247 - HC SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH"]
["BLUE CROSS","BLUE CROSS-PPO","46601","HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT","46601 - HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT",null,null,null,null,null,"UNITED/HARVARD PILGRIM","29580",null,"BLUE CROSS OUT OF STATE","36566 - HC INSJ TUN VAD REQ 2 CATH 2 SITS W/SUBQ PORT"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","46608","HC ANOSCOPY,REMOVE FOREIGN BODY","46608 - HC ANOSCOPY,REMOVE FOREIGN BODY",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","29581",null,"BLUE CROSS OUT OF STATE","36580 - HC REPL CVC,NON_TUN;5/+YO"]
["BLUE CROSS","BLUE CROSS-PPO","47531","NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS","47531 - NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS",null,null,null,null,null,"UNITED/HARVARD PILGRIM","29705",null,"BLUE CROSS OUT OF STATE","37212 - HC THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX"]
["BLUE CROSS","BLUE CROSS-PPO","49407","IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL","49407 - IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL",null,null,null,null,null,"UNICARE","29807",null,"BLUE CROSS OUT OF STATE","40831 - HC REPAIR MOUTH LACERATION,>2.5 CM"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","49451","HC PERC REPL DUD/JEJ TUBE,W/","49451 - HC PERC REPL DUD/JEJ TUBE,W/",null,null,null,null,null,"CIGNA CARELINK","29827",null,"BLUE CROSS OUT OF STATE","41830 - HC REMOVAL OF GUM TISSUE"]
["BLUE CROSS","BLUE CROSS-PPO","50200","RENAL BIOPSY PRQ TROCAR/NEEDLE","50200 - RENAL BIOPSY PRQ TROCAR/NEEDLE",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","29881",null,"BLUE CROSS OUT OF STATE","42415 - HC EXC PAROTD,LAT LOBE,DISSECT 5TH NERV"]
["BLUE CROSS","BLUE CROSS-PPO","50434","CONVERT NEPHROSTOMY CATH TO NEPHROURTRL CATH PRQ","50434 - CONVERT NEPHROSTOMY CATH TO NEPHROURTRL CATH PRQ",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","29888",null,"BLUE CROSS OUT OF STATE","43236 - HC UPPER GI NDSC W/SUBMUCOSAL INJECTION"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","51702","INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE","51702 - INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","30100",null,"BLUE CROSS OUT OF STATE","44382 - HC ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE"]
["BLUE CROSS","BLUE CROSS-PPO","51741","COMPLEX UROFLOMETRY","51741 - COMPLEX UROFLOMETRY",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","30117",null,"BLUE CROSS OUT OF STATE","45349 - SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION"]
["BLUE CROSS","BLUE CROSS-PPO","52310","CYSTO W/SIMPLE REMOVAL STONE & STENT","52310 - CYSTO W/SIMPLE REMOVAL STONE & STENT",null,null,null,null,null,"AETNA","30140",null,"BLUE CROSS OUT OF STATE","46606 - ANOSCOPY W/BX SINGLE/MULTIPLE"]
["BLUE CROSS","BLUE CROSS-PPO","54100","BIOPSY PENIS SEPARATE PROCEDURE","54100 - BIOPSY PENIS SEPARATE PROCEDURE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","30220",null,"BLUE CROSS OUT OF STATE","49423 - HC EXCHNG ABSC/CST DRG CATH RAD GID SPX"]
["BLUE CROSS","BLUE CROSS-PPO","55100","DRAIN SCROTAL WALL ABS","55100 - DRAIN SCROTAL WALL ABS",null,null,null,null,null,"BLUE CROSS-PPO","30465",null,"BLUE CROSS OUT OF STATE","51720 - BLADDER INSTILLATION ANTICARCINOGENIC AGENT"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","56501","DESTRUCTION LESIONS VULVA SIMPLE","56501 - DESTRUCTION LESIONS VULVA SIMPLE",null,null,null,null,null,"BLUE CROSS-HMO BLUE","30560",null,"BLUE CROSS OUT OF STATE","54100 - BIOPSY PENIS SEPARATE PROCEDURE"]
["BLUE CROSS","BLUE CROSS-PPO","57156","HC INSERTION OF CYLINDER","57156 - HC INSERTION OF CYLINDER",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","30801",null,"BLUE CROSS OUT OF STATE","57454 - COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE"]
["BLUE CROSS","BLUE CROSS-PPO","57454","COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE","57454 - COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","30901",null,"BLUE CROSS OUT OF STATE","59000 - AMNIOCENTESIS DIAGNOSIC"]
["BLUE CROSS","BLUE CROSS-PPO","57510","HC CAUTERIZATION,CERVIX,ELECTRO/THERMAL","57510 - HC CAUTERIZATION,CERVIX,ELECTRO/THERMAL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","30903",null,"BLUE CROSS OUT OF STATE","60500 - HC EXPLORE PARATHYROID GLANDS"]
["BLUE CROSS","BLUE CROSS-PPO","58565","HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS","58565 - HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","31032",null,"BLUE CROSS OUT OF STATE","64488 - HC TAP BLOCK BILATERAL BY INJECTION(S)"]
["BLUE CROSS","BLUE CROSS-PPO","59320","CERCLAGE CERVIX PREGNANCY VAGINAL","59320 - CERCLAGE CERVIX PREGNANCY VAGINAL",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","31237",null,"BLUE CROSS OUT OF STATE","64647 - CHEMODENERVATION OF TRUNK 6 OR MORE MUSCLES"]
["BLUE CROSS","BLUE CROSS-PPO","60500","HC EXPLORE PARATHYROID GLANDS","60500 - HC EXPLORE PARATHYROID GLANDS",null,null,null,null,null,"TUFTS SELECT","31239",null,"BLUE CROSS OUT OF STATE","65865 - HC INCISE INNER EYE ADHESIONS"]
["BLUE CROSS","BLUE CROSS-PPO","62264","HC PRQ LYSIS EPIDURAL ADHESIONS MULT SESSIONS 1 DAY","62264 - HC PRQ LYSIS EPIDURAL ADHESIONS MULT SESSIONS 1 DAY",null,null,null,null,null,"CIGNA CARELINK","31500",null,"BLUE CROSS OUT OF STATE","67113 - HC REPAIR COMPLEX RETINA DETACH VITRECTOMY & MEMB PEEL"]
["BLUE CROSS","BLUE CROSS-PPO","62321","HR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN","62321 - HR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN",null,null,null,null,null,"CIGNA CARELINK","31505",null,"BLUE CROSS OUT OF STATE","67810 - INCISIONAL BIOPSY EYELID SKIN & LID MARGIN"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","62367","ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL","62367 - ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL",null,null,null,null,null,"UNITED/HARVARD PILGRIM","31510",null,"BLUE CROSS OUT OF STATE","68020 - HC INCISE/DRAIN CONJUNCTIVA"]
["BLUE CROSS","BLUE CROSS-PPO","64447","HC INJECTION ANESTHETIC AGENT FEMORAL NERVE SINGLE","64447 - HC INJECTION ANESTHETIC AGENT FEMORAL NERVE SINGLE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","31552",null,"BLUE CROSS OUT OF STATE","70330 - RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","64462","HC PVB,THORAC;2ND & ANY ADD¿L INJECT SITE(S) INCLUD IMAGE GUIDE WHEN PERFORMED","64462 - HC PVB,THORAC;2ND & ANY ADD¿L INJECT SITE(S) INCLUD IMAGE GUIDE WHEN PERFORMED",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","31570",null,"BLUE CROSS OUT OF STATE","70488 - HC CHG CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","64492","NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL","64492 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL",null,null,null,null,null,"AETNA","31572",null,"BLUE CROSS OUT OF STATE","71110 - HC CHG RADEX RIBS BILATERAL 3 VIEWS"]
["BLUE CROSS","BLUE CROSS-PPO","64612","CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL","64612 - CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","31574",null,"BLUE CROSS OUT OF STATE","72147 - HC CHG MRI SPINAL CANAL THORACIC W/CONTRAST MATRL"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","64645","CHEMODENERVATION 1 EXTREMITY EA ADDL 5/> MUSCLES","64645 - CHEMODENERVATION 1 EXTREMITY EA ADDL 5/> MUSCLES",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","31576",null,"BLUE CROSS OUT OF STATE","73219 - HC CHG MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL"]
["BLUE CROSS","BLUE CROSS-PPO","65135","HC INSJ OC IMPLT AFTER ENCL MUSC X ATTACHED","65135 - HC INSJ OC IMPLT AFTER ENCL MUSC X ATTACHED",null,null,null,null,null,"CIGNA CARELINK","31579",null,"BLUE CROSS OUT OF STATE","74175 - HC CHG CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","65756","HC CORNEAL TRNSPL ENDOTHELIAL","65756 - HC CORNEAL TRNSPL ENDOTHELIAL",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","31611",null,"BLUE CROSS OUT OF STATE","75736 - HC CHG ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","65920","HC REMOVE IMPLANT OF EYE","65920 - HC REMOVE IMPLANT OF EYE",null,null,null,null,null,"TUFTS SELECT","31615",null,"BLUE CROSS OUT OF STATE","76510 - OPH US DX B-SCAN&QUAN A-SCAN SM PT ENCTR"]
["BLUE CROSS","BLUE CROSS-PPO","66183","HC INSERT ANT DRAINAGE DEVICE","66183 - HC INSERT ANT DRAINAGE DEVICE",null,null,null,null,null,"BLUE CROSS-INDEMNITY","31623",null,"BLUE CROSS OUT OF STATE","76812 - US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","66986","HC EXCHANGE LENS PROSTHESIS","66986 - HC EXCHANGE LENS PROSTHESIS",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","31626",null,"BLUE CROSS OUT OF STATE","77072 - HC CHG BONE AGE STUDIES"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","67040","HC LASER TREATMENT OF RETINA","67040 - HC LASER TREATMENT OF RETINA",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","31628",null,"BLUE CROSS OUT OF STATE","77332 - HC TX DEVICES SIMP"]
["BLUE CROSS","BLUE CROSS-PPO","67210","DSTRJ LOCLZD LES RETINA 1/> SESS PC","67210 - DSTRJ LOCLZD LES RETINA 1/> SESS PC",null,null,null,null,null,"BLUE CROSS-PPO","31632",null,"BLUE CROSS OUT OF STATE","78072 - HC PARATHYROID W SPECTCTAL"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","67515","INJECTION MEDICATION/OTHER SUBST TENON CAPSULE","67515 - INJECTION MEDICATION/OTHER SUBST TENON CAPSULE",null,null,null,null,null,"CIGNA CARELINK","31645",null,"BLUE CROSS OUT OF STATE","78812 - HC CHG PET IMAGING SKULL BASE TO MID-THIGH"]
["BLUE CROSS","BLUE CROSS-PPO","67700","BLEPHAROTOMY DRAINAGE ABSCESS EYELID","67700 - BLEPHAROTOMY DRAINAGE ABSCESS EYELID",null,null,null,null,null,"UNITED/HARVARD PILGRIM","31645",null,"BLUE CROSS OUT OF STATE","79005 - HC CHG RP THERAPY ORAL ADMINISTRATION"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","67882","HC REVISION EYELID,XPOSITN TARSAL PLATE","67882 - HC REVISION EYELID,XPOSITN TARSAL PLATE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","31653",null,"BLUE CROSS OUT OF STATE","80348 - HC CHG DRUG SCREENING BUPRENORPHINE"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","67961","HC REVISION OF EYELID,< 1/4 LID MARGIN","67961 - HC REVISION OF EYELID,< 1/4 LID MARGIN",null,null,null,null,null,"TUFTS SELECT","31820",null,"BLUE CROSS OUT OF STATE","81275 - HC CHG KRAS GENE ANALYSIS VARIANTS IN EXON 2"]
["BLUE CROSS","BLUE CROSS-PPO","68761","CLSR LACRIMAL PUNCTUM PLUG EACH","68761 - CLSR LACRIMAL PUNCTUM PLUG EACH",null,null,null,null,null,"BLUE CROSS-INDEMNITY","32550",null,"BLUE CROSS OUT OF STATE","82310 - HC CHG CALCIUM TOTAL"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","68840","HC EXPLORE LACRIMAL CANALICULI","68840 - HC EXPLORE LACRIMAL CANALICULI",null,null,null,null,null,"BLUE CROSS-HMO BLUE","32551",null,"BLUE CROSS OUT OF STATE","82507 - HC CHG ASSAY OF CITRATE"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","69631","HC TYMPANOPLASTY","69631 - HC TYMPANOPLASTY",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","32554",null,"BLUE CROSS OUT OF STATE","83540 - HC CHG ASSAY OF IRON"]
["BLUE CROSS","BLUE CROSS-PPO","69631","HC TYMPANOPLASTY","69631 - HC TYMPANOPLASTY",null,null,null,null,null,"UNITED/HARVARD PILGRIM","32554",null,"BLUE CROSS OUT OF STATE","83550 - HC CHG IRON BINDING CAPACITY"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","70330","RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT","70330 - RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT",null,null,null,null,null,"BLUE CROSS-INDEMNITY","32994",null,"BLUE CROSS OUT OF STATE","84270 - HC CHG ASSAY OF SEX HORMONE BINDING GLOBULIN"]
["BLUE CROSS","BLUE CROSS-PPO","70487","HC CHG CT MAXILLOFACIAL W/CONTRAST MATERIAL","70487 - HC CHG CT MAXILLOFACIAL W/CONTRAST MATERIAL",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","33015",null,"BLUE CROSS OUT OF STATE","85049 - HC CHG BLOOD COUNT PLATELET AUTOMATED"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","70548","HC CHG MRA NECK W/CONTRAST MATERIAL","70548 - HC CHG MRA NECK W/CONTRAST MATERIAL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","33206",null,"BLUE CROSS OUT OF STATE","85732 - HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","71101","HC CHG RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS","71101 - HC CHG RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","33208",null,"BLUE CROSS OUT OF STATE","86353 - HC CHG LYMPHOCYTE TRANSFORMATION"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","71551","HC CHG MRI CHEST W/CONTRAST MATERIAL","71551 - HC CHG MRI CHEST W/CONTRAST MATERIAL",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","33212",null,"BLUE CROSS OUT OF STATE","86648 - HC CHG ANTIBODY DIPHTHERIA"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","72125","HC CHG CT CERVICAL SPINE W/O CONTRAST MATERIAL","72125 - HC CHG CT CERVICAL SPINE W/O CONTRAST MATERIAL",null,null,null,null,null,"TUFTS HMO","33215",null,"BLUE CROSS OUT OF STATE","86905 - HC CHG BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","72146","HC CHG MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL","72146 - HC CHG MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","33217",null,"BLUE CROSS OUT OF STATE","87188 - HC CHG SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","72158","HC CHG MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL","72158 - HC CHG MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL",null,null,null,null,null,"TUFTS POS","33221",null,"BLUE CROSS OUT OF STATE","87305 - HC CHG IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","73060","HC CHG RADEX HUMERUS MINIMUM 2 VIEWS","73060 - HC CHG RADEX HUMERUS MINIMUM 2 VIEWS",null,null,null,null,null,"TUFTS POS","33225",null,"BLUE CROSS OUT OF STATE","88142 - CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","73090","HC CHG RADEX FOREARM 2 VIEWS","73090 - HC CHG RADEX FOREARM 2 VIEWS",null,null,null,null,null,"BLUE CROSS-PPO","33226",null,"BLUE CROSS OUT OF STATE","88173 - CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","73220","HC CHG MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS","73220 - HC CHG MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","33228",null,"BLUE CROSS OUT OF STATE","88363 - HC CHG EXAM & SELECT ARCHIVE TISSUE MOLECULAR ANALYSI"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","73660","HC CHG RADEX TOE MINIMUM 2 VIEWS","73660 - HC CHG RADEX TOE MINIMUM 2 VIEWS",null,null,null,null,null,"TUFTS PPO","33233",null,"BLUE CROSS OUT OF STATE","90853 - GROUP PSYCHOTHERAPY"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","73723","HC CHG MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL","73723 - HC CHG MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","33235",null,"BLUE CROSS OUT OF STATE","92025 - COMPUTERIZED CORNEAL TOPOGRAPHY UNI/BI"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","74160","HC CHG CT ABDOMEN W/CONTRAST MATERIAL","74160 - HC CHG CT ABDOMEN W/CONTRAST MATERIAL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","33240",null,"BLUE CROSS OUT OF STATE","92265 - NEEDLE OCULOGRAPHY 1/ XOC MUSC 1/BOTH EYE W/I&R"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","74220","HC CHG RADEX ESOPHAGUS","74220 - HC CHG RADEX ESOPHAGUS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","33244",null,"BLUE CROSS OUT OF STATE","92550 - TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","74363","HC CHG PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I","74363 - HC CHG PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I",null,null,null,null,null,"UNITED/HARVARD PILGRIM","33263",null,"BLUE CROSS OUT OF STATE","92941 - HC PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","75557","HC CHG CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST","75557 - HC CHG CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST",null,null,null,null,null,"TUFTS HMO","33270",null,"BLUE CROSS OUT OF STATE","93286 - HC PERI-PX EVAL&PROGRAM IN PRSN PACEMAKER SYSTEM"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","75635","HC CHG CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP","75635 - HC CHG CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","33273",null,"BLUE CROSS OUT OF STATE","93457 - HC CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I"]
["BLUE CROSS","BLUE CROSS-PPO","75805","HC LYMPH VES X-RAY TRUNK UNI","75805 - HC LYMPH VES X-RAY TRUNK UNI",null,null,null,null,null,"AETNA","33285",null,"BLUE CROSS OUT OF STATE","93657 - HC ABLATE L/R ATRIAL FIBRIL W/ISOLATED PULM VEIN"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","75891","HC CHG HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I","75891 - HC CHG HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I",null,null,null,null,null,"TUFTS POS","33289",null,"BLUE CROSS OUT OF STATE","94621 - HC PULMONARY STRESS TESTING COMPLEX"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","76140","HC CONSULT,OUTSIDE EXAM","76140 - HC CONSULT,OUTSIDE EXAM",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","33967",null,"BLUE CROSS OUT OF STATE","95180 - HC RAPID DESENSITIZATION PROC,EACH HOUR"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","76641","HC CHG US BREAST UNI REAL TIME WITH IMAGE COMPLETE","76641 - HC CHG US BREAST UNI REAL TIME WITH IMAGE COMPLETE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","36000",null,"BLUE CROSS OUT OF STATE","95912 - MOTOR &/SENS 11-12 NRV CNDJ PRECONF ELTRODE LIMB"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","76805","US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION","76805 - US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION",null,null,null,null,null,"BLUE CROSS-PPO","36005",null,"BLUE CROSS OUT OF STATE","96121 - HC NEUROBEHAVIORAL STATUS XM PHYS/QHP EA ADDL HOUR"]
["BLUE CROSS","BLUE CROSS-PPO","76815","US PREGNANT UTERUS LIMITED 1/> FETUSES","76815 - US PREGNANT UTERUS LIMITED 1/> FETUSES",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","36010",null,"BLUE CROSS OUT OF STATE","96170 - HC HLTH BHV IVNTJ FAM WO PT 1ST"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","76940","HC CHG US &MNTR PARENCHYMAL TISSUE ABLATION","76940 - HC CHG US &MNTR PARENCHYMAL TISSUE ABLATION",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","36014",null,"BLUE CROSS OUT OF STATE","97542 - HC WHEELCHAIR MGMT EA 15 MIN"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","77002","HC CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON","77002 - HC CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON",null,null,null,null,null,"AETNA","36140",null,"BLUE CROSS OUT OF STATE","99212 - ESTABLISHED PATIENT - PHARM - LEVEL 2"]
["BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","77063","SCREENING DIGITAL BREAST TOMOSYNTHESIS BI","77063 - SCREENING DIGITAL BREAST TOMOSYNTHESIS BI",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","36200",null,"BMC HEALTHNET","33968 - HC REM AORTIC ASSIST DEV PRQ"]
["BLUE CROSS","BLUE CROSS-PPO","77261","HC CHG THERAPEUTIC RADIOLOGY TX PLANNING SIMPLE","77261 - HC CHG THERAPEUTIC RADIOLOGY TX PLANNING SIMPLE",null,null,null,null,null,"BLUE CROSS-HMO BLUE","36217",null,"BMC HEALTHNET","74241 - XR UGI W KUB"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","77295","HC COMPUTER GEN PLAN  3D","77295 - HC COMPUTER GEN PLAN  3D",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","36218",null,"BMC HEALTHNET","78805 - NM ABSCSS LOC LTD"]
["BLUE CROSS","BLUE CROSS-PPO","77336","HC MED PHYSICS CONSULT/WK","77336 - HC MED PHYSICS CONSULT/WK",null,null,null,null,null,"CIGNA CARELINK","36222",null,"BMC HEALTHNET","80320 - DRUG SCREEN QUANTITATIVE ALCOHOLS"]
["BLUE CROSS","BLUE CROSS-PPO","77387","GUIDANCE FOR LOCLZJ TARGET VOL FOR RADJ TX DLVR","77387 - GUIDANCE FOR LOCLZJ TARGET VOL FOR RADJ TX DLVR",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","36223",null,"BMC HEALTHNET","81210 - HC CHG BRAF GENE ANALYSIS V600 VARIANT(S)"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","77778","HC BRACHY INST CMP","77778 - HC BRACHY INST CMP",null,null,null,null,null,"BLUE CROSS-HMO BLUE","36227",null,"BMC HEALTHNET","81596 - HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","78070","HC PARATHYROID IM","78070 - HC PARATHYROID IM",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","36228",null,"BMC HEALTHNET","82247 - HC CHG BILIRUBIN TOTAL"]
["BLUE CROSS","BLUE CROSS-PPO","78278","HC CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING","78278 - HC CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING",null,null,null,null,null,"UNITED/HARVARD PILGRIM","36246",null,"BMC HEALTHNET","82656 - HC CHG ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN"]
["BLUE CROSS","BLUE CROSS-PPO","78451","HC CHG MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS","78451 - HC CHG MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","36251",null,"BMC HEALTHNET","83516 - HC CRL;TTG AB,IGA"]
["BLUE CROSS","BLUE CROSS-PPO","78605","HC BRAIN IMAGE 4+ VIEWS","78605 - HC BRAIN IMAGE 4+ VIEWS",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","36254",null,"BMC HEALTHNET","84146 - HC CHG ASSAY OF PROLACTIN"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","78830","HC RP LOCLZJ TUM SPECT W/CT 1","78830 - HC RP LOCLZJ TUM SPECT W/CT 1",null,null,null,null,null,"TUFTS PPO","36410",null,"BMC HEALTHNET","85014 - HC CHG BLOOD COUNT HEMATOCRIT"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","80061","HC CHG LIPID PANEL","80061 - HC CHG LIPID PANEL",null,null,null,null,null,"TUFTS PUBLIC DIRECT NON SUBSIDIZ","36415",null,"BMC HEALTHNET","85651 - SEDIMENTATION RATE RBC NON-AUTOMATED"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","80158","HC CHG DRUG ASSAY CYCLOSPORINE","80158 - HC CHG DRUG ASSAY CYCLOSPORINE",null,null,null,null,null,"FALLON MEDICAID","36416",null,"BMC HEALTHNET","86255 - HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY"]
["BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","80195","HC CHG DRUG SCREEN QUANTITATIVE SIROLIMUS","80195 - HC CHG DRUG SCREEN QUANTITATIVE SIROLIMUS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","36470",null,"BMC HEALTHNET","86682 - HC Q;CYSTICERCUS AB,BLOT"]
["BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","80280","HC DRUG ASSAY VEDOLIZUMAB","80280 - HC DRUG ASSAY VEDOLIZUMAB",null,null,null,null,null,"AETNA","36473",null,"BMC HEALTHNET","86765 - HC CHG ANTIBODY RUBEOLA"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","80345","HC CHG DRUG SCREENING BARBITURATES","80345 - HC CHG DRUG SCREENING BARBITURATES",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","36474",null,"BMC HEALTHNET","86905 - HC CHG BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","81207","HC Q;P190 BCR-ABL 1","81207 - HC Q;P190 BCR-ABL 1",null,null,null,null,null,"TUFTS HMO","36479",null,"BMC HEALTHNET","87481 - HC CHG CANDIDA, DNA, AMP PROBE"]
["BLUE CROSS","BLUE CROSS-PPO","81210","HC CHG BRAF GENE ANALYSIS V600 VARIANT(S)","81210 - HC CHG BRAF GENE ANALYSIS V600 VARIANT(S)",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","36481",null,"BMC HEALTHNET","87498 - HC CHG IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","81252","HC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCEHC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCE","81252 - HC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCEHC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCE",null,null,null,null,null,"CIGNA CARELINK","36483",null,"BMC HEALTHNET","88104 - HC CHG CYTOPATH FLUIDS SMEAR, INTERP"]
["BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","81272","HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS","81272 - HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS",null,null,null,null,null,"UNITED/HARVARD PILGRIM","36511",null,"BMC HEALTHNET","88341 - IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","81329","HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS","81329 - HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","36522",null,"BMC HEALTHNET","93786 - BL BLD PRESS W/TAPE&/DISK 24/> HR REC ONL"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","81363","HC HBB DUPLICATION/DELETION VARIANTS","81363 - HC HBB DUPLICATION/DELETION VARIANTS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","36555",null,"BMC HEALTHNET","96112 - HC DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR"]
["BLUE CROSS","BLUE CROSS-PPO","82010","HC CHG KETONE BODIES SERUM QUANTITATIVE","82010 - HC CHG KETONE BODIES SERUM QUANTITATIVE",null,null,null,null,null,"BLUE CROSS-PPO","36561",null,"BMC HEALTHNET","99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D"]
["BLUE CROSS","BLUE CROSS-PPO","82075","HC CHG ASSAY OF ALCOHOL BREATH","82075 - HC CHG ASSAY OF ALCOHOL BREATH",null,null,null,null,null,"TUFTS HMO","36565",null,"CIGNA HEALTHCARE","10009 - HC FNA BX W/CT GDN 1ST LES"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","82157","HC CHG ANDROSTENEDIONE","82157 - HC CHG ANDROSTENEDIONE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","36568",null,"CIGNA HEALTHCARE","11104 - HC PUNCH BX SKIN SINGLE LESION"]
["BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","82306","HC CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED","82306 - HC CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","36571",null,"CIGNA HEALTHCARE","11622 - EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM"]
["BLUE CROSS","BLUE CROSS-PPO","82384","HC CHG CATECHOLAMINES FRACTIONATED","82384 - HC CHG CATECHOLAMINES FRACTIONATED",null,null,null,null,null,"TUFTS POS","36573",null,"CIGNA HEALTHCARE","12017 - HC RESUPERF WND FACE 20.1-30 CM"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","82523","HC CHG COLLAGEN CROSS LINKS ANY METHOD","82523 - HC CHG COLLAGEN CROSS LINKS ANY METHOD",null,null,null,null,null,"TUFTS HMO","36576",null,"CIGNA HEALTHCARE","13152 - REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","82553","HC CHG CREATINE KINASE MB FRACTION ONLY","82553 - HC CHG CREATINE KINASE MB FRACTION ONLY",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","36580",null,"CIGNA HEALTHCARE","15278 - HC SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM ADL 100SQ CM"]
["BLUE CROSS","BLUE CROSS-PPO","82677","HC CHG ASSAY OF ESTRIOL","82677 - HC CHG ASSAY OF ESTRIOL",null,null,null,null,null,"TUFTS PPO","36584",null,"CIGNA HEALTHCARE","19086 - BX BREAST W/DEVICE ADDL LESION MAGNET RES GUID"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","82787","HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES","82787 - HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES",null,null,null,null,null,"TUFTS POS","36589",null,"CIGNA HEALTHCARE","20525 - RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP"]
["BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","82941","HC CHG ASSAY OF GASTRIN","82941 - HC CHG ASSAY OF GASTRIN",null,null,null,null,null,"TUFTS PPO","36590",null,"CIGNA HEALTHCARE","20690 - HC APPLY BONE FIXATION DEVICE"]
["BLUE CROSS","BLUE CROSS-PPO","83021","HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY","83021 - HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","36593",null,"CIGNA HEALTHCARE","21933 - EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>"]
["BLUE CROSS","BLUE CROSS-PPO","83036","HEMOGLOBIN GLYCOSYLATED A1C","83036 - HEMOGLOBIN GLYCOSYLATED A1C",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","36595",null,"CIGNA HEALTHCARE","22854 - HC INSJ BIOMCHN DEV VRT CORPECTOMY DEFECT W/ARTHRD"]
["BLUE CROSS","BLUE CROSS-PPO","83540","HC CHG ASSAY OF IRON","83540 - HC CHG ASSAY OF IRON",null,null,null,null,null,"BMCHN MEDICAID","36598",null,"CIGNA HEALTHCARE","24505 - CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","83718","HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL","83718 - HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL",null,null,null,null,null,"BLUE CROSS-INDEMNITY","36620",null,"CIGNA HEALTHCARE","25560 - CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MAN"]
["BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","83945","HC CHG ASSAY OF OXALATE","83945 - HC CHG ASSAY OF OXALATE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","36903",null,"CIGNA HEALTHCARE","27327 - EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ <3CM"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","83993","HC CHG ASSAY OF CALPROTECTIN FECAL","83993 - HC CHG ASSAY OF CALPROTECTIN FECAL",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","36904",null,"CIGNA HEALTHCARE","27532 - HC CLTX TIBIAL FX PROXIMAL W/WO MANJ W/SKEL TRACJ"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","84144","HC CHG ASSAY OF PROGESTERONE","84144 - HC CHG ASSAY OF PROGESTERONE",null,null,null,null,null,"BLUE CROSS-PPO","36906",null,"CIGNA HEALTHCARE","27870 - HC ARTHRODESIS,ANKLE,OPEN"]
["BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","84210","HC CHG ASSAY OF PYRUVATE","84210 - HC CHG ASSAY OF PYRUVATE",null,null,null,null,null,"BMCHN MCO","37182",null,"CIGNA HEALTHCARE","29345 - APPLICATION LONG LEG CAST THIGH-TOE"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","84307","HC CHG ASSAY OF SOMATOSTATIN","84307 - HC CHG ASSAY OF SOMATOSTATIN",null,null,null,null,null,"BLUE CROSS-HMO BLUE","37184",null,"CIGNA HEALTHCARE","30100 - HC BIOPSY INTRANASAL"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","84436","HC CHG ASSAY OF THYROXINE TOTAL","84436 - HC CHG ASSAY OF THYROXINE TOTAL",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","37186",null,"CIGNA HEALTHCARE","31525 - HC LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","84479","HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO","84479 - HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","37188",null,"CIGNA HEALTHCARE","32551 - TUBE THORACOSTOMY INCLUDES WATER SEAL"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","84630","HC CHG ASSAY OF ZINC","84630 - HC CHG ASSAY OF ZINC",null,null,null,null,null,"BLUE CROSS-INDEMNITY","37193",null,"CIGNA HEALTHCARE","33273 - REPOS PREVIOUSLY IMPLANTED SUBQ IMPLANTABLE DFB"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","85045","HC CHG BLOOD COUNT RETICULOCYTE AUTOMATED","85045 - HC CHG BLOOD COUNT RETICULOCYTE AUTOMATED",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","37197",null,"CIGNA HEALTHCARE","36252 - HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BIL"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","85260","HC CHG CLOTTING FACTOR X STUART-PROWER","85260 - HC CHG CLOTTING FACTOR X STUART-PROWER",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","37212",null,"CIGNA HEALTHCARE","36592 - COLLECT BLOOD FROM CATHETER VENOUS NOS"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","85305","HC CHG CLOTTING INHIBITORS PROTEIN S TOTAL","85305 - HC CHG CLOTTING INHIBITORS PROTEIN S TOTAL",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","37214",null,"CIGNA HEALTHCARE","37215 - HC TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","85378","HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN","85378 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","37215",null,"CIGNA HEALTHCARE","37239 - OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","85732","HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA","85732 - HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","37222",null,"CIGNA HEALTHCARE","41112 - EXC LES TONGUE W/CLSR ANTERIOR TWO-THIRDS"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","86022","HC CRL;SEROTONIN RLS ASSAY","86022 - HC CRL;SEROTONIN RLS ASSAY",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","37223",null,"CIGNA HEALTHCARE","41850 - TREATMENT OF GUM LESION"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","86255","HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY","86255 - HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY",null,null,null,null,null,"TUFTS HMO","37226",null,"CIGNA HEALTHCARE","43240 - HC UPR GI NDSC TRANSMURAL DRAINAGE PSEUDOCYST"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","86336","HC CHG INHIBIN A","86336 - HC CHG INHIBIN A",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","37229",null,"CIGNA HEALTHCARE","44377 - HC ENTEROSC >2ND PRTN W/ILEUM W/BX SINGLE/MULTIPLE"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","86355","HC B CELLS TOTAL COUNT","86355 - HC B CELLS TOTAL COUNT",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","37230",null,"CIGNA HEALTHCARE","44799 - PR DILATION OF ILEOSTOMY STRICTURE"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","86485","HC CHG SKIN TEST CANDIDA","86485 - HC CHG SKIN TEST CANDIDA",null,null,null,null,null,"TUFTS POS","37232",null,"CIGNA HEALTHCARE","46040 - I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX"]
["BLUE CROSS","BLUE CROSS-PPO","86611","HC BARTONELLA, ANTIBODY","86611 - HC BARTONELLA, ANTIBODY",null,null,null,null,null,"BLUE CROSS-INDEMNITY","37236",null,"CIGNA HEALTHCARE","47001 - HC BIO,LIVER AT OTH PROC"]
["BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","86652","HC CHG, ENCEPHAL ANTIBODY EAST EQU","86652 - HC CHG, ENCEPHAL ANTIBODY EAST EQU",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","37239",null,"CIGNA HEALTHCARE","50432 - HC PLACEMENT NEPHROSTOMY CATH PRQ NEW ACCESS RAD S&I"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","86666","HC CHG ANTIBODY EHRLICHIA","86666 - HC CHG ANTIBODY EHRLICHIA",null,null,null,null,null,"TUFTS PPO","37241",null,"CIGNA HEALTHCARE","51710 - CHANGE CYSTOSTOMY TUBE COMPLICATED"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","86708","HC CHG HEPATITIS A ANTIBODY HAAB","86708 - HC CHG HEPATITIS A ANTIBODY HAAB",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","37246",null,"CIGNA HEALTHCARE","56605 - BIOPSY VULVA/PERINEUM 1 LESION SPX"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","86744","HC CHG ANTIBODY NOCARDIA","86744 - HC CHG ANTIBODY NOCARDIA",null,null,null,null,null,"TUFTS HMO","37247",null,"CIGNA HEALTHCARE","57180 - HC TREAT VAGINAL BLEEDING"]
["BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","86787","HC CHG ANTIBODY VARICELLA-ZOSTER","86787 - HC CHG ANTIBODY VARICELLA-ZOSTER",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","37252",null,"CIGNA HEALTHCARE","59160 - CURETTAGE POSTPARTUM"]
["BLUE CROSS","BLUE CROSS-PPO","86886","HC CHG ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER","86886 - HC CHG ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER",null,null,null,null,null,"TUFTS HMO","38200",null,"CIGNA HEALTHCARE","64400 - NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH"]
["BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","87046","HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA","87046 - HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA",null,null,null,null,null,"BLUE CROSS-INDEMNITY","38208",null,"CIGNA HEALTHCARE","64585 - REVISE/REMOVE NEUROELECTRODE"]
["BLUE CROSS","BLUE CROSS-PPO","87086","HC CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE","87086 - HC CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE",null,null,null,null,null,"TUFTS HMO","38220",null,"CIGNA HEALTHCARE","64721 - NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE"]
["BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","87176","HC CHG HOMOGENIZATION TISSUE CULTURE","87176 - HC CHG HOMOGENIZATION TISSUE CULTURE",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","38241",null,"CIGNA HEALTHCARE","66710 - CILIARY BODY DSTRJ CYCLOPHOTOCOAG TRANSSCERAL"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","87188","HC CHG SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT","87188 - HC CHG SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT",null,null,null,null,null,"BLUE CROSS-PPO","38500",null,"CIGNA HEALTHCARE","67042 - HC VIT FOR MACULAR HOLE"]
["BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","87220","TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT","87220 - TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT",null,null,null,null,null,"TUFTS POS","38505",null,"CIGNA HEALTHCARE","67400 - HC EXPLORE/BIOPSY EYE SOCKET"]
["BLUE CROSS","BLUE CROSS-PPO","87275","HC CHG IAADI INFLUENZA B VIRUS","87275 - HC CHG IAADI INFLUENZA B VIRUS",null,null,null,null,null,"TUFTS HMO","38531",null,"CIGNA HEALTHCARE","67924 - HC FIX ENTROPION,EXTENSV LID REPAIR"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","87385","HC CHG IAAD IA HISTOPLASM CAPSULATUM","87385 - HC CHG IAAD IA HISTOPLASM CAPSULATUM",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","38790",null,"CIGNA HEALTHCARE","69420 - MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ"]
["BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","87480","HC CHG IADNA CANDIDA SPECIES DIRECT PROBE TQ","87480 - HC CHG IADNA CANDIDA SPECIES DIRECT PROBE TQ",null,null,null,null,null,"TUFTS SELECT","40490",null,"CIGNA HEALTHCARE","70490 - HC CHG CT SOFT TISSUE NECK W/O CONTRAST MATERIAL"]
["BLUE CROSS","BLUE CROSS-PPO","87505","HC CHG NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN","87505 - HC CHG NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN",null,null,null,null,null,"BLUE CROSS-PPO","40520",null,"CIGNA HEALTHCARE","72072 - HC CHG RADEX SPINE THORACIC 3 VIEWS"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","87556","HC CHG IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB","87556 - HC CHG IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB",null,null,null,null,null,"UNITED/HARVARD PILGRIM","40530",null,"CIGNA HEALTHCARE","73000 - ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","87636","HC SARSCOV2 & INF A&B AMP PRB","87636 - HC SARSCOV2 & INF A&B AMP PRB",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","40652",null,"CIGNA HEALTHCARE","73552 - XRAY EXAM FEMUR; MINIMUM 2 VIEWS"]
["BLUE CROSS","BLUE CROSS-PPO","87906","HC Q;HIV1 GENO","87906 - HC Q;HIV1 GENO",null,null,null,null,null,"TUFTS HMO","40804",null,"CIGNA HEALTHCARE","74363 - HC CHG PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","88147","HC CHG CYTOPATH SMEAR CERV/VAG AUTOMATED","88147 - HC CHG CYTOPATH SMEAR CERV/VAG AUTOMATED",null,null,null,null,null,"BLUE CROSS-HMO BLUE","40806",null,"CIGNA HEALTHCARE","75726 - HC CHG ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I"]
["BLUE CROSS","BLUE CROSS-PPO","88185","HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA","88185 - HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","40810",null,"CIGNA HEALTHCARE","76000 - FLUOROSCOPY SPX UP TO 1 HOUR PHYS/QHP TIME"]
["BLUE CROSS","BLUE CROSS-PPO","88291","HC CHG CYTOGENETICS&MOLEC CYTOGENETICS INTERP&REP","88291 - HC CHG CYTOGENETICS&MOLEC CYTOGENETICS INTERP&REP",null,null,null,null,null,"TUFTS POS","40814",null,"CIGNA HEALTHCARE","76821 - DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART"]
["BLUE CROSS","BLUE CROSS-PPO","88332","HC CHG PATH CONSLTJ SURG EA ADDL BLK FROZEN SECTION","88332 - HC CHG PATH CONSLTJ SURG EA ADDL BLK FROZEN SECTION",null,null,null,null,null,"BLUE CROSS-INDEMNITY","40820",null,"CIGNA HEALTHCARE","77062 - DIGITAL BREAST TOMOSYNTHESIS BILATERAL"]
["BLUE CROSS","BLUE CROSS-PPO","88363","HC CHG EXAM & SELECT ARCHIVE TISSUE MOLECULAR ANALYSI","88363 - HC CHG EXAM & SELECT ARCHIVE TISSUE MOLECULAR ANALYSI",null,null,null,null,null,"BLUE CROSS-INDEMNITY","40831",null,"CIGNA HEALTHCARE","77333 - HC TX DEVICES INT"]
["BLUE CROSS","BLUE CROSS-PPO","89320","SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT","89320 - SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT",null,null,null,null,null,"BLUE CROSS-INDEMNITY","40842",null,"CIGNA HEALTHCARE","78012 - HC CHG THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","90661","HC CCIIV3 VACCINE PRESERVATIVE FREE 0.5 ML IM USE","90661 - HC CCIIV3 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","41007",null,"CIGNA HEALTHCARE","78605 - HC BRAIN IMAGE 4+ VIEWS"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","90691","CR BUILD ONLY - TYPHOID VACCINE, IM,TRAVEL","90691 - CR BUILD ONLY - TYPHOID VACCINE, IM,TRAVEL",null,null,null,null,null,"BLUE CROSS-PPO","41009",null,"CIGNA HEALTHCARE","80051 - HC CHG ELECTROLYTE PANEL"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","90713","CR BUILD ONLY - POLIOMYELITIS IMMUNIZATN,INACTV,SUB-Q,DPH","90713 - CR BUILD ONLY - POLIOMYELITIS IMMUNIZATN,INACTV,SUB-Q,DPH",null,null,null,null,null,"BLUE CROSS-PPO","41010",null,"CIGNA HEALTHCARE","80175 - DRUG SCREEN QUANTITATIVE LAMOTRIGINE"]
["BLUE CROSS","BLUE CROSS-PPO","90833","PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 30 MIN","90833 - PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 30 MIN",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","41100",null,"CIGNA HEALTHCARE","81342 - TRG@ GENE REARRANGEMENT ANALYSIS; PRO/TECH"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","90839","HC PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES","90839 - HC PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES",null,null,null,null,null,"BLUE CROSS-HMO BLUE","41105",null,"CIGNA HEALTHCARE","82042 - HC CHG ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN"]
["BLUE CROSS","BLUE CROSS-PPO","90912","HC BFB TRAINING 1ST 15 MIN","90912 - HC BFB TRAINING 1ST 15 MIN",null,null,null,null,null,"BLUE CROSS-INDEMNITY","41110",null,"CIGNA HEALTHCARE","82435 - HC CHG CHLORIDE BLD"]
["BLUE CROSS","BLUE CROSS-PPO","91110","GI IMAG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R","91110 - GI IMAG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R",null,null,null,null,null,"BLUE CROSS-HMO BLUE","41113",null,"CIGNA HEALTHCARE","82747 - HC CHG ASSAY OF FOLIC ACID RBC"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","92202","HC OPSCPY EXTND ON/MAC DRAW","92202 - HC OPSCPY EXTND ON/MAC DRAW",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","41250",null,"CIGNA HEALTHCARE","84133 - HC CHG POTASSIUM URINE"]
["BLUE CROSS","BLUE CROSS-PPO","92250","FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT","92250 - FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT",null,null,null,null,null,"BLUE CROSS-PPO","41251",null,"CIGNA HEALTHCARE","84206 - HC CHG ASSAY OF PROINSULIN"]
["BLUE CROSS","BLUE CROSS-PPO","92310","RX&FITG C-LENS SUPVJ CRNL LENS OU XCPT APHK","92310 - RX&FITG C-LENS SUPVJ CRNL LENS OU XCPT APHK",null,null,null,null,null,"BLUE CROSS-INDEMNITY","41800",null,"CIGNA HEALTHCARE","84520 - HC CHG ASSAY OF UREA NITROGEN QUANTITATIVE"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","92541","SPONTANEOUS NYSTAGMUS TEST","92541 - SPONTANEOUS NYSTAGMUS TEST",null,null,null,null,null,"CIGNA CARELINK","41822",null,"CIGNA HEALTHCARE","85670 - HC CHG THROMBIN TIME PLASMA"]
["BLUE CROSS","BLUE CROSS-PPO","92557","COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ","92557 - COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","41825",null,"CIGNA HEALTHCARE","86334 - HC CHG IMMUNOFIXJ ELECTROPHORESIS SERUM"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","92590","HC HEARING AID EXAMINATION & SELECTION MONAURAL","92590 - HC HEARING AID EXAMINATION & SELECTION MONAURAL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","41850",null,"CIGNA HEALTHCARE","86704 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB TOTAL"]
["BLUE CROSS","BLUE CROSS-PPO","92595","ELECTROACOUS EVAL HEARING AID BINAURAL","92595 - ELECTROACOUS EVAL HEARING AID BINAURAL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","41874",null,"CIGNA HEALTHCARE","86777 - HC CHG ANTIBODY TOXOPLASMA"]
["BLUE CROSS","BLUE CROSS-PPO","92625","HC TINNITUS ASSESSMENT","92625 - HC TINNITUS ASSESSMENT",null,null,null,null,null,"AETNA","42104",null,"CIGNA HEALTHCARE","87172 - HC CHG PINWORM EXAMINATION"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","92938","HC PRQ TRLUML CORONARY BYP GRFT REVASC ADDL VESSEL","92938 - HC PRQ TRLUML CORONARY BYP GRFT REVASC ADDL VESSEL",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","42120",null,"CIGNA HEALTHCARE","87390 - HC CHG IAAD IA HIV-1"]
["BLUE CROSS","BLUE CROSS-PPO","93225","HC XTRNL ECG & 48 HR RECORDING","93225 - HC XTRNL ECG & 48 HR RECORDING",null,null,null,null,null,"BLUE CROSS-HMO BLUE","42180",null,"CIGNA HEALTHCARE","87906 - HC Q;HIV1 GENO"]
["BLUE CROSS","BLUE CROSS-PPO","93284","PROGRM EVAL IMPLANTABLE IN PRSN MLT LD CARD/DFB","93284 - PROGRM EVAL IMPLANTABLE IN PRSN MLT LD CARD/DFB",null,null,null,null,null,"TUFTS HMO","42299",null,"CIGNA HEALTHCARE","88304 - HC CHG LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM"]
["BLUE CROSS","BLUE CROSS-PPO","93291","INTERROGATION EVALUATION IN PERSON ILR SYSTEM","93291 - INTERROGATION EVALUATION IN PERSON ILR SYSTEM",null,null,null,null,null,"TUFTS SELECT","42330",null,"CIGNA HEALTHCARE","88356 - CHG ANALYSIS, NERVE TECH"]
["BLUE CROSS","BLUE CROSS-PPO","93451","HC RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT","93451 - HC RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","42408",null,"CIGNA HEALTHCARE","90839 - HC PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","93457","HC CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I","93457 - HC CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I",null,null,null,null,null,"TUFTS SELECT","42415",null,"CIGNA HEALTHCARE","90937 - HC HEMODIALYSIS PX REPEAT EVAL W/WO REVJ DIALYS RX"]
["BLUE CROSS","BLUE CROSS-PPO","93571","HC IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL","93571 - HC IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL",null,null,null,null,null,"BLUE CROSS-HMO BLUE","42505",null,"CIGNA HEALTHCARE","92507 - TX SPEECH LANG VOICE COMMJ &/AUDITORY PROC IND"]
["BLUE CROSS","BLUE CROSS-PPO","93642","HC EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS","93642 - HC EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","42720",null,"CIGNA HEALTHCARE","92597 - EVAL&/FITG VOICE PROSTC DEV SUPLMNT ORAL SPEEC"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","93656","HC COMPRE EP EVAL ABLTJ ATR FIB","93656 - HC COMPRE EP EVAL ABLTJ ATR FIB",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","42725",null,"CIGNA HEALTHCARE","92627 - HC EVAL AUDITORY REHAB STATUS, EA ADD 15"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","93888","TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD","93888 - TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD",null,null,null,null,null,"TUFTS SELECT","42804",null,"CIGNA HEALTHCARE","93282 - PROGRAM EVAL IMPLANTABLE IN PERSN 1 LD CARD/DFB"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","93979","HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD","93979 - HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD",null,null,null,null,null,"TUFTS HMO","42810",null,"CIGNA HEALTHCARE","93505 - HC ENDOMYOCARDIAL BIOPSY"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","94200","HC MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ","94200 - HC MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","42826",null,"CIGNA HEALTHCARE","93660 - CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","94621","HC PULMONARY STRESS TESTING COMPLEX","94621 - HC PULMONARY STRESS TESTING COMPLEX",null,null,null,null,null,"UNITED/HARVARD PILGRIM","42842",null,"CIGNA HEALTHCARE","93931 - DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","95028","IQ TSTS W/ALLGIC XTRCS DLYD TYP RXN W/READING","95028 - IQ TSTS W/ALLGIC XTRCS DLYD TYP RXN W/READING",null,null,null,null,null,"TUFTS SELECT","43191",null,"CIGNA HEALTHCARE","95700 - HC EEG CONT REC W/VID EEG TECH"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","95120","PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX","95120 - PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","43193",null,"CIGNA HEALTHCARE","95811 - POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND"]
["BLUE CROSS","BLUE CROSS-PPO","95707","HC EEG W/O VID 2-12HR CONT MNTR","95707 - HC EEG W/O VID 2-12HR CONT MNTR",null,null,null,null,null,"TUFTS HMO","43198",null,"CIGNA HEALTHCARE","95962 - HC FUNCJAL CORT & SUBCORT MAPG PHYS/QHP ATTND ADDL HR"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","95819","ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP","95819 - ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP",null,null,null,null,null,"TUFTS HMO","43202",null,"CIGNA HEALTHCARE","96371 - HC SUBQ INFUSION ADDITIONAL PUMP INFUSION SITE"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","95872","NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER","95872 - NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER",null,null,null,null,null,"BLUE CROSS-HMO BLUE","43220",null,"CIGNA HEALTHCARE","97153 - HC ADAPTIVE BEHAVIOR TX BY TECH"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","95885","NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED","95885 - NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED",null,null,null,null,null,"TUFTS HMO","43220",null,"CIGNA HEALTHCARE","97164 - HC PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","95966","HC MEG,EVOKED MAGNET FIELDS, SINGLE MODAL","95966 - HC MEG,EVOKED MAGNET FIELDS, SINGLE MODAL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","43235",null,"CIGNA HEALTHCARE","99396 - PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","95984","HC ALYS BRN NPGT PRGRMG ADDL 15","95984 - HC ALYS BRN NPGT PRGRMG ADDL 15",null,null,null,null,null,"TUFTS POS","43236",null,"CIGNA HEALTHCARE","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","96116","NUBHVL STATUS XM PR HR W/PT INTERPJ&PREPJ","96116 - NUBHVL STATUS XM PR HR W/PT INTERPJ&PREPJ",null,null,null,null,null,"AETNA","43238",null,"COMMONWEALTH CARE ALLIANCE","80158 - HC CHG DRUG ASSAY CYCLOSPORINE"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","96139","HC PSYCL/NRPSYCL TST TECH 2+ TST EA ADDL 30 MIN","96139 - HC PSYCL/NRPSYCL TST TECH 2+ TST EA ADDL 30 MIN",null,null,null,null,null,"TUFTS SELECT","43239",null,"COMMONWEALTH CARE ALLIANCE","81025 - URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS"]
["BLUE CROSS","BLUE CROSS-PPO","96365","IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR","96365 - IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","43242",null,"COMMONWEALTH CARE ALLIANCE","81315 - HC PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","96409","CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG","96409 - CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","43244",null,"COMMONWEALTH CARE ALLIANCE","82270 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","97012","HC APPL MODALITY 1/> AREAS TRACTION MECHANICAL","97012 - HC APPL MODALITY 1/> AREAS TRACTION MECHANICAL",null,null,null,null,null,"CIGNA CARELINK","43246",null,"COMMONWEALTH CARE ALLIANCE","82657 - HC CHG NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","97152","HC BHV ID SUPRT ASSMT BY 1 TECH","97152 - HC BHV ID SUPRT ASSMT BY 1 TECH",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","43248",null,"COMMONWEALTH CARE ALLIANCE","83605 - HC CHG ASSAY OF LACTATE"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","97165","HC OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS","97165 - HC OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS",null,null,null,null,null,"TUFTS POS","43250",null,"COMMONWEALTH CARE ALLIANCE","84132 - HC CHG POTASSIUM SERUM PLASMA/WHOLE BLOOD"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","97804","MEDICAL NUTRITION THERAPY GRP2/ INDIV EA 30 MI","97804 - MEDICAL NUTRITION THERAPY GRP2/ INDIV EA 30 MI",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","43255",null,"COMMONWEALTH CARE ALLIANCE","85018 - POC;HEMOGLOBIN"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","99155","HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS","99155 - HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","43257",null,"COMMONWEALTH CARE ALLIANCE","85347 - HC CHG COAGULATION TIME ACTIVATED"]
["BLUE CROSS","BLUE CROSS-HMO BLUE","99211","ESTABLISHED PATIENT - PHARM - LEVEL 1","99211 - ESTABLISHED PATIENT - PHARM - LEVEL 1",null,null,null,null,null,"TUFTS PPO","43259",null,"COMMONWEALTH CARE ALLIANCE","86161 - HC CHG COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT"]
["BLUE CROSS","BLUE CROSS-PPO","99454","HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","43262",null,"COMMONWEALTH CARE ALLIANCE","86658 - HC CHG ENTEROVIRUS ANTIBODY"]
["BLUE CROSS","BLUE CROSS-INDEMNITY","0238T","HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA",null,null,null,null,null,"TUFTS PPO","43265",null,"COMMONWEALTH CARE ALLIANCE","86788 - HC CHG ANTIBODY WEST NILE VIRUS IGM"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","10021","FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE","10021 - FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE",null,null,null,null,null,"TUFTS POS","43270",null,"COMMONWEALTH CARE ALLIANCE","87118 - HC CHG CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","10140","I&D HEMATOMA SEROMA/FLUID COLLECTION","10140 - I&D HEMATOMA SEROMA/FLUID COLLECTION",null,null,null,null,null,"TUFTS HMO","43274",null,"COMMONWEALTH CARE ALLIANCE","87327 - HC CHG IAAD IA CRYPTOCOCCUS NEOFORMANS"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","11105","HC PUNCH BX SKIN EA SEP/ADDL","11105 - HC PUNCH BX SKIN EA SEP/ADDL",null,null,null,null,null,"TUFTS SELECT","43277",null,"COMMONWEALTH CARE ALLIANCE","87799 - HC CHG IADNA NOS QUANTIFICATION EACH ORGANISM"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","11308","SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM","11308 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM",null,null,null,null,null,"TUFTS PPO","43450",null,"COMMONWEALTH CARE ALLIANCE","90672 - CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","11401","EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM","11401 - EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM",null,null,null,null,null,"TUFTS POS","43752",null,"COMMONWEALTH CARE ALLIANCE","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","11603","EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<","11603 - EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<",null,null,null,null,null,"TUFTS PPO","43762",null,"ELDER SERVICE PLAN","81240 - HC CHG F2 GENE ANALYSIS 20210G >A VARIANT"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","11621","HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM","11621 - HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM",null,null,null,null,null,"CIGNA CARELINK","43763",null,"ELDER SERVICE PLAN","81271 - HC HTT GENE ANALYSIS DECTECT ABNORMAL ALLELES"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","11721","DEBRIDEMENT NAIL ANY METHOD 6/>","11721 - DEBRIDEMENT NAIL ANY METHOD 6/>",null,null,null,null,null,"TUFTS POS","44238",null,"ELDER SERVICE PLAN","82010 - HC CHG KETONE BODIES SERUM QUANTITATIVE"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","11901","INJECTION INTRALESIONAL >7 LESIONS","11901 - INJECTION INTRALESIONAL >7 LESIONS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","44361",null,"ELDER SERVICE PLAN","82375 - HC CHG CARBOXYHEMOGLOBIN QUANTITATIVE"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","12032","REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM","12032 - REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","44369",null,"ELDER SERVICE PLAN","83519 - HC CHG IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","12041","REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<","12041 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","44376",null,"ELDER SERVICE PLAN","83785 - HC CHG, ASSAY OF MANGANESE"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","13131","REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM","13131 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM",null,null,null,null,null,"UNITED/HARVARD PILGRIM","44378",null,"ELDER SERVICE PLAN","84430 - HC CHG ASSAY OF THIOCYANATE"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","14041","ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM","14041 - ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM",null,null,null,null,null,"BMCHN QHP","44381",null,"ELDER SERVICE PLAN","85045 - HC CHG BLOOD COUNT RETICULOCYTE AUTOMATED"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","15120","HB SPLIT GRFT,HEAD,FAC,HAND,FEET <100 SQCM","15120 - HB SPLIT GRFT,HEAD,FAC,HAND,FEET <100 SQCM",null,null,null,null,null,"AETNA","44384",null,"ELDER SERVICE PLAN","85576 - HC CHG PLATELET AGGREGATION IN VITRO EACH AGENT"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","15772","HC GRFG AUTOL FAT LIPO EA ADDL","15772 - HC GRFG AUTOL FAT LIPO EA ADDL",null,null,null,null,null,"AETNA","44388",null,"ELDER SERVICE PLAN","86593 - HC SYPHILIS;QN"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","15822","BLEPHAROPLASTY UPPER EYELID","15822 - BLEPHAROPLASTY UPPER EYELID",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","44388",null,"ELDER SERVICE PLAN","86648 - HC CHG ANTIBODY DIPHTHERIA"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","17004","DESTRUCTION PREMALIGNANT LESION 15/>","17004 - DESTRUCTION PREMALIGNANT LESION 15/>",null,null,null,null,null,"CIGNA CARELINK","44394",null,"ELDER SERVICE PLAN","86850 - HC CHG ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","17271","DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM","17271 - DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","44405",null,"ELDER SERVICE PLAN","87185 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","19086","BX BREAST W/DEVICE ADDL LESION MAGNET RES GUID","19086 - BX BREAST W/DEVICE ADDL LESION MAGNET RES GUID",null,null,null,null,null,"BMCHN ACO","44604",null,"ELDER SERVICE PLAN","87517 - HC CHG IADNA HEPATITIS B VIRUS QUANTIFICATION"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","19283","PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GDNCE","19283 - PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GDNCE",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","44705",null,"ELDER SERVICE PLAN","87636 - HC SARSCOV2 & INF A&B AMP PRB"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","19350","NIPPLE/AREOLA RECONSTRUCTION","19350 - NIPPLE/AREOLA RECONSTRUCTION",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","45005",null,"ELDER SERVICE PLAN","89060 - HC CHG CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","20604","HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT","20604 - HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT",null,null,null,null,null,"UNITED/HARVARD PILGRIM","45305",null,"ELDER SERVICE PLAN OTHER","80306 - HC DRUG TEST PRSMV INSTRMNT"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","20615","ASPIRATION & INJECTION TREATMENT BONE CYST","20615 - ASPIRATION & INJECTION TREATMENT BONE CYST",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","45307",null,"ELDER SERVICE PLAN OTHER","81210 - HC CHG BRAF GENE ANALYSIS V600 VARIANT(S)"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","21032","HC EXCISION,MAXILLARY TORUS PALATINUS","21032 - HC EXCISION,MAXILLARY TORUS PALATINUS",null,null,null,null,null,"UNICARE","45331",null,"ELDER SERVICE PLAN OTHER","82009 - HC CHG KETONE BODIES SERUM QUALITATIVE"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","21198","HC OSTEOTOMY, MANDIBLE","21198 - HC OSTEOTOMY, MANDIBLE",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","45334",null,"ELDER SERVICE PLAN OTHER","82533 - HC CHG CORTISOL TOTAL"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","21244","HC RECONSTR MANDIBLE,BONE PLATE","21244 - HC RECONSTR MANDIBLE,BONE PLATE",null,null,null,null,null,"BLUE CROSS-PPO","45335",null,"ELDER SERVICE PLAN OTHER","82668 - HC CHG ASSAY OF ERYTHROPOIETIN"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","21440","HC DENTAL RIDGE FX","21440 - HC DENTAL RIDGE FX",null,null,null,null,null,"BLUE CROSS-PPO","45338",null,"ELDER SERVICE PLAN OTHER","83497 - HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","21930","EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM","21930 - EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM",null,null,null,null,null,"UNICARE","45341",null,"ELDER SERVICE PLAN OTHER","84156 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY URINE"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","22854","HC INSJ BIOMCHN DEV VRT CORPECTOMY DEFECT W/ARTHRD","22854 - HC INSJ BIOMCHN DEV VRT CORPECTOMY DEFECT W/ARTHRD",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","45346",null,"ELDER SERVICE PLAN OTHER","84466 - HC CHG ASSAY OF L7383TRANSFERRIN"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","23065","HC BIOPSY SOFT TISSUE SHOULDER SUPERFICIAL","23065 - HC BIOPSY SOFT TISSUE SHOULDER SUPERFICIAL",null,null,null,null,null,"TUFTS SELECT","45347",null,"ELDER SERVICE PLAN OTHER","85025 - HC CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","23665","CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ","23665 - CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ",null,null,null,null,null,"TUFTS HMO","45379",null,"ELDER SERVICE PLAN OTHER","86304 - HC CRL;CA-125"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","24076","HC EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM","24076 - HC EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","45380",null,"ELDER SERVICE PLAN OTHER","86382 - HC CHG NEUTRALIZATION TEST VIRAL"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","24576","CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ","24576 - CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ",null,null,null,null,null,"BLUE CROSS-HMO BLUE","45382",null,"ELDER SERVICE PLAN OTHER","86682 - HC Q;CYSTICERCUS AB,BLOT"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","25505","CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION","25505 - CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","45386",null,"ELDER SERVICE PLAN OTHER","87181 - HC CHG SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","25635","CLTX CARPAL BONE FX W/MANJ EACH BONE","25635 - CLTX CARPAL BONE FX W/MANJ EACH BONE",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","45390",null,"ELDER SERVICE PLAN OTHER","87430 - HC CHG IAAD IA STREPTOCOCCUS GROUP A"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","25680","HC CLOSED RX NAVIC/LUNATE FX/DISLOC","25680 - HC CLOSED RX NAVIC/LUNATE FX/DISLOC",null,null,null,null,null,"BMCHN MEDICAID","45390",null,"ELDER SERVICE PLAN OTHER","87498 - HC CHG IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","26700","CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES","26700 - CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES",null,null,null,null,null,"TUFTS PPO","45398",null,"ELDER SERVICE PLAN OTHER","90715 - CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","26765","HC OPEN TX DISTAL PHALANGEAL FRACTURE EACH","26765 - HC OPEN TX DISTAL PHALANGEAL FRACTURE EACH",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","45910",null,"FALLON","21248 - HC RECONSTR JAW,PART-ENDO IMPLNT"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","27048","EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC <5CM","27048 - EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC <5CM",null,null,null,null,null,"CIGNA CARELINK","46020",null,"FALLON","51702 - INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","27250","CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA","27250 - CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","46040",null,"FALLON","77063 - SCREENING DIGITAL BREAST TOMOSYNTHESIS BI"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","27500","CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION","27500 - CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","46083",null,"FALLON","80320 - DRUG SCREEN QUANTITATIVE ALCOHOLS"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","27614","HC BX LOW LEG SOFT TISSUE,DEEP","27614 - HC BX LOW LEG SOFT TISSUE,DEEP",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","46221",null,"FALLON","81256 - HC CHG HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","27780","CLTX PROX FIBULA/SHFT FX W/O MANJ","27780 - CLTX PROX FIBULA/SHFT FX W/O MANJ",null,null,null,null,null,"TUFTS SELECT","46255",null,"FALLON","81522 - HC ONC BREAST MRNA 12 GENES"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","28022","HC ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT","28022 - HC ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT",null,null,null,null,null,"TUFTS HMO","46505",null,"FALLON","82495 - HC CHG ASSAY OF CHROMIUM"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","28192","REMOVAL FOREIGN BODY FOOT DEEP","28192 - REMOVAL FOREIGN BODY FOOT DEEP",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","46601",null,"FALLON","82803 - HC CHG BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","28510","CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ","28510 - CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","46607",null,"FALLON","83970 - HC CHG ASSAY OF PARATHORMONE"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","28825","HC AMP,TOE;INTERPHAL JT","28825 - HC AMP,TOE;INTERPHAL JT",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","46610",null,"FALLON","84255 - HC CHG ASSAY OF SELENIUM"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","29240","STRAPPING SHOULDER","29240 - STRAPPING SHOULDER",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","46900",null,"FALLON","84590 - HC CHG ASSAY OF VITAMIN A"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","29580","STRAPPING UNNA BOOT","29580 - STRAPPING UNNA BOOT",null,null,null,null,null,"BLUE CROSS-INDEMNITY","46922",null,"FALLON","85651 - SEDIMENTATION RATE RBC NON-AUTOMATED"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","30000","DRAINAGE ABSCESS/HEMATOMA NASAL INT APPROACH","30000 - DRAINAGE ABSCESS/HEMATOMA NASAL INT APPROACH",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","47000",null,"FALLON","86341 - HC CHG ISLET CELL ANTIBODY"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","30465","REPAIR NASAL VESTIBULAR STENOSIS","30465 - REPAIR NASAL VESTIBULAR STENOSIS",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","47382",null,"FALLON","86652 - HC CHG, ENCEPHAL ANTIBODY EAST EQU"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","30906","CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ","30906 - CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ",null,null,null,null,null,"TUFTS POS","47399",null,"FALLON","86765 - HC CHG ANTIBODY RUBEOLA"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","31572","HC LARYNGOSCOPY FLEXIBLE ABLATJ DESTJ LESION(S) UNI","31572 - HC LARYNGOSCOPY FLEXIBLE ABLATJ DESTJ LESION(S) UNI",null,null,null,null,null,"BLUE CROSS-HMO BLUE","47533",null,"FALLON","87181 - HC CHG SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","31577","LARYNGOSCOPY FLX FIBEROPTIC RMVL FOREIGN BODY","31577 - LARYNGOSCOPY FLX FIBEROPTIC RMVL FOREIGN BODY",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","47534",null,"FALLON","87269 - HC CHG IAADI GIARDIA"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","31625","BRONCHOSCOPY BRONCHIAL/ENDOBRNCL BX 1+ SITES","31625 - BRONCHOSCOPY BRONCHIAL/ENDOBRNCL BX 1+ SITES",null,null,null,null,null,"UNITED/HARVARD PILGRIM","47535",null,"FALLON","87498 - HC CHG IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","32557","PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING","32557 - PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING",null,null,null,null,null,"BLUE CROSS-INDEMNITY","47552",null,"FALLON","88381 - MICRODISSECTION, MANUAL"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","33016","HC PERICARDIOCENTESIS W/IMAGING","33016 - HC PERICARDIOCENTESIS W/IMAGING",null,null,null,null,null,"TUFTS SELECT","47552",null,"FALLON","90672 - CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","33223","HC RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR","33223 - HC RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR",null,null,null,null,null,"AETNA","47556",null,"FALLON","93985 - DUP-SCAN HEMO COMPL BI STD"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","33235","HC RMVL TRANSVNS PM ELTRD DUAL LEAD SYS","33235 - HC RMVL TRANSVNS PM ELTRD DUAL LEAD SYS",null,null,null,null,null,"UNITED/HARVARD PILGRIM","48102",null,"FALLON","96161 - CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","36011","HC SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH","36011 - HC SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH",null,null,null,null,null,"TUFTS SELECT","49180",null,"HARVARD PILGRIM HEALTH CARE","10012 - HC FNA BX W/MR GDN EA ADDL"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","36160","HC INTRO NEEDLE/INTRACATH AORTIC TRANSLUMBAR","36160 - HC INTRO NEEDLE/INTRACATH AORTIC TRANSLUMBAR",null,null,null,null,null,"TUFTS PPO","49185",null,"HARVARD PILGRIM HEALTH CARE","11010 - HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","36251","HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UN","36251 - HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UN",null,null,null,null,null,"TUFTS PPO","49324",null,"HARVARD PILGRIM HEALTH CARE","11604 - EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","36471","NJX SCLEROSING SOLUTION MULTIPLE VEINS SAME LEG","36471 - NJX SCLEROSING SOLUTION MULTIPLE VEINS SAME LEG",null,null,null,null,null,"BLUE CROSS-INDEMNITY","49406",null,"HARVARD PILGRIM HEALTH CARE","11982 - REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","36511","HC THER APHERESIS,WHITE BLOOD CELLS","36511 - HC THER APHERESIS,WHITE BLOOD CELLS",null,null,null,null,null,"BLUE CROSS-HMO BLUE","49411",null,"HARVARD PILGRIM HEALTH CARE","12055 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","36575","HC RTUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP","36575 - HC RTUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","49423",null,"HARVARD PILGRIM HEALTH CARE","15823 - HC REV UPPER EYELID W EXCESS SKIN"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","36582","HC RPLCMT COMPL TUN CTR VAD W/SUBQ PORT","36582 - HC RPLCMT COMPL TUN CTR VAD W/SUBQ PORT",null,null,null,null,null,"BLUE CROSS-PPO","49424",null,"HARVARD PILGRIM HEALTH CARE","17004 - DESTRUCTION PREMALIGNANT LESION 15/>"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","36600","ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX","36600 - ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX",null,null,null,null,null,"BLUE CROSS-INDEMNITY","49440",null,"HARVARD PILGRIM HEALTH CARE","19281 - PERQ DEVICE PLACEMENT BREAST LOC 1ST LES W/GDNCE"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","37188","PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX","37188 - PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX",null,null,null,null,null,"UNICARE","49446",null,"HARVARD PILGRIM HEALTH CARE","20983 - HC ABLATJ BONE TUMOR CRYO PERQ W/IMG GDN WHEN PRFMD"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","37225","HC REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL","37225 - HC REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL",null,null,null,null,null,"UNITED/HARVARD PILGRIM","49452",null,"HARVARD PILGRIM HEALTH CARE","21550 - BIOPSY SOFT TISSUE NECK/THORAX"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","37230","HC REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL","37230 - HC REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","49460",null,"HARVARD PILGRIM HEALTH CARE","22514 - PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","37244","VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE","37244 - VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE",null,null,null,null,null,"TUFTS SELECT","49570",null,"HARVARD PILGRIM HEALTH CARE","24066 - HC BX ARM/ELBOW SOFT TISSUE,DEEP"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","40490","BIOPSY OF LIP","40490 - BIOPSY OF LIP",null,null,null,null,null,"AETNA","50387",null,"HARVARD PILGRIM HEALTH CARE","26535 - HC ARTHROPLASTY I-P JT"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","40530","HC PARTIAL REMOVAL OF LIP,>1/4","40530 - HC PARTIAL REMOVAL OF LIP,>1/4",null,null,null,null,null,"UNITED/HARVARD PILGRIM","50387",null,"HARVARD PILGRIM HEALTH CARE","26775 - HC CLTX IPHAL JT DISLC W/MANJ REQ ANES"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","40840","HC RECONSTRUC MOUTH ANTERIOR","40840 - HC RECONSTRUC MOUTH ANTERIOR",null,null,null,null,null,"BLUE CROSS-HMO BLUE","50431",null,"HARVARD PILGRIM HEALTH CARE","27752 - CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","41100","BIOPSY TONGUE ANTERIOR TWO-THIRDS","41100 - BIOPSY TONGUE ANTERIOR TWO-THIRDS",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","50433",null,"HARVARD PILGRIM HEALTH CARE","28192 - REMOVAL FOREIGN BODY FOOT DEEP"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","41252","HC REPAIR TONGUE LACER,2.6 CM+/COMPLX","41252 - HC REPAIR TONGUE LACER,2.6 CM+/COMPLX",null,null,null,null,null,"AETNA","50435",null,"HARVARD PILGRIM HEALTH CARE","29086 - HC APPLY CAST,FINGER (CONTRACTURE)"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","42100","BIOPSY PALATE UVULA","42100 - BIOPSY PALATE UVULA",null,null,null,null,null,"BLUE CROSS-INDEMNITY","50437",null,"HARVARD PILGRIM HEALTH CARE","30020 - DRAINAGE ABSCESS/HEMATOMA NASAL SEPTUM"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","42505","HC REPAIR SALIVARY DUCT COMPLICATED","42505 - HC REPAIR SALIVARY DUCT COMPLICATED",null,null,null,null,null,"BLUE CROSS-HMO BLUE","50593",null,"HARVARD PILGRIM HEALTH CARE","31613 - TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","42842","HC RAD RESEC TONSIL/PILLARS","42842 - HC RAD RESEC TONSIL/PILLARS",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","50688",null,"HARVARD PILGRIM HEALTH CARE","33207 - HC INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","43197","HC ESOPHAGOSCOPY FLEXIBLE TRANSNASAL DIAGNOSTIC","43197 - HC ESOPHAGOSCOPY FLEXIBLE TRANSNASAL DIAGNOSTIC",null,null,null,null,null,"BLUE CROSS-PPO","50693",null,"HARVARD PILGRIM HEALTH CARE","33233 - HC REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","43247","HC UPPER GI NDSC W/FOREIGN BODY REMOVAL","43247 - HC UPPER GI NDSC W/FOREIGN BODY REMOVAL",null,null,null,null,null,"BLUE CROSS-INDEMNITY","51102",null,"HARVARD PILGRIM HEALTH CARE","36483 - HC ENDOVEN ABLTI THER CHEM ADHESIVE SBSQ VEIN"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","43253","HC EGD US GUIDED TRANSMURAL INJXN/FIDUCIAL MARKER E","43253 - HC EGD US GUIDED TRANSMURAL INJXN/FIDUCIAL MARKER E",null,null,null,null,null,"BLUE CROSS-INDEMNITY","51600",null,"HARVARD PILGRIM HEALTH CARE","36570 - HC INSJ PRPH CTR VAD W/SUBQ PORT UNDER 5 YR"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","43270","HC EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE","43270 - HC EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE",null,null,null,null,null,"BLUE CROSS-HMO BLUE","51700",null,"HARVARD PILGRIM HEALTH CARE","37184 - HC PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","44380","HC ILEOSCOPY STOMA DX W/WO COLLJ SPEC BR/WA SPX","44380 - HC ILEOSCOPY STOMA DX W/WO COLLJ SPEC BR/WA SPX",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","51703",null,"HARVARD PILGRIM HEALTH CARE","40804 - HC REM FB,MOUTH;SIMP"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","44406","HR COLONOSCOPY STOMA W/ENDOSCOPIC ULTRASOUND EXAM","44406 - HR COLONOSCOPY STOMA W/ENDOSCOPIC ULTRASOUND EXAM",null,null,null,null,null,"CIGNA CARELINK","51710",null,"HARVARD PILGRIM HEALTH CARE","41821 - HC EXCISION OF GUM FLAP"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","44970","HC LAPAROSCOPIC APPENDECTOMY","44970 - HC LAPAROSCOPIC APPENDECTOMY",null,null,null,null,null,"BLUE CROSS-HMO BLUE","51720",null,"HARVARD PILGRIM HEALTH CARE","42106 - EXC LESION PALATE UVULA W/SMPL PRIM CLOSURE"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","45381","HC COLSC FLX PROX SPLENIC FLXR SBMCSL NJX","45381 - HC COLSC FLX PROX SPLENIC FLXR SBMCSL NJX",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","51728",null,"HARVARD PILGRIM HEALTH CARE","43270 - HC EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","45392","HC COLSC FLX PROX SPLENIC FLXR US GID NDL ASPIR/BX","45392 - HC COLSC FLX PROX SPLENIC FLXR US GID NDL ASPIR/BX",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","51729",null,"HARVARD PILGRIM HEALTH CARE","44382 - HC ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","46050","I&D PERIANAL ABSCESS SUPERFICIAL","46050 - I&D PERIANAL ABSCESS SUPERFICIAL",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","51741",null,"HARVARD PILGRIM HEALTH CARE","45333 - HC SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","46601","HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT","46601 - HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","51785",null,"HARVARD PILGRIM HEALTH CARE","46220 - EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","47531","NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS","47531 - NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS",null,null,null,null,null,"BLUE CROSS-INDEMNITY","52000",null,"HARVARD PILGRIM HEALTH CARE","49407 - IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","48102","HC BIOPSY PANCREA PERCUTANEOUS NEEDLE","48102 - HC BIOPSY PANCREA PERCUTANEOUS NEEDLE",null,null,null,null,null,"CIGNA CARELINK","52224",null,"HARVARD PILGRIM HEALTH CARE","51100 - HC ASPIRATION BLADDER NEEDLE"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","49418","INSJ INTRAPERITONEAL CATHETER W/IMG GID","49418 - INSJ INTRAPERITONEAL CATHETER W/IMG GID",null,null,null,null,null,"TUFTS POS","52281",null,"HARVARD PILGRIM HEALTH CARE","54050 - DSTRJ LESION PENIS SIMPLE CHEMICAL"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","50385","HC REMOVE & REPLACE INDWELL URETERAL STENT TRURTHRL","50385 - HC REMOVE & REPLACE INDWELL URETERAL STENT TRURTHRL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","52332",null,"HARVARD PILGRIM HEALTH CARE","57156 - HC INSERTION OF CYLINDER"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","50436","HC DILAT XST TRC NDURLGC PX","50436 - HC DILAT XST TRC NDURLGC PX",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","52356",null,"HARVARD PILGRIM HEALTH CARE","58340 - CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","50695","HC PLMT URET STNTW/SEP NEPH","50695 - HC PLMT URET STNTW/SEP NEPH",null,null,null,null,null,"BLUE CROSS-HMO BLUE","53600",null,"HARVARD PILGRIM HEALTH CARE","59871 - REMOVAL CERCLAGE SUTURE UNDER ANESTHESIA"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","51785","NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ","51785 - NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ",null,null,null,null,null,"CIGNA CARELINK","53899",null,"HARVARD PILGRIM HEALTH CARE","64483 - NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","52351","HC CYSTO/URETERO/PYELOSCOPY, DX","52351 - HC CYSTO/URETERO/PYELOSCOPY, DX",null,null,null,null,null,"TUFTS POS","54050",null,"HARVARD PILGRIM HEALTH CARE","64643 - CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","54162","HC LYSIS/EXCIS,PENILE POSTCIRCUM ADHESIONS","54162 - HC LYSIS/EXCIS,PENILE POSTCIRCUM ADHESIONS",null,null,null,null,null,"TUFTS HMO","54060",null,"HARVARD PILGRIM HEALTH CARE","65875 - HC SEVERING ADS ANT SEG INCAL SPX POST SYNECHIAE"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","55250","VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS","55250 - VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS",null,null,null,null,null,"UNITED/HARVARD PILGRIM","54100",null,"HARVARD PILGRIM HEALTH CARE","67105 - RPR RETINAL DTCHMNT 1/> SES PC W/WO DRG SUBRETI"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","56405","I&D VULVA/PERINEAL ABSCESS","56405 - I&D VULVA/PERINEAL ABSCESS",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","54115",null,"HARVARD PILGRIM HEALTH CARE","67316 - HC STRABISMUS RECESSION/RESCJ 2/MORE VER MUSC"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","57061","DESTRUCTION VAGINAL LESIONS SIMPLE","57061 - DESTRUCTION VAGINAL LESIONS SIMPLE",null,null,null,null,null,"TUFTS POS","54162",null,"HARVARD PILGRIM HEALTH CARE","68110 - EXCISION LESION CONJUNCTIVA </1 CM"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","57456","COLPOSCOPY CERVIX ENDOCERVICAL CURETTAGE","57456 - COLPOSCOPY CERVIX ENDOCERVICAL CURETTAGE",null,null,null,null,null,"BLUE CROSS-HMO BLUE","54231",null,"HARVARD PILGRIM HEALTH CARE","70310 - RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","57510","HC CAUTERIZATION,CERVIX,ELECTRO/THERMAL","57510 - HC CAUTERIZATION,CERVIX,ELECTRO/THERMAL",null,null,null,null,null,"BLUE CROSS-HMO BLUE","54235",null,"HARVARD PILGRIM HEALTH CARE","70482 - HC CHG CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","58301","REMOVAL INTRAUTERINE DEVICE IUD","58301 - REMOVAL INTRAUTERINE DEVICE IUD",null,null,null,null,null,"UNITED/HARVARD PILGRIM","54450",null,"HARVARD PILGRIM HEALTH CARE","71130 - HC CHG RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","58565","HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS","58565 - HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS",null,null,null,null,null,"UNITED/HARVARD PILGRIM","54600",null,"HARVARD PILGRIM HEALTH CARE","72141 - HC CHG MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","59820","TX MISSED ABORTION FIRST TRIMESTER SURGICAL","59820 - TX MISSED ABORTION FIRST TRIMESTER SURGICAL",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","55100",null,"HARVARD PILGRIM HEALTH CARE","73222 - HC CHG MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","61623","HC EVASC TEMP BALLOON ARTL OCCLUSION HEAD/NECK","61623 - HC EVASC TEMP BALLOON ARTL OCCLUSION HEAD/NECK",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","55400",null,"HARVARD PILGRIM HEALTH CARE","74160 - HC CHG CT ABDOMEN W/CONTRAST MATERIAL"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","62302","MYELOGRAPHY VIA LUMBAR INJECTION RS&I CERVICAL","62302 - MYELOGRAPHY VIA LUMBAR INJECTION RS&I CERVICAL",null,null,null,null,null,"TUFTS SELECT","55700",null,"HARVARD PILGRIM HEALTH CARE","75726 - HC CHG ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","62370","ELEC ANLYS IMPLT ITHCL/EDRL PMP W/REPR PHYS/QHP","62370 - ELEC ANLYS IMPLT ITHCL/EDRL PMP W/REPR PHYS/QHP",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","56420",null,"HARVARD PILGRIM HEALTH CARE","76514 - OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","64408","HC INJ,ANES;VAGUS NER","64408 - HC INJ,ANES;VAGUS NER",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","56440",null,"HARVARD PILGRIM HEALTH CARE","76805 - US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","64479","HC INJECT ANES/STEROID FORAMEN CERV/THORACIC W IMG GUIDE ,1 LEVEL","64479 - HC INJECT ANES/STEROID FORAMEN CERV/THORACIC W IMG GUIDE ,1 LEVEL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","56515",null,"HARVARD PILGRIM HEALTH CARE","77066 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","64505","INJECTION ANES AGENT SPHENOPALATINE GANGLION","64505 - INJECTION ANES AGENT SPHENOPALATINE GANGLION",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","56606",null,"HARVARD PILGRIM HEALTH CARE","77370 - HC SPEC MED PHYSICS CONSULT"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","64616","CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA","64616 - CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","56700",null,"HARVARD PILGRIM HEALTH CARE","78071 - HC CHG PARATHYROID PLANAR IMAGING W/WO SUBTRACTION"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","64680","HC DES,NEURO;CELIAC PLEX,WWO","64680 - HC DES,NEURO;CELIAC PLEX,WWO",null,null,null,null,null,"TUFTS HMO","56820",null,"HARVARD PILGRIM HEALTH CARE","78804 - HC RP TUM LOC/RP DIS;BODY,2/"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","65101","HC REMOVAL OF EYE","65101 - HC REMOVAL OF EYE",null,null,null,null,null,"CIGNA CARELINK","56821",null,"HARVARD PILGRIM HEALTH CARE","80048 - HC CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","65280","HC REPAIR OF EYE WOUND","65280 - HC REPAIR OF EYE WOUND",null,null,null,null,null,"CIGNA CARELINK","57023",null,"HARVARD PILGRIM HEALTH CARE","80285 - HC DRUG ASSAY VORICONAZOLE"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","65782","HC OCCULAR SURFACE RECONSTRUCTION LIMBAL AUTOGRAFT","65782 - HC OCCULAR SURFACE RECONSTRUCTION LIMBAL AUTOGRAFT",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","57105",null,"HARVARD PILGRIM HEALTH CARE","81272 - HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","66250","HC FOLLOW-UP SURGERY OF EYE","66250 - HC FOLLOW-UP SURGERY OF EYE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","57155",null,"HARVARD PILGRIM HEALTH CARE","82232 - HC CHG BETA-2 MICROGLOBULIN"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","66711","HC ECP CILIARY BODY DESTRUCTION","66711 - HC ECP CILIARY BODY DESTRUCTION",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","57156",null,"HARVARD PILGRIM HEALTH CARE","82384 - HC CHG CATECHOLAMINES FRACTIONATED"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","66985","INSERT LENS PROSTHESIS ONLY","66985 - INSERT LENS PROSTHESIS ONLY",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","57170",null,"HARVARD PILGRIM HEALTH CARE","82705 - HC CHG FAT/LIPIDS FECES QUALITATIVE"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","67120","HC REMV POST EYE IMPLNT MATER,EXTRAOCUL","67120 - HC REMV POST EYE IMPLNT MATER,EXTRAOCUL",null,null,null,null,null,"TUFTS SELECT","57210",null,"HARVARD PILGRIM HEALTH CARE","83835 - HC CHG METANEPHRINES"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","67316","HC STRABISMUS RECESSION/RESCJ 2/MORE VER MUSC","67316 - HC STRABISMUS RECESSION/RESCJ 2/MORE VER MUSC",null,null,null,null,null,"TUFTS PPO","57415",null,"HARVARD PILGRIM HEALTH CARE","84166 - HC CHG PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","67801","EXCISION CHALAZION MULTIPLE SAME LID","67801 - EXCISION CHALAZION MULTIPLE SAME LID",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","57452",null,"HARVARD PILGRIM HEALTH CARE","85046 - HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","67900","HC REPAIR BROW DEFECT","67900 - HC REPAIR BROW DEFECT",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","57455",null,"HARVARD PILGRIM HEALTH CARE","85611 - HC CHG PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","67930","HC SUTURE EYELID WOUND,PARTIAL THICK","67930 - HC SUTURE EYELID WOUND,PARTIAL THICK",null,null,null,null,null,"TUFTS SELECT","57460",null,"HARVARD PILGRIM HEALTH CARE","86317 - HC IMMUNOASSAY,INFECT AGENT,QUANT"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","68325","HC CONJUNCTIVOPLASTY W/BUCCAL MUC MEMB GRAFT","68325 - HC CONJUNCTIVOPLASTY W/BUCCAL MUC MEMB GRAFT",null,null,null,null,null,"UNITED/HARVARD PILGRIM","57500",null,"HARVARD PILGRIM HEALTH CARE","86638 - HC CHG, Q FEVER ANTIBODY"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","69000","DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE","69000 - DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE",null,null,null,null,null,"UNITED/HARVARD PILGRIM","57511",null,"HARVARD PILGRIM HEALTH CARE","86817 - HC CHG HLA TYPING DR/DQ MULTIPLE ANTIGENS"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","69220","DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE","69220 - DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","57522",null,"HARVARD PILGRIM HEALTH CARE","87140 - HC CHG CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","69631","HC TYMPANOPLASTY","69631 - HC TYMPANOPLASTY",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","57800",null,"HARVARD PILGRIM HEALTH CARE","87275 - HC CHG IAADI INFLUENZA B VIRUS"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","70336","HC CHG MRI TEMPOROMANDIBULAR JOINT","70336 - HC CHG MRI TEMPOROMANDIBULAR JOINT",null,null,null,null,null,"AETNA","58145",null,"HARVARD PILGRIM HEALTH CARE","87801 - HC CHG DETECT AGENT, MULT ORGS, DNA  AMP"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","70380","HC X-RAY SALIVARY GLAND","70380 - HC X-RAY SALIVARY GLAND",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","58145",null,"HARVARD PILGRIM HEALTH CARE","88152 - HC CHG CYTOPATH SMEAR CERV/VAG,AUTO REDO"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","70490","HC CHG CT SOFT TISSUE NECK W/O CONTRAST MATERIAL","70490 - HC CHG CT SOFT TISSUE NECK W/O CONTRAST MATERIAL",null,null,null,null,null,"TUFTS SELECT","58301",null,"HARVARD PILGRIM HEALTH CARE","88331 - PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","71110","HC CHG RADEX RIBS BILATERAL 3 VIEWS","71110 - HC CHG RADEX RIBS BILATERAL 3 VIEWS",null,null,null,null,null,"TUFTS PPO","58323",null,"HARVARD PILGRIM HEALTH CARE","90912 - HC BFB TRAINING 1ST 15 MIN"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","72020","HC CHG RADEX SPINE 1 VIEW SPECIFY LEVEL","72020 - HC CHG RADEX SPINE 1 VIEW SPECIFY LEVEL",null,null,null,null,null,"BMCHN QHP","58345",null,"HARVARD PILGRIM HEALTH CARE","92270 - ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","72070","HC CHG RADEX SPINE THORACIC 2 VIEWS","72070 - HC CHG RADEX SPINE THORACIC 2 VIEWS",null,null,null,null,null,"UNITED/HARVARD PILGRIM","58345",null,"HARVARD PILGRIM HEALTH CARE","92502 - HC EAR AND THROAT EXAMINATION"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","72120","HC X-RAY LUMBAR SPINE FLEX/EXTEN","72120 - HC X-RAY LUMBAR SPINE FLEX/EXTEN",null,null,null,null,null,"TUFTS PPO","58558",null,"HARVARD PILGRIM HEALTH CARE","92586 - AUDITORY EVOKED POTENTIALS LIMITED"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","72191","HC CHG CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST","72191 - HC CHG CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","58565",null,"HARVARD PILGRIM HEALTH CARE","93306 - HC ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D WITH CONTRAST"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","72198","HC CHG MRA PELVIS W/WO CONTRAST MATERIAL","72198 - HC CHG MRA PELVIS W/WO CONTRAST MATERIAL",null,null,null,null,null,"AETNA","58579",null,"HARVARD PILGRIM HEALTH CARE","93459 - HC CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","73050","HC CHG RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ","73050 - HC CHG RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","58925",null,"HARVARD PILGRIM HEALTH CARE","93644 - HC EPHYS EVAL SUBQ IMPLANTABLE DEFIBRILLATOR"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","73219","HC CHG MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL","73219 - HC CHG MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL",null,null,null,null,null,"BLUE CROSS-HMO BLUE","59020",null,"HARVARD PILGRIM HEALTH CARE","94250 - HC EXPIRED GAS COLLECTION QUANT 1 PROCEDURE SPX"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","73552","XRAY EXAM FEMUR; MINIMUM 2 VIEWS","73552 - XRAY EXAM FEMUR; MINIMUM 2 VIEWS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","59160",null,"HARVARD PILGRIM HEALTH CARE","95149 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 5 INSECT"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","73702","HC CHG CT LOWER EXTREMITY W/O & W/CONTRAST MATRL","73702 - HC CHG CT LOWER EXTREMITY W/O & W/CONTRAST MATRL",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","59320",null,"HARVARD PILGRIM HEALTH CARE","95873 - ELECTRICAL STIMULATION GUID W/CHEMODENERVATION"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","74170","HC CT ABDOMEN WITH AND WITHOUT CONTRAST","74170 - HC CT ABDOMEN WITH AND WITHOUT CONTRAST",null,null,null,null,null,"BMCHN MEDICAID","59412",null,"HARVARD PILGRIM HEALTH CARE","96130 - HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","74221","HC X-RAY XM ESOPHAGUS 2CNTRST","74221 - HC X-RAY XM ESOPHAGUS 2CNTRST",null,null,null,null,null,"BLUE CROSS-INDEMNITY","59812",null,"HARVARD PILGRIM HEALTH CARE","96417 - CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","74263","HC CT COLONOGRAPHY;SCREEN","74263 - HC CT COLONOGRAPHY;SCREEN",null,null,null,null,null,"TUFTS POS","59820",null,"HARVARD PILGRIM HEALTH CARE","99152 - HC MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","75559","HC CHG CARDIAC MRI W/O CONTRAST W/STRESS IMAGING","75559 - HC CHG CARDIAC MRI W/O CONTRAST W/STRESS IMAGING",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","59870",null,"SENIOR WHOLE HEALTH","80201 - HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","75705","HC CHG ANGIOGRAPHY SPINAL SELECTIVE RS&I","75705 - HC CHG ANGIOGRAPHY SPINAL SELECTIVE RS&I",null,null,null,null,null,"BMCHN MCO","59897",null,"SENIOR WHOLE HEALTH","81241 - HC CHG F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","75820","HC CHG VENOGRAPHY EXTREMITY UNILATERAL RS&I","75820 - HC CHG VENOGRAPHY EXTREMITY UNILATERAL RS&I",null,null,null,null,null,"BLUE CROSS-HMO BLUE","60300",null,"SENIOR WHOLE HEALTH","82010 - HC CHG KETONE BODIES SERUM QUANTITATIVE"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","75893","HC CHG VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS&","75893 - HC CHG VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS&",null,null,null,null,null,"CIGNA CARELINK","61050",null,"SENIOR WHOLE HEALTH","82436 - HC CHG CHLORIDE URINE"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","75989","RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I","75989 - RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","61055",null,"SENIOR WHOLE HEALTH","82585 - HC CHG ASSAY OF CRYOFIBRN"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","76513","OPH US DX ANT SGM US IMMERSION B-SCAN/HR BIOM","76513 - OPH US DX ANT SGM US IMMERSION B-SCAN/HR BIOM",null,null,null,null,null,"BLUE CROSS-HMO BLUE","61624",null,"SENIOR WHOLE HEALTH","83498 - HC CHG ASSAY OF HYDROXYPROGESTERONE 17-D"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","76810","US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO","76810 - US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO",null,null,null,null,null,"BLUE CROSS-INDEMNITY","61640",null,"SENIOR WHOLE HEALTH","84210 - HC CHG ASSAY OF PYRUVATE"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","76816","US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS","76816 - US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS",null,null,null,null,null,"BLUE CROSS-INDEMNITY","61641",null,"SENIOR WHOLE HEALTH","84436 - HC CHG ASSAY OF THYROXINE TOTAL"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","76830","ULTRASOUND TRANSVAGINAL","76830 - ULTRASOUND TRANSVAGINAL",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","61645",null,"SENIOR WHOLE HEALTH","85027 - HC CHG BLOOD COUNT COMPLETE AUTOMATED"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","76982","HC USE 1ST TARGET LESION","76982 - HC USE 1ST TARGET LESION",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","61885",null,"SENIOR WHOLE HEALTH","86161 - HC CHG COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","77013","HC CHG CT GUIDANCE &MONITORING VISC TISS ABLATION","77013 - HC CHG CT GUIDANCE &MONITORING VISC TISS ABLATION",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","62252",null,"SENIOR WHOLE HEALTH","86403 - HC CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","77071","HC CHG MANUAL APPL STRESS PFRMD PHYS/QHP JOINT FILMS","77071 - HC CHG MANUAL APPL STRESS PFRMD PHYS/QHP JOINT FILMS",null,null,null,null,null,"BLUE CROSS-INDEMNITY","62269",null,"SENIOR WHOLE HEALTH","86703 - HC HIV 1/2 ANTIBODY"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","77306","TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION","77306 - TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","62273",null,"SENIOR WHOLE HEALTH","87118 - HC CHG CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","77373","HC SRS FRACTIONATED 1-5 BODY; 2-5 CRANIAL","77373 - HC SRS FRACTIONATED 1-5 BODY; 2-5 CRANIAL",null,null,null,null,null,"BLUE CROSS-INDEMNITY","62304",null,"SENIOR WHOLE HEALTH","87449 - HC AG DET,ENZ IMM;OTH,EA"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","77412","HC TX DEL =>1 MEV - COMPLEX","77412 - HC TX DEL =>1 MEV - COMPLEX",null,null,null,null,null,"BLUE CROSS-PPO","62305",null,"SENIOR WHOLE HEALTH","87529 - HC CHG IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","78012","HC CHG THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT","78012 - HC CHG THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT",null,null,null,null,null,"BLUE CROSS-PPO","62322",null,"SENIOR WHOLE HEALTH","90672 - CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","78195","HC CHG LYMPHATICS & LYMPH NODES IMAGING","78195 - HC CHG LYMPHATICS & LYMPH NODES IMAGING",null,null,null,null,null,"UNICARE","62323",null,"TUFTS","10012 - HC FNA BX W/MR GDN EA ADDL"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","78258","HC CHG ESOPHAGEAL MOTILITY","78258 - HC CHG ESOPHAGEAL MOTILITY",null,null,null,null,null,"TUFTS SELECT","62324",null,"TUFTS","11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","78491","HC CHG MYOCRD IMAGE PET PERFUS SINGLE STUDY REST/STRESS","78491 - HC CHG MYOCRD IMAGE PET PERFUS SINGLE STUDY REST/STRESS",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","62329",null,"TUFTS","11740 - EVACUATION SUBUNGUAL HEMATOMA"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","78582","HC CHG PULMONARY VENTILATION & PERFUSION IMAGING","78582 - HC CHG PULMONARY VENTILATION & PERFUSION IMAGING",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","62329",null,"TUFTS","11981 - INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","78800","HC NM RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR: LIMITED AREA","78800 - HC NM RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR: LIMITED AREA",null,null,null,null,null,"CIGNA CARELINK","62367",null,"TUFTS","12056 - HC LAYR CLOS WND FACE,FACIAL 20.1-30 CM"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","79200","HC CHG RP THERAPY INRACAVITARY ADMINISTRATION","79200 - HC CHG RP THERAPY INRACAVITARY ADMINISTRATION",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","62370",null,"TUFTS","15772 - HC GRFG AUTOL FAT LIPO EA ADDL"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","80171","DRUG SCREEN QUANTITATIVE GABAPENTIN","80171 - DRUG SCREEN QUANTITATIVE GABAPENTIN",null,null,null,null,null,"TUFTS HMO","63662",null,"TUFTS","19282 - PERQ DEVICE PLACEMT BREAST LOC EA LESION W/GDNCE"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","80186","HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN FREE","80186 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN FREE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","64400",null,"TUFTS","20100 - HC EXPLORE WOUND,NECK"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","80320","DRUG SCREEN QUANTITATIVE ALCOHOLS","80320 - DRUG SCREEN QUANTITATIVE ALCOHOLS",null,null,null,null,null,"UNICARE","64405",null,"TUFTS","20930 - HC ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","81178","HC CHG ATXN1 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","81178 - HC CHG ATXN1 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES",null,null,null,null,null,"AETNA","64416",null,"TUFTS","21480 - CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","81229","HC CYTOG ALYS CHRML ABNR SNPCGH","81229 - HC CYTOG ALYS CHRML ABNR SNPCGH",null,null,null,null,null,"TUFTS SELECT","64417",null,"TUFTS","23330 - REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","81275","HC CHG KRAS GENE ANALYSIS VARIANTS IN EXON 2","81275 - HC CHG KRAS GENE ANALYSIS VARIANTS IN EXON 2",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","64421",null,"TUFTS","25116 - RAD EXCIS WRIST SYNOV/TENDON,EXTEN"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","81311","HC CHG NRAS GENE ANALYSIS VARIANTS IN EXON 2&3","81311 - HC CHG NRAS GENE ANALYSIS VARIANTS IN EXON 2&3",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","64430",null,"TUFTS","26418 - HC REPAIR EXTEN TENDON,DORSUM FINGER,EA"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","81404","VHL (EG, VON HIPPEL-LINDAUFAMILIAL CANCER SYNDROME, FULL GENE SEQ VWF PRO/TECH","81404 - VHL (EG, VON HIPPEL-LINDAUFAMILIAL CANCER SYNDROME, FULL GENE SEQ VWF PRO/TECH",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","64445",null,"TUFTS","27230 - CLTX FEM FX PROX END NCK W/O MANJ"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","82040","HC CHG ALBUMIN SERUM PLASMA/WHOLE BLOOD","82040 - HC CHG ALBUMIN SERUM PLASMA/WHOLE BLOOD",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","64450",null,"TUFTS","27752 - CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","82180","HC CHG ASSAY OF ASCORBIC ACID BLOOD","82180 - HC CHG ASSAY OF ASCORBIC ACID BLOOD",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","64454",null,"TUFTS","28450 - TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","82340","HC Q;KID STONE, UR CALCIUM","82340 - HC Q;KID STONE, UR CALCIUM",null,null,null,null,null,"UNICARE","64455",null,"TUFTS","29405 - APPLICATION SHORT LEG CAST BELOW KNEE-TOE"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","82397","HC CHEMILUMINESCENT ASSAY","82397 - HC CHEMILUMINESCENT ASSAY",null,null,null,null,null,"BLUE CROSS-INDEMNITY","64462",null,"TUFTS","29888 - HC KNEE SCOPE,AID ANT CRUCIATE REPAIR"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","82626","HC CHG DEHYDROEPIANDROSTERONE","82626 - HC CHG DEHYDROEPIANDROSTERONE",null,null,null,null,null,"TUFTS HMO","64484",null,"TUFTS","31632 - HC BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","82657","HC CHG NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA","82657 - HC CHG NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","64486",null,"TUFTS","32552 - HC REMOVAL OF LUNG CATHETER"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","82787","HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES","82787 - HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","64490",null,"TUFTS","33233 - HC REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","83050","HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE","83050 - HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE",null,null,null,null,null,"BLUE CROSS-HMO BLUE","64494",null,"TUFTS","36513 - THERAPEUTIC APHERESIS PLATELETS"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","83070","HC CHG ASSAY OF HEMOSIDERIN QUALITATIVE","83070 - HC CHG ASSAY OF HEMOSIDERIN QUALITATIVE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","64494",null,"TUFTS","36555 - HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","83690","HC CHG ASSAY OF LIPASE","83690 - HC CHG ASSAY OF LIPASE",null,null,null,null,null,"TUFTS POS","64505",null,"TUFTS","37187 - PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","83880","HC CHG NATRIURETIC PEPTIDE","83880 - HC CHG NATRIURETIC PEPTIDE",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","64520",null,"TUFTS","37242 - VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","84144","HC CHG ASSAY OF PROGESTERONE","84144 - HC CHG ASSAY OF PROGESTERONE",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","64569",null,"TUFTS","41105 - HC BIOPSY TONGUE,POSTER 1/3"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","84165","HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM","84165 - HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","64600",null,"TUFTS","42104 - EXC LESION PALATE UVULA W/O CLOSURE"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","84300","HC CHG ASSAY OF URINE SODIUM","84300 - HC CHG ASSAY OF URINE SODIUM",null,null,null,null,null,"BLUE CROSS-PPO","64612",null,"TUFTS","43191 - HC ESOPHAGOSCOPY RIGID TRANSORAL DIAGNOSTIC BRUSH"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","84445","HC CHG THYROID STIMULATING IMMUNE GLOBULINS TSI","84445 - HC CHG THYROID STIMULATING IMMUNE GLOBULINS TSI",null,null,null,null,null,"UNITED/HARVARD PILGRIM","64616",null,"TUFTS","43276 - HC ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","84560","HC CHG ASSAY OF URIC ACID OTHER SOURCE","84560 - HC CHG ASSAY OF URIC ACID OTHER SOURCE",null,null,null,null,null,"BLUE CROSS-PPO","64624",null,"TUFTS","45305 - HC PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","85046","HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS","85046 - HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS",null,null,null,null,null,"BLUE CROSS-INDEMNITY","64632",null,"TUFTS","46255 - HC HEMORRHOIDECTOMY,INT/EXT,1 COLUMN/GROUP"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","85290","HC CHG CLOTTING FACTOR XIII FIBRIN STABILIZING","85290 - HC CHG CLOTTING FACTOR XIII FIBRIN STABILIZING",null,null,null,null,null,"TUFTS SELECT","64634",null,"TUFTS","49329 - HC LAPARO PROC ABDM/PER/OMENT"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","85379","HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE","85379 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE",null,null,null,null,null,"TUFTS PPO","64636",null,"TUFTS","50437 - HC DILAT XST TRC NEW ACCESS RCS"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","85611","HC CHG PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH","85611 - HC CHG PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH",null,null,null,null,null,"BLUE CROSS-PPO","64642",null,"TUFTS","51736 - SIMPLE UROFLOMETRY"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","86160","HC CHG COMPLEMENT ANTIGEN EACH COMPONENT","86160 - HC CHG COMPLEMENT ANTIGEN EACH COMPONENT",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","64645",null,"TUFTS","56805 - HC REPAIR CLITORIS"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","86255","HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY","86255 - HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY",null,null,null,null,null,"TUFTS SELECT","64646",null,"TUFTS","57210 - HC REPAIR VAGINA/PERINEUM"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","86382","HC CHG NEUTRALIZATION TEST VIRAL","86382 - HC CHG NEUTRALIZATION TEST VIRAL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","64680",null,"TUFTS","61050 - HC CISTERNAL/C1-2 PUNCTURE"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","86617","HC CHG ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST","86617 - HC CHG ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST",null,null,null,null,null,"UNITED/HARVARD PILGRIM","64771",null,"TUFTS","64413 - INJECTION ANESTHETIC AGENT CERVICAL PLEXUS"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","86632","HC CHG CHLAMYDIA, IGM ANTIBODY","86632 - HC CHG CHLAMYDIA, IGM ANTIBODY",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","64774",null,"TUFTS","64461 - HC PVB,THORACIC;SINGLE INJECTION SITE INCLUDING IMAGING GUIDANCE WHEN PERFORMED"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","86689","HC HTLV/HIV CONFIRMATORY TEST","86689 - HC HTLV/HIV CONFIRMATORY TEST",null,null,null,null,null,"BLUE CROSS-PPO","65103",null,"TUFTS","64774 - HC EXCISE CUTANEOUS NEUROMA"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","86753","HC CHG ANTIBODY PROTOZOA NES","86753 - HC CHG ANTIBODY PROTOZOA NES",null,null,null,null,null,"TUFTS HMO","65135",null,"TUFTS","66825 - HC REPOSITION INTRAOCULAR LENS"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","86774","HC CHG ANTIBODY TETANUS","86774 - HC CHG ANTIBODY TETANUS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","65175",null,"TUFTS","67040 - HC LASER TREATMENT OF RETINA"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","86807","HC CHG SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH","86807 - HC CHG SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","65210",null,"TUFTS","67412 - HC EXPLORE/TREAT EYE SOCKET"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","87046","HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA","87046 - HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA",null,null,null,null,null,"UNITED/HARVARD PILGRIM","65265",null,"TUFTS","68815 - HC PROBE NASOLAC DUCT,INSERT TUBE/STENT"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","87102","HC CHG CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD","87102 - HC CHG CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","65285",null,"TUFTS","69801 - LABYRINTHOTOMY TRANSCANAL"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","87181","HC CHG SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ","87181 - HC CHG SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ",null,null,null,null,null,"TUFTS PPO","65400",null,"TUFTS","70540 - HC CHG MRI ORBIT FACE &/NECK W/O CONTRAST"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","87275","HC CHG IAADI INFLUENZA B VIRUS","87275 - HC CHG IAADI INFLUENZA B VIRUS",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","65435",null,"TUFTS","72133 - HC CT,L SPINE;W/WO"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","87391","HC CHG IAAD IA HIV-2","87391 - HC CHG IAAD IA HIV-2",null,null,null,null,null,"TUFTS PPO","65730",null,"TUFTS","73218 - HC CHG MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","87497","HC CHG IADNA CYTOMEGALOVIRUS QUANTIFICATION","87497 - HC CHG IADNA CYTOMEGALOVIRUS QUANTIFICATION",null,null,null,null,null,"BLUE CROSS-INDEMNITY","65756",null,"TUFTS","74150 - HC CHG CT ABDOMEN W/O CONTRAST MATERIAL"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","87532","HC CHG IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ","87532 - HC CHG IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ",null,null,null,null,null,"BLUE CROSS-HMO BLUE","65778",null,"TUFTS","74340 - HC CHG INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","87633","HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET","87633 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET",null,null,null,null,null,"TUFTS SELECT","65779",null,"TUFTS","75733 - HC ANGIO ADRENAL BILAT SELECT"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","87660","HC CHG IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ","87660 - HC CHG IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ",null,null,null,null,null,"UNITED/HARVARD PILGRIM","65780",null,"TUFTS","75870 - VENOGRAM SUPER SAG SINUS"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","88165","HC CHG CYTP SLIDES C/V MNL SCR&RESCR PHYS SUPV","88165 - HC CHG CYTP SLIDES C/V MNL SCR&RESCR PHYS SUPV",null,null,null,null,null,"TUFTS HMO","65820",null,"TUFTS","76886 - HC US EXAM INFANT HIPS STATIC"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","88185","HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA","88185 - HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","65855",null,"TUFTS","76998 - ULTRASONIC GUIDANCE INTRAOPERATIVE"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","88291","HC CHG CYTOGENETICS&MOLEC CYTOGENETICS INTERP&REP","88291 - HC CHG CYTOGENETICS&MOLEC CYTOGENETICS INTERP&REP",null,null,null,null,null,"CIGNA CARELINK","65865",null,"TUFTS","77295 - HC COMPUTER GEN PLAN  3D"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","88342","HC CHG IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE","88342 - HC CHG IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE",null,null,null,null,null,"BLUE CROSS-PPO","65920",null,"TUFTS","78013 - HC CHG THYROID IMAGING WITH VASCULAR FLOW"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","88369","M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC EACH","88369 - M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC EACH",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","66030",null,"TUFTS","78458 - HC VEN THROMBOSIS IMAGES BILAT"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","90461","IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT","90461 - IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","66172",null,"TUFTS","78815 - HC CHG PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","90651","CR BUILD ONLY - HPV 9-VALENT IM, DPH","90651 - CR BUILD ONLY - HPV 9-VALENT IM, DPH",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","66180",null,"TUFTS","80177 - DRUG SCREEN QUANTITATIVE LEVETIRACETAM"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","90716","CR BUILD ONLY - CHICKEN POX VACCINE,LIVE,SUB-Q,TRAVEL","90716 - CR BUILD ONLY - CHICKEN POX VACCINE,LIVE,SUB-Q,TRAVEL",null,null,null,null,null,"TUFTS HMO","66250",null,"TUFTS","81256 - HC CHG HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","90750","HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX","90750 - HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","66625",null,"TUFTS","81405 - HC MOPATH PROCEDURE LEVEL 6"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","90853","GROUP PSYCHOTHERAPY","90853 - GROUP PSYCHOTHERAPY",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","66711",null,"TUFTS","82465 - CHOLESTEROL SERUM/WHOLE BLOOD TOTAL"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","91035","GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD","91035 - GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD",null,null,null,null,null,"TUFTS POS","66762",null,"TUFTS","82810 - HC BLOOD GASSES O2 SAT ONLY"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","92004","OPHTH MEDICAL XM&EVAL COMPRE NEW PT 1/> VST","92004 - OPHTH MEDICAL XM&EVAL COMPRE NEW PT 1/> VST",null,null,null,null,null,"TUFTS HMO","66825",null,"TUFTS","83615 - HC CHG LACTATE DEHYDROGENASE LDH"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","92132","CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI","92132 - CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI",null,null,null,null,null,"AETNA","66852",null,"TUFTS","84155 - HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","92284","DARK ADAPTATION XM W/INTERPRETATION & REPORT","92284 - DARK ADAPTATION XM W/INTERPRETATION & REPORT",null,null,null,null,null,"TUFTS PPO","66982",null,"TUFTS","84597 - HC CHG ASSAY OF VITAMIN K"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","92508","TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV","92508 - TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV",null,null,null,null,null,"TUFTS POS","66985",null,"TUFTS","85307 - HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","92526","TX SWALLOWING DYSFUNCTION&/ORAL FUNCJ FEEDING","92526 - TX SWALLOWING DYSFUNCTION&/ORAL FUNCJ FEEDING",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","67005",null,"TUFTS","86021 - HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","92570","HC ACOUSTIC IMMIT TEST TYMPANOMETRY/ACOUST REFLEX/DECAY","92570 - HC ACOUSTIC IMMIT TEST TYMPANOMETRY/ACOUST REFLEX/DECAY",null,null,null,null,null,"TUFTS SELECT","67028",null,"TUFTS","86658 - HC CHG ENTEROVIRUS ANTIBODY"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","92582","CONDITIONING PLAY AUDIOMETRY","92582 - CONDITIONING PLAY AUDIOMETRY",null,null,null,null,null,"UNITED/HARVARD PILGRIM","67031",null,"TUFTS","86707 - HC CHG HEPATITIS BE ANTIBODY HBEAB"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","92594","ELECTROACOUS EVAL HEARING AID MONAURAL","92594 - ELECTROACOUS EVAL HEARING AID MONAURAL",null,null,null,null,null,"TUFTS HMO","67039",null,"TUFTS","86870 - HC CHG ANTIBODY ID RBC ANTIBODIES EA PANEL EA SERUM TQ"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","92928","HC PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH","92928 - HC PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","67101",null,"TUFTS","87425 - HC CHG IAAD IA ROTAVIRUS"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","92928","HC PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH","92928 - HC PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH",null,null,null,null,null,"AETNA","67105",null,"TUFTS","87430 - HC CHG IAAD IA STREPTOCOCCUS GROUP A"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","92979","HC ENDOLUMINAL CORONARY IVUS OCT I&R ADDK VESSEL","92979 - HC ENDOLUMINAL CORONARY IVUS OCT I&R ADDK VESSEL",null,null,null,null,null,"TUFTS POS","67108",null,"TUFTS","87901 - HC CHG NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEAS"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","93278","SIGNAL AVERAGED ELECTROCARDIOGRAPHY W/WO ECG","93278 - SIGNAL AVERAGED ELECTROCARDIOGRAPHY W/WO ECG",null,null,null,null,null,"TUFTS POS","67113",null,"TUFTS","88300 - HC CHG LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","93304","HC F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY","93304 - HC F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","67145",null,"TUFTS","90698 - CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","93320","HC DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY","93320 - HC DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY",null,null,null,null,null,"TUFTS SELECT","67210",null,"TUFTS","90836 - PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 45 MIN"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","93463","HC DRUG ADMIN & HEMODYNMIC MEAS","93463 - HC DRUG ADMIN & HEMODYNMIC MEAS",null,null,null,null,null,"TUFTS HMO","67299",null,"TUFTS","92235 - FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","93565","HC NJX SEL L VENT/ATRIAL ANGIO HRT CATH W/S&I","93565 - HC NJX SEL L VENT/ATRIAL ANGIO HRT CATH W/S&I",null,null,null,null,null,"BLUE CROSS-HMO BLUE","67312",null,"TUFTS","92520 - LARYNGEAL FUNCTION STUDIES"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","93619","HC COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION","93619 - HC COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","67316",null,"TUFTS","92593 - HEARING AID CHECK BINAURAL"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","93657","HC ABLATE L/R ATRIAL FIBRIL W/ISOLATED PULM VEIN","93657 - HC ABLATE L/R ATRIAL FIBRIL W/ISOLATED PULM VEIN",null,null,null,null,null,"AETNA","67332",null,"TUFTS","92977 - HC THROMBOLYSIS,CORONARY,IV INFUSN"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","93922","NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL","93922 - NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL",null,null,null,null,null,"TUFTS POS","67345",null,"TUFTS","93350 - HC ECHO HEART XTHORACIC, STRESS/REST WITH CONTRAST"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","93930","HC DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY","93930 - HC DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY",null,null,null,null,null,"TUFTS HMO","67400",null,"TUFTS","93463 - HC DRUG ADMIN & HEMODYNMIC MEAS"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","94010","SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ","94010 - SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","67414",null,"TUFTS","93786 - BL BLD PRESS W/TAPE&/DISK 24/> HR REC ONL"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","94726","PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST","94726 - PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST",null,null,null,null,null,"TUFTS PPO","67515",null,"TUFTS","95024 - INTRACUTANEOUS TESTS W/ALLERGENIC EXTRACTS"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","94770","CARBON DIOXIDE EXP GAS DETER INFRARED ANALYZER","94770 - CARBON DIOXIDE EXP GAS DETER INFRARED ANALYZER",null,null,null,null,null,"TUFTS POS","67550",null,"TUFTS","95199 - PR ALLERGY SP SUBLINGUAL IMMUNOTHERAPY ADMIN"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","95170","PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY WHL INSE","95170 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY WHL INSE",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","67800",null,"TUFTS","95940 - HC IONM 1 ON 1 IN OR W/ATTENDANCE EACH 15 MINUTES"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","95714","HC VEEG EA 12-26 HR UNMNTR","95714 - HC VEEG EA 12-26 HR UNMNTR",null,null,null,null,null,"TUFTS SELECT","67805",null,"TUFTS","96154 - HC HEAL & BEHAV INTERV,EA 15 MIN,FAM W/PT"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","95806","SLEEP STUDY, UNATTENDED, SIMUL RECORD HR/O2 SAT/RESP FLOW/RESP EFF","95806 - SLEEP STUDY, UNATTENDED, SIMUL RECORD HR/O2 SAT/RESP FLOW/RESP EFF",null,null,null,null,null,"TUFTS PPO","67808",null,"TUFTS","96368 - IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","95866","NEEDLE ELECTROMYOGRAPHY HEMIDIAPHRAGM","95866 - NEEDLE ELECTROMYOGRAPHY HEMIDIAPHRAGM",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","67825",null,"TUFTS","97156 - HC FAM ADAPT BHV TX GDN PHY/QHP"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","95909","MOTOR &/SENS 5-6 NRV CNDJ PRECONF ELTRODE LIMB","95909 - MOTOR &/SENS 5-6 NRV CNDJ PRECONF ELTRODE LIMB",null,null,null,null,null,"AETNA","67875",null,"TUFTS","99201 - OFFICE OUTPATIENT NEW 10 MINUTES"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","95933","ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST","95933 - ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST",null,null,null,null,null,"UNITED/HARVARD PILGRIM","67880",null,"TUFTS","99393 - PERIODIC PREVENTIVE MED EST PATIENT 5-11YRS"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","95971","ELEC ALYS NSTIM PLS GEN SMPL SC/PERPH W/PRGRMG","95971 - ELEC ALYS NSTIM PLS GEN SMPL SC/PERPH W/PRGRMG",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","67900",null,"TUFTS","0159T - HC COMPUTER AIDED DETECTION BREAST MRI"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","96132","HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR","96132 - HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","67904",null,"TUFTS PUBLIC PLANS","61641 - HC BALLOON DIALT INTRACRAN VASOSPASM, ADD SAME FAM"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","96159","HC HLTH BHV IVNTJ INDIV EA ADDL","96159 - HC HLTH BHV IVNTJ INDIV EA ADDL",null,null,null,null,null,"CIGNA CARELINK","67911",null,"TUFTS PUBLIC PLANS","77067 - HC SCR MAMM CAD, BI"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","96367","IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR","96367 - IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","67917",null,"TUFTS PUBLIC PLANS","80280 - HC DRUG ASSAY VEDOLIZUMAB"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","96450","CHEMOTX ADMN CNS REQ SPINAL PUNCTURE","96450 - CHEMOTX ADMN CNS REQ SPINAL PUNCTURE",null,null,null,null,null,"BLUE CROSS-HMO BLUE","67930",null,"TUFTS PUBLIC PLANS","81288 - MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","97112","HC THER PX 1/> AREAS EACH 15 MIN NEUROMUSC REEDUCA","97112 - HC THER PX 1/> AREAS EACH 15 MIN NEUROMUSC REEDUCA",null,null,null,null,null,"TUFTS PPO","67961",null,"TUFTS PUBLIC PLANS","82140 - HC CHG ASSAY OF AMMONIA"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","97116","HC THER PX 1/> AREAS EA 15 MIN GAIT TRAINJ W/STAIR","97116 - HC THER PX 1/> AREAS EA 15 MIN GAIT TRAINJ W/STAIR",null,null,null,null,null,"UNITED/HARVARD PILGRIM","67961",null,"TUFTS PUBLIC PLANS","82164 - HC CHG ANGIOTENSIN I-CONVERTING ENZYME"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","97535","HC SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES","97535 - HC SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES",null,null,null,null,null,"BLUE CROSS-INDEMNITY","68100",null,"TUFTS PUBLIC PLANS","82985 - HC CHG ASSAY OF GLYCATED PROTEIN"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","97760","ORTHOTIC MGMT&TRAINJ UXTR LXTR&/TRNK EA 15","97760 - ORTHOTIC MGMT&TRAINJ UXTR LXTR&/TRNK EA 15",null,null,null,null,null,"TUFTS SELECT","68110",null,"TUFTS PUBLIC PLANS","83695 - HC CHG LIPOPROTEIN (A)"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","97811","HC ACUPUNCTURE 1/> NDLS W/O ELEC STIMJ EA 15 MIN","97811 - HC ACUPUNCTURE 1/> NDLS W/O ELEC STIMJ EA 15 MIN",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","68200",null,"TUFTS PUBLIC PLANS","83970 - HC CHG ASSAY OF PARATHORMONE"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","99281","HC ED VAWA W/MSAECK","99281 - HC ED VAWA W/MSAECK",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","68340",null,"TUFTS PUBLIC PLANS","85045 - HC CHG BLOOD COUNT RETICULOCYTE AUTOMATED"]
["BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","99291","CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN","99291 - CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","68362",null,"TUFTS PUBLIC PLANS","85300 - HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY"]
["BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",null,null,null,null,null,"BLUE CROSS-HMO BLUE","68530",null,"TUFTS PUBLIC PLANS","86038 - HC CHG ANTINUCLEAR ANTIBODIES ANA"]
["BMC HEALTHNET","BMCHN MCO","21121","HC RECONST CHIN SLIDE SINGL OSTEOTOMY","21121 - HC RECONST CHIN SLIDE SINGL OSTEOTOMY",null,null,null,null,null,"TUFTS SELECT","68720",null,"TUFTS PUBLIC PLANS","86611 - HC BARTONELLA, ANTIBODY"]
["BMC HEALTHNET","BMCHN MCO","36415","COLLECTION VENOUS BLOOD VENIPUNCTURE","36415 - COLLECTION VENOUS BLOOD VENIPUNCTURE",null,null,null,null,null,"BLUE CROSS-PPO","68761",null,"TUFTS PUBLIC PLANS","86744 - HC CHG ANTIBODY NOCARDIA"]
["BMC HEALTHNET","BMCHN MEDICAID","44381","HC ILEOSCOPY STOMA W/BALLOON DILATION","44381 - HC ILEOSCOPY STOMA W/BALLOON DILATION",null,null,null,null,null,"BLUE CROSS-PPO","68810",null,"TUFTS PUBLIC PLANS","86923 - HC CHG COMPATIBILITY EACH UNIT ELECTRONIC"]
["BMC HEALTHNET","BMCHN QHP","47383","HC ABLATION 1/> LIVER TUMOR PERQ CRYOABLATION","47383 - HC ABLATION 1/> LIVER TUMOR PERQ CRYOABLATION",null,null,null,null,null,"UNITED/HARVARD PILGRIM","68811",null,"TUFTS PUBLIC PLANS","87185 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ"]
["BMC HEALTHNET","BMCHN MCO","61641","HC BALLOON DIALT INTRACRAN VASOSPASM, ADD SAME FAM","61641 - HC BALLOON DIALT INTRACRAN VASOSPASM, ADD SAME FAM",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","69000",null,"TUFTS PUBLIC PLANS","87536 - HC CHG IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION"]
["BMC HEALTHNET","BMCHN MEDICAID","64454","HC NJX AA&/STRD GNCLR NRV BRNCH","64454 - HC NJX AA&/STRD GNCLR NRV BRNCH",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","69020",null,"TUFTS PUBLIC PLANS","88142 - CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN"]
["BMC HEALTHNET","BMCHN MEDICAID","77790","HC BRACHY , SUP. HANDLING, LOADING","77790 - HC BRACHY , SUP. HANDLING, LOADING",null,null,null,null,null,"CIGNA CARELINK","69105",null,"TUFTS PUBLIC PLANS","90876 - HC INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 45 MIN"]
["BMC HEALTHNET","BMCHN WELL SENSE","80048","HC CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - HC CHG BASIC METABOLIC PANEL CALCIUM TOTAL",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","69145",null,"TUFTS PUBLIC PLANS","96105 - ASSESSMENT PHASIA W/INTERP & REPORT PER HOUR"]
["BMC HEALTHNET","BMCHN MCO","80074","HC CHG ACUTE HEPATITIS PANEL","80074 - HC CHG ACUTE HEPATITIS PANEL",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","69209",null,"TUFTS PUBLIC PLANS","97152 - HC BHV ID SUPRT ASSMT BY 1 TECH"]
["BMC HEALTHNET","BMCHN QHP","80164","HC CHG DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL","80164 - HC CHG DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL",null,null,null,null,null,"TUFTS HMO","69220",null,"TUFTS PUBLIC PLANS","99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM"]
["BMC HEALTHNET","BMCHN QHP","80184","HC CHG DRUG SCREEN QUANTITATIVE PHENOBARBITAL","80184 - HC CHG DRUG SCREEN QUANTITATIVE PHENOBARBITAL",null,null,null,null,null,"BLUE CROSS-INDEMNITY","69420",null,"UHC COMMUNITY CARE","80306 - HC DRUG TEST PRSMV INSTRMNT"]
["BMC HEALTHNET","BMC SENIOR CARE OPTIONS","80201","HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE","80201 - HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE",null,null,null,null,null,"BLUE CROSS-HMO BLUE","69436",null,"UHC COMMUNITY CARE","81261 - IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED; PRO/TECH"]
["BMC HEALTHNET","BMC SENIOR CARE OPTIONS","80299","HC INFLIXIMAB DRUG CONC. AND ANTI-INFLIXIMAB AB","80299 - HC INFLIXIMAB DRUG CONC. AND ANTI-INFLIXIMAB AB",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","69501",null,"UHC COMMUNITY CARE","81342 - TRG@ GENE REARRANGEMENT ANALYSIS; PRO/TECH"]
["BMC HEALTHNET","BMCHN MEDICAID","81000","URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY","81000 - URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY",null,null,null,null,null,"BLUE CROSS-PPO","69801",null,"UHC COMMUNITY CARE","82533 - HC CHG CORTISOL TOTAL"]
["BMC HEALTHNET","BMCHN MEDICAID","81003","URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY","81003 - URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","70010",null,"UHC COMMUNITY CARE","82677 - HC CHG ASSAY OF ESTRIOL"]
["BMC HEALTHNET","BMCHN QHP","81178","HC CHG ATXN1 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","81178 - HC CHG ATXN1 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES",null,null,null,null,null,"UNITED/HARVARD PILGRIM","70030",null,"UHC COMMUNITY CARE","83021 - HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY"]
["BMC HEALTHNET","BMCHN MEDICAID","81241","HC CHG F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT","81241 - HC CHG F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT",null,null,null,null,null,"UNITED/HARVARD PILGRIM","70140",null,"UHC COMMUNITY CARE","84307 - HC CHG ASSAY OF SOMATOSTATIN"]
["BMC HEALTHNET","BMCHN QHP","81241","HC CHG F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT","81241 - HC CHG F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","70150",null,"UHC COMMUNITY CARE","84311 - HC CHG SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED"]
["BMC HEALTHNET","BMC SENIOR CARE OPTIONS","81270","HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT","81270 - HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT",null,null,null,null,null,"TUFTS POS","70200",null,"UHC COMMUNITY CARE","85245 - HC CHG CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT"]
["BMC HEALTHNET","BMCHN MCO","81304","HC MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT","81304 - HC MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT",null,null,null,null,null,"TUFTS PPO","70250",null,"UHC COMMUNITY CARE","86304 - HC CRL;CA-125"]
["BMC HEALTHNET","BMCHN MCO","81350","HC CHG UGT1A1 GENE ANALYSIS COMMON VARIANTS","81350 - HC CHG UGT1A1 GENE ANALYSIS COMMON VARIANTS",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","70300",null,"UHC COMMUNITY CARE","86648 - HC CHG ANTIBODY DIPHTHERIA"]
["BMC HEALTHNET","BMCHN MEDICAID","81403","SEQ & EXON 13 SEQ, IF PERFORMED KRAS (EG, CARCINOMA), GENE ANALYSIS, PRO/TECH","81403 - SEQ & EXON 13 SEQ, IF PERFORMED KRAS (EG, CARCINOMA), GENE ANALYSIS, PRO/TECH",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","70320",null,"UHC COMMUNITY CARE","86735 - HC CHG ANTIBODY MUMPS"]
["BMC HEALTHNET","BMCHN MCO","82010","HC CHG KETONE BODIES SERUM QUANTITATIVE","82010 - HC CHG KETONE BODIES SERUM QUANTITATIVE",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","70336",null,"UHC COMMUNITY CARE","87181 - HC CHG SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ"]
["BMC HEALTHNET","BMC SENIOR CARE OPTIONS","82042","HC CHG ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN","82042 - HC CHG ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN",null,null,null,null,null,"TUFTS HMO","70350",null,"UHC COMMUNITY CARE","87299 - HC CHG AG DETECTION NOS, FLUOR"]
["BMC HEALTHNET","BMCHN ACO","82105","HC CHG ALPHA-FETOPROTEIN SERUM","82105 - HC CHG ALPHA-FETOPROTEIN SERUM",null,null,null,null,null,"UNITED/HARVARD PILGRIM","70360",null,"UHC COMMUNITY CARE","87591 - HC CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ"]
["BMC HEALTHNET","BMCHN WELL SENSE","82172","HC CHG APOLIPOPROTEIN EACH","82172 - HC CHG APOLIPOPROTEIN EACH",null,null,null,null,null,"BLUE CROSS-PPO","70390",null,"UHC COMMUNITY CARE","89060 - HC CHG CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID"]
["BMC HEALTHNET","BMCHN QHP","82274","HC CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3","82274 - HC CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3",null,null,null,null,null,"UNICARE","70460",null,"UNICARE","43238 - HC UPR GI NDSC TNDSC US FINE NDL ASPIR/BX ESOPH"]
["BMC HEALTHNET","BMCHN MCO","82310","HC CHG CALCIUM TOTAL","82310 - HC CHG CALCIUM TOTAL",null,null,null,null,null,"TUFTS PPO","70470",null,"UNICARE","43259 - HC UPPER GI NDSC W/NDSC ULTRASOUND EXAM"]
["BMC HEALTHNET","BMC SENIOR CARE OPTIONS","82379","HC CRL;CARNITINE","82379 - HC CRL;CARNITINE",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","70481",null,"UNICARE","45384 - HC COLSC FLX PROX SPLENIC FLXR RMVL LES CAUT"]
["BMC HEALTHNET","BMCHN QHP","82523","HC CHG COLLAGEN CROSS LINKS ANY METHOD","82523 - HC CHG COLLAGEN CROSS LINKS ANY METHOD",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","70488",null,"UNICARE","70150 - HC CHG RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS"]
["BMC HEALTHNET","BMCHN MCO","82533","HC CHG CORTISOL TOTAL","82533 - HC CHG CORTISOL TOTAL",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","70490",null,"UNICARE","70370 - HC CHG RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ"]
["BMC HEALTHNET","BMCHN MEDICAID","82607","HC CHG CYANOCOBALAMIN VITAMIN B-12","82607 - HC CHG CYANOCOBALAMIN VITAMIN B-12",null,null,null,null,null,"TUFTS SELECT","70496",null,"UNICARE","72083 - XRAY EXAM ENTIRE SPINE INCLUDING SKULL, CERV AND SACRAL SPINE; 4 OR 5 VIEWS"]
["BMC HEALTHNET","BMCHN WELL SENSE","82656","HC CHG ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN","82656 - HC CHG ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN",null,null,null,null,null,"BLUE CROSS-PPO","70540",null,"UNICARE","72191 - HC CHG CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST"]
["BMC HEALTHNET","BMCHN MCO","82705","HC CHG FAT/LIPIDS FECES QUALITATIVE","82705 - HC CHG FAT/LIPIDS FECES QUALITATIVE",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","70543",null,"UNICARE","73219 - HC CHG MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL"]
["BMC HEALTHNET","BMCHN QHP","82787","HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES","82787 - HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","70545",null,"UNICARE","74177 - HC CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL"]
["BMC HEALTHNET","BMCHN WELL SENSE","82950","HC CHG GLUCOSE POST GLUCOSE DOSE","82950 - HC CHG GLUCOSE POST GLUCOSE DOSE",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","70547",null,"UNICARE","75710 - HC CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I"]
["BMC HEALTHNET","BMCHN MCO","82985","HC CHG ASSAY OF GLYCATED PROTEIN","82985 - HC CHG ASSAY OF GLYCATED PROTEIN",null,null,null,null,null,"TUFTS PPO","70549",null,"UNICARE","75984 - CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I"]
["BMC HEALTHNET","BMCHN WELL SENSE","83010","HC CHG ASSAY OF HAPTOGLOBIN, QUANT","83010 - HC CHG ASSAY OF HAPTOGLOBIN, QUANT",null,null,null,null,null,"BLUE CROSS-PPO","70552",null,"UNICARE","76802 - US PREG UTERUS 14 WK TRANSABDL EACH GESTATION"]
["BMC HEALTHNET","BMCHN WELL SENSE","83497","HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA","83497 - HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","71023",null,"UNICARE","77300 - HC BASIC DOS"]
["BMC HEALTHNET","BMCHN QHP","83520","HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE","83520 - HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","71046",null,"UNICARE","77470 - HC SPEC TX PROC/CONCURRENT CHEMO"]
["BMC HEALTHNET","BMCHN MCO","83718","HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL","83718 - HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","71100",null,"UNICARE","78608 - HC CHG BRAIN IMAGING PET METABOLIC EVALUATION"]
["BMC HEALTHNET","BMCHN WELL SENSE","83825","HC CHG ASSAY OF MERCURY QUANTITATIVE","83825 - HC CHG ASSAY OF MERCURY QUANTITATIVE",null,null,null,null,null,"TUFTS SELECT","71110",null,"UNICARE","80150 - HC AMIKACIN"]
["BMC HEALTHNET","BMCHN ACO","83918","HC CHG ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN","83918 - HC CHG ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN",null,null,null,null,null,"BLUE CROSS-PPO","71130",null,"UNICARE","81272 - HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS"]
["BMC HEALTHNET","BMCHN WELL SENSE","83918","HC CHG ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN","83918 - HC CHG ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN",null,null,null,null,null,"CIGNA CARELINK","71130",null,"UNICARE","81291 - HC CHG MTHFR GENE ANALYSIS COMMON VARIANTS"]
["BMC HEALTHNET","BMC SENIOR CARE OPTIONS","84105","HC CHG ASSAY OF PHOSPHORUS INORGANIC URINE","84105 - HC CHG ASSAY OF PHOSPHORUS INORGANIC URINE",null,null,null,null,null,"CIGNA CARELINK","71275",null,"UNICARE","82670 - HC CHG ASSAY OF ESTRADIOL"]
["BMC HEALTHNET","BMCHN MEDICAID","84144","HC CHG ASSAY OF PROGESTERONE","84144 - HC CHG ASSAY OF PROGESTERONE",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","71550",null,"UNICARE","83010 - HC CHG ASSAY OF HAPTOGLOBIN, QUANT"]
["BMC HEALTHNET","BMC SENIOR CARE OPTIONS","84155","HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD","84155 - HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD",null,null,null,null,null,"BLUE CROSS-HMO BLUE","71552",null,"UNICARE","83655 - HC CHG ASSAY OF LEAD"]
["BMC HEALTHNET","BMC SENIOR CARE OPTIONS","84255","HC CHG ASSAY OF SELENIUM","84255 - HC CHG ASSAY OF SELENIUM",null,null,null,null,null,"BLUE CROSS-PPO","72050",null,"UNICARE","84466 - HC CHG ASSAY OF L7383TRANSFERRIN"]
["BMC HEALTHNET","BMCHN QHP","84295","HC CHG SODIUM SERUM PLASMA OR WHOLE BLOOD","84295 - HC CHG SODIUM SERUM PLASMA OR WHOLE BLOOD",null,null,null,null,null,"BLUE CROSS-HMO BLUE","72052",null,"UNICARE","84702 - HC HCG TUMOR MARKER"]
["BMC HEALTHNET","BMCHN ACO","84376","HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC","84376 - HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","72070",null,"UNICARE","85378 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN"]
["BMC HEALTHNET","BMCHN QHP","84439","HC CHG ASSAY OF FREE THYROXINE","84439 - HC CHG ASSAY OF FREE THYROXINE",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","72080",null,"UNICARE","86335 - HC CHG IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS"]
["BMC HEALTHNET","BMCHN QHP","84466","HC CHG ASSAY OF L7383TRANSFERRIN","84466 - HC CHG ASSAY OF L7383TRANSFERRIN",null,null,null,null,null,"TUFTS PPO","72082",null,"UNICARE","86689 - HC HTLV/HIV CONFIRMATORY TEST"]
["BMC HEALTHNET","BMCHN ACO","84484","HC CHG ASSAY OF TROPONIN QUANTITATIVE","84484 - HC CHG ASSAY OF TROPONIN QUANTITATIVE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","72084",null,"UNICARE","86803 - HC CHG HEPATITIS C ANTIBODY"]
["BMC HEALTHNET","BMCHN WELL SENSE","84590","HC CHG ASSAY OF VITAMIN A","84590 - HC CHG ASSAY OF VITAMIN A",null,null,null,null,null,"CIGNA CARELINK","72110",null,"UNICARE","87176 - HC CHG HOMOGENIZATION TISSUE CULTURE"]
["BMC HEALTHNET","BMCHN QHP","85018","POC;HEMOGLOBIN","85018 - POC;HEMOGLOBIN",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","72125",null,"UNICARE","87522 - HC ARUP;HEP C VIR RNA QN"]
["BMC HEALTHNET","BMCHN ACO","85049","HC CHG BLOOD COUNT PLATELET AUTOMATED","85049 - HC CHG BLOOD COUNT PLATELET AUTOMATED",null,null,null,null,null,"BLUE CROSS-PPO","72127",null,"UNICARE","88262 - HC CHG CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING"]
["BMC HEALTHNET","BMCHN QHP","85250","HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS","85250 - HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","72130",null,"UNICARE","92081 - VISUAL FIELD XM UNI/BI W/INTERPRETJ LIMITED EXAM"]
["BMC HEALTHNET","BMC SENIOR CARE OPTIONS","85301","HC CHG CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY","85301 - HC CHG CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","72132",null,"UNICARE","92556 - SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ"]
["BMC HEALTHNET","BMCHN MEDICAID","85307","HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY","85307 - HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","72133",null,"UNICARE","93285 - PROGRAM EVAL IMPLANTABLE DEV IN PRSN ILR SYSTEM"]
["BMC HEALTHNET","BMCHN WELL SENSE","85397","HC CHG CLOTTING FUNCTION ACTIVITY NOS, EA ANALYT","85397 - HC CHG CLOTTING FUNCTION ACTIVITY NOS, EA ANALYT",null,null,null,null,null,"UNITED/HARVARD PILGRIM","72142",null,"UNICARE","93531 - RHC/LHC CNGNITL ANMLES"]
["BMC HEALTHNET","BMC SENIOR CARE OPTIONS","85652","HC CHG SEDIMENTATION RATE RBC AUTOMATED","85652 - HC CHG SEDIMENTATION RATE RBC AUTOMATED",null,null,null,null,null,"TUFTS PPO","72148",null,"UNICARE","94002 - HC VENTILATION ASSIST & MGMT INPATIENT 1ST DAY"]
["BMC HEALTHNET","BMCHN QHP","85670","HC CHG THROMBIN TIME PLASMA","85670 - HC CHG THROMBIN TIME PLASMA",null,null,null,null,null,"TUFTS HMO","72149",null,"UNICARE","94664 - HC DEMO/EVAL INHALER/NEBULIZER - PHARM"]
["BMC HEALTHNET","BMC SENIOR CARE OPTIONS","86022","HC CRL;SEROTONIN RLS ASSAY","86022 - HC CRL;SEROTONIN RLS ASSAY",null,null,null,null,null,"TUFTS PPO","72157",null,"UNICARE","96374 - THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG"]
["BMC HEALTHNET","BMC SENIOR CARE OPTIONS","86162","HC CHG COMPLEMENT TOTAL HEMOLYTIC","86162 - HC CHG COMPLEMENT TOTAL HEMOLYTIC",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","72190",null,"UNICARE","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND"]
["BMC HEALTHNET","BMCHN WELL SENSE","86235","HC CHG EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD","86235 - HC CHG EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD",null,null,null,null,null,"CIGNA CARELINK","72191",null,"UNITED HEALTHCARE","10080 - INCISION & DRAINAGE PILONIDAL CYST SIMPLE"]
["BMC HEALTHNET","BMC SENIOR CARE OPTIONS","86308","HC CHG HETEROPHILE ANTIBODIES SCREEN","86308 - HC CHG HETEROPHILE ANTIBODIES SCREEN",null,null,null,null,null,"BLUE CROSS-INDEMNITY","72193",null,"UNITED HEALTHCARE","11306 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM"]
["BMC HEALTHNET","BMCHN MCO","86341","HC CHG ISLET CELL ANTIBODY","86341 - HC CHG ISLET CELL ANTIBODY",null,null,null,null,null,"BLUE CROSS-PPO","72196",null,"UNITED HEALTHCARE","11770 - EXCISION PILONIDAL CYST/SINUS SIMPLE"]
["BMC HEALTHNET","BMCHN ACO","86357","HC NK CELLS, TOTAL COUNT","86357 - HC NK CELLS, TOTAL COUNT",null,null,null,null,null,"BLUE CROSS-INDEMNITY","72197",null,"UNITED HEALTHCARE","12011 - SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<"]
["BMC HEALTHNET","BMCHN ACO","86481","HC TB TEST CELL MEDIATED ANTIGEN RESPONSE, ENUM GAMMA INTERFRON T-CELL","86481 - HC TB TEST CELL MEDIATED ANTIGEN RESPONSE, ENUM GAMMA INTERFRON T-CELL",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","72200",null,"UNITED HEALTHCARE","14301 - ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM"]
["BMC HEALTHNET","BMCHN WELL SENSE","86612","HC CHG BLASTOMYCES ANTIBODY","86612 - HC CHG BLASTOMYCES ANTIBODY",null,null,null,null,null,"UNITED/HARVARD PILGRIM","72240",null,"UNITED HEALTHCARE","17261 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM"]
["BMC HEALTHNET","BMCHN ACO","86632","HC CHG CHLAMYDIA, IGM ANTIBODY","86632 - HC CHG CHLAMYDIA, IGM ANTIBODY",null,null,null,null,null,"BLUE CROSS-HMO BLUE","73000",null,"UNITED HEALTHCARE","19350 - NIPPLE/AREOLA RECONSTRUCTION"]
["BMC HEALTHNET","BMCHN QHP","86645","HC CHG ANTIBODY CYTOMEGALOVIRUS CMV IGM","86645 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV IGM",null,null,null,null,null,"TUFTS HMO","73010",null,"UNITED HEALTHCARE","20611 - HC PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US"]
["BMC HEALTHNET","BMCHN WELL SENSE","86677","HC CHG ANTIBODY HELICOBACTER PYLORI","86677 - HC CHG ANTIBODY HELICOBACTER PYLORI",null,null,null,null,null,"TUFTS POS","73050",null,"UNITED HEALTHCARE","21445 - HC OPEN RX DENTAL RIDGE FX"]
["BMC HEALTHNET","BMCHN MCO","86694","HC CHG ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST","86694 - HC CHG ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST",null,null,null,null,null,"UNICARE","73060",null,"UNITED HEALTHCARE","22510 - PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC"]
["BMC HEALTHNET","BMCHN WELL SENSE","86701","HC HIV-1","86701 - HC HIV-1",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","73080",null,"UNITED HEALTHCARE","23570 - CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION"]
["BMC HEALTHNET","BMCHN ACO","86735","HC CHG ANTIBODY MUMPS","86735 - HC CHG ANTIBODY MUMPS",null,null,null,null,null,"CIGNA CARELINK","73100",null,"UNITED HEALTHCARE","25606 - HC TREAT FX DISTAL RADIAL"]
["BMC HEALTHNET","BMCHN ACO","86769","ANTIBODY; SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2","86769 - ANTIBODY; SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2",null,null,null,null,null,"BLUE CROSS-HMO BLUE","73130",null,"UNITED HEALTHCARE","27048 - EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC <5CM"]
["BMC HEALTHNET","BMC SENIOR CARE OPTIONS","86778","HC Q;TOXOPLASMA IGM,AB","86778 - HC Q;TOXOPLASMA IGM,AB",null,null,null,null,null,"UNITED/HARVARD PILGRIM","73130",null,"UNITED HEALTHCARE","27266 - HC CLOSED RX POST HIP FIX DISLOC,ANESTH"]
["BMC HEALTHNET","BMCHN MEDICAID","86800","HC CHG THYROGLOBULIN ANTIBODY","86800 - HC CHG THYROGLOBULIN ANTIBODY",null,null,null,null,null,"BLUE CROSS-INDEMNITY","73201",null,"UNITED HEALTHCARE","27786 - CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ"]
["BMC HEALTHNET","BMCHN QHP","86900","HC CHG BLOOD TYPING SEROLOGIC ABO","86900 - HC CHG BLOOD TYPING SEROLOGIC ABO",null,null,null,null,null,"TUFTS SELECT","73218",null,"UNITED HEALTHCARE","29240 - STRAPPING SHOULDER"]
["BMC HEALTHNET","BMCHN MCO","86905","HC CHG BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH","86905 - HC CHG BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH",null,null,null,null,null,"TUFTS POS","73219",null,"UNITED HEALTHCARE","29580 - STRAPPING UNNA BOOT"]
["BMC HEALTHNET","BMCHN QHP","87075","HC CHG CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID","87075 - HC CHG CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID",null,null,null,null,null,"UNITED/HARVARD PILGRIM","73222",null,"UNITED HEALTHCARE","31579 - LARYNGOSCOPY FLX/RGD FIBOPT W/STROBOSCOPY"]
["BMC HEALTHNET","BMCHN ACO","87088","HC CHG CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE","87088 - HC CHG CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","73225",null,"UNITED HEALTHCARE","32552 - HC REMOVAL OF LUNG CATHETER"]
["BMC HEALTHNET","BMCHN QHP","87110","HC CHG CULTURE, CHLAMYDIA","87110 - HC CHG CULTURE, CHLAMYDIA",null,null,null,null,null,"CIGNA CARELINK","73502",null,"UNITED HEALTHCARE","33240 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/1 EXISTING LD"]
["BMC HEALTHNET","BMCHN WELL SENSE","87172","HC CHG PINWORM EXAMINATION","87172 - HC CHG PINWORM EXAMINATION",null,null,null,null,null,"UNICARE","73521",null,"UNITED HEALTHCARE","36247 - HC SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH"]
["BMC HEALTHNET","BMCHN ACO","87205","HC CHG SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL","87205 - HC CHG SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","73551",null,"UNITED HEALTHCARE","36576 - HC RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT"]
["BMC HEALTHNET","BMCHN QHP","87220","TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT","87220 - TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT",null,null,null,null,null,"BLUE CROSS-HMO BLUE","73560",null,"UNITED HEALTHCARE","37192 - HC REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I"]
["BMC HEALTHNET","BMC SENIOR CARE OPTIONS","87269","HC CHG IAADI GIARDIA","87269 - HC CHG IAADI GIARDIA",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","73562",null,"UNITED HEALTHCARE","37247 - HC TRLUML BAL ANGIO ADD ART"]
["BMC HEALTHNET","BMCHN ACO","87327","HC CHG IAAD IA CRYPTOCOCCUS NEOFORMANS","87327 - HC CHG IAAD IA CRYPTOCOCCUS NEOFORMANS",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","73590",null,"UNITED HEALTHCARE","41017 - HC XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB"]
["BMC HEALTHNET","BMCHN WELL SENSE","87341","HC CHG IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION","87341 - HC CHG IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION",null,null,null,null,null,"BLUE CROSS-INDEMNITY","73600",null,"UNITED HEALTHCARE","41850 - TREATMENT OF GUM LESION"]
["BMC HEALTHNET","BMCHN WELL SENSE","87449","HC AG DET,ENZ IMM;OTH,EA","87449 - HC AG DET,ENZ IMM;OTH,EA",null,null,null,null,null,"TUFTS SELECT","73630",null,"UNITED HEALTHCARE","43251 - HC UPR GI NDSC RMVL TUM POLYP/OTH LES SNARE TQ"]
["BMC HEALTHNET","BMCHN MCO","87493","HC CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE","87493 - HC CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE",null,null,null,null,null,"TUFTS HMO","73660",null,"UNITED HEALTHCARE","44376 - HC ENTEROSC >2ND PRTN W/ILEUM W/WO COLLJ SPEC SPX"]
["BMC HEALTHNET","BMCHN MEDICAID","87507","HC IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25","87507 - HC IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25",null,null,null,null,null,"UNITED/HARVARD PILGRIM","73701",null,"UNITED HEALTHCARE","45384 - HC COLSC FLX PROX SPLENIC FLXR RMVL LES CAUT"]
["BMC HEALTHNET","BMCHN MCO","87510","HC CHG IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ","87510 - HC CHG IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","73702",null,"UNITED HEALTHCARE","45390 - HC COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION"]
["BMC HEALTHNET","BMCHN ACO","87624","IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES","87624 - IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","73720",null,"UNITED HEALTHCARE","49452 - HC PERC REPL GAST_JEJ TUBE,W"]
["BMC HEALTHNET","BMCHN ACO","87640","HC CHG IADNA S AUREUS AMPLIFIED PROBE TQ","87640 - HC CHG IADNA S AUREUS AMPLIFIED PROBE TQ",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","73722",null,"UNITED HEALTHCARE","51701 - INSJ NON-NDWELLG BLADDER CATHETER"]
["BMC HEALTHNET","BMCHN WELL SENSE","87653","HC CHG IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ","87653 - HC CHG IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","73722",null,"UNITED HEALTHCARE","51798 - MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP"]
["BMC HEALTHNET","BMCHN MEDICAID","87801","HC CHG DETECT AGENT, MULT ORGS, DNA  AMP","87801 - HC CHG DETECT AGENT, MULT ORGS, DNA  AMP",null,null,null,null,null,"TUFTS SELECT","73725",null,"UNITED HEALTHCARE","54520 - HC REMOVAL OF TESTIS"]
["BMC HEALTHNET","BMCHN QHP","88108","HC CHG CYTP CONCENTRATION SMEARS & INTERPRETATION","88108 - HC CHG CYTP CONCENTRATION SMEARS & INTERPRETATION",null,null,null,null,null,"TUFTS SELECT","74021",null,"UNITED HEALTHCARE","57522 - CONIZATION CERVIX W/WO D&C RPR ELTRD EXC"]
["BMC HEALTHNET","BMCHN MEDICAID","88152","HC CHG CYTOPATH SMEAR CERV/VAG,AUTO REDO","88152 - HC CHG CYTOPATH SMEAR CERV/VAG,AUTO REDO",null,null,null,null,null,"TUFTS PPO","74160",null,"UNITED HEALTHCARE","59812 - TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL"]
["BMC HEALTHNET","BMCHN WELL SENSE","88185","HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA","88185 - HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA",null,null,null,null,null,"BLUE CROSS-INDEMNITY","74175",null,"UNITED HEALTHCARE","63662 - HC REMOVE SPINAL NEUROSTIM ELECTRODE PLATE/PADDLE, INCL FLUORO"]
["BMC HEALTHNET","BMCHN MCO","88271","HC CHG MOLECULAR CYTOGENETICS DNA PROBE EACH","88271 - HC CHG MOLECULAR CYTOGENETICS DNA PROBE EACH",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","74177",null,"UNITED HEALTHCARE","64616 - CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA"]
["BMC HEALTHNET","BMCHN WELL SENSE","88311","HC CHG DECALCIFICATION PROCEDURE","88311 - HC CHG DECALCIFICATION PROCEDURE",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","74181",null,"UNITED HEALTHCARE","65222 - RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP"]
["BMC HEALTHNET","BMCHN WELL SENSE","88369","M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC EACH","88369 - M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC EACH",null,null,null,null,null,"BLUE CROSS-PPO","74183",null,"UNITED HEALTHCARE","66179 - HC AQUEOUS SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT"]
["BMC HEALTHNET","BMCHN QHP","90700","CR BUILD ONLY - DTAP IMMUNIZATION, IM, <7 YO,TRAVEL","90700 - CR BUILD ONLY - DTAP IMMUNIZATION, IM, <7 YO,TRAVEL",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","74221",null,"UNITED HEALTHCARE","67345 - HC DESTROY NERVE OF EYE MUSCLE"]
["BMC HEALTHNET","BMCHN ACO","90912","HC BFB TRAINING 1ST 15 MIN","90912 - HC BFB TRAINING 1ST 15 MIN",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","74240",null,"UNITED HEALTHCARE","67923 - HC REPAIR ENTROPION EXCISION TARSAL WEDGE"]
["BMC HEALTHNET","BMCHN MEDICAID","93786","BL BLD PRESS W/TAPE&/DISK 24/> HR REC ONL","93786 - BL BLD PRESS W/TAPE&/DISK 24/> HR REC ONL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","74246",null,"UNITED HEALTHCARE","70100 - HC CHG RADIOLOGIC EXAMINATION MANDIPLE PRTL <4 VIEWS"]
["BMC HEALTHNET","BMCHN QHP","95700","HC EEG CONT REC W/VID EEG TECH","95700 - HC EEG CONT REC W/VID EEG TECH",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","74248",null,"UNITED HEALTHCARE","70491 - HC CHG CT SOFT TISSUE NECK W/CONTRAST MATERIAL"]
["BMC HEALTHNET","BMCHN QHP","95966","HC MEG,EVOKED MAGNET FIELDS, SINGLE MODAL","95966 - HC MEG,EVOKED MAGNET FIELDS, SINGLE MODAL",null,null,null,null,null,"TUFTS HMO","74249",null,"UNITED HEALTHCARE","70555 - HC CHG MRI BRAIN FUNCTIONAL W/PHYSICIAN ADMNISTRATION"]
["BMC HEALTHNET","BMCHN MCO","96136","HC PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN","96136 - HC PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN",null,null,null,null,null,"TUFTS HMO","74261",null,"UNITED HEALTHCARE","72170 - HC CHG RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS"]
["BMC HEALTHNET","BMCHN QHP","96167","HC HLTH BHV IVNTJ FAM 1ST 30","96167 - HC HLTH BHV IVNTJ FAM 1ST 30",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","74270",null,"UNITED HEALTHCARE","73560 - HC CHG RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS"]
["BMC HEALTHNET","BMCHN QHP","96376","HC THERAPEUTIC PROPHYLACTIC/DX NJX INTRA-ARTERIAL","96376 - HC THERAPEUTIC PROPHYLACTIC/DX NJX INTRA-ARTERIAL",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","74280",null,"UNITED HEALTHCARE","73718 - HC CHG MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL"]
["BMC HEALTHNET","BMCHN ACO","97156","HC FAM ADAPT BHV TX GDN PHY/QHP","97156 - HC FAM ADAPT BHV TX GDN PHY/QHP",null,null,null,null,null,"CIGNA CARELINK","74328",null,"UNITED HEALTHCARE","74329 - HC ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I"]
["BMC HEALTHNET","BMCHN QHP","99359","PROLONGED SERV,NO CONTCT,EA ADD 30 MIN","99359 - PROLONGED SERV,NO CONTCT,EA ADD 30 MIN",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","74360",null,"UNITED HEALTHCARE","76377 - HC CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION"]
["BMC HEALTHNET","BMCHN QHP","99402","PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 30 M","99402 - PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 30 M",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","74363",null,"UNITED HEALTHCARE","76641 - HC CHG US BREAST UNI REAL TIME WITH IMAGE COMPLETE"]
["BMC HEALTHNET","BMCHN QHP","99456","WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS","99456 - WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS",null,null,null,null,null,"BLUE CROSS-INDEMNITY","74425",null,"UNITED HEALTHCARE","76870 - ULTRASOUND SCROTUM & CONTENTS"]
["BMC HEALTHNET","BMCHN ACO","G0465","HC AUTOLOG PRP DIAB WOUND ULCER","G0465 - HC AUTOLOG PRP DIAB WOUND ULCER",null,null,null,null,null,"BLUE CROSS-PPO","74450",null,"UNITED HEALTHCARE","77316 - BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL"]
["CIGNA HEALTHCARE","CIGNA CARELINK","10007","HC FNA BX W/FLUOR GDN 1ST LES","10007 - HC FNA BX W/FLUOR GDN 1ST LES",null,null,null,null,null,"BLUE CROSS-HMO BLUE","74455",null,"UNITED HEALTHCARE","77387 - GUIDANCE FOR LOCLZJ TARGET VOL FOR RADJ TX DLVR"]
["CIGNA HEALTHCARE","CIGNA CARELINK","11311","SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM","11311 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","74740",null,"UNITED HEALTHCARE","78430 - HC MYOCRD IMG PET RST/STRS W/CT"]
["CIGNA HEALTHCARE","CIGNA CARELINK","11921","HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM","11921 - HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM",null,null,null,null,null,"BLUE CROSS-HMO BLUE","75561",null,"UNITED HEALTHCARE","80076 - HC CHG HEPATIC FUNCTION PANEL"]
["CIGNA HEALTHCARE","CIGNA CARELINK","12054","REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM","12054 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM",null,null,null,null,null,"BLUE CROSS-INDEMNITY","75565",null,"UNITED HEALTHCARE","80354 - DRUG SCREENING FENTANYL"]
["CIGNA HEALTHCARE","CIGNA CARELINK","15772","HC GRFG AUTOL FAT LIPO EA ADDL","15772 - HC GRFG AUTOL FAT LIPO EA ADDL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","75574",null,"UNITED HEALTHCARE","81307 - HC PALB2 GENE FULL GENE SEQ"]
["CIGNA HEALTHCARE","CIGNA CARELINK","17271","DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM","17271 - DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","75605",null,"UNITED HEALTHCARE","82103 - HC CHG ALPHA-1-ANTITRYPSIN TOTAL"]
["CIGNA HEALTHCARE","CIGNA CARELINK","19120","EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION","19120 - EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","75625",null,"UNITED HEALTHCARE","82330 - HC CHG CALCIUM IONIZED"]
["CIGNA HEALTHCARE","CIGNA CARELINK","20245","BIOPSY BONE OPEN DEEP","20245 - BIOPSY BONE OPEN DEEP",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","75635",null,"UNITED HEALTHCARE","82595 - HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE"]
["CIGNA HEALTHCARE","CIGNA CARELINK","21235","HC GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR","21235 - HC GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR",null,null,null,null,null,"UNITED/HARVARD PILGRIM","75710",null,"UNITED HEALTHCARE","83630 - HC CHG LACTOFERRIN FECAL QUALITATIVE"]
["CIGNA HEALTHCARE","CIGNA CARELINK","23031","HC DRAIN INFECT SHOULDER BURSA","23031 - HC DRAIN INFECT SHOULDER BURSA",null,null,null,null,null,"TUFTS PPO","75731",null,"UNITED HEALTHCARE","84210 - HC CHG ASSAY OF PYRUVATE"]
["CIGNA HEALTHCARE","CIGNA CARELINK","23575","CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION","23575 - CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION",null,null,null,null,null,"TUFTS HMO","75733",null,"UNITED HEALTHCARE","84436 - HC CHG ASSAY OF THYROXINE TOTAL"]
["CIGNA HEALTHCARE","CIGNA CARELINK","25073","HC  EXC TUMOR SFT TISS FOREARM&//WRIST SUBFASC 3+CM","25073 - HC  EXC TUMOR SFT TISS FOREARM&//WRIST SUBFASC 3+CM",null,null,null,null,null,"TUFTS PPO","75741",null,"UNITED HEALTHCARE","85220 - HC CHG CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR"]
["CIGNA HEALTHCARE","CIGNA CARELINK","26700","CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES","26700 - CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES",null,null,null,null,null,"CIGNA CARELINK","75774",null,"UNITED HEALTHCARE","86160 - HC CHG COMPLEMENT ANTIGEN EACH COMPONENT"]
["CIGNA HEALTHCARE","CIGNA CARELINK","27299","PR HIP ABDUCTOR REPAIR","27299 - PR HIP ABDUCTOR REPAIR",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","75805",null,"UNITED HEALTHCARE","86580 - SKIN TEST TUBERCULOSIS INTRADERMAL"]
["CIGNA HEALTHCARE","CIGNA CARELINK","28046","HC RESECT FOOT/TOE TUMOR < 3 CM","28046 - HC RESECT FOOT/TOE TUMOR < 3 CM",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","75810",null,"UNITED HEALTHCARE","86789 - HC CHG ANTIBODY WEST NILE VIRUS"]
["CIGNA HEALTHCARE","CIGNA CARELINK","28525","HC OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE","28525 - HC OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE",null,null,null,null,null,"BLUE CROSS-HMO BLUE","75822",null,"UNITED HEALTHCARE","87076 - HC CHG CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL"]
["CIGNA HEALTHCARE","CIGNA CARELINK","29540","STRAPPING ANKLE &/FOOT","29540 - STRAPPING ANKLE &/FOOT",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","75825",null,"UNITED HEALTHCARE","87255 - HC CHG VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC"]
["CIGNA HEALTHCARE","CIGNA CARELINK","31238","NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMRRG","31238 - NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMRRG",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","75833",null,"UNITED HEALTHCARE","87522 - HC ARUP;HEP C VIR RNA QN"]
["CIGNA HEALTHCARE","CIGNA CARELINK","32160","HC THORACOTOMY W/CARDIAC MASSAGE","32160 - HC THORACOTOMY W/CARDIAC MASSAGE",null,null,null,null,null,"TUFTS SELECT","75860",null,"UNITED HEALTHCARE","88173 - CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT"]
["CIGNA HEALTHCARE","CIGNA CARELINK","33226","HC RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD","33226 - HC RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD",null,null,null,null,null,"TUFTS HMO","75885",null,"UNITED HEALTHCARE","88348 - HC CHG ELECTRON MICROSCOPY DIAGNOSTIC"]
["CIGNA HEALTHCARE","CIGNA CARELINK","36014","HC SLCTV CATHETER PLMT LEFT/RIGHT PULMONARY ARTERY","36014 - HC SLCTV CATHETER PLMT LEFT/RIGHT PULMONARY ARTERY",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","75889",null,"UNITED HEALTHCARE","90648 - HC HIB VACCINE, PRP-T, IM,DPH"]
["CIGNA HEALTHCARE","CIGNA CARELINK","36558","HC INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>","36558 - HC INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>",null,null,null,null,null,"CIGNA CARELINK","75894",null,"UNITED HEALTHCARE","92072 - FITTING CONTACT LENS FOR MNGT OF KERATOCONUS"]
["CIGNA HEALTHCARE","CIGNA CARELINK","36591","COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE","36591 - COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE",null,null,null,null,null,"TUFTS HMO","75898",null,"UNITED HEALTHCARE","92286 - ANT SGM IMAGING W/MICROSCOPY ENDOTHELIAL ANALY"]
["CIGNA HEALTHCARE","CIGNA CARELINK","38200","HC INJ PROC SPLENOPORTO","38200 - HC INJ PROC SPLENOPORTO",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","75989",null,"UNITED HEALTHCARE","92960 - HC CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL"]
["CIGNA HEALTHCARE","CIGNA CARELINK","40812","EXC LES MUCOSA & SBMCSL VESTIBULE SMPL RPR","40812 - EXC LES MUCOSA & SBMCSL VESTIBULE SMPL RPR",null,null,null,null,null,"TUFTS PPO","76001",null,"UNITED HEALTHCARE","93296 - HC REM INTERROG EVL PM/IDS"]
["CIGNA HEALTHCARE","CIGNA CARELINK","41006","HC INTRAORAL I&D TONGUE/FLOOR SUBLNGL DP SPRMLHYD","41006 - HC INTRAORAL I&D TONGUE/FLOOR SUBLNGL DP SPRMLHYD",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","76010",null,"UNITED HEALTHCARE","93316 - HC ECHO TRANSESOPHAG CONGEN PROBE PLCMT ONLY"]
["CIGNA HEALTHCARE","CIGNA CARELINK","42180","HC REPAIR PALATE LACER <2 CM","42180 - HC REPAIR PALATE LACER <2 CM",null,null,null,null,null,"TUFTS HMO","76098",null,"UNITED HEALTHCARE","93591 - HC PERQ TRANSCATH CLS PARAVALVR LEAK 1 AORTIC VALVE"]
["CIGNA HEALTHCARE","CIGNA CARELINK","43274","HC ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT","43274 - HC ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","76380",null,"UNITED HEALTHCARE","94667 - HC CHEST WALL MANIPULATION,INITIAL"]
["CIGNA HEALTHCARE","CIGNA CARELINK","44389","HC COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE","44389 - HC COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE",null,null,null,null,null,"TUFTS SELECT","76391",null,"UNITED HEALTHCARE","95249 - HC CONT GLUC MONITORING PATIENT PROVIDED EQUIPMENT"]
["CIGNA HEALTHCARE","CIGNA CARELINK","45332","HC SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY","45332 - HC SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY",null,null,null,null,null,"TUFTS PUBLIC DIRECT","76497",null,"UNITED HEALTHCARE","95806 - SLEEP STUDY, UNATTENDED, SIMUL RECORD HR/O2 SAT/RESP FLOW/RESP EFF"]
["CIGNA HEALTHCARE","CIGNA CARELINK","46083","INCISION THROMBOSED HEMORRHOID EXTERNAL","46083 - INCISION THROMBOSED HEMORRHOID EXTERNAL",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","76506",null,"UNITED HEALTHCARE","95912 - MOTOR &/SENS 11-12 NRV CNDJ PRECONF ELTRODE LIMB"]
["CIGNA HEALTHCARE","CIGNA CARELINK","49411","INTERSTITIAL DEV PLMT RADIATION THERAPY 1/MLT","49411 - INTERSTITIAL DEV PLMT RADIATION THERAPY 1/MLT",null,null,null,null,null,"UNITED/HARVARD PILGRIM","76512",null,"UNITED HEALTHCARE","96372 - THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM"]
["CIGNA HEALTHCARE","CIGNA CARELINK","50688","CHNG URTROST TUBE/XTRNLLY ACCESSIBLE STENT ILEAL","50688 - CHNG URTROST TUBE/XTRNLLY ACCESSIBLE STENT ILEAL",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","76514",null,"UNITED HEALTHCARE","97802 - MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI"]
["CIGNA HEALTHCARE","CIGNA CARELINK","54115","HC REMV FOR.BODY DEEP PENILE TISS","54115 - HC REMV FOR.BODY DEEP PENILE TISS",null,null,null,null,null,"TUFTS HMO","76529"]
["CIGNA HEALTHCARE","CIGNA CARELINK","57061","DESTRUCTION VAGINAL LESIONS SIMPLE","57061 - DESTRUCTION VAGINAL LESIONS SIMPLE",null,null,null,null,null,"TUFTS PPO","76604"]
["CIGNA HEALTHCARE","CIGNA CARELINK","58145","MYOMECTOMY 1-4 MYOMAS 250 GM/< VAGINAL APPR","58145 - MYOMECTOMY 1-4 MYOMAS 250 GM/< VAGINAL APPR",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","76642"]
["CIGNA HEALTHCARE","CIGNA CARELINK","59840","INDUCED ABORTION DILATION AND CURETTAGE","59840 - INDUCED ABORTION DILATION AND CURETTAGE",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","76705"]
["CIGNA HEALTHCARE","CIGNA CARELINK","64420","INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE","64420 - INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","76775"]
["CIGNA HEALTHCARE","CIGNA CARELINK","64612","CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL","64612 - CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","76800"]
["CIGNA HEALTHCARE","CIGNA CARELINK","65779","HC PLACE AMNIOTIC MEMBRANE OCULAR SURFACE WOUND HEALING, SUTURED","65779 - HC PLACE AMNIOTIC MEMBRANE OCULAR SURFACE WOUND HEALING, SUTURED",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","76805"]
["CIGNA HEALTHCARE","CIGNA CARELINK","66982","REMV CATARACT EXTRACAP,INSERT LENS,COMP","66982 - REMV CATARACT EXTRACAP,INSERT LENS,COMP",null,null,null,null,null,"BLUE CROSS-INDEMNITY","76811"]
["CIGNA HEALTHCARE","CIGNA CARELINK","67107","HC REPAIR RETINAL DETACHMENT SCLERAL BUCKLING","67107 - HC REPAIR RETINAL DETACHMENT SCLERAL BUCKLING",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","76812"]
["CIGNA HEALTHCARE","CIGNA CARELINK","67921","HC FIX ENTROPION,SUTURE","67921 - HC FIX ENTROPION,SUTURE",null,null,null,null,null,"UNITED/HARVARD PILGRIM","76814"]
["CIGNA HEALTHCARE","CIGNA CARELINK","69540","HC REMV AURAL POLYP","69540 - HC REMV AURAL POLYP",null,null,null,null,null,"UNICARE","76817"]
["CIGNA HEALTHCARE","CIGNA CARELINK","70260","HC CHG RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS","70260 - HC CHG RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS",null,null,null,null,null,"TUFTS PPO","76818"]
["CIGNA HEALTHCARE","CIGNA CARELINK","70551","HC CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL","70551 - HC CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL",null,null,null,null,null,"TUFTS PPO","76820"]
["CIGNA HEALTHCARE","CIGNA CARELINK","72148","HC CHG MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL","72148 - HC CHG MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","76826"]
["CIGNA HEALTHCARE","CIGNA CARELINK","73100","XTRNL ECG & 48 HR RECORDING","73100 - XTRNL ECG & 48 HR RECORDING",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","76828"]
["CIGNA HEALTHCARE","CIGNA CARELINK","73630","HC CHG RADEX FOOT COMPLETE MINIMUM 3 VIEWS","73630 - HC CHG RADEX FOOT COMPLETE MINIMUM 3 VIEWS",null,null,null,null,null,"BLUE CROSS-INDEMNITY","76831"]
["CIGNA HEALTHCARE","CIGNA CARELINK","74430","CYSTOGRAPHY MINIMUM 3 VIEWS RS&I","74430 - CYSTOGRAPHY MINIMUM 3 VIEWS RS&I",null,null,null,null,null,"BLUE CROSS-PPO","76870"]
["CIGNA HEALTHCARE","CIGNA CARELINK","75605","HC CHG AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I","75605 - HC CHG AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","76872"]
["CIGNA HEALTHCARE","CIGNA CARELINK","76497","HC CTGUIDE,SOFT TISS ABL","76497 - HC CTGUIDE,SOFT TISS ABL",null,null,null,null,null,"UNICARE","76881"]
["CIGNA HEALTHCARE","CIGNA CARELINK","76945","US GUIDANCE CHORIONIC VILLUS SAMPLING RS&I","76945 - US GUIDANCE CHORIONIC VILLUS SAMPLING RS&I",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","76886"]
["CIGNA HEALTHCARE","CIGNA CARELINK","77084","HC CHG BONE MARROW BLOOD SUPPLY","77084 - HC CHG BONE MARROW BLOOD SUPPLY",null,null,null,null,null,"TUFTS HMO","76940"]
["CIGNA HEALTHCARE","CIGNA CARELINK","77790","HC BRACHY , SUP. HANDLING, LOADING","77790 - HC BRACHY , SUP. HANDLING, LOADING",null,null,null,null,null,"CIGNA CARELINK","76946"]
["CIGNA HEALTHCARE","CIGNA CARELINK","78430","HC MYOCRD IMG PET RST/STRS W/CT","78430 - HC MYOCRD IMG PET RST/STRS W/CT",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","76979"]
["CIGNA HEALTHCARE","CIGNA CARELINK","78597","HC CHG QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING","78597 - HC CHG QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","76981"]
["CIGNA HEALTHCARE","CIGNA CARELINK","78835","HC RP QUAN MEAS SINGLE AREA","78835 - HC RP QUAN MEAS SINGLE AREA",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","76983"]
["CIGNA HEALTHCARE","CIGNA CARELINK","80175","DRUG SCREEN QUANTITATIVE LAMOTRIGINE","80175 - DRUG SCREEN QUANTITATIVE LAMOTRIGINE",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","77002"]
["CIGNA HEALTHCARE","CIGNA","80299","HC INFLIXIMAB DRUG CONC. AND ANTI-INFLIXIMAB AB","80299 - HC INFLIXIMAB DRUG CONC. AND ANTI-INFLIXIMAB AB",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","77011"]
["CIGNA HEALTHCARE","CIGNA","81025","URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS","81025 - URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS",null,null,null,null,null,"BLUE CROSS-PPO","77013"]
["CIGNA HEALTHCARE","CIGNA CARELINK","81329","HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS","81329 - HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","77021"]
["CIGNA HEALTHCARE","CIGNA PPO","82139","HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE","82139 - HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","77048"]
["CIGNA HEALTHCARE","CIGNA PPO","82270","HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER","82270 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER",null,null,null,null,null,"BLUE CROSS-HMO BLUE","77061"]
["CIGNA HEALTHCARE","CIGNA CARELINK","82507","HC CHG ASSAY OF CITRATE","82507 - HC CHG ASSAY OF CITRATE",null,null,null,null,null,"TUFTS PUBLIC DIRECT NON SUBSIDIZ","77063"]
["CIGNA HEALTHCARE","CIGNA","82570","HC CHG CREATININE OTHER SOURCE","82570 - HC CHG CREATININE OTHER SOURCE",null,null,null,null,null,"TUFTS MEDICARE PREFERRED HMO","77065"]
["CIGNA HEALTHCARE","CIGNA PPO","82670","HC CHG ASSAY OF ESTRADIOL","82670 - HC CHG ASSAY OF ESTRADIOL",null,null,null,null,null,"SENIOR WHOLE HEALTH","77066"]
["CIGNA HEALTHCARE","CIGNA CARELINK","82947","HC CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP","82947 - HC CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","77067"]
["CIGNA HEALTHCARE","CIGNA PPO","83014","HC H PYLORI DRUG ADMIN","83014 - HC H PYLORI DRUG ADMIN",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","77073"]
["CIGNA HEALTHCARE","CIGNA PPO","83519","HC CHG IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","83519 - HC CHG IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","77074"]
["CIGNA HEALTHCARE","CIGNA","83718","HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL","83718 - HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","77076"]
["CIGNA HEALTHCARE","CIGNA PPO","83970","HC CHG ASSAY OF PARATHORMONE","83970 - HC CHG ASSAY OF PARATHORMONE",null,null,null,null,null,"TUFTS PPO","77081"]
["CIGNA HEALTHCARE","CIGNA","84132","HC CHG POTASSIUM SERUM PLASMA/WHOLE BLOOD","84132 - HC CHG POTASSIUM SERUM PLASMA/WHOLE BLOOD",null,null,null,null,null,"UNICARE","77084"]
["CIGNA HEALTHCARE","CIGNA CARELINK","84166","HC CHG PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI","84166 - HC CHG PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","77280"]
["CIGNA HEALTHCARE","CIGNA CARELINK","84445","HC CHG THYROID STIMULATING IMMUNE GLOBULINS TSI","84445 - HC CHG THYROID STIMULATING IMMUNE GLOBULINS TSI",null,null,null,null,null,"BLUE CROSS-INDEMNITY","77295"]
["CIGNA HEALTHCARE","CIGNA CARELINK","84460","HC CHG TRANSFERASE ALANINE AMINO (ALT) (SGPT)","84460 - HC CHG TRANSFERASE ALANINE AMINO (ALT) (SGPT)",null,null,null,null,null,"TUFTS POS","77295"]
["CIGNA HEALTHCARE","CIGNA CARELINK","84591","HC CHG ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED","84591 - HC CHG ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","77301"]
["CIGNA HEALTHCARE","CIGNA CARELINK","85280","HC CHG CLOTTING FACTOR XII HAGEMAN","85280 - HC CHG CLOTTING FACTOR XII HAGEMAN",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","77317"]
["CIGNA HEALTHCARE","CIGNA CARELINK","85366","HC CHG FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ","85366 - HC CHG FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ",null,null,null,null,null,"BLUE CROSS-PPO","77321"]
["CIGNA HEALTHCARE","CIGNA","85549","HC CHG MURAMIDASE","85549 - HC CHG MURAMIDASE",null,null,null,null,null,"BLUE CROSS-PPO","77331"]
["CIGNA HEALTHCARE","CIGNA CARELINK","86060","HC CHG ANTISTREPTOLYSIN O TITER","86060 - HC CHG ANTISTREPTOLYSIN O TITER",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","77334"]
["CIGNA HEALTHCARE","CIGNA","86255","HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY","86255 - HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","77336"]
["CIGNA HEALTHCARE","CIGNA PPO","86340","HC CHG INTRINSIC FACTOR ANTIBODIES","86340 - HC CHG INTRINSIC FACTOR ANTIBODIES",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","77370"]
["CIGNA HEALTHCARE","CIGNA","86611","HC BARTONELLA, ANTIBODY","86611 - HC BARTONELLA, ANTIBODY",null,null,null,null,null,"TUFTS SELECT","77373"]
["CIGNA HEALTHCARE","CIGNA","86648","HC CHG ANTIBODY DIPHTHERIA","86648 - HC CHG ANTIBODY DIPHTHERIA",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","77387"]
["CIGNA HEALTHCARE","CIGNA","86692","HC CHG ANTIBODY HEP DELTA AGENT","86692 - HC CHG ANTIBODY HEP DELTA AGENT",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","77402"]
["CIGNA HEALTHCARE","CIGNA CARELINK","86706","HC CHG HEPATITIS B SURF ANTIBODY HBSAB","86706 - HC CHG HEPATITIS B SURF ANTIBODY HBSAB",null,null,null,null,null,"BLUE CROSS-PPO","77412"]
["CIGNA HEALTHCARE","CIGNA PPO","86790","HC CHG ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED","86790 - HC CHG ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED",null,null,null,null,null,"CIGNA CARELINK","77470"]
["CIGNA HEALTHCARE","CIGNA","86817","HC CHG HLA TYPING DR/DQ MULTIPLE ANTIGENS","86817 - HC CHG HLA TYPING DR/DQ MULTIPLE ANTIGENS",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","77520"]
["CIGNA HEALTHCARE","CIGNA","87110","HC CHG CULTURE, CHLAMYDIA","87110 - HC CHG CULTURE, CHLAMYDIA",null,null,null,null,null,"BLUE CROSS-INDEMNITY","77761"]
["CIGNA HEALTHCARE","CIGNA","87186","HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ","87186 - HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ",null,null,null,null,null,"BLUE CROSS-HMO BLUE","77763"]
["CIGNA HEALTHCARE","CIGNA","87210","SMR PRIM SRC WET MOUNT NFCT AGT","87210 - SMR PRIM SRC WET MOUNT NFCT AGT",null,null,null,null,null,"UNITED/HARVARD PILGRIM","77763"]
["CIGNA HEALTHCARE","CIGNA CARELINK","87341","HC CHG IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION","87341 - HC CHG IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","77770"]
["CIGNA HEALTHCARE","CIGNA PPO","87481","HC CHG CANDIDA, DNA, AMP PROBE","87481 - HC CHG CANDIDA, DNA, AMP PROBE",null,null,null,null,null,"UNICARE","77772"]
["CIGNA HEALTHCARE","CIGNA PPO","87522","HC ARUP;HEP C VIR RNA QN","87522 - HC ARUP;HEP C VIR RNA QN",null,null,null,null,null,"TUFTS POS","77789"]
["CIGNA HEALTHCARE","CIGNA CARELINK","87661","IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH","87661 - IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH",null,null,null,null,null,"TUFTS PPO","77799"]
["CIGNA HEALTHCARE","CIGNA CARELINK","88160","HC CHG CYTP SMRS ANY OTH SRC SCR&INTERPJ","88160 - HC CHG CYTP SMRS ANY OTH SRC SCR&INTERPJ",null,null,null,null,null,"UNICARE","78014"]
["CIGNA HEALTHCARE","CIGNA CARELINK","88262","HC CHG CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING","88262 - HC CHG CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","78020"]
["CIGNA HEALTHCARE","CIGNA PPO","88307","HC CHG LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM","88307 - HC CHG LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM",null,null,null,null,null,"CIGNA CARELINK","78071"]
["CIGNA HEALTHCARE","CIGNA CARELINK","88380","HC CHG MICRODISSECTION PREP IDENTIFIED TARGET LASER","88380 - HC CHG MICRODISSECTION PREP IDENTIFIED TARGET LASER",null,null,null,null,null,"BLUE CROSS-HMO BLUE","78104"]
["CIGNA HEALTHCARE","CIGNA CARELINK","90371","HC HEPB IG, IM","90371 - HC HEPB IG, IM",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","78104"]
["CIGNA HEALTHCARE","CIGNA CARELINK","91034","GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT","91034 - GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","78216"]
["CIGNA HEALTHCARE","CIGNA CARELINK","92235","FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT","92235 - FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","78226"]
["CIGNA HEALTHCARE","CIGNA CARELINK","92544","OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC","92544 - OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC",null,null,null,null,null,"UNICARE","78258"]
["CIGNA HEALTHCARE","CIGNA CARELINK","92567","TYMPANOMETRY","92567 - TYMPANOMETRY",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","78264"]
["CIGNA HEALTHCARE","CIGNA CARELINK","93279","PROGRAM EVAL IMPLANTABLE IN PRSN 1 LD PACEMAKER","93279 - PROGRAM EVAL IMPLANTABLE IN PRSN 1 LD PACEMAKER",null,null,null,null,null,"BLUE CROSS-INDEMNITY","78300"]
["CIGNA HEALTHCARE","CIGNA CARELINK","93299","INTERROGATION EVAL REMOTE </30 D TECH REVIEW","93299 - INTERROGATION EVAL REMOTE </30 D TECH REVIEW",null,null,null,null,null,"BLUE CROSS-INDEMNITY","78305"]
["CIGNA HEALTHCARE","CIGNA CARELINK","93463","HC DRUG ADMIN & HEMODYNMIC MEAS","93463 - HC DRUG ADMIN & HEMODYNMIC MEAS",null,null,null,null,null,"UNICARE","78306"]
["CIGNA HEALTHCARE","CIGNA CARELINK","93923","NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS","93923 - NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","78428"]
["CIGNA HEALTHCARE","CIGNA CARELINK","94660","HC CPAP VENTILATION CPAP INITIATION&MGMT","94660 - HC CPAP VENTILATION CPAP INITIATION&MGMT",null,null,null,null,null,"BLUE CROSS-HMO BLUE","78431"]
["CIGNA HEALTHCARE","CIGNA CARELINK","95199","PR ALLERGY SP SUBLINGUAL IMMUNOTHERAPY ADMIN","95199 - PR ALLERGY SP SUBLINGUAL IMMUNOTHERAPY ADMIN",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","78433"]
["CIGNA HEALTHCARE","CIGNA CARELINK","95867","NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI","95867 - NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","78445"]
["CIGNA HEALTHCARE","CIGNA CARELINK","96113","HC DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN","96113 - HC DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN",null,null,null,null,null,"TUFTS SELECT","78453"]
["CIGNA HEALTHCARE","CIGNA CARELINK","96368","IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS","96368 - IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS",null,null,null,null,null,"TUFTS HMO","78458"]
["CIGNA HEALTHCARE","CIGNA CARELINK","97602","RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS","97602 - RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS",null,null,null,null,null,"BLUE CROSS-HMO BLUE","78491"]
["CIGNA HEALTHCARE","CIGNA CARELINK","99201","OFFICE OUTPATIENT NEW 10 MINUTES","99201 - OFFICE OUTPATIENT NEW 10 MINUTES",null,null,null,null,null,"CIGNA CARELINK","78492"]
["CIGNA HEALTHCARE","CIGNA CARELINK","99393","PERIODIC PREVENTIVE MED EST PATIENT 5-11YRS","99393 - PERIODIC PREVENTIVE MED EST PATIENT 5-11YRS",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","78580"]
["COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","80074","HC CHG ACUTE HEPATITIS PANEL","80074 - HC CHG ACUTE HEPATITIS PANEL",null,null,null,null,null,"UNICARE","78597"]
["COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","81178","HC CHG ATXN1 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","81178 - HC CHG ATXN1 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES",null,null,null,null,null,"TUFTS PPO","78605"]
["COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","81301","HC CHG MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF","81301 - HC CHG MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF",null,null,null,null,null,"TUFTS POS","78608"]
["COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","82017","HC CHG ACYLCARNITINES QUANTIATIVE EACH SPECIMEN","82017 - HC CHG ACYLCARNITINES QUANTIATIVE EACH SPECIMEN",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","78645"]
["COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","82626","HC CHG DEHYDROEPIANDROSTERONE","82626 - HC CHG DEHYDROEPIANDROSTERONE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","78707"]
["COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","82952","HC CHG GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS","82952 - HC CHG GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","78708"]
["COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","83525","HC CHG ASSAY OF INSULIN TOTAL","83525 - HC CHG ASSAY OF INSULIN TOTAL",null,null,null,null,null,"BLUE CROSS-INDEMNITY","78800"]
["COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","84443","HC CHG ASSAY OF THYROID STIMULATING HORMONE TSH","84443 - HC CHG ASSAY OF THYROID STIMULATING HORMONE TSH",null,null,null,null,null,"BLUE CROSS-INDEMNITY","78804"]
["COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","84480","HC CHG ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3","84480 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3",null,null,null,null,null,"TUFTS HMO","78804"]
["COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","85305","HC CHG CLOTTING INHIBITORS PROTEIN S TOTAL","85305 - HC CHG CLOTTING INHIBITORS PROTEIN S TOTAL",null,null,null,null,null,"ALLWAYS HLTH ACO","78807"]
["COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","86615","HC Q;BORDTLLA AB;IGG,IGA","86615 - HC Q;BORDTLLA AB;IGG,IGA",null,null,null,null,null,"BLUE CROSS-INDEMNITY","78815"]
["COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","86703","HC HIV 1/2 ANTIBODY","86703 - HC HIV 1/2 ANTIBODY",null,null,null,null,null,"TUFTS SELECT","78816"]
["COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","86778","HC Q;TOXOPLASMA IGM,AB","86778 - HC Q;TOXOPLASMA IGM,AB",null,null,null,null,null,"UNITED/HARVARD PILGRIM","78830"]
["COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","87252","HC CHG VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT","87252 - HC CHG VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT",null,null,null,null,null,"BLUE CROSS-HMO BLUE","79005"]
["COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","87480","HC CHG IADNA CANDIDA SPECIES DIRECT PROBE TQ","87480 - HC CHG IADNA CANDIDA SPECIES DIRECT PROBE TQ",null,null,null,null,null,"TUFTS PPO","79101"]
["COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","87661","IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH","87661 - IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH",null,null,null,null,null,"TUFTS PPO","79445"]
["COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","90740","HC HEP B VACCINE,DIAL/IMMUNOSUP, IM","90740 - HC HEP B VACCINE,DIAL/IMMUNOSUP, IM",null,null,null,null,null,"TUFTS PUBLIC UNIFY","80048"]
["ELDER SERVICE PLAN","ELEMENT CARE INC","80156","HC CHG DRUG ASSAY CARBAMAZEPINE TOTAL","80156 - HC CHG DRUG ASSAY CARBAMAZEPINE TOTAL",null,null,null,null,null,"TUFTS POS","80051"]
["ELDER SERVICE PLAN","ELEMENT CARE INC","80175","DRUG SCREEN QUANTITATIVE LAMOTRIGINE","80175 - DRUG SCREEN QUANTITATIVE LAMOTRIGINE",null,null,null,null,null,"ALLWAYS HLTH ACO","80053"]
["ELDER SERVICE PLAN","ELEMENT CARE INC","81025","URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS","81025 - URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS",null,null,null,null,null,"AETNA-MEDICARE ADVANTAGE","80055"]
["ELDER SERVICE PLAN","ELEMENT CARE INC","81304","HC MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT","81304 - HC MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT",null,null,null,null,null,"BMC SENIOR CARE OPTIONS","80061"]
["ELDER SERVICE PLAN","ELEMENT CARE INC","81401","HC CHG, MOLECULAR PATHOLOGY PROCEDURE LEVEL 2","81401 - HC CHG, MOLECULAR PATHOLOGY PROCEDURE LEVEL 2",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","80061"]
["ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","82274","HC CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3","82274 - HC CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3",null,null,null,null,null,"UNITED/HARVARD PILGRIM","80069"]
["ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","82495","HC CHG ASSAY OF CHROMIUM","82495 - HC CHG ASSAY OF CHROMIUM",null,null,null,null,null,"TUFTS SELECT","80074"]
["ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","82550","HC CHG CREATINE KINASE TOTAL","82550 - HC CHG CREATINE KINASE TOTAL",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","80076"]
["ELDER SERVICE PLAN","ELEMENT CARE INC","82805","HC CHG GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY","82805 - HC CHG GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY",null,null,null,null,null,"ELDER SERVICE PLAN OTHER","80145"]
["ELDER SERVICE PLAN","ELEMENT CARE INC","83020","HC CHG HEMOGLOBIN ELECTROPHORESIS","83020 - HC CHG HEMOGLOBIN ELECTROPHORESIS",null,null,null,null,null,"CIGNA CARELINK","80150"]
["ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","83615","HC CHG LACTATE DEHYDROGENASE LDH","83615 - HC CHG LACTATE DEHYDROGENASE LDH",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","80156"]
["ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","83915","HC CHG ASSAY OF NUCLEOTIDASE 5'-","83915 - HC CHG ASSAY OF NUCLEOTIDASE 5'-",null,null,null,null,null,"TUFTS PUBLIC DIRECT","80156"]
["ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","84165","HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM","84165 - HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM",null,null,null,null,null,"UHC COMMUNITY CARE (EVERCARE)","80158"]
["ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","84311","HC CHG SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED","84311 - HC CHG SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED",null,null,null,null,null,"FALLON MEDICAID","80162"]
["ELDER SERVICE PLAN","ELEMENT CARE INC","84630","HC CHG ASSAY OF ZINC","84630 - HC CHG ASSAY OF ZINC",null,null,null,null,null,"TUFTS POS","80164"]
["ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","85230","HC CHG CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR","85230 - HC CHG CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR",null,null,null,null,null,"CIGNA CARELINK","80168"]
["ELDER SERVICE PLAN","ELEMENT CARE INC","85280","HC CHG CLOTTING FACTOR XII HAGEMAN","85280 - HC CHG CLOTTING FACTOR XII HAGEMAN",null,null,null,null,null,"TUFTS MEDICARE PREFERRED HMO","80168"]
["ELDER SERVICE PLAN","ELEMENT CARE INC","86141","HC CRL;CARDIO CRP","86141 - HC CRL;CARDIO CRP",null,null,null,null,null,"BMCHN MCO","80170"]
["ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","86317","HC IMMUNOASSAY,INFECT AGENT,QUANT","86317 - HC IMMUNOASSAY,INFECT AGENT,QUANT",null,null,null,null,null,"UNITED HEALTHCARE","80170"]
["ELDER SERVICE PLAN","ELEMENT CARE INC","86481","HC TB TEST CELL MEDIATED ANTIGEN RESPONSE, ENUM GAMMA INTERFRON T-CELL","86481 - HC TB TEST CELL MEDIATED ANTIGEN RESPONSE, ENUM GAMMA INTERFRON T-CELL",null,null,null,null,null,"TUFTS PPO","80171"]
["ELDER SERVICE PLAN","ELEMENT CARE INC","86615","HC Q;BORDTLLA AB;IGG,IGA","86615 - HC Q;BORDTLLA AB;IGG,IGA",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","80175"]
["ELDER SERVICE PLAN","ELEMENT CARE INC","86710","HC INFLUENZA VIRUS","86710 - HC INFLUENZA VIRUS",null,null,null,null,null,"TUFTS MEDICARE SCO","80177"]
["ELDER SERVICE PLAN","ELEMENT CARE INC","86778","HC Q;TOXOPLASMA IGM,AB","86778 - HC Q;TOXOPLASMA IGM,AB",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","80178"]
["ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","86850","HC CHG ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE","86850 - HC CHG ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE",null,null,null,null,null,"TUFTS PPO","80178"]
["ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","87149","HC CHG CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM","87149 - HC CHG CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM",null,null,null,null,null,"TUFTS PUBLIC DIRECT NON SUBSIDIZ","80184"]
["ELDER SERVICE PLAN","ELEMENT CARE INC","87253","HC CHG VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE","87253 - HC CHG VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE",null,null,null,null,null,"FALLON SENIOR PLAN","80185"]
["ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","87341","HC CHG IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION","87341 - HC CHG IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","80186"]
["ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","87496","HC ARUP;CYTOMEG VIR PCR,CSF","87496 - HC ARUP;CYTOMEG VIR PCR,CSF",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","80186"]
["ELDER SERVICE PLAN","ELEMENT CARE INC","87653","HC CHG IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ","87653 - HC CHG IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","80195"]
["ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","88147","HC CHG CYTOPATH SMEAR CERV/VAG AUTOMATED","88147 - HC CHG CYTOPATH SMEAR CERV/VAG AUTOMATED",null,null,null,null,null,"BMCHN ACO","80197"]
["ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","90732","CR BUILD ONLY - PNEUMOCOCCAL VACCINE,23-VALENT,ADULT,TRAVEL","90732 - CR BUILD ONLY - PNEUMOCOCCAL VACCINE,23-VALENT,ADULT,TRAVEL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","80198"]
["ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","77066","HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","80201"]
["ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","80230","HC DRUG ASSAY INFLIXIMAB","80230 - HC DRUG ASSAY INFLIXIMAB",null,null,null,null,null,"TUFTS SPIRIT","80201"]
["ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","81276","HC CHG KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)","81276 - HC CHG KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)",null,null,null,null,null,"TUFTS POS","80202"]
["ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","82104","HC CHG ALPHA-1-ANTITRYPSIN PHENOTYPE","82104 - HC CHG ALPHA-1-ANTITRYPSIN PHENOTYPE",null,null,null,null,null,"SENIOR WHOLE HEALTH","80203"]
["ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","82306","HC CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED","82306 - HC CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED",null,null,null,null,null,"UNITED/HARVARD PILGRIM","80203"]
["ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","82746","HC CHG ASSAY OF FOLIC ACID SERUM","82746 - HC CHG ASSAY OF FOLIC ACID SERUM",null,null,null,null,null,"UHC COMMUNITY CARE (EVERCARE)","80235"]
["ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","83918","HC CHG ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN","83918 - HC CHG ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN",null,null,null,null,null,"BLUE CROSS-PPO","80299"]
["ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","84165","HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM","84165 - HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM",null,null,null,null,null,"TUFTS MEDICARE PREFERRED HMO","80299"]
["ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","84442","HC CHG ASSAY OF THYROXINE BNDNG GLOBULIN","84442 - HC CHG ASSAY OF THYROXINE BNDNG GLOBULIN",null,null,null,null,null,"BLUE CROSS-PPO","80306"]
["ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","85810","HC CHG VISCOSITY","85810 - HC CHG VISCOSITY",null,null,null,null,null,"TUFTS PUBLIC DIRECT","80307"]
["ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","86140","C-REACTIVE PROTEIN","86140 - C-REACTIVE PROTEIN",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","80307"]
["ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","86612","HC CHG BLASTOMYCES ANTIBODY","86612 - HC CHG BLASTOMYCES ANTIBODY",null,null,null,null,null,"BMCHN MCO","80329"]
["ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","86800","HC CHG THYROGLOBULIN ANTIBODY","86800 - HC CHG THYROGLOBULIN ANTIBODY",null,null,null,null,null,"BMCHN MEDICAID","80345"]
["ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","87207","SMR PRIM SRC SPEC STAIN BODIES/PARASITS","87207 - SMR PRIM SRC SPEC STAIN BODIES/PARASITS",null,null,null,null,null,"BLUE CROSS-INDEMNITY","80353"]
["ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","87340","HC CHG IAAD IA HEPATITIS B SURFACE ANTIGEN","87340 - HC CHG IAAD IA HEPATITIS B SURFACE ANTIGEN",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","80353"]
["ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","87899","HC MALARIA ANTIGEN","87899 - HC MALARIA ANTIGEN",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","80361"]
["ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","90662","INFLUENZA VACCINE CELL CULT PRSRV FREE IM FLUZONE HIGH DOSE","90662 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM FLUZONE HIGH DOSE",null,null,null,null,null,"BLUE CROSS-HMO BLUE","80366"]
["FALLON","FALLON MEDICAID","51702","INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE","51702 - INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE",null,null,null,null,null,"TUFTS PUBLIC DIRECT","80438"]
["FALLON","FALLON MEDICAID","69090","EAR PIERCING","69090 - EAR PIERCING",null,null,null,null,null,"BMCHN MCO","81000"]
["FALLON","FALLON MEDICAID","80158","HC CHG DRUG ASSAY CYCLOSPORINE","80158 - HC CHG DRUG ASSAY CYCLOSPORINE",null,null,null,null,null,"BLUE CROSS-MEDICARE ADVANTAGE","81001"]
["FALLON","FALLON MEDICAID","80177","DRUG SCREEN QUANTITATIVE LEVETIRACETAM","80177 - DRUG SCREEN QUANTITATIVE LEVETIRACETAM",null,null,null,null,null,"NEIGHBORHOOD PACE (ESP EB)","81001"]
["FALLON","FALLON SENIOR PLAN","81000","URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY","81000 - URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY",null,null,null,null,null,"CCA ONE CARE","81002"]
["FALLON","FALLON SENIOR PLAN","81259","HC HBA1/HBA2 GENE ANALYSIS FULL GENE SEQUENCE","81259 - HC HBA1/HBA2 GENE ANALYSIS FULL GENE SEQUENCE",null,null,null,null,null,"TUFTS HMO","81003"]
["FALLON","FALLON SENIOR PLAN","81276","HC CHG KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)","81276 - HC CHG KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)",null,null,null,null,null,"UNITED HEALTHCARE","81003"]
["FALLON","FALLON MEDICAID","82042","HC CHG ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN","82042 - HC CHG ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN",null,null,null,null,null,"CIGNA","81025"]
["FALLON","FALLON MEDICAID","82150","HC CHG ASSAY OF AMYLASE","82150 - HC CHG ASSAY OF AMYLASE",null,null,null,null,null,"TUFTS PUBLIC DIRECT","81025"]
["FALLON","FALLON SENIOR PLAN","82340","HC Q;KID STONE, UR CALCIUM","82340 - HC Q;KID STONE, UR CALCIUM",null,null,null,null,null,"NEIGHBORHOOD PACE (ESP EB)","81050"]
["FALLON","FALLON SENIOR PLAN","82575","HC CHG CREATININE CLEARANCE","82575 - HC CHG CREATININE CLEARANCE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","81161"]
["FALLON","FALLON MEDICAID","82785","HC CHG ASSAY OF GAMMAGLOBULIN IGE","82785 - HC CHG ASSAY OF GAMMAGLOBULIN IGE",null,null,null,null,null,"CCA ONE CARE","81178"]
["FALLON","FALLON SENIOR PLAN","83002","HC CHG GONADOTROPIN LUTEINIZING HORMONE","83002 - HC CHG GONADOTROPIN LUTEINIZING HORMONE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","81179"]
["FALLON","FALLON MEDICAID","83525","HC CHG ASSAY OF INSULIN TOTAL","83525 - HC CHG ASSAY OF INSULIN TOTAL",null,null,null,null,null,"UNITED/HARVARD PILGRIM","81179"]
["FALLON","FALLON MEDICAID","83937","HC CHG ASSAY OF OSTEOCALCIN","83937 - HC CHG ASSAY OF OSTEOCALCIN",null,null,null,null,null,"BMC SENIOR CARE OPTIONS","81206"]
["FALLON","FALLON MEDICAID","84146","HC CHG ASSAY OF PROLACTIN","84146 - HC CHG ASSAY OF PROLACTIN",null,null,null,null,null,"UNICARE","81206"]
["FALLON","FALLON MEDICAID","84439","HC CHG ASSAY OF FREE THYROXINE","84439 - HC CHG ASSAY OF FREE THYROXINE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","81210"]
["FALLON","FALLON SENIOR PLAN","84550","HC CHG ASSAY OF BLOOD/URIC ACID","84550 - HC CHG ASSAY OF BLOOD/URIC ACID",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","81210"]
["FALLON","FALLON SENIOR PLAN","84681","HC CHG ASSAY OF C-PEPTIDE","84681 - HC CHG ASSAY OF C-PEPTIDE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","81218"]
["FALLON","FALLON SENIOR PLAN","85461","HC CHG HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE","85461 - HC CHG HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE",null,null,null,null,null,"UNITED/HARVARD PILGRIM","81220"]
["FALLON","FALLON MEDICAID","86022","HC CRL;SEROTONIN RLS ASSAY","86022 - HC CRL;SEROTONIN RLS ASSAY",null,null,null,null,null,"UHC COMMUNITY CARE (EVERCARE)","81221"]
["FALLON","FALLON SENIOR PLAN","86308","HC CHG HETEROPHILE ANTIBODIES SCREEN","86308 - HC CHG HETEROPHILE ANTIBODIES SCREEN",null,null,null,null,null,"UNITED/HARVARD PILGRIM","81222"]
["FALLON","FALLON MEDICAID","86334","HC CHG IMMUNOFIXJ ELECTROPHORESIS SERUM","86334 - HC CHG IMMUNOFIXJ ELECTROPHORESIS SERUM",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","81223"]
["FALLON","FALLON SENIOR PLAN","86652","HC CHG, ENCEPHAL ANTIBODY EAST EQU","86652 - HC CHG, ENCEPHAL ANTIBODY EAST EQU",null,null,null,null,null,"BLUE CROSS-PPO","81235"]
["FALLON","FALLON SENIOR PLAN","86694","HC CHG ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST","86694 - HC CHG ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST",null,null,null,null,null,"TUFTS MEDICARE SCO","81235"]
["FALLON","FALLON SENIOR PLAN","86710","HC INFLUENZA VIRUS","86710 - HC INFLUENZA VIRUS",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","81240"]
["FALLON","FALLON MEDICAID","86880","HC CHG ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM","86880 - HC CHG ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM",null,null,null,null,null,"CIGNA CARELINK","81241"]
["FALLON","FALLON SENIOR PLAN","87086","HC CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE","87086 - HC CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE",null,null,null,null,null,"BLUE CROSS-PPO","81243"]
["FALLON","FALLON MEDICAID","87184","HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD","87184 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","81252"]
["FALLON","FALLON MEDICAID","87281","HC CHG IAADI PNEUMOCUSTIS CARINII","87281 - HC CHG IAADI PNEUMOCUSTIS CARINII",null,null,null,null,null,"BLUE CROSS-PPO","81253"]
["FALLON","FALLON SENIOR PLAN","87491","HC CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ","87491 - HC CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ",null,null,null,null,null,"ELDER SERVICE PLAN OTHER","81254"]
["FALLON","FALLON MEDICAID","87538","HC HIV-2 PROBE&REVRSE TRNSCRIPJ","87538 - HC HIV-2 PROBE&REVRSE TRNSCRIPJ",null,null,null,null,null,"BMCHN QHP","81256"]
["FALLON","FALLON SENIOR PLAN","88143","HC CHG CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS","88143 - HC CHG CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS",null,null,null,null,null,"TUFTS PUBLIC UNIFY","81257"]
["FALLON","FALLON SENIOR PLAN","88264","HC CHG CHRMSM ANALYZE 20-25 CELLS","88264 - HC CHG CHRMSM ANALYZE 20-25 CELLS",null,null,null,null,null,"FALLON SENIOR PLAN","81259"]
["FALLON","FALLON SENIOR PLAN","90691","CR BUILD ONLY - TYPHOID VACCINE, IM,TRAVEL","90691 - CR BUILD ONLY - TYPHOID VACCINE, IM,TRAVEL",null,null,null,null,null,"BMCHN ACO","81261"]
["FALLON","FALLON MEDICAID","95992","CANALITH REPOSITIONING PROCEDURE","95992 - CANALITH REPOSITIONING PROCEDURE",null,null,null,null,null,"BMC SENIOR CARE OPTIONS","81269"]
["FALLON","FALLON MEDICAID","97755","HC ASSTV TECHNOL ASSMT DIR CNTCT W/REPRT EA 15 MIN","97755 - HC ASSTV TECHNOL ASSMT DIR CNTCT W/REPRT EA 15 MIN",null,null,null,null,null,"BMCHN ACO","81270"]
["FALLON","FALLON MEDICAID","99402","PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 30 M","99402 - PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 30 M",null,null,null,null,null,"TUFTS MEDICARE PREFERRED HMO","81270"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","10010","HC FNA BX W/CT GDN EA ADDL","10010 - HC FNA BX W/CT GDN EA ADDL",null,null,null,null,null,"TUFTS MEDICARE PREFERRED HMO","81271"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","11103","HC TANGNTL BX SKIN EA SEP/ADDL","11103 - HC TANGNTL BX SKIN EA SEP/ADDL",null,null,null,null,null,"UNITED/HARVARD PILGRIM","81272"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","11307","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM","11307 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","81274"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","11420","EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<","11420 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<",null,null,null,null,null,"BLUE CROSS-INDEMNITY","81275"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","11642","HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL","11642 - HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL",null,null,null,null,null,"BMCHN QHP","81276"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","11755","BIOPSY NAIL UNIT SEPARATE PROCEDURE","11755 - BIOPSY NAIL UNIT SEPARATE PROCEDURE",null,null,null,null,null,"TUFTS PUBLIC TOGETHER","81276"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","12013","SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM","12013 - SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","81288"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","13101","REPAIR COMPLEX TRUNK 2.6-7.5 CM","13101 - REPAIR COMPLEX TRUNK 2.6-7.5 CM",null,null,null,null,null,"BMCHN MCO","81291"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","15003","HC WOUND PREP, PED, TRK/ARM/LG ADDL 100 CM","15003 - HC WOUND PREP, PED, TRK/ARM/LG ADDL 100 CM",null,null,null,null,null,"BMCHN ACO","81301"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","15272","APP SKN SUB GRFT T/A/L AREA/100SCM EA ADL 25SC","15272 - APP SKN SUB GRFT T/A/L AREA/100SCM EA ADL 25SC",null,null,null,null,null,"TUFTS SPIRIT","81301"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","16000","HC INITIAL RX BURN(S) 1ST DEGREE","16000 - HC INITIAL RX BURN(S) 1ST DEGREE",null,null,null,null,null,"BLUE CROSS-PPO","81304"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","17260","DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<","17260 - DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<",null,null,null,null,null,"UNITED HEALTHCARE","81304"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","19285","PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG","19285 - PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","81307"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","20100","HC EXPLORE WOUND,NECK","20100 - HC EXPLORE WOUND,NECK",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","81308"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","20605","ARTHROCENTESIS ASPIR&/INJECTION INTERM JT/BURS","20605 - ARTHROCENTESIS ASPIR&/INJECTION INTERM JT/BURS",null,null,null,null,null,"TUFTS HMO","81309"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","20680","REMOVAL IMPLANT DEEP","20680 - REMOVAL IMPLANT DEEP",null,null,null,null,null,"BLUE CROSS-HMO BLUE","81311"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","21073","HC MANIPULATION TMJ THERAPEUTIC REQUIRE ANESTHESIA","21073 - HC MANIPULATION TMJ THERAPEUTIC REQUIRE ANESTHESIA",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","81315"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","21337","HC CLOSED RX NASAL SEPTAL FRACTURE","21337 - HC CLOSED RX NASAL SEPTAL FRACTURE",null,null,null,null,null,"AETNA-MEDICARE ADVANTAGE","81329"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","21552","EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>","21552 - EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>",null,null,null,null,null,"TUFTS PUBLIC DIRECT","81329"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","23500","CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION","23500 - CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION",null,null,null,null,null,"FALLON MEDICAID","81342"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","23625","CLTX GRTER HUMERAL TUBEROSITY FX W/MANIPULATION","23625 - CLTX GRTER HUMERAL TUBEROSITY FX W/MANIPULATION",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","81342"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","24560","CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ","24560 - CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ",null,null,null,null,null,"TUFTS PUBLIC TOGETHER","81350"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","25248","HC REMOVE FOREARM/WRIST FOREIGN BODY","25248 - HC REMOVE FOREARM/WRIST FOREIGN BODY",null,null,null,null,null,"ALLWAYS HLTH ACO","81364"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","25690","CLOSED TX LUNATE DISLOCATION W/MANIPULATION","25690 - CLOSED TX LUNATE DISLOCATION W/MANIPULATION",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","81364"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","26600","CLTX METACARPAL FX W/O MANIPULATION EACH BONE","26600 - CLTX METACARPAL FX W/O MANIPULATION EACH BONE",null,null,null,null,null,"TUFTS PUBLIC TOGETHER","81401"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","27041","HC BX SOFT TISSUES,PELV/HIP,DEEP","27041 - HC BX SOFT TISSUES,PELV/HIP,DEEP",null,null,null,null,null,"UHC COMMUNITY CARE (EVERCARE)","81402"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","27327","EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ <3CM","27327 - EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ <3CM",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","81404"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","27550","CLOSED TX KNEE DISLOCATION W/O ANESTHESIA","27550 - CLOSED TX KNEE DISLOCATION W/O ANESTHESIA",null,null,null,null,null,"ALLWAYS HLTH ACO","81405"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","27840","CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA","27840 - CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA",null,null,null,null,null,"SENIOR WHOLE HEALTH","81406"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","28220","HC RELEASE FLEX FOOT TENDON,SINGLE","28220 - HC RELEASE FLEX FOOT TENDON,SINGLE",null,null,null,null,null,"FALLON MEDICAID","81430"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","28296","HC CORRJ HALLUX VALGUS W/SESMDC W/DIST METAR OSTEOT","28296 - HC CORRJ HALLUX VALGUS W/SESMDC W/DIST METAR OSTEOT",null,null,null,null,null,"TUFTS SELECT","81430"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","29405","APPLICATION SHORT LEG CAST BELOW KNEE-TOE","29405 - APPLICATION SHORT LEG CAST BELOW KNEE-TOE",null,null,null,null,null,"FALLON SENIOR PLAN","81450"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","29740","HC WEDGING OF CAST","29740 - HC WEDGING OF CAST",null,null,null,null,null,"BMCHN MCO","81479"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","30465","REPAIR NASAL VESTIBULAR STENOSIS","30465 - REPAIR NASAL VESTIBULAR STENOSIS",null,null,null,null,null,"BLUE CROSS-MEDICARE ADVANTAGE","81542"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","30801","ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC","30801 - ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC",null,null,null,null,null,"TUFTS SPIRIT","81542"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","31615","TRACHEOBRNCHSC THRU EST TRACHS INC","31615 - TRACHEOBRNCHSC THRU EST TRACHS INC",null,null,null,null,null,"BMCHN WELL SENSE","82009"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","31640","HC BRONCHOSCOPY,EXCIS LESN","31640 - HC BRONCHOSCOPY,EXCIS LESN",null,null,null,null,null,"TUFTS PUBLIC DIRECT","82009"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","32554","THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING","32554 - THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING",null,null,null,null,null,"BMCHN WELL SENSE","82010"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","33233","HC REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY","33233 - HC REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY",null,null,null,null,null,"FALLON MEDICAID","82017"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","33286","HC RMVL SUBQ CAR RHYTHM MNTR","33286 - HC RMVL SUBQ CAR RHYTHM MNTR",null,null,null,null,null,"BLUE CROSS-PPO","82024"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","36217","HC SLCTV CATHJ 3RD+ ORD SLCTV THRC/BRCH/CPHLC BRNCH","36217 - HC SLCTV CATHJ 3RD+ ORD SLCTV THRC/BRCH/CPHLC BRNCH",null,null,null,null,null,"TUFTS PUBLIC TOGETHER","82024"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","36410","VNPNXR 3 YEARS/> PHYS/QHP SKILL","36410 - VNPNXR 3 YEARS/> PHYS/QHP SKILL",null,null,null,null,null,"TUFTS MEDICARE PREFERRED HMO","82040"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","36556","HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/>","36556 - HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/>",null,null,null,null,null,"TUFTS MEDICARE PREFERRED HMO","82042"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","36582","HC RPLCMT COMPL TUN CTR VAD W/SUBQ PORT","36582 - HC RPLCMT COMPL TUN CTR VAD W/SUBQ PORT",null,null,null,null,null,"BMCHN WELL SENSE","82043"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","37193","HC RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I","37193 - HC RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","82075"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","37225","HC REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL","37225 - HC REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL",null,null,null,null,null,"BLUE CROSS-PPO","82085"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","37233","HC REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA VSL","37233 - HC REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA VSL",null,null,null,null,null,"ELDER SERVICE PLAN OTHER","82085"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","38550","HC REMOVAL CYST HYGROMA","38550 - HC REMOVAL CYST HYGROMA",null,null,null,null,null,"TUFTS SELECT","82088"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","40819","EXC FRENUM LABIAL/BUCCAL","40819 - EXC FRENUM LABIAL/BUCCAL",null,null,null,null,null,"TUFTS MEDICARE PREFERRED HMO","82103"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","41007","HC I&D MOUTH/TONG INTRA,SUBMENTAL","41007 - HC I&D MOUTH/TONG INTRA,SUBMENTAL",null,null,null,null,null,"UNITED/HARVARD PILGRIM","82103"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","41822","EXCIS FIBROUS TUBER,DENTOALV","41822 - EXCIS FIBROUS TUBER,DENTOALV",null,null,null,null,null,"UHC COMMUNITY CARE (EVERCARE)","82104"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","42804","BIOPSY NASOPHARYNX VISIBLE LESION SIMPLE","42804 - BIOPSY NASOPHARYNX VISIBLE LESION SIMPLE",null,null,null,null,null,"BLUE CROSS-PPO","82139"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","43193","HC ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY","43193 - HC ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY",null,null,null,null,null,"SENIOR WHOLE HEALTH","82139"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","43235","HC UPPER GI NDSC DX W/WO COLLECTION SPECIMEN","43235 - HC UPPER GI NDSC DX W/WO COLLECTION SPECIMEN",null,null,null,null,null,"BLUE CROSS-PPO","82140"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","43270","HC EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE","43270 - HC EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE",null,null,null,null,null,"BMCHN MEDICAID","82150"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","43761","REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO","43761 - REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO",null,null,null,null,null,"TUFTS SPIRIT","82150"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","44391","HC COLONOSCOPY STOMA CONTROL BLEEDING","44391 - HC COLONOSCOPY STOMA CONTROL BLEEDING",null,null,null,null,null,"TUFTS MEDICARE PREFERRED HMO","82157"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","45379","HC COLSC FLX PROX SPLENIC FLXR RMVL FB","45379 - HC COLSC FLX PROX SPLENIC FLXR RMVL FB",null,null,null,null,null,"TUFTS PUBLIC DIRECT NON SUBSIDIZ","82164"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","46220","EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS","46220 - EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS",null,null,null,null,null,"TUFTS POS","82172"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","47382","HC ABLTJ 1/> LVR TUM PRQ RF","47382 - HC ABLTJ 1/> LVR TUM PRQ RF",null,null,null,null,null,"SENIOR WHOLE HEALTH","82175"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","49082","ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE","49082 - ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE",null,null,null,null,null,"BMCHN MEDICAID","82180"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","49423","HC EXCHNG ABSC/CST DRG CATH RAD GID SPX","49423 - HC EXCHNG ABSC/CST DRG CATH RAD GID SPX",null,null,null,null,null,"TUFTS PUBLIC TOGETHER","82180"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","50684","INJ PX URETEROGRAPHY/URETEROPYLOGRAPHY CATH","50684 - INJ PX URETEROGRAPHY/URETEROPYLOGRAPHY CATH",null,null,null,null,null,"BLUE CROSS-INDEMNITY","82247"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","51702","INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE","51702 - INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","82247"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","52310","CYSTO W/SIMPLE REMOVAL STONE & STENT","52310 - CYSTO W/SIMPLE REMOVAL STONE & STENT",null,null,null,null,null,"NEIGHBORHOOD PACE (ESP EB)","82248"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","53854","HC TRURL DSTRJ PRST8 TISS RF WV THERMOTHERAPY","53854 - HC TRURL DSTRJ PRST8 TISS RF WV THERMOTHERAPY",null,null,null,null,null,"TUFTS PUBLIC DIRECT NON SUBSIDIZ","82248"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","55100","DRAIN SCROTAL WALL ABS","55100 - DRAIN SCROTAL WALL ABS",null,null,null,null,null,"TUFTS PPO","82270"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","57020","COLPOCENTESIS SEPARATE PROCEDURE","57020 - COLPOCENTESIS SEPARATE PROCEDURE",null,null,null,null,null,"TUFTS MEDICARE PREFERRED HMO","82271"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","57421","COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX","57421 - COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX",null,null,null,null,null,"BMCHN WELL SENSE","82274"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","58674","HC LAPS ABLTJ UTERINE FIBROIDS","58674 - HC LAPS ABLTJ UTERINE FIBROIDS",null,null,null,null,null,"TUFTS SELECT","82306"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","59412","EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS","59412 - EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","82308"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","61626","HC TCAT PERMANT OCCLUSION/EMBOLIZATION PRQ NON-CNS","61626 - HC TCAT PERMANT OCCLUSION/EMBOLIZATION PRQ NON-CNS",null,null,null,null,null,"UHC COMMUNITY CARE (EVERCARE)","82308"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","63650","HC PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL","63650 - HC PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL",null,null,null,null,null,"AETNA-MEDICARE ADVANTAGE","82330"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","64447","HC INJECTION ANESTHETIC AGENT FEMORAL NERVE SINGLE","64447 - HC INJECTION ANESTHETIC AGENT FEMORAL NERVE SINGLE",null,null,null,null,null,"TUFTS POS","82330"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","64495","NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL","64495 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL",null,null,null,null,null,"CIGNA CARELINK","82340"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","64633","DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA","64633 - DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA",null,null,null,null,null,"BLUE CROSS-PPO","82365"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","65210","HC RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR","65210 - HC RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","82374"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","65750","HC KERATOPLASTY PENETRAING APHAKIA","65750 - HC KERATOPLASTY PENETRAING APHAKIA",null,null,null,null,null,"TUFTS SPIRIT","82374"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","66711","HC ECP CILIARY BODY DESTRUCTION","66711 - HC ECP CILIARY BODY DESTRUCTION",null,null,null,null,null,"AETNA-MEDICARE ADVANTAGE","82378"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","67028","INTRAVITREAL NJX PHARMACOLOGIC AGT SPX","67028 - INTRAVITREAL NJX PHARMACOLOGIC AGT SPX",null,null,null,null,null,"TUFTS POS","82378"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","67105","RPR RETINAL DTCHMNT 1/> SES PC W/WO DRG SUBRETI","67105 - RPR RETINAL DTCHMNT 1/> SES PC W/WO DRG SUBRETI",null,null,null,null,null,"ALLWAYS HLTH ACO","82379"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","67316","HC STRABISMUS RECESSION/RESCJ 2/MORE VER MUSC","67316 - HC STRABISMUS RECESSION/RESCJ 2/MORE VER MUSC",null,null,null,null,null,"TUFTS POS","82379"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","67917","REPAIR ECTROPION EXTENSIVE","67917 - REPAIR ECTROPION EXTENSIVE",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","82390"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","68362","HC CONJUNCTIVAL FLAP TOTAL","68362 - HC CONJUNCTIVAL FLAP TOTAL",null,null,null,null,null,"UNITED HEALTHCARE","82390"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","68750","HC CREATE TEAR DUCT DRAIN","68750 - HC CREATE TEAR DUCT DRAIN",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","82397"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","70150","HC CHG RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS","70150 - HC CHG RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS",null,null,null,null,null,"TUFTS POS","82435"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","70328","RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT","70328 - RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT",null,null,null,null,null,"BLUE CROSS-INDEMNITY","82436"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","70482","HC CHG CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR","70482 - HC CHG CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR",null,null,null,null,null,"TUFTS POS","82436"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","71110","HC CHG RADEX RIBS BILATERAL 3 VIEWS","71110 - HC CHG RADEX RIBS BILATERAL 3 VIEWS",null,null,null,null,null,"TUFTS PUBLIC TOGETHER","82438"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","72070","HC CHG RADEX SPINE THORACIC 2 VIEWS","72070 - HC CHG RADEX SPINE THORACIC 2 VIEWS",null,null,null,null,null,"FALLON MEDICAID","82465"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","72129","HC CHG CT THORACIC SPINE W/CONTRAST MATERIAL","72129 - HC CHG CT THORACIC SPINE W/CONTRAST MATERIAL",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","82495"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","72193","HC CHG CT PELVIS W/CONTRAST MATERIAL","72193 - HC CHG CT PELVIS W/CONTRAST MATERIAL",null,null,null,null,null,"UNITED/HARVARD PILGRIM","82495"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","73130","HC CHG RADEX HAND MINIMUM 3 VIEWS","73130 - HC CHG RADEX HAND MINIMUM 3 VIEWS",null,null,null,null,null,"AETNA-MEDICARE ADVANTAGE","82523"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","73600","HC CHG RADIOLOGIC EXAMINATION ANKLE 2 VIEWS","73600 - HC CHG RADIOLOGIC EXAMINATION ANKLE 2 VIEWS",null,null,null,null,null,"BLUE CROSS-PPO","82525"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","74021","HC XRAY ABD 3+ VIEWS","74021 - HC XRAY ABD 3+ VIEWS",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","82525"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","74221","HC X-RAY XM ESOPHAGUS 2CNTRST","74221 - HC X-RAY XM ESOPHAGUS 2CNTRST",null,null,null,null,null,"FALLON MEDICAID","82530"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","74262","HC CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST","74262 - HC CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST",null,null,null,null,null,"TUFTS PUBLIC TOGETHER","82530"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","75625","HC CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I","75625 - HC CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","82540"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","75831","HC CHG VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I","75831 - HC CHG VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I",null,null,null,null,null,"AETNA-MEDICARE ADVANTAGE","82542"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","75891","HC CHG HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I","75891 - HC CHG HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I",null,null,null,null,null,"BMCHN WELL SENSE","82542"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","76512","OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN","76512 - OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","82550"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","76812","US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT","76812 - US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT",null,null,null,null,null,"BLUE CROSS-PPO","82553"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","76872","ULTRASOUND TRANSRECTAL","76872 - ULTRASOUND TRANSRECTAL",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","82553"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","76982","HC USE 1ST TARGET LESION","76982 - HC USE 1ST TARGET LESION",null,null,null,null,null,"FALLON MEDICAID","82565"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","77075","HC CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL","77075 - HC CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL",null,null,null,null,null,"TUFTS MEDICARE PREFERRED HMO","82570"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","77300","HC BASIC DOS","77300 - HC BASIC DOS",null,null,null,null,null,"BLUE CROSS-HMO BLUE","82575"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","77763","HC BRACHY INCAV CMP","77763 - HC BRACHY INCAV CMP",null,null,null,null,null,"NEIGHBORHOOD PACE (ESP EB)","82585"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","78072","HC PARATHYROID W SPECTCTAL","78072 - HC PARATHYROID W SPECTCTAL",null,null,null,null,null,"BLUE CROSS-PPO","82595"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","78431","HC MYOCRD IMG PET RST&STRS CT","78431 - HC MYOCRD IMG PET RST&STRS CT",null,null,null,null,null,"ALLWAYS HLTH ACO","82607"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","78645","HC CHG CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ","78645 - HC CHG CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ",null,null,null,null,null,"UNITED HEALTHCARE","82607"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","78830","HC RP LOCLZJ TUM SPECT W/CT 1","78830 - HC RP LOCLZJ TUM SPECT W/CT 1",null,null,null,null,null,"TUFTS MEDICARE PREFERRED HMO","82626"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","80055","HC CHG OBSTETRIC PANEL","80055 - HC CHG OBSTETRIC PANEL",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","82627"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","80158","HC CHG DRUG ASSAY CYCLOSPORINE","80158 - HC CHG DRUG ASSAY CYCLOSPORINE",null,null,null,null,null,"TUFTS MEDICARE PREFERRED HMO","82627"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","80230","HC DRUG ASSAY INFLIXIMAB","80230 - HC DRUG ASSAY INFLIXIMAB",null,null,null,null,null,"UNICARE","82652"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","80345","HC CHG DRUG SCREENING BARBITURATES","80345 - HC CHG DRUG SCREENING BARBITURATES",null,null,null,null,null,"FALLON MEDICAID","82656"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","81025","URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS","81025 - URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","82657"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","81229","HC CYTOG ALYS CHRML ABNR SNPCGH","81229 - HC CYTOG ALYS CHRML ABNR SNPCGH",null,null,null,null,null,"BLUE CROSS-HMO BLUE","82668"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","81272","HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS","81272 - HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS",null,null,null,null,null,"AETNA-MEDICARE ADVANTAGE","82670"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","81307","HC PALB2 GENE FULL GENE SEQ","81307 - HC PALB2 GENE FULL GENE SEQ",null,null,null,null,null,"TUFTS POS","82670"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","81596","HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR","81596 - HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR",null,null,null,null,null,"ALLWAYS HLTH ACO","82693"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","82075","HC CHG ASSAY OF ALCOHOL BREATH","82075 - HC CHG ASSAY OF ALCOHOL BREATH",null,null,null,null,null,"FALLON MEDICAID","82693"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","82172","HC CHG APOLIPOPROTEIN EACH","82172 - HC CHG APOLIPOPROTEIN EACH",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","82705"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","82378","HC CHG CARCINOEMBRYONIC ANTIGEN CEA","82378 - HC CHG CARCINOEMBRYONIC ANTIGEN CEA",null,null,null,null,null,"BMCHN MEDICAID","82728"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","82525","HC CHG ASSAY OF COPPER","82525 - HC CHG ASSAY OF COPPER",null,null,null,null,null,"AETNA-MEDICARE ADVANTAGE","82731"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","82595","HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE","82595 - HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE",null,null,null,null,null,"TUFTS POS","82731"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","82728","HC CHG ASSAY OF FERRITIN","82728 - HC CHG ASSAY OF FERRITIN",null,null,null,null,null,"ELEMENT CARE INC","82746"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","82962","HC GLUCOMETER - PHARM","82962 - HC GLUCOMETER - PHARM",null,null,null,null,null,"FALLON MEDICAID","82747"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","83021","HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY","83021 - HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","82784"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","83690","HC CHG ASSAY OF LIPASE","83690 - HC CHG ASSAY OF LIPASE",null,null,null,null,null,"BMCHN QHP","82785"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","83880","HC CHG NATRIURETIC PEPTIDE","83880 - HC CHG NATRIURETIC PEPTIDE",null,null,null,null,null,"AETNA-MEDICARE ADVANTAGE","82787"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","83921","HC CHG ORGANIC ACID 1 QUANTITATIVE","83921 - HC CHG ORGANIC ACID 1 QUANTITATIVE",null,null,null,null,null,"BMCHN QHP","82787"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","84100","HC CHG ASSAY OF PHOSPHORUS INORGANIC","84100 - HC CHG ASSAY OF PHOSPHORUS INORGANIC",null,null,null,null,null,"AETNA-MEDICARE ADVANTAGE","82803"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","84300","HC CHG ASSAY OF URINE SODIUM","84300 - HC CHG ASSAY OF URINE SODIUM",null,null,null,null,null,"FALLON MEDICAID","82805"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","84439","HC CHG ASSAY OF FREE THYROXINE","84439 - HC CHG ASSAY OF FREE THYROXINE",null,null,null,null,null,"BMCHN ACO","82810"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","84446","HC CHG ASSAY OF TOCOPHEROL ALPHA VITAMIN E","84446 - HC CHG ASSAY OF TOCOPHEROL ALPHA VITAMIN E",null,null,null,null,null,"FALLON MEDICAID","82810"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","84681","HC CHG ASSAY OF C-PEPTIDE","84681 - HC CHG ASSAY OF C-PEPTIDE",null,null,null,null,null,"TUFTS MEDICARE PREFERRED HMO","82941"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","85055","HC CHG RETICULATED PLATELET ASSAY","85055 - HC CHG RETICULATED PLATELET ASSAY",null,null,null,null,null,"CIGNA PPO","82945"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","85270","HC CHG CLOTTING FACTOR XI PTA","85270 - HC CHG CLOTTING FACTOR XI PTA",null,null,null,null,null,"AETNA-MEDICARE ADVANTAGE","82947"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","85549","HC CHG MURAMIDASE","85549 - HC CHG MURAMIDASE",null,null,null,null,null,"BLUE CROSS-MEDICARE ADVANTAGE","82950"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","85732","HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA","85732 - HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA",null,null,null,null,null,"TUFTS PUBLIC DIRECT SUBSIDIZED","82950"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","86147","HC Q;CARDLIP AB;IGG,IGM,IGA","86147 - HC Q;CARDLIP AB;IGG,IGM,IGA",null,null,null,null,null,"FALLON MEDICAID","82951"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","86316","HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE","86316 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE",null,null,null,null,null,"BMCHN MCO","82952"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","86431","HC CHG RHEUMATOID FACTOR QUANTITATIVE","86431 - HC CHG RHEUMATOID FACTOR QUANTITATIVE",null,null,null,null,null,"BMCHN QHP","82960"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","86592","HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL","86592 - HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL",null,null,null,null,null,"TUFTS MEDICARE PREFERRED HMO","82960"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","86677","HC CHG ANTIBODY HELICOBACTER PYLORI","86677 - HC CHG ANTIBODY HELICOBACTER PYLORI",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","82977"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","86703","HC HIV 1/2 ANTIBODY","86703 - HC HIV 1/2 ANTIBODY",null,null,null,null,null,"TUFTS PUBLIC DIRECT SUBSIDIZED","82977"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","86708","HC CHG HEPATITIS A ANTIBODY HAAB","86708 - HC CHG HEPATITIS A ANTIBODY HAAB",null,null,null,null,null,"BLUE CROSS-PPO","82985"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","86800","HC CHG THYROGLOBULIN ANTIBODY","86800 - HC CHG THYROGLOBULIN ANTIBODY",null,null,null,null,null,"CIGNA","83001"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","86900","HC CHG BLOOD TYPING SEROLOGIC ABO","86900 - HC CHG BLOOD TYPING SEROLOGIC ABO",null,null,null,null,null,"UNITED HEALTHCARE","83001"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","87046","HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA","87046 - HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA",null,null,null,null,null,"TUFTS MEDICARE PREFERRED HMO","83002"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","87118","HC CHG CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL","87118 - HC CHG CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL",null,null,null,null,null,"FALLON MEDICAID","83003"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","87207","SMR PRIM SRC SPEC STAIN BODIES/PARASITS","87207 - SMR PRIM SRC SPEC STAIN BODIES/PARASITS",null,null,null,null,null,"NEIGHBORHOOD PACE (ESP EB)","83010"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","87279","HC CHG IAADI PARAINFLUENZA VIRUS EACH TYPE","87279 - HC CHG IAADI PARAINFLUENZA VIRUS EACH TYPE",null,null,null,null,null,"BMC SENIOR CARE OPTIONS","83013"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","87350","HC CHG IAAD IA HEPATITIS BE ANTIGEN","87350 - HC CHG IAAD IA HEPATITIS BE ANTIGEN",null,null,null,null,null,"TUFTS PUBLIC DIRECT SUBSIDIZED","83013"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","87498","HC CHG IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP","87498 - HC CHG IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP",null,null,null,null,null,"UNITED HEALTHCARE","83014"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","87517","HC CHG IADNA HEPATITIS B VIRUS QUANTIFICATION","87517 - HC CHG IADNA HEPATITIS B VIRUS QUANTIFICATION",null,null,null,null,null,"CIGNA CARELINK","83020"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","87798","HC EBV DNA, QL PCR","87798 - HC EBV DNA, QL PCR",null,null,null,null,null,"TUFTS PUBLIC DIRECT","83021"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","88112","HC CHG CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V","88112 - HC CHG CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V",null,null,null,null,null,"NEIGHBORHOOD PACE (ESP EB)","83030"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","88235","HC CHG TISSUE CULTURE, PLACENTA","88235 - HC CHG TISSUE CULTURE, PLACENTA",null,null,null,null,null,"BMCHN QHP","83036"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","88319","HC CHG SPECIAL STAIN I&R GROUP III ENZYME CONSITUENTS","88319 - HC CHG SPECIAL STAIN I&R GROUP III ENZYME CONSITUENTS",null,null,null,null,null,"BMCHN MCO","83050"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","88368","HC CHG M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL","88368 - HC CHG M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL",null,null,null,null,null,"UNITED HEALTHCARE","83050"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","90461","IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT","90461 - IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","83070"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","90636","HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM","90636 - HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM",null,null,null,null,null,"UNITED HEALTHCARE","83070"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","90723","CR BUILD ONLY - DTAP/HEPB/IPV VACCINE,IM,DPH","90723 - CR BUILD ONLY - DTAP/HEPB/IPV VACCINE,IM,DPH",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","83497"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","90867","HC TRANSCRANIAL MAGNETIC STIMULATION TREATMENT,PLANNING","90867 - HC TRANSCRANIAL MAGNETIC STIMULATION TREATMENT,PLANNING",null,null,null,null,null,"TUFTS PUBLIC DIRECT","83497"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","92018","HC NEW EYE EXAM & TREATMENT","92018 - HC NEW EYE EXAM & TREATMENT",null,null,null,null,null,"NEIGHBORHOOD PACE (ESP EB)","83498"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","92270","ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT","92270 - ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT",null,null,null,null,null,"BMCHN WELL SENSE","83516"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","92544","OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC","92544 - OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC",null,null,null,null,null,"BMCHN MCO","83519"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","92576","SYNTHETIC SENTENCE IDENTIFICATION TEST","92576 - SYNTHETIC SENTENCE IDENTIFICATION TEST",null,null,null,null,null,"UNITED HEALTHCARE","83519"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","92625","HC TINNITUS ASSESSMENT","92625 - HC TINNITUS ASSESSMENT",null,null,null,null,null,"SENIOR WHOLE HEALTH","83520"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","93017","HC CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY","93017 - HC CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY",null,null,null,null,null,"TUFTS PUBLIC DIRECT","83525"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","93289","HC INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB","93289 - HC INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB",null,null,null,null,null,"NEIGHBORHOOD PACE (ESP EB)","83540"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","93452","HC L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - HC L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","83550"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","93533","CMBN R HRT T-SEPTAL L HRT CATHJ SEPTAL OPNG CGEN","93533 - CMBN R HRT T-SEPTAL L HRT CATHJ SEPTAL OPNG CGEN",null,null,null,null,null,"BMCHN MCO","83605"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","93620","HC COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION","93620 - HC COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION",null,null,null,null,null,"UNITED HEALTHCARE","83605"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","93786","BL BLD PRESS W/TAPE&/DISK 24/> HR REC ONL","93786 - BL BLD PRESS W/TAPE&/DISK 24/> HR REC ONL",null,null,null,null,null,"TUFTS POS","83615"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","93985","DUP-SCAN HEMO COMPL BI STD","93985 - DUP-SCAN HEMO COMPL BI STD",null,null,null,null,null,"TUFTS PUBLIC DIRECT SUBSIDIZED","83630"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","94621","HC PULMONARY STRESS TESTING COMPLEX","94621 - HC PULMONARY STRESS TESTING COMPLEX",null,null,null,null,null,"NEIGHBORHOOD PACE (ESP EB)","83655"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","95120","PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX","95120 - PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX",null,null,null,null,null,"TUFTS HMO","83662"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","95708","HC EEG WO VID EA 12-26HR UNMNTR","95708 - HC EEG WO VID EA 12-26HR UNMNTR",null,null,null,null,null,"BMCHN QHP","83690"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","95782","POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND","95782 - POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND",null,null,null,null,null,"SENIOR WHOLE HEALTH","83690"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","95863","NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS","95863 - NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS",null,null,null,null,null,"BMCHN QHP","83695"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","95933","ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST","95933 - ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST",null,null,null,null,null,"FALLON MEDICAID","83718"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","96131","HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR","96131 - HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","83721"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","96139","HC PSYCL/NRPSYCL TST TECH 2+ TST EA ADDL 30 MIN","96139 - HC PSYCL/NRPSYCL TST TECH 2+ TST EA ADDL 30 MIN",null,null,null,null,null,"TUFTS PUBLIC UNIFY","83721"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","96521","REFILLING & MAINTENANCE PORTABLE PUMP","96521 - REFILLING & MAINTENANCE PORTABLE PUMP",null,null,null,null,null,"AETNA-MEDICARE ADVANTAGE","83785"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","97605","NEGATIVE PRESSURE WOUND THERAPY </= 50 SQ CM","97605 - NEGATIVE PRESSURE WOUND THERAPY </= 50 SQ CM",null,null,null,null,null,"TUFTS SELECT","83785"]
["HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",null,null,null,null,null,"CIGNA","83789"]
["SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","80170","HC CHG DRUG SCREEN QUANTITATIVE GENTAMICIN","80170 - HC CHG DRUG SCREEN QUANTITATIVE GENTAMICIN",null,null,null,null,null,"NEIGHBORHOOD PACE (ESP EB)","83825"]
["SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","81206","HC CHG BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE","81206 - HC CHG BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","83835"]
["SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","81542","HC ONC PROSTATE MRNA 22 CNT GEN","81542 - HC ONC PROSTATE MRNA 22 CNT GEN",null,null,null,null,null,"BMCHN QHP","83873"]
["SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","82105","HC CHG ALPHA-FETOPROTEIN SERUM","82105 - HC CHG ALPHA-FETOPROTEIN SERUM",null,null,null,null,null,"SENIOR WHOLE HEALTH","83873"]
["SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","82656","HC CHG ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN","82656 - HC CHG ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN",null,null,null,null,null,"TUFTS MEDICARE SCO","83874"]
["SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","82810","HC BLOOD GASSES O2 SAT ONLY","82810 - HC BLOOD GASSES O2 SAT ONLY",null,null,null,null,null,"AETNA-MEDICARE ADVANTAGE","83880"]
["SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","84157","HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC","84157 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","83883"]
["SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","84450","HC CHG TRANSFERASE ASPARTATE AMINO AST SGOT","84450 - HC CHG TRANSFERASE ASPARTATE AMINO AST SGOT",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","83915"]
["SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","84630","HC CHG ASSAY OF ZINC","84630 - HC CHG ASSAY OF ZINC",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","83915"]
["SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","86039","HC CHG ANTINUCLEAR ANTIBODIES ANA TITER","86039 - HC CHG ANTINUCLEAR ANTIBODIES ANA TITER",null,null,null,null,null,"TUFTS SELECT","83916"]
["SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","86359","HC CHG T CELLS TOTAL COUNT","86359 - HC CHG T CELLS TOTAL COUNT",null,null,null,null,null,"CIGNA","83918"]
["SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","86677","HC CHG ANTIBODY HELICOBACTER PYLORI","86677 - HC CHG ANTIBODY HELICOBACTER PYLORI",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","83921"]
["SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","86817","HC CHG HLA TYPING DR/DQ MULTIPLE ANTIGENS","86817 - HC CHG HLA TYPING DR/DQ MULTIPLE ANTIGENS",null,null,null,null,null,"UHC COMMUNITY CARE (EVERCARE)","83921"]
["SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","87255","HC CHG VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC","87255 - HC CHG VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC",null,null,null,null,null,"TUFTS PUBLIC UNIFY","83930"]
["SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","87505","HC CHG NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN","87505 - HC CHG NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN",null,null,null,null,null,"SENIOR WHOLE HEALTH","83935"]
["SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","88275","HC CHG MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL","88275 - HC CHG MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL",null,null,null,null,null,"TUFTS MEDICARE SCO","83937"]
["TUFTS","TUFTS HMO","10004","HC FNA BX W/O IMG GDN EA ADDL","10004 - HC FNA BX W/O IMG GDN EA ADDL",null,null,null,null,null,"CIGNA","83945"]
["TUFTS","TUFTS SELECT","10008","HC FNA BX W/FLUOR GDN EA ADDL","10008 - HC FNA BX W/FLUOR GDN EA ADDL",null,null,null,null,null,"TUFTS SPIRIT","83945"]
["TUFTS","TUFTS SELECT","10160","PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","83986"]
["TUFTS","TUFTS HMO","11046","DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM","11046 - DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM",null,null,null,null,null,"TUFTS PUBLIC UNIFY","83986"]
["TUFTS","TUFTS HMO","11106","HC INCAL BX SKN SINGLE LES","11106 - HC INCAL BX SKN SINGLE LES",null,null,null,null,null,"ALLWAYS HLTH ACO","83993"]
["TUFTS","TUFTS SELECT","11310","SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<","11310 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","84075"]
["TUFTS","TUFTS HMO","11406","EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM","11406 - EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM",null,null,null,null,null,"TUFTS SELECT","84075"]
["TUFTS","TUFTS POS","11440","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<","11440 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<",null,null,null,null,null,"BMCHN WELL SENSE","84080"]
["TUFTS","TUFTS HMO","11446","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM","11446 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM",null,null,null,null,null,"TUFTS SELECT","84080"]
["TUFTS","TUFTS PPO","11624","EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM","11624 - EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","84100"]
["TUFTS","TUFTS SELECT","11719","TRIMMING NONDYSTROPHIC NAILS ANY NUMBER","11719 - TRIMMING NONDYSTROPHIC NAILS ANY NUMBER",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","84105"]
["TUFTS","TUFTS HMO","11765","WEDGE EXCISION SKIN NAIL FOLD","11765 - WEDGE EXCISION SKIN NAIL FOLD",null,null,null,null,null,"BMC SENIOR CARE OPTIONS","84132"]
["TUFTS","TUFTS SELECT","11983","RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT","11983 - RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","84133"]
["TUFTS","TUFTS SELECT","12015","SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM","12015 - SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","84134"]
["TUFTS","TUFTS HMO","12035","REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM","12035 - REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM",null,null,null,null,null,"TUFTS SELECT","84134"]
["TUFTS","TUFTS PPO","12046","HC LAYR CLOS WND REST BODY 20.1-30 CM","12046 - HC LAYR CLOS WND REST BODY 20.1-30 CM",null,null,null,null,null,"CIGNA","84144"]
["TUFTS","TUFTS SELECT","13122","REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<","13122 - REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","84145"]
["TUFTS","TUFTS HMO","14020","ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<","14020 - ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<",null,null,null,null,null,"BMCHN MCO","84146"]
["TUFTS","TUFTS SELECT","15100","HC SKIN SPLT GRFT TRNK/ARM/LEG","15100 - HC SKIN SPLT GRFT TRNK/ARM/LEG",null,null,null,null,null,"BMCHN WELL SENSE","84153"]
["TUFTS","TUFTS SELECT","15274","HC APP SKN SUB GRFT T/A/L AREA/>100SCM ADL 100SCM","15274 - HC APP SKN SUB GRFT T/A/L AREA/>100SCM ADL 100SCM",null,null,null,null,null,"BLUE CROSS-HMO BLUE","84155"]
["TUFTS","TUFTS SELECT","15278","HC SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM ADL 100SQ CM","15278 - HC SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM ADL 100SQ CM",null,null,null,null,null,"CCA ONE CARE","84155"]
["TUFTS","TUFTS PPO","15823","HC REV UPPER EYELID W EXCESS SKIN","15823 - HC REV UPPER EYELID W EXCESS SKIN",null,null,null,null,null,"FALLON SENIOR PLAN","84156"]
["TUFTS","TUFTS SELECT","17000","DESTRUCTION PREMALIGNANT LESION 1ST","17000 - DESTRUCTION PREMALIGNANT LESION 1ST",null,null,null,null,null,"TUFTS MEDICARE SCO","84157"]
["TUFTS","TUFTS POS","17250","CHEMICAL CAUTERIZATION GRANULATION TISSUE","17250 - CHEMICAL CAUTERIZATION GRANULATION TISSUE",null,null,null,null,null,"BMCHN MEDICAID","84163"]
["TUFTS","TUFTS PPO","17380","HAIR REMOVAL BY ELECTROLYSIS","17380 - HAIR REMOVAL BY ELECTROLYSIS",null,null,null,null,null,"FALLON SENIOR PLAN","84165"]
["TUFTS","TUFTS SELECT","19084","BX BREAST W/DEVICE ADDL LESION ULTRASOUND GUID","19084 - BX BREAST W/DEVICE ADDL LESION ULTRASOUND GUID",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","84166"]
["TUFTS","TUFTS HMO","19120","EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION","19120 - EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION",null,null,null,null,null,"FALLON SENIOR PLAN","84166"]
["TUFTS","TUFTS SELECT","19287","PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID","19287 - PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID",null,null,null,null,null,"BMCHN ACO","84182"]
["TUFTS","TUFTS PPO","20200","HC MUSCLE BIOPSY","20200 - HC MUSCLE BIOPSY",null,null,null,null,null,"CIGNA PPO","84202"]
["TUFTS","TUFTS POS","20551","INJECTION SINGLE TENDON ORIGIN/INSERTION","20551 - INJECTION SINGLE TENDON ORIGIN/INSERTION",null,null,null,null,null,"NEIGHBORHOOD PACE (ESP EB)","84206"]
["TUFTS","TUFTS SELECT","20600","ARTHROCENTESIS ASPIR&/INJECTION SMALL JT/BURSA","20600 - ARTHROCENTESIS ASPIR&/INJECTION SMALL JT/BURSA",null,null,null,null,null,"TUFTS SPIRIT","84206"]
["TUFTS","TUFTS PPO","20982","HC ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE","20982 - HC ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE",null,null,null,null,null,"UNICARE","84207"]
["TUFTS","TUFTS HMO","21029","HC CONTOUR OF FACE BONE LESION","21029 - HC CONTOUR OF FACE BONE LESION",null,null,null,null,null,"SENIOR WHOLE HEALTH","84210"]
["TUFTS","TUFTS POS","21080","HC PREP FACE/ORAL PROST FINL OBTURATOR","21080 - HC PREP FACE/ORAL PROST FINL OBTURATOR",null,null,null,null,null,"TUFTS PPO","84244"]
["TUFTS","TUFTS SELECT","21208","HC AUGMENT FACIAL BONES","21208 - HC AUGMENT FACIAL BONES",null,null,null,null,null,"BMCHN WELL SENSE","84255"]
["TUFTS","TUFTS PPO","21320","CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION","21320 - CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","84270"]
["TUFTS","TUFTS POS","21462","HC OPEN RX MANDIBLE FX+DENTAL FIX","21462 - HC OPEN RX MANDIBLE FX+DENTAL FIX",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","84295"]
["TUFTS","TUFTS PPO","21501","I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX","21501 - I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX",null,null,null,null,null,"ELDER SERVICE PLAN OTHER","84295"]
["TUFTS","TUFTS PPO","22510","PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC","22510 - PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","84300"]
["TUFTS","TUFTS PPO","22514","PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR","22514 - PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR",null,null,null,null,null,"UNICARE","84300"]
["TUFTS","TUFTS SELECT","23500","CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION","23500 - CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION",null,null,null,null,null,"NEIGHBORHOOD PACE (ESP EB)","84305"]
["TUFTS","TUFTS POS","23545","CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION","23545 - CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION",null,null,null,null,null,"TUFTS SPIRIT","84305"]
["TUFTS","TUFTS PPO","23655","HC CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES","23655 - HC CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES",null,null,null,null,null,"ELEMENT CARE INC","84307"]
["TUFTS","TUFTS PPO","24535","CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ","24535 - CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ",null,null,null,null,null,"TUFTS HMO","84311"]
["TUFTS","TUFTS POS","24640","CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ","24640 - CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ",null,null,null,null,null,"BMCHN MCO","84376"]
["TUFTS","TUFTS PPO","25066","HC BIOPSY FOREARM SOFT TISSUES,DEEP","25066 - HC BIOPSY FOREARM SOFT TISSUES,DEEP",null,null,null,null,null,"UNITED HEALTHCARE","84376"]
["TUFTS","TUFTS SELECT","25505","CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION","25505 - CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION",null,null,null,null,null,"UNICARE","84402"]
["TUFTS","TUFTS POS","25630","CLTX CARPAL BONE FX W/O MANJ EACH BONE","25630 - CLTX CARPAL BONE FX W/O MANJ EACH BONE",null,null,null,null,null,"TUFTS PUBLIC DIRECT","84403"]
["TUFTS","TUFTS HMO","26055","TENDON SHEATH INCISION","26055 - TENDON SHEATH INCISION",null,null,null,null,null,"FALLON MEDICAID","84425"]
["TUFTS","TUFTS HMO","26535","HC ARTHROPLASTY I-P JT","26535 - HC ARTHROPLASTY I-P JT",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","84430"]
["TUFTS","TUFTS POS","26720","CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA","26720 - CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA",null,null,null,null,null,"BMCHN MCO","84432"]
["TUFTS","TUFTS SELECT","26750","CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA","26750 - CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA",null,null,null,null,null,"TUFTS MEDICARE PREFERRED HMO","84432"]
["TUFTS","TUFTS HMO","27220","CLTX ACETABULUM HIP/SOCKT FX W/O MANJ","27220 - CLTX ACETABULUM HIP/SOCKT FX W/O MANJ",null,null,null,null,null,"BLUE CROSS-HMO BLUE","84439"]
["TUFTS","TUFTS POS","27265","CLTX POST HIP ARTHRP DISLC W/O ANES","27265 - CLTX POST HIP ARTHRP DISLC W/O ANES",null,null,null,null,null,"TUFTS PUBLIC DIRECT","84439"]
["TUFTS","TUFTS PPO","27369","HC NJX CNTRST KNE ARTHG/CT/MRI","27369 - HC NJX CNTRST KNE ARTHG/CT/MRI",null,null,null,null,null,"TUFTS PPO","84442"]
["TUFTS","TUFTS HMO","27550","CLOSED TX KNEE DISLOCATION W/O ANESTHESIA","27550 - CLOSED TX KNEE DISLOCATION W/O ANESTHESIA",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","84443"]
["TUFTS","TUFTS POS","27634","HC EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5+CM","27634 - HC EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5+CM",null,null,null,null,null,"BMCHN MCO","84445"]
["TUFTS","TUFTS POS","27762","CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ","27762 - CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ",null,null,null,null,null,"TUFTS PUBLIC UNIFY","84445"]
["TUFTS","TUFTS POS","27786","CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ","27786 - CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ",null,null,null,null,null,"BMCHN MCO","84446"]
["TUFTS","TUFTS PPO","28022","HC ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT","28022 - HC ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT",null,null,null,null,null,"NEIGHBORHOOD PACE (ESP EB)","84450"]
["TUFTS","TUFTS HMO","28150","HC REMOVAL OF SINGLE TOE,EACH","28150 - HC REMOVAL OF SINGLE TOE,EACH",null,null,null,null,null,"BLUE CROSS-HMO BLUE","84460"]
["TUFTS","TUFTS POS","28234","TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON","28234 - TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON",null,null,null,null,null,"TUFTS PUBLIC DIRECT","84460"]
["TUFTS","TUFTS SELECT","28470","CLOSED TX METATARSAL FRACTURE W/O MANIPULATION","28470 - CLOSED TX METATARSAL FRACTURE W/O MANIPULATION",null,null,null,null,null,"TUFTS SELECT","84466"]
["TUFTS","TUFTS HMO","28630","CLOSED RX MT-PHAL TOE DISLOCATION","28630 - CLOSED RX MT-PHAL TOE DISLOCATION",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","84478"]
["TUFTS","TUFTS POS","29105","APPLICATION LONG ARM SPLINT SHOULDER HAND","29105 - APPLICATION LONG ARM SPLINT SHOULDER HAND",null,null,null,null,null,"BMCHN MCO","84479"]
["TUFTS","TUFTS PPO","29280","HC STRAPPING OF HAND OR FINGER","29280 - HC STRAPPING OF HAND OR FINGER",null,null,null,null,null,"UHC COMMUNITY CARE (EVERCARE)","84479"]
["TUFTS","TUFTS HMO","29580","STRAPPING UNNA BOOT","29580 - STRAPPING UNNA BOOT",null,null,null,null,null,"BLUE CROSS-HMO BLUE","84481"]
["TUFTS","TUFTS SELECT","29888","HC KNEE SCOPE,AID ANT CRUCIATE REPAIR","29888 - HC KNEE SCOPE,AID ANT CRUCIATE REPAIR",null,null,null,null,null,"BMC SENIOR CARE OPTIONS","84482"]
["TUFTS","TUFTS SELECT","30140","HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL","30140 - HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL",null,null,null,null,null,"TUFTS PUBLIC DIRECT SUBSIDIZED","84482"]
["TUFTS","TUFTS HMO","30801","ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC","30801 - ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","84484"]
["TUFTS","TUFTS HMO","30905","CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST","30905 - CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","84484"]
["TUFTS","TUFTS PPO","31505","LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX","31505 - LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX",null,null,null,null,null,"UNITED HEALTHCARE","84520"]
["TUFTS","TUFTS HMO","31578","LARYNGOSCOPY FLEXIBLE FIBEROPTIC REMOVAL LESION","31578 - LARYNGOSCOPY FLEXIBLE FIBEROPTIC REMOVAL LESION",null,null,null,null,null,"BLUE CROSS-HMO BLUE","84550"]
["TUFTS","TUFTS POS","31615","TRACHEOBRNCHSC THRU EST TRACHS INC","31615 - TRACHEOBRNCHSC THRU EST TRACHS INC",null,null,null,null,null,"TUFTS POS","84550"]
["TUFTS","TUFTS HMO","31626","HC BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT","31626 - HC BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT",null,null,null,null,null,"BLUE CROSS-HMO BLUE","84560"]
["TUFTS","TUFTS SELECT","32160","HC THORACOTOMY W/CARDIAC MASSAGE","32160 - HC THORACOTOMY W/CARDIAC MASSAGE",null,null,null,null,null,"BMC SENIOR CARE OPTIONS","84590"]
["TUFTS","TUFTS HMO","32555","THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING","32555 - THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING",null,null,null,null,null,"TUFTS PUBLIC TOGETHER","84590"]
["TUFTS","TUFTS HMO","33016","HC PERICARDIOCENTESIS W/IMAGING","33016 - HC PERICARDIOCENTESIS W/IMAGING",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","84591"]
["TUFTS","TUFTS SELECT","33223","HC RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR","33223 - HC RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR",null,null,null,null,null,"TUFTS SELECT","84597"]
["TUFTS","TUFTS POS","33241","HC REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY","33241 - HC REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY",null,null,null,null,null,"TUFTS PUBLIC DIRECT","84630"]
["TUFTS","TUFTS HMO","33263","HC RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD","33263 - HC RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD",null,null,null,null,null,"BLUE CROSS-HMO BLUE","84681"]
["TUFTS","TUFTS SELECT","36010","HC INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA","36010 - HC INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA",null,null,null,null,null,"BMC SENIOR CARE OPTIONS","84702"]
["TUFTS","TUFTS HMO","36200","HC INTRODUCTION CATHETER AORTA","36200 - HC INTRODUCTION CATHETER AORTA",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","84702"]
["TUFTS","TUFTS PPO","36245","HC SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH","36245 - HC SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","85004"]
["TUFTS","TUFTS SELECT","36254","HC SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I","36254 - HC SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I",null,null,null,null,null,"TUFTS POS","85004"]
["TUFTS","TUFTS HMO","36471","NJX SCLEROSING SOLUTION MULTIPLE VEINS SAME LEG","36471 - NJX SCLEROSING SOLUTION MULTIPLE VEINS SAME LEG",null,null,null,null,null,"ELEMENT CARE INC","85014"]
["TUFTS","TUFTS SELECT","36513","THERAPEUTIC APHERESIS PLATELETS","36513 - THERAPEUTIC APHERESIS PLATELETS",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","85018"]
["TUFTS","TUFTS SELECT","36555","HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y","36555 - HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y",null,null,null,null,null,"TUFTS PUBLIC TOGETHER","85018"]
["TUFTS","TUFTS SELECT","36570","HC INSJ PRPH CTR VAD W/SUBQ PORT UNDER 5 YR","36570 - HC INSJ PRPH CTR VAD W/SUBQ PORT UNDER 5 YR",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","85025"]
["TUFTS","TUFTS HMO","36582","HC RPLCMT COMPL TUN CTR VAD W/SUBQ PORT","36582 - HC RPLCMT COMPL TUN CTR VAD W/SUBQ PORT",null,null,null,null,null,"BMCHN MCO","85027"]
["TUFTS","TUFTS HMO","36905","HC PERQ THRMBC/NFS DIAL CIRCUIT TRLUML BALO ANGIOP","36905 - HC PERQ THRMBC/NFS DIAL CIRCUIT TRLUML BALO ANGIOP",null,null,null,null,null,"TUFTS PUBLIC DIRECT","85045"]
["TUFTS","TUFTS SELECT","36908","HC STENT PLMT CENTRAL DIAYLSIS SEG PFRMD DIAL CIR","36908 - HC STENT PLMT CENTRAL DIAYLSIS SEG PFRMD DIAL CIR",null,null,null,null,null,"BLUE CROSS-HMO BLUE","85046"]
["TUFTS","TUFTS HMO","37192","HC REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I","37192 - HC REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I",null,null,null,null,null,"TUFTS PUBLIC DIRECT","85046"]
["TUFTS","TUFTS SELECT","37222","HC REVASC;ILIAC,EAAD,TRN ANG","37222 - HC REVASC;ILIAC,EAAD,TRN ANG",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","85048"]
["TUFTS","TUFTS SELECT","37230","HC REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL","37230 - HC REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL",null,null,null,null,null,"TUFTS HMO","85049"]
["TUFTS","TUFTS HMO","37242","VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I","37242 - VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I",null,null,null,null,null,"BMCHN QHP","85055"]
["TUFTS","TUFTS HMO","38200","HC INJ PROC SPLENOPORTO","38200 - HC INJ PROC SPLENOPORTO",null,null,null,null,null,"CIGNA","85060"]
["TUFTS","TUFTS SELECT","38505","BX/EXC LYMPH NODE NEEDLE SUPERFICIAL","38505 - BX/EXC LYMPH NODE NEEDLE SUPERFICIAL",null,null,null,null,null,"SENIOR WHOLE HEALTH","85210"]
["TUFTS","TUFTS POS","40510","EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR","40510 - EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR",null,null,null,null,null,"BMCHN QHP","85220"]
["TUFTS","TUFTS PPO","40810","EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR","40810 - EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR",null,null,null,null,null,"CCA ONE CARE","85230"]
["TUFTS","TUFTS SELECT","40840","HC RECONSTRUC MOUTH ANTERIOR","40840 - HC RECONSTRUC MOUTH ANTERIOR",null,null,null,null,null,"BLUE CROSS-INDEMNITY","85240"]
["TUFTS","TUFTS PPO","41009","HC I&D MOUTH/TONG INTRA, MASTICATOR","41009 - HC I&D MOUTH/TONG INTRA, MASTICATOR",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","85240"]
["TUFTS","TUFTS PPO","41252","HC REPAIR TONGUE LACER,2.6 CM+/COMPLX","41252 - HC REPAIR TONGUE LACER,2.6 CM+/COMPLX",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","85245"]
["TUFTS","TUFTS SELECT","41830","HC REMOVAL OF GUM TISSUE","41830 - HC REMOVAL OF GUM TISSUE",null,null,null,null,null,"SENIOR WHOLE HEALTH","85246"]
["TUFTS","TUFTS SELECT","42180","HC REPAIR PALATE LACER <2 CM","42180 - HC REPAIR PALATE LACER <2 CM",null,null,null,null,null,"FALLON SENIOR PLAN","85250"]
["TUFTS","TUFTS SELECT","42210","HC RECONST CLEFT PALATE,BONE GRFT","42210 - HC RECONST CLEFT PALATE,BONE GRFT",null,null,null,null,null,"SENIOR WHOLE HEALTH","85250"]
["TUFTS","TUFTS SELECT","42808","EXCISION/DESTRUCTION LESION PHARYNX ANY METHOD","42808 - EXCISION/DESTRUCTION LESION PHARYNX ANY METHOD",null,null,null,null,null,"BLUE CROSS-INDEMNITY","85270"]
["TUFTS","TUFTS PPO","42960","HC CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE","42960 - HC CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE",null,null,null,null,null,"TUFTS MEDICARE SCO","85270"]
["TUFTS","TUFTS SELECT","43197","HC ESOPHAGOSCOPY FLEXIBLE TRANSNASAL DIAGNOSTIC","43197 - HC ESOPHAGOSCOPY FLEXIBLE TRANSNASAL DIAGNOSTIC",null,null,null,null,null,"BLUE CROSS-INDEMNITY","85280"]
["TUFTS","TUFTS POS","43240","HC UPR GI NDSC TRANSMURAL DRAINAGE PSEUDOCYST","43240 - HC UPR GI NDSC TRANSMURAL DRAINAGE PSEUDOCYST",null,null,null,null,null,"CIGNA PPO","85290"]
["TUFTS","TUFTS PPO","43246","HC UPR GI NDSC PLMT PRQ GASTROSTOMY TUBE","43246 - HC UPR GI NDSC PLMT PRQ GASTROSTOMY TUBE",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","85290"]
["TUFTS","TUFTS SELECT","43255","HC UPR GI NDSC CONTROL BLEEDING ANY METHOD","43255 - HC UPR GI NDSC CONTROL BLEEDING ANY METHOD",null,null,null,null,null,"SENIOR WHOLE HEALTH","85300"]
["TUFTS","TUFTS HMO","43275","HC ERCP REMOVE FOREIGN BODY/STENT BILIARY/PANC DUCT","43275 - HC ERCP REMOVE FOREIGN BODY/STENT BILIARY/PANC DUCT",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","85301"]
["TUFTS","TUFTS PPO","43763","HC RPLC GTUBE REVJ GSTRST TRC","43763 - HC RPLC GTUBE REVJ GSTRST TRC",null,null,null,null,null,"CCA ONE CARE","85302"]
["TUFTS","TUFTS SELECT","44366","HC ENTEROSCOPY > 2ND PRTN W/CONTROL BLEEDING","44366 - HC ENTEROSCOPY > 2ND PRTN W/CONTROL BLEEDING",null,null,null,null,null,"BLUE CROSS-INDEMNITY","85303"]
["TUFTS","TUFTS SELECT","44382","HC ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE","44382 - HC ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE",null,null,null,null,null,"TUFTS POS","85303"]
["TUFTS","TUFTS PPO","45190","HC DESTRUCT,RECTAL TUMOR,TRANSANAL APPROACH","45190 - HC DESTRUCT,RECTAL TUMOR,TRANSANAL APPROACH",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","85305"]
["TUFTS","TUFTS POS","45341","HC SIGMOIDOSCOPY FLX NDSC US XM","45341 - HC SIGMOIDOSCOPY FLX NDSC US XM",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","85307"]
["TUFTS","TUFTS HMO","45380","COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",null,null,null,null,null,"TUFTS HMO","85307"]
["TUFTS","TUFTS PPO","45391","HC COLSC FLX PROX SPLENIC FLXR NDSC US XM","45391 - HC COLSC FLX PROX SPLENIC FLXR NDSC US XM",null,null,null,null,null,"CCA ONE CARE","85347"]
["TUFTS","TUFTS PPO","45915","HC REMV RECTAL OBSTR:FECES/F.B. W ANEST","45915 - HC REMV RECTAL OBSTR:FECES/F.B. W ANEST",null,null,null,null,null,"TUFTS SPIRIT","85347"]
["TUFTS","TUFTS SELECT","46320","HC EXCISION THROMBOSED HEMORRHOID, EXTERNAL","46320 - HC EXCISION THROMBOSED HEMORRHOID, EXTERNAL",null,null,null,null,null,"TUFTS PUBLIC DIRECT","85366"]
["TUFTS","TUFTS POS","46900","DSTRJ LESION ANUS SIMPLE CHEMICAL","46900 - DSTRJ LESION ANUS SIMPLE CHEMICAL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","85378"]
["TUFTS","TUFTS PPO","47531","NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS","47531 - NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS",null,null,null,null,null,"FALLON MEDICAID","85379"]
["TUFTS","TUFTS PPO","47536","EXCHANGE BILIARY DRG CATHETER PRQ W/IMAGE GUID RAD S&I","47536 - EXCHANGE BILIARY DRG CATHETER PRQ W/IMAGE GUID RAD S&I",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","85379"]
["TUFTS","TUFTS POS","49320","HC LAP,DIAGNOSTIC ABDOMEN","49320 - HC LAP,DIAGNOSTIC ABDOMEN",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","85397"]
["TUFTS","TUFTS POS","49411","INTERSTITIAL DEV PLMT RADIATION THERAPY 1/MLT","49411 - INTERSTITIAL DEV PLMT RADIATION THERAPY 1/MLT",null,null,null,null,null,"TUFTS POS","85397"]
["TUFTS","TUFTS PPO","49450","HC REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS","49450 - HC REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS",null,null,null,null,null,"NEIGHBORHOOD PACE (ESP EB)","85461"]
["TUFTS","TUFTS POS","50431","HC NJX ANTGRD NPHRSTGRM &/OR URTRGRM COMPL DIAG INCL IMG GUI RAD S&I; EXSTNG ACCES","50431 - HC NJX ANTGRD NPHRSTGRM &/OR URTRGRM COMPL DIAG INCL IMG GUI RAD S&I; EXSTNG ACCES",null,null,null,null,null,"SENIOR WHOLE HEALTH","85520"]
["TUFTS","TUFTS PPO","50693","PLACEMENT URETERAL STENT PRQ WITH PRE-EXISTING NEPHROSTOMY TRACT","50693 - PLACEMENT URETERAL STENT PRQ WITH PRE-EXISTING NEPHROSTOMY TRACT",null,null,null,null,null,"TUFTS HMO","85549"]
["TUFTS","TUFTS HMO","51703","INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED","51703 - INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED",null,null,null,null,null,"CCA ONE CARE","85576"]
["TUFTS","TUFTS POS","51729","COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL","51729 - COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL",null,null,null,null,null,"BLUE CROSS-INDEMNITY","85610"]
["TUFTS","TUFTS POS","52005","HC CYSTOURETHROSCOPY,URETER CATHETER","52005 - HC CYSTOURETHROSCOPY,URETER CATHETER",null,null,null,null,null,"TUFTS PUBLIC DIRECT","85610"]
["TUFTS","TUFTS HMO","53899","HC URETERAL DILATION","53899 - HC URETERAL DILATION",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","85611"]
["TUFTS","TUFTS HMO","54100","BIOPSY PENIS SEPARATE PROCEDURE","54100 - BIOPSY PENIS SEPARATE PROCEDURE",null,null,null,null,null,"FALLON MEDICAID","85613"]
["TUFTS","TUFTS HMO","54164","FRENULOTOMY PENIS","54164 - FRENULOTOMY PENIS",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","85613"]
["TUFTS","TUFTS POS","54700","I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE","54700 - I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE",null,null,null,null,null,"SENIOR WHOLE HEALTH","85651"]
["TUFTS","TUFTS SELECT","56440","MARSUPIALIZATION BARTHOLINS GLAND CYST","56440 - MARSUPIALIZATION BARTHOLINS GLAND CYST",null,null,null,null,null,"TUFTS MEDICARE PREFERRED HMO","85652"]
["TUFTS","TUFTS HMO","56820","COLPOSCOPY VULVA","56820 - COLPOSCOPY VULVA",null,null,null,null,null,"CCA ONE CARE","85660"]
["TUFTS","TUFTS POS","57135","HC EXCIS VAGINAL CYST/TUMOR","57135 - HC EXCIS VAGINAL CYST/TUMOR",null,null,null,null,null,"BLUE CROSS-INDEMNITY","85670"]
["TUFTS","TUFTS HMO","57500","BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX","57500 - BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","85705"]
["TUFTS","TUFTS HMO","57520","HC CONIZATION CERVIX, KNIFE/LASER","57520 - HC CONIZATION CERVIX, KNIFE/LASER",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","85705"]
["TUFTS","TUFTS POS","58300","INSERTION INTRAUTERINE DEVICE IUD","58300 - INSERTION INTRAUTERINE DEVICE IUD",null,null,null,null,null,"SENIOR WHOLE HEALTH","85730"]
["TUFTS","TUFTS POS","58925","HC OVARIAN CYSTECTOMY UNI/BI","58925 - HC OVARIAN CYSTECTOMY UNI/BI",null,null,null,null,null,"TUFTS PUBLIC UNIFY","85732"]
["TUFTS","TUFTS HMO","59200","INSERTION CERVICAL DILATOR SEPARATE PROCEDURE","59200 - INSERTION CERVICAL DILATOR SEPARATE PROCEDURE",null,null,null,null,null,"CCA ONE CARE","85810"]
["TUFTS","TUFTS POS","59821","TX MISSED ABORTION SECOND TRIMESTER SURGICAL","59821 - TX MISSED ABORTION SECOND TRIMESTER SURGICAL",null,null,null,null,null,"BLUE CROSS-INDEMNITY","86003"]
["TUFTS","TUFTS HMO","61055","HC CISTERNAL/LATERAL C1-C2 PUNCTURE W/INJECTION","61055 - HC CISTERNAL/LATERAL C1-C2 PUNCTURE W/INJECTION",null,null,null,null,null,"AETNA-MEDICARE ADVANTAGE","86021"]
["TUFTS","TUFTS HMO","62270","SPINAL PUNCTURE LUMBAR DIAGNOSTIC","62270 - SPINAL PUNCTURE LUMBAR DIAGNOSTIC",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","86021"]
["TUFTS","TUFTS POS","62321","HR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN","62321 - HR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN",null,null,null,null,null,"SENIOR WHOLE HEALTH","86022"]
["TUFTS","TUFTS SELECT","63650","HC PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL","63650 - HC PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL",null,null,null,null,null,"TUFTS SELECT","86038"]
["TUFTS","TUFTS HMO","64415","SINGLE NERVE BLOCK INJECTION ARM NERVE","64415 - SINGLE NERVE BLOCK INJECTION ARM NERVE",null,null,null,null,null,"CCA ONE CARE","86039"]
["TUFTS","TUFTS PPO","64421","MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES","64421 - MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES",null,null,null,null,null,"UHC COMMUNITY CARE (EVERCARE)","86039"]
["TUFTS","TUFTS POS","64490","NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL","64490 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL",null,null,null,null,null,"BMC SENIOR CARE OPTIONS","86140"]
["TUFTS","TUFTS PPO","64520","INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC","64520 - INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","86140"]
["TUFTS","TUFTS POS","64620","HC DEST,INTERCOSTAL,NEUROLYTIC","64620 - HC DEST,INTERCOSTAL,NEUROLYTIC",null,null,null,null,null,"TUFTS PUBLIC DIRECT SUBSIDIZED","86141"]
["TUFTS","TUFTS PPO","64624","HC DSTRJ NULYT AGT GNCLR NRV","64624 - HC DSTRJ NULYT AGT GNCLR NRV",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","86141"]
["TUFTS","TUFTS POS","64650","CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE","64650 - CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","86147"]
["TUFTS","TUFTS HMO","65130","HC INSERT OCULAR IMPLANT","65130 - HC INSERT OCULAR IMPLANT",null,null,null,null,null,"UNITED HEALTHCARE","86147"]
["TUFTS","TUFTS PPO","65220","RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP","65220 - RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP",null,null,null,null,null,"CCA ONE CARE","86157"]
["TUFTS","TUFTS SELECT","65756","HC CORNEAL TRNSPL ENDOTHELIAL","65756 - HC CORNEAL TRNSPL ENDOTHELIAL",null,null,null,null,null,"TUFTS POS","86160"]
["TUFTS","TUFTS POS","65815","HC DRAINAGE OF EYE","65815 - HC DRAINAGE OF EYE",null,null,null,null,null,"BMC SENIOR CARE OPTIONS","86161"]
["TUFTS","TUFTS PPO","66020","INJX ANTERIOR CHAMBER EYE AIR/LIQUID SPX","66020 - INJX ANTERIOR CHAMBER EYE AIR/LIQUID SPX",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","86161"]
["TUFTS","TUFTS PPO","66682","HC REPAIR IRIS & CILIARY BODY","66682 - HC REPAIR IRIS & CILIARY BODY",null,null,null,null,null,"TUFTS PUBLIC TOGETHER","86162"]
["TUFTS","TUFTS POS","66982","REMV CATARACT EXTRACAP,INSERT LENS,COMP","66982 - REMV CATARACT EXTRACAP,INSERT LENS,COMP",null,null,null,null,null,"TUFTS PUBLIC DIRECT","86200"]
["TUFTS","TUFTS HMO","67101","HC RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID CRTX","67101 - HC RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID CRTX",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","86235"]
["TUFTS","TUFTS POS","67105","RPR RETINAL DTCHMNT 1/> SES PC W/WO DRG SUBRETI","67105 - RPR RETINAL DTCHMNT 1/> SES PC W/WO DRG SUBRETI",null,null,null,null,null,"ALLWAYS HLTH ACO","86255"]
["TUFTS","TUFTS POS","67312","HC STRABISMUS RECESSION/RESCJ 2 HRZNTL MUSC","67312 - HC STRABISMUS RECESSION/RESCJ 2 HRZNTL MUSC",null,null,null,null,null,"BMCHN MCO","86256"]
["TUFTS","TUFTS POS","67320","HC TRANSPOSITION PROCEDURE EXTRAOCULAR MUSC ADD-ON","67320 - HC TRANSPOSITION PROCEDURE EXTRAOCULAR MUSC ADD-ON",null,null,null,null,null,"SENIOR WHOLE HEALTH","86256"]
["TUFTS","TUFTS PPO","67801","EXCISION CHALAZION MULTIPLE SAME LID","67801 - EXCISION CHALAZION MULTIPLE SAME LID",null,null,null,null,null,"UNITED HEALTHCARE","86300"]
["TUFTS","TUFTS POS","67882","HC REVISION EYELID,XPOSITN TARSAL PLATE","67882 - HC REVISION EYELID,XPOSITN TARSAL PLATE",null,null,null,null,null,"TUFTS PUBLIC DIRECT","86301"]
["TUFTS","TUFTS POS","67903","HC RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT INTERNAL","67903 - HC RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT INTERNAL",null,null,null,null,null,"BLUE CROSS-INDEMNITY","86304"]
["TUFTS","TUFTS POS","67971","HC RCNSTJ EYELID FULL THICKNESS </TWO-THIRDS 1 STG","67971 - HC RCNSTJ EYELID FULL THICKNESS </TWO-THIRDS 1 STG",null,null,null,null,null,"BLUE CROSS-INDEMNITY","86308"]
["TUFTS","TUFTS HMO","68340","HC DIVISION OF SYMBLEPHARON","68340 - HC DIVISION OF SYMBLEPHARON",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","86308"]
["TUFTS","TUFTS HMO","68811","HC PROBE NASOLACRIMAL DUCT","68811 - HC PROBE NASOLACRIMAL DUCT",null,null,null,null,null,"TUFTS PUBLIC TOGETHER","86316"]
["TUFTS","TUFTS POS","69005","DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX","69005 - DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX",null,null,null,null,null,"BMCHN MCO","86317"]
["TUFTS","TUFTS HMO","69420","MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ","69420 - MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ",null,null,null,null,null,"FALLON MEDICAID","86328"]
["TUFTS","TUFTS SELECT","69631","HC TYMPANOPLASTY","69631 - HC TYMPANOPLASTY",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","86331"]
["TUFTS","TUFTS SELECT","70300","RADIOLOGIC EXAMINATION TEETH 1 VIEW","70300 - RADIOLOGIC EXAMINATION TEETH 1 VIEW",null,null,null,null,null,"NEIGHBORHOOD PACE (ESP EB)","86334"]
["TUFTS","TUFTS HMO","70370","HC CHG RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ","70370 - HC CHG RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ",null,null,null,null,null,"BLUE CROSS-PPO","86335"]
["TUFTS","TUFTS HMO","70490","HC CHG CT SOFT TISSUE NECK W/O CONTRAST MATERIAL","70490 - HC CHG CT SOFT TISSUE NECK W/O CONTRAST MATERIAL",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","86336"]
["TUFTS","TUFTS SELECT","70545","HC CHG MRA HEAD W/CONTRAST MATERIAL","70545 - HC CHG MRA HEAD W/CONTRAST MATERIAL",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","86340"]
["TUFTS","TUFTS HMO","71045","HC CHG RADIOLOGIC EXAM CHEST SINGLE VIEW","71045 - HC CHG RADIOLOGIC EXAM CHEST SINGLE VIEW",null,null,null,null,null,"TUFTS SELECT","86340"]
["TUFTS","TUFTS SELECT","71111","HC CHG RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS","71111 - HC CHG RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS",null,null,null,null,null,"CIGNA CARELINK","86341"]
["TUFTS","TUFTS SELECT","72052","HC CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS","72052 - HC CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","86353"]
["TUFTS","TUFTS PPO","72083","XRAY EXAM ENTIRE SPINE INCLUDING SKULL, CERV AND SACRAL SPINE; 4 OR 5 VIEWS","72083 - XRAY EXAM ENTIRE SPINE INCLUDING SKULL, CERV AND SACRAL SPINE; 4 OR 5 VIEWS",null,null,null,null,null,"BLUE CROSS-INDEMNITY","86355"]
["TUFTS","TUFTS SELECT","72120","HC X-RAY LUMBAR SPINE FLEX/EXTEN","72120 - HC X-RAY LUMBAR SPINE FLEX/EXTEN",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","86355"]
["TUFTS","TUFTS HMO","72133","HC CT,L SPINE;W/WO","72133 - HC CT,L SPINE;W/WO",null,null,null,null,null,"BMCHN MCO","86357"]
["TUFTS","TUFTS POS","72190","HC CHG RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS","72190 - HC CHG RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS",null,null,null,null,null,"BMCHN WELL SENSE","86359"]
["TUFTS","TUFTS SELECT","72200","X-RAY EXAM SI JOINTS","72200 - X-RAY EXAM SI JOINTS",null,null,null,null,null,"BLUE CROSS-MEDICARE ADVANTAGE","86360"]
["TUFTS","TUFTS HMO","73030","HC CHG RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS","73030 - HC CHG RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS",null,null,null,null,null,"TUFTS PUBLIC DIRECT SUBSIDIZED","86360"]
["TUFTS","TUFTS PPO","73120","HC CHG RADEX HAND 2 VIEWS","73120 - HC CHG RADEX HAND 2 VIEWS",null,null,null,null,null,"SENIOR WHOLE HEALTH","86376"]
["TUFTS","TUFTS SELECT","73223","HC CHG MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL","73223 - HC CHG MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL",null,null,null,null,null,"TUFTS HMO","86382"]
["TUFTS","TUFTS HMO","73552","XRAY EXAM FEMUR; MINIMUM 2 VIEWS","73552 - XRAY EXAM FEMUR; MINIMUM 2 VIEWS",null,null,null,null,null,"BMCHN QHP","86403"]
["TUFTS","TUFTS SELECT","73701","HC CHG CT LOWER EXTREMITY W/CONTRAST MATERIAL","73701 - HC CHG CT LOWER EXTREMITY W/CONTRAST MATERIAL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","86431"]
["TUFTS","TUFTS SELECT","73722","HC CHG MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL","73722 - HC CHG MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL",null,null,null,null,null,"BLUE CROSS-MEDICARE ADVANTAGE","86480"]
["TUFTS","TUFTS HMO","74174","HC CHG CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG","74174 - HC CHG CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG",null,null,null,null,null,"TUFTS PUBLIC UNIFY","86480"]
["TUFTS","TUFTS PPO","74221","HC X-RAY XM ESOPHAGUS 2CNTRST","74221 - HC X-RAY XM ESOPHAGUS 2CNTRST",null,null,null,null,null,"TUFTS PUBLIC DIRECT","86481"]
["TUFTS","TUFTS HMO","74262","HC CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST","74262 - HC CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST",null,null,null,null,null,"BMCHN QHP","86486"]
["TUFTS","TUFTS PPO","74360","HC CHG INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I","74360 - HC CHG INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I",null,null,null,null,null,"TUFTS PUBLIC DIRECT","86580"]
["TUFTS","TUFTS SELECT","75559","HC CHG CARDIAC MRI W/O CONTRAST W/STRESS IMAGING","75559 - HC CHG CARDIAC MRI W/O CONTRAST W/STRESS IMAGING",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","86592"]
["TUFTS","TUFTS HMO","75630","HC CHG AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I","75630 - HC CHG AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I",null,null,null,null,null,"TUFTS HMO","86593"]
["TUFTS","TUFTS POS","75726","HC CHG ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I","75726 - HC CHG ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","86606"]
["TUFTS","TUFTS SELECT","75827","HC CHG VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I","75827 - HC CHG VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I",null,null,null,null,null,"ELEMENT CARE INC","86609"]
["TUFTS","TUFTS HMO","75891","HC CHG HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I","75891 - HC CHG HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I",null,null,null,null,null,"BLUE CROSS-MEDICARE ADVANTAGE","86611"]
["TUFTS","TUFTS PPO","76010","HC CHG RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD","76010 - HC CHG RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD",null,null,null,null,null,"AETNA-MEDICARE ADVANTAGE","86612"]
["TUFTS","TUFTS HMO","76098","HC CHG RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN","76098 - HC CHG RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN",null,null,null,null,null,"BLUE CROSS-MEDICARE ADVANTAGE","86612"]
["TUFTS","TUFTS SELECT","76516","OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN","76516 - OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN",null,null,null,null,null,"BMCHN MCO","86615"]
["TUFTS","TUFTS POS","76775","US RETROPERITONEAL REAL TIME W/IMAGE LIMITED","76775 - US RETROPERITONEAL REAL TIME W/IMAGE LIMITED",null,null,null,null,null,"BLUE CROSS-PPO","86617"]
["TUFTS","TUFTS HMO","76810","US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO","76810 - US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO",null,null,null,null,null,"TUFTS HMO","86617"]
["TUFTS","TUFTS HMO","76828","DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT","76828 - DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT",null,null,null,null,null,"UHC COMMUNITY CARE (EVERCARE)","86618"]
["TUFTS","TUFTS SELECT","76872","ULTRASOUND TRANSRECTAL","76872 - ULTRASOUND TRANSRECTAL",null,null,null,null,null,"ELEMENT CARE INC","86622"]
["TUFTS","TUFTS PPO","76981","HC USE PARENCHYMA","76981 - HC USE PARENCHYMA",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","86625"]
["TUFTS","TUFTS SELECT","77001","HC CHG FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT","77001 - HC CHG FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT",null,null,null,null,null,"ALLWAYS HLTH ACO","86631"]
["TUFTS","TUFTS SELECT","77049","HC MRI BREAST C-+ W/CAD BI","77049 - HC MRI BREAST C-+ W/CAD BI",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","86631"]
["TUFTS","TUFTS PPO","77075","HC CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL","77075 - HC CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL",null,null,null,null,null,"BLUE CROSS-HMO BLUE","86635"]
["TUFTS","TUFTS PPO","77076","HC X-RAYS BONE SURVEY INFANT","77076 - HC X-RAYS BONE SURVEY INFANT",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","86635"]
["TUFTS","TUFTS SELECT","77306","TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION","77306 - TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION",null,null,null,null,null,"ELEMENT CARE INC","86638"]
["TUFTS","TUFTS SELECT","77318","BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL","77318 - BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL",null,null,null,null,null,"TUFTS PUBLIC DIRECT","86638"]
["TUFTS","TUFTS SELECT","77402","HC TX DEL =>1 MEV SIMPLE","77402 - HC TX DEL =>1 MEV SIMPLE",null,null,null,null,null,"BLUE CROSS-INDEMNITY","86645"]
["TUFTS","TUFTS PPO","77520","PROTON BEAM DEL,SIMPLE","77520 - PROTON BEAM DEL,SIMPLE",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","86645"]
["TUFTS","TUFTS SELECT","77768","HC HDR RDNCL SKSURF 2.0/2CH>","77768 - HC HDR RDNCL SKSURF 2.0/2CH>",null,null,null,null,null,"BMCHN MCO","86648"]
["TUFTS","TUFTS PPO","78020","HC CHG THYROID CARCINOMA METASTASES UPTAKE","78020 - HC CHG THYROID CARCINOMA METASTASES UPTAKE",null,null,null,null,null,"BMCHN ACO","86652"]
["TUFTS","TUFTS PPO","78215","HC CHG LIVER & SPLEEN IMAGING STATIC ONLY","78215 - HC CHG LIVER & SPLEEN IMAGING STATIC ONLY",null,null,null,null,null,"BLUE CROSS-HMO BLUE","86654"]
["TUFTS","TUFTS POS","78305","HC BONE&/JOINT IM;MULT","78305 - HC BONE&/JOINT IM;MULT",null,null,null,null,null,"UNITED/HARVARD PILGRIM","86654"]
["TUFTS","TUFTS HMO","78430","HC MYOCRD IMG PET RST/STRS W/CT","78430 - HC MYOCRD IMG PET RST/STRS W/CT",null,null,null,null,null,"ELEMENT CARE INC","86658"]
["TUFTS","TUFTS SELECT","78491","HC CHG MYOCRD IMAGE PET PERFUS SINGLE STUDY REST/STRESS","78491 - HC CHG MYOCRD IMAGE PET PERFUS SINGLE STUDY REST/STRESS",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","86663"]
["TUFTS","TUFTS POS","78599","HC LUNG SPECT","78599 - HC LUNG SPECT",null,null,null,null,null,"BLUE CROSS-MEDICARE ADVANTAGE","86664"]
["TUFTS","TUFTS PPO","78804","HC RP TUM LOC/RP DIS;BODY,2/","78804 - HC RP TUM LOC/RP DIS;BODY,2/",null,null,null,null,null,"CIGNA PPO","86665"]
["TUFTS","TUFTS SELECT","78816","HC CHG PET IMAGING FOR CT ATTENUATION WHOLE BODY","78816 - HC CHG PET IMAGING FOR CT ATTENUATION WHOLE BODY",null,null,null,null,null,"BLUE CROSS-HMO BLUE","86666"]
["TUFTS","TUFTS SPIRIT","80051","HC CHG ELECTROLYTE PANEL","80051 - HC CHG ELECTROLYTE PANEL",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","86677"]
["TUFTS","TUFTS PPO","80076","HC CHG HEPATIC FUNCTION PANEL","80076 - HC CHG HEPATIC FUNCTION PANEL",null,null,null,null,null,"UNICARE","86677"]
["TUFTS","TUFTS POS","80162","HC CHG DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL","80162 - HC CHG DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","86682"]
["TUFTS","TUFTS PPO","80171","DRUG SCREEN QUANTITATIVE GABAPENTIN","80171 - DRUG SCREEN QUANTITATIVE GABAPENTIN",null,null,null,null,null,"BMCHN WELL SENSE","86689"]
["TUFTS","TUFTS HMO","80195","HC CHG DRUG SCREEN QUANTITATIVE SIROLIMUS","80195 - HC CHG DRUG SCREEN QUANTITATIVE SIROLIMUS",null,null,null,null,null,"CIGNA PPO","86692"]
["TUFTS","TUFTS SELECT","80201","HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE","80201 - HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","86692"]
["TUFTS","TUFTS HMO","80235","HC DRUG ASSAY LACOSAMIDE","80235 - HC DRUG ASSAY LACOSAMIDE",null,null,null,null,null,"CIGNA PPO","86694"]
["TUFTS","TUFTS MEDICARE PREFERRED HMO","80307","HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS","80307 - HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS",null,null,null,null,null,"BLUE CROSS-HMO BLUE","86695"]
["TUFTS","TUFTS MEDICARE SCO","80438","HC CHG TRH STIM PANEL 1 HR","80438 - HC CHG TRH STIM PANEL 1 HR",null,null,null,null,null,"BLUE CROSS-HMO BLUE","86696"]
["TUFTS","TUFTS SPIRIT","81015","HC CHG URINALYSIS MICROSCOPIC ONLY","81015 - HC CHG URINALYSIS MICROSCOPIC ONLY",null,null,null,null,null,"UNICARE","86696"]
["TUFTS","TUFTS PPO","81179","HC CHG ATXN2 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","81179 - HC CHG ATXN2 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","86698"]
["TUFTS","TUFTS SPIRIT","81218","HC CEBPA GENE ANALYSIS FULL GENE SEQUENC","81218 - HC CEBPA GENE ANALYSIS FULL GENE SEQUENC",null,null,null,null,null,"CIGNA","86701"]
["TUFTS","TUFTS MEDICARE PREFERRED HMO","81256","HC CHG HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS","81256 - HC CHG HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS",null,null,null,null,null,"CIGNA PPO","86702"]
["TUFTS","TUFTS POS","81270","HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT","81270 - HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT",null,null,null,null,null,"BLUE CROSS-HMO BLUE","86703"]
["TUFTS","TUFTS SPIRIT","81291","HC CHG MTHFR GENE ANALYSIS COMMON VARIANTS","81291 - HC CHG MTHFR GENE ANALYSIS COMMON VARIANTS",null,null,null,null,null,"BMCHN MEDICAID","86704"]
["TUFTS","TUFTS MEDICARE SCO","81308","HC PALB2 GENE KNOWN FAMIL VRNT","81308 - HC PALB2 GENE KNOWN FAMIL VRNT",null,null,null,null,null,"UNICARE","86704"]
["TUFTS","TUFTS PPO","81364","HC HBB FULL GENE SEQUENCE","81364 - HC HBB FULL GENE SEQUENCE",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","86706"]
["TUFTS","TUFTS MEDICARE SCO","81406","HC CHG MOLECULAR PATHOLOGY PROCEDURE LEVEL 7","81406 - HC CHG MOLECULAR PATHOLOGY PROCEDURE LEVEL 7",null,null,null,null,null,"ELEMENT CARE INC","86706"]
["TUFTS","TUFTS HMO","82010","HC CHG KETONE BODIES SERUM QUANTITATIVE","82010 - HC CHG KETONE BODIES SERUM QUANTITATIVE",null,null,null,null,null,"CIGNA PPO","86707"]
["TUFTS","TUFTS MEDICARE SCO","82043","HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE","82043 - HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","86708"]
["TUFTS","TUFTS POS","82139","HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE","82139 - HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","86709"]
["TUFTS","TUFTS MEDICARE PREFERRED HMO","82172","HC CHG APOLIPOPROTEIN EACH","82172 - HC CHG APOLIPOPROTEIN EACH",null,null,null,null,null,"UNICARE","86709"]
["TUFTS","TUFTS HMO","82232","HC CHG BETA-2 MICROGLOBULIN","82232 - HC CHG BETA-2 MICROGLOBULIN",null,null,null,null,null,"BMCHN QHP","86710"]
["TUFTS","TUFTS PPO","82330","HC CHG CALCIUM IONIZED","82330 - HC CHG CALCIUM IONIZED",null,null,null,null,null,"TUFTS PPO","86735"]
["TUFTS","TUFTS SPIRIT","82365","HC CHG CALCULUS INFRARED SPECTROSCOPY","82365 - HC CHG CALCULUS INFRARED SPECTROSCOPY",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","86738"]
["TUFTS","TUFTS MEDICARE PREFERRED HMO","82436","HC CHG CHLORIDE URINE","82436 - HC CHG CHLORIDE URINE",null,null,null,null,null,"BMCHN ACO","86744"]
["TUFTS","TUFTS MEDICARE PREFERRED HMO","82438","HC CHG CHLORIDE OTHER SOURCE","82438 - HC CHG CHLORIDE OTHER SOURCE",null,null,null,null,null,"CIGNA PPO","86744"]
["TUFTS","TUFTS HMO","82540","HC CHG ASSAY OF CREATINE","82540 - HC CHG ASSAY OF CREATINE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","86747"]
["TUFTS","TUFTS SPIRIT","82570","HC CHG CREATININE OTHER SOURCE","82570 - HC CHG CREATININE OTHER SOURCE",null,null,null,null,null,"CIGNA PPO","86753"]
["TUFTS","TUFTS MEDICARE SCO","82607","HC CHG CYANOCOBALAMIN VITAMIN B-12","82607 - HC CHG CYANOCOBALAMIN VITAMIN B-12",null,null,null,null,null,"UNICARE","86753"]
["TUFTS","TUFTS SELECT","82677","HC CHG ASSAY OF ESTRIOL","82677 - HC CHG ASSAY OF ESTRIOL",null,null,null,null,null,"BLUE CROSS-MEDICARE ADVANTAGE","86762"]
["TUFTS","TUFTS SELECT","82731","HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN","82731 - HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN",null,null,null,null,null,"TUFTS PPO","86762"]
["TUFTS","TUFTS PPO","82810","HC BLOOD GASSES O2 SAT ONLY","82810 - HC BLOOD GASSES O2 SAT ONLY",null,null,null,null,null,"TUFTS PUBLIC UNIFY","86765"]
["TUFTS","TUFTS POS","82947","HC CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP","82947 - HC CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP",null,null,null,null,null,"BMCHN MCO","86769"]
["TUFTS","TUFTS SPIRIT","82977","HC CHG ASSAY OF GGT","82977 - HC CHG ASSAY OF GGT",null,null,null,null,null,"ELEMENT CARE INC","86774"]
["TUFTS","TUFTS SELECT","83020","HC CHG HEMOGLOBIN ELECTROPHORESIS","83020 - HC CHG HEMOGLOBIN ELECTROPHORESIS",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","86777"]
["TUFTS","TUFTS MEDICARE PREFERRED HMO","83021","HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY","83021 - HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY",null,null,null,null,null,"TUFTS MEDICARE PREFERRED HMO","86777"]
["TUFTS","TUFTS PPO","83497","HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA","83497 - HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","86778"]
["TUFTS","TUFTS MEDICARE SCO","83525","HC CHG ASSAY OF INSULIN TOTAL","83525 - HC CHG ASSAY OF INSULIN TOTAL",null,null,null,null,null,"BMCHN MCO","86780"]
["TUFTS","TUFTS MEDICARE SCO","83695","HC CHG LIPOPROTEIN (A)","83695 - HC CHG LIPOPROTEIN (A)",null,null,null,null,null,"TUFTS HMO","86787"]
["TUFTS","TUFTS SELECT","83735","HC CHG ASSAY OF MAGNESIUM","83735 - HC CHG ASSAY OF MAGNESIUM",null,null,null,null,null,"BLUE CROSS-MEDICARE ADVANTAGE","86788"]
["TUFTS","TUFTS POS","83873","HC CHG MYELIN BASIC PROTEIN CEREBROSPINAL FLUID","83873 - HC CHG MYELIN BASIC PROTEIN CEREBROSPINAL FLUID",null,null,null,null,null,"TUFTS PUBLIC UNIFY","86788"]
["TUFTS","TUFTS HMO","83921","HC CHG ORGANIC ACID 1 QUANTITATIVE","83921 - HC CHG ORGANIC ACID 1 QUANTITATIVE",null,null,null,null,null,"TUFTS PUBLIC UNIFY","86789"]
["TUFTS","TUFTS SPIRIT","83970","HC CHG ASSAY OF PARATHORMONE","83970 - HC CHG ASSAY OF PARATHORMONE",null,null,null,null,null,"TUFTS PPO","86790"]
["TUFTS","TUFTS MEDICARE SCO","84105","HC CHG ASSAY OF PHOSPHORUS INORGANIC URINE","84105 - HC CHG ASSAY OF PHOSPHORUS INORGANIC URINE",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","86800"]
["TUFTS","TUFTS SELECT","84146","HC CHG ASSAY OF PROLACTIN","84146 - HC CHG ASSAY OF PROLACTIN",null,null,null,null,null,"FALLON SENIOR PLAN","86803"]
["TUFTS","TUFTS POS","84163","HC CHG PREGNANCY-ASSOCIATED PLASMA PROTEIN-A","84163 - HC CHG PREGNANCY-ASSOCIATED PLASMA PROTEIN-A",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","86807"]
["TUFTS","TUFTS HMO","84202","HC Q;ERYTH PROTPOR","84202 - HC Q;ERYTH PROTPOR",null,null,null,null,null,"TUFTS SELECT","86807"]
["TUFTS","TUFTS SPIRIT","84300","HC CHG ASSAY OF URINE SODIUM","84300 - HC CHG ASSAY OF URINE SODIUM",null,null,null,null,null,"ALLWAYS HLTH ACO","86813"]
["TUFTS","TUFTS PPO","84376","HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC","84376 - HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC",null,null,null,null,null,"TUFTS PPO","86813"]
["TUFTS","TUFTS HMO","84442","HC CHG ASSAY OF THYROXINE BNDNG GLOBULIN","84442 - HC CHG ASSAY OF THYROXINE BNDNG GLOBULIN",null,null,null,null,null,"TUFTS PUBLIC DIRECT NON SUBSIDIZ","86817"]
["TUFTS","TUFTS HMO","84460","HC CHG TRANSFERASE ALANINE AMINO (ALT) (SGPT)","84460 - HC CHG TRANSFERASE ALANINE AMINO (ALT) (SGPT)",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","86850"]
["TUFTS","TUFTS SELECT","84480","HC CHG ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3","84480 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3",null,null,null,null,null,"CIGNA CARELINK","86860"]
["TUFTS","TUFTS SELECT","84540","HC CHG ASSAY OF UREA NITROGEN URINE","84540 - HC CHG ASSAY OF UREA NITROGEN URINE",null,null,null,null,null,"TUFTS PUBLIC TOGETHER","86870"]
["TUFTS","TUFTS MEDICARE PREFERRED HMO","84702","HC HCG TUMOR MARKER","84702 - HC HCG TUMOR MARKER",null,null,null,null,null,"ALLWAYS HLTH ACO","86886"]
["TUFTS","TUFTS SELECT","85014","HC CHG BLOOD COUNT HEMATOCRIT","85014 - HC CHG BLOOD COUNT HEMATOCRIT",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","86886"]
["TUFTS","TUFTS HMO","85045","HC CHG BLOOD COUNT RETICULOCYTE AUTOMATED","85045 - HC CHG BLOOD COUNT RETICULOCYTE AUTOMATED",null,null,null,null,null,"ALLWAYS HLTH ACO","86900"]
["TUFTS","TUFTS SELECT","85055","HC CHG RETICULATED PLATELET ASSAY","85055 - HC CHG RETICULATED PLATELET ASSAY",null,null,null,null,null,"TUFTS PPO","86900"]
["TUFTS","TUFTS SELECT","85250","HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS","85250 - HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS",null,null,null,null,null,"TUFTS PUBLIC UNIFY","86901"]
["TUFTS","TUFTS PPO","85300","HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY","85300 - HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY",null,null,null,null,null,"SENIOR WHOLE HEALTH","86902"]
["TUFTS","TUFTS MEDICARE SCO","85306","HC CHG CLOTTING INHIBITORS PROTEIN S FREE","85306 - HC CHG CLOTTING INHIBITORS PROTEIN S FREE",null,null,null,null,null,"BMCHN MEDICAID","86905"]
["TUFTS","TUFTS POS","85379","HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE","85379 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE",null,null,null,null,null,"BMCHN ACO","86910"]
["TUFTS","TUFTS SELECT","85610","POC;INR","85610 - POC;INR",null,null,null,null,null,"CIGNA CARELINK","86922"]
["TUFTS","TUFTS POS","85660","HC CHG SICKLING RBC REDUCTION","85660 - HC CHG SICKLING RBC REDUCTION",null,null,null,null,null,"TUFTS PUBLIC DIRECT","86923"]
["TUFTS","TUFTS PPO","86022","HC CRL;SEROTONIN RLS ASSAY","86022 - HC CRL;SEROTONIN RLS ASSAY",null,null,null,null,null,"TUFTS SELECT","87015"]
["TUFTS","TUFTS SPIRIT","86140","C-REACTIVE PROTEIN","86140 - C-REACTIVE PROTEIN",null,null,null,null,null,"CIGNA","87040"]
["TUFTS","TUFTS SELECT","86200","HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY","86200 - HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY",null,null,null,null,null,"FALLON MEDICAID","87045"]
["TUFTS","TUFTS MEDICARE SCO","86256","HC CHG FLUORESCENT ANTIBODY; TITER","86256 - HC CHG FLUORESCENT ANTIBODY; TITER",null,null,null,null,null,"UHC COMMUNITY CARE (EVERCARE)","87045"]
["TUFTS","TUFTS HMO","86328","IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY; CORONAVIRUS 2","86328 - IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY; CORONAVIRUS 2",null,null,null,null,null,"TUFTS PUBLIC UNIFY","87046"]
["TUFTS","TUFTS MEDICARE SCO","86340","HC CHG INTRINSIC FACTOR ANTIBODIES","86340 - HC CHG INTRINSIC FACTOR ANTIBODIES",null,null,null,null,null,"SENIOR WHOLE HEALTH","87070"]
["TUFTS","TUFTS PPO","86376","HC CHG MICROSOMAL ANTIBODIES EACH","86376 - HC CHG MICROSOMAL ANTIBODIES EACH",null,null,null,null,null,"TUFTS MEDICARE SCO","87075"]
["TUFTS","TUFTS SPIRIT","86403","HC CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY","86403 - HC CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY",null,null,null,null,null,"AETNA-MEDICARE ADVANTAGE","87076"]
["TUFTS","TUFTS MEDICARE SCO","86592","HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL","86592 - HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL",null,null,null,null,null,"TUFTS SPIRIT","87076"]
["TUFTS","TUFTS POS","86611","HC BARTONELLA, ANTIBODY","86611 - HC BARTONELLA, ANTIBODY",null,null,null,null,null,"CIGNA","87077"]
["TUFTS","TUFTS MEDICARE SCO","86632","HC CHG CHLAMYDIA, IGM ANTIBODY","86632 - HC CHG CHLAMYDIA, IGM ANTIBODY",null,null,null,null,null,"FALLON MEDICAID","87081"]
["TUFTS","TUFTS POS","86658","HC CHG ENTEROVIRUS ANTIBODY","86658 - HC CHG ENTEROVIRUS ANTIBODY",null,null,null,null,null,"TUFTS POS","87086"]
["TUFTS","TUFTS PPO","86663","HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA","86663 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA",null,null,null,null,null,"TUFTS PUBLIC UNIFY","87086"]
["TUFTS","TUFTS POS","86694","HC CHG ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST","86694 - HC CHG ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST",null,null,null,null,null,"AETNA-MEDICARE ADVANTAGE","87102"]
["TUFTS","TUFTS MEDICARE PREFERRED HMO","86703","HC HIV 1/2 ANTIBODY","86703 - HC HIV 1/2 ANTIBODY",null,null,null,null,null,"TUFTS PUBLIC TOGETHER","87102"]
["TUFTS","TUFTS SPIRIT","86709","HC CHG HEPATITIS ANTIBODY HAAB IGM ANTIBODY","86709 - HC CHG HEPATITIS ANTIBODY HAAB IGM ANTIBODY",null,null,null,null,null,"TUFTS PUBLIC DIRECT SUBSIDIZED","87103"]
["TUFTS","TUFTS HMO","86753","HC CHG ANTIBODY PROTOZOA NES","86753 - HC CHG ANTIBODY PROTOZOA NES",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","87106"]
["TUFTS","TUFTS MEDICARE PREFERRED HMO","86769","ANTIBODY; SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2","86769 - ANTIBODY; SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","87107"]
["TUFTS","TUFTS MEDICARE PREFERRED HMO","86790","HC CHG ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED","86790 - HC CHG ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED",null,null,null,null,null,"BMCHN QHP","87110"]
["TUFTS","TUFTS SPIRIT","86803","HC CHG HEPATITIS C ANTIBODY","86803 - HC CHG HEPATITIS C ANTIBODY",null,null,null,null,null,"TUFTS PPO","87110"]
["TUFTS","TUFTS MEDICARE SCO","86880","HC CHG ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM","86880 - HC CHG ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM",null,null,null,null,null,"TUFTS MEDICARE SCO","87116"]
["TUFTS","TUFTS SELECT","86999","HC CHG UNLISTED TRANSFUSION MEDICINE PROCEDURE","86999 - HC CHG UNLISTED TRANSFUSION MEDICINE PROCEDURE",null,null,null,null,null,"TUFTS PUBLIC DIRECT SUBSIDIZED","87118"]
["TUFTS","TUFTS MEDICARE PREFERRED HMO","87015","HC CHG CONCENTRATION INFECTIOUS AGENTS","87015 - HC CHG CONCENTRATION INFECTIOUS AGENTS",null,null,null,null,null,"TUFTS PUBLIC UNIFY","87118"]
["TUFTS","TUFTS SELECT","87076","HC CHG CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL","87076 - HC CHG CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL",null,null,null,null,null,"TUFTS PUBLIC DIRECT SUBSIDIZED","87140"]
["TUFTS","TUFTS POS","87102","HC CHG CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD","87102 - HC CHG CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD",null,null,null,null,null,"FALLON MEDICAID","87149"]
["TUFTS","TUFTS MEDICARE SCO","87150","HC CHG CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM","87150 - HC CHG CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM",null,null,null,null,null,"TUFTS PUBLIC TOGETHER","87150"]
["TUFTS","TUFTS SPIRIT","87176","HC CHG HOMOGENIZATION TISSUE CULTURE","87176 - HC CHG HOMOGENIZATION TISSUE CULTURE",null,null,null,null,null,"CIGNA CARELINK","87153"]
["TUFTS","TUFTS PPO","87186","HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ","87186 - HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ",null,null,null,null,null,"BLUE CROSS-INDEMNITY","87172"]
["TUFTS","TUFTS SPIRIT","87220","TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT","87220 - TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","87176"]
["TUFTS","TUFTS HMO","87269","HC CHG IAADI GIARDIA","87269 - HC CHG IAADI GIARDIA",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","87176"]
["TUFTS","TUFTS SPIRIT","87281","HC CHG IAADI PNEUMOCUSTIS CARINII","87281 - HC CHG IAADI PNEUMOCUSTIS CARINII",null,null,null,null,null,"TUFTS PUBLIC DIRECT","87177"]
["TUFTS","TUFTS POS","87341","HC CHG IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION","87341 - HC CHG IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION",null,null,null,null,null,"TUFTS SELECT","87181"]
["TUFTS","TUFTS MEDICARE PREFERRED HMO","87391","HC CHG IAAD IA HIV-2","87391 - HC CHG IAAD IA HIV-2",null,null,null,null,null,"CCA ONE CARE","87184"]
["TUFTS","TUFTS PPO","87425","HC CHG IAAD IA ROTAVIRUS","87425 - HC CHG IAAD IA ROTAVIRUS",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","87184"]
["TUFTS","TUFTS MEDICARE PREFERRED HMO","87496","HC ARUP;CYTOMEG VIR PCR,CSF","87496 - HC ARUP;CYTOMEG VIR PCR,CSF",null,null,null,null,null,"BMC SENIOR CARE OPTIONS","87186"]
["TUFTS","TUFTS SPIRIT","87505","HC CHG NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN","87505 - HC CHG NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","87186"]
["TUFTS","TUFTS MEDICARE PREFERRED HMO","87532","HC CHG IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ","87532 - HC CHG IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ",null,null,null,null,null,"UNITED/HARVARD PILGRIM","87188"]
["TUFTS","TUFTS MEDICARE SCO","87563","HC M. GENITALIUM AMP PROBE","87563 - HC M. GENITALIUM AMP PROBE",null,null,null,null,null,"TUFTS SELECT","87205"]
["TUFTS","TUFTS MEDICARE PREFERRED HMO","87632","HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 6-11 TARGETS","87632 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 6-11 TARGETS",null,null,null,null,null,"CCA ONE CARE","87206"]
["TUFTS","TUFTS SELECT","87641","HC CHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ","87641 - HC CHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ",null,null,null,null,null,"BLUE CROSS-MEDICARE ADVANTAGE","87207"]
["TUFTS","TUFTS SELECT","87660","HC CHG IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ","87660 - HC CHG IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ",null,null,null,null,null,"CCA ONE CARE","87207"]
["TUFTS","TUFTS PPO","87902","HC CHG NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS","87902 - HC CHG NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS",null,null,null,null,null,"UNICARE","87209"]
["TUFTS","TUFTS POS","87999","HC CHG UNLISTED MICROBIOLOGY","87999 - HC CHG UNLISTED MICROBIOLOGY",null,null,null,null,null,"BMCHN MCO","87210"]
["TUFTS","TUFTS HMO","88147","HC CHG CYTOPATH SMEAR CERV/VAG AUTOMATED","88147 - HC CHG CYTOPATH SMEAR CERV/VAG AUTOMATED",null,null,null,null,null,"UNITED HEALTHCARE","87210"]
["TUFTS","TUFTS HMO","88187","FLOWCYTOMETRY/READ, 2-8 MARKERS","88187 - FLOWCYTOMETRY/READ, 2-8 MARKERS",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","87252"]
["TUFTS","TUFTS SPIRIT","88262","HC CHG CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING","88262 - HC CHG CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING",null,null,null,null,null,"TUFTS PUBLIC DIRECT","87252"]
["TUFTS","TUFTS PPO","88280","HC CHG CHROMOSOME KARYOTYPE STUDY","88280 - HC CHG CHROMOSOME KARYOTYPE STUDY",null,null,null,null,null,"NEIGHBORHOOD PACE (ESP EB)","87253"]
["TUFTS","TUFTS HMO","88312","HC CHG SPECIAL STAIN GROUP 1 MICROORGANISMS I&R","88312 - HC CHG SPECIAL STAIN GROUP 1 MICROORGANISMS I&R",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","87254"]
["TUFTS","TUFTS HMO","88356","CHG ANALYSIS, NERVE TECH","88356 - CHG ANALYSIS, NERVE TECH",null,null,null,null,null,"BMCHN MCO","87255"]
["TUFTS","TUFTS PPO","89051","HC CHG CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT","89051 - HC CHG CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT",null,null,null,null,null,"NEIGHBORHOOD PACE (ESP EB)","87260"]
["TUFTS","TUFTS PPO","90460","IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX","90460 - IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","87269"]
["TUFTS","TUFTS SELECT","90632","CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL","90632 - CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,null,null,null,null,"TUFTS PUBLIC UNIFY","87269"]
["TUFTS","TUFTS SPIRIT","90673","INFLUENZA VACCINE CELL CULT PRSRV FREE IM","90673 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM",null,null,null,null,null,"AETNA-MEDICARE ADVANTAGE","87275"]
["TUFTS","TUFTS MEDICARE SCO","90686","HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE","90686 - HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,null,null,null,null,"CIGNA","87275"]
["TUFTS","TUFTS SPIRIT","90715","CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH","90715 - CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,null,null,null,null,"CIGNA","87276"]
["TUFTS","TUFTS POS","90739","HC HEPATITIS B VACCINE ADULT 2 DOSE IM","90739 - HC HEPATITIS B VACCINE ADULT 2 DOSE IM",null,null,null,null,null,"BLUE CROSS-HMO BLUE","87279"]
["TUFTS","TUFTS HMO","90833","PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 30 MIN","90833 - PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 30 MIN",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","87281"]
["TUFTS","TUFTS HMO","90838","PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 60 MIN","90838 - PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 60 MIN",null,null,null,null,null,"FALLON MEDICAID","87281"]
["TUFTS","TUFTS SELECT","90867","HC TRANSCRANIAL MAGNETIC STIMULATION TREATMENT,PLANNING","90867 - HC TRANSCRANIAL MAGNETIC STIMULATION TREATMENT,PLANNING",null,null,null,null,null,"BMC SENIOR CARE OPTIONS","87299"]
["TUFTS","TUFTS SELECT","90935","HC HEMODIALYSIS PROCEDURE W/ PHYS/QHP EVALUATION","90935 - HC HEMODIALYSIS PROCEDURE W/ PHYS/QHP EVALUATION",null,null,null,null,null,"TUFTS PUBLIC UNIFY","87299"]
["TUFTS","TUFTS PPO","91200","HC LIVER ELASTOGRAPHY W/O IMAG W/I&R","91200 - HC LIVER ELASTOGRAPHY W/O IMAG W/I&R",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","87324"]
["TUFTS","TUFTS PPO","92082","VISUAL FIELD XM UNI/BI W/INTERP INTERMED EXAM","92082 - VISUAL FIELD XM UNI/BI W/INTERP INTERMED EXAM",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","87327"]
["TUFTS","TUFTS SELECT","92226","OPHTHALMOSCPY EXTENDED RETINAL DRAWING I&R SBS","92226 - OPHTHALMOSCPY EXTENDED RETINAL DRAWING I&R SBS",null,null,null,null,null,"TUFTS PUBLIC UNIFY","87327"]
["TUFTS","TUFTS HMO","92274","HC MULTIFOCAL ERG W/I&R","92274 - HC MULTIFOCAL ERG W/I&R",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","87338"]
["TUFTS","TUFTS SELECT","92313","HC CONTACT LENS FIT,CORNEOSCLERAL LENS","92313 - HC CONTACT LENS FIT,CORNEOSCLERAL LENS",null,null,null,null,null,"CIGNA","87340"]
["TUFTS","TUFTS SELECT","92532","POSITIONAL NYSTAGMUS TEST","92532 - POSITIONAL NYSTAGMUS TEST",null,null,null,null,null,"CIGNA","87341"]
["TUFTS","TUFTS PPO","92550","TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS","92550 - TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS",null,null,null,null,null,"BLUE CROSS-HMO BLUE","87350"]
["TUFTS","TUFTS HMO","92563","TONE DECAY TEST","92563 - TONE DECAY TEST",null,null,null,null,null,"TUFTS PPO","87350"]
["TUFTS","TUFTS SELECT","92586","AUDITORY EVOKED POTENTIALS LIMITED","92586 - AUDITORY EVOKED POTENTIALS LIMITED",null,null,null,null,null,"TUFTS PUBLIC UNIFY","87385"]
["TUFTS","TUFTS POS","92592","HEARING AID CHECK MONAURAL","92592 - HEARING AID CHECK MONAURAL",null,null,null,null,null,"BMC SENIOR CARE OPTIONS","87389"]
["TUFTS","TUFTS SELECT","92603","HC DX ANAL COCHLEAR IMP,PT >7 YRS,W/PROG","92603 - HC DX ANAL COCHLEAR IMP,PT >7 YRS,W/PROG",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","87389"]
["TUFTS","TUFTS HMO","92620","EVAL CENTRAL AUDITORY FUNCJ W/REPRT 1ST 60 MIN","92620 - EVAL CENTRAL AUDITORY FUNCJ W/REPRT 1ST 60 MIN",null,null,null,null,null,"TUFTS HMO","87390"]
["TUFTS","TUFTS HMO","92924","HC PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH","92924 - HC PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH",null,null,null,null,null,"NEIGHBORHOOD PACE (ESP EB)","87391"]
["TUFTS","TUFTS SELECT","92950","CARDIOPULMONARY RESUSCITATION","92950 - CARDIOPULMONARY RESUSCITATION",null,null,null,null,null,"ELEMENT CARE INC","87400"]
["TUFTS","TUFTS HMO","92987","HC PRQ BALLOON VALVULOPLASTY MITRAL VALVE","92987 - HC PRQ BALLOON VALVULOPLASTY MITRAL VALVE",null,null,null,null,null,"BLUE CROSS-MEDICARE ADVANTAGE","87420"]
["TUFTS","TUFTS POS","93284","PROGRM EVAL IMPLANTABLE IN PRSN MLT LD CARD/DFB","93284 - PROGRM EVAL IMPLANTABLE IN PRSN MLT LD CARD/DFB",null,null,null,null,null,"CIGNA PPO","87425"]
["TUFTS","TUFTS SELECT","93291","INTERROGATION EVALUATION IN PERSON ILR SYSTEM","93291 - INTERROGATION EVALUATION IN PERSON ILR SYSTEM",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","87425"]
["TUFTS","TUFTS HMO","93304","HC F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY","93304 - HC F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY",null,null,null,null,null,"TUFTS PUBLIC UNIFY","87426"]
["TUFTS","TUFTS PPO","93350","HC ECHO HEART XTHORACIC, STRESS/REST WITH CONTRAST","93350 - HC ECHO HEART XTHORACIC, STRESS/REST WITH CONTRAST",null,null,null,null,null,"UNITED/HARVARD PILGRIM","87430"]
["TUFTS","TUFTS SELECT","93456","HC CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I","93456 - HC CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I",null,null,null,null,null,"TUFTS SPIRIT","87449"]
["TUFTS","TUFTS SELECT","93505","HC ENDOMYOCARDIAL BIOPSY","93505 - HC ENDOMYOCARDIAL BIOPSY",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","87480"]
["TUFTS","TUFTS PPO","93582","HC PERCUTAN TRANSCATH CLOSURE PAT DUCT ARTERIOSUS","93582 - HC PERCUTAN TRANSCATH CLOSURE PAT DUCT ARTERIOSUS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","87481"]
["TUFTS","TUFTS SELECT","93620","HC COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION","93620 - HC COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION",null,null,null,null,null,"BMCHN ACO","87486"]
["TUFTS","TUFTS HMO","93653","HC COMPRE EP EVAL TX SVT","93653 - HC COMPRE EP EVAL TX SVT",null,null,null,null,null,"TUFTS PUBLIC UNIFY","87486"]
["TUFTS","TUFTS PPO","93880","HC DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY","93880 - HC DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","87491"]
["TUFTS","TUFTS SELECT","93923","NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS","93923 - NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS",null,null,null,null,null,"TUFTS SPIRIT","87491"]
["TUFTS","TUFTS POS","93985","DUP-SCAN HEMO COMPL BI STD","93985 - DUP-SCAN HEMO COMPL BI STD",null,null,null,null,null,"TUFTS PUBLIC TOGETHER","87493"]
["TUFTS","TUFTS HMO","94250","HC EXPIRED GAS COLLECTION QUANT 1 PROCEDURE SPX","94250 - HC EXPIRED GAS COLLECTION QUANT 1 PROCEDURE SPX",null,null,null,null,null,"SENIOR WHOLE HEALTH","87496"]
["TUFTS","TUFTS POS","94642","HC AEROSOL INHALATION TREATMENT","94642 - HC AEROSOL INHALATION TREATMENT",null,null,null,null,null,"BMCHN MEDICAID","87497"]
["TUFTS","TUFTS PPO","94726","PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST","94726 - PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST",null,null,null,null,null,"UNITED/HARVARD PILGRIM","87497"]
["TUFTS","TUFTS POS","94762","NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR","94762 - NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR",null,null,null,null,null,"BMCHN MEDICAID","87498"]
["TUFTS","TUFTS POS","95145","PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 1 INSECT","95145 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 1 INSECT",null,null,null,null,null,"TUFTS PUBLIC DIRECT NON SUBSIDIZ","87502"]
["TUFTS","TUFTS HMO","95170","PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY WHL INSE","95170 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY WHL INSE",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","87505"]
["TUFTS","TUFTS POS","95708","HC EEG WO VID EA 12-26HR UNMNTR","95708 - HC EEG WO VID EA 12-26HR UNMNTR",null,null,null,null,null,"UNITED HEALTHCARE","87505"]
["TUFTS","TUFTS SELECT","95811","POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND","95811 - POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND",null,null,null,null,null,"BLUE CROSS-INDEMNITY","87507"]
["TUFTS","TUFTS SELECT","95860","NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS","95860 - NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","87507"]
["TUFTS","TUFTS PPO","95886","NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE","95886 - NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE",null,null,null,null,null,"BLUE CROSS-HMO BLUE","87511"]
["TUFTS","TUFTS PPO","95907","MOTOR &/SENS 1-2 NRV CNDJ PRECONF ELTRODE LIMB","95907 - MOTOR &/SENS 1-2 NRV CNDJ PRECONF ELTRODE LIMB",null,null,null,null,null,"BMCHN WELL SENSE","87511"]
["TUFTS","TUFTS SELECT","95933","ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST","95933 - ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST",null,null,null,null,null,"ELEMENT CARE INC","87517"]
["TUFTS","TUFTS PPO","95976","HC ALYS SMPL CN NPGT PRGRMG","95976 - HC ALYS SMPL CN NPGT PRGRMG",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","87522"]
["TUFTS","TUFTS SELECT","96020","HC TEST SELECT & ADMN FUNCTL BRAIN MAP PHYS/QHP","96020 - HC TEST SELECT & ADMN FUNCTL BRAIN MAP PHYS/QHP",null,null,null,null,null,"BMCHN MCO","87529"]
["TUFTS","TUFTS SELECT","96127","BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT","96127 - BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","87529"]
["TUFTS","TUFTS SELECT","96133","HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR","96133 - HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR",null,null,null,null,null,"BMCHN MCO","87532"]
["TUFTS","TUFTS HMO","96160","PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM","96160 - PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM",null,null,null,null,null,"CCA ONE CARE","87535"]
["TUFTS","TUFTS PPO","96365","IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR","96365 - IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR",null,null,null,null,null,"BLUE CROSS-HMO BLUE","87536"]
["TUFTS","TUFTS POS","96402","CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO","96402 - CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO",null,null,null,null,null,"BLUE CROSS-PPO","87538"]
["TUFTS","TUFTS PPO","96900","ACTINOTHERAPY ULTRAVIOLET LIGHT","96900 - ACTINOTHERAPY ULTRAVIOLET LIGHT",null,null,null,null,null,"BMCHN ACO","87556"]
["TUFTS","TUFTS PPO","97014","HC APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED","97014 - HC APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","87556"]
["TUFTS","TUFTS HMO","97124","HC THER PX 1 AREAS EA 15 MIN MASSAGE","97124 - HC THER PX 1 AREAS EA 15 MIN MASSAGE",null,null,null,null,null,"TUFTS MEDICARE SCO","87563"]
["TUFTS","TUFTS SELECT","97154","HC GRP ADAPT BHV TX BY TECH","97154 - HC GRP ADAPT BHV TX BY TECH",null,null,null,null,null,"ELEMENT CARE INC","87581"]
["TUFTS","TUFTS PPO","97533","HC SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES","97533 - HC SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","87591"]
["TUFTS","TUFTS POS","97802","MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI","97802 - MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI",null,null,null,null,null,"TUFTS PUBLIC DIRECT","87624"]
["TUFTS","TUFTS POS","99151","HC MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS","99151 - HC MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS",null,null,null,null,null,"FALLON MEDICAID","87631"]
["TUFTS","TUFTS PPO","99201","OFFICE OUTPATIENT NEW 10 MINUTES","99201 - OFFICE OUTPATIENT NEW 10 MINUTES",null,null,null,null,null,"BMC SENIOR CARE OPTIONS","87632"]
["TUFTS","TUFTS HMO","99217","HC OBSERVATION CARE DISCHARGE","99217 - HC OBSERVATION CARE DISCHARGE",null,null,null,null,null,"BLUE CROSS-MEDICARE ADVANTAGE","87633"]
["TUFTS","TUFTS POS","99366","HC TEAM CONFERENCE FACE-TO-FACE NONPHYSICIAN","99366 - HC TEAM CONFERENCE FACE-TO-FACE NONPHYSICIAN",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","87635"]
["TUFTS","TUFTS SELECT","99387","INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&>","99387 - INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&>",null,null,null,null,null,"BLUE CROSS-PPO","87636"]
["TUFTS","TUFTS POS","99394","PERIODIC PREVENTIVE MED EST PATIENT 12-17YRS","99394 - PERIODIC PREVENTIVE MED EST PATIENT 12-17YRS",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","87636"]
["TUFTS","TUFTS POS","99497","HC ADVANCED CARE PLANNING; 1ST HR","99497 - HC ADVANCED CARE PLANNING; 1ST HR",null,null,null,null,null,"BMCHN QHP","87641"]
["TUFTS","TUFTS PPO","99607","MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM",null,null,null,null,null,"TUFTS PPO","87641"]
["TUFTS","TUFTS SELECT","0362T","HC BHV ID SUPRT ASSMT EA 15 MIN","0362T - HC BHV ID SUPRT ASSMT EA 15 MIN",null,null,null,null,null,"CIGNA CARELINK","87653"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","11922","HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",null,null,null,null,null,"BLUE CROSS-HMO BLUE","87660"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","36592","COLLECT BLOOD FROM CATHETER VENOUS NOS","36592 - COLLECT BLOOD FROM CATHETER VENOUS NOS",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","87660"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","61630","HC INTRACRANIAL BALLOON ANGIOPLASTY","61630 - HC INTRACRANIAL BALLOON ANGIOPLASTY",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","87797"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","74241","XR UGI W KUB","74241 - XR UGI W KUB",null,null,null,null,null,"TUFTS SELECT","87797"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","80069","HC CHG RENAL FUNCTION PANEL","80069 - HC CHG RENAL FUNCTION PANEL",null,null,null,null,null,"BLUE CROSS-INDEMNITY","87799"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","80156","HC CHG DRUG ASSAY CARBAMAZEPINE TOTAL","80156 - HC CHG DRUG ASSAY CARBAMAZEPINE TOTAL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","87799"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","80171","DRUG SCREEN QUANTITATIVE GABAPENTIN","80171 - DRUG SCREEN QUANTITATIVE GABAPENTIN",null,null,null,null,null,"BMC SENIOR CARE OPTIONS","87801"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","80198","HC Q;THEOPHYLLINE","80198 - HC Q;THEOPHYLLINE",null,null,null,null,null,"BMCHN ACO","87880"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","80307","HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS","80307 - HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","87899"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","81003","URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY","81003 - URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY",null,null,null,null,null,"UNITED/HARVARD PILGRIM","87899"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","81207","HC Q;P190 BCR-ABL 1","81207 - HC Q;P190 BCR-ABL 1",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","87900"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","81229","HC CYTOG ALYS CHRML ABNR SNPCGH","81229 - HC CYTOG ALYS CHRML ABNR SNPCGH",null,null,null,null,null,"SENIOR WHOLE HEALTH","87901"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","81253","HC CHG GJB2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS","81253 - HC CHG GJB2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","87902"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","81277","HC CYTOGENOMIC NEO MICRORA ALYS","81277 - HC CYTOGENOMIC NEO MICRORA ALYS",null,null,null,null,null,"ELDER SERVICE PLAN OTHER","87906"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","81308","HC PALB2 GENE KNOWN FAMIL VRNT","81308 - HC PALB2 GENE KNOWN FAMIL VRNT",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","87912"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","81403","SEQ & EXON 13 SEQ, IF PERFORMED KRAS (EG, CARCINOMA), GENE ANALYSIS, PRO/TECH","81403 - SEQ & EXON 13 SEQ, IF PERFORMED KRAS (EG, CARCINOMA), GENE ANALYSIS, PRO/TECH",null,null,null,null,null,"ALLWAYS HLTH ACO","88104"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","81596","HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR","81596 - HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR",null,null,null,null,null,"BMCHN MCO","88108"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","82017","HC CHG ACYLCARNITINES QUANTIATIVE EACH SPECIMEN","82017 - HC CHG ACYLCARNITINES QUANTIATIVE EACH SPECIMEN",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","88108"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","82104","HC CHG ALPHA-1-ANTITRYPSIN PHENOTYPE","82104 - HC CHG ALPHA-1-ANTITRYPSIN PHENOTYPE",null,null,null,null,null,"TUFTS POS","88141"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","82150","HC CHG ASSAY OF AMYLASE","82150 - HC CHG ASSAY OF AMYLASE",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","88142"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","82308","HC CHG CALCITONIN","82308 - HC CHG CALCITONIN",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","88143"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","82365","HC CHG CALCULUS INFRARED SPECTROSCOPY","82365 - HC CHG CALCULUS INFRARED SPECTROSCOPY",null,null,null,null,null,"AETNA-MEDICARE ADVANTAGE","88147"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","82397","HC CHEMILUMINESCENT ASSAY","82397 - HC CHEMILUMINESCENT ASSAY",null,null,null,null,null,"TUFTS POS","88147"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","82533","HC CHG CORTISOL TOTAL","82533 - HC CHG CORTISOL TOTAL",null,null,null,null,null,"TUFTS SELECT","88152"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","82575","HC CHG CREATININE CLEARANCE","82575 - HC CHG CREATININE CLEARANCE",null,null,null,null,null,"TUFTS PUBLIC DIRECT","88160"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","82677","HC CHG ASSAY OF ESTRIOL","82677 - HC CHG ASSAY OF ESTRIOL",null,null,null,null,null,"ELDER SERVICE PLAN OTHER","88164"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","82705","HC CHG FAT/LIPIDS FECES QUALITATIVE","82705 - HC CHG FAT/LIPIDS FECES QUALITATIVE",null,null,null,null,null,"TUFTS PPO","88164"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","82941","HC CHG ASSAY OF GASTRIN","82941 - HC CHG ASSAY OF GASTRIN",null,null,null,null,null,"TUFTS PUBLIC TOGETHER","88165"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","83002","HC CHG GONADOTROPIN LUTEINIZING HORMONE","83002 - HC CHG GONADOTROPIN LUTEINIZING HORMONE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","88173"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","83021","HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY","83021 - HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY",null,null,null,null,null,"TUFTS PUBLIC DIRECT SUBSIDIZED","88184"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","83070","HC CHG ASSAY OF HEMOSIDERIN QUALITATIVE","83070 - HC CHG ASSAY OF HEMOSIDERIN QUALITATIVE",null,null,null,null,null,"BMCHN WELL SENSE","88185"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","83520","HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE","83520 - HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE",null,null,null,null,null,"TUFTS PPO","88187"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","83718","HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL","83718 - HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL",null,null,null,null,null,"NEIGHBORHOOD PACE (ESP EB)","88230"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","83873","HC CHG MYELIN BASIC PROTEIN CEREBROSPINAL FLUID","83873 - HC CHG MYELIN BASIC PROTEIN CEREBROSPINAL FLUID",null,null,null,null,null,"BLUE CROSS-PPO","88235"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","83937","HC CHG ASSAY OF OSTEOCALCIN","83937 - HC CHG ASSAY OF OSTEOCALCIN",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","88237"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","84133","HC CHG POTASSIUM URINE","84133 - HC CHG POTASSIUM URINE",null,null,null,null,null,"BMCHN QHP","88262"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","84145","HC CHG PROCALCITONIN (PCT)","84145 - HC CHG PROCALCITONIN (PCT)",null,null,null,null,null,"TUFTS MEDICARE PREFERRED HMO","88262"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","84165","HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM","84165 - HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM",null,null,null,null,null,"BMCHN WELL SENSE","88264"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","84295","HC CHG SODIUM SERUM PLASMA OR WHOLE BLOOD","84295 - HC CHG SODIUM SERUM PLASMA OR WHOLE BLOOD",null,null,null,null,null,"NEIGHBORHOOD PACE (ESP EB)","88271"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","84402","HC CHG ASSAY OF TESTOSTERONE FREE","84402 - HC CHG ASSAY OF TESTOSTERONE FREE",null,null,null,null,null,"BLUE CROSS-PPO","88274"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","84450","HC CHG TRANSFERASE ASPARTATE AMINO AST SGOT","84450 - HC CHG TRANSFERASE ASPARTATE AMINO AST SGOT",null,null,null,null,null,"BMCHN MCO","88275"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","84481","HC CHG ASSAY OF TRIIODOTHYRONINE T3 FREE","84481 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 FREE",null,null,null,null,null,"UNITED HEALTHCARE","88275"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","84590","HC CHG ASSAY OF VITAMIN A","84590 - HC CHG ASSAY OF VITAMIN A",null,null,null,null,null,"TUFTS MEDICARE PREFERRED HMO","88280"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","85004","HC AUTO DIFF","85004 - HC AUTO DIFF",null,null,null,null,null,"TUFTS HMO","88291"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","85210","HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC","85210 - HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","88304"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","85260","HC CHG CLOTTING FACTOR X STUART-PROWER","85260 - HC CHG CLOTTING FACTOR X STUART-PROWER",null,null,null,null,null,"UNITED/HARVARD PILGRIM","88305"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","85290","HC CHG CLOTTING FACTOR XIII FIBRIN STABILIZING","85290 - HC CHG CLOTTING FACTOR XIII FIBRIN STABILIZING",null,null,null,null,null,"TUFTS POS","88307"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","85461","HC CHG HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE","85461 - HC CHG HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE",null,null,null,null,null,"CIGNA PPO","88313"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","85576","HC CHG PLATELET AGGREGATION IN VITRO EACH AGENT","85576 - HC CHG PLATELET AGGREGATION IN VITRO EACH AGENT",null,null,null,null,null,"BMCHN WELL SENSE","88314"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","85670","HC CHG THROMBIN TIME PLASMA","85670 - HC CHG THROMBIN TIME PLASMA",null,null,null,null,null,"BLUE CROSS-HMO BLUE","88329"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","86021","HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES","86021 - HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES",null,null,null,null,null,"TUFTS PPO","88331"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","86157","HC CHG COLD AGGLUTININ TITER","86157 - HC CHG COLD AGGLUTININ TITER",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","88342"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","86301","HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9","86301 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","88346"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","86331","HC CHG IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY","86331 - HC CHG IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","88350"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","86403","HC CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY","86403 - HC CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","88361"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","86580","SKIN TEST TUBERCULOSIS INTRADERMAL","86580 - SKIN TEST TUBERCULOSIS INTRADERMAL",null,null,null,null,null,"TUFTS POS","88362"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","86615","HC Q;BORDTLLA AB;IGG,IGA","86615 - HC Q;BORDTLLA AB;IGG,IGA",null,null,null,null,null,"BLUE CROSS-PPO","88364"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","86644","HC CHG ANTIBODY CYTOMEGALOVIRUS CMV","86644 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV",null,null,null,null,null,"FALLON MEDICAID","88368"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","86665","HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA","86665 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA",null,null,null,null,null,"TUFTS HMO","88380"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","86698","HC CHG ANTIBODY HISTOPLASMA","86698 - HC CHG ANTIBODY HISTOPLASMA",null,null,null,null,null,"BMCHN ACO","89050"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","86709","HC CHG HEPATITIS ANTIBODY HAAB IGM ANTIBODY","86709 - HC CHG HEPATITIS ANTIBODY HAAB IGM ANTIBODY",null,null,null,null,null,"BLUE CROSS-PPO","89051"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","86753","HC CHG ANTIBODY PROTOZOA NES","86753 - HC CHG ANTIBODY PROTOZOA NES",null,null,null,null,null,"TUFTS PUBLIC TOGETHER","89051"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","86777","HC CHG ANTIBODY TOXOPLASMA","86777 - HC CHG ANTIBODY TOXOPLASMA",null,null,null,null,null,"CIGNA PPO","89060"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","86817","HC CHG HLA TYPING DR/DQ MULTIPLE ANTIGENS","86817 - HC CHG HLA TYPING DR/DQ MULTIPLE ANTIGENS",null,null,null,null,null,"TUFTS MEDICARE PREFERRED HMO","89320"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","86880","HC CHG ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM","86880 - HC CHG ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM",null,null,null,null,null,"UNITED/HARVARD PILGRIM","89320"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","87075","HC CHG CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID","87075 - HC CHG CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID",null,null,null,null,null,"TUFTS PPO","90389"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","87106","HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST","87106 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST",null,null,null,null,null,"BLUE CROSS-HMO BLUE","90472"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","87116","HC CHG CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL","87116 - HC CHG CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","90473"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","87184","HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD","87184 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","90621"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","87188","HC CHG SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT","87188 - HC CHG SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","90625"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","87272","HC CHG IAADI CRYPTOSPORIDIUM","87272 - HC CHG IAADI CRYPTOSPORIDIUM",null,null,null,null,null,"TUFTS PPO","90636"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","87299","HC CHG AG DETECTION NOS, FLUOR","87299 - HC CHG AG DETECTION NOS, FLUOR",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","90648"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","87391","HC CHG IAAD IA HIV-2","87391 - HC CHG IAAD IA HIV-2",null,null,null,null,null,"TUFTS PUBLIC DIRECT NON SUBSIDIZ","90653"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","87430","HC CHG IAAD IA STREPTOCOCCUS GROUP A","87430 - HC CHG IAAD IA STREPTOCOCCUS GROUP A",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","90662"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","87496","HC ARUP;CYTOMEG VIR PCR,CSF","87496 - HC ARUP;CYTOMEG VIR PCR,CSF",null,null,null,null,null,"BLUE CROSS-MEDICARE ADVANTAGE","90670"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","87529","HC CHG IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ","87529 - HC CHG IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ",null,null,null,null,null,"TUFTS SELECT","90672"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","87535","HC CHG IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ","87535 - HC CHG IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ",null,null,null,null,null,"AETNA-MEDICARE ADVANTAGE","90673"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","87635","HC SARS-COV-2 COVID-19 AMP PRB","87635 - HC SARS-COV-2 COVID-19 AMP PRB",null,null,null,null,null,"TUFTS POS","90674"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","87880","IAADIADOO STREPTOCOCCUS GROUP A","87880 - IAADIADOO STREPTOCOCCUS GROUP A",null,null,null,null,null,"BMC SENIOR CARE OPTIONS","90686"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","87999","HC CHG UNLISTED MICROBIOLOGY","87999 - HC CHG UNLISTED MICROBIOLOGY",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","90690"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","88143","HC CHG CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS","88143 - HC CHG CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS",null,null,null,null,null,"BLUE CROSS-MEDICARE ADVANTAGE","90691"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","88185","HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA","88185 - HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA",null,null,null,null,null,"BLUE CROSS-INDEMNITY","90694"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","88360","HC CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL","88360 - HC CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL",null,null,null,null,null,"UNITED/HARVARD PILGRIM","90698"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","90653","HC IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE","90653 - HC IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","90707"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","90901","HC BIOFEEDBACK TRAINING, ANY MODALITY","90901 - HC BIOFEEDBACK TRAINING, ANY MODALITY",null,null,null,null,null,"SENIOR WHOLE HEALTH","90714"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","94645","CONTINUOUS INHALATION TREATMENT EA ADDL HR","94645 - CONTINUOUS INHALATION TREATMENT EA ADDL HR",null,null,null,null,null,"TUFTS POS","90715"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","96130","HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR","96130 - HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","90717"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","96167","HC HLTH BHV IVNTJ FAM 1ST 30","96167 - HC HLTH BHV IVNTJ FAM 1ST 30",null,null,null,null,null,"TUFTS POS","90723"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","99354","PROLNG SVC OFFICE O/P DIR CONTACT 1ST HR","99354 - PROLNG SVC OFFICE O/P DIR CONTACT 1ST HR",null,null,null,null,null,"TUFTS PPO","90734"]
["TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","99495","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","90738"]
["UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","80187","HC DRUG ASSAY POSACONAZOLE","80187 - HC DRUG ASSAY POSACONAZOLE",null,null,null,null,null,"CIGNA CARELINK","90740"]
["UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","81229","HC CYTOG ALYS CHRML ABNR SNPCGH","81229 - HC CYTOG ALYS CHRML ABNR SNPCGH",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","90744"]
["UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","81342","TRG@ GENE REARRANGEMENT ANALYSIS; PRO/TECH","81342 - TRG@ GENE REARRANGEMENT ANALYSIS; PRO/TECH",null,null,null,null,null,"AETNA-MEDICARE ADVANTAGE","90746"]
["UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","82274","HC CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3","82274 - HC CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","90750"]
["UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","82731","HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN","82731 - HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN",null,null,null,null,null,"BLUE CROSS-INDEMNITY","90785"]
["UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","83497","HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA","83497 - HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA",null,null,null,null,null,"TUFTS PPO","90792"]
["UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","83721","HC CRL;DIRECT LDL","83721 - HC CRL;DIRECT LDL",null,null,null,null,null,"BLUE CROSS-INDEMNITY","90833"]
["UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","84484","HC CHG ASSAY OF TROPONIN QUANTITATIVE","84484 - HC CHG ASSAY OF TROPONIN QUANTITATIVE",null,null,null,null,null,"BLUE CROSS-INDEMNITY","90840"]
["UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","85055","HC CHG RETICULATED PLATELET ASSAY","85055 - HC CHG RETICULATED PLATELET ASSAY",null,null,null,null,null,"BMCHN MEDICAID","90845"]
["UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","85549","HC CHG MURAMIDASE","85549 - HC CHG MURAMIDASE",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","90847"]
["UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","86304","HC CRL;CA-125","86304 - HC CRL;CA-125",null,null,null,null,null,"BLUE CROSS-INDEMNITY","90867"]
["UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","86663","HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA","86663 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA",null,null,null,null,null,"TUFTS HMO","90882"]
["UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","86817","HC CHG HLA TYPING DR/DQ MULTIPLE ANTIGENS","86817 - HC CHG HLA TYPING DR/DQ MULTIPLE ANTIGENS",null,null,null,null,null,"TUFTS SELECT","90901"]
["UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","87181","HC CHG SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ","87181 - HC CHG SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ",null,null,null,null,null,"BLUE CROSS-INDEMNITY","90913"]
["UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","87581","HC CHG IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ","87581 - HC CHG IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ",null,null,null,null,null,"CIGNA CARELINK","91010"]
["UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","87912","HC CHG NFCT AGENT GENOTYPE HEPATITIS B VIRUS","87912 - HC CHG NFCT AGENT GENOTYPE HEPATITIS B VIRUS",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","91034"]
["UNICARE","UNICARE","29881","HC KNEE SCOPE SINGLE MENISCECTOMY","29881 - HC KNEE SCOPE SINGLE MENISCECTOMY",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","91065"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","43236","HC UPPER GI NDSC W/SUBMUCOSAL INJECTION","43236 - HC UPPER GI NDSC W/SUBMUCOSAL INJECTION",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","91110"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","44180","HC LAP, SURG ENTEROLYSIS","44180 - HC LAP, SURG ENTEROLYSIS",null,null,null,null,null,"TUFTS PUBLIC TOGETHER","91112"]
["UNICARE","UNICARE","45317","HC PROCTOSIGMOIDOSCOPY BLEED","45317 - HC PROCTOSIGMOIDOSCOPY BLEED",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","91200"]
["UNICARE","UNICARE","46606","ANOSCOPY W/BX SINGLE/MULTIPLE","46606 - ANOSCOPY W/BX SINGLE/MULTIPLE",null,null,null,null,null,"TUFTS HMO","92012"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","62323","HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",null,null,null,null,null,"TUFTS SELECT","92015"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","64418","INJECTION ANESTHETIC AGENT SUPRASCAPULAR NERVE","64418 - INJECTION ANESTHETIC AGENT SUPRASCAPULAR NERVE",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","92020"]
["UNICARE","UNICARE","70200","HC CHG RADEX ORBITS COMPLETE MINIMUM 4 VIEWS","70200 - HC CHG RADEX ORBITS COMPLETE MINIMUM 4 VIEWS",null,null,null,null,null,"UNICARE","92065"]
["UNICARE","UNICARE","70328","RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT","70328 - RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT",null,null,null,null,null,"TUFTS PPO","92071"]
["UNICARE","UNICARE","70551","HC CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL","70551 - HC CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","92132"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","70551","HC CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL","70551 - HC CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","92132"]
["UNICARE","UNICARE","72052","HC CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS","72052 - HC CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS",null,null,null,null,null,"TUFTS HMO","92136"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","72142","HC CHG MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL","72142 - HC CHG MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL",null,null,null,null,null,"TUFTS POS","92226"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","72240","HC CHG MYELOGRAPHY CERVICAL RS&I","72240 - HC CHG MYELOGRAPHY CERVICAL RS&I",null,null,null,null,null,"UNITED/HARVARD PILGRIM","92240"]
["UNICARE","UNICARE","73218","HC CHG MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL","73218 - HC CHG MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","92260"]
["UNICARE","UNICARE","73523","XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; MINIMUM 5 VIEWS","73523 - XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; MINIMUM 5 VIEWS",null,null,null,null,null,"TUFTS PPO","92265"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","74020","XR ABD CMPL DECUB ERECT","74020 - XR ABD CMPL DECUB ERECT",null,null,null,null,null,"UNITED/HARVARD PILGRIM","92274"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","74230","SWALLOWING FUNCJ W/CINERADIOGRAPY/VIDRADIOG","74230 - SWALLOWING FUNCJ W/CINERADIOGRAPY/VIDRADIOG",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","92284"]
["UNICARE","UNICARE","74445","HC CHG CORPORA CAVERNOSOGRAPY RS&I","74445 - HC CHG CORPORA CAVERNOSOGRAPY RS&I",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","92286"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","75803","HC LYPMH VESSEL XRAY ARM/LEG","75803 - HC LYPMH VESSEL XRAY ARM/LEG",null,null,null,null,null,"TUFTS POS","92311"]
["UNICARE","UNICARE","75820","HC CHG VENOGRAPHY EXTREMITY UNILATERAL RS&I","75820 - HC CHG VENOGRAPHY EXTREMITY UNILATERAL RS&I",null,null,null,null,null,"BLUE CROSS-INDEMNITY","92312"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","76000","FLUOROSCOPY SPX UP TO 1 HOUR PHYS/QHP TIME","76000 - FLUOROSCOPY SPX UP TO 1 HOUR PHYS/QHP TIME",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","92502"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","76818","FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING","76818 - FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","92520"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","76881","US EXTREMITY NON-VASC REAL-TIME IMG COMPL","76881 - US EXTREMITY NON-VASC REAL-TIME IMG COMPL",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","92522"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","76998","ULTRASONIC GUIDANCE INTRAOPERATIVE","76998 - ULTRASONIC GUIDANCE INTRAOPERATIVE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","92523"]
["UNICARE","UNICARE","77076","HC X-RAYS BONE SURVEY INFANT","77076 - HC X-RAYS BONE SURVEY INFANT",null,null,null,null,null,"TUFTS POS","92526"]
["UNICARE","UNICARE","77387","GUIDANCE FOR LOCLZJ TARGET VOL FOR RADJ TX DLVR","77387 - GUIDANCE FOR LOCLZJ TARGET VOL FOR RADJ TX DLVR",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","92538"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","77771","HC HDR RDNCL NTRSTL/2-12","77771 - HC HDR RDNCL NTRSTL/2-12",null,null,null,null,null,"TUFTS POS","92541"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","78278","HC CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING","78278 - HC CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING",null,null,null,null,null,"TUFTS POS","92545"]
["UNICARE","UNICARE","78492","HC CHG MYOCRD IMAGE PET PERFUS MULTPL STUDY REST/STRESS","78492 - HC CHG MYOCRD IMAGE PET PERFUS MULTPL STUDY REST/STRESS",null,null,null,null,null,"BLUE CROSS-INDEMNITY","92552"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","78740","HC URETERAL REFLUX","78740 - HC URETERAL REFLUX",null,null,null,null,null,"UNITED/HARVARD PILGRIM","92553"]
["UNICARE","UNICARE","79101","HC CHG RP THERAPY INTRAVENOUS ADMINISTRATION","79101 - HC CHG RP THERAPY INTRAVENOUS ADMINISTRATION",null,null,null,null,null,"TUFTS PPO","92556"]
["UNICARE","UNICARE","80307","HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS","80307 - HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS",null,null,null,null,null,"TUFTS SELECT","92562"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","81206","HC CHG BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE","81206 - HC CHG BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","92565"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","81272","HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS","81272 - HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS",null,null,null,null,null,"TUFTS HMO","92567"]
["UNICARE","UNICARE","82270","HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER","82270 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","92572"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","82435","HC CHG CHLORIDE BLD","82435 - HC CHG CHLORIDE BLD",null,null,null,null,null,"BLUE CROSS-INDEMNITY","92577"]
["UNICARE","UNICARE","82627","HC CHG DEHYDROEPIANDROSTERONE-SULFATE","82627 - HC CHG DEHYDROEPIANDROSTERONE-SULFATE",null,null,null,null,null,"CIGNA CARELINK","92582"]
["UNICARE","UNICARE","82951","HC CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS","82951 - HC CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS",null,null,null,null,null,"UNITED/HARVARD PILGRIM","92585"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","83036","HEMOGLOBIN GLYCOSYLATED A1C","83036 - HEMOGLOBIN GLYCOSYLATED A1C",null,null,null,null,null,"TUFTS PPO","92587"]
["UNICARE","UNICARE","83525","HC CHG ASSAY OF INSULIN TOTAL","83525 - HC CHG ASSAY OF INSULIN TOTAL",null,null,null,null,null,"TUFTS POS","92588"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","83835","HC CHG METANEPHRINES","83835 - HC CHG METANEPHRINES",null,null,null,null,null,"BLUE CROSS-INDEMNITY","92592"]
["UNICARE","UNICARE","84157","HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC","84157 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC",null,null,null,null,null,"CIGNA CARELINK","92597"]
["UNICARE","UNICARE","84302","HC CHG ASSAY OF SODIUM OTHER SOURCE","84302 - HC CHG ASSAY OF SODIUM OTHER SOURCE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","92602"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","84450","HC CHG TRANSFERASE ASPARTATE AMINO AST SGOT","84450 - HC CHG TRANSFERASE ASPARTATE AMINO AST SGOT",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","92604"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","85014","HC CHG BLOOD COUNT HEMATOCRIT","85014 - HC CHG BLOOD COUNT HEMATOCRIT",null,null,null,null,null,"TUFTS PPO","92607"]
["UNICARE","UNICARE","85303","HC CHG CLOTTING INHIBITORS PROTEIN C ACTIVITY","85303 - HC CHG CLOTTING INHIBITORS PROTEIN C ACTIVITY",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","92612"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","86022","HC CRL;SEROTONIN RLS ASSAY","86022 - HC CRL;SEROTONIN RLS ASSAY",null,null,null,null,null,"UNITED/HARVARD PILGRIM","92621"]
["UNICARE","UNICARE","86317","HC IMMUNOASSAY,INFECT AGENT,QUANT","86317 - HC IMMUNOASSAY,INFECT AGENT,QUANT",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","92627"]
["UNICARE","UNICARE","86376","HC CHG MICROSOMAL ANTIBODIES EACH","86376 - HC CHG MICROSOMAL ANTIBODIES EACH",null,null,null,null,null,"BMCHN ACO","92633"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","86663","HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA","86663 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","92924"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","86701","HC HIV-1","86701 - HC HIV-1",null,null,null,null,null,"TUFTS PPO","92925"]
["UNICARE","UNICARE","86780","HC CHG ANTIBODY TREPONEMA PALLIDUM","86780 - HC CHG ANTIBODY TREPONEMA PALLIDUM",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","92933"]
["UNICARE","UNICARE","87070","CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL","87070 - CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL",null,null,null,null,null,"UNITED/HARVARD PILGRIM","92937"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","87184","HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD","87184 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD",null,null,null,null,null,"BLUE CROSS-PPO","92943"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","87210","SMR PRIM SRC WET MOUNT NFCT AGT","87210 - SMR PRIM SRC WET MOUNT NFCT AGT",null,null,null,null,null,"BLUE CROSS-PPO","92944"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","87385","HC CHG IAAD IA HISTOPLASM CAPSULATUM","87385 - HC CHG IAAD IA HISTOPLASM CAPSULATUM",null,null,null,null,null,"TUFTS SELECT","92953"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","87640","HC CHG IADNA S AUREUS AMPLIFIED PROBE TQ","87640 - HC CHG IADNA S AUREUS AMPLIFIED PROBE TQ",null,null,null,null,null,"TUFTS POS","92977"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","87880","IAADIADOO STREPTOCOCCUS GROUP A","87880 - IAADIADOO STREPTOCOCCUS GROUP A",null,null,null,null,null,"TUFTS POS","92978"]
["UNICARE","UNICARE","90653","HC IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE","90653 - HC IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE",null,null,null,null,null,"TUFTS HMO","92990"]
["UNICARE","UNICARE","90661","HC CCIIV3 VACCINE PRESERVATIVE FREE 0.5 ML IM USE","90661 - HC CCIIV3 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",null,null,null,null,null,"TUFTS PPO","92990"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","90746","CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL","90746 - CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","93225"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","92270","ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT","92270 - ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","93270"]
["UNICARE","UNICARE","92562","LOUDNESS BALANCE BINAURAL/MONAURAL","92562 - LOUDNESS BALANCE BINAURAL/MONAURAL",null,null,null,null,null,"UNICARE","93278"]
["UNICARE","UNICARE","93226","EXTERNAL ECG SCANNING ANALYSIS REPORT","93226 - EXTERNAL ECG SCANNING ANALYSIS REPORT",null,null,null,null,null,"BLUE CROSS-INDEMNITY","93281"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","93288","INTERROGATION EVAL IN PERSON 1/DUAL/MLT LEAD PM","93288 - INTERROGATION EVAL IN PERSON 1/DUAL/MLT LEAD PM",null,null,null,null,null,"CIGNA CARELINK","93282"]
["UNICARE","UNICARE","93457","HC CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I","93457 - HC CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","93285"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","93572","HC IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL","93572 - HC IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL",null,null,null,null,null,"UNITED/HARVARD PILGRIM","93286"]
["UNICARE","UNICARE","93642","HC EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS","93642 - HC EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","93288"]
["UNICARE","UNICARE","94010","SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ","94010 - SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","93293"]
["UNICARE","UNICARE","94200","HC MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ","94200 - HC MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ",null,null,null,null,null,"UNICARE","93293"]
["UNICARE","UNICARE","95808","POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND","95808 - POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","93296"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","95872","NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER","95872 - NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER",null,null,null,null,null,"TUFTS PPO","93299"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","97598","DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM","97598 - DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM",null,null,null,null,null,"TUFTS HMO","93307"]
["UNICARE","UNICARE","99211","ESTABLISHED PATIENT - PHARM - LEVEL 1","99211 - ESTABLISHED PATIENT - PHARM - LEVEL 1",null,null,null,null,null,"TUFTS POS","93308"]
["UNICARE","UNICARE STATE INDEMNITY PLAN","99386","INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS","99386 - INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","93313"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","10030","IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE","10030 - IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE",null,null,null,null,null,"TUFTS POS","93318"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","11012","HC DBRDMT FX&/DISLC SUBQ T/M/F BONE","11012 - HC DBRDMT FX&/DISLC SUBQ T/M/F BONE",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","93321"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","11307","SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM","11307 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","93350"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","11442","EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM","11442 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM",null,null,null,null,null,"BMCHN MEDICAID","93356"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","11624","EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM","11624 - EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM",null,null,null,null,null,"AETNA","93452"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","11760","REPAIR NAIL BED","11760 - REPAIR NAIL BED",null,null,null,null,null,"TUFTS HMO","93453"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","12031","REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<","12031 - REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<",null,null,null,null,null,"TUFTS HMO","93456"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","12056","HC LAYR CLOS WND FACE,FACIAL 20.1-30 CM","12056 - HC LAYR CLOS WND FACE,FACIAL 20.1-30 CM",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","93458"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","13132","REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM","13132 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","93459"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","15630","HC DELAY/SECTN FLAP LID,NOS,EAR,LIP","15630 - HC DELAY/SECTN FLAP LID,NOS,EAR,LIP",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","93462"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","15851","REMOVE SUTURES DIFF SURGEON","15851 - REMOVE SUTURES DIFF SURGEON",null,null,null,null,null,"UNITED/HARVARD PILGRIM","93464"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","17264","DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM","17264 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","93530"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","19282","PERQ DEVICE PLACEMT BREAST LOC EA LESION W/GDNCE","19282 - PERQ DEVICE PLACEMT BREAST LOC EA LESION W/GDNCE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","93533"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","20200","HC MUSCLE BIOPSY","20200 - HC MUSCLE BIOPSY",null,null,null,null,null,"TUFTS POS","93565"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","20245","BIOPSY BONE OPEN DEEP","20245 - BIOPSY BONE OPEN DEEP",null,null,null,null,null,"CIGNA CARELINK","93566"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","20615","ASPIRATION & INJECTION TREATMENT BONE CYST","20615 - ASPIRATION & INJECTION TREATMENT BONE CYST",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","93568"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","21081","HC PREP FACE/ORAL PROST MANDIBULAR","21081 - HC PREP FACE/ORAL PROST MANDIBULAR",null,null,null,null,null,"TUFTS SELECT","93580"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","21315","CLOSED TX NASAL FRACTURE W/O STABILIZATION","21315 - CLOSED TX NASAL FRACTURE W/O STABILIZATION",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","93590"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","21480","CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ","21480 - CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ",null,null,null,null,null,"BLUE CROSS-PPO","93592"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","22854","HC INSJ BIOMCHN DEV VRT CORPECTOMY DEFECT W/ARTHRD","22854 - HC INSJ BIOMCHN DEV VRT CORPECTOMY DEFECT W/ARTHRD",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","93610"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","23600","CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION","23600 - CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION",null,null,null,null,null,"AETNA","93620"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","24650","CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION","24650 - CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","93622"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","25530","CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION","25530 - CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","93642"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","25660","CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MANJ","25660 - CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MANJ",null,null,null,null,null,"CIGNA CARELINK","93644"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","26725","CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA","26725 - CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA",null,null,null,null,null,"CIGNA CARELINK","93654"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","27041","HC BX SOFT TISSUES,PELV/HIP,DEEP","27041 - HC BX SOFT TISSUES,PELV/HIP,DEEP",null,null,null,null,null,"TUFTS POS","93655"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","27246","CLTX GREATER TROCHANTERIC FX W/O MANJ","27246 - CLTX GREATER TROCHANTERIC FX W/O MANJ",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","93657"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","27613","HC BX LOW LEG SOFT TISSUE,SUPERFICIAL","27613 - HC BX LOW LEG SOFT TISSUE,SUPERFICIAL",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","93662"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","27824","CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ","27824 - CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ",null,null,null,null,null,"TUFTS POS","93750"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","28039","EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>","28039 - EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>",null,null,null,null,null,"BMCHN MEDICAID","93786"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","28405","CLOSED TX CALCANEAL FRACTURE W/MANIPULATION","28405 - CLOSED TX CALCANEAL FRACTURE W/MANIPULATION",null,null,null,null,null,"CIGNA CARELINK","93797"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","29345","APPLICATION LONG LEG CAST THIGH-TOE","29345 - APPLICATION LONG LEG CAST THIGH-TOE",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","93882"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","29505","APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES","29505 - APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES",null,null,null,null,null,"UNICARE","93886"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","30520","HC REPAIR OF NASAL SEPTUM","30520 - HC REPAIR OF NASAL SEPTUM",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","93893"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","31231","NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX","31231 - NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","93895"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","31573","HC LARYNGOSCOPY FLEXIBLE THERAPEUTIC INJECTION UNI","31573 - HC LARYNGOSCOPY FLEXIBLE THERAPEUTIC INJECTION UNI",null,null,null,null,null,"TUFTS SELECT","93923"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","31640","HC BRONCHOSCOPY,EXCIS LESN","31640 - HC BRONCHOSCOPY,EXCIS LESN",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","93926"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","33207","HC INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR","33207 - HC INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR",null,null,null,null,null,"TUFTS HMO","93931"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","33234","HC RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR/VENTR","33234 - HC RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR/VENTR",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","93971"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","33274","HC TCAT INSJ/RPL PERM LDLS PM","33274 - HC TCAT INSJ/RPL PERM LDLS PM",null,null,null,null,null,"BLUE CROSS-PPO","93976"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","36226","HC SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY","36226 - HC SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","93980"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","36406","HC VNPNXR <3 YEARS PHYS/QHP SKILL OTHER VEIN","36406 - HC VNPNXR <3 YEARS PHYS/QHP SKILL OTHER VEIN",null,null,null,null,null,"BMCHN MCO","93985"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","36478","HC ENDOVENOUS LASER, 1ST VEIN","36478 - HC ENDOVENOUS LASER, 1ST VEIN",null,null,null,null,null,"BMCHN MCO","93986"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","36593","DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH","36593 - DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","94010"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","36598","HC CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT","36598 - HC CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT",null,null,null,null,null,"TUFTS POS","94010"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","37195","HC THROMBOLYTIC THERAPY, STROKE","37195 - HC THROMBOLYTIC THERAPY, STROKE",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","94070"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","37229","HC REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL","37229 - HC REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL",null,null,null,null,null,"TUFTS SELECT","94200"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","40490","BIOPSY OF LIP","40490 - BIOPSY OF LIP",null,null,null,null,null,"UNICARE","94453"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","40652","HC REPAIR LIP,<1/2 VERT HEIGHT","40652 - HC REPAIR LIP,<1/2 VERT HEIGHT",null,null,null,null,null,"TUFTS HMO","94617"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","40840","HC RECONSTRUC MOUTH ANTERIOR","40840 - HC RECONSTRUC MOUTH ANTERIOR",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","94621"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","41825","EXCISION OF GUM LESION","41825 - EXCISION OF GUM LESION",null,null,null,null,null,"BMCHN MEDICAID","94644"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","42400","BIOPSY SALIVARY GLAND NEEDLE","42400 - BIOPSY SALIVARY GLAND NEEDLE",null,null,null,null,null,"TUFTS HMO","94645"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","43193","HC ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY","43193 - HC ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY",null,null,null,null,null,"BLUE CROSS-INDEMNITY","94667"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","43242","HC UPPER GI NDSC ULTRASOUND GUIDED BIOPSY","43242 - HC UPPER GI NDSC ULTRASOUND GUIDED BIOPSY",null,null,null,null,null,"CIGNA CARELINK","94690"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","43262","HC ERCP W/SPHINCTEROTOMY/PAPILLOTOMY","43262 - HC ERCP W/SPHINCTEROTOMY/PAPILLOTOMY",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","94727"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","43763","HC RPLC GTUBE REVJ GSTRST TRC","43763 - HC RPLC GTUBE REVJ GSTRST TRC",null,null,null,null,null,"BLUE CROSS-PPO","94761"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","45005","HC I&D RECTAL SUBMUCOSAL ABSCESS","45005 - HC I&D RECTAL SUBMUCOSAL ABSCESS",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","94772"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","45346","HC SIGMOIDOSCOPY FLX ABLATION TUMOR POLYP/OTH LES","45346 - HC SIGMOIDOSCOPY FLX ABLATION TUMOR POLYP/OTH LES",null,null,null,null,null,"BLUE CROSS-HMO BLUE","95004"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","45385","HC COLSC FLX PROX SPLENIC FLXR RMVL LES SNARE TQ","45385 - HC COLSC FLX PROX SPLENIC FLXR RMVL LES SNARE TQ",null,null,null,null,null,"BLUE CROSS-PPO","95017"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","46922","HC SURG EXCISION OF ANAL LESION(S)","46922 - HC SURG EXCISION OF ANAL LESION(S)",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","95044"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","47532","NJX CHOLANGIO PRQ W/IMG GID RS&I NEW ACCESS","47532 - NJX CHOLANGIO PRQ W/IMG GID RS&I NEW ACCESS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","95076"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","49427","HC INJ PROC EXIST VP SHUNT","49427 - HC INJ PROC EXIST VP SHUNT",null,null,null,null,null,"ALLWAYS HLTH ACO","95120"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","50437","HC DILAT XST TRC NEW ACCESS RCS","50437 - HC DILAT XST TRC NEW ACCESS RCS",null,null,null,null,null,"BLUE CROSS-PPO","95144"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","51710","CHANGE CYSTOSTOMY TUBE COMPLICATED","51710 - CHANGE CYSTOSTOMY TUBE COMPLICATED",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","95146"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","51729","COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL","51729 - COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL",null,null,null,null,null,"BLUE CROSS-PPO","95148"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","53450","HC REVISION OF URETHRA","53450 - HC REVISION OF URETHRA",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","95165"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","55250","VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS","55250 - VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","95249"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","56740","HC EXCIS BARTHOLIN GLAND/CYST","56740 - HC EXCIS BARTHOLIN GLAND/CYST",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","95700"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","57500","BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX","57500 - BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX",null,null,null,null,null,"CIGNA CARELINK","95707"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","58110","ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY","58110 - ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY",null,null,null,null,null,"TUFTS HMO","95708"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","59200","INSERTION CERVICAL DILATOR SEPARATE PROCEDURE","59200 - INSERTION CERVICAL DILATOR SEPARATE PROCEDURE",null,null,null,null,null,"TUFTS PPO","95711"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","62272","HC SPINAL PUNCTURE THER DRAIN CEREBROSPINAL FLUID","62272 - HC SPINAL PUNCTURE THER DRAIN CEREBROSPINAL FLUID",null,null,null,null,null,"CIGNA CARELINK","95782"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","62370","ELEC ANLYS IMPLT ITHCL/EDRL PMP W/REPR PHYS/QHP","62370 - ELEC ANLYS IMPLT ITHCL/EDRL PMP W/REPR PHYS/QHP",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","95803"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","64425","INJECTION ANES ILIOINGUINAL ILIOHYPOGASTRIC NRVS","64425 - INJECTION ANES ILIOINGUINAL ILIOHYPOGASTRIC NRVS",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","95806"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","64585","REVISE/REMOVE NEUROELECTRODE","64585 - REVISE/REMOVE NEUROELECTRODE",null,null,null,null,null,"CIGNA CARELINK","95811"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","64633","DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA","64633 - DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA",null,null,null,null,null,"TUFTS POS","95812"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","64680","HC DES,NEURO;CELIAC PLEX,WWO","64680 - HC DES,NEURO;CELIAC PLEX,WWO",null,null,null,null,null,"BLUE CROSS-HMO BLUE","95816"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","65756","HC CORNEAL TRNSPL ENDOTHELIAL","65756 - HC CORNEAL TRNSPL ENDOTHELIAL",null,null,null,null,null,"TUFTS POS","95831"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","66600","HC REMOVE IRIS AND LESION","66600 - HC REMOVE IRIS AND LESION",null,null,null,null,null,"TUFTS PPO","95860"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","66825","HC REPOSITION INTRAOCULAR LENS","66825 - HC REPOSITION INTRAOCULAR LENS",null,null,null,null,null,"TUFTS HMO","95861"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","67105","RPR RETINAL DTCHMNT 1/> SES PC W/WO DRG SUBRETI","67105 - RPR RETINAL DTCHMNT 1/> SES PC W/WO DRG SUBRETI",null,null,null,null,null,"UNICARE","95864"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","67405","HC EXPLORE/DRAIN EYE SOCKET","67405 - HC EXPLORE/DRAIN EYE SOCKET",null,null,null,null,null,"TUFTS POS","95867"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","67840","EXC LESION EYELID W/O CLSR/W/SIMPLE DIR CLOSURE","67840 - EXC LESION EYELID W/O CLSR/W/SIMPLE DIR CLOSURE",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","95869"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","68340","HC DIVISION OF SYMBLEPHARON","68340 - HC DIVISION OF SYMBLEPHARON",null,null,null,null,null,"UNITED/HARVARD PILGRIM","95873"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","68816","HC PROBE NL DUCT W/BALLOON","68816 - HC PROBE NL DUCT W/BALLOON",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","95885"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","69436","HC CREATE EARDRUM OPENING,GEN ANESTH","69436 - HC CREATE EARDRUM OPENING,GEN ANESTH",null,null,null,null,null,"TUFTS HMO","95887"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","70328","RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT","70328 - RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT",null,null,null,null,null,"BLUE CROSS-INDEMNITY","95908"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","70496","HC CHG CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST","70496 - HC CHG CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","95910"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","71101","HC CHG RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS","71101 - HC CHG RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS",null,null,null,null,null,"TUFTS SELECT","95912"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","71130","HC CHG RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS","71130 - HC CHG RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS",null,null,null,null,null,"BLUE CROSS-PPO","95913"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","72146","HC CHG MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL","72146 - HC CHG MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","95925"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","72193","HC CHG CT PELVIS W/CONTRAST MATERIAL","72193 - HC CHG CT PELVIS W/CONTRAST MATERIAL",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","95930"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","73000","ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R","73000 - ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","95933"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","73564","HC CHG RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS","73564 - HC CHG RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS",null,null,null,null,null,"BMCHN MCO","95953"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","73592","HC CHG RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS","73592 - HC CHG RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS",null,null,null,null,null,"TUFTS POS","95953"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","74150","HC CHG CT ABDOMEN W/O CONTRAST MATERIAL","74150 - HC CHG CT ABDOMEN W/O CONTRAST MATERIAL",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","95962"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","74248","HC X-RAY SM INT F-THRU STD","74248 - HC X-RAY SM INT F-THRU STD",null,null,null,null,null,"TUFTS PUBLIC TOGETHER","95966"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","75705","HC CHG ANGIOGRAPHY SPINAL SELECTIVE RS&I","75705 - HC CHG ANGIOGRAPHY SPINAL SELECTIVE RS&I",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","95977"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","75741","HC CHG ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I","75741 - HC CHG ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I",null,null,null,null,null,"UNITED/HARVARD PILGRIM","95977"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","75870","VENOGRAM SUPER SAG SINUS","75870 - VENOGRAM SUPER SAG SINUS",null,null,null,null,null,"TUFTS POS","95984"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","76514","OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI","76514 - OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI",null,null,null,null,null,"TUFTS SELECT","95992"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","76802","US PREG UTERUS 14 WK TRANSABDL EACH GESTATION","76802 - US PREG UTERUS 14 WK TRANSABDL EACH GESTATION",null,null,null,null,null,"TUFTS SELECT","96040"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","76882","US EXTREMITY NON-VASC REAL-TIME IMG LMTD","76882 - US EXTREMITY NON-VASC REAL-TIME IMG LMTD",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","96112"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","77012","HC CHG CT GUIDANCE NEEDLE PLACEMENT","77012 - HC CHG CT GUIDANCE NEEDLE PLACEMENT",null,null,null,null,null,"TUFTS PPO","96113"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","77071","HC CHG MANUAL APPL STRESS PFRMD PHYS/QHP JOINT FILMS","77071 - HC CHG MANUAL APPL STRESS PFRMD PHYS/QHP JOINT FILMS",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","96121"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","77306","TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION","77306 - TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION",null,null,null,null,null,"BMCHN MEDICAID","96125"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","77523","PROTON,BEAM DEL,INTERMED","77523 - PROTON,BEAM DEL,INTERMED",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","96130"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","78018","HC CHG THYROID CARCINOMA METASTASES IMG WHOLE BODY","78018 - HC CHG THYROID CARCINOMA METASTASES IMG WHOLE BODY",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","96132"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","78215","HC CHG LIVER & SPLEEN IMAGING STATIC ONLY","78215 - HC CHG LIVER & SPLEEN IMAGING STATIC ONLY",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","96132"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","78598","HC QUAN DIFF PERF/VENT,IMG","78598 - HC QUAN DIFF PERF/VENT,IMG",null,null,null,null,null,"TUFTS POS","96137"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","78708","HC CHG RENAL FLOW/FUNCT IMAGE,PHARM RX","78708 - HC CHG RENAL FLOW/FUNCT IMAGE,PHARM RX",null,null,null,null,null,"BMCHN ACO","96138"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","80069","HC CHG RENAL FUNCTION PANEL","80069 - HC CHG RENAL FUNCTION PANEL",null,null,null,null,null,"TUFTS PUBLIC DIRECT","96146"]
["UNITED HEALTHCARE","UNITED HEALTHCARE","80184","HC CHG DRUG SCREEN QUANTITATIVE PHENOBARBITAL","80184 - HC CHG DRUG SCREEN QUANTITATIVE PHENOBARBITAL",null,null,null,null,null,"TUFTS HMO","96156"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","80235","HC DRUG ASSAY LACOSAMIDE","80235 - HC DRUG ASSAY LACOSAMIDE",null,null,null,null,null,"BMCHN ACO","96159"]
["UNITED HEALTHCARE","UNITED HEALTHCARE","80307","HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS","80307 - HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","96160"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","81180","HC CHG ATXN3 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","81180 - HC CHG ATXN3 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","96164"]
["UNITED HEALTHCARE","UNITED HEALTHCARE","81240","HC CHG F2 GENE ANALYSIS 20210G >A VARIANT","81240 - HC CHG F2 GENE ANALYSIS 20210G >A VARIANT",null,null,null,null,null,"ALLWAYS HLTH ACO","96167"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","81269","HC HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIENTS","81269 - HC HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIENTS",null,null,null,null,null,"BMCHN MEDICAID","96168"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","81329","HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS","81329 - HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS",null,null,null,null,null,"TUFTS SELECT","96360"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","81364","HC HBB FULL GENE SEQUENCE","81364 - HC HBB FULL GENE SEQUENCE",null,null,null,null,null,"TUFTS PPO","96361"]
["UNITED HEALTHCARE","UNITED HEALTHCARE","82040","HC CHG ALBUMIN SERUM PLASMA/WHOLE BLOOD","82040 - HC CHG ALBUMIN SERUM PLASMA/WHOLE BLOOD",null,null,null,null,null,"TUFTS HMO","96367"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","82247","HC CHG BILIRUBIN TOTAL","82247 - HC CHG BILIRUBIN TOTAL",null,null,null,null,null,"BLUE CROSS-HMO BLUE","96371"]
["UNITED HEALTHCARE","UNITED HEALTHCARE","82378","HC CHG CARCINOEMBRYONIC ANTIGEN CEA","82378 - HC CHG CARCINOEMBRYONIC ANTIGEN CEA",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","96374"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","82390","HC CHG CERULOPLASMIN","82390 - HC CHG CERULOPLASMIN",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","96374"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","82652","HC CHG 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED","82652 - HC CHG 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED",null,null,null,null,null,"TUFTS POS","96401"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","82705","HC CHG FAT/LIPIDS FECES QUALITATIVE","82705 - HC CHG FAT/LIPIDS FECES QUALITATIVE",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","96405"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","82805","HC CHG GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY","82805 - HC CHG GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY",null,null,null,null,null,"TUFTS POS","96409"]
["UNITED HEALTHCARE","UNITED HEALTHCARE","83021","HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY","83021 - HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY",null,null,null,null,null,"BLUE CROSS-PPO","96416"]
["UNITED HEALTHCARE","UNITED HEALTHCARE","83630","HC CHG LACTOFERRIN FECAL QUALITATIVE","83630 - HC CHG LACTOFERRIN FECAL QUALITATIVE",null,null,null,null,null,"BLUE CROSS-PPO","96521"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","83718","HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL","83718 - HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL",null,null,null,null,null,"BLUE CROSS-PPO","96523"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","83918","HC CHG ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN","83918 - HC CHG ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN",null,null,null,null,null,"BMCHN MCO","96567"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","84144","HC CHG ASSAY OF PROGESTERONE","84144 - HC CHG ASSAY OF PROGESTERONE",null,null,null,null,null,"TUFTS HMO","97010"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","84202","HC Q;ERYTH PROTPOR","84202 - HC Q;ERYTH PROTPOR",null,null,null,null,null,"CIGNA CARELINK","97014"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","84439","HC CHG ASSAY OF FREE THYROXINE","84439 - HC CHG ASSAY OF FREE THYROXINE",null,null,null,null,null,"TUFTS HMO","97033"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","84479","HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO","84479 - HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO",null,null,null,null,null,"CIGNA CARELINK","97110"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","84597","HC CHG ASSAY OF VITAMIN K","84597 - HC CHG ASSAY OF VITAMIN K",null,null,null,null,null,"UNICARE","97116"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","85210","HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC","85210 - HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC",null,null,null,null,null,"BMCHN QHP","97130"]
["UNITED HEALTHCARE","UNITED HEALTHCARE","85302","HC CHG CLOTTING INHIBITORS PROTEIN C ANTIGEN","85302 - HC CHG CLOTTING INHIBITORS PROTEIN C ANTIGEN",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","97151"]
["UNITED HEALTHCARE","UNITED HEALTHCARE","85549","HC CHG MURAMIDASE","85549 - HC CHG MURAMIDASE",null,null,null,null,null,"TUFTS SELECT","97152"]
["UNITED HEALTHCARE","UNITED HEALTHCARE","85611","HC CHG PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH","85611 - HC CHG PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH",null,null,null,null,null,"BLUE CROSS-INDEMNITY","97153"]
["UNITED HEALTHCARE","UNITED HEALTHCARE","86200","HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY","86200 - HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","97156"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","86308","HC CHG HETEROPHILE ANTIBODIES SCREEN","86308 - HC CHG HETEROPHILE ANTIBODIES SCREEN",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","97156"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","86353","HC CHG LYMPHOCYTE TRANSFORMATION","86353 - HC CHG LYMPHOCYTE TRANSFORMATION",null,null,null,null,null,"UNITED/HARVARD PILGRIM","97157"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","86631","HC CHG, CHLAMYDIA, ANTIBODY","86631 - HC CHG, CHLAMYDIA, ANTIBODY",null,null,null,null,null,"TUFTS PPO","97164"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","86638","HC CHG, Q FEVER ANTIBODY","86638 - HC CHG, Q FEVER ANTIBODY",null,null,null,null,null,"TUFTS POS","97165"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","86689","HC HTLV/HIV CONFIRMATORY TEST","86689 - HC HTLV/HIV CONFIRMATORY TEST",null,null,null,null,null,"TUFTS PPO","97168"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","86706","HC CHG HEPATITIS B SURF ANTIBODY HBSAB","86706 - HC CHG HEPATITIS B SURF ANTIBODY HBSAB",null,null,null,null,null,"BLUE CROSS-HMO BLUE","97535"]
["UNITED HEALTHCARE","UNITED HEALTHCARE","86807","HC CHG SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH","86807 - HC CHG SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH",null,null,null,null,null,"BLUE CROSS-HMO BLUE","97598"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","86870","HC CHG ANTIBODY ID RBC ANTIBODIES EA PANEL EA SERUM TQ","86870 - HC CHG ANTIBODY ID RBC ANTIBODIES EA PANEL EA SERUM TQ",null,null,null,null,null,"UNITED/HARVARD PILGRIM","97598"]
["UNITED HEALTHCARE","UNITED HEALTHCARE","87081","HC CULT,BACT,SCR,H PYLORI","87081 - HC CULT,BACT,SCR,H PYLORI",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","97750"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","87149","HC CHG CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM","87149 - HC CHG CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM",null,null,null,null,null,"TUFTS PPO","97760"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","87205","HC CHG SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL","87205 - HC CHG SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL",null,null,null,null,null,"BLUE CROSS-HMO BLUE","97802"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","87281","HC CHG IAADI PNEUMOCUSTIS CARINII","87281 - HC CHG IAADI PNEUMOCUSTIS CARINII",null,null,null,null,null,"BLUE CROSS-PPO","97810"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","87400","HC CHG IAAD IA INFLUENZA A/B EACH","87400 - HC CHG IAAD IA INFLUENZA A/B EACH",null,null,null,null,null,"BLUE CROSS-HMO BLUE","98960"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","87493","HC CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE","87493 - HC CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE",null,null,null,null,null,"ALLWAYS HLTH ACO","99151"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","87522","HC ARUP;HEP C VIR RNA QN","87522 - HC ARUP;HEP C VIR RNA QN",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","99152"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","87661","IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH","87661 - IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH",null,null,null,null,null,"BMCHN QHP","99155"]
["UNITED HEALTHCARE","UNITED HEALTHCARE","87880","IAADIADOO STREPTOCOCCUS GROUP A","87880 - IAADIADOO STREPTOCOCCUS GROUP A",null,null,null,null,null,"BLUE CROSS-HMO BLUE","99156"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","88143","HC CHG CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS","88143 - HC CHG CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS",null,null,null,null,null,"BMCHN MEDICAID","99157"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","88311","HC CHG DECALCIFICATION PROCEDURE","88311 - HC CHG DECALCIFICATION PROCEDURE",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","99201"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","88341","IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE","88341 - IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE",null,null,null,null,null,"BLUE CROSS-HMO BLUE","99203"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","90461","IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT","90461 - IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","99211"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","90625","HC  CHOLERA VACCINE ADULT 1 DOSE LIVE FOR ORAL USE","90625 - HC  CHOLERA VACCINE ADULT 1 DOSE LIVE FOR ORAL USE",null,null,null,null,null,"TUFTS PPO","99212"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","90740","HC HEP B VACCINE,DIAL/IMMUNOSUP, IM","90740 - HC HEP B VACCINE,DIAL/IMMUNOSUP, IM",null,null,null,null,null,"UNICARE","99281"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","90912","HC BFB TRAINING 1ST 15 MIN","90912 - HC BFB TRAINING 1ST 15 MIN",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","99282"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","92201","HC OPSCPY EXTND RTA DRAW UNI/BI","92201 - HC OPSCPY EXTND RTA DRAW UNI/BI",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","99292"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","92310","RX&FITG C-LENS SUPVJ CRNL LENS OU XCPT APHK","92310 - RX&FITG C-LENS SUPVJ CRNL LENS OU XCPT APHK",null,null,null,null,null,"FALLON MEDICAID","99355"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","92546","SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING","92546 - SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING",null,null,null,null,null,"TUFTS SELECT","99359"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","92620","EVAL CENTRAL AUDITORY FUNCJ W/REPRT 1ST 60 MIN","92620 - EVAL CENTRAL AUDITORY FUNCJ W/REPRT 1ST 60 MIN",null,null,null,null,null,"TUFTS PPO","99384"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","92925","HC ATHER MAJOR/BRANCH EA ADD","92925 - HC ATHER MAJOR/BRANCH EA ADD",null,null,null,null,null,"UNICARE","99386"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","92978","HC ENDOLUMINAL CORONARY IVUS OCT I&R INITIAL VESSEL","92978 - HC ENDOLUMINAL CORONARY IVUS OCT I&R INITIAL VESSEL",null,null,null,null,null,"TUFTS POS","99394"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93312","HC ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R  WITH CONTRAST","93312 - HC ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R  WITH CONTRAST",null,null,null,null,null,"UNICARE","99403"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","93457","HC CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I","93457 - HC CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I",null,null,null,null,null,"TUFTS PUBLIC DIRECT","99406"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93463","HC DRUG ADMIN & HEMODYNMIC MEAS","93463 - HC DRUG ADMIN & HEMODYNMIC MEAS",null,null,null,null,null,"TUFTS POS","99407"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93660","CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR","93660 - CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR",null,null,null,null,null,"BMCHN QHP","99454"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","93660","CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR","93660 - CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR",null,null,null,null,null,"CIGNA CARELINK","99454"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93662","INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I","93662 - INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I",null,null,null,null,null,"FALLON MEDICAID","99454"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","93662","INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I","93662 - INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","99454"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93724","ANALYZE PACEMAKER SYSTEM","93724 - ANALYZE PACEMAKER SYSTEM",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","99454"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","93724","ANALYZE PACEMAKER SYSTEM","93724 - ANALYZE PACEMAKER SYSTEM",null,null,null,null,null,"TUFTS HMO","99454"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93750","HC INTERROGATION VAD IN PERSON","93750 - HC INTERROGATION VAD IN PERSON",null,null,null,null,null,"TUFTS POS","99454"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","93750","HC INTERROGATION VAD IN PERSON","93750 - HC INTERROGATION VAD IN PERSON",null,null,null,null,null,"TUFTS PPO","99454"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93786","BL BLD PRESS W/TAPE&/DISK 24/> HR REC ONL","93786 - BL BLD PRESS W/TAPE&/DISK 24/> HR REC ONL",null,null,null,null,null,"TUFTS SELECT","99454"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","93786","BL BLD PRESS W/TAPE&/DISK 24/> HR REC ONL","93786 - BL BLD PRESS W/TAPE&/DISK 24/> HR REC ONL",null,null,null,null,null,"TUFTS PUBLIC DIRECT","99454"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93788","AMBL BLD PRESS W/TAPE/DISK 24/>HR ALYS W/REPRT","93788 - AMBL BLD PRESS W/TAPE/DISK 24/>HR ALYS W/REPRT",null,null,null,null,null,"TUFTS PUBLIC TOGETHER","99454"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","93788","AMBL BLD PRESS W/TAPE/DISK 24/>HR ALYS W/REPRT","93788 - AMBL BLD PRESS W/TAPE/DISK 24/>HR ALYS W/REPRT",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","99454"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93797","SP CARD REHAB MAINTAIN","93797 - SP CARD REHAB MAINTAIN",null,null,null,null,null,"UNITED/HARVARD PILGRIM","99454"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","93797","SP CARD REHAB MAINTAIN","93797 - SP CARD REHAB MAINTAIN",null,null,null,null,null,"ALLWAYS HLTH ACO","99456"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93798","OUTPATIENT CARDIAC REHAB W/CONT ECG MONITORING","93798 - OUTPATIENT CARDIAC REHAB W/CONT ECG MONITORING",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","99456"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","93798","OUTPATIENT CARDIAC REHAB W/CONT ECG MONITORING","93798 - OUTPATIENT CARDIAC REHAB W/CONT ECG MONITORING",null,null,null,null,null,"BMCHN ACO","99456"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93880","HC DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY","93880 - HC DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY",null,null,null,null,null,"BMCHN MCO","99456"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","93880","HC DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY","93880 - HC DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY",null,null,null,null,null,"BMCHN MEDICAID","99456"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93882","HC DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY","93882 - HC DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY",null,null,null,null,null,"BMCHN QHP","99456"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","93882","HC DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY","93882 - HC DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY",null,null,null,null,null,"FALLON MEDICAID","99456"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93886","TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL","93886 - TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL",null,null,null,null,null,"TUFTS PUBLIC DIRECT","99456"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","93886","TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL","93886 - TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL",null,null,null,null,null,"TUFTS PUBLIC TOGETHER","99456"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93888","TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD","93888 - TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD",null,null,null,null,null,"ALLWAYS HLTH ACO","99473"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","93888","TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD","93888 - TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","99473"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93890","TRANSCRANIAL DOPPLER INTRACRAN ART VASOREAC STDY","93890 - TRANSCRANIAL DOPPLER INTRACRAN ART VASOREAC STDY",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","99473"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","93890","TRANSCRANIAL DOPPLER INTRACRAN ART VASOREAC STDY","93890 - TRANSCRANIAL DOPPLER INTRACRAN ART VASOREAC STDY",null,null,null,null,null,"BLUE CROSS-HMO BLUE","99473"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93892","HC TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT","93892 - HC TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT",null,null,null,null,null,"BLUE CROSS-INDEMNITY","99473"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","93892","HC TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT","93892 - HC TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT",null,null,null,null,null,"BLUE CROSS-PPO","99473"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93893","HC TRANSCRAN DOPP INTRACRAN, EMBOLI W/INJ","93893 - HC TRANSCRAN DOPP INTRACRAN, EMBOLI W/INJ",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","99473"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","93893","HC TRANSCRAN DOPP INTRACRAN, EMBOLI W/INJ","93893 - HC TRANSCRAN DOPP INTRACRAN, EMBOLI W/INJ",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","99473"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93895","HC CAROTID INTIMA MEDIA & CAROTID ATHEROMA EVAL BI","93895 - HC CAROTID INTIMA MEDIA & CAROTID ATHEROMA EVAL BI",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","99473"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","93895","HC CAROTID INTIMA MEDIA & CAROTID ATHEROMA EVAL BI","93895 - HC CAROTID INTIMA MEDIA & CAROTID ATHEROMA EVAL BI",null,null,null,null,null,"BMCHN ACO","99473"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93922","NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL","93922 - NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL",null,null,null,null,null,"BMCHN MCO","99473"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","93922","NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL","93922 - NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL",null,null,null,null,null,"BMCHN MEDICAID","99473"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93923","NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS","93923 - NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS",null,null,null,null,null,"BMCHN QHP","99473"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","93923","NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS","93923 - NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS",null,null,null,null,null,"CIGNA CARELINK","99473"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93924","HC N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI","93924 - HC N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI",null,null,null,null,null,"FALLON MEDICAID","99473"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","93924","HC N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI","93924 - HC N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI",null,null,null,null,null,"TUFTS HMO","99473"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93925","HC DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY","93925 - HC DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY",null,null,null,null,null,"TUFTS POS","99473"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","93925","HC DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY","93925 - HC DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY",null,null,null,null,null,"TUFTS PPO","99473"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93926","HC DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY","93926 - HC DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY",null,null,null,null,null,"TUFTS SELECT","99473"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","93926","HC DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY","93926 - HC DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY",null,null,null,null,null,"TUFTS PUBLIC DIRECT","99473"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93930","HC DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY","93930 - HC DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY",null,null,null,null,null,"TUFTS PUBLIC TOGETHER","99473"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","93930","HC DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY","93930 - HC DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY",null,null,null,null,null,"CIGNA CARELINK","99483"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93931","DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY","93931 - DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY",null,null,null,null,null,"TUFTS HMO","99483"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","93931","DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY","93931 - DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY",null,null,null,null,null,"TUFTS POS","99483"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93970","HC DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY","93970 - HC DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY",null,null,null,null,null,"TUFTS PPO","99483"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","93970","HC DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY","93970 - HC DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY",null,null,null,null,null,"TUFTS SELECT","99483"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93971","HC DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY","93971 - HC DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY",null,null,null,null,null,"ALLWAYS HLTH ACO","99495"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","93971","HC DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY","93971 - HC DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","99495"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93975","DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM","93975 - DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","99495"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","93975","DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM","93975 - DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM",null,null,null,null,null,"BLUE CROSS-HMO BLUE","99495"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93976","HC DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RORGN LMT","93976 - HC DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RORGN LMT",null,null,null,null,null,"BLUE CROSS-INDEMNITY","99495"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","93976","HC DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RORGN LMT","93976 - HC DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RORGN LMT",null,null,null,null,null,"BLUE CROSS-PPO","99495"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93978","HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE","93978 - HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","99495"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","93978","HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE","93978 - HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","99495"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93979","HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD","93979 - HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","99495"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","93979","HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD","93979 - HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD",null,null,null,null,null,"BMCHN ACO","99495"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93980","DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL","93980 - DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL",null,null,null,null,null,"BMCHN MCO","99495"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","93980","DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL","93980 - DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL",null,null,null,null,null,"BMCHN MEDICAID","99495"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93985","DUP-SCAN HEMO COMPL BI STD","93985 - DUP-SCAN HEMO COMPL BI STD",null,null,null,null,null,"BMCHN QHP","99495"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","93985","DUP-SCAN HEMO COMPL BI STD","93985 - DUP-SCAN HEMO COMPL BI STD",null,null,null,null,null,"CIGNA CARELINK","99495"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93986","DUP-SCAN HEMO COMPL UNI STD","93986 - DUP-SCAN HEMO COMPL UNI STD",null,null,null,null,null,"FALLON MEDICAID","99495"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","93986","DUP-SCAN HEMO COMPL UNI STD","93986 - DUP-SCAN HEMO COMPL UNI STD",null,null,null,null,null,"TUFTS HMO","99495"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","93990","HC DUPLEX SCAN HEMODIALYSIS ACCESS","93990 - HC DUPLEX SCAN HEMODIALYSIS ACCESS",null,null,null,null,null,"TUFTS POS","99495"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","93990","HC DUPLEX SCAN HEMODIALYSIS ACCESS","93990 - HC DUPLEX SCAN HEMODIALYSIS ACCESS",null,null,null,null,null,"TUFTS PPO","99495"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","94002","HC VENTILATION ASSIST & MGMT INPATIENT 1ST DAY","94002 - HC VENTILATION ASSIST & MGMT INPATIENT 1ST DAY",null,null,null,null,null,"TUFTS SELECT","99495"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","94002","HC VENTILATION ASSIST & MGMT INPATIENT 1ST DAY","94002 - HC VENTILATION ASSIST & MGMT INPATIENT 1ST DAY",null,null,null,null,null,"TUFTS PUBLIC DIRECT","99495"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","94003","HC VENTILATION ASSIST & MGMT INPATIENT EA SBSQ DA","94003 - HC VENTILATION ASSIST & MGMT INPATIENT EA SBSQ DA",null,null,null,null,null,"TUFTS PUBLIC TOGETHER","99495"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","94003","HC VENTILATION ASSIST & MGMT INPATIENT EA SBSQ DA","94003 - HC VENTILATION ASSIST & MGMT INPATIENT EA SBSQ DA",null,null,null,null,null,"ALLWAYS HLTH ACO","99496"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","94010","SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ","94010 - SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","99496"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","94010","SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ","94010 - SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","99496"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","94060","BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN","94060 - BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN",null,null,null,null,null,"BLUE CROSS-HMO BLUE","99496"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","94060","BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN","94060 - BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN",null,null,null,null,null,"BLUE CROSS-INDEMNITY","99496"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","94070","BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT","94070 - BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT",null,null,null,null,null,"BLUE CROSS-PPO","99496"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","94070","BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT","94070 - BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","99496"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","94150","VITAL CAPACITY TOTAL SEPARATE PROCEDURE","94150 - VITAL CAPACITY TOTAL SEPARATE PROCEDURE",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","99496"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","94150","VITAL CAPACITY TOTAL SEPARATE PROCEDURE","94150 - VITAL CAPACITY TOTAL SEPARATE PROCEDURE",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","99496"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","94200","HC MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ","94200 - HC MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ",null,null,null,null,null,"BMCHN ACO","99496"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","94200","HC MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ","94200 - HC MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ",null,null,null,null,null,"BMCHN MCO","99496"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","94250","HC EXPIRED GAS COLLECTION QUANT 1 PROCEDURE SPX","94250 - HC EXPIRED GAS COLLECTION QUANT 1 PROCEDURE SPX",null,null,null,null,null,"BMCHN MEDICAID","99496"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","94250","HC EXPIRED GAS COLLECTION QUANT 1 PROCEDURE SPX","94250 - HC EXPIRED GAS COLLECTION QUANT 1 PROCEDURE SPX",null,null,null,null,null,"BMCHN QHP","99496"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","94375","RESPIRATORY FLOW VOLUME LOOP","94375 - RESPIRATORY FLOW VOLUME LOOP",null,null,null,null,null,"CIGNA CARELINK","99496"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","94375","RESPIRATORY FLOW VOLUME LOOP","94375 - RESPIRATORY FLOW VOLUME LOOP",null,null,null,null,null,"FALLON MEDICAID","99496"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","94450","HYPOXIA RESPONSE CURVE","94450 - HYPOXIA RESPONSE CURVE",null,null,null,null,null,"TUFTS HMO","99496"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","94450","HYPOXIA RESPONSE CURVE","94450 - HYPOXIA RESPONSE CURVE",null,null,null,null,null,"TUFTS POS","99496"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","94453","HC HAST W/OXYGEN TITRATE","94453 - HC HAST W/OXYGEN TITRATE",null,null,null,null,null,"TUFTS PPO","99496"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","94453","HC HAST W/OXYGEN TITRATE","94453 - HC HAST W/OXYGEN TITRATE",null,null,null,null,null,"TUFTS SELECT","99496"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","94617","HC EXERCISE TEST FOR BRONCHOSPASM","94617 - HC EXERCISE TEST FOR BRONCHOSPASM",null,null,null,null,null,"TUFTS PUBLIC DIRECT","99496"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","94617","HC EXERCISE TEST FOR BRONCHOSPASM","94617 - HC EXERCISE TEST FOR BRONCHOSPASM",null,null,null,null,null,"TUFTS PUBLIC TOGETHER","99496"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","94618","HC PULMONARY STRESS TESTING","94618 - HC PULMONARY STRESS TESTING",null,null,null,null,null,"ALLWAYS HLTH ACO","99497"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","94618","HC PULMONARY STRESS TESTING","94618 - HC PULMONARY STRESS TESTING",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","99497"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","94621","HC PULMONARY STRESS TESTING COMPLEX","94621 - HC PULMONARY STRESS TESTING COMPLEX",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","99497"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","94621","HC PULMONARY STRESS TESTING COMPLEX","94621 - HC PULMONARY STRESS TESTING COMPLEX",null,null,null,null,null,"BLUE CROSS-HMO BLUE","99497"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","94640","PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT","94640 - PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT",null,null,null,null,null,"BLUE CROSS-INDEMNITY","99497"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","94640","PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT","94640 - PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT",null,null,null,null,null,"BLUE CROSS-PPO","99497"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","94642","HC AEROSOL INHALATION TREATMENT","94642 - HC AEROSOL INHALATION TREATMENT",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","99497"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","94642","HC AEROSOL INHALATION TREATMENT","94642 - HC AEROSOL INHALATION TREATMENT",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","99497"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","94644","CONTINUOUS INHALATION TREATMENT 1ST HR","94644 - CONTINUOUS INHALATION TREATMENT 1ST HR",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","99497"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","94644","CONTINUOUS INHALATION TREATMENT 1ST HR","94644 - CONTINUOUS INHALATION TREATMENT 1ST HR",null,null,null,null,null,"BMCHN ACO","99497"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","94645","CONTINUOUS INHALATION TREATMENT EA ADDL HR","94645 - CONTINUOUS INHALATION TREATMENT EA ADDL HR",null,null,null,null,null,"BMCHN MCO","99497"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","94645","CONTINUOUS INHALATION TREATMENT EA ADDL HR","94645 - CONTINUOUS INHALATION TREATMENT EA ADDL HR",null,null,null,null,null,"BMCHN MEDICAID","99497"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","94660","HC CPAP VENTILATION CPAP INITIATION&MGMT","94660 - HC CPAP VENTILATION CPAP INITIATION&MGMT",null,null,null,null,null,"BMCHN QHP","99497"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","94660","HC CPAP VENTILATION CPAP INITIATION&MGMT","94660 - HC CPAP VENTILATION CPAP INITIATION&MGMT",null,null,null,null,null,"CIGNA CARELINK","99497"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","94664","HC DEMO/EVAL INHALER/NEBULIZER - PHARM","94664 - HC DEMO/EVAL INHALER/NEBULIZER - PHARM",null,null,null,null,null,"FALLON MEDICAID","99497"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","94664","HC DEMO/EVAL INHALER/NEBULIZER - PHARM","94664 - HC DEMO/EVAL INHALER/NEBULIZER - PHARM",null,null,null,null,null,"TUFTS HMO","99497"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","94667","HC CHEST WALL MANIPULATION,INITIAL","94667 - HC CHEST WALL MANIPULATION,INITIAL",null,null,null,null,null,"TUFTS POS","99497"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","94667","HC CHEST WALL MANIPULATION,INITIAL","94667 - HC CHEST WALL MANIPULATION,INITIAL",null,null,null,null,null,"TUFTS PPO","99497"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","94681","O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC","94681 - O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC",null,null,null,null,null,"TUFTS SELECT","99497"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","94681","O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC","94681 - O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC",null,null,null,null,null,"TUFTS PUBLIC DIRECT","99497"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","94690","O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX","94690 - O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX",null,null,null,null,null,"TUFTS PUBLIC TOGETHER","99497"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","94690","O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX","94690 - O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","99498"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","94726","PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST","94726 - PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST",null,null,null,null,null,"BLUE CROSS-HMO BLUE","99498"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","94726","PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST","94726 - PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST",null,null,null,null,null,"BLUE CROSS-INDEMNITY","99498"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","94727","HC GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&VOL","94727 - HC GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&VOL",null,null,null,null,null,"BLUE CROSS-PPO","99498"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","94727","HC GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&VOL","94727 - HC GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&VOL",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","99498"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","94729","CO DIFFUSING CAPACITY","94729 - CO DIFFUSING CAPACITY",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","99498"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","94729","CO DIFFUSING CAPACITY","94729 - CO DIFFUSING CAPACITY",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","99498"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","94761","MEASURE BLOOD OXYGEN LEVEL","94761 - MEASURE BLOOD OXYGEN LEVEL",null,null,null,null,null,"CIGNA CARELINK","99498"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","94761","MEASURE BLOOD OXYGEN LEVEL","94761 - MEASURE BLOOD OXYGEN LEVEL",null,null,null,null,null,"TUFTS HMO","99498"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","94762","NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR","94762 - NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR",null,null,null,null,null,"TUFTS POS","99498"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","94762","NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR","94762 - NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR",null,null,null,null,null,"TUFTS PPO","99498"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","94770","CARBON DIOXIDE EXP GAS DETER INFRARED ANALYZER","94770 - CARBON DIOXIDE EXP GAS DETER INFRARED ANALYZER",null,null,null,null,null,"TUFTS SELECT","99498"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","94770","CARBON DIOXIDE EXP GAS DETER INFRARED ANALYZER","94770 - CARBON DIOXIDE EXP GAS DETER INFRARED ANALYZER",null,null,null,null,null,"ALLWAYS HLTH ACO","99605"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","94772","CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT","94772 - CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","99605"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","94772","CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT","94772 - CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT",null,null,null,null,null,"BMCHN ACO","99605"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","94780","HC CAR SEAT/BED TESTING W/INTERP & REPORT 60 MIN","94780 - HC CAR SEAT/BED TESTING W/INTERP & REPORT 60 MIN",null,null,null,null,null,"BMCHN MCO","99605"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","94780","HC CAR SEAT/BED TESTING W/INTERP & REPORT 60 MIN","94780 - HC CAR SEAT/BED TESTING W/INTERP & REPORT 60 MIN",null,null,null,null,null,"BMCHN MEDICAID","99605"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95004","PERCUTANEOUS TESTS W/ALLERGENIC EXTRACTS","95004 - PERCUTANEOUS TESTS W/ALLERGENIC EXTRACTS",null,null,null,null,null,"BMCHN QHP","99605"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95004","PERCUTANEOUS TESTS W/ALLERGENIC EXTRACTS","95004 - PERCUTANEOUS TESTS W/ALLERGENIC EXTRACTS",null,null,null,null,null,"CIGNA CARELINK","99605"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95017","ALLG TSTG PERQ & IC VENOMS IMMED REACT W/ I&R","95017 - ALLG TSTG PERQ & IC VENOMS IMMED REACT W/ I&R",null,null,null,null,null,"FALLON MEDICAID","99605"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95017","ALLG TSTG PERQ & IC VENOMS IMMED REACT W/ I&R","95017 - ALLG TSTG PERQ & IC VENOMS IMMED REACT W/ I&R",null,null,null,null,null,"TUFTS HMO","99605"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95018","ALLG TEST PERQ & IC DRUG/BIOL IMMED REACT W/ I&R","95018 - ALLG TEST PERQ & IC DRUG/BIOL IMMED REACT W/ I&R",null,null,null,null,null,"TUFTS POS","99605"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95018","ALLG TEST PERQ & IC DRUG/BIOL IMMED REACT W/ I&R","95018 - ALLG TEST PERQ & IC DRUG/BIOL IMMED REACT W/ I&R",null,null,null,null,null,"TUFTS PPO","99605"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95024","INTRACUTANEOUS TESTS W/ALLERGENIC EXTRACTS","95024 - INTRACUTANEOUS TESTS W/ALLERGENIC EXTRACTS",null,null,null,null,null,"TUFTS SELECT","99605"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95024","INTRACUTANEOUS TESTS W/ALLERGENIC EXTRACTS","95024 - INTRACUTANEOUS TESTS W/ALLERGENIC EXTRACTS",null,null,null,null,null,"TUFTS PUBLIC DIRECT","99605"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95028","IQ TSTS W/ALLGIC XTRCS DLYD TYP RXN W/READING","95028 - IQ TSTS W/ALLGIC XTRCS DLYD TYP RXN W/READING",null,null,null,null,null,"TUFTS PUBLIC TOGETHER","99605"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95028","IQ TSTS W/ALLGIC XTRCS DLYD TYP RXN W/READING","95028 - IQ TSTS W/ALLGIC XTRCS DLYD TYP RXN W/READING",null,null,null,null,null,"ALLWAYS HLTH ACO","99606"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95044","PATCH/APPLICATION TEST SPECIFY NUMBER TESTS","95044 - PATCH/APPLICATION TEST SPECIFY NUMBER TESTS",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","99606"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95044","PATCH/APPLICATION TEST SPECIFY NUMBER TESTS","95044 - PATCH/APPLICATION TEST SPECIFY NUMBER TESTS",null,null,null,null,null,"BMCHN ACO","99606"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95076","INGESTION CHALLENGE TEST INITIAL 120 MINUTES","95076 - INGESTION CHALLENGE TEST INITIAL 120 MINUTES",null,null,null,null,null,"BMCHN MCO","99606"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95076","INGESTION CHALLENGE TEST INITIAL 120 MINUTES","95076 - INGESTION CHALLENGE TEST INITIAL 120 MINUTES",null,null,null,null,null,"BMCHN MEDICAID","99606"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95079","INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES","95079 - INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES",null,null,null,null,null,"BMCHN QHP","99606"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95079","INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES","95079 - INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES",null,null,null,null,null,"CIGNA CARELINK","99606"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95115","PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS 1 NJX","95115 - PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS 1 NJX",null,null,null,null,null,"FALLON MEDICAID","99606"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95115","PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS 1 NJX","95115 - PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS 1 NJX",null,null,null,null,null,"TUFTS HMO","99606"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95117","PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS NJXS","95117 - PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS NJXS",null,null,null,null,null,"TUFTS POS","99606"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95117","PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS NJXS","95117 - PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS NJXS",null,null,null,null,null,"TUFTS PPO","99606"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95120","PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX","95120 - PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX",null,null,null,null,null,"TUFTS SELECT","99606"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95120","PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX","95120 - PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX",null,null,null,null,null,"TUFTS PUBLIC DIRECT","99606"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95125","PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 2/> NJX","95125 - PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 2/> NJX",null,null,null,null,null,"TUFTS PUBLIC TOGETHER","99606"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95125","PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 2/> NJX","95125 - PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 2/> NJX",null,null,null,null,null,"ALLWAYS HLTH ACO","99607"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95144","PREPJ& ANTIGEN PRV ALLERGEN IMMUNOTHERAPY 1 DO","95144 - PREPJ& ANTIGEN PRV ALLERGEN IMMUNOTHERAPY 1 DO",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","99607"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95144","PREPJ& ANTIGEN PRV ALLERGEN IMMUNOTHERAPY 1 DO","95144 - PREPJ& ANTIGEN PRV ALLERGEN IMMUNOTHERAPY 1 DO",null,null,null,null,null,"BMCHN ACO","99607"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95145","PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 1 INSECT","95145 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 1 INSECT",null,null,null,null,null,"BMCHN MCO","99607"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95145","PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 1 INSECT","95145 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 1 INSECT",null,null,null,null,null,"BMCHN MEDICAID","99607"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95146","PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 2 INSECT","95146 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 2 INSECT",null,null,null,null,null,"BMCHN QHP","99607"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95146","PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 2 INSECT","95146 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 2 INSECT",null,null,null,null,null,"CIGNA CARELINK","99607"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95148","PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 4 INSECT","95148 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 4 INSECT",null,null,null,null,null,"FALLON MEDICAID","99607"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95148","PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 4 INSECT","95148 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 4 INSECT",null,null,null,null,null,"TUFTS HMO","99607"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95149","PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 5 INSECT","95149 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 5 INSECT",null,null,null,null,null,"TUFTS POS","99607"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95149","PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 5 INSECT","95149 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 5 INSECT",null,null,null,null,null,"TUFTS PPO","99607"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95165","PREPJ& ALLERGEN IMMUNOTHERAPY 1/MLT ANTIGEN","95165 - PREPJ& ALLERGEN IMMUNOTHERAPY 1/MLT ANTIGEN",null,null,null,null,null,"TUFTS SELECT","99607"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95165","PREPJ& ALLERGEN IMMUNOTHERAPY 1/MLT ANTIGEN","95165 - PREPJ& ALLERGEN IMMUNOTHERAPY 1/MLT ANTIGEN",null,null,null,null,null,"TUFTS PUBLIC DIRECT","99607"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95170","PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY WHL INSE","95170 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY WHL INSE",null,null,null,null,null,"TUFTS PUBLIC TOGETHER","99607"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95170","PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY WHL INSE","95170 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY WHL INSE",null,null,null,null,null,"AETNA-MEDICARE ADVANTAGE","0001A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95180","HC RAPID DESENSITIZATION PROC,EACH HOUR","95180 - HC RAPID DESENSITIZATION PROC,EACH HOUR",null,null,null,null,null,"ALLWAYS HLTH ACO","0001A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95180","HC RAPID DESENSITIZATION PROC,EACH HOUR","95180 - HC RAPID DESENSITIZATION PROC,EACH HOUR",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","0001A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95249","HC CONT GLUC MONITORING PATIENT PROVIDED EQUIPMENT","95249 - HC CONT GLUC MONITORING PATIENT PROVIDED EQUIPMENT",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","0001A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95249","HC CONT GLUC MONITORING PATIENT PROVIDED EQUIPMENT","95249 - HC CONT GLUC MONITORING PATIENT PROVIDED EQUIPMENT",null,null,null,null,null,"BLUE CROSS-HMO BLUE","0001A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95250","GLUC MNTR CONT REC FROM INTERSTITIAL TISS FLUID","95250 - GLUC MNTR CONT REC FROM INTERSTITIAL TISS FLUID",null,null,null,null,null,"BLUE CROSS-INDEMNITY","0001A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95250","GLUC MNTR CONT REC FROM INTERSTITIAL TISS FLUID","95250 - GLUC MNTR CONT REC FROM INTERSTITIAL TISS FLUID",null,null,null,null,null,"BLUE CROSS-MEDICARE ADVANTAGE","0001A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95700","HC EEG CONT REC W/VID EEG TECH","95700 - HC EEG CONT REC W/VID EEG TECH",null,null,null,null,null,"BLUE CROSS-PPO","0001A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95700","HC EEG CONT REC W/VID EEG TECH","95700 - HC EEG CONT REC W/VID EEG TECH",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","0001A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95705","HC EEG W/O VID 2-12 HR UNMNTR","95705 - HC EEG W/O VID 2-12 HR UNMNTR",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","0001A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95705","HC EEG W/O VID 2-12 HR UNMNTR","95705 - HC EEG W/O VID 2-12 HR UNMNTR",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","0001A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95706","HC EEG WO VID 2-12HR INTMT MNTR","95706 - HC EEG WO VID 2-12HR INTMT MNTR",null,null,null,null,null,"BMC SENIOR CARE OPTIONS","0001A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95706","HC EEG WO VID 2-12HR INTMT MNTR","95706 - HC EEG WO VID 2-12HR INTMT MNTR",null,null,null,null,null,"BMCHN ACO","0001A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95707","HC EEG W/O VID 2-12HR CONT MNTR","95707 - HC EEG W/O VID 2-12HR CONT MNTR",null,null,null,null,null,"BMCHN MCO","0001A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95707","HC EEG W/O VID 2-12HR CONT MNTR","95707 - HC EEG W/O VID 2-12HR CONT MNTR",null,null,null,null,null,"BMCHN MEDICAID","0001A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95708","HC EEG WO VID EA 12-26HR UNMNTR","95708 - HC EEG WO VID EA 12-26HR UNMNTR",null,null,null,null,null,"BMCHN QHP","0001A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95708","HC EEG WO VID EA 12-26HR UNMNTR","95708 - HC EEG WO VID EA 12-26HR UNMNTR",null,null,null,null,null,"CCA ONE CARE","0001A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95709","HC EEG W/O VID EA 12-26HR INTMT","95709 - HC EEG W/O VID EA 12-26HR INTMT",null,null,null,null,null,"ELEMENT CARE INC","0001A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95709","HC EEG W/O VID EA 12-26HR INTMT","95709 - HC EEG W/O VID EA 12-26HR INTMT",null,null,null,null,null,"NEIGHBORHOOD PACE (ESP EB)","0001A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95710","HC EEG W/O VID EA 12-26HR CONT","95710 - HC EEG W/O VID EA 12-26HR CONT",null,null,null,null,null,"ELDER SERVICE PLAN OTHER","0001A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95710","HC EEG W/O VID EA 12-26HR CONT","95710 - HC EEG W/O VID EA 12-26HR CONT",null,null,null,null,null,"FALLON MEDICAID","0001A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95711","HC VEEG 2-12 HR UNMONITORED","95711 - HC VEEG 2-12 HR UNMONITORED",null,null,null,null,null,"FALLON SENIOR PLAN","0001A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95711","HC VEEG 2-12 HR UNMONITORED","95711 - HC VEEG 2-12 HR UNMONITORED",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","0001A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95712","HC VEEG 2-12 HR INTMT MNTR","95712 - HC VEEG 2-12 HR INTMT MNTR",null,null,null,null,null,"SENIOR WHOLE HEALTH","0001A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95712","HC VEEG 2-12 HR INTMT MNTR","95712 - HC VEEG 2-12 HR INTMT MNTR",null,null,null,null,null,"TUFTS MEDICARE SCO","0001A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95713","HC VEEG 2-12 HR CONT MNTR","95713 - HC VEEG 2-12 HR CONT MNTR",null,null,null,null,null,"TUFTS SPIRIT","0001A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95713","HC VEEG 2-12 HR CONT MNTR","95713 - HC VEEG 2-12 HR CONT MNTR",null,null,null,null,null,"UHC COMMUNITY CARE (EVERCARE)","0001A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95714","HC VEEG EA 12-26 HR UNMNTR","95714 - HC VEEG EA 12-26 HR UNMNTR",null,null,null,null,null,"UNICARE","0001A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95714","HC VEEG EA 12-26 HR UNMNTR","95714 - HC VEEG EA 12-26 HR UNMNTR",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","0001A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95782","POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND","95782 - POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND",null,null,null,null,null,"UNITED HEALTHCARE","0001A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95782","POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND","95782 - POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND",null,null,null,null,null,"AETNA-MEDICARE ADVANTAGE","0002A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95783","POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM","95783 - POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM",null,null,null,null,null,"ALLWAYS HLTH ACO","0002A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95783","POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM","95783 - POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","0002A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95803","ACTIGRAPHY TESTING RECORDING ANALYSIS I&R","95803 - ACTIGRAPHY TESTING RECORDING ANALYSIS I&R",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","0002A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95803","ACTIGRAPHY TESTING RECORDING ANALYSIS I&R","95803 - ACTIGRAPHY TESTING RECORDING ANALYSIS I&R",null,null,null,null,null,"BLUE CROSS-HMO BLUE","0002A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95805","HC MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG","95805 - HC MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG",null,null,null,null,null,"BLUE CROSS-INDEMNITY","0002A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95805","HC MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG","95805 - HC MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG",null,null,null,null,null,"BLUE CROSS-MEDICARE ADVANTAGE","0002A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95806","SLEEP STUDY, UNATTENDED, SIMUL RECORD HR/O2 SAT/RESP FLOW/RESP EFF","95806 - SLEEP STUDY, UNATTENDED, SIMUL RECORD HR/O2 SAT/RESP FLOW/RESP EFF",null,null,null,null,null,"BLUE CROSS-PPO","0002A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95806","SLEEP STUDY, UNATTENDED, SIMUL RECORD HR/O2 SAT/RESP FLOW/RESP EFF","95806 - SLEEP STUDY, UNATTENDED, SIMUL RECORD HR/O2 SAT/RESP FLOW/RESP EFF",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","0002A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95808","POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND","95808 - POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","0002A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95808","POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND","95808 - POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","0002A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95810","POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",null,null,null,null,null,"BMC SENIOR CARE OPTIONS","0002A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95810","POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",null,null,null,null,null,"BMCHN ACO","0002A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95811","POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND","95811 - POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND",null,null,null,null,null,"BMCHN MCO","0002A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95811","POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND","95811 - POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND",null,null,null,null,null,"BMCHN MEDICAID","0002A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95812","ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN","95812 - ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN",null,null,null,null,null,"BMCHN QHP","0002A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95812","ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN","95812 - ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN",null,null,null,null,null,"CCA ONE CARE","0002A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95813","ELECTROENCEPHALOGRAM EXTND MNTR >1 HR","95813 - ELECTROENCEPHALOGRAM EXTND MNTR >1 HR",null,null,null,null,null,"ELEMENT CARE INC","0002A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95813","ELECTROENCEPHALOGRAM EXTND MNTR >1 HR","95813 - ELECTROENCEPHALOGRAM EXTND MNTR >1 HR",null,null,null,null,null,"NEIGHBORHOOD PACE (ESP EB)","0002A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95816","ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY","95816 - ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY",null,null,null,null,null,"ELDER SERVICE PLAN OTHER","0002A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95816","ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY","95816 - ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY",null,null,null,null,null,"FALLON MEDICAID","0002A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95819","ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP","95819 - ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP",null,null,null,null,null,"FALLON SENIOR PLAN","0002A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95819","ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP","95819 - ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","0002A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95824","ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY","95824 - ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY",null,null,null,null,null,"SENIOR WHOLE HEALTH","0002A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95824","ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY","95824 - ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY",null,null,null,null,null,"TUFTS MEDICARE SCO","0002A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95851","HC RANGE MOTION MEASURE,EACH EXTREM","95851 - HC RANGE MOTION MEASURE,EACH EXTREM",null,null,null,null,null,"TUFTS SPIRIT","0002A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95851","HC RANGE MOTION MEASURE,EACH EXTREM","95851 - HC RANGE MOTION MEASURE,EACH EXTREM",null,null,null,null,null,"UHC COMMUNITY CARE (EVERCARE)","0002A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95852","HC ROM MEAS;HAND(S)","95852 - HC ROM MEAS;HAND(S)",null,null,null,null,null,"UNICARE","0002A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95852","HC ROM MEAS;HAND(S)","95852 - HC ROM MEAS;HAND(S)",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","0002A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95860","NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS","95860 - NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS",null,null,null,null,null,"UNITED HEALTHCARE","0002A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95860","NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS","95860 - NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS",null,null,null,null,null,"AETNA-MEDICARE ADVANTAGE","0011A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95861","NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS","95861 - NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS",null,null,null,null,null,"ALLWAYS HLTH ACO","0011A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95861","NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS","95861 - NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","0011A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95863","NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS","95863 - NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","0011A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95863","NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS","95863 - NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS",null,null,null,null,null,"BLUE CROSS-HMO BLUE","0011A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95864","NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS","95864 - NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS",null,null,null,null,null,"BLUE CROSS-INDEMNITY","0011A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95864","NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS","95864 - NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS",null,null,null,null,null,"BLUE CROSS-MEDICARE ADVANTAGE","0011A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95865","NEEDLE ELECTROMYOGRAPHY LARYNX","95865 - NEEDLE ELECTROMYOGRAPHY LARYNX",null,null,null,null,null,"BLUE CROSS-PPO","0011A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95865","NEEDLE ELECTROMYOGRAPHY LARYNX","95865 - NEEDLE ELECTROMYOGRAPHY LARYNX",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","0011A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95866","NEEDLE ELECTROMYOGRAPHY HEMIDIAPHRAGM","95866 - NEEDLE ELECTROMYOGRAPHY HEMIDIAPHRAGM",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","0011A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95866","NEEDLE ELECTROMYOGRAPHY HEMIDIAPHRAGM","95866 - NEEDLE ELECTROMYOGRAPHY HEMIDIAPHRAGM",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","0011A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95867","NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI","95867 - NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI",null,null,null,null,null,"BMC SENIOR CARE OPTIONS","0011A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95867","NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI","95867 - NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI",null,null,null,null,null,"BMCHN ACO","0011A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95868","NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI","95868 - NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI",null,null,null,null,null,"BMCHN MCO","0011A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95868","NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI","95868 - NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI",null,null,null,null,null,"BMCHN MEDICAID","0011A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95869","NEEDLE EMG THRC PARASPI MUSC EXCLUDING T1/T12","95869 - NEEDLE EMG THRC PARASPI MUSC EXCLUDING T1/T12",null,null,null,null,null,"BMCHN QHP","0011A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95869","NEEDLE EMG THRC PARASPI MUSC EXCLUDING T1/T12","95869 - NEEDLE EMG THRC PARASPI MUSC EXCLUDING T1/T12",null,null,null,null,null,"CCA ONE CARE","0011A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95870","NEEDLE EMG LMTD STD MUSC 1 XTR/NON-LIMB UNI/BI","95870 - NEEDLE EMG LMTD STD MUSC 1 XTR/NON-LIMB UNI/BI",null,null,null,null,null,"ELEMENT CARE INC","0011A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95870","NEEDLE EMG LMTD STD MUSC 1 XTR/NON-LIMB UNI/BI","95870 - NEEDLE EMG LMTD STD MUSC 1 XTR/NON-LIMB UNI/BI",null,null,null,null,null,"NEIGHBORHOOD PACE (ESP EB)","0011A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95872","NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER","95872 - NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER",null,null,null,null,null,"ELDER SERVICE PLAN OTHER","0011A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95872","NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER","95872 - NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER",null,null,null,null,null,"FALLON MEDICAID","0011A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95873","ELECTRICAL STIMULATION GUID W/CHEMODENERVATION","95873 - ELECTRICAL STIMULATION GUID W/CHEMODENERVATION",null,null,null,null,null,"FALLON SENIOR PLAN","0011A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95873","ELECTRICAL STIMULATION GUID W/CHEMODENERVATION","95873 - ELECTRICAL STIMULATION GUID W/CHEMODENERVATION",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","0011A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95874","NEEDLE EMG GUID W/CHEMODENERVATION","95874 - NEEDLE EMG GUID W/CHEMODENERVATION",null,null,null,null,null,"SENIOR WHOLE HEALTH","0011A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95874","NEEDLE EMG GUID W/CHEMODENERVATION","95874 - NEEDLE EMG GUID W/CHEMODENERVATION",null,null,null,null,null,"TUFTS MEDICARE SCO","0011A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95885","NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED","95885 - NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED",null,null,null,null,null,"TUFTS SPIRIT","0011A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95885","NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED","95885 - NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED",null,null,null,null,null,"UHC COMMUNITY CARE (EVERCARE)","0011A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95886","NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE","95886 - NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE",null,null,null,null,null,"UNICARE","0011A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95886","NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE","95886 - NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","0011A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95887","NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION","95887 - NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION",null,null,null,null,null,"UNITED HEALTHCARE","0011A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95887","NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION","95887 - NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION",null,null,null,null,null,"AETNA-MEDICARE ADVANTAGE","0012A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95905","HC MOTOR/SENS NERVE CONDUCTION PRECONFIG ELECTRODE ARRAY, EA LIMB","95905 - HC MOTOR/SENS NERVE CONDUCTION PRECONFIG ELECTRODE ARRAY, EA LIMB",null,null,null,null,null,"ALLWAYS HLTH ACO","0012A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95905","HC MOTOR/SENS NERVE CONDUCTION PRECONFIG ELECTRODE ARRAY, EA LIMB","95905 - HC MOTOR/SENS NERVE CONDUCTION PRECONFIG ELECTRODE ARRAY, EA LIMB",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","0012A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95907","MOTOR &/SENS 1-2 NRV CNDJ PRECONF ELTRODE LIMB","95907 - MOTOR &/SENS 1-2 NRV CNDJ PRECONF ELTRODE LIMB",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","0012A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95907","MOTOR &/SENS 1-2 NRV CNDJ PRECONF ELTRODE LIMB","95907 - MOTOR &/SENS 1-2 NRV CNDJ PRECONF ELTRODE LIMB",null,null,null,null,null,"BLUE CROSS-HMO BLUE","0012A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95908","MOTOR &/SENS 3-4 NRV CNDJ PRECONF ELTRODE LIMB","95908 - MOTOR &/SENS 3-4 NRV CNDJ PRECONF ELTRODE LIMB",null,null,null,null,null,"BLUE CROSS-INDEMNITY","0012A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95908","MOTOR &/SENS 3-4 NRV CNDJ PRECONF ELTRODE LIMB","95908 - MOTOR &/SENS 3-4 NRV CNDJ PRECONF ELTRODE LIMB",null,null,null,null,null,"BLUE CROSS-MEDICARE ADVANTAGE","0012A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95909","MOTOR &/SENS 5-6 NRV CNDJ PRECONF ELTRODE LIMB","95909 - MOTOR &/SENS 5-6 NRV CNDJ PRECONF ELTRODE LIMB",null,null,null,null,null,"BLUE CROSS-PPO","0012A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95909","MOTOR &/SENS 5-6 NRV CNDJ PRECONF ELTRODE LIMB","95909 - MOTOR &/SENS 5-6 NRV CNDJ PRECONF ELTRODE LIMB",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","0012A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95910","MOTOR &/SENS 7-8 NRV CNDJ PRECONF ELTRODE LIMB","95910 - MOTOR &/SENS 7-8 NRV CNDJ PRECONF ELTRODE LIMB",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","0012A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95910","MOTOR &/SENS 7-8 NRV CNDJ PRECONF ELTRODE LIMB","95910 - MOTOR &/SENS 7-8 NRV CNDJ PRECONF ELTRODE LIMB",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","0012A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95911","MOTOR &/SENS 9-10 NRV CNDJ PRECONF ELTRODE LIMB","95911 - MOTOR &/SENS 9-10 NRV CNDJ PRECONF ELTRODE LIMB",null,null,null,null,null,"BMC SENIOR CARE OPTIONS","0012A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95911","MOTOR &/SENS 9-10 NRV CNDJ PRECONF ELTRODE LIMB","95911 - MOTOR &/SENS 9-10 NRV CNDJ PRECONF ELTRODE LIMB",null,null,null,null,null,"BMCHN ACO","0012A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95912","MOTOR &/SENS 11-12 NRV CNDJ PRECONF ELTRODE LIMB","95912 - MOTOR &/SENS 11-12 NRV CNDJ PRECONF ELTRODE LIMB",null,null,null,null,null,"BMCHN MCO","0012A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95912","MOTOR &/SENS 11-12 NRV CNDJ PRECONF ELTRODE LIMB","95912 - MOTOR &/SENS 11-12 NRV CNDJ PRECONF ELTRODE LIMB",null,null,null,null,null,"BMCHN MEDICAID","0012A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95913","MOTOR &/SENS 13/> NRV CNDJ PRECONF ELTRODE LIMB","95913 - MOTOR &/SENS 13/> NRV CNDJ PRECONF ELTRODE LIMB",null,null,null,null,null,"BMCHN QHP","0012A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95913","MOTOR &/SENS 13/> NRV CNDJ PRECONF ELTRODE LIMB","95913 - MOTOR &/SENS 13/> NRV CNDJ PRECONF ELTRODE LIMB",null,null,null,null,null,"CCA ONE CARE","0012A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95921","HC AUTONOMIC NRV PARASYM INERVJ","95921 - HC AUTONOMIC NRV PARASYM INERVJ",null,null,null,null,null,"ELEMENT CARE INC","0012A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95921","HC AUTONOMIC NRV PARASYM INERVJ","95921 - HC AUTONOMIC NRV PARASYM INERVJ",null,null,null,null,null,"NEIGHBORHOOD PACE (ESP EB)","0012A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95923","HC AUTONOMIC NRV SYST FUNJ TEST","95923 - HC AUTONOMIC NRV SYST FUNJ TEST",null,null,null,null,null,"ELDER SERVICE PLAN OTHER","0012A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95923","HC AUTONOMIC NRV SYST FUNJ TEST","95923 - HC AUTONOMIC NRV SYST FUNJ TEST",null,null,null,null,null,"FALLON MEDICAID","0012A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95924","TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT","95924 - TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT",null,null,null,null,null,"FALLON SENIOR PLAN","0012A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95924","TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT","95924 - TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","0012A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95925","HC SOMATOSENSORY TEST,UPPER LIMBS","95925 - HC SOMATOSENSORY TEST,UPPER LIMBS",null,null,null,null,null,"SENIOR WHOLE HEALTH","0012A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95925","HC SOMATOSENSORY TEST,UPPER LIMBS","95925 - HC SOMATOSENSORY TEST,UPPER LIMBS",null,null,null,null,null,"TUFTS MEDICARE SCO","0012A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95926","SHORT-LATENCY SOMATOSENS EP STD LWR LIMBS","95926 - SHORT-LATENCY SOMATOSENS EP STD LWR LIMBS",null,null,null,null,null,"TUFTS SPIRIT","0012A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95926","SHORT-LATENCY SOMATOSENS EP STD LWR LIMBS","95926 - SHORT-LATENCY SOMATOSENS EP STD LWR LIMBS",null,null,null,null,null,"UHC COMMUNITY CARE (EVERCARE)","0012A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95930","HC VISUAL EP TESTING CNS EXCEPT GLAUCOMA W/I&R","95930 - HC VISUAL EP TESTING CNS EXCEPT GLAUCOMA W/I&R",null,null,null,null,null,"UNICARE","0012A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95930","HC VISUAL EP TESTING CNS EXCEPT GLAUCOMA W/I&R","95930 - HC VISUAL EP TESTING CNS EXCEPT GLAUCOMA W/I&R",null,null,null,null,null,"UNICARE STATE INDEMNITY PLAN","0012A"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95933","ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST","95933 - ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST",null,null,null,null,null,"UNITED HEALTHCARE","0012A"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95933","ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST","95933 - ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","0106T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95937","NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH","95937 - NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","0106T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95937","NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH","95937 - NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","0106T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95940","HC IONM 1 ON 1 IN OR W/ATTENDANCE EACH 15 MINUTES","95940 - HC IONM 1 ON 1 IN OR W/ATTENDANCE EACH 15 MINUTES",null,null,null,null,null,"UNITED/HARVARD PILGRIM","0106T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95940","HC IONM 1 ON 1 IN OR W/ATTENDANCE EACH 15 MINUTES","95940 - HC IONM 1 ON 1 IN OR W/ATTENDANCE EACH 15 MINUTES",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","0126T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95943","PARASYMP & SYMP NRV FUNCJ HRT RATE VARIABILITY","95943 - PARASYMP & SYMP NRV FUNCJ HRT RATE VARIABILITY",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","0126T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95943","PARASYMP & SYMP NRV FUNCJ HRT RATE VARIABILITY","95943 - PARASYMP & SYMP NRV FUNCJ HRT RATE VARIABILITY",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","0126T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95958","WADA ACTIVATION TEST HEMISPHERIC FUNCTION W/EEG","95958 - WADA ACTIVATION TEST HEMISPHERIC FUNCTION W/EEG",null,null,null,null,null,"UNITED/HARVARD PILGRIM","0126T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95958","WADA ACTIVATION TEST HEMISPHERIC FUNCTION W/EEG","95958 - WADA ACTIVATION TEST HEMISPHERIC FUNCTION W/EEG",null,null,null,null,null,"CIGNA CARELINK","0159T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95961","HC FUNCJAL CORT & SUBCORT MAPG PHYS/QHP ATTND INIT HR","95961 - HC FUNCJAL CORT & SUBCORT MAPG PHYS/QHP ATTND INIT HR",null,null,null,null,null,"TUFTS HMO","0159T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95961","HC FUNCJAL CORT & SUBCORT MAPG PHYS/QHP ATTND INIT HR","95961 - HC FUNCJAL CORT & SUBCORT MAPG PHYS/QHP ATTND INIT HR",null,null,null,null,null,"TUFTS POS","0159T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95962","HC FUNCJAL CORT & SUBCORT MAPG PHYS/QHP ATTND ADDL HR","95962 - HC FUNCJAL CORT & SUBCORT MAPG PHYS/QHP ATTND ADDL HR",null,null,null,null,null,"TUFTS PPO","0159T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95962","HC FUNCJAL CORT & SUBCORT MAPG PHYS/QHP ATTND ADDL HR","95962 - HC FUNCJAL CORT & SUBCORT MAPG PHYS/QHP ATTND ADDL HR",null,null,null,null,null,"TUFTS SELECT","0159T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95966","HC MEG,EVOKED MAGNET FIELDS, SINGLE MODAL","95966 - HC MEG,EVOKED MAGNET FIELDS, SINGLE MODAL",null,null,null,null,null,"AETNA","0191T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95966","HC MEG,EVOKED MAGNET FIELDS, SINGLE MODAL","95966 - HC MEG,EVOKED MAGNET FIELDS, SINGLE MODAL",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","0191T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95970","ELEC ALYS NSTIM PLS GEN BRN/SC/PERPH W/O REPRGRM","95970 - ELEC ALYS NSTIM PLS GEN BRN/SC/PERPH W/O REPRGRM",null,null,null,null,null,"BLUE CROSS-HMO BLUE","0191T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95970","ELEC ALYS NSTIM PLS GEN BRN/SC/PERPH W/O REPRGRM","95970 - ELEC ALYS NSTIM PLS GEN BRN/SC/PERPH W/O REPRGRM",null,null,null,null,null,"BLUE CROSS-INDEMNITY","0191T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95971","ELEC ALYS NSTIM PLS GEN SMPL SC/PERPH W/PRGRMG","95971 - ELEC ALYS NSTIM PLS GEN SMPL SC/PERPH W/PRGRMG",null,null,null,null,null,"BLUE CROSS-PPO","0191T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95971","ELEC ALYS NSTIM PLS GEN SMPL SC/PERPH W/PRGRMG","95971 - ELEC ALYS NSTIM PLS GEN SMPL SC/PERPH W/PRGRMG",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","0191T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95972","ELEC ALYS NSTIM PLS GEN CPLX SC/PERPH 1ST HR","95972 - ELEC ALYS NSTIM PLS GEN CPLX SC/PERPH 1ST HR",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","0191T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95972","ELEC ALYS NSTIM PLS GEN CPLX SC/PERPH 1ST HR","95972 - ELEC ALYS NSTIM PLS GEN CPLX SC/PERPH 1ST HR",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","0191T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95976","HC ALYS SMPL CN NPGT PRGRMG","95976 - HC ALYS SMPL CN NPGT PRGRMG",null,null,null,null,null,"CIGNA CARELINK","0191T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95976","HC ALYS SMPL CN NPGT PRGRMG","95976 - HC ALYS SMPL CN NPGT PRGRMG",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","0191T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95977","HC ALYS CPLX CN NPGT PRGRMG","95977 - HC ALYS CPLX CN NPGT PRGRMG",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","0191T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95977","HC ALYS CPLX CN NPGT PRGRMG","95977 - HC ALYS CPLX CN NPGT PRGRMG",null,null,null,null,null,"TUFTS HMO","0191T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95983","HC ALYS BRN NPGT PRGRMG 15 MIN","95983 - HC ALYS BRN NPGT PRGRMG 15 MIN",null,null,null,null,null,"TUFTS POS","0191T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95983","HC ALYS BRN NPGT PRGRMG 15 MIN","95983 - HC ALYS BRN NPGT PRGRMG 15 MIN",null,null,null,null,null,"TUFTS PPO","0191T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95984","HC ALYS BRN NPGT PRGRMG ADDL 15","95984 - HC ALYS BRN NPGT PRGRMG ADDL 15",null,null,null,null,null,"TUFTS SELECT","0191T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95984","HC ALYS BRN NPGT PRGRMG ADDL 15","95984 - HC ALYS BRN NPGT PRGRMG ADDL 15",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","0191T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95990","REFILL&MAINTENANCE PUMP DRUG DLVR SPINAL/BRAIN","95990 - REFILL&MAINTENANCE PUMP DRUG DLVR SPINAL/BRAIN",null,null,null,null,null,"UNITED/HARVARD PILGRIM","0191T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95990","REFILL&MAINTENANCE PUMP DRUG DLVR SPINAL/BRAIN","95990 - REFILL&MAINTENANCE PUMP DRUG DLVR SPINAL/BRAIN",null,null,null,null,null,"AETNA-MEDICARE ADVANTAGE","0202U"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","95991","RFL&MAIN IMPLT PMP/RSVR DLVR SPI/BRN PHY/QHP","95991 - RFL&MAIN IMPLT PMP/RSVR DLVR SPI/BRN PHY/QHP",null,null,null,null,null,"BLUE CROSS-MEDICARE ADVANTAGE","0202U"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","95991","RFL&MAIN IMPLT PMP/RSVR DLVR SPI/BRN PHY/QHP","95991 - RFL&MAIN IMPLT PMP/RSVR DLVR SPI/BRN PHY/QHP",null,null,null,null,null,"BMC SENIOR CARE OPTIONS","0202U"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96020","HC TEST SELECT & ADMN FUNCTL BRAIN MAP PHYS/QHP","96020 - HC TEST SELECT & ADMN FUNCTL BRAIN MAP PHYS/QHP",null,null,null,null,null,"CCA ONE CARE","0202U"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96020","HC TEST SELECT & ADMN FUNCTL BRAIN MAP PHYS/QHP","96020 - HC TEST SELECT & ADMN FUNCTL BRAIN MAP PHYS/QHP",null,null,null,null,null,"ELEMENT CARE INC","0202U"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96040","MEDICAL GENETICS COUNSELING EACH 30 MINUTES","96040 - MEDICAL GENETICS COUNSELING EACH 30 MINUTES",null,null,null,null,null,"ELDER SERVICE PLAN OTHER","0202U"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96040","MEDICAL GENETICS COUNSELING EACH 30 MINUTES","96040 - MEDICAL GENETICS COUNSELING EACH 30 MINUTES",null,null,null,null,null,"FALLON SENIOR PLAN","0202U"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96105","ASSESSMENT PHASIA W/INTERP & REPORT PER HOUR","96105 - ASSESSMENT PHASIA W/INTERP & REPORT PER HOUR",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","0202U"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96105","ASSESSMENT PHASIA W/INTERP & REPORT PER HOUR","96105 - ASSESSMENT PHASIA W/INTERP & REPORT PER HOUR",null,null,null,null,null,"SENIOR WHOLE HEALTH","0202U"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96112","HC DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR","96112 - HC DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR",null,null,null,null,null,"TUFTS MEDICARE PREFERRED HMO","0202U"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96112","HC DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR","96112 - HC DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR",null,null,null,null,null,"TUFTS MEDICARE SCO","0202U"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96113","HC DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN","96113 - HC DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN",null,null,null,null,null,"TUFTS SPIRIT","0202U"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96113","HC DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN","96113 - HC DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN",null,null,null,null,null,"TUFTS PUBLIC DIRECT NON SUBSIDIZ","0202U"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96116","NUBHVL STATUS XM PR HR W/PT INTERPJ&PREPJ","96116 - NUBHVL STATUS XM PR HR W/PT INTERPJ&PREPJ",null,null,null,null,null,"TUFTS PUBLIC UNIFY","0202U"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96116","NUBHVL STATUS XM PR HR W/PT INTERPJ&PREPJ","96116 - NUBHVL STATUS XM PR HR W/PT INTERPJ&PREPJ",null,null,null,null,null,"UHC COMMUNITY CARE (EVERCARE)","0202U"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96121","HC NEUROBEHAVIORAL STATUS XM PHYS/QHP EA ADDL HOUR","96121 - HC NEUROBEHAVIORAL STATUS XM PHYS/QHP EA ADDL HOUR",null,null,null,null,null,"UNITED HEALTHCARE","0202U"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96121","HC NEUROBEHAVIORAL STATUS XM PHYS/QHP EA ADDL HOUR","96121 - HC NEUROBEHAVIORAL STATUS XM PHYS/QHP EA ADDL HOUR",null,null,null,null,null,"AETNA","0207T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96127","BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT","96127 - BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","0207T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96127","BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT","96127 - BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","0207T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96130","HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR","96130 - HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","0207T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96130","HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR","96130 - HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR",null,null,null,null,null,"UNITED/HARVARD PILGRIM","0207T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96131","HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR","96131 - HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR",null,null,null,null,null,"AETNA","0234T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96131","HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR","96131 - HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","0234T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96132","HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR","96132 - HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","0234T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96132","HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR","96132 - HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","0234T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96133","HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR","96133 - HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR",null,null,null,null,null,"UNITED/HARVARD PILGRIM","0234T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96133","HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR","96133 - HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR",null,null,null,null,null,"AETNA","0236T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96136","HC PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN","96136 - HC PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","0236T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96136","HC PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN","96136 - HC PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","0236T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96137","HC PSYCL/NRPSYCL TST PHYS/QHP 2+ TST EA ADDL 30 MIN","96137 - HC PSYCL/NRPSYCL TST PHYS/QHP 2+ TST EA ADDL 30 MIN",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","0236T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96137","HC PSYCL/NRPSYCL TST PHYS/QHP 2+ TST EA ADDL 30 MIN","96137 - HC PSYCL/NRPSYCL TST PHYS/QHP 2+ TST EA ADDL 30 MIN",null,null,null,null,null,"UNITED/HARVARD PILGRIM","0236T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96138","HC PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN","96138 - HC PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN",null,null,null,null,null,"AETNA","0237T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96138","HC PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN","96138 - HC PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","0237T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96139","HC PSYCL/NRPSYCL TST TECH 2+ TST EA ADDL 30 MIN","96139 - HC PSYCL/NRPSYCL TST TECH 2+ TST EA ADDL 30 MIN",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","0237T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96139","HC PSYCL/NRPSYCL TST TECH 2+ TST EA ADDL 30 MIN","96139 - HC PSYCL/NRPSYCL TST TECH 2+ TST EA ADDL 30 MIN",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","0237T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96146","HC PSYCL/NRPSYCL TST ELEC PLATFORM AUTO RESULT","96146 - HC PSYCL/NRPSYCL TST ELEC PLATFORM AUTO RESULT",null,null,null,null,null,"UNITED/HARVARD PILGRIM","0237T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96146","HC PSYCL/NRPSYCL TST ELEC PLATFORM AUTO RESULT","96146 - HC PSYCL/NRPSYCL TST ELEC PLATFORM AUTO RESULT",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","0238T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96160","PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM","96160 - PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM",null,null,null,null,null,"BLUE CROSS-HMO BLUE","0238T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96160","PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM","96160 - PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM",null,null,null,null,null,"BLUE CROSS-INDEMNITY","0238T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96161","CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM","96161 - CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM",null,null,null,null,null,"BLUE CROSS-PPO","0238T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96161","CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM","96161 - CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","0238T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96360","IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR","96360 - IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","0238T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96360","IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR","96360 - IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","0238T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96361","IV INFUSION HYDRATION EACH ADDITIONAL HOUR","96361 - IV INFUSION HYDRATION EACH ADDITIONAL HOUR",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","0238T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96361","IV INFUSION HYDRATION EACH ADDITIONAL HOUR","96361 - IV INFUSION HYDRATION EACH ADDITIONAL HOUR",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","0238T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96365","IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR","96365 - IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","0238T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96365","IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR","96365 - IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR",null,null,null,null,null,"UNITED/HARVARD PILGRIM","0238T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96366","IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR","96366 - IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR",null,null,null,null,null,"AETNA-MEDICARE ADVANTAGE","0241U"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96366","IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR","96366 - IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR",null,null,null,null,null,"BLUE CROSS-MEDICARE ADVANTAGE","0241U"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96367","IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR","96367 - IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR",null,null,null,null,null,"BMC SENIOR CARE OPTIONS","0241U"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96367","IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR","96367 - IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR",null,null,null,null,null,"CCA ONE CARE","0241U"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96368","IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS","96368 - IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS",null,null,null,null,null,"ELEMENT CARE INC","0241U"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96368","IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS","96368 - IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS",null,null,null,null,null,"ELDER SERVICE PLAN OTHER","0241U"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96369","HC SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR","96369 - HC SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR",null,null,null,null,null,"FALLON SENIOR PLAN","0241U"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96369","HC SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR","96369 - HC SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","0241U"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96370","HC SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,EA ADD HOUR","96370 - HC SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,EA ADD HOUR",null,null,null,null,null,"SENIOR WHOLE HEALTH","0241U"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96370","HC SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,EA ADD HOUR","96370 - HC SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,EA ADD HOUR",null,null,null,null,null,"TUFTS MEDICARE PREFERRED HMO","0241U"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96371","HC SUBQ INFUSION ADDITIONAL PUMP INFUSION SITE","96371 - HC SUBQ INFUSION ADDITIONAL PUMP INFUSION SITE",null,null,null,null,null,"TUFTS MEDICARE SCO","0241U"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96371","HC SUBQ INFUSION ADDITIONAL PUMP INFUSION SITE","96371 - HC SUBQ INFUSION ADDITIONAL PUMP INFUSION SITE",null,null,null,null,null,"TUFTS SPIRIT","0241U"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96372","THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM","96372 - THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM",null,null,null,null,null,"TUFTS PUBLIC DIRECT NON SUBSIDIZ","0241U"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96372","THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM","96372 - THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM",null,null,null,null,null,"TUFTS PUBLIC UNIFY","0241U"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96374","THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG","96374 - THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG",null,null,null,null,null,"UHC COMMUNITY CARE (EVERCARE)","0241U"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96374","THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG","96374 - THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG",null,null,null,null,null,"UNITED HEALTHCARE","0241U"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96375","THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG","96375 - THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG",null,null,null,null,null,"CIGNA CARELINK","0346T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96375","THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG","96375 - THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG",null,null,null,null,null,"TUFTS HMO","0346T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96376","HC THERAPEUTIC PROPHYLACTIC/DX NJX INTRA-ARTERIAL","96376 - HC THERAPEUTIC PROPHYLACTIC/DX NJX INTRA-ARTERIAL",null,null,null,null,null,"TUFTS POS","0346T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96376","HC THERAPEUTIC PROPHYLACTIC/DX NJX INTRA-ARTERIAL","96376 - HC THERAPEUTIC PROPHYLACTIC/DX NJX INTRA-ARTERIAL",null,null,null,null,null,"TUFTS PPO","0346T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96377","HC APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION","96377 - HC APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION",null,null,null,null,null,"TUFTS SELECT","0346T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96377","HC APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION","96377 - HC APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION",null,null,null,null,null,"CIGNA CARELINK","0362T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96401","CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-NEO","96401 - CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-NEO",null,null,null,null,null,"TUFTS HMO","0362T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96401","CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-NEO","96401 - CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-NEO",null,null,null,null,null,"TUFTS POS","0362T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96402","CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO","96402 - CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO",null,null,null,null,null,"TUFTS PPO","0362T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96402","CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO","96402 - CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO",null,null,null,null,null,"TUFTS SELECT","0362T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96405","HC INTRALESIONAL CHEMO ADMIN,<8 LESN","96405 - HC INTRALESIONAL CHEMO ADMIN,<8 LESN",null,null,null,null,null,"CIGNA CARELINK","0373T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96405","HC INTRALESIONAL CHEMO ADMIN,<8 LESN","96405 - HC INTRALESIONAL CHEMO ADMIN,<8 LESN",null,null,null,null,null,"TUFTS HMO","0373T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96409","CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG","96409 - CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG",null,null,null,null,null,"TUFTS POS","0373T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96409","CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG","96409 - CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG",null,null,null,null,null,"TUFTS PPO","0373T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96411","CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG","96411 - CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG",null,null,null,null,null,"TUFTS SELECT","0373T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96411","CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG","96411 - CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG",null,null,null,null,null,"CIGNA CARELINK","0482T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96413","CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG","96413 - CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG",null,null,null,null,null,"TUFTS HMO","0482T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96413","CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG","96413 - CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG",null,null,null,null,null,"TUFTS POS","0482T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96415","CHEMOTHERAPY ADMN IV INFUSION TQ EA HR","96415 - CHEMOTHERAPY ADMN IV INFUSION TQ EA HR",null,null,null,null,null,"TUFTS PPO","0482T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96415","CHEMOTHERAPY ADMN IV INFUSION TQ EA HR","96415 - CHEMOTHERAPY ADMN IV INFUSION TQ EA HR",null,null,null,null,null,"TUFTS SELECT","0482T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96416","CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP","96416 - CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP",null,null,null,null,null,"AETNA","0505T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96416","CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP","96416 - CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","0505T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96417","CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR","96417 - CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","0505T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96417","CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR","96417 - CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","0505T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96450","CHEMOTX ADMN CNS REQ SPINAL PUNCTURE","96450 - CHEMOTX ADMN CNS REQ SPINAL PUNCTURE",null,null,null,null,null,"UNITED/HARVARD PILGRIM","0505T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96450","CHEMOTX ADMN CNS REQ SPINAL PUNCTURE","96450 - CHEMOTX ADMN CNS REQ SPINAL PUNCTURE",null,null,null,null,null,"CIGNA CARELINK","0509T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96521","REFILLING & MAINTENANCE PORTABLE PUMP","96521 - REFILLING & MAINTENANCE PORTABLE PUMP",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","0509T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96521","REFILLING & MAINTENANCE PORTABLE PUMP","96521 - REFILLING & MAINTENANCE PORTABLE PUMP",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","0509T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96523","IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST","96523 - IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST",null,null,null,null,null,"TUFTS HMO","0509T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96523","IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST","96523 - IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST",null,null,null,null,null,"TUFTS POS","0509T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96542","HC CHEMOTHER INJECT,CUBARACH/INTRAVENT","96542 - HC CHEMOTHER INJECT,CUBARACH/INTRAVENT",null,null,null,null,null,"TUFTS PPO","0509T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96542","HC CHEMOTHER INJECT,CUBARACH/INTRAVENT","96542 - HC CHEMOTHER INJECT,CUBARACH/INTRAVENT",null,null,null,null,null,"TUFTS SELECT","0509T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96567","PDT XTRNL APPL LIGHT DSTR LES SKN BY ACTIVJ RX","96567 - PDT XTRNL APPL LIGHT DSTR LES SKN BY ACTIVJ RX",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","0509T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96567","PDT XTRNL APPL LIGHT DSTR LES SKN BY ACTIVJ RX","96567 - PDT XTRNL APPL LIGHT DSTR LES SKN BY ACTIVJ RX",null,null,null,null,null,"UNITED/HARVARD PILGRIM","0509T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96900","ACTINOTHERAPY ULTRAVIOLET LIGHT","96900 - ACTINOTHERAPY ULTRAVIOLET LIGHT",null,null,null,null,null,"CIGNA CARELINK","0523T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96900","ACTINOTHERAPY ULTRAVIOLET LIGHT","96900 - ACTINOTHERAPY ULTRAVIOLET LIGHT",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","0523T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","96910","PHOTOCHEMOTX TAR&UVB/PETROLATUM/UVB","96910 - PHOTOCHEMOTX TAR&UVB/PETROLATUM/UVB",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","0523T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","96910","PHOTOCHEMOTX TAR&UVB/PETROLATUM/UVB","96910 - PHOTOCHEMOTX TAR&UVB/PETROLATUM/UVB",null,null,null,null,null,"TUFTS HMO","0523T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","97151","HC BHV ID ASSMT BY PHYS/QHP","97151 - HC BHV ID ASSMT BY PHYS/QHP",null,null,null,null,null,"TUFTS POS","0523T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","97151","HC BHV ID ASSMT BY PHYS/QHP","97151 - HC BHV ID ASSMT BY PHYS/QHP",null,null,null,null,null,"TUFTS PPO","0523T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","97152","HC BHV ID SUPRT ASSMT BY 1 TECH","97152 - HC BHV ID SUPRT ASSMT BY 1 TECH",null,null,null,null,null,"TUFTS SELECT","0523T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","97152","HC BHV ID SUPRT ASSMT BY 1 TECH","97152 - HC BHV ID SUPRT ASSMT BY 1 TECH",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","0523T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","97153","HC ADAPTIVE BEHAVIOR TX BY TECH","97153 - HC ADAPTIVE BEHAVIOR TX BY TECH",null,null,null,null,null,"UNITED/HARVARD PILGRIM","0523T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","97153","HC ADAPTIVE BEHAVIOR TX BY TECH","97153 - HC ADAPTIVE BEHAVIOR TX BY TECH",null,null,null,null,null,"AETNA","0524T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","97154","HC GRP ADAPT BHV TX BY TECH","97154 - HC GRP ADAPT BHV TX BY TECH",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","0524T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","97154","HC GRP ADAPT BHV TX BY TECH","97154 - HC GRP ADAPT BHV TX BY TECH",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","0524T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","97155","HC ADAPT BEHAVIOR TX PHYS/QHP","97155 - HC ADAPT BEHAVIOR TX PHYS/QHP",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","0524T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","97155","HC ADAPT BEHAVIOR TX PHYS/QHP","97155 - HC ADAPT BEHAVIOR TX PHYS/QHP",null,null,null,null,null,"UNITED/HARVARD PILGRIM","0524T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","97156","HC FAM ADAPT BHV TX GDN PHY/QHP","97156 - HC FAM ADAPT BHV TX GDN PHY/QHP",null,null,null,null,null,"CIGNA CARELINK","0540T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","97156","HC FAM ADAPT BHV TX GDN PHY/QHP","97156 - HC FAM ADAPT BHV TX GDN PHY/QHP",null,null,null,null,null,"TUFTS HMO","0540T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","97157","HC MULT FAM ADAPT BHV TX GDN","97157 - HC MULT FAM ADAPT BHV TX GDN",null,null,null,null,null,"TUFTS POS","0540T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","97157","HC MULT FAM ADAPT BHV TX GDN","97157 - HC MULT FAM ADAPT BHV TX GDN",null,null,null,null,null,"TUFTS PPO","0540T"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","97158","HC GRP ADAPT BHV TX BY PHY/QHP","97158 - HC GRP ADAPT BHV TX BY PHY/QHP",null,null,null,null,null,"TUFTS SELECT","0540T"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","97158","HC GRP ADAPT BHV TX BY PHY/QHP","97158 - HC GRP ADAPT BHV TX BY PHY/QHP",null,null,null,null,null,"ALLWAYS HLTH ACO","G0399"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","97597","DEBRIDEMENT OPEN WOUND 20 SQ CM/<","97597 - DEBRIDEMENT OPEN WOUND 20 SQ CM/<",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","G0399"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","97597","DEBRIDEMENT OPEN WOUND 20 SQ CM/<","97597 - DEBRIDEMENT OPEN WOUND 20 SQ CM/<",null,null,null,null,null,"BMCHN ACO","G0399"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","97598","DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM","97598 - DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM",null,null,null,null,null,"BMCHN MCO","G0399"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","97598","DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM","97598 - DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM",null,null,null,null,null,"BMCHN MEDICAID","G0399"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","97602","RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS","97602 - RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS",null,null,null,null,null,"BMCHN QHP","G0399"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","97602","RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS","97602 - RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS",null,null,null,null,null,"CIGNA CARELINK","G0399"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","97605","NEGATIVE PRESSURE WOUND THERAPY </= 50 SQ CM","97605 - NEGATIVE PRESSURE WOUND THERAPY </= 50 SQ CM",null,null,null,null,null,"FALLON MEDICAID","G0399"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","97605","NEGATIVE PRESSURE WOUND THERAPY </= 50 SQ CM","97605 - NEGATIVE PRESSURE WOUND THERAPY </= 50 SQ CM",null,null,null,null,null,"HPHC-HARVARD PILGRIM HEALTHCAR","G0399"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","97606","NEGATIVE PRESSURE WOUND THERAPY >50 SQ CM","97606 - NEGATIVE PRESSURE WOUND THERAPY >50 SQ CM",null,null,null,null,null,"HPHC-HARVARD PILGRIM HPI","G0399"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","97606","NEGATIVE PRESSURE WOUND THERAPY >50 SQ CM","97606 - NEGATIVE PRESSURE WOUND THERAPY >50 SQ CM",null,null,null,null,null,"TUFTS HMO","G0399"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","97802","MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI","97802 - MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI",null,null,null,null,null,"TUFTS POS","G0399"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","97802","MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI","97802 - MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI",null,null,null,null,null,"TUFTS PPO","G0399"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","97803","MEDICAL NUTRITION RE-ASSMT&IVNTJ INDIV EA 15 M","97803 - MEDICAL NUTRITION RE-ASSMT&IVNTJ INDIV EA 15 M",null,null,null,null,null,"TUFTS SELECT","G0399"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","97803","MEDICAL NUTRITION RE-ASSMT&IVNTJ INDIV EA 15 M","97803 - MEDICAL NUTRITION RE-ASSMT&IVNTJ INDIV EA 15 M",null,null,null,null,null,"TUFTS PUBLIC TOGETHER","G0399"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","97804","MEDICAL NUTRITION THERAPY GRP2/ INDIV EA 30 MI","97804 - MEDICAL NUTRITION THERAPY GRP2/ INDIV EA 30 MI",null,null,null,null,null,"UHC-HPHC STUDENT PLAN","G0399"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","97804","MEDICAL NUTRITION THERAPY GRP2/ INDIV EA 30 MI","97804 - MEDICAL NUTRITION THERAPY GRP2/ INDIV EA 30 MI",null,null,null,null,null,"UNITED/HARVARD PILGRIM","G0399"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","98925","HC OSTEOPATHIC MANIP,1-2 BODY REGN","98925 - HC OSTEOPATHIC MANIP,1-2 BODY REGN",null,null,null,null,null,"ALLWAYS HLTH ACO","G0465"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","98925","HC OSTEOPATHIC MANIP,1-2 BODY REGN","98925 - HC OSTEOPATHIC MANIP,1-2 BODY REGN",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","G0465"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","99151","HC MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS","99151 - HC MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS",null,null,null,null,null,"BMCHN ACO","G0465"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","99151","HC MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS","99151 - HC MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS",null,null,null,null,null,"BMCHN MCO","G0465"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","99152","HC MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS","99152 - HC MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS",null,null,null,null,null,"BMCHN MEDICAID","G0465"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","99152","HC MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS","99152 - HC MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS",null,null,null,null,null,"BMCHN QHP","G0465"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","99153","HC MOD SED SAME PHYS/QHP EACH ADDL 15 MINS","99153 - HC MOD SED SAME PHYS/QHP EACH ADDL 15 MINS",null,null,null,null,null,"FALLON MEDICAID","G0465"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","99153","HC MOD SED SAME PHYS/QHP EACH ADDL 15 MINS","99153 - HC MOD SED SAME PHYS/QHP EACH ADDL 15 MINS",null,null,null,null,null,"TUFTS PUBLIC TOGETHER","G0465"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","99155","HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS","99155 - HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS",null,null,null,null,null,"ALLWAYS HLTH ACO","G2215"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","99155","HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS","99155 - HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","G2215"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","99156","HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS","99156 - HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS",null,null,null,null,null,"BMCHN ACO","G2215"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","99156","HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS","99156 - HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS",null,null,null,null,null,"BMCHN MCO","G2215"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","99157","HC MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS","99157 - HC MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS",null,null,null,null,null,"BMCHN MEDICAID","G2215"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","99157","HC MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS","99157 - HC MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS",null,null,null,null,null,"BMCHN QHP","G2215"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","99195","PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE","99195 - PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE",null,null,null,null,null,"FALLON MEDICAID","G2215"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","99195","PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE","99195 - PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE",null,null,null,null,null,"TUFTS PUBLIC TOGETHER","G2215"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","99453","REM MNTR PHYSIOL PARAM SETUP","99453 - REM MNTR PHYSIOL PARAM SETUP",null,null,null,null,null,"AETNA-MEDICARE ADVANTAGE","U0004"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","99453","REM MNTR PHYSIOL PARAM SETUP","99453 - REM MNTR PHYSIOL PARAM SETUP",null,null,null,null,null,"ALLWAYS HLTH ACO","U0004"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","99454","HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D",null,null,null,null,null,"ALLWAYS HLTH COMM SUBSIDIZED","U0004"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","99454","HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D",null,null,null,null,null,"BLUE BENEFIT ADMIN-PPO","U0004"]
["UNITED HEALTHCARE","UNITED HEALTHCARE","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",null,null,null,null,null,"BLUE CROSS-HMO BLUE","U0004"]
["UNITED HEALTHCARE","UNITED HEALTHCARE","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",null,null,null,null,null,"BLUE CROSS-INDEMNITY","U0004"]
["UNITED HEALTHCARE","UNITED HEALTHCARE","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",null,null,null,null,null,"BLUE CROSS-MEDICARE ADVANTAGE","U0004"]
["UNITED HEALTHCARE","UNITED HEALTHCARE","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",null,null,null,null,null,"BLUE CROSS-PPO","U0004"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","0106T","HC QUANT SENSORY TEST, PER EXTREMITY, TOUCH STIMULI","0106T - HC QUANT SENSORY TEST, PER EXTREMITY, TOUCH STIMULI",null,null,null,null,null,"BLUE CROSS  OUT OF STATE HMO","U0004"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","0106T","HC QUANT SENSORY TEST, PER EXTREMITY, TOUCH STIMULI","0106T - HC QUANT SENSORY TEST, PER EXTREMITY, TOUCH STIMULI",null,null,null,null,null,"BLUE CROSS OUT OF STATE INDEMNIT","U0004"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","0126T","HC COMMON CAROTID INTIMA-MEDIA THICK FOR AHD/CHD RISK ASSESS","0126T - HC COMMON CAROTID INTIMA-MEDIA THICK FOR AHD/CHD RISK ASSESS",null,null,null,null,null,"BLUE CROSS OUT OF STATE PPO","U0004"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","0126T","HC COMMON CAROTID INTIMA-MEDIA THICK FOR AHD/CHD RISK ASSESS","0126T - HC COMMON CAROTID INTIMA-MEDIA THICK FOR AHD/CHD RISK ASSESS",null,null,null,null,null,"BMC SENIOR CARE OPTIONS","U0004"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",null,null,null,null,null,"BMCHN ACO","U0004"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",null,null,null,null,null,"BMCHN MCO","U0004"]
["UNITED HEALTHCARE","UNITED HEALTHCARE","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",null,null,null,null,null,"BMCHN MEDICAID","U0004"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","0207T","HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL","0207T - HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL",null,null,null,null,null,"BMCHN QHP","U0004"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","0207T","HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL","0207T - HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL",null,null,null,null,null,"CIGNA CARELINK","U0004"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","0234T","HC TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA","0234T - HC TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA",null,null,null,null,null,"CCA ONE CARE","U0004"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","0234T","HC TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA","0234T - HC TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA",null,null,null,null,null,"ELEMENT CARE INC","U0004"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","0236T","HC TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA","0236T - HC TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA",null,null,null,null,null,"ELDER SERVICE PLAN OTHER","U0004"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","0236T","HC TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA","0236T - HC TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA",null,null,null,null,null,"FALLON MEDICAID","U0004"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","0237T","HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL","0237T - HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL",null,null,null,null,null,"FALLON SENIOR PLAN","U0004"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","0237T","HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL","0237T - HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL",null,null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE","U0004"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","0238T","HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA",null,null,null,null,null,"SENIOR WHOLE HEALTH","U0004"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","0238T","HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA",null,null,null,null,null,"TUFTS HMO","U0004"]
["UNITED HEALTHCARE","UNITED HEALTHCARE","0241U","HC NFCT DS VIR RESP RNA 4 TRGT","0241U - HC NFCT DS VIR RESP RNA 4 TRGT",null,null,null,null,null,"TUFTS MEDICARE PREFERRED HMO","U0004"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","0505T","HC EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR","0505T - HC EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR",null,null,null,null,null,"TUFTS MEDICARE SCO","U0004"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","0505T","HC EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR","0505T - HC EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR",null,null,null,null,null,"TUFTS POS","U0004"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","0509T","HC PATTERN ERG W/I&R","0509T - HC PATTERN ERG W/I&R",null,null,null,null,null,"TUFTS PPO","U0004"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","0509T","HC PATTERN ERG W/I&R","0509T - HC PATTERN ERG W/I&R",null,null,null,null,null,"TUFTS SPIRIT","U0004"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","0523T","HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING","0523T - HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING",null,null,null,null,null,"TUFTS PUBLIC DIRECT","U0004"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","0523T","HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING","0523T - HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING",null,null,null,null,null,"TUFTS PUBLIC DIRECT NON SUBSIDIZ","U0004"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","0524T","HC EV CATHETER DIR CHEM ABLTJ INCMPTNT XTR VEIN","0524T - HC EV CATHETER DIR CHEM ABLTJ INCMPTNT XTR VEIN",null,null,null,null,null,"TUFTS PUBLIC DIRECT SUBSIDIZED","U0004"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","0524T","HC EV CATHETER DIR CHEM ABLTJ INCMPTNT XTR VEIN","0524T - HC EV CATHETER DIR CHEM ABLTJ INCMPTNT XTR VEIN",null,null,null,null,null,"TUFTS PUBLIC TOGETHER","U0004"]
["UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",null,null,null,null,null,"TUFTS PUBLIC UNIFY","U0004"]
["UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",null,null,null,null,null,"UHC COMMUNITY CARE (EVERCARE)","U0004"]
["UNITED HEALTHCARE","UNITED HEALTHCARE","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",null,null,null,null,null,"UNITED HEALTHCARE","U0004"]

{"sheet":"CPTPayer&Codes&Desc","index":16,"n_rows":3560,"n_cols":19,"rows_kept":3560,"cut":false,"hidden":true,"merged":[]}
["Select Insurance Carrier","AETNA","ALLWAYS HEALTH PARTNERS","BLUE BENEFIT ADMINISTRATORS","BLUE CROSS","BLUE CROSS OUT OF STATE","BMC HEALTHNET","CIGNA HEALTHCARE","COMMONWEALTH CARE ALLIANCE","ELDER SERVICE PLAN","ELDER SERVICE PLAN OTHER","FALLON","HARVARD PILGRIM HEALTH CARE","SENIOR WHOLE HEALTH","TUFTS","TUFTS PUBLIC PLANS","UHC COMMUNITY CARE","UNICARE","UNITED HEALTHCARE"]
["Select CPT Code","Select CPT Code","Select CPT Code","Select CPT Code","Select CPT Code","Select CPT Code","Select CPT Code","Select CPT Code","Select CPT Code","Select CPT Code","Select CPT Code","Select CPT Code","Select CPT Code","Select CPT Code","Select CPT Code","Select CPT Code","Select CPT Code","Select CPT Code","Select CPT Code"]
[null,"10004 - HC FNA BX W/O IMG GDN EA ADDL","10040 - ACNE SURGERY","10004 - HC FNA BX W/O IMG GDN EA ADDL","10004 - HC FNA BX W/O IMG GDN EA ADDL","10004 - HC FNA BX W/O IMG GDN EA ADDL","10040 - ACNE SURGERY","10004 - HC FNA BX W/O IMG GDN EA ADDL","36415 - COLLECTION VENOUS BLOOD VENIPUNCTURE","36415 - COLLECTION VENOUS BLOOD VENIPUNCTURE","36415 - COLLECTION VENOUS BLOOD VENIPUNCTURE","10040 - ACNE SURGERY","10004 - HC FNA BX W/O IMG GDN EA ADDL","36415 - COLLECTION VENOUS BLOOD VENIPUNCTURE","10004 - HC FNA BX W/O IMG GDN EA ADDL","10040 - ACNE SURGERY","36415 - COLLECTION VENOUS BLOOD VENIPUNCTURE","29804 - HC TMJ ARTHROSCOPY/SURGERY","10004 - HC FNA BX W/O IMG GDN EA ADDL"]
[null,"10005 - HC FNA BX W/US GDN 1ST LES","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","10005 - HC FNA BX W/US GDN 1ST LES","10005 - HC FNA BX W/US GDN 1ST LES","10005 - HC FNA BX W/US GDN 1ST LES","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","10005 - HC FNA BX W/US GDN 1ST LES","77063 - SCREENING DIGITAL BREAST TOMOSYNTHESIS BI","77063 - SCREENING DIGITAL BREAST TOMOSYNTHESIS BI","77063 - SCREENING DIGITAL BREAST TOMOSYNTHESIS BI","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","10005 - HC FNA BX W/US GDN 1ST LES","77063 - SCREENING DIGITAL BREAST TOMOSYNTHESIS BI","10005 - HC FNA BX W/US GDN 1ST LES","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","77063 - SCREENING DIGITAL BREAST TOMOSYNTHESIS BI","29807 - HC SHLDR ARTHROSCOP,SURG,REPAIR,SLAP LESION","10005 - HC FNA BX W/US GDN 1ST LES"]
[null,"10006 - HC FNA BX W/US GDN EA ADDL","15828 - HC RHYTIDECTOMY CHEEK CHIN & NECK","10006 - HC FNA BX W/US GDN EA ADDL","10006 - HC FNA BX W/US GDN EA ADDL","10006 - HC FNA BX W/US GDN EA ADDL","15828 - HC RHYTIDECTOMY CHEEK CHIN & NECK","10006 - HC FNA BX W/US GDN EA ADDL","77065 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","15828 - HC RHYTIDECTOMY CHEEK CHIN & NECK","10006 - HC FNA BX W/US GDN EA ADDL","77065 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","10006 - HC FNA BX W/US GDN EA ADDL","15828 - HC RHYTIDECTOMY CHEEK CHIN & NECK","77065 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","29823 - HC SHLDR ARTHROSCOP,EXTEN DEBRIDE 3+","10006 - HC FNA BX W/US GDN EA ADDL"]
[null,"10007 - HC FNA BX W/FLUOR GDN 1ST LES","19316 - SUSPENSION OF BREAST","10007 - HC FNA BX W/FLUOR GDN 1ST LES","10007 - HC FNA BX W/FLUOR GDN 1ST LES","10007 - HC FNA BX W/FLUOR GDN 1ST LES","19316 - SUSPENSION OF BREAST","10007 - HC FNA BX W/FLUOR GDN 1ST LES","77066 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","19316 - SUSPENSION OF BREAST","10007 - HC FNA BX W/FLUOR GDN 1ST LES","77066 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","10007 - HC FNA BX W/FLUOR GDN 1ST LES","19316 - SUSPENSION OF BREAST","77066 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","29827 - HC SHLDR ARTHROSCOP,SURG,W/ROTAT CUFF REPR","10007 - HC FNA BX W/FLUOR GDN 1ST LES"]
[null,"10008 - HC FNA BX W/FLUOR GDN EA ADDL","19355 - HC CORRECT INVERTED NIPPLE(S)","10008 - HC FNA BX W/FLUOR GDN EA ADDL","10008 - HC FNA BX W/FLUOR GDN EA ADDL","10008 - HC FNA BX W/FLUOR GDN EA ADDL","19355 - HC CORRECT INVERTED NIPPLE(S)","10008 - HC FNA BX W/FLUOR GDN EA ADDL","77067 - HC SCR MAMM CAD, BI","77067 - HC SCR MAMM CAD, BI","77067 - HC SCR MAMM CAD, BI","19355 - HC CORRECT INVERTED NIPPLE(S)","10008 - HC FNA BX W/FLUOR GDN EA ADDL","77067 - HC SCR MAMM CAD, BI","10008 - HC FNA BX W/FLUOR GDN EA ADDL","19355 - HC CORRECT INVERTED NIPPLE(S)","77067 - HC SCR MAMM CAD, BI","29881 - HC KNEE SCOPE SINGLE MENISCECTOMY","10008 - HC FNA BX W/FLUOR GDN EA ADDL"]
[null,"10009 - HC FNA BX W/CT GDN 1ST LES","20930 - HC ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED","10009 - HC FNA BX W/CT GDN 1ST LES","10009 - HC FNA BX W/CT GDN 1ST LES","10009 - HC FNA BX W/CT GDN 1ST LES","20930 - HC ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED","10009 - HC FNA BX W/CT GDN 1ST LES","80048 - HC CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - HC CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - HC CHG BASIC METABOLIC PANEL CALCIUM TOTAL","20930 - HC ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED","10009 - HC FNA BX W/CT GDN 1ST LES","80048 - HC CHG BASIC METABOLIC PANEL CALCIUM TOTAL","10009 - HC FNA BX W/CT GDN 1ST LES","20930 - HC ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED","80048 - HC CHG BASIC METABOLIC PANEL CALCIUM TOTAL","29882 - HC KNEE SCOPE,MED OR LAT MENIS REPAIR","10009 - HC FNA BX W/CT GDN 1ST LES"]
[null,"10010 - HC FNA BX W/CT GDN EA ADDL","21121 - HC RECONST CHIN SLIDE SINGL OSTEOTOMY","10010 - HC FNA BX W/CT GDN EA ADDL","10010 - HC FNA BX W/CT GDN EA ADDL","10010 - HC FNA BX W/CT GDN EA ADDL","21121 - HC RECONST CHIN SLIDE SINGL OSTEOTOMY","10010 - HC FNA BX W/CT GDN EA ADDL","80051 - HC CHG ELECTROLYTE PANEL","80051 - HC CHG ELECTROLYTE PANEL","80051 - HC CHG ELECTROLYTE PANEL","21121 - HC RECONST CHIN SLIDE SINGL OSTEOTOMY","10010 - HC FNA BX W/CT GDN EA ADDL","80051 - HC CHG ELECTROLYTE PANEL","10010 - HC FNA BX W/CT GDN EA ADDL","21121 - HC RECONST CHIN SLIDE SINGL OSTEOTOMY","80051 - HC CHG ELECTROLYTE PANEL","29888 - HC KNEE SCOPE,AID ANT CRUCIATE REPAIR","10010 - HC FNA BX W/CT GDN EA ADDL"]
[null,"10011 - HC FNA BX W/MR GDN 1ST LES","21248 - HC RECONSTR JAW,PART-ENDO IMPLNT","10011 - HC FNA BX W/MR GDN 1ST LES","10011 - HC FNA BX W/MR GDN 1ST LES","10011 - HC FNA BX W/MR GDN 1ST LES","21248 - HC RECONSTR JAW,PART-ENDO IMPLNT","10011 - HC FNA BX W/MR GDN 1ST LES","80053 - HC CHG COMPREHENSIVE METABOLIC PANEL","80053 - HC CHG COMPREHENSIVE METABOLIC PANEL","80053 - HC CHG COMPREHENSIVE METABOLIC PANEL","21248 - HC RECONSTR JAW,PART-ENDO IMPLNT","10011 - HC FNA BX W/MR GDN 1ST LES","80053 - HC CHG COMPREHENSIVE METABOLIC PANEL","10011 - HC FNA BX W/MR GDN 1ST LES","21248 - HC RECONSTR JAW,PART-ENDO IMPLNT","80053 - HC CHG COMPREHENSIVE METABOLIC PANEL","36415 - COLLECTION VENOUS BLOOD VENIPUNCTURE","10011 - HC FNA BX W/MR GDN 1ST LES"]
[null,"10012 - HC FNA BX W/MR GDN EA ADDL","32160 - HC THORACOTOMY W/CARDIAC MASSAGE","10021 - FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE","10021 - FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE","10021 - FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE","32160 - HC THORACOTOMY W/CARDIAC MASSAGE","10012 - HC FNA BX W/MR GDN EA ADDL","80055 - HC CHG OBSTETRIC PANEL","80055 - HC CHG OBSTETRIC PANEL","80055 - HC CHG OBSTETRIC PANEL","32160 - HC THORACOTOMY W/CARDIAC MASSAGE","10012 - HC FNA BX W/MR GDN EA ADDL","80055 - HC CHG OBSTETRIC PANEL","10012 - HC FNA BX W/MR GDN EA ADDL","32160 - HC THORACOTOMY W/CARDIAC MASSAGE","80055 - HC CHG OBSTETRIC PANEL","43200 - ESPHGSC RGD/FLX DX W/WO COLLJ SPEC BR/WA SPX","10012 - HC FNA BX W/MR GDN EA ADDL"]
[null,"10021 - FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE","33015 - TUBE PERICARDIOSTOMY","10030 - IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE","10030 - IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE","10030 - IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE","33015 - TUBE PERICARDIOSTOMY","10021 - FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE","80061 - HC CHG LIPID PANEL","80061 - HC CHG LIPID PANEL","80061 - HC CHG LIPID PANEL","33015 - TUBE PERICARDIOSTOMY","10021 - FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE","80061 - HC CHG LIPID PANEL","10021 - FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE","33015 - TUBE PERICARDIOSTOMY","80061 - HC CHG LIPID PANEL","43201 - HC ESOPHAGOSCOPY FLEXIBLE TRANSORAL W SUBMUCOUS INJ","10021 - FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE"]
[null,"10030 - IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE","33289 - HC TCAT IMPL WRLS P-ART PRS SNR L-T HEMODYN MNTR","10035 - HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION","10035 - HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION","10035 - HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION","33289 - HC TCAT IMPL WRLS P-ART PRS SNR L-T HEMODYN MNTR","10030 - IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE","80069 - HC CHG RENAL FUNCTION PANEL","80069 - HC CHG RENAL FUNCTION PANEL","80069 - HC CHG RENAL FUNCTION PANEL","33289 - HC TCAT IMPL WRLS P-ART PRS SNR L-T HEMODYN MNTR","10030 - IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE","80069 - HC CHG RENAL FUNCTION PANEL","10030 - IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE","33289 - HC TCAT IMPL WRLS P-ART PRS SNR L-T HEMODYN MNTR","80069 - HC CHG RENAL FUNCTION PANEL","43202 - ESPHGSC RGD/FLX W/BIOPSY SINGLE/MULTIPLE","10030 - IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE"]
[null,"10035 - HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION","33361 - HC TAVR/TAVI PERC FEM ARTERY","10036 - HC PERQ DEV SOFT TISS ADD IMAG","10036 - HC PERQ DEV SOFT TISS ADD IMAG","10036 - HC PERQ DEV SOFT TISS ADD IMAG","33361 - HC TAVR/TAVI PERC FEM ARTERY","10035 - HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION","80074 - HC CHG ACUTE HEPATITIS PANEL","80074 - HC CHG ACUTE HEPATITIS PANEL","80074 - HC CHG ACUTE HEPATITIS PANEL","33361 - HC TAVR/TAVI PERC FEM ARTERY","10035 - HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION","80074 - HC CHG ACUTE HEPATITIS PANEL","10035 - HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION","33361 - HC TAVR/TAVI PERC FEM ARTERY","80074 - HC CHG ACUTE HEPATITIS PANEL","43215 - HC ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY","10035 - HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION"]
[null,"10036 - HC PERQ DEV SOFT TISS ADD IMAG","33967 - HC PERC INS IAB","10040 - ACNE SURGERY","10040 - ACNE SURGERY","10040 - ACNE SURGERY","33967 - HC PERC INS IAB","10036 - HC PERQ DEV SOFT TISS ADD IMAG","80076 - HC CHG HEPATIC FUNCTION PANEL","80076 - HC CHG HEPATIC FUNCTION PANEL","80076 - HC CHG HEPATIC FUNCTION PANEL","33967 - HC PERC INS IAB","10036 - HC PERQ DEV SOFT TISS ADD IMAG","80076 - HC CHG HEPATIC FUNCTION PANEL","10036 - HC PERQ DEV SOFT TISS ADD IMAG","33967 - HC PERC INS IAB","80076 - HC CHG HEPATIC FUNCTION PANEL","43220 - HC ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM","10036 - HC PERQ DEV SOFT TISS ADD IMAG"]
[null,"10060 - INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE","33968 - HC REM AORTIC ASSIST DEV PRQ","10060 - INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE","10060 - INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE","10060 - INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE","33968 - HC REM AORTIC ASSIST DEV PRQ","10040 - ACNE SURGERY","80145 - HC DRUG ASSAY ADALIMUMAB","80145 - HC DRUG ASSAY ADALIMUMAB","80145 - HC DRUG ASSAY ADALIMUMAB","33968 - HC REM AORTIC ASSIST DEV PRQ","10040 - ACNE SURGERY","80145 - HC DRUG ASSAY ADALIMUMAB","10040 - ACNE SURGERY","33968 - HC REM AORTIC ASSIST DEV PRQ","80145 - HC DRUG ASSAY ADALIMUMAB","43231 - HC ESPHGSC RGD/FLX W/NDSC ULTRASOUND EXAMINATION","10040 - ACNE SURGERY"]
[null,"10061 - INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE","33990 - HC INSJ PERQ VAD W/IMAGING ARTERY ACCESS ONLY","10061 - INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE","10061 - INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE","10061 - INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE","33990 - HC INSJ PERQ VAD W/IMAGING ARTERY ACCESS ONLY","10060 - INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE","80150 - HC AMIKACIN","80150 - HC AMIKACIN","80150 - HC AMIKACIN","33990 - HC INSJ PERQ VAD W/IMAGING ARTERY ACCESS ONLY","10060 - INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE","80150 - HC AMIKACIN","10060 - INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE","33990 - HC INSJ PERQ VAD W/IMAGING ARTERY ACCESS ONLY","80150 - HC AMIKACIN","43232 - HC ESPHGSC RGD/FLX W/TNDSC US-GID FINE NDL ASPIR/BX","10060 - INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE"]
[null,"10080 - INCISION & DRAINAGE PILONIDAL CYST SIMPLE","33992 - HC IMPELLA REMOVAL DIFF SET","10080 - INCISION & DRAINAGE PILONIDAL CYST SIMPLE","10080 - INCISION & DRAINAGE PILONIDAL CYST SIMPLE","10080 - INCISION & DRAINAGE PILONIDAL CYST SIMPLE","33992 - HC IMPELLA REMOVAL DIFF SET","10061 - INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE","80156 - HC CHG DRUG ASSAY CARBAMAZEPINE TOTAL","80156 - HC CHG DRUG ASSAY CARBAMAZEPINE TOTAL","80156 - HC CHG DRUG ASSAY CARBAMAZEPINE TOTAL","33992 - HC IMPELLA REMOVAL DIFF SET","10061 - INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE","80156 - HC CHG DRUG ASSAY CARBAMAZEPINE TOTAL","10061 - INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE","33992 - HC IMPELLA REMOVAL DIFF SET","80156 - HC CHG DRUG ASSAY CARBAMAZEPINE TOTAL","43235 - HC UPPER GI NDSC DX W/WO COLLECTION SPECIMEN","10061 - INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE"]
[null,"10081 - INCISION & DRAINAGE PILONIDAL CYST COMPLICATED","36415 - COLLECTION VENOUS BLOOD VENIPUNCTURE","10081 - INCISION & DRAINAGE PILONIDAL CYST COMPLICATED","10081 - INCISION & DRAINAGE PILONIDAL CYST COMPLICATED","10081 - INCISION & DRAINAGE PILONIDAL CYST COMPLICATED","36415 - COLLECTION VENOUS BLOOD VENIPUNCTURE","10080 - INCISION & DRAINAGE PILONIDAL CYST SIMPLE","80158 - HC CHG DRUG ASSAY CYCLOSPORINE","80158 - HC CHG DRUG ASSAY CYCLOSPORINE","80158 - HC CHG DRUG ASSAY CYCLOSPORINE","36415 - COLLECTION VENOUS BLOOD VENIPUNCTURE","10080 - INCISION & DRAINAGE PILONIDAL CYST SIMPLE","80158 - HC CHG DRUG ASSAY CYCLOSPORINE","10080 - INCISION & DRAINAGE PILONIDAL CYST SIMPLE","36415 - COLLECTION VENOUS BLOOD VENIPUNCTURE","80158 - HC CHG DRUG ASSAY CYCLOSPORINE","43236 - HC UPPER GI NDSC W/SUBMUCOSAL INJECTION","10080 - INCISION & DRAINAGE PILONIDAL CYST SIMPLE"]
[null,"10120 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE","36416 - HC COLLECTION CAPILLARY BLOOD SPECIMEN","10120 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE","10120 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE","10120 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE","36416 - HC COLLECTION CAPILLARY BLOOD SPECIMEN","10081 - INCISION & DRAINAGE PILONIDAL CYST COMPLICATED","80162 - HC CHG DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL","80162 - HC CHG DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL","80162 - HC CHG DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL","36416 - HC COLLECTION CAPILLARY BLOOD SPECIMEN","10081 - INCISION & DRAINAGE PILONIDAL CYST COMPLICATED","80162 - HC CHG DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL","10081 - INCISION & DRAINAGE PILONIDAL CYST COMPLICATED","36416 - HC COLLECTION CAPILLARY BLOOD SPECIMEN","80162 - HC CHG DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL","43237 - UPR GI NDSC & US NDSC EXAM LMTD ESOPHAGUS","10081 - INCISION & DRAINAGE PILONIDAL CYST COMPLICATED"]
[null,"10121 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL","36591 - COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE","10121 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL","10121 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL","10121 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL","36591 - COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE","10120 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE","80164 - HC CHG DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL","80164 - HC CHG DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL","80164 - HC CHG DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL","36591 - COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE","10120 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE","80164 - HC CHG DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL","10120 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE","36591 - COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE","80164 - HC CHG DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL","43238 - HC UPR GI NDSC TNDSC US FINE NDL ASPIR/BX ESOPH","10120 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE"]
[null,"10140 - I&D HEMATOMA SEROMA/FLUID COLLECTION","36592 - COLLECT BLOOD FROM CATHETER VENOUS NOS","10140 - I&D HEMATOMA SEROMA/FLUID COLLECTION","10140 - I&D HEMATOMA SEROMA/FLUID COLLECTION","10140 - I&D HEMATOMA SEROMA/FLUID COLLECTION","36592 - COLLECT BLOOD FROM CATHETER VENOUS NOS","10121 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL","80168 - HC CHG DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE","80168 - HC CHG DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE","80168 - HC CHG DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE","36592 - COLLECT BLOOD FROM CATHETER VENOUS NOS","10121 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL","80168 - HC CHG DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE","10121 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL","36592 - COLLECT BLOOD FROM CATHETER VENOUS NOS","80168 - HC CHG DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE","43239 - HC UPPER NDSC BIOPSY SINGLE/MULTIPLE","10121 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL"]
[null,"10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","36598 - HC CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT","10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","36598 - HC CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT","10140 - I&D HEMATOMA SEROMA/FLUID COLLECTION","80169 - DRUG SCREEN QUANTITATIVE EVEROLIMUS","80169 - DRUG SCREEN QUANTITATIVE EVEROLIMUS","80169 - DRUG SCREEN QUANTITATIVE EVEROLIMUS","36598 - HC CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT","10140 - I&D HEMATOMA SEROMA/FLUID COLLECTION","80169 - DRUG SCREEN QUANTITATIVE EVEROLIMUS","10140 - I&D HEMATOMA SEROMA/FLUID COLLECTION","36598 - HC CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT","80169 - DRUG SCREEN QUANTITATIVE EVEROLIMUS","43240 - HC UPR GI NDSC TRANSMURAL DRAINAGE PSEUDOCYST","10140 - I&D HEMATOMA SEROMA/FLUID COLLECTION"]
[null,"10180 - HC COMPLEX DRAINAGE, WOUND","37182 - HC INSJ TRANSVNS INTRAHEPATC PORTOSYSIC SHUNT","10180 - HC COMPLEX DRAINAGE, WOUND","10180 - HC COMPLEX DRAINAGE, WOUND","10180 - HC COMPLEX DRAINAGE, WOUND","37182 - HC INSJ TRANSVNS INTRAHEPATC PORTOSYSIC SHUNT","10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","80170 - HC CHG DRUG SCREEN QUANTITATIVE GENTAMICIN","80170 - HC CHG DRUG SCREEN QUANTITATIVE GENTAMICIN","80170 - HC CHG DRUG SCREEN QUANTITATIVE GENTAMICIN","37182 - HC INSJ TRANSVNS INTRAHEPATC PORTOSYSIC SHUNT","10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","80170 - HC CHG DRUG SCREEN QUANTITATIVE GENTAMICIN","10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","37182 - HC INSJ TRANSVNS INTRAHEPATC PORTOSYSIC SHUNT","80170 - HC CHG DRUG SCREEN QUANTITATIVE GENTAMICIN","43241 - HC UPR GI NDSC TNDSC INTRALUMINAL TUBE/CATH PLMT","10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST"]
[null,"11000 - DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF","37215 - HC TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ","11000 - DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF","11000 - DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF","11000 - DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF","37215 - HC TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ","10180 - HC COMPLEX DRAINAGE, WOUND","80171 - DRUG SCREEN QUANTITATIVE GABAPENTIN","80171 - DRUG SCREEN QUANTITATIVE GABAPENTIN","80171 - DRUG SCREEN QUANTITATIVE GABAPENTIN","37215 - HC TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ","10180 - HC COMPLEX DRAINAGE, WOUND","80171 - DRUG SCREEN QUANTITATIVE GABAPENTIN","10180 - HC COMPLEX DRAINAGE, WOUND","37215 - HC TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ","80171 - DRUG SCREEN QUANTITATIVE GABAPENTIN","43242 - HC UPPER GI NDSC ULTRASOUND GUIDED BIOPSY","10180 - HC COMPLEX DRAINAGE, WOUND"]
[null,"11010 - HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ","43257 - HC UPR GI NDSC DLVR THERMAL NRG SPHNCTR/CARDIA","11010 - HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ","11010 - HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ","11010 - HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ","43257 - HC UPR GI NDSC DLVR THERMAL NRG SPHNCTR/CARDIA","11000 - DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF","80175 - DRUG SCREEN QUANTITATIVE LAMOTRIGINE","80175 - DRUG SCREEN QUANTITATIVE LAMOTRIGINE","80175 - DRUG SCREEN QUANTITATIVE LAMOTRIGINE","43257 - HC UPR GI NDSC DLVR THERMAL NRG SPHNCTR/CARDIA","11000 - DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF","80175 - DRUG SCREEN QUANTITATIVE LAMOTRIGINE","11000 - DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF","43257 - HC UPR GI NDSC DLVR THERMAL NRG SPHNCTR/CARDIA","80175 - DRUG SCREEN QUANTITATIVE LAMOTRIGINE","43243 - HC UPR GI NDSC NJX SCLEROSIS ESOPHGL&/GSTR VARICE","11000 - DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF"]
[null,"11012 - HC DBRDMT FX&/DISLC SUBQ T/M/F BONE","44381 - HC ILEOSCOPY STOMA W/BALLOON DILATION","11012 - HC DBRDMT FX&/DISLC SUBQ T/M/F BONE","11012 - HC DBRDMT FX&/DISLC SUBQ T/M/F BONE","11012 - HC DBRDMT FX&/DISLC SUBQ T/M/F BONE","44381 - HC ILEOSCOPY STOMA W/BALLOON DILATION","11010 - HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ","80177 - DRUG SCREEN QUANTITATIVE LEVETIRACETAM","80177 - DRUG SCREEN QUANTITATIVE LEVETIRACETAM","80177 - DRUG SCREEN QUANTITATIVE LEVETIRACETAM","44381 - HC ILEOSCOPY STOMA W/BALLOON DILATION","11010 - HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ","80177 - DRUG SCREEN QUANTITATIVE LEVETIRACETAM","11010 - HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ","44381 - HC ILEOSCOPY STOMA W/BALLOON DILATION","80177 - DRUG SCREEN QUANTITATIVE LEVETIRACETAM","43244 - HC UPR GI NDSC BAND LIG ESOPHGL&/GSTR VARICES","11010 - HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ"]
[null,"11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<","44604 - HC SUTURE LRG INTEST","11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<","11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<","11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<","44604 - HC SUTURE LRG INTEST","11012 - HC DBRDMT FX&/DISLC SUBQ T/M/F BONE","80178 - HC CHG DRUG SCREEN QUANTITATIVE LITHIUM","80178 - HC CHG DRUG SCREEN QUANTITATIVE LITHIUM","80178 - HC CHG DRUG SCREEN QUANTITATIVE LITHIUM","44604 - HC SUTURE LRG INTEST","11012 - HC DBRDMT FX&/DISLC SUBQ T/M/F BONE","80178 - HC CHG DRUG SCREEN QUANTITATIVE LITHIUM","11012 - HC DBRDMT FX&/DISLC SUBQ T/M/F BONE","44604 - HC SUTURE LRG INTEST","80178 - HC CHG DRUG SCREEN QUANTITATIVE LITHIUM","43245 - HC UPR GI NDSC DILAT GSTR OUTLET FOR OBSTRCJ","11012 - HC DBRDMT FX&/DISLC SUBQ T/M/F BONE"]
[null,"11043 - DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<","44705 - PREPARE FECAL MICROBIOTA FOR INSTILLATION","11043 - DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<","11043 - DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<","11043 - DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<","44705 - PREPARE FECAL MICROBIOTA FOR INSTILLATION","11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<","80184 - HC CHG DRUG SCREEN QUANTITATIVE PHENOBARBITAL","80184 - HC CHG DRUG SCREEN QUANTITATIVE PHENOBARBITAL","80184 - HC CHG DRUG SCREEN QUANTITATIVE PHENOBARBITAL","44705 - PREPARE FECAL MICROBIOTA FOR INSTILLATION","11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<","80184 - HC CHG DRUG SCREEN QUANTITATIVE PHENOBARBITAL","11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<","44705 - PREPARE FECAL MICROBIOTA FOR INSTILLATION","80184 - HC CHG DRUG SCREEN QUANTITATIVE PHENOBARBITAL","43246 - HC UPR GI NDSC PLMT PRQ GASTROSTOMY TUBE","11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<"]
[null,"11044 - DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<","45349 - SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION","11044 - DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<","11044 - DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<","11044 - DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<","45349 - SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION","11043 - DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<","80185 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL","80185 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL","80185 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL","45349 - SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION","11043 - DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<","80185 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL","11043 - DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<","45349 - SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION","80185 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL","43247 - HC UPPER GI NDSC W/FOREIGN BODY REMOVAL","11043 - DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<"]
[null,"11045 - DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM","45350 - HC SIGMOIDOSCOPY FLX WITH WITH BAND LIGATION(S)","11045 - DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM","11045 - DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM","11045 - DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM","45350 - HC SIGMOIDOSCOPY FLX WITH WITH BAND LIGATION(S)","11044 - DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<","80186 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN FREE","80186 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN FREE","80186 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN FREE","45350 - HC SIGMOIDOSCOPY FLX WITH WITH BAND LIGATION(S)","11044 - DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<","80186 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN FREE","11044 - DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<","45350 - HC SIGMOIDOSCOPY FLX WITH WITH BAND LIGATION(S)","80186 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN FREE","43248 - HC UPR GI NDSC INSJ GUIDE WIRE DILAT ESOPHAGUS","11044 - DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<"]
[null,"11046 - DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM","45390 - HC COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION","11046 - DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM","11046 - DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM","11046 - DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM","45390 - HC COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION","11045 - DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM","80187 - HC DRUG ASSAY POSACONAZOLE","80187 - HC DRUG ASSAY POSACONAZOLE","80187 - HC DRUG ASSAY POSACONAZOLE","45390 - HC COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION","11045 - DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM","80187 - HC DRUG ASSAY POSACONAZOLE","11045 - DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM","45390 - HC COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION","80187 - HC DRUG ASSAY POSACONAZOLE","43249 - HC UPR GI NDSC BALLOON DILAT ESOPH <30 MM DIAM","11045 - DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM"]
[null,"11047 - DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM","45398 - HC COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S)","11047 - DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM","11047 - DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM","11047 - DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM","45398 - HC COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S)","11046 - DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM","80195 - HC CHG DRUG SCREEN QUANTITATIVE SIROLIMUS","80195 - HC CHG DRUG SCREEN QUANTITATIVE SIROLIMUS","80195 - HC CHG DRUG SCREEN QUANTITATIVE SIROLIMUS","45398 - HC COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S)","11046 - DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM","80195 - HC CHG DRUG SCREEN QUANTITATIVE SIROLIMUS","11046 - DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM","45398 - HC COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S)","80195 - HC CHG DRUG SCREEN QUANTITATIVE SIROLIMUS","43250 - HC UPR GI NDSC RMVL LESION HOT BX/BIPOLAR CAUTERY","11046 - DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM"]
[null,"11055 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1","47383 - HC ABLATION 1/> LIVER TUMOR PERQ CRYOABLATION","11055 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1","11055 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1","11055 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1","47383 - HC ABLATION 1/> LIVER TUMOR PERQ CRYOABLATION","11047 - DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM","80197 - HC CHG DRUG SCREEN QUANTITATIVE TACROLIMUS","80197 - HC CHG DRUG SCREEN QUANTITATIVE TACROLIMUS","80197 - HC CHG DRUG SCREEN QUANTITATIVE TACROLIMUS","47383 - HC ABLATION 1/> LIVER TUMOR PERQ CRYOABLATION","11047 - DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM","80197 - HC CHG DRUG SCREEN QUANTITATIVE TACROLIMUS","11047 - DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM","47383 - HC ABLATION 1/> LIVER TUMOR PERQ CRYOABLATION","80197 - HC CHG DRUG SCREEN QUANTITATIVE TACROLIMUS","43251 - HC UPR GI NDSC RMVL TUM POLYP/OTH LES SNARE TQ","11047 - DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM"]
[null,"11056 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4","49010 - HC EXPLORATORY RETROPERITONEAL","11056 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4","11056 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4","11056 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4","49010 - HC EXPLORATORY RETROPERITONEAL","11055 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1","80198 - HC Q;THEOPHYLLINE","80198 - HC Q;THEOPHYLLINE","80198 - HC Q;THEOPHYLLINE","49010 - HC EXPLORATORY RETROPERITONEAL","11055 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1","80198 - HC Q;THEOPHYLLINE","11055 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1","49010 - HC EXPLORATORY RETROPERITONEAL","80198 - HC Q;THEOPHYLLINE","43255 - HC UPR GI NDSC CONTROL BLEEDING ANY METHOD","11055 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1"]
[null,"11057 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4","51701 - INSJ NON-NDWELLG BLADDER CATHETER","11057 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4","11057 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4","11057 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4","51701 - INSJ NON-NDWELLG BLADDER CATHETER","11056 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4","80201 - HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE","80201 - HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE","80201 - HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE","51701 - INSJ NON-NDWELLG BLADDER CATHETER","11056 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4","80201 - HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE","11056 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4","51701 - INSJ NON-NDWELLG BLADDER CATHETER","80201 - HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE","43257 - HC UPR GI NDSC DLVR THERMAL NRG SPHNCTR/CARDIA","11056 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4"]
[null,"11102 - HC TANGNTL BX SKIN SINGLE LES","51702 - INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE","11102 - HC TANGNTL BX SKIN SINGLE LES","11102 - HC TANGNTL BX SKIN SINGLE LES","11102 - HC TANGNTL BX SKIN SINGLE LES","51702 - INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE","11057 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4","80202 - HC CHG DRUG SCREEN QUANTITATIVE VANCOMYCIN","80202 - HC CHG DRUG SCREEN QUANTITATIVE VANCOMYCIN","80202 - HC CHG DRUG SCREEN QUANTITATIVE VANCOMYCIN","51702 - INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE","11057 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4","80202 - HC CHG DRUG SCREEN QUANTITATIVE VANCOMYCIN","11057 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4","51702 - INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE","80202 - HC CHG DRUG SCREEN QUANTITATIVE VANCOMYCIN","43259 - HC UPPER GI NDSC W/NDSC ULTRASOUND EXAM","11057 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4"]
[null,"11103 - HC TANGNTL BX SKIN EA SEP/ADDL","55400 - HC REPAIR OF SPERM DUCT","11103 - HC TANGNTL BX SKIN EA SEP/ADDL","11103 - HC TANGNTL BX SKIN EA SEP/ADDL","11103 - HC TANGNTL BX SKIN EA SEP/ADDL","55400 - HC REPAIR OF SPERM DUCT","11101 - BIOPSY SKIN SUBQ&/MUCOUS MEMBRANE EA ADDL LESN","80203 - DRUG SCREEN QUANTITATIVE ZONISAMIDE","80203 - DRUG SCREEN QUANTITATIVE ZONISAMIDE","80203 - DRUG SCREEN QUANTITATIVE ZONISAMIDE","55400 - HC REPAIR OF SPERM DUCT","11102 - HC TANGNTL BX SKIN SINGLE LES","80203 - DRUG SCREEN QUANTITATIVE ZONISAMIDE","11101 - BIOPSY SKIN SUBQ&/MUCOUS MEMBRANE EA ADDL LESN","55400 - HC REPAIR OF SPERM DUCT","80203 - DRUG SCREEN QUANTITATIVE ZONISAMIDE","43761 - REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO","11102 - HC TANGNTL BX SKIN SINGLE LES"]
[null,"11104 - HC PUNCH BX SKIN SINGLE LESION","58321 - ARTIFICIAL INSEMINATION INTRA-CERVICAL","11104 - HC PUNCH BX SKIN SINGLE LESION","11104 - HC PUNCH BX SKIN SINGLE LESION","11104 - HC PUNCH BX SKIN SINGLE LESION","58321 - ARTIFICIAL INSEMINATION INTRA-CERVICAL","11102 - HC TANGNTL BX SKIN SINGLE LES","80230 - HC DRUG ASSAY INFLIXIMAB","80230 - HC DRUG ASSAY INFLIXIMAB","80230 - HC DRUG ASSAY INFLIXIMAB","58321 - ARTIFICIAL INSEMINATION INTRA-CERVICAL","11103 - HC TANGNTL BX SKIN EA SEP/ADDL","80230 - HC DRUG ASSAY INFLIXIMAB","11102 - HC TANGNTL BX SKIN SINGLE LES","58321 - ARTIFICIAL INSEMINATION INTRA-CERVICAL","80230 - HC DRUG ASSAY INFLIXIMAB","44180 - HC LAP, SURG ENTEROLYSIS","11103 - HC TANGNTL BX SKIN EA SEP/ADDL"]
[null,"11105 - HC PUNCH BX SKIN EA SEP/ADDL","58322 - ARTIFICIAL INSEMINATION INTRA-UTERINE","11105 - HC PUNCH BX SKIN EA SEP/ADDL","11105 - HC PUNCH BX SKIN EA SEP/ADDL","11105 - HC PUNCH BX SKIN EA SEP/ADDL","58322 - ARTIFICIAL INSEMINATION INTRA-UTERINE","11103 - HC TANGNTL BX SKIN EA SEP/ADDL","80235 - HC DRUG ASSAY LACOSAMIDE","80235 - HC DRUG ASSAY LACOSAMIDE","80235 - HC DRUG ASSAY LACOSAMIDE","58322 - ARTIFICIAL INSEMINATION INTRA-UTERINE","11104 - HC PUNCH BX SKIN SINGLE LESION","80235 - HC DRUG ASSAY LACOSAMIDE","11103 - HC TANGNTL BX SKIN EA SEP/ADDL","58322 - ARTIFICIAL INSEMINATION INTRA-UTERINE","80235 - HC DRUG ASSAY LACOSAMIDE","44238 - HC LAPAROSCOPE PROC INTESTINE","11104 - HC PUNCH BX SKIN SINGLE LESION"]
[null,"11106 - HC INCAL BX SKN SINGLE LES","58323 - SPERM WASHING ARTIFICIAL INSEMINATION","11106 - HC INCAL BX SKN SINGLE LES","11106 - HC INCAL BX SKN SINGLE LES","11106 - HC INCAL BX SKN SINGLE LES","58323 - SPERM WASHING ARTIFICIAL INSEMINATION","11104 - HC PUNCH BX SKIN SINGLE LESION","80280 - HC DRUG ASSAY VEDOLIZUMAB","80280 - HC DRUG ASSAY VEDOLIZUMAB","80280 - HC DRUG ASSAY VEDOLIZUMAB","58323 - SPERM WASHING ARTIFICIAL INSEMINATION","11105 - HC PUNCH BX SKIN EA SEP/ADDL","80280 - HC DRUG ASSAY VEDOLIZUMAB","11104 - HC PUNCH BX SKIN SINGLE LESION","58323 - SPERM WASHING ARTIFICIAL INSEMINATION","80280 - HC DRUG ASSAY VEDOLIZUMAB","44360 - HC ENDOSCOPY UPPER SMALL INTESTINE","11105 - HC PUNCH BX SKIN EA SEP/ADDL"]
[null,"11107 - HC INCAL BX SKN EA SEP/ADDL","58345 - HC REOPEN FALLOPIAN TUBE, TRANSCERV CATH","11107 - HC INCAL BX SKN EA SEP/ADDL","11107 - HC INCAL BX SKN EA SEP/ADDL","11107 - HC INCAL BX SKN EA SEP/ADDL","58345 - HC REOPEN FALLOPIAN TUBE, TRANSCERV CATH","11105 - HC PUNCH BX SKIN EA SEP/ADDL","80285 - HC DRUG ASSAY VORICONAZOLE","80285 - HC DRUG ASSAY VORICONAZOLE","80285 - HC DRUG ASSAY VORICONAZOLE","58345 - HC REOPEN FALLOPIAN TUBE, TRANSCERV CATH","11106 - HC INCAL BX SKN SINGLE LES","80285 - HC DRUG ASSAY VORICONAZOLE","11105 - HC PUNCH BX SKIN EA SEP/ADDL","58345 - HC REOPEN FALLOPIAN TUBE, TRANSCERV CATH","80285 - HC DRUG ASSAY VORICONAZOLE","44361 - HC ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY","11106 - HC INCAL BX SKN SINGLE LES"]
[null,"11200 - REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15","59412 - EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS","11200 - REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15","11200 - REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15","11200 - REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15","59412 - EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS","11106 - HC INCAL BX SKN SINGLE LES","80299 - HC INFLIXIMAB DRUG CONC. AND ANTI-INFLIXIMAB AB","80299 - HC INFLIXIMAB DRUG CONC. AND ANTI-INFLIXIMAB AB","80299 - HC INFLIXIMAB DRUG CONC. AND ANTI-INFLIXIMAB AB","59412 - EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS","11107 - HC INCAL BX SKN EA SEP/ADDL","80299 - HC INFLIXIMAB DRUG CONC. AND ANTI-INFLIXIMAB AB","11106 - HC INCAL BX SKN SINGLE LES","59412 - EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS","80299 - HC INFLIXIMAB DRUG CONC. AND ANTI-INFLIXIMAB AB","44363 - HC ENTEROSCOPY > 2ND PRTN W/RMVL FOREIGN BODY","11107 - HC INCAL BX SKN EA SEP/ADDL"]
[null,"11400 - EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<","59897 - HC FETAL INVAS PX W/ US","11300 - SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<","11300 - SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<","11300 - SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<","59897 - HC FETAL INVAS PX W/ US","11107 - HC INCAL BX SKN EA SEP/ADDL","80306 - HC DRUG TEST PRSMV INSTRMNT","80306 - HC DRUG TEST PRSMV INSTRMNT","80306 - HC DRUG TEST PRSMV INSTRMNT","59897 - HC FETAL INVAS PX W/ US","11200 - REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15","80306 - HC DRUG TEST PRSMV INSTRMNT","11107 - HC INCAL BX SKN EA SEP/ADDL","59897 - HC FETAL INVAS PX W/ US","80306 - HC DRUG TEST PRSMV INSTRMNT","44364 - HC ENTEROSCOPY > 2ND PRTN W/RMVL LESION SNARE.","11200 - REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15"]
[null,"11401 - EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM","61624 - HC TCAT PERMANENT OCCLUSION/EMBOLIZATION PRQ CNS","11301 - SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM","11301 - SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM","11301 - SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM","61624 - HC TCAT PERMANENT OCCLUSION/EMBOLIZATION PRQ CNS","11200 - REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15","80307 - HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS","80307 - HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS","80307 - HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS","61624 - HC TCAT PERMANENT OCCLUSION/EMBOLIZATION PRQ CNS","11300 - SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<","80307 - HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS","11200 - REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15","61624 - HC TCAT PERMANENT OCCLUSION/EMBOLIZATION PRQ CNS","80307 - HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS","44366 - HC ENTEROSCOPY > 2ND PRTN W/CONTROL BLEEDING","11300 - SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<"]
[null,"11402 - EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM","61630 - HC INTRACRANIAL BALLOON ANGIOPLASTY","11302 - SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM","11302 - SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM","11302 - SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM","61630 - HC INTRACRANIAL BALLOON ANGIOPLASTY","11300 - SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<","80438 - HC CHG TRH STIM PANEL 1 HR","80438 - HC CHG TRH STIM PANEL 1 HR","80438 - HC CHG TRH STIM PANEL 1 HR","61630 - HC INTRACRANIAL BALLOON ANGIOPLASTY","11301 - SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM","80438 - HC CHG TRH STIM PANEL 1 HR","11300 - SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<","61630 - HC INTRACRANIAL BALLOON ANGIOPLASTY","80438 - HC CHG TRH STIM PANEL 1 HR","44369 - HC ENTEROSCOPY > 2ND PRTN ABLTJ LESION","11301 - SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM"]
[null,"11403 - EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<","61635 - HC TCAT PLMT IV STENT ICRA W/BALO ANGIOP IF PFRMD","11303 - SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM","11303 - SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM","11303 - SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM","61635 - HC TCAT PLMT IV STENT ICRA W/BALO ANGIOP IF PFRMD","11301 - SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM","81000 - URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY","81000 - URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY","81000 - URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY","61635 - HC TCAT PLMT IV STENT ICRA W/BALO ANGIOP IF PFRMD","11302 - SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM","81000 - URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY","11301 - SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM","61635 - HC TCAT PLMT IV STENT ICRA W/BALO ANGIOP IF PFRMD","81000 - URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY","44376 - HC ENTEROSC >2ND PRTN W/ILEUM W/WO COLLJ SPEC SPX","11302 - SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM"]
[null,"11404 - EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM","61640 - HC PERC BAL DIL CRAN VASO;IN","11305 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<","11305 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<","11305 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<","61640 - HC PERC BAL DIL CRAN VASO;IN","11302 - SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM","81001 - URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY","81001 - URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY","81001 - URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY","61640 - HC PERC BAL DIL CRAN VASO;IN","11303 - SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM","81001 - URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY","11302 - SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM","61640 - HC PERC BAL DIL CRAN VASO;IN","81001 - URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY","44377 - HC ENTEROSC >2ND PRTN W/ILEUM W/BX SINGLE/MULTIPLE","11303 - SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM"]
[null,"11406 - EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM","61641 - HC BALLOON DIALT INTRACRAN VASOSPASM, ADD SAME FAM","11306 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM","11306 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM","11306 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM","61641 - HC BALLOON DIALT INTRACRAN VASOSPASM, ADD SAME FAM","11303 - SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM","81002 - URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP","81002 - URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP","81002 - URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP","61641 - HC BALLOON DIALT INTRACRAN VASOSPASM, ADD SAME FAM","11305 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<","81002 - URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP","11303 - SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM","61641 - HC BALLOON DIALT INTRACRAN VASOSPASM, ADD SAME FAM","81002 - URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP","44378 - HC ENTEROSCOPY > 2ND PRTN ILEUM CONTROL BLEEDING","11305 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<"]
[null,"11420 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<","61642 - HC BAL DIL VASO;EA ADD,OTH","11307 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM","11307 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM","11307 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM","61642 - HC BAL DIL VASO;EA ADD,OTH","11305 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<","81003 - URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY","81003 - URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY","81003 - URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY","61642 - HC BAL DIL VASO;EA ADD,OTH","11306 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM","81003 - URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY","11305 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<","61642 - HC BAL DIL VASO;EA ADD,OTH","81003 - URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY","44380 - HC ILEOSCOPY STOMA DX W/WO COLLJ SPEC BR/WA SPX","11306 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM"]
[null,"11421 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM","61645 - HC PERQ ARTERIAL TRANSLUMINAL M-THROMBECTOMY & OR INFUSION","11308 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM","11308 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM","11308 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM","61645 - HC PERQ ARTERIAL TRANSLUMINAL M-THROMBECTOMY & OR INFUSION","11306 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM","81015 - HC CHG URINALYSIS MICROSCOPIC ONLY","81015 - HC CHG URINALYSIS MICROSCOPIC ONLY","81015 - HC CHG URINALYSIS MICROSCOPIC ONLY","61645 - HC PERQ ARTERIAL TRANSLUMINAL M-THROMBECTOMY & OR INFUSION","11307 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM","81015 - HC CHG URINALYSIS MICROSCOPIC ONLY","11306 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM","61645 - HC PERQ ARTERIAL TRANSLUMINAL M-THROMBECTOMY & OR INFUSION","81015 - HC CHG URINALYSIS MICROSCOPIC ONLY","44382 - HC ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE","11307 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM"]
[null,"11422 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM","61650 - ENDOVASCULAR INTRACRANIAL PROLNG ADMN RX AGENT; INITIAL VASCULAR TERRITORY","11310 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<","11310 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<","11310 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<","61650 - ENDOVASCULAR INTRACRANIAL PROLNG ADMN RX AGENT; INITIAL VASCULAR TERRITORY","11307 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM","81025 - URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS","81025 - URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS","81025 - URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS","61650 - ENDOVASCULAR INTRACRANIAL PROLNG ADMN RX AGENT; INITIAL VASCULAR TERRITORY","11308 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM","81025 - URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS","11307 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM","61650 - ENDOVASCULAR INTRACRANIAL PROLNG ADMN RX AGENT; INITIAL VASCULAR TERRITORY","81025 - URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS","44385 - HC NDSC EVAL INTSTINAL POUCH DX W/WO COLLJ SPEC SPX","11308 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM"]
[null,"11423 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM","61651 - ENDOVASCULAR INTRACRANIAL PROLNG ADMN RX AGENT; EACH ADD¿L VASCULAR TERRITORY","11311 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM","11311 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM","11311 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM","61651 - ENDOVASCULAR INTRACRANIAL PROLNG ADMN RX AGENT; EACH ADD¿L VASCULAR TERRITORY","11308 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM","81050 - HC CHG VOLUME MEASUREMENT TIMED COLLECTION EACH","81050 - HC CHG VOLUME MEASUREMENT TIMED COLLECTION EACH","81050 - HC CHG VOLUME MEASUREMENT TIMED COLLECTION EACH","61651 - ENDOVASCULAR INTRACRANIAL PROLNG ADMN RX AGENT; EACH ADD¿L VASCULAR TERRITORY","11310 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<","81050 - HC CHG VOLUME MEASUREMENT TIMED COLLECTION EACH","11308 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM","61651 - ENDOVASCULAR INTRACRANIAL PROLNG ADMN RX AGENT; EACH ADD¿L VASCULAR TERRITORY","81050 - HC CHG VOLUME MEASUREMENT TIMED COLLECTION EACH","44386 - NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE","11310 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<"]
[null,"11424 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM","62328 - HC DX LMBR SPI PNXR W/FLUOR/CT","11312 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM","11312 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM","11312 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM","62328 - HC DX LMBR SPI PNXR W/FLUOR/CT","11310 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<","81161 - HC DMD DUPLICATION/DELETION ANALYSIS","81161 - HC DMD DUPLICATION/DELETION ANALYSIS","81161 - HC DMD DUPLICATION/DELETION ANALYSIS","62328 - HC DX LMBR SPI PNXR W/FLUOR/CT","11311 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM","81161 - HC DMD DUPLICATION/DELETION ANALYSIS","11310 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<","62328 - HC DX LMBR SPI PNXR W/FLUOR/CT","81161 - HC DMD DUPLICATION/DELETION ANALYSIS","44388 - HC COLONOSCOPY STOMA DX W/WO COLLJ SPEC SPX","11311 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM"]
[null,"11426 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM","62329 - HC THER SPI PNXR CSF FLUOR/CT","11313 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM","11313 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM","11313 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM","62329 - HC THER SPI PNXR CSF FLUOR/CT","11311 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM","81178 - HC CHG ATXN1 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","81178 - HC CHG ATXN1 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","81178 - HC CHG ATXN1 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","62329 - HC THER SPI PNXR CSF FLUOR/CT","11312 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM","81178 - HC CHG ATXN1 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","11311 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM","62329 - HC THER SPI PNXR CSF FLUOR/CT","81178 - HC CHG ATXN1 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","44389 - HC COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE","11312 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM"]
[null,"11440 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<","64451 - HC NJX AA&/STRD NRV NRVTG SI JT","11400 - EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<","11400 - EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<","11400 - EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<","64451 - HC NJX AA&/STRD NRV NRVTG SI JT","11312 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM","81179 - HC CHG ATXN2 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","81179 - HC CHG ATXN2 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","81179 - HC CHG ATXN2 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","64451 - HC NJX AA&/STRD NRV NRVTG SI JT","11313 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM","81179 - HC CHG ATXN2 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","11312 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM","64451 - HC NJX AA&/STRD NRV NRVTG SI JT","81179 - HC CHG ATXN2 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","44391 - HC COLONOSCOPY STOMA CONTROL BLEEDING","11313 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM"]
[null,"11441 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM","64454 - HC NJX AA&/STRD GNCLR NRV BRNCH","11401 - EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM","11401 - EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM","11401 - EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM","64454 - HC NJX AA&/STRD GNCLR NRV BRNCH","11313 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM","81180 - HC CHG ATXN3 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","81180 - HC CHG ATXN3 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","81180 - HC CHG ATXN3 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","64454 - HC NJX AA&/STRD GNCLR NRV BRNCH","11400 - EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<","81180 - HC CHG ATXN3 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","11313 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM","64454 - HC NJX AA&/STRD GNCLR NRV BRNCH","81180 - HC CHG ATXN3 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","44394 - HC COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE","11400 - EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<"]
[null,"11442 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM","64624 - HC DSTRJ NULYT AGT GNCLR NRV","11402 - EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM","11402 - EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM","11402 - EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM","64624 - HC DSTRJ NULYT AGT GNCLR NRV","11400 - EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<","81206 - HC CHG BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE","81206 - HC CHG BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE","81206 - HC CHG BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE","64624 - HC DSTRJ NULYT AGT GNCLR NRV","11401 - EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM","81206 - HC CHG BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE","11400 - EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<","64624 - HC DSTRJ NULYT AGT GNCLR NRV","81206 - HC CHG BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE","44970 - HC LAPAROSCOPIC APPENDECTOMY","11401 - EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM"]
[null,"11443 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM","64625 - HC RF ABLTJ NRV NRVTG SI JT","11403 - EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<","11403 - EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<","11403 - EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<","64625 - HC RF ABLTJ NRV NRVTG SI JT","11401 - EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM","81207 - HC Q;P190 BCR-ABL 1","81207 - HC Q;P190 BCR-ABL 1","81207 - HC Q;P190 BCR-ABL 1","64625 - HC RF ABLTJ NRV NRVTG SI JT","11402 - EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM","81207 - HC Q;P190 BCR-ABL 1","11401 - EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM","64625 - HC RF ABLTJ NRV NRVTG SI JT","81207 - HC Q;P190 BCR-ABL 1","45300 - PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX","11402 - EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM"]
[null,"11444 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM","65782 - HC OCCULAR SURFACE RECONSTRUCTION LIMBAL AUTOGRAFT","11404 - EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM","11404 - EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM","11404 - EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM","65782 - HC OCCULAR SURFACE RECONSTRUCTION LIMBAL AUTOGRAFT","11402 - EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM","81210 - HC CHG BRAF GENE ANALYSIS V600 VARIANT(S)","81210 - HC CHG BRAF GENE ANALYSIS V600 VARIANT(S)","81210 - HC CHG BRAF GENE ANALYSIS V600 VARIANT(S)","65782 - HC OCCULAR SURFACE RECONSTRUCTION LIMBAL AUTOGRAFT","11403 - EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<","81210 - HC CHG BRAF GENE ANALYSIS V600 VARIANT(S)","11402 - EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM","65782 - HC OCCULAR SURFACE RECONSTRUCTION LIMBAL AUTOGRAFT","81210 - HC CHG BRAF GENE ANALYSIS V600 VARIANT(S)","45305 - HC PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE","11403 - EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<"]
[null,"11446 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM","69090 - EAR PIERCING","11406 - EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM","11406 - EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM","11406 - EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM","69090 - EAR PIERCING","11403 - EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<","81218 - HC CEBPA GENE ANALYSIS FULL GENE SEQUENC","81218 - HC CEBPA GENE ANALYSIS FULL GENE SEQUENC","81218 - HC CEBPA GENE ANALYSIS FULL GENE SEQUENC","69090 - EAR PIERCING","11404 - EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM","81218 - HC CEBPA GENE ANALYSIS FULL GENE SEQUENC","11403 - EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<","69090 - EAR PIERCING","81218 - HC CEBPA GENE ANALYSIS FULL GENE SEQUENC","45317 - HC PROCTOSIGMOIDOSCOPY BLEED","11404 - EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM"]
[null,"11450 - EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR","74241 - XR UGI W KUB","11420 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<","11420 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<","11420 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<","74241 - XR UGI W KUB","11404 - EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM","81220 - HC CHG CFTR GENE ANALYSIS COMMON VARIANTS","81220 - HC CHG CFTR GENE ANALYSIS COMMON VARIANTS","81220 - HC CHG CFTR GENE ANALYSIS COMMON VARIANTS","74241 - XR UGI W KUB","11406 - EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM","81220 - HC CHG CFTR GENE ANALYSIS COMMON VARIANTS","11404 - EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM","74241 - XR UGI W KUB","81220 - HC CHG CFTR GENE ANALYSIS COMMON VARIANTS","45330 - HC SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD","11406 - EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM"]
[null,"11463 - EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR","74245 - XR UGI W SM BOWEL","11421 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM","11421 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM","11421 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM","74245 - XR UGI W SM BOWEL","11406 - EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM","81221 - HC CHG CFTR GENE ANALYSIS KNOWN FAMILIAL VARIANTS","81221 - HC CHG CFTR GENE ANALYSIS KNOWN FAMILIAL VARIANTS","81221 - HC CHG CFTR GENE ANALYSIS KNOWN FAMILIAL VARIANTS","74245 - XR UGI W SM BOWEL","11420 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<","81221 - HC CHG CFTR GENE ANALYSIS KNOWN FAMILIAL VARIANTS","11406 - EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM","74245 - XR UGI W SM BOWEL","81221 - HC CHG CFTR GENE ANALYSIS KNOWN FAMILIAL VARIANTS","45331 - HC COLON CA SCREEN;BARIUM ENEMA","11420 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<"]
[null,"11470 - EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR","74247 - XR UGI W AIR CON KUB","11422 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM","11422 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM","11422 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM","74247 - XR UGI W AIR CON KUB","11420 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<","81222 - HC GEN CYSTIC FIBROSIS DEL/DUP","81222 - HC GEN CYSTIC FIBROSIS DEL/DUP","81222 - HC GEN CYSTIC FIBROSIS DEL/DUP","74247 - XR UGI W AIR CON KUB","11421 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM","81222 - HC GEN CYSTIC FIBROSIS DEL/DUP","11420 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<","74247 - XR UGI W AIR CON KUB","81222 - HC GEN CYSTIC FIBROSIS DEL/DUP","45332 - HC SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY","11421 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM"]
[null,"11600 - HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG","74249 - XR UGI W AIR CON SM BOWEL","11423 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM","11423 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM","11423 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM","74249 - XR UGI W AIR CON SM BOWEL","11421 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM","81223 - HC CFTR GENE ANALYSIS FULL GENE SEQUENCE","81223 - HC CFTR GENE ANALYSIS FULL GENE SEQUENCE","81223 - HC CFTR GENE ANALYSIS FULL GENE SEQUENCE","74249 - XR UGI W AIR CON SM BOWEL","11422 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM","81223 - HC CFTR GENE ANALYSIS FULL GENE SEQUENCE","11421 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM","74249 - XR UGI W AIR CON SM BOWEL","81223 - HC CFTR GENE ANALYSIS FULL GENE SEQUENCE","45333 - HC SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS","11422 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM"]
[null,"11601 - EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM","75571 - HC CT,HEART;W/OCM;COR CAL","11424 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM","11424 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM","11424 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM","75571 - HC CT,HEART;W/OCM;COR CAL","11422 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM","81229 - HC CYTOG ALYS CHRML ABNR SNPCGH","81229 - HC CYTOG ALYS CHRML ABNR SNPCGH","81229 - HC CYTOG ALYS CHRML ABNR SNPCGH","75571 - HC CT,HEART;W/OCM;COR CAL","11423 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM","81229 - HC CYTOG ALYS CHRML ABNR SNPCGH","11422 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM","75571 - HC CT,HEART;W/OCM;COR CAL","81229 - HC CYTOG ALYS CHRML ABNR SNPCGH","45334 - HC SIGMOIDOSCOPY FLX CONTROL BLEEDING","11423 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM"]
[null,"11602 - EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM","76140 - HC CONSULT,OUTSIDE EXAM","11426 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM","11426 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM","11426 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM","76140 - HC CONSULT,OUTSIDE EXAM","11423 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM","81235 - HC CHG EGFR GENE ANALYSIS COMMON VARIANTS","81235 - HC CHG EGFR GENE ANALYSIS COMMON VARIANTS","81235 - HC CHG EGFR GENE ANALYSIS COMMON VARIANTS","76140 - HC CONSULT,OUTSIDE EXAM","11424 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM","81235 - HC CHG EGFR GENE ANALYSIS COMMON VARIANTS","11423 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM","76140 - HC CONSULT,OUTSIDE EXAM","81235 - HC CHG EGFR GENE ANALYSIS COMMON VARIANTS","45335 - HC SGMDSC FLX DIRED SBMCSL NJX ANY SBST","11424 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM"]
[null,"11603 - EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<","76497 - HC CTGUIDE,SOFT TISS ABL","11440 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<","11440 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<","11440 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<","76497 - HC CTGUIDE,SOFT TISS ABL","11424 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM","81240 - HC CHG F2 GENE ANALYSIS 20210G >A VARIANT","81240 - HC CHG F2 GENE ANALYSIS 20210G >A VARIANT","81240 - HC CHG F2 GENE ANALYSIS 20210G >A VARIANT","76497 - HC CTGUIDE,SOFT TISS ABL","11426 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM","81240 - HC CHG F2 GENE ANALYSIS 20210G >A VARIANT","11424 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM","76497 - HC CTGUIDE,SOFT TISS ABL","81240 - HC CHG F2 GENE ANALYSIS 20210G >A VARIANT","45337 - HC SGMDSC FLX DCMPRN VOLVULUS ANY METHOD","11426 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM"]
[null,"11604 - EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM","76498 - PR MRI PROSTATE FOR RADIATION TREATMENT PLANNING","11441 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM","11441 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM","11441 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM","76498 - PR MRI PROSTATE FOR RADIATION TREATMENT PLANNING","11426 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM","81241 - HC CHG F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT","81241 - HC CHG F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT","81241 - HC CHG F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT","76498 - PR MRI PROSTATE FOR RADIATION TREATMENT PLANNING","11440 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<","81241 - HC CHG F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT","11426 - EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM","76498 - PR MRI PROSTATE FOR RADIATION TREATMENT PLANNING","81241 - HC CHG F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT","45338 - HC SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ","11440 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<"]
[null,"11606 - EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM","77790 - HC BRACHY , SUP. HANDLING, LOADING","11442 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM","11442 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM","11442 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM","77063 - SCREENING DIGITAL BREAST TOMOSYNTHESIS BI","11440 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<","81243 - HC CHG FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES","81243 - HC CHG FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES","81243 - HC CHG FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES","77063 - SCREENING DIGITAL BREAST TOMOSYNTHESIS BI","11441 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM","81243 - HC CHG FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES","11440 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<","77063 - SCREENING DIGITAL BREAST TOMOSYNTHESIS BI","81243 - HC CHG FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES","45340 - HC SIGMOIDOSCOPY FLX DILAT BALO 1/MORE STRIXS","11441 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM"]
[null,"11620 - EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<","78205 - NM LIVER W SPECT","11443 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM","11443 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM","11443 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM","77065 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","11441 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM","81252 - HC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCEHC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCE","81252 - HC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCEHC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCE","81252 - HC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCEHC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCE","77065 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","11442 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM","81252 - HC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCEHC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCE","11441 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM","77065 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","81252 - HC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCEHC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCE","45341 - HC SIGMOIDOSCOPY FLX NDSC US XM","11442 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM"]
[null,"11621 - HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM","78320 - NM BONE SCAN W SPECT","11444 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM","11444 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM","11444 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM","77066 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","11442 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM","81253 - HC CHG GJB2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS","81253 - HC CHG GJB2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS","81253 - HC CHG GJB2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS","77066 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","11443 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM","81253 - HC CHG GJB2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS","11442 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM","77066 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","81253 - HC CHG GJB2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS","45342 - HC SIGMOIDOSCOPY FLX TNDSC US GID NDL ASPIR/BX","11443 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM"]
[null,"11622 - EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM","78607 - NM BRAIN CMPL W SPECT","11446 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM","11446 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM","11446 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM","77067 - HC SCR MAMM CAD, BI","11443 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM","81254 - HC CHG GJB6 GENE ANALYSIS COMMON VARIANTS","81254 - HC CHG GJB6 GENE ANALYSIS COMMON VARIANTS","81254 - HC CHG GJB6 GENE ANALYSIS COMMON VARIANTS","77067 - HC SCR MAMM CAD, BI","11444 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM","81254 - HC CHG GJB6 GENE ANALYSIS COMMON VARIANTS","11443 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM","77067 - HC SCR MAMM CAD, BI","81254 - HC CHG GJB6 GENE ANALYSIS COMMON VARIANTS","45379 - HC COLSC FLX PROX SPLENIC FLXR RMVL FB","11444 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM"]
[null,"11623 - EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<","78805 - NM ABSCSS LOC LTD","11450 - EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR","11450 - EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR","11450 - EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR","77790 - HC BRACHY , SUP. HANDLING, LOADING","11444 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM","81256 - HC CHG HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS","81256 - HC CHG HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS","81256 - HC CHG HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS","77790 - HC BRACHY , SUP. HANDLING, LOADING","11446 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM","81256 - HC CHG HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS","11444 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM","77790 - HC BRACHY , SUP. HANDLING, LOADING","81256 - HC CHG HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS","45380 - COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","11446 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM"]
[null,"11624 - EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM","78806 - NM ABSCSS LOC WB","11463 - EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR","11463 - EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR","11463 - EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR","78205 - NM LIVER W SPECT","11446 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM","81257 - HC CHG HBA1/HBA2 ANALYSIS FOR COMMON DELETIONS/VARIANT","81257 - HC CHG HBA1/HBA2 ANALYSIS FOR COMMON DELETIONS/VARIANT","81257 - HC CHG HBA1/HBA2 ANALYSIS FOR COMMON DELETIONS/VARIANT","78205 - NM LIVER W SPECT","11450 - EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR","81257 - HC CHG HBA1/HBA2 ANALYSIS FOR COMMON DELETIONS/VARIANT","11446 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM","78205 - NM LIVER W SPECT","81257 - HC CHG HBA1/HBA2 ANALYSIS FOR COMMON DELETIONS/VARIANT","45381 - HC COLSC FLX PROX SPLENIC FLXR SBMCSL NJX","11450 - EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR"]
[null,"11626 - EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM","78807 - NM INFLAM LOCAL W SPECT","11470 - EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR","11470 - EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR","11470 - EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR","78320 - NM BONE SCAN W SPECT","11450 - EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR","81259 - HC HBA1/HBA2 GENE ANALYSIS FULL GENE SEQUENCE","81259 - HC HBA1/HBA2 GENE ANALYSIS FULL GENE SEQUENCE","81259 - HC HBA1/HBA2 GENE ANALYSIS FULL GENE SEQUENCE","78320 - NM BONE SCAN W SPECT","11463 - EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR","81259 - HC HBA1/HBA2 GENE ANALYSIS FULL GENE SEQUENCE","11450 - EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR","78320 - NM BONE SCAN W SPECT","81259 - HC HBA1/HBA2 GENE ANALYSIS FULL GENE SEQUENCE","45382 - HC COLSC FLX PROX SPLENIC FLXR CTRL BLD","11463 - EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR"]
[null,"11640 - EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<","80048 - HC CHG BASIC METABOLIC PANEL CALCIUM TOTAL","11600 - HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG","11600 - HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG","11600 - HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG","78607 - NM BRAIN CMPL W SPECT","11463 - EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR","81261 - IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED; PRO/TECH","81261 - IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED; PRO/TECH","81261 - IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED; PRO/TECH","78607 - NM BRAIN CMPL W SPECT","11470 - EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR","81261 - IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED; PRO/TECH","11463 - EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR","78607 - NM BRAIN CMPL W SPECT","81261 - IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED; PRO/TECH","45384 - HC COLSC FLX PROX SPLENIC FLXR RMVL LES CAUT","11470 - EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR"]
[null,"11642 - HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL","80051 - HC CHG ELECTROLYTE PANEL","11601 - EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM","11601 - EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM","11601 - EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM","78805 - NM ABSCSS LOC LTD","11470 - EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR","81269 - HC HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIENTS","81269 - HC HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIENTS","81269 - HC HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIENTS","78805 - NM ABSCSS LOC LTD","11600 - HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG","81269 - HC HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIENTS","11470 - EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR","78805 - NM ABSCSS LOC LTD","81269 - HC HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIENTS","45385 - HC COLSC FLX PROX SPLENIC FLXR RMVL LES SNARE TQ","11600 - HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG"]
[null,"11643 - EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<","80053 - HC CHG COMPREHENSIVE METABOLIC PANEL","11602 - EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM","11602 - EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM","11602 - EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM","78806 - NM ABSCSS LOC WB","11600 - HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG","81270 - HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT","81270 - HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT","81270 - HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT","78806 - NM ABSCSS LOC WB","11601 - EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM","81270 - HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT","11600 - HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG","78806 - NM ABSCSS LOC WB","81270 - HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT","45386 - HC COLSC FLX PROX SPLENIC FLXR DILAT BALO 1/> STRI","11601 - EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM"]
[null,"11644 - EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM","80055 - HC CHG OBSTETRIC PANEL","11603 - EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<","11603 - EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<","11603 - EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<","78807 - NM INFLAM LOCAL W SPECT","11601 - EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM","81271 - HC HTT GENE ANALYSIS DECTECT ABNORMAL ALLELES","81271 - HC HTT GENE ANALYSIS DECTECT ABNORMAL ALLELES","81271 - HC HTT GENE ANALYSIS DECTECT ABNORMAL ALLELES","78807 - NM INFLAM LOCAL W SPECT","11602 - EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM","81271 - HC HTT GENE ANALYSIS DECTECT ABNORMAL ALLELES","11601 - EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM","78807 - NM INFLAM LOCAL W SPECT","81271 - HC HTT GENE ANALYSIS DECTECT ABNORMAL ALLELES","45391 - HC COLSC FLX PROX SPLENIC FLXR NDSC US XM","11602 - EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM"]
[null,"11646 - EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM","80061 - HC CHG LIPID PANEL","11604 - EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM","11604 - EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM","11604 - EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM","80048 - HC CHG BASIC METABOLIC PANEL CALCIUM TOTAL","11602 - EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM","81272 - HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS","81272 - HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS","81272 - HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS","80048 - HC CHG BASIC METABOLIC PANEL CALCIUM TOTAL","11603 - EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<","81272 - HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS","11602 - EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM","80048 - HC CHG BASIC METABOLIC PANEL CALCIUM TOTAL","81272 - HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS","45392 - HC COLSC FLX PROX SPLENIC FLXR US GID NDL ASPIR/BX","11603 - EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<"]
[null,"11720 - DEBRIDEMENT NAIL ANY METHOD 1-5","80069 - HC CHG RENAL FUNCTION PANEL","11606 - EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM","11606 - EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM","11606 - EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM","80051 - HC CHG ELECTROLYTE PANEL","11603 - EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<","81274 - HC HTT GENE ANALYSIS CHARACTERIZATION ALLELES","81274 - HC HTT GENE ANALYSIS CHARACTERIZATION ALLELES","81274 - HC HTT GENE ANALYSIS CHARACTERIZATION ALLELES","80051 - HC CHG ELECTROLYTE PANEL","11604 - EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM","81274 - HC HTT GENE ANALYSIS CHARACTERIZATION ALLELES","11603 - EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<","80051 - HC CHG ELECTROLYTE PANEL","81274 - HC HTT GENE ANALYSIS CHARACTERIZATION ALLELES","46604 - HC ANOSCOPY,W/DILATION","11604 - EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM"]
[null,"11721 - DEBRIDEMENT NAIL ANY METHOD 6/>","80074 - HC CHG ACUTE HEPATITIS PANEL","11620 - EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<","11620 - EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<","11620 - EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<","80053 - HC CHG COMPREHENSIVE METABOLIC PANEL","11604 - EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM","81275 - HC CHG KRAS GENE ANALYSIS VARIANTS IN EXON 2","81275 - HC CHG KRAS GENE ANALYSIS VARIANTS IN EXON 2","81275 - HC CHG KRAS GENE ANALYSIS VARIANTS IN EXON 2","80053 - HC CHG COMPREHENSIVE METABOLIC PANEL","11606 - EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM","81275 - HC CHG KRAS GENE ANALYSIS VARIANTS IN EXON 2","11604 - EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM","80053 - HC CHG COMPREHENSIVE METABOLIC PANEL","81275 - HC CHG KRAS GENE ANALYSIS VARIANTS IN EXON 2","46606 - ANOSCOPY W/BX SINGLE/MULTIPLE","11606 - EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM"]
[null,"11730 - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1","80076 - HC CHG HEPATIC FUNCTION PANEL","11621 - HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM","11621 - HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM","11621 - HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM","80055 - HC CHG OBSTETRIC PANEL","11606 - EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM","81276 - HC CHG KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)","81276 - HC CHG KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)","81276 - HC CHG KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)","80055 - HC CHG OBSTETRIC PANEL","11620 - EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<","81276 - HC CHG KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)","11606 - EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM","80055 - HC CHG OBSTETRIC PANEL","81276 - HC CHG KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)","46608 - HC ANOSCOPY,REMOVE FOREIGN BODY","11620 - EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<"]
[null,"11732 - AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL","80150 - HC AMIKACIN","11622 - EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM","11622 - EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM","11622 - EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM","80061 - HC CHG LIPID PANEL","11620 - EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<","81277 - HC CYTOGENOMIC NEO MICRORA ALYS","81277 - HC CYTOGENOMIC NEO MICRORA ALYS","81277 - HC CYTOGENOMIC NEO MICRORA ALYS","80061 - HC CHG LIPID PANEL","11621 - HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM","81277 - HC CYTOGENOMIC NEO MICRORA ALYS","11620 - EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<","80061 - HC CHG LIPID PANEL","81277 - HC CYTOGENOMIC NEO MICRORA ALYS","49320 - HC LAP,DIAGNOSTIC ABDOMEN","11621 - HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM"]
[null,"11740 - EVACUATION SUBUNGUAL HEMATOMA","80156 - HC CHG DRUG ASSAY CARBAMAZEPINE TOTAL","11623 - EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<","11623 - EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<","11623 - EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<","80069 - HC CHG RENAL FUNCTION PANEL","11621 - HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM","81288 - MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS","81288 - MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS","81288 - MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS","80069 - HC CHG RENAL FUNCTION PANEL","11622 - EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM","81288 - MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS","11621 - HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM","80069 - HC CHG RENAL FUNCTION PANEL","81288 - MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS","49321 - HC LAP,DX SURGICAL ABD W/BIOPSY","11622 - EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM"]
[null,"11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL","80158 - HC CHG DRUG ASSAY CYCLOSPORINE","11624 - EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM","11624 - EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM","11624 - EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM","80074 - HC CHG ACUTE HEPATITIS PANEL","11622 - EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM","81291 - HC CHG MTHFR GENE ANALYSIS COMMON VARIANTS","81291 - HC CHG MTHFR GENE ANALYSIS COMMON VARIANTS","81291 - HC CHG MTHFR GENE ANALYSIS COMMON VARIANTS","80074 - HC CHG ACUTE HEPATITIS PANEL","11623 - EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<","81291 - HC CHG MTHFR GENE ANALYSIS COMMON VARIANTS","11622 - EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM","80074 - HC CHG ACUTE HEPATITIS PANEL","81291 - HC CHG MTHFR GENE ANALYSIS COMMON VARIANTS","49324 - HC LAP INSERTION TUNNELED INTRAPERITONEAL CATHETER","11623 - EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<"]
[null,"11755 - BIOPSY NAIL UNIT SEPARATE PROCEDURE","80162 - HC CHG DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL","11626 - EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM","11626 - EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM","11626 - EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM","80076 - HC CHG HEPATIC FUNCTION PANEL","11623 - EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<","81301 - HC CHG MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF","81301 - HC CHG MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF","81301 - HC CHG MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF","80076 - HC CHG HEPATIC FUNCTION PANEL","11624 - EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM","81301 - HC CHG MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF","11623 - EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<","80076 - HC CHG HEPATIC FUNCTION PANEL","81301 - HC CHG MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF","49440 - INSERT GASTROSTOMY TUBE PERCUTANEOUS","11624 - EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM"]
[null,"11760 - REPAIR NAIL BED","80164 - HC CHG DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL","11640 - EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<","11640 - EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<","11640 - EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<","80145 - HC DRUG ASSAY ADALIMUMAB","11624 - EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM","81302 - HC Q;RETT SYN ANLY","81302 - HC Q;RETT SYN ANLY","81302 - HC Q;RETT SYN ANLY","80145 - HC DRUG ASSAY ADALIMUMAB","11626 - EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM","81302 - HC Q;RETT SYN ANLY","11624 - EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM","80145 - HC DRUG ASSAY ADALIMUMAB","81302 - HC Q;RETT SYN ANLY","49441 - HC INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ","11626 - EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM"]
[null,"11765 - WEDGE EXCISION SKIN NAIL FOLD","80168 - HC CHG DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE","11642 - HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL","11642 - HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL","11642 - HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL","80150 - HC AMIKACIN","11626 - EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM","81304 - HC MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT","81304 - HC MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT","81304 - HC MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT","80150 - HC AMIKACIN","11640 - EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<","81304 - HC MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT","11626 - EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM","80150 - HC AMIKACIN","81304 - HC MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT","49446 - HC CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERQ","11640 - EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<"]
[null,"11770 - EXCISION PILONIDAL CYST/SINUS SIMPLE","80169 - DRUG SCREEN QUANTITATIVE EVEROLIMUS","11643 - EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<","11643 - EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<","11643 - EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<","80156 - HC CHG DRUG ASSAY CARBAMAZEPINE TOTAL","11640 - EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<","81305 - HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT","81305 - HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT","81305 - HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT","80156 - HC CHG DRUG ASSAY CARBAMAZEPINE TOTAL","11642 - HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL","81305 - HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT","11640 - EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<","80156 - HC CHG DRUG ASSAY CARBAMAZEPINE TOTAL","81305 - HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT","58555 - HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE","11642 - HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL"]
[null,"11772 - EXCISION PILONIDAL CYST/SINUS COMPLICATED","80170 - HC CHG DRUG SCREEN QUANTITATIVE GENTAMICIN","11644 - EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM","11644 - EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM","11644 - EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM","80158 - HC CHG DRUG ASSAY CYCLOSPORINE","11642 - HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL","81307 - HC PALB2 GENE FULL GENE SEQ","81307 - HC PALB2 GENE FULL GENE SEQ","81307 - HC PALB2 GENE FULL GENE SEQ","80158 - HC CHG DRUG ASSAY CYCLOSPORINE","11643 - EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<","81307 - HC PALB2 GENE FULL GENE SEQ","11642 - HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL","80158 - HC CHG DRUG ASSAY CYCLOSPORINE","81307 - HC PALB2 GENE FULL GENE SEQ","58558 - HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C","11643 - EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<"]
[null,"11900 - INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS","80171 - DRUG SCREEN QUANTITATIVE GABAPENTIN","11646 - EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM","11646 - EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM","11646 - EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM","80162 - HC CHG DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL","11643 - EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<","81308 - HC PALB2 GENE KNOWN FAMIL VRNT","81308 - HC PALB2 GENE KNOWN FAMIL VRNT","81308 - HC PALB2 GENE KNOWN FAMIL VRNT","80162 - HC CHG DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL","11644 - EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM","81308 - HC PALB2 GENE KNOWN FAMIL VRNT","11643 - EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<","80162 - HC CHG DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL","81308 - HC PALB2 GENE KNOWN FAMIL VRNT","58559 - HC HYSTEROSCOPY LYSIS INTRAUTERINE ADHESIONS","11644 - EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM"]
[null,"11901 - INJECTION INTRALESIONAL >7 LESIONS","80175 - DRUG SCREEN QUANTITATIVE LAMOTRIGINE","11719 - TRIMMING NONDYSTROPHIC NAILS ANY NUMBER","11719 - TRIMMING NONDYSTROPHIC NAILS ANY NUMBER","11719 - TRIMMING NONDYSTROPHIC NAILS ANY NUMBER","80164 - HC CHG DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL","11644 - EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM","81309 - HC PIK3CA GENE TRGT SEQ ALYS","81309 - HC PIK3CA GENE TRGT SEQ ALYS","81309 - HC PIK3CA GENE TRGT SEQ ALYS","80164 - HC CHG DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL","11646 - EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM","81309 - HC PIK3CA GENE TRGT SEQ ALYS","11644 - EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM","80164 - HC CHG DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL","81309 - HC PIK3CA GENE TRGT SEQ ALYS","58561 - HC HYSTEROSCOPY,RMV MYOMA","11646 - EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM"]
[null,"11921 - HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM","80177 - DRUG SCREEN QUANTITATIVE LEVETIRACETAM","11720 - DEBRIDEMENT NAIL ANY METHOD 1-5","11720 - DEBRIDEMENT NAIL ANY METHOD 1-5","11720 - DEBRIDEMENT NAIL ANY METHOD 1-5","80168 - HC CHG DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE","11646 - EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM","81311 - HC CHG NRAS GENE ANALYSIS VARIANTS IN EXON 2&3","81311 - HC CHG NRAS GENE ANALYSIS VARIANTS IN EXON 2&3","81311 - HC CHG NRAS GENE ANALYSIS VARIANTS IN EXON 2&3","80168 - HC CHG DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE","11719 - TRIMMING NONDYSTROPHIC NAILS ANY NUMBER","81311 - HC CHG NRAS GENE ANALYSIS VARIANTS IN EXON 2&3","11646 - EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM","80168 - HC CHG DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE","81311 - HC CHG NRAS GENE ANALYSIS VARIANTS IN EXON 2&3","58562 - HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY","11719 - TRIMMING NONDYSTROPHIC NAILS ANY NUMBER"]
[null,"11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","80178 - HC CHG DRUG SCREEN QUANTITATIVE LITHIUM","11721 - DEBRIDEMENT NAIL ANY METHOD 6/>","11721 - DEBRIDEMENT NAIL ANY METHOD 6/>","11721 - DEBRIDEMENT NAIL ANY METHOD 6/>","80169 - DRUG SCREEN QUANTITATIVE EVEROLIMUS","11719 - TRIMMING NONDYSTROPHIC NAILS ANY NUMBER","81315 - HC PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT","81315 - HC PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT","81315 - HC PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT","80169 - DRUG SCREEN QUANTITATIVE EVEROLIMUS","11720 - DEBRIDEMENT NAIL ANY METHOD 1-5","81315 - HC PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT","11719 - TRIMMING NONDYSTROPHIC NAILS ANY NUMBER","80169 - DRUG SCREEN QUANTITATIVE EVEROLIMUS","81315 - HC PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT","62320 - HC NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN","11720 - DEBRIDEMENT NAIL ANY METHOD 1-5"]
[null,"11976 - REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES","80184 - HC CHG DRUG SCREEN QUANTITATIVE PHENOBARBITAL","11730 - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1","11730 - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1","11730 - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1","80170 - HC CHG DRUG SCREEN QUANTITATIVE GENTAMICIN","11720 - DEBRIDEMENT NAIL ANY METHOD 1-5","81329 - HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS","81329 - HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS","81329 - HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS","80170 - HC CHG DRUG SCREEN QUANTITATIVE GENTAMICIN","11721 - DEBRIDEMENT NAIL ANY METHOD 6/>","81329 - HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS","11720 - DEBRIDEMENT NAIL ANY METHOD 1-5","80170 - HC CHG DRUG SCREEN QUANTITATIVE GENTAMICIN","81329 - HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS","62321 - HR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN","11721 - DEBRIDEMENT NAIL ANY METHOD 6/>"]
[null,"11980 - SUBCUTANEOUS HORMONE PELLET IMPLANTATION","80185 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL","11732 - AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL","11732 - AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL","11732 - AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL","80171 - DRUG SCREEN QUANTITATIVE GABAPENTIN","11721 - DEBRIDEMENT NAIL ANY METHOD 6/>","81331 - HC PRADER-WILLI/ANGELMAN","81331 - HC PRADER-WILLI/ANGELMAN","81331 - HC PRADER-WILLI/ANGELMAN","80171 - DRUG SCREEN QUANTITATIVE GABAPENTIN","11730 - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1","81331 - HC PRADER-WILLI/ANGELMAN","11721 - DEBRIDEMENT NAIL ANY METHOD 6/>","80171 - DRUG SCREEN QUANTITATIVE GABAPENTIN","81331 - HC PRADER-WILLI/ANGELMAN","62322 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","11730 - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1"]
[null,"11981 - INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","80186 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN FREE","11740 - EVACUATION SUBUNGUAL HEMATOMA","11740 - EVACUATION SUBUNGUAL HEMATOMA","11740 - EVACUATION SUBUNGUAL HEMATOMA","80175 - DRUG SCREEN QUANTITATIVE LAMOTRIGINE","11730 - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1","81342 - TRG@ GENE REARRANGEMENT ANALYSIS; PRO/TECH","81342 - TRG@ GENE REARRANGEMENT ANALYSIS; PRO/TECH","81342 - TRG@ GENE REARRANGEMENT ANALYSIS; PRO/TECH","80175 - DRUG SCREEN QUANTITATIVE LAMOTRIGINE","11732 - AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL","81342 - TRG@ GENE REARRANGEMENT ANALYSIS; PRO/TECH","11730 - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1","80175 - DRUG SCREEN QUANTITATIVE LAMOTRIGINE","81342 - TRG@ GENE REARRANGEMENT ANALYSIS; PRO/TECH","62323 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","11732 - AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL"]
[null,"11982 - REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","80195 - HC CHG DRUG SCREEN QUANTITATIVE SIROLIMUS","11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL","11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL","11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL","80177 - DRUG SCREEN QUANTITATIVE LEVETIRACETAM","11732 - AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL","81350 - HC CHG UGT1A1 GENE ANALYSIS COMMON VARIANTS","81350 - HC CHG UGT1A1 GENE ANALYSIS COMMON VARIANTS","81350 - HC CHG UGT1A1 GENE ANALYSIS COMMON VARIANTS","80177 - DRUG SCREEN QUANTITATIVE LEVETIRACETAM","11740 - EVACUATION SUBUNGUAL HEMATOMA","81350 - HC CHG UGT1A1 GENE ANALYSIS COMMON VARIANTS","11732 - AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL","80177 - DRUG SCREEN QUANTITATIVE LEVETIRACETAM","81350 - HC CHG UGT1A1 GENE ANALYSIS COMMON VARIANTS","62324 - HC NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN.","11740 - EVACUATION SUBUNGUAL HEMATOMA"]
[null,"11983 - RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT","80197 - HC CHG DRUG SCREEN QUANTITATIVE TACROLIMUS","11755 - BIOPSY NAIL UNIT SEPARATE PROCEDURE","11755 - BIOPSY NAIL UNIT SEPARATE PROCEDURE","11755 - BIOPSY NAIL UNIT SEPARATE PROCEDURE","80178 - HC CHG DRUG SCREEN QUANTITATIVE LITHIUM","11740 - EVACUATION SUBUNGUAL HEMATOMA","81363 - HC HBB DUPLICATION/DELETION VARIANTS","81363 - HC HBB DUPLICATION/DELETION VARIANTS","81363 - HC HBB DUPLICATION/DELETION VARIANTS","80178 - HC CHG DRUG SCREEN QUANTITATIVE LITHIUM","11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL","81363 - HC HBB DUPLICATION/DELETION VARIANTS","11740 - EVACUATION SUBUNGUAL HEMATOMA","80178 - HC CHG DRUG SCREEN QUANTITATIVE LITHIUM","81363 - HC HBB DUPLICATION/DELETION VARIANTS","62326 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL"]
[null,"12001 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<","80198 - HC Q;THEOPHYLLINE","11760 - REPAIR NAIL BED","11760 - REPAIR NAIL BED","11760 - REPAIR NAIL BED","80184 - HC CHG DRUG SCREEN QUANTITATIVE PHENOBARBITAL","11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL","81364 - HC HBB FULL GENE SEQUENCE","81364 - HC HBB FULL GENE SEQUENCE","81364 - HC HBB FULL GENE SEQUENCE","80184 - HC CHG DRUG SCREEN QUANTITATIVE PHENOBARBITAL","11755 - BIOPSY NAIL UNIT SEPARATE PROCEDURE","81364 - HC HBB FULL GENE SEQUENCE","11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL","80184 - HC CHG DRUG SCREEN QUANTITATIVE PHENOBARBITAL","81364 - HC HBB FULL GENE SEQUENCE","62327 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","11755 - BIOPSY NAIL UNIT SEPARATE PROCEDURE"]
[null,"12004 - SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM","80201 - HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE","11765 - WEDGE EXCISION SKIN NAIL FOLD","11765 - WEDGE EXCISION SKIN NAIL FOLD","11765 - WEDGE EXCISION SKIN NAIL FOLD","80185 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL","11755 - BIOPSY NAIL UNIT SEPARATE PROCEDURE","81401 - HC CHG, MOLECULAR PATHOLOGY PROCEDURE LEVEL 2","81401 - HC CHG, MOLECULAR PATHOLOGY PROCEDURE LEVEL 2","81401 - HC CHG, MOLECULAR PATHOLOGY PROCEDURE LEVEL 2","80185 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL","11760 - REPAIR NAIL BED","81401 - HC CHG, MOLECULAR PATHOLOGY PROCEDURE LEVEL 2","11755 - BIOPSY NAIL UNIT SEPARATE PROCEDURE","80185 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL","81401 - HC CHG, MOLECULAR PATHOLOGY PROCEDURE LEVEL 2","64400 - NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH","11760 - REPAIR NAIL BED"]
[null,"12005 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM","80202 - HC CHG DRUG SCREEN QUANTITATIVE VANCOMYCIN","11770 - EXCISION PILONIDAL CYST/SINUS SIMPLE","11770 - EXCISION PILONIDAL CYST/SINUS SIMPLE","11770 - EXCISION PILONIDAL CYST/SINUS SIMPLE","80186 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN FREE","11760 - REPAIR NAIL BED","81402 - HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 3","81402 - HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 3","81402 - HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 3","80186 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN FREE","11765 - WEDGE EXCISION SKIN NAIL FOLD","81402 - HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 3","11760 - REPAIR NAIL BED","80186 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN FREE","81402 - HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 3","64402 - INJECTION ANESTHETIC AGENT FACIAL NERVE","11765 - WEDGE EXCISION SKIN NAIL FOLD"]
[null,"12006 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM","80203 - DRUG SCREEN QUANTITATIVE ZONISAMIDE","11772 - EXCISION PILONIDAL CYST/SINUS COMPLICATED","11772 - EXCISION PILONIDAL CYST/SINUS COMPLICATED","11772 - EXCISION PILONIDAL CYST/SINUS COMPLICATED","80187 - HC DRUG ASSAY POSACONAZOLE","11765 - WEDGE EXCISION SKIN NAIL FOLD","81403 - SEQ & EXON 13 SEQ, IF PERFORMED KRAS (EG, CARCINOMA), GENE ANALYSIS, PRO/TECH","81403 - SEQ & EXON 13 SEQ, IF PERFORMED KRAS (EG, CARCINOMA), GENE ANALYSIS, PRO/TECH","81403 - SEQ & EXON 13 SEQ, IF PERFORMED KRAS (EG, CARCINOMA), GENE ANALYSIS, PRO/TECH","80187 - HC DRUG ASSAY POSACONAZOLE","11770 - EXCISION PILONIDAL CYST/SINUS SIMPLE","81403 - SEQ & EXON 13 SEQ, IF PERFORMED KRAS (EG, CARCINOMA), GENE ANALYSIS, PRO/TECH","11765 - WEDGE EXCISION SKIN NAIL FOLD","80187 - HC DRUG ASSAY POSACONAZOLE","81403 - SEQ & EXON 13 SEQ, IF PERFORMED KRAS (EG, CARCINOMA), GENE ANALYSIS, PRO/TECH","64405 - INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV","11770 - EXCISION PILONIDAL CYST/SINUS SIMPLE"]
[null,"12007 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM","80299 - HC INFLIXIMAB DRUG CONC. AND ANTI-INFLIXIMAB AB","11900 - INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS","11900 - INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS","11900 - INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS","80195 - HC CHG DRUG SCREEN QUANTITATIVE SIROLIMUS","11770 - EXCISION PILONIDAL CYST/SINUS SIMPLE","81404 - VHL (EG, VON HIPPEL-LINDAUFAMILIAL CANCER SYNDROME, FULL GENE SEQ VWF PRO/TECH","81404 - VHL (EG, VON HIPPEL-LINDAUFAMILIAL CANCER SYNDROME, FULL GENE SEQ VWF PRO/TECH","81404 - VHL (EG, VON HIPPEL-LINDAUFAMILIAL CANCER SYNDROME, FULL GENE SEQ VWF PRO/TECH","80195 - HC CHG DRUG SCREEN QUANTITATIVE SIROLIMUS","11772 - EXCISION PILONIDAL CYST/SINUS COMPLICATED","81404 - VHL (EG, VON HIPPEL-LINDAUFAMILIAL CANCER SYNDROME, FULL GENE SEQ VWF PRO/TECH","11770 - EXCISION PILONIDAL CYST/SINUS SIMPLE","80195 - HC CHG DRUG SCREEN QUANTITATIVE SIROLIMUS","81404 - VHL (EG, VON HIPPEL-LINDAUFAMILIAL CANCER SYNDROME, FULL GENE SEQ VWF PRO/TECH","64408 - HC INJ,ANES;VAGUS NER","11772 - EXCISION PILONIDAL CYST/SINUS COMPLICATED"]
[null,"12014 - SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM","80306 - HC DRUG TEST PRSMV INSTRMNT","11901 - INJECTION INTRALESIONAL >7 LESIONS","11901 - INJECTION INTRALESIONAL >7 LESIONS","11901 - INJECTION INTRALESIONAL >7 LESIONS","80197 - HC CHG DRUG SCREEN QUANTITATIVE TACROLIMUS","11772 - EXCISION PILONIDAL CYST/SINUS COMPLICATED","81405 - HC MOPATH PROCEDURE LEVEL 6","81405 - HC MOPATH PROCEDURE LEVEL 6","81405 - HC MOPATH PROCEDURE LEVEL 6","80197 - HC CHG DRUG SCREEN QUANTITATIVE TACROLIMUS","11900 - INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS","81405 - HC MOPATH PROCEDURE LEVEL 6","11772 - EXCISION PILONIDAL CYST/SINUS COMPLICATED","80197 - HC CHG DRUG SCREEN QUANTITATIVE TACROLIMUS","81405 - HC MOPATH PROCEDURE LEVEL 6","64410 - PHRENIC NERVE BLOCK","11900 - INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS"]
[null,"12015 - SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM","80307 - HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS","11921 - HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM","11921 - HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM","11921 - HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM","80198 - HC Q;THEOPHYLLINE","11900 - INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS","81406 - HC CHG MOLECULAR PATHOLOGY PROCEDURE LEVEL 7","81406 - HC CHG MOLECULAR PATHOLOGY PROCEDURE LEVEL 7","81406 - HC CHG MOLECULAR PATHOLOGY PROCEDURE LEVEL 7","80198 - HC Q;THEOPHYLLINE","11901 - INJECTION INTRALESIONAL >7 LESIONS","81406 - HC CHG MOLECULAR PATHOLOGY PROCEDURE LEVEL 7","11900 - INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS","80198 - HC Q;THEOPHYLLINE","81406 - HC CHG MOLECULAR PATHOLOGY PROCEDURE LEVEL 7","64413 - INJECTION ANESTHETIC AGENT CERVICAL PLEXUS","11901 - INJECTION INTRALESIONAL >7 LESIONS"]
[null,"12016 - SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM","80320 - DRUG SCREEN QUANTITATIVE ALCOHOLS","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","80201 - HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE","11901 - INJECTION INTRALESIONAL >7 LESIONS","81430 - HC CHG HEARING LOSS GENOMIC SEQUENCE ANALYSIS 60 GENES","81430 - HC CHG HEARING LOSS GENOMIC SEQUENCE ANALYSIS 60 GENES","81430 - HC CHG HEARING LOSS GENOMIC SEQUENCE ANALYSIS 60 GENES","80201 - HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE","11921 - HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM","81430 - HC CHG HEARING LOSS GENOMIC SEQUENCE ANALYSIS 60 GENES","11901 - INJECTION INTRALESIONAL >7 LESIONS","80201 - HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE","81430 - HC CHG HEARING LOSS GENOMIC SEQUENCE ANALYSIS 60 GENES","64415 - SINGLE NERVE BLOCK INJECTION ARM NERVE","11921 - HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM"]
[null,"12017 - HC RESUPERF WND FACE 20.1-30 CM","80329 - DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2","11976 - REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES","11976 - REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES","11976 - REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES","80202 - HC CHG DRUG SCREEN QUANTITATIVE VANCOMYCIN","11921 - HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM","81431 - HC CHG HEARING LOSS DUP/DEL ANALYSIS","81431 - HC CHG HEARING LOSS DUP/DEL ANALYSIS","81431 - HC CHG HEARING LOSS DUP/DEL ANALYSIS","80202 - HC CHG DRUG SCREEN QUANTITATIVE VANCOMYCIN","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","81431 - HC CHG HEARING LOSS DUP/DEL ANALYSIS","11921 - HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM","80202 - HC CHG DRUG SCREEN QUANTITATIVE VANCOMYCIN","81431 - HC CHG HEARING LOSS DUP/DEL ANALYSIS","64416 - HC INJ,ANES;CONT INF B PLEX","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM"]
[null,"12018 - HC RESUPERF WND FACE >30 CM","80339 - HC CHG ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 1-3","11980 - SUBCUTANEOUS HORMONE PELLET IMPLANTATION","11980 - SUBCUTANEOUS HORMONE PELLET IMPLANTATION","11980 - SUBCUTANEOUS HORMONE PELLET IMPLANTATION","80203 - DRUG SCREEN QUANTITATIVE ZONISAMIDE","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","81450 - HC CHG GENOMIC SEQ ANALYS DNA&RNA ANALYS 5-50 GENE","81450 - HC CHG GENOMIC SEQ ANALYS DNA&RNA ANALYS 5-50 GENE","81450 - HC CHG GENOMIC SEQ ANALYS DNA&RNA ANALYS 5-50 GENE","80203 - DRUG SCREEN QUANTITATIVE ZONISAMIDE","11976 - REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES","81450 - HC CHG GENOMIC SEQ ANALYS DNA&RNA ANALYS 5-50 GENE","11922 - HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM","80203 - DRUG SCREEN QUANTITATIVE ZONISAMIDE","81450 - HC CHG GENOMIC SEQ ANALYS DNA&RNA ANALYS 5-50 GENE","64417 - INJECTION ANESTHETIC AGENT AXILLARY NERVE","11976 - REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES"]
[null,"12020 - TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE","80345 - HC CHG DRUG SCREENING BARBITURATES","11981 - INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11981 - INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11981 - INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","80230 - HC DRUG ASSAY INFLIXIMAB","11976 - REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES","81522 - HC ONC BREAST MRNA 12 GENES","81522 - HC ONC BREAST MRNA 12 GENES","81522 - HC ONC BREAST MRNA 12 GENES","80230 - HC DRUG ASSAY INFLIXIMAB","11980 - SUBCUTANEOUS HORMONE PELLET IMPLANTATION","81522 - HC ONC BREAST MRNA 12 GENES","11976 - REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES","80230 - HC DRUG ASSAY INFLIXIMAB","81522 - HC ONC BREAST MRNA 12 GENES","64418 - INJECTION ANESTHETIC AGENT SUPRASCAPULAR NERVE","11980 - SUBCUTANEOUS HORMONE PELLET IMPLANTATION"]
[null,"12021 - TX SUPERFICIAL WOUND DEHISCENCE W/PACKING","80348 - HC CHG DRUG SCREENING BUPRENORPHINE","11982 - REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11982 - REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","11982 - REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","80235 - HC DRUG ASSAY LACOSAMIDE","11980 - SUBCUTANEOUS HORMONE PELLET IMPLANTATION","81542 - HC ONC PROSTATE MRNA 22 CNT GEN","81542 - HC ONC PROSTATE MRNA 22 CNT GEN","81542 - HC ONC PROSTATE MRNA 22 CNT GEN","80235 - HC DRUG ASSAY LACOSAMIDE","11981 - INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","81542 - HC ONC PROSTATE MRNA 22 CNT GEN","11980 - SUBCUTANEOUS HORMONE PELLET IMPLANTATION","80235 - HC DRUG ASSAY LACOSAMIDE","81542 - HC ONC PROSTATE MRNA 22 CNT GEN","64420 - INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE","11981 - INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT"]
[null,"12031 - REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<","80353 - HC CHG DRUG SCREENING COCAINE","11983 - RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT","11983 - RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT","11983 - RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT","80280 - HC DRUG ASSAY VEDOLIZUMAB","11981 - INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","81596 - HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR","81596 - HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR","81596 - HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR","80280 - HC DRUG ASSAY VEDOLIZUMAB","11982 - REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","81596 - HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR","11981 - INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","80280 - HC DRUG ASSAY VEDOLIZUMAB","81596 - HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR","64421 - MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES","11982 - REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT"]
[null,"12032 - REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM","80354 - DRUG SCREENING FENTANYL","12001 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<","12001 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<","12001 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<","80285 - HC DRUG ASSAY VORICONAZOLE","11982 - REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","82009 - HC CHG KETONE BODIES SERUM QUALITATIVE","82009 - HC CHG KETONE BODIES SERUM QUALITATIVE","82009 - HC CHG KETONE BODIES SERUM QUALITATIVE","80285 - HC DRUG ASSAY VORICONAZOLE","11983 - RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT","82009 - HC CHG KETONE BODIES SERUM QUALITATIVE","11982 - REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","80285 - HC DRUG ASSAY VORICONAZOLE","82009 - HC CHG KETONE BODIES SERUM QUALITATIVE","64425 - INJECTION ANES ILIOINGUINAL ILIOHYPOGASTRIC NRVS","11983 - RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT"]
[null,"12034 - REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM","80356 - HC CHG DRUG SCREENING HEROIN METABOLITE","12002 - SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM","12002 - SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM","12002 - SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM","80299 - HC INFLIXIMAB DRUG CONC. AND ANTI-INFLIXIMAB AB","11983 - RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT","82010 - HC CHG KETONE BODIES SERUM QUANTITATIVE","82010 - HC CHG KETONE BODIES SERUM QUANTITATIVE","82010 - HC CHG KETONE BODIES SERUM QUANTITATIVE","80299 - HC INFLIXIMAB DRUG CONC. AND ANTI-INFLIXIMAB AB","12001 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<","82010 - HC CHG KETONE BODIES SERUM QUANTITATIVE","11983 - RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT","80299 - HC INFLIXIMAB DRUG CONC. AND ANTI-INFLIXIMAB AB","82010 - HC CHG KETONE BODIES SERUM QUANTITATIVE","64430 - HC INJ,ANES;PUDEND NER","12001 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<"]
[null,"12035 - REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM","80361 - HC CHG DRUG SCREENING OPIATES 1 OR MORE","12004 - SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM","12004 - SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM","12004 - SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM","80306 - HC DRUG TEST PRSMV INSTRMNT","12001 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<","82017 - HC CHG ACYLCARNITINES QUANTIATIVE EACH SPECIMEN","82017 - HC CHG ACYLCARNITINES QUANTIATIVE EACH SPECIMEN","82017 - HC CHG ACYLCARNITINES QUANTIATIVE EACH SPECIMEN","80306 - HC DRUG TEST PRSMV INSTRMNT","12002 - SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM","82017 - HC CHG ACYLCARNITINES QUANTIATIVE EACH SPECIMEN","12001 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<","80306 - HC DRUG TEST PRSMV INSTRMNT","82017 - HC CHG ACYLCARNITINES QUANTIATIVE EACH SPECIMEN","64435 - INJECTION ANESTHETIC PARACERVICAL UTERINE NERVE","12002 - SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM"]
[null,"12036 - HC LAYR CLOS WND TRUNK, ARM, LEG 20.1-30 CM","80366 - HC CHG DRUG SCREENING PREGABALIN","12005 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM","12005 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM","12005 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM","80307 - HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS","12002 - SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM","82024 - HC CHG ADRENOCORTICOTROPIC HORMONE ACTH","82024 - HC CHG ADRENOCORTICOTROPIC HORMONE ACTH","82024 - HC CHG ADRENOCORTICOTROPIC HORMONE ACTH","80307 - HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS","12004 - SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM","82024 - HC CHG ADRENOCORTICOTROPIC HORMONE ACTH","12002 - SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM","80307 - HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS","82024 - HC CHG ADRENOCORTICOTROPIC HORMONE ACTH","64445 - INJECTION ANESTHETIC AGENT SCIATIC NRV SINGLE","12004 - SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM"]
[null,"12037 - REPAIR INTERMEDIATE S/A/T/E >30.0 CM","80438 - HC CHG TRH STIM PANEL 1 HR","12006 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM","12006 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM","12006 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM","80320 - DRUG SCREEN QUANTITATIVE ALCOHOLS","12004 - SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM","82040 - HC CHG ALBUMIN SERUM PLASMA/WHOLE BLOOD","82040 - HC CHG ALBUMIN SERUM PLASMA/WHOLE BLOOD","82040 - HC CHG ALBUMIN SERUM PLASMA/WHOLE BLOOD","80320 - DRUG SCREEN QUANTITATIVE ALCOHOLS","12005 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM","82040 - HC CHG ALBUMIN SERUM PLASMA/WHOLE BLOOD","12004 - SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM","80320 - DRUG SCREEN QUANTITATIVE ALCOHOLS","82040 - HC CHG ALBUMIN SERUM PLASMA/WHOLE BLOOD","64447 - HC INJECTION ANESTHETIC AGENT FEMORAL NERVE SINGLE","12005 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM"]
[null,"12041 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<","81000 - URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY","12007 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM","12007 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM","12007 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM","80329 - DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2","12005 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM","82042 - HC CHG ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN","82042 - HC CHG ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN","82042 - HC CHG ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN","80329 - DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2","12006 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM","82042 - HC CHG ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN","12005 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM","80329 - DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2","82042 - HC CHG ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN","64450 - INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH","12006 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM"]
[null,"12042 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM","81001 - URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY","12011 - SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<","12011 - SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<","12011 - SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<","80339 - HC CHG ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 1-3","12006 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM","82043 - HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE","82043 - HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE","82043 - HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE","80339 - HC CHG ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 1-3","12007 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM","82043 - HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE","12006 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM","80339 - HC CHG ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 1-3","82043 - HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE","64455 - NJX ANES&/STEROID PLANTAR COMMON DIGITAL NERVE","12007 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM"]
[null,"12044 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM","81002 - URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP","12013 - SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM","12013 - SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM","12013 - SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM","80345 - HC CHG DRUG SCREENING BARBITURATES","12007 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM","82075 - HC CHG ASSAY OF ALCOHOL BREATH","82075 - HC CHG ASSAY OF ALCOHOL BREATH","82075 - HC CHG ASSAY OF ALCOHOL BREATH","80345 - HC CHG DRUG SCREENING BARBITURATES","12011 - SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<","82075 - HC CHG ASSAY OF ALCOHOL BREATH","12007 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM","80345 - HC CHG DRUG SCREENING BARBITURATES","82075 - HC CHG ASSAY OF ALCOHOL BREATH","64479 - HC INJECT ANES/STEROID FORAMEN CERV/THORACIC W IMG GUIDE ,1 LEVEL","12011 - SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<"]
[null,"12045 - HC LAYR CLOS WND REST BODY 12.6-20 CM","81003 - URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY","12014 - SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM","12014 - SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM","12014 - SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM","80348 - HC CHG DRUG SCREENING BUPRENORPHINE","12011 - SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<","82085 - HC CHG ASSAY OF ALDOLASE","82085 - HC CHG ASSAY OF ALDOLASE","82085 - HC CHG ASSAY OF ALDOLASE","80348 - HC CHG DRUG SCREENING BUPRENORPHINE","12013 - SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM","82085 - HC CHG ASSAY OF ALDOLASE","12011 - SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<","80348 - HC CHG DRUG SCREENING BUPRENORPHINE","82085 - HC CHG ASSAY OF ALDOLASE","64483 - NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL","12013 - SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM"]
[null,"12046 - HC LAYR CLOS WND REST BODY 20.1-30 CM","81015 - HC CHG URINALYSIS MICROSCOPIC ONLY","12015 - SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM","12015 - SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM","12015 - SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM","80353 - HC CHG DRUG SCREENING COCAINE","12013 - SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM","82088 - HC CHG ASSAY OF ALDOSTERONE","82088 - HC CHG ASSAY OF ALDOSTERONE","82088 - HC CHG ASSAY OF ALDOSTERONE","80353 - HC CHG DRUG SCREENING COCAINE","12014 - SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM","82088 - HC CHG ASSAY OF ALDOSTERONE","12013 - SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM","80353 - HC CHG DRUG SCREENING COCAINE","82088 - HC CHG ASSAY OF ALDOSTERONE","64484 - NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC EA LV","12014 - SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM"]
[null,"12047 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM","81025 - URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS","12016 - SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM","12016 - SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM","12016 - SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM","80354 - DRUG SCREENING FENTANYL","12014 - SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM","82103 - HC CHG ALPHA-1-ANTITRYPSIN TOTAL","82103 - HC CHG ALPHA-1-ANTITRYPSIN TOTAL","82103 - HC CHG ALPHA-1-ANTITRYPSIN TOTAL","80354 - DRUG SCREENING FENTANYL","12015 - SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM","82103 - HC CHG ALPHA-1-ANTITRYPSIN TOTAL","12014 - SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM","80354 - DRUG SCREENING FENTANYL","82103 - HC CHG ALPHA-1-ANTITRYPSIN TOTAL","64490 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL","12015 - SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM"]
[null,"12051 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<","81050 - HC CHG VOLUME MEASUREMENT TIMED COLLECTION EACH","12017 - HC RESUPERF WND FACE 20.1-30 CM","12017 - HC RESUPERF WND FACE 20.1-30 CM","12017 - HC RESUPERF WND FACE 20.1-30 CM","80356 - HC CHG DRUG SCREENING HEROIN METABOLITE","12015 - SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM","82104 - HC CHG ALPHA-1-ANTITRYPSIN PHENOTYPE","82104 - HC CHG ALPHA-1-ANTITRYPSIN PHENOTYPE","82104 - HC CHG ALPHA-1-ANTITRYPSIN PHENOTYPE","80356 - HC CHG DRUG SCREENING HEROIN METABOLITE","12016 - SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM","82104 - HC CHG ALPHA-1-ANTITRYPSIN PHENOTYPE","12015 - SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM","80356 - HC CHG DRUG SCREENING HEROIN METABOLITE","82104 - HC CHG ALPHA-1-ANTITRYPSIN PHENOTYPE","64491 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL","12016 - SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM"]
[null,"12052 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM","81161 - HC DMD DUPLICATION/DELETION ANALYSIS","12018 - HC RESUPERF WND FACE >30 CM","12018 - HC RESUPERF WND FACE >30 CM","12018 - HC RESUPERF WND FACE >30 CM","80361 - HC CHG DRUG SCREENING OPIATES 1 OR MORE","12016 - SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM","82105 - HC CHG ALPHA-FETOPROTEIN SERUM","82105 - HC CHG ALPHA-FETOPROTEIN SERUM","82105 - HC CHG ALPHA-FETOPROTEIN SERUM","80361 - HC CHG DRUG SCREENING OPIATES 1 OR MORE","12017 - HC RESUPERF WND FACE 20.1-30 CM","82105 - HC CHG ALPHA-FETOPROTEIN SERUM","12016 - SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM","80361 - HC CHG DRUG SCREENING OPIATES 1 OR MORE","82105 - HC CHG ALPHA-FETOPROTEIN SERUM","64492 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL","12017 - HC RESUPERF WND FACE 20.1-30 CM"]
[null,"12053 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM","81178 - HC CHG ATXN1 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","12020 - TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE","12020 - TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE","12020 - TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE","80366 - HC CHG DRUG SCREENING PREGABALIN","12017 - HC RESUPERF WND FACE 20.1-30 CM","82139 - HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE","82139 - HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE","82139 - HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE","80366 - HC CHG DRUG SCREENING PREGABALIN","12018 - HC RESUPERF WND FACE >30 CM","82139 - HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE","12017 - HC RESUPERF WND FACE 20.1-30 CM","80366 - HC CHG DRUG SCREENING PREGABALIN","82139 - HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE","64493 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL","12018 - HC RESUPERF WND FACE >30 CM"]
[null,"12054 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM","81179 - HC CHG ATXN2 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","12021 - TX SUPERFICIAL WOUND DEHISCENCE W/PACKING","12021 - TX SUPERFICIAL WOUND DEHISCENCE W/PACKING","12021 - TX SUPERFICIAL WOUND DEHISCENCE W/PACKING","80438 - HC CHG TRH STIM PANEL 1 HR","12018 - HC RESUPERF WND FACE >30 CM","82140 - HC CHG ASSAY OF AMMONIA","82140 - HC CHG ASSAY OF AMMONIA","82140 - HC CHG ASSAY OF AMMONIA","80438 - HC CHG TRH STIM PANEL 1 HR","12020 - TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE","82140 - HC CHG ASSAY OF AMMONIA","12018 - HC RESUPERF WND FACE >30 CM","80438 - HC CHG TRH STIM PANEL 1 HR","82140 - HC CHG ASSAY OF AMMONIA","64494 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL","12020 - TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE"]
[null,"12055 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM","81180 - HC CHG ATXN3 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","12031 - REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<","12031 - REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<","12031 - REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<","81000 - URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY","12020 - TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE","82150 - HC CHG ASSAY OF AMYLASE","82150 - HC CHG ASSAY OF AMYLASE","82150 - HC CHG ASSAY OF AMYLASE","81000 - URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY","12021 - TX SUPERFICIAL WOUND DEHISCENCE W/PACKING","82150 - HC CHG ASSAY OF AMYLASE","12020 - TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE","81000 - URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY","82150 - HC CHG ASSAY OF AMYLASE","64495 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL","12021 - TX SUPERFICIAL WOUND DEHISCENCE W/PACKING"]
[null,"12056 - HC LAYR CLOS WND FACE,FACIAL 20.1-30 CM","81206 - HC CHG BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE","12032 - REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM","12032 - REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM","12032 - REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM","81001 - URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY","12021 - TX SUPERFICIAL WOUND DEHISCENCE W/PACKING","82157 - HC CHG ANDROSTENEDIONE","82157 - HC CHG ANDROSTENEDIONE","82157 - HC CHG ANDROSTENEDIONE","81001 - URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY","12031 - REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<","82157 - HC CHG ANDROSTENEDIONE","12021 - TX SUPERFICIAL WOUND DEHISCENCE W/PACKING","81001 - URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY","82157 - HC CHG ANDROSTENEDIONE","64505 - INJECTION ANES AGENT SPHENOPALATINE GANGLION","12031 - REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<"]
[null,"12057 - HC LAYR CLOS WND FACE,FACIAL >30 CM","81207 - HC Q;P190 BCR-ABL 1","12034 - REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM","12034 - REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM","12034 - REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM","81002 - URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP","12031 - REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<","82164 - HC CHG ANGIOTENSIN I-CONVERTING ENZYME","82164 - HC CHG ANGIOTENSIN I-CONVERTING ENZYME","82164 - HC CHG ANGIOTENSIN I-CONVERTING ENZYME","81002 - URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP","12032 - REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM","82164 - HC CHG ANGIOTENSIN I-CONVERTING ENZYME","12031 - REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<","81002 - URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP","82164 - HC CHG ANGIOTENSIN I-CONVERTING ENZYME","64510 - NJX ANES STELLATE GANGLION CRV SYMPATHETIC","12032 - REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM"]
[null,"13100 - REPAIR COMPLEX TRUNK 1.1-2.5 CM","81210 - HC CHG BRAF GENE ANALYSIS V600 VARIANT(S)","12035 - REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM","12035 - REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM","12035 - REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM","81003 - URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY","12032 - REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM","82172 - HC CHG APOLIPOPROTEIN EACH","82172 - HC CHG APOLIPOPROTEIN EACH","82172 - HC CHG APOLIPOPROTEIN EACH","81003 - URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY","12034 - REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM","82172 - HC CHG APOLIPOPROTEIN EACH","12032 - REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM","81003 - URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY","82172 - HC CHG APOLIPOPROTEIN EACH","64520 - INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC","12034 - REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM"]
[null,"13101 - REPAIR COMPLEX TRUNK 2.6-7.5 CM","81218 - HC CEBPA GENE ANALYSIS FULL GENE SEQUENC","12036 - HC LAYR CLOS WND TRUNK, ARM, LEG 20.1-30 CM","12036 - HC LAYR CLOS WND TRUNK, ARM, LEG 20.1-30 CM","12036 - HC LAYR CLOS WND TRUNK, ARM, LEG 20.1-30 CM","81015 - HC CHG URINALYSIS MICROSCOPIC ONLY","12034 - REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM","82175 - HC CHG ASSAY OF ARSENIC","82175 - HC CHG ASSAY OF ARSENIC","82175 - HC CHG ASSAY OF ARSENIC","81015 - HC CHG URINALYSIS MICROSCOPIC ONLY","12035 - REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM","82175 - HC CHG ASSAY OF ARSENIC","12034 - REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM","81015 - HC CHG URINALYSIS MICROSCOPIC ONLY","82175 - HC CHG ASSAY OF ARSENIC","64530 - INJX ANES CELIAC PLEXUS W/WO RADIOLOGIC MONITRNG","12035 - REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM"]
[null,"13102 - REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<","81220 - HC CHG CFTR GENE ANALYSIS COMMON VARIANTS","12037 - REPAIR INTERMEDIATE S/A/T/E >30.0 CM","12037 - REPAIR INTERMEDIATE S/A/T/E >30.0 CM","12037 - REPAIR INTERMEDIATE S/A/T/E >30.0 CM","81025 - URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS","12035 - REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM","82180 - HC CHG ASSAY OF ASCORBIC ACID BLOOD","82180 - HC CHG ASSAY OF ASCORBIC ACID BLOOD","82180 - HC CHG ASSAY OF ASCORBIC ACID BLOOD","81025 - URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS","12036 - HC LAYR CLOS WND TRUNK, ARM, LEG 20.1-30 CM","82180 - HC CHG ASSAY OF ASCORBIC ACID BLOOD","12035 - REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM","81025 - URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS","82180 - HC CHG ASSAY OF ASCORBIC ACID BLOOD","70010 - HC CHG MYELOGRAPHY POST FOSSA","12036 - HC LAYR CLOS WND TRUNK, ARM, LEG 20.1-30 CM"]
[null,"13120 - REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM","81221 - HC CHG CFTR GENE ANALYSIS KNOWN FAMILIAL VARIANTS","12041 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<","12041 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<","12041 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<","81050 - HC CHG VOLUME MEASUREMENT TIMED COLLECTION EACH","12036 - HC LAYR CLOS WND TRUNK, ARM, LEG 20.1-30 CM","82232 - HC CHG BETA-2 MICROGLOBULIN","82232 - HC CHG BETA-2 MICROGLOBULIN","82232 - HC CHG BETA-2 MICROGLOBULIN","81050 - HC CHG VOLUME MEASUREMENT TIMED COLLECTION EACH","12037 - REPAIR INTERMEDIATE S/A/T/E >30.0 CM","82232 - HC CHG BETA-2 MICROGLOBULIN","12036 - HC LAYR CLOS WND TRUNK, ARM, LEG 20.1-30 CM","81050 - HC CHG VOLUME MEASUREMENT TIMED COLLECTION EACH","82232 - HC CHG BETA-2 MICROGLOBULIN","70030 - HC CHG RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY","12037 - REPAIR INTERMEDIATE S/A/T/E >30.0 CM"]
[null,"13121 - REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM","81222 - HC GEN CYSTIC FIBROSIS DEL/DUP","12042 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM","12042 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM","12042 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM","81161 - HC DMD DUPLICATION/DELETION ANALYSIS","12037 - REPAIR INTERMEDIATE S/A/T/E >30.0 CM","82247 - HC CHG BILIRUBIN TOTAL","82247 - HC CHG BILIRUBIN TOTAL","82247 - HC CHG BILIRUBIN TOTAL","81161 - HC DMD DUPLICATION/DELETION ANALYSIS","12041 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<","82247 - HC CHG BILIRUBIN TOTAL","12037 - REPAIR INTERMEDIATE S/A/T/E >30.0 CM","81161 - HC DMD DUPLICATION/DELETION ANALYSIS","82247 - HC CHG BILIRUBIN TOTAL","70100 - HC CHG RADIOLOGIC EXAMINATION MANDIPLE PRTL <4 VIEWS","12041 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<"]
[null,"13122 - REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<","81223 - HC CFTR GENE ANALYSIS FULL GENE SEQUENCE","12044 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM","12044 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM","12044 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM","81178 - HC CHG ATXN1 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","12041 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<","82248 - HC CHG BILIRUBIN DIRECT","82248 - HC CHG BILIRUBIN DIRECT","82248 - HC CHG BILIRUBIN DIRECT","81178 - HC CHG ATXN1 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","12042 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM","82248 - HC CHG BILIRUBIN DIRECT","12041 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<","81178 - HC CHG ATXN1 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","82248 - HC CHG BILIRUBIN DIRECT","70110 - HC CHG RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS","12042 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM"]
[null,"13131 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM","81229 - HC CYTOG ALYS CHRML ABNR SNPCGH","12045 - HC LAYR CLOS WND REST BODY 12.6-20 CM","12045 - HC LAYR CLOS WND REST BODY 12.6-20 CM","12045 - HC LAYR CLOS WND REST BODY 12.6-20 CM","81179 - HC CHG ATXN2 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","12042 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM","82270 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER","82270 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER","82270 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER","81179 - HC CHG ATXN2 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","12044 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM","82270 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER","12042 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM","81179 - HC CHG ATXN2 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","82270 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER","70130 - HC CHG RADEX MASTOIDS COMPL MINIMUM 3 VIEWS SIDE","12044 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM"]
[null,"13132 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM","81235 - HC CHG EGFR GENE ANALYSIS COMMON VARIANTS","12046 - HC LAYR CLOS WND REST BODY 20.1-30 CM","12046 - HC LAYR CLOS WND REST BODY 20.1-30 CM","12046 - HC LAYR CLOS WND REST BODY 20.1-30 CM","81180 - HC CHG ATXN3 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","12044 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM","82271 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES","82271 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES","82271 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES","81180 - HC CHG ATXN3 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","12045 - HC LAYR CLOS WND REST BODY 12.6-20 CM","82271 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES","12044 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM","81180 - HC CHG ATXN3 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","82271 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES","70140 - HC CHG RADEX FACIAL BONES < 3 VIEWS","12045 - HC LAYR CLOS WND REST BODY 12.6-20 CM"]
[null,"13133 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<","81240 - HC CHG F2 GENE ANALYSIS 20210G >A VARIANT","12047 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM","12047 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM","12047 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM","81206 - HC CHG BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE","12045 - HC LAYR CLOS WND REST BODY 12.6-20 CM","82274 - HC CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3","82274 - HC CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3","82274 - HC CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3","81206 - HC CHG BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE","12046 - HC LAYR CLOS WND REST BODY 20.1-30 CM","82274 - HC CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3","12045 - HC LAYR CLOS WND REST BODY 12.6-20 CM","81206 - HC CHG BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE","82274 - HC CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3","70150 - HC CHG RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS","12046 - HC LAYR CLOS WND REST BODY 20.1-30 CM"]
[null,"13151 - REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM","81241 - HC CHG F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT","12051 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<","12051 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<","12051 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<","81207 - HC Q;P190 BCR-ABL 1","12046 - HC LAYR CLOS WND REST BODY 20.1-30 CM","82306 - HC CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED","82306 - HC CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED","82306 - HC CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED","81207 - HC Q;P190 BCR-ABL 1","12047 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM","82306 - HC CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED","12046 - HC LAYR CLOS WND REST BODY 20.1-30 CM","81207 - HC Q;P190 BCR-ABL 1","82306 - HC CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED","70160 - RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS","12047 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM"]
[null,"13152 - REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM","81243 - HC CHG FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES","12052 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM","12052 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM","12052 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM","81210 - HC CHG BRAF GENE ANALYSIS V600 VARIANT(S)","12047 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM","82308 - HC CHG CALCITONIN","82308 - HC CHG CALCITONIN","82308 - HC CHG CALCITONIN","81210 - HC CHG BRAF GENE ANALYSIS V600 VARIANT(S)","12051 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<","82308 - HC CHG CALCITONIN","12047 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM","81210 - HC CHG BRAF GENE ANALYSIS V600 VARIANT(S)","82308 - HC CHG CALCITONIN","70200 - HC CHG RADEX ORBITS COMPLETE MINIMUM 4 VIEWS","12051 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<"]
[null,"13160 - SECONDARY CLOSURE SURG WOUND/DEHSN EXTSV/COMPLIC","81252 - HC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCEHC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCE","12053 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM","12053 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM","12053 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM","81218 - HC CEBPA GENE ANALYSIS FULL GENE SEQUENC","12051 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<","82310 - HC CHG CALCIUM TOTAL","82310 - HC CHG CALCIUM TOTAL","82310 - HC CHG CALCIUM TOTAL","81218 - HC CEBPA GENE ANALYSIS FULL GENE SEQUENC","12052 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM","82310 - HC CHG CALCIUM TOTAL","12051 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<","81218 - HC CEBPA GENE ANALYSIS FULL GENE SEQUENC","82310 - HC CHG CALCIUM TOTAL","70210 - HC CHG RADEX SINUSES PARANASAL <3 VIEWS","12052 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM"]
[null,"14000 - ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<","81253 - HC CHG GJB2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS","12054 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM","12054 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM","12054 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM","81220 - HC CHG CFTR GENE ANALYSIS COMMON VARIANTS","12052 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM","82330 - HC CHG CALCIUM IONIZED","82330 - HC CHG CALCIUM IONIZED","82330 - HC CHG CALCIUM IONIZED","81220 - HC CHG CFTR GENE ANALYSIS COMMON VARIANTS","12053 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM","82330 - HC CHG CALCIUM IONIZED","12052 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM","81220 - HC CHG CFTR GENE ANALYSIS COMMON VARIANTS","82330 - HC CHG CALCIUM IONIZED","70220 - HC CHG RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS","12053 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM"]
[null,"14001 - ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM","81254 - HC CHG GJB6 GENE ANALYSIS COMMON VARIANTS","12055 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM","12055 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM","12055 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM","81221 - HC CHG CFTR GENE ANALYSIS KNOWN FAMILIAL VARIANTS","12053 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM","82340 - HC Q;KID STONE, UR CALCIUM","82340 - HC Q;KID STONE, UR CALCIUM","82340 - HC Q;KID STONE, UR CALCIUM","81221 - HC CHG CFTR GENE ANALYSIS KNOWN FAMILIAL VARIANTS","12054 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM","82340 - HC Q;KID STONE, UR CALCIUM","12053 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM","81221 - HC CHG CFTR GENE ANALYSIS KNOWN FAMILIAL VARIANTS","82340 - HC Q;KID STONE, UR CALCIUM","70250 - RADIOLOGIC EXAMINATION SKULL 4/> VIEWS","12054 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM"]
[null,"14020 - ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<","81256 - HC CHG HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS","12056 - HC LAYR CLOS WND FACE,FACIAL 20.1-30 CM","12056 - HC LAYR CLOS WND FACE,FACIAL 20.1-30 CM","12056 - HC LAYR CLOS WND FACE,FACIAL 20.1-30 CM","81222 - HC GEN CYSTIC FIBROSIS DEL/DUP","12054 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM","82365 - HC CHG CALCULUS INFRARED SPECTROSCOPY","82365 - HC CHG CALCULUS INFRARED SPECTROSCOPY","82365 - HC CHG CALCULUS INFRARED SPECTROSCOPY","81222 - HC GEN CYSTIC FIBROSIS DEL/DUP","12055 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM","82365 - HC CHG CALCULUS INFRARED SPECTROSCOPY","12054 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM","81222 - HC GEN CYSTIC FIBROSIS DEL/DUP","82365 - HC CHG CALCULUS INFRARED SPECTROSCOPY","70260 - HC CHG RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS","12055 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM"]
[null,"14021 - ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM","81257 - HC CHG HBA1/HBA2 ANALYSIS FOR COMMON DELETIONS/VARIANT","12057 - HC LAYR CLOS WND FACE,FACIAL >30 CM","12057 - HC LAYR CLOS WND FACE,FACIAL >30 CM","12057 - HC LAYR CLOS WND FACE,FACIAL >30 CM","81223 - HC CFTR GENE ANALYSIS FULL GENE SEQUENCE","12055 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM","82374 - HC CHG CARBON DIOXIDE BICARBONATE","82374 - HC CHG CARBON DIOXIDE BICARBONATE","82374 - HC CHG CARBON DIOXIDE BICARBONATE","81223 - HC CFTR GENE ANALYSIS FULL GENE SEQUENCE","12056 - HC LAYR CLOS WND FACE,FACIAL 20.1-30 CM","82374 - HC CHG CARBON DIOXIDE BICARBONATE","12055 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM","81223 - HC CFTR GENE ANALYSIS FULL GENE SEQUENCE","82374 - HC CHG CARBON DIOXIDE BICARBONATE","70300 - RADIOLOGIC EXAMINATION TEETH 1 VIEW","12056 - HC LAYR CLOS WND FACE,FACIAL 20.1-30 CM"]
[null,"14040 - ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<","81259 - HC HBA1/HBA2 GENE ANALYSIS FULL GENE SEQUENCE","13100 - REPAIR COMPLEX TRUNK 1.1-2.5 CM","13100 - REPAIR COMPLEX TRUNK 1.1-2.5 CM","13100 - REPAIR COMPLEX TRUNK 1.1-2.5 CM","81229 - HC CYTOG ALYS CHRML ABNR SNPCGH","12056 - HC LAYR CLOS WND FACE,FACIAL 20.1-30 CM","82375 - HC CHG CARBOXYHEMOGLOBIN QUANTITATIVE","82375 - HC CHG CARBOXYHEMOGLOBIN QUANTITATIVE","82375 - HC CHG CARBOXYHEMOGLOBIN QUANTITATIVE","81229 - HC CYTOG ALYS CHRML ABNR SNPCGH","12057 - HC LAYR CLOS WND FACE,FACIAL >30 CM","82375 - HC CHG CARBOXYHEMOGLOBIN QUANTITATIVE","12056 - HC LAYR CLOS WND FACE,FACIAL 20.1-30 CM","81229 - HC CYTOG ALYS CHRML ABNR SNPCGH","82375 - HC CHG CARBOXYHEMOGLOBIN QUANTITATIVE","70310 - RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH","12057 - HC LAYR CLOS WND FACE,FACIAL >30 CM"]
[null,"14041 - ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM","81261 - IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED; PRO/TECH","13101 - REPAIR COMPLEX TRUNK 2.6-7.5 CM","13101 - REPAIR COMPLEX TRUNK 2.6-7.5 CM","13101 - REPAIR COMPLEX TRUNK 2.6-7.5 CM","81235 - HC CHG EGFR GENE ANALYSIS COMMON VARIANTS","12057 - HC LAYR CLOS WND FACE,FACIAL >30 CM","82378 - HC CHG CARCINOEMBRYONIC ANTIGEN CEA","82378 - HC CHG CARCINOEMBRYONIC ANTIGEN CEA","82378 - HC CHG CARCINOEMBRYONIC ANTIGEN CEA","81235 - HC CHG EGFR GENE ANALYSIS COMMON VARIANTS","13100 - REPAIR COMPLEX TRUNK 1.1-2.5 CM","82378 - HC CHG CARCINOEMBRYONIC ANTIGEN CEA","12057 - HC LAYR CLOS WND FACE,FACIAL >30 CM","81235 - HC CHG EGFR GENE ANALYSIS COMMON VARIANTS","82378 - HC CHG CARCINOEMBRYONIC ANTIGEN CEA","70320 - RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH","13100 - REPAIR COMPLEX TRUNK 1.1-2.5 CM"]
[null,"14060 - ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<","81269 - HC HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIENTS","13102 - REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<","13102 - REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<","13102 - REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<","81240 - HC CHG F2 GENE ANALYSIS 20210G >A VARIANT","13100 - REPAIR COMPLEX TRUNK 1.1-2.5 CM","82379 - HC CRL;CARNITINE","82379 - HC CRL;CARNITINE","82379 - HC CRL;CARNITINE","81240 - HC CHG F2 GENE ANALYSIS 20210G >A VARIANT","13101 - REPAIR COMPLEX TRUNK 2.6-7.5 CM","82379 - HC CRL;CARNITINE","13100 - REPAIR COMPLEX TRUNK 1.1-2.5 CM","81240 - HC CHG F2 GENE ANALYSIS 20210G >A VARIANT","82379 - HC CRL;CARNITINE","70328 - RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT","13101 - REPAIR COMPLEX TRUNK 2.6-7.5 CM"]
[null,"14061 - ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM","81270 - HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT","13120 - REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM","13120 - REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM","13120 - REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM","81241 - HC CHG F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT","13101 - REPAIR COMPLEX TRUNK 2.6-7.5 CM","82384 - HC CHG CATECHOLAMINES FRACTIONATED","82384 - HC CHG CATECHOLAMINES FRACTIONATED","82384 - HC CHG CATECHOLAMINES FRACTIONATED","81241 - HC CHG F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT","13102 - REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<","82384 - HC CHG CATECHOLAMINES FRACTIONATED","13101 - REPAIR COMPLEX TRUNK 2.6-7.5 CM","81241 - HC CHG F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT","82384 - HC CHG CATECHOLAMINES FRACTIONATED","70330 - RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT","13102 - REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<"]
[null,"14301 - ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM","81271 - HC HTT GENE ANALYSIS DECTECT ABNORMAL ALLELES","13121 - REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM","13121 - REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM","13121 - REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM","81243 - HC CHG FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES","13102 - REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<","82390 - HC CHG CERULOPLASMIN","82390 - HC CHG CERULOPLASMIN","82390 - HC CHG CERULOPLASMIN","81243 - HC CHG FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES","13120 - REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM","82390 - HC CHG CERULOPLASMIN","13102 - REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<","81243 - HC CHG FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES","82390 - HC CHG CERULOPLASMIN","70336 - HC CHG MRI TEMPOROMANDIBULAR JOINT","13120 - REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM"]
[null,"14302 - ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM/<","81272 - HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS","13122 - REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<","13122 - REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<","13122 - REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<","81252 - HC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCEHC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCE","13120 - REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM","82397 - HC CHEMILUMINESCENT ASSAY","82397 - HC CHEMILUMINESCENT ASSAY","82397 - HC CHEMILUMINESCENT ASSAY","81252 - HC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCEHC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCE","13121 - REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM","82397 - HC CHEMILUMINESCENT ASSAY","13120 - REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM","81252 - HC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCEHC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCE","82397 - HC CHEMILUMINESCENT ASSAY","70350 - HC CHG CEPHALOGRAM ORTHODONTIC","13121 - REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM"]
[null,"15002 - PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT","81274 - HC HTT GENE ANALYSIS CHARACTERIZATION ALLELES","13131 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM","13131 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM","13131 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM","81253 - HC CHG GJB2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS","13121 - REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM","82435 - HC CHG CHLORIDE BLD","82435 - HC CHG CHLORIDE BLD","82435 - HC CHG CHLORIDE BLD","81253 - HC CHG GJB2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS","13122 - REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<","82435 - HC CHG CHLORIDE BLD","13121 - REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM","81253 - HC CHG GJB2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS","82435 - HC CHG CHLORIDE BLD","70355 - ORTHOPANTOGRAM","13122 - REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<"]
[null,"15003 - HC WOUND PREP, PED, TRK/ARM/LG ADDL 100 CM","81275 - HC CHG KRAS GENE ANALYSIS VARIANTS IN EXON 2","13132 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM","13132 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM","13132 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM","81254 - HC CHG GJB6 GENE ANALYSIS COMMON VARIANTS","13122 - REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<","82436 - HC CHG CHLORIDE URINE","82436 - HC CHG CHLORIDE URINE","82436 - HC CHG CHLORIDE URINE","81254 - HC CHG GJB6 GENE ANALYSIS COMMON VARIANTS","13131 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM","82436 - HC CHG CHLORIDE URINE","13122 - REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<","81254 - HC CHG GJB6 GENE ANALYSIS COMMON VARIANTS","82436 - HC CHG CHLORIDE URINE","70360 - HC CHG RADIOLOGIC EXAMINATION NECK SOFT TISSUE","13131 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM"]
[null,"15004 - PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT","81276 - HC CHG KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)","13133 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<","13133 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<","13133 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<","81256 - HC CHG HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS","13131 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM","82438 - HC CHG CHLORIDE OTHER SOURCE","82438 - HC CHG CHLORIDE OTHER SOURCE","82438 - HC CHG CHLORIDE OTHER SOURCE","81256 - HC CHG HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS","13132 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM","82438 - HC CHG CHLORIDE OTHER SOURCE","13131 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM","81256 - HC CHG HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS","82438 - HC CHG CHLORIDE OTHER SOURCE","70370 - HC CHG RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ","13132 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM"]
[null,"15050 - PINCH GRAFT 1/MLT SM ULCER TIP/OTH AREA 2CM","81288 - MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS","13151 - REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM","13151 - REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM","13151 - REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM","81257 - HC CHG HBA1/HBA2 ANALYSIS FOR COMMON DELETIONS/VARIANT","13132 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM","82465 - CHOLESTEROL SERUM/WHOLE BLOOD TOTAL","82465 - CHOLESTEROL SERUM/WHOLE BLOOD TOTAL","82465 - CHOLESTEROL SERUM/WHOLE BLOOD TOTAL","81257 - HC CHG HBA1/HBA2 ANALYSIS FOR COMMON DELETIONS/VARIANT","13133 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<","82465 - CHOLESTEROL SERUM/WHOLE BLOOD TOTAL","13132 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM","81257 - HC CHG HBA1/HBA2 ANALYSIS FOR COMMON DELETIONS/VARIANT","82465 - CHOLESTEROL SERUM/WHOLE BLOOD TOTAL","70380 - HC X-RAY SALIVARY GLAND","13133 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<"]
[null,"15100 - HC SKIN SPLT GRFT TRNK/ARM/LEG","81291 - HC CHG MTHFR GENE ANALYSIS COMMON VARIANTS","13152 - REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM","13152 - REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM","13152 - REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM","81259 - HC HBA1/HBA2 GENE ANALYSIS FULL GENE SEQUENCE","13133 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<","82495 - HC CHG ASSAY OF CHROMIUM","82495 - HC CHG ASSAY OF CHROMIUM","82495 - HC CHG ASSAY OF CHROMIUM","81259 - HC HBA1/HBA2 GENE ANALYSIS FULL GENE SEQUENCE","13151 - REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM","82495 - HC CHG ASSAY OF CHROMIUM","13133 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<","81259 - HC HBA1/HBA2 GENE ANALYSIS FULL GENE SEQUENCE","82495 - HC CHG ASSAY OF CHROMIUM","70390 - HC SIALOGRAPHY","13151 - REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM"]
[null,"15120 - HB SPLIT GRFT,HEAD,FAC,HAND,FEET <100 SQCM","81301 - HC CHG MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF","13160 - SECONDARY CLOSURE SURG WOUND/DEHSN EXTSV/COMPLIC","13160 - SECONDARY CLOSURE SURG WOUND/DEHSN EXTSV/COMPLIC","13160 - SECONDARY CLOSURE SURG WOUND/DEHSN EXTSV/COMPLIC","81261 - IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED; PRO/TECH","13151 - REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM","82507 - HC CHG ASSAY OF CITRATE","82507 - HC CHG ASSAY OF CITRATE","82507 - HC CHG ASSAY OF CITRATE","81261 - IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED; PRO/TECH","13152 - REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM","82507 - HC CHG ASSAY OF CITRATE","13151 - REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM","81261 - IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED; PRO/TECH","82507 - HC CHG ASSAY OF CITRATE","70450 - HC CHG CT HEAD/BRAIN W/O CONTRAST MATERIAL","13152 - REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM"]
[null,"15220 - HC FULL THICK GRFT SCALP, ARM, LEG, <20SQC","81302 - HC Q;RETT SYN ANLY","14000 - ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<","14000 - ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<","14000 - ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<","81269 - HC HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIENTS","13152 - REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM","82523 - HC CHG COLLAGEN CROSS LINKS ANY METHOD","82523 - HC CHG COLLAGEN CROSS LINKS ANY METHOD","82523 - HC CHG COLLAGEN CROSS LINKS ANY METHOD","81269 - HC HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIENTS","13160 - SECONDARY CLOSURE SURG WOUND/DEHSN EXTSV/COMPLIC","82523 - HC CHG COLLAGEN CROSS LINKS ANY METHOD","13152 - REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM","81269 - HC HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIENTS","82523 - HC CHG COLLAGEN CROSS LINKS ANY METHOD","70460 - HC CHG CT HEAD/BRAIN W/CONTRAST MATERIAL","13160 - SECONDARY CLOSURE SURG WOUND/DEHSN EXTSV/COMPLIC"]
[null,"15240 - FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20 CM/<","81304 - HC MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT","14001 - ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM","14001 - ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM","14001 - ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM","81270 - HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT","13160 - SECONDARY CLOSURE SURG WOUND/DEHSN EXTSV/COMPLIC","82525 - HC CHG ASSAY OF COPPER","82525 - HC CHG ASSAY OF COPPER","82525 - HC CHG ASSAY OF COPPER","81270 - HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT","14000 - ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<","82525 - HC CHG ASSAY OF COPPER","13160 - SECONDARY CLOSURE SURG WOUND/DEHSN EXTSV/COMPLIC","81270 - HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT","82525 - HC CHG ASSAY OF COPPER","70470 - HC CHG CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL","14000 - ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<"]
[null,"15241 - FTH/GT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA20CM/<","81305 - HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT","14020 - ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<","14020 - ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<","14020 - ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<","81271 - HC HTT GENE ANALYSIS DECTECT ABNORMAL ALLELES","14000 - ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<","82530 - HC CHG CORTISOL FREE","82530 - HC CHG CORTISOL FREE","82530 - HC CHG CORTISOL FREE","81271 - HC HTT GENE ANALYSIS DECTECT ABNORMAL ALLELES","14001 - ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM","82530 - HC CHG CORTISOL FREE","14000 - ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<","81271 - HC HTT GENE ANALYSIS DECTECT ABNORMAL ALLELES","82530 - HC CHG CORTISOL FREE","70480 - HC CHG CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL","14001 - ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM"]
[null,"15260 - FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/<","81311 - HC CHG NRAS GENE ANALYSIS VARIANTS IN EXON 2&3","14021 - ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM","14021 - ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM","14021 - ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM","81272 - HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS","14001 - ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM","82533 - HC CHG CORTISOL TOTAL","82533 - HC CHG CORTISOL TOTAL","82533 - HC CHG CORTISOL TOTAL","81272 - HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS","14020 - ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<","82533 - HC CHG CORTISOL TOTAL","14001 - ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM","81272 - HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS","82533 - HC CHG CORTISOL TOTAL","70481 - HC CHG CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL","14020 - ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<"]
[null,"15271 - APP SKN SUB GRFT T/A/L AREA/100SCM /<1ST 25","81315 - HC PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT","14040 - ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<","14040 - ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<","14040 - ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<","81274 - HC HTT GENE ANALYSIS CHARACTERIZATION ALLELES","14020 - ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<","82540 - HC CHG ASSAY OF CREATINE","82540 - HC CHG ASSAY OF CREATINE","82540 - HC CHG ASSAY OF CREATINE","81274 - HC HTT GENE ANALYSIS CHARACTERIZATION ALLELES","14021 - ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM","82540 - HC CHG ASSAY OF CREATINE","14020 - ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<","81274 - HC HTT GENE ANALYSIS CHARACTERIZATION ALLELES","82540 - HC CHG ASSAY OF CREATINE","70482 - HC CHG CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR","14021 - ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM"]
[null,"15272 - APP SKN SUB GRFT T/A/L AREA/100SCM EA ADL 25SC","81329 - HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS","14041 - ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM","14041 - ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM","14041 - ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM","81275 - HC CHG KRAS GENE ANALYSIS VARIANTS IN EXON 2","14021 - ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM","82542 - HC CHG COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC","82542 - HC CHG COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC","82542 - HC CHG COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC","81275 - HC CHG KRAS GENE ANALYSIS VARIANTS IN EXON 2","14040 - ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<","82542 - HC CHG COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC","14021 - ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM","81275 - HC CHG KRAS GENE ANALYSIS VARIANTS IN EXON 2","82542 - HC CHG COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC","70486 - HC CHG CT MAXILLOFACIAL W/O CONTRAST MATERIAL","14040 - ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<"]
[null,"15273 - HC APP SKN SUB GRFT T/A/L AREA/>100SCM 1ST 100SCM","81331 - HC PRADER-WILLI/ANGELMAN","14060 - ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<","14060 - ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<","14060 - ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<","81276 - HC CHG KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)","14040 - ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<","82550 - HC CHG CREATINE KINASE TOTAL","82550 - HC CHG CREATINE KINASE TOTAL","82550 - HC CHG CREATINE KINASE TOTAL","81276 - HC CHG KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)","14041 - ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM","82550 - HC CHG CREATINE KINASE TOTAL","14040 - ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<","81276 - HC CHG KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)","82550 - HC CHG CREATINE KINASE TOTAL","70487 - HC CHG CT MAXILLOFACIAL W/CONTRAST MATERIAL","14041 - ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM"]
[null,"15274 - HC APP SKN SUB GRFT T/A/L AREA/>100SCM ADL 100SCM","81342 - TRG@ GENE REARRANGEMENT ANALYSIS; PRO/TECH","14061 - ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM","14061 - ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM","14061 - ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM","81277 - HC CYTOGENOMIC NEO MICRORA ALYS","14041 - ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM","82553 - HC CHG CREATINE KINASE MB FRACTION ONLY","82553 - HC CHG CREATINE KINASE MB FRACTION ONLY","82553 - HC CHG CREATINE KINASE MB FRACTION ONLY","81277 - HC CYTOGENOMIC NEO MICRORA ALYS","14060 - ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<","82553 - HC CHG CREATINE KINASE MB FRACTION ONLY","14041 - ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM","81277 - HC CYTOGENOMIC NEO MICRORA ALYS","82553 - HC CHG CREATINE KINASE MB FRACTION ONLY","70488 - HC CHG CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL","14060 - ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<"]
[null,"15275 - SUB GRFT F/S/N/H/F/G/M/D <100SCM 1ST 25 SCM","81350 - HC CHG UGT1A1 GENE ANALYSIS COMMON VARIANTS","14301 - ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM","14301 - ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM","14301 - ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM","81288 - MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS","14060 - ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<","82565 - HC CHG CREATININE BLOOD","82565 - HC CHG CREATININE BLOOD","82565 - HC CHG CREATININE BLOOD","81288 - MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS","14061 - ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM","82565 - HC CHG CREATININE BLOOD","14060 - ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<","81288 - MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS","82565 - HC CHG CREATININE BLOOD","70490 - HC CHG CT SOFT TISSUE NECK W/O CONTRAST MATERIAL","14061 - ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM"]
[null,"15276 - SUB GRFT F/S/N/H/F/G/M/D <100SCM EA ADDL 25 SCM","81363 - HC HBB DUPLICATION/DELETION VARIANTS","14302 - ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM/<","14302 - ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM/<","14302 - ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM/<","81291 - HC CHG MTHFR GENE ANALYSIS COMMON VARIANTS","14061 - ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM","82570 - HC CHG CREATININE OTHER SOURCE","82570 - HC CHG CREATININE OTHER SOURCE","82570 - HC CHG CREATININE OTHER SOURCE","81291 - HC CHG MTHFR GENE ANALYSIS COMMON VARIANTS","14301 - ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM","82570 - HC CHG CREATININE OTHER SOURCE","14061 - ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM","81291 - HC CHG MTHFR GENE ANALYSIS COMMON VARIANTS","82570 - HC CHG CREATININE OTHER SOURCE","70491 - HC CHG CT SOFT TISSUE NECK W/CONTRAST MATERIAL","14301 - ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM"]
[null,"15277 - HC SUB GRFT F/S/N/H/F/G/M/D />100SCM 1ST 100SCM","81364 - HC HBB FULL GENE SEQUENCE","15002 - PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT","15002 - PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT","15002 - PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT","81301 - HC CHG MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF","14301 - ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM","82575 - HC CHG CREATININE CLEARANCE","82575 - HC CHG CREATININE CLEARANCE","82575 - HC CHG CREATININE CLEARANCE","81301 - HC CHG MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF","14302 - ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM/<","82575 - HC CHG CREATININE CLEARANCE","14301 - ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM","81301 - HC CHG MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF","82575 - HC CHG CREATININE CLEARANCE","70492 - HC CHG CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL","14302 - ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM/<"]
[null,"15278 - HC SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM ADL 100SQ CM","81401 - HC CHG, MOLECULAR PATHOLOGY PROCEDURE LEVEL 2","15003 - HC WOUND PREP, PED, TRK/ARM/LG ADDL 100 CM","15003 - HC WOUND PREP, PED, TRK/ARM/LG ADDL 100 CM","15003 - HC WOUND PREP, PED, TRK/ARM/LG ADDL 100 CM","81302 - HC Q;RETT SYN ANLY","14302 - ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM/<","82585 - HC CHG ASSAY OF CRYOFIBRN","82585 - HC CHG ASSAY OF CRYOFIBRN","82585 - HC CHG ASSAY OF CRYOFIBRN","81302 - HC Q;RETT SYN ANLY","15002 - PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT","82585 - HC CHG ASSAY OF CRYOFIBRN","14302 - ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM/<","81302 - HC Q;RETT SYN ANLY","82585 - HC CHG ASSAY OF CRYOFIBRN","70496 - HC CHG CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST","15002 - PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT"]
[null,"15620 - DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F","81402 - HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 3","15004 - PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT","15004 - PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT","15004 - PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT","81304 - HC MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT","15002 - PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT","82595 - HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE","82595 - HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE","82595 - HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE","81304 - HC MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT","15003 - HC WOUND PREP, PED, TRK/ARM/LG ADDL 100 CM","82595 - HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE","15002 - PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT","81304 - HC MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT","82595 - HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE","70498 - HC CHG CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST","15003 - HC WOUND PREP, PED, TRK/ARM/LG ADDL 100 CM"]
[null,"15630 - HC DELAY/SECTN FLAP LID,NOS,EAR,LIP","81403 - SEQ & EXON 13 SEQ, IF PERFORMED KRAS (EG, CARCINOMA), GENE ANALYSIS, PRO/TECH","15050 - PINCH GRAFT 1/MLT SM ULCER TIP/OTH AREA 2CM","15050 - PINCH GRAFT 1/MLT SM ULCER TIP/OTH AREA 2CM","15050 - PINCH GRAFT 1/MLT SM ULCER TIP/OTH AREA 2CM","81305 - HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT","15003 - HC WOUND PREP, PED, TRK/ARM/LG ADDL 100 CM","82607 - HC CHG CYANOCOBALAMIN VITAMIN B-12","82607 - HC CHG CYANOCOBALAMIN VITAMIN B-12","82607 - HC CHG CYANOCOBALAMIN VITAMIN B-12","81305 - HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT","15004 - PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT","82607 - HC CHG CYANOCOBALAMIN VITAMIN B-12","15003 - HC WOUND PREP, PED, TRK/ARM/LG ADDL 100 CM","81305 - HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT","82607 - HC CHG CYANOCOBALAMIN VITAMIN B-12","70540 - HC CHG MRI ORBIT FACE &/NECK W/O CONTRAST","15004 - PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT"]
[null,"15731 - FOREHEAD FLAP W/VASC PEDICLE","81404 - VHL (EG, VON HIPPEL-LINDAUFAMILIAL CANCER SYNDROME, FULL GENE SEQ VWF PRO/TECH","15100 - HC SKIN SPLT GRFT TRNK/ARM/LEG","15100 - HC SKIN SPLT GRFT TRNK/ARM/LEG","15100 - HC SKIN SPLT GRFT TRNK/ARM/LEG","81307 - HC PALB2 GENE FULL GENE SEQ","15004 - PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT","82626 - HC CHG DEHYDROEPIANDROSTERONE","82626 - HC CHG DEHYDROEPIANDROSTERONE","82626 - HC CHG DEHYDROEPIANDROSTERONE","81307 - HC PALB2 GENE FULL GENE SEQ","15050 - PINCH GRAFT 1/MLT SM ULCER TIP/OTH AREA 2CM","82626 - HC CHG DEHYDROEPIANDROSTERONE","15004 - PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT","81307 - HC PALB2 GENE FULL GENE SEQ","82626 - HC CHG DEHYDROEPIANDROSTERONE","70542 - HC CHG MRI ORBIT FACE & NECK W/CONTRAST MATERIAL","15050 - PINCH GRAFT 1/MLT SM ULCER TIP/OTH AREA 2CM"]
[null,"15733 - HC MUSC MYOQ/FSCQ FLAP HEAD&NECK W/NAMED VASC PEDCL","81405 - HC MOPATH PROCEDURE LEVEL 6","15120 - HB SPLIT GRFT,HEAD,FAC,HAND,FEET <100 SQCM","15120 - HB SPLIT GRFT,HEAD,FAC,HAND,FEET <100 SQCM","15120 - HB SPLIT GRFT,HEAD,FAC,HAND,FEET <100 SQCM","81308 - HC PALB2 GENE KNOWN FAMIL VRNT","15050 - PINCH GRAFT 1/MLT SM ULCER TIP/OTH AREA 2CM","82627 - HC CHG DEHYDROEPIANDROSTERONE-SULFATE","82627 - HC CHG DEHYDROEPIANDROSTERONE-SULFATE","82627 - HC CHG DEHYDROEPIANDROSTERONE-SULFATE","81308 - HC PALB2 GENE KNOWN FAMIL VRNT","15100 - HC SKIN SPLT GRFT TRNK/ARM/LEG","82627 - HC CHG DEHYDROEPIANDROSTERONE-SULFATE","15050 - PINCH GRAFT 1/MLT SM ULCER TIP/OTH AREA 2CM","81308 - HC PALB2 GENE KNOWN FAMIL VRNT","82627 - HC CHG DEHYDROEPIANDROSTERONE-SULFATE","70543 - HC CHG MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL","15100 - HC SKIN SPLT GRFT TRNK/ARM/LEG"]
[null,"15769 - HC GRFG AUTOL SOFT TISS DIR EXC","81406 - HC CHG MOLECULAR PATHOLOGY PROCEDURE LEVEL 7","15220 - HC FULL THICK GRFT SCALP, ARM, LEG, <20SQC","15220 - HC FULL THICK GRFT SCALP, ARM, LEG, <20SQC","15220 - HC FULL THICK GRFT SCALP, ARM, LEG, <20SQC","81309 - HC PIK3CA GENE TRGT SEQ ALYS","15100 - HC SKIN SPLT GRFT TRNK/ARM/LEG","82652 - HC CHG 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED","82652 - HC CHG 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED","82652 - HC CHG 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED","81309 - HC PIK3CA GENE TRGT SEQ ALYS","15120 - HB SPLIT GRFT,HEAD,FAC,HAND,FEET <100 SQCM","82652 - HC CHG 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED","15100 - HC SKIN SPLT GRFT TRNK/ARM/LEG","81309 - HC PIK3CA GENE TRGT SEQ ALYS","82652 - HC CHG 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED","70544 - HC CHG MRA HEAD W/O CONTRST MATERIAL","15120 - HB SPLIT GRFT,HEAD,FAC,HAND,FEET <100 SQCM"]
[null,"15771 - HC GRFG AUTOL FAT LIPO 50 CC/<","81430 - HC CHG HEARING LOSS GENOMIC SEQUENCE ANALYSIS 60 GENES","15240 - FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20 CM/<","15240 - FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20 CM/<","15240 - FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20 CM/<","81311 - HC CHG NRAS GENE ANALYSIS VARIANTS IN EXON 2&3","15120 - HB SPLIT GRFT,HEAD,FAC,HAND,FEET <100 SQCM","82656 - HC CHG ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN","82656 - HC CHG ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN","82656 - HC CHG ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN","81311 - HC CHG NRAS GENE ANALYSIS VARIANTS IN EXON 2&3","15220 - HC FULL THICK GRFT SCALP, ARM, LEG, <20SQC","82656 - HC CHG ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN","15120 - HB SPLIT GRFT,HEAD,FAC,HAND,FEET <100 SQCM","81311 - HC CHG NRAS GENE ANALYSIS VARIANTS IN EXON 2&3","82656 - HC CHG ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN","70545 - HC CHG MRA HEAD W/CONTRAST MATERIAL","15220 - HC FULL THICK GRFT SCALP, ARM, LEG, <20SQC"]
[null,"15772 - HC GRFG AUTOL FAT LIPO EA ADDL","81431 - HC CHG HEARING LOSS DUP/DEL ANALYSIS","15241 - FTH/GT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA20CM/<","15241 - FTH/GT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA20CM/<","15241 - FTH/GT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA20CM/<","81315 - HC PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT","15220 - HC FULL THICK GRFT SCALP, ARM, LEG, <20SQC","82657 - HC CHG NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA","82657 - HC CHG NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA","82657 - HC CHG NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA","81315 - HC PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT","15240 - FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20 CM/<","82657 - HC CHG NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA","15220 - HC FULL THICK GRFT SCALP, ARM, LEG, <20SQC","81315 - HC PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT","82657 - HC CHG NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA","70546 - HC CHG MRA HEAD W/O & W/CONTRAST MATERIAL","15240 - FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20 CM/<"]
[null,"15773 - GRFG AUTOL FAT LIPO 25 CC/<","81450 - HC CHG GENOMIC SEQ ANALYS DNA&RNA ANALYS 5-50 GENE","15260 - FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/<","15260 - FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/<","15260 - FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/<","81329 - HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS","15240 - FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20 CM/<","82668 - HC CHG ASSAY OF ERYTHROPOIETIN","82668 - HC CHG ASSAY OF ERYTHROPOIETIN","82668 - HC CHG ASSAY OF ERYTHROPOIETIN","81329 - HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS","15241 - FTH/GT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA20CM/<","82668 - HC CHG ASSAY OF ERYTHROPOIETIN","15240 - FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20 CM/<","81329 - HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS","82668 - HC CHG ASSAY OF ERYTHROPOIETIN","70547 - HC CHG MRA NECK W/O CONTRST MATERIAL","15241 - FTH/GT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA20CM/<"]
[null,"15774 - HC GFRG AUTOL FAT LIPO EA ADDL","81479 - HC CHG UNLISTED MOLELCULAR PATHOLOGY PROCEDURE","15271 - APP SKN SUB GRFT T/A/L AREA/100SCM /<1ST 25","15271 - APP SKN SUB GRFT T/A/L AREA/100SCM /<1ST 25","15271 - APP SKN SUB GRFT T/A/L AREA/100SCM /<1ST 25","81331 - HC PRADER-WILLI/ANGELMAN","15241 - FTH/GT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA20CM/<","82670 - HC CHG ASSAY OF ESTRADIOL","82670 - HC CHG ASSAY OF ESTRADIOL","82670 - HC CHG ASSAY OF ESTRADIOL","81331 - HC PRADER-WILLI/ANGELMAN","15260 - FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/<","82670 - HC CHG ASSAY OF ESTRADIOL","15241 - FTH/GT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA20CM/<","81331 - HC PRADER-WILLI/ANGELMAN","82670 - HC CHG ASSAY OF ESTRADIOL","70548 - HC CHG MRA NECK W/CONTRAST MATERIAL","15260 - FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/<"]
[null,"15820 - HC REVISION OF LOWER EYELID","81596 - HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR","15272 - APP SKN SUB GRFT T/A/L AREA/100SCM EA ADL 25SC","15272 - APP SKN SUB GRFT T/A/L AREA/100SCM EA ADL 25SC","15272 - APP SKN SUB GRFT T/A/L AREA/100SCM EA ADL 25SC","81342 - TRG@ GENE REARRANGEMENT ANALYSIS; PRO/TECH","15260 - FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/<","82677 - HC CHG ASSAY OF ESTRIOL","82677 - HC CHG ASSAY OF ESTRIOL","82677 - HC CHG ASSAY OF ESTRIOL","81342 - TRG@ GENE REARRANGEMENT ANALYSIS; PRO/TECH","15271 - APP SKN SUB GRFT T/A/L AREA/100SCM /<1ST 25","82677 - HC CHG ASSAY OF ESTRIOL","15260 - FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/<","81342 - TRG@ GENE REARRANGEMENT ANALYSIS; PRO/TECH","82677 - HC CHG ASSAY OF ESTRIOL","70549 - HC MRA,NECK;W/WO","15271 - APP SKN SUB GRFT T/A/L AREA/100SCM /<1ST 25"]
[null,"15821 - HC REV LOWER EYELID EXTEN FAT PAD","81599 - HC Q;LIVER FIBRISUS ACT TEST","15273 - HC APP SKN SUB GRFT T/A/L AREA/>100SCM 1ST 100SCM","15273 - HC APP SKN SUB GRFT T/A/L AREA/>100SCM 1ST 100SCM","15273 - HC APP SKN SUB GRFT T/A/L AREA/>100SCM 1ST 100SCM","81350 - HC CHG UGT1A1 GENE ANALYSIS COMMON VARIANTS","15271 - APP SKN SUB GRFT T/A/L AREA/100SCM /<1ST 25","82693 - HC CHG ASSAY OF ETHYLENE GLYCOL","82693 - HC CHG ASSAY OF ETHYLENE GLYCOL","82693 - HC CHG ASSAY OF ETHYLENE GLYCOL","81350 - HC CHG UGT1A1 GENE ANALYSIS COMMON VARIANTS","15272 - APP SKN SUB GRFT T/A/L AREA/100SCM EA ADL 25SC","82693 - HC CHG ASSAY OF ETHYLENE GLYCOL","15271 - APP SKN SUB GRFT T/A/L AREA/100SCM /<1ST 25","81350 - HC CHG UGT1A1 GENE ANALYSIS COMMON VARIANTS","82693 - HC CHG ASSAY OF ETHYLENE GLYCOL","70551 - HC CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL","15272 - APP SKN SUB GRFT T/A/L AREA/100SCM EA ADL 25SC"]
[null,"15822 - BLEPHAROPLASTY UPPER EYELID","82009 - HC CHG KETONE BODIES SERUM QUALITATIVE","15274 - HC APP SKN SUB GRFT T/A/L AREA/>100SCM ADL 100SCM","15274 - HC APP SKN SUB GRFT T/A/L AREA/>100SCM ADL 100SCM","15274 - HC APP SKN SUB GRFT T/A/L AREA/>100SCM ADL 100SCM","81363 - HC HBB DUPLICATION/DELETION VARIANTS","15272 - APP SKN SUB GRFT T/A/L AREA/100SCM EA ADL 25SC","82705 - HC CHG FAT/LIPIDS FECES QUALITATIVE","82705 - HC CHG FAT/LIPIDS FECES QUALITATIVE","82705 - HC CHG FAT/LIPIDS FECES QUALITATIVE","81363 - HC HBB DUPLICATION/DELETION VARIANTS","15273 - HC APP SKN SUB GRFT T/A/L AREA/>100SCM 1ST 100SCM","82705 - HC CHG FAT/LIPIDS FECES QUALITATIVE","15272 - APP SKN SUB GRFT T/A/L AREA/100SCM EA ADL 25SC","81363 - HC HBB DUPLICATION/DELETION VARIANTS","82705 - HC CHG FAT/LIPIDS FECES QUALITATIVE","70552 - HC CHG MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL","15273 - HC APP SKN SUB GRFT T/A/L AREA/>100SCM 1ST 100SCM"]
[null,"15823 - HC REV UPPER EYELID W EXCESS SKIN","82010 - HC CHG KETONE BODIES SERUM QUANTITATIVE","15275 - SUB GRFT F/S/N/H/F/G/M/D <100SCM 1ST 25 SCM","15275 - SUB GRFT F/S/N/H/F/G/M/D <100SCM 1ST 25 SCM","15275 - SUB GRFT F/S/N/H/F/G/M/D <100SCM 1ST 25 SCM","81364 - HC HBB FULL GENE SEQUENCE","15273 - HC APP SKN SUB GRFT T/A/L AREA/>100SCM 1ST 100SCM","82728 - HC CHG ASSAY OF FERRITIN","82728 - HC CHG ASSAY OF FERRITIN","82728 - HC CHG ASSAY OF FERRITIN","81364 - HC HBB FULL GENE SEQUENCE","15274 - HC APP SKN SUB GRFT T/A/L AREA/>100SCM ADL 100SCM","82728 - HC CHG ASSAY OF FERRITIN","15273 - HC APP SKN SUB GRFT T/A/L AREA/>100SCM 1ST 100SCM","81364 - HC HBB FULL GENE SEQUENCE","82728 - HC CHG ASSAY OF FERRITIN","70553 - HC CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL","15274 - HC APP SKN SUB GRFT T/A/L AREA/>100SCM ADL 100SCM"]
[null,"15828 - HC RHYTIDECTOMY CHEEK CHIN & NECK","82017 - HC CHG ACYLCARNITINES QUANTIATIVE EACH SPECIMEN","15276 - SUB GRFT F/S/N/H/F/G/M/D <100SCM EA ADDL 25 SCM","15276 - SUB GRFT F/S/N/H/F/G/M/D <100SCM EA ADDL 25 SCM","15276 - SUB GRFT F/S/N/H/F/G/M/D <100SCM EA ADDL 25 SCM","81401 - HC CHG, MOLECULAR PATHOLOGY PROCEDURE LEVEL 2","15274 - HC APP SKN SUB GRFT T/A/L AREA/>100SCM ADL 100SCM","82731 - HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN","82731 - HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN","82731 - HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN","81401 - HC CHG, MOLECULAR PATHOLOGY PROCEDURE LEVEL 2","15275 - SUB GRFT F/S/N/H/F/G/M/D <100SCM 1ST 25 SCM","82731 - HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN","15274 - HC APP SKN SUB GRFT T/A/L AREA/>100SCM ADL 100SCM","81401 - HC CHG, MOLECULAR PATHOLOGY PROCEDURE LEVEL 2","82731 - HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN","70555 - HC CHG MRI BRAIN FUNCTIONAL W/PHYSICIAN ADMNISTRATION","15275 - SUB GRFT F/S/N/H/F/G/M/D <100SCM 1ST 25 SCM"]
[null,"15830 - HC EXCISE EXCESS SKIN TISSUE,ABDOMEN","82024 - HC CHG ADRENOCORTICOTROPIC HORMONE ACTH","15277 - HC SUB GRFT F/S/N/H/F/G/M/D />100SCM 1ST 100SCM","15277 - HC SUB GRFT F/S/N/H/F/G/M/D />100SCM 1ST 100SCM","15277 - HC SUB GRFT F/S/N/H/F/G/M/D />100SCM 1ST 100SCM","81402 - HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 3","15275 - SUB GRFT F/S/N/H/F/G/M/D <100SCM 1ST 25 SCM","82746 - HC CHG ASSAY OF FOLIC ACID SERUM","82746 - HC CHG ASSAY OF FOLIC ACID SERUM","82746 - HC CHG ASSAY OF FOLIC ACID SERUM","81402 - HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 3","15276 - SUB GRFT F/S/N/H/F/G/M/D <100SCM EA ADDL 25 SCM","82746 - HC CHG ASSAY OF FOLIC ACID SERUM","15275 - SUB GRFT F/S/N/H/F/G/M/D <100SCM 1ST 25 SCM","81402 - HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 3","82746 - HC CHG ASSAY OF FOLIC ACID SERUM","71010 - XR CHEST 1V","15276 - SUB GRFT F/S/N/H/F/G/M/D <100SCM EA ADDL 25 SCM"]
[null,"15832 - HC EXCISE EXCESS SKIN TISSUE,THIGH","82040 - HC CHG ALBUMIN SERUM PLASMA/WHOLE BLOOD","15278 - HC SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM ADL 100SQ CM","15278 - HC SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM ADL 100SQ CM","15278 - HC SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM ADL 100SQ CM","81403 - SEQ & EXON 13 SEQ, IF PERFORMED KRAS (EG, CARCINOMA), GENE ANALYSIS, PRO/TECH","15276 - SUB GRFT F/S/N/H/F/G/M/D <100SCM EA ADDL 25 SCM","82747 - HC CHG ASSAY OF FOLIC ACID RBC","82747 - HC CHG ASSAY OF FOLIC ACID RBC","82747 - HC CHG ASSAY OF FOLIC ACID RBC","81403 - SEQ & EXON 13 SEQ, IF PERFORMED KRAS (EG, CARCINOMA), GENE ANALYSIS, PRO/TECH","15277 - HC SUB GRFT F/S/N/H/F/G/M/D />100SCM 1ST 100SCM","82747 - HC CHG ASSAY OF FOLIC ACID RBC","15276 - SUB GRFT F/S/N/H/F/G/M/D <100SCM EA ADDL 25 SCM","81403 - SEQ & EXON 13 SEQ, IF PERFORMED KRAS (EG, CARCINOMA), GENE ANALYSIS, PRO/TECH","82747 - HC CHG ASSAY OF FOLIC ACID RBC","71020 - XR CHEST 2V","15277 - HC SUB GRFT F/S/N/H/F/G/M/D />100SCM 1ST 100SCM"]
[null,"15839 - EXCISION EXCESSIVE SKIN & SUBQ TISSUE OTHER AREA","82042 - HC CHG ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN","15620 - DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F","15620 - DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F","15620 - DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F","81404 - VHL (EG, VON HIPPEL-LINDAUFAMILIAL CANCER SYNDROME, FULL GENE SEQ VWF PRO/TECH","15277 - HC SUB GRFT F/S/N/H/F/G/M/D />100SCM 1ST 100SCM","82784 - HC CHG ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH","82784 - HC CHG ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH","82784 - HC CHG ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH","81404 - VHL (EG, VON HIPPEL-LINDAUFAMILIAL CANCER SYNDROME, FULL GENE SEQ VWF PRO/TECH","15278 - HC SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM ADL 100SQ CM","82784 - HC CHG ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH","15277 - HC SUB GRFT F/S/N/H/F/G/M/D />100SCM 1ST 100SCM","81404 - VHL (EG, VON HIPPEL-LINDAUFAMILIAL CANCER SYNDROME, FULL GENE SEQ VWF PRO/TECH","82784 - HC CHG ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH","71021 - XR CHEST 2V W AP LORDOTIC","15278 - HC SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM ADL 100SQ CM"]
[null,"15850 - REMOVE SUTURES SAME SURGEON","82043 - HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE","15630 - HC DELAY/SECTN FLAP LID,NOS,EAR,LIP","15630 - HC DELAY/SECTN FLAP LID,NOS,EAR,LIP","15630 - HC DELAY/SECTN FLAP LID,NOS,EAR,LIP","81405 - HC MOPATH PROCEDURE LEVEL 6","15278 - HC SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM ADL 100SQ CM","82785 - HC CHG ASSAY OF GAMMAGLOBULIN IGE","82785 - HC CHG ASSAY OF GAMMAGLOBULIN IGE","82785 - HC CHG ASSAY OF GAMMAGLOBULIN IGE","81405 - HC MOPATH PROCEDURE LEVEL 6","15620 - DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F","82785 - HC CHG ASSAY OF GAMMAGLOBULIN IGE","15278 - HC SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM ADL 100SQ CM","81405 - HC MOPATH PROCEDURE LEVEL 6","82785 - HC CHG ASSAY OF GAMMAGLOBULIN IGE","71022 - XR CHEST 2V W OBLIQUES","15620 - DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F"]
[null,"15851 - REMOVE SUTURES DIFF SURGEON","82075 - HC CHG ASSAY OF ALCOHOL BREATH","15731 - FOREHEAD FLAP W/VASC PEDICLE","15731 - FOREHEAD FLAP W/VASC PEDICLE","15731 - FOREHEAD FLAP W/VASC PEDICLE","81406 - HC CHG MOLECULAR PATHOLOGY PROCEDURE LEVEL 7","15620 - DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F","82787 - HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES","82787 - HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES","82787 - HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES","81406 - HC CHG MOLECULAR PATHOLOGY PROCEDURE LEVEL 7","15630 - HC DELAY/SECTN FLAP LID,NOS,EAR,LIP","82787 - HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES","15620 - DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F","81406 - HC CHG MOLECULAR PATHOLOGY PROCEDURE LEVEL 7","82787 - HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES","71023 - XR CHEST 2V W FLUORO","15630 - HC DELAY/SECTN FLAP LID,NOS,EAR,LIP"]
[null,"15852 - HC DRESSING CHANGE,NOT FOR BURN","82085 - HC CHG ASSAY OF ALDOLASE","15733 - HC MUSC MYOQ/FSCQ FLAP HEAD&NECK W/NAMED VASC PEDCL","15733 - HC MUSC MYOQ/FSCQ FLAP HEAD&NECK W/NAMED VASC PEDCL","15733 - HC MUSC MYOQ/FSCQ FLAP HEAD&NECK W/NAMED VASC PEDCL","81430 - HC CHG HEARING LOSS GENOMIC SEQUENCE ANALYSIS 60 GENES","15630 - HC DELAY/SECTN FLAP LID,NOS,EAR,LIP","82803 - HC CHG BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3","82803 - HC CHG BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3","82803 - HC CHG BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3","81430 - HC CHG HEARING LOSS GENOMIC SEQUENCE ANALYSIS 60 GENES","15731 - FOREHEAD FLAP W/VASC PEDICLE","82803 - HC CHG BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3","15630 - HC DELAY/SECTN FLAP LID,NOS,EAR,LIP","81430 - HC CHG HEARING LOSS GENOMIC SEQUENCE ANALYSIS 60 GENES","82803 - HC CHG BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3","71030 - XR CHEST 4V CMPL","15731 - FOREHEAD FLAP W/VASC PEDICLE"]
[null,"15936 - HC EXC SACR HCESS ULC W MUSC FLAP CLO","82088 - HC CHG ASSAY OF ALDOSTERONE","15769 - HC GRFG AUTOL SOFT TISS DIR EXC","15769 - HC GRFG AUTOL SOFT TISS DIR EXC","15769 - HC GRFG AUTOL SOFT TISS DIR EXC","81431 - HC CHG HEARING LOSS DUP/DEL ANALYSIS","15731 - FOREHEAD FLAP W/VASC PEDICLE","82805 - HC CHG GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY","82805 - HC CHG GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY","82805 - HC CHG GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY","81431 - HC CHG HEARING LOSS DUP/DEL ANALYSIS","15733 - HC MUSC MYOQ/FSCQ FLAP HEAD&NECK W/NAMED VASC PEDCL","82805 - HC CHG GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY","15731 - FOREHEAD FLAP W/VASC PEDICLE","81431 - HC CHG HEARING LOSS DUP/DEL ANALYSIS","82805 - HC CHG GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY","71034 - XR CHEST 4V MORE W FLUORO","15733 - HC MUSC MYOQ/FSCQ FLAP HEAD&NECK W/NAMED VASC PEDCL"]
[null,"16020 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL","82103 - HC CHG ALPHA-1-ANTITRYPSIN TOTAL","15771 - HC GRFG AUTOL FAT LIPO 50 CC/<","15771 - HC GRFG AUTOL FAT LIPO 50 CC/<","15771 - HC GRFG AUTOL FAT LIPO 50 CC/<","81450 - HC CHG GENOMIC SEQ ANALYS DNA&RNA ANALYS 5-50 GENE","15733 - HC MUSC MYOQ/FSCQ FLAP HEAD&NECK W/NAMED VASC PEDCL","82810 - HC BLOOD GASSES O2 SAT ONLY","82810 - HC BLOOD GASSES O2 SAT ONLY","82810 - HC BLOOD GASSES O2 SAT ONLY","81450 - HC CHG GENOMIC SEQ ANALYS DNA&RNA ANALYS 5-50 GENE","15769 - HC GRFG AUTOL SOFT TISS DIR EXC","82810 - HC BLOOD GASSES O2 SAT ONLY","15733 - HC MUSC MYOQ/FSCQ FLAP HEAD&NECK W/NAMED VASC PEDCL","81450 - HC CHG GENOMIC SEQ ANALYS DNA&RNA ANALYS 5-50 GENE","82810 - HC BLOOD GASSES O2 SAT ONLY","71035 - XR CHEST SPECIAL V EA","15769 - HC GRFG AUTOL SOFT TISS DIR EXC"]
[null,"16025 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM","82104 - HC CHG ALPHA-1-ANTITRYPSIN PHENOTYPE","15772 - HC GRFG AUTOL FAT LIPO EA ADDL","15772 - HC GRFG AUTOL FAT LIPO EA ADDL","15772 - HC GRFG AUTOL FAT LIPO EA ADDL","81479 - HC CHG UNLISTED MOLELCULAR PATHOLOGY PROCEDURE","15769 - HC GRFG AUTOL SOFT TISS DIR EXC","82941 - HC CHG ASSAY OF GASTRIN","82941 - HC CHG ASSAY OF GASTRIN","82941 - HC CHG ASSAY OF GASTRIN","81479 - HC CHG UNLISTED MOLELCULAR PATHOLOGY PROCEDURE","15771 - HC GRFG AUTOL FAT LIPO 50 CC/<","82941 - HC CHG ASSAY OF GASTRIN","15769 - HC GRFG AUTOL SOFT TISS DIR EXC","81479 - HC CHG UNLISTED MOLELCULAR PATHOLOGY PROCEDURE","82941 - HC CHG ASSAY OF GASTRIN","71100 - HC CHG X-RAY RIBS 2VW UNILAT","15771 - HC GRFG AUTOL FAT LIPO 50 CC/<"]
[null,"16030 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE","82105 - HC CHG ALPHA-FETOPROTEIN SERUM","15773 - GRFG AUTOL FAT LIPO 25 CC/<","15773 - GRFG AUTOL FAT LIPO 25 CC/<","15773 - GRFG AUTOL FAT LIPO 25 CC/<","81522 - HC ONC BREAST MRNA 12 GENES","15771 - HC GRFG AUTOL FAT LIPO 50 CC/<","82945 - HC CHG GLUCOSE BODY FLUID OTHER THAN BLOOD","82945 - HC CHG GLUCOSE BODY FLUID OTHER THAN BLOOD","82945 - HC CHG GLUCOSE BODY FLUID OTHER THAN BLOOD","81522 - HC ONC BREAST MRNA 12 GENES","15772 - HC GRFG AUTOL FAT LIPO EA ADDL","82945 - HC CHG GLUCOSE BODY FLUID OTHER THAN BLOOD","15771 - HC GRFG AUTOL FAT LIPO 50 CC/<","81522 - HC ONC BREAST MRNA 12 GENES","82945 - HC CHG GLUCOSE BODY FLUID OTHER THAN BLOOD","71101 - HC CHG RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS","15772 - HC GRFG AUTOL FAT LIPO EA ADDL"]
[null,"17000 - DESTRUCTION PREMALIGNANT LESION 1ST","82139 - HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE","15774 - HC GFRG AUTOL FAT LIPO EA ADDL","15774 - HC GFRG AUTOL FAT LIPO EA ADDL","15774 - HC GFRG AUTOL FAT LIPO EA ADDL","81542 - HC ONC PROSTATE MRNA 22 CNT GEN","15772 - HC GRFG AUTOL FAT LIPO EA ADDL","82947 - HC CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP","82947 - HC CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP","82947 - HC CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP","81542 - HC ONC PROSTATE MRNA 22 CNT GEN","15773 - GRFG AUTOL FAT LIPO 25 CC/<","82947 - HC CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP","15772 - HC GRFG AUTOL FAT LIPO EA ADDL","81542 - HC ONC PROSTATE MRNA 22 CNT GEN","82947 - HC CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP","71110 - HC CHG RADEX RIBS BILATERAL 3 VIEWS","15773 - GRFG AUTOL FAT LIPO 25 CC/<"]
[null,"17003 - DESTRUCTION PREMALIGNANT LESION 2-14 EA","82140 - HC CHG ASSAY OF AMMONIA","15820 - HC REVISION OF LOWER EYELID","15820 - HC REVISION OF LOWER EYELID","15820 - HC REVISION OF LOWER EYELID","81596 - HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR","15773 - GRFG AUTOL FAT LIPO 25 CC/<","82950 - HC CHG GLUCOSE POST GLUCOSE DOSE","82950 - HC CHG GLUCOSE POST GLUCOSE DOSE","82950 - HC CHG GLUCOSE POST GLUCOSE DOSE","81596 - HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR","15774 - HC GFRG AUTOL FAT LIPO EA ADDL","82950 - HC CHG GLUCOSE POST GLUCOSE DOSE","15773 - GRFG AUTOL FAT LIPO 25 CC/<","81596 - HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR","82950 - HC CHG GLUCOSE POST GLUCOSE DOSE","71111 - HC CHG RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS","15774 - HC GFRG AUTOL FAT LIPO EA ADDL"]
[null,"17004 - DESTRUCTION PREMALIGNANT LESION 15/>","82150 - HC CHG ASSAY OF AMYLASE","15821 - HC REV LOWER EYELID EXTEN FAT PAD","15821 - HC REV LOWER EYELID EXTEN FAT PAD","15821 - HC REV LOWER EYELID EXTEN FAT PAD","81599 - HC Q;LIVER FIBRISUS ACT TEST","15774 - HC GFRG AUTOL FAT LIPO EA ADDL","82951 - HC CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS","82951 - HC CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS","82951 - HC CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS","81599 - HC Q;LIVER FIBRISUS ACT TEST","15820 - HC REVISION OF LOWER EYELID","82951 - HC CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS","15774 - HC GFRG AUTOL FAT LIPO EA ADDL","81599 - HC Q;LIVER FIBRISUS ACT TEST","82951 - HC CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS","71120 - HC CHG RADEX STERNUM MINIMUM 2 VIEWS","15820 - HC REVISION OF LOWER EYELID"]
[null,"17106 - DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM","82157 - HC CHG ANDROSTENEDIONE","15822 - BLEPHAROPLASTY UPPER EYELID","15822 - BLEPHAROPLASTY UPPER EYELID","15822 - BLEPHAROPLASTY UPPER EYELID","82009 - HC CHG KETONE BODIES SERUM QUALITATIVE","15820 - HC REVISION OF LOWER EYELID","82952 - HC CHG GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS","82952 - HC CHG GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS","82952 - HC CHG GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS","82009 - HC CHG KETONE BODIES SERUM QUALITATIVE","15821 - HC REV LOWER EYELID EXTEN FAT PAD","82952 - HC CHG GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS","15820 - HC REVISION OF LOWER EYELID","82009 - HC CHG KETONE BODIES SERUM QUALITATIVE","82952 - HC CHG GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS","71130 - HC CHG RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS","15821 - HC REV LOWER EYELID EXTEN FAT PAD"]
[null,"17107 - DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM","82164 - HC CHG ANGIOTENSIN I-CONVERTING ENZYME","15823 - HC REV UPPER EYELID W EXCESS SKIN","15823 - HC REV UPPER EYELID W EXCESS SKIN","15823 - HC REV UPPER EYELID W EXCESS SKIN","82010 - HC CHG KETONE BODIES SERUM QUANTITATIVE","15821 - HC REV LOWER EYELID EXTEN FAT PAD","82960 - HC CHG GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN","82960 - HC CHG GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN","82960 - HC CHG GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN","82010 - HC CHG KETONE BODIES SERUM QUANTITATIVE","15822 - BLEPHAROPLASTY UPPER EYELID","82960 - HC CHG GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN","15821 - HC REV LOWER EYELID EXTEN FAT PAD","82010 - HC CHG KETONE BODIES SERUM QUANTITATIVE","82960 - HC CHG GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN","71250 - HC CHG CT THORAX W/O CONTRAST MATERIAL","15822 - BLEPHAROPLASTY UPPER EYELID"]
[null,"17108 - DSTRJ CUTANEOUS VASCULAR LESIONS >50.0 SQ CM","82172 - HC CHG APOLIPOPROTEIN EACH","15828 - HC RHYTIDECTOMY CHEEK CHIN & NECK","15828 - HC RHYTIDECTOMY CHEEK CHIN & NECK","15828 - HC RHYTIDECTOMY CHEEK CHIN & NECK","82017 - HC CHG ACYLCARNITINES QUANTIATIVE EACH SPECIMEN","15822 - BLEPHAROPLASTY UPPER EYELID","82962 - HC GLUCOMETER - PHARM","82962 - HC GLUCOMETER - PHARM","82962 - HC GLUCOMETER - PHARM","82017 - HC CHG ACYLCARNITINES QUANTIATIVE EACH SPECIMEN","15823 - HC REV UPPER EYELID W EXCESS SKIN","82962 - HC GLUCOMETER - PHARM","15822 - BLEPHAROPLASTY UPPER EYELID","82017 - HC CHG ACYLCARNITINES QUANTIATIVE EACH SPECIMEN","82962 - HC GLUCOMETER - PHARM","71260 - HC CHG CT THORAX W/CONTRAST MATERIAL","15823 - HC REV UPPER EYELID W EXCESS SKIN"]
[null,"17110 - DESTRUCTION BENIGN LESIONS UP TO 14","82175 - HC CHG ASSAY OF ARSENIC","15830 - HC EXCISE EXCESS SKIN TISSUE,ABDOMEN","15830 - HC EXCISE EXCESS SKIN TISSUE,ABDOMEN","15830 - HC EXCISE EXCESS SKIN TISSUE,ABDOMEN","82024 - HC CHG ADRENOCORTICOTROPIC HORMONE ACTH","15823 - HC REV UPPER EYELID W EXCESS SKIN","82977 - HC CHG ASSAY OF GGT","82977 - HC CHG ASSAY OF GGT","82977 - HC CHG ASSAY OF GGT","82024 - HC CHG ADRENOCORTICOTROPIC HORMONE ACTH","15828 - HC RHYTIDECTOMY CHEEK CHIN & NECK","82977 - HC CHG ASSAY OF GGT","15823 - HC REV UPPER EYELID W EXCESS SKIN","82024 - HC CHG ADRENOCORTICOTROPIC HORMONE ACTH","82977 - HC CHG ASSAY OF GGT","71270 - HC CHG CT THORAX W/O & W/CONTRAST MATERIAL","15828 - HC RHYTIDECTOMY CHEEK CHIN & NECK"]
[null,"17111 - DESTRUCTION BENIGN LESIONS 15/>","82180 - HC CHG ASSAY OF ASCORBIC ACID BLOOD","15832 - HC EXCISE EXCESS SKIN TISSUE,THIGH","15832 - HC EXCISE EXCESS SKIN TISSUE,THIGH","15832 - HC EXCISE EXCESS SKIN TISSUE,THIGH","82040 - HC CHG ALBUMIN SERUM PLASMA/WHOLE BLOOD","15828 - HC RHYTIDECTOMY CHEEK CHIN & NECK","82985 - HC CHG ASSAY OF GLYCATED PROTEIN","82985 - HC CHG ASSAY OF GLYCATED PROTEIN","82985 - HC CHG ASSAY OF GLYCATED PROTEIN","82040 - HC CHG ALBUMIN SERUM PLASMA/WHOLE BLOOD","15830 - HC EXCISE EXCESS SKIN TISSUE,ABDOMEN","82985 - HC CHG ASSAY OF GLYCATED PROTEIN","15828 - HC RHYTIDECTOMY CHEEK CHIN & NECK","82040 - HC CHG ALBUMIN SERUM PLASMA/WHOLE BLOOD","82985 - HC CHG ASSAY OF GLYCATED PROTEIN","71275 - HC CHG CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST","15830 - HC EXCISE EXCESS SKIN TISSUE,ABDOMEN"]
[null,"17250 - CHEMICAL CAUTERIZATION GRANULATION TISSUE","82232 - HC CHG BETA-2 MICROGLOBULIN","15839 - EXCISION EXCESSIVE SKIN & SUBQ TISSUE OTHER AREA","15839 - EXCISION EXCESSIVE SKIN & SUBQ TISSUE OTHER AREA","15839 - EXCISION EXCESSIVE SKIN & SUBQ TISSUE OTHER AREA","82042 - HC CHG ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN","15830 - HC EXCISE EXCESS SKIN TISSUE,ABDOMEN","83001 - HC CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE","83001 - HC CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE","83001 - HC CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE","82042 - HC CHG ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN","15832 - HC EXCISE EXCESS SKIN TISSUE,THIGH","83001 - HC CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE","15830 - HC EXCISE EXCESS SKIN TISSUE,ABDOMEN","82042 - HC CHG ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN","83001 - HC CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE","71550 - HC CHG MRI CHEST W/O CONTRAST MATERIAL","15832 - HC EXCISE EXCESS SKIN TISSUE,THIGH"]
[null,"17260 - DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<","82247 - HC CHG BILIRUBIN TOTAL","15850 - REMOVE SUTURES SAME SURGEON","15850 - REMOVE SUTURES SAME SURGEON","15850 - REMOVE SUTURES SAME SURGEON","82043 - HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE","15832 - HC EXCISE EXCESS SKIN TISSUE,THIGH","83002 - HC CHG GONADOTROPIN LUTEINIZING HORMONE","83002 - HC CHG GONADOTROPIN LUTEINIZING HORMONE","83002 - HC CHG GONADOTROPIN LUTEINIZING HORMONE","82043 - HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE","15839 - EXCISION EXCESSIVE SKIN & SUBQ TISSUE OTHER AREA","83002 - HC CHG GONADOTROPIN LUTEINIZING HORMONE","15832 - HC EXCISE EXCESS SKIN TISSUE,THIGH","82043 - HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE","83002 - HC CHG GONADOTROPIN LUTEINIZING HORMONE","71551 - HC CHG MRI CHEST W/CONTRAST MATERIAL","15839 - EXCISION EXCESSIVE SKIN & SUBQ TISSUE OTHER AREA"]
[null,"17261 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM","82248 - HC CHG BILIRUBIN DIRECT","15851 - REMOVE SUTURES DIFF SURGEON","15851 - REMOVE SUTURES DIFF SURGEON","15851 - REMOVE SUTURES DIFF SURGEON","82075 - HC CHG ASSAY OF ALCOHOL BREATH","15839 - EXCISION EXCESSIVE SKIN & SUBQ TISSUE OTHER AREA","83003 - HC CHG ASSAY OF GROWTH HORMONE HUMAN","83003 - HC CHG ASSAY OF GROWTH HORMONE HUMAN","83003 - HC CHG ASSAY OF GROWTH HORMONE HUMAN","82075 - HC CHG ASSAY OF ALCOHOL BREATH","15850 - REMOVE SUTURES SAME SURGEON","83003 - HC CHG ASSAY OF GROWTH HORMONE HUMAN","15839 - EXCISION EXCESSIVE SKIN & SUBQ TISSUE OTHER AREA","82075 - HC CHG ASSAY OF ALCOHOL BREATH","83003 - HC CHG ASSAY OF GROWTH HORMONE HUMAN","71552 - HC CHG MRI CHEST W/O & W/CONTRAST MATERIAL","15850 - REMOVE SUTURES SAME SURGEON"]
[null,"17262 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM","82270 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER","15852 - HC DRESSING CHANGE,NOT FOR BURN","15852 - HC DRESSING CHANGE,NOT FOR BURN","15852 - HC DRESSING CHANGE,NOT FOR BURN","82085 - HC CHG ASSAY OF ALDOLASE","15850 - REMOVE SUTURES SAME SURGEON","83010 - HC CHG ASSAY OF HAPTOGLOBIN, QUANT","83010 - HC CHG ASSAY OF HAPTOGLOBIN, QUANT","83010 - HC CHG ASSAY OF HAPTOGLOBIN, QUANT","82085 - HC CHG ASSAY OF ALDOLASE","15851 - REMOVE SUTURES DIFF SURGEON","83010 - HC CHG ASSAY OF HAPTOGLOBIN, QUANT","15850 - REMOVE SUTURES SAME SURGEON","82085 - HC CHG ASSAY OF ALDOLASE","83010 - HC CHG ASSAY OF HAPTOGLOBIN, QUANT","72020 - HC CHG RADEX SPINE 1 VIEW SPECIFY LEVEL","15851 - REMOVE SUTURES DIFF SURGEON"]
[null,"17263 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM","82271 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES","15936 - HC EXC SACR HCESS ULC W MUSC FLAP CLO","15936 - HC EXC SACR HCESS ULC W MUSC FLAP CLO","15936 - HC EXC SACR HCESS ULC W MUSC FLAP CLO","82088 - HC CHG ASSAY OF ALDOSTERONE","15851 - REMOVE SUTURES DIFF SURGEON","83013 - HC H PYLORI (C-13) BREATH","83013 - HC H PYLORI (C-13) BREATH","83013 - HC H PYLORI (C-13) BREATH","82088 - HC CHG ASSAY OF ALDOSTERONE","15852 - HC DRESSING CHANGE,NOT FOR BURN","83013 - HC H PYLORI (C-13) BREATH","15851 - REMOVE SUTURES DIFF SURGEON","82088 - HC CHG ASSAY OF ALDOSTERONE","83013 - HC H PYLORI (C-13) BREATH","72040 - HC CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS","15852 - HC DRESSING CHANGE,NOT FOR BURN"]
[null,"17264 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM","82274 - HC CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3","16000 - HC INITIAL RX BURN(S) 1ST DEGREE","16000 - HC INITIAL RX BURN(S) 1ST DEGREE","16000 - HC INITIAL RX BURN(S) 1ST DEGREE","82103 - HC CHG ALPHA-1-ANTITRYPSIN TOTAL","15852 - HC DRESSING CHANGE,NOT FOR BURN","83014 - HC H PYLORI DRUG ADMIN","83014 - HC H PYLORI DRUG ADMIN","83014 - HC H PYLORI DRUG ADMIN","82103 - HC CHG ALPHA-1-ANTITRYPSIN TOTAL","15936 - HC EXC SACR HCESS ULC W MUSC FLAP CLO","83014 - HC H PYLORI DRUG ADMIN","15852 - HC DRESSING CHANGE,NOT FOR BURN","82103 - HC CHG ALPHA-1-ANTITRYPSIN TOTAL","83014 - HC H PYLORI DRUG ADMIN","72050 - HC CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS","15936 - HC EXC SACR HCESS ULC W MUSC FLAP CLO"]
[null,"17271 - DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM","82306 - HC CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED","16020 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL","16020 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL","16020 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL","82104 - HC CHG ALPHA-1-ANTITRYPSIN PHENOTYPE","15936 - HC EXC SACR HCESS ULC W MUSC FLAP CLO","83020 - HC CHG HEMOGLOBIN ELECTROPHORESIS","83020 - HC CHG HEMOGLOBIN ELECTROPHORESIS","83020 - HC CHG HEMOGLOBIN ELECTROPHORESIS","82104 - HC CHG ALPHA-1-ANTITRYPSIN PHENOTYPE","16000 - HC INITIAL RX BURN(S) 1ST DEGREE","83020 - HC CHG HEMOGLOBIN ELECTROPHORESIS","15936 - HC EXC SACR HCESS ULC W MUSC FLAP CLO","82104 - HC CHG ALPHA-1-ANTITRYPSIN PHENOTYPE","83020 - HC CHG HEMOGLOBIN ELECTROPHORESIS","72052 - HC CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS","16000 - HC INITIAL RX BURN(S) 1ST DEGREE"]
[null,"17280 - HC DESTR MALIG FACE,NOSE,LIP <0.6 CM","82308 - HC CHG CALCITONIN","16025 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM","16025 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM","16025 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM","82105 - HC CHG ALPHA-FETOPROTEIN SERUM","16000 - HC INITIAL RX BURN(S) 1ST DEGREE","83021 - HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY","83021 - HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY","83021 - HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY","82105 - HC CHG ALPHA-FETOPROTEIN SERUM","16020 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL","83021 - HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY","16000 - HC INITIAL RX BURN(S) 1ST DEGREE","82105 - HC CHG ALPHA-FETOPROTEIN SERUM","83021 - HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY","72070 - HC CHG RADEX SPINE THORACIC 2 VIEWS","16020 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL"]
[null,"17281 - DESTRUCTION OF SKIN LESIONS","82310 - HC CHG CALCIUM TOTAL","16030 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE","16030 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE","16030 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE","82139 - HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE","16020 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL","83030 - HC CHG HEMOGLOBIN F FETAL CHEMICAL","83030 - HC CHG HEMOGLOBIN F FETAL CHEMICAL","83030 - HC CHG HEMOGLOBIN F FETAL CHEMICAL","82139 - HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE","16025 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM","83030 - HC CHG HEMOGLOBIN F FETAL CHEMICAL","16020 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL","82139 - HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE","83030 - HC CHG HEMOGLOBIN F FETAL CHEMICAL","72072 - HC CHG RADEX SPINE THORACIC 3 VIEWS","16025 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM"]
[null,"17311 - MOHS MICROGRAPHIC H/N/H/F/G 1ST STAGE 5 BLOCKS","82330 - HC CHG CALCIUM IONIZED","17000 - DESTRUCTION PREMALIGNANT LESION 1ST","17000 - DESTRUCTION PREMALIGNANT LESION 1ST","17000 - DESTRUCTION PREMALIGNANT LESION 1ST","82140 - HC CHG ASSAY OF AMMONIA","16025 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM","83036 - HEMOGLOBIN GLYCOSYLATED A1C","83036 - HEMOGLOBIN GLYCOSYLATED A1C","83036 - HEMOGLOBIN GLYCOSYLATED A1C","82140 - HC CHG ASSAY OF AMMONIA","16030 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE","83036 - HEMOGLOBIN GLYCOSYLATED A1C","16025 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM","82140 - HC CHG ASSAY OF AMMONIA","83036 - HEMOGLOBIN GLYCOSYLATED A1C","72074 - HC X-RAY EXAM THORAC SPINE4/>VW","16030 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE"]
[null,"17312 - MOHS,  ADDL STAGE, HEAD/NECK/HAND/FEET/GENTIAL","82340 - HC Q;KID STONE, UR CALCIUM","17003 - DESTRUCTION PREMALIGNANT LESION 2-14 EA","17003 - DESTRUCTION PREMALIGNANT LESION 2-14 EA","17003 - DESTRUCTION PREMALIGNANT LESION 2-14 EA","82150 - HC CHG ASSAY OF AMYLASE","16030 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE","83050 - HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE","83050 - HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE","83050 - HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE","82150 - HC CHG ASSAY OF AMYLASE","17000 - DESTRUCTION PREMALIGNANT LESION 1ST","83050 - HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE","16030 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE","82150 - HC CHG ASSAY OF AMYLASE","83050 - HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE","72080 - HC CHG RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS","17000 - DESTRUCTION PREMALIGNANT LESION 1ST"]
[null,"17313 - MOHS TRUNK/ARM/LEG 1ST STAGE 5 BLOCKS","82365 - HC CHG CALCULUS INFRARED SPECTROSCOPY","17004 - DESTRUCTION PREMALIGNANT LESION 15/>","17004 - DESTRUCTION PREMALIGNANT LESION 15/>","17004 - DESTRUCTION PREMALIGNANT LESION 15/>","82157 - HC CHG ANDROSTENEDIONE","17000 - DESTRUCTION PREMALIGNANT LESION 1ST","83070 - HC CHG ASSAY OF HEMOSIDERIN QUALITATIVE","83070 - HC CHG ASSAY OF HEMOSIDERIN QUALITATIVE","83070 - HC CHG ASSAY OF HEMOSIDERIN QUALITATIVE","82157 - HC CHG ANDROSTENEDIONE","17003 - DESTRUCTION PREMALIGNANT LESION 2-14 EA","83070 - HC CHG ASSAY OF HEMOSIDERIN QUALITATIVE","17000 - DESTRUCTION PREMALIGNANT LESION 1ST","82157 - HC CHG ANDROSTENEDIONE","83070 - HC CHG ASSAY OF HEMOSIDERIN QUALITATIVE","72081 - XRAY EXAM ENTIRE SPINE INCLUDING SKULL, CERV AND SACRAL SPINE; 1 VIEW","17003 - DESTRUCTION PREMALIGNANT LESION 2-14 EA"]
[null,"17314 - MOHS TRUNK/ARM/LEG EA STAGE AFTER 1ST STAGE","82374 - HC CHG CARBON DIOXIDE BICARBONATE","17106 - DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM","17106 - DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM","17106 - DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM","82164 - HC CHG ANGIOTENSIN I-CONVERTING ENZYME","17003 - DESTRUCTION PREMALIGNANT LESION 2-14 EA","83090 - HC CHG ASSAY OF HOMOCYSTEINE","83090 - HC CHG ASSAY OF HOMOCYSTEINE","83090 - HC CHG ASSAY OF HOMOCYSTEINE","82164 - HC CHG ANGIOTENSIN I-CONVERTING ENZYME","17004 - DESTRUCTION PREMALIGNANT LESION 15/>","83090 - HC CHG ASSAY OF HOMOCYSTEINE","17003 - DESTRUCTION PREMALIGNANT LESION 2-14 EA","82164 - HC CHG ANGIOTENSIN I-CONVERTING ENZYME","83090 - HC CHG ASSAY OF HOMOCYSTEINE","72082 - XRAY EXAM ENTIRE SPINE INCLUDING SKULL, CERV AND SACRAL SPINE; 2 OR 3 VIEWS","17004 - DESTRUCTION PREMALIGNANT LESION 15/>"]
[null,"17315 - MOHS TRUNK/ARM/LEG EA ADDL BLOCK ANY STAGE","82375 - HC CHG CARBOXYHEMOGLOBIN QUANTITATIVE","17107 - DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM","17107 - DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM","17107 - DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM","82172 - HC CHG APOLIPOPROTEIN EACH","17004 - DESTRUCTION PREMALIGNANT LESION 15/>","83497 - HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA","83497 - HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA","83497 - HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA","82172 - HC CHG APOLIPOPROTEIN EACH","17106 - DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM","83497 - HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA","17004 - DESTRUCTION PREMALIGNANT LESION 15/>","82172 - HC CHG APOLIPOPROTEIN EACH","83497 - HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA","72083 - XRAY EXAM ENTIRE SPINE INCLUDING SKULL, CERV AND SACRAL SPINE; 4 OR 5 VIEWS","17106 - DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM"]
[null,"17999 - PR PRE OPERATIVE LASER HAIR REMOVAL FOR GENITAL AFFIRMATION SURGERY","82378 - HC CHG CARCINOEMBRYONIC ANTIGEN CEA","17108 - DSTRJ CUTANEOUS VASCULAR LESIONS >50.0 SQ CM","17108 - DSTRJ CUTANEOUS VASCULAR LESIONS >50.0 SQ CM","17108 - DSTRJ CUTANEOUS VASCULAR LESIONS >50.0 SQ CM","82175 - HC CHG ASSAY OF ARSENIC","17106 - DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM","83498 - HC CHG ASSAY OF HYDROXYPROGESTERONE 17-D","83498 - HC CHG ASSAY OF HYDROXYPROGESTERONE 17-D","83498 - HC CHG ASSAY OF HYDROXYPROGESTERONE 17-D","82175 - HC CHG ASSAY OF ARSENIC","17107 - DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM","83498 - HC CHG ASSAY OF HYDROXYPROGESTERONE 17-D","17106 - DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM","82175 - HC CHG ASSAY OF ARSENIC","83498 - HC CHG ASSAY OF HYDROXYPROGESTERONE 17-D","72084 - X-RAY EXAM ENTIRE SPI 6/> VW","17107 - DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM"]
[null,"19000 - PUNCTURE ASPIRATION CYST BREAST","82379 - HC CRL;CARNITINE","17110 - DESTRUCTION BENIGN LESIONS UP TO 14","17110 - DESTRUCTION BENIGN LESIONS UP TO 14","17110 - DESTRUCTION BENIGN LESIONS UP TO 14","82180 - HC CHG ASSAY OF ASCORBIC ACID BLOOD","17107 - DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM","83516 - HC CRL;TTG AB,IGA","83516 - HC CRL;TTG AB,IGA","83516 - HC CRL;TTG AB,IGA","82180 - HC CHG ASSAY OF ASCORBIC ACID BLOOD","17108 - DSTRJ CUTANEOUS VASCULAR LESIONS >50.0 SQ CM","83516 - HC CRL;TTG AB,IGA","17107 - DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM","82180 - HC CHG ASSAY OF ASCORBIC ACID BLOOD","83516 - HC CRL;TTG AB,IGA","72100 - HC CHG RADEX SPINE LUMBOSACRAL 2/3 VIEWS","17108 - DSTRJ CUTANEOUS VASCULAR LESIONS >50.0 SQ CM"]
[null,"19001 - HC CY ASP BREAST;EA ADD","82384 - HC CHG CATECHOLAMINES FRACTIONATED","17111 - DESTRUCTION BENIGN LESIONS 15/>","17111 - DESTRUCTION BENIGN LESIONS 15/>","17111 - DESTRUCTION BENIGN LESIONS 15/>","82232 - HC CHG BETA-2 MICROGLOBULIN","17108 - DSTRJ CUTANEOUS VASCULAR LESIONS >50.0 SQ CM","83519 - HC CHG IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","83519 - HC CHG IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","83519 - HC CHG IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","82232 - HC CHG BETA-2 MICROGLOBULIN","17110 - DESTRUCTION BENIGN LESIONS UP TO 14","83519 - HC CHG IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","17108 - DSTRJ CUTANEOUS VASCULAR LESIONS >50.0 SQ CM","82232 - HC CHG BETA-2 MICROGLOBULIN","83519 - HC CHG IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","72110 - HC CHG RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS","17110 - DESTRUCTION BENIGN LESIONS UP TO 14"]
[null,"19020 - MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP","82390 - HC CHG CERULOPLASMIN","17250 - CHEMICAL CAUTERIZATION GRANULATION TISSUE","17250 - CHEMICAL CAUTERIZATION GRANULATION TISSUE","17250 - CHEMICAL CAUTERIZATION GRANULATION TISSUE","82247 - HC CHG BILIRUBIN TOTAL","17110 - DESTRUCTION BENIGN LESIONS UP TO 14","83520 - HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE","83520 - HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE","83520 - HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE","82247 - HC CHG BILIRUBIN TOTAL","17111 - DESTRUCTION BENIGN LESIONS 15/>","83520 - HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE","17110 - DESTRUCTION BENIGN LESIONS UP TO 14","82247 - HC CHG BILIRUBIN TOTAL","83520 - HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE","72114 - HC CHG RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6","17111 - DESTRUCTION BENIGN LESIONS 15/>"]
[null,"19081 - BX BREAST W/DEVICE 1ST LESION STEREOTACTIC GUID","82397 - HC CHEMILUMINESCENT ASSAY","17260 - DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<","17260 - DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<","17260 - DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<","82248 - HC CHG BILIRUBIN DIRECT","17111 - DESTRUCTION BENIGN LESIONS 15/>","83525 - HC CHG ASSAY OF INSULIN TOTAL","83525 - HC CHG ASSAY OF INSULIN TOTAL","83525 - HC CHG ASSAY OF INSULIN TOTAL","82248 - HC CHG BILIRUBIN DIRECT","17250 - CHEMICAL CAUTERIZATION GRANULATION TISSUE","83525 - HC CHG ASSAY OF INSULIN TOTAL","17111 - DESTRUCTION BENIGN LESIONS 15/>","82248 - HC CHG BILIRUBIN DIRECT","83525 - HC CHG ASSAY OF INSULIN TOTAL","72120 - HC X-RAY LUMBAR SPINE FLEX/EXTEN","17250 - CHEMICAL CAUTERIZATION GRANULATION TISSUE"]
[null,"19082 - BX BREAST W/DEVICE ADDL LESION STEREOTACT GUID","82435 - HC CHG CHLORIDE BLD","17261 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM","17261 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM","17261 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM","82270 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER","17250 - CHEMICAL CAUTERIZATION GRANULATION TISSUE","83540 - HC CHG ASSAY OF IRON","83540 - HC CHG ASSAY OF IRON","83540 - HC CHG ASSAY OF IRON","82270 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER","17260 - DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<","83540 - HC CHG ASSAY OF IRON","17250 - CHEMICAL CAUTERIZATION GRANULATION TISSUE","82270 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER","83540 - HC CHG ASSAY OF IRON","72125 - HC CHG CT CERVICAL SPINE W/O CONTRAST MATERIAL","17260 - DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<"]
[null,"19083 - BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID","82436 - HC CHG CHLORIDE URINE","17262 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM","17262 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM","17262 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM","82271 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES","17260 - DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<","83550 - HC CHG IRON BINDING CAPACITY","83550 - HC CHG IRON BINDING CAPACITY","83550 - HC CHG IRON BINDING CAPACITY","82271 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES","17261 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM","83550 - HC CHG IRON BINDING CAPACITY","17260 - DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<","82271 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES","83550 - HC CHG IRON BINDING CAPACITY","72126 - HC CHG CT CERVICAL SPINE W/CONTRAST MATERIAL","17261 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM"]
[null,"19084 - BX BREAST W/DEVICE ADDL LESION ULTRASOUND GUID","82438 - HC CHG CHLORIDE OTHER SOURCE","17263 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM","17263 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM","17263 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM","82274 - HC CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3","17261 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM","83605 - HC CHG ASSAY OF LACTATE","83605 - HC CHG ASSAY OF LACTATE","83605 - HC CHG ASSAY OF LACTATE","82274 - HC CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3","17262 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM","83605 - HC CHG ASSAY OF LACTATE","17261 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM","82274 - HC CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3","83605 - HC CHG ASSAY OF LACTATE","72127 - HC CT,C SPINE;W/WO","17262 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM"]
[null,"19085 - BX BREAST W/DEVICE 1ST LESION MAGNETIC RES GUID","82465 - CHOLESTEROL SERUM/WHOLE BLOOD TOTAL","17264 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM","17264 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM","17264 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM","82306 - HC CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED","17262 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM","83615 - HC CHG LACTATE DEHYDROGENASE LDH","83615 - HC CHG LACTATE DEHYDROGENASE LDH","83615 - HC CHG LACTATE DEHYDROGENASE LDH","82306 - HC CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED","17263 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM","83615 - HC CHG LACTATE DEHYDROGENASE LDH","17262 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM","82306 - HC CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED","83615 - HC CHG LACTATE DEHYDROGENASE LDH","72128 - HC CHG CT THORACIC SPINE W/O CONTRAST MATERIAL","17263 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM"]
[null,"19086 - BX BREAST W/DEVICE ADDL LESION MAGNET RES GUID","82495 - HC CHG ASSAY OF CHROMIUM","17271 - DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM","17271 - DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM","17271 - DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM","82308 - HC CHG CALCITONIN","17263 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM","83630 - HC CHG LACTOFERRIN FECAL QUALITATIVE","83630 - HC CHG LACTOFERRIN FECAL QUALITATIVE","83630 - HC CHG LACTOFERRIN FECAL QUALITATIVE","82308 - HC CHG CALCITONIN","17264 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM","83630 - HC CHG LACTOFERRIN FECAL QUALITATIVE","17263 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM","82308 - HC CHG CALCITONIN","83630 - HC CHG LACTOFERRIN FECAL QUALITATIVE","72129 - HC CHG CT THORACIC SPINE W/CONTRAST MATERIAL","17264 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM"]
[null,"19100 - BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX","82507 - HC CHG ASSAY OF CITRATE","17280 - HC DESTR MALIG FACE,NOSE,LIP <0.6 CM","17280 - HC DESTR MALIG FACE,NOSE,LIP <0.6 CM","17280 - HC DESTR MALIG FACE,NOSE,LIP <0.6 CM","82310 - HC CHG CALCIUM TOTAL","17264 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM","83655 - HC CHG ASSAY OF LEAD","83655 - HC CHG ASSAY OF LEAD","83655 - HC CHG ASSAY OF LEAD","82310 - HC CHG CALCIUM TOTAL","17271 - DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM","83655 - HC CHG ASSAY OF LEAD","17264 - DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM","82310 - HC CHG CALCIUM TOTAL","83655 - HC CHG ASSAY OF LEAD","72130 - HC CT,T SPINE;W/WO","17271 - DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM"]
[null,"19120 - EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION","82523 - HC CHG COLLAGEN CROSS LINKS ANY METHOD","17281 - DESTRUCTION OF SKIN LESIONS","17281 - DESTRUCTION OF SKIN LESIONS","17281 - DESTRUCTION OF SKIN LESIONS","82330 - HC CHG CALCIUM IONIZED","17271 - DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM","83662 - HC L/S RATIO, FOAM STABILITY","83662 - HC L/S RATIO, FOAM STABILITY","83662 - HC L/S RATIO, FOAM STABILITY","82330 - HC CHG CALCIUM IONIZED","17280 - HC DESTR MALIG FACE,NOSE,LIP <0.6 CM","83662 - HC L/S RATIO, FOAM STABILITY","17271 - DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM","82330 - HC CHG CALCIUM IONIZED","83662 - HC L/S RATIO, FOAM STABILITY","72131 - HC CHG CT LUMBAR SPINE W/O CONTRAST MATERIAL","17280 - HC DESTR MALIG FACE,NOSE,LIP <0.6 CM"]
[null,"19125 - HC EXCISE BREAST LES W XRAY MARKER","82525 - HC CHG ASSAY OF COPPER","17311 - MOHS MICROGRAPHIC H/N/H/F/G 1ST STAGE 5 BLOCKS","17311 - MOHS MICROGRAPHIC H/N/H/F/G 1ST STAGE 5 BLOCKS","17311 - MOHS MICROGRAPHIC H/N/H/F/G 1ST STAGE 5 BLOCKS","82340 - HC Q;KID STONE, UR CALCIUM","17280 - HC DESTR MALIG FACE,NOSE,LIP <0.6 CM","83690 - HC CHG ASSAY OF LIPASE","83690 - HC CHG ASSAY OF LIPASE","83690 - HC CHG ASSAY OF LIPASE","82340 - HC Q;KID STONE, UR CALCIUM","17281 - DESTRUCTION OF SKIN LESIONS","83690 - HC CHG ASSAY OF LIPASE","17280 - HC DESTR MALIG FACE,NOSE,LIP <0.6 CM","82340 - HC Q;KID STONE, UR CALCIUM","83690 - HC CHG ASSAY OF LIPASE","72132 - HC CHG CT LUMBAR SPINE W/CONTRAST MATERIAL","17281 - DESTRUCTION OF SKIN LESIONS"]
[null,"19281 - PERQ DEVICE PLACEMENT BREAST LOC 1ST LES W/GDNCE","82530 - HC CHG CORTISOL FREE","17312 - MOHS,  ADDL STAGE, HEAD/NECK/HAND/FEET/GENTIAL","17312 - MOHS,  ADDL STAGE, HEAD/NECK/HAND/FEET/GENTIAL","17312 - MOHS,  ADDL STAGE, HEAD/NECK/HAND/FEET/GENTIAL","82365 - HC CHG CALCULUS INFRARED SPECTROSCOPY","17281 - DESTRUCTION OF SKIN LESIONS","83695 - HC CHG LIPOPROTEIN (A)","83695 - HC CHG LIPOPROTEIN (A)","83695 - HC CHG LIPOPROTEIN (A)","82365 - HC CHG CALCULUS INFRARED SPECTROSCOPY","17311 - MOHS MICROGRAPHIC H/N/H/F/G 1ST STAGE 5 BLOCKS","83695 - HC CHG LIPOPROTEIN (A)","17281 - DESTRUCTION OF SKIN LESIONS","82365 - HC CHG CALCULUS INFRARED SPECTROSCOPY","83695 - HC CHG LIPOPROTEIN (A)","72133 - HC CT,L SPINE;W/WO","17311 - MOHS MICROGRAPHIC H/N/H/F/G 1ST STAGE 5 BLOCKS"]
[null,"19282 - PERQ DEVICE PLACEMT BREAST LOC EA LESION W/GDNCE","82533 - HC CHG CORTISOL TOTAL","17313 - MOHS TRUNK/ARM/LEG 1ST STAGE 5 BLOCKS","17313 - MOHS TRUNK/ARM/LEG 1ST STAGE 5 BLOCKS","17313 - MOHS TRUNK/ARM/LEG 1ST STAGE 5 BLOCKS","82374 - HC CHG CARBON DIOXIDE BICARBONATE","17311 - MOHS MICROGRAPHIC H/N/H/F/G 1ST STAGE 5 BLOCKS","83718 - HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL","83718 - HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL","83718 - HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL","82374 - HC CHG CARBON DIOXIDE BICARBONATE","17312 - MOHS,  ADDL STAGE, HEAD/NECK/HAND/FEET/GENTIAL","83718 - HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL","17311 - MOHS MICROGRAPHIC H/N/H/F/G 1ST STAGE 5 BLOCKS","82374 - HC CHG CARBON DIOXIDE BICARBONATE","83718 - HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL","72141 - HC CHG MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL","17312 - MOHS,  ADDL STAGE, HEAD/NECK/HAND/FEET/GENTIAL"]
[null,"19283 - PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GDNCE","82540 - HC CHG ASSAY OF CREATINE","17314 - MOHS TRUNK/ARM/LEG EA STAGE AFTER 1ST STAGE","17314 - MOHS TRUNK/ARM/LEG EA STAGE AFTER 1ST STAGE","17314 - MOHS TRUNK/ARM/LEG EA STAGE AFTER 1ST STAGE","82375 - HC CHG CARBOXYHEMOGLOBIN QUANTITATIVE","17312 - MOHS,  ADDL STAGE, HEAD/NECK/HAND/FEET/GENTIAL","83721 - HC CRL;DIRECT LDL","83721 - HC CRL;DIRECT LDL","83721 - HC CRL;DIRECT LDL","82375 - HC CHG CARBOXYHEMOGLOBIN QUANTITATIVE","17313 - MOHS TRUNK/ARM/LEG 1ST STAGE 5 BLOCKS","83721 - HC CRL;DIRECT LDL","17312 - MOHS,  ADDL STAGE, HEAD/NECK/HAND/FEET/GENTIAL","82375 - HC CHG CARBOXYHEMOGLOBIN QUANTITATIVE","83721 - HC CRL;DIRECT LDL","72142 - HC CHG MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL","17313 - MOHS TRUNK/ARM/LEG 1ST STAGE 5 BLOCKS"]
[null,"19284 - HC PERQ BREAST LOC DEVICE PLACEMT EA LESION STRTCTC","82542 - HC CHG COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC","17315 - MOHS TRUNK/ARM/LEG EA ADDL BLOCK ANY STAGE","17315 - MOHS TRUNK/ARM/LEG EA ADDL BLOCK ANY STAGE","17315 - MOHS TRUNK/ARM/LEG EA ADDL BLOCK ANY STAGE","82378 - HC CHG CARCINOEMBRYONIC ANTIGEN CEA","17313 - MOHS TRUNK/ARM/LEG 1ST STAGE 5 BLOCKS","83735 - HC CHG ASSAY OF MAGNESIUM","83735 - HC CHG ASSAY OF MAGNESIUM","83735 - HC CHG ASSAY OF MAGNESIUM","82378 - HC CHG CARCINOEMBRYONIC ANTIGEN CEA","17314 - MOHS TRUNK/ARM/LEG EA STAGE AFTER 1ST STAGE","83735 - HC CHG ASSAY OF MAGNESIUM","17313 - MOHS TRUNK/ARM/LEG 1ST STAGE 5 BLOCKS","82378 - HC CHG CARCINOEMBRYONIC ANTIGEN CEA","83735 - HC CHG ASSAY OF MAGNESIUM","72146 - HC CHG MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL","17314 - MOHS TRUNK/ARM/LEG EA STAGE AFTER 1ST STAGE"]
[null,"19285 - PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG","82550 - HC CHG CREATINE KINASE TOTAL","17380 - HAIR REMOVAL BY ELECTROLYSIS","17380 - HAIR REMOVAL BY ELECTROLYSIS","17380 - HAIR REMOVAL BY ELECTROLYSIS","82379 - HC CRL;CARNITINE","17314 - MOHS TRUNK/ARM/LEG EA STAGE AFTER 1ST STAGE","83785 - HC CHG, ASSAY OF MANGANESE","83785 - HC CHG, ASSAY OF MANGANESE","83785 - HC CHG, ASSAY OF MANGANESE","82379 - HC CRL;CARNITINE","17315 - MOHS TRUNK/ARM/LEG EA ADDL BLOCK ANY STAGE","83785 - HC CHG, ASSAY OF MANGANESE","17314 - MOHS TRUNK/ARM/LEG EA STAGE AFTER 1ST STAGE","82379 - HC CRL;CARNITINE","83785 - HC CHG, ASSAY OF MANGANESE","72147 - HC CHG MRI SPINAL CANAL THORACIC W/CONTRAST MATRL","17315 - MOHS TRUNK/ARM/LEG EA ADDL BLOCK ANY STAGE"]
[null,"19286 - PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE","82553 - HC CHG CREATINE KINASE MB FRACTION ONLY","19000 - PUNCTURE ASPIRATION CYST BREAST","19000 - PUNCTURE ASPIRATION CYST BREAST","19000 - PUNCTURE ASPIRATION CYST BREAST","82384 - HC CHG CATECHOLAMINES FRACTIONATED","17315 - MOHS TRUNK/ARM/LEG EA ADDL BLOCK ANY STAGE","83789 - HC CHG MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA","83789 - HC CHG MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA","83789 - HC CHG MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA","82384 - HC CHG CATECHOLAMINES FRACTIONATED","17380 - HAIR REMOVAL BY ELECTROLYSIS","83789 - HC CHG MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA","17315 - MOHS TRUNK/ARM/LEG EA ADDL BLOCK ANY STAGE","82384 - HC CHG CATECHOLAMINES FRACTIONATED","83789 - HC CHG MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA","72148 - HC CHG MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL","17380 - HAIR REMOVAL BY ELECTROLYSIS"]
[null,"19287 - PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID","82565 - HC CHG CREATININE BLOOD","19001 - HC CY ASP BREAST;EA ADD","19001 - HC CY ASP BREAST;EA ADD","19001 - HC CY ASP BREAST;EA ADD","82390 - HC CHG CERULOPLASMIN","17380 - HAIR REMOVAL BY ELECTROLYSIS","83825 - HC CHG ASSAY OF MERCURY QUANTITATIVE","83825 - HC CHG ASSAY OF MERCURY QUANTITATIVE","83825 - HC CHG ASSAY OF MERCURY QUANTITATIVE","82390 - HC CHG CERULOPLASMIN","19000 - PUNCTURE ASPIRATION CYST BREAST","83825 - HC CHG ASSAY OF MERCURY QUANTITATIVE","17380 - HAIR REMOVAL BY ELECTROLYSIS","82390 - HC CHG CERULOPLASMIN","83825 - HC CHG ASSAY OF MERCURY QUANTITATIVE","72149 - HC CHG MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL","19000 - PUNCTURE ASPIRATION CYST BREAST"]
[null,"19288 - PERQ BREAST LOC DEVICE PLACEMT ADD LESIO MR GUID","82570 - HC CHG CREATININE OTHER SOURCE","19020 - MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP","19020 - MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP","19020 - MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP","82397 - HC CHEMILUMINESCENT ASSAY","17999 - PR PRE OPERATIVE LASER HAIR REMOVAL FOR GENITAL AFFIRMATION SURGERY","83835 - HC CHG METANEPHRINES","83835 - HC CHG METANEPHRINES","83835 - HC CHG METANEPHRINES","82397 - HC CHEMILUMINESCENT ASSAY","19001 - HC CY ASP BREAST;EA ADD","83835 - HC CHG METANEPHRINES","17999 - PR PRE OPERATIVE LASER HAIR REMOVAL FOR GENITAL AFFIRMATION SURGERY","82397 - HC CHEMILUMINESCENT ASSAY","83835 - HC CHG METANEPHRINES","72156 - HC CHG MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL","19001 - HC CY ASP BREAST;EA ADD"]
[null,"19301 - HC PR MASTECTOMY, PARTIAL","82575 - HC CHG CREATININE CLEARANCE","19081 - BX BREAST W/DEVICE 1ST LESION STEREOTACTIC GUID","19081 - BX BREAST W/DEVICE 1ST LESION STEREOTACTIC GUID","19081 - BX BREAST W/DEVICE 1ST LESION STEREOTACTIC GUID","82435 - HC CHG CHLORIDE BLD","19000 - PUNCTURE ASPIRATION CYST BREAST","83873 - HC CHG MYELIN BASIC PROTEIN CEREBROSPINAL FLUID","83873 - HC CHG MYELIN BASIC PROTEIN CEREBROSPINAL FLUID","83873 - HC CHG MYELIN BASIC PROTEIN CEREBROSPINAL FLUID","82435 - HC CHG CHLORIDE BLD","19020 - MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP","83873 - HC CHG MYELIN BASIC PROTEIN CEREBROSPINAL FLUID","19000 - PUNCTURE ASPIRATION CYST BREAST","82435 - HC CHG CHLORIDE BLD","83873 - HC CHG MYELIN BASIC PROTEIN CEREBROSPINAL FLUID","72157 - HC CHG MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL","19020 - MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP"]
[null,"19316 - SUSPENSION OF BREAST","82585 - HC CHG ASSAY OF CRYOFIBRN","19082 - BX BREAST W/DEVICE ADDL LESION STEREOTACT GUID","19082 - BX BREAST W/DEVICE ADDL LESION STEREOTACT GUID","19082 - BX BREAST W/DEVICE ADDL LESION STEREOTACT GUID","82436 - HC CHG CHLORIDE URINE","19001 - HC CY ASP BREAST;EA ADD","83874 - HC CHG MYOGLOBIN","83874 - HC CHG MYOGLOBIN","83874 - HC CHG MYOGLOBIN","82436 - HC CHG CHLORIDE URINE","19081 - BX BREAST W/DEVICE 1ST LESION STEREOTACTIC GUID","83874 - HC CHG MYOGLOBIN","19001 - HC CY ASP BREAST;EA ADD","82436 - HC CHG CHLORIDE URINE","83874 - HC CHG MYOGLOBIN","72158 - HC CHG MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL","19081 - BX BREAST W/DEVICE 1ST LESION STEREOTACTIC GUID"]
[null,"19318 - HC REDUCTION OF LARGE BREAST","82595 - HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE","19083 - BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID","19083 - BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID","19083 - BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID","82438 - HC CHG CHLORIDE OTHER SOURCE","19020 - MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP","83880 - HC CHG NATRIURETIC PEPTIDE","83880 - HC CHG NATRIURETIC PEPTIDE","83880 - HC CHG NATRIURETIC PEPTIDE","82438 - HC CHG CHLORIDE OTHER SOURCE","19082 - BX BREAST W/DEVICE ADDL LESION STEREOTACT GUID","83880 - HC CHG NATRIURETIC PEPTIDE","19020 - MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP","82438 - HC CHG CHLORIDE OTHER SOURCE","83880 - HC CHG NATRIURETIC PEPTIDE","72170 - HC CHG RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS","19082 - BX BREAST W/DEVICE ADDL LESION STEREOTACT GUID"]
[null,"19328 - HC REMOVAL OF BREAST IMPLANT","82607 - HC CHG CYANOCOBALAMIN VITAMIN B-12","19084 - BX BREAST W/DEVICE ADDL LESION ULTRASOUND GUID","19084 - BX BREAST W/DEVICE ADDL LESION ULTRASOUND GUID","19084 - BX BREAST W/DEVICE ADDL LESION ULTRASOUND GUID","82465 - CHOLESTEROL SERUM/WHOLE BLOOD TOTAL","19081 - BX BREAST W/DEVICE 1ST LESION STEREOTACTIC GUID","83883 - HC NEPHELOMETRY, EACH ANALYTE","83883 - HC NEPHELOMETRY, EACH ANALYTE","83883 - HC NEPHELOMETRY, EACH ANALYTE","82465 - CHOLESTEROL SERUM/WHOLE BLOOD TOTAL","19083 - BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID","83883 - HC NEPHELOMETRY, EACH ANALYTE","19081 - BX BREAST W/DEVICE 1ST LESION STEREOTACTIC GUID","82465 - CHOLESTEROL SERUM/WHOLE BLOOD TOTAL","83883 - HC NEPHELOMETRY, EACH ANALYTE","72190 - HC CHG RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS","19083 - BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID"]
[null,"19340 - INSERT BREAST PROS IMMED AFTER EXCIS","82626 - HC CHG DEHYDROEPIANDROSTERONE","19085 - BX BREAST W/DEVICE 1ST LESION MAGNETIC RES GUID","19085 - BX BREAST W/DEVICE 1ST LESION MAGNETIC RES GUID","19085 - BX BREAST W/DEVICE 1ST LESION MAGNETIC RES GUID","82495 - HC CHG ASSAY OF CHROMIUM","19082 - BX BREAST W/DEVICE ADDL LESION STEREOTACT GUID","83915 - HC CHG ASSAY OF NUCLEOTIDASE 5'-","83915 - HC CHG ASSAY OF NUCLEOTIDASE 5'-","83915 - HC CHG ASSAY OF NUCLEOTIDASE 5'-","82495 - HC CHG ASSAY OF CHROMIUM","19084 - BX BREAST W/DEVICE ADDL LESION ULTRASOUND GUID","83915 - HC CHG ASSAY OF NUCLEOTIDASE 5'-","19082 - BX BREAST W/DEVICE ADDL LESION STEREOTACT GUID","82495 - HC CHG ASSAY OF CHROMIUM","83915 - HC CHG ASSAY OF NUCLEOTIDASE 5'-","72191 - HC CHG CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST","19084 - BX BREAST W/DEVICE ADDL LESION ULTRASOUND GUID"]
[null,"19350 - NIPPLE/AREOLA RECONSTRUCTION","82627 - HC CHG DEHYDROEPIANDROSTERONE-SULFATE","19086 - BX BREAST W/DEVICE ADDL LESION MAGNET RES GUID","19086 - BX BREAST W/DEVICE ADDL LESION MAGNET RES GUID","19086 - BX BREAST W/DEVICE ADDL LESION MAGNET RES GUID","82507 - HC CHG ASSAY OF CITRATE","19083 - BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID","83916 - HC CHG OLIGOCLONAL IMMUNE","83916 - HC CHG OLIGOCLONAL IMMUNE","83916 - HC CHG OLIGOCLONAL IMMUNE","82507 - HC CHG ASSAY OF CITRATE","19085 - BX BREAST W/DEVICE 1ST LESION MAGNETIC RES GUID","83916 - HC CHG OLIGOCLONAL IMMUNE","19083 - BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID","82507 - HC CHG ASSAY OF CITRATE","83916 - HC CHG OLIGOCLONAL IMMUNE","72192 - HC CHG CT PELVIS W/O CONTRAST MATERIAL","19085 - BX BREAST W/DEVICE 1ST LESION MAGNETIC RES GUID"]
[null,"19355 - HC CORRECT INVERTED NIPPLE(S)","82652 - HC CHG 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED","19100 - BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX","19100 - BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX","19100 - BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX","82523 - HC CHG COLLAGEN CROSS LINKS ANY METHOD","19084 - BX BREAST W/DEVICE ADDL LESION ULTRASOUND GUID","83918 - HC CHG ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN","83918 - HC CHG ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN","83918 - HC CHG ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN","82523 - HC CHG COLLAGEN CROSS LINKS ANY METHOD","19086 - BX BREAST W/DEVICE ADDL LESION MAGNET RES GUID","83918 - HC CHG ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN","19084 - BX BREAST W/DEVICE ADDL LESION ULTRASOUND GUID","82523 - HC CHG COLLAGEN CROSS LINKS ANY METHOD","83918 - HC CHG ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN","72193 - HC CHG CT PELVIS W/CONTRAST MATERIAL","19086 - BX BREAST W/DEVICE ADDL LESION MAGNET RES GUID"]
[null,"19380 - REVISION RECONSTRUCTED BREAST","82656 - HC CHG ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN","19120 - EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION","19120 - EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION","19120 - EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION","82525 - HC CHG ASSAY OF COPPER","19085 - BX BREAST W/DEVICE 1ST LESION MAGNETIC RES GUID","83921 - HC CHG ORGANIC ACID 1 QUANTITATIVE","83921 - HC CHG ORGANIC ACID 1 QUANTITATIVE","83921 - HC CHG ORGANIC ACID 1 QUANTITATIVE","82525 - HC CHG ASSAY OF COPPER","19100 - BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX","83921 - HC CHG ORGANIC ACID 1 QUANTITATIVE","19085 - BX BREAST W/DEVICE 1ST LESION MAGNETIC RES GUID","82525 - HC CHG ASSAY OF COPPER","83921 - HC CHG ORGANIC ACID 1 QUANTITATIVE","72194 - HC CT,PELVIS;W/WO","19100 - BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX"]
[null,"19499 - PR TOMO GUIDED PLACEMENT OF BREAST LOCALIZATION DEVICE","82657 - HC CHG NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA","19125 - HC EXCISE BREAST LES W XRAY MARKER","19125 - HC EXCISE BREAST LES W XRAY MARKER","19125 - HC EXCISE BREAST LES W XRAY MARKER","82530 - HC CHG CORTISOL FREE","19086 - BX BREAST W/DEVICE ADDL LESION MAGNET RES GUID","83930 - HC Q;OSMOLALITY,SER","83930 - HC Q;OSMOLALITY,SER","83930 - HC Q;OSMOLALITY,SER","82530 - HC CHG CORTISOL FREE","19120 - EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION","83930 - HC Q;OSMOLALITY,SER","19086 - BX BREAST W/DEVICE ADDL LESION MAGNET RES GUID","82530 - HC CHG CORTISOL FREE","83930 - HC Q;OSMOLALITY,SER","72195 - HC CHG MRI PELVIS W/O CONTRAST MATERIAL","19120 - EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION"]
[null,"20103 - EXPLORATION PENETRATING WOUND SPX EXTREMITY","82668 - HC CHG ASSAY OF ERYTHROPOIETIN","19281 - PERQ DEVICE PLACEMENT BREAST LOC 1ST LES W/GDNCE","19281 - PERQ DEVICE PLACEMENT BREAST LOC 1ST LES W/GDNCE","19281 - PERQ DEVICE PLACEMENT BREAST LOC 1ST LES W/GDNCE","82533 - HC CHG CORTISOL TOTAL","19100 - BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX","83935 - HC CHG ASSAY OF OSMOLALITY URINE","83935 - HC CHG ASSAY OF OSMOLALITY URINE","83935 - HC CHG ASSAY OF OSMOLALITY URINE","82533 - HC CHG CORTISOL TOTAL","19125 - HC EXCISE BREAST LES W XRAY MARKER","83935 - HC CHG ASSAY OF OSMOLALITY URINE","19100 - BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX","82533 - HC CHG CORTISOL TOTAL","83935 - HC CHG ASSAY OF OSMOLALITY URINE","72196 - HC CHG MRI PELVIS W/CONTRAST MATERIAL","19125 - HC EXCISE BREAST LES W XRAY MARKER"]
[null,"20200 - HC MUSCLE BIOPSY","82670 - HC CHG ASSAY OF ESTRADIOL","19282 - PERQ DEVICE PLACEMT BREAST LOC EA LESION W/GDNCE","19282 - PERQ DEVICE PLACEMT BREAST LOC EA LESION W/GDNCE","19282 - PERQ DEVICE PLACEMT BREAST LOC EA LESION W/GDNCE","82540 - HC CHG ASSAY OF CREATINE","19120 - EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION","83937 - HC CHG ASSAY OF OSTEOCALCIN","83937 - HC CHG ASSAY OF OSTEOCALCIN","83937 - HC CHG ASSAY OF OSTEOCALCIN","82540 - HC CHG ASSAY OF CREATINE","19281 - PERQ DEVICE PLACEMENT BREAST LOC 1ST LES W/GDNCE","83937 - HC CHG ASSAY OF OSTEOCALCIN","19120 - EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION","82540 - HC CHG ASSAY OF CREATINE","83937 - HC CHG ASSAY OF OSTEOCALCIN","72197 - HC CHG MRI PELVIS W/O & W/CONTRAST MATERIAL","19281 - PERQ DEVICE PLACEMENT BREAST LOC 1ST LES W/GDNCE"]
[null,"20205 - BIOPSY,MUSCLE,DEEP","82677 - HC CHG ASSAY OF ESTRIOL","19283 - PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GDNCE","19283 - PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GDNCE","19283 - PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GDNCE","82542 - HC CHG COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC","19125 - HC EXCISE BREAST LES W XRAY MARKER","83945 - HC CHG ASSAY OF OXALATE","83945 - HC CHG ASSAY OF OXALATE","83945 - HC CHG ASSAY OF OXALATE","82542 - HC CHG COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC","19282 - PERQ DEVICE PLACEMT BREAST LOC EA LESION W/GDNCE","83945 - HC CHG ASSAY OF OXALATE","19125 - HC EXCISE BREAST LES W XRAY MARKER","82542 - HC CHG COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC","83945 - HC CHG ASSAY OF OXALATE","72200 - X-RAY EXAM SI JOINTS","19282 - PERQ DEVICE PLACEMT BREAST LOC EA LESION W/GDNCE"]
[null,"20206 - BIOPSY MUSCLE PERCUTANEOUS NEEDLE","82693 - HC CHG ASSAY OF ETHYLENE GLYCOL","19284 - HC PERQ BREAST LOC DEVICE PLACEMT EA LESION STRTCTC","19284 - HC PERQ BREAST LOC DEVICE PLACEMT EA LESION STRTCTC","19284 - HC PERQ BREAST LOC DEVICE PLACEMT EA LESION STRTCTC","82550 - HC CHG CREATINE KINASE TOTAL","19281 - PERQ DEVICE PLACEMENT BREAST LOC 1ST LES W/GDNCE","83970 - HC CHG ASSAY OF PARATHORMONE","83970 - HC CHG ASSAY OF PARATHORMONE","83970 - HC CHG ASSAY OF PARATHORMONE","82550 - HC CHG CREATINE KINASE TOTAL","19283 - PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GDNCE","83970 - HC CHG ASSAY OF PARATHORMONE","19281 - PERQ DEVICE PLACEMENT BREAST LOC 1ST LES W/GDNCE","82550 - HC CHG CREATINE KINASE TOTAL","83970 - HC CHG ASSAY OF PARATHORMONE","72202 - HC CHG RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS","19283 - PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GDNCE"]
[null,"20220 - HC BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL","82705 - HC CHG FAT/LIPIDS FECES QUALITATIVE","19285 - PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG","19285 - PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG","19285 - PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG","82553 - HC CHG CREATINE KINASE MB FRACTION ONLY","19282 - PERQ DEVICE PLACEMT BREAST LOC EA LESION W/GDNCE","83986 - HC CHG PH BODY FLUID NOT ELSEWHERE SPECIFIED","83986 - HC CHG PH BODY FLUID NOT ELSEWHERE SPECIFIED","83986 - HC CHG PH BODY FLUID NOT ELSEWHERE SPECIFIED","82553 - HC CHG CREATINE KINASE MB FRACTION ONLY","19284 - HC PERQ BREAST LOC DEVICE PLACEMT EA LESION STRTCTC","83986 - HC CHG PH BODY FLUID NOT ELSEWHERE SPECIFIED","19282 - PERQ DEVICE PLACEMT BREAST LOC EA LESION W/GDNCE","82553 - HC CHG CREATINE KINASE MB FRACTION ONLY","83986 - HC CHG PH BODY FLUID NOT ELSEWHERE SPECIFIED","72220 - HC CHG RADEX SACRUM & COCCYX MINIMUM 2 VIEWS","19284 - HC PERQ BREAST LOC DEVICE PLACEMT EA LESION STRTCTC"]
[null,"20225 - HC BIOPSY BONE TROCAR/NEEDLE DEEP","82728 - HC CHG ASSAY OF FERRITIN","19286 - PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE","19286 - PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE","19286 - PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE","82565 - HC CHG CREATININE BLOOD","19283 - PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GDNCE","83993 - HC CHG ASSAY OF CALPROTECTIN FECAL","83992 - HC CHG ASSAY OF PHENCYCLIDINE","83993 - HC CHG ASSAY OF CALPROTECTIN FECAL","82565 - HC CHG CREATININE BLOOD","19285 - PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG","83993 - HC CHG ASSAY OF CALPROTECTIN FECAL","19283 - PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GDNCE","82565 - HC CHG CREATININE BLOOD","83993 - HC CHG ASSAY OF CALPROTECTIN FECAL","72240 - HC CHG MYELOGRAPHY CERVICAL RS&I","19285 - PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG"]
[null,"20240 - HC BIOPSY BONE OPEN SUPERFICIAL","82731 - HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN","19287 - PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID","19287 - PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID","19287 - PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID","82570 - HC CHG CREATININE OTHER SOURCE","19284 - HC PERQ BREAST LOC DEVICE PLACEMT EA LESION STRTCTC","84075 - HC CHG ASSAY OF PHOSPHATASE ALKALINE","83993 - HC CHG ASSAY OF CALPROTECTIN FECAL","84075 - HC CHG ASSAY OF PHOSPHATASE ALKALINE","82570 - HC CHG CREATININE OTHER SOURCE","19286 - PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE","84075 - HC CHG ASSAY OF PHOSPHATASE ALKALINE","19284 - HC PERQ BREAST LOC DEVICE PLACEMT EA LESION STRTCTC","82570 - HC CHG CREATININE OTHER SOURCE","84075 - HC CHG ASSAY OF PHOSPHATASE ALKALINE","72255 - HC CHG MYELOGRAPHY THORACIC RS&I","19286 - PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE"]
[null,"20245 - BIOPSY BONE OPEN DEEP","82746 - HC CHG ASSAY OF FOLIC ACID SERUM","19288 - PERQ BREAST LOC DEVICE PLACEMT ADD LESIO MR GUID","19288 - PERQ BREAST LOC DEVICE PLACEMT ADD LESIO MR GUID","19288 - PERQ BREAST LOC DEVICE PLACEMT ADD LESIO MR GUID","82575 - HC CHG CREATININE CLEARANCE","19285 - PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG","84080 - HC CHG ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES","84075 - HC CHG ASSAY OF PHOSPHATASE ALKALINE","84080 - HC CHG ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES","82575 - HC CHG CREATININE CLEARANCE","19287 - PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID","84080 - HC CHG ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES","19285 - PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG","82575 - HC CHG CREATININE CLEARANCE","84080 - HC CHG ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES","72265 - HC CHG MYELOGRAPY LUMBOSACRAL RS&I","19287 - PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID"]
[null,"20501 - HC INJECTION SINUS TRACT DIAGNOSTIC","82747 - HC CHG ASSAY OF FOLIC ACID RBC","19301 - HC PR MASTECTOMY, PARTIAL","19301 - HC PR MASTECTOMY, PARTIAL","19301 - HC PR MASTECTOMY, PARTIAL","82585 - HC CHG ASSAY OF CRYOFIBRN","19286 - PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE","84100 - HC CHG ASSAY OF PHOSPHORUS INORGANIC","84080 - HC CHG ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES","84100 - HC CHG ASSAY OF PHOSPHORUS INORGANIC","82585 - HC CHG ASSAY OF CRYOFIBRN","19288 - PERQ BREAST LOC DEVICE PLACEMT ADD LESIO MR GUID","84100 - HC CHG ASSAY OF PHOSPHORUS INORGANIC","19286 - PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE","82585 - HC CHG ASSAY OF CRYOFIBRN","84100 - HC CHG ASSAY OF PHOSPHORUS INORGANIC","73000 - ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R","19288 - PERQ BREAST LOC DEVICE PLACEMT ADD LESIO MR GUID"]
[null,"20520 - REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE","82784 - HC CHG ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH","19316 - SUSPENSION OF BREAST","19316 - SUSPENSION OF BREAST","19316 - SUSPENSION OF BREAST","82595 - HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE","19287 - PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID","84105 - HC CHG ASSAY OF PHOSPHORUS INORGANIC URINE","84100 - HC CHG ASSAY OF PHOSPHORUS INORGANIC","84105 - HC CHG ASSAY OF PHOSPHORUS INORGANIC URINE","82595 - HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE","19301 - HC PR MASTECTOMY, PARTIAL","84105 - HC CHG ASSAY OF PHOSPHORUS INORGANIC URINE","19287 - PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID","82595 - HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE","84105 - HC CHG ASSAY OF PHOSPHORUS INORGANIC URINE","73010 - HC CHG RADEX SCAPULA COMPLETE","19301 - HC PR MASTECTOMY, PARTIAL"]
[null,"20525 - RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP","82785 - HC CHG ASSAY OF GAMMAGLOBULIN IGE","19318 - HC REDUCTION OF LARGE BREAST","19318 - HC REDUCTION OF LARGE BREAST","19318 - HC REDUCTION OF LARGE BREAST","82607 - HC CHG CYANOCOBALAMIN VITAMIN B-12","19288 - PERQ BREAST LOC DEVICE PLACEMT ADD LESIO MR GUID","84132 - HC CHG POTASSIUM SERUM PLASMA/WHOLE BLOOD","84105 - HC CHG ASSAY OF PHOSPHORUS INORGANIC URINE","84132 - HC CHG POTASSIUM SERUM PLASMA/WHOLE BLOOD","82607 - HC CHG CYANOCOBALAMIN VITAMIN B-12","19316 - SUSPENSION OF BREAST","84132 - HC CHG POTASSIUM SERUM PLASMA/WHOLE BLOOD","19288 - PERQ BREAST LOC DEVICE PLACEMT ADD LESIO MR GUID","82607 - HC CHG CYANOCOBALAMIN VITAMIN B-12","84132 - HC CHG POTASSIUM SERUM PLASMA/WHOLE BLOOD","73020 - HC CHG RADEX SHOULDER 1 VIEW","19316 - SUSPENSION OF BREAST"]
[null,"20526 - INJECTION THERAPEUTIC CARPAL TUNNEL","82787 - HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES","19328 - HC REMOVAL OF BREAST IMPLANT","19328 - HC REMOVAL OF BREAST IMPLANT","19328 - HC REMOVAL OF BREAST IMPLANT","82626 - HC CHG DEHYDROEPIANDROSTERONE","19301 - HC PR MASTECTOMY, PARTIAL","84133 - HC CHG POTASSIUM URINE","84132 - HC CHG POTASSIUM SERUM PLASMA/WHOLE BLOOD","84133 - HC CHG POTASSIUM URINE","82626 - HC CHG DEHYDROEPIANDROSTERONE","19318 - HC REDUCTION OF LARGE BREAST","84133 - HC CHG POTASSIUM URINE","19301 - HC PR MASTECTOMY, PARTIAL","82626 - HC CHG DEHYDROEPIANDROSTERONE","84133 - HC CHG POTASSIUM URINE","73030 - HC CHG RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS","19318 - HC REDUCTION OF LARGE BREAST"]
[null,"20527 - INJECTION ENZYME PALMAR FASCIAL CORD","82803 - HC CHG BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3","19340 - INSERT BREAST PROS IMMED AFTER EXCIS","19340 - INSERT BREAST PROS IMMED AFTER EXCIS","19340 - INSERT BREAST PROS IMMED AFTER EXCIS","82627 - HC CHG DEHYDROEPIANDROSTERONE-SULFATE","19316 - SUSPENSION OF BREAST","84134 - HC CHG PREALBUMIN","84133 - HC CHG POTASSIUM URINE","84134 - HC CHG PREALBUMIN","82627 - HC CHG DEHYDROEPIANDROSTERONE-SULFATE","19328 - HC REMOVAL OF BREAST IMPLANT","84134 - HC CHG PREALBUMIN","19316 - SUSPENSION OF BREAST","82627 - HC CHG DEHYDROEPIANDROSTERONE-SULFATE","84134 - HC CHG PREALBUMIN","73050 - HC CHG RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ","19328 - HC REMOVAL OF BREAST IMPLANT"]
[null,"20550 - INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS","82805 - HC CHG GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY","19350 - NIPPLE/AREOLA RECONSTRUCTION","19350 - NIPPLE/AREOLA RECONSTRUCTION","19350 - NIPPLE/AREOLA RECONSTRUCTION","82652 - HC CHG 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED","19318 - HC REDUCTION OF LARGE BREAST","84144 - HC CHG ASSAY OF PROGESTERONE","84134 - HC CHG PREALBUMIN","84144 - HC CHG ASSAY OF PROGESTERONE","82652 - HC CHG 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED","19340 - INSERT BREAST PROS IMMED AFTER EXCIS","84144 - HC CHG ASSAY OF PROGESTERONE","19318 - HC REDUCTION OF LARGE BREAST","82652 - HC CHG 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED","84144 - HC CHG ASSAY OF PROGESTERONE","73060 - HC CHG RADEX HUMERUS MINIMUM 2 VIEWS","19340 - INSERT BREAST PROS IMMED AFTER EXCIS"]
[null,"20551 - INJECTION SINGLE TENDON ORIGIN/INSERTION","82810 - HC BLOOD GASSES O2 SAT ONLY","19355 - HC CORRECT INVERTED NIPPLE(S)","19355 - HC CORRECT INVERTED NIPPLE(S)","19355 - HC CORRECT INVERTED NIPPLE(S)","82656 - HC CHG ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN","19328 - HC REMOVAL OF BREAST IMPLANT","84145 - HC CHG PROCALCITONIN (PCT)","84144 - HC CHG ASSAY OF PROGESTERONE","84145 - HC CHG PROCALCITONIN (PCT)","82656 - HC CHG ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN","19350 - NIPPLE/AREOLA RECONSTRUCTION","84145 - HC CHG PROCALCITONIN (PCT)","19328 - HC REMOVAL OF BREAST IMPLANT","82656 - HC CHG ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN","84145 - HC CHG PROCALCITONIN (PCT)","73070 - HC CHG RADEX ELBOW 2 VIEWS","19350 - NIPPLE/AREOLA RECONSTRUCTION"]
[null,"20552 - INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES","82941 - HC CHG ASSAY OF GASTRIN","19380 - REVISION RECONSTRUCTED BREAST","19380 - REVISION RECONSTRUCTED BREAST","19380 - REVISION RECONSTRUCTED BREAST","82657 - HC CHG NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA","19340 - INSERT BREAST PROS IMMED AFTER EXCIS","84146 - HC CHG ASSAY OF PROLACTIN","84145 - HC CHG PROCALCITONIN (PCT)","84146 - HC CHG ASSAY OF PROLACTIN","82657 - HC CHG NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA","19355 - HC CORRECT INVERTED NIPPLE(S)","84146 - HC CHG ASSAY OF PROLACTIN","19340 - INSERT BREAST PROS IMMED AFTER EXCIS","82657 - HC CHG NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA","84146 - HC CHG ASSAY OF PROLACTIN","73080 - HC CHG RADEX ELBOW COMPLETE MINIMUM 3 VIEWS","19355 - HC CORRECT INVERTED NIPPLE(S)"]
[null,"20553 - INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES","82945 - HC CHG GLUCOSE BODY FLUID OTHER THAN BLOOD","20100 - HC EXPLORE WOUND,NECK","20100 - HC EXPLORE WOUND,NECK","20100 - HC EXPLORE WOUND,NECK","82668 - HC CHG ASSAY OF ERYTHROPOIETIN","19350 - NIPPLE/AREOLA RECONSTRUCTION","84153 - HC CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL","84146 - HC CHG ASSAY OF PROLACTIN","84153 - HC CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL","82668 - HC CHG ASSAY OF ERYTHROPOIETIN","19380 - REVISION RECONSTRUCTED BREAST","84153 - HC CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL","19350 - NIPPLE/AREOLA RECONSTRUCTION","82668 - HC CHG ASSAY OF ERYTHROPOIETIN","84153 - HC CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL","73090 - HC CHG RADEX FOREARM 2 VIEWS","19380 - REVISION RECONSTRUCTED BREAST"]
[null,"20600 - ARTHROCENTESIS ASPIR&/INJECTION SMALL JT/BURSA","82947 - HC CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP","20102 - HC EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK","20102 - HC EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK","20102 - HC EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK","82670 - HC CHG ASSAY OF ESTRADIOL","19355 - HC CORRECT INVERTED NIPPLE(S)","84155 - HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD","84153 - HC CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL","84155 - HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD","82670 - HC CHG ASSAY OF ESTRADIOL","20100 - HC EXPLORE WOUND,NECK","84155 - HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD","19355 - HC CORRECT INVERTED NIPPLE(S)","82670 - HC CHG ASSAY OF ESTRADIOL","84155 - HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD","73092 - HC CHG RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS","20100 - HC EXPLORE WOUND,NECK"]
[null,"20604 - HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT","82950 - HC CHG GLUCOSE POST GLUCOSE DOSE","20103 - EXPLORATION PENETRATING WOUND SPX EXTREMITY","20103 - EXPLORATION PENETRATING WOUND SPX EXTREMITY","20103 - EXPLORATION PENETRATING WOUND SPX EXTREMITY","82677 - HC CHG ASSAY OF ESTRIOL","19380 - REVISION RECONSTRUCTED BREAST","84156 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY URINE","84155 - HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD","84156 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY URINE","82677 - HC CHG ASSAY OF ESTRIOL","20102 - HC EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK","84156 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY URINE","19380 - REVISION RECONSTRUCTED BREAST","82677 - HC CHG ASSAY OF ESTRIOL","84156 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY URINE","73100 - XTRNL ECG & 48 HR RECORDING","20102 - HC EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK"]
[null,"20605 - ARTHROCENTESIS ASPIR&/INJECTION INTERM JT/BURS","82951 - HC CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS","20200 - HC MUSCLE BIOPSY","20200 - HC MUSCLE BIOPSY","20200 - HC MUSCLE BIOPSY","82693 - HC CHG ASSAY OF ETHYLENE GLYCOL","19499 - PR TOMO GUIDED PLACEMENT OF BREAST LOCALIZATION DEVICE","84157 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC","84156 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY URINE","84157 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC","82693 - HC CHG ASSAY OF ETHYLENE GLYCOL","20103 - EXPLORATION PENETRATING WOUND SPX EXTREMITY","84157 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC","19499 - PR TOMO GUIDED PLACEMENT OF BREAST LOCALIZATION DEVICE","82693 - HC CHG ASSAY OF ETHYLENE GLYCOL","84157 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC","73110 - HC CHG RADEX WRIST COMPLETE MINIMUM 3 VIEWS","20103 - EXPLORATION PENETRATING WOUND SPX EXTREMITY"]
[null,"20606 - HC PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US","82952 - HC CHG GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS","20205 - BIOPSY,MUSCLE,DEEP","20205 - BIOPSY,MUSCLE,DEEP","20205 - BIOPSY,MUSCLE,DEEP","82705 - HC CHG FAT/LIPIDS FECES QUALITATIVE","20100 - HC EXPLORE WOUND,NECK","84163 - HC CHG PREGNANCY-ASSOCIATED PLASMA PROTEIN-A","84157 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC","84163 - HC CHG PREGNANCY-ASSOCIATED PLASMA PROTEIN-A","82705 - HC CHG FAT/LIPIDS FECES QUALITATIVE","20200 - HC MUSCLE BIOPSY","84163 - HC CHG PREGNANCY-ASSOCIATED PLASMA PROTEIN-A","20100 - HC EXPLORE WOUND,NECK","82705 - HC CHG FAT/LIPIDS FECES QUALITATIVE","84163 - HC CHG PREGNANCY-ASSOCIATED PLASMA PROTEIN-A","73120 - HC CHG RADEX HAND 2 VIEWS","20200 - HC MUSCLE BIOPSY"]
[null,"20610 - ARTHROCENTESIS ASPIR&/INJECTION MAJOR JT/BURSA","82960 - HC CHG GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN","20206 - BIOPSY MUSCLE PERCUTANEOUS NEEDLE","20206 - BIOPSY MUSCLE PERCUTANEOUS NEEDLE","20206 - BIOPSY MUSCLE PERCUTANEOUS NEEDLE","82728 - HC CHG ASSAY OF FERRITIN","20102 - HC EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK","84165 - HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM","84163 - HC CHG PREGNANCY-ASSOCIATED PLASMA PROTEIN-A","84165 - HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM","82728 - HC CHG ASSAY OF FERRITIN","20205 - BIOPSY,MUSCLE,DEEP","84165 - HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM","20102 - HC EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK","82728 - HC CHG ASSAY OF FERRITIN","84165 - HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM","73130 - HC CHG RADEX HAND MINIMUM 3 VIEWS","20205 - BIOPSY,MUSCLE,DEEP"]
[null,"20611 - HC PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US","82962 - HC GLUCOMETER - PHARM","20220 - HC BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL","20220 - HC BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL","20220 - HC BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL","82731 - HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN","20103 - EXPLORATION PENETRATING WOUND SPX EXTREMITY","84166 - HC CHG PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI","84165 - HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM","84166 - HC CHG PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI","82731 - HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN","20206 - BIOPSY MUSCLE PERCUTANEOUS NEEDLE","84166 - HC CHG PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI","20103 - EXPLORATION PENETRATING WOUND SPX EXTREMITY","82731 - HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN","84166 - HC CHG PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI","73140 - HC CHG RADEX FINGR MINIMUM 2 VIEWS","20206 - BIOPSY MUSCLE PERCUTANEOUS NEEDLE"]
[null,"20612 - ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ","82977 - HC CHG ASSAY OF GGT","20225 - HC BIOPSY BONE TROCAR/NEEDLE DEEP","20225 - HC BIOPSY BONE TROCAR/NEEDLE DEEP","20225 - HC BIOPSY BONE TROCAR/NEEDLE DEEP","82746 - HC CHG ASSAY OF FOLIC ACID SERUM","20200 - HC MUSCLE BIOPSY","84182 - HC CHG PROTEIN, WESTERN BLOT TEST, W BAND","84166 - HC CHG PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI","84182 - HC CHG PROTEIN, WESTERN BLOT TEST, W BAND","82746 - HC CHG ASSAY OF FOLIC ACID SERUM","20220 - HC BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL","84182 - HC CHG PROTEIN, WESTERN BLOT TEST, W BAND","20200 - HC MUSCLE BIOPSY","82746 - HC CHG ASSAY OF FOLIC ACID SERUM","84182 - HC CHG PROTEIN, WESTERN BLOT TEST, W BAND","73200 - HC CHG CT UPPER EXTREMITY W/O CONTRAST MATERIAL","20220 - HC BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL"]
[null,"20615 - ASPIRATION & INJECTION TREATMENT BONE CYST","82985 - HC CHG ASSAY OF GLYCATED PROTEIN","20240 - HC BIOPSY BONE OPEN SUPERFICIAL","20240 - HC BIOPSY BONE OPEN SUPERFICIAL","20240 - HC BIOPSY BONE OPEN SUPERFICIAL","82747 - HC CHG ASSAY OF FOLIC ACID RBC","20205 - BIOPSY,MUSCLE,DEEP","84202 - HC Q;ERYTH PROTPOR","84182 - HC CHG PROTEIN, WESTERN BLOT TEST, W BAND","84202 - HC Q;ERYTH PROTPOR","82747 - HC CHG ASSAY OF FOLIC ACID RBC","20225 - HC BIOPSY BONE TROCAR/NEEDLE DEEP","84202 - HC Q;ERYTH PROTPOR","20205 - BIOPSY,MUSCLE,DEEP","82747 - HC CHG ASSAY OF FOLIC ACID RBC","84202 - HC Q;ERYTH PROTPOR","73201 - HC CHG CT UPPER EXTREMITY W/CONTRAST MATERIAL","20225 - HC BIOPSY BONE TROCAR/NEEDLE DEEP"]
[null,"20650 - HC INSERT AND REMOVE BONE PIN","83001 - HC CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE","20245 - BIOPSY BONE OPEN DEEP","20245 - BIOPSY BONE OPEN DEEP","20245 - BIOPSY BONE OPEN DEEP","82784 - HC CHG ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH","20206 - BIOPSY MUSCLE PERCUTANEOUS NEEDLE","84206 - HC CHG ASSAY OF PROINSULIN","84202 - HC Q;ERYTH PROTPOR","84206 - HC CHG ASSAY OF PROINSULIN","82784 - HC CHG ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH","20240 - HC BIOPSY BONE OPEN SUPERFICIAL","84206 - HC CHG ASSAY OF PROINSULIN","20206 - BIOPSY MUSCLE PERCUTANEOUS NEEDLE","82784 - HC CHG ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH","84206 - HC CHG ASSAY OF PROINSULIN","73202 - HC CHG CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL","20240 - HC BIOPSY BONE OPEN SUPERFICIAL"]
[null,"20670 - REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE","83002 - HC CHG GONADOTROPIN LUTEINIZING HORMONE","20501 - HC INJECTION SINUS TRACT DIAGNOSTIC","20501 - HC INJECTION SINUS TRACT DIAGNOSTIC","20501 - HC INJECTION SINUS TRACT DIAGNOSTIC","82785 - HC CHG ASSAY OF GAMMAGLOBULIN IGE","20220 - HC BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL","84207 - HC CHG ASSAY OF PYRIDOXAL PHOSPHATE","84206 - HC CHG ASSAY OF PROINSULIN","84207 - HC CHG ASSAY OF PYRIDOXAL PHOSPHATE","82785 - HC CHG ASSAY OF GAMMAGLOBULIN IGE","20245 - BIOPSY BONE OPEN DEEP","84207 - HC CHG ASSAY OF PYRIDOXAL PHOSPHATE","20220 - HC BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL","82785 - HC CHG ASSAY OF GAMMAGLOBULIN IGE","84207 - HC CHG ASSAY OF PYRIDOXAL PHOSPHATE","73206 - HC CHG CT ANGIOGRAPHY UPPER EXTREMITY","20245 - BIOPSY BONE OPEN DEEP"]
[null,"20680 - REMOVAL IMPLANT DEEP","83003 - HC CHG ASSAY OF GROWTH HORMONE HUMAN","20520 - REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE","20520 - REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE","20520 - REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE","82787 - HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES","20225 - HC BIOPSY BONE TROCAR/NEEDLE DEEP","84210 - HC CHG ASSAY OF PYRUVATE","84207 - HC CHG ASSAY OF PYRIDOXAL PHOSPHATE","84210 - HC CHG ASSAY OF PYRUVATE","82787 - HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES","20501 - HC INJECTION SINUS TRACT DIAGNOSTIC","84210 - HC CHG ASSAY OF PYRUVATE","20225 - HC BIOPSY BONE TROCAR/NEEDLE DEEP","82787 - HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES","84210 - HC CHG ASSAY OF PYRUVATE","73218 - HC CHG MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL","20501 - HC INJECTION SINUS TRACT DIAGNOSTIC"]
[null,"20690 - HC APPLY BONE FIXATION DEVICE","83010 - HC CHG ASSAY OF HAPTOGLOBIN, QUANT","20525 - RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP","20525 - RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP","20525 - RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP","82803 - HC CHG BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3","20240 - HC BIOPSY BONE OPEN SUPERFICIAL","84244 - HC CHG ASSAY OF RENIN","84210 - HC CHG ASSAY OF PYRUVATE","84244 - HC CHG ASSAY OF RENIN","82803 - HC CHG BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3","20520 - REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE","84244 - HC CHG ASSAY OF RENIN","20240 - HC BIOPSY BONE OPEN SUPERFICIAL","82803 - HC CHG BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3","84244 - HC CHG ASSAY OF RENIN","73219 - HC CHG MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL","20520 - REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE"]
[null,"20930 - HC ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED","83013 - HC H PYLORI (C-13) BREATH","20526 - INJECTION THERAPEUTIC CARPAL TUNNEL","20526 - INJECTION THERAPEUTIC CARPAL TUNNEL","20526 - INJECTION THERAPEUTIC CARPAL TUNNEL","82805 - HC CHG GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY","20245 - BIOPSY BONE OPEN DEEP","84255 - HC CHG ASSAY OF SELENIUM","84244 - HC CHG ASSAY OF RENIN","84255 - HC CHG ASSAY OF SELENIUM","82805 - HC CHG GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY","20525 - RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP","84255 - HC CHG ASSAY OF SELENIUM","20245 - BIOPSY BONE OPEN DEEP","82805 - HC CHG GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY","84255 - HC CHG ASSAY OF SELENIUM","73220 - HC CHG MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS","20525 - RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP"]
[null,"20950 - HC RECORD FLUID PRESSURE,MUSCLE","83014 - HC H PYLORI DRUG ADMIN","20527 - INJECTION ENZYME PALMAR FASCIAL CORD","20527 - INJECTION ENZYME PALMAR FASCIAL CORD","20527 - INJECTION ENZYME PALMAR FASCIAL CORD","82810 - HC BLOOD GASSES O2 SAT ONLY","20501 - HC INJECTION SINUS TRACT DIAGNOSTIC","84270 - HC CHG ASSAY OF SEX HORMONE BINDING GLOBULIN","84255 - HC CHG ASSAY OF SELENIUM","84270 - HC CHG ASSAY OF SEX HORMONE BINDING GLOBULIN","82810 - HC BLOOD GASSES O2 SAT ONLY","20526 - INJECTION THERAPEUTIC CARPAL TUNNEL","84270 - HC CHG ASSAY OF SEX HORMONE BINDING GLOBULIN","20501 - HC INJECTION SINUS TRACT DIAGNOSTIC","82810 - HC BLOOD GASSES O2 SAT ONLY","84270 - HC CHG ASSAY OF SEX HORMONE BINDING GLOBULIN","73221 - HC CHG MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL","20526 - INJECTION THERAPEUTIC CARPAL TUNNEL"]
[null,"20982 - HC ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE","83020 - HC CHG HEMOGLOBIN ELECTROPHORESIS","20550 - INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS","20550 - INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS","20550 - INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS","82941 - HC CHG ASSAY OF GASTRIN","20520 - REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE","84295 - HC CHG SODIUM SERUM PLASMA OR WHOLE BLOOD","84270 - HC CHG ASSAY OF SEX HORMONE BINDING GLOBULIN","84295 - HC CHG SODIUM SERUM PLASMA OR WHOLE BLOOD","82941 - HC CHG ASSAY OF GASTRIN","20527 - INJECTION ENZYME PALMAR FASCIAL CORD","84295 - HC CHG SODIUM SERUM PLASMA OR WHOLE BLOOD","20520 - REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE","82941 - HC CHG ASSAY OF GASTRIN","84295 - HC CHG SODIUM SERUM PLASMA OR WHOLE BLOOD","73222 - HC CHG MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL","20527 - INJECTION ENZYME PALMAR FASCIAL CORD"]
[null,"20983 - HC ABLATJ BONE TUMOR CRYO PERQ W/IMG GDN WHEN PRFMD","83021 - HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY","20551 - INJECTION SINGLE TENDON ORIGIN/INSERTION","20551 - INJECTION SINGLE TENDON ORIGIN/INSERTION","20551 - INJECTION SINGLE TENDON ORIGIN/INSERTION","82945 - HC CHG GLUCOSE BODY FLUID OTHER THAN BLOOD","20525 - RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP","84300 - HC CHG ASSAY OF URINE SODIUM","84295 - HC CHG SODIUM SERUM PLASMA OR WHOLE BLOOD","84300 - HC CHG ASSAY OF URINE SODIUM","82945 - HC CHG GLUCOSE BODY FLUID OTHER THAN BLOOD","20550 - INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS","84300 - HC CHG ASSAY OF URINE SODIUM","20525 - RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP","82945 - HC CHG GLUCOSE BODY FLUID OTHER THAN BLOOD","84300 - HC CHG ASSAY OF URINE SODIUM","73223 - HC CHG MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL","20550 - INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS"]
[null,"20999 - PR PLACEMENT OF ANTIBIOTIC BEADS","83030 - HC CHG HEMOGLOBIN F FETAL CHEMICAL","20552 - INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES","20552 - INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES","20552 - INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES","82947 - HC CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP","20526 - INJECTION THERAPEUTIC CARPAL TUNNEL","84302 - HC CHG ASSAY OF SODIUM OTHER SOURCE","84300 - HC CHG ASSAY OF URINE SODIUM","84302 - HC CHG ASSAY OF SODIUM OTHER SOURCE","82947 - HC CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP","20551 - INJECTION SINGLE TENDON ORIGIN/INSERTION","84302 - HC CHG ASSAY OF SODIUM OTHER SOURCE","20526 - INJECTION THERAPEUTIC CARPAL TUNNEL","82947 - HC CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP","84302 - HC CHG ASSAY OF SODIUM OTHER SOURCE","73501 - XRAY EXAM OF HIP UNILATERAL W/PELVIS WHEN PERFORMED; 1 VIEW","20551 - INJECTION SINGLE TENDON ORIGIN/INSERTION"]
[null,"21011 - EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ <2CM","83036 - HEMOGLOBIN GLYCOSYLATED A1C","20553 - INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES","20553 - INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES","20553 - INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES","82950 - HC CHG GLUCOSE POST GLUCOSE DOSE","20527 - INJECTION ENZYME PALMAR FASCIAL CORD","84305 - HC CHG ASSAY OF SOMATOMEDIN","84302 - HC CHG ASSAY OF SODIUM OTHER SOURCE","84305 - HC CHG ASSAY OF SOMATOMEDIN","82950 - HC CHG GLUCOSE POST GLUCOSE DOSE","20552 - INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES","84305 - HC CHG ASSAY OF SOMATOMEDIN","20527 - INJECTION ENZYME PALMAR FASCIAL CORD","82950 - HC CHG GLUCOSE POST GLUCOSE DOSE","84305 - HC CHG ASSAY OF SOMATOMEDIN","73502 - XRAY EXAM OF HIP UNILATERAL W/PELVIS WHEN PERFORMED; 2-3 VIEWS","20552 - INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES"]
[null,"21012 - EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/>","83050 - HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE","20600 - ARTHROCENTESIS ASPIR&/INJECTION SMALL JT/BURSA","20600 - ARTHROCENTESIS ASPIR&/INJECTION SMALL JT/BURSA","20600 - ARTHROCENTESIS ASPIR&/INJECTION SMALL JT/BURSA","82951 - HC CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS","20550 - INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS","84307 - HC CHG ASSAY OF SOMATOSTATIN","84305 - HC CHG ASSAY OF SOMATOMEDIN","84307 - HC CHG ASSAY OF SOMATOSTATIN","82951 - HC CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS","20553 - INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES","84307 - HC CHG ASSAY OF SOMATOSTATIN","20550 - INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS","82951 - HC CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS","84307 - HC CHG ASSAY OF SOMATOSTATIN","73503 - XRAY EXAM OF HIP UNILATERAL W/PELVIS WHEN PERFORMED; MINIMUM 4 VIEWS","20553 - INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES"]
[null,"21013 - EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL <2CM","83070 - HC CHG ASSAY OF HEMOSIDERIN QUALITATIVE","20604 - HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT","20604 - HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT","20604 - HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT","82952 - HC CHG GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS","20551 - INJECTION SINGLE TENDON ORIGIN/INSERTION","84311 - HC CHG SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED","84307 - HC CHG ASSAY OF SOMATOSTATIN","84311 - HC CHG SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED","82952 - HC CHG GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS","20600 - ARTHROCENTESIS ASPIR&/INJECTION SMALL JT/BURSA","84311 - HC CHG SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED","20551 - INJECTION SINGLE TENDON ORIGIN/INSERTION","82952 - HC CHG GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS","84311 - HC CHG SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED","73521 - XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; 2 VIEWS","20600 - ARTHROCENTESIS ASPIR&/INJECTION SMALL JT/BURSA"]
[null,"21014 - EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/>","83090 - HC CHG ASSAY OF HOMOCYSTEINE","20605 - ARTHROCENTESIS ASPIR&/INJECTION INTERM JT/BURS","20605 - ARTHROCENTESIS ASPIR&/INJECTION INTERM JT/BURS","20605 - ARTHROCENTESIS ASPIR&/INJECTION INTERM JT/BURS","82960 - HC CHG GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN","20552 - INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES","84376 - HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC","84311 - HC CHG SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED","84376 - HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC","82960 - HC CHG GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN","20604 - HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT","84376 - HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC","20552 - INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES","82960 - HC CHG GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN","84376 - HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC","73522 - XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; 3-4 VIEWS","20604 - HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT"]
[null,"21025 - HC EXCISION OF BONE, LOWER JAW","83497 - HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA","20606 - HC PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US","20606 - HC PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US","20606 - HC PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US","82962 - HC GLUCOMETER - PHARM","20553 - INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES","84402 - HC CHG ASSAY OF TESTOSTERONE FREE","84376 - HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC","84402 - HC CHG ASSAY OF TESTOSTERONE FREE","82962 - HC GLUCOMETER - PHARM","20605 - ARTHROCENTESIS ASPIR&/INJECTION INTERM JT/BURS","84402 - HC CHG ASSAY OF TESTOSTERONE FREE","20553 - INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES","82962 - HC GLUCOMETER - PHARM","84402 - HC CHG ASSAY OF TESTOSTERONE FREE","73523 - XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; MINIMUM 5 VIEWS","20605 - ARTHROCENTESIS ASPIR&/INJECTION INTERM JT/BURS"]
[null,"21026 - HC EXCISION OF FACIAL BONE(S)","83498 - HC CHG ASSAY OF HYDROXYPROGESTERONE 17-D","20610 - ARTHROCENTESIS ASPIR&/INJECTION MAJOR JT/BURSA","20610 - ARTHROCENTESIS ASPIR&/INJECTION MAJOR JT/BURSA","20610 - ARTHROCENTESIS ASPIR&/INJECTION MAJOR JT/BURSA","82977 - HC CHG ASSAY OF GGT","20600 - ARTHROCENTESIS ASPIR&/INJECTION SMALL JT/BURSA","84403 - HC CHG ASSAY OF TESTOSTERONE TOTAL","84402 - HC CHG ASSAY OF TESTOSTERONE FREE","84403 - HC CHG ASSAY OF TESTOSTERONE TOTAL","82977 - HC CHG ASSAY OF GGT","20606 - HC PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US","84403 - HC CHG ASSAY OF TESTOSTERONE TOTAL","20600 - ARTHROCENTESIS ASPIR&/INJECTION SMALL JT/BURSA","82977 - HC CHG ASSAY OF GGT","84403 - HC CHG ASSAY OF TESTOSTERONE TOTAL","73551 - XRAY EXAM FEMUR; 1 VIEW","20606 - HC PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US"]
[null,"21029 - HC CONTOUR OF FACE BONE LESION","83516 - HC CRL;TTG AB,IGA","20611 - HC PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US","20611 - HC PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US","20611 - HC PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US","82985 - HC CHG ASSAY OF GLYCATED PROTEIN","20604 - HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT","84425 - HC CHG ASSAY OF THIAMINE-VITAMIN B-1","84403 - HC CHG ASSAY OF TESTOSTERONE TOTAL","84425 - HC CHG ASSAY OF THIAMINE-VITAMIN B-1","82985 - HC CHG ASSAY OF GLYCATED PROTEIN","20610 - ARTHROCENTESIS ASPIR&/INJECTION MAJOR JT/BURSA","84425 - HC CHG ASSAY OF THIAMINE-VITAMIN B-1","20604 - HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT","82985 - HC CHG ASSAY OF GLYCATED PROTEIN","84425 - HC CHG ASSAY OF THIAMINE-VITAMIN B-1","73552 - XRAY EXAM FEMUR; MINIMUM 2 VIEWS","20610 - ARTHROCENTESIS ASPIR&/INJECTION MAJOR JT/BURSA"]
[null,"21030 - HC EXC BENIGN TUMOR/CYST MAXL/ZYGOMA ENCL & CURTG","83519 - HC CHG IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","20612 - ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ","20612 - ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ","20612 - ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ","83001 - HC CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE","20605 - ARTHROCENTESIS ASPIR&/INJECTION INTERM JT/BURS","84430 - HC CHG ASSAY OF THIOCYANATE","84425 - HC CHG ASSAY OF THIAMINE-VITAMIN B-1","84430 - HC CHG ASSAY OF THIOCYANATE","83001 - HC CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE","20611 - HC PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US","84430 - HC CHG ASSAY OF THIOCYANATE","20605 - ARTHROCENTESIS ASPIR&/INJECTION INTERM JT/BURS","83001 - HC CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE","84430 - HC CHG ASSAY OF THIOCYANATE","73560 - HC CHG RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS","20611 - HC PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US"]
[null,"21031 - HC EXCISION TORUS MANDIBULARIS","83520 - HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE","20615 - ASPIRATION & INJECTION TREATMENT BONE CYST","20615 - ASPIRATION & INJECTION TREATMENT BONE CYST","20615 - ASPIRATION & INJECTION TREATMENT BONE CYST","83002 - HC CHG GONADOTROPIN LUTEINIZING HORMONE","20606 - HC PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US","84432 - HC CHG ASSAY OF THYROGLOBULIN","84430 - HC CHG ASSAY OF THIOCYANATE","84432 - HC CHG ASSAY OF THYROGLOBULIN","83002 - HC CHG GONADOTROPIN LUTEINIZING HORMONE","20612 - ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ","84432 - HC CHG ASSAY OF THYROGLOBULIN","20606 - HC PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US","83002 - HC CHG GONADOTROPIN LUTEINIZING HORMONE","84432 - HC CHG ASSAY OF THYROGLOBULIN","73562 - HC CHG RADIOLOGIC EXAMINATION KNEE 3 VIEWS","20612 - ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ"]
[null,"21032 - HC EXCISION,MAXILLARY TORUS PALATINUS","83525 - HC CHG ASSAY OF INSULIN TOTAL","20650 - HC INSERT AND REMOVE BONE PIN","20650 - HC INSERT AND REMOVE BONE PIN","20650 - HC INSERT AND REMOVE BONE PIN","83003 - HC CHG ASSAY OF GROWTH HORMONE HUMAN","20610 - ARTHROCENTESIS ASPIR&/INJECTION MAJOR JT/BURSA","84436 - HC CHG ASSAY OF THYROXINE TOTAL","84432 - HC CHG ASSAY OF THYROGLOBULIN","84436 - HC CHG ASSAY OF THYROXINE TOTAL","83003 - HC CHG ASSAY OF GROWTH HORMONE HUMAN","20615 - ASPIRATION & INJECTION TREATMENT BONE CYST","84436 - HC CHG ASSAY OF THYROXINE TOTAL","20610 - ARTHROCENTESIS ASPIR&/INJECTION MAJOR JT/BURSA","83003 - HC CHG ASSAY OF GROWTH HORMONE HUMAN","84436 - HC CHG ASSAY OF THYROXINE TOTAL","73564 - HC CHG RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS","20615 - ASPIRATION & INJECTION TREATMENT BONE CYST"]
[null,"21040 - HC EXCISION BENIGN TUMORE MANDIBLE","83540 - HC CHG ASSAY OF IRON","20670 - REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE","20670 - REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE","20670 - REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE","83010 - HC CHG ASSAY OF HAPTOGLOBIN, QUANT","20611 - HC PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US","84439 - HC CHG ASSAY OF FREE THYROXINE","84436 - HC CHG ASSAY OF THYROXINE TOTAL","84439 - HC CHG ASSAY OF FREE THYROXINE","83010 - HC CHG ASSAY OF HAPTOGLOBIN, QUANT","20650 - HC INSERT AND REMOVE BONE PIN","84439 - HC CHG ASSAY OF FREE THYROXINE","20611 - HC PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US","83010 - HC CHG ASSAY OF HAPTOGLOBIN, QUANT","84439 - HC CHG ASSAY OF FREE THYROXINE","73565 - HC CHG RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST","20650 - HC INSERT AND REMOVE BONE PIN"]
[null,"21044 - HC REMV MALIG JAW BONE LESION","83550 - HC CHG IRON BINDING CAPACITY","20680 - REMOVAL IMPLANT DEEP","20680 - REMOVAL IMPLANT DEEP","20680 - REMOVAL IMPLANT DEEP","83013 - HC H PYLORI (C-13) BREATH","20612 - ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ","84442 - HC CHG ASSAY OF THYROXINE BNDNG GLOBULIN","84439 - HC CHG ASSAY OF FREE THYROXINE","84442 - HC CHG ASSAY OF THYROXINE BNDNG GLOBULIN","83013 - HC H PYLORI (C-13) BREATH","20670 - REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE","84442 - HC CHG ASSAY OF THYROXINE BNDNG GLOBULIN","20612 - ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ","83013 - HC H PYLORI (C-13) BREATH","84442 - HC CHG ASSAY OF THYROXINE BNDNG GLOBULIN","73590 - HC CHG RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS","20670 - REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE"]
[null,"21046 - HC EXCISION,BEN TUMOR,MANDIBLE,INTRA-ORAL","83605 - HC CHG ASSAY OF LACTATE","20690 - HC APPLY BONE FIXATION DEVICE","20690 - HC APPLY BONE FIXATION DEVICE","20690 - HC APPLY BONE FIXATION DEVICE","83014 - HC H PYLORI DRUG ADMIN","20615 - ASPIRATION & INJECTION TREATMENT BONE CYST","84443 - HC CHG ASSAY OF THYROID STIMULATING HORMONE TSH","84442 - HC CHG ASSAY OF THYROXINE BNDNG GLOBULIN","84443 - HC CHG ASSAY OF THYROID STIMULATING HORMONE TSH","83014 - HC H PYLORI DRUG ADMIN","20680 - REMOVAL IMPLANT DEEP","84443 - HC CHG ASSAY OF THYROID STIMULATING HORMONE TSH","20615 - ASPIRATION & INJECTION TREATMENT BONE CYST","83014 - HC H PYLORI DRUG ADMIN","84443 - HC CHG ASSAY OF THYROID STIMULATING HORMONE TSH","73592 - HC CHG RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS","20680 - REMOVAL IMPLANT DEEP"]
[null,"21047 - HC EXCISION,BEN TUMOR,MANDIBLE,EXTRA-ORAL","83615 - HC CHG LACTATE DEHYDROGENASE LDH","20930 - HC ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED","20930 - HC ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED","20930 - HC ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED","83020 - HC CHG HEMOGLOBIN ELECTROPHORESIS","20650 - HC INSERT AND REMOVE BONE PIN","84445 - HC CHG THYROID STIMULATING IMMUNE GLOBULINS TSI","84443 - HC CHG ASSAY OF THYROID STIMULATING HORMONE TSH","84445 - HC CHG THYROID STIMULATING IMMUNE GLOBULINS TSI","83020 - HC CHG HEMOGLOBIN ELECTROPHORESIS","20690 - HC APPLY BONE FIXATION DEVICE","84445 - HC CHG THYROID STIMULATING IMMUNE GLOBULINS TSI","20650 - HC INSERT AND REMOVE BONE PIN","83020 - HC CHG HEMOGLOBIN ELECTROPHORESIS","84445 - HC CHG THYROID STIMULATING IMMUNE GLOBULINS TSI","73600 - HC CHG RADIOLOGIC EXAMINATION ANKLE 2 VIEWS","20690 - HC APPLY BONE FIXATION DEVICE"]
[null,"21048 - HC EXCISION,BEN TUMOR,MAXILLA,INTRA-ORAL","83630 - HC CHG LACTOFERRIN FECAL QUALITATIVE","20950 - HC RECORD FLUID PRESSURE,MUSCLE","20950 - HC RECORD FLUID PRESSURE,MUSCLE","20950 - HC RECORD FLUID PRESSURE,MUSCLE","83021 - HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY","20670 - REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE","84446 - HC CHG ASSAY OF TOCOPHEROL ALPHA VITAMIN E","84445 - HC CHG THYROID STIMULATING IMMUNE GLOBULINS TSI","84446 - HC CHG ASSAY OF TOCOPHEROL ALPHA VITAMIN E","83021 - HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY","20930 - HC ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED","84446 - HC CHG ASSAY OF TOCOPHEROL ALPHA VITAMIN E","20670 - REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE","83021 - HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY","84446 - HC CHG ASSAY OF TOCOPHEROL ALPHA VITAMIN E","73610 - HC CHG RADEX ANKLE COMPLETE MINIMUM 3 VIEWS","20930 - HC ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED"]
[null,"21070 - HC REMV CORONOID PROCESS","83655 - HC CHG ASSAY OF LEAD","20982 - HC ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE","20982 - HC ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE","20982 - HC ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE","83030 - HC CHG HEMOGLOBIN F FETAL CHEMICAL","20680 - REMOVAL IMPLANT DEEP","84450 - HC CHG TRANSFERASE ASPARTATE AMINO AST SGOT","84446 - HC CHG ASSAY OF TOCOPHEROL ALPHA VITAMIN E","84450 - HC CHG TRANSFERASE ASPARTATE AMINO AST SGOT","83030 - HC CHG HEMOGLOBIN F FETAL CHEMICAL","20950 - HC RECORD FLUID PRESSURE,MUSCLE","84450 - HC CHG TRANSFERASE ASPARTATE AMINO AST SGOT","20680 - REMOVAL IMPLANT DEEP","83030 - HC CHG HEMOGLOBIN F FETAL CHEMICAL","84450 - HC CHG TRANSFERASE ASPARTATE AMINO AST SGOT","73620 - HC CHG RADIOLOGIC EXAMINATION FOOT 2 VIEWS","20950 - HC RECORD FLUID PRESSURE,MUSCLE"]
[null,"21073 - HC MANIPULATION TMJ THERAPEUTIC REQUIRE ANESTHESIA","83662 - HC L/S RATIO, FOAM STABILITY","20983 - HC ABLATJ BONE TUMOR CRYO PERQ W/IMG GDN WHEN PRFMD","20983 - HC ABLATJ BONE TUMOR CRYO PERQ W/IMG GDN WHEN PRFMD","20983 - HC ABLATJ BONE TUMOR CRYO PERQ W/IMG GDN WHEN PRFMD","83036 - HEMOGLOBIN GLYCOSYLATED A1C","20690 - HC APPLY BONE FIXATION DEVICE","84460 - HC CHG TRANSFERASE ALANINE AMINO (ALT) (SGPT)","84450 - HC CHG TRANSFERASE ASPARTATE AMINO AST SGOT","84460 - HC CHG TRANSFERASE ALANINE AMINO (ALT) (SGPT)","83036 - HEMOGLOBIN GLYCOSYLATED A1C","20982 - HC ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE","84460 - HC CHG TRANSFERASE ALANINE AMINO (ALT) (SGPT)","20690 - HC APPLY BONE FIXATION DEVICE","83036 - HEMOGLOBIN GLYCOSYLATED A1C","84460 - HC CHG TRANSFERASE ALANINE AMINO (ALT) (SGPT)","73630 - HC CHG RADEX FOOT COMPLETE MINIMUM 3 VIEWS","20982 - HC ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE"]
[null,"21110 - APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC","83690 - HC CHG ASSAY OF LIPASE","21011 - EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ <2CM","21011 - EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ <2CM","21011 - EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ <2CM","83050 - HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE","20930 - HC ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED","84466 - HC CHG ASSAY OF L7383TRANSFERRIN","84460 - HC CHG TRANSFERASE ALANINE AMINO (ALT) (SGPT)","84466 - HC CHG ASSAY OF L7383TRANSFERRIN","83050 - HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE","20983 - HC ABLATJ BONE TUMOR CRYO PERQ W/IMG GDN WHEN PRFMD","84466 - HC CHG ASSAY OF L7383TRANSFERRIN","20930 - HC ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED","83050 - HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE","84466 - HC CHG ASSAY OF L7383TRANSFERRIN","73650 - HC CHG RADEX CALCANEUS MINIMUM 2 VIEWS","20983 - HC ABLATJ BONE TUMOR CRYO PERQ W/IMG GDN WHEN PRFMD"]
[null,"21121 - HC RECONST CHIN SLIDE SINGL OSTEOTOMY","83695 - HC CHG LIPOPROTEIN (A)","21012 - EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/>","21012 - EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/>","21012 - EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/>","83070 - HC CHG ASSAY OF HEMOSIDERIN QUALITATIVE","20950 - HC RECORD FLUID PRESSURE,MUSCLE","84478 - HC CHG ASSAY OF TRIGLYCERIDES","84466 - HC CHG ASSAY OF L7383TRANSFERRIN","84478 - HC CHG ASSAY OF TRIGLYCERIDES","83070 - HC CHG ASSAY OF HEMOSIDERIN QUALITATIVE","21011 - EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ <2CM","84478 - HC CHG ASSAY OF TRIGLYCERIDES","20950 - HC RECORD FLUID PRESSURE,MUSCLE","83070 - HC CHG ASSAY OF HEMOSIDERIN QUALITATIVE","84478 - HC CHG ASSAY OF TRIGLYCERIDES","73660 - HC CHG RADEX TOE MINIMUM 2 VIEWS","21011 - EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ <2CM"]
[null,"21198 - HC OSTEOTOMY, MANDIBLE","83718 - HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL","21013 - EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL <2CM","21013 - EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL <2CM","21013 - EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL <2CM","83090 - HC CHG ASSAY OF HOMOCYSTEINE","20982 - HC ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE","84479 - HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO","84478 - HC CHG ASSAY OF TRIGLYCERIDES","84479 - HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO","83090 - HC CHG ASSAY OF HOMOCYSTEINE","21012 - EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/>","84479 - HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO","20982 - HC ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE","83090 - HC CHG ASSAY OF HOMOCYSTEINE","84479 - HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO","73700 - HC CHG CT LOWER EXTREMITY W/O CONTRAST MATERIAL","21012 - EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/>"]
[null,"21208 - HC AUGMENT FACIAL BONES","83721 - HC CRL;DIRECT LDL","21014 - EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/>","21014 - EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/>","21014 - EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/>","83497 - HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA","20983 - HC ABLATJ BONE TUMOR CRYO PERQ W/IMG GDN WHEN PRFMD","84480 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3","84479 - HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO","84480 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3","83497 - HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA","21013 - EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL <2CM","84480 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3","20983 - HC ABLATJ BONE TUMOR CRYO PERQ W/IMG GDN WHEN PRFMD","83497 - HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA","84480 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3","73701 - HC CHG CT LOWER EXTREMITY W/CONTRAST MATERIAL","21013 - EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL <2CM"]
[null,"21215 - HC MANDIBLE GRAFT","83735 - HC CHG ASSAY OF MAGNESIUM","21025 - HC EXCISION OF BONE, LOWER JAW","21025 - HC EXCISION OF BONE, LOWER JAW","21025 - HC EXCISION OF BONE, LOWER JAW","83498 - HC CHG ASSAY OF HYDROXYPROGESTERONE 17-D","20999 - PR PLACEMENT OF ANTIBIOTIC BEADS","84481 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 FREE","84480 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3","84481 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 FREE","83498 - HC CHG ASSAY OF HYDROXYPROGESTERONE 17-D","21014 - EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/>","84481 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 FREE","20999 - PR PLACEMENT OF ANTIBIOTIC BEADS","83498 - HC CHG ASSAY OF HYDROXYPROGESTERONE 17-D","84481 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 FREE","73702 - HC CHG CT LOWER EXTREMITY W/O & W/CONTRAST MATRL","21014 - EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/>"]
[null,"21235 - HC GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR","83785 - HC CHG, ASSAY OF MANGANESE","21026 - HC EXCISION OF FACIAL BONE(S)","21026 - HC EXCISION OF FACIAL BONE(S)","21026 - HC EXCISION OF FACIAL BONE(S)","83516 - HC CRL;TTG AB,IGA","21011 - EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ <2CM","84482 - HC CHG TRIIODOTHYRONINE T3 REVERSE","84481 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 FREE","84482 - HC CHG TRIIODOTHYRONINE T3 REVERSE","83516 - HC CRL;TTG AB,IGA","21025 - HC EXCISION OF BONE, LOWER JAW","84482 - HC CHG TRIIODOTHYRONINE T3 REVERSE","21011 - EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ <2CM","83516 - HC CRL;TTG AB,IGA","84482 - HC CHG TRIIODOTHYRONINE T3 REVERSE","73706 - HC CHG CT ANGIOGRAPHY LOWER EXTREMITY","21025 - HC EXCISION OF BONE, LOWER JAW"]
[null,"21240 - HC ARTHROPLASTY TMJ","83789 - HC CHG MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA","21029 - HC CONTOUR OF FACE BONE LESION","21029 - HC CONTOUR OF FACE BONE LESION","21029 - HC CONTOUR OF FACE BONE LESION","83519 - HC CHG IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","21012 - EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/>","84484 - HC CHG ASSAY OF TROPONIN QUANTITATIVE","84482 - HC CHG TRIIODOTHYRONINE T3 REVERSE","84484 - HC CHG ASSAY OF TROPONIN QUANTITATIVE","83519 - HC CHG IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","21026 - HC EXCISION OF FACIAL BONE(S)","84484 - HC CHG ASSAY OF TROPONIN QUANTITATIVE","21012 - EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/>","83519 - HC CHG IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","84484 - HC CHG ASSAY OF TROPONIN QUANTITATIVE","73718 - HC CHG MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL","21026 - HC EXCISION OF FACIAL BONE(S)"]
[null,"21243 - HC ARTHROPLASTY TMJ+PROSTHESIS","83825 - HC CHG ASSAY OF MERCURY QUANTITATIVE","21030 - HC EXC BENIGN TUMOR/CYST MAXL/ZYGOMA ENCL & CURTG","21030 - HC EXC BENIGN TUMOR/CYST MAXL/ZYGOMA ENCL & CURTG","21030 - HC EXC BENIGN TUMOR/CYST MAXL/ZYGOMA ENCL & CURTG","83520 - HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE","21013 - EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL <2CM","84520 - HC CHG ASSAY OF UREA NITROGEN QUANTITATIVE","84484 - HC CHG ASSAY OF TROPONIN QUANTITATIVE","84520 - HC CHG ASSAY OF UREA NITROGEN QUANTITATIVE","83520 - HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE","21029 - HC CONTOUR OF FACE BONE LESION","84520 - HC CHG ASSAY OF UREA NITROGEN QUANTITATIVE","21013 - EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL <2CM","83520 - HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE","84520 - HC CHG ASSAY OF UREA NITROGEN QUANTITATIVE","73719 - HC CHG MRI LOWER EXTREM OTH/THN JT W/CONTRAST MATRL","21029 - HC CONTOUR OF FACE BONE LESION"]
[null,"21244 - HC RECONSTR MANDIBLE,BONE PLATE","83835 - HC CHG METANEPHRINES","21031 - HC EXCISION TORUS MANDIBULARIS","21031 - HC EXCISION TORUS MANDIBULARIS","21031 - HC EXCISION TORUS MANDIBULARIS","83525 - HC CHG ASSAY OF INSULIN TOTAL","21014 - EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/>","84540 - HC CHG ASSAY OF UREA NITROGEN URINE","84520 - HC CHG ASSAY OF UREA NITROGEN QUANTITATIVE","84540 - HC CHG ASSAY OF UREA NITROGEN URINE","83525 - HC CHG ASSAY OF INSULIN TOTAL","21030 - HC EXC BENIGN TUMOR/CYST MAXL/ZYGOMA ENCL & CURTG","84540 - HC CHG ASSAY OF UREA NITROGEN URINE","21014 - EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/>","83525 - HC CHG ASSAY OF INSULIN TOTAL","84540 - HC CHG ASSAY OF UREA NITROGEN URINE","73720 - HC CHG MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR","21030 - HC EXC BENIGN TUMOR/CYST MAXL/ZYGOMA ENCL & CURTG"]
[null,"21248 - HC RECONSTR JAW,PART-ENDO IMPLNT","83873 - HC CHG MYELIN BASIC PROTEIN CEREBROSPINAL FLUID","21032 - HC EXCISION,MAXILLARY TORUS PALATINUS","21032 - HC EXCISION,MAXILLARY TORUS PALATINUS","21032 - HC EXCISION,MAXILLARY TORUS PALATINUS","83540 - HC CHG ASSAY OF IRON","21025 - HC EXCISION OF BONE, LOWER JAW","84550 - HC CHG ASSAY OF BLOOD/URIC ACID","84540 - HC CHG ASSAY OF UREA NITROGEN URINE","84550 - HC CHG ASSAY OF BLOOD/URIC ACID","83540 - HC CHG ASSAY OF IRON","21031 - HC EXCISION TORUS MANDIBULARIS","84550 - HC CHG ASSAY OF BLOOD/URIC ACID","21025 - HC EXCISION OF BONE, LOWER JAW","83540 - HC CHG ASSAY OF IRON","84550 - HC CHG ASSAY OF BLOOD/URIC ACID","73721 - HC CHG MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL","21031 - HC EXCISION TORUS MANDIBULARIS"]
[null,"21310 - CLOSED TREATMENT NASAL FRACTURE W/O MANIPULATION","83874 - HC CHG MYOGLOBIN","21040 - HC EXCISION BENIGN TUMORE MANDIBLE","21040 - HC EXCISION BENIGN TUMORE MANDIBLE","21040 - HC EXCISION BENIGN TUMORE MANDIBLE","83550 - HC CHG IRON BINDING CAPACITY","21026 - HC EXCISION OF FACIAL BONE(S)","84560 - HC CHG ASSAY OF URIC ACID OTHER SOURCE","84550 - HC CHG ASSAY OF BLOOD/URIC ACID","84560 - HC CHG ASSAY OF URIC ACID OTHER SOURCE","83550 - HC CHG IRON BINDING CAPACITY","21032 - HC EXCISION,MAXILLARY TORUS PALATINUS","84560 - HC CHG ASSAY OF URIC ACID OTHER SOURCE","21026 - HC EXCISION OF FACIAL BONE(S)","83550 - HC CHG IRON BINDING CAPACITY","84560 - HC CHG ASSAY OF URIC ACID OTHER SOURCE","73722 - HC CHG MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL","21032 - HC EXCISION,MAXILLARY TORUS PALATINUS"]
[null,"21315 - CLOSED TX NASAL FRACTURE W/O STABILIZATION","83880 - HC CHG NATRIURETIC PEPTIDE","21044 - HC REMV MALIG JAW BONE LESION","21044 - HC REMV MALIG JAW BONE LESION","21044 - HC REMV MALIG JAW BONE LESION","83605 - HC CHG ASSAY OF LACTATE","21029 - HC CONTOUR OF FACE BONE LESION","84590 - HC CHG ASSAY OF VITAMIN A","84560 - HC CHG ASSAY OF URIC ACID OTHER SOURCE","84590 - HC CHG ASSAY OF VITAMIN A","83605 - HC CHG ASSAY OF LACTATE","21040 - HC EXCISION BENIGN TUMORE MANDIBLE","84590 - HC CHG ASSAY OF VITAMIN A","21029 - HC CONTOUR OF FACE BONE LESION","83605 - HC CHG ASSAY OF LACTATE","84590 - HC CHG ASSAY OF VITAMIN A","73723 - HC CHG MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL","21040 - HC EXCISION BENIGN TUMORE MANDIBLE"]
[null,"21320 - CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION","83883 - HC NEPHELOMETRY, EACH ANALYTE","21046 - HC EXCISION,BEN TUMOR,MANDIBLE,INTRA-ORAL","21046 - HC EXCISION,BEN TUMOR,MANDIBLE,INTRA-ORAL","21046 - HC EXCISION,BEN TUMOR,MANDIBLE,INTRA-ORAL","83615 - HC CHG LACTATE DEHYDROGENASE LDH","21030 - HC EXC BENIGN TUMOR/CYST MAXL/ZYGOMA ENCL & CURTG","84591 - HC CHG ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED","84590 - HC CHG ASSAY OF VITAMIN A","84591 - HC CHG ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED","83615 - HC CHG LACTATE DEHYDROGENASE LDH","21044 - HC REMV MALIG JAW BONE LESION","84591 - HC CHG ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED","21030 - HC EXC BENIGN TUMOR/CYST MAXL/ZYGOMA ENCL & CURTG","83615 - HC CHG LACTATE DEHYDROGENASE LDH","84591 - HC CHG ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED","74000 - XR ABD 1V AP","21044 - HC REMV MALIG JAW BONE LESION"]
[null,"21325 - HC OPEN RX NOSE FRACTURE","83915 - HC CHG ASSAY OF NUCLEOTIDASE 5'-","21047 - HC EXCISION,BEN TUMOR,MANDIBLE,EXTRA-ORAL","21047 - HC EXCISION,BEN TUMOR,MANDIBLE,EXTRA-ORAL","21047 - HC EXCISION,BEN TUMOR,MANDIBLE,EXTRA-ORAL","83630 - HC CHG LACTOFERRIN FECAL QUALITATIVE","21031 - HC EXCISION TORUS MANDIBULARIS","84597 - HC CHG ASSAY OF VITAMIN K","84591 - HC CHG ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED","84597 - HC CHG ASSAY OF VITAMIN K","83630 - HC CHG LACTOFERRIN FECAL QUALITATIVE","21046 - HC EXCISION,BEN TUMOR,MANDIBLE,INTRA-ORAL","84597 - HC CHG ASSAY OF VITAMIN K","21031 - HC EXCISION TORUS MANDIBULARIS","83630 - HC CHG LACTOFERRIN FECAL QUALITATIVE","84597 - HC CHG ASSAY OF VITAMIN K","74010 - XR ABD W OBLIQUES CONE","21046 - HC EXCISION,BEN TUMOR,MANDIBLE,INTRA-ORAL"]
[null,"21337 - HC CLOSED RX NASAL SEPTAL FRACTURE","83916 - HC CHG OLIGOCLONAL IMMUNE","21048 - HC EXCISION,BEN TUMOR,MAXILLA,INTRA-ORAL","21048 - HC EXCISION,BEN TUMOR,MAXILLA,INTRA-ORAL","21048 - HC EXCISION,BEN TUMOR,MAXILLA,INTRA-ORAL","83655 - HC CHG ASSAY OF LEAD","21032 - HC EXCISION,MAXILLARY TORUS PALATINUS","84630 - HC CHG ASSAY OF ZINC","84597 - HC CHG ASSAY OF VITAMIN K","84630 - HC CHG ASSAY OF ZINC","83655 - HC CHG ASSAY OF LEAD","21047 - HC EXCISION,BEN TUMOR,MANDIBLE,EXTRA-ORAL","84630 - HC CHG ASSAY OF ZINC","21032 - HC EXCISION,MAXILLARY TORUS PALATINUS","83655 - HC CHG ASSAY OF LEAD","84630 - HC CHG ASSAY OF ZINC","74020 - XR ABD CMPL DECUB ERECT","21047 - HC EXCISION,BEN TUMOR,MANDIBLE,EXTRA-ORAL"]
[null,"21365 - HC OPEN RX COMPLX CHEEK BONE FRAC","83918 - HC CHG ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN","21070 - HC REMV CORONOID PROCESS","21070 - HC REMV CORONOID PROCESS","21070 - HC REMV CORONOID PROCESS","83662 - HC L/S RATIO, FOAM STABILITY","21040 - HC EXCISION BENIGN TUMORE MANDIBLE","84681 - HC CHG ASSAY OF C-PEPTIDE","84630 - HC CHG ASSAY OF ZINC","84681 - HC CHG ASSAY OF C-PEPTIDE","83662 - HC L/S RATIO, FOAM STABILITY","21048 - HC EXCISION,BEN TUMOR,MAXILLA,INTRA-ORAL","84681 - HC CHG ASSAY OF C-PEPTIDE","21040 - HC EXCISION BENIGN TUMORE MANDIBLE","83662 - HC L/S RATIO, FOAM STABILITY","84681 - HC CHG ASSAY OF C-PEPTIDE","74150 - HC CHG CT ABDOMEN W/O CONTRAST MATERIAL","21048 - HC EXCISION,BEN TUMOR,MAXILLA,INTRA-ORAL"]
[null,"21390 - HC REPAIR EYE BLOWOUT,PERIORB+IMPLNT","83921 - HC CHG ORGANIC ACID 1 QUANTITATIVE","21073 - HC MANIPULATION TMJ THERAPEUTIC REQUIRE ANESTHESIA","21073 - HC MANIPULATION TMJ THERAPEUTIC REQUIRE ANESTHESIA","21073 - HC MANIPULATION TMJ THERAPEUTIC REQUIRE ANESTHESIA","83690 - HC CHG ASSAY OF LIPASE","21044 - HC REMV MALIG JAW BONE LESION","84702 - HC HCG TUMOR MARKER","84681 - HC CHG ASSAY OF C-PEPTIDE","84702 - HC HCG TUMOR MARKER","83690 - HC CHG ASSAY OF LIPASE","21070 - HC REMV CORONOID PROCESS","84702 - HC HCG TUMOR MARKER","21044 - HC REMV MALIG JAW BONE LESION","83690 - HC CHG ASSAY OF LIPASE","84702 - HC HCG TUMOR MARKER","74160 - HC CHG CT ABDOMEN W/CONTRAST MATERIAL","21070 - HC REMV CORONOID PROCESS"]
[null,"21400 - HC CLOSED RX FX ORBIT","83930 - HC Q;OSMOLALITY,SER","21076 - HC PREP FACE/ORAL PROST OBTURATOR","21076 - HC PREP FACE/ORAL PROST OBTURATOR","21076 - HC PREP FACE/ORAL PROST OBTURATOR","83695 - HC CHG LIPOPROTEIN (A)","21046 - HC EXCISION,BEN TUMOR,MANDIBLE,INTRA-ORAL","84703 - HC GONAD,CHOR(HCG);QL","84702 - HC HCG TUMOR MARKER","84703 - HC GONAD,CHOR(HCG);QL","83695 - HC CHG LIPOPROTEIN (A)","21073 - HC MANIPULATION TMJ THERAPEUTIC REQUIRE ANESTHESIA","84703 - HC GONAD,CHOR(HCG);QL","21046 - HC EXCISION,BEN TUMOR,MANDIBLE,INTRA-ORAL","83695 - HC CHG LIPOPROTEIN (A)","84703 - HC GONAD,CHOR(HCG);QL","74170 - HC CT ABDOMEN WITH AND WITHOUT CONTRAST","21073 - HC MANIPULATION TMJ THERAPEUTIC REQUIRE ANESTHESIA"]
[null,"21407 - HC OPEN RX FX ORBIT W IMPLANT","83935 - HC CHG ASSAY OF OSMOLALITY URINE","21079 - HC PREP FACE/ORAL PROST TEMP OBTURATOR","21079 - HC PREP FACE/ORAL PROST TEMP OBTURATOR","21079 - HC PREP FACE/ORAL PROST TEMP OBTURATOR","83718 - HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL","21047 - HC EXCISION,BEN TUMOR,MANDIBLE,EXTRA-ORAL","85004 - HC AUTO DIFF","84703 - HC GONAD,CHOR(HCG);QL","85004 - HC AUTO DIFF","83718 - HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL","21076 - HC PREP FACE/ORAL PROST OBTURATOR","85004 - HC AUTO DIFF","21047 - HC EXCISION,BEN TUMOR,MANDIBLE,EXTRA-ORAL","83718 - HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL","85004 - HC AUTO DIFF","74174 - HC CHG CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG","21076 - HC PREP FACE/ORAL PROST OBTURATOR"]
[null,"21421 - HC CLOSED RX LEFORTE I+WIRES","83937 - HC CHG ASSAY OF OSTEOCALCIN","21080 - HC PREP FACE/ORAL PROST FINL OBTURATOR","21080 - HC PREP FACE/ORAL PROST FINL OBTURATOR","21080 - HC PREP FACE/ORAL PROST FINL OBTURATOR","83721 - HC CRL;DIRECT LDL","21048 - HC EXCISION,BEN TUMOR,MAXILLA,INTRA-ORAL","85014 - HC CHG BLOOD COUNT HEMATOCRIT","85004 - HC AUTO DIFF","85014 - HC CHG BLOOD COUNT HEMATOCRIT","83721 - HC CRL;DIRECT LDL","21079 - HC PREP FACE/ORAL PROST TEMP OBTURATOR","85014 - HC CHG BLOOD COUNT HEMATOCRIT","21048 - HC EXCISION,BEN TUMOR,MAXILLA,INTRA-ORAL","83721 - HC CRL;DIRECT LDL","85014 - HC CHG BLOOD COUNT HEMATOCRIT","74175 - HC CHG CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST","21079 - HC PREP FACE/ORAL PROST TEMP OBTURATOR"]
[null,"21440 - HC DENTAL RIDGE FX","83945 - HC CHG ASSAY OF OXALATE","21081 - HC PREP FACE/ORAL PROST MANDIBULAR","21081 - HC PREP FACE/ORAL PROST MANDIBULAR","21081 - HC PREP FACE/ORAL PROST MANDIBULAR","83735 - HC CHG ASSAY OF MAGNESIUM","21070 - HC REMV CORONOID PROCESS","85018 - POC;HEMOGLOBIN","85014 - HC CHG BLOOD COUNT HEMATOCRIT","85018 - POC;HEMOGLOBIN","83735 - HC CHG ASSAY OF MAGNESIUM","21080 - HC PREP FACE/ORAL PROST FINL OBTURATOR","85018 - POC;HEMOGLOBIN","21070 - HC REMV CORONOID PROCESS","83735 - HC CHG ASSAY OF MAGNESIUM","85018 - POC;HEMOGLOBIN","74176 - HC CHG CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL","21080 - HC PREP FACE/ORAL PROST FINL OBTURATOR"]
[null,"21445 - HC OPEN RX DENTAL RIDGE FX","83970 - HC CHG ASSAY OF PARATHORMONE","21083 - PREPARE FACE/ORAL PROSTHESIS","21083 - PREPARE FACE/ORAL PROSTHESIS","21083 - PREPARE FACE/ORAL PROSTHESIS","83785 - HC CHG, ASSAY OF MANGANESE","21073 - HC MANIPULATION TMJ THERAPEUTIC REQUIRE ANESTHESIA","85025 - HC CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC","85018 - POC;HEMOGLOBIN","85025 - HC CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC","83785 - HC CHG, ASSAY OF MANGANESE","21081 - HC PREP FACE/ORAL PROST MANDIBULAR","85025 - HC CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC","21073 - HC MANIPULATION TMJ THERAPEUTIC REQUIRE ANESTHESIA","83785 - HC CHG, ASSAY OF MANGANESE","85025 - HC CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC","74177 - HC CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL","21081 - HC PREP FACE/ORAL PROST MANDIBULAR"]
[null,"21450 - HC CLOSED RX MANDIBLE FX","83986 - HC CHG PH BODY FLUID NOT ELSEWHERE SPECIFIED","21085 - HC IMPRESSION & PREPARATION ORAL SURGICAL SPLINT","21085 - HC IMPRESSION & PREPARATION ORAL SURGICAL SPLINT","21085 - HC IMPRESSION & PREPARATION ORAL SURGICAL SPLINT","83789 - HC CHG MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA","21076 - HC PREP FACE/ORAL PROST OBTURATOR","85027 - HC CHG BLOOD COUNT COMPLETE AUTOMATED","85025 - HC CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC","85027 - HC CHG BLOOD COUNT COMPLETE AUTOMATED","83789 - HC CHG MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA","21083 - PREPARE FACE/ORAL PROSTHESIS","85027 - HC CHG BLOOD COUNT COMPLETE AUTOMATED","21076 - HC PREP FACE/ORAL PROST OBTURATOR","83789 - HC CHG MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA","85027 - HC CHG BLOOD COUNT COMPLETE AUTOMATED","74178 - HC CHG CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE","21083 - PREPARE FACE/ORAL PROSTHESIS"]
[null,"21451 - CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION","83992 - HC CHG ASSAY OF PHENCYCLIDINE","21110 - APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC","21110 - APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC","21110 - APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC","83825 - HC CHG ASSAY OF MERCURY QUANTITATIVE","21079 - HC PREP FACE/ORAL PROST TEMP OBTURATOR","85045 - HC CHG BLOOD COUNT RETICULOCYTE AUTOMATED","85027 - HC CHG BLOOD COUNT COMPLETE AUTOMATED","85045 - HC CHG BLOOD COUNT RETICULOCYTE AUTOMATED","83825 - HC CHG ASSAY OF MERCURY QUANTITATIVE","21085 - HC IMPRESSION & PREPARATION ORAL SURGICAL SPLINT","85045 - HC CHG BLOOD COUNT RETICULOCYTE AUTOMATED","21079 - HC PREP FACE/ORAL PROST TEMP OBTURATOR","83825 - HC CHG ASSAY OF MERCURY QUANTITATIVE","85045 - HC CHG BLOOD COUNT RETICULOCYTE AUTOMATED","74181 - HC CHG MRI ABDOMEN W/O CONTRAST MATERIAL","21085 - HC IMPRESSION & PREPARATION ORAL SURGICAL SPLINT"]
[null,"21453 - HC CLOSED RX MANDIBLE FX+DENTAL FIX","83993 - HC CHG ASSAY OF CALPROTECTIN FECAL","21121 - HC RECONST CHIN SLIDE SINGL OSTEOTOMY","21121 - HC RECONST CHIN SLIDE SINGL OSTEOTOMY","21121 - HC RECONST CHIN SLIDE SINGL OSTEOTOMY","83835 - HC CHG METANEPHRINES","21080 - HC PREP FACE/ORAL PROST FINL OBTURATOR","85046 - HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS","85045 - HC CHG BLOOD COUNT RETICULOCYTE AUTOMATED","85046 - HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS","83835 - HC CHG METANEPHRINES","21110 - APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC","85046 - HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS","21080 - HC PREP FACE/ORAL PROST FINL OBTURATOR","83835 - HC CHG METANEPHRINES","85046 - HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS","74182 - HC CHG MRI ABDOMEN W/CONTRAST MATERIAL","21110 - APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC"]
[null,"21461 - HC OPEN RX MANDIBLE FX","84075 - HC CHG ASSAY OF PHOSPHATASE ALKALINE","21198 - HC OSTEOTOMY, MANDIBLE","21198 - HC OSTEOTOMY, MANDIBLE","21198 - HC OSTEOTOMY, MANDIBLE","83873 - HC CHG MYELIN BASIC PROTEIN CEREBROSPINAL FLUID","21081 - HC PREP FACE/ORAL PROST MANDIBULAR","85048 - HC CHG BLOOD COUNT LEUKOCYTE WBC AUTOMATED","85046 - HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS","85048 - HC CHG BLOOD COUNT LEUKOCYTE WBC AUTOMATED","83873 - HC CHG MYELIN BASIC PROTEIN CEREBROSPINAL FLUID","21121 - HC RECONST CHIN SLIDE SINGL OSTEOTOMY","85048 - HC CHG BLOOD COUNT LEUKOCYTE WBC AUTOMATED","21081 - HC PREP FACE/ORAL PROST MANDIBULAR","83873 - HC CHG MYELIN BASIC PROTEIN CEREBROSPINAL FLUID","85048 - HC CHG BLOOD COUNT LEUKOCYTE WBC AUTOMATED","74183 - HC CHG MRI ABDOMEN W/O & W/CONTRAST MATERIAL","21121 - HC RECONST CHIN SLIDE SINGL OSTEOTOMY"]
[null,"21462 - HC OPEN RX MANDIBLE FX+DENTAL FIX","84080 - HC CHG ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES","21208 - HC AUGMENT FACIAL BONES","21208 - HC AUGMENT FACIAL BONES","21208 - HC AUGMENT FACIAL BONES","83874 - HC CHG MYOGLOBIN","21083 - PREPARE FACE/ORAL PROSTHESIS","85049 - HC CHG BLOOD COUNT PLATELET AUTOMATED","85048 - HC CHG BLOOD COUNT LEUKOCYTE WBC AUTOMATED","85049 - HC CHG BLOOD COUNT PLATELET AUTOMATED","83874 - HC CHG MYOGLOBIN","21198 - HC OSTEOTOMY, MANDIBLE","85049 - HC CHG BLOOD COUNT PLATELET AUTOMATED","21083 - PREPARE FACE/ORAL PROSTHESIS","83874 - HC CHG MYOGLOBIN","85049 - HC CHG BLOOD COUNT PLATELET AUTOMATED","74220 - HC CHG RADEX ESOPHAGUS","21198 - HC OSTEOTOMY, MANDIBLE"]
[null,"21470 - HC OPEN RX MANDIBLE CONDYLE FX,COMPL","84100 - HC CHG ASSAY OF PHOSPHORUS INORGANIC","21215 - HC MANDIBLE GRAFT","21215 - HC MANDIBLE GRAFT","21215 - HC MANDIBLE GRAFT","83880 - HC CHG NATRIURETIC PEPTIDE","21085 - HC IMPRESSION & PREPARATION ORAL SURGICAL SPLINT","85055 - HC CHG RETICULATED PLATELET ASSAY","85049 - HC CHG BLOOD COUNT PLATELET AUTOMATED","85055 - HC CHG RETICULATED PLATELET ASSAY","83880 - HC CHG NATRIURETIC PEPTIDE","21208 - HC AUGMENT FACIAL BONES","85055 - HC CHG RETICULATED PLATELET ASSAY","21085 - HC IMPRESSION & PREPARATION ORAL SURGICAL SPLINT","83880 - HC CHG NATRIURETIC PEPTIDE","85055 - HC CHG RETICULATED PLATELET ASSAY","74230 - SWALLOWING FUNCJ W/CINERADIOGRAPY/VIDRADIOG","21208 - HC AUGMENT FACIAL BONES"]
[null,"21480 - CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ","84105 - HC CHG ASSAY OF PHOSPHORUS INORGANIC URINE","21235 - HC GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR","21235 - HC GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR","21235 - HC GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR","83883 - HC NEPHELOMETRY, EACH ANALYTE","21110 - APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC","85210 - HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC","85055 - HC CHG RETICULATED PLATELET ASSAY","85210 - HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC","83883 - HC NEPHELOMETRY, EACH ANALYTE","21215 - HC MANDIBLE GRAFT","85210 - HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC","21110 - APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC","83883 - HC NEPHELOMETRY, EACH ANALYTE","85210 - HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC","74240 - HC XRAY UPPER GI TRACT","21215 - HC MANDIBLE GRAFT"]
[null,"21501 - I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX","84132 - HC CHG POTASSIUM SERUM PLASMA/WHOLE BLOOD","21240 - HC ARTHROPLASTY TMJ","21240 - HC ARTHROPLASTY TMJ","21240 - HC ARTHROPLASTY TMJ","83915 - HC CHG ASSAY OF NUCLEOTIDASE 5'-","21121 - HC RECONST CHIN SLIDE SINGL OSTEOTOMY","85220 - HC CHG CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR","85210 - HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC","85220 - HC CHG CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR","83915 - HC CHG ASSAY OF NUCLEOTIDASE 5'-","21235 - HC GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR","85220 - HC CHG CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR","21121 - HC RECONST CHIN SLIDE SINGL OSTEOTOMY","83915 - HC CHG ASSAY OF NUCLEOTIDASE 5'-","85220 - HC CHG CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR","74241 - XR UGI W KUB","21235 - HC GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR"]
[null,"21550 - BIOPSY SOFT TISSUE NECK/THORAX","84133 - HC CHG POTASSIUM URINE","21243 - HC ARTHROPLASTY TMJ+PROSTHESIS","21243 - HC ARTHROPLASTY TMJ+PROSTHESIS","21243 - HC ARTHROPLASTY TMJ+PROSTHESIS","83916 - HC CHG OLIGOCLONAL IMMUNE","21198 - HC OSTEOTOMY, MANDIBLE","85230 - HC CHG CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR","85220 - HC CHG CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR","85230 - HC CHG CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR","83916 - HC CHG OLIGOCLONAL IMMUNE","21240 - HC ARTHROPLASTY TMJ","85230 - HC CHG CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR","21198 - HC OSTEOTOMY, MANDIBLE","83916 - HC CHG OLIGOCLONAL IMMUNE","85230 - HC CHG CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR","74245 - XR UGI W SM BOWEL","21240 - HC ARTHROPLASTY TMJ"]
[null,"21552 - EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>","84134 - HC CHG PREALBUMIN","21244 - HC RECONSTR MANDIBLE,BONE PLATE","21244 - HC RECONSTR MANDIBLE,BONE PLATE","21244 - HC RECONSTR MANDIBLE,BONE PLATE","83918 - HC CHG ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN","21208 - HC AUGMENT FACIAL BONES","85240 - HC CHG CLOTTING FACTOR VIII AHG 1 STAGE","85230 - HC CHG CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR","85240 - HC CHG CLOTTING FACTOR VIII AHG 1 STAGE","83918 - HC CHG ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN","21243 - HC ARTHROPLASTY TMJ+PROSTHESIS","85240 - HC CHG CLOTTING FACTOR VIII AHG 1 STAGE","21208 - HC AUGMENT FACIAL BONES","83918 - HC CHG ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN","85240 - HC CHG CLOTTING FACTOR VIII AHG 1 STAGE","74246 - HC XRAY UPPER GI AIR CONTRAST","21243 - HC ARTHROPLASTY TMJ+PROSTHESIS"]
[null,"21554 - EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/>","84144 - HC CHG ASSAY OF PROGESTERONE","21248 - HC RECONSTR JAW,PART-ENDO IMPLNT","21248 - HC RECONSTR JAW,PART-ENDO IMPLNT","21248 - HC RECONSTR JAW,PART-ENDO IMPLNT","83921 - HC CHG ORGANIC ACID 1 QUANTITATIVE","21215 - HC MANDIBLE GRAFT","85245 - HC CHG CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT","85240 - HC CHG CLOTTING FACTOR VIII AHG 1 STAGE","85245 - HC CHG CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT","83921 - HC CHG ORGANIC ACID 1 QUANTITATIVE","21244 - HC RECONSTR MANDIBLE,BONE PLATE","85245 - HC CHG CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT","21215 - HC MANDIBLE GRAFT","83921 - HC CHG ORGANIC ACID 1 QUANTITATIVE","85245 - HC CHG CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT","74247 - XR UGI W AIR CON KUB","21244 - HC RECONSTR MANDIBLE,BONE PLATE"]
[null,"21555 - EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM","84145 - HC CHG PROCALCITONIN (PCT)","21310 - CLOSED TREATMENT NASAL FRACTURE W/O MANIPULATION","21310 - CLOSED TREATMENT NASAL FRACTURE W/O MANIPULATION","21310 - CLOSED TREATMENT NASAL FRACTURE W/O MANIPULATION","83930 - HC Q;OSMOLALITY,SER","21235 - HC GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR","85246 - HC CHG CLOTTING FACTOR VIII VW FACTOR ANTIGEN","85245 - HC CHG CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT","85246 - HC CHG CLOTTING FACTOR VIII VW FACTOR ANTIGEN","83930 - HC Q;OSMOLALITY,SER","21248 - HC RECONSTR JAW,PART-ENDO IMPLNT","85246 - HC CHG CLOTTING FACTOR VIII VW FACTOR ANTIGEN","21235 - HC GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR","83930 - HC Q;OSMOLALITY,SER","85246 - HC CHG CLOTTING FACTOR VIII VW FACTOR ANTIGEN","74249 - XR UGI W AIR CON SM BOWEL","21248 - HC RECONSTR JAW,PART-ENDO IMPLNT"]
[null,"21556 - EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM","84146 - HC CHG ASSAY OF PROLACTIN","21315 - CLOSED TX NASAL FRACTURE W/O STABILIZATION","21315 - CLOSED TX NASAL FRACTURE W/O STABILIZATION","21315 - CLOSED TX NASAL FRACTURE W/O STABILIZATION","83935 - HC CHG ASSAY OF OSMOLALITY URINE","21240 - HC ARTHROPLASTY TMJ","85250 - HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS","85246 - HC CHG CLOTTING FACTOR VIII VW FACTOR ANTIGEN","85250 - HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS","83935 - HC CHG ASSAY OF OSMOLALITY URINE","21310 - CLOSED TREATMENT NASAL FRACTURE W/O MANIPULATION","85250 - HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS","21240 - HC ARTHROPLASTY TMJ","83935 - HC CHG ASSAY OF OSMOLALITY URINE","85250 - HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS","74250 - HC CHG RADEX SMALL INTESTINE W/MULTIPLE SERIAL IMAGES","21310 - CLOSED TREATMENT NASAL FRACTURE W/O MANIPULATION"]
[null,"21920 - HC BIOPSY SOFT TISSUE BACK,SUPERF","84153 - HC CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL","21320 - CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION","21320 - CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION","21320 - CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION","83937 - HC CHG ASSAY OF OSTEOCALCIN","21243 - HC ARTHROPLASTY TMJ+PROSTHESIS","85260 - HC CHG CLOTTING FACTOR X STUART-PROWER","85250 - HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS","85260 - HC CHG CLOTTING FACTOR X STUART-PROWER","83937 - HC CHG ASSAY OF OSTEOCALCIN","21315 - CLOSED TX NASAL FRACTURE W/O STABILIZATION","85260 - HC CHG CLOTTING FACTOR X STUART-PROWER","21243 - HC ARTHROPLASTY TMJ+PROSTHESIS","83937 - HC CHG ASSAY OF OSTEOCALCIN","85260 - HC CHG CLOTTING FACTOR X STUART-PROWER","74251 - HC CHG RADEX SM INT W/MLT SRL IMGES VIA ENTEROCLSS TUBE","21315 - CLOSED TX NASAL FRACTURE W/O STABILIZATION"]
[null,"21925 - HC BIOPSY SOFT TISSUE BACK,DEEP","84155 - HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD","21325 - HC OPEN RX NOSE FRACTURE","21325 - HC OPEN RX NOSE FRACTURE","21325 - HC OPEN RX NOSE FRACTURE","83945 - HC CHG ASSAY OF OXALATE","21244 - HC RECONSTR MANDIBLE,BONE PLATE","85270 - HC CHG CLOTTING FACTOR XI PTA","85260 - HC CHG CLOTTING FACTOR X STUART-PROWER","85270 - HC CHG CLOTTING FACTOR XI PTA","83945 - HC CHG ASSAY OF OXALATE","21320 - CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION","85270 - HC CHG CLOTTING FACTOR XI PTA","21244 - HC RECONSTR MANDIBLE,BONE PLATE","83945 - HC CHG ASSAY OF OXALATE","85270 - HC CHG CLOTTING FACTOR XI PTA","74261 - HC CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST","21320 - CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION"]
[null,"21930 - EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM","84156 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY URINE","21337 - HC CLOSED RX NASAL SEPTAL FRACTURE","21337 - HC CLOSED RX NASAL SEPTAL FRACTURE","21337 - HC CLOSED RX NASAL SEPTAL FRACTURE","83970 - HC CHG ASSAY OF PARATHORMONE","21248 - HC RECONSTR JAW,PART-ENDO IMPLNT","85280 - HC CHG CLOTTING FACTOR XII HAGEMAN","85270 - HC CHG CLOTTING FACTOR XI PTA","85280 - HC CHG CLOTTING FACTOR XII HAGEMAN","83970 - HC CHG ASSAY OF PARATHORMONE","21325 - HC OPEN RX NOSE FRACTURE","85280 - HC CHG CLOTTING FACTOR XII HAGEMAN","21248 - HC RECONSTR JAW,PART-ENDO IMPLNT","83970 - HC CHG ASSAY OF PARATHORMONE","85280 - HC CHG CLOTTING FACTOR XII HAGEMAN","74262 - HC CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST","21325 - HC OPEN RX NOSE FRACTURE"]
[null,"21931 - EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/>","84157 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC","21365 - HC OPEN RX COMPLX CHEEK BONE FRAC","21365 - HC OPEN RX COMPLX CHEEK BONE FRAC","21365 - HC OPEN RX COMPLX CHEEK BONE FRAC","83986 - HC CHG PH BODY FLUID NOT ELSEWHERE SPECIFIED","21310 - CLOSED TREATMENT NASAL FRACTURE W/O MANIPULATION","85290 - HC CHG CLOTTING FACTOR XIII FIBRIN STABILIZING","85280 - HC CHG CLOTTING FACTOR XII HAGEMAN","85290 - HC CHG CLOTTING FACTOR XIII FIBRIN STABILIZING","83986 - HC CHG PH BODY FLUID NOT ELSEWHERE SPECIFIED","21337 - HC CLOSED RX NASAL SEPTAL FRACTURE","85290 - HC CHG CLOTTING FACTOR XIII FIBRIN STABILIZING","21310 - CLOSED TREATMENT NASAL FRACTURE W/O MANIPULATION","83986 - HC CHG PH BODY FLUID NOT ELSEWHERE SPECIFIED","85290 - HC CHG CLOTTING FACTOR XIII FIBRIN STABILIZING","74270 - HC CHG RADEX COLON BARIUM ENEMA W/WO KUB","21337 - HC CLOSED RX NASAL SEPTAL FRACTURE"]
[null,"21932 - HC EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM","84163 - HC CHG PREGNANCY-ASSOCIATED PLASMA PROTEIN-A","21390 - HC REPAIR EYE BLOWOUT,PERIORB+IMPLNT","21390 - HC REPAIR EYE BLOWOUT,PERIORB+IMPLNT","21390 - HC REPAIR EYE BLOWOUT,PERIORB+IMPLNT","83992 - HC CHG ASSAY OF PHENCYCLIDINE","21315 - CLOSED TX NASAL FRACTURE W/O STABILIZATION","85300 - HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY","85290 - HC CHG CLOTTING FACTOR XIII FIBRIN STABILIZING","85300 - HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY","83992 - HC CHG ASSAY OF PHENCYCLIDINE","21365 - HC OPEN RX COMPLX CHEEK BONE FRAC","85300 - HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY","21315 - CLOSED TX NASAL FRACTURE W/O STABILIZATION","83992 - HC CHG ASSAY OF PHENCYCLIDINE","85300 - HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY","74280 - HC CHG RADEX COLON W/SPEC HI DNS BARIUM W/WO GLUCAGON","21365 - HC OPEN RX COMPLX CHEEK BONE FRAC"]
[null,"21933 - EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>","84165 - HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM","21400 - HC CLOSED RX FX ORBIT","21400 - HC CLOSED RX FX ORBIT","21400 - HC CLOSED RX FX ORBIT","83993 - HC CHG ASSAY OF CALPROTECTIN FECAL","21320 - CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION","85301 - HC CHG CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY","85300 - HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY","85301 - HC CHG CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY","83993 - HC CHG ASSAY OF CALPROTECTIN FECAL","21390 - HC REPAIR EYE BLOWOUT,PERIORB+IMPLNT","85301 - HC CHG CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY","21320 - CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION","83993 - HC CHG ASSAY OF CALPROTECTIN FECAL","85301 - HC CHG CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY","74283 - HC CHG THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ","21390 - HC REPAIR EYE BLOWOUT,PERIORB+IMPLNT"]
[null,"22310 - CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING","84166 - HC CHG PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI","21407 - HC OPEN RX FX ORBIT W IMPLANT","21407 - HC OPEN RX FX ORBIT W IMPLANT","21407 - HC OPEN RX FX ORBIT W IMPLANT","84075 - HC CHG ASSAY OF PHOSPHATASE ALKALINE","21325 - HC OPEN RX NOSE FRACTURE","85302 - HC CHG CLOTTING INHIBITORS PROTEIN C ANTIGEN","85301 - HC CHG CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY","85302 - HC CHG CLOTTING INHIBITORS PROTEIN C ANTIGEN","84075 - HC CHG ASSAY OF PHOSPHATASE ALKALINE","21400 - HC CLOSED RX FX ORBIT","85302 - HC CHG CLOTTING INHIBITORS PROTEIN C ANTIGEN","21325 - HC OPEN RX NOSE FRACTURE","84075 - HC CHG ASSAY OF PHOSPHATASE ALKALINE","85302 - HC CHG CLOTTING INHIBITORS PROTEIN C ANTIGEN","74340 - HC CHG INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I","21400 - HC CLOSED RX FX ORBIT"]
[null,"22510 - PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC","84182 - HC CHG PROTEIN, WESTERN BLOT TEST, W BAND","21421 - HC CLOSED RX LEFORTE I+WIRES","21421 - HC CLOSED RX LEFORTE I+WIRES","21421 - HC CLOSED RX LEFORTE I+WIRES","84080 - HC CHG ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES","21337 - HC CLOSED RX NASAL SEPTAL FRACTURE","85303 - HC CHG CLOTTING INHIBITORS PROTEIN C ACTIVITY","85302 - HC CHG CLOTTING INHIBITORS PROTEIN C ANTIGEN","85303 - HC CHG CLOTTING INHIBITORS PROTEIN C ACTIVITY","84080 - HC CHG ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES","21407 - HC OPEN RX FX ORBIT W IMPLANT","85303 - HC CHG CLOTTING INHIBITORS PROTEIN C ACTIVITY","21337 - HC CLOSED RX NASAL SEPTAL FRACTURE","84080 - HC CHG ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES","85303 - HC CHG CLOTTING INHIBITORS PROTEIN C ACTIVITY","74360 - HC CHG INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I","21407 - HC OPEN RX FX ORBIT W IMPLANT"]
[null,"22511 - PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL","84202 - HC Q;ERYTH PROTPOR","21440 - HC DENTAL RIDGE FX","21440 - HC DENTAL RIDGE FX","21440 - HC DENTAL RIDGE FX","84100 - HC CHG ASSAY OF PHOSPHORUS INORGANIC","21365 - HC OPEN RX COMPLX CHEEK BONE FRAC","85305 - HC CHG CLOTTING INHIBITORS PROTEIN S TOTAL","85303 - HC CHG CLOTTING INHIBITORS PROTEIN C ACTIVITY","85305 - HC CHG CLOTTING INHIBITORS PROTEIN S TOTAL","84100 - HC CHG ASSAY OF PHOSPHORUS INORGANIC","21421 - HC CLOSED RX LEFORTE I+WIRES","85305 - HC CHG CLOTTING INHIBITORS PROTEIN S TOTAL","21365 - HC OPEN RX COMPLX CHEEK BONE FRAC","84100 - HC CHG ASSAY OF PHOSPHORUS INORGANIC","85305 - HC CHG CLOTTING INHIBITORS PROTEIN S TOTAL","74363 - HC CHG PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I","21421 - HC CLOSED RX LEFORTE I+WIRES"]
[null,"22512 - HC VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL","84206 - HC CHG ASSAY OF PROINSULIN","21445 - HC OPEN RX DENTAL RIDGE FX","21445 - HC OPEN RX DENTAL RIDGE FX","21445 - HC OPEN RX DENTAL RIDGE FX","84105 - HC CHG ASSAY OF PHOSPHORUS INORGANIC URINE","21390 - HC REPAIR EYE BLOWOUT,PERIORB+IMPLNT","85306 - HC CHG CLOTTING INHIBITORS PROTEIN S FREE","85305 - HC CHG CLOTTING INHIBITORS PROTEIN S TOTAL","85306 - HC CHG CLOTTING INHIBITORS PROTEIN S FREE","84105 - HC CHG ASSAY OF PHOSPHORUS INORGANIC URINE","21440 - HC DENTAL RIDGE FX","85306 - HC CHG CLOTTING INHIBITORS PROTEIN S FREE","21390 - HC REPAIR EYE BLOWOUT,PERIORB+IMPLNT","84105 - HC CHG ASSAY OF PHOSPHORUS INORGANIC URINE","85306 - HC CHG CLOTTING INHIBITORS PROTEIN S FREE","74420 - X-RAY URINARY TRACT EXAM WITH CONTRAST MATERIAL","21440 - HC DENTAL RIDGE FX"]
[null,"22513 - HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION","84207 - HC CHG ASSAY OF PYRIDOXAL PHOSPHATE","21450 - HC CLOSED RX MANDIBLE FX","21450 - HC CLOSED RX MANDIBLE FX","21450 - HC CLOSED RX MANDIBLE FX","84132 - HC CHG POTASSIUM SERUM PLASMA/WHOLE BLOOD","21400 - HC CLOSED RX FX ORBIT","85307 - HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY","85306 - HC CHG CLOTTING INHIBITORS PROTEIN S FREE","85307 - HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY","84132 - HC CHG POTASSIUM SERUM PLASMA/WHOLE BLOOD","21445 - HC OPEN RX DENTAL RIDGE FX","85307 - HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY","21400 - HC CLOSED RX FX ORBIT","84132 - HC CHG POTASSIUM SERUM PLASMA/WHOLE BLOOD","85307 - HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY","74425 - UROGRAPHY ANTEGRADE RS&I","21445 - HC OPEN RX DENTAL RIDGE FX"]
[null,"22514 - PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR","84210 - HC CHG ASSAY OF PYRUVATE","21451 - CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION","21451 - CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION","21451 - CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION","84133 - HC CHG POTASSIUM URINE","21407 - HC OPEN RX FX ORBIT W IMPLANT","85347 - HC CHG COAGULATION TIME ACTIVATED","85307 - HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY","85347 - HC CHG COAGULATION TIME ACTIVATED","84133 - HC CHG POTASSIUM URINE","21450 - HC CLOSED RX MANDIBLE FX","85347 - HC CHG COAGULATION TIME ACTIVATED","21407 - HC OPEN RX FX ORBIT W IMPLANT","84133 - HC CHG POTASSIUM URINE","85347 - HC CHG COAGULATION TIME ACTIVATED","74430 - CYSTOGRAPHY MINIMUM 3 VIEWS RS&I","21450 - HC CLOSED RX MANDIBLE FX"]
[null,"22515 - PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH","84244 - HC CHG ASSAY OF RENIN","21453 - HC CLOSED RX MANDIBLE FX+DENTAL FIX","21453 - HC CLOSED RX MANDIBLE FX+DENTAL FIX","21453 - HC CLOSED RX MANDIBLE FX+DENTAL FIX","84134 - HC CHG PREALBUMIN","21421 - HC CLOSED RX LEFORTE I+WIRES","85366 - HC CHG FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ","85347 - HC CHG COAGULATION TIME ACTIVATED","85366 - HC CHG FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ","84134 - HC CHG PREALBUMIN","21451 - CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION","85366 - HC CHG FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ","21421 - HC CLOSED RX LEFORTE I+WIRES","84134 - HC CHG PREALBUMIN","85366 - HC CHG FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ","74445 - HC CHG CORPORA CAVERNOSOGRAPY RS&I","21451 - CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION"]
[null,"22854 - HC INSJ BIOMCHN DEV VRT CORPECTOMY DEFECT W/ARTHRD","84255 - HC CHG ASSAY OF SELENIUM","21461 - HC OPEN RX MANDIBLE FX","21461 - HC OPEN RX MANDIBLE FX","21461 - HC OPEN RX MANDIBLE FX","84144 - HC CHG ASSAY OF PROGESTERONE","21440 - HC DENTAL RIDGE FX","85378 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN","85366 - HC CHG FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ","85378 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN","84144 - HC CHG ASSAY OF PROGESTERONE","21453 - HC CLOSED RX MANDIBLE FX+DENTAL FIX","85378 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN","21440 - HC DENTAL RIDGE FX","84144 - HC CHG ASSAY OF PROGESTERONE","85378 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN","74450 - URETHROCYSTOGRAPHY RETROGRADE RS&I","21453 - HC CLOSED RX MANDIBLE FX+DENTAL FIX"]
[null,"22869 - HC INSJ STABLJ DEV W/O DCMPRN LUMBAR SINGLE LEVEL","84270 - HC CHG ASSAY OF SEX HORMONE BINDING GLOBULIN","21462 - HC OPEN RX MANDIBLE FX+DENTAL FIX","21462 - HC OPEN RX MANDIBLE FX+DENTAL FIX","21462 - HC OPEN RX MANDIBLE FX+DENTAL FIX","84145 - HC CHG PROCALCITONIN (PCT)","21445 - HC OPEN RX DENTAL RIDGE FX","85379 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE","85378 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN","85379 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE","84145 - HC CHG PROCALCITONIN (PCT)","21461 - HC OPEN RX MANDIBLE FX","85379 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE","21445 - HC OPEN RX DENTAL RIDGE FX","84145 - HC CHG PROCALCITONIN (PCT)","85379 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE","74455 - URETHROCYSTOGRAPHY VOIDING RS&I","21461 - HC OPEN RX MANDIBLE FX"]
[null,"22870 - HC INSJ STABLJ DEV W/O DCMPRN LUMBAR SECOND LEVEL","84295 - HC CHG SODIUM SERUM PLASMA OR WHOLE BLOOD","21470 - HC OPEN RX MANDIBLE CONDYLE FX,COMPL","21470 - HC OPEN RX MANDIBLE CONDYLE FX,COMPL","21470 - HC OPEN RX MANDIBLE CONDYLE FX,COMPL","84146 - HC CHG ASSAY OF PROLACTIN","21450 - HC CLOSED RX MANDIBLE FX","85384 - HC CHG FIBRINOGEN ACTIVITY","85379 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE","85384 - HC CHG FIBRINOGEN ACTIVITY","84146 - HC CHG ASSAY OF PROLACTIN","21462 - HC OPEN RX MANDIBLE FX+DENTAL FIX","85384 - HC CHG FIBRINOGEN ACTIVITY","21450 - HC CLOSED RX MANDIBLE FX","84146 - HC CHG ASSAY OF PROLACTIN","85384 - HC CHG FIBRINOGEN ACTIVITY","74740 - HC CHG HYSTEROSALPINGOGRAPHY RS&I","21462 - HC OPEN RX MANDIBLE FX+DENTAL FIX"]
[null,"22901 - HC EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL 5+CM","84300 - HC CHG ASSAY OF URINE SODIUM","21480 - CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ","21480 - CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ","21480 - CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ","84153 - HC CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL","21451 - CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION","85397 - HC CHG CLOTTING FUNCTION ACTIVITY NOS, EA ANALYT","85384 - HC CHG FIBRINOGEN ACTIVITY","85397 - HC CHG CLOTTING FUNCTION ACTIVITY NOS, EA ANALYT","84153 - HC CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL","21470 - HC OPEN RX MANDIBLE CONDYLE FX,COMPL","85397 - HC CHG CLOTTING FUNCTION ACTIVITY NOS, EA ANALYT","21451 - CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION","84153 - HC CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL","85397 - HC CHG CLOTTING FUNCTION ACTIVITY NOS, EA ANALYT","75557 - HC CHG CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST","21470 - HC OPEN RX MANDIBLE CONDYLE FX,COMPL"]
[null,"22902 - HC EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM","84302 - HC CHG ASSAY OF SODIUM OTHER SOURCE","21501 - I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX","21501 - I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX","21501 - I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX","84155 - HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD","21453 - HC CLOSED RX MANDIBLE FX+DENTAL FIX","85461 - HC CHG HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE","85397 - HC CHG CLOTTING FUNCTION ACTIVITY NOS, EA ANALYT","85461 - HC CHG HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE","84155 - HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD","21480 - CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ","85461 - HC CHG HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE","21453 - HC CLOSED RX MANDIBLE FX+DENTAL FIX","84155 - HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD","85461 - HC CHG HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE","75559 - HC CHG CARDIAC MRI W/O CONTRAST W/STRESS IMAGING","21480 - CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ"]
[null,"22903 - HC EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3+CM","84305 - HC CHG ASSAY OF SOMATOMEDIN","21550 - BIOPSY SOFT TISSUE NECK/THORAX","21550 - BIOPSY SOFT TISSUE NECK/THORAX","21550 - BIOPSY SOFT TISSUE NECK/THORAX","84156 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY URINE","21461 - HC OPEN RX MANDIBLE FX","85520 - HC CHG HEPARIN ASSAY","85461 - HC CHG HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE","85520 - HC CHG HEPARIN ASSAY","84156 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY URINE","21501 - I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX","85520 - HC CHG HEPARIN ASSAY","21461 - HC OPEN RX MANDIBLE FX","84156 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY URINE","85520 - HC CHG HEPARIN ASSAY","75561 - HC CHG CARDIAC MRI W/WO CONTRAST & FURTHER SEQ","21501 - I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX"]
[null,"23031 - HC DRAIN INFECT SHOULDER BURSA","84307 - HC CHG ASSAY OF SOMATOSTATIN","21552 - EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>","21552 - EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>","21552 - EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>","84157 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC","21462 - HC OPEN RX MANDIBLE FX+DENTAL FIX","85549 - HC CHG MURAMIDASE","85520 - HC CHG HEPARIN ASSAY","85549 - HC CHG MURAMIDASE","84157 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC","21550 - BIOPSY SOFT TISSUE NECK/THORAX","85549 - HC CHG MURAMIDASE","21462 - HC OPEN RX MANDIBLE FX+DENTAL FIX","84157 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC","85549 - HC CHG MURAMIDASE","75563 - HC CHG CARDIAC MRI W/W/O CONTRAST W/STRESS","21550 - BIOPSY SOFT TISSUE NECK/THORAX"]
[null,"23065 - HC BIOPSY SOFT TISSUE SHOULDER SUPERFICIAL","84311 - HC CHG SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED","21554 - EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/>","21554 - EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/>","21554 - EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/>","84163 - HC CHG PREGNANCY-ASSOCIATED PLASMA PROTEIN-A","21470 - HC OPEN RX MANDIBLE CONDYLE FX,COMPL","85576 - HC CHG PLATELET AGGREGATION IN VITRO EACH AGENT","85549 - HC CHG MURAMIDASE","85576 - HC CHG PLATELET AGGREGATION IN VITRO EACH AGENT","84163 - HC CHG PREGNANCY-ASSOCIATED PLASMA PROTEIN-A","21552 - EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>","85576 - HC CHG PLATELET AGGREGATION IN VITRO EACH AGENT","21470 - HC OPEN RX MANDIBLE CONDYLE FX,COMPL","84163 - HC CHG PREGNANCY-ASSOCIATED PLASMA PROTEIN-A","85576 - HC CHG PLATELET AGGREGATION IN VITRO EACH AGENT","75571 - HC CT,HEART;W/OCM;COR CAL","21552 - EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>"]
[null,"23066 - HC BIOPSY SOFT TISSUE SHOULDER DEEP","84376 - HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC","21555 - EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM","21555 - EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM","21555 - EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM","84165 - HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM","21480 - CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ","85610 - POC;INR","85576 - HC CHG PLATELET AGGREGATION IN VITRO EACH AGENT","85610 - POC;INR","84165 - HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM","21554 - EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/>","85610 - POC;INR","21480 - CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ","84165 - HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM","85610 - POC;INR","75574 - HC CHG CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST","21554 - EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/>"]
[null,"23071 - EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/>","84402 - HC CHG ASSAY OF TESTOSTERONE FREE","21556 - EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM","21556 - EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM","21556 - EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM","84166 - HC CHG PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI","21501 - I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX","85611 - HC CHG PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH","85610 - POC;INR","85611 - HC CHG PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH","84166 - HC CHG PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI","21555 - EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM","85611 - HC CHG PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH","21501 - I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX","84166 - HC CHG PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI","85611 - HC CHG PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH","75600 - HC CHG ANGIO AORTOGRAM THORACIC","21555 - EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM"]
[null,"23073 - HC EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/>","84403 - HC CHG ASSAY OF TESTOSTERONE TOTAL","21920 - HC BIOPSY SOFT TISSUE BACK,SUPERF","21920 - HC BIOPSY SOFT TISSUE BACK,SUPERF","21920 - HC BIOPSY SOFT TISSUE BACK,SUPERF","84182 - HC CHG PROTEIN, WESTERN BLOT TEST, W BAND","21550 - BIOPSY SOFT TISSUE NECK/THORAX","85613 - HC CHG RUSSELL VIPER VENOM DILUTED","85611 - HC CHG PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH","85613 - HC CHG RUSSELL VIPER VENOM DILUTED","84182 - HC CHG PROTEIN, WESTERN BLOT TEST, W BAND","21556 - EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM","85613 - HC CHG RUSSELL VIPER VENOM DILUTED","21550 - BIOPSY SOFT TISSUE NECK/THORAX","84182 - HC CHG PROTEIN, WESTERN BLOT TEST, W BAND","85613 - HC CHG RUSSELL VIPER VENOM DILUTED","75605 - HC CHG AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I","21556 - EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM"]
[null,"23075 - EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM","84425 - HC CHG ASSAY OF THIAMINE-VITAMIN B-1","21925 - HC BIOPSY SOFT TISSUE BACK,DEEP","21925 - HC BIOPSY SOFT TISSUE BACK,DEEP","21925 - HC BIOPSY SOFT TISSUE BACK,DEEP","84202 - HC Q;ERYTH PROTPOR","21552 - EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>","85651 - SEDIMENTATION RATE RBC NON-AUTOMATED","85613 - HC CHG RUSSELL VIPER VENOM DILUTED","85651 - SEDIMENTATION RATE RBC NON-AUTOMATED","84202 - HC Q;ERYTH PROTPOR","21920 - HC BIOPSY SOFT TISSUE BACK,SUPERF","85651 - SEDIMENTATION RATE RBC NON-AUTOMATED","21552 - EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>","84202 - HC Q;ERYTH PROTPOR","85651 - SEDIMENTATION RATE RBC NON-AUTOMATED","75625 - HC CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I","21920 - HC BIOPSY SOFT TISSUE BACK,SUPERF"]
[null,"23076 - HC EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM","84430 - HC CHG ASSAY OF THIOCYANATE","21930 - EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM","21930 - EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM","21930 - EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM","84206 - HC CHG ASSAY OF PROINSULIN","21554 - EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/>","85652 - HC CHG SEDIMENTATION RATE RBC AUTOMATED","85651 - SEDIMENTATION RATE RBC NON-AUTOMATED","85652 - HC CHG SEDIMENTATION RATE RBC AUTOMATED","84206 - HC CHG ASSAY OF PROINSULIN","21925 - HC BIOPSY SOFT TISSUE BACK,DEEP","85652 - HC CHG SEDIMENTATION RATE RBC AUTOMATED","21554 - EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/>","84206 - HC CHG ASSAY OF PROINSULIN","85652 - HC CHG SEDIMENTATION RATE RBC AUTOMATED","75630 - HC CHG AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I","21925 - HC BIOPSY SOFT TISSUE BACK,DEEP"]
[null,"23330 - REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS","84432 - HC CHG ASSAY OF THYROGLOBULIN","21931 - EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/>","21931 - EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/>","21931 - EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/>","84207 - HC CHG ASSAY OF PYRIDOXAL PHOSPHATE","21555 - EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM","85660 - HC CHG SICKLING RBC REDUCTION","85652 - HC CHG SEDIMENTATION RATE RBC AUTOMATED","85660 - HC CHG SICKLING RBC REDUCTION","84207 - HC CHG ASSAY OF PYRIDOXAL PHOSPHATE","21930 - EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM","85660 - HC CHG SICKLING RBC REDUCTION","21555 - EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM","84207 - HC CHG ASSAY OF PYRIDOXAL PHOSPHATE","85660 - HC CHG SICKLING RBC REDUCTION","75635 - HC CHG CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP","21930 - EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM"]
[null,"23350 - HC INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI ARTHG","84436 - HC CHG ASSAY OF THYROXINE TOTAL","21932 - HC EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM","21932 - HC EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM","21932 - HC EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM","84210 - HC CHG ASSAY OF PYRUVATE","21556 - EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM","85670 - HC CHG THROMBIN TIME PLASMA","85660 - HC CHG SICKLING RBC REDUCTION","85670 - HC CHG THROMBIN TIME PLASMA","84210 - HC CHG ASSAY OF PYRUVATE","21931 - EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/>","85670 - HC CHG THROMBIN TIME PLASMA","21556 - EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM","84210 - HC CHG ASSAY OF PYRUVATE","85670 - HC CHG THROMBIN TIME PLASMA","75658 - ANGIO BRACH","21931 - EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/>"]
[null,"23450 - HC REPAIR SHOULDER CAPSULE,ANTERIOR","84439 - HC CHG ASSAY OF FREE THYROXINE","21933 - EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>","21933 - EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>","21933 - EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>","84244 - HC CHG ASSAY OF RENIN","21920 - HC BIOPSY SOFT TISSUE BACK,SUPERF","85705 - HC CHG THROMBOPLASTIN INHIBITION TISSUE","85670 - HC CHG THROMBIN TIME PLASMA","85705 - HC CHG THROMBOPLASTIN INHIBITION TISSUE","84244 - HC CHG ASSAY OF RENIN","21932 - HC EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM","85705 - HC CHG THROMBOPLASTIN INHIBITION TISSUE","21920 - HC BIOPSY SOFT TISSUE BACK,SUPERF","84244 - HC CHG ASSAY OF RENIN","85705 - HC CHG THROMBOPLASTIN INHIBITION TISSUE","75705 - HC CHG ANGIOGRAPHY SPINAL SELECTIVE RS&I","21932 - HC EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM"]
[null,"23500 - CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION","84442 - HC CHG ASSAY OF THYROXINE BNDNG GLOBULIN","22310 - CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING","22310 - CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING","22310 - CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING","84255 - HC CHG ASSAY OF SELENIUM","21925 - HC BIOPSY SOFT TISSUE BACK,DEEP","85730 - HC CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD","85705 - HC CHG THROMBOPLASTIN INHIBITION TISSUE","85730 - HC CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD","84255 - HC CHG ASSAY OF SELENIUM","21933 - EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>","85730 - HC CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD","21925 - HC BIOPSY SOFT TISSUE BACK,DEEP","84255 - HC CHG ASSAY OF SELENIUM","85730 - HC CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD","75710 - HC CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I","21933 - EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>"]
[null,"23505 - CLSD TX CLAVICULAR FRACTURE W/MANIPULATION","84443 - HC CHG ASSAY OF THYROID STIMULATING HORMONE TSH","22510 - PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC","22510 - PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC","22510 - PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC","84270 - HC CHG ASSAY OF SEX HORMONE BINDING GLOBULIN","21930 - EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM","85732 - HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA","85730 - HC CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD","85732 - HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA","84270 - HC CHG ASSAY OF SEX HORMONE BINDING GLOBULIN","22310 - CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING","85732 - HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA","21930 - EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM","84270 - HC CHG ASSAY OF SEX HORMONE BINDING GLOBULIN","85732 - HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA","75716 - HC CHG ANGIOGRAPHY EXTREMITY BILATERAL RS&I","22310 - CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING"]
[null,"23525 - HC CLOSED RX STERN-CLAV DISLOC,MANIP","84445 - HC CHG THYROID STIMULATING IMMUNE GLOBULINS TSI","22511 - PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL","22511 - PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL","22511 - PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL","84295 - HC CHG SODIUM SERUM PLASMA OR WHOLE BLOOD","21931 - EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/>","85810 - HC CHG VISCOSITY","85732 - HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA","85810 - HC CHG VISCOSITY","84295 - HC CHG SODIUM SERUM PLASMA OR WHOLE BLOOD","22510 - PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC","85810 - HC CHG VISCOSITY","21931 - EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/>","84295 - HC CHG SODIUM SERUM PLASMA OR WHOLE BLOOD","85810 - HC CHG VISCOSITY","75726 - HC CHG ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I","22510 - PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC"]
[null,"23540 - CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION","84446 - HC CHG ASSAY OF TOCOPHEROL ALPHA VITAMIN E","22512 - HC VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL","22512 - HC VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL","22512 - HC VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL","84300 - HC CHG ASSAY OF URINE SODIUM","21932 - HC EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM","86003 - HC CHG ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN","85810 - HC CHG VISCOSITY","86003 - HC CHG ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN","84300 - HC CHG ASSAY OF URINE SODIUM","22511 - PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL","86003 - HC CHG ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN","21932 - HC EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM","84300 - HC CHG ASSAY OF URINE SODIUM","86003 - HC CHG ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN","75731 - HC ANGIO ADRENAL UNILAT SELECT","22511 - PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL"]
[null,"23545 - CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION","84450 - HC CHG TRANSFERASE ASPARTATE AMINO AST SGOT","22513 - HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION","22513 - HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION","22513 - HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION","84302 - HC CHG ASSAY OF SODIUM OTHER SOURCE","21933 - EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>","86021 - HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES","86003 - HC CHG ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN","86021 - HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES","84302 - HC CHG ASSAY OF SODIUM OTHER SOURCE","22512 - HC VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL","86021 - HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES","21933 - EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>","84302 - HC CHG ASSAY OF SODIUM OTHER SOURCE","86021 - HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES","75733 - HC ANGIO ADRENAL BILAT SELECT","22512 - HC VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL"]
[null,"23570 - CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION","84460 - HC CHG TRANSFERASE ALANINE AMINO (ALT) (SGPT)","22514 - PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR","22514 - PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR","22514 - PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR","84305 - HC CHG ASSAY OF SOMATOMEDIN","22310 - CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING","86022 - HC CRL;SEROTONIN RLS ASSAY","86021 - HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES","86022 - HC CRL;SEROTONIN RLS ASSAY","84305 - HC CHG ASSAY OF SOMATOMEDIN","22513 - HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION","86022 - HC CRL;SEROTONIN RLS ASSAY","22310 - CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING","84305 - HC CHG ASSAY OF SOMATOMEDIN","86022 - HC CRL;SEROTONIN RLS ASSAY","75736 - HC CHG ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I","22513 - HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION"]
[null,"23575 - CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION","84466 - HC CHG ASSAY OF L7383TRANSFERRIN","22515 - PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH","22515 - PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH","22515 - PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH","84307 - HC CHG ASSAY OF SOMATOSTATIN","22510 - PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC","86038 - HC CHG ANTINUCLEAR ANTIBODIES ANA","86022 - HC CRL;SEROTONIN RLS ASSAY","86038 - HC CHG ANTINUCLEAR ANTIBODIES ANA","84307 - HC CHG ASSAY OF SOMATOSTATIN","22514 - PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR","86038 - HC CHG ANTINUCLEAR ANTIBODIES ANA","22510 - PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC","84307 - HC CHG ASSAY OF SOMATOSTATIN","86038 - HC CHG ANTINUCLEAR ANTIBODIES ANA","75741 - HC CHG ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I","22514 - PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR"]
[null,"23600 - CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION","84478 - HC CHG ASSAY OF TRIGLYCERIDES","22854 - HC INSJ BIOMCHN DEV VRT CORPECTOMY DEFECT W/ARTHRD","22854 - HC INSJ BIOMCHN DEV VRT CORPECTOMY DEFECT W/ARTHRD","22854 - HC INSJ BIOMCHN DEV VRT CORPECTOMY DEFECT W/ARTHRD","84311 - HC CHG SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED","22511 - PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL","86039 - HC CHG ANTINUCLEAR ANTIBODIES ANA TITER","86038 - HC CHG ANTINUCLEAR ANTIBODIES ANA","86039 - HC CHG ANTINUCLEAR ANTIBODIES ANA TITER","84311 - HC CHG SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED","22515 - PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH","86039 - HC CHG ANTINUCLEAR ANTIBODIES ANA TITER","22511 - PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL","84311 - HC CHG SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED","86039 - HC CHG ANTINUCLEAR ANTIBODIES ANA TITER","75743 - HC CHG ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I","22515 - PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH"]
[null,"23605 - CLTX PROX HUMRL FX W/MANJ W/WO SKELETAL TRACJ","84479 - HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO","22869 - HC INSJ STABLJ DEV W/O DCMPRN LUMBAR SINGLE LEVEL","22869 - HC INSJ STABLJ DEV W/O DCMPRN LUMBAR SINGLE LEVEL","22869 - HC INSJ STABLJ DEV W/O DCMPRN LUMBAR SINGLE LEVEL","84376 - HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC","22512 - HC VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL","86060 - HC CHG ANTISTREPTOLYSIN O TITER","86039 - HC CHG ANTINUCLEAR ANTIBODIES ANA TITER","86060 - HC CHG ANTISTREPTOLYSIN O TITER","84376 - HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC","22854 - HC INSJ BIOMCHN DEV VRT CORPECTOMY DEFECT W/ARTHRD","86060 - HC CHG ANTISTREPTOLYSIN O TITER","22512 - HC VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL","84376 - HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC","86060 - HC CHG ANTISTREPTOLYSIN O TITER","75746 - HC CHG ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I","22854 - HC INSJ BIOMCHN DEV VRT CORPECTOMY DEFECT W/ARTHRD"]
[null,"23620 - CLTX GREATER HUMERAL TUBEROSITY FX W/O MANJ","84480 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3","22870 - HC INSJ STABLJ DEV W/O DCMPRN LUMBAR SECOND LEVEL","22870 - HC INSJ STABLJ DEV W/O DCMPRN LUMBAR SECOND LEVEL","22870 - HC INSJ STABLJ DEV W/O DCMPRN LUMBAR SECOND LEVEL","84402 - HC CHG ASSAY OF TESTOSTERONE FREE","22513 - HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION","86140 - C-REACTIVE PROTEIN","86060 - HC CHG ANTISTREPTOLYSIN O TITER","86140 - C-REACTIVE PROTEIN","84402 - HC CHG ASSAY OF TESTOSTERONE FREE","22869 - HC INSJ STABLJ DEV W/O DCMPRN LUMBAR SINGLE LEVEL","86140 - C-REACTIVE PROTEIN","22513 - HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION","84402 - HC CHG ASSAY OF TESTOSTERONE FREE","86140 - C-REACTIVE PROTEIN","75774 - HC CHG ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I","22869 - HC INSJ STABLJ DEV W/O DCMPRN LUMBAR SINGLE LEVEL"]
[null,"23625 - CLTX GRTER HUMERAL TUBEROSITY FX W/MANIPULATION","84481 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 FREE","22901 - HC EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL 5+CM","22901 - HC EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL 5+CM","22901 - HC EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL 5+CM","84403 - HC CHG ASSAY OF TESTOSTERONE TOTAL","22514 - PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR","86141 - HC CRL;CARDIO CRP","86140 - C-REACTIVE PROTEIN","86141 - HC CRL;CARDIO CRP","84403 - HC CHG ASSAY OF TESTOSTERONE TOTAL","22870 - HC INSJ STABLJ DEV W/O DCMPRN LUMBAR SECOND LEVEL","86141 - HC CRL;CARDIO CRP","22514 - PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR","84403 - HC CHG ASSAY OF TESTOSTERONE TOTAL","86141 - HC CRL;CARDIO CRP","75803 - HC LYPMH VESSEL XRAY ARM/LEG","22870 - HC INSJ STABLJ DEV W/O DCMPRN LUMBAR SECOND LEVEL"]
[null,"23650 - CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES","84482 - HC CHG TRIIODOTHYRONINE T3 REVERSE","22902 - HC EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM","22902 - HC EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM","22902 - HC EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM","84425 - HC CHG ASSAY OF THIAMINE-VITAMIN B-1","22515 - PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH","86146 - HC CRL;BETA-2 GLYCPRTN 1 AB","86141 - HC CRL;CARDIO CRP","86146 - HC CRL;BETA-2 GLYCPRTN 1 AB","84425 - HC CHG ASSAY OF THIAMINE-VITAMIN B-1","22901 - HC EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL 5+CM","86146 - HC CRL;BETA-2 GLYCPRTN 1 AB","22515 - PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH","84425 - HC CHG ASSAY OF THIAMINE-VITAMIN B-1","86146 - HC CRL;BETA-2 GLYCPRTN 1 AB","75805 - HC LYMPH VES X-RAY TRUNK UNI","22901 - HC EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL 5+CM"]
[null,"23655 - HC CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES","84484 - HC CHG ASSAY OF TROPONIN QUANTITATIVE","22903 - HC EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3+CM","22903 - HC EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3+CM","22903 - HC EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3+CM","84430 - HC CHG ASSAY OF THIOCYANATE","22854 - HC INSJ BIOMCHN DEV VRT CORPECTOMY DEFECT W/ARTHRD","86147 - HC Q;CARDLIP AB;IGG,IGM,IGA","86146 - HC CRL;BETA-2 GLYCPRTN 1 AB","86147 - HC Q;CARDLIP AB;IGG,IGM,IGA","84430 - HC CHG ASSAY OF THIOCYANATE","22902 - HC EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM","86147 - HC Q;CARDLIP AB;IGG,IGM,IGA","22854 - HC INSJ BIOMCHN DEV VRT CORPECTOMY DEFECT W/ARTHRD","84430 - HC CHG ASSAY OF THIOCYANATE","86147 - HC Q;CARDLIP AB;IGG,IGM,IGA","75807 - HC LYMPH VESSEL X-RAY TRUNK","22902 - HC EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM"]
[null,"23665 - CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ","84520 - HC CHG ASSAY OF UREA NITROGEN QUANTITATIVE","23031 - HC DRAIN INFECT SHOULDER BURSA","23031 - HC DRAIN INFECT SHOULDER BURSA","23031 - HC DRAIN INFECT SHOULDER BURSA","84432 - HC CHG ASSAY OF THYROGLOBULIN","22869 - HC INSJ STABLJ DEV W/O DCMPRN LUMBAR SINGLE LEVEL","86157 - HC CHG COLD AGGLUTININ TITER","86147 - HC Q;CARDLIP AB;IGG,IGM,IGA","86157 - HC CHG COLD AGGLUTININ TITER","84432 - HC CHG ASSAY OF THYROGLOBULIN","22903 - HC EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3+CM","86157 - HC CHG COLD AGGLUTININ TITER","22869 - HC INSJ STABLJ DEV W/O DCMPRN LUMBAR SINGLE LEVEL","84432 - HC CHG ASSAY OF THYROGLOBULIN","86157 - HC CHG COLD AGGLUTININ TITER","75809 - HC INJ&IMAGE PERITONL SHUNT","22903 - HC EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3+CM"]
[null,"24065 - HC BX ARM/ELBOW SOFT TISSUE,SUPERFICIAL","84540 - HC CHG ASSAY OF UREA NITROGEN URINE","23065 - HC BIOPSY SOFT TISSUE SHOULDER SUPERFICIAL","23065 - HC BIOPSY SOFT TISSUE SHOULDER SUPERFICIAL","23065 - HC BIOPSY SOFT TISSUE SHOULDER SUPERFICIAL","84436 - HC CHG ASSAY OF THYROXINE TOTAL","22870 - HC INSJ STABLJ DEV W/O DCMPRN LUMBAR SECOND LEVEL","86160 - HC CHG COMPLEMENT ANTIGEN EACH COMPONENT","86157 - HC CHG COLD AGGLUTININ TITER","86160 - HC CHG COMPLEMENT ANTIGEN EACH COMPONENT","84436 - HC CHG ASSAY OF THYROXINE TOTAL","23031 - HC DRAIN INFECT SHOULDER BURSA","86160 - HC CHG COMPLEMENT ANTIGEN EACH COMPONENT","22870 - HC INSJ STABLJ DEV W/O DCMPRN LUMBAR SECOND LEVEL","84436 - HC CHG ASSAY OF THYROXINE TOTAL","86160 - HC CHG COMPLEMENT ANTIGEN EACH COMPONENT","75810 - HC CHG SPLENOPORTOGRAPY RS&I","23031 - HC DRAIN INFECT SHOULDER BURSA"]
[null,"24066 - HC BX ARM/ELBOW SOFT TISSUE,DEEP","84550 - HC CHG ASSAY OF BLOOD/URIC ACID","23066 - HC BIOPSY SOFT TISSUE SHOULDER DEEP","23066 - HC BIOPSY SOFT TISSUE SHOULDER DEEP","23066 - HC BIOPSY SOFT TISSUE SHOULDER DEEP","84439 - HC CHG ASSAY OF FREE THYROXINE","22901 - HC EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL 5+CM","86161 - HC CHG COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT","86160 - HC CHG COMPLEMENT ANTIGEN EACH COMPONENT","86161 - HC CHG COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT","84439 - HC CHG ASSAY OF FREE THYROXINE","23065 - HC BIOPSY SOFT TISSUE SHOULDER SUPERFICIAL","86161 - HC CHG COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT","22901 - HC EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL 5+CM","84439 - HC CHG ASSAY OF FREE THYROXINE","86161 - HC CHG COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT","75820 - HC CHG VENOGRAPHY EXTREMITY UNILATERAL RS&I","23065 - HC BIOPSY SOFT TISSUE SHOULDER SUPERFICIAL"]
[null,"24071 - EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/>","84560 - HC CHG ASSAY OF URIC ACID OTHER SOURCE","23071 - EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/>","23071 - EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/>","23071 - EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/>","84442 - HC CHG ASSAY OF THYROXINE BNDNG GLOBULIN","22902 - HC EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM","86162 - HC CHG COMPLEMENT TOTAL HEMOLYTIC","86161 - HC CHG COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT","86162 - HC CHG COMPLEMENT TOTAL HEMOLYTIC","84442 - HC CHG ASSAY OF THYROXINE BNDNG GLOBULIN","23066 - HC BIOPSY SOFT TISSUE SHOULDER DEEP","86162 - HC CHG COMPLEMENT TOTAL HEMOLYTIC","22902 - HC EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM","84442 - HC CHG ASSAY OF THYROXINE BNDNG GLOBULIN","86162 - HC CHG COMPLEMENT TOTAL HEMOLYTIC","75822 - HC CHG VENOGRAPHY EXTREMITY BILATERAL RS&I","23066 - HC BIOPSY SOFT TISSUE SHOULDER DEEP"]
[null,"24075 - EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM","84590 - HC CHG ASSAY OF VITAMIN A","23073 - HC EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/>","23073 - HC EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/>","23073 - HC EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/>","84443 - HC CHG ASSAY OF THYROID STIMULATING HORMONE TSH","22903 - HC EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3+CM","86200 - HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY","86162 - HC CHG COMPLEMENT TOTAL HEMOLYTIC","86200 - HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY","84443 - HC CHG ASSAY OF THYROID STIMULATING HORMONE TSH","23071 - EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/>","86200 - HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY","22903 - HC EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3+CM","84443 - HC CHG ASSAY OF THYROID STIMULATING HORMONE TSH","86200 - HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY","75825 - HC CHG VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I","23071 - EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/>"]
[null,"24076 - HC EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM","84591 - HC CHG ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED","23075 - EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM","23075 - EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM","23075 - EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM","84445 - HC CHG THYROID STIMULATING IMMUNE GLOBULINS TSI","23031 - HC DRAIN INFECT SHOULDER BURSA","86235 - HC CHG EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD","86200 - HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY","86235 - HC CHG EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD","84445 - HC CHG THYROID STIMULATING IMMUNE GLOBULINS TSI","23073 - HC EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/>","86235 - HC CHG EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD","23031 - HC DRAIN INFECT SHOULDER BURSA","84445 - HC CHG THYROID STIMULATING IMMUNE GLOBULINS TSI","86235 - HC CHG EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD","75827 - HC CHG VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I","23073 - HC EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/>"]
[null,"24201 - HC REMOVAL ARM/ELBOW F.B.,DEEP","84597 - HC CHG ASSAY OF VITAMIN K","23076 - HC EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM","23076 - HC EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM","23076 - HC EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM","84446 - HC CHG ASSAY OF TOCOPHEROL ALPHA VITAMIN E","23065 - HC BIOPSY SOFT TISSUE SHOULDER SUPERFICIAL","86255 - HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY","86235 - HC CHG EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD","86255 - HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY","84446 - HC CHG ASSAY OF TOCOPHEROL ALPHA VITAMIN E","23075 - EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM","86255 - HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY","23065 - HC BIOPSY SOFT TISSUE SHOULDER SUPERFICIAL","84446 - HC CHG ASSAY OF TOCOPHEROL ALPHA VITAMIN E","86255 - HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY","75831 - HC CHG VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I","23075 - EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM"]
[null,"24220 - HC INJECTION ELBOW ARTHROGRAPHY","84630 - HC CHG ASSAY OF ZINC","23330 - REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS","23330 - REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS","23330 - REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS","84450 - HC CHG TRANSFERASE ASPARTATE AMINO AST SGOT","23066 - HC BIOPSY SOFT TISSUE SHOULDER DEEP","86256 - HC CHG FLUORESCENT ANTIBODY; TITER","86255 - HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY","86256 - HC CHG FLUORESCENT ANTIBODY; TITER","84450 - HC CHG TRANSFERASE ASPARTATE AMINO AST SGOT","23076 - HC EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM","86256 - HC CHG FLUORESCENT ANTIBODY; TITER","23066 - HC BIOPSY SOFT TISSUE SHOULDER DEEP","84450 - HC CHG TRANSFERASE ASPARTATE AMINO AST SGOT","86256 - HC CHG FLUORESCENT ANTIBODY; TITER","75833 - HC CHG VENOGRAM RENAL BILAT","23076 - HC EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM"]
[null,"24357 - HC REPAIR ELBOW PERC","84681 - HC CHG ASSAY OF C-PEPTIDE","23350 - HC INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI ARTHG","23350 - HC INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI ARTHG","23350 - HC INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI ARTHG","84460 - HC CHG TRANSFERASE ALANINE AMINO (ALT) (SGPT)","23071 - EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/>","86300 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3","86256 - HC CHG FLUORESCENT ANTIBODY; TITER","86300 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3","84460 - HC CHG TRANSFERASE ALANINE AMINO (ALT) (SGPT)","23330 - REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS","86300 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3","23071 - EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/>","84460 - HC CHG TRANSFERASE ALANINE AMINO (ALT) (SGPT)","86300 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3","75842 - HC CHG VENOGRAM ADRENAL BILAT","23330 - REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS"]
[null,"24500 - CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION","84702 - HC HCG TUMOR MARKER","23450 - HC REPAIR SHOULDER CAPSULE,ANTERIOR","23450 - HC REPAIR SHOULDER CAPSULE,ANTERIOR","23450 - HC REPAIR SHOULDER CAPSULE,ANTERIOR","84466 - HC CHG ASSAY OF L7383TRANSFERRIN","23073 - HC EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/>","86301 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9","86300 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3","86301 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9","84466 - HC CHG ASSAY OF L7383TRANSFERRIN","23350 - HC INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI ARTHG","86301 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9","23073 - HC EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/>","84466 - HC CHG ASSAY OF L7383TRANSFERRIN","86301 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9","75860 - HC CHG VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I","23350 - HC INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI ARTHG"]
[null,"24505 - CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ","84703 - HC GONAD,CHOR(HCG);QL","23500 - CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION","23500 - CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION","23500 - CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION","84478 - HC CHG ASSAY OF TRIGLYCERIDES","23075 - EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM","86304 - HC CRL;CA-125","86301 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9","86304 - HC CRL;CA-125","84478 - HC CHG ASSAY OF TRIGLYCERIDES","23450 - HC REPAIR SHOULDER CAPSULE,ANTERIOR","86304 - HC CRL;CA-125","23075 - EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM","84478 - HC CHG ASSAY OF TRIGLYCERIDES","86304 - HC CRL;CA-125","75870 - VENOGRAM SUPER SAG SINUS","23450 - HC REPAIR SHOULDER CAPSULE,ANTERIOR"]
[null,"24530 - CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ","85004 - HC AUTO DIFF","23505 - CLSD TX CLAVICULAR FRACTURE W/MANIPULATION","23505 - CLSD TX CLAVICULAR FRACTURE W/MANIPULATION","23505 - CLSD TX CLAVICULAR FRACTURE W/MANIPULATION","84479 - HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO","23076 - HC EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM","86308 - HC CHG HETEROPHILE ANTIBODIES SCREEN","86304 - HC CRL;CA-125","86308 - HC CHG HETEROPHILE ANTIBODIES SCREEN","84479 - HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO","23500 - CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION","86308 - HC CHG HETEROPHILE ANTIBODIES SCREEN","23076 - HC EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM","84479 - HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO","86308 - HC CHG HETEROPHILE ANTIBODIES SCREEN","75885 - HC CHG PERCUT XHEPATIC PORTO+DYNAMIC","23500 - CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION"]
[null,"24535 - CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ","85014 - HC CHG BLOOD COUNT HEMATOCRIT","23525 - HC CLOSED RX STERN-CLAV DISLOC,MANIP","23525 - HC CLOSED RX STERN-CLAV DISLOC,MANIP","23525 - HC CLOSED RX STERN-CLAV DISLOC,MANIP","84480 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3","23330 - REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS","86316 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE","86308 - HC CHG HETEROPHILE ANTIBODIES SCREEN","86316 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE","84480 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3","23505 - CLSD TX CLAVICULAR FRACTURE W/MANIPULATION","86316 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE","23330 - REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS","84480 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3","86316 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE","75887 - HC CHG PERCUT XHEPATIC PORTOGRAM","23505 - CLSD TX CLAVICULAR FRACTURE W/MANIPULATION"]
[null,"24560 - CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ","85018 - POC;HEMOGLOBIN","23540 - CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION","23540 - CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION","23540 - CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION","84481 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 FREE","23350 - HC INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI ARTHG","86317 - HC IMMUNOASSAY,INFECT AGENT,QUANT","86316 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE","86317 - HC IMMUNOASSAY,INFECT AGENT,QUANT","84481 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 FREE","23525 - HC CLOSED RX STERN-CLAV DISLOC,MANIP","86317 - HC IMMUNOASSAY,INFECT AGENT,QUANT","23350 - HC INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI ARTHG","84481 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 FREE","86317 - HC IMMUNOASSAY,INFECT AGENT,QUANT","75889 - HC HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I","23525 - HC CLOSED RX STERN-CLAV DISLOC,MANIP"]
[null,"24565 - CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/MANJ","85025 - HC CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC","23545 - CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION","23545 - CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION","23545 - CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION","84482 - HC CHG TRIIODOTHYRONINE T3 REVERSE","23450 - HC REPAIR SHOULDER CAPSULE,ANTERIOR","86328 - IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY; CORONAVIRUS 2","86317 - HC IMMUNOASSAY,INFECT AGENT,QUANT","86328 - IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY; CORONAVIRUS 2","84482 - HC CHG TRIIODOTHYRONINE T3 REVERSE","23540 - CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION","86328 - IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY; CORONAVIRUS 2","23450 - HC REPAIR SHOULDER CAPSULE,ANTERIOR","84482 - HC CHG TRIIODOTHYRONINE T3 REVERSE","86328 - IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY; CORONAVIRUS 2","75891 - HC CHG HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I","23540 - CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION"]
[null,"24576 - CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ","85027 - HC CHG BLOOD COUNT COMPLETE AUTOMATED","23570 - CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION","23570 - CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION","23570 - CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION","84484 - HC CHG ASSAY OF TROPONIN QUANTITATIVE","23500 - CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION","86331 - HC CHG IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY","86328 - IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY; CORONAVIRUS 2","86331 - HC CHG IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY","84484 - HC CHG ASSAY OF TROPONIN QUANTITATIVE","23545 - CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION","86331 - HC CHG IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY","23500 - CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION","84484 - HC CHG ASSAY OF TROPONIN QUANTITATIVE","86331 - HC CHG IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY","75893 - HC CHG VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS&","23545 - CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION"]
[null,"24577 - CLTX HUMERAL CONDYLAR FX MEDIAL/LATERAL W/MANJ","85045 - HC CHG BLOOD COUNT RETICULOCYTE AUTOMATED","23575 - CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION","23575 - CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION","23575 - CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION","84520 - HC CHG ASSAY OF UREA NITROGEN QUANTITATIVE","23505 - CLSD TX CLAVICULAR FRACTURE W/MANIPULATION","86334 - HC CHG IMMUNOFIXJ ELECTROPHORESIS SERUM","86331 - HC CHG IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY","86334 - HC CHG IMMUNOFIXJ ELECTROPHORESIS SERUM","84520 - HC CHG ASSAY OF UREA NITROGEN QUANTITATIVE","23570 - CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION","86334 - HC CHG IMMUNOFIXJ ELECTROPHORESIS SERUM","23505 - CLSD TX CLAVICULAR FRACTURE W/MANIPULATION","84520 - HC CHG ASSAY OF UREA NITROGEN QUANTITATIVE","86334 - HC CHG IMMUNOFIXJ ELECTROPHORESIS SERUM","75894 - HC CHG TRANSCATHETER EMBOLIZATION ANY METH RS&I","23570 - CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION"]
[null,"24600 - TREATMENT CLOSED ELBOW DISLOCATION W/O ANES","85046 - HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS","23600 - CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION","23600 - CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION","23600 - CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION","84540 - HC CHG ASSAY OF UREA NITROGEN URINE","23525 - HC CLOSED RX STERN-CLAV DISLOC,MANIP","86335 - HC CHG IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS","86334 - HC CHG IMMUNOFIXJ ELECTROPHORESIS SERUM","86335 - HC CHG IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS","84540 - HC CHG ASSAY OF UREA NITROGEN URINE","23575 - CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION","86335 - HC CHG IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS","23525 - HC CLOSED RX STERN-CLAV DISLOC,MANIP","84540 - HC CHG ASSAY OF UREA NITROGEN URINE","86335 - HC CHG IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS","75898 - HC CHG ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS","23575 - CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION"]
[null,"24605 - HC TX ELBOW DISLOC W/ANESTH","85048 - HC CHG BLOOD COUNT LEUKOCYTE WBC AUTOMATED","23605 - CLTX PROX HUMRL FX W/MANJ W/WO SKELETAL TRACJ","23605 - CLTX PROX HUMRL FX W/MANJ W/WO SKELETAL TRACJ","23605 - CLTX PROX HUMRL FX W/MANJ W/WO SKELETAL TRACJ","84550 - HC CHG ASSAY OF BLOOD/URIC ACID","23540 - CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION","86336 - HC CHG INHIBIN A","86335 - HC CHG IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS","86336 - HC CHG INHIBIN A","84550 - HC CHG ASSAY OF BLOOD/URIC ACID","23600 - CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION","86336 - HC CHG INHIBIN A","23540 - CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION","84550 - HC CHG ASSAY OF BLOOD/URIC ACID","86336 - HC CHG INHIBIN A","75902 - HC CHG MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I","23600 - CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION"]
[null,"24620 - HC CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ","85049 - HC CHG BLOOD COUNT PLATELET AUTOMATED","23620 - CLTX GREATER HUMERAL TUBEROSITY FX W/O MANJ","23620 - CLTX GREATER HUMERAL TUBEROSITY FX W/O MANJ","23620 - CLTX GREATER HUMERAL TUBEROSITY FX W/O MANJ","84560 - HC CHG ASSAY OF URIC ACID OTHER SOURCE","23545 - CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION","86340 - HC CHG INTRINSIC FACTOR ANTIBODIES","86336 - HC CHG INHIBIN A","86340 - HC CHG INTRINSIC FACTOR ANTIBODIES","84560 - HC CHG ASSAY OF URIC ACID OTHER SOURCE","23605 - CLTX PROX HUMRL FX W/MANJ W/WO SKELETAL TRACJ","86340 - HC CHG INTRINSIC FACTOR ANTIBODIES","23545 - CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION","84560 - HC CHG ASSAY OF URIC ACID OTHER SOURCE","86340 - HC CHG INTRINSIC FACTOR ANTIBODIES","75970 - HC CHG TRANSCATHETER BIOPSY RS&I","23605 - CLTX PROX HUMRL FX W/MANJ W/WO SKELETAL TRACJ"]
[null,"24650 - CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION","85055 - HC CHG RETICULATED PLATELET ASSAY","23625 - CLTX GRTER HUMERAL TUBEROSITY FX W/MANIPULATION","23625 - CLTX GRTER HUMERAL TUBEROSITY FX W/MANIPULATION","23625 - CLTX GRTER HUMERAL TUBEROSITY FX W/MANIPULATION","84590 - HC CHG ASSAY OF VITAMIN A","23570 - CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION","86341 - HC CHG ISLET CELL ANTIBODY","86340 - HC CHG INTRINSIC FACTOR ANTIBODIES","86341 - HC CHG ISLET CELL ANTIBODY","84590 - HC CHG ASSAY OF VITAMIN A","23620 - CLTX GREATER HUMERAL TUBEROSITY FX W/O MANJ","86341 - HC CHG ISLET CELL ANTIBODY","23570 - CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION","84590 - HC CHG ASSAY OF VITAMIN A","86341 - HC CHG ISLET CELL ANTIBODY","75984 - CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I","23620 - CLTX GREATER HUMERAL TUBEROSITY FX W/O MANJ"]
[null,"24655 - CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION","85060 - HC BL SMEAR W/O DIFF WBC COUNT","23650 - CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES","23650 - CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES","23650 - CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES","84591 - HC CHG ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED","23575 - CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION","86353 - HC CHG LYMPHOCYTE TRANSFORMATION","86341 - HC CHG ISLET CELL ANTIBODY","86353 - HC CHG LYMPHOCYTE TRANSFORMATION","84591 - HC CHG ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED","23625 - CLTX GRTER HUMERAL TUBEROSITY FX W/MANIPULATION","86353 - HC CHG LYMPHOCYTE TRANSFORMATION","23575 - CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION","84591 - HC CHG ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED","86353 - HC CHG LYMPHOCYTE TRANSFORMATION","76000 - FLUOROSCOPY SPX UP TO 1 HOUR PHYS/QHP TIME","23625 - CLTX GRTER HUMERAL TUBEROSITY FX W/MANIPULATION"]
[null,"24670 - CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ","85210 - HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC","23655 - HC CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES","23655 - HC CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES","23655 - HC CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES","84597 - HC CHG ASSAY OF VITAMIN K","23600 - CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION","86355 - HC B CELLS TOTAL COUNT","86353 - HC CHG LYMPHOCYTE TRANSFORMATION","86355 - HC B CELLS TOTAL COUNT","84597 - HC CHG ASSAY OF VITAMIN K","23650 - CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES","86355 - HC B CELLS TOTAL COUNT","23600 - CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION","84597 - HC CHG ASSAY OF VITAMIN K","86355 - HC B CELLS TOTAL COUNT","76010 - HC CHG RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD","23650 - CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES"]
[null,"24675 - CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ","85220 - HC CHG CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR","23665 - CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ","23665 - CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ","23665 - CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ","84630 - HC CHG ASSAY OF ZINC","23605 - CLTX PROX HUMRL FX W/MANJ W/WO SKELETAL TRACJ","86357 - HC NK CELLS, TOTAL COUNT","86355 - HC B CELLS TOTAL COUNT","86357 - HC NK CELLS, TOTAL COUNT","84630 - HC CHG ASSAY OF ZINC","23655 - HC CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES","86357 - HC NK CELLS, TOTAL COUNT","23605 - CLTX PROX HUMRL FX W/MANJ W/WO SKELETAL TRACJ","84630 - HC CHG ASSAY OF ZINC","86357 - HC NK CELLS, TOTAL COUNT","76080 - HC CHG RADEX ABSCESS/FISTULA/SINUS TRACT RS&I","23655 - HC CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES"]
[null,"25000 - HC INCISION EXTENSOR TENDON SHEATH WRIST","85230 - HC CHG CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR","24065 - HC BX ARM/ELBOW SOFT TISSUE,SUPERFICIAL","24065 - HC BX ARM/ELBOW SOFT TISSUE,SUPERFICIAL","24065 - HC BX ARM/ELBOW SOFT TISSUE,SUPERFICIAL","84681 - HC CHG ASSAY OF C-PEPTIDE","23620 - CLTX GREATER HUMERAL TUBEROSITY FX W/O MANJ","86359 - HC CHG T CELLS TOTAL COUNT","86357 - HC NK CELLS, TOTAL COUNT","86359 - HC CHG T CELLS TOTAL COUNT","84681 - HC CHG ASSAY OF C-PEPTIDE","23665 - CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ","86359 - HC CHG T CELLS TOTAL COUNT","23620 - CLTX GREATER HUMERAL TUBEROSITY FX W/O MANJ","84681 - HC CHG ASSAY OF C-PEPTIDE","86359 - HC CHG T CELLS TOTAL COUNT","76098 - HC CHG RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN","23665 - CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ"]
[null,"25031 - HC DRAINAGE OF FOREARM BURSA","85240 - HC CHG CLOTTING FACTOR VIII AHG 1 STAGE","24066 - HC BX ARM/ELBOW SOFT TISSUE,DEEP","24066 - HC BX ARM/ELBOW SOFT TISSUE,DEEP","24066 - HC BX ARM/ELBOW SOFT TISSUE,DEEP","84702 - HC HCG TUMOR MARKER","23625 - CLTX GRTER HUMERAL TUBEROSITY FX W/MANIPULATION","86360 - HC CHG T CELLS ABSOLUTE CD4&CD8 COUNT RATIO","86359 - HC CHG T CELLS TOTAL COUNT","86360 - HC CHG T CELLS ABSOLUTE CD4&CD8 COUNT RATIO","84702 - HC HCG TUMOR MARKER","24065 - HC BX ARM/ELBOW SOFT TISSUE,SUPERFICIAL","86360 - HC CHG T CELLS ABSOLUTE CD4&CD8 COUNT RATIO","23625 - CLTX GRTER HUMERAL TUBEROSITY FX W/MANIPULATION","84702 - HC HCG TUMOR MARKER","86360 - HC CHG T CELLS ABSOLUTE CD4&CD8 COUNT RATIO","76380 - HC CHG CT LIMITED/LOCALIZED FOLLOW UP STUDY","24065 - HC BX ARM/ELBOW SOFT TISSUE,SUPERFICIAL"]
[null,"25065 - HC BIOPSY FOREARM SOFT TISSUES,SUPERFIC","85245 - HC CHG CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT","24071 - EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/>","24071 - EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/>","24071 - EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/>","84703 - HC GONAD,CHOR(HCG);QL","23650 - CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES","86376 - HC CHG MICROSOMAL ANTIBODIES EACH","86360 - HC CHG T CELLS ABSOLUTE CD4&CD8 COUNT RATIO","86376 - HC CHG MICROSOMAL ANTIBODIES EACH","84703 - HC GONAD,CHOR(HCG);QL","24066 - HC BX ARM/ELBOW SOFT TISSUE,DEEP","86376 - HC CHG MICROSOMAL ANTIBODIES EACH","23650 - CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES","84703 - HC GONAD,CHOR(HCG);QL","86376 - HC CHG MICROSOMAL ANTIBODIES EACH","76497 - HC CTGUIDE,SOFT TISS ABL","24066 - HC BX ARM/ELBOW SOFT TISSUE,DEEP"]
[null,"25066 - HC BIOPSY FOREARM SOFT TISSUES,DEEP","85246 - HC CHG CLOTTING FACTOR VIII VW FACTOR ANTIGEN","24075 - EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM","24075 - EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM","24075 - EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM","85004 - HC AUTO DIFF","23655 - HC CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES","86382 - HC CHG NEUTRALIZATION TEST VIRAL","86376 - HC CHG MICROSOMAL ANTIBODIES EACH","86382 - HC CHG NEUTRALIZATION TEST VIRAL","85004 - HC AUTO DIFF","24071 - EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/>","86382 - HC CHG NEUTRALIZATION TEST VIRAL","23655 - HC CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES","85004 - HC AUTO DIFF","86382 - HC CHG NEUTRALIZATION TEST VIRAL","76498 - PR MRI PROSTATE FOR RADIATION TREATMENT PLANNING","24071 - EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/>"]
[null,"25071 - EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/>","85250 - HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS","24076 - HC EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM","24076 - HC EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM","24076 - HC EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM","85014 - HC CHG BLOOD COUNT HEMATOCRIT","23665 - CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ","86403 - HC CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY","86382 - HC CHG NEUTRALIZATION TEST VIRAL","86403 - HC CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY","85014 - HC CHG BLOOD COUNT HEMATOCRIT","24075 - EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM","86403 - HC CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY","23665 - CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ","85014 - HC CHG BLOOD COUNT HEMATOCRIT","86403 - HC CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY","76506 - HC CHG ECHOENCEPHALOGRAPHY REAL TIME IMAGING","24075 - EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM"]
[null,"25073 - HC  EXC TUMOR SFT TISS FOREARM&//WRIST SUBFASC 3+CM","85260 - HC CHG CLOTTING FACTOR X STUART-PROWER","24200 - RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS","24200 - RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS","24200 - RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS","85018 - POC;HEMOGLOBIN","24065 - HC BX ARM/ELBOW SOFT TISSUE,SUPERFICIAL","86431 - HC CHG RHEUMATOID FACTOR QUANTITATIVE","86403 - HC CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY","86431 - HC CHG RHEUMATOID FACTOR QUANTITATIVE","85018 - POC;HEMOGLOBIN","24076 - HC EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM","86431 - HC CHG RHEUMATOID FACTOR QUANTITATIVE","24065 - HC BX ARM/ELBOW SOFT TISSUE,SUPERFICIAL","85018 - POC;HEMOGLOBIN","86431 - HC CHG RHEUMATOID FACTOR QUANTITATIVE","76510 - OPH US DX B-SCAN&QUAN A-SCAN SM PT ENCTR","24076 - HC EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM"]
[null,"25075 - EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM","85270 - HC CHG CLOTTING FACTOR XI PTA","24201 - HC REMOVAL ARM/ELBOW F.B.,DEEP","24201 - HC REMOVAL ARM/ELBOW F.B.,DEEP","24201 - HC REMOVAL ARM/ELBOW F.B.,DEEP","85025 - HC CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC","24066 - HC BX ARM/ELBOW SOFT TISSUE,DEEP","86480 - HC CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON","86431 - HC CHG RHEUMATOID FACTOR QUANTITATIVE","86480 - HC CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON","85025 - HC CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC","24200 - RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS","86480 - HC CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON","24066 - HC BX ARM/ELBOW SOFT TISSUE,DEEP","85025 - HC CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC","86480 - HC CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON","76512 - OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN","24200 - RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS"]
[null,"25076 - EXC FOREARM TUM DEEP < 3 CM","85280 - HC CHG CLOTTING FACTOR XII HAGEMAN","24220 - HC INJECTION ELBOW ARTHROGRAPHY","24220 - HC INJECTION ELBOW ARTHROGRAPHY","24220 - HC INJECTION ELBOW ARTHROGRAPHY","85027 - HC CHG BLOOD COUNT COMPLETE AUTOMATED","24071 - EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/>","86481 - HC TB TEST CELL MEDIATED ANTIGEN RESPONSE, ENUM GAMMA INTERFRON T-CELL","86480 - HC CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON","86481 - HC TB TEST CELL MEDIATED ANTIGEN RESPONSE, ENUM GAMMA INTERFRON T-CELL","85027 - HC CHG BLOOD COUNT COMPLETE AUTOMATED","24201 - HC REMOVAL ARM/ELBOW F.B.,DEEP","86481 - HC TB TEST CELL MEDIATED ANTIGEN RESPONSE, ENUM GAMMA INTERFRON T-CELL","24071 - EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/>","85027 - HC CHG BLOOD COUNT COMPLETE AUTOMATED","86481 - HC TB TEST CELL MEDIATED ANTIGEN RESPONSE, ENUM GAMMA INTERFRON T-CELL","76513 - OPH US DX ANT SGM US IMMERSION B-SCAN/HR BIOM","24201 - HC REMOVAL ARM/ELBOW F.B.,DEEP"]
[null,"25111 - EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY","85290 - HC CHG CLOTTING FACTOR XIII FIBRIN STABILIZING","24357 - HC REPAIR ELBOW PERC","24357 - HC REPAIR ELBOW PERC","24357 - HC REPAIR ELBOW PERC","85045 - HC CHG BLOOD COUNT RETICULOCYTE AUTOMATED","24075 - EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM","86592 - HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL","86481 - HC TB TEST CELL MEDIATED ANTIGEN RESPONSE, ENUM GAMMA INTERFRON T-CELL","86592 - HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL","85045 - HC CHG BLOOD COUNT RETICULOCYTE AUTOMATED","24220 - HC INJECTION ELBOW ARTHROGRAPHY","86592 - HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL","24075 - EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM","85045 - HC CHG BLOOD COUNT RETICULOCYTE AUTOMATED","86592 - HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL","76514 - OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI","24220 - HC INJECTION ELBOW ARTHROGRAPHY"]
[null,"25112 - EXCISION GANGLION WRIST DORSAL/VOLAR RECURRENT","85300 - HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY","24500 - CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION","24500 - CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION","24500 - CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION","85046 - HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS","24076 - HC EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM","86593 - HC SYPHILIS;QN","86592 - HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL","86593 - HC SYPHILIS;QN","85046 - HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS","24357 - HC REPAIR ELBOW PERC","86593 - HC SYPHILIS;QN","24076 - HC EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM","85046 - HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS","86593 - HC SYPHILIS;QN","76516 - OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN","24357 - HC REPAIR ELBOW PERC"]
[null,"25116 - RAD EXCIS WRIST SYNOV/TENDON,EXTEN","85301 - HC CHG CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY","24505 - CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ","24505 - CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ","24505 - CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ","85048 - HC CHG BLOOD COUNT LEUKOCYTE WBC AUTOMATED","24200 - RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS","86606 - HC CHG ANTIBODY ASPERGILLUS","86593 - HC SYPHILIS;QN","86606 - HC CHG ANTIBODY ASPERGILLUS","85048 - HC CHG BLOOD COUNT LEUKOCYTE WBC AUTOMATED","24500 - CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION","86606 - HC CHG ANTIBODY ASPERGILLUS","24200 - RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS","85048 - HC CHG BLOOD COUNT LEUKOCYTE WBC AUTOMATED","86606 - HC CHG ANTIBODY ASPERGILLUS","76519 - OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL","24500 - CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION"]
[null,"25246 - HC INJECTION WRIST ARTHROGRAPHY","85302 - HC CHG CLOTTING INHIBITORS PROTEIN C ANTIGEN","24530 - CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ","24530 - CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ","24530 - CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ","85049 - HC CHG BLOOD COUNT PLATELET AUTOMATED","24201 - HC REMOVAL ARM/ELBOW F.B.,DEEP","86609 - HC CHG ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED","86606 - HC CHG ANTIBODY ASPERGILLUS","86609 - HC CHG ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED","85049 - HC CHG BLOOD COUNT PLATELET AUTOMATED","24505 - CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ","86609 - HC CHG ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED","24201 - HC REMOVAL ARM/ELBOW F.B.,DEEP","85049 - HC CHG BLOOD COUNT PLATELET AUTOMATED","86609 - HC CHG ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED","76529 - OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION","24505 - CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ"]
[null,"25248 - HC REMOVE FOREARM/WRIST FOREIGN BODY","85303 - HC CHG CLOTTING INHIBITORS PROTEIN C ACTIVITY","24535 - CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ","24535 - CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ","24535 - CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ","85055 - HC CHG RETICULATED PLATELET ASSAY","24220 - HC INJECTION ELBOW ARTHROGRAPHY","86611 - HC BARTONELLA, ANTIBODY","86609 - HC CHG ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED","86611 - HC BARTONELLA, ANTIBODY","85055 - HC CHG RETICULATED PLATELET ASSAY","24530 - CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ","86611 - HC BARTONELLA, ANTIBODY","24220 - HC INJECTION ELBOW ARTHROGRAPHY","85055 - HC CHG RETICULATED PLATELET ASSAY","86611 - HC BARTONELLA, ANTIBODY","76536 - US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM","24530 - CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ"]
[null,"25500 - CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION","85305 - HC CHG CLOTTING INHIBITORS PROTEIN S TOTAL","24560 - CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ","24560 - CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ","24560 - CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ","85060 - HC BL SMEAR W/O DIFF WBC COUNT","24357 - HC REPAIR ELBOW PERC","86612 - HC CHG BLASTOMYCES ANTIBODY","86611 - HC BARTONELLA, ANTIBODY","86612 - HC CHG BLASTOMYCES ANTIBODY","85060 - HC BL SMEAR W/O DIFF WBC COUNT","24535 - CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ","86612 - HC CHG BLASTOMYCES ANTIBODY","24357 - HC REPAIR ELBOW PERC","85060 - HC BL SMEAR W/O DIFF WBC COUNT","86612 - HC CHG BLASTOMYCES ANTIBODY","76604 - HC CHG US CHEST REAL TIME W/IMAGE DOCUMENTATION","24535 - CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ"]
[null,"25505 - CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION","85306 - HC CHG CLOTTING INHIBITORS PROTEIN S FREE","24565 - CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/MANJ","24565 - CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/MANJ","24565 - CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/MANJ","85210 - HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC","24500 - CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION","86615 - HC Q;BORDTLLA AB;IGG,IGA","86612 - HC CHG BLASTOMYCES ANTIBODY","86615 - HC Q;BORDTLLA AB;IGG,IGA","85210 - HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC","24560 - CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ","86615 - HC Q;BORDTLLA AB;IGG,IGA","24500 - CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION","85210 - HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC","86615 - HC Q;BORDTLLA AB;IGG,IGA","76641 - HC CHG US BREAST UNI REAL TIME WITH IMAGE COMPLETE","24560 - CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ"]
[null,"25520 - HC CLOSED RX RADIAL SHAFT FX W/DISLOCATION","85307 - HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY","24576 - CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ","24576 - CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ","24576 - CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ","85220 - HC CHG CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR","24505 - CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ","86617 - HC CHG ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST","86615 - HC Q;BORDTLLA AB;IGG,IGA","86617 - HC CHG ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST","85220 - HC CHG CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR","24565 - CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/MANJ","86617 - HC CHG ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST","24505 - CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ","85220 - HC CHG CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR","86617 - HC CHG ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST","76642 - US BREAST UNI REAL TIME WITH IMAGE LIMITED","24565 - CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/MANJ"]
[null,"25530 - CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION","85347 - HC CHG COAGULATION TIME ACTIVATED","24577 - CLTX HUMERAL CONDYLAR FX MEDIAL/LATERAL W/MANJ","24577 - CLTX HUMERAL CONDYLAR FX MEDIAL/LATERAL W/MANJ","24577 - CLTX HUMERAL CONDYLAR FX MEDIAL/LATERAL W/MANJ","85230 - HC CHG CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR","24530 - CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ","86618 - HC Q;LYME AB INDEX CNS INFEC","86617 - HC CHG ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST","86618 - HC Q;LYME AB INDEX CNS INFEC","85230 - HC CHG CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR","24576 - CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ","86618 - HC Q;LYME AB INDEX CNS INFEC","24530 - CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ","85230 - HC CHG CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR","86618 - HC Q;LYME AB INDEX CNS INFEC","76700 - US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION","24576 - CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ"]
[null,"25535 - CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION","85366 - HC CHG FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ","24600 - TREATMENT CLOSED ELBOW DISLOCATION W/O ANES","24600 - TREATMENT CLOSED ELBOW DISLOCATION W/O ANES","24600 - TREATMENT CLOSED ELBOW DISLOCATION W/O ANES","85240 - HC CHG CLOTTING FACTOR VIII AHG 1 STAGE","24535 - CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ","86622 - HC CHG ANTIBODY BRUCELLA","86618 - HC Q;LYME AB INDEX CNS INFEC","86622 - HC CHG ANTIBODY BRUCELLA","85240 - HC CHG CLOTTING FACTOR VIII AHG 1 STAGE","24577 - CLTX HUMERAL CONDYLAR FX MEDIAL/LATERAL W/MANJ","86622 - HC CHG ANTIBODY BRUCELLA","24535 - CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ","85240 - HC CHG CLOTTING FACTOR VIII AHG 1 STAGE","86622 - HC CHG ANTIBODY BRUCELLA","76705 - ULTRASOUND ABDOMINAL REAL TIME W/IMAGE LIMITED","24577 - CLTX HUMERAL CONDYLAR FX MEDIAL/LATERAL W/MANJ"]
[null,"25560 - CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MAN","85378 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN","24605 - HC TX ELBOW DISLOC W/ANESTH","24605 - HC TX ELBOW DISLOC W/ANESTH","24605 - HC TX ELBOW DISLOC W/ANESTH","85245 - HC CHG CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT","24560 - CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ","86625 - HC CAMPYLOBACTER, ANTIBODY","86622 - HC CHG ANTIBODY BRUCELLA","86625 - HC CAMPYLOBACTER, ANTIBODY","85245 - HC CHG CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT","24600 - TREATMENT CLOSED ELBOW DISLOCATION W/O ANES","86625 - HC CAMPYLOBACTER, ANTIBODY","24560 - CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ","85245 - HC CHG CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT","86625 - HC CAMPYLOBACTER, ANTIBODY","76770 - US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE","24600 - TREATMENT CLOSED ELBOW DISLOCATION W/O ANES"]
[null,"25565 - CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ","85379 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE","24620 - HC CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ","24620 - HC CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ","24620 - HC CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ","85246 - HC CHG CLOTTING FACTOR VIII VW FACTOR ANTIGEN","24565 - CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/MANJ","86631 - HC CHG, CHLAMYDIA, ANTIBODY","86625 - HC CAMPYLOBACTER, ANTIBODY","86631 - HC CHG, CHLAMYDIA, ANTIBODY","85246 - HC CHG CLOTTING FACTOR VIII VW FACTOR ANTIGEN","24605 - HC TX ELBOW DISLOC W/ANESTH","86631 - HC CHG, CHLAMYDIA, ANTIBODY","24565 - CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/MANJ","85246 - HC CHG CLOTTING FACTOR VIII VW FACTOR ANTIGEN","86631 - HC CHG, CHLAMYDIA, ANTIBODY","76775 - US RETROPERITONEAL REAL TIME W/IMAGE LIMITED","24605 - HC TX ELBOW DISLOC W/ANESTH"]
[null,"25600 - CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ","85384 - HC CHG FIBRINOGEN ACTIVITY","24640 - CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ","24640 - CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ","24640 - CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ","85250 - HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS","24576 - CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ","86632 - HC CHG CHLAMYDIA, IGM ANTIBODY","86631 - HC CHG, CHLAMYDIA, ANTIBODY","86632 - HC CHG CHLAMYDIA, IGM ANTIBODY","85250 - HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS","24620 - HC CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ","86632 - HC CHG CHLAMYDIA, IGM ANTIBODY","24576 - CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ","85250 - HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS","86632 - HC CHG CHLAMYDIA, IGM ANTIBODY","76776 - HC CHG US TRNSPLNT KIDNEY REAL TIME W/IMAGE DOCMTN","24620 - HC CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ"]
[null,"25605 - CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF","85397 - HC CHG CLOTTING FUNCTION ACTIVITY NOS, EA ANALYT","24650 - CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION","24650 - CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION","24650 - CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION","85260 - HC CHG CLOTTING FACTOR X STUART-PROWER","24577 - CLTX HUMERAL CONDYLAR FX MEDIAL/LATERAL W/MANJ","86635 - HC CHG ANTIBODY COCCIDIOIDES","86632 - HC CHG CHLAMYDIA, IGM ANTIBODY","86635 - HC CHG ANTIBODY COCCIDIOIDES","85260 - HC CHG CLOTTING FACTOR X STUART-PROWER","24640 - CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ","86635 - HC CHG ANTIBODY COCCIDIOIDES","24577 - CLTX HUMERAL CONDYLAR FX MEDIAL/LATERAL W/MANJ","85260 - HC CHG CLOTTING FACTOR X STUART-PROWER","86635 - HC CHG ANTIBODY COCCIDIOIDES","76800 - HC CHG ULTRASOUND SPINAL CANAL & CONTENTS","24640 - CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ"]
[null,"25606 - HC TREAT FX DISTAL RADIAL","85461 - HC CHG HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE","24655 - CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION","24655 - CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION","24655 - CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION","85270 - HC CHG CLOTTING FACTOR XI PTA","24600 - TREATMENT CLOSED ELBOW DISLOCATION W/O ANES","86638 - HC CHG, Q FEVER ANTIBODY","86635 - HC CHG ANTIBODY COCCIDIOIDES","86638 - HC CHG, Q FEVER ANTIBODY","85270 - HC CHG CLOTTING FACTOR XI PTA","24650 - CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION","86638 - HC CHG, Q FEVER ANTIBODY","24600 - TREATMENT CLOSED ELBOW DISLOCATION W/O ANES","85270 - HC CHG CLOTTING FACTOR XI PTA","86638 - HC CHG, Q FEVER ANTIBODY","76801 - US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT","24650 - CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION"]
[null,"25624 - CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ","85520 - HC CHG HEPARIN ASSAY","24670 - CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ","24670 - CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ","24670 - CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ","85280 - HC CHG CLOTTING FACTOR XII HAGEMAN","24605 - HC TX ELBOW DISLOC W/ANESTH","86644 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV","86638 - HC CHG, Q FEVER ANTIBODY","86644 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV","85280 - HC CHG CLOTTING FACTOR XII HAGEMAN","24655 - CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION","86644 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV","24605 - HC TX ELBOW DISLOC W/ANESTH","85280 - HC CHG CLOTTING FACTOR XII HAGEMAN","86644 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV","76802 - US PREG UTERUS 14 WK TRANSABDL EACH GESTATION","24655 - CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION"]
[null,"25630 - CLTX CARPAL BONE FX W/O MANJ EACH BONE","85549 - HC CHG MURAMIDASE","24675 - CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ","24675 - CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ","24675 - CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ","85290 - HC CHG CLOTTING FACTOR XIII FIBRIN STABILIZING","24620 - HC CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ","86645 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV IGM","86644 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV","86645 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV IGM","85290 - HC CHG CLOTTING FACTOR XIII FIBRIN STABILIZING","24670 - CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ","86645 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV IGM","24620 - HC CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ","85290 - HC CHG CLOTTING FACTOR XIII FIBRIN STABILIZING","86645 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV IGM","76805 - US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION","24670 - CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ"]
[null,"25635 - CLTX CARPAL BONE FX W/MANJ EACH BONE","85576 - HC CHG PLATELET AGGREGATION IN VITRO EACH AGENT","25000 - HC INCISION EXTENSOR TENDON SHEATH WRIST","25000 - HC INCISION EXTENSOR TENDON SHEATH WRIST","25000 - HC INCISION EXTENSOR TENDON SHEATH WRIST","85300 - HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY","24640 - CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ","86648 - HC CHG ANTIBODY DIPHTHERIA","86645 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV IGM","86648 - HC CHG ANTIBODY DIPHTHERIA","85300 - HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY","24675 - CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ","86648 - HC CHG ANTIBODY DIPHTHERIA","24640 - CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ","85300 - HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY","86648 - HC CHG ANTIBODY DIPHTHERIA","76810 - US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO","24675 - CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ"]
[null,"25660 - CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MANJ","85610 - POC;INR","25031 - HC DRAINAGE OF FOREARM BURSA","25031 - HC DRAINAGE OF FOREARM BURSA","25031 - HC DRAINAGE OF FOREARM BURSA","85301 - HC CHG CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY","24650 - CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION","86652 - HC CHG, ENCEPHAL ANTIBODY EAST EQU","86648 - HC CHG ANTIBODY DIPHTHERIA","86652 - HC CHG, ENCEPHAL ANTIBODY EAST EQU","85301 - HC CHG CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY","25000 - HC INCISION EXTENSOR TENDON SHEATH WRIST","86652 - HC CHG, ENCEPHAL ANTIBODY EAST EQU","24650 - CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION","85301 - HC CHG CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY","86652 - HC CHG, ENCEPHAL ANTIBODY EAST EQU","76811 - US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION","25000 - HC INCISION EXTENSOR TENDON SHEATH WRIST"]
[null,"25675 - CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ","85611 - HC CHG PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH","25065 - HC BIOPSY FOREARM SOFT TISSUES,SUPERFIC","25065 - HC BIOPSY FOREARM SOFT TISSUES,SUPERFIC","25065 - HC BIOPSY FOREARM SOFT TISSUES,SUPERFIC","85302 - HC CHG CLOTTING INHIBITORS PROTEIN C ANTIGEN","24655 - CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION","86654 - CHG ANTIBODY ENCEPHALITIS WESTRN EQUINE","86652 - HC CHG, ENCEPHAL ANTIBODY EAST EQU","86654 - CHG ANTIBODY ENCEPHALITIS WESTRN EQUINE","85302 - HC CHG CLOTTING INHIBITORS PROTEIN C ANTIGEN","25031 - HC DRAINAGE OF FOREARM BURSA","86654 - CHG ANTIBODY ENCEPHALITIS WESTRN EQUINE","24655 - CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION","85302 - HC CHG CLOTTING INHIBITORS PROTEIN C ANTIGEN","86654 - CHG ANTIBODY ENCEPHALITIS WESTRN EQUINE","76812 - US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT","25031 - HC DRAINAGE OF FOREARM BURSA"]
[null,"25680 - HC CLOSED RX NAVIC/LUNATE FX/DISLOC","85613 - HC CHG RUSSELL VIPER VENOM DILUTED","25066 - HC BIOPSY FOREARM SOFT TISSUES,DEEP","25066 - HC BIOPSY FOREARM SOFT TISSUES,DEEP","25066 - HC BIOPSY FOREARM SOFT TISSUES,DEEP","85303 - HC CHG CLOTTING INHIBITORS PROTEIN C ACTIVITY","24670 - CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ","86658 - HC CHG ENTEROVIRUS ANTIBODY","86654 - CHG ANTIBODY ENCEPHALITIS WESTRN EQUINE","86658 - HC CHG ENTEROVIRUS ANTIBODY","85303 - HC CHG CLOTTING INHIBITORS PROTEIN C ACTIVITY","25065 - HC BIOPSY FOREARM SOFT TISSUES,SUPERFIC","86658 - HC CHG ENTEROVIRUS ANTIBODY","24670 - CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ","85303 - HC CHG CLOTTING INHIBITORS PROTEIN C ACTIVITY","86658 - HC CHG ENTEROVIRUS ANTIBODY","76813 - US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION","25065 - HC BIOPSY FOREARM SOFT TISSUES,SUPERFIC"]
[null,"25690 - CLOSED TX LUNATE DISLOCATION W/MANIPULATION","85651 - SEDIMENTATION RATE RBC NON-AUTOMATED","25071 - EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/>","25071 - EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/>","25071 - EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/>","85305 - HC CHG CLOTTING INHIBITORS PROTEIN S TOTAL","24675 - CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ","86663 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA","86658 - HC CHG ENTEROVIRUS ANTIBODY","86663 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA","85305 - HC CHG CLOTTING INHIBITORS PROTEIN S TOTAL","25066 - HC BIOPSY FOREARM SOFT TISSUES,DEEP","86663 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA","24675 - CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ","85305 - HC CHG CLOTTING INHIBITORS PROTEIN S TOTAL","86663 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA","76814 - US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION","25066 - HC BIOPSY FOREARM SOFT TISSUES,DEEP"]
[null,"26011 - DRAINAGE FINGER ABSCESS COMPLICATED","85652 - HC CHG SEDIMENTATION RATE RBC AUTOMATED","25073 - HC  EXC TUMOR SFT TISS FOREARM&//WRIST SUBFASC 3+CM","25073 - HC  EXC TUMOR SFT TISS FOREARM&//WRIST SUBFASC 3+CM","25073 - HC  EXC TUMOR SFT TISS FOREARM&//WRIST SUBFASC 3+CM","85306 - HC CHG CLOTTING INHIBITORS PROTEIN S FREE","25000 - HC INCISION EXTENSOR TENDON SHEATH WRIST","86664 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA","86663 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA","86664 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA","85306 - HC CHG CLOTTING INHIBITORS PROTEIN S FREE","25071 - EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/>","86664 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA","25000 - HC INCISION EXTENSOR TENDON SHEATH WRIST","85306 - HC CHG CLOTTING INHIBITORS PROTEIN S FREE","86664 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA","76815 - US PREGNANT UTERUS LIMITED 1/> FETUSES","25071 - EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/>"]
[null,"26055 - TENDON SHEATH INCISION","85660 - HC CHG SICKLING RBC REDUCTION","25075 - EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM","25075 - EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM","25075 - EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM","85307 - HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY","25031 - HC DRAINAGE OF FOREARM BURSA","86665 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA","86664 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA","86665 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA","85307 - HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY","25073 - HC  EXC TUMOR SFT TISS FOREARM&//WRIST SUBFASC 3+CM","86665 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA","25031 - HC DRAINAGE OF FOREARM BURSA","85307 - HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY","86665 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA","76816 - US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS","25073 - HC  EXC TUMOR SFT TISS FOREARM&//WRIST SUBFASC 3+CM"]
[null,"26060 - HC INCIS PERCUT FINGER TENDON,SINGLE,EA","85670 - HC CHG THROMBIN TIME PLASMA","25076 - EXC FOREARM TUM DEEP < 3 CM","25076 - EXC FOREARM TUM DEEP < 3 CM","25076 - EXC FOREARM TUM DEEP < 3 CM","85347 - HC CHG COAGULATION TIME ACTIVATED","25065 - HC BIOPSY FOREARM SOFT TISSUES,SUPERFIC","86666 - HC CHG ANTIBODY EHRLICHIA","86665 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA","86666 - HC CHG ANTIBODY EHRLICHIA","85347 - HC CHG COAGULATION TIME ACTIVATED","25075 - EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM","86666 - HC CHG ANTIBODY EHRLICHIA","25065 - HC BIOPSY FOREARM SOFT TISSUES,SUPERFIC","85347 - HC CHG COAGULATION TIME ACTIVATED","86666 - HC CHG ANTIBODY EHRLICHIA","76817 - US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG","25075 - EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM"]
[null,"26080 - HC EXPLORE/TREAT INTERPHALANGEAL JT,EA","85705 - HC CHG THROMBOPLASTIN INHIBITION TISSUE","25111 - EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY","25111 - EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY","25111 - EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY","85366 - HC CHG FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ","25066 - HC BIOPSY FOREARM SOFT TISSUES,DEEP","86677 - HC CHG ANTIBODY HELICOBACTER PYLORI","86666 - HC CHG ANTIBODY EHRLICHIA","86677 - HC CHG ANTIBODY HELICOBACTER PYLORI","85366 - HC CHG FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ","25076 - EXC FOREARM TUM DEEP < 3 CM","86677 - HC CHG ANTIBODY HELICOBACTER PYLORI","25066 - HC BIOPSY FOREARM SOFT TISSUES,DEEP","85366 - HC CHG FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ","86677 - HC CHG ANTIBODY HELICOBACTER PYLORI","76818 - FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING","25076 - EXC FOREARM TUM DEEP < 3 CM"]
[null,"26111 - HC EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5+CM","85730 - HC CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD","25112 - EXCISION GANGLION WRIST DORSAL/VOLAR RECURRENT","25112 - EXCISION GANGLION WRIST DORSAL/VOLAR RECURRENT","25112 - EXCISION GANGLION WRIST DORSAL/VOLAR RECURRENT","85378 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN","25071 - EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/>","86682 - HC Q;CYSTICERCUS AB,BLOT","86677 - HC CHG ANTIBODY HELICOBACTER PYLORI","86682 - HC Q;CYSTICERCUS AB,BLOT","85378 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN","25111 - EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY","86682 - HC Q;CYSTICERCUS AB,BLOT","25071 - EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/>","85378 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN","86682 - HC Q;CYSTICERCUS AB,BLOT","76819 - FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING","25111 - EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY"]
[null,"26113 - EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5CM/>","85732 - HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA","25116 - RAD EXCIS WRIST SYNOV/TENDON,EXTEN","25116 - RAD EXCIS WRIST SYNOV/TENDON,EXTEN","25116 - RAD EXCIS WRIST SYNOV/TENDON,EXTEN","85379 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE","25073 - HC  EXC TUMOR SFT TISS FOREARM&//WRIST SUBFASC 3+CM","86689 - HC HTLV/HIV CONFIRMATORY TEST","86682 - HC Q;CYSTICERCUS AB,BLOT","86689 - HC HTLV/HIV CONFIRMATORY TEST","85379 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE","25112 - EXCISION GANGLION WRIST DORSAL/VOLAR RECURRENT","86689 - HC HTLV/HIV CONFIRMATORY TEST","25073 - HC  EXC TUMOR SFT TISS FOREARM&//WRIST SUBFASC 3+CM","85379 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE","86689 - HC HTLV/HIV CONFIRMATORY TEST","76820 - DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY","25112 - EXCISION GANGLION WRIST DORSAL/VOLAR RECURRENT"]
[null,"26115 - EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM","85810 - HC CHG VISCOSITY","25246 - HC INJECTION WRIST ARTHROGRAPHY","25246 - HC INJECTION WRIST ARTHROGRAPHY","25246 - HC INJECTION WRIST ARTHROGRAPHY","85384 - HC CHG FIBRINOGEN ACTIVITY","25075 - EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM","86692 - HC CHG ANTIBODY HEP DELTA AGENT","86689 - HC HTLV/HIV CONFIRMATORY TEST","86692 - HC CHG ANTIBODY HEP DELTA AGENT","85384 - HC CHG FIBRINOGEN ACTIVITY","25116 - RAD EXCIS WRIST SYNOV/TENDON,EXTEN","86692 - HC CHG ANTIBODY HEP DELTA AGENT","25075 - EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM","85384 - HC CHG FIBRINOGEN ACTIVITY","86692 - HC CHG ANTIBODY HEP DELTA AGENT","76821 - DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART","25116 - RAD EXCIS WRIST SYNOV/TENDON,EXTEN"]
[null,"26116 - EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM","86003 - HC CHG ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN","25248 - HC REMOVE FOREARM/WRIST FOREIGN BODY","25248 - HC REMOVE FOREARM/WRIST FOREIGN BODY","25248 - HC REMOVE FOREARM/WRIST FOREIGN BODY","85397 - HC CHG CLOTTING FUNCTION ACTIVITY NOS, EA ANALYT","25076 - EXC FOREARM TUM DEEP < 3 CM","86694 - HC CHG ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST","86692 - HC CHG ANTIBODY HEP DELTA AGENT","86694 - HC CHG ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST","85397 - HC CHG CLOTTING FUNCTION ACTIVITY NOS, EA ANALYT","25246 - HC INJECTION WRIST ARTHROGRAPHY","86694 - HC CHG ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST","25076 - EXC FOREARM TUM DEEP < 3 CM","85397 - HC CHG CLOTTING FUNCTION ACTIVITY NOS, EA ANALYT","86694 - HC CHG ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST","76825 - ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING","25246 - HC INJECTION WRIST ARTHROGRAPHY"]
[null,"26160 - EXC LES TDN SHTH/JT CAPSL HAND/FNGR","86021 - HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES","25500 - CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION","25500 - CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION","25500 - CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION","85461 - HC CHG HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE","25111 - EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY","86695 - HC CHG ANTIBODY HERPES SMPLX TYPE 1","86694 - HC CHG ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST","86695 - HC CHG ANTIBODY HERPES SMPLX TYPE 1","85461 - HC CHG HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE","25248 - HC REMOVE FOREARM/WRIST FOREIGN BODY","86695 - HC CHG ANTIBODY HERPES SMPLX TYPE 1","25111 - EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY","85461 - HC CHG HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE","86695 - HC CHG ANTIBODY HERPES SMPLX TYPE 1","76826 - ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD","25248 - HC REMOVE FOREARM/WRIST FOREIGN BODY"]
[null,"26236 - HC PR PART REMV BONE,DISTAL PHALANX","86022 - HC CRL;SEROTONIN RLS ASSAY","25505 - CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION","25505 - CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION","25505 - CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION","85520 - HC CHG HEPARIN ASSAY","25112 - EXCISION GANGLION WRIST DORSAL/VOLAR RECURRENT","86696 - HC CHG ANTIBODY HERPES SMPLX TYPE 2","86695 - HC CHG ANTIBODY HERPES SMPLX TYPE 1","86696 - HC CHG ANTIBODY HERPES SMPLX TYPE 2","85520 - HC CHG HEPARIN ASSAY","25500 - CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION","86696 - HC CHG ANTIBODY HERPES SMPLX TYPE 2","25112 - EXCISION GANGLION WRIST DORSAL/VOLAR RECURRENT","85520 - HC CHG HEPARIN ASSAY","86696 - HC CHG ANTIBODY HERPES SMPLX TYPE 2","76827 - DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE","25500 - CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION"]
[null,"26341 - MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD","86038 - HC CHG ANTINUCLEAR ANTIBODIES ANA","25520 - HC CLOSED RX RADIAL SHAFT FX W/DISLOCATION","25520 - HC CLOSED RX RADIAL SHAFT FX W/DISLOCATION","25520 - HC CLOSED RX RADIAL SHAFT FX W/DISLOCATION","85549 - HC CHG MURAMIDASE","25116 - RAD EXCIS WRIST SYNOV/TENDON,EXTEN","86698 - HC CHG ANTIBODY HISTOPLASMA","86696 - HC CHG ANTIBODY HERPES SMPLX TYPE 2","86698 - HC CHG ANTIBODY HISTOPLASMA","85549 - HC CHG MURAMIDASE","25505 - CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION","86698 - HC CHG ANTIBODY HISTOPLASMA","25116 - RAD EXCIS WRIST SYNOV/TENDON,EXTEN","85549 - HC CHG MURAMIDASE","86698 - HC CHG ANTIBODY HISTOPLASMA","76828 - DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT","25505 - CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION"]
[null,"26410 - HC REPAIR EXTEN TENDON,DORSUM HAND,EA","86039 - HC CHG ANTINUCLEAR ANTIBODIES ANA TITER","25530 - CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION","25530 - CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION","25530 - CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION","85576 - HC CHG PLATELET AGGREGATION IN VITRO EACH AGENT","25246 - HC INJECTION WRIST ARTHROGRAPHY","86701 - HC HIV-1","86698 - HC CHG ANTIBODY HISTOPLASMA","86701 - HC HIV-1","85576 - HC CHG PLATELET AGGREGATION IN VITRO EACH AGENT","25520 - HC CLOSED RX RADIAL SHAFT FX W/DISLOCATION","86701 - HC HIV-1","25246 - HC INJECTION WRIST ARTHROGRAPHY","85576 - HC CHG PLATELET AGGREGATION IN VITRO EACH AGENT","86701 - HC HIV-1","76830 - ULTRASOUND TRANSVAGINAL","25520 - HC CLOSED RX RADIAL SHAFT FX W/DISLOCATION"]
[null,"26418 - HC REPAIR EXTEN TENDON,DORSUM FINGER,EA","86060 - HC CHG ANTISTREPTOLYSIN O TITER","25535 - CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION","25535 - CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION","25535 - CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION","85610 - POC;INR","25248 - HC REMOVE FOREARM/WRIST FOREIGN BODY","86702 - HC QL/SEMI MULT AB;HIV2","86701 - HC HIV-1","86702 - HC QL/SEMI MULT AB;HIV2","85610 - POC;INR","25530 - CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION","86702 - HC QL/SEMI MULT AB;HIV2","25248 - HC REMOVE FOREARM/WRIST FOREIGN BODY","85610 - POC;INR","86702 - HC QL/SEMI MULT AB;HIV2","76831 - SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER","25530 - CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION"]
[null,"26432 - CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING","86140 - C-REACTIVE PROTEIN","25560 - CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MAN","25560 - CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MAN","25560 - CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MAN","85611 - HC CHG PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH","25500 - CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION","86703 - HC HIV 1/2 ANTIBODY","86702 - HC QL/SEMI MULT AB;HIV2","86703 - HC HIV 1/2 ANTIBODY","85611 - HC CHG PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH","25535 - CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION","86703 - HC HIV 1/2 ANTIBODY","25500 - CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION","85611 - HC CHG PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH","86703 - HC HIV 1/2 ANTIBODY","76856 - US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE","25535 - CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION"]
[null,"26535 - HC ARTHROPLASTY I-P JT","86141 - HC CRL;CARDIO CRP","25565 - CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ","25565 - CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ","25565 - CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ","85613 - HC CHG RUSSELL VIPER VENOM DILUTED","25505 - CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION","86704 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB TOTAL","86703 - HC HIV 1/2 ANTIBODY","86704 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB TOTAL","85613 - HC CHG RUSSELL VIPER VENOM DILUTED","25560 - CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MAN","86704 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB TOTAL","25505 - CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION","85613 - HC CHG RUSSELL VIPER VENOM DILUTED","86704 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB TOTAL","76857 - US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U","25560 - CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MAN"]
[null,"26605 - CLTX METACARPAL FX W/MANIPULATION EACH BONE","86146 - HC CRL;BETA-2 GLYCPRTN 1 AB","25600 - CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ","25600 - CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ","25600 - CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ","85651 - SEDIMENTATION RATE RBC NON-AUTOMATED","25520 - HC CLOSED RX RADIAL SHAFT FX W/DISLOCATION","86705 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY","86704 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB TOTAL","86705 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY","85651 - SEDIMENTATION RATE RBC NON-AUTOMATED","25565 - CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ","86705 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY","25520 - HC CLOSED RX RADIAL SHAFT FX W/DISLOCATION","85651 - SEDIMENTATION RATE RBC NON-AUTOMATED","86705 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY","76870 - ULTRASOUND SCROTUM & CONTENTS","25565 - CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ"]
[null,"26645 - CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ","86147 - HC Q;CARDLIP AB;IGG,IGM,IGA","25605 - CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF","25605 - CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF","25605 - CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF","85652 - HC CHG SEDIMENTATION RATE RBC AUTOMATED","25530 - CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION","86706 - HC CHG HEPATITIS B SURF ANTIBODY HBSAB","86705 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY","86706 - HC CHG HEPATITIS B SURF ANTIBODY HBSAB","85652 - HC CHG SEDIMENTATION RATE RBC AUTOMATED","25600 - CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ","86706 - HC CHG HEPATITIS B SURF ANTIBODY HBSAB","25530 - CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION","85652 - HC CHG SEDIMENTATION RATE RBC AUTOMATED","86706 - HC CHG HEPATITIS B SURF ANTIBODY HBSAB","76872 - ULTRASOUND TRANSRECTAL","25600 - CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ"]
[null,"26650 - HC PRQ SKEL FIXATION CARP/MTCRPL FX DISLOCATE THUMB","86157 - HC CHG COLD AGGLUTININ TITER","25606 - HC TREAT FX DISTAL RADIAL","25606 - HC TREAT FX DISTAL RADIAL","25606 - HC TREAT FX DISTAL RADIAL","85660 - HC CHG SICKLING RBC REDUCTION","25535 - CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION","86707 - HC CHG HEPATITIS BE ANTIBODY HBEAB","86706 - HC CHG HEPATITIS B SURF ANTIBODY HBSAB","86707 - HC CHG HEPATITIS BE ANTIBODY HBEAB","85660 - HC CHG SICKLING RBC REDUCTION","25605 - CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF","86707 - HC CHG HEPATITIS BE ANTIBODY HBEAB","25535 - CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION","85660 - HC CHG SICKLING RBC REDUCTION","86707 - HC CHG HEPATITIS BE ANTIBODY HBEAB","76873 - US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX","25605 - CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF"]
[null,"26720 - CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA","86160 - HC CHG COMPLEMENT ANTIGEN EACH COMPONENT","25622 - CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ","25622 - CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ","25622 - CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ","85670 - HC CHG THROMBIN TIME PLASMA","25560 - CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MAN","86708 - HC CHG HEPATITIS A ANTIBODY HAAB","86707 - HC CHG HEPATITIS BE ANTIBODY HBEAB","86708 - HC CHG HEPATITIS A ANTIBODY HAAB","85670 - HC CHG THROMBIN TIME PLASMA","25606 - HC TREAT FX DISTAL RADIAL","86708 - HC CHG HEPATITIS A ANTIBODY HAAB","25560 - CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MAN","85670 - HC CHG THROMBIN TIME PLASMA","86708 - HC CHG HEPATITIS A ANTIBODY HAAB","76881 - US EXTREMITY NON-VASC REAL-TIME IMG COMPL","25606 - HC TREAT FX DISTAL RADIAL"]
[null,"26725 - CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA","86161 - HC CHG COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT","25624 - CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ","25624 - CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ","25624 - CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ","85705 - HC CHG THROMBOPLASTIN INHIBITION TISSUE","25565 - CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ","86709 - HC CHG HEPATITIS ANTIBODY HAAB IGM ANTIBODY","86708 - HC CHG HEPATITIS A ANTIBODY HAAB","86709 - HC CHG HEPATITIS ANTIBODY HAAB IGM ANTIBODY","85705 - HC CHG THROMBOPLASTIN INHIBITION TISSUE","25622 - CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ","86709 - HC CHG HEPATITIS ANTIBODY HAAB IGM ANTIBODY","25565 - CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ","85705 - HC CHG THROMBOPLASTIN INHIBITION TISSUE","86709 - HC CHG HEPATITIS ANTIBODY HAAB IGM ANTIBODY","76882 - US EXTREMITY NON-VASC REAL-TIME IMG LMTD","25622 - CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ"]
[null,"26740 - CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ","86162 - HC CHG COMPLEMENT TOTAL HEMOLYTIC","25630 - CLTX CARPAL BONE FX W/O MANJ EACH BONE","25630 - CLTX CARPAL BONE FX W/O MANJ EACH BONE","25630 - CLTX CARPAL BONE FX W/O MANJ EACH BONE","85730 - HC CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD","25600 - CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ","86710 - HC INFLUENZA VIRUS","86709 - HC CHG HEPATITIS ANTIBODY HAAB IGM ANTIBODY","86710 - HC INFLUENZA VIRUS","85730 - HC CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD","25624 - CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ","86710 - HC INFLUENZA VIRUS","25600 - CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ","85730 - HC CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD","86710 - HC INFLUENZA VIRUS","76885 - HC CHG US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ","25624 - CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ"]
[null,"26742 - CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ","86200 - HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY","25635 - CLTX CARPAL BONE FX W/MANJ EACH BONE","25635 - CLTX CARPAL BONE FX W/MANJ EACH BONE","25635 - CLTX CARPAL BONE FX W/MANJ EACH BONE","85732 - HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA","25605 - CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF","86735 - HC CHG ANTIBODY MUMPS","86710 - HC INFLUENZA VIRUS","86735 - HC CHG ANTIBODY MUMPS","85732 - HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA","25630 - CLTX CARPAL BONE FX W/O MANJ EACH BONE","86735 - HC CHG ANTIBODY MUMPS","25605 - CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF","85732 - HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA","86735 - HC CHG ANTIBODY MUMPS","76886 - HC US EXAM INFANT HIPS STATIC","25630 - CLTX CARPAL BONE FX W/O MANJ EACH BONE"]
[null,"26765 - HC OPEN TX DISTAL PHALANGEAL FRACTURE EACH","86235 - HC CHG EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD","25650 - CLOSED TREATMENT ULNAR STYLOID FRACTURE","25650 - CLOSED TREATMENT ULNAR STYLOID FRACTURE","25650 - CLOSED TREATMENT ULNAR STYLOID FRACTURE","85810 - HC CHG VISCOSITY","25606 - HC TREAT FX DISTAL RADIAL","86738 - HC CHG ANTIBODY MYCOPLSM","86735 - HC CHG ANTIBODY MUMPS","86738 - HC CHG ANTIBODY MYCOPLSM","85810 - HC CHG VISCOSITY","25635 - CLTX CARPAL BONE FX W/MANJ EACH BONE","86738 - HC CHG ANTIBODY MYCOPLSM","25606 - HC TREAT FX DISTAL RADIAL","85810 - HC CHG VISCOSITY","86738 - HC CHG ANTIBODY MYCOPLSM","76930 - US PERICARDIOCENT","25635 - CLTX CARPAL BONE FX W/MANJ EACH BONE"]
[null,"26951 - HC AMPUTATION FINGER/THUMB","86255 - HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY","25660 - CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MANJ","25660 - CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MANJ","25660 - CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MANJ","86003 - HC CHG ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN","25622 - CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ","86744 - HC CHG ANTIBODY NOCARDIA","86738 - HC CHG ANTIBODY MYCOPLSM","86744 - HC CHG ANTIBODY NOCARDIA","86003 - HC CHG ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN","25650 - CLOSED TREATMENT ULNAR STYLOID FRACTURE","86744 - HC CHG ANTIBODY NOCARDIA","25622 - CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ","86003 - HC CHG ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN","86744 - HC CHG ANTIBODY NOCARDIA","76940 - HC CHG US &MNTR PARENCHYMAL TISSUE ABLATION","25650 - CLOSED TREATMENT ULNAR STYLOID FRACTURE"]
[null,"26990 - HC INCIS/DRAIN PELVIS/HIP,DEEP ABCESS","86256 - HC CHG FLUORESCENT ANTIBODY; TITER","25675 - CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ","25675 - CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ","25675 - CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ","86021 - HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES","25624 - CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ","86747 - HC CHG ANTIBODY PARVOVIRUS","86744 - HC CHG ANTIBODY NOCARDIA","86747 - HC CHG ANTIBODY PARVOVIRUS","86021 - HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES","25660 - CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MANJ","86747 - HC CHG ANTIBODY PARVOVIRUS","25624 - CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ","86021 - HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES","86747 - HC CHG ANTIBODY PARVOVIRUS","76942 - US GUIDANCE NEEDLE PLACEMENT RS&I","25660 - CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MANJ"]
[null,"27040 - HC BX SOFT TISSUES,PELV/HIP,SUPERFICL","86300 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3","25680 - HC CLOSED RX NAVIC/LUNATE FX/DISLOC","25680 - HC CLOSED RX NAVIC/LUNATE FX/DISLOC","25680 - HC CLOSED RX NAVIC/LUNATE FX/DISLOC","86022 - HC CRL;SEROTONIN RLS ASSAY","25630 - CLTX CARPAL BONE FX W/O MANJ EACH BONE","86753 - HC CHG ANTIBODY PROTOZOA NES","86747 - HC CHG ANTIBODY PARVOVIRUS","86753 - HC CHG ANTIBODY PROTOZOA NES","86022 - HC CRL;SEROTONIN RLS ASSAY","25675 - CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ","86753 - HC CHG ANTIBODY PROTOZOA NES","25630 - CLTX CARPAL BONE FX W/O MANJ EACH BONE","86022 - HC CRL;SEROTONIN RLS ASSAY","86753 - HC CHG ANTIBODY PROTOZOA NES","76945 - US GUIDANCE CHORIONIC VILLUS SAMPLING RS&I","25675 - CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ"]
[null,"27041 - HC BX SOFT TISSUES,PELV/HIP,DEEP","86301 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9","25690 - CLOSED TX LUNATE DISLOCATION W/MANIPULATION","25690 - CLOSED TX LUNATE DISLOCATION W/MANIPULATION","25690 - CLOSED TX LUNATE DISLOCATION W/MANIPULATION","86038 - HC CHG ANTINUCLEAR ANTIBODIES ANA","25635 - CLTX CARPAL BONE FX W/MANJ EACH BONE","86757 - HC CHG, RICKETTSIA","86753 - HC CHG ANTIBODY PROTOZOA NES","86757 - HC CHG, RICKETTSIA","86038 - HC CHG ANTINUCLEAR ANTIBODIES ANA","25680 - HC CLOSED RX NAVIC/LUNATE FX/DISLOC","86757 - HC CHG, RICKETTSIA","25635 - CLTX CARPAL BONE FX W/MANJ EACH BONE","86038 - HC CHG ANTINUCLEAR ANTIBODIES ANA","86757 - HC CHG, RICKETTSIA","76946 - US GUIDANCE AMNIOCENTESIS RS&I","25680 - HC CLOSED RX NAVIC/LUNATE FX/DISLOC"]
[null,"27043 - EXCISION TUMOR SOFT TISSUE PELVIS&HIP SUBQ 3+CM","86304 - HC CRL;CA-125","26010 - DRAINAGE FINGER ABSCESS SIMPLE","26010 - DRAINAGE FINGER ABSCESS SIMPLE","26010 - DRAINAGE FINGER ABSCESS SIMPLE","86039 - HC CHG ANTINUCLEAR ANTIBODIES ANA TITER","25650 - CLOSED TREATMENT ULNAR STYLOID FRACTURE","86762 - HC CHG ANTIBODY RUBELLA","86757 - HC CHG, RICKETTSIA","86762 - HC CHG ANTIBODY RUBELLA","86039 - HC CHG ANTINUCLEAR ANTIBODIES ANA TITER","25690 - CLOSED TX LUNATE DISLOCATION W/MANIPULATION","86762 - HC CHG ANTIBODY RUBELLA","25650 - CLOSED TREATMENT ULNAR STYLOID FRACTURE","86039 - HC CHG ANTINUCLEAR ANTIBODIES ANA TITER","86762 - HC CHG ANTIBODY RUBELLA","76998 - ULTRASONIC GUIDANCE INTRAOPERATIVE","25690 - CLOSED TX LUNATE DISLOCATION W/MANIPULATION"]
[null,"27047 - EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ <3CM","86308 - HC CHG HETEROPHILE ANTIBODIES SCREEN","26011 - DRAINAGE FINGER ABSCESS COMPLICATED","26011 - DRAINAGE FINGER ABSCESS COMPLICATED","26011 - DRAINAGE FINGER ABSCESS COMPLICATED","86060 - HC CHG ANTISTREPTOLYSIN O TITER","25660 - CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MANJ","86765 - HC CHG ANTIBODY RUBEOLA","86762 - HC CHG ANTIBODY RUBELLA","86765 - HC CHG ANTIBODY RUBEOLA","86060 - HC CHG ANTISTREPTOLYSIN O TITER","26010 - DRAINAGE FINGER ABSCESS SIMPLE","86765 - HC CHG ANTIBODY RUBEOLA","25660 - CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MANJ","86060 - HC CHG ANTISTREPTOLYSIN O TITER","86765 - HC CHG ANTIBODY RUBEOLA","77011 - HC CHG CT GUIDANCE STEREOTACTIC LOCALIZATION","26010 - DRAINAGE FINGER ABSCESS SIMPLE"]
[null,"27048 - EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC <5CM","86316 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE","26055 - TENDON SHEATH INCISION","26055 - TENDON SHEATH INCISION","26055 - TENDON SHEATH INCISION","86140 - C-REACTIVE PROTEIN","25675 - CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ","86769 - ANTIBODY; SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2","86765 - HC CHG ANTIBODY RUBEOLA","86769 - ANTIBODY; SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2","86140 - C-REACTIVE PROTEIN","26011 - DRAINAGE FINGER ABSCESS COMPLICATED","86769 - ANTIBODY; SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2","25675 - CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ","86140 - C-REACTIVE PROTEIN","86769 - ANTIBODY; SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2","77012 - HC CHG CT GUIDANCE NEEDLE PLACEMENT","26011 - DRAINAGE FINGER ABSCESS COMPLICATED"]
[null,"27086 - RMVL FOREIGN BODY PELVIS/HIP SUBCUTANEOUS TISS","86317 - HC IMMUNOASSAY,INFECT AGENT,QUANT","26060 - HC INCIS PERCUT FINGER TENDON,SINGLE,EA","26060 - HC INCIS PERCUT FINGER TENDON,SINGLE,EA","26060 - HC INCIS PERCUT FINGER TENDON,SINGLE,EA","86141 - HC CRL;CARDIO CRP","25680 - HC CLOSED RX NAVIC/LUNATE FX/DISLOC","86774 - HC CHG ANTIBODY TETANUS","86769 - ANTIBODY; SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2","86774 - HC CHG ANTIBODY TETANUS","86141 - HC CRL;CARDIO CRP","26055 - TENDON SHEATH INCISION","86774 - HC CHG ANTIBODY TETANUS","25680 - HC CLOSED RX NAVIC/LUNATE FX/DISLOC","86141 - HC CRL;CARDIO CRP","86774 - HC CHG ANTIBODY TETANUS","77013 - HC CHG CT GUIDANCE &MONITORING VISC TISS ABLATION","26055 - TENDON SHEATH INCISION"]
[null,"27087 - REMOVAL FOREIGN BODY PELVIS/HIP DEEP","86328 - IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY; CORONAVIRUS 2","26080 - HC EXPLORE/TREAT INTERPHALANGEAL JT,EA","26080 - HC EXPLORE/TREAT INTERPHALANGEAL JT,EA","26080 - HC EXPLORE/TREAT INTERPHALANGEAL JT,EA","86146 - HC CRL;BETA-2 GLYCPRTN 1 AB","25690 - CLOSED TX LUNATE DISLOCATION W/MANIPULATION","86777 - HC CHG ANTIBODY TOXOPLASMA","86774 - HC CHG ANTIBODY TETANUS","86777 - HC CHG ANTIBODY TOXOPLASMA","86146 - HC CRL;BETA-2 GLYCPRTN 1 AB","26060 - HC INCIS PERCUT FINGER TENDON,SINGLE,EA","86777 - HC CHG ANTIBODY TOXOPLASMA","25690 - CLOSED TX LUNATE DISLOCATION W/MANIPULATION","86146 - HC CRL;BETA-2 GLYCPRTN 1 AB","86777 - HC CHG ANTIBODY TOXOPLASMA","77014 - HC CT GUIDANCE","26060 - HC INCIS PERCUT FINGER TENDON,SINGLE,EA"]
[null,"27093 - HC INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA","86331 - HC CHG IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY","26111 - HC EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5+CM","26111 - HC EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5+CM","26111 - HC EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5+CM","86147 - HC Q;CARDLIP AB;IGG,IGM,IGA","26010 - DRAINAGE FINGER ABSCESS SIMPLE","86778 - HC Q;TOXOPLASMA IGM,AB","86777 - HC CHG ANTIBODY TOXOPLASMA","86778 - HC Q;TOXOPLASMA IGM,AB","86147 - HC Q;CARDLIP AB;IGG,IGM,IGA","26080 - HC EXPLORE/TREAT INTERPHALANGEAL JT,EA","86778 - HC Q;TOXOPLASMA IGM,AB","26010 - DRAINAGE FINGER ABSCESS SIMPLE","86147 - HC Q;CARDLIP AB;IGG,IGM,IGA","86778 - HC Q;TOXOPLASMA IGM,AB","77021 - HC MRGUIDE,NEED PLACE","26080 - HC EXPLORE/TREAT INTERPHALANGEAL JT,EA"]
[null,"27096 - INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA","86334 - HC CHG IMMUNOFIXJ ELECTROPHORESIS SERUM","26113 - EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5CM/>","26113 - EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5CM/>","26113 - EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5CM/>","86157 - HC CHG COLD AGGLUTININ TITER","26011 - DRAINAGE FINGER ABSCESS COMPLICATED","86780 - HC CHG ANTIBODY TREPONEMA PALLIDUM","86778 - HC Q;TOXOPLASMA IGM,AB","86780 - HC CHG ANTIBODY TREPONEMA PALLIDUM","86157 - HC CHG COLD AGGLUTININ TITER","26111 - HC EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5+CM","86780 - HC CHG ANTIBODY TREPONEMA PALLIDUM","26011 - DRAINAGE FINGER ABSCESS COMPLICATED","86157 - HC CHG COLD AGGLUTININ TITER","86780 - HC CHG ANTIBODY TREPONEMA PALLIDUM","77058 - HC CHG MRI BREAST UNILATERAL","26111 - HC EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5+CM"]
[null,"27197 - HC CLSD TX PELVIC RING FX W/O MANIPULATION","86335 - HC CHG IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS","26115 - EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM","26115 - EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM","26115 - EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM","86160 - HC CHG COMPLEMENT ANTIGEN EACH COMPONENT","26055 - TENDON SHEATH INCISION","86787 - HC CHG ANTIBODY VARICELLA-ZOSTER","86780 - HC CHG ANTIBODY TREPONEMA PALLIDUM","86787 - HC CHG ANTIBODY VARICELLA-ZOSTER","86160 - HC CHG COMPLEMENT ANTIGEN EACH COMPONENT","26113 - EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5CM/>","86787 - HC CHG ANTIBODY VARICELLA-ZOSTER","26055 - TENDON SHEATH INCISION","86160 - HC CHG COMPLEMENT ANTIGEN EACH COMPONENT","86787 - HC CHG ANTIBODY VARICELLA-ZOSTER","77059 - HC CHG MRI BREAST BILATERAL","26113 - EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5CM/>"]
[null,"27200 - HC CLOSED TREATMENT COCCYGEAL FRACTURE","86336 - HC CHG INHIBIN A","26116 - EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM","26116 - EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM","26116 - EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM","86161 - HC CHG COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT","26060 - HC INCIS PERCUT FINGER TENDON,SINGLE,EA","86788 - HC CHG ANTIBODY WEST NILE VIRUS IGM","86787 - HC CHG ANTIBODY VARICELLA-ZOSTER","86788 - HC CHG ANTIBODY WEST NILE VIRUS IGM","86161 - HC CHG COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT","26115 - EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM","86788 - HC CHG ANTIBODY WEST NILE VIRUS IGM","26060 - HC INCIS PERCUT FINGER TENDON,SINGLE,EA","86161 - HC CHG COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT","86788 - HC CHG ANTIBODY WEST NILE VIRUS IGM","77063 - SCREENING DIGITAL BREAST TOMOSYNTHESIS BI","26115 - EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM"]
[null,"27230 - CLTX FEM FX PROX END NCK W/O MANJ","86340 - HC CHG INTRINSIC FACTOR ANTIBODIES","26160 - EXC LES TDN SHTH/JT CAPSL HAND/FNGR","26160 - EXC LES TDN SHTH/JT CAPSL HAND/FNGR","26160 - EXC LES TDN SHTH/JT CAPSL HAND/FNGR","86162 - HC CHG COMPLEMENT TOTAL HEMOLYTIC","26080 - HC EXPLORE/TREAT INTERPHALANGEAL JT,EA","86789 - HC CHG ANTIBODY WEST NILE VIRUS","86788 - HC CHG ANTIBODY WEST NILE VIRUS IGM","86789 - HC CHG ANTIBODY WEST NILE VIRUS","86162 - HC CHG COMPLEMENT TOTAL HEMOLYTIC","26116 - EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM","86789 - HC CHG ANTIBODY WEST NILE VIRUS","26080 - HC EXPLORE/TREAT INTERPHALANGEAL JT,EA","86162 - HC CHG COMPLEMENT TOTAL HEMOLYTIC","86789 - HC CHG ANTIBODY WEST NILE VIRUS","77065 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","26116 - EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM"]
[null,"27238 - CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ","86341 - HC CHG ISLET CELL ANTIBODY","26236 - HC PR PART REMV BONE,DISTAL PHALANX","26236 - HC PR PART REMV BONE,DISTAL PHALANX","26236 - HC PR PART REMV BONE,DISTAL PHALANX","86200 - HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY","26111 - HC EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5+CM","86790 - HC CHG ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED","86789 - HC CHG ANTIBODY WEST NILE VIRUS","86790 - HC CHG ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED","86200 - HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY","26160 - EXC LES TDN SHTH/JT CAPSL HAND/FNGR","86790 - HC CHG ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED","26111 - HC EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5+CM","86200 - HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY","86790 - HC CHG ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED","77066 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","26160 - EXC LES TDN SHTH/JT CAPSL HAND/FNGR"]
[null,"27246 - CLTX GREATER TROCHANTERIC FX W/O MANJ","86353 - HC CHG LYMPHOCYTE TRANSFORMATION","26341 - MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD","26341 - MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD","26341 - MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD","86235 - HC CHG EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD","26113 - EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5CM/>","86800 - HC CHG THYROGLOBULIN ANTIBODY","86790 - HC CHG ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED","86800 - HC CHG THYROGLOBULIN ANTIBODY","86235 - HC CHG EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD","26236 - HC PR PART REMV BONE,DISTAL PHALANX","86800 - HC CHG THYROGLOBULIN ANTIBODY","26113 - EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5CM/>","86235 - HC CHG EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD","86800 - HC CHG THYROGLOBULIN ANTIBODY","77067 - HC SCR MAMM CAD, BI","26236 - HC PR PART REMV BONE,DISTAL PHALANX"]
[null,"27250 - CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA","86355 - HC B CELLS TOTAL COUNT","26410 - HC REPAIR EXTEN TENDON,DORSUM HAND,EA","26410 - HC REPAIR EXTEN TENDON,DORSUM HAND,EA","26410 - HC REPAIR EXTEN TENDON,DORSUM HAND,EA","86255 - HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY","26115 - EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM","86803 - HC CHG HEPATITIS C ANTIBODY","86800 - HC CHG THYROGLOBULIN ANTIBODY","86803 - HC CHG HEPATITIS C ANTIBODY","86255 - HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY","26341 - MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD","86803 - HC CHG HEPATITIS C ANTIBODY","26115 - EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM","86255 - HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY","86803 - HC CHG HEPATITIS C ANTIBODY","77071 - HC CHG MANUAL APPL STRESS PFRMD PHYS/QHP JOINT FILMS","26341 - MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD"]
[null,"27252 - HC TX HIP DISLOC W/ANESTH","86357 - HC NK CELLS, TOTAL COUNT","26418 - HC REPAIR EXTEN TENDON,DORSUM FINGER,EA","26418 - HC REPAIR EXTEN TENDON,DORSUM FINGER,EA","26418 - HC REPAIR EXTEN TENDON,DORSUM FINGER,EA","86256 - HC CHG FLUORESCENT ANTIBODY; TITER","26116 - EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM","86807 - HC CHG SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH","86803 - HC CHG HEPATITIS C ANTIBODY","86807 - HC CHG SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH","86256 - HC CHG FLUORESCENT ANTIBODY; TITER","26410 - HC REPAIR EXTEN TENDON,DORSUM HAND,EA","86807 - HC CHG SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH","26116 - EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM","86256 - HC CHG FLUORESCENT ANTIBODY; TITER","86807 - HC CHG SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH","77072 - HC CHG BONE AGE STUDIES","26410 - HC REPAIR EXTEN TENDON,DORSUM HAND,EA"]
[null,"27256 - TX SPONTAN HIP DISLC ABDCT SPLNT/TRCJ W/O ANES","86359 - HC CHG T CELLS TOTAL COUNT","26432 - CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING","26432 - CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING","26432 - CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING","86300 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3","26160 - EXC LES TDN SHTH/JT CAPSL HAND/FNGR","86812 - HC CHG HLA TYPING A/B/C SINGLE ANTIGEN","86807 - HC CHG SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH","86812 - HC CHG HLA TYPING A/B/C SINGLE ANTIGEN","86300 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3","26418 - HC REPAIR EXTEN TENDON,DORSUM FINGER,EA","86812 - HC CHG HLA TYPING A/B/C SINGLE ANTIGEN","26160 - EXC LES TDN SHTH/JT CAPSL HAND/FNGR","86300 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3","86812 - HC CHG HLA TYPING A/B/C SINGLE ANTIGEN","77073 - HC CHG BONE LENGTH STUDIES","26418 - HC REPAIR EXTEN TENDON,DORSUM FINGER,EA"]
[null,"27257 - HC TX HIPDISLOC ABDCT WMANP","86360 - HC CHG T CELLS ABSOLUTE CD4&CD8 COUNT RATIO","26535 - HC ARTHROPLASTY I-P JT","26535 - HC ARTHROPLASTY I-P JT","26535 - HC ARTHROPLASTY I-P JT","86301 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9","26236 - HC PR PART REMV BONE,DISTAL PHALANX","86813 - HC CHG HLA TYPING A/B/C MULTIPLE ANTIGENS","86812 - HC CHG HLA TYPING A/B/C SINGLE ANTIGEN","86813 - HC CHG HLA TYPING A/B/C MULTIPLE ANTIGENS","86301 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9","26432 - CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING","86813 - HC CHG HLA TYPING A/B/C MULTIPLE ANTIGENS","26236 - HC PR PART REMV BONE,DISTAL PHALANX","86301 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9","86813 - HC CHG HLA TYPING A/B/C MULTIPLE ANTIGENS","77074 - HC CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED","26432 - CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING"]
[null,"27265 - CLTX POST HIP ARTHRP DISLC W/O ANES","86376 - HC CHG MICROSOMAL ANTIBODIES EACH","26600 - CLTX METACARPAL FX W/O MANIPULATION EACH BONE","26600 - CLTX METACARPAL FX W/O MANIPULATION EACH BONE","26600 - CLTX METACARPAL FX W/O MANIPULATION EACH BONE","86304 - HC CRL;CA-125","26341 - MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD","86817 - HC CHG HLA TYPING DR/DQ MULTIPLE ANTIGENS","86813 - HC CHG HLA TYPING A/B/C MULTIPLE ANTIGENS","86817 - HC CHG HLA TYPING DR/DQ MULTIPLE ANTIGENS","86304 - HC CRL;CA-125","26535 - HC ARTHROPLASTY I-P JT","86817 - HC CHG HLA TYPING DR/DQ MULTIPLE ANTIGENS","26341 - MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD","86304 - HC CRL;CA-125","86817 - HC CHG HLA TYPING DR/DQ MULTIPLE ANTIGENS","77075 - HC CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL","26535 - HC ARTHROPLASTY I-P JT"]
[null,"27266 - HC CLOSED RX POST HIP FIX DISLOC,ANESTH","86382 - HC CHG NEUTRALIZATION TEST VIRAL","26605 - CLTX METACARPAL FX W/MANIPULATION EACH BONE","26605 - CLTX METACARPAL FX W/MANIPULATION EACH BONE","26605 - CLTX METACARPAL FX W/MANIPULATION EACH BONE","86308 - HC CHG HETEROPHILE ANTIBODIES SCREEN","26410 - HC REPAIR EXTEN TENDON,DORSUM HAND,EA","86850 - HC CHG ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE","86817 - HC CHG HLA TYPING DR/DQ MULTIPLE ANTIGENS","86850 - HC CHG ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE","86308 - HC CHG HETEROPHILE ANTIBODIES SCREEN","26600 - CLTX METACARPAL FX W/O MANIPULATION EACH BONE","86850 - HC CHG ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE","26410 - HC REPAIR EXTEN TENDON,DORSUM HAND,EA","86308 - HC CHG HETEROPHILE ANTIBODIES SCREEN","86850 - HC CHG ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE","77076 - HC X-RAYS BONE SURVEY INFANT","26600 - CLTX METACARPAL FX W/O MANIPULATION EACH BONE"]
[null,"27299 - PR HIP ABDUCTOR REPAIR","86403 - HC CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY","26641 - CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ","26641 - CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ","26641 - CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ","86316 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE","26418 - HC REPAIR EXTEN TENDON,DORSUM FINGER,EA","86880 - HC CHG ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM","86850 - HC CHG ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE","86880 - HC CHG ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM","86316 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE","26605 - CLTX METACARPAL FX W/MANIPULATION EACH BONE","86880 - HC CHG ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM","26418 - HC REPAIR EXTEN TENDON,DORSUM FINGER,EA","86316 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE","86880 - HC CHG ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM","77077 - HC CHG JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS","26605 - CLTX METACARPAL FX W/MANIPULATION EACH BONE"]
[null,"27301 - HC INCIS/DRAIN THIGH/KNEE ABSCESS,DEEP","86431 - HC CHG RHEUMATOID FACTOR QUANTITATIVE","26645 - CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ","26645 - CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ","26645 - CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ","86317 - HC IMMUNOASSAY,INFECT AGENT,QUANT","26432 - CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING","86886 - HC CHG ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER","86880 - HC CHG ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM","86886 - HC CHG ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER","86317 - HC IMMUNOASSAY,INFECT AGENT,QUANT","26641 - CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ","86886 - HC CHG ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER","26432 - CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING","86317 - HC IMMUNOASSAY,INFECT AGENT,QUANT","86886 - HC CHG ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER","77080 - DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL","26641 - CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ"]
[null,"27306 - HC INCISION OF THIGH TENDON","86480 - HC CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON","26650 - HC PRQ SKEL FIXATION CARP/MTCRPL FX DISLOCATE THUMB","26650 - HC PRQ SKEL FIXATION CARP/MTCRPL FX DISLOCATE THUMB","26650 - HC PRQ SKEL FIXATION CARP/MTCRPL FX DISLOCATE THUMB","86328 - IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY; CORONAVIRUS 2","26535 - HC ARTHROPLASTY I-P JT","86900 - HC CHG BLOOD TYPING SEROLOGIC ABO","86886 - HC CHG ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER","86900 - HC CHG BLOOD TYPING SEROLOGIC ABO","86328 - IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY; CORONAVIRUS 2","26645 - CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ","86900 - HC CHG BLOOD TYPING SEROLOGIC ABO","26535 - HC ARTHROPLASTY I-P JT","86328 - IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY; CORONAVIRUS 2","86900 - HC CHG BLOOD TYPING SEROLOGIC ABO","77081 - DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL","26645 - CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ"]
[null,"27323 - HC BX THIGH/KNEE SOFT TISSUES,SUPERF","86481 - HC TB TEST CELL MEDIATED ANTIGEN RESPONSE, ENUM GAMMA INTERFRON T-CELL","26670 - CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES","26670 - CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES","26670 - CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES","86331 - HC CHG IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY","26600 - CLTX METACARPAL FX W/O MANIPULATION EACH BONE","86901 - HC CHG BLOOD TYPING SEROLOGIC RH (D)","86900 - HC CHG BLOOD TYPING SEROLOGIC ABO","86901 - HC CHG BLOOD TYPING SEROLOGIC RH (D)","86331 - HC CHG IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY","26650 - HC PRQ SKEL FIXATION CARP/MTCRPL FX DISLOCATE THUMB","86901 - HC CHG BLOOD TYPING SEROLOGIC RH (D)","26600 - CLTX METACARPAL FX W/O MANIPULATION EACH BONE","86331 - HC CHG IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY","86901 - HC CHG BLOOD TYPING SEROLOGIC RH (D)","77084 - HC CHG BONE MARROW BLOOD SUPPLY","26650 - HC PRQ SKEL FIXATION CARP/MTCRPL FX DISLOCATE THUMB"]
[null,"27324 - HC BX THIGH/KNEE SOFT TISSUES,DEEP","86485 - HC CHG SKIN TEST CANDIDA","26700 - CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES","26700 - CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES","26700 - CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES","86334 - HC CHG IMMUNOFIXJ ELECTROPHORESIS SERUM","26605 - CLTX METACARPAL FX W/MANIPULATION EACH BONE","86902 - HC CHG BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH","86901 - HC CHG BLOOD TYPING SEROLOGIC RH (D)","86902 - HC CHG BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH","86334 - HC CHG IMMUNOFIXJ ELECTROPHORESIS SERUM","26670 - CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES","86902 - HC CHG BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH","26605 - CLTX METACARPAL FX W/MANIPULATION EACH BONE","86334 - HC CHG IMMUNOFIXJ ELECTROPHORESIS SERUM","86902 - HC CHG BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH","77280 - HC SIM SIMPLE","26670 - CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES"]
[null,"27327 - EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ <3CM","86486 - SKIN TEST UNLISTED ANTIGEN EACH","26720 - CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA","26720 - CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA","26720 - CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA","86335 - HC CHG IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS","26641 - CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ","86905 - HC CHG BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH","86902 - HC CHG BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH","86905 - HC CHG BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH","86335 - HC CHG IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS","26700 - CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES","86905 - HC CHG BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH","26641 - CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ","86335 - HC CHG IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS","86905 - HC CHG BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH","77285 - HC SIM INTERMED","26700 - CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES"]
[null,"27328 - HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM","86580 - SKIN TEST TUBERCULOSIS INTRADERMAL","26725 - CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA","26725 - CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA","26725 - CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA","86336 - HC CHG INHIBIN A","26645 - CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ","87015 - HC CHG CONCENTRATION INFECTIOUS AGENTS","86905 - HC CHG BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH","87015 - HC CHG CONCENTRATION INFECTIOUS AGENTS","86336 - HC CHG INHIBIN A","26720 - CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA","87015 - HC CHG CONCENTRATION INFECTIOUS AGENTS","26645 - CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ","86336 - HC CHG INHIBIN A","87015 - HC CHG CONCENTRATION INFECTIOUS AGENTS","77290 - HC SIM COMPLEX","26720 - CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA"]
[null,"27337 - EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/>","86592 - HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL","26740 - CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ","26740 - CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ","26740 - CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ","86340 - HC CHG INTRINSIC FACTOR ANTIBODIES","26650 - HC PRQ SKEL FIXATION CARP/MTCRPL FX DISLOCATE THUMB","87040 - HC CHG CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES","87015 - HC CHG CONCENTRATION INFECTIOUS AGENTS","87040 - HC CHG CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES","86340 - HC CHG INTRINSIC FACTOR ANTIBODIES","26725 - CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA","87040 - HC CHG CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES","26650 - HC PRQ SKEL FIXATION CARP/MTCRPL FX DISLOCATE THUMB","86340 - HC CHG INTRINSIC FACTOR ANTIBODIES","87040 - HC CHG CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES","77295 - HC COMPUTER GEN PLAN  3D","26725 - CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA"]
[null,"27339 - HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC 5+ CM","86593 - HC SYPHILIS;QN","26742 - CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ","26742 - CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ","26742 - CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ","86341 - HC CHG ISLET CELL ANTIBODY","26670 - CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES","87045 - HC CHG CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL","87040 - HC CHG CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES","87045 - HC CHG CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL","86341 - HC CHG ISLET CELL ANTIBODY","26740 - CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ","87045 - HC CHG CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL","26670 - CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES","86341 - HC CHG ISLET CELL ANTIBODY","87045 - HC CHG CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL","77300 - HC BASIC DOS","26740 - CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ"]
[null,"27369 - HC NJX CNTRST KNE ARTHG/CT/MRI","86606 - HC CHG ANTIBODY ASPERGILLUS","26750 - CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA","26750 - CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA","26750 - CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA","86353 - HC CHG LYMPHOCYTE TRANSFORMATION","26700 - CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES","87046 - HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA","87045 - HC CHG CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL","87046 - HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA","86353 - HC CHG LYMPHOCYTE TRANSFORMATION","26742 - CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ","87046 - HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA","26700 - CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES","86353 - HC CHG LYMPHOCYTE TRANSFORMATION","87046 - HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA","77301 - HC IMRT PLAN","26742 - CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ"]
[null,"27372 - REMOVAL FOREIGN BODY DEEP THIGH/KNEE","86609 - HC CHG ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED","26755 - CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA","26755 - CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA","26755 - CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA","86355 - HC B CELLS TOTAL COUNT","26720 - CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA","87070 - CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL","87046 - HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA","87070 - CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL","86355 - HC B CELLS TOTAL COUNT","26750 - CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA","87070 - CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL","26720 - CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA","86355 - HC B CELLS TOTAL COUNT","87070 - CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL","77306 - TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION","26750 - CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA"]
[null,"27500 - CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION","86611 - HC BARTONELLA, ANTIBODY","26765 - HC OPEN TX DISTAL PHALANGEAL FRACTURE EACH","26765 - HC OPEN TX DISTAL PHALANGEAL FRACTURE EACH","26765 - HC OPEN TX DISTAL PHALANGEAL FRACTURE EACH","86357 - HC NK CELLS, TOTAL COUNT","26725 - CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA","87075 - HC CHG CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID","87070 - CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL","87075 - HC CHG CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID","86357 - HC NK CELLS, TOTAL COUNT","26755 - CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA","87075 - HC CHG CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID","26725 - CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA","86357 - HC NK CELLS, TOTAL COUNT","87075 - HC CHG CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID","77307 - TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY","26755 - CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA"]
[null,"27501 - CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANJ","86612 - HC CHG BLASTOMYCES ANTIBODY","26770 - CLTX IPHAL JT DISLC W/MANJ W/O ANES","26770 - CLTX IPHAL JT DISLC W/MANJ W/O ANES","26770 - CLTX IPHAL JT DISLC W/MANJ W/O ANES","86359 - HC CHG T CELLS TOTAL COUNT","26740 - CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ","87076 - HC CHG CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL","87075 - HC CHG CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID","87076 - HC CHG CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL","86359 - HC CHG T CELLS TOTAL COUNT","26765 - HC OPEN TX DISTAL PHALANGEAL FRACTURE EACH","87076 - HC CHG CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL","26740 - CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ","86359 - HC CHG T CELLS TOTAL COUNT","87076 - HC CHG CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL","77316 - BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL","26765 - HC OPEN TX DISTAL PHALANGEAL FRACTURE EACH"]
[null,"27502 - CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ","86615 - HC Q;BORDTLLA AB;IGG,IGA","26775 - HC CLTX IPHAL JT DISLC W/MANJ REQ ANES","26775 - HC CLTX IPHAL JT DISLC W/MANJ REQ ANES","26775 - HC CLTX IPHAL JT DISLC W/MANJ REQ ANES","86360 - HC CHG T CELLS ABSOLUTE CD4&CD8 COUNT RATIO","26742 - CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ","87077 - HC CHG CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL","87076 - HC CHG CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL","87077 - HC CHG CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL","86360 - HC CHG T CELLS ABSOLUTE CD4&CD8 COUNT RATIO","26770 - CLTX IPHAL JT DISLC W/MANJ W/O ANES","87077 - HC CHG CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL","26742 - CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ","86360 - HC CHG T CELLS ABSOLUTE CD4&CD8 COUNT RATIO","87077 - HC CHG CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL","77317 - BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL","26770 - CLTX IPHAL JT DISLC W/MANJ W/O ANES"]
[null,"27508 - CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ","86617 - HC CHG ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST","26951 - HC AMPUTATION FINGER/THUMB","26951 - HC AMPUTATION FINGER/THUMB","26951 - HC AMPUTATION FINGER/THUMB","86376 - HC CHG MICROSOMAL ANTIBODIES EACH","26750 - CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA","87081 - HC CULT,BACT,SCR,H PYLORI","87077 - HC CHG CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL","87081 - HC CULT,BACT,SCR,H PYLORI","86376 - HC CHG MICROSOMAL ANTIBODIES EACH","26775 - HC CLTX IPHAL JT DISLC W/MANJ REQ ANES","87081 - HC CULT,BACT,SCR,H PYLORI","26750 - CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA","86376 - HC CHG MICROSOMAL ANTIBODIES EACH","87081 - HC CULT,BACT,SCR,H PYLORI","77318 - BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL","26775 - HC CLTX IPHAL JT DISLC W/MANJ REQ ANES"]
[null,"27520 - CLOSED TX PATELLAR FRACTURE W/O MANIPULATION","86618 - HC Q;LYME AB INDEX CNS INFEC","26990 - HC INCIS/DRAIN PELVIS/HIP,DEEP ABCESS","26990 - HC INCIS/DRAIN PELVIS/HIP,DEEP ABCESS","26990 - HC INCIS/DRAIN PELVIS/HIP,DEEP ABCESS","86382 - HC CHG NEUTRALIZATION TEST VIRAL","26755 - CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA","87086 - HC CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE","87081 - HC CULT,BACT,SCR,H PYLORI","87086 - HC CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE","86382 - HC CHG NEUTRALIZATION TEST VIRAL","26951 - HC AMPUTATION FINGER/THUMB","87086 - HC CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE","26755 - CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA","86382 - HC CHG NEUTRALIZATION TEST VIRAL","87086 - HC CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE","77321 - HC SPEC PORT PLAN INCLUDES ELECTRONS","26951 - HC AMPUTATION FINGER/THUMB"]
[null,"27530 - CLTX TIBIAL FX PROXIMAL W/O MANIPULATION","86622 - HC CHG ANTIBODY BRUCELLA","27040 - HC BX SOFT TISSUES,PELV/HIP,SUPERFICL","27040 - HC BX SOFT TISSUES,PELV/HIP,SUPERFICL","27040 - HC BX SOFT TISSUES,PELV/HIP,SUPERFICL","86403 - HC CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY","26765 - HC OPEN TX DISTAL PHALANGEAL FRACTURE EACH","87088 - HC CHG CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE","87086 - HC CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE","87088 - HC CHG CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE","86403 - HC CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY","26990 - HC INCIS/DRAIN PELVIS/HIP,DEEP ABCESS","87088 - HC CHG CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE","26765 - HC OPEN TX DISTAL PHALANGEAL FRACTURE EACH","86403 - HC CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY","87088 - HC CHG CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE","77331 - HC SPEC DOSI","26990 - HC INCIS/DRAIN PELVIS/HIP,DEEP ABCESS"]
[null,"27532 - HC CLTX TIBIAL FX PROXIMAL W/WO MANJ W/SKEL TRACJ","86625 - HC CAMPYLOBACTER, ANTIBODY","27041 - HC BX SOFT TISSUES,PELV/HIP,DEEP","27041 - HC BX SOFT TISSUES,PELV/HIP,DEEP","27041 - HC BX SOFT TISSUES,PELV/HIP,DEEP","86431 - HC CHG RHEUMATOID FACTOR QUANTITATIVE","26770 - CLTX IPHAL JT DISLC W/MANJ W/O ANES","87102 - HC CHG CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD","87088 - HC CHG CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE","87102 - HC CHG CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD","86431 - HC CHG RHEUMATOID FACTOR QUANTITATIVE","27040 - HC BX SOFT TISSUES,PELV/HIP,SUPERFICL","87102 - HC CHG CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD","26770 - CLTX IPHAL JT DISLC W/MANJ W/O ANES","86431 - HC CHG RHEUMATOID FACTOR QUANTITATIVE","87102 - HC CHG CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD","77332 - HC TX DEVICES SIMP","27040 - HC BX SOFT TISSUES,PELV/HIP,SUPERFICL"]
[null,"27538 - CLTX INTERCONDYLAR SPI&/TUBRST FX KNE W/WO MAN","86631 - HC CHG, CHLAMYDIA, ANTIBODY","27043 - EXCISION TUMOR SOFT TISSUE PELVIS&HIP SUBQ 3+CM","27043 - EXCISION TUMOR SOFT TISSUE PELVIS&HIP SUBQ 3+CM","27043 - EXCISION TUMOR SOFT TISSUE PELVIS&HIP SUBQ 3+CM","86480 - HC CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON","26775 - HC CLTX IPHAL JT DISLC W/MANJ REQ ANES","87103 - HC CHG CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD","87102 - HC CHG CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD","87103 - HC CHG CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD","86480 - HC CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON","27041 - HC BX SOFT TISSUES,PELV/HIP,DEEP","87103 - HC CHG CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD","26775 - HC CLTX IPHAL JT DISLC W/MANJ REQ ANES","86480 - HC CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON","87103 - HC CHG CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD","77333 - HC TX DEVICES INT","27041 - HC BX SOFT TISSUES,PELV/HIP,DEEP"]
[null,"27550 - CLOSED TX KNEE DISLOCATION W/O ANESTHESIA","86632 - HC CHG CHLAMYDIA, IGM ANTIBODY","27047 - EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ <3CM","27047 - EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ <3CM","27047 - EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ <3CM","86481 - HC TB TEST CELL MEDIATED ANTIGEN RESPONSE, ENUM GAMMA INTERFRON T-CELL","26951 - HC AMPUTATION FINGER/THUMB","87106 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST","87103 - HC CHG CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD","87106 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST","86481 - HC TB TEST CELL MEDIATED ANTIGEN RESPONSE, ENUM GAMMA INTERFRON T-CELL","27043 - EXCISION TUMOR SOFT TISSUE PELVIS&HIP SUBQ 3+CM","87106 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST","26951 - HC AMPUTATION FINGER/THUMB","86481 - HC TB TEST CELL MEDIATED ANTIGEN RESPONSE, ENUM GAMMA INTERFRON T-CELL","87106 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST","77334 - HC TX DEVICES COMP","27043 - EXCISION TUMOR SOFT TISSUE PELVIS&HIP SUBQ 3+CM"]
[null,"27560 - CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA","86635 - HC CHG ANTIBODY COCCIDIOIDES","27048 - EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC <5CM","27048 - EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC <5CM","27048 - EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC <5CM","86485 - HC CHG SKIN TEST CANDIDA","26990 - HC INCIS/DRAIN PELVIS/HIP,DEEP ABCESS","87107 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD","87106 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST","87107 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD","86485 - HC CHG SKIN TEST CANDIDA","27047 - EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ <3CM","87107 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD","26990 - HC INCIS/DRAIN PELVIS/HIP,DEEP ABCESS","86485 - HC CHG SKIN TEST CANDIDA","87107 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD","77336 - HC MED PHYSICS CONSULT/WK","27047 - EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ <3CM"]
[null,"27603 - HC DRAIN LOWER LEG DEEP ABSC/HEMATOMA","86638 - HC CHG, Q FEVER ANTIBODY","27086 - RMVL FOREIGN BODY PELVIS/HIP SUBCUTANEOUS TISS","27086 - RMVL FOREIGN BODY PELVIS/HIP SUBCUTANEOUS TISS","27086 - RMVL FOREIGN BODY PELVIS/HIP SUBCUTANEOUS TISS","86486 - SKIN TEST UNLISTED ANTIGEN EACH","27040 - HC BX SOFT TISSUES,PELV/HIP,SUPERFICL","87110 - HC CHG CULTURE, CHLAMYDIA","87107 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD","87110 - HC CHG CULTURE, CHLAMYDIA","86486 - SKIN TEST UNLISTED ANTIGEN EACH","27048 - EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC <5CM","87110 - HC CHG CULTURE, CHLAMYDIA","27040 - HC BX SOFT TISSUES,PELV/HIP,SUPERFICL","86486 - SKIN TEST UNLISTED ANTIGEN EACH","87110 - HC CHG CULTURE, CHLAMYDIA","77338 - HC MLC DEVICES FOR IMRT","27048 - EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC <5CM"]
[null,"27605 - TENOTOMY PRQ ACHILLES TENDON SPX LOCAL ANES","86644 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV","27087 - REMOVAL FOREIGN BODY PELVIS/HIP DEEP","27087 - REMOVAL FOREIGN BODY PELVIS/HIP DEEP","27087 - REMOVAL FOREIGN BODY PELVIS/HIP DEEP","86580 - SKIN TEST TUBERCULOSIS INTRADERMAL","27041 - HC BX SOFT TISSUES,PELV/HIP,DEEP","87116 - HC CHG CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL","87110 - HC CHG CULTURE, CHLAMYDIA","87116 - HC CHG CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL","86580 - SKIN TEST TUBERCULOSIS INTRADERMAL","27086 - RMVL FOREIGN BODY PELVIS/HIP SUBCUTANEOUS TISS","87116 - HC CHG CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL","27041 - HC BX SOFT TISSUES,PELV/HIP,DEEP","86580 - SKIN TEST TUBERCULOSIS INTRADERMAL","87116 - HC CHG CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL","77370 - HC SPEC MED PHYSICS CONSULT","27086 - RMVL FOREIGN BODY PELVIS/HIP SUBCUTANEOUS TISS"]
[null,"27613 - HC BX LOW LEG SOFT TISSUE,SUPERFICIAL","86645 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV IGM","27093 - HC INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA","27093 - HC INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA","27093 - HC INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA","86592 - HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL","27043 - EXCISION TUMOR SOFT TISSUE PELVIS&HIP SUBQ 3+CM","87118 - HC CHG CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL","87116 - HC CHG CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL","87118 - HC CHG CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL","86592 - HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL","27087 - REMOVAL FOREIGN BODY PELVIS/HIP DEEP","87118 - HC CHG CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL","27043 - EXCISION TUMOR SOFT TISSUE PELVIS&HIP SUBQ 3+CM","86592 - HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL","87118 - HC CHG CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL","77385 - INTENSITY MODULATED RADIATION TX DLVR SIMPLE","27087 - REMOVAL FOREIGN BODY PELVIS/HIP DEEP"]
[null,"27614 - HC BX LOW LEG SOFT TISSUE,DEEP","86648 - HC CHG ANTIBODY DIPHTHERIA","27096 - INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA","27096 - INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA","27096 - INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA","86593 - HC SYPHILIS;QN","27047 - EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ <3CM","87140 - HC CHG CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM","87118 - HC CHG CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL","87140 - HC CHG CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM","86593 - HC SYPHILIS;QN","27093 - HC INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA","87140 - HC CHG CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM","27047 - EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ <3CM","86593 - HC SYPHILIS;QN","87140 - HC CHG CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM","77386 - INTENSITY MODULATED RADIATION TX DLVR COMPLEX","27093 - HC INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA"]
[null,"27618 - EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM","86652 - HC CHG, ENCEPHAL ANTIBODY EAST EQU","27197 - HC CLSD TX PELVIC RING FX W/O MANIPULATION","27197 - HC CLSD TX PELVIC RING FX W/O MANIPULATION","27197 - HC CLSD TX PELVIC RING FX W/O MANIPULATION","86606 - HC CHG ANTIBODY ASPERGILLUS","27048 - EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC <5CM","87149 - HC CHG CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM","87140 - HC CHG CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM","87149 - HC CHG CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM","86606 - HC CHG ANTIBODY ASPERGILLUS","27096 - INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA","87149 - HC CHG CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM","27048 - EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC <5CM","86606 - HC CHG ANTIBODY ASPERGILLUS","87149 - HC CHG CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM","77387 - GUIDANCE FOR LOCLZJ TARGET VOL FOR RADJ TX DLVR","27096 - INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA"]
[null,"27632 - EXCISION TUMOR SOFT TISSUE LEG/ANKLE SUBQ 3 CM/>","86654 - CHG ANTIBODY ENCEPHALITIS WESTRN EQUINE","27200 - HC CLOSED TREATMENT COCCYGEAL FRACTURE","27200 - HC CLOSED TREATMENT COCCYGEAL FRACTURE","27200 - HC CLOSED TREATMENT COCCYGEAL FRACTURE","86609 - HC CHG ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED","27086 - RMVL FOREIGN BODY PELVIS/HIP SUBCUTANEOUS TISS","87150 - HC CHG CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM","87149 - HC CHG CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM","87150 - HC CHG CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM","86609 - HC CHG ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED","27197 - HC CLSD TX PELVIC RING FX W/O MANIPULATION","87150 - HC CHG CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM","27086 - RMVL FOREIGN BODY PELVIS/HIP SUBCUTANEOUS TISS","86609 - HC CHG ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED","87150 - HC CHG CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM","77399 - HC UNLISTED MED PHYSICS PROC","27197 - HC CLSD TX PELVIC RING FX W/O MANIPULATION"]
[null,"27634 - HC EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5+CM","86658 - HC CHG ENTEROVIRUS ANTIBODY","27220 - CLTX ACETABULUM HIP/SOCKT FX W/O MANJ","27220 - CLTX ACETABULUM HIP/SOCKT FX W/O MANJ","27220 - CLTX ACETABULUM HIP/SOCKT FX W/O MANJ","86611 - HC BARTONELLA, ANTIBODY","27087 - REMOVAL FOREIGN BODY PELVIS/HIP DEEP","87153 - HC Q;BACT ID,PHENO,SEQ","87150 - HC CHG CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM","87153 - HC Q;BACT ID,PHENO,SEQ","86611 - HC BARTONELLA, ANTIBODY","27200 - HC CLOSED TREATMENT COCCYGEAL FRACTURE","87153 - HC Q;BACT ID,PHENO,SEQ","27087 - REMOVAL FOREIGN BODY PELVIS/HIP DEEP","86611 - HC BARTONELLA, ANTIBODY","87153 - HC Q;BACT ID,PHENO,SEQ","77402 - HC TX DEL =>1 MEV SIMPLE","27200 - HC CLOSED TREATMENT COCCYGEAL FRACTURE"]
[null,"27648 - HC INJECTION ANKLE ARTHROGRAPHY","86663 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA","27230 - CLTX FEM FX PROX END NCK W/O MANJ","27230 - CLTX FEM FX PROX END NCK W/O MANJ","27230 - CLTX FEM FX PROX END NCK W/O MANJ","86612 - HC CHG BLASTOMYCES ANTIBODY","27093 - HC INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA","87172 - HC CHG PINWORM EXAMINATION","87153 - HC Q;BACT ID,PHENO,SEQ","87172 - HC CHG PINWORM EXAMINATION","86612 - HC CHG BLASTOMYCES ANTIBODY","27220 - CLTX ACETABULUM HIP/SOCKT FX W/O MANJ","87172 - HC CHG PINWORM EXAMINATION","27093 - HC INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA","86612 - HC CHG BLASTOMYCES ANTIBODY","87172 - HC CHG PINWORM EXAMINATION","77407 - HC TX DEL => 1 MEV, 2 AREA, 3 PORTS - INTERMEDIATE","27220 - CLTX ACETABULUM HIP/SOCKT FX W/O MANJ"]
[null,"27685 - HC LENGTH/SHORT LEG/ANKL TENDON,SINGLE","86664 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA","27238 - CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ","27238 - CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ","27238 - CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ","86615 - HC Q;BORDTLLA AB;IGG,IGA","27096 - INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA","87176 - HC CHG HOMOGENIZATION TISSUE CULTURE","87172 - HC CHG PINWORM EXAMINATION","87176 - HC CHG HOMOGENIZATION TISSUE CULTURE","86615 - HC Q;BORDTLLA AB;IGG,IGA","27230 - CLTX FEM FX PROX END NCK W/O MANJ","87176 - HC CHG HOMOGENIZATION TISSUE CULTURE","27096 - INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA","86615 - HC Q;BORDTLLA AB;IGG,IGA","87176 - HC CHG HOMOGENIZATION TISSUE CULTURE","77412 - HC TX DEL =>1 MEV - COMPLEX","27230 - CLTX FEM FX PROX END NCK W/O MANJ"]
[null,"27750 - CLTX TIBIAL SHAFT FX W/O MANIPULATION","86665 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA","27246 - CLTX GREATER TROCHANTERIC FX W/O MANJ","27246 - CLTX GREATER TROCHANTERIC FX W/O MANJ","27246 - CLTX GREATER TROCHANTERIC FX W/O MANJ","86617 - HC CHG ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST","27197 - HC CLSD TX PELVIC RING FX W/O MANIPULATION","87177 - HC CHG OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID","87176 - HC CHG HOMOGENIZATION TISSUE CULTURE","87177 - HC CHG OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID","86617 - HC CHG ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST","27238 - CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ","87177 - HC CHG OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID","27197 - HC CLSD TX PELVIC RING FX W/O MANIPULATION","86617 - HC CHG ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST","87177 - HC CHG OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID","77417 - HC PORT IMAGES","27238 - CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ"]
[null,"27752 - CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ","86666 - HC CHG ANTIBODY EHRLICHIA","27250 - CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA","27250 - CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA","27250 - CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA","86618 - HC Q;LYME AB INDEX CNS INFEC","27200 - HC CLOSED TREATMENT COCCYGEAL FRACTURE","87181 - HC CHG SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ","87177 - HC CHG OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID","87181 - HC CHG SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ","86618 - HC Q;LYME AB INDEX CNS INFEC","27246 - CLTX GREATER TROCHANTERIC FX W/O MANJ","87181 - HC CHG SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ","27200 - HC CLOSED TREATMENT COCCYGEAL FRACTURE","86618 - HC Q;LYME AB INDEX CNS INFEC","87181 - HC CHG SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ","77470 - HC SPEC TX PROC/CONCURRENT CHEMO","27246 - CLTX GREATER TROCHANTERIC FX W/O MANJ"]
[null,"27759 - HC TREAT TIBIAL SHAFT FX, INTRAMED IMPLANT","86677 - HC CHG ANTIBODY HELICOBACTER PYLORI","27252 - HC TX HIP DISLOC W/ANESTH","27252 - HC TX HIP DISLOC W/ANESTH","27252 - HC TX HIP DISLOC W/ANESTH","86622 - HC CHG ANTIBODY BRUCELLA","27220 - CLTX ACETABULUM HIP/SOCKT FX W/O MANJ","87184 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD","87181 - HC CHG SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ","87184 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD","86622 - HC CHG ANTIBODY BRUCELLA","27250 - CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA","87184 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD","27220 - CLTX ACETABULUM HIP/SOCKT FX W/O MANJ","86622 - HC CHG ANTIBODY BRUCELLA","87184 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD","77520 - PROTON BEAM DEL,SIMPLE","27250 - CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA"]
[null,"27760 - CLTX MEDIAL MALLEOLUS FX W/O MANIPULATION","86682 - HC Q;CYSTICERCUS AB,BLOT","27256 - TX SPONTAN HIP DISLC ABDCT SPLNT/TRCJ W/O ANES","27256 - TX SPONTAN HIP DISLC ABDCT SPLNT/TRCJ W/O ANES","27256 - TX SPONTAN HIP DISLC ABDCT SPLNT/TRCJ W/O ANES","86625 - HC CAMPYLOBACTER, ANTIBODY","27230 - CLTX FEM FX PROX END NCK W/O MANJ","87185 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ","87184 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD","87185 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ","86625 - HC CAMPYLOBACTER, ANTIBODY","27252 - HC TX HIP DISLOC W/ANESTH","87185 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ","27230 - CLTX FEM FX PROX END NCK W/O MANJ","86625 - HC CAMPYLOBACTER, ANTIBODY","87185 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ","77522 - PROTON BEAM DEL,SINGLE, W/COMPENSAT","27252 - HC TX HIP DISLOC W/ANESTH"]
[null,"27762 - CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ","86689 - HC HTLV/HIV CONFIRMATORY TEST","27257 - HC TX HIPDISLOC ABDCT WMANP","27257 - HC TX HIPDISLOC ABDCT WMANP","27257 - HC TX HIPDISLOC ABDCT WMANP","86631 - HC CHG, CHLAMYDIA, ANTIBODY","27238 - CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ","87186 - HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ","87185 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ","87186 - HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ","86631 - HC CHG, CHLAMYDIA, ANTIBODY","27256 - TX SPONTAN HIP DISLC ABDCT SPLNT/TRCJ W/O ANES","87186 - HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ","27238 - CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ","86631 - HC CHG, CHLAMYDIA, ANTIBODY","87186 - HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ","77523 - PROTON,BEAM DEL,INTERMED","27256 - TX SPONTAN HIP DISLC ABDCT SPLNT/TRCJ W/O ANES"]
[null,"27767 - HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANIP","86692 - HC CHG ANTIBODY HEP DELTA AGENT","27265 - CLTX POST HIP ARTHRP DISLC W/O ANES","27265 - CLTX POST HIP ARTHRP DISLC W/O ANES","27265 - CLTX POST HIP ARTHRP DISLC W/O ANES","86632 - HC CHG CHLAMYDIA, IGM ANTIBODY","27246 - CLTX GREATER TROCHANTERIC FX W/O MANJ","87188 - HC CHG SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT","87186 - HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ","87188 - HC CHG SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT","86632 - HC CHG CHLAMYDIA, IGM ANTIBODY","27257 - HC TX HIPDISLOC ABDCT WMANP","87188 - HC CHG SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT","27246 - CLTX GREATER TROCHANTERIC FX W/O MANJ","86632 - HC CHG CHLAMYDIA, IGM ANTIBODY","87188 - HC CHG SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT","77525 - PROTON BEAM DEL,MULTIPLE,COMPLEX","27257 - HC TX HIPDISLOC ABDCT WMANP"]
[null,"27768 - HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ","86694 - HC CHG ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST","27266 - HC CLOSED RX POST HIP FIX DISLOC,ANESTH","27266 - HC CLOSED RX POST HIP FIX DISLOC,ANESTH","27266 - HC CLOSED RX POST HIP FIX DISLOC,ANESTH","86635 - HC CHG ANTIBODY COCCIDIOIDES","27250 - CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA","87205 - HC CHG SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL","87188 - HC CHG SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT","87205 - HC CHG SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL","86635 - HC CHG ANTIBODY COCCIDIOIDES","27265 - CLTX POST HIP ARTHRP DISLC W/O ANES","87205 - HC CHG SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL","27250 - CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA","86635 - HC CHG ANTIBODY COCCIDIOIDES","87205 - HC CHG SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL","77761 - HC BRACHY INCAV SMP","27265 - CLTX POST HIP ARTHRP DISLC W/O ANES"]
[null,"27780 - CLTX PROX FIBULA/SHFT FX W/O MANJ","86695 - HC CHG ANTIBODY HERPES SMPLX TYPE 1","27301 - HC INCIS/DRAIN THIGH/KNEE ABSCESS,DEEP","27301 - HC INCIS/DRAIN THIGH/KNEE ABSCESS,DEEP","27301 - HC INCIS/DRAIN THIGH/KNEE ABSCESS,DEEP","86638 - HC CHG, Q FEVER ANTIBODY","27252 - HC TX HIP DISLOC W/ANESTH","87206 - HC CHG SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT","87205 - HC CHG SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL","87206 - HC CHG SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT","86638 - HC CHG, Q FEVER ANTIBODY","27266 - HC CLOSED RX POST HIP FIX DISLOC,ANESTH","87206 - HC CHG SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT","27252 - HC TX HIP DISLOC W/ANESTH","86638 - HC CHG, Q FEVER ANTIBODY","87206 - HC CHG SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT","77762 - HC BRACHY INCAV INT","27266 - HC CLOSED RX POST HIP FIX DISLOC,ANESTH"]
[null,"27781 - CLTX PROX FIBULA/SHFT FX W/MANJ","86696 - HC CHG ANTIBODY HERPES SMPLX TYPE 2","27306 - HC INCISION OF THIGH TENDON","27306 - HC INCISION OF THIGH TENDON","27306 - HC INCISION OF THIGH TENDON","86644 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV","27256 - TX SPONTAN HIP DISLC ABDCT SPLNT/TRCJ W/O ANES","87207 - SMR PRIM SRC SPEC STAIN BODIES/PARASITS","87206 - HC CHG SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT","87207 - SMR PRIM SRC SPEC STAIN BODIES/PARASITS","86644 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV","27301 - HC INCIS/DRAIN THIGH/KNEE ABSCESS,DEEP","87207 - SMR PRIM SRC SPEC STAIN BODIES/PARASITS","27256 - TX SPONTAN HIP DISLC ABDCT SPLNT/TRCJ W/O ANES","86644 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV","87207 - SMR PRIM SRC SPEC STAIN BODIES/PARASITS","77763 - HC BRACHY INCAV CMP","27301 - HC INCIS/DRAIN THIGH/KNEE ABSCESS,DEEP"]
[null,"27786 - CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ","86698 - HC CHG ANTIBODY HISTOPLASMA","27323 - HC BX THIGH/KNEE SOFT TISSUES,SUPERF","27323 - HC BX THIGH/KNEE SOFT TISSUES,SUPERF","27323 - HC BX THIGH/KNEE SOFT TISSUES,SUPERF","86645 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV IGM","27257 - HC TX HIPDISLOC ABDCT WMANP","87209 - HC CHG SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS","87207 - SMR PRIM SRC SPEC STAIN BODIES/PARASITS","87209 - HC CHG SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS","86645 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV IGM","27306 - HC INCISION OF THIGH TENDON","87209 - HC CHG SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS","27257 - HC TX HIPDISLOC ABDCT WMANP","86645 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV IGM","87209 - HC CHG SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS","77767 - HC HDR RDNCL SKSURF 2.0/1CH","27306 - HC INCISION OF THIGH TENDON"]
[null,"27788 - CLTX DSTL FIBULAR FX LAT MALLS W/MANJ","86701 - HC HIV-1","27324 - HC BX THIGH/KNEE SOFT TISSUES,DEEP","27324 - HC BX THIGH/KNEE SOFT TISSUES,DEEP","27324 - HC BX THIGH/KNEE SOFT TISSUES,DEEP","86648 - HC CHG ANTIBODY DIPHTHERIA","27265 - CLTX POST HIP ARTHRP DISLC W/O ANES","87210 - SMR PRIM SRC WET MOUNT NFCT AGT","87209 - HC CHG SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS","87210 - SMR PRIM SRC WET MOUNT NFCT AGT","86648 - HC CHG ANTIBODY DIPHTHERIA","27323 - HC BX THIGH/KNEE SOFT TISSUES,SUPERF","87210 - SMR PRIM SRC WET MOUNT NFCT AGT","27265 - CLTX POST HIP ARTHRP DISLC W/O ANES","86648 - HC CHG ANTIBODY DIPHTHERIA","87210 - SMR PRIM SRC WET MOUNT NFCT AGT","77768 - HC HDR RDNCL SKSURF 2.0/2CH>","27323 - HC BX THIGH/KNEE SOFT TISSUES,SUPERF"]
[null,"27808 - CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ","86702 - HC QL/SEMI MULT AB;HIV2","27327 - EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ <3CM","27327 - EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ <3CM","27327 - EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ <3CM","86652 - HC CHG, ENCEPHAL ANTIBODY EAST EQU","27266 - HC CLOSED RX POST HIP FIX DISLOC,ANESTH","87220 - TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT","87210 - SMR PRIM SRC WET MOUNT NFCT AGT","87220 - TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT","86652 - HC CHG, ENCEPHAL ANTIBODY EAST EQU","27324 - HC BX THIGH/KNEE SOFT TISSUES,DEEP","87220 - TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT","27266 - HC CLOSED RX POST HIP FIX DISLOC,ANESTH","86652 - HC CHG, ENCEPHAL ANTIBODY EAST EQU","87220 - TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT","77770 - HC HDR RDNCL NTRSTL/1ST","27324 - HC BX THIGH/KNEE SOFT TISSUES,DEEP"]
[null,"27810 - CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ","86703 - HC HIV 1/2 ANTIBODY","27328 - HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM","27328 - HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM","27328 - HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM","86654 - CHG ANTIBODY ENCEPHALITIS WESTRN EQUINE","27299 - PR HIP ABDUCTOR REPAIR","87252 - HC CHG VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT","87220 - TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT","87252 - HC CHG VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT","86654 - CHG ANTIBODY ENCEPHALITIS WESTRN EQUINE","27327 - EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ <3CM","87252 - HC CHG VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT","27299 - PR HIP ABDUCTOR REPAIR","86654 - CHG ANTIBODY ENCEPHALITIS WESTRN EQUINE","87252 - HC CHG VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT","77771 - HC HDR RDNCL NTRSTL/2-12","27327 - EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ <3CM"]
[null,"27814 - HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE","86704 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB TOTAL","27337 - EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/>","27337 - EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/>","27337 - EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/>","86658 - HC CHG ENTEROVIRUS ANTIBODY","27301 - HC INCIS/DRAIN THIGH/KNEE ABSCESS,DEEP","87253 - HC CHG VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE","87252 - HC CHG VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT","87253 - HC CHG VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE","86658 - HC CHG ENTEROVIRUS ANTIBODY","27328 - HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM","87253 - HC CHG VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE","27301 - HC INCIS/DRAIN THIGH/KNEE ABSCESS,DEEP","86658 - HC CHG ENTEROVIRUS ANTIBODY","87253 - HC CHG VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE","77772 - HC HDR RDNCL NTRSTL/12+","27328 - HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM"]
[null,"27816 - CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION","86705 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY","27339 - HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC 5+ CM","27339 - HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC 5+ CM","27339 - HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC 5+ CM","86663 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA","27306 - HC INCISION OF THIGH TENDON","87254 - HC CHG VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA","87253 - HC CHG VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE","87254 - HC CHG VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA","86663 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA","27337 - EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/>","87254 - HC CHG VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA","27306 - HC INCISION OF THIGH TENDON","86663 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA","87254 - HC CHG VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA","77778 - HC BRACHY INST CMP","27337 - EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/>"]
[null,"27818 - CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION","86706 - HC CHG HEPATITIS B SURF ANTIBODY HBSAB","27369 - HC NJX CNTRST KNE ARTHG/CT/MRI","27369 - HC NJX CNTRST KNE ARTHG/CT/MRI","27369 - HC NJX CNTRST KNE ARTHG/CT/MRI","86664 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA","27323 - HC BX THIGH/KNEE SOFT TISSUES,SUPERF","87255 - HC CHG VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC","87254 - HC CHG VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA","87255 - HC CHG VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC","86664 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA","27339 - HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC 5+ CM","87255 - HC CHG VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC","27323 - HC BX THIGH/KNEE SOFT TISSUES,SUPERF","86664 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA","87255 - HC CHG VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC","77789 - HC BRACHY SURF APP","27339 - HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC 5+ CM"]
[null,"27824 - CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ","86707 - HC CHG HEPATITIS BE ANTIBODY HBEAB","27372 - REMOVAL FOREIGN BODY DEEP THIGH/KNEE","27372 - REMOVAL FOREIGN BODY DEEP THIGH/KNEE","27372 - REMOVAL FOREIGN BODY DEEP THIGH/KNEE","86665 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA","27324 - HC BX THIGH/KNEE SOFT TISSUES,DEEP","87260 - HC CHG IAADI ADENOVIRUS","87255 - HC CHG VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC","87260 - HC CHG IAADI ADENOVIRUS","86665 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA","27369 - HC NJX CNTRST KNE ARTHG/CT/MRI","87260 - HC CHG IAADI ADENOVIRUS","27324 - HC BX THIGH/KNEE SOFT TISSUES,DEEP","86665 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA","87260 - HC CHG IAADI ADENOVIRUS","78012 - HC CHG THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT","27369 - HC NJX CNTRST KNE ARTHG/CT/MRI"]
[null,"27825 - CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ","86708 - HC CHG HEPATITIS A ANTIBODY HAAB","27500 - CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION","27500 - CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION","27500 - CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION","86666 - HC CHG ANTIBODY EHRLICHIA","27327 - EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ <3CM","87269 - HC CHG IAADI GIARDIA","87260 - HC CHG IAADI ADENOVIRUS","87269 - HC CHG IAADI GIARDIA","86666 - HC CHG ANTIBODY EHRLICHIA","27372 - REMOVAL FOREIGN BODY DEEP THIGH/KNEE","87269 - HC CHG IAADI GIARDIA","27327 - EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ <3CM","86666 - HC CHG ANTIBODY EHRLICHIA","87269 - HC CHG IAADI GIARDIA","78013 - HC CHG THYROID IMAGING WITH VASCULAR FLOW","27372 - REMOVAL FOREIGN BODY DEEP THIGH/KNEE"]
[null,"27830 - CLTX PROX TIBFIB JT DISLC W/O ANES","86709 - HC CHG HEPATITIS ANTIBODY HAAB IGM ANTIBODY","27501 - CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANJ","27501 - CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANJ","27501 - CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANJ","86677 - HC CHG ANTIBODY HELICOBACTER PYLORI","27328 - HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM","87272 - HC CHG IAADI CRYPTOSPORIDIUM","87269 - HC CHG IAADI GIARDIA","87272 - HC CHG IAADI CRYPTOSPORIDIUM","86677 - HC CHG ANTIBODY HELICOBACTER PYLORI","27500 - CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION","87272 - HC CHG IAADI CRYPTOSPORIDIUM","27328 - HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM","86677 - HC CHG ANTIBODY HELICOBACTER PYLORI","87272 - HC CHG IAADI CRYPTOSPORIDIUM","78014 - HC CHG THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS","27500 - CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION"]
[null,"27840 - CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA","86710 - HC INFLUENZA VIRUS","27502 - CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ","27502 - CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ","27502 - CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ","86682 - HC Q;CYSTICERCUS AB,BLOT","27337 - EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/>","87275 - HC CHG IAADI INFLUENZA B VIRUS","87272 - HC CHG IAADI CRYPTOSPORIDIUM","87275 - HC CHG IAADI INFLUENZA B VIRUS","86682 - HC Q;CYSTICERCUS AB,BLOT","27501 - CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANJ","87275 - HC CHG IAADI INFLUENZA B VIRUS","27337 - EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/>","86682 - HC Q;CYSTICERCUS AB,BLOT","87275 - HC CHG IAADI INFLUENZA B VIRUS","78018 - HC CHG THYROID CARCINOMA METASTASES IMG WHOLE BODY","27501 - CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANJ"]
[null,"27870 - HC ARTHRODESIS,ANKLE,OPEN","86735 - HC CHG ANTIBODY MUMPS","27508 - CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ","27508 - CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ","27508 - CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ","86689 - HC HTLV/HIV CONFIRMATORY TEST","27339 - HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC 5+ CM","87276 - HC CHG IAADI INFFLUENZA A VIRUS","87275 - HC CHG IAADI INFLUENZA B VIRUS","87276 - HC CHG IAADI INFFLUENZA A VIRUS","86689 - HC HTLV/HIV CONFIRMATORY TEST","27502 - CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ","87276 - HC CHG IAADI INFFLUENZA A VIRUS","27339 - HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC 5+ CM","86689 - HC HTLV/HIV CONFIRMATORY TEST","87276 - HC CHG IAADI INFFLUENZA A VIRUS","78020 - HC CHG THYROID CARCINOMA METASTASES UPTAKE","27502 - CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ"]
[null,"28010 - TENOTOMY PERCUTANEOUS TOE SINGLE TENDON","86738 - HC CHG ANTIBODY MYCOPLSM","27520 - CLOSED TX PATELLAR FRACTURE W/O MANIPULATION","27520 - CLOSED TX PATELLAR FRACTURE W/O MANIPULATION","27520 - CLOSED TX PATELLAR FRACTURE W/O MANIPULATION","86692 - HC CHG ANTIBODY HEP DELTA AGENT","27369 - HC NJX CNTRST KNE ARTHG/CT/MRI","87279 - HC CHG IAADI PARAINFLUENZA VIRUS EACH TYPE","87276 - HC CHG IAADI INFFLUENZA A VIRUS","87279 - HC CHG IAADI PARAINFLUENZA VIRUS EACH TYPE","86692 - HC CHG ANTIBODY HEP DELTA AGENT","27508 - CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ","87279 - HC CHG IAADI PARAINFLUENZA VIRUS EACH TYPE","27369 - HC NJX CNTRST KNE ARTHG/CT/MRI","86692 - HC CHG ANTIBODY HEP DELTA AGENT","87279 - HC CHG IAADI PARAINFLUENZA VIRUS EACH TYPE","78070 - HC PARATHYROID IM","27508 - CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ"]
[null,"28011 - HC INCISION OF TOE TENDONS","86744 - HC CHG ANTIBODY NOCARDIA","27530 - CLTX TIBIAL FX PROXIMAL W/O MANIPULATION","27530 - CLTX TIBIAL FX PROXIMAL W/O MANIPULATION","27530 - CLTX TIBIAL FX PROXIMAL W/O MANIPULATION","86694 - HC CHG ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST","27370 - INJ ARTHRO KNEE","87281 - HC CHG IAADI PNEUMOCUSTIS CARINII","87279 - HC CHG IAADI PARAINFLUENZA VIRUS EACH TYPE","87281 - HC CHG IAADI PNEUMOCUSTIS CARINII","86694 - HC CHG ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST","27520 - CLOSED TX PATELLAR FRACTURE W/O MANIPULATION","87281 - HC CHG IAADI PNEUMOCUSTIS CARINII","27370 - INJ ARTHRO KNEE","86694 - HC CHG ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST","87281 - HC CHG IAADI PNEUMOCUSTIS CARINII","78071 - HC CHG PARATHYROID PLANAR IMAGING W/WO SUBTRACTION","27520 - CLOSED TX PATELLAR FRACTURE W/O MANIPULATION"]
[null,"28022 - HC ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT","86747 - HC CHG ANTIBODY PARVOVIRUS","27532 - HC CLTX TIBIAL FX PROXIMAL W/WO MANJ W/SKEL TRACJ","27532 - HC CLTX TIBIAL FX PROXIMAL W/WO MANJ W/SKEL TRACJ","27532 - HC CLTX TIBIAL FX PROXIMAL W/WO MANJ W/SKEL TRACJ","86695 - HC CHG ANTIBODY HERPES SMPLX TYPE 1","27372 - REMOVAL FOREIGN BODY DEEP THIGH/KNEE","87299 - HC CHG AG DETECTION NOS, FLUOR","87281 - HC CHG IAADI PNEUMOCUSTIS CARINII","87299 - HC CHG AG DETECTION NOS, FLUOR","86695 - HC CHG ANTIBODY HERPES SMPLX TYPE 1","27530 - CLTX TIBIAL FX PROXIMAL W/O MANIPULATION","87299 - HC CHG AG DETECTION NOS, FLUOR","27372 - REMOVAL FOREIGN BODY DEEP THIGH/KNEE","86695 - HC CHG ANTIBODY HERPES SMPLX TYPE 1","87299 - HC CHG AG DETECTION NOS, FLUOR","78072 - HC PARATHYROID W SPECTCTAL","27530 - CLTX TIBIAL FX PROXIMAL W/O MANIPULATION"]
[null,"28039 - EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>","86753 - HC CHG ANTIBODY PROTOZOA NES","27538 - CLTX INTERCONDYLAR SPI&/TUBRST FX KNE W/WO MAN","27538 - CLTX INTERCONDYLAR SPI&/TUBRST FX KNE W/WO MAN","27538 - CLTX INTERCONDYLAR SPI&/TUBRST FX KNE W/WO MAN","86696 - HC CHG ANTIBODY HERPES SMPLX TYPE 2","27500 - CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION","87305 - HC CHG IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS","87299 - HC CHG AG DETECTION NOS, FLUOR","87305 - HC CHG IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS","86696 - HC CHG ANTIBODY HERPES SMPLX TYPE 2","27532 - HC CLTX TIBIAL FX PROXIMAL W/WO MANJ W/SKEL TRACJ","87305 - HC CHG IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS","27500 - CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION","86696 - HC CHG ANTIBODY HERPES SMPLX TYPE 2","87305 - HC CHG IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS","78099 - HC THYROID SPECT","27532 - HC CLTX TIBIAL FX PROXIMAL W/WO MANJ W/SKEL TRACJ"]
[null,"28041 - HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5+CM","86757 - HC CHG, RICKETTSIA","27550 - CLOSED TX KNEE DISLOCATION W/O ANESTHESIA","27550 - CLOSED TX KNEE DISLOCATION W/O ANESTHESIA","27550 - CLOSED TX KNEE DISLOCATION W/O ANESTHESIA","86698 - HC CHG ANTIBODY HISTOPLASMA","27501 - CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANJ","87324 - HC CHG IAAD IA CLOSTRIDIUM DIFFICILE TOXIN","87305 - HC CHG IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS","87324 - HC CHG IAAD IA CLOSTRIDIUM DIFFICILE TOXIN","86698 - HC CHG ANTIBODY HISTOPLASMA","27538 - CLTX INTERCONDYLAR SPI&/TUBRST FX KNE W/WO MAN","87324 - HC CHG IAAD IA CLOSTRIDIUM DIFFICILE TOXIN","27501 - CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANJ","86698 - HC CHG ANTIBODY HISTOPLASMA","87324 - HC CHG IAAD IA CLOSTRIDIUM DIFFICILE TOXIN","78102 - HC BONE MARROW IM;LIM","27538 - CLTX INTERCONDYLAR SPI&/TUBRST FX KNE W/WO MAN"]
[null,"28043 - EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM","86762 - HC CHG ANTIBODY RUBELLA","27560 - CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA","27560 - CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA","27560 - CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA","86701 - HC HIV-1","27502 - CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ","87327 - HC CHG IAAD IA CRYPTOCOCCUS NEOFORMANS","87324 - HC CHG IAAD IA CLOSTRIDIUM DIFFICILE TOXIN","87327 - HC CHG IAAD IA CRYPTOCOCCUS NEOFORMANS","86701 - HC HIV-1","27550 - CLOSED TX KNEE DISLOCATION W/O ANESTHESIA","87327 - HC CHG IAAD IA CRYPTOCOCCUS NEOFORMANS","27502 - CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ","86701 - HC HIV-1","87327 - HC CHG IAAD IA CRYPTOCOCCUS NEOFORMANS","78104 - HC CHG BONE MARROW IMAGING WHOLE BODY","27550 - CLOSED TX KNEE DISLOCATION W/O ANESTHESIA"]
[null,"28045 - HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC <1.5CM","86765 - HC CHG ANTIBODY RUBEOLA","27603 - HC DRAIN LOWER LEG DEEP ABSC/HEMATOMA","27603 - HC DRAIN LOWER LEG DEEP ABSC/HEMATOMA","27603 - HC DRAIN LOWER LEG DEEP ABSC/HEMATOMA","86702 - HC QL/SEMI MULT AB;HIV2","27508 - CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ","87338 - HC CHG IAAD IA HPYLORI STOOL","87327 - HC CHG IAAD IA CRYPTOCOCCUS NEOFORMANS","87338 - HC CHG IAAD IA HPYLORI STOOL","86702 - HC QL/SEMI MULT AB;HIV2","27560 - CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA","87338 - HC CHG IAAD IA HPYLORI STOOL","27508 - CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ","86702 - HC QL/SEMI MULT AB;HIV2","87338 - HC CHG IAAD IA HPYLORI STOOL","78195 - HC CHG LYMPHATICS & LYMPH NODES IMAGING","27560 - CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA"]
[null,"28046 - HC RESECT FOOT/TOE TUMOR < 3 CM","86769 - ANTIBODY; SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2","27605 - TENOTOMY PRQ ACHILLES TENDON SPX LOCAL ANES","27605 - TENOTOMY PRQ ACHILLES TENDON SPX LOCAL ANES","27605 - TENOTOMY PRQ ACHILLES TENDON SPX LOCAL ANES","86703 - HC HIV 1/2 ANTIBODY","27520 - CLOSED TX PATELLAR FRACTURE W/O MANIPULATION","87340 - HC CHG IAAD IA HEPATITIS B SURFACE ANTIGEN","87338 - HC CHG IAAD IA HPYLORI STOOL","87340 - HC CHG IAAD IA HEPATITIS B SURFACE ANTIGEN","86703 - HC HIV 1/2 ANTIBODY","27603 - HC DRAIN LOWER LEG DEEP ABSC/HEMATOMA","87340 - HC CHG IAAD IA HEPATITIS B SURFACE ANTIGEN","27520 - CLOSED TX PATELLAR FRACTURE W/O MANIPULATION","86703 - HC HIV 1/2 ANTIBODY","87340 - HC CHG IAAD IA HEPATITIS B SURFACE ANTIGEN","78201 - HC CHG LIVER IMAGING SPECT","27603 - HC DRAIN LOWER LEG DEEP ABSC/HEMATOMA"]
[null,"28090 - HC REMOVAL OF FOOT LESION","86774 - HC CHG ANTIBODY TETANUS","27613 - HC BX LOW LEG SOFT TISSUE,SUPERFICIAL","27613 - HC BX LOW LEG SOFT TISSUE,SUPERFICIAL","27613 - HC BX LOW LEG SOFT TISSUE,SUPERFICIAL","86704 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB TOTAL","27530 - CLTX TIBIAL FX PROXIMAL W/O MANIPULATION","87341 - HC CHG IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION","87340 - HC CHG IAAD IA HEPATITIS B SURFACE ANTIGEN","87341 - HC CHG IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION","86704 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB TOTAL","27605 - TENOTOMY PRQ ACHILLES TENDON SPX LOCAL ANES","87341 - HC CHG IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION","27530 - CLTX TIBIAL FX PROXIMAL W/O MANIPULATION","86704 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB TOTAL","87341 - HC CHG IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION","78205 - NM LIVER W SPECT","27605 - TENOTOMY PRQ ACHILLES TENDON SPX LOCAL ANES"]
[null,"28124 - PARTIAL REMOVAL OF TOE","86777 - HC CHG ANTIBODY TOXOPLASMA","27614 - HC BX LOW LEG SOFT TISSUE,DEEP","27614 - HC BX LOW LEG SOFT TISSUE,DEEP","27614 - HC BX LOW LEG SOFT TISSUE,DEEP","86705 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY","27532 - HC CLTX TIBIAL FX PROXIMAL W/WO MANJ W/SKEL TRACJ","87350 - HC CHG IAAD IA HEPATITIS BE ANTIGEN","87341 - HC CHG IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION","87350 - HC CHG IAAD IA HEPATITIS BE ANTIGEN","86705 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY","27613 - HC BX LOW LEG SOFT TISSUE,SUPERFICIAL","87350 - HC CHG IAAD IA HEPATITIS BE ANTIGEN","27532 - HC CLTX TIBIAL FX PROXIMAL W/WO MANJ W/SKEL TRACJ","86705 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY","87350 - HC CHG IAAD IA HEPATITIS BE ANTIGEN","78215 - HC CHG LIVER & SPLEEN IMAGING STATIC ONLY","27613 - HC BX LOW LEG SOFT TISSUE,SUPERFICIAL"]
[null,"28150 - HC REMOVAL OF SINGLE TOE,EACH","86778 - HC Q;TOXOPLASMA IGM,AB","27618 - EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM","27618 - EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM","27618 - EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM","86706 - HC CHG HEPATITIS B SURF ANTIBODY HBSAB","27538 - CLTX INTERCONDYLAR SPI&/TUBRST FX KNE W/WO MAN","87385 - HC CHG IAAD IA HISTOPLASM CAPSULATUM","87350 - HC CHG IAAD IA HEPATITIS BE ANTIGEN","87385 - HC CHG IAAD IA HISTOPLASM CAPSULATUM","86706 - HC CHG HEPATITIS B SURF ANTIBODY HBSAB","27614 - HC BX LOW LEG SOFT TISSUE,DEEP","87385 - HC CHG IAAD IA HISTOPLASM CAPSULATUM","27538 - CLTX INTERCONDYLAR SPI&/TUBRST FX KNE W/WO MAN","86706 - HC CHG HEPATITIS B SURF ANTIBODY HBSAB","87385 - HC CHG IAAD IA HISTOPLASM CAPSULATUM","78216 - HC LIVER&SPLEEN IM;W/FLO","27614 - HC BX LOW LEG SOFT TISSUE,DEEP"]
[null,"28153 - HC RESEC HEAD OF PHALANX,TOE","86780 - HC CHG ANTIBODY TREPONEMA PALLIDUM","27632 - EXCISION TUMOR SOFT TISSUE LEG/ANKLE SUBQ 3 CM/>","27632 - EXCISION TUMOR SOFT TISSUE LEG/ANKLE SUBQ 3 CM/>","27632 - EXCISION TUMOR SOFT TISSUE LEG/ANKLE SUBQ 3 CM/>","86707 - HC CHG HEPATITIS BE ANTIBODY HBEAB","27550 - CLOSED TX KNEE DISLOCATION W/O ANESTHESIA","87389 - HC CHG IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE","87385 - HC CHG IAAD IA HISTOPLASM CAPSULATUM","87389 - HC CHG IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE","86707 - HC CHG HEPATITIS BE ANTIBODY HBEAB","27618 - EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM","87389 - HC CHG IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE","27550 - CLOSED TX KNEE DISLOCATION W/O ANESTHESIA","86707 - HC CHG HEPATITIS BE ANTIBODY HBEAB","87389 - HC CHG IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE","78226 - HC CHG HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER","27618 - EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM"]
[null,"28190 - REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS","86787 - HC CHG ANTIBODY VARICELLA-ZOSTER","27634 - HC EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5+CM","27634 - HC EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5+CM","27634 - HC EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5+CM","86708 - HC CHG HEPATITIS A ANTIBODY HAAB","27560 - CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA","87390 - HC CHG IAAD IA HIV-1","87389 - HC CHG IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE","87390 - HC CHG IAAD IA HIV-1","86708 - HC CHG HEPATITIS A ANTIBODY HAAB","27632 - EXCISION TUMOR SOFT TISSUE LEG/ANKLE SUBQ 3 CM/>","87390 - HC CHG IAAD IA HIV-1","27560 - CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA","86708 - HC CHG HEPATITIS A ANTIBODY HAAB","87390 - HC CHG IAAD IA HIV-1","78227 - HC CHG HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ","27632 - EXCISION TUMOR SOFT TISSUE LEG/ANKLE SUBQ 3 CM/>"]
[null,"28192 - REMOVAL FOREIGN BODY FOOT DEEP","86788 - HC CHG ANTIBODY WEST NILE VIRUS IGM","27648 - HC INJECTION ANKLE ARTHROGRAPHY","27648 - HC INJECTION ANKLE ARTHROGRAPHY","27648 - HC INJECTION ANKLE ARTHROGRAPHY","86709 - HC CHG HEPATITIS ANTIBODY HAAB IGM ANTIBODY","27603 - HC DRAIN LOWER LEG DEEP ABSC/HEMATOMA","87391 - HC CHG IAAD IA HIV-2","87390 - HC CHG IAAD IA HIV-1","87391 - HC CHG IAAD IA HIV-2","86709 - HC CHG HEPATITIS ANTIBODY HAAB IGM ANTIBODY","27634 - HC EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5+CM","87391 - HC CHG IAAD IA HIV-2","27603 - HC DRAIN LOWER LEG DEEP ABSC/HEMATOMA","86709 - HC CHG HEPATITIS ANTIBODY HAAB IGM ANTIBODY","87391 - HC CHG IAAD IA HIV-2","78258 - HC CHG ESOPHAGEAL MOTILITY","27634 - HC EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5+CM"]
[null,"28220 - HC RELEASE FLEX FOOT TENDON,SINGLE","86789 - HC CHG ANTIBODY WEST NILE VIRUS","27685 - HC LENGTH/SHORT LEG/ANKL TENDON,SINGLE","27685 - HC LENGTH/SHORT LEG/ANKL TENDON,SINGLE","27685 - HC LENGTH/SHORT LEG/ANKL TENDON,SINGLE","86710 - HC INFLUENZA VIRUS","27605 - TENOTOMY PRQ ACHILLES TENDON SPX LOCAL ANES","87400 - HC CHG IAAD IA INFLUENZA A/B EACH","87391 - HC CHG IAAD IA HIV-2","87400 - HC CHG IAAD IA INFLUENZA A/B EACH","86710 - HC INFLUENZA VIRUS","27648 - HC INJECTION ANKLE ARTHROGRAPHY","87400 - HC CHG IAAD IA INFLUENZA A/B EACH","27605 - TENOTOMY PRQ ACHILLES TENDON SPX LOCAL ANES","86710 - HC INFLUENZA VIRUS","87400 - HC CHG IAAD IA INFLUENZA A/B EACH","78264 - HC CHG GASTRIC EMPTYING IMAGING STUDY","27648 - HC INJECTION ANKLE ARTHROGRAPHY"]
[null,"28222 - HC TENOLYSIS FLEXOR FOOT MULTIPLE TENDONS","86790 - HC CHG ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED","27750 - CLTX TIBIAL SHAFT FX W/O MANIPULATION","27750 - CLTX TIBIAL SHAFT FX W/O MANIPULATION","27750 - CLTX TIBIAL SHAFT FX W/O MANIPULATION","86735 - HC CHG ANTIBODY MUMPS","27613 - HC BX LOW LEG SOFT TISSUE,SUPERFICIAL","87420 - HC CHG IAAD IA RESPIRATORY SYNCTIAL VIRUS","87400 - HC CHG IAAD IA INFLUENZA A/B EACH","87420 - HC CHG IAAD IA RESPIRATORY SYNCTIAL VIRUS","86735 - HC CHG ANTIBODY MUMPS","27685 - HC LENGTH/SHORT LEG/ANKL TENDON,SINGLE","87420 - HC CHG IAAD IA RESPIRATORY SYNCTIAL VIRUS","27613 - HC BX LOW LEG SOFT TISSUE,SUPERFICIAL","86735 - HC CHG ANTIBODY MUMPS","87420 - HC CHG IAAD IA RESPIRATORY SYNCTIAL VIRUS","78278 - HC CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING","27685 - HC LENGTH/SHORT LEG/ANKL TENDON,SINGLE"]
[null,"28230 - TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPX","86800 - HC CHG THYROGLOBULIN ANTIBODY","27752 - CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ","27752 - CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ","27752 - CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ","86738 - HC CHG ANTIBODY MYCOPLSM","27614 - HC BX LOW LEG SOFT TISSUE,DEEP","87425 - HC CHG IAAD IA ROTAVIRUS","87420 - HC CHG IAAD IA RESPIRATORY SYNCTIAL VIRUS","87425 - HC CHG IAAD IA ROTAVIRUS","86738 - HC CHG ANTIBODY MYCOPLSM","27750 - CLTX TIBIAL SHAFT FX W/O MANIPULATION","87425 - HC CHG IAAD IA ROTAVIRUS","27614 - HC BX LOW LEG SOFT TISSUE,DEEP","86738 - HC CHG ANTIBODY MYCOPLSM","87425 - HC CHG IAAD IA ROTAVIRUS","78290 - HC CHG INTESTINE IMAGING","27750 - CLTX TIBIAL SHAFT FX W/O MANIPULATION"]
[null,"28232 - TX OPEN TENDON FLEXOR TOE 1 TENDON SPX","86803 - HC CHG HEPATITIS C ANTIBODY","27759 - HC TREAT TIBIAL SHAFT FX, INTRAMED IMPLANT","27759 - HC TREAT TIBIAL SHAFT FX, INTRAMED IMPLANT","27759 - HC TREAT TIBIAL SHAFT FX, INTRAMED IMPLANT","86744 - HC CHG ANTIBODY NOCARDIA","27618 - EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM","87426 - SARSCOV CORONAVIRUS AG IA","87425 - HC CHG IAAD IA ROTAVIRUS","87426 - SARSCOV CORONAVIRUS AG IA","86744 - HC CHG ANTIBODY NOCARDIA","27752 - CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ","87426 - SARSCOV CORONAVIRUS AG IA","27618 - EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM","86744 - HC CHG ANTIBODY NOCARDIA","87426 - SARSCOV CORONAVIRUS AG IA","78291 - HC PV SHUNT PATENCY","27752 - CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ"]
[null,"28234 - TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON","86807 - HC CHG SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH","27760 - CLTX MEDIAL MALLEOLUS FX W/O MANIPULATION","27760 - CLTX MEDIAL MALLEOLUS FX W/O MANIPULATION","27760 - CLTX MEDIAL MALLEOLUS FX W/O MANIPULATION","86747 - HC CHG ANTIBODY PARVOVIRUS","27632 - EXCISION TUMOR SOFT TISSUE LEG/ANKLE SUBQ 3 CM/>","87430 - HC CHG IAAD IA STREPTOCOCCUS GROUP A","87426 - SARSCOV CORONAVIRUS AG IA","87430 - HC CHG IAAD IA STREPTOCOCCUS GROUP A","86747 - HC CHG ANTIBODY PARVOVIRUS","27759 - HC TREAT TIBIAL SHAFT FX, INTRAMED IMPLANT","87430 - HC CHG IAAD IA STREPTOCOCCUS GROUP A","27632 - EXCISION TUMOR SOFT TISSUE LEG/ANKLE SUBQ 3 CM/>","86747 - HC CHG ANTIBODY PARVOVIRUS","87430 - HC CHG IAAD IA STREPTOCOCCUS GROUP A","78299 - HC UNLISTED GI PROC,DX NM","27759 - HC TREAT TIBIAL SHAFT FX, INTRAMED IMPLANT"]
[null,"28285 - CORRECTION HAMMERTOE","86812 - HC CHG HLA TYPING A/B/C SINGLE ANTIGEN","27762 - CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ","27762 - CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ","27762 - CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ","86753 - HC CHG ANTIBODY PROTOZOA NES","27634 - HC EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5+CM","87449 - HC AG DET,ENZ IMM;OTH,EA","87430 - HC CHG IAAD IA STREPTOCOCCUS GROUP A","87449 - HC AG DET,ENZ IMM;OTH,EA","86753 - HC CHG ANTIBODY PROTOZOA NES","27760 - CLTX MEDIAL MALLEOLUS FX W/O MANIPULATION","87449 - HC AG DET,ENZ IMM;OTH,EA","27634 - HC EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5+CM","86753 - HC CHG ANTIBODY PROTOZOA NES","87449 - HC AG DET,ENZ IMM;OTH,EA","78300 - HC CHG BONE IMAGING, LIMITED AREA","27760 - CLTX MEDIAL MALLEOLUS FX W/O MANIPULATION"]
[null,"28296 - HC CORRJ HALLUX VALGUS W/SESMDC W/DIST METAR OSTEOT","86813 - HC CHG HLA TYPING A/B/C MULTIPLE ANTIGENS","27767 - HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANIP","27767 - HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANIP","27767 - HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANIP","86757 - HC CHG, RICKETTSIA","27648 - HC INJECTION ANKLE ARTHROGRAPHY","87480 - HC CHG IADNA CANDIDA SPECIES DIRECT PROBE TQ","87449 - HC AG DET,ENZ IMM;OTH,EA","87480 - HC CHG IADNA CANDIDA SPECIES DIRECT PROBE TQ","86757 - HC CHG, RICKETTSIA","27762 - CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ","87480 - HC CHG IADNA CANDIDA SPECIES DIRECT PROBE TQ","27648 - HC INJECTION ANKLE ARTHROGRAPHY","86757 - HC CHG, RICKETTSIA","87480 - HC CHG IADNA CANDIDA SPECIES DIRECT PROBE TQ","78305 - HC BONE&/JOINT IM;MULT","27762 - CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ"]
[null,"28308 - OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA","86817 - HC CHG HLA TYPING DR/DQ MULTIPLE ANTIGENS","27768 - HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ","27768 - HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ","27768 - HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ","86762 - HC CHG ANTIBODY RUBELLA","27685 - HC LENGTH/SHORT LEG/ANKL TENDON,SINGLE","87481 - HC CHG CANDIDA, DNA, AMP PROBE","87480 - HC CHG IADNA CANDIDA SPECIES DIRECT PROBE TQ","87481 - HC CHG CANDIDA, DNA, AMP PROBE","86762 - HC CHG ANTIBODY RUBELLA","27767 - HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANIP","87481 - HC CHG CANDIDA, DNA, AMP PROBE","27685 - HC LENGTH/SHORT LEG/ANKL TENDON,SINGLE","86762 - HC CHG ANTIBODY RUBELLA","87481 - HC CHG CANDIDA, DNA, AMP PROBE","78306 - HC CHG BONE &/JOINT IMAGING WHOLE BODY","27767 - HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANIP"]
[null,"28400 - CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION","86850 - HC CHG ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE","27780 - CLTX PROX FIBULA/SHFT FX W/O MANJ","27780 - CLTX PROX FIBULA/SHFT FX W/O MANJ","27780 - CLTX PROX FIBULA/SHFT FX W/O MANJ","86765 - HC CHG ANTIBODY RUBEOLA","27750 - CLTX TIBIAL SHAFT FX W/O MANIPULATION","87486 - HC CHG IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ","87481 - HC CHG CANDIDA, DNA, AMP PROBE","87486 - HC CHG IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ","86765 - HC CHG ANTIBODY RUBEOLA","27768 - HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ","87486 - HC CHG IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ","27750 - CLTX TIBIAL SHAFT FX W/O MANIPULATION","86765 - HC CHG ANTIBODY RUBEOLA","87486 - HC CHG IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ","78315 - HC CHG BONE &/JOINT IMAGING 3 PHASE STUDY","27768 - HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ"]
[null,"28405 - CLOSED TX CALCANEAL FRACTURE W/MANIPULATION","86860 - HC CHG ANTIBODY ELUTION RBC EACH ELUTION","27781 - CLTX PROX FIBULA/SHFT FX W/MANJ","27781 - CLTX PROX FIBULA/SHFT FX W/MANJ","27781 - CLTX PROX FIBULA/SHFT FX W/MANJ","86769 - ANTIBODY; SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2","27752 - CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ","87490 - HC CHG IADNA CHLAMYDIA TRACHOMATIS DIRECT PROBE TQ","87486 - HC CHG IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ","87490 - HC CHG IADNA CHLAMYDIA TRACHOMATIS DIRECT PROBE TQ","86769 - ANTIBODY; SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2","27780 - CLTX PROX FIBULA/SHFT FX W/O MANJ","87490 - HC CHG IADNA CHLAMYDIA TRACHOMATIS DIRECT PROBE TQ","27752 - CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ","86769 - ANTIBODY; SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2","87490 - HC CHG IADNA CHLAMYDIA TRACHOMATIS DIRECT PROBE TQ","78320 - NM BONE SCAN W SPECT","27780 - CLTX PROX FIBULA/SHFT FX W/O MANJ"]
[null,"28430 - CLOSED TX TALUS FRACTURE W/O MANIPULATION","86870 - HC CHG ANTIBODY ID RBC ANTIBODIES EA PANEL EA SERUM TQ","27786 - CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ","27786 - CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ","27786 - CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ","86774 - HC CHG ANTIBODY TETANUS","27759 - HC TREAT TIBIAL SHAFT FX, INTRAMED IMPLANT","87491 - HC CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ","87490 - HC CHG IADNA CHLAMYDIA TRACHOMATIS DIRECT PROBE TQ","87491 - HC CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ","86774 - HC CHG ANTIBODY TETANUS","27781 - CLTX PROX FIBULA/SHFT FX W/MANJ","87491 - HC CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ","27759 - HC TREAT TIBIAL SHAFT FX, INTRAMED IMPLANT","86774 - HC CHG ANTIBODY TETANUS","87491 - HC CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ","78428 - HC CHG CARDIAC SHUNT DETECTION","27781 - CLTX PROX FIBULA/SHFT FX W/MANJ"]
[null,"28435 - CLOSED TX TALUS FRACTURE W/MANIPULATION","86880 - HC CHG ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM","27788 - CLTX DSTL FIBULAR FX LAT MALLS W/MANJ","27788 - CLTX DSTL FIBULAR FX LAT MALLS W/MANJ","27788 - CLTX DSTL FIBULAR FX LAT MALLS W/MANJ","86777 - HC CHG ANTIBODY TOXOPLASMA","27760 - CLTX MEDIAL MALLEOLUS FX W/O MANIPULATION","87493 - HC CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE","87491 - HC CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ","87493 - HC CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE","86777 - HC CHG ANTIBODY TOXOPLASMA","27786 - CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ","87493 - HC CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE","27760 - CLTX MEDIAL MALLEOLUS FX W/O MANIPULATION","86777 - HC CHG ANTIBODY TOXOPLASMA","87493 - HC CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE","78445 - HC CHG NONCARDIAC VASCULAR FLOW IMAGING","27786 - CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ"]
[null,"28450 - TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ","86886 - HC CHG ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER","27808 - CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ","27808 - CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ","27808 - CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ","86778 - HC Q;TOXOPLASMA IGM,AB","27762 - CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ","87496 - HC ARUP;CYTOMEG VIR PCR,CSF","87493 - HC CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE","87496 - HC ARUP;CYTOMEG VIR PCR,CSF","86778 - HC Q;TOXOPLASMA IGM,AB","27788 - CLTX DSTL FIBULAR FX LAT MALLS W/MANJ","87496 - HC ARUP;CYTOMEG VIR PCR,CSF","27762 - CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ","86778 - HC Q;TOXOPLASMA IGM,AB","87496 - HC ARUP;CYTOMEG VIR PCR,CSF","78451 - HC CHG MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS","27788 - CLTX DSTL FIBULAR FX LAT MALLS W/MANJ"]
[null,"28455 - TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ","86900 - HC CHG BLOOD TYPING SEROLOGIC ABO","27810 - CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ","27810 - CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ","27810 - CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ","86780 - HC CHG ANTIBODY TREPONEMA PALLIDUM","27767 - HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANIP","87497 - HC CHG IADNA CYTOMEGALOVIRUS QUANTIFICATION","87496 - HC ARUP;CYTOMEG VIR PCR,CSF","87497 - HC CHG IADNA CYTOMEGALOVIRUS QUANTIFICATION","86780 - HC CHG ANTIBODY TREPONEMA PALLIDUM","27808 - CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ","87497 - HC CHG IADNA CYTOMEGALOVIRUS QUANTIFICATION","27767 - HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANIP","86780 - HC CHG ANTIBODY TREPONEMA PALLIDUM","87497 - HC CHG IADNA CYTOMEGALOVIRUS QUANTIFICATION","78452 - HC CHG MYOCARDIAL SPECT MULTIPLE STUDIES","27808 - CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ"]
[null,"28465 - HC TREAT MIDFOOT FRACTURE EACH","86901 - HC CHG BLOOD TYPING SEROLOGIC RH (D)","27814 - HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE","27814 - HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE","27814 - HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE","86787 - HC CHG ANTIBODY VARICELLA-ZOSTER","27768 - HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ","87498 - HC CHG IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP","87497 - HC CHG IADNA CYTOMEGALOVIRUS QUANTIFICATION","87498 - HC CHG IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP","86787 - HC CHG ANTIBODY VARICELLA-ZOSTER","27810 - CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ","87498 - HC CHG IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP","27768 - HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ","86787 - HC CHG ANTIBODY VARICELLA-ZOSTER","87498 - HC CHG IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP","78453 - HC MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS","27810 - CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ"]
[null,"28470 - CLOSED TX METATARSAL FRACTURE W/O MANIPULATION","86902 - HC CHG BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH","27816 - CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION","27816 - CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION","27816 - CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION","86788 - HC CHG ANTIBODY WEST NILE VIRUS IGM","27780 - CLTX PROX FIBULA/SHFT FX W/O MANJ","87502 - HC Q;FLU AG DET,MULT TYP,2,2","87498 - HC CHG IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP","87502 - HC Q;FLU AG DET,MULT TYP,2,2","86788 - HC CHG ANTIBODY WEST NILE VIRUS IGM","27814 - HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE","87502 - HC Q;FLU AG DET,MULT TYP,2,2","27780 - CLTX PROX FIBULA/SHFT FX W/O MANJ","86788 - HC CHG ANTIBODY WEST NILE VIRUS IGM","87502 - HC Q;FLU AG DET,MULT TYP,2,2","78457 - HC VENOUS THROMBOSIS IMAGING","27814 - HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE"]
[null,"28475 - CLTX METAR FX W/MANJ","86905 - HC CHG BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH","27818 - CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION","27818 - CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION","27818 - CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION","86789 - HC CHG ANTIBODY WEST NILE VIRUS","27781 - CLTX PROX FIBULA/SHFT FX W/MANJ","87505 - HC CHG NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN","87502 - HC Q;FLU AG DET,MULT TYP,2,2","87505 - HC CHG NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN","86789 - HC CHG ANTIBODY WEST NILE VIRUS","27816 - CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION","87505 - HC CHG NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN","27781 - CLTX PROX FIBULA/SHFT FX W/MANJ","86789 - HC CHG ANTIBODY WEST NILE VIRUS","87505 - HC CHG NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN","78458 - HC VEN THROMBOSIS IMAGES BILAT","27816 - CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION"]
[null,"28490 - CLTX FX GRT TOE PHLX/PHLG W/O MANJ","86910 - HC CHG BLOOD TYPING PATERNITY INDIV ABO RH&MN","27824 - CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ","27824 - CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ","27824 - CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ","86790 - HC CHG ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED","27786 - CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ","87506 - HC CHG IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11","87505 - HC CHG NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN","87506 - HC CHG IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11","86790 - HC CHG ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED","27818 - CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION","87506 - HC CHG IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11","27786 - CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ","86790 - HC CHG ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED","87506 - HC CHG IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11","78459 - HC CHG MYOCARDIAL IMAGING PET METABOLIC EVALUATION","27818 - CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION"]
[null,"28495 - CLTX FX GRT TOE PHLX/PHLG W/MANJ","86920 - HC CHG COMPATIBILITY EACH UNIT IMMEDIATE SPIN TECHNIQUE","27825 - CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ","27825 - CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ","27825 - CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ","86800 - HC CHG THYROGLOBULIN ANTIBODY","27788 - CLTX DSTL FIBULAR FX LAT MALLS W/MANJ","87507 - HC IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25","87506 - HC CHG IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11","87507 - HC IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25","86800 - HC CHG THYROGLOBULIN ANTIBODY","27824 - CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ","87507 - HC IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25","27788 - CLTX DSTL FIBULAR FX LAT MALLS W/MANJ","86800 - HC CHG THYROGLOBULIN ANTIBODY","87507 - HC IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25","78469 - HC MYO INFARCT AVID SPECT","27824 - CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ"]
[null,"28510 - CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ","86922 - HC CHG COMPATIBILITY EACH UNIT ANTIGLOBULIN","27830 - CLTX PROX TIBFIB JT DISLC W/O ANES","27830 - CLTX PROX TIBFIB JT DISLC W/O ANES","27830 - CLTX PROX TIBFIB JT DISLC W/O ANES","86803 - HC CHG HEPATITIS C ANTIBODY","27808 - CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ","87510 - HC CHG IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ","87507 - HC IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25","87510 - HC CHG IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ","86803 - HC CHG HEPATITIS C ANTIBODY","27825 - CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ","87510 - HC CHG IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ","27808 - CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ","86803 - HC CHG HEPATITIS C ANTIBODY","87510 - HC CHG IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ","78472 - HC CHG CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS","27825 - CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ"]
[null,"28515 - CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ","86923 - HC CHG COMPATIBILITY EACH UNIT ELECTRONIC","27840 - CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA","27840 - CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA","27840 - CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA","86807 - HC CHG SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH","27810 - CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ","87511 - HC CHG GARDNER VAG, DNA  AMP PROBE","87510 - HC CHG IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ","87511 - HC CHG GARDNER VAG, DNA  AMP PROBE","86807 - HC CHG SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH","27830 - CLTX PROX TIBFIB JT DISLC W/O ANES","87511 - HC CHG GARDNER VAG, DNA  AMP PROBE","27810 - CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ","86807 - HC CHG SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH","87511 - HC CHG GARDNER VAG, DNA  AMP PROBE","78491 - HC CHG MYOCRD IMAGE PET PERFUS SINGLE STUDY REST/STRESS","27830 - CLTX PROX TIBFIB JT DISLC W/O ANES"]
[null,"28525 - HC OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE","86999 - HC CHG UNLISTED TRANSFUSION MEDICINE PROCEDURE","27870 - HC ARTHRODESIS,ANKLE,OPEN","27870 - HC ARTHRODESIS,ANKLE,OPEN","27870 - HC ARTHRODESIS,ANKLE,OPEN","86812 - HC CHG HLA TYPING A/B/C SINGLE ANTIGEN","27814 - HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE","87517 - HC CHG IADNA HEPATITIS B VIRUS QUANTIFICATION","87511 - HC CHG GARDNER VAG, DNA  AMP PROBE","87517 - HC CHG IADNA HEPATITIS B VIRUS QUANTIFICATION","86812 - HC CHG HLA TYPING A/B/C SINGLE ANTIGEN","27840 - CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA","87517 - HC CHG IADNA HEPATITIS B VIRUS QUANTIFICATION","27814 - HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE","86812 - HC CHG HLA TYPING A/B/C SINGLE ANTIGEN","87517 - HC CHG IADNA HEPATITIS B VIRUS QUANTIFICATION","78492 - HC CHG MYOCRD IMAGE PET PERFUS MULTPL STUDY REST/STRESS","27840 - CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA"]
[null,"28530 - HC CLOSED RX SESAMOID BONE FX","87015 - HC CHG CONCENTRATION INFECTIOUS AGENTS","28010 - TENOTOMY PERCUTANEOUS TOE SINGLE TENDON","28010 - TENOTOMY PERCUTANEOUS TOE SINGLE TENDON","28010 - TENOTOMY PERCUTANEOUS TOE SINGLE TENDON","86813 - HC CHG HLA TYPING A/B/C MULTIPLE ANTIGENS","27816 - CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION","87522 - HC ARUP;HEP C VIR RNA QN","87517 - HC CHG IADNA HEPATITIS B VIRUS QUANTIFICATION","87522 - HC ARUP;HEP C VIR RNA QN","86813 - HC CHG HLA TYPING A/B/C MULTIPLE ANTIGENS","27870 - HC ARTHRODESIS,ANKLE,OPEN","87522 - HC ARUP;HEP C VIR RNA QN","27816 - CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION","86813 - HC CHG HLA TYPING A/B/C MULTIPLE ANTIGENS","87522 - HC ARUP;HEP C VIR RNA QN","78579 - HC PUL VENT IMAG (AERO/GAS)","27870 - HC ARTHRODESIS,ANKLE,OPEN"]
[null,"28540 - CLTX TARSAL DISLC OTH/THN TALOTARSAL W/O ANES","87040 - HC CHG CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES","28011 - HC INCISION OF TOE TENDONS","28011 - HC INCISION OF TOE TENDONS","28011 - HC INCISION OF TOE TENDONS","86817 - HC CHG HLA TYPING DR/DQ MULTIPLE ANTIGENS","27818 - CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION","87529 - HC CHG IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ","87522 - HC ARUP;HEP C VIR RNA QN","87529 - HC CHG IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ","86817 - HC CHG HLA TYPING DR/DQ MULTIPLE ANTIGENS","28010 - TENOTOMY PERCUTANEOUS TOE SINGLE TENDON","87529 - HC CHG IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ","27818 - CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION","86817 - HC CHG HLA TYPING DR/DQ MULTIPLE ANTIGENS","87529 - HC CHG IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ","78580 - HC CHG PULMONARY PERFUSION IMAGING PARTICULATE","28010 - TENOTOMY PERCUTANEOUS TOE SINGLE TENDON"]
[null,"28570 - HC CLOSED RX TALOTARSAL DISLOC","87045 - HC CHG CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL","28022 - HC ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT","28022 - HC ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT","28022 - HC ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT","86850 - HC CHG ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE","27824 - CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ","87532 - HC CHG IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ","87529 - HC CHG IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ","87532 - HC CHG IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ","86850 - HC CHG ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE","28011 - HC INCISION OF TOE TENDONS","87532 - HC CHG IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ","27824 - CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ","86850 - HC CHG ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE","87532 - HC CHG IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ","78582 - HC CHG PULMONARY VENTILATION & PERFUSION IMAGING","28011 - HC INCISION OF TOE TENDONS"]
[null,"28600 - CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES","87046 - HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA","28039 - EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>","28039 - EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>","28039 - EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>","86860 - HC CHG ANTIBODY ELUTION RBC EACH ELUTION","27825 - CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ","87535 - HC CHG IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ","87532 - HC CHG IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ","87535 - HC CHG IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ","86860 - HC CHG ANTIBODY ELUTION RBC EACH ELUTION","28022 - HC ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT","87535 - HC CHG IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ","27825 - CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ","86860 - HC CHG ANTIBODY ELUTION RBC EACH ELUTION","87535 - HC CHG IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ","78597 - HC CHG QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING","28022 - HC ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT"]
[null,"28630 - CLOSED RX MT-PHAL TOE DISLOCATION","87070 - CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL","28041 - HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5+CM","28041 - HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5+CM","28041 - HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5+CM","86870 - HC CHG ANTIBODY ID RBC ANTIBODIES EA PANEL EA SERUM TQ","27830 - CLTX PROX TIBFIB JT DISLC W/O ANES","87536 - HC CHG IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION","87535 - HC CHG IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ","87536 - HC CHG IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION","86870 - HC CHG ANTIBODY ID RBC ANTIBODIES EA PANEL EA SERUM TQ","28039 - EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>","87536 - HC CHG IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION","27830 - CLTX PROX TIBFIB JT DISLC W/O ANES","86870 - HC CHG ANTIBODY ID RBC ANTIBODIES EA PANEL EA SERUM TQ","87536 - HC CHG IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION","78598 - HC QUAN DIFF PERF/VENT,IMG","28039 - EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>"]
[null,"28660 - HC CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES","87075 - HC CHG CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID","28043 - EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM","28043 - EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM","28043 - EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM","86880 - HC CHG ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM","27840 - CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA","87538 - HC HIV-2 PROBE&REVRSE TRNSCRIPJ","87536 - HC CHG IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION","87538 - HC HIV-2 PROBE&REVRSE TRNSCRIPJ","86880 - HC CHG ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM","28041 - HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5+CM","87538 - HC HIV-2 PROBE&REVRSE TRNSCRIPJ","27840 - CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA","86880 - HC CHG ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM","87538 - HC HIV-2 PROBE&REVRSE TRNSCRIPJ","78599 - HC LUNG SPECT","28041 - HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5+CM"]
[null,"28825 - HC AMP,TOE;INTERPHAL JT","87076 - HC CHG CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL","28045 - HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC <1.5CM","28045 - HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC <1.5CM","28045 - HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC <1.5CM","86886 - HC CHG ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER","27870 - HC ARTHRODESIS,ANKLE,OPEN","87556 - HC CHG IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB","87538 - HC HIV-2 PROBE&REVRSE TRNSCRIPJ","87556 - HC CHG IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB","86886 - HC CHG ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER","28043 - EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM","87556 - HC CHG IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB","27870 - HC ARTHRODESIS,ANKLE,OPEN","86886 - HC CHG ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER","87556 - HC CHG IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB","78605 - HC BRAIN IMAGE 4+ VIEWS","28043 - EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM"]
[null,"28899 - CHEILECTOMY LESSER MPJ W/ IMPLANT","87077 - HC CHG CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL","28046 - HC RESECT FOOT/TOE TUMOR < 3 CM","28046 - HC RESECT FOOT/TOE TUMOR < 3 CM","28046 - HC RESECT FOOT/TOE TUMOR < 3 CM","86900 - HC CHG BLOOD TYPING SEROLOGIC ABO","28010 - TENOTOMY PERCUTANEOUS TOE SINGLE TENDON","87563 - HC M. GENITALIUM AMP PROBE","87556 - HC CHG IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB","87563 - HC M. GENITALIUM AMP PROBE","86900 - HC CHG BLOOD TYPING SEROLOGIC ABO","28045 - HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC <1.5CM","87563 - HC M. GENITALIUM AMP PROBE","28010 - TENOTOMY PERCUTANEOUS TOE SINGLE TENDON","86900 - HC CHG BLOOD TYPING SEROLOGIC ABO","87563 - HC M. GENITALIUM AMP PROBE","78607 - NM BRAIN CMPL W SPECT","28045 - HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC <1.5CM"]
[null,"29345 - APPLICATION LONG LEG CAST THIGH-TOE","87081 - HC CULT,BACT,SCR,H PYLORI","28090 - HC REMOVAL OF FOOT LESION","28090 - HC REMOVAL OF FOOT LESION","28090 - HC REMOVAL OF FOOT LESION","86901 - HC CHG BLOOD TYPING SEROLOGIC RH (D)","28011 - HC INCISION OF TOE TENDONS","87581 - HC CHG IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ","87563 - HC M. GENITALIUM AMP PROBE","87581 - HC CHG IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ","86901 - HC CHG BLOOD TYPING SEROLOGIC RH (D)","28046 - HC RESECT FOOT/TOE TUMOR < 3 CM","87581 - HC CHG IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ","28011 - HC INCISION OF TOE TENDONS","86901 - HC CHG BLOOD TYPING SEROLOGIC RH (D)","87581 - HC CHG IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ","78608 - HC CHG BRAIN IMAGING PET METABOLIC EVALUATION","28046 - HC RESECT FOOT/TOE TUMOR < 3 CM"]
[null,"29804 - HC TMJ ARTHROSCOPY/SURGERY","87086 - HC CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE","28124 - PARTIAL REMOVAL OF TOE","28124 - PARTIAL REMOVAL OF TOE","28124 - PARTIAL REMOVAL OF TOE","86902 - HC CHG BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH","28022 - HC ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT","87591 - HC CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ","87581 - HC CHG IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ","87591 - HC CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ","86902 - HC CHG BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH","28090 - HC REMOVAL OF FOOT LESION","87591 - HC CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ","28022 - HC ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT","86902 - HC CHG BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH","87591 - HC CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ","78609 - HC CHG BRAIN IMAGING PET PERFUSION EVALUATION","28090 - HC REMOVAL OF FOOT LESION"]
[null,"29807 - HC SHLDR ARTHROSCOP,SURG,REPAIR,SLAP LESION","87088 - HC CHG CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE","28150 - HC REMOVAL OF SINGLE TOE,EACH","28150 - HC REMOVAL OF SINGLE TOE,EACH","28150 - HC REMOVAL OF SINGLE TOE,EACH","86905 - HC CHG BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH","28039 - EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>","87624 - IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES","87591 - HC CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ","87624 - IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES","86905 - HC CHG BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH","28124 - PARTIAL REMOVAL OF TOE","87624 - IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES","28039 - EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>","86905 - HC CHG BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH","87624 - IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES","78645 - HC CHG CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ","28124 - PARTIAL REMOVAL OF TOE"]
[null,"29823 - HC SHLDR ARTHROSCOP,EXTEN DEBRIDE 3+","87102 - HC CHG CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD","28153 - HC RESEC HEAD OF PHALANX,TOE","28153 - HC RESEC HEAD OF PHALANX,TOE","28153 - HC RESEC HEAD OF PHALANX,TOE","86910 - HC CHG BLOOD TYPING PATERNITY INDIV ABO RH&MN","28041 - HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5+CM","87631 - HC INFLUENZA A/B,RSV PCR","87624 - IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES","87631 - HC INFLUENZA A/B,RSV PCR","86910 - HC CHG BLOOD TYPING PATERNITY INDIV ABO RH&MN","28150 - HC REMOVAL OF SINGLE TOE,EACH","87631 - HC INFLUENZA A/B,RSV PCR","28041 - HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5+CM","86910 - HC CHG BLOOD TYPING PATERNITY INDIV ABO RH&MN","87631 - HC INFLUENZA A/B,RSV PCR","78650 - HC CSF LEAK DETECT/LOC","28150 - HC REMOVAL OF SINGLE TOE,EACH"]
[null,"29827 - HC SHLDR ARTHROSCOP,SURG,W/ROTAT CUFF REPR","87103 - HC CHG CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD","28190 - REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS","28190 - REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS","28190 - REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS","86920 - HC CHG COMPATIBILITY EACH UNIT IMMEDIATE SPIN TECHNIQUE","28043 - EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM","87632 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 6-11 TARGETS","87631 - HC INFLUENZA A/B,RSV PCR","87632 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 6-11 TARGETS","86920 - HC CHG COMPATIBILITY EACH UNIT IMMEDIATE SPIN TECHNIQUE","28153 - HC RESEC HEAD OF PHALANX,TOE","87632 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 6-11 TARGETS","28043 - EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM","86920 - HC CHG COMPATIBILITY EACH UNIT IMMEDIATE SPIN TECHNIQUE","87632 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 6-11 TARGETS","78700 - HC RENAL IM MORPH","28153 - HC RESEC HEAD OF PHALANX,TOE"]
[null,"29881 - HC KNEE SCOPE SINGLE MENISCECTOMY","87106 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST","28192 - REMOVAL FOREIGN BODY FOOT DEEP","28192 - REMOVAL FOREIGN BODY FOOT DEEP","28192 - REMOVAL FOREIGN BODY FOOT DEEP","86922 - HC CHG COMPATIBILITY EACH UNIT ANTIGLOBULIN","28045 - HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC <1.5CM","87633 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET","87632 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 6-11 TARGETS","87633 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET","86922 - HC CHG COMPATIBILITY EACH UNIT ANTIGLOBULIN","28190 - REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS","87633 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET","28045 - HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC <1.5CM","86922 - HC CHG COMPATIBILITY EACH UNIT ANTIGLOBULIN","87633 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET","78707 - HC CHG KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/O RX","28190 - REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS"]
[null,"29882 - HC KNEE SCOPE,MED OR LAT MENIS REPAIR","87107 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD","28220 - HC RELEASE FLEX FOOT TENDON,SINGLE","28220 - HC RELEASE FLEX FOOT TENDON,SINGLE","28220 - HC RELEASE FLEX FOOT TENDON,SINGLE","86923 - HC CHG COMPATIBILITY EACH UNIT ELECTRONIC","28046 - HC RESECT FOOT/TOE TUMOR < 3 CM","87635 - HC SARS-COV-2 COVID-19 AMP PRB","87633 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET","87635 - HC SARS-COV-2 COVID-19 AMP PRB","86923 - HC CHG COMPATIBILITY EACH UNIT ELECTRONIC","28192 - REMOVAL FOREIGN BODY FOOT DEEP","87635 - HC SARS-COV-2 COVID-19 AMP PRB","28046 - HC RESECT FOOT/TOE TUMOR < 3 CM","86923 - HC CHG COMPATIBILITY EACH UNIT ELECTRONIC","87635 - HC SARS-COV-2 COVID-19 AMP PRB","78708 - HC CHG RENAL FLOW/FUNCT IMAGE,PHARM RX","28192 - REMOVAL FOREIGN BODY FOOT DEEP"]
[null,"29888 - HC KNEE SCOPE,AID ANT CRUCIATE REPAIR","87110 - HC CHG CULTURE, CHLAMYDIA","28222 - HC TENOLYSIS FLEXOR FOOT MULTIPLE TENDONS","28222 - HC TENOLYSIS FLEXOR FOOT MULTIPLE TENDONS","28222 - HC TENOLYSIS FLEXOR FOOT MULTIPLE TENDONS","86999 - HC CHG UNLISTED TRANSFUSION MEDICINE PROCEDURE","28090 - HC REMOVAL OF FOOT LESION","87636 - HC SARSCOV2 & INF A&B AMP PRB","87635 - HC SARS-COV-2 COVID-19 AMP PRB","87636 - HC SARSCOV2 & INF A&B AMP PRB","86999 - HC CHG UNLISTED TRANSFUSION MEDICINE PROCEDURE","28220 - HC RELEASE FLEX FOOT TENDON,SINGLE","87636 - HC SARSCOV2 & INF A&B AMP PRB","28090 - HC REMOVAL OF FOOT LESION","86999 - HC CHG UNLISTED TRANSFUSION MEDICINE PROCEDURE","87636 - HC SARSCOV2 & INF A&B AMP PRB","78740 - HC URETERAL REFLUX","28220 - HC RELEASE FLEX FOOT TENDON,SINGLE"]
[null,"30000 - DRAINAGE ABSCESS/HEMATOMA NASAL INT APPROACH","87116 - HC CHG CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL","28230 - TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPX","28230 - TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPX","28230 - TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPX","87015 - HC CHG CONCENTRATION INFECTIOUS AGENTS","28124 - PARTIAL REMOVAL OF TOE","87640 - HC CHG IADNA S AUREUS AMPLIFIED PROBE TQ","87636 - HC SARSCOV2 & INF A&B AMP PRB","87640 - HC CHG IADNA S AUREUS AMPLIFIED PROBE TQ","87015 - HC CHG CONCENTRATION INFECTIOUS AGENTS","28222 - HC TENOLYSIS FLEXOR FOOT MULTIPLE TENDONS","87640 - HC CHG IADNA S AUREUS AMPLIFIED PROBE TQ","28124 - PARTIAL REMOVAL OF TOE","87015 - HC CHG CONCENTRATION INFECTIOUS AGENTS","87640 - HC CHG IADNA S AUREUS AMPLIFIED PROBE TQ","78800 - HC NM RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR: LIMITED AREA","28222 - HC TENOLYSIS FLEXOR FOOT MULTIPLE TENDONS"]
[null,"30020 - DRAINAGE ABSCESS/HEMATOMA NASAL SEPTUM","87118 - HC CHG CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL","28232 - TX OPEN TENDON FLEXOR TOE 1 TENDON SPX","28232 - TX OPEN TENDON FLEXOR TOE 1 TENDON SPX","28232 - TX OPEN TENDON FLEXOR TOE 1 TENDON SPX","87040 - HC CHG CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES","28150 - HC REMOVAL OF SINGLE TOE,EACH","87641 - HC CHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ","87640 - HC CHG IADNA S AUREUS AMPLIFIED PROBE TQ","87641 - HC CHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ","87040 - HC CHG CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES","28230 - TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPX","87641 - HC CHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ","28150 - HC REMOVAL OF SINGLE TOE,EACH","87040 - HC CHG CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES","87641 - HC CHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ","78801 - HC RP LOCLZJ TUM 2+AREA 1+D IMG","28230 - TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPX"]
[null,"30100 - HC BIOPSY INTRANASAL","87140 - HC CHG CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM","28234 - TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON","28234 - TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON","28234 - TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON","87045 - HC CHG CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL","28153 - HC RESEC HEAD OF PHALANX,TOE","87653 - HC CHG IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ","87641 - HC CHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ","87653 - HC CHG IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ","87045 - HC CHG CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL","28232 - TX OPEN TENDON FLEXOR TOE 1 TENDON SPX","87653 - HC CHG IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ","28153 - HC RESEC HEAD OF PHALANX,TOE","87045 - HC CHG CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL","87653 - HC CHG IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ","78802 - HC CHG RP LOCLZJ TUMOR/DSTRBJ AGENT WHOLE BDY 1 DAY","28232 - TX OPEN TENDON FLEXOR TOE 1 TENDON SPX"]
[null,"30110 - EXCISION NASAL POLYP SIMPLE","87149 - HC CHG CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM","28285 - CORRECTION HAMMERTOE","28285 - CORRECTION HAMMERTOE","28285 - CORRECTION HAMMERTOE","87046 - HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA","28190 - REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS","87660 - HC CHG IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ","87653 - HC CHG IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ","87660 - HC CHG IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ","87046 - HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA","28234 - TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON","87660 - HC CHG IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ","28190 - REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS","87046 - HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA","87660 - HC CHG IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ","78803 - HC CHG RP LOCLZJ TUMOR/DSTRBJ AGENT TOMOG SPECT","28234 - TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON"]
[null,"30117 - EXCISION/DESTRUCTION INTRANASAL LESION INT APPR","87150 - HC CHG CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM","28296 - HC CORRJ HALLUX VALGUS W/SESMDC W/DIST METAR OSTEOT","28296 - HC CORRJ HALLUX VALGUS W/SESMDC W/DIST METAR OSTEOT","28296 - HC CORRJ HALLUX VALGUS W/SESMDC W/DIST METAR OSTEOT","87070 - CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL","28192 - REMOVAL FOREIGN BODY FOOT DEEP","87661 - IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH","87660 - HC CHG IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ","87661 - IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH","87070 - CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL","28285 - CORRECTION HAMMERTOE","87661 - IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH","28192 - REMOVAL FOREIGN BODY FOOT DEEP","87070 - CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL","87661 - IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH","78804 - HC RP TUM LOC/RP DIS;BODY,2/","28285 - CORRECTION HAMMERTOE"]
[null,"30130 - HC EXCISION TURBINATE","87153 - HC Q;BACT ID,PHENO,SEQ","28308 - OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA","28308 - OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA","28308 - OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA","87075 - HC CHG CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID","28220 - HC RELEASE FLEX FOOT TENDON,SINGLE","87797 - HC CHG DETECT AGENT NOS, DNA, DIR","87661 - IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH","87797 - HC CHG DETECT AGENT NOS, DNA, DIR","87075 - HC CHG CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID","28296 - HC CORRJ HALLUX VALGUS W/SESMDC W/DIST METAR OSTEOT","87797 - HC CHG DETECT AGENT NOS, DNA, DIR","28220 - HC RELEASE FLEX FOOT TENDON,SINGLE","87075 - HC CHG CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID","87797 - HC CHG DETECT AGENT NOS, DNA, DIR","78805 - NM ABSCSS LOC LTD","28296 - HC CORRJ HALLUX VALGUS W/SESMDC W/DIST METAR OSTEOT"]
[null,"30140 - HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL","87172 - HC CHG PINWORM EXAMINATION","28400 - CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION","28400 - CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION","28400 - CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION","87076 - HC CHG CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL","28222 - HC TENOLYSIS FLEXOR FOOT MULTIPLE TENDONS","87798 - HC EBV DNA, QL PCR","87797 - HC CHG DETECT AGENT NOS, DNA, DIR","87798 - HC EBV DNA, QL PCR","87076 - HC CHG CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL","28308 - OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA","87798 - HC EBV DNA, QL PCR","28222 - HC TENOLYSIS FLEXOR FOOT MULTIPLE TENDONS","87076 - HC CHG CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL","87798 - HC EBV DNA, QL PCR","78806 - NM ABSCSS LOC WB","28308 - OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA"]
[null,"30220 - INSERTION NASAL SEPTAL PROSTHESIS BUTTON","87176 - HC CHG HOMOGENIZATION TISSUE CULTURE","28405 - CLOSED TX CALCANEAL FRACTURE W/MANIPULATION","28405 - CLOSED TX CALCANEAL FRACTURE W/MANIPULATION","28405 - CLOSED TX CALCANEAL FRACTURE W/MANIPULATION","87077 - HC CHG CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL","28230 - TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPX","87799 - HC CHG IADNA NOS QUANTIFICATION EACH ORGANISM","87798 - HC EBV DNA, QL PCR","87799 - HC CHG IADNA NOS QUANTIFICATION EACH ORGANISM","87077 - HC CHG CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL","28400 - CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION","87799 - HC CHG IADNA NOS QUANTIFICATION EACH ORGANISM","28230 - TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPX","87077 - HC CHG CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL","87799 - HC CHG IADNA NOS QUANTIFICATION EACH ORGANISM","78807 - NM INFLAM LOCAL W SPECT","28400 - CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION"]
[null,"30420 - HC RECONSTR NOSE+MAJ SEPTAL REPAIR","87177 - HC CHG OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID","28430 - CLOSED TX TALUS FRACTURE W/O MANIPULATION","28430 - CLOSED TX TALUS FRACTURE W/O MANIPULATION","28430 - CLOSED TX TALUS FRACTURE W/O MANIPULATION","87081 - HC CULT,BACT,SCR,H PYLORI","28232 - TX OPEN TENDON FLEXOR TOE 1 TENDON SPX","87801 - HC CHG DETECT AGENT, MULT ORGS, DNA  AMP","87799 - HC CHG IADNA NOS QUANTIFICATION EACH ORGANISM","87801 - HC CHG DETECT AGENT, MULT ORGS, DNA  AMP","87081 - HC CULT,BACT,SCR,H PYLORI","28405 - CLOSED TX CALCANEAL FRACTURE W/MANIPULATION","87801 - HC CHG DETECT AGENT, MULT ORGS, DNA  AMP","28232 - TX OPEN TENDON FLEXOR TOE 1 TENDON SPX","87081 - HC CULT,BACT,SCR,H PYLORI","87801 - HC CHG DETECT AGENT, MULT ORGS, DNA  AMP","78811 - HC CHG PET IMAGING LIMITED AREA CHEST HEAD/NECK","28405 - CLOSED TX CALCANEAL FRACTURE W/MANIPULATION"]
[null,"30465 - REPAIR NASAL VESTIBULAR STENOSIS","87181 - HC CHG SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ","28435 - CLOSED TX TALUS FRACTURE W/MANIPULATION","28435 - CLOSED TX TALUS FRACTURE W/MANIPULATION","28435 - CLOSED TX TALUS FRACTURE W/MANIPULATION","87086 - HC CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE","28234 - TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON","87880 - IAADIADOO STREPTOCOCCUS GROUP A","87801 - HC CHG DETECT AGENT, MULT ORGS, DNA  AMP","87880 - IAADIADOO STREPTOCOCCUS GROUP A","87086 - HC CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE","28430 - CLOSED TX TALUS FRACTURE W/O MANIPULATION","87880 - IAADIADOO STREPTOCOCCUS GROUP A","28234 - TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON","87086 - HC CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE","87880 - IAADIADOO STREPTOCOCCUS GROUP A","78812 - HC CHG PET IMAGING SKULL BASE TO MID-THIGH","28430 - CLOSED TX TALUS FRACTURE W/O MANIPULATION"]
[null,"30520 - HC REPAIR OF NASAL SEPTUM","87184 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD","28450 - TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ","28450 - TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ","28450 - TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ","87088 - HC CHG CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE","28285 - CORRECTION HAMMERTOE","87899 - HC MALARIA ANTIGEN","87880 - IAADIADOO STREPTOCOCCUS GROUP A","87899 - HC MALARIA ANTIGEN","87088 - HC CHG CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE","28435 - CLOSED TX TALUS FRACTURE W/MANIPULATION","87899 - HC MALARIA ANTIGEN","28285 - CORRECTION HAMMERTOE","87088 - HC CHG CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE","87899 - HC MALARIA ANTIGEN","78814 - HC PET&CT ATT CORR;LIM","28435 - CLOSED TX TALUS FRACTURE W/MANIPULATION"]
[null,"30560 - HC RELEASE OF NASAL ADHESIONS","87185 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ","28455 - TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ","28455 - TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ","28455 - TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ","87102 - HC CHG CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD","28296 - HC CORRJ HALLUX VALGUS W/SESMDC W/DIST METAR OSTEOT","87900 - HC CHG NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION","87899 - HC MALARIA ANTIGEN","87900 - HC CHG NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION","87102 - HC CHG CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD","28450 - TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ","87900 - HC CHG NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION","28296 - HC CORRJ HALLUX VALGUS W/SESMDC W/DIST METAR OSTEOT","87102 - HC CHG CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD","87900 - HC CHG NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION","78815 - HC CHG PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH","28450 - TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ"]
[null,"30580 - HC REPAIR FISTULA OROMAXILLARY","87186 - HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ","28465 - HC TREAT MIDFOOT FRACTURE EACH","28465 - HC TREAT MIDFOOT FRACTURE EACH","28465 - HC TREAT MIDFOOT FRACTURE EACH","87103 - HC CHG CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD","28308 - OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA","87901 - HC CHG NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEAS","87900 - HC CHG NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION","87901 - HC CHG NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEAS","87103 - HC CHG CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD","28455 - TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ","87901 - HC CHG NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEAS","28308 - OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA","87103 - HC CHG CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD","87901 - HC CHG NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEAS","78816 - HC CHG PET IMAGING FOR CT ATTENUATION WHOLE BODY","28455 - TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ"]
[null,"30600 - HC REPAIR ORO-NASAL FISTULA","87188 - HC CHG SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT","28470 - CLOSED TX METATARSAL FRACTURE W/O MANIPULATION","28470 - CLOSED TX METATARSAL FRACTURE W/O MANIPULATION","28470 - CLOSED TX METATARSAL FRACTURE W/O MANIPULATION","87106 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST","28400 - CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION","87902 - HC CHG NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS","87901 - HC CHG NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEAS","87902 - HC CHG NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS","87106 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST","28465 - HC TREAT MIDFOOT FRACTURE EACH","87902 - HC CHG NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS","28400 - CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION","87106 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST","87902 - HC CHG NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS","78999 - HC FUSE CT & NUC MED IMAGES","28465 - HC TREAT MIDFOOT FRACTURE EACH"]
[null,"30801 - ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC","87205 - HC CHG SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL","28475 - CLTX METAR FX W/MANJ","28475 - CLTX METAR FX W/MANJ","28475 - CLTX METAR FX W/MANJ","87107 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD","28405 - CLOSED TX CALCANEAL FRACTURE W/MANIPULATION","87906 - HC Q;HIV1 GENO","87902 - HC CHG NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS","87906 - HC Q;HIV1 GENO","87107 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD","28470 - CLOSED TX METATARSAL FRACTURE W/O MANIPULATION","87906 - HC Q;HIV1 GENO","28405 - CLOSED TX CALCANEAL FRACTURE W/MANIPULATION","87107 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD","87906 - HC Q;HIV1 GENO","79005 - HC CHG RP THERAPY ORAL ADMINISTRATION","28470 - CLOSED TX METATARSAL FRACTURE W/O MANIPULATION"]
[null,"30802 - ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL","87206 - HC CHG SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT","28490 - CLTX FX GRT TOE PHLX/PHLG W/O MANJ","28490 - CLTX FX GRT TOE PHLX/PHLG W/O MANJ","28490 - CLTX FX GRT TOE PHLX/PHLG W/O MANJ","87110 - HC CHG CULTURE, CHLAMYDIA","28430 - CLOSED TX TALUS FRACTURE W/O MANIPULATION","87912 - HC CHG NFCT AGENT GENOTYPE HEPATITIS B VIRUS","87906 - HC Q;HIV1 GENO","87912 - HC CHG NFCT AGENT GENOTYPE HEPATITIS B VIRUS","87110 - HC CHG CULTURE, CHLAMYDIA","28475 - CLTX METAR FX W/MANJ","87912 - HC CHG NFCT AGENT GENOTYPE HEPATITIS B VIRUS","28430 - CLOSED TX TALUS FRACTURE W/O MANIPULATION","87110 - HC CHG CULTURE, CHLAMYDIA","87912 - HC CHG NFCT AGENT GENOTYPE HEPATITIS B VIRUS","79101 - HC CHG RP THERAPY INTRAVENOUS ADMINISTRATION","28475 - CLTX METAR FX W/MANJ"]
[null,"30901 - CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE","87207 - SMR PRIM SRC SPEC STAIN BODIES/PARASITS","28495 - CLTX FX GRT TOE PHLX/PHLG W/MANJ","28495 - CLTX FX GRT TOE PHLX/PHLG W/MANJ","28495 - CLTX FX GRT TOE PHLX/PHLG W/MANJ","87116 - HC CHG CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL","28435 - CLOSED TX TALUS FRACTURE W/MANIPULATION","88142 - CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN","87912 - HC CHG NFCT AGENT GENOTYPE HEPATITIS B VIRUS","88142 - CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN","87116 - HC CHG CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL","28490 - CLTX FX GRT TOE PHLX/PHLG W/O MANJ","88142 - CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN","28435 - CLOSED TX TALUS FRACTURE W/MANIPULATION","87116 - HC CHG CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL","88142 - CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN","79200 - HC CHG RP THERAPY INRACAVITARY ADMINISTRATION","28490 - CLTX FX GRT TOE PHLX/PHLG W/O MANJ"]
[null,"30903 - CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX","87209 - HC CHG SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS","28510 - CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ","28510 - CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ","28510 - CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ","87118 - HC CHG CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL","28450 - TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ","88143 - HC CHG CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS","88142 - CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN","88143 - HC CHG CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS","87118 - HC CHG CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL","28495 - CLTX FX GRT TOE PHLX/PHLG W/MANJ","88143 - HC CHG CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS","28450 - TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ","87118 - HC CHG CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL","88143 - HC CHG CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS","79445 - HC CHG RP THERAPY INTRA-ARTERIAL PARTICULATE ADMN","28495 - CLTX FX GRT TOE PHLX/PHLG W/MANJ"]
[null,"30905 - CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST","87210 - SMR PRIM SRC WET MOUNT NFCT AGT","28515 - CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ","28515 - CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ","28515 - CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ","87140 - HC CHG CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM","28455 - TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ","88147 - HC CHG CYTOPATH SMEAR CERV/VAG AUTOMATED","88143 - HC CHG CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS","88147 - HC CHG CYTOPATH SMEAR CERV/VAG AUTOMATED","87140 - HC CHG CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM","28510 - CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ","88147 - HC CHG CYTOPATH SMEAR CERV/VAG AUTOMATED","28455 - TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ","87140 - HC CHG CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM","88147 - HC CHG CYTOPATH SMEAR CERV/VAG AUTOMATED","80048 - HC CHG BASIC METABOLIC PANEL CALCIUM TOTAL","28510 - CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ"]
[null,"30906 - CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ","87220 - TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT","28525 - HC OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE","28525 - HC OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE","28525 - HC OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE","87149 - HC CHG CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM","28465 - HC TREAT MIDFOOT FRACTURE EACH","88152 - HC CHG CYTOPATH SMEAR CERV/VAG,AUTO REDO","88147 - HC CHG CYTOPATH SMEAR CERV/VAG AUTOMATED","88152 - HC CHG CYTOPATH SMEAR CERV/VAG,AUTO REDO","87149 - HC CHG CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM","28515 - CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ","88152 - HC CHG CYTOPATH SMEAR CERV/VAG,AUTO REDO","28465 - HC TREAT MIDFOOT FRACTURE EACH","87149 - HC CHG CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM","88152 - HC CHG CYTOPATH SMEAR CERV/VAG,AUTO REDO","80051 - HC CHG ELECTROLYTE PANEL","28515 - CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ"]
[null,"30930 - HC THER FX NASAL INF TURBINATE","87252 - HC CHG VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT","28530 - HC CLOSED RX SESAMOID BONE FX","28530 - HC CLOSED RX SESAMOID BONE FX","28530 - HC CLOSED RX SESAMOID BONE FX","87150 - HC CHG CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM","28470 - CLOSED TX METATARSAL FRACTURE W/O MANIPULATION","88164 - HC CHG CYTOPATH TBS CERV/VAG MANUAL","88152 - HC CHG CYTOPATH SMEAR CERV/VAG,AUTO REDO","88164 - HC CHG CYTOPATH TBS CERV/VAG MANUAL","87150 - HC CHG CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM","28525 - HC OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE","88164 - HC CHG CYTOPATH TBS CERV/VAG MANUAL","28470 - CLOSED TX METATARSAL FRACTURE W/O MANIPULATION","87150 - HC CHG CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM","88164 - HC CHG CYTOPATH TBS CERV/VAG MANUAL","80053 - HC CHG COMPREHENSIVE METABOLIC PANEL","28525 - HC OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE"]
[null,"31032 - HC EXPLOR MAXILL SINUS,RMV POLYPS","87253 - HC CHG VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE","28540 - CLTX TARSAL DISLC OTH/THN TALOTARSAL W/O ANES","28540 - CLTX TARSAL DISLC OTH/THN TALOTARSAL W/O ANES","28540 - CLTX TARSAL DISLC OTH/THN TALOTARSAL W/O ANES","87153 - HC Q;BACT ID,PHENO,SEQ","28475 - CLTX METAR FX W/MANJ","88165 - HC CHG CYTP SLIDES C/V MNL SCR&RESCR PHYS SUPV","88164 - HC CHG CYTOPATH TBS CERV/VAG MANUAL","88165 - HC CHG CYTP SLIDES C/V MNL SCR&RESCR PHYS SUPV","87153 - HC Q;BACT ID,PHENO,SEQ","28530 - HC CLOSED RX SESAMOID BONE FX","88165 - HC CHG CYTP SLIDES C/V MNL SCR&RESCR PHYS SUPV","28475 - CLTX METAR FX W/MANJ","87153 - HC Q;BACT ID,PHENO,SEQ","88165 - HC CHG CYTP SLIDES C/V MNL SCR&RESCR PHYS SUPV","80061 - HC CHG LIPID PANEL","28530 - HC CLOSED RX SESAMOID BONE FX"]
[null,"31231 - NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX","87254 - HC CHG VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA","28570 - HC CLOSED RX TALOTARSAL DISLOC","28570 - HC CLOSED RX TALOTARSAL DISLOC","28570 - HC CLOSED RX TALOTARSAL DISLOC","87172 - HC CHG PINWORM EXAMINATION","28490 - CLTX FX GRT TOE PHLX/PHLG W/O MANJ","88230 - HC CHG TISS CUL NON-NEO DISORDERS LYMPHOCYTE","88165 - HC CHG CYTP SLIDES C/V MNL SCR&RESCR PHYS SUPV","88230 - HC CHG TISS CUL NON-NEO DISORDERS LYMPHOCYTE","87172 - HC CHG PINWORM EXAMINATION","28540 - CLTX TARSAL DISLC OTH/THN TALOTARSAL W/O ANES","88230 - HC CHG TISS CUL NON-NEO DISORDERS LYMPHOCYTE","28490 - CLTX FX GRT TOE PHLX/PHLG W/O MANJ","87172 - HC CHG PINWORM EXAMINATION","88230 - HC CHG TISS CUL NON-NEO DISORDERS LYMPHOCYTE","80069 - HC CHG RENAL FUNCTION PANEL","28540 - CLTX TARSAL DISLC OTH/THN TALOTARSAL W/O ANES"]
[null,"31237 - NASAL/SINUS NDSC SURG W/BX POLYPECT/DBRDMT SPX","87255 - HC CHG VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC","28600 - CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES","28600 - CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES","28600 - CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES","87176 - HC CHG HOMOGENIZATION TISSUE CULTURE","28495 - CLTX FX GRT TOE PHLX/PHLG W/MANJ","88235 - HC CHG TISSUE CULTURE, PLACENTA","88230 - HC CHG TISS CUL NON-NEO DISORDERS LYMPHOCYTE","88235 - HC CHG TISSUE CULTURE, PLACENTA","87176 - HC CHG HOMOGENIZATION TISSUE CULTURE","28570 - HC CLOSED RX TALOTARSAL DISLOC","88235 - HC CHG TISSUE CULTURE, PLACENTA","28495 - CLTX FX GRT TOE PHLX/PHLG W/MANJ","87176 - HC CHG HOMOGENIZATION TISSUE CULTURE","88235 - HC CHG TISSUE CULTURE, PLACENTA","80074 - HC CHG ACUTE HEPATITIS PANEL","28570 - HC CLOSED RX TALOTARSAL DISLOC"]
[null,"31238 - NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMRRG","87260 - HC CHG IAADI ADENOVIRUS","28630 - CLOSED RX MT-PHAL TOE DISLOCATION","28630 - CLOSED RX MT-PHAL TOE DISLOCATION","28630 - CLOSED RX MT-PHAL TOE DISLOCATION","87177 - HC CHG OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID","28510 - CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ","88237 - HC CHG TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS","88235 - HC CHG TISSUE CULTURE, PLACENTA","88237 - HC CHG TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS","87177 - HC CHG OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID","28600 - CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES","88237 - HC CHG TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS","28510 - CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ","87177 - HC CHG OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID","88237 - HC CHG TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS","80076 - HC CHG HEPATIC FUNCTION PANEL","28600 - CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES"]
[null,"31239 - HC NASAL/SINUS ENDOSCOPY SURG","87269 - HC CHG IAADI GIARDIA","28660 - HC CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES","28660 - HC CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES","28660 - HC CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES","87181 - HC CHG SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ","28515 - CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ","88262 - HC CHG CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING","88237 - HC CHG TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS","88262 - HC CHG CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING","87181 - HC CHG SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ","28630 - CLOSED RX MT-PHAL TOE DISLOCATION","88262 - HC CHG CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING","28515 - CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ","87181 - HC CHG SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ","88262 - HC CHG CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING","80150 - HC AMIKACIN","28630 - CLOSED RX MT-PHAL TOE DISLOCATION"]
[null,"31256 - HC EXPLORATION MAXILLARY SINUS","87272 - HC CHG IAADI CRYPTOSPORIDIUM","28825 - HC AMP,TOE;INTERPHAL JT","28825 - HC AMP,TOE;INTERPHAL JT","28825 - HC AMP,TOE;INTERPHAL JT","87184 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD","28525 - HC OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE","88264 - HC CHG CHRMSM ANALYZE 20-25 CELLS","88262 - HC CHG CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING","88264 - HC CHG CHRMSM ANALYZE 20-25 CELLS","87184 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD","28660 - HC CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES","88264 - HC CHG CHRMSM ANALYZE 20-25 CELLS","28525 - HC OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE","87184 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD","88264 - HC CHG CHRMSM ANALYZE 20-25 CELLS","80156 - HC CHG DRUG ASSAY CARBAMAZEPINE TOTAL","28660 - HC CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES"]
[null,"31267 - HC NASAL/SINUS ENDOSCOPY,RMV TISS MAXILL SINUS","87275 - HC CHG IAADI INFLUENZA B VIRUS","29065 - APPLICATION CAST SHOULDER HAND LONG ARM","29065 - APPLICATION CAST SHOULDER HAND LONG ARM","29065 - APPLICATION CAST SHOULDER HAND LONG ARM","87185 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ","28530 - HC CLOSED RX SESAMOID BONE FX","88271 - HC CHG MOLECULAR CYTOGENETICS DNA PROBE EACH","88264 - HC CHG CHRMSM ANALYZE 20-25 CELLS","88271 - HC CHG MOLECULAR CYTOGENETICS DNA PROBE EACH","87185 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ","28825 - HC AMP,TOE;INTERPHAL JT","88271 - HC CHG MOLECULAR CYTOGENETICS DNA PROBE EACH","28530 - HC CLOSED RX SESAMOID BONE FX","87185 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ","88271 - HC CHG MOLECULAR CYTOGENETICS DNA PROBE EACH","80158 - HC CHG DRUG ASSAY CYCLOSPORINE","28825 - HC AMP,TOE;INTERPHAL JT"]
[null,"31500 - HC INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE","87276 - HC CHG IAADI INFFLUENZA A VIRUS","29075 - APPLICATION CAST ELBOW FINGER SHORT ARM","29075 - APPLICATION CAST ELBOW FINGER SHORT ARM","29075 - APPLICATION CAST ELBOW FINGER SHORT ARM","87186 - HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ","28540 - CLTX TARSAL DISLC OTH/THN TALOTARSAL W/O ANES","88274 - HC CHG MOLECULAR CYTOGENETICS INTERPHASE ISH 25-99 CLL","88271 - HC CHG MOLECULAR CYTOGENETICS DNA PROBE EACH","88274 - HC CHG MOLECULAR CYTOGENETICS INTERPHASE ISH 25-99 CLL","87186 - HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ","29065 - APPLICATION CAST SHOULDER HAND LONG ARM","88274 - HC CHG MOLECULAR CYTOGENETICS INTERPHASE ISH 25-99 CLL","28540 - CLTX TARSAL DISLC OTH/THN TALOTARSAL W/O ANES","87186 - HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ","88274 - HC CHG MOLECULAR CYTOGENETICS INTERPHASE ISH 25-99 CLL","80162 - HC CHG DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL","29065 - APPLICATION CAST SHOULDER HAND LONG ARM"]
[null,"31502 - TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT","87279 - HC CHG IAADI PARAINFLUENZA VIRUS EACH TYPE","29085 - APPLICATION CAST HAND & LOWER FOREARM GAUNTLET","29085 - APPLICATION CAST HAND & LOWER FOREARM GAUNTLET","29085 - APPLICATION CAST HAND & LOWER FOREARM GAUNTLET","87188 - HC CHG SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT","28570 - HC CLOSED RX TALOTARSAL DISLOC","88275 - HC CHG MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL","88274 - HC CHG MOLECULAR CYTOGENETICS INTERPHASE ISH 25-99 CLL","88275 - HC CHG MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL","87188 - HC CHG SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT","29075 - APPLICATION CAST ELBOW FINGER SHORT ARM","88275 - HC CHG MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL","28570 - HC CLOSED RX TALOTARSAL DISLOC","87188 - HC CHG SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT","88275 - HC CHG MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL","80164 - HC CHG DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL","29075 - APPLICATION CAST ELBOW FINGER SHORT ARM"]
[null,"31510 - HC LARYNGOSCOPY,INDIRECT WITH BIOPSY","87281 - HC CHG IAADI PNEUMOCUSTIS CARINII","29086 - HC APPLY CAST,FINGER (CONTRACTURE)","29086 - HC APPLY CAST,FINGER (CONTRACTURE)","29086 - HC APPLY CAST,FINGER (CONTRACTURE)","87205 - HC CHG SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL","28600 - CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES","88280 - HC CHG CHROMOSOME KARYOTYPE STUDY","88275 - HC CHG MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL","88280 - HC CHG CHROMOSOME KARYOTYPE STUDY","87205 - HC CHG SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL","29085 - APPLICATION CAST HAND & LOWER FOREARM GAUNTLET","88280 - HC CHG CHROMOSOME KARYOTYPE STUDY","28600 - CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES","87205 - HC CHG SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL","88280 - HC CHG CHROMOSOME KARYOTYPE STUDY","80168 - HC CHG DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE","29085 - APPLICATION CAST HAND & LOWER FOREARM GAUNTLET"]
[null,"31511 - HC LARYNGOSCOPY,INDIRECT+REMV FOR.BODY","87299 - HC CHG AG DETECTION NOS, FLUOR","29105 - APPLICATION LONG ARM SPLINT SHOULDER HAND","29105 - APPLICATION LONG ARM SPLINT SHOULDER HAND","29105 - APPLICATION LONG ARM SPLINT SHOULDER HAND","87206 - HC CHG SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT","28630 - CLOSED RX MT-PHAL TOE DISLOCATION","89050 - HC CHG CELL COUNT MISCELLANEOUS BODY FLUIDS","88280 - HC CHG CHROMOSOME KARYOTYPE STUDY","89050 - HC CHG CELL COUNT MISCELLANEOUS BODY FLUIDS","87206 - HC CHG SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT","29086 - HC APPLY CAST,FINGER (CONTRACTURE)","89050 - HC CHG CELL COUNT MISCELLANEOUS BODY FLUIDS","28630 - CLOSED RX MT-PHAL TOE DISLOCATION","87206 - HC CHG SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT","89050 - HC CHG CELL COUNT MISCELLANEOUS BODY FLUIDS","80170 - HC CHG DRUG SCREEN QUANTITATIVE GENTAMICIN","29086 - HC APPLY CAST,FINGER (CONTRACTURE)"]
[null,"31525 - HC LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN","87305 - HC CHG IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS","29125 - APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC","29125 - APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC","29125 - APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC","87207 - SMR PRIM SRC SPEC STAIN BODIES/PARASITS","28660 - HC CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES","89051 - HC CHG CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT","89050 - HC CHG CELL COUNT MISCELLANEOUS BODY FLUIDS","89051 - HC CHG CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT","87207 - SMR PRIM SRC SPEC STAIN BODIES/PARASITS","29105 - APPLICATION LONG ARM SPLINT SHOULDER HAND","89051 - HC CHG CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT","28660 - HC CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES","87207 - SMR PRIM SRC SPEC STAIN BODIES/PARASITS","89051 - HC CHG CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT","80178 - HC CHG DRUG SCREEN QUANTITATIVE LITHIUM","29105 - APPLICATION LONG ARM SPLINT SHOULDER HAND"]
[null,"31530 - HC LARYNGOSCOPY,DIRCT,OP,F.B. REMVL","87324 - HC CHG IAAD IA CLOSTRIDIUM DIFFICILE TOXIN","29126 - APPLICATION SHORT ARM SPLINT DYNAMIC","29126 - APPLICATION SHORT ARM SPLINT DYNAMIC","29126 - APPLICATION SHORT ARM SPLINT DYNAMIC","87209 - HC CHG SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS","28825 - HC AMP,TOE;INTERPHAL JT","89060 - HC CHG CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID","89051 - HC CHG CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT","89060 - HC CHG CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID","87209 - HC CHG SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS","29125 - APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC","89060 - HC CHG CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID","28825 - HC AMP,TOE;INTERPHAL JT","87209 - HC CHG SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS","89060 - HC CHG CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID","80184 - HC CHG DRUG SCREEN QUANTITATIVE PHENOBARBITAL","29125 - APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC"]
[null,"31552 - HC LARYNGOPLASTY LARYNGEAL STEN W/O STENT 12 YRS>","87327 - HC CHG IAAD IA CRYPTOCOCCUS NEOFORMANS","29130 - APPLICATION FINGER SPLINT STATIC","29130 - APPLICATION FINGER SPLINT STATIC","29130 - APPLICATION FINGER SPLINT STATIC","87210 - SMR PRIM SRC WET MOUNT NFCT AGT","28899 - CHEILECTOMY LESSER MPJ W/ IMPLANT","89320 - SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT","89060 - HC CHG CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID","89320 - SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT","87210 - SMR PRIM SRC WET MOUNT NFCT AGT","29126 - APPLICATION SHORT ARM SPLINT DYNAMIC","89320 - SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT","28899 - CHEILECTOMY LESSER MPJ W/ IMPLANT","87210 - SMR PRIM SRC WET MOUNT NFCT AGT","89320 - SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT","80185 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL","29126 - APPLICATION SHORT ARM SPLINT DYNAMIC"]
[null,"31570 - HC LARYNGOSCOPY,DIRCT,INJ VOCAL CORD","87338 - HC CHG IAAD IA HPYLORI STOOL","29131 - APPLICATION FINGER SPLINT DYNAMIC","29131 - APPLICATION FINGER SPLINT DYNAMIC","29131 - APPLICATION FINGER SPLINT DYNAMIC","87220 - TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT","29065 - APPLICATION CAST SHOULDER HAND LONG ARM","90371 - HC HEPB IG, IM","89320 - SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT","90371 - HC HEPB IG, IM","87220 - TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT","29130 - APPLICATION FINGER SPLINT STATIC","90371 - HC HEPB IG, IM","29065 - APPLICATION CAST SHOULDER HAND LONG ARM","87220 - TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT","90371 - HC HEPB IG, IM","80186 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN FREE","29130 - APPLICATION FINGER SPLINT STATIC"]
[null,"31571 - LARGSC W/NJX VOCAL CORD THER W/MICRO/TELESCOPE","87340 - HC CHG IAAD IA HEPATITIS B SURFACE ANTIGEN","29200 - STRAPPING THORAX","29200 - STRAPPING THORAX","29200 - STRAPPING THORAX","87252 - HC CHG VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT","29075 - APPLICATION CAST ELBOW FINGER SHORT ARM","90632 - CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL","90371 - HC HEPB IG, IM","90632 - CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL","87252 - HC CHG VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT","29131 - APPLICATION FINGER SPLINT DYNAMIC","90632 - CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL","29075 - APPLICATION CAST ELBOW FINGER SHORT ARM","87252 - HC CHG VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT","90632 - CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL","80195 - HC CHG DRUG SCREEN QUANTITATIVE SIROLIMUS","29131 - APPLICATION FINGER SPLINT DYNAMIC"]
[null,"31572 - HC LARYNGOSCOPY FLEXIBLE ABLATJ DESTJ LESION(S) UNI","87341 - HC CHG IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION","29240 - STRAPPING SHOULDER","29240 - STRAPPING SHOULDER","29240 - STRAPPING SHOULDER","87253 - HC CHG VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE","29085 - APPLICATION CAST HAND & LOWER FOREARM GAUNTLET","90653 - HC IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE","90632 - CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL","90653 - HC IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE","87253 - HC CHG VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE","29200 - STRAPPING THORAX","90653 - HC IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE","29085 - APPLICATION CAST HAND & LOWER FOREARM GAUNTLET","87253 - HC CHG VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE","90653 - HC IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE","80197 - HC CHG DRUG SCREEN QUANTITATIVE TACROLIMUS","29200 - STRAPPING THORAX"]
[null,"31573 - HC LARYNGOSCOPY FLEXIBLE THERAPEUTIC INJECTION UNI","87350 - HC CHG IAAD IA HEPATITIS BE ANTIGEN","29280 - HC STRAPPING OF HAND OR FINGER","29280 - HC STRAPPING OF HAND OR FINGER","29280 - HC STRAPPING OF HAND OR FINGER","87254 - HC CHG VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA","29086 - HC APPLY CAST,FINGER (CONTRACTURE)","90662 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM FLUZONE HIGH DOSE","90653 - HC IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE","90662 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM FLUZONE HIGH DOSE","87254 - HC CHG VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA","29240 - STRAPPING SHOULDER","90662 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM FLUZONE HIGH DOSE","29086 - HC APPLY CAST,FINGER (CONTRACTURE)","87254 - HC CHG VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA","90662 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM FLUZONE HIGH DOSE","80198 - HC Q;THEOPHYLLINE","29240 - STRAPPING SHOULDER"]
[null,"31574 - HC LARYNGOSCOPY FLEXIBLE W/INJECTION AGMNTJ UNI","87385 - HC CHG IAAD IA HISTOPLASM CAPSULATUM","29345 - APPLICATION LONG LEG CAST THIGH-TOE","29345 - APPLICATION LONG LEG CAST THIGH-TOE","29345 - APPLICATION LONG LEG CAST THIGH-TOE","87255 - HC CHG VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC","29105 - APPLICATION LONG ARM SPLINT SHOULDER HAND","90670 - CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH","90662 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM FLUZONE HIGH DOSE","90670 - CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH","87255 - HC CHG VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC","29280 - HC STRAPPING OF HAND OR FINGER","90670 - CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH","29105 - APPLICATION LONG ARM SPLINT SHOULDER HAND","87255 - HC CHG VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC","90670 - CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH","80201 - HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE","29280 - HC STRAPPING OF HAND OR FINGER"]
[null,"31575 - LARYNGOSCOPY FLEXIBLE FIBEROPTIC DIAGNOSTIC","87389 - HC CHG IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE","29355 - HC APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE","29355 - HC APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE","29355 - HC APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE","87260 - HC CHG IAADI ADENOVIRUS","29125 - APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC","90672 - CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST","90670 - CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH","90672 - CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST","87260 - HC CHG IAADI ADENOVIRUS","29345 - APPLICATION LONG LEG CAST THIGH-TOE","90672 - CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST","29125 - APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC","87260 - HC CHG IAADI ADENOVIRUS","90672 - CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST","80202 - HC CHG DRUG SCREEN QUANTITATIVE VANCOMYCIN","29345 - APPLICATION LONG LEG CAST THIGH-TOE"]
[null,"31576 - LARYNGOSCOPY FLEXIBLE FIBEROPTIC W/BIOPSY","87390 - HC CHG IAAD IA HIV-1","29365 - APPLICATION CYLINDER CAST THIGH ANKLE","29365 - APPLICATION CYLINDER CAST THIGH ANKLE","29365 - APPLICATION CYLINDER CAST THIGH ANKLE","87269 - HC CHG IAADI GIARDIA","29126 - APPLICATION SHORT ARM SPLINT DYNAMIC","90673 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM","90672 - CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST","90673 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM","87269 - HC CHG IAADI GIARDIA","29355 - HC APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE","90673 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM","29126 - APPLICATION SHORT ARM SPLINT DYNAMIC","87269 - HC CHG IAADI GIARDIA","90673 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM","80299 - HC INFLIXIMAB DRUG CONC. AND ANTI-INFLIXIMAB AB","29355 - HC APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE"]
[null,"31577 - LARYNGOSCOPY FLX FIBEROPTIC RMVL FOREIGN BODY","87391 - HC CHG IAAD IA HIV-2","29405 - APPLICATION SHORT LEG CAST BELOW KNEE-TOE","29405 - APPLICATION SHORT LEG CAST BELOW KNEE-TOE","29405 - APPLICATION SHORT LEG CAST BELOW KNEE-TOE","87272 - HC CHG IAADI CRYPTOSPORIDIUM","29130 - APPLICATION FINGER SPLINT STATIC","90674 - HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE","90673 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM","90674 - HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE","87272 - HC CHG IAADI CRYPTOSPORIDIUM","29365 - APPLICATION CYLINDER CAST THIGH ANKLE","90674 - HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE","29130 - APPLICATION FINGER SPLINT STATIC","87272 - HC CHG IAADI CRYPTOSPORIDIUM","90674 - HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE","80306 - HC DRUG TEST PRSMV INSTRMNT","29365 - APPLICATION CYLINDER CAST THIGH ANKLE"]
[null,"31578 - LARYNGOSCOPY FLEXIBLE FIBEROPTIC REMOVAL LESION","87400 - HC CHG IAAD IA INFLUENZA A/B EACH","29425 - APPLICATION SHORT LEG CAST WALKING/AMBULATORY","29425 - APPLICATION SHORT LEG CAST WALKING/AMBULATORY","29425 - APPLICATION SHORT LEG CAST WALKING/AMBULATORY","87275 - HC CHG IAADI INFLUENZA B VIRUS","29131 - APPLICATION FINGER SPLINT DYNAMIC","90675 - CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL","90674 - HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE","90675 - CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL","87275 - HC CHG IAADI INFLUENZA B VIRUS","29405 - APPLICATION SHORT LEG CAST BELOW KNEE-TOE","90675 - CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL","29131 - APPLICATION FINGER SPLINT DYNAMIC","87275 - HC CHG IAADI INFLUENZA B VIRUS","90675 - CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL","80307 - HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS","29405 - APPLICATION SHORT LEG CAST BELOW KNEE-TOE"]
[null,"31579 - LARYNGOSCOPY FLX/RGD FIBOPT W/STROBOSCOPY","87420 - HC CHG IAAD IA RESPIRATORY SYNCTIAL VIRUS","29440 - HC ADDITION OF WALKER TO CAST","29440 - HC ADDITION OF WALKER TO CAST","29440 - HC ADDITION OF WALKER TO CAST","87276 - HC CHG IAADI INFFLUENZA A VIRUS","29200 - STRAPPING THORAX","90686 - HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE","90675 - CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL","90686 - HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE","87276 - HC CHG IAADI INFFLUENZA A VIRUS","29425 - APPLICATION SHORT LEG CAST WALKING/AMBULATORY","90686 - HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE","29200 - STRAPPING THORAX","87276 - HC CHG IAADI INFFLUENZA A VIRUS","90686 - HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE","80320 - DRUG SCREEN QUANTITATIVE ALCOHOLS","29425 - APPLICATION SHORT LEG CAST WALKING/AMBULATORY"]
[null,"31599 - SML WITH EXCISION OF TRACHEAL/SUBGLOTTIC STENOSIS","87425 - HC CHG IAAD IA ROTAVIRUS","29445 - HC APPLICATION RIGID TOTAL CONTACT LEG CAST","29445 - HC APPLICATION RIGID TOTAL CONTACT LEG CAST","29445 - HC APPLICATION RIGID TOTAL CONTACT LEG CAST","87279 - HC CHG IAADI PARAINFLUENZA VIRUS EACH TYPE","29240 - STRAPPING SHOULDER","90691 - CR BUILD ONLY - TYPHOID VACCINE, IM,TRAVEL","90686 - HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE","90691 - CR BUILD ONLY - TYPHOID VACCINE, IM,TRAVEL","87279 - HC CHG IAADI PARAINFLUENZA VIRUS EACH TYPE","29440 - HC ADDITION OF WALKER TO CAST","90691 - CR BUILD ONLY - TYPHOID VACCINE, IM,TRAVEL","29240 - STRAPPING SHOULDER","87279 - HC CHG IAADI PARAINFLUENZA VIRUS EACH TYPE","90691 - CR BUILD ONLY - TYPHOID VACCINE, IM,TRAVEL","80329 - DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2","29440 - HC ADDITION OF WALKER TO CAST"]
[null,"31603 - HC TRACHEOSTOMY,EMERG,XTRACH","87426 - SARSCOV CORONAVIRUS AG IA","29450 - APPL CLUBFOOT CAST MOLDING/MANJ LONG/SHORT LEG","29450 - APPL CLUBFOOT CAST MOLDING/MANJ LONG/SHORT LEG","29450 - APPL CLUBFOOT CAST MOLDING/MANJ LONG/SHORT LEG","87281 - HC CHG IAADI PNEUMOCUSTIS CARINII","29280 - HC STRAPPING OF HAND OR FINGER","90694 - HC VACC AIIV4 NO PRSRV 0.5ML IM","90691 - CR BUILD ONLY - TYPHOID VACCINE, IM,TRAVEL","90694 - HC VACC AIIV4 NO PRSRV 0.5ML IM","87281 - HC CHG IAADI PNEUMOCUSTIS CARINII","29445 - HC APPLICATION RIGID TOTAL CONTACT LEG CAST","90694 - HC VACC AIIV4 NO PRSRV 0.5ML IM","29280 - HC STRAPPING OF HAND OR FINGER","87281 - HC CHG IAADI PNEUMOCUSTIS CARINII","90694 - HC VACC AIIV4 NO PRSRV 0.5ML IM","80339 - HC CHG ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 1-3","29445 - HC APPLICATION RIGID TOTAL CONTACT LEG CAST"]
[null,"31605 - HC TRACHEOSTOMY,EMERG,CRICOTHYROID","87430 - HC CHG IAAD IA STREPTOCOCCUS GROUP A","29505 - APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES","29505 - APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES","29505 - APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES","87299 - HC CHG AG DETECTION NOS, FLUOR","29345 - APPLICATION LONG LEG CAST THIGH-TOE","90714 - CR BUILD ONLY - TD VACCINE NO PRSRV >/= 7 YO, IM,DPH","90694 - HC VACC AIIV4 NO PRSRV 0.5ML IM","90714 - CR BUILD ONLY - TD VACCINE NO PRSRV >/= 7 YO, IM,DPH","87299 - HC CHG AG DETECTION NOS, FLUOR","29450 - APPL CLUBFOOT CAST MOLDING/MANJ LONG/SHORT LEG","90714 - CR BUILD ONLY - TD VACCINE NO PRSRV >/= 7 YO, IM,DPH","29345 - APPLICATION LONG LEG CAST THIGH-TOE","87299 - HC CHG AG DETECTION NOS, FLUOR","90714 - CR BUILD ONLY - TD VACCINE NO PRSRV >/= 7 YO, IM,DPH","80345 - HC CHG DRUG SCREENING BARBITURATES","29450 - APPL CLUBFOOT CAST MOLDING/MANJ LONG/SHORT LEG"]
[null,"31611 - CONSTJ TRACHEOESOPHGL FSTL&INSJ SP PROSTH","87449 - HC AG DET,ENZ IMM;OTH,EA","29515 - APPLICATION SHORT LEG SPLINT CALF FOOT","29515 - APPLICATION SHORT LEG SPLINT CALF FOOT","29515 - APPLICATION SHORT LEG SPLINT CALF FOOT","87305 - HC CHG IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS","29355 - HC APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE","90715 - CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH","90714 - CR BUILD ONLY - TD VACCINE NO PRSRV >/= 7 YO, IM,DPH","90715 - CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH","87305 - HC CHG IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS","29505 - APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES","90715 - CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH","29355 - HC APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE","87305 - HC CHG IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS","90715 - CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH","80353 - HC CHG DRUG SCREENING COCAINE","29505 - APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES"]
[null,"31613 - TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION","87480 - HC CHG IADNA CANDIDA SPECIES DIRECT PROBE TQ","29520 - STRAPPING HIP","29520 - STRAPPING HIP","29520 - STRAPPING HIP","87324 - HC CHG IAAD IA CLOSTRIDIUM DIFFICILE TOXIN","29365 - APPLICATION CYLINDER CAST THIGH ANKLE","90732 - CR BUILD ONLY - PNEUMOCOCCAL VACCINE,23-VALENT,ADULT,TRAVEL","90715 - CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH","90732 - CR BUILD ONLY - PNEUMOCOCCAL VACCINE,23-VALENT,ADULT,TRAVEL","87324 - HC CHG IAAD IA CLOSTRIDIUM DIFFICILE TOXIN","29515 - APPLICATION SHORT LEG SPLINT CALF FOOT","90732 - CR BUILD ONLY - PNEUMOCOCCAL VACCINE,23-VALENT,ADULT,TRAVEL","29365 - APPLICATION CYLINDER CAST THIGH ANKLE","87324 - HC CHG IAAD IA CLOSTRIDIUM DIFFICILE TOXIN","90732 - CR BUILD ONLY - PNEUMOCOCCAL VACCINE,23-VALENT,ADULT,TRAVEL","80361 - HC CHG DRUG SCREENING OPIATES 1 OR MORE","29515 - APPLICATION SHORT LEG SPLINT CALF FOOT"]
[null,"31615 - TRACHEOBRNCHSC THRU EST TRACHS INC","87481 - HC CHG CANDIDA, DNA, AMP PROBE","29530 - STRAPPING KNEE","29530 - STRAPPING KNEE","29530 - STRAPPING KNEE","87327 - HC CHG IAAD IA CRYPTOCOCCUS NEOFORMANS","29405 - APPLICATION SHORT LEG CAST BELOW KNEE-TOE","90739 - HC HEPATITIS B VACCINE ADULT 2 DOSE IM","90732 - CR BUILD ONLY - PNEUMOCOCCAL VACCINE,23-VALENT,ADULT,TRAVEL","90739 - HC HEPATITIS B VACCINE ADULT 2 DOSE IM","87327 - HC CHG IAAD IA CRYPTOCOCCUS NEOFORMANS","29520 - STRAPPING HIP","90739 - HC HEPATITIS B VACCINE ADULT 2 DOSE IM","29405 - APPLICATION SHORT LEG CAST BELOW KNEE-TOE","87327 - HC CHG IAAD IA CRYPTOCOCCUS NEOFORMANS","90739 - HC HEPATITIS B VACCINE ADULT 2 DOSE IM","80438 - HC CHG TRH STIM PANEL 1 HR","29520 - STRAPPING HIP"]
[null,"31622 - BRNCHSC INCL FLUOR GID DX W/CELL WASHG SPX","87486 - HC CHG IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ","29540 - STRAPPING ANKLE &/FOOT","29540 - STRAPPING ANKLE &/FOOT","29540 - STRAPPING ANKLE &/FOOT","87338 - HC CHG IAAD IA HPYLORI STOOL","29425 - APPLICATION SHORT LEG CAST WALKING/AMBULATORY","90740 - HC HEP B VACCINE,DIAL/IMMUNOSUP, IM","90739 - HC HEPATITIS B VACCINE ADULT 2 DOSE IM","90740 - HC HEP B VACCINE,DIAL/IMMUNOSUP, IM","87338 - HC CHG IAAD IA HPYLORI STOOL","29530 - STRAPPING KNEE","90740 - HC HEP B VACCINE,DIAL/IMMUNOSUP, IM","29425 - APPLICATION SHORT LEG CAST WALKING/AMBULATORY","87338 - HC CHG IAAD IA HPYLORI STOOL","90740 - HC HEP B VACCINE,DIAL/IMMUNOSUP, IM","81000 - URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY","29530 - STRAPPING KNEE"]
[null,"31623 - BRNCHSC BRUSHING/PROTECTED BRUSHINGS","87490 - HC CHG IADNA CHLAMYDIA TRACHOMATIS DIRECT PROBE TQ","29550 - STRAPPING TOES","29550 - STRAPPING TOES","29550 - STRAPPING TOES","87340 - HC CHG IAAD IA HEPATITIS B SURFACE ANTIGEN","29440 - HC ADDITION OF WALKER TO CAST","90744 - CR BUILD ONLY - HEP B VACCINE,PED/ADOL,IM,DPH","90740 - HC HEP B VACCINE,DIAL/IMMUNOSUP, IM","90744 - CR BUILD ONLY - HEP B VACCINE,PED/ADOL,IM,DPH","87340 - HC CHG IAAD IA HEPATITIS B SURFACE ANTIGEN","29540 - STRAPPING ANKLE &/FOOT","90744 - CR BUILD ONLY - HEP B VACCINE,PED/ADOL,IM,DPH","29440 - HC ADDITION OF WALKER TO CAST","87340 - HC CHG IAAD IA HEPATITIS B SURFACE ANTIGEN","90744 - CR BUILD ONLY - HEP B VACCINE,PED/ADOL,IM,DPH","81001 - URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY","29540 - STRAPPING ANKLE &/FOOT"]
[null,"31624 - BRNCHSC W/BRNCL ALVEOLAR LAVAGE","87491 - HC CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ","29580 - STRAPPING UNNA BOOT","29580 - STRAPPING UNNA BOOT","29580 - STRAPPING UNNA BOOT","87341 - HC CHG IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION","29445 - HC APPLICATION RIGID TOTAL CONTACT LEG CAST","90746 - CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL","90744 - CR BUILD ONLY - HEP B VACCINE,PED/ADOL,IM,DPH","90746 - CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL","87341 - HC CHG IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION","29550 - STRAPPING TOES","90746 - CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL","29445 - HC APPLICATION RIGID TOTAL CONTACT LEG CAST","87341 - HC CHG IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION","90746 - CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL","81002 - URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP","29550 - STRAPPING TOES"]
[null,"31625 - BRONCHOSCOPY BRONCHIAL/ENDOBRNCL BX 1+ SITES","87493 - HC CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE","29581 - APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT","29581 - APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT","29581 - APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT","87350 - HC CHG IAAD IA HEPATITIS BE ANTIGEN","29450 - APPL CLUBFOOT CAST MOLDING/MANJ LONG/SHORT LEG","90756 - HC CCIIV4 VACCINE ANTIBIOTIC FREE 0.5ML DOS IM USE","90746 - CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL","90756 - HC CCIIV4 VACCINE ANTIBIOTIC FREE 0.5ML DOS IM USE","87350 - HC CHG IAAD IA HEPATITIS BE ANTIGEN","29580 - STRAPPING UNNA BOOT","90756 - HC CCIIV4 VACCINE ANTIBIOTIC FREE 0.5ML DOS IM USE","29450 - APPL CLUBFOOT CAST MOLDING/MANJ LONG/SHORT LEG","87350 - HC CHG IAAD IA HEPATITIS BE ANTIGEN","90756 - HC CCIIV4 VACCINE ANTIBIOTIC FREE 0.5ML DOS IM USE","81003 - URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY","29580 - STRAPPING UNNA BOOT"]
[null,"31626 - HC BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT","87496 - HC ARUP;CYTOMEG VIR PCR,CSF","29700 - REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST","29700 - REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST","29700 - REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST","87385 - HC CHG IAAD IA HISTOPLASM CAPSULATUM","29505 - APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","90756 - HC CCIIV4 VACCINE ANTIBIOTIC FREE 0.5ML DOS IM USE","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","87385 - HC CHG IAAD IA HISTOPLASM CAPSULATUM","29581 - APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","29505 - APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES","87385 - HC CHG IAAD IA HISTOPLASM CAPSULATUM","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","81015 - HC CHG URINALYSIS MICROSCOPIC ONLY","29581 - APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT"]
[null,"31628 - BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX 1 LOBE","87497 - HC CHG IADNA CYTOMEGALOVIRUS QUANTIFICATION","29705 - HC REMV/REVISN FULL ARM/LEG CAST","29705 - HC REMV/REVISN FULL ARM/LEG CAST","29705 - HC REMV/REVISN FULL ARM/LEG CAST","87389 - HC CHG IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE","29515 - APPLICATION SHORT LEG SPLINT CALF FOOT","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","87389 - HC CHG IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE","29700 - REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","29515 - APPLICATION SHORT LEG SPLINT CALF FOOT","87389 - HC CHG IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","81025 - URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS","29700 - REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST"]
[null,"31629 - HC BRONCHOSCOPY NEEDLE BX TRACHEA MAIN STEM&/BRON","87498 - HC CHG IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP","29730 - HC WINDOWING OF CAST","29730 - HC WINDOWING OF CAST","29730 - HC WINDOWING OF CAST","87390 - HC CHG IAAD IA HIV-1","29520 - STRAPPING HIP","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","87390 - HC CHG IAAD IA HIV-1","29705 - HC REMV/REVISN FULL ARM/LEG CAST","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","29520 - STRAPPING HIP","87390 - HC CHG IAAD IA HIV-1","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","81050 - HC CHG VOLUME MEASUREMENT TIMED COLLECTION EACH","29705 - HC REMV/REVISN FULL ARM/LEG CAST"]
[null,"31630 - HC BRONCHOSCOPY,TRACH/BRONCH DILATN","87502 - HC Q;FLU AG DET,MULT TYP,2,2","29740 - HC WEDGING OF CAST","29740 - HC WEDGING OF CAST","29740 - HC WEDGING OF CAST","87391 - HC CHG IAAD IA HIV-2","29530 - STRAPPING KNEE","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","87391 - HC CHG IAAD IA HIV-2","29730 - HC WINDOWING OF CAST","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","29530 - STRAPPING KNEE","87391 - HC CHG IAAD IA HIV-2","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","81161 - HC DMD DUPLICATION/DELETION ANALYSIS","29730 - HC WINDOWING OF CAST"]
[null,"31632 - HC BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE","87505 - HC CHG NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN","29804 - HC TMJ ARTHROSCOPY/SURGERY","29804 - HC TMJ ARTHROSCOPY/SURGERY","29804 - HC TMJ ARTHROSCOPY/SURGERY","87400 - HC CHG IAAD IA INFLUENZA A/B EACH","29540 - STRAPPING ANKLE &/FOOT","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","87400 - HC CHG IAAD IA INFLUENZA A/B EACH","29740 - HC WEDGING OF CAST","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","29540 - STRAPPING ANKLE &/FOOT","87400 - HC CHG IAAD IA INFLUENZA A/B EACH","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","81206 - HC CHG BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE","29740 - HC WEDGING OF CAST"]
[null,"31635 - HC BRONCHOSCOPY W/REMOVAL FOREIGN BODY","87506 - HC CHG IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11","29807 - HC SHLDR ARTHROSCOP,SURG,REPAIR,SLAP LESION","29807 - HC SHLDR ARTHROSCOP,SURG,REPAIR,SLAP LESION","29807 - HC SHLDR ARTHROSCOP,SURG,REPAIR,SLAP LESION","87420 - HC CHG IAAD IA RESPIRATORY SYNCTIAL VIRUS","29550 - STRAPPING TOES","0241U - HC NFCT DS VIR RESP RNA 4 TRGT","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","0241U - HC NFCT DS VIR RESP RNA 4 TRGT","87420 - HC CHG IAAD IA RESPIRATORY SYNCTIAL VIRUS","29804 - HC TMJ ARTHROSCOPY/SURGERY","0241U - HC NFCT DS VIR RESP RNA 4 TRGT","29550 - STRAPPING TOES","87420 - HC CHG IAAD IA RESPIRATORY SYNCTIAL VIRUS","0241U - HC NFCT DS VIR RESP RNA 4 TRGT","81207 - HC Q;P190 BCR-ABL 1","29804 - HC TMJ ARTHROSCOPY/SURGERY"]
[null,"31640 - HC BRONCHOSCOPY,EXCIS LESN","87507 - HC IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25","29823 - HC SHLDR ARTHROSCOP,EXTEN DEBRIDE 3+","29823 - HC SHLDR ARTHROSCOP,EXTEN DEBRIDE 3+","29823 - HC SHLDR ARTHROSCOP,EXTEN DEBRIDE 3+","87425 - HC CHG IAAD IA ROTAVIRUS","29580 - STRAPPING UNNA BOOT","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","0241U - HC NFCT DS VIR RESP RNA 4 TRGT","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","87425 - HC CHG IAAD IA ROTAVIRUS","29807 - HC SHLDR ARTHROSCOP,SURG,REPAIR,SLAP LESION","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","29580 - STRAPPING UNNA BOOT","87425 - HC CHG IAAD IA ROTAVIRUS","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","81210 - HC CHG BRAF GENE ANALYSIS V600 VARIANT(S)","29807 - HC SHLDR ARTHROSCOP,SURG,REPAIR,SLAP LESION"]
[null,"31645 - HC BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE 1ST","87510 - HC CHG IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ","29827 - HC SHLDR ARTHROSCOP,SURG,W/ROTAT CUFF REPR","29827 - HC SHLDR ARTHROSCOP,SURG,W/ROTAT CUFF REPR","29827 - HC SHLDR ARTHROSCOP,SURG,W/ROTAT CUFF REPR","87426 - SARSCOV CORONAVIRUS AG IA","29581 - APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT",null,"U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",null,"87426 - SARSCOV CORONAVIRUS AG IA","29823 - HC SHLDR ARTHROSCOP,EXTEN DEBRIDE 3+",null,"29581 - APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT","87426 - SARSCOV CORONAVIRUS AG IA",null,"81218 - HC CEBPA GENE ANALYSIS FULL GENE SEQUENC","29823 - HC SHLDR ARTHROSCOP,EXTEN DEBRIDE 3+"]
[null,"31646 - HC BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE SBSQ","87511 - HC CHG GARDNER VAG, DNA  AMP PROBE","29881 - HC KNEE SCOPE SINGLE MENISCECTOMY","29881 - HC KNEE SCOPE SINGLE MENISCECTOMY","29881 - HC KNEE SCOPE SINGLE MENISCECTOMY","87430 - HC CHG IAAD IA STREPTOCOCCUS GROUP A","29700 - REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST",null,null,null,"87430 - HC CHG IAAD IA STREPTOCOCCUS GROUP A","29827 - HC SHLDR ARTHROSCOP,SURG,W/ROTAT CUFF REPR",null,"29700 - REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST","87430 - HC CHG IAAD IA STREPTOCOCCUS GROUP A",null,"81235 - HC CHG EGFR GENE ANALYSIS COMMON VARIANTS","29827 - HC SHLDR ARTHROSCOP,SURG,W/ROTAT CUFF REPR"]
[null,"31652 - HC BRNCHSC EBUS GUIDED SAMPL 1/2 NODE STATION/STRUX","87517 - HC CHG IADNA HEPATITIS B VIRUS QUANTIFICATION","29882 - HC KNEE SCOPE,MED OR LAT MENIS REPAIR","29882 - HC KNEE SCOPE,MED OR LAT MENIS REPAIR","29882 - HC KNEE SCOPE,MED OR LAT MENIS REPAIR","87449 - HC AG DET,ENZ IMM;OTH,EA","29705 - HC REMV/REVISN FULL ARM/LEG CAST",null,null,null,"87449 - HC AG DET,ENZ IMM;OTH,EA","29881 - HC KNEE SCOPE SINGLE MENISCECTOMY",null,"29705 - HC REMV/REVISN FULL ARM/LEG CAST","87449 - HC AG DET,ENZ IMM;OTH,EA",null,"81240 - HC CHG F2 GENE ANALYSIS 20210G >A VARIANT","29881 - HC KNEE SCOPE SINGLE MENISCECTOMY"]
[null,"31653 - HC BRONCH EBUS SAMPLING 3 OR MORE NODES","87522 - HC ARUP;HEP C VIR RNA QN","29888 - HC KNEE SCOPE,AID ANT CRUCIATE REPAIR","29888 - HC KNEE SCOPE,AID ANT CRUCIATE REPAIR","29888 - HC KNEE SCOPE,AID ANT CRUCIATE REPAIR","87480 - HC CHG IADNA CANDIDA SPECIES DIRECT PROBE TQ","29730 - HC WINDOWING OF CAST",null,null,null,"87480 - HC CHG IADNA CANDIDA SPECIES DIRECT PROBE TQ","29882 - HC KNEE SCOPE,MED OR LAT MENIS REPAIR",null,"29730 - HC WINDOWING OF CAST","87480 - HC CHG IADNA CANDIDA SPECIES DIRECT PROBE TQ",null,"81241 - HC CHG F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT","29882 - HC KNEE SCOPE,MED OR LAT MENIS REPAIR"]
[null,"31720 - HC CATHETER ASPIRATION NASOTRACHEAL SPX","87529 - HC CHG IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ","30000 - DRAINAGE ABSCESS/HEMATOMA NASAL INT APPROACH","30000 - DRAINAGE ABSCESS/HEMATOMA NASAL INT APPROACH","30000 - DRAINAGE ABSCESS/HEMATOMA NASAL INT APPROACH","87481 - HC CHG CANDIDA, DNA, AMP PROBE","29740 - HC WEDGING OF CAST",null,null,null,"87481 - HC CHG CANDIDA, DNA, AMP PROBE","29888 - HC KNEE SCOPE,AID ANT CRUCIATE REPAIR",null,"29740 - HC WEDGING OF CAST","87481 - HC CHG CANDIDA, DNA, AMP PROBE",null,"81256 - HC CHG HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS","29888 - HC KNEE SCOPE,AID ANT CRUCIATE REPAIR"]
[null,"31820 - HC SURG CLOSURE TRACH/FISTULA","87532 - HC CHG IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ","30020 - DRAINAGE ABSCESS/HEMATOMA NASAL SEPTUM","30020 - DRAINAGE ABSCESS/HEMATOMA NASAL SEPTUM","30020 - DRAINAGE ABSCESS/HEMATOMA NASAL SEPTUM","87486 - HC CHG IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ","29799 - UNLISTED PROCEDURE CASTING/STRAPPING",null,null,null,"87486 - HC CHG IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ","30000 - DRAINAGE ABSCESS/HEMATOMA NASAL INT APPROACH",null,"29799 - UNLISTED PROCEDURE CASTING/STRAPPING","87486 - HC CHG IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ",null,"81261 - IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED; PRO/TECH","30000 - DRAINAGE ABSCESS/HEMATOMA NASAL INT APPROACH"]
[null,"32400 - HC BIOPSY PLEURA PERCUTANEOUS NEEDLE","87535 - HC CHG IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ","30100 - HC BIOPSY INTRANASAL","30100 - HC BIOPSY INTRANASAL","30100 - HC BIOPSY INTRANASAL","87490 - HC CHG IADNA CHLAMYDIA TRACHOMATIS DIRECT PROBE TQ","29804 - HC TMJ ARTHROSCOPY/SURGERY",null,null,null,"87490 - HC CHG IADNA CHLAMYDIA TRACHOMATIS DIRECT PROBE TQ","30020 - DRAINAGE ABSCESS/HEMATOMA NASAL SEPTUM",null,"29804 - HC TMJ ARTHROSCOPY/SURGERY","87490 - HC CHG IADNA CHLAMYDIA TRACHOMATIS DIRECT PROBE TQ",null,"81270 - HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT","30020 - DRAINAGE ABSCESS/HEMATOMA NASAL SEPTUM"]
[null,"32405 - HC BIOPSY LUNG/MEDIASTINUM PERCUTANEOUS NEEDLE","87536 - HC CHG IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION","30110 - EXCISION NASAL POLYP SIMPLE","30110 - EXCISION NASAL POLYP SIMPLE","30110 - EXCISION NASAL POLYP SIMPLE","87491 - HC CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ","29807 - HC SHLDR ARTHROSCOP,SURG,REPAIR,SLAP LESION",null,null,null,"87491 - HC CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ","30100 - HC BIOPSY INTRANASAL",null,"29807 - HC SHLDR ARTHROSCOP,SURG,REPAIR,SLAP LESION","87491 - HC CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ",null,"81272 - HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS","30100 - HC BIOPSY INTRANASAL"]
[null,"32550 - HC INS TUNN PLEURAL CATH W/U","87538 - HC HIV-2 PROBE&REVRSE TRNSCRIPJ","30117 - EXCISION/DESTRUCTION INTRANASAL LESION INT APPR","30117 - EXCISION/DESTRUCTION INTRANASAL LESION INT APPR","30117 - EXCISION/DESTRUCTION INTRANASAL LESION INT APPR","87493 - HC CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE","29823 - HC SHLDR ARTHROSCOP,EXTEN DEBRIDE 3+",null,null,null,"87493 - HC CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE","30110 - EXCISION NASAL POLYP SIMPLE",null,"29823 - HC SHLDR ARTHROSCOP,EXTEN DEBRIDE 3+","87493 - HC CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE",null,"81275 - HC CHG KRAS GENE ANALYSIS VARIANTS IN EXON 2","30110 - EXCISION NASAL POLYP SIMPLE"]
[null,"32551 - TUBE THORACOSTOMY INCLUDES WATER SEAL","87556 - HC CHG IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB","30130 - HC EXCISION TURBINATE","30130 - HC EXCISION TURBINATE","30130 - HC EXCISION TURBINATE","87496 - HC ARUP;CYTOMEG VIR PCR,CSF","29827 - HC SHLDR ARTHROSCOP,SURG,W/ROTAT CUFF REPR",null,null,null,"87496 - HC ARUP;CYTOMEG VIR PCR,CSF","30117 - EXCISION/DESTRUCTION INTRANASAL LESION INT APPR",null,"29827 - HC SHLDR ARTHROSCOP,SURG,W/ROTAT CUFF REPR","87496 - HC ARUP;CYTOMEG VIR PCR,CSF",null,"81276 - HC CHG KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)","30117 - EXCISION/DESTRUCTION INTRANASAL LESION INT APPR"]
[null,"32552 - HC REMOVAL OF LUNG CATHETER","87581 - HC CHG IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ","30140 - HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL","30140 - HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL","30140 - HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL","87497 - HC CHG IADNA CYTOMEGALOVIRUS QUANTIFICATION","29881 - HC KNEE SCOPE SINGLE MENISCECTOMY",null,null,null,"87497 - HC CHG IADNA CYTOMEGALOVIRUS QUANTIFICATION","30130 - HC EXCISION TURBINATE",null,"29881 - HC KNEE SCOPE SINGLE MENISCECTOMY","87497 - HC CHG IADNA CYTOMEGALOVIRUS QUANTIFICATION",null,"81288 - MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS","30130 - HC EXCISION TURBINATE"]
[null,"32553 - HC PLMT NTRSTL DEV RADJ THX GID PRQ INTRATHRC 1/MLT","87591 - HC CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ","30200 - INJECTION INTO TURBINATE","30200 - INJECTION INTO TURBINATE","30200 - INJECTION INTO TURBINATE","87498 - HC CHG IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP","29882 - HC KNEE SCOPE,MED OR LAT MENIS REPAIR",null,null,null,"87498 - HC CHG IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP","30140 - HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL",null,"29882 - HC KNEE SCOPE,MED OR LAT MENIS REPAIR","87498 - HC CHG IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP",null,"81291 - HC CHG MTHFR GENE ANALYSIS COMMON VARIANTS","30140 - HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL"]
[null,"32554 - THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING","87624 - IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES","30220 - INSERTION NASAL SEPTAL PROSTHESIS BUTTON","30220 - INSERTION NASAL SEPTAL PROSTHESIS BUTTON","30220 - INSERTION NASAL SEPTAL PROSTHESIS BUTTON","87502 - HC Q;FLU AG DET,MULT TYP,2,2","29888 - HC KNEE SCOPE,AID ANT CRUCIATE REPAIR",null,null,null,"87502 - HC Q;FLU AG DET,MULT TYP,2,2","30200 - INJECTION INTO TURBINATE",null,"29888 - HC KNEE SCOPE,AID ANT CRUCIATE REPAIR","87502 - HC Q;FLU AG DET,MULT TYP,2,2",null,"81301 - HC CHG MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF","30200 - INJECTION INTO TURBINATE"]
[null,"32555 - THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING","87631 - HC INFLUENZA A/B,RSV PCR","30300 - REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE","30300 - REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE","30300 - REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE","87505 - HC CHG NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN","30000 - DRAINAGE ABSCESS/HEMATOMA NASAL INT APPROACH",null,null,null,"87505 - HC CHG NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN","30220 - INSERTION NASAL SEPTAL PROSTHESIS BUTTON",null,"30000 - DRAINAGE ABSCESS/HEMATOMA NASAL INT APPROACH","87505 - HC CHG NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN",null,"81311 - HC CHG NRAS GENE ANALYSIS VARIANTS IN EXON 2&3","30220 - INSERTION NASAL SEPTAL PROSTHESIS BUTTON"]
[null,"32556 - PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING","87632 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 6-11 TARGETS","30420 - HC RECONSTR NOSE+MAJ SEPTAL REPAIR","30420 - HC RECONSTR NOSE+MAJ SEPTAL REPAIR","30420 - HC RECONSTR NOSE+MAJ SEPTAL REPAIR","87506 - HC CHG IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11","30020 - DRAINAGE ABSCESS/HEMATOMA NASAL SEPTUM",null,null,null,"87506 - HC CHG IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11","30300 - REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE",null,"30020 - DRAINAGE ABSCESS/HEMATOMA NASAL SEPTUM","87506 - HC CHG IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11",null,"81315 - HC PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT","30300 - REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE"]
[null,"32557 - PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING","87633 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET","30465 - REPAIR NASAL VESTIBULAR STENOSIS","30465 - REPAIR NASAL VESTIBULAR STENOSIS","30465 - REPAIR NASAL VESTIBULAR STENOSIS","87507 - HC IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25","30100 - HC BIOPSY INTRANASAL",null,null,null,"87507 - HC IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25","30420 - HC RECONSTR NOSE+MAJ SEPTAL REPAIR",null,"30100 - HC BIOPSY INTRANASAL","87507 - HC IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25",null,"81342 - TRG@ GENE REARRANGEMENT ANALYSIS; PRO/TECH","30420 - HC RECONSTR NOSE+MAJ SEPTAL REPAIR"]
[null,"32994 - HC ABLATION THER 1+ PULM TUMORS PREQ CRYOABLATION","87635 - HC SARS-COV-2 COVID-19 AMP PRB","30520 - HC REPAIR OF NASAL SEPTUM","30520 - HC REPAIR OF NASAL SEPTUM","30520 - HC REPAIR OF NASAL SEPTUM","87510 - HC CHG IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ","30110 - EXCISION NASAL POLYP SIMPLE",null,null,null,"87510 - HC CHG IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ","30465 - REPAIR NASAL VESTIBULAR STENOSIS",null,"30110 - EXCISION NASAL POLYP SIMPLE","87510 - HC CHG IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ",null,"81450 - HC CHG GENOMIC SEQ ANALYS DNA&RNA ANALYS 5-50 GENE","30465 - REPAIR NASAL VESTIBULAR STENOSIS"]
[null,"32998 - HC ABLATION PULMONARY TUMOR PERQ RADIOFREQUENCY UNI","87636 - HC SARSCOV2 & INF A&B AMP PRB","30560 - HC RELEASE OF NASAL ADHESIONS","30560 - HC RELEASE OF NASAL ADHESIONS","30560 - HC RELEASE OF NASAL ADHESIONS","87511 - HC CHG GARDNER VAG, DNA  AMP PROBE","30117 - EXCISION/DESTRUCTION INTRANASAL LESION INT APPR",null,null,null,"87511 - HC CHG GARDNER VAG, DNA  AMP PROBE","30520 - HC REPAIR OF NASAL SEPTUM",null,"30117 - EXCISION/DESTRUCTION INTRANASAL LESION INT APPR","87511 - HC CHG GARDNER VAG, DNA  AMP PROBE",null,"82009 - HC CHG KETONE BODIES SERUM QUALITATIVE","30520 - HC REPAIR OF NASAL SEPTUM"]
[null,"33016 - HC PERICARDIOCENTESIS W/IMAGING","87640 - HC CHG IADNA S AUREUS AMPLIFIED PROBE TQ","30580 - HC REPAIR FISTULA OROMAXILLARY","30580 - HC REPAIR FISTULA OROMAXILLARY","30580 - HC REPAIR FISTULA OROMAXILLARY","87517 - HC CHG IADNA HEPATITIS B VIRUS QUANTIFICATION","30130 - HC EXCISION TURBINATE",null,null,null,"87517 - HC CHG IADNA HEPATITIS B VIRUS QUANTIFICATION","30560 - HC RELEASE OF NASAL ADHESIONS",null,"30130 - HC EXCISION TURBINATE","87517 - HC CHG IADNA HEPATITIS B VIRUS QUANTIFICATION",null,"82010 - HC CHG KETONE BODIES SERUM QUANTITATIVE","30560 - HC RELEASE OF NASAL ADHESIONS"]
[null,"33206 - HC INS NEW/RPLCMT PRM PACEMAKR W/TRANS ELTRD ATRIAL","87641 - HC CHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ","30600 - HC REPAIR ORO-NASAL FISTULA","30600 - HC REPAIR ORO-NASAL FISTULA","30600 - HC REPAIR ORO-NASAL FISTULA","87522 - HC ARUP;HEP C VIR RNA QN","30140 - HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL",null,null,null,"87522 - HC ARUP;HEP C VIR RNA QN","30580 - HC REPAIR FISTULA OROMAXILLARY",null,"30140 - HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL","87522 - HC ARUP;HEP C VIR RNA QN",null,"82017 - HC CHG ACYLCARNITINES QUANTIATIVE EACH SPECIMEN","30580 - HC REPAIR FISTULA OROMAXILLARY"]
[null,"33207 - HC INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR","87653 - HC CHG IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ","30801 - ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC","30801 - ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC","30801 - ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC","87529 - HC CHG IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ","30200 - INJECTION INTO TURBINATE",null,null,null,"87529 - HC CHG IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ","30600 - HC REPAIR ORO-NASAL FISTULA",null,"30200 - INJECTION INTO TURBINATE","87529 - HC CHG IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ",null,"82024 - HC CHG ADRENOCORTICOTROPIC HORMONE ACTH","30600 - HC REPAIR ORO-NASAL FISTULA"]
[null,"33208 - HC INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT","87660 - HC CHG IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ","30802 - ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL","30802 - ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL","30802 - ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL","87532 - HC CHG IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ","30220 - INSERTION NASAL SEPTAL PROSTHESIS BUTTON",null,null,null,"87532 - HC CHG IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ","30801 - ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC",null,"30220 - INSERTION NASAL SEPTAL PROSTHESIS BUTTON","87532 - HC CHG IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ",null,"82040 - HC CHG ALBUMIN SERUM PLASMA/WHOLE BLOOD","30801 - ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC"]
[null,"33210 - HC INSJ/RPLCMT TEMP TRANSVNS 1CHMBR ELTRD/PM CATH","87661 - IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH","30901 - CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE","30901 - CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE","30901 - CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE","87535 - HC CHG IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ","30300 - REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE",null,null,null,"87535 - HC CHG IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ","30802 - ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL",null,"30300 - REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE","87535 - HC CHG IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ",null,"82042 - HC CHG ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN","30802 - ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL"]
[null,"33212 - HC INS PM PLS GEN W/EXIST SINGLE LEAD","87797 - HC CHG DETECT AGENT NOS, DNA, DIR","30903 - CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX","30903 - CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX","30903 - CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX","87536 - HC CHG IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION","30420 - HC RECONSTR NOSE+MAJ SEPTAL REPAIR",null,null,null,"87536 - HC CHG IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION","30901 - CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE",null,"30420 - HC RECONSTR NOSE+MAJ SEPTAL REPAIR","87536 - HC CHG IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION",null,"82043 - HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE","30901 - CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE"]
[null,"33213 - HC INS PACEMAKER PULSE GEN ONLY W/EXIST DUAL LEADS","87798 - HC EBV DNA, QL PCR","30905 - CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST","30905 - CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST","30905 - CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST","87538 - HC HIV-2 PROBE&REVRSE TRNSCRIPJ","30465 - REPAIR NASAL VESTIBULAR STENOSIS",null,null,null,"87538 - HC HIV-2 PROBE&REVRSE TRNSCRIPJ","30903 - CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX",null,"30465 - REPAIR NASAL VESTIBULAR STENOSIS","87538 - HC HIV-2 PROBE&REVRSE TRNSCRIPJ",null,"82075 - HC CHG ASSAY OF ALCOHOL BREATH","30903 - CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX"]
[null,"33214 - HC UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS","87799 - HC CHG IADNA NOS QUANTIFICATION EACH ORGANISM","30906 - CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ","30906 - CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ","30906 - CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ","87556 - HC CHG IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB","30520 - HC REPAIR OF NASAL SEPTUM",null,null,null,"87556 - HC CHG IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB","30905 - CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST",null,"30520 - HC REPAIR OF NASAL SEPTUM","87556 - HC CHG IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB",null,"82085 - HC CHG ASSAY OF ALDOLASE","30905 - CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST"]
[null,"33215 - HC RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE","87801 - HC CHG DETECT AGENT, MULT ORGS, DNA  AMP","30930 - HC THER FX NASAL INF TURBINATE","30930 - HC THER FX NASAL INF TURBINATE","30930 - HC THER FX NASAL INF TURBINATE","87563 - HC M. GENITALIUM AMP PROBE","30560 - HC RELEASE OF NASAL ADHESIONS",null,null,null,"87563 - HC M. GENITALIUM AMP PROBE","30906 - CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ",null,"30560 - HC RELEASE OF NASAL ADHESIONS","87563 - HC M. GENITALIUM AMP PROBE",null,"82088 - HC CHG ASSAY OF ALDOSTERONE","30906 - CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ"]
[null,"33216 - HC INSJ 1 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB","87880 - IAADIADOO STREPTOCOCCUS GROUP A","31032 - HC EXPLOR MAXILL SINUS,RMV POLYPS","31032 - HC EXPLOR MAXILL SINUS,RMV POLYPS","31032 - HC EXPLOR MAXILL SINUS,RMV POLYPS","87581 - HC CHG IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ","30580 - HC REPAIR FISTULA OROMAXILLARY",null,null,null,"87581 - HC CHG IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ","30930 - HC THER FX NASAL INF TURBINATE",null,"30580 - HC REPAIR FISTULA OROMAXILLARY","87581 - HC CHG IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ",null,"82103 - HC CHG ALPHA-1-ANTITRYPSIN TOTAL","30930 - HC THER FX NASAL INF TURBINATE"]
[null,"33217 - HC INSJ 2 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB","87899 - HC MALARIA ANTIGEN","31231 - NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX","31231 - NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX","31231 - NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX","87591 - HC CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ","30600 - HC REPAIR ORO-NASAL FISTULA",null,null,null,"87591 - HC CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ","31032 - HC EXPLOR MAXILL SINUS,RMV POLYPS",null,"30600 - HC REPAIR ORO-NASAL FISTULA","87591 - HC CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ",null,"82104 - HC CHG ALPHA-1-ANTITRYPSIN PHENOTYPE","31032 - HC EXPLOR MAXILL SINUS,RMV POLYPS"]
[null,"33221 - HC INS PACEMAKER PULSE GEN ONLY W/EXIST MULT LEADS","87900 - HC CHG NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION","31237 - NASAL/SINUS NDSC SURG W/BX POLYPECT/DBRDMT SPX","31237 - NASAL/SINUS NDSC SURG W/BX POLYPECT/DBRDMT SPX","31237 - NASAL/SINUS NDSC SURG W/BX POLYPECT/DBRDMT SPX","87624 - IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES","30801 - ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC",null,null,null,"87624 - IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES","31231 - NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX",null,"30801 - ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC","87624 - IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES",null,"82105 - HC CHG ALPHA-FETOPROTEIN SERUM","31231 - NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX"]
[null,"33222 - HC RELOCATION OF SKIN POCKET FOR PACEMAKER","87901 - HC CHG NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEAS","31238 - NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMRRG","31238 - NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMRRG","31238 - NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMRRG","87631 - HC INFLUENZA A/B,RSV PCR","30802 - ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL",null,null,null,"87631 - HC INFLUENZA A/B,RSV PCR","31237 - NASAL/SINUS NDSC SURG W/BX POLYPECT/DBRDMT SPX",null,"30802 - ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL","87631 - HC INFLUENZA A/B,RSV PCR",null,"82139 - HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE","31237 - NASAL/SINUS NDSC SURG W/BX POLYPECT/DBRDMT SPX"]
[null,"33223 - HC RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR","87902 - HC CHG NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS","31239 - HC NASAL/SINUS ENDOSCOPY SURG","31239 - HC NASAL/SINUS ENDOSCOPY SURG","31239 - HC NASAL/SINUS ENDOSCOPY SURG","87632 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 6-11 TARGETS","30901 - CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE",null,null,null,"87632 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 6-11 TARGETS","31238 - NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMRRG",null,"30901 - CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE","87632 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 6-11 TARGETS",null,"82140 - HC CHG ASSAY OF AMMONIA","31238 - NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMRRG"]
[null,"33224 - HC INSJ ELTRD CAR VEN SYS ATTCH PREV PM/DFB PLS GEN","87906 - HC Q;HIV1 GENO","31256 - HC EXPLORATION MAXILLARY SINUS","31256 - HC EXPLORATION MAXILLARY SINUS","31256 - HC EXPLORATION MAXILLARY SINUS","87633 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET","30903 - CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX",null,null,null,"87633 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET","31239 - HC NASAL/SINUS ENDOSCOPY SURG",null,"30903 - CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX","87633 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET",null,"82150 - HC CHG ASSAY OF AMYLASE","31239 - HC NASAL/SINUS ENDOSCOPY SURG"]
[null,"33225 - HC INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN","87912 - HC CHG NFCT AGENT GENOTYPE HEPATITIS B VIRUS","31267 - HC NASAL/SINUS ENDOSCOPY,RMV TISS MAXILL SINUS","31267 - HC NASAL/SINUS ENDOSCOPY,RMV TISS MAXILL SINUS","31267 - HC NASAL/SINUS ENDOSCOPY,RMV TISS MAXILL SINUS","87635 - HC SARS-COV-2 COVID-19 AMP PRB","30905 - CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST",null,null,null,"87635 - HC SARS-COV-2 COVID-19 AMP PRB","31256 - HC EXPLORATION MAXILLARY SINUS",null,"30905 - CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST","87635 - HC SARS-COV-2 COVID-19 AMP PRB",null,"82157 - HC CHG ANDROSTENEDIONE","31256 - HC EXPLORATION MAXILLARY SINUS"]
[null,"33226 - HC RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD","87999 - HC CHG UNLISTED MICROBIOLOGY","31500 - HC INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE","31500 - HC INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE","31500 - HC INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE","87636 - HC SARSCOV2 & INF A&B AMP PRB","30906 - CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ",null,null,null,"87636 - HC SARSCOV2 & INF A&B AMP PRB","31267 - HC NASAL/SINUS ENDOSCOPY,RMV TISS MAXILL SINUS",null,"30906 - CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ","87636 - HC SARSCOV2 & INF A&B AMP PRB",null,"82164 - HC CHG ANGIOTENSIN I-CONVERTING ENZYME","31267 - HC NASAL/SINUS ENDOSCOPY,RMV TISS MAXILL SINUS"]
[null,"33227 - HC REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD","88104 - HC CHG CYTOPATH FLUIDS SMEAR, INTERP","31502 - TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT","31502 - TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT","31502 - TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT","87640 - HC CHG IADNA S AUREUS AMPLIFIED PROBE TQ","30930 - HC THER FX NASAL INF TURBINATE",null,null,null,"87640 - HC CHG IADNA S AUREUS AMPLIFIED PROBE TQ","31500 - HC INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE",null,"30930 - HC THER FX NASAL INF TURBINATE","87640 - HC CHG IADNA S AUREUS AMPLIFIED PROBE TQ",null,"82172 - HC CHG APOLIPOPROTEIN EACH","31500 - HC INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE"]
[null,"33228 - HC REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS","88108 - HC CHG CYTP CONCENTRATION SMEARS & INTERPRETATION","31505 - LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX","31505 - LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX","31505 - LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX","87641 - HC CHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ","31032 - HC EXPLOR MAXILL SINUS,RMV POLYPS",null,null,null,"87641 - HC CHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ","31502 - TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT",null,"31032 - HC EXPLOR MAXILL SINUS,RMV POLYPS","87641 - HC CHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ",null,"82175 - HC CHG ASSAY OF ARSENIC","31502 - TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT"]
[null,"33229 - HC REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD","88112 - HC CHG CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V","31510 - HC LARYNGOSCOPY,INDIRECT WITH BIOPSY","31510 - HC LARYNGOSCOPY,INDIRECT WITH BIOPSY","31510 - HC LARYNGOSCOPY,INDIRECT WITH BIOPSY","87653 - HC CHG IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ","31231 - NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX",null,null,null,"87653 - HC CHG IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ","31505 - LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX",null,"31231 - NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX","87653 - HC CHG IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ",null,"82180 - HC CHG ASSAY OF ASCORBIC ACID BLOOD","31505 - LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX"]
[null,"33230 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST DUAL LEADS","88141 - HC CYTOPATH CERV/VAG INTEPRET","31511 - HC LARYNGOSCOPY,INDIRECT+REMV FOR.BODY","31511 - HC LARYNGOSCOPY,INDIRECT+REMV FOR.BODY","31511 - HC LARYNGOSCOPY,INDIRECT+REMV FOR.BODY","87660 - HC CHG IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ","31237 - NASAL/SINUS NDSC SURG W/BX POLYPECT/DBRDMT SPX",null,null,null,"87660 - HC CHG IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ","31510 - HC LARYNGOSCOPY,INDIRECT WITH BIOPSY",null,"31237 - NASAL/SINUS NDSC SURG W/BX POLYPECT/DBRDMT SPX","87660 - HC CHG IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ",null,"82232 - HC CHG BETA-2 MICROGLOBULIN","31510 - HC LARYNGOSCOPY,INDIRECT WITH BIOPSY"]
[null,"33231 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST MULTILEADS","88142 - CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN","31525 - HC LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN","31525 - HC LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN","31525 - HC LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN","87661 - IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH","31238 - NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMRRG",null,null,null,"87661 - IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH","31511 - HC LARYNGOSCOPY,INDIRECT+REMV FOR.BODY",null,"31238 - NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMRRG","87661 - IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH",null,"82247 - HC CHG BILIRUBIN TOTAL","31511 - HC LARYNGOSCOPY,INDIRECT+REMV FOR.BODY"]
[null,"33233 - HC REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY","88143 - HC CHG CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS","31530 - HC LARYNGOSCOPY,DIRCT,OP,F.B. REMVL","31530 - HC LARYNGOSCOPY,DIRCT,OP,F.B. REMVL","31530 - HC LARYNGOSCOPY,DIRCT,OP,F.B. REMVL","87797 - HC CHG DETECT AGENT NOS, DNA, DIR","31239 - HC NASAL/SINUS ENDOSCOPY SURG",null,null,null,"87797 - HC CHG DETECT AGENT NOS, DNA, DIR","31525 - HC LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN",null,"31239 - HC NASAL/SINUS ENDOSCOPY SURG","87797 - HC CHG DETECT AGENT NOS, DNA, DIR",null,"82248 - HC CHG BILIRUBIN DIRECT","31525 - HC LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN"]
[null,"33234 - HC RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR/VENTR","88147 - HC CHG CYTOPATH SMEAR CERV/VAG AUTOMATED","31552 - HC LARYNGOPLASTY LARYNGEAL STEN W/O STENT 12 YRS>","31552 - HC LARYNGOPLASTY LARYNGEAL STEN W/O STENT 12 YRS>","31552 - HC LARYNGOPLASTY LARYNGEAL STEN W/O STENT 12 YRS>","87798 - HC EBV DNA, QL PCR","31256 - HC EXPLORATION MAXILLARY SINUS",null,null,null,"87798 - HC EBV DNA, QL PCR","31530 - HC LARYNGOSCOPY,DIRCT,OP,F.B. REMVL",null,"31256 - HC EXPLORATION MAXILLARY SINUS","87798 - HC EBV DNA, QL PCR",null,"82270 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER","31530 - HC LARYNGOSCOPY,DIRCT,OP,F.B. REMVL"]
[null,"33235 - HC RMVL TRANSVNS PM ELTRD DUAL LEAD SYS","88152 - HC CHG CYTOPATH SMEAR CERV/VAG,AUTO REDO","31570 - HC LARYNGOSCOPY,DIRCT,INJ VOCAL CORD","31570 - HC LARYNGOSCOPY,DIRCT,INJ VOCAL CORD","31570 - HC LARYNGOSCOPY,DIRCT,INJ VOCAL CORD","87799 - HC CHG IADNA NOS QUANTIFICATION EACH ORGANISM","31267 - HC NASAL/SINUS ENDOSCOPY,RMV TISS MAXILL SINUS",null,null,null,"87799 - HC CHG IADNA NOS QUANTIFICATION EACH ORGANISM","31552 - HC LARYNGOPLASTY LARYNGEAL STEN W/O STENT 12 YRS>",null,"31267 - HC NASAL/SINUS ENDOSCOPY,RMV TISS MAXILL SINUS","87799 - HC CHG IADNA NOS QUANTIFICATION EACH ORGANISM",null,"82271 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES","31552 - HC LARYNGOPLASTY LARYNGEAL STEN W/O STENT 12 YRS>"]
[null,"33240 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/1 EXISTING LD","88160 - HC CHG CYTP SMRS ANY OTH SRC SCR&INTERPJ","31571 - LARGSC W/NJX VOCAL CORD THER W/MICRO/TELESCOPE","31571 - LARGSC W/NJX VOCAL CORD THER W/MICRO/TELESCOPE","31571 - LARGSC W/NJX VOCAL CORD THER W/MICRO/TELESCOPE","87801 - HC CHG DETECT AGENT, MULT ORGS, DNA  AMP","31500 - HC INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE",null,null,null,"87801 - HC CHG DETECT AGENT, MULT ORGS, DNA  AMP","31570 - HC LARYNGOSCOPY,DIRCT,INJ VOCAL CORD",null,"31500 - HC INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE","87801 - HC CHG DETECT AGENT, MULT ORGS, DNA  AMP",null,"82274 - HC CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3","31570 - HC LARYNGOSCOPY,DIRCT,INJ VOCAL CORD"]
[null,"33241 - HC REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY","88161 - HC CHG CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ","31572 - HC LARYNGOSCOPY FLEXIBLE ABLATJ DESTJ LESION(S) UNI","31572 - HC LARYNGOSCOPY FLEXIBLE ABLATJ DESTJ LESION(S) UNI","31572 - HC LARYNGOSCOPY FLEXIBLE ABLATJ DESTJ LESION(S) UNI","87880 - IAADIADOO STREPTOCOCCUS GROUP A","31502 - TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT",null,null,null,"87880 - IAADIADOO STREPTOCOCCUS GROUP A","31571 - LARGSC W/NJX VOCAL CORD THER W/MICRO/TELESCOPE",null,"31502 - TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT","87880 - IAADIADOO STREPTOCOCCUS GROUP A",null,"82306 - HC CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED","31571 - LARGSC W/NJX VOCAL CORD THER W/MICRO/TELESCOPE"]
[null,"33244 - HC RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ","88164 - HC CHG CYTOPATH TBS CERV/VAG MANUAL","31573 - HC LARYNGOSCOPY FLEXIBLE THERAPEUTIC INJECTION UNI","31573 - HC LARYNGOSCOPY FLEXIBLE THERAPEUTIC INJECTION UNI","31573 - HC LARYNGOSCOPY FLEXIBLE THERAPEUTIC INJECTION UNI","87899 - HC MALARIA ANTIGEN","31505 - LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX",null,null,null,"87899 - HC MALARIA ANTIGEN","31572 - HC LARYNGOSCOPY FLEXIBLE ABLATJ DESTJ LESION(S) UNI",null,"31505 - LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX","87899 - HC MALARIA ANTIGEN",null,"82308 - HC CHG CALCITONIN","31572 - HC LARYNGOSCOPY FLEXIBLE ABLATJ DESTJ LESION(S) UNI"]
[null,"33249 - HC INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR","88165 - HC CHG CYTP SLIDES C/V MNL SCR&RESCR PHYS SUPV","31574 - HC LARYNGOSCOPY FLEXIBLE W/INJECTION AGMNTJ UNI","31574 - HC LARYNGOSCOPY FLEXIBLE W/INJECTION AGMNTJ UNI","31574 - HC LARYNGOSCOPY FLEXIBLE W/INJECTION AGMNTJ UNI","87900 - HC CHG NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION","31510 - HC LARYNGOSCOPY,INDIRECT WITH BIOPSY",null,null,null,"87900 - HC CHG NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION","31573 - HC LARYNGOSCOPY FLEXIBLE THERAPEUTIC INJECTION UNI",null,"31510 - HC LARYNGOSCOPY,INDIRECT WITH BIOPSY","87900 - HC CHG NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION",null,"82310 - HC CHG CALCIUM TOTAL","31573 - HC LARYNGOSCOPY FLEXIBLE THERAPEUTIC INJECTION UNI"]
[null,"33262 - HC RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD","88172 - CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST","31575 - LARYNGOSCOPY FLEXIBLE FIBEROPTIC DIAGNOSTIC","31575 - LARYNGOSCOPY FLEXIBLE FIBEROPTIC DIAGNOSTIC","31575 - LARYNGOSCOPY FLEXIBLE FIBEROPTIC DIAGNOSTIC","87901 - HC CHG NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEAS","31511 - HC LARYNGOSCOPY,INDIRECT+REMV FOR.BODY",null,null,null,"87901 - HC CHG NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEAS","31574 - HC LARYNGOSCOPY FLEXIBLE W/INJECTION AGMNTJ UNI",null,"31511 - HC LARYNGOSCOPY,INDIRECT+REMV FOR.BODY","87901 - HC CHG NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEAS",null,"82330 - HC CHG CALCIUM IONIZED","31574 - HC LARYNGOSCOPY FLEXIBLE W/INJECTION AGMNTJ UNI"]
[null,"33263 - HC RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD","88173 - CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT","31576 - LARYNGOSCOPY FLEXIBLE FIBEROPTIC W/BIOPSY","31576 - LARYNGOSCOPY FLEXIBLE FIBEROPTIC W/BIOPSY","31576 - LARYNGOSCOPY FLEXIBLE FIBEROPTIC W/BIOPSY","87902 - HC CHG NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS","31525 - HC LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN",null,null,null,"87902 - HC CHG NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS","31575 - LARYNGOSCOPY FLEXIBLE FIBEROPTIC DIAGNOSTIC",null,"31525 - HC LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN","87902 - HC CHG NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS",null,"82340 - HC Q;KID STONE, UR CALCIUM","31575 - LARYNGOSCOPY FLEXIBLE FIBEROPTIC DIAGNOSTIC"]
[null,"33264 - HC EXCHNG ICD GEN MULTI SYST","88184 - HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST","31577 - LARYNGOSCOPY FLX FIBEROPTIC RMVL FOREIGN BODY","31577 - LARYNGOSCOPY FLX FIBEROPTIC RMVL FOREIGN BODY","31577 - LARYNGOSCOPY FLX FIBEROPTIC RMVL FOREIGN BODY","87906 - HC Q;HIV1 GENO","31530 - HC LARYNGOSCOPY,DIRCT,OP,F.B. REMVL",null,null,null,"87906 - HC Q;HIV1 GENO","31576 - LARYNGOSCOPY FLEXIBLE FIBEROPTIC W/BIOPSY",null,"31530 - HC LARYNGOSCOPY,DIRCT,OP,F.B. REMVL","87906 - HC Q;HIV1 GENO",null,"82365 - HC CHG CALCULUS INFRARED SPECTROSCOPY","31576 - LARYNGOSCOPY FLEXIBLE FIBEROPTIC W/BIOPSY"]
[null,"33270 - INS/RPLCMNT PERM SUBQ IMPLTBL DFB W/SUBQ ELTRD","88185 - HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA","31578 - LARYNGOSCOPY FLEXIBLE FIBEROPTIC REMOVAL LESION","31578 - LARYNGOSCOPY FLEXIBLE FIBEROPTIC REMOVAL LESION","31578 - LARYNGOSCOPY FLEXIBLE FIBEROPTIC REMOVAL LESION","87912 - HC CHG NFCT AGENT GENOTYPE HEPATITIS B VIRUS","31552 - HC LARYNGOPLASTY LARYNGEAL STEN W/O STENT 12 YRS>",null,null,null,"87912 - HC CHG NFCT AGENT GENOTYPE HEPATITIS B VIRUS","31577 - LARYNGOSCOPY FLX FIBEROPTIC RMVL FOREIGN BODY",null,"31552 - HC LARYNGOPLASTY LARYNGEAL STEN W/O STENT 12 YRS>","87912 - HC CHG NFCT AGENT GENOTYPE HEPATITIS B VIRUS",null,"82374 - HC CHG CARBON DIOXIDE BICARBONATE","31577 - LARYNGOSCOPY FLX FIBEROPTIC RMVL FOREIGN BODY"]
[null,"33271 - INSJ OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE","88187 - FLOWCYTOMETRY/READ, 2-8 MARKERS","31579 - LARYNGOSCOPY FLX/RGD FIBOPT W/STROBOSCOPY","31579 - LARYNGOSCOPY FLX/RGD FIBOPT W/STROBOSCOPY","31579 - LARYNGOSCOPY FLX/RGD FIBOPT W/STROBOSCOPY","87999 - HC CHG UNLISTED MICROBIOLOGY","31570 - HC LARYNGOSCOPY,DIRCT,INJ VOCAL CORD",null,null,null,"87999 - HC CHG UNLISTED MICROBIOLOGY","31578 - LARYNGOSCOPY FLEXIBLE FIBEROPTIC REMOVAL LESION",null,"31570 - HC LARYNGOSCOPY,DIRCT,INJ VOCAL CORD","87999 - HC CHG UNLISTED MICROBIOLOGY",null,"82375 - HC CHG CARBOXYHEMOGLOBIN QUANTITATIVE","31578 - LARYNGOSCOPY FLEXIBLE FIBEROPTIC REMOVAL LESION"]
[null,"33273 - REPOS PREVIOUSLY IMPLANTED SUBQ IMPLANTABLE DFB","88188 - FLOWCYTOMETRY/READ, 9-15 MARKERS","31603 - HC TRACHEOSTOMY,EMERG,XTRACH","31603 - HC TRACHEOSTOMY,EMERG,XTRACH","31603 - HC TRACHEOSTOMY,EMERG,XTRACH","88104 - HC CHG CYTOPATH FLUIDS SMEAR, INTERP","31571 - LARGSC W/NJX VOCAL CORD THER W/MICRO/TELESCOPE",null,null,null,"88104 - HC CHG CYTOPATH FLUIDS SMEAR, INTERP","31579 - LARYNGOSCOPY FLX/RGD FIBOPT W/STROBOSCOPY",null,"31571 - LARGSC W/NJX VOCAL CORD THER W/MICRO/TELESCOPE","88104 - HC CHG CYTOPATH FLUIDS SMEAR, INTERP",null,"82378 - HC CHG CARCINOEMBRYONIC ANTIGEN CEA","31579 - LARYNGOSCOPY FLX/RGD FIBOPT W/STROBOSCOPY"]
[null,"33274 - HC TCAT INSJ/RPL PERM LDLS PM","88230 - HC CHG TISS CUL NON-NEO DISORDERS LYMPHOCYTE","31605 - HC TRACHEOSTOMY,EMERG,CRICOTHYROID","31605 - HC TRACHEOSTOMY,EMERG,CRICOTHYROID","31605 - HC TRACHEOSTOMY,EMERG,CRICOTHYROID","88108 - HC CHG CYTP CONCENTRATION SMEARS & INTERPRETATION","31572 - HC LARYNGOSCOPY FLEXIBLE ABLATJ DESTJ LESION(S) UNI",null,null,null,"88108 - HC CHG CYTP CONCENTRATION SMEARS & INTERPRETATION","31603 - HC TRACHEOSTOMY,EMERG,XTRACH",null,"31572 - HC LARYNGOSCOPY FLEXIBLE ABLATJ DESTJ LESION(S) UNI","88108 - HC CHG CYTP CONCENTRATION SMEARS & INTERPRETATION",null,"82379 - HC CRL;CARNITINE","31603 - HC TRACHEOSTOMY,EMERG,XTRACH"]
[null,"33275 - HC TCAT RMVL PERM LDLS PM","88235 - HC CHG TISSUE CULTURE, PLACENTA","31611 - CONSTJ TRACHEOESOPHGL FSTL&INSJ SP PROSTH","31611 - CONSTJ TRACHEOESOPHGL FSTL&INSJ SP PROSTH","31611 - CONSTJ TRACHEOESOPHGL FSTL&INSJ SP PROSTH","88112 - HC CHG CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V","31573 - HC LARYNGOSCOPY FLEXIBLE THERAPEUTIC INJECTION UNI",null,null,null,"88112 - HC CHG CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V","31605 - HC TRACHEOSTOMY,EMERG,CRICOTHYROID",null,"31573 - HC LARYNGOSCOPY FLEXIBLE THERAPEUTIC INJECTION UNI","88112 - HC CHG CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V",null,"82384 - HC CHG CATECHOLAMINES FRACTIONATED","31605 - HC TRACHEOSTOMY,EMERG,CRICOTHYROID"]
[null,"33285 - HC INSJ SUBQ CAR RHYTHM MNTR","88237 - HC CHG TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS","31613 - TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION","31613 - TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION","31613 - TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION","88141 - HC CYTOPATH CERV/VAG INTEPRET","31574 - HC LARYNGOSCOPY FLEXIBLE W/INJECTION AGMNTJ UNI",null,null,null,"88141 - HC CYTOPATH CERV/VAG INTEPRET","31611 - CONSTJ TRACHEOESOPHGL FSTL&INSJ SP PROSTH",null,"31574 - HC LARYNGOSCOPY FLEXIBLE W/INJECTION AGMNTJ UNI","88141 - HC CYTOPATH CERV/VAG INTEPRET",null,"82390 - HC CHG CERULOPLASMIN","31611 - CONSTJ TRACHEOESOPHGL FSTL&INSJ SP PROSTH"]
[null,"33286 - HC RMVL SUBQ CAR RHYTHM MNTR","88262 - HC CHG CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING","31615 - TRACHEOBRNCHSC THRU EST TRACHS INC","31615 - TRACHEOBRNCHSC THRU EST TRACHS INC","31615 - TRACHEOBRNCHSC THRU EST TRACHS INC","88142 - CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN","31575 - LARYNGOSCOPY FLEXIBLE FIBEROPTIC DIAGNOSTIC",null,null,null,"88142 - CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN","31613 - TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION",null,"31575 - LARYNGOSCOPY FLEXIBLE FIBEROPTIC DIAGNOSTIC","88142 - CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN",null,"82397 - HC CHEMILUMINESCENT ASSAY","31613 - TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION"]
[null,"33289 - HC TCAT IMPL WRLS P-ART PRS SNR L-T HEMODYN MNTR","88264 - HC CHG CHRMSM ANALYZE 20-25 CELLS","31622 - BRNCHSC INCL FLUOR GID DX W/CELL WASHG SPX","31622 - BRNCHSC INCL FLUOR GID DX W/CELL WASHG SPX","31622 - BRNCHSC INCL FLUOR GID DX W/CELL WASHG SPX","88143 - HC CHG CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS","31576 - LARYNGOSCOPY FLEXIBLE FIBEROPTIC W/BIOPSY",null,null,null,"88143 - HC CHG CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS","31615 - TRACHEOBRNCHSC THRU EST TRACHS INC",null,"31576 - LARYNGOSCOPY FLEXIBLE FIBEROPTIC W/BIOPSY","88143 - HC CHG CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS",null,"82435 - HC CHG CHLORIDE BLD","31615 - TRACHEOBRNCHSC THRU EST TRACHS INC"]
[null,"33968 - HC REM AORTIC ASSIST DEV PRQ","88271 - HC CHG MOLECULAR CYTOGENETICS DNA PROBE EACH","31623 - BRNCHSC BRUSHING/PROTECTED BRUSHINGS","31623 - BRNCHSC BRUSHING/PROTECTED BRUSHINGS","31623 - BRNCHSC BRUSHING/PROTECTED BRUSHINGS","88147 - HC CHG CYTOPATH SMEAR CERV/VAG AUTOMATED","31577 - LARYNGOSCOPY FLX FIBEROPTIC RMVL FOREIGN BODY",null,null,null,"88147 - HC CHG CYTOPATH SMEAR CERV/VAG AUTOMATED","31622 - BRNCHSC INCL FLUOR GID DX W/CELL WASHG SPX",null,"31577 - LARYNGOSCOPY FLX FIBEROPTIC RMVL FOREIGN BODY","88147 - HC CHG CYTOPATH SMEAR CERV/VAG AUTOMATED",null,"82436 - HC CHG CHLORIDE URINE","31622 - BRNCHSC INCL FLUOR GID DX W/CELL WASHG SPX"]
[null,"36002 - HC INJECTION RX EXTREMITY PSEUDOANEURYSM","88274 - HC CHG MOLECULAR CYTOGENETICS INTERPHASE ISH 25-99 CLL","31624 - BRNCHSC W/BRNCL ALVEOLAR LAVAGE","31624 - BRNCHSC W/BRNCL ALVEOLAR LAVAGE","31624 - BRNCHSC W/BRNCL ALVEOLAR LAVAGE","88152 - HC CHG CYTOPATH SMEAR CERV/VAG,AUTO REDO","31578 - LARYNGOSCOPY FLEXIBLE FIBEROPTIC REMOVAL LESION",null,null,null,"88152 - HC CHG CYTOPATH SMEAR CERV/VAG,AUTO REDO","31623 - BRNCHSC BRUSHING/PROTECTED BRUSHINGS",null,"31578 - LARYNGOSCOPY FLEXIBLE FIBEROPTIC REMOVAL LESION","88152 - HC CHG CYTOPATH SMEAR CERV/VAG,AUTO REDO",null,"82438 - HC CHG CHLORIDE OTHER SOURCE","31623 - BRNCHSC BRUSHING/PROTECTED BRUSHINGS"]
[null,"36005 - HC NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH","88275 - HC CHG MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL","31625 - BRONCHOSCOPY BRONCHIAL/ENDOBRNCL BX 1+ SITES","31625 - BRONCHOSCOPY BRONCHIAL/ENDOBRNCL BX 1+ SITES","31625 - BRONCHOSCOPY BRONCHIAL/ENDOBRNCL BX 1+ SITES","88160 - HC CHG CYTP SMRS ANY OTH SRC SCR&INTERPJ","31579 - LARYNGOSCOPY FLX/RGD FIBOPT W/STROBOSCOPY",null,null,null,"88160 - HC CHG CYTP SMRS ANY OTH SRC SCR&INTERPJ","31624 - BRNCHSC W/BRNCL ALVEOLAR LAVAGE",null,"31579 - LARYNGOSCOPY FLX/RGD FIBOPT W/STROBOSCOPY","88160 - HC CHG CYTP SMRS ANY OTH SRC SCR&INTERPJ",null,"82465 - CHOLESTEROL SERUM/WHOLE BLOOD TOTAL","31624 - BRNCHSC W/BRNCL ALVEOLAR LAVAGE"]
[null,"36010 - HC INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA","88280 - HC CHG CHROMOSOME KARYOTYPE STUDY","31626 - HC BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT","31626 - HC BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT","31626 - HC BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT","88161 - HC CHG CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ","31599 - SML WITH EXCISION OF TRACHEAL/SUBGLOTTIC STENOSIS",null,null,null,"88161 - HC CHG CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ","31625 - BRONCHOSCOPY BRONCHIAL/ENDOBRNCL BX 1+ SITES",null,"31599 - SML WITH EXCISION OF TRACHEAL/SUBGLOTTIC STENOSIS","88161 - HC CHG CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ",null,"82495 - HC CHG ASSAY OF CHROMIUM","31625 - BRONCHOSCOPY BRONCHIAL/ENDOBRNCL BX 1+ SITES"]
[null,"36011 - HC SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH","88291 - HC CHG CYTOGENETICS&MOLEC CYTOGENETICS INTERP&REP","31628 - BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX 1 LOBE","31628 - BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX 1 LOBE","31628 - BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX 1 LOBE","88164 - HC CHG CYTOPATH TBS CERV/VAG MANUAL","31603 - HC TRACHEOSTOMY,EMERG,XTRACH",null,null,null,"88164 - HC CHG CYTOPATH TBS CERV/VAG MANUAL","31626 - HC BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT",null,"31603 - HC TRACHEOSTOMY,EMERG,XTRACH","88164 - HC CHG CYTOPATH TBS CERV/VAG MANUAL",null,"82507 - HC CHG ASSAY OF CITRATE","31626 - HC BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT"]
[null,"36012 - HC SLCTV CATH PLMT VEN SYS 2ND ORDER/> SLCTV BRANC","88360 - HC CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL","31629 - HC BRONCHOSCOPY NEEDLE BX TRACHEA MAIN STEM&/BRON","31629 - HC BRONCHOSCOPY NEEDLE BX TRACHEA MAIN STEM&/BRON","31629 - HC BRONCHOSCOPY NEEDLE BX TRACHEA MAIN STEM&/BRON","88165 - HC CHG CYTP SLIDES C/V MNL SCR&RESCR PHYS SUPV","31605 - HC TRACHEOSTOMY,EMERG,CRICOTHYROID",null,null,null,"88165 - HC CHG CYTP SLIDES C/V MNL SCR&RESCR PHYS SUPV","31628 - BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX 1 LOBE",null,"31605 - HC TRACHEOSTOMY,EMERG,CRICOTHYROID","88165 - HC CHG CYTP SLIDES C/V MNL SCR&RESCR PHYS SUPV",null,"82523 - HC CHG COLLAGEN CROSS LINKS ANY METHOD","31628 - BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX 1 LOBE"]
[null,"36013 - HC INTRO CATHETER RIGHT HEART/MAIN PULMONARY ARTERY","88363 - HC CHG EXAM & SELECT ARCHIVE TISSUE MOLECULAR ANALYSI","31630 - HC BRONCHOSCOPY,TRACH/BRONCH DILATN","31630 - HC BRONCHOSCOPY,TRACH/BRONCH DILATN","31630 - HC BRONCHOSCOPY,TRACH/BRONCH DILATN","88172 - CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST","31611 - CONSTJ TRACHEOESOPHGL FSTL&INSJ SP PROSTH",null,null,null,"88172 - CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST","31629 - HC BRONCHOSCOPY NEEDLE BX TRACHEA MAIN STEM&/BRON",null,"31611 - CONSTJ TRACHEOESOPHGL FSTL&INSJ SP PROSTH","88172 - CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST",null,"82525 - HC CHG ASSAY OF COPPER","31629 - HC BRONCHOSCOPY NEEDLE BX TRACHEA MAIN STEM&/BRON"]
[null,"36014 - HC SLCTV CATHETER PLMT LEFT/RIGHT PULMONARY ARTERY","88368 - HC CHG M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL","31632 - HC BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE","31632 - HC BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE","31632 - HC BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE","88173 - CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT","31613 - TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION",null,null,null,"88173 - CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT","31630 - HC BRONCHOSCOPY,TRACH/BRONCH DILATN",null,"31613 - TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION","88173 - CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT",null,"82530 - HC CHG CORTISOL FREE","31630 - HC BRONCHOSCOPY,TRACH/BRONCH DILATN"]
[null,"36015 - HC SLCTV CATH PLMT SEGMENTAL/SUBSEGMENTAL PULM ART","88381 - MICRODISSECTION, MANUAL","31635 - HC BRONCHOSCOPY W/REMOVAL FOREIGN BODY","31635 - HC BRONCHOSCOPY W/REMOVAL FOREIGN BODY","31635 - HC BRONCHOSCOPY W/REMOVAL FOREIGN BODY","88184 - HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST","31615 - TRACHEOBRNCHSC THRU EST TRACHS INC",null,null,null,"88184 - HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST","31632 - HC BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE",null,"31615 - TRACHEOBRNCHSC THRU EST TRACHS INC","88184 - HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST",null,"82533 - HC CHG CORTISOL TOTAL","31632 - HC BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE"]
[null,"36140 - HC INTRO NEEDLE/INTRACATH EXTREMITY ARTERY","89050 - HC CHG CELL COUNT MISCELLANEOUS BODY FLUIDS","31640 - HC BRONCHOSCOPY,EXCIS LESN","31640 - HC BRONCHOSCOPY,EXCIS LESN","31640 - HC BRONCHOSCOPY,EXCIS LESN","88185 - HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA","31622 - BRNCHSC INCL FLUOR GID DX W/CELL WASHG SPX",null,null,null,"88185 - HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA","31635 - HC BRONCHOSCOPY W/REMOVAL FOREIGN BODY",null,"31622 - BRNCHSC INCL FLUOR GID DX W/CELL WASHG SPX","88185 - HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA",null,"82540 - HC CHG ASSAY OF CREATINE","31635 - HC BRONCHOSCOPY W/REMOVAL FOREIGN BODY"]
[null,"36160 - HC INTRO NEEDLE/INTRACATH AORTIC TRANSLUMBAR","89051 - HC CHG CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT","31645 - HC BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE 1ST","31645 - HC BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE 1ST","31645 - HC BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE 1ST","88187 - FLOWCYTOMETRY/READ, 2-8 MARKERS","31623 - BRNCHSC BRUSHING/PROTECTED BRUSHINGS",null,null,null,"88187 - FLOWCYTOMETRY/READ, 2-8 MARKERS","31640 - HC BRONCHOSCOPY,EXCIS LESN",null,"31623 - BRNCHSC BRUSHING/PROTECTED BRUSHINGS","88187 - FLOWCYTOMETRY/READ, 2-8 MARKERS",null,"82542 - HC CHG COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC","31640 - HC BRONCHOSCOPY,EXCIS LESN"]
[null,"36200 - HC INTRODUCTION CATHETER AORTA","89060 - HC CHG CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID","31646 - HC BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE SBSQ","31646 - HC BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE SBSQ","31646 - HC BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE SBSQ","88188 - FLOWCYTOMETRY/READ, 9-15 MARKERS","31624 - BRNCHSC W/BRNCL ALVEOLAR LAVAGE",null,null,null,"88188 - FLOWCYTOMETRY/READ, 9-15 MARKERS","31645 - HC BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE 1ST",null,"31624 - BRNCHSC W/BRNCL ALVEOLAR LAVAGE","88188 - FLOWCYTOMETRY/READ, 9-15 MARKERS",null,"82550 - HC CHG CREATINE KINASE TOTAL","31645 - HC BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE 1ST"]
[null,"36215 - HC SLCTV CATHJ EA 1ST ORD THRC/BRCH/CPHLC BRNCH","89320 - SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT","31652 - HC BRNCHSC EBUS GUIDED SAMPL 1/2 NODE STATION/STRUX","31652 - HC BRNCHSC EBUS GUIDED SAMPL 1/2 NODE STATION/STRUX","31652 - HC BRNCHSC EBUS GUIDED SAMPL 1/2 NODE STATION/STRUX","88230 - HC CHG TISS CUL NON-NEO DISORDERS LYMPHOCYTE","31625 - BRONCHOSCOPY BRONCHIAL/ENDOBRNCL BX 1+ SITES",null,null,null,"88230 - HC CHG TISS CUL NON-NEO DISORDERS LYMPHOCYTE","31646 - HC BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE SBSQ",null,"31625 - BRONCHOSCOPY BRONCHIAL/ENDOBRNCL BX 1+ SITES","88230 - HC CHG TISS CUL NON-NEO DISORDERS LYMPHOCYTE",null,"82553 - HC CHG CREATINE KINASE MB FRACTION ONLY","31646 - HC BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE SBSQ"]
[null,"36216 - HC SLCTV CATHJ 1ST 2ND ORD THRC/BRCH/CPHLC BRNCH","90648 - HC HIB VACCINE, PRP-T, IM,DPH","31653 - HC BRONCH EBUS SAMPLING 3 OR MORE NODES","31653 - HC BRONCH EBUS SAMPLING 3 OR MORE NODES","31653 - HC BRONCH EBUS SAMPLING 3 OR MORE NODES","88235 - HC CHG TISSUE CULTURE, PLACENTA","31626 - HC BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT",null,null,null,"88235 - HC CHG TISSUE CULTURE, PLACENTA","31652 - HC BRNCHSC EBUS GUIDED SAMPL 1/2 NODE STATION/STRUX",null,"31626 - HC BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT","88235 - HC CHG TISSUE CULTURE, PLACENTA",null,"82565 - HC CHG CREATININE BLOOD","31652 - HC BRNCHSC EBUS GUIDED SAMPL 1/2 NODE STATION/STRUX"]
[null,"36217 - HC SLCTV CATHJ 3RD+ ORD SLCTV THRC/BRCH/CPHLC BRNCH","90698 - CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH","31720 - HC CATHETER ASPIRATION NASOTRACHEAL SPX","31720 - HC CATHETER ASPIRATION NASOTRACHEAL SPX","31720 - HC CATHETER ASPIRATION NASOTRACHEAL SPX","88237 - HC CHG TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS","31628 - BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX 1 LOBE",null,null,null,"88237 - HC CHG TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS","31653 - HC BRONCH EBUS SAMPLING 3 OR MORE NODES",null,"31628 - BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX 1 LOBE","88237 - HC CHG TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS",null,"82570 - HC CHG CREATININE OTHER SOURCE","31653 - HC BRONCH EBUS SAMPLING 3 OR MORE NODES"]
[null,"36218 - HC SLCTV CATHJ EA 2ND+ ORD THRC/BRCH/CPHLC BRNCH","90700 - CR BUILD ONLY - DTAP IMMUNIZATION, IM, <7 YO,TRAVEL","31820 - HC SURG CLOSURE TRACH/FISTULA","31820 - HC SURG CLOSURE TRACH/FISTULA","31820 - HC SURG CLOSURE TRACH/FISTULA","88262 - HC CHG CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING","31629 - HC BRONCHOSCOPY NEEDLE BX TRACHEA MAIN STEM&/BRON",null,null,null,"88262 - HC CHG CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING","31720 - HC CATHETER ASPIRATION NASOTRACHEAL SPX",null,"31629 - HC BRONCHOSCOPY NEEDLE BX TRACHEA MAIN STEM&/BRON","88262 - HC CHG CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING",null,"82575 - HC CHG CREATININE CLEARANCE","31720 - HC CATHETER ASPIRATION NASOTRACHEAL SPX"]
[null,"36221 - HC NONSLCTV CATH THOR AORTA ANGIO INTR/XTRCRANL ART","90723 - CR BUILD ONLY - DTAP/HEPB/IPV VACCINE,IM,DPH","32160 - HC THORACOTOMY W/CARDIAC MASSAGE","32160 - HC THORACOTOMY W/CARDIAC MASSAGE","32160 - HC THORACOTOMY W/CARDIAC MASSAGE","88264 - HC CHG CHRMSM ANALYZE 20-25 CELLS","31630 - HC BRONCHOSCOPY,TRACH/BRONCH DILATN",null,null,null,"88264 - HC CHG CHRMSM ANALYZE 20-25 CELLS","31820 - HC SURG CLOSURE TRACH/FISTULA",null,"31630 - HC BRONCHOSCOPY,TRACH/BRONCH DILATN","88264 - HC CHG CHRMSM ANALYZE 20-25 CELLS",null,"82585 - HC CHG ASSAY OF CRYOFIBRN","31820 - HC SURG CLOSURE TRACH/FISTULA"]
[null,"36222 - HC SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART","90744 - CR BUILD ONLY - HEP B VACCINE,PED/ADOL,IM,DPH","32400 - HC BIOPSY PLEURA PERCUTANEOUS NEEDLE","32400 - HC BIOPSY PLEURA PERCUTANEOUS NEEDLE","32400 - HC BIOPSY PLEURA PERCUTANEOUS NEEDLE","88271 - HC CHG MOLECULAR CYTOGENETICS DNA PROBE EACH","31632 - HC BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE",null,null,null,"88271 - HC CHG MOLECULAR CYTOGENETICS DNA PROBE EACH","32400 - HC BIOPSY PLEURA PERCUTANEOUS NEEDLE",null,"31632 - HC BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE","88271 - HC CHG MOLECULAR CYTOGENETICS DNA PROBE EACH",null,"82595 - HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE","32400 - HC BIOPSY PLEURA PERCUTANEOUS NEEDLE"]
[null,"36223 - HC SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART","90845 - PSYCHOANALYSIS","32405 - HC BIOPSY LUNG/MEDIASTINUM PERCUTANEOUS NEEDLE","32405 - HC BIOPSY LUNG/MEDIASTINUM PERCUTANEOUS NEEDLE","32405 - HC BIOPSY LUNG/MEDIASTINUM PERCUTANEOUS NEEDLE","88274 - HC CHG MOLECULAR CYTOGENETICS INTERPHASE ISH 25-99 CLL","31635 - HC BRONCHOSCOPY W/REMOVAL FOREIGN BODY",null,null,null,"88274 - HC CHG MOLECULAR CYTOGENETICS INTERPHASE ISH 25-99 CLL","32405 - HC BIOPSY LUNG/MEDIASTINUM PERCUTANEOUS NEEDLE",null,"31635 - HC BRONCHOSCOPY W/REMOVAL FOREIGN BODY","88274 - HC CHG MOLECULAR CYTOGENETICS INTERPHASE ISH 25-99 CLL",null,"82607 - HC CHG CYANOCOBALAMIN VITAMIN B-12","32405 - HC BIOPSY LUNG/MEDIASTINUM PERCUTANEOUS NEEDLE"]
[null,"36224 - HC SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART","90876 - HC INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 45 MIN","32550 - HC INS TUNN PLEURAL CATH W/U","32550 - HC INS TUNN PLEURAL CATH W/U","32550 - HC INS TUNN PLEURAL CATH W/U","88275 - HC CHG MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL","31640 - HC BRONCHOSCOPY,EXCIS LESN",null,null,null,"88275 - HC CHG MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL","32550 - HC INS TUNN PLEURAL CATH W/U",null,"31640 - HC BRONCHOSCOPY,EXCIS LESN","88275 - HC CHG MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL",null,"82626 - HC CHG DEHYDROEPIANDROSTERONE","32550 - HC INS TUNN PLEURAL CATH W/U"]
[null,"36225 - HC SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY","90889 - HC PREP REPORT PT PSYCH STATUS AGENCY/PAYER","32551 - TUBE THORACOSTOMY INCLUDES WATER SEAL","32551 - TUBE THORACOSTOMY INCLUDES WATER SEAL","32551 - TUBE THORACOSTOMY INCLUDES WATER SEAL","88280 - HC CHG CHROMOSOME KARYOTYPE STUDY","31645 - HC BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE 1ST",null,null,null,"88280 - HC CHG CHROMOSOME KARYOTYPE STUDY","32551 - TUBE THORACOSTOMY INCLUDES WATER SEAL",null,"31645 - HC BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE 1ST","88280 - HC CHG CHROMOSOME KARYOTYPE STUDY",null,"82627 - HC CHG DEHYDROEPIANDROSTERONE-SULFATE","32551 - TUBE THORACOSTOMY INCLUDES WATER SEAL"]
[null,"36226 - HC SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY","90901 - HC BIOFEEDBACK TRAINING, ANY MODALITY","32552 - HC REMOVAL OF LUNG CATHETER","32552 - HC REMOVAL OF LUNG CATHETER","32552 - HC REMOVAL OF LUNG CATHETER","88291 - HC CHG CYTOGENETICS&MOLEC CYTOGENETICS INTERP&REP","31646 - HC BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE SBSQ",null,null,null,"88291 - HC CHG CYTOGENETICS&MOLEC CYTOGENETICS INTERP&REP","32552 - HC REMOVAL OF LUNG CATHETER",null,"31646 - HC BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE SBSQ","88291 - HC CHG CYTOGENETICS&MOLEC CYTOGENETICS INTERP&REP",null,"82652 - HC CHG 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED","32552 - HC REMOVAL OF LUNG CATHETER"]
[null,"36227 - HC SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC","90912 - HC BFB TRAINING 1ST 15 MIN","32553 - HC PLMT NTRSTL DEV RADJ THX GID PRQ INTRATHRC 1/MLT","32553 - HC PLMT NTRSTL DEV RADJ THX GID PRQ INTRATHRC 1/MLT","32553 - HC PLMT NTRSTL DEV RADJ THX GID PRQ INTRATHRC 1/MLT","88300 - HC CHG LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY","31652 - HC BRNCHSC EBUS GUIDED SAMPL 1/2 NODE STATION/STRUX",null,null,null,"88360 - HC CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL","32553 - HC PLMT NTRSTL DEV RADJ THX GID PRQ INTRATHRC 1/MLT",null,"31652 - HC BRNCHSC EBUS GUIDED SAMPL 1/2 NODE STATION/STRUX","88360 - HC CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL",null,"82656 - HC CHG ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN","32553 - HC PLMT NTRSTL DEV RADJ THX GID PRQ INTRATHRC 1/MLT"]
[null,"36228 - HC SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT","90913 - HC BFB TRAINING EA ADDL 15 MIN","32554 - THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING","32554 - THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING","32554 - THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING","88302 - HC CHG LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM","31653 - HC BRONCH EBUS SAMPLING 3 OR MORE NODES",null,null,null,"88363 - HC CHG EXAM & SELECT ARCHIVE TISSUE MOLECULAR ANALYSI","32554 - THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING",null,"31653 - HC BRONCH EBUS SAMPLING 3 OR MORE NODES","88363 - HC CHG EXAM & SELECT ARCHIVE TISSUE MOLECULAR ANALYSI",null,"82657 - HC CHG NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA","32554 - THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING"]
[null,"36245 - HC SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH","91112 - GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP","32555 - THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING","32555 - THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING","32555 - THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING","88304 - HC CHG LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM","31720 - HC CATHETER ASPIRATION NASOTRACHEAL SPX",null,null,null,"88368 - HC CHG M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL","32555 - THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING",null,"31720 - HC CATHETER ASPIRATION NASOTRACHEAL SPX","88368 - HC CHG M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL",null,"82668 - HC CHG ASSAY OF ERYTHROPOIETIN","32555 - THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING"]
[null,"36246 - HC SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH","92532 - POSITIONAL NYSTAGMUS TEST","32556 - PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING","32556 - PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING","32556 - PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING","88305 - CELL BLCK","31820 - HC SURG CLOSURE TRACH/FISTULA",null,null,null,"88381 - MICRODISSECTION, MANUAL","32556 - PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING",null,"31820 - HC SURG CLOSURE TRACH/FISTULA","88381 - MICRODISSECTION, MANUAL",null,"82670 - HC CHG ASSAY OF ESTRADIOL","32556 - PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING"]
[null,"36247 - HC SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH","92562 - LOUDNESS BALANCE BINAURAL/MONAURAL","32557 - PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING","32557 - PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING","32557 - PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING","88307 - HC CHG LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM","32160 - HC THORACOTOMY W/CARDIAC MASSAGE",null,null,null,"89050 - HC CHG CELL COUNT MISCELLANEOUS BODY FLUIDS","32557 - PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING",null,"32160 - HC THORACOTOMY W/CARDIAC MASSAGE","89050 - HC CHG CELL COUNT MISCELLANEOUS BODY FLUIDS",null,"82677 - HC CHG ASSAY OF ESTRIOL","32557 - PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING"]
[null,"36248 - HC SLCTV CATHJ EA 2ND+ ORD ABDL PEL/LXTR ART BRNCH","92597 - EVAL&/FITG VOICE PROSTC DEV SUPLMNT ORAL SPEEC","32994 - HC ABLATION THER 1+ PULM TUMORS PREQ CRYOABLATION","32994 - HC ABLATION THER 1+ PULM TUMORS PREQ CRYOABLATION","32994 - HC ABLATION THER 1+ PULM TUMORS PREQ CRYOABLATION","88309 - HC CHG LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM","32400 - HC BIOPSY PLEURA PERCUTANEOUS NEEDLE",null,null,null,"89051 - HC CHG CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT","32994 - HC ABLATION THER 1+ PULM TUMORS PREQ CRYOABLATION",null,"32400 - HC BIOPSY PLEURA PERCUTANEOUS NEEDLE","89051 - HC CHG CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT",null,"82693 - HC CHG ASSAY OF ETHYLENE GLYCOL","32994 - HC ABLATION THER 1+ PULM TUMORS PREQ CRYOABLATION"]
[null,"36251 - HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UN","92605 - EVAL RX N-SP-GEN AUGMT ALT COMMUN DEV F2F 1ST HR","32998 - HC ABLATION PULMONARY TUMOR PERQ RADIOFREQUENCY UNI","32998 - HC ABLATION PULMONARY TUMOR PERQ RADIOFREQUENCY UNI","32998 - HC ABLATION PULMONARY TUMOR PERQ RADIOFREQUENCY UNI","88311 - HC CHG DECALCIFICATION PROCEDURE","32405 - HC BIOPSY LUNG/MEDIASTINUM PERCUTANEOUS NEEDLE",null,null,null,"89060 - HC CHG CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID","32998 - HC ABLATION PULMONARY TUMOR PERQ RADIOFREQUENCY UNI",null,"32405 - HC BIOPSY LUNG/MEDIASTINUM PERCUTANEOUS NEEDLE","89060 - HC CHG CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID",null,"82705 - HC CHG FAT/LIPIDS FECES QUALITATIVE","32998 - HC ABLATION PULMONARY TUMOR PERQ RADIOFREQUENCY UNI"]
[null,"36252 - HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BIL","92630 - HC AUD REHA PRELING HEARLOSS","33016 - HC PERICARDIOCENTESIS W/IMAGING","33016 - HC PERICARDIOCENTESIS W/IMAGING","33016 - HC PERICARDIOCENTESIS W/IMAGING","88312 - HC CHG SPECIAL STAIN GROUP 1 MICROORGANISMS I&R","32550 - HC INS TUNN PLEURAL CATH W/U",null,null,null,"89320 - SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT","33016 - HC PERICARDIOCENTESIS W/IMAGING",null,"32550 - HC INS TUNN PLEURAL CATH W/U","89320 - SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT",null,"82728 - HC CHG ASSAY OF FERRITIN","33016 - HC PERICARDIOCENTESIS W/IMAGING"]
[null,"36253 - HC SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I","92633 - HC AUD REH POSTLING HEARLOSS","33206 - HC INS NEW/RPLCMT PRM PACEMAKR W/TRANS ELTRD ATRIAL","33206 - HC INS NEW/RPLCMT PRM PACEMAKR W/TRANS ELTRD ATRIAL","33206 - HC INS NEW/RPLCMT PRM PACEMAKR W/TRANS ELTRD ATRIAL","88313 - HC CHG SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT","32551 - TUBE THORACOSTOMY INCLUDES WATER SEAL",null,null,null,"90371 - HC HEPB IG, IM","33206 - HC INS NEW/RPLCMT PRM PACEMAKR W/TRANS ELTRD ATRIAL",null,"32551 - TUBE THORACOSTOMY INCLUDES WATER SEAL","90371 - HC HEPB IG, IM",null,"82731 - HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN","33206 - HC INS NEW/RPLCMT PRM PACEMAKR W/TRANS ELTRD ATRIAL"]
[null,"36254 - HC SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I","92941 - HC PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL","33207 - HC INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR","33207 - HC INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR","33207 - HC INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR","88314 - HC HISTOCHEMICAL STAIN","32552 - HC REMOVAL OF LUNG CATHETER",null,null,null,"90632 - CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL","33207 - HC INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR",null,"32552 - HC REMOVAL OF LUNG CATHETER","90632 - CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,"82746 - HC CHG ASSAY OF FOLIC ACID SERUM","33207 - HC INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR"]
[null,"36415 - COLLECTION VENOUS BLOOD VENIPUNCTURE","93356 - HC MYOCRD STRAIN IMG SPCKL TRCK","33208 - HC INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT","33208 - HC INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT","33208 - HC INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT","88319 - HC CHG SPECIAL STAIN I&R GROUP III ENZYME CONSITUENTS","32553 - HC PLMT NTRSTL DEV RADJ THX GID PRQ INTRATHRC 1/MLT",null,null,null,"90648 - HC HIB VACCINE, PRP-T, IM,DPH","33208 - HC INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT",null,"32553 - HC PLMT NTRSTL DEV RADJ THX GID PRQ INTRATHRC 1/MLT","90648 - HC HIB VACCINE, PRP-T, IM,DPH",null,"82747 - HC CHG ASSAY OF FOLIC ACID RBC","33208 - HC INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT"]
[null,"36430 - TRANSFUSION BLOOD/BLOOD COMPONENTS","93660 - CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR","33210 - HC INSJ/RPLCMT TEMP TRANSVNS 1CHMBR ELTRD/PM CATH","33210 - HC INSJ/RPLCMT TEMP TRANSVNS 1CHMBR ELTRD/PM CATH","33210 - HC INSJ/RPLCMT TEMP TRANSVNS 1CHMBR ELTRD/PM CATH","88329 - HC CHG PATHOLOGY CONSULTATION DURING SURGERY","32554 - THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING",null,null,null,"90653 - HC IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE","33210 - HC INSJ/RPLCMT TEMP TRANSVNS 1CHMBR ELTRD/PM CATH",null,"32554 - THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING","90653 - HC IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE",null,"82784 - HC CHG ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH","33210 - HC INSJ/RPLCMT TEMP TRANSVNS 1CHMBR ELTRD/PM CATH"]
[null,"36455 - HC EXCHANGE TRANSFUION, OTHR","93668 - HC PERIPHERAL ART DISEASE REHAB, EA","33212 - HC INS PM PLS GEN W/EXIST SINGLE LEAD","33212 - HC INS PM PLS GEN W/EXIST SINGLE LEAD","33212 - HC INS PM PLS GEN W/EXIST SINGLE LEAD","88331 - PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC","32555 - THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING",null,null,null,"90662 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM FLUZONE HIGH DOSE","33212 - HC INS PM PLS GEN W/EXIST SINGLE LEAD",null,"32555 - THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING","90662 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM FLUZONE HIGH DOSE",null,"82785 - HC CHG ASSAY OF GAMMAGLOBULIN IGE","33212 - HC INS PM PLS GEN W/EXIST SINGLE LEAD"]
[null,"36470 - NJX SCLEROSING SOLUTION SINGLE VEIN","93786 - BL BLD PRESS W/TAPE&/DISK 24/> HR REC ONL","33213 - HC INS PACEMAKER PULSE GEN ONLY W/EXIST DUAL LEADS","33213 - HC INS PACEMAKER PULSE GEN ONLY W/EXIST DUAL LEADS","33213 - HC INS PACEMAKER PULSE GEN ONLY W/EXIST DUAL LEADS","88332 - HC CHG PATH CONSLTJ SURG EA ADDL BLK FROZEN SECTION","32556 - PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING",null,null,null,"90670 - CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH","33213 - HC INS PACEMAKER PULSE GEN ONLY W/EXIST DUAL LEADS",null,"32556 - PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING","90670 - CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH",null,"82787 - HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES","33213 - HC INS PACEMAKER PULSE GEN ONLY W/EXIST DUAL LEADS"]
[null,"36471 - NJX SCLEROSING SOLUTION MULTIPLE VEINS SAME LEG","93895 - HC CAROTID INTIMA MEDIA & CAROTID ATHEROMA EVAL BI","33214 - HC UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS","33214 - HC UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS","33214 - HC UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS","88341 - IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE","32557 - PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING",null,null,null,"90672 - CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST","33214 - HC UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS",null,"32557 - PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING","90672 - CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST",null,"82803 - HC CHG BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3","33214 - HC UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS"]
[null,"36473 - HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM 1ST VEIN","93985 - DUP-SCAN HEMO COMPL BI STD","33215 - HC RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE","33215 - HC RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE","33215 - HC RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE","88342 - HC CHG IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE","32994 - HC ABLATION THER 1+ PULM TUMORS PREQ CRYOABLATION",null,null,null,"90673 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM","33215 - HC RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE",null,"32994 - HC ABLATION THER 1+ PULM TUMORS PREQ CRYOABLATION","90674 - HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",null,"82805 - HC CHG GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY","33215 - HC RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE"]
[null,"36474 - HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM SBSQ VEINS","93986 - DUP-SCAN HEMO COMPL UNI STD","33216 - HC INSJ 1 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB","33216 - HC INSJ 1 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB","33216 - HC INSJ 1 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB","88344 - IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE","32998 - HC ABLATION PULMONARY TUMOR PERQ RADIOFREQUENCY UNI",null,null,null,"90674 - HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE","33216 - HC INSJ 1 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB",null,"32998 - HC ABLATION PULMONARY TUMOR PERQ RADIOFREQUENCY UNI","90675 - CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,"82810 - HC BLOOD GASSES O2 SAT ONLY","33216 - HC INSJ 1 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB"]
[null,"36475 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN","94644 - CONTINUOUS INHALATION TREATMENT 1ST HR","33217 - HC INSJ 2 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB","33217 - HC INSJ 2 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB","33217 - HC INSJ 2 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB","88346 - HC CHG IMMUNOFLUORESCENCE PER SPEC 1ST SINGL ANTB STAIN","32999 - CHEST TUBE REPOSITIONING AND REPLACEMENT",null,null,null,"90675 - CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL","33217 - HC INSJ 2 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB",null,"32999 - CHEST TUBE REPOSITIONING AND REPLACEMENT","90686 - HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,"82941 - HC CHG ASSAY OF GASTRIN","33217 - HC INSJ 2 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB"]
[null,"36476 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS","94645 - CONTINUOUS INHALATION TREATMENT EA ADDL HR","33221 - HC INS PACEMAKER PULSE GEN ONLY W/EXIST MULT LEADS","33221 - HC INS PACEMAKER PULSE GEN ONLY W/EXIST MULT LEADS","33221 - HC INS PACEMAKER PULSE GEN ONLY W/EXIST MULT LEADS","88348 - HC CHG ELECTRON MICROSCOPY DIAGNOSTIC","33010 - PERICARDIOCENT INI",null,null,null,"90686 - HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE","33221 - HC INS PACEMAKER PULSE GEN ONLY W/EXIST MULT LEADS",null,"33010 - PERICARDIOCENT INI","90691 - CR BUILD ONLY - TYPHOID VACCINE, IM,TRAVEL",null,"82945 - HC CHG GLUCOSE BODY FLUID OTHER THAN BLOOD","33221 - HC INS PACEMAKER PULSE GEN ONLY W/EXIST MULT LEADS"]
[null,"36478 - HC ENDOVENOUS LASER, 1ST VEIN","95120 - PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX","33222 - HC RELOCATION OF SKIN POCKET FOR PACEMAKER","33222 - HC RELOCATION OF SKIN POCKET FOR PACEMAKER","33222 - HC RELOCATION OF SKIN POCKET FOR PACEMAKER","88350 - IMMUNOFLUORESCENCE PER SPEC ADD SINGL ANTB STAIN","33011 - PERICARDIOCEN SUBQ",null,null,null,"90691 - CR BUILD ONLY - TYPHOID VACCINE, IM,TRAVEL","33222 - HC RELOCATION OF SKIN POCKET FOR PACEMAKER",null,"33011 - PERICARDIOCEN SUBQ","90694 - HC VACC AIIV4 NO PRSRV 0.5ML IM",null,"82947 - HC CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP","33222 - HC RELOCATION OF SKIN POCKET FOR PACEMAKER"]
[null,"36479 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS","95125 - PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 2/> NJX","33223 - HC RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR","33223 - HC RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR","33223 - HC RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR","88356 - CHG ANALYSIS, NERVE TECH","33015 - TUBE PERICARDIOSTOMY",null,null,null,"90694 - HC VACC AIIV4 NO PRSRV 0.5ML IM","33223 - HC RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR",null,"33015 - TUBE PERICARDIOSTOMY","90698 - CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,"82950 - HC CHG GLUCOSE POST GLUCOSE DOSE","33223 - HC RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR"]
[null,"36481 - HC PERC PORTAL VEIN CATH","95700 - HC EEG CONT REC W/VID EEG TECH","33224 - HC INSJ ELTRD CAR VEN SYS ATTCH PREV PM/DFB PLS GEN","33224 - HC INSJ ELTRD CAR VEN SYS ATTCH PREV PM/DFB PLS GEN","33224 - HC INSJ ELTRD CAR VEN SYS ATTCH PREV PM/DFB PLS GEN","88360 - HC CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL","33016 - HC PERICARDIOCENTESIS W/IMAGING",null,null,null,"90698 - CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH","33224 - HC INSJ ELTRD CAR VEN SYS ATTCH PREV PM/DFB PLS GEN",null,"33016 - HC PERICARDIOCENTESIS W/IMAGING","90700 - CR BUILD ONLY - DTAP IMMUNIZATION, IM, <7 YO,TRAVEL",null,"82951 - HC CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS","33224 - HC INSJ ELTRD CAR VEN SYS ATTCH PREV PM/DFB PLS GEN"]
[null,"36482 - HC ENDOVEN ABLTI THER CHEM ADHESIVE 1ST VEIN","95824 - ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY","33225 - HC INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN","33225 - HC INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN","33225 - HC INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN","88361 - HC CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST","33206 - HC INS NEW/RPLCMT PRM PACEMAKR W/TRANS ELTRD ATRIAL",null,null,null,"90700 - CR BUILD ONLY - DTAP IMMUNIZATION, IM, <7 YO,TRAVEL","33225 - HC INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN",null,"33206 - HC INS NEW/RPLCMT PRM PACEMAKR W/TRANS ELTRD ATRIAL","90714 - CR BUILD ONLY - TD VACCINE NO PRSRV >/= 7 YO, IM,DPH",null,"82952 - HC CHG GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS","33225 - HC INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN"]
[null,"36483 - HC ENDOVEN ABLTI THER CHEM ADHESIVE SBSQ VEIN","95951 - LOCALIZE CEREBRAL SEIZURE CABLE/RADIO EEG/VIDEO","33226 - HC RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD","33226 - HC RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD","33226 - HC RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD","88362 - HC NERVE TEASING PREPARATIONS","33207 - HC INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR",null,null,null,"90714 - CR BUILD ONLY - TD VACCINE NO PRSRV >/= 7 YO, IM,DPH","33226 - HC RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD",null,"33207 - HC INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR","90715 - CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,"82960 - HC CHG GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN","33226 - HC RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD"]
[null,"36500 - HC VEN CATHJ SLCTV ORGAN BLD SAMPLING","95953 - LOCALIZE CEREBRAL SEIZURE CPTR PORTABLE EEG","33227 - HC REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD","33227 - HC REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD","33227 - HC REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD","88363 - HC CHG EXAM & SELECT ARCHIVE TISSUE MOLECULAR ANALYSI","33208 - HC INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT",null,null,null,"90715 - CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH","33227 - HC REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD",null,"33208 - HC INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT","90723 - CR BUILD ONLY - DTAP/HEPB/IPV VACCINE,IM,DPH",null,"82962 - HC GLUCOMETER - PHARM","33227 - HC REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD"]
[null,"36511 - HC THER APHERESIS,WHITE BLOOD CELLS","95966 - HC MEG,EVOKED MAGNET FIELDS, SINGLE MODAL","33228 - HC REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS","33228 - HC REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS","33228 - HC REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS","88364 - IN SITU HYBRIDIZATION EA ADDL PROBE STAIN","33210 - HC INSJ/RPLCMT TEMP TRANSVNS 1CHMBR ELTRD/PM CATH",null,null,null,"90723 - CR BUILD ONLY - DTAP/HEPB/IPV VACCINE,IM,DPH","33228 - HC REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS",null,"33210 - HC INSJ/RPLCMT TEMP TRANSVNS 1CHMBR ELTRD/PM CATH","90732 - CR BUILD ONLY - PNEUMOCOCCAL VACCINE,23-VALENT,ADULT,TRAVEL",null,"82977 - HC CHG ASSAY OF GGT","33228 - HC REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS"]
[null,"36512 - THERAPEUTIC APHERESIS RED BLOOD CELLS","95992 - CANALITH REPOSITIONING PROCEDURE","33229 - HC REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD","33229 - HC REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD","33229 - HC REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD","88365 - HC CHG IN SITU HYBRIDIZATION 1ST PROBE STAIN","33212 - HC INS PM PLS GEN W/EXIST SINGLE LEAD",null,null,null,"90732 - CR BUILD ONLY - PNEUMOCOCCAL VACCINE,23-VALENT,ADULT,TRAVEL","33229 - HC REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD",null,"33212 - HC INS PM PLS GEN W/EXIST SINGLE LEAD","90739 - HC HEPATITIS B VACCINE ADULT 2 DOSE IM",null,"82985 - HC CHG ASSAY OF GLYCATED PROTEIN","33229 - HC REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD"]
[null,"36513 - THERAPEUTIC APHERESIS PLATELETS","96040 - MEDICAL GENETICS COUNSELING EACH 30 MINUTES","33230 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST DUAL LEADS","33230 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST DUAL LEADS","33230 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST DUAL LEADS","88368 - HC CHG M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL","33213 - HC INS PACEMAKER PULSE GEN ONLY W/EXIST DUAL LEADS",null,null,null,"90739 - HC HEPATITIS B VACCINE ADULT 2 DOSE IM","33230 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST DUAL LEADS",null,"33213 - HC INS PACEMAKER PULSE GEN ONLY W/EXIST DUAL LEADS","90740 - HC HEP B VACCINE,DIAL/IMMUNOSUP, IM",null,"83001 - HC CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE","33230 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST DUAL LEADS"]
[null,"36514 - THERAPEUTIC APHERESIS PLASMA PHERESIS","96105 - ASSESSMENT PHASIA W/INTERP & REPORT PER HOUR","33231 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST MULTILEADS","33231 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST MULTILEADS","33231 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST MULTILEADS","88369 - M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC EACH","33214 - HC UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS",null,null,null,"90740 - HC HEP B VACCINE,DIAL/IMMUNOSUP, IM","33231 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST MULTILEADS",null,"33214 - HC UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS","90744 - CR BUILD ONLY - HEP B VACCINE,PED/ADOL,IM,DPH",null,"83002 - HC CHG GONADOTROPIN LUTEINIZING HORMONE","33231 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST MULTILEADS"]
[null,"36522 - PHOTOPHERESIS EXTRACORPOREAL","96112 - HC DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR","33233 - HC REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY","33233 - HC REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY","33233 - HC REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY","88380 - HC CHG MICRODISSECTION PREP IDENTIFIED TARGET LASER","33215 - HC RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE",null,null,null,"90744 - CR BUILD ONLY - HEP B VACCINE,PED/ADOL,IM,DPH","33233 - HC REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY",null,"33215 - HC RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE","90746 - CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL",null,"83003 - HC CHG ASSAY OF GROWTH HORMONE HUMAN","33233 - HC REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY"]
[null,"36555 - HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y","96113 - HC DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN","33234 - HC RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR/VENTR","33234 - HC RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR/VENTR","33234 - HC RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR/VENTR","88381 - MICRODISSECTION, MANUAL","33216 - HC INSJ 1 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB",null,null,null,"90746 - CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL","33234 - HC RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR/VENTR",null,"33216 - HC INSJ 1 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB","90756 - HC CCIIV4 VACCINE ANTIBIOTIC FREE 0.5ML DOS IM USE",null,"83010 - HC CHG ASSAY OF HAPTOGLOBIN, QUANT","33234 - HC RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR/VENTR"]
[null,"36556 - HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/>","96116 - NUBHVL STATUS XM PR HR W/PT INTERPJ&PREPJ","33235 - HC RMVL TRANSVNS PM ELTRD DUAL LEAD SYS","33235 - HC RMVL TRANSVNS PM ELTRD DUAL LEAD SYS","33235 - HC RMVL TRANSVNS PM ELTRD DUAL LEAD SYS","89050 - HC CHG CELL COUNT MISCELLANEOUS BODY FLUIDS","33217 - HC INSJ 2 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB",null,null,null,"90756 - HC CCIIV4 VACCINE ANTIBIOTIC FREE 0.5ML DOS IM USE","33235 - HC RMVL TRANSVNS PM ELTRD DUAL LEAD SYS",null,"33217 - HC INSJ 2 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB","90845 - PSYCHOANALYSIS",null,"83013 - HC H PYLORI (C-13) BREATH","33235 - HC RMVL TRANSVNS PM ELTRD DUAL LEAD SYS"]
[null,"36558 - HC INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>","96121 - HC NEUROBEHAVIORAL STATUS XM PHYS/QHP EA ADDL HOUR","33240 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/1 EXISTING LD","33240 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/1 EXISTING LD","33240 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/1 EXISTING LD","89051 - HC CHG CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT","33221 - HC INS PACEMAKER PULSE GEN ONLY W/EXIST MULT LEADS",null,null,null,"90845 - PSYCHOANALYSIS","33240 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/1 EXISTING LD",null,"33221 - HC INS PACEMAKER PULSE GEN ONLY W/EXIST MULT LEADS","90876 - HC INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 45 MIN",null,"83014 - HC H PYLORI DRUG ADMIN","33240 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/1 EXISTING LD"]
[null,"36560 - HC INSJ TUNNELED CTR VAD W/SUBQ PORT UNDER 5 YR","96125 - STANDARDIZED COGNITIVE PERFORMANCE TESTING","33241 - HC REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY","33241 - HC REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY","33241 - HC REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY","89060 - HC CHG CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID","33222 - HC RELOCATION OF SKIN POCKET FOR PACEMAKER",null,null,null,"90876 - HC INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 45 MIN","33241 - HC REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY",null,"33222 - HC RELOCATION OF SKIN POCKET FOR PACEMAKER","90889 - HC PREP REPORT PT PSYCH STATUS AGENCY/PAYER",null,"83020 - HC CHG HEMOGLOBIN ELECTROPHORESIS","33241 - HC REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY"]
[null,"36561 - HC INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>","96127 - BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT","33244 - HC RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ","33244 - HC RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ","33244 - HC RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ","89320 - SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT","33223 - HC RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR",null,null,null,"90889 - HC PREP REPORT PT PSYCH STATUS AGENCY/PAYER","33244 - HC RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ",null,"33223 - HC RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR","90901 - HC BIOFEEDBACK TRAINING, ANY MODALITY",null,"83021 - HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY","33244 - HC RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ"]
[null,"36565 - HC INSJ TUN VAD REQ 2 CATH 2 SITS W/O SUBQ PORT/PMP","96130 - HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR","33249 - HC INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR","33249 - HC INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR","33249 - HC INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR","90371 - HC HEPB IG, IM","33224 - HC INSJ ELTRD CAR VEN SYS ATTCH PREV PM/DFB PLS GEN",null,null,null,"90901 - HC BIOFEEDBACK TRAINING, ANY MODALITY","33249 - HC INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR",null,"33224 - HC INSJ ELTRD CAR VEN SYS ATTCH PREV PM/DFB PLS GEN","90912 - HC BFB TRAINING 1ST 15 MIN",null,"83030 - HC CHG HEMOGLOBIN F FETAL CHEMICAL","33249 - HC INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR"]
[null,"36566 - HC INSJ TUN VAD REQ 2 CATH 2 SITS W/SUBQ PORT","96131 - HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR","33262 - HC RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD","33262 - HC RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD","33262 - HC RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD","90632 - CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL","33225 - HC INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN",null,null,null,"90912 - HC BFB TRAINING 1ST 15 MIN","33262 - HC RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD",null,"33225 - HC INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN","90913 - HC BFB TRAINING EA ADDL 15 MIN",null,"83036 - HEMOGLOBIN GLYCOSYLATED A1C","33262 - HC RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD"]
[null,"36568 - HC INS PICC;W/O PMP/PRT;<5YR","96132 - HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR","33263 - HC RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD","33263 - HC RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD","33263 - HC RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD","90648 - HC HIB VACCINE, PRP-T, IM,DPH","33226 - HC RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD",null,null,null,"90913 - HC BFB TRAINING EA ADDL 15 MIN","33263 - HC RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD",null,"33226 - HC RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD","91112 - GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP",null,"83050 - HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE","33263 - HC RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD"]
[null,"36569 - INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/>","96133 - HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR","33264 - HC EXCHNG ICD GEN MULTI SYST","33264 - HC EXCHNG ICD GEN MULTI SYST","33264 - HC EXCHNG ICD GEN MULTI SYST","90653 - HC IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE","33227 - HC REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD",null,null,null,"91112 - GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP","33264 - HC EXCHNG ICD GEN MULTI SYST",null,"33227 - HC REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD","92532 - POSITIONAL NYSTAGMUS TEST",null,"83070 - HC CHG ASSAY OF HEMOSIDERIN QUALITATIVE","33264 - HC EXCHNG ICD GEN MULTI SYST"]
[null,"36570 - HC INSJ PRPH CTR VAD W/SUBQ PORT UNDER 5 YR","96136 - HC PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN","33270 - INS/RPLCMNT PERM SUBQ IMPLTBL DFB W/SUBQ ELTRD","33270 - INS/RPLCMNT PERM SUBQ IMPLTBL DFB W/SUBQ ELTRD","33270 - INS/RPLCMNT PERM SUBQ IMPLTBL DFB W/SUBQ ELTRD","90662 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM FLUZONE HIGH DOSE","33228 - HC REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS",null,null,null,"92532 - POSITIONAL NYSTAGMUS TEST","33270 - INS/RPLCMNT PERM SUBQ IMPLTBL DFB W/SUBQ ELTRD",null,"33228 - HC REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS","92562 - LOUDNESS BALANCE BINAURAL/MONAURAL",null,"83090 - HC CHG ASSAY OF HOMOCYSTEINE","33270 - INS/RPLCMNT PERM SUBQ IMPLTBL DFB W/SUBQ ELTRD"]
[null,"36571 - HC INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>","96137 - HC PSYCL/NRPSYCL TST PHYS/QHP 2+ TST EA ADDL 30 MIN","33271 - INSJ OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE","33271 - INSJ OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE","33271 - INSJ OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE","90670 - CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH","33229 - HC REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD",null,null,null,"92562 - LOUDNESS BALANCE BINAURAL/MONAURAL","33271 - INSJ OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE",null,"33229 - HC REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD","92597 - EVAL&/FITG VOICE PROSTC DEV SUPLMNT ORAL SPEEC",null,"83497 - HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA","33271 - INSJ OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE"]
[null,"36572 - HC INSJ PICC RS&I <5 YR","96138 - HC PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN","33273 - REPOS PREVIOUSLY IMPLANTED SUBQ IMPLANTABLE DFB","33273 - REPOS PREVIOUSLY IMPLANTED SUBQ IMPLANTABLE DFB","33273 - REPOS PREVIOUSLY IMPLANTED SUBQ IMPLANTABLE DFB","90672 - CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST","33230 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST DUAL LEADS",null,null,null,"92597 - EVAL&/FITG VOICE PROSTC DEV SUPLMNT ORAL SPEEC","33273 - REPOS PREVIOUSLY IMPLANTED SUBQ IMPLANTABLE DFB",null,"33230 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST DUAL LEADS","92605 - EVAL RX N-SP-GEN AUGMT ALT COMMUN DEV F2F 1ST HR",null,"83498 - HC CHG ASSAY OF HYDROXYPROGESTERONE 17-D","33273 - REPOS PREVIOUSLY IMPLANTED SUBQ IMPLANTABLE DFB"]
[null,"36573 - HC INSJ PICC RS&I 5 YR+","96139 - HC PSYCL/NRPSYCL TST TECH 2+ TST EA ADDL 30 MIN","33274 - HC TCAT INSJ/RPL PERM LDLS PM","33274 - HC TCAT INSJ/RPL PERM LDLS PM","33274 - HC TCAT INSJ/RPL PERM LDLS PM","90673 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM","33231 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST MULTILEADS",null,null,null,"92605 - EVAL RX N-SP-GEN AUGMT ALT COMMUN DEV F2F 1ST HR","33274 - HC TCAT INSJ/RPL PERM LDLS PM",null,"33231 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST MULTILEADS","92630 - HC AUD REHA PRELING HEARLOSS",null,"83516 - HC CRL;TTG AB,IGA","33274 - HC TCAT INSJ/RPL PERM LDLS PM"]
[null,"36575 - HC RTUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP","96146 - HC PSYCL/NRPSYCL TST ELEC PLATFORM AUTO RESULT","33275 - HC TCAT RMVL PERM LDLS PM","33275 - HC TCAT RMVL PERM LDLS PM","33275 - HC TCAT RMVL PERM LDLS PM","90674 - HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE","33233 - HC REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY",null,null,null,"92630 - HC AUD REHA PRELING HEARLOSS","33275 - HC TCAT RMVL PERM LDLS PM",null,"33233 - HC REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY","92633 - HC AUD REH POSTLING HEARLOSS",null,"83519 - HC CHG IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","33275 - HC TCAT RMVL PERM LDLS PM"]
[null,"36576 - HC RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT","96156 - HC HLTH BHV ASSMT/REASSESSMENT","33285 - HC INSJ SUBQ CAR RHYTHM MNTR","33285 - HC INSJ SUBQ CAR RHYTHM MNTR","33285 - HC INSJ SUBQ CAR RHYTHM MNTR","90675 - CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL","33234 - HC RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR/VENTR",null,null,null,"92633 - HC AUD REH POSTLING HEARLOSS","33285 - HC INSJ SUBQ CAR RHYTHM MNTR",null,"33234 - HC RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR/VENTR","92941 - HC PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL",null,"83520 - HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE","33285 - HC INSJ SUBQ CAR RHYTHM MNTR"]
[null,"36578 - HC RPLCMT CATH CTR VAD SUBQ PORT/PMP","96158 - HC HLTH BHV IVNTJ INDIV 1ST 30","33286 - HC RMVL SUBQ CAR RHYTHM MNTR","33286 - HC RMVL SUBQ CAR RHYTHM MNTR","33286 - HC RMVL SUBQ CAR RHYTHM MNTR","90686 - HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE","33235 - HC RMVL TRANSVNS PM ELTRD DUAL LEAD SYS",null,null,null,"92941 - HC PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL","33286 - HC RMVL SUBQ CAR RHYTHM MNTR",null,"33235 - HC RMVL TRANSVNS PM ELTRD DUAL LEAD SYS","93356 - HC MYOCRD STRAIN IMG SPCKL TRCK",null,"83525 - HC CHG ASSAY OF INSULIN TOTAL","33286 - HC RMVL SUBQ CAR RHYTHM MNTR"]
[null,"36580 - HC REPL CVC,NON_TUN;5/+YO","96159 - HC HLTH BHV IVNTJ INDIV EA ADDL","33361 - HC TAVR/TAVI PERC FEM ARTERY","33361 - HC TAVR/TAVI PERC FEM ARTERY","33361 - HC TAVR/TAVI PERC FEM ARTERY","90691 - CR BUILD ONLY - TYPHOID VACCINE, IM,TRAVEL","33240 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/1 EXISTING LD",null,null,null,"93356 - HC MYOCRD STRAIN IMG SPCKL TRCK","33289 - HC TCAT IMPL WRLS P-ART PRS SNR L-T HEMODYN MNTR",null,"33240 - HC INSJ IMPLNTBL DEFIB PULSE GEN W/1 EXISTING LD","93660 - CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR",null,"83540 - HC CHG ASSAY OF IRON","33289 - HC TCAT IMPL WRLS P-ART PRS SNR L-T HEMODYN MNTR"]
[null,"36581 - RPLCMT COMPL TUN CVC W/O SUBQ PORT/PMP","96160 - PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM","33440 - HC RPLCMT AORTIC VALVE BY TLCJ AUTOL PULM VALVE","33440 - HC RPLCMT AORTIC VALVE BY TLCJ AUTOL PULM VALVE","33440 - HC RPLCMT AORTIC VALVE BY TLCJ AUTOL PULM VALVE","90694 - HC VACC AIIV4 NO PRSRV 0.5ML IM","33241 - HC REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY",null,null,null,"93660 - CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR","36000 - INTRODUCTION NEEDLE/INTRACATHETER VEIN",null,"33241 - HC REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY","93668 - HC PERIPHERAL ART DISEASE REHAB, EA",null,"83550 - HC CHG IRON BINDING CAPACITY","33967 - HC PERC INS IAB"]
[null,"36582 - HC RPLCMT COMPL TUN CTR VAD W/SUBQ PORT","96161 - CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM","33967 - HC PERC INS IAB","33967 - HC PERC INS IAB","33967 - HC PERC INS IAB","90698 - CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH","33244 - HC RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ",null,null,null,"93668 - HC PERIPHERAL ART DISEASE REHAB, EA","36002 - HC INJECTION RX EXTREMITY PSEUDOANEURYSM",null,"33244 - HC RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ","93786 - BL BLD PRESS W/TAPE&/DISK 24/> HR REC ONL",null,"83605 - HC CHG ASSAY OF LACTATE","33968 - HC REM AORTIC ASSIST DEV PRQ"]
[null,"36584 - RPLCMT COMPL PRPH CVC W/O SUBQ PORT/PMP","96164 - HC HLTH BHV IVNTJ GRP 1ST 30","33990 - HC INSJ PERQ VAD W/IMAGING ARTERY ACCESS ONLY","33990 - HC INSJ PERQ VAD W/IMAGING ARTERY ACCESS ONLY","33990 - HC INSJ PERQ VAD W/IMAGING ARTERY ACCESS ONLY","90700 - CR BUILD ONLY - DTAP IMMUNIZATION, IM, <7 YO,TRAVEL","33249 - HC INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR",null,null,null,"93786 - BL BLD PRESS W/TAPE&/DISK 24/> HR REC ONL","36005 - HC NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH",null,"33249 - HC INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR","93895 - HC CAROTID INTIMA MEDIA & CAROTID ATHEROMA EVAL BI",null,"83615 - HC CHG LACTATE DEHYDROGENASE LDH","36000 - INTRODUCTION NEEDLE/INTRACATHETER VEIN"]
[null,"36585 - HC RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT","96165 - HC HLTH BHV IVNTJ GRP EA ADDL","36000 - INTRODUCTION NEEDLE/INTRACATHETER VEIN","36000 - INTRODUCTION NEEDLE/INTRACATHETER VEIN","36000 - INTRODUCTION NEEDLE/INTRACATHETER VEIN","90714 - CR BUILD ONLY - TD VACCINE NO PRSRV >/= 7 YO, IM,DPH","33262 - HC RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD",null,null,null,"93895 - HC CAROTID INTIMA MEDIA & CAROTID ATHEROMA EVAL BI","36010 - HC INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA",null,"33262 - HC RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD","93985 - DUP-SCAN HEMO COMPL BI STD",null,"83630 - HC CHG LACTOFERRIN FECAL QUALITATIVE","36002 - HC INJECTION RX EXTREMITY PSEUDOANEURYSM"]
[null,"36589 - RMVL TUN CVC W/O SUBQ PORT/PMP","96167 - HC HLTH BHV IVNTJ FAM 1ST 30","36002 - HC INJECTION RX EXTREMITY PSEUDOANEURYSM","36002 - HC INJECTION RX EXTREMITY PSEUDOANEURYSM","36002 - HC INJECTION RX EXTREMITY PSEUDOANEURYSM","90715 - CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH","33263 - HC RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD",null,null,null,"93985 - DUP-SCAN HEMO COMPL BI STD","36011 - HC SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH",null,"33263 - HC RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD","93986 - DUP-SCAN HEMO COMPL UNI STD",null,"83655 - HC CHG ASSAY OF LEAD","36005 - HC NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH"]
[null,"36590 - HC RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ","96168 - HC HLTH BHV IVNTJ FAM EA ADDL","36005 - HC NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH","36005 - HC NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH","36005 - HC NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH","90723 - CR BUILD ONLY - DTAP/HEPB/IPV VACCINE,IM,DPH","33264 - HC EXCHNG ICD GEN MULTI SYST",null,null,null,"93986 - DUP-SCAN HEMO COMPL UNI STD","36012 - HC SLCTV CATH PLMT VEN SYS 2ND ORDER/> SLCTV BRANC",null,"33264 - HC EXCHNG ICD GEN MULTI SYST","94644 - CONTINUOUS INHALATION TREATMENT 1ST HR",null,"83662 - HC L/S RATIO, FOAM STABILITY","36010 - HC INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA"]
[null,"36593 - DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH","96170 - HC HLTH BHV IVNTJ FAM WO PT 1ST","36010 - HC INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA","36010 - HC INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA","36010 - HC INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA","90732 - CR BUILD ONLY - PNEUMOCOCCAL VACCINE,23-VALENT,ADULT,TRAVEL","33270 - INS/RPLCMNT PERM SUBQ IMPLTBL DFB W/SUBQ ELTRD",null,null,null,"94644 - CONTINUOUS INHALATION TREATMENT 1ST HR","36013 - HC INTRO CATHETER RIGHT HEART/MAIN PULMONARY ARTERY",null,"33270 - INS/RPLCMNT PERM SUBQ IMPLTBL DFB W/SUBQ ELTRD","94645 - CONTINUOUS INHALATION TREATMENT EA ADDL HR",null,"83690 - HC CHG ASSAY OF LIPASE","36011 - HC SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH"]
[null,"36595 - HC MECH REMOV PERICATH OBSTR CV DEV VIA VEN ACCESS","96171 - HC HLTH BHV IVNTJ FAM W/O PT EA","36011 - HC SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH","36011 - HC SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH","36011 - HC SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH","90739 - HC HEPATITIS B VACCINE ADULT 2 DOSE IM","33271 - INSJ OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE",null,null,null,"94645 - CONTINUOUS INHALATION TREATMENT EA ADDL HR","36014 - HC SLCTV CATHETER PLMT LEFT/RIGHT PULMONARY ARTERY",null,"33271 - INSJ OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE","95120 - PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX",null,"83695 - HC CHG LIPOPROTEIN (A)","36012 - HC SLCTV CATH PLMT VEN SYS 2ND ORDER/> SLCTV BRANC"]
[null,"36596 - HC MCHNL RMVL INTRAL OBSTR CV DEV THRU DEV LUMEN","96376 - HC THERAPEUTIC PROPHYLACTIC/DX NJX INTRA-ARTERIAL","36012 - HC SLCTV CATH PLMT VEN SYS 2ND ORDER/> SLCTV BRANC","36012 - HC SLCTV CATH PLMT VEN SYS 2ND ORDER/> SLCTV BRANC","36012 - HC SLCTV CATH PLMT VEN SYS 2ND ORDER/> SLCTV BRANC","90740 - HC HEP B VACCINE,DIAL/IMMUNOSUP, IM","33273 - REPOS PREVIOUSLY IMPLANTED SUBQ IMPLANTABLE DFB",null,null,null,"95120 - PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX","36015 - HC SLCTV CATH PLMT SEGMENTAL/SUBSEGMENTAL PULM ART",null,"33273 - REPOS PREVIOUSLY IMPLANTED SUBQ IMPLANTABLE DFB","95125 - PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 2/> NJX",null,"83718 - HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL","36013 - HC INTRO CATHETER RIGHT HEART/MAIN PULMONARY ARTERY"]
[null,"36598 - HC CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT","96567 - PDT XTRNL APPL LIGHT DSTR LES SKN BY ACTIVJ RX","36013 - HC INTRO CATHETER RIGHT HEART/MAIN PULMONARY ARTERY","36013 - HC INTRO CATHETER RIGHT HEART/MAIN PULMONARY ARTERY","36013 - HC INTRO CATHETER RIGHT HEART/MAIN PULMONARY ARTERY","90744 - CR BUILD ONLY - HEP B VACCINE,PED/ADOL,IM,DPH","33274 - HC TCAT INSJ/RPL PERM LDLS PM",null,null,null,"95125 - PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 2/> NJX","36140 - HC INTRO NEEDLE/INTRACATH EXTREMITY ARTERY",null,"33274 - HC TCAT INSJ/RPL PERM LDLS PM","95700 - HC EEG CONT REC W/VID EEG TECH",null,"83721 - HC CRL;DIRECT LDL","36014 - HC SLCTV CATHETER PLMT LEFT/RIGHT PULMONARY ARTERY"]
[null,"36620 - HC INSERT CATH,ART,PERCUT,SHORTTERM","97014 - HC APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED","36014 - HC SLCTV CATHETER PLMT LEFT/RIGHT PULMONARY ARTERY","36014 - HC SLCTV CATHETER PLMT LEFT/RIGHT PULMONARY ARTERY","36014 - HC SLCTV CATHETER PLMT LEFT/RIGHT PULMONARY ARTERY","90746 - CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL","33275 - HC TCAT RMVL PERM LDLS PM",null,null,null,"95700 - HC EEG CONT REC W/VID EEG TECH","36160 - HC INTRO NEEDLE/INTRACATH AORTIC TRANSLUMBAR",null,"33275 - HC TCAT RMVL PERM LDLS PM","95824 - ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY",null,"83735 - HC CHG ASSAY OF MAGNESIUM","36015 - HC SLCTV CATH PLMT SEGMENTAL/SUBSEGMENTAL PULM ART"]
[null,"36680 - HC PLACEMENT NEEDLE INTRAOSSEOUS INFUSION","97129 - HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES","36015 - HC SLCTV CATH PLMT SEGMENTAL/SUBSEGMENTAL PULM ART","36015 - HC SLCTV CATH PLMT SEGMENTAL/SUBSEGMENTAL PULM ART","36015 - HC SLCTV CATH PLMT SEGMENTAL/SUBSEGMENTAL PULM ART","90756 - HC CCIIV4 VACCINE ANTIBIOTIC FREE 0.5ML DOS IM USE","33285 - HC INSJ SUBQ CAR RHYTHM MNTR",null,null,null,"95824 - ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY","36200 - HC INTRODUCTION CATHETER AORTA",null,"33285 - HC INSJ SUBQ CAR RHYTHM MNTR","95951 - LOCALIZE CEREBRAL SEIZURE CABLE/RADIO EEG/VIDEO",null,"83785 - HC CHG, ASSAY OF MANGANESE","36140 - HC INTRO NEEDLE/INTRACATH EXTREMITY ARTERY"]
[null,"36901 - HC INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR S&I","97130 - HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTE","36140 - HC INTRO NEEDLE/INTRACATH EXTREMITY ARTERY","36140 - HC INTRO NEEDLE/INTRACATH EXTREMITY ARTERY","36140 - HC INTRO NEEDLE/INTRACATH EXTREMITY ARTERY","90845 - PSYCHOANALYSIS","33286 - HC RMVL SUBQ CAR RHYTHM MNTR",null,null,null,"95951 - LOCALIZE CEREBRAL SEIZURE CABLE/RADIO EEG/VIDEO","36215 - HC SLCTV CATHJ EA 1ST ORD THRC/BRCH/CPHLC BRNCH",null,"33286 - HC RMVL SUBQ CAR RHYTHM MNTR","95953 - LOCALIZE CEREBRAL SEIZURE CPTR PORTABLE EEG",null,"83789 - HC CHG MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA","36160 - HC INTRO NEEDLE/INTRACATH AORTIC TRANSLUMBAR"]
[null,"36902 - HC INTRO CATH DIALYSIS CIRCUIT W/TRLUML BALO ANGIOP","97151 - HC BHV ID ASSMT BY PHYS/QHP","36160 - HC INTRO NEEDLE/INTRACATH AORTIC TRANSLUMBAR","36160 - HC INTRO NEEDLE/INTRACATH AORTIC TRANSLUMBAR","36160 - HC INTRO NEEDLE/INTRACATH AORTIC TRANSLUMBAR","90876 - HC INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 45 MIN","33289 - HC TCAT IMPL WRLS P-ART PRS SNR L-T HEMODYN MNTR",null,null,null,"95953 - LOCALIZE CEREBRAL SEIZURE CPTR PORTABLE EEG","36216 - HC SLCTV CATHJ 1ST 2ND ORD THRC/BRCH/CPHLC BRNCH",null,"33289 - HC TCAT IMPL WRLS P-ART PRS SNR L-T HEMODYN MNTR","95966 - HC MEG,EVOKED MAGNET FIELDS, SINGLE MODAL",null,"83825 - HC CHG ASSAY OF MERCURY QUANTITATIVE","36200 - HC INTRODUCTION CATHETER AORTA"]
[null,"36903 - HC INTRO CATH DIALYSIS CIRCUIT W/TCAT PLMT IV STENT","97152 - HC BHV ID SUPRT ASSMT BY 1 TECH","36200 - HC INTRODUCTION CATHETER AORTA","36200 - HC INTRODUCTION CATHETER AORTA","36200 - HC INTRODUCTION CATHETER AORTA","90889 - HC PREP REPORT PT PSYCH STATUS AGENCY/PAYER","36000 - INTRODUCTION NEEDLE/INTRACATHETER VEIN",null,null,null,"95966 - HC MEG,EVOKED MAGNET FIELDS, SINGLE MODAL","36217 - HC SLCTV CATHJ 3RD+ ORD SLCTV THRC/BRCH/CPHLC BRNCH",null,"36000 - INTRODUCTION NEEDLE/INTRACATHETER VEIN","95992 - CANALITH REPOSITIONING PROCEDURE",null,"83835 - HC CHG METANEPHRINES","36215 - HC SLCTV CATHJ EA 1ST ORD THRC/BRCH/CPHLC BRNCH"]
[null,"36904 - HC PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH","97153 - HC ADAPTIVE BEHAVIOR TX BY TECH","36215 - HC SLCTV CATHJ EA 1ST ORD THRC/BRCH/CPHLC BRNCH","36215 - HC SLCTV CATHJ EA 1ST ORD THRC/BRCH/CPHLC BRNCH","36215 - HC SLCTV CATHJ EA 1ST ORD THRC/BRCH/CPHLC BRNCH","90901 - HC BIOFEEDBACK TRAINING, ANY MODALITY","36002 - HC INJECTION RX EXTREMITY PSEUDOANEURYSM",null,null,null,"95992 - CANALITH REPOSITIONING PROCEDURE","36218 - HC SLCTV CATHJ EA 2ND+ ORD THRC/BRCH/CPHLC BRNCH",null,"36002 - HC INJECTION RX EXTREMITY PSEUDOANEURYSM","96040 - MEDICAL GENETICS COUNSELING EACH 30 MINUTES",null,"83873 - HC CHG MYELIN BASIC PROTEIN CEREBROSPINAL FLUID","36216 - HC SLCTV CATHJ 1ST 2ND ORD THRC/BRCH/CPHLC BRNCH"]
[null,"36905 - HC PERQ THRMBC/NFS DIAL CIRCUIT TRLUML BALO ANGIOP","97154 - HC GRP ADAPT BHV TX BY TECH","36216 - HC SLCTV CATHJ 1ST 2ND ORD THRC/BRCH/CPHLC BRNCH","36216 - HC SLCTV CATHJ 1ST 2ND ORD THRC/BRCH/CPHLC BRNCH","36216 - HC SLCTV CATHJ 1ST 2ND ORD THRC/BRCH/CPHLC BRNCH","90912 - HC BFB TRAINING 1ST 15 MIN","36005 - HC NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH",null,null,null,"96040 - MEDICAL GENETICS COUNSELING EACH 30 MINUTES","36221 - HC NONSLCTV CATH THOR AORTA ANGIO INTR/XTRCRANL ART",null,"36005 - HC NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH","96105 - ASSESSMENT PHASIA W/INTERP & REPORT PER HOUR",null,"83874 - HC CHG MYOGLOBIN","36217 - HC SLCTV CATHJ 3RD+ ORD SLCTV THRC/BRCH/CPHLC BRNCH"]
[null,"36906 - HC PERQ THRMBC/NFS DIAL CIRCUIT TCAT PLMT IV STENT","97155 - HC ADAPT BEHAVIOR TX PHYS/QHP","36217 - HC SLCTV CATHJ 3RD+ ORD SLCTV THRC/BRCH/CPHLC BRNCH","36217 - HC SLCTV CATHJ 3RD+ ORD SLCTV THRC/BRCH/CPHLC BRNCH","36217 - HC SLCTV CATHJ 3RD+ ORD SLCTV THRC/BRCH/CPHLC BRNCH","90913 - HC BFB TRAINING EA ADDL 15 MIN","36010 - HC INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA",null,null,null,"96105 - ASSESSMENT PHASIA W/INTERP & REPORT PER HOUR","36222 - HC SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART",null,"36010 - HC INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA","96112 - HC DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR",null,"83880 - HC CHG NATRIURETIC PEPTIDE","36218 - HC SLCTV CATHJ EA 2ND+ ORD THRC/BRCH/CPHLC BRNCH"]
[null,"36907 - HC TRLUML BAL ANGIO CTR DIAL","97156 - HC FAM ADAPT BHV TX GDN PHY/QHP","36218 - HC SLCTV CATHJ EA 2ND+ ORD THRC/BRCH/CPHLC BRNCH","36218 - HC SLCTV CATHJ EA 2ND+ ORD THRC/BRCH/CPHLC BRNCH","36218 - HC SLCTV CATHJ EA 2ND+ ORD THRC/BRCH/CPHLC BRNCH","91112 - GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP","36011 - HC SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH",null,null,null,"96112 - HC DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR","36223 - HC SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART",null,"36011 - HC SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH","96113 - HC DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN",null,"83883 - HC NEPHELOMETRY, EACH ANALYTE","36221 - HC NONSLCTV CATH THOR AORTA ANGIO INTR/XTRCRANL ART"]
[null,"36908 - HC STENT PLMT CENTRAL DIAYLSIS SEG PFRMD DIAL CIR","97157 - HC MULT FAM ADAPT BHV TX GDN","36221 - HC NONSLCTV CATH THOR AORTA ANGIO INTR/XTRCRANL ART","36221 - HC NONSLCTV CATH THOR AORTA ANGIO INTR/XTRCRANL ART","36221 - HC NONSLCTV CATH THOR AORTA ANGIO INTR/XTRCRANL ART","92532 - POSITIONAL NYSTAGMUS TEST","36012 - HC SLCTV CATH PLMT VEN SYS 2ND ORDER/> SLCTV BRANC",null,null,null,"96113 - HC DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN","36224 - HC SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART",null,"36012 - HC SLCTV CATH PLMT VEN SYS 2ND ORDER/> SLCTV BRANC","96116 - NUBHVL STATUS XM PR HR W/PT INTERPJ&PREPJ",null,"83915 - HC CHG ASSAY OF NUCLEOTIDASE 5'-","36222 - HC SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART"]
[null,"37183 - HC REVJ TRANSVNS INTRAHEPATIC PORTOSYSTEMIC SHUNT","97158 - HC GRP ADAPT BHV TX BY PHY/QHP","36222 - HC SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART","36222 - HC SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART","36222 - HC SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART","92562 - LOUDNESS BALANCE BINAURAL/MONAURAL","36013 - HC INTRO CATHETER RIGHT HEART/MAIN PULMONARY ARTERY",null,null,null,"96116 - NUBHVL STATUS XM PR HR W/PT INTERPJ&PREPJ","36225 - HC SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY",null,"36013 - HC INTRO CATHETER RIGHT HEART/MAIN PULMONARY ARTERY","96121 - HC NEUROBEHAVIORAL STATUS XM PHYS/QHP EA ADDL HOUR",null,"83916 - HC CHG OLIGOCLONAL IMMUNE","36223 - HC SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART"]
[null,"37184 - HC PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST","97537 - HC COMMUNITY/WORK REINTEGRATION TRAINJ EA 15 MIN","36223 - HC SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART","36223 - HC SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART","36223 - HC SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART","92597 - EVAL&/FITG VOICE PROSTC DEV SUPLMNT ORAL SPEEC","36014 - HC SLCTV CATHETER PLMT LEFT/RIGHT PULMONARY ARTERY",null,null,null,"96121 - HC NEUROBEHAVIORAL STATUS XM PHYS/QHP EA ADDL HOUR","36226 - HC SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY",null,"36014 - HC SLCTV CATHETER PLMT LEFT/RIGHT PULMONARY ARTERY","96125 - STANDARDIZED COGNITIVE PERFORMANCE TESTING",null,"83918 - HC CHG ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN","36224 - HC SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART"]
[null,"37185 - PRIM PRQ TRLUML MCHNL THRMBC SBSQ VSL","97755 - HC ASSTV TECHNOL ASSMT DIR CNTCT W/REPRT EA 15 MIN","36224 - HC SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART","36224 - HC SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART","36224 - HC SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART","92605 - EVAL RX N-SP-GEN AUGMT ALT COMMUN DEV F2F 1ST HR","36015 - HC SLCTV CATH PLMT SEGMENTAL/SUBSEGMENTAL PULM ART",null,null,null,"96125 - STANDARDIZED COGNITIVE PERFORMANCE TESTING","36227 - HC SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC",null,"36015 - HC SLCTV CATH PLMT SEGMENTAL/SUBSEGMENTAL PULM ART","96127 - BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT",null,"83921 - HC CHG ORGANIC ACID 1 QUANTITATIVE","36225 - HC SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY"]
[null,"37186 - HC SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL","98960 - HC EDUCATION&TRAINING SELF-MGMT NONPHYS 1 PT","36225 - HC SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY","36225 - HC SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY","36225 - HC SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY","92630 - HC AUD REHA PRELING HEARLOSS","36120 - PERC/BRACHIAL ARTERY",null,null,null,"96127 - BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT","36228 - HC SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT",null,"36120 - PERC/BRACHIAL ARTERY","96130 - HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR",null,"83930 - HC Q;OSMOLALITY,SER","36226 - HC SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY"]
[null,"37187 - PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN","99151 - HC MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS","36226 - HC SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY","36226 - HC SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY","36226 - HC SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY","92633 - HC AUD REH POSTLING HEARLOSS","36140 - HC INTRO NEEDLE/INTRACATH EXTREMITY ARTERY",null,null,null,"96130 - HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR","36245 - HC SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH",null,"36140 - HC INTRO NEEDLE/INTRACATH EXTREMITY ARTERY","96131 - HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR",null,"83935 - HC CHG ASSAY OF OSMOLALITY URINE","36227 - HC SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC"]
[null,"37188 - PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX","99152 - HC MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS","36227 - HC SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC","36227 - HC SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC","36227 - HC SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC","92941 - HC PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL","36160 - HC INTRO NEEDLE/INTRACATH AORTIC TRANSLUMBAR",null,null,null,"96131 - HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR","36246 - HC SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH",null,"36160 - HC INTRO NEEDLE/INTRACATH AORTIC TRANSLUMBAR","96132 - HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR",null,"83937 - HC CHG ASSAY OF OSTEOCALCIN","36228 - HC SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT"]
[null,"37191 - HC INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I","99153 - HC MOD SED SAME PHYS/QHP EACH ADDL 15 MINS","36228 - HC SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT","36228 - HC SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT","36228 - HC SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT","93356 - HC MYOCRD STRAIN IMG SPCKL TRCK","36200 - HC INTRODUCTION CATHETER AORTA",null,null,null,"96132 - HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR","36247 - HC SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH",null,"36200 - HC INTRODUCTION CATHETER AORTA","96133 - HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR",null,"83945 - HC CHG ASSAY OF OXALATE","36245 - HC SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH"]
[null,"37192 - HC REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I","99155 - HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS","36245 - HC SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH","36245 - HC SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH","36245 - HC SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH","93660 - CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR","36215 - HC SLCTV CATHJ EA 1ST ORD THRC/BRCH/CPHLC BRNCH",null,null,null,"96133 - HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR","36248 - HC SLCTV CATHJ EA 2ND+ ORD ABDL PEL/LXTR ART BRNCH",null,"36215 - HC SLCTV CATHJ EA 1ST ORD THRC/BRCH/CPHLC BRNCH","96136 - HC PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN",null,"83970 - HC CHG ASSAY OF PARATHORMONE","36246 - HC SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH"]
[null,"37193 - HC RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I","99156 - HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS","36246 - HC SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH","36246 - HC SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH","36246 - HC SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH","93668 - HC PERIPHERAL ART DISEASE REHAB, EA","36216 - HC SLCTV CATHJ 1ST 2ND ORD THRC/BRCH/CPHLC BRNCH",null,null,null,"96136 - HC PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN","36251 - HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UN",null,"36216 - HC SLCTV CATHJ 1ST 2ND ORD THRC/BRCH/CPHLC BRNCH","96137 - HC PSYCL/NRPSYCL TST PHYS/QHP 2+ TST EA ADDL 30 MIN",null,"83986 - HC CHG PH BODY FLUID NOT ELSEWHERE SPECIFIED","36247 - HC SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH"]
[null,"37197 - HC PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING","99157 - HC MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS","36247 - HC SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH","36247 - HC SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH","36247 - HC SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH","93786 - BL BLD PRESS W/TAPE&/DISK 24/> HR REC ONL","36217 - HC SLCTV CATHJ 3RD+ ORD SLCTV THRC/BRCH/CPHLC BRNCH",null,null,null,"96137 - HC PSYCL/NRPSYCL TST PHYS/QHP 2+ TST EA ADDL 30 MIN","36252 - HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BIL",null,"36217 - HC SLCTV CATHJ 3RD+ ORD SLCTV THRC/BRCH/CPHLC BRNCH","96138 - HC PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN",null,"83992 - HC CHG ASSAY OF PHENCYCLIDINE","36248 - HC SLCTV CATHJ EA 2ND+ ORD ABDL PEL/LXTR ART BRNCH"]
[null,"37200 - HC TRANSCATHETER BIOPSY","99172 - VISUAL FUNCT SCRNG AUTO SEMI-AUTO BI QUAN DETERM","36248 - HC SLCTV CATHJ EA 2ND+ ORD ABDL PEL/LXTR ART BRNCH","36248 - HC SLCTV CATHJ EA 2ND+ ORD ABDL PEL/LXTR ART BRNCH","36248 - HC SLCTV CATHJ EA 2ND+ ORD ABDL PEL/LXTR ART BRNCH","93895 - HC CAROTID INTIMA MEDIA & CAROTID ATHEROMA EVAL BI","36218 - HC SLCTV CATHJ EA 2ND+ ORD THRC/BRCH/CPHLC BRNCH",null,null,null,"96138 - HC PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN","36253 - HC SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I",null,"36218 - HC SLCTV CATHJ EA 2ND+ ORD THRC/BRCH/CPHLC BRNCH","96139 - HC PSYCL/NRPSYCL TST TECH 2+ TST EA ADDL 30 MIN",null,"83993 - HC CHG ASSAY OF CALPROTECTIN FECAL","36251 - HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UN"]
[null,"37211 - HC THROMBOLYSIS ARTERIAL INFUSION ICRA RS&I INIT TX","99354 - PROLNG SVC OFFICE O/P DIR CONTACT 1ST HR","36251 - HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UN","36251 - HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UN","36251 - HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UN","93985 - DUP-SCAN HEMO COMPL BI STD","36221 - HC NONSLCTV CATH THOR AORTA ANGIO INTR/XTRCRANL ART",null,null,null,"96139 - HC PSYCL/NRPSYCL TST TECH 2+ TST EA ADDL 30 MIN","36254 - HC SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I",null,"36221 - HC NONSLCTV CATH THOR AORTA ANGIO INTR/XTRCRANL ART","96146 - HC PSYCL/NRPSYCL TST ELEC PLATFORM AUTO RESULT",null,"84075 - HC CHG ASSAY OF PHOSPHATASE ALKALINE","36252 - HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BIL"]
[null,"37212 - HC THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX","99355 - PROLNG SVC OFFICE O/P DIR CONTACT EA 30 MINUTES","36252 - HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BIL","36252 - HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BIL","36252 - HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BIL","93986 - DUP-SCAN HEMO COMPL UNI STD","36222 - HC SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART",null,null,null,"96146 - HC PSYCL/NRPSYCL TST ELEC PLATFORM AUTO RESULT","36299 - PR CENTRAL VENOGRAPHY",null,"36222 - HC SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART","96156 - HC HLTH BHV ASSMT/REASSESSMENT",null,"84080 - HC CHG ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES","36253 - HC SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I"]
[null,"37213 - HC THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX","99358 - HC PROLONGED SERV,NO CONTACT,1ST HR","36253 - HC SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I","36253 - HC SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I","36253 - HC SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I","94644 - CONTINUOUS INHALATION TREATMENT 1ST HR","36223 - HC SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART",null,null,null,"96156 - HC HLTH BHV ASSMT/REASSESSMENT","36406 - HC VNPNXR <3 YEARS PHYS/QHP SKILL OTHER VEIN",null,"36223 - HC SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART","96158 - HC HLTH BHV IVNTJ INDIV 1ST 30",null,"84100 - HC CHG ASSAY OF PHOSPHORUS INORGANIC","36254 - HC SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I"]
[null,"37214 - HC CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL","99359 - PROLONGED SERV,NO CONTCT,EA ADD 30 MIN","36254 - HC SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I","36254 - HC SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I","36254 - HC SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I","94645 - CONTINUOUS INHALATION TREATMENT EA ADDL HR","36224 - HC SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART",null,null,null,"96158 - HC HLTH BHV IVNTJ INDIV 1ST 30","36410 - VNPNXR 3 YEARS/> PHYS/QHP SKILL",null,"36224 - HC SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART","96159 - HC HLTH BHV IVNTJ INDIV EA ADDL",null,"84105 - HC CHG ASSAY OF PHOSPHORUS INORGANIC URINE","36299 - PR CENTRAL VENOGRAPHY"]
[null,"37215 - HC TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ","99366 - HC TEAM CONFERENCE FACE-TO-FACE NONPHYSICIAN","36406 - HC VNPNXR <3 YEARS PHYS/QHP SKILL OTHER VEIN","36406 - HC VNPNXR <3 YEARS PHYS/QHP SKILL OTHER VEIN","36406 - HC VNPNXR <3 YEARS PHYS/QHP SKILL OTHER VEIN","95120 - PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX","36225 - HC SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY",null,null,null,"96159 - HC HLTH BHV IVNTJ INDIV EA ADDL","36415 - COLLECTION VENOUS BLOOD VENIPUNCTURE",null,"36225 - HC SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY","96160 - PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM",null,"84132 - HC CHG POTASSIUM SERUM PLASMA/WHOLE BLOOD","36406 - HC VNPNXR <3 YEARS PHYS/QHP SKILL OTHER VEIN"]
[null,"37216 - HC TCAT IV STENT CRV CRTD ART W/O EMBOLIC PROTECJ [37216]","99368 - HC TEAM CONFERENCE NON-FACE-TO-FACE NONPHYSICIAN","36410 - VNPNXR 3 YEARS/> PHYS/QHP SKILL","36410 - VNPNXR 3 YEARS/> PHYS/QHP SKILL","36410 - VNPNXR 3 YEARS/> PHYS/QHP SKILL","95125 - PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 2/> NJX","36226 - HC SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY",null,null,null,"96160 - PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM","36416 - HC COLLECTION CAPILLARY BLOOD SPECIMEN",null,"36226 - HC SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY","96161 - CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM",null,"84133 - HC CHG POTASSIUM URINE","36410 - VNPNXR 3 YEARS/> PHYS/QHP SKILL"]
[null,"37220 - HC REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL","99401 - PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 15 M","36415 - COLLECTION VENOUS BLOOD VENIPUNCTURE","36415 - COLLECTION VENOUS BLOOD VENIPUNCTURE","36415 - COLLECTION VENOUS BLOOD VENIPUNCTURE","95700 - HC EEG CONT REC W/VID EEG TECH","36227 - HC SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC",null,null,null,"96161 - CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM","36430 - TRANSFUSION BLOOD/BLOOD COMPONENTS",null,"36227 - HC SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC","96164 - HC HLTH BHV IVNTJ GRP 1ST 30",null,"84134 - HC CHG PREALBUMIN","36415 - COLLECTION VENOUS BLOOD VENIPUNCTURE"]
[null,"37221 - HC REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOPLSTY","99402 - PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 30 M","36416 - HC COLLECTION CAPILLARY BLOOD SPECIMEN","36416 - HC COLLECTION CAPILLARY BLOOD SPECIMEN","36416 - HC COLLECTION CAPILLARY BLOOD SPECIMEN","95824 - ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY","36228 - HC SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT",null,null,null,"96164 - HC HLTH BHV IVNTJ GRP 1ST 30","36455 - HC EXCHANGE TRANSFUION, OTHR",null,"36228 - HC SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT","96165 - HC HLTH BHV IVNTJ GRP EA ADDL",null,"84144 - HC CHG ASSAY OF PROGESTERONE","36416 - HC COLLECTION CAPILLARY BLOOD SPECIMEN"]
[null,"37222 - HC REVASC;ILIAC,EAAD,TRN ANG","99403 - HC PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 45 MIN","36430 - TRANSFUSION BLOOD/BLOOD COMPONENTS","36430 - TRANSFUSION BLOOD/BLOOD COMPONENTS","36430 - TRANSFUSION BLOOD/BLOOD COMPONENTS","95951 - LOCALIZE CEREBRAL SEIZURE CABLE/RADIO EEG/VIDEO","36245 - HC SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH",null,null,null,"96165 - HC HLTH BHV IVNTJ GRP EA ADDL","36470 - NJX SCLEROSING SOLUTION SINGLE VEIN",null,"36245 - HC SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH","96167 - HC HLTH BHV IVNTJ FAM 1ST 30",null,"84145 - HC CHG PROCALCITONIN (PCT)","36430 - TRANSFUSION BLOOD/BLOOD COMPONENTS"]
[null,"37223 - HC REVASC;ILIAC,EAAD,TRN STN","99404 - HC PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 60 MIN","36455 - HC EXCHANGE TRANSFUION, OTHR","36455 - HC EXCHANGE TRANSFUION, OTHR","36455 - HC EXCHANGE TRANSFUION, OTHR","95953 - LOCALIZE CEREBRAL SEIZURE CPTR PORTABLE EEG","36246 - HC SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH",null,null,null,"96167 - HC HLTH BHV IVNTJ FAM 1ST 30","36471 - NJX SCLEROSING SOLUTION MULTIPLE VEINS SAME LEG",null,"36246 - HC SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH","96168 - HC HLTH BHV IVNTJ FAM EA ADDL",null,"84146 - HC CHG ASSAY OF PROLACTIN","36455 - HC EXCHANGE TRANSFUION, OTHR"]
[null,"37224 - HC REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI","99406 - TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES","36470 - NJX SCLEROSING SOLUTION SINGLE VEIN","36470 - NJX SCLEROSING SOLUTION SINGLE VEIN","36470 - NJX SCLEROSING SOLUTION SINGLE VEIN","95966 - HC MEG,EVOKED MAGNET FIELDS, SINGLE MODAL","36247 - HC SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH",null,null,null,"96168 - HC HLTH BHV IVNTJ FAM EA ADDL","36473 - HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM 1ST VEIN",null,"36247 - HC SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH","96170 - HC HLTH BHV IVNTJ FAM WO PT 1ST",null,"84153 - HC CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL","36470 - NJX SCLEROSING SOLUTION SINGLE VEIN"]
[null,"37225 - HC REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL","99411 - PREV MED COUNSEL & RISK FACTOR REDJ GRP SPX 30 M","36471 - NJX SCLEROSING SOLUTION MULTIPLE VEINS SAME LEG","36471 - NJX SCLEROSING SOLUTION MULTIPLE VEINS SAME LEG","36471 - NJX SCLEROSING SOLUTION MULTIPLE VEINS SAME LEG","95992 - CANALITH REPOSITIONING PROCEDURE","36248 - HC SLCTV CATHJ EA 2ND+ ORD ABDL PEL/LXTR ART BRNCH",null,null,null,"96170 - HC HLTH BHV IVNTJ FAM WO PT 1ST","36474 - HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM SBSQ VEINS",null,"36248 - HC SLCTV CATHJ EA 2ND+ ORD ABDL PEL/LXTR ART BRNCH","96171 - HC HLTH BHV IVNTJ FAM W/O PT EA",null,"84155 - HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD","36471 - NJX SCLEROSING SOLUTION MULTIPLE VEINS SAME LEG"]
[null,"37226 - HC REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL","99412 - PREV MED COUNSEL & RISK FACTOR REDJ GRP SPX 60 M","36473 - HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM 1ST VEIN","36473 - HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM 1ST VEIN","36473 - HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM 1ST VEIN","96040 - MEDICAL GENETICS COUNSELING EACH 30 MINUTES","36251 - HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UN",null,null,null,"96171 - HC HLTH BHV IVNTJ FAM W/O PT EA","36475 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN",null,"36251 - HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UN","96376 - HC THERAPEUTIC PROPHYLACTIC/DX NJX INTRA-ARTERIAL",null,"84156 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY URINE","36473 - HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM 1ST VEIN"]
[null,"37227 - HC REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL","99453 - REM MNTR PHYSIOL PARAM SETUP","36474 - HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM SBSQ VEINS","36474 - HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM SBSQ VEINS","36474 - HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM SBSQ VEINS","96105 - ASSESSMENT PHASIA W/INTERP & REPORT PER HOUR","36252 - HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BIL",null,null,null,"96376 - HC THERAPEUTIC PROPHYLACTIC/DX NJX INTRA-ARTERIAL","36476 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS",null,"36252 - HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BIL","96567 - PDT XTRNL APPL LIGHT DSTR LES SKN BY ACTIVJ RX",null,"84157 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC","36474 - HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM SBSQ VEINS"]
[null,"37228 - HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI","99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","36475 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN","36475 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN","36475 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN","96112 - HC DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR","36253 - HC SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I",null,null,null,"96567 - PDT XTRNL APPL LIGHT DSTR LES SKN BY ACTIVJ RX","36478 - HC ENDOVENOUS LASER, 1ST VEIN",null,"36253 - HC SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I","97014 - HC APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED",null,"84163 - HC CHG PREGNANCY-ASSOCIATED PLASMA PROTEIN-A","36475 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN"]
[null,"37229 - HC REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL","99456 - WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS","36476 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS","36476 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS","36476 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS","96113 - HC DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN","36254 - HC SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I",null,null,null,"97014 - HC APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED","36479 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS",null,"36254 - HC SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I","97129 - HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES",null,"84165 - HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM","36476 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS"]
[null,"37230 - HC REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN","36478 - HC ENDOVENOUS LASER, 1ST VEIN","36478 - HC ENDOVENOUS LASER, 1ST VEIN","36478 - HC ENDOVENOUS LASER, 1ST VEIN","96116 - NUBHVL STATUS XM PR HR W/PT INTERPJ&PREPJ","36299 - PR CENTRAL VENOGRAPHY",null,null,null,"97129 - HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES","36481 - HC PERC PORTAL VEIN CATH",null,"36299 - PR CENTRAL VENOGRAPHY","97130 - HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTE",null,"84166 - HC CHG PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI","36478 - HC ENDOVENOUS LASER, 1ST VEIN"]
[null,"37231 - HC REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP SM VSL","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","36479 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS","36479 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS","36479 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS","96121 - HC NEUROBEHAVIORAL STATUS XM PHYS/QHP EA ADDL HOUR","36406 - HC VNPNXR <3 YEARS PHYS/QHP SKILL OTHER VEIN",null,null,null,"97130 - HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTE","36482 - HC ENDOVEN ABLTI THER CHEM ADHESIVE 1ST VEIN",null,"36406 - HC VNPNXR <3 YEARS PHYS/QHP SKILL OTHER VEIN","97151 - HC BHV ID ASSMT BY PHYS/QHP",null,"84182 - HC CHG PROTEIN, WESTERN BLOT TEST, W BAND","36479 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS"]
[null,"37232 - HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","36481 - HC PERC PORTAL VEIN CATH","36481 - HC PERC PORTAL VEIN CATH","36481 - HC PERC PORTAL VEIN CATH","96125 - STANDARDIZED COGNITIVE PERFORMANCE TESTING","36410 - VNPNXR 3 YEARS/> PHYS/QHP SKILL",null,null,null,"97151 - HC BHV ID ASSMT BY PHYS/QHP","36483 - HC ENDOVEN ABLTI THER CHEM ADHESIVE SBSQ VEIN",null,"36410 - VNPNXR 3 YEARS/> PHYS/QHP SKILL","97152 - HC BHV ID SUPRT ASSMT BY 1 TECH",null,"84202 - HC Q;ERYTH PROTPOR","36481 - HC PERC PORTAL VEIN CATH"]
[null,"37233 - HC REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA VSL","99497 - HC ADVANCED CARE PLANNING; 1ST HR","36482 - HC ENDOVEN ABLTI THER CHEM ADHESIVE 1ST VEIN","36482 - HC ENDOVEN ABLTI THER CHEM ADHESIVE 1ST VEIN","36482 - HC ENDOVEN ABLTI THER CHEM ADHESIVE 1ST VEIN","96127 - BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT","36415 - COLLECTION VENOUS BLOOD VENIPUNCTURE",null,null,null,"97152 - HC BHV ID SUPRT ASSMT BY 1 TECH","36500 - HC VEN CATHJ SLCTV ORGAN BLD SAMPLING",null,"36415 - COLLECTION VENOUS BLOOD VENIPUNCTURE","97153 - HC ADAPTIVE BEHAVIOR TX BY TECH",null,"84206 - HC CHG ASSAY OF PROINSULIN","36482 - HC ENDOVEN ABLTI THER CHEM ADHESIVE 1ST VEIN"]
[null,"37236 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL","99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","36483 - HC ENDOVEN ABLTI THER CHEM ADHESIVE SBSQ VEIN","36483 - HC ENDOVEN ABLTI THER CHEM ADHESIVE SBSQ VEIN","36483 - HC ENDOVEN ABLTI THER CHEM ADHESIVE SBSQ VEIN","96130 - HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR","36416 - HC COLLECTION CAPILLARY BLOOD SPECIMEN",null,null,null,"97153 - HC ADAPTIVE BEHAVIOR TX BY TECH","36511 - HC THER APHERESIS,WHITE BLOOD CELLS",null,"36416 - HC COLLECTION CAPILLARY BLOOD SPECIMEN","97154 - HC GRP ADAPT BHV TX BY TECH",null,"84207 - HC CHG ASSAY OF PYRIDOXAL PHOSPHATE","36483 - HC ENDOVEN ABLTI THER CHEM ADHESIVE SBSQ VEIN"]
[null,"37237 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL","99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","36500 - HC VEN CATHJ SLCTV ORGAN BLD SAMPLING","36500 - HC VEN CATHJ SLCTV ORGAN BLD SAMPLING","36500 - HC VEN CATHJ SLCTV ORGAN BLD SAMPLING","96131 - HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR","36430 - TRANSFUSION BLOOD/BLOOD COMPONENTS",null,null,null,"97154 - HC GRP ADAPT BHV TX BY TECH","36512 - THERAPEUTIC APHERESIS RED BLOOD CELLS",null,"36430 - TRANSFUSION BLOOD/BLOOD COMPONENTS","97155 - HC ADAPT BEHAVIOR TX PHYS/QHP",null,"84210 - HC CHG ASSAY OF PYRUVATE","36500 - HC VEN CATHJ SLCTV ORGAN BLD SAMPLING"]
[null,"37238 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST","99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","36511 - HC THER APHERESIS,WHITE BLOOD CELLS","36511 - HC THER APHERESIS,WHITE BLOOD CELLS","36511 - HC THER APHERESIS,WHITE BLOOD CELLS","96132 - HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR","36455 - HC EXCHANGE TRANSFUION, OTHR",null,null,null,"97155 - HC ADAPT BEHAVIOR TX PHYS/QHP","36513 - THERAPEUTIC APHERESIS PLATELETS",null,"36455 - HC EXCHANGE TRANSFUION, OTHR","97156 - HC FAM ADAPT BHV TX GDN PHY/QHP",null,"84244 - HC CHG ASSAY OF RENIN","36511 - HC THER APHERESIS,WHITE BLOOD CELLS"]
[null,"37239 - OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","36512 - THERAPEUTIC APHERESIS RED BLOOD CELLS","36512 - THERAPEUTIC APHERESIS RED BLOOD CELLS","36512 - THERAPEUTIC APHERESIS RED BLOOD CELLS","96133 - HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR","36470 - NJX SCLEROSING SOLUTION SINGLE VEIN",null,null,null,"97156 - HC FAM ADAPT BHV TX GDN PHY/QHP","36514 - THERAPEUTIC APHERESIS PLASMA PHERESIS",null,"36470 - NJX SCLEROSING SOLUTION SINGLE VEIN","97157 - HC MULT FAM ADAPT BHV TX GDN",null,"84255 - HC CHG ASSAY OF SELENIUM","36512 - THERAPEUTIC APHERESIS RED BLOOD CELLS"]
[null,"37241 - VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","36513 - THERAPEUTIC APHERESIS PLATELETS","36513 - THERAPEUTIC APHERESIS PLATELETS","36513 - THERAPEUTIC APHERESIS PLATELETS","96136 - HC PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN","36471 - NJX SCLEROSING SOLUTION MULTIPLE VEINS SAME LEG",null,null,null,"97157 - HC MULT FAM ADAPT BHV TX GDN","36522 - PHOTOPHERESIS EXTRACORPOREAL",null,"36471 - NJX SCLEROSING SOLUTION MULTIPLE VEINS SAME LEG","97158 - HC GRP ADAPT BHV TX BY PHY/QHP",null,"84270 - HC CHG ASSAY OF SEX HORMONE BINDING GLOBULIN","36513 - THERAPEUTIC APHERESIS PLATELETS"]
[null,"37242 - VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","36514 - THERAPEUTIC APHERESIS PLASMA PHERESIS","36514 - THERAPEUTIC APHERESIS PLASMA PHERESIS","36514 - THERAPEUTIC APHERESIS PLASMA PHERESIS","96137 - HC PSYCL/NRPSYCL TST PHYS/QHP 2+ TST EA ADDL 30 MIN","36473 - HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM 1ST VEIN",null,null,null,"97158 - HC GRP ADAPT BHV TX BY PHY/QHP","36555 - HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y",null,"36473 - HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM 1ST VEIN","97537 - HC COMMUNITY/WORK REINTEGRATION TRAINJ EA 15 MIN",null,"84295 - HC CHG SODIUM SERUM PLASMA OR WHOLE BLOOD","36514 - THERAPEUTIC APHERESIS PLASMA PHERESIS"]
[null,"37243 - VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","36522 - PHOTOPHERESIS EXTRACORPOREAL","36522 - PHOTOPHERESIS EXTRACORPOREAL","36522 - PHOTOPHERESIS EXTRACORPOREAL","96138 - HC PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN","36474 - HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM SBSQ VEINS",null,null,null,"97537 - HC COMMUNITY/WORK REINTEGRATION TRAINJ EA 15 MIN","36556 - HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/>",null,"36474 - HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM SBSQ VEINS","97755 - HC ASSTV TECHNOL ASSMT DIR CNTCT W/REPRT EA 15 MIN",null,"84300 - HC CHG ASSAY OF URINE SODIUM","36522 - PHOTOPHERESIS EXTRACORPOREAL"]
[null,"37244 - VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA","36555 - HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y","36555 - HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y","36555 - HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y","96139 - HC PSYCL/NRPSYCL TST TECH 2+ TST EA ADDL 30 MIN","36475 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN",null,null,null,"97755 - HC ASSTV TECHNOL ASSMT DIR CNTCT W/REPRT EA 15 MIN","36558 - HC INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>",null,"36475 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN","98960 - HC EDUCATION&TRAINING SELF-MGMT NONPHYS 1 PT",null,"84302 - HC CHG ASSAY OF SODIUM OTHER SOURCE","36555 - HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y"]
[null,"37246 - HC TRLUML BAL ANGIO 1ST ART","G0465 - HC AUTOLOG PRP DIAB WOUND ULCER","36556 - HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/>","36556 - HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/>","36556 - HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/>","96146 - HC PSYCL/NRPSYCL TST ELEC PLATFORM AUTO RESULT","36476 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS",null,null,null,"98960 - HC EDUCATION&TRAINING SELF-MGMT NONPHYS 1 PT","36560 - HC INSJ TUNNELED CTR VAD W/SUBQ PORT UNDER 5 YR",null,"36476 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS","99151 - HC MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS",null,"84305 - HC CHG ASSAY OF SOMATOMEDIN","36556 - HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/>"]
[null,"37247 - HC TRLUML BAL ANGIO ADD ART","G2215 - HC HOME SUPPLY NASAL NALOXONE","36558 - HC INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>","36558 - HC INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>","36558 - HC INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>","96156 - HC HLTH BHV ASSMT/REASSESSMENT","36478 - HC ENDOVENOUS LASER, 1ST VEIN",null,null,null,"99151 - HC MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS","36561 - HC INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>",null,"36478 - HC ENDOVENOUS LASER, 1ST VEIN","99152 - HC MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS",null,"84307 - HC CHG ASSAY OF SOMATOSTATIN","36558 - HC INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>"]
[null,"37248 - HC TRLUML BAL ANGIO 1ST VEIN","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","36560 - HC INSJ TUNNELED CTR VAD W/SUBQ PORT UNDER 5 YR","36560 - HC INSJ TUNNELED CTR VAD W/SUBQ PORT UNDER 5 YR","36560 - HC INSJ TUNNELED CTR VAD W/SUBQ PORT UNDER 5 YR","96158 - HC HLTH BHV IVNTJ INDIV 1ST 30","36479 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS",null,null,null,"99152 - HC MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS","36565 - HC INSJ TUN VAD REQ 2 CATH 2 SITS W/O SUBQ PORT/PMP",null,"36479 - HC ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS","99153 - HC MOD SED SAME PHYS/QHP EACH ADDL 15 MINS",null,"84311 - HC CHG SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED","36560 - HC INSJ TUNNELED CTR VAD W/SUBQ PORT UNDER 5 YR"]
[null,"37249 - HC TRLUML BAL ANGIO ADD VEIN",null,"36561 - HC INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>","36561 - HC INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>","36561 - HC INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>","96159 - HC HLTH BHV IVNTJ INDIV EA ADDL","36481 - HC PERC PORTAL VEIN CATH",null,null,null,"99153 - HC MOD SED SAME PHYS/QHP EACH ADDL 15 MINS","36566 - HC INSJ TUN VAD REQ 2 CATH 2 SITS W/SUBQ PORT",null,"36481 - HC PERC PORTAL VEIN CATH","99155 - HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS",null,"84376 - HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC","36561 - HC INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>"]
[null,"37252 - INTRAVSC US DURNG DX EVAL &/OR THERPUTC INTRVNTN INCL RAD S&I; 1ST NONCRNRY VES",null,"36565 - HC INSJ TUN VAD REQ 2 CATH 2 SITS W/O SUBQ PORT/PMP","36565 - HC INSJ TUN VAD REQ 2 CATH 2 SITS W/O SUBQ PORT/PMP","36565 - HC INSJ TUN VAD REQ 2 CATH 2 SITS W/O SUBQ PORT/PMP","96160 - PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM","36482 - HC ENDOVEN ABLTI THER CHEM ADHESIVE 1ST VEIN",null,null,null,"99155 - HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS","36568 - HC INS PICC;W/O PMP/PRT;<5YR",null,"36482 - HC ENDOVEN ABLTI THER CHEM ADHESIVE 1ST VEIN","99156 - HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS",null,"84402 - HC CHG ASSAY OF TESTOSTERONE FREE","36565 - HC INSJ TUN VAD REQ 2 CATH 2 SITS W/O SUBQ PORT/PMP"]
[null,"37253 - HC INTVASC US NONCORON ADD",null,"36566 - HC INSJ TUN VAD REQ 2 CATH 2 SITS W/SUBQ PORT","36566 - HC INSJ TUN VAD REQ 2 CATH 2 SITS W/SUBQ PORT","36566 - HC INSJ TUN VAD REQ 2 CATH 2 SITS W/SUBQ PORT","96161 - CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM","36483 - HC ENDOVEN ABLTI THER CHEM ADHESIVE SBSQ VEIN",null,null,null,"99156 - HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS","36569 - INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/>",null,"36483 - HC ENDOVEN ABLTI THER CHEM ADHESIVE SBSQ VEIN","99157 - HC MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS",null,"84403 - HC CHG ASSAY OF TESTOSTERONE TOTAL","36566 - HC INSJ TUN VAD REQ 2 CATH 2 SITS W/SUBQ PORT"]
[null,"37609 - HC TEMPORAL ARTERY LIGATN OR BX",null,"36568 - HC INS PICC;W/O PMP/PRT;<5YR","36568 - HC INS PICC;W/O PMP/PRT;<5YR","36568 - HC INS PICC;W/O PMP/PRT;<5YR","96164 - HC HLTH BHV IVNTJ GRP 1ST 30","36500 - HC VEN CATHJ SLCTV ORGAN BLD SAMPLING",null,null,null,"99157 - HC MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS","36570 - HC INSJ PRPH CTR VAD W/SUBQ PORT UNDER 5 YR",null,"36500 - HC VEN CATHJ SLCTV ORGAN BLD SAMPLING","99172 - VISUAL FUNCT SCRNG AUTO SEMI-AUTO BI QUAN DETERM",null,"84425 - HC CHG ASSAY OF THIAMINE-VITAMIN B-1","36568 - HC INS PICC;W/O PMP/PRT;<5YR"]
[null,"37799 - UNLISTED PROCEDURE,VASCULAR SURGERY",null,"36569 - INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/>","36569 - INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/>","36569 - INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/>","96165 - HC HLTH BHV IVNTJ GRP EA ADDL","36511 - HC THER APHERESIS,WHITE BLOOD CELLS",null,null,null,"99172 - VISUAL FUNCT SCRNG AUTO SEMI-AUTO BI QUAN DETERM","36571 - HC INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>",null,"36511 - HC THER APHERESIS,WHITE BLOOD CELLS","99354 - PROLNG SVC OFFICE O/P DIR CONTACT 1ST HR",null,"84430 - HC CHG ASSAY OF THIOCYANATE","36569 - INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/>"]
[null,"38200 - HC INJ PROC SPLENOPORTO",null,"36570 - HC INSJ PRPH CTR VAD W/SUBQ PORT UNDER 5 YR","36570 - HC INSJ PRPH CTR VAD W/SUBQ PORT UNDER 5 YR","36570 - HC INSJ PRPH CTR VAD W/SUBQ PORT UNDER 5 YR","96167 - HC HLTH BHV IVNTJ FAM 1ST 30","36512 - THERAPEUTIC APHERESIS RED BLOOD CELLS",null,null,null,"99354 - PROLNG SVC OFFICE O/P DIR CONTACT 1ST HR","36572 - HC INSJ PICC RS&I <5 YR",null,"36512 - THERAPEUTIC APHERESIS RED BLOOD CELLS","99355 - PROLNG SVC OFFICE O/P DIR CONTACT EA 30 MINUTES",null,"84432 - HC CHG ASSAY OF THYROGLOBULIN","36570 - HC INSJ PRPH CTR VAD W/SUBQ PORT UNDER 5 YR"]
[null,"38220 - MARROW ASPIRATION ONLY",null,"36571 - HC INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>","36571 - HC INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>","36571 - HC INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>","96168 - HC HLTH BHV IVNTJ FAM EA ADDL","36513 - THERAPEUTIC APHERESIS PLATELETS",null,null,null,"99355 - PROLNG SVC OFFICE O/P DIR CONTACT EA 30 MINUTES","36573 - HC INSJ PICC RS&I 5 YR+",null,"36513 - THERAPEUTIC APHERESIS PLATELETS","99358 - HC PROLONGED SERV,NO CONTACT,1ST HR",null,"84436 - HC CHG ASSAY OF THYROXINE TOTAL","36571 - HC INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>"]
[null,"38221 - BONE MARROW BIOPSY NEEDLE/TROCAR",null,"36572 - HC INSJ PICC RS&I <5 YR","36572 - HC INSJ PICC RS&I <5 YR","36572 - HC INSJ PICC RS&I <5 YR","96170 - HC HLTH BHV IVNTJ FAM WO PT 1ST","36514 - THERAPEUTIC APHERESIS PLASMA PHERESIS",null,null,null,"99358 - HC PROLONGED SERV,NO CONTACT,1ST HR","36575 - HC RTUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP",null,"36514 - THERAPEUTIC APHERESIS PLASMA PHERESIS","99359 - PROLONGED SERV,NO CONTCT,EA ADD 30 MIN",null,"84439 - HC CHG ASSAY OF FREE THYROXINE","36572 - HC INSJ PICC RS&I <5 YR"]
[null,"38222 - HC DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS",null,"36573 - HC INSJ PICC RS&I 5 YR+","36573 - HC INSJ PICC RS&I 5 YR+","36573 - HC INSJ PICC RS&I 5 YR+","96171 - HC HLTH BHV IVNTJ FAM W/O PT EA","36522 - PHOTOPHERESIS EXTRACORPOREAL",null,null,null,"99359 - PROLONGED SERV,NO CONTCT,EA ADD 30 MIN","36576 - HC RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT",null,"36522 - PHOTOPHERESIS EXTRACORPOREAL","99366 - HC TEAM CONFERENCE FACE-TO-FACE NONPHYSICIAN",null,"84442 - HC CHG ASSAY OF THYROXINE BNDNG GLOBULIN","36573 - HC INSJ PICC RS&I 5 YR+"]
[null,"38241 - TRNSPLJ AUTOLOGOUS HEMATOPOIETIC CELLS PER DONOR",null,"36575 - HC RTUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP","36575 - HC RTUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP","36575 - HC RTUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP","96376 - HC THERAPEUTIC PROPHYLACTIC/DX NJX INTRA-ARTERIAL","36555 - HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y",null,null,null,"99366 - HC TEAM CONFERENCE FACE-TO-FACE NONPHYSICIAN","36578 - HC RPLCMT CATH CTR VAD SUBQ PORT/PMP",null,"36555 - HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y","99368 - HC TEAM CONFERENCE NON-FACE-TO-FACE NONPHYSICIAN",null,"84443 - HC CHG ASSAY OF THYROID STIMULATING HORMONE TSH","36575 - HC RTUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP"]
[null,"38300 - DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL",null,"36576 - HC RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT","36576 - HC RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT","36576 - HC RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT","96567 - PDT XTRNL APPL LIGHT DSTR LES SKN BY ACTIVJ RX","36556 - HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/>",null,null,null,"99368 - HC TEAM CONFERENCE NON-FACE-TO-FACE NONPHYSICIAN","36580 - HC REPL CVC,NON_TUN;5/+YO",null,"36556 - HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/>","99401 - PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 15 M",null,"84445 - HC CHG THYROID STIMULATING IMMUNE GLOBULINS TSI","36576 - HC RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT"]
[null,"38500 - HC BIOPSY/EXCISION, LYMPH NODE(S)",null,"36578 - HC RPLCMT CATH CTR VAD SUBQ PORT/PMP","36578 - HC RPLCMT CATH CTR VAD SUBQ PORT/PMP","36578 - HC RPLCMT CATH CTR VAD SUBQ PORT/PMP","97014 - HC APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED","36558 - HC INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>",null,null,null,"99401 - PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 15 M","36581 - RPLCMT COMPL TUN CVC W/O SUBQ PORT/PMP",null,"36558 - HC INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>","99402 - PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 30 M",null,"84446 - HC CHG ASSAY OF TOCOPHEROL ALPHA VITAMIN E","36578 - HC RPLCMT CATH CTR VAD SUBQ PORT/PMP"]
[null,"38505 - BX/EXC LYMPH NODE NEEDLE SUPERFICIAL",null,"36580 - HC REPL CVC,NON_TUN;5/+YO","36580 - HC REPL CVC,NON_TUN;5/+YO","36580 - HC REPL CVC,NON_TUN;5/+YO","97129 - HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES","36560 - HC INSJ TUNNELED CTR VAD W/SUBQ PORT UNDER 5 YR",null,null,null,"99402 - PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 30 M","36582 - HC RPLCMT COMPL TUN CTR VAD W/SUBQ PORT",null,"36560 - HC INSJ TUNNELED CTR VAD W/SUBQ PORT UNDER 5 YR","99403 - HC PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 45 MIN",null,"84450 - HC CHG TRANSFERASE ASPARTATE AMINO AST SGOT","36580 - HC REPL CVC,NON_TUN;5/+YO"]
[null,"38510 - HC BX/REMV,LYMPH NODE,DEEP CERV",null,"36581 - RPLCMT COMPL TUN CVC W/O SUBQ PORT/PMP","36581 - RPLCMT COMPL TUN CVC W/O SUBQ PORT/PMP","36581 - RPLCMT COMPL TUN CVC W/O SUBQ PORT/PMP","97130 - HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTE","36561 - HC INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>",null,null,null,"99403 - HC PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 45 MIN","36584 - RPLCMT COMPL PRPH CVC W/O SUBQ PORT/PMP",null,"36561 - HC INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>","99404 - HC PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 60 MIN",null,"84460 - HC CHG TRANSFERASE ALANINE AMINO (ALT) (SGPT)","36581 - RPLCMT COMPL TUN CVC W/O SUBQ PORT/PMP"]
[null,"38531 - HC OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES",null,"36582 - HC RPLCMT COMPL TUN CTR VAD W/SUBQ PORT","36582 - HC RPLCMT COMPL TUN CTR VAD W/SUBQ PORT","36582 - HC RPLCMT COMPL TUN CTR VAD W/SUBQ PORT","97151 - HC BHV ID ASSMT BY PHYS/QHP","36565 - HC INSJ TUN VAD REQ 2 CATH 2 SITS W/O SUBQ PORT/PMP",null,null,null,"99404 - HC PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 60 MIN","36585 - HC RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT",null,"36565 - HC INSJ TUN VAD REQ 2 CATH 2 SITS W/O SUBQ PORT/PMP","99406 - TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES",null,"84466 - HC CHG ASSAY OF L7383TRANSFERRIN","36582 - HC RPLCMT COMPL TUN CTR VAD W/SUBQ PORT"]
[null,"38542 - HC EXPLORE DEEP NODE(S), NECK",null,"36584 - RPLCMT COMPL PRPH CVC W/O SUBQ PORT/PMP","36584 - RPLCMT COMPL PRPH CVC W/O SUBQ PORT/PMP","36584 - RPLCMT COMPL PRPH CVC W/O SUBQ PORT/PMP","97152 - HC BHV ID SUPRT ASSMT BY 1 TECH","36566 - HC INSJ TUN VAD REQ 2 CATH 2 SITS W/SUBQ PORT",null,null,null,"99406 - TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES","36589 - RMVL TUN CVC W/O SUBQ PORT/PMP",null,"36566 - HC INSJ TUN VAD REQ 2 CATH 2 SITS W/SUBQ PORT","99411 - PREV MED COUNSEL & RISK FACTOR REDJ GRP SPX 30 M",null,"84478 - HC CHG ASSAY OF TRIGLYCERIDES","36584 - RPLCMT COMPL PRPH CVC W/O SUBQ PORT/PMP"]
[null,"38550 - HC REMOVAL CYST HYGROMA",null,"36585 - HC RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT","36585 - HC RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT","36585 - HC RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT","97153 - HC ADAPTIVE BEHAVIOR TX BY TECH","36568 - HC INS PICC;W/O PMP/PRT;<5YR",null,null,null,"99411 - PREV MED COUNSEL & RISK FACTOR REDJ GRP SPX 30 M","36590 - HC RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ",null,"36568 - HC INS PICC;W/O PMP/PRT;<5YR","99412 - PREV MED COUNSEL & RISK FACTOR REDJ GRP SPX 60 M",null,"84479 - HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO","36585 - HC RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT"]
[null,"38790 - HC INJECTION PROCEDURE LYMPHANGIOGRAPHY",null,"36589 - RMVL TUN CVC W/O SUBQ PORT/PMP","36589 - RMVL TUN CVC W/O SUBQ PORT/PMP","36589 - RMVL TUN CVC W/O SUBQ PORT/PMP","97154 - HC GRP ADAPT BHV TX BY TECH","36569 - INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/>",null,null,null,"99412 - PREV MED COUNSEL & RISK FACTOR REDJ GRP SPX 60 M","36591 - COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE",null,"36569 - INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/>","99453 - REM MNTR PHYSIOL PARAM SETUP",null,"84480 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3","36589 - RMVL TUN CVC W/O SUBQ PORT/PMP"]
[null,"38792 - HC INJ PROC;SENTINAL NODE ID",null,"36590 - HC RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ","36590 - HC RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ","36590 - HC RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ","97155 - HC ADAPT BEHAVIOR TX PHYS/QHP","36570 - HC INSJ PRPH CTR VAD W/SUBQ PORT UNDER 5 YR",null,null,null,"99453 - REM MNTR PHYSIOL PARAM SETUP","36592 - COLLECT BLOOD FROM CATHETER VENOUS NOS",null,"36570 - HC INSJ PRPH CTR VAD W/SUBQ PORT UNDER 5 YR","99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D",null,"84481 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 FREE","36590 - HC RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ"]
[null,"40500 - HC LIP SHAVE",null,"36591 - COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE","36591 - COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE","36591 - COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE","97156 - HC FAM ADAPT BHV TX GDN PHY/QHP","36571 - HC INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>",null,null,null,"99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","36593 - DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH",null,"36571 - HC INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>","99456 - WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS",null,"84482 - HC CHG TRIIODOTHYRONINE T3 REVERSE","36591 - COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE"]
[null,"40510 - EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR",null,"36592 - COLLECT BLOOD FROM CATHETER VENOUS NOS","36592 - COLLECT BLOOD FROM CATHETER VENOUS NOS","36592 - COLLECT BLOOD FROM CATHETER VENOUS NOS","97157 - HC MULT FAM ADAPT BHV TX GDN","36572 - HC INSJ PICC RS&I <5 YR",null,null,null,"99456 - WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS","36595 - HC MECH REMOV PERICATH OBSTR CV DEV VIA VEN ACCESS",null,"36572 - HC INSJ PICC RS&I <5 YR","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",null,"84484 - HC CHG ASSAY OF TROPONIN QUANTITATIVE","36592 - COLLECT BLOOD FROM CATHETER VENOUS NOS"]
[null,"40520 - HC PARTIAL EXCISION OF LIP",null,"36593 - DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH","36593 - DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH","36593 - DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH","97158 - HC GRP ADAPT BHV TX BY PHY/QHP","36573 - HC INSJ PICC RS&I 5 YR+",null,null,null,"99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN","36596 - HC MCHNL RMVL INTRAL OBSTR CV DEV THRU DEV LUMEN",null,"36573 - HC INSJ PICC RS&I 5 YR+","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",null,"84520 - HC CHG ASSAY OF UREA NITROGEN QUANTITATIVE","36593 - DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH"]
[null,"40525 - HC FULL THICK EXCIS LIP,RECON W FLAP",null,"36595 - HC MECH REMOV PERICATH OBSTR CV DEV VIA VEN ACCESS","36595 - HC MECH REMOV PERICATH OBSTR CV DEV VIA VEN ACCESS","36595 - HC MECH REMOV PERICATH OBSTR CV DEV VIA VEN ACCESS","97537 - HC COMMUNITY/WORK REINTEGRATION TRAINJ EA 15 MIN","36575 - HC RTUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP",null,null,null,"99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","36598 - HC CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT",null,"36575 - HC RTUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",null,"84540 - HC CHG ASSAY OF UREA NITROGEN URINE","36595 - HC MECH REMOV PERICATH OBSTR CV DEV VIA VEN ACCESS"]
[null,"40530 - HC PARTIAL REMOVAL OF LIP,>1/4",null,"36596 - HC MCHNL RMVL INTRAL OBSTR CV DEV THRU DEV LUMEN","36596 - HC MCHNL RMVL INTRAL OBSTR CV DEV THRU DEV LUMEN","36596 - HC MCHNL RMVL INTRAL OBSTR CV DEV THRU DEV LUMEN","97755 - HC ASSTV TECHNOL ASSMT DIR CNTCT W/REPRT EA 15 MIN","36576 - HC RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT",null,null,null,"99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","36600 - ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX",null,"36576 - HC RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT","99497 - HC ADVANCED CARE PLANNING; 1ST HR",null,"84550 - HC CHG ASSAY OF BLOOD/URIC ACID","36596 - HC MCHNL RMVL INTRAL OBSTR CV DEV THRU DEV LUMEN"]
[null,"40650 - HC REPAIR LIP,FULL THICK,VERMILION",null,"36598 - HC CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT","36598 - HC CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT","36598 - HC CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT","98960 - HC EDUCATION&TRAINING SELF-MGMT NONPHYS 1 PT","36578 - HC RPLCMT CATH CTR VAD SUBQ PORT/PMP",null,null,null,"99497 - HC ADVANCED CARE PLANNING; 1ST HR","36620 - HC INSERT CATH,ART,PERCUT,SHORTTERM",null,"36578 - HC RPLCMT CATH CTR VAD SUBQ PORT/PMP","99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM",null,"84560 - HC CHG ASSAY OF URIC ACID OTHER SOURCE","36598 - HC CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT"]
[null,"40652 - HC REPAIR LIP,<1/2 VERT HEIGHT",null,"36600 - ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX","36600 - ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX","36600 - ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX","99151 - HC MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS","36580 - HC REPL CVC,NON_TUN;5/+YO",null,null,null,"99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","36680 - HC PLACEMENT NEEDLE INTRAOSSEOUS INFUSION",null,"36580 - HC REPL CVC,NON_TUN;5/+YO","99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM",null,"84590 - HC CHG ASSAY OF VITAMIN A","36600 - ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX"]
[null,"40654 - HC REPAIR LIP,>1/2 VERT HEIGHT",null,"36620 - HC INSERT CATH,ART,PERCUT,SHORTTERM","36620 - HC INSERT CATH,ART,PERCUT,SHORTTERM","36620 - HC INSERT CATH,ART,PERCUT,SHORTTERM","99152 - HC MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS","36581 - RPLCMT COMPL TUN CVC W/O SUBQ PORT/PMP",null,null,null,"99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","36901 - HC INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR S&I",null,"36581 - RPLCMT COMPL TUN CVC W/O SUBQ PORT/PMP","99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM",null,"84591 - HC CHG ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED","36620 - HC INSERT CATH,ART,PERCUT,SHORTTERM"]
[null,"40801 - DRG ABSC CST HMTMA VESTIBULE MOUTH COMP",null,"36680 - HC PLACEMENT NEEDLE INTRAOSSEOUS INFUSION","36680 - HC PLACEMENT NEEDLE INTRAOSSEOUS INFUSION","36680 - HC PLACEMENT NEEDLE INTRAOSSEOUS INFUSION","99153 - HC MOD SED SAME PHYS/QHP EACH ADDL 15 MINS","36582 - HC RPLCMT COMPL TUN CTR VAD W/SUBQ PORT",null,null,null,"99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","36902 - HC INTRO CATH DIALYSIS CIRCUIT W/TRLUML BALO ANGIOP",null,"36582 - HC RPLCMT COMPL TUN CTR VAD W/SUBQ PORT","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",null,"84597 - HC CHG ASSAY OF VITAMIN K","36680 - HC PLACEMENT NEEDLE INTRAOSSEOUS INFUSION"]
[null,"40805 - HC REMOVAL FOREIGN BODY,MOUTH,COMPLEX",null,"36901 - HC INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR S&I","36901 - HC INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR S&I","36901 - HC INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR S&I","99155 - HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS","36584 - RPLCMT COMPL PRPH CVC W/O SUBQ PORT/PMP",null,null,null,"0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","36903 - HC INTRO CATH DIALYSIS CIRCUIT W/TCAT PLMT IV STENT",null,"36584 - RPLCMT COMPL PRPH CVC W/O SUBQ PORT/PMP","0241U - HC NFCT DS VIR RESP RNA 4 TRGT",null,"84630 - HC CHG ASSAY OF ZINC","36901 - HC INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR S&I"]
[null,"40806 - INCISION OF LIP FOLD",null,"36902 - HC INTRO CATH DIALYSIS CIRCUIT W/TRLUML BALO ANGIOP","36902 - HC INTRO CATH DIALYSIS CIRCUIT W/TRLUML BALO ANGIOP","36902 - HC INTRO CATH DIALYSIS CIRCUIT W/TRLUML BALO ANGIOP","99156 - HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS","36585 - HC RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT",null,null,null,"0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","36904 - HC PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH",null,"36585 - HC RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",null,"84681 - HC CHG ASSAY OF C-PEPTIDE","36902 - HC INTRO CATH DIALYSIS CIRCUIT W/TRLUML BALO ANGIOP"]
[null,"40808 - BIOPSY VESTIBULE MOUTH",null,"36903 - HC INTRO CATH DIALYSIS CIRCUIT W/TCAT PLMT IV STENT","36903 - HC INTRO CATH DIALYSIS CIRCUIT W/TCAT PLMT IV STENT","36903 - HC INTRO CATH DIALYSIS CIRCUIT W/TCAT PLMT IV STENT","99157 - HC MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS","36589 - RMVL TUN CVC W/O SUBQ PORT/PMP",null,null,null,"0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","36905 - HC PERQ THRMBC/NFS DIAL CIRCUIT TRLUML BALO ANGIOP",null,"36589 - RMVL TUN CVC W/O SUBQ PORT/PMP","G0465 - HC AUTOLOG PRP DIAB WOUND ULCER",null,"84702 - HC HCG TUMOR MARKER","36903 - HC INTRO CATH DIALYSIS CIRCUIT W/TCAT PLMT IV STENT"]
[null,"40810 - EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR",null,"36904 - HC PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH","36904 - HC PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH","36904 - HC PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH","99172 - VISUAL FUNCT SCRNG AUTO SEMI-AUTO BI QUAN DETERM","36590 - HC RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ",null,null,null,"0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","36906 - HC PERQ THRMBC/NFS DIAL CIRCUIT TCAT PLMT IV STENT",null,"36590 - HC RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ","G2215 - HC HOME SUPPLY NASAL NALOXONE",null,"84703 - HC GONAD,CHOR(HCG);QL","36904 - HC PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH"]
[null,"40812 - EXC LES MUCOSA & SBMCSL VESTIBULE SMPL RPR",null,"36905 - HC PERQ THRMBC/NFS DIAL CIRCUIT TRLUML BALO ANGIOP","36905 - HC PERQ THRMBC/NFS DIAL CIRCUIT TRLUML BALO ANGIOP","36905 - HC PERQ THRMBC/NFS DIAL CIRCUIT TRLUML BALO ANGIOP","99354 - PROLNG SVC OFFICE O/P DIR CONTACT 1ST HR","36591 - COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE",null,null,null,"0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","36907 - HC TRLUML BAL ANGIO CTR DIAL",null,"36591 - COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",null,"85004 - HC AUTO DIFF","36905 - HC PERQ THRMBC/NFS DIAL CIRCUIT TRLUML BALO ANGIOP"]
[null,"40814 - HC EXCIS MOUTH MUCOSA/SUB,COMPLX REPR",null,"36906 - HC PERQ THRMBC/NFS DIAL CIRCUIT TCAT PLMT IV STENT","36906 - HC PERQ THRMBC/NFS DIAL CIRCUIT TCAT PLMT IV STENT","36906 - HC PERQ THRMBC/NFS DIAL CIRCUIT TCAT PLMT IV STENT","99355 - PROLNG SVC OFFICE O/P DIR CONTACT EA 30 MINUTES","36592 - COLLECT BLOOD FROM CATHETER VENOUS NOS",null,null,null,"0241U - HC NFCT DS VIR RESP RNA 4 TRGT","36908 - HC STENT PLMT CENTRAL DIAYLSIS SEG PFRMD DIAL CIR",null,"36592 - COLLECT BLOOD FROM CATHETER VENOUS NOS",null,null,"85014 - HC CHG BLOOD COUNT HEMATOCRIT","36906 - HC PERQ THRMBC/NFS DIAL CIRCUIT TCAT PLMT IV STENT"]
[null,"40816 - EXC LES MUCOSA&SBMCSL VESTIBULE CPLX EXC MUSC",null,"36907 - HC TRLUML BAL ANGIO CTR DIAL","36907 - HC TRLUML BAL ANGIO CTR DIAL","36907 - HC TRLUML BAL ANGIO CTR DIAL","99358 - HC PROLONGED SERV,NO CONTACT,1ST HR","36593 - DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH",null,null,null,"G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA","37183 - HC REVJ TRANSVNS INTRAHEPATIC PORTOSYSTEMIC SHUNT",null,"36593 - DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH",null,null,"85018 - POC;HEMOGLOBIN","36907 - HC TRLUML BAL ANGIO CTR DIAL"]
[null,"40819 - EXC FRENUM LABIAL/BUCCAL",null,"36908 - HC STENT PLMT CENTRAL DIAYLSIS SEG PFRMD DIAL CIR","36908 - HC STENT PLMT CENTRAL DIAYLSIS SEG PFRMD DIAL CIR","36908 - HC STENT PLMT CENTRAL DIAYLSIS SEG PFRMD DIAL CIR","99359 - PROLONGED SERV,NO CONTCT,EA ADD 30 MIN","36595 - HC MECH REMOV PERICATH OBSTR CV DEV VIA VEN ACCESS",null,null,null,"G0465 - HC AUTOLOG PRP DIAB WOUND ULCER","37184 - HC PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST",null,"36595 - HC MECH REMOV PERICATH OBSTR CV DEV VIA VEN ACCESS",null,null,"85025 - HC CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC","36908 - HC STENT PLMT CENTRAL DIAYLSIS SEG PFRMD DIAL CIR"]
[null,"40820 - HC DESTRUC MOUTH LESION/SCAR",null,"37182 - HC INSJ TRANSVNS INTRAHEPATC PORTOSYSIC SHUNT","37182 - HC INSJ TRANSVNS INTRAHEPATC PORTOSYSIC SHUNT","37182 - HC INSJ TRANSVNS INTRAHEPATC PORTOSYSIC SHUNT","99366 - HC TEAM CONFERENCE FACE-TO-FACE NONPHYSICIAN","36596 - HC MCHNL RMVL INTRAL OBSTR CV DEV THRU DEV LUMEN",null,null,null,"G2215 - HC HOME SUPPLY NASAL NALOXONE","37185 - PRIM PRQ TRLUML MCHNL THRMBC SBSQ VSL",null,"36596 - HC MCHNL RMVL INTRAL OBSTR CV DEV THRU DEV LUMEN",null,null,"85027 - HC CHG BLOOD COUNT COMPLETE AUTOMATED","37183 - HC REVJ TRANSVNS INTRAHEPATIC PORTOSYSTEMIC SHUNT"]
[null,"40831 - HC REPAIR MOUTH LACERATION,>2.5 CM",null,"37183 - HC REVJ TRANSVNS INTRAHEPATIC PORTOSYSTEMIC SHUNT","37183 - HC REVJ TRANSVNS INTRAHEPATIC PORTOSYSTEMIC SHUNT","37183 - HC REVJ TRANSVNS INTRAHEPATIC PORTOSYSTEMIC SHUNT","99368 - HC TEAM CONFERENCE NON-FACE-TO-FACE NONPHYSICIAN","36598 - HC CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT",null,null,null,"U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","37186 - HC SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL",null,"36598 - HC CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT",null,null,"85045 - HC CHG BLOOD COUNT RETICULOCYTE AUTOMATED","37184 - HC PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST"]
[null,"40840 - HC RECONSTRUC MOUTH ANTERIOR",null,"37184 - HC PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST","37184 - HC PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST","37184 - HC PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST","99401 - PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 15 M","36600 - ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX",null,null,null,null,"37187 - PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN",null,"36600 - ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX",null,null,"85046 - HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS","37185 - PRIM PRQ TRLUML MCHNL THRMBC SBSQ VSL"]
[null,"40842 - HC RECONSTRUC MOUTH POSTER,UNILAT",null,"37185 - PRIM PRQ TRLUML MCHNL THRMBC SBSQ VSL","37185 - PRIM PRQ TRLUML MCHNL THRMBC SBSQ VSL","37185 - PRIM PRQ TRLUML MCHNL THRMBC SBSQ VSL","99402 - PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 30 M","36620 - HC INSERT CATH,ART,PERCUT,SHORTTERM",null,null,null,null,"37188 - PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX",null,"36620 - HC INSERT CATH,ART,PERCUT,SHORTTERM",null,null,"85048 - HC CHG BLOOD COUNT LEUKOCYTE WBC AUTOMATED","37186 - HC SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL"]
[null,"40845 - HC RECONSTRUC MOUTH COMPLEX",null,"37186 - HC SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL","37186 - HC SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL","37186 - HC SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL","99403 - HC PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 45 MIN","36680 - HC PLACEMENT NEEDLE INTRAOSSEOUS INFUSION",null,null,null,null,"37191 - HC INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I",null,"36680 - HC PLACEMENT NEEDLE INTRAOSSEOUS INFUSION",null,null,"85049 - HC CHG BLOOD COUNT PLATELET AUTOMATED","37187 - PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN"]
[null,"41006 - HC INTRAORAL I&D TONGUE/FLOOR SUBLNGL DP SPRMLHYD",null,"37187 - PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN","37187 - PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN","37187 - PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN","99404 - HC PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 60 MIN","36901 - HC INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR S&I",null,null,null,null,"37192 - HC REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I",null,"36901 - HC INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR S&I",null,null,"85055 - HC CHG RETICULATED PLATELET ASSAY","37188 - PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX"]
[null,"41007 - HC I&D MOUTH/TONG INTRA,SUBMENTAL",null,"37188 - PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX","37188 - PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX","37188 - PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX","99406 - TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES","36902 - HC INTRO CATH DIALYSIS CIRCUIT W/TRLUML BALO ANGIOP",null,null,null,null,"37193 - HC RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I",null,"36902 - HC INTRO CATH DIALYSIS CIRCUIT W/TRLUML BALO ANGIOP",null,null,"85210 - HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC","37191 - HC INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I"]
[null,"41008 - HC I&D MOUTH/TONG INTRA,SUBMANDIBULAR",null,"37191 - HC INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I","37191 - HC INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I","37191 - HC INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I","99411 - PREV MED COUNSEL & RISK FACTOR REDJ GRP SPX 30 M","36903 - HC INTRO CATH DIALYSIS CIRCUIT W/TCAT PLMT IV STENT",null,null,null,null,"37195 - HC THROMBOLYTIC THERAPY, STROKE",null,"36903 - HC INTRO CATH DIALYSIS CIRCUIT W/TCAT PLMT IV STENT",null,null,"85220 - HC CHG CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR","37192 - HC REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I"]
[null,"41009 - HC I&D MOUTH/TONG INTRA, MASTICATOR",null,"37192 - HC REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I","37192 - HC REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I","37192 - HC REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I","99412 - PREV MED COUNSEL & RISK FACTOR REDJ GRP SPX 60 M","36904 - HC PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH",null,null,null,null,"37197 - HC PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING",null,"36904 - HC PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH",null,null,"85230 - HC CHG CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR","37193 - HC RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I"]
[null,"41010 - INCISION LINGUAL FRENUM FRENOTOMY",null,"37193 - HC RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I","37193 - HC RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I","37193 - HC RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I","99453 - REM MNTR PHYSIOL PARAM SETUP","36905 - HC PERQ THRMBC/NFS DIAL CIRCUIT TRLUML BALO ANGIOP",null,null,null,null,"37200 - HC TRANSCATHETER BIOPSY",null,"36905 - HC PERQ THRMBC/NFS DIAL CIRCUIT TRLUML BALO ANGIOP",null,null,"85240 - HC CHG CLOTTING FACTOR VIII AHG 1 STAGE","37195 - HC THROMBOLYTIC THERAPY, STROKE"]
[null,"41016 - HC MOUTH/TONG EXTRA,SUBMENTAL",null,"37195 - HC THROMBOLYTIC THERAPY, STROKE","37195 - HC THROMBOLYTIC THERAPY, STROKE","37195 - HC THROMBOLYTIC THERAPY, STROKE","99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","36906 - HC PERQ THRMBC/NFS DIAL CIRCUIT TCAT PLMT IV STENT",null,null,null,null,"37211 - HC THROMBOLYSIS ARTERIAL INFUSION ICRA RS&I INIT TX",null,"36906 - HC PERQ THRMBC/NFS DIAL CIRCUIT TCAT PLMT IV STENT",null,null,"85245 - HC CHG CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT","37197 - HC PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING"]
[null,"41017 - HC XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB",null,"37197 - HC PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING","37197 - HC PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING","37197 - HC PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING","99456 - WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS","36907 - HC TRLUML BAL ANGIO CTR DIAL",null,null,null,null,"37212 - HC THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX",null,"36907 - HC TRLUML BAL ANGIO CTR DIAL",null,null,"85246 - HC CHG CLOTTING FACTOR VIII VW FACTOR ANTIGEN","37200 - HC TRANSCATHETER BIOPSY"]
[null,"41018 - HC I&D MOUTH/TONG EXTRA,MASTICATOR",null,"37200 - HC TRANSCATHETER BIOPSY","37200 - HC TRANSCATHETER BIOPSY","37200 - HC TRANSCATHETER BIOPSY","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN","36908 - HC STENT PLMT CENTRAL DIAYLSIS SEG PFRMD DIAL CIR",null,null,null,null,"37213 - HC THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX",null,"36908 - HC STENT PLMT CENTRAL DIAYLSIS SEG PFRMD DIAL CIR",null,null,"85250 - HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS","37211 - HC THROMBOLYSIS ARTERIAL INFUSION ICRA RS&I INIT TX"]
[null,"41100 - BIOPSY TONGUE ANTERIOR TWO-THIRDS",null,"37211 - HC THROMBOLYSIS ARTERIAL INFUSION ICRA RS&I INIT TX","37211 - HC THROMBOLYSIS ARTERIAL INFUSION ICRA RS&I INIT TX","37211 - HC THROMBOLYSIS ARTERIAL INFUSION ICRA RS&I INIT TX","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","37182 - HC INSJ TRANSVNS INTRAHEPATC PORTOSYSIC SHUNT",null,null,null,null,"37214 - HC CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL",null,"37182 - HC INSJ TRANSVNS INTRAHEPATC PORTOSYSIC SHUNT",null,null,"85260 - HC CHG CLOTTING FACTOR X STUART-PROWER","37212 - HC THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX"]
[null,"41105 - HC BIOPSY TONGUE,POSTER 1/3",null,"37212 - HC THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX","37212 - HC THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX","37212 - HC THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","37183 - HC REVJ TRANSVNS INTRAHEPATIC PORTOSYSTEMIC SHUNT",null,null,null,null,"37220 - HC REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL",null,"37183 - HC REVJ TRANSVNS INTRAHEPATIC PORTOSYSTEMIC SHUNT",null,null,"85270 - HC CHG CLOTTING FACTOR XI PTA","37213 - HC THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX"]
[null,"41108 - BIOPSY FLOOR MOUTH",null,"37213 - HC THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX","37213 - HC THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX","37213 - HC THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX","99497 - HC ADVANCED CARE PLANNING; 1ST HR","37184 - HC PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST",null,null,null,null,"37221 - HC REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOPLSTY",null,"37184 - HC PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST",null,null,"85280 - HC CHG CLOTTING FACTOR XII HAGEMAN","37214 - HC CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL"]
[null,"41110 - EXCISION LESION TONGUE W/O CLOSURE",null,"37214 - HC CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL","37214 - HC CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL","37214 - HC CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL","99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM","37185 - PRIM PRQ TRLUML MCHNL THRMBC SBSQ VSL",null,null,null,null,"37222 - HC REVASC;ILIAC,EAAD,TRN ANG",null,"37185 - PRIM PRQ TRLUML MCHNL THRMBC SBSQ VSL",null,null,"85290 - HC CHG CLOTTING FACTOR XIII FIBRIN STABILIZING","37220 - HC REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL"]
[null,"41112 - EXC LES TONGUE W/CLSR ANTERIOR TWO-THIRDS",null,"37215 - HC TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ","37215 - HC TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ","37215 - HC TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ","99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM","37186 - HC SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL",null,null,null,null,"37223 - HC REVASC;ILIAC,EAAD,TRN STN",null,"37186 - HC SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL",null,null,"85300 - HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY","37221 - HC REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOPLSTY"]
[null,"41113 - HC EXCIS TONGUE LESN,POST 1/3",null,"37216 - HC TCAT IV STENT CRV CRTD ART W/O EMBOLIC PROTECJ [37216]","37216 - HC TCAT IV STENT CRV CRTD ART W/O EMBOLIC PROTECJ [37216]","37216 - HC TCAT IV STENT CRV CRTD ART W/O EMBOLIC PROTECJ [37216]","99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM","37187 - PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN",null,null,null,null,"37224 - HC REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI",null,"37187 - PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN",null,null,"85301 - HC CHG CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY","37222 - HC REVASC;ILIAC,EAAD,TRN ANG"]
[null,"41115 - EXCIISION LINGUAL FRENUM FRENECTOMY",null,"37220 - HC REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL","37220 - HC REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL","37220 - HC REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","37188 - PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX",null,null,null,null,"37225 - HC REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL",null,"37188 - PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX",null,null,"85302 - HC CHG CLOTTING INHIBITORS PROTEIN C ANTIGEN","37223 - HC REVASC;ILIAC,EAAD,TRN STN"]
[null,"41116 - EXCISION LESION FLOOR MOUTH",null,"37221 - HC REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOPLSTY","37221 - HC REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOPLSTY","37221 - HC REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOPLSTY","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","37191 - HC INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I",null,null,null,null,"37226 - HC REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL",null,"37191 - HC INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I",null,null,"85303 - HC CHG CLOTTING INHIBITORS PROTEIN C ACTIVITY","37224 - HC REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI"]
[null,"41120 - HC PART REMOVAL TONGUE,<1/2",null,"37222 - HC REVASC;ILIAC,EAAD,TRN ANG","37222 - HC REVASC;ILIAC,EAAD,TRN ANG","37222 - HC REVASC;ILIAC,EAAD,TRN ANG","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","37192 - HC REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I",null,null,null,null,"37227 - HC REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL",null,"37192 - HC REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I",null,null,"85305 - HC CHG CLOTTING INHIBITORS PROTEIN S TOTAL","37225 - HC REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL"]
[null,"41250 - HC RLAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG",null,"37223 - HC REVASC;ILIAC,EAAD,TRN STN","37223 - HC REVASC;ILIAC,EAAD,TRN STN","37223 - HC REVASC;ILIAC,EAAD,TRN STN","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","37193 - HC RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I",null,null,null,null,"37228 - HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI",null,"37193 - HC RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I",null,null,"85306 - HC CHG CLOTTING INHIBITORS PROTEIN S FREE","37226 - HC REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL"]
[null,"41251 - HC REPAIR TONGUE LACER,POST 1/3",null,"37224 - HC REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI","37224 - HC REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI","37224 - HC REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI","0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","37195 - HC THROMBOLYTIC THERAPY, STROKE",null,null,null,null,"37229 - HC REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL",null,"37195 - HC THROMBOLYTIC THERAPY, STROKE",null,null,"85307 - HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY","37227 - HC REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL"]
[null,"41252 - HC REPAIR TONGUE LACER,2.6 CM+/COMPLX",null,"37225 - HC REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL","37225 - HC REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL","37225 - HC REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL","0241U - HC NFCT DS VIR RESP RNA 4 TRGT","37197 - HC PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING",null,null,null,null,"37230 - HC REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL",null,"37197 - HC PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING",null,null,"85347 - HC CHG COAGULATION TIME ACTIVATED","37228 - HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI"]
[null,"41800 - HC DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS",null,"37226 - HC REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL","37226 - HC REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL","37226 - HC REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL","G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA","37200 - HC TRANSCATHETER BIOPSY",null,null,null,null,"37231 - HC REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP SM VSL",null,"37200 - HC TRANSCATHETER BIOPSY",null,null,"85366 - HC CHG FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ","37229 - HC REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL"]
[null,"41820 - HC EXCISION, GUM, EACH QUADRANT",null,"37227 - HC REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL","37227 - HC REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL","37227 - HC REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL","G0465 - HC AUTOLOG PRP DIAB WOUND ULCER","37211 - HC THROMBOLYSIS ARTERIAL INFUSION ICRA RS&I INIT TX",null,null,null,null,"37232 - HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL",null,"37211 - HC THROMBOLYSIS ARTERIAL INFUSION ICRA RS&I INIT TX",null,null,"85378 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN","37230 - HC REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL"]
[null,"41821 - HC EXCISION OF GUM FLAP",null,"37228 - HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI","37228 - HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI","37228 - HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI","G2215 - HC HOME SUPPLY NASAL NALOXONE","37212 - HC THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX",null,null,null,null,"37233 - HC REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA VSL",null,"37212 - HC THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX",null,null,"85379 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE","37231 - HC REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP SM VSL"]
[null,"41822 - EXCIS FIBROUS TUBER,DENTOALV",null,"37229 - HC REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL","37229 - HC REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL","37229 - HC REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","37213 - HC THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX",null,null,null,null,"37236 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL",null,"37213 - HC THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX",null,null,"85384 - HC CHG FIBRINOGEN ACTIVITY","37232 - HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL"]
[null,"41823 - HC EXCIS OSSEOUS TUBER,DENTOALV",null,"37230 - HC REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL","37230 - HC REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL","37230 - HC REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL",null,"37214 - HC CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL",null,null,null,null,"37237 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL",null,"37214 - HC CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL",null,null,"85397 - HC CHG CLOTTING FUNCTION ACTIVITY NOS, EA ANALYT","37233 - HC REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA VSL"]
[null,"41825 - EXCISION OF GUM LESION",null,"37231 - HC REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP SM VSL","37231 - HC REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP SM VSL","37231 - HC REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP SM VSL",null,"37215 - HC TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ",null,null,null,null,"37238 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST",null,"37215 - HC TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ",null,null,"85461 - HC CHG HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE","37236 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL"]
[null,"41826 - HC EXCIS DENTOALV LESN,SIMPL REPR",null,"37232 - HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL","37232 - HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL","37232 - HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL",null,"37216 - HC TCAT IV STENT CRV CRTD ART W/O EMBOLIC PROTECJ [37216]",null,null,null,null,"37239 - OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL",null,"37216 - HC TCAT IV STENT CRV CRTD ART W/O EMBOLIC PROTECJ [37216]",null,null,"85520 - HC CHG HEPARIN ASSAY","37237 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL"]
[null,"41830 - HC REMOVAL OF GUM TISSUE",null,"37233 - HC REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA VSL","37233 - HC REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA VSL","37233 - HC REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA VSL",null,"37220 - HC REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL",null,null,null,null,"37241 - VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I",null,"37220 - HC REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL",null,null,"85549 - HC CHG MURAMIDASE","37238 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST"]
[null,"41850 - TREATMENT OF GUM LESION",null,"37236 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL","37236 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL","37236 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL",null,"37221 - HC REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOPLSTY",null,null,null,null,"37242 - VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I",null,"37221 - HC REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOPLSTY",null,null,"85576 - HC CHG PLATELET AGGREGATION IN VITRO EACH AGENT","37239 - OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL"]
[null,"41874 - HC REPAIR TOOTH SOCKET",null,"37237 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL","37237 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL","37237 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL",null,"37222 - HC REVASC;ILIAC,EAAD,TRN ANG",null,null,null,null,"37243 - VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT",null,"37222 - HC REVASC;ILIAC,EAAD,TRN ANG",null,null,"85610 - POC;INR","37241 - VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I"]
[null,"41899 - HC SUR REM TOOTH&BONE",null,"37238 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST","37238 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST","37238 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST",null,"37223 - HC REVASC;ILIAC,EAAD,TRN STN",null,null,null,null,"37244 - VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE",null,"37223 - HC REVASC;ILIAC,EAAD,TRN STN",null,null,"85611 - HC CHG PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH","37242 - VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I"]
[null,"42000 - HC DRAINAGE ABSCESS PALATE UVULA",null,"37239 - OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL","37239 - OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL","37239 - OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL",null,"37224 - HC REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI",null,null,null,null,"37246 - HC TRLUML BAL ANGIO 1ST ART",null,"37224 - HC REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI",null,null,"85613 - HC CHG RUSSELL VIPER VENOM DILUTED","37243 - VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT"]
[null,"42100 - BIOPSY PALATE UVULA",null,"37241 - VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I","37241 - VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I","37241 - VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I",null,"37225 - HC REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL",null,null,null,null,"37247 - HC TRLUML BAL ANGIO ADD ART",null,"37225 - HC REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL",null,null,"85651 - SEDIMENTATION RATE RBC NON-AUTOMATED","37244 - VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE"]
[null,"42104 - EXC LESION PALATE UVULA W/O CLOSURE",null,"37242 - VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I","37242 - VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I","37242 - VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I",null,"37226 - HC REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL",null,null,null,null,"37248 - HC TRLUML BAL ANGIO 1ST VEIN",null,"37226 - HC REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL",null,null,"85652 - HC CHG SEDIMENTATION RATE RBC AUTOMATED","37246 - HC TRLUML BAL ANGIO 1ST ART"]
[null,"42106 - EXC LESION PALATE UVULA W/SMPL PRIM CLOSURE",null,"37243 - VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT","37243 - VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT","37243 - VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT",null,"37227 - HC REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL",null,null,null,null,"37249 - HC TRLUML BAL ANGIO ADD VEIN",null,"37227 - HC REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL",null,null,"85660 - HC CHG SICKLING RBC REDUCTION","37247 - HC TRLUML BAL ANGIO ADD ART"]
[null,"42120 - HC RESCJ PALATE/EXTENSIVE RESCJ LESION",null,"37244 - VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE","37244 - VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE","37244 - VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE",null,"37228 - HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI",null,null,null,null,"37252 - INTRAVSC US DURNG DX EVAL &/OR THERPUTC INTRVNTN INCL RAD S&I; 1ST NONCRNRY VES",null,"37228 - HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI",null,null,"85670 - HC CHG THROMBIN TIME PLASMA","37248 - HC TRLUML BAL ANGIO 1ST VEIN"]
[null,"42140 - HC UVULECTOMY EXCISION UVULA",null,"37246 - HC TRLUML BAL ANGIO 1ST ART","37246 - HC TRLUML BAL ANGIO 1ST ART","37246 - HC TRLUML BAL ANGIO 1ST ART",null,"37229 - HC REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL",null,null,null,null,"37253 - HC INTVASC US NONCORON ADD",null,"37229 - HC REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL",null,null,"85705 - HC CHG THROMBOPLASTIN INHIBITION TISSUE","37249 - HC TRLUML BAL ANGIO ADD VEIN"]
[null,"42160 - HC DESTRUC LESN PALATE/UVULVA",null,"37247 - HC TRLUML BAL ANGIO ADD ART","37247 - HC TRLUML BAL ANGIO ADD ART","37247 - HC TRLUML BAL ANGIO ADD ART",null,"37230 - HC REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL",null,null,null,null,"37609 - HC TEMPORAL ARTERY LIGATN OR BX",null,"37230 - HC REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL",null,null,"85730 - HC CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD","37252 - INTRAVSC US DURNG DX EVAL &/OR THERPUTC INTRVNTN INCL RAD S&I; 1ST NONCRNRY VES"]
[null,"42180 - HC REPAIR PALATE LACER <2 CM",null,"37248 - HC TRLUML BAL ANGIO 1ST VEIN","37248 - HC TRLUML BAL ANGIO 1ST VEIN","37248 - HC TRLUML BAL ANGIO 1ST VEIN",null,"37231 - HC REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP SM VSL",null,null,null,null,"38200 - HC INJ PROC SPLENOPORTO",null,"37231 - HC REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP SM VSL",null,null,"85732 - HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA","37253 - HC INTVASC US NONCORON ADD"]
[null,"42210 - HC RECONST CLEFT PALATE,BONE GRFT",null,"37249 - HC TRLUML BAL ANGIO ADD VEIN","37249 - HC TRLUML BAL ANGIO ADD VEIN","37249 - HC TRLUML BAL ANGIO ADD VEIN",null,"37232 - HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL",null,null,null,null,"38206 - HC BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ AUTOL",null,"37232 - HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL",null,null,"85810 - HC CHG VISCOSITY","37609 - HC TEMPORAL ARTERY LIGATN OR BX"]
[null,"42330 - SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL",null,"37252 - INTRAVSC US DURNG DX EVAL &/OR THERPUTC INTRVNTN INCL RAD S&I; 1ST NONCRNRY VES","37252 - INTRAVSC US DURNG DX EVAL &/OR THERPUTC INTRVNTN INCL RAD S&I; 1ST NONCRNRY VES","37252 - INTRAVSC US DURNG DX EVAL &/OR THERPUTC INTRVNTN INCL RAD S&I; 1ST NONCRNRY VES",null,"37233 - HC REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA VSL",null,null,null,null,"38207 - HC TRNSPL PREPJ HEMATOP PROGEN CELLS CRYOPRSRV STOR",null,"37233 - HC REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA VSL",null,null,"86003 - HC CHG ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN","38200 - HC INJ PROC SPLENOPORTO"]
[null,"42335 - HC REMOVAL SUBMAND STONE,COMPLICATED",null,"37253 - HC INTVASC US NONCORON ADD","37253 - HC INTVASC US NONCORON ADD","37253 - HC INTVASC US NONCORON ADD",null,"37236 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL",null,null,null,null,"38208 - HC TRNSPL PREP HEMATOP PROGEN THAW PREV HRV PER DNR",null,"37236 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL",null,null,"86021 - HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES","38206 - HC BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ AUTOL"]
[null,"42400 - BIOPSY SALIVARY GLAND NEEDLE",null,"37609 - HC TEMPORAL ARTERY LIGATN OR BX","37609 - HC TEMPORAL ARTERY LIGATN OR BX","37609 - HC TEMPORAL ARTERY LIGATN OR BX",null,"37237 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL",null,null,null,null,"38220 - MARROW ASPIRATION ONLY",null,"37237 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL",null,null,"86022 - HC CRL;SEROTONIN RLS ASSAY","38207 - HC TRNSPL PREPJ HEMATOP PROGEN CELLS CRYOPRSRV STOR"]
[null,"42405 - BIOPSY SALIVARY GLAND INCISIONAL",null,"38206 - HC BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ AUTOL","38206 - HC BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ AUTOL","38206 - HC BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ AUTOL",null,"37238 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST",null,null,null,null,"38221 - BONE MARROW BIOPSY NEEDLE/TROCAR",null,"37238 - OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST",null,null,"86038 - HC CHG ANTINUCLEAR ANTIBODIES ANA","38208 - HC TRNSPL PREP HEMATOP PROGEN THAW PREV HRV PER DNR"]
[null,"42408 - HC EXCISION SUBLING SALIVARY CYST",null,"38207 - HC TRNSPL PREPJ HEMATOP PROGEN CELLS CRYOPRSRV STOR","38207 - HC TRNSPL PREPJ HEMATOP PROGEN CELLS CRYOPRSRV STOR","38207 - HC TRNSPL PREPJ HEMATOP PROGEN CELLS CRYOPRSRV STOR",null,"37239 - OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL",null,null,null,null,"38222 - HC DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS",null,"37239 - OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL",null,null,"86039 - HC CHG ANTINUCLEAR ANTIBODIES ANA TITER","38220 - MARROW ASPIRATION ONLY"]
[null,"42415 - HC EXC PAROTD,LAT LOBE,DISSECT 5TH NERV",null,"38208 - HC TRNSPL PREP HEMATOP PROGEN THAW PREV HRV PER DNR","38208 - HC TRNSPL PREP HEMATOP PROGEN THAW PREV HRV PER DNR","38208 - HC TRNSPL PREP HEMATOP PROGEN THAW PREV HRV PER DNR",null,"37241 - VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I",null,null,null,null,"38241 - TRNSPLJ AUTOLOGOUS HEMATOPOIETIC CELLS PER DONOR",null,"37241 - VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I",null,null,"86060 - HC CHG ANTISTREPTOLYSIN O TITER","38221 - BONE MARROW BIOPSY NEEDLE/TROCAR"]
[null,"42440 - HC EXCISION SUBMAXILLARY GLAND",null,"38220 - MARROW ASPIRATION ONLY","38220 - MARROW ASPIRATION ONLY","38220 - MARROW ASPIRATION ONLY",null,"37242 - VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I",null,null,null,null,"38300 - DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL",null,"37242 - VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I",null,null,"86140 - C-REACTIVE PROTEIN","38222 - HC DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS"]
[null,"42450 - HC EXCISION SUBLINGUAL GLAND",null,"38221 - BONE MARROW BIOPSY NEEDLE/TROCAR","38221 - BONE MARROW BIOPSY NEEDLE/TROCAR","38221 - BONE MARROW BIOPSY NEEDLE/TROCAR",null,"37243 - VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT",null,null,null,null,"38500 - HC BIOPSY/EXCISION, LYMPH NODE(S)",null,"37243 - VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT",null,null,"86141 - HC CRL;CARDIO CRP","38241 - TRNSPLJ AUTOLOGOUS HEMATOPOIETIC CELLS PER DONOR"]
[null,"42500 - HC PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY PRIM",null,"38222 - HC DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS","38222 - HC DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS","38222 - HC DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS",null,"37244 - VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE",null,null,null,null,"38505 - BX/EXC LYMPH NODE NEEDLE SUPERFICIAL",null,"37244 - VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE",null,null,"86146 - HC CRL;BETA-2 GLYCPRTN 1 AB","38300 - DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL"]
[null,"42505 - HC REPAIR SALIVARY DUCT COMPLICATED",null,"38241 - TRNSPLJ AUTOLOGOUS HEMATOPOIETIC CELLS PER DONOR","38241 - TRNSPLJ AUTOLOGOUS HEMATOPOIETIC CELLS PER DONOR","38241 - TRNSPLJ AUTOLOGOUS HEMATOPOIETIC CELLS PER DONOR",null,"37246 - HC TRLUML BAL ANGIO 1ST ART",null,null,null,null,"38510 - HC BX/REMV,LYMPH NODE,DEEP CERV",null,"37246 - HC TRLUML BAL ANGIO 1ST ART",null,null,"86147 - HC Q;CARDLIP AB;IGG,IGM,IGA","38500 - HC BIOPSY/EXCISION, LYMPH NODE(S)"]
[null,"42699 - SIAOENDOSCOPY",null,"38300 - DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL","38300 - DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL","38300 - DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL",null,"37247 - HC TRLUML BAL ANGIO ADD ART",null,null,null,null,"38531 - HC OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES",null,"37247 - HC TRLUML BAL ANGIO ADD ART",null,null,"86157 - HC CHG COLD AGGLUTININ TITER","38505 - BX/EXC LYMPH NODE NEEDLE SUPERFICIAL"]
[null,"42700 - I&D ABSCESS PERITONSILLAR",null,"38500 - HC BIOPSY/EXCISION, LYMPH NODE(S)","38500 - HC BIOPSY/EXCISION, LYMPH NODE(S)","38500 - HC BIOPSY/EXCISION, LYMPH NODE(S)",null,"37248 - HC TRLUML BAL ANGIO 1ST VEIN",null,null,null,null,"38542 - HC EXPLORE DEEP NODE(S), NECK",null,"37248 - HC TRLUML BAL ANGIO 1ST VEIN",null,null,"86160 - HC CHG COMPLEMENT ANTIGEN EACH COMPONENT","38510 - HC BX/REMV,LYMPH NODE,DEEP CERV"]
[null,"42720 - HC INC/DRAIN RETROPHARYNG ABSCESS,ORAL",null,"38505 - BX/EXC LYMPH NODE NEEDLE SUPERFICIAL","38505 - BX/EXC LYMPH NODE NEEDLE SUPERFICIAL","38505 - BX/EXC LYMPH NODE NEEDLE SUPERFICIAL",null,"37249 - HC TRLUML BAL ANGIO ADD VEIN",null,null,null,null,"38550 - HC REMOVAL CYST HYGROMA",null,"37249 - HC TRLUML BAL ANGIO ADD VEIN",null,null,"86161 - HC CHG COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT","38531 - HC OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES"]
[null,"42725 - HC INC/DRAIN RETROPHARYNG ABSCESS,EXT",null,"38510 - HC BX/REMV,LYMPH NODE,DEEP CERV","38510 - HC BX/REMV,LYMPH NODE,DEEP CERV","38510 - HC BX/REMV,LYMPH NODE,DEEP CERV",null,"37252 - INTRAVSC US DURNG DX EVAL &/OR THERPUTC INTRVNTN INCL RAD S&I; 1ST NONCRNRY VES",null,null,null,null,"38790 - HC INJECTION PROCEDURE LYMPHANGIOGRAPHY",null,"37252 - INTRAVSC US DURNG DX EVAL &/OR THERPUTC INTRVNTN INCL RAD S&I; 1ST NONCRNRY VES",null,null,"86162 - HC CHG COMPLEMENT TOTAL HEMOLYTIC","38542 - HC EXPLORE DEEP NODE(S), NECK"]
[null,"42800 - BIOPSY OROPHARYNX",null,"38531 - HC OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES","38531 - HC OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES","38531 - HC OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES",null,"37253 - HC INTVASC US NONCORON ADD",null,null,null,null,"38792 - HC INJ PROC;SENTINAL NODE ID",null,"37253 - HC INTVASC US NONCORON ADD",null,null,"86200 - HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY","38550 - HC REMOVAL CYST HYGROMA"]
[null,"42804 - BIOPSY NASOPHARYNX VISIBLE LESION SIMPLE",null,"38542 - HC EXPLORE DEEP NODE(S), NECK","38542 - HC EXPLORE DEEP NODE(S), NECK","38542 - HC EXPLORE DEEP NODE(S), NECK",null,"37609 - HC TEMPORAL ARTERY LIGATN OR BX",null,null,null,null,"40490 - BIOPSY OF LIP",null,"37609 - HC TEMPORAL ARTERY LIGATN OR BX",null,null,"86235 - HC CHG EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD","38790 - HC INJECTION PROCEDURE LYMPHANGIOGRAPHY"]
[null,"42808 - EXCISION/DESTRUCTION LESION PHARYNX ANY METHOD",null,"38550 - HC REMOVAL CYST HYGROMA","38550 - HC REMOVAL CYST HYGROMA","38550 - HC REMOVAL CYST HYGROMA",null,"37799 - UNLISTED PROCEDURE,VASCULAR SURGERY",null,null,null,null,"40500 - HC LIP SHAVE",null,"37799 - UNLISTED PROCEDURE,VASCULAR SURGERY",null,null,"86255 - HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY","38792 - HC INJ PROC;SENTINAL NODE ID"]
[null,"42809 - REMOVAL FOREIGN BODY PHARYNX",null,"38790 - HC INJECTION PROCEDURE LYMPHANGIOGRAPHY","38790 - HC INJECTION PROCEDURE LYMPHANGIOGRAPHY","38790 - HC INJECTION PROCEDURE LYMPHANGIOGRAPHY",null,"38200 - HC INJ PROC SPLENOPORTO",null,null,null,null,"40510 - EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR",null,"38200 - HC INJ PROC SPLENOPORTO",null,null,"86256 - HC CHG FLUORESCENT ANTIBODY; TITER","40490 - BIOPSY OF LIP"]
[null,"42810 - EXC BRANCHIAL CLEFT CYST CONFINED SKN&SUBQ TIS",null,"38792 - HC INJ PROC;SENTINAL NODE ID","38792 - HC INJ PROC;SENTINAL NODE ID","38792 - HC INJ PROC;SENTINAL NODE ID",null,"38206 - HC BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ AUTOL",null,null,null,null,"40520 - HC PARTIAL EXCISION OF LIP",null,"38206 - HC BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ AUTOL",null,null,"86300 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3","40500 - HC LIP SHAVE"]
[null,"42815 - HC EXCISION BRANC CLFT CYST,DEEP",null,"40490 - BIOPSY OF LIP","40490 - BIOPSY OF LIP","40490 - BIOPSY OF LIP",null,"38207 - HC TRNSPL PREPJ HEMATOP PROGEN CELLS CRYOPRSRV STOR",null,null,null,null,"40525 - HC FULL THICK EXCIS LIP,RECON W FLAP",null,"38207 - HC TRNSPL PREPJ HEMATOP PROGEN CELLS CRYOPRSRV STOR",null,null,"86301 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9","40510 - EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR"]
[null,"42826 - TONSILLECTOMY ONE-HALF AGE 12/>",null,"40500 - HC LIP SHAVE","40500 - HC LIP SHAVE","40500 - HC LIP SHAVE",null,"38208 - HC TRNSPL PREP HEMATOP PROGEN THAW PREV HRV PER DNR",null,null,null,null,"40530 - HC PARTIAL REMOVAL OF LIP,>1/4",null,"38208 - HC TRNSPL PREP HEMATOP PROGEN THAW PREV HRV PER DNR",null,null,"86304 - HC CRL;CA-125","40520 - HC PARTIAL EXCISION OF LIP"]
[null,"42960 - HC CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE",null,"40510 - EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR","40510 - EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR","40510 - EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR",null,"38220 - MARROW ASPIRATION ONLY",null,null,null,null,"40650 - HC REPAIR LIP,FULL THICK,VERMILION",null,"38220 - MARROW ASPIRATION ONLY",null,null,"86308 - HC CHG HETEROPHILE ANTIBODIES SCREEN","40525 - HC FULL THICK EXCIS LIP,RECON W FLAP"]
[null,"42970 - HC CTRL NASOPHARYNGEAL HEMRRG SMPL W/PST NSL PACKS",null,"40520 - HC PARTIAL EXCISION OF LIP","40520 - HC PARTIAL EXCISION OF LIP","40520 - HC PARTIAL EXCISION OF LIP",null,"38221 - BONE MARROW BIOPSY NEEDLE/TROCAR",null,null,null,null,"40652 - HC REPAIR LIP,<1/2 VERT HEIGHT",null,"38221 - BONE MARROW BIOPSY NEEDLE/TROCAR",null,null,"86316 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE","40530 - HC PARTIAL REMOVAL OF LIP,>1/4"]
[null,"43191 - HC ESOPHAGOSCOPY RIGID TRANSORAL DIAGNOSTIC BRUSH",null,"40525 - HC FULL THICK EXCIS LIP,RECON W FLAP","40525 - HC FULL THICK EXCIS LIP,RECON W FLAP","40525 - HC FULL THICK EXCIS LIP,RECON W FLAP",null,"38222 - HC DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS",null,null,null,null,"40654 - HC REPAIR LIP,>1/2 VERT HEIGHT",null,"38222 - HC DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS",null,null,"86317 - HC IMMUNOASSAY,INFECT AGENT,QUANT","40650 - HC REPAIR LIP,FULL THICK,VERMILION"]
[null,"43193 - HC ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY",null,"40530 - HC PARTIAL REMOVAL OF LIP,>1/4","40530 - HC PARTIAL REMOVAL OF LIP,>1/4","40530 - HC PARTIAL REMOVAL OF LIP,>1/4",null,"38241 - TRNSPLJ AUTOLOGOUS HEMATOPOIETIC CELLS PER DONOR",null,null,null,null,"40800 - HC DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL",null,"38241 - TRNSPLJ AUTOLOGOUS HEMATOPOIETIC CELLS PER DONOR",null,null,"86331 - HC CHG IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY","40652 - HC REPAIR LIP,<1/2 VERT HEIGHT"]
[null,"43195 - HC ESOPHAGOSCOPY RIGID TRANSORAL BALLOON DILATION",null,"40650 - HC REPAIR LIP,FULL THICK,VERMILION","40650 - HC REPAIR LIP,FULL THICK,VERMILION","40650 - HC REPAIR LIP,FULL THICK,VERMILION",null,"38300 - DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL",null,null,null,null,"40801 - DRG ABSC CST HMTMA VESTIBULE MOUTH COMP",null,"38300 - DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL",null,null,"86334 - HC CHG IMMUNOFIXJ ELECTROPHORESIS SERUM","40654 - HC REPAIR LIP,>1/2 VERT HEIGHT"]
[null,"43197 - HC ESOPHAGOSCOPY FLEXIBLE TRANSNASAL DIAGNOSTIC",null,"40652 - HC REPAIR LIP,<1/2 VERT HEIGHT","40652 - HC REPAIR LIP,<1/2 VERT HEIGHT","40652 - HC REPAIR LIP,<1/2 VERT HEIGHT",null,"38500 - HC BIOPSY/EXCISION, LYMPH NODE(S)",null,null,null,null,"40804 - HC REM FB,MOUTH;SIMP",null,"38500 - HC BIOPSY/EXCISION, LYMPH NODE(S)",null,null,"86335 - HC CHG IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS","40800 - HC DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL"]
[null,"43198 - ESOPHAGOSCOPY FLEXIBLE TRANSNASAL WITH BIOPSY",null,"40654 - HC REPAIR LIP,>1/2 VERT HEIGHT","40654 - HC REPAIR LIP,>1/2 VERT HEIGHT","40654 - HC REPAIR LIP,>1/2 VERT HEIGHT",null,"38505 - BX/EXC LYMPH NODE NEEDLE SUPERFICIAL",null,null,null,null,"40805 - HC REMOVAL FOREIGN BODY,MOUTH,COMPLEX",null,"38505 - BX/EXC LYMPH NODE NEEDLE SUPERFICIAL",null,null,"86336 - HC CHG INHIBIN A","40801 - DRG ABSC CST HMTMA VESTIBULE MOUTH COMP"]
[null,"43200 - ESPHGSC RGD/FLX DX W/WO COLLJ SPEC BR/WA SPX",null,"40800 - HC DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL","40800 - HC DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL","40800 - HC DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL",null,"38510 - HC BX/REMV,LYMPH NODE,DEEP CERV",null,null,null,null,"40806 - INCISION OF LIP FOLD",null,"38510 - HC BX/REMV,LYMPH NODE,DEEP CERV",null,null,"86340 - HC CHG INTRINSIC FACTOR ANTIBODIES","40804 - HC REM FB,MOUTH;SIMP"]
[null,"43201 - HC ESOPHAGOSCOPY FLEXIBLE TRANSORAL W SUBMUCOUS INJ",null,"40801 - DRG ABSC CST HMTMA VESTIBULE MOUTH COMP","40801 - DRG ABSC CST HMTMA VESTIBULE MOUTH COMP","40801 - DRG ABSC CST HMTMA VESTIBULE MOUTH COMP",null,"38531 - HC OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES",null,null,null,null,"40808 - BIOPSY VESTIBULE MOUTH",null,"38531 - HC OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES",null,null,"86341 - HC CHG ISLET CELL ANTIBODY","40805 - HC REMOVAL FOREIGN BODY,MOUTH,COMPLEX"]
[null,"43202 - ESPHGSC RGD/FLX W/BIOPSY SINGLE/MULTIPLE",null,"40804 - HC REM FB,MOUTH;SIMP","40804 - HC REM FB,MOUTH;SIMP","40804 - HC REM FB,MOUTH;SIMP",null,"38542 - HC EXPLORE DEEP NODE(S), NECK",null,null,null,null,"40810 - EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR",null,"38542 - HC EXPLORE DEEP NODE(S), NECK",null,null,"86353 - HC CHG LYMPHOCYTE TRANSFORMATION","40806 - INCISION OF LIP FOLD"]
[null,"43212 - HC ESOPHAGOSCOPY TRANSORAL STENT PLACEMENT",null,"40805 - HC REMOVAL FOREIGN BODY,MOUTH,COMPLEX","40805 - HC REMOVAL FOREIGN BODY,MOUTH,COMPLEX","40805 - HC REMOVAL FOREIGN BODY,MOUTH,COMPLEX",null,"38550 - HC REMOVAL CYST HYGROMA",null,null,null,null,"40812 - EXC LES MUCOSA & SBMCSL VESTIBULE SMPL RPR",null,"38550 - HC REMOVAL CYST HYGROMA",null,null,"86355 - HC B CELLS TOTAL COUNT","40808 - BIOPSY VESTIBULE MOUTH"]
[null,"43215 - HC ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY",null,"40806 - INCISION OF LIP FOLD","40806 - INCISION OF LIP FOLD","40806 - INCISION OF LIP FOLD",null,"38790 - HC INJECTION PROCEDURE LYMPHANGIOGRAPHY",null,null,null,null,"40814 - HC EXCIS MOUTH MUCOSA/SUB,COMPLX REPR",null,"38790 - HC INJECTION PROCEDURE LYMPHANGIOGRAPHY",null,null,"86357 - HC NK CELLS, TOTAL COUNT","40810 - EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR"]
[null,"43220 - HC ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM",null,"40808 - BIOPSY VESTIBULE MOUTH","40808 - BIOPSY VESTIBULE MOUTH","40808 - BIOPSY VESTIBULE MOUTH",null,"38792 - HC INJ PROC;SENTINAL NODE ID",null,null,null,null,"40816 - EXC LES MUCOSA&SBMCSL VESTIBULE CPLX EXC MUSC",null,"38792 - HC INJ PROC;SENTINAL NODE ID",null,null,"86359 - HC CHG T CELLS TOTAL COUNT","40812 - EXC LES MUCOSA & SBMCSL VESTIBULE SMPL RPR"]
[null,"43229 - HC ESOPHAGOSCOPY FLEX TRANSORAL LESION ABLATION",null,"40810 - EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR","40810 - EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR","40810 - EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR",null,"40490 - BIOPSY OF LIP",null,null,null,null,"40819 - EXC FRENUM LABIAL/BUCCAL",null,"40490 - BIOPSY OF LIP",null,null,"86360 - HC CHG T CELLS ABSOLUTE CD4&CD8 COUNT RATIO","40814 - HC EXCIS MOUTH MUCOSA/SUB,COMPLX REPR"]
[null,"43231 - HC ESPHGSC RGD/FLX W/NDSC ULTRASOUND EXAMINATION",null,"40812 - EXC LES MUCOSA & SBMCSL VESTIBULE SMPL RPR","40812 - EXC LES MUCOSA & SBMCSL VESTIBULE SMPL RPR","40812 - EXC LES MUCOSA & SBMCSL VESTIBULE SMPL RPR",null,"40500 - HC LIP SHAVE",null,null,null,null,"40820 - HC DESTRUC MOUTH LESION/SCAR",null,"40500 - HC LIP SHAVE",null,null,"86376 - HC CHG MICROSOMAL ANTIBODIES EACH","40816 - EXC LES MUCOSA&SBMCSL VESTIBULE CPLX EXC MUSC"]
[null,"43232 - HC ESPHGSC RGD/FLX W/TNDSC US-GID FINE NDL ASPIR/BX",null,"40814 - HC EXCIS MOUTH MUCOSA/SUB,COMPLX REPR","40814 - HC EXCIS MOUTH MUCOSA/SUB,COMPLX REPR","40814 - HC EXCIS MOUTH MUCOSA/SUB,COMPLX REPR",null,"40510 - EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR",null,null,null,null,"40830 - HC CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/<",null,"40510 - EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR",null,null,"86382 - HC CHG NEUTRALIZATION TEST VIRAL","40819 - EXC FRENUM LABIAL/BUCCAL"]
[null,"43235 - HC UPPER GI NDSC DX W/WO COLLECTION SPECIMEN",null,"40816 - EXC LES MUCOSA&SBMCSL VESTIBULE CPLX EXC MUSC","40816 - EXC LES MUCOSA&SBMCSL VESTIBULE CPLX EXC MUSC","40816 - EXC LES MUCOSA&SBMCSL VESTIBULE CPLX EXC MUSC",null,"40520 - HC PARTIAL EXCISION OF LIP",null,null,null,null,"40831 - HC REPAIR MOUTH LACERATION,>2.5 CM",null,"40520 - HC PARTIAL EXCISION OF LIP",null,null,"86403 - HC CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY","40820 - HC DESTRUC MOUTH LESION/SCAR"]
[null,"43236 - HC UPPER GI NDSC W/SUBMUCOSAL INJECTION",null,"40819 - EXC FRENUM LABIAL/BUCCAL","40819 - EXC FRENUM LABIAL/BUCCAL","40819 - EXC FRENUM LABIAL/BUCCAL",null,"40525 - HC FULL THICK EXCIS LIP,RECON W FLAP",null,null,null,null,"40840 - HC RECONSTRUC MOUTH ANTERIOR",null,"40525 - HC FULL THICK EXCIS LIP,RECON W FLAP",null,null,"86431 - HC CHG RHEUMATOID FACTOR QUANTITATIVE","40830 - HC CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/<"]
[null,"43237 - UPR GI NDSC & US NDSC EXAM LMTD ESOPHAGUS",null,"40820 - HC DESTRUC MOUTH LESION/SCAR","40820 - HC DESTRUC MOUTH LESION/SCAR","40820 - HC DESTRUC MOUTH LESION/SCAR",null,"40530 - HC PARTIAL REMOVAL OF LIP,>1/4",null,null,null,null,"40842 - HC RECONSTRUC MOUTH POSTER,UNILAT",null,"40530 - HC PARTIAL REMOVAL OF LIP,>1/4",null,null,"86480 - HC CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON","40831 - HC REPAIR MOUTH LACERATION,>2.5 CM"]
[null,"43238 - HC UPR GI NDSC TNDSC US FINE NDL ASPIR/BX ESOPH",null,"40830 - HC CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/<","40830 - HC CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/<","40830 - HC CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/<",null,"40650 - HC REPAIR LIP,FULL THICK,VERMILION",null,null,null,null,"40845 - HC RECONSTRUC MOUTH COMPLEX",null,"40650 - HC REPAIR LIP,FULL THICK,VERMILION",null,null,"86481 - HC TB TEST CELL MEDIATED ANTIGEN RESPONSE, ENUM GAMMA INTERFRON T-CELL","40840 - HC RECONSTRUC MOUTH ANTERIOR"]
[null,"43239 - HC UPPER NDSC BIOPSY SINGLE/MULTIPLE",null,"40831 - HC REPAIR MOUTH LACERATION,>2.5 CM","40831 - HC REPAIR MOUTH LACERATION,>2.5 CM","40831 - HC REPAIR MOUTH LACERATION,>2.5 CM",null,"40652 - HC REPAIR LIP,<1/2 VERT HEIGHT",null,null,null,null,"41006 - HC INTRAORAL I&D TONGUE/FLOOR SUBLNGL DP SPRMLHYD",null,"40652 - HC REPAIR LIP,<1/2 VERT HEIGHT",null,null,"86592 - HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL","40842 - HC RECONSTRUC MOUTH POSTER,UNILAT"]
[null,"43240 - HC UPR GI NDSC TRANSMURAL DRAINAGE PSEUDOCYST",null,"40840 - HC RECONSTRUC MOUTH ANTERIOR","40840 - HC RECONSTRUC MOUTH ANTERIOR","40840 - HC RECONSTRUC MOUTH ANTERIOR",null,"40654 - HC REPAIR LIP,>1/2 VERT HEIGHT",null,null,null,null,"41007 - HC I&D MOUTH/TONG INTRA,SUBMENTAL",null,"40654 - HC REPAIR LIP,>1/2 VERT HEIGHT",null,null,"86593 - HC SYPHILIS;QN","40845 - HC RECONSTRUC MOUTH COMPLEX"]
[null,"43241 - HC UPR GI NDSC TNDSC INTRALUMINAL TUBE/CATH PLMT",null,"40842 - HC RECONSTRUC MOUTH POSTER,UNILAT","40842 - HC RECONSTRUC MOUTH POSTER,UNILAT","40842 - HC RECONSTRUC MOUTH POSTER,UNILAT",null,"40800 - HC DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL",null,null,null,null,"41008 - HC I&D MOUTH/TONG INTRA,SUBMANDIBULAR",null,"40800 - HC DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL",null,null,"86606 - HC CHG ANTIBODY ASPERGILLUS","41006 - HC INTRAORAL I&D TONGUE/FLOOR SUBLNGL DP SPRMLHYD"]
[null,"43242 - HC UPPER GI NDSC ULTRASOUND GUIDED BIOPSY",null,"40845 - HC RECONSTRUC MOUTH COMPLEX","40845 - HC RECONSTRUC MOUTH COMPLEX","40845 - HC RECONSTRUC MOUTH COMPLEX",null,"40801 - DRG ABSC CST HMTMA VESTIBULE MOUTH COMP",null,null,null,null,"41009 - HC I&D MOUTH/TONG INTRA, MASTICATOR",null,"40801 - DRG ABSC CST HMTMA VESTIBULE MOUTH COMP",null,null,"86609 - HC CHG ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED","41007 - HC I&D MOUTH/TONG INTRA,SUBMENTAL"]
[null,"43243 - HC UPR GI NDSC NJX SCLEROSIS ESOPHGL&/GSTR VARICE",null,"41006 - HC INTRAORAL I&D TONGUE/FLOOR SUBLNGL DP SPRMLHYD","41006 - HC INTRAORAL I&D TONGUE/FLOOR SUBLNGL DP SPRMLHYD","41006 - HC INTRAORAL I&D TONGUE/FLOOR SUBLNGL DP SPRMLHYD",null,"40804 - HC REM FB,MOUTH;SIMP",null,null,null,null,"41010 - INCISION LINGUAL FRENUM FRENOTOMY",null,"40804 - HC REM FB,MOUTH;SIMP",null,null,"86611 - HC BARTONELLA, ANTIBODY","41008 - HC I&D MOUTH/TONG INTRA,SUBMANDIBULAR"]
[null,"43244 - HC UPR GI NDSC BAND LIG ESOPHGL&/GSTR VARICES",null,"41007 - HC I&D MOUTH/TONG INTRA,SUBMENTAL","41007 - HC I&D MOUTH/TONG INTRA,SUBMENTAL","41007 - HC I&D MOUTH/TONG INTRA,SUBMENTAL",null,"40805 - HC REMOVAL FOREIGN BODY,MOUTH,COMPLEX",null,null,null,null,"41016 - HC MOUTH/TONG EXTRA,SUBMENTAL",null,"40805 - HC REMOVAL FOREIGN BODY,MOUTH,COMPLEX",null,null,"86612 - HC CHG BLASTOMYCES ANTIBODY","41009 - HC I&D MOUTH/TONG INTRA, MASTICATOR"]
[null,"43245 - HC UPR GI NDSC DILAT GSTR OUTLET FOR OBSTRCJ",null,"41008 - HC I&D MOUTH/TONG INTRA,SUBMANDIBULAR","41008 - HC I&D MOUTH/TONG INTRA,SUBMANDIBULAR","41008 - HC I&D MOUTH/TONG INTRA,SUBMANDIBULAR",null,"40806 - INCISION OF LIP FOLD",null,null,null,null,"41017 - HC XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB",null,"40806 - INCISION OF LIP FOLD",null,null,"86615 - HC Q;BORDTLLA AB;IGG,IGA","41010 - INCISION LINGUAL FRENUM FRENOTOMY"]
[null,"43246 - HC UPR GI NDSC PLMT PRQ GASTROSTOMY TUBE",null,"41009 - HC I&D MOUTH/TONG INTRA, MASTICATOR","41009 - HC I&D MOUTH/TONG INTRA, MASTICATOR","41009 - HC I&D MOUTH/TONG INTRA, MASTICATOR",null,"40808 - BIOPSY VESTIBULE MOUTH",null,null,null,null,"41018 - HC I&D MOUTH/TONG EXTRA,MASTICATOR",null,"40808 - BIOPSY VESTIBULE MOUTH",null,null,"86617 - HC CHG ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST","41016 - HC MOUTH/TONG EXTRA,SUBMENTAL"]
[null,"43247 - HC UPPER GI NDSC W/FOREIGN BODY REMOVAL",null,"41010 - INCISION LINGUAL FRENUM FRENOTOMY","41010 - INCISION LINGUAL FRENUM FRENOTOMY","41010 - INCISION LINGUAL FRENUM FRENOTOMY",null,"40810 - EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR",null,null,null,null,"41100 - BIOPSY TONGUE ANTERIOR TWO-THIRDS",null,"40810 - EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR",null,null,"86618 - HC Q;LYME AB INDEX CNS INFEC","41017 - HC XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB"]
[null,"43248 - HC UPR GI NDSC INSJ GUIDE WIRE DILAT ESOPHAGUS",null,"41016 - HC MOUTH/TONG EXTRA,SUBMENTAL","41016 - HC MOUTH/TONG EXTRA,SUBMENTAL","41016 - HC MOUTH/TONG EXTRA,SUBMENTAL",null,"40812 - EXC LES MUCOSA & SBMCSL VESTIBULE SMPL RPR",null,null,null,null,"41105 - HC BIOPSY TONGUE,POSTER 1/3",null,"40812 - EXC LES MUCOSA & SBMCSL VESTIBULE SMPL RPR",null,null,"86622 - HC CHG ANTIBODY BRUCELLA","41018 - HC I&D MOUTH/TONG EXTRA,MASTICATOR"]
[null,"43249 - HC UPR GI NDSC BALLOON DILAT ESOPH <30 MM DIAM",null,"41017 - HC XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB","41017 - HC XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB","41017 - HC XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB",null,"40814 - HC EXCIS MOUTH MUCOSA/SUB,COMPLX REPR",null,null,null,null,"41108 - BIOPSY FLOOR MOUTH",null,"40814 - HC EXCIS MOUTH MUCOSA/SUB,COMPLX REPR",null,null,"86625 - HC CAMPYLOBACTER, ANTIBODY","41100 - BIOPSY TONGUE ANTERIOR TWO-THIRDS"]
[null,"43250 - HC UPR GI NDSC RMVL LESION HOT BX/BIPOLAR CAUTERY",null,"41018 - HC I&D MOUTH/TONG EXTRA,MASTICATOR","41018 - HC I&D MOUTH/TONG EXTRA,MASTICATOR","41018 - HC I&D MOUTH/TONG EXTRA,MASTICATOR",null,"40816 - EXC LES MUCOSA&SBMCSL VESTIBULE CPLX EXC MUSC",null,null,null,null,"41110 - EXCISION LESION TONGUE W/O CLOSURE",null,"40816 - EXC LES MUCOSA&SBMCSL VESTIBULE CPLX EXC MUSC",null,null,"86631 - HC CHG, CHLAMYDIA, ANTIBODY","41105 - HC BIOPSY TONGUE,POSTER 1/3"]
[null,"43251 - HC UPR GI NDSC RMVL TUM POLYP/OTH LES SNARE TQ",null,"41100 - BIOPSY TONGUE ANTERIOR TWO-THIRDS","41100 - BIOPSY TONGUE ANTERIOR TWO-THIRDS","41100 - BIOPSY TONGUE ANTERIOR TWO-THIRDS",null,"40819 - EXC FRENUM LABIAL/BUCCAL",null,null,null,null,"41112 - EXC LES TONGUE W/CLSR ANTERIOR TWO-THIRDS",null,"40819 - EXC FRENUM LABIAL/BUCCAL",null,null,"86632 - HC CHG CHLAMYDIA, IGM ANTIBODY","41108 - BIOPSY FLOOR MOUTH"]
[null,"43253 - HC EGD US GUIDED TRANSMURAL INJXN/FIDUCIAL MARKER E",null,"41105 - HC BIOPSY TONGUE,POSTER 1/3","41105 - HC BIOPSY TONGUE,POSTER 1/3","41105 - HC BIOPSY TONGUE,POSTER 1/3",null,"40820 - HC DESTRUC MOUTH LESION/SCAR",null,null,null,null,"41113 - HC EXCIS TONGUE LESN,POST 1/3",null,"40820 - HC DESTRUC MOUTH LESION/SCAR",null,null,"86635 - HC CHG ANTIBODY COCCIDIOIDES","41110 - EXCISION LESION TONGUE W/O CLOSURE"]
[null,"43254 - HC EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION",null,"41108 - BIOPSY FLOOR MOUTH","41108 - BIOPSY FLOOR MOUTH","41108 - BIOPSY FLOOR MOUTH",null,"40830 - HC CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/<",null,null,null,null,"41115 - EXCIISION LINGUAL FRENUM FRENECTOMY",null,"40830 - HC CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/<",null,null,"86638 - HC CHG, Q FEVER ANTIBODY","41112 - EXC LES TONGUE W/CLSR ANTERIOR TWO-THIRDS"]
[null,"43255 - HC UPR GI NDSC CONTROL BLEEDING ANY METHOD",null,"41110 - EXCISION LESION TONGUE W/O CLOSURE","41110 - EXCISION LESION TONGUE W/O CLOSURE","41110 - EXCISION LESION TONGUE W/O CLOSURE",null,"40831 - HC REPAIR MOUTH LACERATION,>2.5 CM",null,null,null,null,"41116 - EXCISION LESION FLOOR MOUTH",null,"40831 - HC REPAIR MOUTH LACERATION,>2.5 CM",null,null,"86644 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV","41113 - HC EXCIS TONGUE LESN,POST 1/3"]
[null,"43257 - HC UPR GI NDSC DLVR THERMAL NRG SPHNCTR/CARDIA",null,"41112 - EXC LES TONGUE W/CLSR ANTERIOR TWO-THIRDS","41112 - EXC LES TONGUE W/CLSR ANTERIOR TWO-THIRDS","41112 - EXC LES TONGUE W/CLSR ANTERIOR TWO-THIRDS",null,"40840 - HC RECONSTRUC MOUTH ANTERIOR",null,null,null,null,"41120 - HC PART REMOVAL TONGUE,<1/2",null,"40840 - HC RECONSTRUC MOUTH ANTERIOR",null,null,"86645 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV IGM","41115 - EXCIISION LINGUAL FRENUM FRENECTOMY"]
[null,"43259 - HC UPPER GI NDSC W/NDSC ULTRASOUND EXAM",null,"41113 - HC EXCIS TONGUE LESN,POST 1/3","41113 - HC EXCIS TONGUE LESN,POST 1/3","41113 - HC EXCIS TONGUE LESN,POST 1/3",null,"40842 - HC RECONSTRUC MOUTH POSTER,UNILAT",null,null,null,null,"41250 - HC RLAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG",null,"40842 - HC RECONSTRUC MOUTH POSTER,UNILAT",null,null,"86648 - HC CHG ANTIBODY DIPHTHERIA","41116 - EXCISION LESION FLOOR MOUTH"]
[null,"43260 - HC ERCP DX W/WO COLLJ SPEC BRUSHING/WASHING SPX",null,"41115 - EXCIISION LINGUAL FRENUM FRENECTOMY","41115 - EXCIISION LINGUAL FRENUM FRENECTOMY","41115 - EXCIISION LINGUAL FRENUM FRENECTOMY",null,"40845 - HC RECONSTRUC MOUTH COMPLEX",null,null,null,null,"41251 - HC REPAIR TONGUE LACER,POST 1/3",null,"40845 - HC RECONSTRUC MOUTH COMPLEX",null,null,"86652 - HC CHG, ENCEPHAL ANTIBODY EAST EQU","41120 - HC PART REMOVAL TONGUE,<1/2"]
[null,"43261 - HC ERCP W/BIOPSY SINGLE/MULTIPLE",null,"41116 - EXCISION LESION FLOOR MOUTH","41116 - EXCISION LESION FLOOR MOUTH","41116 - EXCISION LESION FLOOR MOUTH",null,"41006 - HC INTRAORAL I&D TONGUE/FLOOR SUBLNGL DP SPRMLHYD",null,null,null,null,"41252 - HC REPAIR TONGUE LACER,2.6 CM+/COMPLX",null,"41006 - HC INTRAORAL I&D TONGUE/FLOOR SUBLNGL DP SPRMLHYD",null,null,"86654 - CHG ANTIBODY ENCEPHALITIS WESTRN EQUINE","41250 - HC RLAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG"]
[null,"43262 - HC ERCP W/SPHINCTEROTOMY/PAPILLOTOMY",null,"41120 - HC PART REMOVAL TONGUE,<1/2","41120 - HC PART REMOVAL TONGUE,<1/2","41120 - HC PART REMOVAL TONGUE,<1/2",null,"41007 - HC I&D MOUTH/TONG INTRA,SUBMENTAL",null,null,null,null,"41800 - HC DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS",null,"41007 - HC I&D MOUTH/TONG INTRA,SUBMENTAL",null,null,"86658 - HC CHG ENTEROVIRUS ANTIBODY","41251 - HC REPAIR TONGUE LACER,POST 1/3"]
[null,"43264 - HC ERCP W/RMVCALCULI BILIARY&/PANCREATIC DUCTS",null,"41250 - HC RLAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG","41250 - HC RLAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG","41250 - HC RLAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG",null,"41008 - HC I&D MOUTH/TONG INTRA,SUBMANDIBULAR",null,null,null,null,"41820 - HC EXCISION, GUM, EACH QUADRANT",null,"41008 - HC I&D MOUTH/TONG INTRA,SUBMANDIBULAR",null,null,"86663 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA","41252 - HC REPAIR TONGUE LACER,2.6 CM+/COMPLX"]
[null,"43265 - HC ERCP W/DSTRJ LITHOTRIPSY CALCULI ANY METHOD",null,"41251 - HC REPAIR TONGUE LACER,POST 1/3","41251 - HC REPAIR TONGUE LACER,POST 1/3","41251 - HC REPAIR TONGUE LACER,POST 1/3",null,"41009 - HC I&D MOUTH/TONG INTRA, MASTICATOR",null,null,null,null,"41821 - HC EXCISION OF GUM FLAP",null,"41009 - HC I&D MOUTH/TONG INTRA, MASTICATOR",null,null,"86664 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA","41800 - HC DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS"]
[null,"43266 - HC EGD ENDOSCOPIC STENT PLACEMENT W/WIRE& DILATION",null,"41252 - HC REPAIR TONGUE LACER,2.6 CM+/COMPLX","41252 - HC REPAIR TONGUE LACER,2.6 CM+/COMPLX","41252 - HC REPAIR TONGUE LACER,2.6 CM+/COMPLX",null,"41010 - INCISION LINGUAL FRENUM FRENOTOMY",null,null,null,null,"41822 - EXCIS FIBROUS TUBER,DENTOALV",null,"41010 - INCISION LINGUAL FRENUM FRENOTOMY",null,null,"86665 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA","41820 - HC EXCISION, GUM, EACH QUADRANT"]
[null,"43270 - HC EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE",null,"41800 - HC DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS","41800 - HC DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS","41800 - HC DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS",null,"41016 - HC MOUTH/TONG EXTRA,SUBMENTAL",null,null,null,null,"41823 - HC EXCIS OSSEOUS TUBER,DENTOALV",null,"41016 - HC MOUTH/TONG EXTRA,SUBMENTAL",null,null,"86666 - HC CHG ANTIBODY EHRLICHIA","41821 - HC EXCISION OF GUM FLAP"]
[null,"43273 - HC ENDOSCOPIC PAPILLA CANNULATION BILE PANCREATIC",null,"41820 - HC EXCISION, GUM, EACH QUADRANT","41820 - HC EXCISION, GUM, EACH QUADRANT","41820 - HC EXCISION, GUM, EACH QUADRANT",null,"41017 - HC XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB",null,null,null,null,"41825 - EXCISION OF GUM LESION",null,"41017 - HC XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB",null,null,"86677 - HC CHG ANTIBODY HELICOBACTER PYLORI","41822 - EXCIS FIBROUS TUBER,DENTOALV"]
[null,"43274 - HC ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT",null,"41821 - HC EXCISION OF GUM FLAP","41821 - HC EXCISION OF GUM FLAP","41821 - HC EXCISION OF GUM FLAP",null,"41018 - HC I&D MOUTH/TONG EXTRA,MASTICATOR",null,null,null,null,"41826 - HC EXCIS DENTOALV LESN,SIMPL REPR",null,"41018 - HC I&D MOUTH/TONG EXTRA,MASTICATOR",null,null,"86682 - HC Q;CYSTICERCUS AB,BLOT","41823 - HC EXCIS OSSEOUS TUBER,DENTOALV"]
[null,"43275 - HC ERCP REMOVE FOREIGN BODY/STENT BILIARY/PANC DUCT",null,"41822 - EXCIS FIBROUS TUBER,DENTOALV","41822 - EXCIS FIBROUS TUBER,DENTOALV","41822 - EXCIS FIBROUS TUBER,DENTOALV",null,"41100 - BIOPSY TONGUE ANTERIOR TWO-THIRDS",null,null,null,null,"41830 - HC REMOVAL OF GUM TISSUE",null,"41100 - BIOPSY TONGUE ANTERIOR TWO-THIRDS",null,null,"86689 - HC HTLV/HIV CONFIRMATORY TEST","41825 - EXCISION OF GUM LESION"]
[null,"43276 - HC ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE",null,"41823 - HC EXCIS OSSEOUS TUBER,DENTOALV","41823 - HC EXCIS OSSEOUS TUBER,DENTOALV","41823 - HC EXCIS OSSEOUS TUBER,DENTOALV",null,"41105 - HC BIOPSY TONGUE,POSTER 1/3",null,null,null,null,"41850 - TREATMENT OF GUM LESION",null,"41105 - HC BIOPSY TONGUE,POSTER 1/3",null,null,"86692 - HC CHG ANTIBODY HEP DELTA AGENT","41826 - HC EXCIS DENTOALV LESN,SIMPL REPR"]
[null,"43277 - HC ERCP BALLOON DILATE BILIARY/PANC DUCT/AMPULLA EA",null,"41825 - EXCISION OF GUM LESION","41825 - EXCISION OF GUM LESION","41825 - EXCISION OF GUM LESION",null,"41108 - BIOPSY FLOOR MOUTH",null,null,null,null,"41874 - HC REPAIR TOOTH SOCKET",null,"41108 - BIOPSY FLOOR MOUTH",null,null,"86694 - HC CHG ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST","41830 - HC REMOVAL OF GUM TISSUE"]
[null,"43278 - HC ERCP LESION ABLATE W/DILATE",null,"41826 - HC EXCIS DENTOALV LESN,SIMPL REPR","41826 - HC EXCIS DENTOALV LESN,SIMPL REPR","41826 - HC EXCIS DENTOALV LESN,SIMPL REPR",null,"41110 - EXCISION LESION TONGUE W/O CLOSURE",null,null,null,null,"42000 - HC DRAINAGE ABSCESS PALATE UVULA",null,"41110 - EXCISION LESION TONGUE W/O CLOSURE",null,null,"86695 - HC CHG ANTIBODY HERPES SMPLX TYPE 1","41850 - TREATMENT OF GUM LESION"]
[null,"43450 - HC DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS",null,"41830 - HC REMOVAL OF GUM TISSUE","41830 - HC REMOVAL OF GUM TISSUE","41830 - HC REMOVAL OF GUM TISSUE",null,"41112 - EXC LES TONGUE W/CLSR ANTERIOR TWO-THIRDS",null,null,null,null,"42100 - BIOPSY PALATE UVULA",null,"41112 - EXC LES TONGUE W/CLSR ANTERIOR TWO-THIRDS",null,null,"86696 - HC CHG ANTIBODY HERPES SMPLX TYPE 2","41874 - HC REPAIR TOOTH SOCKET"]
[null,"43752 - HC PLACEMENT NG/OG TUBE BY PHYSICIAN",null,"41850 - TREATMENT OF GUM LESION","41850 - TREATMENT OF GUM LESION","41850 - TREATMENT OF GUM LESION",null,"41113 - HC EXCIS TONGUE LESN,POST 1/3",null,null,null,null,"42104 - EXC LESION PALATE UVULA W/O CLOSURE",null,"41113 - HC EXCIS TONGUE LESN,POST 1/3",null,null,"86698 - HC CHG ANTIBODY HISTOPLASMA","42000 - HC DRAINAGE ABSCESS PALATE UVULA"]
[null,"43753 - GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE",null,"41874 - HC REPAIR TOOTH SOCKET","41874 - HC REPAIR TOOTH SOCKET","41874 - HC REPAIR TOOTH SOCKET",null,"41115 - EXCIISION LINGUAL FRENUM FRENECTOMY",null,null,null,null,"42106 - EXC LESION PALATE UVULA W/SMPL PRIM CLOSURE",null,"41115 - EXCIISION LINGUAL FRENUM FRENECTOMY",null,null,"86701 - HC HIV-1","42100 - BIOPSY PALATE UVULA"]
[null,"43754 - HC GASTRIC INTUBAT DX W/ASPIRATION SINGLE SPECIME",null,"42000 - HC DRAINAGE ABSCESS PALATE UVULA","42000 - HC DRAINAGE ABSCESS PALATE UVULA","42000 - HC DRAINAGE ABSCESS PALATE UVULA",null,"41116 - EXCISION LESION FLOOR MOUTH",null,null,null,null,"42120 - HC RESCJ PALATE/EXTENSIVE RESCJ LESION",null,"41116 - EXCISION LESION FLOOR MOUTH",null,null,"86702 - HC QL/SEMI MULT AB;HIV2","42104 - EXC LESION PALATE UVULA W/O CLOSURE"]
[null,"43761 - REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO",null,"42100 - BIOPSY PALATE UVULA","42100 - BIOPSY PALATE UVULA","42100 - BIOPSY PALATE UVULA",null,"41120 - HC PART REMOVAL TONGUE,<1/2",null,null,null,null,"42140 - HC UVULECTOMY EXCISION UVULA",null,"41120 - HC PART REMOVAL TONGUE,<1/2",null,null,"86703 - HC HIV 1/2 ANTIBODY","42106 - EXC LESION PALATE UVULA W/SMPL PRIM CLOSURE"]
[null,"43762 - HC RPLC GTUBE NO REVJ TRC",null,"42104 - EXC LESION PALATE UVULA W/O CLOSURE","42104 - EXC LESION PALATE UVULA W/O CLOSURE","42104 - EXC LESION PALATE UVULA W/O CLOSURE",null,"41250 - HC RLAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG",null,null,null,null,"42160 - HC DESTRUC LESN PALATE/UVULVA",null,"41250 - HC RLAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG",null,null,"86704 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB TOTAL","42120 - HC RESCJ PALATE/EXTENSIVE RESCJ LESION"]
[null,"43763 - HC RPLC GTUBE REVJ GSTRST TRC",null,"42106 - EXC LESION PALATE UVULA W/SMPL PRIM CLOSURE","42106 - EXC LESION PALATE UVULA W/SMPL PRIM CLOSURE","42106 - EXC LESION PALATE UVULA W/SMPL PRIM CLOSURE",null,"41251 - HC REPAIR TONGUE LACER,POST 1/3",null,null,null,null,"42180 - HC REPAIR PALATE LACER <2 CM",null,"41251 - HC REPAIR TONGUE LACER,POST 1/3",null,null,"86705 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY","42140 - HC UVULECTOMY EXCISION UVULA"]
[null,"43999 - ENDOSCOPIC ENDOLUMINAL GASTRIC PLICATION",null,"42120 - HC RESCJ PALATE/EXTENSIVE RESCJ LESION","42120 - HC RESCJ PALATE/EXTENSIVE RESCJ LESION","42120 - HC RESCJ PALATE/EXTENSIVE RESCJ LESION",null,"41252 - HC REPAIR TONGUE LACER,2.6 CM+/COMPLX",null,null,null,null,"42210 - HC RECONST CLEFT PALATE,BONE GRFT",null,"41252 - HC REPAIR TONGUE LACER,2.6 CM+/COMPLX",null,null,"86706 - HC CHG HEPATITIS B SURF ANTIBODY HBSAB","42160 - HC DESTRUC LESN PALATE/UVULVA"]
[null,"44180 - HC LAP, SURG ENTEROLYSIS",null,"42140 - HC UVULECTOMY EXCISION UVULA","42140 - HC UVULECTOMY EXCISION UVULA","42140 - HC UVULECTOMY EXCISION UVULA",null,"41800 - HC DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS",null,null,null,null,"42330 - SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL",null,"41800 - HC DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS",null,null,"86707 - HC CHG HEPATITIS BE ANTIBODY HBEAB","42180 - HC REPAIR PALATE LACER <2 CM"]
[null,"44360 - HC ENDOSCOPY UPPER SMALL INTESTINE",null,"42160 - HC DESTRUC LESN PALATE/UVULVA","42160 - HC DESTRUC LESN PALATE/UVULVA","42160 - HC DESTRUC LESN PALATE/UVULVA",null,"41820 - HC EXCISION, GUM, EACH QUADRANT",null,null,null,null,"42335 - HC REMOVAL SUBMAND STONE,COMPLICATED",null,"41820 - HC EXCISION, GUM, EACH QUADRANT",null,null,"86708 - HC CHG HEPATITIS A ANTIBODY HAAB","42210 - HC RECONST CLEFT PALATE,BONE GRFT"]
[null,"44361 - HC ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY",null,"42180 - HC REPAIR PALATE LACER <2 CM","42180 - HC REPAIR PALATE LACER <2 CM","42180 - HC REPAIR PALATE LACER <2 CM",null,"41821 - HC EXCISION OF GUM FLAP",null,null,null,null,"42400 - BIOPSY SALIVARY GLAND NEEDLE",null,"41821 - HC EXCISION OF GUM FLAP",null,null,"86709 - HC CHG HEPATITIS ANTIBODY HAAB IGM ANTIBODY","42330 - SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL"]
[null,"44363 - HC ENTEROSCOPY > 2ND PRTN W/RMVL FOREIGN BODY",null,"42210 - HC RECONST CLEFT PALATE,BONE GRFT","42210 - HC RECONST CLEFT PALATE,BONE GRFT","42210 - HC RECONST CLEFT PALATE,BONE GRFT",null,"41822 - EXCIS FIBROUS TUBER,DENTOALV",null,null,null,null,"42405 - BIOPSY SALIVARY GLAND INCISIONAL",null,"41822 - EXCIS FIBROUS TUBER,DENTOALV",null,null,"86710 - HC INFLUENZA VIRUS","42335 - HC REMOVAL SUBMAND STONE,COMPLICATED"]
[null,"44364 - HC ENTEROSCOPY > 2ND PRTN W/RMVL LESION SNARE.",null,"42330 - SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL","42330 - SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL","42330 - SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL",null,"41823 - HC EXCIS OSSEOUS TUBER,DENTOALV",null,null,null,null,"42408 - HC EXCISION SUBLING SALIVARY CYST",null,"41823 - HC EXCIS OSSEOUS TUBER,DENTOALV",null,null,"86735 - HC CHG ANTIBODY MUMPS","42400 - BIOPSY SALIVARY GLAND NEEDLE"]
[null,"44366 - HC ENTEROSCOPY > 2ND PRTN W/CONTROL BLEEDING",null,"42335 - HC REMOVAL SUBMAND STONE,COMPLICATED","42335 - HC REMOVAL SUBMAND STONE,COMPLICATED","42335 - HC REMOVAL SUBMAND STONE,COMPLICATED",null,"41825 - EXCISION OF GUM LESION",null,null,null,null,"42415 - HC EXC PAROTD,LAT LOBE,DISSECT 5TH NERV",null,"41825 - EXCISION OF GUM LESION",null,null,"86738 - HC CHG ANTIBODY MYCOPLSM","42405 - BIOPSY SALIVARY GLAND INCISIONAL"]
[null,"44369 - HC ENTEROSCOPY > 2ND PRTN ABLTJ LESION",null,"42400 - BIOPSY SALIVARY GLAND NEEDLE","42400 - BIOPSY SALIVARY GLAND NEEDLE","42400 - BIOPSY SALIVARY GLAND NEEDLE",null,"41826 - HC EXCIS DENTOALV LESN,SIMPL REPR",null,null,null,null,"42440 - HC EXCISION SUBMAXILLARY GLAND",null,"41826 - HC EXCIS DENTOALV LESN,SIMPL REPR",null,null,"86744 - HC CHG ANTIBODY NOCARDIA","42408 - HC EXCISION SUBLING SALIVARY CYST"]
[null,"44376 - HC ENTEROSC >2ND PRTN W/ILEUM W/WO COLLJ SPEC SPX",null,"42405 - BIOPSY SALIVARY GLAND INCISIONAL","42405 - BIOPSY SALIVARY GLAND INCISIONAL","42405 - BIOPSY SALIVARY GLAND INCISIONAL",null,"41830 - HC REMOVAL OF GUM TISSUE",null,null,null,null,"42450 - HC EXCISION SUBLINGUAL GLAND",null,"41830 - HC REMOVAL OF GUM TISSUE",null,null,"86747 - HC CHG ANTIBODY PARVOVIRUS","42415 - HC EXC PAROTD,LAT LOBE,DISSECT 5TH NERV"]
[null,"44377 - HC ENTEROSC >2ND PRTN W/ILEUM W/BX SINGLE/MULTIPLE",null,"42408 - HC EXCISION SUBLING SALIVARY CYST","42408 - HC EXCISION SUBLING SALIVARY CYST","42408 - HC EXCISION SUBLING SALIVARY CYST",null,"41850 - TREATMENT OF GUM LESION",null,null,null,null,"42500 - HC PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY PRIM",null,"41850 - TREATMENT OF GUM LESION",null,null,"86753 - HC CHG ANTIBODY PROTOZOA NES","42440 - HC EXCISION SUBMAXILLARY GLAND"]
[null,"44378 - HC ENTEROSCOPY > 2ND PRTN ILEUM CONTROL BLEEDING",null,"42415 - HC EXC PAROTD,LAT LOBE,DISSECT 5TH NERV","42415 - HC EXC PAROTD,LAT LOBE,DISSECT 5TH NERV","42415 - HC EXC PAROTD,LAT LOBE,DISSECT 5TH NERV",null,"41874 - HC REPAIR TOOTH SOCKET",null,null,null,null,"42505 - HC REPAIR SALIVARY DUCT COMPLICATED",null,"41874 - HC REPAIR TOOTH SOCKET",null,null,"86757 - HC CHG, RICKETTSIA","42450 - HC EXCISION SUBLINGUAL GLAND"]
[null,"44380 - HC ILEOSCOPY STOMA DX W/WO COLLJ SPEC BR/WA SPX",null,"42440 - HC EXCISION SUBMAXILLARY GLAND","42440 - HC EXCISION SUBMAXILLARY GLAND","42440 - HC EXCISION SUBMAXILLARY GLAND",null,"41899 - HC SUR REM TOOTH&BONE",null,null,null,null,"42700 - I&D ABSCESS PERITONSILLAR",null,"41899 - HC SUR REM TOOTH&BONE",null,null,"86762 - HC CHG ANTIBODY RUBELLA","42500 - HC PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY PRIM"]
[null,"44381 - HC ILEOSCOPY STOMA W/BALLOON DILATION",null,"42450 - HC EXCISION SUBLINGUAL GLAND","42450 - HC EXCISION SUBLINGUAL GLAND","42450 - HC EXCISION SUBLINGUAL GLAND",null,"42000 - HC DRAINAGE ABSCESS PALATE UVULA",null,null,null,null,"42720 - HC INC/DRAIN RETROPHARYNG ABSCESS,ORAL",null,"42000 - HC DRAINAGE ABSCESS PALATE UVULA",null,null,"86765 - HC CHG ANTIBODY RUBEOLA","42505 - HC REPAIR SALIVARY DUCT COMPLICATED"]
[null,"44382 - HC ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE",null,"42500 - HC PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY PRIM","42500 - HC PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY PRIM","42500 - HC PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY PRIM",null,"42100 - BIOPSY PALATE UVULA",null,null,null,null,"42725 - HC INC/DRAIN RETROPHARYNG ABSCESS,EXT",null,"42100 - BIOPSY PALATE UVULA",null,null,"86774 - HC CHG ANTIBODY TETANUS","42700 - I&D ABSCESS PERITONSILLAR"]
[null,"44384 - ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT",null,"42505 - HC REPAIR SALIVARY DUCT COMPLICATED","42505 - HC REPAIR SALIVARY DUCT COMPLICATED","42505 - HC REPAIR SALIVARY DUCT COMPLICATED",null,"42104 - EXC LESION PALATE UVULA W/O CLOSURE",null,null,null,null,"42800 - BIOPSY OROPHARYNX",null,"42104 - EXC LESION PALATE UVULA W/O CLOSURE",null,null,"86777 - HC CHG ANTIBODY TOXOPLASMA","42720 - HC INC/DRAIN RETROPHARYNG ABSCESS,ORAL"]
[null,"44385 - HC NDSC EVAL INTSTINAL POUCH DX W/WO COLLJ SPEC SPX",null,"42700 - I&D ABSCESS PERITONSILLAR","42700 - I&D ABSCESS PERITONSILLAR","42700 - I&D ABSCESS PERITONSILLAR",null,"42106 - EXC LESION PALATE UVULA W/SMPL PRIM CLOSURE",null,null,null,null,"42804 - BIOPSY NASOPHARYNX VISIBLE LESION SIMPLE",null,"42106 - EXC LESION PALATE UVULA W/SMPL PRIM CLOSURE",null,null,"86778 - HC Q;TOXOPLASMA IGM,AB","42725 - HC INC/DRAIN RETROPHARYNG ABSCESS,EXT"]
[null,"44386 - NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE",null,"42720 - HC INC/DRAIN RETROPHARYNG ABSCESS,ORAL","42720 - HC INC/DRAIN RETROPHARYNG ABSCESS,ORAL","42720 - HC INC/DRAIN RETROPHARYNG ABSCESS,ORAL",null,"42120 - HC RESCJ PALATE/EXTENSIVE RESCJ LESION",null,null,null,null,"42808 - EXCISION/DESTRUCTION LESION PHARYNX ANY METHOD",null,"42120 - HC RESCJ PALATE/EXTENSIVE RESCJ LESION",null,null,"86780 - HC CHG ANTIBODY TREPONEMA PALLIDUM","42800 - BIOPSY OROPHARYNX"]
[null,"44388 - HC COLONOSCOPY STOMA DX W/WO COLLJ SPEC SPX",null,"42725 - HC INC/DRAIN RETROPHARYNG ABSCESS,EXT","42725 - HC INC/DRAIN RETROPHARYNG ABSCESS,EXT","42725 - HC INC/DRAIN RETROPHARYNG ABSCESS,EXT",null,"42140 - HC UVULECTOMY EXCISION UVULA",null,null,null,null,"42809 - REMOVAL FOREIGN BODY PHARYNX",null,"42140 - HC UVULECTOMY EXCISION UVULA",null,null,"86787 - HC CHG ANTIBODY VARICELLA-ZOSTER","42804 - BIOPSY NASOPHARYNX VISIBLE LESION SIMPLE"]
[null,"44389 - HC COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE",null,"42800 - BIOPSY OROPHARYNX","42800 - BIOPSY OROPHARYNX","42800 - BIOPSY OROPHARYNX",null,"42160 - HC DESTRUC LESN PALATE/UVULVA",null,null,null,null,"42810 - EXC BRANCHIAL CLEFT CYST CONFINED SKN&SUBQ TIS",null,"42160 - HC DESTRUC LESN PALATE/UVULVA",null,null,"86788 - HC CHG ANTIBODY WEST NILE VIRUS IGM","42808 - EXCISION/DESTRUCTION LESION PHARYNX ANY METHOD"]
[null,"44391 - HC COLONOSCOPY STOMA CONTROL BLEEDING",null,"42804 - BIOPSY NASOPHARYNX VISIBLE LESION SIMPLE","42804 - BIOPSY NASOPHARYNX VISIBLE LESION SIMPLE","42804 - BIOPSY NASOPHARYNX VISIBLE LESION SIMPLE",null,"42180 - HC REPAIR PALATE LACER <2 CM",null,null,null,null,"42815 - HC EXCISION BRANC CLFT CYST,DEEP",null,"42180 - HC REPAIR PALATE LACER <2 CM",null,null,"86789 - HC CHG ANTIBODY WEST NILE VIRUS","42809 - REMOVAL FOREIGN BODY PHARYNX"]
[null,"44394 - HC COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE",null,"42808 - EXCISION/DESTRUCTION LESION PHARYNX ANY METHOD","42808 - EXCISION/DESTRUCTION LESION PHARYNX ANY METHOD","42808 - EXCISION/DESTRUCTION LESION PHARYNX ANY METHOD",null,"42210 - HC RECONST CLEFT PALATE,BONE GRFT",null,null,null,null,"42826 - TONSILLECTOMY ONE-HALF AGE 12/>",null,"42210 - HC RECONST CLEFT PALATE,BONE GRFT",null,null,"86790 - HC CHG ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED","42810 - EXC BRANCHIAL CLEFT CYST CONFINED SKN&SUBQ TIS"]
[null,"44404 - HC COLONOSCOPY STOMA W/SUBMUCOSAL INJECTION",null,"42809 - REMOVAL FOREIGN BODY PHARYNX","42809 - REMOVAL FOREIGN BODY PHARYNX","42809 - REMOVAL FOREIGN BODY PHARYNX",null,"42299 - HC PALATE/UVULA SURGERY UNLISTED",null,null,null,null,"42842 - HC RAD RESEC TONSIL/PILLARS",null,"42299 - HC PALATE/UVULA SURGERY UNLISTED",null,null,"86800 - HC CHG THYROGLOBULIN ANTIBODY","42815 - HC EXCISION BRANC CLFT CYST,DEEP"]
[null,"44405 - HC COLONOSCOPY STOMA W/BALLOON DILATION",null,"42810 - EXC BRANCHIAL CLEFT CYST CONFINED SKN&SUBQ TIS","42810 - EXC BRANCHIAL CLEFT CYST CONFINED SKN&SUBQ TIS","42810 - EXC BRANCHIAL CLEFT CYST CONFINED SKN&SUBQ TIS",null,"42330 - SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL",null,null,null,null,"42844 - HC RAD RESEC TONSIL/PILLARS,CLOS LOCAL",null,"42330 - SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL",null,null,"86803 - HC CHG HEPATITIS C ANTIBODY","42826 - TONSILLECTOMY ONE-HALF AGE 12/>"]
[null,"44406 - HR COLONOSCOPY STOMA W/ENDOSCOPIC ULTRASOUND EXAM",null,"42815 - HC EXCISION BRANC CLFT CYST,DEEP","42815 - HC EXCISION BRANC CLFT CYST,DEEP","42815 - HC EXCISION BRANC CLFT CYST,DEEP",null,"42335 - HC REMOVAL SUBMAND STONE,COMPLICATED",null,null,null,null,"42960 - HC CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE",null,"42335 - HC REMOVAL SUBMAND STONE,COMPLICATED",null,null,"86807 - HC CHG SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH","42842 - HC RAD RESEC TONSIL/PILLARS"]
[null,"44705 - PREPARE FECAL MICROBIOTA FOR INSTILLATION",null,"42826 - TONSILLECTOMY ONE-HALF AGE 12/>","42826 - TONSILLECTOMY ONE-HALF AGE 12/>","42826 - TONSILLECTOMY ONE-HALF AGE 12/>",null,"42400 - BIOPSY SALIVARY GLAND NEEDLE",null,null,null,null,"42970 - HC CTRL NASOPHARYNGEAL HEMRRG SMPL W/PST NSL PACKS",null,"42400 - BIOPSY SALIVARY GLAND NEEDLE",null,null,"86812 - HC CHG HLA TYPING A/B/C SINGLE ANTIGEN","42844 - HC RAD RESEC TONSIL/PILLARS,CLOS LOCAL"]
[null,"44799 - PR DILATION OF ILEOSTOMY STRICTURE",null,"42842 - HC RAD RESEC TONSIL/PILLARS","42842 - HC RAD RESEC TONSIL/PILLARS","42842 - HC RAD RESEC TONSIL/PILLARS",null,"42405 - BIOPSY SALIVARY GLAND INCISIONAL",null,null,null,null,"43191 - HC ESOPHAGOSCOPY RIGID TRANSORAL DIAGNOSTIC BRUSH",null,"42405 - BIOPSY SALIVARY GLAND INCISIONAL",null,null,"86813 - HC CHG HLA TYPING A/B/C MULTIPLE ANTIGENS","42960 - HC CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE"]
[null,"44970 - HC LAPAROSCOPIC APPENDECTOMY",null,"42844 - HC RAD RESEC TONSIL/PILLARS,CLOS LOCAL","42844 - HC RAD RESEC TONSIL/PILLARS,CLOS LOCAL","42844 - HC RAD RESEC TONSIL/PILLARS,CLOS LOCAL",null,"42408 - HC EXCISION SUBLING SALIVARY CYST",null,null,null,null,"43193 - HC ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY",null,"42408 - HC EXCISION SUBLING SALIVARY CYST",null,null,"86817 - HC CHG HLA TYPING DR/DQ MULTIPLE ANTIGENS","42970 - HC CTRL NASOPHARYNGEAL HEMRRG SMPL W/PST NSL PACKS"]
[null,"45005 - HC I&D RECTAL SUBMUCOSAL ABSCESS",null,"42960 - HC CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE","42960 - HC CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE","42960 - HC CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE",null,"42415 - HC EXC PAROTD,LAT LOBE,DISSECT 5TH NERV",null,null,null,null,"43195 - HC ESOPHAGOSCOPY RIGID TRANSORAL BALLOON DILATION",null,"42415 - HC EXC PAROTD,LAT LOBE,DISSECT 5TH NERV",null,null,"86880 - HC CHG ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM","43191 - HC ESOPHAGOSCOPY RIGID TRANSORAL DIAGNOSTIC BRUSH"]
[null,"45190 - HC DESTRUCT,RECTAL TUMOR,TRANSANAL APPROACH",null,"42970 - HC CTRL NASOPHARYNGEAL HEMRRG SMPL W/PST NSL PACKS","42970 - HC CTRL NASOPHARYNGEAL HEMRRG SMPL W/PST NSL PACKS","42970 - HC CTRL NASOPHARYNGEAL HEMRRG SMPL W/PST NSL PACKS",null,"42440 - HC EXCISION SUBMAXILLARY GLAND",null,null,null,null,"43197 - HC ESOPHAGOSCOPY FLEXIBLE TRANSNASAL DIAGNOSTIC",null,"42440 - HC EXCISION SUBMAXILLARY GLAND",null,null,"86886 - HC CHG ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER","43193 - HC ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY"]
[null,"45300 - PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX",null,"43191 - HC ESOPHAGOSCOPY RIGID TRANSORAL DIAGNOSTIC BRUSH","43191 - HC ESOPHAGOSCOPY RIGID TRANSORAL DIAGNOSTIC BRUSH","43191 - HC ESOPHAGOSCOPY RIGID TRANSORAL DIAGNOSTIC BRUSH",null,"42450 - HC EXCISION SUBLINGUAL GLAND",null,null,null,null,"43198 - ESOPHAGOSCOPY FLEXIBLE TRANSNASAL WITH BIOPSY",null,"42450 - HC EXCISION SUBLINGUAL GLAND",null,null,"86900 - HC CHG BLOOD TYPING SEROLOGIC ABO","43195 - HC ESOPHAGOSCOPY RIGID TRANSORAL BALLOON DILATION"]
[null,"45305 - HC PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE",null,"43193 - HC ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY","43193 - HC ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY","43193 - HC ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY",null,"42500 - HC PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY PRIM",null,null,null,null,"43200 - ESPHGSC RGD/FLX DX W/WO COLLJ SPEC BR/WA SPX",null,"42500 - HC PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY PRIM",null,null,"86901 - HC CHG BLOOD TYPING SEROLOGIC RH (D)","43197 - HC ESOPHAGOSCOPY FLEXIBLE TRANSNASAL DIAGNOSTIC"]
[null,"45307 - HC PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY",null,"43195 - HC ESOPHAGOSCOPY RIGID TRANSORAL BALLOON DILATION","43195 - HC ESOPHAGOSCOPY RIGID TRANSORAL BALLOON DILATION","43195 - HC ESOPHAGOSCOPY RIGID TRANSORAL BALLOON DILATION",null,"42505 - HC REPAIR SALIVARY DUCT COMPLICATED",null,null,null,null,"43201 - HC ESOPHAGOSCOPY FLEXIBLE TRANSORAL W SUBMUCOUS INJ",null,"42505 - HC REPAIR SALIVARY DUCT COMPLICATED",null,null,"86902 - HC CHG BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH","43198 - ESOPHAGOSCOPY FLEXIBLE TRANSNASAL WITH BIOPSY"]
[null,"45317 - HC PROCTOSIGMOIDOSCOPY BLEED",null,"43197 - HC ESOPHAGOSCOPY FLEXIBLE TRANSNASAL DIAGNOSTIC","43197 - HC ESOPHAGOSCOPY FLEXIBLE TRANSNASAL DIAGNOSTIC","43197 - HC ESOPHAGOSCOPY FLEXIBLE TRANSNASAL DIAGNOSTIC",null,"42699 - SIAOENDOSCOPY",null,null,null,null,"43202 - ESPHGSC RGD/FLX W/BIOPSY SINGLE/MULTIPLE",null,"42699 - SIAOENDOSCOPY",null,null,"86905 - HC CHG BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH","43200 - ESPHGSC RGD/FLX DX W/WO COLLJ SPEC BR/WA SPX"]
[null,"45330 - HC SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD",null,"43198 - ESOPHAGOSCOPY FLEXIBLE TRANSNASAL WITH BIOPSY","43198 - ESOPHAGOSCOPY FLEXIBLE TRANSNASAL WITH BIOPSY","43198 - ESOPHAGOSCOPY FLEXIBLE TRANSNASAL WITH BIOPSY",null,"42700 - I&D ABSCESS PERITONSILLAR",null,null,null,null,"43212 - HC ESOPHAGOSCOPY TRANSORAL STENT PLACEMENT",null,"42700 - I&D ABSCESS PERITONSILLAR",null,null,"87015 - HC CHG CONCENTRATION INFECTIOUS AGENTS","43201 - HC ESOPHAGOSCOPY FLEXIBLE TRANSORAL W SUBMUCOUS INJ"]
[null,"45331 - HC COLON CA SCREEN;BARIUM ENEMA",null,"43200 - ESPHGSC RGD/FLX DX W/WO COLLJ SPEC BR/WA SPX","43200 - ESPHGSC RGD/FLX DX W/WO COLLJ SPEC BR/WA SPX","43200 - ESPHGSC RGD/FLX DX W/WO COLLJ SPEC BR/WA SPX",null,"42720 - HC INC/DRAIN RETROPHARYNG ABSCESS,ORAL",null,null,null,null,"43215 - HC ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY",null,"42720 - HC INC/DRAIN RETROPHARYNG ABSCESS,ORAL",null,null,"87040 - HC CHG CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES","43202 - ESPHGSC RGD/FLX W/BIOPSY SINGLE/MULTIPLE"]
[null,"45332 - HC SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY",null,"43201 - HC ESOPHAGOSCOPY FLEXIBLE TRANSORAL W SUBMUCOUS INJ","43201 - HC ESOPHAGOSCOPY FLEXIBLE TRANSORAL W SUBMUCOUS INJ","43201 - HC ESOPHAGOSCOPY FLEXIBLE TRANSORAL W SUBMUCOUS INJ",null,"42725 - HC INC/DRAIN RETROPHARYNG ABSCESS,EXT",null,null,null,null,"43220 - HC ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM",null,"42725 - HC INC/DRAIN RETROPHARYNG ABSCESS,EXT",null,null,"87045 - HC CHG CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL","43212 - HC ESOPHAGOSCOPY TRANSORAL STENT PLACEMENT"]
[null,"45333 - HC SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS",null,"43202 - ESPHGSC RGD/FLX W/BIOPSY SINGLE/MULTIPLE","43202 - ESPHGSC RGD/FLX W/BIOPSY SINGLE/MULTIPLE","43202 - ESPHGSC RGD/FLX W/BIOPSY SINGLE/MULTIPLE",null,"42800 - BIOPSY OROPHARYNX",null,null,null,null,"43229 - HC ESOPHAGOSCOPY FLEX TRANSORAL LESION ABLATION",null,"42800 - BIOPSY OROPHARYNX",null,null,"87046 - HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA","43215 - HC ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY"]
[null,"45334 - HC SIGMOIDOSCOPY FLX CONTROL BLEEDING",null,"43215 - HC ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY","43215 - HC ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY","43215 - HC ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY",null,"42804 - BIOPSY NASOPHARYNX VISIBLE LESION SIMPLE",null,null,null,null,"43231 - HC ESPHGSC RGD/FLX W/NDSC ULTRASOUND EXAMINATION",null,"42804 - BIOPSY NASOPHARYNX VISIBLE LESION SIMPLE",null,null,"87070 - CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL","43220 - HC ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM"]
[null,"45335 - HC SGMDSC FLX DIRED SBMCSL NJX ANY SBST",null,"43220 - HC ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM","43220 - HC ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM","43220 - HC ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM",null,"42808 - EXCISION/DESTRUCTION LESION PHARYNX ANY METHOD",null,null,null,null,"43232 - HC ESPHGSC RGD/FLX W/TNDSC US-GID FINE NDL ASPIR/BX",null,"42808 - EXCISION/DESTRUCTION LESION PHARYNX ANY METHOD",null,null,"87075 - HC CHG CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID","43229 - HC ESOPHAGOSCOPY FLEX TRANSORAL LESION ABLATION"]
[null,"45337 - HC SGMDSC FLX DCMPRN VOLVULUS ANY METHOD",null,"43229 - HC ESOPHAGOSCOPY FLEX TRANSORAL LESION ABLATION","43229 - HC ESOPHAGOSCOPY FLEX TRANSORAL LESION ABLATION","43229 - HC ESOPHAGOSCOPY FLEX TRANSORAL LESION ABLATION",null,"42809 - REMOVAL FOREIGN BODY PHARYNX",null,null,null,null,"43235 - HC UPPER GI NDSC DX W/WO COLLECTION SPECIMEN",null,"42809 - REMOVAL FOREIGN BODY PHARYNX",null,null,"87076 - HC CHG CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL","43231 - HC ESPHGSC RGD/FLX W/NDSC ULTRASOUND EXAMINATION"]
[null,"45338 - HC SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ",null,"43231 - HC ESPHGSC RGD/FLX W/NDSC ULTRASOUND EXAMINATION","43231 - HC ESPHGSC RGD/FLX W/NDSC ULTRASOUND EXAMINATION","43231 - HC ESPHGSC RGD/FLX W/NDSC ULTRASOUND EXAMINATION",null,"42810 - EXC BRANCHIAL CLEFT CYST CONFINED SKN&SUBQ TIS",null,null,null,null,"43236 - HC UPPER GI NDSC W/SUBMUCOSAL INJECTION",null,"42810 - EXC BRANCHIAL CLEFT CYST CONFINED SKN&SUBQ TIS",null,null,"87077 - HC CHG CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL","43232 - HC ESPHGSC RGD/FLX W/TNDSC US-GID FINE NDL ASPIR/BX"]
[null,"45340 - HC SIGMOIDOSCOPY FLX DILAT BALO 1/MORE STRIXS",null,"43232 - HC ESPHGSC RGD/FLX W/TNDSC US-GID FINE NDL ASPIR/BX","43232 - HC ESPHGSC RGD/FLX W/TNDSC US-GID FINE NDL ASPIR/BX","43232 - HC ESPHGSC RGD/FLX W/TNDSC US-GID FINE NDL ASPIR/BX",null,"42815 - HC EXCISION BRANC CLFT CYST,DEEP",null,null,null,null,"43237 - UPR GI NDSC & US NDSC EXAM LMTD ESOPHAGUS",null,"42815 - HC EXCISION BRANC CLFT CYST,DEEP",null,null,"87081 - HC CULT,BACT,SCR,H PYLORI","43235 - HC UPPER GI NDSC DX W/WO COLLECTION SPECIMEN"]
[null,"45341 - HC SIGMOIDOSCOPY FLX NDSC US XM",null,"43235 - HC UPPER GI NDSC DX W/WO COLLECTION SPECIMEN","43235 - HC UPPER GI NDSC DX W/WO COLLECTION SPECIMEN","43235 - HC UPPER GI NDSC DX W/WO COLLECTION SPECIMEN",null,"42826 - TONSILLECTOMY ONE-HALF AGE 12/>",null,null,null,null,"43238 - HC UPR GI NDSC TNDSC US FINE NDL ASPIR/BX ESOPH",null,"42826 - TONSILLECTOMY ONE-HALF AGE 12/>",null,null,"87086 - HC CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE","43236 - HC UPPER GI NDSC W/SUBMUCOSAL INJECTION"]
[null,"45342 - HC SIGMOIDOSCOPY FLX TNDSC US GID NDL ASPIR/BX",null,"43236 - HC UPPER GI NDSC W/SUBMUCOSAL INJECTION","43236 - HC UPPER GI NDSC W/SUBMUCOSAL INJECTION","43236 - HC UPPER GI NDSC W/SUBMUCOSAL INJECTION",null,"42842 - HC RAD RESEC TONSIL/PILLARS",null,null,null,null,"43239 - HC UPPER NDSC BIOPSY SINGLE/MULTIPLE",null,"42842 - HC RAD RESEC TONSIL/PILLARS",null,null,"87088 - HC CHG CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE","43237 - UPR GI NDSC & US NDSC EXAM LMTD ESOPHAGUS"]
[null,"45346 - HC SIGMOIDOSCOPY FLX ABLATION TUMOR POLYP/OTH LES",null,"43237 - UPR GI NDSC & US NDSC EXAM LMTD ESOPHAGUS","43237 - UPR GI NDSC & US NDSC EXAM LMTD ESOPHAGUS","43237 - UPR GI NDSC & US NDSC EXAM LMTD ESOPHAGUS",null,"42844 - HC RAD RESEC TONSIL/PILLARS,CLOS LOCAL",null,null,null,null,"43240 - HC UPR GI NDSC TRANSMURAL DRAINAGE PSEUDOCYST",null,"42844 - HC RAD RESEC TONSIL/PILLARS,CLOS LOCAL",null,null,"87102 - HC CHG CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD","43238 - HC UPR GI NDSC TNDSC US FINE NDL ASPIR/BX ESOPH"]
[null,"45347 - HC SIGMOIDOSCOPY FLX PLACEMENT OF ENDOSCOPIC STENT",null,"43238 - HC UPR GI NDSC TNDSC US FINE NDL ASPIR/BX ESOPH","43238 - HC UPR GI NDSC TNDSC US FINE NDL ASPIR/BX ESOPH","43238 - HC UPR GI NDSC TNDSC US FINE NDL ASPIR/BX ESOPH",null,"42960 - HC CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE",null,null,null,null,"43241 - HC UPR GI NDSC TNDSC INTRALUMINAL TUBE/CATH PLMT",null,"42960 - HC CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE",null,null,"87103 - HC CHG CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD","43239 - HC UPPER NDSC BIOPSY SINGLE/MULTIPLE"]
[null,"45349 - SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION",null,"43239 - HC UPPER NDSC BIOPSY SINGLE/MULTIPLE","43239 - HC UPPER NDSC BIOPSY SINGLE/MULTIPLE","43239 - HC UPPER NDSC BIOPSY SINGLE/MULTIPLE",null,"42970 - HC CTRL NASOPHARYNGEAL HEMRRG SMPL W/PST NSL PACKS",null,null,null,null,"43242 - HC UPPER GI NDSC ULTRASOUND GUIDED BIOPSY",null,"42970 - HC CTRL NASOPHARYNGEAL HEMRRG SMPL W/PST NSL PACKS",null,null,"87106 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST","43240 - HC UPR GI NDSC TRANSMURAL DRAINAGE PSEUDOCYST"]
[null,"45350 - HC SIGMOIDOSCOPY FLX WITH WITH BAND LIGATION(S)",null,"43240 - HC UPR GI NDSC TRANSMURAL DRAINAGE PSEUDOCYST","43240 - HC UPR GI NDSC TRANSMURAL DRAINAGE PSEUDOCYST","43240 - HC UPR GI NDSC TRANSMURAL DRAINAGE PSEUDOCYST",null,"43191 - HC ESOPHAGOSCOPY RIGID TRANSORAL DIAGNOSTIC BRUSH",null,null,null,null,"43243 - HC UPR GI NDSC NJX SCLEROSIS ESOPHGL&/GSTR VARICE",null,"43191 - HC ESOPHAGOSCOPY RIGID TRANSORAL DIAGNOSTIC BRUSH",null,null,"87107 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD","43241 - HC UPR GI NDSC TNDSC INTRALUMINAL TUBE/CATH PLMT"]
[null,"45379 - HC COLSC FLX PROX SPLENIC FLXR RMVL FB",null,"43241 - HC UPR GI NDSC TNDSC INTRALUMINAL TUBE/CATH PLMT","43241 - HC UPR GI NDSC TNDSC INTRALUMINAL TUBE/CATH PLMT","43241 - HC UPR GI NDSC TNDSC INTRALUMINAL TUBE/CATH PLMT",null,"43193 - HC ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY",null,null,null,null,"43244 - HC UPR GI NDSC BAND LIG ESOPHGL&/GSTR VARICES",null,"43193 - HC ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY",null,null,"87110 - HC CHG CULTURE, CHLAMYDIA","43242 - HC UPPER GI NDSC ULTRASOUND GUIDED BIOPSY"]
[null,"45380 - COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",null,"43242 - HC UPPER GI NDSC ULTRASOUND GUIDED BIOPSY","43242 - HC UPPER GI NDSC ULTRASOUND GUIDED BIOPSY","43242 - HC UPPER GI NDSC ULTRASOUND GUIDED BIOPSY",null,"43195 - HC ESOPHAGOSCOPY RIGID TRANSORAL BALLOON DILATION",null,null,null,null,"43245 - HC UPR GI NDSC DILAT GSTR OUTLET FOR OBSTRCJ",null,"43195 - HC ESOPHAGOSCOPY RIGID TRANSORAL BALLOON DILATION",null,null,"87116 - HC CHG CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL","43243 - HC UPR GI NDSC NJX SCLEROSIS ESOPHGL&/GSTR VARICE"]
[null,"45381 - HC COLSC FLX PROX SPLENIC FLXR SBMCSL NJX",null,"43243 - HC UPR GI NDSC NJX SCLEROSIS ESOPHGL&/GSTR VARICE","43243 - HC UPR GI NDSC NJX SCLEROSIS ESOPHGL&/GSTR VARICE","43243 - HC UPR GI NDSC NJX SCLEROSIS ESOPHGL&/GSTR VARICE",null,"43197 - HC ESOPHAGOSCOPY FLEXIBLE TRANSNASAL DIAGNOSTIC",null,null,null,null,"43246 - HC UPR GI NDSC PLMT PRQ GASTROSTOMY TUBE",null,"43197 - HC ESOPHAGOSCOPY FLEXIBLE TRANSNASAL DIAGNOSTIC",null,null,"87118 - HC CHG CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL","43244 - HC UPR GI NDSC BAND LIG ESOPHGL&/GSTR VARICES"]
[null,"45382 - HC COLSC FLX PROX SPLENIC FLXR CTRL BLD",null,"43244 - HC UPR GI NDSC BAND LIG ESOPHGL&/GSTR VARICES","43244 - HC UPR GI NDSC BAND LIG ESOPHGL&/GSTR VARICES","43244 - HC UPR GI NDSC BAND LIG ESOPHGL&/GSTR VARICES",null,"43198 - ESOPHAGOSCOPY FLEXIBLE TRANSNASAL WITH BIOPSY",null,null,null,null,"43247 - HC UPPER GI NDSC W/FOREIGN BODY REMOVAL",null,"43198 - ESOPHAGOSCOPY FLEXIBLE TRANSNASAL WITH BIOPSY",null,null,"87140 - HC CHG CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM","43245 - HC UPR GI NDSC DILAT GSTR OUTLET FOR OBSTRCJ"]
[null,"45384 - HC COLSC FLX PROX SPLENIC FLXR RMVL LES CAUT",null,"43245 - HC UPR GI NDSC DILAT GSTR OUTLET FOR OBSTRCJ","43245 - HC UPR GI NDSC DILAT GSTR OUTLET FOR OBSTRCJ","43245 - HC UPR GI NDSC DILAT GSTR OUTLET FOR OBSTRCJ",null,"43200 - ESPHGSC RGD/FLX DX W/WO COLLJ SPEC BR/WA SPX",null,null,null,null,"43248 - HC UPR GI NDSC INSJ GUIDE WIRE DILAT ESOPHAGUS",null,"43200 - ESPHGSC RGD/FLX DX W/WO COLLJ SPEC BR/WA SPX",null,null,"87149 - HC CHG CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM","43246 - HC UPR GI NDSC PLMT PRQ GASTROSTOMY TUBE"]
[null,"45385 - HC COLSC FLX PROX SPLENIC FLXR RMVL LES SNARE TQ",null,"43246 - HC UPR GI NDSC PLMT PRQ GASTROSTOMY TUBE","43246 - HC UPR GI NDSC PLMT PRQ GASTROSTOMY TUBE","43246 - HC UPR GI NDSC PLMT PRQ GASTROSTOMY TUBE",null,"43201 - HC ESOPHAGOSCOPY FLEXIBLE TRANSORAL W SUBMUCOUS INJ",null,null,null,null,"43249 - HC UPR GI NDSC BALLOON DILAT ESOPH <30 MM DIAM",null,"43201 - HC ESOPHAGOSCOPY FLEXIBLE TRANSORAL W SUBMUCOUS INJ",null,null,"87150 - HC CHG CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM","43247 - HC UPPER GI NDSC W/FOREIGN BODY REMOVAL"]
[null,"45386 - HC COLSC FLX PROX SPLENIC FLXR DILAT BALO 1/> STRI",null,"43247 - HC UPPER GI NDSC W/FOREIGN BODY REMOVAL","43247 - HC UPPER GI NDSC W/FOREIGN BODY REMOVAL","43247 - HC UPPER GI NDSC W/FOREIGN BODY REMOVAL",null,"43202 - ESPHGSC RGD/FLX W/BIOPSY SINGLE/MULTIPLE",null,null,null,null,"43250 - HC UPR GI NDSC RMVL LESION HOT BX/BIPOLAR CAUTERY",null,"43202 - ESPHGSC RGD/FLX W/BIOPSY SINGLE/MULTIPLE",null,null,"87153 - HC Q;BACT ID,PHENO,SEQ","43248 - HC UPR GI NDSC INSJ GUIDE WIRE DILAT ESOPHAGUS"]
[null,"45388 - HC COLONOSCOPY FLX ABLATION TUMOR POLYP/OTHER LES",null,"43248 - HC UPR GI NDSC INSJ GUIDE WIRE DILAT ESOPHAGUS","43248 - HC UPR GI NDSC INSJ GUIDE WIRE DILAT ESOPHAGUS","43248 - HC UPR GI NDSC INSJ GUIDE WIRE DILAT ESOPHAGUS",null,"43212 - HC ESOPHAGOSCOPY TRANSORAL STENT PLACEMENT",null,null,null,null,"43251 - HC UPR GI NDSC RMVL TUM POLYP/OTH LES SNARE TQ",null,"43212 - HC ESOPHAGOSCOPY TRANSORAL STENT PLACEMENT",null,null,"87172 - HC CHG PINWORM EXAMINATION","43249 - HC UPR GI NDSC BALLOON DILAT ESOPH <30 MM DIAM"]
[null,"45389 - HC COLONOSCOPY FLX WITH ENDOSCOPIC STENT PLACEMENT",null,"43249 - HC UPR GI NDSC BALLOON DILAT ESOPH <30 MM DIAM","43249 - HC UPR GI NDSC BALLOON DILAT ESOPH <30 MM DIAM","43249 - HC UPR GI NDSC BALLOON DILAT ESOPH <30 MM DIAM",null,"43215 - HC ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY",null,null,null,null,"43253 - HC EGD US GUIDED TRANSMURAL INJXN/FIDUCIAL MARKER E",null,"43215 - HC ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY",null,null,"87176 - HC CHG HOMOGENIZATION TISSUE CULTURE","43250 - HC UPR GI NDSC RMVL LESION HOT BX/BIPOLAR CAUTERY"]
[null,"45390 - HC COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION",null,"43250 - HC UPR GI NDSC RMVL LESION HOT BX/BIPOLAR CAUTERY","43250 - HC UPR GI NDSC RMVL LESION HOT BX/BIPOLAR CAUTERY","43250 - HC UPR GI NDSC RMVL LESION HOT BX/BIPOLAR CAUTERY",null,"43220 - HC ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM",null,null,null,null,"43254 - HC EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION",null,"43220 - HC ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM",null,null,"87177 - HC CHG OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID","43251 - HC UPR GI NDSC RMVL TUM POLYP/OTH LES SNARE TQ"]
[null,"45391 - HC COLSC FLX PROX SPLENIC FLXR NDSC US XM",null,"43251 - HC UPR GI NDSC RMVL TUM POLYP/OTH LES SNARE TQ","43251 - HC UPR GI NDSC RMVL TUM POLYP/OTH LES SNARE TQ","43251 - HC UPR GI NDSC RMVL TUM POLYP/OTH LES SNARE TQ",null,"43229 - HC ESOPHAGOSCOPY FLEX TRANSORAL LESION ABLATION",null,null,null,null,"43255 - HC UPR GI NDSC CONTROL BLEEDING ANY METHOD",null,"43229 - HC ESOPHAGOSCOPY FLEX TRANSORAL LESION ABLATION",null,null,"87181 - HC CHG SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ","43253 - HC EGD US GUIDED TRANSMURAL INJXN/FIDUCIAL MARKER E"]
[null,"45392 - HC COLSC FLX PROX SPLENIC FLXR US GID NDL ASPIR/BX",null,"43253 - HC EGD US GUIDED TRANSMURAL INJXN/FIDUCIAL MARKER E","43253 - HC EGD US GUIDED TRANSMURAL INJXN/FIDUCIAL MARKER E","43253 - HC EGD US GUIDED TRANSMURAL INJXN/FIDUCIAL MARKER E",null,"43231 - HC ESPHGSC RGD/FLX W/NDSC ULTRASOUND EXAMINATION",null,null,null,null,"43257 - HC UPR GI NDSC DLVR THERMAL NRG SPHNCTR/CARDIA",null,"43231 - HC ESPHGSC RGD/FLX W/NDSC ULTRASOUND EXAMINATION",null,null,"87184 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD","43254 - HC EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION"]
[null,"45398 - HC COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S)",null,"43254 - HC EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION","43254 - HC EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION","43254 - HC EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION",null,"43232 - HC ESPHGSC RGD/FLX W/TNDSC US-GID FINE NDL ASPIR/BX",null,null,null,null,"43259 - HC UPPER GI NDSC W/NDSC ULTRASOUND EXAM",null,"43232 - HC ESPHGSC RGD/FLX W/TNDSC US-GID FINE NDL ASPIR/BX",null,null,"87185 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ","43255 - HC UPR GI NDSC CONTROL BLEEDING ANY METHOD"]
[null,"45910 - HC DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL",null,"43255 - HC UPR GI NDSC CONTROL BLEEDING ANY METHOD","43255 - HC UPR GI NDSC CONTROL BLEEDING ANY METHOD","43255 - HC UPR GI NDSC CONTROL BLEEDING ANY METHOD",null,"43235 - HC UPPER GI NDSC DX W/WO COLLECTION SPECIMEN",null,null,null,null,"43260 - HC ERCP DX W/WO COLLJ SPEC BRUSHING/WASHING SPX",null,"43235 - HC UPPER GI NDSC DX W/WO COLLECTION SPECIMEN",null,null,"87186 - HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ","43257 - HC UPR GI NDSC DLVR THERMAL NRG SPHNCTR/CARDIA"]
[null,"45915 - HC REMV RECTAL OBSTR:FECES/F.B. W ANEST",null,"43257 - HC UPR GI NDSC DLVR THERMAL NRG SPHNCTR/CARDIA","43257 - HC UPR GI NDSC DLVR THERMAL NRG SPHNCTR/CARDIA","43257 - HC UPR GI NDSC DLVR THERMAL NRG SPHNCTR/CARDIA",null,"43236 - HC UPPER GI NDSC W/SUBMUCOSAL INJECTION",null,null,null,null,"43261 - HC ERCP W/BIOPSY SINGLE/MULTIPLE",null,"43236 - HC UPPER GI NDSC W/SUBMUCOSAL INJECTION",null,null,"87188 - HC CHG SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT","43259 - HC UPPER GI NDSC W/NDSC ULTRASOUND EXAM"]
[null,"46020 - PLACEMENT ON SETON",null,"43259 - HC UPPER GI NDSC W/NDSC ULTRASOUND EXAM","43259 - HC UPPER GI NDSC W/NDSC ULTRASOUND EXAM","43259 - HC UPPER GI NDSC W/NDSC ULTRASOUND EXAM",null,"43237 - UPR GI NDSC & US NDSC EXAM LMTD ESOPHAGUS",null,null,null,null,"43262 - HC ERCP W/SPHINCTEROTOMY/PAPILLOTOMY",null,"43237 - UPR GI NDSC & US NDSC EXAM LMTD ESOPHAGUS",null,null,"87205 - HC CHG SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL","43260 - HC ERCP DX W/WO COLLJ SPEC BRUSHING/WASHING SPX"]
[null,"46030 - REMOVAL OF RECTAL MARKER",null,"43260 - HC ERCP DX W/WO COLLJ SPEC BRUSHING/WASHING SPX","43260 - HC ERCP DX W/WO COLLJ SPEC BRUSHING/WASHING SPX","43260 - HC ERCP DX W/WO COLLJ SPEC BRUSHING/WASHING SPX",null,"43238 - HC UPR GI NDSC TNDSC US FINE NDL ASPIR/BX ESOPH",null,null,null,null,"43264 - HC ERCP W/RMVCALCULI BILIARY&/PANCREATIC DUCTS",null,"43238 - HC UPR GI NDSC TNDSC US FINE NDL ASPIR/BX ESOPH",null,null,"87206 - HC CHG SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT","43261 - HC ERCP W/BIOPSY SINGLE/MULTIPLE"]
[null,"46040 - I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX",null,"43261 - HC ERCP W/BIOPSY SINGLE/MULTIPLE","43261 - HC ERCP W/BIOPSY SINGLE/MULTIPLE","43261 - HC ERCP W/BIOPSY SINGLE/MULTIPLE",null,"43239 - HC UPPER NDSC BIOPSY SINGLE/MULTIPLE",null,null,null,null,"43265 - HC ERCP W/DSTRJ LITHOTRIPSY CALCULI ANY METHOD",null,"43239 - HC UPPER NDSC BIOPSY SINGLE/MULTIPLE",null,null,"87207 - SMR PRIM SRC SPEC STAIN BODIES/PARASITS","43262 - HC ERCP W/SPHINCTEROTOMY/PAPILLOTOMY"]
[null,"46050 - I&D PERIANAL ABSCESS SUPERFICIAL",null,"43262 - HC ERCP W/SPHINCTEROTOMY/PAPILLOTOMY","43262 - HC ERCP W/SPHINCTEROTOMY/PAPILLOTOMY","43262 - HC ERCP W/SPHINCTEROTOMY/PAPILLOTOMY",null,"43240 - HC UPR GI NDSC TRANSMURAL DRAINAGE PSEUDOCYST",null,null,null,null,"43266 - HC EGD ENDOSCOPIC STENT PLACEMENT W/WIRE& DILATION",null,"43240 - HC UPR GI NDSC TRANSMURAL DRAINAGE PSEUDOCYST",null,null,"87209 - HC CHG SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS","43264 - HC ERCP W/RMVCALCULI BILIARY&/PANCREATIC DUCTS"]
[null,"46060 - I&D ISCHIORCT/INTRAMURAL ABSC W/WO SETON",null,"43264 - HC ERCP W/RMVCALCULI BILIARY&/PANCREATIC DUCTS","43264 - HC ERCP W/RMVCALCULI BILIARY&/PANCREATIC DUCTS","43264 - HC ERCP W/RMVCALCULI BILIARY&/PANCREATIC DUCTS",null,"43241 - HC UPR GI NDSC TNDSC INTRALUMINAL TUBE/CATH PLMT",null,null,null,null,"43270 - HC EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE",null,"43241 - HC UPR GI NDSC TNDSC INTRALUMINAL TUBE/CATH PLMT",null,null,"87210 - SMR PRIM SRC WET MOUNT NFCT AGT","43265 - HC ERCP W/DSTRJ LITHOTRIPSY CALCULI ANY METHOD"]
[null,"46083 - INCISION THROMBOSED HEMORRHOID EXTERNAL",null,"43265 - HC ERCP W/DSTRJ LITHOTRIPSY CALCULI ANY METHOD","43265 - HC ERCP W/DSTRJ LITHOTRIPSY CALCULI ANY METHOD","43265 - HC ERCP W/DSTRJ LITHOTRIPSY CALCULI ANY METHOD",null,"43242 - HC UPPER GI NDSC ULTRASOUND GUIDED BIOPSY",null,null,null,null,"43273 - HC ENDOSCOPIC PAPILLA CANNULATION BILE PANCREATIC",null,"43242 - HC UPPER GI NDSC ULTRASOUND GUIDED BIOPSY",null,null,"87220 - TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT","43266 - HC EGD ENDOSCOPIC STENT PLACEMENT W/WIRE& DILATION"]
[null,"46220 - EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS",null,"43266 - HC EGD ENDOSCOPIC STENT PLACEMENT W/WIRE& DILATION","43266 - HC EGD ENDOSCOPIC STENT PLACEMENT W/WIRE& DILATION","43266 - HC EGD ENDOSCOPIC STENT PLACEMENT W/WIRE& DILATION",null,"43243 - HC UPR GI NDSC NJX SCLEROSIS ESOPHGL&/GSTR VARICE",null,null,null,null,"43274 - HC ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT",null,"43243 - HC UPR GI NDSC NJX SCLEROSIS ESOPHGL&/GSTR VARICE",null,null,"87252 - HC CHG VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT","43270 - HC EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE"]
[null,"46221 - HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS",null,"43270 - HC EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE","43270 - HC EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE","43270 - HC EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE",null,"43244 - HC UPR GI NDSC BAND LIG ESOPHGL&/GSTR VARICES",null,null,null,null,"43275 - HC ERCP REMOVE FOREIGN BODY/STENT BILIARY/PANC DUCT",null,"43244 - HC UPR GI NDSC BAND LIG ESOPHGL&/GSTR VARICES",null,null,"87253 - HC CHG VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE","43273 - HC ENDOSCOPIC PAPILLA CANNULATION BILE PANCREATIC"]
[null,"46250 - HC HEMORRHOIDECTOMY,EXTERNAL, 2+ COLUMNS/GROUPS",null,"43273 - HC ENDOSCOPIC PAPILLA CANNULATION BILE PANCREATIC","43273 - HC ENDOSCOPIC PAPILLA CANNULATION BILE PANCREATIC","43273 - HC ENDOSCOPIC PAPILLA CANNULATION BILE PANCREATIC",null,"43245 - HC UPR GI NDSC DILAT GSTR OUTLET FOR OBSTRCJ",null,null,null,null,"43276 - HC ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE",null,"43245 - HC UPR GI NDSC DILAT GSTR OUTLET FOR OBSTRCJ",null,null,"87254 - HC CHG VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA","43274 - HC ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT"]
[null,"46255 - HC HEMORRHOIDECTOMY,INT/EXT,1 COLUMN/GROUP",null,"43274 - HC ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT","43274 - HC ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT","43274 - HC ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT",null,"43246 - HC UPR GI NDSC PLMT PRQ GASTROSTOMY TUBE",null,null,null,null,"43277 - HC ERCP BALLOON DILATE BILIARY/PANC DUCT/AMPULLA EA",null,"43246 - HC UPR GI NDSC PLMT PRQ GASTROSTOMY TUBE",null,null,"87255 - HC CHG VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC","43275 - HC ERCP REMOVE FOREIGN BODY/STENT BILIARY/PANC DUCT"]
[null,"46260 - HC HEMORRHOIDECTOMY INT & XTRNL 2/> COLUMN/GRO",null,"43275 - HC ERCP REMOVE FOREIGN BODY/STENT BILIARY/PANC DUCT","43275 - HC ERCP REMOVE FOREIGN BODY/STENT BILIARY/PANC DUCT","43275 - HC ERCP REMOVE FOREIGN BODY/STENT BILIARY/PANC DUCT",null,"43247 - HC UPPER GI NDSC W/FOREIGN BODY REMOVAL",null,null,null,null,"43278 - HC ERCP LESION ABLATE W/DILATE",null,"43247 - HC UPPER GI NDSC W/FOREIGN BODY REMOVAL",null,null,"87260 - HC CHG IAADI ADENOVIRUS","43276 - HC ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE"]
[null,"46320 - HC EXCISION THROMBOSED HEMORRHOID, EXTERNAL",null,"43276 - HC ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE","43276 - HC ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE","43276 - HC ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE",null,"43248 - HC UPR GI NDSC INSJ GUIDE WIRE DILAT ESOPHAGUS",null,null,null,null,"43450 - HC DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS",null,"43248 - HC UPR GI NDSC INSJ GUIDE WIRE DILAT ESOPHAGUS",null,null,"87269 - HC CHG IAADI GIARDIA","43277 - HC ERCP BALLOON DILATE BILIARY/PANC DUCT/AMPULLA EA"]
[null,"46505 - CHEMODENERVATION ANAL SPHINCTER",null,"43277 - HC ERCP BALLOON DILATE BILIARY/PANC DUCT/AMPULLA EA","43277 - HC ERCP BALLOON DILATE BILIARY/PANC DUCT/AMPULLA EA","43277 - HC ERCP BALLOON DILATE BILIARY/PANC DUCT/AMPULLA EA",null,"43249 - HC UPR GI NDSC BALLOON DILAT ESOPH <30 MM DIAM",null,null,null,null,"43752 - HC PLACEMENT NG/OG TUBE BY PHYSICIAN",null,"43249 - HC UPR GI NDSC BALLOON DILAT ESOPH <30 MM DIAM",null,null,"87272 - HC CHG IAADI CRYPTOSPORIDIUM","43278 - HC ERCP LESION ABLATE W/DILATE"]
[null,"46600 - ANOSCOPY DX W/WO COLLJ SPEC BR/WA SPX",null,"43278 - HC ERCP LESION ABLATE W/DILATE","43278 - HC ERCP LESION ABLATE W/DILATE","43278 - HC ERCP LESION ABLATE W/DILATE",null,"43250 - HC UPR GI NDSC RMVL LESION HOT BX/BIPOLAR CAUTERY",null,null,null,null,"43753 - GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE",null,"43250 - HC UPR GI NDSC RMVL LESION HOT BX/BIPOLAR CAUTERY",null,null,"87275 - HC CHG IAADI INFLUENZA B VIRUS","43450 - HC DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS"]
[null,"46601 - HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT",null,"43450 - HC DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS","43450 - HC DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS","43450 - HC DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS",null,"43251 - HC UPR GI NDSC RMVL TUM POLYP/OTH LES SNARE TQ",null,null,null,null,"43754 - HC GASTRIC INTUBAT DX W/ASPIRATION SINGLE SPECIME",null,"43251 - HC UPR GI NDSC RMVL TUM POLYP/OTH LES SNARE TQ",null,null,"87276 - HC CHG IAADI INFFLUENZA A VIRUS","43752 - HC PLACEMENT NG/OG TUBE BY PHYSICIAN"]
[null,"46604 - HC ANOSCOPY,W/DILATION",null,"43752 - HC PLACEMENT NG/OG TUBE BY PHYSICIAN","43752 - HC PLACEMENT NG/OG TUBE BY PHYSICIAN","43752 - HC PLACEMENT NG/OG TUBE BY PHYSICIAN",null,"43253 - HC EGD US GUIDED TRANSMURAL INJXN/FIDUCIAL MARKER E",null,null,null,null,"43761 - REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO",null,"43253 - HC EGD US GUIDED TRANSMURAL INJXN/FIDUCIAL MARKER E",null,null,"87279 - HC CHG IAADI PARAINFLUENZA VIRUS EACH TYPE","43753 - GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE"]
[null,"46606 - ANOSCOPY W/BX SINGLE/MULTIPLE",null,"43753 - GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE","43753 - GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE","43753 - GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE",null,"43254 - HC EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION",null,null,null,null,"43762 - HC RPLC GTUBE NO REVJ TRC",null,"43254 - HC EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION",null,null,"87281 - HC CHG IAADI PNEUMOCUSTIS CARINII","43754 - HC GASTRIC INTUBAT DX W/ASPIRATION SINGLE SPECIME"]
[null,"46607 - HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT W/BX",null,"43754 - HC GASTRIC INTUBAT DX W/ASPIRATION SINGLE SPECIME","43754 - HC GASTRIC INTUBAT DX W/ASPIRATION SINGLE SPECIME","43754 - HC GASTRIC INTUBAT DX W/ASPIRATION SINGLE SPECIME",null,"43255 - HC UPR GI NDSC CONTROL BLEEDING ANY METHOD",null,null,null,null,"43763 - HC RPLC GTUBE REVJ GSTRST TRC",null,"43255 - HC UPR GI NDSC CONTROL BLEEDING ANY METHOD",null,null,"87299 - HC CHG AG DETECTION NOS, FLUOR","43761 - REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO"]
[null,"46608 - HC ANOSCOPY,REMOVE FOREIGN BODY",null,"43761 - REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO","43761 - REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO","43761 - REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO",null,"43257 - HC UPR GI NDSC DLVR THERMAL NRG SPHNCTR/CARDIA",null,null,null,null,"44180 - HC LAP, SURG ENTEROLYSIS",null,"43257 - HC UPR GI NDSC DLVR THERMAL NRG SPHNCTR/CARDIA",null,null,"87305 - HC CHG IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS","43762 - HC RPLC GTUBE NO REVJ TRC"]
[null,"46610 - HC ANOSCOPY W/RMVL LESION CAUTERY",null,"43762 - HC RPLC GTUBE NO REVJ TRC","43762 - HC RPLC GTUBE NO REVJ TRC","43762 - HC RPLC GTUBE NO REVJ TRC",null,"43259 - HC UPPER GI NDSC W/NDSC ULTRASOUND EXAM",null,null,null,null,"44360 - HC ENDOSCOPY UPPER SMALL INTESTINE",null,"43259 - HC UPPER GI NDSC W/NDSC ULTRASOUND EXAM",null,null,"87324 - HC CHG IAAD IA CLOSTRIDIUM DIFFICILE TOXIN","43763 - HC RPLC GTUBE REVJ GSTRST TRC"]
[null,"46615 - ANOSCOPY ABLATION LESION",null,"43763 - HC RPLC GTUBE REVJ GSTRST TRC","43763 - HC RPLC GTUBE REVJ GSTRST TRC","43763 - HC RPLC GTUBE REVJ GSTRST TRC",null,"43260 - HC ERCP DX W/WO COLLJ SPEC BRUSHING/WASHING SPX",null,null,null,null,"44361 - HC ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY",null,"43260 - HC ERCP DX W/WO COLLJ SPEC BRUSHING/WASHING SPX",null,null,"87327 - HC CHG IAAD IA CRYPTOCOCCUS NEOFORMANS","44180 - HC LAP, SURG ENTEROLYSIS"]
[null,"46900 - DSTRJ LESION ANUS SIMPLE CHEMICAL",null,"44180 - HC LAP, SURG ENTEROLYSIS","44180 - HC LAP, SURG ENTEROLYSIS","44180 - HC LAP, SURG ENTEROLYSIS",null,"43261 - HC ERCP W/BIOPSY SINGLE/MULTIPLE",null,null,null,null,"44363 - HC ENTEROSCOPY > 2ND PRTN W/RMVL FOREIGN BODY",null,"43261 - HC ERCP W/BIOPSY SINGLE/MULTIPLE",null,null,"87338 - HC CHG IAAD IA HPYLORI STOOL","44360 - HC ENDOSCOPY UPPER SMALL INTESTINE"]
[null,"46910 - DSTRJ LESION ANUS SMPL ELTRDSICCATION",null,"44360 - HC ENDOSCOPY UPPER SMALL INTESTINE","44360 - HC ENDOSCOPY UPPER SMALL INTESTINE","44360 - HC ENDOSCOPY UPPER SMALL INTESTINE",null,"43262 - HC ERCP W/SPHINCTEROTOMY/PAPILLOTOMY",null,null,null,null,"44364 - HC ENTEROSCOPY > 2ND PRTN W/RMVL LESION SNARE.",null,"43262 - HC ERCP W/SPHINCTEROTOMY/PAPILLOTOMY",null,null,"87340 - HC CHG IAAD IA HEPATITIS B SURFACE ANTIGEN","44361 - HC ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY"]
[null,"46916 - DSTRJ LESION ANUS SIMPLE CRYOSURGERY",null,"44361 - HC ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY","44361 - HC ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY","44361 - HC ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY",null,"43264 - HC ERCP W/RMVCALCULI BILIARY&/PANCREATIC DUCTS",null,null,null,null,"44366 - HC ENTEROSCOPY > 2ND PRTN W/CONTROL BLEEDING",null,"43264 - HC ERCP W/RMVCALCULI BILIARY&/PANCREATIC DUCTS",null,null,"87341 - HC CHG IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION","44363 - HC ENTEROSCOPY > 2ND PRTN W/RMVL FOREIGN BODY"]
[null,"46922 - HC SURG EXCISION OF ANAL LESION(S)",null,"44363 - HC ENTEROSCOPY > 2ND PRTN W/RMVL FOREIGN BODY","44363 - HC ENTEROSCOPY > 2ND PRTN W/RMVL FOREIGN BODY","44363 - HC ENTEROSCOPY > 2ND PRTN W/RMVL FOREIGN BODY",null,"43265 - HC ERCP W/DSTRJ LITHOTRIPSY CALCULI ANY METHOD",null,null,null,null,"44369 - HC ENTEROSCOPY > 2ND PRTN ABLTJ LESION",null,"43265 - HC ERCP W/DSTRJ LITHOTRIPSY CALCULI ANY METHOD",null,null,"87350 - HC CHG IAAD IA HEPATITIS BE ANTIGEN","44364 - HC ENTEROSCOPY > 2ND PRTN W/RMVL LESION SNARE."]
[null,"46924 - DSTRJ LESION ANUS EXTENSIVE",null,"44364 - HC ENTEROSCOPY > 2ND PRTN W/RMVL LESION SNARE.","44364 - HC ENTEROSCOPY > 2ND PRTN W/RMVL LESION SNARE.","44364 - HC ENTEROSCOPY > 2ND PRTN W/RMVL LESION SNARE.",null,"43266 - HC EGD ENDOSCOPIC STENT PLACEMENT W/WIRE& DILATION",null,null,null,null,"44376 - HC ENTEROSC >2ND PRTN W/ILEUM W/WO COLLJ SPEC SPX",null,"43266 - HC EGD ENDOSCOPIC STENT PLACEMENT W/WIRE& DILATION",null,null,"87385 - HC CHG IAAD IA HISTOPLASM CAPSULATUM","44366 - HC ENTEROSCOPY > 2ND PRTN W/CONTROL BLEEDING"]
[null,"47000 - HEARING AID EXAMINATION & SELECTION MONAURAL",null,"44366 - HC ENTEROSCOPY > 2ND PRTN W/CONTROL BLEEDING","44366 - HC ENTEROSCOPY > 2ND PRTN W/CONTROL BLEEDING","44366 - HC ENTEROSCOPY > 2ND PRTN W/CONTROL BLEEDING",null,"43270 - HC EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE",null,null,null,null,"44377 - HC ENTEROSC >2ND PRTN W/ILEUM W/BX SINGLE/MULTIPLE",null,"43270 - HC EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE",null,null,"87390 - HC CHG IAAD IA HIV-1","44369 - HC ENTEROSCOPY > 2ND PRTN ABLTJ LESION"]
[null,"47001 - HC BIO,LIVER AT OTH PROC",null,"44369 - HC ENTEROSCOPY > 2ND PRTN ABLTJ LESION","44369 - HC ENTEROSCOPY > 2ND PRTN ABLTJ LESION","44369 - HC ENTEROSCOPY > 2ND PRTN ABLTJ LESION",null,"43273 - HC ENDOSCOPIC PAPILLA CANNULATION BILE PANCREATIC",null,null,null,null,"44378 - HC ENTEROSCOPY > 2ND PRTN ILEUM CONTROL BLEEDING",null,"43273 - HC ENDOSCOPIC PAPILLA CANNULATION BILE PANCREATIC",null,null,"87391 - HC CHG IAAD IA HIV-2","44376 - HC ENTEROSC >2ND PRTN W/ILEUM W/WO COLLJ SPEC SPX"]
[null,"47382 - HC ABLTJ 1/> LVR TUM PRQ RF",null,"44376 - HC ENTEROSC >2ND PRTN W/ILEUM W/WO COLLJ SPEC SPX","44376 - HC ENTEROSC >2ND PRTN W/ILEUM W/WO COLLJ SPEC SPX","44376 - HC ENTEROSC >2ND PRTN W/ILEUM W/WO COLLJ SPEC SPX",null,"43274 - HC ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT",null,null,null,null,"44380 - HC ILEOSCOPY STOMA DX W/WO COLLJ SPEC BR/WA SPX",null,"43274 - HC ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT",null,null,"87400 - HC CHG IAAD IA INFLUENZA A/B EACH","44377 - HC ENTEROSC >2ND PRTN W/ILEUM W/BX SINGLE/MULTIPLE"]
[null,"47383 - HC ABLATION 1/> LIVER TUMOR PERQ CRYOABLATION",null,"44377 - HC ENTEROSC >2ND PRTN W/ILEUM W/BX SINGLE/MULTIPLE","44377 - HC ENTEROSC >2ND PRTN W/ILEUM W/BX SINGLE/MULTIPLE","44377 - HC ENTEROSC >2ND PRTN W/ILEUM W/BX SINGLE/MULTIPLE",null,"43275 - HC ERCP REMOVE FOREIGN BODY/STENT BILIARY/PANC DUCT",null,null,null,null,"44381 - HC ILEOSCOPY STOMA W/BALLOON DILATION",null,"43275 - HC ERCP REMOVE FOREIGN BODY/STENT BILIARY/PANC DUCT",null,null,"87420 - HC CHG IAAD IA RESPIRATORY SYNCTIAL VIRUS","44378 - HC ENTEROSCOPY > 2ND PRTN ILEUM CONTROL BLEEDING"]
[null,"47531 - NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS",null,"44378 - HC ENTEROSCOPY > 2ND PRTN ILEUM CONTROL BLEEDING","44378 - HC ENTEROSCOPY > 2ND PRTN ILEUM CONTROL BLEEDING","44378 - HC ENTEROSCOPY > 2ND PRTN ILEUM CONTROL BLEEDING",null,"43276 - HC ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE",null,null,null,null,"44382 - HC ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE",null,"43276 - HC ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE",null,null,"87425 - HC CHG IAAD IA ROTAVIRUS","44380 - HC ILEOSCOPY STOMA DX W/WO COLLJ SPEC BR/WA SPX"]
[null,"47532 - NJX CHOLANGIO PRQ W/IMG GID RS&I NEW ACCESS",null,"44380 - HC ILEOSCOPY STOMA DX W/WO COLLJ SPEC BR/WA SPX","44380 - HC ILEOSCOPY STOMA DX W/WO COLLJ SPEC BR/WA SPX","44380 - HC ILEOSCOPY STOMA DX W/WO COLLJ SPEC BR/WA SPX",null,"43277 - HC ERCP BALLOON DILATE BILIARY/PANC DUCT/AMPULLA EA",null,null,null,null,"44384 - ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT",null,"43277 - HC ERCP BALLOON DILATE BILIARY/PANC DUCT/AMPULLA EA",null,null,"87430 - HC CHG IAAD IA STREPTOCOCCUS GROUP A","44381 - HC ILEOSCOPY STOMA W/BALLOON DILATION"]
[null,"47533 - PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL",null,"44381 - HC ILEOSCOPY STOMA W/BALLOON DILATION","44381 - HC ILEOSCOPY STOMA W/BALLOON DILATION","44381 - HC ILEOSCOPY STOMA W/BALLOON DILATION",null,"43278 - HC ERCP LESION ABLATE W/DILATE",null,null,null,null,"44385 - HC NDSC EVAL INTSTINAL POUCH DX W/WO COLLJ SPEC SPX",null,"43278 - HC ERCP LESION ABLATE W/DILATE",null,null,"87449 - HC AG DET,ENZ IMM;OTH,EA","44382 - HC ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE"]
[null,"47534 - PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I INT-EXT",null,"44382 - HC ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE","44382 - HC ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE","44382 - HC ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE",null,"43450 - HC DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS",null,null,null,null,"44386 - NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE",null,"43450 - HC DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS",null,null,"87480 - HC CHG IADNA CANDIDA SPECIES DIRECT PROBE TQ","44384 - ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT"]
[null,"47535 - HC CONV EXT BIL DRG CATH TO INT-EXT BIL DRG CATH",null,"44384 - ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT","44384 - ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT","44384 - ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT",null,"43752 - HC PLACEMENT NG/OG TUBE BY PHYSICIAN",null,null,null,null,"44388 - HC COLONOSCOPY STOMA DX W/WO COLLJ SPEC SPX",null,"43752 - HC PLACEMENT NG/OG TUBE BY PHYSICIAN",null,null,"87481 - HC CHG CANDIDA, DNA, AMP PROBE","44385 - HC NDSC EVAL INTSTINAL POUCH DX W/WO COLLJ SPEC SPX"]
[null,"47536 - EXCHANGE BILIARY DRG CATHETER PRQ W/IMAGE GUID RAD S&I",null,"44385 - HC NDSC EVAL INTSTINAL POUCH DX W/WO COLLJ SPEC SPX","44385 - HC NDSC EVAL INTSTINAL POUCH DX W/WO COLLJ SPEC SPX","44385 - HC NDSC EVAL INTSTINAL POUCH DX W/WO COLLJ SPEC SPX",null,"43753 - GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE",null,null,null,null,"44389 - HC COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE",null,"43753 - GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE",null,null,"87486 - HC CHG IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ","44386 - NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE"]
[null,"47537 - REMOVAL BILIARY DRG CATHETER REQ FLUOR GUID RAD S&I",null,"44386 - NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE","44386 - NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE","44386 - NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE",null,"43754 - HC GASTRIC INTUBAT DX W/ASPIRATION SINGLE SPECIME",null,null,null,null,"44391 - HC COLONOSCOPY STOMA CONTROL BLEEDING",null,"43754 - HC GASTRIC INTUBAT DX W/ASPIRATION SINGLE SPECIME",null,null,"87490 - HC CHG IADNA CHLAMYDIA TRACHOMATIS DIRECT PROBE TQ","44388 - HC COLONOSCOPY STOMA DX W/WO COLLJ SPEC SPX"]
[null,"47538 - HC PERQ PLMTBIL DUCTSTNT EX",null,"44388 - HC COLONOSCOPY STOMA DX W/WO COLLJ SPEC SPX","44388 - HC COLONOSCOPY STOMA DX W/WO COLLJ SPEC SPX","44388 - HC COLONOSCOPY STOMA DX W/WO COLLJ SPEC SPX",null,"43761 - REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO",null,null,null,null,"44394 - HC COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE",null,"43761 - REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO",null,null,"87491 - HC CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ","44389 - HC COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE"]
[null,"47542 - BALLOON DILAT BILIARY DUCT/AMPULLA PRQ EACH DUCT",null,"44389 - HC COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE","44389 - HC COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE","44389 - HC COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE",null,"43762 - HC RPLC GTUBE NO REVJ TRC",null,null,null,null,"44404 - HC COLONOSCOPY STOMA W/SUBMUCOSAL INJECTION",null,"43762 - HC RPLC GTUBE NO REVJ TRC",null,null,"87493 - HC CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE","44391 - HC COLONOSCOPY STOMA CONTROL BLEEDING"]
[null,"47552 - HC BILIARY ENDO PRQ T-TUBE DX W/COLLECT SPEC BRUSH",null,"44391 - HC COLONOSCOPY STOMA CONTROL BLEEDING","44391 - HC COLONOSCOPY STOMA CONTROL BLEEDING","44391 - HC COLONOSCOPY STOMA CONTROL BLEEDING",null,"43763 - HC RPLC GTUBE REVJ GSTRST TRC",null,null,null,null,"44405 - HC COLONOSCOPY STOMA W/BALLOON DILATION",null,"43763 - HC RPLC GTUBE REVJ GSTRST TRC",null,null,"87496 - HC ARUP;CYTOMEG VIR PCR,CSF","44394 - HC COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE"]
[null,"47554 - HC BILIARY ENDOSCOPY,PERCUT,W/REM, STONE(S)",null,"44394 - HC COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE","44394 - HC COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE","44394 - HC COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE",null,"43999 - ENDOSCOPIC ENDOLUMINAL GASTRIC PLICATION",null,null,null,null,"44406 - HR COLONOSCOPY STOMA W/ENDOSCOPIC ULTRASOUND EXAM",null,"43999 - ENDOSCOPIC ENDOLUMINAL GASTRIC PLICATION",null,null,"87497 - HC CHG IADNA CYTOMEGALOVIRUS QUANTIFICATION","44404 - HC COLONOSCOPY STOMA W/SUBMUCOSAL INJECTION"]
[null,"47555 - HC BIL ENDO,PERC;DIL W/O STE",null,"44404 - HC COLONOSCOPY STOMA W/SUBMUCOSAL INJECTION","44404 - HC COLONOSCOPY STOMA W/SUBMUCOSAL INJECTION","44404 - HC COLONOSCOPY STOMA W/SUBMUCOSAL INJECTION",null,"44180 - HC LAP, SURG ENTEROLYSIS",null,null,null,null,"44500 - HC INTRODUCTION LONG GI TUBE SEPARATE PROCEDURE.",null,"44180 - HC LAP, SURG ENTEROLYSIS",null,null,"87498 - HC CHG IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP","44405 - HC COLONOSCOPY STOMA W/BALLOON DILATION"]
[null,"47556 - HC BILIARY NDSC PRQ T-TUBE DILAT STRIX W/STENT",null,"44405 - HC COLONOSCOPY STOMA W/BALLOON DILATION","44405 - HC COLONOSCOPY STOMA W/BALLOON DILATION","44405 - HC COLONOSCOPY STOMA W/BALLOON DILATION",null,"44238 - HC LAPAROSCOPE PROC INTESTINE",null,null,null,null,"44970 - HC LAPAROSCOPIC APPENDECTOMY",null,"44238 - HC LAPAROSCOPE PROC INTESTINE",null,null,"87502 - HC Q;FLU AG DET,MULT TYP,2,2","44406 - HR COLONOSCOPY STOMA W/ENDOSCOPIC ULTRASOUND EXAM"]
[null,"48102 - HC BIOPSY PANCREA PERCUTANEOUS NEEDLE",null,"44406 - HR COLONOSCOPY STOMA W/ENDOSCOPIC ULTRASOUND EXAM","44406 - HR COLONOSCOPY STOMA W/ENDOSCOPIC ULTRASOUND EXAM","44406 - HR COLONOSCOPY STOMA W/ENDOSCOPIC ULTRASOUND EXAM",null,"44360 - HC ENDOSCOPY UPPER SMALL INTESTINE",null,null,null,null,"45005 - HC I&D RECTAL SUBMUCOSAL ABSCESS",null,"44360 - HC ENDOSCOPY UPPER SMALL INTESTINE",null,null,"87510 - HC CHG IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ","44500 - HC INTRODUCTION LONG GI TUBE SEPARATE PROCEDURE."]
[null,"49010 - HC EXPLORATORY RETROPERITONEAL",null,"44500 - HC INTRODUCTION LONG GI TUBE SEPARATE PROCEDURE.","44500 - HC INTRODUCTION LONG GI TUBE SEPARATE PROCEDURE.","44500 - HC INTRODUCTION LONG GI TUBE SEPARATE PROCEDURE.",null,"44361 - HC ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY",null,null,null,null,"45190 - HC DESTRUCT,RECTAL TUMOR,TRANSANAL APPROACH",null,"44361 - HC ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY",null,null,"87511 - HC CHG GARDNER VAG, DNA  AMP PROBE","44970 - HC LAPAROSCOPIC APPENDECTOMY"]
[null,"49082 - ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE",null,"44604 - HC SUTURE LRG INTEST","44604 - HC SUTURE LRG INTEST","44604 - HC SUTURE LRG INTEST",null,"44363 - HC ENTEROSCOPY > 2ND PRTN W/RMVL FOREIGN BODY",null,null,null,null,"45300 - PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX",null,"44363 - HC ENTEROSCOPY > 2ND PRTN W/RMVL FOREIGN BODY",null,null,"87517 - HC CHG IADNA HEPATITIS B VIRUS QUANTIFICATION","45005 - HC I&D RECTAL SUBMUCOSAL ABSCESS"]
[null,"49083 - ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE",null,"44705 - PREPARE FECAL MICROBIOTA FOR INSTILLATION","44705 - PREPARE FECAL MICROBIOTA FOR INSTILLATION","44705 - PREPARE FECAL MICROBIOTA FOR INSTILLATION",null,"44364 - HC ENTEROSCOPY > 2ND PRTN W/RMVL LESION SNARE.",null,null,null,null,"45305 - HC PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE",null,"44364 - HC ENTEROSCOPY > 2ND PRTN W/RMVL LESION SNARE.",null,null,"87522 - HC ARUP;HEP C VIR RNA QN","45190 - HC DESTRUCT,RECTAL TUMOR,TRANSANAL APPROACH"]
[null,"49180 - BX ABDL/RETROPERITONEAL MASS PRQ NEEDLE",null,"44970 - HC LAPAROSCOPIC APPENDECTOMY","44970 - HC LAPAROSCOPIC APPENDECTOMY","44970 - HC LAPAROSCOPIC APPENDECTOMY",null,"44366 - HC ENTEROSCOPY > 2ND PRTN W/CONTROL BLEEDING",null,null,null,null,"45307 - HC PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY",null,"44366 - HC ENTEROSCOPY > 2ND PRTN W/CONTROL BLEEDING",null,null,"87529 - HC CHG IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ","45300 - PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX"]
[null,"49185 - SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID",null,"45005 - HC I&D RECTAL SUBMUCOSAL ABSCESS","45005 - HC I&D RECTAL SUBMUCOSAL ABSCESS","45005 - HC I&D RECTAL SUBMUCOSAL ABSCESS",null,"44369 - HC ENTEROSCOPY > 2ND PRTN ABLTJ LESION",null,null,null,null,"45317 - HC PROCTOSIGMOIDOSCOPY BLEED",null,"44369 - HC ENTEROSCOPY > 2ND PRTN ABLTJ LESION",null,null,"87532 - HC CHG IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ","45305 - HC PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE"]
[null,"49320 - HC LAP,DIAGNOSTIC ABDOMEN",null,"45190 - HC DESTRUCT,RECTAL TUMOR,TRANSANAL APPROACH","45190 - HC DESTRUCT,RECTAL TUMOR,TRANSANAL APPROACH","45190 - HC DESTRUCT,RECTAL TUMOR,TRANSANAL APPROACH",null,"44376 - HC ENTEROSC >2ND PRTN W/ILEUM W/WO COLLJ SPEC SPX",null,null,null,null,"45330 - HC SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD",null,"44376 - HC ENTEROSC >2ND PRTN W/ILEUM W/WO COLLJ SPEC SPX",null,null,"87535 - HC CHG IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ","45307 - HC PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY"]
[null,"49321 - HC LAP,DX SURGICAL ABD W/BIOPSY",null,"45300 - PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX","45300 - PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX","45300 - PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX",null,"44377 - HC ENTEROSC >2ND PRTN W/ILEUM W/BX SINGLE/MULTIPLE",null,null,null,null,"45331 - HC COLON CA SCREEN;BARIUM ENEMA",null,"44377 - HC ENTEROSC >2ND PRTN W/ILEUM W/BX SINGLE/MULTIPLE",null,null,"87536 - HC CHG IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION","45317 - HC PROCTOSIGMOIDOSCOPY BLEED"]
[null,"49324 - HC LAP INSERTION TUNNELED INTRAPERITONEAL CATHETER",null,"45305 - HC PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE","45305 - HC PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE","45305 - HC PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE",null,"44378 - HC ENTEROSCOPY > 2ND PRTN ILEUM CONTROL BLEEDING",null,null,null,null,"45332 - HC SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY",null,"44378 - HC ENTEROSCOPY > 2ND PRTN ILEUM CONTROL BLEEDING",null,null,"87538 - HC HIV-2 PROBE&REVRSE TRNSCRIPJ","45330 - HC SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD"]
[null,"49329 - HC LAPARO PROC ABDM/PER/OMENT",null,"45307 - HC PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY","45307 - HC PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY","45307 - HC PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY",null,"44380 - HC ILEOSCOPY STOMA DX W/WO COLLJ SPEC BR/WA SPX",null,null,null,null,"45333 - HC SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS",null,"44380 - HC ILEOSCOPY STOMA DX W/WO COLLJ SPEC BR/WA SPX",null,null,"87556 - HC CHG IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB","45331 - HC COLON CA SCREEN;BARIUM ENEMA"]
[null,"49405 - IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ",null,"45317 - HC PROCTOSIGMOIDOSCOPY BLEED","45317 - HC PROCTOSIGMOIDOSCOPY BLEED","45317 - HC PROCTOSIGMOIDOSCOPY BLEED",null,"44381 - HC ILEOSCOPY STOMA W/BALLOON DILATION",null,null,null,null,"45334 - HC SIGMOIDOSCOPY FLX CONTROL BLEEDING",null,"44381 - HC ILEOSCOPY STOMA W/BALLOON DILATION",null,null,"87581 - HC CHG IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ","45332 - HC SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY"]
[null,"49406 - IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ",null,"45330 - HC SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD","45330 - HC SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD","45330 - HC SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD",null,"44382 - HC ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE",null,null,null,null,"45335 - HC SGMDSC FLX DIRED SBMCSL NJX ANY SBST",null,"44382 - HC ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE",null,null,"87591 - HC CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ","45333 - HC SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS"]
[null,"49407 - IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL",null,"45331 - HC COLON CA SCREEN;BARIUM ENEMA","45331 - HC COLON CA SCREEN;BARIUM ENEMA","45331 - HC COLON CA SCREEN;BARIUM ENEMA",null,"44384 - ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT",null,null,null,null,"45337 - HC SGMDSC FLX DCMPRN VOLVULUS ANY METHOD",null,"44384 - ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT",null,null,"87624 - IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES","45334 - HC SIGMOIDOSCOPY FLX CONTROL BLEEDING"]
[null,"49411 - INTERSTITIAL DEV PLMT RADIATION THERAPY 1/MLT",null,"45332 - HC SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY","45332 - HC SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY","45332 - HC SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY",null,"44385 - HC NDSC EVAL INTSTINAL POUCH DX W/WO COLLJ SPEC SPX",null,null,null,null,"45338 - HC SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ",null,"44385 - HC NDSC EVAL INTSTINAL POUCH DX W/WO COLLJ SPEC SPX",null,null,"87640 - HC CHG IADNA S AUREUS AMPLIFIED PROBE TQ","45335 - HC SGMDSC FLX DIRED SBMCSL NJX ANY SBST"]
[null,"49418 - INSJ INTRAPERITONEAL CATHETER W/IMG GID",null,"45333 - HC SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS","45333 - HC SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS","45333 - HC SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS",null,"44386 - NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE",null,null,null,null,"45340 - HC SIGMOIDOSCOPY FLX DILAT BALO 1/MORE STRIXS",null,"44386 - NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE",null,null,"87641 - HC CHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ","45337 - HC SGMDSC FLX DCMPRN VOLVULUS ANY METHOD"]
[null,"49422 - REMOVE TUNNELED IP CATH",null,"45334 - HC SIGMOIDOSCOPY FLX CONTROL BLEEDING","45334 - HC SIGMOIDOSCOPY FLX CONTROL BLEEDING","45334 - HC SIGMOIDOSCOPY FLX CONTROL BLEEDING",null,"44388 - HC COLONOSCOPY STOMA DX W/WO COLLJ SPEC SPX",null,null,null,null,"45341 - HC SIGMOIDOSCOPY FLX NDSC US XM",null,"44388 - HC COLONOSCOPY STOMA DX W/WO COLLJ SPEC SPX",null,null,"87653 - HC CHG IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ","45338 - HC SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ"]
[null,"49423 - HC EXCHNG ABSC/CST DRG CATH RAD GID SPX",null,"45335 - HC SGMDSC FLX DIRED SBMCSL NJX ANY SBST","45335 - HC SGMDSC FLX DIRED SBMCSL NJX ANY SBST","45335 - HC SGMDSC FLX DIRED SBMCSL NJX ANY SBST",null,"44389 - HC COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE",null,null,null,null,"45342 - HC SIGMOIDOSCOPY FLX TNDSC US GID NDL ASPIR/BX",null,"44389 - HC COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE",null,null,"87660 - HC CHG IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ","45340 - HC SIGMOIDOSCOPY FLX DILAT BALO 1/MORE STRIXS"]
[null,"49424 - HC INJ CONT ABS/CY EVAL",null,"45337 - HC SGMDSC FLX DCMPRN VOLVULUS ANY METHOD","45337 - HC SGMDSC FLX DCMPRN VOLVULUS ANY METHOD","45337 - HC SGMDSC FLX DCMPRN VOLVULUS ANY METHOD",null,"44391 - HC COLONOSCOPY STOMA CONTROL BLEEDING",null,null,null,null,"45346 - HC SIGMOIDOSCOPY FLX ABLATION TUMOR POLYP/OTH LES",null,"44391 - HC COLONOSCOPY STOMA CONTROL BLEEDING",null,null,"87797 - HC CHG DETECT AGENT NOS, DNA, DIR","45341 - HC SIGMOIDOSCOPY FLX NDSC US XM"]
[null,"49427 - HC INJ PROC EXIST VP SHUNT",null,"45338 - HC SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ","45338 - HC SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ","45338 - HC SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ",null,"44394 - HC COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE",null,null,null,null,"45347 - HC SIGMOIDOSCOPY FLX PLACEMENT OF ENDOSCOPIC STENT",null,"44394 - HC COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE",null,null,"87798 - HC EBV DNA, QL PCR","45342 - HC SIGMOIDOSCOPY FLX TNDSC US GID NDL ASPIR/BX"]
[null,"49440 - INSERT GASTROSTOMY TUBE PERCUTANEOUS",null,"45340 - HC SIGMOIDOSCOPY FLX DILAT BALO 1/MORE STRIXS","45340 - HC SIGMOIDOSCOPY FLX DILAT BALO 1/MORE STRIXS","45340 - HC SIGMOIDOSCOPY FLX DILAT BALO 1/MORE STRIXS",null,"44404 - HC COLONOSCOPY STOMA W/SUBMUCOSAL INJECTION",null,null,null,null,"45349 - SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION",null,"44404 - HC COLONOSCOPY STOMA W/SUBMUCOSAL INJECTION",null,null,"87799 - HC CHG IADNA NOS QUANTIFICATION EACH ORGANISM","45346 - HC SIGMOIDOSCOPY FLX ABLATION TUMOR POLYP/OTH LES"]
[null,"49441 - HC INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ",null,"45341 - HC SIGMOIDOSCOPY FLX NDSC US XM","45341 - HC SIGMOIDOSCOPY FLX NDSC US XM","45341 - HC SIGMOIDOSCOPY FLX NDSC US XM",null,"44405 - HC COLONOSCOPY STOMA W/BALLOON DILATION",null,null,null,null,"45350 - HC SIGMOIDOSCOPY FLX WITH WITH BAND LIGATION(S)",null,"44405 - HC COLONOSCOPY STOMA W/BALLOON DILATION",null,null,"87801 - HC CHG DETECT AGENT, MULT ORGS, DNA  AMP","45347 - HC SIGMOIDOSCOPY FLX PLACEMENT OF ENDOSCOPIC STENT"]
[null,"49446 - HC CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERQ",null,"45342 - HC SIGMOIDOSCOPY FLX TNDSC US GID NDL ASPIR/BX","45342 - HC SIGMOIDOSCOPY FLX TNDSC US GID NDL ASPIR/BX","45342 - HC SIGMOIDOSCOPY FLX TNDSC US GID NDL ASPIR/BX",null,"44406 - HR COLONOSCOPY STOMA W/ENDOSCOPIC ULTRASOUND EXAM",null,null,null,null,"45379 - HC COLSC FLX PROX SPLENIC FLXR RMVL FB",null,"44406 - HR COLONOSCOPY STOMA W/ENDOSCOPIC ULTRASOUND EXAM",null,null,"87880 - IAADIADOO STREPTOCOCCUS GROUP A","45349 - SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION"]
[null,"49450 - HC REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS",null,"45346 - HC SIGMOIDOSCOPY FLX ABLATION TUMOR POLYP/OTH LES","45346 - HC SIGMOIDOSCOPY FLX ABLATION TUMOR POLYP/OTH LES","45346 - HC SIGMOIDOSCOPY FLX ABLATION TUMOR POLYP/OTH LES",null,"44500 - HC INTRODUCTION LONG GI TUBE SEPARATE PROCEDURE.",null,null,null,null,"45380 - COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",null,"44500 - HC INTRODUCTION LONG GI TUBE SEPARATE PROCEDURE.",null,null,"87899 - HC MALARIA ANTIGEN","45350 - HC SIGMOIDOSCOPY FLX WITH WITH BAND LIGATION(S)"]
[null,"49451 - HC PERC REPL DUD/JEJ TUBE,W/",null,"45347 - HC SIGMOIDOSCOPY FLX PLACEMENT OF ENDOSCOPIC STENT","45347 - HC SIGMOIDOSCOPY FLX PLACEMENT OF ENDOSCOPIC STENT","45347 - HC SIGMOIDOSCOPY FLX PLACEMENT OF ENDOSCOPIC STENT",null,"44799 - PR DILATION OF ILEOSTOMY STRICTURE",null,null,null,null,"45381 - HC COLSC FLX PROX SPLENIC FLXR SBMCSL NJX",null,"44799 - PR DILATION OF ILEOSTOMY STRICTURE",null,null,"87900 - HC CHG NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION","45379 - HC COLSC FLX PROX SPLENIC FLXR RMVL FB"]
[null,"49452 - HC PERC REPL GAST_JEJ TUBE,W",null,"45349 - SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION","45349 - SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION","45349 - SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION",null,"44970 - HC LAPAROSCOPIC APPENDECTOMY",null,null,null,null,"45382 - HC COLSC FLX PROX SPLENIC FLXR CTRL BLD",null,"44970 - HC LAPAROSCOPIC APPENDECTOMY",null,null,"87901 - HC CHG NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEAS","45380 - COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
[null,"49460 - HC FIX G/COLON TUBE W/DEVICE",null,"45350 - HC SIGMOIDOSCOPY FLX WITH WITH BAND LIGATION(S)","45350 - HC SIGMOIDOSCOPY FLX WITH WITH BAND LIGATION(S)","45350 - HC SIGMOIDOSCOPY FLX WITH WITH BAND LIGATION(S)",null,"45005 - HC I&D RECTAL SUBMUCOSAL ABSCESS",null,null,null,null,"45384 - HC COLSC FLX PROX SPLENIC FLXR RMVL LES CAUT",null,"45005 - HC I&D RECTAL SUBMUCOSAL ABSCESS",null,null,"87902 - HC CHG NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS","45381 - HC COLSC FLX PROX SPLENIC FLXR SBMCSL NJX"]
[null,"49465 - HC CONTRAST INJECTION PERQ RADIOLOGIC EVAL GI TUBE",null,"45379 - HC COLSC FLX PROX SPLENIC FLXR RMVL FB","45379 - HC COLSC FLX PROX SPLENIC FLXR RMVL FB","45379 - HC COLSC FLX PROX SPLENIC FLXR RMVL FB",null,"45190 - HC DESTRUCT,RECTAL TUMOR,TRANSANAL APPROACH",null,null,null,null,"45385 - HC COLSC FLX PROX SPLENIC FLXR RMVL LES SNARE TQ",null,"45190 - HC DESTRUCT,RECTAL TUMOR,TRANSANAL APPROACH",null,null,"87906 - HC Q;HIV1 GENO","45382 - HC COLSC FLX PROX SPLENIC FLXR CTRL BLD"]
[null,"49570 - HC REPAIR EPIGASTRIC HERNIA,REDUC",null,"45380 - COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",null,"45300 - PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX",null,null,null,null,"45386 - HC COLSC FLX PROX SPLENIC FLXR DILAT BALO 1/> STRI",null,"45300 - PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX",null,null,"88142 - CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN","45384 - HC COLSC FLX PROX SPLENIC FLXR RMVL LES CAUT"]
[null,"50200 - RENAL BIOPSY PRQ TROCAR/NEEDLE",null,"45381 - HC COLSC FLX PROX SPLENIC FLXR SBMCSL NJX","45381 - HC COLSC FLX PROX SPLENIC FLXR SBMCSL NJX","45381 - HC COLSC FLX PROX SPLENIC FLXR SBMCSL NJX",null,"45305 - HC PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE",null,null,null,null,"45388 - HC COLONOSCOPY FLX ABLATION TUMOR POLYP/OTHER LES",null,"45305 - HC PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE",null,null,"88143 - HC CHG CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS","45385 - HC COLSC FLX PROX SPLENIC FLXR RMVL LES SNARE TQ"]
[null,"50382 - HC RMVL & RPLCMT INTLY DWELLING URETERAL STENT PRQ",null,"45382 - HC COLSC FLX PROX SPLENIC FLXR CTRL BLD","45382 - HC COLSC FLX PROX SPLENIC FLXR CTRL BLD","45382 - HC COLSC FLX PROX SPLENIC FLXR CTRL BLD",null,"45307 - HC PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY",null,null,null,null,"45389 - HC COLONOSCOPY FLX WITH ENDOSCOPIC STENT PLACEMENT",null,"45307 - HC PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY",null,null,"88147 - HC CHG CYTOPATH SMEAR CERV/VAG AUTOMATED","45386 - HC COLSC FLX PROX SPLENIC FLXR DILAT BALO 1/> STRI"]
[null,"50385 - HC REMOVE & REPLACE INDWELL URETERAL STENT TRURTHRL",null,"45384 - HC COLSC FLX PROX SPLENIC FLXR RMVL LES CAUT","45384 - HC COLSC FLX PROX SPLENIC FLXR RMVL LES CAUT","45384 - HC COLSC FLX PROX SPLENIC FLXR RMVL LES CAUT",null,"45317 - HC PROCTOSIGMOIDOSCOPY BLEED",null,null,null,null,"45390 - HC COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION",null,"45317 - HC PROCTOSIGMOIDOSCOPY BLEED",null,null,"88152 - HC CHG CYTOPATH SMEAR CERV/VAG,AUTO REDO","45388 - HC COLONOSCOPY FLX ABLATION TUMOR POLYP/OTHER LES"]
[null,"50386 - HC REM URET STENT,TRANS,W/O",null,"45385 - HC COLSC FLX PROX SPLENIC FLXR RMVL LES SNARE TQ","45385 - HC COLSC FLX PROX SPLENIC FLXR RMVL LES SNARE TQ","45385 - HC COLSC FLX PROX SPLENIC FLXR RMVL LES SNARE TQ",null,"45330 - HC SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD",null,null,null,null,"45391 - HC COLSC FLX PROX SPLENIC FLXR NDSC US XM",null,"45330 - HC SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD",null,null,"88164 - HC CHG CYTOPATH TBS CERV/VAG MANUAL","45389 - HC COLONOSCOPY FLX WITH ENDOSCOPIC STENT PLACEMENT"]
[null,"50387 - HC RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH",null,"45386 - HC COLSC FLX PROX SPLENIC FLXR DILAT BALO 1/> STRI","45386 - HC COLSC FLX PROX SPLENIC FLXR DILAT BALO 1/> STRI","45386 - HC COLSC FLX PROX SPLENIC FLXR DILAT BALO 1/> STRI",null,"45331 - HC COLON CA SCREEN;BARIUM ENEMA",null,null,null,null,"45392 - HC COLSC FLX PROX SPLENIC FLXR US GID NDL ASPIR/BX",null,"45331 - HC COLON CA SCREEN;BARIUM ENEMA",null,null,"88165 - HC CHG CYTP SLIDES C/V MNL SCR&RESCR PHYS SUPV","45390 - HC COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION"]
[null,"50389 - HC RMVL NFROS TUBE REQ FLUORO GUIDANCE",null,"45388 - HC COLONOSCOPY FLX ABLATION TUMOR POLYP/OTHER LES","45388 - HC COLONOSCOPY FLX ABLATION TUMOR POLYP/OTHER LES","45388 - HC COLONOSCOPY FLX ABLATION TUMOR POLYP/OTHER LES",null,"45332 - HC SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY",null,null,null,null,"45398 - HC COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S)",null,"45332 - HC SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY",null,null,"88230 - HC CHG TISS CUL NON-NEO DISORDERS LYMPHOCYTE","45391 - HC COLSC FLX PROX SPLENIC FLXR NDSC US XM"]
[null,"50390 - ASPIR &/NJX RENAL CYST/PELVIS NEEDLE PRQ",null,"45389 - HC COLONOSCOPY FLX WITH ENDOSCOPIC STENT PLACEMENT","45389 - HC COLONOSCOPY FLX WITH ENDOSCOPIC STENT PLACEMENT","45389 - HC COLONOSCOPY FLX WITH ENDOSCOPIC STENT PLACEMENT",null,"45333 - HC SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS",null,null,null,null,"45910 - HC DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL",null,"45333 - HC SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS",null,null,"88235 - HC CHG TISSUE CULTURE, PLACENTA","45392 - HC COLSC FLX PROX SPLENIC FLXR US GID NDL ASPIR/BX"]
[null,"50430 - HC NJX PX ANTEGRDE NFROSGRM &/URTRGRM NEW ACCESS",null,"45390 - HC COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION","45390 - HC COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION","45390 - HC COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION",null,"45334 - HC SIGMOIDOSCOPY FLX CONTROL BLEEDING",null,null,null,null,"45915 - HC REMV RECTAL OBSTR:FECES/F.B. W ANEST",null,"45334 - HC SIGMOIDOSCOPY FLX CONTROL BLEEDING",null,null,"88237 - HC CHG TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS","45398 - HC COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S)"]
[null,"50431 - HC NJX ANTGRD NPHRSTGRM &/OR URTRGRM COMPL DIAG INCL IMG GUI RAD S&I; EXSTNG ACCES",null,"45391 - HC COLSC FLX PROX SPLENIC FLXR NDSC US XM","45391 - HC COLSC FLX PROX SPLENIC FLXR NDSC US XM","45391 - HC COLSC FLX PROX SPLENIC FLXR NDSC US XM",null,"45335 - HC SGMDSC FLX DIRED SBMCSL NJX ANY SBST",null,null,null,null,"46020 - PLACEMENT ON SETON",null,"45335 - HC SGMDSC FLX DIRED SBMCSL NJX ANY SBST",null,null,"88262 - HC CHG CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING","45910 - HC DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL"]
[null,"50432 - HC PLACEMENT NEPHROSTOMY CATH PRQ NEW ACCESS RAD S&I",null,"45392 - HC COLSC FLX PROX SPLENIC FLXR US GID NDL ASPIR/BX","45392 - HC COLSC FLX PROX SPLENIC FLXR US GID NDL ASPIR/BX","45392 - HC COLSC FLX PROX SPLENIC FLXR US GID NDL ASPIR/BX",null,"45337 - HC SGMDSC FLX DCMPRN VOLVULUS ANY METHOD",null,null,null,null,"46030 - REMOVAL OF RECTAL MARKER",null,"45337 - HC SGMDSC FLX DCMPRN VOLVULUS ANY METHOD",null,null,"88264 - HC CHG CHRMSM ANALYZE 20-25 CELLS","45915 - HC REMV RECTAL OBSTR:FECES/F.B. W ANEST"]
[null,"50433 - PLACEMENT NEPHROURETERAL CATH PRQ NEW ACCESS RAD S&I",null,"45398 - HC COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S)","45398 - HC COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S)","45398 - HC COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S)",null,"45338 - HC SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ",null,null,null,null,"46040 - I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX",null,"45338 - HC SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ",null,null,"88271 - HC CHG MOLECULAR CYTOGENETICS DNA PROBE EACH","46020 - PLACEMENT ON SETON"]
[null,"50434 - CONVERT NEPHROSTOMY CATH TO NEPHROURTRL CATH PRQ",null,"45910 - HC DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL","45910 - HC DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL","45910 - HC DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL",null,"45340 - HC SIGMOIDOSCOPY FLX DILAT BALO 1/MORE STRIXS",null,null,null,null,"46050 - I&D PERIANAL ABSCESS SUPERFICIAL",null,"45340 - HC SIGMOIDOSCOPY FLX DILAT BALO 1/MORE STRIXS",null,null,"88274 - HC CHG MOLECULAR CYTOGENETICS INTERPHASE ISH 25-99 CLL","46030 - REMOVAL OF RECTAL MARKER"]
[null,"50435 - EXCHANGE NEPHROSTOMY CATHETER PRQ W/IMAGE GUIDE RAD S&I",null,"45915 - HC REMV RECTAL OBSTR:FECES/F.B. W ANEST","45915 - HC REMV RECTAL OBSTR:FECES/F.B. W ANEST","45915 - HC REMV RECTAL OBSTR:FECES/F.B. W ANEST",null,"45341 - HC SIGMOIDOSCOPY FLX NDSC US XM",null,null,null,null,"46060 - I&D ISCHIORCT/INTRAMURAL ABSC W/WO SETON",null,"45341 - HC SIGMOIDOSCOPY FLX NDSC US XM",null,null,"88275 - HC CHG MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL","46040 - I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX"]
[null,"50436 - HC DILAT XST TRC NDURLGC PX",null,"46020 - PLACEMENT ON SETON","46020 - PLACEMENT ON SETON","46020 - PLACEMENT ON SETON",null,"45342 - HC SIGMOIDOSCOPY FLX TNDSC US GID NDL ASPIR/BX",null,null,null,null,"46083 - INCISION THROMBOSED HEMORRHOID EXTERNAL",null,"45342 - HC SIGMOIDOSCOPY FLX TNDSC US GID NDL ASPIR/BX",null,null,"88280 - HC CHG CHROMOSOME KARYOTYPE STUDY","46050 - I&D PERIANAL ABSCESS SUPERFICIAL"]
[null,"50437 - HC DILAT XST TRC NEW ACCESS RCS",null,"46030 - REMOVAL OF RECTAL MARKER","46030 - REMOVAL OF RECTAL MARKER","46030 - REMOVAL OF RECTAL MARKER",null,"45346 - HC SIGMOIDOSCOPY FLX ABLATION TUMOR POLYP/OTH LES",null,null,null,null,"46220 - EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS",null,"45346 - HC SIGMOIDOSCOPY FLX ABLATION TUMOR POLYP/OTH LES",null,null,"89050 - HC CHG CELL COUNT MISCELLANEOUS BODY FLUIDS","46060 - I&D ISCHIORCT/INTRAMURAL ABSC W/WO SETON"]
[null,"50561 - HC RENAL ENDOSCOPY,REMV FB/STONE",null,"46040 - I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX","46040 - I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX","46040 - I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX",null,"45347 - HC SIGMOIDOSCOPY FLX PLACEMENT OF ENDOSCOPIC STENT",null,null,null,null,"46221 - HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS",null,"45347 - HC SIGMOIDOSCOPY FLX PLACEMENT OF ENDOSCOPIC STENT",null,null,"89051 - HC CHG CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT","46083 - INCISION THROMBOSED HEMORRHOID EXTERNAL"]
[null,"50592 - HC ABLTJ 1/> RENAL TUMOR PRQ UNI RADIOFREQUENCY",null,"46050 - I&D PERIANAL ABSCESS SUPERFICIAL","46050 - I&D PERIANAL ABSCESS SUPERFICIAL","46050 - I&D PERIANAL ABSCESS SUPERFICIAL",null,"45349 - SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION",null,null,null,null,"46250 - HC HEMORRHOIDECTOMY,EXTERNAL, 2+ COLUMNS/GROUPS",null,"45349 - SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION",null,null,"89060 - HC CHG CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID","46220 - EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS"]
[null,"50593 - HC ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY",null,"46060 - I&D ISCHIORCT/INTRAMURAL ABSC W/WO SETON","46060 - I&D ISCHIORCT/INTRAMURAL ABSC W/WO SETON","46060 - I&D ISCHIORCT/INTRAMURAL ABSC W/WO SETON",null,"45350 - HC SIGMOIDOSCOPY FLX WITH WITH BAND LIGATION(S)",null,null,null,null,"46255 - HC HEMORRHOIDECTOMY,INT/EXT,1 COLUMN/GROUP",null,"45350 - HC SIGMOIDOSCOPY FLX WITH WITH BAND LIGATION(S)",null,null,"89320 - SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT","46221 - HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS"]
[null,"50684 - INJ PX URETEROGRAPHY/URETEROPYLOGRAPHY CATH",null,"46083 - INCISION THROMBOSED HEMORRHOID EXTERNAL","46083 - INCISION THROMBOSED HEMORRHOID EXTERNAL","46083 - INCISION THROMBOSED HEMORRHOID EXTERNAL",null,"45379 - HC COLSC FLX PROX SPLENIC FLXR RMVL FB",null,null,null,null,"46260 - HC HEMORRHOIDECTOMY INT & XTRNL 2/> COLUMN/GRO",null,"45379 - HC COLSC FLX PROX SPLENIC FLXR RMVL FB",null,null,"90371 - HC HEPB IG, IM","46250 - HC HEMORRHOIDECTOMY,EXTERNAL, 2+ COLUMNS/GROUPS"]
[null,"50688 - CHNG URTROST TUBE/XTRNLLY ACCESSIBLE STENT ILEAL",null,"46220 - EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS","46220 - EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS","46220 - EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS",null,"45380 - COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",null,null,null,null,"46320 - HC EXCISION THROMBOSED HEMORRHOID, EXTERNAL",null,"45380 - COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",null,null,"90384 - HC IG;RHO D HUMAN/300MCG","46255 - HC HEMORRHOIDECTOMY,INT/EXT,1 COLUMN/GROUP"]
[null,"50693 - PLACEMENT URETERAL STENT PRQ WITH PRE-EXISTING NEPHROSTOMY TRACT",null,"46221 - HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS","46221 - HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS","46221 - HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS",null,"45381 - HC COLSC FLX PROX SPLENIC FLXR SBMCSL NJX",null,null,null,null,"46505 - CHEMODENERVATION ANAL SPHINCTER",null,"45381 - HC COLSC FLX PROX SPLENIC FLXR SBMCSL NJX",null,null,"90389 - HC US SCREENING SAAAVE MCR","46260 - HC HEMORRHOIDECTOMY INT & XTRNL 2/> COLUMN/GRO"]
[null,"50694 - PLACEMENT URETERAL STENT PRQ NEW ACESS WITHOUT SEP NEPHROSTOMY CATH",null,"46250 - HC HEMORRHOIDECTOMY,EXTERNAL, 2+ COLUMNS/GROUPS","46250 - HC HEMORRHOIDECTOMY,EXTERNAL, 2+ COLUMNS/GROUPS","46250 - HC HEMORRHOIDECTOMY,EXTERNAL, 2+ COLUMNS/GROUPS",null,"45382 - HC COLSC FLX PROX SPLENIC FLXR CTRL BLD",null,null,null,null,"46600 - ANOSCOPY DX W/WO COLLJ SPEC BR/WA SPX",null,"45382 - HC COLSC FLX PROX SPLENIC FLXR CTRL BLD",null,null,"90632 - CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL","46320 - HC EXCISION THROMBOSED HEMORRHOID, EXTERNAL"]
[null,"50695 - HC PLMT URET STNTW/SEP NEPH",null,"46255 - HC HEMORRHOIDECTOMY,INT/EXT,1 COLUMN/GROUP","46255 - HC HEMORRHOIDECTOMY,INT/EXT,1 COLUMN/GROUP","46255 - HC HEMORRHOIDECTOMY,INT/EXT,1 COLUMN/GROUP",null,"45384 - HC COLSC FLX PROX SPLENIC FLXR RMVL LES CAUT",null,null,null,null,"46601 - HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT",null,"45384 - HC COLSC FLX PROX SPLENIC FLXR RMVL LES CAUT",null,null,"90633 - CR BUILD ONLY - HEPA VACCINE PED/ADOL-2 DOSE,DPH","46505 - CHEMODENERVATION ANAL SPHINCTER"]
[null,"51100 - HC ASPIRATION BLADDER NEEDLE",null,"46260 - HC HEMORRHOIDECTOMY INT & XTRNL 2/> COLUMN/GRO","46260 - HC HEMORRHOIDECTOMY INT & XTRNL 2/> COLUMN/GRO","46260 - HC HEMORRHOIDECTOMY INT & XTRNL 2/> COLUMN/GRO",null,"45385 - HC COLSC FLX PROX SPLENIC FLXR RMVL LES SNARE TQ",null,null,null,null,"46604 - HC ANOSCOPY,W/DILATION",null,"45385 - HC COLSC FLX PROX SPLENIC FLXR RMVL LES SNARE TQ",null,null,"90636 - HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM","46600 - ANOSCOPY DX W/WO COLLJ SPEC BR/WA SPX"]
[null,"51102 - HC ASP BLADDER;W/INS SUPRAPU",null,"46320 - HC EXCISION THROMBOSED HEMORRHOID, EXTERNAL","46320 - HC EXCISION THROMBOSED HEMORRHOID, EXTERNAL","46320 - HC EXCISION THROMBOSED HEMORRHOID, EXTERNAL",null,"45386 - HC COLSC FLX PROX SPLENIC FLXR DILAT BALO 1/> STRI",null,null,null,null,"46606 - ANOSCOPY W/BX SINGLE/MULTIPLE",null,"45386 - HC COLSC FLX PROX SPLENIC FLXR DILAT BALO 1/> STRI",null,null,"90648 - HC HIB VACCINE, PRP-T, IM,DPH","46601 - HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT"]
[null,"51700 - BLDR IRRIGATION SMPL LAVAGE &/INSTLJ",null,"46505 - CHEMODENERVATION ANAL SPHINCTER","46505 - CHEMODENERVATION ANAL SPHINCTER","46505 - CHEMODENERVATION ANAL SPHINCTER",null,"45388 - HC COLONOSCOPY FLX ABLATION TUMOR POLYP/OTHER LES",null,null,null,null,"46607 - HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT W/BX",null,"45388 - HC COLONOSCOPY FLX ABLATION TUMOR POLYP/OTHER LES",null,null,"90653 - HC IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE","46604 - HC ANOSCOPY,W/DILATION"]
[null,"51701 - INSJ NON-NDWELLG BLADDER CATHETER",null,"46600 - ANOSCOPY DX W/WO COLLJ SPEC BR/WA SPX","46600 - ANOSCOPY DX W/WO COLLJ SPEC BR/WA SPX","46600 - ANOSCOPY DX W/WO COLLJ SPEC BR/WA SPX",null,"45389 - HC COLONOSCOPY FLX WITH ENDOSCOPIC STENT PLACEMENT",null,null,null,null,"46608 - HC ANOSCOPY,REMOVE FOREIGN BODY",null,"45389 - HC COLONOSCOPY FLX WITH ENDOSCOPIC STENT PLACEMENT",null,null,"90661 - HC CCIIV3 VACCINE PRESERVATIVE FREE 0.5 ML IM USE","46606 - ANOSCOPY W/BX SINGLE/MULTIPLE"]
[null,"51702 - INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE",null,"46601 - HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT","46601 - HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT","46601 - HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT",null,"45390 - HC COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION",null,null,null,null,"46610 - HC ANOSCOPY W/RMVL LESION CAUTERY",null,"45390 - HC COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION",null,null,"90662 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM FLUZONE HIGH DOSE","46607 - HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT W/BX"]
[null,"51703 - INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED",null,"46604 - HC ANOSCOPY,W/DILATION","46604 - HC ANOSCOPY,W/DILATION","46604 - HC ANOSCOPY,W/DILATION",null,"45391 - HC COLSC FLX PROX SPLENIC FLXR NDSC US XM",null,null,null,null,"46615 - ANOSCOPY ABLATION LESION",null,"45391 - HC COLSC FLX PROX SPLENIC FLXR NDSC US XM",null,null,"90670 - CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH","46608 - HC ANOSCOPY,REMOVE FOREIGN BODY"]
[null,"51705 - CHANGE CYSTOSTOMY TUBE SIMPLE",null,"46606 - ANOSCOPY W/BX SINGLE/MULTIPLE","46606 - ANOSCOPY W/BX SINGLE/MULTIPLE","46606 - ANOSCOPY W/BX SINGLE/MULTIPLE",null,"45392 - HC COLSC FLX PROX SPLENIC FLXR US GID NDL ASPIR/BX",null,null,null,null,"46900 - DSTRJ LESION ANUS SIMPLE CHEMICAL",null,"45392 - HC COLSC FLX PROX SPLENIC FLXR US GID NDL ASPIR/BX",null,null,"90672 - CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST","46610 - HC ANOSCOPY W/RMVL LESION CAUTERY"]
[null,"51710 - CHANGE CYSTOSTOMY TUBE COMPLICATED",null,"46607 - HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT W/BX","46607 - HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT W/BX","46607 - HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT W/BX",null,"45398 - HC COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S)",null,null,null,null,"46910 - DSTRJ LESION ANUS SMPL ELTRDSICCATION",null,"45398 - HC COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S)",null,null,"90673 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM","46615 - ANOSCOPY ABLATION LESION"]
[null,"51720 - BLADDER INSTILLATION ANTICARCINOGENIC AGENT",null,"46608 - HC ANOSCOPY,REMOVE FOREIGN BODY","46608 - HC ANOSCOPY,REMOVE FOREIGN BODY","46608 - HC ANOSCOPY,REMOVE FOREIGN BODY",null,"45910 - HC DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL",null,null,null,null,"46916 - DSTRJ LESION ANUS SIMPLE CRYOSURGERY",null,"45910 - HC DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL",null,null,"90674 - HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE","46900 - DSTRJ LESION ANUS SIMPLE CHEMICAL"]
[null,"51725 - SIMPLE CYSTOMETROGRAM",null,"46610 - HC ANOSCOPY W/RMVL LESION CAUTERY","46610 - HC ANOSCOPY W/RMVL LESION CAUTERY","46610 - HC ANOSCOPY W/RMVL LESION CAUTERY",null,"45915 - HC REMV RECTAL OBSTR:FECES/F.B. W ANEST",null,null,null,null,"46922 - HC SURG EXCISION OF ANAL LESION(S)",null,"45915 - HC REMV RECTAL OBSTR:FECES/F.B. W ANEST",null,null,"90675 - CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL","46910 - DSTRJ LESION ANUS SMPL ELTRDSICCATION"]
[null,"51726 - BLADDER PRESSURE MEASUREMENT DURING FILLING",null,"46615 - ANOSCOPY ABLATION LESION","46615 - ANOSCOPY ABLATION LESION","46615 - ANOSCOPY ABLATION LESION",null,"46020 - PLACEMENT ON SETON",null,null,null,null,"46924 - DSTRJ LESION ANUS EXTENSIVE",null,"46020 - PLACEMENT ON SETON",null,null,"90686 - HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE","46916 - DSTRJ LESION ANUS SIMPLE CRYOSURGERY"]
[null,"51727 - COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE",null,"46900 - DSTRJ LESION ANUS SIMPLE CHEMICAL","46900 - DSTRJ LESION ANUS SIMPLE CHEMICAL","46900 - DSTRJ LESION ANUS SIMPLE CHEMICAL",null,"46030 - REMOVAL OF RECTAL MARKER",null,null,null,null,"47000 - HEARING AID EXAMINATION & SELECTION MONAURAL",null,"46030 - REMOVAL OF RECTAL MARKER",null,null,"90690 - CR BUILD ONLY - TYPHOID VACCINE, ORAL,TRAVEL","46922 - HC SURG EXCISION OF ANAL LESION(S)"]
[null,"51728 - COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES",null,"46910 - DSTRJ LESION ANUS SMPL ELTRDSICCATION","46910 - DSTRJ LESION ANUS SMPL ELTRDSICCATION","46910 - DSTRJ LESION ANUS SMPL ELTRDSICCATION",null,"46040 - I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX",null,null,null,null,"47001 - HC BIO,LIVER AT OTH PROC",null,"46040 - I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX",null,null,"90691 - CR BUILD ONLY - TYPHOID VACCINE, IM,TRAVEL","46924 - DSTRJ LESION ANUS EXTENSIVE"]
[null,"51729 - COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL",null,"46916 - DSTRJ LESION ANUS SIMPLE CRYOSURGERY","46916 - DSTRJ LESION ANUS SIMPLE CRYOSURGERY","46916 - DSTRJ LESION ANUS SIMPLE CRYOSURGERY",null,"46050 - I&D PERIANAL ABSCESS SUPERFICIAL",null,null,null,null,"47382 - HC ABLTJ 1/> LVR TUM PRQ RF",null,"46050 - I&D PERIANAL ABSCESS SUPERFICIAL",null,null,"90694 - HC VACC AIIV4 NO PRSRV 0.5ML IM","47000 - HEARING AID EXAMINATION & SELECTION MONAURAL"]
[null,"51785 - NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ",null,"46922 - HC SURG EXCISION OF ANAL LESION(S)","46922 - HC SURG EXCISION OF ANAL LESION(S)","46922 - HC SURG EXCISION OF ANAL LESION(S)",null,"46060 - I&D ISCHIORCT/INTRAMURAL ABSC W/WO SETON",null,null,null,null,"47383 - HC ABLATION 1/> LIVER TUMOR PERQ CRYOABLATION",null,"46060 - I&D ISCHIORCT/INTRAMURAL ABSC W/WO SETON",null,null,"90698 - CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH","47001 - HC BIO,LIVER AT OTH PROC"]
[null,"51797 - VOID PRESSURE STUDIES INTRAABDOMINAL",null,"46924 - DSTRJ LESION ANUS EXTENSIVE","46924 - DSTRJ LESION ANUS EXTENSIVE","46924 - DSTRJ LESION ANUS EXTENSIVE",null,"46083 - INCISION THROMBOSED HEMORRHOID EXTERNAL",null,null,null,null,"47490 - HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT",null,"46083 - INCISION THROMBOSED HEMORRHOID EXTERNAL",null,null,"90700 - CR BUILD ONLY - DTAP IMMUNIZATION, IM, <7 YO,TRAVEL","47382 - HC ABLTJ 1/> LVR TUM PRQ RF"]
[null,"52000 - CYSTOURETHROSCOPY",null,"47000 - HEARING AID EXAMINATION & SELECTION MONAURAL","47000 - HEARING AID EXAMINATION & SELECTION MONAURAL","47000 - HEARING AID EXAMINATION & SELECTION MONAURAL",null,"46220 - EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS",null,null,null,null,"47531 - NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS",null,"46220 - EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS",null,null,"90707 - CR BUILD ONLY - MMR VIRUS IMMUNIZATION, SUBCUT,TRAVEL,PEDI","47383 - HC ABLATION 1/> LIVER TUMOR PERQ CRYOABLATION"]
[null,"52005 - HC CYSTOURETHROSCOPY,URETER CATHETER",null,"47001 - HC BIO,LIVER AT OTH PROC","47001 - HC BIO,LIVER AT OTH PROC","47001 - HC BIO,LIVER AT OTH PROC",null,"46221 - HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS",null,null,null,null,"47532 - NJX CHOLANGIO PRQ W/IMG GID RS&I NEW ACCESS",null,"46221 - HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS",null,null,"90713 - CR BUILD ONLY - POLIOMYELITIS IMMUNIZATN,INACTV,SUB-Q,DPH","47490 - HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT"]
[null,"52224 - CYSTO W/REMOVAL OF LESIONS SMALL",null,"47382 - HC ABLTJ 1/> LVR TUM PRQ RF","47382 - HC ABLTJ 1/> LVR TUM PRQ RF","47382 - HC ABLTJ 1/> LVR TUM PRQ RF",null,"46250 - HC HEMORRHOIDECTOMY,EXTERNAL, 2+ COLUMNS/GROUPS",null,null,null,null,"47533 - PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL",null,"46250 - HC HEMORRHOIDECTOMY,EXTERNAL, 2+ COLUMNS/GROUPS",null,null,"90714 - CR BUILD ONLY - TD VACCINE NO PRSRV >/= 7 YO, IM,DPH","47531 - NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS"]
[null,"52234 - HC CYSTO W/REMOVAL OF TUMORS SMALL",null,"47490 - HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT","47490 - HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT","47490 - HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT",null,"46255 - HC HEMORRHOIDECTOMY,INT/EXT,1 COLUMN/GROUP",null,null,null,null,"47534 - PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I INT-EXT",null,"46255 - HC HEMORRHOIDECTOMY,INT/EXT,1 COLUMN/GROUP",null,null,"90715 - CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH","47532 - NJX CHOLANGIO PRQ W/IMG GID RS&I NEW ACCESS"]
[null,"52281 - CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS",null,"47531 - NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS","47531 - NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS","47531 - NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS",null,"46260 - HC HEMORRHOIDECTOMY INT & XTRNL 2/> COLUMN/GRO",null,null,null,null,"47535 - HC CONV EXT BIL DRG CATH TO INT-EXT BIL DRG CATH",null,"46260 - HC HEMORRHOIDECTOMY INT & XTRNL 2/> COLUMN/GRO",null,null,"90716 - CR BUILD ONLY - CHICKEN POX VACCINE,LIVE,SUB-Q,TRAVEL","47533 - PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL"]
[null,"52285 - HC CYSTOSCOPY AND TREATMENT",null,"47532 - NJX CHOLANGIO PRQ W/IMG GID RS&I NEW ACCESS","47532 - NJX CHOLANGIO PRQ W/IMG GID RS&I NEW ACCESS","47532 - NJX CHOLANGIO PRQ W/IMG GID RS&I NEW ACCESS",null,"46320 - HC EXCISION THROMBOSED HEMORRHOID, EXTERNAL",null,null,null,null,"47536 - EXCHANGE BILIARY DRG CATHETER PRQ W/IMAGE GUID RAD S&I",null,"46320 - HC EXCISION THROMBOSED HEMORRHOID, EXTERNAL",null,null,"90717 - YELLOW FEVER VACCINE SUBQ","47534 - PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I INT-EXT"]
[null,"52310 - CYSTO W/SIMPLE REMOVAL STONE & STENT",null,"47533 - PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL","47533 - PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL","47533 - PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL",null,"46505 - CHEMODENERVATION ANAL SPHINCTER",null,null,null,null,"47537 - REMOVAL BILIARY DRG CATHETER REQ FLUOR GUID RAD S&I",null,"46505 - CHEMODENERVATION ANAL SPHINCTER",null,null,"90723 - CR BUILD ONLY - DTAP/HEPB/IPV VACCINE,IM,DPH","47535 - HC CONV EXT BIL DRG CATH TO INT-EXT BIL DRG CATH"]
[null,"52332 - HC CYSTOSCOPY, INSERT URETERAL STENT",null,"47534 - PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I INT-EXT","47534 - PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I INT-EXT","47534 - PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I INT-EXT",null,"46600 - ANOSCOPY DX W/WO COLLJ SPEC BR/WA SPX",null,null,null,null,"47538 - HC PERQ PLMTBIL DUCTSTNT EX",null,"46600 - ANOSCOPY DX W/WO COLLJ SPEC BR/WA SPX",null,null,"90732 - CR BUILD ONLY - PNEUMOCOCCAL VACCINE,23-VALENT,ADULT,TRAVEL","47536 - EXCHANGE BILIARY DRG CATHETER PRQ W/IMAGE GUID RAD S&I"]
[null,"52351 - HC CYSTO/URETERO/PYELOSCOPY, DX",null,"47535 - HC CONV EXT BIL DRG CATH TO INT-EXT BIL DRG CATH","47535 - HC CONV EXT BIL DRG CATH TO INT-EXT BIL DRG CATH","47535 - HC CONV EXT BIL DRG CATH TO INT-EXT BIL DRG CATH",null,"46601 - HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT",null,null,null,null,"47542 - BALLOON DILAT BILIARY DUCT/AMPULLA PRQ EACH DUCT",null,"46601 - HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT",null,null,"90734 - CR BUILD ONLY - MENINGOCOCCAL VACCINE, IM,TRAVEL","47537 - REMOVAL BILIARY DRG CATHETER REQ FLUOR GUID RAD S&I"]
[null,"52356 - HC CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT",null,"47536 - EXCHANGE BILIARY DRG CATHETER PRQ W/IMAGE GUID RAD S&I","47536 - EXCHANGE BILIARY DRG CATHETER PRQ W/IMAGE GUID RAD S&I","47536 - EXCHANGE BILIARY DRG CATHETER PRQ W/IMAGE GUID RAD S&I",null,"46604 - HC ANOSCOPY,W/DILATION",null,null,null,null,"47552 - HC BILIARY ENDO PRQ T-TUBE DX W/COLLECT SPEC BRUSH",null,"46604 - HC ANOSCOPY,W/DILATION",null,null,"90736 - ZOSTER SHINGLES VACCINE LIVE SUBCUTANEOUS","47538 - HC PERQ PLMTBIL DUCTSTNT EX"]
[null,"53450 - HC REVISION OF URETHRA",null,"47537 - REMOVAL BILIARY DRG CATHETER REQ FLUOR GUID RAD S&I","47537 - REMOVAL BILIARY DRG CATHETER REQ FLUOR GUID RAD S&I","47537 - REMOVAL BILIARY DRG CATHETER REQ FLUOR GUID RAD S&I",null,"46606 - ANOSCOPY W/BX SINGLE/MULTIPLE",null,null,null,null,"47554 - HC BILIARY ENDOSCOPY,PERCUT,W/REM, STONE(S)",null,"46606 - ANOSCOPY W/BX SINGLE/MULTIPLE",null,null,"90738 - HC JAPANESE ENCEPH VACC, INACTIVATED, IM,TRAVEL","47542 - BALLOON DILAT BILIARY DUCT/AMPULLA PRQ EACH DUCT"]
[null,"53600 - DILAT URETHRAL STRIX DILATOR MALE 1ST",null,"47538 - HC PERQ PLMTBIL DUCTSTNT EX","47538 - HC PERQ PLMTBIL DUCTSTNT EX","47538 - HC PERQ PLMTBIL DUCTSTNT EX",null,"46607 - HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT W/BX",null,null,null,null,"47555 - HC BIL ENDO,PERC;DIL W/O STE",null,"46607 - HC ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT W/BX",null,null,"90739 - HC HEPATITIS B VACCINE ADULT 2 DOSE IM","47552 - HC BILIARY ENDO PRQ T-TUBE DX W/COLLECT SPEC BRUSH"]
[null,"53620 - DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE 1ST",null,"47542 - BALLOON DILAT BILIARY DUCT/AMPULLA PRQ EACH DUCT","47542 - BALLOON DILAT BILIARY DUCT/AMPULLA PRQ EACH DUCT","47542 - BALLOON DILAT BILIARY DUCT/AMPULLA PRQ EACH DUCT",null,"46608 - HC ANOSCOPY,REMOVE FOREIGN BODY",null,null,null,null,"47556 - HC BILIARY NDSC PRQ T-TUBE DILAT STRIX W/STENT",null,"46608 - HC ANOSCOPY,REMOVE FOREIGN BODY",null,null,"90740 - HC HEP B VACCINE,DIAL/IMMUNOSUP, IM","47554 - HC BILIARY ENDOSCOPY,PERCUT,W/REM, STONE(S)"]
[null,"53660 - HC DILATION OF URETHRA",null,"47552 - HC BILIARY ENDO PRQ T-TUBE DX W/COLLECT SPEC BRUSH","47552 - HC BILIARY ENDO PRQ T-TUBE DX W/COLLECT SPEC BRUSH","47552 - HC BILIARY ENDO PRQ T-TUBE DX W/COLLECT SPEC BRUSH",null,"46610 - HC ANOSCOPY W/RMVL LESION CAUTERY",null,null,null,null,"48102 - HC BIOPSY PANCREA PERCUTANEOUS NEEDLE",null,"46610 - HC ANOSCOPY W/RMVL LESION CAUTERY",null,null,"90744 - CR BUILD ONLY - HEP B VACCINE,PED/ADOL,IM,DPH","47555 - HC BIL ENDO,PERC;DIL W/O STE"]
[null,"53854 - HC TRURL DSTRJ PRST8 TISS RF WV THERMOTHERAPY",null,"47554 - HC BILIARY ENDOSCOPY,PERCUT,W/REM, STONE(S)","47554 - HC BILIARY ENDOSCOPY,PERCUT,W/REM, STONE(S)","47554 - HC BILIARY ENDOSCOPY,PERCUT,W/REM, STONE(S)",null,"46615 - ANOSCOPY ABLATION LESION",null,null,null,null,"49082 - ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE",null,"46615 - ANOSCOPY ABLATION LESION",null,null,"90746 - CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL","47556 - HC BILIARY NDSC PRQ T-TUBE DILAT STRIX W/STENT"]
[null,"53899 - HC URETERAL DILATION",null,"47555 - HC BIL ENDO,PERC;DIL W/O STE","47555 - HC BIL ENDO,PERC;DIL W/O STE","47555 - HC BIL ENDO,PERC;DIL W/O STE",null,"46900 - DSTRJ LESION ANUS SIMPLE CHEMICAL",null,null,null,null,"49083 - ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE",null,"46900 - DSTRJ LESION ANUS SIMPLE CHEMICAL",null,null,"90756 - HC CCIIV4 VACCINE ANTIBIOTIC FREE 0.5ML DOS IM USE","48102 - HC BIOPSY PANCREA PERCUTANEOUS NEEDLE"]
[null,"54001 - HC SLITTING OF PREPUCE",null,"47556 - HC BILIARY NDSC PRQ T-TUBE DILAT STRIX W/STENT","47556 - HC BILIARY NDSC PRQ T-TUBE DILAT STRIX W/STENT","47556 - HC BILIARY NDSC PRQ T-TUBE DILAT STRIX W/STENT",null,"46910 - DSTRJ LESION ANUS SMPL ELTRDSICCATION",null,null,null,null,"49180 - BX ABDL/RETROPERITONEAL MASS PRQ NEEDLE",null,"46910 - DSTRJ LESION ANUS SMPL ELTRDSICCATION",null,null,"92002 - OPHTH MEDICAL XM&EVAL INTERMEDIATE NEW PT","49082 - ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE"]
[null,"54060 - HC DESTR PENIS LESN,SIMPL,SURG EXCIS",null,"48102 - HC BIOPSY PANCREA PERCUTANEOUS NEEDLE","48102 - HC BIOPSY PANCREA PERCUTANEOUS NEEDLE","48102 - HC BIOPSY PANCREA PERCUTANEOUS NEEDLE",null,"46916 - DSTRJ LESION ANUS SIMPLE CRYOSURGERY",null,null,null,null,"49185 - SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID",null,"46916 - DSTRJ LESION ANUS SIMPLE CRYOSURGERY",null,null,"92004 - OPHTH MEDICAL XM&EVAL COMPRE NEW PT 1/> VST","49083 - ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE"]
[null,"54065 - DSTRJ LESION PENIS EXTENSIVE",null,"49010 - HC EXPLORATORY RETROPERITONEAL","49010 - HC EXPLORATORY RETROPERITONEAL","49010 - HC EXPLORATORY RETROPERITONEAL",null,"46922 - HC SURG EXCISION OF ANAL LESION(S)",null,null,null,null,"49320 - HC LAP,DIAGNOSTIC ABDOMEN",null,"46922 - HC SURG EXCISION OF ANAL LESION(S)",null,null,"92012 - OPHTH MEDICAL XM&EVAL INTERMEDIATE ESTAB PT","49180 - BX ABDL/RETROPERITONEAL MASS PRQ NEEDLE"]
[null,"54100 - BIOPSY PENIS SEPARATE PROCEDURE",null,"49082 - ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE","49082 - ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE","49082 - ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE",null,"46924 - DSTRJ LESION ANUS EXTENSIVE",null,null,null,null,"49321 - HC LAP,DX SURGICAL ABD W/BIOPSY",null,"46924 - DSTRJ LESION ANUS EXTENSIVE",null,null,"92014 - OPHTH MEDICAL XM&EVAL COMPRHNSV ESTAB PT 1/>","49185 - SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID"]
[null,"54115 - HC REMV FOR.BODY DEEP PENILE TISS",null,"49083 - ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE","49083 - ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE","49083 - ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE",null,"47000 - HEARING AID EXAMINATION & SELECTION MONAURAL",null,null,null,null,"49324 - HC LAP INSERTION TUNNELED INTRAPERITONEAL CATHETER",null,"47000 - HEARING AID EXAMINATION & SELECTION MONAURAL",null,null,"92018 - HC NEW EYE EXAM & TREATMENT","49320 - HC LAP,DIAGNOSTIC ABDOMEN"]
[null,"54150 - CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK",null,"49180 - BX ABDL/RETROPERITONEAL MASS PRQ NEEDLE","49180 - BX ABDL/RETROPERITONEAL MASS PRQ NEEDLE","49180 - BX ABDL/RETROPERITONEAL MASS PRQ NEEDLE",null,"47001 - HC BIO,LIVER AT OTH PROC",null,null,null,null,"49405 - IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ",null,"47001 - HC BIO,LIVER AT OTH PROC",null,null,"92020 - GONIOSCOPY SEPARATE PROCEDURE","49321 - HC LAP,DX SURGICAL ABD W/BIOPSY"]
[null,"54161 - HC CIRCUM 28 DAYS OR OLDER",null,"49185 - SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID","49185 - SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID","49185 - SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID",null,"47382 - HC ABLTJ 1/> LVR TUM PRQ RF",null,null,null,null,"49406 - IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ",null,"47382 - HC ABLTJ 1/> LVR TUM PRQ RF",null,null,"92060 - SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX","49324 - HC LAP INSERTION TUNNELED INTRAPERITONEAL CATHETER"]
[null,"54162 - HC LYSIS/EXCIS,PENILE POSTCIRCUM ADHESIONS",null,"49320 - HC LAP,DIAGNOSTIC ABDOMEN","49320 - HC LAP,DIAGNOSTIC ABDOMEN","49320 - HC LAP,DIAGNOSTIC ABDOMEN",null,"47383 - HC ABLATION 1/> LIVER TUMOR PERQ CRYOABLATION",null,null,null,null,"49407 - IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL",null,"47383 - HC ABLATION 1/> LIVER TUMOR PERQ CRYOABLATION",null,null,"92065 - ORTHOPTIC &/PLEOPTIC TRAINING W/MEDICAL DIRECTJ","49405 - IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ"]
[null,"54164 - FRENULOTOMY PENIS",null,"49321 - HC LAP,DX SURGICAL ABD W/BIOPSY","49321 - HC LAP,DX SURGICAL ABD W/BIOPSY","49321 - HC LAP,DX SURGICAL ABD W/BIOPSY",null,"47399 - HC ABL,ALCOHOL,1/+ LIVER TUM",null,null,null,null,"49411 - INTERSTITIAL DEV PLMT RADIATION THERAPY 1/MLT",null,"47399 - HC ABL,ALCOHOL,1/+ LIVER TUM",null,null,"92081 - VISUAL FIELD XM UNI/BI W/INTERPRETJ LIMITED EXAM","49406 - IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ"]
[null,"54220 - IRRIGATION CORPORA CAVERNOSA PRIAPISM",null,"49324 - HC LAP INSERTION TUNNELED INTRAPERITONEAL CATHETER","49324 - HC LAP INSERTION TUNNELED INTRAPERITONEAL CATHETER","49324 - HC LAP INSERTION TUNNELED INTRAPERITONEAL CATHETER",null,"47490 - HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT",null,null,null,null,"49418 - INSJ INTRAPERITONEAL CATHETER W/IMG GID",null,"47490 - HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT",null,null,"92082 - VISUAL FIELD XM UNI/BI W/INTERP INTERMED EXAM","49407 - IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL"]
[null,"54450 - FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING",null,"49405 - IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ","49405 - IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ","49405 - IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ",null,"47531 - NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS",null,null,null,null,"49422 - REMOVE TUNNELED IP CATH",null,"47531 - NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS",null,null,"92132 - CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI","49411 - INTERSTITIAL DEV PLMT RADIATION THERAPY 1/MLT"]
[null,"54520 - HC REMOVAL OF TESTIS",null,"49406 - IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ","49406 - IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ","49406 - IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ",null,"47532 - NJX CHOLANGIO PRQ W/IMG GID RS&I NEW ACCESS",null,null,null,null,"49423 - HC EXCHNG ABSC/CST DRG CATH RAD GID SPX",null,"47532 - NJX CHOLANGIO PRQ W/IMG GID RS&I NEW ACCESS",null,null,"92133 - COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE","49418 - INSJ INTRAPERITONEAL CATHETER W/IMG GID"]
[null,"54600 - HC REDUCE TESTIS TORSION",null,"49407 - IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL","49407 - IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL","49407 - IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL",null,"47533 - PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL",null,null,null,null,"49424 - HC INJ CONT ABS/CY EVAL",null,"47533 - PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL",null,null,"92134 - COMPUTERIZED OPHTHALMIC IMAGING RETINA","49422 - REMOVE TUNNELED IP CATH"]
[null,"54700 - I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE",null,"49411 - INTERSTITIAL DEV PLMT RADIATION THERAPY 1/MLT","49411 - INTERSTITIAL DEV PLMT RADIATION THERAPY 1/MLT","49411 - INTERSTITIAL DEV PLMT RADIATION THERAPY 1/MLT",null,"47534 - PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I INT-EXT",null,null,null,null,"49427 - HC INJ PROC EXIST VP SHUNT",null,"47534 - PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I INT-EXT",null,null,"92136 - OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL","49423 - HC EXCHNG ABSC/CST DRG CATH RAD GID SPX"]
[null,"55100 - DRAIN SCROTAL WALL ABS",null,"49418 - INSJ INTRAPERITONEAL CATHETER W/IMG GID","49418 - INSJ INTRAPERITONEAL CATHETER W/IMG GID","49418 - INSJ INTRAPERITONEAL CATHETER W/IMG GID",null,"47535 - HC CONV EXT BIL DRG CATH TO INT-EXT BIL DRG CATH",null,null,null,null,"49440 - INSERT GASTROSTOMY TUBE PERCUTANEOUS",null,"47535 - HC CONV EXT BIL DRG CATH TO INT-EXT BIL DRG CATH",null,null,"92225 - OPHTHALMOSCPY EXTENDED RETINAL DRAWING I&R 1ST","49424 - HC INJ CONT ABS/CY EVAL"]
[null,"55120 - HB REMOVAL OF SCROTAL FOR BODY",null,"49422 - REMOVE TUNNELED IP CATH","49422 - REMOVE TUNNELED IP CATH","49422 - REMOVE TUNNELED IP CATH",null,"47536 - EXCHANGE BILIARY DRG CATHETER PRQ W/IMAGE GUID RAD S&I",null,null,null,null,"49441 - HC INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ",null,"47536 - EXCHANGE BILIARY DRG CATHETER PRQ W/IMAGE GUID RAD S&I",null,null,"92226 - OPHTHALMOSCPY EXTENDED RETINAL DRAWING I&R SBS","49427 - HC INJ PROC EXIST VP SHUNT"]
[null,"55250 - VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS",null,"49423 - HC EXCHNG ABSC/CST DRG CATH RAD GID SPX","49423 - HC EXCHNG ABSC/CST DRG CATH RAD GID SPX","49423 - HC EXCHNG ABSC/CST DRG CATH RAD GID SPX",null,"47537 - REMOVAL BILIARY DRG CATHETER REQ FLUOR GUID RAD S&I",null,null,null,null,"49446 - HC CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERQ",null,"47537 - REMOVAL BILIARY DRG CATHETER REQ FLUOR GUID RAD S&I",null,null,"92235 - FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT","49440 - INSERT GASTROSTOMY TUBE PERCUTANEOUS"]
[null,"55400 - HC REPAIR OF SPERM DUCT",null,"49424 - HC INJ CONT ABS/CY EVAL","49424 - HC INJ CONT ABS/CY EVAL","49424 - HC INJ CONT ABS/CY EVAL",null,"47538 - HC PERQ PLMTBIL DUCTSTNT EX",null,null,null,null,"49450 - HC REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS",null,"47538 - HC PERQ PLMTBIL DUCTSTNT EX",null,null,"92240 - INDOCYANINE GREEN ANGIOGRAPHY W/INTERP & REPOR","49441 - HC INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ"]
[null,"55520 - HC REMOVAL OF SPERM CORD LESION",null,"49427 - HC INJ PROC EXIST VP SHUNT","49427 - HC INJ PROC EXIST VP SHUNT","49427 - HC INJ PROC EXIST VP SHUNT",null,"47542 - BALLOON DILAT BILIARY DUCT/AMPULLA PRQ EACH DUCT",null,null,null,null,"49451 - HC PERC REPL DUD/JEJ TUBE,W/",null,"47542 - BALLOON DILAT BILIARY DUCT/AMPULLA PRQ EACH DUCT",null,null,"92250 - FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT","49446 - HC CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERQ"]
[null,"55700 - PROSTATE NEEDLE BIOPSY ANY APPROACH",null,"49440 - INSERT GASTROSTOMY TUBE PERCUTANEOUS","49440 - INSERT GASTROSTOMY TUBE PERCUTANEOUS","49440 - INSERT GASTROSTOMY TUBE PERCUTANEOUS",null,"47552 - HC BILIARY ENDO PRQ T-TUBE DX W/COLLECT SPEC BRUSH",null,null,null,null,"49452 - HC PERC REPL GAST_JEJ TUBE,W",null,"47552 - HC BILIARY ENDO PRQ T-TUBE DX W/COLLECT SPEC BRUSH",null,null,"92260 - OPHTHALMODYNAMOMETRY","49450 - HC REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS"]
[null,"55876 - PLMT INTERSTITIAL DEV RADIAT TX PROSTATE 1/MULT",null,"49441 - HC INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ","49441 - HC INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ","49441 - HC INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ",null,"47554 - HC BILIARY ENDOSCOPY,PERCUT,W/REM, STONE(S)",null,null,null,null,"49460 - HC FIX G/COLON TUBE W/DEVICE",null,"47554 - HC BILIARY ENDOSCOPY,PERCUT,W/REM, STONE(S)",null,null,"92265 - NEEDLE OCULOGRAPHY 1/ XOC MUSC 1/BOTH EYE W/I&R","49451 - HC PERC REPL DUD/JEJ TUBE,W/"]
[null,"55899 - UNLISTED PROCEDURE MALE GENITAL SYSTEM",null,"49446 - HC CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERQ","49446 - HC CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERQ","49446 - HC CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERQ",null,"47555 - HC BIL ENDO,PERC;DIL W/O STE",null,null,null,null,"49465 - HC CONTRAST INJECTION PERQ RADIOLOGIC EVAL GI TUBE",null,"47555 - HC BIL ENDO,PERC;DIL W/O STE",null,null,"92270 - ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT","49452 - HC PERC REPL GAST_JEJ TUBE,W"]
[null,"56405 - I&D VULVA/PERINEAL ABSCESS",null,"49450 - HC REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS","49450 - HC REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS","49450 - HC REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS",null,"47556 - HC BILIARY NDSC PRQ T-TUBE DILAT STRIX W/STENT",null,null,null,null,"49570 - HC REPAIR EPIGASTRIC HERNIA,REDUC",null,"47556 - HC BILIARY NDSC PRQ T-TUBE DILAT STRIX W/STENT",null,null,"92275 - ELECTRORETINOGRAPY W/INTERPRETATION & REPORT","49460 - HC FIX G/COLON TUBE W/DEVICE"]
[null,"56420 - I&D OF BARTHOLINS GLAND ABSCESS",null,"49451 - HC PERC REPL DUD/JEJ TUBE,W/","49451 - HC PERC REPL DUD/JEJ TUBE,W/","49451 - HC PERC REPL DUD/JEJ TUBE,W/",null,"48102 - HC BIOPSY PANCREA PERCUTANEOUS NEEDLE",null,null,null,null,"50200 - RENAL BIOPSY PRQ TROCAR/NEEDLE",null,"48102 - HC BIOPSY PANCREA PERCUTANEOUS NEEDLE",null,null,"92283 - HC COLOR VISION EXAMINATION","49465 - HC CONTRAST INJECTION PERQ RADIOLOGIC EVAL GI TUBE"]
[null,"56440 - MARSUPIALIZATION BARTHOLINS GLAND CYST",null,"49452 - HC PERC REPL GAST_JEJ TUBE,W","49452 - HC PERC REPL GAST_JEJ TUBE,W","49452 - HC PERC REPL GAST_JEJ TUBE,W",null,"49010 - HC EXPLORATORY RETROPERITONEAL",null,null,null,null,"50382 - HC RMVL & RPLCMT INTLY DWELLING URETERAL STENT PRQ",null,"49010 - HC EXPLORATORY RETROPERITONEAL",null,null,"92284 - DARK ADAPTATION XM W/INTERPRETATION & REPORT","49570 - HC REPAIR EPIGASTRIC HERNIA,REDUC"]
[null,"56442 - HYMENOTOMY",null,"49460 - HC FIX G/COLON TUBE W/DEVICE","49460 - HC FIX G/COLON TUBE W/DEVICE","49460 - HC FIX G/COLON TUBE W/DEVICE",null,"49082 - ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE",null,null,null,null,"50385 - HC REMOVE & REPLACE INDWELL URETERAL STENT TRURTHRL",null,"49082 - ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE",null,null,"92285 - XTRNL OCULAR PHOTOG W/I&R DOCMT MEDICAL PROGRE","50200 - RENAL BIOPSY PRQ TROCAR/NEEDLE"]
[null,"56501 - DESTRUCTION LESIONS VULVA SIMPLE",null,"49465 - HC CONTRAST INJECTION PERQ RADIOLOGIC EVAL GI TUBE","49465 - HC CONTRAST INJECTION PERQ RADIOLOGIC EVAL GI TUBE","49465 - HC CONTRAST INJECTION PERQ RADIOLOGIC EVAL GI TUBE",null,"49083 - ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE",null,null,null,null,"50386 - HC REM URET STENT,TRANS,W/O",null,"49083 - ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE",null,null,"92286 - ANT SGM IMAGING W/MICROSCOPY ENDOTHELIAL ANALY","50382 - HC RMVL & RPLCMT INTLY DWELLING URETERAL STENT PRQ"]
[null,"56515 - DESTRUCTION LESIONS VULVA EXTENSIVE",null,"49570 - HC REPAIR EPIGASTRIC HERNIA,REDUC","49570 - HC REPAIR EPIGASTRIC HERNIA,REDUC","49570 - HC REPAIR EPIGASTRIC HERNIA,REDUC",null,"49180 - BX ABDL/RETROPERITONEAL MASS PRQ NEEDLE",null,null,null,null,"50387 - HC RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH",null,"49180 - BX ABDL/RETROPERITONEAL MASS PRQ NEEDLE",null,null,"92287 - ANT SGM IMAGING W/FLUOROSCEIN ANGIO & I&R","50385 - HC REMOVE & REPLACE INDWELL URETERAL STENT TRURTHRL"]
[null,"56605 - BIOPSY VULVA/PERINEUM 1 LESION SPX",null,"50200 - RENAL BIOPSY PRQ TROCAR/NEEDLE","50200 - RENAL BIOPSY PRQ TROCAR/NEEDLE","50200 - RENAL BIOPSY PRQ TROCAR/NEEDLE",null,"49185 - SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID",null,null,null,null,"50389 - HC RMVL NFROS TUBE REQ FLUORO GUIDANCE",null,"49185 - SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID",null,null,"92311 - HC CONTACT LENS FIT, APHAKIA UNILAT","50386 - HC REM URET STENT,TRANS,W/O"]
[null,"56606 - BIOPSY VULVA/PERINEUM EACH ADDL LESION",null,"50382 - HC RMVL & RPLCMT INTLY DWELLING URETERAL STENT PRQ","50382 - HC RMVL & RPLCMT INTLY DWELLING URETERAL STENT PRQ","50382 - HC RMVL & RPLCMT INTLY DWELLING URETERAL STENT PRQ",null,"49320 - HC LAP,DIAGNOSTIC ABDOMEN",null,null,null,null,"50390 - ASPIR &/NJX RENAL CYST/PELVIS NEEDLE PRQ",null,"49320 - HC LAP,DIAGNOSTIC ABDOMEN",null,null,"92312 - HC CONTACT LENS FIT,APHAKIA BILAT","50387 - HC RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH"]
[null,"56620 - HC PART SIMPLE REMV VULVA",null,"50385 - HC REMOVE & REPLACE INDWELL URETERAL STENT TRURTHRL","50385 - HC REMOVE & REPLACE INDWELL URETERAL STENT TRURTHRL","50385 - HC REMOVE & REPLACE INDWELL URETERAL STENT TRURTHRL",null,"49321 - HC LAP,DX SURGICAL ABD W/BIOPSY",null,null,null,null,"50430 - HC NJX PX ANTEGRDE NFROSGRM &/URTRGRM NEW ACCESS",null,"49321 - HC LAP,DX SURGICAL ABD W/BIOPSY",null,null,"92313 - HC CONTACT LENS FIT,CORNEOSCLERAL LENS","50389 - HC RMVL NFROS TUBE REQ FLUORO GUIDANCE"]
[null,"56700 - HC PARTIAL REMOVAL OF HYMEN",null,"50386 - HC REM URET STENT,TRANS,W/O","50386 - HC REM URET STENT,TRANS,W/O","50386 - HC REM URET STENT,TRANS,W/O",null,"49324 - HC LAP INSERTION TUNNELED INTRAPERITONEAL CATHETER",null,null,null,null,"50431 - HC NJX ANTGRD NPHRSTGRM &/OR URTRGRM COMPL DIAG INCL IMG GUI RAD S&I; EXSTNG ACCES",null,"49324 - HC LAP INSERTION TUNNELED INTRAPERITONEAL CATHETER",null,null,"92507 - TX SPEECH LANG VOICE COMMJ &/AUDITORY PROC IND","50390 - ASPIR &/NJX RENAL CYST/PELVIS NEEDLE PRQ"]
[null,"56740 - HC EXCIS BARTHOLIN GLAND/CYST",null,"50387 - HC RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH","50387 - HC RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH","50387 - HC RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH",null,"49329 - HC LAPARO PROC ABDM/PER/OMENT",null,null,null,null,"50432 - HC PLACEMENT NEPHROSTOMY CATH PRQ NEW ACCESS RAD S&I",null,"49329 - HC LAPARO PROC ABDM/PER/OMENT",null,null,"92508 - TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV","50430 - HC NJX PX ANTEGRDE NFROSGRM &/URTRGRM NEW ACCESS"]
[null,"56820 - COLPOSCOPY VULVA",null,"50389 - HC RMVL NFROS TUBE REQ FLUORO GUIDANCE","50389 - HC RMVL NFROS TUBE REQ FLUORO GUIDANCE","50389 - HC RMVL NFROS TUBE REQ FLUORO GUIDANCE",null,"49405 - IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ",null,null,null,null,"50433 - PLACEMENT NEPHROURETERAL CATH PRQ NEW ACCESS RAD S&I",null,"49405 - IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ",null,null,"92521 - EVALUATION OF SPEECH FLUENCY (STUTTER CLUTTER)","50431 - HC NJX ANTGRD NPHRSTGRM &/OR URTRGRM COMPL DIAG INCL IMG GUI RAD S&I; EXSTNG ACCES"]
[null,"56821 - COLPOSCOPY VULVA W/BIOPSY",null,"50390 - ASPIR &/NJX RENAL CYST/PELVIS NEEDLE PRQ","50390 - ASPIR &/NJX RENAL CYST/PELVIS NEEDLE PRQ","50390 - ASPIR &/NJX RENAL CYST/PELVIS NEEDLE PRQ",null,"49406 - IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ",null,null,null,null,"50434 - CONVERT NEPHROSTOMY CATH TO NEPHROURTRL CATH PRQ",null,"49406 - IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ",null,null,"92522 - EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE","50432 - HC PLACEMENT NEPHROSTOMY CATH PRQ NEW ACCESS RAD S&I"]
[null,"57020 - COLPOCENTESIS SEPARATE PROCEDURE",null,"50430 - HC NJX PX ANTEGRDE NFROSGRM &/URTRGRM NEW ACCESS","50430 - HC NJX PX ANTEGRDE NFROSGRM &/URTRGRM NEW ACCESS","50430 - HC NJX PX ANTEGRDE NFROSGRM &/URTRGRM NEW ACCESS",null,"49407 - IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL",null,null,null,null,"50435 - EXCHANGE NEPHROSTOMY CATHETER PRQ W/IMAGE GUIDE RAD S&I",null,"49407 - IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL",null,null,"92523 - EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION","50433 - PLACEMENT NEPHROURETERAL CATH PRQ NEW ACCESS RAD S&I"]
[null,"57023 - HC I & D VAG HEMATOMA NON-OB",null,"50431 - HC NJX ANTGRD NPHRSTGRM &/OR URTRGRM COMPL DIAG INCL IMG GUI RAD S&I; EXSTNG ACCES","50431 - HC NJX ANTGRD NPHRSTGRM &/OR URTRGRM COMPL DIAG INCL IMG GUI RAD S&I; EXSTNG ACCES","50431 - HC NJX ANTGRD NPHRSTGRM &/OR URTRGRM COMPL DIAG INCL IMG GUI RAD S&I; EXSTNG ACCES",null,"49411 - INTERSTITIAL DEV PLMT RADIATION THERAPY 1/MLT",null,null,null,null,"50436 - HC DILAT XST TRC NDURLGC PX",null,"49411 - INTERSTITIAL DEV PLMT RADIATION THERAPY 1/MLT",null,null,"92524 - BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE","50434 - CONVERT NEPHROSTOMY CATH TO NEPHROURTRL CATH PRQ"]
[null,"57061 - DESTRUCTION VAGINAL LESIONS SIMPLE",null,"50432 - HC PLACEMENT NEPHROSTOMY CATH PRQ NEW ACCESS RAD S&I","50432 - HC PLACEMENT NEPHROSTOMY CATH PRQ NEW ACCESS RAD S&I","50432 - HC PLACEMENT NEPHROSTOMY CATH PRQ NEW ACCESS RAD S&I",null,"49418 - INSJ INTRAPERITONEAL CATHETER W/IMG GID",null,null,null,null,"50437 - HC DILAT XST TRC NEW ACCESS RCS",null,"49418 - INSJ INTRAPERITONEAL CATHETER W/IMG GID",null,null,"92552 - PURE TONE AUDIOMETRY AIR ONLY","50435 - EXCHANGE NEPHROSTOMY CATHETER PRQ W/IMAGE GUIDE RAD S&I"]
[null,"57100 - BIOPSY VAGINAL MUCOSA SIMPLE",null,"50433 - PLACEMENT NEPHROURETERAL CATH PRQ NEW ACCESS RAD S&I","50433 - PLACEMENT NEPHROURETERAL CATH PRQ NEW ACCESS RAD S&I","50433 - PLACEMENT NEPHROURETERAL CATH PRQ NEW ACCESS RAD S&I",null,"49422 - REMOVE TUNNELED IP CATH",null,null,null,null,"50561 - HC RENAL ENDOSCOPY,REMV FB/STONE",null,"49422 - REMOVE TUNNELED IP CATH",null,null,"92553 - PURE TONE AUDIOMETRY AIR & BONE","50436 - HC DILAT XST TRC NDURLGC PX"]
[null,"57105 - HC BIOPSY OF VAGINA",null,"50434 - CONVERT NEPHROSTOMY CATH TO NEPHROURTRL CATH PRQ","50434 - CONVERT NEPHROSTOMY CATH TO NEPHROURTRL CATH PRQ","50434 - CONVERT NEPHROSTOMY CATH TO NEPHROURTRL CATH PRQ",null,"49423 - HC EXCHNG ABSC/CST DRG CATH RAD GID SPX",null,null,null,null,"50592 - HC ABLTJ 1/> RENAL TUMOR PRQ UNI RADIOFREQUENCY",null,"49423 - HC EXCHNG ABSC/CST DRG CATH RAD GID SPX",null,null,"92555 - SPEECH AUDIOMETRY THRESHOLD","50437 - HC DILAT XST TRC NEW ACCESS RCS"]
[null,"57107 - REMOVE VAGINA TISSUE PART",null,"50435 - EXCHANGE NEPHROSTOMY CATHETER PRQ W/IMAGE GUIDE RAD S&I","50435 - EXCHANGE NEPHROSTOMY CATHETER PRQ W/IMAGE GUIDE RAD S&I","50435 - EXCHANGE NEPHROSTOMY CATHETER PRQ W/IMAGE GUIDE RAD S&I",null,"49424 - HC INJ CONT ABS/CY EVAL",null,null,null,null,"50593 - HC ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY",null,"49424 - HC INJ CONT ABS/CY EVAL",null,null,"92556 - SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ","50561 - HC RENAL ENDOSCOPY,REMV FB/STONE"]
[null,"57135 - HC EXCIS VAGINAL CYST/TUMOR",null,"50436 - HC DILAT XST TRC NDURLGC PX","50436 - HC DILAT XST TRC NDURLGC PX","50436 - HC DILAT XST TRC NDURLGC PX",null,"49427 - HC INJ PROC EXIST VP SHUNT",null,null,null,null,"50684 - INJ PX URETEROGRAPHY/URETEROPYLOGRAPHY CATH",null,"49427 - HC INJ PROC EXIST VP SHUNT",null,null,"92557 - COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ","50592 - HC ABLTJ 1/> RENAL TUMOR PRQ UNI RADIOFREQUENCY"]
[null,"57155 - HC OR INSERTION OF T&O",null,"50437 - HC DILAT XST TRC NEW ACCESS RCS","50437 - HC DILAT XST TRC NEW ACCESS RCS","50437 - HC DILAT XST TRC NEW ACCESS RCS",null,"49440 - INSERT GASTROSTOMY TUBE PERCUTANEOUS",null,null,null,null,"50688 - CHNG URTROST TUBE/XTRNLLY ACCESSIBLE STENT ILEAL",null,"49440 - INSERT GASTROSTOMY TUBE PERCUTANEOUS",null,null,"92562 - LOUDNESS BALANCE BINAURAL/MONAURAL","50593 - HC ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY"]
[null,"57156 - HC INSERTION OF CYLINDER",null,"50561 - HC RENAL ENDOSCOPY,REMV FB/STONE","50561 - HC RENAL ENDOSCOPY,REMV FB/STONE","50561 - HC RENAL ENDOSCOPY,REMV FB/STONE",null,"49441 - HC INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ",null,null,null,null,"50693 - PLACEMENT URETERAL STENT PRQ WITH PRE-EXISTING NEPHROSTOMY TRACT",null,"49441 - HC INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ",null,null,"92563 - TONE DECAY TEST","50684 - INJ PX URETEROGRAPHY/URETEROPYLOGRAPHY CATH"]
[null,"57200 - HC COLPORRHAPHY, SUTURE VAGINAL INJURY, NON-OB",null,"50592 - HC ABLTJ 1/> RENAL TUMOR PRQ UNI RADIOFREQUENCY","50592 - HC ABLTJ 1/> RENAL TUMOR PRQ UNI RADIOFREQUENCY","50592 - HC ABLTJ 1/> RENAL TUMOR PRQ UNI RADIOFREQUENCY",null,"49446 - HC CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERQ",null,null,null,null,"50694 - PLACEMENT URETERAL STENT PRQ NEW ACESS WITHOUT SEP NEPHROSTOMY CATH",null,"49446 - HC CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERQ",null,null,"92565 - STENGER TEST PURE TONE","50688 - CHNG URTROST TUBE/XTRNLLY ACCESSIBLE STENT ILEAL"]
[null,"57210 - HC REPAIR VAGINA/PERINEUM",null,"50593 - HC ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY","50593 - HC ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY","50593 - HC ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY",null,"49450 - HC REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS",null,null,null,null,"50695 - HC PLMT URET STNTW/SEP NEPH",null,"49450 - HC REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS",null,null,"92567 - TYMPANOMETRY","50693 - PLACEMENT URETERAL STENT PRQ WITH PRE-EXISTING NEPHROSTOMY TRACT"]
[null,"57410 - HC PELVIC EXAMINATION W ANESTH",null,"50684 - INJ PX URETEROGRAPHY/URETEROPYLOGRAPHY CATH","50684 - INJ PX URETEROGRAPHY/URETEROPYLOGRAPHY CATH","50684 - INJ PX URETEROGRAPHY/URETEROPYLOGRAPHY CATH",null,"49451 - HC PERC REPL DUD/JEJ TUBE,W/",null,null,null,null,"51100 - HC ASPIRATION BLADDER NEEDLE",null,"49451 - HC PERC REPL DUD/JEJ TUBE,W/",null,null,"92568 - ACOUSTIC REFLEX THRESHOLD","50694 - PLACEMENT URETERAL STENT PRQ NEW ACESS WITHOUT SEP NEPHROSTOMY CATH"]
[null,"57415 - HC REMOVAL VAGINAL FOR.BODY W ANESTH",null,"50688 - CHNG URTROST TUBE/XTRNLLY ACCESSIBLE STENT ILEAL","50688 - CHNG URTROST TUBE/XTRNLLY ACCESSIBLE STENT ILEAL","50688 - CHNG URTROST TUBE/XTRNLLY ACCESSIBLE STENT ILEAL",null,"49452 - HC PERC REPL GAST_JEJ TUBE,W",null,null,null,null,"51102 - HC ASP BLADDER;W/INS SUPRAPU",null,"49452 - HC PERC REPL GAST_JEJ TUBE,W",null,null,"92570 - HC ACOUSTIC IMMIT TEST TYMPANOMETRY/ACOUST REFLEX/DECAY","50695 - HC PLMT URET STNTW/SEP NEPH"]
[null,"57420 - COLPOSCOPY ENTIRE VAGINA W/CERVIX IF PRESENT",null,"50693 - PLACEMENT URETERAL STENT PRQ WITH PRE-EXISTING NEPHROSTOMY TRACT","50693 - PLACEMENT URETERAL STENT PRQ WITH PRE-EXISTING NEPHROSTOMY TRACT","50693 - PLACEMENT URETERAL STENT PRQ WITH PRE-EXISTING NEPHROSTOMY TRACT",null,"49460 - HC FIX G/COLON TUBE W/DEVICE",null,null,null,null,"51600 - NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPY",null,"49460 - HC FIX G/COLON TUBE W/DEVICE",null,null,"92571 - FILTERED SPEECH TEST","51100 - HC ASPIRATION BLADDER NEEDLE"]
[null,"57421 - COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX",null,"50694 - PLACEMENT URETERAL STENT PRQ NEW ACESS WITHOUT SEP NEPHROSTOMY CATH","50694 - PLACEMENT URETERAL STENT PRQ NEW ACESS WITHOUT SEP NEPHROSTOMY CATH","50694 - PLACEMENT URETERAL STENT PRQ NEW ACESS WITHOUT SEP NEPHROSTOMY CATH",null,"49465 - HC CONTRAST INJECTION PERQ RADIOLOGIC EVAL GI TUBE",null,null,null,null,"51610 - NJX RETROGRADE URETHROCSTOGRAPY",null,"49465 - HC CONTRAST INJECTION PERQ RADIOLOGIC EVAL GI TUBE",null,null,"92572 - STAGGERED SPONDAIC WORD","51102 - HC ASP BLADDER;W/INS SUPRAPU"]
[null,"57452 - COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA",null,"50695 - HC PLMT URET STNTW/SEP NEPH","50695 - HC PLMT URET STNTW/SEP NEPH","50695 - HC PLMT URET STNTW/SEP NEPH",null,"49570 - HC REPAIR EPIGASTRIC HERNIA,REDUC",null,null,null,null,"51700 - BLDR IRRIGATION SMPL LAVAGE &/INSTLJ",null,"49570 - HC REPAIR EPIGASTRIC HERNIA,REDUC",null,null,"92576 - SYNTHETIC SENTENCE IDENTIFICATION TEST","51600 - NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPY"]
[null,"57454 - COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE",null,"51100 - HC ASPIRATION BLADDER NEEDLE","51100 - HC ASPIRATION BLADDER NEEDLE","51100 - HC ASPIRATION BLADDER NEEDLE",null,"50200 - RENAL BIOPSY PRQ TROCAR/NEEDLE",null,null,null,null,"51701 - INSJ NON-NDWELLG BLADDER CATHETER",null,"50200 - RENAL BIOPSY PRQ TROCAR/NEEDLE",null,null,"92577 - STENGER TEST SPEECH","51610 - NJX RETROGRADE URETHROCSTOGRAPY"]
[null,"57455 - COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX",null,"51102 - HC ASP BLADDER;W/INS SUPRAPU","51102 - HC ASP BLADDER;W/INS SUPRAPU","51102 - HC ASP BLADDER;W/INS SUPRAPU",null,"50382 - HC RMVL & RPLCMT INTLY DWELLING URETERAL STENT PRQ",null,null,null,null,"51702 - INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE",null,"50382 - HC RMVL & RPLCMT INTLY DWELLING URETERAL STENT PRQ",null,null,"92579 - VISUAL REINFORCEMENT AUDIOMETRY","51700 - BLDR IRRIGATION SMPL LAVAGE &/INSTLJ"]
[null,"57456 - COLPOSCOPY CERVIX ENDOCERVICAL CURETTAGE",null,"51600 - NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPY","51600 - NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPY","51600 - NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPY",null,"50385 - HC REMOVE & REPLACE INDWELL URETERAL STENT TRURTHRL",null,null,null,null,"51703 - INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED",null,"50385 - HC REMOVE & REPLACE INDWELL URETERAL STENT TRURTHRL",null,null,"92582 - CONDITIONING PLAY AUDIOMETRY","51701 - INSJ NON-NDWELLG BLADDER CATHETER"]
[null,"57460 - COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX",null,"51610 - NJX RETROGRADE URETHROCSTOGRAPY","51610 - NJX RETROGRADE URETHROCSTOGRAPY","51610 - NJX RETROGRADE URETHROCSTOGRAPY",null,"50386 - HC REM URET STENT,TRANS,W/O",null,null,null,null,"51705 - CHANGE CYSTOSTOMY TUBE SIMPLE",null,"50386 - HC REM URET STENT,TRANS,W/O",null,null,"92584 - ELECTROCOCHLEOGRAPY","51702 - INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE"]
[null,"57461 - COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX",null,"51700 - BLDR IRRIGATION SMPL LAVAGE &/INSTLJ","51700 - BLDR IRRIGATION SMPL LAVAGE &/INSTLJ","51700 - BLDR IRRIGATION SMPL LAVAGE &/INSTLJ",null,"50387 - HC RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH",null,null,null,null,"51710 - CHANGE CYSTOSTOMY TUBE COMPLICATED",null,"50387 - HC RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH",null,null,"92585 - AUDITORY EVOKED POTENTIALS COMPREHENSIVE","51703 - INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED"]
[null,"57500 - BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX",null,"51701 - INSJ NON-NDWELLG BLADDER CATHETER","51701 - INSJ NON-NDWELLG BLADDER CATHETER","51701 - INSJ NON-NDWELLG BLADDER CATHETER",null,"50389 - HC RMVL NFROS TUBE REQ FLUORO GUIDANCE",null,null,null,null,"51720 - BLADDER INSTILLATION ANTICARCINOGENIC AGENT",null,"50389 - HC RMVL NFROS TUBE REQ FLUORO GUIDANCE",null,null,"92586 - AUDITORY EVOKED POTENTIALS LIMITED","51705 - CHANGE CYSTOSTOMY TUBE SIMPLE"]
[null,"57505 - ENDOCERVICAL CURETTAGE W/DILATION & CURETTAGE",null,"51702 - INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE","51702 - INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE","51702 - INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE",null,"50390 - ASPIR &/NJX RENAL CYST/PELVIS NEEDLE PRQ",null,null,null,null,"51725 - SIMPLE CYSTOMETROGRAM",null,"50390 - ASPIR &/NJX RENAL CYST/PELVIS NEEDLE PRQ",null,null,"92587 - DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD","51710 - CHANGE CYSTOSTOMY TUBE COMPLICATED"]
[null,"57510 - HC CAUTERIZATION,CERVIX,ELECTRO/THERMAL",null,"51703 - INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED","51703 - INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED","51703 - INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED",null,"50430 - HC NJX PX ANTEGRDE NFROSGRM &/URTRGRM NEW ACCESS",null,null,null,null,"51726 - BLADDER PRESSURE MEASUREMENT DURING FILLING",null,"50430 - HC NJX PX ANTEGRDE NFROSGRM &/URTRGRM NEW ACCESS",null,null,"92588 - DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL","51720 - BLADDER INSTILLATION ANTICARCINOGENIC AGENT"]
[null,"57511 - HC CRYOCAUTERY OF CERVIX",null,"51705 - CHANGE CYSTOSTOMY TUBE SIMPLE","51705 - CHANGE CYSTOSTOMY TUBE SIMPLE","51705 - CHANGE CYSTOSTOMY TUBE SIMPLE",null,"50431 - HC NJX ANTGRD NPHRSTGRM &/OR URTRGRM COMPL DIAG INCL IMG GUI RAD S&I; EXSTNG ACCES",null,null,null,null,"51727 - COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE",null,"50431 - HC NJX ANTGRD NPHRSTGRM &/OR URTRGRM COMPL DIAG INCL IMG GUI RAD S&I; EXSTNG ACCES",null,null,"92700 - UNLISTED OTORHINOLARYNGOLOGICAL SERVICE","51725 - SIMPLE CYSTOMETROGRAM"]
[null,"57520 - HC CONIZATION CERVIX, KNIFE/LASER",null,"51710 - CHANGE CYSTOSTOMY TUBE COMPLICATED","51710 - CHANGE CYSTOSTOMY TUBE COMPLICATED","51710 - CHANGE CYSTOSTOMY TUBE COMPLICATED",null,"50432 - HC PLACEMENT NEPHROSTOMY CATH PRQ NEW ACCESS RAD S&I",null,null,null,null,"51728 - COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES",null,"50432 - HC PLACEMENT NEPHROSTOMY CATH PRQ NEW ACCESS RAD S&I",null,null,"93005 - ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R","51726 - BLADDER PRESSURE MEASUREMENT DURING FILLING"]
[null,"57522 - CONIZATION CERVIX W/WO D&C RPR ELTRD EXC",null,"51720 - BLADDER INSTILLATION ANTICARCINOGENIC AGENT","51720 - BLADDER INSTILLATION ANTICARCINOGENIC AGENT","51720 - BLADDER INSTILLATION ANTICARCINOGENIC AGENT",null,"50433 - PLACEMENT NEPHROURETERAL CATH PRQ NEW ACCESS RAD S&I",null,null,null,null,"51729 - COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL",null,"50433 - PLACEMENT NEPHROURETERAL CATH PRQ NEW ACCESS RAD S&I",null,null,"93017 - HC CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY","51727 - COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE"]
[null,"57558 - DILATION & CURETTAGE CERVICAL STUMP",null,"51725 - SIMPLE CYSTOMETROGRAM","51725 - SIMPLE CYSTOMETROGRAM","51725 - SIMPLE CYSTOMETROGRAM",null,"50434 - CONVERT NEPHROSTOMY CATH TO NEPHROURTRL CATH PRQ",null,null,null,null,"51736 - SIMPLE UROFLOMETRY",null,"50434 - CONVERT NEPHROSTOMY CATH TO NEPHROURTRL CATH PRQ",null,null,"93225 - HC XTRNL ECG & 48 HR RECORDING","51728 - COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES"]
[null,"57800 - DILATION CERVICAL CANAL INSTRUMENTAL SPX",null,"51726 - BLADDER PRESSURE MEASUREMENT DURING FILLING","51726 - BLADDER PRESSURE MEASUREMENT DURING FILLING","51726 - BLADDER PRESSURE MEASUREMENT DURING FILLING",null,"50435 - EXCHANGE NEPHROSTOMY CATHETER PRQ W/IMAGE GUIDE RAD S&I",null,null,null,null,"51741 - COMPLEX UROFLOMETRY",null,"50435 - EXCHANGE NEPHROSTOMY CATHETER PRQ W/IMAGE GUIDE RAD S&I",null,null,"93226 - EXTERNAL ECG SCANNING ANALYSIS REPORT","51729 - COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL"]
[null,"58100 - ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX",null,"51727 - COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE","51727 - COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE","51727 - COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE",null,"50436 - HC DILAT XST TRC NDURLGC PX",null,null,null,null,"51784 - EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL",null,"50436 - HC DILAT XST TRC NDURLGC PX",null,null,"93270 - XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS","51736 - SIMPLE UROFLOMETRY"]
[null,"58110 - ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY",null,"51728 - COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES","51728 - COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES","51728 - COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES",null,"50437 - HC DILAT XST TRC NEW ACCESS RCS",null,null,null,null,"51785 - NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ",null,"50437 - HC DILAT XST TRC NEW ACCESS RCS",null,null,"93271 - HC EXT ECG,PT DEMAND EVENT, SYMPT MEMORY LOOP, TRANSMIT","51741 - COMPLEX UROFLOMETRY"]
[null,"58120 - DILATION & CURETTAGE DX&/THER NONOBSTETRIC",null,"51729 - COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL","51729 - COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL","51729 - COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL",null,"50561 - HC RENAL ENDOSCOPY,REMV FB/STONE",null,null,null,null,"51797 - VOID PRESSURE STUDIES INTRAABDOMINAL",null,"50561 - HC RENAL ENDOSCOPY,REMV FB/STONE",null,null,"93278 - SIGNAL AVERAGED ELECTROCARDIOGRAPHY W/WO ECG","51784 - EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL"]
[null,"58145 - MYOMECTOMY 1-4 MYOMAS 250 GM/< VAGINAL APPR",null,"51736 - SIMPLE UROFLOMETRY","51736 - SIMPLE UROFLOMETRY","51736 - SIMPLE UROFLOMETRY",null,"50592 - HC ABLTJ 1/> RENAL TUMOR PRQ UNI RADIOFREQUENCY",null,null,null,null,"51798 - MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP",null,"50592 - HC ABLTJ 1/> RENAL TUMOR PRQ UNI RADIOFREQUENCY",null,null,"93279 - PROGRAM EVAL IMPLANTABLE IN PRSN 1 LD PACEMAKER","51785 - NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ"]
[null,"58300 - INSERTION INTRAUTERINE DEVICE IUD",null,"51741 - COMPLEX UROFLOMETRY","51741 - COMPLEX UROFLOMETRY","51741 - COMPLEX UROFLOMETRY",null,"50593 - HC ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY",null,null,null,null,"52000 - CYSTOURETHROSCOPY",null,"50593 - HC ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY",null,null,"93280 - PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER","51797 - VOID PRESSURE STUDIES INTRAABDOMINAL"]
[null,"58301 - REMOVAL INTRAUTERINE DEVICE IUD",null,"51784 - EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL","51784 - EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL","51784 - EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL",null,"50684 - INJ PX URETEROGRAPHY/URETEROPYLOGRAPHY CATH",null,null,null,null,"52005 - HC CYSTOURETHROSCOPY,URETER CATHETER",null,"50684 - INJ PX URETEROGRAPHY/URETEROPYLOGRAPHY CATH",null,null,"93281 - PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER","51798 - MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP"]
[null,"58340 - CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI",null,"51785 - NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ","51785 - NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ","51785 - NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ",null,"50688 - CHNG URTROST TUBE/XTRNLLY ACCESSIBLE STENT ILEAL",null,null,null,null,"52224 - CYSTO W/REMOVAL OF LESIONS SMALL",null,"50688 - CHNG URTROST TUBE/XTRNLLY ACCESSIBLE STENT ILEAL",null,null,"93282 - PROGRAM EVAL IMPLANTABLE IN PERSN 1 LD CARD/DFB","52000 - CYSTOURETHROSCOPY"]
[null,"58345 - HC REOPEN FALLOPIAN TUBE, TRANSCERV CATH",null,"51797 - VOID PRESSURE STUDIES INTRAABDOMINAL","51797 - VOID PRESSURE STUDIES INTRAABDOMINAL","51797 - VOID PRESSURE STUDIES INTRAABDOMINAL",null,"50693 - PLACEMENT URETERAL STENT PRQ WITH PRE-EXISTING NEPHROSTOMY TRACT",null,null,null,null,"52234 - HC CYSTO W/REMOVAL OF TUMORS SMALL",null,"50693 - PLACEMENT URETERAL STENT PRQ WITH PRE-EXISTING NEPHROSTOMY TRACT",null,null,"93283 - PROGRM EVAL IMPLANTABLE IN PRSN DUAL L CARD/DFB","52005 - HC CYSTOURETHROSCOPY,URETER CATHETER"]
[null,"58555 - HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE",null,"51798 - MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP","51798 - MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP","51798 - MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP",null,"50694 - PLACEMENT URETERAL STENT PRQ NEW ACESS WITHOUT SEP NEPHROSTOMY CATH",null,null,null,null,"52281 - CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS",null,"50694 - PLACEMENT URETERAL STENT PRQ NEW ACESS WITHOUT SEP NEPHROSTOMY CATH",null,null,"93284 - PROGRM EVAL IMPLANTABLE IN PRSN MLT LD CARD/DFB","52224 - CYSTO W/REMOVAL OF LESIONS SMALL"]
[null,"58558 - HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C",null,"52000 - CYSTOURETHROSCOPY","52000 - CYSTOURETHROSCOPY","52000 - CYSTOURETHROSCOPY",null,"50695 - HC PLMT URET STNTW/SEP NEPH",null,null,null,null,"52285 - HC CYSTOSCOPY AND TREATMENT",null,"50695 - HC PLMT URET STNTW/SEP NEPH",null,null,"93285 - PROGRAM EVAL IMPLANTABLE DEV IN PRSN ILR SYSTEM","52234 - HC CYSTO W/REMOVAL OF TUMORS SMALL"]
[null,"58559 - HC HYSTEROSCOPY LYSIS INTRAUTERINE ADHESIONS",null,"52005 - HC CYSTOURETHROSCOPY,URETER CATHETER","52005 - HC CYSTOURETHROSCOPY,URETER CATHETER","52005 - HC CYSTOURETHROSCOPY,URETER CATHETER",null,"51100 - HC ASPIRATION BLADDER NEEDLE",null,null,null,null,"52310 - CYSTO W/SIMPLE REMOVAL STONE & STENT",null,"51100 - HC ASPIRATION BLADDER NEEDLE",null,null,"93288 - INTERROGATION EVAL IN PERSON 1/DUAL/MLT LEAD PM","52281 - CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS"]
[null,"58561 - HC HYSTEROSCOPY,RMV MYOMA",null,"52224 - CYSTO W/REMOVAL OF LESIONS SMALL","52224 - CYSTO W/REMOVAL OF LESIONS SMALL","52224 - CYSTO W/REMOVAL OF LESIONS SMALL",null,"51102 - HC ASP BLADDER;W/INS SUPRAPU",null,null,null,null,"52332 - HC CYSTOSCOPY, INSERT URETERAL STENT",null,"51102 - HC ASP BLADDER;W/INS SUPRAPU",null,null,"93289 - HC INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB","52285 - HC CYSTOSCOPY AND TREATMENT"]
[null,"58562 - HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY",null,"52234 - HC CYSTO W/REMOVAL OF TUMORS SMALL","52234 - HC CYSTO W/REMOVAL OF TUMORS SMALL","52234 - HC CYSTO W/REMOVAL OF TUMORS SMALL",null,"51600 - NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPY",null,null,null,null,"52351 - HC CYSTO/URETERO/PYELOSCOPY, DX",null,"51600 - NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPY",null,null,"93291 - INTERROGATION EVALUATION IN PERSON ILR SYSTEM","52310 - CYSTO W/SIMPLE REMOVAL STONE & STENT"]
[null,"58565 - HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS",null,"52281 - CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS","52281 - CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS","52281 - CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS",null,"51610 - NJX RETROGRADE URETHROCSTOGRAPY",null,null,null,null,"52356 - HC CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT",null,"51610 - NJX RETROGRADE URETHROCSTOGRAPY",null,null,"93292 - INTERROGATION EVAL IN PERSON WR DEFIBRILLATOR","52332 - HC CYSTOSCOPY, INSERT URETERAL STENT"]
[null,"58579 - HC UNLISTED HYSTEROSCOPY PROCEDURE UTERUS",null,"52285 - HC CYSTOSCOPY AND TREATMENT","52285 - HC CYSTOSCOPY AND TREATMENT","52285 - HC CYSTOSCOPY AND TREATMENT",null,"51700 - BLDR IRRIGATION SMPL LAVAGE &/INSTLJ",null,null,null,null,"53450 - HC REVISION OF URETHRA",null,"51700 - BLDR IRRIGATION SMPL LAVAGE &/INSTLJ",null,null,"93293 - HC TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL","52351 - HC CYSTO/URETERO/PYELOSCOPY, DX"]
[null,"58674 - HC LAPS ABLTJ UTERINE FIBROIDS",null,"52310 - CYSTO W/SIMPLE REMOVAL STONE & STENT","52310 - CYSTO W/SIMPLE REMOVAL STONE & STENT","52310 - CYSTO W/SIMPLE REMOVAL STONE & STENT",null,"51701 - INSJ NON-NDWELLG BLADDER CATHETER",null,null,null,null,"53600 - DILAT URETHRAL STRIX DILATOR MALE 1ST",null,"51701 - INSJ NON-NDWELLG BLADDER CATHETER",null,null,"93296 - HC REM INTERROG EVL PM/IDS","52356 - HC CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT"]
[null,"58925 - HC OVARIAN CYSTECTOMY UNI/BI",null,"52332 - HC CYSTOSCOPY, INSERT URETERAL STENT","52332 - HC CYSTOSCOPY, INSERT URETERAL STENT","52332 - HC CYSTOSCOPY, INSERT URETERAL STENT",null,"51702 - INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE",null,null,null,null,"53620 - DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE 1ST",null,"51702 - INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE",null,null,"93299 - INTERROGATION EVAL REMOTE </30 D TECH REVIEW","53450 - HC REVISION OF URETHRA"]
[null,"58999 - HC GENITAL SURG PROC, FEMALE UNLISTED",null,"52351 - HC CYSTO/URETERO/PYELOSCOPY, DX","52351 - HC CYSTO/URETERO/PYELOSCOPY, DX","52351 - HC CYSTO/URETERO/PYELOSCOPY, DX",null,"51703 - INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED",null,null,null,null,"53660 - HC DILATION OF URETHRA",null,"51703 - INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED",null,null,"93303 - HC COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY","53600 - DILAT URETHRAL STRIX DILATOR MALE 1ST"]
[null,"59000 - AMNIOCENTESIS DIAGNOSIC",null,"52356 - HC CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT","52356 - HC CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT","52356 - HC CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT",null,"51705 - CHANGE CYSTOSTOMY TUBE SIMPLE",null,null,null,null,"53854 - HC TRURL DSTRJ PRST8 TISS RF WV THERMOTHERAPY",null,"51705 - CHANGE CYSTOSTOMY TUBE SIMPLE",null,null,"93304 - HC F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY","53620 - DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE 1ST"]
[null,"59160 - CURETTAGE POSTPARTUM",null,"53450 - HC REVISION OF URETHRA","53450 - HC REVISION OF URETHRA","53450 - HC REVISION OF URETHRA",null,"51710 - CHANGE CYSTOSTOMY TUBE COMPLICATED",null,null,null,null,"54001 - HC SLITTING OF PREPUCE",null,"51710 - CHANGE CYSTOSTOMY TUBE COMPLICATED",null,null,"93306 - HC ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D WITH CONTRAST","53660 - HC DILATION OF URETHRA"]
[null,"59200 - INSERTION CERVICAL DILATOR SEPARATE PROCEDURE",null,"53600 - DILAT URETHRAL STRIX DILATOR MALE 1ST","53600 - DILAT URETHRAL STRIX DILATOR MALE 1ST","53600 - DILAT URETHRAL STRIX DILATOR MALE 1ST",null,"51720 - BLADDER INSTILLATION ANTICARCINOGENIC AGENT",null,null,null,null,"54050 - DSTRJ LESION PENIS SIMPLE CHEMICAL",null,"51720 - BLADDER INSTILLATION ANTICARCINOGENIC AGENT",null,null,"93307 - HC ECHO HEART XTHORACIC,COMPLETE, W/O DOPPLER  WITH CONTRAST","53854 - HC TRURL DSTRJ PRST8 TISS RF WV THERMOTHERAPY"]
[null,"59300 - HC EPISIOTOMY/VAG RPR OTH/THN ATTENDING",null,"53620 - DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE 1ST","53620 - DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE 1ST","53620 - DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE 1ST",null,"51725 - SIMPLE CYSTOMETROGRAM",null,null,null,null,"54055 - DSTRJ LESION PENIS SIMPLE ELECTRODESICCATION",null,"51725 - SIMPLE CYSTOMETROGRAM",null,null,"93308 - HC ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD WITH CONTRAST","54001 - HC SLITTING OF PREPUCE"]
[null,"59320 - CERCLAGE CERVIX PREGNANCY VAGINAL",null,"53660 - HC DILATION OF URETHRA","53660 - HC DILATION OF URETHRA","53660 - HC DILATION OF URETHRA",null,"51726 - BLADDER PRESSURE MEASUREMENT DURING FILLING",null,null,null,null,"54056 - DSTRJ LESION PENIS SIMPLE CRYOSURGERY",null,"51726 - BLADDER PRESSURE MEASUREMENT DURING FILLING",null,null,"93312 - HC ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R  WITH CONTRAST","54050 - DSTRJ LESION PENIS SIMPLE CHEMICAL"]
[null,"59409 - HC VAGINAL DELIVERY ONLY",null,"54001 - HC SLITTING OF PREPUCE","54001 - HC SLITTING OF PREPUCE","54001 - HC SLITTING OF PREPUCE",null,"51727 - COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE",null,null,null,null,"54060 - HC DESTR PENIS LESN,SIMPL,SURG EXCIS",null,"51727 - COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE",null,null,"93313 - HC ECHO R-T 2D W/PROBE PLACEMENT ONLY","54055 - DSTRJ LESION PENIS SIMPLE ELECTRODESICCATION"]
[null,"59812 - TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL",null,"54050 - DSTRJ LESION PENIS SIMPLE CHEMICAL","54050 - DSTRJ LESION PENIS SIMPLE CHEMICAL","54050 - DSTRJ LESION PENIS SIMPLE CHEMICAL",null,"51728 - COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES",null,null,null,null,"54065 - DSTRJ LESION PENIS EXTENSIVE",null,"51728 - COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES",null,null,"93315 - HC ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R WITH CONTRAST","54056 - DSTRJ LESION PENIS SIMPLE CRYOSURGERY"]
[null,"59820 - TX MISSED ABORTION FIRST TRIMESTER SURGICAL",null,"54055 - DSTRJ LESION PENIS SIMPLE ELECTRODESICCATION","54055 - DSTRJ LESION PENIS SIMPLE ELECTRODESICCATION","54055 - DSTRJ LESION PENIS SIMPLE ELECTRODESICCATION",null,"51729 - COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL",null,null,null,null,"54100 - BIOPSY PENIS SEPARATE PROCEDURE",null,"51729 - COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL",null,null,"93316 - HC ECHO TRANSESOPHAG CONGEN PROBE PLCMT ONLY","54060 - HC DESTR PENIS LESN,SIMPL,SURG EXCIS"]
[null,"59821 - TX MISSED ABORTION SECOND TRIMESTER SURGICAL",null,"54056 - DSTRJ LESION PENIS SIMPLE CRYOSURGERY","54056 - DSTRJ LESION PENIS SIMPLE CRYOSURGERY","54056 - DSTRJ LESION PENIS SIMPLE CRYOSURGERY",null,"51736 - SIMPLE UROFLOMETRY",null,null,null,null,"54115 - HC REMV FOR.BODY DEEP PENILE TISS",null,"51736 - SIMPLE UROFLOMETRY",null,null,"93318 - HC ECHO TRANSEOPHAG MONTR CARDIAC PUMP FUNCTJ","54065 - DSTRJ LESION PENIS EXTENSIVE"]
[null,"59840 - INDUCED ABORTION DILATION AND CURETTAGE",null,"54060 - HC DESTR PENIS LESN,SIMPL,SURG EXCIS","54060 - HC DESTR PENIS LESN,SIMPL,SURG EXCIS","54060 - HC DESTR PENIS LESN,SIMPL,SURG EXCIS",null,"51741 - COMPLEX UROFLOMETRY",null,null,null,null,"54150 - CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK",null,"51741 - COMPLEX UROFLOMETRY",null,null,"93320 - HC DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY","54100 - BIOPSY PENIS SEPARATE PROCEDURE"]
[null,"59841 - INDUCED ABORTION DILATION & EVAUCATION",null,"54065 - DSTRJ LESION PENIS EXTENSIVE","54065 - DSTRJ LESION PENIS EXTENSIVE","54065 - DSTRJ LESION PENIS EXTENSIVE",null,"51784 - EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL",null,null,null,null,"54161 - HC CIRCUM 28 DAYS OR OLDER",null,"51784 - EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL",null,null,"93321 - HC DOP ECHOCARD PULSE WAVE W/SPECTRAL F-UP/LMTD STD","54115 - HC REMV FOR.BODY DEEP PENILE TISS"]
[null,"59870 - UTERINE EVACUATION & CURETTAGE HYDATIDIFORM MOLE",null,"54100 - BIOPSY PENIS SEPARATE PROCEDURE","54100 - BIOPSY PENIS SEPARATE PROCEDURE","54100 - BIOPSY PENIS SEPARATE PROCEDURE",null,"51785 - NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ",null,null,null,null,"54162 - HC LYSIS/EXCIS,PENILE POSTCIRCUM ADHESIONS",null,"51785 - NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ",null,null,"93325 - DOP ECHOCARD COLOR FLOW VELOCITY MAPPING","54150 - CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK"]
[null,"59871 - REMOVAL CERCLAGE SUTURE UNDER ANESTHESIA",null,"54115 - HC REMV FOR.BODY DEEP PENILE TISS","54115 - HC REMV FOR.BODY DEEP PENILE TISS","54115 - HC REMV FOR.BODY DEEP PENILE TISS",null,"51797 - VOID PRESSURE STUDIES INTRAABDOMINAL",null,null,null,null,"54164 - FRENULOTOMY PENIS",null,"51797 - VOID PRESSURE STUDIES INTRAABDOMINAL",null,null,"93350 - HC ECHO HEART XTHORACIC, STRESS/REST WITH CONTRAST","54161 - HC CIRCUM 28 DAYS OR OLDER"]
[null,"59897 - HC FETAL INVAS PX W/ US",null,"54150 - CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK","54150 - CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK","54150 - CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK",null,"51798 - MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP",null,null,null,null,"54200 - INJECTION PEYRONIE DISEASE",null,"51798 - MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP",null,null,"93351 - HC ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG WITH CONTRAST","54162 - HC LYSIS/EXCIS,PENILE POSTCIRCUM ADHESIONS"]
[null,"60100 - BIOPSY THYROID PERCUTANEOUS CORE NEEDLE",null,"54161 - HC CIRCUM 28 DAYS OR OLDER","54161 - HC CIRCUM 28 DAYS OR OLDER","54161 - HC CIRCUM 28 DAYS OR OLDER",null,"52000 - CYSTOURETHROSCOPY",null,null,null,null,"54220 - IRRIGATION CORPORA CAVERNOSA PRIAPISM",null,"52000 - CYSTOURETHROSCOPY",null,null,"93451 - HC RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT","54164 - FRENULOTOMY PENIS"]
[null,"60220 - HC THYROID LOBECTOMY,UNILAT",null,"54162 - HC LYSIS/EXCIS,PENILE POSTCIRCUM ADHESIONS","54162 - HC LYSIS/EXCIS,PENILE POSTCIRCUM ADHESIONS","54162 - HC LYSIS/EXCIS,PENILE POSTCIRCUM ADHESIONS",null,"52005 - HC CYSTOURETHROSCOPY,URETER CATHETER",null,null,null,null,"54231 - DYNAMIC CAVERNOSOMETRY NJX VASOACTIVE DRUGS",null,"52005 - HC CYSTOURETHROSCOPY,URETER CATHETER",null,null,"93452 - HC L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","54200 - INJECTION PEYRONIE DISEASE"]
[null,"60300 - HB ASPIRATION AND/OR INJECTION THYROID CYST",null,"54164 - FRENULOTOMY PENIS","54164 - FRENULOTOMY PENIS","54164 - FRENULOTOMY PENIS",null,"52224 - CYSTO W/REMOVAL OF LESIONS SMALL",null,null,null,null,"54235 - NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT",null,"52224 - CYSTO W/REMOVAL OF LESIONS SMALL",null,null,"93453 - HC R & L HRT CATH W/NJX L VENTRICULOG IMG S&I","54220 - IRRIGATION CORPORA CAVERNOSA PRIAPISM"]
[null,"60500 - HC EXPLORE PARATHYROID GLANDS",null,"54200 - INJECTION PEYRONIE DISEASE","54200 - INJECTION PEYRONIE DISEASE","54200 - INJECTION PEYRONIE DISEASE",null,"52234 - HC CYSTO W/REMOVAL OF TUMORS SMALL",null,null,null,null,"54450 - FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING",null,"52234 - HC CYSTO W/REMOVAL OF TUMORS SMALL",null,null,"93454 - HC CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I","54231 - DYNAMIC CAVERNOSOMETRY NJX VASOACTIVE DRUGS"]
[null,"61050 - HC CISTERNAL/C1-2 PUNCTURE",null,"54220 - IRRIGATION CORPORA CAVERNOSA PRIAPISM","54220 - IRRIGATION CORPORA CAVERNOSA PRIAPISM","54220 - IRRIGATION CORPORA CAVERNOSA PRIAPISM",null,"52281 - CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS",null,null,null,null,"54520 - HC REMOVAL OF TESTIS",null,"52281 - CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS",null,null,"93455 - HC CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I","54235 - NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT"]
[null,"61055 - HC CISTERNAL/LATERAL C1-C2 PUNCTURE W/INJECTION",null,"54231 - DYNAMIC CAVERNOSOMETRY NJX VASOACTIVE DRUGS","54231 - DYNAMIC CAVERNOSOMETRY NJX VASOACTIVE DRUGS","54231 - DYNAMIC CAVERNOSOMETRY NJX VASOACTIVE DRUGS",null,"52285 - HC CYSTOSCOPY AND TREATMENT",null,null,null,null,"54600 - HC REDUCE TESTIS TORSION",null,"52285 - HC CYSTOSCOPY AND TREATMENT",null,null,"93456 - HC CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I","54450 - FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING"]
[null,"61070 - HC PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX",null,"54235 - NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT","54235 - NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT","54235 - NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT",null,"52310 - CYSTO W/SIMPLE REMOVAL STONE & STENT",null,null,null,null,"54700 - I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE",null,"52310 - CYSTO W/SIMPLE REMOVAL STONE & STENT",null,null,"93457 - HC CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I","54520 - HC REMOVAL OF TESTIS"]
[null,"61623 - HC EVASC TEMP BALLOON ARTL OCCLUSION HEAD/NECK",null,"54450 - FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING","54450 - FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING","54450 - FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING",null,"52332 - HC CYSTOSCOPY, INSERT URETERAL STENT",null,null,null,null,"55000 - PNXR ASPIR HYDROCELE TUNICA VAGIS W/WO NJX MED",null,"52332 - HC CYSTOSCOPY, INSERT URETERAL STENT",null,null,"93458 - HC CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I","54600 - HC REDUCE TESTIS TORSION"]
[null,"61626 - HC TCAT PERMANT OCCLUSION/EMBOLIZATION PRQ NON-CNS",null,"54520 - HC REMOVAL OF TESTIS","54520 - HC REMOVAL OF TESTIS","54520 - HC REMOVAL OF TESTIS",null,"52351 - HC CYSTO/URETERO/PYELOSCOPY, DX",null,null,null,null,"55100 - DRAIN SCROTAL WALL ABS",null,"52351 - HC CYSTO/URETERO/PYELOSCOPY, DX",null,null,"93459 - HC CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I","54700 - I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE"]
[null,"61645 - HC PERQ ARTERIAL TRANSLUMINAL M-THROMBECTOMY & OR INFUSION",null,"54600 - HC REDUCE TESTIS TORSION","54600 - HC REDUCE TESTIS TORSION","54600 - HC REDUCE TESTIS TORSION",null,"52356 - HC CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT",null,null,null,null,"55120 - HB REMOVAL OF SCROTAL FOR BODY",null,"52356 - HC CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT",null,null,"93460 - HC R & L HRT CATH WINJX HRT ART& L VENTR IMG","55000 - PNXR ASPIR HYDROCELE TUNICA VAGIS W/WO NJX MED"]
[null,"61885 - HC IMP STIM,CRANIAL,SUBQ,1 ARRAY",null,"54700 - I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE","54700 - I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE","54700 - I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE",null,"53450 - HC REVISION OF URETHRA",null,null,null,null,"55250 - VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS",null,"53450 - HC REVISION OF URETHRA",null,null,"93461 - HC R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I","55100 - DRAIN SCROTAL WALL ABS"]
[null,"62264 - HC PRQ LYSIS EPIDURAL ADHESIONS MULT SESSIONS 1 DAY",null,"55000 - PNXR ASPIR HYDROCELE TUNICA VAGIS W/WO NJX MED","55000 - PNXR ASPIR HYDROCELE TUNICA VAGIS W/WO NJX MED","55000 - PNXR ASPIR HYDROCELE TUNICA VAGIS W/WO NJX MED",null,"53600 - DILAT URETHRAL STRIX DILATOR MALE 1ST",null,null,null,null,"55400 - HC REPAIR OF SPERM DUCT",null,"53600 - DILAT URETHRAL STRIX DILATOR MALE 1ST",null,null,"93462 - HC LEFT HEART CATH BY TRANSEPTAL PUNCTURE","55120 - HB REMOVAL OF SCROTAL FOR BODY"]
[null,"62268 - HC PERCUTANEOUS ASPIRATION SPINAL CORD CYST/SYRINX",null,"55100 - DRAIN SCROTAL WALL ABS","55100 - DRAIN SCROTAL WALL ABS","55100 - DRAIN SCROTAL WALL ABS",null,"53620 - DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE 1ST",null,null,null,null,"55520 - HC REMOVAL OF SPERM CORD LESION",null,"53620 - DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE 1ST",null,null,"93503 - HC INSERTION FLOW DIRECTED CATHETER FOR MONITORING","55250 - VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS"]
[null,"62269 - HC BIO,SPINAL CORD,PERC NEED",null,"55120 - HB REMOVAL OF SCROTAL FOR BODY","55120 - HB REMOVAL OF SCROTAL FOR BODY","55120 - HB REMOVAL OF SCROTAL FOR BODY",null,"53660 - HC DILATION OF URETHRA",null,null,null,null,"55700 - PROSTATE NEEDLE BIOPSY ANY APPROACH",null,"53660 - HC DILATION OF URETHRA",null,null,"93505 - HC ENDOMYOCARDIAL BIOPSY","55400 - HC REPAIR OF SPERM DUCT"]
[null,"62270 - SPINAL PUNCTURE LUMBAR DIAGNOSTIC",null,"55250 - VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS","55250 - VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS","55250 - VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS",null,"53854 - HC TRURL DSTRJ PRST8 TISS RF WV THERMOTHERAPY",null,null,null,null,"55876 - PLMT INTERSTITIAL DEV RADIAT TX PROSTATE 1/MULT",null,"53854 - HC TRURL DSTRJ PRST8 TISS RF WV THERMOTHERAPY",null,null,"93530 - RHC CNGNITL ANMLES","55520 - HC REMOVAL OF SPERM CORD LESION"]
[null,"62272 - HC SPINAL PUNCTURE THER DRAIN CEREBROSPINAL FLUID",null,"55400 - HC REPAIR OF SPERM DUCT","55400 - HC REPAIR OF SPERM DUCT","55400 - HC REPAIR OF SPERM DUCT",null,"53899 - HC URETERAL DILATION",null,null,null,null,"56405 - I&D VULVA/PERINEAL ABSCESS",null,"53899 - HC URETERAL DILATION",null,null,"93531 - RHC/LHC CNGNITL ANMLES","55700 - PROSTATE NEEDLE BIOPSY ANY APPROACH"]
[null,"62273 - HC INJECTION EPIDURAL BLOOD/CLOT PATCH",null,"55520 - HC REMOVAL OF SPERM CORD LESION","55520 - HC REMOVAL OF SPERM CORD LESION","55520 - HC REMOVAL OF SPERM CORD LESION",null,"54001 - HC SLITTING OF PREPUCE",null,null,null,null,"56420 - I&D OF BARTHOLINS GLAND ABSCESS",null,"54001 - HC SLITTING OF PREPUCE",null,null,"93533 - CMBN R HRT T-SEPTAL L HRT CATHJ SEPTAL OPNG CGEN","55876 - PLMT INTERSTITIAL DEV RADIAT TX PROSTATE 1/MULT"]
[null,"62284 - HC INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR",null,"55700 - PROSTATE NEEDLE BIOPSY ANY APPROACH","55700 - PROSTATE NEEDLE BIOPSY ANY APPROACH","55700 - PROSTATE NEEDLE BIOPSY ANY APPROACH",null,"54050 - DSTRJ LESION PENIS SIMPLE CHEMICAL",null,null,null,null,"56440 - MARSUPIALIZATION BARTHOLINS GLAND CYST",null,"54050 - DSTRJ LESION PENIS SIMPLE CHEMICAL",null,null,"93571 - HC IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL","56405 - I&D VULVA/PERINEAL ABSCESS"]
[null,"62302 - MYELOGRAPHY VIA LUMBAR INJECTION RS&I CERVICAL",null,"55876 - PLMT INTERSTITIAL DEV RADIAT TX PROSTATE 1/MULT","55876 - PLMT INTERSTITIAL DEV RADIAT TX PROSTATE 1/MULT","55876 - PLMT INTERSTITIAL DEV RADIAT TX PROSTATE 1/MULT",null,"54055 - DSTRJ LESION PENIS SIMPLE ELECTRODESICCATION",null,null,null,null,"56442 - HYMENOTOMY",null,"54055 - DSTRJ LESION PENIS SIMPLE ELECTRODESICCATION",null,null,"93572 - HC IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL","56420 - I&D OF BARTHOLINS GLAND ABSCESS"]
[null,"62304 - MYELOGRAPHY VIA LUMBAR INJECT RS&I LUMBOSACRAL",null,"56405 - I&D VULVA/PERINEAL ABSCESS","56405 - I&D VULVA/PERINEAL ABSCESS","56405 - I&D VULVA/PERINEAL ABSCESS",null,"54056 - DSTRJ LESION PENIS SIMPLE CRYOSURGERY",null,null,null,null,"56501 - DESTRUCTION LESIONS VULVA SIMPLE",null,"54056 - DSTRJ LESION PENIS SIMPLE CRYOSURGERY",null,null,"93580 - PRQ TCAT CLSR CGEN INTRATRL COMUNICAJ W/IMPLT","56440 - MARSUPIALIZATION BARTHOLINS GLAND CYST"]
[null,"62305 - MYELOGRAPHY VIA LUMBAR INJECTION RS&I 2+ REGIONS",null,"56420 - I&D OF BARTHOLINS GLAND ABSCESS","56420 - I&D OF BARTHOLINS GLAND ABSCESS","56420 - I&D OF BARTHOLINS GLAND ABSCESS",null,"54060 - HC DESTR PENIS LESN,SIMPL,SURG EXCIS",null,null,null,null,"56515 - DESTRUCTION LESIONS VULVA EXTENSIVE",null,"54060 - HC DESTR PENIS LESN,SIMPL,SURG EXCIS",null,null,"93582 - HC PERCUTAN TRANSCATH CLOSURE PAT DUCT ARTERIOSUS","56442 - HYMENOTOMY"]
[null,"62320 - HC NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN",null,"56440 - MARSUPIALIZATION BARTHOLINS GLAND CYST","56440 - MARSUPIALIZATION BARTHOLINS GLAND CYST","56440 - MARSUPIALIZATION BARTHOLINS GLAND CYST",null,"54065 - DSTRJ LESION PENIS EXTENSIVE",null,null,null,null,"56605 - BIOPSY VULVA/PERINEUM 1 LESION SPX",null,"54065 - DSTRJ LESION PENIS EXTENSIVE",null,null,"93609 - HC INTRA-VENTRIC&/ATRIAL MAPG TACHYCARD W/CATH MA","56501 - DESTRUCTION LESIONS VULVA SIMPLE"]
[null,"62321 - HR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN",null,"56442 - HYMENOTOMY","56442 - HYMENOTOMY","56442 - HYMENOTOMY",null,"54100 - BIOPSY PENIS SEPARATE PROCEDURE",null,null,null,null,"56606 - BIOPSY VULVA/PERINEUM EACH ADDL LESION",null,"54100 - BIOPSY PENIS SEPARATE PROCEDURE",null,null,"93610 - HC INTRA-ATRIAL PACING","56515 - DESTRUCTION LESIONS VULVA EXTENSIVE"]
[null,"62322 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",null,"56501 - DESTRUCTION LESIONS VULVA SIMPLE","56501 - DESTRUCTION LESIONS VULVA SIMPLE","56501 - DESTRUCTION LESIONS VULVA SIMPLE",null,"54115 - HC REMV FOR.BODY DEEP PENILE TISS",null,null,null,null,"56620 - HC PART SIMPLE REMV VULVA",null,"54115 - HC REMV FOR.BODY DEEP PENILE TISS",null,null,"93613 - HC INTRACARDIAC ELECTROPHYSIOLOGIC 3D MAPPING","56605 - BIOPSY VULVA/PERINEUM 1 LESION SPX"]
[null,"62323 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",null,"56515 - DESTRUCTION LESIONS VULVA EXTENSIVE","56515 - DESTRUCTION LESIONS VULVA EXTENSIVE","56515 - DESTRUCTION LESIONS VULVA EXTENSIVE",null,"54150 - CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK",null,null,null,null,"56700 - HC PARTIAL REMOVAL OF HYMEN",null,"54150 - CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK",null,null,"93619 - HC COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION","56606 - BIOPSY VULVA/PERINEUM EACH ADDL LESION"]
[null,"62324 - HC NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN.",null,"56605 - BIOPSY VULVA/PERINEUM 1 LESION SPX","56605 - BIOPSY VULVA/PERINEUM 1 LESION SPX","56605 - BIOPSY VULVA/PERINEUM 1 LESION SPX",null,"54161 - HC CIRCUM 28 DAYS OR OLDER",null,null,null,null,"56740 - HC EXCIS BARTHOLIN GLAND/CYST",null,"54161 - HC CIRCUM 28 DAYS OR OLDER",null,null,"93620 - HC COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION","56620 - HC PART SIMPLE REMV VULVA"]
[null,"62326 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",null,"56606 - BIOPSY VULVA/PERINEUM EACH ADDL LESION","56606 - BIOPSY VULVA/PERINEUM EACH ADDL LESION","56606 - BIOPSY VULVA/PERINEUM EACH ADDL LESION",null,"54162 - HC LYSIS/EXCIS,PENILE POSTCIRCUM ADHESIONS",null,null,null,null,"56805 - HC REPAIR CLITORIS",null,"54162 - HC LYSIS/EXCIS,PENILE POSTCIRCUM ADHESIONS",null,null,"93621 - HC COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC","56700 - HC PARTIAL REMOVAL OF HYMEN"]
[null,"62327 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",null,"56620 - HC PART SIMPLE REMV VULVA","56620 - HC PART SIMPLE REMV VULVA","56620 - HC PART SIMPLE REMV VULVA",null,"54164 - FRENULOTOMY PENIS",null,null,null,null,"56820 - COLPOSCOPY VULVA",null,"54164 - FRENULOTOMY PENIS",null,null,"93622 - HC COMPRE ELECTROPHYSIOL XM W/LEFT VENTR PACNG/REC","56740 - HC EXCIS BARTHOLIN GLAND/CYST"]
[null,"62328 - HC DX LMBR SPI PNXR W/FLUOR/CT",null,"56700 - HC PARTIAL REMOVAL OF HYMEN","56700 - HC PARTIAL REMOVAL OF HYMEN","56700 - HC PARTIAL REMOVAL OF HYMEN",null,"54200 - INJECTION PEYRONIE DISEASE",null,null,null,null,"56821 - COLPOSCOPY VULVA W/BIOPSY",null,"54200 - INJECTION PEYRONIE DISEASE",null,null,"93623 - HC PROGRAMMED STIMJ & PACG AFTER IV DRUG NFS","56805 - HC REPAIR CLITORIS"]
[null,"62329 - HC THER SPI PNXR CSF FLUOR/CT",null,"56740 - HC EXCIS BARTHOLIN GLAND/CYST","56740 - HC EXCIS BARTHOLIN GLAND/CYST","56740 - HC EXCIS BARTHOLIN GLAND/CYST",null,"54220 - IRRIGATION CORPORA CAVERNOSA PRIAPISM",null,null,null,null,"57020 - COLPOCENTESIS SEPARATE PROCEDURE",null,"54220 - IRRIGATION CORPORA CAVERNOSA PRIAPISM",null,null,"93641 - HC EPHYS EVAL PACG CVDFB LDS W/TSTG OF PULSE GEN","56820 - COLPOSCOPY VULVA"]
[null,"62365 - HC REMOVE INFUSN DEVICE/PUMP",null,"56805 - HC REPAIR CLITORIS","56805 - HC REPAIR CLITORIS","56805 - HC REPAIR CLITORIS",null,"54231 - DYNAMIC CAVERNOSOMETRY NJX VASOACTIVE DRUGS",null,null,null,null,"57023 - HC I & D VAG HEMATOMA NON-OB",null,"54231 - DYNAMIC CAVERNOSOMETRY NJX VASOACTIVE DRUGS",null,null,"93642 - HC EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS","56821 - COLPOSCOPY VULVA W/BIOPSY"]
[null,"62367 - ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL",null,"56820 - COLPOSCOPY VULVA","56820 - COLPOSCOPY VULVA","56820 - COLPOSCOPY VULVA",null,"54235 - NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT",null,null,null,null,"57061 - DESTRUCTION VAGINAL LESIONS SIMPLE",null,"54235 - NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT",null,null,"93650 - HC ICAR CATHETER ABLATION ATRIOVENTR NODE FUNCTION","57020 - COLPOCENTESIS SEPARATE PROCEDURE"]
[null,"62368 - ELECT ANALYS IMPLT ITHCL/EDRL PUMP W/REPRGRMG",null,"56821 - COLPOSCOPY VULVA W/BIOPSY","56821 - COLPOSCOPY VULVA W/BIOPSY","56821 - COLPOSCOPY VULVA W/BIOPSY",null,"54450 - FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING",null,null,null,null,"57100 - BIOPSY VAGINAL MUCOSA SIMPLE",null,"54450 - FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING",null,null,"93653 - HC COMPRE EP EVAL TX SVT","57023 - HC I & D VAG HEMATOMA NON-OB"]
[null,"62370 - ELEC ANLYS IMPLT ITHCL/EDRL PMP W/REPR PHYS/QHP",null,"57020 - COLPOCENTESIS SEPARATE PROCEDURE","57020 - COLPOCENTESIS SEPARATE PROCEDURE","57020 - COLPOCENTESIS SEPARATE PROCEDURE",null,"54520 - HC REMOVAL OF TESTIS",null,null,null,null,"57105 - HC BIOPSY OF VAGINA",null,"54520 - HC REMOVAL OF TESTIS",null,null,"93654 - HC COMPRE EP EVAL TX VT","57061 - DESTRUCTION VAGINAL LESIONS SIMPLE"]
[null,"63650 - HC PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL",null,"57023 - HC I & D VAG HEMATOMA NON-OB","57023 - HC I & D VAG HEMATOMA NON-OB","57023 - HC I & D VAG HEMATOMA NON-OB",null,"54600 - HC REDUCE TESTIS TORSION",null,null,null,null,"57107 - REMOVE VAGINA TISSUE PART",null,"54600 - HC REDUCE TESTIS TORSION",null,null,"93656 - HC COMPRE EP EVAL ABLTJ ATR FIB","57100 - BIOPSY VAGINAL MUCOSA SIMPLE"]
[null,"63661 - HC RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR",null,"57061 - DESTRUCTION VAGINAL LESIONS SIMPLE","57061 - DESTRUCTION VAGINAL LESIONS SIMPLE","57061 - DESTRUCTION VAGINAL LESIONS SIMPLE",null,"54700 - I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE",null,null,null,null,"57135 - HC EXCIS VAGINAL CYST/TUMOR",null,"54700 - I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE",null,null,"93660 - CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR","57105 - HC BIOPSY OF VAGINA"]
[null,"63662 - HC REMOVE SPINAL NEUROSTIM ELECTRODE PLATE/PADDLE, INCL FLUORO",null,"57100 - BIOPSY VAGINAL MUCOSA SIMPLE","57100 - BIOPSY VAGINAL MUCOSA SIMPLE","57100 - BIOPSY VAGINAL MUCOSA SIMPLE",null,"55000 - PNXR ASPIR HYDROCELE TUNICA VAGIS W/WO NJX MED",null,null,null,null,"57155 - HC OR INSERTION OF T&O",null,"55000 - PNXR ASPIR HYDROCELE TUNICA VAGIS W/WO NJX MED",null,null,"93662 - INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I","57107 - REMOVE VAGINA TISSUE PART"]
[null,"64400 - NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH",null,"57105 - HC BIOPSY OF VAGINA","57105 - HC BIOPSY OF VAGINA","57105 - HC BIOPSY OF VAGINA",null,"55100 - DRAIN SCROTAL WALL ABS",null,null,null,null,"57156 - HC INSERTION OF CYLINDER",null,"55100 - DRAIN SCROTAL WALL ABS",null,null,"93724 - ANALYZE PACEMAKER SYSTEM","57135 - HC EXCIS VAGINAL CYST/TUMOR"]
[null,"64405 - INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV",null,"57107 - REMOVE VAGINA TISSUE PART","57107 - REMOVE VAGINA TISSUE PART","57107 - REMOVE VAGINA TISSUE PART",null,"55120 - HB REMOVAL OF SCROTAL FOR BODY",null,null,null,null,"57160 - FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPORT DEVI",null,"55120 - HB REMOVAL OF SCROTAL FOR BODY",null,null,"93786 - BL BLD PRESS W/TAPE&/DISK 24/> HR REC ONL","57155 - HC OR INSERTION OF T&O"]
[null,"64408 - HC INJ,ANES;VAGUS NER",null,"57135 - HC EXCIS VAGINAL CYST/TUMOR","57135 - HC EXCIS VAGINAL CYST/TUMOR","57135 - HC EXCIS VAGINAL CYST/TUMOR",null,"55250 - VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS",null,null,null,null,"57170 - DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS",null,"55250 - VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS",null,null,"93788 - AMBL BLD PRESS W/TAPE/DISK 24/>HR ALYS W/REPRT","57156 - HC INSERTION OF CYLINDER"]
[null,"64415 - SINGLE NERVE BLOCK INJECTION ARM NERVE",null,"57155 - HC OR INSERTION OF T&O","57155 - HC OR INSERTION OF T&O","57155 - HC OR INSERTION OF T&O",null,"55400 - HC REPAIR OF SPERM DUCT",null,null,null,null,"57180 - HC TREAT VAGINAL BLEEDING",null,"55400 - HC REPAIR OF SPERM DUCT",null,null,"93797 - SP CARD REHAB MAINTAIN","57160 - FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPORT DEVI"]
[null,"64416 - HC INJ,ANES;CONT INF B PLEX",null,"57156 - HC INSERTION OF CYLINDER","57156 - HC INSERTION OF CYLINDER","57156 - HC INSERTION OF CYLINDER",null,"55520 - HC REMOVAL OF SPERM CORD LESION",null,null,null,null,"57200 - HC COLPORRHAPHY, SUTURE VAGINAL INJURY, NON-OB",null,"55520 - HC REMOVAL OF SPERM CORD LESION",null,null,"93798 - OUTPATIENT CARDIAC REHAB W/CONT ECG MONITORING","57170 - DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS"]
[null,"64417 - INJECTION ANESTHETIC AGENT AXILLARY NERVE",null,"57160 - FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPORT DEVI","57160 - FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPORT DEVI","57160 - FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPORT DEVI",null,"55700 - PROSTATE NEEDLE BIOPSY ANY APPROACH",null,null,null,null,"57210 - HC REPAIR VAGINA/PERINEUM",null,"55700 - PROSTATE NEEDLE BIOPSY ANY APPROACH",null,null,"93880 - HC DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY","57180 - HC TREAT VAGINAL BLEEDING"]
[null,"64418 - INJECTION ANESTHETIC AGENT SUPRASCAPULAR NERVE",null,"57170 - DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS","57170 - DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS","57170 - DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS",null,"55876 - PLMT INTERSTITIAL DEV RADIAT TX PROSTATE 1/MULT",null,null,null,null,"57410 - HC PELVIC EXAMINATION W ANESTH",null,"55876 - PLMT INTERSTITIAL DEV RADIAT TX PROSTATE 1/MULT",null,null,"93882 - HC DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY","57200 - HC COLPORRHAPHY, SUTURE VAGINAL INJURY, NON-OB"]
[null,"64420 - INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE",null,"57180 - HC TREAT VAGINAL BLEEDING","57180 - HC TREAT VAGINAL BLEEDING","57180 - HC TREAT VAGINAL BLEEDING",null,"55899 - UNLISTED PROCEDURE MALE GENITAL SYSTEM",null,null,null,null,"57415 - HC REMOVAL VAGINAL FOR.BODY W ANESTH",null,"55899 - UNLISTED PROCEDURE MALE GENITAL SYSTEM",null,null,"93886 - TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL","57210 - HC REPAIR VAGINA/PERINEUM"]
[null,"64421 - MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES",null,"57200 - HC COLPORRHAPHY, SUTURE VAGINAL INJURY, NON-OB","57200 - HC COLPORRHAPHY, SUTURE VAGINAL INJURY, NON-OB","57200 - HC COLPORRHAPHY, SUTURE VAGINAL INJURY, NON-OB",null,"56405 - I&D VULVA/PERINEAL ABSCESS",null,null,null,null,"57420 - COLPOSCOPY ENTIRE VAGINA W/CERVIX IF PRESENT",null,"56405 - I&D VULVA/PERINEAL ABSCESS",null,null,"93888 - TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD","57410 - HC PELVIC EXAMINATION W ANESTH"]
[null,"64425 - INJECTION ANES ILIOINGUINAL ILIOHYPOGASTRIC NRVS",null,"57210 - HC REPAIR VAGINA/PERINEUM","57210 - HC REPAIR VAGINA/PERINEUM","57210 - HC REPAIR VAGINA/PERINEUM",null,"56420 - I&D OF BARTHOLINS GLAND ABSCESS",null,null,null,null,"57421 - COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX",null,"56420 - I&D OF BARTHOLINS GLAND ABSCESS",null,null,"93890 - TRANSCRANIAL DOPPLER INTRACRAN ART VASOREAC STDY","57415 - HC REMOVAL VAGINAL FOR.BODY W ANESTH"]
[null,"64430 - HC INJ,ANES;PUDEND NER",null,"57410 - HC PELVIC EXAMINATION W ANESTH","57410 - HC PELVIC EXAMINATION W ANESTH","57410 - HC PELVIC EXAMINATION W ANESTH",null,"56440 - MARSUPIALIZATION BARTHOLINS GLAND CYST",null,null,null,null,"57452 - COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA",null,"56440 - MARSUPIALIZATION BARTHOLINS GLAND CYST",null,null,"93892 - HC TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT","57420 - COLPOSCOPY ENTIRE VAGINA W/CERVIX IF PRESENT"]
[null,"64435 - INJECTION ANESTHETIC PARACERVICAL UTERINE NERVE",null,"57415 - HC REMOVAL VAGINAL FOR.BODY W ANESTH","57415 - HC REMOVAL VAGINAL FOR.BODY W ANESTH","57415 - HC REMOVAL VAGINAL FOR.BODY W ANESTH",null,"56442 - HYMENOTOMY",null,null,null,null,"57454 - COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE",null,"56442 - HYMENOTOMY",null,null,"93893 - HC TRANSCRAN DOPP INTRACRAN, EMBOLI W/INJ","57421 - COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX"]
[null,"64445 - INJECTION ANESTHETIC AGENT SCIATIC NRV SINGLE",null,"57420 - COLPOSCOPY ENTIRE VAGINA W/CERVIX IF PRESENT","57420 - COLPOSCOPY ENTIRE VAGINA W/CERVIX IF PRESENT","57420 - COLPOSCOPY ENTIRE VAGINA W/CERVIX IF PRESENT",null,"56501 - DESTRUCTION LESIONS VULVA SIMPLE",null,null,null,null,"57455 - COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX",null,"56501 - DESTRUCTION LESIONS VULVA SIMPLE",null,null,"93922 - NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL","57452 - COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA"]
[null,"64450 - INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH",null,"57421 - COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX","57421 - COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX","57421 - COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX",null,"56515 - DESTRUCTION LESIONS VULVA EXTENSIVE",null,null,null,null,"57456 - COLPOSCOPY CERVIX ENDOCERVICAL CURETTAGE",null,"56515 - DESTRUCTION LESIONS VULVA EXTENSIVE",null,null,"93923 - NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS","57454 - COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE"]
[null,"64451 - HC NJX AA&/STRD NRV NRVTG SI JT",null,"57452 - COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA","57452 - COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA","57452 - COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA",null,"56605 - BIOPSY VULVA/PERINEUM 1 LESION SPX",null,null,null,null,"57460 - COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX",null,"56605 - BIOPSY VULVA/PERINEUM 1 LESION SPX",null,null,"93924 - HC N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI","57455 - COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX"]
[null,"64454 - HC NJX AA&/STRD GNCLR NRV BRNCH",null,"57454 - COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE","57454 - COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE","57454 - COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE",null,"56606 - BIOPSY VULVA/PERINEUM EACH ADDL LESION",null,null,null,null,"57461 - COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX",null,"56606 - BIOPSY VULVA/PERINEUM EACH ADDL LESION",null,null,"93925 - HC DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY","57456 - COLPOSCOPY CERVIX ENDOCERVICAL CURETTAGE"]
[null,"64455 - NJX ANES&/STEROID PLANTAR COMMON DIGITAL NERVE",null,"57455 - COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX","57455 - COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX","57455 - COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX",null,"56620 - HC PART SIMPLE REMV VULVA",null,null,null,null,"57500 - BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX",null,"56620 - HC PART SIMPLE REMV VULVA",null,null,"93926 - HC DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY","57460 - COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX"]
[null,"64461 - HC PVB,THORACIC;SINGLE INJECTION SITE INCLUDING IMAGING GUIDANCE WHEN PERFORMED",null,"57456 - COLPOSCOPY CERVIX ENDOCERVICAL CURETTAGE","57456 - COLPOSCOPY CERVIX ENDOCERVICAL CURETTAGE","57456 - COLPOSCOPY CERVIX ENDOCERVICAL CURETTAGE",null,"56700 - HC PARTIAL REMOVAL OF HYMEN",null,null,null,null,"57505 - ENDOCERVICAL CURETTAGE W/DILATION & CURETTAGE",null,"56700 - HC PARTIAL REMOVAL OF HYMEN",null,null,"93930 - HC DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY","57461 - COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX"]
[null,"64462 - HC PVB,THORAC;2ND & ANY ADD¿L INJECT SITE(S) INCLUD IMAGE GUIDE WHEN PERFORMED",null,"57460 - COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX","57460 - COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX","57460 - COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX",null,"56740 - HC EXCIS BARTHOLIN GLAND/CYST",null,null,null,null,"57510 - HC CAUTERIZATION,CERVIX,ELECTRO/THERMAL",null,"56740 - HC EXCIS BARTHOLIN GLAND/CYST",null,null,"93931 - DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY","57500 - BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX"]
[null,"64479 - HC INJECT ANES/STEROID FORAMEN CERV/THORACIC W IMG GUIDE ,1 LEVEL",null,"57461 - COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX","57461 - COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX","57461 - COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX",null,"56805 - HC REPAIR CLITORIS",null,null,null,null,"57511 - HC CRYOCAUTERY OF CERVIX",null,"56805 - HC REPAIR CLITORIS",null,null,"93970 - HC DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY","57505 - ENDOCERVICAL CURETTAGE W/DILATION & CURETTAGE"]
[null,"64483 - NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL",null,"57500 - BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX","57500 - BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX","57500 - BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX",null,"56820 - COLPOSCOPY VULVA",null,null,null,null,"57520 - HC CONIZATION CERVIX, KNIFE/LASER",null,"56820 - COLPOSCOPY VULVA",null,null,"93971 - HC DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY","57510 - HC CAUTERIZATION,CERVIX,ELECTRO/THERMAL"]
[null,"64484 - NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC EA LV",null,"57505 - ENDOCERVICAL CURETTAGE W/DILATION & CURETTAGE","57505 - ENDOCERVICAL CURETTAGE W/DILATION & CURETTAGE","57505 - ENDOCERVICAL CURETTAGE W/DILATION & CURETTAGE",null,"56821 - COLPOSCOPY VULVA W/BIOPSY",null,null,null,null,"57522 - CONIZATION CERVIX W/WO D&C RPR ELTRD EXC",null,"56821 - COLPOSCOPY VULVA W/BIOPSY",null,null,"93975 - DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM","57511 - HC CRYOCAUTERY OF CERVIX"]
[null,"64486 - TAP BLOCK UNILATERAL BY INJECTION(S)",null,"57510 - HC CAUTERIZATION,CERVIX,ELECTRO/THERMAL","57510 - HC CAUTERIZATION,CERVIX,ELECTRO/THERMAL","57510 - HC CAUTERIZATION,CERVIX,ELECTRO/THERMAL",null,"57020 - COLPOCENTESIS SEPARATE PROCEDURE",null,null,null,null,"57558 - DILATION & CURETTAGE CERVICAL STUMP",null,"57020 - COLPOCENTESIS SEPARATE PROCEDURE",null,null,"93976 - HC DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RORGN LMT","57520 - HC CONIZATION CERVIX, KNIFE/LASER"]
[null,"64488 - HC TAP BLOCK BILATERAL BY INJECTION(S)",null,"57511 - HC CRYOCAUTERY OF CERVIX","57511 - HC CRYOCAUTERY OF CERVIX","57511 - HC CRYOCAUTERY OF CERVIX",null,"57023 - HC I & D VAG HEMATOMA NON-OB",null,null,null,null,"57800 - DILATION CERVICAL CANAL INSTRUMENTAL SPX",null,"57023 - HC I & D VAG HEMATOMA NON-OB",null,null,"93978 - HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE","57522 - CONIZATION CERVIX W/WO D&C RPR ELTRD EXC"]
[null,"64490 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL",null,"57520 - HC CONIZATION CERVIX, KNIFE/LASER","57520 - HC CONIZATION CERVIX, KNIFE/LASER","57520 - HC CONIZATION CERVIX, KNIFE/LASER",null,"57061 - DESTRUCTION VAGINAL LESIONS SIMPLE",null,null,null,null,"58100 - ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX",null,"57061 - DESTRUCTION VAGINAL LESIONS SIMPLE",null,null,"93979 - HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD","57558 - DILATION & CURETTAGE CERVICAL STUMP"]
[null,"64491 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL",null,"57522 - CONIZATION CERVIX W/WO D&C RPR ELTRD EXC","57522 - CONIZATION CERVIX W/WO D&C RPR ELTRD EXC","57522 - CONIZATION CERVIX W/WO D&C RPR ELTRD EXC",null,"57100 - BIOPSY VAGINAL MUCOSA SIMPLE",null,null,null,null,"58110 - ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY",null,"57100 - BIOPSY VAGINAL MUCOSA SIMPLE",null,null,"93980 - DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL","57800 - DILATION CERVICAL CANAL INSTRUMENTAL SPX"]
[null,"64492 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL",null,"57558 - DILATION & CURETTAGE CERVICAL STUMP","57558 - DILATION & CURETTAGE CERVICAL STUMP","57558 - DILATION & CURETTAGE CERVICAL STUMP",null,"57105 - HC BIOPSY OF VAGINA",null,null,null,null,"58120 - DILATION & CURETTAGE DX&/THER NONOBSTETRIC",null,"57105 - HC BIOPSY OF VAGINA",null,null,"93990 - HC DUPLEX SCAN HEMODIALYSIS ACCESS","58100 - ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX"]
[null,"64493 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL",null,"57800 - DILATION CERVICAL CANAL INSTRUMENTAL SPX","57800 - DILATION CERVICAL CANAL INSTRUMENTAL SPX","57800 - DILATION CERVICAL CANAL INSTRUMENTAL SPX",null,"57107 - REMOVE VAGINA TISSUE PART",null,null,null,null,"58145 - MYOMECTOMY 1-4 MYOMAS 250 GM/< VAGINAL APPR",null,"57107 - REMOVE VAGINA TISSUE PART",null,null,"94002 - HC VENTILATION ASSIST & MGMT INPATIENT 1ST DAY","58110 - ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY"]
[null,"64494 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL",null,"58100 - ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX","58100 - ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX","58100 - ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX",null,"57135 - HC EXCIS VAGINAL CYST/TUMOR",null,null,null,null,"58300 - INSERTION INTRAUTERINE DEVICE IUD",null,"57135 - HC EXCIS VAGINAL CYST/TUMOR",null,null,"94003 - HC VENTILATION ASSIST & MGMT INPATIENT EA SBSQ DA","58120 - DILATION & CURETTAGE DX&/THER NONOBSTETRIC"]
[null,"64495 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL",null,"58110 - ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY","58110 - ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY","58110 - ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY",null,"57155 - HC OR INSERTION OF T&O",null,null,null,null,"58301 - REMOVAL INTRAUTERINE DEVICE IUD",null,"57155 - HC OR INSERTION OF T&O",null,null,"94010 - SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ","58145 - MYOMECTOMY 1-4 MYOMAS 250 GM/< VAGINAL APPR"]
[null,"64505 - INJECTION ANES AGENT SPHENOPALATINE GANGLION",null,"58120 - DILATION & CURETTAGE DX&/THER NONOBSTETRIC","58120 - DILATION & CURETTAGE DX&/THER NONOBSTETRIC","58120 - DILATION & CURETTAGE DX&/THER NONOBSTETRIC",null,"57156 - HC INSERTION OF CYLINDER",null,null,null,null,"58321 - ARTIFICIAL INSEMINATION INTRA-CERVICAL",null,"57156 - HC INSERTION OF CYLINDER",null,null,"94060 - BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN","58300 - INSERTION INTRAUTERINE DEVICE IUD"]
[null,"64510 - NJX ANES STELLATE GANGLION CRV SYMPATHETIC",null,"58145 - MYOMECTOMY 1-4 MYOMAS 250 GM/< VAGINAL APPR","58145 - MYOMECTOMY 1-4 MYOMAS 250 GM/< VAGINAL APPR","58145 - MYOMECTOMY 1-4 MYOMAS 250 GM/< VAGINAL APPR",null,"57160 - FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPORT DEVI",null,null,null,null,"58322 - ARTIFICIAL INSEMINATION INTRA-UTERINE",null,"57160 - FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPORT DEVI",null,null,"94070 - BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT","58301 - REMOVAL INTRAUTERINE DEVICE IUD"]
[null,"64520 - INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC",null,"58300 - INSERTION INTRAUTERINE DEVICE IUD","58300 - INSERTION INTRAUTERINE DEVICE IUD","58300 - INSERTION INTRAUTERINE DEVICE IUD",null,"57170 - DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS",null,null,null,null,"58323 - SPERM WASHING ARTIFICIAL INSEMINATION",null,"57170 - DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS",null,null,"94150 - VITAL CAPACITY TOTAL SEPARATE PROCEDURE","58321 - ARTIFICIAL INSEMINATION INTRA-CERVICAL"]
[null,"64530 - INJX ANES CELIAC PLEXUS W/WO RADIOLOGIC MONITRNG",null,"58301 - REMOVAL INTRAUTERINE DEVICE IUD","58301 - REMOVAL INTRAUTERINE DEVICE IUD","58301 - REMOVAL INTRAUTERINE DEVICE IUD",null,"57180 - HC TREAT VAGINAL BLEEDING",null,null,null,null,"58340 - CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI",null,"57180 - HC TREAT VAGINAL BLEEDING",null,null,"94200 - HC MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ","58322 - ARTIFICIAL INSEMINATION INTRA-UTERINE"]
[null,"64561 - IMPLANT NEUROELECTRODES",null,"58321 - ARTIFICIAL INSEMINATION INTRA-CERVICAL","58321 - ARTIFICIAL INSEMINATION INTRA-CERVICAL","58321 - ARTIFICIAL INSEMINATION INTRA-CERVICAL",null,"57200 - HC COLPORRHAPHY, SUTURE VAGINAL INJURY, NON-OB",null,null,null,null,"58345 - HC REOPEN FALLOPIAN TUBE, TRANSCERV CATH",null,"57200 - HC COLPORRHAPHY, SUTURE VAGINAL INJURY, NON-OB",null,null,"94250 - HC EXPIRED GAS COLLECTION QUANT 1 PROCEDURE SPX","58323 - SPERM WASHING ARTIFICIAL INSEMINATION"]
[null,"64569 - HC REVISE/REPLACE CRANIAL NERVE STIM ELECTRODE/CONNECT PULSE GEN",null,"58322 - ARTIFICIAL INSEMINATION INTRA-UTERINE","58322 - ARTIFICIAL INSEMINATION INTRA-UTERINE","58322 - ARTIFICIAL INSEMINATION INTRA-UTERINE",null,"57210 - HC REPAIR VAGINA/PERINEUM",null,null,null,null,"58555 - HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE",null,"57210 - HC REPAIR VAGINA/PERINEUM",null,null,"94375 - RESPIRATORY FLOW VOLUME LOOP","58340 - CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI"]
[null,"64585 - REVISE/REMOVE NEUROELECTRODE",null,"58323 - SPERM WASHING ARTIFICIAL INSEMINATION","58323 - SPERM WASHING ARTIFICIAL INSEMINATION","58323 - SPERM WASHING ARTIFICIAL INSEMINATION",null,"57410 - HC PELVIC EXAMINATION W ANESTH",null,null,null,null,"58558 - HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C",null,"57410 - HC PELVIC EXAMINATION W ANESTH",null,null,"94450 - HYPOXIA RESPONSE CURVE","58345 - HC REOPEN FALLOPIAN TUBE, TRANSCERV CATH"]
[null,"64600 - INJECTION TREATMENT OF NERVE",null,"58340 - CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI","58340 - CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI","58340 - CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI",null,"57415 - HC REMOVAL VAGINAL FOR.BODY W ANESTH",null,null,null,null,"58559 - HC HYSTEROSCOPY LYSIS INTRAUTERINE ADHESIONS",null,"57415 - HC REMOVAL VAGINAL FOR.BODY W ANESTH",null,null,"94453 - HC HAST W/OXYGEN TITRATE","58555 - HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE"]
[null,"64611 - CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS",null,"58345 - HC REOPEN FALLOPIAN TUBE, TRANSCERV CATH","58345 - HC REOPEN FALLOPIAN TUBE, TRANSCERV CATH","58345 - HC REOPEN FALLOPIAN TUBE, TRANSCERV CATH",null,"57420 - COLPOSCOPY ENTIRE VAGINA W/CERVIX IF PRESENT",null,null,null,null,"58561 - HC HYSTEROSCOPY,RMV MYOMA",null,"57420 - COLPOSCOPY ENTIRE VAGINA W/CERVIX IF PRESENT",null,null,"94620 - HC PULMONARY STRESS TESTING SIMPLE","58558 - HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C"]
[null,"64612 - CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL",null,"58555 - HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE","58555 - HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE","58555 - HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE",null,"57421 - COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX",null,null,null,null,"58562 - HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY",null,"57421 - COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX",null,null,"94621 - HC PULMONARY STRESS TESTING COMPLEX","58559 - HC HYSTEROSCOPY LYSIS INTRAUTERINE ADHESIONS"]
[null,"64615 - CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE",null,"58558 - HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C","58558 - HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C","58558 - HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C",null,"57452 - COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA",null,null,null,null,"58565 - HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS",null,"57452 - COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA",null,null,"94640 - PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT","58561 - HC HYSTEROSCOPY,RMV MYOMA"]
[null,"64616 - CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA",null,"58559 - HC HYSTEROSCOPY LYSIS INTRAUTERINE ADHESIONS","58559 - HC HYSTEROSCOPY LYSIS INTRAUTERINE ADHESIONS","58559 - HC HYSTEROSCOPY LYSIS INTRAUTERINE ADHESIONS",null,"57454 - COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE",null,null,null,null,"58674 - HC LAPS ABLTJ UTERINE FIBROIDS",null,"57454 - COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE",null,null,"94642 - HC AEROSOL INHALATION TREATMENT","58562 - HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY"]
[null,"64617 - CHEMODENERVATION MUSCLE LARYNX UNILAT W/EMG",null,"58561 - HC HYSTEROSCOPY,RMV MYOMA","58561 - HC HYSTEROSCOPY,RMV MYOMA","58561 - HC HYSTEROSCOPY,RMV MYOMA",null,"57455 - COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX",null,null,null,null,"58925 - HC OVARIAN CYSTECTOMY UNI/BI",null,"57455 - COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX",null,null,"94660 - HC CPAP VENTILATION CPAP INITIATION&MGMT","58565 - HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS"]
[null,"64620 - HC DEST,INTERCOSTAL,NEUROLYTIC",null,"58562 - HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY","58562 - HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY","58562 - HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY",null,"57456 - COLPOSCOPY CERVIX ENDOCERVICAL CURETTAGE",null,null,null,null,"59000 - AMNIOCENTESIS DIAGNOSIC",null,"57456 - COLPOSCOPY CERVIX ENDOCERVICAL CURETTAGE",null,null,"94664 - HC DEMO/EVAL INHALER/NEBULIZER - PHARM","58674 - HC LAPS ABLTJ UTERINE FIBROIDS"]
[null,"64624 - HC DSTRJ NULYT AGT GNCLR NRV",null,"58565 - HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS","58565 - HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS","58565 - HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS",null,"57460 - COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX",null,null,null,null,"59015 - CHORIONIC VILLUS SAMPLING",null,"57460 - COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX",null,null,"94667 - HC CHEST WALL MANIPULATION,INITIAL","58925 - HC OVARIAN CYSTECTOMY UNI/BI"]
[null,"64625 - HC RF ABLTJ NRV NRVTG SI JT",null,"58575 - HC LAPS TOT HYSTERECTOMY RESJ MALIGNANCY W/OMNTC","58575 - HC LAPS TOT HYSTERECTOMY RESJ MALIGNANCY W/OMNTC","58575 - HC LAPS TOT HYSTERECTOMY RESJ MALIGNANCY W/OMNTC",null,"57461 - COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX",null,null,null,null,"59020 - FETAL CONTRACTION STRESS TEST",null,"57461 - COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX",null,null,"94681 - O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC","59000 - AMNIOCENTESIS DIAGNOSIC"]
[null,"64632 - DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE",null,"58674 - HC LAPS ABLTJ UTERINE FIBROIDS","58674 - HC LAPS ABLTJ UTERINE FIBROIDS","58674 - HC LAPS ABLTJ UTERINE FIBROIDS",null,"57500 - BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX",null,null,null,null,"59025 - FETAL NONSTRESS TEST",null,"57500 - BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX",null,null,"94690 - O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX","59015 - CHORIONIC VILLUS SAMPLING"]
[null,"64633 - DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA",null,"58925 - HC OVARIAN CYSTECTOMY UNI/BI","58925 - HC OVARIAN CYSTECTOMY UNI/BI","58925 - HC OVARIAN CYSTECTOMY UNI/BI",null,"57505 - ENDOCERVICAL CURETTAGE W/DILATION & CURETTAGE",null,null,null,null,"59160 - CURETTAGE POSTPARTUM",null,"57505 - ENDOCERVICAL CURETTAGE W/DILATION & CURETTAGE",null,null,"94726 - PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST","59020 - FETAL CONTRACTION STRESS TEST"]
[null,"64634 - HC DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA",null,"59000 - AMNIOCENTESIS DIAGNOSIC","59000 - AMNIOCENTESIS DIAGNOSIC","59000 - AMNIOCENTESIS DIAGNOSIC",null,"57510 - HC CAUTERIZATION,CERVIX,ELECTRO/THERMAL",null,null,null,null,"59200 - INSERTION CERVICAL DILATOR SEPARATE PROCEDURE",null,"57510 - HC CAUTERIZATION,CERVIX,ELECTRO/THERMAL",null,null,"94727 - HC GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&VOL","59025 - FETAL NONSTRESS TEST"]
[null,"64635 - DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL",null,"59015 - CHORIONIC VILLUS SAMPLING","59015 - CHORIONIC VILLUS SAMPLING","59015 - CHORIONIC VILLUS SAMPLING",null,"57511 - HC CRYOCAUTERY OF CERVIX",null,null,null,null,"59300 - HC EPISIOTOMY/VAG RPR OTH/THN ATTENDING",null,"57511 - HC CRYOCAUTERY OF CERVIX",null,null,"94729 - CO DIFFUSING CAPACITY","59160 - CURETTAGE POSTPARTUM"]
[null,"64636 - DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL",null,"59020 - FETAL CONTRACTION STRESS TEST","59020 - FETAL CONTRACTION STRESS TEST","59020 - FETAL CONTRACTION STRESS TEST",null,"57520 - HC CONIZATION CERVIX, KNIFE/LASER",null,null,null,null,"59320 - CERCLAGE CERVIX PREGNANCY VAGINAL",null,"57520 - HC CONIZATION CERVIX, KNIFE/LASER",null,null,"94770 - CARBON DIOXIDE EXP GAS DETER INFRARED ANALYZER","59200 - INSERTION CERVICAL DILATOR SEPARATE PROCEDURE"]
[null,"64640 - DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE",null,"59025 - FETAL NONSTRESS TEST","59025 - FETAL NONSTRESS TEST","59025 - FETAL NONSTRESS TEST",null,"57522 - CONIZATION CERVIX W/WO D&C RPR ELTRD EXC",null,null,null,null,"59409 - HC VAGINAL DELIVERY ONLY",null,"57522 - CONIZATION CERVIX W/WO D&C RPR ELTRD EXC",null,null,"95805 - HC MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG","59300 - HC EPISIOTOMY/VAG RPR OTH/THN ATTENDING"]
[null,"64642 - CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE",null,"59160 - CURETTAGE POSTPARTUM","59160 - CURETTAGE POSTPARTUM","59160 - CURETTAGE POSTPARTUM",null,"57558 - DILATION & CURETTAGE CERVICAL STUMP",null,null,null,null,"59412 - EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS",null,"57558 - DILATION & CURETTAGE CERVICAL STUMP",null,null,"95806 - SLEEP STUDY, UNATTENDED, SIMUL RECORD HR/O2 SAT/RESP FLOW/RESP EFF","59320 - CERCLAGE CERVIX PREGNANCY VAGINAL"]
[null,"64643 - CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE",null,"59200 - INSERTION CERVICAL DILATOR SEPARATE PROCEDURE","59200 - INSERTION CERVICAL DILATOR SEPARATE PROCEDURE","59200 - INSERTION CERVICAL DILATOR SEPARATE PROCEDURE",null,"57800 - DILATION CERVICAL CANAL INSTRUMENTAL SPX",null,null,null,null,"59414 - HC DELIVER PLACENTA",null,"57800 - DILATION CERVICAL CANAL INSTRUMENTAL SPX",null,null,"95808 - POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND","59409 - HC VAGINAL DELIVERY ONLY"]
[null,"64644 - CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES",null,"59300 - HC EPISIOTOMY/VAG RPR OTH/THN ATTENDING","59300 - HC EPISIOTOMY/VAG RPR OTH/THN ATTENDING","59300 - HC EPISIOTOMY/VAG RPR OTH/THN ATTENDING",null,"58100 - ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX",null,null,null,null,"59812 - TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL",null,"58100 - ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX",null,null,"95810 - POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","59412 - EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS"]
[null,"64645 - CHEMODENERVATION 1 EXTREMITY EA ADDL 5/> MUSCLES",null,"59320 - CERCLAGE CERVIX PREGNANCY VAGINAL","59320 - CERCLAGE CERVIX PREGNANCY VAGINAL","59320 - CERCLAGE CERVIX PREGNANCY VAGINAL",null,"58110 - ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY",null,null,null,null,"59820 - TX MISSED ABORTION FIRST TRIMESTER SURGICAL",null,"58110 - ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY",null,null,"95811 - POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND","59414 - HC DELIVER PLACENTA"]
[null,"64646 - CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES",null,"59409 - HC VAGINAL DELIVERY ONLY","59409 - HC VAGINAL DELIVERY ONLY","59409 - HC VAGINAL DELIVERY ONLY",null,"58120 - DILATION & CURETTAGE DX&/THER NONOBSTETRIC",null,null,null,null,"59821 - TX MISSED ABORTION SECOND TRIMESTER SURGICAL",null,"58120 - DILATION & CURETTAGE DX&/THER NONOBSTETRIC",null,null,"95812 - ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN","59812 - TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL"]
[null,"64647 - CHEMODENERVATION OF TRUNK 6 OR MORE MUSCLES",null,"59412 - EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS","59412 - EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS","59412 - EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS",null,"58145 - MYOMECTOMY 1-4 MYOMAS 250 GM/< VAGINAL APPR",null,null,null,null,"59840 - INDUCED ABORTION DILATION AND CURETTAGE",null,"58145 - MYOMECTOMY 1-4 MYOMAS 250 GM/< VAGINAL APPR",null,null,"95813 - ELECTROENCEPHALOGRAM EXTND MNTR >1 HR","59820 - TX MISSED ABORTION FIRST TRIMESTER SURGICAL"]
[null,"64650 - CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE",null,"59414 - HC DELIVER PLACENTA","59414 - HC DELIVER PLACENTA","59414 - HC DELIVER PLACENTA",null,"58300 - INSERTION INTRAUTERINE DEVICE IUD",null,null,null,null,"59841 - INDUCED ABORTION DILATION & EVAUCATION",null,"58300 - INSERTION INTRAUTERINE DEVICE IUD",null,null,"95816 - ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY","59821 - TX MISSED ABORTION SECOND TRIMESTER SURGICAL"]
[null,"64653 - CHEMODENERVATION ECCRINE GLANDS OTH AREA PER DAY",null,"59812 - TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL","59812 - TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL","59812 - TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL",null,"58301 - REMOVAL INTRAUTERINE DEVICE IUD",null,null,null,null,"59870 - UTERINE EVACUATION & CURETTAGE HYDATIDIFORM MOLE",null,"58301 - REMOVAL INTRAUTERINE DEVICE IUD",null,null,"95819 - ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP","59840 - INDUCED ABORTION DILATION AND CURETTAGE"]
[null,"64680 - HC DES,NEURO;CELIAC PLEX,WWO",null,"59820 - TX MISSED ABORTION FIRST TRIMESTER SURGICAL","59820 - TX MISSED ABORTION FIRST TRIMESTER SURGICAL","59820 - TX MISSED ABORTION FIRST TRIMESTER SURGICAL",null,"58321 - ARTIFICIAL INSEMINATION INTRA-CERVICAL",null,null,null,null,"59871 - REMOVAL CERCLAGE SUTURE UNDER ANESTHESIA",null,"58321 - ARTIFICIAL INSEMINATION INTRA-CERVICAL",null,null,"95824 - ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY","59841 - INDUCED ABORTION DILATION & EVAUCATION"]
[null,"64721 - NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE",null,"59821 - TX MISSED ABORTION SECOND TRIMESTER SURGICAL","59821 - TX MISSED ABORTION SECOND TRIMESTER SURGICAL","59821 - TX MISSED ABORTION SECOND TRIMESTER SURGICAL",null,"58322 - ARTIFICIAL INSEMINATION INTRA-UTERINE",null,null,null,null,"60100 - BIOPSY THYROID PERCUTANEOUS CORE NEEDLE",null,"58322 - ARTIFICIAL INSEMINATION INTRA-UTERINE",null,null,"95860 - NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS","59870 - UTERINE EVACUATION & CURETTAGE HYDATIDIFORM MOLE"]
[null,"64771 - HC TRANSECT OTHER CRAN N,EXTRADURAL",null,"59840 - INDUCED ABORTION DILATION AND CURETTAGE","59840 - INDUCED ABORTION DILATION AND CURETTAGE","59840 - INDUCED ABORTION DILATION AND CURETTAGE",null,"58323 - SPERM WASHING ARTIFICIAL INSEMINATION",null,null,null,null,"60220 - HC THYROID LOBECTOMY,UNILAT",null,"58323 - SPERM WASHING ARTIFICIAL INSEMINATION",null,null,"95861 - NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS","59871 - REMOVAL CERCLAGE SUTURE UNDER ANESTHESIA"]
[null,"64774 - HC EXCISE CUTANEOUS NEUROMA",null,"59841 - INDUCED ABORTION DILATION & EVAUCATION","59841 - INDUCED ABORTION DILATION & EVAUCATION","59841 - INDUCED ABORTION DILATION & EVAUCATION",null,"58340 - CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI",null,null,null,null,"60300 - HB ASPIRATION AND/OR INJECTION THYROID CYST",null,"58340 - CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI",null,null,"95863 - NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS","60100 - BIOPSY THYROID PERCUTANEOUS CORE NEEDLE"]
[null,"64999 - PR SACROCOCCYGEAL JOINT INJECTION AND GANGLION OF IMPAR BLOCK",null,"59870 - UTERINE EVACUATION & CURETTAGE HYDATIDIFORM MOLE","59870 - UTERINE EVACUATION & CURETTAGE HYDATIDIFORM MOLE","59870 - UTERINE EVACUATION & CURETTAGE HYDATIDIFORM MOLE",null,"58345 - HC REOPEN FALLOPIAN TUBE, TRANSCERV CATH",null,null,null,null,"60500 - HC EXPLORE PARATHYROID GLANDS",null,"58345 - HC REOPEN FALLOPIAN TUBE, TRANSCERV CATH",null,null,"95864 - NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS","60220 - HC THYROID LOBECTOMY,UNILAT"]
[null,"65093 - HC REVISE EYE WITH IMPLANT",null,"59871 - REMOVAL CERCLAGE SUTURE UNDER ANESTHESIA","59871 - REMOVAL CERCLAGE SUTURE UNDER ANESTHESIA","59871 - REMOVAL CERCLAGE SUTURE UNDER ANESTHESIA",null,"58555 - HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE",null,null,null,null,"61050 - HC CISTERNAL/C1-2 PUNCTURE",null,"58555 - HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE",null,null,"95867 - NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI","60300 - HB ASPIRATION AND/OR INJECTION THYROID CYST"]
[null,"65101 - HC REMOVAL OF EYE",null,"60100 - BIOPSY THYROID PERCUTANEOUS CORE NEEDLE","60100 - BIOPSY THYROID PERCUTANEOUS CORE NEEDLE","60100 - BIOPSY THYROID PERCUTANEOUS CORE NEEDLE",null,"58558 - HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C",null,null,null,null,"61055 - HC CISTERNAL/LATERAL C1-C2 PUNCTURE W/INJECTION",null,"58558 - HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C",null,null,"95868 - NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI","60500 - HC EXPLORE PARATHYROID GLANDS"]
[null,"65103 - HC REMOVE EYE/INSERT IMPLANT",null,"60220 - HC THYROID LOBECTOMY,UNILAT","60220 - HC THYROID LOBECTOMY,UNILAT","60220 - HC THYROID LOBECTOMY,UNILAT",null,"58559 - HC HYSTEROSCOPY LYSIS INTRAUTERINE ADHESIONS",null,null,null,null,"61070 - HC PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX",null,"58559 - HC HYSTEROSCOPY LYSIS INTRAUTERINE ADHESIONS",null,null,"95869 - NEEDLE EMG THRC PARASPI MUSC EXCLUDING T1/T12","61050 - HC CISTERNAL/C1-2 PUNCTURE"]
[null,"65105 - HC REMOVE EYE/ATTACH IMPLANT",null,"60300 - HB ASPIRATION AND/OR INJECTION THYROID CYST","60300 - HB ASPIRATION AND/OR INJECTION THYROID CYST","60300 - HB ASPIRATION AND/OR INJECTION THYROID CYST",null,"58561 - HC HYSTEROSCOPY,RMV MYOMA",null,null,null,null,"61623 - HC EVASC TEMP BALLOON ARTL OCCLUSION HEAD/NECK",null,"58561 - HC HYSTEROSCOPY,RMV MYOMA",null,null,"95870 - NEEDLE EMG LMTD STD MUSC 1 XTR/NON-LIMB UNI/BI","61055 - HC CISTERNAL/LATERAL C1-C2 PUNCTURE W/INJECTION"]
[null,"65130 - HC INSERT OCULAR IMPLANT",null,"60500 - HC EXPLORE PARATHYROID GLANDS","60500 - HC EXPLORE PARATHYROID GLANDS","60500 - HC EXPLORE PARATHYROID GLANDS",null,"58562 - HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY",null,null,null,null,"61626 - HC TCAT PERMANT OCCLUSION/EMBOLIZATION PRQ NON-CNS",null,"58562 - HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY",null,null,"95872 - NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER","61070 - HC PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX"]
[null,"65135 - HC INSJ OC IMPLT AFTER ENCL MUSC X ATTACHED",null,"61050 - HC CISTERNAL/C1-2 PUNCTURE","61050 - HC CISTERNAL/C1-2 PUNCTURE","61050 - HC CISTERNAL/C1-2 PUNCTURE",null,"58565 - HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS",null,null,null,null,"61885 - HC IMP STIM,CRANIAL,SUBQ,1 ARRAY",null,"58565 - HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS",null,null,"95905 - HC MOTOR/SENS NERVE CONDUCTION PRECONFIG ELECTRODE ARRAY, EA LIMB","61623 - HC EVASC TEMP BALLOON ARTL OCCLUSION HEAD/NECK"]
[null,"65175 - HC REMOVAL OF OCULAR IMPLANT",null,"61055 - HC CISTERNAL/LATERAL C1-C2 PUNCTURE W/INJECTION","61055 - HC CISTERNAL/LATERAL C1-C2 PUNCTURE W/INJECTION","61055 - HC CISTERNAL/LATERAL C1-C2 PUNCTURE W/INJECTION",null,"58579 - HC UNLISTED HYSTEROSCOPY PROCEDURE UTERUS",null,null,null,null,"62252 - HC REPRGRMG PROGRAMMABLE CEREBROSPINAL SHUNT",null,"58579 - HC UNLISTED HYSTEROSCOPY PROCEDURE UTERUS",null,null,"95907 - MOTOR &/SENS 1-2 NRV CNDJ PRECONF ELTRODE LIMB","61626 - HC TCAT PERMANT OCCLUSION/EMBOLIZATION PRQ NON-CNS"]
[null,"65265 - HC REMOVE FOREIGN BODY FROM EYE",null,"61070 - HC PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX","61070 - HC PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX","61070 - HC PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX",null,"58674 - HC LAPS ABLTJ UTERINE FIBROIDS",null,null,null,null,"62264 - HC PRQ LYSIS EPIDURAL ADHESIONS MULT SESSIONS 1 DAY",null,"58674 - HC LAPS ABLTJ UTERINE FIBROIDS",null,null,"95908 - MOTOR &/SENS 3-4 NRV CNDJ PRECONF ELTRODE LIMB","61885 - HC IMP STIM,CRANIAL,SUBQ,1 ARRAY"]
[null,"65280 - HC REPAIR OF EYE WOUND",null,"61623 - HC EVASC TEMP BALLOON ARTL OCCLUSION HEAD/NECK","61623 - HC EVASC TEMP BALLOON ARTL OCCLUSION HEAD/NECK","61623 - HC EVASC TEMP BALLOON ARTL OCCLUSION HEAD/NECK",null,"58925 - HC OVARIAN CYSTECTOMY UNI/BI",null,null,null,null,"62268 - HC PERCUTANEOUS ASPIRATION SPINAL CORD CYST/SYRINX",null,"58925 - HC OVARIAN CYSTECTOMY UNI/BI",null,null,"95909 - MOTOR &/SENS 5-6 NRV CNDJ PRECONF ELTRODE LIMB","62252 - HC REPRGRMG PROGRAMMABLE CEREBROSPINAL SHUNT"]
[null,"65285 - HC RPR LAC CORN&/SCLRA PERF W/REPOS/RESCJ UVEAL T",null,"61624 - HC TCAT PERMANENT OCCLUSION/EMBOLIZATION PRQ CNS","61624 - HC TCAT PERMANENT OCCLUSION/EMBOLIZATION PRQ CNS","61624 - HC TCAT PERMANENT OCCLUSION/EMBOLIZATION PRQ CNS",null,"58999 - HC GENITAL SURG PROC, FEMALE UNLISTED",null,null,null,null,"62269 - HC BIO,SPINAL CORD,PERC NEED",null,"58999 - HC GENITAL SURG PROC, FEMALE UNLISTED",null,null,"95910 - MOTOR &/SENS 7-8 NRV CNDJ PRECONF ELTRODE LIMB","62264 - HC PRQ LYSIS EPIDURAL ADHESIONS MULT SESSIONS 1 DAY"]
[null,"65286 - RPR LAC APPL TISSUE GLUE WOUND CORNEA&/SCLERA",null,"61626 - HC TCAT PERMANT OCCLUSION/EMBOLIZATION PRQ NON-CNS","61626 - HC TCAT PERMANT OCCLUSION/EMBOLIZATION PRQ NON-CNS","61626 - HC TCAT PERMANT OCCLUSION/EMBOLIZATION PRQ NON-CNS",null,"59000 - AMNIOCENTESIS DIAGNOSIC",null,null,null,null,"62270 - SPINAL PUNCTURE LUMBAR DIAGNOSTIC",null,"59000 - AMNIOCENTESIS DIAGNOSIC",null,null,"95911 - MOTOR &/SENS 9-10 NRV CNDJ PRECONF ELTRODE LIMB","62268 - HC PERCUTANEOUS ASPIRATION SPINAL CORD CYST/SYRINX"]
[null,"65400 - EXCISION LESION CORNEA XCP PTERYGIUM",null,"61640 - HC PERC BAL DIL CRAN VASO;IN","61640 - HC PERC BAL DIL CRAN VASO;IN","61640 - HC PERC BAL DIL CRAN VASO;IN",null,"59015 - CHORIONIC VILLUS SAMPLING",null,null,null,null,"62272 - HC SPINAL PUNCTURE THER DRAIN CEREBROSPINAL FLUID",null,"59015 - CHORIONIC VILLUS SAMPLING",null,null,"95912 - MOTOR &/SENS 11-12 NRV CNDJ PRECONF ELTRODE LIMB","62269 - HC BIO,SPINAL CORD,PERC NEED"]
[null,"65420 - HC REMOVAL OF EYE LESION",null,"61641 - HC BALLOON DIALT INTRACRAN VASOSPASM, ADD SAME FAM","61641 - HC BALLOON DIALT INTRACRAN VASOSPASM, ADD SAME FAM","61641 - HC BALLOON DIALT INTRACRAN VASOSPASM, ADD SAME FAM",null,"59020 - FETAL CONTRACTION STRESS TEST",null,null,null,null,"62273 - HC INJECTION EPIDURAL BLOOD/CLOT PATCH",null,"59020 - FETAL CONTRACTION STRESS TEST",null,null,"95913 - MOTOR &/SENS 13/> NRV CNDJ PRECONF ELTRODE LIMB","62270 - SPINAL PUNCTURE LUMBAR DIAGNOSTIC"]
[null,"65426 - EXCISION/TRANSPOSITION PTERYGIUM W/GRAFG",null,"61642 - HC BAL DIL VASO;EA ADD,OTH","61642 - HC BAL DIL VASO;EA ADD,OTH","61642 - HC BAL DIL VASO;EA ADD,OTH",null,"59025 - FETAL NONSTRESS TEST",null,null,null,null,"62284 - HC INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR",null,"59025 - FETAL NONSTRESS TEST",null,null,"96360 - IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR","62272 - HC SPINAL PUNCTURE THER DRAIN CEREBROSPINAL FLUID"]
[null,"65435 - RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION",null,"61645 - HC PERQ ARTERIAL TRANSLUMINAL M-THROMBECTOMY & OR INFUSION","61645 - HC PERQ ARTERIAL TRANSLUMINAL M-THROMBECTOMY & OR INFUSION","61645 - HC PERQ ARTERIAL TRANSLUMINAL M-THROMBECTOMY & OR INFUSION",null,"59160 - CURETTAGE POSTPARTUM",null,null,null,null,"62302 - MYELOGRAPHY VIA LUMBAR INJECTION RS&I CERVICAL",null,"59160 - CURETTAGE POSTPARTUM",null,null,"96365 - IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR","62273 - HC INJECTION EPIDURAL BLOOD/CLOT PATCH"]
[null,"65436 - RMVL CORNEAL EPITHELIUM W/APPL CHELATING AGENT",null,"61650 - ENDOVASCULAR INTRACRANIAL PROLNG ADMN RX AGENT; INITIAL VASCULAR TERRITORY","61650 - ENDOVASCULAR INTRACRANIAL PROLNG ADMN RX AGENT; INITIAL VASCULAR TERRITORY","61650 - ENDOVASCULAR INTRACRANIAL PROLNG ADMN RX AGENT; INITIAL VASCULAR TERRITORY",null,"59200 - INSERTION CERVICAL DILATOR SEPARATE PROCEDURE",null,null,null,null,"62304 - MYELOGRAPHY VIA LUMBAR INJECT RS&I LUMBOSACRAL",null,"59200 - INSERTION CERVICAL DILATOR SEPARATE PROCEDURE",null,null,"96372 - THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM","62284 - HC INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR"]
[null,"65730 - HC KERATOPLASTY PENTRG EXCEPT APHAKIA/PSEUDOPHAKIA",null,"61651 - ENDOVASCULAR INTRACRANIAL PROLNG ADMN RX AGENT; EACH ADD¿L VASCULAR TERRITORY","61651 - ENDOVASCULAR INTRACRANIAL PROLNG ADMN RX AGENT; EACH ADD¿L VASCULAR TERRITORY","61651 - ENDOVASCULAR INTRACRANIAL PROLNG ADMN RX AGENT; EACH ADD¿L VASCULAR TERRITORY",null,"59300 - HC EPISIOTOMY/VAG RPR OTH/THN ATTENDING",null,null,null,null,"62305 - MYELOGRAPHY VIA LUMBAR INJECTION RS&I 2+ REGIONS",null,"59300 - HC EPISIOTOMY/VAG RPR OTH/THN ATTENDING",null,null,"96374 - THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG","62302 - MYELOGRAPHY VIA LUMBAR INJECTION RS&I CERVICAL"]
[null,"65750 - HC KERATOPLASTY PENETRAING APHAKIA",null,"61885 - HC IMP STIM,CRANIAL,SUBQ,1 ARRAY","61885 - HC IMP STIM,CRANIAL,SUBQ,1 ARRAY","61885 - HC IMP STIM,CRANIAL,SUBQ,1 ARRAY",null,"59320 - CERCLAGE CERVIX PREGNANCY VAGINAL",null,null,null,null,"62320 - HC NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN",null,"59320 - CERCLAGE CERVIX PREGNANCY VAGINAL",null,null,"97010 - HC APPLICATION MODALITY 1/> AREAS HOT/COLD PACKS","62304 - MYELOGRAPHY VIA LUMBAR INJECT RS&I LUMBOSACRAL"]
[null,"65755 - HC KERATOPLASTY PENETRATING PSEUDOPHAKIA",null,"62252 - HC REPRGRMG PROGRAMMABLE CEREBROSPINAL SHUNT","62252 - HC REPRGRMG PROGRAMMABLE CEREBROSPINAL SHUNT","62252 - HC REPRGRMG PROGRAMMABLE CEREBROSPINAL SHUNT",null,"59409 - HC VAGINAL DELIVERY ONLY",null,null,null,null,"62321 - HR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN",null,"59409 - HC VAGINAL DELIVERY ONLY",null,null,"97012 - HC APPL MODALITY 1/> AREAS TRACTION MECHANICAL","62305 - MYELOGRAPHY VIA LUMBAR INJECTION RS&I 2+ REGIONS"]
[null,"65756 - HC CORNEAL TRNSPL ENDOTHELIAL",null,"62264 - HC PRQ LYSIS EPIDURAL ADHESIONS MULT SESSIONS 1 DAY","62264 - HC PRQ LYSIS EPIDURAL ADHESIONS MULT SESSIONS 1 DAY","62264 - HC PRQ LYSIS EPIDURAL ADHESIONS MULT SESSIONS 1 DAY",null,"59412 - EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS",null,null,null,null,"62322 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",null,"59412 - EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS",null,null,"97014 - HC APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED","62320 - HC NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN"]
[null,"65770 - HC REVISE CORNEA WITH IMPLANT",null,"62268 - HC PERCUTANEOUS ASPIRATION SPINAL CORD CYST/SYRINX","62268 - HC PERCUTANEOUS ASPIRATION SPINAL CORD CYST/SYRINX","62268 - HC PERCUTANEOUS ASPIRATION SPINAL CORD CYST/SYRINX",null,"59414 - HC DELIVER PLACENTA",null,null,null,null,"62323 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",null,"59414 - HC DELIVER PLACENTA",null,null,"97018 - HC APPL MODALITY 1/> AREAS PARAFFIN BATH","62321 - HR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN"]
[null,"65778 - PLACE AMNIOTIC MEMB OCULAR SURFACE SELF RETAIN",null,"62269 - HC BIO,SPINAL CORD,PERC NEED","62269 - HC BIO,SPINAL CORD,PERC NEED","62269 - HC BIO,SPINAL CORD,PERC NEED",null,"59812 - TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL",null,null,null,null,"62324 - HC NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN.",null,"59812 - TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL",null,null,"97022 - HC APPLICATION MODALITY 1/> AREAS WHIRLPOOL","62322 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
[null,"65779 - HC PLACE AMNIOTIC MEMBRANE OCULAR SURFACE WOUND HEALING, SUTURED",null,"62270 - SPINAL PUNCTURE LUMBAR DIAGNOSTIC","62270 - SPINAL PUNCTURE LUMBAR DIAGNOSTIC","62270 - SPINAL PUNCTURE LUMBAR DIAGNOSTIC",null,"59820 - TX MISSED ABORTION FIRST TRIMESTER SURGICAL",null,null,null,null,"62326 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",null,"59820 - TX MISSED ABORTION FIRST TRIMESTER SURGICAL",null,null,"97032 - HC APPL MODALITY 1/> AREAS ELEC STIMJ EA 15 MIN","62323 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
[null,"65780 - HC OCULAR RECONST TRANSPLANT",null,"62272 - HC SPINAL PUNCTURE THER DRAIN CEREBROSPINAL FLUID","62272 - HC SPINAL PUNCTURE THER DRAIN CEREBROSPINAL FLUID","62272 - HC SPINAL PUNCTURE THER DRAIN CEREBROSPINAL FLUID",null,"59821 - TX MISSED ABORTION SECOND TRIMESTER SURGICAL",null,null,null,null,"62327 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",null,"59821 - TX MISSED ABORTION SECOND TRIMESTER SURGICAL",null,null,"97033 - APPL MODALITY 1/> AREAS IONTOPHORESIS EA 15 MIN","62324 - HC NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN."]
[null,"65782 - HC OCCULAR SURFACE RECONSTRUCTION LIMBAL AUTOGRAFT",null,"62273 - HC INJECTION EPIDURAL BLOOD/CLOT PATCH","62273 - HC INJECTION EPIDURAL BLOOD/CLOT PATCH","62273 - HC INJECTION EPIDURAL BLOOD/CLOT PATCH",null,"59840 - INDUCED ABORTION DILATION AND CURETTAGE",null,null,null,null,"62328 - HC DX LMBR SPI PNXR W/FLUOR/CT",null,"59840 - INDUCED ABORTION DILATION AND CURETTAGE",null,null,"97035 - HC APPL MODALITY 1/> AREAS ULTRASOUND EA 15 MIN","62326 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
[null,"65800 - PARACENTSIS ANT CHAMB EYE ASPIR AQUEOUS SPX",null,"62284 - HC INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR","62284 - HC INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR","62284 - HC INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR",null,"59841 - INDUCED ABORTION DILATION & EVAUCATION",null,null,null,null,"62329 - HC THER SPI PNXR CSF FLUOR/CT",null,"59841 - INDUCED ABORTION DILATION & EVAUCATION",null,null,"97110 - THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES","62327 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
[null,"65815 - HC DRAINAGE OF EYE",null,"62302 - MYELOGRAPHY VIA LUMBAR INJECTION RS&I CERVICAL","62302 - MYELOGRAPHY VIA LUMBAR INJECTION RS&I CERVICAL","62302 - MYELOGRAPHY VIA LUMBAR INJECTION RS&I CERVICAL",null,"59870 - UTERINE EVACUATION & CURETTAGE HYDATIDIFORM MOLE",null,null,null,null,"62365 - HC REMOVE INFUSN DEVICE/PUMP",null,"59870 - UTERINE EVACUATION & CURETTAGE HYDATIDIFORM MOLE",null,null,"97112 - HC THER PX 1/> AREAS EACH 15 MIN NEUROMUSC REEDUCA","62328 - HC DX LMBR SPI PNXR W/FLUOR/CT"]
[null,"65820 - HC RELIEVE INNER EYE PRESSURE",null,"62304 - MYELOGRAPHY VIA LUMBAR INJECT RS&I LUMBOSACRAL","62304 - MYELOGRAPHY VIA LUMBAR INJECT RS&I LUMBOSACRAL","62304 - MYELOGRAPHY VIA LUMBAR INJECT RS&I LUMBOSACRAL",null,"59871 - REMOVAL CERCLAGE SUTURE UNDER ANESTHESIA",null,null,null,null,"62367 - ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL",null,"59871 - REMOVAL CERCLAGE SUTURE UNDER ANESTHESIA",null,null,"97116 - HC THER PX 1/> AREAS EA 15 MIN GAIT TRAINJ W/STAIR","62329 - HC THER SPI PNXR CSF FLUOR/CT"]
[null,"65855 - TRABECULOPLASTY LASER SURG 1/> SESSIONS",null,"62305 - MYELOGRAPHY VIA LUMBAR INJECTION RS&I 2+ REGIONS","62305 - MYELOGRAPHY VIA LUMBAR INJECTION RS&I 2+ REGIONS","62305 - MYELOGRAPHY VIA LUMBAR INJECTION RS&I 2+ REGIONS",null,"59897 - HC FETAL INVAS PX W/ US",null,null,null,null,"62368 - ELECT ANALYS IMPLT ITHCL/EDRL PUMP W/REPRGRMG",null,"59897 - HC FETAL INVAS PX W/ US",null,null,"97124 - HC THER PX 1 AREAS EA 15 MIN MASSAGE","62365 - HC REMOVE INFUSN DEVICE/PUMP"]
[null,"65860 - SEVERING ADHESIONS ANTERIOR SEGMENT LASER SPX",null,"62320 - HC NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN","62320 - HC NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN","62320 - HC NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN",null,"60100 - BIOPSY THYROID PERCUTANEOUS CORE NEEDLE",null,null,null,null,"62369 - ELECT ANLYS IMPLT ITHCL/EDRL PMP W/REPRG&REFIL",null,"60100 - BIOPSY THYROID PERCUTANEOUS CORE NEEDLE",null,null,"97140 - HC MANUAL THER TECH,1+REGIONS,EA 15 MIN","62367 - ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL"]
[null,"65865 - HC INCISE INNER EYE ADHESIONS",null,"62321 - HR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN","62321 - HR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN","62321 - HR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN",null,"60220 - HC THYROID LOBECTOMY,UNILAT",null,null,null,null,"62370 - ELEC ANLYS IMPLT ITHCL/EDRL PMP W/REPR PHYS/QHP",null,"60220 - HC THYROID LOBECTOMY,UNILAT",null,null,"97150 - HC THERAPEUTIC PROCEDURES GROUP 2/> INDIVIDUALS","62368 - ELECT ANALYS IMPLT ITHCL/EDRL PUMP W/REPRGRMG"]
[null,"65870 - HC SEVERING ADS ANT SEG INCAL SPX ANT SYNECHIAE",null,"62322 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",null,"60300 - HB ASPIRATION AND/OR INJECTION THYROID CYST",null,null,null,null,"63650 - HC PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL",null,"60300 - HB ASPIRATION AND/OR INJECTION THYROID CYST",null,null,"97530 - THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN","62369 - ELECT ANLYS IMPLT ITHCL/EDRL PMP W/REPRG&REFIL"]
[null,"65875 - HC SEVERING ADS ANT SEG INCAL SPX POST SYNECHIAE",null,"62323 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",null,"60500 - HC EXPLORE PARATHYROID GLANDS",null,null,null,null,"63661 - HC RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR",null,"60500 - HC EXPLORE PARATHYROID GLANDS",null,null,"97532 - DEVELOPMENT OF COGNITIVE SKILLS EACH 15 MINUTES","62370 - ELEC ANLYS IMPLT ITHCL/EDRL PMP W/REPR PHYS/QHP"]
[null,"65920 - HC REMOVE IMPLANT OF EYE",null,"62324 - HC NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN.","62324 - HC NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN.","62324 - HC NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN.",null,"61050 - HC CISTERNAL/C1-2 PUNCTURE",null,null,null,null,"63662 - HC REMOVE SPINAL NEUROSTIM ELECTRODE PLATE/PADDLE, INCL FLUORO",null,"61050 - HC CISTERNAL/C1-2 PUNCTURE",null,null,"97533 - HC SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES","63650 - HC PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL"]
[null,"66020 - INJX ANTERIOR CHAMBER EYE AIR/LIQUID SPX",null,"62326 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62326 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62326 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",null,"61055 - HC CISTERNAL/LATERAL C1-C2 PUNCTURE W/INJECTION",null,null,null,null,"64400 - NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH",null,"61055 - HC CISTERNAL/LATERAL C1-C2 PUNCTURE W/INJECTION",null,null,"97535 - HC SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES","63661 - HC RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR"]
[null,"66030 - HC INJECTION TREATMENT OF EYE",null,"62327 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62327 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62327 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",null,"61070 - HC PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX",null,null,null,null,"64405 - INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV",null,"61070 - HC PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX",null,null,"97537 - HC COMMUNITY/WORK REINTEGRATION TRAINJ EA 15 MIN","63662 - HC REMOVE SPINAL NEUROSTIM ELECTRODE PLATE/PADDLE, INCL FLUORO"]
[null,"66170 - HC GLAUCOMA SURGERY",null,"62328 - HC DX LMBR SPI PNXR W/FLUOR/CT","62328 - HC DX LMBR SPI PNXR W/FLUOR/CT","62328 - HC DX LMBR SPI PNXR W/FLUOR/CT",null,"61623 - HC EVASC TEMP BALLOON ARTL OCCLUSION HEAD/NECK",null,null,null,null,"64408 - HC INJ,ANES;VAGUS NER",null,"61623 - HC EVASC TEMP BALLOON ARTL OCCLUSION HEAD/NECK",null,null,"97542 - HC WHEELCHAIR MGMT EA 15 MIN","64400 - NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH"]
[null,"66172 - HC INCISION OF EYE",null,"62329 - HC THER SPI PNXR CSF FLUOR/CT","62329 - HC THER SPI PNXR CSF FLUOR/CT","62329 - HC THER SPI PNXR CSF FLUOR/CT",null,"61624 - HC TCAT PERMANENT OCCLUSION/EMBOLIZATION PRQ CNS",null,null,null,null,"64415 - SINGLE NERVE BLOCK INJECTION ARM NERVE",null,"61624 - HC TCAT PERMANENT OCCLUSION/EMBOLIZATION PRQ CNS",null,null,"97597 - DEBRIDEMENT OPEN WOUND 20 SQ CM/<","64405 - INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV"]
[null,"66179 - HC AQUEOUS SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT",null,"62365 - HC REMOVE INFUSN DEVICE/PUMP","62365 - HC REMOVE INFUSN DEVICE/PUMP","62365 - HC REMOVE INFUSN DEVICE/PUMP",null,"61626 - HC TCAT PERMANT OCCLUSION/EMBOLIZATION PRQ NON-CNS",null,null,null,null,"64416 - HC INJ,ANES;CONT INF B PLEX",null,"61626 - HC TCAT PERMANT OCCLUSION/EMBOLIZATION PRQ NON-CNS",null,null,"97598 - DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM","64408 - HC INJ,ANES;VAGUS NER"]
[null,"66180 - HC AQUEOUS SHUNT EYE W/GRAFT",null,"62367 - ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL","62367 - ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL","62367 - ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL",null,"61645 - HC PERQ ARTERIAL TRANSLUMINAL M-THROMBECTOMY & OR INFUSION",null,null,null,null,"64417 - INJECTION ANESTHETIC AGENT AXILLARY NERVE",null,"61645 - HC PERQ ARTERIAL TRANSLUMINAL M-THROMBECTOMY & OR INFUSION",null,null,"97750 - HC PHYSICAL PERFORMANCE TEST/MEAS W/REPRT EA 15 MIN","64415 - SINGLE NERVE BLOCK INJECTION ARM NERVE"]
[null,"66183 - HC INSERT ANT DRAINAGE DEVICE",null,"62368 - ELECT ANALYS IMPLT ITHCL/EDRL PUMP W/REPRGRMG","62368 - ELECT ANALYS IMPLT ITHCL/EDRL PUMP W/REPRGRMG","62368 - ELECT ANALYS IMPLT ITHCL/EDRL PUMP W/REPRGRMG",null,"61885 - HC IMP STIM,CRANIAL,SUBQ,1 ARRAY",null,null,null,null,"64418 - INJECTION ANESTHETIC AGENT SUPRASCAPULAR NERVE",null,"61885 - HC IMP STIM,CRANIAL,SUBQ,1 ARRAY",null,null,"97760 - ORTHOTIC MGMT&TRAINJ UXTR LXTR&/TRNK EA 15","64416 - HC INJ,ANES;CONT INF B PLEX"]
[null,"66185 - HC REVISE AQUEOUS SHUNT EYE",null,"62369 - ELECT ANLYS IMPLT ITHCL/EDRL PMP W/REPRG&REFIL","62369 - ELECT ANLYS IMPLT ITHCL/EDRL PMP W/REPRG&REFIL","62369 - ELECT ANLYS IMPLT ITHCL/EDRL PMP W/REPRG&REFIL",null,"62252 - HC REPRGRMG PROGRAMMABLE CEREBROSPINAL SHUNT",null,null,null,null,"64420 - INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE",null,"62252 - HC REPRGRMG PROGRAMMABLE CEREBROSPINAL SHUNT",null,null,"97761 - HC PROSTHETIC TRAINING UPPR&/LOWER EXTREM EA 15 M","64417 - INJECTION ANESTHETIC AGENT AXILLARY NERVE"]
[null,"66250 - HC FOLLOW-UP SURGERY OF EYE",null,"62370 - ELEC ANLYS IMPLT ITHCL/EDRL PMP W/REPR PHYS/QHP","62370 - ELEC ANLYS IMPLT ITHCL/EDRL PMP W/REPR PHYS/QHP","62370 - ELEC ANLYS IMPLT ITHCL/EDRL PMP W/REPR PHYS/QHP",null,"62264 - HC PRQ LYSIS EPIDURAL ADHESIONS MULT SESSIONS 1 DAY",null,null,null,null,"64421 - MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES",null,"62264 - HC PRQ LYSIS EPIDURAL ADHESIONS MULT SESSIONS 1 DAY",null,null,"97762 - CHECKOUT ORTH/PROSTH 15 MIN","64418 - INJECTION ANESTHETIC AGENT SUPRASCAPULAR NERVE"]
[null,"66600 - HC REMOVE IRIS AND LESION",null,"63650 - HC PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL","63650 - HC PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL","63650 - HC PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL",null,"62268 - HC PERCUTANEOUS ASPIRATION SPINAL CORD CYST/SYRINX",null,null,null,null,"64425 - INJECTION ANES ILIOINGUINAL ILIOHYPOGASTRIC NRVS",null,"62268 - HC PERCUTANEOUS ASPIRATION SPINAL CORD CYST/SYRINX",null,null,"99201 - OFFICE OUTPATIENT NEW 10 MINUTES","64420 - INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE"]
[null,"66625 - HC REMV IRIS PERIPH FOR GLAUCOMA",null,"63661 - HC RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR","63661 - HC RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR","63661 - HC RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR",null,"62269 - HC BIO,SPINAL CORD,PERC NEED",null,null,null,null,"64430 - HC INJ,ANES;PUDEND NER",null,"62269 - HC BIO,SPINAL CORD,PERC NEED",null,null,"99202 - OFFICE OUTPATIENT NEW 20 MINUTES","64421 - MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES"]
[null,"66682 - HC REPAIR IRIS & CILIARY BODY",null,"63662 - HC REMOVE SPINAL NEUROSTIM ELECTRODE PLATE/PADDLE, INCL FLUORO","63662 - HC REMOVE SPINAL NEUROSTIM ELECTRODE PLATE/PADDLE, INCL FLUORO","63662 - HC REMOVE SPINAL NEUROSTIM ELECTRODE PLATE/PADDLE, INCL FLUORO",null,"62270 - SPINAL PUNCTURE LUMBAR DIAGNOSTIC",null,null,null,null,"64435 - INJECTION ANESTHETIC PARACERVICAL UTERINE NERVE",null,"62270 - SPINAL PUNCTURE LUMBAR DIAGNOSTIC",null,null,"99203 - OFFICE OUTPATIENT NEW 30 MINUTES","64425 - INJECTION ANES ILIOINGUINAL ILIOHYPOGASTRIC NRVS"]
[null,"66710 - CILIARY BODY DSTRJ CYCLOPHOTOCOAG TRANSSCERAL",null,"64400 - NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH","64400 - NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH","64400 - NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH",null,"62272 - HC SPINAL PUNCTURE THER DRAIN CEREBROSPINAL FLUID",null,null,null,null,"64445 - INJECTION ANESTHETIC AGENT SCIATIC NRV SINGLE",null,"62272 - HC SPINAL PUNCTURE THER DRAIN CEREBROSPINAL FLUID",null,null,"99204 - OFFICE OUTPATIENT NEW 45 MINUTES","64430 - HC INJ,ANES;PUDEND NER"]
[null,"66711 - HC ECP CILIARY BODY DESTRUCTION",null,"64405 - INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV","64405 - INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV","64405 - INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV",null,"62273 - HC INJECTION EPIDURAL BLOOD/CLOT PATCH",null,null,null,null,"64447 - HC INJECTION ANESTHETIC AGENT FEMORAL NERVE SINGLE",null,"62273 - HC INJECTION EPIDURAL BLOOD/CLOT PATCH",null,null,"99205 - OFFICE OUTPATIENT NEW 60 MINUTES","64435 - INJECTION ANESTHETIC PARACERVICAL UTERINE NERVE"]
[null,"66761 - IRIDOTOMY/IRRIDECTOMY LASER SURG PER SESSION",null,"64408 - HC INJ,ANES;VAGUS NER","64408 - HC INJ,ANES;VAGUS NER","64408 - HC INJ,ANES;VAGUS NER",null,"62284 - HC INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR",null,null,null,null,"64450 - INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH",null,"62284 - HC INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR",null,null,"99211 - ESTABLISHED PATIENT - PHARM - LEVEL 1","64445 - INJECTION ANESTHETIC AGENT SCIATIC NRV SINGLE"]
[null,"66762 - IRIDOPLASTY PHOTOCOAGULATION 1/> SESSIONS",null,"64415 - SINGLE NERVE BLOCK INJECTION ARM NERVE","64415 - SINGLE NERVE BLOCK INJECTION ARM NERVE","64415 - SINGLE NERVE BLOCK INJECTION ARM NERVE",null,"62302 - MYELOGRAPHY VIA LUMBAR INJECTION RS&I CERVICAL",null,null,null,null,"64451 - HC NJX AA&/STRD NRV NRVTG SI JT",null,"62302 - MYELOGRAPHY VIA LUMBAR INJECTION RS&I CERVICAL",null,null,"99212 - ESTABLISHED PATIENT - PHARM - LEVEL 2","64447 - HC INJECTION ANESTHETIC AGENT FEMORAL NERVE SINGLE"]
[null,"66821 - POST-CATARACT LASER SURGERY",null,"64416 - HC INJ,ANES;CONT INF B PLEX","64416 - HC INJ,ANES;CONT INF B PLEX","64416 - HC INJ,ANES;CONT INF B PLEX",null,"62304 - MYELOGRAPHY VIA LUMBAR INJECT RS&I LUMBOSACRAL",null,null,null,null,"64454 - HC NJX AA&/STRD GNCLR NRV BRNCH",null,"62304 - MYELOGRAPHY VIA LUMBAR INJECT RS&I LUMBOSACRAL",null,null,"99213 - ESTABLISHED PATIENT - PHARM - LEVEL 3","64450 - INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH"]
[null,"66825 - HC REPOSITION INTRAOCULAR LENS",null,"64417 - INJECTION ANESTHETIC AGENT AXILLARY NERVE","64417 - INJECTION ANESTHETIC AGENT AXILLARY NERVE","64417 - INJECTION ANESTHETIC AGENT AXILLARY NERVE",null,"62305 - MYELOGRAPHY VIA LUMBAR INJECTION RS&I 2+ REGIONS",null,null,null,null,"64455 - NJX ANES&/STEROID PLANTAR COMMON DIGITAL NERVE",null,"62305 - MYELOGRAPHY VIA LUMBAR INJECTION RS&I 2+ REGIONS",null,null,"99214 - ESTABLISHED PATIENT - PHARM - LEVEL 4","64451 - HC NJX AA&/STRD NRV NRVTG SI JT"]
[null,"66840 - HC RMVL LENS MATERIAL ASPIR TQ 1/> STAGES",null,"64418 - INJECTION ANESTHETIC AGENT SUPRASCAPULAR NERVE","64418 - INJECTION ANESTHETIC AGENT SUPRASCAPULAR NERVE","64418 - INJECTION ANESTHETIC AGENT SUPRASCAPULAR NERVE",null,"62320 - HC NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN",null,null,null,null,"64461 - HC PVB,THORACIC;SINGLE INJECTION SITE INCLUDING IMAGING GUIDANCE WHEN PERFORMED",null,"62320 - HC NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN",null,null,"99215 - ESTABLISHED PATIENT - PHARM - LEVEL 5","64454 - HC NJX AA&/STRD GNCLR NRV BRNCH"]
[null,"66850 - HC RMVL LENS MATERIAL PHACOFRAGMENTATION ASPIR",null,"64420 - INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE","64420 - INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE","64420 - INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE",null,"62321 - HR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN",null,null,null,null,"64462 - HC PVB,THORAC;2ND & ANY ADD¿L INJECT SITE(S) INCLUD IMAGE GUIDE WHEN PERFORMED",null,"62321 - HR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN",null,null,"99218 - HC INITIAL OBSERVATION CARE/DAY 30 MINUTES","64455 - NJX ANES&/STEROID PLANTAR COMMON DIGITAL NERVE"]
[null,"66852 - HC RMVL LENS MATERIAL PARS PLANA W/WO VITRECTOMY",null,"64421 - MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES","64421 - MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES","64421 - MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES",null,"62322 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",null,null,null,null,"64479 - HC INJECT ANES/STEROID FORAMEN CERV/THORACIC W IMG GUIDE ,1 LEVEL",null,"62322 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",null,null,"99281 - HC ED VAWA W/MSAECK","64461 - HC PVB,THORACIC;SINGLE INJECTION SITE INCLUDING IMAGING GUIDANCE WHEN PERFORMED"]
[null,"66940 - HC EXTRACTION OF LENS",null,"64425 - INJECTION ANES ILIOINGUINAL ILIOHYPOGASTRIC NRVS","64425 - INJECTION ANES ILIOINGUINAL ILIOHYPOGASTRIC NRVS","64425 - INJECTION ANES ILIOINGUINAL ILIOHYPOGASTRIC NRVS",null,"62323 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",null,null,null,null,"64483 - NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL",null,"62323 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",null,null,"99282 - HC EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY","64462 - HC PVB,THORAC;2ND & ANY ADD¿L INJECT SITE(S) INCLUD IMAGE GUIDE WHEN PERFORMED"]
[null,"66982 - REMV CATARACT EXTRACAP,INSERT LENS,COMP",null,"64430 - HC INJ,ANES;PUDEND NER","64430 - HC INJ,ANES;PUDEND NER","64430 - HC INJ,ANES;PUDEND NER",null,"62324 - HC NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN.",null,null,null,null,"64484 - NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC EA LV",null,"62324 - HC NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN.",null,null,"99283 - HC EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY","64479 - HC INJECT ANES/STEROID FORAMEN CERV/THORACIC W IMG GUIDE ,1 LEVEL"]
[null,"66984 - REMV CATARACT EXTRACAP,INSERT LENS",null,"64435 - INJECTION ANESTHETIC PARACERVICAL UTERINE NERVE","64435 - INJECTION ANESTHETIC PARACERVICAL UTERINE NERVE","64435 - INJECTION ANESTHETIC PARACERVICAL UTERINE NERVE",null,"62326 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",null,null,null,null,"64486 - TAP BLOCK UNILATERAL BY INJECTION(S)",null,"62326 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",null,null,"99284 - HC EMERGENCY DEPARTMENT VISIT HIGH/URGENT SEVERITY","64483 - NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL"]
[null,"66985 - INSERT LENS PROSTHESIS ONLY",null,"64445 - INJECTION ANESTHETIC AGENT SCIATIC NRV SINGLE","64445 - INJECTION ANESTHETIC AGENT SCIATIC NRV SINGLE","64445 - INJECTION ANESTHETIC AGENT SCIATIC NRV SINGLE",null,"62327 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",null,null,null,null,"64488 - HC TAP BLOCK BILATERAL BY INJECTION(S)",null,"62327 - HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",null,null,"99285 - HC EMERGENCY DEPT VISIT HIGH SEVERITY&THREAT FUNCJ","64484 - NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC EA LV"]
[null,"66986 - HC EXCHANGE LENS PROSTHESIS",null,"64447 - HC INJECTION ANESTHETIC AGENT FEMORAL NERVE SINGLE","64447 - HC INJECTION ANESTHETIC AGENT FEMORAL NERVE SINGLE","64447 - HC INJECTION ANESTHETIC AGENT FEMORAL NERVE SINGLE",null,"62328 - HC DX LMBR SPI PNXR W/FLUOR/CT",null,null,null,null,"64490 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL",null,"62328 - HC DX LMBR SPI PNXR W/FLUOR/CT",null,null,"99381 - INITIAL PREVENTIVE MEDICINE NEW PATIENT <1YEAR","64486 - TAP BLOCK UNILATERAL BY INJECTION(S)"]
[null,"67005 - HC RMVL VITREOUS ANT APPR PARTIAL REMOVAL",null,"64450 - INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH","64450 - INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH","64450 - INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH",null,"62329 - HC THER SPI PNXR CSF FLUOR/CT",null,null,null,null,"64491 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL",null,"62329 - HC THER SPI PNXR CSF FLUOR/CT",null,null,"99382 - INITIAL PREVENTIVE MEDICINE NEW PT AGE 1-4 YRS","64488 - HC TAP BLOCK BILATERAL BY INJECTION(S)"]
[null,"67010 - HC RMVL VITREOUS ANT APPR SUBTOT RMVL MECH VITRECT",null,"64451 - HC NJX AA&/STRD NRV NRVTG SI JT","64451 - HC NJX AA&/STRD NRV NRVTG SI JT","64451 - HC NJX AA&/STRD NRV NRVTG SI JT",null,"62365 - HC REMOVE INFUSN DEVICE/PUMP",null,null,null,null,"64492 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL",null,"62365 - HC REMOVE INFUSN DEVICE/PUMP",null,null,"99383 - INITIAL PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS","64490 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL"]
[null,"67015 - ASPIRATION/RELEASE VITREOUS SUBRETINAL/CHOROIDAL",null,"64454 - HC NJX AA&/STRD GNCLR NRV BRNCH","64454 - HC NJX AA&/STRD GNCLR NRV BRNCH","64454 - HC NJX AA&/STRD GNCLR NRV BRNCH",null,"62367 - ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL",null,null,null,null,"64493 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL",null,"62367 - ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL",null,null,"99384 - INITIAL PREVENTIVE MEDICINE NEW PT AGE 12-17 YR","64491 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL"]
[null,"67028 - INTRAVITREAL NJX PHARMACOLOGIC AGT SPX",null,"64455 - NJX ANES&/STEROID PLANTAR COMMON DIGITAL NERVE","64455 - NJX ANES&/STEROID PLANTAR COMMON DIGITAL NERVE","64455 - NJX ANES&/STEROID PLANTAR COMMON DIGITAL NERVE",null,"62368 - ELECT ANALYS IMPLT ITHCL/EDRL PUMP W/REPRGRMG",null,null,null,null,"64494 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL",null,"62368 - ELECT ANALYS IMPLT ITHCL/EDRL PUMP W/REPRGRMG",null,null,"99385 - INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS","64492 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL"]
[null,"67031 - SEVERING VITREOUS STRANS LASER 1/> STAGES",null,"64461 - HC PVB,THORACIC;SINGLE INJECTION SITE INCLUDING IMAGING GUIDANCE WHEN PERFORMED","64461 - HC PVB,THORACIC;SINGLE INJECTION SITE INCLUDING IMAGING GUIDANCE WHEN PERFORMED","64461 - HC PVB,THORACIC;SINGLE INJECTION SITE INCLUDING IMAGING GUIDANCE WHEN PERFORMED",null,"62369 - ELECT ANLYS IMPLT ITHCL/EDRL PMP W/REPRG&REFIL",null,null,null,null,"64495 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL",null,"62369 - ELECT ANLYS IMPLT ITHCL/EDRL PMP W/REPRG&REFIL",null,null,"99386 - INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS","64493 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL"]
[null,"67036 - HC VITRECTOMY,MECHANICAL",null,"64462 - HC PVB,THORAC;2ND & ANY ADD¿L INJECT SITE(S) INCLUD IMAGE GUIDE WHEN PERFORMED","64462 - HC PVB,THORAC;2ND & ANY ADD¿L INJECT SITE(S) INCLUD IMAGE GUIDE WHEN PERFORMED","64462 - HC PVB,THORAC;2ND & ANY ADD¿L INJECT SITE(S) INCLUD IMAGE GUIDE WHEN PERFORMED",null,"62370 - ELEC ANLYS IMPLT ITHCL/EDRL PMP W/REPR PHYS/QHP",null,null,null,null,"64505 - INJECTION ANES AGENT SPHENOPALATINE GANGLION",null,"62370 - ELEC ANLYS IMPLT ITHCL/EDRL PMP W/REPR PHYS/QHP",null,null,"99387 - INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&>","64494 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL"]
[null,"67039 - HC VITRECTOMY,FOCAL LASER RX RETINA",null,"64479 - HC INJECT ANES/STEROID FORAMEN CERV/THORACIC W IMG GUIDE ,1 LEVEL","64479 - HC INJECT ANES/STEROID FORAMEN CERV/THORACIC W IMG GUIDE ,1 LEVEL","64479 - HC INJECT ANES/STEROID FORAMEN CERV/THORACIC W IMG GUIDE ,1 LEVEL",null,"63650 - HC PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL",null,null,null,null,"64510 - NJX ANES STELLATE GANGLION CRV SYMPATHETIC",null,"63650 - HC PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL",null,null,"99391 - PERIODIC PREVENTIVE MED ESTABLISHED PATIENT <1Y","64495 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL"]
[null,"67040 - HC LASER TREATMENT OF RETINA",null,"64483 - NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL","64483 - NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL","64483 - NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL",null,"63661 - HC RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR",null,null,null,null,"64520 - INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC",null,"63661 - HC RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR",null,null,"99392 - PERIODIC PREVENTIVE MED EST PATIENT 1-4YRS","64505 - INJECTION ANES AGENT SPHENOPALATINE GANGLION"]
[null,"67041 - HC VIT FOR MACULAR PUCKER",null,"64484 - NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC EA LV","64484 - NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC EA LV","64484 - NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC EA LV",null,"63662 - HC REMOVE SPINAL NEUROSTIM ELECTRODE PLATE/PADDLE, INCL FLUORO",null,null,null,null,"64530 - INJX ANES CELIAC PLEXUS W/WO RADIOLOGIC MONITRNG",null,"63662 - HC REMOVE SPINAL NEUROSTIM ELECTRODE PLATE/PADDLE, INCL FLUORO",null,null,"99393 - PERIODIC PREVENTIVE MED EST PATIENT 5-11YRS","64510 - NJX ANES STELLATE GANGLION CRV SYMPATHETIC"]
[null,"67042 - HC VIT FOR MACULAR HOLE",null,"64486 - TAP BLOCK UNILATERAL BY INJECTION(S)","64486 - TAP BLOCK UNILATERAL BY INJECTION(S)","64486 - TAP BLOCK UNILATERAL BY INJECTION(S)",null,"64400 - NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH",null,null,null,null,"64561 - IMPLANT NEUROELECTRODES",null,"64400 - NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH",null,null,"99394 - PERIODIC PREVENTIVE MED EST PATIENT 12-17YRS","64520 - INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC"]
[null,"67101 - HC RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID CRTX",null,"64488 - HC TAP BLOCK BILATERAL BY INJECTION(S)","64488 - HC TAP BLOCK BILATERAL BY INJECTION(S)","64488 - HC TAP BLOCK BILATERAL BY INJECTION(S)",null,"64402 - INJECTION ANESTHETIC AGENT FACIAL NERVE",null,null,null,null,"64569 - HC REVISE/REPLACE CRANIAL NERVE STIM ELECTRODE/CONNECT PULSE GEN",null,"64402 - INJECTION ANESTHETIC AGENT FACIAL NERVE",null,null,"99395 - PERIODIC PREVENTIVE MED EST PATIENT 18-39 YRS","64530 - INJX ANES CELIAC PLEXUS W/WO RADIOLOGIC MONITRNG"]
[null,"67105 - RPR RETINAL DTCHMNT 1/> SES PC W/WO DRG SUBRETI",null,"64490 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL","64490 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL","64490 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL",null,"64405 - INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV",null,null,null,null,"64585 - REVISE/REMOVE NEUROELECTRODE",null,"64405 - INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV",null,null,"99396 - PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS","64561 - IMPLANT NEUROELECTRODES"]
[null,"67107 - HC REPAIR RETINAL DETACHMENT SCLERAL BUCKLING",null,"64491 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL","64491 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL","64491 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL",null,"64408 - HC INJ,ANES;VAGUS NER",null,null,null,null,"64600 - INJECTION TREATMENT OF NERVE",null,"64408 - HC INJ,ANES;VAGUS NER",null,null,"99397 - PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER","64569 - HC REVISE/REPLACE CRANIAL NERVE STIM ELECTRODE/CONNECT PULSE GEN"]
[null,"67108 - HC RPR RETINAL DTCHMNT W/VITRECTOMY ANY METH",null,"64492 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL","64492 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL","64492 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL",null,"64410 - PHRENIC NERVE BLOCK",null,null,null,null,"64611 - CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS",null,"64410 - PHRENIC NERVE BLOCK",null,null,"99401 - PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 15 M","64585 - REVISE/REMOVE NEUROELECTRODE"]
[null,"67113 - HC REPAIR COMPLEX RETINA DETACH VITRECTOMY & MEMB PEEL",null,"64493 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL","64493 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL","64493 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL",null,"64413 - INJECTION ANESTHETIC AGENT CERVICAL PLEXUS",null,null,null,null,"64612 - CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL",null,"64413 - INJECTION ANESTHETIC AGENT CERVICAL PLEXUS",null,null,"99402 - PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 30 M","64600 - INJECTION TREATMENT OF NERVE"]
[null,"67120 - HC REMV POST EYE IMPLNT MATER,EXTRAOCUL",null,"64494 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL","64494 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL","64494 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL",null,"64415 - SINGLE NERVE BLOCK INJECTION ARM NERVE",null,null,null,null,"64615 - CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE",null,"64415 - SINGLE NERVE BLOCK INJECTION ARM NERVE",null,null,"99403 - HC PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 45 MIN","64611 - CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS"]
[null,"67121 - HC REMOVE EYE IMPLANT MATERIAL",null,"64495 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL","64495 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL","64495 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL",null,"64416 - HC INJ,ANES;CONT INF B PLEX",null,null,null,null,"64616 - CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA",null,"64416 - HC INJ,ANES;CONT INF B PLEX",null,null,"99404 - HC PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 60 MIN","64612 - CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL"]
[null,"67141 - HC PROPH RTA DTCHMNT CRTX DTHRM",null,"64505 - INJECTION ANES AGENT SPHENOPALATINE GANGLION","64505 - INJECTION ANES AGENT SPHENOPALATINE GANGLION","64505 - INJECTION ANES AGENT SPHENOPALATINE GANGLION",null,"64417 - INJECTION ANESTHETIC AGENT AXILLARY NERVE",null,null,null,null,"64617 - CHEMODENERVATION MUSCLE LARYNX UNILAT W/EMG",null,"64417 - INJECTION ANESTHETIC AGENT AXILLARY NERVE",null,null,"99411 - PREV MED COUNSEL & RISK FACTOR REDJ GRP SPX 30 M","64615 - CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE"]
[null,"67145 - PROPH RTA DTCHMNT W/O DRG 1/> SESS",null,"64510 - NJX ANES STELLATE GANGLION CRV SYMPATHETIC","64510 - NJX ANES STELLATE GANGLION CRV SYMPATHETIC","64510 - NJX ANES STELLATE GANGLION CRV SYMPATHETIC",null,"64418 - INJECTION ANESTHETIC AGENT SUPRASCAPULAR NERVE",null,null,null,null,"64620 - HC DEST,INTERCOSTAL,NEUROLYTIC",null,"64418 - INJECTION ANESTHETIC AGENT SUPRASCAPULAR NERVE",null,null,"99412 - PREV MED COUNSEL & RISK FACTOR REDJ GRP SPX 60 M","64616 - CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA"]
[null,"67210 - DSTRJ LOCLZD LES RETINA 1/> SESS PC",null,"64520 - INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC","64520 - INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC","64520 - INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC",null,"64420 - INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE",null,null,null,null,"64624 - HC DSTRJ NULYT AGT GNCLR NRV",null,"64420 - INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE",null,null,"0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","64617 - CHEMODENERVATION MUSCLE LARYNX UNILAT W/EMG"]
[null,"67220 - DSTRJ LES CHOROID PC 1/> SESS",null,"64530 - INJX ANES CELIAC PLEXUS W/WO RADIOLOGIC MONITRNG","64530 - INJX ANES CELIAC PLEXUS W/WO RADIOLOGIC MONITRNG","64530 - INJX ANES CELIAC PLEXUS W/WO RADIOLOGIC MONITRNG",null,"64421 - MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES",null,null,null,null,"64625 - HC RF ABLTJ NRV NRVTG SI JT",null,"64421 - MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES",null,null,"0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","64620 - HC DEST,INTERCOSTAL,NEUROLYTIC"]
[null,"67221 - DSTRJ LESION CHOROID PHOTODYNAMIC THERAPY",null,"64561 - IMPLANT NEUROELECTRODES","64561 - IMPLANT NEUROELECTRODES","64561 - IMPLANT NEUROELECTRODES",null,"64425 - INJECTION ANES ILIOINGUINAL ILIOHYPOGASTRIC NRVS",null,null,null,null,"64632 - DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE",null,"64425 - INJECTION ANES ILIOINGUINAL ILIOHYPOGASTRIC NRVS",null,null,"0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","64624 - HC DSTRJ NULYT AGT GNCLR NRV"]
[null,"67228 - EXTENSIVE RETINOPATHY 1/> SESS PHOTOCOAGULATION",null,"64569 - HC REVISE/REPLACE CRANIAL NERVE STIM ELECTRODE/CONNECT PULSE GEN","64569 - HC REVISE/REPLACE CRANIAL NERVE STIM ELECTRODE/CONNECT PULSE GEN","64569 - HC REVISE/REPLACE CRANIAL NERVE STIM ELECTRODE/CONNECT PULSE GEN",null,"64430 - HC INJ,ANES;PUDEND NER",null,null,null,null,"64633 - DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA",null,"64430 - HC INJ,ANES;PUDEND NER",null,null,"0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","64625 - HC RF ABLTJ NRV NRVTG SI JT"]
[null,"67311 - HC STRABISMUS RECESSION/RESCJ 1 HRZNTL MUSC",null,"64585 - REVISE/REMOVE NEUROELECTRODE","64585 - REVISE/REMOVE NEUROELECTRODE","64585 - REVISE/REMOVE NEUROELECTRODE",null,"64435 - INJECTION ANESTHETIC PARACERVICAL UTERINE NERVE",null,null,null,null,"64634 - HC DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA",null,"64435 - INJECTION ANESTHETIC PARACERVICAL UTERINE NERVE",null,null,null,"64632 - DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE"]
[null,"67312 - HC STRABISMUS RECESSION/RESCJ 2 HRZNTL MUSC",null,"64600 - INJECTION TREATMENT OF NERVE","64600 - INJECTION TREATMENT OF NERVE","64600 - INJECTION TREATMENT OF NERVE",null,"64445 - INJECTION ANESTHETIC AGENT SCIATIC NRV SINGLE",null,null,null,null,"64635 - DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL",null,"64445 - INJECTION ANESTHETIC AGENT SCIATIC NRV SINGLE",null,null,null,"64633 - DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA"]
[null,"67314 - HC STRABISMUS RECESSION/RESCJ 1 VER MUSC",null,"64611 - CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS","64611 - CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS","64611 - CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS",null,"64447 - HC INJECTION ANESTHETIC AGENT FEMORAL NERVE SINGLE",null,null,null,null,"64636 - DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL",null,"64447 - HC INJECTION ANESTHETIC AGENT FEMORAL NERVE SINGLE",null,null,null,"64634 - HC DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA"]
[null,"67316 - HC STRABISMUS RECESSION/RESCJ 2/MORE VER MUSC",null,"64612 - CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL","64612 - CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL","64612 - CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL",null,"64450 - INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH",null,null,null,null,"64640 - DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE",null,"64450 - INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH",null,null,null,"64635 - DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL"]
[null,"67318 - HC STRABISMUS ANY SUPERIOR OBLIQUE MUSCLE",null,"64615 - CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE","64615 - CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE","64615 - CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE",null,"64451 - HC NJX AA&/STRD NRV NRVTG SI JT",null,null,null,null,"64642 - CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE",null,"64451 - HC NJX AA&/STRD NRV NRVTG SI JT",null,null,null,"64636 - DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL"]
[null,"67320 - HC TRANSPOSITION PROCEDURE EXTRAOCULAR MUSC ADD-ON",null,"64616 - CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA","64616 - CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA","64616 - CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA",null,"64454 - HC NJX AA&/STRD GNCLR NRV BRNCH",null,null,null,null,"64643 - CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE",null,"64454 - HC NJX AA&/STRD GNCLR NRV BRNCH",null,null,null,"64640 - DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE"]
[null,"67332 - HC STRABISMUS SCARRING EO MUSC/RSTCV MYOPATHY ADD-ON",null,"64617 - CHEMODENERVATION MUSCLE LARYNX UNILAT W/EMG","64617 - CHEMODENERVATION MUSCLE LARYNX UNILAT W/EMG","64617 - CHEMODENERVATION MUSCLE LARYNX UNILAT W/EMG",null,"64455 - NJX ANES&/STEROID PLANTAR COMMON DIGITAL NERVE",null,null,null,null,"64644 - CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES",null,"64455 - NJX ANES&/STEROID PLANTAR COMMON DIGITAL NERVE",null,null,null,"64642 - CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE"]
[null,"67343 - HC RELEASE EYE TISSUE",null,"64620 - HC DEST,INTERCOSTAL,NEUROLYTIC","64620 - HC DEST,INTERCOSTAL,NEUROLYTIC","64620 - HC DEST,INTERCOSTAL,NEUROLYTIC",null,"64461 - HC PVB,THORACIC;SINGLE INJECTION SITE INCLUDING IMAGING GUIDANCE WHEN PERFORMED",null,null,null,null,"64645 - CHEMODENERVATION 1 EXTREMITY EA ADDL 5/> MUSCLES",null,"64461 - HC PVB,THORACIC;SINGLE INJECTION SITE INCLUDING IMAGING GUIDANCE WHEN PERFORMED",null,null,null,"64643 - CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE"]
[null,"67345 - HC DESTROY NERVE OF EYE MUSCLE",null,"64624 - HC DSTRJ NULYT AGT GNCLR NRV","64624 - HC DSTRJ NULYT AGT GNCLR NRV","64624 - HC DSTRJ NULYT AGT GNCLR NRV",null,"64462 - HC PVB,THORAC;2ND & ANY ADD¿L INJECT SITE(S) INCLUD IMAGE GUIDE WHEN PERFORMED",null,null,null,null,"64646 - CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES",null,"64462 - HC PVB,THORAC;2ND & ANY ADD¿L INJECT SITE(S) INCLUD IMAGE GUIDE WHEN PERFORMED",null,null,null,"64644 - CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES"]
[null,"67400 - HC EXPLORE/BIOPSY EYE SOCKET",null,"64632 - DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE","64632 - DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE","64632 - DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE",null,"64479 - HC INJECT ANES/STEROID FORAMEN CERV/THORACIC W IMG GUIDE ,1 LEVEL",null,null,null,null,"64647 - CHEMODENERVATION OF TRUNK 6 OR MORE MUSCLES",null,"64479 - HC INJECT ANES/STEROID FORAMEN CERV/THORACIC W IMG GUIDE ,1 LEVEL",null,null,null,"64645 - CHEMODENERVATION 1 EXTREMITY EA ADDL 5/> MUSCLES"]
[null,"67405 - HC EXPLORE/DRAIN EYE SOCKET",null,"64633 - DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA","64633 - DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA","64633 - DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA",null,"64483 - NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL",null,null,null,null,"64650 - CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE",null,"64483 - NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL",null,null,null,"64646 - CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES"]
[null,"67412 - HC EXPLORE/TREAT EYE SOCKET",null,"64634 - HC DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA","64634 - HC DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA","64634 - HC DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA",null,"64484 - NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC EA LV",null,null,null,null,"64653 - CHEMODENERVATION ECCRINE GLANDS OTH AREA PER DAY",null,"64484 - NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC EA LV",null,null,null,"64647 - CHEMODENERVATION OF TRUNK 6 OR MORE MUSCLES"]
[null,"67414 - HC EXPLR/DECOMPRESS EYE SOCKET",null,"64635 - DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL","64635 - DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL","64635 - DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL",null,"64486 - TAP BLOCK UNILATERAL BY INJECTION(S)",null,null,null,null,"64680 - HC DES,NEURO;CELIAC PLEX,WWO",null,"64486 - TAP BLOCK UNILATERAL BY INJECTION(S)",null,null,null,"64650 - CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE"]
[null,"67420 - HC EXPLORE/TREAT EYE SOCKET",null,"64636 - DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL","64636 - DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL","64636 - DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL",null,"64488 - HC TAP BLOCK BILATERAL BY INJECTION(S)",null,null,null,null,"64721 - NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE",null,"64488 - HC TAP BLOCK BILATERAL BY INJECTION(S)",null,null,null,"64653 - CHEMODENERVATION ECCRINE GLANDS OTH AREA PER DAY"]
[null,"67505 - HC INJECT/TREAT EYE SOCKET",null,"64640 - DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE","64640 - DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE","64640 - DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE",null,"64490 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL",null,null,null,null,"64771 - HC TRANSECT OTHER CRAN N,EXTRADURAL",null,"64490 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL",null,null,null,"64680 - HC DES,NEURO;CELIAC PLEX,WWO"]
[null,"67515 - INJECTION MEDICATION/OTHER SUBST TENON CAPSULE",null,"64642 - CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE","64642 - CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE","64642 - CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE",null,"64491 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL",null,null,null,null,"64774 - HC EXCISE CUTANEOUS NEUROMA",null,"64491 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL",null,null,null,"64721 - NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE"]
[null,"67550 - HC INSERT EYE SOCKET IMPLANT",null,"64643 - CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE","64643 - CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE","64643 - CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE",null,"64492 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL",null,null,null,null,"65093 - HC REVISE EYE WITH IMPLANT",null,"64492 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL",null,null,null,"64771 - HC TRANSECT OTHER CRAN N,EXTRADURAL"]
[null,"67700 - BLEPHAROTOMY DRAINAGE ABSCESS EYELID",null,"64644 - CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES","64644 - CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES","64644 - CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES",null,"64493 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL",null,null,null,null,"65101 - HC REMOVAL OF EYE",null,"64493 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL",null,null,null,"64774 - HC EXCISE CUTANEOUS NEUROMA"]
[null,"67710 - SEVERING TARSORRHAPHY",null,"64645 - CHEMODENERVATION 1 EXTREMITY EA ADDL 5/> MUSCLES","64645 - CHEMODENERVATION 1 EXTREMITY EA ADDL 5/> MUSCLES","64645 - CHEMODENERVATION 1 EXTREMITY EA ADDL 5/> MUSCLES",null,"64494 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL",null,null,null,null,"65103 - HC REMOVE EYE/INSERT IMPLANT",null,"64494 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL",null,null,null,"65093 - HC REVISE EYE WITH IMPLANT"]
[null,"67715 - HC CANTHOTOMY SEPARATE PROCEDURE",null,"64646 - CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES","64646 - CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES","64646 - CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES",null,"64495 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL",null,null,null,null,"65105 - HC REMOVE EYE/ATTACH IMPLANT",null,"64495 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL",null,null,null,"65101 - HC REMOVAL OF EYE"]
[null,"67800 - EXCISION CHALAZION SINGLE",null,"64647 - CHEMODENERVATION OF TRUNK 6 OR MORE MUSCLES","64647 - CHEMODENERVATION OF TRUNK 6 OR MORE MUSCLES","64647 - CHEMODENERVATION OF TRUNK 6 OR MORE MUSCLES",null,"64505 - INJECTION ANES AGENT SPHENOPALATINE GANGLION",null,null,null,null,"65130 - HC INSERT OCULAR IMPLANT",null,"64505 - INJECTION ANES AGENT SPHENOPALATINE GANGLION",null,null,null,"65103 - HC REMOVE EYE/INSERT IMPLANT"]
[null,"67801 - EXCISION CHALAZION MULTIPLE SAME LID",null,"64650 - CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE","64650 - CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE","64650 - CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE",null,"64510 - NJX ANES STELLATE GANGLION CRV SYMPATHETIC",null,null,null,null,"65135 - HC INSJ OC IMPLT AFTER ENCL MUSC X ATTACHED",null,"64510 - NJX ANES STELLATE GANGLION CRV SYMPATHETIC",null,null,null,"65105 - HC REMOVE EYE/ATTACH IMPLANT"]
[null,"67805 - EXCISION CHALAZION MULTIPLE DIFFERENT LIDS",null,"64653 - CHEMODENERVATION ECCRINE GLANDS OTH AREA PER DAY","64653 - CHEMODENERVATION ECCRINE GLANDS OTH AREA PER DAY","64653 - CHEMODENERVATION ECCRINE GLANDS OTH AREA PER DAY",null,"64520 - INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC",null,null,null,null,"65175 - HC REMOVAL OF OCULAR IMPLANT",null,"64520 - INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC",null,null,null,"65130 - HC INSERT OCULAR IMPLANT"]
[null,"67808 - HC REMOVE EYELID LESION(S)",null,"64680 - HC DES,NEURO;CELIAC PLEX,WWO","64680 - HC DES,NEURO;CELIAC PLEX,WWO","64680 - HC DES,NEURO;CELIAC PLEX,WWO",null,"64530 - INJX ANES CELIAC PLEXUS W/WO RADIOLOGIC MONITRNG",null,null,null,null,"65205 - REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL",null,"64530 - INJX ANES CELIAC PLEXUS W/WO RADIOLOGIC MONITRNG",null,null,null,"65135 - HC INSJ OC IMPLT AFTER ENCL MUSC X ATTACHED"]
[null,"67810 - INCISIONAL BIOPSY EYELID SKIN & LID MARGIN",null,"64721 - NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE","64721 - NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE","64721 - NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE",null,"64561 - IMPLANT NEUROELECTRODES",null,null,null,null,"65210 - HC RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR",null,"64561 - IMPLANT NEUROELECTRODES",null,null,null,"65175 - HC REMOVAL OF OCULAR IMPLANT"]
[null,"67840 - EXC LESION EYELID W/O CLSR/W/SIMPLE DIR CLOSURE",null,"64771 - HC TRANSECT OTHER CRAN N,EXTRADURAL","64771 - HC TRANSECT OTHER CRAN N,EXTRADURAL","64771 - HC TRANSECT OTHER CRAN N,EXTRADURAL",null,"64569 - HC REVISE/REPLACE CRANIAL NERVE STIM ELECTRODE/CONNECT PULSE GEN",null,null,null,null,"65220 - RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP",null,"64569 - HC REVISE/REPLACE CRANIAL NERVE STIM ELECTRODE/CONNECT PULSE GEN",null,null,null,"65205 - REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL"]
[null,"67850 - HC DESTRUC EYELID LESN, <1 CM",null,"64774 - HC EXCISE CUTANEOUS NEUROMA","64774 - HC EXCISE CUTANEOUS NEUROMA","64774 - HC EXCISE CUTANEOUS NEUROMA",null,"64585 - REVISE/REMOVE NEUROELECTRODE",null,null,null,null,"65222 - RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP",null,"64585 - REVISE/REMOVE NEUROELECTRODE",null,null,null,"65210 - HC RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR"]
[null,"67875 - TEMPORARY CLOSURE EYELIDS SUTURE",null,"65093 - HC REVISE EYE WITH IMPLANT","65093 - HC REVISE EYE WITH IMPLANT","65093 - HC REVISE EYE WITH IMPLANT",null,"64600 - INJECTION TREATMENT OF NERVE",null,null,null,null,"65265 - HC REMOVE FOREIGN BODY FROM EYE",null,"64600 - INJECTION TREATMENT OF NERVE",null,null,null,"65220 - RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP"]
[null,"67880 - HC REVISION OF EYELID",null,"65101 - HC REMOVAL OF EYE","65101 - HC REMOVAL OF EYE","65101 - HC REMOVAL OF EYE",null,"64611 - CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS",null,null,null,null,"65280 - HC REPAIR OF EYE WOUND",null,"64611 - CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS",null,null,null,"65222 - RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP"]
[null,"67882 - HC REVISION EYELID,XPOSITN TARSAL PLATE",null,"65103 - HC REMOVE EYE/INSERT IMPLANT","65103 - HC REMOVE EYE/INSERT IMPLANT","65103 - HC REMOVE EYE/INSERT IMPLANT",null,"64612 - CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL",null,null,null,null,"65285 - HC RPR LAC CORN&/SCLRA PERF W/REPOS/RESCJ UVEAL T",null,"64612 - CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL",null,null,null,"65265 - HC REMOVE FOREIGN BODY FROM EYE"]
[null,"67900 - HC REPAIR BROW DEFECT",null,"65105 - HC REMOVE EYE/ATTACH IMPLANT","65105 - HC REMOVE EYE/ATTACH IMPLANT","65105 - HC REMOVE EYE/ATTACH IMPLANT",null,"64615 - CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE",null,null,null,null,"65286 - RPR LAC APPL TISSUE GLUE WOUND CORNEA&/SCLERA",null,"64615 - CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE",null,null,null,"65280 - HC REPAIR OF EYE WOUND"]
[null,"67901 - HC RPR BLEPHAROPTOSIS FRONTALIS MUSC SUTR/OTH MATRL",null,"65130 - HC INSERT OCULAR IMPLANT","65130 - HC INSERT OCULAR IMPLANT","65130 - HC INSERT OCULAR IMPLANT",null,"64616 - CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA",null,null,null,null,"65400 - EXCISION LESION CORNEA XCP PTERYGIUM",null,"64616 - CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA",null,null,null,"65285 - HC RPR LAC CORN&/SCLRA PERF W/REPOS/RESCJ UVEAL T"]
[null,"67902 - HC RPR BLEPHAROPT FRONTALIS MUSC AUTOL FASCAL SLING",null,"65135 - HC INSJ OC IMPLT AFTER ENCL MUSC X ATTACHED","65135 - HC INSJ OC IMPLT AFTER ENCL MUSC X ATTACHED","65135 - HC INSJ OC IMPLT AFTER ENCL MUSC X ATTACHED",null,"64617 - CHEMODENERVATION MUSCLE LARYNX UNILAT W/EMG",null,null,null,null,"65420 - HC REMOVAL OF EYE LESION",null,"64617 - CHEMODENERVATION MUSCLE LARYNX UNILAT W/EMG",null,null,null,"65286 - RPR LAC APPL TISSUE GLUE WOUND CORNEA&/SCLERA"]
[null,"67903 - HC RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT INTERNAL",null,"65175 - HC REMOVAL OF OCULAR IMPLANT","65175 - HC REMOVAL OF OCULAR IMPLANT","65175 - HC REMOVAL OF OCULAR IMPLANT",null,"64620 - HC DEST,INTERCOSTAL,NEUROLYTIC",null,null,null,null,"65426 - EXCISION/TRANSPOSITION PTERYGIUM W/GRAFG",null,"64620 - HC DEST,INTERCOSTAL,NEUROLYTIC",null,null,null,"65400 - EXCISION LESION CORNEA XCP PTERYGIUM"]
[null,"67904 - HC RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT XTRNL",null,"65205 - REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL","65205 - REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL","65205 - REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL",null,"64624 - HC DSTRJ NULYT AGT GNCLR NRV",null,null,null,null,"65430 - CORNEA SCRAPING DIAGNOSTIC SMEAR &/CULTURE",null,"64624 - HC DSTRJ NULYT AGT GNCLR NRV",null,null,null,"65420 - HC REMOVAL OF EYE LESION"]
[null,"67911 - HC CORRECT LID RETRACTN",null,"65210 - HC RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR","65210 - HC RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR","65210 - HC RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR",null,"64625 - HC RF ABLTJ NRV NRVTG SI JT",null,null,null,null,"65435 - RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION",null,"64625 - HC RF ABLTJ NRV NRVTG SI JT",null,null,null,"65426 - EXCISION/TRANSPOSITION PTERYGIUM W/GRAFG"]
[null,"67912 - CORRJ LAGOPHTHALMOS IMPLTJ UPR EYELID LID LOAD",null,"65220 - RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP","65220 - RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP","65220 - RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP",null,"64632 - DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE",null,null,null,null,"65436 - RMVL CORNEAL EPITHELIUM W/APPL CHELATING AGENT",null,"64632 - DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE",null,null,null,"65430 - CORNEA SCRAPING DIAGNOSTIC SMEAR &/CULTURE"]
[null,"67917 - REPAIR ECTROPION EXTENSIVE",null,"65222 - RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP","65222 - RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP","65222 - RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP",null,"64633 - DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA",null,null,null,null,"65730 - HC KERATOPLASTY PENTRG EXCEPT APHAKIA/PSEUDOPHAKIA",null,"64633 - DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA",null,null,null,"65435 - RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION"]
[null,"67921 - HC FIX ENTROPION,SUTURE",null,"65265 - HC REMOVE FOREIGN BODY FROM EYE","65265 - HC REMOVE FOREIGN BODY FROM EYE","65265 - HC REMOVE FOREIGN BODY FROM EYE",null,"64634 - HC DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA",null,null,null,null,"65750 - HC KERATOPLASTY PENETRAING APHAKIA",null,"64634 - HC DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA",null,null,null,"65436 - RMVL CORNEAL EPITHELIUM W/APPL CHELATING AGENT"]
[null,"67923 - HC REPAIR ENTROPION EXCISION TARSAL WEDGE",null,"65280 - HC REPAIR OF EYE WOUND","65280 - HC REPAIR OF EYE WOUND","65280 - HC REPAIR OF EYE WOUND",null,"64635 - DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL",null,null,null,null,"65755 - HC KERATOPLASTY PENETRATING PSEUDOPHAKIA",null,"64635 - DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL",null,null,null,"65730 - HC KERATOPLASTY PENTRG EXCEPT APHAKIA/PSEUDOPHAKIA"]
[null,"67924 - HC FIX ENTROPION,EXTENSV LID REPAIR",null,"65285 - HC RPR LAC CORN&/SCLRA PERF W/REPOS/RESCJ UVEAL T","65285 - HC RPR LAC CORN&/SCLRA PERF W/REPOS/RESCJ UVEAL T","65285 - HC RPR LAC CORN&/SCLRA PERF W/REPOS/RESCJ UVEAL T",null,"64636 - DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL",null,null,null,null,"65756 - HC CORNEAL TRNSPL ENDOTHELIAL",null,"64636 - DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL",null,null,null,"65750 - HC KERATOPLASTY PENETRAING APHAKIA"]
[null,"67930 - HC SUTURE EYELID WOUND,PARTIAL THICK",null,"65286 - RPR LAC APPL TISSUE GLUE WOUND CORNEA&/SCLERA","65286 - RPR LAC APPL TISSUE GLUE WOUND CORNEA&/SCLERA","65286 - RPR LAC APPL TISSUE GLUE WOUND CORNEA&/SCLERA",null,"64640 - DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE",null,null,null,null,"65770 - HC REVISE CORNEA WITH IMPLANT",null,"64640 - DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE",null,null,null,"65755 - HC KERATOPLASTY PENETRATING PSEUDOPHAKIA"]
[null,"67935 - HC SUTURE EYELID WOUND,FULL THICK",null,"65400 - EXCISION LESION CORNEA XCP PTERYGIUM","65400 - EXCISION LESION CORNEA XCP PTERYGIUM","65400 - EXCISION LESION CORNEA XCP PTERYGIUM",null,"64642 - CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE",null,null,null,null,"65778 - PLACE AMNIOTIC MEMB OCULAR SURFACE SELF RETAIN",null,"64642 - CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE",null,null,null,"65756 - HC CORNEAL TRNSPL ENDOTHELIAL"]
[null,"67961 - HC REVISION OF EYELID,< 1/4 LID MARGIN",null,"65420 - HC REMOVAL OF EYE LESION","65420 - HC REMOVAL OF EYE LESION","65420 - HC REMOVAL OF EYE LESION",null,"64643 - CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE",null,null,null,null,"65779 - HC PLACE AMNIOTIC MEMBRANE OCULAR SURFACE WOUND HEALING, SUTURED",null,"64643 - CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE",null,null,null,"65770 - HC REVISE CORNEA WITH IMPLANT"]
[null,"67966 - HC EXCISION & REPAIR EYELID ONE-FOURTH LID MARGIN",null,"65426 - EXCISION/TRANSPOSITION PTERYGIUM W/GRAFG","65426 - EXCISION/TRANSPOSITION PTERYGIUM W/GRAFG","65426 - EXCISION/TRANSPOSITION PTERYGIUM W/GRAFG",null,"64644 - CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES",null,null,null,null,"65780 - HC OCULAR RECONST TRANSPLANT",null,"64644 - CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES",null,null,null,"65778 - PLACE AMNIOTIC MEMB OCULAR SURFACE SELF RETAIN"]
[null,"67971 - HC RCNSTJ EYELID FULL THICKNESS </TWO-THIRDS 1 STG",null,"65430 - CORNEA SCRAPING DIAGNOSTIC SMEAR &/CULTURE","65430 - CORNEA SCRAPING DIAGNOSTIC SMEAR &/CULTURE","65430 - CORNEA SCRAPING DIAGNOSTIC SMEAR &/CULTURE",null,"64645 - CHEMODENERVATION 1 EXTREMITY EA ADDL 5/> MUSCLES",null,null,null,null,"65782 - HC OCCULAR SURFACE RECONSTRUCTION LIMBAL AUTOGRAFT",null,"64645 - CHEMODENERVATION 1 EXTREMITY EA ADDL 5/> MUSCLES",null,null,null,"65779 - HC PLACE AMNIOTIC MEMBRANE OCULAR SURFACE WOUND HEALING, SUTURED"]
[null,"67973 - HC RCNSTJ EYELID FULL THICKNESS LOWER EYELID 1 STG",null,"65435 - RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION","65435 - RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION","65435 - RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION",null,"64646 - CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES",null,null,null,null,"65800 - PARACENTSIS ANT CHAMB EYE ASPIR AQUEOUS SPX",null,"64646 - CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES",null,null,null,"65780 - HC OCULAR RECONST TRANSPLANT"]
[null,"68020 - HC INCISE/DRAIN CONJUNCTIVA",null,"65436 - RMVL CORNEAL EPITHELIUM W/APPL CHELATING AGENT","65436 - RMVL CORNEAL EPITHELIUM W/APPL CHELATING AGENT","65436 - RMVL CORNEAL EPITHELIUM W/APPL CHELATING AGENT",null,"64647 - CHEMODENERVATION OF TRUNK 6 OR MORE MUSCLES",null,null,null,null,"65815 - HC DRAINAGE OF EYE",null,"64647 - CHEMODENERVATION OF TRUNK 6 OR MORE MUSCLES",null,null,null,"65782 - HC OCCULAR SURFACE RECONSTRUCTION LIMBAL AUTOGRAFT"]
[null,"68100 - HC BIOPSY OF CONJUNCTIVA",null,"65730 - HC KERATOPLASTY PENTRG EXCEPT APHAKIA/PSEUDOPHAKIA","65730 - HC KERATOPLASTY PENTRG EXCEPT APHAKIA/PSEUDOPHAKIA","65730 - HC KERATOPLASTY PENTRG EXCEPT APHAKIA/PSEUDOPHAKIA",null,"64650 - CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE",null,null,null,null,"65820 - HC RELIEVE INNER EYE PRESSURE",null,"64650 - CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE",null,null,null,"65800 - PARACENTSIS ANT CHAMB EYE ASPIR AQUEOUS SPX"]
[null,"68110 - EXCISION LESION CONJUNCTIVA </1 CM",null,"65750 - HC KERATOPLASTY PENETRAING APHAKIA","65750 - HC KERATOPLASTY PENETRAING APHAKIA","65750 - HC KERATOPLASTY PENETRAING APHAKIA",null,"64653 - CHEMODENERVATION ECCRINE GLANDS OTH AREA PER DAY",null,null,null,null,"65855 - TRABECULOPLASTY LASER SURG 1/> SESSIONS",null,"64653 - CHEMODENERVATION ECCRINE GLANDS OTH AREA PER DAY",null,null,null,"65815 - HC DRAINAGE OF EYE"]
[null,"68115 - HC REMOVE EYELID LINING LESION",null,"65755 - HC KERATOPLASTY PENETRATING PSEUDOPHAKIA","65755 - HC KERATOPLASTY PENETRATING PSEUDOPHAKIA","65755 - HC KERATOPLASTY PENETRATING PSEUDOPHAKIA",null,"64680 - HC DES,NEURO;CELIAC PLEX,WWO",null,null,null,null,"65860 - SEVERING ADHESIONS ANTERIOR SEGMENT LASER SPX",null,"64680 - HC DES,NEURO;CELIAC PLEX,WWO",null,null,null,"65820 - HC RELIEVE INNER EYE PRESSURE"]
[null,"68320 - HC CONJUNCTIVOPLASTY W/GRF/XTNSV REARRANGEMENT",null,"65756 - HC CORNEAL TRNSPL ENDOTHELIAL","65756 - HC CORNEAL TRNSPL ENDOTHELIAL","65756 - HC CORNEAL TRNSPL ENDOTHELIAL",null,"64721 - NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE",null,null,null,null,"65865 - HC INCISE INNER EYE ADHESIONS",null,"64721 - NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE",null,null,null,"65855 - TRABECULOPLASTY LASER SURG 1/> SESSIONS"]
[null,"68325 - HC CONJUNCTIVOPLASTY W/BUCCAL MUC MEMB GRAFT",null,"65770 - HC REVISE CORNEA WITH IMPLANT","65770 - HC REVISE CORNEA WITH IMPLANT","65770 - HC REVISE CORNEA WITH IMPLANT",null,"64771 - HC TRANSECT OTHER CRAN N,EXTRADURAL",null,null,null,null,"65870 - HC SEVERING ADS ANT SEG INCAL SPX ANT SYNECHIAE",null,"64771 - HC TRANSECT OTHER CRAN N,EXTRADURAL",null,null,null,"65860 - SEVERING ADHESIONS ANTERIOR SEGMENT LASER SPX"]
[null,"68335 - HC RPR SYMBLEPHARON FR GRF CJNC/BUCCAL MUC MEMB",null,"65778 - PLACE AMNIOTIC MEMB OCULAR SURFACE SELF RETAIN","65778 - PLACE AMNIOTIC MEMB OCULAR SURFACE SELF RETAIN","65778 - PLACE AMNIOTIC MEMB OCULAR SURFACE SELF RETAIN",null,"64774 - HC EXCISE CUTANEOUS NEUROMA",null,null,null,null,"65875 - HC SEVERING ADS ANT SEG INCAL SPX POST SYNECHIAE",null,"64774 - HC EXCISE CUTANEOUS NEUROMA",null,null,null,"65865 - HC INCISE INNER EYE ADHESIONS"]
[null,"68340 - HC DIVISION OF SYMBLEPHARON",null,"65779 - HC PLACE AMNIOTIC MEMBRANE OCULAR SURFACE WOUND HEALING, SUTURED","65779 - HC PLACE AMNIOTIC MEMBRANE OCULAR SURFACE WOUND HEALING, SUTURED","65779 - HC PLACE AMNIOTIC MEMBRANE OCULAR SURFACE WOUND HEALING, SUTURED",null,"64999 - PR SACROCOCCYGEAL JOINT INJECTION AND GANGLION OF IMPAR BLOCK",null,null,null,null,"65920 - HC REMOVE IMPLANT OF EYE",null,"64999 - PR SACROCOCCYGEAL JOINT INJECTION AND GANGLION OF IMPAR BLOCK",null,null,null,"65870 - HC SEVERING ADS ANT SEG INCAL SPX ANT SYNECHIAE"]
[null,"68362 - HC CONJUNCTIVAL FLAP TOTAL",null,"65780 - HC OCULAR RECONST TRANSPLANT","65780 - HC OCULAR RECONST TRANSPLANT","65780 - HC OCULAR RECONST TRANSPLANT",null,"65093 - HC REVISE EYE WITH IMPLANT",null,null,null,null,"66020 - INJX ANTERIOR CHAMBER EYE AIR/LIQUID SPX",null,"65093 - HC REVISE EYE WITH IMPLANT",null,null,null,"65875 - HC SEVERING ADS ANT SEG INCAL SPX POST SYNECHIAE"]
[null,"68440 - HC INCISE TEAR DUCT OPENING",null,"65782 - HC OCCULAR SURFACE RECONSTRUCTION LIMBAL AUTOGRAFT","65782 - HC OCCULAR SURFACE RECONSTRUCTION LIMBAL AUTOGRAFT","65782 - HC OCCULAR SURFACE RECONSTRUCTION LIMBAL AUTOGRAFT",null,"65101 - HC REMOVAL OF EYE",null,null,null,null,"66030 - HC INJECTION TREATMENT OF EYE",null,"65101 - HC REMOVAL OF EYE",null,null,null,"65920 - HC REMOVE IMPLANT OF EYE"]
[null,"68530 - HC CLEARANCE OF TEAR DUCT",null,"65800 - PARACENTSIS ANT CHAMB EYE ASPIR AQUEOUS SPX","65800 - PARACENTSIS ANT CHAMB EYE ASPIR AQUEOUS SPX","65800 - PARACENTSIS ANT CHAMB EYE ASPIR AQUEOUS SPX",null,"65103 - HC REMOVE EYE/INSERT IMPLANT",null,null,null,null,"66170 - HC GLAUCOMA SURGERY",null,"65103 - HC REMOVE EYE/INSERT IMPLANT",null,null,null,"66020 - INJX ANTERIOR CHAMBER EYE AIR/LIQUID SPX"]
[null,"68700 - HC REPAIR TEAR DUCTS",null,"65815 - HC DRAINAGE OF EYE","65815 - HC DRAINAGE OF EYE","65815 - HC DRAINAGE OF EYE",null,"65105 - HC REMOVE EYE/ATTACH IMPLANT",null,null,null,null,"66172 - HC INCISION OF EYE",null,"65105 - HC REMOVE EYE/ATTACH IMPLANT",null,null,null,"66030 - HC INJECTION TREATMENT OF EYE"]
[null,"68720 - HC CREATE TEAR SAC DRAIN",null,"65820 - HC RELIEVE INNER EYE PRESSURE","65820 - HC RELIEVE INNER EYE PRESSURE","65820 - HC RELIEVE INNER EYE PRESSURE",null,"65130 - HC INSERT OCULAR IMPLANT",null,null,null,null,"66179 - HC AQUEOUS SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT",null,"65130 - HC INSERT OCULAR IMPLANT",null,null,null,"66170 - HC GLAUCOMA SURGERY"]
[null,"68750 - HC CREATE TEAR DUCT DRAIN",null,"65855 - TRABECULOPLASTY LASER SURG 1/> SESSIONS","65855 - TRABECULOPLASTY LASER SURG 1/> SESSIONS","65855 - TRABECULOPLASTY LASER SURG 1/> SESSIONS",null,"65135 - HC INSJ OC IMPLT AFTER ENCL MUSC X ATTACHED",null,null,null,null,"66180 - HC AQUEOUS SHUNT EYE W/GRAFT",null,"65135 - HC INSJ OC IMPLT AFTER ENCL MUSC X ATTACHED",null,null,null,"66172 - HC INCISION OF EYE"]
[null,"68760 - HC CLOSE TEAR DUCT OPENING",null,"65860 - SEVERING ADHESIONS ANTERIOR SEGMENT LASER SPX","65860 - SEVERING ADHESIONS ANTERIOR SEGMENT LASER SPX","65860 - SEVERING ADHESIONS ANTERIOR SEGMENT LASER SPX",null,"65175 - HC REMOVAL OF OCULAR IMPLANT",null,null,null,null,"66183 - HC INSERT ANT DRAINAGE DEVICE",null,"65175 - HC REMOVAL OF OCULAR IMPLANT",null,null,null,"66179 - HC AQUEOUS SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT"]
[null,"68761 - CLSR LACRIMAL PUNCTUM PLUG EACH",null,"65865 - HC INCISE INNER EYE ADHESIONS","65865 - HC INCISE INNER EYE ADHESIONS","65865 - HC INCISE INNER EYE ADHESIONS",null,"65205 - REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL",null,null,null,null,"66185 - HC REVISE AQUEOUS SHUNT EYE",null,"65205 - REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL",null,null,null,"66180 - HC AQUEOUS SHUNT EYE W/GRAFT"]
[null,"68810 - HC PROBE NASOLACRIMAL DUCT",null,"65870 - HC SEVERING ADS ANT SEG INCAL SPX ANT SYNECHIAE","65870 - HC SEVERING ADS ANT SEG INCAL SPX ANT SYNECHIAE","65870 - HC SEVERING ADS ANT SEG INCAL SPX ANT SYNECHIAE",null,"65210 - HC RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR",null,null,null,null,"66250 - HC FOLLOW-UP SURGERY OF EYE",null,"65210 - HC RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR",null,null,null,"66183 - HC INSERT ANT DRAINAGE DEVICE"]
[null,"68811 - HC PROBE NASOLACRIMAL DUCT",null,"65875 - HC SEVERING ADS ANT SEG INCAL SPX POST SYNECHIAE","65875 - HC SEVERING ADS ANT SEG INCAL SPX POST SYNECHIAE","65875 - HC SEVERING ADS ANT SEG INCAL SPX POST SYNECHIAE",null,"65220 - RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP",null,null,null,null,"66600 - HC REMOVE IRIS AND LESION",null,"65220 - RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP",null,null,null,"66185 - HC REVISE AQUEOUS SHUNT EYE"]
[null,"68815 - HC PROBE NASOLAC DUCT,INSERT TUBE/STENT",null,"65920 - HC REMOVE IMPLANT OF EYE","65920 - HC REMOVE IMPLANT OF EYE","65920 - HC REMOVE IMPLANT OF EYE",null,"65222 - RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP",null,null,null,null,"66625 - HC REMV IRIS PERIPH FOR GLAUCOMA",null,"65222 - RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP",null,null,null,"66250 - HC FOLLOW-UP SURGERY OF EYE"]
[null,"68816 - HC PROBE NL DUCT W/BALLOON",null,"66020 - INJX ANTERIOR CHAMBER EYE AIR/LIQUID SPX","66020 - INJX ANTERIOR CHAMBER EYE AIR/LIQUID SPX","66020 - INJX ANTERIOR CHAMBER EYE AIR/LIQUID SPX",null,"65265 - HC REMOVE FOREIGN BODY FROM EYE",null,null,null,null,"66682 - HC REPAIR IRIS & CILIARY BODY",null,"65265 - HC REMOVE FOREIGN BODY FROM EYE",null,null,null,"66600 - HC REMOVE IRIS AND LESION"]
[null,"68840 - HC EXPLORE LACRIMAL CANALICULI",null,"66030 - HC INJECTION TREATMENT OF EYE","66030 - HC INJECTION TREATMENT OF EYE","66030 - HC INJECTION TREATMENT OF EYE",null,"65280 - HC REPAIR OF EYE WOUND",null,null,null,null,"66710 - CILIARY BODY DSTRJ CYCLOPHOTOCOAG TRANSSCERAL",null,"65280 - HC REPAIR OF EYE WOUND",null,null,null,"66625 - HC REMV IRIS PERIPH FOR GLAUCOMA"]
[null,"69000 - DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE",null,"66170 - HC GLAUCOMA SURGERY","66170 - HC GLAUCOMA SURGERY","66170 - HC GLAUCOMA SURGERY",null,"65285 - HC RPR LAC CORN&/SCLRA PERF W/REPOS/RESCJ UVEAL T",null,null,null,null,"66711 - HC ECP CILIARY BODY DESTRUCTION",null,"65285 - HC RPR LAC CORN&/SCLRA PERF W/REPOS/RESCJ UVEAL T",null,null,null,"66682 - HC REPAIR IRIS & CILIARY BODY"]
[null,"69005 - DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX",null,"66172 - HC INCISION OF EYE","66172 - HC INCISION OF EYE","66172 - HC INCISION OF EYE",null,"65286 - RPR LAC APPL TISSUE GLUE WOUND CORNEA&/SCLERA",null,null,null,null,"66761 - IRIDOTOMY/IRRIDECTOMY LASER SURG PER SESSION",null,"65286 - RPR LAC APPL TISSUE GLUE WOUND CORNEA&/SCLERA",null,null,null,"66710 - CILIARY BODY DSTRJ CYCLOPHOTOCOAG TRANSSCERAL"]
[null,"69020 - DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS",null,"66179 - HC AQUEOUS SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT","66179 - HC AQUEOUS SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT","66179 - HC AQUEOUS SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT",null,"65400 - EXCISION LESION CORNEA XCP PTERYGIUM",null,null,null,null,"66762 - IRIDOPLASTY PHOTOCOAGULATION 1/> SESSIONS",null,"65400 - EXCISION LESION CORNEA XCP PTERYGIUM",null,null,null,"66711 - HC ECP CILIARY BODY DESTRUCTION"]
[null,"69110 - HC REMOVAL EXTERNAL EAR,PARTIAL",null,"66180 - HC AQUEOUS SHUNT EYE W/GRAFT","66180 - HC AQUEOUS SHUNT EYE W/GRAFT","66180 - HC AQUEOUS SHUNT EYE W/GRAFT",null,"65420 - HC REMOVAL OF EYE LESION",null,null,null,null,"66821 - POST-CATARACT LASER SURGERY",null,"65420 - HC REMOVAL OF EYE LESION",null,null,null,"66761 - IRIDOTOMY/IRRIDECTOMY LASER SURG PER SESSION"]
[null,"69145 - EXCISION SOFT TIS LES EXTERNAL AUDITORY CANAL",null,"66183 - HC INSERT ANT DRAINAGE DEVICE","66183 - HC INSERT ANT DRAINAGE DEVICE","66183 - HC INSERT ANT DRAINAGE DEVICE",null,"65426 - EXCISION/TRANSPOSITION PTERYGIUM W/GRAFG",null,null,null,null,"66825 - HC REPOSITION INTRAOCULAR LENS",null,"65426 - EXCISION/TRANSPOSITION PTERYGIUM W/GRAFG",null,null,null,"66762 - IRIDOPLASTY PHOTOCOAGULATION 1/> SESSIONS"]
[null,"69209 - RMVL IMPACTED CERUMEN USING IRRIGATION/LAVAGE,UNILATERAL",null,"66185 - HC REVISE AQUEOUS SHUNT EYE","66185 - HC REVISE AQUEOUS SHUNT EYE","66185 - HC REVISE AQUEOUS SHUNT EYE",null,"65430 - CORNEA SCRAPING DIAGNOSTIC SMEAR &/CULTURE",null,null,null,null,"66840 - HC RMVL LENS MATERIAL ASPIR TQ 1/> STAGES",null,"65430 - CORNEA SCRAPING DIAGNOSTIC SMEAR &/CULTURE",null,null,null,"66821 - POST-CATARACT LASER SURGERY"]
[null,"69210 - RMVL IMPACTED CERUMEN SPX 1/BOTH EARS",null,"66250 - HC FOLLOW-UP SURGERY OF EYE","66250 - HC FOLLOW-UP SURGERY OF EYE","66250 - HC FOLLOW-UP SURGERY OF EYE",null,"65435 - RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION",null,null,null,null,"66850 - HC RMVL LENS MATERIAL PHACOFRAGMENTATION ASPIR",null,"65435 - RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION",null,null,null,"66825 - HC REPOSITION INTRAOCULAR LENS"]
[null,"69222 - DEBRIDEMENT MASTOIDECTOMY CAVITY CMPLX",null,"66600 - HC REMOVE IRIS AND LESION","66600 - HC REMOVE IRIS AND LESION","66600 - HC REMOVE IRIS AND LESION",null,"65436 - RMVL CORNEAL EPITHELIUM W/APPL CHELATING AGENT",null,null,null,null,"66852 - HC RMVL LENS MATERIAL PARS PLANA W/WO VITRECTOMY",null,"65436 - RMVL CORNEAL EPITHELIUM W/APPL CHELATING AGENT",null,null,null,"66840 - HC RMVL LENS MATERIAL ASPIR TQ 1/> STAGES"]
[null,"69300 - HC OTOPLASTY PROTRUDING EAR W WO SIZE RDCTJ",null,"66625 - HC REMV IRIS PERIPH FOR GLAUCOMA","66625 - HC REMV IRIS PERIPH FOR GLAUCOMA","66625 - HC REMV IRIS PERIPH FOR GLAUCOMA",null,"65730 - HC KERATOPLASTY PENTRG EXCEPT APHAKIA/PSEUDOPHAKIA",null,null,null,null,"66940 - HC EXTRACTION OF LENS",null,"65730 - HC KERATOPLASTY PENTRG EXCEPT APHAKIA/PSEUDOPHAKIA",null,null,null,"66850 - HC RMVL LENS MATERIAL PHACOFRAGMENTATION ASPIR"]
[null,"69420 - MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ",null,"66682 - HC REPAIR IRIS & CILIARY BODY","66682 - HC REPAIR IRIS & CILIARY BODY","66682 - HC REPAIR IRIS & CILIARY BODY",null,"65750 - HC KERATOPLASTY PENETRAING APHAKIA",null,null,null,null,"66982 - REMV CATARACT EXTRACAP,INSERT LENS,COMP",null,"65750 - HC KERATOPLASTY PENETRAING APHAKIA",null,null,null,"66852 - HC RMVL LENS MATERIAL PARS PLANA W/WO VITRECTOMY"]
[null,"69433 - TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA",null,"66710 - CILIARY BODY DSTRJ CYCLOPHOTOCOAG TRANSSCERAL","66710 - CILIARY BODY DSTRJ CYCLOPHOTOCOAG TRANSSCERAL","66710 - CILIARY BODY DSTRJ CYCLOPHOTOCOAG TRANSSCERAL",null,"65755 - HC KERATOPLASTY PENETRATING PSEUDOPHAKIA",null,null,null,null,"66984 - REMV CATARACT EXTRACAP,INSERT LENS",null,"65755 - HC KERATOPLASTY PENETRATING PSEUDOPHAKIA",null,null,null,"66940 - HC EXTRACTION OF LENS"]
[null,"69436 - HC CREATE EARDRUM OPENING,GEN ANESTH",null,"66711 - HC ECP CILIARY BODY DESTRUCTION","66711 - HC ECP CILIARY BODY DESTRUCTION","66711 - HC ECP CILIARY BODY DESTRUCTION",null,"65756 - HC CORNEAL TRNSPL ENDOTHELIAL",null,null,null,null,"66985 - INSERT LENS PROSTHESIS ONLY",null,"65756 - HC CORNEAL TRNSPL ENDOTHELIAL",null,null,null,"66982 - REMV CATARACT EXTRACAP,INSERT LENS,COMP"]
[null,"69501 - MASTOIDECTOMY,SIMPLE",null,"66761 - IRIDOTOMY/IRRIDECTOMY LASER SURG PER SESSION","66761 - IRIDOTOMY/IRRIDECTOMY LASER SURG PER SESSION","66761 - IRIDOTOMY/IRRIDECTOMY LASER SURG PER SESSION",null,"65770 - HC REVISE CORNEA WITH IMPLANT",null,null,null,null,"66986 - HC EXCHANGE LENS PROSTHESIS",null,"65770 - HC REVISE CORNEA WITH IMPLANT",null,null,null,"66984 - REMV CATARACT EXTRACAP,INSERT LENS"]
[null,"69540 - HC REMV AURAL POLYP",null,"66762 - IRIDOPLASTY PHOTOCOAGULATION 1/> SESSIONS","66762 - IRIDOPLASTY PHOTOCOAGULATION 1/> SESSIONS","66762 - IRIDOPLASTY PHOTOCOAGULATION 1/> SESSIONS",null,"65778 - PLACE AMNIOTIC MEMB OCULAR SURFACE SELF RETAIN",null,null,null,null,"67005 - HC RMVL VITREOUS ANT APPR PARTIAL REMOVAL",null,"65778 - PLACE AMNIOTIC MEMB OCULAR SURFACE SELF RETAIN",null,null,null,"66985 - INSERT LENS PROSTHESIS ONLY"]
[null,"69620 - MYRINGOPLASTY",null,"66821 - POST-CATARACT LASER SURGERY","66821 - POST-CATARACT LASER SURGERY","66821 - POST-CATARACT LASER SURGERY",null,"65779 - HC PLACE AMNIOTIC MEMBRANE OCULAR SURFACE WOUND HEALING, SUTURED",null,null,null,null,"67010 - HC RMVL VITREOUS ANT APPR SUBTOT RMVL MECH VITRECT",null,"65779 - HC PLACE AMNIOTIC MEMBRANE OCULAR SURFACE WOUND HEALING, SUTURED",null,null,null,"66986 - HC EXCHANGE LENS PROSTHESIS"]
[null,"69631 - HC TYMPANOPLASTY",null,"66825 - HC REPOSITION INTRAOCULAR LENS","66825 - HC REPOSITION INTRAOCULAR LENS","66825 - HC REPOSITION INTRAOCULAR LENS",null,"65780 - HC OCULAR RECONST TRANSPLANT",null,null,null,null,"67015 - ASPIRATION/RELEASE VITREOUS SUBRETINAL/CHOROIDAL",null,"65780 - HC OCULAR RECONST TRANSPLANT",null,null,null,"67005 - HC RMVL VITREOUS ANT APPR PARTIAL REMOVAL"]
[null,"69801 - LABYRINTHOTOMY TRANSCANAL",null,"66840 - HC RMVL LENS MATERIAL ASPIR TQ 1/> STAGES","66840 - HC RMVL LENS MATERIAL ASPIR TQ 1/> STAGES","66840 - HC RMVL LENS MATERIAL ASPIR TQ 1/> STAGES",null,"65782 - HC OCCULAR SURFACE RECONSTRUCTION LIMBAL AUTOGRAFT",null,null,null,null,"67028 - INTRAVITREAL NJX PHARMACOLOGIC AGT SPX",null,"65782 - HC OCCULAR SURFACE RECONSTRUCTION LIMBAL AUTOGRAFT",null,null,null,"67010 - HC RMVL VITREOUS ANT APPR SUBTOT RMVL MECH VITRECT"]
[null,"77063 - SCREENING DIGITAL BREAST TOMOSYNTHESIS BI",null,"66850 - HC RMVL LENS MATERIAL PHACOFRAGMENTATION ASPIR","66850 - HC RMVL LENS MATERIAL PHACOFRAGMENTATION ASPIR","66850 - HC RMVL LENS MATERIAL PHACOFRAGMENTATION ASPIR",null,"65800 - PARACENTSIS ANT CHAMB EYE ASPIR AQUEOUS SPX",null,null,null,null,"67031 - SEVERING VITREOUS STRANS LASER 1/> STAGES",null,"65800 - PARACENTSIS ANT CHAMB EYE ASPIR AQUEOUS SPX",null,null,null,"67015 - ASPIRATION/RELEASE VITREOUS SUBRETINAL/CHOROIDAL"]
[null,"77065 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",null,"66852 - HC RMVL LENS MATERIAL PARS PLANA W/WO VITRECTOMY","66852 - HC RMVL LENS MATERIAL PARS PLANA W/WO VITRECTOMY","66852 - HC RMVL LENS MATERIAL PARS PLANA W/WO VITRECTOMY",null,"65815 - HC DRAINAGE OF EYE",null,null,null,null,"67036 - HC VITRECTOMY,MECHANICAL",null,"65815 - HC DRAINAGE OF EYE",null,null,null,"67028 - INTRAVITREAL NJX PHARMACOLOGIC AGT SPX"]
[null,"77066 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",null,"66940 - HC EXTRACTION OF LENS","66940 - HC EXTRACTION OF LENS","66940 - HC EXTRACTION OF LENS",null,"65820 - HC RELIEVE INNER EYE PRESSURE",null,null,null,null,"67039 - HC VITRECTOMY,FOCAL LASER RX RETINA",null,"65820 - HC RELIEVE INNER EYE PRESSURE",null,null,null,"67031 - SEVERING VITREOUS STRANS LASER 1/> STAGES"]
[null,"77067 - HC SCR MAMM CAD, BI",null,"66982 - REMV CATARACT EXTRACAP,INSERT LENS,COMP","66982 - REMV CATARACT EXTRACAP,INSERT LENS,COMP","66982 - REMV CATARACT EXTRACAP,INSERT LENS,COMP",null,"65855 - TRABECULOPLASTY LASER SURG 1/> SESSIONS",null,null,null,null,"67040 - HC LASER TREATMENT OF RETINA",null,"65855 - TRABECULOPLASTY LASER SURG 1/> SESSIONS",null,null,null,"67036 - HC VITRECTOMY,MECHANICAL"]
[null,"80048 - HC CHG BASIC METABOLIC PANEL CALCIUM TOTAL",null,"66984 - REMV CATARACT EXTRACAP,INSERT LENS","66984 - REMV CATARACT EXTRACAP,INSERT LENS","66984 - REMV CATARACT EXTRACAP,INSERT LENS",null,"65860 - SEVERING ADHESIONS ANTERIOR SEGMENT LASER SPX",null,null,null,null,"67041 - HC VIT FOR MACULAR PUCKER",null,"65860 - SEVERING ADHESIONS ANTERIOR SEGMENT LASER SPX",null,null,null,"67039 - HC VITRECTOMY,FOCAL LASER RX RETINA"]
[null,"80051 - HC CHG ELECTROLYTE PANEL",null,"66985 - INSERT LENS PROSTHESIS ONLY","66985 - INSERT LENS PROSTHESIS ONLY","66985 - INSERT LENS PROSTHESIS ONLY",null,"65865 - HC INCISE INNER EYE ADHESIONS",null,null,null,null,"67042 - HC VIT FOR MACULAR HOLE",null,"65865 - HC INCISE INNER EYE ADHESIONS",null,null,null,"67040 - HC LASER TREATMENT OF RETINA"]
[null,"80053 - HC CHG COMPREHENSIVE METABOLIC PANEL",null,"66986 - HC EXCHANGE LENS PROSTHESIS","66986 - HC EXCHANGE LENS PROSTHESIS","66986 - HC EXCHANGE LENS PROSTHESIS",null,"65870 - HC SEVERING ADS ANT SEG INCAL SPX ANT SYNECHIAE",null,null,null,null,"67101 - HC RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID CRTX",null,"65870 - HC SEVERING ADS ANT SEG INCAL SPX ANT SYNECHIAE",null,null,null,"67041 - HC VIT FOR MACULAR PUCKER"]
[null,"80055 - HC CHG OBSTETRIC PANEL",null,"67005 - HC RMVL VITREOUS ANT APPR PARTIAL REMOVAL","67005 - HC RMVL VITREOUS ANT APPR PARTIAL REMOVAL","67005 - HC RMVL VITREOUS ANT APPR PARTIAL REMOVAL",null,"65875 - HC SEVERING ADS ANT SEG INCAL SPX POST SYNECHIAE",null,null,null,null,"67105 - RPR RETINAL DTCHMNT 1/> SES PC W/WO DRG SUBRETI",null,"65875 - HC SEVERING ADS ANT SEG INCAL SPX POST SYNECHIAE",null,null,null,"67042 - HC VIT FOR MACULAR HOLE"]
[null,"80061 - HC CHG LIPID PANEL",null,"67010 - HC RMVL VITREOUS ANT APPR SUBTOT RMVL MECH VITRECT","67010 - HC RMVL VITREOUS ANT APPR SUBTOT RMVL MECH VITRECT","67010 - HC RMVL VITREOUS ANT APPR SUBTOT RMVL MECH VITRECT",null,"65920 - HC REMOVE IMPLANT OF EYE",null,null,null,null,"67107 - HC REPAIR RETINAL DETACHMENT SCLERAL BUCKLING",null,"65920 - HC REMOVE IMPLANT OF EYE",null,null,null,"67101 - HC RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID CRTX"]
[null,"80069 - HC CHG RENAL FUNCTION PANEL",null,"67015 - ASPIRATION/RELEASE VITREOUS SUBRETINAL/CHOROIDAL","67015 - ASPIRATION/RELEASE VITREOUS SUBRETINAL/CHOROIDAL","67015 - ASPIRATION/RELEASE VITREOUS SUBRETINAL/CHOROIDAL",null,"66020 - INJX ANTERIOR CHAMBER EYE AIR/LIQUID SPX",null,null,null,null,"67108 - HC RPR RETINAL DTCHMNT W/VITRECTOMY ANY METH",null,"66020 - INJX ANTERIOR CHAMBER EYE AIR/LIQUID SPX",null,null,null,"67105 - RPR RETINAL DTCHMNT 1/> SES PC W/WO DRG SUBRETI"]
[null,"80074 - HC CHG ACUTE HEPATITIS PANEL",null,"67028 - INTRAVITREAL NJX PHARMACOLOGIC AGT SPX","67028 - INTRAVITREAL NJX PHARMACOLOGIC AGT SPX","67028 - INTRAVITREAL NJX PHARMACOLOGIC AGT SPX",null,"66030 - HC INJECTION TREATMENT OF EYE",null,null,null,null,"67110 - RPR RETINAL DTCHMNT INJECTION AIR/OTHER GAS",null,"66030 - HC INJECTION TREATMENT OF EYE",null,null,null,"67107 - HC REPAIR RETINAL DETACHMENT SCLERAL BUCKLING"]
[null,"80076 - HC CHG HEPATIC FUNCTION PANEL",null,"67031 - SEVERING VITREOUS STRANS LASER 1/> STAGES","67031 - SEVERING VITREOUS STRANS LASER 1/> STAGES","67031 - SEVERING VITREOUS STRANS LASER 1/> STAGES",null,"66170 - HC GLAUCOMA SURGERY",null,null,null,null,"67113 - HC REPAIR COMPLEX RETINA DETACH VITRECTOMY & MEMB PEEL",null,"66170 - HC GLAUCOMA SURGERY",null,null,null,"67108 - HC RPR RETINAL DTCHMNT W/VITRECTOMY ANY METH"]
[null,"80145 - HC DRUG ASSAY ADALIMUMAB",null,"67036 - HC VITRECTOMY,MECHANICAL","67036 - HC VITRECTOMY,MECHANICAL","67036 - HC VITRECTOMY,MECHANICAL",null,"66172 - HC INCISION OF EYE",null,null,null,null,"67120 - HC REMV POST EYE IMPLNT MATER,EXTRAOCUL",null,"66172 - HC INCISION OF EYE",null,null,null,"67110 - RPR RETINAL DTCHMNT INJECTION AIR/OTHER GAS"]
[null,"80150 - HC AMIKACIN",null,"67039 - HC VITRECTOMY,FOCAL LASER RX RETINA","67039 - HC VITRECTOMY,FOCAL LASER RX RETINA","67039 - HC VITRECTOMY,FOCAL LASER RX RETINA",null,"66179 - HC AQUEOUS SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT",null,null,null,null,"67121 - HC REMOVE EYE IMPLANT MATERIAL",null,"66179 - HC AQUEOUS SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT",null,null,null,"67113 - HC REPAIR COMPLEX RETINA DETACH VITRECTOMY & MEMB PEEL"]
[null,"80156 - HC CHG DRUG ASSAY CARBAMAZEPINE TOTAL",null,"67040 - HC LASER TREATMENT OF RETINA","67040 - HC LASER TREATMENT OF RETINA","67040 - HC LASER TREATMENT OF RETINA",null,"66180 - HC AQUEOUS SHUNT EYE W/GRAFT",null,null,null,null,"67141 - HC PROPH RTA DTCHMNT CRTX DTHRM",null,"66180 - HC AQUEOUS SHUNT EYE W/GRAFT",null,null,null,"67120 - HC REMV POST EYE IMPLNT MATER,EXTRAOCUL"]
[null,"80158 - HC CHG DRUG ASSAY CYCLOSPORINE",null,"67041 - HC VIT FOR MACULAR PUCKER","67041 - HC VIT FOR MACULAR PUCKER","67041 - HC VIT FOR MACULAR PUCKER",null,"66183 - HC INSERT ANT DRAINAGE DEVICE",null,null,null,null,"67145 - PROPH RTA DTCHMNT W/O DRG 1/> SESS",null,"66183 - HC INSERT ANT DRAINAGE DEVICE",null,null,null,"67121 - HC REMOVE EYE IMPLANT MATERIAL"]
[null,"80162 - HC CHG DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL",null,"67042 - HC VIT FOR MACULAR HOLE","67042 - HC VIT FOR MACULAR HOLE","67042 - HC VIT FOR MACULAR HOLE",null,"66185 - HC REVISE AQUEOUS SHUNT EYE",null,null,null,null,"67210 - DSTRJ LOCLZD LES RETINA 1/> SESS PC",null,"66185 - HC REVISE AQUEOUS SHUNT EYE",null,null,null,"67141 - HC PROPH RTA DTCHMNT CRTX DTHRM"]
[null,"80164 - HC CHG DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL",null,"67101 - HC RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID CRTX","67101 - HC RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID CRTX","67101 - HC RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID CRTX",null,"66250 - HC FOLLOW-UP SURGERY OF EYE",null,null,null,null,"67220 - DSTRJ LES CHOROID PC 1/> SESS",null,"66250 - HC FOLLOW-UP SURGERY OF EYE",null,null,null,"67145 - PROPH RTA DTCHMNT W/O DRG 1/> SESS"]
[null,"80168 - HC CHG DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE",null,"67105 - RPR RETINAL DTCHMNT 1/> SES PC W/WO DRG SUBRETI","67105 - RPR RETINAL DTCHMNT 1/> SES PC W/WO DRG SUBRETI","67105 - RPR RETINAL DTCHMNT 1/> SES PC W/WO DRG SUBRETI",null,"66600 - HC REMOVE IRIS AND LESION",null,null,null,null,"67221 - DSTRJ LESION CHOROID PHOTODYNAMIC THERAPY",null,"66600 - HC REMOVE IRIS AND LESION",null,null,null,"67210 - DSTRJ LOCLZD LES RETINA 1/> SESS PC"]
[null,"80169 - DRUG SCREEN QUANTITATIVE EVEROLIMUS",null,"67107 - HC REPAIR RETINAL DETACHMENT SCLERAL BUCKLING","67107 - HC REPAIR RETINAL DETACHMENT SCLERAL BUCKLING","67107 - HC REPAIR RETINAL DETACHMENT SCLERAL BUCKLING",null,"66625 - HC REMV IRIS PERIPH FOR GLAUCOMA",null,null,null,null,"67228 - EXTENSIVE RETINOPATHY 1/> SESS PHOTOCOAGULATION",null,"66625 - HC REMV IRIS PERIPH FOR GLAUCOMA",null,null,null,"67220 - DSTRJ LES CHOROID PC 1/> SESS"]
[null,"80170 - HC CHG DRUG SCREEN QUANTITATIVE GENTAMICIN",null,"67108 - HC RPR RETINAL DTCHMNT W/VITRECTOMY ANY METH","67108 - HC RPR RETINAL DTCHMNT W/VITRECTOMY ANY METH","67108 - HC RPR RETINAL DTCHMNT W/VITRECTOMY ANY METH",null,"66682 - HC REPAIR IRIS & CILIARY BODY",null,null,null,null,"67311 - HC STRABISMUS RECESSION/RESCJ 1 HRZNTL MUSC",null,"66682 - HC REPAIR IRIS & CILIARY BODY",null,null,null,"67221 - DSTRJ LESION CHOROID PHOTODYNAMIC THERAPY"]
[null,"80171 - DRUG SCREEN QUANTITATIVE GABAPENTIN",null,"67110 - RPR RETINAL DTCHMNT INJECTION AIR/OTHER GAS","67110 - RPR RETINAL DTCHMNT INJECTION AIR/OTHER GAS","67110 - RPR RETINAL DTCHMNT INJECTION AIR/OTHER GAS",null,"66710 - CILIARY BODY DSTRJ CYCLOPHOTOCOAG TRANSSCERAL",null,null,null,null,"67312 - HC STRABISMUS RECESSION/RESCJ 2 HRZNTL MUSC",null,"66710 - CILIARY BODY DSTRJ CYCLOPHOTOCOAG TRANSSCERAL",null,null,null,"67228 - EXTENSIVE RETINOPATHY 1/> SESS PHOTOCOAGULATION"]
[null,"80175 - DRUG SCREEN QUANTITATIVE LAMOTRIGINE",null,"67113 - HC REPAIR COMPLEX RETINA DETACH VITRECTOMY & MEMB PEEL","67113 - HC REPAIR COMPLEX RETINA DETACH VITRECTOMY & MEMB PEEL","67113 - HC REPAIR COMPLEX RETINA DETACH VITRECTOMY & MEMB PEEL",null,"66711 - HC ECP CILIARY BODY DESTRUCTION",null,null,null,null,"67314 - HC STRABISMUS RECESSION/RESCJ 1 VER MUSC",null,"66711 - HC ECP CILIARY BODY DESTRUCTION",null,null,null,"67311 - HC STRABISMUS RECESSION/RESCJ 1 HRZNTL MUSC"]
[null,"80177 - DRUG SCREEN QUANTITATIVE LEVETIRACETAM",null,"67120 - HC REMV POST EYE IMPLNT MATER,EXTRAOCUL","67120 - HC REMV POST EYE IMPLNT MATER,EXTRAOCUL","67120 - HC REMV POST EYE IMPLNT MATER,EXTRAOCUL",null,"66761 - IRIDOTOMY/IRRIDECTOMY LASER SURG PER SESSION",null,null,null,null,"67316 - HC STRABISMUS RECESSION/RESCJ 2/MORE VER MUSC",null,"66761 - IRIDOTOMY/IRRIDECTOMY LASER SURG PER SESSION",null,null,null,"67312 - HC STRABISMUS RECESSION/RESCJ 2 HRZNTL MUSC"]
[null,"80178 - HC CHG DRUG SCREEN QUANTITATIVE LITHIUM",null,"67121 - HC REMOVE EYE IMPLANT MATERIAL","67121 - HC REMOVE EYE IMPLANT MATERIAL","67121 - HC REMOVE EYE IMPLANT MATERIAL",null,"66762 - IRIDOPLASTY PHOTOCOAGULATION 1/> SESSIONS",null,null,null,null,"67318 - HC STRABISMUS ANY SUPERIOR OBLIQUE MUSCLE",null,"66762 - IRIDOPLASTY PHOTOCOAGULATION 1/> SESSIONS",null,null,null,"67314 - HC STRABISMUS RECESSION/RESCJ 1 VER MUSC"]
[null,"80184 - HC CHG DRUG SCREEN QUANTITATIVE PHENOBARBITAL",null,"67141 - HC PROPH RTA DTCHMNT CRTX DTHRM","67141 - HC PROPH RTA DTCHMNT CRTX DTHRM","67141 - HC PROPH RTA DTCHMNT CRTX DTHRM",null,"66821 - POST-CATARACT LASER SURGERY",null,null,null,null,"67320 - HC TRANSPOSITION PROCEDURE EXTRAOCULAR MUSC ADD-ON",null,"66821 - POST-CATARACT LASER SURGERY",null,null,null,"67316 - HC STRABISMUS RECESSION/RESCJ 2/MORE VER MUSC"]
[null,"80185 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL",null,"67145 - PROPH RTA DTCHMNT W/O DRG 1/> SESS","67145 - PROPH RTA DTCHMNT W/O DRG 1/> SESS","67145 - PROPH RTA DTCHMNT W/O DRG 1/> SESS",null,"66825 - HC REPOSITION INTRAOCULAR LENS",null,null,null,null,"67332 - HC STRABISMUS SCARRING EO MUSC/RSTCV MYOPATHY ADD-ON",null,"66825 - HC REPOSITION INTRAOCULAR LENS",null,null,null,"67318 - HC STRABISMUS ANY SUPERIOR OBLIQUE MUSCLE"]
[null,"80186 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN FREE",null,"67210 - DSTRJ LOCLZD LES RETINA 1/> SESS PC","67210 - DSTRJ LOCLZD LES RETINA 1/> SESS PC","67210 - DSTRJ LOCLZD LES RETINA 1/> SESS PC",null,"66840 - HC RMVL LENS MATERIAL ASPIR TQ 1/> STAGES",null,null,null,null,"67343 - HC RELEASE EYE TISSUE",null,"66840 - HC RMVL LENS MATERIAL ASPIR TQ 1/> STAGES",null,null,null,"67320 - HC TRANSPOSITION PROCEDURE EXTRAOCULAR MUSC ADD-ON"]
[null,"80187 - HC DRUG ASSAY POSACONAZOLE",null,"67220 - DSTRJ LES CHOROID PC 1/> SESS","67220 - DSTRJ LES CHOROID PC 1/> SESS","67220 - DSTRJ LES CHOROID PC 1/> SESS",null,"66850 - HC RMVL LENS MATERIAL PHACOFRAGMENTATION ASPIR",null,null,null,null,"67345 - HC DESTROY NERVE OF EYE MUSCLE",null,"66850 - HC RMVL LENS MATERIAL PHACOFRAGMENTATION ASPIR",null,null,null,"67332 - HC STRABISMUS SCARRING EO MUSC/RSTCV MYOPATHY ADD-ON"]
[null,"80195 - HC CHG DRUG SCREEN QUANTITATIVE SIROLIMUS",null,"67221 - DSTRJ LESION CHOROID PHOTODYNAMIC THERAPY","67221 - DSTRJ LESION CHOROID PHOTODYNAMIC THERAPY","67221 - DSTRJ LESION CHOROID PHOTODYNAMIC THERAPY",null,"66852 - HC RMVL LENS MATERIAL PARS PLANA W/WO VITRECTOMY",null,null,null,null,"67400 - HC EXPLORE/BIOPSY EYE SOCKET",null,"66852 - HC RMVL LENS MATERIAL PARS PLANA W/WO VITRECTOMY",null,null,null,"67343 - HC RELEASE EYE TISSUE"]
[null,"80197 - HC CHG DRUG SCREEN QUANTITATIVE TACROLIMUS",null,"67228 - EXTENSIVE RETINOPATHY 1/> SESS PHOTOCOAGULATION","67228 - EXTENSIVE RETINOPATHY 1/> SESS PHOTOCOAGULATION","67228 - EXTENSIVE RETINOPATHY 1/> SESS PHOTOCOAGULATION",null,"66940 - HC EXTRACTION OF LENS",null,null,null,null,"67405 - HC EXPLORE/DRAIN EYE SOCKET",null,"66940 - HC EXTRACTION OF LENS",null,null,null,"67345 - HC DESTROY NERVE OF EYE MUSCLE"]
[null,"80198 - HC Q;THEOPHYLLINE",null,"67311 - HC STRABISMUS RECESSION/RESCJ 1 HRZNTL MUSC","67311 - HC STRABISMUS RECESSION/RESCJ 1 HRZNTL MUSC","67311 - HC STRABISMUS RECESSION/RESCJ 1 HRZNTL MUSC",null,"66982 - REMV CATARACT EXTRACAP,INSERT LENS,COMP",null,null,null,null,"67412 - HC EXPLORE/TREAT EYE SOCKET",null,"66982 - REMV CATARACT EXTRACAP,INSERT LENS,COMP",null,null,null,"67400 - HC EXPLORE/BIOPSY EYE SOCKET"]
[null,"80201 - HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE",null,"67312 - HC STRABISMUS RECESSION/RESCJ 2 HRZNTL MUSC","67312 - HC STRABISMUS RECESSION/RESCJ 2 HRZNTL MUSC","67312 - HC STRABISMUS RECESSION/RESCJ 2 HRZNTL MUSC",null,"66984 - REMV CATARACT EXTRACAP,INSERT LENS",null,null,null,null,"67414 - HC EXPLR/DECOMPRESS EYE SOCKET",null,"66984 - REMV CATARACT EXTRACAP,INSERT LENS",null,null,null,"67405 - HC EXPLORE/DRAIN EYE SOCKET"]
[null,"80202 - HC CHG DRUG SCREEN QUANTITATIVE VANCOMYCIN",null,"67314 - HC STRABISMUS RECESSION/RESCJ 1 VER MUSC","67314 - HC STRABISMUS RECESSION/RESCJ 1 VER MUSC","67314 - HC STRABISMUS RECESSION/RESCJ 1 VER MUSC",null,"66985 - INSERT LENS PROSTHESIS ONLY",null,null,null,null,"67420 - HC EXPLORE/TREAT EYE SOCKET",null,"66985 - INSERT LENS PROSTHESIS ONLY",null,null,null,"67412 - HC EXPLORE/TREAT EYE SOCKET"]
[null,"80203 - DRUG SCREEN QUANTITATIVE ZONISAMIDE",null,"67316 - HC STRABISMUS RECESSION/RESCJ 2/MORE VER MUSC","67316 - HC STRABISMUS RECESSION/RESCJ 2/MORE VER MUSC","67316 - HC STRABISMUS RECESSION/RESCJ 2/MORE VER MUSC",null,"66986 - HC EXCHANGE LENS PROSTHESIS",null,null,null,null,"67505 - HC INJECT/TREAT EYE SOCKET",null,"66986 - HC EXCHANGE LENS PROSTHESIS",null,null,null,"67414 - HC EXPLR/DECOMPRESS EYE SOCKET"]
[null,"80230 - HC DRUG ASSAY INFLIXIMAB",null,"67318 - HC STRABISMUS ANY SUPERIOR OBLIQUE MUSCLE","67318 - HC STRABISMUS ANY SUPERIOR OBLIQUE MUSCLE","67318 - HC STRABISMUS ANY SUPERIOR OBLIQUE MUSCLE",null,"67005 - HC RMVL VITREOUS ANT APPR PARTIAL REMOVAL",null,null,null,null,"67515 - INJECTION MEDICATION/OTHER SUBST TENON CAPSULE",null,"67005 - HC RMVL VITREOUS ANT APPR PARTIAL REMOVAL",null,null,null,"67420 - HC EXPLORE/TREAT EYE SOCKET"]
[null,"80235 - HC DRUG ASSAY LACOSAMIDE",null,"67320 - HC TRANSPOSITION PROCEDURE EXTRAOCULAR MUSC ADD-ON","67320 - HC TRANSPOSITION PROCEDURE EXTRAOCULAR MUSC ADD-ON","67320 - HC TRANSPOSITION PROCEDURE EXTRAOCULAR MUSC ADD-ON",null,"67010 - HC RMVL VITREOUS ANT APPR SUBTOT RMVL MECH VITRECT",null,null,null,null,"67550 - HC INSERT EYE SOCKET IMPLANT",null,"67010 - HC RMVL VITREOUS ANT APPR SUBTOT RMVL MECH VITRECT",null,null,null,"67505 - HC INJECT/TREAT EYE SOCKET"]
[null,"80280 - HC DRUG ASSAY VEDOLIZUMAB",null,"67332 - HC STRABISMUS SCARRING EO MUSC/RSTCV MYOPATHY ADD-ON","67332 - HC STRABISMUS SCARRING EO MUSC/RSTCV MYOPATHY ADD-ON","67332 - HC STRABISMUS SCARRING EO MUSC/RSTCV MYOPATHY ADD-ON",null,"67015 - ASPIRATION/RELEASE VITREOUS SUBRETINAL/CHOROIDAL",null,null,null,null,"67700 - BLEPHAROTOMY DRAINAGE ABSCESS EYELID",null,"67015 - ASPIRATION/RELEASE VITREOUS SUBRETINAL/CHOROIDAL",null,null,null,"67515 - INJECTION MEDICATION/OTHER SUBST TENON CAPSULE"]
[null,"80285 - HC DRUG ASSAY VORICONAZOLE",null,"67343 - HC RELEASE EYE TISSUE","67343 - HC RELEASE EYE TISSUE","67343 - HC RELEASE EYE TISSUE",null,"67028 - INTRAVITREAL NJX PHARMACOLOGIC AGT SPX",null,null,null,null,"67710 - SEVERING TARSORRHAPHY",null,"67028 - INTRAVITREAL NJX PHARMACOLOGIC AGT SPX",null,null,null,"67550 - HC INSERT EYE SOCKET IMPLANT"]
[null,"80299 - HC INFLIXIMAB DRUG CONC. AND ANTI-INFLIXIMAB AB",null,"67345 - HC DESTROY NERVE OF EYE MUSCLE","67345 - HC DESTROY NERVE OF EYE MUSCLE","67345 - HC DESTROY NERVE OF EYE MUSCLE",null,"67031 - SEVERING VITREOUS STRANS LASER 1/> STAGES",null,null,null,null,"67715 - HC CANTHOTOMY SEPARATE PROCEDURE",null,"67031 - SEVERING VITREOUS STRANS LASER 1/> STAGES",null,null,null,"67700 - BLEPHAROTOMY DRAINAGE ABSCESS EYELID"]
[null,"80306 - HC DRUG TEST PRSMV INSTRMNT",null,"67400 - HC EXPLORE/BIOPSY EYE SOCKET","67400 - HC EXPLORE/BIOPSY EYE SOCKET","67400 - HC EXPLORE/BIOPSY EYE SOCKET",null,"67036 - HC VITRECTOMY,MECHANICAL",null,null,null,null,"67800 - EXCISION CHALAZION SINGLE",null,"67036 - HC VITRECTOMY,MECHANICAL",null,null,null,"67710 - SEVERING TARSORRHAPHY"]
[null,"80307 - HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS",null,"67405 - HC EXPLORE/DRAIN EYE SOCKET","67405 - HC EXPLORE/DRAIN EYE SOCKET","67405 - HC EXPLORE/DRAIN EYE SOCKET",null,"67039 - HC VITRECTOMY,FOCAL LASER RX RETINA",null,null,null,null,"67801 - EXCISION CHALAZION MULTIPLE SAME LID",null,"67039 - HC VITRECTOMY,FOCAL LASER RX RETINA",null,null,null,"67715 - HC CANTHOTOMY SEPARATE PROCEDURE"]
[null,"80438 - HC CHG TRH STIM PANEL 1 HR",null,"67412 - HC EXPLORE/TREAT EYE SOCKET","67412 - HC EXPLORE/TREAT EYE SOCKET","67412 - HC EXPLORE/TREAT EYE SOCKET",null,"67040 - HC LASER TREATMENT OF RETINA",null,null,null,null,"67805 - EXCISION CHALAZION MULTIPLE DIFFERENT LIDS",null,"67040 - HC LASER TREATMENT OF RETINA",null,null,null,"67800 - EXCISION CHALAZION SINGLE"]
[null,"81000 - URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY",null,"67414 - HC EXPLR/DECOMPRESS EYE SOCKET","67414 - HC EXPLR/DECOMPRESS EYE SOCKET","67414 - HC EXPLR/DECOMPRESS EYE SOCKET",null,"67041 - HC VIT FOR MACULAR PUCKER",null,null,null,null,"67808 - HC REMOVE EYELID LESION(S)",null,"67041 - HC VIT FOR MACULAR PUCKER",null,null,null,"67801 - EXCISION CHALAZION MULTIPLE SAME LID"]
[null,"81001 - URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY",null,"67420 - HC EXPLORE/TREAT EYE SOCKET","67420 - HC EXPLORE/TREAT EYE SOCKET","67420 - HC EXPLORE/TREAT EYE SOCKET",null,"67042 - HC VIT FOR MACULAR HOLE",null,null,null,null,"67810 - INCISIONAL BIOPSY EYELID SKIN & LID MARGIN",null,"67042 - HC VIT FOR MACULAR HOLE",null,null,null,"67805 - EXCISION CHALAZION MULTIPLE DIFFERENT LIDS"]
[null,"81002 - URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP",null,"67505 - HC INJECT/TREAT EYE SOCKET","67505 - HC INJECT/TREAT EYE SOCKET","67505 - HC INJECT/TREAT EYE SOCKET",null,"67101 - HC RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID CRTX",null,null,null,null,"67820 - CORRECTION TRICHIASIS EPILATION FORCEPS ONLY",null,"67101 - HC RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID CRTX",null,null,null,"67808 - HC REMOVE EYELID LESION(S)"]
[null,"81003 - URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY",null,"67515 - INJECTION MEDICATION/OTHER SUBST TENON CAPSULE","67515 - INJECTION MEDICATION/OTHER SUBST TENON CAPSULE","67515 - INJECTION MEDICATION/OTHER SUBST TENON CAPSULE",null,"67105 - RPR RETINAL DTCHMNT 1/> SES PC W/WO DRG SUBRETI",null,null,null,null,"67825 - CORRECTION TRICHIASIS EPILATION OTH/THAN FORCEPS",null,"67105 - RPR RETINAL DTCHMNT 1/> SES PC W/WO DRG SUBRETI",null,null,null,"67810 - INCISIONAL BIOPSY EYELID SKIN & LID MARGIN"]
[null,"81015 - HC CHG URINALYSIS MICROSCOPIC ONLY",null,"67550 - HC INSERT EYE SOCKET IMPLANT","67550 - HC INSERT EYE SOCKET IMPLANT","67550 - HC INSERT EYE SOCKET IMPLANT",null,"67107 - HC REPAIR RETINAL DETACHMENT SCLERAL BUCKLING",null,null,null,null,"67840 - EXC LESION EYELID W/O CLSR/W/SIMPLE DIR CLOSURE",null,"67107 - HC REPAIR RETINAL DETACHMENT SCLERAL BUCKLING",null,null,null,"67820 - CORRECTION TRICHIASIS EPILATION FORCEPS ONLY"]
[null,"81025 - URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS",null,"67700 - BLEPHAROTOMY DRAINAGE ABSCESS EYELID","67700 - BLEPHAROTOMY DRAINAGE ABSCESS EYELID","67700 - BLEPHAROTOMY DRAINAGE ABSCESS EYELID",null,"67108 - HC RPR RETINAL DTCHMNT W/VITRECTOMY ANY METH",null,null,null,null,"67850 - HC DESTRUC EYELID LESN, <1 CM",null,"67108 - HC RPR RETINAL DTCHMNT W/VITRECTOMY ANY METH",null,null,null,"67825 - CORRECTION TRICHIASIS EPILATION OTH/THAN FORCEPS"]
[null,"81050 - HC CHG VOLUME MEASUREMENT TIMED COLLECTION EACH",null,"67710 - SEVERING TARSORRHAPHY","67710 - SEVERING TARSORRHAPHY","67710 - SEVERING TARSORRHAPHY",null,"67110 - RPR RETINAL DTCHMNT INJECTION AIR/OTHER GAS",null,null,null,null,"67875 - TEMPORARY CLOSURE EYELIDS SUTURE",null,"67110 - RPR RETINAL DTCHMNT INJECTION AIR/OTHER GAS",null,null,null,"67840 - EXC LESION EYELID W/O CLSR/W/SIMPLE DIR CLOSURE"]
[null,"81161 - HC DMD DUPLICATION/DELETION ANALYSIS",null,"67715 - HC CANTHOTOMY SEPARATE PROCEDURE","67715 - HC CANTHOTOMY SEPARATE PROCEDURE","67715 - HC CANTHOTOMY SEPARATE PROCEDURE",null,"67113 - HC REPAIR COMPLEX RETINA DETACH VITRECTOMY & MEMB PEEL",null,null,null,null,"67880 - HC REVISION OF EYELID",null,"67113 - HC REPAIR COMPLEX RETINA DETACH VITRECTOMY & MEMB PEEL",null,null,null,"67850 - HC DESTRUC EYELID LESN, <1 CM"]
[null,"81178 - HC CHG ATXN1 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES",null,"67800 - EXCISION CHALAZION SINGLE","67800 - EXCISION CHALAZION SINGLE","67800 - EXCISION CHALAZION SINGLE",null,"67120 - HC REMV POST EYE IMPLNT MATER,EXTRAOCUL",null,null,null,null,"67882 - HC REVISION EYELID,XPOSITN TARSAL PLATE",null,"67120 - HC REMV POST EYE IMPLNT MATER,EXTRAOCUL",null,null,null,"67875 - TEMPORARY CLOSURE EYELIDS SUTURE"]
[null,"81179 - HC CHG ATXN2 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES",null,"67801 - EXCISION CHALAZION MULTIPLE SAME LID","67801 - EXCISION CHALAZION MULTIPLE SAME LID","67801 - EXCISION CHALAZION MULTIPLE SAME LID",null,"67121 - HC REMOVE EYE IMPLANT MATERIAL",null,null,null,null,"67900 - HC REPAIR BROW DEFECT",null,"67121 - HC REMOVE EYE IMPLANT MATERIAL",null,null,null,"67880 - HC REVISION OF EYELID"]
[null,"81180 - HC CHG ATXN3 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES",null,"67805 - EXCISION CHALAZION MULTIPLE DIFFERENT LIDS","67805 - EXCISION CHALAZION MULTIPLE DIFFERENT LIDS","67805 - EXCISION CHALAZION MULTIPLE DIFFERENT LIDS",null,"67141 - HC PROPH RTA DTCHMNT CRTX DTHRM",null,null,null,null,"67901 - HC RPR BLEPHAROPTOSIS FRONTALIS MUSC SUTR/OTH MATRL",null,"67141 - HC PROPH RTA DTCHMNT CRTX DTHRM",null,null,null,"67882 - HC REVISION EYELID,XPOSITN TARSAL PLATE"]
[null,"81206 - HC CHG BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE",null,"67808 - HC REMOVE EYELID LESION(S)","67808 - HC REMOVE EYELID LESION(S)","67808 - HC REMOVE EYELID LESION(S)",null,"67145 - PROPH RTA DTCHMNT W/O DRG 1/> SESS",null,null,null,null,"67902 - HC RPR BLEPHAROPT FRONTALIS MUSC AUTOL FASCAL SLING",null,"67145 - PROPH RTA DTCHMNT W/O DRG 1/> SESS",null,null,null,"67900 - HC REPAIR BROW DEFECT"]
[null,"81207 - HC Q;P190 BCR-ABL 1",null,"67810 - INCISIONAL BIOPSY EYELID SKIN & LID MARGIN","67810 - INCISIONAL BIOPSY EYELID SKIN & LID MARGIN","67810 - INCISIONAL BIOPSY EYELID SKIN & LID MARGIN",null,"67210 - DSTRJ LOCLZD LES RETINA 1/> SESS PC",null,null,null,null,"67903 - HC RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT INTERNAL",null,"67210 - DSTRJ LOCLZD LES RETINA 1/> SESS PC",null,null,null,"67901 - HC RPR BLEPHAROPTOSIS FRONTALIS MUSC SUTR/OTH MATRL"]
[null,"81210 - HC CHG BRAF GENE ANALYSIS V600 VARIANT(S)",null,"67820 - CORRECTION TRICHIASIS EPILATION FORCEPS ONLY","67820 - CORRECTION TRICHIASIS EPILATION FORCEPS ONLY","67820 - CORRECTION TRICHIASIS EPILATION FORCEPS ONLY",null,"67220 - DSTRJ LES CHOROID PC 1/> SESS",null,null,null,null,"67904 - HC RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT XTRNL",null,"67220 - DSTRJ LES CHOROID PC 1/> SESS",null,null,null,"67902 - HC RPR BLEPHAROPT FRONTALIS MUSC AUTOL FASCAL SLING"]
[null,"81218 - HC CEBPA GENE ANALYSIS FULL GENE SEQUENC",null,"67825 - CORRECTION TRICHIASIS EPILATION OTH/THAN FORCEPS","67825 - CORRECTION TRICHIASIS EPILATION OTH/THAN FORCEPS","67825 - CORRECTION TRICHIASIS EPILATION OTH/THAN FORCEPS",null,"67221 - DSTRJ LESION CHOROID PHOTODYNAMIC THERAPY",null,null,null,null,"67911 - HC CORRECT LID RETRACTN",null,"67221 - DSTRJ LESION CHOROID PHOTODYNAMIC THERAPY",null,null,null,"67903 - HC RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT INTERNAL"]
[null,"81220 - HC CHG CFTR GENE ANALYSIS COMMON VARIANTS",null,"67840 - EXC LESION EYELID W/O CLSR/W/SIMPLE DIR CLOSURE","67840 - EXC LESION EYELID W/O CLSR/W/SIMPLE DIR CLOSURE","67840 - EXC LESION EYELID W/O CLSR/W/SIMPLE DIR CLOSURE",null,"67228 - EXTENSIVE RETINOPATHY 1/> SESS PHOTOCOAGULATION",null,null,null,null,"67912 - CORRJ LAGOPHTHALMOS IMPLTJ UPR EYELID LID LOAD",null,"67228 - EXTENSIVE RETINOPATHY 1/> SESS PHOTOCOAGULATION",null,null,null,"67904 - HC RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT XTRNL"]
[null,"81221 - HC CHG CFTR GENE ANALYSIS KNOWN FAMILIAL VARIANTS",null,"67850 - HC DESTRUC EYELID LESN, <1 CM","67850 - HC DESTRUC EYELID LESN, <1 CM","67850 - HC DESTRUC EYELID LESN, <1 CM",null,"67299 - EYE SURG POST SGMT PROC UNLISTED",null,null,null,null,"67917 - REPAIR ECTROPION EXTENSIVE",null,"67299 - EYE SURG POST SGMT PROC UNLISTED",null,null,null,"67911 - HC CORRECT LID RETRACTN"]
[null,"81222 - HC GEN CYSTIC FIBROSIS DEL/DUP",null,"67875 - TEMPORARY CLOSURE EYELIDS SUTURE","67875 - TEMPORARY CLOSURE EYELIDS SUTURE","67875 - TEMPORARY CLOSURE EYELIDS SUTURE",null,"67311 - HC STRABISMUS RECESSION/RESCJ 1 HRZNTL MUSC",null,null,null,null,"67921 - HC FIX ENTROPION,SUTURE",null,"67311 - HC STRABISMUS RECESSION/RESCJ 1 HRZNTL MUSC",null,null,null,"67912 - CORRJ LAGOPHTHALMOS IMPLTJ UPR EYELID LID LOAD"]
[null,"81223 - HC CFTR GENE ANALYSIS FULL GENE SEQUENCE",null,"67880 - HC REVISION OF EYELID","67880 - HC REVISION OF EYELID","67880 - HC REVISION OF EYELID",null,"67312 - HC STRABISMUS RECESSION/RESCJ 2 HRZNTL MUSC",null,null,null,null,"67923 - HC REPAIR ENTROPION EXCISION TARSAL WEDGE",null,"67312 - HC STRABISMUS RECESSION/RESCJ 2 HRZNTL MUSC",null,null,null,"67917 - REPAIR ECTROPION EXTENSIVE"]
[null,"81229 - HC CYTOG ALYS CHRML ABNR SNPCGH",null,"67882 - HC REVISION EYELID,XPOSITN TARSAL PLATE","67882 - HC REVISION EYELID,XPOSITN TARSAL PLATE","67882 - HC REVISION EYELID,XPOSITN TARSAL PLATE",null,"67314 - HC STRABISMUS RECESSION/RESCJ 1 VER MUSC",null,null,null,null,"67924 - HC FIX ENTROPION,EXTENSV LID REPAIR",null,"67314 - HC STRABISMUS RECESSION/RESCJ 1 VER MUSC",null,null,null,"67921 - HC FIX ENTROPION,SUTURE"]
[null,"81235 - HC CHG EGFR GENE ANALYSIS COMMON VARIANTS",null,"67900 - HC REPAIR BROW DEFECT","67900 - HC REPAIR BROW DEFECT","67900 - HC REPAIR BROW DEFECT",null,"67316 - HC STRABISMUS RECESSION/RESCJ 2/MORE VER MUSC",null,null,null,null,"67930 - HC SUTURE EYELID WOUND,PARTIAL THICK",null,"67316 - HC STRABISMUS RECESSION/RESCJ 2/MORE VER MUSC",null,null,null,"67923 - HC REPAIR ENTROPION EXCISION TARSAL WEDGE"]
[null,"81240 - HC CHG F2 GENE ANALYSIS 20210G >A VARIANT",null,"67901 - HC RPR BLEPHAROPTOSIS FRONTALIS MUSC SUTR/OTH MATRL","67901 - HC RPR BLEPHAROPTOSIS FRONTALIS MUSC SUTR/OTH MATRL","67901 - HC RPR BLEPHAROPTOSIS FRONTALIS MUSC SUTR/OTH MATRL",null,"67318 - HC STRABISMUS ANY SUPERIOR OBLIQUE MUSCLE",null,null,null,null,"67935 - HC SUTURE EYELID WOUND,FULL THICK",null,"67318 - HC STRABISMUS ANY SUPERIOR OBLIQUE MUSCLE",null,null,null,"67924 - HC FIX ENTROPION,EXTENSV LID REPAIR"]
[null,"81241 - HC CHG F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT",null,"67902 - HC RPR BLEPHAROPT FRONTALIS MUSC AUTOL FASCAL SLING","67902 - HC RPR BLEPHAROPT FRONTALIS MUSC AUTOL FASCAL SLING","67902 - HC RPR BLEPHAROPT FRONTALIS MUSC AUTOL FASCAL SLING",null,"67320 - HC TRANSPOSITION PROCEDURE EXTRAOCULAR MUSC ADD-ON",null,null,null,null,"67961 - HC REVISION OF EYELID,< 1/4 LID MARGIN",null,"67320 - HC TRANSPOSITION PROCEDURE EXTRAOCULAR MUSC ADD-ON",null,null,null,"67930 - HC SUTURE EYELID WOUND,PARTIAL THICK"]
[null,"81243 - HC CHG FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES",null,"67903 - HC RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT INTERNAL","67903 - HC RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT INTERNAL","67903 - HC RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT INTERNAL",null,"67332 - HC STRABISMUS SCARRING EO MUSC/RSTCV MYOPATHY ADD-ON",null,null,null,null,"67966 - HC EXCISION & REPAIR EYELID ONE-FOURTH LID MARGIN",null,"67332 - HC STRABISMUS SCARRING EO MUSC/RSTCV MYOPATHY ADD-ON",null,null,null,"67935 - HC SUTURE EYELID WOUND,FULL THICK"]
[null,"81252 - HC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCEHC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCE",null,"67904 - HC RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT XTRNL","67904 - HC RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT XTRNL","67904 - HC RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT XTRNL",null,"67343 - HC RELEASE EYE TISSUE",null,null,null,null,"67971 - HC RCNSTJ EYELID FULL THICKNESS </TWO-THIRDS 1 STG",null,"67343 - HC RELEASE EYE TISSUE",null,null,null,"67961 - HC REVISION OF EYELID,< 1/4 LID MARGIN"]
[null,"81253 - HC CHG GJB2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS",null,"67911 - HC CORRECT LID RETRACTN","67911 - HC CORRECT LID RETRACTN","67911 - HC CORRECT LID RETRACTN",null,"67345 - HC DESTROY NERVE OF EYE MUSCLE",null,null,null,null,"67973 - HC RCNSTJ EYELID FULL THICKNESS LOWER EYELID 1 STG",null,"67345 - HC DESTROY NERVE OF EYE MUSCLE",null,null,null,"67966 - HC EXCISION & REPAIR EYELID ONE-FOURTH LID MARGIN"]
[null,"81254 - HC CHG GJB6 GENE ANALYSIS COMMON VARIANTS",null,"67912 - CORRJ LAGOPHTHALMOS IMPLTJ UPR EYELID LID LOAD","67912 - CORRJ LAGOPHTHALMOS IMPLTJ UPR EYELID LID LOAD","67912 - CORRJ LAGOPHTHALMOS IMPLTJ UPR EYELID LID LOAD",null,"67400 - HC EXPLORE/BIOPSY EYE SOCKET",null,null,null,null,"68020 - HC INCISE/DRAIN CONJUNCTIVA",null,"67400 - HC EXPLORE/BIOPSY EYE SOCKET",null,null,null,"67971 - HC RCNSTJ EYELID FULL THICKNESS </TWO-THIRDS 1 STG"]
[null,"81256 - HC CHG HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS",null,"67917 - REPAIR ECTROPION EXTENSIVE","67917 - REPAIR ECTROPION EXTENSIVE","67917 - REPAIR ECTROPION EXTENSIVE",null,"67405 - HC EXPLORE/DRAIN EYE SOCKET",null,null,null,null,"68100 - HC BIOPSY OF CONJUNCTIVA",null,"67405 - HC EXPLORE/DRAIN EYE SOCKET",null,null,null,"67973 - HC RCNSTJ EYELID FULL THICKNESS LOWER EYELID 1 STG"]
[null,"81257 - HC CHG HBA1/HBA2 ANALYSIS FOR COMMON DELETIONS/VARIANT",null,"67921 - HC FIX ENTROPION,SUTURE","67921 - HC FIX ENTROPION,SUTURE","67921 - HC FIX ENTROPION,SUTURE",null,"67412 - HC EXPLORE/TREAT EYE SOCKET",null,null,null,null,"68110 - EXCISION LESION CONJUNCTIVA </1 CM",null,"67412 - HC EXPLORE/TREAT EYE SOCKET",null,null,null,"68020 - HC INCISE/DRAIN CONJUNCTIVA"]
[null,"81259 - HC HBA1/HBA2 GENE ANALYSIS FULL GENE SEQUENCE",null,"67923 - HC REPAIR ENTROPION EXCISION TARSAL WEDGE","67923 - HC REPAIR ENTROPION EXCISION TARSAL WEDGE","67923 - HC REPAIR ENTROPION EXCISION TARSAL WEDGE",null,"67414 - HC EXPLR/DECOMPRESS EYE SOCKET",null,null,null,null,"68115 - HC REMOVE EYELID LINING LESION",null,"67414 - HC EXPLR/DECOMPRESS EYE SOCKET",null,null,null,"68100 - HC BIOPSY OF CONJUNCTIVA"]
[null,"81261 - IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED; PRO/TECH",null,"67924 - HC FIX ENTROPION,EXTENSV LID REPAIR","67924 - HC FIX ENTROPION,EXTENSV LID REPAIR","67924 - HC FIX ENTROPION,EXTENSV LID REPAIR",null,"67420 - HC EXPLORE/TREAT EYE SOCKET",null,null,null,null,"68200 - SUBCONJUNCTIVAL INJECTION",null,"67420 - HC EXPLORE/TREAT EYE SOCKET",null,null,null,"68110 - EXCISION LESION CONJUNCTIVA </1 CM"]
[null,"81269 - HC HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIENTS",null,"67930 - HC SUTURE EYELID WOUND,PARTIAL THICK","67930 - HC SUTURE EYELID WOUND,PARTIAL THICK","67930 - HC SUTURE EYELID WOUND,PARTIAL THICK",null,"67505 - HC INJECT/TREAT EYE SOCKET",null,null,null,null,"68320 - HC CONJUNCTIVOPLASTY W/GRF/XTNSV REARRANGEMENT",null,"67505 - HC INJECT/TREAT EYE SOCKET",null,null,null,"68115 - HC REMOVE EYELID LINING LESION"]
[null,"81270 - HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT",null,"67935 - HC SUTURE EYELID WOUND,FULL THICK","67935 - HC SUTURE EYELID WOUND,FULL THICK","67935 - HC SUTURE EYELID WOUND,FULL THICK",null,"67515 - INJECTION MEDICATION/OTHER SUBST TENON CAPSULE",null,null,null,null,"68325 - HC CONJUNCTIVOPLASTY W/BUCCAL MUC MEMB GRAFT",null,"67515 - INJECTION MEDICATION/OTHER SUBST TENON CAPSULE",null,null,null,"68200 - SUBCONJUNCTIVAL INJECTION"]
[null,"81271 - HC HTT GENE ANALYSIS DECTECT ABNORMAL ALLELES",null,"67961 - HC REVISION OF EYELID,< 1/4 LID MARGIN","67961 - HC REVISION OF EYELID,< 1/4 LID MARGIN","67961 - HC REVISION OF EYELID,< 1/4 LID MARGIN",null,"67550 - HC INSERT EYE SOCKET IMPLANT",null,null,null,null,"68335 - HC RPR SYMBLEPHARON FR GRF CJNC/BUCCAL MUC MEMB",null,"67550 - HC INSERT EYE SOCKET IMPLANT",null,null,null,"68320 - HC CONJUNCTIVOPLASTY W/GRF/XTNSV REARRANGEMENT"]
[null,"81272 - HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS",null,"67966 - HC EXCISION & REPAIR EYELID ONE-FOURTH LID MARGIN","67966 - HC EXCISION & REPAIR EYELID ONE-FOURTH LID MARGIN","67966 - HC EXCISION & REPAIR EYELID ONE-FOURTH LID MARGIN",null,"67700 - BLEPHAROTOMY DRAINAGE ABSCESS EYELID",null,null,null,null,"68340 - HC DIVISION OF SYMBLEPHARON",null,"67700 - BLEPHAROTOMY DRAINAGE ABSCESS EYELID",null,null,null,"68325 - HC CONJUNCTIVOPLASTY W/BUCCAL MUC MEMB GRAFT"]
[null,"81274 - HC HTT GENE ANALYSIS CHARACTERIZATION ALLELES",null,"67971 - HC RCNSTJ EYELID FULL THICKNESS </TWO-THIRDS 1 STG","67971 - HC RCNSTJ EYELID FULL THICKNESS </TWO-THIRDS 1 STG","67971 - HC RCNSTJ EYELID FULL THICKNESS </TWO-THIRDS 1 STG",null,"67710 - SEVERING TARSORRHAPHY",null,null,null,null,"68362 - HC CONJUNCTIVAL FLAP TOTAL",null,"67710 - SEVERING TARSORRHAPHY",null,null,null,"68335 - HC RPR SYMBLEPHARON FR GRF CJNC/BUCCAL MUC MEMB"]
[null,"81275 - HC CHG KRAS GENE ANALYSIS VARIANTS IN EXON 2",null,"67973 - HC RCNSTJ EYELID FULL THICKNESS LOWER EYELID 1 STG","67973 - HC RCNSTJ EYELID FULL THICKNESS LOWER EYELID 1 STG","67973 - HC RCNSTJ EYELID FULL THICKNESS LOWER EYELID 1 STG",null,"67715 - HC CANTHOTOMY SEPARATE PROCEDURE",null,null,null,null,"68440 - HC INCISE TEAR DUCT OPENING",null,"67715 - HC CANTHOTOMY SEPARATE PROCEDURE",null,null,null,"68340 - HC DIVISION OF SYMBLEPHARON"]
[null,"81276 - HC CHG KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)",null,"68020 - HC INCISE/DRAIN CONJUNCTIVA","68020 - HC INCISE/DRAIN CONJUNCTIVA","68020 - HC INCISE/DRAIN CONJUNCTIVA",null,"67800 - EXCISION CHALAZION SINGLE",null,null,null,null,"68530 - HC CLEARANCE OF TEAR DUCT",null,"67800 - EXCISION CHALAZION SINGLE",null,null,null,"68362 - HC CONJUNCTIVAL FLAP TOTAL"]
[null,"81277 - HC CYTOGENOMIC NEO MICRORA ALYS",null,"68100 - HC BIOPSY OF CONJUNCTIVA","68100 - HC BIOPSY OF CONJUNCTIVA","68100 - HC BIOPSY OF CONJUNCTIVA",null,"67801 - EXCISION CHALAZION MULTIPLE SAME LID",null,null,null,null,"68700 - HC REPAIR TEAR DUCTS",null,"67801 - EXCISION CHALAZION MULTIPLE SAME LID",null,null,null,"68440 - HC INCISE TEAR DUCT OPENING"]
[null,"81288 - MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS",null,"68110 - EXCISION LESION CONJUNCTIVA </1 CM","68110 - EXCISION LESION CONJUNCTIVA </1 CM","68110 - EXCISION LESION CONJUNCTIVA </1 CM",null,"67805 - EXCISION CHALAZION MULTIPLE DIFFERENT LIDS",null,null,null,null,"68720 - HC CREATE TEAR SAC DRAIN",null,"67805 - EXCISION CHALAZION MULTIPLE DIFFERENT LIDS",null,null,null,"68530 - HC CLEARANCE OF TEAR DUCT"]
[null,"81291 - HC CHG MTHFR GENE ANALYSIS COMMON VARIANTS",null,"68115 - HC REMOVE EYELID LINING LESION","68115 - HC REMOVE EYELID LINING LESION","68115 - HC REMOVE EYELID LINING LESION",null,"67808 - HC REMOVE EYELID LESION(S)",null,null,null,null,"68750 - HC CREATE TEAR DUCT DRAIN",null,"67808 - HC REMOVE EYELID LESION(S)",null,null,null,"68700 - HC REPAIR TEAR DUCTS"]
[null,"81301 - HC CHG MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF",null,"68200 - SUBCONJUNCTIVAL INJECTION","68200 - SUBCONJUNCTIVAL INJECTION","68200 - SUBCONJUNCTIVAL INJECTION",null,"67810 - INCISIONAL BIOPSY EYELID SKIN & LID MARGIN",null,null,null,null,"68760 - HC CLOSE TEAR DUCT OPENING",null,"67810 - INCISIONAL BIOPSY EYELID SKIN & LID MARGIN",null,null,null,"68720 - HC CREATE TEAR SAC DRAIN"]
[null,"81302 - HC Q;RETT SYN ANLY",null,"68320 - HC CONJUNCTIVOPLASTY W/GRF/XTNSV REARRANGEMENT","68320 - HC CONJUNCTIVOPLASTY W/GRF/XTNSV REARRANGEMENT","68320 - HC CONJUNCTIVOPLASTY W/GRF/XTNSV REARRANGEMENT",null,"67820 - CORRECTION TRICHIASIS EPILATION FORCEPS ONLY",null,null,null,null,"68761 - CLSR LACRIMAL PUNCTUM PLUG EACH",null,"67820 - CORRECTION TRICHIASIS EPILATION FORCEPS ONLY",null,null,null,"68750 - HC CREATE TEAR DUCT DRAIN"]
[null,"81304 - HC MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT",null,"68325 - HC CONJUNCTIVOPLASTY W/BUCCAL MUC MEMB GRAFT","68325 - HC CONJUNCTIVOPLASTY W/BUCCAL MUC MEMB GRAFT","68325 - HC CONJUNCTIVOPLASTY W/BUCCAL MUC MEMB GRAFT",null,"67825 - CORRECTION TRICHIASIS EPILATION OTH/THAN FORCEPS",null,null,null,null,"68801 - DILATION LACRIMAL PUNCTUM W/WO IRRGATION",null,"67825 - CORRECTION TRICHIASIS EPILATION OTH/THAN FORCEPS",null,null,null,"68760 - HC CLOSE TEAR DUCT OPENING"]
[null,"81305 - HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT",null,"68335 - HC RPR SYMBLEPHARON FR GRF CJNC/BUCCAL MUC MEMB","68335 - HC RPR SYMBLEPHARON FR GRF CJNC/BUCCAL MUC MEMB","68335 - HC RPR SYMBLEPHARON FR GRF CJNC/BUCCAL MUC MEMB",null,"67840 - EXC LESION EYELID W/O CLSR/W/SIMPLE DIR CLOSURE",null,null,null,null,"68810 - HC PROBE NASOLACRIMAL DUCT",null,"67840 - EXC LESION EYELID W/O CLSR/W/SIMPLE DIR CLOSURE",null,null,null,"68761 - CLSR LACRIMAL PUNCTUM PLUG EACH"]
[null,"81307 - HC PALB2 GENE FULL GENE SEQ",null,"68340 - HC DIVISION OF SYMBLEPHARON","68340 - HC DIVISION OF SYMBLEPHARON","68340 - HC DIVISION OF SYMBLEPHARON",null,"67850 - HC DESTRUC EYELID LESN, <1 CM",null,null,null,null,"68811 - HC PROBE NASOLACRIMAL DUCT",null,"67850 - HC DESTRUC EYELID LESN, <1 CM",null,null,null,"68801 - DILATION LACRIMAL PUNCTUM W/WO IRRGATION"]
[null,"81308 - HC PALB2 GENE KNOWN FAMIL VRNT",null,"68362 - HC CONJUNCTIVAL FLAP TOTAL","68362 - HC CONJUNCTIVAL FLAP TOTAL","68362 - HC CONJUNCTIVAL FLAP TOTAL",null,"67875 - TEMPORARY CLOSURE EYELIDS SUTURE",null,null,null,null,"68815 - HC PROBE NASOLAC DUCT,INSERT TUBE/STENT",null,"67875 - TEMPORARY CLOSURE EYELIDS SUTURE",null,null,null,"68810 - HC PROBE NASOLACRIMAL DUCT"]
[null,"81309 - HC PIK3CA GENE TRGT SEQ ALYS",null,"68440 - HC INCISE TEAR DUCT OPENING","68440 - HC INCISE TEAR DUCT OPENING","68440 - HC INCISE TEAR DUCT OPENING",null,"67880 - HC REVISION OF EYELID",null,null,null,null,"68816 - HC PROBE NL DUCT W/BALLOON",null,"67880 - HC REVISION OF EYELID",null,null,null,"68811 - HC PROBE NASOLACRIMAL DUCT"]
[null,"81311 - HC CHG NRAS GENE ANALYSIS VARIANTS IN EXON 2&3",null,"68530 - HC CLEARANCE OF TEAR DUCT","68530 - HC CLEARANCE OF TEAR DUCT","68530 - HC CLEARANCE OF TEAR DUCT",null,"67882 - HC REVISION EYELID,XPOSITN TARSAL PLATE",null,null,null,null,"68840 - HC EXPLORE LACRIMAL CANALICULI",null,"67882 - HC REVISION EYELID,XPOSITN TARSAL PLATE",null,null,null,"68815 - HC PROBE NASOLAC DUCT,INSERT TUBE/STENT"]
[null,"81315 - HC PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT",null,"68700 - HC REPAIR TEAR DUCTS","68700 - HC REPAIR TEAR DUCTS","68700 - HC REPAIR TEAR DUCTS",null,"67900 - HC REPAIR BROW DEFECT",null,null,null,null,"69000 - DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE",null,"67900 - HC REPAIR BROW DEFECT",null,null,null,"68816 - HC PROBE NL DUCT W/BALLOON"]
[null,"81329 - HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS",null,"68720 - HC CREATE TEAR SAC DRAIN","68720 - HC CREATE TEAR SAC DRAIN","68720 - HC CREATE TEAR SAC DRAIN",null,"67901 - HC RPR BLEPHAROPTOSIS FRONTALIS MUSC SUTR/OTH MATRL",null,null,null,null,"69005 - DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX",null,"67901 - HC RPR BLEPHAROPTOSIS FRONTALIS MUSC SUTR/OTH MATRL",null,null,null,"68840 - HC EXPLORE LACRIMAL CANALICULI"]
[null,"81331 - HC PRADER-WILLI/ANGELMAN",null,"68750 - HC CREATE TEAR DUCT DRAIN","68750 - HC CREATE TEAR DUCT DRAIN","68750 - HC CREATE TEAR DUCT DRAIN",null,"67902 - HC RPR BLEPHAROPT FRONTALIS MUSC AUTOL FASCAL SLING",null,null,null,null,"69020 - DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS",null,"67902 - HC RPR BLEPHAROPT FRONTALIS MUSC AUTOL FASCAL SLING",null,null,null,"69000 - DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE"]
[null,"81342 - TRG@ GENE REARRANGEMENT ANALYSIS; PRO/TECH",null,"68760 - HC CLOSE TEAR DUCT OPENING","68760 - HC CLOSE TEAR DUCT OPENING","68760 - HC CLOSE TEAR DUCT OPENING",null,"67903 - HC RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT INTERNAL",null,null,null,null,"69100 - BIOPSY EXTERNAL EAR",null,"67903 - HC RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT INTERNAL",null,null,null,"69005 - DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX"]
[null,"81350 - HC CHG UGT1A1 GENE ANALYSIS COMMON VARIANTS",null,"68761 - CLSR LACRIMAL PUNCTUM PLUG EACH","68761 - CLSR LACRIMAL PUNCTUM PLUG EACH","68761 - CLSR LACRIMAL PUNCTUM PLUG EACH",null,"67904 - HC RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT XTRNL",null,null,null,null,"69105 - BIOPSY EXTERNAL AUDITORY CANAL",null,"67904 - HC RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT XTRNL",null,null,null,"69020 - DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS"]
[null,"81363 - HC HBB DUPLICATION/DELETION VARIANTS",null,"68801 - DILATION LACRIMAL PUNCTUM W/WO IRRGATION","68801 - DILATION LACRIMAL PUNCTUM W/WO IRRGATION","68801 - DILATION LACRIMAL PUNCTUM W/WO IRRGATION",null,"67911 - HC CORRECT LID RETRACTN",null,null,null,null,"69110 - HC REMOVAL EXTERNAL EAR,PARTIAL",null,"67911 - HC CORRECT LID RETRACTN",null,null,null,"69100 - BIOPSY EXTERNAL EAR"]
[null,"81364 - HC HBB FULL GENE SEQUENCE",null,"68810 - HC PROBE NASOLACRIMAL DUCT","68810 - HC PROBE NASOLACRIMAL DUCT","68810 - HC PROBE NASOLACRIMAL DUCT",null,"67912 - CORRJ LAGOPHTHALMOS IMPLTJ UPR EYELID LID LOAD",null,null,null,null,"69145 - EXCISION SOFT TIS LES EXTERNAL AUDITORY CANAL",null,"67912 - CORRJ LAGOPHTHALMOS IMPLTJ UPR EYELID LID LOAD",null,null,null,"69105 - BIOPSY EXTERNAL AUDITORY CANAL"]
[null,"81401 - HC CHG, MOLECULAR PATHOLOGY PROCEDURE LEVEL 2",null,"68811 - HC PROBE NASOLACRIMAL DUCT","68811 - HC PROBE NASOLACRIMAL DUCT","68811 - HC PROBE NASOLACRIMAL DUCT",null,"67917 - REPAIR ECTROPION EXTENSIVE",null,null,null,null,"69200 - RMVL FB XTRNL AUDITORY CANAL W/O ANES",null,"67917 - REPAIR ECTROPION EXTENSIVE",null,null,null,"69110 - HC REMOVAL EXTERNAL EAR,PARTIAL"]
[null,"81402 - HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 3",null,"68815 - HC PROBE NASOLAC DUCT,INSERT TUBE/STENT","68815 - HC PROBE NASOLAC DUCT,INSERT TUBE/STENT","68815 - HC PROBE NASOLAC DUCT,INSERT TUBE/STENT",null,"67921 - HC FIX ENTROPION,SUTURE",null,null,null,null,"69209 - RMVL IMPACTED CERUMEN USING IRRIGATION/LAVAGE,UNILATERAL",null,"67921 - HC FIX ENTROPION,SUTURE",null,null,null,"69145 - EXCISION SOFT TIS LES EXTERNAL AUDITORY CANAL"]
[null,"81403 - SEQ & EXON 13 SEQ, IF PERFORMED KRAS (EG, CARCINOMA), GENE ANALYSIS, PRO/TECH",null,"68816 - HC PROBE NL DUCT W/BALLOON","68816 - HC PROBE NL DUCT W/BALLOON","68816 - HC PROBE NL DUCT W/BALLOON",null,"67923 - HC REPAIR ENTROPION EXCISION TARSAL WEDGE",null,null,null,null,"69210 - RMVL IMPACTED CERUMEN SPX 1/BOTH EARS",null,"67923 - HC REPAIR ENTROPION EXCISION TARSAL WEDGE",null,null,null,"69200 - RMVL FB XTRNL AUDITORY CANAL W/O ANES"]
[null,"81404 - VHL (EG, VON HIPPEL-LINDAUFAMILIAL CANCER SYNDROME, FULL GENE SEQ VWF PRO/TECH",null,"68840 - HC EXPLORE LACRIMAL CANALICULI","68840 - HC EXPLORE LACRIMAL CANALICULI","68840 - HC EXPLORE LACRIMAL CANALICULI",null,"67924 - HC FIX ENTROPION,EXTENSV LID REPAIR",null,null,null,null,"69220 - DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE",null,"67924 - HC FIX ENTROPION,EXTENSV LID REPAIR",null,null,null,"69209 - RMVL IMPACTED CERUMEN USING IRRIGATION/LAVAGE,UNILATERAL"]
[null,"81405 - HC MOPATH PROCEDURE LEVEL 6",null,"69000 - DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE","69000 - DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE","69000 - DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE",null,"67930 - HC SUTURE EYELID WOUND,PARTIAL THICK",null,null,null,null,"69222 - DEBRIDEMENT MASTOIDECTOMY CAVITY CMPLX",null,"67930 - HC SUTURE EYELID WOUND,PARTIAL THICK",null,null,null,"69210 - RMVL IMPACTED CERUMEN SPX 1/BOTH EARS"]
[null,"81406 - HC CHG MOLECULAR PATHOLOGY PROCEDURE LEVEL 7",null,"69005 - DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX","69005 - DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX","69005 - DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX",null,"67935 - HC SUTURE EYELID WOUND,FULL THICK",null,null,null,null,"69300 - HC OTOPLASTY PROTRUDING EAR W WO SIZE RDCTJ",null,"67935 - HC SUTURE EYELID WOUND,FULL THICK",null,null,null,"69220 - DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE"]
[null,"81430 - HC CHG HEARING LOSS GENOMIC SEQUENCE ANALYSIS 60 GENES",null,"69020 - DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS","69020 - DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS","69020 - DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS",null,"67961 - HC REVISION OF EYELID,< 1/4 LID MARGIN",null,null,null,null,"69420 - MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ",null,"67961 - HC REVISION OF EYELID,< 1/4 LID MARGIN",null,null,null,"69222 - DEBRIDEMENT MASTOIDECTOMY CAVITY CMPLX"]
[null,"81431 - HC CHG HEARING LOSS DUP/DEL ANALYSIS",null,"69090 - EAR PIERCING","69090 - EAR PIERCING","69090 - EAR PIERCING",null,"67966 - HC EXCISION & REPAIR EYELID ONE-FOURTH LID MARGIN",null,null,null,null,"69433 - TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA",null,"67966 - HC EXCISION & REPAIR EYELID ONE-FOURTH LID MARGIN",null,null,null,"69300 - HC OTOPLASTY PROTRUDING EAR W WO SIZE RDCTJ"]
[null,"81450 - HC CHG GENOMIC SEQ ANALYS DNA&RNA ANALYS 5-50 GENE",null,"69100 - BIOPSY EXTERNAL EAR","69100 - BIOPSY EXTERNAL EAR","69100 - BIOPSY EXTERNAL EAR",null,"67971 - HC RCNSTJ EYELID FULL THICKNESS </TWO-THIRDS 1 STG",null,null,null,null,"69436 - HC CREATE EARDRUM OPENING,GEN ANESTH",null,"67971 - HC RCNSTJ EYELID FULL THICKNESS </TWO-THIRDS 1 STG",null,null,null,"69420 - MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ"]
[null,"81522 - HC ONC BREAST MRNA 12 GENES",null,"69105 - BIOPSY EXTERNAL AUDITORY CANAL","69105 - BIOPSY EXTERNAL AUDITORY CANAL","69105 - BIOPSY EXTERNAL AUDITORY CANAL",null,"67973 - HC RCNSTJ EYELID FULL THICKNESS LOWER EYELID 1 STG",null,null,null,null,"69501 - MASTOIDECTOMY,SIMPLE",null,"67973 - HC RCNSTJ EYELID FULL THICKNESS LOWER EYELID 1 STG",null,null,null,"69433 - TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA"]
[null,"81542 - HC ONC PROSTATE MRNA 22 CNT GEN",null,"69110 - HC REMOVAL EXTERNAL EAR,PARTIAL","69110 - HC REMOVAL EXTERNAL EAR,PARTIAL","69110 - HC REMOVAL EXTERNAL EAR,PARTIAL",null,"68020 - HC INCISE/DRAIN CONJUNCTIVA",null,null,null,null,"69540 - HC REMV AURAL POLYP",null,"68020 - HC INCISE/DRAIN CONJUNCTIVA",null,null,null,"69436 - HC CREATE EARDRUM OPENING,GEN ANESTH"]
[null,"81596 - HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR",null,"69145 - EXCISION SOFT TIS LES EXTERNAL AUDITORY CANAL","69145 - EXCISION SOFT TIS LES EXTERNAL AUDITORY CANAL","69145 - EXCISION SOFT TIS LES EXTERNAL AUDITORY CANAL",null,"68100 - HC BIOPSY OF CONJUNCTIVA",null,null,null,null,"69620 - MYRINGOPLASTY",null,"68100 - HC BIOPSY OF CONJUNCTIVA",null,null,null,"69501 - MASTOIDECTOMY,SIMPLE"]
[null,"82009 - HC CHG KETONE BODIES SERUM QUALITATIVE",null,"69200 - RMVL FB XTRNL AUDITORY CANAL W/O ANES","69200 - RMVL FB XTRNL AUDITORY CANAL W/O ANES","69200 - RMVL FB XTRNL AUDITORY CANAL W/O ANES",null,"68110 - EXCISION LESION CONJUNCTIVA </1 CM",null,null,null,null,"69631 - HC TYMPANOPLASTY",null,"68110 - EXCISION LESION CONJUNCTIVA </1 CM",null,null,null,"69540 - HC REMV AURAL POLYP"]
[null,"82010 - HC CHG KETONE BODIES SERUM QUANTITATIVE",null,"69209 - RMVL IMPACTED CERUMEN USING IRRIGATION/LAVAGE,UNILATERAL","69209 - RMVL IMPACTED CERUMEN USING IRRIGATION/LAVAGE,UNILATERAL","69209 - RMVL IMPACTED CERUMEN USING IRRIGATION/LAVAGE,UNILATERAL",null,"68115 - HC REMOVE EYELID LINING LESION",null,null,null,null,"69801 - LABYRINTHOTOMY TRANSCANAL",null,"68115 - HC REMOVE EYELID LINING LESION",null,null,null,"69620 - MYRINGOPLASTY"]
[null,"82017 - HC CHG ACYLCARNITINES QUANTIATIVE EACH SPECIMEN",null,"69210 - RMVL IMPACTED CERUMEN SPX 1/BOTH EARS","69210 - RMVL IMPACTED CERUMEN SPX 1/BOTH EARS","69210 - RMVL IMPACTED CERUMEN SPX 1/BOTH EARS",null,"68200 - SUBCONJUNCTIVAL INJECTION",null,null,null,null,"70010 - HC CHG MYELOGRAPHY POST FOSSA",null,"68200 - SUBCONJUNCTIVAL INJECTION",null,null,null,"69631 - HC TYMPANOPLASTY"]
[null,"82024 - HC CHG ADRENOCORTICOTROPIC HORMONE ACTH",null,"69220 - DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE","69220 - DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE","69220 - DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE",null,"68320 - HC CONJUNCTIVOPLASTY W/GRF/XTNSV REARRANGEMENT",null,null,null,null,"70030 - HC CHG RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY",null,"68320 - HC CONJUNCTIVOPLASTY W/GRF/XTNSV REARRANGEMENT",null,null,null,"69801 - LABYRINTHOTOMY TRANSCANAL"]
[null,"82040 - HC CHG ALBUMIN SERUM PLASMA/WHOLE BLOOD",null,"69222 - DEBRIDEMENT MASTOIDECTOMY CAVITY CMPLX","69222 - DEBRIDEMENT MASTOIDECTOMY CAVITY CMPLX","69222 - DEBRIDEMENT MASTOIDECTOMY CAVITY CMPLX",null,"68325 - HC CONJUNCTIVOPLASTY W/BUCCAL MUC MEMB GRAFT",null,null,null,null,"70100 - HC CHG RADIOLOGIC EXAMINATION MANDIPLE PRTL <4 VIEWS",null,"68325 - HC CONJUNCTIVOPLASTY W/BUCCAL MUC MEMB GRAFT",null,null,null,"70010 - HC CHG MYELOGRAPHY POST FOSSA"]
[null,"82042 - HC CHG ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN",null,"69300 - HC OTOPLASTY PROTRUDING EAR W WO SIZE RDCTJ","69300 - HC OTOPLASTY PROTRUDING EAR W WO SIZE RDCTJ","69300 - HC OTOPLASTY PROTRUDING EAR W WO SIZE RDCTJ",null,"68335 - HC RPR SYMBLEPHARON FR GRF CJNC/BUCCAL MUC MEMB",null,null,null,null,"70110 - HC CHG RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS",null,"68335 - HC RPR SYMBLEPHARON FR GRF CJNC/BUCCAL MUC MEMB",null,null,null,"70030 - HC CHG RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY"]
[null,"82043 - HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE",null,"69420 - MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ","69420 - MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ","69420 - MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ",null,"68340 - HC DIVISION OF SYMBLEPHARON",null,null,null,null,"70130 - HC CHG RADEX MASTOIDS COMPL MINIMUM 3 VIEWS SIDE",null,"68340 - HC DIVISION OF SYMBLEPHARON",null,null,null,"70100 - HC CHG RADIOLOGIC EXAMINATION MANDIPLE PRTL <4 VIEWS"]
[null,"82075 - HC CHG ASSAY OF ALCOHOL BREATH",null,"69433 - TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA","69433 - TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA","69433 - TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA",null,"68362 - HC CONJUNCTIVAL FLAP TOTAL",null,null,null,null,"70140 - HC CHG RADEX FACIAL BONES < 3 VIEWS",null,"68362 - HC CONJUNCTIVAL FLAP TOTAL",null,null,null,"70110 - HC CHG RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS"]
[null,"82085 - HC CHG ASSAY OF ALDOLASE",null,"69436 - HC CREATE EARDRUM OPENING,GEN ANESTH","69436 - HC CREATE EARDRUM OPENING,GEN ANESTH","69436 - HC CREATE EARDRUM OPENING,GEN ANESTH",null,"68440 - HC INCISE TEAR DUCT OPENING",null,null,null,null,"70150 - HC CHG RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS",null,"68440 - HC INCISE TEAR DUCT OPENING",null,null,null,"70130 - HC CHG RADEX MASTOIDS COMPL MINIMUM 3 VIEWS SIDE"]
[null,"82088 - HC CHG ASSAY OF ALDOSTERONE",null,"69501 - MASTOIDECTOMY,SIMPLE","69501 - MASTOIDECTOMY,SIMPLE","69501 - MASTOIDECTOMY,SIMPLE",null,"68530 - HC CLEARANCE OF TEAR DUCT",null,null,null,null,"70160 - RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS",null,"68530 - HC CLEARANCE OF TEAR DUCT",null,null,null,"70140 - HC CHG RADEX FACIAL BONES < 3 VIEWS"]
[null,"82103 - HC CHG ALPHA-1-ANTITRYPSIN TOTAL",null,"69540 - HC REMV AURAL POLYP","69540 - HC REMV AURAL POLYP","69540 - HC REMV AURAL POLYP",null,"68700 - HC REPAIR TEAR DUCTS",null,null,null,null,"70200 - HC CHG RADEX ORBITS COMPLETE MINIMUM 4 VIEWS",null,"68700 - HC REPAIR TEAR DUCTS",null,null,null,"70150 - HC CHG RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS"]
[null,"82104 - HC CHG ALPHA-1-ANTITRYPSIN PHENOTYPE",null,"69620 - MYRINGOPLASTY","69620 - MYRINGOPLASTY","69620 - MYRINGOPLASTY",null,"68720 - HC CREATE TEAR SAC DRAIN",null,null,null,null,"70210 - HC CHG RADEX SINUSES PARANASAL <3 VIEWS",null,"68720 - HC CREATE TEAR SAC DRAIN",null,null,null,"70160 - RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS"]
[null,"82105 - HC CHG ALPHA-FETOPROTEIN SERUM",null,"69631 - HC TYMPANOPLASTY","69631 - HC TYMPANOPLASTY","69631 - HC TYMPANOPLASTY",null,"68750 - HC CREATE TEAR DUCT DRAIN",null,null,null,null,"70220 - HC CHG RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS",null,"68750 - HC CREATE TEAR DUCT DRAIN",null,null,null,"70200 - HC CHG RADEX ORBITS COMPLETE MINIMUM 4 VIEWS"]
[null,"82139 - HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE",null,"69801 - LABYRINTHOTOMY TRANSCANAL","69801 - LABYRINTHOTOMY TRANSCANAL","69801 - LABYRINTHOTOMY TRANSCANAL",null,"68760 - HC CLOSE TEAR DUCT OPENING",null,null,null,null,"70250 - RADIOLOGIC EXAMINATION SKULL 4/> VIEWS",null,"68760 - HC CLOSE TEAR DUCT OPENING",null,null,null,"70210 - HC CHG RADEX SINUSES PARANASAL <3 VIEWS"]
[null,"82140 - HC CHG ASSAY OF AMMONIA",null,"70010 - HC CHG MYELOGRAPHY POST FOSSA","70010 - HC CHG MYELOGRAPHY POST FOSSA","70010 - HC CHG MYELOGRAPHY POST FOSSA",null,"68761 - CLSR LACRIMAL PUNCTUM PLUG EACH",null,null,null,null,"70260 - HC CHG RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS",null,"68761 - CLSR LACRIMAL PUNCTUM PLUG EACH",null,null,null,"70220 - HC CHG RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS"]
[null,"82150 - HC CHG ASSAY OF AMYLASE",null,"70030 - HC CHG RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY","70030 - HC CHG RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY","70030 - HC CHG RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY",null,"68801 - DILATION LACRIMAL PUNCTUM W/WO IRRGATION",null,null,null,null,"70300 - RADIOLOGIC EXAMINATION TEETH 1 VIEW",null,"68801 - DILATION LACRIMAL PUNCTUM W/WO IRRGATION",null,null,null,"70250 - RADIOLOGIC EXAMINATION SKULL 4/> VIEWS"]
[null,"82157 - HC CHG ANDROSTENEDIONE",null,"70100 - HC CHG RADIOLOGIC EXAMINATION MANDIPLE PRTL <4 VIEWS","70100 - HC CHG RADIOLOGIC EXAMINATION MANDIPLE PRTL <4 VIEWS","70100 - HC CHG RADIOLOGIC EXAMINATION MANDIPLE PRTL <4 VIEWS",null,"68810 - HC PROBE NASOLACRIMAL DUCT",null,null,null,null,"70310 - RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH",null,"68810 - HC PROBE NASOLACRIMAL DUCT",null,null,null,"70260 - HC CHG RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS"]
[null,"82164 - HC CHG ANGIOTENSIN I-CONVERTING ENZYME",null,"70110 - HC CHG RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS","70110 - HC CHG RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS","70110 - HC CHG RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS",null,"68811 - HC PROBE NASOLACRIMAL DUCT",null,null,null,null,"70320 - RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH",null,"68811 - HC PROBE NASOLACRIMAL DUCT",null,null,null,"70300 - RADIOLOGIC EXAMINATION TEETH 1 VIEW"]
[null,"82172 - HC CHG APOLIPOPROTEIN EACH",null,"70130 - HC CHG RADEX MASTOIDS COMPL MINIMUM 3 VIEWS SIDE","70130 - HC CHG RADEX MASTOIDS COMPL MINIMUM 3 VIEWS SIDE","70130 - HC CHG RADEX MASTOIDS COMPL MINIMUM 3 VIEWS SIDE",null,"68815 - HC PROBE NASOLAC DUCT,INSERT TUBE/STENT",null,null,null,null,"70328 - RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT",null,"68815 - HC PROBE NASOLAC DUCT,INSERT TUBE/STENT",null,null,null,"70310 - RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH"]
[null,"82175 - HC CHG ASSAY OF ARSENIC",null,"70140 - HC CHG RADEX FACIAL BONES < 3 VIEWS","70140 - HC CHG RADEX FACIAL BONES < 3 VIEWS","70140 - HC CHG RADEX FACIAL BONES < 3 VIEWS",null,"68816 - HC PROBE NL DUCT W/BALLOON",null,null,null,null,"70330 - RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT",null,"68816 - HC PROBE NL DUCT W/BALLOON",null,null,null,"70320 - RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH"]
[null,"82180 - HC CHG ASSAY OF ASCORBIC ACID BLOOD",null,"70150 - HC CHG RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS","70150 - HC CHG RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS","70150 - HC CHG RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS",null,"68840 - HC EXPLORE LACRIMAL CANALICULI",null,null,null,null,"70336 - HC CHG MRI TEMPOROMANDIBULAR JOINT",null,"68840 - HC EXPLORE LACRIMAL CANALICULI",null,null,null,"70328 - RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT"]
[null,"82232 - HC CHG BETA-2 MICROGLOBULIN",null,"70160 - RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS","70160 - RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS","70160 - RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS",null,"69000 - DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE",null,null,null,null,"70350 - HC CHG CEPHALOGRAM ORTHODONTIC",null,"69000 - DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE",null,null,null,"70330 - RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT"]
[null,"82247 - HC CHG BILIRUBIN TOTAL",null,"70200 - HC CHG RADEX ORBITS COMPLETE MINIMUM 4 VIEWS","70200 - HC CHG RADEX ORBITS COMPLETE MINIMUM 4 VIEWS","70200 - HC CHG RADEX ORBITS COMPLETE MINIMUM 4 VIEWS",null,"69005 - DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX",null,null,null,null,"70355 - ORTHOPANTOGRAM",null,"69005 - DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX",null,null,null,"70336 - HC CHG MRI TEMPOROMANDIBULAR JOINT"]
[null,"82248 - HC CHG BILIRUBIN DIRECT",null,"70210 - HC CHG RADEX SINUSES PARANASAL <3 VIEWS","70210 - HC CHG RADEX SINUSES PARANASAL <3 VIEWS","70210 - HC CHG RADEX SINUSES PARANASAL <3 VIEWS",null,"69020 - DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS",null,null,null,null,"70360 - HC CHG RADIOLOGIC EXAMINATION NECK SOFT TISSUE",null,"69020 - DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS",null,null,null,"70350 - HC CHG CEPHALOGRAM ORTHODONTIC"]
[null,"82270 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER",null,"70220 - HC CHG RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS","70220 - HC CHG RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS","70220 - HC CHG RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS",null,"69090 - EAR PIERCING",null,null,null,null,"70370 - HC CHG RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ",null,"69090 - EAR PIERCING",null,null,null,"70355 - ORTHOPANTOGRAM"]
[null,"82271 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES",null,"70250 - RADIOLOGIC EXAMINATION SKULL 4/> VIEWS","70250 - RADIOLOGIC EXAMINATION SKULL 4/> VIEWS","70250 - RADIOLOGIC EXAMINATION SKULL 4/> VIEWS",null,"69100 - BIOPSY EXTERNAL EAR",null,null,null,null,"70380 - HC X-RAY SALIVARY GLAND",null,"69100 - BIOPSY EXTERNAL EAR",null,null,null,"70360 - HC CHG RADIOLOGIC EXAMINATION NECK SOFT TISSUE"]
[null,"82274 - HC CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3",null,"70260 - HC CHG RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS","70260 - HC CHG RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS","70260 - HC CHG RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS",null,"69105 - BIOPSY EXTERNAL AUDITORY CANAL",null,null,null,null,"70390 - HC SIALOGRAPHY",null,"69105 - BIOPSY EXTERNAL AUDITORY CANAL",null,null,null,"70370 - HC CHG RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ"]
[null,"82306 - HC CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED",null,"70300 - RADIOLOGIC EXAMINATION TEETH 1 VIEW","70300 - RADIOLOGIC EXAMINATION TEETH 1 VIEW","70300 - RADIOLOGIC EXAMINATION TEETH 1 VIEW",null,"69110 - HC REMOVAL EXTERNAL EAR,PARTIAL",null,null,null,null,"70450 - HC CHG CT HEAD/BRAIN W/O CONTRAST MATERIAL",null,"69110 - HC REMOVAL EXTERNAL EAR,PARTIAL",null,null,null,"70380 - HC X-RAY SALIVARY GLAND"]
[null,"82308 - HC CHG CALCITONIN",null,"70310 - RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH","70310 - RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH","70310 - RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH",null,"69145 - EXCISION SOFT TIS LES EXTERNAL AUDITORY CANAL",null,null,null,null,"70460 - HC CHG CT HEAD/BRAIN W/CONTRAST MATERIAL",null,"69145 - EXCISION SOFT TIS LES EXTERNAL AUDITORY CANAL",null,null,null,"70390 - HC SIALOGRAPHY"]
[null,"82310 - HC CHG CALCIUM TOTAL",null,"70320 - RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH","70320 - RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH","70320 - RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH",null,"69200 - RMVL FB XTRNL AUDITORY CANAL W/O ANES",null,null,null,null,"70470 - HC CHG CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL",null,"69200 - RMVL FB XTRNL AUDITORY CANAL W/O ANES",null,null,null,"70450 - HC CHG CT HEAD/BRAIN W/O CONTRAST MATERIAL"]
[null,"82330 - HC CHG CALCIUM IONIZED",null,"70328 - RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT","70328 - RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT","70328 - RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT",null,"69209 - RMVL IMPACTED CERUMEN USING IRRIGATION/LAVAGE,UNILATERAL",null,null,null,null,"70480 - HC CHG CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL",null,"69209 - RMVL IMPACTED CERUMEN USING IRRIGATION/LAVAGE,UNILATERAL",null,null,null,"70460 - HC CHG CT HEAD/BRAIN W/CONTRAST MATERIAL"]
[null,"82340 - HC Q;KID STONE, UR CALCIUM",null,"70330 - RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT","70330 - RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT","70330 - RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT",null,"69210 - RMVL IMPACTED CERUMEN SPX 1/BOTH EARS",null,null,null,null,"70481 - HC CHG CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL",null,"69210 - RMVL IMPACTED CERUMEN SPX 1/BOTH EARS",null,null,null,"70470 - HC CHG CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL"]
[null,"82365 - HC CHG CALCULUS INFRARED SPECTROSCOPY",null,"70336 - HC CHG MRI TEMPOROMANDIBULAR JOINT","70336 - HC CHG MRI TEMPOROMANDIBULAR JOINT","70336 - HC CHG MRI TEMPOROMANDIBULAR JOINT",null,"69220 - DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE",null,null,null,null,"70482 - HC CHG CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR",null,"69220 - DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE",null,null,null,"70480 - HC CHG CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL"]
[null,"82374 - HC CHG CARBON DIOXIDE BICARBONATE",null,"70350 - HC CHG CEPHALOGRAM ORTHODONTIC","70350 - HC CHG CEPHALOGRAM ORTHODONTIC","70350 - HC CHG CEPHALOGRAM ORTHODONTIC",null,"69222 - DEBRIDEMENT MASTOIDECTOMY CAVITY CMPLX",null,null,null,null,"70486 - HC CHG CT MAXILLOFACIAL W/O CONTRAST MATERIAL",null,"69222 - DEBRIDEMENT MASTOIDECTOMY CAVITY CMPLX",null,null,null,"70481 - HC CHG CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL"]
[null,"82375 - HC CHG CARBOXYHEMOGLOBIN QUANTITATIVE",null,"70355 - ORTHOPANTOGRAM","70355 - ORTHOPANTOGRAM","70355 - ORTHOPANTOGRAM",null,"69300 - HC OTOPLASTY PROTRUDING EAR W WO SIZE RDCTJ",null,null,null,null,"70487 - HC CHG CT MAXILLOFACIAL W/CONTRAST MATERIAL",null,"69300 - HC OTOPLASTY PROTRUDING EAR W WO SIZE RDCTJ",null,null,null,"70482 - HC CHG CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR"]
[null,"82378 - HC CHG CARCINOEMBRYONIC ANTIGEN CEA",null,"70360 - HC CHG RADIOLOGIC EXAMINATION NECK SOFT TISSUE","70360 - HC CHG RADIOLOGIC EXAMINATION NECK SOFT TISSUE","70360 - HC CHG RADIOLOGIC EXAMINATION NECK SOFT TISSUE",null,"69399 - HC OUTER EAR SURGERY PROCEDURE",null,null,null,null,"70488 - HC CHG CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL",null,"69399 - HC OUTER EAR SURGERY PROCEDURE",null,null,null,"70486 - HC CHG CT MAXILLOFACIAL W/O CONTRAST MATERIAL"]
[null,"82379 - HC CRL;CARNITINE",null,"70370 - HC CHG RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ","70370 - HC CHG RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ","70370 - HC CHG RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ",null,"69420 - MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ",null,null,null,null,"70490 - HC CHG CT SOFT TISSUE NECK W/O CONTRAST MATERIAL",null,"69420 - MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ",null,null,null,"70487 - HC CHG CT MAXILLOFACIAL W/CONTRAST MATERIAL"]
[null,"82384 - HC CHG CATECHOLAMINES FRACTIONATED",null,"70380 - HC X-RAY SALIVARY GLAND","70380 - HC X-RAY SALIVARY GLAND","70380 - HC X-RAY SALIVARY GLAND",null,"69433 - TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA",null,null,null,null,"70491 - HC CHG CT SOFT TISSUE NECK W/CONTRAST MATERIAL",null,"69433 - TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA",null,null,null,"70488 - HC CHG CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL"]
[null,"82390 - HC CHG CERULOPLASMIN",null,"70390 - HC SIALOGRAPHY","70390 - HC SIALOGRAPHY","70390 - HC SIALOGRAPHY",null,"69436 - HC CREATE EARDRUM OPENING,GEN ANESTH",null,null,null,null,"70492 - HC CHG CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL",null,"69436 - HC CREATE EARDRUM OPENING,GEN ANESTH",null,null,null,"70490 - HC CHG CT SOFT TISSUE NECK W/O CONTRAST MATERIAL"]
[null,"82397 - HC CHEMILUMINESCENT ASSAY",null,"70450 - HC CHG CT HEAD/BRAIN W/O CONTRAST MATERIAL","70450 - HC CHG CT HEAD/BRAIN W/O CONTRAST MATERIAL","70450 - HC CHG CT HEAD/BRAIN W/O CONTRAST MATERIAL",null,"69501 - MASTOIDECTOMY,SIMPLE",null,null,null,null,"70496 - HC CHG CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST",null,"69501 - MASTOIDECTOMY,SIMPLE",null,null,null,"70491 - HC CHG CT SOFT TISSUE NECK W/CONTRAST MATERIAL"]
[null,"82435 - HC CHG CHLORIDE BLD",null,"70460 - HC CHG CT HEAD/BRAIN W/CONTRAST MATERIAL","70460 - HC CHG CT HEAD/BRAIN W/CONTRAST MATERIAL","70460 - HC CHG CT HEAD/BRAIN W/CONTRAST MATERIAL",null,"69540 - HC REMV AURAL POLYP",null,null,null,null,"70498 - HC CHG CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST",null,"69540 - HC REMV AURAL POLYP",null,null,null,"70492 - HC CHG CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL"]
[null,"82436 - HC CHG CHLORIDE URINE",null,"70470 - HC CHG CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL","70470 - HC CHG CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL","70470 - HC CHG CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL",null,"69620 - MYRINGOPLASTY",null,null,null,null,"70540 - HC CHG MRI ORBIT FACE &/NECK W/O CONTRAST",null,"69620 - MYRINGOPLASTY",null,null,null,"70496 - HC CHG CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST"]
[null,"82438 - HC CHG CHLORIDE OTHER SOURCE",null,"70480 - HC CHG CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL","70480 - HC CHG CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL","70480 - HC CHG CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL",null,"69631 - HC TYMPANOPLASTY",null,null,null,null,"70542 - HC CHG MRI ORBIT FACE & NECK W/CONTRAST MATERIAL",null,"69631 - HC TYMPANOPLASTY",null,null,null,"70498 - HC CHG CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST"]
[null,"82465 - CHOLESTEROL SERUM/WHOLE BLOOD TOTAL",null,"70481 - HC CHG CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL","70481 - HC CHG CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL","70481 - HC CHG CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL",null,"69801 - LABYRINTHOTOMY TRANSCANAL",null,null,null,null,"70543 - HC CHG MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL",null,"69801 - LABYRINTHOTOMY TRANSCANAL",null,null,null,"70540 - HC CHG MRI ORBIT FACE &/NECK W/O CONTRAST"]
[null,"82495 - HC CHG ASSAY OF CHROMIUM",null,"70482 - HC CHG CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR","70482 - HC CHG CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR","70482 - HC CHG CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR",null,"70010 - HC CHG MYELOGRAPHY POST FOSSA",null,null,null,null,"70544 - HC CHG MRA HEAD W/O CONTRST MATERIAL",null,"70010 - HC CHG MYELOGRAPHY POST FOSSA",null,null,null,"70542 - HC CHG MRI ORBIT FACE & NECK W/CONTRAST MATERIAL"]
[null,"82507 - HC CHG ASSAY OF CITRATE",null,"70486 - HC CHG CT MAXILLOFACIAL W/O CONTRAST MATERIAL","70486 - HC CHG CT MAXILLOFACIAL W/O CONTRAST MATERIAL","70486 - HC CHG CT MAXILLOFACIAL W/O CONTRAST MATERIAL",null,"70030 - HC CHG RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY",null,null,null,null,"70545 - HC CHG MRA HEAD W/CONTRAST MATERIAL",null,"70030 - HC CHG RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY",null,null,null,"70543 - HC CHG MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL"]
[null,"82523 - HC CHG COLLAGEN CROSS LINKS ANY METHOD",null,"70487 - HC CHG CT MAXILLOFACIAL W/CONTRAST MATERIAL","70487 - HC CHG CT MAXILLOFACIAL W/CONTRAST MATERIAL","70487 - HC CHG CT MAXILLOFACIAL W/CONTRAST MATERIAL",null,"70100 - HC CHG RADIOLOGIC EXAMINATION MANDIPLE PRTL <4 VIEWS",null,null,null,null,"70546 - HC CHG MRA HEAD W/O & W/CONTRAST MATERIAL",null,"70100 - HC CHG RADIOLOGIC EXAMINATION MANDIPLE PRTL <4 VIEWS",null,null,null,"70544 - HC CHG MRA HEAD W/O CONTRST MATERIAL"]
[null,"82525 - HC CHG ASSAY OF COPPER",null,"70488 - HC CHG CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL","70488 - HC CHG CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL","70488 - HC CHG CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL",null,"70110 - HC CHG RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS",null,null,null,null,"70547 - HC CHG MRA NECK W/O CONTRST MATERIAL",null,"70110 - HC CHG RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS",null,null,null,"70545 - HC CHG MRA HEAD W/CONTRAST MATERIAL"]
[null,"82530 - HC CHG CORTISOL FREE",null,"70490 - HC CHG CT SOFT TISSUE NECK W/O CONTRAST MATERIAL","70490 - HC CHG CT SOFT TISSUE NECK W/O CONTRAST MATERIAL","70490 - HC CHG CT SOFT TISSUE NECK W/O CONTRAST MATERIAL",null,"70130 - HC CHG RADEX MASTOIDS COMPL MINIMUM 3 VIEWS SIDE",null,null,null,null,"70548 - HC CHG MRA NECK W/CONTRAST MATERIAL",null,"70130 - HC CHG RADEX MASTOIDS COMPL MINIMUM 3 VIEWS SIDE",null,null,null,"70546 - HC CHG MRA HEAD W/O & W/CONTRAST MATERIAL"]
[null,"82533 - HC CHG CORTISOL TOTAL",null,"70491 - HC CHG CT SOFT TISSUE NECK W/CONTRAST MATERIAL","70491 - HC CHG CT SOFT TISSUE NECK W/CONTRAST MATERIAL","70491 - HC CHG CT SOFT TISSUE NECK W/CONTRAST MATERIAL",null,"70140 - HC CHG RADEX FACIAL BONES < 3 VIEWS",null,null,null,null,"70549 - HC MRA,NECK;W/WO",null,"70140 - HC CHG RADEX FACIAL BONES < 3 VIEWS",null,null,null,"70547 - HC CHG MRA NECK W/O CONTRST MATERIAL"]
[null,"82540 - HC CHG ASSAY OF CREATINE",null,"70492 - HC CHG CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL","70492 - HC CHG CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL","70492 - HC CHG CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL",null,"70150 - HC CHG RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS",null,null,null,null,"70551 - HC CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL",null,"70150 - HC CHG RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS",null,null,null,"70548 - HC CHG MRA NECK W/CONTRAST MATERIAL"]
[null,"82542 - HC CHG COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC",null,"70496 - HC CHG CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST","70496 - HC CHG CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST","70496 - HC CHG CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST",null,"70160 - RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS",null,null,null,null,"70552 - HC CHG MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL",null,"70160 - RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS",null,null,null,"70549 - HC MRA,NECK;W/WO"]
[null,"82550 - HC CHG CREATINE KINASE TOTAL",null,"70498 - HC CHG CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST","70498 - HC CHG CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST","70498 - HC CHG CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST",null,"70200 - HC CHG RADEX ORBITS COMPLETE MINIMUM 4 VIEWS",null,null,null,null,"70553 - HC CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL",null,"70200 - HC CHG RADEX ORBITS COMPLETE MINIMUM 4 VIEWS",null,null,null,"70551 - HC CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL"]
[null,"82553 - HC CHG CREATINE KINASE MB FRACTION ONLY",null,"70540 - HC CHG MRI ORBIT FACE &/NECK W/O CONTRAST","70540 - HC CHG MRI ORBIT FACE &/NECK W/O CONTRAST","70540 - HC CHG MRI ORBIT FACE &/NECK W/O CONTRAST",null,"70210 - HC CHG RADEX SINUSES PARANASAL <3 VIEWS",null,null,null,null,"70555 - HC CHG MRI BRAIN FUNCTIONAL W/PHYSICIAN ADMNISTRATION",null,"70210 - HC CHG RADEX SINUSES PARANASAL <3 VIEWS",null,null,null,"70552 - HC CHG MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL"]
[null,"82565 - HC CHG CREATININE BLOOD",null,"70542 - HC CHG MRI ORBIT FACE & NECK W/CONTRAST MATERIAL","70542 - HC CHG MRI ORBIT FACE & NECK W/CONTRAST MATERIAL","70542 - HC CHG MRI ORBIT FACE & NECK W/CONTRAST MATERIAL",null,"70220 - HC CHG RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS",null,null,null,null,"71045 - HC CHG RADIOLOGIC EXAM CHEST SINGLE VIEW",null,"70220 - HC CHG RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS",null,null,null,"70553 - HC CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL"]
[null,"82570 - HC CHG CREATININE OTHER SOURCE",null,"70543 - HC CHG MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL","70543 - HC CHG MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL","70543 - HC CHG MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL",null,"70250 - RADIOLOGIC EXAMINATION SKULL 4/> VIEWS",null,null,null,null,"71046 - HC CHG RADIOLOGIC EXAM CHEST 2 VIEWS",null,"70250 - RADIOLOGIC EXAMINATION SKULL 4/> VIEWS",null,null,null,"70555 - HC CHG MRI BRAIN FUNCTIONAL W/PHYSICIAN ADMNISTRATION"]
[null,"82575 - HC CHG CREATININE CLEARANCE",null,"70544 - HC CHG MRA HEAD W/O CONTRST MATERIAL","70544 - HC CHG MRA HEAD W/O CONTRST MATERIAL","70544 - HC CHG MRA HEAD W/O CONTRST MATERIAL",null,"70260 - HC CHG RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS",null,null,null,null,"71047 - HC XRAY CHEST 3 VIEWS",null,"70260 - HC CHG RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS",null,null,null,"71045 - HC CHG RADIOLOGIC EXAM CHEST SINGLE VIEW"]
[null,"82585 - HC CHG ASSAY OF CRYOFIBRN",null,"70545 - HC CHG MRA HEAD W/CONTRAST MATERIAL","70545 - HC CHG MRA HEAD W/CONTRAST MATERIAL","70545 - HC CHG MRA HEAD W/CONTRAST MATERIAL",null,"70300 - RADIOLOGIC EXAMINATION TEETH 1 VIEW",null,null,null,null,"71048 - HC XRAY CHEST 4+ VIEWS",null,"70300 - RADIOLOGIC EXAMINATION TEETH 1 VIEW",null,null,null,"71046 - HC CHG RADIOLOGIC EXAM CHEST 2 VIEWS"]
[null,"82595 - HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE",null,"70546 - HC CHG MRA HEAD W/O & W/CONTRAST MATERIAL","70546 - HC CHG MRA HEAD W/O & W/CONTRAST MATERIAL","70546 - HC CHG MRA HEAD W/O & W/CONTRAST MATERIAL",null,"70310 - RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH",null,null,null,null,"71100 - HC CHG X-RAY RIBS 2VW UNILAT",null,"70310 - RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH",null,null,null,"71047 - HC XRAY CHEST 3 VIEWS"]
[null,"82607 - HC CHG CYANOCOBALAMIN VITAMIN B-12",null,"70547 - HC CHG MRA NECK W/O CONTRST MATERIAL","70547 - HC CHG MRA NECK W/O CONTRST MATERIAL","70547 - HC CHG MRA NECK W/O CONTRST MATERIAL",null,"70320 - RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH",null,null,null,null,"71101 - HC CHG RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS",null,"70320 - RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH",null,null,null,"71048 - HC XRAY CHEST 4+ VIEWS"]
[null,"82626 - HC CHG DEHYDROEPIANDROSTERONE",null,"70548 - HC CHG MRA NECK W/CONTRAST MATERIAL","70548 - HC CHG MRA NECK W/CONTRAST MATERIAL","70548 - HC CHG MRA NECK W/CONTRAST MATERIAL",null,"70328 - RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT",null,null,null,null,"71110 - HC CHG RADEX RIBS BILATERAL 3 VIEWS",null,"70328 - RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT",null,null,null,"71100 - HC CHG X-RAY RIBS 2VW UNILAT"]
[null,"82627 - HC CHG DEHYDROEPIANDROSTERONE-SULFATE",null,"70549 - HC MRA,NECK;W/WO","70549 - HC MRA,NECK;W/WO","70549 - HC MRA,NECK;W/WO",null,"70330 - RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT",null,null,null,null,"71111 - HC CHG RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS",null,"70330 - RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT",null,null,null,"71101 - HC CHG RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS"]
[null,"82652 - HC CHG 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED",null,"70551 - HC CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL","70551 - HC CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL","70551 - HC CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL",null,"70336 - HC CHG MRI TEMPOROMANDIBULAR JOINT",null,null,null,null,"71120 - HC CHG RADEX STERNUM MINIMUM 2 VIEWS",null,"70336 - HC CHG MRI TEMPOROMANDIBULAR JOINT",null,null,null,"71110 - HC CHG RADEX RIBS BILATERAL 3 VIEWS"]
[null,"82656 - HC CHG ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN",null,"70552 - HC CHG MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL","70552 - HC CHG MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL","70552 - HC CHG MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL",null,"70350 - HC CHG CEPHALOGRAM ORTHODONTIC",null,null,null,null,"71130 - HC CHG RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS",null,"70350 - HC CHG CEPHALOGRAM ORTHODONTIC",null,null,null,"71111 - HC CHG RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS"]
[null,"82657 - HC CHG NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA",null,"70553 - HC CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL","70553 - HC CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL","70553 - HC CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL",null,"70355 - ORTHOPANTOGRAM",null,null,null,null,"71250 - HC CHG CT THORAX W/O CONTRAST MATERIAL",null,"70355 - ORTHOPANTOGRAM",null,null,null,"71120 - HC CHG RADEX STERNUM MINIMUM 2 VIEWS"]
[null,"82668 - HC CHG ASSAY OF ERYTHROPOIETIN",null,"70555 - HC CHG MRI BRAIN FUNCTIONAL W/PHYSICIAN ADMNISTRATION","70555 - HC CHG MRI BRAIN FUNCTIONAL W/PHYSICIAN ADMNISTRATION","70555 - HC CHG MRI BRAIN FUNCTIONAL W/PHYSICIAN ADMNISTRATION",null,"70360 - HC CHG RADIOLOGIC EXAMINATION NECK SOFT TISSUE",null,null,null,null,"71260 - HC CHG CT THORAX W/CONTRAST MATERIAL",null,"70360 - HC CHG RADIOLOGIC EXAMINATION NECK SOFT TISSUE",null,null,null,"71130 - HC CHG RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS"]
[null,"82670 - HC CHG ASSAY OF ESTRADIOL",null,"71045 - HC CHG RADIOLOGIC EXAM CHEST SINGLE VIEW","71045 - HC CHG RADIOLOGIC EXAM CHEST SINGLE VIEW","71045 - HC CHG RADIOLOGIC EXAM CHEST SINGLE VIEW",null,"70370 - HC CHG RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ",null,null,null,null,"71270 - HC CHG CT THORAX W/O & W/CONTRAST MATERIAL",null,"70370 - HC CHG RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ",null,null,null,"71250 - HC CHG CT THORAX W/O CONTRAST MATERIAL"]
[null,"82677 - HC CHG ASSAY OF ESTRIOL",null,"71046 - HC CHG RADIOLOGIC EXAM CHEST 2 VIEWS","71046 - HC CHG RADIOLOGIC EXAM CHEST 2 VIEWS","71046 - HC CHG RADIOLOGIC EXAM CHEST 2 VIEWS",null,"70380 - HC X-RAY SALIVARY GLAND",null,null,null,null,"71275 - HC CHG CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST",null,"70380 - HC X-RAY SALIVARY GLAND",null,null,null,"71260 - HC CHG CT THORAX W/CONTRAST MATERIAL"]
[null,"82693 - HC CHG ASSAY OF ETHYLENE GLYCOL",null,"71047 - HC XRAY CHEST 3 VIEWS","71047 - HC XRAY CHEST 3 VIEWS","71047 - HC XRAY CHEST 3 VIEWS",null,"70390 - HC SIALOGRAPHY",null,null,null,null,"71550 - HC CHG MRI CHEST W/O CONTRAST MATERIAL",null,"70390 - HC SIALOGRAPHY",null,null,null,"71270 - HC CHG CT THORAX W/O & W/CONTRAST MATERIAL"]
[null,"82705 - HC CHG FAT/LIPIDS FECES QUALITATIVE",null,"71048 - HC XRAY CHEST 4+ VIEWS","71048 - HC XRAY CHEST 4+ VIEWS","71048 - HC XRAY CHEST 4+ VIEWS",null,"70450 - HC CHG CT HEAD/BRAIN W/O CONTRAST MATERIAL",null,null,null,null,"71551 - HC CHG MRI CHEST W/CONTRAST MATERIAL",null,"70450 - HC CHG CT HEAD/BRAIN W/O CONTRAST MATERIAL",null,null,null,"71275 - HC CHG CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST"]
[null,"82728 - HC CHG ASSAY OF FERRITIN",null,"71100 - HC CHG X-RAY RIBS 2VW UNILAT","71100 - HC CHG X-RAY RIBS 2VW UNILAT","71100 - HC CHG X-RAY RIBS 2VW UNILAT",null,"70460 - HC CHG CT HEAD/BRAIN W/CONTRAST MATERIAL",null,null,null,null,"71552 - HC CHG MRI CHEST W/O & W/CONTRAST MATERIAL",null,"70460 - HC CHG CT HEAD/BRAIN W/CONTRAST MATERIAL",null,null,null,"71550 - HC CHG MRI CHEST W/O CONTRAST MATERIAL"]
[null,"82731 - HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN",null,"71101 - HC CHG RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS","71101 - HC CHG RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS","71101 - HC CHG RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS",null,"70470 - HC CHG CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL",null,null,null,null,"71555 - HC CHG MRA CHEST W/O & W/CONTRAST MATERIAL",null,"70470 - HC CHG CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL",null,null,null,"71551 - HC CHG MRI CHEST W/CONTRAST MATERIAL"]
[null,"82746 - HC CHG ASSAY OF FOLIC ACID SERUM",null,"71110 - HC CHG RADEX RIBS BILATERAL 3 VIEWS","71110 - HC CHG RADEX RIBS BILATERAL 3 VIEWS","71110 - HC CHG RADEX RIBS BILATERAL 3 VIEWS",null,"70480 - HC CHG CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL",null,null,null,null,"72020 - HC CHG RADEX SPINE 1 VIEW SPECIFY LEVEL",null,"70480 - HC CHG CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL",null,null,null,"71552 - HC CHG MRI CHEST W/O & W/CONTRAST MATERIAL"]
[null,"82747 - HC CHG ASSAY OF FOLIC ACID RBC",null,"71111 - HC CHG RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS","71111 - HC CHG RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS","71111 - HC CHG RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS",null,"70481 - HC CHG CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL",null,null,null,null,"72040 - HC CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS",null,"70481 - HC CHG CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL",null,null,null,"71555 - HC CHG MRA CHEST W/O & W/CONTRAST MATERIAL"]
[null,"82784 - HC CHG ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH",null,"71120 - HC CHG RADEX STERNUM MINIMUM 2 VIEWS","71120 - HC CHG RADEX STERNUM MINIMUM 2 VIEWS","71120 - HC CHG RADEX STERNUM MINIMUM 2 VIEWS",null,"70482 - HC CHG CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR",null,null,null,null,"72050 - HC CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS",null,"70482 - HC CHG CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR",null,null,null,"72020 - HC CHG RADEX SPINE 1 VIEW SPECIFY LEVEL"]
[null,"82785 - HC CHG ASSAY OF GAMMAGLOBULIN IGE",null,"71130 - HC CHG RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS","71130 - HC CHG RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS","71130 - HC CHG RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS",null,"70486 - HC CHG CT MAXILLOFACIAL W/O CONTRAST MATERIAL",null,null,null,null,"72052 - HC CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS",null,"70486 - HC CHG CT MAXILLOFACIAL W/O CONTRAST MATERIAL",null,null,null,"72040 - HC CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS"]
[null,"82787 - HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES",null,"71250 - HC CHG CT THORAX W/O CONTRAST MATERIAL","71250 - HC CHG CT THORAX W/O CONTRAST MATERIAL","71250 - HC CHG CT THORAX W/O CONTRAST MATERIAL",null,"70487 - HC CHG CT MAXILLOFACIAL W/CONTRAST MATERIAL",null,null,null,null,"72070 - HC CHG RADEX SPINE THORACIC 2 VIEWS",null,"70487 - HC CHG CT MAXILLOFACIAL W/CONTRAST MATERIAL",null,null,null,"72050 - HC CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS"]
[null,"82803 - HC CHG BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3",null,"71260 - HC CHG CT THORAX W/CONTRAST MATERIAL","71260 - HC CHG CT THORAX W/CONTRAST MATERIAL","71260 - HC CHG CT THORAX W/CONTRAST MATERIAL",null,"70488 - HC CHG CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL",null,null,null,null,"72072 - HC CHG RADEX SPINE THORACIC 3 VIEWS",null,"70488 - HC CHG CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL",null,null,null,"72052 - HC CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS"]
[null,"82805 - HC CHG GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY",null,"71270 - HC CHG CT THORAX W/O & W/CONTRAST MATERIAL","71270 - HC CHG CT THORAX W/O & W/CONTRAST MATERIAL","71270 - HC CHG CT THORAX W/O & W/CONTRAST MATERIAL",null,"70490 - HC CHG CT SOFT TISSUE NECK W/O CONTRAST MATERIAL",null,null,null,null,"72074 - HC X-RAY EXAM THORAC SPINE4/>VW",null,"70490 - HC CHG CT SOFT TISSUE NECK W/O CONTRAST MATERIAL",null,null,null,"72070 - HC CHG RADEX SPINE THORACIC 2 VIEWS"]
[null,"82810 - HC BLOOD GASSES O2 SAT ONLY",null,"71275 - HC CHG CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST","71275 - HC CHG CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST","71275 - HC CHG CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST",null,"70491 - HC CHG CT SOFT TISSUE NECK W/CONTRAST MATERIAL",null,null,null,null,"72080 - HC CHG RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS",null,"70491 - HC CHG CT SOFT TISSUE NECK W/CONTRAST MATERIAL",null,null,null,"72072 - HC CHG RADEX SPINE THORACIC 3 VIEWS"]
[null,"82941 - HC CHG ASSAY OF GASTRIN",null,"71550 - HC CHG MRI CHEST W/O CONTRAST MATERIAL","71550 - HC CHG MRI CHEST W/O CONTRAST MATERIAL","71550 - HC CHG MRI CHEST W/O CONTRAST MATERIAL",null,"70492 - HC CHG CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL",null,null,null,null,"72081 - XRAY EXAM ENTIRE SPINE INCLUDING SKULL, CERV AND SACRAL SPINE; 1 VIEW",null,"70492 - HC CHG CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL",null,null,null,"72074 - HC X-RAY EXAM THORAC SPINE4/>VW"]
[null,"82945 - HC CHG GLUCOSE BODY FLUID OTHER THAN BLOOD",null,"71551 - HC CHG MRI CHEST W/CONTRAST MATERIAL","71551 - HC CHG MRI CHEST W/CONTRAST MATERIAL","71551 - HC CHG MRI CHEST W/CONTRAST MATERIAL",null,"70496 - HC CHG CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST",null,null,null,null,"72082 - XRAY EXAM ENTIRE SPINE INCLUDING SKULL, CERV AND SACRAL SPINE; 2 OR 3 VIEWS",null,"70496 - HC CHG CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST",null,null,null,"72080 - HC CHG RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS"]
[null,"82947 - HC CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP",null,"71552 - HC CHG MRI CHEST W/O & W/CONTRAST MATERIAL","71552 - HC CHG MRI CHEST W/O & W/CONTRAST MATERIAL","71552 - HC CHG MRI CHEST W/O & W/CONTRAST MATERIAL",null,"70498 - HC CHG CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST",null,null,null,null,"72083 - XRAY EXAM ENTIRE SPINE INCLUDING SKULL, CERV AND SACRAL SPINE; 4 OR 5 VIEWS",null,"70498 - HC CHG CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST",null,null,null,"72081 - XRAY EXAM ENTIRE SPINE INCLUDING SKULL, CERV AND SACRAL SPINE; 1 VIEW"]
[null,"82950 - HC CHG GLUCOSE POST GLUCOSE DOSE",null,"71555 - HC CHG MRA CHEST W/O & W/CONTRAST MATERIAL","71555 - HC CHG MRA CHEST W/O & W/CONTRAST MATERIAL","71555 - HC CHG MRA CHEST W/O & W/CONTRAST MATERIAL",null,"70540 - HC CHG MRI ORBIT FACE &/NECK W/O CONTRAST",null,null,null,null,"72084 - X-RAY EXAM ENTIRE SPI 6/> VW",null,"70540 - HC CHG MRI ORBIT FACE &/NECK W/O CONTRAST",null,null,null,"72082 - XRAY EXAM ENTIRE SPINE INCLUDING SKULL, CERV AND SACRAL SPINE; 2 OR 3 VIEWS"]
[null,"82951 - HC CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS",null,"72020 - HC CHG RADEX SPINE 1 VIEW SPECIFY LEVEL","72020 - HC CHG RADEX SPINE 1 VIEW SPECIFY LEVEL","72020 - HC CHG RADEX SPINE 1 VIEW SPECIFY LEVEL",null,"70542 - HC CHG MRI ORBIT FACE & NECK W/CONTRAST MATERIAL",null,null,null,null,"72100 - HC CHG RADEX SPINE LUMBOSACRAL 2/3 VIEWS",null,"70542 - HC CHG MRI ORBIT FACE & NECK W/CONTRAST MATERIAL",null,null,null,"72083 - XRAY EXAM ENTIRE SPINE INCLUDING SKULL, CERV AND SACRAL SPINE; 4 OR 5 VIEWS"]
[null,"82952 - HC CHG GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS",null,"72040 - HC CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS","72040 - HC CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS","72040 - HC CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS",null,"70543 - HC CHG MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL",null,null,null,null,"72110 - HC CHG RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS",null,"70543 - HC CHG MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL",null,null,null,"72084 - X-RAY EXAM ENTIRE SPI 6/> VW"]
[null,"82960 - HC CHG GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN",null,"72050 - HC CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS","72050 - HC CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS","72050 - HC CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS",null,"70544 - HC CHG MRA HEAD W/O CONTRST MATERIAL",null,null,null,null,"72114 - HC CHG RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6",null,"70544 - HC CHG MRA HEAD W/O CONTRST MATERIAL",null,null,null,"72100 - HC CHG RADEX SPINE LUMBOSACRAL 2/3 VIEWS"]
[null,"82962 - HC GLUCOMETER - PHARM",null,"72052 - HC CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS","72052 - HC CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS","72052 - HC CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS",null,"70545 - HC CHG MRA HEAD W/CONTRAST MATERIAL",null,null,null,null,"72120 - HC X-RAY LUMBAR SPINE FLEX/EXTEN",null,"70545 - HC CHG MRA HEAD W/CONTRAST MATERIAL",null,null,null,"72110 - HC CHG RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS"]
[null,"82977 - HC CHG ASSAY OF GGT",null,"72070 - HC CHG RADEX SPINE THORACIC 2 VIEWS","72070 - HC CHG RADEX SPINE THORACIC 2 VIEWS","72070 - HC CHG RADEX SPINE THORACIC 2 VIEWS",null,"70546 - HC CHG MRA HEAD W/O & W/CONTRAST MATERIAL",null,null,null,null,"72125 - HC CHG CT CERVICAL SPINE W/O CONTRAST MATERIAL",null,"70546 - HC CHG MRA HEAD W/O & W/CONTRAST MATERIAL",null,null,null,"72114 - HC CHG RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6"]
[null,"82985 - HC CHG ASSAY OF GLYCATED PROTEIN",null,"72072 - HC CHG RADEX SPINE THORACIC 3 VIEWS","72072 - HC CHG RADEX SPINE THORACIC 3 VIEWS","72072 - HC CHG RADEX SPINE THORACIC 3 VIEWS",null,"70547 - HC CHG MRA NECK W/O CONTRST MATERIAL",null,null,null,null,"72126 - HC CHG CT CERVICAL SPINE W/CONTRAST MATERIAL",null,"70547 - HC CHG MRA NECK W/O CONTRST MATERIAL",null,null,null,"72120 - HC X-RAY LUMBAR SPINE FLEX/EXTEN"]
[null,"83001 - HC CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE",null,"72074 - HC X-RAY EXAM THORAC SPINE4/>VW","72074 - HC X-RAY EXAM THORAC SPINE4/>VW","72074 - HC X-RAY EXAM THORAC SPINE4/>VW",null,"70548 - HC CHG MRA NECK W/CONTRAST MATERIAL",null,null,null,null,"72127 - HC CT,C SPINE;W/WO",null,"70548 - HC CHG MRA NECK W/CONTRAST MATERIAL",null,null,null,"72125 - HC CHG CT CERVICAL SPINE W/O CONTRAST MATERIAL"]
[null,"83002 - HC CHG GONADOTROPIN LUTEINIZING HORMONE",null,"72080 - HC CHG RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS","72080 - HC CHG RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS","72080 - HC CHG RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS",null,"70549 - HC MRA,NECK;W/WO",null,null,null,null,"72128 - HC CHG CT THORACIC SPINE W/O CONTRAST MATERIAL",null,"70549 - HC MRA,NECK;W/WO",null,null,null,"72126 - HC CHG CT CERVICAL SPINE W/CONTRAST MATERIAL"]
[null,"83003 - HC CHG ASSAY OF GROWTH HORMONE HUMAN",null,"72081 - XRAY EXAM ENTIRE SPINE INCLUDING SKULL, CERV AND SACRAL SPINE; 1 VIEW","72081 - XRAY EXAM ENTIRE SPINE INCLUDING SKULL, CERV AND SACRAL SPINE; 1 VIEW","72081 - XRAY EXAM ENTIRE SPINE INCLUDING SKULL, CERV AND SACRAL SPINE; 1 VIEW",null,"70551 - HC CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL",null,null,null,null,"72129 - HC CHG CT THORACIC SPINE W/CONTRAST MATERIAL",null,"70551 - HC CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL",null,null,null,"72127 - HC CT,C SPINE;W/WO"]
[null,"83010 - HC CHG ASSAY OF HAPTOGLOBIN, QUANT",null,"72082 - XRAY EXAM ENTIRE SPINE INCLUDING SKULL, CERV AND SACRAL SPINE; 2 OR 3 VIEWS","72082 - XRAY EXAM ENTIRE SPINE INCLUDING SKULL, CERV AND SACRAL SPINE; 2 OR 3 VIEWS","72082 - XRAY EXAM ENTIRE SPINE INCLUDING SKULL, CERV AND SACRAL SPINE; 2 OR 3 VIEWS",null,"70552 - HC CHG MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL",null,null,null,null,"72130 - HC CT,T SPINE;W/WO",null,"70552 - HC CHG MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL",null,null,null,"72128 - HC CHG CT THORACIC SPINE W/O CONTRAST MATERIAL"]
[null,"83013 - HC H PYLORI (C-13) BREATH",null,"72083 - XRAY EXAM ENTIRE SPINE INCLUDING SKULL, CERV AND SACRAL SPINE; 4 OR 5 VIEWS","72083 - XRAY EXAM ENTIRE SPINE INCLUDING SKULL, CERV AND SACRAL SPINE; 4 OR 5 VIEWS","72083 - XRAY EXAM ENTIRE SPINE INCLUDING SKULL, CERV AND SACRAL SPINE; 4 OR 5 VIEWS",null,"70553 - HC CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL",null,null,null,null,"72131 - HC CHG CT LUMBAR SPINE W/O CONTRAST MATERIAL",null,"70553 - HC CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL",null,null,null,"72129 - HC CHG CT THORACIC SPINE W/CONTRAST MATERIAL"]
[null,"83014 - HC H PYLORI DRUG ADMIN",null,"72084 - X-RAY EXAM ENTIRE SPI 6/> VW","72084 - X-RAY EXAM ENTIRE SPI 6/> VW","72084 - X-RAY EXAM ENTIRE SPI 6/> VW",null,"70555 - HC CHG MRI BRAIN FUNCTIONAL W/PHYSICIAN ADMNISTRATION",null,null,null,null,"72132 - HC CHG CT LUMBAR SPINE W/CONTRAST MATERIAL",null,"70555 - HC CHG MRI BRAIN FUNCTIONAL W/PHYSICIAN ADMNISTRATION",null,null,null,"72130 - HC CT,T SPINE;W/WO"]
[null,"83020 - HC CHG HEMOGLOBIN ELECTROPHORESIS",null,"72100 - HC CHG RADEX SPINE LUMBOSACRAL 2/3 VIEWS","72100 - HC CHG RADEX SPINE LUMBOSACRAL 2/3 VIEWS","72100 - HC CHG RADEX SPINE LUMBOSACRAL 2/3 VIEWS",null,"71045 - HC CHG RADIOLOGIC EXAM CHEST SINGLE VIEW",null,null,null,null,"72133 - HC CT,L SPINE;W/WO",null,"71045 - HC CHG RADIOLOGIC EXAM CHEST SINGLE VIEW",null,null,null,"72131 - HC CHG CT LUMBAR SPINE W/O CONTRAST MATERIAL"]
[null,"83021 - HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY",null,"72110 - HC CHG RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS","72110 - HC CHG RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS","72110 - HC CHG RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS",null,"71046 - HC CHG RADIOLOGIC EXAM CHEST 2 VIEWS",null,null,null,null,"72141 - HC CHG MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL",null,"71046 - HC CHG RADIOLOGIC EXAM CHEST 2 VIEWS",null,null,null,"72132 - HC CHG CT LUMBAR SPINE W/CONTRAST MATERIAL"]
[null,"83030 - HC CHG HEMOGLOBIN F FETAL CHEMICAL",null,"72114 - HC CHG RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6","72114 - HC CHG RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6","72114 - HC CHG RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6",null,"71047 - HC XRAY CHEST 3 VIEWS",null,null,null,null,"72142 - HC CHG MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL",null,"71047 - HC XRAY CHEST 3 VIEWS",null,null,null,"72133 - HC CT,L SPINE;W/WO"]
[null,"83036 - HEMOGLOBIN GLYCOSYLATED A1C",null,"72120 - HC X-RAY LUMBAR SPINE FLEX/EXTEN","72120 - HC X-RAY LUMBAR SPINE FLEX/EXTEN","72120 - HC X-RAY LUMBAR SPINE FLEX/EXTEN",null,"71048 - HC XRAY CHEST 4+ VIEWS",null,null,null,null,"72146 - HC CHG MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL",null,"71048 - HC XRAY CHEST 4+ VIEWS",null,null,null,"72141 - HC CHG MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL"]
[null,"83050 - HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE",null,"72125 - HC CHG CT CERVICAL SPINE W/O CONTRAST MATERIAL","72125 - HC CHG CT CERVICAL SPINE W/O CONTRAST MATERIAL","72125 - HC CHG CT CERVICAL SPINE W/O CONTRAST MATERIAL",null,"71100 - HC CHG X-RAY RIBS 2VW UNILAT",null,null,null,null,"72147 - HC CHG MRI SPINAL CANAL THORACIC W/CONTRAST MATRL",null,"71100 - HC CHG X-RAY RIBS 2VW UNILAT",null,null,null,"72142 - HC CHG MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL"]
[null,"83070 - HC CHG ASSAY OF HEMOSIDERIN QUALITATIVE",null,"72126 - HC CHG CT CERVICAL SPINE W/CONTRAST MATERIAL","72126 - HC CHG CT CERVICAL SPINE W/CONTRAST MATERIAL","72126 - HC CHG CT CERVICAL SPINE W/CONTRAST MATERIAL",null,"71101 - HC CHG RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS",null,null,null,null,"72148 - HC CHG MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL",null,"71101 - HC CHG RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS",null,null,null,"72146 - HC CHG MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL"]
[null,"83090 - HC CHG ASSAY OF HOMOCYSTEINE",null,"72127 - HC CT,C SPINE;W/WO","72127 - HC CT,C SPINE;W/WO","72127 - HC CT,C SPINE;W/WO",null,"71110 - HC CHG RADEX RIBS BILATERAL 3 VIEWS",null,null,null,null,"72149 - HC CHG MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL",null,"71110 - HC CHG RADEX RIBS BILATERAL 3 VIEWS",null,null,null,"72147 - HC CHG MRI SPINAL CANAL THORACIC W/CONTRAST MATRL"]
[null,"83497 - HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA",null,"72128 - HC CHG CT THORACIC SPINE W/O CONTRAST MATERIAL","72128 - HC CHG CT THORACIC SPINE W/O CONTRAST MATERIAL","72128 - HC CHG CT THORACIC SPINE W/O CONTRAST MATERIAL",null,"71111 - HC CHG RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS",null,null,null,null,"72156 - HC CHG MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL",null,"71111 - HC CHG RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS",null,null,null,"72148 - HC CHG MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL"]
[null,"83498 - HC CHG ASSAY OF HYDROXYPROGESTERONE 17-D",null,"72129 - HC CHG CT THORACIC SPINE W/CONTRAST MATERIAL","72129 - HC CHG CT THORACIC SPINE W/CONTRAST MATERIAL","72129 - HC CHG CT THORACIC SPINE W/CONTRAST MATERIAL",null,"71120 - HC CHG RADEX STERNUM MINIMUM 2 VIEWS",null,null,null,null,"72157 - HC CHG MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL",null,"71120 - HC CHG RADEX STERNUM MINIMUM 2 VIEWS",null,null,null,"72149 - HC CHG MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL"]
[null,"83516 - HC CRL;TTG AB,IGA",null,"72130 - HC CT,T SPINE;W/WO","72130 - HC CT,T SPINE;W/WO","72130 - HC CT,T SPINE;W/WO",null,"71130 - HC CHG RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS",null,null,null,null,"72158 - HC CHG MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL",null,"71130 - HC CHG RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS",null,null,null,"72156 - HC CHG MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL"]
[null,"83519 - HC CHG IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY",null,"72131 - HC CHG CT LUMBAR SPINE W/O CONTRAST MATERIAL","72131 - HC CHG CT LUMBAR SPINE W/O CONTRAST MATERIAL","72131 - HC CHG CT LUMBAR SPINE W/O CONTRAST MATERIAL",null,"71250 - HC CHG CT THORAX W/O CONTRAST MATERIAL",null,null,null,null,"72159 - HC MRA,SPINE,W/WO",null,"71250 - HC CHG CT THORAX W/O CONTRAST MATERIAL",null,null,null,"72157 - HC CHG MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL"]
[null,"83520 - HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE",null,"72132 - HC CHG CT LUMBAR SPINE W/CONTRAST MATERIAL","72132 - HC CHG CT LUMBAR SPINE W/CONTRAST MATERIAL","72132 - HC CHG CT LUMBAR SPINE W/CONTRAST MATERIAL",null,"71260 - HC CHG CT THORAX W/CONTRAST MATERIAL",null,null,null,null,"72170 - HC CHG RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS",null,"71260 - HC CHG CT THORAX W/CONTRAST MATERIAL",null,null,null,"72158 - HC CHG MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL"]
[null,"83525 - HC CHG ASSAY OF INSULIN TOTAL",null,"72133 - HC CT,L SPINE;W/WO","72133 - HC CT,L SPINE;W/WO","72133 - HC CT,L SPINE;W/WO",null,"71270 - HC CHG CT THORAX W/O & W/CONTRAST MATERIAL",null,null,null,null,"72190 - HC CHG RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS",null,"71270 - HC CHG CT THORAX W/O & W/CONTRAST MATERIAL",null,null,null,"72159 - HC MRA,SPINE,W/WO"]
[null,"83540 - HC CHG ASSAY OF IRON",null,"72141 - HC CHG MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL","72141 - HC CHG MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL","72141 - HC CHG MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL",null,"71275 - HC CHG CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST",null,null,null,null,"72191 - HC CHG CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST",null,"71275 - HC CHG CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST",null,null,null,"72170 - HC CHG RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS"]
[null,"83550 - HC CHG IRON BINDING CAPACITY",null,"72142 - HC CHG MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL","72142 - HC CHG MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL","72142 - HC CHG MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL",null,"71550 - HC CHG MRI CHEST W/O CONTRAST MATERIAL",null,null,null,null,"72192 - HC CHG CT PELVIS W/O CONTRAST MATERIAL",null,"71550 - HC CHG MRI CHEST W/O CONTRAST MATERIAL",null,null,null,"72190 - HC CHG RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS"]
[null,"83605 - HC CHG ASSAY OF LACTATE",null,"72146 - HC CHG MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL","72146 - HC CHG MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL","72146 - HC CHG MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL",null,"71551 - HC CHG MRI CHEST W/CONTRAST MATERIAL",null,null,null,null,"72193 - HC CHG CT PELVIS W/CONTRAST MATERIAL",null,"71551 - HC CHG MRI CHEST W/CONTRAST MATERIAL",null,null,null,"72191 - HC CHG CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST"]
[null,"83615 - HC CHG LACTATE DEHYDROGENASE LDH",null,"72147 - HC CHG MRI SPINAL CANAL THORACIC W/CONTRAST MATRL","72147 - HC CHG MRI SPINAL CANAL THORACIC W/CONTRAST MATRL","72147 - HC CHG MRI SPINAL CANAL THORACIC W/CONTRAST MATRL",null,"71552 - HC CHG MRI CHEST W/O & W/CONTRAST MATERIAL",null,null,null,null,"72194 - HC CT,PELVIS;W/WO",null,"71552 - HC CHG MRI CHEST W/O & W/CONTRAST MATERIAL",null,null,null,"72192 - HC CHG CT PELVIS W/O CONTRAST MATERIAL"]
[null,"83630 - HC CHG LACTOFERRIN FECAL QUALITATIVE",null,"72148 - HC CHG MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL","72148 - HC CHG MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL","72148 - HC CHG MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL",null,"71555 - HC CHG MRA CHEST W/O & W/CONTRAST MATERIAL",null,null,null,null,"72195 - HC CHG MRI PELVIS W/O CONTRAST MATERIAL",null,"71555 - HC CHG MRA CHEST W/O & W/CONTRAST MATERIAL",null,null,null,"72193 - HC CHG CT PELVIS W/CONTRAST MATERIAL"]
[null,"83655 - HC CHG ASSAY OF LEAD",null,"72149 - HC CHG MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL","72149 - HC CHG MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL","72149 - HC CHG MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL",null,"72020 - HC CHG RADEX SPINE 1 VIEW SPECIFY LEVEL",null,null,null,null,"72196 - HC CHG MRI PELVIS W/CONTRAST MATERIAL",null,"72020 - HC CHG RADEX SPINE 1 VIEW SPECIFY LEVEL",null,null,null,"72194 - HC CT,PELVIS;W/WO"]
[null,"83662 - HC L/S RATIO, FOAM STABILITY",null,"72156 - HC CHG MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL","72156 - HC CHG MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL","72156 - HC CHG MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL",null,"72040 - HC CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS",null,null,null,null,"72197 - HC CHG MRI PELVIS W/O & W/CONTRAST MATERIAL",null,"72040 - HC CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS",null,null,null,"72195 - HC CHG MRI PELVIS W/O CONTRAST MATERIAL"]
[null,"83690 - HC CHG ASSAY OF LIPASE",null,"72157 - HC CHG MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL","72157 - HC CHG MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL","72157 - HC CHG MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL",null,"72050 - HC CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS",null,null,null,null,"72198 - HC CHG MRA PELVIS W/WO CONTRAST MATERIAL",null,"72050 - HC CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS",null,null,null,"72196 - HC CHG MRI PELVIS W/CONTRAST MATERIAL"]
[null,"83695 - HC CHG LIPOPROTEIN (A)",null,"72158 - HC CHG MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL","72158 - HC CHG MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL","72158 - HC CHG MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL",null,"72052 - HC CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS",null,null,null,null,"72200 - X-RAY EXAM SI JOINTS",null,"72052 - HC CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS",null,null,null,"72197 - HC CHG MRI PELVIS W/O & W/CONTRAST MATERIAL"]
[null,"83718 - HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL",null,"72159 - HC MRA,SPINE,W/WO","72159 - HC MRA,SPINE,W/WO","72159 - HC MRA,SPINE,W/WO",null,"72070 - HC CHG RADEX SPINE THORACIC 2 VIEWS",null,null,null,null,"72202 - HC CHG RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS",null,"72070 - HC CHG RADEX SPINE THORACIC 2 VIEWS",null,null,null,"72198 - HC CHG MRA PELVIS W/WO CONTRAST MATERIAL"]
[null,"83721 - HC CRL;DIRECT LDL",null,"72170 - HC CHG RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS","72170 - HC CHG RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS","72170 - HC CHG RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS",null,"72072 - HC CHG RADEX SPINE THORACIC 3 VIEWS",null,null,null,null,"72220 - HC CHG RADEX SACRUM & COCCYX MINIMUM 2 VIEWS",null,"72072 - HC CHG RADEX SPINE THORACIC 3 VIEWS",null,null,null,"72200 - X-RAY EXAM SI JOINTS"]
[null,"83735 - HC CHG ASSAY OF MAGNESIUM",null,"72190 - HC CHG RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS","72190 - HC CHG RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS","72190 - HC CHG RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS",null,"72074 - HC X-RAY EXAM THORAC SPINE4/>VW",null,null,null,null,"72240 - HC CHG MYELOGRAPHY CERVICAL RS&I",null,"72074 - HC X-RAY EXAM THORAC SPINE4/>VW",null,null,null,"72202 - HC CHG RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS"]
[null,"83785 - HC CHG, ASSAY OF MANGANESE",null,"72191 - HC CHG CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST","72191 - HC CHG CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST","72191 - HC CHG CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST",null,"72080 - HC CHG RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS",null,null,null,null,"72255 - HC CHG MYELOGRAPHY THORACIC RS&I",null,"72080 - HC CHG RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS",null,null,null,"72220 - HC CHG RADEX SACRUM & COCCYX MINIMUM 2 VIEWS"]
[null,"83789 - HC CHG MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA",null,"72192 - HC CHG CT PELVIS W/O CONTRAST MATERIAL","72192 - HC CHG CT PELVIS W/O CONTRAST MATERIAL","72192 - HC CHG CT PELVIS W/O CONTRAST MATERIAL",null,"72081 - XRAY EXAM ENTIRE SPINE INCLUDING SKULL, CERV AND SACRAL SPINE; 1 VIEW",null,null,null,null,"72265 - HC CHG MYELOGRAPY LUMBOSACRAL RS&I",null,"72081 - XRAY EXAM ENTIRE SPINE INCLUDING SKULL, CERV AND SACRAL SPINE; 1 VIEW",null,null,null,"72240 - HC CHG MYELOGRAPHY CERVICAL RS&I"]
[null,"83825 - HC CHG ASSAY OF MERCURY QUANTITATIVE",null,"72193 - HC CHG CT PELVIS W/CONTRAST MATERIAL","72193 - HC CHG CT PELVIS W/CONTRAST MATERIAL","72193 - HC CHG CT PELVIS W/CONTRAST MATERIAL",null,"72082 - XRAY EXAM ENTIRE SPINE INCLUDING SKULL, CERV AND SACRAL SPINE; 2 OR 3 VIEWS",null,null,null,null,"73000 - ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R",null,"72082 - XRAY EXAM ENTIRE SPINE INCLUDING SKULL, CERV AND SACRAL SPINE; 2 OR 3 VIEWS",null,null,null,"72255 - HC CHG MYELOGRAPHY THORACIC RS&I"]
[null,"83835 - HC CHG METANEPHRINES",null,"72194 - HC CT,PELVIS;W/WO","72194 - HC CT,PELVIS;W/WO","72194 - HC CT,PELVIS;W/WO",null,"72083 - XRAY EXAM ENTIRE SPINE INCLUDING SKULL, CERV AND SACRAL SPINE; 4 OR 5 VIEWS",null,null,null,null,"73010 - HC CHG RADEX SCAPULA COMPLETE",null,"72083 - XRAY EXAM ENTIRE SPINE INCLUDING SKULL, CERV AND SACRAL SPINE; 4 OR 5 VIEWS",null,null,null,"72265 - HC CHG MYELOGRAPY LUMBOSACRAL RS&I"]
[null,"83873 - HC CHG MYELIN BASIC PROTEIN CEREBROSPINAL FLUID",null,"72195 - HC CHG MRI PELVIS W/O CONTRAST MATERIAL","72195 - HC CHG MRI PELVIS W/O CONTRAST MATERIAL","72195 - HC CHG MRI PELVIS W/O CONTRAST MATERIAL",null,"72084 - X-RAY EXAM ENTIRE SPI 6/> VW",null,null,null,null,"73020 - HC CHG RADEX SHOULDER 1 VIEW",null,"72084 - X-RAY EXAM ENTIRE SPI 6/> VW",null,null,null,"73000 - ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R"]
[null,"83874 - HC CHG MYOGLOBIN",null,"72196 - HC CHG MRI PELVIS W/CONTRAST MATERIAL","72196 - HC CHG MRI PELVIS W/CONTRAST MATERIAL","72196 - HC CHG MRI PELVIS W/CONTRAST MATERIAL",null,"72100 - HC CHG RADEX SPINE LUMBOSACRAL 2/3 VIEWS",null,null,null,null,"73030 - HC CHG RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS",null,"72100 - HC CHG RADEX SPINE LUMBOSACRAL 2/3 VIEWS",null,null,null,"73010 - HC CHG RADEX SCAPULA COMPLETE"]
[null,"83880 - HC CHG NATRIURETIC PEPTIDE",null,"72197 - HC CHG MRI PELVIS W/O & W/CONTRAST MATERIAL","72197 - HC CHG MRI PELVIS W/O & W/CONTRAST MATERIAL","72197 - HC CHG MRI PELVIS W/O & W/CONTRAST MATERIAL",null,"72110 - HC CHG RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS",null,null,null,null,"73050 - HC CHG RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ",null,"72110 - HC CHG RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS",null,null,null,"73020 - HC CHG RADEX SHOULDER 1 VIEW"]
[null,"83883 - HC NEPHELOMETRY, EACH ANALYTE",null,"72198 - HC CHG MRA PELVIS W/WO CONTRAST MATERIAL","72198 - HC CHG MRA PELVIS W/WO CONTRAST MATERIAL","72198 - HC CHG MRA PELVIS W/WO CONTRAST MATERIAL",null,"72114 - HC CHG RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6",null,null,null,null,"73060 - HC CHG RADEX HUMERUS MINIMUM 2 VIEWS",null,"72114 - HC CHG RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6",null,null,null,"73030 - HC CHG RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS"]
[null,"83915 - HC CHG ASSAY OF NUCLEOTIDASE 5'-",null,"72200 - X-RAY EXAM SI JOINTS","72200 - X-RAY EXAM SI JOINTS","72200 - X-RAY EXAM SI JOINTS",null,"72120 - HC X-RAY LUMBAR SPINE FLEX/EXTEN",null,null,null,null,"73070 - HC CHG RADEX ELBOW 2 VIEWS",null,"72120 - HC X-RAY LUMBAR SPINE FLEX/EXTEN",null,null,null,"73050 - HC CHG RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ"]
[null,"83916 - HC CHG OLIGOCLONAL IMMUNE",null,"72202 - HC CHG RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS","72202 - HC CHG RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS","72202 - HC CHG RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS",null,"72125 - HC CHG CT CERVICAL SPINE W/O CONTRAST MATERIAL",null,null,null,null,"73080 - HC CHG RADEX ELBOW COMPLETE MINIMUM 3 VIEWS",null,"72125 - HC CHG CT CERVICAL SPINE W/O CONTRAST MATERIAL",null,null,null,"73060 - HC CHG RADEX HUMERUS MINIMUM 2 VIEWS"]
[null,"83918 - HC CHG ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN",null,"72220 - HC CHG RADEX SACRUM & COCCYX MINIMUM 2 VIEWS","72220 - HC CHG RADEX SACRUM & COCCYX MINIMUM 2 VIEWS","72220 - HC CHG RADEX SACRUM & COCCYX MINIMUM 2 VIEWS",null,"72126 - HC CHG CT CERVICAL SPINE W/CONTRAST MATERIAL",null,null,null,null,"73090 - HC CHG RADEX FOREARM 2 VIEWS",null,"72126 - HC CHG CT CERVICAL SPINE W/CONTRAST MATERIAL",null,null,null,"73070 - HC CHG RADEX ELBOW 2 VIEWS"]
[null,"83921 - HC CHG ORGANIC ACID 1 QUANTITATIVE",null,"72240 - HC CHG MYELOGRAPHY CERVICAL RS&I","72240 - HC CHG MYELOGRAPHY CERVICAL RS&I","72240 - HC CHG MYELOGRAPHY CERVICAL RS&I",null,"72127 - HC CT,C SPINE;W/WO",null,null,null,null,"73092 - HC CHG RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS",null,"72127 - HC CT,C SPINE;W/WO",null,null,null,"73080 - HC CHG RADEX ELBOW COMPLETE MINIMUM 3 VIEWS"]
[null,"83930 - HC Q;OSMOLALITY,SER",null,"72255 - HC CHG MYELOGRAPHY THORACIC RS&I","72255 - HC CHG MYELOGRAPHY THORACIC RS&I","72255 - HC CHG MYELOGRAPHY THORACIC RS&I",null,"72128 - HC CHG CT THORACIC SPINE W/O CONTRAST MATERIAL",null,null,null,null,"73100 - XTRNL ECG & 48 HR RECORDING",null,"72128 - HC CHG CT THORACIC SPINE W/O CONTRAST MATERIAL",null,null,null,"73090 - HC CHG RADEX FOREARM 2 VIEWS"]
[null,"83935 - HC CHG ASSAY OF OSMOLALITY URINE",null,"72265 - HC CHG MYELOGRAPY LUMBOSACRAL RS&I","72265 - HC CHG MYELOGRAPY LUMBOSACRAL RS&I","72265 - HC CHG MYELOGRAPY LUMBOSACRAL RS&I",null,"72129 - HC CHG CT THORACIC SPINE W/CONTRAST MATERIAL",null,null,null,null,"73110 - HC CHG RADEX WRIST COMPLETE MINIMUM 3 VIEWS",null,"72129 - HC CHG CT THORACIC SPINE W/CONTRAST MATERIAL",null,null,null,"73092 - HC CHG RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS"]
[null,"83937 - HC CHG ASSAY OF OSTEOCALCIN",null,"73000 - ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R","73000 - ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R","73000 - ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R",null,"72130 - HC CT,T SPINE;W/WO",null,null,null,null,"73120 - HC CHG RADEX HAND 2 VIEWS",null,"72130 - HC CT,T SPINE;W/WO",null,null,null,"73100 - XTRNL ECG & 48 HR RECORDING"]
[null,"83945 - HC CHG ASSAY OF OXALATE",null,"73010 - HC CHG RADEX SCAPULA COMPLETE","73010 - HC CHG RADEX SCAPULA COMPLETE","73010 - HC CHG RADEX SCAPULA COMPLETE",null,"72131 - HC CHG CT LUMBAR SPINE W/O CONTRAST MATERIAL",null,null,null,null,"73130 - HC CHG RADEX HAND MINIMUM 3 VIEWS",null,"72131 - HC CHG CT LUMBAR SPINE W/O CONTRAST MATERIAL",null,null,null,"73110 - HC CHG RADEX WRIST COMPLETE MINIMUM 3 VIEWS"]
[null,"83970 - HC CHG ASSAY OF PARATHORMONE",null,"73020 - HC CHG RADEX SHOULDER 1 VIEW","73020 - HC CHG RADEX SHOULDER 1 VIEW","73020 - HC CHG RADEX SHOULDER 1 VIEW",null,"72132 - HC CHG CT LUMBAR SPINE W/CONTRAST MATERIAL",null,null,null,null,"73140 - HC CHG RADEX FINGR MINIMUM 2 VIEWS",null,"72132 - HC CHG CT LUMBAR SPINE W/CONTRAST MATERIAL",null,null,null,"73120 - HC CHG RADEX HAND 2 VIEWS"]
[null,"83986 - HC CHG PH BODY FLUID NOT ELSEWHERE SPECIFIED",null,"73030 - HC CHG RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS","73030 - HC CHG RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS","73030 - HC CHG RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS",null,"72133 - HC CT,L SPINE;W/WO",null,null,null,null,"73200 - HC CHG CT UPPER EXTREMITY W/O CONTRAST MATERIAL",null,"72133 - HC CT,L SPINE;W/WO",null,null,null,"73130 - HC CHG RADEX HAND MINIMUM 3 VIEWS"]
[null,"83993 - HC CHG ASSAY OF CALPROTECTIN FECAL",null,"73050 - HC CHG RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ","73050 - HC CHG RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ","73050 - HC CHG RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ",null,"72141 - HC CHG MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL",null,null,null,null,"73201 - HC CHG CT UPPER EXTREMITY W/CONTRAST MATERIAL",null,"72141 - HC CHG MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL",null,null,null,"73140 - HC CHG RADEX FINGR MINIMUM 2 VIEWS"]
[null,"84075 - HC CHG ASSAY OF PHOSPHATASE ALKALINE",null,"73060 - HC CHG RADEX HUMERUS MINIMUM 2 VIEWS","73060 - HC CHG RADEX HUMERUS MINIMUM 2 VIEWS","73060 - HC CHG RADEX HUMERUS MINIMUM 2 VIEWS",null,"72142 - HC CHG MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL",null,null,null,null,"73202 - HC CHG CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL",null,"72142 - HC CHG MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL",null,null,null,"73200 - HC CHG CT UPPER EXTREMITY W/O CONTRAST MATERIAL"]
[null,"84080 - HC CHG ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES",null,"73070 - HC CHG RADEX ELBOW 2 VIEWS","73070 - HC CHG RADEX ELBOW 2 VIEWS","73070 - HC CHG RADEX ELBOW 2 VIEWS",null,"72146 - HC CHG MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL",null,null,null,null,"73206 - HC CHG CT ANGIOGRAPHY UPPER EXTREMITY",null,"72146 - HC CHG MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL",null,null,null,"73201 - HC CHG CT UPPER EXTREMITY W/CONTRAST MATERIAL"]
[null,"84100 - HC CHG ASSAY OF PHOSPHORUS INORGANIC",null,"73080 - HC CHG RADEX ELBOW COMPLETE MINIMUM 3 VIEWS","73080 - HC CHG RADEX ELBOW COMPLETE MINIMUM 3 VIEWS","73080 - HC CHG RADEX ELBOW COMPLETE MINIMUM 3 VIEWS",null,"72147 - HC CHG MRI SPINAL CANAL THORACIC W/CONTRAST MATRL",null,null,null,null,"73218 - HC CHG MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL",null,"72147 - HC CHG MRI SPINAL CANAL THORACIC W/CONTRAST MATRL",null,null,null,"73202 - HC CHG CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL"]
[null,"84105 - HC CHG ASSAY OF PHOSPHORUS INORGANIC URINE",null,"73090 - HC CHG RADEX FOREARM 2 VIEWS","73090 - HC CHG RADEX FOREARM 2 VIEWS","73090 - HC CHG RADEX FOREARM 2 VIEWS",null,"72148 - HC CHG MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL",null,null,null,null,"73219 - HC CHG MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL",null,"72148 - HC CHG MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL",null,null,null,"73206 - HC CHG CT ANGIOGRAPHY UPPER EXTREMITY"]
[null,"84132 - HC CHG POTASSIUM SERUM PLASMA/WHOLE BLOOD",null,"73092 - HC CHG RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS","73092 - HC CHG RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS","73092 - HC CHG RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS",null,"72149 - HC CHG MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL",null,null,null,null,"73220 - HC CHG MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS",null,"72149 - HC CHG MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL",null,null,null,"73218 - HC CHG MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL"]
[null,"84133 - HC CHG POTASSIUM URINE",null,"73100 - XTRNL ECG & 48 HR RECORDING","73100 - XTRNL ECG & 48 HR RECORDING","73100 - XTRNL ECG & 48 HR RECORDING",null,"72156 - HC CHG MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL",null,null,null,null,"73221 - HC CHG MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL",null,"72156 - HC CHG MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL",null,null,null,"73219 - HC CHG MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL"]
[null,"84134 - HC CHG PREALBUMIN",null,"73110 - HC CHG RADEX WRIST COMPLETE MINIMUM 3 VIEWS","73110 - HC CHG RADEX WRIST COMPLETE MINIMUM 3 VIEWS","73110 - HC CHG RADEX WRIST COMPLETE MINIMUM 3 VIEWS",null,"72157 - HC CHG MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL",null,null,null,null,"73222 - HC CHG MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL",null,"72157 - HC CHG MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL",null,null,null,"73220 - HC CHG MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS"]
[null,"84144 - HC CHG ASSAY OF PROGESTERONE",null,"73120 - HC CHG RADEX HAND 2 VIEWS","73120 - HC CHG RADEX HAND 2 VIEWS","73120 - HC CHG RADEX HAND 2 VIEWS",null,"72158 - HC CHG MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL",null,null,null,null,"73223 - HC CHG MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL",null,"72158 - HC CHG MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL",null,null,null,"73221 - HC CHG MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL"]
[null,"84145 - HC CHG PROCALCITONIN (PCT)",null,"73130 - HC CHG RADEX HAND MINIMUM 3 VIEWS","73130 - HC CHG RADEX HAND MINIMUM 3 VIEWS","73130 - HC CHG RADEX HAND MINIMUM 3 VIEWS",null,"72159 - HC MRA,SPINE,W/WO",null,null,null,null,"73225 - HC CHG MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL",null,"72159 - HC MRA,SPINE,W/WO",null,null,null,"73222 - HC CHG MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL"]
[null,"84146 - HC CHG ASSAY OF PROLACTIN",null,"73140 - HC CHG RADEX FINGR MINIMUM 2 VIEWS","73140 - HC CHG RADEX FINGR MINIMUM 2 VIEWS","73140 - HC CHG RADEX FINGR MINIMUM 2 VIEWS",null,"72170 - HC CHG RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS",null,null,null,null,"73501 - XRAY EXAM OF HIP UNILATERAL W/PELVIS WHEN PERFORMED; 1 VIEW",null,"72170 - HC CHG RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS",null,null,null,"73223 - HC CHG MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL"]
[null,"84153 - HC CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL",null,"73200 - HC CHG CT UPPER EXTREMITY W/O CONTRAST MATERIAL","73200 - HC CHG CT UPPER EXTREMITY W/O CONTRAST MATERIAL","73200 - HC CHG CT UPPER EXTREMITY W/O CONTRAST MATERIAL",null,"72190 - HC CHG RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS",null,null,null,null,"73502 - XRAY EXAM OF HIP UNILATERAL W/PELVIS WHEN PERFORMED; 2-3 VIEWS",null,"72190 - HC CHG RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS",null,null,null,"73225 - HC CHG MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL"]
[null,"84155 - HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD",null,"73201 - HC CHG CT UPPER EXTREMITY W/CONTRAST MATERIAL","73201 - HC CHG CT UPPER EXTREMITY W/CONTRAST MATERIAL","73201 - HC CHG CT UPPER EXTREMITY W/CONTRAST MATERIAL",null,"72191 - HC CHG CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST",null,null,null,null,"73503 - XRAY EXAM OF HIP UNILATERAL W/PELVIS WHEN PERFORMED; MINIMUM 4 VIEWS",null,"72191 - HC CHG CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST",null,null,null,"73501 - XRAY EXAM OF HIP UNILATERAL W/PELVIS WHEN PERFORMED; 1 VIEW"]
[null,"84156 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY URINE",null,"73202 - HC CHG CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL","73202 - HC CHG CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL","73202 - HC CHG CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL",null,"72192 - HC CHG CT PELVIS W/O CONTRAST MATERIAL",null,null,null,null,"73521 - XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; 2 VIEWS",null,"72192 - HC CHG CT PELVIS W/O CONTRAST MATERIAL",null,null,null,"73502 - XRAY EXAM OF HIP UNILATERAL W/PELVIS WHEN PERFORMED; 2-3 VIEWS"]
[null,"84157 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC",null,"73206 - HC CHG CT ANGIOGRAPHY UPPER EXTREMITY","73206 - HC CHG CT ANGIOGRAPHY UPPER EXTREMITY","73206 - HC CHG CT ANGIOGRAPHY UPPER EXTREMITY",null,"72193 - HC CHG CT PELVIS W/CONTRAST MATERIAL",null,null,null,null,"73522 - XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; 3-4 VIEWS",null,"72193 - HC CHG CT PELVIS W/CONTRAST MATERIAL",null,null,null,"73503 - XRAY EXAM OF HIP UNILATERAL W/PELVIS WHEN PERFORMED; MINIMUM 4 VIEWS"]
[null,"84163 - HC CHG PREGNANCY-ASSOCIATED PLASMA PROTEIN-A",null,"73218 - HC CHG MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL","73218 - HC CHG MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL","73218 - HC CHG MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL",null,"72194 - HC CT,PELVIS;W/WO",null,null,null,null,"73523 - XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; MINIMUM 5 VIEWS",null,"72194 - HC CT,PELVIS;W/WO",null,null,null,"73521 - XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; 2 VIEWS"]
[null,"84165 - HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM",null,"73219 - HC CHG MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL","73219 - HC CHG MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL","73219 - HC CHG MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL",null,"72195 - HC CHG MRI PELVIS W/O CONTRAST MATERIAL",null,null,null,null,"73551 - XRAY EXAM FEMUR; 1 VIEW",null,"72195 - HC CHG MRI PELVIS W/O CONTRAST MATERIAL",null,null,null,"73522 - XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; 3-4 VIEWS"]
[null,"84166 - HC CHG PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI",null,"73220 - HC CHG MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS","73220 - HC CHG MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS","73220 - HC CHG MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS",null,"72196 - HC CHG MRI PELVIS W/CONTRAST MATERIAL",null,null,null,null,"73552 - XRAY EXAM FEMUR; MINIMUM 2 VIEWS",null,"72196 - HC CHG MRI PELVIS W/CONTRAST MATERIAL",null,null,null,"73523 - XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; MINIMUM 5 VIEWS"]
[null,"84182 - HC CHG PROTEIN, WESTERN BLOT TEST, W BAND",null,"73221 - HC CHG MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL","73221 - HC CHG MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL","73221 - HC CHG MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL",null,"72197 - HC CHG MRI PELVIS W/O & W/CONTRAST MATERIAL",null,null,null,null,"73560 - HC CHG RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS",null,"72197 - HC CHG MRI PELVIS W/O & W/CONTRAST MATERIAL",null,null,null,"73551 - XRAY EXAM FEMUR; 1 VIEW"]
[null,"84202 - HC Q;ERYTH PROTPOR",null,"73222 - HC CHG MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL","73222 - HC CHG MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL","73222 - HC CHG MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL",null,"72198 - HC CHG MRA PELVIS W/WO CONTRAST MATERIAL",null,null,null,null,"73562 - HC CHG RADIOLOGIC EXAMINATION KNEE 3 VIEWS",null,"72198 - HC CHG MRA PELVIS W/WO CONTRAST MATERIAL",null,null,null,"73552 - XRAY EXAM FEMUR; MINIMUM 2 VIEWS"]
[null,"84206 - HC CHG ASSAY OF PROINSULIN",null,"73223 - HC CHG MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL","73223 - HC CHG MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL","73223 - HC CHG MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL",null,"72200 - X-RAY EXAM SI JOINTS",null,null,null,null,"73564 - HC CHG RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS",null,"72200 - X-RAY EXAM SI JOINTS",null,null,null,"73560 - HC CHG RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS"]
[null,"84207 - HC CHG ASSAY OF PYRIDOXAL PHOSPHATE",null,"73225 - HC CHG MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL","73225 - HC CHG MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL","73225 - HC CHG MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL",null,"72202 - HC CHG RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS",null,null,null,null,"73565 - HC CHG RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST",null,"72202 - HC CHG RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS",null,null,null,"73562 - HC CHG RADIOLOGIC EXAMINATION KNEE 3 VIEWS"]
[null,"84210 - HC CHG ASSAY OF PYRUVATE",null,"73501 - XRAY EXAM OF HIP UNILATERAL W/PELVIS WHEN PERFORMED; 1 VIEW","73501 - XRAY EXAM OF HIP UNILATERAL W/PELVIS WHEN PERFORMED; 1 VIEW","73501 - XRAY EXAM OF HIP UNILATERAL W/PELVIS WHEN PERFORMED; 1 VIEW",null,"72220 - HC CHG RADEX SACRUM & COCCYX MINIMUM 2 VIEWS",null,null,null,null,"73590 - HC CHG RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS",null,"72220 - HC CHG RADEX SACRUM & COCCYX MINIMUM 2 VIEWS",null,null,null,"73564 - HC CHG RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS"]
[null,"84244 - HC CHG ASSAY OF RENIN",null,"73502 - XRAY EXAM OF HIP UNILATERAL W/PELVIS WHEN PERFORMED; 2-3 VIEWS","73502 - XRAY EXAM OF HIP UNILATERAL W/PELVIS WHEN PERFORMED; 2-3 VIEWS","73502 - XRAY EXAM OF HIP UNILATERAL W/PELVIS WHEN PERFORMED; 2-3 VIEWS",null,"72240 - HC CHG MYELOGRAPHY CERVICAL RS&I",null,null,null,null,"73592 - HC CHG RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS",null,"72240 - HC CHG MYELOGRAPHY CERVICAL RS&I",null,null,null,"73565 - HC CHG RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST"]
[null,"84255 - HC CHG ASSAY OF SELENIUM",null,"73503 - XRAY EXAM OF HIP UNILATERAL W/PELVIS WHEN PERFORMED; MINIMUM 4 VIEWS","73503 - XRAY EXAM OF HIP UNILATERAL W/PELVIS WHEN PERFORMED; MINIMUM 4 VIEWS","73503 - XRAY EXAM OF HIP UNILATERAL W/PELVIS WHEN PERFORMED; MINIMUM 4 VIEWS",null,"72255 - HC CHG MYELOGRAPHY THORACIC RS&I",null,null,null,null,"73600 - HC CHG RADIOLOGIC EXAMINATION ANKLE 2 VIEWS",null,"72255 - HC CHG MYELOGRAPHY THORACIC RS&I",null,null,null,"73590 - HC CHG RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS"]
[null,"84270 - HC CHG ASSAY OF SEX HORMONE BINDING GLOBULIN",null,"73521 - XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; 2 VIEWS","73521 - XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; 2 VIEWS","73521 - XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; 2 VIEWS",null,"72265 - HC CHG MYELOGRAPY LUMBOSACRAL RS&I",null,null,null,null,"73610 - HC CHG RADEX ANKLE COMPLETE MINIMUM 3 VIEWS",null,"72265 - HC CHG MYELOGRAPY LUMBOSACRAL RS&I",null,null,null,"73592 - HC CHG RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS"]
[null,"84295 - HC CHG SODIUM SERUM PLASMA OR WHOLE BLOOD",null,"73522 - XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; 3-4 VIEWS","73522 - XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; 3-4 VIEWS","73522 - XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; 3-4 VIEWS",null,"73000 - ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R",null,null,null,null,"73620 - HC CHG RADIOLOGIC EXAMINATION FOOT 2 VIEWS",null,"73000 - ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R",null,null,null,"73600 - HC CHG RADIOLOGIC EXAMINATION ANKLE 2 VIEWS"]
[null,"84300 - HC CHG ASSAY OF URINE SODIUM",null,"73523 - XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; MINIMUM 5 VIEWS","73523 - XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; MINIMUM 5 VIEWS","73523 - XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; MINIMUM 5 VIEWS",null,"73010 - HC CHG RADEX SCAPULA COMPLETE",null,null,null,null,"73630 - HC CHG RADEX FOOT COMPLETE MINIMUM 3 VIEWS",null,"73010 - HC CHG RADEX SCAPULA COMPLETE",null,null,null,"73610 - HC CHG RADEX ANKLE COMPLETE MINIMUM 3 VIEWS"]
[null,"84302 - HC CHG ASSAY OF SODIUM OTHER SOURCE",null,"73551 - XRAY EXAM FEMUR; 1 VIEW","73551 - XRAY EXAM FEMUR; 1 VIEW","73551 - XRAY EXAM FEMUR; 1 VIEW",null,"73020 - HC CHG RADEX SHOULDER 1 VIEW",null,null,null,null,"73650 - HC CHG RADEX CALCANEUS MINIMUM 2 VIEWS",null,"73020 - HC CHG RADEX SHOULDER 1 VIEW",null,null,null,"73620 - HC CHG RADIOLOGIC EXAMINATION FOOT 2 VIEWS"]
[null,"84305 - HC CHG ASSAY OF SOMATOMEDIN",null,"73552 - XRAY EXAM FEMUR; MINIMUM 2 VIEWS","73552 - XRAY EXAM FEMUR; MINIMUM 2 VIEWS","73552 - XRAY EXAM FEMUR; MINIMUM 2 VIEWS",null,"73030 - HC CHG RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS",null,null,null,null,"73660 - HC CHG RADEX TOE MINIMUM 2 VIEWS",null,"73030 - HC CHG RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS",null,null,null,"73630 - HC CHG RADEX FOOT COMPLETE MINIMUM 3 VIEWS"]
[null,"84307 - HC CHG ASSAY OF SOMATOSTATIN",null,"73560 - HC CHG RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS","73560 - HC CHG RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS","73560 - HC CHG RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS",null,"73050 - HC CHG RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ",null,null,null,null,"73700 - HC CHG CT LOWER EXTREMITY W/O CONTRAST MATERIAL",null,"73050 - HC CHG RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ",null,null,null,"73650 - HC CHG RADEX CALCANEUS MINIMUM 2 VIEWS"]
[null,"84311 - HC CHG SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED",null,"73562 - HC CHG RADIOLOGIC EXAMINATION KNEE 3 VIEWS","73562 - HC CHG RADIOLOGIC EXAMINATION KNEE 3 VIEWS","73562 - HC CHG RADIOLOGIC EXAMINATION KNEE 3 VIEWS",null,"73060 - HC CHG RADEX HUMERUS MINIMUM 2 VIEWS",null,null,null,null,"73701 - HC CHG CT LOWER EXTREMITY W/CONTRAST MATERIAL",null,"73060 - HC CHG RADEX HUMERUS MINIMUM 2 VIEWS",null,null,null,"73660 - HC CHG RADEX TOE MINIMUM 2 VIEWS"]
[null,"84376 - HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC",null,"73564 - HC CHG RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS","73564 - HC CHG RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS","73564 - HC CHG RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS",null,"73070 - HC CHG RADEX ELBOW 2 VIEWS",null,null,null,null,"73702 - HC CHG CT LOWER EXTREMITY W/O & W/CONTRAST MATRL",null,"73070 - HC CHG RADEX ELBOW 2 VIEWS",null,null,null,"73700 - HC CHG CT LOWER EXTREMITY W/O CONTRAST MATERIAL"]
[null,"84402 - HC CHG ASSAY OF TESTOSTERONE FREE",null,"73565 - HC CHG RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST","73565 - HC CHG RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST","73565 - HC CHG RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST",null,"73080 - HC CHG RADEX ELBOW COMPLETE MINIMUM 3 VIEWS",null,null,null,null,"73706 - HC CHG CT ANGIOGRAPHY LOWER EXTREMITY",null,"73080 - HC CHG RADEX ELBOW COMPLETE MINIMUM 3 VIEWS",null,null,null,"73701 - HC CHG CT LOWER EXTREMITY W/CONTRAST MATERIAL"]
[null,"84403 - HC CHG ASSAY OF TESTOSTERONE TOTAL",null,"73590 - HC CHG RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS","73590 - HC CHG RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS","73590 - HC CHG RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS",null,"73090 - HC CHG RADEX FOREARM 2 VIEWS",null,null,null,null,"73718 - HC CHG MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL",null,"73090 - HC CHG RADEX FOREARM 2 VIEWS",null,null,null,"73702 - HC CHG CT LOWER EXTREMITY W/O & W/CONTRAST MATRL"]
[null,"84425 - HC CHG ASSAY OF THIAMINE-VITAMIN B-1",null,"73592 - HC CHG RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS","73592 - HC CHG RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS","73592 - HC CHG RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS",null,"73092 - HC CHG RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS",null,null,null,null,"73719 - HC CHG MRI LOWER EXTREM OTH/THN JT W/CONTRAST MATRL",null,"73092 - HC CHG RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS",null,null,null,"73706 - HC CHG CT ANGIOGRAPHY LOWER EXTREMITY"]
[null,"84430 - HC CHG ASSAY OF THIOCYANATE",null,"73600 - HC CHG RADIOLOGIC EXAMINATION ANKLE 2 VIEWS","73600 - HC CHG RADIOLOGIC EXAMINATION ANKLE 2 VIEWS","73600 - HC CHG RADIOLOGIC EXAMINATION ANKLE 2 VIEWS",null,"73100 - XTRNL ECG & 48 HR RECORDING",null,null,null,null,"73720 - HC CHG MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR",null,"73100 - XTRNL ECG & 48 HR RECORDING",null,null,null,"73718 - HC CHG MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL"]
[null,"84432 - HC CHG ASSAY OF THYROGLOBULIN",null,"73610 - HC CHG RADEX ANKLE COMPLETE MINIMUM 3 VIEWS","73610 - HC CHG RADEX ANKLE COMPLETE MINIMUM 3 VIEWS","73610 - HC CHG RADEX ANKLE COMPLETE MINIMUM 3 VIEWS",null,"73110 - HC CHG RADEX WRIST COMPLETE MINIMUM 3 VIEWS",null,null,null,null,"73721 - HC CHG MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL",null,"73110 - HC CHG RADEX WRIST COMPLETE MINIMUM 3 VIEWS",null,null,null,"73719 - HC CHG MRI LOWER EXTREM OTH/THN JT W/CONTRAST MATRL"]
[null,"84436 - HC CHG ASSAY OF THYROXINE TOTAL",null,"73620 - HC CHG RADIOLOGIC EXAMINATION FOOT 2 VIEWS","73620 - HC CHG RADIOLOGIC EXAMINATION FOOT 2 VIEWS","73620 - HC CHG RADIOLOGIC EXAMINATION FOOT 2 VIEWS",null,"73120 - HC CHG RADEX HAND 2 VIEWS",null,null,null,null,"73722 - HC CHG MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL",null,"73120 - HC CHG RADEX HAND 2 VIEWS",null,null,null,"73720 - HC CHG MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR"]
[null,"84439 - HC CHG ASSAY OF FREE THYROXINE",null,"73630 - HC CHG RADEX FOOT COMPLETE MINIMUM 3 VIEWS","73630 - HC CHG RADEX FOOT COMPLETE MINIMUM 3 VIEWS","73630 - HC CHG RADEX FOOT COMPLETE MINIMUM 3 VIEWS",null,"73130 - HC CHG RADEX HAND MINIMUM 3 VIEWS",null,null,null,null,"73723 - HC CHG MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL",null,"73130 - HC CHG RADEX HAND MINIMUM 3 VIEWS",null,null,null,"73721 - HC CHG MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL"]
[null,"84442 - HC CHG ASSAY OF THYROXINE BNDNG GLOBULIN",null,"73650 - HC CHG RADEX CALCANEUS MINIMUM 2 VIEWS","73650 - HC CHG RADEX CALCANEUS MINIMUM 2 VIEWS","73650 - HC CHG RADEX CALCANEUS MINIMUM 2 VIEWS",null,"73140 - HC CHG RADEX FINGR MINIMUM 2 VIEWS",null,null,null,null,"73725 - HC MRA,LE,W/O",null,"73140 - HC CHG RADEX FINGR MINIMUM 2 VIEWS",null,null,null,"73722 - HC CHG MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL"]
[null,"84443 - HC CHG ASSAY OF THYROID STIMULATING HORMONE TSH",null,"73660 - HC CHG RADEX TOE MINIMUM 2 VIEWS","73660 - HC CHG RADEX TOE MINIMUM 2 VIEWS","73660 - HC CHG RADEX TOE MINIMUM 2 VIEWS",null,"73200 - HC CHG CT UPPER EXTREMITY W/O CONTRAST MATERIAL",null,null,null,null,"74018 - HC X-RAY EXAM ABDOMEN 1 VIEW",null,"73200 - HC CHG CT UPPER EXTREMITY W/O CONTRAST MATERIAL",null,null,null,"73723 - HC CHG MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL"]
[null,"84445 - HC CHG THYROID STIMULATING IMMUNE GLOBULINS TSI",null,"73700 - HC CHG CT LOWER EXTREMITY W/O CONTRAST MATERIAL","73700 - HC CHG CT LOWER EXTREMITY W/O CONTRAST MATERIAL","73700 - HC CHG CT LOWER EXTREMITY W/O CONTRAST MATERIAL",null,"73201 - HC CHG CT UPPER EXTREMITY W/CONTRAST MATERIAL",null,null,null,null,"74019 - HC XRAY ABD 2 VIEWS",null,"73201 - HC CHG CT UPPER EXTREMITY W/CONTRAST MATERIAL",null,null,null,"73725 - HC MRA,LE,W/O"]
[null,"84446 - HC CHG ASSAY OF TOCOPHEROL ALPHA VITAMIN E",null,"73701 - HC CHG CT LOWER EXTREMITY W/CONTRAST MATERIAL","73701 - HC CHG CT LOWER EXTREMITY W/CONTRAST MATERIAL","73701 - HC CHG CT LOWER EXTREMITY W/CONTRAST MATERIAL",null,"73202 - HC CHG CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL",null,null,null,null,"74021 - HC XRAY ABD 3+ VIEWS",null,"73202 - HC CHG CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL",null,null,null,"74018 - HC X-RAY EXAM ABDOMEN 1 VIEW"]
[null,"84450 - HC CHG TRANSFERASE ASPARTATE AMINO AST SGOT",null,"73702 - HC CHG CT LOWER EXTREMITY W/O & W/CONTRAST MATRL","73702 - HC CHG CT LOWER EXTREMITY W/O & W/CONTRAST MATRL","73702 - HC CHG CT LOWER EXTREMITY W/O & W/CONTRAST MATRL",null,"73206 - HC CHG CT ANGIOGRAPHY UPPER EXTREMITY",null,null,null,null,"74150 - HC CHG CT ABDOMEN W/O CONTRAST MATERIAL",null,"73206 - HC CHG CT ANGIOGRAPHY UPPER EXTREMITY",null,null,null,"74019 - HC XRAY ABD 2 VIEWS"]
[null,"84460 - HC CHG TRANSFERASE ALANINE AMINO (ALT) (SGPT)",null,"73706 - HC CHG CT ANGIOGRAPHY LOWER EXTREMITY","73706 - HC CHG CT ANGIOGRAPHY LOWER EXTREMITY","73706 - HC CHG CT ANGIOGRAPHY LOWER EXTREMITY",null,"73218 - HC CHG MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL",null,null,null,null,"74160 - HC CHG CT ABDOMEN W/CONTRAST MATERIAL",null,"73218 - HC CHG MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL",null,null,null,"74021 - HC XRAY ABD 3+ VIEWS"]
[null,"84466 - HC CHG ASSAY OF L7383TRANSFERRIN",null,"73718 - HC CHG MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL","73718 - HC CHG MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL","73718 - HC CHG MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL",null,"73219 - HC CHG MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL",null,null,null,null,"74170 - HC CT ABDOMEN WITH AND WITHOUT CONTRAST",null,"73219 - HC CHG MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL",null,null,null,"74150 - HC CHG CT ABDOMEN W/O CONTRAST MATERIAL"]
[null,"84478 - HC CHG ASSAY OF TRIGLYCERIDES",null,"73719 - HC CHG MRI LOWER EXTREM OTH/THN JT W/CONTRAST MATRL","73719 - HC CHG MRI LOWER EXTREM OTH/THN JT W/CONTRAST MATRL","73719 - HC CHG MRI LOWER EXTREM OTH/THN JT W/CONTRAST MATRL",null,"73220 - HC CHG MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS",null,null,null,null,"74174 - HC CHG CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG",null,"73220 - HC CHG MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS",null,null,null,"74160 - HC CHG CT ABDOMEN W/CONTRAST MATERIAL"]
[null,"84479 - HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO",null,"73720 - HC CHG MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR","73720 - HC CHG MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR","73720 - HC CHG MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR",null,"73221 - HC CHG MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL",null,null,null,null,"74175 - HC CHG CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST",null,"73221 - HC CHG MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL",null,null,null,"74170 - HC CT ABDOMEN WITH AND WITHOUT CONTRAST"]
[null,"84480 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3",null,"73721 - HC CHG MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL","73721 - HC CHG MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL","73721 - HC CHG MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL",null,"73222 - HC CHG MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL",null,null,null,null,"74176 - HC CHG CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL",null,"73222 - HC CHG MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL",null,null,null,"74174 - HC CHG CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG"]
[null,"84481 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 FREE",null,"73722 - HC CHG MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL","73722 - HC CHG MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL","73722 - HC CHG MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL",null,"73223 - HC CHG MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL",null,null,null,null,"74177 - HC CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL",null,"73223 - HC CHG MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL",null,null,null,"74175 - HC CHG CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST"]
[null,"84482 - HC CHG TRIIODOTHYRONINE T3 REVERSE",null,"73723 - HC CHG MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL","73723 - HC CHG MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL","73723 - HC CHG MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL",null,"73225 - HC CHG MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL",null,null,null,null,"74178 - HC CHG CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE",null,"73225 - HC CHG MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL",null,null,null,"74176 - HC CHG CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL"]
[null,"84484 - HC CHG ASSAY OF TROPONIN QUANTITATIVE",null,"73725 - HC MRA,LE,W/O","73725 - HC MRA,LE,W/O","73725 - HC MRA,LE,W/O",null,"73501 - XRAY EXAM OF HIP UNILATERAL W/PELVIS WHEN PERFORMED; 1 VIEW",null,null,null,null,"74181 - HC CHG MRI ABDOMEN W/O CONTRAST MATERIAL",null,"73501 - XRAY EXAM OF HIP UNILATERAL W/PELVIS WHEN PERFORMED; 1 VIEW",null,null,null,"74177 - HC CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL"]
[null,"84520 - HC CHG ASSAY OF UREA NITROGEN QUANTITATIVE",null,"74018 - HC X-RAY EXAM ABDOMEN 1 VIEW","74018 - HC X-RAY EXAM ABDOMEN 1 VIEW","74018 - HC X-RAY EXAM ABDOMEN 1 VIEW",null,"73502 - XRAY EXAM OF HIP UNILATERAL W/PELVIS WHEN PERFORMED; 2-3 VIEWS",null,null,null,null,"74182 - HC CHG MRI ABDOMEN W/CONTRAST MATERIAL",null,"73502 - XRAY EXAM OF HIP UNILATERAL W/PELVIS WHEN PERFORMED; 2-3 VIEWS",null,null,null,"74178 - HC CHG CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE"]
[null,"84540 - HC CHG ASSAY OF UREA NITROGEN URINE",null,"74019 - HC XRAY ABD 2 VIEWS","74019 - HC XRAY ABD 2 VIEWS","74019 - HC XRAY ABD 2 VIEWS",null,"73503 - XRAY EXAM OF HIP UNILATERAL W/PELVIS WHEN PERFORMED; MINIMUM 4 VIEWS",null,null,null,null,"74183 - HC CHG MRI ABDOMEN W/O & W/CONTRAST MATERIAL",null,"73503 - XRAY EXAM OF HIP UNILATERAL W/PELVIS WHEN PERFORMED; MINIMUM 4 VIEWS",null,null,null,"74181 - HC CHG MRI ABDOMEN W/O CONTRAST MATERIAL"]
[null,"84550 - HC CHG ASSAY OF BLOOD/URIC ACID",null,"74021 - HC XRAY ABD 3+ VIEWS","74021 - HC XRAY ABD 3+ VIEWS","74021 - HC XRAY ABD 3+ VIEWS",null,"73521 - XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; 2 VIEWS",null,null,null,null,"74185 - HC MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, ABDOMEN",null,"73521 - XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; 2 VIEWS",null,null,null,"74182 - HC CHG MRI ABDOMEN W/CONTRAST MATERIAL"]
[null,"84560 - HC CHG ASSAY OF URIC ACID OTHER SOURCE",null,"74150 - HC CHG CT ABDOMEN W/O CONTRAST MATERIAL","74150 - HC CHG CT ABDOMEN W/O CONTRAST MATERIAL","74150 - HC CHG CT ABDOMEN W/O CONTRAST MATERIAL",null,"73522 - XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; 3-4 VIEWS",null,null,null,null,"74220 - HC CHG RADEX ESOPHAGUS",null,"73522 - XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; 3-4 VIEWS",null,null,null,"74183 - HC CHG MRI ABDOMEN W/O & W/CONTRAST MATERIAL"]
[null,"84590 - HC CHG ASSAY OF VITAMIN A",null,"74160 - HC CHG CT ABDOMEN W/CONTRAST MATERIAL","74160 - HC CHG CT ABDOMEN W/CONTRAST MATERIAL","74160 - HC CHG CT ABDOMEN W/CONTRAST MATERIAL",null,"73523 - XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; MINIMUM 5 VIEWS",null,null,null,null,"74221 - HC X-RAY XM ESOPHAGUS 2CNTRST",null,"73523 - XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; MINIMUM 5 VIEWS",null,null,null,"74185 - HC MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, ABDOMEN"]
[null,"84591 - HC CHG ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED",null,"74170 - HC CT ABDOMEN WITH AND WITHOUT CONTRAST","74170 - HC CT ABDOMEN WITH AND WITHOUT CONTRAST","74170 - HC CT ABDOMEN WITH AND WITHOUT CONTRAST",null,"73551 - XRAY EXAM FEMUR; 1 VIEW",null,null,null,null,"74230 - SWALLOWING FUNCJ W/CINERADIOGRAPY/VIDRADIOG",null,"73551 - XRAY EXAM FEMUR; 1 VIEW",null,null,null,"74220 - HC CHG RADEX ESOPHAGUS"]
[null,"84597 - HC CHG ASSAY OF VITAMIN K",null,"74174 - HC CHG CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG","74174 - HC CHG CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG","74174 - HC CHG CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG",null,"73552 - XRAY EXAM FEMUR; MINIMUM 2 VIEWS",null,null,null,null,"74240 - HC XRAY UPPER GI TRACT",null,"73552 - XRAY EXAM FEMUR; MINIMUM 2 VIEWS",null,null,null,"74221 - HC X-RAY XM ESOPHAGUS 2CNTRST"]
[null,"84630 - HC CHG ASSAY OF ZINC",null,"74175 - HC CHG CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST","74175 - HC CHG CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST","74175 - HC CHG CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST",null,"73560 - HC CHG RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS",null,null,null,null,"74246 - HC XRAY UPPER GI AIR CONTRAST",null,"73560 - HC CHG RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS",null,null,null,"74230 - SWALLOWING FUNCJ W/CINERADIOGRAPY/VIDRADIOG"]
[null,"84681 - HC CHG ASSAY OF C-PEPTIDE",null,"74176 - HC CHG CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL","74176 - HC CHG CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL","74176 - HC CHG CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL",null,"73562 - HC CHG RADIOLOGIC EXAMINATION KNEE 3 VIEWS",null,null,null,null,"74248 - HC X-RAY SM INT F-THRU STD",null,"73562 - HC CHG RADIOLOGIC EXAMINATION KNEE 3 VIEWS",null,null,null,"74240 - HC XRAY UPPER GI TRACT"]
[null,"84702 - HC HCG TUMOR MARKER",null,"74177 - HC CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL","74177 - HC CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL","74177 - HC CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL",null,"73564 - HC CHG RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS",null,null,null,null,"74250 - HC CHG RADEX SMALL INTESTINE W/MULTIPLE SERIAL IMAGES",null,"73564 - HC CHG RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS",null,null,null,"74246 - HC XRAY UPPER GI AIR CONTRAST"]
[null,"84703 - HC GONAD,CHOR(HCG);QL",null,"74178 - HC CHG CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE","74178 - HC CHG CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE","74178 - HC CHG CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE",null,"73565 - HC CHG RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST",null,null,null,null,"74251 - HC CHG RADEX SM INT W/MLT SRL IMGES VIA ENTEROCLSS TUBE",null,"73565 - HC CHG RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST",null,null,null,"74248 - HC X-RAY SM INT F-THRU STD"]
[null,"85004 - HC AUTO DIFF",null,"74181 - HC CHG MRI ABDOMEN W/O CONTRAST MATERIAL","74181 - HC CHG MRI ABDOMEN W/O CONTRAST MATERIAL","74181 - HC CHG MRI ABDOMEN W/O CONTRAST MATERIAL",null,"73590 - HC CHG RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS",null,null,null,null,"74261 - HC CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST",null,"73590 - HC CHG RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS",null,null,null,"74250 - HC CHG RADEX SMALL INTESTINE W/MULTIPLE SERIAL IMAGES"]
[null,"85014 - HC CHG BLOOD COUNT HEMATOCRIT",null,"74182 - HC CHG MRI ABDOMEN W/CONTRAST MATERIAL","74182 - HC CHG MRI ABDOMEN W/CONTRAST MATERIAL","74182 - HC CHG MRI ABDOMEN W/CONTRAST MATERIAL",null,"73592 - HC CHG RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS",null,null,null,null,"74262 - HC CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST",null,"73592 - HC CHG RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS",null,null,null,"74251 - HC CHG RADEX SM INT W/MLT SRL IMGES VIA ENTEROCLSS TUBE"]
[null,"85018 - POC;HEMOGLOBIN",null,"74183 - HC CHG MRI ABDOMEN W/O & W/CONTRAST MATERIAL","74183 - HC CHG MRI ABDOMEN W/O & W/CONTRAST MATERIAL","74183 - HC CHG MRI ABDOMEN W/O & W/CONTRAST MATERIAL",null,"73600 - HC CHG RADIOLOGIC EXAMINATION ANKLE 2 VIEWS",null,null,null,null,"74263 - HC CT COLONOGRAPHY;SCREEN",null,"73600 - HC CHG RADIOLOGIC EXAMINATION ANKLE 2 VIEWS",null,null,null,"74261 - HC CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST"]
[null,"85025 - HC CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC",null,"74185 - HC MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, ABDOMEN","74185 - HC MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, ABDOMEN","74185 - HC MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, ABDOMEN",null,"73610 - HC CHG RADEX ANKLE COMPLETE MINIMUM 3 VIEWS",null,null,null,null,"74270 - HC CHG RADEX COLON BARIUM ENEMA W/WO KUB",null,"73610 - HC CHG RADEX ANKLE COMPLETE MINIMUM 3 VIEWS",null,null,null,"74262 - HC CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST"]
[null,"85027 - HC CHG BLOOD COUNT COMPLETE AUTOMATED",null,"74220 - HC CHG RADEX ESOPHAGUS","74220 - HC CHG RADEX ESOPHAGUS","74220 - HC CHG RADEX ESOPHAGUS",null,"73620 - HC CHG RADIOLOGIC EXAMINATION FOOT 2 VIEWS",null,null,null,null,"74280 - HC CHG RADEX COLON W/SPEC HI DNS BARIUM W/WO GLUCAGON",null,"73620 - HC CHG RADIOLOGIC EXAMINATION FOOT 2 VIEWS",null,null,null,"74263 - HC CT COLONOGRAPHY;SCREEN"]
[null,"85045 - HC CHG BLOOD COUNT RETICULOCYTE AUTOMATED",null,"74221 - HC X-RAY XM ESOPHAGUS 2CNTRST","74221 - HC X-RAY XM ESOPHAGUS 2CNTRST","74221 - HC X-RAY XM ESOPHAGUS 2CNTRST",null,"73630 - HC CHG RADEX FOOT COMPLETE MINIMUM 3 VIEWS",null,null,null,null,"74283 - HC CHG THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ",null,"73630 - HC CHG RADEX FOOT COMPLETE MINIMUM 3 VIEWS",null,null,null,"74270 - HC CHG RADEX COLON BARIUM ENEMA W/WO KUB"]
[null,"85046 - HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS",null,"74230 - SWALLOWING FUNCJ W/CINERADIOGRAPY/VIDRADIOG","74230 - SWALLOWING FUNCJ W/CINERADIOGRAPY/VIDRADIOG","74230 - SWALLOWING FUNCJ W/CINERADIOGRAPY/VIDRADIOG",null,"73650 - HC CHG RADEX CALCANEUS MINIMUM 2 VIEWS",null,null,null,null,"74328 - HC ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I",null,"73650 - HC CHG RADEX CALCANEUS MINIMUM 2 VIEWS",null,null,null,"74280 - HC CHG RADEX COLON W/SPEC HI DNS BARIUM W/WO GLUCAGON"]
[null,"85048 - HC CHG BLOOD COUNT LEUKOCYTE WBC AUTOMATED",null,"74240 - HC XRAY UPPER GI TRACT","74240 - HC XRAY UPPER GI TRACT","74240 - HC XRAY UPPER GI TRACT",null,"73660 - HC CHG RADEX TOE MINIMUM 2 VIEWS",null,null,null,null,"74329 - HC ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I",null,"73660 - HC CHG RADEX TOE MINIMUM 2 VIEWS",null,null,null,"74283 - HC CHG THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ"]
[null,"85049 - HC CHG BLOOD COUNT PLATELET AUTOMATED",null,"74246 - HC XRAY UPPER GI AIR CONTRAST","74246 - HC XRAY UPPER GI AIR CONTRAST","74246 - HC XRAY UPPER GI AIR CONTRAST",null,"73700 - HC CHG CT LOWER EXTREMITY W/O CONTRAST MATERIAL",null,null,null,null,"74330 - HC CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I",null,"73700 - HC CHG CT LOWER EXTREMITY W/O CONTRAST MATERIAL",null,null,null,"74328 - HC ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I"]
[null,"85055 - HC CHG RETICULATED PLATELET ASSAY",null,"74248 - HC X-RAY SM INT F-THRU STD","74248 - HC X-RAY SM INT F-THRU STD","74248 - HC X-RAY SM INT F-THRU STD",null,"73701 - HC CHG CT LOWER EXTREMITY W/CONTRAST MATERIAL",null,null,null,null,"74340 - HC CHG INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I",null,"73701 - HC CHG CT LOWER EXTREMITY W/CONTRAST MATERIAL",null,null,null,"74329 - HC ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I"]
[null,"85210 - HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC",null,"74250 - HC CHG RADEX SMALL INTESTINE W/MULTIPLE SERIAL IMAGES","74250 - HC CHG RADEX SMALL INTESTINE W/MULTIPLE SERIAL IMAGES","74250 - HC CHG RADEX SMALL INTESTINE W/MULTIPLE SERIAL IMAGES",null,"73702 - HC CHG CT LOWER EXTREMITY W/O & W/CONTRAST MATRL",null,null,null,null,"74360 - HC CHG INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I",null,"73702 - HC CHG CT LOWER EXTREMITY W/O & W/CONTRAST MATRL",null,null,null,"74330 - HC CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I"]
[null,"85220 - HC CHG CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR",null,"74251 - HC CHG RADEX SM INT W/MLT SRL IMGES VIA ENTEROCLSS TUBE","74251 - HC CHG RADEX SM INT W/MLT SRL IMGES VIA ENTEROCLSS TUBE","74251 - HC CHG RADEX SM INT W/MLT SRL IMGES VIA ENTEROCLSS TUBE",null,"73706 - HC CHG CT ANGIOGRAPHY LOWER EXTREMITY",null,null,null,null,"74363 - HC CHG PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I",null,"73706 - HC CHG CT ANGIOGRAPHY LOWER EXTREMITY",null,null,null,"74340 - HC CHG INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I"]
[null,"85230 - HC CHG CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR",null,"74261 - HC CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST","74261 - HC CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST","74261 - HC CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST",null,"73718 - HC CHG MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL",null,null,null,null,"74420 - X-RAY URINARY TRACT EXAM WITH CONTRAST MATERIAL",null,"73718 - HC CHG MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL",null,null,null,"74360 - HC CHG INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I"]
[null,"85240 - HC CHG CLOTTING FACTOR VIII AHG 1 STAGE",null,"74262 - HC CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST","74262 - HC CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST","74262 - HC CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST",null,"73719 - HC CHG MRI LOWER EXTREM OTH/THN JT W/CONTRAST MATRL",null,null,null,null,"74425 - UROGRAPHY ANTEGRADE RS&I",null,"73719 - HC CHG MRI LOWER EXTREM OTH/THN JT W/CONTRAST MATRL",null,null,null,"74363 - HC CHG PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I"]
[null,"85245 - HC CHG CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT",null,"74263 - HC CT COLONOGRAPHY;SCREEN","74263 - HC CT COLONOGRAPHY;SCREEN","74263 - HC CT COLONOGRAPHY;SCREEN",null,"73720 - HC CHG MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR",null,null,null,null,"74430 - CYSTOGRAPHY MINIMUM 3 VIEWS RS&I",null,"73720 - HC CHG MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR",null,null,null,"74420 - X-RAY URINARY TRACT EXAM WITH CONTRAST MATERIAL"]
[null,"85246 - HC CHG CLOTTING FACTOR VIII VW FACTOR ANTIGEN",null,"74270 - HC CHG RADEX COLON BARIUM ENEMA W/WO KUB","74270 - HC CHG RADEX COLON BARIUM ENEMA W/WO KUB","74270 - HC CHG RADEX COLON BARIUM ENEMA W/WO KUB",null,"73721 - HC CHG MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL",null,null,null,null,"74445 - HC CHG CORPORA CAVERNOSOGRAPY RS&I",null,"73721 - HC CHG MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL",null,null,null,"74425 - UROGRAPHY ANTEGRADE RS&I"]
[null,"85250 - HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS",null,"74280 - HC CHG RADEX COLON W/SPEC HI DNS BARIUM W/WO GLUCAGON","74280 - HC CHG RADEX COLON W/SPEC HI DNS BARIUM W/WO GLUCAGON","74280 - HC CHG RADEX COLON W/SPEC HI DNS BARIUM W/WO GLUCAGON",null,"73722 - HC CHG MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL",null,null,null,null,"74450 - URETHROCYSTOGRAPHY RETROGRADE RS&I",null,"73722 - HC CHG MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL",null,null,null,"74430 - CYSTOGRAPHY MINIMUM 3 VIEWS RS&I"]
[null,"85260 - HC CHG CLOTTING FACTOR X STUART-PROWER",null,"74283 - HC CHG THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ","74283 - HC CHG THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ","74283 - HC CHG THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ",null,"73723 - HC CHG MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL",null,null,null,null,"74455 - URETHROCYSTOGRAPHY VOIDING RS&I",null,"73723 - HC CHG MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL",null,null,null,"74445 - HC CHG CORPORA CAVERNOSOGRAPY RS&I"]
[null,"85270 - HC CHG CLOTTING FACTOR XI PTA",null,"74328 - HC ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I","74328 - HC ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I","74328 - HC ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I",null,"73725 - HC MRA,LE,W/O",null,null,null,null,"74712 - HC MRI FETAL SNGL/1ST GEST",null,"73725 - HC MRA,LE,W/O",null,null,null,"74450 - URETHROCYSTOGRAPHY RETROGRADE RS&I"]
[null,"85280 - HC CHG CLOTTING FACTOR XII HAGEMAN",null,"74329 - HC ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I","74329 - HC ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I","74329 - HC ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I",null,"74018 - HC X-RAY EXAM ABDOMEN 1 VIEW",null,null,null,null,"74713 - HC MRI FETAL EA ADD GEST",null,"74018 - HC X-RAY EXAM ABDOMEN 1 VIEW",null,null,null,"74455 - URETHROCYSTOGRAPHY VOIDING RS&I"]
[null,"85290 - HC CHG CLOTTING FACTOR XIII FIBRIN STABILIZING",null,"74330 - HC CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I","74330 - HC CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I","74330 - HC CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I",null,"74019 - HC XRAY ABD 2 VIEWS",null,null,null,null,"74740 - HC CHG HYSTEROSALPINGOGRAPHY RS&I",null,"74019 - HC XRAY ABD 2 VIEWS",null,null,null,"74712 - HC MRI FETAL SNGL/1ST GEST"]
[null,"85300 - HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY",null,"74340 - HC CHG INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I","74340 - HC CHG INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I","74340 - HC CHG INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I",null,"74021 - HC XRAY ABD 3+ VIEWS",null,null,null,null,"75557 - HC CHG CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST",null,"74021 - HC XRAY ABD 3+ VIEWS",null,null,null,"74713 - HC MRI FETAL EA ADD GEST"]
[null,"85301 - HC CHG CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY",null,"74360 - HC CHG INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I","74360 - HC CHG INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I","74360 - HC CHG INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I",null,"74150 - HC CHG CT ABDOMEN W/O CONTRAST MATERIAL",null,null,null,null,"75559 - HC CHG CARDIAC MRI W/O CONTRAST W/STRESS IMAGING",null,"74150 - HC CHG CT ABDOMEN W/O CONTRAST MATERIAL",null,null,null,"74740 - HC CHG HYSTEROSALPINGOGRAPHY RS&I"]
[null,"85302 - HC CHG CLOTTING INHIBITORS PROTEIN C ANTIGEN",null,"74363 - HC CHG PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I","74363 - HC CHG PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I","74363 - HC CHG PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I",null,"74160 - HC CHG CT ABDOMEN W/CONTRAST MATERIAL",null,null,null,null,"75561 - HC CHG CARDIAC MRI W/WO CONTRAST & FURTHER SEQ",null,"74160 - HC CHG CT ABDOMEN W/CONTRAST MATERIAL",null,null,null,"75557 - HC CHG CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST"]
[null,"85303 - HC CHG CLOTTING INHIBITORS PROTEIN C ACTIVITY",null,"74420 - X-RAY URINARY TRACT EXAM WITH CONTRAST MATERIAL","74420 - X-RAY URINARY TRACT EXAM WITH CONTRAST MATERIAL","74420 - X-RAY URINARY TRACT EXAM WITH CONTRAST MATERIAL",null,"74170 - HC CT ABDOMEN WITH AND WITHOUT CONTRAST",null,null,null,null,"75563 - HC CHG CARDIAC MRI W/W/O CONTRAST W/STRESS",null,"74170 - HC CT ABDOMEN WITH AND WITHOUT CONTRAST",null,null,null,"75559 - HC CHG CARDIAC MRI W/O CONTRAST W/STRESS IMAGING"]
[null,"85305 - HC CHG CLOTTING INHIBITORS PROTEIN S TOTAL",null,"74425 - UROGRAPHY ANTEGRADE RS&I","74425 - UROGRAPHY ANTEGRADE RS&I","74425 - UROGRAPHY ANTEGRADE RS&I",null,"74174 - HC CHG CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG",null,null,null,null,"75565 - HC CHG CARDIAC MRI FOR VELOCITY FLOW MAPPING",null,"74174 - HC CHG CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG",null,null,null,"75561 - HC CHG CARDIAC MRI W/WO CONTRAST & FURTHER SEQ"]
[null,"85306 - HC CHG CLOTTING INHIBITORS PROTEIN S FREE",null,"74430 - CYSTOGRAPHY MINIMUM 3 VIEWS RS&I","74430 - CYSTOGRAPHY MINIMUM 3 VIEWS RS&I","74430 - CYSTOGRAPHY MINIMUM 3 VIEWS RS&I",null,"74175 - HC CHG CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST",null,null,null,null,"75571 - HC CT,HEART;W/OCM;COR CAL",null,"74175 - HC CHG CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST",null,null,null,"75563 - HC CHG CARDIAC MRI W/W/O CONTRAST W/STRESS"]
[null,"85307 - HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY",null,"74445 - HC CHG CORPORA CAVERNOSOGRAPY RS&I","74445 - HC CHG CORPORA CAVERNOSOGRAPY RS&I","74445 - HC CHG CORPORA CAVERNOSOGRAPY RS&I",null,"74176 - HC CHG CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL",null,null,null,null,"75574 - HC CHG CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST",null,"74176 - HC CHG CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL",null,null,null,"75565 - HC CHG CARDIAC MRI FOR VELOCITY FLOW MAPPING"]
[null,"85347 - HC CHG COAGULATION TIME ACTIVATED",null,"74450 - URETHROCYSTOGRAPHY RETROGRADE RS&I","74450 - URETHROCYSTOGRAPHY RETROGRADE RS&I","74450 - URETHROCYSTOGRAPHY RETROGRADE RS&I",null,"74177 - HC CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL",null,null,null,null,"75600 - HC CHG ANGIO AORTOGRAM THORACIC",null,"74177 - HC CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL",null,null,null,"75571 - HC CT,HEART;W/OCM;COR CAL"]
[null,"85366 - HC CHG FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ",null,"74455 - URETHROCYSTOGRAPHY VOIDING RS&I","74455 - URETHROCYSTOGRAPHY VOIDING RS&I","74455 - URETHROCYSTOGRAPHY VOIDING RS&I",null,"74178 - HC CHG CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE",null,null,null,null,"75605 - HC CHG AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I",null,"74178 - HC CHG CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE",null,null,null,"75574 - HC CHG CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST"]
[null,"85378 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN",null,"74712 - HC MRI FETAL SNGL/1ST GEST","74712 - HC MRI FETAL SNGL/1ST GEST","74712 - HC MRI FETAL SNGL/1ST GEST",null,"74181 - HC CHG MRI ABDOMEN W/O CONTRAST MATERIAL",null,null,null,null,"75625 - HC CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I",null,"74181 - HC CHG MRI ABDOMEN W/O CONTRAST MATERIAL",null,null,null,"75600 - HC CHG ANGIO AORTOGRAM THORACIC"]
[null,"85379 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE",null,"74713 - HC MRI FETAL EA ADD GEST","74713 - HC MRI FETAL EA ADD GEST","74713 - HC MRI FETAL EA ADD GEST",null,"74182 - HC CHG MRI ABDOMEN W/CONTRAST MATERIAL",null,null,null,null,"75630 - HC CHG AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I",null,"74182 - HC CHG MRI ABDOMEN W/CONTRAST MATERIAL",null,null,null,"75605 - HC CHG AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I"]
[null,"85384 - HC CHG FIBRINOGEN ACTIVITY",null,"74740 - HC CHG HYSTEROSALPINGOGRAPHY RS&I","74740 - HC CHG HYSTEROSALPINGOGRAPHY RS&I","74740 - HC CHG HYSTEROSALPINGOGRAPHY RS&I",null,"74183 - HC CHG MRI ABDOMEN W/O & W/CONTRAST MATERIAL",null,null,null,null,"75635 - HC CHG CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP",null,"74183 - HC CHG MRI ABDOMEN W/O & W/CONTRAST MATERIAL",null,null,null,"75625 - HC CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I"]
[null,"85397 - HC CHG CLOTTING FUNCTION ACTIVITY NOS, EA ANALYT",null,"75557 - HC CHG CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST","75557 - HC CHG CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST","75557 - HC CHG CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST",null,"74185 - HC MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, ABDOMEN",null,null,null,null,"75705 - HC CHG ANGIOGRAPHY SPINAL SELECTIVE RS&I",null,"74185 - HC MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, ABDOMEN",null,null,null,"75630 - HC CHG AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I"]
[null,"85461 - HC CHG HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE",null,"75559 - HC CHG CARDIAC MRI W/O CONTRAST W/STRESS IMAGING","75559 - HC CHG CARDIAC MRI W/O CONTRAST W/STRESS IMAGING","75559 - HC CHG CARDIAC MRI W/O CONTRAST W/STRESS IMAGING",null,"74220 - HC CHG RADEX ESOPHAGUS",null,null,null,null,"75710 - HC CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I",null,"74220 - HC CHG RADEX ESOPHAGUS",null,null,null,"75635 - HC CHG CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP"]
[null,"85520 - HC CHG HEPARIN ASSAY",null,"75561 - HC CHG CARDIAC MRI W/WO CONTRAST & FURTHER SEQ","75561 - HC CHG CARDIAC MRI W/WO CONTRAST & FURTHER SEQ","75561 - HC CHG CARDIAC MRI W/WO CONTRAST & FURTHER SEQ",null,"74221 - HC X-RAY XM ESOPHAGUS 2CNTRST",null,null,null,null,"75716 - HC CHG ANGIOGRAPHY EXTREMITY BILATERAL RS&I",null,"74221 - HC X-RAY XM ESOPHAGUS 2CNTRST",null,null,null,"75705 - HC CHG ANGIOGRAPHY SPINAL SELECTIVE RS&I"]
[null,"85549 - HC CHG MURAMIDASE",null,"75563 - HC CHG CARDIAC MRI W/W/O CONTRAST W/STRESS","75563 - HC CHG CARDIAC MRI W/W/O CONTRAST W/STRESS","75563 - HC CHG CARDIAC MRI W/W/O CONTRAST W/STRESS",null,"74230 - SWALLOWING FUNCJ W/CINERADIOGRAPY/VIDRADIOG",null,null,null,null,"75726 - HC CHG ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I",null,"74230 - SWALLOWING FUNCJ W/CINERADIOGRAPY/VIDRADIOG",null,null,null,"75710 - HC CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I"]
[null,"85576 - HC CHG PLATELET AGGREGATION IN VITRO EACH AGENT",null,"75565 - HC CHG CARDIAC MRI FOR VELOCITY FLOW MAPPING","75565 - HC CHG CARDIAC MRI FOR VELOCITY FLOW MAPPING","75565 - HC CHG CARDIAC MRI FOR VELOCITY FLOW MAPPING",null,"74240 - HC XRAY UPPER GI TRACT",null,null,null,null,"75731 - HC ANGIO ADRENAL UNILAT SELECT",null,"74240 - HC XRAY UPPER GI TRACT",null,null,null,"75716 - HC CHG ANGIOGRAPHY EXTREMITY BILATERAL RS&I"]
[null,"85610 - POC;INR",null,"75571 - HC CT,HEART;W/OCM;COR CAL","75571 - HC CT,HEART;W/OCM;COR CAL","75571 - HC CT,HEART;W/OCM;COR CAL",null,"74241 - XR UGI W KUB",null,null,null,null,"75733 - HC ANGIO ADRENAL BILAT SELECT",null,"74241 - XR UGI W KUB",null,null,null,"75726 - HC CHG ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I"]
[null,"85611 - HC CHG PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH",null,"75574 - HC CHG CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST","75574 - HC CHG CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST","75574 - HC CHG CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST",null,"74245 - XR UGI W SM BOWEL",null,null,null,null,"75736 - HC CHG ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I",null,"74245 - XR UGI W SM BOWEL",null,null,null,"75731 - HC ANGIO ADRENAL UNILAT SELECT"]
[null,"85613 - HC CHG RUSSELL VIPER VENOM DILUTED",null,"75600 - HC CHG ANGIO AORTOGRAM THORACIC","75600 - HC CHG ANGIO AORTOGRAM THORACIC","75600 - HC CHG ANGIO AORTOGRAM THORACIC",null,"74246 - HC XRAY UPPER GI AIR CONTRAST",null,null,null,null,"75741 - HC CHG ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I",null,"74246 - HC XRAY UPPER GI AIR CONTRAST",null,null,null,"75733 - HC ANGIO ADRENAL BILAT SELECT"]
[null,"85651 - SEDIMENTATION RATE RBC NON-AUTOMATED",null,"75605 - HC CHG AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I","75605 - HC CHG AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I","75605 - HC CHG AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I",null,"74247 - XR UGI W AIR CON KUB",null,null,null,null,"75743 - HC CHG ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I",null,"74247 - XR UGI W AIR CON KUB",null,null,null,"75736 - HC CHG ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I"]
[null,"85652 - HC CHG SEDIMENTATION RATE RBC AUTOMATED",null,"75625 - HC CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I","75625 - HC CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I","75625 - HC CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I",null,"74248 - HC X-RAY SM INT F-THRU STD",null,null,null,null,"75746 - HC CHG ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I",null,"74248 - HC X-RAY SM INT F-THRU STD",null,null,null,"75741 - HC CHG ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I"]
[null,"85660 - HC CHG SICKLING RBC REDUCTION",null,"75630 - HC CHG AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I","75630 - HC CHG AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I","75630 - HC CHG AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I",null,"74249 - XR UGI W AIR CON SM BOWEL",null,null,null,null,"75774 - HC CHG ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I",null,"74249 - XR UGI W AIR CON SM BOWEL",null,null,null,"75743 - HC CHG ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I"]
[null,"85670 - HC CHG THROMBIN TIME PLASMA",null,"75635 - HC CHG CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP","75635 - HC CHG CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP","75635 - HC CHG CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP",null,"74250 - HC CHG RADEX SMALL INTESTINE W/MULTIPLE SERIAL IMAGES",null,null,null,null,"75803 - HC LYPMH VESSEL XRAY ARM/LEG",null,"74250 - HC CHG RADEX SMALL INTESTINE W/MULTIPLE SERIAL IMAGES",null,null,null,"75746 - HC CHG ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I"]
[null,"85705 - HC CHG THROMBOPLASTIN INHIBITION TISSUE",null,"75705 - HC CHG ANGIOGRAPHY SPINAL SELECTIVE RS&I","75705 - HC CHG ANGIOGRAPHY SPINAL SELECTIVE RS&I","75705 - HC CHG ANGIOGRAPHY SPINAL SELECTIVE RS&I",null,"74251 - HC CHG RADEX SM INT W/MLT SRL IMGES VIA ENTEROCLSS TUBE",null,null,null,null,"75805 - HC LYMPH VES X-RAY TRUNK UNI",null,"74251 - HC CHG RADEX SM INT W/MLT SRL IMGES VIA ENTEROCLSS TUBE",null,null,null,"75774 - HC CHG ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I"]
[null,"85730 - HC CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD",null,"75710 - HC CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I","75710 - HC CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I","75710 - HC CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I",null,"74261 - HC CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST",null,null,null,null,"75807 - HC LYMPH VESSEL X-RAY TRUNK",null,"74261 - HC CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST",null,null,null,"75803 - HC LYPMH VESSEL XRAY ARM/LEG"]
[null,"85732 - HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA",null,"75716 - HC CHG ANGIOGRAPHY EXTREMITY BILATERAL RS&I","75716 - HC CHG ANGIOGRAPHY EXTREMITY BILATERAL RS&I","75716 - HC CHG ANGIOGRAPHY EXTREMITY BILATERAL RS&I",null,"74262 - HC CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST",null,null,null,null,"75809 - HC INJ&IMAGE PERITONL SHUNT",null,"74262 - HC CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST",null,null,null,"75805 - HC LYMPH VES X-RAY TRUNK UNI"]
[null,"85810 - HC CHG VISCOSITY",null,"75726 - HC CHG ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I","75726 - HC CHG ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I","75726 - HC CHG ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I",null,"74263 - HC CT COLONOGRAPHY;SCREEN",null,null,null,null,"75810 - HC CHG SPLENOPORTOGRAPY RS&I",null,"74263 - HC CT COLONOGRAPHY;SCREEN",null,null,null,"75807 - HC LYMPH VESSEL X-RAY TRUNK"]
[null,"86003 - HC CHG ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN",null,"75731 - HC ANGIO ADRENAL UNILAT SELECT","75731 - HC ANGIO ADRENAL UNILAT SELECT","75731 - HC ANGIO ADRENAL UNILAT SELECT",null,"74270 - HC CHG RADEX COLON BARIUM ENEMA W/WO KUB",null,null,null,null,"75820 - HC CHG VENOGRAPHY EXTREMITY UNILATERAL RS&I",null,"74270 - HC CHG RADEX COLON BARIUM ENEMA W/WO KUB",null,null,null,"75809 - HC INJ&IMAGE PERITONL SHUNT"]
[null,"86021 - HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES",null,"75733 - HC ANGIO ADRENAL BILAT SELECT","75733 - HC ANGIO ADRENAL BILAT SELECT","75733 - HC ANGIO ADRENAL BILAT SELECT",null,"74280 - HC CHG RADEX COLON W/SPEC HI DNS BARIUM W/WO GLUCAGON",null,null,null,null,"75822 - HC CHG VENOGRAPHY EXTREMITY BILATERAL RS&I",null,"74280 - HC CHG RADEX COLON W/SPEC HI DNS BARIUM W/WO GLUCAGON",null,null,null,"75810 - HC CHG SPLENOPORTOGRAPY RS&I"]
[null,"86022 - HC CRL;SEROTONIN RLS ASSAY",null,"75736 - HC CHG ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I","75736 - HC CHG ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I","75736 - HC CHG ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I",null,"74283 - HC CHG THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ",null,null,null,null,"75825 - HC CHG VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I",null,"74283 - HC CHG THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ",null,null,null,"75820 - HC CHG VENOGRAPHY EXTREMITY UNILATERAL RS&I"]
[null,"86038 - HC CHG ANTINUCLEAR ANTIBODIES ANA",null,"75741 - HC CHG ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I","75741 - HC CHG ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I","75741 - HC CHG ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I",null,"74328 - HC ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I",null,null,null,null,"75827 - HC CHG VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I",null,"74328 - HC ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I",null,null,null,"75822 - HC CHG VENOGRAPHY EXTREMITY BILATERAL RS&I"]
[null,"86039 - HC CHG ANTINUCLEAR ANTIBODIES ANA TITER",null,"75743 - HC CHG ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I","75743 - HC CHG ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I","75743 - HC CHG ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I",null,"74329 - HC ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I",null,null,null,null,"75831 - HC CHG VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I",null,"74329 - HC ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I",null,null,null,"75825 - HC CHG VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I"]
[null,"86060 - HC CHG ANTISTREPTOLYSIN O TITER",null,"75746 - HC CHG ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I","75746 - HC CHG ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I","75746 - HC CHG ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I",null,"74330 - HC CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I",null,null,null,null,"75833 - HC CHG VENOGRAM RENAL BILAT",null,"74330 - HC CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I",null,null,null,"75827 - HC CHG VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I"]
[null,"86140 - C-REACTIVE PROTEIN",null,"75774 - HC CHG ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I","75774 - HC CHG ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I","75774 - HC CHG ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I",null,"74340 - HC CHG INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I",null,null,null,null,"75842 - HC CHG VENOGRAM ADRENAL BILAT",null,"74340 - HC CHG INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I",null,null,null,"75831 - HC CHG VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I"]
[null,"86141 - HC CRL;CARDIO CRP",null,"75803 - HC LYPMH VESSEL XRAY ARM/LEG","75803 - HC LYPMH VESSEL XRAY ARM/LEG","75803 - HC LYPMH VESSEL XRAY ARM/LEG",null,"74360 - HC CHG INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I",null,null,null,null,"75860 - HC CHG VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I",null,"74360 - HC CHG INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I",null,null,null,"75833 - HC CHG VENOGRAM RENAL BILAT"]
[null,"86146 - HC CRL;BETA-2 GLYCPRTN 1 AB",null,"75805 - HC LYMPH VES X-RAY TRUNK UNI","75805 - HC LYMPH VES X-RAY TRUNK UNI","75805 - HC LYMPH VES X-RAY TRUNK UNI",null,"74363 - HC CHG PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I",null,null,null,null,"75870 - VENOGRAM SUPER SAG SINUS",null,"74363 - HC CHG PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I",null,null,null,"75842 - HC CHG VENOGRAM ADRENAL BILAT"]
[null,"86147 - HC Q;CARDLIP AB;IGG,IGM,IGA",null,"75807 - HC LYMPH VESSEL X-RAY TRUNK","75807 - HC LYMPH VESSEL X-RAY TRUNK","75807 - HC LYMPH VESSEL X-RAY TRUNK",null,"74420 - X-RAY URINARY TRACT EXAM WITH CONTRAST MATERIAL",null,null,null,null,"75885 - HC CHG PERCUT XHEPATIC PORTO+DYNAMIC",null,"74420 - X-RAY URINARY TRACT EXAM WITH CONTRAST MATERIAL",null,null,null,"75860 - HC CHG VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I"]
[null,"86157 - HC CHG COLD AGGLUTININ TITER",null,"75809 - HC INJ&IMAGE PERITONL SHUNT","75809 - HC INJ&IMAGE PERITONL SHUNT","75809 - HC INJ&IMAGE PERITONL SHUNT",null,"74425 - UROGRAPHY ANTEGRADE RS&I",null,null,null,null,"75887 - HC CHG PERCUT XHEPATIC PORTOGRAM",null,"74425 - UROGRAPHY ANTEGRADE RS&I",null,null,null,"75870 - VENOGRAM SUPER SAG SINUS"]
[null,"86160 - HC CHG COMPLEMENT ANTIGEN EACH COMPONENT",null,"75810 - HC CHG SPLENOPORTOGRAPY RS&I","75810 - HC CHG SPLENOPORTOGRAPY RS&I","75810 - HC CHG SPLENOPORTOGRAPY RS&I",null,"74430 - CYSTOGRAPHY MINIMUM 3 VIEWS RS&I",null,null,null,null,"75889 - HC HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I",null,"74430 - CYSTOGRAPHY MINIMUM 3 VIEWS RS&I",null,null,null,"75885 - HC CHG PERCUT XHEPATIC PORTO+DYNAMIC"]
[null,"86161 - HC CHG COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT",null,"75820 - HC CHG VENOGRAPHY EXTREMITY UNILATERAL RS&I","75820 - HC CHG VENOGRAPHY EXTREMITY UNILATERAL RS&I","75820 - HC CHG VENOGRAPHY EXTREMITY UNILATERAL RS&I",null,"74445 - HC CHG CORPORA CAVERNOSOGRAPY RS&I",null,null,null,null,"75891 - HC CHG HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I",null,"74445 - HC CHG CORPORA CAVERNOSOGRAPY RS&I",null,null,null,"75887 - HC CHG PERCUT XHEPATIC PORTOGRAM"]
[null,"86162 - HC CHG COMPLEMENT TOTAL HEMOLYTIC",null,"75822 - HC CHG VENOGRAPHY EXTREMITY BILATERAL RS&I","75822 - HC CHG VENOGRAPHY EXTREMITY BILATERAL RS&I","75822 - HC CHG VENOGRAPHY EXTREMITY BILATERAL RS&I",null,"74450 - URETHROCYSTOGRAPHY RETROGRADE RS&I",null,null,null,null,"75893 - HC CHG VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS&",null,"74450 - URETHROCYSTOGRAPHY RETROGRADE RS&I",null,null,null,"75889 - HC HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I"]
[null,"86200 - HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY",null,"75825 - HC CHG VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I","75825 - HC CHG VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I","75825 - HC CHG VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I",null,"74455 - URETHROCYSTOGRAPHY VOIDING RS&I",null,null,null,null,"75894 - HC CHG TRANSCATHETER EMBOLIZATION ANY METH RS&I",null,"74455 - URETHROCYSTOGRAPHY VOIDING RS&I",null,null,null,"75891 - HC CHG HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I"]
[null,"86235 - HC CHG EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD",null,"75827 - HC CHG VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I","75827 - HC CHG VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I","75827 - HC CHG VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I",null,"74712 - HC MRI FETAL SNGL/1ST GEST",null,null,null,null,"75898 - HC CHG ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS",null,"74712 - HC MRI FETAL SNGL/1ST GEST",null,null,null,"75893 - HC CHG VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS&"]
[null,"86255 - HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY",null,"75831 - HC CHG VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I","75831 - HC CHG VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I","75831 - HC CHG VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I",null,"74713 - HC MRI FETAL EA ADD GEST",null,null,null,null,"75902 - HC CHG MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I",null,"74713 - HC MRI FETAL EA ADD GEST",null,null,null,"75894 - HC CHG TRANSCATHETER EMBOLIZATION ANY METH RS&I"]
[null,"86256 - HC CHG FLUORESCENT ANTIBODY; TITER",null,"75833 - HC CHG VENOGRAM RENAL BILAT","75833 - HC CHG VENOGRAM RENAL BILAT","75833 - HC CHG VENOGRAM RENAL BILAT",null,"74740 - HC CHG HYSTEROSALPINGOGRAPHY RS&I",null,null,null,null,"75970 - HC CHG TRANSCATHETER BIOPSY RS&I",null,"74740 - HC CHG HYSTEROSALPINGOGRAPHY RS&I",null,null,null,"75898 - HC CHG ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS"]
[null,"86300 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3",null,"75842 - HC CHG VENOGRAM ADRENAL BILAT","75842 - HC CHG VENOGRAM ADRENAL BILAT","75842 - HC CHG VENOGRAM ADRENAL BILAT",null,"75557 - HC CHG CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST",null,null,null,null,"75984 - CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I",null,"75557 - HC CHG CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST",null,null,null,"75902 - HC CHG MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I"]
[null,"86301 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9",null,"75860 - HC CHG VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I","75860 - HC CHG VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I","75860 - HC CHG VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I",null,"75559 - HC CHG CARDIAC MRI W/O CONTRAST W/STRESS IMAGING",null,null,null,null,"75989 - RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I",null,"75559 - HC CHG CARDIAC MRI W/O CONTRAST W/STRESS IMAGING",null,null,null,"75970 - HC CHG TRANSCATHETER BIOPSY RS&I"]
[null,"86304 - HC CRL;CA-125",null,"75870 - VENOGRAM SUPER SAG SINUS","75870 - VENOGRAM SUPER SAG SINUS","75870 - VENOGRAM SUPER SAG SINUS",null,"75561 - HC CHG CARDIAC MRI W/WO CONTRAST & FURTHER SEQ",null,null,null,null,"76000 - FLUOROSCOPY SPX UP TO 1 HOUR PHYS/QHP TIME",null,"75561 - HC CHG CARDIAC MRI W/WO CONTRAST & FURTHER SEQ",null,null,null,"75984 - CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I"]
[null,"86308 - HC CHG HETEROPHILE ANTIBODIES SCREEN",null,"75885 - HC CHG PERCUT XHEPATIC PORTO+DYNAMIC","75885 - HC CHG PERCUT XHEPATIC PORTO+DYNAMIC","75885 - HC CHG PERCUT XHEPATIC PORTO+DYNAMIC",null,"75563 - HC CHG CARDIAC MRI W/W/O CONTRAST W/STRESS",null,null,null,null,"76010 - HC CHG RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD",null,"75563 - HC CHG CARDIAC MRI W/W/O CONTRAST W/STRESS",null,null,null,"75989 - RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I"]
[null,"86316 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE",null,"75887 - HC CHG PERCUT XHEPATIC PORTOGRAM","75887 - HC CHG PERCUT XHEPATIC PORTOGRAM","75887 - HC CHG PERCUT XHEPATIC PORTOGRAM",null,"75565 - HC CHG CARDIAC MRI FOR VELOCITY FLOW MAPPING",null,null,null,null,"76080 - HC CHG RADEX ABSCESS/FISTULA/SINUS TRACT RS&I",null,"75565 - HC CHG CARDIAC MRI FOR VELOCITY FLOW MAPPING",null,null,null,"76000 - FLUOROSCOPY SPX UP TO 1 HOUR PHYS/QHP TIME"]
[null,"86317 - HC IMMUNOASSAY,INFECT AGENT,QUANT",null,"75889 - HC HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I","75889 - HC HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I","75889 - HC HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I",null,"75571 - HC CT,HEART;W/OCM;COR CAL",null,null,null,null,"76098 - HC CHG RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN",null,"75571 - HC CT,HEART;W/OCM;COR CAL",null,null,null,"76010 - HC CHG RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD"]
[null,"86328 - IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY; CORONAVIRUS 2",null,"75891 - HC CHG HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I","75891 - HC CHG HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I","75891 - HC CHG HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I",null,"75574 - HC CHG CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST",null,null,null,null,"76376 - HC CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION",null,"75574 - HC CHG CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST",null,null,null,"76080 - HC CHG RADEX ABSCESS/FISTULA/SINUS TRACT RS&I"]
[null,"86331 - HC CHG IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY",null,"75893 - HC CHG VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS&","75893 - HC CHG VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS&","75893 - HC CHG VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS&",null,"75600 - HC CHG ANGIO AORTOGRAM THORACIC",null,null,null,null,"76377 - HC CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION",null,"75600 - HC CHG ANGIO AORTOGRAM THORACIC",null,null,null,"76098 - HC CHG RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN"]
[null,"86334 - HC CHG IMMUNOFIXJ ELECTROPHORESIS SERUM",null,"75894 - HC CHG TRANSCATHETER EMBOLIZATION ANY METH RS&I","75894 - HC CHG TRANSCATHETER EMBOLIZATION ANY METH RS&I","75894 - HC CHG TRANSCATHETER EMBOLIZATION ANY METH RS&I",null,"75605 - HC CHG AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I",null,null,null,null,"76380 - HC CHG CT LIMITED/LOCALIZED FOLLOW UP STUDY",null,"75605 - HC CHG AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I",null,null,null,"76376 - HC CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION"]
[null,"86335 - HC CHG IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS",null,"75898 - HC CHG ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS","75898 - HC CHG ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS","75898 - HC CHG ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS",null,"75625 - HC CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I",null,null,null,null,"76390 - HC CHG MRI SPECTROSCOPY",null,"75625 - HC CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I",null,null,null,"76377 - HC CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION"]
[null,"86336 - HC CHG INHIBIN A",null,"75902 - HC CHG MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I","75902 - HC CHG MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I","75902 - HC CHG MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I",null,"75630 - HC CHG AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I",null,null,null,null,"76391 - HC MAGNETIC RESONANCE ELASTOGRAPHY",null,"75630 - HC CHG AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I",null,null,null,"76380 - HC CHG CT LIMITED/LOCALIZED FOLLOW UP STUDY"]
[null,"86340 - HC CHG INTRINSIC FACTOR ANTIBODIES",null,"75970 - HC CHG TRANSCATHETER BIOPSY RS&I","75970 - HC CHG TRANSCATHETER BIOPSY RS&I","75970 - HC CHG TRANSCATHETER BIOPSY RS&I",null,"75635 - HC CHG CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP",null,null,null,null,"76497 - HC CTGUIDE,SOFT TISS ABL",null,"75635 - HC CHG CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP",null,null,null,"76390 - HC CHG MRI SPECTROSCOPY"]
[null,"86341 - HC CHG ISLET CELL ANTIBODY",null,"75984 - CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I","75984 - CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I","75984 - CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I",null,"75705 - HC CHG ANGIOGRAPHY SPINAL SELECTIVE RS&I",null,null,null,null,"76498 - PR MRI PROSTATE FOR RADIATION TREATMENT PLANNING",null,"75705 - HC CHG ANGIOGRAPHY SPINAL SELECTIVE RS&I",null,null,null,"76391 - HC MAGNETIC RESONANCE ELASTOGRAPHY"]
[null,"86353 - HC CHG LYMPHOCYTE TRANSFORMATION",null,"75989 - RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I","75989 - RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I","75989 - RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I",null,"75710 - HC CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I",null,null,null,null,"76506 - HC CHG ECHOENCEPHALOGRAPHY REAL TIME IMAGING",null,"75710 - HC CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I",null,null,null,"76497 - HC CTGUIDE,SOFT TISS ABL"]
[null,"86355 - HC B CELLS TOTAL COUNT",null,"76000 - FLUOROSCOPY SPX UP TO 1 HOUR PHYS/QHP TIME","76000 - FLUOROSCOPY SPX UP TO 1 HOUR PHYS/QHP TIME","76000 - FLUOROSCOPY SPX UP TO 1 HOUR PHYS/QHP TIME",null,"75716 - HC CHG ANGIOGRAPHY EXTREMITY BILATERAL RS&I",null,null,null,null,"76510 - OPH US DX B-SCAN&QUAN A-SCAN SM PT ENCTR",null,"75716 - HC CHG ANGIOGRAPHY EXTREMITY BILATERAL RS&I",null,null,null,"76498 - PR MRI PROSTATE FOR RADIATION TREATMENT PLANNING"]
[null,"86357 - HC NK CELLS, TOTAL COUNT",null,"76010 - HC CHG RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD","76010 - HC CHG RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD","76010 - HC CHG RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD",null,"75726 - HC CHG ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I",null,null,null,null,"76512 - OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN",null,"75726 - HC CHG ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I",null,null,null,"76506 - HC CHG ECHOENCEPHALOGRAPHY REAL TIME IMAGING"]
[null,"86359 - HC CHG T CELLS TOTAL COUNT",null,"76080 - HC CHG RADEX ABSCESS/FISTULA/SINUS TRACT RS&I","76080 - HC CHG RADEX ABSCESS/FISTULA/SINUS TRACT RS&I","76080 - HC CHG RADEX ABSCESS/FISTULA/SINUS TRACT RS&I",null,"75731 - HC ANGIO ADRENAL UNILAT SELECT",null,null,null,null,"76513 - OPH US DX ANT SGM US IMMERSION B-SCAN/HR BIOM",null,"75731 - HC ANGIO ADRENAL UNILAT SELECT",null,null,null,"76510 - OPH US DX B-SCAN&QUAN A-SCAN SM PT ENCTR"]
[null,"86360 - HC CHG T CELLS ABSOLUTE CD4&CD8 COUNT RATIO",null,"76098 - HC CHG RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN","76098 - HC CHG RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN","76098 - HC CHG RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN",null,"75733 - HC ANGIO ADRENAL BILAT SELECT",null,null,null,null,"76514 - OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI",null,"75733 - HC ANGIO ADRENAL BILAT SELECT",null,null,null,"76512 - OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN"]
[null,"86376 - HC CHG MICROSOMAL ANTIBODIES EACH",null,"76140 - HC CONSULT,OUTSIDE EXAM","76140 - HC CONSULT,OUTSIDE EXAM","76140 - HC CONSULT,OUTSIDE EXAM",null,"75736 - HC CHG ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I",null,null,null,null,"76516 - OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN",null,"75736 - HC CHG ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I",null,null,null,"76513 - OPH US DX ANT SGM US IMMERSION B-SCAN/HR BIOM"]
[null,"86382 - HC CHG NEUTRALIZATION TEST VIRAL",null,"76376 - HC CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION","76376 - HC CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION","76376 - HC CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION",null,"75741 - HC CHG ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I",null,null,null,null,"76519 - OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL",null,"75741 - HC CHG ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I",null,null,null,"76514 - OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI"]
[null,"86403 - HC CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY",null,"76377 - HC CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION","76377 - HC CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION","76377 - HC CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION",null,"75743 - HC CHG ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I",null,null,null,null,"76529 - OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION",null,"75743 - HC CHG ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I",null,null,null,"76516 - OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN"]
[null,"86431 - HC CHG RHEUMATOID FACTOR QUANTITATIVE",null,"76380 - HC CHG CT LIMITED/LOCALIZED FOLLOW UP STUDY","76380 - HC CHG CT LIMITED/LOCALIZED FOLLOW UP STUDY","76380 - HC CHG CT LIMITED/LOCALIZED FOLLOW UP STUDY",null,"75746 - HC CHG ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I",null,null,null,null,"76536 - US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM",null,"75746 - HC CHG ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I",null,null,null,"76519 - OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL"]
[null,"86480 - HC CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON",null,"76390 - HC CHG MRI SPECTROSCOPY","76390 - HC CHG MRI SPECTROSCOPY","76390 - HC CHG MRI SPECTROSCOPY",null,"75774 - HC CHG ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I",null,null,null,null,"76604 - HC CHG US CHEST REAL TIME W/IMAGE DOCUMENTATION",null,"75774 - HC CHG ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I",null,null,null,"76529 - OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION"]
[null,"86481 - HC TB TEST CELL MEDIATED ANTIGEN RESPONSE, ENUM GAMMA INTERFRON T-CELL",null,"76391 - HC MAGNETIC RESONANCE ELASTOGRAPHY","76391 - HC MAGNETIC RESONANCE ELASTOGRAPHY","76391 - HC MAGNETIC RESONANCE ELASTOGRAPHY",null,"75803 - HC LYPMH VESSEL XRAY ARM/LEG",null,null,null,null,"76641 - HC CHG US BREAST UNI REAL TIME WITH IMAGE COMPLETE",null,"75803 - HC LYPMH VESSEL XRAY ARM/LEG",null,null,null,"76536 - US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM"]
[null,"86592 - HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL",null,"76498 - PR MRI PROSTATE FOR RADIATION TREATMENT PLANNING","76498 - PR MRI PROSTATE FOR RADIATION TREATMENT PLANNING","76498 - PR MRI PROSTATE FOR RADIATION TREATMENT PLANNING",null,"75805 - HC LYMPH VES X-RAY TRUNK UNI",null,null,null,null,"76642 - US BREAST UNI REAL TIME WITH IMAGE LIMITED",null,"75805 - HC LYMPH VES X-RAY TRUNK UNI",null,null,null,"76604 - HC CHG US CHEST REAL TIME W/IMAGE DOCUMENTATION"]
[null,"86593 - HC SYPHILIS;QN",null,"76506 - HC CHG ECHOENCEPHALOGRAPHY REAL TIME IMAGING","76506 - HC CHG ECHOENCEPHALOGRAPHY REAL TIME IMAGING","76506 - HC CHG ECHOENCEPHALOGRAPHY REAL TIME IMAGING",null,"75807 - HC LYMPH VESSEL X-RAY TRUNK",null,null,null,null,"76700 - US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION",null,"75807 - HC LYMPH VESSEL X-RAY TRUNK",null,null,null,"76641 - HC CHG US BREAST UNI REAL TIME WITH IMAGE COMPLETE"]
[null,"86606 - HC CHG ANTIBODY ASPERGILLUS",null,"76510 - OPH US DX B-SCAN&QUAN A-SCAN SM PT ENCTR","76510 - OPH US DX B-SCAN&QUAN A-SCAN SM PT ENCTR","76510 - OPH US DX B-SCAN&QUAN A-SCAN SM PT ENCTR",null,"75809 - HC INJ&IMAGE PERITONL SHUNT",null,null,null,null,"76705 - ULTRASOUND ABDOMINAL REAL TIME W/IMAGE LIMITED",null,"75809 - HC INJ&IMAGE PERITONL SHUNT",null,null,null,"76642 - US BREAST UNI REAL TIME WITH IMAGE LIMITED"]
[null,"86609 - HC CHG ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED",null,"76512 - OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN","76512 - OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN","76512 - OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN",null,"75810 - HC CHG SPLENOPORTOGRAPY RS&I",null,null,null,null,"76706 - HC CHG US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA",null,"75810 - HC CHG SPLENOPORTOGRAPY RS&I",null,null,null,"76700 - US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION"]
[null,"86611 - HC BARTONELLA, ANTIBODY",null,"76513 - OPH US DX ANT SGM US IMMERSION B-SCAN/HR BIOM","76513 - OPH US DX ANT SGM US IMMERSION B-SCAN/HR BIOM","76513 - OPH US DX ANT SGM US IMMERSION B-SCAN/HR BIOM",null,"75820 - HC CHG VENOGRAPHY EXTREMITY UNILATERAL RS&I",null,null,null,null,"76770 - US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE",null,"75820 - HC CHG VENOGRAPHY EXTREMITY UNILATERAL RS&I",null,null,null,"76705 - ULTRASOUND ABDOMINAL REAL TIME W/IMAGE LIMITED"]
[null,"86612 - HC CHG BLASTOMYCES ANTIBODY",null,"76514 - OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI","76514 - OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI","76514 - OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI",null,"75822 - HC CHG VENOGRAPHY EXTREMITY BILATERAL RS&I",null,null,null,null,"76775 - US RETROPERITONEAL REAL TIME W/IMAGE LIMITED",null,"75822 - HC CHG VENOGRAPHY EXTREMITY BILATERAL RS&I",null,null,null,"76706 - HC CHG US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA"]
[null,"86615 - HC Q;BORDTLLA AB;IGG,IGA",null,"76516 - OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN","76516 - OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN","76516 - OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN",null,"75825 - HC CHG VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I",null,null,null,null,"76776 - HC CHG US TRNSPLNT KIDNEY REAL TIME W/IMAGE DOCMTN",null,"75825 - HC CHG VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I",null,null,null,"76770 - US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE"]
[null,"86617 - HC CHG ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST",null,"76519 - OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL","76519 - OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL","76519 - OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL",null,"75827 - HC CHG VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I",null,null,null,null,"76800 - HC CHG ULTRASOUND SPINAL CANAL & CONTENTS",null,"75827 - HC CHG VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I",null,null,null,"76775 - US RETROPERITONEAL REAL TIME W/IMAGE LIMITED"]
[null,"86618 - HC Q;LYME AB INDEX CNS INFEC",null,"76529 - OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION","76529 - OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION","76529 - OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION",null,"75831 - HC CHG VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I",null,null,null,null,"76801 - US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT",null,"75831 - HC CHG VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I",null,null,null,"76776 - HC CHG US TRNSPLNT KIDNEY REAL TIME W/IMAGE DOCMTN"]
[null,"86622 - HC CHG ANTIBODY BRUCELLA",null,"76536 - US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM","76536 - US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM","76536 - US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM",null,"75833 - HC CHG VENOGRAM RENAL BILAT",null,null,null,null,"76802 - US PREG UTERUS 14 WK TRANSABDL EACH GESTATION",null,"75833 - HC CHG VENOGRAM RENAL BILAT",null,null,null,"76800 - HC CHG ULTRASOUND SPINAL CANAL & CONTENTS"]
[null,"86625 - HC CAMPYLOBACTER, ANTIBODY",null,"76604 - HC CHG US CHEST REAL TIME W/IMAGE DOCUMENTATION","76604 - HC CHG US CHEST REAL TIME W/IMAGE DOCUMENTATION","76604 - HC CHG US CHEST REAL TIME W/IMAGE DOCUMENTATION",null,"75842 - HC CHG VENOGRAM ADRENAL BILAT",null,null,null,null,"76805 - US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION",null,"75842 - HC CHG VENOGRAM ADRENAL BILAT",null,null,null,"76801 - US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT"]
[null,"86631 - HC CHG, CHLAMYDIA, ANTIBODY",null,"76641 - HC CHG US BREAST UNI REAL TIME WITH IMAGE COMPLETE","76641 - HC CHG US BREAST UNI REAL TIME WITH IMAGE COMPLETE","76641 - HC CHG US BREAST UNI REAL TIME WITH IMAGE COMPLETE",null,"75860 - HC CHG VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I",null,null,null,null,"76810 - US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO",null,"75860 - HC CHG VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I",null,null,null,"76802 - US PREG UTERUS 14 WK TRANSABDL EACH GESTATION"]
[null,"86632 - HC CHG CHLAMYDIA, IGM ANTIBODY",null,"76642 - US BREAST UNI REAL TIME WITH IMAGE LIMITED","76642 - US BREAST UNI REAL TIME WITH IMAGE LIMITED","76642 - US BREAST UNI REAL TIME WITH IMAGE LIMITED",null,"75870 - VENOGRAM SUPER SAG SINUS",null,null,null,null,"76811 - US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION",null,"75870 - VENOGRAM SUPER SAG SINUS",null,null,null,"76805 - US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION"]
[null,"86635 - HC CHG ANTIBODY COCCIDIOIDES",null,"76700 - US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION","76700 - US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION","76700 - US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION",null,"75885 - HC CHG PERCUT XHEPATIC PORTO+DYNAMIC",null,null,null,null,"76812 - US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT",null,"75885 - HC CHG PERCUT XHEPATIC PORTO+DYNAMIC",null,null,null,"76810 - US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO"]
[null,"86638 - HC CHG, Q FEVER ANTIBODY",null,"76705 - ULTRASOUND ABDOMINAL REAL TIME W/IMAGE LIMITED","76705 - ULTRASOUND ABDOMINAL REAL TIME W/IMAGE LIMITED","76705 - ULTRASOUND ABDOMINAL REAL TIME W/IMAGE LIMITED",null,"75887 - HC CHG PERCUT XHEPATIC PORTOGRAM",null,null,null,null,"76813 - US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION",null,"75887 - HC CHG PERCUT XHEPATIC PORTOGRAM",null,null,null,"76811 - US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION"]
[null,"86644 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV",null,"76706 - HC CHG US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA","76706 - HC CHG US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA","76706 - HC CHG US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA",null,"75889 - HC HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I",null,null,null,null,"76814 - US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION",null,"75889 - HC HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I",null,null,null,"76812 - US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT"]
[null,"86645 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV IGM",null,"76770 - US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE","76770 - US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE","76770 - US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE",null,"75891 - HC CHG HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I",null,null,null,null,"76815 - US PREGNANT UTERUS LIMITED 1/> FETUSES",null,"75891 - HC CHG HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I",null,null,null,"76813 - US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION"]
[null,"86648 - HC CHG ANTIBODY DIPHTHERIA",null,"76775 - US RETROPERITONEAL REAL TIME W/IMAGE LIMITED","76775 - US RETROPERITONEAL REAL TIME W/IMAGE LIMITED","76775 - US RETROPERITONEAL REAL TIME W/IMAGE LIMITED",null,"75893 - HC CHG VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS&",null,null,null,null,"76816 - US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS",null,"75893 - HC CHG VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS&",null,null,null,"76814 - US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION"]
[null,"86652 - HC CHG, ENCEPHAL ANTIBODY EAST EQU",null,"76776 - HC CHG US TRNSPLNT KIDNEY REAL TIME W/IMAGE DOCMTN","76776 - HC CHG US TRNSPLNT KIDNEY REAL TIME W/IMAGE DOCMTN","76776 - HC CHG US TRNSPLNT KIDNEY REAL TIME W/IMAGE DOCMTN",null,"75894 - HC CHG TRANSCATHETER EMBOLIZATION ANY METH RS&I",null,null,null,null,"76817 - US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG",null,"75894 - HC CHG TRANSCATHETER EMBOLIZATION ANY METH RS&I",null,null,null,"76815 - US PREGNANT UTERUS LIMITED 1/> FETUSES"]
[null,"86654 - CHG ANTIBODY ENCEPHALITIS WESTRN EQUINE",null,"76800 - HC CHG ULTRASOUND SPINAL CANAL & CONTENTS","76800 - HC CHG ULTRASOUND SPINAL CANAL & CONTENTS","76800 - HC CHG ULTRASOUND SPINAL CANAL & CONTENTS",null,"75898 - HC CHG ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS",null,null,null,null,"76818 - FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING",null,"75898 - HC CHG ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS",null,null,null,"76816 - US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS"]
[null,"86658 - HC CHG ENTEROVIRUS ANTIBODY",null,"76801 - US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT","76801 - US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT","76801 - US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT",null,"75902 - HC CHG MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I",null,null,null,null,"76819 - FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING",null,"75902 - HC CHG MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I",null,null,null,"76817 - US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG"]
[null,"86663 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA",null,"76802 - US PREG UTERUS 14 WK TRANSABDL EACH GESTATION","76802 - US PREG UTERUS 14 WK TRANSABDL EACH GESTATION","76802 - US PREG UTERUS 14 WK TRANSABDL EACH GESTATION",null,"75970 - HC CHG TRANSCATHETER BIOPSY RS&I",null,null,null,null,"76820 - DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY",null,"75970 - HC CHG TRANSCATHETER BIOPSY RS&I",null,null,null,"76818 - FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING"]
[null,"86664 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA",null,"76805 - US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION","76805 - US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION","76805 - US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION",null,"75984 - CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I",null,null,null,null,"76821 - DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART",null,"75984 - CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I",null,null,null,"76819 - FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING"]
[null,"86665 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA",null,"76810 - US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO","76810 - US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO","76810 - US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO",null,"75989 - RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I",null,null,null,null,"76825 - ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING",null,"75989 - RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I",null,null,null,"76820 - DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY"]
[null,"86666 - HC CHG ANTIBODY EHRLICHIA",null,"76811 - US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION","76811 - US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION","76811 - US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION",null,"76000 - FLUOROSCOPY SPX UP TO 1 HOUR PHYS/QHP TIME",null,null,null,null,"76826 - ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD",null,"76000 - FLUOROSCOPY SPX UP TO 1 HOUR PHYS/QHP TIME",null,null,null,"76821 - DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART"]
[null,"86677 - HC CHG ANTIBODY HELICOBACTER PYLORI",null,"76812 - US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT","76812 - US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT","76812 - US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT",null,"76001 - HC FLUOROSCOPY SPX >1 HOUR PHYS/QHP TIME",null,null,null,null,"76827 - DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE",null,"76001 - HC FLUOROSCOPY SPX >1 HOUR PHYS/QHP TIME",null,null,null,"76825 - ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING"]
[null,"86682 - HC Q;CYSTICERCUS AB,BLOT",null,"76813 - US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION","76813 - US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION","76813 - US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION",null,"76010 - HC CHG RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD",null,null,null,null,"76828 - DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT",null,"76010 - HC CHG RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD",null,null,null,"76826 - ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD"]
[null,"86689 - HC HTLV/HIV CONFIRMATORY TEST",null,"76814 - US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION","76814 - US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION","76814 - US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION",null,"76080 - HC CHG RADEX ABSCESS/FISTULA/SINUS TRACT RS&I",null,null,null,null,"76830 - ULTRASOUND TRANSVAGINAL",null,"76080 - HC CHG RADEX ABSCESS/FISTULA/SINUS TRACT RS&I",null,null,null,"76827 - DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE"]
[null,"86692 - HC CHG ANTIBODY HEP DELTA AGENT",null,"76815 - US PREGNANT UTERUS LIMITED 1/> FETUSES","76815 - US PREGNANT UTERUS LIMITED 1/> FETUSES","76815 - US PREGNANT UTERUS LIMITED 1/> FETUSES",null,"76098 - HC CHG RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN",null,null,null,null,"76831 - SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER",null,"76098 - HC CHG RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN",null,null,null,"76828 - DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT"]
[null,"86694 - HC CHG ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST",null,"76816 - US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS","76816 - US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS","76816 - US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS",null,"76376 - HC CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION",null,null,null,null,"76856 - US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE",null,"76376 - HC CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION",null,null,null,"76830 - ULTRASOUND TRANSVAGINAL"]
[null,"86695 - HC CHG ANTIBODY HERPES SMPLX TYPE 1",null,"76817 - US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG","76817 - US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG","76817 - US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG",null,"76377 - HC CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION",null,null,null,null,"76857 - US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U",null,"76377 - HC CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION",null,null,null,"76831 - SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER"]
[null,"86696 - HC CHG ANTIBODY HERPES SMPLX TYPE 2",null,"76818 - FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING","76818 - FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING","76818 - FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING",null,"76380 - HC CHG CT LIMITED/LOCALIZED FOLLOW UP STUDY",null,null,null,null,"76870 - ULTRASOUND SCROTUM & CONTENTS",null,"76380 - HC CHG CT LIMITED/LOCALIZED FOLLOW UP STUDY",null,null,null,"76856 - US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE"]
[null,"86698 - HC CHG ANTIBODY HISTOPLASMA",null,"76819 - FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING","76819 - FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING","76819 - FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING",null,"76390 - HC CHG MRI SPECTROSCOPY",null,null,null,null,"76872 - ULTRASOUND TRANSRECTAL",null,"76390 - HC CHG MRI SPECTROSCOPY",null,null,null,"76857 - US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U"]
[null,"86701 - HC HIV-1",null,"76820 - DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY","76820 - DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY","76820 - DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY",null,"76391 - HC MAGNETIC RESONANCE ELASTOGRAPHY",null,null,null,null,"76873 - US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX",null,"76391 - HC MAGNETIC RESONANCE ELASTOGRAPHY",null,null,null,"76870 - ULTRASOUND SCROTUM & CONTENTS"]
[null,"86702 - HC QL/SEMI MULT AB;HIV2",null,"76821 - DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART","76821 - DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART","76821 - DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART",null,"76497 - HC CTGUIDE,SOFT TISS ABL",null,null,null,null,"76881 - US EXTREMITY NON-VASC REAL-TIME IMG COMPL",null,"76497 - HC CTGUIDE,SOFT TISS ABL",null,null,null,"76872 - ULTRASOUND TRANSRECTAL"]
[null,"86703 - HC HIV 1/2 ANTIBODY",null,"76825 - ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING","76825 - ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING","76825 - ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING",null,"76498 - PR MRI PROSTATE FOR RADIATION TREATMENT PLANNING",null,null,null,null,"76882 - US EXTREMITY NON-VASC REAL-TIME IMG LMTD",null,"76498 - PR MRI PROSTATE FOR RADIATION TREATMENT PLANNING",null,null,null,"76873 - US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX"]
[null,"86704 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB TOTAL",null,"76826 - ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD","76826 - ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD","76826 - ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD",null,"76506 - HC CHG ECHOENCEPHALOGRAPHY REAL TIME IMAGING",null,null,null,null,"76885 - HC CHG US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ",null,"76506 - HC CHG ECHOENCEPHALOGRAPHY REAL TIME IMAGING",null,null,null,"76881 - US EXTREMITY NON-VASC REAL-TIME IMG COMPL"]
[null,"86705 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY",null,"76827 - DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE","76827 - DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE","76827 - DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE",null,"76510 - OPH US DX B-SCAN&QUAN A-SCAN SM PT ENCTR",null,null,null,null,"76886 - HC US EXAM INFANT HIPS STATIC",null,"76510 - OPH US DX B-SCAN&QUAN A-SCAN SM PT ENCTR",null,null,null,"76882 - US EXTREMITY NON-VASC REAL-TIME IMG LMTD"]
[null,"86706 - HC CHG HEPATITIS B SURF ANTIBODY HBSAB",null,"76828 - DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT","76828 - DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT","76828 - DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT",null,"76512 - OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN",null,null,null,null,"76937 - HC CHG US VASC ACCESS SITS VSL PATENCY NDL ENTRY",null,"76512 - OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN",null,null,null,"76885 - HC CHG US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ"]
[null,"86707 - HC CHG HEPATITIS BE ANTIBODY HBEAB",null,"76830 - ULTRASOUND TRANSVAGINAL","76830 - ULTRASOUND TRANSVAGINAL","76830 - ULTRASOUND TRANSVAGINAL",null,"76513 - OPH US DX ANT SGM US IMMERSION B-SCAN/HR BIOM",null,null,null,null,"76940 - HC CHG US &MNTR PARENCHYMAL TISSUE ABLATION",null,"76513 - OPH US DX ANT SGM US IMMERSION B-SCAN/HR BIOM",null,null,null,"76886 - HC US EXAM INFANT HIPS STATIC"]
[null,"86708 - HC CHG HEPATITIS A ANTIBODY HAAB",null,"76831 - SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER","76831 - SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER","76831 - SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER",null,"76514 - OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI",null,null,null,null,"76942 - US GUIDANCE NEEDLE PLACEMENT RS&I",null,"76514 - OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI",null,null,null,"76937 - HC CHG US VASC ACCESS SITS VSL PATENCY NDL ENTRY"]
[null,"86709 - HC CHG HEPATITIS ANTIBODY HAAB IGM ANTIBODY",null,"76856 - US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE","76856 - US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE","76856 - US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE",null,"76516 - OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN",null,null,null,null,"76945 - US GUIDANCE CHORIONIC VILLUS SAMPLING RS&I",null,"76516 - OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN",null,null,null,"76940 - HC CHG US &MNTR PARENCHYMAL TISSUE ABLATION"]
[null,"86710 - HC INFLUENZA VIRUS",null,"76857 - US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U","76857 - US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U","76857 - US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U",null,"76519 - OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL",null,null,null,null,"76946 - US GUIDANCE AMNIOCENTESIS RS&I",null,"76519 - OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL",null,null,null,"76942 - US GUIDANCE NEEDLE PLACEMENT RS&I"]
[null,"86735 - HC CHG ANTIBODY MUMPS",null,"76870 - ULTRASOUND SCROTUM & CONTENTS","76870 - ULTRASOUND SCROTUM & CONTENTS","76870 - ULTRASOUND SCROTUM & CONTENTS",null,"76529 - OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION",null,null,null,null,"76978 - HC US TRGT DYN MBUBB 1ST LES",null,"76529 - OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION",null,null,null,"76945 - US GUIDANCE CHORIONIC VILLUS SAMPLING RS&I"]
[null,"86738 - HC CHG ANTIBODY MYCOPLSM",null,"76872 - ULTRASOUND TRANSRECTAL","76872 - ULTRASOUND TRANSRECTAL","76872 - ULTRASOUND TRANSRECTAL",null,"76536 - US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM",null,null,null,null,"76979 - HC US TRGT DYN MBUBB EA ADDL",null,"76536 - US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM",null,null,null,"76946 - US GUIDANCE AMNIOCENTESIS RS&I"]
[null,"86744 - HC CHG ANTIBODY NOCARDIA",null,"76873 - US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX","76873 - US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX","76873 - US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX",null,"76604 - HC CHG US CHEST REAL TIME W/IMAGE DOCUMENTATION",null,null,null,null,"76981 - HC USE PARENCHYMA",null,"76604 - HC CHG US CHEST REAL TIME W/IMAGE DOCUMENTATION",null,null,null,"76978 - HC US TRGT DYN MBUBB 1ST LES"]
[null,"86747 - HC CHG ANTIBODY PARVOVIRUS",null,"76881 - US EXTREMITY NON-VASC REAL-TIME IMG COMPL","76881 - US EXTREMITY NON-VASC REAL-TIME IMG COMPL","76881 - US EXTREMITY NON-VASC REAL-TIME IMG COMPL",null,"76641 - HC CHG US BREAST UNI REAL TIME WITH IMAGE COMPLETE",null,null,null,null,"76982 - HC USE 1ST TARGET LESION",null,"76641 - HC CHG US BREAST UNI REAL TIME WITH IMAGE COMPLETE",null,null,null,"76979 - HC US TRGT DYN MBUBB EA ADDL"]
[null,"86753 - HC CHG ANTIBODY PROTOZOA NES",null,"76882 - US EXTREMITY NON-VASC REAL-TIME IMG LMTD","76882 - US EXTREMITY NON-VASC REAL-TIME IMG LMTD","76882 - US EXTREMITY NON-VASC REAL-TIME IMG LMTD",null,"76642 - US BREAST UNI REAL TIME WITH IMAGE LIMITED",null,null,null,null,"76983 - HC USE EA ADDL TARGET LESION",null,"76642 - US BREAST UNI REAL TIME WITH IMAGE LIMITED",null,null,null,"76981 - HC USE PARENCHYMA"]
[null,"86757 - HC CHG, RICKETTSIA",null,"76885 - HC CHG US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ","76885 - HC CHG US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ","76885 - HC CHG US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ",null,"76700 - US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION",null,null,null,null,"76998 - ULTRASONIC GUIDANCE INTRAOPERATIVE",null,"76700 - US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION",null,null,null,"76982 - HC USE 1ST TARGET LESION"]
[null,"86762 - HC CHG ANTIBODY RUBELLA",null,"76886 - HC US EXAM INFANT HIPS STATIC","76886 - HC US EXAM INFANT HIPS STATIC","76886 - HC US EXAM INFANT HIPS STATIC",null,"76705 - ULTRASOUND ABDOMINAL REAL TIME W/IMAGE LIMITED",null,null,null,null,"77001 - HC CHG FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT",null,"76705 - ULTRASOUND ABDOMINAL REAL TIME W/IMAGE LIMITED",null,null,null,"76983 - HC USE EA ADDL TARGET LESION"]
[null,"86765 - HC CHG ANTIBODY RUBEOLA",null,"76937 - HC CHG US VASC ACCESS SITS VSL PATENCY NDL ENTRY","76937 - HC CHG US VASC ACCESS SITS VSL PATENCY NDL ENTRY","76937 - HC CHG US VASC ACCESS SITS VSL PATENCY NDL ENTRY",null,"76706 - HC CHG US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA",null,null,null,null,"77002 - HC CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON",null,"76706 - HC CHG US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA",null,null,null,"76998 - ULTRASONIC GUIDANCE INTRAOPERATIVE"]
[null,"86769 - ANTIBODY; SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2",null,"76940 - HC CHG US &MNTR PARENCHYMAL TISSUE ABLATION","76940 - HC CHG US &MNTR PARENCHYMAL TISSUE ABLATION","76940 - HC CHG US &MNTR PARENCHYMAL TISSUE ABLATION",null,"76770 - US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE",null,null,null,null,"77003 - HC CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON",null,"76770 - US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE",null,null,null,"77001 - HC CHG FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT"]
[null,"86774 - HC CHG ANTIBODY TETANUS",null,"76942 - US GUIDANCE NEEDLE PLACEMENT RS&I","76942 - US GUIDANCE NEEDLE PLACEMENT RS&I","76942 - US GUIDANCE NEEDLE PLACEMENT RS&I",null,"76775 - US RETROPERITONEAL REAL TIME W/IMAGE LIMITED",null,null,null,null,"77011 - HC CHG CT GUIDANCE STEREOTACTIC LOCALIZATION",null,"76775 - US RETROPERITONEAL REAL TIME W/IMAGE LIMITED",null,null,null,"77002 - HC CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON"]
[null,"86777 - HC CHG ANTIBODY TOXOPLASMA",null,"76945 - US GUIDANCE CHORIONIC VILLUS SAMPLING RS&I","76945 - US GUIDANCE CHORIONIC VILLUS SAMPLING RS&I","76945 - US GUIDANCE CHORIONIC VILLUS SAMPLING RS&I",null,"76776 - HC CHG US TRNSPLNT KIDNEY REAL TIME W/IMAGE DOCMTN",null,null,null,null,"77012 - HC CHG CT GUIDANCE NEEDLE PLACEMENT",null,"76776 - HC CHG US TRNSPLNT KIDNEY REAL TIME W/IMAGE DOCMTN",null,null,null,"77003 - HC CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON"]
[null,"86778 - HC Q;TOXOPLASMA IGM,AB",null,"76946 - US GUIDANCE AMNIOCENTESIS RS&I","76946 - US GUIDANCE AMNIOCENTESIS RS&I","76946 - US GUIDANCE AMNIOCENTESIS RS&I",null,"76800 - HC CHG ULTRASOUND SPINAL CANAL & CONTENTS",null,null,null,null,"77013 - HC CHG CT GUIDANCE &MONITORING VISC TISS ABLATION",null,"76800 - HC CHG ULTRASOUND SPINAL CANAL & CONTENTS",null,null,null,"77011 - HC CHG CT GUIDANCE STEREOTACTIC LOCALIZATION"]
[null,"86780 - HC CHG ANTIBODY TREPONEMA PALLIDUM",null,"76978 - HC US TRGT DYN MBUBB 1ST LES","76978 - HC US TRGT DYN MBUBB 1ST LES","76978 - HC US TRGT DYN MBUBB 1ST LES",null,"76801 - US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT",null,null,null,null,"77014 - HC CT GUIDANCE",null,"76801 - US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT",null,null,null,"77012 - HC CHG CT GUIDANCE NEEDLE PLACEMENT"]
[null,"86787 - HC CHG ANTIBODY VARICELLA-ZOSTER",null,"76979 - HC US TRGT DYN MBUBB EA ADDL","76979 - HC US TRGT DYN MBUBB EA ADDL","76979 - HC US TRGT DYN MBUBB EA ADDL",null,"76802 - US PREG UTERUS 14 WK TRANSABDL EACH GESTATION",null,null,null,null,"77021 - HC MRGUIDE,NEED PLACE",null,"76802 - US PREG UTERUS 14 WK TRANSABDL EACH GESTATION",null,null,null,"77013 - HC CHG CT GUIDANCE &MONITORING VISC TISS ABLATION"]
[null,"86788 - HC CHG ANTIBODY WEST NILE VIRUS IGM",null,"76981 - HC USE PARENCHYMA","76981 - HC USE PARENCHYMA","76981 - HC USE PARENCHYMA",null,"76805 - US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION",null,null,null,null,"77046 - HC MRI BREAST C- UNILATERAL",null,"76805 - US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION",null,null,null,"77014 - HC CT GUIDANCE"]
[null,"86789 - HC CHG ANTIBODY WEST NILE VIRUS",null,"76982 - HC USE 1ST TARGET LESION","76982 - HC USE 1ST TARGET LESION","76982 - HC USE 1ST TARGET LESION",null,"76810 - US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO",null,null,null,null,"77047 - HC MRI BREAST C- BILATERAL",null,"76810 - US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO",null,null,null,"77021 - HC MRGUIDE,NEED PLACE"]
[null,"86790 - HC CHG ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED",null,"76983 - HC USE EA ADDL TARGET LESION","76983 - HC USE EA ADDL TARGET LESION","76983 - HC USE EA ADDL TARGET LESION",null,"76811 - US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION",null,null,null,null,"77048 - HC MRI BREAST C-+ W/CAD UNI",null,"76811 - US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION",null,null,null,"77046 - HC MRI BREAST C- UNILATERAL"]
[null,"86800 - HC CHG THYROGLOBULIN ANTIBODY",null,"76998 - ULTRASONIC GUIDANCE INTRAOPERATIVE","76998 - ULTRASONIC GUIDANCE INTRAOPERATIVE","76998 - ULTRASONIC GUIDANCE INTRAOPERATIVE",null,"76812 - US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT",null,null,null,null,"77049 - HC MRI BREAST C-+ W/CAD BI",null,"76812 - US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT",null,null,null,"77047 - HC MRI BREAST C- BILATERAL"]
[null,"86803 - HC CHG HEPATITIS C ANTIBODY",null,"77001 - HC CHG FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT","77001 - HC CHG FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT","77001 - HC CHG FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT",null,"76813 - US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION",null,null,null,null,"77061 - DIGITAL BREAST TOMOSYNTHESIS UNILATERAL",null,"76813 - US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION",null,null,null,"77048 - HC MRI BREAST C-+ W/CAD UNI"]
[null,"86807 - HC CHG SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH",null,"77002 - HC CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON","77002 - HC CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON","77002 - HC CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON",null,"76814 - US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION",null,null,null,null,"77062 - DIGITAL BREAST TOMOSYNTHESIS BILATERAL",null,"76814 - US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION",null,null,null,"77049 - HC MRI BREAST C-+ W/CAD BI"]
[null,"86812 - HC CHG HLA TYPING A/B/C SINGLE ANTIGEN",null,"77003 - HC CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON","77003 - HC CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON","77003 - HC CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON",null,"76815 - US PREGNANT UTERUS LIMITED 1/> FETUSES",null,null,null,null,"77063 - SCREENING DIGITAL BREAST TOMOSYNTHESIS BI",null,"76815 - US PREGNANT UTERUS LIMITED 1/> FETUSES",null,null,null,"77061 - DIGITAL BREAST TOMOSYNTHESIS UNILATERAL"]
[null,"86813 - HC CHG HLA TYPING A/B/C MULTIPLE ANTIGENS",null,"77011 - HC CHG CT GUIDANCE STEREOTACTIC LOCALIZATION","77011 - HC CHG CT GUIDANCE STEREOTACTIC LOCALIZATION","77011 - HC CHG CT GUIDANCE STEREOTACTIC LOCALIZATION",null,"76816 - US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS",null,null,null,null,"77065 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",null,"76816 - US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS",null,null,null,"77062 - DIGITAL BREAST TOMOSYNTHESIS BILATERAL"]
[null,"86817 - HC CHG HLA TYPING DR/DQ MULTIPLE ANTIGENS",null,"77012 - HC CHG CT GUIDANCE NEEDLE PLACEMENT","77012 - HC CHG CT GUIDANCE NEEDLE PLACEMENT","77012 - HC CHG CT GUIDANCE NEEDLE PLACEMENT",null,"76817 - US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG",null,null,null,null,"77066 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",null,"76817 - US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG",null,null,null,"77063 - SCREENING DIGITAL BREAST TOMOSYNTHESIS BI"]
[null,"86850 - HC CHG ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE",null,"77013 - HC CHG CT GUIDANCE &MONITORING VISC TISS ABLATION","77013 - HC CHG CT GUIDANCE &MONITORING VISC TISS ABLATION","77013 - HC CHG CT GUIDANCE &MONITORING VISC TISS ABLATION",null,"76818 - FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING",null,null,null,null,"77067 - HC SCR MAMM CAD, BI",null,"76818 - FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING",null,null,null,"77065 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
[null,"86880 - HC CHG ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM",null,"77014 - HC CT GUIDANCE","77014 - HC CT GUIDANCE","77014 - HC CT GUIDANCE",null,"76819 - FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING",null,null,null,null,"77071 - HC CHG MANUAL APPL STRESS PFRMD PHYS/QHP JOINT FILMS",null,"76819 - FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING",null,null,null,"77066 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
[null,"86886 - HC CHG ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER",null,"77021 - HC MRGUIDE,NEED PLACE","77021 - HC MRGUIDE,NEED PLACE","77021 - HC MRGUIDE,NEED PLACE",null,"76820 - DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY",null,null,null,null,"77072 - HC CHG BONE AGE STUDIES",null,"76820 - DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY",null,null,null,"77067 - HC SCR MAMM CAD, BI"]
[null,"86900 - HC CHG BLOOD TYPING SEROLOGIC ABO",null,"77046 - HC MRI BREAST C- UNILATERAL","77046 - HC MRI BREAST C- UNILATERAL","77046 - HC MRI BREAST C- UNILATERAL",null,"76821 - DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART",null,null,null,null,"77073 - HC CHG BONE LENGTH STUDIES",null,"76821 - DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART",null,null,null,"77071 - HC CHG MANUAL APPL STRESS PFRMD PHYS/QHP JOINT FILMS"]
[null,"86901 - HC CHG BLOOD TYPING SEROLOGIC RH (D)",null,"77047 - HC MRI BREAST C- BILATERAL","77047 - HC MRI BREAST C- BILATERAL","77047 - HC MRI BREAST C- BILATERAL",null,"76825 - ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING",null,null,null,null,"77074 - HC CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED",null,"76825 - ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING",null,null,null,"77072 - HC CHG BONE AGE STUDIES"]
[null,"86902 - HC CHG BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH",null,"77048 - HC MRI BREAST C-+ W/CAD UNI","77048 - HC MRI BREAST C-+ W/CAD UNI","77048 - HC MRI BREAST C-+ W/CAD UNI",null,"76826 - ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD",null,null,null,null,"77075 - HC CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL",null,"76826 - ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD",null,null,null,"77073 - HC CHG BONE LENGTH STUDIES"]
[null,"86905 - HC CHG BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH",null,"77049 - HC MRI BREAST C-+ W/CAD BI","77049 - HC MRI BREAST C-+ W/CAD BI","77049 - HC MRI BREAST C-+ W/CAD BI",null,"76827 - DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE",null,null,null,null,"77076 - HC X-RAYS BONE SURVEY INFANT",null,"76827 - DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE",null,null,null,"77074 - HC CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED"]
[null,"87015 - HC CHG CONCENTRATION INFECTIOUS AGENTS",null,"77061 - DIGITAL BREAST TOMOSYNTHESIS UNILATERAL","77061 - DIGITAL BREAST TOMOSYNTHESIS UNILATERAL","77061 - DIGITAL BREAST TOMOSYNTHESIS UNILATERAL",null,"76828 - DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT",null,null,null,null,"77077 - HC CHG JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS",null,"76828 - DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT",null,null,null,"77075 - HC CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL"]
[null,"87040 - HC CHG CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES",null,"77062 - DIGITAL BREAST TOMOSYNTHESIS BILATERAL","77062 - DIGITAL BREAST TOMOSYNTHESIS BILATERAL","77062 - DIGITAL BREAST TOMOSYNTHESIS BILATERAL",null,"76830 - ULTRASOUND TRANSVAGINAL",null,null,null,null,"77080 - DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL",null,"76830 - ULTRASOUND TRANSVAGINAL",null,null,null,"77076 - HC X-RAYS BONE SURVEY INFANT"]
[null,"87045 - HC CHG CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL",null,"77063 - SCREENING DIGITAL BREAST TOMOSYNTHESIS BI","77063 - SCREENING DIGITAL BREAST TOMOSYNTHESIS BI","77063 - SCREENING DIGITAL BREAST TOMOSYNTHESIS BI",null,"76831 - SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER",null,null,null,null,"77081 - DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL",null,"76831 - SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER",null,null,null,"77077 - HC CHG JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS"]
[null,"87046 - HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA",null,"77065 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",null,"76856 - US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE",null,null,null,null,"77084 - HC CHG BONE MARROW BLOOD SUPPLY",null,"76856 - US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE",null,null,null,"77080 - DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL"]
[null,"87070 - CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL",null,"77066 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",null,"76857 - US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U",null,null,null,null,"77280 - HC SIM SIMPLE",null,"76857 - US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U",null,null,null,"77081 - DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL"]
[null,"87075 - HC CHG CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID",null,"77067 - HC SCR MAMM CAD, BI","77067 - HC SCR MAMM CAD, BI","77067 - HC SCR MAMM CAD, BI",null,"76870 - ULTRASOUND SCROTUM & CONTENTS",null,null,null,null,"77285 - HC SIM INTERMED",null,"76870 - ULTRASOUND SCROTUM & CONTENTS",null,null,null,"77084 - HC CHG BONE MARROW BLOOD SUPPLY"]
[null,"87076 - HC CHG CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL",null,"77071 - HC CHG MANUAL APPL STRESS PFRMD PHYS/QHP JOINT FILMS","77071 - HC CHG MANUAL APPL STRESS PFRMD PHYS/QHP JOINT FILMS","77071 - HC CHG MANUAL APPL STRESS PFRMD PHYS/QHP JOINT FILMS",null,"76872 - ULTRASOUND TRANSRECTAL",null,null,null,null,"77290 - HC SIM COMPLEX",null,"76872 - ULTRASOUND TRANSRECTAL",null,null,null,"77280 - HC SIM SIMPLE"]
[null,"87077 - HC CHG CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL",null,"77072 - HC CHG BONE AGE STUDIES","77072 - HC CHG BONE AGE STUDIES","77072 - HC CHG BONE AGE STUDIES",null,"76873 - US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX",null,null,null,null,"77293 - RESPIRATORY MOTION MANAGEMENT SIMULATION",null,"76873 - US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX",null,null,null,"77285 - HC SIM INTERMED"]
[null,"87081 - HC CULT,BACT,SCR,H PYLORI",null,"77073 - HC CHG BONE LENGTH STUDIES","77073 - HC CHG BONE LENGTH STUDIES","77073 - HC CHG BONE LENGTH STUDIES",null,"76881 - US EXTREMITY NON-VASC REAL-TIME IMG COMPL",null,null,null,null,"77295 - HC COMPUTER GEN PLAN  3D",null,"76881 - US EXTREMITY NON-VASC REAL-TIME IMG COMPL",null,null,null,"77290 - HC SIM COMPLEX"]
[null,"87086 - HC CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE",null,"77074 - HC CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED","77074 - HC CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED","77074 - HC CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED",null,"76882 - US EXTREMITY NON-VASC REAL-TIME IMG LMTD",null,null,null,null,"77300 - HC BASIC DOS",null,"76882 - US EXTREMITY NON-VASC REAL-TIME IMG LMTD",null,null,null,"77293 - RESPIRATORY MOTION MANAGEMENT SIMULATION"]
[null,"87088 - HC CHG CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE",null,"77075 - HC CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL","77075 - HC CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL","77075 - HC CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL",null,"76885 - HC CHG US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ",null,null,null,null,"77301 - HC IMRT PLAN",null,"76885 - HC CHG US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ",null,null,null,"77295 - HC COMPUTER GEN PLAN  3D"]
[null,"87102 - HC CHG CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD",null,"77076 - HC X-RAYS BONE SURVEY INFANT","77076 - HC X-RAYS BONE SURVEY INFANT","77076 - HC X-RAYS BONE SURVEY INFANT",null,"76886 - HC US EXAM INFANT HIPS STATIC",null,null,null,null,"77306 - TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION",null,"76886 - HC US EXAM INFANT HIPS STATIC",null,null,null,"77300 - HC BASIC DOS"]
[null,"87103 - HC CHG CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD",null,"77077 - HC CHG JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS","77077 - HC CHG JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS","77077 - HC CHG JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS",null,"76930 - US PERICARDIOCENT",null,null,null,null,"77307 - TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY",null,"76930 - US PERICARDIOCENT",null,null,null,"77301 - HC IMRT PLAN"]
[null,"87106 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST",null,"77080 - DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL","77080 - DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL","77080 - DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL",null,"76937 - HC CHG US VASC ACCESS SITS VSL PATENCY NDL ENTRY",null,null,null,null,"77316 - BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL",null,"76937 - HC CHG US VASC ACCESS SITS VSL PATENCY NDL ENTRY",null,null,null,"77306 - TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION"]
[null,"87107 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD",null,"77081 - DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL","77081 - DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL","77081 - DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL",null,"76940 - HC CHG US &MNTR PARENCHYMAL TISSUE ABLATION",null,null,null,null,"77317 - BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL",null,"76940 - HC CHG US &MNTR PARENCHYMAL TISSUE ABLATION",null,null,null,"77307 - TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY"]
[null,"87110 - HC CHG CULTURE, CHLAMYDIA",null,"77084 - HC CHG BONE MARROW BLOOD SUPPLY","77084 - HC CHG BONE MARROW BLOOD SUPPLY","77084 - HC CHG BONE MARROW BLOOD SUPPLY",null,"76942 - US GUIDANCE NEEDLE PLACEMENT RS&I",null,null,null,null,"77318 - BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL",null,"76942 - US GUIDANCE NEEDLE PLACEMENT RS&I",null,null,null,"77316 - BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL"]
[null,"87116 - HC CHG CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL",null,"77261 - HC CHG THERAPEUTIC RADIOLOGY TX PLANNING SIMPLE","77261 - HC CHG THERAPEUTIC RADIOLOGY TX PLANNING SIMPLE","77261 - HC CHG THERAPEUTIC RADIOLOGY TX PLANNING SIMPLE",null,"76945 - US GUIDANCE CHORIONIC VILLUS SAMPLING RS&I",null,null,null,null,"77321 - HC SPEC PORT PLAN INCLUDES ELECTRONS",null,"76945 - US GUIDANCE CHORIONIC VILLUS SAMPLING RS&I",null,null,null,"77317 - BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL"]
[null,"87118 - HC CHG CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL",null,"77262 - RADIATION THERAPY PLAN INTERM","77262 - RADIATION THERAPY PLAN INTERM","77262 - RADIATION THERAPY PLAN INTERM",null,"76946 - US GUIDANCE AMNIOCENTESIS RS&I",null,null,null,null,"77331 - HC SPEC DOSI",null,"76946 - US GUIDANCE AMNIOCENTESIS RS&I",null,null,null,"77318 - BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL"]
[null,"87140 - HC CHG CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM",null,"77280 - HC SIM SIMPLE","77280 - HC SIM SIMPLE","77280 - HC SIM SIMPLE",null,"76978 - HC US TRGT DYN MBUBB 1ST LES",null,null,null,null,"77332 - HC TX DEVICES SIMP",null,"76978 - HC US TRGT DYN MBUBB 1ST LES",null,null,null,"77321 - HC SPEC PORT PLAN INCLUDES ELECTRONS"]
[null,"87149 - HC CHG CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM",null,"77285 - HC SIM INTERMED","77285 - HC SIM INTERMED","77285 - HC SIM INTERMED",null,"76979 - HC US TRGT DYN MBUBB EA ADDL",null,null,null,null,"77333 - HC TX DEVICES INT",null,"76979 - HC US TRGT DYN MBUBB EA ADDL",null,null,null,"77331 - HC SPEC DOSI"]
[null,"87150 - HC CHG CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM",null,"77290 - HC SIM COMPLEX","77290 - HC SIM COMPLEX","77290 - HC SIM COMPLEX",null,"76981 - HC USE PARENCHYMA",null,null,null,null,"77334 - HC TX DEVICES COMP",null,"76981 - HC USE PARENCHYMA",null,null,null,"77332 - HC TX DEVICES SIMP"]
[null,"87153 - HC Q;BACT ID,PHENO,SEQ",null,"77293 - RESPIRATORY MOTION MANAGEMENT SIMULATION","77293 - RESPIRATORY MOTION MANAGEMENT SIMULATION","77293 - RESPIRATORY MOTION MANAGEMENT SIMULATION",null,"76982 - HC USE 1ST TARGET LESION",null,null,null,null,"77336 - HC MED PHYSICS CONSULT/WK",null,"76982 - HC USE 1ST TARGET LESION",null,null,null,"77333 - HC TX DEVICES INT"]
[null,"87172 - HC CHG PINWORM EXAMINATION",null,"77295 - HC COMPUTER GEN PLAN  3D","77295 - HC COMPUTER GEN PLAN  3D","77295 - HC COMPUTER GEN PLAN  3D",null,"76983 - HC USE EA ADDL TARGET LESION",null,null,null,null,"77338 - HC MLC DEVICES FOR IMRT",null,"76983 - HC USE EA ADDL TARGET LESION",null,null,null,"77334 - HC TX DEVICES COMP"]
[null,"87176 - HC CHG HOMOGENIZATION TISSUE CULTURE",null,"77300 - HC BASIC DOS","77300 - HC BASIC DOS","77300 - HC BASIC DOS",null,"76998 - ULTRASONIC GUIDANCE INTRAOPERATIVE",null,null,null,null,"77370 - HC SPEC MED PHYSICS CONSULT",null,"76998 - ULTRASONIC GUIDANCE INTRAOPERATIVE",null,null,null,"77336 - HC MED PHYSICS CONSULT/WK"]
[null,"87177 - HC CHG OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID",null,"77301 - HC IMRT PLAN","77301 - HC IMRT PLAN","77301 - HC IMRT PLAN",null,"76999 - UNLISTED US PROCEDURE",null,null,null,null,"77371 - RADIATION DELIVERY STEREOTACTIC CRANIAL COBALT",null,"76999 - UNLISTED US PROCEDURE",null,null,null,"77338 - HC MLC DEVICES FOR IMRT"]
[null,"87181 - HC CHG SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ",null,"77306 - TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION","77306 - TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION","77306 - TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION",null,"77001 - HC CHG FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT",null,null,null,null,"77372 - HC SRS SINGLE CRANIAL TX",null,"77001 - HC CHG FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT",null,null,null,"77370 - HC SPEC MED PHYSICS CONSULT"]
[null,"87184 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD",null,"77307 - TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY","77307 - TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY","77307 - TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY",null,"77002 - HC CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON",null,null,null,null,"77373 - HC SRS FRACTIONATED 1-5 BODY; 2-5 CRANIAL",null,"77002 - HC CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON",null,null,null,"77371 - RADIATION DELIVERY STEREOTACTIC CRANIAL COBALT"]
[null,"87185 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ",null,"77316 - BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL","77316 - BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL","77316 - BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL",null,"77003 - HC CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON",null,null,null,null,"77385 - INTENSITY MODULATED RADIATION TX DLVR SIMPLE",null,"77003 - HC CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON",null,null,null,"77372 - HC SRS SINGLE CRANIAL TX"]
[null,"87186 - HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ",null,"77317 - BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL","77317 - BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL","77317 - BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL",null,"77011 - HC CHG CT GUIDANCE STEREOTACTIC LOCALIZATION",null,null,null,null,"77386 - INTENSITY MODULATED RADIATION TX DLVR COMPLEX",null,"77011 - HC CHG CT GUIDANCE STEREOTACTIC LOCALIZATION",null,null,null,"77373 - HC SRS FRACTIONATED 1-5 BODY; 2-5 CRANIAL"]
[null,"87188 - HC CHG SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT",null,"77318 - BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL","77318 - BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL","77318 - BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL",null,"77012 - HC CHG CT GUIDANCE NEEDLE PLACEMENT",null,null,null,null,"77387 - GUIDANCE FOR LOCLZJ TARGET VOL FOR RADJ TX DLVR",null,"77012 - HC CHG CT GUIDANCE NEEDLE PLACEMENT",null,null,null,"77385 - INTENSITY MODULATED RADIATION TX DLVR SIMPLE"]
[null,"87205 - HC CHG SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL",null,"77321 - HC SPEC PORT PLAN INCLUDES ELECTRONS","77321 - HC SPEC PORT PLAN INCLUDES ELECTRONS","77321 - HC SPEC PORT PLAN INCLUDES ELECTRONS",null,"77013 - HC CHG CT GUIDANCE &MONITORING VISC TISS ABLATION",null,null,null,null,"77402 - HC TX DEL =>1 MEV SIMPLE",null,"77013 - HC CHG CT GUIDANCE &MONITORING VISC TISS ABLATION",null,null,null,"77386 - INTENSITY MODULATED RADIATION TX DLVR COMPLEX"]
[null,"87206 - HC CHG SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT",null,"77331 - HC SPEC DOSI","77331 - HC SPEC DOSI","77331 - HC SPEC DOSI",null,"77014 - HC CT GUIDANCE",null,null,null,null,"77407 - HC TX DEL => 1 MEV, 2 AREA, 3 PORTS - INTERMEDIATE",null,"77014 - HC CT GUIDANCE",null,null,null,"77387 - GUIDANCE FOR LOCLZJ TARGET VOL FOR RADJ TX DLVR"]
[null,"87207 - SMR PRIM SRC SPEC STAIN BODIES/PARASITS",null,"77332 - HC TX DEVICES SIMP","77332 - HC TX DEVICES SIMP","77332 - HC TX DEVICES SIMP",null,"77021 - HC MRGUIDE,NEED PLACE",null,null,null,null,"77412 - HC TX DEL =>1 MEV - COMPLEX",null,"77021 - HC MRGUIDE,NEED PLACE",null,null,null,"77402 - HC TX DEL =>1 MEV SIMPLE"]
[null,"87209 - HC CHG SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS",null,"77333 - HC TX DEVICES INT","77333 - HC TX DEVICES INT","77333 - HC TX DEVICES INT",null,"77046 - HC MRI BREAST C- UNILATERAL",null,null,null,null,"77417 - HC PORT IMAGES",null,"77046 - HC MRI BREAST C- UNILATERAL",null,null,null,"77407 - HC TX DEL => 1 MEV, 2 AREA, 3 PORTS - INTERMEDIATE"]
[null,"87210 - SMR PRIM SRC WET MOUNT NFCT AGT",null,"77334 - HC TX DEVICES COMP","77334 - HC TX DEVICES COMP","77334 - HC TX DEVICES COMP",null,"77047 - HC MRI BREAST C- BILATERAL",null,null,null,null,"77435 - RADN RX DELIV,BODY, MANAGEMENT, PER COURSE",null,"77047 - HC MRI BREAST C- BILATERAL",null,null,null,"77412 - HC TX DEL =>1 MEV - COMPLEX"]
[null,"87220 - TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT",null,"77336 - HC MED PHYSICS CONSULT/WK","77336 - HC MED PHYSICS CONSULT/WK","77336 - HC MED PHYSICS CONSULT/WK",null,"77048 - HC MRI BREAST C-+ W/CAD UNI",null,null,null,null,"77470 - HC SPEC TX PROC/CONCURRENT CHEMO",null,"77048 - HC MRI BREAST C-+ W/CAD UNI",null,null,null,"77417 - HC PORT IMAGES"]
[null,"87252 - HC CHG VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT",null,"77338 - HC MLC DEVICES FOR IMRT","77338 - HC MLC DEVICES FOR IMRT","77338 - HC MLC DEVICES FOR IMRT",null,"77049 - HC MRI BREAST C-+ W/CAD BI",null,null,null,null,"77520 - PROTON BEAM DEL,SIMPLE",null,"77049 - HC MRI BREAST C-+ W/CAD BI",null,null,null,"77435 - RADN RX DELIV,BODY, MANAGEMENT, PER COURSE"]
[null,"87253 - HC CHG VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE",null,"77370 - HC SPEC MED PHYSICS CONSULT","77370 - HC SPEC MED PHYSICS CONSULT","77370 - HC SPEC MED PHYSICS CONSULT",null,"77061 - DIGITAL BREAST TOMOSYNTHESIS UNILATERAL",null,null,null,null,"77522 - PROTON BEAM DEL,SINGLE, W/COMPENSAT",null,"77061 - DIGITAL BREAST TOMOSYNTHESIS UNILATERAL",null,null,null,"77470 - HC SPEC TX PROC/CONCURRENT CHEMO"]
[null,"87254 - HC CHG VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA",null,"77371 - RADIATION DELIVERY STEREOTACTIC CRANIAL COBALT","77371 - RADIATION DELIVERY STEREOTACTIC CRANIAL COBALT","77371 - RADIATION DELIVERY STEREOTACTIC CRANIAL COBALT",null,"77062 - DIGITAL BREAST TOMOSYNTHESIS BILATERAL",null,null,null,null,"77523 - PROTON,BEAM DEL,INTERMED",null,"77062 - DIGITAL BREAST TOMOSYNTHESIS BILATERAL",null,null,null,"77520 - PROTON BEAM DEL,SIMPLE"]
[null,"87255 - HC CHG VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC",null,"77372 - HC SRS SINGLE CRANIAL TX","77372 - HC SRS SINGLE CRANIAL TX","77372 - HC SRS SINGLE CRANIAL TX",null,"77063 - SCREENING DIGITAL BREAST TOMOSYNTHESIS BI",null,null,null,null,"77525 - PROTON BEAM DEL,MULTIPLE,COMPLEX",null,"77063 - SCREENING DIGITAL BREAST TOMOSYNTHESIS BI",null,null,null,"77522 - PROTON BEAM DEL,SINGLE, W/COMPENSAT"]
[null,"87260 - HC CHG IAADI ADENOVIRUS",null,"77373 - HC SRS FRACTIONATED 1-5 BODY; 2-5 CRANIAL","77373 - HC SRS FRACTIONATED 1-5 BODY; 2-5 CRANIAL","77373 - HC SRS FRACTIONATED 1-5 BODY; 2-5 CRANIAL",null,"77065 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",null,null,null,null,"77761 - HC BRACHY INCAV SMP",null,"77065 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",null,null,null,"77523 - PROTON,BEAM DEL,INTERMED"]
[null,"87269 - HC CHG IAADI GIARDIA",null,"77385 - INTENSITY MODULATED RADIATION TX DLVR SIMPLE","77385 - INTENSITY MODULATED RADIATION TX DLVR SIMPLE","77385 - INTENSITY MODULATED RADIATION TX DLVR SIMPLE",null,"77066 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",null,null,null,null,"77762 - HC BRACHY INCAV INT",null,"77066 - HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",null,null,null,"77525 - PROTON BEAM DEL,MULTIPLE,COMPLEX"]
[null,"87272 - HC CHG IAADI CRYPTOSPORIDIUM",null,"77386 - INTENSITY MODULATED RADIATION TX DLVR COMPLEX","77386 - INTENSITY MODULATED RADIATION TX DLVR COMPLEX","77386 - INTENSITY MODULATED RADIATION TX DLVR COMPLEX",null,"77067 - HC SCR MAMM CAD, BI",null,null,null,null,"77763 - HC BRACHY INCAV CMP",null,"77067 - HC SCR MAMM CAD, BI",null,null,null,"77761 - HC BRACHY INCAV SMP"]
[null,"87275 - HC CHG IAADI INFLUENZA B VIRUS",null,"77387 - GUIDANCE FOR LOCLZJ TARGET VOL FOR RADJ TX DLVR","77387 - GUIDANCE FOR LOCLZJ TARGET VOL FOR RADJ TX DLVR","77387 - GUIDANCE FOR LOCLZJ TARGET VOL FOR RADJ TX DLVR",null,"77071 - HC CHG MANUAL APPL STRESS PFRMD PHYS/QHP JOINT FILMS",null,null,null,null,"77767 - HC HDR RDNCL SKSURF 2.0/1CH",null,"77071 - HC CHG MANUAL APPL STRESS PFRMD PHYS/QHP JOINT FILMS",null,null,null,"77762 - HC BRACHY INCAV INT"]
[null,"87276 - HC CHG IAADI INFFLUENZA A VIRUS",null,"77402 - HC TX DEL =>1 MEV SIMPLE","77402 - HC TX DEL =>1 MEV SIMPLE","77402 - HC TX DEL =>1 MEV SIMPLE",null,"77072 - HC CHG BONE AGE STUDIES",null,null,null,null,"77768 - HC HDR RDNCL SKSURF 2.0/2CH>",null,"77072 - HC CHG BONE AGE STUDIES",null,null,null,"77763 - HC BRACHY INCAV CMP"]
[null,"87279 - HC CHG IAADI PARAINFLUENZA VIRUS EACH TYPE",null,"77407 - HC TX DEL => 1 MEV, 2 AREA, 3 PORTS - INTERMEDIATE","77407 - HC TX DEL => 1 MEV, 2 AREA, 3 PORTS - INTERMEDIATE","77407 - HC TX DEL => 1 MEV, 2 AREA, 3 PORTS - INTERMEDIATE",null,"77073 - HC CHG BONE LENGTH STUDIES",null,null,null,null,"77770 - HC HDR RDNCL NTRSTL/1ST",null,"77073 - HC CHG BONE LENGTH STUDIES",null,null,null,"77767 - HC HDR RDNCL SKSURF 2.0/1CH"]
[null,"87281 - HC CHG IAADI PNEUMOCUSTIS CARINII",null,"77412 - HC TX DEL =>1 MEV - COMPLEX","77412 - HC TX DEL =>1 MEV - COMPLEX","77412 - HC TX DEL =>1 MEV - COMPLEX",null,"77074 - HC CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED",null,null,null,null,"77771 - HC HDR RDNCL NTRSTL/2-12",null,"77074 - HC CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED",null,null,null,"77768 - HC HDR RDNCL SKSURF 2.0/2CH>"]
[null,"87299 - HC CHG AG DETECTION NOS, FLUOR",null,"77417 - HC PORT IMAGES","77417 - HC PORT IMAGES","77417 - HC PORT IMAGES",null,"77075 - HC CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL",null,null,null,null,"77772 - HC HDR RDNCL NTRSTL/12+",null,"77075 - HC CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL",null,null,null,"77770 - HC HDR RDNCL NTRSTL/1ST"]
[null,"87305 - HC CHG IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS",null,"77435 - RADN RX DELIV,BODY, MANAGEMENT, PER COURSE","77435 - RADN RX DELIV,BODY, MANAGEMENT, PER COURSE","77435 - RADN RX DELIV,BODY, MANAGEMENT, PER COURSE",null,"77076 - HC X-RAYS BONE SURVEY INFANT",null,null,null,null,"77778 - HC BRACHY INST CMP",null,"77076 - HC X-RAYS BONE SURVEY INFANT",null,null,null,"77771 - HC HDR RDNCL NTRSTL/2-12"]
[null,"87324 - HC CHG IAAD IA CLOSTRIDIUM DIFFICILE TOXIN",null,"77470 - HC SPEC TX PROC/CONCURRENT CHEMO","77470 - HC SPEC TX PROC/CONCURRENT CHEMO","77470 - HC SPEC TX PROC/CONCURRENT CHEMO",null,"77077 - HC CHG JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS",null,null,null,null,"77789 - HC BRACHY SURF APP",null,"77077 - HC CHG JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS",null,null,null,"77772 - HC HDR RDNCL NTRSTL/12+"]
[null,"87327 - HC CHG IAAD IA CRYPTOCOCCUS NEOFORMANS",null,"77520 - PROTON BEAM DEL,SIMPLE","77520 - PROTON BEAM DEL,SIMPLE","77520 - PROTON BEAM DEL,SIMPLE",null,"77080 - DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL",null,null,null,null,"77790 - HC BRACHY , SUP. HANDLING, LOADING",null,"77080 - DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL",null,null,null,"77778 - HC BRACHY INST CMP"]
[null,"87338 - HC CHG IAAD IA HPYLORI STOOL",null,"77522 - PROTON BEAM DEL,SINGLE, W/COMPENSAT","77522 - PROTON BEAM DEL,SINGLE, W/COMPENSAT","77522 - PROTON BEAM DEL,SINGLE, W/COMPENSAT",null,"77081 - DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL",null,null,null,null,"78012 - HC CHG THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT",null,"77081 - DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL",null,null,null,"77789 - HC BRACHY SURF APP"]
[null,"87340 - HC CHG IAAD IA HEPATITIS B SURFACE ANTIGEN",null,"77523 - PROTON,BEAM DEL,INTERMED","77523 - PROTON,BEAM DEL,INTERMED","77523 - PROTON,BEAM DEL,INTERMED",null,"77084 - HC CHG BONE MARROW BLOOD SUPPLY",null,null,null,null,"78013 - HC CHG THYROID IMAGING WITH VASCULAR FLOW",null,"77084 - HC CHG BONE MARROW BLOOD SUPPLY",null,null,null,"77790 - HC BRACHY , SUP. HANDLING, LOADING"]
[null,"87341 - HC CHG IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION",null,"77525 - PROTON BEAM DEL,MULTIPLE,COMPLEX","77525 - PROTON BEAM DEL,MULTIPLE,COMPLEX","77525 - PROTON BEAM DEL,MULTIPLE,COMPLEX",null,"77261 - HC CHG THERAPEUTIC RADIOLOGY TX PLANNING SIMPLE",null,null,null,null,"78014 - HC CHG THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS",null,"77261 - HC CHG THERAPEUTIC RADIOLOGY TX PLANNING SIMPLE",null,null,null,"78012 - HC CHG THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT"]
[null,"87350 - HC CHG IAAD IA HEPATITIS BE ANTIGEN",null,"77761 - HC BRACHY INCAV SMP","77761 - HC BRACHY INCAV SMP","77761 - HC BRACHY INCAV SMP",null,"77262 - RADIATION THERAPY PLAN INTERM",null,null,null,null,"78018 - HC CHG THYROID CARCINOMA METASTASES IMG WHOLE BODY",null,"77262 - RADIATION THERAPY PLAN INTERM",null,null,null,"78013 - HC CHG THYROID IMAGING WITH VASCULAR FLOW"]
[null,"87385 - HC CHG IAAD IA HISTOPLASM CAPSULATUM",null,"77762 - HC BRACHY INCAV INT","77762 - HC BRACHY INCAV INT","77762 - HC BRACHY INCAV INT",null,"77280 - HC SIM SIMPLE",null,null,null,null,"78020 - HC CHG THYROID CARCINOMA METASTASES UPTAKE",null,"77280 - HC SIM SIMPLE",null,null,null,"78014 - HC CHG THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS"]
[null,"87389 - HC CHG IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE",null,"77763 - HC BRACHY INCAV CMP","77763 - HC BRACHY INCAV CMP","77763 - HC BRACHY INCAV CMP",null,"77285 - HC SIM INTERMED",null,null,null,null,"78070 - HC PARATHYROID IM",null,"77285 - HC SIM INTERMED",null,null,null,"78018 - HC CHG THYROID CARCINOMA METASTASES IMG WHOLE BODY"]
[null,"87390 - HC CHG IAAD IA HIV-1",null,"77767 - HC HDR RDNCL SKSURF 2.0/1CH","77767 - HC HDR RDNCL SKSURF 2.0/1CH","77767 - HC HDR RDNCL SKSURF 2.0/1CH",null,"77290 - HC SIM COMPLEX",null,null,null,null,"78071 - HC CHG PARATHYROID PLANAR IMAGING W/WO SUBTRACTION",null,"77290 - HC SIM COMPLEX",null,null,null,"78020 - HC CHG THYROID CARCINOMA METASTASES UPTAKE"]
[null,"87391 - HC CHG IAAD IA HIV-2",null,"77768 - HC HDR RDNCL SKSURF 2.0/2CH>","77768 - HC HDR RDNCL SKSURF 2.0/2CH>","77768 - HC HDR RDNCL SKSURF 2.0/2CH>",null,"77293 - RESPIRATORY MOTION MANAGEMENT SIMULATION",null,null,null,null,"78072 - HC PARATHYROID W SPECTCTAL",null,"77293 - RESPIRATORY MOTION MANAGEMENT SIMULATION",null,null,null,"78070 - HC PARATHYROID IM"]
[null,"87400 - HC CHG IAAD IA INFLUENZA A/B EACH",null,"77770 - HC HDR RDNCL NTRSTL/1ST","77770 - HC HDR RDNCL NTRSTL/1ST","77770 - HC HDR RDNCL NTRSTL/1ST",null,"77295 - HC COMPUTER GEN PLAN  3D",null,null,null,null,"78102 - HC BONE MARROW IM;LIM",null,"77295 - HC COMPUTER GEN PLAN  3D",null,null,null,"78071 - HC CHG PARATHYROID PLANAR IMAGING W/WO SUBTRACTION"]
[null,"87420 - HC CHG IAAD IA RESPIRATORY SYNCTIAL VIRUS",null,"77771 - HC HDR RDNCL NTRSTL/2-12","77771 - HC HDR RDNCL NTRSTL/2-12","77771 - HC HDR RDNCL NTRSTL/2-12",null,"77299 - HC UNLISTED TX PLAN",null,null,null,null,"78104 - HC CHG BONE MARROW IMAGING WHOLE BODY",null,"77299 - HC UNLISTED TX PLAN",null,null,null,"78072 - HC PARATHYROID W SPECTCTAL"]
[null,"87425 - HC CHG IAAD IA ROTAVIRUS",null,"77772 - HC HDR RDNCL NTRSTL/12+","77772 - HC HDR RDNCL NTRSTL/12+","77772 - HC HDR RDNCL NTRSTL/12+",null,"77300 - HC BASIC DOS",null,null,null,null,"78195 - HC CHG LYMPHATICS & LYMPH NODES IMAGING",null,"77300 - HC BASIC DOS",null,null,null,"78102 - HC BONE MARROW IM;LIM"]
[null,"87426 - SARSCOV CORONAVIRUS AG IA",null,"77778 - HC BRACHY INST CMP","77778 - HC BRACHY INST CMP","77778 - HC BRACHY INST CMP",null,"77301 - HC IMRT PLAN",null,null,null,null,"78201 - HC CHG LIVER IMAGING SPECT",null,"77301 - HC IMRT PLAN",null,null,null,"78104 - HC CHG BONE MARROW IMAGING WHOLE BODY"]
[null,"87430 - HC CHG IAAD IA STREPTOCOCCUS GROUP A",null,"77789 - HC BRACHY SURF APP","77789 - HC BRACHY SURF APP","77789 - HC BRACHY SURF APP",null,"77306 - TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION",null,null,null,null,"78215 - HC CHG LIVER & SPLEEN IMAGING STATIC ONLY",null,"77306 - TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION",null,null,null,"78195 - HC CHG LYMPHATICS & LYMPH NODES IMAGING"]
[null,"87449 - HC AG DET,ENZ IMM;OTH,EA",null,"77790 - HC BRACHY , SUP. HANDLING, LOADING","77790 - HC BRACHY , SUP. HANDLING, LOADING","77790 - HC BRACHY , SUP. HANDLING, LOADING",null,"77307 - TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY",null,null,null,null,"78216 - HC LIVER&SPLEEN IM;W/FLO",null,"77307 - TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY",null,null,null,"78201 - HC CHG LIVER IMAGING SPECT"]
[null,"87480 - HC CHG IADNA CANDIDA SPECIES DIRECT PROBE TQ",null,"78012 - HC CHG THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT","78012 - HC CHG THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT","78012 - HC CHG THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT",null,"77316 - BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL",null,null,null,null,"78226 - HC CHG HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER",null,"77316 - BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL",null,null,null,"78215 - HC CHG LIVER & SPLEEN IMAGING STATIC ONLY"]
[null,"87481 - HC CHG CANDIDA, DNA, AMP PROBE",null,"78013 - HC CHG THYROID IMAGING WITH VASCULAR FLOW","78013 - HC CHG THYROID IMAGING WITH VASCULAR FLOW","78013 - HC CHG THYROID IMAGING WITH VASCULAR FLOW",null,"77317 - BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL",null,null,null,null,"78227 - HC CHG HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ",null,"77317 - BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL",null,null,null,"78216 - HC LIVER&SPLEEN IM;W/FLO"]
[null,"87486 - HC CHG IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ",null,"78014 - HC CHG THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS","78014 - HC CHG THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS","78014 - HC CHG THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS",null,"77318 - BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL",null,null,null,null,"78258 - HC CHG ESOPHAGEAL MOTILITY",null,"77318 - BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL",null,null,null,"78226 - HC CHG HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER"]
[null,"87490 - HC CHG IADNA CHLAMYDIA TRACHOMATIS DIRECT PROBE TQ",null,"78018 - HC CHG THYROID CARCINOMA METASTASES IMG WHOLE BODY","78018 - HC CHG THYROID CARCINOMA METASTASES IMG WHOLE BODY","78018 - HC CHG THYROID CARCINOMA METASTASES IMG WHOLE BODY",null,"77321 - HC SPEC PORT PLAN INCLUDES ELECTRONS",null,null,null,null,"78264 - HC CHG GASTRIC EMPTYING IMAGING STUDY",null,"77321 - HC SPEC PORT PLAN INCLUDES ELECTRONS",null,null,null,"78227 - HC CHG HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ"]
[null,"87491 - HC CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ",null,"78020 - HC CHG THYROID CARCINOMA METASTASES UPTAKE","78020 - HC CHG THYROID CARCINOMA METASTASES UPTAKE","78020 - HC CHG THYROID CARCINOMA METASTASES UPTAKE",null,"77331 - HC SPEC DOSI",null,null,null,null,"78278 - HC CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING",null,"77331 - HC SPEC DOSI",null,null,null,"78258 - HC CHG ESOPHAGEAL MOTILITY"]
[null,"87493 - HC CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE",null,"78070 - HC PARATHYROID IM","78070 - HC PARATHYROID IM","78070 - HC PARATHYROID IM",null,"77332 - HC TX DEVICES SIMP",null,null,null,null,"78290 - HC CHG INTESTINE IMAGING",null,"77332 - HC TX DEVICES SIMP",null,null,null,"78264 - HC CHG GASTRIC EMPTYING IMAGING STUDY"]
[null,"87496 - HC ARUP;CYTOMEG VIR PCR,CSF",null,"78071 - HC CHG PARATHYROID PLANAR IMAGING W/WO SUBTRACTION","78071 - HC CHG PARATHYROID PLANAR IMAGING W/WO SUBTRACTION","78071 - HC CHG PARATHYROID PLANAR IMAGING W/WO SUBTRACTION",null,"77333 - HC TX DEVICES INT",null,null,null,null,"78291 - HC PV SHUNT PATENCY",null,"77333 - HC TX DEVICES INT",null,null,null,"78278 - HC CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING"]
[null,"87497 - HC CHG IADNA CYTOMEGALOVIRUS QUANTIFICATION",null,"78072 - HC PARATHYROID W SPECTCTAL","78072 - HC PARATHYROID W SPECTCTAL","78072 - HC PARATHYROID W SPECTCTAL",null,"77334 - HC TX DEVICES COMP",null,null,null,null,"78300 - HC CHG BONE IMAGING, LIMITED AREA",null,"77334 - HC TX DEVICES COMP",null,null,null,"78290 - HC CHG INTESTINE IMAGING"]
[null,"87498 - HC CHG IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP",null,"78102 - HC BONE MARROW IM;LIM","78102 - HC BONE MARROW IM;LIM","78102 - HC BONE MARROW IM;LIM",null,"77336 - HC MED PHYSICS CONSULT/WK",null,null,null,null,"78305 - HC BONE&/JOINT IM;MULT",null,"77336 - HC MED PHYSICS CONSULT/WK",null,null,null,"78291 - HC PV SHUNT PATENCY"]
[null,"87502 - HC Q;FLU AG DET,MULT TYP,2,2",null,"78104 - HC CHG BONE MARROW IMAGING WHOLE BODY","78104 - HC CHG BONE MARROW IMAGING WHOLE BODY","78104 - HC CHG BONE MARROW IMAGING WHOLE BODY",null,"77338 - HC MLC DEVICES FOR IMRT",null,null,null,null,"78306 - HC CHG BONE &/JOINT IMAGING WHOLE BODY",null,"77338 - HC MLC DEVICES FOR IMRT",null,null,null,"78300 - HC CHG BONE IMAGING, LIMITED AREA"]
[null,"87505 - HC CHG NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN",null,"78195 - HC CHG LYMPHATICS & LYMPH NODES IMAGING","78195 - HC CHG LYMPHATICS & LYMPH NODES IMAGING","78195 - HC CHG LYMPHATICS & LYMPH NODES IMAGING",null,"77370 - HC SPEC MED PHYSICS CONSULT",null,null,null,null,"78315 - HC CHG BONE &/JOINT IMAGING 3 PHASE STUDY",null,"77370 - HC SPEC MED PHYSICS CONSULT",null,null,null,"78305 - HC BONE&/JOINT IM;MULT"]
[null,"87506 - HC CHG IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11",null,"78201 - HC CHG LIVER IMAGING SPECT","78201 - HC CHG LIVER IMAGING SPECT","78201 - HC CHG LIVER IMAGING SPECT",null,"77371 - RADIATION DELIVERY STEREOTACTIC CRANIAL COBALT",null,null,null,null,"78428 - HC CHG CARDIAC SHUNT DETECTION",null,"77371 - RADIATION DELIVERY STEREOTACTIC CRANIAL COBALT",null,null,null,"78306 - HC CHG BONE &/JOINT IMAGING WHOLE BODY"]
[null,"87507 - HC IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25",null,"78215 - HC CHG LIVER & SPLEEN IMAGING STATIC ONLY","78215 - HC CHG LIVER & SPLEEN IMAGING STATIC ONLY","78215 - HC CHG LIVER & SPLEEN IMAGING STATIC ONLY",null,"77372 - HC SRS SINGLE CRANIAL TX",null,null,null,null,"78429 - HC MYOCRD IMG PET 1 STD W/CT",null,"77372 - HC SRS SINGLE CRANIAL TX",null,null,null,"78315 - HC CHG BONE &/JOINT IMAGING 3 PHASE STUDY"]
[null,"87510 - HC CHG IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ",null,"78216 - HC LIVER&SPLEEN IM;W/FLO","78216 - HC LIVER&SPLEEN IM;W/FLO","78216 - HC LIVER&SPLEEN IM;W/FLO",null,"77373 - HC SRS FRACTIONATED 1-5 BODY; 2-5 CRANIAL",null,null,null,null,"78430 - HC MYOCRD IMG PET RST/STRS W/CT",null,"77373 - HC SRS FRACTIONATED 1-5 BODY; 2-5 CRANIAL",null,null,null,"78428 - HC CHG CARDIAC SHUNT DETECTION"]
[null,"87511 - HC CHG GARDNER VAG, DNA  AMP PROBE",null,"78226 - HC CHG HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER","78226 - HC CHG HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER","78226 - HC CHG HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER",null,"77385 - INTENSITY MODULATED RADIATION TX DLVR SIMPLE",null,null,null,null,"78431 - HC MYOCRD IMG PET RST&STRS CT",null,"77385 - INTENSITY MODULATED RADIATION TX DLVR SIMPLE",null,null,null,"78429 - HC MYOCRD IMG PET 1 STD W/CT"]
[null,"87517 - HC CHG IADNA HEPATITIS B VIRUS QUANTIFICATION",null,"78227 - HC CHG HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ","78227 - HC CHG HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ","78227 - HC CHG HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ",null,"77386 - INTENSITY MODULATED RADIATION TX DLVR COMPLEX",null,null,null,null,"78432 - HC MYOCRD IMG PET 2RTRACER",null,"77386 - INTENSITY MODULATED RADIATION TX DLVR COMPLEX",null,null,null,"78430 - HC MYOCRD IMG PET RST/STRS W/CT"]
[null,"87522 - HC ARUP;HEP C VIR RNA QN",null,"78258 - HC CHG ESOPHAGEAL MOTILITY","78258 - HC CHG ESOPHAGEAL MOTILITY","78258 - HC CHG ESOPHAGEAL MOTILITY",null,"77387 - GUIDANCE FOR LOCLZJ TARGET VOL FOR RADJ TX DLVR",null,null,null,null,"78433 - HC MYOCRD IMG PET 2RTRACER CT",null,"77387 - GUIDANCE FOR LOCLZJ TARGET VOL FOR RADJ TX DLVR",null,null,null,"78431 - HC MYOCRD IMG PET RST&STRS CT"]
[null,"87529 - HC CHG IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ",null,"78264 - HC CHG GASTRIC EMPTYING IMAGING STUDY","78264 - HC CHG GASTRIC EMPTYING IMAGING STUDY","78264 - HC CHG GASTRIC EMPTYING IMAGING STUDY",null,"77399 - HC UNLISTED MED PHYSICS PROC",null,null,null,null,"78434 - HC AQMBF PET REST & RX STRESS",null,"77399 - HC UNLISTED MED PHYSICS PROC",null,null,null,"78432 - HC MYOCRD IMG PET 2RTRACER"]
[null,"87532 - HC CHG IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ",null,"78278 - HC CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING","78278 - HC CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING","78278 - HC CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING",null,"77402 - HC TX DEL =>1 MEV SIMPLE",null,null,null,null,"78445 - HC CHG NONCARDIAC VASCULAR FLOW IMAGING",null,"77402 - HC TX DEL =>1 MEV SIMPLE",null,null,null,"78433 - HC MYOCRD IMG PET 2RTRACER CT"]
[null,"87535 - HC CHG IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ",null,"78290 - HC CHG INTESTINE IMAGING","78290 - HC CHG INTESTINE IMAGING","78290 - HC CHG INTESTINE IMAGING",null,"77407 - HC TX DEL => 1 MEV, 2 AREA, 3 PORTS - INTERMEDIATE",null,null,null,null,"78451 - HC CHG MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS",null,"77407 - HC TX DEL => 1 MEV, 2 AREA, 3 PORTS - INTERMEDIATE",null,null,null,"78434 - HC AQMBF PET REST & RX STRESS"]
[null,"87536 - HC CHG IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION",null,"78291 - HC PV SHUNT PATENCY","78291 - HC PV SHUNT PATENCY","78291 - HC PV SHUNT PATENCY",null,"77412 - HC TX DEL =>1 MEV - COMPLEX",null,null,null,null,"78452 - HC CHG MYOCARDIAL SPECT MULTIPLE STUDIES",null,"77412 - HC TX DEL =>1 MEV - COMPLEX",null,null,null,"78445 - HC CHG NONCARDIAC VASCULAR FLOW IMAGING"]
[null,"87538 - HC HIV-2 PROBE&REVRSE TRNSCRIPJ",null,"78300 - HC CHG BONE IMAGING, LIMITED AREA","78300 - HC CHG BONE IMAGING, LIMITED AREA","78300 - HC CHG BONE IMAGING, LIMITED AREA",null,"77417 - HC PORT IMAGES",null,null,null,null,"78453 - HC MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS",null,"77417 - HC PORT IMAGES",null,null,null,"78451 - HC CHG MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS"]
[null,"87556 - HC CHG IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB",null,"78305 - HC BONE&/JOINT IM;MULT","78305 - HC BONE&/JOINT IM;MULT","78305 - HC BONE&/JOINT IM;MULT",null,"77435 - RADN RX DELIV,BODY, MANAGEMENT, PER COURSE",null,null,null,null,"78457 - HC VENOUS THROMBOSIS IMAGING",null,"77435 - RADN RX DELIV,BODY, MANAGEMENT, PER COURSE",null,null,null,"78452 - HC CHG MYOCARDIAL SPECT MULTIPLE STUDIES"]
[null,"87563 - HC M. GENITALIUM AMP PROBE",null,"78306 - HC CHG BONE &/JOINT IMAGING WHOLE BODY","78306 - HC CHG BONE &/JOINT IMAGING WHOLE BODY","78306 - HC CHG BONE &/JOINT IMAGING WHOLE BODY",null,"77470 - HC SPEC TX PROC/CONCURRENT CHEMO",null,null,null,null,"78458 - HC VEN THROMBOSIS IMAGES BILAT",null,"77470 - HC SPEC TX PROC/CONCURRENT CHEMO",null,null,null,"78453 - HC MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS"]
[null,"87581 - HC CHG IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ",null,"78315 - HC CHG BONE &/JOINT IMAGING 3 PHASE STUDY","78315 - HC CHG BONE &/JOINT IMAGING 3 PHASE STUDY","78315 - HC CHG BONE &/JOINT IMAGING 3 PHASE STUDY",null,"77520 - PROTON BEAM DEL,SIMPLE",null,null,null,null,"78459 - HC CHG MYOCARDIAL IMAGING PET METABOLIC EVALUATION",null,"77520 - PROTON BEAM DEL,SIMPLE",null,null,null,"78457 - HC VENOUS THROMBOSIS IMAGING"]
[null,"87591 - HC CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ",null,"78428 - HC CHG CARDIAC SHUNT DETECTION","78428 - HC CHG CARDIAC SHUNT DETECTION","78428 - HC CHG CARDIAC SHUNT DETECTION",null,"77522 - PROTON BEAM DEL,SINGLE, W/COMPENSAT",null,null,null,null,"78469 - HC MYO INFARCT AVID SPECT",null,"77522 - PROTON BEAM DEL,SINGLE, W/COMPENSAT",null,null,null,"78458 - HC VEN THROMBOSIS IMAGES BILAT"]
[null,"87624 - IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES",null,"78429 - HC MYOCRD IMG PET 1 STD W/CT","78429 - HC MYOCRD IMG PET 1 STD W/CT","78429 - HC MYOCRD IMG PET 1 STD W/CT",null,"77523 - PROTON,BEAM DEL,INTERMED",null,null,null,null,"78472 - HC CHG CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS",null,"77523 - PROTON,BEAM DEL,INTERMED",null,null,null,"78459 - HC CHG MYOCARDIAL IMAGING PET METABOLIC EVALUATION"]
[null,"87631 - HC INFLUENZA A/B,RSV PCR",null,"78430 - HC MYOCRD IMG PET RST/STRS W/CT","78430 - HC MYOCRD IMG PET RST/STRS W/CT","78430 - HC MYOCRD IMG PET RST/STRS W/CT",null,"77525 - PROTON BEAM DEL,MULTIPLE,COMPLEX",null,null,null,null,"78491 - HC CHG MYOCRD IMAGE PET PERFUS SINGLE STUDY REST/STRESS",null,"77525 - PROTON BEAM DEL,MULTIPLE,COMPLEX",null,null,null,"78469 - HC MYO INFARCT AVID SPECT"]
[null,"87632 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 6-11 TARGETS",null,"78431 - HC MYOCRD IMG PET RST&STRS CT","78431 - HC MYOCRD IMG PET RST&STRS CT","78431 - HC MYOCRD IMG PET RST&STRS CT",null,"77761 - HC BRACHY INCAV SMP",null,null,null,null,"78492 - HC CHG MYOCRD IMAGE PET PERFUS MULTPL STUDY REST/STRESS",null,"77761 - HC BRACHY INCAV SMP",null,null,null,"78472 - HC CHG CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS"]
[null,"87633 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET",null,"78432 - HC MYOCRD IMG PET 2RTRACER","78432 - HC MYOCRD IMG PET 2RTRACER","78432 - HC MYOCRD IMG PET 2RTRACER",null,"77762 - HC BRACHY INCAV INT",null,null,null,null,"78579 - HC PUL VENT IMAG (AERO/GAS)",null,"77762 - HC BRACHY INCAV INT",null,null,null,"78491 - HC CHG MYOCRD IMAGE PET PERFUS SINGLE STUDY REST/STRESS"]
[null,"87635 - HC SARS-COV-2 COVID-19 AMP PRB",null,"78433 - HC MYOCRD IMG PET 2RTRACER CT","78433 - HC MYOCRD IMG PET 2RTRACER CT","78433 - HC MYOCRD IMG PET 2RTRACER CT",null,"77763 - HC BRACHY INCAV CMP",null,null,null,null,"78580 - HC CHG PULMONARY PERFUSION IMAGING PARTICULATE",null,"77763 - HC BRACHY INCAV CMP",null,null,null,"78492 - HC CHG MYOCRD IMAGE PET PERFUS MULTPL STUDY REST/STRESS"]
[null,"87636 - HC SARSCOV2 & INF A&B AMP PRB",null,"78445 - HC CHG NONCARDIAC VASCULAR FLOW IMAGING","78445 - HC CHG NONCARDIAC VASCULAR FLOW IMAGING","78445 - HC CHG NONCARDIAC VASCULAR FLOW IMAGING",null,"77767 - HC HDR RDNCL SKSURF 2.0/1CH",null,null,null,null,"78582 - HC CHG PULMONARY VENTILATION & PERFUSION IMAGING",null,"77767 - HC HDR RDNCL SKSURF 2.0/1CH",null,null,null,"78579 - HC PUL VENT IMAG (AERO/GAS)"]
[null,"87640 - HC CHG IADNA S AUREUS AMPLIFIED PROBE TQ",null,"78451 - HC CHG MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS","78451 - HC CHG MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS","78451 - HC CHG MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS",null,"77768 - HC HDR RDNCL SKSURF 2.0/2CH>",null,null,null,null,"78597 - HC CHG QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING",null,"77768 - HC HDR RDNCL SKSURF 2.0/2CH>",null,null,null,"78580 - HC CHG PULMONARY PERFUSION IMAGING PARTICULATE"]
[null,"87641 - HC CHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ",null,"78452 - HC CHG MYOCARDIAL SPECT MULTIPLE STUDIES","78452 - HC CHG MYOCARDIAL SPECT MULTIPLE STUDIES","78452 - HC CHG MYOCARDIAL SPECT MULTIPLE STUDIES",null,"77770 - HC HDR RDNCL NTRSTL/1ST",null,null,null,null,"78598 - HC QUAN DIFF PERF/VENT,IMG",null,"77770 - HC HDR RDNCL NTRSTL/1ST",null,null,null,"78582 - HC CHG PULMONARY VENTILATION & PERFUSION IMAGING"]
[null,"87653 - HC CHG IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ",null,"78453 - HC MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS","78453 - HC MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS","78453 - HC MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS",null,"77771 - HC HDR RDNCL NTRSTL/2-12",null,null,null,null,"78605 - HC BRAIN IMAGE 4+ VIEWS",null,"77771 - HC HDR RDNCL NTRSTL/2-12",null,null,null,"78597 - HC CHG QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING"]
[null,"87660 - HC CHG IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ",null,"78457 - HC VENOUS THROMBOSIS IMAGING","78457 - HC VENOUS THROMBOSIS IMAGING","78457 - HC VENOUS THROMBOSIS IMAGING",null,"77772 - HC HDR RDNCL NTRSTL/12+",null,null,null,null,"78608 - HC CHG BRAIN IMAGING PET METABOLIC EVALUATION",null,"77772 - HC HDR RDNCL NTRSTL/12+",null,null,null,"78598 - HC QUAN DIFF PERF/VENT,IMG"]
[null,"87661 - IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH",null,"78458 - HC VEN THROMBOSIS IMAGES BILAT","78458 - HC VEN THROMBOSIS IMAGES BILAT","78458 - HC VEN THROMBOSIS IMAGES BILAT",null,"77778 - HC BRACHY INST CMP",null,null,null,null,"78609 - HC CHG BRAIN IMAGING PET PERFUSION EVALUATION",null,"77778 - HC BRACHY INST CMP",null,null,null,"78605 - HC BRAIN IMAGE 4+ VIEWS"]
[null,"87797 - HC CHG DETECT AGENT NOS, DNA, DIR",null,"78459 - HC CHG MYOCARDIAL IMAGING PET METABOLIC EVALUATION","78459 - HC CHG MYOCARDIAL IMAGING PET METABOLIC EVALUATION","78459 - HC CHG MYOCARDIAL IMAGING PET METABOLIC EVALUATION",null,"77789 - HC BRACHY SURF APP",null,null,null,null,"78645 - HC CHG CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ",null,"77789 - HC BRACHY SURF APP",null,null,null,"78608 - HC CHG BRAIN IMAGING PET METABOLIC EVALUATION"]
[null,"87798 - HC EBV DNA, QL PCR",null,"78469 - HC MYO INFARCT AVID SPECT","78469 - HC MYO INFARCT AVID SPECT","78469 - HC MYO INFARCT AVID SPECT",null,"77790 - HC BRACHY , SUP. HANDLING, LOADING",null,null,null,null,"78650 - HC CSF LEAK DETECT/LOC",null,"77790 - HC BRACHY , SUP. HANDLING, LOADING",null,null,null,"78609 - HC CHG BRAIN IMAGING PET PERFUSION EVALUATION"]
[null,"87799 - HC CHG IADNA NOS QUANTIFICATION EACH ORGANISM",null,"78472 - HC CHG CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS","78472 - HC CHG CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS","78472 - HC CHG CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS",null,"77799 - HC UNLIST BRACHY",null,null,null,null,"78700 - HC RENAL IM MORPH",null,"77799 - HC UNLIST BRACHY",null,null,null,"78645 - HC CHG CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ"]
[null,"87801 - HC CHG DETECT AGENT, MULT ORGS, DNA  AMP",null,"78491 - HC CHG MYOCRD IMAGE PET PERFUS SINGLE STUDY REST/STRESS","78491 - HC CHG MYOCRD IMAGE PET PERFUS SINGLE STUDY REST/STRESS","78491 - HC CHG MYOCRD IMAGE PET PERFUS SINGLE STUDY REST/STRESS",null,"78012 - HC CHG THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT",null,null,null,null,"78707 - HC CHG KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/O RX",null,"78012 - HC CHG THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT",null,null,null,"78650 - HC CSF LEAK DETECT/LOC"]
[null,"87880 - IAADIADOO STREPTOCOCCUS GROUP A",null,"78492 - HC CHG MYOCRD IMAGE PET PERFUS MULTPL STUDY REST/STRESS","78492 - HC CHG MYOCRD IMAGE PET PERFUS MULTPL STUDY REST/STRESS","78492 - HC CHG MYOCRD IMAGE PET PERFUS MULTPL STUDY REST/STRESS",null,"78013 - HC CHG THYROID IMAGING WITH VASCULAR FLOW",null,null,null,null,"78708 - HC CHG RENAL FLOW/FUNCT IMAGE,PHARM RX",null,"78013 - HC CHG THYROID IMAGING WITH VASCULAR FLOW",null,null,null,"78700 - HC RENAL IM MORPH"]
[null,"87899 - HC MALARIA ANTIGEN",null,"78579 - HC PUL VENT IMAG (AERO/GAS)","78579 - HC PUL VENT IMAG (AERO/GAS)","78579 - HC PUL VENT IMAG (AERO/GAS)",null,"78014 - HC CHG THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS",null,null,null,null,"78740 - HC URETERAL REFLUX",null,"78014 - HC CHG THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS",null,null,null,"78707 - HC CHG KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/O RX"]
[null,"87900 - HC CHG NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION",null,"78580 - HC CHG PULMONARY PERFUSION IMAGING PARTICULATE","78580 - HC CHG PULMONARY PERFUSION IMAGING PARTICULATE","78580 - HC CHG PULMONARY PERFUSION IMAGING PARTICULATE",null,"78018 - HC CHG THYROID CARCINOMA METASTASES IMG WHOLE BODY",null,null,null,null,"78800 - HC NM RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR: LIMITED AREA",null,"78018 - HC CHG THYROID CARCINOMA METASTASES IMG WHOLE BODY",null,null,null,"78708 - HC CHG RENAL FLOW/FUNCT IMAGE,PHARM RX"]
[null,"87901 - HC CHG NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEAS",null,"78582 - HC CHG PULMONARY VENTILATION & PERFUSION IMAGING","78582 - HC CHG PULMONARY VENTILATION & PERFUSION IMAGING","78582 - HC CHG PULMONARY VENTILATION & PERFUSION IMAGING",null,"78020 - HC CHG THYROID CARCINOMA METASTASES UPTAKE",null,null,null,null,"78801 - HC RP LOCLZJ TUM 2+AREA 1+D IMG",null,"78020 - HC CHG THYROID CARCINOMA METASTASES UPTAKE",null,null,null,"78740 - HC URETERAL REFLUX"]
[null,"87902 - HC CHG NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS",null,"78597 - HC CHG QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING","78597 - HC CHG QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING","78597 - HC CHG QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING",null,"78070 - HC PARATHYROID IM",null,null,null,null,"78802 - HC CHG RP LOCLZJ TUMOR/DSTRBJ AGENT WHOLE BDY 1 DAY",null,"78070 - HC PARATHYROID IM",null,null,null,"78800 - HC NM RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR: LIMITED AREA"]
[null,"87906 - HC Q;HIV1 GENO",null,"78598 - HC QUAN DIFF PERF/VENT,IMG","78598 - HC QUAN DIFF PERF/VENT,IMG","78598 - HC QUAN DIFF PERF/VENT,IMG",null,"78071 - HC CHG PARATHYROID PLANAR IMAGING W/WO SUBTRACTION",null,null,null,null,"78803 - HC CHG RP LOCLZJ TUMOR/DSTRBJ AGENT TOMOG SPECT",null,"78071 - HC CHG PARATHYROID PLANAR IMAGING W/WO SUBTRACTION",null,null,null,"78801 - HC RP LOCLZJ TUM 2+AREA 1+D IMG"]
[null,"87912 - HC CHG NFCT AGENT GENOTYPE HEPATITIS B VIRUS",null,"78605 - HC BRAIN IMAGE 4+ VIEWS","78605 - HC BRAIN IMAGE 4+ VIEWS","78605 - HC BRAIN IMAGE 4+ VIEWS",null,"78072 - HC PARATHYROID W SPECTCTAL",null,null,null,null,"78804 - HC RP TUM LOC/RP DIS;BODY,2/",null,"78072 - HC PARATHYROID W SPECTCTAL",null,null,null,"78802 - HC CHG RP LOCLZJ TUMOR/DSTRBJ AGENT WHOLE BDY 1 DAY"]
[null,"88142 - CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN",null,"78608 - HC CHG BRAIN IMAGING PET METABOLIC EVALUATION","78608 - HC CHG BRAIN IMAGING PET METABOLIC EVALUATION","78608 - HC CHG BRAIN IMAGING PET METABOLIC EVALUATION",null,"78099 - HC THYROID SPECT",null,null,null,null,"78811 - HC CHG PET IMAGING LIMITED AREA CHEST HEAD/NECK",null,"78099 - HC THYROID SPECT",null,null,null,"78803 - HC CHG RP LOCLZJ TUMOR/DSTRBJ AGENT TOMOG SPECT"]
[null,"88143 - HC CHG CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS",null,"78609 - HC CHG BRAIN IMAGING PET PERFUSION EVALUATION","78609 - HC CHG BRAIN IMAGING PET PERFUSION EVALUATION","78609 - HC CHG BRAIN IMAGING PET PERFUSION EVALUATION",null,"78102 - HC BONE MARROW IM;LIM",null,null,null,null,"78812 - HC CHG PET IMAGING SKULL BASE TO MID-THIGH",null,"78102 - HC BONE MARROW IM;LIM",null,null,null,"78804 - HC RP TUM LOC/RP DIS;BODY,2/"]
[null,"88147 - HC CHG CYTOPATH SMEAR CERV/VAG AUTOMATED",null,"78645 - HC CHG CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ","78645 - HC CHG CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ","78645 - HC CHG CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ",null,"78104 - HC CHG BONE MARROW IMAGING WHOLE BODY",null,null,null,null,"78814 - HC PET&CT ATT CORR;LIM",null,"78104 - HC CHG BONE MARROW IMAGING WHOLE BODY",null,null,null,"78811 - HC CHG PET IMAGING LIMITED AREA CHEST HEAD/NECK"]
[null,"88152 - HC CHG CYTOPATH SMEAR CERV/VAG,AUTO REDO",null,"78650 - HC CSF LEAK DETECT/LOC","78650 - HC CSF LEAK DETECT/LOC","78650 - HC CSF LEAK DETECT/LOC",null,"78195 - HC CHG LYMPHATICS & LYMPH NODES IMAGING",null,null,null,null,"78815 - HC CHG PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH",null,"78195 - HC CHG LYMPHATICS & LYMPH NODES IMAGING",null,null,null,"78812 - HC CHG PET IMAGING SKULL BASE TO MID-THIGH"]
[null,"88164 - HC CHG CYTOPATH TBS CERV/VAG MANUAL",null,"78700 - HC RENAL IM MORPH","78700 - HC RENAL IM MORPH","78700 - HC RENAL IM MORPH",null,"78201 - HC CHG LIVER IMAGING SPECT",null,null,null,null,"78816 - HC CHG PET IMAGING FOR CT ATTENUATION WHOLE BODY",null,"78201 - HC CHG LIVER IMAGING SPECT",null,null,null,"78814 - HC PET&CT ATT CORR;LIM"]
[null,"88165 - HC CHG CYTP SLIDES C/V MNL SCR&RESCR PHYS SUPV",null,"78707 - HC CHG KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/O RX","78707 - HC CHG KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/O RX","78707 - HC CHG KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/O RX",null,"78205 - NM LIVER W SPECT",null,null,null,null,"78830 - HC RP LOCLZJ TUM SPECT W/CT 1",null,"78205 - NM LIVER W SPECT",null,null,null,"78815 - HC CHG PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH"]
[null,"88230 - HC CHG TISS CUL NON-NEO DISORDERS LYMPHOCYTE",null,"78708 - HC CHG RENAL FLOW/FUNCT IMAGE,PHARM RX","78708 - HC CHG RENAL FLOW/FUNCT IMAGE,PHARM RX","78708 - HC CHG RENAL FLOW/FUNCT IMAGE,PHARM RX",null,"78215 - HC CHG LIVER & SPLEEN IMAGING STATIC ONLY",null,null,null,null,"78831 - HC NM LOCLZJ TUM SPECT 2 AREAS",null,"78215 - HC CHG LIVER & SPLEEN IMAGING STATIC ONLY",null,null,null,"78816 - HC CHG PET IMAGING FOR CT ATTENUATION WHOLE BODY"]
[null,"88235 - HC CHG TISSUE CULTURE, PLACENTA",null,"78740 - HC URETERAL REFLUX","78740 - HC URETERAL REFLUX","78740 - HC URETERAL REFLUX",null,"78216 - HC LIVER&SPLEEN IM;W/FLO",null,null,null,null,"78832 - HC RP LOCLZJ TUM SPECT W/CT 2",null,"78216 - HC LIVER&SPLEEN IM;W/FLO",null,null,null,"78830 - HC RP LOCLZJ TUM SPECT W/CT 1"]
[null,"88237 - HC CHG TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS",null,"78800 - HC NM RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR: LIMITED AREA","78800 - HC NM RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR: LIMITED AREA","78800 - HC NM RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR: LIMITED AREA",null,"78226 - HC CHG HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER",null,null,null,null,"78835 - HC RP QUAN MEAS SINGLE AREA",null,"78226 - HC CHG HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER",null,null,null,"78831 - HC NM LOCLZJ TUM SPECT 2 AREAS"]
[null,"88262 - HC CHG CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING",null,"78801 - HC RP LOCLZJ TUM 2+AREA 1+D IMG","78801 - HC RP LOCLZJ TUM 2+AREA 1+D IMG","78801 - HC RP LOCLZJ TUM 2+AREA 1+D IMG",null,"78227 - HC CHG HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ",null,null,null,null,"79005 - HC CHG RP THERAPY ORAL ADMINISTRATION",null,"78227 - HC CHG HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ",null,null,null,"78832 - HC RP LOCLZJ TUM SPECT W/CT 2"]
[null,"88264 - HC CHG CHRMSM ANALYZE 20-25 CELLS",null,"78802 - HC CHG RP LOCLZJ TUMOR/DSTRBJ AGENT WHOLE BDY 1 DAY","78802 - HC CHG RP LOCLZJ TUMOR/DSTRBJ AGENT WHOLE BDY 1 DAY","78802 - HC CHG RP LOCLZJ TUMOR/DSTRBJ AGENT WHOLE BDY 1 DAY",null,"78258 - HC CHG ESOPHAGEAL MOTILITY",null,null,null,null,"79101 - HC CHG RP THERAPY INTRAVENOUS ADMINISTRATION",null,"78258 - HC CHG ESOPHAGEAL MOTILITY",null,null,null,"78835 - HC RP QUAN MEAS SINGLE AREA"]
[null,"88271 - HC CHG MOLECULAR CYTOGENETICS DNA PROBE EACH",null,"78803 - HC CHG RP LOCLZJ TUMOR/DSTRBJ AGENT TOMOG SPECT","78803 - HC CHG RP LOCLZJ TUMOR/DSTRBJ AGENT TOMOG SPECT","78803 - HC CHG RP LOCLZJ TUMOR/DSTRBJ AGENT TOMOG SPECT",null,"78264 - HC CHG GASTRIC EMPTYING IMAGING STUDY",null,null,null,null,"79200 - HC CHG RP THERAPY INRACAVITARY ADMINISTRATION",null,"78264 - HC CHG GASTRIC EMPTYING IMAGING STUDY",null,null,null,"79005 - HC CHG RP THERAPY ORAL ADMINISTRATION"]
[null,"88274 - HC CHG MOLECULAR CYTOGENETICS INTERPHASE ISH 25-99 CLL",null,"78804 - HC RP TUM LOC/RP DIS;BODY,2/","78804 - HC RP TUM LOC/RP DIS;BODY,2/","78804 - HC RP TUM LOC/RP DIS;BODY,2/",null,"78278 - HC CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING",null,null,null,null,"79445 - HC CHG RP THERAPY INTRA-ARTERIAL PARTICULATE ADMN",null,"78278 - HC CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING",null,null,null,"79101 - HC CHG RP THERAPY INTRAVENOUS ADMINISTRATION"]
[null,"88275 - HC CHG MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL",null,"78811 - HC CHG PET IMAGING LIMITED AREA CHEST HEAD/NECK","78811 - HC CHG PET IMAGING LIMITED AREA CHEST HEAD/NECK","78811 - HC CHG PET IMAGING LIMITED AREA CHEST HEAD/NECK",null,"78290 - HC CHG INTESTINE IMAGING",null,null,null,null,"80048 - HC CHG BASIC METABOLIC PANEL CALCIUM TOTAL",null,"78290 - HC CHG INTESTINE IMAGING",null,null,null,"79200 - HC CHG RP THERAPY INRACAVITARY ADMINISTRATION"]
[null,"88280 - HC CHG CHROMOSOME KARYOTYPE STUDY",null,"78812 - HC CHG PET IMAGING SKULL BASE TO MID-THIGH","78812 - HC CHG PET IMAGING SKULL BASE TO MID-THIGH","78812 - HC CHG PET IMAGING SKULL BASE TO MID-THIGH",null,"78291 - HC PV SHUNT PATENCY",null,null,null,null,"80051 - HC CHG ELECTROLYTE PANEL",null,"78291 - HC PV SHUNT PATENCY",null,null,null,"79445 - HC CHG RP THERAPY INTRA-ARTERIAL PARTICULATE ADMN"]
[null,"89050 - HC CHG CELL COUNT MISCELLANEOUS BODY FLUIDS",null,"78814 - HC PET&CT ATT CORR;LIM","78814 - HC PET&CT ATT CORR;LIM","78814 - HC PET&CT ATT CORR;LIM",null,"78299 - HC UNLISTED GI PROC,DX NM",null,null,null,null,"80053 - HC CHG COMPREHENSIVE METABOLIC PANEL",null,"78299 - HC UNLISTED GI PROC,DX NM",null,null,null,"80048 - HC CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
[null,"89051 - HC CHG CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT",null,"78815 - HC CHG PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH","78815 - HC CHG PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH","78815 - HC CHG PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH",null,"78300 - HC CHG BONE IMAGING, LIMITED AREA",null,null,null,null,"80055 - HC CHG OBSTETRIC PANEL",null,"78300 - HC CHG BONE IMAGING, LIMITED AREA",null,null,null,"80051 - HC CHG ELECTROLYTE PANEL"]
[null,"89060 - HC CHG CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID",null,"78816 - HC CHG PET IMAGING FOR CT ATTENUATION WHOLE BODY","78816 - HC CHG PET IMAGING FOR CT ATTENUATION WHOLE BODY","78816 - HC CHG PET IMAGING FOR CT ATTENUATION WHOLE BODY",null,"78305 - HC BONE&/JOINT IM;MULT",null,null,null,null,"80061 - HC CHG LIPID PANEL",null,"78305 - HC BONE&/JOINT IM;MULT",null,null,null,"80053 - HC CHG COMPREHENSIVE METABOLIC PANEL"]
[null,"89320 - SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT",null,"78830 - HC RP LOCLZJ TUM SPECT W/CT 1","78830 - HC RP LOCLZJ TUM SPECT W/CT 1","78830 - HC RP LOCLZJ TUM SPECT W/CT 1",null,"78306 - HC CHG BONE &/JOINT IMAGING WHOLE BODY",null,null,null,null,"80069 - HC CHG RENAL FUNCTION PANEL",null,"78306 - HC CHG BONE &/JOINT IMAGING WHOLE BODY",null,null,null,"80055 - HC CHG OBSTETRIC PANEL"]
[null,"90371 - HC HEPB IG, IM",null,"78831 - HC NM LOCLZJ TUM SPECT 2 AREAS","78831 - HC NM LOCLZJ TUM SPECT 2 AREAS","78831 - HC NM LOCLZJ TUM SPECT 2 AREAS",null,"78315 - HC CHG BONE &/JOINT IMAGING 3 PHASE STUDY",null,null,null,null,"80074 - HC CHG ACUTE HEPATITIS PANEL",null,"78315 - HC CHG BONE &/JOINT IMAGING 3 PHASE STUDY",null,null,null,"80061 - HC CHG LIPID PANEL"]
[null,"90632 - CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,"78832 - HC RP LOCLZJ TUM SPECT W/CT 2","78832 - HC RP LOCLZJ TUM SPECT W/CT 2","78832 - HC RP LOCLZJ TUM SPECT W/CT 2",null,"78320 - NM BONE SCAN W SPECT",null,null,null,null,"80076 - HC CHG HEPATIC FUNCTION PANEL",null,"78320 - NM BONE SCAN W SPECT",null,null,null,"80069 - HC CHG RENAL FUNCTION PANEL"]
[null,"90653 - HC IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE",null,"78835 - HC RP QUAN MEAS SINGLE AREA","78835 - HC RP QUAN MEAS SINGLE AREA","78835 - HC RP QUAN MEAS SINGLE AREA",null,"78428 - HC CHG CARDIAC SHUNT DETECTION",null,null,null,null,"80145 - HC DRUG ASSAY ADALIMUMAB",null,"78428 - HC CHG CARDIAC SHUNT DETECTION",null,null,null,"80074 - HC CHG ACUTE HEPATITIS PANEL"]
[null,"90662 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM FLUZONE HIGH DOSE",null,"79005 - HC CHG RP THERAPY ORAL ADMINISTRATION","79005 - HC CHG RP THERAPY ORAL ADMINISTRATION","79005 - HC CHG RP THERAPY ORAL ADMINISTRATION",null,"78429 - HC MYOCRD IMG PET 1 STD W/CT",null,null,null,null,"80150 - HC AMIKACIN",null,"78429 - HC MYOCRD IMG PET 1 STD W/CT",null,null,null,"80076 - HC CHG HEPATIC FUNCTION PANEL"]
[null,"90670 - CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH",null,"79101 - HC CHG RP THERAPY INTRAVENOUS ADMINISTRATION","79101 - HC CHG RP THERAPY INTRAVENOUS ADMINISTRATION","79101 - HC CHG RP THERAPY INTRAVENOUS ADMINISTRATION",null,"78430 - HC MYOCRD IMG PET RST/STRS W/CT",null,null,null,null,"80156 - HC CHG DRUG ASSAY CARBAMAZEPINE TOTAL",null,"78430 - HC MYOCRD IMG PET RST/STRS W/CT",null,null,null,"80145 - HC DRUG ASSAY ADALIMUMAB"]
[null,"90672 - CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST",null,"79200 - HC CHG RP THERAPY INRACAVITARY ADMINISTRATION","79200 - HC CHG RP THERAPY INRACAVITARY ADMINISTRATION","79200 - HC CHG RP THERAPY INRACAVITARY ADMINISTRATION",null,"78431 - HC MYOCRD IMG PET RST&STRS CT",null,null,null,null,"80158 - HC CHG DRUG ASSAY CYCLOSPORINE",null,"78431 - HC MYOCRD IMG PET RST&STRS CT",null,null,null,"80150 - HC AMIKACIN"]
[null,"90673 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM",null,"79445 - HC CHG RP THERAPY INTRA-ARTERIAL PARTICULATE ADMN","79445 - HC CHG RP THERAPY INTRA-ARTERIAL PARTICULATE ADMN","79445 - HC CHG RP THERAPY INTRA-ARTERIAL PARTICULATE ADMN",null,"78432 - HC MYOCRD IMG PET 2RTRACER",null,null,null,null,"80162 - HC CHG DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL",null,"78432 - HC MYOCRD IMG PET 2RTRACER",null,null,null,"80156 - HC CHG DRUG ASSAY CARBAMAZEPINE TOTAL"]
[null,"90674 - HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",null,"80048 - HC CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - HC CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - HC CHG BASIC METABOLIC PANEL CALCIUM TOTAL",null,"78433 - HC MYOCRD IMG PET 2RTRACER CT",null,null,null,null,"80164 - HC CHG DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL",null,"78433 - HC MYOCRD IMG PET 2RTRACER CT",null,null,null,"80158 - HC CHG DRUG ASSAY CYCLOSPORINE"]
[null,"90675 - CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,"80051 - HC CHG ELECTROLYTE PANEL","80051 - HC CHG ELECTROLYTE PANEL","80051 - HC CHG ELECTROLYTE PANEL",null,"78434 - HC AQMBF PET REST & RX STRESS",null,null,null,null,"80168 - HC CHG DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE",null,"78434 - HC AQMBF PET REST & RX STRESS",null,null,null,"80162 - HC CHG DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL"]
[null,"90686 - HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,"80053 - HC CHG COMPREHENSIVE METABOLIC PANEL","80053 - HC CHG COMPREHENSIVE METABOLIC PANEL","80053 - HC CHG COMPREHENSIVE METABOLIC PANEL",null,"78445 - HC CHG NONCARDIAC VASCULAR FLOW IMAGING",null,null,null,null,"80169 - DRUG SCREEN QUANTITATIVE EVEROLIMUS",null,"78445 - HC CHG NONCARDIAC VASCULAR FLOW IMAGING",null,null,null,"80164 - HC CHG DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL"]
[null,"90691 - CR BUILD ONLY - TYPHOID VACCINE, IM,TRAVEL",null,"80055 - HC CHG OBSTETRIC PANEL","80055 - HC CHG OBSTETRIC PANEL","80055 - HC CHG OBSTETRIC PANEL",null,"78451 - HC CHG MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS",null,null,null,null,"80170 - HC CHG DRUG SCREEN QUANTITATIVE GENTAMICIN",null,"78451 - HC CHG MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS",null,null,null,"80168 - HC CHG DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE"]
[null,"90694 - HC VACC AIIV4 NO PRSRV 0.5ML IM",null,"80061 - HC CHG LIPID PANEL","80061 - HC CHG LIPID PANEL","80061 - HC CHG LIPID PANEL",null,"78452 - HC CHG MYOCARDIAL SPECT MULTIPLE STUDIES",null,null,null,null,"80171 - DRUG SCREEN QUANTITATIVE GABAPENTIN",null,"78452 - HC CHG MYOCARDIAL SPECT MULTIPLE STUDIES",null,null,null,"80169 - DRUG SCREEN QUANTITATIVE EVEROLIMUS"]
[null,"90714 - CR BUILD ONLY - TD VACCINE NO PRSRV >/= 7 YO, IM,DPH",null,"80069 - HC CHG RENAL FUNCTION PANEL","80069 - HC CHG RENAL FUNCTION PANEL","80069 - HC CHG RENAL FUNCTION PANEL",null,"78453 - HC MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS",null,null,null,null,"80175 - DRUG SCREEN QUANTITATIVE LAMOTRIGINE",null,"78453 - HC MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS",null,null,null,"80170 - HC CHG DRUG SCREEN QUANTITATIVE GENTAMICIN"]
[null,"90715 - CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,"80074 - HC CHG ACUTE HEPATITIS PANEL","80074 - HC CHG ACUTE HEPATITIS PANEL","80074 - HC CHG ACUTE HEPATITIS PANEL",null,"78457 - HC VENOUS THROMBOSIS IMAGING",null,null,null,null,"80177 - DRUG SCREEN QUANTITATIVE LEVETIRACETAM",null,"78457 - HC VENOUS THROMBOSIS IMAGING",null,null,null,"80171 - DRUG SCREEN QUANTITATIVE GABAPENTIN"]
[null,"90732 - CR BUILD ONLY - PNEUMOCOCCAL VACCINE,23-VALENT,ADULT,TRAVEL",null,"80076 - HC CHG HEPATIC FUNCTION PANEL","80076 - HC CHG HEPATIC FUNCTION PANEL","80076 - HC CHG HEPATIC FUNCTION PANEL",null,"78458 - HC VEN THROMBOSIS IMAGES BILAT",null,null,null,null,"80178 - HC CHG DRUG SCREEN QUANTITATIVE LITHIUM",null,"78458 - HC VEN THROMBOSIS IMAGES BILAT",null,null,null,"80175 - DRUG SCREEN QUANTITATIVE LAMOTRIGINE"]
[null,"90739 - HC HEPATITIS B VACCINE ADULT 2 DOSE IM",null,"80150 - HC AMIKACIN","80145 - HC DRUG ASSAY ADALIMUMAB","80150 - HC AMIKACIN",null,"78459 - HC CHG MYOCARDIAL IMAGING PET METABOLIC EVALUATION",null,null,null,null,"80184 - HC CHG DRUG SCREEN QUANTITATIVE PHENOBARBITAL",null,"78459 - HC CHG MYOCARDIAL IMAGING PET METABOLIC EVALUATION",null,null,null,"80177 - DRUG SCREEN QUANTITATIVE LEVETIRACETAM"]
[null,"90740 - HC HEP B VACCINE,DIAL/IMMUNOSUP, IM",null,"80156 - HC CHG DRUG ASSAY CARBAMAZEPINE TOTAL","80150 - HC AMIKACIN","80156 - HC CHG DRUG ASSAY CARBAMAZEPINE TOTAL",null,"78469 - HC MYO INFARCT AVID SPECT",null,null,null,null,"80185 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL",null,"78469 - HC MYO INFARCT AVID SPECT",null,null,null,"80178 - HC CHG DRUG SCREEN QUANTITATIVE LITHIUM"]
[null,"90744 - CR BUILD ONLY - HEP B VACCINE,PED/ADOL,IM,DPH",null,"80158 - HC CHG DRUG ASSAY CYCLOSPORINE","80156 - HC CHG DRUG ASSAY CARBAMAZEPINE TOTAL","80158 - HC CHG DRUG ASSAY CYCLOSPORINE",null,"78472 - HC CHG CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS",null,null,null,null,"80186 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN FREE",null,"78472 - HC CHG CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS",null,null,null,"80184 - HC CHG DRUG SCREEN QUANTITATIVE PHENOBARBITAL"]
[null,"90746 - CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL",null,"80162 - HC CHG DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL","80158 - HC CHG DRUG ASSAY CYCLOSPORINE","80162 - HC CHG DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL",null,"78491 - HC CHG MYOCRD IMAGE PET PERFUS SINGLE STUDY REST/STRESS",null,null,null,null,"80187 - HC DRUG ASSAY POSACONAZOLE",null,"78491 - HC CHG MYOCRD IMAGE PET PERFUS SINGLE STUDY REST/STRESS",null,null,null,"80185 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL"]
[null,"90756 - HC CCIIV4 VACCINE ANTIBIOTIC FREE 0.5ML DOS IM USE",null,"80164 - HC CHG DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL","80162 - HC CHG DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL","80164 - HC CHG DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL",null,"78492 - HC CHG MYOCRD IMAGE PET PERFUS MULTPL STUDY REST/STRESS",null,null,null,null,"80195 - HC CHG DRUG SCREEN QUANTITATIVE SIROLIMUS",null,"78492 - HC CHG MYOCRD IMAGE PET PERFUS MULTPL STUDY REST/STRESS",null,null,null,"80186 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN FREE"]
[null,"91010 - ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT",null,"80168 - HC CHG DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE","80164 - HC CHG DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL","80168 - HC CHG DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE",null,"78579 - HC PUL VENT IMAG (AERO/GAS)",null,null,null,null,"80197 - HC CHG DRUG SCREEN QUANTITATIVE TACROLIMUS",null,"78579 - HC PUL VENT IMAG (AERO/GAS)",null,null,null,"80187 - HC DRUG ASSAY POSACONAZOLE"]
[null,"92511 - NASOPHARYNGOSCOPY W/ENDOSCOPE SPX",null,"80169 - DRUG SCREEN QUANTITATIVE EVEROLIMUS","80168 - HC CHG DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE","80169 - DRUG SCREEN QUANTITATIVE EVEROLIMUS",null,"78580 - HC CHG PULMONARY PERFUSION IMAGING PARTICULATE",null,null,null,null,"80198 - HC Q;THEOPHYLLINE",null,"78580 - HC CHG PULMONARY PERFUSION IMAGING PARTICULATE",null,null,null,"80195 - HC CHG DRUG SCREEN QUANTITATIVE SIROLIMUS"]
[null,"93451 - HC RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT",null,"80170 - HC CHG DRUG SCREEN QUANTITATIVE GENTAMICIN","80169 - DRUG SCREEN QUANTITATIVE EVEROLIMUS","80170 - HC CHG DRUG SCREEN QUANTITATIVE GENTAMICIN",null,"78582 - HC CHG PULMONARY VENTILATION & PERFUSION IMAGING",null,null,null,null,"80201 - HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE",null,"78582 - HC CHG PULMONARY VENTILATION & PERFUSION IMAGING",null,null,null,"80197 - HC CHG DRUG SCREEN QUANTITATIVE TACROLIMUS"]
[null,"93452 - HC L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",null,"80171 - DRUG SCREEN QUANTITATIVE GABAPENTIN","80170 - HC CHG DRUG SCREEN QUANTITATIVE GENTAMICIN","80171 - DRUG SCREEN QUANTITATIVE GABAPENTIN",null,"78597 - HC CHG QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING",null,null,null,null,"80202 - HC CHG DRUG SCREEN QUANTITATIVE VANCOMYCIN",null,"78597 - HC CHG QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING",null,null,null,"80198 - HC Q;THEOPHYLLINE"]
[null,"93453 - HC R & L HRT CATH W/NJX L VENTRICULOG IMG S&I",null,"80175 - DRUG SCREEN QUANTITATIVE LAMOTRIGINE","80171 - DRUG SCREEN QUANTITATIVE GABAPENTIN","80175 - DRUG SCREEN QUANTITATIVE LAMOTRIGINE",null,"78598 - HC QUAN DIFF PERF/VENT,IMG",null,null,null,null,"80203 - DRUG SCREEN QUANTITATIVE ZONISAMIDE",null,"78598 - HC QUAN DIFF PERF/VENT,IMG",null,null,null,"80201 - HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE"]
[null,"93454 - HC CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I",null,"80177 - DRUG SCREEN QUANTITATIVE LEVETIRACETAM","80175 - DRUG SCREEN QUANTITATIVE LAMOTRIGINE","80177 - DRUG SCREEN QUANTITATIVE LEVETIRACETAM",null,"78599 - HC LUNG SPECT",null,null,null,null,"80230 - HC DRUG ASSAY INFLIXIMAB",null,"78599 - HC LUNG SPECT",null,null,null,"80202 - HC CHG DRUG SCREEN QUANTITATIVE VANCOMYCIN"]
[null,"93455 - HC CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I",null,"80178 - HC CHG DRUG SCREEN QUANTITATIVE LITHIUM","80177 - DRUG SCREEN QUANTITATIVE LEVETIRACETAM","80178 - HC CHG DRUG SCREEN QUANTITATIVE LITHIUM",null,"78605 - HC BRAIN IMAGE 4+ VIEWS",null,null,null,null,"80235 - HC DRUG ASSAY LACOSAMIDE",null,"78605 - HC BRAIN IMAGE 4+ VIEWS",null,null,null,"80203 - DRUG SCREEN QUANTITATIVE ZONISAMIDE"]
[null,"93456 - HC CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I",null,"80184 - HC CHG DRUG SCREEN QUANTITATIVE PHENOBARBITAL","80178 - HC CHG DRUG SCREEN QUANTITATIVE LITHIUM","80184 - HC CHG DRUG SCREEN QUANTITATIVE PHENOBARBITAL",null,"78607 - NM BRAIN CMPL W SPECT",null,null,null,null,"80280 - HC DRUG ASSAY VEDOLIZUMAB",null,"78607 - NM BRAIN CMPL W SPECT",null,null,null,"80230 - HC DRUG ASSAY INFLIXIMAB"]
[null,"93457 - HC CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I",null,"80185 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL","80184 - HC CHG DRUG SCREEN QUANTITATIVE PHENOBARBITAL","80185 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL",null,"78608 - HC CHG BRAIN IMAGING PET METABOLIC EVALUATION",null,null,null,null,"80285 - HC DRUG ASSAY VORICONAZOLE",null,"78608 - HC CHG BRAIN IMAGING PET METABOLIC EVALUATION",null,null,null,"80235 - HC DRUG ASSAY LACOSAMIDE"]
[null,"93458 - HC CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I",null,"80186 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN FREE","80185 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL","80186 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN FREE",null,"78609 - HC CHG BRAIN IMAGING PET PERFUSION EVALUATION",null,null,null,null,"80299 - HC INFLIXIMAB DRUG CONC. AND ANTI-INFLIXIMAB AB",null,"78609 - HC CHG BRAIN IMAGING PET PERFUSION EVALUATION",null,null,null,"80280 - HC DRUG ASSAY VEDOLIZUMAB"]
[null,"93459 - HC CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I",null,"80195 - HC CHG DRUG SCREEN QUANTITATIVE SIROLIMUS","80186 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN FREE","80195 - HC CHG DRUG SCREEN QUANTITATIVE SIROLIMUS",null,"78645 - HC CHG CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ",null,null,null,null,"80306 - HC DRUG TEST PRSMV INSTRMNT",null,"78645 - HC CHG CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ",null,null,null,"80285 - HC DRUG ASSAY VORICONAZOLE"]
[null,"93460 - HC R & L HRT CATH WINJX HRT ART& L VENTR IMG",null,"80197 - HC CHG DRUG SCREEN QUANTITATIVE TACROLIMUS","80187 - HC DRUG ASSAY POSACONAZOLE","80197 - HC CHG DRUG SCREEN QUANTITATIVE TACROLIMUS",null,"78650 - HC CSF LEAK DETECT/LOC",null,null,null,null,"80307 - HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS",null,"78650 - HC CSF LEAK DETECT/LOC",null,null,null,"80299 - HC INFLIXIMAB DRUG CONC. AND ANTI-INFLIXIMAB AB"]
[null,"93461 - HC R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I",null,"80198 - HC Q;THEOPHYLLINE","80195 - HC CHG DRUG SCREEN QUANTITATIVE SIROLIMUS","80198 - HC Q;THEOPHYLLINE",null,"78700 - HC RENAL IM MORPH",null,null,null,null,"80320 - DRUG SCREEN QUANTITATIVE ALCOHOLS",null,"78700 - HC RENAL IM MORPH",null,null,null,"80306 - HC DRUG TEST PRSMV INSTRMNT"]
[null,"93462 - HC LEFT HEART CATH BY TRANSEPTAL PUNCTURE",null,"80201 - HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE","80197 - HC CHG DRUG SCREEN QUANTITATIVE TACROLIMUS","80201 - HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE",null,"78707 - HC CHG KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/O RX",null,null,null,null,"80329 - DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2",null,"78707 - HC CHG KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/O RX",null,null,null,"80307 - HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS"]
[null,"93503 - HC INSERTION FLOW DIRECTED CATHETER FOR MONITORING",null,"80202 - HC CHG DRUG SCREEN QUANTITATIVE VANCOMYCIN","80198 - HC Q;THEOPHYLLINE","80202 - HC CHG DRUG SCREEN QUANTITATIVE VANCOMYCIN",null,"78708 - HC CHG RENAL FLOW/FUNCT IMAGE,PHARM RX",null,null,null,null,"80339 - HC CHG ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 1-3",null,"78708 - HC CHG RENAL FLOW/FUNCT IMAGE,PHARM RX",null,null,null,"80320 - DRUG SCREEN QUANTITATIVE ALCOHOLS"]
[null,"93505 - HC ENDOMYOCARDIAL BIOPSY",null,"80203 - DRUG SCREEN QUANTITATIVE ZONISAMIDE","80201 - HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE","80203 - DRUG SCREEN QUANTITATIVE ZONISAMIDE",null,"78740 - HC URETERAL REFLUX",null,null,null,null,"80345 - HC CHG DRUG SCREENING BARBITURATES",null,"78740 - HC URETERAL REFLUX",null,null,null,"80329 - DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2"]
[null,"93530 - RHC CNGNITL ANMLES",null,"80299 - HC INFLIXIMAB DRUG CONC. AND ANTI-INFLIXIMAB AB","80202 - HC CHG DRUG SCREEN QUANTITATIVE VANCOMYCIN","80299 - HC INFLIXIMAB DRUG CONC. AND ANTI-INFLIXIMAB AB",null,"78800 - HC NM RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR: LIMITED AREA",null,null,null,null,"80348 - HC CHG DRUG SCREENING BUPRENORPHINE",null,"78800 - HC NM RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR: LIMITED AREA",null,null,null,"80339 - HC CHG ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 1-3"]
[null,"93531 - RHC/LHC CNGNITL ANMLES",null,"80306 - HC DRUG TEST PRSMV INSTRMNT","80203 - DRUG SCREEN QUANTITATIVE ZONISAMIDE","80306 - HC DRUG TEST PRSMV INSTRMNT",null,"78801 - HC RP LOCLZJ TUM 2+AREA 1+D IMG",null,null,null,null,"80353 - HC CHG DRUG SCREENING COCAINE",null,"78801 - HC RP LOCLZJ TUM 2+AREA 1+D IMG",null,null,null,"80345 - HC CHG DRUG SCREENING BARBITURATES"]
[null,"93533 - CMBN R HRT T-SEPTAL L HRT CATHJ SEPTAL OPNG CGEN",null,"80307 - HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS","80230 - HC DRUG ASSAY INFLIXIMAB","80307 - HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS",null,"78802 - HC CHG RP LOCLZJ TUMOR/DSTRBJ AGENT WHOLE BDY 1 DAY",null,null,null,null,"80354 - DRUG SCREENING FENTANYL",null,"78802 - HC CHG RP LOCLZJ TUMOR/DSTRBJ AGENT WHOLE BDY 1 DAY",null,null,null,"80348 - HC CHG DRUG SCREENING BUPRENORPHINE"]
[null,"93580 - PRQ TCAT CLSR CGEN INTRATRL COMUNICAJ W/IMPLT",null,"80320 - DRUG SCREEN QUANTITATIVE ALCOHOLS","80235 - HC DRUG ASSAY LACOSAMIDE","80320 - DRUG SCREEN QUANTITATIVE ALCOHOLS",null,"78803 - HC CHG RP LOCLZJ TUMOR/DSTRBJ AGENT TOMOG SPECT",null,null,null,null,"80356 - HC CHG DRUG SCREENING HEROIN METABOLITE",null,"78803 - HC CHG RP LOCLZJ TUMOR/DSTRBJ AGENT TOMOG SPECT",null,null,null,"80353 - HC CHG DRUG SCREENING COCAINE"]
[null,"93582 - HC PERCUTAN TRANSCATH CLOSURE PAT DUCT ARTERIOSUS",null,"80329 - DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2","80280 - HC DRUG ASSAY VEDOLIZUMAB","80329 - DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2",null,"78804 - HC RP TUM LOC/RP DIS;BODY,2/",null,null,null,null,"80361 - HC CHG DRUG SCREENING OPIATES 1 OR MORE",null,"78804 - HC RP TUM LOC/RP DIS;BODY,2/",null,null,null,"80354 - DRUG SCREENING FENTANYL"]
[null,"93590 - HC PERQ TRANSCATH CLS PARAVALVR LEAK 1 MITRAL VALVE",null,"80339 - HC CHG ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 1-3","80285 - HC DRUG ASSAY VORICONAZOLE","80339 - HC CHG ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 1-3",null,"78805 - NM ABSCSS LOC LTD",null,null,null,null,"80366 - HC CHG DRUG SCREENING PREGABALIN",null,"78805 - NM ABSCSS LOC LTD",null,null,null,"80356 - HC CHG DRUG SCREENING HEROIN METABOLITE"]
[null,"93591 - HC PERQ TRANSCATH CLS PARAVALVR LEAK 1 AORTIC VALVE",null,"80345 - HC CHG DRUG SCREENING BARBITURATES","80299 - HC INFLIXIMAB DRUG CONC. AND ANTI-INFLIXIMAB AB","80345 - HC CHG DRUG SCREENING BARBITURATES",null,"78806 - NM ABSCSS LOC WB",null,null,null,null,"80438 - HC CHG TRH STIM PANEL 1 HR",null,"78806 - NM ABSCSS LOC WB",null,null,null,"80361 - HC CHG DRUG SCREENING OPIATES 1 OR MORE"]
[null,"93592 - HC PERQ TRANSCATH CLS PARAVALVR LEAK EACH OCCLS DEV",null,"80348 - HC CHG DRUG SCREENING BUPRENORPHINE","80306 - HC DRUG TEST PRSMV INSTRMNT","80348 - HC CHG DRUG SCREENING BUPRENORPHINE",null,"78807 - NM INFLAM LOCAL W SPECT",null,null,null,null,"81000 - URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY",null,"78807 - NM INFLAM LOCAL W SPECT",null,null,null,"80366 - HC CHG DRUG SCREENING PREGABALIN"]
[null,"93609 - HC INTRA-VENTRIC&/ATRIAL MAPG TACHYCARD W/CATH MA",null,"80353 - HC CHG DRUG SCREENING COCAINE","80307 - HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS","80353 - HC CHG DRUG SCREENING COCAINE",null,"78811 - HC CHG PET IMAGING LIMITED AREA CHEST HEAD/NECK",null,null,null,null,"81001 - URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY",null,"78811 - HC CHG PET IMAGING LIMITED AREA CHEST HEAD/NECK",null,null,null,"80438 - HC CHG TRH STIM PANEL 1 HR"]
[null,"93619 - HC COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION",null,"80354 - DRUG SCREENING FENTANYL","80320 - DRUG SCREEN QUANTITATIVE ALCOHOLS","80354 - DRUG SCREENING FENTANYL",null,"78812 - HC CHG PET IMAGING SKULL BASE TO MID-THIGH",null,null,null,null,"81002 - URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP",null,"78812 - HC CHG PET IMAGING SKULL BASE TO MID-THIGH",null,null,null,"81000 - URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY"]
[null,"93620 - HC COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION",null,"80356 - HC CHG DRUG SCREENING HEROIN METABOLITE","80329 - DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2","80356 - HC CHG DRUG SCREENING HEROIN METABOLITE",null,"78814 - HC PET&CT ATT CORR;LIM",null,null,null,null,"81003 - URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY",null,"78814 - HC PET&CT ATT CORR;LIM",null,null,null,"81001 - URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY"]
[null,"93621 - HC COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC",null,"80361 - HC CHG DRUG SCREENING OPIATES 1 OR MORE","80339 - HC CHG ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 1-3","80361 - HC CHG DRUG SCREENING OPIATES 1 OR MORE",null,"78815 - HC CHG PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH",null,null,null,null,"81015 - HC CHG URINALYSIS MICROSCOPIC ONLY",null,"78815 - HC CHG PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH",null,null,null,"81002 - URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP"]
[null,"93622 - HC COMPRE ELECTROPHYSIOL XM W/LEFT VENTR PACNG/REC",null,"80366 - HC CHG DRUG SCREENING PREGABALIN","80345 - HC CHG DRUG SCREENING BARBITURATES","80366 - HC CHG DRUG SCREENING PREGABALIN",null,"78816 - HC CHG PET IMAGING FOR CT ATTENUATION WHOLE BODY",null,null,null,null,"81025 - URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS",null,"78816 - HC CHG PET IMAGING FOR CT ATTENUATION WHOLE BODY",null,null,null,"81003 - URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY"]
[null,"93641 - HC EPHYS EVAL PACG CVDFB LDS W/TSTG OF PULSE GEN",null,"80438 - HC CHG TRH STIM PANEL 1 HR","80348 - HC CHG DRUG SCREENING BUPRENORPHINE","80438 - HC CHG TRH STIM PANEL 1 HR",null,"78830 - HC RP LOCLZJ TUM SPECT W/CT 1",null,null,null,null,"81050 - HC CHG VOLUME MEASUREMENT TIMED COLLECTION EACH",null,"78830 - HC RP LOCLZJ TUM SPECT W/CT 1",null,null,null,"81015 - HC CHG URINALYSIS MICROSCOPIC ONLY"]
[null,"93642 - HC EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS",null,"81000 - URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY","80353 - HC CHG DRUG SCREENING COCAINE","81000 - URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY",null,"78831 - HC NM LOCLZJ TUM SPECT 2 AREAS",null,null,null,null,"81161 - HC DMD DUPLICATION/DELETION ANALYSIS","x","78831 - HC NM LOCLZJ TUM SPECT 2 AREAS",null,null,null,"81025 - URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS"]
[null,"93650 - HC ICAR CATHETER ABLATION ATRIOVENTR NODE FUNCTION",null,"81001 - URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY","80354 - DRUG SCREENING FENTANYL","81001 - URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY",null,"78832 - HC RP LOCLZJ TUM SPECT W/CT 2",null,null,null,null,"81178 - HC CHG ATXN1 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES",null,"78832 - HC RP LOCLZJ TUM SPECT W/CT 2",null,null,null,"81050 - HC CHG VOLUME MEASUREMENT TIMED COLLECTION EACH"]
[null,"93653 - HC COMPRE EP EVAL TX SVT",null,"81002 - URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP","80356 - HC CHG DRUG SCREENING HEROIN METABOLITE","81002 - URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP",null,"78835 - HC RP QUAN MEAS SINGLE AREA",null,null,null,null,"81179 - HC CHG ATXN2 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES",null,"78835 - HC RP QUAN MEAS SINGLE AREA",null,null,null,"81161 - HC DMD DUPLICATION/DELETION ANALYSIS"]
[null,"93654 - HC COMPRE EP EVAL TX VT",null,"81003 - URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY","80361 - HC CHG DRUG SCREENING OPIATES 1 OR MORE","81003 - URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY",null,"78999 - HC FUSE CT & NUC MED IMAGES",null,null,null,null,"81180 - HC CHG ATXN3 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES",null,"78999 - HC FUSE CT & NUC MED IMAGES",null,null,null,"81178 - HC CHG ATXN1 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES"]
[null,"93655 - HC ICAR CATHETER ABLATION ARRHYTHMIA ADD ON",null,"81015 - HC CHG URINALYSIS MICROSCOPIC ONLY","80366 - HC CHG DRUG SCREENING PREGABALIN","81015 - HC CHG URINALYSIS MICROSCOPIC ONLY",null,"79005 - HC CHG RP THERAPY ORAL ADMINISTRATION",null,null,null,null,"81206 - HC CHG BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE",null,"79005 - HC CHG RP THERAPY ORAL ADMINISTRATION",null,null,null,"81179 - HC CHG ATXN2 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES"]
[null,"93656 - HC COMPRE EP EVAL ABLTJ ATR FIB",null,"81025 - URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS","80438 - HC CHG TRH STIM PANEL 1 HR","81025 - URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS",null,"79101 - HC CHG RP THERAPY INTRAVENOUS ADMINISTRATION",null,null,null,null,"81207 - HC Q;P190 BCR-ABL 1",null,"79101 - HC CHG RP THERAPY INTRAVENOUS ADMINISTRATION",null,null,null,"81180 - HC CHG ATXN3 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES"]
[null,"93657 - HC ABLATE L/R ATRIAL FIBRIL W/ISOLATED PULM VEIN",null,"81050 - HC CHG VOLUME MEASUREMENT TIMED COLLECTION EACH","81000 - URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY","81050 - HC CHG VOLUME MEASUREMENT TIMED COLLECTION EACH",null,"79200 - HC CHG RP THERAPY INRACAVITARY ADMINISTRATION",null,null,null,null,"81210 - HC CHG BRAF GENE ANALYSIS V600 VARIANT(S)",null,"79200 - HC CHG RP THERAPY INRACAVITARY ADMINISTRATION",null,null,null,"81206 - HC CHG BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE"]
[null,"96377 - HC APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION",null,"81161 - HC DMD DUPLICATION/DELETION ANALYSIS","81001 - URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY","81161 - HC DMD DUPLICATION/DELETION ANALYSIS",null,"79445 - HC CHG RP THERAPY INTRA-ARTERIAL PARTICULATE ADMN",null,null,null,null,"81218 - HC CEBPA GENE ANALYSIS FULL GENE SEQUENC",null,"79445 - HC CHG RP THERAPY INTRA-ARTERIAL PARTICULATE ADMN",null,null,null,"81207 - HC Q;P190 BCR-ABL 1"]
[null,"97597 - DEBRIDEMENT OPEN WOUND 20 SQ CM/<",null,"81178 - HC CHG ATXN1 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","81002 - URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP","81178 - HC CHG ATXN1 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES",null,"80048 - HC CHG BASIC METABOLIC PANEL CALCIUM TOTAL",null,null,null,null,"81220 - HC CHG CFTR GENE ANALYSIS COMMON VARIANTS","x","80048 - HC CHG BASIC METABOLIC PANEL CALCIUM TOTAL",null,null,null,"81210 - HC CHG BRAF GENE ANALYSIS V600 VARIANT(S)"]
[null,"97598 - DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM",null,"81179 - HC CHG ATXN2 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","81003 - URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY","81179 - HC CHG ATXN2 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES",null,"80051 - HC CHG ELECTROLYTE PANEL",null,null,null,null,"81221 - HC CHG CFTR GENE ANALYSIS KNOWN FAMILIAL VARIANTS",null,"80051 - HC CHG ELECTROLYTE PANEL",null,null,null,"81218 - HC CEBPA GENE ANALYSIS FULL GENE SEQUENC"]
[null,"0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",null,"81180 - HC CHG ATXN3 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","81015 - HC CHG URINALYSIS MICROSCOPIC ONLY","81180 - HC CHG ATXN3 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES",null,"80053 - HC CHG COMPREHENSIVE METABOLIC PANEL",null,null,null,null,"81222 - HC GEN CYSTIC FIBROSIS DEL/DUP",null,"80053 - HC CHG COMPREHENSIVE METABOLIC PANEL",null,null,null,"81220 - HC CHG CFTR GENE ANALYSIS COMMON VARIANTS"]
[null,"0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",null,"81206 - HC CHG BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE","81025 - URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS","81206 - HC CHG BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE",null,"80055 - HC CHG OBSTETRIC PANEL",null,null,null,null,"81223 - HC CFTR GENE ANALYSIS FULL GENE SEQUENCE",null,"80055 - HC CHG OBSTETRIC PANEL",null,null,null,"81221 - HC CHG CFTR GENE ANALYSIS KNOWN FAMILIAL VARIANTS"]
[null,"0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",null,"81207 - HC Q;P190 BCR-ABL 1","81050 - HC CHG VOLUME MEASUREMENT TIMED COLLECTION EACH","81207 - HC Q;P190 BCR-ABL 1",null,"80061 - HC CHG LIPID PANEL",null,null,null,null,"81229 - HC CYTOG ALYS CHRML ABNR SNPCGH",null,"80061 - HC CHG LIPID PANEL",null,null,null,"81222 - HC GEN CYSTIC FIBROSIS DEL/DUP"]
[null,"0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",null,"81210 - HC CHG BRAF GENE ANALYSIS V600 VARIANT(S)","81161 - HC DMD DUPLICATION/DELETION ANALYSIS","81210 - HC CHG BRAF GENE ANALYSIS V600 VARIANT(S)",null,"80069 - HC CHG RENAL FUNCTION PANEL",null,null,null,null,"81235 - HC CHG EGFR GENE ANALYSIS COMMON VARIANTS",null,"80069 - HC CHG RENAL FUNCTION PANEL",null,null,null,"81223 - HC CFTR GENE ANALYSIS FULL GENE SEQUENCE"]
[null,"0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",null,"81218 - HC CEBPA GENE ANALYSIS FULL GENE SEQUENC","81178 - HC CHG ATXN1 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","81218 - HC CEBPA GENE ANALYSIS FULL GENE SEQUENC",null,"80074 - HC CHG ACUTE HEPATITIS PANEL",null,null,null,null,"81240 - HC CHG F2 GENE ANALYSIS 20210G >A VARIANT",null,"80074 - HC CHG ACUTE HEPATITIS PANEL",null,null,null,"81229 - HC CYTOG ALYS CHRML ABNR SNPCGH"]
[null,"0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",null,"81220 - HC CHG CFTR GENE ANALYSIS COMMON VARIANTS","81179 - HC CHG ATXN2 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","81220 - HC CHG CFTR GENE ANALYSIS COMMON VARIANTS",null,"80076 - HC CHG HEPATIC FUNCTION PANEL",null,null,null,null,"81241 - HC CHG F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT",null,"80076 - HC CHG HEPATIC FUNCTION PANEL",null,null,null,"81235 - HC CHG EGFR GENE ANALYSIS COMMON VARIANTS"]
[null,"0207T - HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL",null,"81221 - HC CHG CFTR GENE ANALYSIS KNOWN FAMILIAL VARIANTS","81180 - HC CHG ATXN3 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES","81221 - HC CHG CFTR GENE ANALYSIS KNOWN FAMILIAL VARIANTS",null,"80145 - HC DRUG ASSAY ADALIMUMAB",null,null,null,null,"81243 - HC CHG FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES",null,"80145 - HC DRUG ASSAY ADALIMUMAB",null,null,null,"81240 - HC CHG F2 GENE ANALYSIS 20210G >A VARIANT"]
[null,"0234T - HC TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA",null,"81222 - HC GEN CYSTIC FIBROSIS DEL/DUP","81206 - HC CHG BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE","81222 - HC GEN CYSTIC FIBROSIS DEL/DUP",null,"80150 - HC AMIKACIN",null,null,null,null,"81252 - HC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCEHC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCE",null,"80150 - HC AMIKACIN",null,null,null,"81241 - HC CHG F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT"]
[null,"0236T - HC TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA",null,"81223 - HC CFTR GENE ANALYSIS FULL GENE SEQUENCE","81207 - HC Q;P190 BCR-ABL 1","81223 - HC CFTR GENE ANALYSIS FULL GENE SEQUENCE",null,"80156 - HC CHG DRUG ASSAY CARBAMAZEPINE TOTAL",null,null,null,null,"81253 - HC CHG GJB2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS",null,"80156 - HC CHG DRUG ASSAY CARBAMAZEPINE TOTAL",null,null,null,"81243 - HC CHG FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES"]
[null,"0237T - HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL",null,"81229 - HC CYTOG ALYS CHRML ABNR SNPCGH","81210 - HC CHG BRAF GENE ANALYSIS V600 VARIANT(S)","81229 - HC CYTOG ALYS CHRML ABNR SNPCGH",null,"80158 - HC CHG DRUG ASSAY CYCLOSPORINE",null,null,null,null,"81254 - HC CHG GJB6 GENE ANALYSIS COMMON VARIANTS",null,"80158 - HC CHG DRUG ASSAY CYCLOSPORINE",null,null,null,"81252 - HC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCEHC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCE"]
[null,"0241U - HC NFCT DS VIR RESP RNA 4 TRGT",null,"81235 - HC CHG EGFR GENE ANALYSIS COMMON VARIANTS","81218 - HC CEBPA GENE ANALYSIS FULL GENE SEQUENC","81235 - HC CHG EGFR GENE ANALYSIS COMMON VARIANTS",null,"80162 - HC CHG DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL",null,null,null,null,"81256 - HC CHG HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS",null,"80162 - HC CHG DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL",null,null,null,"81253 - HC CHG GJB2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS"]
[null,"0505T - HC EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR",null,"81240 - HC CHG F2 GENE ANALYSIS 20210G >A VARIANT","81220 - HC CHG CFTR GENE ANALYSIS COMMON VARIANTS","81240 - HC CHG F2 GENE ANALYSIS 20210G >A VARIANT",null,"80164 - HC CHG DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL",null,null,null,null,"81257 - HC CHG HBA1/HBA2 ANALYSIS FOR COMMON DELETIONS/VARIANT",null,"80164 - HC CHG DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL",null,null,null,"81254 - HC CHG GJB6 GENE ANALYSIS COMMON VARIANTS"]
[null,"0524T - HC EV CATHETER DIR CHEM ABLTJ INCMPTNT XTR VEIN",null,"81241 - HC CHG F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT","81221 - HC CHG CFTR GENE ANALYSIS KNOWN FAMILIAL VARIANTS","81241 - HC CHG F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT",null,"80168 - HC CHG DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE",null,null,null,null,"81259 - HC HBA1/HBA2 GENE ANALYSIS FULL GENE SEQUENCE",null,"80168 - HC CHG DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE",null,null,null,"81256 - HC CHG HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS"]
[null,"U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",null,"81243 - HC CHG FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES","81222 - HC GEN CYSTIC FIBROSIS DEL/DUP","81243 - HC CHG FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES",null,"80169 - DRUG SCREEN QUANTITATIVE EVEROLIMUS",null,null,null,null,"81261 - IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED; PRO/TECH",null,"80169 - DRUG SCREEN QUANTITATIVE EVEROLIMUS",null,null,null,"81257 - HC CHG HBA1/HBA2 ANALYSIS FOR COMMON DELETIONS/VARIANT"]
[null,null,null,"81252 - HC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCEHC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCE","81223 - HC CFTR GENE ANALYSIS FULL GENE SEQUENCE","81252 - HC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCEHC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCE",null,"80170 - HC CHG DRUG SCREEN QUANTITATIVE GENTAMICIN",null,null,null,null,"81269 - HC HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIENTS",null,"80170 - HC CHG DRUG SCREEN QUANTITATIVE GENTAMICIN",null,null,null,"81259 - HC HBA1/HBA2 GENE ANALYSIS FULL GENE SEQUENCE"]
[null,null,null,"81253 - HC CHG GJB2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS","81229 - HC CYTOG ALYS CHRML ABNR SNPCGH","81253 - HC CHG GJB2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS",null,"80171 - DRUG SCREEN QUANTITATIVE GABAPENTIN",null,null,null,null,"81270 - HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT",null,"80171 - DRUG SCREEN QUANTITATIVE GABAPENTIN",null,null,null,"81261 - IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED; PRO/TECH"]
[null,null,null,"81254 - HC CHG GJB6 GENE ANALYSIS COMMON VARIANTS","81235 - HC CHG EGFR GENE ANALYSIS COMMON VARIANTS","81254 - HC CHG GJB6 GENE ANALYSIS COMMON VARIANTS",null,"80175 - DRUG SCREEN QUANTITATIVE LAMOTRIGINE",null,null,null,null,"81271 - HC HTT GENE ANALYSIS DECTECT ABNORMAL ALLELES",null,"80175 - DRUG SCREEN QUANTITATIVE LAMOTRIGINE",null,null,null,"81269 - HC HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIENTS"]
[null,null,null,"81256 - HC CHG HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS","81240 - HC CHG F2 GENE ANALYSIS 20210G >A VARIANT","81256 - HC CHG HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS",null,"80177 - DRUG SCREEN QUANTITATIVE LEVETIRACETAM",null,null,null,null,"81272 - HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS",null,"80177 - DRUG SCREEN QUANTITATIVE LEVETIRACETAM",null,null,null,"81270 - HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT"]
[null,null,null,"81257 - HC CHG HBA1/HBA2 ANALYSIS FOR COMMON DELETIONS/VARIANT","81241 - HC CHG F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT","81257 - HC CHG HBA1/HBA2 ANALYSIS FOR COMMON DELETIONS/VARIANT",null,"80178 - HC CHG DRUG SCREEN QUANTITATIVE LITHIUM",null,null,null,null,"81274 - HC HTT GENE ANALYSIS CHARACTERIZATION ALLELES",null,"80178 - HC CHG DRUG SCREEN QUANTITATIVE LITHIUM",null,null,null,"81271 - HC HTT GENE ANALYSIS DECTECT ABNORMAL ALLELES"]
[null,null,null,"81259 - HC HBA1/HBA2 GENE ANALYSIS FULL GENE SEQUENCE","81243 - HC CHG FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES","81259 - HC HBA1/HBA2 GENE ANALYSIS FULL GENE SEQUENCE",null,"80184 - HC CHG DRUG SCREEN QUANTITATIVE PHENOBARBITAL",null,null,null,null,"81275 - HC CHG KRAS GENE ANALYSIS VARIANTS IN EXON 2",null,"80184 - HC CHG DRUG SCREEN QUANTITATIVE PHENOBARBITAL",null,null,null,"81272 - HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS"]
[null,null,null,"81261 - IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED; PRO/TECH","81252 - HC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCEHC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCE","81261 - IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED; PRO/TECH",null,"80185 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL",null,null,null,null,"81276 - HC CHG KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)",null,"80185 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL",null,null,null,"81274 - HC HTT GENE ANALYSIS CHARACTERIZATION ALLELES"]
[null,null,null,"81269 - HC HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIENTS","81253 - HC CHG GJB2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS","81269 - HC HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIENTS",null,"80186 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN FREE",null,null,null,null,"81277 - HC CYTOGENOMIC NEO MICRORA ALYS",null,"80186 - HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN FREE",null,null,null,"81275 - HC CHG KRAS GENE ANALYSIS VARIANTS IN EXON 2"]
[null,null,null,"81270 - HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT","81254 - HC CHG GJB6 GENE ANALYSIS COMMON VARIANTS","81270 - HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT",null,"80187 - HC DRUG ASSAY POSACONAZOLE",null,null,null,null,"81288 - MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS",null,"80187 - HC DRUG ASSAY POSACONAZOLE",null,null,null,"81276 - HC CHG KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)"]
[null,null,null,"81271 - HC HTT GENE ANALYSIS DECTECT ABNORMAL ALLELES","81256 - HC CHG HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS","81271 - HC HTT GENE ANALYSIS DECTECT ABNORMAL ALLELES",null,"80195 - HC CHG DRUG SCREEN QUANTITATIVE SIROLIMUS",null,null,null,null,"81291 - HC CHG MTHFR GENE ANALYSIS COMMON VARIANTS",null,"80195 - HC CHG DRUG SCREEN QUANTITATIVE SIROLIMUS",null,null,null,"81277 - HC CYTOGENOMIC NEO MICRORA ALYS"]
[null,null,null,"81272 - HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS","81257 - HC CHG HBA1/HBA2 ANALYSIS FOR COMMON DELETIONS/VARIANT","81272 - HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS",null,"80197 - HC CHG DRUG SCREEN QUANTITATIVE TACROLIMUS",null,null,null,null,"81301 - HC CHG MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF",null,"80197 - HC CHG DRUG SCREEN QUANTITATIVE TACROLIMUS",null,null,null,"81288 - MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS"]
[null,null,null,"81274 - HC HTT GENE ANALYSIS CHARACTERIZATION ALLELES","81259 - HC HBA1/HBA2 GENE ANALYSIS FULL GENE SEQUENCE","81274 - HC HTT GENE ANALYSIS CHARACTERIZATION ALLELES",null,"80198 - HC Q;THEOPHYLLINE",null,null,null,null,"81302 - HC Q;RETT SYN ANLY",null,"80198 - HC Q;THEOPHYLLINE",null,null,null,"81291 - HC CHG MTHFR GENE ANALYSIS COMMON VARIANTS"]
[null,null,null,"81275 - HC CHG KRAS GENE ANALYSIS VARIANTS IN EXON 2","81261 - IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED; PRO/TECH","81275 - HC CHG KRAS GENE ANALYSIS VARIANTS IN EXON 2",null,"80201 - HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE",null,null,null,null,"81304 - HC MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT",null,"80201 - HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE",null,null,null,"81301 - HC CHG MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF"]
[null,null,null,"81276 - HC CHG KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)","81269 - HC HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIENTS","81276 - HC CHG KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)",null,"80202 - HC CHG DRUG SCREEN QUANTITATIVE VANCOMYCIN",null,null,null,null,"81305 - HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT",null,"80202 - HC CHG DRUG SCREEN QUANTITATIVE VANCOMYCIN",null,null,null,"81302 - HC Q;RETT SYN ANLY"]
[null,null,null,"81277 - HC CYTOGENOMIC NEO MICRORA ALYS","81270 - HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT","81277 - HC CYTOGENOMIC NEO MICRORA ALYS",null,"80203 - DRUG SCREEN QUANTITATIVE ZONISAMIDE",null,null,null,null,"81307 - HC PALB2 GENE FULL GENE SEQ",null,"80203 - DRUG SCREEN QUANTITATIVE ZONISAMIDE",null,null,null,"81304 - HC MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT"]
[null,null,null,"81288 - MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS","81271 - HC HTT GENE ANALYSIS DECTECT ABNORMAL ALLELES","81288 - MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS",null,"80230 - HC DRUG ASSAY INFLIXIMAB",null,null,null,null,"81308 - HC PALB2 GENE KNOWN FAMIL VRNT",null,"80230 - HC DRUG ASSAY INFLIXIMAB",null,null,null,"81305 - HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT"]
[null,null,null,"81291 - HC CHG MTHFR GENE ANALYSIS COMMON VARIANTS","81272 - HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS","81291 - HC CHG MTHFR GENE ANALYSIS COMMON VARIANTS",null,"80235 - HC DRUG ASSAY LACOSAMIDE",null,null,null,null,"81309 - HC PIK3CA GENE TRGT SEQ ALYS",null,"80235 - HC DRUG ASSAY LACOSAMIDE",null,null,null,"81307 - HC PALB2 GENE FULL GENE SEQ"]
[null,null,null,"81301 - HC CHG MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF","81274 - HC HTT GENE ANALYSIS CHARACTERIZATION ALLELES","81301 - HC CHG MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF",null,"80280 - HC DRUG ASSAY VEDOLIZUMAB",null,null,null,null,"81311 - HC CHG NRAS GENE ANALYSIS VARIANTS IN EXON 2&3",null,"80280 - HC DRUG ASSAY VEDOLIZUMAB",null,null,null,"81308 - HC PALB2 GENE KNOWN FAMIL VRNT"]
[null,null,null,"81302 - HC Q;RETT SYN ANLY","81275 - HC CHG KRAS GENE ANALYSIS VARIANTS IN EXON 2","81302 - HC Q;RETT SYN ANLY",null,"80285 - HC DRUG ASSAY VORICONAZOLE",null,null,null,null,"81315 - HC PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT",null,"80285 - HC DRUG ASSAY VORICONAZOLE",null,null,null,"81309 - HC PIK3CA GENE TRGT SEQ ALYS"]
[null,null,null,"81304 - HC MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT","81276 - HC CHG KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)","81304 - HC MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT",null,"80299 - HC INFLIXIMAB DRUG CONC. AND ANTI-INFLIXIMAB AB",null,null,null,null,"81329 - HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS",null,"80299 - HC INFLIXIMAB DRUG CONC. AND ANTI-INFLIXIMAB AB",null,null,null,"81311 - HC CHG NRAS GENE ANALYSIS VARIANTS IN EXON 2&3"]
[null,null,null,"81305 - HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT","81277 - HC CYTOGENOMIC NEO MICRORA ALYS","81305 - HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT",null,"80306 - HC DRUG TEST PRSMV INSTRMNT",null,null,null,null,"81331 - HC PRADER-WILLI/ANGELMAN",null,"80306 - HC DRUG TEST PRSMV INSTRMNT",null,null,null,"81315 - HC PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT"]
[null,null,null,"81307 - HC PALB2 GENE FULL GENE SEQ","81288 - MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS","81307 - HC PALB2 GENE FULL GENE SEQ",null,"80307 - HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS",null,null,null,null,"81342 - TRG@ GENE REARRANGEMENT ANALYSIS; PRO/TECH",null,"80307 - HC CHG DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS",null,null,null,"81329 - HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS"]
[null,null,null,"81308 - HC PALB2 GENE KNOWN FAMIL VRNT","81291 - HC CHG MTHFR GENE ANALYSIS COMMON VARIANTS","81308 - HC PALB2 GENE KNOWN FAMIL VRNT",null,"80320 - DRUG SCREEN QUANTITATIVE ALCOHOLS",null,null,null,null,"81350 - HC CHG UGT1A1 GENE ANALYSIS COMMON VARIANTS",null,"80320 - DRUG SCREEN QUANTITATIVE ALCOHOLS",null,null,null,"81331 - HC PRADER-WILLI/ANGELMAN"]
[null,null,null,"81309 - HC PIK3CA GENE TRGT SEQ ALYS","81301 - HC CHG MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF","81309 - HC PIK3CA GENE TRGT SEQ ALYS",null,"80329 - DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2",null,null,null,null,"81363 - HC HBB DUPLICATION/DELETION VARIANTS",null,"80329 - DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2",null,null,null,"81342 - TRG@ GENE REARRANGEMENT ANALYSIS; PRO/TECH"]
[null,null,null,"81311 - HC CHG NRAS GENE ANALYSIS VARIANTS IN EXON 2&3","81302 - HC Q;RETT SYN ANLY","81311 - HC CHG NRAS GENE ANALYSIS VARIANTS IN EXON 2&3",null,"80339 - HC CHG ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 1-3",null,null,null,null,"81364 - HC HBB FULL GENE SEQUENCE",null,"80339 - HC CHG ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 1-3",null,null,null,"81350 - HC CHG UGT1A1 GENE ANALYSIS COMMON VARIANTS"]
[null,null,null,"81315 - HC PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT","81304 - HC MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT","81315 - HC PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT",null,"80345 - HC CHG DRUG SCREENING BARBITURATES",null,null,null,null,"81401 - HC CHG, MOLECULAR PATHOLOGY PROCEDURE LEVEL 2",null,"80345 - HC CHG DRUG SCREENING BARBITURATES",null,null,null,"81363 - HC HBB DUPLICATION/DELETION VARIANTS"]
[null,null,null,"81329 - HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS","81305 - HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT","81329 - HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS",null,"80348 - HC CHG DRUG SCREENING BUPRENORPHINE",null,null,null,null,"81402 - HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 3",null,"80348 - HC CHG DRUG SCREENING BUPRENORPHINE",null,null,null,"81364 - HC HBB FULL GENE SEQUENCE"]
[null,null,null,"81331 - HC PRADER-WILLI/ANGELMAN","81307 - HC PALB2 GENE FULL GENE SEQ","81331 - HC PRADER-WILLI/ANGELMAN",null,"80353 - HC CHG DRUG SCREENING COCAINE",null,null,null,null,"81403 - SEQ & EXON 13 SEQ, IF PERFORMED KRAS (EG, CARCINOMA), GENE ANALYSIS, PRO/TECH",null,"80353 - HC CHG DRUG SCREENING COCAINE",null,null,null,"81401 - HC CHG, MOLECULAR PATHOLOGY PROCEDURE LEVEL 2"]
[null,null,null,"81342 - TRG@ GENE REARRANGEMENT ANALYSIS; PRO/TECH","81308 - HC PALB2 GENE KNOWN FAMIL VRNT","81342 - TRG@ GENE REARRANGEMENT ANALYSIS; PRO/TECH",null,"80354 - DRUG SCREENING FENTANYL",null,null,null,null,"81404 - VHL (EG, VON HIPPEL-LINDAUFAMILIAL CANCER SYNDROME, FULL GENE SEQ VWF PRO/TECH",null,"80354 - DRUG SCREENING FENTANYL",null,null,null,"81402 - HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 3"]
[null,null,null,"81350 - HC CHG UGT1A1 GENE ANALYSIS COMMON VARIANTS","81309 - HC PIK3CA GENE TRGT SEQ ALYS","81350 - HC CHG UGT1A1 GENE ANALYSIS COMMON VARIANTS",null,"80356 - HC CHG DRUG SCREENING HEROIN METABOLITE",null,null,null,null,"81405 - HC MOPATH PROCEDURE LEVEL 6",null,"80356 - HC CHG DRUG SCREENING HEROIN METABOLITE",null,null,null,"81403 - SEQ & EXON 13 SEQ, IF PERFORMED KRAS (EG, CARCINOMA), GENE ANALYSIS, PRO/TECH"]
[null,null,null,"81363 - HC HBB DUPLICATION/DELETION VARIANTS","81311 - HC CHG NRAS GENE ANALYSIS VARIANTS IN EXON 2&3","81363 - HC HBB DUPLICATION/DELETION VARIANTS",null,"80361 - HC CHG DRUG SCREENING OPIATES 1 OR MORE",null,null,null,null,"81406 - HC CHG MOLECULAR PATHOLOGY PROCEDURE LEVEL 7",null,"80361 - HC CHG DRUG SCREENING OPIATES 1 OR MORE",null,null,null,"81404 - VHL (EG, VON HIPPEL-LINDAUFAMILIAL CANCER SYNDROME, FULL GENE SEQ VWF PRO/TECH"]
[null,null,null,"81364 - HC HBB FULL GENE SEQUENCE","81315 - HC PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT","81364 - HC HBB FULL GENE SEQUENCE",null,"80366 - HC CHG DRUG SCREENING PREGABALIN",null,null,null,null,"81430 - HC CHG HEARING LOSS GENOMIC SEQUENCE ANALYSIS 60 GENES",null,"80366 - HC CHG DRUG SCREENING PREGABALIN",null,null,null,"81405 - HC MOPATH PROCEDURE LEVEL 6"]
[null,null,null,"81401 - HC CHG, MOLECULAR PATHOLOGY PROCEDURE LEVEL 2","81329 - HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS","81401 - HC CHG, MOLECULAR PATHOLOGY PROCEDURE LEVEL 2",null,"80438 - HC CHG TRH STIM PANEL 1 HR",null,null,null,null,"81431 - HC CHG HEARING LOSS DUP/DEL ANALYSIS",null,"80438 - HC CHG TRH STIM PANEL 1 HR",null,null,null,"81406 - HC CHG MOLECULAR PATHOLOGY PROCEDURE LEVEL 7"]
[null,null,null,"81402 - HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 3","81331 - HC PRADER-WILLI/ANGELMAN","81402 - HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 3",null,"81000 - URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY",null,null,null,null,"81450 - HC CHG GENOMIC SEQ ANALYS DNA&RNA ANALYS 5-50 GENE",null,"81000 - URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY",null,null,null,"81430 - HC CHG HEARING LOSS GENOMIC SEQUENCE ANALYSIS 60 GENES"]
[null,null,null,"81403 - SEQ & EXON 13 SEQ, IF PERFORMED KRAS (EG, CARCINOMA), GENE ANALYSIS, PRO/TECH","81342 - TRG@ GENE REARRANGEMENT ANALYSIS; PRO/TECH","81403 - SEQ & EXON 13 SEQ, IF PERFORMED KRAS (EG, CARCINOMA), GENE ANALYSIS, PRO/TECH",null,"81001 - URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY",null,null,null,null,"81522 - HC ONC BREAST MRNA 12 GENES",null,"81001 - URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY",null,null,null,"81431 - HC CHG HEARING LOSS DUP/DEL ANALYSIS"]
[null,null,null,"81404 - VHL (EG, VON HIPPEL-LINDAUFAMILIAL CANCER SYNDROME, FULL GENE SEQ VWF PRO/TECH","81350 - HC CHG UGT1A1 GENE ANALYSIS COMMON VARIANTS","81404 - VHL (EG, VON HIPPEL-LINDAUFAMILIAL CANCER SYNDROME, FULL GENE SEQ VWF PRO/TECH",null,"81002 - URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP",null,null,null,null,"81542 - HC ONC PROSTATE MRNA 22 CNT GEN",null,"81002 - URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP",null,null,null,"81450 - HC CHG GENOMIC SEQ ANALYS DNA&RNA ANALYS 5-50 GENE"]
[null,null,null,"81405 - HC MOPATH PROCEDURE LEVEL 6","81363 - HC HBB DUPLICATION/DELETION VARIANTS","81405 - HC MOPATH PROCEDURE LEVEL 6",null,"81003 - URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY",null,null,null,null,"81596 - HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR",null,"81003 - URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY",null,null,null,"81522 - HC ONC BREAST MRNA 12 GENES"]
[null,null,null,"81406 - HC CHG MOLECULAR PATHOLOGY PROCEDURE LEVEL 7","81364 - HC HBB FULL GENE SEQUENCE","81406 - HC CHG MOLECULAR PATHOLOGY PROCEDURE LEVEL 7",null,"81015 - HC CHG URINALYSIS MICROSCOPIC ONLY",null,null,null,null,"82009 - HC CHG KETONE BODIES SERUM QUALITATIVE",null,"81015 - HC CHG URINALYSIS MICROSCOPIC ONLY",null,null,null,"81542 - HC ONC PROSTATE MRNA 22 CNT GEN"]
[null,null,null,"81430 - HC CHG HEARING LOSS GENOMIC SEQUENCE ANALYSIS 60 GENES","81401 - HC CHG, MOLECULAR PATHOLOGY PROCEDURE LEVEL 2","81430 - HC CHG HEARING LOSS GENOMIC SEQUENCE ANALYSIS 60 GENES",null,"81025 - URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS",null,null,null,null,"82010 - HC CHG KETONE BODIES SERUM QUANTITATIVE",null,"81025 - URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS",null,null,null,"81596 - HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR"]
[null,null,null,"81431 - HC CHG HEARING LOSS DUP/DEL ANALYSIS","81402 - HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 3","81431 - HC CHG HEARING LOSS DUP/DEL ANALYSIS",null,"81050 - HC CHG VOLUME MEASUREMENT TIMED COLLECTION EACH",null,null,null,null,"82017 - HC CHG ACYLCARNITINES QUANTIATIVE EACH SPECIMEN",null,"81050 - HC CHG VOLUME MEASUREMENT TIMED COLLECTION EACH",null,null,null,"82009 - HC CHG KETONE BODIES SERUM QUALITATIVE"]
[null,null,null,"81450 - HC CHG GENOMIC SEQ ANALYS DNA&RNA ANALYS 5-50 GENE","81403 - SEQ & EXON 13 SEQ, IF PERFORMED KRAS (EG, CARCINOMA), GENE ANALYSIS, PRO/TECH","81450 - HC CHG GENOMIC SEQ ANALYS DNA&RNA ANALYS 5-50 GENE",null,"81161 - HC DMD DUPLICATION/DELETION ANALYSIS",null,null,null,null,"82024 - HC CHG ADRENOCORTICOTROPIC HORMONE ACTH",null,"81161 - HC DMD DUPLICATION/DELETION ANALYSIS",null,null,null,"82010 - HC CHG KETONE BODIES SERUM QUANTITATIVE"]
[null,null,null,"81479 - HC CHG UNLISTED MOLELCULAR PATHOLOGY PROCEDURE","81404 - VHL (EG, VON HIPPEL-LINDAUFAMILIAL CANCER SYNDROME, FULL GENE SEQ VWF PRO/TECH","81479 - HC CHG UNLISTED MOLELCULAR PATHOLOGY PROCEDURE",null,"81178 - HC CHG ATXN1 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES",null,null,null,null,"82040 - HC CHG ALBUMIN SERUM PLASMA/WHOLE BLOOD",null,"81178 - HC CHG ATXN1 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES",null,null,null,"82017 - HC CHG ACYLCARNITINES QUANTIATIVE EACH SPECIMEN"]
[null,null,null,"81522 - HC ONC BREAST MRNA 12 GENES","81405 - HC MOPATH PROCEDURE LEVEL 6","81522 - HC ONC BREAST MRNA 12 GENES",null,"81179 - HC CHG ATXN2 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES",null,null,null,null,"82042 - HC CHG ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN",null,"81179 - HC CHG ATXN2 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES",null,null,null,"82024 - HC CHG ADRENOCORTICOTROPIC HORMONE ACTH"]
[null,null,null,"81596 - HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR","81406 - HC CHG MOLECULAR PATHOLOGY PROCEDURE LEVEL 7","81596 - HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR",null,"81180 - HC CHG ATXN3 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES",null,null,null,null,"82043 - HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE",null,"81180 - HC CHG ATXN3 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES",null,null,null,"82040 - HC CHG ALBUMIN SERUM PLASMA/WHOLE BLOOD"]
[null,null,null,"82009 - HC CHG KETONE BODIES SERUM QUALITATIVE","81430 - HC CHG HEARING LOSS GENOMIC SEQUENCE ANALYSIS 60 GENES","82009 - HC CHG KETONE BODIES SERUM QUALITATIVE",null,"81206 - HC CHG BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE",null,null,null,null,"82075 - HC CHG ASSAY OF ALCOHOL BREATH",null,"81206 - HC CHG BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE",null,null,null,"82042 - HC CHG ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN"]
[null,null,null,"82010 - HC CHG KETONE BODIES SERUM QUANTITATIVE","81431 - HC CHG HEARING LOSS DUP/DEL ANALYSIS","82010 - HC CHG KETONE BODIES SERUM QUANTITATIVE",null,"81207 - HC Q;P190 BCR-ABL 1",null,null,null,null,"82085 - HC CHG ASSAY OF ALDOLASE",null,"81207 - HC Q;P190 BCR-ABL 1",null,null,null,"82043 - HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE"]
[null,null,null,"82017 - HC CHG ACYLCARNITINES QUANTIATIVE EACH SPECIMEN","81450 - HC CHG GENOMIC SEQ ANALYS DNA&RNA ANALYS 5-50 GENE","82017 - HC CHG ACYLCARNITINES QUANTIATIVE EACH SPECIMEN",null,"81210 - HC CHG BRAF GENE ANALYSIS V600 VARIANT(S)",null,null,null,null,"82088 - HC CHG ASSAY OF ALDOSTERONE",null,"81210 - HC CHG BRAF GENE ANALYSIS V600 VARIANT(S)",null,null,null,"82075 - HC CHG ASSAY OF ALCOHOL BREATH"]
[null,null,null,"82024 - HC CHG ADRENOCORTICOTROPIC HORMONE ACTH","81479 - HC CHG UNLISTED MOLELCULAR PATHOLOGY PROCEDURE","82024 - HC CHG ADRENOCORTICOTROPIC HORMONE ACTH",null,"81218 - HC CEBPA GENE ANALYSIS FULL GENE SEQUENC",null,null,null,null,"82103 - HC CHG ALPHA-1-ANTITRYPSIN TOTAL",null,"81218 - HC CEBPA GENE ANALYSIS FULL GENE SEQUENC",null,null,null,"82085 - HC CHG ASSAY OF ALDOLASE"]
[null,null,null,"82040 - HC CHG ALBUMIN SERUM PLASMA/WHOLE BLOOD","81522 - HC ONC BREAST MRNA 12 GENES","82040 - HC CHG ALBUMIN SERUM PLASMA/WHOLE BLOOD",null,"81235 - HC CHG EGFR GENE ANALYSIS COMMON VARIANTS",null,null,null,null,"82104 - HC CHG ALPHA-1-ANTITRYPSIN PHENOTYPE",null,"81220 - HC CHG CFTR GENE ANALYSIS COMMON VARIANTS",null,null,null,"82088 - HC CHG ASSAY OF ALDOSTERONE"]
[null,null,null,"82042 - HC CHG ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN","81542 - HC ONC PROSTATE MRNA 22 CNT GEN","82042 - HC CHG ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN",null,"81240 - HC CHG F2 GENE ANALYSIS 20210G >A VARIANT",null,null,null,null,"82105 - HC CHG ALPHA-FETOPROTEIN SERUM",null,"81221 - HC CHG CFTR GENE ANALYSIS KNOWN FAMILIAL VARIANTS",null,null,null,"82103 - HC CHG ALPHA-1-ANTITRYPSIN TOTAL"]
[null,null,null,"82043 - HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE","81596 - HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR","82043 - HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE",null,"81241 - HC CHG F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT",null,null,null,null,"82139 - HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE",null,"81222 - HC GEN CYSTIC FIBROSIS DEL/DUP",null,null,null,"82104 - HC CHG ALPHA-1-ANTITRYPSIN PHENOTYPE"]
[null,null,null,"82075 - HC CHG ASSAY OF ALCOHOL BREATH","82009 - HC CHG KETONE BODIES SERUM QUALITATIVE","82075 - HC CHG ASSAY OF ALCOHOL BREATH",null,"81256 - HC CHG HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS",null,null,null,null,"82140 - HC CHG ASSAY OF AMMONIA",null,"81223 - HC CFTR GENE ANALYSIS FULL GENE SEQUENCE",null,null,null,"82105 - HC CHG ALPHA-FETOPROTEIN SERUM"]
[null,null,null,"82085 - HC CHG ASSAY OF ALDOLASE","82010 - HC CHG KETONE BODIES SERUM QUANTITATIVE","82085 - HC CHG ASSAY OF ALDOLASE",null,"81259 - HC HBA1/HBA2 GENE ANALYSIS FULL GENE SEQUENCE",null,null,null,null,"82150 - HC CHG ASSAY OF AMYLASE",null,"81229 - HC CYTOG ALYS CHRML ABNR SNPCGH",null,null,null,"82139 - HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE"]
[null,null,null,"82088 - HC CHG ASSAY OF ALDOSTERONE","82017 - HC CHG ACYLCARNITINES QUANTIATIVE EACH SPECIMEN","82088 - HC CHG ASSAY OF ALDOSTERONE",null,"81261 - IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED; PRO/TECH",null,null,null,null,"82157 - HC CHG ANDROSTENEDIONE",null,"81235 - HC CHG EGFR GENE ANALYSIS COMMON VARIANTS",null,null,null,"82140 - HC CHG ASSAY OF AMMONIA"]
[null,null,null,"82103 - HC CHG ALPHA-1-ANTITRYPSIN TOTAL","82024 - HC CHG ADRENOCORTICOTROPIC HORMONE ACTH","82103 - HC CHG ALPHA-1-ANTITRYPSIN TOTAL",null,"81269 - HC HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIENTS",null,null,null,null,"82164 - HC CHG ANGIOTENSIN I-CONVERTING ENZYME",null,"81240 - HC CHG F2 GENE ANALYSIS 20210G >A VARIANT",null,null,null,"82150 - HC CHG ASSAY OF AMYLASE"]
[null,null,null,"82104 - HC CHG ALPHA-1-ANTITRYPSIN PHENOTYPE","82040 - HC CHG ALBUMIN SERUM PLASMA/WHOLE BLOOD","82104 - HC CHG ALPHA-1-ANTITRYPSIN PHENOTYPE",null,"81270 - HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT",null,null,null,null,"82172 - HC CHG APOLIPOPROTEIN EACH",null,"81241 - HC CHG F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT",null,null,null,"82157 - HC CHG ANDROSTENEDIONE"]
[null,null,null,"82105 - HC CHG ALPHA-FETOPROTEIN SERUM","82042 - HC CHG ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN","82105 - HC CHG ALPHA-FETOPROTEIN SERUM",null,"81271 - HC HTT GENE ANALYSIS DECTECT ABNORMAL ALLELES",null,null,null,null,"82175 - HC CHG ASSAY OF ARSENIC",null,"81243 - HC CHG FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES",null,null,null,"82164 - HC CHG ANGIOTENSIN I-CONVERTING ENZYME"]
[null,null,null,"82139 - HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE","82043 - HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE","82139 - HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE",null,"81272 - HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS",null,null,null,null,"82180 - HC CHG ASSAY OF ASCORBIC ACID BLOOD",null,"81252 - HC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCEHC CHG GJB2 GENE ANALYSIS FULL GENE SEQUENCE",null,null,null,"82172 - HC CHG APOLIPOPROTEIN EACH"]
[null,null,null,"82140 - HC CHG ASSAY OF AMMONIA","82075 - HC CHG ASSAY OF ALCOHOL BREATH","82140 - HC CHG ASSAY OF AMMONIA",null,"81274 - HC HTT GENE ANALYSIS CHARACTERIZATION ALLELES",null,null,null,null,"82232 - HC CHG BETA-2 MICROGLOBULIN",null,"81253 - HC CHG GJB2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS",null,null,null,"82175 - HC CHG ASSAY OF ARSENIC"]
[null,null,null,"82150 - HC CHG ASSAY OF AMYLASE","82085 - HC CHG ASSAY OF ALDOLASE","82150 - HC CHG ASSAY OF AMYLASE",null,"81275 - HC CHG KRAS GENE ANALYSIS VARIANTS IN EXON 2",null,null,null,null,"82247 - HC CHG BILIRUBIN TOTAL",null,"81254 - HC CHG GJB6 GENE ANALYSIS COMMON VARIANTS",null,null,null,"82180 - HC CHG ASSAY OF ASCORBIC ACID BLOOD"]
[null,null,null,"82157 - HC CHG ANDROSTENEDIONE","82088 - HC CHG ASSAY OF ALDOSTERONE","82157 - HC CHG ANDROSTENEDIONE",null,"81276 - HC CHG KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)",null,null,null,null,"82248 - HC CHG BILIRUBIN DIRECT",null,"81256 - HC CHG HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS",null,null,null,"82232 - HC CHG BETA-2 MICROGLOBULIN"]
[null,null,null,"82164 - HC CHG ANGIOTENSIN I-CONVERTING ENZYME","82103 - HC CHG ALPHA-1-ANTITRYPSIN TOTAL","82164 - HC CHG ANGIOTENSIN I-CONVERTING ENZYME",null,"81277 - HC CYTOGENOMIC NEO MICRORA ALYS",null,null,null,null,"82270 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER",null,"81257 - HC CHG HBA1/HBA2 ANALYSIS FOR COMMON DELETIONS/VARIANT",null,null,null,"82247 - HC CHG BILIRUBIN TOTAL"]
[null,null,null,"82172 - HC CHG APOLIPOPROTEIN EACH","82104 - HC CHG ALPHA-1-ANTITRYPSIN PHENOTYPE","82172 - HC CHG APOLIPOPROTEIN EACH",null,"81288 - MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS",null,null,null,null,"82271 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES",null,"81259 - HC HBA1/HBA2 GENE ANALYSIS FULL GENE SEQUENCE",null,null,null,"82248 - HC CHG BILIRUBIN DIRECT"]
[null,null,null,"82175 - HC CHG ASSAY OF ARSENIC","82105 - HC CHG ALPHA-FETOPROTEIN SERUM","82175 - HC CHG ASSAY OF ARSENIC",null,"81291 - HC CHG MTHFR GENE ANALYSIS COMMON VARIANTS",null,null,null,null,"82274 - HC CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3",null,"81261 - IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED; PRO/TECH",null,null,null,"82270 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER"]
[null,null,null,"82180 - HC CHG ASSAY OF ASCORBIC ACID BLOOD","82139 - HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE","82180 - HC CHG ASSAY OF ASCORBIC ACID BLOOD",null,"81301 - HC CHG MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF",null,null,null,null,"82306 - HC CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED",null,"81269 - HC HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIENTS",null,null,null,"82271 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES"]
[null,null,null,"82232 - HC CHG BETA-2 MICROGLOBULIN","82140 - HC CHG ASSAY OF AMMONIA","82232 - HC CHG BETA-2 MICROGLOBULIN",null,"81305 - HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT",null,null,null,null,"82308 - HC CHG CALCITONIN",null,"81270 - HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT",null,null,null,"82274 - HC CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3"]
[null,null,null,"82247 - HC CHG BILIRUBIN TOTAL","82150 - HC CHG ASSAY OF AMYLASE","82247 - HC CHG BILIRUBIN TOTAL",null,"81307 - HC PALB2 GENE FULL GENE SEQ",null,null,null,null,"82310 - HC CHG CALCIUM TOTAL",null,"81271 - HC HTT GENE ANALYSIS DECTECT ABNORMAL ALLELES",null,null,null,"82306 - HC CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED"]
[null,null,null,"82248 - HC CHG BILIRUBIN DIRECT","82157 - HC CHG ANDROSTENEDIONE","82248 - HC CHG BILIRUBIN DIRECT",null,"81308 - HC PALB2 GENE KNOWN FAMIL VRNT",null,null,null,null,"82330 - HC CHG CALCIUM IONIZED",null,"81272 - HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS",null,null,null,"82308 - HC CHG CALCITONIN"]
[null,null,null,"82270 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER","82164 - HC CHG ANGIOTENSIN I-CONVERTING ENZYME","82270 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER",null,"81309 - HC PIK3CA GENE TRGT SEQ ALYS",null,null,null,null,"82340 - HC Q;KID STONE, UR CALCIUM",null,"81274 - HC HTT GENE ANALYSIS CHARACTERIZATION ALLELES",null,null,null,"82310 - HC CHG CALCIUM TOTAL"]
[null,null,null,"82271 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES","82172 - HC CHG APOLIPOPROTEIN EACH","82271 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES",null,"81311 - HC CHG NRAS GENE ANALYSIS VARIANTS IN EXON 2&3",null,null,null,null,"82365 - HC CHG CALCULUS INFRARED SPECTROSCOPY",null,"81275 - HC CHG KRAS GENE ANALYSIS VARIANTS IN EXON 2",null,null,null,"82330 - HC CHG CALCIUM IONIZED"]
[null,null,null,"82274 - HC CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3","82175 - HC CHG ASSAY OF ARSENIC","82274 - HC CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3",null,"81315 - HC PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT",null,null,null,null,"82374 - HC CHG CARBON DIOXIDE BICARBONATE",null,"81276 - HC CHG KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)",null,null,null,"82340 - HC Q;KID STONE, UR CALCIUM"]
[null,null,null,"82306 - HC CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED","82180 - HC CHG ASSAY OF ASCORBIC ACID BLOOD","82306 - HC CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED",null,"81329 - HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS",null,null,null,null,"82375 - HC CHG CARBOXYHEMOGLOBIN QUANTITATIVE",null,"81277 - HC CYTOGENOMIC NEO MICRORA ALYS",null,null,null,"82365 - HC CHG CALCULUS INFRARED SPECTROSCOPY"]
[null,null,null,"82308 - HC CHG CALCITONIN","82232 - HC CHG BETA-2 MICROGLOBULIN","82308 - HC CHG CALCITONIN",null,"81342 - TRG@ GENE REARRANGEMENT ANALYSIS; PRO/TECH",null,null,null,null,"82378 - HC CHG CARCINOEMBRYONIC ANTIGEN CEA",null,"81288 - MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS",null,null,null,"82374 - HC CHG CARBON DIOXIDE BICARBONATE"]
[null,null,null,"82310 - HC CHG CALCIUM TOTAL","82247 - HC CHG BILIRUBIN TOTAL","82310 - HC CHG CALCIUM TOTAL",null,"81363 - HC HBB DUPLICATION/DELETION VARIANTS",null,null,null,null,"82379 - HC CRL;CARNITINE",null,"81291 - HC CHG MTHFR GENE ANALYSIS COMMON VARIANTS",null,null,null,"82375 - HC CHG CARBOXYHEMOGLOBIN QUANTITATIVE"]
[null,null,null,"82330 - HC CHG CALCIUM IONIZED","82248 - HC CHG BILIRUBIN DIRECT","82330 - HC CHG CALCIUM IONIZED",null,"81364 - HC HBB FULL GENE SEQUENCE",null,null,null,null,"82384 - HC CHG CATECHOLAMINES FRACTIONATED",null,"81301 - HC CHG MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF",null,null,null,"82378 - HC CHG CARCINOEMBRYONIC ANTIGEN CEA"]
[null,null,null,"82340 - HC Q;KID STONE, UR CALCIUM","82270 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER","82340 - HC Q;KID STONE, UR CALCIUM",null,"81430 - HC CHG HEARING LOSS GENOMIC SEQUENCE ANALYSIS 60 GENES",null,null,null,null,"82390 - HC CHG CERULOPLASMIN",null,"81302 - HC Q;RETT SYN ANLY",null,null,null,"82379 - HC CRL;CARNITINE"]
[null,null,null,"82365 - HC CHG CALCULUS INFRARED SPECTROSCOPY","82271 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES","82365 - HC CHG CALCULUS INFRARED SPECTROSCOPY",null,"81431 - HC CHG HEARING LOSS DUP/DEL ANALYSIS",null,null,null,null,"82397 - HC CHEMILUMINESCENT ASSAY",null,"81304 - HC MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT",null,null,null,"82384 - HC CHG CATECHOLAMINES FRACTIONATED"]
[null,null,null,"82374 - HC CHG CARBON DIOXIDE BICARBONATE","82274 - HC CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3","82374 - HC CHG CARBON DIOXIDE BICARBONATE",null,"81450 - HC CHG GENOMIC SEQ ANALYS DNA&RNA ANALYS 5-50 GENE",null,null,null,null,"82435 - HC CHG CHLORIDE BLD",null,"81305 - HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT",null,null,null,"82390 - HC CHG CERULOPLASMIN"]
[null,null,null,"82375 - HC CHG CARBOXYHEMOGLOBIN QUANTITATIVE","82306 - HC CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED","82375 - HC CHG CARBOXYHEMOGLOBIN QUANTITATIVE",null,"81522 - HC ONC BREAST MRNA 12 GENES",null,null,null,null,"82436 - HC CHG CHLORIDE URINE",null,"81307 - HC PALB2 GENE FULL GENE SEQ",null,null,null,"82397 - HC CHEMILUMINESCENT ASSAY"]
[null,null,null,"82378 - HC CHG CARCINOEMBRYONIC ANTIGEN CEA","82308 - HC CHG CALCITONIN","82378 - HC CHG CARCINOEMBRYONIC ANTIGEN CEA",null,"81596 - HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR",null,null,null,null,"82438 - HC CHG CHLORIDE OTHER SOURCE",null,"81308 - HC PALB2 GENE KNOWN FAMIL VRNT",null,null,null,"82435 - HC CHG CHLORIDE BLD"]
[null,null,null,"82379 - HC CRL;CARNITINE","82310 - HC CHG CALCIUM TOTAL","82379 - HC CRL;CARNITINE",null,"82009 - HC CHG KETONE BODIES SERUM QUALITATIVE",null,null,null,null,"82465 - CHOLESTEROL SERUM/WHOLE BLOOD TOTAL",null,"81309 - HC PIK3CA GENE TRGT SEQ ALYS",null,null,null,"82436 - HC CHG CHLORIDE URINE"]
[null,null,null,"82384 - HC CHG CATECHOLAMINES FRACTIONATED","82330 - HC CHG CALCIUM IONIZED","82384 - HC CHG CATECHOLAMINES FRACTIONATED",null,"82010 - HC CHG KETONE BODIES SERUM QUANTITATIVE",null,null,null,null,"82495 - HC CHG ASSAY OF CHROMIUM",null,"81311 - HC CHG NRAS GENE ANALYSIS VARIANTS IN EXON 2&3",null,null,null,"82438 - HC CHG CHLORIDE OTHER SOURCE"]
[null,null,null,"82390 - HC CHG CERULOPLASMIN","82340 - HC Q;KID STONE, UR CALCIUM","82390 - HC CHG CERULOPLASMIN",null,"82017 - HC CHG ACYLCARNITINES QUANTIATIVE EACH SPECIMEN",null,null,null,null,"82507 - HC CHG ASSAY OF CITRATE",null,"81315 - HC PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT",null,null,null,"82465 - CHOLESTEROL SERUM/WHOLE BLOOD TOTAL"]
[null,null,null,"82397 - HC CHEMILUMINESCENT ASSAY","82365 - HC CHG CALCULUS INFRARED SPECTROSCOPY","82397 - HC CHEMILUMINESCENT ASSAY",null,"82024 - HC CHG ADRENOCORTICOTROPIC HORMONE ACTH",null,null,null,null,"82523 - HC CHG COLLAGEN CROSS LINKS ANY METHOD",null,"81329 - HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS",null,null,null,"82495 - HC CHG ASSAY OF CHROMIUM"]
[null,null,null,"82435 - HC CHG CHLORIDE BLD","82374 - HC CHG CARBON DIOXIDE BICARBONATE","82435 - HC CHG CHLORIDE BLD",null,"82040 - HC CHG ALBUMIN SERUM PLASMA/WHOLE BLOOD",null,null,null,null,"82525 - HC CHG ASSAY OF COPPER",null,"81331 - HC PRADER-WILLI/ANGELMAN",null,null,null,"82507 - HC CHG ASSAY OF CITRATE"]
[null,null,null,"82436 - HC CHG CHLORIDE URINE","82375 - HC CHG CARBOXYHEMOGLOBIN QUANTITATIVE","82436 - HC CHG CHLORIDE URINE",null,"82042 - HC CHG ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN",null,null,null,null,"82530 - HC CHG CORTISOL FREE",null,"81342 - TRG@ GENE REARRANGEMENT ANALYSIS; PRO/TECH",null,null,null,"82523 - HC CHG COLLAGEN CROSS LINKS ANY METHOD"]
[null,null,null,"82438 - HC CHG CHLORIDE OTHER SOURCE","82378 - HC CHG CARCINOEMBRYONIC ANTIGEN CEA","82438 - HC CHG CHLORIDE OTHER SOURCE",null,"82043 - HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE",null,null,null,null,"82533 - HC CHG CORTISOL TOTAL",null,"81350 - HC CHG UGT1A1 GENE ANALYSIS COMMON VARIANTS",null,null,null,"82525 - HC CHG ASSAY OF COPPER"]
[null,null,null,"82465 - CHOLESTEROL SERUM/WHOLE BLOOD TOTAL","82379 - HC CRL;CARNITINE","82465 - CHOLESTEROL SERUM/WHOLE BLOOD TOTAL",null,"82075 - HC CHG ASSAY OF ALCOHOL BREATH",null,null,null,null,"82540 - HC CHG ASSAY OF CREATINE",null,"81363 - HC HBB DUPLICATION/DELETION VARIANTS",null,null,null,"82530 - HC CHG CORTISOL FREE"]
[null,null,null,"82495 - HC CHG ASSAY OF CHROMIUM","82384 - HC CHG CATECHOLAMINES FRACTIONATED","82495 - HC CHG ASSAY OF CHROMIUM",null,"82085 - HC CHG ASSAY OF ALDOLASE",null,null,null,null,"82542 - HC CHG COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC",null,"81364 - HC HBB FULL GENE SEQUENCE",null,null,null,"82533 - HC CHG CORTISOL TOTAL"]
[null,null,null,"82507 - HC CHG ASSAY OF CITRATE","82390 - HC CHG CERULOPLASMIN","82507 - HC CHG ASSAY OF CITRATE",null,"82088 - HC CHG ASSAY OF ALDOSTERONE",null,null,null,null,"82550 - HC CHG CREATINE KINASE TOTAL",null,"81401 - HC CHG, MOLECULAR PATHOLOGY PROCEDURE LEVEL 2",null,null,null,"82540 - HC CHG ASSAY OF CREATINE"]
[null,null,null,"82523 - HC CHG COLLAGEN CROSS LINKS ANY METHOD","82397 - HC CHEMILUMINESCENT ASSAY","82523 - HC CHG COLLAGEN CROSS LINKS ANY METHOD",null,"82103 - HC CHG ALPHA-1-ANTITRYPSIN TOTAL",null,null,null,null,"82553 - HC CHG CREATINE KINASE MB FRACTION ONLY",null,"81402 - HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 3",null,null,null,"82542 - HC CHG COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC"]
[null,null,null,"82525 - HC CHG ASSAY OF COPPER","82435 - HC CHG CHLORIDE BLD","82525 - HC CHG ASSAY OF COPPER",null,"82104 - HC CHG ALPHA-1-ANTITRYPSIN PHENOTYPE",null,null,null,null,"82565 - HC CHG CREATININE BLOOD",null,"81403 - SEQ & EXON 13 SEQ, IF PERFORMED KRAS (EG, CARCINOMA), GENE ANALYSIS, PRO/TECH",null,null,null,"82550 - HC CHG CREATINE KINASE TOTAL"]
[null,null,null,"82530 - HC CHG CORTISOL FREE","82436 - HC CHG CHLORIDE URINE","82530 - HC CHG CORTISOL FREE",null,"82105 - HC CHG ALPHA-FETOPROTEIN SERUM",null,null,null,null,"82570 - HC CHG CREATININE OTHER SOURCE",null,"81404 - VHL (EG, VON HIPPEL-LINDAUFAMILIAL CANCER SYNDROME, FULL GENE SEQ VWF PRO/TECH",null,null,null,"82553 - HC CHG CREATINE KINASE MB FRACTION ONLY"]
[null,null,null,"82533 - HC CHG CORTISOL TOTAL","82438 - HC CHG CHLORIDE OTHER SOURCE","82533 - HC CHG CORTISOL TOTAL",null,"82139 - HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE",null,null,null,null,"82575 - HC CHG CREATININE CLEARANCE",null,"81405 - HC MOPATH PROCEDURE LEVEL 6",null,null,null,"82565 - HC CHG CREATININE BLOOD"]
[null,null,null,"82540 - HC CHG ASSAY OF CREATINE","82465 - CHOLESTEROL SERUM/WHOLE BLOOD TOTAL","82540 - HC CHG ASSAY OF CREATINE",null,"82140 - HC CHG ASSAY OF AMMONIA",null,null,null,null,"82585 - HC CHG ASSAY OF CRYOFIBRN",null,"81406 - HC CHG MOLECULAR PATHOLOGY PROCEDURE LEVEL 7",null,null,null,"82570 - HC CHG CREATININE OTHER SOURCE"]
[null,null,null,"82542 - HC CHG COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC","82495 - HC CHG ASSAY OF CHROMIUM","82542 - HC CHG COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC",null,"82150 - HC CHG ASSAY OF AMYLASE",null,null,null,null,"82595 - HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE",null,"81430 - HC CHG HEARING LOSS GENOMIC SEQUENCE ANALYSIS 60 GENES",null,null,null,"82575 - HC CHG CREATININE CLEARANCE"]
[null,null,null,"82550 - HC CHG CREATINE KINASE TOTAL","82507 - HC CHG ASSAY OF CITRATE","82550 - HC CHG CREATINE KINASE TOTAL",null,"82157 - HC CHG ANDROSTENEDIONE",null,null,null,null,"82607 - HC CHG CYANOCOBALAMIN VITAMIN B-12",null,"81431 - HC CHG HEARING LOSS DUP/DEL ANALYSIS",null,null,null,"82585 - HC CHG ASSAY OF CRYOFIBRN"]
[null,null,null,"82553 - HC CHG CREATINE KINASE MB FRACTION ONLY","82523 - HC CHG COLLAGEN CROSS LINKS ANY METHOD","82553 - HC CHG CREATINE KINASE MB FRACTION ONLY",null,"82164 - HC CHG ANGIOTENSIN I-CONVERTING ENZYME",null,null,null,null,"82626 - HC CHG DEHYDROEPIANDROSTERONE",null,"81450 - HC CHG GENOMIC SEQ ANALYS DNA&RNA ANALYS 5-50 GENE",null,null,null,"82595 - HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE"]
[null,null,null,"82565 - HC CHG CREATININE BLOOD","82525 - HC CHG ASSAY OF COPPER","82565 - HC CHG CREATININE BLOOD",null,"82172 - HC CHG APOLIPOPROTEIN EACH",null,null,null,null,"82627 - HC CHG DEHYDROEPIANDROSTERONE-SULFATE",null,"81522 - HC ONC BREAST MRNA 12 GENES",null,null,null,"82607 - HC CHG CYANOCOBALAMIN VITAMIN B-12"]
[null,null,null,"82570 - HC CHG CREATININE OTHER SOURCE","82530 - HC CHG CORTISOL FREE","82570 - HC CHG CREATININE OTHER SOURCE",null,"82175 - HC CHG ASSAY OF ARSENIC",null,null,null,null,"82652 - HC CHG 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED",null,"81542 - HC ONC PROSTATE MRNA 22 CNT GEN",null,null,null,"82626 - HC CHG DEHYDROEPIANDROSTERONE"]
[null,null,null,"82575 - HC CHG CREATININE CLEARANCE","82533 - HC CHG CORTISOL TOTAL","82575 - HC CHG CREATININE CLEARANCE",null,"82180 - HC CHG ASSAY OF ASCORBIC ACID BLOOD",null,null,null,null,"82656 - HC CHG ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN",null,"81596 - HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR",null,null,null,"82627 - HC CHG DEHYDROEPIANDROSTERONE-SULFATE"]
[null,null,null,"82585 - HC CHG ASSAY OF CRYOFIBRN","82540 - HC CHG ASSAY OF CREATINE","82585 - HC CHG ASSAY OF CRYOFIBRN",null,"82232 - HC CHG BETA-2 MICROGLOBULIN",null,null,null,null,"82657 - HC CHG NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA",null,"82009 - HC CHG KETONE BODIES SERUM QUALITATIVE",null,null,null,"82652 - HC CHG 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED"]
[null,null,null,"82595 - HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE","82542 - HC CHG COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC","82595 - HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE",null,"82247 - HC CHG BILIRUBIN TOTAL",null,null,null,null,"82668 - HC CHG ASSAY OF ERYTHROPOIETIN",null,"82010 - HC CHG KETONE BODIES SERUM QUANTITATIVE",null,null,null,"82656 - HC CHG ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN"]
[null,null,null,"82607 - HC CHG CYANOCOBALAMIN VITAMIN B-12","82550 - HC CHG CREATINE KINASE TOTAL","82607 - HC CHG CYANOCOBALAMIN VITAMIN B-12",null,"82248 - HC CHG BILIRUBIN DIRECT",null,null,null,null,"82670 - HC CHG ASSAY OF ESTRADIOL",null,"82017 - HC CHG ACYLCARNITINES QUANTIATIVE EACH SPECIMEN",null,null,null,"82657 - HC CHG NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA"]
[null,null,null,"82626 - HC CHG DEHYDROEPIANDROSTERONE","82553 - HC CHG CREATINE KINASE MB FRACTION ONLY","82626 - HC CHG DEHYDROEPIANDROSTERONE",null,"82270 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER",null,null,null,null,"82677 - HC CHG ASSAY OF ESTRIOL",null,"82024 - HC CHG ADRENOCORTICOTROPIC HORMONE ACTH",null,null,null,"82668 - HC CHG ASSAY OF ERYTHROPOIETIN"]
[null,null,null,"82627 - HC CHG DEHYDROEPIANDROSTERONE-SULFATE","82565 - HC CHG CREATININE BLOOD","82627 - HC CHG DEHYDROEPIANDROSTERONE-SULFATE",null,"82271 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES",null,null,null,null,"82693 - HC CHG ASSAY OF ETHYLENE GLYCOL",null,"82040 - HC CHG ALBUMIN SERUM PLASMA/WHOLE BLOOD",null,null,null,"82670 - HC CHG ASSAY OF ESTRADIOL"]
[null,null,null,"82652 - HC CHG 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED","82570 - HC CHG CREATININE OTHER SOURCE","82652 - HC CHG 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED",null,"82274 - HC CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3",null,null,null,null,"82705 - HC CHG FAT/LIPIDS FECES QUALITATIVE",null,"82042 - HC CHG ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN",null,null,null,"82677 - HC CHG ASSAY OF ESTRIOL"]
[null,null,null,"82656 - HC CHG ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN","82575 - HC CHG CREATININE CLEARANCE","82656 - HC CHG ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN",null,"82306 - HC CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED",null,null,null,null,"82728 - HC CHG ASSAY OF FERRITIN",null,"82043 - HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE",null,null,null,"82693 - HC CHG ASSAY OF ETHYLENE GLYCOL"]
[null,null,null,"82657 - HC CHG NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA","82585 - HC CHG ASSAY OF CRYOFIBRN","82657 - HC CHG NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA",null,"82308 - HC CHG CALCITONIN",null,null,null,null,"82731 - HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN",null,"82075 - HC CHG ASSAY OF ALCOHOL BREATH",null,null,null,"82705 - HC CHG FAT/LIPIDS FECES QUALITATIVE"]
[null,null,null,"82668 - HC CHG ASSAY OF ERYTHROPOIETIN","82595 - HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE","82668 - HC CHG ASSAY OF ERYTHROPOIETIN",null,"82310 - HC CHG CALCIUM TOTAL",null,null,null,null,"82746 - HC CHG ASSAY OF FOLIC ACID SERUM",null,"82085 - HC CHG ASSAY OF ALDOLASE",null,null,null,"82728 - HC CHG ASSAY OF FERRITIN"]
[null,null,null,"82670 - HC CHG ASSAY OF ESTRADIOL","82607 - HC CHG CYANOCOBALAMIN VITAMIN B-12","82670 - HC CHG ASSAY OF ESTRADIOL",null,"82330 - HC CHG CALCIUM IONIZED",null,null,null,null,"82747 - HC CHG ASSAY OF FOLIC ACID RBC",null,"82088 - HC CHG ASSAY OF ALDOSTERONE",null,null,null,"82731 - HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN"]
[null,null,null,"82677 - HC CHG ASSAY OF ESTRIOL","82626 - HC CHG DEHYDROEPIANDROSTERONE","82677 - HC CHG ASSAY OF ESTRIOL",null,"82340 - HC Q;KID STONE, UR CALCIUM",null,null,null,null,"82784 - HC CHG ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH",null,"82103 - HC CHG ALPHA-1-ANTITRYPSIN TOTAL",null,null,null,"82746 - HC CHG ASSAY OF FOLIC ACID SERUM"]
[null,null,null,"82693 - HC CHG ASSAY OF ETHYLENE GLYCOL","82627 - HC CHG DEHYDROEPIANDROSTERONE-SULFATE","82693 - HC CHG ASSAY OF ETHYLENE GLYCOL",null,"82365 - HC CHG CALCULUS INFRARED SPECTROSCOPY",null,null,null,null,"82785 - HC CHG ASSAY OF GAMMAGLOBULIN IGE",null,"82104 - HC CHG ALPHA-1-ANTITRYPSIN PHENOTYPE",null,null,null,"82747 - HC CHG ASSAY OF FOLIC ACID RBC"]
[null,null,null,"82705 - HC CHG FAT/LIPIDS FECES QUALITATIVE","82652 - HC CHG 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED","82705 - HC CHG FAT/LIPIDS FECES QUALITATIVE",null,"82374 - HC CHG CARBON DIOXIDE BICARBONATE",null,null,null,null,"82787 - HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES",null,"82105 - HC CHG ALPHA-FETOPROTEIN SERUM",null,null,null,"82784 - HC CHG ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH"]
[null,null,null,"82728 - HC CHG ASSAY OF FERRITIN","82656 - HC CHG ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN","82728 - HC CHG ASSAY OF FERRITIN",null,"82375 - HC CHG CARBOXYHEMOGLOBIN QUANTITATIVE",null,null,null,null,"82803 - HC CHG BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3",null,"82139 - HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE",null,null,null,"82785 - HC CHG ASSAY OF GAMMAGLOBULIN IGE"]
[null,null,null,"82731 - HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN","82657 - HC CHG NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA","82731 - HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN",null,"82378 - HC CHG CARCINOEMBRYONIC ANTIGEN CEA",null,null,null,null,"82805 - HC CHG GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY",null,"82140 - HC CHG ASSAY OF AMMONIA",null,null,null,"82787 - HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES"]
[null,null,null,"82746 - HC CHG ASSAY OF FOLIC ACID SERUM","82668 - HC CHG ASSAY OF ERYTHROPOIETIN","82746 - HC CHG ASSAY OF FOLIC ACID SERUM",null,"82379 - HC CRL;CARNITINE",null,null,null,null,"82810 - HC BLOOD GASSES O2 SAT ONLY",null,"82150 - HC CHG ASSAY OF AMYLASE",null,null,null,"82803 - HC CHG BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3"]
[null,null,null,"82747 - HC CHG ASSAY OF FOLIC ACID RBC","82670 - HC CHG ASSAY OF ESTRADIOL","82747 - HC CHG ASSAY OF FOLIC ACID RBC",null,"82384 - HC CHG CATECHOLAMINES FRACTIONATED",null,null,null,null,"82941 - HC CHG ASSAY OF GASTRIN",null,"82157 - HC CHG ANDROSTENEDIONE",null,null,null,"82805 - HC CHG GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY"]
[null,null,null,"82784 - HC CHG ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH","82677 - HC CHG ASSAY OF ESTRIOL","82784 - HC CHG ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH",null,"82390 - HC CHG CERULOPLASMIN",null,null,null,null,"82945 - HC CHG GLUCOSE BODY FLUID OTHER THAN BLOOD",null,"82164 - HC CHG ANGIOTENSIN I-CONVERTING ENZYME",null,null,null,"82810 - HC BLOOD GASSES O2 SAT ONLY"]
[null,null,null,"82785 - HC CHG ASSAY OF GAMMAGLOBULIN IGE","82693 - HC CHG ASSAY OF ETHYLENE GLYCOL","82785 - HC CHG ASSAY OF GAMMAGLOBULIN IGE",null,"82397 - HC CHEMILUMINESCENT ASSAY",null,null,null,null,"82947 - HC CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP",null,"82172 - HC CHG APOLIPOPROTEIN EACH",null,null,null,"82941 - HC CHG ASSAY OF GASTRIN"]
[null,null,null,"82787 - HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES","82705 - HC CHG FAT/LIPIDS FECES QUALITATIVE","82787 - HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES",null,"82435 - HC CHG CHLORIDE BLD",null,null,null,null,"82950 - HC CHG GLUCOSE POST GLUCOSE DOSE",null,"82175 - HC CHG ASSAY OF ARSENIC",null,null,null,"82945 - HC CHG GLUCOSE BODY FLUID OTHER THAN BLOOD"]
[null,null,null,"82803 - HC CHG BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3","82728 - HC CHG ASSAY OF FERRITIN","82803 - HC CHG BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3",null,"82436 - HC CHG CHLORIDE URINE",null,null,null,null,"82951 - HC CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS",null,"82180 - HC CHG ASSAY OF ASCORBIC ACID BLOOD",null,null,null,"82947 - HC CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP"]
[null,null,null,"82805 - HC CHG GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY","82731 - HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN","82805 - HC CHG GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY",null,"82438 - HC CHG CHLORIDE OTHER SOURCE",null,null,null,null,"82952 - HC CHG GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS",null,"82232 - HC CHG BETA-2 MICROGLOBULIN",null,null,null,"82950 - HC CHG GLUCOSE POST GLUCOSE DOSE"]
[null,null,null,"82810 - HC BLOOD GASSES O2 SAT ONLY","82746 - HC CHG ASSAY OF FOLIC ACID SERUM","82810 - HC BLOOD GASSES O2 SAT ONLY",null,"82465 - CHOLESTEROL SERUM/WHOLE BLOOD TOTAL",null,null,null,null,"82960 - HC CHG GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN",null,"82247 - HC CHG BILIRUBIN TOTAL",null,null,null,"82951 - HC CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS"]
[null,null,null,"82941 - HC CHG ASSAY OF GASTRIN","82747 - HC CHG ASSAY OF FOLIC ACID RBC","82941 - HC CHG ASSAY OF GASTRIN",null,"82495 - HC CHG ASSAY OF CHROMIUM",null,null,null,null,"82962 - HC GLUCOMETER - PHARM",null,"82248 - HC CHG BILIRUBIN DIRECT",null,null,null,"82952 - HC CHG GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS"]
[null,null,null,"82945 - HC CHG GLUCOSE BODY FLUID OTHER THAN BLOOD","82784 - HC CHG ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH","82945 - HC CHG GLUCOSE BODY FLUID OTHER THAN BLOOD",null,"82507 - HC CHG ASSAY OF CITRATE",null,null,null,null,"82977 - HC CHG ASSAY OF GGT",null,"82270 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER",null,null,null,"82960 - HC CHG GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN"]
[null,null,null,"82947 - HC CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP","82785 - HC CHG ASSAY OF GAMMAGLOBULIN IGE","82947 - HC CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP",null,"82523 - HC CHG COLLAGEN CROSS LINKS ANY METHOD",null,null,null,null,"82985 - HC CHG ASSAY OF GLYCATED PROTEIN",null,"82271 - HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES",null,null,null,"82962 - HC GLUCOMETER - PHARM"]
[null,null,null,"82950 - HC CHG GLUCOSE POST GLUCOSE DOSE","82787 - HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES","82950 - HC CHG GLUCOSE POST GLUCOSE DOSE",null,"82525 - HC CHG ASSAY OF COPPER",null,null,null,null,"83001 - HC CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE",null,"82274 - HC CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3",null,null,null,"82977 - HC CHG ASSAY OF GGT"]
[null,null,null,"82951 - HC CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS","82803 - HC CHG BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3","82951 - HC CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS",null,"82530 - HC CHG CORTISOL FREE",null,null,null,null,"83002 - HC CHG GONADOTROPIN LUTEINIZING HORMONE",null,"82306 - HC CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED",null,null,null,"82985 - HC CHG ASSAY OF GLYCATED PROTEIN"]
[null,null,null,"82952 - HC CHG GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS","82805 - HC CHG GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY","82952 - HC CHG GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS",null,"82533 - HC CHG CORTISOL TOTAL",null,null,null,null,"83003 - HC CHG ASSAY OF GROWTH HORMONE HUMAN",null,"82308 - HC CHG CALCITONIN",null,null,null,"83001 - HC CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE"]
[null,null,null,"82960 - HC CHG GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN","82810 - HC BLOOD GASSES O2 SAT ONLY","82960 - HC CHG GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN",null,"82540 - HC CHG ASSAY OF CREATINE",null,null,null,null,"83010 - HC CHG ASSAY OF HAPTOGLOBIN, QUANT",null,"82310 - HC CHG CALCIUM TOTAL",null,null,null,"83002 - HC CHG GONADOTROPIN LUTEINIZING HORMONE"]
[null,null,null,"82962 - HC GLUCOMETER - PHARM","82941 - HC CHG ASSAY OF GASTRIN","82962 - HC GLUCOMETER - PHARM",null,"82542 - HC CHG COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC",null,null,null,null,"83013 - HC H PYLORI (C-13) BREATH",null,"82330 - HC CHG CALCIUM IONIZED",null,null,null,"83003 - HC CHG ASSAY OF GROWTH HORMONE HUMAN"]
[null,null,null,"82977 - HC CHG ASSAY OF GGT","82945 - HC CHG GLUCOSE BODY FLUID OTHER THAN BLOOD","82977 - HC CHG ASSAY OF GGT",null,"82550 - HC CHG CREATINE KINASE TOTAL",null,null,null,null,"83014 - HC H PYLORI DRUG ADMIN",null,"82340 - HC Q;KID STONE, UR CALCIUM",null,null,null,"83010 - HC CHG ASSAY OF HAPTOGLOBIN, QUANT"]
[null,null,null,"82985 - HC CHG ASSAY OF GLYCATED PROTEIN","82947 - HC CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP","82985 - HC CHG ASSAY OF GLYCATED PROTEIN",null,"82553 - HC CHG CREATINE KINASE MB FRACTION ONLY",null,null,null,null,"83020 - HC CHG HEMOGLOBIN ELECTROPHORESIS",null,"82365 - HC CHG CALCULUS INFRARED SPECTROSCOPY",null,null,null,"83013 - HC H PYLORI (C-13) BREATH"]
[null,null,null,"83001 - HC CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE","82950 - HC CHG GLUCOSE POST GLUCOSE DOSE","83001 - HC CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE",null,"82565 - HC CHG CREATININE BLOOD",null,null,null,null,"83021 - HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY",null,"82374 - HC CHG CARBON DIOXIDE BICARBONATE",null,null,null,"83014 - HC H PYLORI DRUG ADMIN"]
[null,null,null,"83002 - HC CHG GONADOTROPIN LUTEINIZING HORMONE","82951 - HC CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS","83002 - HC CHG GONADOTROPIN LUTEINIZING HORMONE",null,"82570 - HC CHG CREATININE OTHER SOURCE",null,null,null,null,"83030 - HC CHG HEMOGLOBIN F FETAL CHEMICAL",null,"82375 - HC CHG CARBOXYHEMOGLOBIN QUANTITATIVE",null,null,null,"83020 - HC CHG HEMOGLOBIN ELECTROPHORESIS"]
[null,null,null,"83003 - HC CHG ASSAY OF GROWTH HORMONE HUMAN","82952 - HC CHG GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS","83003 - HC CHG ASSAY OF GROWTH HORMONE HUMAN",null,"82575 - HC CHG CREATININE CLEARANCE",null,null,null,null,"83036 - HEMOGLOBIN GLYCOSYLATED A1C",null,"82378 - HC CHG CARCINOEMBRYONIC ANTIGEN CEA",null,null,null,"83021 - HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY"]
[null,null,null,"83010 - HC CHG ASSAY OF HAPTOGLOBIN, QUANT","82960 - HC CHG GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN","83010 - HC CHG ASSAY OF HAPTOGLOBIN, QUANT",null,"82585 - HC CHG ASSAY OF CRYOFIBRN",null,null,null,null,"83050 - HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE",null,"82379 - HC CRL;CARNITINE",null,null,null,"83030 - HC CHG HEMOGLOBIN F FETAL CHEMICAL"]
[null,null,null,"83013 - HC H PYLORI (C-13) BREATH","82962 - HC GLUCOMETER - PHARM","83013 - HC H PYLORI (C-13) BREATH",null,"82595 - HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE",null,null,null,null,"83070 - HC CHG ASSAY OF HEMOSIDERIN QUALITATIVE",null,"82384 - HC CHG CATECHOLAMINES FRACTIONATED",null,null,null,"83036 - HEMOGLOBIN GLYCOSYLATED A1C"]
[null,null,null,"83014 - HC H PYLORI DRUG ADMIN","82977 - HC CHG ASSAY OF GGT","83014 - HC H PYLORI DRUG ADMIN",null,"82607 - HC CHG CYANOCOBALAMIN VITAMIN B-12",null,null,null,null,"83090 - HC CHG ASSAY OF HOMOCYSTEINE",null,"82390 - HC CHG CERULOPLASMIN",null,null,null,"83050 - HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE"]
[null,null,null,"83020 - HC CHG HEMOGLOBIN ELECTROPHORESIS","82985 - HC CHG ASSAY OF GLYCATED PROTEIN","83020 - HC CHG HEMOGLOBIN ELECTROPHORESIS",null,"82626 - HC CHG DEHYDROEPIANDROSTERONE",null,null,null,null,"83497 - HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA",null,"82397 - HC CHEMILUMINESCENT ASSAY",null,null,null,"83070 - HC CHG ASSAY OF HEMOSIDERIN QUALITATIVE"]
[null,null,null,"83021 - HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY","83001 - HC CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE","83021 - HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY",null,"82627 - HC CHG DEHYDROEPIANDROSTERONE-SULFATE",null,null,null,null,"83498 - HC CHG ASSAY OF HYDROXYPROGESTERONE 17-D",null,"82435 - HC CHG CHLORIDE BLD",null,null,null,"83090 - HC CHG ASSAY OF HOMOCYSTEINE"]
[null,null,null,"83030 - HC CHG HEMOGLOBIN F FETAL CHEMICAL","83002 - HC CHG GONADOTROPIN LUTEINIZING HORMONE","83030 - HC CHG HEMOGLOBIN F FETAL CHEMICAL",null,"82652 - HC CHG 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED",null,null,null,null,"83516 - HC CRL;TTG AB,IGA",null,"82436 - HC CHG CHLORIDE URINE",null,null,null,"83497 - HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA"]
[null,null,null,"83036 - HEMOGLOBIN GLYCOSYLATED A1C","83003 - HC CHG ASSAY OF GROWTH HORMONE HUMAN","83036 - HEMOGLOBIN GLYCOSYLATED A1C",null,"82656 - HC CHG ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN",null,null,null,null,"83519 - HC CHG IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY",null,"82438 - HC CHG CHLORIDE OTHER SOURCE",null,null,null,"83498 - HC CHG ASSAY OF HYDROXYPROGESTERONE 17-D"]
[null,null,null,"83050 - HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE","83010 - HC CHG ASSAY OF HAPTOGLOBIN, QUANT","83050 - HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE",null,"82657 - HC CHG NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA",null,null,null,null,"83520 - HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE",null,"82465 - CHOLESTEROL SERUM/WHOLE BLOOD TOTAL",null,null,null,"83516 - HC CRL;TTG AB,IGA"]
[null,null,null,"83070 - HC CHG ASSAY OF HEMOSIDERIN QUALITATIVE","83013 - HC H PYLORI (C-13) BREATH","83070 - HC CHG ASSAY OF HEMOSIDERIN QUALITATIVE",null,"82668 - HC CHG ASSAY OF ERYTHROPOIETIN",null,null,null,null,"83525 - HC CHG ASSAY OF INSULIN TOTAL",null,"82495 - HC CHG ASSAY OF CHROMIUM",null,null,null,"83519 - HC CHG IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY"]
[null,null,null,"83090 - HC CHG ASSAY OF HOMOCYSTEINE","83014 - HC H PYLORI DRUG ADMIN","83090 - HC CHG ASSAY OF HOMOCYSTEINE",null,"82670 - HC CHG ASSAY OF ESTRADIOL",null,null,null,null,"83540 - HC CHG ASSAY OF IRON",null,"82507 - HC CHG ASSAY OF CITRATE",null,null,null,"83520 - HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE"]
[null,null,null,"83497 - HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA","83020 - HC CHG HEMOGLOBIN ELECTROPHORESIS","83497 - HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA",null,"82677 - HC CHG ASSAY OF ESTRIOL",null,null,null,null,"83550 - HC CHG IRON BINDING CAPACITY",null,"82523 - HC CHG COLLAGEN CROSS LINKS ANY METHOD",null,null,null,"83525 - HC CHG ASSAY OF INSULIN TOTAL"]
[null,null,null,"83498 - HC CHG ASSAY OF HYDROXYPROGESTERONE 17-D","83021 - HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY","83498 - HC CHG ASSAY OF HYDROXYPROGESTERONE 17-D",null,"82693 - HC CHG ASSAY OF ETHYLENE GLYCOL",null,null,null,null,"83605 - HC CHG ASSAY OF LACTATE",null,"82525 - HC CHG ASSAY OF COPPER",null,null,null,"83540 - HC CHG ASSAY OF IRON"]
[null,null,null,"83516 - HC CRL;TTG AB,IGA","83030 - HC CHG HEMOGLOBIN F FETAL CHEMICAL","83516 - HC CRL;TTG AB,IGA",null,"82705 - HC CHG FAT/LIPIDS FECES QUALITATIVE",null,null,null,null,"83615 - HC CHG LACTATE DEHYDROGENASE LDH",null,"82530 - HC CHG CORTISOL FREE",null,null,null,"83550 - HC CHG IRON BINDING CAPACITY"]
[null,null,null,"83519 - HC CHG IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","83036 - HEMOGLOBIN GLYCOSYLATED A1C","83519 - HC CHG IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY",null,"82728 - HC CHG ASSAY OF FERRITIN",null,null,null,null,"83630 - HC CHG LACTOFERRIN FECAL QUALITATIVE",null,"82533 - HC CHG CORTISOL TOTAL",null,null,null,"83605 - HC CHG ASSAY OF LACTATE"]
[null,null,null,"83520 - HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE","83050 - HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE","83520 - HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE",null,"82731 - HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN",null,null,null,null,"83655 - HC CHG ASSAY OF LEAD",null,"82540 - HC CHG ASSAY OF CREATINE",null,null,null,"83615 - HC CHG LACTATE DEHYDROGENASE LDH"]
[null,null,null,"83525 - HC CHG ASSAY OF INSULIN TOTAL","83070 - HC CHG ASSAY OF HEMOSIDERIN QUALITATIVE","83525 - HC CHG ASSAY OF INSULIN TOTAL",null,"82746 - HC CHG ASSAY OF FOLIC ACID SERUM",null,null,null,null,"83662 - HC L/S RATIO, FOAM STABILITY",null,"82542 - HC CHG COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC",null,null,null,"83630 - HC CHG LACTOFERRIN FECAL QUALITATIVE"]
[null,null,null,"83540 - HC CHG ASSAY OF IRON","83090 - HC CHG ASSAY OF HOMOCYSTEINE","83540 - HC CHG ASSAY OF IRON",null,"82747 - HC CHG ASSAY OF FOLIC ACID RBC",null,null,null,null,"83690 - HC CHG ASSAY OF LIPASE",null,"82550 - HC CHG CREATINE KINASE TOTAL",null,null,null,"83655 - HC CHG ASSAY OF LEAD"]
[null,null,null,"83550 - HC CHG IRON BINDING CAPACITY","83497 - HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA","83550 - HC CHG IRON BINDING CAPACITY",null,"82784 - HC CHG ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH",null,null,null,null,"83695 - HC CHG LIPOPROTEIN (A)",null,"82553 - HC CHG CREATINE KINASE MB FRACTION ONLY",null,null,null,"83662 - HC L/S RATIO, FOAM STABILITY"]
[null,null,null,"83605 - HC CHG ASSAY OF LACTATE","83498 - HC CHG ASSAY OF HYDROXYPROGESTERONE 17-D","83605 - HC CHG ASSAY OF LACTATE",null,"82785 - HC CHG ASSAY OF GAMMAGLOBULIN IGE",null,null,null,null,"83718 - HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL",null,"82565 - HC CHG CREATININE BLOOD",null,null,null,"83690 - HC CHG ASSAY OF LIPASE"]
[null,null,null,"83615 - HC CHG LACTATE DEHYDROGENASE LDH","83516 - HC CRL;TTG AB,IGA","83615 - HC CHG LACTATE DEHYDROGENASE LDH",null,"82787 - HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES",null,null,null,null,"83721 - HC CRL;DIRECT LDL",null,"82570 - HC CHG CREATININE OTHER SOURCE",null,null,null,"83695 - HC CHG LIPOPROTEIN (A)"]
[null,null,null,"83630 - HC CHG LACTOFERRIN FECAL QUALITATIVE","83519 - HC CHG IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","83630 - HC CHG LACTOFERRIN FECAL QUALITATIVE",null,"82803 - HC CHG BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3",null,null,null,null,"83735 - HC CHG ASSAY OF MAGNESIUM",null,"82575 - HC CHG CREATININE CLEARANCE",null,null,null,"83718 - HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL"]
[null,null,null,"83655 - HC CHG ASSAY OF LEAD","83520 - HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE","83655 - HC CHG ASSAY OF LEAD",null,"82805 - HC CHG GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY",null,null,null,null,"83785 - HC CHG, ASSAY OF MANGANESE",null,"82585 - HC CHG ASSAY OF CRYOFIBRN",null,null,null,"83721 - HC CRL;DIRECT LDL"]
[null,null,null,"83662 - HC L/S RATIO, FOAM STABILITY","83525 - HC CHG ASSAY OF INSULIN TOTAL","83662 - HC L/S RATIO, FOAM STABILITY",null,"82810 - HC BLOOD GASSES O2 SAT ONLY",null,null,null,null,"83789 - HC CHG MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA",null,"82595 - HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE",null,null,null,"83735 - HC CHG ASSAY OF MAGNESIUM"]
[null,null,null,"83690 - HC CHG ASSAY OF LIPASE","83540 - HC CHG ASSAY OF IRON","83690 - HC CHG ASSAY OF LIPASE",null,"82941 - HC CHG ASSAY OF GASTRIN",null,null,null,null,"83825 - HC CHG ASSAY OF MERCURY QUANTITATIVE",null,"82607 - HC CHG CYANOCOBALAMIN VITAMIN B-12",null,null,null,"83785 - HC CHG, ASSAY OF MANGANESE"]
[null,null,null,"83695 - HC CHG LIPOPROTEIN (A)","83550 - HC CHG IRON BINDING CAPACITY","83695 - HC CHG LIPOPROTEIN (A)",null,"82945 - HC CHG GLUCOSE BODY FLUID OTHER THAN BLOOD",null,null,null,null,"83835 - HC CHG METANEPHRINES",null,"82626 - HC CHG DEHYDROEPIANDROSTERONE",null,null,null,"83789 - HC CHG MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA"]
[null,null,null,"83718 - HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL","83605 - HC CHG ASSAY OF LACTATE","83718 - HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL",null,"82947 - HC CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP",null,null,null,null,"83873 - HC CHG MYELIN BASIC PROTEIN CEREBROSPINAL FLUID",null,"82627 - HC CHG DEHYDROEPIANDROSTERONE-SULFATE",null,null,null,"83825 - HC CHG ASSAY OF MERCURY QUANTITATIVE"]
[null,null,null,"83721 - HC CRL;DIRECT LDL","83615 - HC CHG LACTATE DEHYDROGENASE LDH","83721 - HC CRL;DIRECT LDL",null,"82950 - HC CHG GLUCOSE POST GLUCOSE DOSE",null,null,null,null,"83874 - HC CHG MYOGLOBIN",null,"82652 - HC CHG 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED",null,null,null,"83835 - HC CHG METANEPHRINES"]
[null,null,null,"83735 - HC CHG ASSAY OF MAGNESIUM","83630 - HC CHG LACTOFERRIN FECAL QUALITATIVE","83735 - HC CHG ASSAY OF MAGNESIUM",null,"82951 - HC CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS",null,null,null,null,"83880 - HC CHG NATRIURETIC PEPTIDE",null,"82656 - HC CHG ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN",null,null,null,"83873 - HC CHG MYELIN BASIC PROTEIN CEREBROSPINAL FLUID"]
[null,null,null,"83785 - HC CHG, ASSAY OF MANGANESE","83655 - HC CHG ASSAY OF LEAD","83785 - HC CHG, ASSAY OF MANGANESE",null,"82952 - HC CHG GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS",null,null,null,null,"83883 - HC NEPHELOMETRY, EACH ANALYTE",null,"82657 - HC CHG NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA",null,null,null,"83874 - HC CHG MYOGLOBIN"]
[null,null,null,"83789 - HC CHG MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA","83662 - HC L/S RATIO, FOAM STABILITY","83789 - HC CHG MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA",null,"82960 - HC CHG GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN",null,null,null,null,"83915 - HC CHG ASSAY OF NUCLEOTIDASE 5'-",null,"82668 - HC CHG ASSAY OF ERYTHROPOIETIN",null,null,null,"83880 - HC CHG NATRIURETIC PEPTIDE"]
[null,null,null,"83825 - HC CHG ASSAY OF MERCURY QUANTITATIVE","83690 - HC CHG ASSAY OF LIPASE","83825 - HC CHG ASSAY OF MERCURY QUANTITATIVE",null,"82962 - HC GLUCOMETER - PHARM",null,null,null,null,"83916 - HC CHG OLIGOCLONAL IMMUNE",null,"82670 - HC CHG ASSAY OF ESTRADIOL",null,null,null,"83883 - HC NEPHELOMETRY, EACH ANALYTE"]
[null,null,null,"83835 - HC CHG METANEPHRINES","83695 - HC CHG LIPOPROTEIN (A)","83835 - HC CHG METANEPHRINES",null,"82977 - HC CHG ASSAY OF GGT",null,null,null,null,"83918 - HC CHG ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN",null,"82677 - HC CHG ASSAY OF ESTRIOL",null,null,null,"83915 - HC CHG ASSAY OF NUCLEOTIDASE 5'-"]
[null,null,null,"83873 - HC CHG MYELIN BASIC PROTEIN CEREBROSPINAL FLUID","83718 - HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL","83873 - HC CHG MYELIN BASIC PROTEIN CEREBROSPINAL FLUID",null,"82985 - HC CHG ASSAY OF GLYCATED PROTEIN",null,null,null,null,"83921 - HC CHG ORGANIC ACID 1 QUANTITATIVE",null,"82693 - HC CHG ASSAY OF ETHYLENE GLYCOL",null,null,null,"83916 - HC CHG OLIGOCLONAL IMMUNE"]
[null,null,null,"83874 - HC CHG MYOGLOBIN","83721 - HC CRL;DIRECT LDL","83874 - HC CHG MYOGLOBIN",null,"83001 - HC CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE",null,null,null,null,"83930 - HC Q;OSMOLALITY,SER",null,"82705 - HC CHG FAT/LIPIDS FECES QUALITATIVE",null,null,null,"83918 - HC CHG ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN"]
[null,null,null,"83880 - HC CHG NATRIURETIC PEPTIDE","83735 - HC CHG ASSAY OF MAGNESIUM","83880 - HC CHG NATRIURETIC PEPTIDE",null,"83002 - HC CHG GONADOTROPIN LUTEINIZING HORMONE",null,null,null,null,"83935 - HC CHG ASSAY OF OSMOLALITY URINE",null,"82728 - HC CHG ASSAY OF FERRITIN",null,null,null,"83921 - HC CHG ORGANIC ACID 1 QUANTITATIVE"]
[null,null,null,"83883 - HC NEPHELOMETRY, EACH ANALYTE","83785 - HC CHG, ASSAY OF MANGANESE","83883 - HC NEPHELOMETRY, EACH ANALYTE",null,"83003 - HC CHG ASSAY OF GROWTH HORMONE HUMAN",null,null,null,null,"83937 - HC CHG ASSAY OF OSTEOCALCIN",null,"82731 - HC CHG FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN",null,null,null,"83930 - HC Q;OSMOLALITY,SER"]
[null,null,null,"83915 - HC CHG ASSAY OF NUCLEOTIDASE 5'-","83789 - HC CHG MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA","83915 - HC CHG ASSAY OF NUCLEOTIDASE 5'-",null,"83010 - HC CHG ASSAY OF HAPTOGLOBIN, QUANT",null,null,null,null,"83945 - HC CHG ASSAY OF OXALATE",null,"82746 - HC CHG ASSAY OF FOLIC ACID SERUM",null,null,null,"83935 - HC CHG ASSAY OF OSMOLALITY URINE"]
[null,null,null,"83916 - HC CHG OLIGOCLONAL IMMUNE","83825 - HC CHG ASSAY OF MERCURY QUANTITATIVE","83916 - HC CHG OLIGOCLONAL IMMUNE",null,"83013 - HC H PYLORI (C-13) BREATH",null,null,null,null,"83970 - HC CHG ASSAY OF PARATHORMONE",null,"82747 - HC CHG ASSAY OF FOLIC ACID RBC",null,null,null,"83937 - HC CHG ASSAY OF OSTEOCALCIN"]
[null,null,null,"83918 - HC CHG ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN","83835 - HC CHG METANEPHRINES","83918 - HC CHG ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN",null,"83014 - HC H PYLORI DRUG ADMIN",null,null,null,null,"83986 - HC CHG PH BODY FLUID NOT ELSEWHERE SPECIFIED",null,"82784 - HC CHG ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH",null,null,null,"83945 - HC CHG ASSAY OF OXALATE"]
[null,null,null,"83921 - HC CHG ORGANIC ACID 1 QUANTITATIVE","83873 - HC CHG MYELIN BASIC PROTEIN CEREBROSPINAL FLUID","83921 - HC CHG ORGANIC ACID 1 QUANTITATIVE",null,"83020 - HC CHG HEMOGLOBIN ELECTROPHORESIS",null,null,null,null,"83992 - HC CHG ASSAY OF PHENCYCLIDINE",null,"82785 - HC CHG ASSAY OF GAMMAGLOBULIN IGE",null,null,null,"83970 - HC CHG ASSAY OF PARATHORMONE"]
[null,null,null,"83930 - HC Q;OSMOLALITY,SER","83874 - HC CHG MYOGLOBIN","83930 - HC Q;OSMOLALITY,SER",null,"83021 - HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY",null,null,null,null,"83993 - HC CHG ASSAY OF CALPROTECTIN FECAL",null,"82787 - HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES",null,null,null,"83986 - HC CHG PH BODY FLUID NOT ELSEWHERE SPECIFIED"]
[null,null,null,"83935 - HC CHG ASSAY OF OSMOLALITY URINE","83880 - HC CHG NATRIURETIC PEPTIDE","83935 - HC CHG ASSAY OF OSMOLALITY URINE",null,"83030 - HC CHG HEMOGLOBIN F FETAL CHEMICAL",null,null,null,null,"84075 - HC CHG ASSAY OF PHOSPHATASE ALKALINE",null,"82803 - HC CHG BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3",null,null,null,"83992 - HC CHG ASSAY OF PHENCYCLIDINE"]
[null,null,null,"83937 - HC CHG ASSAY OF OSTEOCALCIN","83883 - HC NEPHELOMETRY, EACH ANALYTE","83937 - HC CHG ASSAY OF OSTEOCALCIN",null,"83036 - HEMOGLOBIN GLYCOSYLATED A1C",null,null,null,null,"84080 - HC CHG ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES",null,"82805 - HC CHG GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY",null,null,null,"83993 - HC CHG ASSAY OF CALPROTECTIN FECAL"]
[null,null,null,"83945 - HC CHG ASSAY OF OXALATE","83915 - HC CHG ASSAY OF NUCLEOTIDASE 5'-","83945 - HC CHG ASSAY OF OXALATE",null,"83050 - HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE",null,null,null,null,"84100 - HC CHG ASSAY OF PHOSPHORUS INORGANIC",null,"82810 - HC BLOOD GASSES O2 SAT ONLY",null,null,null,"84075 - HC CHG ASSAY OF PHOSPHATASE ALKALINE"]
[null,null,null,"83970 - HC CHG ASSAY OF PARATHORMONE","83916 - HC CHG OLIGOCLONAL IMMUNE","83970 - HC CHG ASSAY OF PARATHORMONE",null,"83070 - HC CHG ASSAY OF HEMOSIDERIN QUALITATIVE",null,null,null,null,"84105 - HC CHG ASSAY OF PHOSPHORUS INORGANIC URINE",null,"82941 - HC CHG ASSAY OF GASTRIN",null,null,null,"84080 - HC CHG ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES"]
[null,null,null,"83986 - HC CHG PH BODY FLUID NOT ELSEWHERE SPECIFIED","83918 - HC CHG ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN","83986 - HC CHG PH BODY FLUID NOT ELSEWHERE SPECIFIED",null,"83090 - HC CHG ASSAY OF HOMOCYSTEINE",null,null,null,null,"84132 - HC CHG POTASSIUM SERUM PLASMA/WHOLE BLOOD",null,"82945 - HC CHG GLUCOSE BODY FLUID OTHER THAN BLOOD",null,null,null,"84100 - HC CHG ASSAY OF PHOSPHORUS INORGANIC"]
[null,null,null,"83992 - HC CHG ASSAY OF PHENCYCLIDINE","83921 - HC CHG ORGANIC ACID 1 QUANTITATIVE","83992 - HC CHG ASSAY OF PHENCYCLIDINE",null,"83497 - HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA",null,null,null,null,"84133 - HC CHG POTASSIUM URINE",null,"82947 - HC CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP",null,null,null,"84105 - HC CHG ASSAY OF PHOSPHORUS INORGANIC URINE"]
[null,null,null,"83993 - HC CHG ASSAY OF CALPROTECTIN FECAL","83930 - HC Q;OSMOLALITY,SER","83993 - HC CHG ASSAY OF CALPROTECTIN FECAL",null,"83498 - HC CHG ASSAY OF HYDROXYPROGESTERONE 17-D",null,null,null,null,"84134 - HC CHG PREALBUMIN",null,"82950 - HC CHG GLUCOSE POST GLUCOSE DOSE",null,null,null,"84132 - HC CHG POTASSIUM SERUM PLASMA/WHOLE BLOOD"]
[null,null,null,"84075 - HC CHG ASSAY OF PHOSPHATASE ALKALINE","83935 - HC CHG ASSAY OF OSMOLALITY URINE","84075 - HC CHG ASSAY OF PHOSPHATASE ALKALINE",null,"83516 - HC CRL;TTG AB,IGA",null,null,null,null,"84144 - HC CHG ASSAY OF PROGESTERONE",null,"82951 - HC CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS",null,null,null,"84133 - HC CHG POTASSIUM URINE"]
[null,null,null,"84080 - HC CHG ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES","83937 - HC CHG ASSAY OF OSTEOCALCIN","84080 - HC CHG ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES",null,"83519 - HC CHG IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY",null,null,null,null,"84145 - HC CHG PROCALCITONIN (PCT)",null,"82952 - HC CHG GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS",null,null,null,"84134 - HC CHG PREALBUMIN"]
[null,null,null,"84100 - HC CHG ASSAY OF PHOSPHORUS INORGANIC","83945 - HC CHG ASSAY OF OXALATE","84100 - HC CHG ASSAY OF PHOSPHORUS INORGANIC",null,"83520 - HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE",null,null,null,null,"84146 - HC CHG ASSAY OF PROLACTIN",null,"82960 - HC CHG GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN",null,null,null,"84144 - HC CHG ASSAY OF PROGESTERONE"]
[null,null,null,"84105 - HC CHG ASSAY OF PHOSPHORUS INORGANIC URINE","83970 - HC CHG ASSAY OF PARATHORMONE","84105 - HC CHG ASSAY OF PHOSPHORUS INORGANIC URINE",null,"83525 - HC CHG ASSAY OF INSULIN TOTAL",null,null,null,null,"84153 - HC CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL",null,"82962 - HC GLUCOMETER - PHARM",null,null,null,"84145 - HC CHG PROCALCITONIN (PCT)"]
[null,null,null,"84132 - HC CHG POTASSIUM SERUM PLASMA/WHOLE BLOOD","83986 - HC CHG PH BODY FLUID NOT ELSEWHERE SPECIFIED","84132 - HC CHG POTASSIUM SERUM PLASMA/WHOLE BLOOD",null,"83540 - HC CHG ASSAY OF IRON",null,null,null,null,"84155 - HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD",null,"82977 - HC CHG ASSAY OF GGT",null,null,null,"84146 - HC CHG ASSAY OF PROLACTIN"]
[null,null,null,"84133 - HC CHG POTASSIUM URINE","83992 - HC CHG ASSAY OF PHENCYCLIDINE","84133 - HC CHG POTASSIUM URINE",null,"83550 - HC CHG IRON BINDING CAPACITY",null,null,null,null,"84156 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY URINE",null,"82985 - HC CHG ASSAY OF GLYCATED PROTEIN",null,null,null,"84153 - HC CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL"]
[null,null,null,"84134 - HC CHG PREALBUMIN","83993 - HC CHG ASSAY OF CALPROTECTIN FECAL","84134 - HC CHG PREALBUMIN",null,"83605 - HC CHG ASSAY OF LACTATE",null,null,null,null,"84157 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC",null,"83001 - HC CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE",null,null,null,"84155 - HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD"]
[null,null,null,"84144 - HC CHG ASSAY OF PROGESTERONE","84075 - HC CHG ASSAY OF PHOSPHATASE ALKALINE","84144 - HC CHG ASSAY OF PROGESTERONE",null,"83615 - HC CHG LACTATE DEHYDROGENASE LDH",null,null,null,null,"84163 - HC CHG PREGNANCY-ASSOCIATED PLASMA PROTEIN-A",null,"83002 - HC CHG GONADOTROPIN LUTEINIZING HORMONE",null,null,null,"84156 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY URINE"]
[null,null,null,"84145 - HC CHG PROCALCITONIN (PCT)","84080 - HC CHG ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES","84145 - HC CHG PROCALCITONIN (PCT)",null,"83630 - HC CHG LACTOFERRIN FECAL QUALITATIVE",null,null,null,null,"84165 - HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM",null,"83003 - HC CHG ASSAY OF GROWTH HORMONE HUMAN",null,null,null,"84157 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC"]
[null,null,null,"84146 - HC CHG ASSAY OF PROLACTIN","84100 - HC CHG ASSAY OF PHOSPHORUS INORGANIC","84146 - HC CHG ASSAY OF PROLACTIN",null,"83655 - HC CHG ASSAY OF LEAD",null,null,null,null,"84166 - HC CHG PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI",null,"83010 - HC CHG ASSAY OF HAPTOGLOBIN, QUANT",null,null,null,"84163 - HC CHG PREGNANCY-ASSOCIATED PLASMA PROTEIN-A"]
[null,null,null,"84153 - HC CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL","84105 - HC CHG ASSAY OF PHOSPHORUS INORGANIC URINE","84153 - HC CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL",null,"83662 - HC L/S RATIO, FOAM STABILITY",null,null,null,null,"84182 - HC CHG PROTEIN, WESTERN BLOT TEST, W BAND",null,"83013 - HC H PYLORI (C-13) BREATH",null,null,null,"84165 - HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM"]
[null,null,null,"84155 - HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD","84132 - HC CHG POTASSIUM SERUM PLASMA/WHOLE BLOOD","84155 - HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD",null,"83690 - HC CHG ASSAY OF LIPASE",null,null,null,null,"84202 - HC Q;ERYTH PROTPOR",null,"83014 - HC H PYLORI DRUG ADMIN",null,null,null,"84166 - HC CHG PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI"]
[null,null,null,"84156 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY URINE","84133 - HC CHG POTASSIUM URINE","84156 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY URINE",null,"83695 - HC CHG LIPOPROTEIN (A)",null,null,null,null,"84206 - HC CHG ASSAY OF PROINSULIN",null,"83020 - HC CHG HEMOGLOBIN ELECTROPHORESIS",null,null,null,"84182 - HC CHG PROTEIN, WESTERN BLOT TEST, W BAND"]
[null,null,null,"84157 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC","84134 - HC CHG PREALBUMIN","84157 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC",null,"83718 - HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL",null,null,null,null,"84207 - HC CHG ASSAY OF PYRIDOXAL PHOSPHATE",null,"83021 - HC CHG HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY",null,null,null,"84202 - HC Q;ERYTH PROTPOR"]
[null,null,null,"84163 - HC CHG PREGNANCY-ASSOCIATED PLASMA PROTEIN-A","84144 - HC CHG ASSAY OF PROGESTERONE","84163 - HC CHG PREGNANCY-ASSOCIATED PLASMA PROTEIN-A",null,"83721 - HC CRL;DIRECT LDL",null,null,null,null,"84210 - HC CHG ASSAY OF PYRUVATE",null,"83030 - HC CHG HEMOGLOBIN F FETAL CHEMICAL",null,null,null,"84206 - HC CHG ASSAY OF PROINSULIN"]
[null,null,null,"84165 - HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM","84145 - HC CHG PROCALCITONIN (PCT)","84165 - HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM",null,"83735 - HC CHG ASSAY OF MAGNESIUM",null,null,null,null,"84244 - HC CHG ASSAY OF RENIN",null,"83036 - HEMOGLOBIN GLYCOSYLATED A1C",null,null,null,"84207 - HC CHG ASSAY OF PYRIDOXAL PHOSPHATE"]
[null,null,null,"84166 - HC CHG PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI","84146 - HC CHG ASSAY OF PROLACTIN","84166 - HC CHG PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI",null,"83785 - HC CHG, ASSAY OF MANGANESE",null,null,null,null,"84255 - HC CHG ASSAY OF SELENIUM",null,"83050 - HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE",null,null,null,"84210 - HC CHG ASSAY OF PYRUVATE"]
[null,null,null,"84182 - HC CHG PROTEIN, WESTERN BLOT TEST, W BAND","84153 - HC CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL","84182 - HC CHG PROTEIN, WESTERN BLOT TEST, W BAND",null,"83789 - HC CHG MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA",null,null,null,null,"84270 - HC CHG ASSAY OF SEX HORMONE BINDING GLOBULIN",null,"83070 - HC CHG ASSAY OF HEMOSIDERIN QUALITATIVE",null,null,null,"84244 - HC CHG ASSAY OF RENIN"]
[null,null,null,"84202 - HC Q;ERYTH PROTPOR","84155 - HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD","84202 - HC Q;ERYTH PROTPOR",null,"83825 - HC CHG ASSAY OF MERCURY QUANTITATIVE",null,null,null,null,"84295 - HC CHG SODIUM SERUM PLASMA OR WHOLE BLOOD",null,"83090 - HC CHG ASSAY OF HOMOCYSTEINE",null,null,null,"84255 - HC CHG ASSAY OF SELENIUM"]
[null,null,null,"84206 - HC CHG ASSAY OF PROINSULIN","84156 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY URINE","84206 - HC CHG ASSAY OF PROINSULIN",null,"83835 - HC CHG METANEPHRINES",null,null,null,null,"84300 - HC CHG ASSAY OF URINE SODIUM",null,"83497 - HC CHG ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA",null,null,null,"84270 - HC CHG ASSAY OF SEX HORMONE BINDING GLOBULIN"]
[null,null,null,"84207 - HC CHG ASSAY OF PYRIDOXAL PHOSPHATE","84157 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC","84207 - HC CHG ASSAY OF PYRIDOXAL PHOSPHATE",null,"83873 - HC CHG MYELIN BASIC PROTEIN CEREBROSPINAL FLUID",null,null,null,null,"84302 - HC CHG ASSAY OF SODIUM OTHER SOURCE",null,"83498 - HC CHG ASSAY OF HYDROXYPROGESTERONE 17-D",null,null,null,"84295 - HC CHG SODIUM SERUM PLASMA OR WHOLE BLOOD"]
[null,null,null,"84210 - HC CHG ASSAY OF PYRUVATE","84163 - HC CHG PREGNANCY-ASSOCIATED PLASMA PROTEIN-A","84210 - HC CHG ASSAY OF PYRUVATE",null,"83874 - HC CHG MYOGLOBIN",null,null,null,null,"84305 - HC CHG ASSAY OF SOMATOMEDIN",null,"83516 - HC CRL;TTG AB,IGA",null,null,null,"84300 - HC CHG ASSAY OF URINE SODIUM"]
[null,null,null,"84244 - HC CHG ASSAY OF RENIN","84165 - HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM","84244 - HC CHG ASSAY OF RENIN",null,"83880 - HC CHG NATRIURETIC PEPTIDE",null,null,null,null,"84307 - HC CHG ASSAY OF SOMATOSTATIN",null,"83519 - HC CHG IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY",null,null,null,"84302 - HC CHG ASSAY OF SODIUM OTHER SOURCE"]
[null,null,null,"84255 - HC CHG ASSAY OF SELENIUM","84166 - HC CHG PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI","84255 - HC CHG ASSAY OF SELENIUM",null,"83883 - HC NEPHELOMETRY, EACH ANALYTE",null,null,null,null,"84311 - HC CHG SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED",null,"83520 - HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE",null,null,null,"84305 - HC CHG ASSAY OF SOMATOMEDIN"]
[null,null,null,"84270 - HC CHG ASSAY OF SEX HORMONE BINDING GLOBULIN","84182 - HC CHG PROTEIN, WESTERN BLOT TEST, W BAND","84270 - HC CHG ASSAY OF SEX HORMONE BINDING GLOBULIN",null,"83915 - HC CHG ASSAY OF NUCLEOTIDASE 5'-",null,null,null,null,"84376 - HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC",null,"83525 - HC CHG ASSAY OF INSULIN TOTAL",null,null,null,"84307 - HC CHG ASSAY OF SOMATOSTATIN"]
[null,null,null,"84295 - HC CHG SODIUM SERUM PLASMA OR WHOLE BLOOD","84202 - HC Q;ERYTH PROTPOR","84295 - HC CHG SODIUM SERUM PLASMA OR WHOLE BLOOD",null,"83916 - HC CHG OLIGOCLONAL IMMUNE",null,null,null,null,"84402 - HC CHG ASSAY OF TESTOSTERONE FREE",null,"83540 - HC CHG ASSAY OF IRON",null,null,null,"84311 - HC CHG SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED"]
[null,null,null,"84300 - HC CHG ASSAY OF URINE SODIUM","84206 - HC CHG ASSAY OF PROINSULIN","84300 - HC CHG ASSAY OF URINE SODIUM",null,"83918 - HC CHG ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN",null,null,null,null,"84403 - HC CHG ASSAY OF TESTOSTERONE TOTAL",null,"83550 - HC CHG IRON BINDING CAPACITY",null,null,null,"84376 - HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC"]
[null,null,null,"84302 - HC CHG ASSAY OF SODIUM OTHER SOURCE","84207 - HC CHG ASSAY OF PYRIDOXAL PHOSPHATE","84302 - HC CHG ASSAY OF SODIUM OTHER SOURCE",null,"83921 - HC CHG ORGANIC ACID 1 QUANTITATIVE",null,null,null,null,"84425 - HC CHG ASSAY OF THIAMINE-VITAMIN B-1",null,"83605 - HC CHG ASSAY OF LACTATE",null,null,null,"84402 - HC CHG ASSAY OF TESTOSTERONE FREE"]
[null,null,null,"84305 - HC CHG ASSAY OF SOMATOMEDIN","84210 - HC CHG ASSAY OF PYRUVATE","84305 - HC CHG ASSAY OF SOMATOMEDIN",null,"83930 - HC Q;OSMOLALITY,SER",null,null,null,null,"84430 - HC CHG ASSAY OF THIOCYANATE",null,"83615 - HC CHG LACTATE DEHYDROGENASE LDH",null,null,null,"84403 - HC CHG ASSAY OF TESTOSTERONE TOTAL"]
[null,null,null,"84307 - HC CHG ASSAY OF SOMATOSTATIN","84244 - HC CHG ASSAY OF RENIN","84307 - HC CHG ASSAY OF SOMATOSTATIN",null,"83935 - HC CHG ASSAY OF OSMOLALITY URINE",null,null,null,null,"84432 - HC CHG ASSAY OF THYROGLOBULIN",null,"83630 - HC CHG LACTOFERRIN FECAL QUALITATIVE",null,null,null,"84425 - HC CHG ASSAY OF THIAMINE-VITAMIN B-1"]
[null,null,null,"84311 - HC CHG SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED","84255 - HC CHG ASSAY OF SELENIUM","84311 - HC CHG SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED",null,"83937 - HC CHG ASSAY OF OSTEOCALCIN",null,null,null,null,"84436 - HC CHG ASSAY OF THYROXINE TOTAL",null,"83655 - HC CHG ASSAY OF LEAD",null,null,null,"84430 - HC CHG ASSAY OF THIOCYANATE"]
[null,null,null,"84376 - HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC","84270 - HC CHG ASSAY OF SEX HORMONE BINDING GLOBULIN","84376 - HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC",null,"83945 - HC CHG ASSAY OF OXALATE",null,null,null,null,"84439 - HC CHG ASSAY OF FREE THYROXINE",null,"83662 - HC L/S RATIO, FOAM STABILITY",null,null,null,"84432 - HC CHG ASSAY OF THYROGLOBULIN"]
[null,null,null,"84402 - HC CHG ASSAY OF TESTOSTERONE FREE","84295 - HC CHG SODIUM SERUM PLASMA OR WHOLE BLOOD","84402 - HC CHG ASSAY OF TESTOSTERONE FREE",null,"83970 - HC CHG ASSAY OF PARATHORMONE",null,null,null,null,"84442 - HC CHG ASSAY OF THYROXINE BNDNG GLOBULIN",null,"83690 - HC CHG ASSAY OF LIPASE",null,null,null,"84436 - HC CHG ASSAY OF THYROXINE TOTAL"]
[null,null,null,"84403 - HC CHG ASSAY OF TESTOSTERONE TOTAL","84300 - HC CHG ASSAY OF URINE SODIUM","84403 - HC CHG ASSAY OF TESTOSTERONE TOTAL",null,"83986 - HC CHG PH BODY FLUID NOT ELSEWHERE SPECIFIED",null,null,null,null,"84443 - HC CHG ASSAY OF THYROID STIMULATING HORMONE TSH",null,"83695 - HC CHG LIPOPROTEIN (A)",null,null,null,"84439 - HC CHG ASSAY OF FREE THYROXINE"]
[null,null,null,"84425 - HC CHG ASSAY OF THIAMINE-VITAMIN B-1","84302 - HC CHG ASSAY OF SODIUM OTHER SOURCE","84425 - HC CHG ASSAY OF THIAMINE-VITAMIN B-1",null,"83992 - HC CHG ASSAY OF PHENCYCLIDINE",null,null,null,null,"84445 - HC CHG THYROID STIMULATING IMMUNE GLOBULINS TSI",null,"83718 - HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL",null,null,null,"84442 - HC CHG ASSAY OF THYROXINE BNDNG GLOBULIN"]
[null,null,null,"84430 - HC CHG ASSAY OF THIOCYANATE","84305 - HC CHG ASSAY OF SOMATOMEDIN","84430 - HC CHG ASSAY OF THIOCYANATE",null,"83993 - HC CHG ASSAY OF CALPROTECTIN FECAL",null,null,null,null,"84446 - HC CHG ASSAY OF TOCOPHEROL ALPHA VITAMIN E",null,"83721 - HC CRL;DIRECT LDL",null,null,null,"84443 - HC CHG ASSAY OF THYROID STIMULATING HORMONE TSH"]
[null,null,null,"84432 - HC CHG ASSAY OF THYROGLOBULIN","84307 - HC CHG ASSAY OF SOMATOSTATIN","84432 - HC CHG ASSAY OF THYROGLOBULIN",null,"84075 - HC CHG ASSAY OF PHOSPHATASE ALKALINE",null,null,null,null,"84450 - HC CHG TRANSFERASE ASPARTATE AMINO AST SGOT",null,"83735 - HC CHG ASSAY OF MAGNESIUM",null,null,null,"84445 - HC CHG THYROID STIMULATING IMMUNE GLOBULINS TSI"]
[null,null,null,"84436 - HC CHG ASSAY OF THYROXINE TOTAL","84311 - HC CHG SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED","84436 - HC CHG ASSAY OF THYROXINE TOTAL",null,"84080 - HC CHG ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES",null,null,null,null,"84460 - HC CHG TRANSFERASE ALANINE AMINO (ALT) (SGPT)",null,"83785 - HC CHG, ASSAY OF MANGANESE",null,null,null,"84446 - HC CHG ASSAY OF TOCOPHEROL ALPHA VITAMIN E"]
[null,null,null,"84439 - HC CHG ASSAY OF FREE THYROXINE","84376 - HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC","84439 - HC CHG ASSAY OF FREE THYROXINE",null,"84100 - HC CHG ASSAY OF PHOSPHORUS INORGANIC",null,null,null,null,"84466 - HC CHG ASSAY OF L7383TRANSFERRIN",null,"83789 - HC CHG MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA",null,null,null,"84450 - HC CHG TRANSFERASE ASPARTATE AMINO AST SGOT"]
[null,null,null,"84442 - HC CHG ASSAY OF THYROXINE BNDNG GLOBULIN","84402 - HC CHG ASSAY OF TESTOSTERONE FREE","84442 - HC CHG ASSAY OF THYROXINE BNDNG GLOBULIN",null,"84105 - HC CHG ASSAY OF PHOSPHORUS INORGANIC URINE",null,null,null,null,"84478 - HC CHG ASSAY OF TRIGLYCERIDES",null,"83825 - HC CHG ASSAY OF MERCURY QUANTITATIVE",null,null,null,"84460 - HC CHG TRANSFERASE ALANINE AMINO (ALT) (SGPT)"]
[null,null,null,"84443 - HC CHG ASSAY OF THYROID STIMULATING HORMONE TSH","84403 - HC CHG ASSAY OF TESTOSTERONE TOTAL","84443 - HC CHG ASSAY OF THYROID STIMULATING HORMONE TSH",null,"84132 - HC CHG POTASSIUM SERUM PLASMA/WHOLE BLOOD",null,null,null,null,"84479 - HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO",null,"83835 - HC CHG METANEPHRINES",null,null,null,"84466 - HC CHG ASSAY OF L7383TRANSFERRIN"]
[null,null,null,"84445 - HC CHG THYROID STIMULATING IMMUNE GLOBULINS TSI","84425 - HC CHG ASSAY OF THIAMINE-VITAMIN B-1","84445 - HC CHG THYROID STIMULATING IMMUNE GLOBULINS TSI",null,"84133 - HC CHG POTASSIUM URINE",null,null,null,null,"84480 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3",null,"83873 - HC CHG MYELIN BASIC PROTEIN CEREBROSPINAL FLUID",null,null,null,"84478 - HC CHG ASSAY OF TRIGLYCERIDES"]
[null,null,null,"84446 - HC CHG ASSAY OF TOCOPHEROL ALPHA VITAMIN E","84430 - HC CHG ASSAY OF THIOCYANATE","84446 - HC CHG ASSAY OF TOCOPHEROL ALPHA VITAMIN E",null,"84134 - HC CHG PREALBUMIN",null,null,null,null,"84481 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 FREE",null,"83874 - HC CHG MYOGLOBIN",null,null,null,"84479 - HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO"]
[null,null,null,"84450 - HC CHG TRANSFERASE ASPARTATE AMINO AST SGOT","84432 - HC CHG ASSAY OF THYROGLOBULIN","84450 - HC CHG TRANSFERASE ASPARTATE AMINO AST SGOT",null,"84144 - HC CHG ASSAY OF PROGESTERONE",null,null,null,null,"84482 - HC CHG TRIIODOTHYRONINE T3 REVERSE",null,"83880 - HC CHG NATRIURETIC PEPTIDE",null,null,null,"84480 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3"]
[null,null,null,"84460 - HC CHG TRANSFERASE ALANINE AMINO (ALT) (SGPT)","84436 - HC CHG ASSAY OF THYROXINE TOTAL","84460 - HC CHG TRANSFERASE ALANINE AMINO (ALT) (SGPT)",null,"84145 - HC CHG PROCALCITONIN (PCT)",null,null,null,null,"84484 - HC CHG ASSAY OF TROPONIN QUANTITATIVE",null,"83883 - HC NEPHELOMETRY, EACH ANALYTE",null,null,null,"84481 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 FREE"]
[null,null,null,"84466 - HC CHG ASSAY OF L7383TRANSFERRIN","84439 - HC CHG ASSAY OF FREE THYROXINE","84466 - HC CHG ASSAY OF L7383TRANSFERRIN",null,"84146 - HC CHG ASSAY OF PROLACTIN",null,null,null,null,"84520 - HC CHG ASSAY OF UREA NITROGEN QUANTITATIVE",null,"83915 - HC CHG ASSAY OF NUCLEOTIDASE 5'-",null,null,null,"84482 - HC CHG TRIIODOTHYRONINE T3 REVERSE"]
[null,null,null,"84478 - HC CHG ASSAY OF TRIGLYCERIDES","84442 - HC CHG ASSAY OF THYROXINE BNDNG GLOBULIN","84478 - HC CHG ASSAY OF TRIGLYCERIDES",null,"84153 - HC CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL",null,null,null,null,"84540 - HC CHG ASSAY OF UREA NITROGEN URINE",null,"83916 - HC CHG OLIGOCLONAL IMMUNE",null,null,null,"84484 - HC CHG ASSAY OF TROPONIN QUANTITATIVE"]
[null,null,null,"84479 - HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO","84443 - HC CHG ASSAY OF THYROID STIMULATING HORMONE TSH","84479 - HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO",null,"84155 - HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD",null,null,null,null,"84550 - HC CHG ASSAY OF BLOOD/URIC ACID",null,"83918 - HC CHG ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN",null,null,null,"84520 - HC CHG ASSAY OF UREA NITROGEN QUANTITATIVE"]
[null,null,null,"84480 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3","84445 - HC CHG THYROID STIMULATING IMMUNE GLOBULINS TSI","84480 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3",null,"84156 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY URINE",null,null,null,null,"84560 - HC CHG ASSAY OF URIC ACID OTHER SOURCE",null,"83921 - HC CHG ORGANIC ACID 1 QUANTITATIVE",null,null,null,"84540 - HC CHG ASSAY OF UREA NITROGEN URINE"]
[null,null,null,"84481 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 FREE","84446 - HC CHG ASSAY OF TOCOPHEROL ALPHA VITAMIN E","84481 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 FREE",null,"84157 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC",null,null,null,null,"84590 - HC CHG ASSAY OF VITAMIN A",null,"83930 - HC Q;OSMOLALITY,SER",null,null,null,"84550 - HC CHG ASSAY OF BLOOD/URIC ACID"]
[null,null,null,"84482 - HC CHG TRIIODOTHYRONINE T3 REVERSE","84450 - HC CHG TRANSFERASE ASPARTATE AMINO AST SGOT","84482 - HC CHG TRIIODOTHYRONINE T3 REVERSE",null,"84163 - HC CHG PREGNANCY-ASSOCIATED PLASMA PROTEIN-A",null,null,null,null,"84591 - HC CHG ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED",null,"83935 - HC CHG ASSAY OF OSMOLALITY URINE",null,null,null,"84560 - HC CHG ASSAY OF URIC ACID OTHER SOURCE"]
[null,null,null,"84484 - HC CHG ASSAY OF TROPONIN QUANTITATIVE","84460 - HC CHG TRANSFERASE ALANINE AMINO (ALT) (SGPT)","84484 - HC CHG ASSAY OF TROPONIN QUANTITATIVE",null,"84165 - HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM",null,null,null,null,"84597 - HC CHG ASSAY OF VITAMIN K",null,"83937 - HC CHG ASSAY OF OSTEOCALCIN",null,null,null,"84590 - HC CHG ASSAY OF VITAMIN A"]
[null,null,null,"84520 - HC CHG ASSAY OF UREA NITROGEN QUANTITATIVE","84466 - HC CHG ASSAY OF L7383TRANSFERRIN","84520 - HC CHG ASSAY OF UREA NITROGEN QUANTITATIVE",null,"84166 - HC CHG PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI",null,null,null,null,"84630 - HC CHG ASSAY OF ZINC",null,"83945 - HC CHG ASSAY OF OXALATE",null,null,null,"84591 - HC CHG ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED"]
[null,null,null,"84540 - HC CHG ASSAY OF UREA NITROGEN URINE","84478 - HC CHG ASSAY OF TRIGLYCERIDES","84540 - HC CHG ASSAY OF UREA NITROGEN URINE",null,"84182 - HC CHG PROTEIN, WESTERN BLOT TEST, W BAND",null,null,null,null,"84681 - HC CHG ASSAY OF C-PEPTIDE",null,"83970 - HC CHG ASSAY OF PARATHORMONE",null,null,null,"84597 - HC CHG ASSAY OF VITAMIN K"]
[null,null,null,"84550 - HC CHG ASSAY OF BLOOD/URIC ACID","84479 - HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO","84550 - HC CHG ASSAY OF BLOOD/URIC ACID",null,"84202 - HC Q;ERYTH PROTPOR",null,null,null,null,"84702 - HC HCG TUMOR MARKER",null,"83986 - HC CHG PH BODY FLUID NOT ELSEWHERE SPECIFIED",null,null,null,"84630 - HC CHG ASSAY OF ZINC"]
[null,null,null,"84560 - HC CHG ASSAY OF URIC ACID OTHER SOURCE","84480 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3","84560 - HC CHG ASSAY OF URIC ACID OTHER SOURCE",null,"84206 - HC CHG ASSAY OF PROINSULIN",null,null,null,null,"84703 - HC GONAD,CHOR(HCG);QL",null,"83992 - HC CHG ASSAY OF PHENCYCLIDINE",null,null,null,"84681 - HC CHG ASSAY OF C-PEPTIDE"]
[null,null,null,"84590 - HC CHG ASSAY OF VITAMIN A","84481 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 FREE","84590 - HC CHG ASSAY OF VITAMIN A",null,"84207 - HC CHG ASSAY OF PYRIDOXAL PHOSPHATE",null,null,null,null,"85004 - HC AUTO DIFF",null,"83993 - HC CHG ASSAY OF CALPROTECTIN FECAL",null,null,null,"84702 - HC HCG TUMOR MARKER"]
[null,null,null,"84591 - HC CHG ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED","84482 - HC CHG TRIIODOTHYRONINE T3 REVERSE","84591 - HC CHG ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED",null,"84210 - HC CHG ASSAY OF PYRUVATE",null,null,null,null,"85014 - HC CHG BLOOD COUNT HEMATOCRIT",null,"84075 - HC CHG ASSAY OF PHOSPHATASE ALKALINE",null,null,null,"84703 - HC GONAD,CHOR(HCG);QL"]
[null,null,null,"84597 - HC CHG ASSAY OF VITAMIN K","84484 - HC CHG ASSAY OF TROPONIN QUANTITATIVE","84597 - HC CHG ASSAY OF VITAMIN K",null,"84244 - HC CHG ASSAY OF RENIN",null,null,null,null,"85018 - POC;HEMOGLOBIN",null,"84080 - HC CHG ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES",null,null,null,"85004 - HC AUTO DIFF"]
[null,null,null,"84630 - HC CHG ASSAY OF ZINC","84520 - HC CHG ASSAY OF UREA NITROGEN QUANTITATIVE","84630 - HC CHG ASSAY OF ZINC",null,"84255 - HC CHG ASSAY OF SELENIUM",null,null,null,null,"85025 - HC CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC",null,"84100 - HC CHG ASSAY OF PHOSPHORUS INORGANIC",null,null,null,"85014 - HC CHG BLOOD COUNT HEMATOCRIT"]
[null,null,null,"84681 - HC CHG ASSAY OF C-PEPTIDE","84540 - HC CHG ASSAY OF UREA NITROGEN URINE","84681 - HC CHG ASSAY OF C-PEPTIDE",null,"84270 - HC CHG ASSAY OF SEX HORMONE BINDING GLOBULIN",null,null,null,null,"85027 - HC CHG BLOOD COUNT COMPLETE AUTOMATED",null,"84105 - HC CHG ASSAY OF PHOSPHORUS INORGANIC URINE",null,null,null,"85018 - POC;HEMOGLOBIN"]
[null,null,null,"84702 - HC HCG TUMOR MARKER","84550 - HC CHG ASSAY OF BLOOD/URIC ACID","84702 - HC HCG TUMOR MARKER",null,"84295 - HC CHG SODIUM SERUM PLASMA OR WHOLE BLOOD",null,null,null,null,"85045 - HC CHG BLOOD COUNT RETICULOCYTE AUTOMATED",null,"84132 - HC CHG POTASSIUM SERUM PLASMA/WHOLE BLOOD",null,null,null,"85025 - HC CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC"]
[null,null,null,"84703 - HC GONAD,CHOR(HCG);QL","84560 - HC CHG ASSAY OF URIC ACID OTHER SOURCE","84703 - HC GONAD,CHOR(HCG);QL",null,"84300 - HC CHG ASSAY OF URINE SODIUM",null,null,null,null,"85046 - HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS",null,"84133 - HC CHG POTASSIUM URINE",null,null,null,"85027 - HC CHG BLOOD COUNT COMPLETE AUTOMATED"]
[null,null,null,"85004 - HC AUTO DIFF","84590 - HC CHG ASSAY OF VITAMIN A","85004 - HC AUTO DIFF",null,"84302 - HC CHG ASSAY OF SODIUM OTHER SOURCE",null,null,null,null,"85048 - HC CHG BLOOD COUNT LEUKOCYTE WBC AUTOMATED",null,"84134 - HC CHG PREALBUMIN",null,null,null,"85045 - HC CHG BLOOD COUNT RETICULOCYTE AUTOMATED"]
[null,null,null,"85014 - HC CHG BLOOD COUNT HEMATOCRIT","84591 - HC CHG ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED","85014 - HC CHG BLOOD COUNT HEMATOCRIT",null,"84305 - HC CHG ASSAY OF SOMATOMEDIN",null,null,null,null,"85049 - HC CHG BLOOD COUNT PLATELET AUTOMATED",null,"84144 - HC CHG ASSAY OF PROGESTERONE",null,null,null,"85046 - HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS"]
[null,null,null,"85018 - POC;HEMOGLOBIN","84597 - HC CHG ASSAY OF VITAMIN K","85018 - POC;HEMOGLOBIN",null,"84307 - HC CHG ASSAY OF SOMATOSTATIN",null,null,null,null,"85055 - HC CHG RETICULATED PLATELET ASSAY",null,"84145 - HC CHG PROCALCITONIN (PCT)",null,null,null,"85048 - HC CHG BLOOD COUNT LEUKOCYTE WBC AUTOMATED"]
[null,null,null,"85025 - HC CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC","84630 - HC CHG ASSAY OF ZINC","85025 - HC CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC",null,"84311 - HC CHG SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED",null,null,null,null,"85060 - HC BL SMEAR W/O DIFF WBC COUNT",null,"84146 - HC CHG ASSAY OF PROLACTIN",null,null,null,"85049 - HC CHG BLOOD COUNT PLATELET AUTOMATED"]
[null,null,null,"85027 - HC CHG BLOOD COUNT COMPLETE AUTOMATED","84681 - HC CHG ASSAY OF C-PEPTIDE","85027 - HC CHG BLOOD COUNT COMPLETE AUTOMATED",null,"84376 - HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC",null,null,null,null,"85210 - HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC",null,"84153 - HC CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL",null,null,null,"85055 - HC CHG RETICULATED PLATELET ASSAY"]
[null,null,null,"85045 - HC CHG BLOOD COUNT RETICULOCYTE AUTOMATED","84702 - HC HCG TUMOR MARKER","85045 - HC CHG BLOOD COUNT RETICULOCYTE AUTOMATED",null,"84402 - HC CHG ASSAY OF TESTOSTERONE FREE",null,null,null,null,"85220 - HC CHG CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR",null,"84155 - HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD",null,null,null,"85060 - HC BL SMEAR W/O DIFF WBC COUNT"]
[null,null,null,"85046 - HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS","84703 - HC GONAD,CHOR(HCG);QL","85046 - HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS",null,"84403 - HC CHG ASSAY OF TESTOSTERONE TOTAL",null,null,null,null,"85230 - HC CHG CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR",null,"84156 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY URINE",null,null,null,"85210 - HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC"]
[null,null,null,"85048 - HC CHG BLOOD COUNT LEUKOCYTE WBC AUTOMATED","85004 - HC AUTO DIFF","85048 - HC CHG BLOOD COUNT LEUKOCYTE WBC AUTOMATED",null,"84425 - HC CHG ASSAY OF THIAMINE-VITAMIN B-1",null,null,null,null,"85240 - HC CHG CLOTTING FACTOR VIII AHG 1 STAGE",null,"84157 - HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC",null,null,null,"85220 - HC CHG CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR"]
[null,null,null,"85049 - HC CHG BLOOD COUNT PLATELET AUTOMATED","85014 - HC CHG BLOOD COUNT HEMATOCRIT","85049 - HC CHG BLOOD COUNT PLATELET AUTOMATED",null,"84430 - HC CHG ASSAY OF THIOCYANATE",null,null,null,null,"85245 - HC CHG CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT",null,"84163 - HC CHG PREGNANCY-ASSOCIATED PLASMA PROTEIN-A",null,null,null,"85230 - HC CHG CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR"]
[null,null,null,"85055 - HC CHG RETICULATED PLATELET ASSAY","85018 - POC;HEMOGLOBIN","85055 - HC CHG RETICULATED PLATELET ASSAY",null,"84432 - HC CHG ASSAY OF THYROGLOBULIN",null,null,null,null,"85246 - HC CHG CLOTTING FACTOR VIII VW FACTOR ANTIGEN",null,"84165 - HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM",null,null,null,"85240 - HC CHG CLOTTING FACTOR VIII AHG 1 STAGE"]
[null,null,null,"85060 - HC BL SMEAR W/O DIFF WBC COUNT","85025 - HC CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC","85060 - HC BL SMEAR W/O DIFF WBC COUNT",null,"84436 - HC CHG ASSAY OF THYROXINE TOTAL",null,null,null,null,"85250 - HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS",null,"84166 - HC CHG PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI",null,null,null,"85245 - HC CHG CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT"]
[null,null,null,"85210 - HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC","85027 - HC CHG BLOOD COUNT COMPLETE AUTOMATED","85210 - HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC",null,"84439 - HC CHG ASSAY OF FREE THYROXINE",null,null,null,null,"85260 - HC CHG CLOTTING FACTOR X STUART-PROWER",null,"84182 - HC CHG PROTEIN, WESTERN BLOT TEST, W BAND",null,null,null,"85246 - HC CHG CLOTTING FACTOR VIII VW FACTOR ANTIGEN"]
[null,null,null,"85220 - HC CHG CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR","85045 - HC CHG BLOOD COUNT RETICULOCYTE AUTOMATED","85220 - HC CHG CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR",null,"84442 - HC CHG ASSAY OF THYROXINE BNDNG GLOBULIN",null,null,null,null,"85270 - HC CHG CLOTTING FACTOR XI PTA",null,"84202 - HC Q;ERYTH PROTPOR",null,null,null,"85250 - HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS"]
[null,null,null,"85230 - HC CHG CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR","85046 - HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS","85230 - HC CHG CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR",null,"84443 - HC CHG ASSAY OF THYROID STIMULATING HORMONE TSH",null,null,null,null,"85280 - HC CHG CLOTTING FACTOR XII HAGEMAN",null,"84206 - HC CHG ASSAY OF PROINSULIN",null,null,null,"85260 - HC CHG CLOTTING FACTOR X STUART-PROWER"]
[null,null,null,"85240 - HC CHG CLOTTING FACTOR VIII AHG 1 STAGE","85048 - HC CHG BLOOD COUNT LEUKOCYTE WBC AUTOMATED","85240 - HC CHG CLOTTING FACTOR VIII AHG 1 STAGE",null,"84445 - HC CHG THYROID STIMULATING IMMUNE GLOBULINS TSI",null,null,null,null,"85290 - HC CHG CLOTTING FACTOR XIII FIBRIN STABILIZING",null,"84207 - HC CHG ASSAY OF PYRIDOXAL PHOSPHATE",null,null,null,"85270 - HC CHG CLOTTING FACTOR XI PTA"]
[null,null,null,"85245 - HC CHG CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT","85049 - HC CHG BLOOD COUNT PLATELET AUTOMATED","85245 - HC CHG CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT",null,"84446 - HC CHG ASSAY OF TOCOPHEROL ALPHA VITAMIN E",null,null,null,null,"85300 - HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY",null,"84210 - HC CHG ASSAY OF PYRUVATE",null,null,null,"85280 - HC CHG CLOTTING FACTOR XII HAGEMAN"]
[null,null,null,"85246 - HC CHG CLOTTING FACTOR VIII VW FACTOR ANTIGEN","85055 - HC CHG RETICULATED PLATELET ASSAY","85246 - HC CHG CLOTTING FACTOR VIII VW FACTOR ANTIGEN",null,"84450 - HC CHG TRANSFERASE ASPARTATE AMINO AST SGOT",null,null,null,null,"85301 - HC CHG CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY",null,"84244 - HC CHG ASSAY OF RENIN",null,null,null,"85290 - HC CHG CLOTTING FACTOR XIII FIBRIN STABILIZING"]
[null,null,null,"85250 - HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS","85060 - HC BL SMEAR W/O DIFF WBC COUNT","85250 - HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS",null,"84460 - HC CHG TRANSFERASE ALANINE AMINO (ALT) (SGPT)",null,null,null,null,"85302 - HC CHG CLOTTING INHIBITORS PROTEIN C ANTIGEN",null,"84255 - HC CHG ASSAY OF SELENIUM",null,null,null,"85300 - HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY"]
[null,null,null,"85260 - HC CHG CLOTTING FACTOR X STUART-PROWER","85210 - HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC","85260 - HC CHG CLOTTING FACTOR X STUART-PROWER",null,"84466 - HC CHG ASSAY OF L7383TRANSFERRIN",null,null,null,null,"85303 - HC CHG CLOTTING INHIBITORS PROTEIN C ACTIVITY",null,"84270 - HC CHG ASSAY OF SEX HORMONE BINDING GLOBULIN",null,null,null,"85301 - HC CHG CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY"]
[null,null,null,"85270 - HC CHG CLOTTING FACTOR XI PTA","85220 - HC CHG CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR","85270 - HC CHG CLOTTING FACTOR XI PTA",null,"84478 - HC CHG ASSAY OF TRIGLYCERIDES",null,null,null,null,"85305 - HC CHG CLOTTING INHIBITORS PROTEIN S TOTAL",null,"84295 - HC CHG SODIUM SERUM PLASMA OR WHOLE BLOOD",null,null,null,"85302 - HC CHG CLOTTING INHIBITORS PROTEIN C ANTIGEN"]
[null,null,null,"85280 - HC CHG CLOTTING FACTOR XII HAGEMAN","85230 - HC CHG CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR","85280 - HC CHG CLOTTING FACTOR XII HAGEMAN",null,"84479 - HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO",null,null,null,null,"85306 - HC CHG CLOTTING INHIBITORS PROTEIN S FREE",null,"84300 - HC CHG ASSAY OF URINE SODIUM",null,null,null,"85303 - HC CHG CLOTTING INHIBITORS PROTEIN C ACTIVITY"]
[null,null,null,"85290 - HC CHG CLOTTING FACTOR XIII FIBRIN STABILIZING","85240 - HC CHG CLOTTING FACTOR VIII AHG 1 STAGE","85290 - HC CHG CLOTTING FACTOR XIII FIBRIN STABILIZING",null,"84480 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3",null,null,null,null,"85307 - HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY",null,"84302 - HC CHG ASSAY OF SODIUM OTHER SOURCE",null,null,null,"85305 - HC CHG CLOTTING INHIBITORS PROTEIN S TOTAL"]
[null,null,null,"85300 - HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY","85245 - HC CHG CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT","85300 - HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY",null,"84481 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 FREE",null,null,null,null,"85347 - HC CHG COAGULATION TIME ACTIVATED",null,"84305 - HC CHG ASSAY OF SOMATOMEDIN",null,null,null,"85306 - HC CHG CLOTTING INHIBITORS PROTEIN S FREE"]
[null,null,null,"85301 - HC CHG CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY","85246 - HC CHG CLOTTING FACTOR VIII VW FACTOR ANTIGEN","85301 - HC CHG CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY",null,"84482 - HC CHG TRIIODOTHYRONINE T3 REVERSE",null,null,null,null,"85366 - HC CHG FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ",null,"84307 - HC CHG ASSAY OF SOMATOSTATIN",null,null,null,"85307 - HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY"]
[null,null,null,"85302 - HC CHG CLOTTING INHIBITORS PROTEIN C ANTIGEN","85250 - HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS","85302 - HC CHG CLOTTING INHIBITORS PROTEIN C ANTIGEN",null,"84484 - HC CHG ASSAY OF TROPONIN QUANTITATIVE",null,null,null,null,"85378 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN",null,"84311 - HC CHG SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED",null,null,null,"85347 - HC CHG COAGULATION TIME ACTIVATED"]
[null,null,null,"85303 - HC CHG CLOTTING INHIBITORS PROTEIN C ACTIVITY","85260 - HC CHG CLOTTING FACTOR X STUART-PROWER","85303 - HC CHG CLOTTING INHIBITORS PROTEIN C ACTIVITY",null,"84520 - HC CHG ASSAY OF UREA NITROGEN QUANTITATIVE",null,null,null,null,"85379 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE",null,"84376 - HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC",null,null,null,"85366 - HC CHG FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ"]
[null,null,null,"85305 - HC CHG CLOTTING INHIBITORS PROTEIN S TOTAL","85270 - HC CHG CLOTTING FACTOR XI PTA","85305 - HC CHG CLOTTING INHIBITORS PROTEIN S TOTAL",null,"84540 - HC CHG ASSAY OF UREA NITROGEN URINE",null,null,null,null,"85384 - HC CHG FIBRINOGEN ACTIVITY",null,"84402 - HC CHG ASSAY OF TESTOSTERONE FREE",null,null,null,"85378 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN"]
[null,null,null,"85306 - HC CHG CLOTTING INHIBITORS PROTEIN S FREE","85280 - HC CHG CLOTTING FACTOR XII HAGEMAN","85306 - HC CHG CLOTTING INHIBITORS PROTEIN S FREE",null,"84550 - HC CHG ASSAY OF BLOOD/URIC ACID",null,null,null,null,"85397 - HC CHG CLOTTING FUNCTION ACTIVITY NOS, EA ANALYT",null,"84403 - HC CHG ASSAY OF TESTOSTERONE TOTAL",null,null,null,"85379 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE"]
[null,null,null,"85307 - HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY","85290 - HC CHG CLOTTING FACTOR XIII FIBRIN STABILIZING","85307 - HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY",null,"84560 - HC CHG ASSAY OF URIC ACID OTHER SOURCE",null,null,null,null,"85461 - HC CHG HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE",null,"84425 - HC CHG ASSAY OF THIAMINE-VITAMIN B-1",null,null,null,"85384 - HC CHG FIBRINOGEN ACTIVITY"]
[null,null,null,"85347 - HC CHG COAGULATION TIME ACTIVATED","85300 - HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY","85347 - HC CHG COAGULATION TIME ACTIVATED",null,"84590 - HC CHG ASSAY OF VITAMIN A",null,null,null,null,"85520 - HC CHG HEPARIN ASSAY",null,"84430 - HC CHG ASSAY OF THIOCYANATE",null,null,null,"85397 - HC CHG CLOTTING FUNCTION ACTIVITY NOS, EA ANALYT"]
[null,null,null,"85366 - HC CHG FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ","85301 - HC CHG CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY","85366 - HC CHG FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ",null,"84591 - HC CHG ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED",null,null,null,null,"85549 - HC CHG MURAMIDASE",null,"84432 - HC CHG ASSAY OF THYROGLOBULIN",null,null,null,"85461 - HC CHG HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE"]
[null,null,null,"85378 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN","85302 - HC CHG CLOTTING INHIBITORS PROTEIN C ANTIGEN","85378 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN",null,"84597 - HC CHG ASSAY OF VITAMIN K",null,null,null,null,"85576 - HC CHG PLATELET AGGREGATION IN VITRO EACH AGENT",null,"84436 - HC CHG ASSAY OF THYROXINE TOTAL",null,null,null,"85520 - HC CHG HEPARIN ASSAY"]
[null,null,null,"85379 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE","85303 - HC CHG CLOTTING INHIBITORS PROTEIN C ACTIVITY","85379 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE",null,"84630 - HC CHG ASSAY OF ZINC",null,null,null,null,"85610 - POC;INR",null,"84439 - HC CHG ASSAY OF FREE THYROXINE",null,null,null,"85549 - HC CHG MURAMIDASE"]
[null,null,null,"85384 - HC CHG FIBRINOGEN ACTIVITY","85305 - HC CHG CLOTTING INHIBITORS PROTEIN S TOTAL","85384 - HC CHG FIBRINOGEN ACTIVITY",null,"84681 - HC CHG ASSAY OF C-PEPTIDE",null,null,null,null,"85611 - HC CHG PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH",null,"84442 - HC CHG ASSAY OF THYROXINE BNDNG GLOBULIN",null,null,null,"85576 - HC CHG PLATELET AGGREGATION IN VITRO EACH AGENT"]
[null,null,null,"85397 - HC CHG CLOTTING FUNCTION ACTIVITY NOS, EA ANALYT","85306 - HC CHG CLOTTING INHIBITORS PROTEIN S FREE","85397 - HC CHG CLOTTING FUNCTION ACTIVITY NOS, EA ANALYT",null,"84702 - HC HCG TUMOR MARKER",null,null,null,null,"85613 - HC CHG RUSSELL VIPER VENOM DILUTED",null,"84443 - HC CHG ASSAY OF THYROID STIMULATING HORMONE TSH",null,null,null,"85610 - POC;INR"]
[null,null,null,"85461 - HC CHG HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE","85307 - HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY","85461 - HC CHG HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE",null,"84703 - HC GONAD,CHOR(HCG);QL",null,null,null,null,"85651 - SEDIMENTATION RATE RBC NON-AUTOMATED",null,"84445 - HC CHG THYROID STIMULATING IMMUNE GLOBULINS TSI",null,null,null,"85611 - HC CHG PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH"]
[null,null,null,"85520 - HC CHG HEPARIN ASSAY","85347 - HC CHG COAGULATION TIME ACTIVATED","85520 - HC CHG HEPARIN ASSAY",null,"85004 - HC AUTO DIFF",null,null,null,null,"85652 - HC CHG SEDIMENTATION RATE RBC AUTOMATED",null,"84446 - HC CHG ASSAY OF TOCOPHEROL ALPHA VITAMIN E",null,null,null,"85613 - HC CHG RUSSELL VIPER VENOM DILUTED"]
[null,null,null,"85549 - HC CHG MURAMIDASE","85366 - HC CHG FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ","85549 - HC CHG MURAMIDASE",null,"85014 - HC CHG BLOOD COUNT HEMATOCRIT",null,null,null,null,"85660 - HC CHG SICKLING RBC REDUCTION",null,"84450 - HC CHG TRANSFERASE ASPARTATE AMINO AST SGOT",null,null,null,"85651 - SEDIMENTATION RATE RBC NON-AUTOMATED"]
[null,null,null,"85576 - HC CHG PLATELET AGGREGATION IN VITRO EACH AGENT","85378 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN","85576 - HC CHG PLATELET AGGREGATION IN VITRO EACH AGENT",null,"85018 - POC;HEMOGLOBIN",null,null,null,null,"85670 - HC CHG THROMBIN TIME PLASMA",null,"84460 - HC CHG TRANSFERASE ALANINE AMINO (ALT) (SGPT)",null,null,null,"85652 - HC CHG SEDIMENTATION RATE RBC AUTOMATED"]
[null,null,null,"85610 - POC;INR","85379 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE","85610 - POC;INR",null,"85025 - HC CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC",null,null,null,null,"85705 - HC CHG THROMBOPLASTIN INHIBITION TISSUE",null,"84466 - HC CHG ASSAY OF L7383TRANSFERRIN",null,null,null,"85660 - HC CHG SICKLING RBC REDUCTION"]
[null,null,null,"85611 - HC CHG PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH","85384 - HC CHG FIBRINOGEN ACTIVITY","85611 - HC CHG PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH",null,"85027 - HC CHG BLOOD COUNT COMPLETE AUTOMATED",null,null,null,null,"85730 - HC CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD",null,"84478 - HC CHG ASSAY OF TRIGLYCERIDES",null,null,null,"85670 - HC CHG THROMBIN TIME PLASMA"]
[null,null,null,"85613 - HC CHG RUSSELL VIPER VENOM DILUTED","85397 - HC CHG CLOTTING FUNCTION ACTIVITY NOS, EA ANALYT","85613 - HC CHG RUSSELL VIPER VENOM DILUTED",null,"85045 - HC CHG BLOOD COUNT RETICULOCYTE AUTOMATED",null,null,null,null,"85732 - HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA",null,"84479 - HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO",null,null,null,"85705 - HC CHG THROMBOPLASTIN INHIBITION TISSUE"]
[null,null,null,"85651 - SEDIMENTATION RATE RBC NON-AUTOMATED","85461 - HC CHG HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE","85651 - SEDIMENTATION RATE RBC NON-AUTOMATED",null,"85046 - HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS",null,null,null,null,"85810 - HC CHG VISCOSITY",null,"84480 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3",null,null,null,"85730 - HC CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD"]
[null,null,null,"85652 - HC CHG SEDIMENTATION RATE RBC AUTOMATED","85520 - HC CHG HEPARIN ASSAY","85652 - HC CHG SEDIMENTATION RATE RBC AUTOMATED",null,"85048 - HC CHG BLOOD COUNT LEUKOCYTE WBC AUTOMATED",null,null,null,null,"86003 - HC CHG ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN",null,"84481 - HC CHG ASSAY OF TRIIODOTHYRONINE T3 FREE",null,null,null,"85732 - HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA"]
[null,null,null,"85660 - HC CHG SICKLING RBC REDUCTION","85549 - HC CHG MURAMIDASE","85660 - HC CHG SICKLING RBC REDUCTION",null,"85049 - HC CHG BLOOD COUNT PLATELET AUTOMATED",null,null,null,null,"86021 - HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES",null,"84482 - HC CHG TRIIODOTHYRONINE T3 REVERSE",null,null,null,"85810 - HC CHG VISCOSITY"]
[null,null,null,"85670 - HC CHG THROMBIN TIME PLASMA","85576 - HC CHG PLATELET AGGREGATION IN VITRO EACH AGENT","85670 - HC CHG THROMBIN TIME PLASMA",null,"85055 - HC CHG RETICULATED PLATELET ASSAY",null,null,null,null,"86022 - HC CRL;SEROTONIN RLS ASSAY",null,"84484 - HC CHG ASSAY OF TROPONIN QUANTITATIVE",null,null,null,"86003 - HC CHG ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN"]
[null,null,null,"85705 - HC CHG THROMBOPLASTIN INHIBITION TISSUE","85610 - POC;INR","85705 - HC CHG THROMBOPLASTIN INHIBITION TISSUE",null,"85060 - HC BL SMEAR W/O DIFF WBC COUNT",null,null,null,null,"86038 - HC CHG ANTINUCLEAR ANTIBODIES ANA",null,"84520 - HC CHG ASSAY OF UREA NITROGEN QUANTITATIVE",null,null,null,"86021 - HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES"]
[null,null,null,"85730 - HC CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD","85611 - HC CHG PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH","85730 - HC CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD",null,"85210 - HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC",null,null,null,null,"86039 - HC CHG ANTINUCLEAR ANTIBODIES ANA TITER",null,"84540 - HC CHG ASSAY OF UREA NITROGEN URINE",null,null,null,"86022 - HC CRL;SEROTONIN RLS ASSAY"]
[null,null,null,"85732 - HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA","85613 - HC CHG RUSSELL VIPER VENOM DILUTED","85732 - HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA",null,"85220 - HC CHG CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR",null,null,null,null,"86060 - HC CHG ANTISTREPTOLYSIN O TITER",null,"84550 - HC CHG ASSAY OF BLOOD/URIC ACID",null,null,null,"86038 - HC CHG ANTINUCLEAR ANTIBODIES ANA"]
[null,null,null,"85810 - HC CHG VISCOSITY","85651 - SEDIMENTATION RATE RBC NON-AUTOMATED","85810 - HC CHG VISCOSITY",null,"85230 - HC CHG CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR",null,null,null,null,"86140 - C-REACTIVE PROTEIN",null,"84560 - HC CHG ASSAY OF URIC ACID OTHER SOURCE",null,null,null,"86039 - HC CHG ANTINUCLEAR ANTIBODIES ANA TITER"]
[null,null,null,"86003 - HC CHG ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN","85652 - HC CHG SEDIMENTATION RATE RBC AUTOMATED","86003 - HC CHG ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN",null,"85240 - HC CHG CLOTTING FACTOR VIII AHG 1 STAGE",null,null,null,null,"86141 - HC CRL;CARDIO CRP",null,"84590 - HC CHG ASSAY OF VITAMIN A",null,null,null,"86060 - HC CHG ANTISTREPTOLYSIN O TITER"]
[null,null,null,"86021 - HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES","85660 - HC CHG SICKLING RBC REDUCTION","86021 - HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES",null,"85245 - HC CHG CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT",null,null,null,null,"86146 - HC CRL;BETA-2 GLYCPRTN 1 AB",null,"84591 - HC CHG ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED",null,null,null,"86140 - C-REACTIVE PROTEIN"]
[null,null,null,"86022 - HC CRL;SEROTONIN RLS ASSAY","85670 - HC CHG THROMBIN TIME PLASMA","86022 - HC CRL;SEROTONIN RLS ASSAY",null,"85246 - HC CHG CLOTTING FACTOR VIII VW FACTOR ANTIGEN",null,null,null,null,"86147 - HC Q;CARDLIP AB;IGG,IGM,IGA",null,"84597 - HC CHG ASSAY OF VITAMIN K",null,null,null,"86141 - HC CRL;CARDIO CRP"]
[null,null,null,"86038 - HC CHG ANTINUCLEAR ANTIBODIES ANA","85705 - HC CHG THROMBOPLASTIN INHIBITION TISSUE","86038 - HC CHG ANTINUCLEAR ANTIBODIES ANA",null,"85250 - HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS",null,null,null,null,"86157 - HC CHG COLD AGGLUTININ TITER",null,"84630 - HC CHG ASSAY OF ZINC",null,null,null,"86146 - HC CRL;BETA-2 GLYCPRTN 1 AB"]
[null,null,null,"86039 - HC CHG ANTINUCLEAR ANTIBODIES ANA TITER","85730 - HC CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD","86039 - HC CHG ANTINUCLEAR ANTIBODIES ANA TITER",null,"85260 - HC CHG CLOTTING FACTOR X STUART-PROWER",null,null,null,null,"86160 - HC CHG COMPLEMENT ANTIGEN EACH COMPONENT",null,"84681 - HC CHG ASSAY OF C-PEPTIDE",null,null,null,"86147 - HC Q;CARDLIP AB;IGG,IGM,IGA"]
[null,null,null,"86060 - HC CHG ANTISTREPTOLYSIN O TITER","85732 - HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA","86060 - HC CHG ANTISTREPTOLYSIN O TITER",null,"85270 - HC CHG CLOTTING FACTOR XI PTA",null,null,null,null,"86161 - HC CHG COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT",null,"84702 - HC HCG TUMOR MARKER",null,null,null,"86157 - HC CHG COLD AGGLUTININ TITER"]
[null,null,null,"86140 - C-REACTIVE PROTEIN","85810 - HC CHG VISCOSITY","86140 - C-REACTIVE PROTEIN",null,"85280 - HC CHG CLOTTING FACTOR XII HAGEMAN",null,null,null,null,"86162 - HC CHG COMPLEMENT TOTAL HEMOLYTIC",null,"84703 - HC GONAD,CHOR(HCG);QL",null,null,null,"86160 - HC CHG COMPLEMENT ANTIGEN EACH COMPONENT"]
[null,null,null,"86141 - HC CRL;CARDIO CRP","86003 - HC CHG ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN","86141 - HC CRL;CARDIO CRP",null,"85290 - HC CHG CLOTTING FACTOR XIII FIBRIN STABILIZING",null,null,null,null,"86200 - HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY",null,"85004 - HC AUTO DIFF",null,null,null,"86161 - HC CHG COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT"]
[null,null,null,"86146 - HC CRL;BETA-2 GLYCPRTN 1 AB","86021 - HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES","86146 - HC CRL;BETA-2 GLYCPRTN 1 AB",null,"85300 - HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY",null,null,null,null,"86235 - HC CHG EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD",null,"85014 - HC CHG BLOOD COUNT HEMATOCRIT",null,null,null,"86162 - HC CHG COMPLEMENT TOTAL HEMOLYTIC"]
[null,null,null,"86147 - HC Q;CARDLIP AB;IGG,IGM,IGA","86022 - HC CRL;SEROTONIN RLS ASSAY","86147 - HC Q;CARDLIP AB;IGG,IGM,IGA",null,"85301 - HC CHG CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY",null,null,null,null,"86255 - HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY",null,"85018 - POC;HEMOGLOBIN",null,null,null,"86200 - HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY"]
[null,null,null,"86157 - HC CHG COLD AGGLUTININ TITER","86038 - HC CHG ANTINUCLEAR ANTIBODIES ANA","86157 - HC CHG COLD AGGLUTININ TITER",null,"85302 - HC CHG CLOTTING INHIBITORS PROTEIN C ANTIGEN",null,null,null,null,"86256 - HC CHG FLUORESCENT ANTIBODY; TITER",null,"85025 - HC CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC",null,null,null,"86235 - HC CHG EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD"]
[null,null,null,"86160 - HC CHG COMPLEMENT ANTIGEN EACH COMPONENT","86039 - HC CHG ANTINUCLEAR ANTIBODIES ANA TITER","86160 - HC CHG COMPLEMENT ANTIGEN EACH COMPONENT",null,"85303 - HC CHG CLOTTING INHIBITORS PROTEIN C ACTIVITY",null,null,null,null,"86300 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3",null,"85027 - HC CHG BLOOD COUNT COMPLETE AUTOMATED",null,null,null,"86255 - HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY"]
[null,null,null,"86161 - HC CHG COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT","86060 - HC CHG ANTISTREPTOLYSIN O TITER","86161 - HC CHG COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT",null,"85305 - HC CHG CLOTTING INHIBITORS PROTEIN S TOTAL",null,null,null,null,"86301 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9",null,"85045 - HC CHG BLOOD COUNT RETICULOCYTE AUTOMATED",null,null,null,"86256 - HC CHG FLUORESCENT ANTIBODY; TITER"]
[null,null,null,"86162 - HC CHG COMPLEMENT TOTAL HEMOLYTIC","86140 - C-REACTIVE PROTEIN","86162 - HC CHG COMPLEMENT TOTAL HEMOLYTIC",null,"85306 - HC CHG CLOTTING INHIBITORS PROTEIN S FREE",null,null,null,null,"86304 - HC CRL;CA-125",null,"85046 - HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS",null,null,null,"86300 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3"]
[null,null,null,"86200 - HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY","86141 - HC CRL;CARDIO CRP","86200 - HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY",null,"85307 - HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY",null,null,null,null,"86308 - HC CHG HETEROPHILE ANTIBODIES SCREEN",null,"85048 - HC CHG BLOOD COUNT LEUKOCYTE WBC AUTOMATED",null,null,null,"86301 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9"]
[null,null,null,"86235 - HC CHG EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD","86146 - HC CRL;BETA-2 GLYCPRTN 1 AB","86235 - HC CHG EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD",null,"85347 - HC CHG COAGULATION TIME ACTIVATED",null,null,null,null,"86316 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE",null,"85049 - HC CHG BLOOD COUNT PLATELET AUTOMATED",null,null,null,"86304 - HC CRL;CA-125"]
[null,null,null,"86255 - HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY","86147 - HC Q;CARDLIP AB;IGG,IGM,IGA","86255 - HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY",null,"85366 - HC CHG FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ",null,null,null,null,"86317 - HC IMMUNOASSAY,INFECT AGENT,QUANT",null,"85055 - HC CHG RETICULATED PLATELET ASSAY",null,null,null,"86308 - HC CHG HETEROPHILE ANTIBODIES SCREEN"]
[null,null,null,"86256 - HC CHG FLUORESCENT ANTIBODY; TITER","86157 - HC CHG COLD AGGLUTININ TITER","86256 - HC CHG FLUORESCENT ANTIBODY; TITER",null,"85378 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN",null,null,null,null,"86328 - IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY; CORONAVIRUS 2",null,"85060 - HC BL SMEAR W/O DIFF WBC COUNT",null,null,null,"86316 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE"]
[null,null,null,"86300 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3","86160 - HC CHG COMPLEMENT ANTIGEN EACH COMPONENT","86300 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3",null,"85379 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE",null,null,null,null,"86331 - HC CHG IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY",null,"85210 - HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC",null,null,null,"86317 - HC IMMUNOASSAY,INFECT AGENT,QUANT"]
[null,null,null,"86301 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9","86161 - HC CHG COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT","86301 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9",null,"85384 - HC CHG FIBRINOGEN ACTIVITY",null,null,null,null,"86334 - HC CHG IMMUNOFIXJ ELECTROPHORESIS SERUM",null,"85220 - HC CHG CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR",null,null,null,"86328 - IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY; CORONAVIRUS 2"]
[null,null,null,"86304 - HC CRL;CA-125","86162 - HC CHG COMPLEMENT TOTAL HEMOLYTIC","86304 - HC CRL;CA-125",null,"85397 - HC CHG CLOTTING FUNCTION ACTIVITY NOS, EA ANALYT",null,null,null,null,"86335 - HC CHG IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS",null,"85230 - HC CHG CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR",null,null,null,"86331 - HC CHG IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY"]
[null,null,null,"86308 - HC CHG HETEROPHILE ANTIBODIES SCREEN","86200 - HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY","86308 - HC CHG HETEROPHILE ANTIBODIES SCREEN",null,"85461 - HC CHG HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE",null,null,null,null,"86336 - HC CHG INHIBIN A",null,"85240 - HC CHG CLOTTING FACTOR VIII AHG 1 STAGE",null,null,null,"86334 - HC CHG IMMUNOFIXJ ELECTROPHORESIS SERUM"]
[null,null,null,"86316 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE","86235 - HC CHG EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD","86316 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE",null,"85520 - HC CHG HEPARIN ASSAY",null,null,null,null,"86340 - HC CHG INTRINSIC FACTOR ANTIBODIES",null,"85245 - HC CHG CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT",null,null,null,"86335 - HC CHG IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS"]
[null,null,null,"86317 - HC IMMUNOASSAY,INFECT AGENT,QUANT","86255 - HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY","86317 - HC IMMUNOASSAY,INFECT AGENT,QUANT",null,"85549 - HC CHG MURAMIDASE",null,null,null,null,"86341 - HC CHG ISLET CELL ANTIBODY",null,"85246 - HC CHG CLOTTING FACTOR VIII VW FACTOR ANTIGEN",null,null,null,"86336 - HC CHG INHIBIN A"]
[null,null,null,"86328 - IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY; CORONAVIRUS 2","86256 - HC CHG FLUORESCENT ANTIBODY; TITER","86328 - IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY; CORONAVIRUS 2",null,"85576 - HC CHG PLATELET AGGREGATION IN VITRO EACH AGENT",null,null,null,null,"86353 - HC CHG LYMPHOCYTE TRANSFORMATION",null,"85250 - HC CHG CLOTTING FACTOR IX PTC/CHRISTMAS",null,null,null,"86340 - HC CHG INTRINSIC FACTOR ANTIBODIES"]
[null,null,null,"86331 - HC CHG IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY","86300 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3","86331 - HC CHG IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY",null,"85610 - POC;INR",null,null,null,null,"86355 - HC B CELLS TOTAL COUNT",null,"85260 - HC CHG CLOTTING FACTOR X STUART-PROWER",null,null,null,"86341 - HC CHG ISLET CELL ANTIBODY"]
[null,null,null,"86334 - HC CHG IMMUNOFIXJ ELECTROPHORESIS SERUM","86301 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9","86334 - HC CHG IMMUNOFIXJ ELECTROPHORESIS SERUM",null,"85611 - HC CHG PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH",null,null,null,null,"86357 - HC NK CELLS, TOTAL COUNT",null,"85270 - HC CHG CLOTTING FACTOR XI PTA",null,null,null,"86353 - HC CHG LYMPHOCYTE TRANSFORMATION"]
[null,null,null,"86335 - HC CHG IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS","86304 - HC CRL;CA-125","86335 - HC CHG IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS",null,"85613 - HC CHG RUSSELL VIPER VENOM DILUTED",null,null,null,null,"86359 - HC CHG T CELLS TOTAL COUNT",null,"85280 - HC CHG CLOTTING FACTOR XII HAGEMAN",null,null,null,"86355 - HC B CELLS TOTAL COUNT"]
[null,null,null,"86336 - HC CHG INHIBIN A","86308 - HC CHG HETEROPHILE ANTIBODIES SCREEN","86336 - HC CHG INHIBIN A",null,"85651 - SEDIMENTATION RATE RBC NON-AUTOMATED",null,null,null,null,"86360 - HC CHG T CELLS ABSOLUTE CD4&CD8 COUNT RATIO",null,"85290 - HC CHG CLOTTING FACTOR XIII FIBRIN STABILIZING",null,null,null,"86357 - HC NK CELLS, TOTAL COUNT"]
[null,null,null,"86340 - HC CHG INTRINSIC FACTOR ANTIBODIES","86316 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE","86340 - HC CHG INTRINSIC FACTOR ANTIBODIES",null,"85652 - HC CHG SEDIMENTATION RATE RBC AUTOMATED",null,null,null,null,"86376 - HC CHG MICROSOMAL ANTIBODIES EACH",null,"85300 - HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY",null,null,null,"86359 - HC CHG T CELLS TOTAL COUNT"]
[null,null,null,"86341 - HC CHG ISLET CELL ANTIBODY","86317 - HC IMMUNOASSAY,INFECT AGENT,QUANT","86341 - HC CHG ISLET CELL ANTIBODY",null,"85660 - HC CHG SICKLING RBC REDUCTION",null,null,null,null,"86382 - HC CHG NEUTRALIZATION TEST VIRAL",null,"85301 - HC CHG CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY",null,null,null,"86360 - HC CHG T CELLS ABSOLUTE CD4&CD8 COUNT RATIO"]
[null,null,null,"86353 - HC CHG LYMPHOCYTE TRANSFORMATION","86328 - IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY; CORONAVIRUS 2","86353 - HC CHG LYMPHOCYTE TRANSFORMATION",null,"85670 - HC CHG THROMBIN TIME PLASMA",null,null,null,null,"86403 - HC CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY",null,"85302 - HC CHG CLOTTING INHIBITORS PROTEIN C ANTIGEN",null,null,null,"86376 - HC CHG MICROSOMAL ANTIBODIES EACH"]
[null,null,null,"86355 - HC B CELLS TOTAL COUNT","86331 - HC CHG IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY","86355 - HC B CELLS TOTAL COUNT",null,"85705 - HC CHG THROMBOPLASTIN INHIBITION TISSUE",null,null,null,null,"86431 - HC CHG RHEUMATOID FACTOR QUANTITATIVE",null,"85303 - HC CHG CLOTTING INHIBITORS PROTEIN C ACTIVITY",null,null,null,"86382 - HC CHG NEUTRALIZATION TEST VIRAL"]
[null,null,null,"86357 - HC NK CELLS, TOTAL COUNT","86334 - HC CHG IMMUNOFIXJ ELECTROPHORESIS SERUM","86357 - HC NK CELLS, TOTAL COUNT",null,"85730 - HC CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD",null,null,null,null,"86480 - HC CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON",null,"85305 - HC CHG CLOTTING INHIBITORS PROTEIN S TOTAL",null,null,null,"86403 - HC CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY"]
[null,null,null,"86359 - HC CHG T CELLS TOTAL COUNT","86335 - HC CHG IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS","86359 - HC CHG T CELLS TOTAL COUNT",null,"85732 - HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA",null,null,null,null,"86481 - HC TB TEST CELL MEDIATED ANTIGEN RESPONSE, ENUM GAMMA INTERFRON T-CELL",null,"85306 - HC CHG CLOTTING INHIBITORS PROTEIN S FREE",null,null,null,"86431 - HC CHG RHEUMATOID FACTOR QUANTITATIVE"]
[null,null,null,"86360 - HC CHG T CELLS ABSOLUTE CD4&CD8 COUNT RATIO","86336 - HC CHG INHIBIN A","86360 - HC CHG T CELLS ABSOLUTE CD4&CD8 COUNT RATIO",null,"85810 - HC CHG VISCOSITY",null,null,null,null,"86485 - HC CHG SKIN TEST CANDIDA",null,"85307 - HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY",null,null,null,"86480 - HC CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON"]
[null,null,null,"86376 - HC CHG MICROSOMAL ANTIBODIES EACH","86340 - HC CHG INTRINSIC FACTOR ANTIBODIES","86376 - HC CHG MICROSOMAL ANTIBODIES EACH",null,"86003 - HC CHG ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN",null,null,null,null,"86486 - SKIN TEST UNLISTED ANTIGEN EACH",null,"85347 - HC CHG COAGULATION TIME ACTIVATED",null,null,null,"86481 - HC TB TEST CELL MEDIATED ANTIGEN RESPONSE, ENUM GAMMA INTERFRON T-CELL"]
[null,null,null,"86382 - HC CHG NEUTRALIZATION TEST VIRAL","86341 - HC CHG ISLET CELL ANTIBODY","86382 - HC CHG NEUTRALIZATION TEST VIRAL",null,"86021 - HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES",null,null,null,null,"86580 - SKIN TEST TUBERCULOSIS INTRADERMAL",null,"85366 - HC CHG FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ",null,null,null,"86485 - HC CHG SKIN TEST CANDIDA"]
[null,null,null,"86403 - HC CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY","86353 - HC CHG LYMPHOCYTE TRANSFORMATION","86403 - HC CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY",null,"86022 - HC CRL;SEROTONIN RLS ASSAY",null,null,null,null,"86592 - HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL",null,"85378 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN",null,null,null,"86486 - SKIN TEST UNLISTED ANTIGEN EACH"]
[null,null,null,"86431 - HC CHG RHEUMATOID FACTOR QUANTITATIVE","86355 - HC B CELLS TOTAL COUNT","86431 - HC CHG RHEUMATOID FACTOR QUANTITATIVE",null,"86038 - HC CHG ANTINUCLEAR ANTIBODIES ANA",null,null,null,null,"86593 - HC SYPHILIS;QN",null,"85379 - HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE",null,null,null,"86580 - SKIN TEST TUBERCULOSIS INTRADERMAL"]
[null,null,null,"86480 - HC CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON","86357 - HC NK CELLS, TOTAL COUNT","86480 - HC CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON",null,"86039 - HC CHG ANTINUCLEAR ANTIBODIES ANA TITER",null,null,null,null,"86606 - HC CHG ANTIBODY ASPERGILLUS",null,"85384 - HC CHG FIBRINOGEN ACTIVITY",null,null,null,"86592 - HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL"]
[null,null,null,"86481 - HC TB TEST CELL MEDIATED ANTIGEN RESPONSE, ENUM GAMMA INTERFRON T-CELL","86359 - HC CHG T CELLS TOTAL COUNT","86481 - HC TB TEST CELL MEDIATED ANTIGEN RESPONSE, ENUM GAMMA INTERFRON T-CELL",null,"86060 - HC CHG ANTISTREPTOLYSIN O TITER",null,null,null,null,"86609 - HC CHG ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED",null,"85397 - HC CHG CLOTTING FUNCTION ACTIVITY NOS, EA ANALYT",null,null,null,"86593 - HC SYPHILIS;QN"]
[null,null,null,"86485 - HC CHG SKIN TEST CANDIDA","86360 - HC CHG T CELLS ABSOLUTE CD4&CD8 COUNT RATIO","86485 - HC CHG SKIN TEST CANDIDA",null,"86140 - C-REACTIVE PROTEIN",null,null,null,null,"86611 - HC BARTONELLA, ANTIBODY",null,"85461 - HC CHG HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE",null,null,null,"86606 - HC CHG ANTIBODY ASPERGILLUS"]
[null,null,null,"86580 - SKIN TEST TUBERCULOSIS INTRADERMAL","86376 - HC CHG MICROSOMAL ANTIBODIES EACH","86580 - SKIN TEST TUBERCULOSIS INTRADERMAL",null,"86141 - HC CRL;CARDIO CRP",null,null,null,null,"86612 - HC CHG BLASTOMYCES ANTIBODY",null,"85520 - HC CHG HEPARIN ASSAY",null,null,null,"86609 - HC CHG ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED"]
[null,null,null,"86592 - HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL","86382 - HC CHG NEUTRALIZATION TEST VIRAL","86592 - HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL",null,"86146 - HC CRL;BETA-2 GLYCPRTN 1 AB",null,null,null,null,"86615 - HC Q;BORDTLLA AB;IGG,IGA",null,"85549 - HC CHG MURAMIDASE",null,null,null,"86611 - HC BARTONELLA, ANTIBODY"]
[null,null,null,"86593 - HC SYPHILIS;QN","86403 - HC CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY","86593 - HC SYPHILIS;QN",null,"86147 - HC Q;CARDLIP AB;IGG,IGM,IGA",null,null,null,null,"86617 - HC CHG ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST",null,"85576 - HC CHG PLATELET AGGREGATION IN VITRO EACH AGENT",null,null,null,"86612 - HC CHG BLASTOMYCES ANTIBODY"]
[null,null,null,"86606 - HC CHG ANTIBODY ASPERGILLUS","86431 - HC CHG RHEUMATOID FACTOR QUANTITATIVE","86606 - HC CHG ANTIBODY ASPERGILLUS",null,"86157 - HC CHG COLD AGGLUTININ TITER",null,null,null,null,"86618 - HC Q;LYME AB INDEX CNS INFEC",null,"85610 - POC;INR",null,null,null,"86615 - HC Q;BORDTLLA AB;IGG,IGA"]
[null,null,null,"86609 - HC CHG ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED","86480 - HC CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON","86609 - HC CHG ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED",null,"86160 - HC CHG COMPLEMENT ANTIGEN EACH COMPONENT",null,null,null,null,"86622 - HC CHG ANTIBODY BRUCELLA",null,"85611 - HC CHG PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH",null,null,null,"86617 - HC CHG ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST"]
[null,null,null,"86611 - HC BARTONELLA, ANTIBODY","86481 - HC TB TEST CELL MEDIATED ANTIGEN RESPONSE, ENUM GAMMA INTERFRON T-CELL","86611 - HC BARTONELLA, ANTIBODY",null,"86161 - HC CHG COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT",null,null,null,null,"86625 - HC CAMPYLOBACTER, ANTIBODY",null,"85613 - HC CHG RUSSELL VIPER VENOM DILUTED",null,null,null,"86618 - HC Q;LYME AB INDEX CNS INFEC"]
[null,null,null,"86612 - HC CHG BLASTOMYCES ANTIBODY","86485 - HC CHG SKIN TEST CANDIDA","86612 - HC CHG BLASTOMYCES ANTIBODY",null,"86162 - HC CHG COMPLEMENT TOTAL HEMOLYTIC",null,null,null,null,"86631 - HC CHG, CHLAMYDIA, ANTIBODY",null,"85651 - SEDIMENTATION RATE RBC NON-AUTOMATED",null,null,null,"86622 - HC CHG ANTIBODY BRUCELLA"]
[null,null,null,"86615 - HC Q;BORDTLLA AB;IGG,IGA","86580 - SKIN TEST TUBERCULOSIS INTRADERMAL","86615 - HC Q;BORDTLLA AB;IGG,IGA",null,"86200 - HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY",null,null,null,null,"86632 - HC CHG CHLAMYDIA, IGM ANTIBODY",null,"85652 - HC CHG SEDIMENTATION RATE RBC AUTOMATED",null,null,null,"86625 - HC CAMPYLOBACTER, ANTIBODY"]
[null,null,null,"86617 - HC CHG ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST","86592 - HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL","86617 - HC CHG ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST",null,"86235 - HC CHG EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD",null,null,null,null,"86635 - HC CHG ANTIBODY COCCIDIOIDES",null,"85660 - HC CHG SICKLING RBC REDUCTION",null,null,null,"86631 - HC CHG, CHLAMYDIA, ANTIBODY"]
[null,null,null,"86618 - HC Q;LYME AB INDEX CNS INFEC","86593 - HC SYPHILIS;QN","86618 - HC Q;LYME AB INDEX CNS INFEC",null,"86255 - HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY",null,null,null,null,"86638 - HC CHG, Q FEVER ANTIBODY",null,"85670 - HC CHG THROMBIN TIME PLASMA",null,null,null,"86632 - HC CHG CHLAMYDIA, IGM ANTIBODY"]
[null,null,null,"86622 - HC CHG ANTIBODY BRUCELLA","86606 - HC CHG ANTIBODY ASPERGILLUS","86622 - HC CHG ANTIBODY BRUCELLA",null,"86256 - HC CHG FLUORESCENT ANTIBODY; TITER",null,null,null,null,"86644 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV",null,"85705 - HC CHG THROMBOPLASTIN INHIBITION TISSUE",null,null,null,"86635 - HC CHG ANTIBODY COCCIDIOIDES"]
[null,null,null,"86625 - HC CAMPYLOBACTER, ANTIBODY","86609 - HC CHG ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED","86625 - HC CAMPYLOBACTER, ANTIBODY",null,"86300 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3",null,null,null,null,"86645 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV IGM",null,"85730 - HC CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD",null,null,null,"86638 - HC CHG, Q FEVER ANTIBODY"]
[null,null,null,"86631 - HC CHG, CHLAMYDIA, ANTIBODY","86611 - HC BARTONELLA, ANTIBODY","86631 - HC CHG, CHLAMYDIA, ANTIBODY",null,"86301 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9",null,null,null,null,"86648 - HC CHG ANTIBODY DIPHTHERIA",null,"85732 - HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA",null,null,null,"86644 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV"]
[null,null,null,"86632 - HC CHG CHLAMYDIA, IGM ANTIBODY","86612 - HC CHG BLASTOMYCES ANTIBODY","86632 - HC CHG CHLAMYDIA, IGM ANTIBODY",null,"86304 - HC CRL;CA-125",null,null,null,null,"86652 - HC CHG, ENCEPHAL ANTIBODY EAST EQU",null,"85810 - HC CHG VISCOSITY",null,null,null,"86645 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV IGM"]
[null,null,null,"86635 - HC CHG ANTIBODY COCCIDIOIDES","86615 - HC Q;BORDTLLA AB;IGG,IGA","86635 - HC CHG ANTIBODY COCCIDIOIDES",null,"86308 - HC CHG HETEROPHILE ANTIBODIES SCREEN",null,null,null,null,"86654 - CHG ANTIBODY ENCEPHALITIS WESTRN EQUINE",null,"86003 - HC CHG ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN",null,null,null,"86648 - HC CHG ANTIBODY DIPHTHERIA"]
[null,null,null,"86638 - HC CHG, Q FEVER ANTIBODY","86617 - HC CHG ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST","86638 - HC CHG, Q FEVER ANTIBODY",null,"86316 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE",null,null,null,null,"86658 - HC CHG ENTEROVIRUS ANTIBODY",null,"86021 - HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES",null,null,null,"86652 - HC CHG, ENCEPHAL ANTIBODY EAST EQU"]
[null,null,null,"86644 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV","86618 - HC Q;LYME AB INDEX CNS INFEC","86644 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV",null,"86317 - HC IMMUNOASSAY,INFECT AGENT,QUANT",null,null,null,null,"86663 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA",null,"86022 - HC CRL;SEROTONIN RLS ASSAY",null,null,null,"86654 - CHG ANTIBODY ENCEPHALITIS WESTRN EQUINE"]
[null,null,null,"86645 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV IGM","86622 - HC CHG ANTIBODY BRUCELLA","86645 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV IGM",null,"86328 - IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY; CORONAVIRUS 2",null,null,null,null,"86664 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA",null,"86038 - HC CHG ANTINUCLEAR ANTIBODIES ANA",null,null,null,"86658 - HC CHG ENTEROVIRUS ANTIBODY"]
[null,null,null,"86648 - HC CHG ANTIBODY DIPHTHERIA","86625 - HC CAMPYLOBACTER, ANTIBODY","86648 - HC CHG ANTIBODY DIPHTHERIA",null,"86331 - HC CHG IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY",null,null,null,null,"86665 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA",null,"86039 - HC CHG ANTINUCLEAR ANTIBODIES ANA TITER",null,null,null,"86663 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA"]
[null,null,null,"86652 - HC CHG, ENCEPHAL ANTIBODY EAST EQU","86631 - HC CHG, CHLAMYDIA, ANTIBODY","86652 - HC CHG, ENCEPHAL ANTIBODY EAST EQU",null,"86334 - HC CHG IMMUNOFIXJ ELECTROPHORESIS SERUM",null,null,null,null,"86666 - HC CHG ANTIBODY EHRLICHIA",null,"86060 - HC CHG ANTISTREPTOLYSIN O TITER",null,null,null,"86664 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA"]
[null,null,null,"86654 - CHG ANTIBODY ENCEPHALITIS WESTRN EQUINE","86632 - HC CHG CHLAMYDIA, IGM ANTIBODY","86654 - CHG ANTIBODY ENCEPHALITIS WESTRN EQUINE",null,"86335 - HC CHG IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS",null,null,null,null,"86677 - HC CHG ANTIBODY HELICOBACTER PYLORI",null,"86140 - C-REACTIVE PROTEIN",null,null,null,"86665 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA"]
[null,null,null,"86658 - HC CHG ENTEROVIRUS ANTIBODY","86635 - HC CHG ANTIBODY COCCIDIOIDES","86658 - HC CHG ENTEROVIRUS ANTIBODY",null,"86336 - HC CHG INHIBIN A",null,null,null,null,"86682 - HC Q;CYSTICERCUS AB,BLOT",null,"86141 - HC CRL;CARDIO CRP",null,null,null,"86666 - HC CHG ANTIBODY EHRLICHIA"]
[null,null,null,"86663 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA","86638 - HC CHG, Q FEVER ANTIBODY","86663 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA",null,"86340 - HC CHG INTRINSIC FACTOR ANTIBODIES",null,null,null,null,"86689 - HC HTLV/HIV CONFIRMATORY TEST",null,"86146 - HC CRL;BETA-2 GLYCPRTN 1 AB",null,null,null,"86677 - HC CHG ANTIBODY HELICOBACTER PYLORI"]
[null,null,null,"86664 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA","86644 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV","86664 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA",null,"86341 - HC CHG ISLET CELL ANTIBODY",null,null,null,null,"86692 - HC CHG ANTIBODY HEP DELTA AGENT",null,"86147 - HC Q;CARDLIP AB;IGG,IGM,IGA",null,null,null,"86682 - HC Q;CYSTICERCUS AB,BLOT"]
[null,null,null,"86665 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA","86645 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV IGM","86665 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA",null,"86353 - HC CHG LYMPHOCYTE TRANSFORMATION",null,null,null,null,"86694 - HC CHG ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST",null,"86157 - HC CHG COLD AGGLUTININ TITER",null,null,null,"86689 - HC HTLV/HIV CONFIRMATORY TEST"]
[null,null,null,"86666 - HC CHG ANTIBODY EHRLICHIA","86648 - HC CHG ANTIBODY DIPHTHERIA","86666 - HC CHG ANTIBODY EHRLICHIA",null,"86355 - HC B CELLS TOTAL COUNT",null,null,null,null,"86695 - HC CHG ANTIBODY HERPES SMPLX TYPE 1",null,"86160 - HC CHG COMPLEMENT ANTIGEN EACH COMPONENT",null,null,null,"86692 - HC CHG ANTIBODY HEP DELTA AGENT"]
[null,null,null,"86677 - HC CHG ANTIBODY HELICOBACTER PYLORI","86652 - HC CHG, ENCEPHAL ANTIBODY EAST EQU","86677 - HC CHG ANTIBODY HELICOBACTER PYLORI",null,"86357 - HC NK CELLS, TOTAL COUNT",null,null,null,null,"86696 - HC CHG ANTIBODY HERPES SMPLX TYPE 2",null,"86161 - HC CHG COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT",null,null,null,"86694 - HC CHG ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST"]
[null,null,null,"86682 - HC Q;CYSTICERCUS AB,BLOT","86654 - CHG ANTIBODY ENCEPHALITIS WESTRN EQUINE","86682 - HC Q;CYSTICERCUS AB,BLOT",null,"86359 - HC CHG T CELLS TOTAL COUNT",null,null,null,null,"86698 - HC CHG ANTIBODY HISTOPLASMA",null,"86162 - HC CHG COMPLEMENT TOTAL HEMOLYTIC",null,null,null,"86695 - HC CHG ANTIBODY HERPES SMPLX TYPE 1"]
[null,null,null,"86689 - HC HTLV/HIV CONFIRMATORY TEST","86658 - HC CHG ENTEROVIRUS ANTIBODY","86689 - HC HTLV/HIV CONFIRMATORY TEST",null,"86360 - HC CHG T CELLS ABSOLUTE CD4&CD8 COUNT RATIO",null,null,null,null,"86701 - HC HIV-1",null,"86200 - HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY",null,null,null,"86696 - HC CHG ANTIBODY HERPES SMPLX TYPE 2"]
[null,null,null,"86692 - HC CHG ANTIBODY HEP DELTA AGENT","86663 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA","86692 - HC CHG ANTIBODY HEP DELTA AGENT",null,"86376 - HC CHG MICROSOMAL ANTIBODIES EACH",null,null,null,null,"86702 - HC QL/SEMI MULT AB;HIV2",null,"86235 - HC CHG EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD",null,null,null,"86698 - HC CHG ANTIBODY HISTOPLASMA"]
[null,null,null,"86694 - HC CHG ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST","86664 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA","86694 - HC CHG ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST",null,"86382 - HC CHG NEUTRALIZATION TEST VIRAL",null,null,null,null,"86703 - HC HIV 1/2 ANTIBODY",null,"86255 - HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY",null,null,null,"86701 - HC HIV-1"]
[null,null,null,"86695 - HC CHG ANTIBODY HERPES SMPLX TYPE 1","86665 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA","86695 - HC CHG ANTIBODY HERPES SMPLX TYPE 1",null,"86403 - HC CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY",null,null,null,null,"86704 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB TOTAL",null,"86256 - HC CHG FLUORESCENT ANTIBODY; TITER",null,null,null,"86702 - HC QL/SEMI MULT AB;HIV2"]
[null,null,null,"86696 - HC CHG ANTIBODY HERPES SMPLX TYPE 2","86666 - HC CHG ANTIBODY EHRLICHIA","86696 - HC CHG ANTIBODY HERPES SMPLX TYPE 2",null,"86431 - HC CHG RHEUMATOID FACTOR QUANTITATIVE",null,null,null,null,"86705 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY",null,"86300 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3",null,null,null,"86703 - HC HIV 1/2 ANTIBODY"]
[null,null,null,"86698 - HC CHG ANTIBODY HISTOPLASMA","86677 - HC CHG ANTIBODY HELICOBACTER PYLORI","86698 - HC CHG ANTIBODY HISTOPLASMA",null,"86480 - HC CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON",null,null,null,null,"86706 - HC CHG HEPATITIS B SURF ANTIBODY HBSAB",null,"86301 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9",null,null,null,"86704 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB TOTAL"]
[null,null,null,"86701 - HC HIV-1","86682 - HC Q;CYSTICERCUS AB,BLOT","86701 - HC HIV-1",null,"86481 - HC TB TEST CELL MEDIATED ANTIGEN RESPONSE, ENUM GAMMA INTERFRON T-CELL",null,null,null,null,"86707 - HC CHG HEPATITIS BE ANTIBODY HBEAB",null,"86304 - HC CRL;CA-125",null,null,null,"86705 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY"]
[null,null,null,"86702 - HC QL/SEMI MULT AB;HIV2","86689 - HC HTLV/HIV CONFIRMATORY TEST","86702 - HC QL/SEMI MULT AB;HIV2",null,"86485 - HC CHG SKIN TEST CANDIDA",null,null,null,null,"86708 - HC CHG HEPATITIS A ANTIBODY HAAB",null,"86308 - HC CHG HETEROPHILE ANTIBODIES SCREEN",null,null,null,"86706 - HC CHG HEPATITIS B SURF ANTIBODY HBSAB"]
[null,null,null,"86703 - HC HIV 1/2 ANTIBODY","86692 - HC CHG ANTIBODY HEP DELTA AGENT","86703 - HC HIV 1/2 ANTIBODY",null,"86486 - SKIN TEST UNLISTED ANTIGEN EACH",null,null,null,null,"86709 - HC CHG HEPATITIS ANTIBODY HAAB IGM ANTIBODY",null,"86316 - HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE",null,null,null,"86707 - HC CHG HEPATITIS BE ANTIBODY HBEAB"]
[null,null,null,"86704 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB TOTAL","86694 - HC CHG ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST","86704 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB TOTAL",null,"86580 - SKIN TEST TUBERCULOSIS INTRADERMAL",null,null,null,null,"86710 - HC INFLUENZA VIRUS",null,"86317 - HC IMMUNOASSAY,INFECT AGENT,QUANT",null,null,null,"86708 - HC CHG HEPATITIS A ANTIBODY HAAB"]
[null,null,null,"86705 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY","86695 - HC CHG ANTIBODY HERPES SMPLX TYPE 1","86705 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY",null,"86592 - HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL",null,null,null,null,"86735 - HC CHG ANTIBODY MUMPS",null,"86328 - IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY; CORONAVIRUS 2",null,null,null,"86709 - HC CHG HEPATITIS ANTIBODY HAAB IGM ANTIBODY"]
[null,null,null,"86706 - HC CHG HEPATITIS B SURF ANTIBODY HBSAB","86696 - HC CHG ANTIBODY HERPES SMPLX TYPE 2","86706 - HC CHG HEPATITIS B SURF ANTIBODY HBSAB",null,"86593 - HC SYPHILIS;QN",null,null,null,null,"86738 - HC CHG ANTIBODY MYCOPLSM",null,"86331 - HC CHG IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY",null,null,null,"86710 - HC INFLUENZA VIRUS"]
[null,null,null,"86707 - HC CHG HEPATITIS BE ANTIBODY HBEAB","86698 - HC CHG ANTIBODY HISTOPLASMA","86707 - HC CHG HEPATITIS BE ANTIBODY HBEAB",null,"86606 - HC CHG ANTIBODY ASPERGILLUS",null,null,null,null,"86744 - HC CHG ANTIBODY NOCARDIA",null,"86334 - HC CHG IMMUNOFIXJ ELECTROPHORESIS SERUM",null,null,null,"86735 - HC CHG ANTIBODY MUMPS"]
[null,null,null,"86708 - HC CHG HEPATITIS A ANTIBODY HAAB","86701 - HC HIV-1","86708 - HC CHG HEPATITIS A ANTIBODY HAAB",null,"86609 - HC CHG ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED",null,null,null,null,"86747 - HC CHG ANTIBODY PARVOVIRUS",null,"86335 - HC CHG IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS",null,null,null,"86738 - HC CHG ANTIBODY MYCOPLSM"]
[null,null,null,"86709 - HC CHG HEPATITIS ANTIBODY HAAB IGM ANTIBODY","86702 - HC QL/SEMI MULT AB;HIV2","86709 - HC CHG HEPATITIS ANTIBODY HAAB IGM ANTIBODY",null,"86611 - HC BARTONELLA, ANTIBODY",null,null,null,null,"86753 - HC CHG ANTIBODY PROTOZOA NES",null,"86336 - HC CHG INHIBIN A",null,null,null,"86744 - HC CHG ANTIBODY NOCARDIA"]
[null,null,null,"86710 - HC INFLUENZA VIRUS","86703 - HC HIV 1/2 ANTIBODY","86710 - HC INFLUENZA VIRUS",null,"86612 - HC CHG BLASTOMYCES ANTIBODY",null,null,null,null,"86757 - HC CHG, RICKETTSIA",null,"86340 - HC CHG INTRINSIC FACTOR ANTIBODIES",null,null,null,"86747 - HC CHG ANTIBODY PARVOVIRUS"]
[null,null,null,"86735 - HC CHG ANTIBODY MUMPS","86704 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB TOTAL","86735 - HC CHG ANTIBODY MUMPS",null,"86615 - HC Q;BORDTLLA AB;IGG,IGA",null,null,null,null,"86762 - HC CHG ANTIBODY RUBELLA",null,"86341 - HC CHG ISLET CELL ANTIBODY",null,null,null,"86753 - HC CHG ANTIBODY PROTOZOA NES"]
[null,null,null,"86738 - HC CHG ANTIBODY MYCOPLSM","86705 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY","86738 - HC CHG ANTIBODY MYCOPLSM",null,"86617 - HC CHG ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST",null,null,null,null,"86765 - HC CHG ANTIBODY RUBEOLA",null,"86353 - HC CHG LYMPHOCYTE TRANSFORMATION",null,null,null,"86757 - HC CHG, RICKETTSIA"]
[null,null,null,"86744 - HC CHG ANTIBODY NOCARDIA","86706 - HC CHG HEPATITIS B SURF ANTIBODY HBSAB","86744 - HC CHG ANTIBODY NOCARDIA",null,"86618 - HC Q;LYME AB INDEX CNS INFEC",null,null,null,null,"86769 - ANTIBODY; SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2",null,"86355 - HC B CELLS TOTAL COUNT",null,null,null,"86762 - HC CHG ANTIBODY RUBELLA"]
[null,null,null,"86747 - HC CHG ANTIBODY PARVOVIRUS","86707 - HC CHG HEPATITIS BE ANTIBODY HBEAB","86747 - HC CHG ANTIBODY PARVOVIRUS",null,"86622 - HC CHG ANTIBODY BRUCELLA",null,null,null,null,"86774 - HC CHG ANTIBODY TETANUS",null,"86357 - HC NK CELLS, TOTAL COUNT",null,null,null,"86765 - HC CHG ANTIBODY RUBEOLA"]
[null,null,null,"86753 - HC CHG ANTIBODY PROTOZOA NES","86708 - HC CHG HEPATITIS A ANTIBODY HAAB","86753 - HC CHG ANTIBODY PROTOZOA NES",null,"86625 - HC CAMPYLOBACTER, ANTIBODY",null,null,null,null,"86777 - HC CHG ANTIBODY TOXOPLASMA",null,"86359 - HC CHG T CELLS TOTAL COUNT",null,null,null,"86769 - ANTIBODY; SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2"]
[null,null,null,"86757 - HC CHG, RICKETTSIA","86709 - HC CHG HEPATITIS ANTIBODY HAAB IGM ANTIBODY","86757 - HC CHG, RICKETTSIA",null,"86631 - HC CHG, CHLAMYDIA, ANTIBODY",null,null,null,null,"86778 - HC Q;TOXOPLASMA IGM,AB",null,"86360 - HC CHG T CELLS ABSOLUTE CD4&CD8 COUNT RATIO",null,null,null,"86774 - HC CHG ANTIBODY TETANUS"]
[null,null,null,"86762 - HC CHG ANTIBODY RUBELLA","86710 - HC INFLUENZA VIRUS","86762 - HC CHG ANTIBODY RUBELLA",null,"86632 - HC CHG CHLAMYDIA, IGM ANTIBODY",null,null,null,null,"86780 - HC CHG ANTIBODY TREPONEMA PALLIDUM",null,"86376 - HC CHG MICROSOMAL ANTIBODIES EACH",null,null,null,"86777 - HC CHG ANTIBODY TOXOPLASMA"]
[null,null,null,"86765 - HC CHG ANTIBODY RUBEOLA","86735 - HC CHG ANTIBODY MUMPS","86765 - HC CHG ANTIBODY RUBEOLA",null,"86635 - HC CHG ANTIBODY COCCIDIOIDES",null,null,null,null,"86787 - HC CHG ANTIBODY VARICELLA-ZOSTER",null,"86382 - HC CHG NEUTRALIZATION TEST VIRAL",null,null,null,"86778 - HC Q;TOXOPLASMA IGM,AB"]
[null,null,null,"86769 - ANTIBODY; SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2","86738 - HC CHG ANTIBODY MYCOPLSM","86769 - ANTIBODY; SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2",null,"86638 - HC CHG, Q FEVER ANTIBODY",null,null,null,null,"86788 - HC CHG ANTIBODY WEST NILE VIRUS IGM",null,"86403 - HC CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY",null,null,null,"86780 - HC CHG ANTIBODY TREPONEMA PALLIDUM"]
[null,null,null,"86774 - HC CHG ANTIBODY TETANUS","86744 - HC CHG ANTIBODY NOCARDIA","86774 - HC CHG ANTIBODY TETANUS",null,"86644 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV",null,null,null,null,"86789 - HC CHG ANTIBODY WEST NILE VIRUS",null,"86431 - HC CHG RHEUMATOID FACTOR QUANTITATIVE",null,null,null,"86787 - HC CHG ANTIBODY VARICELLA-ZOSTER"]
[null,null,null,"86777 - HC CHG ANTIBODY TOXOPLASMA","86747 - HC CHG ANTIBODY PARVOVIRUS","86777 - HC CHG ANTIBODY TOXOPLASMA",null,"86645 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV IGM",null,null,null,null,"86790 - HC CHG ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED",null,"86480 - HC CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON",null,null,null,"86788 - HC CHG ANTIBODY WEST NILE VIRUS IGM"]
[null,null,null,"86778 - HC Q;TOXOPLASMA IGM,AB","86753 - HC CHG ANTIBODY PROTOZOA NES","86778 - HC Q;TOXOPLASMA IGM,AB",null,"86648 - HC CHG ANTIBODY DIPHTHERIA",null,null,null,null,"86800 - HC CHG THYROGLOBULIN ANTIBODY",null,"86481 - HC TB TEST CELL MEDIATED ANTIGEN RESPONSE, ENUM GAMMA INTERFRON T-CELL",null,null,null,"86789 - HC CHG ANTIBODY WEST NILE VIRUS"]
[null,null,null,"86780 - HC CHG ANTIBODY TREPONEMA PALLIDUM","86757 - HC CHG, RICKETTSIA","86780 - HC CHG ANTIBODY TREPONEMA PALLIDUM",null,"86652 - HC CHG, ENCEPHAL ANTIBODY EAST EQU",null,null,null,null,"86803 - HC CHG HEPATITIS C ANTIBODY",null,"86485 - HC CHG SKIN TEST CANDIDA",null,null,null,"86790 - HC CHG ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED"]
[null,null,null,"86787 - HC CHG ANTIBODY VARICELLA-ZOSTER","86762 - HC CHG ANTIBODY RUBELLA","86787 - HC CHG ANTIBODY VARICELLA-ZOSTER",null,"86654 - CHG ANTIBODY ENCEPHALITIS WESTRN EQUINE",null,null,null,null,"86807 - HC CHG SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH",null,"86486 - SKIN TEST UNLISTED ANTIGEN EACH",null,null,null,"86800 - HC CHG THYROGLOBULIN ANTIBODY"]
[null,null,null,"86788 - HC CHG ANTIBODY WEST NILE VIRUS IGM","86765 - HC CHG ANTIBODY RUBEOLA","86788 - HC CHG ANTIBODY WEST NILE VIRUS IGM",null,"86658 - HC CHG ENTEROVIRUS ANTIBODY",null,null,null,null,"86812 - HC CHG HLA TYPING A/B/C SINGLE ANTIGEN",null,"86580 - SKIN TEST TUBERCULOSIS INTRADERMAL",null,null,null,"86803 - HC CHG HEPATITIS C ANTIBODY"]
[null,null,null,"86789 - HC CHG ANTIBODY WEST NILE VIRUS","86769 - ANTIBODY; SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2","86789 - HC CHG ANTIBODY WEST NILE VIRUS",null,"86663 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA",null,null,null,null,"86813 - HC CHG HLA TYPING A/B/C MULTIPLE ANTIGENS",null,"86592 - HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL",null,null,null,"86807 - HC CHG SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH"]
[null,null,null,"86790 - HC CHG ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED","86774 - HC CHG ANTIBODY TETANUS","86790 - HC CHG ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED",null,"86664 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA",null,null,null,null,"86817 - HC CHG HLA TYPING DR/DQ MULTIPLE ANTIGENS",null,"86593 - HC SYPHILIS;QN",null,null,null,"86812 - HC CHG HLA TYPING A/B/C SINGLE ANTIGEN"]
[null,null,null,"86800 - HC CHG THYROGLOBULIN ANTIBODY","86777 - HC CHG ANTIBODY TOXOPLASMA","86800 - HC CHG THYROGLOBULIN ANTIBODY",null,"86665 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA",null,null,null,null,"86850 - HC CHG ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE",null,"86606 - HC CHG ANTIBODY ASPERGILLUS",null,null,null,"86813 - HC CHG HLA TYPING A/B/C MULTIPLE ANTIGENS"]
[null,null,null,"86803 - HC CHG HEPATITIS C ANTIBODY","86778 - HC Q;TOXOPLASMA IGM,AB","86803 - HC CHG HEPATITIS C ANTIBODY",null,"86666 - HC CHG ANTIBODY EHRLICHIA",null,null,null,null,"86860 - HC CHG ANTIBODY ELUTION RBC EACH ELUTION",null,"86609 - HC CHG ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED",null,null,null,"86817 - HC CHG HLA TYPING DR/DQ MULTIPLE ANTIGENS"]
[null,null,null,"86807 - HC CHG SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH","86780 - HC CHG ANTIBODY TREPONEMA PALLIDUM","86807 - HC CHG SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH",null,"86677 - HC CHG ANTIBODY HELICOBACTER PYLORI",null,null,null,null,"86870 - HC CHG ANTIBODY ID RBC ANTIBODIES EA PANEL EA SERUM TQ",null,"86611 - HC BARTONELLA, ANTIBODY",null,null,null,"86850 - HC CHG ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE"]
[null,null,null,"86812 - HC CHG HLA TYPING A/B/C SINGLE ANTIGEN","86787 - HC CHG ANTIBODY VARICELLA-ZOSTER","86812 - HC CHG HLA TYPING A/B/C SINGLE ANTIGEN",null,"86682 - HC Q;CYSTICERCUS AB,BLOT",null,null,null,null,"86880 - HC CHG ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM",null,"86612 - HC CHG BLASTOMYCES ANTIBODY",null,null,null,"86860 - HC CHG ANTIBODY ELUTION RBC EACH ELUTION"]
[null,null,null,"86813 - HC CHG HLA TYPING A/B/C MULTIPLE ANTIGENS","86788 - HC CHG ANTIBODY WEST NILE VIRUS IGM","86813 - HC CHG HLA TYPING A/B/C MULTIPLE ANTIGENS",null,"86689 - HC HTLV/HIV CONFIRMATORY TEST",null,null,null,null,"86886 - HC CHG ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER",null,"86615 - HC Q;BORDTLLA AB;IGG,IGA",null,null,null,"86870 - HC CHG ANTIBODY ID RBC ANTIBODIES EA PANEL EA SERUM TQ"]
[null,null,null,"86817 - HC CHG HLA TYPING DR/DQ MULTIPLE ANTIGENS","86789 - HC CHG ANTIBODY WEST NILE VIRUS","86817 - HC CHG HLA TYPING DR/DQ MULTIPLE ANTIGENS",null,"86692 - HC CHG ANTIBODY HEP DELTA AGENT",null,null,null,null,"86900 - HC CHG BLOOD TYPING SEROLOGIC ABO",null,"86617 - HC CHG ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST",null,null,null,"86880 - HC CHG ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM"]
[null,null,null,"86850 - HC CHG ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE","86790 - HC CHG ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED","86850 - HC CHG ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE",null,"86694 - HC CHG ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST",null,null,null,null,"86901 - HC CHG BLOOD TYPING SEROLOGIC RH (D)",null,"86618 - HC Q;LYME AB INDEX CNS INFEC",null,null,null,"86886 - HC CHG ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER"]
[null,null,null,"86860 - HC CHG ANTIBODY ELUTION RBC EACH ELUTION","86800 - HC CHG THYROGLOBULIN ANTIBODY","86860 - HC CHG ANTIBODY ELUTION RBC EACH ELUTION",null,"86695 - HC CHG ANTIBODY HERPES SMPLX TYPE 1",null,null,null,null,"86902 - HC CHG BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH",null,"86622 - HC CHG ANTIBODY BRUCELLA",null,null,null,"86900 - HC CHG BLOOD TYPING SEROLOGIC ABO"]
[null,null,null,"86870 - HC CHG ANTIBODY ID RBC ANTIBODIES EA PANEL EA SERUM TQ","86803 - HC CHG HEPATITIS C ANTIBODY","86870 - HC CHG ANTIBODY ID RBC ANTIBODIES EA PANEL EA SERUM TQ",null,"86696 - HC CHG ANTIBODY HERPES SMPLX TYPE 2",null,null,null,null,"86905 - HC CHG BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH",null,"86625 - HC CAMPYLOBACTER, ANTIBODY",null,null,null,"86901 - HC CHG BLOOD TYPING SEROLOGIC RH (D)"]
[null,null,null,"86880 - HC CHG ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM","86807 - HC CHG SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH","86880 - HC CHG ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM",null,"86698 - HC CHG ANTIBODY HISTOPLASMA",null,null,null,null,"86910 - HC CHG BLOOD TYPING PATERNITY INDIV ABO RH&MN",null,"86631 - HC CHG, CHLAMYDIA, ANTIBODY",null,null,null,"86902 - HC CHG BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH"]
[null,null,null,"86886 - HC CHG ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER","86812 - HC CHG HLA TYPING A/B/C SINGLE ANTIGEN","86886 - HC CHG ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER",null,"86701 - HC HIV-1",null,null,null,null,"86920 - HC CHG COMPATIBILITY EACH UNIT IMMEDIATE SPIN TECHNIQUE",null,"86632 - HC CHG CHLAMYDIA, IGM ANTIBODY",null,null,null,"86905 - HC CHG BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH"]
[null,null,null,"86900 - HC CHG BLOOD TYPING SEROLOGIC ABO","86813 - HC CHG HLA TYPING A/B/C MULTIPLE ANTIGENS","86900 - HC CHG BLOOD TYPING SEROLOGIC ABO",null,"86702 - HC QL/SEMI MULT AB;HIV2",null,null,null,null,"86922 - HC CHG COMPATIBILITY EACH UNIT ANTIGLOBULIN",null,"86635 - HC CHG ANTIBODY COCCIDIOIDES",null,null,null,"86910 - HC CHG BLOOD TYPING PATERNITY INDIV ABO RH&MN"]
[null,null,null,"86901 - HC CHG BLOOD TYPING SEROLOGIC RH (D)","86817 - HC CHG HLA TYPING DR/DQ MULTIPLE ANTIGENS","86901 - HC CHG BLOOD TYPING SEROLOGIC RH (D)",null,"86703 - HC HIV 1/2 ANTIBODY",null,null,null,null,"86923 - HC CHG COMPATIBILITY EACH UNIT ELECTRONIC",null,"86638 - HC CHG, Q FEVER ANTIBODY",null,null,null,"86920 - HC CHG COMPATIBILITY EACH UNIT IMMEDIATE SPIN TECHNIQUE"]
[null,null,null,"86902 - HC CHG BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH","86850 - HC CHG ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE","86902 - HC CHG BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH",null,"86704 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB TOTAL",null,null,null,null,"86999 - HC CHG UNLISTED TRANSFUSION MEDICINE PROCEDURE",null,"86644 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV",null,null,null,"86922 - HC CHG COMPATIBILITY EACH UNIT ANTIGLOBULIN"]
[null,null,null,"86905 - HC CHG BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH","86860 - HC CHG ANTIBODY ELUTION RBC EACH ELUTION","86905 - HC CHG BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH",null,"86705 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY",null,null,null,null,"87015 - HC CHG CONCENTRATION INFECTIOUS AGENTS",null,"86645 - HC CHG ANTIBODY CYTOMEGALOVIRUS CMV IGM",null,null,null,"86923 - HC CHG COMPATIBILITY EACH UNIT ELECTRONIC"]
[null,null,null,"86920 - HC CHG COMPATIBILITY EACH UNIT IMMEDIATE SPIN TECHNIQUE","86870 - HC CHG ANTIBODY ID RBC ANTIBODIES EA PANEL EA SERUM TQ","86920 - HC CHG COMPATIBILITY EACH UNIT IMMEDIATE SPIN TECHNIQUE",null,"86706 - HC CHG HEPATITIS B SURF ANTIBODY HBSAB",null,null,null,null,"87040 - HC CHG CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES",null,"86648 - HC CHG ANTIBODY DIPHTHERIA",null,null,null,"86999 - HC CHG UNLISTED TRANSFUSION MEDICINE PROCEDURE"]
[null,null,null,"86922 - HC CHG COMPATIBILITY EACH UNIT ANTIGLOBULIN","86880 - HC CHG ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM","86922 - HC CHG COMPATIBILITY EACH UNIT ANTIGLOBULIN",null,"86707 - HC CHG HEPATITIS BE ANTIBODY HBEAB",null,null,null,null,"87045 - HC CHG CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL",null,"86652 - HC CHG, ENCEPHAL ANTIBODY EAST EQU",null,null,null,"87015 - HC CHG CONCENTRATION INFECTIOUS AGENTS"]
[null,null,null,"86923 - HC CHG COMPATIBILITY EACH UNIT ELECTRONIC","86886 - HC CHG ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER","86923 - HC CHG COMPATIBILITY EACH UNIT ELECTRONIC",null,"86708 - HC CHG HEPATITIS A ANTIBODY HAAB",null,null,null,null,"87046 - HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA",null,"86654 - CHG ANTIBODY ENCEPHALITIS WESTRN EQUINE",null,null,null,"87040 - HC CHG CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES"]
[null,null,null,"87015 - HC CHG CONCENTRATION INFECTIOUS AGENTS","86900 - HC CHG BLOOD TYPING SEROLOGIC ABO","87015 - HC CHG CONCENTRATION INFECTIOUS AGENTS",null,"86709 - HC CHG HEPATITIS ANTIBODY HAAB IGM ANTIBODY",null,null,null,null,"87070 - CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL",null,"86658 - HC CHG ENTEROVIRUS ANTIBODY",null,null,null,"87045 - HC CHG CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL"]
[null,null,null,"87040 - HC CHG CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES","86901 - HC CHG BLOOD TYPING SEROLOGIC RH (D)","87040 - HC CHG CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES",null,"86710 - HC INFLUENZA VIRUS",null,null,null,null,"87075 - HC CHG CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID",null,"86663 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA",null,null,null,"87046 - HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA"]
[null,null,null,"87045 - HC CHG CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL","86902 - HC CHG BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH","87045 - HC CHG CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL",null,"86735 - HC CHG ANTIBODY MUMPS",null,null,null,null,"87076 - HC CHG CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL",null,"86664 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA",null,null,null,"87070 - CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL"]
[null,null,null,"87046 - HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA","86905 - HC CHG BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH","87046 - HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA",null,"86738 - HC CHG ANTIBODY MYCOPLSM",null,null,null,null,"87077 - HC CHG CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL",null,"86665 - HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA",null,null,null,"87075 - HC CHG CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID"]
[null,null,null,"87070 - CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL","86920 - HC CHG COMPATIBILITY EACH UNIT IMMEDIATE SPIN TECHNIQUE","87070 - CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL",null,"86744 - HC CHG ANTIBODY NOCARDIA",null,null,null,null,"87081 - HC CULT,BACT,SCR,H PYLORI",null,"86666 - HC CHG ANTIBODY EHRLICHIA",null,null,null,"87076 - HC CHG CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL"]
[null,null,null,"87075 - HC CHG CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID","86922 - HC CHG COMPATIBILITY EACH UNIT ANTIGLOBULIN","87075 - HC CHG CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID",null,"86747 - HC CHG ANTIBODY PARVOVIRUS",null,null,null,null,"87086 - HC CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE",null,"86677 - HC CHG ANTIBODY HELICOBACTER PYLORI",null,null,null,"87077 - HC CHG CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL"]
[null,null,null,"87076 - HC CHG CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL","86923 - HC CHG COMPATIBILITY EACH UNIT ELECTRONIC","87076 - HC CHG CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL",null,"86753 - HC CHG ANTIBODY PROTOZOA NES",null,null,null,null,"87088 - HC CHG CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE",null,"86682 - HC Q;CYSTICERCUS AB,BLOT",null,null,null,"87081 - HC CULT,BACT,SCR,H PYLORI"]
[null,null,null,"87077 - HC CHG CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL","87015 - HC CHG CONCENTRATION INFECTIOUS AGENTS","87077 - HC CHG CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL",null,"86757 - HC CHG, RICKETTSIA",null,null,null,null,"87102 - HC CHG CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD",null,"86689 - HC HTLV/HIV CONFIRMATORY TEST",null,null,null,"87086 - HC CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE"]
[null,null,null,"87081 - HC CULT,BACT,SCR,H PYLORI","87040 - HC CHG CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES","87081 - HC CULT,BACT,SCR,H PYLORI",null,"86762 - HC CHG ANTIBODY RUBELLA",null,null,null,null,"87103 - HC CHG CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD",null,"86692 - HC CHG ANTIBODY HEP DELTA AGENT",null,null,null,"87088 - HC CHG CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE"]
[null,null,null,"87086 - HC CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE","87045 - HC CHG CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL","87086 - HC CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE",null,"86765 - HC CHG ANTIBODY RUBEOLA",null,null,null,null,"87106 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST",null,"86694 - HC CHG ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST",null,null,null,"87102 - HC CHG CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD"]
[null,null,null,"87088 - HC CHG CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE","87046 - HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA","87088 - HC CHG CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE",null,"86769 - ANTIBODY; SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2",null,null,null,null,"87107 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD",null,"86695 - HC CHG ANTIBODY HERPES SMPLX TYPE 1",null,null,null,"87103 - HC CHG CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD"]
[null,null,null,"87102 - HC CHG CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD","87070 - CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL","87102 - HC CHG CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD",null,"86774 - HC CHG ANTIBODY TETANUS",null,null,null,null,"87110 - HC CHG CULTURE, CHLAMYDIA",null,"86696 - HC CHG ANTIBODY HERPES SMPLX TYPE 2",null,null,null,"87106 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST"]
[null,null,null,"87103 - HC CHG CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD","87075 - HC CHG CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID","87103 - HC CHG CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD",null,"86777 - HC CHG ANTIBODY TOXOPLASMA",null,null,null,null,"87116 - HC CHG CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL",null,"86698 - HC CHG ANTIBODY HISTOPLASMA",null,null,null,"87107 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD"]
[null,null,null,"87106 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST","87076 - HC CHG CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL","87106 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST",null,"86778 - HC Q;TOXOPLASMA IGM,AB",null,null,null,null,"87118 - HC CHG CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL",null,"86701 - HC HIV-1",null,null,null,"87110 - HC CHG CULTURE, CHLAMYDIA"]
[null,null,null,"87107 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD","87077 - HC CHG CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL","87107 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD",null,"86780 - HC CHG ANTIBODY TREPONEMA PALLIDUM",null,null,null,null,"87140 - HC CHG CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM",null,"86702 - HC QL/SEMI MULT AB;HIV2",null,null,null,"87116 - HC CHG CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL"]
[null,null,null,"87110 - HC CHG CULTURE, CHLAMYDIA","87081 - HC CULT,BACT,SCR,H PYLORI","87110 - HC CHG CULTURE, CHLAMYDIA",null,"86787 - HC CHG ANTIBODY VARICELLA-ZOSTER",null,null,null,null,"87149 - HC CHG CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM",null,"86703 - HC HIV 1/2 ANTIBODY",null,null,null,"87118 - HC CHG CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL"]
[null,null,null,"87116 - HC CHG CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL","87086 - HC CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE","87116 - HC CHG CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL",null,"86788 - HC CHG ANTIBODY WEST NILE VIRUS IGM",null,null,null,null,"87150 - HC CHG CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM",null,"86704 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB TOTAL",null,null,null,"87140 - HC CHG CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM"]
[null,null,null,"87118 - HC CHG CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL","87088 - HC CHG CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE","87118 - HC CHG CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL",null,"86789 - HC CHG ANTIBODY WEST NILE VIRUS",null,null,null,null,"87153 - HC Q;BACT ID,PHENO,SEQ",null,"86705 - HC CHG HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY",null,null,null,"87149 - HC CHG CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM"]
[null,null,null,"87140 - HC CHG CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM","87102 - HC CHG CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD","87140 - HC CHG CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM",null,"86790 - HC CHG ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED",null,null,null,null,"87172 - HC CHG PINWORM EXAMINATION",null,"86706 - HC CHG HEPATITIS B SURF ANTIBODY HBSAB",null,null,null,"87150 - HC CHG CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM"]
[null,null,null,"87149 - HC CHG CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM","87103 - HC CHG CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD","87149 - HC CHG CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM",null,"86800 - HC CHG THYROGLOBULIN ANTIBODY",null,null,null,null,"87176 - HC CHG HOMOGENIZATION TISSUE CULTURE",null,"86707 - HC CHG HEPATITIS BE ANTIBODY HBEAB",null,null,null,"87153 - HC Q;BACT ID,PHENO,SEQ"]
[null,null,null,"87150 - HC CHG CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM","87106 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST","87150 - HC CHG CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM",null,"86803 - HC CHG HEPATITIS C ANTIBODY",null,null,null,null,"87177 - HC CHG OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID",null,"86708 - HC CHG HEPATITIS A ANTIBODY HAAB",null,null,null,"87172 - HC CHG PINWORM EXAMINATION"]
[null,null,null,"87153 - HC Q;BACT ID,PHENO,SEQ","87107 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD","87153 - HC Q;BACT ID,PHENO,SEQ",null,"86807 - HC CHG SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH",null,null,null,null,"87181 - HC CHG SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ",null,"86709 - HC CHG HEPATITIS ANTIBODY HAAB IGM ANTIBODY",null,null,null,"87176 - HC CHG HOMOGENIZATION TISSUE CULTURE"]
[null,null,null,"87172 - HC CHG PINWORM EXAMINATION","87110 - HC CHG CULTURE, CHLAMYDIA","87172 - HC CHG PINWORM EXAMINATION",null,"86812 - HC CHG HLA TYPING A/B/C SINGLE ANTIGEN",null,null,null,null,"87184 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD",null,"86710 - HC INFLUENZA VIRUS",null,null,null,"87177 - HC CHG OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID"]
[null,null,null,"87176 - HC CHG HOMOGENIZATION TISSUE CULTURE","87116 - HC CHG CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL","87176 - HC CHG HOMOGENIZATION TISSUE CULTURE",null,"86813 - HC CHG HLA TYPING A/B/C MULTIPLE ANTIGENS",null,null,null,null,"87185 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ",null,"86735 - HC CHG ANTIBODY MUMPS",null,null,null,"87181 - HC CHG SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ"]
[null,null,null,"87177 - HC CHG OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID","87118 - HC CHG CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL","87177 - HC CHG OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID",null,"86817 - HC CHG HLA TYPING DR/DQ MULTIPLE ANTIGENS",null,null,null,null,"87186 - HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ",null,"86738 - HC CHG ANTIBODY MYCOPLSM",null,null,null,"87184 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD"]
[null,null,null,"87181 - HC CHG SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ","87140 - HC CHG CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM","87181 - HC CHG SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ",null,"86850 - HC CHG ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE",null,null,null,null,"87188 - HC CHG SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT",null,"86744 - HC CHG ANTIBODY NOCARDIA",null,null,null,"87185 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ"]
[null,null,null,"87184 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD","87149 - HC CHG CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM","87184 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD",null,"86860 - HC CHG ANTIBODY ELUTION RBC EACH ELUTION",null,null,null,null,"87205 - HC CHG SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL",null,"86747 - HC CHG ANTIBODY PARVOVIRUS",null,null,null,"87186 - HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ"]
[null,null,null,"87185 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ","87150 - HC CHG CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM","87185 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ",null,"86870 - HC CHG ANTIBODY ID RBC ANTIBODIES EA PANEL EA SERUM TQ",null,null,null,null,"87206 - HC CHG SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT",null,"86753 - HC CHG ANTIBODY PROTOZOA NES",null,null,null,"87188 - HC CHG SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT"]
[null,null,null,"87186 - HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ","87153 - HC Q;BACT ID,PHENO,SEQ","87186 - HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ",null,"86880 - HC CHG ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM",null,null,null,null,"87207 - SMR PRIM SRC SPEC STAIN BODIES/PARASITS",null,"86757 - HC CHG, RICKETTSIA",null,null,null,"87205 - HC CHG SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL"]
[null,null,null,"87188 - HC CHG SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT","87172 - HC CHG PINWORM EXAMINATION","87188 - HC CHG SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT",null,"86886 - HC CHG ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER",null,null,null,null,"87209 - HC CHG SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS",null,"86762 - HC CHG ANTIBODY RUBELLA",null,null,null,"87206 - HC CHG SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT"]
[null,null,null,"87205 - HC CHG SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL","87176 - HC CHG HOMOGENIZATION TISSUE CULTURE","87205 - HC CHG SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL",null,"86900 - HC CHG BLOOD TYPING SEROLOGIC ABO",null,null,null,null,"87210 - SMR PRIM SRC WET MOUNT NFCT AGT",null,"86765 - HC CHG ANTIBODY RUBEOLA",null,null,null,"87207 - SMR PRIM SRC SPEC STAIN BODIES/PARASITS"]
[null,null,null,"87206 - HC CHG SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT","87177 - HC CHG OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID","87206 - HC CHG SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT",null,"86901 - HC CHG BLOOD TYPING SEROLOGIC RH (D)",null,null,null,null,"87220 - TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT",null,"86769 - ANTIBODY; SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2",null,null,null,"87209 - HC CHG SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS"]
[null,null,null,"87207 - SMR PRIM SRC SPEC STAIN BODIES/PARASITS","87181 - HC CHG SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ","87207 - SMR PRIM SRC SPEC STAIN BODIES/PARASITS",null,"86902 - HC CHG BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH",null,null,null,null,"87252 - HC CHG VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT",null,"86774 - HC CHG ANTIBODY TETANUS",null,null,null,"87210 - SMR PRIM SRC WET MOUNT NFCT AGT"]
[null,null,null,"87209 - HC CHG SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS","87184 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD","87209 - HC CHG SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS",null,"86905 - HC CHG BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH",null,null,null,null,"87253 - HC CHG VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE",null,"86777 - HC CHG ANTIBODY TOXOPLASMA",null,null,null,"87220 - TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT"]
[null,null,null,"87210 - SMR PRIM SRC WET MOUNT NFCT AGT","87185 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ","87210 - SMR PRIM SRC WET MOUNT NFCT AGT",null,"86920 - HC CHG COMPATIBILITY EACH UNIT IMMEDIATE SPIN TECHNIQUE",null,null,null,null,"87254 - HC CHG VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA",null,"86778 - HC Q;TOXOPLASMA IGM,AB",null,null,null,"87252 - HC CHG VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT"]
[null,null,null,"87220 - TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT","87186 - HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ","87220 - TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT",null,"86922 - HC CHG COMPATIBILITY EACH UNIT ANTIGLOBULIN",null,null,null,null,"87255 - HC CHG VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC",null,"86780 - HC CHG ANTIBODY TREPONEMA PALLIDUM",null,null,null,"87253 - HC CHG VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE"]
[null,null,null,"87252 - HC CHG VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT","87188 - HC CHG SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT","87252 - HC CHG VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT",null,"86923 - HC CHG COMPATIBILITY EACH UNIT ELECTRONIC",null,null,null,null,"87260 - HC CHG IAADI ADENOVIRUS",null,"86787 - HC CHG ANTIBODY VARICELLA-ZOSTER",null,null,null,"87254 - HC CHG VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA"]
[null,null,null,"87253 - HC CHG VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE","87205 - HC CHG SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL","87253 - HC CHG VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE",null,"86999 - HC CHG UNLISTED TRANSFUSION MEDICINE PROCEDURE",null,null,null,null,"87269 - HC CHG IAADI GIARDIA",null,"86788 - HC CHG ANTIBODY WEST NILE VIRUS IGM",null,null,null,"87255 - HC CHG VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC"]
[null,null,null,"87254 - HC CHG VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA","87206 - HC CHG SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT","87254 - HC CHG VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA",null,"87015 - HC CHG CONCENTRATION INFECTIOUS AGENTS",null,null,null,null,"87272 - HC CHG IAADI CRYPTOSPORIDIUM",null,"86789 - HC CHG ANTIBODY WEST NILE VIRUS",null,null,null,"87260 - HC CHG IAADI ADENOVIRUS"]
[null,null,null,"87255 - HC CHG VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC","87207 - SMR PRIM SRC SPEC STAIN BODIES/PARASITS","87255 - HC CHG VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC",null,"87040 - HC CHG CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES",null,null,null,null,"87275 - HC CHG IAADI INFLUENZA B VIRUS",null,"86790 - HC CHG ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED",null,null,null,"87269 - HC CHG IAADI GIARDIA"]
[null,null,null,"87260 - HC CHG IAADI ADENOVIRUS","87209 - HC CHG SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS","87260 - HC CHG IAADI ADENOVIRUS",null,"87045 - HC CHG CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL",null,null,null,null,"87276 - HC CHG IAADI INFFLUENZA A VIRUS",null,"86800 - HC CHG THYROGLOBULIN ANTIBODY",null,null,null,"87272 - HC CHG IAADI CRYPTOSPORIDIUM"]
[null,null,null,"87269 - HC CHG IAADI GIARDIA","87210 - SMR PRIM SRC WET MOUNT NFCT AGT","87269 - HC CHG IAADI GIARDIA",null,"87046 - HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA",null,null,null,null,"87279 - HC CHG IAADI PARAINFLUENZA VIRUS EACH TYPE",null,"86803 - HC CHG HEPATITIS C ANTIBODY",null,null,null,"87275 - HC CHG IAADI INFLUENZA B VIRUS"]
[null,null,null,"87272 - HC CHG IAADI CRYPTOSPORIDIUM","87220 - TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT","87272 - HC CHG IAADI CRYPTOSPORIDIUM",null,"87070 - CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL",null,null,null,null,"87281 - HC CHG IAADI PNEUMOCUSTIS CARINII",null,"86807 - HC CHG SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH",null,null,null,"87276 - HC CHG IAADI INFFLUENZA A VIRUS"]
[null,null,null,"87275 - HC CHG IAADI INFLUENZA B VIRUS","87252 - HC CHG VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT","87275 - HC CHG IAADI INFLUENZA B VIRUS",null,"87075 - HC CHG CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID",null,null,null,null,"87299 - HC CHG AG DETECTION NOS, FLUOR",null,"86812 - HC CHG HLA TYPING A/B/C SINGLE ANTIGEN",null,null,null,"87279 - HC CHG IAADI PARAINFLUENZA VIRUS EACH TYPE"]
[null,null,null,"87276 - HC CHG IAADI INFFLUENZA A VIRUS","87253 - HC CHG VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE","87276 - HC CHG IAADI INFFLUENZA A VIRUS",null,"87076 - HC CHG CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL",null,null,null,null,"87305 - HC CHG IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS",null,"86813 - HC CHG HLA TYPING A/B/C MULTIPLE ANTIGENS",null,null,null,"87281 - HC CHG IAADI PNEUMOCUSTIS CARINII"]
[null,null,null,"87279 - HC CHG IAADI PARAINFLUENZA VIRUS EACH TYPE","87254 - HC CHG VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA","87279 - HC CHG IAADI PARAINFLUENZA VIRUS EACH TYPE",null,"87077 - HC CHG CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL",null,null,null,null,"87324 - HC CHG IAAD IA CLOSTRIDIUM DIFFICILE TOXIN",null,"86817 - HC CHG HLA TYPING DR/DQ MULTIPLE ANTIGENS",null,null,null,"87299 - HC CHG AG DETECTION NOS, FLUOR"]
[null,null,null,"87281 - HC CHG IAADI PNEUMOCUSTIS CARINII","87255 - HC CHG VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC","87281 - HC CHG IAADI PNEUMOCUSTIS CARINII",null,"87081 - HC CULT,BACT,SCR,H PYLORI",null,null,null,null,"87327 - HC CHG IAAD IA CRYPTOCOCCUS NEOFORMANS",null,"86850 - HC CHG ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE",null,null,null,"87305 - HC CHG IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS"]
[null,null,null,"87299 - HC CHG AG DETECTION NOS, FLUOR","87260 - HC CHG IAADI ADENOVIRUS","87299 - HC CHG AG DETECTION NOS, FLUOR",null,"87086 - HC CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE",null,null,null,null,"87338 - HC CHG IAAD IA HPYLORI STOOL",null,"86860 - HC CHG ANTIBODY ELUTION RBC EACH ELUTION",null,null,null,"87324 - HC CHG IAAD IA CLOSTRIDIUM DIFFICILE TOXIN"]
[null,null,null,"87305 - HC CHG IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS","87269 - HC CHG IAADI GIARDIA","87305 - HC CHG IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS",null,"87088 - HC CHG CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE",null,null,null,null,"87340 - HC CHG IAAD IA HEPATITIS B SURFACE ANTIGEN",null,"86870 - HC CHG ANTIBODY ID RBC ANTIBODIES EA PANEL EA SERUM TQ",null,null,null,"87327 - HC CHG IAAD IA CRYPTOCOCCUS NEOFORMANS"]
[null,null,null,"87324 - HC CHG IAAD IA CLOSTRIDIUM DIFFICILE TOXIN","87272 - HC CHG IAADI CRYPTOSPORIDIUM","87324 - HC CHG IAAD IA CLOSTRIDIUM DIFFICILE TOXIN",null,"87102 - HC CHG CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD",null,null,null,null,"87341 - HC CHG IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION",null,"86880 - HC CHG ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM",null,null,null,"87338 - HC CHG IAAD IA HPYLORI STOOL"]
[null,null,null,"87327 - HC CHG IAAD IA CRYPTOCOCCUS NEOFORMANS","87275 - HC CHG IAADI INFLUENZA B VIRUS","87327 - HC CHG IAAD IA CRYPTOCOCCUS NEOFORMANS",null,"87103 - HC CHG CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD",null,null,null,null,"87350 - HC CHG IAAD IA HEPATITIS BE ANTIGEN",null,"86886 - HC CHG ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER",null,null,null,"87340 - HC CHG IAAD IA HEPATITIS B SURFACE ANTIGEN"]
[null,null,null,"87338 - HC CHG IAAD IA HPYLORI STOOL","87276 - HC CHG IAADI INFFLUENZA A VIRUS","87338 - HC CHG IAAD IA HPYLORI STOOL",null,"87106 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST",null,null,null,null,"87385 - HC CHG IAAD IA HISTOPLASM CAPSULATUM",null,"86900 - HC CHG BLOOD TYPING SEROLOGIC ABO",null,null,null,"87341 - HC CHG IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION"]
[null,null,null,"87340 - HC CHG IAAD IA HEPATITIS B SURFACE ANTIGEN","87279 - HC CHG IAADI PARAINFLUENZA VIRUS EACH TYPE","87340 - HC CHG IAAD IA HEPATITIS B SURFACE ANTIGEN",null,"87107 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD",null,null,null,null,"87389 - HC CHG IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE",null,"86901 - HC CHG BLOOD TYPING SEROLOGIC RH (D)",null,null,null,"87350 - HC CHG IAAD IA HEPATITIS BE ANTIGEN"]
[null,null,null,"87341 - HC CHG IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION","87281 - HC CHG IAADI PNEUMOCUSTIS CARINII","87341 - HC CHG IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION",null,"87110 - HC CHG CULTURE, CHLAMYDIA",null,null,null,null,"87390 - HC CHG IAAD IA HIV-1",null,"86902 - HC CHG BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH",null,null,null,"87385 - HC CHG IAAD IA HISTOPLASM CAPSULATUM"]
[null,null,null,"87350 - HC CHG IAAD IA HEPATITIS BE ANTIGEN","87299 - HC CHG AG DETECTION NOS, FLUOR","87350 - HC CHG IAAD IA HEPATITIS BE ANTIGEN",null,"87116 - HC CHG CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL",null,null,null,null,"87391 - HC CHG IAAD IA HIV-2",null,"86905 - HC CHG BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH",null,null,null,"87389 - HC CHG IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE"]
[null,null,null,"87385 - HC CHG IAAD IA HISTOPLASM CAPSULATUM","87305 - HC CHG IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS","87385 - HC CHG IAAD IA HISTOPLASM CAPSULATUM",null,"87118 - HC CHG CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL",null,null,null,null,"87400 - HC CHG IAAD IA INFLUENZA A/B EACH",null,"86920 - HC CHG COMPATIBILITY EACH UNIT IMMEDIATE SPIN TECHNIQUE",null,null,null,"87390 - HC CHG IAAD IA HIV-1"]
[null,null,null,"87389 - HC CHG IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE","87324 - HC CHG IAAD IA CLOSTRIDIUM DIFFICILE TOXIN","87389 - HC CHG IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE",null,"87140 - HC CHG CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM",null,null,null,null,"87420 - HC CHG IAAD IA RESPIRATORY SYNCTIAL VIRUS",null,"86922 - HC CHG COMPATIBILITY EACH UNIT ANTIGLOBULIN",null,null,null,"87391 - HC CHG IAAD IA HIV-2"]
[null,null,null,"87390 - HC CHG IAAD IA HIV-1","87327 - HC CHG IAAD IA CRYPTOCOCCUS NEOFORMANS","87390 - HC CHG IAAD IA HIV-1",null,"87149 - HC CHG CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM",null,null,null,null,"87425 - HC CHG IAAD IA ROTAVIRUS",null,"86923 - HC CHG COMPATIBILITY EACH UNIT ELECTRONIC",null,null,null,"87400 - HC CHG IAAD IA INFLUENZA A/B EACH"]
[null,null,null,"87391 - HC CHG IAAD IA HIV-2","87338 - HC CHG IAAD IA HPYLORI STOOL","87391 - HC CHG IAAD IA HIV-2",null,"87150 - HC CHG CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM",null,null,null,null,"87426 - SARSCOV CORONAVIRUS AG IA",null,"86999 - HC CHG UNLISTED TRANSFUSION MEDICINE PROCEDURE",null,null,null,"87420 - HC CHG IAAD IA RESPIRATORY SYNCTIAL VIRUS"]
[null,null,null,"87400 - HC CHG IAAD IA INFLUENZA A/B EACH","87340 - HC CHG IAAD IA HEPATITIS B SURFACE ANTIGEN","87400 - HC CHG IAAD IA INFLUENZA A/B EACH",null,"87153 - HC Q;BACT ID,PHENO,SEQ",null,null,null,null,"87430 - HC CHG IAAD IA STREPTOCOCCUS GROUP A",null,"87015 - HC CHG CONCENTRATION INFECTIOUS AGENTS",null,null,null,"87425 - HC CHG IAAD IA ROTAVIRUS"]
[null,null,null,"87420 - HC CHG IAAD IA RESPIRATORY SYNCTIAL VIRUS","87341 - HC CHG IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION","87420 - HC CHG IAAD IA RESPIRATORY SYNCTIAL VIRUS",null,"87172 - HC CHG PINWORM EXAMINATION",null,null,null,null,"87449 - HC AG DET,ENZ IMM;OTH,EA",null,"87040 - HC CHG CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES",null,null,null,"87426 - SARSCOV CORONAVIRUS AG IA"]
[null,null,null,"87425 - HC CHG IAAD IA ROTAVIRUS","87350 - HC CHG IAAD IA HEPATITIS BE ANTIGEN","87425 - HC CHG IAAD IA ROTAVIRUS",null,"87176 - HC CHG HOMOGENIZATION TISSUE CULTURE",null,null,null,null,"87480 - HC CHG IADNA CANDIDA SPECIES DIRECT PROBE TQ",null,"87045 - HC CHG CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL",null,null,null,"87430 - HC CHG IAAD IA STREPTOCOCCUS GROUP A"]
[null,null,null,"87426 - SARSCOV CORONAVIRUS AG IA","87385 - HC CHG IAAD IA HISTOPLASM CAPSULATUM","87426 - SARSCOV CORONAVIRUS AG IA",null,"87177 - HC CHG OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID",null,null,null,null,"87481 - HC CHG CANDIDA, DNA, AMP PROBE",null,"87046 - HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA",null,null,null,"87449 - HC AG DET,ENZ IMM;OTH,EA"]
[null,null,null,"87430 - HC CHG IAAD IA STREPTOCOCCUS GROUP A","87389 - HC CHG IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE","87430 - HC CHG IAAD IA STREPTOCOCCUS GROUP A",null,"87181 - HC CHG SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ",null,null,null,null,"87486 - HC CHG IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ",null,"87070 - CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL",null,null,null,"87480 - HC CHG IADNA CANDIDA SPECIES DIRECT PROBE TQ"]
[null,null,null,"87449 - HC AG DET,ENZ IMM;OTH,EA","87390 - HC CHG IAAD IA HIV-1","87449 - HC AG DET,ENZ IMM;OTH,EA",null,"87184 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD",null,null,null,null,"87490 - HC CHG IADNA CHLAMYDIA TRACHOMATIS DIRECT PROBE TQ",null,"87075 - HC CHG CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID",null,null,null,"87481 - HC CHG CANDIDA, DNA, AMP PROBE"]
[null,null,null,"87480 - HC CHG IADNA CANDIDA SPECIES DIRECT PROBE TQ","87391 - HC CHG IAAD IA HIV-2","87480 - HC CHG IADNA CANDIDA SPECIES DIRECT PROBE TQ",null,"87185 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ",null,null,null,null,"87491 - HC CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ",null,"87076 - HC CHG CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL",null,null,null,"87486 - HC CHG IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ"]
[null,null,null,"87481 - HC CHG CANDIDA, DNA, AMP PROBE","87400 - HC CHG IAAD IA INFLUENZA A/B EACH","87481 - HC CHG CANDIDA, DNA, AMP PROBE",null,"87186 - HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ",null,null,null,null,"87493 - HC CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE",null,"87077 - HC CHG CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL",null,null,null,"87490 - HC CHG IADNA CHLAMYDIA TRACHOMATIS DIRECT PROBE TQ"]
[null,null,null,"87486 - HC CHG IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ","87420 - HC CHG IAAD IA RESPIRATORY SYNCTIAL VIRUS","87486 - HC CHG IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ",null,"87188 - HC CHG SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT",null,null,null,null,"87496 - HC ARUP;CYTOMEG VIR PCR,CSF",null,"87081 - HC CULT,BACT,SCR,H PYLORI",null,null,null,"87491 - HC CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ"]
[null,null,null,"87490 - HC CHG IADNA CHLAMYDIA TRACHOMATIS DIRECT PROBE TQ","87425 - HC CHG IAAD IA ROTAVIRUS","87490 - HC CHG IADNA CHLAMYDIA TRACHOMATIS DIRECT PROBE TQ",null,"87205 - HC CHG SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL",null,null,null,null,"87497 - HC CHG IADNA CYTOMEGALOVIRUS QUANTIFICATION",null,"87086 - HC CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE",null,null,null,"87493 - HC CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE"]
[null,null,null,"87491 - HC CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ","87426 - SARSCOV CORONAVIRUS AG IA","87491 - HC CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ",null,"87206 - HC CHG SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT",null,null,null,null,"87498 - HC CHG IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP",null,"87088 - HC CHG CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE",null,null,null,"87496 - HC ARUP;CYTOMEG VIR PCR,CSF"]
[null,null,null,"87493 - HC CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE","87430 - HC CHG IAAD IA STREPTOCOCCUS GROUP A","87493 - HC CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE",null,"87207 - SMR PRIM SRC SPEC STAIN BODIES/PARASITS",null,null,null,null,"87502 - HC Q;FLU AG DET,MULT TYP,2,2",null,"87102 - HC CHG CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD",null,null,null,"87497 - HC CHG IADNA CYTOMEGALOVIRUS QUANTIFICATION"]
[null,null,null,"87496 - HC ARUP;CYTOMEG VIR PCR,CSF","87449 - HC AG DET,ENZ IMM;OTH,EA","87496 - HC ARUP;CYTOMEG VIR PCR,CSF",null,"87209 - HC CHG SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS",null,null,null,null,"87505 - HC CHG NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN",null,"87103 - HC CHG CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD",null,null,null,"87498 - HC CHG IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP"]
[null,null,null,"87497 - HC CHG IADNA CYTOMEGALOVIRUS QUANTIFICATION","87480 - HC CHG IADNA CANDIDA SPECIES DIRECT PROBE TQ","87497 - HC CHG IADNA CYTOMEGALOVIRUS QUANTIFICATION",null,"87210 - SMR PRIM SRC WET MOUNT NFCT AGT",null,null,null,null,"87506 - HC CHG IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11",null,"87106 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST",null,null,null,"87502 - HC Q;FLU AG DET,MULT TYP,2,2"]
[null,null,null,"87498 - HC CHG IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP","87481 - HC CHG CANDIDA, DNA, AMP PROBE","87498 - HC CHG IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP",null,"87220 - TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT",null,null,null,null,"87507 - HC IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25",null,"87107 - HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD",null,null,null,"87505 - HC CHG NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN"]
[null,null,null,"87502 - HC Q;FLU AG DET,MULT TYP,2,2","87486 - HC CHG IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ","87502 - HC Q;FLU AG DET,MULT TYP,2,2",null,"87252 - HC CHG VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT",null,null,null,null,"87510 - HC CHG IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ",null,"87110 - HC CHG CULTURE, CHLAMYDIA",null,null,null,"87506 - HC CHG IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11"]
[null,null,null,"87505 - HC CHG NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN","87490 - HC CHG IADNA CHLAMYDIA TRACHOMATIS DIRECT PROBE TQ","87505 - HC CHG NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN",null,"87253 - HC CHG VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE",null,null,null,null,"87511 - HC CHG GARDNER VAG, DNA  AMP PROBE",null,"87116 - HC CHG CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL",null,null,null,"87507 - HC IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25"]
[null,null,null,"87506 - HC CHG IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11","87491 - HC CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ","87506 - HC CHG IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11",null,"87254 - HC CHG VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA",null,null,null,null,"87517 - HC CHG IADNA HEPATITIS B VIRUS QUANTIFICATION",null,"87118 - HC CHG CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL",null,null,null,"87510 - HC CHG IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ"]
[null,null,null,"87507 - HC IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25","87493 - HC CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE","87507 - HC IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25",null,"87255 - HC CHG VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC",null,null,null,null,"87522 - HC ARUP;HEP C VIR RNA QN",null,"87140 - HC CHG CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM",null,null,null,"87511 - HC CHG GARDNER VAG, DNA  AMP PROBE"]
[null,null,null,"87510 - HC CHG IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ","87496 - HC ARUP;CYTOMEG VIR PCR,CSF","87510 - HC CHG IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ",null,"87260 - HC CHG IAADI ADENOVIRUS",null,null,null,null,"87529 - HC CHG IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ",null,"87149 - HC CHG CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM",null,null,null,"87517 - HC CHG IADNA HEPATITIS B VIRUS QUANTIFICATION"]
[null,null,null,"87511 - HC CHG GARDNER VAG, DNA  AMP PROBE","87497 - HC CHG IADNA CYTOMEGALOVIRUS QUANTIFICATION","87511 - HC CHG GARDNER VAG, DNA  AMP PROBE",null,"87269 - HC CHG IAADI GIARDIA",null,null,null,null,"87532 - HC CHG IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ",null,"87150 - HC CHG CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM",null,null,null,"87522 - HC ARUP;HEP C VIR RNA QN"]
[null,null,null,"87517 - HC CHG IADNA HEPATITIS B VIRUS QUANTIFICATION","87498 - HC CHG IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP","87517 - HC CHG IADNA HEPATITIS B VIRUS QUANTIFICATION",null,"87272 - HC CHG IAADI CRYPTOSPORIDIUM",null,null,null,null,"87535 - HC CHG IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ",null,"87153 - HC Q;BACT ID,PHENO,SEQ",null,null,null,"87529 - HC CHG IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ"]
[null,null,null,"87522 - HC ARUP;HEP C VIR RNA QN","87502 - HC Q;FLU AG DET,MULT TYP,2,2","87522 - HC ARUP;HEP C VIR RNA QN",null,"87275 - HC CHG IAADI INFLUENZA B VIRUS",null,null,null,null,"87536 - HC CHG IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION",null,"87172 - HC CHG PINWORM EXAMINATION",null,null,null,"87532 - HC CHG IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ"]
[null,null,null,"87529 - HC CHG IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ","87505 - HC CHG NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN","87529 - HC CHG IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ",null,"87276 - HC CHG IAADI INFFLUENZA A VIRUS",null,null,null,null,"87538 - HC HIV-2 PROBE&REVRSE TRNSCRIPJ",null,"87176 - HC CHG HOMOGENIZATION TISSUE CULTURE",null,null,null,"87535 - HC CHG IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ"]
[null,null,null,"87532 - HC CHG IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ","87506 - HC CHG IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11","87532 - HC CHG IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ",null,"87279 - HC CHG IAADI PARAINFLUENZA VIRUS EACH TYPE",null,null,null,null,"87556 - HC CHG IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB",null,"87177 - HC CHG OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID",null,null,null,"87536 - HC CHG IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION"]
[null,null,null,"87535 - HC CHG IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ","87507 - HC IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25","87535 - HC CHG IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ",null,"87281 - HC CHG IAADI PNEUMOCUSTIS CARINII",null,null,null,null,"87563 - HC M. GENITALIUM AMP PROBE",null,"87181 - HC CHG SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ",null,null,null,"87538 - HC HIV-2 PROBE&REVRSE TRNSCRIPJ"]
[null,null,null,"87536 - HC CHG IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION","87510 - HC CHG IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ","87536 - HC CHG IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION",null,"87299 - HC CHG AG DETECTION NOS, FLUOR",null,null,null,null,"87581 - HC CHG IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ",null,"87184 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD",null,null,null,"87556 - HC CHG IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB"]
[null,null,null,"87538 - HC HIV-2 PROBE&REVRSE TRNSCRIPJ","87511 - HC CHG GARDNER VAG, DNA  AMP PROBE","87538 - HC HIV-2 PROBE&REVRSE TRNSCRIPJ",null,"87305 - HC CHG IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS",null,null,null,null,"87591 - HC CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ",null,"87185 - HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ",null,null,null,"87563 - HC M. GENITALIUM AMP PROBE"]
[null,null,null,"87556 - HC CHG IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB","87517 - HC CHG IADNA HEPATITIS B VIRUS QUANTIFICATION","87556 - HC CHG IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB",null,"87324 - HC CHG IAAD IA CLOSTRIDIUM DIFFICILE TOXIN",null,null,null,null,"87624 - IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES",null,"87186 - HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ",null,null,null,"87581 - HC CHG IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ"]
[null,null,null,"87581 - HC CHG IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ","87522 - HC ARUP;HEP C VIR RNA QN","87581 - HC CHG IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ",null,"87327 - HC CHG IAAD IA CRYPTOCOCCUS NEOFORMANS",null,null,null,null,"87631 - HC INFLUENZA A/B,RSV PCR",null,"87188 - HC CHG SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT",null,null,null,"87591 - HC CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ"]
[null,null,null,"87591 - HC CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ","87529 - HC CHG IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ","87591 - HC CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ",null,"87338 - HC CHG IAAD IA HPYLORI STOOL",null,null,null,null,"87632 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 6-11 TARGETS",null,"87205 - HC CHG SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL",null,null,null,"87624 - IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES"]
[null,null,null,"87624 - IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES","87532 - HC CHG IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ","87624 - IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES",null,"87340 - HC CHG IAAD IA HEPATITIS B SURFACE ANTIGEN",null,null,null,null,"87633 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET",null,"87206 - HC CHG SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT",null,null,null,"87631 - HC INFLUENZA A/B,RSV PCR"]
[null,null,null,"87631 - HC INFLUENZA A/B,RSV PCR","87535 - HC CHG IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ","87631 - HC INFLUENZA A/B,RSV PCR",null,"87341 - HC CHG IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION",null,null,null,null,"87635 - HC SARS-COV-2 COVID-19 AMP PRB",null,"87207 - SMR PRIM SRC SPEC STAIN BODIES/PARASITS",null,null,null,"87632 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 6-11 TARGETS"]
[null,null,null,"87632 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 6-11 TARGETS","87536 - HC CHG IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION","87632 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 6-11 TARGETS",null,"87350 - HC CHG IAAD IA HEPATITIS BE ANTIGEN",null,null,null,null,"87636 - HC SARSCOV2 & INF A&B AMP PRB",null,"87209 - HC CHG SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS",null,null,null,"87633 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET"]
[null,null,null,"87633 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET","87538 - HC HIV-2 PROBE&REVRSE TRNSCRIPJ","87633 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET",null,"87385 - HC CHG IAAD IA HISTOPLASM CAPSULATUM",null,null,null,null,"87640 - HC CHG IADNA S AUREUS AMPLIFIED PROBE TQ",null,"87210 - SMR PRIM SRC WET MOUNT NFCT AGT",null,null,null,"87635 - HC SARS-COV-2 COVID-19 AMP PRB"]
[null,null,null,"87635 - HC SARS-COV-2 COVID-19 AMP PRB","87556 - HC CHG IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB","87635 - HC SARS-COV-2 COVID-19 AMP PRB",null,"87389 - HC CHG IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE",null,null,null,null,"87641 - HC CHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ",null,"87220 - TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT",null,null,null,"87636 - HC SARSCOV2 & INF A&B AMP PRB"]
[null,null,null,"87636 - HC SARSCOV2 & INF A&B AMP PRB","87563 - HC M. GENITALIUM AMP PROBE","87636 - HC SARSCOV2 & INF A&B AMP PRB",null,"87390 - HC CHG IAAD IA HIV-1",null,null,null,null,"87653 - HC CHG IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ",null,"87252 - HC CHG VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT",null,null,null,"87640 - HC CHG IADNA S AUREUS AMPLIFIED PROBE TQ"]
[null,null,null,"87640 - HC CHG IADNA S AUREUS AMPLIFIED PROBE TQ","87581 - HC CHG IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ","87640 - HC CHG IADNA S AUREUS AMPLIFIED PROBE TQ",null,"87391 - HC CHG IAAD IA HIV-2",null,null,null,null,"87660 - HC CHG IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ",null,"87253 - HC CHG VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE",null,null,null,"87641 - HC CHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ"]
[null,null,null,"87641 - HC CHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ","87591 - HC CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ","87641 - HC CHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ",null,"87400 - HC CHG IAAD IA INFLUENZA A/B EACH",null,null,null,null,"87661 - IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH",null,"87254 - HC CHG VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA",null,null,null,"87653 - HC CHG IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ"]
[null,null,null,"87653 - HC CHG IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ","87624 - IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES","87653 - HC CHG IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ",null,"87420 - HC CHG IAAD IA RESPIRATORY SYNCTIAL VIRUS",null,null,null,null,"87797 - HC CHG DETECT AGENT NOS, DNA, DIR",null,"87255 - HC CHG VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC",null,null,null,"87660 - HC CHG IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ"]
[null,null,null,"87660 - HC CHG IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ","87631 - HC INFLUENZA A/B,RSV PCR","87660 - HC CHG IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ",null,"87425 - HC CHG IAAD IA ROTAVIRUS",null,null,null,null,"87798 - HC EBV DNA, QL PCR",null,"87260 - HC CHG IAADI ADENOVIRUS",null,null,null,"87661 - IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH"]
[null,null,null,"87661 - IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH","87632 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 6-11 TARGETS","87661 - IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH",null,"87430 - HC CHG IAAD IA STREPTOCOCCUS GROUP A",null,null,null,null,"87799 - HC CHG IADNA NOS QUANTIFICATION EACH ORGANISM",null,"87269 - HC CHG IAADI GIARDIA",null,null,null,"87797 - HC CHG DETECT AGENT NOS, DNA, DIR"]
[null,null,null,"87797 - HC CHG DETECT AGENT NOS, DNA, DIR","87633 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET","87797 - HC CHG DETECT AGENT NOS, DNA, DIR",null,"87449 - HC AG DET,ENZ IMM;OTH,EA",null,null,null,null,"87801 - HC CHG DETECT AGENT, MULT ORGS, DNA  AMP",null,"87272 - HC CHG IAADI CRYPTOSPORIDIUM",null,null,null,"87798 - HC EBV DNA, QL PCR"]
[null,null,null,"87798 - HC EBV DNA, QL PCR","87635 - HC SARS-COV-2 COVID-19 AMP PRB","87798 - HC EBV DNA, QL PCR",null,"87480 - HC CHG IADNA CANDIDA SPECIES DIRECT PROBE TQ",null,null,null,null,"87880 - IAADIADOO STREPTOCOCCUS GROUP A",null,"87275 - HC CHG IAADI INFLUENZA B VIRUS",null,null,null,"87799 - HC CHG IADNA NOS QUANTIFICATION EACH ORGANISM"]
[null,null,null,"87799 - HC CHG IADNA NOS QUANTIFICATION EACH ORGANISM","87636 - HC SARSCOV2 & INF A&B AMP PRB","87799 - HC CHG IADNA NOS QUANTIFICATION EACH ORGANISM",null,"87481 - HC CHG CANDIDA, DNA, AMP PROBE",null,null,null,null,"87899 - HC MALARIA ANTIGEN",null,"87276 - HC CHG IAADI INFFLUENZA A VIRUS",null,null,null,"87801 - HC CHG DETECT AGENT, MULT ORGS, DNA  AMP"]
[null,null,null,"87801 - HC CHG DETECT AGENT, MULT ORGS, DNA  AMP","87640 - HC CHG IADNA S AUREUS AMPLIFIED PROBE TQ","87801 - HC CHG DETECT AGENT, MULT ORGS, DNA  AMP",null,"87486 - HC CHG IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ",null,null,null,null,"87900 - HC CHG NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION",null,"87279 - HC CHG IAADI PARAINFLUENZA VIRUS EACH TYPE",null,null,null,"87880 - IAADIADOO STREPTOCOCCUS GROUP A"]
[null,null,null,"87880 - IAADIADOO STREPTOCOCCUS GROUP A","87641 - HC CHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ","87880 - IAADIADOO STREPTOCOCCUS GROUP A",null,"87490 - HC CHG IADNA CHLAMYDIA TRACHOMATIS DIRECT PROBE TQ",null,null,null,null,"87901 - HC CHG NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEAS",null,"87281 - HC CHG IAADI PNEUMOCUSTIS CARINII",null,null,null,"87899 - HC MALARIA ANTIGEN"]
[null,null,null,"87899 - HC MALARIA ANTIGEN","87653 - HC CHG IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ","87899 - HC MALARIA ANTIGEN",null,"87491 - HC CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ",null,null,null,null,"87902 - HC CHG NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS",null,"87299 - HC CHG AG DETECTION NOS, FLUOR",null,null,null,"87900 - HC CHG NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION"]
[null,null,null,"87900 - HC CHG NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION","87660 - HC CHG IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ","87900 - HC CHG NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION",null,"87493 - HC CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE",null,null,null,null,"87906 - HC Q;HIV1 GENO",null,"87305 - HC CHG IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS",null,null,null,"87901 - HC CHG NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEAS"]
[null,null,null,"87901 - HC CHG NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEAS","87661 - IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH","87901 - HC CHG NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEAS",null,"87496 - HC ARUP;CYTOMEG VIR PCR,CSF",null,null,null,null,"87912 - HC CHG NFCT AGENT GENOTYPE HEPATITIS B VIRUS",null,"87324 - HC CHG IAAD IA CLOSTRIDIUM DIFFICILE TOXIN",null,null,null,"87902 - HC CHG NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS"]
[null,null,null,"87902 - HC CHG NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS","87797 - HC CHG DETECT AGENT NOS, DNA, DIR","87902 - HC CHG NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS",null,"87497 - HC CHG IADNA CYTOMEGALOVIRUS QUANTIFICATION",null,null,null,null,"88104 - HC CHG CYTOPATH FLUIDS SMEAR, INTERP",null,"87327 - HC CHG IAAD IA CRYPTOCOCCUS NEOFORMANS",null,null,null,"87906 - HC Q;HIV1 GENO"]
[null,null,null,"87906 - HC Q;HIV1 GENO","87798 - HC EBV DNA, QL PCR","87906 - HC Q;HIV1 GENO",null,"87498 - HC CHG IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP",null,null,null,null,"88108 - HC CHG CYTP CONCENTRATION SMEARS & INTERPRETATION",null,"87338 - HC CHG IAAD IA HPYLORI STOOL",null,null,null,"87912 - HC CHG NFCT AGENT GENOTYPE HEPATITIS B VIRUS"]
[null,null,null,"87912 - HC CHG NFCT AGENT GENOTYPE HEPATITIS B VIRUS","87799 - HC CHG IADNA NOS QUANTIFICATION EACH ORGANISM","87912 - HC CHG NFCT AGENT GENOTYPE HEPATITIS B VIRUS",null,"87502 - HC Q;FLU AG DET,MULT TYP,2,2",null,null,null,null,"88112 - HC CHG CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V",null,"87340 - HC CHG IAAD IA HEPATITIS B SURFACE ANTIGEN",null,null,null,"88104 - HC CHG CYTOPATH FLUIDS SMEAR, INTERP"]
[null,null,null,"88104 - HC CHG CYTOPATH FLUIDS SMEAR, INTERP","87801 - HC CHG DETECT AGENT, MULT ORGS, DNA  AMP","88104 - HC CHG CYTOPATH FLUIDS SMEAR, INTERP",null,"87505 - HC CHG NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN",null,null,null,null,"88141 - HC CYTOPATH CERV/VAG INTEPRET",null,"87341 - HC CHG IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION",null,null,null,"88108 - HC CHG CYTP CONCENTRATION SMEARS & INTERPRETATION"]
[null,null,null,"88108 - HC CHG CYTP CONCENTRATION SMEARS & INTERPRETATION","87880 - IAADIADOO STREPTOCOCCUS GROUP A","88108 - HC CHG CYTP CONCENTRATION SMEARS & INTERPRETATION",null,"87506 - HC CHG IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11",null,null,null,null,"88142 - CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN",null,"87350 - HC CHG IAAD IA HEPATITIS BE ANTIGEN",null,null,null,"88112 - HC CHG CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V"]
[null,null,null,"88112 - HC CHG CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V","87899 - HC MALARIA ANTIGEN","88112 - HC CHG CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V",null,"87507 - HC IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25",null,null,null,null,"88143 - HC CHG CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS",null,"87385 - HC CHG IAAD IA HISTOPLASM CAPSULATUM",null,null,null,"88141 - HC CYTOPATH CERV/VAG INTEPRET"]
[null,null,null,"88141 - HC CYTOPATH CERV/VAG INTEPRET","87900 - HC CHG NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION","88141 - HC CYTOPATH CERV/VAG INTEPRET",null,"87510 - HC CHG IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ",null,null,null,null,"88147 - HC CHG CYTOPATH SMEAR CERV/VAG AUTOMATED",null,"87389 - HC CHG IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE",null,null,null,"88142 - CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN"]
[null,null,null,"88142 - CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN","87901 - HC CHG NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEAS","88142 - CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN",null,"87511 - HC CHG GARDNER VAG, DNA  AMP PROBE",null,null,null,null,"88152 - HC CHG CYTOPATH SMEAR CERV/VAG,AUTO REDO",null,"87390 - HC CHG IAAD IA HIV-1",null,null,null,"88143 - HC CHG CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS"]
[null,null,null,"88143 - HC CHG CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS","87902 - HC CHG NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS","88143 - HC CHG CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS",null,"87517 - HC CHG IADNA HEPATITIS B VIRUS QUANTIFICATION",null,null,null,null,"88160 - HC CHG CYTP SMRS ANY OTH SRC SCR&INTERPJ",null,"87391 - HC CHG IAAD IA HIV-2",null,null,null,"88147 - HC CHG CYTOPATH SMEAR CERV/VAG AUTOMATED"]
[null,null,null,"88147 - HC CHG CYTOPATH SMEAR CERV/VAG AUTOMATED","87906 - HC Q;HIV1 GENO","88147 - HC CHG CYTOPATH SMEAR CERV/VAG AUTOMATED",null,"87522 - HC ARUP;HEP C VIR RNA QN",null,null,null,null,"88161 - HC CHG CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ",null,"87400 - HC CHG IAAD IA INFLUENZA A/B EACH",null,null,null,"88152 - HC CHG CYTOPATH SMEAR CERV/VAG,AUTO REDO"]
[null,null,null,"88152 - HC CHG CYTOPATH SMEAR CERV/VAG,AUTO REDO","87912 - HC CHG NFCT AGENT GENOTYPE HEPATITIS B VIRUS","88152 - HC CHG CYTOPATH SMEAR CERV/VAG,AUTO REDO",null,"87529 - HC CHG IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ",null,null,null,null,"88164 - HC CHG CYTOPATH TBS CERV/VAG MANUAL",null,"87420 - HC CHG IAAD IA RESPIRATORY SYNCTIAL VIRUS",null,null,null,"88160 - HC CHG CYTP SMRS ANY OTH SRC SCR&INTERPJ"]
[null,null,null,"88160 - HC CHG CYTP SMRS ANY OTH SRC SCR&INTERPJ","88104 - HC CHG CYTOPATH FLUIDS SMEAR, INTERP","88160 - HC CHG CYTP SMRS ANY OTH SRC SCR&INTERPJ",null,"87532 - HC CHG IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ",null,null,null,null,"88165 - HC CHG CYTP SLIDES C/V MNL SCR&RESCR PHYS SUPV",null,"87425 - HC CHG IAAD IA ROTAVIRUS",null,null,null,"88161 - HC CHG CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ"]
[null,null,null,"88161 - HC CHG CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ","88108 - HC CHG CYTP CONCENTRATION SMEARS & INTERPRETATION","88161 - HC CHG CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ",null,"87535 - HC CHG IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ",null,null,null,null,"88172 - CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST",null,"87426 - SARSCOV CORONAVIRUS AG IA",null,null,null,"88164 - HC CHG CYTOPATH TBS CERV/VAG MANUAL"]
[null,null,null,"88164 - HC CHG CYTOPATH TBS CERV/VAG MANUAL","88112 - HC CHG CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V","88164 - HC CHG CYTOPATH TBS CERV/VAG MANUAL",null,"87536 - HC CHG IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION",null,null,null,null,"88173 - CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT",null,"87430 - HC CHG IAAD IA STREPTOCOCCUS GROUP A",null,null,null,"88165 - HC CHG CYTP SLIDES C/V MNL SCR&RESCR PHYS SUPV"]
[null,null,null,"88165 - HC CHG CYTP SLIDES C/V MNL SCR&RESCR PHYS SUPV","88141 - HC CYTOPATH CERV/VAG INTEPRET","88165 - HC CHG CYTP SLIDES C/V MNL SCR&RESCR PHYS SUPV",null,"87538 - HC HIV-2 PROBE&REVRSE TRNSCRIPJ",null,null,null,null,"88184 - HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST",null,"87449 - HC AG DET,ENZ IMM;OTH,EA",null,null,null,"88172 - CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST"]
[null,null,null,"88172 - CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST","88142 - CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN","88172 - CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST",null,"87556 - HC CHG IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB",null,null,null,null,"88185 - HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA",null,"87480 - HC CHG IADNA CANDIDA SPECIES DIRECT PROBE TQ",null,null,null,"88173 - CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT"]
[null,null,null,"88173 - CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT","88143 - HC CHG CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS","88173 - CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT",null,"87563 - HC M. GENITALIUM AMP PROBE",null,null,null,null,"88187 - FLOWCYTOMETRY/READ, 2-8 MARKERS",null,"87481 - HC CHG CANDIDA, DNA, AMP PROBE",null,null,null,"88184 - HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST"]
[null,null,null,"88184 - HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST","88147 - HC CHG CYTOPATH SMEAR CERV/VAG AUTOMATED","88184 - HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST",null,"87581 - HC CHG IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ",null,null,null,null,"88188 - FLOWCYTOMETRY/READ, 9-15 MARKERS",null,"87486 - HC CHG IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ",null,null,null,"88185 - HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA"]
[null,null,null,"88185 - HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA","88152 - HC CHG CYTOPATH SMEAR CERV/VAG,AUTO REDO","88185 - HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA",null,"87591 - HC CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ",null,null,null,null,"88230 - HC CHG TISS CUL NON-NEO DISORDERS LYMPHOCYTE",null,"87490 - HC CHG IADNA CHLAMYDIA TRACHOMATIS DIRECT PROBE TQ",null,null,null,"88187 - FLOWCYTOMETRY/READ, 2-8 MARKERS"]
[null,null,null,"88187 - FLOWCYTOMETRY/READ, 2-8 MARKERS","88160 - HC CHG CYTP SMRS ANY OTH SRC SCR&INTERPJ","88187 - FLOWCYTOMETRY/READ, 2-8 MARKERS",null,"87624 - IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES",null,null,null,null,"88235 - HC CHG TISSUE CULTURE, PLACENTA",null,"87491 - HC CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ",null,null,null,"88188 - FLOWCYTOMETRY/READ, 9-15 MARKERS"]
[null,null,null,"88188 - FLOWCYTOMETRY/READ, 9-15 MARKERS","88161 - HC CHG CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ","88188 - FLOWCYTOMETRY/READ, 9-15 MARKERS",null,"87631 - HC INFLUENZA A/B,RSV PCR",null,null,null,null,"88237 - HC CHG TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS",null,"87493 - HC CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE",null,null,null,"88230 - HC CHG TISS CUL NON-NEO DISORDERS LYMPHOCYTE"]
[null,null,null,"88230 - HC CHG TISS CUL NON-NEO DISORDERS LYMPHOCYTE","88164 - HC CHG CYTOPATH TBS CERV/VAG MANUAL","88230 - HC CHG TISS CUL NON-NEO DISORDERS LYMPHOCYTE",null,"87632 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 6-11 TARGETS",null,null,null,null,"88262 - HC CHG CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING",null,"87496 - HC ARUP;CYTOMEG VIR PCR,CSF",null,null,null,"88235 - HC CHG TISSUE CULTURE, PLACENTA"]
[null,null,null,"88235 - HC CHG TISSUE CULTURE, PLACENTA","88165 - HC CHG CYTP SLIDES C/V MNL SCR&RESCR PHYS SUPV","88235 - HC CHG TISSUE CULTURE, PLACENTA",null,"87633 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET",null,null,null,null,"88264 - HC CHG CHRMSM ANALYZE 20-25 CELLS",null,"87497 - HC CHG IADNA CYTOMEGALOVIRUS QUANTIFICATION",null,null,null,"88237 - HC CHG TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS"]
[null,null,null,"88237 - HC CHG TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS","88172 - CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST","88237 - HC CHG TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS",null,"87635 - HC SARS-COV-2 COVID-19 AMP PRB",null,null,null,null,"88271 - HC CHG MOLECULAR CYTOGENETICS DNA PROBE EACH",null,"87498 - HC CHG IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP",null,null,null,"88262 - HC CHG CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING"]
[null,null,null,"88262 - HC CHG CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING","88173 - CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT","88262 - HC CHG CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING",null,"87640 - HC CHG IADNA S AUREUS AMPLIFIED PROBE TQ",null,null,null,null,"88274 - HC CHG MOLECULAR CYTOGENETICS INTERPHASE ISH 25-99 CLL",null,"87502 - HC Q;FLU AG DET,MULT TYP,2,2",null,null,null,"88264 - HC CHG CHRMSM ANALYZE 20-25 CELLS"]
[null,null,null,"88264 - HC CHG CHRMSM ANALYZE 20-25 CELLS","88184 - HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST","88264 - HC CHG CHRMSM ANALYZE 20-25 CELLS",null,"87641 - HC CHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ",null,null,null,null,"88275 - HC CHG MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL",null,"87505 - HC CHG NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN",null,null,null,"88271 - HC CHG MOLECULAR CYTOGENETICS DNA PROBE EACH"]
[null,null,null,"88271 - HC CHG MOLECULAR CYTOGENETICS DNA PROBE EACH","88185 - HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA","88271 - HC CHG MOLECULAR CYTOGENETICS DNA PROBE EACH",null,"87653 - HC CHG IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ",null,null,null,null,"88280 - HC CHG CHROMOSOME KARYOTYPE STUDY",null,"87506 - HC CHG IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11",null,null,null,"88274 - HC CHG MOLECULAR CYTOGENETICS INTERPHASE ISH 25-99 CLL"]
[null,null,null,"88274 - HC CHG MOLECULAR CYTOGENETICS INTERPHASE ISH 25-99 CLL","88187 - FLOWCYTOMETRY/READ, 2-8 MARKERS","88274 - HC CHG MOLECULAR CYTOGENETICS INTERPHASE ISH 25-99 CLL",null,"87660 - HC CHG IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ",null,null,null,null,"88291 - HC CHG CYTOGENETICS&MOLEC CYTOGENETICS INTERP&REP",null,"87507 - HC IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25",null,null,null,"88275 - HC CHG MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL"]
[null,null,null,"88275 - HC CHG MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL","88188 - FLOWCYTOMETRY/READ, 9-15 MARKERS","88275 - HC CHG MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL",null,"87661 - IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH",null,null,null,null,"88300 - HC CHG LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY",null,"87510 - HC CHG IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ",null,null,null,"88280 - HC CHG CHROMOSOME KARYOTYPE STUDY"]
[null,null,null,"88280 - HC CHG CHROMOSOME KARYOTYPE STUDY","88230 - HC CHG TISS CUL NON-NEO DISORDERS LYMPHOCYTE","88280 - HC CHG CHROMOSOME KARYOTYPE STUDY",null,"87797 - HC CHG DETECT AGENT NOS, DNA, DIR",null,null,null,null,"88302 - HC CHG LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM",null,"87511 - HC CHG GARDNER VAG, DNA  AMP PROBE",null,null,null,"88291 - HC CHG CYTOGENETICS&MOLEC CYTOGENETICS INTERP&REP"]
[null,null,null,"88291 - HC CHG CYTOGENETICS&MOLEC CYTOGENETICS INTERP&REP","88235 - HC CHG TISSUE CULTURE, PLACENTA","88291 - HC CHG CYTOGENETICS&MOLEC CYTOGENETICS INTERP&REP",null,"87798 - HC EBV DNA, QL PCR",null,null,null,null,"88304 - HC CHG LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM",null,"87517 - HC CHG IADNA HEPATITIS B VIRUS QUANTIFICATION",null,null,null,"88300 - HC CHG LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY"]
[null,null,null,"88300 - HC CHG LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY","88237 - HC CHG TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS","88300 - HC CHG LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY",null,"87799 - HC CHG IADNA NOS QUANTIFICATION EACH ORGANISM",null,null,null,null,"88305 - CELL BLCK",null,"87522 - HC ARUP;HEP C VIR RNA QN",null,null,null,"88302 - HC CHG LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM"]
[null,null,null,"88302 - HC CHG LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM","88262 - HC CHG CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING","88302 - HC CHG LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM",null,"87801 - HC CHG DETECT AGENT, MULT ORGS, DNA  AMP",null,null,null,null,"88307 - HC CHG LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM",null,"87529 - HC CHG IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ",null,null,null,"88304 - HC CHG LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM"]
[null,null,null,"88304 - HC CHG LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM","88264 - HC CHG CHRMSM ANALYZE 20-25 CELLS","88304 - HC CHG LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM",null,"87880 - IAADIADOO STREPTOCOCCUS GROUP A",null,null,null,null,"88309 - HC CHG LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM",null,"87532 - HC CHG IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ",null,null,null,"88305 - CELL BLCK"]
[null,null,null,"88305 - CELL BLCK","88271 - HC CHG MOLECULAR CYTOGENETICS DNA PROBE EACH","88305 - CELL BLCK",null,"87899 - HC MALARIA ANTIGEN",null,null,null,null,"88311 - HC CHG DECALCIFICATION PROCEDURE",null,"87535 - HC CHG IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ",null,null,null,"88307 - HC CHG LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM"]
[null,null,null,"88307 - HC CHG LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM","88274 - HC CHG MOLECULAR CYTOGENETICS INTERPHASE ISH 25-99 CLL","88307 - HC CHG LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM",null,"87900 - HC CHG NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION",null,null,null,null,"88312 - HC CHG SPECIAL STAIN GROUP 1 MICROORGANISMS I&R",null,"87536 - HC CHG IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION",null,null,null,"88309 - HC CHG LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM"]
[null,null,null,"88309 - HC CHG LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM","88275 - HC CHG MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL","88309 - HC CHG LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM",null,"87901 - HC CHG NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEAS",null,null,null,null,"88313 - HC CHG SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT",null,"87538 - HC HIV-2 PROBE&REVRSE TRNSCRIPJ",null,null,null,"88311 - HC CHG DECALCIFICATION PROCEDURE"]
[null,null,null,"88311 - HC CHG DECALCIFICATION PROCEDURE","88280 - HC CHG CHROMOSOME KARYOTYPE STUDY","88311 - HC CHG DECALCIFICATION PROCEDURE",null,"87902 - HC CHG NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS",null,null,null,null,"88314 - HC HISTOCHEMICAL STAIN",null,"87556 - HC CHG IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB",null,null,null,"88312 - HC CHG SPECIAL STAIN GROUP 1 MICROORGANISMS I&R"]
[null,null,null,"88312 - HC CHG SPECIAL STAIN GROUP 1 MICROORGANISMS I&R","88291 - HC CHG CYTOGENETICS&MOLEC CYTOGENETICS INTERP&REP","88312 - HC CHG SPECIAL STAIN GROUP 1 MICROORGANISMS I&R",null,"87906 - HC Q;HIV1 GENO",null,null,null,null,"88319 - HC CHG SPECIAL STAIN I&R GROUP III ENZYME CONSITUENTS",null,"87563 - HC M. GENITALIUM AMP PROBE",null,null,null,"88313 - HC CHG SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT"]
[null,null,null,"88313 - HC CHG SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT","88300 - HC CHG LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY","88313 - HC CHG SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT",null,"87912 - HC CHG NFCT AGENT GENOTYPE HEPATITIS B VIRUS",null,null,null,null,"88329 - HC CHG PATHOLOGY CONSULTATION DURING SURGERY",null,"87581 - HC CHG IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ",null,null,null,"88314 - HC HISTOCHEMICAL STAIN"]
[null,null,null,"88314 - HC HISTOCHEMICAL STAIN","88302 - HC CHG LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM","88314 - HC HISTOCHEMICAL STAIN",null,"87999 - HC CHG UNLISTED MICROBIOLOGY",null,null,null,null,"88331 - PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC",null,"87591 - HC CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ",null,null,null,"88319 - HC CHG SPECIAL STAIN I&R GROUP III ENZYME CONSITUENTS"]
[null,null,null,"88319 - HC CHG SPECIAL STAIN I&R GROUP III ENZYME CONSITUENTS","88304 - HC CHG LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM","88319 - HC CHG SPECIAL STAIN I&R GROUP III ENZYME CONSITUENTS",null,"88104 - HC CHG CYTOPATH FLUIDS SMEAR, INTERP",null,null,null,null,"88332 - HC CHG PATH CONSLTJ SURG EA ADDL BLK FROZEN SECTION",null,"87624 - IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES",null,null,null,"88329 - HC CHG PATHOLOGY CONSULTATION DURING SURGERY"]
[null,null,null,"88329 - HC CHG PATHOLOGY CONSULTATION DURING SURGERY","88305 - CELL BLCK","88329 - HC CHG PATHOLOGY CONSULTATION DURING SURGERY",null,"88108 - HC CHG CYTP CONCENTRATION SMEARS & INTERPRETATION",null,null,null,null,"88341 - IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE",null,"87631 - HC INFLUENZA A/B,RSV PCR",null,null,null,"88331 - PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC"]
[null,null,null,"88331 - PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC","88307 - HC CHG LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM","88331 - PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC",null,"88112 - HC CHG CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V",null,null,null,null,"88342 - HC CHG IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE",null,"87632 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 6-11 TARGETS",null,null,null,"88332 - HC CHG PATH CONSLTJ SURG EA ADDL BLK FROZEN SECTION"]
[null,null,null,"88332 - HC CHG PATH CONSLTJ SURG EA ADDL BLK FROZEN SECTION","88309 - HC CHG LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM","88332 - HC CHG PATH CONSLTJ SURG EA ADDL BLK FROZEN SECTION",null,"88141 - HC CYTOPATH CERV/VAG INTEPRET",null,null,null,null,"88344 - IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE",null,"87633 - HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET",null,null,null,"88341 - IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE"]
[null,null,null,"88341 - IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE","88311 - HC CHG DECALCIFICATION PROCEDURE","88341 - IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE",null,"88142 - CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN",null,null,null,null,"88346 - HC CHG IMMUNOFLUORESCENCE PER SPEC 1ST SINGL ANTB STAIN",null,"87635 - HC SARS-COV-2 COVID-19 AMP PRB",null,null,null,"88342 - HC CHG IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE"]
[null,null,null,"88342 - HC CHG IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE","88312 - HC CHG SPECIAL STAIN GROUP 1 MICROORGANISMS I&R","88342 - HC CHG IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE",null,"88143 - HC CHG CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS",null,null,null,null,"88348 - HC CHG ELECTRON MICROSCOPY DIAGNOSTIC",null,"87636 - HC SARSCOV2 & INF A&B AMP PRB",null,null,null,"88344 - IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE"]
[null,null,null,"88344 - IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE","88313 - HC CHG SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT","88344 - IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE",null,"88147 - HC CHG CYTOPATH SMEAR CERV/VAG AUTOMATED",null,null,null,null,"88350 - IMMUNOFLUORESCENCE PER SPEC ADD SINGL ANTB STAIN",null,"87640 - HC CHG IADNA S AUREUS AMPLIFIED PROBE TQ",null,null,null,"88346 - HC CHG IMMUNOFLUORESCENCE PER SPEC 1ST SINGL ANTB STAIN"]
[null,null,null,"88346 - HC CHG IMMUNOFLUORESCENCE PER SPEC 1ST SINGL ANTB STAIN","88314 - HC HISTOCHEMICAL STAIN","88346 - HC CHG IMMUNOFLUORESCENCE PER SPEC 1ST SINGL ANTB STAIN",null,"88152 - HC CHG CYTOPATH SMEAR CERV/VAG,AUTO REDO",null,null,null,null,"88356 - CHG ANALYSIS, NERVE TECH",null,"87641 - HC CHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ",null,null,null,"88348 - HC CHG ELECTRON MICROSCOPY DIAGNOSTIC"]
[null,null,null,"88348 - HC CHG ELECTRON MICROSCOPY DIAGNOSTIC","88319 - HC CHG SPECIAL STAIN I&R GROUP III ENZYME CONSITUENTS","88348 - HC CHG ELECTRON MICROSCOPY DIAGNOSTIC",null,"88160 - HC CHG CYTP SMRS ANY OTH SRC SCR&INTERPJ",null,null,null,null,"88360 - HC CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL",null,"87653 - HC CHG IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ",null,null,null,"88350 - IMMUNOFLUORESCENCE PER SPEC ADD SINGL ANTB STAIN"]
[null,null,null,"88350 - IMMUNOFLUORESCENCE PER SPEC ADD SINGL ANTB STAIN","88329 - HC CHG PATHOLOGY CONSULTATION DURING SURGERY","88350 - IMMUNOFLUORESCENCE PER SPEC ADD SINGL ANTB STAIN",null,"88161 - HC CHG CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ",null,null,null,null,"88361 - HC CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST",null,"87660 - HC CHG IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ",null,null,null,"88356 - CHG ANALYSIS, NERVE TECH"]
[null,null,null,"88356 - CHG ANALYSIS, NERVE TECH","88331 - PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC","88356 - CHG ANALYSIS, NERVE TECH",null,"88164 - HC CHG CYTOPATH TBS CERV/VAG MANUAL",null,null,null,null,"88362 - HC NERVE TEASING PREPARATIONS",null,"87661 - IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH",null,null,null,"88360 - HC CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL"]
[null,null,null,"88360 - HC CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL","88332 - HC CHG PATH CONSLTJ SURG EA ADDL BLK FROZEN SECTION","88360 - HC CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL",null,"88165 - HC CHG CYTP SLIDES C/V MNL SCR&RESCR PHYS SUPV",null,null,null,null,"88363 - HC CHG EXAM & SELECT ARCHIVE TISSUE MOLECULAR ANALYSI",null,"87797 - HC CHG DETECT AGENT NOS, DNA, DIR",null,null,null,"88361 - HC CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST"]
[null,null,null,"88361 - HC CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST","88341 - IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE","88361 - HC CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST",null,"88172 - CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST",null,null,null,null,"88364 - IN SITU HYBRIDIZATION EA ADDL PROBE STAIN",null,"87798 - HC EBV DNA, QL PCR",null,null,null,"88362 - HC NERVE TEASING PREPARATIONS"]
[null,null,null,"88362 - HC NERVE TEASING PREPARATIONS","88342 - HC CHG IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE","88362 - HC NERVE TEASING PREPARATIONS",null,"88173 - CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT",null,null,null,null,"88365 - HC CHG IN SITU HYBRIDIZATION 1ST PROBE STAIN",null,"87799 - HC CHG IADNA NOS QUANTIFICATION EACH ORGANISM",null,null,null,"88363 - HC CHG EXAM & SELECT ARCHIVE TISSUE MOLECULAR ANALYSI"]
[null,null,null,"88363 - HC CHG EXAM & SELECT ARCHIVE TISSUE MOLECULAR ANALYSI","88344 - IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE","88363 - HC CHG EXAM & SELECT ARCHIVE TISSUE MOLECULAR ANALYSI",null,"88184 - HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST",null,null,null,null,"88368 - HC CHG M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL",null,"87801 - HC CHG DETECT AGENT, MULT ORGS, DNA  AMP",null,null,null,"88364 - IN SITU HYBRIDIZATION EA ADDL PROBE STAIN"]
[null,null,null,"88364 - IN SITU HYBRIDIZATION EA ADDL PROBE STAIN","88346 - HC CHG IMMUNOFLUORESCENCE PER SPEC 1ST SINGL ANTB STAIN","88364 - IN SITU HYBRIDIZATION EA ADDL PROBE STAIN",null,"88185 - HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA",null,null,null,null,"88369 - M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC EACH",null,"87880 - IAADIADOO STREPTOCOCCUS GROUP A",null,null,null,"88365 - HC CHG IN SITU HYBRIDIZATION 1ST PROBE STAIN"]
[null,null,null,"88365 - HC CHG IN SITU HYBRIDIZATION 1ST PROBE STAIN","88348 - HC CHG ELECTRON MICROSCOPY DIAGNOSTIC","88365 - HC CHG IN SITU HYBRIDIZATION 1ST PROBE STAIN",null,"88187 - FLOWCYTOMETRY/READ, 2-8 MARKERS",null,null,null,null,"88380 - HC CHG MICRODISSECTION PREP IDENTIFIED TARGET LASER",null,"87899 - HC MALARIA ANTIGEN",null,null,null,"88368 - HC CHG M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL"]
[null,null,null,"88368 - HC CHG M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL","88350 - IMMUNOFLUORESCENCE PER SPEC ADD SINGL ANTB STAIN","88368 - HC CHG M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL",null,"88188 - FLOWCYTOMETRY/READ, 9-15 MARKERS",null,null,null,null,"88381 - MICRODISSECTION, MANUAL",null,"87900 - HC CHG NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION",null,null,null,"88369 - M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC EACH"]
[null,null,null,"88369 - M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC EACH","88356 - CHG ANALYSIS, NERVE TECH","88369 - M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC EACH",null,"88230 - HC CHG TISS CUL NON-NEO DISORDERS LYMPHOCYTE",null,null,null,null,"89050 - HC CHG CELL COUNT MISCELLANEOUS BODY FLUIDS",null,"87901 - HC CHG NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEAS",null,null,null,"88380 - HC CHG MICRODISSECTION PREP IDENTIFIED TARGET LASER"]
[null,null,null,"88380 - HC CHG MICRODISSECTION PREP IDENTIFIED TARGET LASER","88360 - HC CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL","88380 - HC CHG MICRODISSECTION PREP IDENTIFIED TARGET LASER",null,"88235 - HC CHG TISSUE CULTURE, PLACENTA",null,null,null,null,"89051 - HC CHG CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT",null,"87902 - HC CHG NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS",null,null,null,"88381 - MICRODISSECTION, MANUAL"]
[null,null,null,"88381 - MICRODISSECTION, MANUAL","88361 - HC CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST","88381 - MICRODISSECTION, MANUAL",null,"88237 - HC CHG TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS",null,null,null,null,"89060 - HC CHG CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID",null,"87906 - HC Q;HIV1 GENO",null,null,null,"89050 - HC CHG CELL COUNT MISCELLANEOUS BODY FLUIDS"]
[null,null,null,"89050 - HC CHG CELL COUNT MISCELLANEOUS BODY FLUIDS","88362 - HC NERVE TEASING PREPARATIONS","89050 - HC CHG CELL COUNT MISCELLANEOUS BODY FLUIDS",null,"88262 - HC CHG CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING",null,null,null,null,"89320 - SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT",null,"87912 - HC CHG NFCT AGENT GENOTYPE HEPATITIS B VIRUS",null,null,null,"89051 - HC CHG CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT"]
[null,null,null,"89051 - HC CHG CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT","88363 - HC CHG EXAM & SELECT ARCHIVE TISSUE MOLECULAR ANALYSI","89051 - HC CHG CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT",null,"88264 - HC CHG CHRMSM ANALYZE 20-25 CELLS",null,null,null,null,"90371 - HC HEPB IG, IM",null,"87999 - HC CHG UNLISTED MICROBIOLOGY",null,null,null,"89060 - HC CHG CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID"]
[null,null,null,"89060 - HC CHG CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID","88364 - IN SITU HYBRIDIZATION EA ADDL PROBE STAIN","89060 - HC CHG CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID",null,"88271 - HC CHG MOLECULAR CYTOGENETICS DNA PROBE EACH",null,null,null,null,"90384 - HC IG;RHO D HUMAN/300MCG",null,"88104 - HC CHG CYTOPATH FLUIDS SMEAR, INTERP",null,null,null,"89320 - SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT"]
[null,null,null,"89320 - SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT","88365 - HC CHG IN SITU HYBRIDIZATION 1ST PROBE STAIN","89320 - SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT",null,"88274 - HC CHG MOLECULAR CYTOGENETICS INTERPHASE ISH 25-99 CLL",null,null,null,null,"90389 - HC US SCREENING SAAAVE MCR",null,"88108 - HC CHG CYTP CONCENTRATION SMEARS & INTERPRETATION",null,null,null,"90371 - HC HEPB IG, IM"]
[null,null,null,"90371 - HC HEPB IG, IM","88368 - HC CHG M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL","90371 - HC HEPB IG, IM",null,"88275 - HC CHG MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL",null,null,null,null,"90460 - IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX",null,"88112 - HC CHG CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V",null,null,null,"90384 - HC IG;RHO D HUMAN/300MCG"]
[null,null,null,"90384 - HC IG;RHO D HUMAN/300MCG","88369 - M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC EACH","90384 - HC IG;RHO D HUMAN/300MCG",null,"88280 - HC CHG CHROMOSOME KARYOTYPE STUDY",null,null,null,null,"90461 - IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT",null,"88141 - HC CYTOPATH CERV/VAG INTEPRET",null,null,null,"90389 - HC US SCREENING SAAAVE MCR"]
[null,null,null,"90389 - HC US SCREENING SAAAVE MCR","88380 - HC CHG MICRODISSECTION PREP IDENTIFIED TARGET LASER","90389 - HC US SCREENING SAAAVE MCR",null,"88291 - HC CHG CYTOGENETICS&MOLEC CYTOGENETICS INTERP&REP",null,null,null,null,"90472 - IMADM PRQ ID SUBQ/IM NJXS EA VACCINE",null,"88142 - CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN",null,null,null,"90460 - IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX"]
[null,null,null,"90460 - IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX","88381 - MICRODISSECTION, MANUAL","90460 - IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX",null,"88300 - HC CHG LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY",null,null,null,null,"90473 - IMADM INTRANSL/ORAL 1 VACCINE",null,"88143 - HC CHG CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS",null,null,null,"90461 - IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT"]
[null,null,null,"90461 - IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT","89050 - HC CHG CELL COUNT MISCELLANEOUS BODY FLUIDS","90461 - IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT",null,"88302 - HC CHG LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM",null,null,null,null,"90474 - IMADM INTRANSL/ORAL EA VACCINE",null,"88147 - HC CHG CYTOPATH SMEAR CERV/VAG AUTOMATED",null,null,null,"90472 - IMADM PRQ ID SUBQ/IM NJXS EA VACCINE"]
[null,null,null,"90472 - IMADM PRQ ID SUBQ/IM NJXS EA VACCINE","89051 - HC CHG CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT","90472 - IMADM PRQ ID SUBQ/IM NJXS EA VACCINE",null,"88304 - HC CHG LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM",null,null,null,null,"90620 - HC MENB RECOMBINANT PROT W/OUT MEMBR VESIC VACC IM",null,"88152 - HC CHG CYTOPATH SMEAR CERV/VAG,AUTO REDO",null,null,null,"90473 - IMADM INTRANSL/ORAL 1 VACCINE"]
[null,null,null,"90474 - IMADM INTRANSL/ORAL EA VACCINE","89060 - HC CHG CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID","90474 - IMADM INTRANSL/ORAL EA VACCINE",null,"88305 - CELL BLCK",null,null,null,null,"90621 - MENB-FHBP RECOMBNT LIPOPROTEIN VACC 2/3 DOSE IM",null,"88160 - HC CHG CYTP SMRS ANY OTH SRC SCR&INTERPJ",null,null,null,"90474 - IMADM INTRANSL/ORAL EA VACCINE"]
[null,null,null,"90620 - HC MENB RECOMBINANT PROT W/OUT MEMBR VESIC VACC IM","89320 - SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT","90620 - HC MENB RECOMBINANT PROT W/OUT MEMBR VESIC VACC IM",null,"88307 - HC CHG LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM",null,null,null,null,"90625 - HC  CHOLERA VACCINE ADULT 1 DOSE LIVE FOR ORAL USE",null,"88161 - HC CHG CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ",null,null,null,"90620 - HC MENB RECOMBINANT PROT W/OUT MEMBR VESIC VACC IM"]
[null,null,null,"90621 - MENB-FHBP RECOMBNT LIPOPROTEIN VACC 2/3 DOSE IM","90371 - HC HEPB IG, IM","90621 - MENB-FHBP RECOMBNT LIPOPROTEIN VACC 2/3 DOSE IM",null,"88309 - HC CHG LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM",null,null,null,null,"90632 - CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,"88164 - HC CHG CYTOPATH TBS CERV/VAG MANUAL",null,null,null,"90621 - MENB-FHBP RECOMBNT LIPOPROTEIN VACC 2/3 DOSE IM"]
[null,null,null,"90625 - HC  CHOLERA VACCINE ADULT 1 DOSE LIVE FOR ORAL USE","90384 - HC IG;RHO D HUMAN/300MCG","90625 - HC  CHOLERA VACCINE ADULT 1 DOSE LIVE FOR ORAL USE",null,"88311 - HC CHG DECALCIFICATION PROCEDURE",null,null,null,null,"90633 - CR BUILD ONLY - HEPA VACCINE PED/ADOL-2 DOSE,DPH",null,"88165 - HC CHG CYTP SLIDES C/V MNL SCR&RESCR PHYS SUPV",null,null,null,"90625 - HC  CHOLERA VACCINE ADULT 1 DOSE LIVE FOR ORAL USE"]
[null,null,null,"90632 - CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL","90389 - HC US SCREENING SAAAVE MCR","90632 - CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,"88312 - HC CHG SPECIAL STAIN GROUP 1 MICROORGANISMS I&R",null,null,null,null,"90636 - HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM",null,"88172 - CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST",null,null,null,"90632 - CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL"]
[null,null,null,"90633 - CR BUILD ONLY - HEPA VACCINE PED/ADOL-2 DOSE,DPH","90460 - IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX","90633 - CR BUILD ONLY - HEPA VACCINE PED/ADOL-2 DOSE,DPH",null,"88313 - HC CHG SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT",null,null,null,null,"90648 - HC HIB VACCINE, PRP-T, IM,DPH",null,"88173 - CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT",null,null,null,"90633 - CR BUILD ONLY - HEPA VACCINE PED/ADOL-2 DOSE,DPH"]
[null,null,null,"90636 - HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM","90461 - IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT","90636 - HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM",null,"88314 - HC HISTOCHEMICAL STAIN",null,null,null,null,"90651 - CR BUILD ONLY - HPV 9-VALENT IM, DPH",null,"88184 - HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST",null,null,null,"90636 - HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM"]
[null,null,null,"90648 - HC HIB VACCINE, PRP-T, IM,DPH","90472 - IMADM PRQ ID SUBQ/IM NJXS EA VACCINE","90648 - HC HIB VACCINE, PRP-T, IM,DPH",null,"88319 - HC CHG SPECIAL STAIN I&R GROUP III ENZYME CONSITUENTS",null,null,null,null,"90653 - HC IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE",null,"88185 - HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA",null,null,null,"90648 - HC HIB VACCINE, PRP-T, IM,DPH"]
[null,null,null,"90651 - CR BUILD ONLY - HPV 9-VALENT IM, DPH","90474 - IMADM INTRANSL/ORAL EA VACCINE","90651 - CR BUILD ONLY - HPV 9-VALENT IM, DPH",null,"88329 - HC CHG PATHOLOGY CONSULTATION DURING SURGERY",null,null,null,null,"90661 - HC CCIIV3 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",null,"88187 - FLOWCYTOMETRY/READ, 2-8 MARKERS",null,null,null,"90651 - CR BUILD ONLY - HPV 9-VALENT IM, DPH"]
[null,null,null,"90653 - HC IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE","90620 - HC MENB RECOMBINANT PROT W/OUT MEMBR VESIC VACC IM","90653 - HC IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE",null,"88331 - PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC",null,null,null,null,"90662 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM FLUZONE HIGH DOSE",null,"88188 - FLOWCYTOMETRY/READ, 9-15 MARKERS",null,null,null,"90653 - HC IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE"]
[null,null,null,"90661 - HC CCIIV3 VACCINE PRESERVATIVE FREE 0.5 ML IM USE","90621 - MENB-FHBP RECOMBNT LIPOPROTEIN VACC 2/3 DOSE IM","90661 - HC CCIIV3 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",null,"88332 - HC CHG PATH CONSLTJ SURG EA ADDL BLK FROZEN SECTION",null,null,null,null,"90670 - CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH",null,"88230 - HC CHG TISS CUL NON-NEO DISORDERS LYMPHOCYTE",null,null,null,"90661 - HC CCIIV3 VACCINE PRESERVATIVE FREE 0.5 ML IM USE"]
[null,null,null,"90662 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM FLUZONE HIGH DOSE","90625 - HC  CHOLERA VACCINE ADULT 1 DOSE LIVE FOR ORAL USE","90662 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM FLUZONE HIGH DOSE",null,"88341 - IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE",null,null,null,null,"90672 - CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST",null,"88235 - HC CHG TISSUE CULTURE, PLACENTA",null,null,null,"90662 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM FLUZONE HIGH DOSE"]
[null,null,null,"90670 - CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH","90632 - CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL","90670 - CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH",null,"88342 - HC CHG IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE",null,null,null,null,"90673 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM",null,"88237 - HC CHG TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS",null,null,null,"90670 - CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH"]
[null,null,null,"90672 - CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST","90633 - CR BUILD ONLY - HEPA VACCINE PED/ADOL-2 DOSE,DPH","90672 - CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST",null,"88344 - IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE",null,null,null,null,"90674 - HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",null,"88262 - HC CHG CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING",null,null,null,"90672 - CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST"]
[null,null,null,"90673 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM","90636 - HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM","90673 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM",null,"88346 - HC CHG IMMUNOFLUORESCENCE PER SPEC 1ST SINGL ANTB STAIN",null,null,null,null,"90675 - CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,"88264 - HC CHG CHRMSM ANALYZE 20-25 CELLS",null,null,null,"90673 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM"]
[null,null,null,"90674 - HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE","90648 - HC HIB VACCINE, PRP-T, IM,DPH","90674 - HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",null,"88348 - HC CHG ELECTRON MICROSCOPY DIAGNOSTIC",null,null,null,null,"90686 - HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,"88271 - HC CHG MOLECULAR CYTOGENETICS DNA PROBE EACH",null,null,null,"90674 - HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE"]
[null,null,null,"90675 - CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL","90651 - CR BUILD ONLY - HPV 9-VALENT IM, DPH","90675 - CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,"88350 - IMMUNOFLUORESCENCE PER SPEC ADD SINGL ANTB STAIN",null,null,null,null,"90690 - CR BUILD ONLY - TYPHOID VACCINE, ORAL,TRAVEL",null,"88274 - HC CHG MOLECULAR CYTOGENETICS INTERPHASE ISH 25-99 CLL",null,null,null,"90675 - CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL"]
[null,null,null,"90686 - HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE","90653 - HC IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE","90686 - HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,"88356 - CHG ANALYSIS, NERVE TECH",null,null,null,null,"90691 - CR BUILD ONLY - TYPHOID VACCINE, IM,TRAVEL",null,"88275 - HC CHG MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL",null,null,null,"90686 - HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE"]
[null,null,null,"90690 - CR BUILD ONLY - TYPHOID VACCINE, ORAL,TRAVEL","90661 - HC CCIIV3 VACCINE PRESERVATIVE FREE 0.5 ML IM USE","90690 - CR BUILD ONLY - TYPHOID VACCINE, ORAL,TRAVEL",null,"88360 - HC CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL",null,null,null,null,"90694 - HC VACC AIIV4 NO PRSRV 0.5ML IM",null,"88280 - HC CHG CHROMOSOME KARYOTYPE STUDY",null,null,null,"90690 - CR BUILD ONLY - TYPHOID VACCINE, ORAL,TRAVEL"]
[null,null,null,"90691 - CR BUILD ONLY - TYPHOID VACCINE, IM,TRAVEL","90662 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM FLUZONE HIGH DOSE","90691 - CR BUILD ONLY - TYPHOID VACCINE, IM,TRAVEL",null,"88361 - HC CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST",null,null,null,null,"90698 - CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,"88291 - HC CHG CYTOGENETICS&MOLEC CYTOGENETICS INTERP&REP",null,null,null,"90691 - CR BUILD ONLY - TYPHOID VACCINE, IM,TRAVEL"]
[null,null,null,"90694 - HC VACC AIIV4 NO PRSRV 0.5ML IM","90670 - CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH","90694 - HC VACC AIIV4 NO PRSRV 0.5ML IM",null,"88362 - HC NERVE TEASING PREPARATIONS",null,null,null,null,"90700 - CR BUILD ONLY - DTAP IMMUNIZATION, IM, <7 YO,TRAVEL",null,"88300 - HC CHG LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY",null,null,null,"90694 - HC VACC AIIV4 NO PRSRV 0.5ML IM"]
[null,null,null,"90698 - CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH","90672 - CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST","90698 - CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,"88363 - HC CHG EXAM & SELECT ARCHIVE TISSUE MOLECULAR ANALYSI",null,null,null,null,"90707 - CR BUILD ONLY - MMR VIRUS IMMUNIZATION, SUBCUT,TRAVEL,PEDI",null,"88302 - HC CHG LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM",null,null,null,"90698 - CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH"]
[null,null,null,"90700 - CR BUILD ONLY - DTAP IMMUNIZATION, IM, <7 YO,TRAVEL","90673 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM","90700 - CR BUILD ONLY - DTAP IMMUNIZATION, IM, <7 YO,TRAVEL",null,"88364 - IN SITU HYBRIDIZATION EA ADDL PROBE STAIN",null,null,null,null,"90713 - CR BUILD ONLY - POLIOMYELITIS IMMUNIZATN,INACTV,SUB-Q,DPH",null,"88304 - HC CHG LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM",null,null,null,"90700 - CR BUILD ONLY - DTAP IMMUNIZATION, IM, <7 YO,TRAVEL"]
[null,null,null,"90707 - CR BUILD ONLY - MMR VIRUS IMMUNIZATION, SUBCUT,TRAVEL,PEDI","90674 - HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE","90707 - CR BUILD ONLY - MMR VIRUS IMMUNIZATION, SUBCUT,TRAVEL,PEDI",null,"88365 - HC CHG IN SITU HYBRIDIZATION 1ST PROBE STAIN",null,null,null,null,"90714 - CR BUILD ONLY - TD VACCINE NO PRSRV >/= 7 YO, IM,DPH",null,"88305 - CELL BLCK",null,null,null,"90707 - CR BUILD ONLY - MMR VIRUS IMMUNIZATION, SUBCUT,TRAVEL,PEDI"]
[null,null,null,"90713 - CR BUILD ONLY - POLIOMYELITIS IMMUNIZATN,INACTV,SUB-Q,DPH","90675 - CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL","90713 - CR BUILD ONLY - POLIOMYELITIS IMMUNIZATN,INACTV,SUB-Q,DPH",null,"88368 - HC CHG M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL",null,null,null,null,"90715 - CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,"88307 - HC CHG LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM",null,null,null,"90713 - CR BUILD ONLY - POLIOMYELITIS IMMUNIZATN,INACTV,SUB-Q,DPH"]
[null,null,null,"90714 - CR BUILD ONLY - TD VACCINE NO PRSRV >/= 7 YO, IM,DPH","90686 - HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE","90714 - CR BUILD ONLY - TD VACCINE NO PRSRV >/= 7 YO, IM,DPH",null,"88369 - M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC EACH",null,null,null,null,"90716 - CR BUILD ONLY - CHICKEN POX VACCINE,LIVE,SUB-Q,TRAVEL",null,"88309 - HC CHG LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM",null,null,null,"90714 - CR BUILD ONLY - TD VACCINE NO PRSRV >/= 7 YO, IM,DPH"]
[null,null,null,"90715 - CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH","90690 - CR BUILD ONLY - TYPHOID VACCINE, ORAL,TRAVEL","90715 - CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,"88380 - HC CHG MICRODISSECTION PREP IDENTIFIED TARGET LASER",null,null,null,null,"90717 - YELLOW FEVER VACCINE SUBQ",null,"88311 - HC CHG DECALCIFICATION PROCEDURE",null,null,null,"90715 - CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH"]
[null,null,null,"90716 - CR BUILD ONLY - CHICKEN POX VACCINE,LIVE,SUB-Q,TRAVEL","90691 - CR BUILD ONLY - TYPHOID VACCINE, IM,TRAVEL","90716 - CR BUILD ONLY - CHICKEN POX VACCINE,LIVE,SUB-Q,TRAVEL",null,"88381 - MICRODISSECTION, MANUAL",null,null,null,null,"90723 - CR BUILD ONLY - DTAP/HEPB/IPV VACCINE,IM,DPH",null,"88312 - HC CHG SPECIAL STAIN GROUP 1 MICROORGANISMS I&R",null,null,null,"90716 - CR BUILD ONLY - CHICKEN POX VACCINE,LIVE,SUB-Q,TRAVEL"]
[null,null,null,"90717 - YELLOW FEVER VACCINE SUBQ","90694 - HC VACC AIIV4 NO PRSRV 0.5ML IM","90717 - YELLOW FEVER VACCINE SUBQ",null,"89050 - HC CHG CELL COUNT MISCELLANEOUS BODY FLUIDS",null,null,null,null,"90732 - CR BUILD ONLY - PNEUMOCOCCAL VACCINE,23-VALENT,ADULT,TRAVEL",null,"88313 - HC CHG SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT",null,null,null,"90717 - YELLOW FEVER VACCINE SUBQ"]
[null,null,null,"90723 - CR BUILD ONLY - DTAP/HEPB/IPV VACCINE,IM,DPH","90698 - CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH","90723 - CR BUILD ONLY - DTAP/HEPB/IPV VACCINE,IM,DPH",null,"89051 - HC CHG CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT",null,null,null,null,"90734 - CR BUILD ONLY - MENINGOCOCCAL VACCINE, IM,TRAVEL",null,"88314 - HC HISTOCHEMICAL STAIN",null,null,null,"90723 - CR BUILD ONLY - DTAP/HEPB/IPV VACCINE,IM,DPH"]
[null,null,null,"90732 - CR BUILD ONLY - PNEUMOCOCCAL VACCINE,23-VALENT,ADULT,TRAVEL","90700 - CR BUILD ONLY - DTAP IMMUNIZATION, IM, <7 YO,TRAVEL","90732 - CR BUILD ONLY - PNEUMOCOCCAL VACCINE,23-VALENT,ADULT,TRAVEL",null,"89060 - HC CHG CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID",null,null,null,null,"90736 - ZOSTER SHINGLES VACCINE LIVE SUBCUTANEOUS",null,"88319 - HC CHG SPECIAL STAIN I&R GROUP III ENZYME CONSITUENTS",null,null,null,"90732 - CR BUILD ONLY - PNEUMOCOCCAL VACCINE,23-VALENT,ADULT,TRAVEL"]
[null,null,null,"90734 - CR BUILD ONLY - MENINGOCOCCAL VACCINE, IM,TRAVEL","90707 - CR BUILD ONLY - MMR VIRUS IMMUNIZATION, SUBCUT,TRAVEL,PEDI","90734 - CR BUILD ONLY - MENINGOCOCCAL VACCINE, IM,TRAVEL",null,"89320 - SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT",null,null,null,null,"90738 - HC JAPANESE ENCEPH VACC, INACTIVATED, IM,TRAVEL",null,"88329 - HC CHG PATHOLOGY CONSULTATION DURING SURGERY",null,null,null,"90734 - CR BUILD ONLY - MENINGOCOCCAL VACCINE, IM,TRAVEL"]
[null,null,null,"90736 - ZOSTER SHINGLES VACCINE LIVE SUBCUTANEOUS","90713 - CR BUILD ONLY - POLIOMYELITIS IMMUNIZATN,INACTV,SUB-Q,DPH","90736 - ZOSTER SHINGLES VACCINE LIVE SUBCUTANEOUS",null,"90371 - HC HEPB IG, IM",null,null,null,null,"90739 - HC HEPATITIS B VACCINE ADULT 2 DOSE IM",null,"88331 - PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC",null,null,null,"90736 - ZOSTER SHINGLES VACCINE LIVE SUBCUTANEOUS"]
[null,null,null,"90738 - HC JAPANESE ENCEPH VACC, INACTIVATED, IM,TRAVEL","90714 - CR BUILD ONLY - TD VACCINE NO PRSRV >/= 7 YO, IM,DPH","90738 - HC JAPANESE ENCEPH VACC, INACTIVATED, IM,TRAVEL",null,"90384 - HC IG;RHO D HUMAN/300MCG",null,null,null,null,"90740 - HC HEP B VACCINE,DIAL/IMMUNOSUP, IM",null,"88332 - HC CHG PATH CONSLTJ SURG EA ADDL BLK FROZEN SECTION",null,null,null,"90738 - HC JAPANESE ENCEPH VACC, INACTIVATED, IM,TRAVEL"]
[null,null,null,"90739 - HC HEPATITIS B VACCINE ADULT 2 DOSE IM","90715 - CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH","90739 - HC HEPATITIS B VACCINE ADULT 2 DOSE IM",null,"90389 - HC US SCREENING SAAAVE MCR",null,null,null,null,"90744 - CR BUILD ONLY - HEP B VACCINE,PED/ADOL,IM,DPH",null,"88341 - IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE",null,null,null,"90739 - HC HEPATITIS B VACCINE ADULT 2 DOSE IM"]
[null,null,null,"90740 - HC HEP B VACCINE,DIAL/IMMUNOSUP, IM","90716 - CR BUILD ONLY - CHICKEN POX VACCINE,LIVE,SUB-Q,TRAVEL","90740 - HC HEP B VACCINE,DIAL/IMMUNOSUP, IM",null,"90460 - IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX",null,null,null,null,"90746 - CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL",null,"88342 - HC CHG IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE",null,null,null,"90740 - HC HEP B VACCINE,DIAL/IMMUNOSUP, IM"]
[null,null,null,"90744 - CR BUILD ONLY - HEP B VACCINE,PED/ADOL,IM,DPH","90717 - YELLOW FEVER VACCINE SUBQ","90744 - CR BUILD ONLY - HEP B VACCINE,PED/ADOL,IM,DPH",null,"90461 - IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT",null,null,null,null,"90750 - HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX",null,"88344 - IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE",null,null,null,"90744 - CR BUILD ONLY - HEP B VACCINE,PED/ADOL,IM,DPH"]
[null,null,null,"90746 - CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL","90723 - CR BUILD ONLY - DTAP/HEPB/IPV VACCINE,IM,DPH","90746 - CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL",null,"90472 - IMADM PRQ ID SUBQ/IM NJXS EA VACCINE",null,null,null,null,"90756 - HC CCIIV4 VACCINE ANTIBIOTIC FREE 0.5ML DOS IM USE",null,"88346 - HC CHG IMMUNOFLUORESCENCE PER SPEC 1ST SINGL ANTB STAIN",null,null,null,"90746 - CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL"]
[null,null,null,"90750 - HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX","90732 - CR BUILD ONLY - PNEUMOCOCCAL VACCINE,23-VALENT,ADULT,TRAVEL","90750 - HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX",null,"90473 - IMADM INTRANSL/ORAL 1 VACCINE",null,null,null,null,"90867 - HC TRANSCRANIAL MAGNETIC STIMULATION TREATMENT,PLANNING",null,"88348 - HC CHG ELECTRON MICROSCOPY DIAGNOSTIC",null,null,null,"90750 - HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX"]
[null,null,null,"90756 - HC CCIIV4 VACCINE ANTIBIOTIC FREE 0.5ML DOS IM USE","90734 - CR BUILD ONLY - MENINGOCOCCAL VACCINE, IM,TRAVEL","90756 - HC CCIIV4 VACCINE ANTIBIOTIC FREE 0.5ML DOS IM USE",null,"90474 - IMADM INTRANSL/ORAL EA VACCINE",null,null,null,null,"90901 - HC BIOFEEDBACK TRAINING, ANY MODALITY",null,"88350 - IMMUNOFLUORESCENCE PER SPEC ADD SINGL ANTB STAIN",null,null,null,"90756 - HC CCIIV4 VACCINE ANTIBIOTIC FREE 0.5ML DOS IM USE"]
[null,null,null,"90785 - PSYCHOTHERAPY COMPLEX INTERACTIVE","90736 - ZOSTER SHINGLES VACCINE LIVE SUBCUTANEOUS","90785 - PSYCHOTHERAPY COMPLEX INTERACTIVE",null,"90620 - HC MENB RECOMBINANT PROT W/OUT MEMBR VESIC VACC IM",null,null,null,null,"90912 - HC BFB TRAINING 1ST 15 MIN",null,"88356 - CHG ANALYSIS, NERVE TECH",null,null,null,"90867 - HC TRANSCRANIAL MAGNETIC STIMULATION TREATMENT,PLANNING"]
[null,null,null,"90791 - PSYCHIATRIC DIAGNOSTIC EVALUATION","90738 - HC JAPANESE ENCEPH VACC, INACTIVATED, IM,TRAVEL","90791 - PSYCHIATRIC DIAGNOSTIC EVALUATION",null,"90621 - MENB-FHBP RECOMBNT LIPOPROTEIN VACC 2/3 DOSE IM",null,null,null,null,"90913 - HC BFB TRAINING EA ADDL 15 MIN",null,"88360 - HC CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL",null,null,null,"90901 - HC BIOFEEDBACK TRAINING, ANY MODALITY"]
[null,null,null,"90792 - PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES","90739 - HC HEPATITIS B VACCINE ADULT 2 DOSE IM","90792 - PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES",null,"90632 - CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,null,null,null,"91010 - ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT",null,"88361 - HC CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST",null,null,null,"90912 - HC BFB TRAINING 1ST 15 MIN"]
[null,null,null,"90832 - PSYCHOTHERAPY PATIENT &/ FAMILY 30 MINUTES","90740 - HC HEP B VACCINE,DIAL/IMMUNOSUP, IM","90832 - PSYCHOTHERAPY PATIENT &/ FAMILY 30 MINUTES",null,"90633 - CR BUILD ONLY - HEPA VACCINE PED/ADOL-2 DOSE,DPH",null,null,null,null,"91034 - GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT",null,"88362 - HC NERVE TEASING PREPARATIONS",null,null,null,"90913 - HC BFB TRAINING EA ADDL 15 MIN"]
[null,null,null,"90833 - PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 30 MIN","90744 - CR BUILD ONLY - HEP B VACCINE,PED/ADOL,IM,DPH","90833 - PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 30 MIN",null,"90636 - HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM",null,null,null,null,"91035 - GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD",null,"88363 - HC CHG EXAM & SELECT ARCHIVE TISSUE MOLECULAR ANALYSI",null,null,null,"91010 - ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT"]
[null,null,null,"90834 - PSYCHOTHERAPY PATIENT &/ FAMILY 45 MINUTES","90746 - CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL","90834 - PSYCHOTHERAPY PATIENT &/ FAMILY 45 MINUTES",null,"90648 - HC HIB VACCINE, PRP-T, IM,DPH",null,null,null,null,"91037 - GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD",null,"88364 - IN SITU HYBRIDIZATION EA ADDL PROBE STAIN",null,null,null,"91034 - GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT"]
[null,null,null,"90836 - PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 45 MIN","90750 - HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX","90836 - PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 45 MIN",null,"90651 - CR BUILD ONLY - HPV 9-VALENT IM, DPH",null,null,null,null,"91038 - ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG",null,"88365 - HC CHG IN SITU HYBRIDIZATION 1ST PROBE STAIN",null,null,null,"91035 - GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD"]
[null,null,null,"90837 - PSYCHOTHERAPY PATIENT &/ FAMILY 60 MINUTES","90756 - HC CCIIV4 VACCINE ANTIBIOTIC FREE 0.5ML DOS IM USE","90837 - PSYCHOTHERAPY PATIENT &/ FAMILY 60 MINUTES",null,"90653 - HC IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE",null,null,null,null,"91065 - BREATH HYDROGEN TEST",null,"88368 - HC CHG M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL",null,null,null,"91037 - GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD"]
[null,null,null,"90838 - PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 60 MIN","90785 - PSYCHOTHERAPY COMPLEX INTERACTIVE","90838 - PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 60 MIN",null,"90661 - HC CCIIV3 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",null,null,null,null,"91110 - GI IMAG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R",null,"88369 - M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC EACH",null,null,null,"91038 - ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG"]
[null,null,null,"90839 - HC PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES","90791 - PSYCHIATRIC DIAGNOSTIC EVALUATION","90839 - HC PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES",null,"90662 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM FLUZONE HIGH DOSE",null,null,null,null,"91111 - GASTROINTESTINAL TRACT IMAGING ESOPHAGUS W/I&R",null,"88380 - HC CHG MICRODISSECTION PREP IDENTIFIED TARGET LASER",null,null,null,"91065 - BREATH HYDROGEN TEST"]
[null,null,null,"90840 - HC PSYCHOTHERAPY FOR CRISIS EACH ADDL 30 MINUTES","90792 - PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES","90840 - HC PSYCHOTHERAPY FOR CRISIS EACH ADDL 30 MINUTES",null,"90670 - CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH",null,null,null,null,"91112 - GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP",null,"88381 - MICRODISSECTION, MANUAL",null,null,null,"91110 - GI IMAG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R"]
[null,null,null,"90845 - PSYCHOANALYSIS","90832 - PSYCHOTHERAPY PATIENT &/ FAMILY 30 MINUTES","90845 - PSYCHOANALYSIS",null,"90672 - CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST",null,null,null,null,"91120 - RECTAL SESATION TONE & COMPLIANCE TEST",null,"89050 - HC CHG CELL COUNT MISCELLANEOUS BODY FLUIDS",null,null,null,"91111 - GASTROINTESTINAL TRACT IMAGING ESOPHAGUS W/I&R"]
[null,null,null,"90846 - FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT","90833 - PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 30 MIN","90846 - FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT",null,"90673 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM",null,null,null,null,"91122 - ANORECTAL MANOMETRY",null,"89051 - HC CHG CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT",null,null,null,"91112 - GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP"]
[null,null,null,"90847 - FAMILY PSYCHOTHERAPY W/PATIENT PRESENT","90834 - PSYCHOTHERAPY PATIENT &/ FAMILY 45 MINUTES","90847 - FAMILY PSYCHOTHERAPY W/PATIENT PRESENT",null,"90674 - HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",null,null,null,null,"91200 - HC LIVER ELASTOGRAPHY W/O IMAG W/I&R",null,"89060 - HC CHG CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID",null,null,null,"91120 - RECTAL SESATION TONE & COMPLIANCE TEST"]
[null,null,null,"90849 - MULTIPLE FAMILY GROUP PSYCHOTHERAPY","90836 - PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 45 MIN","90849 - MULTIPLE FAMILY GROUP PSYCHOTHERAPY",null,"90675 - CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,null,null,null,"92015 - DETERMINATION REFRACTIVE STATE",null,"89320 - SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT",null,null,null,"91122 - ANORECTAL MANOMETRY"]
[null,null,null,"90853 - GROUP PSYCHOTHERAPY","90837 - PSYCHOTHERAPY PATIENT &/ FAMILY 60 MINUTES","90853 - GROUP PSYCHOTHERAPY",null,"90686 - HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,null,null,null,"92018 - HC NEW EYE EXAM & TREATMENT",null,"90371 - HC HEPB IG, IM",null,null,null,"91200 - HC LIVER ELASTOGRAPHY W/O IMAG W/I&R"]
[null,null,null,"90867 - HC TRANSCRANIAL MAGNETIC STIMULATION TREATMENT,PLANNING","90838 - PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 60 MIN","90867 - HC TRANSCRANIAL MAGNETIC STIMULATION TREATMENT,PLANNING",null,"90690 - CR BUILD ONLY - TYPHOID VACCINE, ORAL,TRAVEL",null,null,null,null,"92020 - GONIOSCOPY SEPARATE PROCEDURE",null,"90384 - HC IG;RHO D HUMAN/300MCG",null,null,null,"92015 - DETERMINATION REFRACTIVE STATE"]
[null,null,null,"90876 - HC INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 45 MIN","90839 - HC PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES","90876 - HC INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 45 MIN",null,"90691 - CR BUILD ONLY - TYPHOID VACCINE, IM,TRAVEL",null,null,null,null,"92025 - COMPUTERIZED CORNEAL TOPOGRAPHY UNI/BI",null,"90389 - HC US SCREENING SAAAVE MCR",null,null,null,"92018 - HC NEW EYE EXAM & TREATMENT"]
[null,null,null,"90882 - HC ENVIRONMENTAL IVNTJ MGMT PURPOSES PSYC PT","90840 - HC PSYCHOTHERAPY FOR CRISIS EACH ADDL 30 MINUTES","90882 - HC ENVIRONMENTAL IVNTJ MGMT PURPOSES PSYC PT",null,"90698 - CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,null,null,null,"92060 - SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX",null,"90460 - IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX",null,null,null,"92020 - GONIOSCOPY SEPARATE PROCEDURE"]
[null,null,null,"90887 - INTERPJ/EXPLNAJ RESULTS PSYCHIATRIC EXAM FAMILY","90845 - PSYCHOANALYSIS","90887 - INTERPJ/EXPLNAJ RESULTS PSYCHIATRIC EXAM FAMILY",null,"90700 - CR BUILD ONLY - DTAP IMMUNIZATION, IM, <7 YO,TRAVEL",null,null,null,null,"92065 - ORTHOPTIC &/PLEOPTIC TRAINING W/MEDICAL DIRECTJ",null,"90461 - IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT",null,null,null,"92025 - COMPUTERIZED CORNEAL TOPOGRAPHY UNI/BI"]
[null,null,null,"90912 - HC BFB TRAINING 1ST 15 MIN","90846 - FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT","90889 - HC PREP REPORT PT PSYCH STATUS AGENCY/PAYER",null,"90707 - CR BUILD ONLY - MMR VIRUS IMMUNIZATION, SUBCUT,TRAVEL,PEDI",null,null,null,null,"92071 - FIT CONTACT LENS TX OCULAR SURFACE DISEASE",null,"90472 - IMADM PRQ ID SUBQ/IM NJXS EA VACCINE",null,null,null,"92060 - SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX"]
[null,null,null,"90913 - HC BFB TRAINING EA ADDL 15 MIN","90847 - FAMILY PSYCHOTHERAPY W/PATIENT PRESENT","90912 - HC BFB TRAINING 1ST 15 MIN",null,"90713 - CR BUILD ONLY - POLIOMYELITIS IMMUNIZATN,INACTV,SUB-Q,DPH",null,null,null,null,"92072 - FITTING CONTACT LENS FOR MNGT OF KERATOCONUS",null,"90473 - IMADM INTRANSL/ORAL 1 VACCINE",null,null,null,"92065 - ORTHOPTIC &/PLEOPTIC TRAINING W/MEDICAL DIRECTJ"]
[null,null,null,"90935 - HC HEMODIALYSIS PROCEDURE W/ PHYS/QHP EVALUATION","90849 - MULTIPLE FAMILY GROUP PSYCHOTHERAPY","90913 - HC BFB TRAINING EA ADDL 15 MIN",null,"90714 - CR BUILD ONLY - TD VACCINE NO PRSRV >/= 7 YO, IM,DPH",null,null,null,null,"92081 - VISUAL FIELD XM UNI/BI W/INTERPRETJ LIMITED EXAM",null,"90474 - IMADM INTRANSL/ORAL EA VACCINE",null,null,null,"92071 - FIT CONTACT LENS TX OCULAR SURFACE DISEASE"]
[null,null,null,"90937 - HC HEMODIALYSIS PX REPEAT EVAL W/WO REVJ DIALYS RX","90853 - GROUP PSYCHOTHERAPY","90935 - HC HEMODIALYSIS PROCEDURE W/ PHYS/QHP EVALUATION",null,"90715 - CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,null,null,null,"92082 - VISUAL FIELD XM UNI/BI W/INTERP INTERMED EXAM",null,"90620 - HC MENB RECOMBINANT PROT W/OUT MEMBR VESIC VACC IM",null,null,null,"92072 - FITTING CONTACT LENS FOR MNGT OF KERATOCONUS"]
[null,null,null,"90945 - HC DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL","90867 - HC TRANSCRANIAL MAGNETIC STIMULATION TREATMENT,PLANNING","90937 - HC HEMODIALYSIS PX REPEAT EVAL W/WO REVJ DIALYS RX",null,"90716 - CR BUILD ONLY - CHICKEN POX VACCINE,LIVE,SUB-Q,TRAVEL",null,null,null,null,"92132 - CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI",null,"90621 - MENB-FHBP RECOMBNT LIPOPROTEIN VACC 2/3 DOSE IM",null,null,null,"92081 - VISUAL FIELD XM UNI/BI W/INTERPRETJ LIMITED EXAM"]
[null,null,null,"91010 - ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT","90876 - HC INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 45 MIN","90945 - HC DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL",null,"90717 - YELLOW FEVER VACCINE SUBQ",null,null,null,null,"92133 - COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE",null,"90632 - CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,null,null,"92082 - VISUAL FIELD XM UNI/BI W/INTERP INTERMED EXAM"]
[null,null,null,"91034 - GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT","90882 - HC ENVIRONMENTAL IVNTJ MGMT PURPOSES PSYC PT","91010 - ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT",null,"90723 - CR BUILD ONLY - DTAP/HEPB/IPV VACCINE,IM,DPH",null,null,null,null,"92134 - COMPUTERIZED OPHTHALMIC IMAGING RETINA",null,"90633 - CR BUILD ONLY - HEPA VACCINE PED/ADOL-2 DOSE,DPH",null,null,null,"92132 - CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI"]
[null,null,null,"91035 - GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD","90887 - INTERPJ/EXPLNAJ RESULTS PSYCHIATRIC EXAM FAMILY","91034 - GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT",null,"90732 - CR BUILD ONLY - PNEUMOCOCCAL VACCINE,23-VALENT,ADULT,TRAVEL",null,null,null,null,"92136 - OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL",null,"90636 - HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM",null,null,null,"92133 - COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE"]
[null,null,null,"91037 - GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD","90912 - HC BFB TRAINING 1ST 15 MIN","91035 - GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD",null,"90734 - CR BUILD ONLY - MENINGOCOCCAL VACCINE, IM,TRAVEL",null,null,null,null,"92201 - HC OPSCPY EXTND RTA DRAW UNI/BI",null,"90648 - HC HIB VACCINE, PRP-T, IM,DPH",null,null,null,"92134 - COMPUTERIZED OPHTHALMIC IMAGING RETINA"]
[null,null,null,"91038 - ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG","90913 - HC BFB TRAINING EA ADDL 15 MIN","91037 - GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD",null,"90736 - ZOSTER SHINGLES VACCINE LIVE SUBCUTANEOUS",null,null,null,null,"92202 - HC OPSCPY EXTND ON/MAC DRAW",null,"90651 - CR BUILD ONLY - HPV 9-VALENT IM, DPH",null,null,null,"92136 - OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL"]
[null,null,null,"91065 - BREATH HYDROGEN TEST","90935 - HC HEMODIALYSIS PROCEDURE W/ PHYS/QHP EVALUATION","91038 - ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG",null,"90738 - HC JAPANESE ENCEPH VACC, INACTIVATED, IM,TRAVEL",null,null,null,null,"92235 - FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT",null,"90653 - HC IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE",null,null,null,"92201 - HC OPSCPY EXTND RTA DRAW UNI/BI"]
[null,null,null,"91110 - GI IMAG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R","90937 - HC HEMODIALYSIS PX REPEAT EVAL W/WO REVJ DIALYS RX","91065 - BREATH HYDROGEN TEST",null,"90739 - HC HEPATITIS B VACCINE ADULT 2 DOSE IM",null,null,null,null,"92240 - INDOCYANINE GREEN ANGIOGRAPHY W/INTERP & REPOR",null,"90661 - HC CCIIV3 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",null,null,null,"92202 - HC OPSCPY EXTND ON/MAC DRAW"]
[null,null,null,"91111 - GASTROINTESTINAL TRACT IMAGING ESOPHAGUS W/I&R","90945 - HC DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL","91110 - GI IMAG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R",null,"90740 - HC HEP B VACCINE,DIAL/IMMUNOSUP, IM",null,null,null,null,"92242 - HC FLUORESCEIN ICG ANGRPH W/MULTIFRAME I&R UNI/BI",null,"90662 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM FLUZONE HIGH DOSE",null,null,null,"92235 - FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT"]
[null,null,null,"91112 - GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP","91010 - ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT","91111 - GASTROINTESTINAL TRACT IMAGING ESOPHAGUS W/I&R",null,"90744 - CR BUILD ONLY - HEP B VACCINE,PED/ADOL,IM,DPH",null,null,null,null,"92250 - FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT",null,"90670 - CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH",null,null,null,"92240 - INDOCYANINE GREEN ANGIOGRAPHY W/INTERP & REPOR"]
[null,null,null,"91120 - RECTAL SESATION TONE & COMPLIANCE TEST","91034 - GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT","91112 - GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP",null,"90746 - CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL",null,null,null,null,"92260 - OPHTHALMODYNAMOMETRY",null,"90672 - CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST",null,null,null,"92242 - HC FLUORESCEIN ICG ANGRPH W/MULTIFRAME I&R UNI/BI"]
[null,null,null,"91122 - ANORECTAL MANOMETRY","91035 - GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD","91120 - RECTAL SESATION TONE & COMPLIANCE TEST",null,"90750 - HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX",null,null,null,null,"92265 - NEEDLE OCULOGRAPHY 1/ XOC MUSC 1/BOTH EYE W/I&R",null,"90673 - INFLUENZA VACCINE CELL CULT PRSRV FREE IM",null,null,null,"92250 - FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT"]
[null,null,null,"91200 - HC LIVER ELASTOGRAPHY W/O IMAG W/I&R","91037 - GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD","91122 - ANORECTAL MANOMETRY",null,"90756 - HC CCIIV4 VACCINE ANTIBIOTIC FREE 0.5ML DOS IM USE",null,null,null,null,"92270 - ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT",null,"90674 - HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",null,null,null,"92260 - OPHTHALMODYNAMOMETRY"]
[null,null,null,"92002 - OPHTH MEDICAL XM&EVAL INTERMEDIATE NEW PT","91038 - ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG","91200 - HC LIVER ELASTOGRAPHY W/O IMAG W/I&R",null,"90785 - PSYCHOTHERAPY COMPLEX INTERACTIVE",null,null,null,null,"92273 - HC FULL FIELD ERG W/I&R",null,"90675 - CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,null,null,"92265 - NEEDLE OCULOGRAPHY 1/ XOC MUSC 1/BOTH EYE W/I&R"]
[null,null,null,"92004 - OPHTH MEDICAL XM&EVAL COMPRE NEW PT 1/> VST","91065 - BREATH HYDROGEN TEST","92002 - OPHTH MEDICAL XM&EVAL INTERMEDIATE NEW PT",null,"90791 - PSYCHIATRIC DIAGNOSTIC EVALUATION",null,null,null,null,"92274 - HC MULTIFOCAL ERG W/I&R",null,"90686 - HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,null,null,"92270 - ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT"]
[null,null,null,"92012 - OPHTH MEDICAL XM&EVAL INTERMEDIATE ESTAB PT","91110 - GI IMAG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R","92004 - OPHTH MEDICAL XM&EVAL COMPRE NEW PT 1/> VST",null,"90792 - PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES",null,null,null,null,"92283 - HC COLOR VISION EXAMINATION",null,"90690 - CR BUILD ONLY - TYPHOID VACCINE, ORAL,TRAVEL",null,null,null,"92273 - HC FULL FIELD ERG W/I&R"]
[null,null,null,"92014 - OPHTH MEDICAL XM&EVAL COMPRHNSV ESTAB PT 1/>","91111 - GASTROINTESTINAL TRACT IMAGING ESOPHAGUS W/I&R","92012 - OPHTH MEDICAL XM&EVAL INTERMEDIATE ESTAB PT",null,"90832 - PSYCHOTHERAPY PATIENT &/ FAMILY 30 MINUTES",null,null,null,null,"92284 - DARK ADAPTATION XM W/INTERPRETATION & REPORT",null,"90691 - CR BUILD ONLY - TYPHOID VACCINE, IM,TRAVEL",null,null,null,"92274 - HC MULTIFOCAL ERG W/I&R"]
[null,null,null,"92015 - DETERMINATION REFRACTIVE STATE","91112 - GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP","92014 - OPHTH MEDICAL XM&EVAL COMPRHNSV ESTAB PT 1/>",null,"90833 - PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 30 MIN",null,null,null,null,"92285 - XTRNL OCULAR PHOTOG W/I&R DOCMT MEDICAL PROGRE",null,"90694 - HC VACC AIIV4 NO PRSRV 0.5ML IM",null,null,null,"92283 - HC COLOR VISION EXAMINATION"]
[null,null,null,"92018 - HC NEW EYE EXAM & TREATMENT","91120 - RECTAL SESATION TONE & COMPLIANCE TEST","92015 - DETERMINATION REFRACTIVE STATE",null,"90834 - PSYCHOTHERAPY PATIENT &/ FAMILY 45 MINUTES",null,null,null,null,"92286 - ANT SGM IMAGING W/MICROSCOPY ENDOTHELIAL ANALY",null,"90698 - CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,null,null,"92284 - DARK ADAPTATION XM W/INTERPRETATION & REPORT"]
[null,null,null,"92020 - GONIOSCOPY SEPARATE PROCEDURE","91122 - ANORECTAL MANOMETRY","92018 - HC NEW EYE EXAM & TREATMENT",null,"90836 - PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 45 MIN",null,null,null,null,"92287 - ANT SGM IMAGING W/FLUOROSCEIN ANGIO & I&R",null,"90700 - CR BUILD ONLY - DTAP IMMUNIZATION, IM, <7 YO,TRAVEL",null,null,null,"92285 - XTRNL OCULAR PHOTOG W/I&R DOCMT MEDICAL PROGRE"]
[null,null,null,"92025 - COMPUTERIZED CORNEAL TOPOGRAPHY UNI/BI","91200 - HC LIVER ELASTOGRAPHY W/O IMAG W/I&R","92020 - GONIOSCOPY SEPARATE PROCEDURE",null,"90837 - PSYCHOTHERAPY PATIENT &/ FAMILY 60 MINUTES",null,null,null,null,"92310 - RX&FITG C-LENS SUPVJ CRNL LENS OU XCPT APHK",null,"90707 - CR BUILD ONLY - MMR VIRUS IMMUNIZATION, SUBCUT,TRAVEL,PEDI",null,null,null,"92286 - ANT SGM IMAGING W/MICROSCOPY ENDOTHELIAL ANALY"]
[null,null,null,"92060 - SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX","92002 - OPHTH MEDICAL XM&EVAL INTERMEDIATE NEW PT","92025 - COMPUTERIZED CORNEAL TOPOGRAPHY UNI/BI",null,"90838 - PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 60 MIN",null,null,null,null,"92311 - HC CONTACT LENS FIT, APHAKIA UNILAT",null,"90713 - CR BUILD ONLY - POLIOMYELITIS IMMUNIZATN,INACTV,SUB-Q,DPH",null,null,null,"92287 - ANT SGM IMAGING W/FLUOROSCEIN ANGIO & I&R"]
[null,null,null,"92065 - ORTHOPTIC &/PLEOPTIC TRAINING W/MEDICAL DIRECTJ","92004 - OPHTH MEDICAL XM&EVAL COMPRE NEW PT 1/> VST","92060 - SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX",null,"90839 - HC PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES",null,null,null,null,"92312 - HC CONTACT LENS FIT,APHAKIA BILAT",null,"90714 - CR BUILD ONLY - TD VACCINE NO PRSRV >/= 7 YO, IM,DPH",null,null,null,"92310 - RX&FITG C-LENS SUPVJ CRNL LENS OU XCPT APHK"]
[null,null,null,"92071 - FIT CONTACT LENS TX OCULAR SURFACE DISEASE","92012 - OPHTH MEDICAL XM&EVAL INTERMEDIATE ESTAB PT","92065 - ORTHOPTIC &/PLEOPTIC TRAINING W/MEDICAL DIRECTJ",null,"90840 - HC PSYCHOTHERAPY FOR CRISIS EACH ADDL 30 MINUTES",null,null,null,null,"92313 - HC CONTACT LENS FIT,CORNEOSCLERAL LENS",null,"90715 - CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,null,null,"92311 - HC CONTACT LENS FIT, APHAKIA UNILAT"]
[null,null,null,"92072 - FITTING CONTACT LENS FOR MNGT OF KERATOCONUS","92014 - OPHTH MEDICAL XM&EVAL COMPRHNSV ESTAB PT 1/>","92071 - FIT CONTACT LENS TX OCULAR SURFACE DISEASE",null,"90845 - PSYCHOANALYSIS",null,null,null,null,"92502 - HC EAR AND THROAT EXAMINATION",null,"90716 - CR BUILD ONLY - CHICKEN POX VACCINE,LIVE,SUB-Q,TRAVEL",null,null,null,"92312 - HC CONTACT LENS FIT,APHAKIA BILAT"]
[null,null,null,"92081 - VISUAL FIELD XM UNI/BI W/INTERPRETJ LIMITED EXAM","92015 - DETERMINATION REFRACTIVE STATE","92072 - FITTING CONTACT LENS FOR MNGT OF KERATOCONUS",null,"90846 - FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT",null,null,null,null,"92504 - BINOCULAR MICROSCOPY SEPARATE DX PROCEDURE",null,"90717 - YELLOW FEVER VACCINE SUBQ",null,null,null,"92313 - HC CONTACT LENS FIT,CORNEOSCLERAL LENS"]
[null,null,null,"92082 - VISUAL FIELD XM UNI/BI W/INTERP INTERMED EXAM","92018 - HC NEW EYE EXAM & TREATMENT","92081 - VISUAL FIELD XM UNI/BI W/INTERPRETJ LIMITED EXAM",null,"90847 - FAMILY PSYCHOTHERAPY W/PATIENT PRESENT",null,null,null,null,"92511 - NASOPHARYNGOSCOPY W/ENDOSCOPE SPX",null,"90723 - CR BUILD ONLY - DTAP/HEPB/IPV VACCINE,IM,DPH",null,null,null,"92502 - HC EAR AND THROAT EXAMINATION"]
[null,null,null,"92132 - CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI","92020 - GONIOSCOPY SEPARATE PROCEDURE","92082 - VISUAL FIELD XM UNI/BI W/INTERP INTERMED EXAM",null,"90849 - MULTIPLE FAMILY GROUP PSYCHOTHERAPY",null,null,null,null,"92520 - LARYNGEAL FUNCTION STUDIES",null,"90732 - CR BUILD ONLY - PNEUMOCOCCAL VACCINE,23-VALENT,ADULT,TRAVEL",null,null,null,"92504 - BINOCULAR MICROSCOPY SEPARATE DX PROCEDURE"]
[null,null,null,"92133 - COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE","92025 - COMPUTERIZED CORNEAL TOPOGRAPHY UNI/BI","92132 - CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI",null,"90853 - GROUP PSYCHOTHERAPY",null,null,null,null,"92532 - POSITIONAL NYSTAGMUS TEST",null,"90734 - CR BUILD ONLY - MENINGOCOCCAL VACCINE, IM,TRAVEL",null,null,null,"92511 - NASOPHARYNGOSCOPY W/ENDOSCOPE SPX"]
[null,null,null,"92134 - COMPUTERIZED OPHTHALMIC IMAGING RETINA","92060 - SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX","92133 - COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE",null,"90867 - HC TRANSCRANIAL MAGNETIC STIMULATION TREATMENT,PLANNING",null,null,null,null,"92537 - CALORIC VESTIBULAR WITH RECORDING, BILATERAL; BITHERMAL",null,"90736 - ZOSTER SHINGLES VACCINE LIVE SUBCUTANEOUS",null,null,null,"92520 - LARYNGEAL FUNCTION STUDIES"]
[null,null,null,"92136 - OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL","92065 - ORTHOPTIC &/PLEOPTIC TRAINING W/MEDICAL DIRECTJ","92134 - COMPUTERIZED OPHTHALMIC IMAGING RETINA",null,"90876 - HC INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 45 MIN",null,null,null,null,"92538 - CALORIC VEST BILATERAL MONOTHERMAL",null,"90738 - HC JAPANESE ENCEPH VACC, INACTIVATED, IM,TRAVEL",null,null,null,"92532 - POSITIONAL NYSTAGMUS TEST"]
[null,null,null,"92201 - HC OPSCPY EXTND RTA DRAW UNI/BI","92071 - FIT CONTACT LENS TX OCULAR SURFACE DISEASE","92136 - OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL",null,"90882 - HC ENVIRONMENTAL IVNTJ MGMT PURPOSES PSYC PT",null,null,null,null,"92540 - VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRK",null,"90739 - HC HEPATITIS B VACCINE ADULT 2 DOSE IM",null,null,null,"92537 - CALORIC VESTIBULAR WITH RECORDING, BILATERAL; BITHERMAL"]
[null,null,null,"92202 - HC OPSCPY EXTND ON/MAC DRAW","92072 - FITTING CONTACT LENS FOR MNGT OF KERATOCONUS","92201 - HC OPSCPY EXTND RTA DRAW UNI/BI",null,"90887 - INTERPJ/EXPLNAJ RESULTS PSYCHIATRIC EXAM FAMILY",null,null,null,null,"92541 - SPONTANEOUS NYSTAGMUS TEST",null,"90740 - HC HEP B VACCINE,DIAL/IMMUNOSUP, IM",null,null,null,"92538 - CALORIC VEST BILATERAL MONOTHERMAL"]
[null,null,null,"92235 - FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT","92081 - VISUAL FIELD XM UNI/BI W/INTERPRETJ LIMITED EXAM","92202 - HC OPSCPY EXTND ON/MAC DRAW",null,"90889 - HC PREP REPORT PT PSYCH STATUS AGENCY/PAYER",null,null,null,null,"92542 - POSITIONAL NYSTAGMUS TEST",null,"90744 - CR BUILD ONLY - HEP B VACCINE,PED/ADOL,IM,DPH",null,null,null,"92540 - VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRK"]
[null,null,null,"92240 - INDOCYANINE GREEN ANGIOGRAPHY W/INTERP & REPOR","92082 - VISUAL FIELD XM UNI/BI W/INTERP INTERMED EXAM","92235 - FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT",null,"90901 - HC BIOFEEDBACK TRAINING, ANY MODALITY",null,null,null,null,"92544 - OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC",null,"90746 - CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL",null,null,null,"92541 - SPONTANEOUS NYSTAGMUS TEST"]
[null,null,null,"92242 - HC FLUORESCEIN ICG ANGRPH W/MULTIFRAME I&R UNI/BI","92132 - CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI","92240 - INDOCYANINE GREEN ANGIOGRAPHY W/INTERP & REPOR",null,"90912 - HC BFB TRAINING 1ST 15 MIN",null,null,null,null,"92545 - OSCILLATING TRACKING TEST W/RECORDING",null,"90750 - HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX",null,null,null,"92542 - POSITIONAL NYSTAGMUS TEST"]
[null,null,null,"92250 - FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT","92133 - COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE","92242 - HC FLUORESCEIN ICG ANGRPH W/MULTIFRAME I&R UNI/BI",null,"90913 - HC BFB TRAINING EA ADDL 15 MIN",null,null,null,null,"92546 - SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING",null,"90756 - HC CCIIV4 VACCINE ANTIBIOTIC FREE 0.5ML DOS IM USE",null,null,null,"92544 - OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC"]
[null,null,null,"92260 - OPHTHALMODYNAMOMETRY","92134 - COMPUTERIZED OPHTHALMIC IMAGING RETINA","92250 - FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT",null,"90935 - HC HEMODIALYSIS PROCEDURE W/ PHYS/QHP EVALUATION",null,null,null,null,"92550 - TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS",null,"90785 - PSYCHOTHERAPY COMPLEX INTERACTIVE",null,null,null,"92545 - OSCILLATING TRACKING TEST W/RECORDING"]
[null,null,null,"92265 - NEEDLE OCULOGRAPHY 1/ XOC MUSC 1/BOTH EYE W/I&R","92136 - OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL","92260 - OPHTHALMODYNAMOMETRY",null,"90937 - HC HEMODIALYSIS PX REPEAT EVAL W/WO REVJ DIALYS RX",null,null,null,null,"92552 - PURE TONE AUDIOMETRY AIR ONLY",null,"90791 - PSYCHIATRIC DIAGNOSTIC EVALUATION",null,null,null,"92546 - SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING"]
[null,null,null,"92270 - ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT","92201 - HC OPSCPY EXTND RTA DRAW UNI/BI","92265 - NEEDLE OCULOGRAPHY 1/ XOC MUSC 1/BOTH EYE W/I&R",null,"90945 - HC DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL",null,null,null,null,"92553 - PURE TONE AUDIOMETRY AIR & BONE",null,"90792 - PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES",null,null,null,"92550 - TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS"]
[null,null,null,"92273 - HC FULL FIELD ERG W/I&R","92202 - HC OPSCPY EXTND ON/MAC DRAW","92270 - ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT",null,"91010 - ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT",null,null,null,null,"92555 - SPEECH AUDIOMETRY THRESHOLD",null,"90832 - PSYCHOTHERAPY PATIENT &/ FAMILY 30 MINUTES",null,null,null,"92552 - PURE TONE AUDIOMETRY AIR ONLY"]
[null,null,null,"92274 - HC MULTIFOCAL ERG W/I&R","92235 - FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT","92273 - HC FULL FIELD ERG W/I&R",null,"91034 - GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT",null,null,null,null,"92556 - SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ",null,"90833 - PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 30 MIN",null,null,null,"92553 - PURE TONE AUDIOMETRY AIR & BONE"]
[null,null,null,"92283 - HC COLOR VISION EXAMINATION","92240 - INDOCYANINE GREEN ANGIOGRAPHY W/INTERP & REPOR","92274 - HC MULTIFOCAL ERG W/I&R",null,"91035 - GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD",null,null,null,null,"92557 - COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ",null,"90834 - PSYCHOTHERAPY PATIENT &/ FAMILY 45 MINUTES",null,null,null,"92555 - SPEECH AUDIOMETRY THRESHOLD"]
[null,null,null,"92284 - DARK ADAPTATION XM W/INTERPRETATION & REPORT","92242 - HC FLUORESCEIN ICG ANGRPH W/MULTIFRAME I&R UNI/BI","92283 - HC COLOR VISION EXAMINATION",null,"91037 - GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD",null,null,null,null,"92562 - LOUDNESS BALANCE BINAURAL/MONAURAL",null,"90836 - PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 45 MIN",null,null,null,"92556 - SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ"]
[null,null,null,"92285 - XTRNL OCULAR PHOTOG W/I&R DOCMT MEDICAL PROGRE","92250 - FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT","92284 - DARK ADAPTATION XM W/INTERPRETATION & REPORT",null,"91038 - ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG",null,null,null,null,"92563 - TONE DECAY TEST",null,"90837 - PSYCHOTHERAPY PATIENT &/ FAMILY 60 MINUTES",null,null,null,"92557 - COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ"]
[null,null,null,"92286 - ANT SGM IMAGING W/MICROSCOPY ENDOTHELIAL ANALY","92260 - OPHTHALMODYNAMOMETRY","92285 - XTRNL OCULAR PHOTOG W/I&R DOCMT MEDICAL PROGRE",null,"91065 - BREATH HYDROGEN TEST",null,null,null,null,"92565 - STENGER TEST PURE TONE",null,"90838 - PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 60 MIN",null,null,null,"92562 - LOUDNESS BALANCE BINAURAL/MONAURAL"]
[null,null,null,"92287 - ANT SGM IMAGING W/FLUOROSCEIN ANGIO & I&R","92265 - NEEDLE OCULOGRAPHY 1/ XOC MUSC 1/BOTH EYE W/I&R","92286 - ANT SGM IMAGING W/MICROSCOPY ENDOTHELIAL ANALY",null,"91110 - GI IMAG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R",null,null,null,null,"92567 - TYMPANOMETRY",null,"90839 - HC PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES",null,null,null,"92563 - TONE DECAY TEST"]
[null,null,null,"92310 - RX&FITG C-LENS SUPVJ CRNL LENS OU XCPT APHK","92270 - ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT","92287 - ANT SGM IMAGING W/FLUOROSCEIN ANGIO & I&R",null,"91111 - GASTROINTESTINAL TRACT IMAGING ESOPHAGUS W/I&R",null,null,null,null,"92568 - ACOUSTIC REFLEX THRESHOLD",null,"90840 - HC PSYCHOTHERAPY FOR CRISIS EACH ADDL 30 MINUTES",null,null,null,"92565 - STENGER TEST PURE TONE"]
[null,null,null,"92311 - HC CONTACT LENS FIT, APHAKIA UNILAT","92273 - HC FULL FIELD ERG W/I&R","92310 - RX&FITG C-LENS SUPVJ CRNL LENS OU XCPT APHK",null,"91112 - GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP",null,null,null,null,"92570 - HC ACOUSTIC IMMIT TEST TYMPANOMETRY/ACOUST REFLEX/DECAY",null,"90845 - PSYCHOANALYSIS",null,null,null,"92567 - TYMPANOMETRY"]
[null,null,null,"92312 - HC CONTACT LENS FIT,APHAKIA BILAT","92274 - HC MULTIFOCAL ERG W/I&R","92311 - HC CONTACT LENS FIT, APHAKIA UNILAT",null,"91120 - RECTAL SESATION TONE & COMPLIANCE TEST",null,null,null,null,"92571 - FILTERED SPEECH TEST",null,"90846 - FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT",null,null,null,"92568 - ACOUSTIC REFLEX THRESHOLD"]
[null,null,null,"92313 - HC CONTACT LENS FIT,CORNEOSCLERAL LENS","92283 - HC COLOR VISION EXAMINATION","92312 - HC CONTACT LENS FIT,APHAKIA BILAT",null,"91122 - ANORECTAL MANOMETRY",null,null,null,null,"92572 - STAGGERED SPONDAIC WORD",null,"90847 - FAMILY PSYCHOTHERAPY W/PATIENT PRESENT",null,null,null,"92570 - HC ACOUSTIC IMMIT TEST TYMPANOMETRY/ACOUST REFLEX/DECAY"]
[null,null,null,"92502 - HC EAR AND THROAT EXAMINATION","92284 - DARK ADAPTATION XM W/INTERPRETATION & REPORT","92313 - HC CONTACT LENS FIT,CORNEOSCLERAL LENS",null,"91200 - HC LIVER ELASTOGRAPHY W/O IMAG W/I&R",null,null,null,null,"92576 - SYNTHETIC SENTENCE IDENTIFICATION TEST",null,"90849 - MULTIPLE FAMILY GROUP PSYCHOTHERAPY",null,null,null,"92571 - FILTERED SPEECH TEST"]
[null,null,null,"92504 - BINOCULAR MICROSCOPY SEPARATE DX PROCEDURE","92285 - XTRNL OCULAR PHOTOG W/I&R DOCMT MEDICAL PROGRE","92502 - HC EAR AND THROAT EXAMINATION",null,"92002 - OPHTH MEDICAL XM&EVAL INTERMEDIATE NEW PT",null,null,null,null,"92577 - STENGER TEST SPEECH",null,"90853 - GROUP PSYCHOTHERAPY",null,null,null,"92572 - STAGGERED SPONDAIC WORD"]
[null,null,null,"92507 - TX SPEECH LANG VOICE COMMJ &/AUDITORY PROC IND","92286 - ANT SGM IMAGING W/MICROSCOPY ENDOTHELIAL ANALY","92504 - BINOCULAR MICROSCOPY SEPARATE DX PROCEDURE",null,"92004 - OPHTH MEDICAL XM&EVAL COMPRE NEW PT 1/> VST",null,null,null,null,"92579 - VISUAL REINFORCEMENT AUDIOMETRY",null,"90867 - HC TRANSCRANIAL MAGNETIC STIMULATION TREATMENT,PLANNING",null,null,null,"92576 - SYNTHETIC SENTENCE IDENTIFICATION TEST"]
[null,null,null,"92508 - TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV","92287 - ANT SGM IMAGING W/FLUOROSCEIN ANGIO & I&R","92507 - TX SPEECH LANG VOICE COMMJ &/AUDITORY PROC IND",null,"92012 - OPHTH MEDICAL XM&EVAL INTERMEDIATE ESTAB PT",null,null,null,null,"92582 - CONDITIONING PLAY AUDIOMETRY",null,"90876 - HC INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 45 MIN",null,null,null,"92577 - STENGER TEST SPEECH"]
[null,null,null,"92511 - NASOPHARYNGOSCOPY W/ENDOSCOPE SPX","92310 - RX&FITG C-LENS SUPVJ CRNL LENS OU XCPT APHK","92508 - TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV",null,"92014 - OPHTH MEDICAL XM&EVAL COMPRHNSV ESTAB PT 1/>",null,null,null,null,"92584 - ELECTROCOCHLEOGRAPY",null,"90882 - HC ENVIRONMENTAL IVNTJ MGMT PURPOSES PSYC PT",null,null,null,"92579 - VISUAL REINFORCEMENT AUDIOMETRY"]
[null,null,null,"92520 - LARYNGEAL FUNCTION STUDIES","92311 - HC CONTACT LENS FIT, APHAKIA UNILAT","92511 - NASOPHARYNGOSCOPY W/ENDOSCOPE SPX",null,"92015 - DETERMINATION REFRACTIVE STATE",null,null,null,null,"92585 - AUDITORY EVOKED POTENTIALS COMPREHENSIVE",null,"90887 - INTERPJ/EXPLNAJ RESULTS PSYCHIATRIC EXAM FAMILY",null,null,null,"92582 - CONDITIONING PLAY AUDIOMETRY"]
[null,null,null,"92521 - EVALUATION OF SPEECH FLUENCY (STUTTER CLUTTER)","92312 - HC CONTACT LENS FIT,APHAKIA BILAT","92520 - LARYNGEAL FUNCTION STUDIES",null,"92018 - HC NEW EYE EXAM & TREATMENT",null,null,null,null,"92586 - AUDITORY EVOKED POTENTIALS LIMITED",null,"90889 - HC PREP REPORT PT PSYCH STATUS AGENCY/PAYER",null,null,null,"92584 - ELECTROCOCHLEOGRAPY"]
[null,null,null,"92522 - EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE","92313 - HC CONTACT LENS FIT,CORNEOSCLERAL LENS","92521 - EVALUATION OF SPEECH FLUENCY (STUTTER CLUTTER)",null,"92020 - GONIOSCOPY SEPARATE PROCEDURE",null,null,null,null,"92587 - DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD",null,"90901 - HC BIOFEEDBACK TRAINING, ANY MODALITY",null,null,null,"92585 - AUDITORY EVOKED POTENTIALS COMPREHENSIVE"]
[null,null,null,"92523 - EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION","92502 - HC EAR AND THROAT EXAMINATION","92522 - EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE",null,"92025 - COMPUTERIZED CORNEAL TOPOGRAPHY UNI/BI",null,null,null,null,"92588 - DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL",null,"90912 - HC BFB TRAINING 1ST 15 MIN",null,null,null,"92586 - AUDITORY EVOKED POTENTIALS LIMITED"]
[null,null,null,"92524 - BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE","92504 - BINOCULAR MICROSCOPY SEPARATE DX PROCEDURE","92523 - EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION",null,"92060 - SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX",null,null,null,null,"92601 - HC DX ANAL COCHLEAR IMP,PT <7 YRS,W/PROG",null,"90913 - HC BFB TRAINING EA ADDL 15 MIN",null,null,null,"92587 - DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD"]
[null,null,null,"92526 - TX SWALLOWING DYSFUNCTION&/ORAL FUNCJ FEEDING","92507 - TX SPEECH LANG VOICE COMMJ &/AUDITORY PROC IND","92524 - BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE",null,"92065 - ORTHOPTIC &/PLEOPTIC TRAINING W/MEDICAL DIRECTJ",null,null,null,null,"92602 - HC REPROGRAM COCHLEAR IMPLT <7",null,"90935 - HC HEMODIALYSIS PROCEDURE W/ PHYS/QHP EVALUATION",null,null,null,"92588 - DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL"]
[null,null,null,"92532 - POSITIONAL NYSTAGMUS TEST","92508 - TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV","92526 - TX SWALLOWING DYSFUNCTION&/ORAL FUNCJ FEEDING",null,"92071 - FIT CONTACT LENS TX OCULAR SURFACE DISEASE",null,null,null,null,"92603 - HC DX ANAL COCHLEAR IMP,PT >7 YRS,W/PROG",null,"90937 - HC HEMODIALYSIS PX REPEAT EVAL W/WO REVJ DIALYS RX",null,null,null,"92601 - HC DX ANAL COCHLEAR IMP,PT <7 YRS,W/PROG"]
[null,null,null,"92537 - CALORIC VESTIBULAR WITH RECORDING, BILATERAL; BITHERMAL","92511 - NASOPHARYNGOSCOPY W/ENDOSCOPE SPX","92532 - POSITIONAL NYSTAGMUS TEST",null,"92072 - FITTING CONTACT LENS FOR MNGT OF KERATOCONUS",null,null,null,null,"92604 - HC DX ANAL COCHLEAR IMP, PT >7 YRS, REPROG",null,"90945 - HC DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL",null,null,null,"92602 - HC REPROGRAM COCHLEAR IMPLT <7"]
[null,null,null,"92538 - CALORIC VEST BILATERAL MONOTHERMAL","92520 - LARYNGEAL FUNCTION STUDIES","92537 - CALORIC VESTIBULAR WITH RECORDING, BILATERAL; BITHERMAL",null,"92081 - VISUAL FIELD XM UNI/BI W/INTERPRETJ LIMITED EXAM",null,null,null,null,"92620 - EVAL CENTRAL AUDITORY FUNCJ W/REPRT 1ST 60 MIN",null,"91010 - ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT",null,null,null,"92603 - HC DX ANAL COCHLEAR IMP,PT >7 YRS,W/PROG"]
[null,null,null,"92540 - VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRK","92521 - EVALUATION OF SPEECH FLUENCY (STUTTER CLUTTER)","92538 - CALORIC VEST BILATERAL MONOTHERMAL",null,"92082 - VISUAL FIELD XM UNI/BI W/INTERP INTERMED EXAM",null,null,null,null,"92621 - EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN",null,"91034 - GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT",null,null,null,"92604 - HC DX ANAL COCHLEAR IMP, PT >7 YRS, REPROG"]
[null,null,null,"92541 - SPONTANEOUS NYSTAGMUS TEST","92522 - EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE","92540 - VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRK",null,"92132 - CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI",null,null,null,null,"92625 - HC TINNITUS ASSESSMENT",null,"91035 - GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD",null,null,null,"92620 - EVAL CENTRAL AUDITORY FUNCJ W/REPRT 1ST 60 MIN"]
[null,null,null,"92542 - POSITIONAL NYSTAGMUS TEST","92523 - EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION","92541 - SPONTANEOUS NYSTAGMUS TEST",null,"92133 - COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE",null,null,null,null,"92626 - HC EVAL AUDITORY REHAB STATUS, 1ST HOUR",null,"91037 - GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD",null,null,null,"92621 - EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN"]
[null,null,null,"92544 - OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC","92524 - BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE","92542 - POSITIONAL NYSTAGMUS TEST",null,"92134 - COMPUTERIZED OPHTHALMIC IMAGING RETINA",null,null,null,null,"92627 - HC EVAL AUDITORY REHAB STATUS, EA ADD 15",null,"91038 - ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG",null,null,null,"92625 - HC TINNITUS ASSESSMENT"]
[null,null,null,"92545 - OSCILLATING TRACKING TEST W/RECORDING","92526 - TX SWALLOWING DYSFUNCTION&/ORAL FUNCJ FEEDING","92544 - OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC",null,"92136 - OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL",null,null,null,null,"92920 - HC PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH",null,"91065 - BREATH HYDROGEN TEST",null,null,null,"92626 - HC EVAL AUDITORY REHAB STATUS, 1ST HOUR"]
[null,null,null,"92546 - SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING","92532 - POSITIONAL NYSTAGMUS TEST","92545 - OSCILLATING TRACKING TEST W/RECORDING",null,"92201 - HC OPSCPY EXTND RTA DRAW UNI/BI",null,null,null,null,"92921 - HC PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH",null,"91110 - GI IMAG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R",null,null,null,"92627 - HC EVAL AUDITORY REHAB STATUS, EA ADD 15"]
[null,null,null,"92550 - TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS","92537 - CALORIC VESTIBULAR WITH RECORDING, BILATERAL; BITHERMAL","92546 - SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING",null,"92202 - HC OPSCPY EXTND ON/MAC DRAW",null,null,null,null,"92924 - HC PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH",null,"91111 - GASTROINTESTINAL TRACT IMAGING ESOPHAGUS W/I&R",null,null,null,"92920 - HC PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH"]
[null,null,null,"92552 - PURE TONE AUDIOMETRY AIR ONLY","92538 - CALORIC VEST BILATERAL MONOTHERMAL","92550 - TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS",null,"92225 - OPHTHALMOSCPY EXTENDED RETINAL DRAWING I&R 1ST",null,null,null,null,"92925 - HC ATHER MAJOR/BRANCH EA ADD",null,"91112 - GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP",null,null,null,"92921 - HC PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH"]
[null,null,null,"92553 - PURE TONE AUDIOMETRY AIR & BONE","92540 - VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRK","92552 - PURE TONE AUDIOMETRY AIR ONLY",null,"92226 - OPHTHALMOSCPY EXTENDED RETINAL DRAWING I&R SBS",null,null,null,null,"92928 - HC PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH",null,"91120 - RECTAL SESATION TONE & COMPLIANCE TEST",null,null,null,"92924 - HC PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH"]
[null,null,null,"92555 - SPEECH AUDIOMETRY THRESHOLD","92541 - SPONTANEOUS NYSTAGMUS TEST","92553 - PURE TONE AUDIOMETRY AIR & BONE",null,"92235 - FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT",null,null,null,null,"92929 - HC PRQ TRLUML CORONARY STENT W/ANGIO ADDL ART/BRNCH",null,"91122 - ANORECTAL MANOMETRY",null,null,null,"92925 - HC ATHER MAJOR/BRANCH EA ADD"]
[null,null,null,"92556 - SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ","92542 - POSITIONAL NYSTAGMUS TEST","92555 - SPEECH AUDIOMETRY THRESHOLD",null,"92240 - INDOCYANINE GREEN ANGIOGRAPHY W/INTERP & REPOR",null,null,null,null,"92933 - HC PRQ TRLUML CORONRY STENT/ATH/ANGIO ONE ART/BRNCH",null,"91200 - HC LIVER ELASTOGRAPHY W/O IMAG W/I&R",null,null,null,"92928 - HC PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH"]
[null,null,null,"92557 - COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ","92544 - OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC","92556 - SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ",null,"92242 - HC FLUORESCEIN ICG ANGRPH W/MULTIFRAME I&R UNI/BI",null,null,null,null,"92934 - HC PRQ TRLUML CORONARY STENT/ATH/ANGIO ADDL BRANCH",null,"92002 - OPHTH MEDICAL XM&EVAL INTERMEDIATE NEW PT",null,null,null,"92929 - HC PRQ TRLUML CORONARY STENT W/ANGIO ADDL ART/BRNCH"]
[null,null,null,"92558 - EVOKED OTOACOUSTIC EMISSIONS SCREEN AUTO ANALYS","92545 - OSCILLATING TRACKING TEST W/RECORDING","92557 - COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ",null,"92250 - FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT",null,null,null,null,"92937 - HC PRQ TRLUML CORONARY BYP GRFT REVASC ONE VESSEL",null,"92004 - OPHTH MEDICAL XM&EVAL COMPRE NEW PT 1/> VST",null,null,null,"92933 - HC PRQ TRLUML CORONRY STENT/ATH/ANGIO ONE ART/BRNCH"]
[null,null,null,"92562 - LOUDNESS BALANCE BINAURAL/MONAURAL","92546 - SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING","92558 - EVOKED OTOACOUSTIC EMISSIONS SCREEN AUTO ANALYS",null,"92260 - OPHTHALMODYNAMOMETRY",null,null,null,null,"92938 - HC PRQ TRLUML CORONARY BYP GRFT REVASC ADDL VESSEL",null,"92012 - OPHTH MEDICAL XM&EVAL INTERMEDIATE ESTAB PT",null,null,null,"92934 - HC PRQ TRLUML CORONARY STENT/ATH/ANGIO ADDL BRANCH"]
[null,null,null,"92563 - TONE DECAY TEST","92550 - TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS","92562 - LOUDNESS BALANCE BINAURAL/MONAURAL",null,"92265 - NEEDLE OCULOGRAPHY 1/ XOC MUSC 1/BOTH EYE W/I&R",null,null,null,null,"92941 - HC PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL",null,"92014 - OPHTH MEDICAL XM&EVAL COMPRHNSV ESTAB PT 1/>",null,null,null,"92937 - HC PRQ TRLUML CORONARY BYP GRFT REVASC ONE VESSEL"]
[null,null,null,"92565 - STENGER TEST PURE TONE","92552 - PURE TONE AUDIOMETRY AIR ONLY","92563 - TONE DECAY TEST",null,"92270 - ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT",null,null,null,null,"92943 - HC PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL",null,"92015 - DETERMINATION REFRACTIVE STATE",null,null,null,"92938 - HC PRQ TRLUML CORONARY BYP GRFT REVASC ADDL VESSEL"]
[null,null,null,"92567 - TYMPANOMETRY","92553 - PURE TONE AUDIOMETRY AIR & BONE","92565 - STENGER TEST PURE TONE",null,"92273 - HC FULL FIELD ERG W/I&R",null,null,null,null,"92944 - PRQ TRLUML CORONRY CHRNIC OCCLUS REVASC ADDL VSL",null,"92018 - HC NEW EYE EXAM & TREATMENT",null,null,null,"92941 - HC PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL"]
[null,null,null,"92568 - ACOUSTIC REFLEX THRESHOLD","92555 - SPEECH AUDIOMETRY THRESHOLD","92567 - TYMPANOMETRY",null,"92274 - HC MULTIFOCAL ERG W/I&R",null,null,null,null,"92950 - CARDIOPULMONARY RESUSCITATION",null,"92020 - GONIOSCOPY SEPARATE PROCEDURE",null,null,null,"92943 - HC PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL"]
[null,null,null,"92570 - HC ACOUSTIC IMMIT TEST TYMPANOMETRY/ACOUST REFLEX/DECAY","92556 - SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ","92568 - ACOUSTIC REFLEX THRESHOLD",null,"92283 - HC COLOR VISION EXAMINATION",null,null,null,null,"92953 - HC TEMPORARY TRANSCUTANEOUS PACING",null,"92025 - COMPUTERIZED CORNEAL TOPOGRAPHY UNI/BI",null,null,null,"92944 - PRQ TRLUML CORONRY CHRNIC OCCLUS REVASC ADDL VSL"]
[null,null,null,"92571 - FILTERED SPEECH TEST","92557 - COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ","92570 - HC ACOUSTIC IMMIT TEST TYMPANOMETRY/ACOUST REFLEX/DECAY",null,"92284 - DARK ADAPTATION XM W/INTERPRETATION & REPORT",null,null,null,null,"92960 - HC CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL",null,"92060 - SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX",null,null,null,"92950 - CARDIOPULMONARY RESUSCITATION"]
[null,null,null,"92572 - STAGGERED SPONDAIC WORD","92558 - EVOKED OTOACOUSTIC EMISSIONS SCREEN AUTO ANALYS","92571 - FILTERED SPEECH TEST",null,"92285 - XTRNL OCULAR PHOTOG W/I&R DOCMT MEDICAL PROGRE",null,null,null,null,"92961 - HC CARDIOVERSION ELECTIVE ARRHYTHMIA INTERNAL SPX",null,"92065 - ORTHOPTIC &/PLEOPTIC TRAINING W/MEDICAL DIRECTJ",null,null,null,"92953 - HC TEMPORARY TRANSCUTANEOUS PACING"]
[null,null,null,"92576 - SYNTHETIC SENTENCE IDENTIFICATION TEST","92562 - LOUDNESS BALANCE BINAURAL/MONAURAL","92572 - STAGGERED SPONDAIC WORD",null,"92286 - ANT SGM IMAGING W/MICROSCOPY ENDOTHELIAL ANALY",null,null,null,null,"92973 - HC PRQ TRANSLUMINAL CORONARY MECHANICL THROMBECTOMY",null,"92071 - FIT CONTACT LENS TX OCULAR SURFACE DISEASE",null,null,null,"92960 - HC CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL"]
[null,null,null,"92577 - STENGER TEST SPEECH","92563 - TONE DECAY TEST","92576 - SYNTHETIC SENTENCE IDENTIFICATION TEST",null,"92287 - ANT SGM IMAGING W/FLUOROSCEIN ANGIO & I&R",null,null,null,null,"92977 - HC THROMBOLYSIS,CORONARY,IV INFUSN",null,"92072 - FITTING CONTACT LENS FOR MNGT OF KERATOCONUS",null,null,null,"92961 - HC CARDIOVERSION ELECTIVE ARRHYTHMIA INTERNAL SPX"]
[null,null,null,"92579 - VISUAL REINFORCEMENT AUDIOMETRY","92565 - STENGER TEST PURE TONE","92577 - STENGER TEST SPEECH",null,"92310 - RX&FITG C-LENS SUPVJ CRNL LENS OU XCPT APHK",null,null,null,null,"92978 - HC ENDOLUMINAL CORONARY IVUS OCT I&R INITIAL VESSEL",null,"92081 - VISUAL FIELD XM UNI/BI W/INTERPRETJ LIMITED EXAM",null,null,null,"92973 - HC PRQ TRANSLUMINAL CORONARY MECHANICL THROMBECTOMY"]
[null,null,null,"92582 - CONDITIONING PLAY AUDIOMETRY","92567 - TYMPANOMETRY","92579 - VISUAL REINFORCEMENT AUDIOMETRY",null,"92311 - HC CONTACT LENS FIT, APHAKIA UNILAT",null,null,null,null,"92979 - HC ENDOLUMINAL CORONARY IVUS OCT I&R ADDK VESSEL",null,"92082 - VISUAL FIELD XM UNI/BI W/INTERP INTERMED EXAM",null,null,null,"92977 - HC THROMBOLYSIS,CORONARY,IV INFUSN"]
[null,null,null,"92584 - ELECTROCOCHLEOGRAPY","92568 - ACOUSTIC REFLEX THRESHOLD","92582 - CONDITIONING PLAY AUDIOMETRY",null,"92312 - HC CONTACT LENS FIT,APHAKIA BILAT",null,null,null,null,"92986 - HC PRQ BALLOON VALVULOPLASTY AORTIC VALVE",null,"92132 - CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI",null,null,null,"92978 - HC ENDOLUMINAL CORONARY IVUS OCT I&R INITIAL VESSEL"]
[null,null,null,"92585 - AUDITORY EVOKED POTENTIALS COMPREHENSIVE","92570 - HC ACOUSTIC IMMIT TEST TYMPANOMETRY/ACOUST REFLEX/DECAY","92584 - ELECTROCOCHLEOGRAPY",null,"92313 - HC CONTACT LENS FIT,CORNEOSCLERAL LENS",null,null,null,null,"92987 - HC PRQ BALLOON VALVULOPLASTY MITRAL VALVE",null,"92133 - COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE",null,null,null,"92979 - HC ENDOLUMINAL CORONARY IVUS OCT I&R ADDK VESSEL"]
[null,null,null,"92586 - AUDITORY EVOKED POTENTIALS LIMITED","92571 - FILTERED SPEECH TEST","92585 - AUDITORY EVOKED POTENTIALS COMPREHENSIVE",null,"92502 - HC EAR AND THROAT EXAMINATION",null,null,null,null,"92990 - PRQ BALLOON VALVULOPLASTY PULMONARY VALVE",null,"92134 - COMPUTERIZED OPHTHALMIC IMAGING RETINA",null,null,null,"92986 - HC PRQ BALLOON VALVULOPLASTY AORTIC VALVE"]
[null,null,null,"92587 - DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD","92572 - STAGGERED SPONDAIC WORD","92586 - AUDITORY EVOKED POTENTIALS LIMITED",null,"92504 - BINOCULAR MICROSCOPY SEPARATE DX PROCEDURE",null,null,null,null,"93005 - ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R",null,"92136 - OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL",null,null,null,"92987 - HC PRQ BALLOON VALVULOPLASTY MITRAL VALVE"]
[null,null,null,"92588 - DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL","92576 - SYNTHETIC SENTENCE IDENTIFICATION TEST","92587 - DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD",null,"92507 - TX SPEECH LANG VOICE COMMJ &/AUDITORY PROC IND",null,null,null,null,"93017 - HC CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY",null,"92201 - HC OPSCPY EXTND RTA DRAW UNI/BI",null,null,null,"92990 - PRQ BALLOON VALVULOPLASTY PULMONARY VALVE"]
[null,null,null,"92590 - HC HEARING AID EXAMINATION & SELECTION MONAURAL","92577 - STENGER TEST SPEECH","92588 - DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL",null,"92508 - TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV",null,null,null,null,"93225 - HC XTRNL ECG & 48 HR RECORDING",null,"92202 - HC OPSCPY EXTND ON/MAC DRAW",null,null,null,"93005 - ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R"]
[null,null,null,"92591 - HEARING AID EXAMINATION & SELECTION BINAURAL","92579 - VISUAL REINFORCEMENT AUDIOMETRY","92590 - HC HEARING AID EXAMINATION & SELECTION MONAURAL",null,"92511 - NASOPHARYNGOSCOPY W/ENDOSCOPE SPX",null,null,null,null,"93226 - EXTERNAL ECG SCANNING ANALYSIS REPORT",null,"92225 - OPHTHALMOSCPY EXTENDED RETINAL DRAWING I&R 1ST",null,null,null,"93017 - HC CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY"]
[null,null,null,"92592 - HEARING AID CHECK MONAURAL","92582 - CONDITIONING PLAY AUDIOMETRY","92591 - HEARING AID EXAMINATION & SELECTION BINAURAL",null,"92520 - LARYNGEAL FUNCTION STUDIES",null,null,null,null,"93260 - HC PRGRMG DEV EVAL IMPLANTABLE SUBQ LEAD DFB SYSTEM",null,"92226 - OPHTHALMOSCPY EXTENDED RETINAL DRAWING I&R SBS",null,null,null,"93225 - HC XTRNL ECG & 48 HR RECORDING"]
[null,null,null,"92593 - HEARING AID CHECK BINAURAL","92584 - ELECTROCOCHLEOGRAPY","92592 - HEARING AID CHECK MONAURAL",null,"92521 - EVALUATION OF SPEECH FLUENCY (STUTTER CLUTTER)",null,null,null,null,"93270 - XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS",null,"92235 - FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT",null,null,null,"93226 - EXTERNAL ECG SCANNING ANALYSIS REPORT"]
[null,null,null,"92594 - ELECTROACOUS EVAL HEARING AID MONAURAL","92585 - AUDITORY EVOKED POTENTIALS COMPREHENSIVE","92593 - HEARING AID CHECK BINAURAL",null,"92522 - EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE",null,null,null,null,"93271 - HC EXT ECG,PT DEMAND EVENT, SYMPT MEMORY LOOP, TRANSMIT",null,"92240 - INDOCYANINE GREEN ANGIOGRAPHY W/INTERP & REPOR",null,null,null,"93260 - HC PRGRMG DEV EVAL IMPLANTABLE SUBQ LEAD DFB SYSTEM"]
[null,null,null,"92595 - ELECTROACOUS EVAL HEARING AID BINAURAL","92586 - AUDITORY EVOKED POTENTIALS LIMITED","92594 - ELECTROACOUS EVAL HEARING AID MONAURAL",null,"92523 - EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION",null,null,null,null,"93278 - SIGNAL AVERAGED ELECTROCARDIOGRAPHY W/WO ECG",null,"92242 - HC FLUORESCEIN ICG ANGRPH W/MULTIFRAME I&R UNI/BI",null,null,null,"93270 - XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS"]
[null,null,null,"92597 - EVAL&/FITG VOICE PROSTC DEV SUPLMNT ORAL SPEEC","92587 - DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD","92595 - ELECTROACOUS EVAL HEARING AID BINAURAL",null,"92524 - BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE",null,null,null,null,"93279 - PROGRAM EVAL IMPLANTABLE IN PRSN 1 LD PACEMAKER",null,"92250 - FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT",null,null,null,"93271 - HC EXT ECG,PT DEMAND EVENT, SYMPT MEMORY LOOP, TRANSMIT"]
[null,null,null,"92601 - HC DX ANAL COCHLEAR IMP,PT <7 YRS,W/PROG","92588 - DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL","92597 - EVAL&/FITG VOICE PROSTC DEV SUPLMNT ORAL SPEEC",null,"92526 - TX SWALLOWING DYSFUNCTION&/ORAL FUNCJ FEEDING",null,null,null,null,"93280 - PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER",null,"92260 - OPHTHALMODYNAMOMETRY",null,null,null,"93278 - SIGNAL AVERAGED ELECTROCARDIOGRAPHY W/WO ECG"]
[null,null,null,"92602 - HC REPROGRAM COCHLEAR IMPLT <7","92590 - HC HEARING AID EXAMINATION & SELECTION MONAURAL","92601 - HC DX ANAL COCHLEAR IMP,PT <7 YRS,W/PROG",null,"92532 - POSITIONAL NYSTAGMUS TEST",null,null,null,null,"93281 - PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER",null,"92265 - NEEDLE OCULOGRAPHY 1/ XOC MUSC 1/BOTH EYE W/I&R",null,null,null,"93279 - PROGRAM EVAL IMPLANTABLE IN PRSN 1 LD PACEMAKER"]
[null,null,null,"92603 - HC DX ANAL COCHLEAR IMP,PT >7 YRS,W/PROG","92591 - HEARING AID EXAMINATION & SELECTION BINAURAL","92602 - HC REPROGRAM COCHLEAR IMPLT <7",null,"92537 - CALORIC VESTIBULAR WITH RECORDING, BILATERAL; BITHERMAL",null,null,null,null,"93282 - PROGRAM EVAL IMPLANTABLE IN PERSN 1 LD CARD/DFB",null,"92270 - ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT",null,null,null,"93280 - PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER"]
[null,null,null,"92604 - HC DX ANAL COCHLEAR IMP, PT >7 YRS, REPROG","92592 - HEARING AID CHECK MONAURAL","92603 - HC DX ANAL COCHLEAR IMP,PT >7 YRS,W/PROG",null,"92538 - CALORIC VEST BILATERAL MONOTHERMAL",null,null,null,null,"93283 - PROGRM EVAL IMPLANTABLE IN PRSN DUAL L CARD/DFB",null,"92273 - HC FULL FIELD ERG W/I&R",null,null,null,"93281 - PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER"]
[null,null,null,"92605 - EVAL RX N-SP-GEN AUGMT ALT COMMUN DEV F2F 1ST HR","92593 - HEARING AID CHECK BINAURAL","92604 - HC DX ANAL COCHLEAR IMP, PT >7 YRS, REPROG",null,"92540 - VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRK",null,null,null,null,"93284 - PROGRM EVAL IMPLANTABLE IN PRSN MLT LD CARD/DFB",null,"92274 - HC MULTIFOCAL ERG W/I&R",null,null,null,"93282 - PROGRAM EVAL IMPLANTABLE IN PERSN 1 LD CARD/DFB"]
[null,null,null,"92607 - RX SP-GENRATJ AUGMNT&COMUNICAJ DEV 1ST HR","92594 - ELECTROACOUS EVAL HEARING AID MONAURAL","92605 - EVAL RX N-SP-GEN AUGMT ALT COMMUN DEV F2F 1ST HR",null,"92541 - SPONTANEOUS NYSTAGMUS TEST",null,null,null,null,"93285 - PROGRAM EVAL IMPLANTABLE DEV IN PRSN ILR SYSTEM",null,"92283 - HC COLOR VISION EXAMINATION",null,null,null,"93283 - PROGRM EVAL IMPLANTABLE IN PRSN DUAL L CARD/DFB"]
[null,null,null,"92608 - HC EX FOR SPEECH DEVICE RX ADDL","92595 - ELECTROACOUS EVAL HEARING AID BINAURAL","92607 - RX SP-GENRATJ AUGMNT&COMUNICAJ DEV 1ST HR",null,"92542 - POSITIONAL NYSTAGMUS TEST",null,null,null,null,"93286 - HC PERI-PX EVAL&PROGRAM IN PRSN PACEMAKER SYSTEM",null,"92284 - DARK ADAPTATION XM W/INTERPRETATION & REPORT",null,null,null,"93284 - PROGRM EVAL IMPLANTABLE IN PRSN MLT LD CARD/DFB"]
[null,null,null,"92609 - HC USE OF SPEECH DEVICE SERVICE","92597 - EVAL&/FITG VOICE PROSTC DEV SUPLMNT ORAL SPEEC","92608 - HC EX FOR SPEECH DEVICE RX ADDL",null,"92544 - OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC",null,null,null,null,"93287 - HC PERI-PX DEV EVAL & PROG SING/DUAL/MULTI LEAD DFB",null,"92285 - XTRNL OCULAR PHOTOG W/I&R DOCMT MEDICAL PROGRE",null,null,null,"93285 - PROGRAM EVAL IMPLANTABLE DEV IN PRSN ILR SYSTEM"]
[null,null,null,"92610 - EVAL ORAL&PHARYNGEAL SWLNG FUNCJ","92601 - HC DX ANAL COCHLEAR IMP,PT <7 YRS,W/PROG","92609 - HC USE OF SPEECH DEVICE SERVICE",null,"92545 - OSCILLATING TRACKING TEST W/RECORDING",null,null,null,null,"93288 - INTERROGATION EVAL IN PERSON 1/DUAL/MLT LEAD PM",null,"92286 - ANT SGM IMAGING W/MICROSCOPY ENDOTHELIAL ANALY",null,null,null,"93286 - HC PERI-PX EVAL&PROGRAM IN PRSN PACEMAKER SYSTEM"]
[null,null,null,"92611 - MOTION FLUOR EVAL SWLNG FUNCJ C/V REC","92602 - HC REPROGRAM COCHLEAR IMPLT <7","92610 - EVAL ORAL&PHARYNGEAL SWLNG FUNCJ",null,"92546 - SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING",null,null,null,null,"93289 - HC INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB",null,"92287 - ANT SGM IMAGING W/FLUOROSCEIN ANGIO & I&R",null,null,null,"93287 - HC PERI-PX DEV EVAL & PROG SING/DUAL/MULTI LEAD DFB"]
[null,null,null,"92612 - FLX FIBOPT NDSC EVAL SWLNG C/V REC","92603 - HC DX ANAL COCHLEAR IMP,PT >7 YRS,W/PROG","92611 - MOTION FLUOR EVAL SWLNG FUNCJ C/V REC",null,"92550 - TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS",null,null,null,null,"93291 - INTERROGATION EVALUATION IN PERSON ILR SYSTEM",null,"92310 - RX&FITG C-LENS SUPVJ CRNL LENS OU XCPT APHK",null,null,null,"93288 - INTERROGATION EVAL IN PERSON 1/DUAL/MLT LEAD PM"]
[null,null,null,"92616 - FLX FIBOPT NDSC EVAL SWLNG&LARYN SENS C/V REC","92604 - HC DX ANAL COCHLEAR IMP, PT >7 YRS, REPROG","92612 - FLX FIBOPT NDSC EVAL SWLNG C/V REC",null,"92552 - PURE TONE AUDIOMETRY AIR ONLY",null,null,null,null,"93292 - INTERROGATION EVAL IN PERSON WR DEFIBRILLATOR",null,"92311 - HC CONTACT LENS FIT, APHAKIA UNILAT",null,null,null,"93289 - HC INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB"]
[null,null,null,"92620 - EVAL CENTRAL AUDITORY FUNCJ W/REPRT 1ST 60 MIN","92605 - EVAL RX N-SP-GEN AUGMT ALT COMMUN DEV F2F 1ST HR","92616 - FLX FIBOPT NDSC EVAL SWLNG&LARYN SENS C/V REC",null,"92553 - PURE TONE AUDIOMETRY AIR & BONE",null,null,null,null,"93293 - HC TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL",null,"92312 - HC CONTACT LENS FIT,APHAKIA BILAT",null,null,null,"93291 - INTERROGATION EVALUATION IN PERSON ILR SYSTEM"]
[null,null,null,"92621 - EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN","92607 - RX SP-GENRATJ AUGMNT&COMUNICAJ DEV 1ST HR","92620 - EVAL CENTRAL AUDITORY FUNCJ W/REPRT 1ST 60 MIN",null,"92555 - SPEECH AUDIOMETRY THRESHOLD",null,null,null,null,"93294 - INTERROGATION EVAL REMOTE </90 D 1/2/MLT LEAD PM",null,"92313 - HC CONTACT LENS FIT,CORNEOSCLERAL LENS",null,null,null,"93292 - INTERROGATION EVAL IN PERSON WR DEFIBRILLATOR"]
[null,null,null,"92625 - HC TINNITUS ASSESSMENT","92608 - HC EX FOR SPEECH DEVICE RX ADDL","92621 - EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN",null,"92556 - SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ",null,null,null,null,"93295 - INTERROGATION EVAL REMOTE </90 D 1/2/MLT LD ICD",null,"92502 - HC EAR AND THROAT EXAMINATION",null,null,null,"93293 - HC TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL"]
[null,null,null,"92626 - HC EVAL AUDITORY REHAB STATUS, 1ST HOUR","92609 - HC USE OF SPEECH DEVICE SERVICE","92625 - HC TINNITUS ASSESSMENT",null,"92557 - COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ",null,null,null,null,"93296 - HC REM INTERROG EVL PM/IDS",null,"92504 - BINOCULAR MICROSCOPY SEPARATE DX PROCEDURE",null,null,null,"93294 - INTERROGATION EVAL REMOTE </90 D 1/2/MLT LEAD PM"]
[null,null,null,"92627 - HC EVAL AUDITORY REHAB STATUS, EA ADD 15","92610 - EVAL ORAL&PHARYNGEAL SWLNG FUNCJ","92626 - HC EVAL AUDITORY REHAB STATUS, 1ST HOUR",null,"92558 - EVOKED OTOACOUSTIC EMISSIONS SCREEN AUTO ANALYS",null,null,null,null,"93298 - INTERROGATION EVALUATION REMOTE </30 D ILR SYS",null,"92507 - TX SPEECH LANG VOICE COMMJ &/AUDITORY PROC IND",null,null,null,"93295 - INTERROGATION EVAL REMOTE </90 D 1/2/MLT LD ICD"]
[null,null,null,"92920 - HC PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH","92611 - MOTION FLUOR EVAL SWLNG FUNCJ C/V REC","92627 - HC EVAL AUDITORY REHAB STATUS, EA ADD 15",null,"92562 - LOUDNESS BALANCE BINAURAL/MONAURAL",null,null,null,null,"93303 - HC COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY",null,"92508 - TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV",null,null,null,"93296 - HC REM INTERROG EVL PM/IDS"]
[null,null,null,"92921 - HC PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH","92612 - FLX FIBOPT NDSC EVAL SWLNG C/V REC","92920 - HC PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH",null,"92563 - TONE DECAY TEST",null,null,null,null,"93304 - HC F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY",null,"92511 - NASOPHARYNGOSCOPY W/ENDOSCOPE SPX",null,null,null,"93298 - INTERROGATION EVALUATION REMOTE </30 D ILR SYS"]
[null,null,null,"92924 - HC PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH","92616 - FLX FIBOPT NDSC EVAL SWLNG&LARYN SENS C/V REC","92921 - HC PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH",null,"92565 - STENGER TEST PURE TONE",null,null,null,null,"93306 - HC ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D WITH CONTRAST",null,"92520 - LARYNGEAL FUNCTION STUDIES",null,null,null,"93303 - HC COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY"]
[null,null,null,"92925 - HC ATHER MAJOR/BRANCH EA ADD","92620 - EVAL CENTRAL AUDITORY FUNCJ W/REPRT 1ST 60 MIN","92924 - HC PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH",null,"92567 - TYMPANOMETRY",null,null,null,null,"93307 - HC ECHO HEART XTHORACIC,COMPLETE, W/O DOPPLER  WITH CONTRAST",null,"92521 - EVALUATION OF SPEECH FLUENCY (STUTTER CLUTTER)",null,null,null,"93304 - HC F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY"]
[null,null,null,"92928 - HC PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH","92621 - EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN","92925 - HC ATHER MAJOR/BRANCH EA ADD",null,"92568 - ACOUSTIC REFLEX THRESHOLD",null,null,null,null,"93308 - HC ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD WITH CONTRAST",null,"92522 - EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE",null,null,null,"93306 - HC ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D WITH CONTRAST"]
[null,null,null,"92929 - HC PRQ TRLUML CORONARY STENT W/ANGIO ADDL ART/BRNCH","92625 - HC TINNITUS ASSESSMENT","92928 - HC PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH",null,"92570 - HC ACOUSTIC IMMIT TEST TYMPANOMETRY/ACOUST REFLEX/DECAY",null,null,null,null,"93312 - HC ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R  WITH CONTRAST",null,"92523 - EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION",null,null,null,"93307 - HC ECHO HEART XTHORACIC,COMPLETE, W/O DOPPLER  WITH CONTRAST"]
[null,null,null,"92933 - HC PRQ TRLUML CORONRY STENT/ATH/ANGIO ONE ART/BRNCH","92626 - HC EVAL AUDITORY REHAB STATUS, 1ST HOUR","92929 - HC PRQ TRLUML CORONARY STENT W/ANGIO ADDL ART/BRNCH",null,"92571 - FILTERED SPEECH TEST",null,null,null,null,"93313 - HC ECHO R-T 2D W/PROBE PLACEMENT ONLY",null,"92524 - BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE",null,null,null,"93308 - HC ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD WITH CONTRAST"]
[null,null,null,"92934 - HC PRQ TRLUML CORONARY STENT/ATH/ANGIO ADDL BRANCH","92627 - HC EVAL AUDITORY REHAB STATUS, EA ADD 15","92933 - HC PRQ TRLUML CORONRY STENT/ATH/ANGIO ONE ART/BRNCH",null,"92572 - STAGGERED SPONDAIC WORD",null,null,null,null,"93315 - HC ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R WITH CONTRAST",null,"92526 - TX SWALLOWING DYSFUNCTION&/ORAL FUNCJ FEEDING",null,null,null,"93312 - HC ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R  WITH CONTRAST"]
[null,null,null,"92937 - HC PRQ TRLUML CORONARY BYP GRFT REVASC ONE VESSEL","92920 - HC PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH","92934 - HC PRQ TRLUML CORONARY STENT/ATH/ANGIO ADDL BRANCH",null,"92576 - SYNTHETIC SENTENCE IDENTIFICATION TEST",null,null,null,null,"93316 - HC ECHO TRANSESOPHAG CONGEN PROBE PLCMT ONLY",null,"92532 - POSITIONAL NYSTAGMUS TEST",null,null,null,"93313 - HC ECHO R-T 2D W/PROBE PLACEMENT ONLY"]
[null,null,null,"92938 - HC PRQ TRLUML CORONARY BYP GRFT REVASC ADDL VESSEL","92921 - HC PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH","92937 - HC PRQ TRLUML CORONARY BYP GRFT REVASC ONE VESSEL",null,"92577 - STENGER TEST SPEECH",null,null,null,null,"93318 - HC ECHO TRANSEOPHAG MONTR CARDIAC PUMP FUNCTJ",null,"92537 - CALORIC VESTIBULAR WITH RECORDING, BILATERAL; BITHERMAL",null,null,null,"93315 - HC ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R WITH CONTRAST"]
[null,null,null,"92941 - HC PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL","92924 - HC PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH","92938 - HC PRQ TRLUML CORONARY BYP GRFT REVASC ADDL VESSEL",null,"92579 - VISUAL REINFORCEMENT AUDIOMETRY",null,null,null,null,"93320 - HC DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY",null,"92538 - CALORIC VEST BILATERAL MONOTHERMAL",null,null,null,"93316 - HC ECHO TRANSESOPHAG CONGEN PROBE PLCMT ONLY"]
[null,null,null,"92943 - HC PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL","92925 - HC ATHER MAJOR/BRANCH EA ADD","92941 - HC PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL",null,"92582 - CONDITIONING PLAY AUDIOMETRY",null,null,null,null,"93321 - HC DOP ECHOCARD PULSE WAVE W/SPECTRAL F-UP/LMTD STD",null,"92540 - VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRK",null,null,null,"93318 - HC ECHO TRANSEOPHAG MONTR CARDIAC PUMP FUNCTJ"]
[null,null,null,"92944 - PRQ TRLUML CORONRY CHRNIC OCCLUS REVASC ADDL VSL","92928 - HC PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH","92943 - HC PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL",null,"92584 - ELECTROCOCHLEOGRAPY",null,null,null,null,"93325 - DOP ECHOCARD COLOR FLOW VELOCITY MAPPING",null,"92541 - SPONTANEOUS NYSTAGMUS TEST",null,null,null,"93320 - HC DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY"]
[null,null,null,"92950 - CARDIOPULMONARY RESUSCITATION","92929 - HC PRQ TRLUML CORONARY STENT W/ANGIO ADDL ART/BRNCH","92944 - PRQ TRLUML CORONRY CHRNIC OCCLUS REVASC ADDL VSL",null,"92585 - AUDITORY EVOKED POTENTIALS COMPREHENSIVE",null,null,null,null,"93350 - HC ECHO HEART XTHORACIC, STRESS/REST WITH CONTRAST",null,"92542 - POSITIONAL NYSTAGMUS TEST",null,null,null,"93321 - HC DOP ECHOCARD PULSE WAVE W/SPECTRAL F-UP/LMTD STD"]
[null,null,null,"92953 - HC TEMPORARY TRANSCUTANEOUS PACING","92933 - HC PRQ TRLUML CORONRY STENT/ATH/ANGIO ONE ART/BRNCH","92950 - CARDIOPULMONARY RESUSCITATION",null,"92586 - AUDITORY EVOKED POTENTIALS LIMITED",null,null,null,null,"93351 - HC ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG WITH CONTRAST",null,"92544 - OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC",null,null,null,"93325 - DOP ECHOCARD COLOR FLOW VELOCITY MAPPING"]
[null,null,null,"92960 - HC CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL","92934 - HC PRQ TRLUML CORONARY STENT/ATH/ANGIO ADDL BRANCH","92953 - HC TEMPORARY TRANSCUTANEOUS PACING",null,"92587 - DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD",null,null,null,null,"93355 - ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN",null,"92545 - OSCILLATING TRACKING TEST W/RECORDING",null,null,null,"93350 - HC ECHO HEART XTHORACIC, STRESS/REST WITH CONTRAST"]
[null,null,null,"92961 - HC CARDIOVERSION ELECTIVE ARRHYTHMIA INTERNAL SPX","92937 - HC PRQ TRLUML CORONARY BYP GRFT REVASC ONE VESSEL","92960 - HC CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL",null,"92588 - DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL",null,null,null,null,"93356 - HC MYOCRD STRAIN IMG SPCKL TRCK",null,"92546 - SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING",null,null,null,"93351 - HC ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG WITH CONTRAST"]
[null,null,null,"92973 - HC PRQ TRANSLUMINAL CORONARY MECHANICL THROMBECTOMY","92938 - HC PRQ TRLUML CORONARY BYP GRFT REVASC ADDL VESSEL","92961 - HC CARDIOVERSION ELECTIVE ARRHYTHMIA INTERNAL SPX",null,"92590 - HC HEARING AID EXAMINATION & SELECTION MONAURAL",null,null,null,null,"93451 - HC RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT",null,"92550 - TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS",null,null,null,"93355 - ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN"]
[null,null,null,"92977 - HC THROMBOLYSIS,CORONARY,IV INFUSN","92941 - HC PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL","92973 - HC PRQ TRANSLUMINAL CORONARY MECHANICL THROMBECTOMY",null,"92591 - HEARING AID EXAMINATION & SELECTION BINAURAL",null,null,null,null,"93452 - HC L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",null,"92552 - PURE TONE AUDIOMETRY AIR ONLY",null,null,null,"93356 - HC MYOCRD STRAIN IMG SPCKL TRCK"]
[null,null,null,"92978 - HC ENDOLUMINAL CORONARY IVUS OCT I&R INITIAL VESSEL","92943 - HC PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL","92977 - HC THROMBOLYSIS,CORONARY,IV INFUSN",null,"92592 - HEARING AID CHECK MONAURAL",null,null,null,null,"93453 - HC R & L HRT CATH W/NJX L VENTRICULOG IMG S&I",null,"92553 - PURE TONE AUDIOMETRY AIR & BONE",null,null,null,"93451 - HC RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT"]
[null,null,null,"92979 - HC ENDOLUMINAL CORONARY IVUS OCT I&R ADDK VESSEL","92944 - PRQ TRLUML CORONRY CHRNIC OCCLUS REVASC ADDL VSL","92978 - HC ENDOLUMINAL CORONARY IVUS OCT I&R INITIAL VESSEL",null,"92593 - HEARING AID CHECK BINAURAL",null,null,null,null,"93454 - HC CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I",null,"92555 - SPEECH AUDIOMETRY THRESHOLD",null,null,null,"93452 - HC L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
[null,null,null,"92986 - HC PRQ BALLOON VALVULOPLASTY AORTIC VALVE","92950 - CARDIOPULMONARY RESUSCITATION","92979 - HC ENDOLUMINAL CORONARY IVUS OCT I&R ADDK VESSEL",null,"92594 - ELECTROACOUS EVAL HEARING AID MONAURAL",null,null,null,null,"93455 - HC CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I",null,"92556 - SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ",null,null,null,"93453 - HC R & L HRT CATH W/NJX L VENTRICULOG IMG S&I"]
[null,null,null,"92987 - HC PRQ BALLOON VALVULOPLASTY MITRAL VALVE","92953 - HC TEMPORARY TRANSCUTANEOUS PACING","92986 - HC PRQ BALLOON VALVULOPLASTY AORTIC VALVE",null,"92595 - ELECTROACOUS EVAL HEARING AID BINAURAL",null,null,null,null,"93456 - HC CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I",null,"92557 - COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ",null,null,null,"93454 - HC CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I"]
[null,null,null,"92990 - PRQ BALLOON VALVULOPLASTY PULMONARY VALVE","92960 - HC CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL","92987 - HC PRQ BALLOON VALVULOPLASTY MITRAL VALVE",null,"92597 - EVAL&/FITG VOICE PROSTC DEV SUPLMNT ORAL SPEEC",null,null,null,null,"93457 - HC CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I",null,"92558 - EVOKED OTOACOUSTIC EMISSIONS SCREEN AUTO ANALYS",null,null,null,"93455 - HC CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I"]
[null,null,null,"93005 - ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R","92961 - HC CARDIOVERSION ELECTIVE ARRHYTHMIA INTERNAL SPX","92990 - PRQ BALLOON VALVULOPLASTY PULMONARY VALVE",null,"92601 - HC DX ANAL COCHLEAR IMP,PT <7 YRS,W/PROG",null,null,null,null,"93458 - HC CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I",null,"92562 - LOUDNESS BALANCE BINAURAL/MONAURAL",null,null,null,"93456 - HC CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I"]
[null,null,null,"93017 - HC CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY","92973 - HC PRQ TRANSLUMINAL CORONARY MECHANICL THROMBECTOMY","93005 - ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R",null,"92602 - HC REPROGRAM COCHLEAR IMPLT <7",null,null,null,null,"93459 - HC CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I",null,"92563 - TONE DECAY TEST",null,null,null,"93457 - HC CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I"]
[null,null,null,"93225 - HC XTRNL ECG & 48 HR RECORDING","92977 - HC THROMBOLYSIS,CORONARY,IV INFUSN","93017 - HC CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY",null,"92603 - HC DX ANAL COCHLEAR IMP,PT >7 YRS,W/PROG",null,null,null,null,"93460 - HC R & L HRT CATH WINJX HRT ART& L VENTR IMG",null,"92565 - STENGER TEST PURE TONE",null,null,null,"93458 - HC CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I"]
[null,null,null,"93226 - EXTERNAL ECG SCANNING ANALYSIS REPORT","92978 - HC ENDOLUMINAL CORONARY IVUS OCT I&R INITIAL VESSEL","93225 - HC XTRNL ECG & 48 HR RECORDING",null,"92604 - HC DX ANAL COCHLEAR IMP, PT >7 YRS, REPROG",null,null,null,null,"93461 - HC R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I",null,"92567 - TYMPANOMETRY",null,null,null,"93459 - HC CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I"]
[null,null,null,"93260 - HC PRGRMG DEV EVAL IMPLANTABLE SUBQ LEAD DFB SYSTEM","92979 - HC ENDOLUMINAL CORONARY IVUS OCT I&R ADDK VESSEL","93226 - EXTERNAL ECG SCANNING ANALYSIS REPORT",null,"92605 - EVAL RX N-SP-GEN AUGMT ALT COMMUN DEV F2F 1ST HR",null,null,null,null,"93462 - HC LEFT HEART CATH BY TRANSEPTAL PUNCTURE",null,"92568 - ACOUSTIC REFLEX THRESHOLD",null,null,null,"93460 - HC R & L HRT CATH WINJX HRT ART& L VENTR IMG"]
[null,null,null,"93270 - XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS","92986 - HC PRQ BALLOON VALVULOPLASTY AORTIC VALVE","93260 - HC PRGRMG DEV EVAL IMPLANTABLE SUBQ LEAD DFB SYSTEM",null,"92607 - RX SP-GENRATJ AUGMNT&COMUNICAJ DEV 1ST HR",null,null,null,null,"93463 - HC DRUG ADMIN & HEMODYNMIC MEAS",null,"92570 - HC ACOUSTIC IMMIT TEST TYMPANOMETRY/ACOUST REFLEX/DECAY",null,null,null,"93461 - HC R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I"]
[null,null,null,"93271 - HC EXT ECG,PT DEMAND EVENT, SYMPT MEMORY LOOP, TRANSMIT","92987 - HC PRQ BALLOON VALVULOPLASTY MITRAL VALVE","93270 - XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS",null,"92609 - HC USE OF SPEECH DEVICE SERVICE",null,null,null,null,"93464 - HC PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU",null,"92571 - FILTERED SPEECH TEST",null,null,null,"93462 - HC LEFT HEART CATH BY TRANSEPTAL PUNCTURE"]
[null,null,null,"93278 - SIGNAL AVERAGED ELECTROCARDIOGRAPHY W/WO ECG","92990 - PRQ BALLOON VALVULOPLASTY PULMONARY VALVE","93271 - HC EXT ECG,PT DEMAND EVENT, SYMPT MEMORY LOOP, TRANSMIT",null,"92610 - EVAL ORAL&PHARYNGEAL SWLNG FUNCJ",null,null,null,null,"93503 - HC INSERTION FLOW DIRECTED CATHETER FOR MONITORING",null,"92572 - STAGGERED SPONDAIC WORD",null,null,null,"93463 - HC DRUG ADMIN & HEMODYNMIC MEAS"]
[null,null,null,"93279 - PROGRAM EVAL IMPLANTABLE IN PRSN 1 LD PACEMAKER","93005 - ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R","93278 - SIGNAL AVERAGED ELECTROCARDIOGRAPHY W/WO ECG",null,"92611 - MOTION FLUOR EVAL SWLNG FUNCJ C/V REC",null,null,null,null,"93505 - HC ENDOMYOCARDIAL BIOPSY",null,"92576 - SYNTHETIC SENTENCE IDENTIFICATION TEST",null,null,null,"93464 - HC PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU"]
[null,null,null,"93280 - PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER","93017 - HC CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY","93279 - PROGRAM EVAL IMPLANTABLE IN PRSN 1 LD PACEMAKER",null,"92612 - FLX FIBOPT NDSC EVAL SWLNG C/V REC",null,null,null,null,"93530 - RHC CNGNITL ANMLES",null,"92577 - STENGER TEST SPEECH",null,null,null,"93503 - HC INSERTION FLOW DIRECTED CATHETER FOR MONITORING"]
[null,null,null,"93281 - PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER","93225 - HC XTRNL ECG & 48 HR RECORDING","93280 - PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER",null,"92616 - FLX FIBOPT NDSC EVAL SWLNG&LARYN SENS C/V REC",null,null,null,null,"93531 - RHC/LHC CNGNITL ANMLES",null,"92579 - VISUAL REINFORCEMENT AUDIOMETRY",null,null,null,"93505 - HC ENDOMYOCARDIAL BIOPSY"]
[null,null,null,"93282 - PROGRAM EVAL IMPLANTABLE IN PERSN 1 LD CARD/DFB","93226 - EXTERNAL ECG SCANNING ANALYSIS REPORT","93281 - PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER",null,"92620 - EVAL CENTRAL AUDITORY FUNCJ W/REPRT 1ST 60 MIN",null,null,null,null,"93533 - CMBN R HRT T-SEPTAL L HRT CATHJ SEPTAL OPNG CGEN",null,"92582 - CONDITIONING PLAY AUDIOMETRY",null,null,null,"93530 - RHC CNGNITL ANMLES"]
[null,null,null,"93283 - PROGRM EVAL IMPLANTABLE IN PRSN DUAL L CARD/DFB","93260 - HC PRGRMG DEV EVAL IMPLANTABLE SUBQ LEAD DFB SYSTEM","93282 - PROGRAM EVAL IMPLANTABLE IN PERSN 1 LD CARD/DFB",null,"92621 - EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN",null,null,null,null,"93563 - HC NJX SEL HRT ART CONGENITAL HRT CATH W/S&I",null,"92584 - ELECTROCOCHLEOGRAPY",null,null,null,"93531 - RHC/LHC CNGNITL ANMLES"]
[null,null,null,"93284 - PROGRM EVAL IMPLANTABLE IN PRSN MLT LD CARD/DFB","93270 - XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS","93283 - PROGRM EVAL IMPLANTABLE IN PRSN DUAL L CARD/DFB",null,"92625 - HC TINNITUS ASSESSMENT",null,null,null,null,"93565 - HC NJX SEL L VENT/ATRIAL ANGIO HRT CATH W/S&I",null,"92585 - AUDITORY EVOKED POTENTIALS COMPREHENSIVE",null,null,null,"93533 - CMBN R HRT T-SEPTAL L HRT CATHJ SEPTAL OPNG CGEN"]
[null,null,null,"93285 - PROGRAM EVAL IMPLANTABLE DEV IN PRSN ILR SYSTEM","93271 - HC EXT ECG,PT DEMAND EVENT, SYMPT MEMORY LOOP, TRANSMIT","93284 - PROGRM EVAL IMPLANTABLE IN PRSN MLT LD CARD/DFB",null,"92626 - HC EVAL AUDITORY REHAB STATUS, 1ST HOUR",null,null,null,null,"93566 - HC NJX SEL R VENT/ATRIAL ANGIO HRT CATH W/S&I",null,"92586 - AUDITORY EVOKED POTENTIALS LIMITED",null,null,null,"93563 - HC NJX SEL HRT ART CONGENITAL HRT CATH W/S&I"]
[null,null,null,"93286 - HC PERI-PX EVAL&PROGRAM IN PRSN PACEMAKER SYSTEM","93278 - SIGNAL AVERAGED ELECTROCARDIOGRAPHY W/WO ECG","93285 - PROGRAM EVAL IMPLANTABLE DEV IN PRSN ILR SYSTEM",null,"92627 - HC EVAL AUDITORY REHAB STATUS, EA ADD 15",null,null,null,null,"93567 - HC NJX SUPRAVALV AORTOG HRT CATH W/S&I",null,"92587 - DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD",null,null,null,"93565 - HC NJX SEL L VENT/ATRIAL ANGIO HRT CATH W/S&I"]
[null,null,null,"93287 - HC PERI-PX DEV EVAL & PROG SING/DUAL/MULTI LEAD DFB","93279 - PROGRAM EVAL IMPLANTABLE IN PRSN 1 LD PACEMAKER","93286 - HC PERI-PX EVAL&PROGRAM IN PRSN PACEMAKER SYSTEM",null,"92630 - HC AUD REHA PRELING HEARLOSS",null,null,null,null,"93568 - HC NJX PULMONARY ANGIO HRT CATH W/S&I",null,"92588 - DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL",null,null,null,"93566 - HC NJX SEL R VENT/ATRIAL ANGIO HRT CATH W/S&I"]
[null,null,null,"93288 - INTERROGATION EVAL IN PERSON 1/DUAL/MLT LEAD PM","93280 - PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER","93287 - HC PERI-PX DEV EVAL & PROG SING/DUAL/MULTI LEAD DFB",null,"92633 - HC AUD REH POSTLING HEARLOSS",null,null,null,null,"93571 - HC IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL",null,"92590 - HC HEARING AID EXAMINATION & SELECTION MONAURAL",null,null,null,"93567 - HC NJX SUPRAVALV AORTOG HRT CATH W/S&I"]
[null,null,null,"93289 - HC INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB","93281 - PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER","93288 - INTERROGATION EVAL IN PERSON 1/DUAL/MLT LEAD PM",null,"92700 - UNLISTED OTORHINOLARYNGOLOGICAL SERVICE",null,null,null,null,"93572 - HC IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL",null,"92591 - HEARING AID EXAMINATION & SELECTION BINAURAL",null,null,null,"93568 - HC NJX PULMONARY ANGIO HRT CATH W/S&I"]
[null,null,null,"93291 - INTERROGATION EVALUATION IN PERSON ILR SYSTEM","93282 - PROGRAM EVAL IMPLANTABLE IN PERSN 1 LD CARD/DFB","93289 - HC INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB",null,"92920 - HC PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH",null,null,null,null,"93580 - PRQ TCAT CLSR CGEN INTRATRL COMUNICAJ W/IMPLT",null,"92592 - HEARING AID CHECK MONAURAL",null,null,null,"93571 - HC IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL"]
[null,null,null,"93292 - INTERROGATION EVAL IN PERSON WR DEFIBRILLATOR","93283 - PROGRM EVAL IMPLANTABLE IN PRSN DUAL L CARD/DFB","93291 - INTERROGATION EVALUATION IN PERSON ILR SYSTEM",null,"92921 - HC PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH",null,null,null,null,"93582 - HC PERCUTAN TRANSCATH CLOSURE PAT DUCT ARTERIOSUS",null,"92593 - HEARING AID CHECK BINAURAL",null,null,null,"93572 - HC IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL"]
[null,null,null,"93293 - HC TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL","93284 - PROGRM EVAL IMPLANTABLE IN PRSN MLT LD CARD/DFB","93292 - INTERROGATION EVAL IN PERSON WR DEFIBRILLATOR",null,"92924 - HC PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH",null,null,null,null,"93590 - HC PERQ TRANSCATH CLS PARAVALVR LEAK 1 MITRAL VALVE",null,"92594 - ELECTROACOUS EVAL HEARING AID MONAURAL",null,null,null,"93580 - PRQ TCAT CLSR CGEN INTRATRL COMUNICAJ W/IMPLT"]
[null,null,null,"93294 - INTERROGATION EVAL REMOTE </90 D 1/2/MLT LEAD PM","93285 - PROGRAM EVAL IMPLANTABLE DEV IN PRSN ILR SYSTEM","93293 - HC TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL",null,"92925 - HC ATHER MAJOR/BRANCH EA ADD",null,null,null,null,"93591 - HC PERQ TRANSCATH CLS PARAVALVR LEAK 1 AORTIC VALVE",null,"92595 - ELECTROACOUS EVAL HEARING AID BINAURAL",null,null,null,"93582 - HC PERCUTAN TRANSCATH CLOSURE PAT DUCT ARTERIOSUS"]
[null,null,null,"93295 - INTERROGATION EVAL REMOTE </90 D 1/2/MLT LD ICD","93286 - HC PERI-PX EVAL&PROGRAM IN PRSN PACEMAKER SYSTEM","93294 - INTERROGATION EVAL REMOTE </90 D 1/2/MLT LEAD PM",null,"92928 - HC PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH",null,null,null,null,"93592 - HC PERQ TRANSCATH CLS PARAVALVR LEAK EACH OCCLS DEV",null,"92597 - EVAL&/FITG VOICE PROSTC DEV SUPLMNT ORAL SPEEC",null,null,null,"93590 - HC PERQ TRANSCATH CLS PARAVALVR LEAK 1 MITRAL VALVE"]
[null,null,null,"93296 - HC REM INTERROG EVL PM/IDS","93287 - HC PERI-PX DEV EVAL & PROG SING/DUAL/MULTI LEAD DFB","93295 - INTERROGATION EVAL REMOTE </90 D 1/2/MLT LD ICD",null,"92929 - HC PRQ TRLUML CORONARY STENT W/ANGIO ADDL ART/BRNCH",null,null,null,null,"93609 - HC INTRA-VENTRIC&/ATRIAL MAPG TACHYCARD W/CATH MA",null,"92601 - HC DX ANAL COCHLEAR IMP,PT <7 YRS,W/PROG",null,null,null,"93591 - HC PERQ TRANSCATH CLS PARAVALVR LEAK 1 AORTIC VALVE"]
[null,null,null,"93298 - INTERROGATION EVALUATION REMOTE </30 D ILR SYS","93288 - INTERROGATION EVAL IN PERSON 1/DUAL/MLT LEAD PM","93296 - HC REM INTERROG EVL PM/IDS",null,"92933 - HC PRQ TRLUML CORONRY STENT/ATH/ANGIO ONE ART/BRNCH",null,null,null,null,"93610 - HC INTRA-ATRIAL PACING",null,"92602 - HC REPROGRAM COCHLEAR IMPLT <7",null,null,null,"93592 - HC PERQ TRANSCATH CLS PARAVALVR LEAK EACH OCCLS DEV"]
[null,null,null,"93303 - HC COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY","93289 - HC INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB","93298 - INTERROGATION EVALUATION REMOTE </30 D ILR SYS",null,"92934 - HC PRQ TRLUML CORONARY STENT/ATH/ANGIO ADDL BRANCH",null,null,null,null,"93613 - HC INTRACARDIAC ELECTROPHYSIOLOGIC 3D MAPPING",null,"92603 - HC DX ANAL COCHLEAR IMP,PT >7 YRS,W/PROG",null,null,null,"93609 - HC INTRA-VENTRIC&/ATRIAL MAPG TACHYCARD W/CATH MA"]
[null,null,null,"93304 - HC F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY","93291 - INTERROGATION EVALUATION IN PERSON ILR SYSTEM","93303 - HC COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY",null,"92937 - HC PRQ TRLUML CORONARY BYP GRFT REVASC ONE VESSEL",null,null,null,null,"93619 - HC COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION",null,"92604 - HC DX ANAL COCHLEAR IMP, PT >7 YRS, REPROG",null,null,null,"93610 - HC INTRA-ATRIAL PACING"]
[null,null,null,"93306 - HC ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D WITH CONTRAST","93292 - INTERROGATION EVAL IN PERSON WR DEFIBRILLATOR","93304 - HC F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY",null,"92938 - HC PRQ TRLUML CORONARY BYP GRFT REVASC ADDL VESSEL",null,null,null,null,"93620 - HC COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION",null,"92605 - EVAL RX N-SP-GEN AUGMT ALT COMMUN DEV F2F 1ST HR",null,null,null,"93613 - HC INTRACARDIAC ELECTROPHYSIOLOGIC 3D MAPPING"]
[null,null,null,"93307 - HC ECHO HEART XTHORACIC,COMPLETE, W/O DOPPLER  WITH CONTRAST","93293 - HC TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL","93306 - HC ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D WITH CONTRAST",null,"92941 - HC PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL",null,null,null,null,"93621 - HC COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC",null,"92607 - RX SP-GENRATJ AUGMNT&COMUNICAJ DEV 1ST HR",null,null,null,"93619 - HC COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION"]
[null,null,null,"93308 - HC ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD WITH CONTRAST","93294 - INTERROGATION EVAL REMOTE </90 D 1/2/MLT LEAD PM","93307 - HC ECHO HEART XTHORACIC,COMPLETE, W/O DOPPLER  WITH CONTRAST",null,"92943 - HC PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL",null,null,null,null,"93622 - HC COMPRE ELECTROPHYSIOL XM W/LEFT VENTR PACNG/REC",null,"92609 - HC USE OF SPEECH DEVICE SERVICE",null,null,null,"93620 - HC COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION"]
[null,null,null,"93312 - HC ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R  WITH CONTRAST","93295 - INTERROGATION EVAL REMOTE </90 D 1/2/MLT LD ICD","93308 - HC ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD WITH CONTRAST",null,"92944 - PRQ TRLUML CORONRY CHRNIC OCCLUS REVASC ADDL VSL",null,null,null,null,"93623 - HC PROGRAMMED STIMJ & PACG AFTER IV DRUG NFS",null,"92610 - EVAL ORAL&PHARYNGEAL SWLNG FUNCJ",null,null,null,"93621 - HC COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC"]
[null,null,null,"93313 - HC ECHO R-T 2D W/PROBE PLACEMENT ONLY","93296 - HC REM INTERROG EVL PM/IDS","93312 - HC ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R  WITH CONTRAST",null,"92950 - CARDIOPULMONARY RESUSCITATION",null,null,null,null,"93641 - HC EPHYS EVAL PACG CVDFB LDS W/TSTG OF PULSE GEN",null,"92611 - MOTION FLUOR EVAL SWLNG FUNCJ C/V REC",null,null,null,"93622 - HC COMPRE ELECTROPHYSIOL XM W/LEFT VENTR PACNG/REC"]
[null,null,null,"93315 - HC ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R WITH CONTRAST","93298 - INTERROGATION EVALUATION REMOTE </30 D ILR SYS","93313 - HC ECHO R-T 2D W/PROBE PLACEMENT ONLY",null,"92953 - HC TEMPORARY TRANSCUTANEOUS PACING",null,null,null,null,"93642 - HC EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS",null,"92612 - FLX FIBOPT NDSC EVAL SWLNG C/V REC",null,null,null,"93623 - HC PROGRAMMED STIMJ & PACG AFTER IV DRUG NFS"]
[null,null,null,"93316 - HC ECHO TRANSESOPHAG CONGEN PROBE PLCMT ONLY","93303 - HC COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY","93315 - HC ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R WITH CONTRAST",null,"92960 - HC CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL",null,null,null,null,"93644 - HC EPHYS EVAL SUBQ IMPLANTABLE DEFIBRILLATOR",null,"92616 - FLX FIBOPT NDSC EVAL SWLNG&LARYN SENS C/V REC",null,null,null,"93641 - HC EPHYS EVAL PACG CVDFB LDS W/TSTG OF PULSE GEN"]
[null,null,null,"93318 - HC ECHO TRANSEOPHAG MONTR CARDIAC PUMP FUNCTJ","93304 - HC F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY","93316 - HC ECHO TRANSESOPHAG CONGEN PROBE PLCMT ONLY",null,"92961 - HC CARDIOVERSION ELECTIVE ARRHYTHMIA INTERNAL SPX",null,null,null,null,"93650 - HC ICAR CATHETER ABLATION ATRIOVENTR NODE FUNCTION",null,"92620 - EVAL CENTRAL AUDITORY FUNCJ W/REPRT 1ST 60 MIN",null,null,null,"93642 - HC EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS"]
[null,null,null,"93320 - HC DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY","93306 - HC ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D WITH CONTRAST","93318 - HC ECHO TRANSEOPHAG MONTR CARDIAC PUMP FUNCTJ",null,"92973 - HC PRQ TRANSLUMINAL CORONARY MECHANICL THROMBECTOMY",null,null,null,null,"93653 - HC COMPRE EP EVAL TX SVT",null,"92621 - EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN",null,null,null,"93644 - HC EPHYS EVAL SUBQ IMPLANTABLE DEFIBRILLATOR"]
[null,null,null,"93321 - HC DOP ECHOCARD PULSE WAVE W/SPECTRAL F-UP/LMTD STD","93307 - HC ECHO HEART XTHORACIC,COMPLETE, W/O DOPPLER  WITH CONTRAST","93320 - HC DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY",null,"92977 - HC THROMBOLYSIS,CORONARY,IV INFUSN",null,null,null,null,"93654 - HC COMPRE EP EVAL TX VT",null,"92625 - HC TINNITUS ASSESSMENT",null,null,null,"93650 - HC ICAR CATHETER ABLATION ATRIOVENTR NODE FUNCTION"]
[null,null,null,"93325 - DOP ECHOCARD COLOR FLOW VELOCITY MAPPING","93308 - HC ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD WITH CONTRAST","93321 - HC DOP ECHOCARD PULSE WAVE W/SPECTRAL F-UP/LMTD STD",null,"92978 - HC ENDOLUMINAL CORONARY IVUS OCT I&R INITIAL VESSEL",null,null,null,null,"93655 - HC ICAR CATHETER ABLATION ARRHYTHMIA ADD ON",null,"92626 - HC EVAL AUDITORY REHAB STATUS, 1ST HOUR",null,null,null,"93653 - HC COMPRE EP EVAL TX SVT"]
[null,null,null,"93350 - HC ECHO HEART XTHORACIC, STRESS/REST WITH CONTRAST","93312 - HC ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R  WITH CONTRAST","93325 - DOP ECHOCARD COLOR FLOW VELOCITY MAPPING",null,"92979 - HC ENDOLUMINAL CORONARY IVUS OCT I&R ADDK VESSEL",null,null,null,null,"93656 - HC COMPRE EP EVAL ABLTJ ATR FIB",null,"92627 - HC EVAL AUDITORY REHAB STATUS, EA ADD 15",null,null,null,"93654 - HC COMPRE EP EVAL TX VT"]
[null,null,null,"93351 - HC ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG WITH CONTRAST","93313 - HC ECHO R-T 2D W/PROBE PLACEMENT ONLY","93350 - HC ECHO HEART XTHORACIC, STRESS/REST WITH CONTRAST",null,"92986 - HC PRQ BALLOON VALVULOPLASTY AORTIC VALVE",null,null,null,null,"93657 - HC ABLATE L/R ATRIAL FIBRIL W/ISOLATED PULM VEIN",null,"92630 - HC AUD REHA PRELING HEARLOSS",null,null,null,"93655 - HC ICAR CATHETER ABLATION ARRHYTHMIA ADD ON"]
[null,null,null,"93355 - ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN","93315 - HC ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R WITH CONTRAST","93351 - HC ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG WITH CONTRAST",null,"92987 - HC PRQ BALLOON VALVULOPLASTY MITRAL VALVE",null,null,null,null,"93660 - CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR",null,"92633 - HC AUD REH POSTLING HEARLOSS",null,null,null,"93656 - HC COMPRE EP EVAL ABLTJ ATR FIB"]
[null,null,null,"93451 - HC RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT","93316 - HC ECHO TRANSESOPHAG CONGEN PROBE PLCMT ONLY","93355 - ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN",null,"92990 - PRQ BALLOON VALVULOPLASTY PULMONARY VALVE",null,null,null,null,"93662 - INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I",null,"92700 - UNLISTED OTORHINOLARYNGOLOGICAL SERVICE",null,null,null,"93657 - HC ABLATE L/R ATRIAL FIBRIL W/ISOLATED PULM VEIN"]
[null,null,null,"93452 - HC L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93318 - HC ECHO TRANSEOPHAG MONTR CARDIAC PUMP FUNCTJ","93451 - HC RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT",null,"93005 - ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R",null,null,null,null,"93724 - ANALYZE PACEMAKER SYSTEM",null,"92920 - HC PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH",null,null,null,"93660 - CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR"]
[null,null,null,"93453 - HC R & L HRT CATH W/NJX L VENTRICULOG IMG S&I","93320 - HC DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY","93452 - HC L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",null,"93017 - HC CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY",null,null,null,null,"93750 - HC INTERROGATION VAD IN PERSON",null,"92921 - HC PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH",null,null,null,"93662 - INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I"]
[null,null,null,"93454 - HC CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I","93321 - HC DOP ECHOCARD PULSE WAVE W/SPECTRAL F-UP/LMTD STD","93453 - HC R & L HRT CATH W/NJX L VENTRICULOG IMG S&I",null,"93225 - HC XTRNL ECG & 48 HR RECORDING",null,null,null,null,"93786 - BL BLD PRESS W/TAPE&/DISK 24/> HR REC ONL",null,"92924 - HC PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH",null,null,null,"93724 - ANALYZE PACEMAKER SYSTEM"]
[null,null,null,"93455 - HC CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I","93325 - DOP ECHOCARD COLOR FLOW VELOCITY MAPPING","93454 - HC CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I",null,"93226 - EXTERNAL ECG SCANNING ANALYSIS REPORT",null,null,null,null,"93788 - AMBL BLD PRESS W/TAPE/DISK 24/>HR ALYS W/REPRT",null,"92925 - HC ATHER MAJOR/BRANCH EA ADD",null,null,null,"93750 - HC INTERROGATION VAD IN PERSON"]
[null,null,null,"93456 - HC CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I","93350 - HC ECHO HEART XTHORACIC, STRESS/REST WITH CONTRAST","93455 - HC CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I",null,"93260 - HC PRGRMG DEV EVAL IMPLANTABLE SUBQ LEAD DFB SYSTEM",null,null,null,null,"93797 - SP CARD REHAB MAINTAIN",null,"92928 - HC PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH",null,null,null,"93786 - BL BLD PRESS W/TAPE&/DISK 24/> HR REC ONL"]
[null,null,null,"93457 - HC CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I","93351 - HC ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG WITH CONTRAST","93456 - HC CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I",null,"93270 - XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS",null,null,null,null,"93798 - OUTPATIENT CARDIAC REHAB W/CONT ECG MONITORING",null,"92929 - HC PRQ TRLUML CORONARY STENT W/ANGIO ADDL ART/BRNCH",null,null,null,"93788 - AMBL BLD PRESS W/TAPE/DISK 24/>HR ALYS W/REPRT"]
[null,null,null,"93458 - HC CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I","93355 - ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN","93457 - HC CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I",null,"93271 - HC EXT ECG,PT DEMAND EVENT, SYMPT MEMORY LOOP, TRANSMIT",null,null,null,null,"93880 - HC DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY",null,"92933 - HC PRQ TRLUML CORONRY STENT/ATH/ANGIO ONE ART/BRNCH",null,null,null,"93797 - SP CARD REHAB MAINTAIN"]
[null,null,null,"93459 - HC CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I","93451 - HC RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT","93458 - HC CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I",null,"93278 - SIGNAL AVERAGED ELECTROCARDIOGRAPHY W/WO ECG",null,null,null,null,"93882 - HC DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY",null,"92934 - HC PRQ TRLUML CORONARY STENT/ATH/ANGIO ADDL BRANCH",null,null,null,"93798 - OUTPATIENT CARDIAC REHAB W/CONT ECG MONITORING"]
[null,null,null,"93460 - HC R & L HRT CATH WINJX HRT ART& L VENTR IMG","93452 - HC L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93459 - HC CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I",null,"93279 - PROGRAM EVAL IMPLANTABLE IN PRSN 1 LD PACEMAKER",null,null,null,null,"93886 - TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL",null,"92937 - HC PRQ TRLUML CORONARY BYP GRFT REVASC ONE VESSEL",null,null,null,"93880 - HC DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY"]
[null,null,null,"93461 - HC R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I","93453 - HC R & L HRT CATH W/NJX L VENTRICULOG IMG S&I","93460 - HC R & L HRT CATH WINJX HRT ART& L VENTR IMG",null,"93280 - PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER",null,null,null,null,"93888 - TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD",null,"92938 - HC PRQ TRLUML CORONARY BYP GRFT REVASC ADDL VESSEL",null,null,null,"93882 - HC DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY"]
[null,null,null,"93462 - HC LEFT HEART CATH BY TRANSEPTAL PUNCTURE","93454 - HC CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I","93461 - HC R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I",null,"93281 - PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER",null,null,null,null,"93890 - TRANSCRANIAL DOPPLER INTRACRAN ART VASOREAC STDY",null,"92941 - HC PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL",null,null,null,"93886 - TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL"]
[null,null,null,"93463 - HC DRUG ADMIN & HEMODYNMIC MEAS","93455 - HC CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I","93462 - HC LEFT HEART CATH BY TRANSEPTAL PUNCTURE",null,"93282 - PROGRAM EVAL IMPLANTABLE IN PERSN 1 LD CARD/DFB",null,null,null,null,"93892 - HC TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT",null,"92943 - HC PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL",null,null,null,"93888 - TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD"]
[null,null,null,"93464 - HC PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU","93456 - HC CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I","93463 - HC DRUG ADMIN & HEMODYNMIC MEAS",null,"93283 - PROGRM EVAL IMPLANTABLE IN PRSN DUAL L CARD/DFB",null,null,null,null,"93893 - HC TRANSCRAN DOPP INTRACRAN, EMBOLI W/INJ",null,"92944 - PRQ TRLUML CORONRY CHRNIC OCCLUS REVASC ADDL VSL",null,null,null,"93890 - TRANSCRANIAL DOPPLER INTRACRAN ART VASOREAC STDY"]
[null,null,null,"93503 - HC INSERTION FLOW DIRECTED CATHETER FOR MONITORING","93457 - HC CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I","93464 - HC PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU",null,"93284 - PROGRM EVAL IMPLANTABLE IN PRSN MLT LD CARD/DFB",null,null,null,null,"93895 - HC CAROTID INTIMA MEDIA & CAROTID ATHEROMA EVAL BI",null,"92950 - CARDIOPULMONARY RESUSCITATION",null,null,null,"93892 - HC TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT"]
[null,null,null,"93505 - HC ENDOMYOCARDIAL BIOPSY","93458 - HC CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I","93503 - HC INSERTION FLOW DIRECTED CATHETER FOR MONITORING",null,"93285 - PROGRAM EVAL IMPLANTABLE DEV IN PRSN ILR SYSTEM",null,null,null,null,"93922 - NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL",null,"92953 - HC TEMPORARY TRANSCUTANEOUS PACING",null,null,null,"93893 - HC TRANSCRAN DOPP INTRACRAN, EMBOLI W/INJ"]
[null,null,null,"93530 - RHC CNGNITL ANMLES","93459 - HC CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I","93505 - HC ENDOMYOCARDIAL BIOPSY",null,"93286 - HC PERI-PX EVAL&PROGRAM IN PRSN PACEMAKER SYSTEM",null,null,null,null,"93923 - NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS",null,"92960 - HC CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL",null,null,null,"93895 - HC CAROTID INTIMA MEDIA & CAROTID ATHEROMA EVAL BI"]
[null,null,null,"93531 - RHC/LHC CNGNITL ANMLES","93460 - HC R & L HRT CATH WINJX HRT ART& L VENTR IMG","93530 - RHC CNGNITL ANMLES",null,"93287 - HC PERI-PX DEV EVAL & PROG SING/DUAL/MULTI LEAD DFB",null,null,null,null,"93924 - HC N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI",null,"92961 - HC CARDIOVERSION ELECTIVE ARRHYTHMIA INTERNAL SPX",null,null,null,"93922 - NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL"]
[null,null,null,"93533 - CMBN R HRT T-SEPTAL L HRT CATHJ SEPTAL OPNG CGEN","93461 - HC R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I","93531 - RHC/LHC CNGNITL ANMLES",null,"93288 - INTERROGATION EVAL IN PERSON 1/DUAL/MLT LEAD PM",null,null,null,null,"93925 - HC DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY",null,"92973 - HC PRQ TRANSLUMINAL CORONARY MECHANICL THROMBECTOMY",null,null,null,"93923 - NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS"]
[null,null,null,"93563 - HC NJX SEL HRT ART CONGENITAL HRT CATH W/S&I","93462 - HC LEFT HEART CATH BY TRANSEPTAL PUNCTURE","93533 - CMBN R HRT T-SEPTAL L HRT CATHJ SEPTAL OPNG CGEN",null,"93289 - HC INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB",null,null,null,null,"93926 - HC DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY",null,"92977 - HC THROMBOLYSIS,CORONARY,IV INFUSN",null,null,null,"93924 - HC N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI"]
[null,null,null,"93565 - HC NJX SEL L VENT/ATRIAL ANGIO HRT CATH W/S&I","93463 - HC DRUG ADMIN & HEMODYNMIC MEAS","93563 - HC NJX SEL HRT ART CONGENITAL HRT CATH W/S&I",null,"93291 - INTERROGATION EVALUATION IN PERSON ILR SYSTEM",null,null,null,null,"93930 - HC DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY",null,"92978 - HC ENDOLUMINAL CORONARY IVUS OCT I&R INITIAL VESSEL",null,null,null,"93925 - HC DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY"]
[null,null,null,"93566 - HC NJX SEL R VENT/ATRIAL ANGIO HRT CATH W/S&I","93464 - HC PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU","93565 - HC NJX SEL L VENT/ATRIAL ANGIO HRT CATH W/S&I",null,"93292 - INTERROGATION EVAL IN PERSON WR DEFIBRILLATOR",null,null,null,null,"93931 - DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY",null,"92979 - HC ENDOLUMINAL CORONARY IVUS OCT I&R ADDK VESSEL",null,null,null,"93926 - HC DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY"]
[null,null,null,"93567 - HC NJX SUPRAVALV AORTOG HRT CATH W/S&I","93503 - HC INSERTION FLOW DIRECTED CATHETER FOR MONITORING","93566 - HC NJX SEL R VENT/ATRIAL ANGIO HRT CATH W/S&I",null,"93293 - HC TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL",null,null,null,null,"93970 - HC DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY",null,"92986 - HC PRQ BALLOON VALVULOPLASTY AORTIC VALVE",null,null,null,"93930 - HC DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY"]
[null,null,null,"93568 - HC NJX PULMONARY ANGIO HRT CATH W/S&I","93505 - HC ENDOMYOCARDIAL BIOPSY","93567 - HC NJX SUPRAVALV AORTOG HRT CATH W/S&I",null,"93294 - INTERROGATION EVAL REMOTE </90 D 1/2/MLT LEAD PM",null,null,null,null,"93971 - HC DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY",null,"92987 - HC PRQ BALLOON VALVULOPLASTY MITRAL VALVE",null,null,null,"93931 - DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY"]
[null,null,null,"93571 - HC IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL","93530 - RHC CNGNITL ANMLES","93568 - HC NJX PULMONARY ANGIO HRT CATH W/S&I",null,"93295 - INTERROGATION EVAL REMOTE </90 D 1/2/MLT LD ICD",null,null,null,null,"93975 - DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM",null,"92990 - PRQ BALLOON VALVULOPLASTY PULMONARY VALVE",null,null,null,"93970 - HC DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY"]
[null,null,null,"93572 - HC IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL","93531 - RHC/LHC CNGNITL ANMLES","93571 - HC IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL",null,"93296 - HC REM INTERROG EVL PM/IDS",null,null,null,null,"93976 - HC DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RORGN LMT",null,"93005 - ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R",null,null,null,"93971 - HC DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY"]
[null,null,null,"93580 - PRQ TCAT CLSR CGEN INTRATRL COMUNICAJ W/IMPLT","93533 - CMBN R HRT T-SEPTAL L HRT CATHJ SEPTAL OPNG CGEN","93572 - HC IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL",null,"93298 - INTERROGATION EVALUATION REMOTE </30 D ILR SYS",null,null,null,null,"93978 - HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE",null,"93017 - HC CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY",null,null,null,"93975 - DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM"]
[null,null,null,"93582 - HC PERCUTAN TRANSCATH CLOSURE PAT DUCT ARTERIOSUS","93563 - HC NJX SEL HRT ART CONGENITAL HRT CATH W/S&I","93580 - PRQ TCAT CLSR CGEN INTRATRL COMUNICAJ W/IMPLT",null,"93299 - INTERROGATION EVAL REMOTE </30 D TECH REVIEW",null,null,null,null,"93979 - HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD",null,"93225 - HC XTRNL ECG & 48 HR RECORDING",null,null,null,"93976 - HC DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RORGN LMT"]
[null,null,null,"93590 - HC PERQ TRANSCATH CLS PARAVALVR LEAK 1 MITRAL VALVE","93565 - HC NJX SEL L VENT/ATRIAL ANGIO HRT CATH W/S&I","93582 - HC PERCUTAN TRANSCATH CLOSURE PAT DUCT ARTERIOSUS",null,"93303 - HC COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY",null,null,null,null,"93980 - DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL",null,"93226 - EXTERNAL ECG SCANNING ANALYSIS REPORT",null,null,null,"93978 - HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE"]
[null,null,null,"93591 - HC PERQ TRANSCATH CLS PARAVALVR LEAK 1 AORTIC VALVE","93566 - HC NJX SEL R VENT/ATRIAL ANGIO HRT CATH W/S&I","93590 - HC PERQ TRANSCATH CLS PARAVALVR LEAK 1 MITRAL VALVE",null,"93304 - HC F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY",null,null,null,null,"93985 - DUP-SCAN HEMO COMPL BI STD",null,"93260 - HC PRGRMG DEV EVAL IMPLANTABLE SUBQ LEAD DFB SYSTEM",null,null,null,"93979 - HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD"]
[null,null,null,"93592 - HC PERQ TRANSCATH CLS PARAVALVR LEAK EACH OCCLS DEV","93567 - HC NJX SUPRAVALV AORTOG HRT CATH W/S&I","93591 - HC PERQ TRANSCATH CLS PARAVALVR LEAK 1 AORTIC VALVE",null,"93306 - HC ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D WITH CONTRAST",null,null,null,null,"93986 - DUP-SCAN HEMO COMPL UNI STD",null,"93270 - XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS",null,null,null,"93980 - DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL"]
[null,null,null,"93609 - HC INTRA-VENTRIC&/ATRIAL MAPG TACHYCARD W/CATH MA","93568 - HC NJX PULMONARY ANGIO HRT CATH W/S&I","93592 - HC PERQ TRANSCATH CLS PARAVALVR LEAK EACH OCCLS DEV",null,"93307 - HC ECHO HEART XTHORACIC,COMPLETE, W/O DOPPLER  WITH CONTRAST",null,null,null,null,"93990 - HC DUPLEX SCAN HEMODIALYSIS ACCESS",null,"93271 - HC EXT ECG,PT DEMAND EVENT, SYMPT MEMORY LOOP, TRANSMIT",null,null,null,"93985 - DUP-SCAN HEMO COMPL BI STD"]
[null,null,null,"93610 - HC INTRA-ATRIAL PACING","93571 - HC IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL","93609 - HC INTRA-VENTRIC&/ATRIAL MAPG TACHYCARD W/CATH MA",null,"93308 - HC ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD WITH CONTRAST",null,null,null,null,"94002 - HC VENTILATION ASSIST & MGMT INPATIENT 1ST DAY",null,"93278 - SIGNAL AVERAGED ELECTROCARDIOGRAPHY W/WO ECG",null,null,null,"93986 - DUP-SCAN HEMO COMPL UNI STD"]
[null,null,null,"93613 - HC INTRACARDIAC ELECTROPHYSIOLOGIC 3D MAPPING","93572 - HC IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL","93610 - HC INTRA-ATRIAL PACING",null,"93312 - HC ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R  WITH CONTRAST",null,null,null,null,"94003 - HC VENTILATION ASSIST & MGMT INPATIENT EA SBSQ DA",null,"93279 - PROGRAM EVAL IMPLANTABLE IN PRSN 1 LD PACEMAKER",null,null,null,"93990 - HC DUPLEX SCAN HEMODIALYSIS ACCESS"]
[null,null,null,"93619 - HC COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION","93580 - PRQ TCAT CLSR CGEN INTRATRL COMUNICAJ W/IMPLT","93613 - HC INTRACARDIAC ELECTROPHYSIOLOGIC 3D MAPPING",null,"93313 - HC ECHO R-T 2D W/PROBE PLACEMENT ONLY",null,null,null,null,"94010 - SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ",null,"93280 - PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER",null,null,null,"94002 - HC VENTILATION ASSIST & MGMT INPATIENT 1ST DAY"]
[null,null,null,"93620 - HC COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION","93582 - HC PERCUTAN TRANSCATH CLOSURE PAT DUCT ARTERIOSUS","93619 - HC COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION",null,"93315 - HC ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R WITH CONTRAST",null,null,null,null,"94060 - BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN",null,"93281 - PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER",null,null,null,"94003 - HC VENTILATION ASSIST & MGMT INPATIENT EA SBSQ DA"]
[null,null,null,"93621 - HC COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC","93590 - HC PERQ TRANSCATH CLS PARAVALVR LEAK 1 MITRAL VALVE","93620 - HC COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION",null,"93316 - HC ECHO TRANSESOPHAG CONGEN PROBE PLCMT ONLY",null,null,null,null,"94070 - BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT",null,"93282 - PROGRAM EVAL IMPLANTABLE IN PERSN 1 LD CARD/DFB",null,null,null,"94010 - SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ"]
[null,null,null,"93622 - HC COMPRE ELECTROPHYSIOL XM W/LEFT VENTR PACNG/REC","93591 - HC PERQ TRANSCATH CLS PARAVALVR LEAK 1 AORTIC VALVE","93621 - HC COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC",null,"93318 - HC ECHO TRANSEOPHAG MONTR CARDIAC PUMP FUNCTJ",null,null,null,null,"94150 - VITAL CAPACITY TOTAL SEPARATE PROCEDURE",null,"93283 - PROGRM EVAL IMPLANTABLE IN PRSN DUAL L CARD/DFB",null,null,null,"94060 - BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN"]
[null,null,null,"93623 - HC PROGRAMMED STIMJ & PACG AFTER IV DRUG NFS","93592 - HC PERQ TRANSCATH CLS PARAVALVR LEAK EACH OCCLS DEV","93622 - HC COMPRE ELECTROPHYSIOL XM W/LEFT VENTR PACNG/REC",null,"93320 - HC DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY",null,null,null,null,"94200 - HC MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ",null,"93284 - PROGRM EVAL IMPLANTABLE IN PRSN MLT LD CARD/DFB",null,null,null,"94070 - BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT"]
[null,null,null,"93641 - HC EPHYS EVAL PACG CVDFB LDS W/TSTG OF PULSE GEN","93609 - HC INTRA-VENTRIC&/ATRIAL MAPG TACHYCARD W/CATH MA","93623 - HC PROGRAMMED STIMJ & PACG AFTER IV DRUG NFS",null,"93321 - HC DOP ECHOCARD PULSE WAVE W/SPECTRAL F-UP/LMTD STD",null,null,null,null,"94250 - HC EXPIRED GAS COLLECTION QUANT 1 PROCEDURE SPX",null,"93285 - PROGRAM EVAL IMPLANTABLE DEV IN PRSN ILR SYSTEM",null,null,null,"94150 - VITAL CAPACITY TOTAL SEPARATE PROCEDURE"]
[null,null,null,"93642 - HC EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS","93610 - HC INTRA-ATRIAL PACING","93641 - HC EPHYS EVAL PACG CVDFB LDS W/TSTG OF PULSE GEN",null,"93325 - DOP ECHOCARD COLOR FLOW VELOCITY MAPPING",null,null,null,null,"94375 - RESPIRATORY FLOW VOLUME LOOP",null,"93286 - HC PERI-PX EVAL&PROGRAM IN PRSN PACEMAKER SYSTEM",null,null,null,"94200 - HC MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ"]
[null,null,null,"93644 - HC EPHYS EVAL SUBQ IMPLANTABLE DEFIBRILLATOR","93613 - HC INTRACARDIAC ELECTROPHYSIOLOGIC 3D MAPPING","93642 - HC EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS",null,"93350 - HC ECHO HEART XTHORACIC, STRESS/REST WITH CONTRAST",null,null,null,null,"94450 - HYPOXIA RESPONSE CURVE",null,"93287 - HC PERI-PX DEV EVAL & PROG SING/DUAL/MULTI LEAD DFB",null,null,null,"94250 - HC EXPIRED GAS COLLECTION QUANT 1 PROCEDURE SPX"]
[null,null,null,"93650 - HC ICAR CATHETER ABLATION ATRIOVENTR NODE FUNCTION","93619 - HC COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION","93644 - HC EPHYS EVAL SUBQ IMPLANTABLE DEFIBRILLATOR",null,"93351 - HC ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG WITH CONTRAST",null,null,null,null,"94453 - HC HAST W/OXYGEN TITRATE",null,"93288 - INTERROGATION EVAL IN PERSON 1/DUAL/MLT LEAD PM",null,null,null,"94375 - RESPIRATORY FLOW VOLUME LOOP"]
[null,null,null,"93653 - HC COMPRE EP EVAL TX SVT","93620 - HC COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION","93650 - HC ICAR CATHETER ABLATION ATRIOVENTR NODE FUNCTION",null,"93355 - ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN",null,null,null,null,"94617 - HC EXERCISE TEST FOR BRONCHOSPASM",null,"93289 - HC INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB",null,null,null,"94450 - HYPOXIA RESPONSE CURVE"]
[null,null,null,"93654 - HC COMPRE EP EVAL TX VT","93621 - HC COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC","93653 - HC COMPRE EP EVAL TX SVT",null,"93356 - HC MYOCRD STRAIN IMG SPCKL TRCK",null,null,null,null,"94618 - HC PULMONARY STRESS TESTING",null,"93291 - INTERROGATION EVALUATION IN PERSON ILR SYSTEM",null,null,null,"94453 - HC HAST W/OXYGEN TITRATE"]
[null,null,null,"93655 - HC ICAR CATHETER ABLATION ARRHYTHMIA ADD ON","93622 - HC COMPRE ELECTROPHYSIOL XM W/LEFT VENTR PACNG/REC","93654 - HC COMPRE EP EVAL TX VT",null,"93451 - HC RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT",null,null,null,null,"94621 - HC PULMONARY STRESS TESTING COMPLEX",null,"93292 - INTERROGATION EVAL IN PERSON WR DEFIBRILLATOR",null,null,null,"94617 - HC EXERCISE TEST FOR BRONCHOSPASM"]
[null,null,null,"93656 - HC COMPRE EP EVAL ABLTJ ATR FIB","93623 - HC PROGRAMMED STIMJ & PACG AFTER IV DRUG NFS","93655 - HC ICAR CATHETER ABLATION ARRHYTHMIA ADD ON",null,"93452 - HC L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",null,null,null,null,"94640 - PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT",null,"93293 - HC TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL",null,null,null,"94618 - HC PULMONARY STRESS TESTING"]
[null,null,null,"93657 - HC ABLATE L/R ATRIAL FIBRIL W/ISOLATED PULM VEIN","93641 - HC EPHYS EVAL PACG CVDFB LDS W/TSTG OF PULSE GEN","93656 - HC COMPRE EP EVAL ABLTJ ATR FIB",null,"93453 - HC R & L HRT CATH W/NJX L VENTRICULOG IMG S&I",null,null,null,null,"94642 - HC AEROSOL INHALATION TREATMENT",null,"93294 - INTERROGATION EVAL REMOTE </90 D 1/2/MLT LEAD PM",null,null,null,"94621 - HC PULMONARY STRESS TESTING COMPLEX"]
[null,null,null,"93660 - CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR","93642 - HC EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS","93657 - HC ABLATE L/R ATRIAL FIBRIL W/ISOLATED PULM VEIN",null,"93454 - HC CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I",null,null,null,null,"94644 - CONTINUOUS INHALATION TREATMENT 1ST HR",null,"93295 - INTERROGATION EVAL REMOTE </90 D 1/2/MLT LD ICD",null,null,null,"94640 - PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT"]
[null,null,null,"93662 - INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I","93644 - HC EPHYS EVAL SUBQ IMPLANTABLE DEFIBRILLATOR","93660 - CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR",null,"93455 - HC CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I",null,null,null,null,"94645 - CONTINUOUS INHALATION TREATMENT EA ADDL HR",null,"93296 - HC REM INTERROG EVL PM/IDS",null,null,null,"94642 - HC AEROSOL INHALATION TREATMENT"]
[null,null,null,"93724 - ANALYZE PACEMAKER SYSTEM","93650 - HC ICAR CATHETER ABLATION ATRIOVENTR NODE FUNCTION","93662 - INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I",null,"93456 - HC CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I",null,null,null,null,"94660 - HC CPAP VENTILATION CPAP INITIATION&MGMT",null,"93298 - INTERROGATION EVALUATION REMOTE </30 D ILR SYS",null,null,null,"94644 - CONTINUOUS INHALATION TREATMENT 1ST HR"]
[null,null,null,"93750 - HC INTERROGATION VAD IN PERSON","93653 - HC COMPRE EP EVAL TX SVT","93724 - ANALYZE PACEMAKER SYSTEM",null,"93457 - HC CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I",null,null,null,null,"94664 - HC DEMO/EVAL INHALER/NEBULIZER - PHARM",null,"93299 - INTERROGATION EVAL REMOTE </30 D TECH REVIEW",null,null,null,"94645 - CONTINUOUS INHALATION TREATMENT EA ADDL HR"]
[null,null,null,"93786 - BL BLD PRESS W/TAPE&/DISK 24/> HR REC ONL","93654 - HC COMPRE EP EVAL TX VT","93750 - HC INTERROGATION VAD IN PERSON",null,"93458 - HC CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I",null,null,null,null,"94667 - HC CHEST WALL MANIPULATION,INITIAL",null,"93303 - HC COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY",null,null,null,"94660 - HC CPAP VENTILATION CPAP INITIATION&MGMT"]
[null,null,null,"93788 - AMBL BLD PRESS W/TAPE/DISK 24/>HR ALYS W/REPRT","93655 - HC ICAR CATHETER ABLATION ARRHYTHMIA ADD ON","93786 - BL BLD PRESS W/TAPE&/DISK 24/> HR REC ONL",null,"93459 - HC CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I",null,null,null,null,"94681 - O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC",null,"93304 - HC F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY",null,null,null,"94664 - HC DEMO/EVAL INHALER/NEBULIZER - PHARM"]
[null,null,null,"93797 - SP CARD REHAB MAINTAIN","93656 - HC COMPRE EP EVAL ABLTJ ATR FIB","93788 - AMBL BLD PRESS W/TAPE/DISK 24/>HR ALYS W/REPRT",null,"93460 - HC R & L HRT CATH WINJX HRT ART& L VENTR IMG",null,null,null,null,"94690 - O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX",null,"93306 - HC ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D WITH CONTRAST",null,null,null,"94667 - HC CHEST WALL MANIPULATION,INITIAL"]
[null,null,null,"93798 - OUTPATIENT CARDIAC REHAB W/CONT ECG MONITORING","93657 - HC ABLATE L/R ATRIAL FIBRIL W/ISOLATED PULM VEIN","93797 - SP CARD REHAB MAINTAIN",null,"93461 - HC R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I",null,null,null,null,"94726 - PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST",null,"93307 - HC ECHO HEART XTHORACIC,COMPLETE, W/O DOPPLER  WITH CONTRAST",null,null,null,"94681 - O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC"]
[null,null,null,"93880 - HC DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY","93660 - CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR","93798 - OUTPATIENT CARDIAC REHAB W/CONT ECG MONITORING",null,"93462 - HC LEFT HEART CATH BY TRANSEPTAL PUNCTURE",null,null,null,null,"94727 - HC GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&VOL",null,"93308 - HC ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD WITH CONTRAST",null,null,null,"94690 - O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX"]
[null,null,null,"93882 - HC DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY","93662 - INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I","93880 - HC DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY",null,"93463 - HC DRUG ADMIN & HEMODYNMIC MEAS",null,null,null,null,"94729 - CO DIFFUSING CAPACITY",null,"93312 - HC ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R  WITH CONTRAST",null,null,null,"94726 - PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST"]
[null,null,null,"93886 - TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL","93724 - ANALYZE PACEMAKER SYSTEM","93882 - HC DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY",null,"93464 - HC PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU",null,null,null,null,"94761 - MEASURE BLOOD OXYGEN LEVEL",null,"93313 - HC ECHO R-T 2D W/PROBE PLACEMENT ONLY",null,null,null,"94727 - HC GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&VOL"]
[null,null,null,"93888 - TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD","93750 - HC INTERROGATION VAD IN PERSON","93886 - TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL",null,"93503 - HC INSERTION FLOW DIRECTED CATHETER FOR MONITORING",null,null,null,null,"94762 - NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR",null,"93315 - HC ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R WITH CONTRAST",null,null,null,"94729 - CO DIFFUSING CAPACITY"]
[null,null,null,"93890 - TRANSCRANIAL DOPPLER INTRACRAN ART VASOREAC STDY","93786 - BL BLD PRESS W/TAPE&/DISK 24/> HR REC ONL","93888 - TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD",null,"93505 - HC ENDOMYOCARDIAL BIOPSY",null,null,null,null,"94770 - CARBON DIOXIDE EXP GAS DETER INFRARED ANALYZER",null,"93316 - HC ECHO TRANSESOPHAG CONGEN PROBE PLCMT ONLY",null,null,null,"94761 - MEASURE BLOOD OXYGEN LEVEL"]
[null,null,null,"93892 - HC TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT","93788 - AMBL BLD PRESS W/TAPE/DISK 24/>HR ALYS W/REPRT","93890 - TRANSCRANIAL DOPPLER INTRACRAN ART VASOREAC STDY",null,"93530 - RHC CNGNITL ANMLES",null,null,null,null,"94772 - CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT",null,"93318 - HC ECHO TRANSEOPHAG MONTR CARDIAC PUMP FUNCTJ",null,null,null,"94762 - NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR"]
[null,null,null,"93893 - HC TRANSCRAN DOPP INTRACRAN, EMBOLI W/INJ","93797 - SP CARD REHAB MAINTAIN","93892 - HC TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT",null,"93531 - RHC/LHC CNGNITL ANMLES",null,null,null,null,"94780 - HC CAR SEAT/BED TESTING W/INTERP & REPORT 60 MIN",null,"93320 - HC DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY",null,null,null,"94770 - CARBON DIOXIDE EXP GAS DETER INFRARED ANALYZER"]
[null,null,null,"93922 - NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL","93798 - OUTPATIENT CARDIAC REHAB W/CONT ECG MONITORING","93893 - HC TRANSCRAN DOPP INTRACRAN, EMBOLI W/INJ",null,"93533 - CMBN R HRT T-SEPTAL L HRT CATHJ SEPTAL OPNG CGEN",null,null,null,null,"95004 - PERCUTANEOUS TESTS W/ALLERGENIC EXTRACTS",null,"93321 - HC DOP ECHOCARD PULSE WAVE W/SPECTRAL F-UP/LMTD STD",null,null,null,"94772 - CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT"]
[null,null,null,"93923 - NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS","93880 - HC DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY","93922 - NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL",null,"93563 - HC NJX SEL HRT ART CONGENITAL HRT CATH W/S&I",null,null,null,null,"95017 - ALLG TSTG PERQ & IC VENOMS IMMED REACT W/ I&R",null,"93325 - DOP ECHOCARD COLOR FLOW VELOCITY MAPPING",null,null,null,"94780 - HC CAR SEAT/BED TESTING W/INTERP & REPORT 60 MIN"]
[null,null,null,"93924 - HC N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI","93882 - HC DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY","93923 - NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS",null,"93565 - HC NJX SEL L VENT/ATRIAL ANGIO HRT CATH W/S&I",null,null,null,null,"95018 - ALLG TEST PERQ & IC DRUG/BIOL IMMED REACT W/ I&R",null,"93350 - HC ECHO HEART XTHORACIC, STRESS/REST WITH CONTRAST",null,null,null,"95004 - PERCUTANEOUS TESTS W/ALLERGENIC EXTRACTS"]
[null,null,null,"93925 - HC DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY","93886 - TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL","93924 - HC N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI",null,"93566 - HC NJX SEL R VENT/ATRIAL ANGIO HRT CATH W/S&I",null,null,null,null,"95024 - INTRACUTANEOUS TESTS W/ALLERGENIC EXTRACTS",null,"93351 - HC ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG WITH CONTRAST",null,null,null,"95017 - ALLG TSTG PERQ & IC VENOMS IMMED REACT W/ I&R"]
[null,null,null,"93926 - HC DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY","93888 - TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD","93925 - HC DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY",null,"93567 - HC NJX SUPRAVALV AORTOG HRT CATH W/S&I",null,null,null,null,"95028 - IQ TSTS W/ALLGIC XTRCS DLYD TYP RXN W/READING",null,"93355 - ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN",null,null,null,"95018 - ALLG TEST PERQ & IC DRUG/BIOL IMMED REACT W/ I&R"]
[null,null,null,"93930 - HC DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY","93890 - TRANSCRANIAL DOPPLER INTRACRAN ART VASOREAC STDY","93926 - HC DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY",null,"93568 - HC NJX PULMONARY ANGIO HRT CATH W/S&I",null,null,null,null,"95044 - PATCH/APPLICATION TEST SPECIFY NUMBER TESTS",null,"93356 - HC MYOCRD STRAIN IMG SPCKL TRCK",null,null,null,"95024 - INTRACUTANEOUS TESTS W/ALLERGENIC EXTRACTS"]
[null,null,null,"93931 - DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY","93892 - HC TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT","93930 - HC DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY",null,"93571 - HC IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL",null,null,null,null,"95076 - INGESTION CHALLENGE TEST INITIAL 120 MINUTES",null,"93451 - HC RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT",null,null,null,"95028 - IQ TSTS W/ALLGIC XTRCS DLYD TYP RXN W/READING"]
[null,null,null,"93970 - HC DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY","93893 - HC TRANSCRAN DOPP INTRACRAN, EMBOLI W/INJ","93931 - DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY",null,"93572 - HC IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL",null,null,null,null,"95079 - INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES",null,"93452 - HC L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",null,null,null,"95044 - PATCH/APPLICATION TEST SPECIFY NUMBER TESTS"]
[null,null,null,"93971 - HC DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY","93922 - NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL","93970 - HC DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY",null,"93580 - PRQ TCAT CLSR CGEN INTRATRL COMUNICAJ W/IMPLT",null,null,null,null,"95115 - PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS 1 NJX",null,"93453 - HC R & L HRT CATH W/NJX L VENTRICULOG IMG S&I",null,null,null,"95076 - INGESTION CHALLENGE TEST INITIAL 120 MINUTES"]
[null,null,null,"93975 - DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM","93923 - NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS","93971 - HC DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY",null,"93582 - HC PERCUTAN TRANSCATH CLOSURE PAT DUCT ARTERIOSUS",null,null,null,null,"95117 - PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS NJXS",null,"93454 - HC CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I",null,null,null,"95079 - INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES"]
[null,null,null,"93976 - HC DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RORGN LMT","93924 - HC N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI","93975 - DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM",null,"93590 - HC PERQ TRANSCATH CLS PARAVALVR LEAK 1 MITRAL VALVE",null,null,null,null,"95120 - PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX",null,"93455 - HC CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I",null,null,null,"95115 - PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS 1 NJX"]
[null,null,null,"93978 - HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE","93925 - HC DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY","93976 - HC DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RORGN LMT",null,"93591 - HC PERQ TRANSCATH CLS PARAVALVR LEAK 1 AORTIC VALVE",null,null,null,null,"95125 - PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 2/> NJX",null,"93456 - HC CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I",null,null,null,"95117 - PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS NJXS"]
[null,null,null,"93979 - HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD","93926 - HC DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY","93978 - HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE",null,"93592 - HC PERQ TRANSCATH CLS PARAVALVR LEAK EACH OCCLS DEV",null,null,null,null,"95144 - PREPJ& ANTIGEN PRV ALLERGEN IMMUNOTHERAPY 1 DO",null,"93457 - HC CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I",null,null,null,"95120 - PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX"]
[null,null,null,"93980 - DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL","93930 - HC DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY","93979 - HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD",null,"93609 - HC INTRA-VENTRIC&/ATRIAL MAPG TACHYCARD W/CATH MA",null,null,null,null,"95145 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 1 INSECT",null,"93458 - HC CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I",null,null,null,"95125 - PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 2/> NJX"]
[null,null,null,"93985 - DUP-SCAN HEMO COMPL BI STD","93931 - DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY","93980 - DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL",null,"93610 - HC INTRA-ATRIAL PACING",null,null,null,null,"95146 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 2 INSECT",null,"93459 - HC CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I",null,null,null,"95144 - PREPJ& ANTIGEN PRV ALLERGEN IMMUNOTHERAPY 1 DO"]
[null,null,null,"93986 - DUP-SCAN HEMO COMPL UNI STD","93970 - HC DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY","93985 - DUP-SCAN HEMO COMPL BI STD",null,"93613 - HC INTRACARDIAC ELECTROPHYSIOLOGIC 3D MAPPING",null,null,null,null,"95148 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 4 INSECT",null,"93460 - HC R & L HRT CATH WINJX HRT ART& L VENTR IMG",null,null,null,"95145 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 1 INSECT"]
[null,null,null,"93990 - HC DUPLEX SCAN HEMODIALYSIS ACCESS","93971 - HC DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY","93986 - DUP-SCAN HEMO COMPL UNI STD",null,"93619 - HC COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION",null,null,null,null,"95149 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 5 INSECT",null,"93461 - HC R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I",null,null,null,"95146 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 2 INSECT"]
[null,null,null,"94002 - HC VENTILATION ASSIST & MGMT INPATIENT 1ST DAY","93975 - DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM","93990 - HC DUPLEX SCAN HEMODIALYSIS ACCESS",null,"93620 - HC COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION",null,null,null,null,"95165 - PREPJ& ALLERGEN IMMUNOTHERAPY 1/MLT ANTIGEN",null,"93462 - HC LEFT HEART CATH BY TRANSEPTAL PUNCTURE",null,null,null,"95148 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 4 INSECT"]
[null,null,null,"94003 - HC VENTILATION ASSIST & MGMT INPATIENT EA SBSQ DA","93976 - HC DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RORGN LMT","94002 - HC VENTILATION ASSIST & MGMT INPATIENT 1ST DAY",null,"93621 - HC COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC",null,null,null,null,"95170 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY WHL INSE",null,"93463 - HC DRUG ADMIN & HEMODYNMIC MEAS",null,null,null,"95149 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 5 INSECT"]
[null,null,null,"94010 - SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ","93978 - HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE","94003 - HC VENTILATION ASSIST & MGMT INPATIENT EA SBSQ DA",null,"93622 - HC COMPRE ELECTROPHYSIOL XM W/LEFT VENTR PACNG/REC",null,null,null,null,"95180 - HC RAPID DESENSITIZATION PROC,EACH HOUR",null,"93464 - HC PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU",null,null,null,"95165 - PREPJ& ALLERGEN IMMUNOTHERAPY 1/MLT ANTIGEN"]
[null,null,null,"94060 - BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN","93979 - HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD","94010 - SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ",null,"93623 - HC PROGRAMMED STIMJ & PACG AFTER IV DRUG NFS",null,null,null,null,"95249 - HC CONT GLUC MONITORING PATIENT PROVIDED EQUIPMENT",null,"93503 - HC INSERTION FLOW DIRECTED CATHETER FOR MONITORING",null,null,null,"95170 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY WHL INSE"]
[null,null,null,"94070 - BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT","93980 - DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL","94060 - BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN",null,"93641 - HC EPHYS EVAL PACG CVDFB LDS W/TSTG OF PULSE GEN",null,null,null,null,"95250 - GLUC MNTR CONT REC FROM INTERSTITIAL TISS FLUID",null,"93505 - HC ENDOMYOCARDIAL BIOPSY",null,null,null,"95180 - HC RAPID DESENSITIZATION PROC,EACH HOUR"]
[null,null,null,"94150 - VITAL CAPACITY TOTAL SEPARATE PROCEDURE","93985 - DUP-SCAN HEMO COMPL BI STD","94070 - BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT",null,"93642 - HC EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS",null,null,null,null,"95700 - HC EEG CONT REC W/VID EEG TECH",null,"93530 - RHC CNGNITL ANMLES",null,null,null,"95249 - HC CONT GLUC MONITORING PATIENT PROVIDED EQUIPMENT"]
[null,null,null,"94200 - HC MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ","93986 - DUP-SCAN HEMO COMPL UNI STD","94150 - VITAL CAPACITY TOTAL SEPARATE PROCEDURE",null,"93644 - HC EPHYS EVAL SUBQ IMPLANTABLE DEFIBRILLATOR",null,null,null,null,"95705 - HC EEG W/O VID 2-12 HR UNMNTR",null,"93531 - RHC/LHC CNGNITL ANMLES",null,null,null,"95250 - GLUC MNTR CONT REC FROM INTERSTITIAL TISS FLUID"]
[null,null,null,"94250 - HC EXPIRED GAS COLLECTION QUANT 1 PROCEDURE SPX","93990 - HC DUPLEX SCAN HEMODIALYSIS ACCESS","94200 - HC MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ",null,"93650 - HC ICAR CATHETER ABLATION ATRIOVENTR NODE FUNCTION",null,null,null,null,"95706 - HC EEG WO VID 2-12HR INTMT MNTR",null,"93533 - CMBN R HRT T-SEPTAL L HRT CATHJ SEPTAL OPNG CGEN",null,null,null,"95700 - HC EEG CONT REC W/VID EEG TECH"]
[null,null,null,"94375 - RESPIRATORY FLOW VOLUME LOOP","94002 - HC VENTILATION ASSIST & MGMT INPATIENT 1ST DAY","94250 - HC EXPIRED GAS COLLECTION QUANT 1 PROCEDURE SPX",null,"93653 - HC COMPRE EP EVAL TX SVT",null,null,null,null,"95707 - HC EEG W/O VID 2-12HR CONT MNTR",null,"93563 - HC NJX SEL HRT ART CONGENITAL HRT CATH W/S&I",null,null,null,"95705 - HC EEG W/O VID 2-12 HR UNMNTR"]
[null,null,null,"94450 - HYPOXIA RESPONSE CURVE","94003 - HC VENTILATION ASSIST & MGMT INPATIENT EA SBSQ DA","94375 - RESPIRATORY FLOW VOLUME LOOP",null,"93654 - HC COMPRE EP EVAL TX VT",null,null,null,null,"95708 - HC EEG WO VID EA 12-26HR UNMNTR",null,"93565 - HC NJX SEL L VENT/ATRIAL ANGIO HRT CATH W/S&I",null,null,null,"95706 - HC EEG WO VID 2-12HR INTMT MNTR"]
[null,null,null,"94453 - HC HAST W/OXYGEN TITRATE","94010 - SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ","94450 - HYPOXIA RESPONSE CURVE",null,"93655 - HC ICAR CATHETER ABLATION ARRHYTHMIA ADD ON",null,null,null,null,"95709 - HC EEG W/O VID EA 12-26HR INTMT",null,"93566 - HC NJX SEL R VENT/ATRIAL ANGIO HRT CATH W/S&I",null,null,null,"95707 - HC EEG W/O VID 2-12HR CONT MNTR"]
[null,null,null,"94617 - HC EXERCISE TEST FOR BRONCHOSPASM","94060 - BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN","94453 - HC HAST W/OXYGEN TITRATE",null,"93656 - HC COMPRE EP EVAL ABLTJ ATR FIB",null,null,null,null,"95710 - HC EEG W/O VID EA 12-26HR CONT",null,"93567 - HC NJX SUPRAVALV AORTOG HRT CATH W/S&I",null,null,null,"95708 - HC EEG WO VID EA 12-26HR UNMNTR"]
[null,null,null,"94618 - HC PULMONARY STRESS TESTING","94070 - BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT","94617 - HC EXERCISE TEST FOR BRONCHOSPASM",null,"93657 - HC ABLATE L/R ATRIAL FIBRIL W/ISOLATED PULM VEIN",null,null,null,null,"95711 - HC VEEG 2-12 HR UNMONITORED",null,"93568 - HC NJX PULMONARY ANGIO HRT CATH W/S&I",null,null,null,"95709 - HC EEG W/O VID EA 12-26HR INTMT"]
[null,null,null,"94621 - HC PULMONARY STRESS TESTING COMPLEX","94150 - VITAL CAPACITY TOTAL SEPARATE PROCEDURE","94618 - HC PULMONARY STRESS TESTING",null,"93660 - CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR",null,null,null,null,"95712 - HC VEEG 2-12 HR INTMT MNTR",null,"93571 - HC IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL",null,null,null,"95710 - HC EEG W/O VID EA 12-26HR CONT"]
[null,null,null,"94640 - PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT","94200 - HC MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ","94621 - HC PULMONARY STRESS TESTING COMPLEX",null,"93662 - INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I",null,null,null,null,"95713 - HC VEEG 2-12 HR CONT MNTR",null,"93572 - HC IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL",null,null,null,"95711 - HC VEEG 2-12 HR UNMONITORED"]
[null,null,null,"94642 - HC AEROSOL INHALATION TREATMENT","94250 - HC EXPIRED GAS COLLECTION QUANT 1 PROCEDURE SPX","94640 - PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT",null,"93668 - HC PERIPHERAL ART DISEASE REHAB, EA",null,null,null,null,"95714 - HC VEEG EA 12-26 HR UNMNTR",null,"93580 - PRQ TCAT CLSR CGEN INTRATRL COMUNICAJ W/IMPLT",null,null,null,"95712 - HC VEEG 2-12 HR INTMT MNTR"]
[null,null,null,"94644 - CONTINUOUS INHALATION TREATMENT 1ST HR","94375 - RESPIRATORY FLOW VOLUME LOOP","94642 - HC AEROSOL INHALATION TREATMENT",null,"93724 - ANALYZE PACEMAKER SYSTEM",null,null,null,null,"95782 - POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND",null,"93582 - HC PERCUTAN TRANSCATH CLOSURE PAT DUCT ARTERIOSUS",null,null,null,"95713 - HC VEEG 2-12 HR CONT MNTR"]
[null,null,null,"94645 - CONTINUOUS INHALATION TREATMENT EA ADDL HR","94450 - HYPOXIA RESPONSE CURVE","94644 - CONTINUOUS INHALATION TREATMENT 1ST HR",null,"93750 - HC INTERROGATION VAD IN PERSON",null,null,null,null,"95783 - POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM",null,"93590 - HC PERQ TRANSCATH CLS PARAVALVR LEAK 1 MITRAL VALVE",null,null,null,"95714 - HC VEEG EA 12-26 HR UNMNTR"]
[null,null,null,"94660 - HC CPAP VENTILATION CPAP INITIATION&MGMT","94453 - HC HAST W/OXYGEN TITRATE","94645 - CONTINUOUS INHALATION TREATMENT EA ADDL HR",null,"93786 - BL BLD PRESS W/TAPE&/DISK 24/> HR REC ONL",null,null,null,null,"95803 - ACTIGRAPHY TESTING RECORDING ANALYSIS I&R",null,"93591 - HC PERQ TRANSCATH CLS PARAVALVR LEAK 1 AORTIC VALVE",null,null,null,"95782 - POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND"]
[null,null,null,"94664 - HC DEMO/EVAL INHALER/NEBULIZER - PHARM","94617 - HC EXERCISE TEST FOR BRONCHOSPASM","94660 - HC CPAP VENTILATION CPAP INITIATION&MGMT",null,"93788 - AMBL BLD PRESS W/TAPE/DISK 24/>HR ALYS W/REPRT",null,null,null,null,"95805 - HC MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG",null,"93592 - HC PERQ TRANSCATH CLS PARAVALVR LEAK EACH OCCLS DEV",null,null,null,"95783 - POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM"]
[null,null,null,"94667 - HC CHEST WALL MANIPULATION,INITIAL","94618 - HC PULMONARY STRESS TESTING","94664 - HC DEMO/EVAL INHALER/NEBULIZER - PHARM",null,"93797 - SP CARD REHAB MAINTAIN",null,null,null,null,"95806 - SLEEP STUDY, UNATTENDED, SIMUL RECORD HR/O2 SAT/RESP FLOW/RESP EFF",null,"93609 - HC INTRA-VENTRIC&/ATRIAL MAPG TACHYCARD W/CATH MA",null,null,null,"95803 - ACTIGRAPHY TESTING RECORDING ANALYSIS I&R"]
[null,null,null,"94681 - O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC","94621 - HC PULMONARY STRESS TESTING COMPLEX","94667 - HC CHEST WALL MANIPULATION,INITIAL",null,"93798 - OUTPATIENT CARDIAC REHAB W/CONT ECG MONITORING",null,null,null,null,"95808 - POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND",null,"93610 - HC INTRA-ATRIAL PACING",null,null,null,"95805 - HC MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG"]
[null,null,null,"94690 - O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX","94640 - PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT","94681 - O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC",null,"93880 - HC DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY",null,null,null,null,"95810 - POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",null,"93613 - HC INTRACARDIAC ELECTROPHYSIOLOGIC 3D MAPPING",null,null,null,"95806 - SLEEP STUDY, UNATTENDED, SIMUL RECORD HR/O2 SAT/RESP FLOW/RESP EFF"]
[null,null,null,"94726 - PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST","94642 - HC AEROSOL INHALATION TREATMENT","94690 - O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX",null,"93882 - HC DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY",null,null,null,null,"95811 - POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND",null,"93619 - HC COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION",null,null,null,"95808 - POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND"]
[null,null,null,"94727 - HC GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&VOL","94644 - CONTINUOUS INHALATION TREATMENT 1ST HR","94726 - PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST",null,"93886 - TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL",null,null,null,null,"95812 - ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN",null,"93620 - HC COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION",null,null,null,"95810 - POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
[null,null,null,"94729 - CO DIFFUSING CAPACITY","94645 - CONTINUOUS INHALATION TREATMENT EA ADDL HR","94727 - HC GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&VOL",null,"93888 - TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD",null,null,null,null,"95813 - ELECTROENCEPHALOGRAM EXTND MNTR >1 HR",null,"93621 - HC COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC",null,null,null,"95811 - POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND"]
[null,null,null,"94761 - MEASURE BLOOD OXYGEN LEVEL","94660 - HC CPAP VENTILATION CPAP INITIATION&MGMT","94729 - CO DIFFUSING CAPACITY",null,"93890 - TRANSCRANIAL DOPPLER INTRACRAN ART VASOREAC STDY",null,null,null,null,"95816 - ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY",null,"93622 - HC COMPRE ELECTROPHYSIOL XM W/LEFT VENTR PACNG/REC",null,null,null,"95812 - ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN"]
[null,null,null,"94762 - NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR","94664 - HC DEMO/EVAL INHALER/NEBULIZER - PHARM","94761 - MEASURE BLOOD OXYGEN LEVEL",null,"93892 - HC TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT",null,null,null,null,"95819 - ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP",null,"93623 - HC PROGRAMMED STIMJ & PACG AFTER IV DRUG NFS",null,null,null,"95813 - ELECTROENCEPHALOGRAM EXTND MNTR >1 HR"]
[null,null,null,"94770 - CARBON DIOXIDE EXP GAS DETER INFRARED ANALYZER","94667 - HC CHEST WALL MANIPULATION,INITIAL","94762 - NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR",null,"93893 - HC TRANSCRAN DOPP INTRACRAN, EMBOLI W/INJ",null,null,null,null,"95824 - ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY",null,"93641 - HC EPHYS EVAL PACG CVDFB LDS W/TSTG OF PULSE GEN",null,null,null,"95816 - ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY"]
[null,null,null,"94772 - CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT","94681 - O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC","94770 - CARBON DIOXIDE EXP GAS DETER INFRARED ANALYZER",null,"93922 - NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL",null,null,null,null,"95851 - HC RANGE MOTION MEASURE,EACH EXTREM",null,"93642 - HC EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS",null,null,null,"95819 - ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP"]
[null,null,null,"94780 - HC CAR SEAT/BED TESTING W/INTERP & REPORT 60 MIN","94690 - O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX","94772 - CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT",null,"93923 - NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS",null,null,null,null,"95852 - HC ROM MEAS;HAND(S)",null,"93644 - HC EPHYS EVAL SUBQ IMPLANTABLE DEFIBRILLATOR",null,null,null,"95824 - ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY"]
[null,null,null,"95004 - PERCUTANEOUS TESTS W/ALLERGENIC EXTRACTS","94726 - PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST","94780 - HC CAR SEAT/BED TESTING W/INTERP & REPORT 60 MIN",null,"93924 - HC N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI",null,null,null,null,"95860 - NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS",null,"93650 - HC ICAR CATHETER ABLATION ATRIOVENTR NODE FUNCTION",null,null,null,"95851 - HC RANGE MOTION MEASURE,EACH EXTREM"]
[null,null,null,"95017 - ALLG TSTG PERQ & IC VENOMS IMMED REACT W/ I&R","94727 - HC GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&VOL","95004 - PERCUTANEOUS TESTS W/ALLERGENIC EXTRACTS",null,"93925 - HC DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY",null,null,null,null,"95861 - NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS",null,"93653 - HC COMPRE EP EVAL TX SVT",null,null,null,"95852 - HC ROM MEAS;HAND(S)"]
[null,null,null,"95018 - ALLG TEST PERQ & IC DRUG/BIOL IMMED REACT W/ I&R","94729 - CO DIFFUSING CAPACITY","95017 - ALLG TSTG PERQ & IC VENOMS IMMED REACT W/ I&R",null,"93926 - HC DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY",null,null,null,null,"95863 - NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS",null,"93654 - HC COMPRE EP EVAL TX VT",null,null,null,"95860 - NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS"]
[null,null,null,"95024 - INTRACUTANEOUS TESTS W/ALLERGENIC EXTRACTS","94761 - MEASURE BLOOD OXYGEN LEVEL","95018 - ALLG TEST PERQ & IC DRUG/BIOL IMMED REACT W/ I&R",null,"93930 - HC DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY",null,null,null,null,"95864 - NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS",null,"93655 - HC ICAR CATHETER ABLATION ARRHYTHMIA ADD ON",null,null,null,"95861 - NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS"]
[null,null,null,"95028 - IQ TSTS W/ALLGIC XTRCS DLYD TYP RXN W/READING","94762 - NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR","95024 - INTRACUTANEOUS TESTS W/ALLERGENIC EXTRACTS",null,"93931 - DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY",null,null,null,null,"95865 - NEEDLE ELECTROMYOGRAPHY LARYNX",null,"93656 - HC COMPRE EP EVAL ABLTJ ATR FIB",null,null,null,"95863 - NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS"]
[null,null,null,"95044 - PATCH/APPLICATION TEST SPECIFY NUMBER TESTS","94770 - CARBON DIOXIDE EXP GAS DETER INFRARED ANALYZER","95028 - IQ TSTS W/ALLGIC XTRCS DLYD TYP RXN W/READING",null,"93970 - HC DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY",null,null,null,null,"95866 - NEEDLE ELECTROMYOGRAPHY HEMIDIAPHRAGM",null,"93657 - HC ABLATE L/R ATRIAL FIBRIL W/ISOLATED PULM VEIN",null,null,null,"95864 - NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS"]
[null,null,null,"95076 - INGESTION CHALLENGE TEST INITIAL 120 MINUTES","94772 - CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT","95044 - PATCH/APPLICATION TEST SPECIFY NUMBER TESTS",null,"93971 - HC DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY",null,null,null,null,"95867 - NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI",null,"93660 - CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR",null,null,null,"95865 - NEEDLE ELECTROMYOGRAPHY LARYNX"]
[null,null,null,"95079 - INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES","94780 - HC CAR SEAT/BED TESTING W/INTERP & REPORT 60 MIN","95076 - INGESTION CHALLENGE TEST INITIAL 120 MINUTES",null,"93975 - DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM",null,null,null,null,"95868 - NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI",null,"93662 - INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I",null,null,null,"95866 - NEEDLE ELECTROMYOGRAPHY HEMIDIAPHRAGM"]
[null,null,null,"95115 - PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS 1 NJX","95004 - PERCUTANEOUS TESTS W/ALLERGENIC EXTRACTS","95079 - INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES",null,"93976 - HC DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RORGN LMT",null,null,null,null,"95869 - NEEDLE EMG THRC PARASPI MUSC EXCLUDING T1/T12",null,"93668 - HC PERIPHERAL ART DISEASE REHAB, EA",null,null,null,"95867 - NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI"]
[null,null,null,"95117 - PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS NJXS","95017 - ALLG TSTG PERQ & IC VENOMS IMMED REACT W/ I&R","95115 - PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS 1 NJX",null,"93978 - HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE",null,null,null,null,"95870 - NEEDLE EMG LMTD STD MUSC 1 XTR/NON-LIMB UNI/BI",null,"93724 - ANALYZE PACEMAKER SYSTEM",null,null,null,"95868 - NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI"]
[null,null,null,"95120 - PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX","95018 - ALLG TEST PERQ & IC DRUG/BIOL IMMED REACT W/ I&R","95117 - PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS NJXS",null,"93979 - HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD",null,null,null,null,"95872 - NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER",null,"93750 - HC INTERROGATION VAD IN PERSON",null,null,null,"95869 - NEEDLE EMG THRC PARASPI MUSC EXCLUDING T1/T12"]
[null,null,null,"95125 - PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 2/> NJX","95024 - INTRACUTANEOUS TESTS W/ALLERGENIC EXTRACTS","95120 - PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX",null,"93980 - DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL",null,null,null,null,"95873 - ELECTRICAL STIMULATION GUID W/CHEMODENERVATION",null,"93786 - BL BLD PRESS W/TAPE&/DISK 24/> HR REC ONL",null,null,null,"95870 - NEEDLE EMG LMTD STD MUSC 1 XTR/NON-LIMB UNI/BI"]
[null,null,null,"95144 - PREPJ& ANTIGEN PRV ALLERGEN IMMUNOTHERAPY 1 DO","95028 - IQ TSTS W/ALLGIC XTRCS DLYD TYP RXN W/READING","95125 - PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 2/> NJX",null,"93985 - DUP-SCAN HEMO COMPL BI STD",null,null,null,null,"95874 - NEEDLE EMG GUID W/CHEMODENERVATION",null,"93788 - AMBL BLD PRESS W/TAPE/DISK 24/>HR ALYS W/REPRT",null,null,null,"95872 - NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER"]
[null,null,null,"95145 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 1 INSECT","95044 - PATCH/APPLICATION TEST SPECIFY NUMBER TESTS","95144 - PREPJ& ANTIGEN PRV ALLERGEN IMMUNOTHERAPY 1 DO",null,"93986 - DUP-SCAN HEMO COMPL UNI STD",null,null,null,null,"95885 - NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED",null,"93797 - SP CARD REHAB MAINTAIN",null,null,null,"95873 - ELECTRICAL STIMULATION GUID W/CHEMODENERVATION"]
[null,null,null,"95146 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 2 INSECT","95076 - INGESTION CHALLENGE TEST INITIAL 120 MINUTES","95145 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 1 INSECT",null,"93990 - HC DUPLEX SCAN HEMODIALYSIS ACCESS",null,null,null,null,"95886 - NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE",null,"93798 - OUTPATIENT CARDIAC REHAB W/CONT ECG MONITORING",null,null,null,"95874 - NEEDLE EMG GUID W/CHEMODENERVATION"]
[null,null,null,"95148 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 4 INSECT","95079 - INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES","95146 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 2 INSECT",null,"94002 - HC VENTILATION ASSIST & MGMT INPATIENT 1ST DAY",null,null,null,null,"95887 - NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION",null,"93880 - HC DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY",null,null,null,"95885 - NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED"]
[null,null,null,"95149 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 5 INSECT","95115 - PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS 1 NJX","95148 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 4 INSECT",null,"94003 - HC VENTILATION ASSIST & MGMT INPATIENT EA SBSQ DA",null,null,null,null,"95905 - HC MOTOR/SENS NERVE CONDUCTION PRECONFIG ELECTRODE ARRAY, EA LIMB",null,"93882 - HC DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY",null,null,null,"95886 - NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE"]
[null,null,null,"95165 - PREPJ& ALLERGEN IMMUNOTHERAPY 1/MLT ANTIGEN","95117 - PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS NJXS","95149 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 5 INSECT",null,"94010 - SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ",null,null,null,null,"95907 - MOTOR &/SENS 1-2 NRV CNDJ PRECONF ELTRODE LIMB",null,"93886 - TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL",null,null,null,"95887 - NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION"]
[null,null,null,"95170 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY WHL INSE","95120 - PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX","95165 - PREPJ& ALLERGEN IMMUNOTHERAPY 1/MLT ANTIGEN",null,"94060 - BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN",null,null,null,null,"95908 - MOTOR &/SENS 3-4 NRV CNDJ PRECONF ELTRODE LIMB",null,"93888 - TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD",null,null,null,"95905 - HC MOTOR/SENS NERVE CONDUCTION PRECONFIG ELECTRODE ARRAY, EA LIMB"]
[null,null,null,"95180 - HC RAPID DESENSITIZATION PROC,EACH HOUR","95125 - PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 2/> NJX","95170 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY WHL INSE",null,"94070 - BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT",null,null,null,null,"95909 - MOTOR &/SENS 5-6 NRV CNDJ PRECONF ELTRODE LIMB",null,"93890 - TRANSCRANIAL DOPPLER INTRACRAN ART VASOREAC STDY",null,null,null,"95907 - MOTOR &/SENS 1-2 NRV CNDJ PRECONF ELTRODE LIMB"]
[null,null,null,"95249 - HC CONT GLUC MONITORING PATIENT PROVIDED EQUIPMENT","95144 - PREPJ& ANTIGEN PRV ALLERGEN IMMUNOTHERAPY 1 DO","95180 - HC RAPID DESENSITIZATION PROC,EACH HOUR",null,"94150 - VITAL CAPACITY TOTAL SEPARATE PROCEDURE",null,null,null,null,"95910 - MOTOR &/SENS 7-8 NRV CNDJ PRECONF ELTRODE LIMB",null,"93892 - HC TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT",null,null,null,"95908 - MOTOR &/SENS 3-4 NRV CNDJ PRECONF ELTRODE LIMB"]
[null,null,null,"95250 - GLUC MNTR CONT REC FROM INTERSTITIAL TISS FLUID","95145 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 1 INSECT","95249 - HC CONT GLUC MONITORING PATIENT PROVIDED EQUIPMENT",null,"94200 - HC MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ",null,null,null,null,"95911 - MOTOR &/SENS 9-10 NRV CNDJ PRECONF ELTRODE LIMB",null,"93893 - HC TRANSCRAN DOPP INTRACRAN, EMBOLI W/INJ",null,null,null,"95909 - MOTOR &/SENS 5-6 NRV CNDJ PRECONF ELTRODE LIMB"]
[null,null,null,"95700 - HC EEG CONT REC W/VID EEG TECH","95146 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 2 INSECT","95250 - GLUC MNTR CONT REC FROM INTERSTITIAL TISS FLUID",null,"94250 - HC EXPIRED GAS COLLECTION QUANT 1 PROCEDURE SPX",null,null,null,null,"95912 - MOTOR &/SENS 11-12 NRV CNDJ PRECONF ELTRODE LIMB",null,"93922 - NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL",null,null,null,"95910 - MOTOR &/SENS 7-8 NRV CNDJ PRECONF ELTRODE LIMB"]
[null,null,null,"95705 - HC EEG W/O VID 2-12 HR UNMNTR","95148 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 4 INSECT","95700 - HC EEG CONT REC W/VID EEG TECH",null,"94375 - RESPIRATORY FLOW VOLUME LOOP",null,null,null,null,"95913 - MOTOR &/SENS 13/> NRV CNDJ PRECONF ELTRODE LIMB",null,"93923 - NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS",null,null,null,"95911 - MOTOR &/SENS 9-10 NRV CNDJ PRECONF ELTRODE LIMB"]
[null,null,null,"95706 - HC EEG WO VID 2-12HR INTMT MNTR","95149 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 5 INSECT","95705 - HC EEG W/O VID 2-12 HR UNMNTR",null,"94450 - HYPOXIA RESPONSE CURVE",null,null,null,null,"95921 - HC AUTONOMIC NRV PARASYM INERVJ",null,"93924 - HC N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI",null,null,null,"95912 - MOTOR &/SENS 11-12 NRV CNDJ PRECONF ELTRODE LIMB"]
[null,null,null,"95707 - HC EEG W/O VID 2-12HR CONT MNTR","95165 - PREPJ& ALLERGEN IMMUNOTHERAPY 1/MLT ANTIGEN","95706 - HC EEG WO VID 2-12HR INTMT MNTR",null,"94453 - HC HAST W/OXYGEN TITRATE",null,null,null,null,"95923 - HC AUTONOMIC NRV SYST FUNJ TEST",null,"93925 - HC DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY",null,null,null,"95913 - MOTOR &/SENS 13/> NRV CNDJ PRECONF ELTRODE LIMB"]
[null,null,null,"95708 - HC EEG WO VID EA 12-26HR UNMNTR","95170 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY WHL INSE","95707 - HC EEG W/O VID 2-12HR CONT MNTR",null,"94617 - HC EXERCISE TEST FOR BRONCHOSPASM",null,null,null,null,"95924 - TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT",null,"93926 - HC DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY",null,null,null,"95921 - HC AUTONOMIC NRV PARASYM INERVJ"]
[null,null,null,"95709 - HC EEG W/O VID EA 12-26HR INTMT","95180 - HC RAPID DESENSITIZATION PROC,EACH HOUR","95708 - HC EEG WO VID EA 12-26HR UNMNTR",null,"94618 - HC PULMONARY STRESS TESTING",null,null,null,null,"95925 - HC SOMATOSENSORY TEST,UPPER LIMBS",null,"93930 - HC DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY",null,null,null,"95923 - HC AUTONOMIC NRV SYST FUNJ TEST"]
[null,null,null,"95710 - HC EEG W/O VID EA 12-26HR CONT","95249 - HC CONT GLUC MONITORING PATIENT PROVIDED EQUIPMENT","95709 - HC EEG W/O VID EA 12-26HR INTMT",null,"94621 - HC PULMONARY STRESS TESTING COMPLEX",null,null,null,null,"95926 - SHORT-LATENCY SOMATOSENS EP STD LWR LIMBS",null,"93931 - DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY",null,null,null,"95924 - TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT"]
[null,null,null,"95711 - HC VEEG 2-12 HR UNMONITORED","95250 - GLUC MNTR CONT REC FROM INTERSTITIAL TISS FLUID","95710 - HC EEG W/O VID EA 12-26HR CONT",null,"94640 - PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT",null,null,null,null,"95930 - HC VISUAL EP TESTING CNS EXCEPT GLAUCOMA W/I&R",null,"93970 - HC DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY",null,null,null,"95925 - HC SOMATOSENSORY TEST,UPPER LIMBS"]
[null,null,null,"95712 - HC VEEG 2-12 HR INTMT MNTR","95700 - HC EEG CONT REC W/VID EEG TECH","95711 - HC VEEG 2-12 HR UNMONITORED",null,"94642 - HC AEROSOL INHALATION TREATMENT",null,null,null,null,"95933 - ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST",null,"93971 - HC DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY",null,null,null,"95926 - SHORT-LATENCY SOMATOSENS EP STD LWR LIMBS"]
[null,null,null,"95713 - HC VEEG 2-12 HR CONT MNTR","95705 - HC EEG W/O VID 2-12 HR UNMNTR","95712 - HC VEEG 2-12 HR INTMT MNTR",null,"94644 - CONTINUOUS INHALATION TREATMENT 1ST HR",null,null,null,null,"95937 - NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH",null,"93975 - DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM",null,null,null,"95930 - HC VISUAL EP TESTING CNS EXCEPT GLAUCOMA W/I&R"]
[null,null,null,"95714 - HC VEEG EA 12-26 HR UNMNTR","95706 - HC EEG WO VID 2-12HR INTMT MNTR","95713 - HC VEEG 2-12 HR CONT MNTR",null,"94645 - CONTINUOUS INHALATION TREATMENT EA ADDL HR",null,null,null,null,"95940 - HC IONM 1 ON 1 IN OR W/ATTENDANCE EACH 15 MINUTES",null,"93976 - HC DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RORGN LMT",null,null,null,"95933 - ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST"]
[null,null,null,"95782 - POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND","95707 - HC EEG W/O VID 2-12HR CONT MNTR","95714 - HC VEEG EA 12-26 HR UNMNTR",null,"94660 - HC CPAP VENTILATION CPAP INITIATION&MGMT",null,null,null,null,"95943 - PARASYMP & SYMP NRV FUNCJ HRT RATE VARIABILITY",null,"93978 - HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE",null,null,null,"95937 - NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH"]
[null,null,null,"95783 - POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM","95708 - HC EEG WO VID EA 12-26HR UNMNTR","95782 - POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND",null,"94664 - HC DEMO/EVAL INHALER/NEBULIZER - PHARM",null,null,null,null,"95958 - WADA ACTIVATION TEST HEMISPHERIC FUNCTION W/EEG",null,"93979 - HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD",null,null,null,"95940 - HC IONM 1 ON 1 IN OR W/ATTENDANCE EACH 15 MINUTES"]
[null,null,null,"95803 - ACTIGRAPHY TESTING RECORDING ANALYSIS I&R","95709 - HC EEG W/O VID EA 12-26HR INTMT","95783 - POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM",null,"94667 - HC CHEST WALL MANIPULATION,INITIAL",null,null,null,null,"95961 - HC FUNCJAL CORT & SUBCORT MAPG PHYS/QHP ATTND INIT HR",null,"93980 - DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL",null,null,null,"95943 - PARASYMP & SYMP NRV FUNCJ HRT RATE VARIABILITY"]
[null,null,null,"95805 - HC MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG","95710 - HC EEG W/O VID EA 12-26HR CONT","95803 - ACTIGRAPHY TESTING RECORDING ANALYSIS I&R",null,"94681 - O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC",null,null,null,null,"95962 - HC FUNCJAL CORT & SUBCORT MAPG PHYS/QHP ATTND ADDL HR",null,"93985 - DUP-SCAN HEMO COMPL BI STD",null,null,null,"95958 - WADA ACTIVATION TEST HEMISPHERIC FUNCTION W/EEG"]
[null,null,null,"95806 - SLEEP STUDY, UNATTENDED, SIMUL RECORD HR/O2 SAT/RESP FLOW/RESP EFF","95711 - HC VEEG 2-12 HR UNMONITORED","95805 - HC MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG",null,"94690 - O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX",null,null,null,null,"95966 - HC MEG,EVOKED MAGNET FIELDS, SINGLE MODAL",null,"93986 - DUP-SCAN HEMO COMPL UNI STD",null,null,null,"95961 - HC FUNCJAL CORT & SUBCORT MAPG PHYS/QHP ATTND INIT HR"]
[null,null,null,"95808 - POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND","95712 - HC VEEG 2-12 HR INTMT MNTR","95806 - SLEEP STUDY, UNATTENDED, SIMUL RECORD HR/O2 SAT/RESP FLOW/RESP EFF",null,"94726 - PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST",null,null,null,null,"95970 - ELEC ALYS NSTIM PLS GEN BRN/SC/PERPH W/O REPRGRM",null,"93990 - HC DUPLEX SCAN HEMODIALYSIS ACCESS",null,null,null,"95962 - HC FUNCJAL CORT & SUBCORT MAPG PHYS/QHP ATTND ADDL HR"]
[null,null,null,"95810 - POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95713 - HC VEEG 2-12 HR CONT MNTR","95808 - POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND",null,"94727 - HC GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&VOL",null,null,null,null,"95971 - ELEC ALYS NSTIM PLS GEN SMPL SC/PERPH W/PRGRMG",null,"94002 - HC VENTILATION ASSIST & MGMT INPATIENT 1ST DAY",null,null,null,"95966 - HC MEG,EVOKED MAGNET FIELDS, SINGLE MODAL"]
[null,null,null,"95811 - POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND","95714 - HC VEEG EA 12-26 HR UNMNTR","95810 - POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",null,"94729 - CO DIFFUSING CAPACITY",null,null,null,null,"95972 - ELEC ALYS NSTIM PLS GEN CPLX SC/PERPH 1ST HR",null,"94003 - HC VENTILATION ASSIST & MGMT INPATIENT EA SBSQ DA",null,null,null,"95970 - ELEC ALYS NSTIM PLS GEN BRN/SC/PERPH W/O REPRGRM"]
[null,null,null,"95812 - ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN","95782 - POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND","95811 - POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND",null,"94761 - MEASURE BLOOD OXYGEN LEVEL",null,null,null,null,"95976 - HC ALYS SMPL CN NPGT PRGRMG",null,"94010 - SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ",null,null,null,"95971 - ELEC ALYS NSTIM PLS GEN SMPL SC/PERPH W/PRGRMG"]
[null,null,null,"95813 - ELECTROENCEPHALOGRAM EXTND MNTR >1 HR","95783 - POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM","95812 - ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN",null,"94762 - NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR",null,null,null,null,"95977 - HC ALYS CPLX CN NPGT PRGRMG",null,"94060 - BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN",null,null,null,"95972 - ELEC ALYS NSTIM PLS GEN CPLX SC/PERPH 1ST HR"]
[null,null,null,"95816 - ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY","95803 - ACTIGRAPHY TESTING RECORDING ANALYSIS I&R","95813 - ELECTROENCEPHALOGRAM EXTND MNTR >1 HR",null,"94770 - CARBON DIOXIDE EXP GAS DETER INFRARED ANALYZER",null,null,null,null,"95983 - HC ALYS BRN NPGT PRGRMG 15 MIN",null,"94070 - BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT",null,null,null,"95976 - HC ALYS SMPL CN NPGT PRGRMG"]
[null,null,null,"95819 - ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP","95805 - HC MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG","95816 - ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY",null,"94772 - CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT",null,null,null,null,"95984 - HC ALYS BRN NPGT PRGRMG ADDL 15",null,"94150 - VITAL CAPACITY TOTAL SEPARATE PROCEDURE",null,null,null,"95977 - HC ALYS CPLX CN NPGT PRGRMG"]
[null,null,null,"95851 - HC RANGE MOTION MEASURE,EACH EXTREM","95806 - SLEEP STUDY, UNATTENDED, SIMUL RECORD HR/O2 SAT/RESP FLOW/RESP EFF","95819 - ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP",null,"94780 - HC CAR SEAT/BED TESTING W/INTERP & REPORT 60 MIN",null,null,null,null,"95990 - REFILL&MAINTENANCE PUMP DRUG DLVR SPINAL/BRAIN",null,"94200 - HC MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ",null,null,null,"95983 - HC ALYS BRN NPGT PRGRMG 15 MIN"]
[null,null,null,"95852 - HC ROM MEAS;HAND(S)","95808 - POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND","95851 - HC RANGE MOTION MEASURE,EACH EXTREM",null,"94799 - UNLISTED PULMONARY SERVICE/PROCEDURE",null,null,null,null,"95991 - RFL&MAIN IMPLT PMP/RSVR DLVR SPI/BRN PHY/QHP",null,"94250 - HC EXPIRED GAS COLLECTION QUANT 1 PROCEDURE SPX",null,null,null,"95984 - HC ALYS BRN NPGT PRGRMG ADDL 15"]
[null,null,null,"95860 - NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS","95810 - POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95852 - HC ROM MEAS;HAND(S)",null,"95004 - PERCUTANEOUS TESTS W/ALLERGENIC EXTRACTS",null,null,null,null,"96020 - HC TEST SELECT & ADMN FUNCTL BRAIN MAP PHYS/QHP",null,"94375 - RESPIRATORY FLOW VOLUME LOOP",null,null,null,"95990 - REFILL&MAINTENANCE PUMP DRUG DLVR SPINAL/BRAIN"]
[null,null,null,"95861 - NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS","95811 - POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND","95860 - NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS",null,"95017 - ALLG TSTG PERQ & IC VENOMS IMMED REACT W/ I&R",null,null,null,null,"96040 - MEDICAL GENETICS COUNSELING EACH 30 MINUTES",null,"94450 - HYPOXIA RESPONSE CURVE",null,null,null,"95991 - RFL&MAIN IMPLT PMP/RSVR DLVR SPI/BRN PHY/QHP"]
[null,null,null,"95863 - NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS","95812 - ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN","95861 - NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS",null,"95018 - ALLG TEST PERQ & IC DRUG/BIOL IMMED REACT W/ I&R",null,null,null,null,"96105 - ASSESSMENT PHASIA W/INTERP & REPORT PER HOUR",null,"94453 - HC HAST W/OXYGEN TITRATE",null,null,null,"96020 - HC TEST SELECT & ADMN FUNCTL BRAIN MAP PHYS/QHP"]
[null,null,null,"95864 - NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS","95813 - ELECTROENCEPHALOGRAM EXTND MNTR >1 HR","95863 - NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS",null,"95024 - INTRACUTANEOUS TESTS W/ALLERGENIC EXTRACTS",null,null,null,null,"96112 - HC DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR",null,"94617 - HC EXERCISE TEST FOR BRONCHOSPASM",null,null,null,"96040 - MEDICAL GENETICS COUNSELING EACH 30 MINUTES"]
[null,null,null,"95865 - NEEDLE ELECTROMYOGRAPHY LARYNX","95816 - ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY","95864 - NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS",null,"95028 - IQ TSTS W/ALLGIC XTRCS DLYD TYP RXN W/READING",null,null,null,null,"96113 - HC DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN",null,"94618 - HC PULMONARY STRESS TESTING",null,null,null,"96105 - ASSESSMENT PHASIA W/INTERP & REPORT PER HOUR"]
[null,null,null,"95866 - NEEDLE ELECTROMYOGRAPHY HEMIDIAPHRAGM","95819 - ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP","95865 - NEEDLE ELECTROMYOGRAPHY LARYNX",null,"95044 - PATCH/APPLICATION TEST SPECIFY NUMBER TESTS",null,null,null,null,"96116 - NUBHVL STATUS XM PR HR W/PT INTERPJ&PREPJ",null,"94621 - HC PULMONARY STRESS TESTING COMPLEX",null,null,null,"96112 - HC DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR"]
[null,null,null,"95867 - NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI","95851 - HC RANGE MOTION MEASURE,EACH EXTREM","95866 - NEEDLE ELECTROMYOGRAPHY HEMIDIAPHRAGM",null,"95076 - INGESTION CHALLENGE TEST INITIAL 120 MINUTES",null,null,null,null,"96121 - HC NEUROBEHAVIORAL STATUS XM PHYS/QHP EA ADDL HOUR",null,"94640 - PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT",null,null,null,"96113 - HC DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN"]
[null,null,null,"95868 - NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI","95852 - HC ROM MEAS;HAND(S)","95867 - NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI",null,"95079 - INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES",null,null,null,null,"96127 - BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT",null,"94642 - HC AEROSOL INHALATION TREATMENT",null,null,null,"96116 - NUBHVL STATUS XM PR HR W/PT INTERPJ&PREPJ"]
[null,null,null,"95869 - NEEDLE EMG THRC PARASPI MUSC EXCLUDING T1/T12","95860 - NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS","95868 - NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI",null,"95115 - PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS 1 NJX",null,null,null,null,"96130 - HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR",null,"94644 - CONTINUOUS INHALATION TREATMENT 1ST HR",null,null,null,"96121 - HC NEUROBEHAVIORAL STATUS XM PHYS/QHP EA ADDL HOUR"]
[null,null,null,"95870 - NEEDLE EMG LMTD STD MUSC 1 XTR/NON-LIMB UNI/BI","95861 - NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS","95869 - NEEDLE EMG THRC PARASPI MUSC EXCLUDING T1/T12",null,"95117 - PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS NJXS",null,null,null,null,"96131 - HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR",null,"94645 - CONTINUOUS INHALATION TREATMENT EA ADDL HR",null,null,null,"96127 - BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT"]
[null,null,null,"95872 - NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER","95863 - NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS","95870 - NEEDLE EMG LMTD STD MUSC 1 XTR/NON-LIMB UNI/BI",null,"95120 - PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX",null,null,null,null,"96132 - HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR",null,"94660 - HC CPAP VENTILATION CPAP INITIATION&MGMT",null,null,null,"96130 - HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR"]
[null,null,null,"95873 - ELECTRICAL STIMULATION GUID W/CHEMODENERVATION","95864 - NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS","95872 - NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER",null,"95144 - PREPJ& ANTIGEN PRV ALLERGEN IMMUNOTHERAPY 1 DO",null,null,null,null,"96133 - HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR",null,"94664 - HC DEMO/EVAL INHALER/NEBULIZER - PHARM",null,null,null,"96131 - HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR"]
[null,null,null,"95874 - NEEDLE EMG GUID W/CHEMODENERVATION","95865 - NEEDLE ELECTROMYOGRAPHY LARYNX","95873 - ELECTRICAL STIMULATION GUID W/CHEMODENERVATION",null,"95145 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 1 INSECT",null,null,null,null,"96136 - HC PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN",null,"94667 - HC CHEST WALL MANIPULATION,INITIAL",null,null,null,"96132 - HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR"]
[null,null,null,"95885 - NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED","95866 - NEEDLE ELECTROMYOGRAPHY HEMIDIAPHRAGM","95874 - NEEDLE EMG GUID W/CHEMODENERVATION",null,"95146 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 2 INSECT",null,null,null,null,"96137 - HC PSYCL/NRPSYCL TST PHYS/QHP 2+ TST EA ADDL 30 MIN",null,"94681 - O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC",null,null,null,"96133 - HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR"]
[null,null,null,"95886 - NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE","95867 - NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI","95885 - NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED",null,"95148 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 4 INSECT",null,null,null,null,"96138 - HC PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN",null,"94690 - O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX",null,null,null,"96136 - HC PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN"]
[null,null,null,"95887 - NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION","95868 - NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI","95886 - NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE",null,"95149 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 5 INSECT",null,null,null,null,"96139 - HC PSYCL/NRPSYCL TST TECH 2+ TST EA ADDL 30 MIN",null,"94726 - PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST",null,null,null,"96137 - HC PSYCL/NRPSYCL TST PHYS/QHP 2+ TST EA ADDL 30 MIN"]
[null,null,null,"95905 - HC MOTOR/SENS NERVE CONDUCTION PRECONFIG ELECTRODE ARRAY, EA LIMB","95869 - NEEDLE EMG THRC PARASPI MUSC EXCLUDING T1/T12","95887 - NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION",null,"95165 - PREPJ& ALLERGEN IMMUNOTHERAPY 1/MLT ANTIGEN",null,null,null,null,"96146 - HC PSYCL/NRPSYCL TST ELEC PLATFORM AUTO RESULT",null,"94727 - HC GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&VOL",null,null,null,"96138 - HC PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN"]
[null,null,null,"95907 - MOTOR &/SENS 1-2 NRV CNDJ PRECONF ELTRODE LIMB","95870 - NEEDLE EMG LMTD STD MUSC 1 XTR/NON-LIMB UNI/BI","95905 - HC MOTOR/SENS NERVE CONDUCTION PRECONFIG ELECTRODE ARRAY, EA LIMB",null,"95170 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY WHL INSE",null,null,null,null,"96160 - PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM",null,"94729 - CO DIFFUSING CAPACITY",null,null,null,"96139 - HC PSYCL/NRPSYCL TST TECH 2+ TST EA ADDL 30 MIN"]
[null,null,null,"95908 - MOTOR &/SENS 3-4 NRV CNDJ PRECONF ELTRODE LIMB","95872 - NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER","95907 - MOTOR &/SENS 1-2 NRV CNDJ PRECONF ELTRODE LIMB",null,"95180 - HC RAPID DESENSITIZATION PROC,EACH HOUR",null,null,null,null,"96161 - CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM",null,"94761 - MEASURE BLOOD OXYGEN LEVEL",null,null,null,"96146 - HC PSYCL/NRPSYCL TST ELEC PLATFORM AUTO RESULT"]
[null,null,null,"95909 - MOTOR &/SENS 5-6 NRV CNDJ PRECONF ELTRODE LIMB","95873 - ELECTRICAL STIMULATION GUID W/CHEMODENERVATION","95908 - MOTOR &/SENS 3-4 NRV CNDJ PRECONF ELTRODE LIMB",null,"95199 - PR ALLERGY SP SUBLINGUAL IMMUNOTHERAPY ADMIN",null,null,null,null,"96360 - IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR",null,"94762 - NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR",null,null,null,"96160 - PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM"]
[null,null,null,"95910 - MOTOR &/SENS 7-8 NRV CNDJ PRECONF ELTRODE LIMB","95874 - NEEDLE EMG GUID W/CHEMODENERVATION","95909 - MOTOR &/SENS 5-6 NRV CNDJ PRECONF ELTRODE LIMB",null,"95249 - HC CONT GLUC MONITORING PATIENT PROVIDED EQUIPMENT",null,null,null,null,"96361 - IV INFUSION HYDRATION EACH ADDITIONAL HOUR",null,"94770 - CARBON DIOXIDE EXP GAS DETER INFRARED ANALYZER",null,null,null,"96161 - CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM"]
[null,null,null,"95911 - MOTOR &/SENS 9-10 NRV CNDJ PRECONF ELTRODE LIMB","95885 - NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED","95910 - MOTOR &/SENS 7-8 NRV CNDJ PRECONF ELTRODE LIMB",null,"95250 - GLUC MNTR CONT REC FROM INTERSTITIAL TISS FLUID",null,null,null,null,"96365 - IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR",null,"94772 - CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT",null,null,null,"96360 - IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR"]
[null,null,null,"95912 - MOTOR &/SENS 11-12 NRV CNDJ PRECONF ELTRODE LIMB","95886 - NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE","95911 - MOTOR &/SENS 9-10 NRV CNDJ PRECONF ELTRODE LIMB",null,"95700 - HC EEG CONT REC W/VID EEG TECH",null,null,null,null,"96366 - IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR",null,"94780 - HC CAR SEAT/BED TESTING W/INTERP & REPORT 60 MIN",null,null,null,"96361 - IV INFUSION HYDRATION EACH ADDITIONAL HOUR"]
[null,null,null,"95913 - MOTOR &/SENS 13/> NRV CNDJ PRECONF ELTRODE LIMB","95887 - NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION","95912 - MOTOR &/SENS 11-12 NRV CNDJ PRECONF ELTRODE LIMB",null,"95705 - HC EEG W/O VID 2-12 HR UNMNTR",null,null,null,null,"96367 - IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR",null,"94799 - UNLISTED PULMONARY SERVICE/PROCEDURE",null,null,null,"96365 - IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR"]
[null,null,null,"95921 - HC AUTONOMIC NRV PARASYM INERVJ","95905 - HC MOTOR/SENS NERVE CONDUCTION PRECONFIG ELECTRODE ARRAY, EA LIMB","95913 - MOTOR &/SENS 13/> NRV CNDJ PRECONF ELTRODE LIMB",null,"95706 - HC EEG WO VID 2-12HR INTMT MNTR",null,null,null,null,"96368 - IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS",null,"95004 - PERCUTANEOUS TESTS W/ALLERGENIC EXTRACTS",null,null,null,"96366 - IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR"]
[null,null,null,"95923 - HC AUTONOMIC NRV SYST FUNJ TEST","95907 - MOTOR &/SENS 1-2 NRV CNDJ PRECONF ELTRODE LIMB","95921 - HC AUTONOMIC NRV PARASYM INERVJ",null,"95707 - HC EEG W/O VID 2-12HR CONT MNTR",null,null,null,null,"96369 - HC SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR",null,"95017 - ALLG TSTG PERQ & IC VENOMS IMMED REACT W/ I&R",null,null,null,"96367 - IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR"]
[null,null,null,"95924 - TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT","95908 - MOTOR &/SENS 3-4 NRV CNDJ PRECONF ELTRODE LIMB","95923 - HC AUTONOMIC NRV SYST FUNJ TEST",null,"95708 - HC EEG WO VID EA 12-26HR UNMNTR",null,null,null,null,"96370 - HC SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,EA ADD HOUR",null,"95018 - ALLG TEST PERQ & IC DRUG/BIOL IMMED REACT W/ I&R",null,null,null,"96368 - IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS"]
[null,null,null,"95925 - HC SOMATOSENSORY TEST,UPPER LIMBS","95909 - MOTOR &/SENS 5-6 NRV CNDJ PRECONF ELTRODE LIMB","95924 - TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT",null,"95709 - HC EEG W/O VID EA 12-26HR INTMT",null,null,null,null,"96371 - HC SUBQ INFUSION ADDITIONAL PUMP INFUSION SITE",null,"95024 - INTRACUTANEOUS TESTS W/ALLERGENIC EXTRACTS",null,null,null,"96369 - HC SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR"]
[null,null,null,"95926 - SHORT-LATENCY SOMATOSENS EP STD LWR LIMBS","95910 - MOTOR &/SENS 7-8 NRV CNDJ PRECONF ELTRODE LIMB","95925 - HC SOMATOSENSORY TEST,UPPER LIMBS",null,"95710 - HC EEG W/O VID EA 12-26HR CONT",null,null,null,null,"96372 - THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM",null,"95028 - IQ TSTS W/ALLGIC XTRCS DLYD TYP RXN W/READING",null,null,null,"96370 - HC SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,EA ADD HOUR"]
[null,null,null,"95930 - HC VISUAL EP TESTING CNS EXCEPT GLAUCOMA W/I&R","95911 - MOTOR &/SENS 9-10 NRV CNDJ PRECONF ELTRODE LIMB","95926 - SHORT-LATENCY SOMATOSENS EP STD LWR LIMBS",null,"95711 - HC VEEG 2-12 HR UNMONITORED",null,null,null,null,"96374 - THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG",null,"95044 - PATCH/APPLICATION TEST SPECIFY NUMBER TESTS",null,null,null,"96371 - HC SUBQ INFUSION ADDITIONAL PUMP INFUSION SITE"]
[null,null,null,"95933 - ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST","95912 - MOTOR &/SENS 11-12 NRV CNDJ PRECONF ELTRODE LIMB","95930 - HC VISUAL EP TESTING CNS EXCEPT GLAUCOMA W/I&R",null,"95712 - HC VEEG 2-12 HR INTMT MNTR",null,null,null,null,"96375 - THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG",null,"95076 - INGESTION CHALLENGE TEST INITIAL 120 MINUTES",null,null,null,"96372 - THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM"]
[null,null,null,"95937 - NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH","95913 - MOTOR &/SENS 13/> NRV CNDJ PRECONF ELTRODE LIMB","95933 - ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST",null,"95713 - HC VEEG 2-12 HR CONT MNTR",null,null,null,null,"96376 - HC THERAPEUTIC PROPHYLACTIC/DX NJX INTRA-ARTERIAL",null,"95079 - INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES",null,null,null,"96374 - THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG"]
[null,null,null,"95940 - HC IONM 1 ON 1 IN OR W/ATTENDANCE EACH 15 MINUTES","95921 - HC AUTONOMIC NRV PARASYM INERVJ","95937 - NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH",null,"95714 - HC VEEG EA 12-26 HR UNMNTR",null,null,null,null,"96377 - HC APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION",null,"95115 - PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS 1 NJX",null,null,null,"96375 - THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG"]
[null,null,null,"95943 - PARASYMP & SYMP NRV FUNCJ HRT RATE VARIABILITY","95923 - HC AUTONOMIC NRV SYST FUNJ TEST","95940 - HC IONM 1 ON 1 IN OR W/ATTENDANCE EACH 15 MINUTES",null,"95782 - POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND",null,null,null,null,"96401 - CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-NEO",null,"95117 - PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS NJXS",null,null,null,"96376 - HC THERAPEUTIC PROPHYLACTIC/DX NJX INTRA-ARTERIAL"]
[null,null,null,"95958 - WADA ACTIVATION TEST HEMISPHERIC FUNCTION W/EEG","95924 - TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT","95943 - PARASYMP & SYMP NRV FUNCJ HRT RATE VARIABILITY",null,"95783 - POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM",null,null,null,null,"96402 - CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO",null,"95120 - PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX",null,null,null,"96377 - HC APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION"]
[null,null,null,"95961 - HC FUNCJAL CORT & SUBCORT MAPG PHYS/QHP ATTND INIT HR","95925 - HC SOMATOSENSORY TEST,UPPER LIMBS","95958 - WADA ACTIVATION TEST HEMISPHERIC FUNCTION W/EEG",null,"95803 - ACTIGRAPHY TESTING RECORDING ANALYSIS I&R",null,null,null,null,"96405 - HC INTRALESIONAL CHEMO ADMIN,<8 LESN",null,"95144 - PREPJ& ANTIGEN PRV ALLERGEN IMMUNOTHERAPY 1 DO",null,null,null,"96401 - CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-NEO"]
[null,null,null,"95962 - HC FUNCJAL CORT & SUBCORT MAPG PHYS/QHP ATTND ADDL HR","95926 - SHORT-LATENCY SOMATOSENS EP STD LWR LIMBS","95961 - HC FUNCJAL CORT & SUBCORT MAPG PHYS/QHP ATTND INIT HR",null,"95805 - HC MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG",null,null,null,null,"96409 - CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG",null,"95145 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 1 INSECT",null,null,null,"96402 - CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO"]
[null,null,null,"95966 - HC MEG,EVOKED MAGNET FIELDS, SINGLE MODAL","95930 - HC VISUAL EP TESTING CNS EXCEPT GLAUCOMA W/I&R","95962 - HC FUNCJAL CORT & SUBCORT MAPG PHYS/QHP ATTND ADDL HR",null,"95806 - SLEEP STUDY, UNATTENDED, SIMUL RECORD HR/O2 SAT/RESP FLOW/RESP EFF",null,null,null,null,"96411 - CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG",null,"95146 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 2 INSECT",null,null,null,"96405 - HC INTRALESIONAL CHEMO ADMIN,<8 LESN"]
[null,null,null,"95970 - ELEC ALYS NSTIM PLS GEN BRN/SC/PERPH W/O REPRGRM","95933 - ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST","95966 - HC MEG,EVOKED MAGNET FIELDS, SINGLE MODAL",null,"95808 - POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND",null,null,null,null,"96413 - CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG",null,"95148 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 4 INSECT",null,null,null,"96409 - CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG"]
[null,null,null,"95971 - ELEC ALYS NSTIM PLS GEN SMPL SC/PERPH W/PRGRMG","95937 - NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH","95970 - ELEC ALYS NSTIM PLS GEN BRN/SC/PERPH W/O REPRGRM",null,"95810 - POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",null,null,null,null,"96415 - CHEMOTHERAPY ADMN IV INFUSION TQ EA HR",null,"95149 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 5 INSECT",null,null,null,"96411 - CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG"]
[null,null,null,"95972 - ELEC ALYS NSTIM PLS GEN CPLX SC/PERPH 1ST HR","95940 - HC IONM 1 ON 1 IN OR W/ATTENDANCE EACH 15 MINUTES","95971 - ELEC ALYS NSTIM PLS GEN SMPL SC/PERPH W/PRGRMG",null,"95811 - POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND",null,null,null,null,"96416 - CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP",null,"95165 - PREPJ& ALLERGEN IMMUNOTHERAPY 1/MLT ANTIGEN",null,null,null,"96413 - CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG"]
[null,null,null,"95976 - HC ALYS SMPL CN NPGT PRGRMG","95943 - PARASYMP & SYMP NRV FUNCJ HRT RATE VARIABILITY","95972 - ELEC ALYS NSTIM PLS GEN CPLX SC/PERPH 1ST HR",null,"95812 - ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN",null,null,null,null,"96417 - CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR",null,"95170 - PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY WHL INSE",null,null,null,"96415 - CHEMOTHERAPY ADMN IV INFUSION TQ EA HR"]
[null,null,null,"95977 - HC ALYS CPLX CN NPGT PRGRMG","95958 - WADA ACTIVATION TEST HEMISPHERIC FUNCTION W/EEG","95976 - HC ALYS SMPL CN NPGT PRGRMG",null,"95813 - ELECTROENCEPHALOGRAM EXTND MNTR >1 HR",null,null,null,null,"96450 - CHEMOTX ADMN CNS REQ SPINAL PUNCTURE",null,"95180 - HC RAPID DESENSITIZATION PROC,EACH HOUR",null,null,null,"96416 - CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP"]
[null,null,null,"95983 - HC ALYS BRN NPGT PRGRMG 15 MIN","95961 - HC FUNCJAL CORT & SUBCORT MAPG PHYS/QHP ATTND INIT HR","95977 - HC ALYS CPLX CN NPGT PRGRMG",null,"95816 - ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY",null,null,null,null,"96521 - REFILLING & MAINTENANCE PORTABLE PUMP",null,"95199 - PR ALLERGY SP SUBLINGUAL IMMUNOTHERAPY ADMIN",null,null,null,"96417 - CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR"]
[null,null,null,"95984 - HC ALYS BRN NPGT PRGRMG ADDL 15","95962 - HC FUNCJAL CORT & SUBCORT MAPG PHYS/QHP ATTND ADDL HR","95983 - HC ALYS BRN NPGT PRGRMG 15 MIN",null,"95819 - ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP",null,null,null,null,"96523 - IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST",null,"95249 - HC CONT GLUC MONITORING PATIENT PROVIDED EQUIPMENT",null,null,null,"96450 - CHEMOTX ADMN CNS REQ SPINAL PUNCTURE"]
[null,null,null,"95990 - REFILL&MAINTENANCE PUMP DRUG DLVR SPINAL/BRAIN","95966 - HC MEG,EVOKED MAGNET FIELDS, SINGLE MODAL","95984 - HC ALYS BRN NPGT PRGRMG ADDL 15",null,"95824 - ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY",null,null,null,null,"96542 - HC CHEMOTHER INJECT,CUBARACH/INTRAVENT",null,"95250 - GLUC MNTR CONT REC FROM INTERSTITIAL TISS FLUID",null,null,null,"96521 - REFILLING & MAINTENANCE PORTABLE PUMP"]
[null,null,null,"95991 - RFL&MAIN IMPLT PMP/RSVR DLVR SPI/BRN PHY/QHP","95970 - ELEC ALYS NSTIM PLS GEN BRN/SC/PERPH W/O REPRGRM","95990 - REFILL&MAINTENANCE PUMP DRUG DLVR SPINAL/BRAIN",null,"95831 - MUSCLE TESTING EXTREMITY OR TRUNK",null,null,null,null,"96567 - PDT XTRNL APPL LIGHT DSTR LES SKN BY ACTIVJ RX",null,"95700 - HC EEG CONT REC W/VID EEG TECH",null,null,null,"96523 - IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST"]
[null,null,null,"95992 - CANALITH REPOSITIONING PROCEDURE","95971 - ELEC ALYS NSTIM PLS GEN SMPL SC/PERPH W/PRGRMG","95991 - RFL&MAIN IMPLT PMP/RSVR DLVR SPI/BRN PHY/QHP",null,"95851 - HC RANGE MOTION MEASURE,EACH EXTREM",null,null,null,null,"96900 - ACTINOTHERAPY ULTRAVIOLET LIGHT",null,"95705 - HC EEG W/O VID 2-12 HR UNMNTR",null,null,null,"96542 - HC CHEMOTHER INJECT,CUBARACH/INTRAVENT"]
[null,null,null,"96040 - MEDICAL GENETICS COUNSELING EACH 30 MINUTES","95972 - ELEC ALYS NSTIM PLS GEN CPLX SC/PERPH 1ST HR","95992 - CANALITH REPOSITIONING PROCEDURE",null,"95852 - HC ROM MEAS;HAND(S)",null,null,null,null,"96910 - PHOTOCHEMOTX TAR&UVB/PETROLATUM/UVB",null,"95706 - HC EEG WO VID 2-12HR INTMT MNTR",null,null,null,"96567 - PDT XTRNL APPL LIGHT DSTR LES SKN BY ACTIVJ RX"]
[null,null,null,"96105 - ASSESSMENT PHASIA W/INTERP & REPORT PER HOUR","95976 - HC ALYS SMPL CN NPGT PRGRMG","96040 - MEDICAL GENETICS COUNSELING EACH 30 MINUTES",null,"95860 - NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS",null,null,null,null,"97151 - HC BHV ID ASSMT BY PHYS/QHP",null,"95707 - HC EEG W/O VID 2-12HR CONT MNTR",null,null,null,"96900 - ACTINOTHERAPY ULTRAVIOLET LIGHT"]
[null,null,null,"96110 - DEVELOPMENTAL SCREENING W/INTERP&REPRT STD FOR","95977 - HC ALYS CPLX CN NPGT PRGRMG","96101 - PSYCHOLOGICAL TESTING PR HR WITH PATIENT",null,"95861 - NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS",null,null,null,null,"97152 - HC BHV ID SUPRT ASSMT BY 1 TECH",null,"95708 - HC EEG WO VID EA 12-26HR UNMNTR",null,null,null,"96910 - PHOTOCHEMOTX TAR&UVB/PETROLATUM/UVB"]
[null,null,null,"96112 - HC DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR","95983 - HC ALYS BRN NPGT PRGRMG 15 MIN","96105 - ASSESSMENT PHASIA W/INTERP & REPORT PER HOUR",null,"95863 - NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS",null,null,null,null,"97153 - HC ADAPTIVE BEHAVIOR TX BY TECH",null,"95709 - HC EEG W/O VID EA 12-26HR INTMT",null,null,null,"97151 - HC BHV ID ASSMT BY PHYS/QHP"]
[null,null,null,"96113 - HC DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN","95984 - HC ALYS BRN NPGT PRGRMG ADDL 15","96110 - DEVELOPMENTAL SCREENING W/INTERP&REPRT STD FOR",null,"95864 - NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS",null,null,null,null,"97154 - HC GRP ADAPT BHV TX BY TECH",null,"95710 - HC EEG W/O VID EA 12-26HR CONT",null,null,null,"97152 - HC BHV ID SUPRT ASSMT BY 1 TECH"]
[null,null,null,"96116 - NUBHVL STATUS XM PR HR W/PT INTERPJ&PREPJ","95990 - REFILL&MAINTENANCE PUMP DRUG DLVR SPINAL/BRAIN","96112 - HC DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR",null,"95865 - NEEDLE ELECTROMYOGRAPHY LARYNX",null,null,null,null,"97155 - HC ADAPT BEHAVIOR TX PHYS/QHP",null,"95711 - HC VEEG 2-12 HR UNMONITORED",null,null,null,"97153 - HC ADAPTIVE BEHAVIOR TX BY TECH"]
[null,null,null,"96121 - HC NEUROBEHAVIORAL STATUS XM PHYS/QHP EA ADDL HOUR","95991 - RFL&MAIN IMPLT PMP/RSVR DLVR SPI/BRN PHY/QHP","96113 - HC DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN",null,"95866 - NEEDLE ELECTROMYOGRAPHY HEMIDIAPHRAGM",null,null,null,null,"97156 - HC FAM ADAPT BHV TX GDN PHY/QHP",null,"95712 - HC VEEG 2-12 HR INTMT MNTR",null,null,null,"97154 - HC GRP ADAPT BHV TX BY TECH"]
[null,null,null,"96125 - STANDARDIZED COGNITIVE PERFORMANCE TESTING","95992 - CANALITH REPOSITIONING PROCEDURE","96116 - NUBHVL STATUS XM PR HR W/PT INTERPJ&PREPJ",null,"95867 - NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI",null,null,null,null,"97157 - HC MULT FAM ADAPT BHV TX GDN",null,"95713 - HC VEEG 2-12 HR CONT MNTR",null,null,null,"97155 - HC ADAPT BEHAVIOR TX PHYS/QHP"]
[null,null,null,"96127 - BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT","96040 - MEDICAL GENETICS COUNSELING EACH 30 MINUTES","96121 - HC NEUROBEHAVIORAL STATUS XM PHYS/QHP EA ADDL HOUR",null,"95868 - NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI",null,null,null,null,"97158 - HC GRP ADAPT BHV TX BY PHY/QHP",null,"95714 - HC VEEG EA 12-26 HR UNMNTR",null,null,null,"97156 - HC FAM ADAPT BHV TX GDN PHY/QHP"]
[null,null,null,"96130 - HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR","96105 - ASSESSMENT PHASIA W/INTERP & REPORT PER HOUR","96125 - STANDARDIZED COGNITIVE PERFORMANCE TESTING",null,"95869 - NEEDLE EMG THRC PARASPI MUSC EXCLUDING T1/T12",null,null,null,null,"97597 - DEBRIDEMENT OPEN WOUND 20 SQ CM/<",null,"95782 - POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND",null,null,null,"97157 - HC MULT FAM ADAPT BHV TX GDN"]
[null,null,null,"96131 - HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR","96110 - DEVELOPMENTAL SCREENING W/INTERP&REPRT STD FOR","96127 - BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT",null,"95870 - NEEDLE EMG LMTD STD MUSC 1 XTR/NON-LIMB UNI/BI",null,null,null,null,"97598 - DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM",null,"95783 - POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM",null,null,null,"97158 - HC GRP ADAPT BHV TX BY PHY/QHP"]
[null,null,null,"96132 - HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR","96112 - HC DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR","96130 - HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR",null,"95872 - NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER",null,null,null,null,"97602 - RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS",null,"95803 - ACTIGRAPHY TESTING RECORDING ANALYSIS I&R",null,null,null,"97597 - DEBRIDEMENT OPEN WOUND 20 SQ CM/<"]
[null,null,null,"96133 - HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR","96113 - HC DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN","96131 - HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR",null,"95873 - ELECTRICAL STIMULATION GUID W/CHEMODENERVATION",null,null,null,null,"97605 - NEGATIVE PRESSURE WOUND THERAPY </= 50 SQ CM",null,"95805 - HC MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG",null,null,null,"97598 - DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM"]
[null,null,null,"96136 - HC PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN","96116 - NUBHVL STATUS XM PR HR W/PT INTERPJ&PREPJ","96132 - HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR",null,"95874 - NEEDLE EMG GUID W/CHEMODENERVATION",null,null,null,null,"97606 - NEGATIVE PRESSURE WOUND THERAPY >50 SQ CM",null,"95806 - SLEEP STUDY, UNATTENDED, SIMUL RECORD HR/O2 SAT/RESP FLOW/RESP EFF",null,null,null,"97602 - RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS"]
[null,null,null,"96137 - HC PSYCL/NRPSYCL TST PHYS/QHP 2+ TST EA ADDL 30 MIN","96121 - HC NEUROBEHAVIORAL STATUS XM PHYS/QHP EA ADDL HOUR","96133 - HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR",null,"95885 - NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED",null,null,null,null,"97802 - MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI",null,"95808 - POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND",null,null,null,"97605 - NEGATIVE PRESSURE WOUND THERAPY </= 50 SQ CM"]
[null,null,null,"96138 - HC PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN","96125 - STANDARDIZED COGNITIVE PERFORMANCE TESTING","96136 - HC PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN",null,"95886 - NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE",null,null,null,null,"97803 - MEDICAL NUTRITION RE-ASSMT&IVNTJ INDIV EA 15 M",null,"95810 - POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",null,null,null,"97606 - NEGATIVE PRESSURE WOUND THERAPY >50 SQ CM"]
[null,null,null,"96139 - HC PSYCL/NRPSYCL TST TECH 2+ TST EA ADDL 30 MIN","96127 - BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT","96137 - HC PSYCL/NRPSYCL TST PHYS/QHP 2+ TST EA ADDL 30 MIN",null,"95887 - NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION",null,null,null,null,"97804 - MEDICAL NUTRITION THERAPY GRP2/ INDIV EA 30 MI",null,"95811 - POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND",null,null,null,"97802 - MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI"]
[null,null,null,"96156 - HC HLTH BHV ASSMT/REASSESSMENT","96130 - HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR","96138 - HC PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN",null,"95905 - HC MOTOR/SENS NERVE CONDUCTION PRECONFIG ELECTRODE ARRAY, EA LIMB",null,null,null,null,"98925 - HC OSTEOPATHIC MANIP,1-2 BODY REGN",null,"95812 - ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN",null,null,null,"97803 - MEDICAL NUTRITION RE-ASSMT&IVNTJ INDIV EA 15 M"]
[null,null,null,"96158 - HC HLTH BHV IVNTJ INDIV 1ST 30","96131 - HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR","96139 - HC PSYCL/NRPSYCL TST TECH 2+ TST EA ADDL 30 MIN",null,"95907 - MOTOR &/SENS 1-2 NRV CNDJ PRECONF ELTRODE LIMB",null,null,null,null,"99151 - HC MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS",null,"95813 - ELECTROENCEPHALOGRAM EXTND MNTR >1 HR",null,null,null,"97804 - MEDICAL NUTRITION THERAPY GRP2/ INDIV EA 30 MI"]
[null,null,null,"96159 - HC HLTH BHV IVNTJ INDIV EA ADDL","96132 - HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR","96156 - HC HLTH BHV ASSMT/REASSESSMENT",null,"95908 - MOTOR &/SENS 3-4 NRV CNDJ PRECONF ELTRODE LIMB",null,null,null,null,"99152 - HC MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS",null,"95816 - ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY",null,null,null,"98925 - HC OSTEOPATHIC MANIP,1-2 BODY REGN"]
[null,null,null,"96160 - PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM","96133 - HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR","96158 - HC HLTH BHV IVNTJ INDIV 1ST 30",null,"95909 - MOTOR &/SENS 5-6 NRV CNDJ PRECONF ELTRODE LIMB",null,null,null,null,"99153 - HC MOD SED SAME PHYS/QHP EACH ADDL 15 MINS",null,"95819 - ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP",null,null,null,"99151 - HC MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS"]
[null,null,null,"96161 - CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM","96136 - HC PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN","96159 - HC HLTH BHV IVNTJ INDIV EA ADDL",null,"95910 - MOTOR &/SENS 7-8 NRV CNDJ PRECONF ELTRODE LIMB",null,null,null,null,"99155 - HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS",null,"95824 - ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY",null,null,null,"99152 - HC MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS"]
[null,null,null,"96164 - HC HLTH BHV IVNTJ GRP 1ST 30","96137 - HC PSYCL/NRPSYCL TST PHYS/QHP 2+ TST EA ADDL 30 MIN","96160 - PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM",null,"95911 - MOTOR &/SENS 9-10 NRV CNDJ PRECONF ELTRODE LIMB",null,null,null,null,"99156 - HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS",null,"95831 - MUSCLE TESTING EXTREMITY OR TRUNK",null,null,null,"99153 - HC MOD SED SAME PHYS/QHP EACH ADDL 15 MINS"]
[null,null,null,"96165 - HC HLTH BHV IVNTJ GRP EA ADDL","96138 - HC PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN","96161 - CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM",null,"95912 - MOTOR &/SENS 11-12 NRV CNDJ PRECONF ELTRODE LIMB",null,null,null,null,"99157 - HC MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS",null,"95851 - HC RANGE MOTION MEASURE,EACH EXTREM",null,null,null,"99155 - HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS"]
[null,null,null,"96167 - HC HLTH BHV IVNTJ FAM 1ST 30","96139 - HC PSYCL/NRPSYCL TST TECH 2+ TST EA ADDL 30 MIN","96164 - HC HLTH BHV IVNTJ GRP 1ST 30",null,"95913 - MOTOR &/SENS 13/> NRV CNDJ PRECONF ELTRODE LIMB",null,null,null,null,"99195 - PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE",null,"95852 - HC ROM MEAS;HAND(S)",null,null,null,"99156 - HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS"]
[null,null,null,"96168 - HC HLTH BHV IVNTJ FAM EA ADDL","96156 - HC HLTH BHV ASSMT/REASSESSMENT","96165 - HC HLTH BHV IVNTJ GRP EA ADDL",null,"95921 - HC AUTONOMIC NRV PARASYM INERVJ",null,null,null,null,"99453 - REM MNTR PHYSIOL PARAM SETUP",null,"95860 - NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS",null,null,null,"99157 - HC MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS"]
[null,null,null,"96170 - HC HLTH BHV IVNTJ FAM WO PT 1ST","96158 - HC HLTH BHV IVNTJ INDIV 1ST 30","96167 - HC HLTH BHV IVNTJ FAM 1ST 30",null,"95923 - HC AUTONOMIC NRV SYST FUNJ TEST",null,null,null,null,"99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D",null,"95861 - NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS",null,null,null,"99195 - PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE"]
[null,null,null,"96171 - HC HLTH BHV IVNTJ FAM W/O PT EA","96159 - HC HLTH BHV IVNTJ INDIV EA ADDL","96168 - HC HLTH BHV IVNTJ FAM EA ADDL",null,"95924 - TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT",null,null,null,null,"0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",null,"95863 - NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS",null,null,null,"99453 - REM MNTR PHYSIOL PARAM SETUP"]
[null,null,null,"96360 - IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR","96160 - PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM","96170 - HC HLTH BHV IVNTJ FAM WO PT 1ST",null,"95925 - HC SOMATOSENSORY TEST,UPPER LIMBS",null,null,null,null,"0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",null,"95864 - NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS",null,null,null,"99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D"]
[null,null,null,"96361 - IV INFUSION HYDRATION EACH ADDITIONAL HOUR","96161 - CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM","96171 - HC HLTH BHV IVNTJ FAM W/O PT EA",null,"95926 - SHORT-LATENCY SOMATOSENS EP STD LWR LIMBS",null,null,null,null,"0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",null,"95865 - NEEDLE ELECTROMYOGRAPHY LARYNX",null,null,null,"0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST"]
[null,null,null,"96365 - IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR","96164 - HC HLTH BHV IVNTJ GRP 1ST 30","96360 - IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR",null,"95930 - HC VISUAL EP TESTING CNS EXCEPT GLAUCOMA W/I&R",null,null,null,null,"0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",null,"95866 - NEEDLE ELECTROMYOGRAPHY HEMIDIAPHRAGM",null,null,null,"0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND"]
[null,null,null,"96366 - IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR","96165 - HC HLTH BHV IVNTJ GRP EA ADDL","96361 - IV INFUSION HYDRATION EACH ADDITIONAL HOUR",null,"95933 - ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST",null,null,null,null,"0106T - HC QUANT SENSORY TEST, PER EXTREMITY, TOUCH STIMULI",null,"95867 - NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI",null,null,null,"0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST"]
[null,null,null,"96367 - IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR","96167 - HC HLTH BHV IVNTJ FAM 1ST 30","96365 - IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR",null,"95937 - NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH",null,null,null,null,"0126T - HC COMMON CAROTID INTIMA-MEDIA THICK FOR AHD/CHD RISK ASSESS",null,"95868 - NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI",null,null,null,"0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND"]
[null,null,null,"96368 - IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS","96168 - HC HLTH BHV IVNTJ FAM EA ADDL","96366 - IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR",null,"95940 - HC IONM 1 ON 1 IN OR W/ATTENDANCE EACH 15 MINUTES",null,null,null,null,"0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",null,"95869 - NEEDLE EMG THRC PARASPI MUSC EXCLUDING T1/T12",null,null,null,"0106T - HC QUANT SENSORY TEST, PER EXTREMITY, TOUCH STIMULI"]
[null,null,null,"96369 - HC SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR","96170 - HC HLTH BHV IVNTJ FAM WO PT 1ST","96367 - IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR",null,"95943 - PARASYMP & SYMP NRV FUNCJ HRT RATE VARIABILITY",null,null,null,null,"0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",null,"95870 - NEEDLE EMG LMTD STD MUSC 1 XTR/NON-LIMB UNI/BI",null,null,null,"0126T - HC COMMON CAROTID INTIMA-MEDIA THICK FOR AHD/CHD RISK ASSESS"]
[null,null,null,"96370 - HC SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,EA ADD HOUR","96171 - HC HLTH BHV IVNTJ FAM W/O PT EA","96368 - IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS",null,"95951 - LOCALIZE CEREBRAL SEIZURE CABLE/RADIO EEG/VIDEO",null,null,null,null,"0207T - HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL",null,"95872 - NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER",null,null,null,"0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR"]
[null,null,null,"96371 - HC SUBQ INFUSION ADDITIONAL PUMP INFUSION SITE","96360 - IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR","96369 - HC SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR",null,"95953 - LOCALIZE CEREBRAL SEIZURE CPTR PORTABLE EEG",null,null,null,null,"0234T - HC TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA",null,"95873 - ELECTRICAL STIMULATION GUID W/CHEMODENERVATION",null,null,null,"0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2"]
[null,null,null,"96372 - THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM","96361 - IV INFUSION HYDRATION EACH ADDITIONAL HOUR","96370 - HC SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,EA ADD HOUR",null,"95958 - WADA ACTIVATION TEST HEMISPHERIC FUNCTION W/EEG",null,null,null,null,"0236T - HC TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA",null,"95874 - NEEDLE EMG GUID W/CHEMODENERVATION",null,null,null,"0207T - HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL"]
[null,null,null,"96374 - THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG","96365 - IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR","96371 - HC SUBQ INFUSION ADDITIONAL PUMP INFUSION SITE",null,"95961 - HC FUNCJAL CORT & SUBCORT MAPG PHYS/QHP ATTND INIT HR",null,null,null,null,"0237T - HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL",null,"95885 - NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED",null,null,null,"0234T - HC TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA"]
[null,null,null,"96375 - THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG","96366 - IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR","96372 - THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM",null,"95962 - HC FUNCJAL CORT & SUBCORT MAPG PHYS/QHP ATTND ADDL HR",null,null,null,null,"0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA",null,"95886 - NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE",null,null,null,"0236T - HC TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA"]
[null,null,null,"96376 - HC THERAPEUTIC PROPHYLACTIC/DX NJX INTRA-ARTERIAL","96367 - IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR","96374 - THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG",null,"95966 - HC MEG,EVOKED MAGNET FIELDS, SINGLE MODAL",null,null,null,null,"0241U - HC NFCT DS VIR RESP RNA 4 TRGT",null,"95887 - NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION",null,null,null,"0237T - HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL"]
[null,null,null,"96377 - HC APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION","96368 - IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS","96375 - THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG",null,"95970 - ELEC ALYS NSTIM PLS GEN BRN/SC/PERPH W/O REPRGRM",null,null,null,null,"0505T - HC EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR",null,"95905 - HC MOTOR/SENS NERVE CONDUCTION PRECONFIG ELECTRODE ARRAY, EA LIMB",null,null,null,"0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA"]
[null,null,null,"96401 - CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-NEO","96369 - HC SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR","96376 - HC THERAPEUTIC PROPHYLACTIC/DX NJX INTRA-ARTERIAL",null,"95971 - ELEC ALYS NSTIM PLS GEN SMPL SC/PERPH W/PRGRMG",null,null,null,null,"0509T - HC PATTERN ERG W/I&R",null,"95907 - MOTOR &/SENS 1-2 NRV CNDJ PRECONF ELTRODE LIMB",null,null,null,"0241U - HC NFCT DS VIR RESP RNA 4 TRGT"]
[null,null,null,"96402 - CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO","96370 - HC SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,EA ADD HOUR","96377 - HC APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION",null,"95972 - ELEC ALYS NSTIM PLS GEN CPLX SC/PERPH 1ST HR",null,null,null,null,"0523T - HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING",null,"95908 - MOTOR &/SENS 3-4 NRV CNDJ PRECONF ELTRODE LIMB",null,null,null,"0505T - HC EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR"]
[null,null,null,"96405 - HC INTRALESIONAL CHEMO ADMIN,<8 LESN","96371 - HC SUBQ INFUSION ADDITIONAL PUMP INFUSION SITE","96401 - CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-NEO",null,"95975 - ELEC ALYS NSTIM PLS GEN CPLX CRNL NRV EA 30 MIN",null,null,null,null,"0524T - HC EV CATHETER DIR CHEM ABLTJ INCMPTNT XTR VEIN",null,"95909 - MOTOR &/SENS 5-6 NRV CNDJ PRECONF ELTRODE LIMB",null,null,null,"0509T - HC PATTERN ERG W/I&R"]
[null,null,null,"96409 - CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG","96372 - THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM","96402 - CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO",null,"95976 - HC ALYS SMPL CN NPGT PRGRMG",null,null,null,null,"G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",null,"95910 - MOTOR &/SENS 7-8 NRV CNDJ PRECONF ELTRODE LIMB",null,null,null,"0523T - HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING"]
[null,null,null,"96411 - CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG","96374 - THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG","96405 - HC INTRALESIONAL CHEMO ADMIN,<8 LESN",null,"95977 - HC ALYS CPLX CN NPGT PRGRMG",null,null,null,null,"U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",null,"95911 - MOTOR &/SENS 9-10 NRV CNDJ PRECONF ELTRODE LIMB",null,null,null,"0524T - HC EV CATHETER DIR CHEM ABLTJ INCMPTNT XTR VEIN"]
[null,null,null,"96413 - CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG","96375 - THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG","96409 - CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG",null,"95979 - ELEC ALYS NSTIM PLS GEN CPLX DP BRN EA 30 MIN",null,null,null,null,null,null,"95912 - MOTOR &/SENS 11-12 NRV CNDJ PRECONF ELTRODE LIMB",null,null,null,"G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA"]
[null,null,null,"96415 - CHEMOTHERAPY ADMN IV INFUSION TQ EA HR","96376 - HC THERAPEUTIC PROPHYLACTIC/DX NJX INTRA-ARTERIAL","96411 - CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG",null,"95983 - HC ALYS BRN NPGT PRGRMG 15 MIN",null,null,null,null,null,null,"95913 - MOTOR &/SENS 13/> NRV CNDJ PRECONF ELTRODE LIMB",null,null,null,"U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV"]
[null,null,null,"96416 - CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP","96377 - HC APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION","96413 - CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG",null,"95984 - HC ALYS BRN NPGT PRGRMG ADDL 15",null,null,null,null,null,null,"95921 - HC AUTONOMIC NRV PARASYM INERVJ"]
[null,null,null,"96417 - CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR","96401 - CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-NEO","96415 - CHEMOTHERAPY ADMN IV INFUSION TQ EA HR",null,"95990 - REFILL&MAINTENANCE PUMP DRUG DLVR SPINAL/BRAIN",null,null,null,null,null,null,"95923 - HC AUTONOMIC NRV SYST FUNJ TEST"]
[null,null,null,"96450 - CHEMOTX ADMN CNS REQ SPINAL PUNCTURE","96402 - CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO","96416 - CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP",null,"95991 - RFL&MAIN IMPLT PMP/RSVR DLVR SPI/BRN PHY/QHP",null,null,null,null,null,null,"95924 - TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT"]
[null,null,null,"96521 - REFILLING & MAINTENANCE PORTABLE PUMP","96405 - HC INTRALESIONAL CHEMO ADMIN,<8 LESN","96417 - CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR",null,"95992 - CANALITH REPOSITIONING PROCEDURE",null,null,null,null,null,null,"95925 - HC SOMATOSENSORY TEST,UPPER LIMBS"]
[null,null,null,"96523 - IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST","96409 - CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG","96450 - CHEMOTX ADMN CNS REQ SPINAL PUNCTURE",null,"96020 - HC TEST SELECT & ADMN FUNCTL BRAIN MAP PHYS/QHP",null,null,null,null,null,null,"95926 - SHORT-LATENCY SOMATOSENS EP STD LWR LIMBS"]
[null,null,null,"96542 - HC CHEMOTHER INJECT,CUBARACH/INTRAVENT","96411 - CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG","96521 - REFILLING & MAINTENANCE PORTABLE PUMP",null,"96040 - MEDICAL GENETICS COUNSELING EACH 30 MINUTES",null,null,null,null,null,null,"95930 - HC VISUAL EP TESTING CNS EXCEPT GLAUCOMA W/I&R"]
[null,null,null,"96567 - PDT XTRNL APPL LIGHT DSTR LES SKN BY ACTIVJ RX","96413 - CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG","96523 - IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST",null,"96105 - ASSESSMENT PHASIA W/INTERP & REPORT PER HOUR",null,null,null,null,null,null,"95933 - ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST"]
[null,null,null,"96900 - ACTINOTHERAPY ULTRAVIOLET LIGHT","96415 - CHEMOTHERAPY ADMN IV INFUSION TQ EA HR","96542 - HC CHEMOTHER INJECT,CUBARACH/INTRAVENT",null,"96110 - DEVELOPMENTAL SCREENING W/INTERP&REPRT STD FOR",null,null,null,null,null,null,"95937 - NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH"]
[null,null,null,"96910 - PHOTOCHEMOTX TAR&UVB/PETROLATUM/UVB","96416 - CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP","96567 - PDT XTRNL APPL LIGHT DSTR LES SKN BY ACTIVJ RX",null,"96112 - HC DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR",null,null,null,null,null,null,"95940 - HC IONM 1 ON 1 IN OR W/ATTENDANCE EACH 15 MINUTES"]
[null,null,null,"97012 - HC APPL MODALITY 1/> AREAS TRACTION MECHANICAL","96417 - CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR","96900 - ACTINOTHERAPY ULTRAVIOLET LIGHT",null,"96113 - HC DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN",null,null,null,null,null,null,"95943 - PARASYMP & SYMP NRV FUNCJ HRT RATE VARIABILITY"]
[null,null,null,"97014 - HC APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED","96450 - CHEMOTX ADMN CNS REQ SPINAL PUNCTURE","96910 - PHOTOCHEMOTX TAR&UVB/PETROLATUM/UVB",null,"96116 - NUBHVL STATUS XM PR HR W/PT INTERPJ&PREPJ",null,null,null,null,null,null,"95951 - LOCALIZE CEREBRAL SEIZURE CABLE/RADIO EEG/VIDEO"]
[null,null,null,"97018 - HC APPL MODALITY 1/> AREAS PARAFFIN BATH","96521 - REFILLING & MAINTENANCE PORTABLE PUMP","97012 - HC APPL MODALITY 1/> AREAS TRACTION MECHANICAL",null,"96121 - HC NEUROBEHAVIORAL STATUS XM PHYS/QHP EA ADDL HOUR",null,null,null,null,null,null,"95953 - LOCALIZE CEREBRAL SEIZURE CPTR PORTABLE EEG"]
[null,null,null,"97022 - HC APPLICATION MODALITY 1/> AREAS WHIRLPOOL","96523 - IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST","97014 - HC APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED",null,"96127 - BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT",null,null,null,null,null,null,"95958 - WADA ACTIVATION TEST HEMISPHERIC FUNCTION W/EEG"]
[null,null,null,"97032 - HC APPL MODALITY 1/> AREAS ELEC STIMJ EA 15 MIN","96542 - HC CHEMOTHER INJECT,CUBARACH/INTRAVENT","97018 - HC APPL MODALITY 1/> AREAS PARAFFIN BATH",null,"96130 - HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR",null,null,null,null,null,null,"95961 - HC FUNCJAL CORT & SUBCORT MAPG PHYS/QHP ATTND INIT HR"]
[null,null,null,"97033 - APPL MODALITY 1/> AREAS IONTOPHORESIS EA 15 MIN","96567 - PDT XTRNL APPL LIGHT DSTR LES SKN BY ACTIVJ RX","97022 - HC APPLICATION MODALITY 1/> AREAS WHIRLPOOL",null,"96131 - HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR",null,null,null,null,null,null,"95962 - HC FUNCJAL CORT & SUBCORT MAPG PHYS/QHP ATTND ADDL HR"]
[null,null,null,"97035 - HC APPL MODALITY 1/> AREAS ULTRASOUND EA 15 MIN","96900 - ACTINOTHERAPY ULTRAVIOLET LIGHT","97032 - HC APPL MODALITY 1/> AREAS ELEC STIMJ EA 15 MIN",null,"96132 - HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR",null,null,null,null,null,null,"95966 - HC MEG,EVOKED MAGNET FIELDS, SINGLE MODAL"]
[null,null,null,"97110 - THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES","96910 - PHOTOCHEMOTX TAR&UVB/PETROLATUM/UVB","97033 - APPL MODALITY 1/> AREAS IONTOPHORESIS EA 15 MIN",null,"96133 - HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR",null,null,null,null,null,null,"95970 - ELEC ALYS NSTIM PLS GEN BRN/SC/PERPH W/O REPRGRM"]
[null,null,null,"97112 - HC THER PX 1/> AREAS EACH 15 MIN NEUROMUSC REEDUCA","97012 - HC APPL MODALITY 1/> AREAS TRACTION MECHANICAL","97035 - HC APPL MODALITY 1/> AREAS ULTRASOUND EA 15 MIN",null,"96136 - HC PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN",null,null,null,null,null,null,"95971 - ELEC ALYS NSTIM PLS GEN SMPL SC/PERPH W/PRGRMG"]
[null,null,null,"97116 - HC THER PX 1/> AREAS EA 15 MIN GAIT TRAINJ W/STAIR","97014 - HC APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED","97110 - THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES",null,"96137 - HC PSYCL/NRPSYCL TST PHYS/QHP 2+ TST EA ADDL 30 MIN",null,null,null,null,null,null,"95972 - ELEC ALYS NSTIM PLS GEN CPLX SC/PERPH 1ST HR"]
[null,null,null,"97124 - HC THER PX 1 AREAS EA 15 MIN MASSAGE","97018 - HC APPL MODALITY 1/> AREAS PARAFFIN BATH","97112 - HC THER PX 1/> AREAS EACH 15 MIN NEUROMUSC REEDUCA",null,"96138 - HC PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN",null,null,null,null,null,null,"95975 - ELEC ALYS NSTIM PLS GEN CPLX CRNL NRV EA 30 MIN"]
[null,null,null,"97129 - HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES","97022 - HC APPLICATION MODALITY 1/> AREAS WHIRLPOOL","97116 - HC THER PX 1/> AREAS EA 15 MIN GAIT TRAINJ W/STAIR",null,"96139 - HC PSYCL/NRPSYCL TST TECH 2+ TST EA ADDL 30 MIN",null,null,null,null,null,null,"95976 - HC ALYS SMPL CN NPGT PRGRMG"]
[null,null,null,"97130 - HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTE","97032 - HC APPL MODALITY 1/> AREAS ELEC STIMJ EA 15 MIN","97124 - HC THER PX 1 AREAS EA 15 MIN MASSAGE",null,"96146 - HC PSYCL/NRPSYCL TST ELEC PLATFORM AUTO RESULT",null,null,null,null,null,null,"95977 - HC ALYS CPLX CN NPGT PRGRMG"]
[null,null,null,"97140 - HC MANUAL THER TECH,1+REGIONS,EA 15 MIN","97033 - APPL MODALITY 1/> AREAS IONTOPHORESIS EA 15 MIN","97129 - HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES",null,"96150 - HC HEAL & BEHAV ASSESS,EA 15 MIN,INIT",null,null,null,null,null,null,"95979 - ELEC ALYS NSTIM PLS GEN CPLX DP BRN EA 30 MIN"]
[null,null,null,"97150 - HC THERAPEUTIC PROCEDURES GROUP 2/> INDIVIDUALS","97035 - HC APPL MODALITY 1/> AREAS ULTRASOUND EA 15 MIN","97130 - HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTE",null,"96151 - HEAL & BEHAV ASSESS,EA 15 MIN,RE-ASSESS",null,null,null,null,null,null,"95983 - HC ALYS BRN NPGT PRGRMG 15 MIN"]
[null,null,null,"97151 - HC BHV ID ASSMT BY PHYS/QHP","97110 - THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES","97140 - HC MANUAL THER TECH,1+REGIONS,EA 15 MIN",null,"96152 - HC HEAL & BEHAV INTERVENT,EA 15 MIN,INDIV",null,null,null,null,null,null,"95984 - HC ALYS BRN NPGT PRGRMG ADDL 15"]
[null,null,null,"97152 - HC BHV ID SUPRT ASSMT BY 1 TECH","97112 - HC THER PX 1/> AREAS EACH 15 MIN NEUROMUSC REEDUCA","97150 - HC THERAPEUTIC PROCEDURES GROUP 2/> INDIVIDUALS",null,"96153 - HEAL & BEHAV INTERVENT,EA 15 MIN,GROUP",null,null,null,null,null,null,"95990 - REFILL&MAINTENANCE PUMP DRUG DLVR SPINAL/BRAIN"]
[null,null,null,"97153 - HC ADAPTIVE BEHAVIOR TX BY TECH","97116 - HC THER PX 1/> AREAS EA 15 MIN GAIT TRAINJ W/STAIR","97151 - HC BHV ID ASSMT BY PHYS/QHP",null,"96154 - HC HEAL & BEHAV INTERV,EA 15 MIN,FAM W/PT",null,null,null,null,null,null,"95991 - RFL&MAIN IMPLT PMP/RSVR DLVR SPI/BRN PHY/QHP"]
[null,null,null,"97154 - HC GRP ADAPT BHV TX BY TECH","97124 - HC THER PX 1 AREAS EA 15 MIN MASSAGE","97152 - HC BHV ID SUPRT ASSMT BY 1 TECH",null,"96155 - HC HEAL & BEHAV INTERV,EA 15 MIN,FAM W/O PT",null,null,null,null,null,null,"95992 - CANALITH REPOSITIONING PROCEDURE"]
[null,null,null,"97155 - HC ADAPT BEHAVIOR TX PHYS/QHP","97129 - HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES","97153 - HC ADAPTIVE BEHAVIOR TX BY TECH",null,"96156 - HC HLTH BHV ASSMT/REASSESSMENT",null,null,null,null,null,null,"96020 - HC TEST SELECT & ADMN FUNCTL BRAIN MAP PHYS/QHP"]
[null,null,null,"97156 - HC FAM ADAPT BHV TX GDN PHY/QHP","97130 - HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTE","97154 - HC GRP ADAPT BHV TX BY TECH",null,"96158 - HC HLTH BHV IVNTJ INDIV 1ST 30",null,null,null,null,null,null,"96040 - MEDICAL GENETICS COUNSELING EACH 30 MINUTES"]
[null,null,null,"97157 - HC MULT FAM ADAPT BHV TX GDN","97140 - HC MANUAL THER TECH,1+REGIONS,EA 15 MIN","97155 - HC ADAPT BEHAVIOR TX PHYS/QHP",null,"96159 - HC HLTH BHV IVNTJ INDIV EA ADDL",null,null,null,null,null,null,"96105 - ASSESSMENT PHASIA W/INTERP & REPORT PER HOUR"]
[null,null,null,"97158 - HC GRP ADAPT BHV TX BY PHY/QHP","97150 - HC THERAPEUTIC PROCEDURES GROUP 2/> INDIVIDUALS","97156 - HC FAM ADAPT BHV TX GDN PHY/QHP",null,"96160 - PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM",null,null,null,null,null,null,"96110 - DEVELOPMENTAL SCREENING W/INTERP&REPRT STD FOR"]
[null,null,null,"97161 - HC PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS","97151 - HC BHV ID ASSMT BY PHYS/QHP","97157 - HC MULT FAM ADAPT BHV TX GDN",null,"96161 - CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM",null,null,null,null,null,null,"96112 - HC DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR"]
[null,null,null,"97162 - HC PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS","97152 - HC BHV ID SUPRT ASSMT BY 1 TECH","97158 - HC GRP ADAPT BHV TX BY PHY/QHP",null,"96164 - HC HLTH BHV IVNTJ GRP 1ST 30",null,null,null,null,null,null,"96113 - HC DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN"]
[null,null,null,"97163 - HC PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS","97153 - HC ADAPTIVE BEHAVIOR TX BY TECH","97161 - HC PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS",null,"96165 - HC HLTH BHV IVNTJ GRP EA ADDL",null,null,null,null,null,null,"96116 - NUBHVL STATUS XM PR HR W/PT INTERPJ&PREPJ"]
[null,null,null,"97164 - HC PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS","97154 - HC GRP ADAPT BHV TX BY TECH","97162 - HC PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS",null,"96167 - HC HLTH BHV IVNTJ FAM 1ST 30",null,null,null,null,null,null,"96121 - HC NEUROBEHAVIORAL STATUS XM PHYS/QHP EA ADDL HOUR"]
[null,null,null,"97165 - HC OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS","97155 - HC ADAPT BEHAVIOR TX PHYS/QHP","97163 - HC PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS",null,"96168 - HC HLTH BHV IVNTJ FAM EA ADDL",null,null,null,null,null,null,"96127 - BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT"]
[null,null,null,"97166 - HC OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS","97156 - HC FAM ADAPT BHV TX GDN PHY/QHP","97164 - HC PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS",null,"96360 - IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR",null,null,null,null,null,null,"96130 - HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR"]
[null,null,null,"97167 - HC OCCUPATIONAL THERAPY EVAL HIGH COMPLEX 60 MINS","97157 - HC MULT FAM ADAPT BHV TX GDN","97165 - HC OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS",null,"96361 - IV INFUSION HYDRATION EACH ADDITIONAL HOUR",null,null,null,null,null,null,"96131 - HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR"]
[null,null,null,"97168 - HC OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS","97158 - HC GRP ADAPT BHV TX BY PHY/QHP","97166 - HC OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS",null,"96365 - IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR",null,null,null,null,null,null,"96132 - HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR"]
[null,null,null,"97530 - THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN","97161 - HC PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS","97167 - HC OCCUPATIONAL THERAPY EVAL HIGH COMPLEX 60 MINS",null,"96366 - IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR",null,null,null,null,null,null,"96133 - HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR"]
[null,null,null,"97533 - HC SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES","97162 - HC PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS","97168 - HC OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS",null,"96367 - IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR",null,null,null,null,null,null,"96136 - HC PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN"]
[null,null,null,"97535 - HC SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES","97163 - HC PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS","97530 - THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN",null,"96368 - IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS",null,null,null,null,null,null,"96137 - HC PSYCL/NRPSYCL TST PHYS/QHP 2+ TST EA ADDL 30 MIN"]
[null,null,null,"97537 - HC COMMUNITY/WORK REINTEGRATION TRAINJ EA 15 MIN","97164 - HC PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS","97533 - HC SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES",null,"96369 - HC SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR",null,null,null,null,null,null,"96138 - HC PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN"]
[null,null,null,"97542 - HC WHEELCHAIR MGMT EA 15 MIN","97165 - HC OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS","97535 - HC SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES",null,"96370 - HC SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,EA ADD HOUR",null,null,null,null,null,null,"96139 - HC PSYCL/NRPSYCL TST TECH 2+ TST EA ADDL 30 MIN"]
[null,null,null,"97597 - DEBRIDEMENT OPEN WOUND 20 SQ CM/<","97166 - HC OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS","97537 - HC COMMUNITY/WORK REINTEGRATION TRAINJ EA 15 MIN",null,"96371 - HC SUBQ INFUSION ADDITIONAL PUMP INFUSION SITE",null,null,null,null,null,null,"96146 - HC PSYCL/NRPSYCL TST ELEC PLATFORM AUTO RESULT"]
[null,null,null,"97598 - DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM","97167 - HC OCCUPATIONAL THERAPY EVAL HIGH COMPLEX 60 MINS","97542 - HC WHEELCHAIR MGMT EA 15 MIN",null,"96372 - THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM",null,null,null,null,null,null,"96150 - HC HEAL & BEHAV ASSESS,EA 15 MIN,INIT"]
[null,null,null,"97602 - RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS","97168 - HC OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS","97597 - DEBRIDEMENT OPEN WOUND 20 SQ CM/<",null,"96374 - THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG",null,null,null,null,null,null,"96151 - HEAL & BEHAV ASSESS,EA 15 MIN,RE-ASSESS"]
[null,null,null,"97605 - NEGATIVE PRESSURE WOUND THERAPY </= 50 SQ CM","97530 - THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN","97598 - DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM",null,"96375 - THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG",null,null,null,null,null,null,"96152 - HC HEAL & BEHAV INTERVENT,EA 15 MIN,INDIV"]
[null,null,null,"97606 - NEGATIVE PRESSURE WOUND THERAPY >50 SQ CM","97533 - HC SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES","97602 - RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS",null,"96376 - HC THERAPEUTIC PROPHYLACTIC/DX NJX INTRA-ARTERIAL",null,null,null,null,null,null,"96153 - HEAL & BEHAV INTERVENT,EA 15 MIN,GROUP"]
[null,null,null,"97750 - HC PHYSICAL PERFORMANCE TEST/MEAS W/REPRT EA 15 MIN","97535 - HC SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES","97605 - NEGATIVE PRESSURE WOUND THERAPY </= 50 SQ CM",null,"96377 - HC APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION",null,null,null,null,null,null,"96154 - HC HEAL & BEHAV INTERV,EA 15 MIN,FAM W/PT"]
[null,null,null,"97760 - ORTHOTIC MGMT&TRAINJ UXTR LXTR&/TRNK EA 15","97537 - HC COMMUNITY/WORK REINTEGRATION TRAINJ EA 15 MIN","97606 - NEGATIVE PRESSURE WOUND THERAPY >50 SQ CM",null,"96401 - CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-NEO",null,null,null,null,null,null,"96155 - HC HEAL & BEHAV INTERV,EA 15 MIN,FAM W/O PT"]
[null,null,null,"97761 - HC PROSTHETIC TRAINING UPPR&/LOWER EXTREM EA 15 M","97542 - HC WHEELCHAIR MGMT EA 15 MIN","97750 - HC PHYSICAL PERFORMANCE TEST/MEAS W/REPRT EA 15 MIN",null,"96402 - CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO",null,null,null,null,null,null,"96156 - HC HLTH BHV ASSMT/REASSESSMENT"]
[null,null,null,"97763 - HC ORTH/PROST MGMT ENC 15MIN","97597 - DEBRIDEMENT OPEN WOUND 20 SQ CM/<","97760 - ORTHOTIC MGMT&TRAINJ UXTR LXTR&/TRNK EA 15",null,"96405 - HC INTRALESIONAL CHEMO ADMIN,<8 LESN",null,null,null,null,null,null,"96158 - HC HLTH BHV IVNTJ INDIV 1ST 30"]
[null,null,null,"97802 - MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI","97598 - DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM","97761 - HC PROSTHETIC TRAINING UPPR&/LOWER EXTREM EA 15 M",null,"96409 - CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG",null,null,null,null,null,null,"96159 - HC HLTH BHV IVNTJ INDIV EA ADDL"]
[null,null,null,"97803 - MEDICAL NUTRITION RE-ASSMT&IVNTJ INDIV EA 15 M","97602 - RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS","97763 - HC ORTH/PROST MGMT ENC 15MIN",null,"96411 - CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG",null,null,null,null,null,null,"96160 - PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM"]
[null,null,null,"97804 - MEDICAL NUTRITION THERAPY GRP2/ INDIV EA 30 MI","97605 - NEGATIVE PRESSURE WOUND THERAPY </= 50 SQ CM","97802 - MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI",null,"96413 - CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG",null,null,null,null,null,null,"96161 - CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM"]
[null,null,null,"97810 - HC ACUPUNCTURE 1/> NDLES W/O ELEC STIMJ INIT 15 MIN","97606 - NEGATIVE PRESSURE WOUND THERAPY >50 SQ CM","97803 - MEDICAL NUTRITION RE-ASSMT&IVNTJ INDIV EA 15 M",null,"96415 - CHEMOTHERAPY ADMN IV INFUSION TQ EA HR",null,null,null,null,null,null,"96164 - HC HLTH BHV IVNTJ GRP 1ST 30"]
[null,null,null,"97811 - HC ACUPUNCTURE 1/> NDLS W/O ELEC STIMJ EA 15 MIN","97750 - HC PHYSICAL PERFORMANCE TEST/MEAS W/REPRT EA 15 MIN","97804 - MEDICAL NUTRITION THERAPY GRP2/ INDIV EA 30 MI",null,"96416 - CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP",null,null,null,null,null,null,"96165 - HC HLTH BHV IVNTJ GRP EA ADDL"]
[null,null,null,"97813 - HC ACUPUNCT W/ ELEC STIMUL 15 MIN","97760 - ORTHOTIC MGMT&TRAINJ UXTR LXTR&/TRNK EA 15","97810 - HC ACUPUNCTURE 1/> NDLES W/O ELEC STIMJ INIT 15 MIN",null,"96417 - CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR",null,null,null,null,null,null,"96167 - HC HLTH BHV IVNTJ FAM 1ST 30"]
[null,null,null,"97814 - HC ACUPUNCT W/ ELEC STIMUL ADDL 15M","97761 - HC PROSTHETIC TRAINING UPPR&/LOWER EXTREM EA 15 M","97811 - HC ACUPUNCTURE 1/> NDLS W/O ELEC STIMJ EA 15 MIN",null,"96450 - CHEMOTX ADMN CNS REQ SPINAL PUNCTURE",null,null,null,null,null,null,"96168 - HC HLTH BHV IVNTJ FAM EA ADDL"]
[null,null,null,"98960 - HC EDUCATION&TRAINING SELF-MGMT NONPHYS 1 PT","97763 - HC ORTH/PROST MGMT ENC 15MIN","97813 - HC ACUPUNCT W/ ELEC STIMUL 15 MIN",null,"96521 - REFILLING & MAINTENANCE PORTABLE PUMP",null,null,null,null,null,null,"96360 - IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR"]
[null,null,null,"99151 - HC MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS","97802 - MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI","97814 - HC ACUPUNCT W/ ELEC STIMUL ADDL 15M",null,"96523 - IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST",null,null,null,null,null,null,"96361 - IV INFUSION HYDRATION EACH ADDITIONAL HOUR"]
[null,null,null,"99152 - HC MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS","97803 - MEDICAL NUTRITION RE-ASSMT&IVNTJ INDIV EA 15 M","98960 - HC EDUCATION&TRAINING SELF-MGMT NONPHYS 1 PT",null,"96542 - HC CHEMOTHER INJECT,CUBARACH/INTRAVENT",null,null,null,null,null,null,"96365 - IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR"]
[null,null,null,"99153 - HC MOD SED SAME PHYS/QHP EACH ADDL 15 MINS","97804 - MEDICAL NUTRITION THERAPY GRP2/ INDIV EA 30 MI","99151 - HC MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS",null,"96567 - PDT XTRNL APPL LIGHT DSTR LES SKN BY ACTIVJ RX",null,null,null,null,null,null,"96366 - IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR"]
[null,null,null,"99155 - HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS","97810 - HC ACUPUNCTURE 1/> NDLES W/O ELEC STIMJ INIT 15 MIN","99152 - HC MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS",null,"96900 - ACTINOTHERAPY ULTRAVIOLET LIGHT",null,null,null,null,null,null,"96367 - IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR"]
[null,null,null,"99156 - HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS","97811 - HC ACUPUNCTURE 1/> NDLS W/O ELEC STIMJ EA 15 MIN","99153 - HC MOD SED SAME PHYS/QHP EACH ADDL 15 MINS",null,"96910 - PHOTOCHEMOTX TAR&UVB/PETROLATUM/UVB",null,null,null,null,null,null,"96368 - IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS"]
[null,null,null,"99157 - HC MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS","97813 - HC ACUPUNCT W/ ELEC STIMUL 15 MIN","99155 - HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS",null,"97010 - HC APPLICATION MODALITY 1/> AREAS HOT/COLD PACKS",null,null,null,null,null,null,"96369 - HC SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR"]
[null,null,null,"99172 - VISUAL FUNCT SCRNG AUTO SEMI-AUTO BI QUAN DETERM","97814 - HC ACUPUNCT W/ ELEC STIMUL ADDL 15M","99156 - HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS",null,"97012 - HC APPL MODALITY 1/> AREAS TRACTION MECHANICAL",null,null,null,null,null,null,"96370 - HC SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,EA ADD HOUR"]
[null,null,null,"99173 - SCREENING TEST VISUAL ACUITY QUANTITATIVE BILAT","98960 - HC EDUCATION&TRAINING SELF-MGMT NONPHYS 1 PT","99157 - HC MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS",null,"97014 - HC APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED",null,null,null,null,null,null,"96371 - HC SUBQ INFUSION ADDITIONAL PUMP INFUSION SITE"]
[null,null,null,"99195 - PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE","99151 - HC MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS","99172 - VISUAL FUNCT SCRNG AUTO SEMI-AUTO BI QUAN DETERM",null,"97018 - HC APPL MODALITY 1/> AREAS PARAFFIN BATH",null,null,null,null,null,null,"96372 - THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM"]
[null,null,null,"99201 - OFFICE OUTPATIENT NEW 10 MINUTES","99152 - HC MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS","99173 - SCREENING TEST VISUAL ACUITY QUANTITATIVE BILAT",null,"97022 - HC APPLICATION MODALITY 1/> AREAS WHIRLPOOL",null,null,null,null,null,null,"96374 - THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG"]
[null,null,null,"99202 - OFFICE OUTPATIENT NEW 20 MINUTES","99153 - HC MOD SED SAME PHYS/QHP EACH ADDL 15 MINS","99195 - PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE",null,"97032 - HC APPL MODALITY 1/> AREAS ELEC STIMJ EA 15 MIN",null,null,null,null,null,null,"96375 - THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG"]
[null,null,null,"99203 - OFFICE OUTPATIENT NEW 30 MINUTES","99155 - HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS","99201 - OFFICE OUTPATIENT NEW 10 MINUTES",null,"97033 - APPL MODALITY 1/> AREAS IONTOPHORESIS EA 15 MIN",null,null,null,null,null,null,"96376 - HC THERAPEUTIC PROPHYLACTIC/DX NJX INTRA-ARTERIAL"]
[null,null,null,"99204 - OFFICE OUTPATIENT NEW 45 MINUTES","99156 - HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS","99202 - OFFICE OUTPATIENT NEW 20 MINUTES",null,"97035 - HC APPL MODALITY 1/> AREAS ULTRASOUND EA 15 MIN",null,null,null,null,null,null,"96377 - HC APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION"]
[null,null,null,"99205 - OFFICE OUTPATIENT NEW 60 MINUTES","99157 - HC MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS","99203 - OFFICE OUTPATIENT NEW 30 MINUTES",null,"97110 - THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES",null,null,null,null,null,null,"96401 - CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-NEO"]
[null,null,null,"99211 - ESTABLISHED PATIENT - PHARM - LEVEL 1","99172 - VISUAL FUNCT SCRNG AUTO SEMI-AUTO BI QUAN DETERM","99204 - OFFICE OUTPATIENT NEW 45 MINUTES",null,"97112 - HC THER PX 1/> AREAS EACH 15 MIN NEUROMUSC REEDUCA",null,null,null,null,null,null,"96402 - CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO"]
[null,null,null,"99212 - ESTABLISHED PATIENT - PHARM - LEVEL 2","99173 - SCREENING TEST VISUAL ACUITY QUANTITATIVE BILAT","99205 - OFFICE OUTPATIENT NEW 60 MINUTES",null,"97116 - HC THER PX 1/> AREAS EA 15 MIN GAIT TRAINJ W/STAIR",null,null,null,null,null,null,"96405 - HC INTRALESIONAL CHEMO ADMIN,<8 LESN"]
[null,null,null,"99213 - ESTABLISHED PATIENT - PHARM - LEVEL 3","99195 - PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE","99211 - ESTABLISHED PATIENT - PHARM - LEVEL 1",null,"97124 - HC THER PX 1 AREAS EA 15 MIN MASSAGE",null,null,null,null,null,null,"96409 - CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG"]
[null,null,null,"99214 - ESTABLISHED PATIENT - PHARM - LEVEL 4","99201 - OFFICE OUTPATIENT NEW 10 MINUTES","99212 - ESTABLISHED PATIENT - PHARM - LEVEL 2",null,"97127 - THERAPEUTIC IVNTJ W/FOCUS ON COGNITIVE FUNCTION",null,null,null,null,null,null,"96411 - CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG"]
[null,null,null,"99215 - ESTABLISHED PATIENT - PHARM - LEVEL 5","99202 - OFFICE OUTPATIENT NEW 20 MINUTES","99213 - ESTABLISHED PATIENT - PHARM - LEVEL 3",null,"97140 - HC MANUAL THER TECH,1+REGIONS,EA 15 MIN",null,null,null,null,null,null,"96413 - CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG"]
[null,null,null,"99217 - HC OBSERVATION CARE DISCHARGE","99203 - OFFICE OUTPATIENT NEW 30 MINUTES","99214 - ESTABLISHED PATIENT - PHARM - LEVEL 4",null,"97150 - HC THERAPEUTIC PROCEDURES GROUP 2/> INDIVIDUALS",null,null,null,null,null,null,"96415 - CHEMOTHERAPY ADMN IV INFUSION TQ EA HR"]
[null,null,null,"99281 - HC ED VAWA W/MSAECK","99204 - OFFICE OUTPATIENT NEW 45 MINUTES","99215 - ESTABLISHED PATIENT - PHARM - LEVEL 5",null,"97151 - HC BHV ID ASSMT BY PHYS/QHP",null,null,null,null,null,null,"96416 - CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP"]
[null,null,null,"99282 - HC EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY","99205 - OFFICE OUTPATIENT NEW 60 MINUTES","99217 - HC OBSERVATION CARE DISCHARGE",null,"97152 - HC BHV ID SUPRT ASSMT BY 1 TECH",null,null,null,null,null,null,"96417 - CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR"]
[null,null,null,"99283 - HC EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY","99211 - ESTABLISHED PATIENT - PHARM - LEVEL 1","99281 - HC ED VAWA W/MSAECK",null,"97153 - HC ADAPTIVE BEHAVIOR TX BY TECH",null,null,null,null,null,null,"96450 - CHEMOTX ADMN CNS REQ SPINAL PUNCTURE"]
[null,null,null,"99284 - HC EMERGENCY DEPARTMENT VISIT HIGH/URGENT SEVERITY","99212 - ESTABLISHED PATIENT - PHARM - LEVEL 2","99282 - HC EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY",null,"97154 - HC GRP ADAPT BHV TX BY TECH",null,null,null,null,null,null,"96521 - REFILLING & MAINTENANCE PORTABLE PUMP"]
[null,null,null,"99285 - HC EMERGENCY DEPT VISIT HIGH SEVERITY&THREAT FUNCJ","99213 - ESTABLISHED PATIENT - PHARM - LEVEL 3","99283 - HC EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY",null,"97155 - HC ADAPT BEHAVIOR TX PHYS/QHP",null,null,null,null,null,null,"96523 - IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST"]
[null,null,null,"99291 - CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN","99214 - ESTABLISHED PATIENT - PHARM - LEVEL 4","99284 - HC EMERGENCY DEPARTMENT VISIT HIGH/URGENT SEVERITY",null,"97156 - HC FAM ADAPT BHV TX GDN PHY/QHP",null,null,null,null,null,null,"96542 - HC CHEMOTHER INJECT,CUBARACH/INTRAVENT"]
[null,null,null,"99292 - CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN","99215 - ESTABLISHED PATIENT - PHARM - LEVEL 5","99285 - HC EMERGENCY DEPT VISIT HIGH SEVERITY&THREAT FUNCJ",null,"97157 - HC MULT FAM ADAPT BHV TX GDN",null,null,null,null,null,null,"96567 - PDT XTRNL APPL LIGHT DSTR LES SKN BY ACTIVJ RX"]
[null,null,null,"99406 - TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES","99217 - HC OBSERVATION CARE DISCHARGE","99291 - CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN",null,"97158 - HC GRP ADAPT BHV TX BY PHY/QHP",null,null,null,null,null,null,"96900 - ACTINOTHERAPY ULTRAVIOLET LIGHT"]
[null,null,null,"99407 - TOBACCO USE CESSATION INTENSIVE >10 MINUTES","99281 - HC ED VAWA W/MSAECK","99292 - CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN",null,"97161 - HC PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS",null,null,null,null,null,null,"96910 - PHOTOCHEMOTX TAR&UVB/PETROLATUM/UVB"]
[null,null,null,"99453 - REM MNTR PHYSIOL PARAM SETUP","99282 - HC EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY","99406 - TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES",null,"97162 - HC PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS",null,null,null,null,null,null,"97010 - HC APPLICATION MODALITY 1/> AREAS HOT/COLD PACKS"]
[null,null,null,"99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","99283 - HC EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY","99407 - TOBACCO USE CESSATION INTENSIVE >10 MINUTES",null,"97163 - HC PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS",null,null,null,null,null,null,"97012 - HC APPL MODALITY 1/> AREAS TRACTION MECHANICAL"]
[null,null,null,"99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN","99284 - HC EMERGENCY DEPARTMENT VISIT HIGH/URGENT SEVERITY","99453 - REM MNTR PHYSIOL PARAM SETUP",null,"97164 - HC PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS",null,null,null,null,null,null,"97014 - HC APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED"]
[null,null,null,"99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","99285 - HC EMERGENCY DEPT VISIT HIGH SEVERITY&THREAT FUNCJ","99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D",null,"97165 - HC OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS",null,null,null,null,null,null,"97018 - HC APPL MODALITY 1/> AREAS PARAFFIN BATH"]
[null,null,null,"99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","99291 - CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",null,"97166 - HC OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS",null,null,null,null,null,null,"97022 - HC APPLICATION MODALITY 1/> AREAS WHIRLPOOL"]
[null,null,null,"99497 - HC ADVANCED CARE PLANNING; 1ST HR","99292 - CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",null,"97167 - HC OCCUPATIONAL THERAPY EVAL HIGH COMPLEX 60 MINS",null,null,null,null,null,null,"97032 - HC APPL MODALITY 1/> AREAS ELEC STIMJ EA 15 MIN"]
[null,null,null,"99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","99406 - TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",null,"97168 - HC OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS",null,null,null,null,null,null,"97033 - APPL MODALITY 1/> AREAS IONTOPHORESIS EA 15 MIN"]
[null,null,null,"0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","99407 - TOBACCO USE CESSATION INTENSIVE >10 MINUTES","99497 - HC ADVANCED CARE PLANNING; 1ST HR",null,"97530 - THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN",null,null,null,null,null,null,"97035 - HC APPL MODALITY 1/> AREAS ULTRASOUND EA 15 MIN"]
[null,null,null,"0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND","99453 - REM MNTR PHYSIOL PARAM SETUP","99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS",null,"97533 - HC SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES",null,null,null,null,null,null,"97110 - THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES"]
[null,null,null,"0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST","99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D","0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST",null,"97535 - HC SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES",null,null,null,null,null,null,"97112 - HC THER PX 1/> AREAS EACH 15 MIN NEUROMUSC REEDUCA"]
[null,null,null,"0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND","99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN","0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",null,"97537 - HC COMMUNITY/WORK REINTEGRATION TRAINJ EA 15 MIN",null,null,null,null,null,null,"97116 - HC THER PX 1/> AREAS EA 15 MIN GAIT TRAINJ W/STAIR"]
[null,null,null,"0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR","99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",null,"97542 - HC WHEELCHAIR MGMT EA 15 MIN",null,null,null,null,null,null,"97124 - HC THER PX 1 AREAS EA 15 MIN MASSAGE"]
[null,null,null,"0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA","99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",null,"97597 - DEBRIDEMENT OPEN WOUND 20 SQ CM/<",null,null,null,null,null,null,"97127 - THERAPEUTIC IVNTJ W/FOCUS ON COGNITIVE FUNCTION"]
[null,null,null,"U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV","99497 - HC ADVANCED CARE PLANNING; 1ST HR","0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",null,"97598 - DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM",null,null,null,null,null,null,"97140 - HC MANUAL THER TECH,1+REGIONS,EA 15 MIN"]
[null,null,null,null,"99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS","0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA",null,"97602 - RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS",null,null,null,null,null,null,"97150 - HC THERAPEUTIC PROCEDURES GROUP 2/> INDIVIDUALS"]
[null,null,null,null,"0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST","U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",null,"97605 - NEGATIVE PRESSURE WOUND THERAPY </= 50 SQ CM",null,null,null,null,null,null,"97151 - HC BHV ID ASSMT BY PHYS/QHP"]
[null,null,null,null,"0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND",null,null,"97606 - NEGATIVE PRESSURE WOUND THERAPY >50 SQ CM",null,null,null,null,null,null,"97152 - HC BHV ID SUPRT ASSMT BY 1 TECH"]
[null,null,null,null,"0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST",null,null,"97750 - HC PHYSICAL PERFORMANCE TEST/MEAS W/REPRT EA 15 MIN",null,null,null,null,null,null,"97153 - HC ADAPTIVE BEHAVIOR TX BY TECH"]
[null,null,null,null,"0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND",null,null,"97755 - HC ASSTV TECHNOL ASSMT DIR CNTCT W/REPRT EA 15 MIN",null,null,null,null,null,null,"97154 - HC GRP ADAPT BHV TX BY TECH"]
[null,null,null,null,"0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",null,null,"97760 - ORTHOTIC MGMT&TRAINJ UXTR LXTR&/TRNK EA 15",null,null,null,null,null,null,"97155 - HC ADAPT BEHAVIOR TX PHYS/QHP"]
[null,null,null,null,"0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",null,null,"97761 - HC PROSTHETIC TRAINING UPPR&/LOWER EXTREM EA 15 M",null,null,null,null,null,null,"97156 - HC FAM ADAPT BHV TX GDN PHY/QHP"]
[null,null,null,null,"0238T - HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA",null,null,"97763 - HC ORTH/PROST MGMT ENC 15MIN",null,null,null,null,null,null,"97157 - HC MULT FAM ADAPT BHV TX GDN"]
[null,null,null,null,"0241U - HC NFCT DS VIR RESP RNA 4 TRGT",null,null,"97802 - MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI",null,null,null,null,null,null,"97158 - HC GRP ADAPT BHV TX BY PHY/QHP"]
[null,null,null,null,"U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",null,null,"97803 - MEDICAL NUTRITION RE-ASSMT&IVNTJ INDIV EA 15 M",null,null,null,null,null,null,"97161 - HC PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS"]
[null,null,null,null,null,null,null,"97804 - MEDICAL NUTRITION THERAPY GRP2/ INDIV EA 30 MI",null,null,null,null,null,null,"97162 - HC PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS"]
[null,null,null,null,null,null,null,"98925 - HC OSTEOPATHIC MANIP,1-2 BODY REGN",null,null,null,null,null,null,"97163 - HC PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS"]
[null,null,null,null,null,null,null,"98960 - HC EDUCATION&TRAINING SELF-MGMT NONPHYS 1 PT",null,null,null,null,null,null,"97164 - HC PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS"]
[null,null,null,null,null,null,null,"98966 - NONPHYSICIAN TELEPHONE ASSESSMENT 5-10 MIN",null,null,null,null,null,null,"97165 - HC OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS"]
[null,null,null,null,null,null,null,"98967 - NONPHYSICIAN TELEPHONE ASSESSMENT 11-20 MIN",null,null,null,null,null,null,"97166 - HC OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS"]
[null,null,null,null,null,null,null,"98968 - NONPHYSICIAN TELEPHONE ASSESSMENT 21-30 MIN",null,null,null,null,null,null,"97167 - HC OCCUPATIONAL THERAPY EVAL HIGH COMPLEX 60 MINS"]
[null,null,null,null,null,null,null,"99151 - HC MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS",null,null,null,null,null,null,"97168 - HC OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS"]
[null,null,null,null,null,null,null,"99152 - HC MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS",null,null,null,null,null,null,"97530 - THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN"]
[null,null,null,null,null,null,null,"99153 - HC MOD SED SAME PHYS/QHP EACH ADDL 15 MINS",null,null,null,null,null,null,"97533 - HC SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES"]
[null,null,null,null,null,null,null,"99155 - HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS",null,null,null,null,null,null,"97535 - HC SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES"]
[null,null,null,null,null,null,null,"99156 - HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS",null,null,null,null,null,null,"97537 - HC COMMUNITY/WORK REINTEGRATION TRAINJ EA 15 MIN"]
[null,null,null,null,null,null,null,"99157 - HC MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS",null,null,null,null,null,null,"97542 - HC WHEELCHAIR MGMT EA 15 MIN"]
[null,null,null,null,null,null,null,"99173 - SCREENING TEST VISUAL ACUITY QUANTITATIVE BILAT",null,null,null,null,null,null,"97597 - DEBRIDEMENT OPEN WOUND 20 SQ CM/<"]
[null,null,null,null,null,null,null,"99195 - PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE",null,null,null,null,null,null,"97598 - DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM"]
[null,null,null,null,null,null,null,"99201 - OFFICE OUTPATIENT NEW 10 MINUTES",null,null,null,null,null,null,"97602 - RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS"]
[null,null,null,null,null,null,null,"99202 - OFFICE OUTPATIENT NEW 20 MINUTES",null,null,null,null,null,null,"97605 - NEGATIVE PRESSURE WOUND THERAPY </= 50 SQ CM"]
[null,null,null,null,null,null,null,"99203 - OFFICE OUTPATIENT NEW 30 MINUTES",null,null,null,null,null,null,"97606 - NEGATIVE PRESSURE WOUND THERAPY >50 SQ CM"]
[null,null,null,null,null,null,null,"99204 - OFFICE OUTPATIENT NEW 45 MINUTES",null,null,null,null,null,null,"97750 - HC PHYSICAL PERFORMANCE TEST/MEAS W/REPRT EA 15 MIN"]
[null,null,null,null,null,null,null,"99205 - OFFICE OUTPATIENT NEW 60 MINUTES",null,null,null,null,null,null,"97755 - HC ASSTV TECHNOL ASSMT DIR CNTCT W/REPRT EA 15 MIN"]
[null,null,null,null,null,null,null,"99211 - ESTABLISHED PATIENT - PHARM - LEVEL 1",null,null,null,null,null,null,"97760 - ORTHOTIC MGMT&TRAINJ UXTR LXTR&/TRNK EA 15"]
[null,null,null,null,null,null,null,"99212 - ESTABLISHED PATIENT - PHARM - LEVEL 2",null,null,null,null,null,null,"97761 - HC PROSTHETIC TRAINING UPPR&/LOWER EXTREM EA 15 M"]
[null,null,null,null,null,null,null,"99213 - ESTABLISHED PATIENT - PHARM - LEVEL 3",null,null,null,null,null,null,"97763 - HC ORTH/PROST MGMT ENC 15MIN"]
[null,null,null,null,null,null,null,"99214 - ESTABLISHED PATIENT - PHARM - LEVEL 4",null,null,null,null,null,null,"97802 - MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI"]
[null,null,null,null,null,null,null,"99215 - ESTABLISHED PATIENT - PHARM - LEVEL 5",null,null,null,null,null,null,"97803 - MEDICAL NUTRITION RE-ASSMT&IVNTJ INDIV EA 15 M"]
[null,null,null,null,null,null,null,"99217 - HC OBSERVATION CARE DISCHARGE",null,null,null,null,null,null,"97804 - MEDICAL NUTRITION THERAPY GRP2/ INDIV EA 30 MI"]
[null,null,null,null,null,null,null,"99281 - HC ED VAWA W/MSAECK",null,null,null,null,null,null,"98925 - HC OSTEOPATHIC MANIP,1-2 BODY REGN"]
[null,null,null,null,null,null,null,"99282 - HC EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY",null,null,null,null,null,null,"98960 - HC EDUCATION&TRAINING SELF-MGMT NONPHYS 1 PT"]
[null,null,null,null,null,null,null,"99283 - HC EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY",null,null,null,null,null,null,"98966 - NONPHYSICIAN TELEPHONE ASSESSMENT 5-10 MIN"]
[null,null,null,null,null,null,null,"99284 - HC EMERGENCY DEPARTMENT VISIT HIGH/URGENT SEVERITY",null,null,null,null,null,null,"98967 - NONPHYSICIAN TELEPHONE ASSESSMENT 11-20 MIN"]
[null,null,null,null,null,null,null,"99285 - HC EMERGENCY DEPT VISIT HIGH SEVERITY&THREAT FUNCJ",null,null,null,null,null,null,"98968 - NONPHYSICIAN TELEPHONE ASSESSMENT 21-30 MIN"]
[null,null,null,null,null,null,null,"99291 - CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN",null,null,null,null,null,null,"99151 - HC MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS"]
[null,null,null,null,null,null,null,"99292 - CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN",null,null,null,null,null,null,"99152 - HC MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS"]
[null,null,null,null,null,null,null,"99354 - PROLNG SVC OFFICE O/P DIR CONTACT 1ST HR",null,null,null,null,null,null,"99153 - HC MOD SED SAME PHYS/QHP EACH ADDL 15 MINS"]
[null,null,null,null,null,null,null,"99355 - PROLNG SVC OFFICE O/P DIR CONTACT EA 30 MINUTES",null,null,null,null,null,null,"99155 - HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS"]
[null,null,null,null,null,null,null,"99358 - HC PROLONGED SERV,NO CONTACT,1ST HR",null,null,null,null,null,null,"99156 - HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS"]
[null,null,null,null,null,null,null,"99359 - PROLONGED SERV,NO CONTCT,EA ADD 30 MIN",null,null,null,null,null,null,"99157 - HC MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS"]
[null,null,null,null,null,null,null,"99366 - HC TEAM CONFERENCE FACE-TO-FACE NONPHYSICIAN",null,null,null,null,null,null,"99173 - SCREENING TEST VISUAL ACUITY QUANTITATIVE BILAT"]
[null,null,null,null,null,null,null,"99368 - HC TEAM CONFERENCE NON-FACE-TO-FACE NONPHYSICIAN",null,null,null,null,null,null,"99195 - PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE"]
[null,null,null,null,null,null,null,"99381 - INITIAL PREVENTIVE MEDICINE NEW PATIENT <1YEAR",null,null,null,null,null,null,"99201 - OFFICE OUTPATIENT NEW 10 MINUTES"]
[null,null,null,null,null,null,null,"99382 - INITIAL PREVENTIVE MEDICINE NEW PT AGE 1-4 YRS",null,null,null,null,null,null,"99202 - OFFICE OUTPATIENT NEW 20 MINUTES"]
[null,null,null,null,null,null,null,"99383 - INITIAL PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS",null,null,null,null,null,null,"99203 - OFFICE OUTPATIENT NEW 30 MINUTES"]
[null,null,null,null,null,null,null,"99384 - INITIAL PREVENTIVE MEDICINE NEW PT AGE 12-17 YR",null,null,null,null,null,null,"99204 - OFFICE OUTPATIENT NEW 45 MINUTES"]
[null,null,null,null,null,null,null,"99385 - INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS",null,null,null,null,null,null,"99205 - OFFICE OUTPATIENT NEW 60 MINUTES"]
[null,null,null,null,null,null,null,"99386 - INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS",null,null,null,null,null,null,"99211 - ESTABLISHED PATIENT - PHARM - LEVEL 1"]
[null,null,null,null,null,null,null,"99387 - INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&>",null,null,null,null,null,null,"99212 - ESTABLISHED PATIENT - PHARM - LEVEL 2"]
[null,null,null,null,null,null,null,"99391 - PERIODIC PREVENTIVE MED ESTABLISHED PATIENT <1Y",null,null,null,null,null,null,"99213 - ESTABLISHED PATIENT - PHARM - LEVEL 3"]
[null,null,null,null,null,null,null,"99392 - PERIODIC PREVENTIVE MED EST PATIENT 1-4YRS",null,null,null,null,null,null,"99214 - ESTABLISHED PATIENT - PHARM - LEVEL 4"]
[null,null,null,null,null,null,null,"99393 - PERIODIC PREVENTIVE MED EST PATIENT 5-11YRS",null,null,null,null,null,null,"99215 - ESTABLISHED PATIENT - PHARM - LEVEL 5"]
[null,null,null,null,null,null,null,"99394 - PERIODIC PREVENTIVE MED EST PATIENT 12-17YRS",null,null,null,null,null,null,"99217 - HC OBSERVATION CARE DISCHARGE"]
[null,null,null,null,null,null,null,"99395 - PERIODIC PREVENTIVE MED EST PATIENT 18-39 YRS",null,null,null,null,null,null,"99281 - HC ED VAWA W/MSAECK"]
[null,null,null,null,null,null,null,"99396 - PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS",null,null,null,null,null,null,"99282 - HC EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY"]
[null,null,null,null,null,null,null,"99397 - PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER",null,null,null,null,null,null,"99283 - HC EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY"]
[null,null,null,null,null,null,null,"99401 - PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 15 M",null,null,null,null,null,null,"99284 - HC EMERGENCY DEPARTMENT VISIT HIGH/URGENT SEVERITY"]
[null,null,null,null,null,null,null,"99402 - PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 30 M",null,null,null,null,null,null,"99285 - HC EMERGENCY DEPT VISIT HIGH SEVERITY&THREAT FUNCJ"]
[null,null,null,null,null,null,null,"99403 - HC PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 45 MIN",null,null,null,null,null,null,"99291 - CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN"]
[null,null,null,null,null,null,null,"99404 - HC PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 60 MIN",null,null,null,null,null,null,"99292 - CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN"]
[null,null,null,null,null,null,null,"99406 - TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES",null,null,null,null,null,null,"99354 - PROLNG SVC OFFICE O/P DIR CONTACT 1ST HR"]
[null,null,null,null,null,null,null,"99407 - TOBACCO USE CESSATION INTENSIVE >10 MINUTES",null,null,null,null,null,null,"99355 - PROLNG SVC OFFICE O/P DIR CONTACT EA 30 MINUTES"]
[null,null,null,null,null,null,null,"99411 - PREV MED COUNSEL & RISK FACTOR REDJ GRP SPX 30 M",null,null,null,null,null,null,"99358 - HC PROLONGED SERV,NO CONTACT,1ST HR"]
[null,null,null,null,null,null,null,"99412 - PREV MED COUNSEL & RISK FACTOR REDJ GRP SPX 60 M",null,null,null,null,null,null,"99359 - PROLONGED SERV,NO CONTCT,EA ADD 30 MIN"]
[null,null,null,null,null,null,null,"99453 - REM MNTR PHYSIOL PARAM SETUP",null,null,null,null,null,null,"99366 - HC TEAM CONFERENCE FACE-TO-FACE NONPHYSICIAN"]
[null,null,null,null,null,null,null,"99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D",null,null,null,null,null,null,"99368 - HC TEAM CONFERENCE NON-FACE-TO-FACE NONPHYSICIAN"]
[null,null,null,null,null,null,null,"99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN",null,null,null,null,null,null,"99381 - INITIAL PREVENTIVE MEDICINE NEW PATIENT <1YEAR"]
[null,null,null,null,null,null,null,"99483 - HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT",null,null,null,null,null,null,"99382 - INITIAL PREVENTIVE MEDICINE NEW PT AGE 1-4 YRS"]
[null,null,null,null,null,null,null,"99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE",null,null,null,null,null,null,"99383 - INITIAL PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS"]
[null,null,null,null,null,null,null,"99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",null,null,null,null,null,null,"99384 - INITIAL PREVENTIVE MEDICINE NEW PT AGE 12-17 YR"]
[null,null,null,null,null,null,null,"99497 - HC ADVANCED CARE PLANNING; 1ST HR",null,null,null,null,null,null,"99385 - INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS"]
[null,null,null,null,null,null,null,"99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS",null,null,null,null,null,null,"99386 - INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS"]
[null,null,null,null,null,null,null,"99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM",null,null,null,null,null,null,"99387 - INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&>"]
[null,null,null,null,null,null,null,"99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM",null,null,null,null,null,null,"99391 - PERIODIC PREVENTIVE MED ESTABLISHED PATIENT <1Y"]
[null,null,null,null,null,null,null,"99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM",null,null,null,null,null,null,"99392 - PERIODIC PREVENTIVE MED EST PATIENT 1-4YRS"]
[null,null,null,null,null,null,null,"0159T - HC COMPUTER AIDED DETECTION BREAST MRI",null,null,null,null,null,null,"99393 - PERIODIC PREVENTIVE MED EST PATIENT 5-11YRS"]
[null,null,null,null,null,null,null,"0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",null,null,null,null,null,null,"99394 - PERIODIC PREVENTIVE MED EST PATIENT 12-17YRS"]
[null,null,null,null,null,null,null,"0346T - ULTRASOUND ELASTOGRAPHY",null,null,null,null,null,null,"99395 - PERIODIC PREVENTIVE MED EST PATIENT 18-39 YRS"]
[null,null,null,null,null,null,null,"0362T - HC BHV ID SUPRT ASSMT EA 15 MIN",null,null,null,null,null,null,"99396 - PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS"]
[null,null,null,null,null,null,null,"0373T - HC ADAPT BHV TX EA 15 MIN",null,null,null,null,null,null,"99397 - PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER"]
[null,null,null,null,null,null,null,"0482T - ABSOLUTE QUAN MYOCARD BLD FLO PET STRESS & REST",null,null,null,null,null,null,"99401 - PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 15 M"]
[null,null,null,null,null,null,null,"0509T - HC PATTERN ERG W/I&R",null,null,null,null,null,null,"99402 - PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 30 M"]
[null,null,null,null,null,null,null,"0523T - HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING",null,null,null,null,null,null,"99403 - HC PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 45 MIN"]
[null,null,null,null,null,null,null,"0540T - HC CAR-T CLL ADMN AUTOLOGOUS",null,null,null,null,null,null,"99404 - HC PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 60 MIN"]
[null,null,null,null,null,null,null,"G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA",null,null,null,null,null,null,"99406 - TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES"]
[null,null,null,null,null,null,null,"U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",null,null,null,null,null,null,"99407 - TOBACCO USE CESSATION INTENSIVE >10 MINUTES"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"99411 - PREV MED COUNSEL & RISK FACTOR REDJ GRP SPX 30 M"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"99412 - PREV MED COUNSEL & RISK FACTOR REDJ GRP SPX 60 M"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"99453 - REM MNTR PHYSIOL PARAM SETUP"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"99454 - HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"99473 - HC SELF-MEAS BP PT EDUCAJ/TRAIN"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"99483 - HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"99495 - TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"99496 - TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"99497 - HC ADVANCED CARE PLANNING; 1ST HR"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"99498 - HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"99605 - MEDICATION THERAPY, NEWPATIENT, 1ST 15 MIN - PHARM"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"99606 - MEDICATION THERAPY,1ST 15 MIN EST PATIENT- PHARM"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"99607 - MEDICATION THERAPY,EA ADDITIONAL 15 MIN - PHARM"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"0001A - HC ADM SARSCOV2 30MCG/0.3ML 1ST"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"0002A - HC ADM SARSCOV2 30MCG/0.3ML 2ND"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"0011A - HC ADM SARSCOV2 100MCG/0.5ML1ST"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"0012A - HC ADM SARSCOV2 100MCG/0.5ML2ND"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"0159T - HC COMPUTER AIDED DETECTION BREAST MRI"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"0191T - INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"0202U - HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"0241U - HC NFCT DS VIR RESP RNA 4 TRGT"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"0346T - ULTRASOUND ELASTOGRAPHY"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"0362T - HC BHV ID SUPRT ASSMT EA 15 MIN"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"0373T - HC ADAPT BHV TX EA 15 MIN"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"0482T - ABSOLUTE QUAN MYOCARD BLD FLO PET STRESS & REST"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"0509T - HC PATTERN ERG W/I&R"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"0523T - HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"0540T - HC CAR-T CLL ADMN AUTOLOGOUS"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"G0399 - HC HOME SLEEP TEST/TYPE 3 PORTA"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"U0004 - 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV"]

{"sheet":"CPT Table","index":17,"n_rows":82842,"n_cols":14,"rows_kept":4500,"cut":true,"hidden":true,"merged":[],"bounds":{"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0}}
["IP/OP","Payer - Plan - Bill Type - Bill Code","Payer","Plan","Bill Type","Bill Code","Billing Description","CPT Mod","Gross Charge Amount","Payer Charge Amount","Minimum Charge Amount","Maximum Charge Amount","Self-Pay Charge","Duplicate"]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11056","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",11056,"PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4",null,171,508.23,171.09,1198.25,42.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11056","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",11056,"PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4",null,171,296.32,171.09,1198.25,42.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11057","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",11057,"PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4",null,273,380.96,296.32,1198.25,68.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11057","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",11057,"PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4",null,273,943.8,296.32,1198.25,68.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11057","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",11057,"PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4",null,273,296.32,296.32,1198.25,68.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11102","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",11102,"HC TANGNTL BX SKIN SINGLE LES",null,272,380.96,296.32,1198.25,68,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11102","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",11102,"HC TANGNTL BX SKIN SINGLE LES",null,272,296.32,296.32,1198.25,68,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11103","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",11103,"HC TANGNTL BX SKIN EA SEP/ADDL",null,133,0,57.32,1198.25,33.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 11103","TUFTS","TUFTS POS","CPT",11103,"HC TANGNTL BX SKIN EA SEP/ADDL",null,133,0,57.32,1198.25,33.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11103","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",11103,"HC TANGNTL BX SKIN EA SEP/ADDL",null,133,57.32,57.32,1198.25,33.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11104","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",11104,"HC PUNCH BX SKIN SINGLE LESION",null,272,943.8,296.32,1198.25,68,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11104","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",11104,"HC PUNCH BX SKIN SINGLE LESION",null,272,380.96,296.32,1198.25,68,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 11104","TUFTS","TUFTS SELECT","CPT",11104,"HC PUNCH BX SKIN SINGLE LESION",null,272,317.70999999999998,296.32,1198.25,68,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11104","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",11104,"HC PUNCH BX SKIN SINGLE LESION",null,272,296.32,296.32,1198.25,68,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11104","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",11104,"HC PUNCH BX SKIN SINGLE LESION",null,272,296.32,296.32,1198.25,68,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11105","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",11105,"HC PUNCH BX SKIN EA SEP/ADDL",null,133,0,67.709999999999994,1198.25,33.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11105","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",11105,"HC PUNCH BX SKIN EA SEP/ADDL",null,133,67.709999999999994,67.709999999999994,1198.25,33.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11106","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",11106,"HC INCAL BX SKN SINGLE LES",null,484,527.46,317.70999999999998,1198.25,121,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 11107","TUFTS","TUFTS POS","CPT",11107,"HC INCAL BX SKN EA SEP/ADDL",null,236,0,80.709999999999994,1198.25,59,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11107","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",11107,"HC INCAL BX SKN EA SEP/ADDL",null,236,80.709999999999994,80.709999999999994,1198.25,59,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11200","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",11200,"REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15",null,559,380.96,296.32,1198.25,139.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11300","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",11300,"SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<",null,232,380.96,171.09,508.23,58,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11300","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",11300,"SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<",null,232,296.32,171.09,508.23,58,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 11300","BLUE CROSS","BLUE CROSS-PPO","CPT",11300,"SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<",null,232,296.32,171.09,508.23,58,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 11302","TUFTS","TUFTS PPO","CPT",11302,"SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM",null,484,320.41000000000003,171.09,508.23,121,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 11302","TUFTS","TUFTS SELECT","CPT",11302,"SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM",null,484,171.09,171.09,508.23,121,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11303","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",11303,"SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM",null,570,943.8,317.70999999999998,943.8,142.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11303","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",11303,"SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM",null,570,678.1,317.70999999999998,943.8,142.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11303","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",11303,"SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM",null,570,527.46,317.70999999999998,943.8,142.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11306","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",11306,"SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM",null,405,380.96,171.09,508.23,101.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 11306","TUFTS","TUFTS POS","CPT",11306,"SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM",null,405,320.41000000000003,171.09,508.23,101.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11306","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",11306,"SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM",null,405,296.32,171.09,508.23,101.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11306","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",11306,"SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM",null,405,296.32,171.09,508.23,101.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11307","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",11307,"SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM",null,487,380.96,171.09,508.23,121.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 11307","TUFTS","TUFTS POS","CPT",11307,"SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM",null,487,320.41000000000003,171.09,508.23,121.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11307","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",11307,"SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM",null,487,296.32,171.09,508.23,121.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11308","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",11308,"SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM",null,557,661.45,317.70999999999998,943.8,139.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11311","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",11311,"SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM",null,484,296.32,171.09,508.23,121,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 11312","TUFTS","TUFTS HMO","CPT",11312,"SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM",null,559,595.01,317.70999999999998,943.8,139.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 11312","TUFTS","TUFTS PPO","CPT",11312,"SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM",null,559,595.01,317.70999999999998,943.8,139.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11312","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",11312,"SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM",null,559,527.46,317.70999999999998,943.8,139.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 11312","BLUE CROSS","BLUE CROSS-PPO","CPT",11312,"SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM",null,559,527.46,317.70999999999998,943.8,139.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11313","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",11313,"SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM",null,750,661.45,317.70999999999998,943.8,187.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 11313","TUFTS","TUFTS PPO","CPT",11313,"SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM",null,750,595.01,317.70999999999998,943.8,187.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11400","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",11400,"EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<",null,611,2032.26,684.11,2032.26,152.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11400","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",11400,"EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<",null,611,1250.8,684.11,2032.26,152.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11400","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",11400,"EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<",null,611,972.93,684.11,2032.26,152.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11400","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",11400,"EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<",null,611,972.93,684.11,2032.26,152.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11401","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",11401,"EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM",null,798,527.46,527.46,2032.26,199.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 11401","BLUE CROSS","BLUE CROSS-PPO","CPT",11401,"EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM",null,798,527.46,527.46,2032.26,199.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11402","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",11402,"EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM",null,876,2032.26,684.11,2032.26,219,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 11402","TUFTS","TUFTS POS","CPT",11402,"EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM",null,876,1281.21,684.11,2032.26,219,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11402","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",11402,"EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM",null,876,972.93,684.11,2032.26,219,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11402","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",11402,"EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM",null,876,972.93,684.11,2032.26,219,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11403","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",11403,"EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<",null,1130,1250.8,972.93,3264.67,282.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11404","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",11404,"EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM",null,1972,2672.73,1098.98,3264.67,493,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11406","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",11406,"EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM",null,1873,2672.73,1500.85,7703.8,468.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11406","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",11406,"EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM",null,1873,7703.8,1500.85,7703.8,468.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 11406","TUFTS","TUFTS SELECT","CPT",11406,"EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM",null,1873,2593.31,1500.85,7703.8,468.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11420","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",11420,"EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<",null,1103,2672.73,1098.98,3264.67,275.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 11421","TUFTS","TUFTS POS","CPT",11421,"EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM",null,1103,2058.17,972.93,3264.67,275.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11422","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",11422,"EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM",null,1039,2309.9699999999998,1098.98,3264.67,259.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11424","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",11424,"EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM",null,1972,2607.12,1500.85,7703.8,493,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11424","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",11424,"EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM",null,1972,7703.8,1500.85,7703.8,493,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11424","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",11424,"EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM",null,1972,2672.73,1500.85,7703.8,493,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 11424","TUFTS","TUFTS POS","CPT",11424,"EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM",null,1972,4856.75,1500.85,7703.8,493,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11426","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",11426,"EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM",null,2987,4507.8100000000004,1500.85,7703.8,746.75,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 11426","TUFTS","TUFTS HMO","CPT",11426,"EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM",null,2987,4856.75,1500.85,7703.8,746.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 11426","TUFTS","TUFTS POS","CPT",11426,"EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM",null,2987,4856.75,1500.85,7703.8,746.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 11426","TUFTS","TUFTS PPO","CPT",11426,"EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM",null,2987,4856.75,1500.85,7703.8,746.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11426","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",11426,"EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM",null,2987,3994.03,1500.85,7703.8,746.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 11440","TUFTS","TUFTS SELECT","CPT",11440,"EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<",null,792,684.11,684.11,2032.26,198,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11440","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",11440,"EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<",null,792,972.93,684.11,2032.26,198,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11441","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",11441,"EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM",null,1009,1250.8,684.11,2032.26,252.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 11441","TUFTS","TUFTS HMO","CPT",11441,"EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM",null,1009,1281.21,684.11,2032.26,252.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11441","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",11441,"EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM",null,1009,972.93,684.11,2032.26,252.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11441","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",11441,"EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM",null,1009,972.93,684.11,2032.26,252.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11442","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",11442,"EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM",null,1046,1250.8,972.93,3264.67,261.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 11442","TUFTS","TUFTS SELECT","CPT",11442,"EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM",null,1046,1098.98,972.93,3264.67,261.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11442","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",11442,"EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM",null,1046,972.93,972.93,3264.67,261.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11443","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",11443,"EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM",null,1375,2309.9699999999998,1098.98,3264.67,343.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11446","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",11446,"EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM",null,2492,4507.8100000000004,1500.85,7703.8,623,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11446","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",11446,"EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM",null,2492,4621.25,1500.85,7703.8,623,1]
["OUTPATIENT","AETNA - AETNA - CPT - 11446","AETNA","AETNA","CPT",11446,"EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM",null,2492,1500.85,1500.85,7703.8,623,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11446","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",11446,"EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM",null,2492,3994.03,1500.85,7703.8,623,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11446","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",11446,"EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM",null,2492,3994.03,1500.85,7703.8,623,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11446","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",11446,"EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM",null,2492,3994.03,1500.85,7703.8,623,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11450","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",11450,"EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR",null,2778,3994.03,1500.85,7703.8,694.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11463","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",11463,"EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR",null,2490,4621.25,1500.85,7703.8,622.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11470","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",11470,"EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR",null,2987,4621.25,1500.85,7703.8,746.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 11470","TUFTS","TUFTS PPO","CPT",11470,"EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR",null,2987,4856.75,1500.85,7703.8,746.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 11470","TUFTS","TUFTS SELECT","CPT",11470,"EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR",null,2987,2593.31,1500.85,7703.8,746.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11470","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",11470,"EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR",null,2987,3994.03,1500.85,7703.8,746.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11470","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",11470,"EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR",null,2987,3994.03,1500.85,7703.8,746.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11600","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",11600,"HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG",null,870,972.93,972.93,3264.67,217.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11600","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",11600,"HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG",null,870,972.93,972.93,3264.67,217.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11601","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",11601,"EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM",null,1146,2032.26,684.11,2032.26,286.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 11601","AETNA","AETNA","CPT",11601,"EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM",null,1146,1198.25,684.11,2032.26,286.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11602","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",11602,"EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM",null,1262,678.1,527.46,2032.26,315.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 11602","TUFTS","TUFTS POS","CPT",11602,"EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM",null,1262,1281.21,527.46,2032.26,315.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 11602","TUFTS","TUFTS PPO","CPT",11602,"EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM",null,1262,1281.21,527.46,2032.26,315.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11603","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",11603,"EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<",null,1505,1250.8,972.93,3264.67,376.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 11603","TUFTS","TUFTS POS","CPT",11603,"EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<",null,1505,2058.17,972.93,3264.67,376.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 11603","TUFTS","TUFTS SELECT","CPT",11603,"EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<",null,1505,1098.98,972.93,3264.67,376.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11603","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",11603,"EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<",null,1505,972.93,972.93,3264.67,376.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 11603","BLUE CROSS","BLUE CROSS-PPO","CPT",11603,"EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<",null,1505,972.93,972.93,3264.67,376.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 11604","TUFTS","TUFTS HMO","CPT",11604,"EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM",null,1656,4856.75,972.93,7703.8,414,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 11604","TUFTS","TUFTS PPO","CPT",11604,"EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM",null,1656,4856.75,972.93,7703.8,414,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 11604","BLUE CROSS","BLUE CROSS-PPO","CPT",11604,"EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM",null,1656,972.93,972.93,7703.8,414,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11606","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",11606,"EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM",null,2452,2309.9699999999998,1500.85,7703.8,613,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11620","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",11620,"EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<",null,930,2309.9699999999998,1098.98,3264.67,232.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 11621","TUFTS","TUFTS HMO","CPT",11621,"HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM",null,860,1281.21,684.11,2032.26,215,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11621","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",11621,"HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM",null,860,972.93,684.11,2032.26,215,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11621","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",11621,"HC EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM",null,860,972.93,684.11,2032.26,215,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11622","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",11622,"EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM",null,1324,1250.8,972.93,3264.67,331,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11623","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",11623,"EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<",null,1637,2672.73,1098.98,3264.67,409.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 11623","TUFTS","TUFTS PPO","CPT",11623,"EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<",null,1637,2058.16,1098.98,3264.67,409.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 11623","BLUE CROSS","BLUE CROSS-PPO","CPT",11623,"EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<",null,1637,2309.9699999999998,1098.98,3264.67,409.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 11624","TUFTS","TUFTS POS","CPT",11624,"EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM",null,1856,4856.75,1500.85,7703.8,464,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11626","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",11626,"EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM",null,2987,4621.25,1500.85,7703.8,746.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11626","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",11626,"EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM",null,2987,4621.25,1500.85,7703.8,746.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 11626","TUFTS","TUFTS PPO","CPT",11626,"EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM",null,2987,4856.75,1500.85,7703.8,746.75,1]
["OUTPATIENT","AETNA - AETNA - CPT - 11626","AETNA","AETNA","CPT",11626,"EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM",null,2987,1500.85,1500.85,7703.8,746.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11626","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",11626,"EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM",null,2987,3994.03,1500.85,7703.8,746.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11640","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",11640,"EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<",null,967,1250.8,684.11,2032.26,241.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11640","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",11640,"EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<",null,967,972.93,684.11,2032.26,241.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11640","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",11640,"EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<",null,967,972.93,684.11,2032.26,241.75,1]
["OUTPATIENT","AETNA - AETNA - CPT - 11643","AETNA","AETNA","CPT",11643,"EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<",null,1786,1500.85,1098.98,3264.67,446.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11643","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",11643,"EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<",null,1786,2309.9699999999998,1098.98,3264.67,446.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11644","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",11644,"EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM",null,2210,7703.8,1500.85,7703.8,552.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 11644","TUFTS","TUFTS PPO","CPT",11644,"EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM",null,2210,4856.75,1500.85,7703.8,552.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 11644","TUFTS","TUFTS SELECT","CPT",11644,"EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM",null,2210,2593.31,1500.85,7703.8,552.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11644","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",11644,"EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM",null,2210,2309.9699999999998,1500.85,7703.8,552.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11646","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",11646,"EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM",null,3063,3994.03,1500.85,7703.8,765.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 11719","BLUE CROSS","BLUE CROSS-PPO","CPT",11719,"TRIMMING NONDYSTROPHIC NAILS ANY NUMBER",null,106,93.87,93.87,508.23,26.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11719","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",11719,"TRIMMING NONDYSTROPHIC NAILS ANY NUMBER",null,106,93.87,93.87,508.23,26.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 11720","TUFTS","TUFTS PPO","CPT",11720,"DEBRIDEMENT NAIL ANY METHOD 1-5",null,165,320.41000000000003,93.87,1198.25,41.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11720","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",11720,"DEBRIDEMENT NAIL ANY METHOD 1-5",null,165,93.87,93.87,1198.25,41.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11721","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",11721,"DEBRIDEMENT NAIL ANY METHOD 6/>",null,187,120.69,93.87,1198.25,46.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11730","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",11730,"AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1",null,383,943.8,296.32,1198.25,95.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11732","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",11732,"AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL",null,155,0,43.37,1198.25,38.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11732","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",11732,"AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL",null,155,0,43.37,1198.25,38.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11732","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",11732,"AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL",null,155,0,43.37,1198.25,38.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 11732","TUFTS","TUFTS PPO","CPT",11732,"AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL",null,155,0,43.37,1198.25,38.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 11732","BLUE CROSS","BLUE CROSS-PPO","CPT",11732,"AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL",null,155,43.37,43.37,1198.25,38.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 11750","TUFTS","TUFTS POS","CPT",11750,"EXCISION NAIL MATRIX PERMANENT REMOVAL",null,1315,1281.21,527.46,2032.26,328.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 11750","TUFTS","TUFTS SELECT","CPT",11750,"EXCISION NAIL MATRIX PERMANENT REMOVAL",null,1315,684.11,527.46,2032.26,328.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11760","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",11760,"REPAIR NAIL BED",null,1035,1042.56,317.70999999999998,1198.25,258.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11760","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",11760,"REPAIR NAIL BED",null,1035,810.95,317.70999999999998,1198.25,258.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 11765","TUFTS","TUFTS PPO","CPT",11765,"WEDGE EXCISION SKIN NAIL FOLD",null,704,595.01,317.70999999999998,1198.25,176,1]
["OUTPATIENT","AETNA - AETNA - CPT - 11765","AETNA","AETNA","CPT",11765,"WEDGE EXCISION SKIN NAIL FOLD",null,704,1198.25,317.70999999999998,1198.25,176,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11765","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",11765,"WEDGE EXCISION SKIN NAIL FOLD",null,704,527.46,317.70999999999998,1198.25,176,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11770","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",11770,"EXCISION PILONIDAL CYST/SINUS SIMPLE",null,2987,3994.03,1990.62,11845.41,746.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11772","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",11772,"EXCISION PILONIDAL CYST/SINUS COMPLICATED",null,4398,4621.25,1990.62,11845.41,1099.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 11772","TUFTS","TUFTS SELECT","CPT",11772,"EXCISION PILONIDAL CYST/SINUS COMPLICATED",null,4398,3987.49,1990.62,11845.41,1099.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11772","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",11772,"EXCISION PILONIDAL CYST/SINUS COMPLICATED",null,4398,3994.03,1990.62,11845.41,1099.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11900","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",11900,"INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS",null,243,296.32,171.09,1198.25,60.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 11901","TUFTS","TUFTS PPO","CPT",11901,"INJECTION INTRALESIONAL >7 LESIONS",null,375,320.41000000000003,171.09,1198.25,93.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11901","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",11901,"INJECTION INTRALESIONAL >7 LESIONS",null,375,296.32,171.09,1198.25,93.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11901","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",11901,"INJECTION INTRALESIONAL >7 LESIONS",null,375,296.32,171.09,1198.25,93.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11901","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",11901,"INJECTION INTRALESIONAL >7 LESIONS",null,375,296.32,171.09,1198.25,93.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11921","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",11921,"HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM",null,740,810.95,684.11,2032.26,185,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11922","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",11922,"HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",null,371,0,73.66,1198.25,92.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11922","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",11922,"HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",null,371,0,73.66,1198.25,92.75,1]
["OUTPATIENT","FALLON - FALLON MEDICAID - CPT - 11922","FALLON","FALLON MEDICAID","CPT",11922,"HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",null,371,0,73.66,1198.25,92.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11922","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",11922,"HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",null,371,73.66,73.66,1198.25,92.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11922","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",11922,"HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",null,371,73.66,73.66,1198.25,92.75,1]
["OUTPATIENT","AETNA - AETNA - CPT - 11976","AETNA","AETNA","CPT",11976,"REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES",null,742,1198.25,684.11,2032.26,185.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11980","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",11980,"SUBCUTANEOUS HORMONE PELLET IMPLANTATION",null,619,751.68,317.70999999999998,1198.25,154.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11981","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",11981,"INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",null,616,229.89,178.83,1198.25,154,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 11981","TUFTS","TUFTS SELECT","CPT",11981,"INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",null,616,317.70999999999998,178.83,1198.25,154,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11982","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",11982,"REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",null,734,751.68,317.70999999999998,1198.25,183.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11982","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",11982,"REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",null,734,751.68,317.70999999999998,1198.25,183.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 11982","TUFTS","TUFTS HMO","CPT",11982,"REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",null,734,595.01,317.70999999999998,1198.25,183.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 11982","AETNA","AETNA","CPT",11982,"REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",null,734,1198.25,317.70999999999998,1198.25,183.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 11983","TUFTS","TUFTS PPO","CPT",11983,"RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT",null,1269,595.01,317.70999999999998,1198.25,317.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11983","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",11983,"RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT",null,1269,584.69000000000005,317.70999999999998,1198.25,317.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 12001","TUFTS","TUFTS POS","CPT",12001,"SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<",null,343,595.01,296.32,1198.25,85.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 12002","TUFTS","TUFTS POS","CPT",12002,"SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM",null,454,595.01,296.32,943.8,113.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 12004","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",12004,"SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM",null,565,380.96,296.32,3264.67,141.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 12004","TUFTS","TUFTS POS","CPT",12004,"SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM",null,565,2058.17,296.32,3264.67,141.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 12006","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",12006,"SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM",null,930,7703.8,527.46,7703.8,232.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 12006","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",12006,"SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM",null,930,678.1,527.46,7703.8,232.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 12006","TUFTS","TUFTS PPO","CPT",12006,"SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM",null,930,4856.75,527.46,7703.8,232.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 12006","TUFTS","TUFTS SELECT","CPT",12006,"SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM",null,930,2593.31,527.46,7703.8,232.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 12007","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",12007,"SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM",null,1144,380.96,296.32,7703.8,286,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 12011","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",12011,"SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<",null,428,371.6,296.32,3264.67,107,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 12011","TUFTS","TUFTS PPO","CPT",12011,"SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<",null,428,2058.16,296.32,3264.67,107,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 12011","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",12011,"SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<",null,428,296.32,296.32,3264.67,107,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 12014","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",12014,"SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM",null,606,296.32,296.32,3264.67,151.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 12015","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",12015,"SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM",null,754,296.32,296.32,1198.25,188.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 12015","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",12015,"SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM",null,754,296.32,296.32,1198.25,188.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 12016","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",12016,"SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM",null,1029,527.46,527.46,7703.8,257.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 12017","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",12017,"HC RESUPERF WND FACE 20.1-30 CM",null,477,527.46,527.46,7703.8,119.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 12018","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",12018,"HC RESUPERF WND FACE >30 CM",null,260,7703.8,296.32,7703.8,65,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 12020","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",12020,"TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE",null,1435,1042.56,684.11,2032.26,358.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 12021","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",12021,"TX SUPERFICIAL WOUND DEHISCENCE W/PACKING",null,1090,678.1,527.46,2032.26,272.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 12021","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",12021,"TX SUPERFICIAL WOUND DEHISCENCE W/PACKING",null,1090,678.1,527.46,2032.26,272.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 12021","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",12021,"TX SUPERFICIAL WOUND DEHISCENCE W/PACKING",null,1090,527.46,527.46,2032.26,272.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 12021","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",12021,"TX SUPERFICIAL WOUND DEHISCENCE W/PACKING",null,1090,527.46,527.46,2032.26,272.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 12031","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",12031,"REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<",null,1177,661.45,527.46,2032.26,294.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 12031","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",12031,"REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<",null,1177,678.1,527.46,2032.26,294.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 12031","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",12031,"REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<",null,1177,527.46,527.46,2032.26,294.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 12032","TUFTS","TUFTS POS","CPT",12032,"REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM",null,1505,1281.21,527.46,2032.26,376.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 12032","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",12032,"REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM",null,1505,527.46,527.46,2032.26,376.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 12034","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",12034,"REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM",null,1588,527.46,527.46,2032.26,397,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 12034","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",12034,"REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM",null,1588,527.46,527.46,2032.26,397,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 12035","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",12035,"REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM",null,1839,678.1,527.46,2032.26,459.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 12035","TUFTS","TUFTS SELECT","CPT",12035,"REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM",null,1839,684.11,527.46,2032.26,459.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 12036","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",12036,"HC LAYR CLOS WND TRUNK, ARM, LEG 20.1-30 CM",null,725,1042.56,684.11,2032.26,181.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 20551","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",20551,"INJECTION SINGLE TENDON ORIGIN/INSERTION",null,324,521.19000000000005,317.70999999999998,1198.25,81,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 12036","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",12036,"HC LAYR CLOS WND TRUNK, ARM, LEG 20.1-30 CM",null,725,810.95,684.11,2032.26,181.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 12041","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",12041,"REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<",null,1204,678.1,317.70999999999998,1198.25,301,1]
["OUTPATIENT","AETNA - AETNA - CPT - 12041","AETNA","AETNA","CPT",12041,"REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<",null,1204,1198.25,317.70999999999998,1198.25,301,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 12041","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",12041,"REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<",null,1204,527.46,317.70999999999998,1198.25,301,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 12044","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",12044,"REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM",null,1648,1042.56,684.11,2032.26,412,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 12044","TUFTS","TUFTS HMO","CPT",12044,"REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM",null,1648,1281.21,684.11,2032.26,412,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 12044","BLUE CROSS","BLUE CROSS-PPO","CPT",12044,"REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM",null,1648,810.95,684.11,2032.26,412,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 12045","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",12045,"HC LAYR CLOS WND REST BODY 12.6-20 CM",null,740,2032.26,684.11,2032.26,185,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 12045","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",12045,"HC LAYR CLOS WND REST BODY 12.6-20 CM",null,740,810.95,684.11,2032.26,185,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 12045","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",12045,"HC LAYR CLOS WND REST BODY 12.6-20 CM",null,740,810.95,684.11,2032.26,185,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 12046","TUFTS","TUFTS HMO","CPT",12046,"HC LAYR CLOS WND REST BODY 20.1-30 CM",null,477,1281.21,527.46,2032.26,119.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 12046","AETNA","AETNA","CPT",12046,"HC LAYR CLOS WND REST BODY 20.1-30 CM",null,477,1500.85,527.46,2032.26,119.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 12047","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",12047,"REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM",null,2627,3344.2,684.11,3344.2,656.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 12047","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",12047,"REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM",null,2627,2601.27,684.11,3344.2,656.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 12047","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",12047,"REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM",null,2627,2601.27,684.11,3344.2,656.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 12051","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",12051,"REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<",null,1324,678.1,527.46,2032.26,331,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 12051","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",12051,"REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<",null,1324,527.46,527.46,2032.26,331,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 12051","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",12051,"REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<",null,1324,527.46,527.46,2032.26,331,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 12052","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",12052,"REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM",null,1569,527.46,527.46,2032.26,392.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 12052","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",12052,"REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM",null,1569,527.46,527.46,2032.26,392.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 12052","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",12052,"REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM",null,1569,527.46,527.46,2032.26,392.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 12053","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",12053,"REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM",null,1677,2032.26,527.46,2032.26,419.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 12053","TUFTS","TUFTS SELECT","CPT",12053,"REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM",null,1677,684.11,527.46,2032.26,419.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 12053","AETNA","AETNA","CPT",12053,"REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM",null,1677,1198.25,527.46,2032.26,419.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 12053","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",12053,"REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM",null,1677,527.46,527.46,2032.26,419.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 12053","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",12053,"REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM",null,1677,527.46,527.46,2032.26,419.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 12053","BLUE CROSS","BLUE CROSS-PPO","CPT",12053,"REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM",null,1677,527.46,527.46,2032.26,419.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 12054","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",12054,"REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM",null,1758,678.1,317.70999999999998,1500.85,439.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 12055","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",12055,"REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM",null,2322,527.46,527.46,2032.26,580.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 12055","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",12055,"REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM",null,2322,527.46,527.46,2032.26,580.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 12056","TUFTS","TUFTS SELECT","CPT",12056,"HC LAYR CLOS WND FACE,FACIAL 20.1-30 CM",null,477,684.11,527.46,2032.26,119.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 13100","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",13100,"REPAIR COMPLEX TRUNK 1.1-2.5 CM",null,1793,2032.26,684.11,2032.26,448.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 13100","TUFTS","TUFTS PPO","CPT",13100,"REPAIR COMPLEX TRUNK 1.1-2.5 CM",null,1793,1281.21,684.11,2032.26,448.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 13101","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",13101,"REPAIR COMPLEX TRUNK 2.6-7.5 CM",null,2180,1016.97,684.11,2032.26,545,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 13101","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",13101,"REPAIR COMPLEX TRUNK 2.6-7.5 CM",null,2180,2032.26,684.11,2032.26,545,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 13101","TUFTS","TUFTS POS","CPT",13101,"REPAIR COMPLEX TRUNK 2.6-7.5 CM",null,2180,1281.21,684.11,2032.26,545,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 13101","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",13101,"REPAIR COMPLEX TRUNK 2.6-7.5 CM",null,2180,810.95,684.11,2032.26,545,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 13101","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",13101,"REPAIR COMPLEX TRUNK 2.6-7.5 CM",null,2180,810.95,684.11,2032.26,545,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 13102","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",13102,"REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<",null,577,0,185.3,1198.25,144.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 13120","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",13120,"REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM",null,1884,810.95,684.11,2032.26,471,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 13120","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",13120,"REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM",null,1884,810.95,684.11,2032.26,471,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 13121","TUFTS","TUFTS PPO","CPT",13121,"REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM",null,2517,1281.21,684.11,2032.26,629.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 13121","AETNA","AETNA","CPT",13121,"REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM",null,2517,1990.62,684.11,2032.26,629.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 13122","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",13122,"REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<",null,661,213.81,213.81,1198.25,165.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 13131","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",13131,"REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM",null,2113,2032.26,527.46,2032.26,528.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 13131","TUFTS","TUFTS POS","CPT",13131,"REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM",null,2113,1281.21,527.46,2032.26,528.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 13131","TUFTS","TUFTS SELECT","CPT",13131,"REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM",null,2113,684.11,527.46,2032.26,528.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 13131","BLUE CROSS","BLUE CROSS-PPO","CPT",13131,"REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM",null,2113,527.46,527.46,2032.26,528.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 13133","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",13133,"REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<",null,1015,0,326.66000000000003,1198.25,253.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 13151","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",13151,"REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM",null,2426,1042.56,684.11,2032.26,606.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 13151","BLUE CROSS","BLUE CROSS-PPO","CPT",13151,"REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM",null,2426,810.95,684.11,2032.26,606.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 13151","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",13151,"REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM",null,2426,810.95,684.11,2032.26,606.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 13152","AETNA","AETNA","CPT",13152,"REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM",null,3239,1990.62,684.11,2032.26,809.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 13152","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",13152,"REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM",null,3239,810.95,684.11,2032.26,809.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 13160","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",13160,"SECONDARY CLOSURE SURG WOUND/DEHSN EXTSV/COMPLIC",null,6205,3344.2,1500.85,7703.8,1551.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 13160","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",13160,"SECONDARY CLOSURE SURG WOUND/DEHSN EXTSV/COMPLIC",null,6205,3344.2,1500.85,7703.8,1551.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 13160","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",13160,"SECONDARY CLOSURE SURG WOUND/DEHSN EXTSV/COMPLIC",null,6205,2601.27,1500.85,7703.8,1551.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 13160","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",13160,"SECONDARY CLOSURE SURG WOUND/DEHSN EXTSV/COMPLIC",null,6205,2601.27,1500.85,7703.8,1551.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 14000","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",14000,"ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<",null,3904,2601.27,1500.85,7703.8,976,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 14000","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",14000,"ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<",null,3904,2601.27,1500.85,7703.8,976,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 14000","BLUE CROSS","BLUE CROSS-PPO","CPT",14000,"ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<",null,3904,2601.27,1500.85,7703.8,976,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 14001","BLUE CROSS","BLUE CROSS-PPO","CPT",14001,"ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM",null,5072,2601.27,1990.62,11845.41,1268,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 14020","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",14020,"ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<",null,4426,3262.11,1990.62,11845.41,1106.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 14020","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",14020,"ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<",null,4426,3344.2,1990.62,11845.41,1106.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 14020","TUFTS","TUFTS PPO","CPT",14020,"ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<",null,4426,7467.76,1990.62,11845.41,1106.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 14021","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",14021,"ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM",null,5587,3262.11,1990.62,11845.41,1396.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 14021","TUFTS","TUFTS PPO","CPT",14021,"ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM",null,5587,7467.76,1990.62,11845.41,1396.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 14021","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",14021,"ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM",null,5587,2601.27,1990.62,11845.41,1396.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 14041","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",14041,"ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM",null,6040,2601.27,1990.62,11845.41,1510,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 14041","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",14041,"ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM",null,6040,2601.27,1990.62,11845.41,1510,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 14060","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",14060,"ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<",null,5231,11845.41,1990.62,11845.41,1307.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 14060","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",14060,"ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<",null,5231,3344.2,1990.62,11845.41,1307.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 14061","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",14061,"ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM",null,6450,3344.2,1990.62,11845.41,1612.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 14061","TUFTS","TUFTS POS","CPT",14061,"ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM",null,6450,7467.76,1990.62,11845.41,1612.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 14061","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",14061,"ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM",null,6450,2601.27,1990.62,11845.41,1612.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 14061","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",14061,"ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM",null,6450,2601.27,1990.62,11845.41,1612.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 14301","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",14301,"ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM",null,6875,5972.07,1990.62,11845.41,1718.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 14301","BLUE CROSS","BLUE CROSS-PPO","CPT",14301,"ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM",null,6875,4645.3599999999997,1990.62,11845.41,1718.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 14302","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",14302,"ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM/<",null,1598,0,548.05999999999995,1198.25,399.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 14302","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",14302,"ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM/<",null,1598,548.05999999999995,548.05999999999995,1198.25,399.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 14302","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",14302,"ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM/<",null,1598,548.05999999999995,548.05999999999995,1198.25,399.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 15002","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",15002,"PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT",null,1752,3344.2,684.11,3344.2,438,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 15002","TUFTS","TUFTS HMO","CPT",15002,"PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT",null,1752,1281.21,684.11,3344.2,438,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 15002","TUFTS","TUFTS SELECT","CPT",15002,"PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT",null,1752,684.11,684.11,3344.2,438,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 15002","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",15002,"PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT",null,1752,2601.27,684.11,3344.2,438,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 15003","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",15003,"HC WOUND PREP, PED, TRK/ARM/LG ADDL 100 CM",null,1421,113.61,113.61,1198.25,355.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 15004","AETNA","AETNA","CPT",15004,"PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT",null,2072,1500.85,684.11,2032.26,518,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 15004","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",15004,"PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT",null,2072,810.95,684.11,2032.26,518,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 15004","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",15004,"PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT",null,2072,810.95,684.11,2032.26,518,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 15050","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",15050,"PINCH GRAFT 1/MLT SM ULCER TIP/OTH AREA 2CM",null,3469,1042.56,684.11,2032.26,867.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 15050","AETNA","AETNA","CPT",15050,"PINCH GRAFT 1/MLT SM ULCER TIP/OTH AREA 2CM",null,3469,1500.85,684.11,2032.26,867.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 15050","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",15050,"PINCH GRAFT 1/MLT SM ULCER TIP/OTH AREA 2CM",null,3469,810.95,684.11,2032.26,867.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 15100","AETNA","AETNA","CPT",15100,"HC SKIN SPLT GRFT TRNK/ARM/LEG",null,2354,1500.85,1500.85,7703.8,588.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 15120","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",15120,"HB SPLIT GRFT,HEAD,FAC,HAND,FEET <100 SQCM",null,4152,5825.47,1500.85,7703.8,1038,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 15120","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",15120,"HB SPLIT GRFT,HEAD,FAC,HAND,FEET <100 SQCM",null,4152,5972.07,1500.85,7703.8,1038,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 15120","TUFTS","TUFTS SELECT","CPT",15120,"HB SPLIT GRFT,HEAD,FAC,HAND,FEET <100 SQCM",null,4152,2593.31,1500.85,7703.8,1038,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 15240","TUFTS","TUFTS POS","CPT",15240,"FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20 CM/<",null,6235,7467.76,1990.62,11845.41,1558.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 15240","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",15240,"FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20 CM/<",null,6235,2601.27,1990.62,11845.41,1558.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 15241","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",15241,"FTH/GT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA20CM/<",null,870,0,275.18,1990.62,217.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 15241","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",15241,"FTH/GT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA20CM/<",null,870,275.18,275.18,1990.62,217.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 15260","TUFTS","TUFTS POS","CPT",15260,"FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/<",null,3002,4856.75,1500.85,7703.8,750.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 15271","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",15271,"APP SKN SUB GRFT T/A/L AREA/100SCM /<1ST 25",null,2356,3344.2,1098.98,3344.2,589,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 15271","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",15271,"APP SKN SUB GRFT T/A/L AREA/100SCM /<1ST 25",null,2356,2601.27,1098.98,3344.2,589,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 15271","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",15271,"APP SKN SUB GRFT T/A/L AREA/100SCM /<1ST 25",null,2356,2601.27,1098.98,3344.2,589,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 15272","TUFTS","TUFTS SELECT","CPT",15272,"APP SKN SUB GRFT T/A/L AREA/100SCM EA ADL 25SC",null,133,0,42.82,1198.25,33.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 15273","TUFTS","TUFTS PPO","CPT",15273,"HC APP SKN SUB GRFT T/A/L AREA/>100SCM 1ST 100SCM",null,5186,1281.21,684.11,5972.07,1296.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 15273","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",15273,"HC APP SKN SUB GRFT T/A/L AREA/>100SCM 1ST 100SCM",null,5186,4645.3599999999997,684.11,5972.07,1296.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 15273","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",15273,"HC APP SKN SUB GRFT T/A/L AREA/>100SCM 1ST 100SCM",null,5186,4645.3599999999997,684.11,5972.07,1296.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 15273","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",15273,"HC APP SKN SUB GRFT T/A/L AREA/>100SCM 1ST 100SCM",null,5186,4645.3599999999997,684.11,5972.07,1296.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 15274","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",15274,"HC APP SKN SUB GRFT T/A/L AREA/>100SCM ADL 100SCM",null,2594,0,114.44,1198.25,648.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 15274","TUFTS","TUFTS HMO","CPT",15274,"HC APP SKN SUB GRFT T/A/L AREA/>100SCM ADL 100SCM",null,2594,0,114.44,1198.25,648.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 15275","BLUE CROSS","BLUE CROSS-PPO","CPT",15275,"SUB GRFT F/S/N/H/F/G/M/D <100SCM 1ST 25 SCM",null,2356,2601.27,1098.98,3344.2,589,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 15276","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",15276,"SUB GRFT F/S/N/H/F/G/M/D <100SCM EA ADDL 25 SCM",null,191,62.43,62.43,1198.25,47.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 15276","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",15276,"SUB GRFT F/S/N/H/F/G/M/D <100SCM EA ADDL 25 SCM",null,191,62.43,62.43,1198.25,47.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 15277","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",15277,"HC SUB GRFT F/S/N/H/F/G/M/D />100SCM 1ST 100SCM",null,2192,2601.27,684.11,3344.2,548,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 15277","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",15277,"HC SUB GRFT F/S/N/H/F/G/M/D />100SCM 1ST 100SCM",null,2192,2601.27,684.11,3344.2,548,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 15278","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",15278,"HC SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM ADL 100SQ CM",null,1818,0,142.94999999999999,1198.25,454.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 15278","TUFTS","TUFTS HMO","CPT",15278,"HC SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM ADL 100SQ CM",null,1818,0,142.94999999999999,1198.25,454.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 15278","TUFTS","TUFTS PPO","CPT",15278,"HC SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM ADL 100SQ CM",null,1818,0,142.94999999999999,1198.25,454.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 15278","TUFTS","TUFTS SELECT","CPT",15278,"HC SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM ADL 100SQ CM",null,1818,0,142.94999999999999,1198.25,454.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 15278","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",15278,"HC SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM ADL 100SQ CM",null,1818,142.94999999999999,142.94999999999999,1198.25,454.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 15278","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",15278,"HC SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM ADL 100SQ CM",null,1818,142.94999999999999,142.94999999999999,1198.25,454.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 15278","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",15278,"HC SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM ADL 100SQ CM",null,1818,142.94999999999999,142.94999999999999,1198.25,454.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 15620","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",15620,"DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F",null,2535,3262.11,2166.09,11845.41,633.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 15620","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",15620,"DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F",null,2535,3344.2,2166.09,11845.41,633.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 15620","TUFTS","TUFTS PPO","CPT",15620,"DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F",null,2535,7467.76,2166.09,11845.41,633.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 15620","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",15620,"DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F",null,2535,2601.27,2166.09,11845.41,633.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 15630","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",15630,"HC DELAY/SECTN FLAP LID,NOS,EAR,LIP",null,2701,11845.41,1990.62,11845.41,675.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 15630","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",15630,"HC DELAY/SECTN FLAP LID,NOS,EAR,LIP",null,2701,3344.2,1990.62,11845.41,675.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 15630","TUFTS","TUFTS POS","CPT",15630,"HC DELAY/SECTN FLAP LID,NOS,EAR,LIP",null,2701,7467.76,1990.62,11845.41,675.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 15630","TUFTS","TUFTS SELECT","CPT",15630,"HC DELAY/SECTN FLAP LID,NOS,EAR,LIP",null,2701,3987.49,1990.62,11845.41,675.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 15630","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",15630,"HC DELAY/SECTN FLAP LID,NOS,EAR,LIP",null,2701,2601.27,1990.62,11845.41,675.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 15630","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",15630,"HC DELAY/SECTN FLAP LID,NOS,EAR,LIP",null,2701,2601.27,1990.62,11845.41,675.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 15731","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",15731,"FOREHEAD FLAP W/VASC PEDICLE",null,5186,5825.47,1990.62,7703.8,1296.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 15731","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",15731,"FOREHEAD FLAP W/VASC PEDICLE",null,5186,4645.3599999999997,1990.62,7703.8,1296.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 15731","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",15731,"FOREHEAD FLAP W/VASC PEDICLE",null,5186,4645.3599999999997,1990.62,7703.8,1296.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 15733","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",15733,"HC MUSC MYOQ/FSCQ FLAP HEAD&NECK W/NAMED VASC PEDCL",null,4069,4645.3599999999997,1990.62,11845.41,1017.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 15769","TUFTS","TUFTS PPO","CPT",15769,"HC GRFG AUTOL SOFT TISS DIR EXC",null,3778,7467.76,2166.09,11845.41,944.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 15769","BLUE CROSS","BLUE CROSS-PPO","CPT",15769,"HC GRFG AUTOL SOFT TISS DIR EXC",null,3778,4791.8,2166.09,11845.41,944.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 15771","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",15771,"HC GRFG AUTOL FAT LIPO 50 CC/<",null,3778,5972.07,2166.09,11845.41,944.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 15774","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",15774,"HC GFRG AUTOL FAT LIPO EA ADDL",null,1031,336.33,336.33,1198.25,257.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 15774","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",15774,"HC GFRG AUTOL FAT LIPO EA ADDL",null,1031,336.33,336.33,1198.25,257.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 15774","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",15774,"HC GFRG AUTOL FAT LIPO EA ADDL",null,1031,336.33,336.33,1198.25,257.75,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 15820","TUFTS","TUFTS HMO","CPT",15820,"HC REVISION OF LOWER EYELID",null,2527,4856.75,1990.62,7703.8,631.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 15820","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",15820,"HC REVISION OF LOWER EYELID",null,2527,2601.27,1990.62,7703.8,631.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 15821","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",15821,"HC REV LOWER EYELID EXTEN FAT PAD",null,2527,3344.2,1990.62,7703.8,631.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 15821","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",15821,"HC REV LOWER EYELID EXTEN FAT PAD",null,2527,2601.27,1990.62,7703.8,631.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 15821","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",15821,"HC REV LOWER EYELID EXTEN FAT PAD",null,2527,2601.27,1990.62,7703.8,631.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 15822","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",15822,"BLEPHAROPLASTY UPPER EYELID",null,3039,3262.11,1990.62,7703.8,759.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 15822","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",15822,"BLEPHAROPLASTY UPPER EYELID",null,3039,2601.27,1990.62,7703.8,759.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 15828","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",15828,"HC RHYTIDECTOMY CHEEK CHIN & NECK",null,5109,4645.3599999999997,1990.62,7703.8,1277.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 15830","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",15830,"HC EXCISE EXCESS SKIN TISSUE,ABDOMEN",null,8148,8254.4500000000007,1990.62,11845.41,2037,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 15832","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",15832,"HC EXCISE EXCESS SKIN TISSUE,THIGH",null,1528,3994.03,1990.62,7703.8,382,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 15839","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",15839,"EXCISION EXCESSIVE SKIN & SUBQ TISSUE OTHER AREA",null,5680,3994.03,1098.98,4621.25,1420,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 15850","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",15850,"REMOVE SUTURES SAME SURGEON",null,773,810.95,317.70999999999998,1198.25,193.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 15851","AETNA","AETNA","CPT",15851,"REMOVE SUTURES DIFF SURGEON",null,2527,1198.25,317.70999999999998,3344.2,631.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 15852","TUFTS","TUFTS PPO","CPT",15852,"HC DRESSING CHANGE,NOT FOR BURN",null,733,320.41000000000003,171.09,1198.25,183.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 15852","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",15852,"HC DRESSING CHANGE,NOT FOR BURN",null,733,810.95,171.09,1198.25,183.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 15852","BLUE CROSS","BLUE CROSS-PPO","CPT",15852,"HC DRESSING CHANGE,NOT FOR BURN",null,733,810.95,171.09,1198.25,183.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 15936","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",15936,"HC EXC SACR HCESS ULC W MUSC FLAP CLO",null,1858,11845.41,2166.09,11845.41,464.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 16020","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",16020,"DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL",null,417,943.8,296.32,1198.25,104.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 16020","TUFTS","TUFTS SELECT","CPT",16020,"DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL",null,417,317.70999999999998,296.32,1198.25,104.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 16020","AETNA","AETNA","CPT",16020,"DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL",null,417,1198.25,296.32,1198.25,104.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 16030","TUFTS","TUFTS HMO","CPT",16030,"DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE",null,1025,595.01,317.70999999999998,1500.85,256.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 16030","TUFTS","TUFTS SELECT","CPT",16030,"DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE",null,1025,317.70999999999998,317.70999999999998,1500.85,256.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 17000","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",17000,"DESTRUCTION PREMALIGNANT LESION 1ST",null,430,296.32,171.09,1198.25,107.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 17003","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",17003,"DESTRUCTION PREMALIGNANT LESION 2-14 EA",null,34,0,6.04,1198.25,8.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 17003","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",17003,"DESTRUCTION PREMALIGNANT LESION 2-14 EA",null,34,0,6.04,1198.25,8.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 17003","TUFTS","TUFTS POS","CPT",17003,"DESTRUCTION PREMALIGNANT LESION 2-14 EA",null,34,0,6.04,1198.25,8.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 17004","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",17004,"DESTRUCTION PREMALIGNANT LESION 15/>",null,1004,527.46,317.70999999999998,1198.25,251,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 17106","BLUE CROSS","BLUE CROSS-PPO","CPT",17106,"DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM",null,2104,527.46,317.70999999999998,1198.25,526,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 17107","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",17107,"DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM",null,2675,943.8,317.70999999999998,1198.25,668.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 17107","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",17107,"DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM",null,2675,1042.56,317.70999999999998,1198.25,668.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 17107","TUFTS","TUFTS SELECT","CPT",17107,"DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM",null,2675,317.70999999999998,317.70999999999998,1198.25,668.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 17107","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",17107,"DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM",null,2675,810.95,317.70999999999998,1198.25,668.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 17111","BLUE CROSS","BLUE CROSS-PPO","CPT",17111,"DESTRUCTION BENIGN LESIONS 15/>",null,657,296.32,296.32,1198.25,164.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 17250","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",17250,"CHEMICAL CAUTERIZATION GRANULATION TISSUE",null,328,380.96,296.32,1198.25,82,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 17250","TUFTS","TUFTS SELECT","CPT",17250,"CHEMICAL CAUTERIZATION GRANULATION TISSUE",null,328,308.57,296.32,1198.25,82,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 17250","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",17250,"CHEMICAL CAUTERIZATION GRANULATION TISSUE",null,328,296.32,296.32,1198.25,82,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 17260","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",17260,"DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<",null,536,380.96,296.32,1198.25,134,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 17260","TUFTS","TUFTS HMO","CPT",17260,"DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<",null,536,595.01,296.32,1198.25,134,1]
["OUTPATIENT","AETNA - AETNA - CPT - 17261","AETNA","AETNA","CPT",17261,"DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM",null,709,1198.25,296.32,1198.25,177.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 17261","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",17261,"DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM",null,709,296.32,296.32,1198.25,177.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 17262","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",17262,"DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM",null,899,296.32,296.32,1198.25,224.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 17263","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",17263,"DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM",null,995,380.96,296.32,1198.25,248.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 17263","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",17263,"DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM",null,995,380.96,296.32,1198.25,248.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 17263","TUFTS","TUFTS POS","CPT",17263,"DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM",null,995,595.01,296.32,1198.25,248.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 17264","TUFTS","TUFTS SELECT","CPT",17264,"DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM",null,1065,317.70999999999998,317.70999999999998,1198.25,266.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 17271","TUFTS","TUFTS PPO","CPT",17271,"DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM",null,858,595.01,296.32,1198.25,214.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 17271","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",17271,"DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM",null,858,296.32,296.32,1198.25,214.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 17280","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",17280,"HC DESTR MALIG FACE,NOSE,LIP <0.6 CM",null,264,380.96,296.32,1198.25,66,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 17280","TUFTS","TUFTS PPO","CPT",17280,"HC DESTR MALIG FACE,NOSE,LIP <0.6 CM",null,264,595.01,296.32,1198.25,66,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 17280","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",17280,"HC DESTR MALIG FACE,NOSE,LIP <0.6 CM",null,264,296.32,296.32,1198.25,66,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 17281","BLUE CROSS","BLUE CROSS-PPO","CPT",17281,"DESTRUCTION OF SKIN LESIONS",null,510,527.46,317.70999999999998,1198.25,127.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 17311","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",17311,"MOHS MICROGRAPHIC H/N/H/F/G 1ST STAGE 5 BLOCKS",null,2913,810.95,684.11,2032.26,728.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 17312","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",17312,"MOHS,  ADDL STAGE, HEAD/NECK/HAND/FEET/GENTIAL",null,1547,499.91,499.91,1198.25,386.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 17312","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",17312,"MOHS,  ADDL STAGE, HEAD/NECK/HAND/FEET/GENTIAL",null,1547,499.91,499.91,1198.25,386.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 17313","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",17313,"MOHS TRUNK/ARM/LEG 1ST STAGE 5 BLOCKS",null,2612,1042.56,684.11,2032.26,653,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 17313","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",17313,"MOHS TRUNK/ARM/LEG 1ST STAGE 5 BLOCKS",null,2612,1042.56,684.11,2032.26,653,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 17313","TUFTS","TUFTS SELECT","CPT",17313,"MOHS TRUNK/ARM/LEG 1ST STAGE 5 BLOCKS",null,2612,684.11,684.11,2032.26,653,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 17313","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",17313,"MOHS TRUNK/ARM/LEG 1ST STAGE 5 BLOCKS",null,2612,810.95,684.11,2032.26,653,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 17313","BLUE CROSS","BLUE CROSS-PPO","CPT",17313,"MOHS TRUNK/ARM/LEG 1ST STAGE 5 BLOCKS",null,2612,810.95,684.11,2032.26,653,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 17314","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",17314,"MOHS TRUNK/ARM/LEG EA STAGE AFTER 1ST STAGE",null,1437,0,463.49,1198.25,359.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 17315","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",17315,"MOHS TRUNK/ARM/LEG EA ADDL BLOCK ANY STAGE",null,405,131.91999999999999,131.91999999999999,1198.25,101.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 17380","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",17380,"HAIR REMOVAL BY ELECTROLYSIS",null,773,1016.97,767.54,2446.2800000000002,193.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 17999","TUFTS","TUFTS HMO","CPT",17999,"PR PRE OPERATIVE LASER HAIR REMOVAL FOR GENITAL AFFIRMATION SURGERY",null,264,595.01,317.70999999999998,1198.25,66,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 19000","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",19000,"PUNCTURE ASPIRATION CYST BREAST",null,709,1220.0899999999999,684.11,2032.26,177.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 19000","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",19000,"PUNCTURE ASPIRATION CYST BREAST",null,709,972.93,684.11,2032.26,177.25,1]
["OUTPATIENT","FALLON - FALLON MEDICAID - CPT - 0001A","FALLON","FALLON MEDICAID","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST",null,58,33.880000000000003,16.940000000000001,74.13,14.5,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 0001A","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST",null,58,45.98,16.940000000000001,74.13,14.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 0001A","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","0001A","HC ADM SARSCOV2 30MCG/0.3ML 1ST",null,58,38.97,16.940000000000001,74.13,14.5,1]
["OUTPATIENT","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 0002A","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND",null,58,28.39,28.39,124.23,14.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 0002A","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND",null,58,65.31,28.39,124.23,14.5,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN ACO - CPT - 0002A","BMC HEALTHNET","BMCHN ACO","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND",null,58,124.23,28.39,124.23,14.5,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MEDICAID - CPT - 0002A","BMC HEALTHNET","BMCHN MEDICAID","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND",null,58,56.78,28.39,124.23,14.5,1]
["OUTPATIENT","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 0011A","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST",null,59,16.940000000000001,16.940000000000001,74.13,14.75,1]
["OUTPATIENT","FALLON - FALLON MEDICAID - CPT - 0011A","FALLON","FALLON MEDICAID","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST",null,59,33.880000000000003,16.940000000000001,74.13,14.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 0011A","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT","0011A","HC ADM SARSCOV2 100MCG/0.5ML1ST",null,59,38.97,16.940000000000001,74.13,14.75,1]
["OUTPATIENT","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 0012A","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND",null,59,28.39,28.39,124.23,14.75,1]
["OUTPATIENT","FALLON - FALLON MEDICAID - CPT - 0012A","FALLON","FALLON MEDICAID","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND",null,59,56.78,28.39,124.23,14.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 0012A","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT","0012A","HC ADM SARSCOV2 100MCG/0.5ML2ND",null,59,65.31,28.39,124.23,14.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 0126T","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","0126T","HC COMMON CAROTID INTIMA-MEDIA THICK FOR AHD/CHD RISK ASSESS",null,650,69.349999999999994,67.64,69.349999999999994,162.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 0159T","TUFTS","TUFTS PPO","CPT","0159T","HC COMPUTER AIDED DETECTION BREAST MRI",null,331,0,null,null,82.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 0191T","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",null,5769,17023.61,1990.62,17023.61,1442.25,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 0202U","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",null,1355,0,null,null,338.75,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 0202U","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",null,1355,0,null,null,338.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 0207T","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","0207T","HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL",null,85,120.69,117.73,1198.25,21.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 0234T","AETNA","AETNA","CPT","0234T","HC TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA",null,9897,1990.62,1990.62,18787.919999999998,2474.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 0238T","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT","0238T","HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA",null,15225,29102.92,25785.9,29835.33,3806.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 0238T","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT","0238T","HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA",null,15225,29835.33,25785.9,29835.33,3806.25,1]
["OUTPATIENT","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 0241U","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT",null,229,142.63,142.63,358.89,57.25,1]
["OUTPATIENT","ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 0241U","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT",null,229,142.63,142.63,358.89,57.25,1]
["OUTPATIENT","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 0241U","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT","0241U","HC NFCT DS VIR RESP RNA 4 TRGT",null,229,315.2,142.63,358.89,57.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 0346T","CIGNA HEALTHCARE","CIGNA CARELINK","CPT","0346T","ULTRASOUND ELASTOGRAPHY",null,1279,0,null,null,319.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 0346T","TUFTS","TUFTS POS","CPT","0346T","ULTRASOUND ELASTOGRAPHY",null,1279,0,null,null,319.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 0346T","TUFTS","TUFTS PPO","CPT","0346T","ULTRASOUND ELASTOGRAPHY",null,1279,0,null,null,319.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 0362T","TUFTS","TUFTS SELECT","CPT","0362T","HC BHV ID SUPRT ASSMT EA 15 MIN",null,378,33.74,33.74,61.23,94.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 0524T","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT","0524T","HC EV CATHETER DIR CHEM ABLTJ INCMPTNT XTR VEIN",null,4065,5703.04,1990.62,5703.04,1016.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 0540T","TUFTS","TUFTS SELECT","CPT","0540T","HC CAR-T CLL ADMN AUTOLOGOUS",null,451,548.67999999999995,548.67999999999995,1748.74,112.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 10004","TUFTS","TUFTS SELECT","CPT",10004,"HC FNA BX W/O IMG GDN EA ADDL",null,435,0,107.47,1198.25,108.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 10005","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",10005,"HC FNA BX W/US GDN 1ST LES",null,892,2032.26,684.11,2032.26,223,1]
["OUTPATIENT","AETNA - AETNA - CPT - 10005","AETNA","AETNA","CPT",10005,"HC FNA BX W/US GDN 1ST LES",null,892,1198.25,684.11,2032.26,223,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 10005","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",10005,"HC FNA BX W/US GDN 1ST LES",null,892,972.93,684.11,2032.26,223,1]
["OUTPATIENT","AETNA - AETNA - CPT - 10006","AETNA","AETNA","CPT",10006,"HC FNA BX W/US GDN EA ADDL",null,435,1198.25,122.2,1198.25,108.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 10006","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",10006,"HC FNA BX W/US GDN EA ADDL",null,435,122.2,122.2,1198.25,108.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 10007","BLUE CROSS","BLUE CROSS-PPO","CPT",10007,"HC FNA BX W/FLUOR GDN 1ST LES",null,892,972.93,684.11,2032.26,223,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 10008","TUFTS","TUFTS POS","CPT",10008,"HC FNA BX W/FLUOR GDN EA ADDL",null,436,0,151.03,1198.25,109,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 10008","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",10008,"HC FNA BX W/FLUOR GDN EA ADDL",null,436,151.03,151.03,1198.25,109,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 10009","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",10009,"HC FNA BX W/CT GDN 1ST LES",null,892,2032.26,684.11,2032.26,223,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 10009","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",10009,"HC FNA BX W/CT GDN 1ST LES",null,892,1250.8,684.11,2032.26,223,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 10009","TUFTS","TUFTS SELECT","CPT",10009,"HC FNA BX W/CT GDN 1ST LES",null,892,684.11,684.11,2032.26,223,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 10009","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",10009,"HC FNA BX W/CT GDN 1ST LES",null,892,972.93,684.11,2032.26,223,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 10010","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",10010,"HC FNA BX W/CT GDN EA ADDL",null,436,204.55,204.55,1198.25,109,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 10010","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",10010,"HC FNA BX W/CT GDN EA ADDL",null,436,204.55,204.55,1198.25,109,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 10011","TUFTS","TUFTS SELECT","CPT",10011,"HC FNA BX W/MR GDN 1ST LES",null,892,684.11,684.11,2032.26,223,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 10011","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",10011,"HC FNA BX W/MR GDN 1ST LES",null,892,972.93,684.11,2032.26,223,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 10011","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",10011,"HC FNA BX W/MR GDN 1ST LES",null,892,972.93,684.11,2032.26,223,1]
["OUTPATIENT","AETNA - AETNA - CPT - 10021","AETNA","AETNA","CPT",10021,"FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE",null,538,1198.25,317.70999999999998,1198.25,134.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 10021","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",10021,"FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE",null,538,527.46,317.70999999999998,1198.25,134.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 10021","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",10021,"FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE",null,538,527.46,317.70999999999998,1198.25,134.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 10030","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",10030,"IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE",null,1149,943.8,317.70999999999998,1500.85,287.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 10030","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",10030,"IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE",null,1149,972.93,317.70999999999998,1500.85,287.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 10035","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",10035,"HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION",null,930,3264.67,972.93,3264.67,232.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 10035","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",10035,"HC PLCMNT SOFT TISSUE LOCALIZATION DEVICE(S) PERCUT, INCLG IMG GUID; FIRST LESION",null,930,972.93,972.93,3264.67,232.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 10036","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",10036,"HC PERQ DEV SOFT TISS ADD IMAG",null,861,0,107.09,1198.25,215.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 10036","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",10036,"HC PERQ DEV SOFT TISS ADD IMAG",null,861,0,107.09,1198.25,215.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 10036","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",10036,"HC PERQ DEV SOFT TISS ADD IMAG",null,861,0,107.09,1198.25,215.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 10036","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",10036,"HC PERQ DEV SOFT TISS ADD IMAG",null,861,107.09,107.09,1198.25,215.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 10040","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",10040,"ACNE SURGERY",null,681,380.96,171.09,508.23,170.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 10040","TUFTS","TUFTS PPO","CPT",10040,"ACNE SURGERY",null,681,320.41000000000003,171.09,508.23,170.25,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 10040","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT",10040,"ACNE SURGERY",null,681,0,171.09,508.23,170.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 10040","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",10040,"ACNE SURGERY",null,681,296.32,171.09,508.23,170.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 10060","TUFTS","TUFTS HMO","CPT",10060,"INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE",null,729,595.01,296.32,1198.25,182.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 10060","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",10060,"INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE",null,729,296.32,296.32,1198.25,182.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 10061","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",10061,"INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE",null,1357,678.1,317.70999999999998,1198.25,339.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 10061","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",10061,"INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE",null,1357,527.46,317.70999999999998,1198.25,339.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 10081","TUFTS","TUFTS SELECT","CPT",10081,"INCISION & DRAINAGE PILONIDAL CYST COMPLICATED",null,1356,1098.98,972.93,3264.67,339,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 10081","BLUE CROSS","BLUE CROSS-PPO","CPT",10081,"INCISION & DRAINAGE PILONIDAL CYST COMPLICATED",null,1356,972.93,972.93,3264.67,339,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 10121","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",10121,"INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL",null,1972,2607.12,1098.98,3264.67,493,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 10121","TUFTS","TUFTS PPO","CPT",10121,"INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL",null,1972,2058.16,1098.98,3264.67,493,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 10121","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",10121,"INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL",null,1972,2309.9699999999998,1098.98,3264.67,493,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 10121","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",10121,"INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL",null,1972,2309.9699999999998,1098.98,3264.67,493,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 10140","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",10140,"I&D HEMATOMA SEROMA/FLUID COLLECTION",null,1453,2607.12,1098.98,3264.67,363.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 10140","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",10140,"I&D HEMATOMA SEROMA/FLUID COLLECTION",null,1453,2672.73,1098.98,3264.67,363.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 10140","TUFTS","TUFTS SELECT","CPT",10140,"I&D HEMATOMA SEROMA/FLUID COLLECTION",null,1453,1098.98,1098.98,3264.67,363.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 10140","AETNA","AETNA","CPT",10140,"I&D HEMATOMA SEROMA/FLUID COLLECTION",null,1453,1198.25,1098.98,3264.67,363.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 10140","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",10140,"I&D HEMATOMA SEROMA/FLUID COLLECTION",null,1453,2309.9699999999998,1098.98,3264.67,363.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 10140","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",10140,"I&D HEMATOMA SEROMA/FLUID COLLECTION",null,1453,2309.9699999999998,1098.98,3264.67,363.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 10180","TUFTS","TUFTS HMO","CPT",10180,"HC COMPLEX DRAINAGE, WOUND",null,3570,4856.75,1500.85,7703.8,892.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11010","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",11010,"HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ",null,2161,1220.0899999999999,684.11,2032.26,540.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11010","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",11010,"HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ",null,2161,1250.8,684.11,2032.26,540.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11010","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",11010,"HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ",null,2161,972.93,684.11,2032.26,540.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11012","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",11012,"HC DBRDMT FX&/DISLC SUBQ T/M/F BONE",null,3490,4621.25,684.11,4621.25,872.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11042","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",11042,"DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<",null,473,678.1,317.70999999999998,1500.85,118.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11043","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",11043,"DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<",null,1202,810.95,317.70999999999998,1500.85,300.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11043","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",11043,"DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<",null,1202,810.95,317.70999999999998,1500.85,300.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11044","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",11044,"DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<",null,1795,2672.73,1500.85,7703.8,448.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11044","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",11044,"DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<",null,1795,2309.9699999999998,1500.85,7703.8,448.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11045","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",11045,"DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM",null,206,0,65.06,1198.25,51.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11045","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",11045,"DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM",null,206,0,65.06,1198.25,51.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 11045","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",11045,"DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM",null,206,0,65.06,1198.25,51.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11045","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",11045,"DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM",null,206,65.06,65.06,1198.25,51.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 11045","BLUE CROSS","BLUE CROSS-PPO","CPT",11045,"DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM",null,206,65.06,65.06,1198.25,51.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11046","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",11046,"DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM",null,420,0,138.07,1198.25,105,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 11046","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",11046,"DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM",null,420,0,138.07,1198.25,105,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11046","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",11046,"DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM",null,420,0,138.07,1198.25,105,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 11046","TUFTS","TUFTS PPO","CPT",11046,"DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM",null,420,0,138.07,1198.25,105,1]
["OUTPATIENT","AETNA - AETNA - CPT - 11046","AETNA","AETNA","CPT",11046,"DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM",null,420,1198.25,138.07,1198.25,105,1]
["OUTPATIENT","AETNA - AETNA - CPT - 11047","AETNA","AETNA","CPT",11047,"DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM",null,742,1198.25,244.48,1198.25,185.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11055","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",11055,"PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1",null,148,380.96,296.32,1198.25,37,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11056","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",11056,"PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4",null,171,371.6,171.09,1198.25,42.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 20553","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",20553,"INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES",null,324,521.19000000000005,317.70999999999998,1198.25,81,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 20553","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",20553,"INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES",null,324,534.30999999999995,317.70999999999998,1198.25,81,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 20553","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",20553,"INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES",null,324,534.30999999999995,317.70999999999998,1198.25,81,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 20553","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",20553,"INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES",null,324,534.30999999999995,317.70999999999998,1198.25,81,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 20553","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",20553,"INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES",null,324,415.61,317.70999999999998,1198.25,81,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 20600","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",20600,"ARTHROCENTESIS ASPIR&/INJECTION SMALL JT/BURSA",null,293,521.19000000000005,317.70999999999998,1198.25,73.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 20600","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",20600,"ARTHROCENTESIS ASPIR&/INJECTION SMALL JT/BURSA",null,293,534.30999999999995,317.70999999999998,1198.25,73.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 20600","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",20600,"ARTHROCENTESIS ASPIR&/INJECTION SMALL JT/BURSA",null,293,415.61,317.70999999999998,1198.25,73.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 20604","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",20604,"HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT",null,323,521.19000000000005,317.70999999999998,1198.25,80.75,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 20604","TUFTS","TUFTS HMO","CPT",20604,"HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT",null,323,595.01,317.70999999999998,1198.25,80.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 20606","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",20606,"HC PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US",null,366,1005.62,317.70999999999998,1292.83,91.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 20610","TUFTS","TUFTS PPO","CPT",20610,"ARTHROCENTESIS ASPIR&/INJECTION MAJOR JT/BURSA",null,381,595.01,317.70999999999998,1198.25,95.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 20610","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",20610,"ARTHROCENTESIS ASPIR&/INJECTION MAJOR JT/BURSA",null,381,415.61,317.70999999999998,1198.25,95.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 20611","AETNA","AETNA","CPT",20611,"HC PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US",null,430,1198.25,317.70999999999998,1198.25,107.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 20611","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",20611,"HC PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US",null,430,415.61,317.70999999999998,1198.25,107.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 20611","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",20611,"HC PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US",null,430,415.61,317.70999999999998,1198.25,107.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 20612","TUFTS","TUFTS SELECT","CPT",20612,"ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ",null,316,317.70999999999998,317.70999999999998,1198.25,79,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 20612","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",20612,"ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ",null,316,415.61,317.70999999999998,1198.25,79,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 20612","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",20612,"ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ",null,316,415.61,317.70999999999998,1198.25,79,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 20612","BLUE CROSS","BLUE CROSS-PPO","CPT",20612,"ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ",null,316,415.61,317.70999999999998,1198.25,79,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 20615","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",20615,"ASPIRATION & INJECTION TREATMENT BONE CYST",null,1220,1250.8,684.11,2032.26,305,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 20650","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",20650,"HC INSERT AND REMOVE BONE PIN",null,4072,4405.5600000000004,1990.62,11845.41,1018,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 20670","TUFTS","TUFTS POS","CPT",20670,"REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE",null,1972,2058.17,1098.98,3264.67,493,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 20690","TUFTS","TUFTS POS","CPT",20690,"HC APPLY BONE FIXATION DEVICE",null,9361,4856.75,1500.85,11074.87,2340.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 20690","TUFTS","TUFTS PPO","CPT",20690,"HC APPLY BONE FIXATION DEVICE",null,9361,4856.75,1500.85,11074.87,2340.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 20690","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",20690,"HC APPLY BONE FIXATION DEVICE",null,9361,9571.73,1500.85,11074.87,2340.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 20930","TUFTS","TUFTS HMO","CPT",20930,"HC ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED",null,2590,0,270.92,1198.25,647.5,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 20930","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT",20930,"HC ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED",null,2590,0,270.92,1198.25,647.5,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN QHP - CPT - 20930","BMC HEALTHNET","BMCHN QHP","CPT",20930,"HC ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED",null,2590,0,270.92,1198.25,647.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 20950","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",20950,"HC RECORD FLUID PRESSURE,MUSCLE",null,860,1250.8,317.70999999999998,1250.8,215,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 20950","TUFTS","TUFTS POS","CPT",20950,"HC RECORD FLUID PRESSURE,MUSCLE",null,860,595.01,317.70999999999998,1250.8,215,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 20950","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",20950,"HC RECORD FLUID PRESSURE,MUSCLE",null,860,972.93,317.70999999999998,1250.8,215,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 20950","BLUE CROSS","BLUE CROSS-PPO","CPT",20950,"HC RECORD FLUID PRESSURE,MUSCLE",null,860,972.93,317.70999999999998,1250.8,215,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 20982","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",20982,"HC ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE",null,6499,10803,1198.25,11074.87,1624.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 20982","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",20982,"HC ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE",null,6499,11074.87,1198.25,11074.87,1624.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 20982","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",20982,"HC ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE",null,6499,9571.73,1198.25,11074.87,1624.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 20983","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",20983,"HC ABLATJ BONE TUMOR CRYO PERQ W/IMG GDN WHEN PRFMD",null,8897,7703.8,1500.85,11074.87,2224.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 20999","TUFTS","TUFTS POS","CPT",20999,"PR PLACEMENT OF ANTIBIOTIC BEADS",null,2819,7467.76,1198.25,11845.41,704.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 21011","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",21011,"EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ <2CM",null,1996,2672.73,1098.98,3264.67,499,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 21011","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",21011,"EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ <2CM",null,1996,2309.9699999999998,1098.98,3264.67,499,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 21013","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",21013,"EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL <2CM",null,3106,2672.73,1098.98,3264.67,776.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 21013","AETNA","AETNA","CPT",21013,"EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL <2CM",null,3106,1198.25,1098.98,3264.67,776.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 21014","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",21014,"EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/>",null,4004,4621.25,1098.98,4621.25,1001,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 21014","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",21014,"EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/>",null,4004,4621.25,1098.98,4621.25,1001,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 21014","BLUE CROSS","BLUE CROSS-PPO","CPT",21014,"EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/>",null,4004,3994.03,1098.98,4621.25,1001,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 21025","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",21025,"HC EXCISION OF BONE, LOWER JAW",null,5755,7429.92,1500.85,8596.73,1438.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 21026","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",21026,"HC EXCISION OF FACIAL BONE(S)",null,6641,8596.73,1500.85,8596.73,1660.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 21026","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",21026,"HC EXCISION OF FACIAL BONE(S)",null,6641,7429.92,1500.85,8596.73,1660.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 21029","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",21029,"HC CONTOUR OF FACE BONE LESION",null,3896,4229.1400000000003,1500.85,11845.41,974,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 21029","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",21029,"HC CONTOUR OF FACE BONE LESION",null,3896,3747.12,1500.85,11845.41,974,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 21029","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",21029,"HC CONTOUR OF FACE BONE LESION",null,3896,3747.12,1500.85,11845.41,974,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 21030","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",21030,"HC EXC BENIGN TUMOR/CYST MAXL/ZYGOMA ENCL & CURTG",null,6512,7703.8,1500.85,8596.73,1628,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 21030","TUFTS","TUFTS SELECT","CPT",21030,"HC EXC BENIGN TUMOR/CYST MAXL/ZYGOMA ENCL & CURTG",null,6512,2593.31,1500.85,8596.73,1628,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 21030","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",21030,"HC EXC BENIGN TUMOR/CYST MAXL/ZYGOMA ENCL & CURTG",null,6512,7429.92,1500.85,8596.73,1628,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 21030","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",21030,"HC EXC BENIGN TUMOR/CYST MAXL/ZYGOMA ENCL & CURTG",null,6512,7429.92,1500.85,8596.73,1628,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 21031","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",21031,"HC EXCISION TORUS MANDIBULARIS",null,3301,3747.12,1198.25,7703.8,825.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 21032","TUFTS","TUFTS HMO","CPT",21032,"HC EXCISION,MAXILLARY TORUS PALATINUS",null,3896,4856.75,1198.25,7703.8,974,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 21032","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",21032,"HC EXCISION,MAXILLARY TORUS PALATINUS",null,3896,3747.12,1198.25,7703.8,974,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 21032","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",21032,"HC EXCISION,MAXILLARY TORUS PALATINUS",null,3896,3747.12,1198.25,7703.8,974,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 21040","TUFTS","TUFTS SELECT","CPT",21040,"HC EXCISION BENIGN TUMORE MANDIBLE",null,3209,2593.31,1500.85,7703.8,802.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 21044","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",21044,"HC REMV MALIG JAW BONE LESION",null,7214,8596.73,1500.85,8596.73,1803.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 21044","TUFTS","TUFTS HMO","CPT",21044,"HC REMV MALIG JAW BONE LESION",null,7214,4856.75,1500.85,8596.73,1803.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 21044","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",21044,"HC REMV MALIG JAW BONE LESION",null,7214,7429.92,1500.85,8596.73,1803.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 21044","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",21044,"HC REMV MALIG JAW BONE LESION",null,7214,7429.92,1500.85,8596.73,1803.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 21046","TUFTS","TUFTS PPO","CPT",21046,"HC EXCISION,BEN TUMOR,MANDIBLE,INTRA-ORAL",null,5309,4856.75,1500.85,8596.73,1327.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 21047","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",21047,"HC EXCISION,BEN TUMOR,MANDIBLE,EXTRA-ORAL",null,7214,7703.8,1500.85,8596.73,1803.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 21047","TUFTS","TUFTS HMO","CPT",21047,"HC EXCISION,BEN TUMOR,MANDIBLE,EXTRA-ORAL",null,7214,4856.75,1500.85,8596.73,1803.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 21047","AETNA","AETNA","CPT",21047,"HC EXCISION,BEN TUMOR,MANDIBLE,EXTRA-ORAL",null,7214,1500.85,1500.85,8596.73,1803.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 21047","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",21047,"HC EXCISION,BEN TUMOR,MANDIBLE,EXTRA-ORAL",null,7214,7429.92,1500.85,8596.73,1803.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 21048","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",21048,"HC EXCISION,BEN TUMOR,MAXILLA,INTRA-ORAL",null,6641,8596.73,1500.85,8596.73,1660.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 21048","TUFTS","TUFTS POS","CPT",21048,"HC EXCISION,BEN TUMOR,MAXILLA,INTRA-ORAL",null,6641,4856.75,1500.85,8596.73,1660.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 21073","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",21073,"HC MANIPULATION TMJ THERAPEUTIC REQUIRE ANESTHESIA",null,2007,2148.08,1098.98,3264.67,501.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 21073","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",21073,"HC MANIPULATION TMJ THERAPEUTIC REQUIRE ANESTHESIA",null,2007,2148.08,1098.98,3264.67,501.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 21076","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",21076,"HC PREP FACE/ORAL PROST OBTURATOR",null,3209,2148.08,2148.08,17023.61,802.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 21079","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",21079,"HC PREP FACE/ORAL PROST TEMP OBTURATOR",null,3209,17023.61,3747.12,17023.61,802.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 21079","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",21079,"HC PREP FACE/ORAL PROST TEMP OBTURATOR",null,3209,3747.12,3747.12,17023.61,802.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 21079","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",21079,"HC PREP FACE/ORAL PROST TEMP OBTURATOR",null,3209,3747.12,3747.12,17023.61,802.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 21080","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",21080,"HC PREP FACE/ORAL PROST FINL OBTURATOR",null,3209,4335.57,3747.12,17023.61,802.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 21080","TUFTS","TUFTS SELECT","CPT",21080,"HC PREP FACE/ORAL PROST FINL OBTURATOR",null,3209,5730.6,3747.12,17023.61,802.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 21080","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",21080,"HC PREP FACE/ORAL PROST FINL OBTURATOR",null,3209,3747.12,3747.12,17023.61,802.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 21081","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",21081,"HC PREP FACE/ORAL PROST MANDIBULAR",null,3209,8385.69,5730.6,17023.61,802.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 21083","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",21083,"PREPARE FACE/ORAL PROSTHESIS",null,4030,4335.57,3747.12,17023.61,1007.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 21083","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",21083,"PREPARE FACE/ORAL PROSTHESIS",null,4030,3747.12,3747.12,17023.61,1007.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 21083","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",21083,"PREPARE FACE/ORAL PROSTHESIS",null,4030,3747.12,3747.12,17023.61,1007.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 21085","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",21085,"HC IMPRESSION & PREPARATION ORAL SURGICAL SPLINT",null,691,434.13,346.18,17023.61,172.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 21085","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",21085,"HC IMPRESSION & PREPARATION ORAL SURGICAL SPLINT",null,691,346.18,346.18,17023.61,172.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 21085","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",21085,"HC IMPRESSION & PREPARATION ORAL SURGICAL SPLINT",null,691,346.18,346.18,17023.61,172.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 21110","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",21110,"APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC",null,5125,2693.78,1198.25,7703.8,1281.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 21110","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",21110,"APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC",null,5125,2761.58,1198.25,7703.8,1281.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 21110","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",21110,"APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC",null,5125,2761.58,1198.25,7703.8,1281.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 21110","TUFTS","TUFTS HMO","CPT",21110,"APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC",null,5125,4856.75,1198.25,7703.8,1281.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 21110","TUFTS","TUFTS POS","CPT",21110,"APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC",null,5125,4856.75,1198.25,7703.8,1281.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 21110","TUFTS","TUFTS PPO","CPT",21110,"APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC",null,5125,4856.75,1198.25,7703.8,1281.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 21110","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",21110,"APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC",null,5125,2148.08,1198.25,7703.8,1281.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 21110","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",21110,"APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC",null,5125,2148.08,1198.25,7703.8,1281.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 21110","BLUE CROSS","BLUE CROSS-PPO","CPT",21110,"APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC",null,5125,2148.08,1198.25,7703.8,1281.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 21121","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",21121,"HC RECONST CHIN SLIDE SINGL OSTEOTOMY",null,3896,4229.1400000000003,2531.06,17023.61,974,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 21121","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT",21121,"HC RECONST CHIN SLIDE SINGL OSTEOTOMY",null,3896,0,2531.06,17023.61,974,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 21121","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",21121,"HC RECONST CHIN SLIDE SINGL OSTEOTOMY",null,3896,3747.12,2531.06,17023.61,974,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 21121","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",21121,"HC RECONST CHIN SLIDE SINGL OSTEOTOMY",null,3896,3747.12,2531.06,17023.61,974,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 21198","TUFTS","TUFTS HMO","CPT",21198,"HC OSTEOTOMY, MANDIBLE",null,7214,7467.76,1990.62,11845.41,1803.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 21198","TUFTS","TUFTS PPO","CPT",21198,"HC OSTEOTOMY, MANDIBLE",null,7214,7467.76,1990.62,11845.41,1803.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 21198","AETNA","AETNA","CPT",21198,"HC OSTEOTOMY, MANDIBLE",null,7214,1990.62,1990.62,11845.41,1803.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 21198","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",21198,"HC OSTEOTOMY, MANDIBLE",null,7214,7429.92,1990.62,11845.41,1803.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 21208","TUFTS","TUFTS POS","CPT",21208,"HC AUGMENT FACIAL BONES",null,7214,9609.09,2531.06,15242.01,1803.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 21208","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",21208,"HC AUGMENT FACIAL BONES",null,7214,7429.92,2531.06,15242.01,1803.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 21215","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",21215,"HC MANDIBLE GRAFT",null,7214,7429.92,2531.06,15242.01,1803.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 21235","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",21235,"HC GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR",null,2622,15242.01,2531.06,15242.01,655.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 21235","TUFTS","TUFTS POS","CPT",21235,"HC GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR",null,2622,9609.09,2531.06,15242.01,655.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 21235","TUFTS","TUFTS PPO","CPT",21235,"HC GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR",null,2622,9609.09,2531.06,15242.01,655.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 21235","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",21235,"HC GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR",null,2622,7429.92,2531.06,15242.01,655.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 21240","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",21240,"HC ARTHROPLASTY TMJ",null,7214,8596.73,2166.09,11845.41,1803.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 21243","AETNA","AETNA","CPT",21243,"HC ARTHROPLASTY TMJ+PROSTHESIS",null,23714,2354.5,2354.5,29928.51,5928.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 21243","BLUE CROSS","BLUE CROSS-PPO","CPT",21243,"HC ARTHROPLASTY TMJ+PROSTHESIS",null,23714,25866.44,2354.5,29928.51,5928.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 21244","TUFTS","TUFTS POS","CPT",21244,"HC RECONSTR MANDIBLE,BONE PLATE",null,7214,9609.09,2531.06,15242.01,1803.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 21248","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",21248,"HC RECONSTR JAW,PART-ENDO IMPLNT",null,6644,8385.69,2531.06,15242.01,1661,1]
["OUTPATIENT","AETNA - AETNA - CPT - 21248","AETNA","AETNA","CPT",21248,"HC RECONSTR JAW,PART-ENDO IMPLNT",null,6644,2531.06,2531.06,15242.01,1661,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 21248","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",21248,"HC RECONSTR JAW,PART-ENDO IMPLNT",null,6644,7429.92,2531.06,15242.01,1661,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 21248","BLUE CROSS","BLUE CROSS-PPO","CPT",21248,"HC RECONSTR JAW,PART-ENDO IMPLNT",null,6644,7429.92,2531.06,15242.01,1661,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 21310","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",21310,"CLOSED TREATMENT NASAL FRACTURE W/O MANIPULATION",null,323,378,378,7703.8,80.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 21315","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",21315,"CLOSED TX NASAL FRACTURE W/O STABILIZATION",null,1426,2148.08,1098.98,3264.67,356.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 21320","AETNA","AETNA","CPT",21320,"CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION",null,2094,1500.85,1500.85,7703.8,523.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 21325","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",21325,"HC OPEN RX NOSE FRACTURE",null,3350,4335.57,2166.09,11845.41,837.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 21325","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",21325,"HC OPEN RX NOSE FRACTURE",null,3350,3747.12,2166.09,11845.41,837.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 21337","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",21337,"HC CLOSED RX NASAL SEPTAL FRACTURE",null,3896,4335.57,1500.85,7703.8,974,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 21365","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",21365,"HC OPEN RX COMPLX CHEEK BONE FRAC",null,7214,15242.01,2354.5,15242.01,1803.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 21365","TUFTS","TUFTS PPO","CPT",21365,"HC OPEN RX COMPLX CHEEK BONE FRAC",null,7214,9609.09,2354.5,15242.01,1803.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 21365","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",21365,"HC OPEN RX COMPLX CHEEK BONE FRAC",null,7214,7429.92,2354.5,15242.01,1803.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 21365","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",21365,"HC OPEN RX COMPLX CHEEK BONE FRAC",null,7214,7429.92,2354.5,15242.01,1803.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 21390","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",21390,"HC REPAIR EYE BLOWOUT,PERIORB+IMPLNT",null,7214,8596.73,2531.06,15242.01,1803.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 21390","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",21390,"HC REPAIR EYE BLOWOUT,PERIORB+IMPLNT",null,7214,7429.92,2531.06,15242.01,1803.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 21390","BLUE CROSS","BLUE CROSS-PPO","CPT",21390,"HC REPAIR EYE BLOWOUT,PERIORB+IMPLNT",null,7214,7429.92,2531.06,15242.01,1803.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 21390","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",21390,"HC REPAIR EYE BLOWOUT,PERIORB+IMPLNT",null,7214,7429.92,2531.06,15242.01,1803.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 21400","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",21400,"HC CLOSED RX FX ORBIT",null,658,1025.9000000000001,818.07,7703.8,164.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 21400","TUFTS","TUFTS PPO","CPT",21400,"HC CLOSED RX FX ORBIT",null,658,4856.75,818.07,7703.8,164.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 21400","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",21400,"HC CLOSED RX FX ORBIT",null,658,818.07,818.07,7703.8,164.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 21400","BLUE CROSS","BLUE CROSS-PPO","CPT",21400,"HC CLOSED RX FX ORBIT",null,658,818.07,818.07,7703.8,164.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 21407","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",21407,"HC OPEN RX FX ORBIT W IMPLANT",null,7214,8385.69,2354.5,15242.01,1803.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 21407","TUFTS","TUFTS SELECT","CPT",21407,"HC OPEN RX FX ORBIT W IMPLANT",null,7214,5130.87,2354.5,15242.01,1803.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 21407","BLUE CROSS","BLUE CROSS-PPO","CPT",21407,"HC OPEN RX FX ORBIT W IMPLANT",null,7214,7429.92,2354.5,15242.01,1803.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 21421","AETNA","AETNA","CPT",21421,"HC CLOSED RX LEFORTE I+WIRES",null,3350,2166.09,2166.09,11845.41,837.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 21421","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",21421,"HC CLOSED RX LEFORTE I+WIRES",null,3350,3747.12,2166.09,11845.41,837.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 21440","TUFTS","TUFTS HMO","CPT",21440,"HC DENTAL RIDGE FX",null,3620,7467.76,1990.62,11845.41,905,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 21440","TUFTS","TUFTS PPO","CPT",21440,"HC DENTAL RIDGE FX",null,3620,7467.76,1990.62,11845.41,905,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 21440","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",21440,"HC DENTAL RIDGE FX",null,3620,3747.12,1990.62,11845.41,905,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 21445","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",21445,"HC OPEN RX DENTAL RIDGE FX",null,7214,8596.73,2166.09,11845.41,1803.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 21445","AETNA","AETNA","CPT",21445,"HC OPEN RX DENTAL RIDGE FX",null,7214,2166.09,2166.09,11845.41,1803.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 21445","BLUE CROSS","BLUE CROSS-PPO","CPT",21445,"HC OPEN RX DENTAL RIDGE FX",null,7214,7429.92,2166.09,11845.41,1803.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 21450","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",21450,"HC CLOSED RX MANDIBLE FX",null,658,818.07,818.07,11845.41,164.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 21451","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",21451,"CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION",null,4870,2485.42,2148.08,11845.41,1217.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 21451","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",21451,"CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION",null,4870,11845.41,2148.08,11845.41,1217.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 21451","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",21451,"CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION",null,4870,2485.42,2148.08,11845.41,1217.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 21451","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",21451,"CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION",null,4870,2485.42,2148.08,11845.41,1217.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 21451","TUFTS","TUFTS HMO","CPT",21451,"CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION",null,4870,7467.76,2148.08,11845.41,1217.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 21451","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",21451,"CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION",null,4870,2148.08,2148.08,11845.41,1217.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 21451","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",21451,"CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION",null,4870,2148.08,2148.08,11845.41,1217.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 21451","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",21451,"CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION",null,4870,2148.08,2148.08,11845.41,1217.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 21453","TUFTS","TUFTS SELECT","CPT",21453,"HC CLOSED RX MANDIBLE FX+DENTAL FIX",null,5309,3987.49,1990.62,11845.41,1327.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 21453","AETNA","AETNA","CPT",21453,"HC CLOSED RX MANDIBLE FX+DENTAL FIX",null,5309,1990.62,1990.62,11845.41,1327.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 21453","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",21453,"HC CLOSED RX MANDIBLE FX+DENTAL FIX",null,5309,7429.92,1990.62,11845.41,1327.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 21461","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",21461,"HC OPEN RX MANDIBLE FX",null,7214,8596.73,2166.09,11845.41,1803.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 21461","TUFTS","TUFTS HMO","CPT",21461,"HC OPEN RX MANDIBLE FX",null,7214,7467.76,2166.09,11845.41,1803.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 21461","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",21461,"HC OPEN RX MANDIBLE FX",null,7214,7429.92,2166.09,11845.41,1803.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 21461","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",21461,"HC OPEN RX MANDIBLE FX",null,7214,7429.92,2166.09,11845.41,1803.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 21462","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",21462,"HC OPEN RX MANDIBLE FX+DENTAL FIX",null,7214,8385.69,2354.5,15242.01,1803.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 21470","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",21470,"HC OPEN RX MANDIBLE CONDYLE FX,COMPL",null,7214,8596.73,2354.5,15242.01,1803.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 21470","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",21470,"HC OPEN RX MANDIBLE CONDYLE FX,COMPL",null,7214,7429.92,2354.5,15242.01,1803.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 21501","TUFTS","TUFTS HMO","CPT",21501,"I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX",null,2480,4856.75,1500.85,7703.8,620,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 21501","TUFTS","TUFTS PPO","CPT",21501,"I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX",null,2480,4856.75,1500.85,7703.8,620,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 21550","TUFTS","TUFTS HMO","CPT",21550,"BIOPSY SOFT TISSUE NECK/THORAX",null,1972,2057.7399999999998,1098.98,3264.67,493,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 21550","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",21550,"BIOPSY SOFT TISSUE NECK/THORAX",null,1972,2309.9699999999998,1098.98,3264.67,493,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 21554","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",21554,"EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/>",null,5571,4621.25,1990.62,11845.41,1392.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 21554","TUFTS","TUFTS SELECT","CPT",21554,"EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/>",null,5571,3987.49,1990.62,11845.41,1392.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 21554","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",21554,"EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/>",null,5571,3994.03,1990.62,11845.41,1392.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 21554","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",21554,"EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/>",null,5571,3994.03,1990.62,11845.41,1392.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 21555","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",21555,"EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM",null,2366,2672.73,1500.85,7703.8,591.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 21556","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",21556,"EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM",null,4117,4621.25,1500.85,7703.8,1029.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 21556","TUFTS","TUFTS POS","CPT",21556,"EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM",null,4117,4856.75,1500.85,7703.8,1029.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 21920","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",21920,"HC BIOPSY SOFT TISSUE BACK,SUPERF",null,2043,2309.9699999999998,1098.98,3264.67,510.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 21925","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",21925,"HC BIOPSY SOFT TISSUE BACK,DEEP",null,2043,2607.12,1500.85,7703.8,510.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 21931","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",21931,"EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/>",null,2987,2309.9699999999998,1990.62,11845.41,746.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 21932","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",21932,"HC EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM",null,3570,4621.25,1500.85,7703.8,892.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 21932","TUFTS","TUFTS SELECT","CPT",21932,"HC EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM",null,3570,2593.31,1500.85,7703.8,892.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 21933","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",21933,"EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>",null,5650,11845.41,1990.62,11845.41,1412.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 21933","TUFTS","TUFTS SELECT","CPT",21933,"EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>",null,5650,3987.49,1990.62,11845.41,1412.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 21933","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",21933,"EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>",null,5650,3994.03,1990.62,11845.41,1412.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 22310","TUFTS","TUFTS PPO","CPT",22310,"CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING",null,1336,2058.16,378,3264.67,334,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 22310","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",22310,"CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING",null,1336,378,378,3264.67,334,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 22510","TUFTS","TUFTS POS","CPT",22510,"PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC",null,9073,4856.75,2397.88,7703.8,2268.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 22510","TUFTS","TUFTS SELECT","CPT",22510,"PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC",null,9073,2593.31,2397.88,7703.8,2268.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 22511","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",22511,"PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL",null,9073,4972.29,2397.88,7703.8,2268.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 22511","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",22511,"PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL",null,9073,5097.42,2397.88,7703.8,2268.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 22511","TUFTS","TUFTS POS","CPT",22511,"PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL",null,9073,4856.75,2397.88,7703.8,2268.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 22511","TUFTS","TUFTS PPO","CPT",22511,"PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL",null,9073,4856.75,2397.88,7703.8,2268.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 22512","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",22512,"HC VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL",null,5718,0,512.76,1198.25,1429.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 22512","TUFTS","TUFTS PPO","CPT",22512,"HC VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL",null,5718,0,512.76,1198.25,1429.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 22512","BLUE CROSS","BLUE CROSS-PPO","CPT",22512,"HC VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL",null,5718,512.76,512.76,1198.25,1429.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 22513","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",22513,"HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION",null,8897,9571.73,1990.62,17023.61,2224.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 22513","BLUE CROSS","BLUE CROSS-PPO","CPT",22513,"HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION",null,8897,9571.73,1990.62,17023.61,2224.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 22513","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",22513,"HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION",null,8897,9571.73,1990.62,17023.61,2224.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 22514","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",22514,"PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR",null,22040,17023.61,1990.62,17023.61,5510,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 22514","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",22514,"PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR",null,22040,9571.73,1990.62,17023.61,5510,1]
["OUTPATIENT","AETNA - AETNA - CPT - 22854","AETNA","AETNA","CPT",22854,"HC INSJ BIOMCHN DEV VRT CORPECTOMY DEFECT W/ARTHRD",null,660,1198.25,842.2,1198.25,165,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 22854","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",22854,"HC INSJ BIOMCHN DEV VRT CORPECTOMY DEFECT W/ARTHRD",null,660,842.2,842.2,1198.25,165,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 22869","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",22869,"HC INSJ STABLJ DEV W/O DCMPRN LUMBAR SINGLE LEVEL",null,7580,29193.81,1500.85,62742.78,1895,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 22869","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",22869,"HC INSJ STABLJ DEV W/O DCMPRN LUMBAR SINGLE LEVEL",null,7580,25866.44,1500.85,62742.78,1895,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 22870","TUFTS","TUFTS PPO","CPT",22870,"HC INSJ STABLJ DEV W/O DCMPRN LUMBAR SECOND LEVEL",null,2523,0,311.33,1198.25,630.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 22902","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",22902,"HC EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM",null,2024,2309.9699999999998,1500.85,7703.8,506,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 22902","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",22902,"HC EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM",null,2024,2309.9699999999998,1500.85,7703.8,506,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 22902","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",22902,"HC EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM",null,2024,2309.9699999999998,1500.85,7703.8,506,1]
["OUTPATIENT","AETNA - AETNA - CPT - 22903","AETNA","AETNA","CPT",22903,"HC EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3+CM",null,3338,1990.62,1990.62,11845.41,834.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 23031","TUFTS","TUFTS POS","CPT",23031,"HC DRAIN INFECT SHOULDER BURSA",null,2066,4856.75,1990.62,7703.8,516.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 23065","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",23065,"HC BIOPSY SOFT TISSUE SHOULDER SUPERFICIAL",null,2043,2672.73,1098.98,3264.67,510.75,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 23065","TUFTS","TUFTS HMO","CPT",23065,"HC BIOPSY SOFT TISSUE SHOULDER SUPERFICIAL",null,2043,2057.7399999999998,1098.98,3264.67,510.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 23066","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",23066,"HC BIOPSY SOFT TISSUE SHOULDER DEEP",null,3449,3994.03,1500.85,7703.8,862.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 23071","TUFTS","TUFTS SELECT","CPT",23071,"EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/>",null,5419,3987.49,1990.62,11845.41,1354.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 23071","BLUE CROSS","BLUE CROSS-PPO","CPT",23071,"EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/>",null,5419,2309.9699999999998,1990.62,11845.41,1354.75,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 23075","TUFTS","TUFTS HMO","CPT",23075,"EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM",null,1972,4856.75,1500.85,7703.8,493,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 23075","TUFTS","TUFTS PPO","CPT",23075,"EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM",null,1972,4856.75,1500.85,7703.8,493,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 23075","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",23075,"EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM",null,1972,2309.9699999999998,1500.85,7703.8,493,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 23076","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",23076,"HC EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM",null,3490,4507.8100000000004,1500.85,7703.8,872.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 23076","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",23076,"HC EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM",null,3490,7703.8,1500.85,7703.8,872.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 23076","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",23076,"HC EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM",null,3490,4621.25,1500.85,7703.8,872.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 23076","TUFTS","TUFTS POS","CPT",23076,"HC EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM",null,3490,4856.75,1500.85,7703.8,872.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 23330","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",23330,"REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS",null,930,1220.0899999999999,972.93,3264.67,232.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 23330","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",23330,"REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS",null,930,972.93,972.93,3264.67,232.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 23350","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",23350,"HC INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI ARTHG",null,637,0,126.08,1198.25,159.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 23350","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",23350,"HC INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI ARTHG",null,637,126.08,126.08,1198.25,159.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 23500","TUFTS","TUFTS POS","CPT",23500,"CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION",null,1217,2058.17,378,3264.67,304.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 23505","TUFTS","TUFTS SELECT","CPT",23505,"CLSD TX CLAVICULAR FRACTURE W/MANIPULATION",null,1738,1098.98,1098.98,3264.67,434.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 23505","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",23505,"CLSD TX CLAVICULAR FRACTURE W/MANIPULATION",null,1738,2205.59,1098.98,3264.67,434.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 23505","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",23505,"CLSD TX CLAVICULAR FRACTURE W/MANIPULATION",null,1738,2205.59,1098.98,3264.67,434.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 23525","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",23525,"HC CLOSED RX STERN-CLAV DISLOC,MANIP",null,321,485.97,378,3264.67,80.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 23525","TUFTS","TUFTS HMO","CPT",23525,"HC CLOSED RX STERN-CLAV DISLOC,MANIP",null,321,2057.7399999999998,378,3264.67,80.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 23525","TUFTS","TUFTS POS","CPT",23525,"HC CLOSED RX STERN-CLAV DISLOC,MANIP",null,321,2058.17,378,3264.67,80.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 23525","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",23525,"HC CLOSED RX STERN-CLAV DISLOC,MANIP",null,321,378,378,3264.67,80.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 23525","BLUE CROSS","BLUE CROSS-PPO","CPT",23525,"HC CLOSED RX STERN-CLAV DISLOC,MANIP",null,321,378,378,3264.67,80.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 23540","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",23540,"CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION",null,1217,485.97,378,3264.67,304.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 23540","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",23540,"CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION",null,1217,378,378,3264.67,304.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 23545","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",23545,"CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION",null,1738,474.04,378,3264.67,434.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 23545","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",23545,"CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION",null,1738,378,378,3264.67,434.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 23545","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",23545,"CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION",null,1738,378,378,3264.67,434.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 23570","TUFTS","TUFTS SELECT","CPT",23570,"CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION",null,1217,1098.98,378,3264.67,304.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 23570","BLUE CROSS","BLUE CROSS-PPO","CPT",23570,"CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION",null,1217,378,378,3264.67,304.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 23575","TUFTS","TUFTS PPO","CPT",23575,"CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION",null,1738,2058.16,1098.98,3264.67,434.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 23575","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",23575,"CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION",null,1738,2205.59,1098.98,3264.67,434.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 23600","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",23600,"CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION",null,1217,485.97,378,3264.67,304.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 23600","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",23600,"CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION",null,1217,485.97,378,3264.67,304.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 23600","TUFTS","TUFTS HMO","CPT",23600,"CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION",null,1217,2057.7399999999998,378,3264.67,304.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 23600","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",23600,"CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION",null,1217,378,378,3264.67,304.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 23600","BLUE CROSS","BLUE CROSS-PPO","CPT",23600,"CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION",null,1217,378,378,3264.67,304.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 23620","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",23620,"CLTX GREATER HUMERAL TUBEROSITY FX W/O MANJ",null,1217,474.04,378,3264.67,304.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 23620","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",23620,"CLTX GREATER HUMERAL TUBEROSITY FX W/O MANJ",null,1217,485.97,378,3264.67,304.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 23620","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",23620,"CLTX GREATER HUMERAL TUBEROSITY FX W/O MANJ",null,1217,378,378,3264.67,304.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 23625","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",23625,"CLTX GRTER HUMERAL TUBEROSITY FX W/MANIPULATION",null,2021,2205.59,1500.85,7703.8,505.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 23625","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",23625,"CLTX GRTER HUMERAL TUBEROSITY FX W/MANIPULATION",null,2021,2205.59,1500.85,7703.8,505.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 23650","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",23650,"CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES",null,989,485.97,378,3264.67,247.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 23650","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",23650,"CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES",null,989,378,378,3264.67,247.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 23665","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",23665,"CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ",null,1757,2551.96,1500.85,7703.8,439.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 23665","TUFTS","TUFTS SELECT","CPT",23665,"CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ",null,1757,2593.31,1500.85,7703.8,439.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 23665","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",23665,"CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ",null,1757,2205.59,1500.85,7703.8,439.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 23665","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",23665,"CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ",null,1757,2205.59,1500.85,7703.8,439.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 24066","TUFTS","TUFTS SELECT","CPT",24066,"HC BX ARM/ELBOW SOFT TISSUE,DEEP",null,3449,2593.31,1500.85,7703.8,862.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 24071","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",24071,"EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/>",null,5269,4621.25,1990.62,11845.41,1317.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 24071","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",24071,"EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/>",null,5269,3994.03,1990.62,11845.41,1317.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 24071","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",24071,"EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/>",null,5269,3994.03,1990.62,11845.41,1317.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 24075","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",24075,"EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM",null,1972,2309.9699999999998,1500.85,7703.8,493,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 24076","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",24076,"HC EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM",null,3490,7703.8,1500.85,7703.8,872.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 24076","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",24076,"HC EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM",null,3490,3994.03,1500.85,7703.8,872.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 24200","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",24200,"RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS",null,1217,2672.73,1098.98,3264.67,304.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 24200","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",24200,"RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS",null,1217,2309.9699999999998,1098.98,3264.67,304.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 24200","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",24200,"RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS",null,1217,2309.9699999999998,1098.98,3264.67,304.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 24200","BLUE CROSS","BLUE CROSS-PPO","CPT",24200,"RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS",null,1217,2309.9699999999998,1098.98,3264.67,304.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 24200","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",24200,"RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS",null,1217,2309.9699999999998,1098.98,3264.67,304.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 24200","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",24200,"RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS",null,1217,2309.9699999999998,1098.98,3264.67,304.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 24200","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",24200,"RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS",null,1217,2309.9699999999998,1098.98,3264.67,304.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 24201","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",24201,"HC REMOVAL ARM/ELBOW F.B.,DEEP",null,2858,7703.8,1500.85,7703.8,714.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 24201","AETNA","AETNA","CPT",24201,"HC REMOVAL ARM/ELBOW F.B.,DEEP",null,2858,1500.85,1500.85,7703.8,714.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 24220","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",24220,"HC INJECTION ELBOW ARTHROGRAPHY",null,637,0,167.43,1198.25,159.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 24220","BLUE CROSS","BLUE CROSS-PPO","CPT",24220,"HC INJECTION ELBOW ARTHROGRAPHY",null,637,167.43,167.43,1198.25,159.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 24357","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",24357,"HC REPAIR ELBOW PERC",null,4106,5097.42,1990.62,11845.41,1026.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 24500","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",24500,"CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION",null,1217,485.97,378,3264.67,304.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 24505","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",24505,"CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ",null,1738,2489.31,1098.98,3264.67,434.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 24505","AETNA","AETNA","CPT",24505,"CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ",null,1738,1198.25,1098.98,3264.67,434.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 24530","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",24530,"CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ",null,1217,485.97,378,3264.67,304.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 24530","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",24530,"CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ",null,1217,485.97,378,3264.67,304.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 24530","TUFTS","TUFTS HMO","CPT",24530,"CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ",null,1217,2057.7399999999998,378,3264.67,304.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 24530","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",24530,"CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ",null,1217,378,378,3264.67,304.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 24560","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",24560,"CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ",null,1217,3264.67,378,3264.67,304.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 24560","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",24560,"CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ",null,1217,378,378,3264.67,304.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 24565","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",24565,"CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/MANJ",null,2021,2551.96,1500.85,7703.8,505.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 24565","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",24565,"CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/MANJ",null,2021,2205.59,1500.85,7703.8,505.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 24576","TUFTS","TUFTS HMO","CPT",24576,"CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ",null,2327,2057.7399999999998,378,3264.67,581.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 24576","BLUE CROSS","BLUE CROSS-PPO","CPT",24576,"CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ",null,2327,378,378,3264.67,581.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 24576","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",24576,"CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ",null,2327,378,378,3264.67,581.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 24577","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",24577,"CLTX HUMERAL CONDYLAR FX MEDIAL/LATERAL W/MANJ",null,3821,2205.59,1098.98,3264.67,955.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 24577","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",24577,"CLTX HUMERAL CONDYLAR FX MEDIAL/LATERAL W/MANJ",null,3821,2205.59,1098.98,3264.67,955.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 24600","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",24600,"TREATMENT CLOSED ELBOW DISLOCATION W/O ANES",null,2540,3264.67,378,3264.67,635,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 24600","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",24600,"TREATMENT CLOSED ELBOW DISLOCATION W/O ANES",null,2540,485.97,378,3264.67,635,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 24600","TUFTS","TUFTS HMO","CPT",24600,"TREATMENT CLOSED ELBOW DISLOCATION W/O ANES",null,2540,2057.7399999999998,378,3264.67,635,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 24600","TUFTS","TUFTS SELECT","CPT",24600,"TREATMENT CLOSED ELBOW DISLOCATION W/O ANES",null,2540,1098.98,378,3264.67,635,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 24600","BLUE CROSS","BLUE CROSS-PPO","CPT",24600,"TREATMENT CLOSED ELBOW DISLOCATION W/O ANES",null,2540,378,378,3264.67,635,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 24605","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",24605,"HC TX ELBOW DISLOC W/ANESTH",null,2026,2205.59,1500.85,7703.8,506.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 24620","TUFTS","TUFTS SELECT","CPT",24620,"HC CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ",null,2026,2593.31,1500.85,7703.8,506.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 24620","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",24620,"HC CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ",null,2026,2205.59,1500.85,7703.8,506.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 24620","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",24620,"HC CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ",null,2026,2205.59,1500.85,7703.8,506.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 24650","TUFTS","TUFTS HMO","CPT",24650,"CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION",null,1836,595.01,317.70999999999998,1198.25,459,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 24650","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",24650,"CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION",null,1836,378,317.70999999999998,1198.25,459,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 24655","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",24655,"CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION",null,3067,2489.31,1098.98,3264.67,766.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 24655","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",24655,"CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION",null,3067,2551.96,1098.98,3264.67,766.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 24655","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",24655,"CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION",null,3067,2205.59,1098.98,3264.67,766.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 24655","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",24655,"CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION",null,3067,2205.59,1098.98,3264.67,766.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 24655","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",24655,"CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION",null,3067,2205.59,1098.98,3264.67,766.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 24670","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",24670,"CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ",null,2004,485.97,378,3264.67,501,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 24670","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",24670,"CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ",null,2004,378,378,3264.67,501,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 24670","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",24670,"CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ",null,2004,378,378,3264.67,501,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 19001","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",19001,"HC CY ASP BREAST;EA ADD",null,163,0,53.07,1198.25,40.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 19001","TUFTS","TUFTS PPO","CPT",19001,"HC CY ASP BREAST;EA ADD",null,163,0,53.07,1198.25,40.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 19001","BLUE CROSS","BLUE CROSS-PPO","CPT",19001,"HC CY ASP BREAST;EA ADD",null,163,53.07,53.07,1198.25,40.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 19020","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",19020,"MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP",null,2335,7703.8,1500.85,7703.8,583.75,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 19020","TUFTS","TUFTS HMO","CPT",19020,"MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP",null,2335,4856.75,1500.85,7703.8,583.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 19081","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",19081,"BX BREAST W/DEVICE 1ST LESION STEREOTACTIC GUID",null,1351,3264.67,1098.98,3264.67,337.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 19081","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",19081,"BX BREAST W/DEVICE 1ST LESION STEREOTACTIC GUID",null,1351,2672.73,1098.98,3264.67,337.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 19083","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",19083,"BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID",null,1266,2672.73,1098.98,3264.67,316.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 19083","TUFTS","TUFTS HMO","CPT",19083,"BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID",null,1266,2057.7399999999998,1098.98,3264.67,316.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 19084","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",19084,"BX BREAST W/DEVICE ADDL LESION ULTRASOUND GUID",null,606,0,195.36,1198.25,151.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 19085","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",19085,"BX BREAST W/DEVICE 1ST LESION MAGNETIC RES GUID",null,1479,2672.73,1098.98,3264.67,369.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 19085","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",19085,"BX BREAST W/DEVICE 1ST LESION MAGNETIC RES GUID",null,1479,2309.9699999999998,1098.98,3264.67,369.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 19085","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",19085,"BX BREAST W/DEVICE 1ST LESION MAGNETIC RES GUID",null,1479,2309.9699999999998,1098.98,3264.67,369.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 19100","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",19100,"BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX",null,709,2672.73,684.11,2672.73,177.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 19100","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",19100,"BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX",null,709,2309.9699999999998,684.11,2672.73,177.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 19120","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",19120,"EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION",null,3135,5337.47,1990.62,11845.41,783.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 19120","TUFTS","TUFTS SELECT","CPT",19120,"EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION",null,3135,3987.49,1990.62,11845.41,783.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 19120","BLUE CROSS","BLUE CROSS-PPO","CPT",19120,"EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION",null,3135,4729.13,1990.62,11845.41,783.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 19125","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",19125,"HC EXCISE BREAST LES W XRAY MARKER",null,4228,5471.79,1990.62,7703.8,1057,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 19125","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",19125,"HC EXCISE BREAST LES W XRAY MARKER",null,4228,4729.13,1990.62,7703.8,1057,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 19281","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",19281,"PERQ DEVICE PLACEMENT BREAST LOC 1ST LES W/GDNCE",null,759,1250.8,317.70999999999998,1500.85,189.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 19281","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",19281,"PERQ DEVICE PLACEMENT BREAST LOC 1ST LES W/GDNCE",null,759,1250.8,317.70999999999998,1500.85,189.75,1]
["OUTPATIENT","AETNA - AETNA - CPT - 19281","AETNA","AETNA","CPT",19281,"PERQ DEVICE PLACEMENT BREAST LOC 1ST LES W/GDNCE",null,759,1500.85,317.70999999999998,1500.85,189.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 19281","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",19281,"PERQ DEVICE PLACEMENT BREAST LOC 1ST LES W/GDNCE",null,759,972.93,317.70999999999998,1500.85,189.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 19282","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",19282,"PERQ DEVICE PLACEMT BREAST LOC EA LESION W/GDNCE",null,362,0,125.12,1198.25,90.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 19282","TUFTS","TUFTS HMO","CPT",19282,"PERQ DEVICE PLACEMT BREAST LOC EA LESION W/GDNCE",null,362,0,125.12,1198.25,90.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 19282","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",19282,"PERQ DEVICE PLACEMT BREAST LOC EA LESION W/GDNCE",null,362,125.12,125.12,1198.25,90.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 19282","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",19282,"PERQ DEVICE PLACEMT BREAST LOC EA LESION W/GDNCE",null,362,125.12,125.12,1198.25,90.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 19283","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",19283,"PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GDNCE",null,766,1250.8,317.70999999999998,1500.85,191.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 19283","TUFTS","TUFTS HMO","CPT",19283,"PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GDNCE",null,766,595.01,317.70999999999998,1500.85,191.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 19283","AETNA","AETNA","CPT",19283,"PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GDNCE",null,766,1500.85,317.70999999999998,1500.85,191.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 19283","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",19283,"PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GDNCE",null,766,972.93,317.70999999999998,1500.85,191.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 19284","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",19284,"HC PERQ BREAST LOC DEVICE PLACEMT EA LESION STRTCTC",null,383,0,128.53,1198.25,95.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 19284","TUFTS","TUFTS POS","CPT",19284,"HC PERQ BREAST LOC DEVICE PLACEMT EA LESION STRTCTC",null,383,0,128.53,1198.25,95.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 19284","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",19284,"HC PERQ BREAST LOC DEVICE PLACEMT EA LESION STRTCTC",null,383,128.53,128.53,1198.25,95.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 19284","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",19284,"HC PERQ BREAST LOC DEVICE PLACEMT EA LESION STRTCTC",null,383,128.53,128.53,1198.25,95.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 19284","BLUE CROSS","BLUE CROSS-PPO","CPT",19284,"HC PERQ BREAST LOC DEVICE PLACEMT EA LESION STRTCTC",null,383,128.53,128.53,1198.25,95.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 19285","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",19285,"PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG",null,650,1250.8,317.70999999999998,1500.85,162.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 19285","TUFTS","TUFTS HMO","CPT",19285,"PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG",null,650,595.01,317.70999999999998,1500.85,162.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 19285","TUFTS","TUFTS PPO","CPT",19285,"PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG",null,650,595.01,317.70999999999998,1500.85,162.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 19285","AETNA","AETNA","CPT",19285,"PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG",null,650,1500.85,317.70999999999998,1500.85,162.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 19285","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",19285,"PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG",null,650,972.93,317.70999999999998,1500.85,162.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 19285","BLUE CROSS","BLUE CROSS-PPO","CPT",19285,"PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG",null,650,972.93,317.70999999999998,1500.85,162.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 19286","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",19286,"PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE",null,314,0,107.09,1198.25,78.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 19286","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",19286,"PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE",null,314,0,107.09,1198.25,78.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 19286","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",19286,"PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE",null,314,107.09,107.09,1198.25,78.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 19287","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",19287,"PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID",null,1056,1250.8,317.70999999999998,1990.62,264,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 19287","TUFTS","TUFTS POS","CPT",19287,"PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID",null,1056,595.01,317.70999999999998,1990.62,264,1]
["OUTPATIENT","AETNA - AETNA - CPT - 19287","AETNA","AETNA","CPT",19287,"PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID",null,1056,1990.62,317.70999999999998,1990.62,264,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 19288","TUFTS","TUFTS SELECT","CPT",19288,"PERQ BREAST LOC DEVICE PLACEMT ADD LESIO MR GUID",null,469,0,160.32,1198.25,117.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 19288","AETNA","AETNA","CPT",19288,"PERQ BREAST LOC DEVICE PLACEMT ADD LESIO MR GUID",null,469,1198.25,160.32,1198.25,117.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 19301","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",19301,"HC PR MASTECTOMY, PARTIAL",null,4228,4729.13,1990.62,11845.41,1057,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 19301","BLUE CROSS","BLUE CROSS-PPO","CPT",19301,"HC PR MASTECTOMY, PARTIAL",null,4228,4729.13,1990.62,11845.41,1057,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 19316","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",19316,"SUSPENSION OF BREAST",null,7790,11845.41,2166.09,11845.41,1947.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 19316","TUFTS","TUFTS POS","CPT",19316,"SUSPENSION OF BREAST",null,7790,7467.76,2166.09,11845.41,1947.5,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 19316","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT",19316,"SUSPENSION OF BREAST",null,7790,0,2166.09,11845.41,1947.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 19316","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",19316,"SUSPENSION OF BREAST",null,7790,8254.4500000000007,2166.09,11845.41,1947.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 19316","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",19316,"SUSPENSION OF BREAST",null,7790,8254.4500000000007,2166.09,11845.41,1947.5,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MCO - CPT - 19316","BMC HEALTHNET","BMCHN MCO","CPT",19316,"SUSPENSION OF BREAST",null,7790,0,2166.09,11845.41,1947.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 19316","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",19316,"SUSPENSION OF BREAST",null,7790,8254.4500000000007,2166.09,11845.41,1947.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 19318","TUFTS","TUFTS POS","CPT",19318,"HC REDUCTION OF LARGE BREAST",null,8148,7467.76,2166.09,11845.41,2037,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 19318","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",19318,"HC REDUCTION OF LARGE BREAST",null,8148,8254.4500000000007,2166.09,11845.41,2037,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 19318","BLUE CROSS","BLUE CROSS-PPO","CPT",19318,"HC REDUCTION OF LARGE BREAST",null,8148,8254.4500000000007,2166.09,11845.41,2037,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 19328","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",19328,"HC REMOVAL OF BREAST IMPLANT",null,4228,4729.13,1098.98,6079.77,1057,1]
["OUTPATIENT","AETNA - AETNA - CPT - 19340","AETNA","AETNA","CPT",19340,"INSERT BREAST PROS IMMED AFTER EXCIS",null,7790,1500.85,1500.85,9550.75,1947.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 19355","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",19355,"HC CORRECT INVERTED NIPPLE(S)",null,4227,4729.13,2166.09,11845.41,1056.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 19355","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",19355,"HC CORRECT INVERTED NIPPLE(S)",null,4227,4729.13,2166.09,11845.41,1056.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 19380","TUFTS","TUFTS PPO","CPT",19380,"REVISION RECONSTRUCTED BREAST",null,5998,9609.09,2354.5,15242.01,1499.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 19499","TUFTS","TUFTS PPO","CPT",19499,"PR TOMO GUIDED PLACEMENT OF BREAST LOCALIZATION DEVICE",null,4071,7467.76,1198.25,11845.41,1017.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 20102","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",20102,"HC EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK",null,2354,2601.27,1098.98,3344.2,588.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 20103","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",20103,"EXPLORATION PENETRATING WOUND SPX EXTREMITY",null,2701,1250.8,972.93,3264.67,675.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 20103","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",20103,"EXPLORATION PENETRATING WOUND SPX EXTREMITY",null,2701,1250.8,972.93,3264.67,675.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 20103","AETNA","AETNA","CPT",20103,"EXPLORATION PENETRATING WOUND SPX EXTREMITY",null,2701,1198.25,972.93,3264.67,675.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 20200","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",20200,"HC MUSCLE BIOPSY",null,2043,7703.8,1500.85,7703.8,510.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 20200","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",20200,"HC MUSCLE BIOPSY",null,2043,2672.73,1500.85,7703.8,510.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 20200","TUFTS","TUFTS POS","CPT",20200,"HC MUSCLE BIOPSY",null,2043,4856.75,1500.85,7703.8,510.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 20200","TUFTS","TUFTS PPO","CPT",20200,"HC MUSCLE BIOPSY",null,2043,4856.75,1500.85,7703.8,510.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 20200","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",20200,"HC MUSCLE BIOPSY",null,2043,2309.9699999999998,1500.85,7703.8,510.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 20205","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",20205,"BIOPSY,MUSCLE,DEEP",null,1972,11845.41,1990.62,11845.41,493,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 20205","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",20205,"BIOPSY,MUSCLE,DEEP",null,1972,4621.25,1990.62,11845.41,493,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 20205","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",20205,"BIOPSY,MUSCLE,DEEP",null,1972,3994.03,1990.62,11845.41,493,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 20205","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",20205,"BIOPSY,MUSCLE,DEEP",null,1972,3994.03,1990.62,11845.41,493,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 20205","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",20205,"BIOPSY,MUSCLE,DEEP",null,1972,3994.03,1990.62,11845.41,493,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 20220","TUFTS","TUFTS SELECT","CPT",20220,"HC BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL",null,1103,1098.98,1098.98,3264.67,275.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 20220","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",20220,"HC BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL",null,1103,2309.9699999999998,1098.98,3264.67,275.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 20220","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",20220,"HC BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL",null,1103,2309.9699999999998,1098.98,3264.67,275.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 20225","TUFTS","TUFTS POS","CPT",20225,"HC BIOPSY BONE TROCAR/NEEDLE DEEP",null,1972,4856.75,1500.85,7703.8,493,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 20240","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",20240,"HC BIOPSY BONE OPEN SUPERFICIAL",null,3570,4621.25,1500.85,7703.8,892.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 20240","TUFTS","TUFTS HMO","CPT",20240,"HC BIOPSY BONE OPEN SUPERFICIAL",null,3570,4856.75,1500.85,7703.8,892.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 20240","TUFTS","TUFTS SELECT","CPT",20240,"HC BIOPSY BONE OPEN SUPERFICIAL",null,3570,2593.31,1500.85,7703.8,892.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 20245","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",20245,"BIOPSY BONE OPEN DEEP",null,4807,3994.03,1990.62,11845.41,1201.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 20501","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",20501,"HC INJECTION SINUS TRACT DIAGNOSTIC",null,262,0,93.24,1198.25,65.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 20501","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",20501,"HC INJECTION SINUS TRACT DIAGNOSTIC",null,262,93.24,93.24,1198.25,65.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 20501","BLUE CROSS","BLUE CROSS-PPO","CPT",20501,"HC INJECTION SINUS TRACT DIAGNOSTIC",null,262,93.24,93.24,1198.25,65.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 20520","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",20520,"REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE",null,1125,2309.9699999999998,684.11,2672.73,281.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 20520","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",20520,"REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE",null,1125,2309.9699999999998,684.11,2672.73,281.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 20520","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",20520,"REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE",null,1125,2309.9699999999998,684.11,2672.73,281.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 20525","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",20525,"RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP",null,2987,4621.25,1990.62,11845.41,746.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 20525","TUFTS","TUFTS PPO","CPT",20525,"RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP",null,2987,7467.76,1990.62,11845.41,746.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 20525","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",20525,"RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP",null,2987,3994.03,1990.62,11845.41,746.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 20525","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",20525,"RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP",null,2987,3994.03,1990.62,11845.41,746.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 20525","BLUE CROSS","BLUE CROSS-PPO","CPT",20525,"RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP",null,2987,3994.03,1990.62,11845.41,746.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 20526","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",20526,"INJECTION THERAPEUTIC CARPAL TUNNEL",null,433,534.30999999999995,317.70999999999998,1198.25,108.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 20527","TUFTS","TUFTS HMO","CPT",20527,"INJECTION ENZYME PALMAR FASCIAL CORD",null,454,595.01,317.70999999999998,1198.25,113.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 20527","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",20527,"INJECTION ENZYME PALMAR FASCIAL CORD",null,454,415.61,317.70999999999998,1198.25,113.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 20550","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",20550,"INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS",null,313,415.61,317.70999999999998,1198.25,78.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 20550","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",20550,"INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS",null,313,415.61,317.70999999999998,1198.25,78.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 26600","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",26600,"CLTX METACARPAL FX W/O MANIPULATION EACH BONE",null,2120,378,317.70999999999998,943.8,530,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 26605","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",26605,"CLTX METACARPAL FX W/MANIPULATION EACH BONE",null,2246,378,378,7703.8,561.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 26641","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",26641,"CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ",null,2528,474.04,317.70999999999998,943.8,632,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 26641","TUFTS","TUFTS SELECT","CPT",26641,"CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ",null,2528,317.70999999999998,317.70999999999998,943.8,632,1]
["OUTPATIENT","AETNA - AETNA - CPT - 26645","AETNA","AETNA","CPT",26645,"CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ",null,2976,1198.25,1098.98,3264.67,744,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 26650","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",26650,"HC PRQ SKEL FIXATION CARP/MTCRPL FX DISLOCATE THUMB",null,4072,4972.29,1500.85,7703.8,1018,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 26650","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",26650,"HC PRQ SKEL FIXATION CARP/MTCRPL FX DISLOCATE THUMB",null,4072,5097.42,1500.85,7703.8,1018,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 26650","TUFTS","TUFTS PPO","CPT",26650,"HC PRQ SKEL FIXATION CARP/MTCRPL FX DISLOCATE THUMB",null,4072,4856.75,1500.85,7703.8,1018,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 26650","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",26650,"HC PRQ SKEL FIXATION CARP/MTCRPL FX DISLOCATE THUMB",null,4072,4405.5600000000004,1500.85,7703.8,1018,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 26650","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",26650,"HC PRQ SKEL FIXATION CARP/MTCRPL FX DISLOCATE THUMB",null,4072,4405.5600000000004,1500.85,7703.8,1018,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 26670","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",26670,"CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES",null,2305,485.97,317.70999999999998,943.8,576.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 26670","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",26670,"CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES",null,2305,378,317.70999999999998,943.8,576.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 26670","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",26670,"CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES",null,2305,378,317.70999999999998,943.8,576.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 26700","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",26700,"CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES",null,2298,485.97,317.70999999999998,943.8,574.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 26700","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",26700,"CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES",null,2298,378,317.70999999999998,943.8,574.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 26700","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",26700,"CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES",null,2298,378,317.70999999999998,943.8,574.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 26720","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",26720,"CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA",null,1413,485.97,317.70999999999998,1198.25,353.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 26720","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",26720,"CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA",null,1413,378,317.70999999999998,1198.25,353.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 26725","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",26725,"CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA",null,2335,474.04,378,3264.67,583.75,1]
["OUTPATIENT","AETNA - AETNA - CPT - 26725","AETNA","AETNA","CPT",26725,"CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA",null,2335,1500.85,378,3264.67,583.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 26725","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",26725,"CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA",null,2335,378,378,3264.67,583.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 26725","BLUE CROSS","BLUE CROSS-PPO","CPT",26725,"CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA",null,2335,378,378,3264.67,583.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 26740","TUFTS","TUFTS POS","CPT",26740,"CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ",null,1643,595.01,317.70999999999998,1198.25,410.75,1]
["OUTPATIENT","AETNA - AETNA - CPT - 26740","AETNA","AETNA","CPT",26740,"CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ",null,1643,1198.25,317.70999999999998,1198.25,410.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 26740","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",26740,"CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ",null,1643,378,317.70999999999998,1198.25,410.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 26740","BLUE CROSS","BLUE CROSS-PPO","CPT",26740,"CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ",null,1643,378,317.70999999999998,1198.25,410.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 26742","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",26742,"CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ",null,2562,2205.59,1500.85,7703.8,640.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 26742","BLUE CROSS","BLUE CROSS-PPO","CPT",26742,"CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ",null,2562,2205.59,1500.85,7703.8,640.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 26750","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",26750,"CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA",null,1413,378,317.70999999999998,943.8,353.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 26750","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",26750,"CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA",null,1413,378,317.70999999999998,943.8,353.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 26755","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",26755,"CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA",null,2102,943.8,317.70999999999998,943.8,525.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 26755","BLUE CROSS","BLUE CROSS-PPO","CPT",26755,"CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA",null,2102,378,317.70999999999998,943.8,525.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 26765","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",26765,"HC OPEN TX DISTAL PHALANGEAL FRACTURE EACH",null,3938,4972.29,2166.09,11845.41,984.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 26765","TUFTS","TUFTS SELECT","CPT",26765,"HC OPEN TX DISTAL PHALANGEAL FRACTURE EACH",null,3938,3987.49,2166.09,11845.41,984.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 26765","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",26765,"HC OPEN TX DISTAL PHALANGEAL FRACTURE EACH",null,3938,4405.5600000000004,2166.09,11845.41,984.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 26765","BLUE CROSS","BLUE CROSS-PPO","CPT",26765,"HC OPEN TX DISTAL PHALANGEAL FRACTURE EACH",null,3938,4405.5600000000004,2166.09,11845.41,984.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 26770","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",26770,"CLTX IPHAL JT DISLC W/MANJ W/O ANES",null,1939,474.04,317.70999999999998,943.8,484.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 26770","TUFTS","TUFTS POS","CPT",26770,"CLTX IPHAL JT DISLC W/MANJ W/O ANES",null,1939,595.01,317.70999999999998,943.8,484.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 26770","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",26770,"CLTX IPHAL JT DISLC W/MANJ W/O ANES",null,1939,378,317.70999999999998,943.8,484.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 26770","BLUE CROSS","BLUE CROSS-PPO","CPT",26770,"CLTX IPHAL JT DISLC W/MANJ W/O ANES",null,1939,378,317.70999999999998,943.8,484.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 26770","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",26770,"CLTX IPHAL JT DISLC W/MANJ W/O ANES",null,1939,378,317.70999999999998,943.8,484.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 26775","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",26775,"HC CLTX IPHAL JT DISLC W/MANJ REQ ANES",null,2658,3264.67,395.63,3264.67,664.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 26775","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",26775,"HC CLTX IPHAL JT DISLC W/MANJ REQ ANES",null,2658,395.63,395.63,3264.67,664.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 26775","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",26775,"HC CLTX IPHAL JT DISLC W/MANJ REQ ANES",null,2658,395.63,395.63,3264.67,664.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 26775","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",26775,"HC CLTX IPHAL JT DISLC W/MANJ REQ ANES",null,2658,395.63,395.63,3264.67,664.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 26990","TUFTS","TUFTS PPO","CPT",26990,"HC INCIS/DRAIN PELVIS/HIP,DEEP ABCESS",null,3970,2058.16,1098.98,5097.42,992.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 26990","TUFTS","TUFTS SELECT","CPT",26990,"HC INCIS/DRAIN PELVIS/HIP,DEEP ABCESS",null,3970,1098.98,1098.98,5097.42,992.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 27040","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",27040,"HC BX SOFT TISSUES,PELV/HIP,SUPERFICL",null,2043,2672.73,1098.98,3264.67,510.75,1]
["OUTPATIENT","AETNA - AETNA - CPT - 27040","AETNA","AETNA","CPT",27040,"HC BX SOFT TISSUES,PELV/HIP,SUPERFICL",null,2043,1198.25,1098.98,3264.67,510.75,1]
["OUTPATIENT","AETNA - AETNA - CPT - 27041","AETNA","AETNA","CPT",27041,"HC BX SOFT TISSUES,PELV/HIP,DEEP",null,2043,1500.85,1500.85,7703.8,510.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 27043","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",27043,"EXCISION TUMOR SOFT TISSUE PELVIS&HIP SUBQ 3+CM",null,1528,3994.03,1990.62,11845.41,382,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 27043","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",27043,"EXCISION TUMOR SOFT TISSUE PELVIS&HIP SUBQ 3+CM",null,1528,3994.03,1990.62,11845.41,382,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 27047","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",27047,"EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ <3CM",null,2794,4621.25,1500.85,7703.8,698.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 27047","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",27047,"EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ <3CM",null,2794,3994.03,1500.85,7703.8,698.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 27048","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",27048,"EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC <5CM",null,1528,11845.41,1990.62,11845.41,382,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 27048","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",27048,"EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC <5CM",null,1528,4621.25,1990.62,11845.41,382,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 27048","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",27048,"EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC <5CM",null,1528,3994.03,1990.62,11845.41,382,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 27048","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",27048,"EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC <5CM",null,1528,3994.03,1990.62,11845.41,382,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 27086","TUFTS","TUFTS HMO","CPT",27086,"RMVL FOREIGN BODY PELVIS/HIP SUBCUTANEOUS TISS",null,1141,2057.7399999999998,1098.98,3264.67,285.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 27086","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",27086,"RMVL FOREIGN BODY PELVIS/HIP SUBCUTANEOUS TISS",null,1141,2309.9699999999998,1098.98,3264.67,285.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 27087","TUFTS","TUFTS HMO","CPT",27087,"REMOVAL FOREIGN BODY PELVIS/HIP DEEP",null,4826,7467.76,1990.62,11845.41,1206.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 27087","TUFTS","TUFTS PPO","CPT",27087,"REMOVAL FOREIGN BODY PELVIS/HIP DEEP",null,4826,7467.76,1990.62,11845.41,1206.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 27093","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",27093,"HC INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA",null,533,0,173.01,1198.25,133.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 27096","AETNA","AETNA","CPT",27096,"INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA",null,652,1198.25,205.98,1292.83,163,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 27197","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",27197,"HC CLSD TX PELVIC RING FX W/O MANIPULATION",null,3647,7703.8,378,7703.8,911.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 27197","TUFTS","TUFTS PPO","CPT",27197,"HC CLSD TX PELVIC RING FX W/O MANIPULATION",null,3647,4856.75,378,7703.8,911.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 27197","BLUE CROSS","BLUE CROSS-PPO","CPT",27197,"HC CLSD TX PELVIC RING FX W/O MANIPULATION",null,3647,378,378,7703.8,911.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 27200","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",27200,"HC CLOSED TREATMENT COCCYGEAL FRACTURE",null,1431,485.97,317.70999999999998,1198.25,357.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 27200","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",27200,"HC CLOSED TREATMENT COCCYGEAL FRACTURE",null,1431,485.97,317.70999999999998,1198.25,357.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 27200","TUFTS","TUFTS POS","CPT",27200,"HC CLOSED TREATMENT COCCYGEAL FRACTURE",null,1431,595.01,317.70999999999998,1198.25,357.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 27220","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",27220,"CLTX ACETABULUM HIP/SOCKT FX W/O MANJ",null,4008,485.97,378,2032.26,1002,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 27220","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",27220,"CLTX ACETABULUM HIP/SOCKT FX W/O MANJ",null,4008,485.97,378,2032.26,1002,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 27238","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",27238,"CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ",null,3509,2551.96,1098.98,3264.67,877.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 27246","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",27246,"CLTX GREATER TROCHANTERIC FX W/O MANJ",null,2950,474.04,378,3264.67,737.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 27246","AETNA","AETNA","CPT",27246,"CLTX GREATER TROCHANTERIC FX W/O MANJ",null,2950,1198.25,378,3264.67,737.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 27246","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",27246,"CLTX GREATER TROCHANTERIC FX W/O MANJ",null,2950,378,378,3264.67,737.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 27246","BLUE CROSS","BLUE CROSS-PPO","CPT",27246,"CLTX GREATER TROCHANTERIC FX W/O MANJ",null,2950,378,378,3264.67,737.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 27250","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",27250,"CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA",null,325,485.97,378,3264.67,81.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 27250","TUFTS","TUFTS HMO","CPT",27250,"CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA",null,325,2057.7399999999998,378,3264.67,81.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 27250","TUFTS","TUFTS POS","CPT",27250,"CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA",null,325,2058.17,378,3264.67,81.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 27250","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",27250,"CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA",null,325,378,378,3264.67,81.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 27252","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",27252,"HC TX HIP DISLOC W/ANESTH",null,2025,2205.59,1500.85,7703.8,506.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 27252","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",27252,"HC TX HIP DISLOC W/ANESTH",null,2025,2205.59,1500.85,7703.8,506.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 27256","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",27256,"TX SPONTAN HIP DISLC ABDCT SPLNT/TRCJ W/O ANES",null,325,474.04,378,7703.8,81.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 27256","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",27256,"TX SPONTAN HIP DISLC ABDCT SPLNT/TRCJ W/O ANES",null,325,7703.8,378,7703.8,81.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 27256","AETNA","AETNA","CPT",27256,"TX SPONTAN HIP DISLC ABDCT SPLNT/TRCJ W/O ANES",null,325,1500.85,378,7703.8,81.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 27257","TUFTS","TUFTS HMO","CPT",27257,"HC TX HIPDISLOC ABDCT WMANP",null,2026,4856.75,1990.62,7703.8,506.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 27265","AETNA","AETNA","CPT",27265,"CLTX POST HIP ARTHRP DISLC W/O ANES",null,3055,1198.25,378,3264.67,763.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 27265","BLUE CROSS","BLUE CROSS-PPO","CPT",27265,"CLTX POST HIP ARTHRP DISLC W/O ANES",null,3055,378,378,3264.67,763.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 27266","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",27266,"HC CLOSED RX POST HIP FIX DISLOC,ANESTH",null,2021,3264.67,1098.98,3264.67,505.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 27301","AETNA","AETNA","CPT",27301,"HC INCIS/DRAIN THIGH/KNEE ABSCESS,DEEP",null,3449,1990.62,1990.62,11845.41,862.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 27301","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",27301,"HC INCIS/DRAIN THIGH/KNEE ABSCESS,DEEP",null,3449,3994.03,1990.62,11845.41,862.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 27323","TUFTS","TUFTS SELECT","CPT",27323,"HC BX THIGH/KNEE SOFT TISSUES,SUPERF",null,2043,1098.98,1098.98,3264.67,510.75,1]
["OUTPATIENT","AETNA - AETNA - CPT - 27323","AETNA","AETNA","CPT",27323,"HC BX THIGH/KNEE SOFT TISSUES,SUPERF",null,2043,1198.25,1098.98,3264.67,510.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 27324","BLUE CROSS","BLUE CROSS-PPO","CPT",27324,"HC BX THIGH/KNEE SOFT TISSUES,DEEP",null,3449,3994.03,1098.98,4621.25,862.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 27324","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",27324,"HC BX THIGH/KNEE SOFT TISSUES,DEEP",null,3449,3994.03,1098.98,4621.25,862.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 27327","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",27327,"EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ <3CM",null,2987,2309.9699999999998,1500.85,7703.8,746.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 27328","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",27328,"HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM",null,4466,4507.8100000000004,1990.62,11845.41,1116.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 27328","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",27328,"HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM",null,4466,4621.25,1990.62,11845.41,1116.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 27328","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",27328,"HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM",null,4466,3994.03,1990.62,11845.41,1116.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 27328","BLUE CROSS","BLUE CROSS-PPO","CPT",27328,"HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM",null,4466,3994.03,1990.62,11845.41,1116.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 27337","TUFTS","TUFTS PPO","CPT",27337,"EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/>",null,3207,7467.76,1990.62,11845.41,801.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 27339","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",27339,"HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC 5+ CM",null,4466,4621.25,1990.62,11845.41,1116.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 27339","TUFTS","TUFTS POS","CPT",27339,"HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC 5+ CM",null,4466,7467.76,1990.62,11845.41,1116.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 27369","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",27369,"HC NJX CNTRST KNE ARTHG/CT/MRI",null,399,0,100.46,1198.25,99.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 27369","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",27369,"HC NJX CNTRST KNE ARTHG/CT/MRI",null,399,0,100.46,1198.25,99.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 27369","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",27369,"HC NJX CNTRST KNE ARTHG/CT/MRI",null,399,0,100.46,1198.25,99.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 27372","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",27372,"REMOVAL FOREIGN BODY DEEP THIGH/KNEE",null,3089,3994.03,2531.06,15242.01,772.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 27500","TUFTS","TUFTS POS","CPT",27500,"CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION",null,3651,2058.17,378,3264.67,912.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 27500","TUFTS","TUFTS SELECT","CPT",27500,"CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION",null,3651,1098.98,378,3264.67,912.75,1]
["OUTPATIENT","AETNA - AETNA - CPT - 27500","AETNA","AETNA","CPT",27500,"CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION",null,3651,1198.25,378,3264.67,912.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 27501","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",27501,"CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANJ",null,3811,378,378,7703.8,952.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 27502","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",27502,"CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ",null,5928,2205.59,1500.85,7703.8,1482,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 27508","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",27508,"CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ",null,3770,485.97,378,3264.67,942.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 27508","BLUE CROSS","BLUE CROSS-PPO","CPT",27508,"CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ",null,3770,378,378,3264.67,942.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 27520","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",27520,"CLOSED TX PATELLAR FRACTURE W/O MANIPULATION",null,2263,485.97,378,3264.67,565.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 27530","TUFTS","TUFTS SELECT","CPT",27530,"CLTX TIBIAL FX PROXIMAL W/O MANIPULATION",null,2146,1098.98,378,3264.67,536.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 27530","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",27530,"CLTX TIBIAL FX PROXIMAL W/O MANIPULATION",null,2146,378,378,3264.67,536.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 27532","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",27532,"HC CLTX TIBIAL FX PROXIMAL W/WO MANJ W/SKEL TRACJ",null,4413,5097.42,1098.98,5097.42,1103.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 27532","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",27532,"HC CLTX TIBIAL FX PROXIMAL W/WO MANJ W/SKEL TRACJ",null,4413,4405.5600000000004,1098.98,5097.42,1103.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 27538","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",27538,"CLTX INTERCONDYLAR SPI&/TUBRST FX KNE W/WO MAN",null,3392,474.04,378,3264.67,848,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 27538","TUFTS","TUFTS PPO","CPT",27538,"CLTX INTERCONDYLAR SPI&/TUBRST FX KNE W/WO MAN",null,3392,2058.16,378,3264.67,848,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 27538","TUFTS","TUFTS SELECT","CPT",27538,"CLTX INTERCONDYLAR SPI&/TUBRST FX KNE W/WO MAN",null,3392,1098.98,378,3264.67,848,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 27550","TUFTS","TUFTS HMO","CPT",27550,"CLOSED TX KNEE DISLOCATION W/O ANESTHESIA",null,3509,2057.7399999999998,378,3264.67,877.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 27550","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",27550,"CLOSED TX KNEE DISLOCATION W/O ANESTHESIA",null,3509,378,378,3264.67,877.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 27550","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",27550,"CLOSED TX KNEE DISLOCATION W/O ANESTHESIA",null,3509,378,378,3264.67,877.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 27550","BLUE CROSS","BLUE CROSS-PPO","CPT",27550,"CLOSED TX KNEE DISLOCATION W/O ANESTHESIA",null,3509,378,378,3264.67,877.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 27550","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",27550,"CLOSED TX KNEE DISLOCATION W/O ANESTHESIA",null,3509,378,378,3264.67,877.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 27560","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",27560,"CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA",null,2696,474.04,378,3264.67,674,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 27560","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",27560,"CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA",null,2696,378,378,3264.67,674,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 27560","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",27560,"CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA",null,2696,378,378,3264.67,674,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 27603","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",27603,"HC DRAIN LOWER LEG DEEP ABSC/HEMATOMA",null,3573,4507.8100000000004,1500.85,7703.8,893.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 27603","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",27603,"HC DRAIN LOWER LEG DEEP ABSC/HEMATOMA",null,3573,7703.8,1500.85,7703.8,893.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 27603","BLUE CROSS","BLUE CROSS-PPO","CPT",27603,"HC DRAIN LOWER LEG DEEP ABSC/HEMATOMA",null,3573,3994.03,1500.85,7703.8,893.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 27605","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",27605,"TENOTOMY PRQ ACHILLES TENDON SPX LOCAL ANES",null,2895,2489.31,1098.98,3264.67,723.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 27605","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",27605,"TENOTOMY PRQ ACHILLES TENDON SPX LOCAL ANES",null,2895,2551.96,1098.98,3264.67,723.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 27605","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",27605,"TENOTOMY PRQ ACHILLES TENDON SPX LOCAL ANES",null,2895,2205.59,1098.98,3264.67,723.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 27613","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",27613,"HC BX LOW LEG SOFT TISSUE,SUPERFICIAL",null,2043,2672.73,1098.98,3264.67,510.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 27613","TUFTS","TUFTS PPO","CPT",27613,"HC BX LOW LEG SOFT TISSUE,SUPERFICIAL",null,2043,2058.16,1098.98,3264.67,510.75,1]
["OUTPATIENT","AETNA - AETNA - CPT - 27613","AETNA","AETNA","CPT",27613,"HC BX LOW LEG SOFT TISSUE,SUPERFICIAL",null,2043,1198.25,1098.98,3264.67,510.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 27613","BLUE CROSS","BLUE CROSS-PPO","CPT",27613,"HC BX LOW LEG SOFT TISSUE,SUPERFICIAL",null,2043,2309.9699999999998,1098.98,3264.67,510.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 27613","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",27613,"HC BX LOW LEG SOFT TISSUE,SUPERFICIAL",null,2043,2309.9699999999998,1098.98,3264.67,510.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 27614","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",27614,"HC BX LOW LEG SOFT TISSUE,DEEP",null,3449,4621.25,1500.85,7703.8,862.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 27614","TUFTS","TUFTS SELECT","CPT",27614,"HC BX LOW LEG SOFT TISSUE,DEEP",null,3449,2593.31,1500.85,7703.8,862.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 27614","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",27614,"HC BX LOW LEG SOFT TISSUE,DEEP",null,3449,3994.03,1500.85,7703.8,862.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 27614","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",27614,"HC BX LOW LEG SOFT TISSUE,DEEP",null,3449,3994.03,1500.85,7703.8,862.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 27618","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",27618,"EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM",null,2331,7703.8,1500.85,7703.8,582.75,1]
["OUTPATIENT","AETNA - AETNA - CPT - 27618","AETNA","AETNA","CPT",27618,"EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM",null,2331,1500.85,1500.85,7703.8,582.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 27618","BLUE CROSS","BLUE CROSS-PPO","CPT",27618,"EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM",null,2331,2309.9699999999998,1500.85,7703.8,582.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 27634","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",27634,"HC EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5+CM",null,3570,11845.41,1990.62,11845.41,892.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 27634","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",27634,"HC EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5+CM",null,3570,4621.25,1990.62,11845.41,892.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 27634","TUFTS","TUFTS HMO","CPT",27634,"HC EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5+CM",null,3570,7467.76,1990.62,11845.41,892.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 27634","BLUE CROSS","BLUE CROSS-PPO","CPT",27634,"HC EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5+CM",null,3570,3994.03,1990.62,11845.41,892.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 27634","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",27634,"HC EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5+CM",null,3570,3994.03,1990.62,11845.41,892.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 27634","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",27634,"HC EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5+CM",null,3570,3994.03,1990.62,11845.41,892.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 27648","BLUE CROSS","BLUE CROSS-PPO","CPT",27648,"HC INJECTION ANKLE ARTHROGRAPHY",null,396,130.88,130.88,1198.25,99,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 27685","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",27685,"HC LENGTH/SHORT LEG/ANKL TENDON,SINGLE",null,4428,4972.29,1990.62,11845.41,1107,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 27685","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",27685,"HC LENGTH/SHORT LEG/ANKL TENDON,SINGLE",null,4428,5097.42,1990.62,11845.41,1107,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 27685","TUFTS","TUFTS PPO","CPT",27685,"HC LENGTH/SHORT LEG/ANKL TENDON,SINGLE",null,4428,7467.76,1990.62,11845.41,1107,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 27752","TUFTS","TUFTS HMO","CPT",27752,"CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ",null,3806,2057.7399999999998,1098.98,3264.67,951.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 27752","TUFTS","TUFTS POS","CPT",27752,"CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ",null,3806,2058.17,1098.98,3264.67,951.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 27752","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",27752,"CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ",null,3806,2205.59,1098.98,3264.67,951.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 27752","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",27752,"CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ",null,3806,2205.59,1098.98,3264.67,951.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 27752","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",27752,"CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ",null,3806,2205.59,1098.98,3264.67,951.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 27759","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",27759,"HC TREAT TIBIAL SHAFT FX, INTRAMED IMPLANT",null,16080,20307.080000000002,2166.09,20818.13,4020,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 27759","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",27759,"HC TREAT TIBIAL SHAFT FX, INTRAMED IMPLANT",null,16080,20818.13,2166.09,20818.13,4020,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 27759","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",27759,"HC TREAT TIBIAL SHAFT FX, INTRAMED IMPLANT",null,16080,11845.41,2166.09,20818.13,4020,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 27759","TUFTS","TUFTS SELECT","CPT",27759,"HC TREAT TIBIAL SHAFT FX, INTRAMED IMPLANT",null,16080,3987.49,2166.09,20818.13,4020,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 27759","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",27759,"HC TREAT TIBIAL SHAFT FX, INTRAMED IMPLANT",null,16080,17992.57,2166.09,20818.13,4020,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 27760","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",27760,"CLTX MEDIAL MALLEOLUS FX W/O MANIPULATION",null,2337,485.97,378,3264.67,584.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 27760","TUFTS","TUFTS POS","CPT",27760,"CLTX MEDIAL MALLEOLUS FX W/O MANIPULATION",null,2337,2058.17,378,3264.67,584.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 27760","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",27760,"CLTX MEDIAL MALLEOLUS FX W/O MANIPULATION",null,2337,378,378,3264.67,584.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 27762","BLUE CROSS","BLUE CROSS-PPO","CPT",27762,"CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ",null,3361,2205.59,1098.98,3264.67,840.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 27767","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",27767,"HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANIP",null,2180,485.97,317.70999999999998,1198.25,545,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 27767","TUFTS","TUFTS SELECT","CPT",27767,"HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANIP",null,2180,317.70999999999998,317.70999999999998,1198.25,545,1]
["OUTPATIENT","AETNA - AETNA - CPT - 27767","AETNA","AETNA","CPT",27767,"HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANIP",null,2180,1198.25,317.70999999999998,1198.25,545,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 27767","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",27767,"HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANIP",null,2180,378,317.70999999999998,1198.25,545,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 27767","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",27767,"HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANIP",null,2180,378,317.70999999999998,1198.25,545,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 27780","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",27780,"CLTX PROX FIBULA/SHFT FX W/O MANJ",null,2135,378,378,3264.67,533.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 27781","TUFTS","TUFTS PPO","CPT",27781,"CLTX PROX FIBULA/SHFT FX W/MANJ",null,3029,2058.16,1098.98,3264.67,757.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 27786","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",27786,"CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ",null,2195,485.97,378,3264.67,548.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 27786","TUFTS","TUFTS SELECT","CPT",27786,"CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ",null,2195,1098.98,378,3264.67,548.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 27788","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",27788,"CLTX DSTL FIBULAR FX LAT MALLS W/MANJ",null,2964,485.97,378,3264.67,741,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 27788","TUFTS","TUFTS PPO","CPT",27788,"CLTX DSTL FIBULAR FX LAT MALLS W/MANJ",null,2964,2058.16,378,3264.67,741,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 27788","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",27788,"CLTX DSTL FIBULAR FX LAT MALLS W/MANJ",null,2964,378,378,3264.67,741,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 27808","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",27808,"CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ",null,2302,378,378,3264.67,575.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 27810","BLUE CROSS","BLUE CROSS-PPO","CPT",27810,"CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ",null,3285,2205.59,1098.98,3264.67,821.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 27814","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",27814,"HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE",null,8554,11074.87,1990.62,11845.41,2138.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 27814","TUFTS","TUFTS HMO","CPT",27814,"HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE",null,8554,7467.76,1990.62,11845.41,2138.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 27814","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",27814,"HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE",null,8554,9571.73,1990.62,11845.41,2138.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 27816","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",27816,"CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION",null,2193,485.97,378,3264.67,548.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 27816","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",27816,"CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION",null,2193,378,378,3264.67,548.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 27816","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",27816,"CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION",null,2193,378,378,3264.67,548.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 27818","TUFTS","TUFTS HMO","CPT",27818,"CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION",null,3337,2057.7399999999998,1098.98,3264.67,834.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 27818","BLUE CROSS","BLUE CROSS-PPO","CPT",27818,"CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION",null,3337,2205.59,1098.98,3264.67,834.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 27824","TUFTS","TUFTS POS","CPT",27824,"CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ",null,2325,2058.17,378,3264.67,581.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 27825","TUFTS","TUFTS POS","CPT",27825,"CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ",null,3788,2058.17,1098.98,3264.67,947,1]
["OUTPATIENT","AETNA - AETNA - CPT - 27825","AETNA","AETNA","CPT",27825,"CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ",null,3788,1500.85,1098.98,3264.67,947,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 27825","BLUE CROSS","BLUE CROSS-PPO","CPT",27825,"CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ",null,3788,2205.59,1098.98,3264.67,947,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 27825","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",27825,"CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ",null,3788,2205.59,1098.98,3264.67,947,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 27830","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",27830,"CLTX PROX TIBFIB JT DISLC W/O ANES",null,2510,378,378,3264.67,627.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 27840","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",27840,"CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA",null,2813,485.97,378,3264.67,703.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 27840","TUFTS","TUFTS SELECT","CPT",27840,"CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA",null,2813,1098.98,378,3264.67,703.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 27840","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",27840,"CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA",null,2813,378,378,3264.67,703.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 27870","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",27870,"HC ARTHRODESIS,ANKLE,OPEN",null,15193,20307.080000000002,2166.09,20818.13,3798.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 27870","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",27870,"HC ARTHRODESIS,ANKLE,OPEN",null,15193,20818.13,2166.09,20818.13,3798.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 27870","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",27870,"HC ARTHRODESIS,ANKLE,OPEN",null,15193,20818.13,2166.09,20818.13,3798.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 28011","AETNA","AETNA","CPT",28011,"HC INCISION OF TOE TENDONS",null,2020,1990.62,1990.62,7703.8,505,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 28011","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",28011,"HC INCISION OF TOE TENDONS",null,2020,2205.59,1990.62,7703.8,505,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 28011","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",28011,"HC INCISION OF TOE TENDONS",null,2020,2205.59,1990.62,7703.8,505,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 28039","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",28039,"EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>",null,2723,4621.25,1198.25,11845.41,680.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 28039","TUFTS","TUFTS POS","CPT",28039,"EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>",null,2723,7467.76,1198.25,11845.41,680.75,1]
["OUTPATIENT","AETNA - AETNA - CPT - 28039","AETNA","AETNA","CPT",28039,"EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>",null,2723,1198.25,1198.25,11845.41,680.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 28041","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",28041,"HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5+CM",null,3490,4621.25,1990.62,11845.41,872.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 28041","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",28041,"HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5+CM",null,3490,3994.03,1990.62,11845.41,872.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 28043","TUFTS","TUFTS HMO","CPT",28043,"EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM",null,2008,4856.75,1500.85,7703.8,502,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 28043","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",28043,"EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM",null,2008,2309.9699999999998,1500.85,7703.8,502,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 28045","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",28045,"HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC <1.5CM",null,3490,4621.25,1990.62,11845.41,872.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 28045","TUFTS","TUFTS POS","CPT",28045,"HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC <1.5CM",null,3490,7467.76,1990.62,11845.41,872.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 28046","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",28046,"HC RESECT FOOT/TOE TUMOR < 3 CM",null,3438,4507.8100000000004,1990.62,11845.41,859.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 28046","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",28046,"HC RESECT FOOT/TOE TUMOR < 3 CM",null,3438,4621.25,1990.62,11845.41,859.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 28090","TUFTS","TUFTS HMO","CPT",28090,"HC REMOVAL OF FOOT LESION",null,2051,7467.76,1990.62,11845.41,512.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 28090","TUFTS","TUFTS PPO","CPT",28090,"HC REMOVAL OF FOOT LESION",null,2051,7467.76,1990.62,11845.41,512.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 28090","TUFTS","TUFTS SELECT","CPT",28090,"HC REMOVAL OF FOOT LESION",null,2051,3987.49,1990.62,11845.41,512.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 28124","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",28124,"PARTIAL REMOVAL OF TOE",null,4168,4972.29,1098.98,5097.42,1042,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 28124","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",28124,"PARTIAL REMOVAL OF TOE",null,4168,3264.67,1098.98,5097.42,1042,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 28124","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",28124,"PARTIAL REMOVAL OF TOE",null,4168,4405.5600000000004,1098.98,5097.42,1042,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 28150","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",28150,"HC REMOVAL OF SINGLE TOE,EACH",null,3938,4405.5600000000004,1990.62,7703.8,984.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 28150","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",28150,"HC REMOVAL OF SINGLE TOE,EACH",null,3938,4405.5600000000004,1990.62,7703.8,984.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 28153","BLUE CROSS","BLUE CROSS-PPO","CPT",28153,"HC RESEC HEAD OF PHALANX,TOE",null,3938,4405.5600000000004,1990.62,7703.8,984.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 28190","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",28190,"REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS",null,1023,1250.8,972.93,3264.67,255.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 28190","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",28190,"REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS",null,1023,972.93,972.93,3264.67,255.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 28192","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",28192,"REMOVAL FOREIGN BODY FOOT DEEP",null,2407,2309.9699999999998,1500.85,7703.8,601.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 28192","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",28192,"REMOVAL FOREIGN BODY FOOT DEEP",null,2407,2309.9699999999998,1500.85,7703.8,601.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 28192","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",28192,"REMOVAL FOREIGN BODY FOOT DEEP",null,2407,2309.9699999999998,1500.85,7703.8,601.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 28220","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",28220,"HC RELEASE FLEX FOOT TENDON,SINGLE",null,2837,2205.59,1098.98,3264.67,709.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 28222","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",28222,"HC TENOLYSIS FLEXOR FOOT MULTIPLE TENDONS",null,3970,4972.29,1098.98,5097.42,992.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 28222","TUFTS","TUFTS HMO","CPT",28222,"HC TENOLYSIS FLEXOR FOOT MULTIPLE TENDONS",null,3970,2057.7399999999998,1098.98,5097.42,992.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 28230","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",28230,"TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPX",null,2895,2489.31,1098.98,3264.67,723.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 28232","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",28232,"TX OPEN TENDON FLEXOR TOE 1 TENDON SPX",null,2895,2551.96,1098.98,3264.67,723.75,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 28232","TUFTS","TUFTS HMO","CPT",28232,"TX OPEN TENDON FLEXOR TOE 1 TENDON SPX",null,2895,2057.7399999999998,1098.98,3264.67,723.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 28232","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",28232,"TX OPEN TENDON FLEXOR TOE 1 TENDON SPX",null,2895,2205.59,1098.98,3264.67,723.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 28232","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",28232,"TX OPEN TENDON FLEXOR TOE 1 TENDON SPX",null,2895,2205.59,1098.98,3264.67,723.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 28234","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",28234,"TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON",null,2895,3264.67,1098.98,3264.67,723.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 28234","TUFTS","TUFTS POS","CPT",28234,"TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON",null,2895,2058.17,1098.98,3264.67,723.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 28234","TUFTS","TUFTS SELECT","CPT",28234,"TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON",null,2895,1098.98,1098.98,3264.67,723.75,1]
["OUTPATIENT","AETNA - AETNA - CPT - 28234","AETNA","AETNA","CPT",28234,"TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON",null,2895,1500.85,1098.98,3264.67,723.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 28234","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",28234,"TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON",null,2895,2205.59,1098.98,3264.67,723.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 28285","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",28285,"CORRECTION HAMMERTOE",null,2861,5097.42,1990.62,11845.41,715.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 28285","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",28285,"CORRECTION HAMMERTOE",null,2861,11845.41,1990.62,11845.41,715.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 28285","TUFTS","TUFTS SELECT","CPT",28285,"CORRECTION HAMMERTOE",null,2861,3987.49,1990.62,11845.41,715.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 28296","TUFTS","TUFTS PPO","CPT",28296,"HC CORRJ HALLUX VALGUS W/SESMDC W/DIST METAR OSTEOT",null,3939,7467.76,1990.62,11845.41,984.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 28296","BLUE CROSS","BLUE CROSS-PPO","CPT",28296,"HC CORRJ HALLUX VALGUS W/SESMDC W/DIST METAR OSTEOT",null,3939,4405.5600000000004,1990.62,11845.41,984.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 28308","TUFTS","TUFTS POS","CPT",28308,"OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA",null,2861,4856.75,1500.85,7703.8,715.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 28308","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",28308,"OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA",null,2861,4405.5600000000004,1500.85,7703.8,715.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 28308","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",28308,"OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA",null,2861,4405.5600000000004,1500.85,7703.8,715.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 28308","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",28308,"OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA",null,2861,4405.5600000000004,1500.85,7703.8,715.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 28400","AETNA","AETNA","CPT",28400,"CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION",null,1743,1198.25,378,3264.67,435.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 28400","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",28400,"CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION",null,1743,378,378,3264.67,435.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 28405","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",28405,"CLOSED TX CALCANEAL FRACTURE W/MANIPULATION",null,2660,378,378,7703.8,665,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 28430","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",28430,"CLOSED TX TALUS FRACTURE W/O MANIPULATION",null,1603,2032.26,378,2032.26,400.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 28450","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",28450,"TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ",null,1480,485.97,317.70999999999998,1198.25,370,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 28450","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",28450,"TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ",null,1480,943.8,317.70999999999998,1198.25,370,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 28450","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",28450,"TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ",null,1480,378,317.70999999999998,1198.25,370,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 28450","BLUE CROSS","BLUE CROSS-PPO","CPT",28450,"TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ",null,1480,378,317.70999999999998,1198.25,370,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 28455","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",28455,"TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ",null,1989,2489.31,1098.98,3264.67,497.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 28455","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",28455,"TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ",null,1989,2551.96,1098.98,3264.67,497.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 28455","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",28455,"TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ",null,1989,2551.96,1098.98,3264.67,497.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 28455","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",28455,"TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ",null,1989,2205.59,1098.98,3264.67,497.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 28455","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",28455,"TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ",null,1989,2205.59,1098.98,3264.67,497.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 28455","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",28455,"TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ",null,1989,2205.59,1098.98,3264.67,497.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 28465","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",28465,"HC TREAT MIDFOOT FRACTURE EACH",null,9088,11074.87,1990.62,11845.41,2272,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 28465","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",28465,"HC TREAT MIDFOOT FRACTURE EACH",null,9088,11074.87,1990.62,11845.41,2272,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 28465","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",28465,"HC TREAT MIDFOOT FRACTURE EACH",null,9088,9571.73,1990.62,11845.41,2272,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 28465","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",28465,"HC TREAT MIDFOOT FRACTURE EACH",null,9088,9571.73,1990.62,11845.41,2272,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 28465","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",28465,"HC TREAT MIDFOOT FRACTURE EACH",null,9088,9571.73,1990.62,11845.41,2272,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 28465","BLUE CROSS","BLUE CROSS-PPO","CPT",28465,"HC TREAT MIDFOOT FRACTURE EACH",null,9088,9571.73,1990.62,11845.41,2272,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 28470","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",28470,"CLOSED TX METATARSAL FRACTURE W/O MANIPULATION",null,1468,485.97,317.70999999999998,1198.25,367,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 28470","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",28470,"CLOSED TX METATARSAL FRACTURE W/O MANIPULATION",null,1468,485.97,317.70999999999998,1198.25,367,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 28470","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",28470,"CLOSED TX METATARSAL FRACTURE W/O MANIPULATION",null,1468,378,317.70999999999998,1198.25,367,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 28470","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",28470,"CLOSED TX METATARSAL FRACTURE W/O MANIPULATION",null,1468,378,317.70999999999998,1198.25,367,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 28470","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",28470,"CLOSED TX METATARSAL FRACTURE W/O MANIPULATION",null,1468,378,317.70999999999998,1198.25,367,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 28475","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",28475,"CLTX METAR FX W/MANJ",null,1754,474.04,317.70999999999998,1198.25,438.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 28475","TUFTS","TUFTS HMO","CPT",28475,"CLTX METAR FX W/MANJ",null,1754,595.01,317.70999999999998,1198.25,438.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 28475","TUFTS","TUFTS PPO","CPT",28475,"CLTX METAR FX W/MANJ",null,1754,595.01,317.70999999999998,1198.25,438.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 28475","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",28475,"CLTX METAR FX W/MANJ",null,1754,378,317.70999999999998,1198.25,438.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 28490","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",28490,"CLTX FX GRT TOE PHLX/PHLG W/O MANJ",null,960,943.8,317.70999999999998,1198.25,240,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 28490","TUFTS","TUFTS SELECT","CPT",28490,"CLTX FX GRT TOE PHLX/PHLG W/O MANJ",null,960,317.70999999999998,317.70999999999998,1198.25,240,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 28490","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",28490,"CLTX FX GRT TOE PHLX/PHLG W/O MANJ",null,960,378,317.70999999999998,1198.25,240,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 28490","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",28490,"CLTX FX GRT TOE PHLX/PHLG W/O MANJ",null,960,378,317.70999999999998,1198.25,240,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 28495","TUFTS","TUFTS PPO","CPT",28495,"CLTX FX GRT TOE PHLX/PHLG W/MANJ",null,1159,595.01,317.70999999999998,1198.25,289.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 28495","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",28495,"CLTX FX GRT TOE PHLX/PHLG W/MANJ",null,1159,378,317.70999999999998,1198.25,289.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 28510","TUFTS","TUFTS PPO","CPT",28510,"CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ",null,914,595.01,317.70999999999998,1198.25,228.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 28510","TUFTS","TUFTS SELECT","CPT",28510,"CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ",null,914,317.70999999999998,317.70999999999998,1198.25,228.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 28510","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",28510,"CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ",null,914,378,317.70999999999998,1198.25,228.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 28510","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",28510,"CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ",null,914,378,317.70999999999998,1198.25,228.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 28515","TUFTS","TUFTS HMO","CPT",28515,"CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ",null,1084,595.01,317.70999999999998,1198.25,271,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 28530","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",28530,"HC CLOSED RX SESAMOID BONE FX",null,321,378,317.70999999999998,1198.25,80.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 28540","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",28540,"CLTX TARSAL DISLC OTH/THN TALOTARSAL W/O ANES",null,1406,485.97,378,2032.26,351.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 28570","TUFTS","TUFTS SELECT","CPT",28570,"HC CLOSED RX TALOTARSAL DISLOC",null,321,1098.98,378,3264.67,80.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 28570","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",28570,"HC CLOSED RX TALOTARSAL DISLOC",null,321,378,378,3264.67,80.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 28570","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",28570,"HC CLOSED RX TALOTARSAL DISLOC",null,321,378,378,3264.67,80.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 28600","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",28600,"CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES",null,1431,485.97,317.70999999999998,1198.25,357.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 28630","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",28630,"CLOSED RX MT-PHAL TOE DISLOCATION",null,275,943.8,317.70999999999998,1198.25,68.75,1]
["OUTPATIENT","AETNA - AETNA - CPT - 28630","AETNA","AETNA","CPT",28630,"CLOSED RX MT-PHAL TOE DISLOCATION",null,275,1198.25,317.70999999999998,1198.25,68.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 28630","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",28630,"CLOSED RX MT-PHAL TOE DISLOCATION",null,275,378,317.70999999999998,1198.25,68.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 28630","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",28630,"CLOSED RX MT-PHAL TOE DISLOCATION",null,275,378,317.70999999999998,1198.25,68.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 28630","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",28630,"CLOSED RX MT-PHAL TOE DISLOCATION",null,275,378,317.70999999999998,1198.25,68.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 28660","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",28660,"HC CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES",null,323,378,317.70999999999998,1198.25,80.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 28660","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",28660,"HC CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES",null,323,378,317.70999999999998,1198.25,80.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 28825","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",28825,"HC AMP,TOE;INTERPHAL JT",null,2883,4405.5600000000004,1500.85,7703.8,720.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 28825","BLUE CROSS","BLUE CROSS-PPO","CPT",28825,"HC AMP,TOE;INTERPHAL JT",null,2883,4405.5600000000004,1500.85,7703.8,720.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 28899","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",28899,"CHEILECTOMY LESSER MPJ W/ IMPLANT",null,305,943.8,317.70999999999998,1198.25,76.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 28899","TUFTS","TUFTS SELECT","CPT",28899,"CHEILECTOMY LESSER MPJ W/ IMPLANT",null,305,317.70999999999998,317.70999999999998,1198.25,76.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 29065","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",29065,"APPLICATION CAST SHOULDER HAND LONG ARM",null,527,1308.22,395.63,1308.22,131.75,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 29065","TUFTS","TUFTS HMO","CPT",29065,"APPLICATION CAST SHOULDER HAND LONG ARM",null,527,770.98,395.63,1308.22,131.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 29065","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",29065,"APPLICATION CAST SHOULDER HAND LONG ARM",null,527,395.63,395.63,1308.22,131.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 29065","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",29065,"APPLICATION CAST SHOULDER HAND LONG ARM",null,527,395.63,395.63,1308.22,131.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 29075","TUFTS","TUFTS PPO","CPT",29075,"APPLICATION CAST ELBOW FINGER SHORT ARM",null,481,824.75,395.63,1308.22,120.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 29085","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",29085,"APPLICATION CAST HAND & LOWER FOREARM GAUNTLET",null,516,283.51,226.08,764.24,129,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 24675","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",24675,"CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ",null,3187,2205.59,1098.98,3264.67,796.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 25000","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",25000,"HC INCISION EXTENSOR TENDON SHEATH WRIST",null,2568,2489.31,1990.62,11845.41,642,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 25000","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",25000,"HC INCISION EXTENSOR TENDON SHEATH WRIST",null,2568,2551.96,1990.62,11845.41,642,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 25000","TUFTS","TUFTS HMO","CPT",25000,"HC INCISION EXTENSOR TENDON SHEATH WRIST",null,2568,7467.76,1990.62,11845.41,642,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 25000","BLUE CROSS","BLUE CROSS-PPO","CPT",25000,"HC INCISION EXTENSOR TENDON SHEATH WRIST",null,2568,2205.59,1990.62,11845.41,642,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 25000","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",25000,"HC INCISION EXTENSOR TENDON SHEATH WRIST",null,2568,2205.59,1990.62,11845.41,642,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 25065","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",25065,"HC BIOPSY FOREARM SOFT TISSUES,SUPERFIC",null,2043,2672.73,1098.98,3264.67,510.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 25065","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",25065,"HC BIOPSY FOREARM SOFT TISSUES,SUPERFIC",null,2043,2309.9699999999998,1098.98,3264.67,510.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 25065","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",25065,"HC BIOPSY FOREARM SOFT TISSUES,SUPERFIC",null,2043,2309.9699999999998,1098.98,3264.67,510.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 25066","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",25066,"HC BIOPSY FOREARM SOFT TISSUES,DEEP",null,3449,3994.03,1500.85,7703.8,862.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 25071","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",25071,"EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/>",null,3254,2672.73,1990.62,11845.41,813.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 25071","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",25071,"EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/>",null,3254,2309.9699999999998,1990.62,11845.41,813.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 25073","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",25073,"HC  EXC TUMOR SFT TISS FOREARM&//WRIST SUBFASC 3+CM",null,2858,4621.25,1990.62,11845.41,714.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 25073","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",25073,"HC  EXC TUMOR SFT TISS FOREARM&//WRIST SUBFASC 3+CM",null,2858,4621.25,1990.62,11845.41,714.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 25075","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",25075,"EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM",null,2428,2309.9699999999998,1500.85,7703.8,607,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 25076","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",25076,"EXC FOREARM TUM DEEP < 3 CM",null,2041,11845.41,1990.62,11845.41,510.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 25111","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",25111,"EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY",null,2450,2551.96,1990.62,11845.41,612.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 25111","TUFTS","TUFTS SELECT","CPT",25111,"EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY",null,2450,3987.49,1990.62,11845.41,612.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 25111","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",25111,"EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY",null,2450,2205.59,1990.62,11845.41,612.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 25112","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",25112,"EXCISION GANGLION WRIST DORSAL/VOLAR RECURRENT",null,4070,2205.59,2166.09,11845.41,1017.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 25112","BLUE CROSS","BLUE CROSS-PPO","CPT",25112,"EXCISION GANGLION WRIST DORSAL/VOLAR RECURRENT",null,4070,2205.59,2166.09,11845.41,1017.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 25116","TUFTS","TUFTS POS","CPT",25116,"RAD EXCIS WRIST SYNOV/TENDON,EXTEN",null,1528,7467.76,2166.09,11845.41,382,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 25116","TUFTS","TUFTS SELECT","CPT",25116,"RAD EXCIS WRIST SYNOV/TENDON,EXTEN",null,1528,3987.49,2166.09,11845.41,382,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 25116","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",25116,"RAD EXCIS WRIST SYNOV/TENDON,EXTEN",null,1528,4405.5600000000004,2166.09,11845.41,382,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 25246","TUFTS","TUFTS POS","CPT",25246,"HC INJECTION WRIST ARTHROGRAPHY",null,559,0,185.4,1198.25,139.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 25246","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",25246,"HC INJECTION WRIST ARTHROGRAPHY",null,559,185.4,185.4,1198.25,139.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 25246","BLUE CROSS","BLUE CROSS-PPO","CPT",25246,"HC INJECTION WRIST ARTHROGRAPHY",null,559,185.4,185.4,1198.25,139.75,1]
["OUTPATIENT","AETNA - AETNA - CPT - 25248","AETNA","AETNA","CPT",25248,"HC REMOVE FOREARM/WRIST FOREIGN BODY",null,2026,1500.85,1500.85,7703.8,506.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 25500","TUFTS","TUFTS SELECT","CPT",25500,"CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION",null,1908,317.70999999999998,317.70999999999998,1198.25,477,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 25500","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",25500,"CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION",null,1908,378,317.70999999999998,1198.25,477,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 25500","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",25500,"CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION",null,1908,378,317.70999999999998,1198.25,477,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 25505","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",25505,"CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION",null,3521,2551.96,1098.98,3264.67,880.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 25505","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",25505,"CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION",null,3521,2205.59,1098.98,3264.67,880.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 25520","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",25520,"HC CLOSED RX RADIAL SHAFT FX W/DISLOCATION",null,2026,2489.31,1198.25,7703.8,506.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 25520","AETNA","AETNA","CPT",25520,"HC CLOSED RX RADIAL SHAFT FX W/DISLOCATION",null,2026,1198.25,1198.25,7703.8,506.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 25520","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",25520,"HC CLOSED RX RADIAL SHAFT FX W/DISLOCATION",null,2026,2205.59,1198.25,7703.8,506.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 25530","AETNA","AETNA","CPT",25530,"CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION",null,1808,1198.25,317.70999999999998,1198.25,452,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 25535","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",25535,"CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION",null,3469,3264.67,378,3264.67,867.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 25535","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",25535,"CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION",null,3469,378,378,3264.67,867.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 25560","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",25560,"CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MAN",null,1903,474.04,317.70999999999998,1198.25,475.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 25565","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",25565,"CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ",null,3607,2551.96,1500.85,7703.8,901.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 25565","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",25565,"CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ",null,3607,2205.59,1500.85,7703.8,901.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 25600","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",25600,"CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ",null,2371,378,317.70999999999998,1198.25,592.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 25606","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",25606,"HC TREAT FX DISTAL RADIAL",null,4233,11845.41,1990.62,11845.41,1058.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 25622","TUFTS","TUFTS HMO","CPT",25622,"CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ",null,2123,595.01,317.70999999999998,943.8,530.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 25622","TUFTS","TUFTS POS","CPT",25622,"CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ",null,2123,595.01,317.70999999999998,943.8,530.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 25622","TUFTS","TUFTS SELECT","CPT",25622,"CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ",null,2123,317.70999999999998,317.70999999999998,943.8,530.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 25624","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",25624,"CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ",null,3297,2205.59,1500.85,7703.8,824.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 25624","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",25624,"CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ",null,3297,2205.59,1500.85,7703.8,824.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 25635","TUFTS","TUFTS PPO","CPT",25635,"CLTX CARPAL BONE FX W/MANJ EACH BONE",null,3159,2058.16,1098.98,3264.67,789.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 25635","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",25635,"CLTX CARPAL BONE FX W/MANJ EACH BONE",null,3159,2205.59,1098.98,3264.67,789.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 25635","BLUE CROSS","BLUE CROSS-PPO","CPT",25635,"CLTX CARPAL BONE FX W/MANJ EACH BONE",null,3159,2205.59,1098.98,3264.67,789.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 25650","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",25650,"CLOSED TREATMENT ULNAR STYLOID FRACTURE",null,2305,485.97,317.70999999999998,943.8,576.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 25650","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",25650,"CLOSED TREATMENT ULNAR STYLOID FRACTURE",null,2305,943.8,317.70999999999998,943.8,576.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 25650","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",25650,"CLOSED TREATMENT ULNAR STYLOID FRACTURE",null,2305,485.97,317.70999999999998,943.8,576.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 25650","TUFTS","TUFTS HMO","CPT",25650,"CLOSED TREATMENT ULNAR STYLOID FRACTURE",null,2305,595.01,317.70999999999998,943.8,576.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 25660","TUFTS","TUFTS PPO","CPT",25660,"CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MANJ",null,325,2058.16,378,3264.67,81.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 25660","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",25660,"CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MANJ",null,325,378,378,3264.67,81.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 25675","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",25675,"CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ",null,325,485.97,378,3264.67,81.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 25675","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",25675,"CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ",null,325,378,378,3264.67,81.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 25680","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",25680,"HC CLOSED RX NAVIC/LUNATE FX/DISLOC",null,321,378,378,7703.8,80.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 25680","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",25680,"HC CLOSED RX NAVIC/LUNATE FX/DISLOC",null,321,378,378,7703.8,80.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 26010","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",26010,"DRAINAGE FINGER ABSCESS SIMPLE",null,1058,943.8,296.32,943.8,264.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 26010","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",26010,"DRAINAGE FINGER ABSCESS SIMPLE",null,1058,296.32,296.32,943.8,264.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 26010","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",26010,"DRAINAGE FINGER ABSCESS SIMPLE",null,1058,296.32,296.32,943.8,264.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 26011","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",26011,"DRAINAGE FINGER ABSCESS COMPLICATED",null,1418,2607.12,1098.98,3264.67,354.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 26011","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",26011,"DRAINAGE FINGER ABSCESS COMPLICATED",null,1418,3264.67,1098.98,3264.67,354.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 26011","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",26011,"DRAINAGE FINGER ABSCESS COMPLICATED",null,1418,2672.73,1098.98,3264.67,354.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 26011","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",26011,"DRAINAGE FINGER ABSCESS COMPLICATED",null,1418,2309.9699999999998,1098.98,3264.67,354.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 26011","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",26011,"DRAINAGE FINGER ABSCESS COMPLICATED",null,1418,2309.9699999999998,1098.98,3264.67,354.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 26011","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",26011,"DRAINAGE FINGER ABSCESS COMPLICATED",null,1418,2309.9699999999998,1098.98,3264.67,354.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 26055","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",26055,"TENDON SHEATH INCISION",null,2377,2551.96,1500.85,7703.8,594.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 26055","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",26055,"TENDON SHEATH INCISION",null,2377,2205.59,1500.85,7703.8,594.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 26055","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",26055,"TENDON SHEATH INCISION",null,2377,2205.59,1500.85,7703.8,594.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 26060","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",26060,"HC INCIS PERCUT FINGER TENDON,SINGLE,EA",null,3045,2551.96,1500.85,7703.8,761.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 26060","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",26060,"HC INCIS PERCUT FINGER TENDON,SINGLE,EA",null,3045,2551.96,1500.85,7703.8,761.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 26060","BLUE CROSS","BLUE CROSS-PPO","CPT",26060,"HC INCIS PERCUT FINGER TENDON,SINGLE,EA",null,3045,2205.59,1500.85,7703.8,761.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 26111","TUFTS","TUFTS POS","CPT",26111,"HC EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5+CM",null,4001,7467.76,1990.62,11845.41,1000.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 26111","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",26111,"HC EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5+CM",null,4001,2309.9699999999998,1990.62,11845.41,1000.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 26111","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",26111,"HC EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5+CM",null,4001,2309.9699999999998,1990.62,11845.41,1000.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 26113","AETNA","AETNA","CPT",26113,"EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5CM/>",null,4200,1990.62,1990.62,11845.41,1050,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 26115","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",26115,"EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM",null,2545,7703.8,1500.85,7703.8,636.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 26116","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",26116,"EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM",null,4035,2672.73,1500.85,7703.8,1008.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 26160","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",26160,"EXC LES TDN SHTH/JT CAPSL HAND/FNGR",null,2559,11845.41,1990.62,11845.41,639.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 26160","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",26160,"EXC LES TDN SHTH/JT CAPSL HAND/FNGR",null,2559,2205.59,1990.62,11845.41,639.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 26236","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",26236,"HC PR PART REMV BONE,DISTAL PHALANX",null,1975,2205.59,1990.62,11845.41,493.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 26236","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",26236,"HC PR PART REMV BONE,DISTAL PHALANX",null,1975,2205.59,1990.62,11845.41,493.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 26341","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",26341,"MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD",null,567,378,378,2032.26,141.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 26341","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",26341,"MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD",null,567,378,378,2032.26,141.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 26410","TUFTS","TUFTS SELECT","CPT",26410,"HC REPAIR EXTEN TENDON,DORSUM HAND,EA",null,2026,3987.49,1990.62,11845.41,506.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 26418","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",26418,"HC REPAIR EXTEN TENDON,DORSUM FINGER,EA",null,3693,2489.31,2166.09,11845.41,923.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 26418","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",26418,"HC REPAIR EXTEN TENDON,DORSUM FINGER,EA",null,3693,2205.59,2166.09,11845.41,923.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 26418","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",26418,"HC REPAIR EXTEN TENDON,DORSUM FINGER,EA",null,3693,2205.59,2166.09,11845.41,923.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 26432","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",26432,"CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING",null,3772,2489.31,1990.62,11845.41,943,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 26432","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",26432,"CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING",null,3772,11845.41,1990.62,11845.41,943,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 26432","TUFTS","TUFTS SELECT","CPT",26432,"CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING",null,3772,3987.49,1990.62,11845.41,943,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 26432","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",26432,"CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING",null,3772,2205.59,1990.62,11845.41,943,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 26432","BLUE CROSS","BLUE CROSS-PPO","CPT",26432,"CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING",null,3772,2205.59,1990.62,11845.41,943,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 26535","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",26535,"HC ARTHROPLASTY I-P JT",null,3781,5097.42,2354.5,15242.01,945.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 26535","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",26535,"HC ARTHROPLASTY I-P JT",null,3781,4405.5600000000004,2354.5,15242.01,945.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 26535","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",26535,"HC ARTHROPLASTY I-P JT",null,3781,4405.5600000000004,2354.5,15242.01,945.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 26535","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",26535,"HC ARTHROPLASTY I-P JT",null,3781,4405.5600000000004,2354.5,15242.01,945.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 26600","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",26600,"CLTX METACARPAL FX W/O MANIPULATION EACH BONE",null,2120,485.97,317.70999999999998,943.8,530,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 26600","TUFTS","TUFTS POS","CPT",26600,"CLTX METACARPAL FX W/O MANIPULATION EACH BONE",null,2120,595.01,317.70999999999998,943.8,530,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 30903","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",30903,"CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX",null,621,229.89,178.83,1198.25,155.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 30903","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",30903,"CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX",null,621,229.89,178.83,1198.25,155.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 30903","TUFTS","TUFTS HMO","CPT",30903,"CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX",null,621,358.22,178.83,1198.25,155.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 30903","TUFTS","TUFTS POS","CPT",30903,"CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX",null,621,358.22,178.83,1198.25,155.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 30903","AETNA","AETNA","CPT",30903,"CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX",null,621,1198.25,178.83,1198.25,155.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 30903","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",30903,"CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX",null,621,178.83,178.83,1198.25,155.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 30905","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",30905,"CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST",null,781,3264.67,178.83,3264.67,195.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 30905","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",30905,"CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST",null,781,178.83,178.83,3264.67,195.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 30906","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",30906,"CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ",null,280,346.18,346.18,3264.67,70,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 30906","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",30906,"CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ",null,280,346.18,346.18,3264.67,70,1]
["OUTPATIENT","AETNA - AETNA - CPT - 30930","AETNA","AETNA","CPT",30930,"HC THER FX NASAL INF TURBINATE",null,4030,2166.09,2166.09,7703.8,1007.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 31231","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",31231,"NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX",null,598,354.01,275.37,1500.85,149.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 31231","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",31231,"NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX",null,598,275.37,275.37,1500.85,149.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 31237","TUFTS","TUFTS PPO","CPT",31237,"NASAL/SINUS NDSC SURG W/BX POLYPECT/DBRDMT SPX",null,2091,4856.75,1500.85,7703.8,522.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 31238","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",31238,"NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMRRG",null,2091,2660.67,1098.98,3264.67,522.75,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 31238","TUFTS","TUFTS HMO","CPT",31238,"NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMRRG",null,2091,2057.7399999999998,1098.98,3264.67,522.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 31238","BLUE CROSS","BLUE CROSS-PPO","CPT",31238,"NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMRRG",null,2091,2299.54,1098.98,3264.67,522.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 31239","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",31239,"HC NASAL/SINUS ENDOSCOPY SURG",null,4562,11845.41,2166.09,11845.41,1140.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 31239","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",31239,"HC NASAL/SINUS ENDOSCOPY SURG",null,4562,4602.58,2166.09,11845.41,1140.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 31239","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",31239,"HC NASAL/SINUS ENDOSCOPY SURG",null,4562,4602.58,2166.09,11845.41,1140.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 31239","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",31239,"HC NASAL/SINUS ENDOSCOPY SURG",null,4562,4602.58,2166.09,11845.41,1140.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 31256","TUFTS","TUFTS PPO","CPT",31256,"HC EXPLORATION MAXILLARY SINUS",null,4562,4856.75,1990.62,7703.8,1140.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 31500","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",31500,"HC INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE",null,840,1130.24,346.18,1198.25,210,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 31502","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",31502,"TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT",null,270,445.06,317.70999999999998,1198.25,67.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 31502","TUFTS","TUFTS PPO","CPT",31502,"TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT",null,270,595.01,317.70999999999998,1198.25,67.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 31505","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",31505,"LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX",null,383,275.37,275.37,943.8,95.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 31505","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",31505,"LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX",null,383,275.37,275.37,943.8,95.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 31505","BLUE CROSS","BLUE CROSS-PPO","CPT",31505,"LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX",null,383,275.37,275.37,943.8,95.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 31510","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",31510,"HC LARYNGOSCOPY,INDIRECT WITH BIOPSY",null,4562,5325.37,1500.85,7703.8,1140.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 31510","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",31510,"HC LARYNGOSCOPY,INDIRECT WITH BIOPSY",null,4562,5325.37,1500.85,7703.8,1140.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 31510","AETNA","AETNA","CPT",31510,"HC LARYNGOSCOPY,INDIRECT WITH BIOPSY",null,4562,1500.85,1500.85,7703.8,1140.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 31510","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",31510,"HC LARYNGOSCOPY,INDIRECT WITH BIOPSY",null,4562,4602.58,1500.85,7703.8,1140.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 31511","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",31511,"HC LARYNGOSCOPY,INDIRECT+REMV FOR.BODY",null,234,275.37,275.37,2032.26,58.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 31511","BLUE CROSS","BLUE CROSS-PPO","CPT",31511,"HC LARYNGOSCOPY,INDIRECT+REMV FOR.BODY",null,234,275.37,275.37,2032.26,58.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 31525","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",31525,"HC LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN",null,2091,2595.35,1098.98,3264.67,522.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 31525","TUFTS","TUFTS SELECT","CPT",31525,"HC LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN",null,2091,1098.98,1098.98,3264.67,522.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 31525","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",31525,"HC LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN",null,2091,2299.54,1098.98,3264.67,522.75,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 31530","TUFTS","TUFTS HMO","CPT",31530,"HC LARYNGOSCOPY,DIRCT,OP,F.B. REMVL",null,2128,4856.75,1500.85,7703.8,532,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 31552","TUFTS","TUFTS HMO","CPT",31552,"HC LARYNGOPLASTY LARYNGEAL STEN W/O STENT 12 YRS>",null,6641,9609.09,2354.5,15242.01,1660.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 31570","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",31570,"HC LARYNGOSCOPY,DIRCT,INJ VOCAL CORD",null,4112,4602.58,1500.85,7703.8,1028,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 31571","TUFTS","TUFTS SELECT","CPT",31571,"LARGSC W/NJX VOCAL CORD THER W/MICRO/TELESCOPE",null,3233,2593.31,1500.85,7703.8,808.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 31572","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",31572,"HC LARYNGOSCOPY FLEXIBLE ABLATJ DESTJ LESION(S) UNI",null,3233,7703.8,1500.85,7703.8,808.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 31572","AETNA","AETNA","CPT",31572,"HC LARYNGOSCOPY FLEXIBLE ABLATJ DESTJ LESION(S) UNI",null,3233,1500.85,1500.85,7703.8,808.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 31572","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",31572,"HC LARYNGOSCOPY FLEXIBLE ABLATJ DESTJ LESION(S) UNI",null,3233,4602.58,1500.85,7703.8,808.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 31573","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",31573,"HC LARYNGOSCOPY FLEXIBLE THERAPEUTIC INJECTION UNI",null,2069,2299.54,1500.85,7703.8,517.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 31573","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",31573,"HC LARYNGOSCOPY FLEXIBLE THERAPEUTIC INJECTION UNI",null,2069,2299.54,1500.85,7703.8,517.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 31574","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",31574,"HC LARYNGOSCOPY FLEXIBLE W/INJECTION AGMNTJ UNI",null,2056,2299.54,1500.85,7703.8,514,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 31574","BLUE CROSS","BLUE CROSS-PPO","CPT",31574,"HC LARYNGOSCOPY FLEXIBLE W/INJECTION AGMNTJ UNI",null,2056,2299.54,1500.85,7703.8,514,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 31576","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",31576,"LARYNGOSCOPY FLEXIBLE FIBEROPTIC W/BIOPSY",null,2091,2660.67,1500.85,7703.8,522.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 31576","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",31576,"LARYNGOSCOPY FLEXIBLE FIBEROPTIC W/BIOPSY",null,2091,2299.54,1500.85,7703.8,522.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 31578","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",31578,"LARYNGOSCOPY FLEXIBLE FIBEROPTIC REMOVAL LESION",null,2091,5194.6400000000003,1500.85,7703.8,522.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 31578","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",31578,"LARYNGOSCOPY FLEXIBLE FIBEROPTIC REMOVAL LESION",null,2091,7703.8,1500.85,7703.8,522.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 31578","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",31578,"LARYNGOSCOPY FLEXIBLE FIBEROPTIC REMOVAL LESION",null,2091,4602.58,1500.85,7703.8,522.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 31579","TUFTS","TUFTS PPO","CPT",31579,"LARYNGOSCOPY FLX/RGD FIBOPT W/STROBOSCOPY",null,1103,1281.21,649.07000000000005,2032.26,275.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 31579","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",31579,"LARYNGOSCOPY FLX/RGD FIBOPT W/STROBOSCOPY",null,1103,649.07000000000005,649.07000000000005,2032.26,275.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 31579","BLUE CROSS","BLUE CROSS-PPO","CPT",31579,"LARYNGOSCOPY FLX/RGD FIBOPT W/STROBOSCOPY",null,1103,649.07000000000005,649.07000000000005,2032.26,275.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 31599","TUFTS","TUFTS PPO","CPT",31599,"SML WITH EXCISION OF TRACHEAL/SUBGLOTTIC STENOSIS",null,2964,595.01,317.70999999999998,1198.25,741,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 31603","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",31603,"HC TRACHEOSTOMY,EMERG,XTRACH",null,2007,2148.08,1098.98,3264.67,501.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 31605","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",31605,"HC TRACHEOSTOMY,EMERG,CRICOTHYROID",null,254,445.06,346.18,3264.67,63.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 31605","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",31605,"HC TRACHEOSTOMY,EMERG,CRICOTHYROID",null,254,346.18,346.18,3264.67,63.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 31611","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",31611,"CONSTJ TRACHEOESOPHGL FSTL&INSJ SP PROSTH",null,4242,3747.12,1990.62,11845.41,1060.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 31611","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",31611,"CONSTJ TRACHEOESOPHGL FSTL&INSJ SP PROSTH",null,4242,3747.12,1990.62,11845.41,1060.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 31613","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",31613,"TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION",null,3197,4229.1400000000003,1500.85,7703.8,799.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 31613","TUFTS","TUFTS HMO","CPT",31613,"TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION",null,3197,4856.75,1500.85,7703.8,799.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 31613","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",31613,"TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION",null,3197,3747.12,1500.85,7703.8,799.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 31615","TUFTS","TUFTS HMO","CPT",31615,"TRACHEOBRNCHSC THRU EST TRACHS INC",null,998,2057.7399999999998,818.07,3264.67,249.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 31615","TUFTS","TUFTS SELECT","CPT",31615,"TRACHEOBRNCHSC THRU EST TRACHS INC",null,998,1098.98,818.07,3264.67,249.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 31615","AETNA","AETNA","CPT",31615,"TRACHEOBRNCHSC THRU EST TRACHS INC",null,998,1198.25,818.07,3264.67,249.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 31615","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",31615,"TRACHEOBRNCHSC THRU EST TRACHS INC",null,998,818.07,818.07,3264.67,249.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 31622","TUFTS","TUFTS POS","CPT",31622,"BRNCHSC INCL FLUOR GID DX W/CELL WASHG SPX",null,1637,2058.17,1098.98,3264.67,409.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 31622","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",31622,"BRNCHSC INCL FLUOR GID DX W/CELL WASHG SPX",null,1637,2299.54,1098.98,3264.67,409.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 31622","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",31622,"BRNCHSC INCL FLUOR GID DX W/CELL WASHG SPX",null,1637,2299.54,1098.98,3264.67,409.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 31624","AETNA","AETNA","CPT",31624,"BRNCHSC W/BRNCL ALVEOLAR LAVAGE",null,1637,1500.85,1098.98,3264.67,409.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 31624","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",31624,"BRNCHSC W/BRNCL ALVEOLAR LAVAGE",null,1637,2299.54,1098.98,3264.67,409.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 31625","BLUE CROSS","BLUE CROSS-PPO","CPT",31625,"BRONCHOSCOPY BRONCHIAL/ENDOBRNCL BX 1+ SITES",null,1637,2299.54,1500.85,7703.8,409.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 31626","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",31626,"HC BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT",null,8573,9756.7000000000007,1990.62,10002.24,2143.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 31626","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",31626,"HC BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT",null,8573,10002.24,1990.62,10002.24,2143.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 31626","TUFTS","TUFTS POS","CPT",31626,"HC BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT",null,8573,4856.75,1990.62,10002.24,2143.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 31626","TUFTS","TUFTS PPO","CPT",31626,"HC BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT",null,8573,4856.75,1990.62,10002.24,2143.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 31626","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",31626,"HC BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT",null,8573,8644.68,1990.62,10002.24,2143.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 31626","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",31626,"HC BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT",null,8573,8644.68,1990.62,10002.24,2143.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 31628","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",31628,"BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX 1 LOBE",null,1449,5325.37,1500.85,7703.8,362.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 31628","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",31628,"BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX 1 LOBE",null,1449,4602.58,1500.85,7703.8,362.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 31629","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",31629,"HC BRONCHOSCOPY NEEDLE BX TRACHEA MAIN STEM&/BRON",null,3439,5325.37,1500.85,7703.8,859.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 31629","TUFTS","TUFTS PPO","CPT",31629,"HC BRONCHOSCOPY NEEDLE BX TRACHEA MAIN STEM&/BRON",null,3439,4856.75,1500.85,7703.8,859.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 31630","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",31630,"HC BRONCHOSCOPY,TRACH/BRONCH DILATN",null,4368,5325.37,1500.85,7703.8,1092,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 31630","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",31630,"HC BRONCHOSCOPY,TRACH/BRONCH DILATN",null,4368,4602.58,1500.85,7703.8,1092,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 31632","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",31632,"HC BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE",null,378,0,120.16,1500.85,94.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 31632","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",31632,"HC BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE",null,378,0,120.16,1500.85,94.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 31632","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",31632,"HC BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE",null,378,0,120.16,1500.85,94.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 31632","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",31632,"HC BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE",null,378,120.16,120.16,1500.85,94.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 31635","AETNA","AETNA","CPT",31635,"HC BRONCHOSCOPY W/REMOVAL FOREIGN BODY",null,1445,1500.85,1500.85,7703.8,361.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 31640","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",31640,"HC BRONCHOSCOPY,EXCIS LESN",null,4368,5194.6400000000003,1500.85,7703.8,1092,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 31640","TUFTS","TUFTS HMO","CPT",31640,"HC BRONCHOSCOPY,EXCIS LESN",null,4368,4856.75,1500.85,7703.8,1092,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 31645","TUFTS","TUFTS POS","CPT",31645,"HC BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE 1ST",null,1637,2058.17,1098.98,3264.67,409.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 31646","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",31646,"HC BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE SBSQ",null,1637,813.97,649.07000000000005,3264.67,409.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 31646","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",31646,"HC BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE SBSQ",null,1637,834.45,649.07000000000005,3264.67,409.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 31646","TUFTS","TUFTS HMO","CPT",31646,"HC BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE SBSQ",null,1637,2057.7399999999998,649.07000000000005,3264.67,409.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 31646","BLUE CROSS","BLUE CROSS-PPO","CPT",31646,"HC BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE SBSQ",null,1637,649.07000000000005,649.07000000000005,3264.67,409.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 31652","TUFTS","TUFTS SELECT","CPT",31652,"HC BRNCHSC EBUS GUIDED SAMPL 1/2 NODE STATION/STRUX",null,3928,5730.6,1500.85,17023.61,982,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 31652","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",31652,"HC BRNCHSC EBUS GUIDED SAMPL 1/2 NODE STATION/STRUX",null,3928,4602.58,1500.85,17023.61,982,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 31652","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",31652,"HC BRNCHSC EBUS GUIDED SAMPL 1/2 NODE STATION/STRUX",null,3928,4602.58,1500.85,17023.61,982,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 31653","TUFTS","TUFTS POS","CPT",31653,"HC BRONCH EBUS SAMPLING 3 OR MORE NODES",null,2800,10732.28,1500.85,17023.61,700,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 31653","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",31653,"HC BRONCH EBUS SAMPLING 3 OR MORE NODES",null,2800,4602.58,1500.85,17023.61,700,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 31820","TUFTS","TUFTS POS","CPT",31820,"HC SURG CLOSURE TRACH/FISTULA",null,3301,2058.17,1098.98,4335.57,825.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 31820","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",31820,"HC SURG CLOSURE TRACH/FISTULA",null,3301,3747.12,1098.98,4335.57,825.25,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 32160","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT",32160,"HC THORACOTOMY W/CARDIAC MASSAGE",null,6063,0,1983.09,7703.8,1515.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 32160","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",32160,"HC THORACOTOMY W/CARDIAC MASSAGE",null,6063,1983.09,1983.09,7703.8,1515.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 32400","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",32400,"HC BIOPSY PLEURA PERCUTANEOUS NEEDLE",null,1304,2309.9699999999998,1098.98,3264.67,326,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 32405","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",32405,"HC BIOPSY LUNG/MEDIASTINUM PERCUTANEOUS NEEDLE",null,1284,2672.73,1098.98,3264.67,321,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 32550","TUFTS","TUFTS PPO","CPT",32550,"HC INS TUNN PLEURAL CATH W/U",null,4154,4856.75,1500.85,7703.8,1038.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 32550","AETNA","AETNA","CPT",32550,"HC INS TUNN PLEURAL CATH W/U",null,4154,1500.85,1500.85,7703.8,1038.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 32550","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",32550,"HC INS TUNN PLEURAL CATH W/U",null,4154,4949.6400000000003,1500.85,7703.8,1038.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 32550","BLUE CROSS","BLUE CROSS-PPO","CPT",32550,"HC INS TUNN PLEURAL CATH W/U",null,4154,4949.6400000000003,1500.85,7703.8,1038.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 32551","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",32551,"TUBE THORACOSTOMY INCLUDES WATER SEAL",null,1299,1836.61,1500.85,7703.8,324.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 32552","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",32552,"HC REMOVAL OF LUNG CATHETER",null,1299,1338.6,1041.23,3264.67,324.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 32552","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",32552,"HC REMOVAL OF LUNG CATHETER",null,1299,1041.23,1041.23,3264.67,324.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 32552","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",32552,"HC REMOVAL OF LUNG CATHETER",null,1299,1041.23,1041.23,3264.67,324.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 32553","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",32553,"HC PLMT NTRSTL DEV RADJ THX GID PRQ INTRATHRC 1/MLT",null,1590,2573.36,1198.25,7703.8,397.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 32553","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",32553,"HC PLMT NTRSTL DEV RADJ THX GID PRQ INTRATHRC 1/MLT",null,1590,2001.68,1198.25,7703.8,397.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 32553","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",32553,"HC PLMT NTRSTL DEV RADJ THX GID PRQ INTRATHRC 1/MLT",null,1590,2001.68,1198.25,7703.8,397.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 32554","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",32554,"THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING",null,836,1041.23,1041.23,3264.67,209,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 32555","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",32555,"THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING",null,836,1338.6,1041.23,3264.67,209,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 32555","TUFTS","TUFTS POS","CPT",32555,"THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING",null,836,2058.17,1041.23,3264.67,209,1]
["OUTPATIENT","AETNA - AETNA - CPT - 32555","AETNA","AETNA","CPT",32555,"THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING",null,836,1198.25,1041.23,3264.67,209,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 32555","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",32555,"THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING",null,836,1041.23,1041.23,3264.67,209,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 32556","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",32556,"PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING",null,836,2882.31,1098.98,3264.67,209,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 32556","TUFTS","TUFTS POS","CPT",32556,"PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING",null,836,2058.17,1098.98,3264.67,209,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 32556","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",32556,"PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING",null,836,2491.1,1098.98,3264.67,209,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 32994","TUFTS","TUFTS HMO","CPT",32994,"HC ABLATION THER 1+ PULM TUMORS PREQ CRYOABLATION",null,1343,9609.09,2166.09,15242.01,335.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 32994","TUFTS","TUFTS PPO","CPT",32994,"HC ABLATION THER 1+ PULM TUMORS PREQ CRYOABLATION",null,1343,9609.09,2166.09,15242.01,335.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 32994","TUFTS","TUFTS SELECT","CPT",32994,"HC ABLATION THER 1+ PULM TUMORS PREQ CRYOABLATION",null,1343,5130.87,2166.09,15242.01,335.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 32994","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",32994,"HC ABLATION THER 1+ PULM TUMORS PREQ CRYOABLATION",null,1343,7718.14,2166.09,15242.01,335.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 32994","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",32994,"HC ABLATION THER 1+ PULM TUMORS PREQ CRYOABLATION",null,1343,7718.14,2166.09,15242.01,335.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 32998","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",32998,"HC ABLATION PULMONARY TUMOR PERQ RADIOFREQUENCY UNI",null,7058,8930.2099999999991,2166.09,15242.01,1764.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 32998","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",32998,"HC ABLATION PULMONARY TUMOR PERQ RADIOFREQUENCY UNI",null,7058,7718.14,2166.09,15242.01,1764.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 32999","TUFTS","TUFTS SELECT","CPT",32999,"CHEST TUBE REPOSITIONING AND REPLACEMENT",null,770,684.11,684.11,2032.26,192.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 33011","TUFTS","TUFTS SELECT","CPT",33011,"PERICARDIOCEN SUBQ",null,1645,1098.98,1098.98,3264.67,411.25,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 33015","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT",33015,"TUBE PERICARDIOSTOMY",null,3850,0,3987.49,11845.41,962.5,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MEDICAID - CPT - 33015","BMC HEALTHNET","BMCHN MEDICAID","CPT",33015,"TUBE PERICARDIOSTOMY",null,3850,0,3987.49,11845.41,962.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 33016","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",33016,"HC PERICARDIOCENTESIS W/IMAGING",null,2070,2303.1799999999998,1500.85,7703.8,517.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 33016","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",33016,"HC PERICARDIOCENTESIS W/IMAGING",null,2070,2361.15,1500.85,7703.8,517.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 33016","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",33016,"HC PERICARDIOCENTESIS W/IMAGING",null,2070,7703.8,1500.85,7703.8,517.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 33016","BLUE CROSS","BLUE CROSS-PPO","CPT",33016,"HC PERICARDIOCENTESIS W/IMAGING",null,2070,2625.22,1500.85,7703.8,517.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 33206","TUFTS","TUFTS PPO","CPT",33206,"HC INS NEW/RPLCMT PRM PACEMAKR W/TRANS ELTRD ATRIAL",null,10670,23407.53,2531.06,37129.18,2667.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 33206","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",33206,"HC INS NEW/RPLCMT PRM PACEMAKR W/TRANS ELTRD ATRIAL",null,10670,16591.07,2531.06,37129.18,2667.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 33207","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",33207,"HC INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR",null,10670,16591.07,2531.06,31200.07,2667.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 33208","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",33208,"HC INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT",null,10670,16591.07,2531.06,31200.07,2667.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 33210","BLUE CROSS","BLUE CROSS-PPO","CPT",33210,"HC INSJ/RPLCMT TEMP TRANSVNS 1CHMBR ELTRD/PM CATH",null,7357,12434.24,2166.09,25611.61,1839.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 33210","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",33210,"HC INSJ/RPLCMT TEMP TRANSVNS 1CHMBR ELTRD/PM CATH",null,7357,12434.24,2166.09,25611.61,1839.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 33213","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",33213,"HC INS PACEMAKER PULSE GEN ONLY W/EXIST DUAL LEADS",null,10670,13864.17,1990.62,37129.18,2667.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 33213","TUFTS","TUFTS PPO","CPT",33213,"HC INS PACEMAKER PULSE GEN ONLY W/EXIST DUAL LEADS",null,10670,23407.53,1990.62,37129.18,2667.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 33213","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",33213,"HC INS PACEMAKER PULSE GEN ONLY W/EXIST DUAL LEADS",null,10670,16591.07,1990.62,37129.18,2667.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 33213","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",33213,"HC INS PACEMAKER PULSE GEN ONLY W/EXIST DUAL LEADS",null,10670,16591.07,1990.62,37129.18,2667.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 33214","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",33214,"HC UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS",null,10670,13864.17,2531.06,37129.18,2667.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 33214","TUFTS","TUFTS PPO","CPT",33214,"HC UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS",null,10670,23407.53,2531.06,37129.18,2667.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 33214","TUFTS","TUFTS SELECT","CPT",33214,"HC UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS",null,10670,12498.68,2531.06,37129.18,2667.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 33214","AETNA","AETNA","CPT",33214,"HC UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS",null,10670,2531.06,2531.06,37129.18,2667.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 33215","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",33215,"HC RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE",null,2275,3264.67,1098.98,5132.74,568.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 33215","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",33215,"HC RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE",null,2275,4436.09,1098.98,5132.74,568.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 33215","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",33215,"HC RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE",null,2275,4436.09,1098.98,5132.74,568.75,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 33216","TUFTS","TUFTS HMO","CPT",33216,"HC INSJ 1 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB",null,7357,19666.71,2166.09,31200.07,1839.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 33216","AETNA","AETNA","CPT",33216,"HC INSJ 1 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB",null,7357,2166.09,2166.09,31200.07,1839.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 33216","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",33216,"HC INSJ 1 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB",null,7357,12434.24,2166.09,31200.07,1839.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 33217","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",33217,"HC INSJ 2 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB",null,7357,31200.07,2166.09,31200.07,1839.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 33217","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",33217,"HC INSJ 2 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB",null,7357,12434.24,2166.09,31200.07,1839.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 33221","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",33221,"HC INS PACEMAKER PULSE GEN ONLY W/EXIST MULT LEADS",null,18441,24809.85,1990.62,62742.78,4610.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 33221","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",33221,"HC INS PACEMAKER PULSE GEN ONLY W/EXIST MULT LEADS",null,18441,29689.62,1990.62,62742.78,4610.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 33221","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",33221,"HC INS PACEMAKER PULSE GEN ONLY W/EXIST MULT LEADS",null,18441,29689.62,1990.62,62742.78,4610.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 33223","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",33223,"HC RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR",null,3089,3262.11,1098.98,3344.2,772.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 33223","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",33223,"HC RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR",null,3089,3344.2,1098.98,3344.2,772.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 33223","AETNA","AETNA","CPT",33223,"HC RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR",null,3089,1500.85,1098.98,3344.2,772.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 33224","AETNA","AETNA","CPT",33224,"HC INSJ ELTRD CAR VEN SYS ATTCH PREV PM/DFB PLS GEN",null,10670,1990.62,1098.98,16591.07,2667.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 33224","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",33224,"HC INSJ ELTRD CAR VEN SYS ATTCH PREV PM/DFB PLS GEN",null,10670,16591.07,1098.98,16591.07,2667.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 33225","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",33225,"HC INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN",null,3408,0,1173.46,2166.09,852,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 33225","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",33225,"HC INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN",null,3408,1173.46,1173.46,2166.09,852,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 33226","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",33226,"HC RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD",null,3654,4436.09,1098.98,5132.74,913.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 33226","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",33226,"HC RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD",null,3654,4436.09,1098.98,5132.74,913.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 33227","AETNA","AETNA","CPT",33227,"HC REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD",null,7357,1990.62,1990.62,62742.78,1839.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 33228","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",33228,"HC REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS",null,10670,13864.17,1990.62,62742.78,2667.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 33228","TUFTS","TUFTS SELECT","CPT",33228,"HC REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS",null,10670,21120.9,1990.62,62742.78,2667.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 33228","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",33228,"HC REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS",null,10670,16591.07,1990.62,62742.78,2667.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 33229","BLUE CROSS","BLUE CROSS-PPO","CPT",33229,"HC REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD",null,18441,29689.62,1990.62,62742.78,4610.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 33229","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",33229,"HC REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD",null,18441,29689.62,1990.62,62742.78,4610.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 33231","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",33231,"HC INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST MULTILEADS",null,34636,62742.78,1990.62,62742.78,8659,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 33231","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",33231,"HC INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST MULTILEADS",null,34636,51483.43,1990.62,62742.78,8659,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 33233","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",33233,"HC REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY",null,7357,10390.549999999999,1098.98,12434.24,1839.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 33233","AETNA","AETNA","CPT",33233,"HC REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY",null,7357,1500.85,1098.98,12434.24,1839.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 33233","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",33233,"HC REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY",null,7357,12434.24,1098.98,12434.24,1839.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 33234","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",33234,"HC RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR/VENTR",null,3634,6592.9,1098.98,6758.81,908.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 33234","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",33234,"HC RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR/VENTR",null,3634,6758.81,1098.98,6758.81,908.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 33234","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",33234,"HC RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR/VENTR",null,3634,5257.32,1098.98,6758.81,908.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 33235","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",33235,"HC RMVL TRANSVNS PM ELTRD DUAL LEAD SYS",null,4756,7703.8,2166.09,7703.8,1189,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 33240","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",33240,"HC INSJ IMPLNTBL DEFIB PULSE GEN W/1 EXISTING LD",null,25757,36940.21,2531.06,62742.78,6439.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 33244","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",33244,"HC RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ",null,6372,7703.8,2166.09,7703.8,1593,1]
["OUTPATIENT","AETNA - AETNA - CPT - 33244","AETNA","AETNA","CPT",33244,"HC RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ",null,6372,2166.09,2166.09,7703.8,1593,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 33249","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",33249,"HC INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR",null,34636,43021.64,2531.06,62742.78,8659,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 33249","BLUE CROSS","BLUE CROSS-PPO","CPT",33249,"HC INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR",null,34636,51483.43,2531.06,62742.78,8659,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 33262","TUFTS","TUFTS PPO","CPT",33262,"HC RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD",null,25757,39555.230000000003,1990.62,62742.78,6439.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 33262","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",33262,"HC RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD",null,25757,36940.21,1990.62,62742.78,6439.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 33263","AETNA","AETNA","CPT",33263,"HC RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD",null,25757,1990.62,1990.62,62742.78,6439.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 33264","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",33264,"HC EXCHNG ICD GEN MULTI SYST",null,34636,41965.52,1990.62,62742.78,8659,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 33264","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",33264,"HC EXCHNG ICD GEN MULTI SYST",null,34636,51483.43,1990.62,62742.78,8659,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 33270","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",33270,"INS/RPLCMNT PERM SUBQ IMPLTBL DFB W/SUBQ ELTRD",null,53692,43021.64,1990.62,62742.78,13423,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 33270","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",33270,"INS/RPLCMNT PERM SUBQ IMPLTBL DFB W/SUBQ ELTRD",null,53692,43021.64,1990.62,62742.78,13423,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 33270","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",33270,"INS/RPLCMNT PERM SUBQ IMPLTBL DFB W/SUBQ ELTRD",null,53692,51483.43,1990.62,62742.78,13423,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 29085","TUFTS","TUFTS POS","CPT",29085,"APPLICATION CAST HAND & LOWER FOREARM GAUNTLET",null,516,450.38,226.08,764.24,129,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 29085","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",29085,"APPLICATION CAST HAND & LOWER FOREARM GAUNTLET",null,516,226.08,226.08,764.24,129,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 29086","TUFTS","TUFTS POS","CPT",29086,"HC APPLY CAST,FINGER (CONTRACTURE)",null,203,450.38,226.08,764.24,50.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 29086","TUFTS","TUFTS PPO","CPT",29086,"HC APPLY CAST,FINGER (CONTRACTURE)",null,203,481.81,226.08,764.24,50.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 29086","TUFTS","TUFTS SELECT","CPT",29086,"HC APPLY CAST,FINGER (CONTRACTURE)",null,203,239.79,226.08,764.24,50.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 29105","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",29105,"APPLICATION LONG ARM SPLINT SHOULDER HAND",null,459,290.64,226.08,764.24,114.75,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 29105","TUFTS","TUFTS HMO","CPT",29105,"APPLICATION LONG ARM SPLINT SHOULDER HAND",null,459,450.38,226.08,764.24,114.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 29125","BLUE CROSS","BLUE CROSS-PPO","CPT",29125,"APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC",null,304,178.83,178.83,607.84,76,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 29126","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",29126,"APPLICATION SHORT ARM SPLINT DYNAMIC",null,373,224.25,178.83,607.84,93.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 29126","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",29126,"APPLICATION SHORT ARM SPLINT DYNAMIC",null,373,229.89,178.83,607.84,93.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 29126","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",29126,"APPLICATION SHORT ARM SPLINT DYNAMIC",null,373,178.83,178.83,607.84,93.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 29130","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",29130,"APPLICATION FINGER SPLINT STATIC",null,218,93.87,93.87,317.35000000000002,54.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 29131","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",29131,"APPLICATION FINGER SPLINT DYNAMIC",null,260,120.69,93.87,317.35000000000002,65,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 29131","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",29131,"APPLICATION FINGER SPLINT DYNAMIC",null,260,317.35000000000002,93.87,317.35000000000002,65,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 29131","TUFTS","TUFTS SELECT","CPT",29131,"APPLICATION FINGER SPLINT DYNAMIC",null,260,99.57,93.87,317.35000000000002,65,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 29200","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",29200,"STRAPPING THORAX",null,302,226.08,226.08,740.26,75.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 29200","BLUE CROSS","BLUE CROSS-PPO","CPT",29200,"STRAPPING THORAX",null,302,226.08,226.08,740.26,75.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 29240","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",29240,"STRAPPING SHOULDER",null,329,229.89,162.21,516.99,82.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 29240","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",29240,"STRAPPING SHOULDER",null,329,229.89,162.21,516.99,82.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 29240","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",29240,"STRAPPING SHOULDER",null,329,178.83,162.21,516.99,82.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 29240","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",29240,"STRAPPING SHOULDER",null,329,178.83,162.21,516.99,82.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 29280","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",29280,"HC STRAPPING OF HAND OR FINGER",null,224,69.349999999999994,53.94,194.97,56,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 29280","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",29280,"HC STRAPPING OF HAND OR FINGER",null,224,53.94,53.94,194.97,56,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 29345","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",29345,"APPLICATION LONG LEG CAST THIGH-TOE",null,776,496.13,395.63,1308.22,194,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 29345","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",29345,"APPLICATION LONG LEG CAST THIGH-TOE",null,776,1308.22,395.63,1308.22,194,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 29345","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",29345,"APPLICATION LONG LEG CAST THIGH-TOE",null,776,395.63,395.63,1308.22,194,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 29355","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",29355,"HC APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE",null,357,496.13,395.63,1308.22,89.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 29355","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",29355,"HC APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE",null,357,395.63,395.63,1308.22,89.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 29365","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",29365,"APPLICATION CYLINDER CAST THIGH ANKLE",null,675,395.63,395.63,1308.22,168.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 29425","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",29425,"APPLICATION SHORT LEG CAST WALKING/AMBULATORY",null,435,508.62,395.63,1308.22,108.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 29425","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",29425,"APPLICATION SHORT LEG CAST WALKING/AMBULATORY",null,435,1308.22,395.63,1308.22,108.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 29425","TUFTS","TUFTS SELECT","CPT",29425,"APPLICATION SHORT LEG CAST WALKING/AMBULATORY",null,435,410.47,395.63,1308.22,108.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 29440","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",29440,"HC ADDITION OF WALKER TO CAST",null,199,290.64,226.08,764.24,49.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 29440","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",29440,"HC ADDITION OF WALKER TO CAST",null,199,290.64,226.08,764.24,49.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 29445","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",29445,"HC APPLICATION RIGID TOTAL CONTACT LEG CAST",null,357,395.63,395.63,1308.22,89.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 29450","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",29450,"APPL CLUBFOOT CAST MOLDING/MANJ LONG/SHORT LEG",null,866,764.24,226.08,764.24,216.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 29450","TUFTS","TUFTS HMO","CPT",29450,"APPL CLUBFOOT CAST MOLDING/MANJ LONG/SHORT LEG",null,866,450.38,226.08,764.24,216.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 29450","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",29450,"APPL CLUBFOOT CAST MOLDING/MANJ LONG/SHORT LEG",null,866,226.08,226.08,764.24,216.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 29505","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",29505,"APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES",null,378,290.64,226.08,764.24,94.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 29505","TUFTS","TUFTS POS","CPT",29505,"APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES",null,378,450.38,226.08,764.24,94.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 29505","TUFTS","TUFTS SELECT","CPT",29505,"APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES",null,378,239.79,226.08,764.24,94.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 29505","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",29505,"APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES",null,378,226.08,226.08,764.24,94.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 29515","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",29515,"APPLICATION SHORT LEG SPLINT CALF FOOT",null,378,290.64,226.08,764.24,94.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 29515","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",29515,"APPLICATION SHORT LEG SPLINT CALF FOOT",null,378,290.64,226.08,764.24,94.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 29515","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",29515,"APPLICATION SHORT LEG SPLINT CALF FOOT",null,378,226.08,226.08,764.24,94.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 29520","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",29520,"STRAPPING HIP",null,275,93.87,93.87,317.35000000000002,68.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 29520","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",29520,"STRAPPING HIP",null,275,93.87,93.87,317.35000000000002,68.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 29520","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",29520,"STRAPPING HIP",null,275,93.87,93.87,317.35000000000002,68.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 29530","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",29530,"STRAPPING KNEE",null,288,229.89,162.21,516.99,72,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 29530","TUFTS","TUFTS POS","CPT",29530,"STRAPPING KNEE",null,288,304.69,162.21,516.99,72,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 29530","TUFTS","TUFTS SELECT","CPT",29530,"STRAPPING KNEE",null,288,162.21,162.21,516.99,72,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 29540","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",29540,"STRAPPING ANKLE &/FOOT",null,198,283.51,226.08,740.26,49.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 29540","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",29540,"STRAPPING ANKLE &/FOOT",null,198,226.08,226.08,740.26,49.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 29550","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",29550,"STRAPPING TOES",null,145,93.87,93.87,317.35000000000002,36.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 29550","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",29550,"STRAPPING TOES",null,145,93.87,93.87,317.35000000000002,36.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 29580","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",29580,"STRAPPING UNNA BOOT",null,328,764.24,226.08,764.24,82,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 29580","TUFTS","TUFTS HMO","CPT",29580,"STRAPPING UNNA BOOT",null,328,450.38,226.08,764.24,82,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 29580","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",29580,"STRAPPING UNNA BOOT",null,328,226.08,226.08,764.24,82,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 29581","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",29581,"APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT",null,174,226.08,226.08,943.8,43.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 29700","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",29700,"REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST",null,262,496.13,374.59,1193.8800000000001,65.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 29700","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",29700,"REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST",null,262,395.63,374.59,1193.8800000000001,65.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 29705","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",29705,"HC REMV/REVISN FULL ARM/LEG CAST",null,354,395.63,395.63,1274.1099999999999,88.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 29730","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",29730,"HC WINDOWING OF CAST",null,199,226.08,226.08,764.24,49.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 29730","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",29730,"HC WINDOWING OF CAST",null,199,226.08,226.08,764.24,49.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 29740","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",29740,"HC WEDGING OF CAST",null,343,395.63,395.63,1274.1099999999999,85.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 29804","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",29804,"HC TMJ ARTHROSCOPY/SURGERY",null,4072,5097.42,1990.62,7703.8,1018,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 29804","TUFTS","TUFTS HMO","CPT",29804,"HC TMJ ARTHROSCOPY/SURGERY",null,4072,4856.75,1990.62,7703.8,1018,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 29804","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",29804,"HC TMJ ARTHROSCOPY/SURGERY",null,4072,4405.5600000000004,1990.62,7703.8,1018,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 29804","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",29804,"HC TMJ ARTHROSCOPY/SURGERY",null,4072,4405.5600000000004,1990.62,7703.8,1018,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 29823","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",29823,"HC SHLDR ARTHROSCOP,EXTEN DEBRIDE 3+",null,4886,11845.41,1990.62,11845.41,1221.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 29823","TUFTS","TUFTS POS","CPT",29823,"HC SHLDR ARTHROSCOP,EXTEN DEBRIDE 3+",null,4886,7467.76,1990.62,11845.41,1221.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 29823","TUFTS","TUFTS SELECT","CPT",29823,"HC SHLDR ARTHROSCOP,EXTEN DEBRIDE 3+",null,4886,3987.49,1990.62,11845.41,1221.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 29827","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",29827,"HC SHLDR ARTHROSCOP,SURG,W/ROTAT CUFF REPR",null,10676,11074.87,2354.5,15242.01,2669,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 29827","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",29827,"HC SHLDR ARTHROSCOP,SURG,W/ROTAT CUFF REPR",null,10676,9571.73,2354.5,15242.01,2669,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 29881","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",29881,"HC KNEE SCOPE SINGLE MENISCECTOMY",null,4072,5097.42,2166.09,7703.8,1018,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 29881","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",29881,"HC KNEE SCOPE SINGLE MENISCECTOMY",null,4072,5097.42,2166.09,7703.8,1018,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 29881","TUFTS","TUFTS SELECT","CPT",29881,"HC KNEE SCOPE SINGLE MENISCECTOMY",null,4072,2593.31,2166.09,7703.8,1018,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 29882","TUFTS","TUFTS POS","CPT",29882,"HC KNEE SCOPE,MED OR LAT MENIS REPAIR",null,4072,4856.75,1990.62,7703.8,1018,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 29882","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",29882,"HC KNEE SCOPE,MED OR LAT MENIS REPAIR",null,4072,4405.5600000000004,1990.62,7703.8,1018,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 29888","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",29888,"HC KNEE SCOPE,AID ANT CRUCIATE REPAIR",null,8897,10803,1990.62,11845.41,2224.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 29888","TUFTS","TUFTS PPO","CPT",29888,"HC KNEE SCOPE,AID ANT CRUCIATE REPAIR",null,8897,7467.76,1990.62,11845.41,2224.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 30020","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",30020,"DRAINAGE ABSCESS/HEMATOMA NASAL SEPTUM",null,933,818.07,684.11,2032.26,233.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 30100","TUFTS","TUFTS POS","CPT",30100,"HC BIOPSY INTRANASAL",null,939,2058.17,1098.98,3264.67,234.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 30100","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",30100,"HC BIOPSY INTRANASAL",null,939,2148.08,1098.98,3264.67,234.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 30110","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",30110,"EXCISION NASAL POLYP SIMPLE",null,1023,2148.08,1098.98,3264.67,255.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 30110","BLUE CROSS","BLUE CROSS-PPO","CPT",30110,"EXCISION NASAL POLYP SIMPLE",null,1023,2148.08,1098.98,3264.67,255.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 30110","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",30110,"EXCISION NASAL POLYP SIMPLE",null,1023,2148.08,1098.98,3264.67,255.75,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 30117","TUFTS","TUFTS HMO","CPT",30117,"EXCISION/DESTRUCTION INTRANASAL LESION INT APPR",null,2646,7467.76,1990.62,11845.41,661.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 30130","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",30130,"HC EXCISION TURBINATE",null,3896,3747.12,1990.62,11845.41,974,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 30130","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",30130,"HC EXCISION TURBINATE",null,3896,3747.12,1990.62,11845.41,974,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 30200","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",30200,"INJECTION INTO TURBINATE",null,731,1051.71,809.85,2581.13,182.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 30200","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",30200,"INJECTION INTO TURBINATE",null,731,818.07,809.85,2581.13,182.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 30220","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",30220,"INSERTION NASAL SEPTAL PROSTHESIS BUTTON",null,2094,2148.08,1990.62,7703.8,523.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 30420","TUFTS","TUFTS HMO","CPT",30420,"HC RECONSTR NOSE+MAJ SEPTAL REPAIR",null,7489,9609.09,2354.5,15242.01,1872.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 30420","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",30420,"HC RECONSTR NOSE+MAJ SEPTAL REPAIR",null,7489,7429.92,2354.5,15242.01,1872.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 30420","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",30420,"HC RECONSTR NOSE+MAJ SEPTAL REPAIR",null,7489,7429.92,2354.5,15242.01,1872.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 30465","TUFTS","TUFTS PPO","CPT",30465,"REPAIR NASAL VESTIBULAR STENOSIS",null,7658,9609.09,2531.06,15242.01,1914.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 30465","TUFTS","TUFTS SELECT","CPT",30465,"REPAIR NASAL VESTIBULAR STENOSIS",null,7658,5130.87,2531.06,15242.01,1914.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 30465","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",30465,"REPAIR NASAL VESTIBULAR STENOSIS",null,7658,7429.92,2531.06,15242.01,1914.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 30520","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",30520,"HC REPAIR OF NASAL SEPTUM",null,3896,3747.12,2166.09,11845.41,974,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 30520","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",30520,"HC REPAIR OF NASAL SEPTUM",null,3896,3747.12,2166.09,11845.41,974,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 30560","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",30560,"HC RELEASE OF NASAL ADHESIONS",null,731,7703.8,818.07,7703.8,182.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 30560","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",30560,"HC RELEASE OF NASAL ADHESIONS",null,731,1051.71,818.07,7703.8,182.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 30560","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",30560,"HC RELEASE OF NASAL ADHESIONS",null,731,818.07,818.07,7703.8,182.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 30580","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",30580,"HC REPAIR FISTULA OROMAXILLARY",null,6512,8596.73,2166.09,11845.41,1628,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 30580","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",30580,"HC REPAIR FISTULA OROMAXILLARY",null,6512,7429.92,2166.09,11845.41,1628,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 30580","BLUE CROSS","BLUE CROSS-PPO","CPT",30580,"HC REPAIR FISTULA OROMAXILLARY",null,6512,7429.92,2166.09,11845.41,1628,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 30801","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",30801,"ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC",null,1076,3264.67,1098.98,3264.67,269,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 30802","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",30802,"ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL",null,2094,2148.08,1098.98,3264.67,523.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 30901","AETNA","AETNA","CPT",30901,"CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE",null,435,1198.25,178.83,1198.25,108.75,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN QHP - CPT - 36415","BMC HEALTHNET","BMCHN QHP","CPT",36415,"COLLECTION VENOUS BLOOD VENIPUNCTURE",null,26,0,2.2200000000000002,25.55,6.5,1]
["OUTPATIENT","FALLON - FALLON MEDICAID - CPT - 36416","FALLON","FALLON MEDICAID","CPT",36416,"HC COLLECTION CAPILLARY BLOOD SPECIMEN",null,22,0,5.27,5.27,5.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 36416","TUFTS","TUFTS SELECT","CPT",36416,"HC COLLECTION CAPILLARY BLOOD SPECIMEN",null,22,0,5.27,5.27,5.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 36416","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",36416,"HC COLLECTION CAPILLARY BLOOD SPECIMEN",null,22,5.27,5.27,5.27,5.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 36430","TUFTS","TUFTS SELECT","CPT",36430,"TRANSFUSION BLOOD/BLOOD COMPONENTS",null,928,699.8,643.03,2230.38,232,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 36430","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",36430,"TRANSFUSION BLOOD/BLOOD COMPONENTS",null,928,643.03,643.03,2230.38,232,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 36455","TUFTS","TUFTS HMO","CPT",36455,"HC EXCHANGE TRANSFUION, OTHR",null,1271,1314.44,643.03,2230.38,317.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 36455","TUFTS","TUFTS SELECT","CPT",36455,"HC EXCHANGE TRANSFUION, OTHR",null,1271,699.8,643.03,2230.38,317.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 36455","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",36455,"HC EXCHANGE TRANSFUION, OTHR",null,1271,643.03,643.03,2230.38,317.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 36455","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",36455,"HC EXCHANGE TRANSFUION, OTHR",null,1271,643.03,643.03,2230.38,317.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 36455","BLUE CROSS","BLUE CROSS-PPO","CPT",36455,"HC EXCHANGE TRANSFUION, OTHR",null,1271,643.03,643.03,2230.38,317.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 36473","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",36473,"HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM 1ST VEIN",null,4122,4436.09,1990.62,11845.41,1030.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 36474","AETNA","AETNA","CPT",36474,"HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM SBSQ VEINS",null,2062,1198.25,218.48,1198.25,515.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 36474","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",36474,"HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM SBSQ VEINS",null,2062,218.48,218.48,1198.25,515.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 36475","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",36475,"HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN",null,3421,5132.74,1990.62,11845.41,855.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 36476","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",36476,"HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS",null,2062,334.4,334.4,1198.25,515.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 36478","TUFTS","TUFTS PPO","CPT",36478,"HC ENDOVENOUS LASER, 1ST VEIN",null,4122,7467.76,1990.62,11845.41,1030.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 36478","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",36478,"HC ENDOVENOUS LASER, 1ST VEIN",null,4122,4436.09,1990.62,11845.41,1030.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 36478","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",36478,"HC ENDOVENOUS LASER, 1ST VEIN",null,4122,4436.09,1990.62,11845.41,1030.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 36479","TUFTS","TUFTS SELECT","CPT",36479,"HC ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS",null,2062,0,336.67,1198.25,515.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 36479","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",36479,"HC ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS",null,2062,336.67,336.67,1198.25,515.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 36479","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",36479,"HC ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS",null,2062,336.67,336.67,1198.25,515.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 36482","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",36482,"HC ENDOVEN ABLTI THER CHEM ADHESIVE 1ST VEIN",null,6846,8504.02,1990.62,25611.61,1711.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 36482","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",36482,"HC ENDOVEN ABLTI THER CHEM ADHESIVE 1ST VEIN",null,6846,7349.8,1990.62,25611.61,1711.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 36482","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",36482,"HC ENDOVEN ABLTI THER CHEM ADHESIVE 1ST VEIN",null,6846,7349.8,1990.62,25611.61,1711.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 36483","TUFTS","TUFTS PPO","CPT",36483,"HC ENDOVEN ABLTI THER CHEM ADHESIVE SBSQ VEIN",null,3423,0,218.56,1198.25,855.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 36483","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",36483,"HC ENDOVEN ABLTI THER CHEM ADHESIVE SBSQ VEIN",null,3423,218.56,218.56,1198.25,855.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 36483","BLUE CROSS","BLUE CROSS-PPO","CPT",36483,"HC ENDOVEN ABLTI THER CHEM ADHESIVE SBSQ VEIN",null,3423,218.56,218.56,1198.25,855.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 36500","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",36500,"HC VEN CATHJ SLCTV ORGAN BLD SAMPLING",null,1371,0,453.05,1198.25,342.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 36511","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",36511,"HC THER APHERESIS,WHITE BLOOD CELLS",null,1867,7279.25,1500.85,7279.25,466.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 36511","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",36511,"HC THER APHERESIS,WHITE BLOOD CELLS",null,1867,2094.1799999999998,1500.85,7279.25,466.75,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 36512","TUFTS","TUFTS HMO","CPT",36512,"THERAPEUTIC APHERESIS RED BLOOD CELLS",null,1867,4289.8999999999996,1500.85,7279.25,466.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 36512","TUFTS","TUFTS POS","CPT",36512,"THERAPEUTIC APHERESIS RED BLOOD CELLS",null,1867,4289.8999999999996,1500.85,7279.25,466.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 36512","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",36512,"THERAPEUTIC APHERESIS RED BLOOD CELLS",null,1867,2094.1799999999998,1500.85,7279.25,466.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 36513","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",36513,"THERAPEUTIC APHERESIS PLATELETS",null,1867,643.03,643.03,2792.38,466.75,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 36514","TUFTS","TUFTS HMO","CPT",36514,"THERAPEUTIC APHERESIS PLASMA PHERESIS",null,1867,4289.8999999999996,1500.85,7279.25,466.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 36522","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",36522,"PHOTOPHERESIS EXTRACORPOREAL",null,7093,8260.7900000000009,1500.85,20857.57,1773.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 36522","TUFTS","TUFTS PPO","CPT",36522,"PHOTOPHERESIS EXTRACORPOREAL",null,7093,13149.34,1500.85,20857.57,1773.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 36522","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",36522,"PHOTOPHERESIS EXTRACORPOREAL",null,7093,6587.33,1500.85,20857.57,1773.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 36555","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",36555,"HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y",null,1359,2361.15,1098.98,3264.67,339.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 36556","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",36556,"HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/>",null,1461,3264.67,1098.98,3264.67,365.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 36556","TUFTS","TUFTS HMO","CPT",36556,"HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/>",null,1461,2057.7399999999998,1098.98,3264.67,365.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 36556","TUFTS","TUFTS PPO","CPT",36556,"HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/>",null,1461,2058.16,1098.98,3264.67,365.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 36558","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",36558,"HC INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>",null,3308,5132.74,1098.98,5132.74,827,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 36558","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",36558,"HC INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>",null,3308,5132.74,1098.98,5132.74,827,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 36558","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",36558,"HC INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>",null,3308,4436.09,1098.98,5132.74,827,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 36560","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",36560,"HC INSJ TUNNELED CTR VAD W/SUBQ PORT UNDER 5 YR",null,4034,4436.09,1990.62,7703.8,1008.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 36561","TUFTS","TUFTS POS","CPT",36561,"HC INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>",null,4034,4856.75,1990.62,7703.8,1008.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 36565","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",36565,"HC INSJ TUN VAD REQ 2 CATH 2 SITS W/O SUBQ PORT/PMP",null,4122,4436.09,1990.62,7703.8,1030.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 36566","TUFTS","TUFTS SELECT","CPT",36566,"HC INSJ TUN VAD REQ 2 CATH 2 SITS W/SUBQ PORT",null,6569,3987.49,1990.62,11845.41,1642.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 36566","AETNA","AETNA","CPT",36566,"HC INSJ TUN VAD REQ 2 CATH 2 SITS W/SUBQ PORT",null,6569,1990.62,1990.62,11845.41,1642.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 36566","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",36566,"HC INSJ TUN VAD REQ 2 CATH 2 SITS W/SUBQ PORT",null,6569,7349.8,1990.62,11845.41,1642.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 36566","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",36566,"HC INSJ TUN VAD REQ 2 CATH 2 SITS W/SUBQ PORT",null,6569,7349.8,1990.62,11845.41,1642.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 36568","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",36568,"HC INS PICC;W/O PMP/PRT;<5YR",null,1461,1338.6,1041.23,7703.8,365.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 36568","BLUE CROSS","BLUE CROSS-PPO","CPT",36568,"HC INS PICC;W/O PMP/PRT;<5YR",null,1461,1041.23,1041.23,7703.8,365.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 36569","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",36569,"INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/>",null,1461,2361.15,1198.25,7703.8,365.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 36569","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",36569,"INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/>",null,1461,1836.61,1198.25,7703.8,365.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 36570","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",36570,"HC INSJ PRPH CTR VAD W/SUBQ PORT UNDER 5 YR",null,4122,4436.09,1990.62,7703.8,1030.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 36571","BLUE CROSS","BLUE CROSS-PPO","CPT",36571,"HC INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>",null,4122,4436.09,1990.62,7703.8,1030.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 36572","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",36572,"HC INSJ PICC RS&I <5 YR",null,955,1338.6,1041.23,3264.67,238.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 36572","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",36572,"HC INSJ PICC RS&I <5 YR",null,955,1041.23,1041.23,3264.67,238.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 36573","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",36573,"HC INSJ PICC RS&I 5 YR+",null,1683,2361.15,1198.25,7703.8,420.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 36573","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",36573,"HC INSJ PICC RS&I 5 YR+",null,1683,2361.15,1198.25,7703.8,420.75,1]
["OUTPATIENT","AETNA - AETNA - CPT - 36573","AETNA","AETNA","CPT",36573,"HC INSJ PICC RS&I 5 YR+",null,1683,1198.25,1198.25,7703.8,420.75,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 36575","TUFTS","TUFTS HMO","CPT",36575,"HC RTUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP",null,803,1281.21,684.11,2032.26,200.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 36576","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",36576,"HC RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT",null,2426,2303.1799999999998,1098.98,3264.67,606.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 36576","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",36576,"HC RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT",null,2426,2361.15,1098.98,3264.67,606.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 36576","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",36576,"HC RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT",null,2426,2361.15,1098.98,3264.67,606.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 36576","TUFTS","TUFTS HMO","CPT",36576,"HC RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT",null,2426,2057.7399999999998,1098.98,3264.67,606.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 36578","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",36578,"HC RPLCMT CATH CTR VAD SUBQ PORT/PMP",null,3308,5132.74,1500.85,11845.41,827,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 36578","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",36578,"HC RPLCMT CATH CTR VAD SUBQ PORT/PMP",null,3308,5132.74,1500.85,11845.41,827,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 36578","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",36578,"HC RPLCMT CATH CTR VAD SUBQ PORT/PMP",null,3308,4436.09,1500.85,11845.41,827,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 36580","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",36580,"HC REPL CVC,NON_TUN;5/+YO",null,1461,1836.61,1198.25,7703.8,365.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 36580","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",36580,"HC REPL CVC,NON_TUN;5/+YO",null,1461,1836.61,1198.25,7703.8,365.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 36582","TUFTS","TUFTS HMO","CPT",36582,"HC RPLCMT COMPL TUN CTR VAD W/SUBQ PORT",null,4034,4856.75,1990.62,7703.8,1008.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 36582","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",36582,"HC RPLCMT COMPL TUN CTR VAD W/SUBQ PORT",null,4034,4436.09,1990.62,7703.8,1008.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 36585","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",36585,"HC RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT",null,3308,5132.74,1990.62,7703.8,827,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 36585","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",36585,"HC RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT",null,3308,5132.74,1990.62,7703.8,827,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 36585","TUFTS","TUFTS SELECT","CPT",36585,"HC RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT",null,3308,2593.31,1990.62,7703.8,827,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 36585","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",36585,"HC RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT",null,3308,4436.09,1990.62,7703.8,827,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 36589","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",36589,"RMVL TUN CVC W/O SUBQ PORT/PMP",null,1072,1041.23,684.11,2032.26,268,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 36590","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",36590,"HC RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ",null,1588,3264.67,1041.23,3264.67,397,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 36591","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT",36591,"COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE",null,192,0,178.83,607.66,48,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 36592","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",36592,"COLLECT BLOOD FROM CATHETER VENOUS NOS",null,196,229.89,178.83,1076.77,49,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 36592","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",36592,"COLLECT BLOOD FROM CATHETER VENOUS NOS",null,196,229.89,178.83,1076.77,49,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 36592","TUFTS","TUFTS SELECT","CPT",36592,"COLLECT BLOOD FROM CATHETER VENOUS NOS",null,196,190.66,178.83,1076.77,49,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 36592","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",36592,"COLLECT BLOOD FROM CATHETER VENOUS NOS",null,196,178.83,178.83,1076.77,49,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MEDICAID - CPT - 36592","BMC HEALTHNET","BMCHN MEDICAID","CPT",36592,"COLLECT BLOOD FROM CATHETER VENOUS NOS",null,196,0,178.83,1076.77,49,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 36593","TUFTS","TUFTS HMO","CPT",36593,"DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH",null,492,1004.82,484.3,1705.01,123,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 36593","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",36593,"DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH",null,492,484.3,484.3,1705.01,123,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 36595","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",36595,"HC MECH REMOV PERICATH OBSTR CV DEV VIA VEN ACCESS",null,4214,5132.74,2166.09,11845.41,1053.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 36595","BLUE CROSS","BLUE CROSS-PPO","CPT",36595,"HC MECH REMOV PERICATH OBSTR CV DEV VIA VEN ACCESS",null,4214,4436.09,2166.09,11845.41,1053.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 36596","TUFTS","TUFTS POS","CPT",36596,"HC MCHNL RMVL INTRAL OBSTR CV DEV THRU DEV LUMEN",null,1461,4856.75,1198.25,7703.8,365.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 36596","BLUE CROSS","BLUE CROSS-PPO","CPT",36596,"HC MCHNL RMVL INTRAL OBSTR CV DEV THRU DEV LUMEN",null,1461,1836.61,1198.25,7703.8,365.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 36598","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",36598,"HC CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT",null,275,404.12,314.33999999999997,1500.85,68.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 36598","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",36598,"HC CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT",null,275,314.33999999999997,314.33999999999997,1500.85,68.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 36600","TUFTS","TUFTS PPO","CPT",36600,"ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX",null,171,341.32,169.87,541.4,42.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 36680","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",36680,"HC PLACEMENT NEEDLE INTRAOSSEOUS INFUSION",null,454,733.22,317.70999999999998,1198.25,113.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 36680","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",36680,"HC PLACEMENT NEEDLE INTRAOSSEOUS INFUSION",null,454,751.68,317.70999999999998,1198.25,113.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 36680","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",36680,"HC PLACEMENT NEEDLE INTRAOSSEOUS INFUSION",null,454,584.69000000000005,317.70999999999998,1198.25,113.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 36680","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",36680,"HC PLACEMENT NEEDLE INTRAOSSEOUS INFUSION",null,454,584.69000000000005,317.70999999999998,1198.25,113.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 36901","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",36901,"HC INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR S&I",null,1114,2361.15,1098.98,3264.67,278.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 36902","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",36902,"HC INTRO CATH DIALYSIS CIRCUIT W/TRLUML BALO ANGIOP",null,7857,7856.99,2531.06,9090.86,1964.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 36903","TUFTS","TUFTS HMO","CPT",36903,"HC INTRO CATH DIALYSIS CIRCUIT W/TCAT PLMT IV STENT",null,15870,7467.76,2531.06,18787.919999999998,3967.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 36903","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",36903,"HC INTRO CATH DIALYSIS CIRCUIT W/TCAT PLMT IV STENT",null,15870,16237.9,2531.06,18787.919999999998,3967.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 36904","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",36904,"HC PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH",null,7857,7703.8,2354.5,9090.86,1964.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 36904","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",36904,"HC PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH",null,7857,9090.86,2354.5,9090.86,1964.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 36904","TUFTS","TUFTS POS","CPT",36904,"HC PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH",null,7857,4856.75,2354.5,9090.86,1964.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 36905","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",36905,"HC PERQ THRMBC/NFS DIAL CIRCUIT TRLUML BALO ANGIOP",null,15870,18787.919999999998,2531.06,18787.919999999998,3967.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 36905","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",36905,"HC PERQ THRMBC/NFS DIAL CIRCUIT TRLUML BALO ANGIOP",null,15870,16237.9,2531.06,18787.919999999998,3967.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 36906","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",36906,"HC PERQ THRMBC/NFS DIAL CIRCUIT TCAT PLMT IV STENT",null,24055,29102.92,2531.06,37129.18,6013.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 36906","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",36906,"HC PERQ THRMBC/NFS DIAL CIRCUIT TCAT PLMT IV STENT",null,24055,29835.33,2531.06,37129.18,6013.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 36906","BLUE CROSS","BLUE CROSS-PPO","CPT",36906,"HC PERQ THRMBC/NFS DIAL CIRCUIT TCAT PLMT IV STENT",null,24055,25785.9,2531.06,37129.18,6013.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 36907","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",36907,"HC TRLUML BAL ANGIO CTR DIAL",null,11188,0,362.66,1198.25,2797,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 36907","TUFTS","TUFTS PPO","CPT",36907,"HC TRLUML BAL ANGIO CTR DIAL",null,11188,0,362.66,1198.25,2797,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 36908","TUFTS","TUFTS POS","CPT",36908,"HC STENT PLMT CENTRAL DIAYLSIS SEG PFRMD DIAL CIR",null,1114,0,512.95000000000005,1198.25,278.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 36908","AETNA","AETNA","CPT",36908,"HC STENT PLMT CENTRAL DIAYLSIS SEG PFRMD DIAL CIR",null,1114,1198.25,512.95000000000005,1198.25,278.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 37182","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",37182,"HC INSJ TRANSVNS INTRAHEPATC PORTOSYSIC SHUNT",null,6320,2031.06,2031.06,11845.41,1580,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN ACO - CPT - 37182","BMC HEALTHNET","BMCHN ACO","CPT",37182,"HC INSJ TRANSVNS INTRAHEPATC PORTOSYSIC SHUNT",null,6320,0,2031.06,11845.41,1580,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN QHP - CPT - 37182","BMC HEALTHNET","BMCHN QHP","CPT",37182,"HC INSJ TRANSVNS INTRAHEPATC PORTOSYSIC SHUNT",null,6320,0,2031.06,11845.41,1580,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 37183","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",37183,"HC REVJ TRANSVNS INTRAHEPATIC PORTOSYSTEMIC SHUNT",null,15672,11845.41,2397.88,11845.41,3918,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 37183","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",37183,"HC REVJ TRANSVNS INTRAHEPATIC PORTOSYSTEMIC SHUNT",null,15672,7856.99,2397.88,11845.41,3918,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 37183","BLUE CROSS","BLUE CROSS-PPO","CPT",37183,"HC REVJ TRANSVNS INTRAHEPATIC PORTOSYSTEMIC SHUNT",null,15672,7856.99,2397.88,11845.41,3918,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 37184","TUFTS","TUFTS SELECT","CPT",37184,"HC PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST",null,5624,5130.87,2397.88,15242.01,1406,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 37184","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",37184,"HC PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST",null,5624,7856.99,2397.88,15242.01,1406,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 37185","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",37185,"PRIM PRQ TRLUML MCHNL THRMBC SBSQ VSL",null,1287,0,412.75,1500.85,321.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 37185","TUFTS","TUFTS SELECT","CPT",37185,"PRIM PRQ TRLUML MCHNL THRMBC SBSQ VSL",null,1287,0,412.75,1500.85,321.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 37185","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",37185,"PRIM PRQ TRLUML MCHNL THRMBC SBSQ VSL",null,1287,412.75,412.75,1500.85,321.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 37185","BLUE CROSS","BLUE CROSS-PPO","CPT",37185,"PRIM PRQ TRLUML MCHNL THRMBC SBSQ VSL",null,1287,412.75,412.75,1500.85,321.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 37186","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",37186,"HC SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL",null,1951,603,603,1198.25,487.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 37186","BLUE CROSS","BLUE CROSS-PPO","CPT",37186,"HC SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL",null,1951,603,603,1198.25,487.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 37187","TUFTS","TUFTS SELECT","CPT",37187,"PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN",null,5624,5130.87,2397.88,15242.01,1406,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 37187","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",37187,"PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN",null,5624,7856.99,2397.88,15242.01,1406,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 37188","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",37188,"PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX",null,5624,5132.74,2397.88,15242.01,1406,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 37188","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",37188,"PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX",null,5624,4436.09,2397.88,15242.01,1406,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 37188","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",37188,"PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX",null,5624,4436.09,2397.88,15242.01,1406,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 37191","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",37191,"HC INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I",null,4893,7349.8,1990.62,17023.61,1223.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 37191","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",37191,"HC INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I",null,4893,7349.8,1990.62,17023.61,1223.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 37192","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",37192,"HC REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I",null,3752,11845.41,1990.62,11845.41,938,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 37193","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",37193,"HC RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I",null,4034,5006.74,1990.62,11845.41,1008.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 37193","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",37193,"HC RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I",null,4034,5132.74,1990.62,11845.41,1008.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 37193","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",37193,"HC RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I",null,4034,5132.74,1990.62,11845.41,1008.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 37193","BLUE CROSS","BLUE CROSS-PPO","CPT",37193,"HC RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I",null,4034,4436.09,1990.62,11845.41,1008.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 37193","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",37193,"HC RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I",null,4034,4436.09,1990.62,11845.41,1008.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 37195","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",37195,"HC THROMBOLYTIC THERAPY, STROKE",null,346,622.61,484.3,3264.67,86.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 37195","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",37195,"HC THROMBOLYTIC THERAPY, STROKE",null,346,484.3,484.3,3264.67,86.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 37197","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",37197,"HC PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING",null,4034,4436.09,1098.98,5132.74,1008.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 37200","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",37200,"HC TRANSCATHETER BIOPSY",null,4034,7349.8,1098.98,8504.02,1008.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 37211","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",37211,"HC THROMBOLYSIS ARTERIAL INFUSION ICRA RS&I INIT TX",null,3798,8504.02,1098.98,8504.02,949.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 37211","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",37211,"HC THROMBOLYSIS ARTERIAL INFUSION ICRA RS&I INIT TX",null,3798,7349.8,1098.98,8504.02,949.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 37211","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",37211,"HC THROMBOLYSIS ARTERIAL INFUSION ICRA RS&I INIT TX",null,3798,7349.8,1098.98,8504.02,949.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 37212","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",37212,"HC THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX",null,3354,3264.67,1098.98,5132.74,838.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 37212","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",37212,"HC THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX",null,3354,4436.09,1098.98,5132.74,838.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 37213","TUFTS","TUFTS HMO","CPT",37213,"HC THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX",null,3308,2057.7399999999998,1098.98,3264.67,827,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 37213","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",37213,"HC THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX",null,3308,1836.61,1098.98,3264.67,827,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 37214","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",37214,"HC CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL",null,3308,2361.15,1098.98,3264.67,827,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 37214","TUFTS","TUFTS HMO","CPT",37214,"HC CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL",null,3308,2057.7399999999998,1098.98,3264.67,827,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 37214","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",37214,"HC CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL",null,3308,1836.61,1098.98,3264.67,827,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 37215","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT",37215,"HC TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ",null,8331,0,1990.62,7703.8,2082.75,1]
["OUTPATIENT","AETNA - AETNA - CPT - 37215","AETNA","AETNA","CPT",37215,"HC TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ",null,8331,1990.62,1990.62,7703.8,2082.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 37220","TUFTS","TUFTS SELECT","CPT",37220,"HC REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL",null,7580,8621.5499999999993,2166.09,25611.61,1895,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 37220","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",37220,"HC REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL",null,7580,7856.99,2166.09,25611.61,1895,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 37220","BLUE CROSS","BLUE CROSS-PPO","CPT",37220,"HC REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL",null,7580,7856.99,2166.09,25611.61,1895,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 37222","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",37222,"HC REVASC;ILIAC,EAAD,TRN ANG",null,7580,0,459.91,1198.25,1895,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 37222","TUFTS","TUFTS POS","CPT",37222,"HC REVASC;ILIAC,EAAD,TRN ANG",null,7580,0,459.91,1198.25,1895,1]
["OUTPATIENT","AETNA - AETNA - CPT - 37222","AETNA","AETNA","CPT",37222,"HC REVASC;ILIAC,EAAD,TRN ANG",null,7580,1198.25,459.91,1198.25,1895,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 37223","TUFTS","TUFTS POS","CPT",37223,"HC REVASC;ILIAC,EAAD,TRN STN",null,7051,0,526.34,1198.25,1762.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 37224","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",37224,"HC REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI",null,7580,7856.99,2166.09,11845.41,1895,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 37224","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",37224,"HC REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI",null,7580,7856.99,2166.09,11845.41,1895,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 37225","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",37225,"HC REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL",null,15672,18787.919999999998,2166.09,18787.919999999998,3918,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 37225","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",37225,"HC REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL",null,15672,16237.9,2166.09,18787.919999999998,3918,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 37226","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",37226,"HC REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL",null,15672,18326.71,2166.09,18787.919999999998,3918,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 37226","TUFTS","TUFTS HMO","CPT",37226,"HC REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL",null,15672,7467.76,2166.09,18787.919999999998,3918,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 37226","BLUE CROSS","BLUE CROSS-PPO","CPT",37226,"HC REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL",null,15672,16237.9,2166.09,18787.919999999998,3918,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 37227","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",37227,"HC REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL",null,26649,29835.33,2166.09,62742.78,6662.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 37227","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",37227,"HC REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL",null,26649,62742.78,2166.09,62742.78,6662.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 37227","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",37227,"HC REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL",null,26649,29835.33,2166.09,62742.78,6662.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 37227","TUFTS","TUFTS SELECT","CPT",37227,"HC REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL",null,26649,21120.9,2166.09,62742.78,6662.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 37228","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",37228,"HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI",null,10821,18326.71,2166.09,37129.18,2705.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 37228","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",37228,"HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI",null,10821,18787.919999999998,2166.09,37129.18,2705.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 37228","TUFTS","TUFTS SELECT","CPT",37228,"HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI",null,10821,12498.68,2166.09,37129.18,2705.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 37228","AETNA","AETNA","CPT",37228,"HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI",null,10821,2166.09,2166.09,37129.18,2705.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 37228","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",37228,"HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI",null,10821,16237.9,2166.09,37129.18,2705.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 37229","AETNA","AETNA","CPT",37229,"HC REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL",null,16686,2166.09,2166.09,62742.78,4171.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 37229","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",37229,"HC REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL",null,16686,25785.9,2166.09,62742.78,4171.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 37230","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",37230,"HC REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL",null,16686,29102.92,2166.09,62742.78,4171.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 37230","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",37230,"HC REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL",null,16686,25785.9,2166.09,62742.78,4171.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 37230","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",37230,"HC REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL",null,16686,25785.9,2166.09,62742.78,4171.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 37231","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",37231,"HC REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP SM VSL",null,24790,25785.9,2166.09,62742.78,6197.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 37232","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",37232,"HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL",null,7580,0,497.3,1198.25,1895,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 37232","TUFTS","TUFTS POS","CPT",37232,"HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL",null,7580,0,497.3,1198.25,1895,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 37232","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",37232,"HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL",null,7580,497.3,497.3,1198.25,1895,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 37236","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",37236,"OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL",null,15672,16237.9,1990.62,18787.919999999998,3918,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 37237","TUFTS","TUFTS SELECT","CPT",37237,"OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL",null,7580,0,525.59,1198.25,1895,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 37238","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",37238,"OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST",null,15672,18326.71,1990.62,18787.919999999998,3918,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 37238","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",37238,"OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST",null,15672,7703.8,1990.62,18787.919999999998,3918,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 37238","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",37238,"OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST",null,15672,16237.9,1990.62,18787.919999999998,3918,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 37238","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",37238,"OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST",null,15672,16237.9,1990.62,18787.919999999998,3918,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 37238","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",37238,"OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST",null,15672,16237.9,1990.62,18787.919999999998,3918,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 37238","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",37238,"OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST",null,15672,16237.9,1990.62,18787.919999999998,3918,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 37239","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",37239,"OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL",null,7580,0,376.39,1198.25,1895,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 37239","TUFTS","TUFTS SELECT","CPT",37239,"OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL",null,7580,0,376.39,1198.25,1895,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 37239","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",37239,"OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL",null,7580,376.39,376.39,1198.25,1895,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 37239","BLUE CROSS","BLUE CROSS-PPO","CPT",37239,"OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL",null,7580,376.39,376.39,1198.25,1895,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 37241","TUFTS","TUFTS SELECT","CPT",37241,"VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I",null,15195,2593.31,1990.62,18787.919999999998,3798.75,1]
["OUTPATIENT","AETNA - AETNA - CPT - 37241","AETNA","AETNA","CPT",37241,"VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I",null,15195,1990.62,1990.62,18787.919999999998,3798.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 37242","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",37242,"VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I",null,15195,18787.919999999998,1990.62,37129.18,3798.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 37242","TUFTS","TUFTS PPO","CPT",37242,"VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I",null,15195,23407.53,1990.62,37129.18,3798.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 37242","TUFTS","TUFTS SELECT","CPT",37242,"VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I",null,15195,12498.68,1990.62,37129.18,3798.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 37243","BLUE CROSS","BLUE CROSS-PPO","CPT",37243,"VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT",null,15195,16237.9,1990.62,37129.18,3798.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 37244","TUFTS","TUFTS SELECT","CPT",37244,"VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE",null,15195,12498.68,1990.62,37129.18,3798.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 37244","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",37244,"VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE",null,15195,16237.9,1990.62,37129.18,3798.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 37244","BLUE CROSS","BLUE CROSS-PPO","CPT",37244,"VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE",null,15195,16237.9,1990.62,37129.18,3798.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 37244","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",37244,"VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE",null,15195,16237.9,1990.62,37129.18,3798.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 37246","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",37246,"HC TRLUML BAL ANGIO 1ST ART",null,7857,11845.41,2531.06,11845.41,1964.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 37246","TUFTS","TUFTS POS","CPT",37246,"HC TRLUML BAL ANGIO 1ST ART",null,7857,7467.76,2531.06,11845.41,1964.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 37246","TUFTS","TUFTS SELECT","CPT",37246,"HC TRLUML BAL ANGIO 1ST ART",null,7857,3987.49,2531.06,11845.41,1964.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 37246","AETNA","AETNA","CPT",37246,"HC TRLUML BAL ANGIO 1ST ART",null,7857,2531.06,2531.06,11845.41,1964.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 37247","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",37247,"HC TRLUML BAL ANGIO ADD ART",null,3929,0,422.81,1198.25,982.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 37247","TUFTS","TUFTS PPO","CPT",37247,"HC TRLUML BAL ANGIO ADD ART",null,3929,0,422.81,1198.25,982.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 37247","AETNA","AETNA","CPT",37247,"HC TRLUML BAL ANGIO ADD ART",null,3929,1198.25,422.81,1198.25,982.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 37247","BLUE CROSS","BLUE CROSS-PPO","CPT",37247,"HC TRLUML BAL ANGIO ADD ART",null,3929,422.81,422.81,1198.25,982.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 37247","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",37247,"HC TRLUML BAL ANGIO ADD ART",null,3929,422.81,422.81,1198.25,982.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 37248","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",37248,"HC TRLUML BAL ANGIO 1ST VEIN",null,7857,11845.41,2531.06,11845.41,1964.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 37248","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",37248,"HC TRLUML BAL ANGIO 1ST VEIN",null,7857,7856.99,2531.06,11845.41,1964.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 37249","TUFTS","TUFTS POS","CPT",37249,"HC TRLUML BAL ANGIO ADD VEIN",null,3929,0,359.24,1198.25,982.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 37249","TUFTS","TUFTS PPO","CPT",37249,"HC TRLUML BAL ANGIO ADD VEIN",null,3929,0,359.24,1198.25,982.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 37249","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",37249,"HC TRLUML BAL ANGIO ADD VEIN",null,3929,359.24,359.24,1198.25,982.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 37252","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",37252,"INTRAVSC US DURNG DX EVAL &/OR THERPUTC INTRVNTN INCL RAD S&I; 1ST NONCRNRY VES",null,652,0,225.25,1198.25,163,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 37252","TUFTS","TUFTS SELECT","CPT",37252,"INTRAVSC US DURNG DX EVAL &/OR THERPUTC INTRVNTN INCL RAD S&I; 1ST NONCRNRY VES",null,652,0,225.25,1198.25,163,1]
["OUTPATIENT","AETNA - AETNA - CPT - 37252","AETNA","AETNA","CPT",37252,"INTRAVSC US DURNG DX EVAL &/OR THERPUTC INTRVNTN INCL RAD S&I; 1ST NONCRNRY VES",null,652,1198.25,225.25,1198.25,163,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 37252","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",37252,"INTRAVSC US DURNG DX EVAL &/OR THERPUTC INTRVNTN INCL RAD S&I; 1ST NONCRNRY VES",null,652,225.25,225.25,1198.25,163,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 37253","TUFTS","TUFTS SELECT","CPT",37253,"HC INTVASC US NONCORON ADD",null,521,0,181.09,1198.25,130.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 37253","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",37253,"HC INTVASC US NONCORON ADD",null,521,181.09,181.09,1198.25,130.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 37609","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",37609,"HC TEMPORAL ARTERY LIGATN OR BX",null,1633,2672.73,1500.85,7703.8,408.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 37609","AETNA","AETNA","CPT",37609,"HC TEMPORAL ARTERY LIGATN OR BX",null,1633,1500.85,1500.85,7703.8,408.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 37609","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",37609,"HC TEMPORAL ARTERY LIGATN OR BX",null,1633,2309.9699999999998,1500.85,7703.8,408.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 37609","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",37609,"HC TEMPORAL ARTERY LIGATN OR BX",null,1633,2309.9699999999998,1500.85,7703.8,408.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 37799","TUFTS","TUFTS POS","CPT",37799,"UNLISTED PROCEDURE,VASCULAR SURGERY",null,494,595.01,317.70999999999998,1500.85,123.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 38206","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",38206,"HC BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ AUTOL",null,1744,2692.27,1098.98,3264.67,436,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 38206","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",38206,"HC BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ AUTOL",null,1744,2094.1799999999998,1098.98,3264.67,436,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 38207","TUFTS","TUFTS PPO","CPT",38207,"HC TRNSPL PREPJ HEMATOP PROGEN CELLS CRYOPRSRV STOR",null,1015,1281.21,643.03,2032.26,253.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 38207","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",38207,"HC TRNSPL PREPJ HEMATOP PROGEN CELLS CRYOPRSRV STOR",null,1015,643.03,643.03,2032.26,253.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 38221","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",38221,"BONE MARROW BIOPSY NEEDLE/TROCAR",null,1103,2672.73,1098.98,3264.67,275.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 38221","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",38221,"BONE MARROW BIOPSY NEEDLE/TROCAR",null,1103,2309.9699999999998,1098.98,3264.67,275.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 38222","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",38222,"HC DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS",null,1103,2309.9699999999998,1098.98,3264.67,275.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 38241","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",38241,"TRNSPLJ AUTOLOGOUS HEMATOPOIETIC CELLS PER DONOR",null,5269,2094.1799999999998,2094.1799999999998,15242.01,1317.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 38241","BLUE CROSS","BLUE CROSS-PPO","CPT",38241,"TRNSPLJ AUTOLOGOUS HEMATOPOIETIC CELLS PER DONOR",null,5269,2094.1799999999998,2094.1799999999998,15242.01,1317.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 38300","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",38300,"DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL",null,1435,2672.73,1098.98,3264.67,358.75,1]
["OUTPATIENT","AETNA - AETNA - CPT - 38300","AETNA","AETNA","CPT",38300,"DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL",null,1435,1198.25,1098.98,3264.67,358.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 38300","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",38300,"DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL",null,1435,2309.9699999999998,1098.98,3264.67,358.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 38500","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",38500,"HC BIOPSY/EXCISION, LYMPH NODE(S)",null,4095,4729.13,1500.85,7703.8,1023.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 38505","TUFTS","TUFTS POS","CPT",38505,"BX/EXC LYMPH NODE NEEDLE SUPERFICIAL",null,1209,2058.17,1098.98,3264.67,302.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 38510","TUFTS","TUFTS HMO","CPT",38510,"HC BX/REMV,LYMPH NODE,DEEP CERV",null,4506,4856.75,1500.85,7703.8,1126.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 38510","TUFTS","TUFTS PPO","CPT",38510,"HC BX/REMV,LYMPH NODE,DEEP CERV",null,4506,4856.75,1500.85,7703.8,1126.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 38510","TUFTS","TUFTS SELECT","CPT",38510,"HC BX/REMV,LYMPH NODE,DEEP CERV",null,4506,2593.31,1500.85,7703.8,1126.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 38542","TUFTS","TUFTS HMO","CPT",38542,"HC EXPLORE DEEP NODE(S), NECK",null,6737,4856.75,1500.85,8930.2099999999991,1684.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 38542","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",38542,"HC EXPLORE DEEP NODE(S), NECK",null,6737,7718.14,1500.85,8930.2099999999991,1684.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 38550","TUFTS","TUFTS HMO","CPT",38550,"HC REMOVAL CYST HYGROMA",null,4650,7467.76,1990.62,11845.41,1162.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 38550","AETNA","AETNA","CPT",38550,"HC REMOVAL CYST HYGROMA",null,4650,1990.62,1990.62,11845.41,1162.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 38790","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",38790,"HC INJECTION PROCEDURE LYMPHANGIOGRAPHY",null,644,0,208.28,1198.25,161,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 38790","TUFTS","TUFTS SELECT","CPT",38790,"HC INJECTION PROCEDURE LYMPHANGIOGRAPHY",null,644,0,208.28,1198.25,161,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 38790","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",38790,"HC INJECTION PROCEDURE LYMPHANGIOGRAPHY",null,644,208.28,208.28,1198.25,161,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 38792","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",38792,"HC INJ PROC;SENTINAL NODE ID",null,444,593.65,593.65,2063.4,111,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 40490","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",40490,"BIOPSY OF LIP",null,573,445.06,346.18,2032.26,143.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 40500","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",40500,"HC LIP SHAVE",null,4030,4335.57,1500.85,7703.8,1007.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 40500","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",40500,"HC LIP SHAVE",null,4030,3747.12,1500.85,7703.8,1007.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 40500","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",40500,"HC LIP SHAVE",null,4030,3747.12,1500.85,7703.8,1007.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 40520","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",40520,"HC PARTIAL EXCISION OF LIP",null,4029,3747.12,1500.85,7703.8,1007.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 40525","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",40525,"HC FULL THICK EXCIS LIP,RECON W FLAP",null,3896,4229.1400000000003,1500.85,7703.8,974,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 40525","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",40525,"HC FULL THICK EXCIS LIP,RECON W FLAP",null,3896,3747.12,1500.85,7703.8,974,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 40530","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",40530,"HC PARTIAL REMOVAL OF LIP,>1/4",null,3896,3747.12,1500.85,7703.8,974,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 40530","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",40530,"HC PARTIAL REMOVAL OF LIP,>1/4",null,3896,3747.12,1500.85,7703.8,974,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 40650","TUFTS","TUFTS HMO","CPT",40650,"HC REPAIR LIP,FULL THICK,VERMILION",null,691,7467.76,818.07,11845.41,172.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 40650","TUFTS","TUFTS PPO","CPT",40650,"HC REPAIR LIP,FULL THICK,VERMILION",null,691,7467.76,818.07,11845.41,172.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 40650","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",40650,"HC REPAIR LIP,FULL THICK,VERMILION",null,691,818.07,818.07,11845.41,172.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 40650","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",40650,"HC REPAIR LIP,FULL THICK,VERMILION",null,691,818.07,818.07,11845.41,172.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 40650","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",40650,"HC REPAIR LIP,FULL THICK,VERMILION",null,691,818.07,818.07,11845.41,172.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 40654","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",40654,"HC REPAIR LIP,>1/2 VERT HEIGHT",null,2007,2148.08,1990.62,11845.41,501.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 40800","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",40800,"HC DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL",null,1027,1250.8,317.70999999999998,1250.8,256.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 40800","TUFTS","TUFTS SELECT","CPT",40800,"HC DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL",null,1027,317.70999999999998,317.70999999999998,1250.8,256.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 40801","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",40801,"DRG ABSC CST HMTMA VESTIBULE MOUTH COMP",null,1723,818.07,818.07,7703.8,430.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 40804","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",40804,"HC REM FB,MOUTH;SIMP",null,1058,1644.19,171.09,1644.19,264.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 40804","TUFTS","TUFTS HMO","CPT",40804,"HC REM FB,MOUTH;SIMP",null,1058,320.41000000000003,171.09,1644.19,264.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 40804","TUFTS","TUFTS SELECT","CPT",40804,"HC REM FB,MOUTH;SIMP",null,1058,171.09,171.09,1644.19,264.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 40805","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",40805,"HC REMOVAL FOREIGN BODY,MOUTH,COMPLEX",null,658,1051.71,818.07,7703.8,164.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 40805","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",40805,"HC REMOVAL FOREIGN BODY,MOUTH,COMPLEX",null,658,818.07,818.07,7703.8,164.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 40806","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",40806,"INCISION OF LIP FOLD",null,667,1025.9000000000001,684.11,2032.26,166.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 40806","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",40806,"INCISION OF LIP FOLD",null,667,2032.26,684.11,2032.26,166.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 40806","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",40806,"INCISION OF LIP FOLD",null,667,818.07,684.11,2032.26,166.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 40808","TUFTS","TUFTS SELECT","CPT",40808,"BIOPSY VESTIBULE MOUTH",null,848,684.11,684.11,2032.26,212,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 40810","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",40810,"EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR",null,2094,4335.57,1098.98,4335.57,523.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 40810","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",40810,"EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR",null,2094,4335.57,1098.98,4335.57,523.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 40810","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",40810,"EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR",null,2094,3747.12,1098.98,4335.57,523.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 40810","BLUE CROSS","BLUE CROSS-PPO","CPT",40810,"EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR",null,2094,3747.12,1098.98,4335.57,523.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 40812","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",40812,"EXC LES MUCOSA & SBMCSL VESTIBULE SMPL RPR",null,2094,4229.1400000000003,1098.98,4335.57,523.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 40812","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",40812,"EXC LES MUCOSA & SBMCSL VESTIBULE SMPL RPR",null,2094,3747.12,1098.98,4335.57,523.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 40814","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",40814,"HC EXCIS MOUTH MUCOSA/SUB,COMPLX REPR",null,3197,3747.12,1500.85,7703.8,799.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 40816","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",40816,"EXC LES MUCOSA&SBMCSL VESTIBULE CPLX EXC MUSC",null,3197,3747.12,1500.85,7703.8,799.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 40819","TUFTS","TUFTS POS","CPT",40819,"EXC FRENUM LABIAL/BUCCAL",null,1836,2058.17,1098.98,3264.67,459,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 40820","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",40820,"HC DESTRUC MOUTH LESION/SCAR",null,3301,3747.12,1098.98,4335.57,825.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 40830","TUFTS","TUFTS POS","CPT",40830,"HC CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/<",null,268,1281.21,346.18,2032.26,67,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 40830","TUFTS","TUFTS PPO","CPT",40830,"HC CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/<",null,268,1281.21,346.18,2032.26,67,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 40831","TUFTS","TUFTS HMO","CPT",40831,"HC REPAIR MOUTH LACERATION,>2.5 CM",null,691,2057.7399999999998,818.07,3264.67,172.75,1]
["OUTPATIENT","AETNA - AETNA - CPT - 40831","AETNA","AETNA","CPT",40831,"HC REPAIR MOUTH LACERATION,>2.5 CM",null,691,1198.25,818.07,3264.67,172.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 40831","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",40831,"HC REPAIR MOUTH LACERATION,>2.5 CM",null,691,818.07,818.07,3264.67,172.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 40831","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",40831,"HC REPAIR MOUTH LACERATION,>2.5 CM",null,691,818.07,818.07,3264.67,172.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 40840","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",40840,"HC RECONSTRUC MOUTH ANTERIOR",null,6641,8596.73,1500.85,8596.73,1660.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 40840","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",40840,"HC RECONSTRUC MOUTH ANTERIOR",null,6641,8596.73,1500.85,8596.73,1660.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 40842","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",40842,"HC RECONSTRUC MOUTH POSTER,UNILAT",null,6641,8385.69,1990.62,11845.41,1660.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 40842","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",40842,"HC RECONSTRUC MOUTH POSTER,UNILAT",null,6641,8596.73,1990.62,11845.41,1660.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 40842","AETNA","AETNA","CPT",40842,"HC RECONSTRUC MOUTH POSTER,UNILAT",null,6641,1990.62,1990.62,11845.41,1660.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 40845","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",40845,"HC RECONSTRUC MOUTH COMPLEX",null,7214,8596.73,2354.5,15242.01,1803.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 41006","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",41006,"HC INTRAORAL I&D TONGUE/FLOOR SUBLNGL DP SPRMLHYD",null,1709,2485.42,1098.98,3264.67,427.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 36002","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",36002,"HC INJECTION RX EXTREMITY PSEUDOANEURYSM",null,818,1338.6,317.70999999999998,1338.6,204.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 36223","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",36223,"HC SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART",null,4429,7349.8,1500.85,15242.01,1107.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 36254","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",36254,"HC SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I",null,4429,4436.09,1500.85,11845.41,1107.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 43193","TUFTS","TUFTS HMO","CPT",43193,"HC ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY",null,2317,4856.75,1198.25,7703.8,579.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 43248","TUFTS","TUFTS HMO","CPT",43248,"HC UPR GI NDSC INSJ GUIDE WIRE DILAT ESOPHAGUS",null,1449,4856.75,1010.64,7703.8,362.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 43260","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",43260,"HC ERCP DX W/WO COLLJ SPEC BRUSHING/WASHING SPX",null,2660,4743.7,1500.85,7703.8,665,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 44180","TUFTS","TUFTS HMO","CPT",44180,"HC LAP, SURG ENTEROLYSIS",null,7452,9609.09,1990.62,15242.01,1863,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 44378","BLUE CROSS","BLUE CROSS-PPO","CPT",44378,"HC ENTEROSCOPY > 2ND PRTN ILEUM CONTROL BLEEDING",null,3165,2491.1,1013.38,7703.8,791.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 45190","AETNA","AETNA","CPT",45190,"HC DESTRUCT,RECTAL TUMOR,TRANSANAL APPROACH",null,3504,1500.85,1500.85,15242.01,876,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 45389","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",45389,"HC COLONOSCOPY FLX WITH ENDOSCOPIC STENT PLACEMENT",null,1378,7550.56,1098.98,8736.31,344.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 41009","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",41009,"HC I&D MOUTH/TONG INTRA, MASTICATOR",null,2270,1051.71,684.11,2032.26,567.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 41823","TUFTS","TUFTS HMO","CPT",41823,"HC EXCIS OSSEOUS TUBER,DENTOALV",null,6641,4856.75,1500.85,8596.73,1660.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 42104","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",42104,"EXC LESION PALATE UVULA W/O CLOSURE",null,2094,4335.57,1500.85,7703.8,523.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 49424","TUFTS","TUFTS PPO","CPT",49424,"HC INJ CONT ABS/CY EVAL",null,290,0,94.18,1198.25,72.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 50431","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",50431,"HC NJX ANTGRD NPHRSTGRM &/OR URTRGRM COMPL DIAG INCL IMG GUI RAD S&I; EXSTNG ACCES",null,844,1213.9000000000001,944.22,3176.09,211,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 50593","TUFTS","TUFTS HMO","CPT",50593,"HC ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY",null,12512,9609.09,2397.88,15242.01,3128,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 51726","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",51726,"BLADDER PRESSURE MEASUREMENT DURING FILLING",null,2050,487.37,388.64,2518.29,512.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 54056","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",54056,"DSTRJ LESION PENIS SIMPLE CRYOSURGERY",null,852,508.23,171.09,508.23,213,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 54700","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",54700,"I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE",null,2985,3380.52,1500.85,7703.8,746.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 56515","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",56515,"DESTRUCTION LESIONS VULVA EXTENSIVE",null,2598,2601.27,1990.62,11845.41,649.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 57100","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",57100,"BIOPSY VAGINAL MUCOSA SIMPLE",null,549,937.16,937.16,3264.67,137.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 46220","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",46220,"EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS",null,2442,3264.67,1098.98,3264.67,610.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 47382","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",47382,"HC ABLTJ 1/> LVR TUM PRQ RF",null,5817,7718.14,2166.09,15242.01,1454.25,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MCO - CPT - 47383","BMC HEALTHNET","BMCHN MCO","CPT",47383,"HC ABLATION 1/> LIVER TUMOR PERQ CRYOABLATION",null,7189,0,2397.88,15242.01,1797.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 61645","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",61645,"HC PERQ ARTERIAL TRANSLUMINAL M-THROMBECTOMY & OR INFUSION",null,5444,2084.5,2084.5,15242.01,1361,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 62304","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",62304,"MYELOGRAPHY VIA LUMBAR INJECT RS&I LUMBOSACRAL",null,862,1456.83,1098.98,3264.67,215.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 64425","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",64425,"INJECTION ANES ILIOINGUINAL ILIOHYPOGASTRIC NRVS",null,736,1261.0899999999999,310.58,2032.26,184,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 64493","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",64493,"NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL",null,2074,4375.87,829.82,4375.87,518.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 64569","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",64569,"HC REVISE/REPLACE CRANIAL NERVE STIM ELECTRODE/CONNECT PULSE GEN",null,8974,10041.84,1500.85,11618.83,2243.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 57511","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",57511,"HC CRYOCAUTERY OF CERVIX",null,409,458.47,317.70999999999998,1198.25,102.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 58345","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",58345,"HC REOPEN FALLOPIAN TUBE, TRANSCERV CATH",null,3412,3965.45,1098.98,4588.18,853,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 65855","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",65855,"TRABECULOPLASTY LASER SURG 1/> SESSIONS",null,2309,3264.67,833.27,3264.67,577.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 66682","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",66682,"HC REPAIR IRIS & CILIARY BODY",null,3062,3725.22,1500.85,7703.8,765.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 66985","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",66985,"INSERT LENS PROSTHESIS ONLY",null,3062,3219.62,2398.64,7703.8,765.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 67105","TUFTS","TUFTS SELECT","CPT",67105,"RPR RETINAL DTCHMNT 1/> SES PC W/WO DRG SUBRETI",null,4946,1098.98,833.27,3264.67,1236.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 67420","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",67420,"HC EXPLORE/TREAT EYE SOCKET",null,4867,4996.58,2354.5,15242.01,1216.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 67923","BLUE CROSS","BLUE CROSS-PPO","CPT",67923,"HC REPAIR ENTROPION EXCISION TARSAL WEDGE",null,2949,3044.16,2166.09,11845.41,737.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 68320","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",68320,"HC CONJUNCTIVOPLASTY W/GRF/XTNSV REARRANGEMENT",null,2949,3522.21,2166.09,11845.41,737.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 68801","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",68801,"DILATION LACRIMAL PUNCTUM W/WO IRRGATION",null,830,733.22,171.09,751.68,207.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 69105","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",69105,"BIOPSY EXTERNAL AUDITORY CANAL",null,2094,2148.08,1098.98,3264.67,523.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 64646","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",64646,"CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES",null,856,1005.62,684.11,2032.26,214,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 65222","TUFTS","TUFTS HMO","CPT",65222,"RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP",null,449,595.01,178.83,943.8,112.25,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 70496","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",70496,"HC CHG CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST",null,4798,527.79999999999995,347.19,2420.09,1199.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 70551","TUFTS","TUFTS POS","CPT",70551,"HC CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL",null,4113,882.67,396.79,2653.95,1028.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 72081","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",72081,"XRAY EXAM ENTIRE SPINE INCLUDING SKULL, CERV AND SACRAL SPINE; 1 VIEW",null,213,107.22,72.290000000000006,801.26,53.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 72149","TUFTS","TUFTS POS","CPT",72149,"HC CHG MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL",null,4538,1430.06,637.16,4299.8,1134.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 72156","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",72156,"HC CHG MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL",null,5367,1105.27,664.1,4707.1099999999997,1341.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 72265","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",72265,"HC CHG MYELOGRAPY LUMBOSACRAL RS&I",null,1195,1190.5,308.97000000000003,7066.23,298.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 73202","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",73202,"HC CHG CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL",null,3140,577.83000000000004,347.19,2420.09,785,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 73706","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",73706,"HC CHG CT ANGIOGRAPHY LOWER EXTREMITY",null,3840,527.79999999999995,347.19,2420.09,960,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 70140","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",70140,"HC CHG RADEX FACIAL BONES < 3 VIEWS",null,288,801.26,72.290000000000006,801.26,72,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 70320","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",70320,"RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH",null,498,2060.09,136.68,2060.09,124.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 70450","BLUE CROSS","BLUE CROSS-PPO","CPT",70450,"HC CHG CT HEAD/BRAIN W/O CONTRAST MATERIAL",null,1569,322.25,193.63,1274.24,392.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 74740","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",74740,"HC CHG HYSTEROSALPINGOGRAPHY RS&I",null,792,396.79,303.20999999999998,2562.5700000000002,198,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 75831","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",75831,"HC CHG VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I",null,4288,4546.0600000000004,780.65,31186.53,1072,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 76010","TUFTS","TUFTS PPO","CPT",76010,"HC CHG RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD",null,249,285.07,72.290000000000006,801.26,62.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 76512","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",76512,"OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN",null,867,147.96,147.96,1274.24,216.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 76642","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",76642,"US BREAST UNI REAL TIME WITH IMAGE LIMITED",null,471,81.93,81.93,932.7,117.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 76826","TUFTS","TUFTS POS","CPT",76826,"ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD",null,1251,1001.95,142.59,3012.56,312.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 77046","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",77046,"HC MRI BREAST C- UNILATERAL",null,356,660.39,396.79,2720.22,89,1]
["OUTPATIENT","AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 77066","AETNA","AETNA-MEDICARE ADVANTAGE","CPT",77066,"HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",null,1041,169.31,114.75,1410.44,260.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 74176","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",74176,"HC CHG CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL",null,2117,660.39,396.79,2562.5700000000002,529.25,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 74360","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",74360,"HC CHG INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I",null,349,227.11,213.77,272.52999999999997,87.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 74360","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",74360,"HC CHG INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I",null,349,213.77,213.77,272.52999999999997,87.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 78216","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",78216,"HC LIVER&SPLEEN IM;W/FLO",null,1086,608.36,430.8,4270.45,271.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 78315","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",78315,"HC CHG BONE &/JOINT IMAGING 3 PHASE STUDY",null,3304,464.88,394.65,4270.45,826,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 78582","TUFTS","TUFTS PPO","CPT",78582,"HC CHG PULMONARY VENTILATION & PERFUSION IMAGING",null,3009,1957.69,524.19000000000005,5502.59,752.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 78835","TUFTS","TUFTS POS","CPT",78835,"HC RP QUAN MEAS SINGLE AREA",null,1832,0,375.38,375.38,458,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 80053","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT",80053,"HC CHG COMPREHENSIVE METABOLIC PANEL","QW",375,15.31,9.6300000000000008,118.56,93.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 77301","BLUE CROSS","BLUE CROSS-PPO","CPT",77301,"HC IMRT PLAN",null,16122,3429.66,1340.75,14341.71,4030.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 77399","TUFTS","TUFTS HMO","CPT",77399,"HC UNLISTED MED PHYSICS PROC",null,346,588.29,160.66,1474.02,86.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 77522","BLUE CROSS","BLUE CROSS-PPO","CPT",77522,"PROTON BEAM DEL,SINGLE, W/COMPENSAT",null,1883,3104.64,925.54,13219.58,470.75,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 80299","TUFTS","TUFTS MEDICARE SCO","CPT",80299,"HC INFLIXIMAB DRUG CONC. AND ANTI-INFLIXIMAB AB",null,718,27.03,13.77,180.75,179.5,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN ACO - CPT - 80345","BMC HEALTHNET","BMCHN ACO","CPT",80345,"HC CHG DRUG SCREENING BARBITURATES",null,95,0,16.41,105.68,23.75,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MEDICAID - CPT - 81001","BMC HEALTHNET","BMCHN MEDICAID","CPT",81001,"URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY",null,17,2.9,2.9,35.659999999999997,4.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 81025","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT",81025,"URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS",null,32,21.66,6.36,83.47,8,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MEDICAID - CPT - 81223","BMC HEALTHNET","BMCHN MEDICAID","CPT",81223,"HC CFTR GENE ANALYSIS FULL GENE SEQUENCE",null,1523,0,499,1255.58,380.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 81254","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT",81254,"HC CHG GJB6 GENE ANALYSIS COMMON VARIANTS",null,51,88.07,35,88.07,12.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 81261","TUFTS","TUFTS POS","CPT",81261,"IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED; PRO/TECH",null,737,739.22,180.6,2222.63,184.25,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 81276","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",81276,"HC CHG KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)",null,3198,260.54000000000002,142.78,1874.37,799.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 80145","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT",80145,"HC DRUG ASSAY ADALIMUMAB",null,91,97.05,38.57,206.18,22.75,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 80177","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT",80177,"DRUG SCREEN QUANTITATIVE LEVETIRACETAM",null,174,18.28,12.09,148.84,43.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 81405","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT",81405,"HC MOPATH PROCEDURE LEVEL 6",null,629,758.26,301.35000000000002,758.26,157.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 81479","BLUE CROSS","BLUE CROSS-PPO","CPT",81479,"HC CHG UNLISTED MOLELCULAR PATHOLOGY PROCEDURE",null,1744,100.02,100.02,100.02,436,1]
["OUTPATIENT","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 82040","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT",82040,"HC CHG ALBUMIN SERUM PLASMA/WHOLE BLOOD",null,26,5.94,4.51,55.55,6.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 82139","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",82139,"HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE",null,98,40.46,14.65,189.43,24.5,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MCO - CPT - 82157","BMC HEALTHNET","BMCHN MCO","CPT",82157,"HC CHG ANDROSTENEDIONE",null,141,26.7,26.7,328.66,35.25,1]
["OUTPATIENT","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 82248","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT",82248,"HC CHG BILIRUBIN DIRECT",null,26,6.02,4.57,56.28,6.5,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 82308","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT",82308,"HC CHG CALCITONIN",null,128,33.17,24.44,300.82,32,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 82379","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT",82379,"HC CRL;CARNITINE",null,52,20.88,14.65,189.43,13,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 81288","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",81288,"MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS",null,1882,415.22,142.1,1865.32,470.5,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81305","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT",81305,"HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT",null,223,0,130.97,1701.28,55.75,1]
["OUTPATIENT","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 81331","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT",81331,"HC PRADER-WILLI/ANGELMAN",null,301,88.86,51.07,128.5,75.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 82627","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",82627,"HC CHG DEHYDROEPIANDROSTERONE-SULFATE",null,110,53.35,20.28,249.67,27.5,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 82677","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT",82677,"HC CHG ASSAY OF ESTRIOL",null,90,26.02,22.05,271.39,22.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 82785","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT",82785,"HC CHG ASSAY OF GAMMAGLOBULIN IGE",null,82,41.42,15.01,184.75,20.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 82810","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",82810,"HC BLOOD GASSES O2 SAT ONLY",null,52,19.760000000000002,7.96,98.14,13,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 82960","TUFTS","TUFTS PPO","CPT",82960,"HC CHG GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN",null,29,24.14,5.52,67.86,7.25,1]
["OUTPATIENT","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 83001","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT",83001,"HC CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE",null,93,22.3,16.95,208.59,23.25,1]
["OUTPATIENT","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 83050","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT",83050,"HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE",null,37,14.27,6.69,82.45,9.25,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 83516","TUFTS","TUFTS MEDICARE SCO","CPT",83516,"HC CRL;TTG AB,IGA",null,55,16.72,10.52,129.47999999999999,13.75,1]
["OUTPATIENT","ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 83525","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT",83525,"HC CHG ASSAY OF INSULIN TOTAL",null,57,11.43,10.43,128.30000000000001,14.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 82525","TUFTS","TUFTS POS","CPT",82525,"HC CHG ASSAY OF COPPER",null,62,46.33,11.32,139.30000000000001,15.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 82525","TUFTS","TUFTS PPO","CPT",82525,"HC CHG ASSAY OF COPPER",null,62,49.56,11.32,139.30000000000001,15.5,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN WELL SENSE - CPT - 82595","BMC HEALTHNET","BMCHN WELL SENSE","CPT",82595,"HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE",null,33,12.79,5.9,72.55,8.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 21085","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",21085,"HC IMPRESSION & PREPARATION ORAL SURGICAL SPLINT",null,691,445.06,346.18,17023.61,172.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 21244","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",21244,"HC RECONSTR MANDIBLE,BONE PLATE",null,7214,7429.92,2531.06,15242.01,1803.5,1]
["OUTPATIENT","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 84155","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT",84155,"HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD",null,20,6.39,3.35,41.16,5,1]
["OUTPATIENT","AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 84202","AETNA","AETNA-MEDICARE ADVANTAGE","CPT",84202,"HC Q;ERYTH PROTPOR",null,23,16.93,13.09,161.07,5.75,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MCO - CPT - 84244","BMC HEALTHNET","BMCHN MCO","CPT",84244,"HC CHG ASSAY OF RENIN",null,106,20.059999999999999,20.059999999999999,246.86,26.5,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 87426","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT",87426,"SARSCOV CORONAVIRUS AG IA",null,100,16.54,10.94,88.9,25,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 87480","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",87480,"HC CHG IADNA CANDIDA SPECIES DIRECT PROBE TQ",null,157,27.03,18.29,225.1,39.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 97140","TUFTS","TUFTS POS","CPT",97140,"HC MANUAL THER TECH,1+REGIONS,EA 15 MIN",null,145,103.37,47.1,175.4,36.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 97597","AETNA","AETNA","CPT",97597,"DEBRIDEMENT OPEN WOUND 20 SQ CM/<",null,625,1198.25,98.22,1198.25,156.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 98967","TUFTS","TUFTS PPO","CPT",98967,"NONPHYSICIAN TELEPHONE ASSESSMENT 11-20 MIN",null,72,38.6,38.6,108.49,18,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 99195","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",99195,"PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE",null,454,229.89,178.83,607.66,113.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 22514","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",22514,"PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR",null,22040,9571.73,1990.62,17023.61,5510,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 23545","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",23545,"CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION",null,1738,378,378,3264.67,434.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 84311","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",84311,"HC CHG SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED",null,32,15.81,6.38,79.27,8,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 84430","TUFTS","TUFTS PPO","CPT",84430,"HC CHG ASSAY OF THIOCYANATE",null,58,46.47,10.61,130.62,14.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 84442","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",84442,"HC CHG ASSAY OF THYROXINE BNDNG GLOBULIN",null,92,35.47,13.48,166,23,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA - CPT - 87510","CIGNA HEALTHCARE","CIGNA","CPT",87510,"HC CHG IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ",null,157,90.36,18.29,225.1,39.25,1]
["OUTPATIENT","FALLON - FALLON MEDICAID - CPT - 87591","FALLON","FALLON MEDICAID","CPT",87591,"HC CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ",null,129,32.01,32.01,393.99,32.25,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 87631","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",87631,"HC INFLUENZA A/B,RSV PCR","QW",504,192.29,103.92,1440.32,126,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 99385","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",99385,"INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS",null,411,239.07,33.74,286.88,102.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 23665","BLUE CROSS","BLUE CROSS-PPO","CPT",23665,"CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ",null,1757,2205.59,1500.85,7703.8,439.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 24600","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",24600,"TREATMENT CLOSED ELBOW DISLOCATION W/O ANES",null,2540,378,378,3264.67,635,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 25031","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",25031,"HC DRAINAGE OF FOREARM BURSA",null,2020,2205.59,1500.85,7703.8,505,1]
["OUTPATIENT","TUFTS - TUFTS SPIRIT - CPT - 84479","TUFTS","TUFTS SPIRIT","CPT",84479,"HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO",null,33,7.12,5.9,72.55,8.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 84481","TUFTS","TUFTS HMO","CPT",84481,"HC CHG ASSAY OF TRIIODOTHYRONINE T3 FREE",null,83,75.900000000000006,15.46,190.17,20.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 84591","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",84591,"HC CHG ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED",null,58,36.83,12.6,165.43,14.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 87640","TUFTS","TUFTS HMO","CPT",87640,"HC CHG IADNA S AUREUS AMPLIFIED PROBE TQ",null,194,157.24,32.01,393.99,48.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 87660","TUFTS","TUFTS PPO","CPT",87660,"HC CHG IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ",null,157,80.08,18.29,225.1,39.25,1]
["OUTPATIENT","TUFTS - TUFTS SPIRIT - CPT - 87801","TUFTS","TUFTS SPIRIT","CPT",87801,"HC CHG DETECT AGENT, MULT ORGS, DNA  AMP",null,310,77.22,64.03,787.98,77.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 25605","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",25605,"CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF",null,3956,2205.59,1098.98,3264.67,989,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 26750","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",26750,"CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA",null,1413,378,317.70999999999998,943.8,353.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 27048","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",27048,"EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC <5CM",null,1528,4621.25,1990.62,11845.41,382,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA PPO - CPT - 85018","CIGNA HEALTHCARE","CIGNA PPO","CPT",85018,"POC;HEMOGLOBIN",null,12,6.03,2.16,26.61,3,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 85045","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT",85045,"HC CHG BLOOD COUNT RETICULOCYTE AUTOMATED",null,22,5.5,3.64,44.83,5.5,1]
["OUTPATIENT","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 85220","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT",85220,"HC CHG CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR",null,90,21.18,16.100000000000001,198.11,22.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA - CPT - 88142","CIGNA HEALTHCARE","CIGNA","CPT",88142,"CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN",null,101,91.29,18.48,227.42,25.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 88165","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",88165,"HC CHG CYTP SLIDES C/V MNL SCR&RESCR PHYS SUPV",null,52,91.15,13.16,409.48,13,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 27252","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",27252,"HC TX HIP DISLOC W/ANESTH",null,2025,2489.31,1500.85,7703.8,506.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 27337","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",27337,"EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/>",null,3207,3994.03,1990.62,11845.41,801.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 27750","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",27750,"CLTX TIBIAL SHAFT FX W/O MANIPULATION",null,2433,3264.67,378,3264.67,608.25,1]
["OUTPATIENT","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 85260","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT",85260,"HC CHG CLOTTING FACTOR X STUART-PROWER",null,91,39.56,16.329999999999998,200.93,22.75,1]
["OUTPATIENT","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 85303","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT",85303,"HC CHG CLOTTING INHIBITORS PROTEIN C ACTIVITY",null,62,13.84,12.62,155.28,15.5,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 85366","TUFTS","TUFTS MEDICARE SCO","CPT",85366,"HC CHG FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ",null,38,116.67,10.33,780.44,9.5,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN WELL SENSE - CPT - 88313","BMC HEALTHNET","BMCHN WELL SENSE","CPT",88313,"HC CHG SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT",null,483,29.44,29.44,366.72,120.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 88356","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",88356,"CHG ANALYSIS, NERVE TECH",null,836,650.54999999999995,67.040000000000006,683.56,209,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 38200","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",38200,"HC INJ PROC SPLENOPORTO",null,1095,0,1198.25,1198.25,273.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 38510","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",38510,"HC BX/REMV,LYMPH NODE,DEEP CERV",null,4506,5471.79,1500.85,7703.8,1126.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 40820","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",40820,"HC DESTRUC MOUTH LESION/SCAR",null,3301,3747.12,1098.98,4335.57,825.25,1]
["OUTPATIENT","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 85549","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT",85549,"HC CHG MURAMIDASE",null,91,25.72,17.100000000000001,210.55,22.75,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 85613","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",85613,"HC CHG RUSSELL VIPER VENOM DILUTED",null,13,12.92,8.23,107.56,3.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 88380","TUFTS","TUFTS PPO","CPT",88380,"HC CHG MICRODISSECTION PREP IDENTIFIED TARGET LASER",null,3123,0,28.59,161.54,780.75,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 89320","TUFTS","TUFTS HMO","CPT",89320,"SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT",null,118,53.99,10.99,135.27000000000001,29.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90662","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",90662,"INFLUENZA VACCINE CELL CULT PRSRV FREE IM FLUZONE HIGH DOSE",null,129,70.13,60.98,244.17,32.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 29700","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",29700,"REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST",null,262,395.63,374.59,1193.8800000000001,65.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 30140","TUFTS","TUFTS POS","CPT",30140,"HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL",null,3301,4856.75,1500.85,7703.8,825.25,1]
["OUTPATIENT","AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 85732","AETNA","AETNA-MEDICARE ADVANTAGE","CPT",85732,"HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA",null,33,7.63,5.9,72.55,8.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 86022","TUFTS","TUFTS SELECT","CPT",86022,"HC CRL;SEROTONIN RLS ASSAY",null,265,32.03,16.760000000000002,206.23,66.25,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN WELL SENSE - CPT - 86157","BMC HEALTHNET","BMCHN WELL SENSE","CPT",86157,"HC CHG COLD AGGLUTININ TITER",null,38,20.49,7.35,90.48,9.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 90836","BLUE CROSS","BLUE CROSS-PPO","CPT",90836,"PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 45 MIN",null,27,196.74,196.74,196.74,6.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 91038","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",91038,"ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG",null,2395,982.93,764.57,4429.7299999999996,598.75,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 33289","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT",33289,"HC TCAT IMPL WRLS P-ART PRS SNR L-T HEMODYN MNTR",null,45145,0,2531.06,62742.78,11286.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 36227","BLUE CROSS","BLUE CROSS-PPO","CPT",36227,"HC SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC",null,1026,292.08999999999997,292.08999999999997,1198.25,256.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 86160","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT",86160,"HC CHG COMPLEMENT ANTIGEN EACH COMPONENT",null,61,30.19,10.94,134.62,15.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA - CPT - 86300","CIGNA HEALTHCARE","CIGNA","CPT",86300,"HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3",null,96,93.78,18.989999999999998,233.69,24,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 86308","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",86308,"HC CHG HETEROPHILE ANTIBODIES SCREEN",null,24,11.86,4.72,58.08,6,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 92134","TUFTS","TUFTS SELECT","CPT",92134,"COMPUTERIZED OPHTHALMIC IMAGING RETINA",null,226,99.57,68.75,562.35,56.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 92312","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",92312,"HC CONTACT LENS FIT,APHAKIA BILAT",null,163,229.89,93.14,587.33000000000004,40.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 92523","TUFTS","TUFTS POS","CPT",92523,"EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION",null,912,700.25,279.74,1188.2,228,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 41108","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",41108,"BIOPSY FLOOR MOUTH",null,1103,2309.9699999999998,684.11,2672.73,275.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 41251","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",41251,"HC REPAIR TONGUE LACER,POST 1/3",null,310,346.18,346.18,2032.26,77.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 42408","AETNA","AETNA","CPT",42408,"HC EXCISION SUBLING SALIVARY CYST",null,3896,1990.62,1990.62,11845.41,974,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 86382","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT",86382,"HC CHG NEUTRALIZATION TEST VIRAL",null,324,20.94,15.43,189.88,81,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA PPO - CPT - 86485","CIGNA HEALTHCARE","CIGNA PPO","CPT",86485,"HC CHG SKIN TEST CANDIDA",null,60,10.72,10.72,280.56,15,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 86606","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",86606,"HC CHG ANTIBODY ASPERGILLUS",null,71,35.229999999999997,13.74,169.1,17.75,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 92562","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT",92562,"LOUDNESS BALANCE BINAURAL/MONAURAL",null,215,0,59.1,1274.6400000000001,53.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 92620","BLUE CROSS","BLUE CROSS-PPO","CPT",92620,"EVAL CENTRAL AUDITORY FUNCJ W/REPRT 1ST 60 MIN",null,410,228.32,228.32,1391.25,102.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 0191T","TUFTS","TUFTS PPO","CPT","0191T","INSERT ANT SEGMENT DRAIN WO RESERVOIR, INTERNAL APPR, INTO TRABECULAR",null,5769,10732.28,1990.62,17023.61,1442.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 31267","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",31267,"HC NASAL/SINUS ENDOSCOPY,RMV TISS MAXILL SINUS",null,6192,11845.41,1990.62,11845.41,1548,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 31574","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",31574,"HC LARYNGOSCOPY FLEXIBLE W/INJECTION AGMNTJ UNI",null,2056,2660.67,1500.85,7703.8,514,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 31630","TUFTS","TUFTS HMO","CPT",31630,"HC BRONCHOSCOPY,TRACH/BRONCH DILATN",null,4368,4856.75,1500.85,7703.8,1092,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 86625","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",86625,"HC CAMPYLOBACTER, ANTIBODY",null,16,29.65,11.97,147.33000000000001,4,1]
["OUTPATIENT","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 86652","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT",86652,"HC CHG, ENCEPHAL ANTIBODY EAST EQU",null,66,15.83,12.03,148.07,16.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 92950","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",92950,"CARDIOPULMONARY RESUSCITATION",null,1712,423.72,423.72,2582.75,428,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 93283","UNICARE","UNICARE","CPT",93283,"PROGRM EVAL IMPLANTABLE IN PRSN DUAL L CARD/DFB",null,720,80.650000000000006,62.4,370.47,180,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 0202U","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",null,1355,0,null,null,338.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 10008","BLUE CROSS","BLUE CROSS-PPO","CPT",10008,"HC FNA BX W/FLUOR GDN EA ADDL",null,436,151.03,151.03,1198.25,109,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 10081","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",10081,"INCISION & DRAINAGE PILONIDAL CYST COMPLICATED",null,1356,3264.67,972.93,3264.67,339,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11200","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",11200,"REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15",null,559,380.96,296.32,1198.25,139.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 36555","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",36555,"HC INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y",null,1359,1836.61,1098.98,3264.67,339.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 36591","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",36591,"COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE",null,192,178.83,178.83,607.66,48,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 86677","TUFTS","TUFTS MEDICARE SCO","CPT",86677,"HC CHG ANTIBODY HELICOBACTER PYLORI",null,66,24.43,13.23,164.61,16.5,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 86694","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT",86694,"HC CHG ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST",null,34,19.850000000000001,13.13,161.6,8.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 86705","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",86705,"HC CHG HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY",null,60,27.55,10.74,132.21,15,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 93356","TUFTS","TUFTS POS","CPT",93356,"HC MYOCRD STRAIN IMG SPCKL TRCK",null,1869,0,null,null,467.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 93563","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",93563,"HC NJX SEL HRT ART CONGENITAL HRT CATH W/S&I",null,515,144.49,144.49,144.49,128.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 93609","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",93609,"HC INTRA-VENTRIC&/ATRIAL MAPG TACHYCARD W/CATH MA",null,2513,0,884.46,5539.84,628.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 11403","TUFTS","TUFTS SELECT","CPT",11403,"EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<",null,1130,1098.98,972.93,3264.67,282.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11600","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",11600,"HC EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG",null,870,972.93,972.93,3264.67,217.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 28010","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",28010,"TENOTOMY PERCUTANEOUS TOE SINGLE TENDON",null,2895,2205.59,1098.98,3264.67,723.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 28400","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",28400,"CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION",null,1743,485.97,378,3264.67,435.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 28495","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",28495,"CLTX FX GRT TOE PHLX/PHLG W/MANJ",null,1159,474.04,317.70999999999998,1198.25,289.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 86762","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",86762,"HC CHG ANTIBODY RUBELLA",null,70,32.28,13.13,161.6,17.5,1]
["OUTPATIENT","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 86765","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT",86765,"HC CHG ANTIBODY RUBEOLA",null,102,12.88,11.75,144.6,25.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 86803","TUFTS","TUFTS SELECT","CPT",86803,"HC CHG HEPATITIS C ANTIBODY",null,58,24.87,13.01,160.13,14.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 93650","BLUE CROSS","BLUE CROSS-PPO","CPT",93650,"HC ICAR CATHETER ABLATION ATRIOVENTR NODE FUNCTION",null,5358,8560.41,2531.06,17023.61,1339.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 93924","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",93924,"HC N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI",null,1746,1412.44,211.22,1412.44,436.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 12007","BLUE CROSS","BLUE CROSS-PPO","CPT",12007,"SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM",null,1144,296.32,296.32,7703.8,286,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 12032","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",12032,"REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM",null,1505,678.1,527.46,2032.26,376.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 13101","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",13101,"REPAIR COMPLEX TRUNK 2.6-7.5 CM",null,2180,810.95,684.11,2032.26,545,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 32550","TUFTS","TUFTS HMO","CPT",32550,"HC INS TUNN PLEURAL CATH W/U",null,4154,4856.75,1500.85,7703.8,1038.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 33215","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",33215,"HC RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE",null,2275,4436.09,1098.98,5132.74,568.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 33234","TUFTS","TUFTS PPO","CPT",33234,"HC RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR/VENTR",null,3634,2058.16,1098.98,6758.81,908.5,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 86880","TUFTS","TUFTS MEDICARE SCO","CPT",86880,"HC CHG ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM",null,142,7.82,4.91,366.72,35.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 86905","BLUE CROSS","BLUE CROSS-PPO","CPT",86905,"HC CHG BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH",null,87,360.63,3.49,2229.4299999999998,21.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 93970","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",93970,"HC DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY",null,630,387.2,300.69,2134.23,157.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 94450","TUFTS","TUFTS PPO","CPT",94450,"HYPOXIA RESPONSE CURVE",null,390,502.51,117.36,1412.44,97.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 95076","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",95076,"INGESTION CHALLENGE TEST INITIAL 120 MINUTES",null,629,764.57,764.57,2713.03,157.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 14060","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",14060,"ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<",null,5231,2601.27,1990.62,11845.41,1307.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 15731","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",15731,"FOREHEAD FLAP W/VASC PEDICLE",null,5186,4645.3599999999997,1990.62,7703.8,1296.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 15823","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",15823,"HC REV UPPER EYELID W EXCESS SKIN",null,2414,3344.2,2354.5,11845.41,603.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 37200","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",37200,"HC TRANSCATHETER BIOPSY",null,4034,7349.8,1098.98,8504.02,1008.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 37232","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",37232,"HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL",null,7580,497.3,497.3,1198.25,1895,1]
["OUTPATIENT","FALLON - FALLON MEDICAID - CPT - 87046","FALLON","FALLON MEDICAID","CPT",87046,"HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA",null,48,8.6199999999999992,6,105.97,12,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 87086","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",87086,"HC CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE",null,41,18.45,7.36,90.56,10.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 95149","TUFTS","TUFTS POS","CPT",95149,"PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 5 INSECT",null,78,203.7,100.35,345.64,19.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 95711","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",95711,"HC VEEG 2-12 HR UNMONITORED",null,377,544.74,407.35,2582.75,94.25,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 95861","UNICARE","UNICARE","CPT",95861,"NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS",null,726,371.29,178.83,1077.0999999999999,181.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 15852","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",15852,"HC DRESSING CHANGE,NOT FOR BURN",null,733,810.95,171.09,1198.25,183.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 19081","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",19081,"BX BREAST W/DEVICE 1ST LESION STEREOTACTIC GUID",null,1351,2309.9699999999998,1098.98,3264.67,337.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 83550","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",83550,"HC CHG IRON BINDING CAPACITY",null,44,19.760000000000002,7.97,98.14,11,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 83655","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",83655,"HC CHG ASSAY OF LEAD",null,58,27.01,11.05,135.91999999999999,14.5,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 83785","UNICARE","UNICARE","CPT",83785,"HC CHG, ASSAY OF MANGANESE",null,109,59.7,22.44,276.16000000000003,27.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 83873","TUFTS","TUFTS POS","CPT",83873,"HC CHG MYELIN BASIC PROTEIN CEREBROSPINAL FLUID",null,84,64.25,15.69,193.18,21,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 87185","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT",87185,"HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ",null,25,11.95,3.54,53.31,6.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA - CPT - 87205","CIGNA HEALTHCARE","CIGNA","CPT",87205,"HC CHG SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL",null,23,19.239999999999998,3.89,47.89,5.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 95908","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",95908,"MOTOR &/SENS 3-4 NRV CNDJ PRECONF ELTRODE LIMB",null,582,531.36,282.57,1457.53,145.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 95970","TUFTS","TUFTS SELECT","CPT",95970,"ELEC ALYS NSTIM PLS GEN BRN/SC/PERPH W/O REPRGRM",null,175,183.47,178.83,1036.18,43.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 96112","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",96112,"HC DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR",null,341,293.52,194.05,618.47,85.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 20200","BLUE CROSS","BLUE CROSS-PPO","CPT",20200,"HC MUSCLE BIOPSY",null,2043,2309.9699999999998,1500.85,7703.8,510.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 20610","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",20610,"ARTHROCENTESIS ASPIR&/INJECTION MAJOR JT/BURSA",null,381,415.61,317.70999999999998,1198.25,95.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 20950","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",20950,"HC RECORD FLUID PRESSURE,MUSCLE",null,860,1250.8,317.70999999999998,1250.8,215,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 83992","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT",83992,"HC CHG ASSAY OF PHENCYCLIDINE",null,71,22.92,15.16,162.9,17.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 83992","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",83992,"HC CHG ASSAY OF PHENCYCLIDINE",null,71,79.05,15.16,162.9,17.75,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 87254","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT",87254,"HC CHG VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA",null,98,24.21,12.44,219.59,24.5,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 87281","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT",87281,"HC CHG IAADI PNEUMOCUSTIS CARINII",null,57,14.85,10.94,134.54,14.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 87341","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",87341,"HC CHG IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION",null,51,24.79,9.42,115.95,12.75,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN ACO - CPT - 96146","BMC HEALTHNET","BMCHN ACO","CPT",96146,"HC PSYCL/NRPSYCL TST ELEC PLATFORM AUTO RESULT",null,341,0,36.159999999999997,129.58000000000001,85.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 96415","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",96415,"CHEMOTHERAPY ADMN IV INFUSION TQ EA HR",null,139,129,100.35,612.48,34.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 97022","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",97022,"HC APPLICATION MODALITY 1/> AREAS WHIRLPOOL",null,116,46.01,29.95,116.98,29,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MEDICAID - CPT - 86788","BMC HEALTHNET","BMCHN MEDICAID","CPT",86788,"HC CHG ANTIBODY WEST NILE VIRUS IGM",null,88,15.37,15.37,189.15,22,1]
["OUTPATIENT","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 86803","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT",86803,"HC CHG HEPATITIS C ANTIBODY","QW",58,17.12,13.01,160.13,14.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 44405","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",44405,"HC COLONOSCOPY STOMA W/BALLOON DILATION",null,1378,1645.44,1098.98,3264.67,344.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 45330","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",45330,"HC SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD",null,794,1250.94,420.29,3264.67,198.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 45382","TUFTS","TUFTS HMO","CPT",45382,"HC COLSC FLX PROX SPLENIC FLXR CTRL BLD",null,2540,2057.7399999999998,1020.59,3264.67,635,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 45398","BLUE CROSS","BLUE CROSS-PPO","CPT",45398,"HC COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S)",null,1378,1645.44,1098.98,3264.67,344.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 74425","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",74425,"UROGRAPHY ANTEGRADE RS&I",null,375,507.47,267.85000000000002,4285.49,93.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 75803","TUFTS","TUFTS PPO","CPT",75803,"HC LYPMH VESSEL XRAY ARM/LEG",null,1271,4109.0200000000004,321.11,11549.48,317.75,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 82941","UNICARE","UNICARE","CPT",82941,"HC CHG ASSAY OF GASTRIN",null,85,42.8,16.079999999999998,197.91,21.25,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 82951","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",82951,"HC CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS",null,64,12.87,11.74,144.52000000000001,16,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 82952","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",82952,"HC CHG GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS",null,15,10.45,3.58,43.98,3.75,1]
["OUTPATIENT","TUFTS - TUFTS SPIRIT - CPT - 86902","TUFTS","TUFTS SPIRIT","CPT",86902,"HC CHG BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH",null,87,6.99,4.6900000000000004,2272.4699999999998,21.75,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 87076","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT",87076,"HC CHG CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL",null,27,8.67,7.18,90.64,6.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 46020","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",46020,"PLACEMENT ON SETON",null,2694,11845.41,1990.62,11845.41,673.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 46606","TUFTS","TUFTS POS","CPT",46606,"ANOSCOPY W/BX SINGLE/MULTIPLE",null,1341,2058.17,420.29,3264.67,335.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 75805","TUFTS","TUFTS SELECT","CPT",75805,"HC LYMPH VES X-RAY TRUNK UNI",null,636,1947.7,321.11,12540.99,159,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 75970","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",75970,"HC CHG TRANSCATHETER BIOPSY RS&I",null,3286,0,632.41999999999996,816.53,821.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 76390","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",76390,"HC CHG MRI SPECTROSCOPY",null,4489,640.69000000000005,640.69000000000005,4256.72,1122.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 76604","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",76604,"HC CHG US CHEST REAL TIME W/IMAGE DOCUMENTATION",null,829,147.96,147.96,1274.24,207.25,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN WELL SENSE - CPT - 83002","BMC HEALTHNET","BMCHN WELL SENSE","CPT",83002,"HC CHG GONADOTROPIN LUTEINIZING HORMONE",null,93,36.619999999999997,16.89,207.81,23.25,1]
["OUTPATIENT","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 83050","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT",83050,"HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE",null,37,10.050000000000001,6.69,82.45,9.25,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 87107","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",87107,"HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD",null,51,10.32,9.41,115.87,12.75,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 87140","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT",87140,"HC CHG CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM",null,28,5.99,5.08,62.56,7,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 87172","TUFTS","TUFTS MEDICARE SCO","CPT",87172,"HC CHG PINWORM EXAMINATION",null,23,6.19,3.89,47.89,5.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 49406","TUFTS","TUFTS SELECT","CPT",49406,"IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ",null,2105,2593.31,1500.85,7703.8,526.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 50436","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",50436,"HC DILAT XST TRC NDURLGC PX",null,2677,2921.68,1098.98,3380.52,669.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 76706","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",76706,"HC CHG US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA",null,301,193.63,147.96,1274.24,75.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 76815","TUFTS","TUFTS SELECT","CPT",76815,"US PREGNANT UTERUS LIMITED 1/> FETUSES",null,864,197.9,98.34,1274.24,216,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 76857","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",76857,"US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U",null,919,193.63,98.34,1179.76,229.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 83520","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",83520,"HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE",null,63,31.63,12.76,167.51,15.75,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 83718","UNICARE","UNICARE","CPT",83718,"HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL",null,41,19.87,7.48,91.95,10.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 83735","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",83735,"HC CHG ASSAY OF MAGNESIUM",null,34,14.47,6.11,75.150000000000006,8.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA - CPT - 87207","CIGNA HEALTHCARE","CIGNA","CPT",87207,"SMR PRIM SRC SPEC STAIN BODIES/PARASITS",null,281,26.98,5.47,67.33,70.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 87209","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",87209,"HC CHG SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS",null,91,40.85,16.399999999999999,201.74,22.75,1]
["OUTPATIENT","FALLON - FALLON MEDICAID - CPT - 87255","FALLON","FALLON MEDICAID","CPT",87255,"HC CHG VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC",null,168,30.89,30.89,380.17,42,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 52005","BLUE CROSS","BLUE CROSS-PPO","CPT",52005,"HC CYSTOURETHROSCOPY,URETER CATHETER",null,2091,2921.68,1500.85,7703.8,522.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 53620","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",53620,"DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE 1ST",null,2441,944.22,944.22,11845.41,610.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 54235","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",54235,"NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT",null,550,1338.81,388.64,1338.81,137.5,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 77067","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",77067,"HC SCR MAMM CAD, BI",null,378,160.41,107.96,1165.46,94.5,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 77295","UNICARE","UNICARE","CPT",77295,"HC COMPUTER GEN PLAN  3D",null,3774,1608.9,1340.75,14341.71,943.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 83880","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",83880,"HC CHG NATRIURETIC PEPTIDE",null,169,84.76,30.96,384.74,42.25,1]
["OUTPATIENT","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 83918","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT",83918,"HC CHG ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN",null,62,41.06,17.440000000000001,228.93,15.5,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 83986","UNICARE","UNICARE","CPT",83986,"HC CHG PH BODY FLUID NOT ELSEWHERE SPECIFIED",null,20,8.68,3.27,40.229999999999997,5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 87305","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",87305,"HC CHG IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS",null,272,28.05,10.94,134.54,68,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 87327","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT",87327,"HC CHG IAAD IA CRYPTOCOCCUS NEOFORMANS",null,57,19.46,10.94,134.82,14.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 87420","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT",87420,"HC CHG IAAD IA RESPIRATORY SYNCTIAL VIRUS",null,57,29.29,10.94,136.04,14.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 55100","TUFTS","TUFTS PPO","CPT",55100,"DRAIN SCROTAL WALL ABS",null,1256,2058.16,1098.98,3264.67,314,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 57105","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",57105,"HC BIOPSY OF VAGINA",null,3805,7703.8,1500.85,7703.8,951.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 77334","TUFTS","TUFTS HMO","CPT",77334,"HC TX DEVICES COMP",null,1239,1553.49,269.72000000000003,3892.44,309.75,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 77407","TUFTS","TUFTS HMO","CPT",77407,"HC TX DEL => 1 MEV, 2 AREA, 3 PORTS - INTERMEDIATE",null,2226,726.21,143.49,1819.55,556.5,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 77772","UNICARE","UNICARE","CPT",77772,"HC HDR RDNCL NTRSTL/12+",null,4931,628.62,523.85,8624.5,1232.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 78216","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",78216,"HC LIVER&SPLEEN IM;W/FLO",null,1086,608.36,430.8,4270.45,271.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84146","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",84146,"HC CHG ASSAY OF PROLACTIN",null,97,43.48,17.670000000000002,217.56,24.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 84182","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",84182,"HC CHG PROTEIN, WESTERN BLOT TEST, W BAND",null,264,283.38,21.58,283.38,66,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 92072","TUFTS","TUFTS PPO","CPT",92072,"FITTING CONTACT LENS FOR MNGT OF KERATOCONUS",null,336,0,224.25,244.1,84,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 92310","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",92310,"RX&FITG C-LENS SUPVJ CRNL LENS OU XCPT APHK",null,20,145.02000000000001,58.01,751.68,5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 57454","AETNA","AETNA","CPT",57454,"COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE",null,1638,1500.85,458.47,2032.26,409.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 58100","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",58100,"ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX",null,683,358.24,278.66000000000003,1198.25,170.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 58561","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",58561,"HC HYSTEROSCOPY,RMV MYOMA",null,7714,6928.79,1990.62,11845.41,1928.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 59200","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",59200,"INSERTION CERVICAL DILATOR SEPARATE PROCEDURE",null,356,589.41,317.70999999999998,1198.25,89,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 78598","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",78598,"HC QUAN DIFF PERF/VENT,IMG",null,2826,783.95,524.19000000000005,5502.59,706.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 78802","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",78802,"HC CHG RP LOCLZJ TUMOR/DSTRBJ AGENT WHOLE BDY 1 DAY",null,3055,1616.75,425.49,12662.56,763.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 84244","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",84244,"HC CHG ASSAY OF RENIN",null,106,49.4,20.059999999999999,246.86,26.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 84307","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT",84307,"HC CHG ASSAY OF SOMATOSTATIN",null,515,46,16.670000000000002,205.12,128.75,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 84403","TUFTS","TUFTS MEDICARE SCO","CPT",84403,"HC CHG ASSAY OF TESTOSTERONE TOTAL",null,124,37.42,23.55,289.82,31,1]
["OUTPATIENT","TUFTS - TUFTS SPIRIT - CPT - 87529","TUFTS","TUFTS SPIRIT","CPT",87529,"HC CHG IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ",null,140,38.6,32.01,393.99,35,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN QHP - CPT - 87581","BMC HEALTHNET","BMCHN QHP","CPT",87581,"HC CHG IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ",null,127,38.409999999999997,32.01,393.99,31.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 59841","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",59841,"INDUCED ABORTION DILATION & EVAUCATION",null,2816,4475.54,2354.5,11845.41,704,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 59841","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",59841,"INDUCED ABORTION DILATION & EVAUCATION",null,2816,3965.45,2354.5,11845.41,704,1]
["OUTPATIENT","FALLON - FALLON MEDICAID - CPT - 61650","FALLON","FALLON MEDICAID","CPT",61650,"ENDOVASCULAR INTRACRANIAL PROLNG ADMN RX AGENT; INITIAL VASCULAR TERRITORY",null,3730,0,1377.69,1377.69,932.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 80048","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",80048,"HC CHG BASIC METABOLIC PANEL CALCIUM TOTAL",null,226,19.100000000000001,7.71,94.96,56.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 80074","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",80074,"HC CHG ACUTE HEPATITIS PANEL",null,391,114.28,43.45,534.79999999999995,97.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 80156","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",80156,"HC CHG DRUG ASSAY CARBAMAZEPINE TOTAL",null,72,32.94,13.28,163.47,18,1]
["OUTPATIENT","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 84445","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT",84445,"HC CHG THYROID STIMULATING IMMUNE GLOBULINS TSI",null,244,69.760000000000005,46.39,570.91,61,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 84480","TUFTS","TUFTS POS","CPT",84480,"HC CHG ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3",null,71,52.94,12.94,159.19,17.75,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 84591","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT",84591,"HC CHG ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED",null,58,15.12,12.6,165.43,14.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 88302","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",88302,"HC CHG LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM",null,180,42.24,36.799999999999997,310.36,45,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA PPO - CPT - 88329","CIGNA HEALTHCARE","CIGNA PPO","CPT",88329,"HC CHG PATHOLOGY CONSULTATION DURING SURGERY",null,110,99.61,42.24,364.6,27.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 64408","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",64408,"HC INJ,ANES;VAGUS NER",null,579,415.61,310.58,2032.26,144.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 64418","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",64418,"INJECTION ANESTHETIC AGENT SUPRASCAPULAR NERVE",null,575,1005.62,310.58,2032.26,143.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 64494","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",64494,"NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL",null,399,0,127.95,1198.25,99.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 80171","TUFTS","TUFTS PPO","CPT",80171,"DRUG SCREEN QUANTITATIVE GABAPENTIN",null,83,74.78,16.010000000000002,210.18,20.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 80195","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",80195,"HC CHG DRUG SCREEN QUANTITATIVE SIROLIMUS",null,35,32.950000000000003,10.01,154.22,8.75,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN WELL SENSE - CPT - 84597","BMC HEALTHNET","BMCHN WELL SENSE","CPT",84597,"HC CHG ASSAY OF VITAMIN K",null,149,27.09,12.52,154.06,37.25,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 85014","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT",85014,"HC CHG BLOOD COUNT HEMATOCRIT",null,12,2.93,2.16,26.61,3,1]
["OUTPATIENT","TUFTS - TUFTS SPIRIT - CPT - 85045","TUFTS","TUFTS SPIRIT","CPT",85045,"HC CHG BLOOD COUNT RETICULOCYTE AUTOMATED",null,22,4.3899999999999997,3.64,44.83,5.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 85220","TUFTS","TUFTS PPO","CPT",85220,"HC CHG CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR",null,90,70.48,16.100000000000001,198.11,22.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 92562","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",92562,"LOUDNESS BALANCE BINAURAL/MONAURAL",null,215,1274.6400000000001,59.1,1274.6400000000001,53.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 92609","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",92609,"HC USE OF SPEECH DEVICE SERVICE",null,309,272.39999999999998,139.9,790.1,77.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 64624","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",64624,"HC DSTRJ NULYT AGT GNCLR NRV",null,2182,2767.2,1198.25,7703.8,545.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 64647","TUFTS","TUFTS POS","CPT",64647,"CHEMODENERVATION OF TRUNK 6 OR MORE MUSCLES",null,988,1281.21,684.11,2032.26,247,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 65436","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",65436,"RMVL CORNEAL EPITHELIUM W/APPL CHELATING AGENT",null,2900,3044.16,1098.98,3522.21,725,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 80361","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",80361,"HC CHG DRUG SCREENING OPIATES 1 OR MORE",null,102,29.79,25.61,164.9,25.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 81180","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",81180,"HC CHG ATXN3 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES",null,175,295.77999999999997,102.3,1328.77,43.75,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MEDICAID - CPT - 81210","BMC HEALTHNET","BMCHN MEDICAID","CPT",81210,"HC CHG BRAF GENE ANALYSIS V600 VARIANT(S)",null,492,0,129.6,1701.28,123,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 85300","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT",85300,"HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY",null,57,17.18,10.81,133.03,14.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 85306","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",85306,"HC CHG CLOTTING INHIBITORS PROTEIN S FREE",null,69,34.26,13.98,172.07,17.25,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 85461","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT",85461,"HC CHG HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE",null,34,11.23,6.92,90.76,8.5,1]
["OUTPATIENT","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 87899","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT",87899,"HC MALARIA ANTIGEN","QW",94,15.71,11.87,155.81,23.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 87902","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",87902,"HC CHG NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS",null,437,581.03,112.85,2890.09,109.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 65860","TUFTS","TUFTS HMO","CPT",65860,"SEVERING ADHESIONS ANTERIOR SEGMENT LASER SPX",null,2164,2057.7399999999998,833.27,3264.67,541,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67005","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",67005,"HC RMVL VITREOUS ANT APPR PARTIAL REMOVAL",null,3062,3219.62,2166.09,11845.41,765.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 67039","TUFTS","TUFTS POS","CPT",67039,"HC VITRECTOMY,FOCAL LASER RX RETINA",null,5679,9609.09,2531.06,15242.01,1419.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 81240","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",81240,"HC CHG F2 GENE ANALYSIS 20210G >A VARIANT",null,434,141.82,48.54,637.1,108.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 81256","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",81256,"HC CHG HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS",null,434,147.56,59.62,733.73,108.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 85520","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",85520,"HC CHG HEPARIN ASSAY",null,138,31.41,11.94,146.97,34.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 85730","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",85730,"HC CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD",null,31,13.83,5.48,67.41,7.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 86021","TUFTS","TUFTS PPO","CPT",86021,"HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES",null,72,60.16,13.74,169.1,18,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 89051","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",89051,"HC CHG CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT",null,28,7.55,5.0199999999999996,61.83,7,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90473","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",90473,"IMADM INTRANSL/ORAL 1 VACCINE",null,64,129,108.45,345.64,16,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 67121","TUFTS","TUFTS HMO","CPT",67121,"HC REMOVE EYE IMPLANT MATERIAL",null,3062,4856.75,1500.85,7703.8,765.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 67880","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",67880,"HC REVISION OF EYELID",null,2874,3522.21,1990.62,11845.41,718.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 67961","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",67961,"HC REVISION OF EYELID,< 1/4 LID MARGIN",null,4464,3522.21,1990.62,11845.41,1116,1]
["OUTPATIENT","TUFTS - TUFTS SPIRIT - CPT - 81277","TUFTS","TUFTS SPIRIT","CPT",81277,"HC CYTOGENOMIC NEO MICRORA ALYS",null,175,1276,1160,6199.92,43.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 81311","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT",81311,"HC CHG NRAS GENE ANALYSIS VARIANTS IN EXON 2&3",null,4795,744.27,218.55,2868.9,1198.75,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 86141","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT",86141,"HC CRL;CARDIO CRP",null,63,15.54,11.81,145.38,15.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 86161","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",86161,"HC CHG COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT",null,58,27.01,10.94,134.62,14.5,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 86300","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT",86300,"HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3",null,96,24.97,18.989999999999998,233.69,24,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 87449","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT",87449,"HC AG DET,ENZ IMM;OTH,EA",null,57,12.91,10.94,134.54,14.25,1]
["OUTPATIENT","FALLON - FALLON SENIOR PLAN - CPT - 87505","FALLON","FALLON SENIOR PLAN","CPT",87505,"HC CHG NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN",null,181,128.29,103.92,1440.15,45.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 68325","BLUE CROSS","BLUE CROSS-PPO","CPT",68325,"HC CONJUNCTIVOPLASTY W/BUCCAL MUC MEMB GRAFT",null,4867,4996.58,2166.09,11845.41,1216.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 68811","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",68811,"HC PROBE NASOLACRIMAL DUCT",null,2949,3044.16,1098.98,3522.21,737.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 69200","TUFTS","TUFTS SELECT","CPT",69200,"RMVL FB XTRNL AUDITORY CANAL W/O ANES",null,454,317.70999999999998,178.83,943.8,113.5,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 81342","UNICARE","UNICARE","CPT",81342,"TRG@ GENE REARRANGEMENT ANALYSIS; PRO/TECH",null,534,488.23,183.8,2261.92,133.5,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN QHP - CPT - 81431","BMC HEALTHNET","BMCHN QHP","CPT",81431,"HC CHG HEARING LOSS DUP/DEL ANALYSIS",null,863,602.53,679.57,6591.3,215.75,1]
["OUTPATIENT","FALLON - FALLON SENIOR PLAN - CPT - 82009","FALLON","FALLON SENIOR PLAN","CPT",82009,"HC CHG KETONE BODIES SERUM QUALITATIVE",null,24,4.5199999999999996,4.12,50.7,6,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 86336","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",86336,"HC CHG INHIBIN A",null,76,31.52,14.22,174.97,19,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 86341","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT",86341,"HC CHG ISLET CELL ANTIBODY",null,96,28.28,18.05,228.64,24,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MCO - CPT - 88108","BMC HEALTHNET","BMCHN MCO","CPT",88108,"HC CHG CYTP CONCENTRATION SMEARS & INTERPRETATION",null,224,39.479999999999997,39.479999999999997,366.72,56,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 88164","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT",88164,"HC CHG CYTOPATH TBS CERV/VAG MANUAL",null,52,12.74,10.82,145.38,13,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 88187","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",88187,"FLOWCYTOMETRY/READ, 2-8 MARKERS",null,158,84.03,49.74,381.48,39.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 70250","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",70250,"RADIOLOGIC EXAMINATION SKULL 4/> VIEWS",null,355,193.63,72.290000000000006,1103.3900000000001,88.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 70450","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",70450,"HC CHG CT HEAD/BRAIN W/O CONTRAST MATERIAL",null,1569,322.25,193.63,1274.24,392.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 71045","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",71045,"HC CHG RADIOLOGIC EXAM CHEST SINGLE VIEW",null,221,81.93,81.93,801.26,55.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 82043","TUFTS","TUFTS HMO","CPT",82043,"HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE",null,27,25.89,5.28,64.88,6.75,1]
["OUTPATIENT","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 82103","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT",82103,"HC CHG ALPHA-1-ANTITRYPSIN TOTAL",null,65,13.44,12.26,150.88,16.25,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN QHP - CPT - 86431","BMC HEALTHNET","BMCHN QHP","CPT",86431,"HC CHG RHEUMATOID FACTOR QUANTITATIVE",null,27,6.2,5.17,63.66,6.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86593","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",86593,"HC SYPHILIS;QN",null,23,9.8800000000000008,4.0199999999999996,49.48,5.75,1]
["OUTPATIENT","ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 86618","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT",86618,"HC Q;LYME AB INDEX CNS INFEC","QW",191,17.03,15.53,191.1,47.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 90738","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",90738,"HC JAPANESE ENCEPH VACC, INACTIVATED, IM,TRAVEL",null,479,351.57,53.59,929.69,119.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90846","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",90846,"FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT",null,238,144.07,44.81,214.2,59.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 92025","TUFTS","TUFTS PPO","CPT",92025,"COMPUTERIZED CORNEAL TOPOGRAPHY UNI/BI",null,189,200.07,93.87,317.35000000000002,47.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 72074","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",72074,"HC X-RAY EXAM THORAC SPINE4/>VW",null,161,193.63,72.290000000000006,1274.24,40.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 72131","TUFTS","TUFTS HMO","CPT",72131,"HC CHG CT LUMBAR SPINE W/O CONTRAST MATERIAL",null,1997,521.92999999999995,193.63,1307.74,499.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 72159","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",72159,"HC MRA,SPINE,W/WO",null,4562,1426,567.59,3654.63,1140.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 82232","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",82232,"HC CHG BETA-2 MICROGLOBULIN",null,81,36.24,14.76,181.61,20.25,1]
["OUTPATIENT","ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 82365","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT",82365,"HC CHG CALCULUS INFRARED SPECTROSCOPY",null,120,12.9,11.76,144.81,30,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 86645","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT",86645,"HC CHG ANTIBODY CYTOMEGALOVIRUS CMV IGM",null,71,42.4,15.37,189.15,17.75,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 86658","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT",86658,"HC CHG ENTEROVIRUS ANTIBODY",null,70,14.26,11.88,146.19,17.5,1]
["OUTPATIENT","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 86698","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT",86698,"HC CHG ANTIBODY HISTOPLASMA",null,28,13.79,11.4,140.32,7,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 86701","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",86701,"HC HIV-1",null,44,23.68,8.11,99.73,11,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 43215","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",43215,"HC ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY",null,1782,1010.64,1010.64,3264.67,445.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 43244","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",43244,"HC UPR GI NDSC BAND LIG ESOPHGL&/GSTR VARICES",null,2267,2491.1,1010.64,7703.8,566.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 72240","TUFTS","TUFTS PPO","CPT",72240,"HC CHG MYELOGRAPHY CERVICAL RS&I",null,1230,2514,308.97000000000003,7066.23,307.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 73080","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",73080,"HC CHG RADEX ELBOW COMPLETE MINIMUM 3 VIEWS",null,323,107.22,72.290000000000006,851.68,80.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 73222","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",73222,"HC CHG MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL",null,4142,1190.5,637.16,6980.89,1035.5,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 82465","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT",82465,"CHOLESTEROL SERUM/WHOLE BLOOD TOTAL",null,23,5.22,3.97,48.83,5.75,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MCO - CPT - 82525","BMC HEALTHNET","BMCHN MCO","CPT",82525,"HC CHG ASSAY OF COPPER",null,62,11.32,11.32,139.30000000000001,15.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 82553","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",82553,"HC CHG CREATINE KINASE MB FRACTION ONLY",null,38,26.35,10.54,129.69,9.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 86710","BLUE CROSS","BLUE CROSS-PPO","CPT",86710,"HC INFLUENZA VIRUS",null,35,30.3,12.36,152.1,8.75,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MEDICAID - CPT - 86765","BMC HEALTHNET","BMCHN MEDICAID","CPT",86765,"HC CHG ANTIBODY RUBEOLA",null,102,11.75,11.75,144.6,25.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 86774","TUFTS","TUFTS PPO","CPT",86774,"HC CHG ANTIBODY TETANUS",null,83,59.09,12.77,166.08,20.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 43266","TUFTS","TUFTS SELECT","CPT",43266,"HC EGD ENDOSCOPIC STENT PLACEMENT W/WIRE& DILATION",null,4077,2593.31,1990.62,8736.31,1019.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 44377","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",44377,"HC ENTEROSC >2ND PRTN W/ILEUM W/BX SINGLE/MULTIPLE",null,2469,2882.31,1013.38,7703.8,617.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 73706","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",73706,"HC CHG CT ANGIOGRAPHY LOWER EXTREMITY",null,3840,347.19,347.19,2420.09,960,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 74182","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",74182,"HC CHG MRI ABDOMEN W/CONTRAST MATERIAL",null,4960,1105.27,637.16,4299.8,1240,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 74246","TUFTS","TUFTS HMO","CPT",74246,"HC XRAY UPPER GI AIR CONTRAST",null,843,758.07,148.44,1899.39,210.75,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 82595","UNICARE","UNICARE","CPT",82595,"HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE",null,33,15.71,5.9,72.55,8.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 82656","TUFTS","TUFTS SELECT","CPT",82656,"HC CHG ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN",null,55,20.11,10.52,129.47999999999999,13.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 67800","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",67800,"EXCISION CHALAZION SINGLE",null,808,476.13,476.13,2032.26,202,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 67875","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",67875,"TEMPORARY CLOSURE EYELIDS SUTURE",null,1212,1355.74,1098.98,3264.67,303,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 67973","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",67973,"HC RCNSTJ EYELID FULL THICKNESS LOWER EYELID 1 STG",null,2949,3435.75,1990.62,11845.41,737.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 93892","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",93892,"HC TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT",null,3107,188.94,188.94,1117.6500000000001,776.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 93922","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",93922,"NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL",null,888,224.25,178.83,1077.0999999999999,222,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 11442","TUFTS","TUFTS POS","CPT",11442,"EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM",null,1046,2058.17,972.93,3264.67,261.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11602","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",11602,"EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM",null,1262,527.46,527.46,2032.26,315.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11740","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",11740,"EVACUATION SUBUNGUAL HEMATOMA",null,246,229.89,178.83,1198.25,61.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11921","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",11921,"HC CORRECT SKIN COLR DEFCT 6.1-20 SQCM",null,740,810.95,684.11,2032.26,185,1]
["OUTPATIENT","AETNA - AETNA - CPT - 36620","AETNA","AETNA","CPT",36620,"HC INSERT CATH,ART,PERCUT,SHORTTERM",null,366,1198.25,108.25,1198.25,91.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 37225","TUFTS","TUFTS HMO","CPT",37225,"HC REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL",null,15672,7467.76,2166.09,18787.919999999998,3918,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 68816","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",68816,"HC PROBE NL DUCT W/BALLOON",null,2949,3044.16,1500.85,7703.8,737.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 69501","TUFTS","TUFTS PPO","CPT",69501,"MASTOIDECTOMY,SIMPLE",null,643,9609.09,2531.06,15242.01,160.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 94664","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",94664,"HC DEMO/EVAL INHALER/NEBULIZER - PHARM",null,219,403.51,40.020000000000003,1630.85,54.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 94770","TUFTS","TUFTS SELECT","CPT",94770,"CARBON DIOXIDE EXP GAS DETER INFRARED ANALYZER",null,414,381.28,71.61,2153.34,103.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 95117","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",95117,"PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS NJXS",null,86,81.78,63.62,218.59,21.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 95707","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",95707,"HC EEG W/O VID 2-12HR CONT MNTR",null,377,544.74,407.35,2582.75,94.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 12021","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",12021,"TX SUPERFICIAL WOUND DEHISCENCE W/PACKING",null,1090,527.46,527.46,2032.26,272.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 13152","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",13152,"REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM",null,3239,810.95,684.11,2032.26,809.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 37242","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",37242,"VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I",null,15195,16237.9,1990.62,37129.18,3798.75,1]
["OUTPATIENT","AETNA - AETNA - CPT - 38221","AETNA","AETNA","CPT",38221,"BONE MARROW BIOPSY NEEDLE/TROCAR",null,1103,1198.25,1098.98,3264.67,275.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 40525","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",40525,"HC FULL THICK EXCIS LIP,RECON W FLAP",null,3896,4335.57,1500.85,7703.8,974,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 70543","BLUE CROSS","BLUE CROSS-PPO","CPT",70543,"HC CHG MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL",null,5365,1105.27,664.1,4707.1099999999997,1341.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 71260","TUFTS","TUFTS PPO","CPT",71260,"HC CHG CT THORAX W/CONTRAST MATERIAL",null,2497,861.01,347.19,2420.09,624.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 95710","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",95710,"HC EEG W/O VID EA 12-26HR CONT",null,723,982.93,781.56,4577.47,180.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 95851","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",95851,"HC RANGE MOTION MEASURE,EACH EXTREM",null,87,71.98,12.75,71.98,21.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 95869","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",95869,"NEEDLE EMG THRC PARASPI MUSC EXCLUDING T1/T12",null,372,228.32,178.47,1310.18,93,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 15004","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",15004,"PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT",null,2072,1042.56,684.11,2032.26,518,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 15773","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",15773,"GRFG AUTOL FAT LIPO 25 CC/<",null,2060,5972.07,1500.85,7703.8,515,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 15850","TUFTS","TUFTS SELECT","CPT",15850,"REMOVE SUTURES SAME SURGEON",null,773,317.70999999999998,317.70999999999998,1198.25,193.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 41017","TUFTS","TUFTS PPO","CPT",41017,"HC XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB",null,3301,2058.16,1098.98,4335.57,825.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 42120","TUFTS","TUFTS HMO","CPT",42120,"HC RESCJ PALATE/EXTENSIVE RESCJ LESION",null,6512,7467.76,2166.09,11845.41,1628,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 72082","TUFTS","TUFTS HMO","CPT",72082,"XRAY EXAM ENTIRE SPINE INCLUDING SKULL, CERV AND SACRAL SPINE; 2 OR 3 VIEWS",null,385,508.55,125.38,1274.24,96.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 72157","TUFTS","TUFTS SELECT","CPT",72157,"HC CHG MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL",null,5001,731.05,664.1,4707.1099999999997,1250.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 72195","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",72195,"HC CHG MRI PELVIS W/O CONTRAST MATERIAL",null,4076,396.79,396.79,2653.95,1019,1]
["OUTPATIENT","FALLON - FALLON MEDICAID - CPT - 95953","FALLON","FALLON MEDICAID","CPT",95953,"LOCALIZE CEREBRAL SEIZURE CPTR PORTABLE EEG",null,2165,0,811.7,4584.1899999999996,541.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 96110","TUFTS","TUFTS PPO","CPT",96110,"DEVELOPMENTAL SCREENING W/INTERP&REPRT STD FOR",null,311,406.52,26.3,1142.6400000000001,77.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 96132","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",96132,"HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR",null,341,228.32,71.41,293.52,85.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 17250","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",17250,"CHEMICAL CAUTERIZATION GRANULATION TISSUE",null,328,296.32,296.32,1198.25,82,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 19082","TUFTS","TUFTS SELECT","CPT",19082,"BX BREAST W/DEVICE ADDL LESION STEREOTACT GUID",null,646,0,209.09,1198.25,161.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 42720","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",42720,"HC INC/DRAIN RETROPHARYNG ABSCESS,ORAL",null,3349,3747.12,1098.98,4335.57,837.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 43201","TUFTS","TUFTS PPO","CPT",43201,"HC ESOPHAGOSCOPY FLEXIBLE TRANSORAL W SUBMUCOUS INJ",null,2394,2058.16,1010.64,3264.67,598.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 43238","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",43238,"HC UPR GI NDSC TNDSC US FINE NDL ASPIR/BX ESOPH",null,2244,2882.31,1010.64,3264.67,561,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 73080","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",73080,"HC CHG RADEX ELBOW COMPLETE MINIMUM 3 VIEWS",null,323,81.93,72.290000000000006,851.68,80.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 73551","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",73551,"XRAY EXAM FEMUR; 1 VIEW",null,163,81.93,72.290000000000006,801.26,40.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 96138","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",96138,"HC PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN",null,341,28.83,28.83,129.58000000000001,85.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 96360","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",96360,"IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR",null,363,314.33999999999997,132.85,984.54,90.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 96377","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",96377,"HC APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION",null,165,81.78,63.62,1198.25,41.25,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 96567","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT",96567,"PDT XTRNL APPL LIGHT DSTR LES SKN BY ACTIVJ RX",null,645,0,296.32,983.48,161.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 20501","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",20501,"HC INJECTION SINUS TRACT DIAGNOSTIC",null,262,93.24,93.24,1198.25,65.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 20983","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",20983,"HC ABLATJ BONE TUMOR CRYO PERQ W/IMG GDN WHEN PRFMD",null,8897,9571.73,1500.85,11074.87,2224.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 43266","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",43266,"HC EGD ENDOSCOPIC STENT PLACEMENT W/WIRE& DILATION",null,4077,8736.31,1990.62,8736.31,1019.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 43753","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",43753,"GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE",null,158,423.72,317.70999999999998,1198.25,39.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 80158","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",80158,"HC CHG DRUG ASSAY CYCLOSPORINE",null,91,40.85,16.46,202.6,22.75,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 80177","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",80177,"DRUG SCREEN QUANTITATIVE LEVETIRACETAM",null,174,17.86,12.09,148.84,43.5,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 80186","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",80186,"HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN FREE",null,46,18.55,12.55,154.51,11.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 97140","BLUE CROSS","BLUE CROSS-PPO","CPT",97140,"HC MANUAL THER TECH,1+REGIONS,EA 15 MIN",null,145,69.37,47.1,175.4,36.25,1]
["OUTPATIENT","FALLON - FALLON MEDICAID - CPT - 97157","FALLON","FALLON MEDICAID","CPT",97157,"HC MULT FAM ADAPT BHV TX GDN",null,378,0,56.05,129.58000000000001,94.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 99152","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",99152,"HC MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS",null,101,29.88,29.88,29.88,25.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 21208","TUFTS","TUFTS HMO","CPT",21208,"HC AUGMENT FACIAL BONES",null,7214,9609.09,2531.06,15242.01,1803.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 21365","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",21365,"HC OPEN RX COMPLX CHEEK BONE FRAC",null,7214,8385.69,2354.5,15242.01,1803.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 21480","TUFTS","TUFTS POS","CPT",21480,"CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ",null,246,2058.17,378,3264.67,61.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 45334","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",45334,"HC SIGMOIDOSCOPY FLX CONTROL BLEEDING",null,1262,2115.37,737.96,3264.67,315.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 45386","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",45386,"HC COLSC FLX PROX SPLENIC FLXR DILAT BALO 1/> STRI",null,2054,1645.44,1020.59,3264.67,513.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 75705","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",75705,"HC CHG ANGIOGRAPHY SPINAL SELECTIVE RS&I",null,7165,5755.52,632.41999999999996,49146.35,1791.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 75774","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",75774,"HC CHG ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I",null,1462,135.78,135.78,992.93,365.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 75827","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",75827,"HC CHG VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I",null,1532,815.37,815.37,8605.14,383,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN QHP - CPT - 99156","BMC HEALTHNET","BMCHN QHP","CPT",99156,"HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS",null,101,0,190.51,190.51,25.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 99285","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",99285,"HC EMERGENCY DEPT VISIT HIGH SEVERITY&THREAT FUNCJ",null,2729,882.17,352.73,4848.78,682.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 99498","TUFTS","TUFTS POS","CPT",99498,"HC ADD ON--ADVANCED CARE PLANNING; EA ADD'L 30 MINS",null,283,0,180.79,180.79,70.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 23031","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",23031,"HC DRAIN INFECT SHOULDER BURSA",null,2066,2309.9699999999998,1990.62,7703.8,516.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 46040","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",46040,"I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX",null,3165,2115.37,1645.44,11845.41,791.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 46040","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",46040,"I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX",null,3165,2115.37,1645.44,11845.41,791.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 47533","TUFTS","TUFTS HMO","CPT",47533,"PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL",null,2142,2057.7399999999998,1098.98,5726.94,535.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 49083","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",49083,"ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE",null,818,1278.93,1098.98,3264.67,204.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 77331","TUFTS","TUFTS SELECT","CPT",77331,"HC SPEC DOSI",null,1015,228.93,160.66,1474.02,253.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 77771","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",77771,"HC HDR RDNCL NTRSTL/2-12",null,3125,2027.78,523.85,8624.5,781.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 24066","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",24066,"HC BX ARM/ELBOW SOFT TISSUE,DEEP",null,3449,4621.25,1500.85,7703.8,862.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 24640","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",24640,"CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ",null,720,378,317.70999999999998,943.8,180,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 25535","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",25535,"CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION",null,3469,378,378,3264.67,867.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 49418","TUFTS","TUFTS PPO","CPT",49418,"INSJ INTRAPERITONEAL CATHETER W/IMG GID",null,4154,2058.16,1098.98,5726.94,1038.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 50592","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",50592,"HC ABLTJ 1/> RENAL TUMOR PRQ UNI RADIOFREQUENCY",null,7058,7718.14,2166.09,15242.01,1764.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 51701","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",51701,"INSJ NON-NDWELLG BLADDER CATHETER",null,208,178.83,178.83,1198.25,52,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 80306","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT",80306,"HC DRUG TEST PRSMV INSTRMNT",null,192,16.13,11.89,145.87,48,1]
["OUTPATIENT","FALLON - FALLON MEDICAID - CPT - 80345","FALLON","FALLON MEDICAID","CPT",80345,"HC CHG DRUG SCREENING BARBITURATES",null,95,0,16.41,105.68,23.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 26060","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",26060,"HC INCIS PERCUT FINGER TENDON,SINGLE,EA",null,3045,2205.59,1500.85,7703.8,761.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 26720","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",26720,"CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA",null,1413,485.97,317.70999999999998,1198.25,353.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 27043","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",27043,"EXCISION TUMOR SOFT TISSUE PELVIS&HIP SUBQ 3+CM",null,1528,4621.25,1990.62,11845.41,382,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 51728","TUFTS","TUFTS HMO","CPT",51728,"COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES",null,2386,1871.78,944.22,3176.09,596.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 52281","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",52281,"CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS",null,2072,3380.52,1500.85,7703.8,518,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 54231","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",54231,"DYNAMIC CAVERNOSOMETRY NJX VASOACTIVE DRUGS",null,2441,11845.41,388.64,11845.41,610.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 76641","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",76641,"HC CHG US BREAST UNI REAL TIME WITH IMAGE COMPLETE",null,168,193.63,147.96,1179.6400000000001,42,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 76706","BLUE CROSS","BLUE CROSS-PPO","CPT",76706,"HC CHG US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA",null,301,147.96,147.96,1274.24,75.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 76827","TUFTS","TUFTS SELECT","CPT",76827,"DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE",null,580,221.01,147.96,1423.04,145,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 27603","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",27603,"HC DRAIN LOWER LEG DEEP ABSC/HEMATOMA",null,3573,3994.03,1500.85,7703.8,893.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 27767","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",27767,"HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANIP",null,2180,943.8,317.70999999999998,1198.25,545,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 56405","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",56405,"I&D VULVA/PERINEAL ABSCESS",null,840,3264.67,458.47,3264.67,210,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 56740","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",56740,"HC EXCIS BARTHOLIN GLAND/CYST",null,3544,4588.18,1990.62,11845.41,886,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 57454","TUFTS","TUFTS SELECT","CPT",57454,"COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE",null,1638,684.11,458.47,2032.26,409.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 78278","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",78278,"HC CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING",null,3311,608.36,373.93,4270.45,827.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 78431","TUFTS","TUFTS POS","CPT",78431,"HC MYOCRD IMG PET RST&STRS CT",null,2857,4010.82,3873.11,12028.4,714.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 78598","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",78598,"HC QUAN DIFF PERF/VENT,IMG",null,2826,599.04999999999995,524.19000000000005,5502.59,706.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 28041","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",28041,"HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5+CM",null,3490,3994.03,1990.62,11845.41,872.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 28308","BLUE CROSS","BLUE CROSS-PPO","CPT",28308,"OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA",null,2861,4405.5600000000004,1500.85,7703.8,715.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 58300","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",58300,"INSERTION INTRAUTERINE DEVICE IUD",null,387,173.05,132.08000000000001,1198.25,96.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 58565","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",58565,"HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS",null,6134,6928.79,1990.62,11845.41,1533.5,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 59897","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT",59897,"HC FETAL INVAS PX W/ US",null,356,0,684.11,2032.26,89,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN ACO - CPT - 61630","BMC HEALTHNET","BMCHN ACO","CPT",61630,"HC INTRACRANIAL BALLOON ANGIOPLASTY",null,10401,0,null,null,2600.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 74251","TUFTS","TUFTS POS","CPT",74251,"HC CHG RADEX SM INT W/MLT SRL IMGES VIA ENTEROCLSS TUBE",null,3808,730.06,228.79,2195.08,952,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 74450","BLUE CROSS","BLUE CROSS-PPO","CPT",74450,"URETHROCYSTOGRAPHY RETROGRADE RS&I",null,375,303.20999999999998,267.85000000000002,2562.5700000000002,93.75,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 29075","TUFTS","TUFTS HMO","CPT",29075,"APPLICATION CAST ELBOW FINGER SHORT ARM",null,481,770.98,395.63,1308.22,120.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 29730","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",29730,"HC WINDOWING OF CAST",null,199,283.51,226.08,764.24,49.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 29730","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",29730,"HC WINDOWING OF CAST",null,199,226.08,226.08,764.24,49.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 62321","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",62321,"HR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN",null,1153,1292.83,829.82,3264.67,288.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 64400","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",64400,"NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH",null,531,2032.26,310.58,2032.26,132.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 76942","TUFTS","TUFTS SELECT","CPT",76942,"US GUIDANCE NEEDLE PLACEMENT RS&I",null,1935,0,51.61,133.38,483.75,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 77065","UNICARE","UNICARE","CPT",77065,"HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",null,812,110.6,92.17,1102.04,203,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 30110","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",30110,"EXCISION NASAL POLYP SIMPLE",null,1023,2148.08,1098.98,3264.67,255.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 30801","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",30801,"ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC",null,1076,2485.42,1098.98,3264.67,269,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 31552","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",31552,"HC LARYNGOPLASTY LARYNGEAL STEN W/O STENT 12 YRS>",null,6641,8596.73,2354.5,15242.01,1660.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 31599","TUFTS","TUFTS HMO","CPT",31599,"SML WITH EXCISION OF TRACHEAL/SUBGLOTTIC STENOSIS",null,2964,595.01,317.70999999999998,1198.25,741,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 64505","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",64505,"INJECTION ANES AGENT SPHENOPALATINE GANGLION",null,647,415.61,310.58,1198.25,161.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 64643","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",64643,"CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE",null,531,179.6,179.6,1198.25,132.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 78800","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",78800,"HC NM RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR: LIMITED AREA",null,1784,608.36,425.49,4270.45,446,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 78816","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",78816,"HC CHG PET IMAGING FOR CT ATTENUATION WHOLE BODY",null,6151,16731.72,2059.9699999999998,16731.72,1537.75,1]
["OUTPATIENT","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 80061","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT",80061,"HC CHG LIPID PANEL","QW",131,18.37,12.21,150.31,32.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 31635","TUFTS","TUFTS POS","CPT",31635,"HC BRONCHOSCOPY W/REMOVAL FOREIGN BODY",null,1445,4856.75,1500.85,7703.8,361.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 33206","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",33206,"HC INS NEW/RPLCMT PRM PACEMAKR W/TRANS ELTRD ATRIAL",null,10670,16591.07,2531.06,37129.18,2667.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 33222","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",33222,"HC RELOCATION OF SKIN POCKET FOR PACEMAKER",null,2594,3344.2,1098.98,3344.2,648.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 65130","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",65130,"HC INSERT OCULAR IMPLANT",null,4867,4996.58,1990.62,11845.41,1216.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 65780","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",65780,"HC OCULAR RECONST TRANSPLANT",null,4867,5639.32,2354.5,11845.41,1216.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 92977","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",92977,"HC THROMBOLYSIS,CORONARY,IV INFUSN",null,437,622.61,484.3,3021.28,109.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 93284","TUFTS","TUFTS POS","CPT",93284,"PROGRM EVAL IMPLANTABLE IN PRSN MLT LD CARD/DFB",null,792,123.21,62.4,370.47,198,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 93313","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",93313,"HC ECHO R-T 2D W/PROBE PLACEMENT ONLY",null,1031,835.47,756.94,5016.9799999999996,257.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 10004","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",10004,"HC FNA BX W/O IMG GDN EA ADDL",null,435,107.47,107.47,1198.25,108.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 10160","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",10160,"PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST",null,729,678.1,317.70999999999998,1198.25,182.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 33244","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",33244,"HC RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ",null,6372,6592.9,2166.09,7703.8,1593,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 33285","TUFTS","TUFTS HMO","CPT",33285,"HC INSJ SUBQ CAR RHYTHM MNTR",null,11393,16146.45,1198.25,25611.61,2848.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 36226","TUFTS","TUFTS POS","CPT",36226,"HC SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY",null,7758,10732.28,1990.62,17023.61,1939.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 67039","TUFTS","TUFTS SELECT","CPT",67039,"HC VITRECTOMY,FOCAL LASER RX RETINA",null,5679,5130.87,2531.06,15242.01,1419.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 67312","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",67312,"HC STRABISMUS RECESSION/RESCJ 2 HRZNTL MUSC",null,4867,4996.58,2166.09,11845.41,1216.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 93454","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",93454,"HC CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I",null,8485,4719.71,2531.06,7703.8,2121.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 93464","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",93464,"HC PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU",null,845,427.95,427.95,427.95,211.25,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 93620","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",93620,"HC COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION",null,8184,4308.7299999999996,2531.06,9904.74,2046,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11105","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",11105,"HC PUNCH BX SKIN EA SEP/ADDL",null,133,67.709999999999994,67.709999999999994,1198.25,33.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 11305","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",11305,"SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<",null,246,296.32,171.09,508.23,61.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11426","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",11426,"EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM",null,2987,3994.03,1500.85,7703.8,746.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 36254","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",36254,"HC SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I",null,4429,5703.04,1500.85,11845.41,1107.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 36483","TUFTS","TUFTS HMO","CPT",36483,"HC ENDOVEN ABLTI THER CHEM ADHESIVE SBSQ VEIN",null,3423,0,218.56,1198.25,855.75,1]
["OUTPATIENT","FALLON - FALLON MEDICAID - CPT - 81291","FALLON","FALLON MEDICAID","CPT",81291,"HC CHG MTHFR GENE ANALYSIS COMMON VARIANTS",null,434,48.28,48.28,633.76,108.5,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MEDICAID - CPT - 81301","BMC HEALTHNET","BMCHN MEDICAID","CPT",81301,"HC CHG MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF",null,534,0,264.13,3380.71,133.5,1]
["OUTPATIENT","ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 81342","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT",81342,"TRG@ GENE REARRANGEMENT ANALYSIS; PRO/TECH",null,534,201.5,183.8,2261.92,133.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 86039","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",86039,"HC CHG ANTINUCLEAR ANTIBODIES ANA TITER",null,170,25.04,10.18,125.28,42.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA PPO - CPT - 86162","CIGNA HEALTHCARE","CIGNA PPO","CPT",86162,"HC CHG COMPLEMENT TOTAL HEMOLYTIC",null,98,51.66,18.54,228.19,24.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 91112","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",91112,"GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP",null,5914,4318.55,1278.93,4318.55,1478.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 92071","TUFTS","TUFTS PPO","CPT",92071,"FIT CONTACT LENS TX OCULAR SURFACE DISEASE",null,108,0,82.25,229.89,27,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 92270","TUFTS","TUFTS SELECT","CPT",92270,"ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT",null,464,190.08,68.75,1073.51,116,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 81430","TUFTS","TUFTS MEDICARE SCO","CPT",81430,"HC CHG HEARING LOSS GENOMIC SEQUENCE ANALYSIS 60 GENES",null,2063,2356.25,1625,15761.12,515.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 81522","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",81522,"HC ONC BREAST MRNA 12 GENES",null,92,4453.95,3873,20700.3,23,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 82024","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT",82024,"HC CHG ADRENOCORTICOTROPIC HORMONE ACTH",null,185,97.18,35.229999999999997,433.56,46.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 86334","TUFTS","TUFTS POS","CPT",86334,"HC CHG IMMUNOFIXJ ELECTROPHORESIS SERUM",null,80,83.43,20.39,250.85,20,1]
["OUTPATIENT","ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 86376","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT",86376,"HC CHG MICROSOMAL ANTIBODIES EACH",null,70,14.55,13.27,163.31,17.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 92540","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",92540,"VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRK",null,499,228.32,228.32,1412.44,124.75,1]
["OUTPATIENT","FALLON - FALLON MEDICAID - CPT - 92562","FALLON","FALLON MEDICAID","CPT",92562,"LOUDNESS BALANCE BINAURAL/MONAURAL",null,215,0,59.1,1274.6400000000001,53.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 92592","BLUE CROSS","BLUE CROSS-PPO","CPT",92592,"HEARING AID CHECK MONAURAL",null,67,49.9,24.58,138.81,16.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 92611","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",92611,"MOTION FLUOR EVAL SWLNG FUNCJ C/V REC",null,420,224.01,224.01,1702.26,105,1]
["OUTPATIENT","FALLON - FALLON SENIOR PLAN - CPT - 82139","FALLON","FALLON SENIOR PLAN","CPT",82139,"HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE",null,98,16.87,14.65,189.43,24.5,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 82232","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT",82232,"HC CHG BETA-2 MICROGLOBULIN",null,81,17.420000000000002,14.76,181.61,20.25,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 86592","TUFTS","TUFTS MEDICARE SCO","CPT",86592,"HC CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL",null,28,6.19,3.89,47.89,7,1]
["OUTPATIENT","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 86618","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT",86618,"HC Q;LYME AB INDEX CNS INFEC",null,191,37.630000000000003,15.53,191.1,47.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86632","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",86632,"HC CHG CHLAMYDIA, IGM ANTIBODY",null,53,28.32,11.57,142.36000000000001,13.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 92941","TUFTS","TUFTS HMO","CPT",92941,"HC PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL",null,10821,23407.53,1657.51,37129.18,2705.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 93279","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",93279,"PROGRAM EVAL IMPLANTABLE IN PRSN 1 LD PACEMAKER",null,448,62.4,41.48,370.47,112,1]
["OUTPATIENT","FALLON - FALLON MEDICAID - CPT - 0002A","FALLON","FALLON MEDICAID","CPT","0002A","HC ADM SARSCOV2 30MCG/0.3ML 2ND",null,58,56.78,28.39,124.23,14.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 0202U","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT","0202U","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2",null,1355,0,null,null,338.75,1]
["OUTPATIENT","FALLON - FALLON SENIOR PLAN - CPT - 82306","FALLON","FALLON SENIOR PLAN","CPT",82306,"HC CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED",null,146,29.6,27.01,332.37,36.5,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 82330","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",82330,"HC CHG CALCIUM IONIZED",null,69,13.68,12.47,153.49,17.25,1]
["OUTPATIENT","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 82379","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT",82379,"HC CRL;CARNITINE",null,52,16.87,14.65,189.43,13,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 82435","TUFTS","TUFTS SELECT","CPT",82435,"HC CHG CHLORIDE BLD",null,24,8.02,4.2,51.64,6,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 86677","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",86677,"HC CHG ANTIBODY HELICOBACTER PYLORI",null,66,36.380000000000003,13.23,164.61,16.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA - CPT - 86705","CIGNA HEALTHCARE","CIGNA","CPT",86705,"HC CHG HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY",null,60,53.06,10.74,132.21,15,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 93306","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",93306,"HC ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D WITH CONTRAST",null,2511,835.47,403.66,4775.3,627.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 93453","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",93453,"HC R & L HRT CATH W/NJX L VENTRICULOG IMG S&I",null,10776,4719.71,2531.06,7703.8,2694,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 93530","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",93530,"RHC CNGNITL ANMLES",null,2897,5326.85,2531.06,7703.8,724.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11102","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",11102,"HC TANGNTL BX SKIN SINGLE LES",null,272,296.32,296.32,1198.25,68,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 11302","TUFTS","TUFTS HMO","CPT",11302,"SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM",null,484,320.41000000000003,171.09,508.23,121,1]
["OUTPATIENT","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 82438","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT",82438,"HC CHG CHLORIDE OTHER SOURCE",null,25,8.6999999999999993,4.46,54.82,6.25,1]
["OUTPATIENT","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 82523","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT",82523,"HC CHG COLLAGEN CROSS LINKS ANY METHOD","QW",62,18.68,17.05,209.77,15.5,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 82550","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT",82550,"HC CHG CREATINE KINASE TOTAL",null,33,7.01,5.94,73.12,8.25,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN WELL SENSE - CPT - 86735","BMC HEALTHNET","BMCHN WELL SENSE","CPT",86735,"HC CHG ANTIBODY MUMPS",null,65,25.78,11.9,146.47999999999999,16.25,1]
["OUTPATIENT","ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 86765","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT",86765,"HC CHG ANTIBODY RUBEOLA",null,102,12.88,11.75,144.6,25.5,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 86778","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT",86778,"HC Q;TOXOPLASMA IGM,AB",null,72,15.77,13.14,161.72,18,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 86788","TUFTS","TUFTS HMO","CPT",86788,"HC CHG ANTIBODY WEST NILE VIRUS IGM",null,88,75.5,15.37,189.15,22,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 93656","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",93656,"HC COMPRE EP EVAL ABLTJ ATR FIB",null,25096,32266.99,2531.06,62742.78,6274,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 93976","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",93976,"HC DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RORGN LMT",null,1992,188.94,188.94,1378.16,498,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 11626","TUFTS","TUFTS HMO","CPT",11626,"EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM",null,2987,4856.75,1500.85,7703.8,746.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11982","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",11982,"REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",null,734,584.69000000000005,317.70999999999998,1198.25,183.5,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 82657","UNICARE","UNICARE","CPT",82657,"HC CHG NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA",null,1263,43.82,16.47,215.03,315.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 82705","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",82705,"HC CHG FAT/LIPIDS FECES QUALITATIVE",null,25,11.2,4.6500000000000004,57.22,6.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 82784","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",82784,"HC CHG ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH",null,37,22.32,8.48,104.38,9.25,1]
["OUTPATIENT","ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 82803","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT",82803,"HC CHG BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3",null,97,26.07,19.260000000000002,252.81,24.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 86860","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",86860,"HC CHG ANTIBODY ELUTION RBC EACH ELUTION",null,142,304.8,23.92,1356.56,35.5,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 86905","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT",86905,"HC CHG BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH",null,87,5.55,3.49,2229.4299999999998,21.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 94617","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",94617,"HC EXERCISE TEST FOR BRONCHOSPASM",null,276,229.89,178.83,1085.78,69,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 94690","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",94690,"O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX",null,252,117.36,53.94,321.69,63,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 95024","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",95024,"INTRACUTANEOUS TESTS W/ALLERGENIC EXTRACTS",null,121,120.69,62.52,562.35,30.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 12045","TUFTS","TUFTS PPO","CPT",12045,"HC LAYR CLOS WND REST BODY 12.6-20 CM",null,740,1281.21,684.11,2032.26,185,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 15003","BLUE CROSS","BLUE CROSS-PPO","CPT",15003,"HC WOUND PREP, PED, TRK/ARM/LG ADDL 100 CM",null,1421,113.61,113.61,1198.25,355.25,1]
["OUTPATIENT","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 82805","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT",82805,"HC CHG GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY",null,141,78.77,38.92,764.01,35.25,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MCO - CPT - 82960","BMC HEALTHNET","BMCHN MCO","CPT",82960,"HC CHG GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN",null,29,5.52,5.52,67.86,7.25,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 83001","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",83001,"HC CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE","QW",93,18.579999999999998,16.95,208.59,23.25,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 87070","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT",87070,"CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL",null,43,10.34,7.86,96.71,10.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 87106","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",87106,"HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST",null,51,24.76,9.41,115.87,12.75,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN WELL SENSE - CPT - 87116","BMC HEALTHNET","BMCHN WELL SENSE","CPT",87116,"HC CHG CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL",null,54,21.37,9.86,121.29,13.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 95711","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",95711,"HC VEEG 2-12 HR UNMONITORED",null,377,407.35,407.35,2582.75,94.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 95873","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",95873,"ELECTRICAL STIMULATION GUID W/CHEMODENERVATION",null,360,147.08000000000001,147.08000000000001,147.08000000000001,90,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 95874","TUFTS","TUFTS HMO","CPT",95874,"NEEDLE EMG GUID W/CHEMODENERVATION",null,344,0,151.79,151.79,86,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 16000","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",16000,"HC INITIAL RX BURN(S) 1ST DEGREE",null,264,296.32,296.32,943.8,66,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 17107","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",17107,"DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM",null,2675,810.95,317.70999999999998,1198.25,668.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 83030","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",83030,"HC CHG HEMOGLOBIN F FETAL CHEMICAL",null,42,19.760000000000002,7.94,104.21,10.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 83520","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",83520,"HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE",null,63,31.63,12.76,167.51,15.75,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 83630","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",83630,"HC CHG LACTOFERRIN FECAL QUALITATIVE",null,112,19.7,17.91,220.45,28,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 87176","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",87176,"HC CHG HOMOGENIZATION TISSUE CULTURE",null,29,5.88,5.36,66.02,7.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 87186","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",87186,"HC CHG SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ",null,43,20.75,7.88,97,10.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 95874","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",95874,"NEEDLE EMG GUID W/CHEMODENERVATION",null,344,151.79,151.79,151.79,86,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 95972","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",95972,"ELEC ALYS NSTIM PLS GEN CPLX SC/PERPH 1ST HR",null,390,197.39,197.39,1144.02,97.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 17280","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",17280,"HC DESTR MALIG FACE,NOSE,LIP <0.6 CM",null,264,380.96,296.32,1198.25,66,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 19082","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",19082,"BX BREAST W/DEVICE ADDL LESION STEREOTACT GUID",null,646,0,209.09,1198.25,161.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 19288","TUFTS","TUFTS PPO","CPT",19288,"PERQ BREAST LOC DEVICE PLACEMT ADD LESIO MR GUID",null,469,0,160.32,1198.25,117.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 20240","TUFTS","TUFTS POS","CPT",20240,"HC BIOPSY BONE OPEN SUPERFICIAL",null,3570,4856.75,1500.85,7703.8,892.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 83735","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",83735,"HC CHG ASSAY OF MAGNESIUM",null,34,15.16,6.11,75.150000000000006,8.5,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN ACO - CPT - 83789","BMC HEALTHNET","BMCHN ACO","CPT",83789,"HC CHG MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA",null,91,38.97,17.809999999999999,233.86,22.75,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 83916","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT",83916,"HC CHG OLIGOCLONAL IMMUNE",null,97,24.29,20.239999999999998,265.61,24.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 87255","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",87255,"HC CHG VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC",null,168,76.42,30.89,380.17,42,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 87338","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",87338,"HC CHG IAAD IA HPYLORI STOOL",null,102,31.05,13.12,161.52000000000001,25.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 96132","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",96132,"HC NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR",null,341,228.32,71.41,293.52,85.25,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MCO - CPT - 96159","BMC HEALTHNET","BMCHN MCO","CPT",96159,"HC HLTH BHV IVNTJ INDIV EA ADDL",null,41,0,49.89,49.89,10.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 96368","BLUE CROSS","BLUE CROSS-PPO","CPT",96368,"IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS",null,90,53.54,53.54,53.54,22.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 20999","TUFTS","TUFTS PPO","CPT",20999,"PR PLACEMENT OF ANTIBIOTIC BEADS",null,2819,7467.76,1198.25,11845.41,704.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 21044","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",21044,"HC REMV MALIG JAW BONE LESION",null,7214,8596.73,1500.85,8596.73,1803.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 83921","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",83921,"HC CHG ORGANIC ACID 1 QUANTITATIVE",null,80,45.79,15.67,205.7,20,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 83937","BLUE CROSS","BLUE CROSS-PPO","CPT",83937,"HC CHG ASSAY OF OSTEOCALCIN",null,143,67.19,27.23,335.1,35.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 84080","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT",84080,"HC CHG ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES",null,71,31.13,13.48,166,17.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 87385","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",87385,"HC CHG IAAD IA HISTOPLASM CAPSULATUM",null,46,27.01,10.94,134.54,11.5,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MCO - CPT - 87426","BMC HEALTHNET","BMCHN MCO","CPT",87426,"SARSCOV CORONAVIRUS AG IA",null,100,10.94,10.94,88.9,25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 87493","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",87493,"HC CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE",null,120,82.11,32.01,393.99,30,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 96409","BLUE CROSS","BLUE CROSS-PPO","CPT",96409,"CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG",null,498,314.33999999999997,314.33999999999997,1868.91,124.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 97153","TUFTS","TUFTS POS","CPT",97153,"HC ADAPTIVE BEHAVIOR TX BY TECH",null,378,81.69,56.05,129.58000000000001,94.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 21208","TUFTS","TUFTS SELECT","CPT",21208,"HC AUGMENT FACIAL BONES",null,7214,5130.87,2531.06,15242.01,1803.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 21421","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",21421,"HC CLOSED RX LEFORTE I+WIRES",null,3350,3747.12,2166.09,11845.41,837.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 21501","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",21501,"I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX",null,2480,3994.03,1500.85,7703.8,620,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 22310","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",22310,"CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING",null,1336,378,378,3264.67,334,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 84182","TUFTS","TUFTS PPO","CPT",84182,"HC CHG PROTEIN, WESTERN BLOT TEST, W BAND",null,264,100.82,21.58,283.38,66,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MCO - CPT - 84270","BMC HEALTHNET","BMCHN MCO","CPT",84270,"HC CHG ASSAY OF SEX HORMONE BINDING GLOBULIN",null,105,19.82,19.82,243.97,26.25,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 87502","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",87502,"HC Q;FLU AG DET,MULT TYP,2,2",null,269,95.8,77.11,958.3,67.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 87535","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",87535,"HC CHG IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ",null,359,79.05,32.01,393.99,89.75,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 87536","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT",87536,"HC CHG IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION",null,279,117.36,77.09,955.28,69.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 97802","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",97802,"MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI",null,165,79.69,57.12,182.04,41.25,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 99203","UNICARE","UNICARE","CPT",99203,"OFFICE OUTPATIENT NEW 30 MINUTES",null,322,101.32,33.74,184.8,80.5,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 99358","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT",99358,"HC PROLONGED SERV,NO CONTACT,1ST HR",null,125,0,null,null,31.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 23665","TUFTS","TUFTS POS","CPT",23665,"CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ",null,1757,4856.75,1500.85,7703.8,439.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 24066","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",24066,"HC BX ARM/ELBOW SOFT TISSUE,DEEP",null,3449,3994.03,1500.85,7703.8,862.25,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 84376","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT",84376,"HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC",null,27,5.91,5.0199999999999996,61.7,6.75,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 84436","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT",84436,"HC CHG ASSAY OF THYROXINE TOTAL",null,35,7.52,6.27,77.11,8.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA - CPT - 84445","CIGNA HEALTHCARE","CIGNA","CPT",84445,"HC CHG THYROID STIMULATING IMMUNE GLOBULINS TSI",null,244,229.13,46.39,570.91,61,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 87641","TUFTS","TUFTS MEDICARE SCO","CPT",87641,"HC CHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ",null,129,50.88,32.01,393.99,32.25,1]
["OUTPATIENT","FALLON - FALLON SENIOR PLAN - CPT - 87801","FALLON","FALLON SENIOR PLAN","CPT",87801,"HC CHG DETECT AGENT, MULT ORGS, DNA  AMP",null,310,70.2,64.03,787.98,77.5,1]
["OUTPATIENT","FALLON - FALLON SENIOR PLAN - CPT - 87899","FALLON","FALLON SENIOR PLAN","CPT",87899,"HC MALARIA ANTIGEN","QW",94,16.07,11.87,155.81,23.5,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MEDICAID - CPT - 99453","BMC HEALTHNET","BMCHN MEDICAID","CPT",99453,"REM MNTR PHYSIOL PARAM SETUP",null,176,0,194.55,665.76,44,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 24650","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",24650,"CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION",null,1836,943.8,317.70999999999998,1198.25,459,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 25606","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",25606,"HC TREAT FX DISTAL RADIAL",null,4233,4405.5600000000004,1990.62,11845.41,1058.25,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 84478","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",84478,"HC CHG ASSAY OF TRIGLYCERIDES",null,29,11.64,5.24,64.44,7.25,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 84520","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT",84520,"HC CHG ASSAY OF UREA NITROGEN QUANTITATIVE","QW",21,4.74,3.61,44.34,5.25,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MCO - CPT - 84540","BMC HEALTHNET","BMCHN MCO","CPT",84540,"HC CHG ASSAY OF UREA NITROGEN URINE",null,25,4.33,4.33,53.96,6.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84630","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",84630,"HC CHG ASSAY OF ZINC",null,55,25.69,10.39,127.81,13.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 88142","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",88142,"CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN",null,101,227.42,18.48,227.42,25.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 88160","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",88160,"HC CHG CYTP SMRS ANY OTH SRC SCR&INTERPJ",null,182,200.27,22.57,200.27,45.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 26432","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",26432,"CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING",null,3772,2205.59,1990.62,11845.41,943,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 27200","BLUE CROSS","BLUE CROSS-PPO","CPT",27200,"HC CLOSED TREATMENT COCCYGEAL FRACTURE",null,1431,378,317.70999999999998,1198.25,357.75,1]
["OUTPATIENT","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 85014","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT",85014,"HC CHG BLOOD COUNT HEMATOCRIT","QW",12,2.37,2.16,26.61,3,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 85046","TUFTS","TUFTS HMO","CPT",85046,"HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS",null,141,24.97,5.08,62.56,35.25,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN WELL SENSE - CPT - 85210","BMC HEALTHNET","BMCHN WELL SENSE","CPT",85210,"HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC",null,65,33.03,11.84,145.74,16.25,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 88185","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT",88185,"HC CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA",null,158,48.43,35.42,62.22,39.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 88280","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",88280,"HC CHG CHROMOSOME KARYOTYPE STUDY",null,149,70.489999999999995,24.73,324.62,37.25,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 81025","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT",81025,"URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS",null,32,8.6300000000000008,6.36,83.47,8,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 81179","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",81179,"HC CHG ATXN2 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES",null,175,157.55000000000001,102.3,1328.77,43.75,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 81207","UNICARE","UNICARE","CPT",81207,"HC Q;P190 BCR-ABL 1",null,287,350.95,132.12,1625.92,71.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 81235","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",81235,"HC CHG EGFR GENE ANALYSIS COMMON VARIANTS",null,1038,683.57,239.82,3148.12,259.5,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 85306","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT",85306,"HC CHG CLOTTING INHIBITORS PROTEIN S FREE",null,69,22.21,13.98,172.07,17.25,1]
["OUTPATIENT","FALLON - FALLON MEDICAID - CPT - 85378","FALLON","FALLON MEDICAID","CPT",85378,"HC CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN",null,36,7.18,7.18,94.31,9,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 88331","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",88331,"PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC",null,299,190.34,34.96,1369.2,74.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA - CPT - 89050","CIGNA HEALTHCARE","CIGNA","CPT",89050,"HC CHG CELL COUNT MISCELLANEOUS BODY FLUIDS",null,25,21.27,4.3099999999999996,53.02,6.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - G0399","TUFTS","TUFTS PPO","CPT","G0399","HC HOME SLEEP TEST/TYPE 3 PORTA",null,206,581.65,286.31,1634.89,51.5,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 81261","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT",81261,"IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED; PRO/TECH",null,737,213.11,180.6,2222.63,184.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 81274","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",81274,"HC HTT GENE ANALYSIS CHARACTERIZATION ALLELES",null,175,593.36,205.22,2665.65,43.75,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MEDICAID - CPT - 85610","BMC HEALTHNET","BMCHN MEDICAID","CPT",85610,"POC;INR",null,21,3.58,3.58,44.06,5.25,1]
["OUTPATIENT","FALLON - FALLON SENIOR PLAN - CPT - 85730","FALLON","FALLON SENIOR PLAN","CPT",85730,"HC CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD",null,31,6.01,5.48,67.41,7.75,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 86003","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT",86003,"HC CHG ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN",null,22,7.2,4.76,58.53,5.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90876","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",90876,"HC INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 45 MIN",null,1070,235.11,235.11,235.11,267.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 91038","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",91038,"ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG",null,2395,764.57,764.57,4429.7299999999996,598.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 84134","BLUE CROSS","BLUE CROSS-PPO","CPT",84134,"HC CHG PREALBUMIN",null,72,32.94,13.31,163.76,18,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 84166","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT",84166,"HC CHG PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI",null,99,37.549999999999997,16.260000000000002,200.15,24.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 29580","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",29580,"STRAPPING UNNA BOOT",null,328,226.08,226.08,764.24,82,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 30100","BLUE CROSS","BLUE CROSS-PPO","CPT",30100,"HC BIOPSY INTRANASAL",null,939,2148.08,1098.98,3264.67,234.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 30560","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",30560,"HC RELEASE OF NASAL ADHESIONS",null,731,1025.9000000000001,818.07,7703.8,182.75,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN QHP - CPT - 62329","BMC HEALTHNET","BMCHN QHP","CPT",62329,"HC THER SPI PNXR CSF FLUOR/CT",null,794,0,1005.99,3264.67,198.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 64454","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",64454,"HC NJX AA&/STRD GNCLR NRV BRNCH",null,794,1292.83,1005.99,3474.13,198.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 64461","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",64461,"HC PVB,THORACIC;SINGLE INJECTION SITE INCLUDING IMAGING GUIDANCE WHEN PERFORMED",null,824,1005.62,1005.62,3264.67,206,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 79101","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",79101,"HC CHG RP THERAPY INTRAVENOUS ADMINISTRATION",null,1381,397.36,303.64999999999998,2756.08,345.25,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 80053","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT",80053,"HC CHG COMPREHENSIVE METABOLIC PANEL",null,375,11.36,9.6300000000000008,118.56,93.75,1]
["OUTPATIENT","FALLON - FALLON SENIOR PLAN - CPT - 84206","FALLON","FALLON SENIOR PLAN","CPT",84206,"HC CHG ASSAY OF PROINSULIN",null,86,26.69,19.72,258.88,21.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 84302","TUFTS","TUFTS SELECT","CPT",84302,"HC CHG ASSAY OF SODIUM OTHER SOURCE",null,25,8.4700000000000006,4.43,54.53,6.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 84311","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",84311,"HC CHG SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED",null,32,17.489999999999998,6.38,79.27,8,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 31256","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",31256,"HC EXPLORATION MAXILLARY SINUS",null,4562,4602.58,1990.62,7703.8,1140.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 31579","AETNA","AETNA","CPT",31579,"LARYNGOSCOPY FLX/RGD FIBOPT W/STROBOSCOPY",null,1103,1500.85,649.07000000000005,2032.26,275.75,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 32555","TUFTS","TUFTS HMO","CPT",32555,"THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING",null,836,2057.7399999999998,1041.23,3264.67,209,1]
["OUTPATIENT","AETNA - AETNA - CPT - 64612","AETNA","AETNA","CPT",64612,"CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL",null,1247,1198.25,415.61,2032.26,311.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 64640","TUFTS","TUFTS PPO","CPT",64640,"DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE",null,1297,2058.16,1098.98,3264.67,324.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 65105","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",65105,"HC REMOVE EYE/ATTACH IMPLANT",null,4867,4996.58,2166.09,11845.41,1216.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 80171","TUFTS","TUFTS SELECT","CPT",80171,"DRUG SCREEN QUANTITATIVE GABAPENTIN",null,83,32.64,16.010000000000002,210.18,20.75,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 80197","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",80197,"HC CHG DRUG SCREEN QUANTITATIVE TACROLIMUS",null,36,13.73,10.01,154.22,9,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 84445","TUFTS","TUFTS POS","CPT",84445,"HC CHG THYROID STIMULATING IMMUNE GLOBULINS TSI",null,244,189.88,46.39,570.91,61,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 84460","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT",84460,"HC CHG TRANSFERASE ALANINE AMINO (ALT) (SGPT)",null,27,6.36,4.83,59.46,6.75,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 33011","TUFTS","TUFTS HMO","CPT",33011,"PERICARDIOCEN SUBQ",null,1645,2057.7399999999998,1098.98,3264.67,411.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 33224","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",33224,"HC INSJ ELTRD CAR VEN SYS ATTCH PREV PM/DFB PLS GEN",null,10670,16591.07,1098.98,16591.07,2667.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 33235","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",33235,"HC RMVL TRANSVNS PM ELTRD DUAL LEAD SYS",null,4756,5257.32,2166.09,7703.8,1189,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 65280","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",65280,"HC REPAIR OF EYE WOUND",null,5769,6113.35,2166.09,11845.41,1442.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 65435","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",65435,"RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION",null,1108,1355.74,1098.98,3264.67,277,1]
["OUTPATIENT","AETNA - AETNA - CPT - 66682","AETNA","AETNA","CPT",66682,"HC REPAIR IRIS & CILIARY BODY",null,3062,1500.85,1500.85,7703.8,765.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 80306","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",80306,"HC DRUG TEST PRSMV INSTRMNT",null,192,37.01,11.89,145.87,48,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MEDICAID - CPT - 80353","BMC HEALTHNET","BMCHN MEDICAID","CPT",80353,"HC CHG DRUG SCREENING COCAINE",null,71,0,18.37,118.27,17.75,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81002","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT",81002,"URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP",null,12,3.08,2.57,33.79,3,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 84560","UNICARE","UNICARE","CPT",84560,"HC CHG ASSAY OF URIC ACID OTHER SOURCE",null,25,11.52,4.33,53.31,6.25,1]
["OUTPATIENT","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 85018","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT",85018,"POC;HEMOGLOBIN","QW",12,2.37,2.16,26.61,3,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 33285","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",33285,"HC INSJ SUBQ CAR RHYTHM MNTR",null,11393,12434.24,1198.25,25611.61,2848.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 36012","AETNA","AETNA","CPT",36012,"HC SLCTV CATH PLMT VEN SYS 2ND ORDER/> SLCTV BRANC",null,1351,1198.25,428.26,1198.25,337.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 36218","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",36218,"HC SLCTV CATHJ EA 2ND+ ORD THRC/BRCH/CPHLC BRNCH",null,401,0,128.88,1500.85,100.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 66986","BLUE CROSS","BLUE CROSS-PPO","CPT",66986,"HC EXCHANGE LENS PROSTHESIS",null,3062,3219.62,2398.64,7703.8,765.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 67042","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",67042,"HC VIT FOR MACULAR HOLE",null,5769,7073.38,2354.5,15242.01,1442.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 67312","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",67312,"HC STRABISMUS RECESSION/RESCJ 2 HRZNTL MUSC",null,4867,4996.58,2166.09,11845.41,1216.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 81025","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",81025,"URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS",null,32,18.59,6.36,83.47,8,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 81218","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT",81218,"HC CEBPA GENE ANALYSIS FULL GENE SEQUENC",null,551,333.62,159,2715.49,137.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 85060","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",85060,"HC BL SMEAR W/O DIFF WBC COUNT",null,79,183.73,15.64,183.73,19.75,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN QHP - CPT - 85060","BMC HEALTHNET","BMCHN QHP","CPT",85060,"HC BL SMEAR W/O DIFF WBC COUNT",null,79,20.420000000000002,15.64,183.73,19.75,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 85270","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT",85270,"HC CHG CLOTTING FACTOR XI PTA",null,91,19.22,16.329999999999998,200.93,22.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 36474","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",36474,"HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM SBSQ VEINS",null,2062,0,218.48,1198.25,515.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 36573","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",36573,"HC INSJ PICC RS&I 5 YR+",null,1683,1836.61,1198.25,7703.8,420.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 67405","TUFTS","TUFTS PPO","CPT",67405,"HC EXPLORE/DRAIN EYE SOCKET",null,2949,7467.76,2166.09,11845.41,737.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 67715","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",67715,"HC CANTHOTOMY SEPARATE PROCEDURE",null,2719,3044.16,1098.98,3522.21,679.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 67882","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",67882,"HC REVISION EYELID,XPOSITN TARSAL PLATE",null,3716,3522.21,1990.62,11845.41,929,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 68020","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",68020,"HC INCISE/DRAIN CONJUNCTIVA",null,1212,1355.74,684.11,2032.26,303,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 81256","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",81256,"HC CHG HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS",null,434,156.79,59.62,733.73,108.5,1]
["OUTPATIENT","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 81272","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT",81272,"HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS",null,660,395.41,159,3195.92,165,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 85366","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",85366,"HC CHG FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ",null,38,169.45,10.33,780.44,9.5,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN ACO - CPT - 85549","BMC HEALTHNET","BMCHN ACO","CPT",85549,"HC CHG MURAMIDASE",null,91,37.409999999999997,17.100000000000001,210.55,22.75,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 85610","TUFTS","TUFTS HMO","CPT",85610,"POC;INR",null,21,17.59,3.58,44.06,5.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 37192","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",37192,"HC REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I",null,3752,4436.09,1990.62,11845.41,938,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 37221","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",37221,"HC REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOPLSTY",null,15672,18787.919999999998,2166.09,37129.18,3918,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 68320","BLUE CROSS","BLUE CROSS-PPO","CPT",68320,"HC CONJUNCTIVOPLASTY W/GRF/XTNSV REARRANGEMENT",null,2949,3044.16,2166.09,11845.41,737.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 69220","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",69220,"DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE",null,487,380.96,171.09,508.23,121.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 70130","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",70130,"HC CHG RADEX MASTOIDS COMPL MINIMUM 3 VIEWS SIDE",null,546,193.63,72.290000000000006,1103.3900000000001,136.5,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 81291","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT",81291,"HC CHG MTHFR GENE ANALYSIS COMMON VARIANTS",null,434,73,48.28,633.76,108.5,1]
["OUTPATIENT","AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 81305","AETNA","AETNA-MEDICARE ADVANTAGE","CPT",81305,"HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT",null,223,206.97,130.97,1701.28,55.75,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 81342","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT",81342,"TRG@ GENE REARRANGEMENT ANALYSIS; PRO/TECH",null,534,216.88,183.8,2261.92,133.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 86022","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",86022,"HC CRL;SEROTONIN RLS ASSAY",null,265,44.07,16.760000000000002,206.23,66.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 86140","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",86140,"C-REACTIVE PROTEIN",null,106,12.41,4.72,58.08,26.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 38206","TUFTS","TUFTS HMO","CPT",38206,"HC BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ AUTOL",null,1744,2057.7399999999998,1098.98,3264.67,436,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 38220","TUFTS","TUFTS SELECT","CPT",38220,"MARROW ASPIRATION ONLY",null,1103,1098.98,1098.98,3264.67,275.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 40652","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",40652,"HC REPAIR LIP,<1/2 VERT HEIGHT",null,658,1025.9000000000001,818.07,11845.41,164.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 70460","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",70460,"HC CHG CT HEAD/BRAIN W/CONTRAST MATERIAL",null,2057,347.19,347.19,2420.09,514.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 70498","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",70498,"HC CHG CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST",null,4973,577.83000000000004,347.19,2420.09,1243.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 71045","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",71045,"HC CHG RADIOLOGIC EXAM CHEST SINGLE VIEW",null,221,81.93,81.93,801.26,55.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 81402","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",81402,"HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 3",null,434,274.7,150.33000000000001,378.26,108.5,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 81479","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT",81479,"HC CHG UNLISTED MOLELCULAR PATHOLOGY PROCEDURE",null,1744,0,100.02,100.02,436,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 86235","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT",86235,"HC CHG EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD",null,81,24.74,16.36,201.29,20.25,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 86301","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT",86301,"HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9",null,100,22.79,18.989999999999998,233.69,25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 86334","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT",86334,"HC CHG IMMUNOFIXJ ELECTROPHORESIS SERUM",null,80,47.05,20.39,250.85,20,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 40831","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",40831,"HC REPAIR MOUTH LACERATION,>2.5 CM",null,691,1051.71,818.07,3264.67,172.75,1]
["OUTPATIENT","AETNA - AETNA - CPT - 41822","AETNA","AETNA","CPT",41822,"EXCIS FIBROUS TUBER,DENTOALV",null,2007,1198.25,1098.98,3264.67,501.75,1]
["OUTPATIENT","AETNA - AETNA - CPT - 42500","AETNA","AETNA","CPT",42500,"HC PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY PRIM",null,6512,1990.62,1990.62,11845.41,1628,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 72050","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",72050,"HC CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS",null,504,193.63,125.38,1304.76,126,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 72128","BLUE CROSS","BLUE CROSS-PPO","CPT",72128,"HC CHG CT THORACIC SPINE W/O CONTRAST MATERIAL",null,2005,322.25,193.63,1307.74,501.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 82085","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",82085,"HC CHG ASSAY OF ALDOLASE",null,48,20.96,8.86,109.06,12,1]
["OUTPATIENT","ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 82105","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT",82105,"HC CHG ALPHA-FETOPROTEIN SERUM",null,84,16.77,15.3,188.33,21,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA PPO - CPT - 82157","CIGNA HEALTHCARE","CIGNA PPO","CPT",82157,"HC CHG ANDROSTENEDIONE",null,141,74.45,26.7,328.66,35.25,1]
["OUTPATIENT","TUFTS - TUFTS SPIRIT - CPT - 86340","TUFTS","TUFTS SPIRIT","CPT",86340,"HC CHG INTRINSIC FACTOR ANTIBODIES",null,73,16.59,13.75,169.26,18.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 86376","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",86376,"HC CHG MICROSOMAL ANTIBODIES EACH",null,70,32.94,13.27,163.31,17.5,1]
["OUTPATIENT","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 86611","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT",86611,"HC BARTONELLA, ANTIBODY",null,61,13.39,9.2799999999999994,114.2,15.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 42842","TUFTS","TUFTS PPO","CPT",42842,"HC RAD RESEC TONSIL/PILLARS",null,7214,7467.76,3987.49,11845.41,1803.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 43246","TUFTS","TUFTS HMO","CPT",43246,"HC UPR GI NDSC PLMT PRQ GASTROSTOMY TUBE",null,1937,4856.75,1010.64,7703.8,484.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 43250","TUFTS","TUFTS PPO","CPT",43250,"HC UPR GI NDSC RMVL LESION HOT BX/BIPOLAR CAUTERY",null,1459,4856.75,1010.64,7703.8,364.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 72240","BLUE CROSS","BLUE CROSS-PPO","CPT",72240,"HC CHG MYELOGRAPHY CERVICAL RS&I",null,1230,909.72,308.97000000000003,7066.23,307.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 73130","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",73130,"HC CHG RADEX HAND MINIMUM 3 VIEWS",null,310,107.22,72.290000000000006,851.68,77.5,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 82232","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT",82232,"HC CHG BETA-2 MICROGLOBULIN",null,81,19.420000000000002,14.76,181.61,20.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 82271","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT",82271,"HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES","QW",15,13.39,3.93,51.64,3.75,1]
["OUTPATIENT","FALLON - FALLON MEDICAID - CPT - 82310","FALLON","FALLON MEDICAID","CPT",82310,"HC CHG CALCIUM TOTAL",null,26,4.71,4.71,57.87,6.5,1]
["OUTPATIENT","AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 86618","AETNA","AETNA-MEDICARE ADVANTAGE","CPT",86618,"HC Q;LYME AB INDEX CNS INFEC","QW",191,20.100000000000001,15.53,191.1,47.75,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 86638","TUFTS","TUFTS MEDICARE SCO","CPT",86638,"HC CHG, Q FEVER ANTIBODY",null,63,17.57,11.06,136.13,15.75,1]
["OUTPATIENT","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 86654","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT",86654,"CHG ANTIBODY ENCEPHALITIS WESTRN EQUINE",null,28,13.19,12.03,148.07,7,1]
["OUTPATIENT","AETNA - AETNA - CPT - 43763","AETNA","AETNA","CPT",43763,"HC RPLC GTUBE REVJ GSTRST TRC",null,357,1198.25,388.64,3264.67,89.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 43763","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",43763,"HC RPLC GTUBE REVJ GSTRST TRC",null,357,388.64,388.64,3264.67,89.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 44500","TUFTS","TUFTS SELECT","CPT",44500,"HC INTRODUCTION LONG GI TUBE SEPARATE PROCEDURE.",null,1170,1098.98,1098.98,3264.67,292.5,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 73660","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",73660,"HC CHG RADEX TOE MINIMUM 2 VIEWS",null,294,72.290000000000006,72.290000000000006,801.26,73.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 74018","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",74018,"HC X-RAY EXAM ABDOMEN 1 VIEW",null,232,81.93,81.93,801.26,58,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MCO - CPT - 82438","BMC HEALTHNET","BMCHN MCO","CPT",82438,"HC CHG CHLORIDE OTHER SOURCE",null,25,4.46,4.46,54.82,6.25,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 82533","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",82533,"HC CHG CORTISOL TOTAL",null,82,21.98,14.87,182.99,20.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 82550","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",82550,"HC CHG CREATINE KINASE TOTAL",null,33,17.36,5.94,73.12,8.25,1]
["OUTPATIENT","TUFTS - TUFTS SPIRIT - CPT - 86666","TUFTS","TUFTS SPIRIT","CPT",86666,"HC CHG ANTIBODY EHRLICHIA",null,77,11.2,9.2799999999999994,114.2,19.25,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 86694","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT",86694,"HC CHG ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST",null,34,15.49,13.13,161.6,8.5,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MCO - CPT - 86706","BMC HEALTHNET","BMCHN MCO","CPT",86706,"HC CHG HEPATITIS B SURF ANTIBODY HBSAB",null,52,9.8000000000000007,9.8000000000000007,120.52,13,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 45349","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",45349,"SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION",null,2215,2115.37,1098.98,3264.67,553.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 45386","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",45386,"HC COLSC FLX PROX SPLENIC FLXR DILAT BALO 1/> STRI",null,2054,2063.44,1020.59,3264.67,513.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 46060","TUFTS","TUFTS PPO","CPT",46060,"I&D ISCHIORCT/INTRAMURAL ABSC W/WO SETON",null,3647,4856.75,1500.85,7703.8,911.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 74340","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",74340,"HC CHG INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I",null,245,0,130.34,197.5,61.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 75710","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",75710,"HC CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I",null,6293,3473.84,1894.5,31186.53,1573.25,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 82595","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT",82595,"HC CHG CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE",null,33,8.01,5.9,72.55,8.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 82652","TUFTS","TUFTS HMO","CPT",82652,"HC CHG 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED",null,191,172.49,35.119999999999997,432.18,47.75,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN ACO - CPT - 82668","BMC HEALTHNET","BMCHN ACO","CPT",82668,"HC CHG ASSAY OF ERYTHROPOIETIN",null,91,37.5,17.14,210.99,22.75,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 86708","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT",86708,"HC CHG HEPATITIS A ANTIBODY HAAB",null,58,13.56,11.3,139.02000000000001,14.5,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 86780","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT",86780,"HC CHG ANTIBODY TREPONEMA PALLIDUM",null,61,19.2,12.07,148.63999999999999,15.25,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 86789","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",86789,"HC CHG ANTIBODY WEST NILE VIRUS",null,79,19.399999999999999,13.13,161.6,19.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 46916","TUFTS","TUFTS PPO","CPT",46916,"DSTRJ LESION ANUS SIMPLE CRYOSURGERY",null,1115,595.01,296.32,1500.85,278.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 49321","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",49321,"HC LAP,DX SURGICAL ABD W/BIOPSY",null,7189,7718.14,2166.09,11845.41,1797.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 75810","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",75810,"HC CHG SPLENOPORTOGRAPY RS&I",null,4288,1882.14,827.44,17690.02,1072,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 75831","TUFTS","TUFTS SELECT","CPT",75831,"HC CHG VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I",null,4288,4843.46,780.65,31186.53,1072,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 76010","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",76010,"HC CHG RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD",null,249,801.26,72.290000000000006,801.26,62.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 82747","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",82747,"HC CHG ASSAY OF FOLIC ACID RBC",null,76,38.11,15.8,194.37,19,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 82947","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",82947,"HC CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP",null,21,44.06,3.58,44.06,5.25,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 86813","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT",86813,"HC CHG HLA TYPING A/B/C MULTIPLE ANTIGENS",null,266,62.42,52.9,651.04,66.5,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MCO - CPT - 86870","BMC HEALTHNET","BMCHN MCO","CPT",86870,"HC CHG ANTIBODY ID RBC ANTIBODIES EA PANEL EA SERUM TQ",null,209,0,57.04,2437.5300000000002,52.25,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 86902","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT",86902,"HC CHG BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH",null,87,7.62,4.6900000000000004,2272.4699999999998,21.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 49411","BLUE CROSS","BLUE CROSS-PPO","CPT",49411,"INTERSTITIAL DEV PLMT RADIATION THERAPY 1/MLT",null,1473,2001.68,1198.25,7703.8,368.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 50593","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",50593,"HC ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY",null,12512,15042.77,2397.88,15242.01,3128,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 51702","TUFTS","TUFTS SELECT","CPT",51702,"INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE",null,228,190.72,178.83,1198.25,57,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 76706","TUFTS","TUFTS SELECT","CPT",76706,"HC CHG US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA",null,301,197.9,147.96,1274.24,75.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 76811","BLUE CROSS","BLUE CROSS-PPO","CPT",76811,"US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION",null,1767,303.20999999999998,227.73,2433.2600000000002,441.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 82960","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",82960,"HC CHG GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN",null,29,13.83,5.52,67.86,7.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA - CPT - 83002","CIGNA HEALTHCARE","CIGNA","CPT",83002,"HC CHG GONADOTROPIN LUTEINIZING HORMONE",null,93,83.47,16.89,207.81,23.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 83014","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",83014,"HC H PYLORI DRUG ADMIN",null,40,17.79,7.17,88.24,10,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 87046","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",87046,"HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA",null,48,105.97,6,105.97,12,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 87081","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",87081,"HC CULT,BACT,SCR,H PYLORI",null,34,15.16,6.04,74.42,8.5,1]
["OUTPATIENT","FALLON - FALLON MEDICAID - CPT - 87107","FALLON","FALLON MEDICAID","CPT",87107,"HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD",null,51,9.41,9.41,115.87,12.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 54001","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",54001,"HC SLITTING OF PREPUCE",null,2635,2921.68,1500.85,7703.8,658.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 54162","BLUE CROSS","BLUE CROSS-PPO","CPT",54162,"HC LYSIS/EXCIS,PENILE POSTCIRCUM ADHESIONS",null,2614,2921.68,1500.85,7703.8,653.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 56440","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",56440,"MARSUPIALIZATION BARTHOLINS GLAND CYST",null,2365,3965.45,1500.85,7703.8,591.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 77047","TUFTS","TUFTS SELECT","CPT",77047,"HC MRI BREAST C- BILATERAL",null,356,412.18,396.79,2720.22,89,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 77075","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",77075,"HC CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL",null,981,147.96,125.38,1304.76,245.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA - CPT - 83498","CIGNA HEALTHCARE","CIGNA","CPT",83498,"HC CHG ASSAY OF HYDROXYPROGESTERONE 17-D",null,130,122.39,24.78,305.02,32.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 83615","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT",83615,"HC CHG LACTATE DEHYDROGENASE LDH",null,31,15.2,5.5,67.78,7.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 83655","BLUE CROSS","BLUE CROSS-PPO","CPT",83655,"HC CHG ASSAY OF LEAD",null,58,27.01,11.05,135.91999999999999,14.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 27532","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",27532,"HC CLTX TIBIAL FX PROXIMAL W/WO MANJ W/SKEL TRACJ",null,4413,4405.5600000000004,1098.98,5097.42,1103.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 27648","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",27648,"HC INJECTION ANKLE ARTHROGRAPHY",null,396,0,130.88,1198.25,99,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 27810","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",27810,"CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ",null,3285,2205.59,1098.98,3264.67,821.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 57061","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",57061,"DESTRUCTION VAGINAL LESIONS SIMPLE",null,2365,3264.67,1098.98,4588.18,591.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 57461","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",57461,"COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX",null,2365,3965.45,1990.62,11845.41,591.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 77317","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",77317,"BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL",null,1185,553.85,369.25,3892.44,296.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 77373","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",77373,"HC SRS FRACTIONATED 1-5 BODY; 2-5 CRANIAL",null,13470,4864.47,2909.47,20524.84,3367.5,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 77763","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",77763,"HC BRACHY INCAV CMP",null,5993,523.85,523.85,8077.76,1498.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 77790","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",77790,"HC BRACHY , SUP. HANDLING, LOADING",null,846,69.3,69.3,69.3,211.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 83915","BLUE CROSS","BLUE CROSS-PPO","CPT",83915,"HC CHG ASSAY OF NUCLEOTIDASE 5'-",null,54,25.04,10.17,125.2,13.5,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 83937","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT",83937,"HC CHG ASSAY OF OSTEOCALCIN",null,143,35.82,27.23,335.1,35.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 27830","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",27830,"CLTX PROX TIBFIB JT DISLC W/O ANES",null,2510,378,378,3264.67,627.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 28430","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",28430,"CLOSED TX TALUS FRACTURE W/O MANIPULATION",null,1603,485.97,378,2032.26,400.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 59015","TUFTS","TUFTS POS","CPT",59015,"CHORIONIC VILLUS SAMPLING",null,1037,1281.21,684.11,2032.26,259.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 59820","TUFTS","TUFTS POS","CPT",59820,"TX MISSED ABORTION FIRST TRIMESTER SURGICAL",null,2772,7467.76,2354.5,11845.41,693,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 61642","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT",61642,"HC BAL DIL VASO;EA ADD,OTH",null,3302,0,812.01,812.01,825.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 62302","AETNA","AETNA","CPT",62302,"MYELOGRAPHY VIA LUMBAR INJECTION RS&I CERVICAL",null,877,1198.25,1098.98,3264.67,219.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 78432","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",78432,"HC MYOCRD IMG PET 2RTRACER",null,3491,7550.99,4733.6099999999997,14700.77,872.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 78645","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",78645,"HC CHG CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ",null,3070,783.95,345.6,5427.23,767.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 43753","TUFTS","TUFTS SELECT","CPT",43753,"GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE",null,158,317.70999999999998,317.70999999999998,1198.25,39.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 44377","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",44377,"HC ENTEROSC >2ND PRTN W/ILEUM W/BX SINGLE/MULTIPLE",null,2469,2491.1,1013.38,7703.8,617.25,1]
["OUTPATIENT","AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 87385","AETNA","AETNA-MEDICARE ADVANTAGE","CPT",87385,"HC CHG IAAD IA HISTOPLASM CAPSULATUM",null,46,15.63,10.94,134.54,11.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 87420","TUFTS","TUFTS POS","CPT",87420,"HC CHG IAAD IA RESPIRATORY SYNCTIAL VIRUS",null,57,45.24,10.94,136.04,14.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 87481","TUFTS","TUFTS PPO","CPT",87481,"HC CHG CANDIDA, DNA, AMP PROBE",null,124,140.16999999999999,32.01,393.99,31,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 87496","BLUE CROSS","BLUE CROSS-PPO","CPT",87496,"HC ARUP;CYTOMEG VIR PCR,CSF",null,41,79.05,32.01,393.99,10.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 97150","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",97150,"HC THERAPEUTIC PROCEDURES GROUP 2/> INDIVIDUALS",null,102,45.54,30.91,115.14,25.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 97163","TUFTS","TUFTS HMO","CPT",97163,"HC PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS",null,426,270.06,143.78,458.25,106.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 97802","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",97802,"MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI",null,165,84.13,57.12,182.04,41.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 22515","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",22515,"PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH",null,11021,554.91,554.91,1198.25,2755.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 23073","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",23073,"HC EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/>",null,1528,3994.03,1990.62,11845.41,382,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 45300","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",45300,"PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX",null,794,1250.94,420.29,3264.67,198.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 45349","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",45349,"SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION",null,2215,1645.44,1098.98,3264.67,553.75,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 87502","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT",87502,"HC Q;FLU AG DET,MULT TYP,2,2",null,269,138.91,77.11,958.3,67.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 87510","TUFTS","TUFTS SELECT","CPT",87510,"HC CHG IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ",null,157,34.96,18.29,225.1,39.25,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 87538","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",87538,"HC HIV-2 PROBE&REVRSE TRNSCRIPJ",null,326,47.31,32.01,393.99,81.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 99203","TUFTS","TUFTS HMO","CPT",99203,"OFFICE OUTPATIENT NEW 30 MINUTES",null,322,46.32,33.74,184.8,80.5,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 99403","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT",99403,"HC PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 45 MIN",null,312,0,34.03,233.09,78,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 99496","TUFTS","TUFTS SELECT","CPT",99496,"TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE",null,827,0,194.55,1179.72,206.75,1]
["OUTPATIENT","AETNA - AETNA - CPT - 23620","AETNA","AETNA","CPT",23620,"CLTX GREATER HUMERAL TUBEROSITY FX W/O MANJ",null,1217,1198.25,378,3264.67,304.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 24605","TUFTS","TUFTS PPO","CPT",24605,"HC TX ELBOW DISLOC W/ANESTH",null,2026,4856.75,1500.85,7703.8,506.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 46221","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",46221,"HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS",null,1473,1250.94,1098.98,3264.67,368.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 47382","AETNA","AETNA","CPT",47382,"HC ABLTJ 1/> LVR TUM PRQ RF",null,5817,2166.09,2166.09,15242.01,1454.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 47536","TUFTS","TUFTS POS","CPT",47536,"EXCHANGE BILIARY DRG CATHETER PRQ W/IMAGE GUID RAD S&I",null,1033,2058.17,1098.98,5726.94,258.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 49082","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",49082,"ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE",null,836,1603.82,1098.98,3264.67,209,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 87641","TUFTS","TUFTS SELECT","CPT",87641,"HC CHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ",null,129,61.19,32.01,393.99,32.25,1]
["OUTPATIENT","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 87900","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT",87900,"HC CHG NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION",null,600,156.41999999999999,118.9,1463.3,150,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 26011","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",26011,"DRAINAGE FINGER ABSCESS COMPLICATED",null,1418,2672.73,1098.98,3264.67,354.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 26341","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",26341,"MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD",null,567,485.97,378,2032.26,141.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 26720","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",26720,"CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA",null,1413,378,317.70999999999998,1198.25,353.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 49422","BLUE CROSS","BLUE CROSS-PPO","CPT",49422,"REMOVE TUNNELED IP CATH",null,4214,4436.09,1098.98,5703.04,1053.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 50387","TUFTS","TUFTS POS","CPT",50387,"HC RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH",null,2635,2058.17,1098.98,3380.52,658.75,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 87906","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT",87906,"HC Q;HIV1 GENO",null,2063,186.66,56.44,1445.09,515.75,1]
["OUTPATIENT","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 88152","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT",88152,"HC CHG CYTOPATH SMEAR CERV/VAG,AUTO REDO",null,36,27.64,13.16,268.05,9,1]
["OUTPATIENT","AETNA - AETNA - CPT - 27047","AETNA","AETNA","CPT",27047,"EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ <3CM",null,2794,1500.85,1500.85,7703.8,698.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 27047","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",27047,"EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ <3CM",null,2794,3994.03,1500.85,7703.8,698.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 27502","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",27502,"CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ",null,5928,2489.31,1500.85,7703.8,1482,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 27618","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",27618,"EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM",null,2331,2672.73,1500.85,7703.8,582.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 51725","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",51725,"SIMPLE CYSTOMETROGRAM",null,1404,1338.81,388.64,1338.81,351,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 54164","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",54164,"FRENULOTOMY PENIS",null,2985,3380.52,1500.85,7703.8,746.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 88264","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",88264,"HC CHG CHRMSM ANALYZE 20-25 CELLS",null,519,281.29000000000002,113.7,1414.07,129.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 88307","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",88307,"HC CHG LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM",null,757,360.63,73.599999999999994,1975.12,189.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 88356","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",88356,"CHG ANALYSIS, NERVE TECH",null,836,67.040000000000006,67.040000000000006,683.56,209,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 27808","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",27808,"CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ",null,2302,378,378,3264.67,575.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 28296","AETNA","AETNA","CPT",28296,"HC CORRJ HALLUX VALGUS W/SESMDC W/DIST METAR OSTEOT",null,3939,1990.62,1990.62,11845.41,984.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 54520","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",54520,"HC REMOVAL OF TESTIS",null,4463,2921.68,1990.62,7703.8,1115.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 56740","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",56740,"HC EXCIS BARTHOLIN GLAND/CYST",null,3544,4588.18,1990.62,11845.41,886,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 57156","TUFTS","TUFTS SELECT","CPT",57156,"HC INSERTION OF CYLINDER",null,406,684.11,458.47,2032.26,101.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 89050","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT",89050,"HC CHG CELL COUNT MISCELLANEOUS BODY FLUIDS",null,25,9.94,4.3099999999999996,53.02,6.25,1]
["OUTPATIENT","FALLON - FALLON SENIOR PLAN - CPT - 90662","FALLON","FALLON SENIOR PLAN","CPT",90662,"INFLUENZA VACCINE CELL CULT PRSRV FREE IM FLUZONE HIGH DOSE",null,129,60.98,60.98,244.17,32.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 28600","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",28600,"CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES",null,1431,485.97,317.70999999999998,1198.25,357.75,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 29345","TUFTS","TUFTS HMO","CPT",29345,"APPLICATION LONG LEG CAST THIGH-TOE",null,776,770.98,395.63,1308.22,194,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 29700","TUFTS","TUFTS HMO","CPT",29700,"REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST",null,262,703.6,374.59,1193.8800000000001,65.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 58575","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",58575,"HC LAPS TOT HYSTERECTOMY RESJ MALIGNANCY W/OMNTC",null,3031,4699.7299999999996,4699.7299999999996,4699.7299999999996,757.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 59870","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",59870,"UTERINE EVACUATION & CURETTAGE HYDATIDIFORM MOLE",null,3675,4588.18,2354.5,11845.41,918.75,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 90845","TUFTS","TUFTS HMO","CPT",90845,"PSYCHOANALYSIS",null,153,55.42,40.369999999999997,214.2,38.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 90912","TUFTS","TUFTS PPO","CPT",90912,"HC BFB TRAINING 1ST 15 MIN",null,260,487.64,108.42,1370.62,65,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 29881","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",29881,"HC KNEE SCOPE SINGLE MENISCECTOMY",null,4072,4405.5600000000004,2166.09,7703.8,1018,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 30300","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",30300,"REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE",null,993,943.8,178.83,943.8,248.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 31238","TUFTS","TUFTS PPO","CPT",31238,"NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMRRG",null,2091,2058.16,1098.98,3264.67,522.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 31530","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",31530,"HC LARYNGOSCOPY,DIRCT,OP,F.B. REMVL",null,2128,2299.54,1500.85,7703.8,532,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 62322","UNICARE","UNICARE","CPT",62322,"HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",null,1153,995.78,829.82,3264.67,288.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 64408","TUFTS","TUFTS PPO","CPT",64408,"HC INJ,ANES;VAGUS NER",null,579,1281.21,310.58,2032.26,144.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 92225","TUFTS","TUFTS PPO","CPT",92225,"OPHTHALMOSCPY EXTENDED RETINAL DRAWING I&R 1ST",null,107,201.93,68.75,320.3,26.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 92313","TUFTS","TUFTS POS","CPT",92313,"HC CONTACT LENS FIT,CORNEOSCLERAL LENS",null,212,358.22,93.14,607.84,53,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 92532","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",92532,"POSITIONAL NYSTAGMUS TEST",null,163,0,42.65,42.65,40.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 31629","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",31629,"HC BRONCHOSCOPY NEEDLE BX TRACHEA MAIN STEM&/BRON",null,3439,7703.8,1500.85,7703.8,859.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 31632","TUFTS","TUFTS SELECT","CPT",31632,"HC BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE",null,378,0,120.16,1500.85,94.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 64417","AETNA","AETNA","CPT",64417,"INJECTION ANESTHETIC AGENT AXILLARY NERVE",null,548,1198.25,310.58,2032.26,137,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 64461","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",64461,"HC PVB,THORACIC;SINGLE INJECTION SITE INCLUDING IMAGING GUIDANCE WHEN PERFORMED",null,824,1292.83,1005.62,3264.67,206,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 64493","TUFTS","TUFTS PPO","CPT",64493,"NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL",null,2074,2758.7,829.82,4375.87,518.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 92577","TUFTS","TUFTS HMO","CPT",92577,"STENGER TEST SPEECH",null,286,1516.9,158,3800.82,71.5,1]
["OUTPATIENT","FALLON - FALLON MEDICAID - CPT - 92605","FALLON","FALLON MEDICAID","CPT",92605,"EVAL RX N-SP-GEN AUGMT ALT COMMUN DEV F2F 1ST HR",null,402,0,152.96,863.86,100.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 92933","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",92933,"HC PRQ TRLUML CORONRY STENT/ATH/ANGIO ONE ART/BRNCH",null,16686,29835.33,3954.83,62742.78,4171.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 33271","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",33271,"INSJ OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE",null,11405,10135.48,1990.62,31200.07,2851.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 33271","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",33271,"INSJ OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE",null,11405,10390.549999999999,1990.62,31200.07,2851.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 64644","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",64644,"CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES",null,865,1292.83,684.11,2032.26,216.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 65175","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",65175,"HC REMOVAL OF OCULAR IMPLANT",null,4867,5639.32,1098.98,5781.24,1216.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 65779","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",65779,"HC PLACE AMNIOTIC MEMBRANE OCULAR SURFACE WOUND HEALING, SUTURED",null,4466,4996.58,1098.98,6423.61,1116.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 93278","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",93278,"SIGNAL AVERAGED ELECTROCARDIOGRAPHY W/WO ECG",null,85,120.69,47.27,562.35,21.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 93299","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",93299,"INTERROGATION EVAL REMOTE </30 D TECH REVIEW",null,165,369.9,65.5,369.9,41.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - U0004","TUFTS","TUFTS POS","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",null,150,322.60000000000002,100,906.74,37.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 10009","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",10009,"HC FNA BX W/CT GDN 1ST LES",null,892,1250.8,684.11,2032.26,223,1]
["OUTPATIENT","AETNA - AETNA - CPT - 10060","AETNA","AETNA","CPT",10060,"INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE",null,729,1198.25,296.32,1198.25,182.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 36406","TUFTS","TUFTS HMO","CPT",36406,"HC VNPNXR <3 YEARS PHYS/QHP SKILL OTHER VEIN",null,78,0,21.37,21.37,19.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 36512","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",36512,"THERAPEUTIC APHERESIS RED BLOOD CELLS",null,1867,2094.1799999999998,1500.85,7279.25,466.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 65920","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",65920,"HC REMOVE IMPLANT OF EYE",null,3062,3219.62,2531.06,15242.01,765.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 66710","TUFTS","TUFTS POS","CPT",66710,"CILIARY BODY DSTRJ CYCLOPHOTOCOAG TRANSSCERAL",null,3098,4856.75,1500.85,7703.8,774.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 67010","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",67010,"HC RMVL VITREOUS ANT APPR SUBTOT RMVL MECH VITRECT",null,3062,3219.62,2166.09,11845.41,765.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 93453","TUFTS","TUFTS POS","CPT",93453,"HC R & L HRT CATH W/NJX L VENTRICULOG IMG S&I",null,10776,4856.75,2531.06,7703.8,2694,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 93571","BLUE CROSS","BLUE CROSS-PPO","CPT",93571,"HC IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL",null,818,519.97,519.97,4520.62,204.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 93610","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",93610,"HC INTRA-ATRIAL PACING",null,8754,8560.41,4616.53,47572.639999999999,2188.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 11102","TUFTS","TUFTS SELECT","CPT",11102,"HC TANGNTL BX SKIN SINGLE LES",null,272,317.70999999999998,296.32,1198.25,68,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11402","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",11402,"EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM",null,876,972.93,684.11,2032.26,219,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 36578","TUFTS","TUFTS HMO","CPT",36578,"HC RPLCMT CATH CTR VAD SUBQ PORT/PMP",null,3308,7467.76,1500.85,11845.41,827,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 36904","TUFTS","TUFTS SELECT","CPT",36904,"HC PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH",null,7857,2593.31,2354.5,9090.86,1964.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 37184","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",37184,"HC PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST",null,5624,7856.99,2397.88,15242.01,1406,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 67505","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",67505,"HC INJECT/TREAT EYE SOCKET",null,385,612.12,476.13,2032.26,96.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 67903","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",67903,"HC RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT INTERNAL",null,2949,3044.16,2166.09,11845.41,737.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 93622","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",93622,"HC COMPRE ELECTROPHYSIOL XM W/LEFT VENTR PACNG/REC",null,1561,524.51,524.51,5170.4799999999996,390.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 93656","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",93656,"HC COMPRE EP EVAL ABLTJ ATR FIB",null,25096,37334.22,2531.06,62742.78,6274,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 93886","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",93886,"TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL",null,3426,387.2,300.69,2134.23,856.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 11643","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",11643,"EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<",null,1786,2672.73,1098.98,3264.67,446.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 12011","TUFTS","TUFTS SELECT","CPT",12011,"SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<",null,428,1098.98,296.32,3264.67,107,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 12031","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",12031,"REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<",null,1177,2032.26,527.46,2032.26,294.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 37220","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",37220,"HC REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL",null,7580,7856.99,2166.09,25611.61,1895,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 37241","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",37241,"VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I",null,15195,18787.919999999998,1990.62,18787.919999999998,3798.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 68320","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",68320,"HC CONJUNCTIVOPLASTY W/GRF/XTNSV REARRANGEMENT",null,2949,3044.16,2166.09,11845.41,737.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 68761","TUFTS","TUFTS POS","CPT",68761,"CLSR LACRIMAL PUNCTUM PLUG EACH",null,924,1281.21,476.13,2032.26,231,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 69436","TUFTS","TUFTS POS","CPT",69436,"HC CREATE EARDRUM OPENING,GEN ANESTH",null,2007,4856.75,1990.62,7703.8,501.75,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 70160","TUFTS","TUFTS HMO","CPT",70160,"RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS",null,316,319.77999999999997,72.290000000000006,801.26,79,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 94644","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",94644,"CONTINUOUS INHALATION TREATMENT 1ST HR",null,226,224.25,178.83,1077.0999999999999,56.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 95165","TUFTS","TUFTS HMO","CPT",95165,"PREPJ& ALLERGEN IMMUNOTHERAPY 1/MLT ANTIGEN",null,99,128.82,63.62,218.59,24.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 12044","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",12044,"REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM",null,1648,810.95,684.11,2032.26,412,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 14040","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",14040,"ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<",null,4928,3344.2,1500.85,7703.8,1232,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 15241","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",15241,"FTH/GT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA20CM/<",null,870,0,275.18,1990.62,217.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 40530","TUFTS","TUFTS PPO","CPT",40530,"HC PARTIAL REMOVAL OF LIP,>1/4",null,3896,4856.75,1500.85,7703.8,974,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 41108","TUFTS","TUFTS PPO","CPT",41108,"BIOPSY FLOOR MOUTH",null,1103,1281.21,684.11,2672.73,275.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 70210","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",70210,"HC CHG RADEX SINUSES PARANASAL <3 VIEWS",null,302,107.22,72.290000000000006,801.26,75.5,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 70390","UNICARE","UNICARE","CPT",70390,"HC SIALOGRAPHY",null,971,208.63,173.86,2562.5700000000002,242.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 95249","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",95249,"HC CONT GLUC MONITORING PATIENT PROVIDED EQUIPMENT",null,134,117.73,93.87,562.35,33.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 95713","TUFTS","TUFTS PPO","CPT",95713,"HC VEEG 2-12 HR CONT MNTR",null,723,1628.55,781.56,4577.47,180.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 95865","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",95865,"NEEDLE ELECTROMYOGRAPHY LARYNX",null,636,1036.18,178.83,1036.18,159,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 95887","TUFTS","TUFTS PPO","CPT",95887,"NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION",null,389,0,117.85,117.85,97.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 15820","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",15820,"HC REVISION OF LOWER EYELID",null,2527,3262.11,1990.62,7703.8,631.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 17110","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",17110,"DESTRUCTION BENIGN LESIONS UP TO 14",null,536,296.32,171.09,1198.25,134,1]
["OUTPATIENT","AETNA - AETNA - CPT - 41823","AETNA","AETNA","CPT",41823,"HC EXCIS OSSEOUS TUBER,DENTOALV",null,6641,1500.85,1500.85,8596.73,1660.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 42408","TUFTS","TUFTS SELECT","CPT",42408,"HC EXCISION SUBLING SALIVARY CYST",null,3896,3987.49,1990.62,11845.41,974,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 42800","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",42800,"BIOPSY OROPHARYNX",null,2094,4335.57,1098.98,4335.57,523.5,1]
["OUTPATIENT","TUFTS - TUFTS SPIRIT - CPT - 87177","TUFTS","TUFTS SPIRIT","CPT",87177,"HC CHG OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID",null,44,9.7899999999999991,8.1199999999999992,99.89,11,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 87205","TUFTS","TUFTS HMO","CPT",87205,"HC CHG SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL",null,23,19.12,3.89,47.89,5.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 95907","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",95907,"MOTOR &/SENS 1-2 NRV CNDJ PRECONF ELTRODE LIMB",null,473,228.32,178.47,797.09,118.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 95961","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",95961,"HC FUNCJAL CORT & SUBCORT MAPG PHYS/QHP ATTND INIT HR",null,1352,1532.92,1419.2,8015.16,338,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 95990","BLUE CROSS","BLUE CROSS-PPO","CPT",95990,"REFILL&MAINTENANCE PUMP DRUG DLVR SPINAL/BRAIN",null,457,484.3,484.3,1636.93,114.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 19100","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",19100,"BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX",null,709,2032.26,684.11,2672.73,177.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 20100","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",20100,"HC EXPLORE WOUND,NECK",null,658,818.07,818.07,3264.67,164.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 20527","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",20527,"INJECTION ENZYME PALMAR FASCIAL CORD",null,454,415.61,317.70999999999998,1198.25,113.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 43237","BLUE CROSS","BLUE CROSS-PPO","CPT",43237,"UPR GI NDSC & US NDSC EXAM LMTD ESOPHAGUS",null,1797,2491.1,1010.64,3264.67,449.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 43265","BLUE CROSS","BLUE CROSS-PPO","CPT",43265,"HC ERCP W/DSTRJ LITHOTRIPSY CALCULI ANY METHOD",null,4415,7550.56,1500.85,8736.31,1103.75,1]
["OUTPATIENT","AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 87253","AETNA","AETNA-MEDICARE ADVANTAGE","CPT",87253,"HC CHG VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE",null,100,23.84,18.43,226.77,25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 87276","TUFTS","TUFTS SELECT","CPT",87276,"HC CHG IAADI INFFLUENZA A VIRUS",null,57,24.2,11.87,155.81,14.25,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 87327","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",87327,"HC CHG IAAD IA CRYPTOCOCCUS NEOFORMANS",null,57,13.42,10.94,134.82,14.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 96160","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",96160,"PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM",null,42,56.05,50.95,162.4,10.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 96371","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",96371,"HC SUBQ INFUSION ADDITIONAL PUMP INFUSION SITE",null,405,100.35,100.35,345.64,101.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 96413","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",96413,"CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG",null,754,484.3,484.3,3098.76,188.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 21012","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",21012,"EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/>",null,2586,2309.9699999999998,1098.98,3264.67,646.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 21040","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",21040,"HC EXCISION BENIGN TUMORE MANDIBLE",null,3209,3747.12,1500.85,7703.8,802.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 92620","TUFTS","TUFTS PPO","CPT",92620,"EVAL CENTRAL AUDITORY FUNCJ W/REPRT 1ST 60 MIN",null,410,494.97,228.32,1391.25,102.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 92921","TUFTS","TUFTS POS","CPT",92921,"HC PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH",null,5911,0,6476.91,6476.91,1477.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 92977","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",92977,"HC THROMBOLYSIS,CORONARY,IV INFUSN",null,437,484.3,484.3,3021.28,109.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 73564","TUFTS","TUFTS PPO","CPT",73564,"HC CHG RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS",null,422,392.56,72.290000000000006,1103.3900000000001,105.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 73700","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",73700,"HC CHG CT LOWER EXTREMITY W/O CONTRAST MATERIAL",null,1997,193.63,193.63,1274.24,499.25,1]
["OUTPATIENT","FALLON - FALLON SENIOR PLAN - CPT - 82374","FALLON","FALLON SENIOR PLAN","CPT",82374,"HC CHG CARBON DIOXIDE BICARBONATE",null,25,4.88,4.46,54.82,6.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 82435","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",82435,"HC CHG CHLORIDE BLD",null,24,51.64,4.2,51.64,6,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MCO - CPT - 82495","BMC HEALTHNET","BMCHN MCO","CPT",82495,"HC CHG ASSAY OF CHROMIUM",null,98,18.5,18.5,227.7,24.5,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN ACO - CPT - 82525","BMC HEALTHNET","BMCHN ACO","CPT",82525,"HC CHG ASSAY OF COPPER",null,62,24.77,11.32,139.30000000000001,15.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 86648","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",86648,"HC CHG ANTIBODY DIPHTHERIA",null,83,36.49,13.39,170.69,20.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 86689","BLUE CROSS","BLUE CROSS-PPO","CPT",86689,"HC HTLV/HIV CONFIRMATORY TEST",null,52,43.48,17.66,217.35,13,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 93279","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",93279,"PROGRAM EVAL IMPLANTABLE IN PRSN 1 LD PACEMAKER",null,448,78.260000000000005,41.48,370.47,112,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 93288","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",93288,"INTERROGATION EVAL IN PERSON 1/DUAL/MLT LEAD PM",null,334,80.23,41.48,370.47,83.5,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 93321","UNICARE","UNICARE","CPT",93321,"HC DOP ECHOCARD PULSE WAVE W/SPECTRAL F-UP/LMTD STD",null,224,225.94,51.85,225.94,56,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 74262","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",74262,"HC CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST",null,5902,347.19,347.19,2420.09,1475.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 74445","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",74445,"HC CHG CORPORA CAVERNOSOGRAPY RS&I",null,490,193.63,147.96,1756.83,122.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 75565","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",75565,"HC CHG CARDIAC MRI FOR VELOCITY FLOW MAPPING",null,619,0,186.53,186.53,154.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 82570","TUFTS","TUFTS POS","CPT",82570,"HC CHG CREATININE OTHER SOURCE",null,26,19.309999999999999,4.72,58.08,6.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA PPO - CPT - 82670","CIGNA HEALTHCARE","CIGNA PPO","CPT",82670,"HC CHG ASSAY OF ESTRADIOL",null,139,71.069999999999993,25.48,313.62,34.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86702","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",86702,"HC QL/SEMI MULT AB;HIV2",null,82,30.3,12.33,151.72999999999999,20.5,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 86708","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",86708,"HC CHG HEPATITIS A ANTIBODY HAAB",null,58,16.7,11.3,139.02000000000001,14.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 86744","TUFTS","TUFTS HMO","CPT",86744,"HC CHG ANTIBODY NOCARDIA",null,46,61.89,12.03,155.08000000000001,11.5,1]
["OUTPATIENT","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 86774","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT",86774,"HC CHG ANTIBODY TETANUS",null,83,32.71,12.77,166.08,20.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 93582","TUFTS","TUFTS POS","CPT",93582,"HC PERCUTAN TRANSCATH CLOSURE PAT DUCT ARTERIOSUS",null,23044,3954.83,2574.12,62742.78,5761,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 93662","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",93662,"INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I",null,1277,426.19,426.19,4520.62,319.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 75827","TUFTS","TUFTS HMO","CPT",75827,"HC CHG VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I",null,1532,3434.38,815.37,8605.14,383,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 75833","TUFTS","TUFTS HMO","CPT",75833,"HC CHG VENOGRAM RENAL BILAT",null,4122,12446.74,827.44,31186.53,1030.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 76377","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",76377,"HC CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION",null,742,0,64.89,64.89,185.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 82785","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",82785,"HC CHG ASSAY OF GAMMAGLOBULIN IGE",null,82,36.89,15.01,184.75,20.5,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 82810","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",82810,"HC BLOOD GASSES O2 SAT ONLY",null,52,13.17,7.96,98.14,13,1]
["OUTPATIENT","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 82951","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT",82951,"HC CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS","QW",64,22.39,11.74,144.52000000000001,16,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 86790","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",86790,"HC CHG ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED",null,32,17.36,11.75,144.6,8,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 86850","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT",86850,"HC CHG ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE",null,87,9.8000000000000007,5.25,501.09,21.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 93893","TUFTS","TUFTS POS","CPT",93893,"HC TRANSCRAN DOPP INTRACRAN, EMBOLI W/INJ",null,3150,354.6,188.79,1066.22,787.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 93975","TUFTS","TUFTS POS","CPT",93975,"DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM",null,3476,709.8,300.69,2134.23,869,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 94453","BLUE CROSS","BLUE CROSS-PPO","CPT",94453,"HC HAST W/OXYGEN TITRATE",null,163,178.83,117.36,1077.0999999999999,40.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 76810","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",76810,"US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO",null,930,0,88.6,183.41,232.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 76816","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",76816,"US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS",null,1146,147.96,98.34,1179.76,286.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 82952","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",82952,"HC CHG GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS",null,15,8.57,3.58,43.98,3.75,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 83001","UNICARE","UNICARE","CPT",83001,"HC CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE",null,93,45.11,16.95,208.59,23.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 83020","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",83020,"HC CHG HEMOGLOBIN ELECTROPHORESIS",null,63,144.52000000000001,11.74,144.52000000000001,15.75,1]
["OUTPATIENT","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 87070","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT",87070,"CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL",null,43,11.82,7.86,96.71,10.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 87086","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",87086,"HC CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE",null,41,18.45,7.36,90.56,10.25,1]
["OUTPATIENT","TUFTS - TUFTS SPIRIT - CPT - 87107","TUFTS","TUFTS SPIRIT","CPT",87107,"HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD",null,51,11.35,9.41,115.87,12.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 94690","BLUE CROSS","BLUE CROSS-PPO","CPT",94690,"O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX",null,252,53.94,53.94,321.69,63,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 95079","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",95079,"INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES",null,330,0,169.15,169.15,82.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 76981","TUFTS","TUFTS POS","CPT",76981,"HC USE PARENCHYMA",null,174,331.51,141.28,996.77,43.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 77014","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",77014,"HC CT GUIDANCE",null,1088,345.55,161,345.55,272,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 77080","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",77080,"DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL",null,913,193.63,119.6,1198.1400000000001,228.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 83070","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT",83070,"HC CHG ASSAY OF HEMOSIDERIN QUALITATIVE",null,25,11.95,4.33,53.31,6.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 83550","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",83550,"HC CHG IRON BINDING CAPACITY",null,44,19.760000000000002,7.97,98.14,11,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 83695","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT",83695,"HC CHG LIPOPROTEIN (A)",null,63,14.17,11.81,145.38,15.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 87149","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",87149,"HC CHG CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM",null,100,48.1,18.29,225.1,25,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 87185","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",87185,"HC CHG SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ",null,25,9.6,3.54,53.31,6.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 87207","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT",87207,"SMR PRIM SRC SPEC STAIN BODIES/PARASITS",null,281,12.61,5.47,67.33,70.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 95866","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",95866,"NEEDLE ELECTROMYOGRAPHY HEMIDIAPHRAGM",null,580,228.32,228.32,1310.18,145,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 95923","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",95923,"HC AUTONOMIC NRV SYST FUNJ TEST",null,163,229.89,178.83,1036.18,40.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 77293","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",77293,"RESPIRATORY MOTION MANAGEMENT SIMULATION",null,2899,0,1626.4,1626.4,724.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 77370","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",77370,"HC SPEC MED PHYSICS CONSULT",null,938,356.14,160.66,1474.02,234.5,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MCO - CPT - 83718","BMC HEALTHNET","BMCHN MCO","CPT",83718,"HC CHG LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL",null,41,7.48,7.48,91.95,10.25,1]
["OUTPATIENT","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 83785","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT",83785,"HC CHG, ASSAY OF MANGANESE",null,109,31.98,22.44,276.16000000000003,27.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA PPO - CPT - 83916","CIGNA HEALTHCARE","CIGNA PPO","CPT",83916,"HC CHG OLIGOCLONAL IMMUNE",null,97,51.13,20.239999999999998,265.61,24.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 83930","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",83930,"HC Q;OSMOLALITY,SER",null,33,15.87,6.03,74.22,8.25,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 87269","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT",87269,"HC CHG IAADI GIARDIA",null,57,16.329999999999998,10.94,135.27000000000001,14.25,1]
["OUTPATIENT","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 87305","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT",87305,"HC CHG IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS",null,272,15.71,10.94,134.54,68,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 95962","TUFTS","TUFTS PPO","CPT",95962,"HC FUNCJAL CORT & SUBCORT MAPG PHYS/QHP ATTND ADDL HR",null,676,0,236.55,236.55,169,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MCO - CPT - 96040","BMC HEALTHNET","BMCHN MCO","CPT",96040,"MEDICAL GENETICS COUNSELING EACH 30 MINUTES",null,231,0,33.74,122.29,57.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 96130","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",96130,"HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR",null,341,228.32,71.41,293.52,85.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 78227","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",78227,"HC CHG HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ",null,4204,783.95,430.8,5427.23,1051,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 78445","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",78445,"HC CHG NONCARDIAC VASCULAR FLOW IMAGING",null,1640,4231.53,239.64,4231.53,410,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 78491","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",78491,"HC CHG MYOCRD IMAGE PET PERFUS SINGLE STUDY REST/STRESS",null,3492,3939.92,1212.54,16731.72,873,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 84100","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT",84100,"HC CHG ASSAY OF PHOSPHORUS INORGANIC",null,25,5.86,4.32,53.23,6.25,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 84144","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",84144,"HC CHG ASSAY OF PROGESTERONE",null,104,20.86,19.03,234.27,26,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 87338","TUFTS","TUFTS HMO","CPT",87338,"HC CHG IAAD IA HPYLORI STOOL",null,102,64.47,13.12,161.52000000000001,25.5,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN QHP - CPT - 87390","BMC HEALTHNET","BMCHN QHP","CPT",87390,"HC CHG IAAD IA HIV-1",null,87,21.34,17.78,233.33,21.75,1]
["OUTPATIENT","ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 87425","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT",87425,"HC CHG IAAD IA ROTAVIRUS",null,57,11.98,10.94,134.54,14.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 96367","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",96367,"IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR",null,144,129,100.35,345.64,36,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 96370","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",96370,"HC SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,EA ADD HOUR",null,57,218.59,63.62,218.59,14.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 97124","TUFTS","TUFTS POS","CPT",97124,"HC THER PX 1 AREAS EA 15 MIN MASSAGE",null,130,109.46,43.93,185.72,32.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 78804","TUFTS","TUFTS POS","CPT",78804,"HC RP TUM LOC/RP DIS;BODY,2/",null,5251,4909.7700000000004,1071.19,14762.31,1312.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 78835","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",78835,"HC RP QUAN MEAS SINGLE AREA",null,1832,0,375.38,375.38,458,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 84156","TUFTS","TUFTS POS","CPT",84156,"HC CHG PROTEIN TOTAL XCPT REFRACTOMETRY URINE",null,20,13.69,3.35,41.16,5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 84207","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",84207,"HC CHG ASSAY OF PYRIDOXAL PHOSPHATE",null,130,67.400000000000006,25.63,315.49,32.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 84210","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",84210,"HC CHG ASSAY OF PYRUVATE",null,53,26.35,10.7,140.4,13.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 84302","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",84302,"HC CHG ASSAY OF SODIUM OTHER SOURCE",null,25,11.66,4.43,54.53,6.25,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN ACO - CPT - 87493","BMC HEALTHNET","BMCHN ACO","CPT",87493,"HC CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE",null,120,70.040000000000006,32.01,393.99,30,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 87529","UNICARE","UNICARE","CPT",87529,"HC CHG IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ",null,140,63.22,32.01,393.99,35,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 97161","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",97161,"HC PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS",null,316,211.79,143.78,458.25,79,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 97542","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",97542,"HC WHEELCHAIR MGMT EA 15 MIN",null,150,82.83,55,209.44,37.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 98967","TUFTS","TUFTS HMO","CPT",98967,"NONPHYSICIAN TELEPHONE ASSESSMENT 11-20 MIN",null,72,0,38.6,108.49,18,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 80074","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",80074,"HC CHG ACUTE HEPATITIS PANEL",null,391,64.209999999999994,43.45,534.79999999999995,97.75,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 80175","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",80175,"DRUG SCREEN QUANTITATIVE LAMOTRIGINE",null,64,17.86,12.09,148.84,16,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 84402","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT",84402,"HC CHG ASSAY OF TESTOSTERONE FREE",null,123,30.56,23.24,285.98,30.75,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 84432","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",84432,"HC CHG ASSAY OF THYROGLOBULIN",null,79,16.059999999999999,14.65,180.3,19.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA - CPT - 84466","CIGNA HEALTHCARE","CIGNA","CPT",84466,"HC CHG ASSAY OF L7383TRANSFERRIN",null,64,57.55,11.64,143.30000000000001,16,1]
["OUTPATIENT","FALLON - FALLON MEDICAID - CPT - 87538","FALLON","FALLON MEDICAID","CPT",87538,"HC HIV-2 PROBE&REVRSE TRNSCRIPJ",null,326,32.01,32.01,393.99,81.5,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 87635","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",87635,"HC SARS-COV-2 COVID-19 AMP PRB",null,153,69.180000000000007,51.31,465.19,38.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 87660","TUFTS","TUFTS SELECT","CPT",87660,"HC CHG IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ",null,157,34.96,18.29,225.1,39.25,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 99202","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",99202,"OFFICE OUTPATIENT NEW 20 MINUTES",null,211,77.44,33.74,123.21,52.75,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN ACO - CPT - 99406","BMC HEALTHNET","BMCHN ACO","CPT",99406,"TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES",null,83,0,50.95,287.77999999999997,20.75,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 80195","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT",80195,"HC CHG DRUG SCREEN QUANTITATIVE SIROLIMUS",null,35,16.48,10.01,154.22,8.75,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN ACO - CPT - 80201","BMC HEALTHNET","BMCHN ACO","CPT",80201,"HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE",null,46,23.81,10.88,133.80000000000001,11.5,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 80280","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",80280,"HC DRUG ASSAY VEDOLIZUMAB",null,67,38.57,38.57,206.18,16.75,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 80345","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT",80345,"HC CHG DRUG SCREENING BARBITURATES",null,95,0,16.41,105.68,23.75,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 84591","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",84591,"HC CHG ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED",null,58,23.45,12.6,165.43,14.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 84681","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",84681,"HC CHG ASSAY OF C-PEPTIDE",null,100,46.77,18.989999999999998,233.69,25,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 87801","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT",87801,"HC CHG DETECT AGENT, MULT ORGS, DNA  AMP",null,310,76.84,64.03,787.98,77.5,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 88142","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",88142,"CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN",null,101,27.31,18.48,227.42,25.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 88143","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",88143,"HC CHG CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS",null,101,45.46,18.48,228.72,25.25,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 81002","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT",81002,"URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP",null,12,3.02,2.57,33.79,3,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 81050","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",81050,"HC CHG VOLUME MEASUREMENT TIMED COLLECTION EACH",null,15,35.29,2.74,35.29,3.75,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 81207","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT",81207,"HC Q;P190 BCR-ABL 1",null,287,0,132.12,1625.92,71.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 85025","TUFTS","TUFTS POS","CPT",85025,"HC CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC",null,40,29,7.09,87.22,10,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MCO - CPT - 85055","BMC HEALTHNET","BMCHN MCO","CPT",85055,"HC CHG RETICULATED PLATELET ASSAY",null,141,26.41,15.07,346.67,35.25,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN ACO - CPT - 88188","BMC HEALTHNET","BMCHN ACO","CPT",88188,"FLOWCYTOMETRY/READ, 9-15 MARKERS",null,272,61.72,59.25,381.48,68,1]
["OUTPATIENT","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 88262","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT",88262,"HC CHG CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING",null,492,277.32,113.7,1399.23,123,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA PPO - CPT - 88304","CIGNA HEALTHCARE","CIGNA PPO","CPT",88304,"HC CHG LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM",null,191,88.99,55.2,557.29999999999995,47.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 81235","TUFTS","TUFTS POS","CPT",81235,"HC CHG EGFR GENE ANALYSIS COMMON VARIANTS",null,1038,1047.03,239.82,3148.12,259.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 81243","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",81243,"HC CHG FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES",null,434,104.09,57.04,371.04,108.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 85270","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",85270,"HC CHG CLOTTING FACTOR XI PTA",null,91,40.18,16.329999999999998,200.93,22.75,1]
["OUTPATIENT","ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 85301","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT",85301,"HC CHG CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY",null,52,10.81,9.86,121.37,13,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 85366","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",85366,"HC CHG FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ",null,38,173.71,10.33,780.44,9.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 88363","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",88363,"HC CHG EXAM & SELECT ARCHIVE TISSUE MOLECULAR ANALYSI",null,51,22.57,12.3,200.27,12.75,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 89050","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",89050,"HC CHG CELL COUNT MISCELLANEOUS BODY FLUIDS",null,25,4.72,4.3099999999999996,53.02,6.25,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 81261","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT",81261,"IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED; PRO/TECH",null,737,0,180.6,2222.63,184.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 81272","TUFTS","TUFTS POS","CPT",81272,"HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS",null,660,1062.94,159,3195.92,165,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 81305","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",81305,"HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT",null,223,175.4,130.97,1701.28,55.75,1]
["OUTPATIENT","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 85610","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT",85610,"POC;INR",null,21,5.15,3.58,44.06,5.25,1]
["OUTPATIENT","TUFTS - TUFTS SPIRIT - CPT - 85651","TUFTS","TUFTS SPIRIT","CPT",85651,"SEDIMENTATION RATE RBC NON-AUTOMATED",null,20,4.7,3.24,41.45,5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 86003","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT",86003,"HC CHG ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN",null,22,13.13,4.76,58.53,5.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90840","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",90840,"HC PSYCHOTHERAPY FOR CRISIS EACH ADDL 30 MINUTES",null,92,147.96,147.96,147.96,23,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 81308","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",81308,"HC PALB2 GENE KNOWN FAMIL VRNT",null,223,301.35000000000002,301.35000000000002,1610.68,55.75,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 81363","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT",81363,"HC HBB DUPLICATION/DELETION VARIANTS",null,455,293.48,149.54,1963.05,113.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 81404","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",81404,"VHL (EG, VON HIPPEL-LINDAUFAMILIAL CANCER SYNDROME, FULL GENE SEQ VWF PRO/TECH",null,629,502.63,274.83,691.53,157.25,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN QHP - CPT - 86039","BMC HEALTHNET","BMCHN QHP","CPT",86039,"HC CHG ANTINUCLEAR ANTIBODIES ANA TITER",null,170,12.22,10.18,125.28,42.5,1]
["OUTPATIENT","FALLON - FALLON SENIOR PLAN - CPT - 86200","FALLON","FALLON SENIOR PLAN","CPT",86200,"HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY",null,63,12.95,11.81,145.38,15.75,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 86200","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT",86200,"HC CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY",null,63,14.17,11.81,145.38,15.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 91111","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",91111,"GASTROINTESTINAL TRACT IMAGING ESOPHAGUS W/I&R",null,3770,1278.93,1278.93,7945.14,942.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 92060","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",92060,"SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX",null,322,120.69,68.75,344.19,80.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 71111","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",71111,"HC CHG RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS",null,504,193.63,125.38,1274.24,126,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 72074","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",72074,"HC X-RAY EXAM THORAC SPINE4/>VW",null,161,147.96,72.290000000000006,1274.24,40.25,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 72125","UNICARE","UNICARE","CPT",72125,"HC CHG CT CERVICAL SPINE W/O CONTRAST MATERIAL",null,2037,382.14,193.63,1307.74,509.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 72133","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",72133,"HC CT,L SPINE;W/WO",null,2997,577.83000000000004,347.19,2420.09,749.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA PPO - CPT - 82043","CIGNA HEALTHCARE","CIGNA PPO","CPT",82043,"HC CHG ALBUMIN URINE MICROALBUMIN QUANTIATIVE",null,27,13.75,5.28,64.88,6.75,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 82164","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",82164,"HC CHG ANGIOTENSIN I-CONVERTING ENZYME",null,71,29.51,13.32,163.96,17.75,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 86335","TUFTS","TUFTS MEDICARE SCO","CPT",86335,"HC CHG IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS",null,138,42.56,26.77,329.47,34.5,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 86341","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT",86341,"HC CHG ISLET CELL ANTIBODY",null,96,21.3,18.05,228.64,24,1]
["OUTPATIENT","FALLON - FALLON MEDICAID - CPT - 86382","FALLON","FALLON MEDICAID","CPT",86382,"HC CHG NEUTRALIZATION TEST VIRAL",null,324,15.43,15.43,189.88,81,1]
["OUTPATIENT","AETNA - AETNA - CPT - 92511","AETNA","AETNA","CPT",92511,"NASOPHARYNGOSCOPY W/ENDOSCOPE SPX",null,328,1198.25,275.37,1646.99,82,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 92577","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",92577,"STENGER TEST SPEECH",null,286,764.57,158,3800.82,71.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 72147","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",72147,"HC CHG MRI SPINAL CANAL THORACIC W/CONTRAST MATRL",null,4142,1105.27,637.16,4285.49,1035.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 72198","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",72198,"HC CHG MRA PELVIS W/WO CONTRAST MATERIAL",null,4469,664.1,547.75,3526.9,1117.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 73020","TUFTS","TUFTS POS","CPT",73020,"HC CHG RADEX SHOULDER 1 VIEW",null,229,266.48,72.290000000000006,801.26,57.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 82232","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",82232,"HC CHG BETA-2 MICROGLOBULIN",null,81,34.93,14.76,181.61,20.25,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 82271","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",82271,"HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES","QW",15,7.17,3.93,51.64,3.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 82340","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",82340,"HC Q;KID STONE, UR CALCIUM",null,31,14.47,5.5,67.7,7.75,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 86481","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT",86481,"HC TB TEST CELL MEDIATED ANTIGEN RESPONSE, ENUM GAMMA INTERFRON T-CELL",null,127,86.97,73.89,969.95,31.75,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 86618","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT",86618,"HC Q;LYME AB INDEX CNS INFEC",null,191,24.69,15.53,191.1,47.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 78453","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",78453,"HC MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS",null,1924,2115.7600000000002,1360.45,13344.86,481,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 78457","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",78457,"HC VENOUS THROMBOSIS IMAGING",null,710,2115.7600000000002,239.64,11909.96,177.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 78804","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",78804,"HC RP TUM LOC/RP DIS;BODY,2/",null,5251,14762.31,1071.19,14762.31,1312.75,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 80048","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT",80048,"HC CHG BASIC METABOLIC PANEL CALCIUM TOTAL",null,226,10.15,7.71,94.96,56.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 33231","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",33231,"HC INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST MULTILEADS",null,34636,41965.52,1990.62,62742.78,8659,1]
["OUTPATIENT","AETNA - AETNA - CPT - 33285","AETNA","AETNA","CPT",33285,"HC INSJ SUBQ CAR RHYTHM MNTR",null,11393,1198.25,1198.25,25611.61,2848.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 64561","BLUE CROSS","BLUE CROSS-PPO","CPT",64561,"IMPLANT NEUROELECTRODES",null,9071,10041.84,1098.98,11618.83,2267.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 64632","TUFTS","TUFTS POS","CPT",64632,"DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE",null,522,595.01,317.70999999999998,1198.25,130.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 65093","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",65093,"HC REVISE EYE WITH IMPLANT",null,4867,5781.24,1990.62,11845.41,1216.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 80076","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",80076,"HC CHG HEPATIC FUNCTION PANEL",null,224,18.45,7.46,91.78,56,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 80168","UNICARE","UNICARE","CPT",80168,"HC CHG DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE",null,75,39.65,14.9,183.36,18.75,1]
["OUTPATIENT","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - U0004","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",null,150,120,100,906.74,37.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 0106T","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT","0106T","HC QUANT SENSORY TEST, PER EXTREMITY, TOUCH STIMULI",null,49,69.349999999999994,67.64,69.349999999999994,12.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 10120","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",10120,"INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE",null,715,661.45,317.70999999999998,1198.25,178.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 36224","TUFTS","TUFTS PPO","CPT",36224,"HC SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART",null,7758,10732.28,1990.62,17023.61,1939.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 36254","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",36254,"HC SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I",null,4429,5703.04,1500.85,11845.41,1107.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 65280","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",65280,"HC REPAIR OF EYE WOUND",null,5769,11845.41,2166.09,11845.41,1442.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 65860","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",65860,"SEVERING ADHESIONS ANTERIOR SEGMENT LASER SPX",null,2164,3264.67,833.27,3264.67,541,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 65860","TUFTS","TUFTS PPO","CPT",65860,"SEVERING ADHESIONS ANTERIOR SEGMENT LASER SPX",null,2164,2058.16,833.27,3264.67,541,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 80185","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",80185,"HC CHG DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL",null,66,29.65,12.09,148.84,16.5,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN QHP - CPT - 80198","BMC HEALTHNET","BMCHN QHP","CPT",80198,"HC Q;THEOPHYLLINE",null,71,15.48,12.9,158.69999999999999,17.75,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 80320","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",80320,"DRUG SCREEN QUANTITATIVE ALCOHOLS",null,235,21.86,16.89,108.78,58.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 11305","BLUE CROSS","BLUE CROSS-PPO","CPT",11305,"SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<",null,246,296.32,171.09,508.23,61.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 11402","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",11402,"EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM",null,876,1250.8,684.11,2032.26,219,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 36513","TUFTS","TUFTS PPO","CPT",36513,"THERAPEUTIC APHERESIS PLATELETS",null,1867,1760.42,643.03,2792.38,466.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 36589","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",36589,"RMVL TUN CVC W/O SUBQ PORT/PMP",null,1072,1338.6,684.11,2032.26,268,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 36596","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",36596,"HC MCHNL RMVL INTRAL OBSTR CV DEV THRU DEV LUMEN",null,1461,2361.15,1198.25,7703.8,365.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 67028","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",67028,"INTRAVITREAL NJX PHARMACOLOGIC AGT SPX",null,770,622.61,484.3,2032.26,192.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67105","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",67105,"RPR RETINAL DTCHMNT 1/> SES PC W/WO DRG SUBRETI",null,4946,833.27,833.27,3264.67,1236.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 80345","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",80345,"HC CHG DRUG SCREENING BARBITURATES",null,95,33.93,16.41,105.68,23.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 80366","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",80366,"HC CHG DRUG SCREENING PREGABALIN",null,56,80,12.43,80,14,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 81178","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT",81178,"HC CHG ATXN1 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES",null,175,198.65,102.3,1328.77,43.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 11603","TUFTS","TUFTS PPO","CPT",11603,"EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<",null,1505,2058.16,972.93,3264.67,376.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 11644","TUFTS","TUFTS HMO","CPT",11644,"EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM",null,2210,4856.75,1500.85,7703.8,552.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11922","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",11922,"HC CORRECT SKIN COLR DEFCT ADDN 20 SQCM",null,371,73.66,73.66,1198.25,92.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 37182","TUFTS","TUFTS PPO","CPT",37182,"HC INSJ TRANSVNS INTRAHEPATC PORTOSYSIC SHUNT",null,6320,7467.76,2031.06,11845.41,1580,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 37229","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",37229,"HC REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL",null,16686,25785.9,2166.09,62742.78,4171.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 67515","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",67515,"INJECTION MEDICATION/OTHER SUBST TENON CAPSULE",null,706,597.09,476.13,2032.26,176.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 67875","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",67875,"TEMPORARY CLOSURE EYELIDS SUTURE",null,1212,1700.15,1098.98,3264.67,303,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 68320","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",68320,"HC CONJUNCTIVOPLASTY W/GRF/XTNSV REARRANGEMENT",null,2949,3044.16,2166.09,11845.41,737.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 81220","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT",81220,"HC CHG CFTR GENE ANALYSIS COMMON VARIANTS",null,847,1400.52,411.25,1400.52,211.75,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 81240","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT",81240,"HC CHG F2 GENE ANALYSIS 20210G >A VARIANT",null,434,0,48.54,637.1,108.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 81257","BLUE CROSS","BLUE CROSS-PPO","CPT",81257,"HC CHG HBA1/HBA2 ANALYSIS FOR COMMON DELETIONS/VARIANT",null,455,187.08,102.26,257.31,113.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 12016","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",12016,"SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM",null,1029,678.1,527.46,7703.8,257.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 12057","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",12057,"HC LAYR CLOS WND FACE,FACIAL >30 CM",null,477,527.46,527.46,2032.26,119.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 38790","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",38790,"HC INJECTION PROCEDURE LYMPHANGIOGRAPHY",null,644,208.28,208.28,1198.25,161,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 40650","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",40650,"HC REPAIR LIP,FULL THICK,VERMILION",null,691,818.07,818.07,11845.41,172.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 40840","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",40840,"HC RECONSTRUC MOUTH ANTERIOR",null,6641,7703.8,1500.85,8596.73,1660.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 69145","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",69145,"EXCISION SOFT TIS LES EXTERNAL AUDITORY CANAL",null,1972,7703.8,1500.85,7703.8,493,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 70130","TUFTS","TUFTS PPO","CPT",70130,"HC CHG RADEX MASTOIDS COMPL MINIMUM 3 VIEWS SIDE",null,546,392.56,72.290000000000006,1103.3900000000001,136.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 81270","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",81270,"HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT",null,434,219.89,83.62,1029.05,108.5,1]
["OUTPATIENT","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 81272","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT",81272,"HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS",null,660,728.18,159,3195.92,165,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 81301","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",81301,"HC CHG MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF",null,534,734.07,264.13,3380.71,133.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 14001","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",14001,"ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM",null,5072,2601.27,1990.62,11845.41,1268,1]
["OUTPATIENT","AETNA - AETNA - CPT - 15772","AETNA","AETNA","CPT",15772,"HC GRFG AUTOL FAT LIPO EA ADDL",null,1889,1198.25,349.94,1198.25,472.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 41008","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",41008,"HC I&D MOUTH/TONG INTRA,SUBMANDIBULAR",null,3349,3747.12,1098.98,4335.57,837.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 41250","TUFTS","TUFTS PPO","CPT",41250,"HC RLAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG",null,1199,4856.75,178.83,7703.8,299.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 42725","BLUE CROSS","BLUE CROSS-PPO","CPT",42725,"HC INC/DRAIN RETROPHARYNG ABSCESS,EXT",null,7214,7429.92,1500.85,8596.73,1803.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 42800","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",42800,"BIOPSY OROPHARYNX",null,2094,3747.12,1098.98,4335.57,523.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 70490","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",70490,"HC CHG CT SOFT TISSUE NECK W/O CONTRAST MATERIAL",null,2110,322.25,193.63,1274.24,527.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 71100","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",71100,"HC CHG X-RAY RIBS 2VW UNILAT",null,116,81.93,72.290000000000006,801.26,29,1]
["OUTPATIENT","FALLON - FALLON SENIOR PLAN - CPT - 81309","FALLON","FALLON SENIOR PLAN","CPT",81309,"HC PIK3CA GENE TRGT SEQ ALYS",null,223,274.83,274.83,1468.89,55.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 81404","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",81404,"VHL (EG, VON HIPPEL-LINDAUFAMILIAL CANCER SYNDROME, FULL GENE SEQ VWF PRO/TECH",null,629,502.63,274.83,691.53,157.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 17110","TUFTS","TUFTS SELECT","CPT",17110,"DESTRUCTION BENIGN LESIONS UP TO 14",null,536,171.09,171.09,1198.25,134,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 17312","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",17312,"MOHS,  ADDL STAGE, HEAD/NECK/HAND/FEET/GENTIAL",null,1547,0,499.91,1198.25,386.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 19125","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",19125,"HC EXCISE BREAST LES W XRAY MARKER",null,4228,4729.13,1990.62,7703.8,1057,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 19328","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",19328,"HC REMOVAL OF BREAST IMPLANT",null,4228,6079.77,1098.98,6079.77,1057,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 43236","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",43236,"HC UPPER GI NDSC W/SUBMUCOSAL INJECTION",null,1347,3264.67,1010.64,3264.67,336.75,1]
["OUTPATIENT","AETNA - AETNA - CPT - 43251","AETNA","AETNA","CPT",43251,"HC UPR GI NDSC RMVL TUM POLYP/OTH LES SNARE TQ",null,1681,1500.85,1010.64,7703.8,420.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 71551","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",71551,"HC CHG MRI CHEST W/CONTRAST MATERIAL",null,5082,1190.5,637.16,6980.89,1270.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 72080","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",72080,"HC CHG RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS",null,353,107.22,72.290000000000006,801.26,88.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 72133","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",72133,"HC CT,L SPINE;W/WO",null,2997,347.19,347.19,2420.09,749.25,1]
["OUTPATIENT","FALLON - FALLON MEDICAID - CPT - 82024","FALLON","FALLON MEDICAID","CPT",82024,"HC CHG ADRENOCORTICOTROPIC HORMONE ACTH",null,185,35.229999999999997,35.229999999999997,433.56,46.25,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 82139","UNICARE","UNICARE","CPT",82139,"HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE",null,98,25.96,14.65,189.43,24.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 20102","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",20102,"HC EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK",null,2354,2601.27,1098.98,3344.2,588.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 20525","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",20525,"RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP",null,2987,4621.25,1990.62,11845.41,746.75,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 20690","TUFTS","TUFTS HMO","CPT",20690,"HC APPLY BONE FIXATION DEVICE",null,9361,4856.75,1500.85,11074.87,2340.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 43278","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",43278,"HC ERCP LESION ABLATE W/DILATE",null,4537,4743.7,1990.62,7703.8,1134.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 44369","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",44369,"HC ENTEROSCOPY > 2ND PRTN ABLTJ LESION",null,2282,2491.1,1013.38,7703.8,570.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 44388","AETNA","AETNA","CPT",44388,"HC COLONOSCOPY STOMA DX W/WO COLLJ SPEC SPX",null,1284,1198.25,1020.59,3264.67,321,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 73030","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",73030,"HC CHG RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS",null,294,81.93,72.290000000000006,801.26,73.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 73225","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",73225,"HC CHG MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL",null,4357,1372.95,551.97,3554.09,1089.25,1]
["OUTPATIENT","AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 82172","AETNA","AETNA-MEDICARE ADVANTAGE","CPT",82172,"HC CHG APOLIPOPROTEIN EACH",null,146,24.89,15.58,204.55,36.5,1]
["OUTPATIENT","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 82308","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT",82308,"HC CHG CALCITONIN",null,128,32.15,24.44,300.82,32,1]
["OUTPATIENT","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 82310","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT",82310,"HC CHG CALCIUM TOTAL","QW",26,5.16,4.71,57.87,6.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 21208","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",21208,"HC AUGMENT FACIAL BONES",null,7214,7429.92,2531.06,15242.01,1803.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 21453","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",21453,"HC CLOSED RX MANDIBLE FX+DENTAL FIX",null,5309,7429.92,1990.62,11845.41,1327.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 21556","TUFTS","TUFTS SELECT","CPT",21556,"EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM",null,4117,2593.31,1500.85,7703.8,1029.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 45305","TUFTS","TUFTS POS","CPT",45305,"HC PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE",null,1341,2058.17,737.96,3264.67,335.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 45340","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",45340,"HC SIGMOIDOSCOPY FLX DILAT BALO 1/MORE STRIXS",null,1341,1645.44,737.96,3264.67,335.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 73590","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",73590,"HC CHG RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS",null,262,81.93,72.290000000000006,801.26,65.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 73720","BLUE CROSS","BLUE CROSS-PPO","CPT",73720,"HC CHG MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR",null,5507,1105.27,664.1,4299.8,1376.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 74221","TUFTS","TUFTS PPO","CPT",74221,"HC X-RAY XM ESOPHAGUS 2CNTRST",null,232,618.66,229.65,1738.9,58,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 82375","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT",82375,"HC CHG CARBOXYHEMOGLOBIN QUANTITATIVE",null,62,13.49,11.24,138.29,15.5,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 82435","TUFTS","TUFTS MEDICARE SCO","CPT",82435,"HC CHG CHLORIDE BLD","QW",24,6.67,4.2,51.64,6,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 82530","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",82530,"HC CHG CORTISOL FREE",null,82,33.81,15.24,187.56,20.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 22870","TUFTS","TUFTS SELECT","CPT",22870,"HC INSJ STABLJ DEV W/O DCMPRN LUMBAR SECOND LEVEL",null,2523,0,311.33,1198.25,630.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 23575","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",23575,"CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION",null,1738,2205.59,1098.98,3264.67,434.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 24500","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",24500,"CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION",null,1217,378,378,3264.67,304.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 46050","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",46050,"I&D PERIANAL ABSCESS SUPERFICIAL",null,756,1608.22,684.11,2032.26,189,1]
["OUTPATIENT","AETNA - AETNA - CPT - 47535","AETNA","AETNA","CPT",47535,"HC CONV EXT BIL DRG CATH TO INT-EXT BIL DRG CATH",null,4625,1500.85,1098.98,5726.94,1156.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 74263","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",74263,"HC CT COLONOGRAPHY;SCREEN",null,7561,7450.24,193.63,7450.24,1890.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 74425","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",74425,"UROGRAPHY ANTEGRADE RS&I",null,375,507.47,267.85000000000002,4285.49,93.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 82553","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",82553,"HC CHG CREATINE KINASE MB FRACTION ONLY",null,38,27.02,10.54,129.69,9.5,1]
["OUTPATIENT","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 82575","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT",82575,"HC CHG CREATININE CLEARANCE",null,48,20.91,8.6199999999999992,106.17,12,1]
["OUTPATIENT","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 82656","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT",82656,"HC CHG ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN",null,55,20.059999999999999,10.52,129.47999999999999,13.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA PPO - CPT - 82693","CIGNA HEALTHCARE","CIGNA PPO","CPT",82693,"HC CHG ASSAY OF ETHYLENE GLYCOL",null,72,37.880000000000003,13.59,167.3,18,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 25520","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",25520,"HC CLOSED RX RADIAL SHAFT FX W/DISLOCATION",null,2026,2205.59,1198.25,7703.8,506.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 26111","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",26111,"HC EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5+CM",null,4001,2672.73,1990.62,11845.41,1000.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 49405","TUFTS","TUFTS POS","CPT",49405,"IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ",null,2105,4856.75,1500.85,7703.8,526.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 49460","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",49460,"HC FIX G/COLON TUBE W/DEVICE",null,1116,1278.93,684.11,2032.26,279,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 50432","TUFTS","TUFTS PPO","CPT",50432,"HC PLACEMENT NEPHROSTOMY CATH PRQ NEW ACCESS RAD S&I",null,3162,2058.16,1098.98,3380.52,790.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 75736","BLUE CROSS","BLUE CROSS-PPO","CPT",75736,"HC CHG ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I",null,4288,5755.52,1894.5,49146.35,1072,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 75898","TUFTS","TUFTS SELECT","CPT",75898,"HC CHG ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS",null,1421,2139.98,173.86,13779.11,355.25,1]
["OUTPATIENT","FALLON - FALLON MEDICAID - CPT - 82728","FALLON","FALLON MEDICAID","CPT",82728,"HC CHG ASSAY OF FERRITIN",null,67,12.43,12.43,153.04,16.75,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 82810","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",82810,"HC BLOOD GASSES O2 SAT ONLY",null,52,9.77,7.96,98.14,13,1]
["OUTPATIENT","FALLON - FALLON MEDICAID - CPT - 82950","FALLON","FALLON MEDICAID","CPT",82950,"HC CHG GLUCOSE POST GLUCOSE DOSE",null,25,4.33,4.33,53.31,6.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 26700","TUFTS","TUFTS SELECT","CPT",26700,"CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES",null,2298,317.70999999999998,317.70999999999998,943.8,574.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 26990","AETNA","AETNA","CPT",26990,"HC INCIS/DRAIN PELVIS/HIP,DEEP ABCESS",null,3970,1198.25,1098.98,5097.42,992.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 27265","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",27265,"CLTX POST HIP ARTHRP DISLC W/O ANES",null,3055,378,378,3264.67,763.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 51610","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",51610,"NJX RETROGRADE URETHROCSTOGRAPY",null,478,0,161.22,161.22,119.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 53450","AETNA","AETNA","CPT",53450,"HC REVISION OF URETHRA",null,4463,1198.25,1098.98,3380.52,1115.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 76376","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",76376,"HC CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION",null,559,27.24,27.24,27.24,139.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 76529","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",76529,"OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION",null,738,107.22,81.93,824.29,184.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 76802","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",76802,"US PREG UTERUS 14 WK TRANSABDL EACH GESTATION",null,634,0,45.03,118.01,158.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 83002","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",83002,"HC CHG GONADOTROPIN LUTEINIZING HORMONE",null,93,41.5,16.89,207.81,23.25,1]
["OUTPATIENT","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 83030","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT",83030,"HC CHG HEMOGLOBIN F FETAL CHEMICAL",null,42,23.73,7.94,104.21,10.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA PPO - CPT - 83090","CIGNA HEALTHCARE","CIGNA PPO","CPT",83090,"HC CHG ASSAY OF HOMOCYSTEINE",null,84,42.89,15.39,189.43,21,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 27560","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",27560,"CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA",null,2696,378,378,3264.67,674,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 27768","TUFTS","TUFTS HMO","CPT",27768,"HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ",null,3357,595.01,317.70999999999998,2551.96,839.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 54065","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",54065,"DSTRJ LESION PENIS EXTENSIVE",null,2598,3344.2,1198.25,7703.8,649.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 55700","AETNA","AETNA","CPT",55700,"PROSTATE NEEDLE BIOPSY ANY APPROACH",null,1826,1500.85,1098.98,3380.52,456.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 56740","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",56740,"HC EXCIS BARTHOLIN GLAND/CYST",null,3544,3965.45,1990.62,11845.41,886,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 76826","TUFTS","TUFTS HMO","CPT",76826,"ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD",null,1251,1202.3399999999999,142.59,3012.56,312.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 76872","TUFTS","TUFTS SELECT","CPT",76872,"ULTRASOUND TRANSRECTAL",null,1256,207.07,147.96,1333.33,314,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 77021","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",77021,"HC MRGUIDE,NEED PLACE",null,3686,838.57,567.87,838.57,921.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 83520","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT",83520,"HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE","QW",63,36.369999999999997,12.76,167.51,15.75,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MEDICAID - CPT - 83550","BMC HEALTHNET","BMCHN MEDICAID","CPT",83550,"HC CHG IRON BINDING CAPACITY",null,44,7.97,7.97,98.14,11,1]
["OUTPATIENT","TUFTS - TUFTS SPIRIT - CPT - 83655","TUFTS","TUFTS SPIRIT","CPT",83655,"HC CHG ASSAY OF LEAD","QW",58,13.32,11.05,135.91999999999999,14.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 28192","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",28192,"REMOVAL FOREIGN BODY FOOT DEEP",null,2407,2309.9699999999998,1500.85,7703.8,601.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 29086","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",29086,"HC APPLY CAST,FINGER (CONTRACTURE)",null,203,226.08,226.08,764.24,50.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 57200","TUFTS","TUFTS SELECT","CPT",57200,"HC COLPORRHAPHY, SUTURE VAGINAL INJURY, NON-OB",null,3715,1098.98,1098.98,4588.18,928.75,1]
["OUTPATIENT","AETNA - AETNA - CPT - 58120","AETNA","AETNA","CPT",58120,"DILATION & CURETTAGE DX&/THER NONOBSTETRIC",null,2365,1500.85,1098.98,4588.18,591.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 58579","TUFTS","TUFTS PPO","CPT",58579,"HC UNLISTED HYSTEROSCOPY PROCEDURE UTERUS",null,242,7467.76,1990.62,11845.41,60.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 77077","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",77077,"HC CHG JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS",null,389,147.96,72.290000000000006,1262.6600000000001,97.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 77307","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",77307,"TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY",null,1070,926.01,369.25,3236.35,267.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 77334","TUFTS","TUFTS POS","CPT",77334,"HC TX DEVICES COMP",null,1239,1294.57,269.72000000000003,3892.44,309.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 29700","BLUE CROSS","BLUE CROSS-PPO","CPT",29700,"REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST",null,262,395.63,374.59,1193.8800000000001,65.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 30110","TUFTS","TUFTS SELECT","CPT",30110,"EXCISION NASAL POLYP SIMPLE",null,1023,1098.98,1098.98,3264.67,255.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 59025","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",59025,"FETAL NONSTRESS TEST",null,373,358.24,278.66000000000003,951.58,93.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 59821","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",59821,"TX MISSED ABORTION SECOND TRIMESTER SURGICAL",null,4336,3965.45,2354.5,11845.41,1084,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 61624","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT",61624,"HC TCAT PERMANENT OCCLUSION/EMBOLIZATION PRQ CNS",null,8320,0,2890.31,15242.01,2080,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 62302","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",62302,"MYELOGRAPHY VIA LUMBAR INJECTION RS&I CERVICAL",null,877,1161.71,1098.98,3264.67,219.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 78018","TUFTS","TUFTS PPO","CPT",78018,"HC CHG THYROID CARCINOMA METASTASES IMG WHOLE BODY",null,2963,1803.23,425.49,5068.46,740.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 78430","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",78430,"HC MYOCRD IMG PET RST/STRS W/CT",null,1832,2367.3000000000002,2367.3000000000002,16731.72,458,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 31502","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",31502,"TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT",null,270,346.18,317.70999999999998,1198.25,67.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 31576","TUFTS","TUFTS HMO","CPT",31576,"LARYNGOSCOPY FLEXIBLE FIBEROPTIC W/BIOPSY",null,2091,4856.75,1500.85,7703.8,522.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 31640","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",31640,"HC BRONCHOSCOPY,EXCIS LESN",null,4368,4602.58,1500.85,7703.8,1092,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 63650","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",63650,"HC PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL",null,7397,10041.84,1500.85,11618.83,1849.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 64447","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",64447,"HC INJECTION ANESTHETIC AGENT FEMORAL NERVE SINGLE",null,509,1005.62,310.58,2032.26,127.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 64486","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",64486,"TAP BLOCK UNILATERAL BY INJECTION(S)",null,423,0,136.02000000000001,1500.85,105.75,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 20680","TUFTS","TUFTS HMO","CPT",20680,"REMOVAL IMPLANT DEEP",null,3265,4856.75,1990.62,7703.8,816.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 20690","AETNA","AETNA","CPT",20690,"HC APPLY BONE FIXATION DEVICE",null,9361,1500.85,1500.85,11074.87,2340.25,1]
["OUTPATIENT","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 84165","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT",84165,"HC CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM",null,63,23.73,9.8000000000000007,120.52,15.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 84210","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",84210,"HC CHG ASSAY OF PYRUVATE",null,53,26.35,10.7,140.4,13.25,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 87400","TUFTS","TUFTS MEDICARE SCO","CPT",87400,"HC CHG IAAD IA INFLUENZA A/B EACH",null,57,20.49,10.94,137.06,14.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 87486","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",87486,"HC CHG IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ",null,127,79.05,32.01,393.99,31.75,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 87498","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT",87498,"HC CHG IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP",null,322,50.88,32.01,393.99,80.5,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 97014","UNICARE","UNICARE","CPT",97014,"HC APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED",null,80,28.92,28.92,37.4,20,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 97140","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",97140,"HC MANUAL THER TECH,1+REGIONS,EA 15 MIN",null,145,51.64,47.1,175.4,36.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 97164","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",97164,"HC PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS",null,262,144.63999999999999,98.19,365.72,65.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 97760","BLUE CROSS","BLUE CROSS-PPO","CPT",97760,"ORTHOTIC MGMT&TRAINJ UXTR LXTR&/TRNK EA 15",null,189,121.26,60.33,306.58999999999997,47.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 21320","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",21320,"CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION",null,2094,4335.57,1500.85,7703.8,523.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 21461","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",21461,"HC OPEN RX MANDIBLE FX",null,7214,11845.41,2166.09,11845.41,1803.5,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN QHP - CPT - 84376","BMC HEALTHNET","BMCHN QHP","CPT",84376,"HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC",null,27,6.02,5.0199999999999996,61.7,6.75,1]
["OUTPATIENT","AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 84439","AETNA","AETNA-MEDICARE ADVANTAGE","CPT",84439,"HC CHG ASSAY OF FREE THYROXINE",null,46,10.64,8.2200000000000006,101.2,11.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA PPO - CPT - 84480","CIGNA HEALTHCARE","CIGNA PPO","CPT",84480,"HC CHG ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3",null,71,36.06,12.94,159.19,17.75,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 87517","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT",87517,"HC CHG IADNA HEPATITIS B VIRUS QUANTIFICATION",null,213,53.02,39.07,480.84,53.25,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 87563","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT",87563,"HC M. GENITALIUM AMP PROBE",null,129,50.88,35.090000000000003,187.56,32.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 87632","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",87632,"HC CHG IADNA RESPIRATRY PROBE & REV TRNSCR 6-11 TARGETS",null,504,511.99,157.59,2395.92,126,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 99214","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",99214,"ESTABLISHED PATIENT - PHARM - LEVEL 4",null,327,190.85,33.74,190.85,81.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 99391","TUFTS","TUFTS POS","CPT",99391,"PERIODIC PREVENTIVE MED ESTABLISHED PATIENT <1Y",null,293,38.6,33.74,189.91,73.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 21930","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",21930,"EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM",null,2797,7703.8,1500.85,7703.8,699.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 22902","TUFTS","TUFTS HMO","CPT",22902,"HC EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM",null,2024,4856.75,1500.85,7703.8,506,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 84482","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT",84482,"HC CHG TRIIODOTHYRONINE T3 REVERSE",null,73,16.93,14.38,176.92,18.25,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MEDICAID - CPT - 84540","BMC HEALTHNET","BMCHN MEDICAID","CPT",84540,"HC CHG ASSAY OF UREA NITROGEN URINE",null,25,4.33,4.33,53.96,6.25,1]
["OUTPATIENT","TUFTS - TUFTS SPIRIT - CPT - 84681","TUFTS","TUFTS SPIRIT","CPT",84681,"HC CHG ASSAY OF C-PEPTIDE",null,100,22.89,18.989999999999998,233.69,25,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 85004","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",85004,"HC AUTO DIFF",null,22,8.7200000000000006,5.9,72.55,5.5,1]
["OUTPATIENT","FALLON - FALLON MEDICAID - CPT - 87798","FALLON","FALLON MEDICAID","CPT",87798,"HC EBV DNA, QL PCR",null,129,32.01,32.01,393.99,32.25,1]
["OUTPATIENT","ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 87900","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT",87900,"HC CHG NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION",null,600,130.35,118.9,1463.3,150,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 99453","BLUE CROSS","BLUE CROSS-PPO","CPT",99453,"REM MNTR PHYSIOL PARAM SETUP",null,176,194.55,194.55,665.76,44,1]
["OUTPATIENT","AETNA - AETNA - CPT - 23655","AETNA","AETNA","CPT",23655,"HC CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES",null,1986,1198.25,1098.98,3264.67,496.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 24535","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",24535,"CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ",null,1738,2205.59,1098.98,3264.67,434.5,1]
["OUTPATIENT","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 85025","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT",85025,"HC CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC",null,40,7.77,7.09,87.22,10,1]
["OUTPATIENT","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 85027","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT",85027,"HC CHG BLOOD COUNT COMPLETE AUTOMATED",null,33,8.8699999999999992,5.9,72.55,8.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA - CPT - 85230","CIGNA HEALTHCARE","CIGNA","CPT",85230,"HC CHG CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR",null,91,80.7,16.329999999999998,200.93,22.75,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 87902","UNICARE","UNICARE","CPT",87902,"HC CHG NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS",null,437,199.7,112.85,2890.09,109.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 88142","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",88142,"CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN",null,101,43.74,18.48,227.42,25.25,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 88235","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT",88235,"HC CHG TISSUE CULTURE, PLACENTA",null,594,180.36,120.58,1653.19,148.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 26060","TUFTS","TUFTS POS","CPT",26060,"HC INCIS PERCUT FINGER TENDON,SINGLE,EA",null,3045,4856.75,1500.85,7703.8,761.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 26160","TUFTS","TUFTS SELECT","CPT",26160,"EXC LES TDN SHTH/JT CAPSL HAND/FNGR",null,2559,3987.49,1990.62,11845.41,639.75,1]
["OUTPATIENT","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 85290","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT",85290,"HC CHG CLOTTING FACTOR XIII FIBRIN STABILIZING",null,82,28.43,14.9,183.36,20.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 85290","TUFTS","TUFTS POS","CPT",85290,"HC CHG CLOTTING FACTOR XIII FIBRIN STABILIZING",null,82,60.99,14.9,183.36,20.5,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 85347","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT",85347,"HC CHG COAGULATION TIME ACTIVATED",null,21,6.21,3.89,47.81,5.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 88271","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",88271,"HC CHG MOLECULAR CYTOGENETICS DNA PROBE EACH",null,373,48.09,19.54,240.42,93.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA - CPT - 88302","CIGNA HEALTHCARE","CIGNA","CPT",88302,"HC CHG LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM",null,180,124.79,36.799999999999997,310.36,45,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 88361","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",88361,"HC CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST",null,475,360.63,194.53,2458.16,118.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 27301","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",27301,"HC INCIS/DRAIN THIGH/KNEE ABSCESS,DEEP",null,3449,3994.03,1990.62,11845.41,862.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 27502","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",27502,"CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ",null,5928,2551.96,1500.85,7703.8,1482,1]
["OUTPATIENT","AETNA - AETNA - CPT - 27759","AETNA","AETNA","CPT",27759,"HC TREAT TIBIAL SHAFT FX, INTRAMED IMPLANT",null,16080,2166.09,2166.09,20818.13,4020,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 85610","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT",85610,"POC;INR",null,21,6.22,3.58,44.06,5.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 85732","TUFTS","TUFTS POS","CPT",85732,"HC CHG THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA",null,33,24.13,5.9,72.55,8.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 89050","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",89050,"HC CHG CELL COUNT MISCELLANEOUS BODY FLUIDS",null,25,10.55,4.3099999999999996,53.02,6.25,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 90653","TUFTS","TUFTS MEDICARE SCO","CPT",90653,"HC IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE",null,79,86.32,59.53,149.79,19.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 27780","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",27780,"CLTX PROX FIBULA/SHFT FX W/O MANJ",null,2135,485.97,378,3264.67,533.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 28043","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",28043,"EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM",null,2008,2672.73,1500.85,7703.8,502,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN ACO - CPT - 86038","BMC HEALTHNET","BMCHN ACO","CPT",86038,"HC CHG ANTINUCLEAR ANTIBODIES ANA",null,175,24.11,11.02,135.68,43.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 86160","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",86160,"HC CHG COMPLEMENT ANTIGEN EACH COMPONENT",null,61,134.62,10.94,134.62,15.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86255","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",86255,"HC CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY",null,35,34.94,10.99,135.27000000000001,8.75,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 86300","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT",86300,"HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3",null,96,22.79,18.989999999999998,233.69,24,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 90847","BLUE CROSS","BLUE CROSS-PPO","CPT",90847,"FAMILY PSYCHOTHERAPY W/PATIENT PRESENT",null,281,214.2,44.81,214.2,70.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 92015","BLUE CROSS","BLUE CROSS-PPO","CPT",92015,"DETERMINATION REFRACTIVE STATE",null,94,47.23,42.5,47.23,23.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 29105","BLUE CROSS","BLUE CROSS-PPO","CPT",29105,"APPLICATION LONG ARM SPLINT SHOULDER HAND",null,459,226.08,226.08,764.24,114.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 29405","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",29405,"APPLICATION SHORT LEG CAST BELOW KNEE-TOE",null,459,508.62,395.63,1308.22,114.75,1]
["OUTPATIENT","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 86308","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT",86308,"HC CHG HETEROPHILE ANTIBODIES SCREEN","QW",24,7.1,4.72,58.08,6,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 86336","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT",86336,"HC CHG INHIBIN A",null,76,19.3,14.22,174.97,19,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 86357","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT",86357,"HC NK CELLS, TOTAL COUNT",null,412,54.71,15.71,423.58,103,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 86403","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",86403,"HC CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY",null,269,24.91,9.2899999999999991,114.93,67.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 92283","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",92283,"HC COLOR VISION EXAMINATION",null,163,178.83,68.75,861.5,40.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 92544","TUFTS","TUFTS SELECT","CPT",92544,"OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC",null,163,250.1,228.32,1412.44,40.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 30802","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",30802,"ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL",null,2094,2485.42,1098.98,3264.67,523.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 31237","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",31237,"NASAL/SINUS NDSC SURG W/BX POLYPECT/DBRDMT SPX",null,2091,2299.54,1500.85,7703.8,522.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 31574","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",31574,"HC LARYNGOSCOPY FLEXIBLE W/INJECTION AGMNTJ UNI",null,2056,2299.54,1500.85,7703.8,514,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN WELL SENSE - CPT - 86486","BMC HEALTHNET","BMCHN WELL SENSE","CPT",86486,"SKIN TEST UNLISTED ANTIGEN EACH",null,34,66.95,4.09,199.34,8.5,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 86625","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT",86625,"HC CAMPYLOBACTER, ANTIBODY",null,16,14.36,11.97,147.33000000000001,4,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 86645","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT",86645,"HC CHG ANTIBODY CYTOMEGALOVIRUS CMV IGM",null,71,20.22,15.37,189.15,17.75,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 92592","TUFTS","TUFTS HMO","CPT",92592,"HEARING AID CHECK MONAURAL",null,67,55.4,24.58,138.81,16.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 92607","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",92607,"RX SP-GENRATJ AUGMNT&COMUNICAJ DEV 1ST HR",null,518,325.64,166.37,939.63,129.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 92938","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",92938,"HC PRQ TRLUML CORONARY BYP GRFT REVASC ADDL VESSEL",null,8975,0,6373.27,6373.27,2243.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 32557","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",32557,"PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING",null,836,3264.67,1098.98,3264.67,209,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 33213","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",33213,"HC INS PACEMAKER PULSE GEN ONLY W/EXIST DUAL LEADS",null,10670,16591.07,1990.62,37129.18,2667.5,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 86664","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",86664,"HC CHG ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA",null,37,15.29,13.95,171.71,9.25,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 86682","UNICARE","UNICARE","CPT",86682,"HC Q;CYSTICERCUS AB,BLOT",null,104,23.7,11.87,146.03,26,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 86698","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",86698,"HC CHG ANTIBODY HISTOPLASMA",null,28,29.77,11.4,140.32,7,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 93017","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",93017,"HC CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY",null,547,2582.75,309.68,2582.75,136.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 93280","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",93280,"PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER",null,519,62.4,41.48,370.47,129.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 93306","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",93306,"HC ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D WITH CONTRAST",null,2511,835.47,403.66,4775.3,627.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 10030","BLUE CROSS","BLUE CROSS-PPO","CPT",10030,"IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE",null,1149,972.93,317.70999999999998,1500.85,287.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 33241","TUFTS","TUFTS HMO","CPT",33241,"HC REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY",null,3984,4856.75,2166.09,7703.8,996,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN ACO - CPT - 33968","BMC HEALTHNET","BMCHN ACO","CPT",33968,"HC REM AORTIC ASSIST DEV PRQ",null,168,0,1198.25,26020.16,42,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 36015","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",36015,"HC SLCTV CATH PLMT SEGMENTAL/SUBSEGMENTAL PULM ART",null,1312,424.76,424.76,1198.25,328,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 86706","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",86706,"HC CHG HEPATITIS B SURF ANTIBODY HBSAB",null,52,25.76,9.8000000000000007,120.52,13,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 86762","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",86762,"HC CHG ANTIBODY RUBELLA",null,70,14.39,13.13,161.6,17.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 86765","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",86765,"HC CHG ANTIBODY RUBEOLA",null,102,30.9,11.75,144.6,25.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 93356","TUFTS","TUFTS SELECT","CPT",93356,"HC MYOCRD STRAIN IMG SPCKL TRCK",null,1869,0,null,null,467.25,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 93462","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",93462,"HC LEFT HEART CATH BY TRANSEPTAL PUNCTURE",null,6104,4496.8,524.49,5396.16,1526,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 11042","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",11042,"DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<",null,473,527.46,317.70999999999998,1500.85,118.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 11302","TUFTS","TUFTS POS","CPT",11302,"SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM",null,484,320.41000000000003,171.09,508.23,121,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11400","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",11400,"EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<",null,611,1220.0899999999999,684.11,2032.26,152.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 36248","BLUE CROSS","BLUE CROSS-PPO","CPT",36248,"HC SLCTV CATHJ EA 2ND+ ORD ABDL PEL/LXTR ART BRNCH",null,389,121.05,121.05,1500.85,97.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 36471","TUFTS","TUFTS HMO","CPT",36471,"NJX SCLEROSING SOLUTION MULTIPLE VEINS SAME LEG",null,783,979.2,521.32000000000005,1661.52,195.75,1]
["OUTPATIENT","AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 86780","AETNA","AETNA-MEDICARE ADVANTAGE","CPT",86780,"HC CHG ANTIBODY TREPONEMA PALLIDUM","QW",61,15.62,12.07,148.63999999999999,15.25,1]
["OUTPATIENT","AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 86803","AETNA","AETNA-MEDICARE ADVANTAGE","CPT",86803,"HC CHG HEPATITIS C ANTIBODY","QW",58,16.84,13.01,160.13,14.5,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 86817","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",86817,"HC CHG HLA TYPING DR/DQ MULTIPLE ANTIGENS",null,296,143.1,78.42,1029.42,74,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 93610","TUFTS","TUFTS PPO","CPT",93610,"HC INTRA-ATRIAL PACING",null,8754,16925.2,4616.53,47572.639999999999,2188.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 93888","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",93888,"TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD",null,2022,188.94,188.94,1147.04,505.5,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 93930","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",93930,"HC DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY",null,2332,300.69,300.69,2134.23,583,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 11622","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",11622,"EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM",null,1324,972.93,972.93,3264.67,331,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 11732","TUFTS","TUFTS HMO","CPT",11732,"AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL",null,155,0,43.37,1198.25,38.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 36578","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",36578,"HC RPLCMT CATH CTR VAD SUBQ PORT/PMP",null,3308,4436.09,1500.85,11845.41,827,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 36620","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",36620,"HC INSERT CATH,ART,PERCUT,SHORTTERM",null,366,0,108.25,1198.25,91.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 37188","BLUE CROSS","BLUE CROSS-PPO","CPT",37188,"PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX",null,5624,4436.09,2397.88,15242.01,1406,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 86905","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",86905,"HC CHG BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH",null,87,360.63,3.49,2229.4299999999998,21.75,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 87015","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",87015,"HC CHG CONCENTRATION INFECTIOUS AGENTS",null,34,9.01,6.09,74.989999999999995,8.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 93980","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",93980,"DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL",null,1568,188.94,188.94,1117.6500000000001,392,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 94644","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT",94644,"CONTINUOUS INHALATION TREATMENT 1ST HR",null,226,0,178.83,1077.0999999999999,56.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 95076","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",95076,"INGESTION CHALLENGE TEST INITIAL 120 MINUTES",null,629,764.57,764.57,2713.03,157.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 12002","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",12002,"SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM",null,454,296.32,296.32,943.8,113.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 12034","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",12034,"REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM",null,1588,527.46,527.46,2032.26,397,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 13152","BLUE CROSS","BLUE CROSS-PPO","CPT",13152,"REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM",null,3239,810.95,684.11,2032.26,809.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 37236","TUFTS","TUFTS PPO","CPT",37236,"OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL",null,15672,4856.75,1990.62,18787.919999999998,3918,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 38207","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",38207,"HC TRNSPL PREPJ HEMATOP PROGEN CELLS CRYOPRSRV STOR",null,1015,806.39,643.03,2032.26,253.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 40510","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",40510,"EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR",null,2787,7703.8,1500.85,7703.8,696.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 87103","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",87103,"HC CHG CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD",null,46,37.549999999999997,12.37,198.48,11.5,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MEDICAID - CPT - 87172","BMC HEALTHNET","BMCHN MEDICAID","CPT",87172,"HC CHG PINWORM EXAMINATION",null,23,3.89,3.89,47.89,5.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 95705","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",95705,"HC EEG W/O VID 2-12 HR UNMNTR",null,377,407.35,407.35,2582.75,94.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 95783","BLUE CROSS","BLUE CROSS-PPO","CPT",95783,"POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM",null,5560,1532.92,1532.92,5229.46,1390,1]
["OUTPATIENT","AETNA - AETNA - CPT - 14041","AETNA","AETNA","CPT",14041,"ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM",null,6040,1990.62,1990.62,11845.41,1510,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 15100","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",15100,"HC SKIN SPLT GRFT TRNK/ARM/LEG",null,2354,2601.27,1500.85,7703.8,588.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 15828","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",15828,"HC RHYTIDECTOMY CHEEK CHIN & NECK",null,5109,4645.3599999999997,1990.62,7703.8,1277.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 16000","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",16000,"HC INITIAL RX BURN(S) 1ST DEGREE",null,264,296.32,296.32,943.8,66,1]
["OUTPATIENT","TUFTS - TUFTS SPIRIT - CPT - 83825","TUFTS","TUFTS SPIRIT","CPT",83825,"HC CHG ASSAY OF MERCURY QUANTITATIVE",null,80,17.89,14.83,182.55,20,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN WELL SENSE - CPT - 83921","BMC HEALTHNET","BMCHN WELL SENSE","CPT",83921,"HC CHG ORGANIC ACID 1 QUANTITATIVE",null,80,32.54,15.67,205.7,20,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 87205","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",87205,"HC CHG SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL",null,23,10.26,3.89,47.89,5.75,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MCO - CPT - 87209","BMC HEALTHNET","BMCHN MCO","CPT",87209,"HC CHG SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS",null,91,16.399999999999999,16.399999999999999,201.74,22.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 87253","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",87253,"HC CHG VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE",null,100,43.61,18.43,226.77,25,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 95908","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",95908,"MOTOR &/SENS 3-4 NRV CNDJ PRECONF ELTRODE LIMB",null,582,282.57,282.57,1457.53,145.5,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 96125","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT",96125,"STANDARDIZED COGNITIVE PERFORMANCE TESTING",null,504,0,273.64999999999998,273.64999999999998,126,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 17108","TUFTS","TUFTS HMO","CPT",17108,"DSTRJ CUTANEOUS VASCULAR LESIONS >50.0 SQ CM",null,4033,595.01,317.70999999999998,3344.2,1008.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 17281","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",17281,"DESTRUCTION OF SKIN LESIONS",null,510,527.46,317.70999999999998,1198.25,127.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 19287","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",19287,"PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID",null,1056,943.8,317.70999999999998,1990.62,264,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN QHP - CPT - 83937","BMC HEALTHNET","BMCHN QHP","CPT",83937,"HC CHG ASSAY OF OSTEOCALCIN",null,143,32.68,27.23,335.1,35.75,1]
["OUTPATIENT","AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 84132","AETNA","AETNA-MEDICARE ADVANTAGE","CPT",84132,"HC CHG POTASSIUM SERUM PLASMA/WHOLE BLOOD",null,24,5.62,4.2,51.64,6,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 84146","TUFTS","TUFTS SELECT","CPT",84146,"HC CHG ASSAY OF PROLACTIN",null,97,33.78,17.670000000000002,217.56,24.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 87276","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",87276,"HC CHG IAADI INFFLUENZA A VIRUS",null,57,29.65,11.87,155.81,14.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 87305","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",87305,"HC CHG IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS",null,272,27.01,10.94,134.54,68,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 87341","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",87341,"HC CHG IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION",null,51,115.95,9.42,115.95,12.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 96360","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",96360,"IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR",null,363,404.12,132.85,984.54,90.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 96377","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",96377,"HC APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION",null,165,63.62,63.62,1198.25,41.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 96910","BLUE CROSS","BLUE CROSS-PPO","CPT",96910,"PHOTOCHEMOTX TAR&UVB/PETROLATUM/UVB",null,341,93.87,93.87,317.35000000000002,85.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 86769","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",86769,"ANTIBODY; SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2",null,203,48.46,42.13,382.01,50.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 86777","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT",86777,"HC CHG ANTIBODY TOXOPLASMA",null,180,36.21,13.13,161.6,45,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 43273","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",43273,"HC ENDOSCOPIC PAPILLA CANNULATION BILE PANCREATIC",null,969,0,300.25,1500.85,242.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 43762","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",43762,"HC RPLC GTUBE NO REVJ TRC",null,357,388.64,388.64,3264.67,89.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 44388","TUFTS","TUFTS SELECT","CPT",44388,"HC COLONOSCOPY STOMA DX W/WO COLLJ SPEC SPX",null,1284,1098.98,1020.59,3264.67,321,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 74220","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",74220,"HC CHG RADEX ESOPHAGUS",null,864,265.3,148.44,1738.9,216,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 74270","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",74270,"HC CHG RADEX COLON BARIUM ENEMA W/WO KUB",null,1493,347.19,148.44,1899.39,373.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 75571","TUFTS","TUFTS SELECT","CPT",75571,"HC CT,HEART;W/OCM;COR CAL",null,153,101.34,32.409999999999997,652.5,38.25,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN QHP - CPT - 82705","BMC HEALTHNET","BMCHN QHP","CPT",82705,"HC CHG FAT/LIPIDS FECES QUALITATIVE",null,25,5.58,4.6500000000000004,57.22,6.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 82787","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",82787,"HC CHG GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES",null,19,17.79,5.07,89.99,4.75,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN WELL SENSE - CPT - 86850","BMC HEALTHNET","BMCHN WELL SENSE","CPT",86850,"HC CHG ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE",null,87,23.92,5.25,501.09,21.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 86901","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",86901,"HC CHG BLOOD TYPING SEROLOGIC RH (D)",null,87,67.64,2.73,348.71,21.75,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 87046","UNICARE","UNICARE","CPT",87046,"HC CHG CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA",null,48,22.91,6,105.97,12,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 45346","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",45346,"HC SIGMOIDOSCOPY FLX ABLATION TUMOR POLYP/OTH LES",null,1406,1645.44,1098.98,3264.67,351.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 46040","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",46040,"I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX",null,3165,1645.44,1645.44,11845.41,791.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 75635","TUFTS","TUFTS HMO","CPT",75635,"HC CHG CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP",null,4210,965.87,265.3,2420.09,1052.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 75746","TUFTS","TUFTS PPO","CPT",75746,"HC CHG ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I",null,1610,5160.83,827.44,14505.83,402.5,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 75889","UNICARE","UNICARE","CPT",75889,"HC HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I",null,3742,2273.4,1894.5,31186.53,935.5,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 82985","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT",82985,"HC CHG ASSAY OF GLYCATED PROTEIN",null,73,24.3,13.75,169.26,18.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 83014","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT",83014,"HC H PYLORI DRUG ADMIN",null,40,16.55,7.17,88.24,10,1]
["OUTPATIENT","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 83050","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT",83050,"HC CHG HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE",null,37,8.1999999999999993,6.69,82.45,9.25,1]
["OUTPATIENT","FALLON - FALLON MEDICAID - CPT - 87081","FALLON","FALLON MEDICAID","CPT",87081,"HC CULT,BACT,SCR,H PYLORI",null,34,6.04,6.04,74.42,8.5,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 87107","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT",87107,"HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD",null,51,11.1,9.41,115.87,12.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 47490","TUFTS","TUFTS SELECT","CPT",47490,"HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT",null,4625,3987.49,3987.49,11845.41,1156.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 47552","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",47552,"HC BILIARY ENDO PRQ T-TUBE DX W/COLLECT SPEC BRUSH",null,3075,4949.6400000000003,1500.85,7703.8,768.75,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 49450","TUFTS","TUFTS HMO","CPT",49450,"HC REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS",null,803,1281.21,684.11,2032.26,200.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 50200","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",50200,"RENAL BIOPSY PRQ TROCAR/NEEDLE",null,1185,2309.9699999999998,1098.98,3264.67,296.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 76805","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",76805,"US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION",null,1417,147.96,147.96,1361.54,354.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 76831","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",76831,"SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER",null,1228,303.20999999999998,152.84,2653.95,307,1]
["OUTPATIENT","ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 83520","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT",83520,"HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE","QW",63,17.27,12.76,167.51,15.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 83630","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",83630,"HC CHG LACTOFERRIN FECAL QUALITATIVE",null,112,44.14,17.91,220.45,28,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 83695","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",83695,"HC CHG LIPOPROTEIN (A)",null,63,31.07,11.81,145.38,15.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 87206","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT",87206,"HC CHG SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT",null,27,11.35,4.91,60.48,6.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 87255","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",87255,"HC CHG VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC",null,168,380.17,30.89,380.17,42,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 50386","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",50386,"HC REM URET STENT,TRANS,W/O",null,1312,3264.67,1098.98,3756.12,328,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 51728","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",51728,"COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES",null,2386,1184.0999999999999,944.22,3176.09,596.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 52285","TUFTS","TUFTS PPO","CPT",52285,"HC CYSTOSCOPY AND TREATMENT",null,834,4856.75,944.22,7703.8,208.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 76937","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",76937,"HC CHG US VASC ACCESS SITS VSL PATENCY NDL ENTRY",null,329,40.61,40.61,40.61,82.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 77049","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",77049,"HC MRI BREAST C-+ W/CAD BI",null,594,664.1,664.1,4750.68,148.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 77066","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",77066,"HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",null,1041,246.53,114.75,1410.44,260.25,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 83921","UNICARE","UNICARE","CPT",83921,"HC CHG ORGANIC ACID 1 QUANTITATIVE",null,80,39.96,15.67,205.7,20,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 83970","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT",83970,"HC CHG ASSAY OF PARATHORMONE",null,206,86.94,37.65,463.35,51.5,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 87276","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT",87276,"HC CHG IAADI INFFLUENZA A VIRUS",null,57,14.01,11.87,155.81,14.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 87324","TUFTS","TUFTS SELECT","CPT",87324,"HC CHG IAAD IA CLOSTRIDIUM DIFFICILE TOXIN",null,57,20.89,10.94,134.54,14.25,1]
["OUTPATIENT","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 87341","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT",87341,"HC CHG IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION",null,51,10.33,9.42,115.95,12.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 54115","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",54115,"HC REMV FOR.BODY DEEP PENILE TISS",null,3570,3994.03,1098.98,4621.25,892.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 55876","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",55876,"PLMT INTERSTITIAL DEV RADIAT TX PROSTATE 1/MULT",null,1783,2573.36,1198.25,7703.8,445.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 56805","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",56805,"HC REPAIR CLITORIS",null,3805,3965.45,3965.45,11845.41,951.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 77317","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",77317,"BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL",null,1185,3892.44,369.25,3892.44,296.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 77321","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",77321,"HC SPEC PORT PLAN INCLUDES ELECTRONS",null,965,553.85,369.25,3892.44,241.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 77768","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",77768,"HC HDR RDNCL SKSURF 2.0/2CH>",null,2180,645.86,143.49,2711.86,545,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 84132","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT",84132,"HC CHG POTASSIUM SERUM PLASMA/WHOLE BLOOD",null,24,5.04,4.2,51.64,6,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 84144","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT",84144,"HC CHG ASSAY OF PROGESTERONE",null,104,28.77,19.03,234.27,26,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 84155","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT",84155,"HC CHG PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD",null,20,7.73,3.35,41.16,5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 92310","BLUE CROSS","BLUE CROSS-PPO","CPT",92310,"RX&FITG C-LENS SUPVJ CRNL LENS OU XCPT APHK",null,20,145.02000000000001,58.01,751.68,5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 92570","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",92570,"HC ACOUSTIC IMMIT TEST TYMPANOMETRY/ACOUST REFLEX/DECAY",null,207,228.32,59.1,785.13,51.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 57452","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",57452,"COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA",null,711,278.66000000000003,278.66000000000003,1500.85,177.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 58100","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",58100,"ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX",null,683,349.45,278.66000000000003,1198.25,170.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 59025","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",59025,"FETAL NONSTRESS TEST",null,373,278.66000000000003,278.66000000000003,951.58,93.25,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MCO - CPT - 78205","BMC HEALTHNET","BMCHN MCO","CPT",78205,"NM LIVER W SPECT",null,1997,0,430.8,10212.15,499.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 78258","TUFTS","TUFTS HMO","CPT",78258,"HC CHG ESOPHAGEAL MOTILITY",null,2202,1704.36,373.93,4270.45,550.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 78452","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",78452,"HC CHG MYOCARDIAL SPECT MULTIPLE STUDIES",null,4705,2115.7600000000002,1360.45,14762.31,1176.25,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN ACO - CPT - 84202","BMC HEALTHNET","BMCHN ACO","CPT",84202,"HC Q;ERYTH PROTPOR",null,23,28.64,13.09,161.07,5.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA - CPT - 84307","CIGNA HEALTHCARE","CIGNA","CPT",84307,"HC CHG ASSAY OF SOMATOSTATIN",null,515,76.17,16.670000000000002,205.12,128.75,1]
["OUTPATIENT","ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 87517","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT",87517,"HC CHG IADNA HEPATITIS B VIRUS QUANTIFICATION",null,213,42.84,39.07,480.84,53.25,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN ACO - CPT - 87532","BMC HEALTHNET","BMCHN ACO","CPT",87532,"HC CHG IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ",null,38,70.040000000000006,32.01,393.99,9.5,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 87591","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT",87591,"HC CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ",null,129,37.770000000000003,32.01,393.99,32.25,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 87636","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT",87636,"HC SARSCOV2 & INF A&B AMP PRB",null,378,0,142.63,358.89,94.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 61885","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",61885,"HC IMP STIM,CRANIAL,SUBQ,1 ARRAY",null,28075,62742.78,1500.85,62742.78,7018.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 62321","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",62321,"HR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN",null,1153,1292.83,829.82,3264.67,288.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 78605","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",78605,"HC BRAIN IMAGE 4+ VIEWS",null,721,599.04999999999995,489.45,5502.59,180.25,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 78999","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",78999,"HC FUSE CT & NUC MED IMAGES",null,736,167.19,167.19,3840.32,184,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 79200","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",79200,"HC CHG RP THERAPY INRACAVITARY ADMINISTRATION",null,1480,303.64999999999998,303.64999999999998,2756.08,370,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 84443","UNICARE","UNICARE","CPT",84443,"HC CHG ASSAY OF THYROID STIMULATING HORMONE TSH",null,84,40.78,15.33,188.7,21,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 84446","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT",84446,"HC CHG ASSAY OF TOCOPHEROL ALPHA VITAMIN E",null,69,15.27,12.94,159.19,17.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 84479","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",84479,"HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO",null,33,14.49,5.9,72.55,8.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 88309","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",88309,"HC CHG LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM",null,1149,733.98,84.64,6254.99,287.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA - CPT - 88356","CIGNA HEALTHCARE","CIGNA","CPT",88356,"CHG ANALYSIS, NERVE TECH",null,836,683.56,67.040000000000006,683.56,209,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 64415","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",64415,"SINGLE NERVE BLOCK INJECTION ARM NERVE",null,503,1284.45,310.58,3264.67,125.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 64447","TUFTS","TUFTS SELECT","CPT",64447,"HC INJECTION ANESTHETIC AGENT FEMORAL NERVE SINGLE",null,509,684.11,310.58,2032.26,127.25,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 64494","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",64494,"NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL",null,399,829.82,127.95,1198.25,99.75,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 80156","TUFTS","TUFTS MEDICARE SCO","CPT",80156,"HC CHG DRUG ASSAY CARBAMAZEPINE TOTAL",null,72,21.13,13.28,163.47,18,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 80168","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",80168,"HC CHG DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE",null,75,39.19,14.9,183.36,18.75,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 80175","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT",80175,"DRUG SCREEN QUANTITATIVE LAMOTRIGINE",null,64,18.28,12.09,148.84,16,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 84540","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",84540,"HC CHG ASSAY OF UREA NITROGEN URINE",null,25,7.5,4.33,53.96,6.25,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MCO - CPT - 84630","BMC HEALTHNET","BMCHN MCO","CPT",84630,"HC CHG ASSAY OF ZINC",null,55,10.39,10.39,127.81,13.75,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 92612","TUFTS","TUFTS HMO","CPT",92612,"FLX FIBOPT NDSC EVAL SWLNG C/V REC",null,338,387.52,167.41,970.97,84.5,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 92700","UNICARE","UNICARE","CPT",92700,"UNLISTED OTORHINOLARYNGOLOGICAL SERVICE",null,165,70.92,39.69,224.12,41.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 92978","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",92978,"HC ENDOLUMINAL CORONARY IVUS OCT I&R INITIAL VESSEL",null,821,646.49,646.49,646.49,205.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 64612","TUFTS","TUFTS SELECT","CPT",64612,"CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL",null,1247,684.11,415.61,2032.26,311.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 64771","TUFTS","TUFTS PPO","CPT",64771,"HC TRANSECT OTHER CRAN N,EXTRADURAL",null,1959,4856.75,1500.85,7703.8,489.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 80184","TUFTS","TUFTS POS","CPT",80184,"HC CHG DRUG SCREEN QUANTITATIVE PHENOBARBITAL",null,46,49.34,11.3,148.35,11.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 80197","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",80197,"HC CHG DRUG SCREEN QUANTITATIVE TACROLIMUS",null,36,30.96,10.01,154.22,9,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 80280","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",80280,"HC DRUG ASSAY VEDOLIZUMAB",null,67,83.27,38.57,206.18,16.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 80320","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",80320,"DRUG SCREEN QUANTITATIVE ALCOHOLS",null,235,29.08,16.89,108.78,58.75,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 85240","UNICARE","UNICARE","CPT",85240,"HC CHG CLOTTING FACTOR VIII AHG 1 STAGE",null,91,43.48,16.329999999999998,200.93,22.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 85300","BLUE CROSS","BLUE CROSS-PPO","CPT",85300,"HC CHG CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY",null,57,27.01,10.81,133.03,14.25,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 87660","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT",87660,"HC CHG IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ",null,157,21.53,18.29,225.1,39.25,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MCO - CPT - 87880","BMC HEALTHNET","BMCHN MCO","CPT",87880,"IAADIADOO STREPTOCOCCUS GROUP A",null,57,12.21,12.21,160.29,14.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 65750","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",65750,"HC KERATOPLASTY PENETRAING APHAKIA",null,5769,6113.35,2531.06,15242.01,1442.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 65870","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",65870,"HC SEVERING ADS ANT SEG INCAL SPX ANT SYNECHIAE",null,3062,3725.22,2166.09,11845.41,765.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 66840","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",66840,"HC RMVL LENS MATERIAL ASPIR TQ 1/> STAGES",null,3062,3219.62,2166.09,11845.41,765.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 67105","TUFTS","TUFTS PPO","CPT",67105,"RPR RETINAL DTCHMNT 1/> SES PC W/WO DRG SUBRETI",null,4946,2058.16,833.27,3264.67,1236.5,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 81161","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",81161,"HC DMD DUPLICATION/DELETION ANALYSIS",null,366,376.15,141.12,2706.08,91.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 81218","TUFTS","TUFTS HMO","CPT",81218,"HC CEBPA GENE ANALYSIS FULL GENE SEQUENC",null,551,1083.78,159,2715.49,137.75,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 85307","TUFTS","TUFTS MEDICARE SCO","CPT",85307,"HC CHG ACTIVATED PROTEIN C APC RESISTANCE ASSAY",null,69,22.21,13.98,172.07,17.25,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 85461","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT",85461,"HC CHG HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE",null,34,9.39,6.92,90.76,8.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90461","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",90461,"IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT",null,78,32.1,23.77,75.739999999999995,19.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 90845","BLUE CROSS","BLUE CROSS-PPO","CPT",90845,"PSYCHOANALYSIS",null,153,214.2,40.369999999999997,214.2,38.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 67316","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",67316,"HC STRABISMUS RECESSION/RESCJ 2/MORE VER MUSC",null,2949,3522.21,2166.09,11845.41,737.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 67505","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",67505,"HC INJECT/TREAT EYE SOCKET",null,385,476.13,476.13,2032.26,96.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 67900","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",67900,"HC REPAIR BROW DEFECT",null,2949,3044.16,2166.09,11845.41,737.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 81235","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",81235,"HC CHG EGFR GENE ANALYSIS COMMON VARIANTS",null,1038,593.54,239.82,3148.12,259.5,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN ACO - CPT - 81271","BMC HEALTHNET","BMCHN ACO","CPT",81271,"HC HTT GENE ANALYSIS DECTECT ABNORMAL ALLELES",null,175,223.83,102.3,1328.77,43.75,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN WELL SENSE - CPT - 85670","BMC HEALTHNET","BMCHN WELL SENSE","CPT",85670,"HC CHG THROMBIN TIME PLASMA",null,29,11.41,5.26,64.72,7.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 86021","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT",86021,"HC CHG ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES",null,72,31.7,13.74,169.1,18,1]
["OUTPATIENT","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 86039","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT",86039,"HC CHG ANTINUCLEAR ANTIBODIES ANA TITER",null,170,24.66,10.18,125.28,42.5,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 86162","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT",86162,"HC CHG COMPLEMENT TOTAL HEMOLYTIC",null,98,21.88,18.54,228.19,24.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 87493","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",87493,"HC CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE",null,120,79.05,32.01,393.99,30,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 87510","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT",87510,"HC CHG IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ",null,157,29.07,18.29,225.1,39.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 68100","TUFTS","TUFTS POS","CPT",68100,"HC BIOPSY OF CONJUNCTIVA",null,1108,2058.17,1098.98,3522.21,277,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 69100","TUFTS","TUFTS SELECT","CPT",69100,"BIOPSY EXTERNAL EAR",null,410,684.11,346.18,2032.26,102.5,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN QHP - CPT - 81304","BMC HEALTHNET","BMCHN QHP","CPT",81304,"HC MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT",null,183,0,150,377.43,45.75,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 81311","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",81311,"HC CHG NRAS GENE ANALYSIS VARIANTS IN EXON 2&3",null,4795,398.78,218.55,2868.9,1198.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 81403","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",81403,"SEQ & EXON 13 SEQ, IF PERFORMED KRAS (EG, CARCINOMA), GENE ANALYSIS, PRO/TECH",null,659,399.85,185.2,466,164.75,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 86235","UNICARE","UNICARE","CPT",86235,"HC CHG EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD",null,81,43.54,16.36,201.29,20.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA PPO - CPT - 86334","CIGNA HEALTHCARE","CIGNA PPO","CPT",86334,"HC CHG IMMUNOFIXJ ELECTROPHORESIS SERUM",null,80,56.81,20.39,250.85,20,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 88142","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",88142,"CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN",null,101,45.46,18.48,227.42,25.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 88164","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",88164,"HC CHG CYTOPATH TBS CERV/VAG MANUAL",null,52,145.38,10.82,145.38,13,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 88187","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",88187,"FLOWCYTOMETRY/READ, 2-8 MARKERS",null,158,84.03,49.74,381.48,39.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 70030","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",70030,"HC CHG RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY",null,275,107.22,72.290000000000006,801.26,68.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 70330","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",70330,"RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT",null,462,107.22,72.290000000000006,801.26,115.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 70491","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",70491,"HC CHG CT SOFT TISSUE NECK W/CONTRAST MATERIAL",null,2545,577.83000000000004,347.19,2420.09,636.25,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 81450","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",81450,"HC CHG GENOMIC SEQ ANALYS DNA&RNA ANALYS 5-50 GENE",null,2132,961.12,561.19000000000005,7366.77,533,1]
["OUTPATIENT","AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 82010","AETNA","AETNA-MEDICARE ADVANTAGE","CPT",82010,"HC CHG KETONE BODIES SERUM QUANTITATIVE",null,40,9.64,7.46,91.78,10,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 82075","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",82075,"HC CHG ASSAY OF ALCOHOL BREATH",null,86,64.77,16.53,291,21.5,1]
["OUTPATIENT","FALLON - FALLON SENIOR PLAN - CPT - 86360","FALLON","FALLON SENIOR PLAN","CPT",86360,"HC CHG T CELLS ABSOLUTE CD4&CD8 COUNT RATIO",null,69,46.98,18.87,527.5,17.25,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MEDICAID - CPT - 86580","BMC HEALTHNET","BMCHN MEDICAID","CPT",86580,"SKIN TEST TUBERCULOSIS INTRADERMAL",null,55,6.04,6.04,199.34,13.75,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 86615","TUFTS","TUFTS HMO","CPT",86615,"HC Q;BORDTLLA AB;IGG,IGA",null,174,59.09,12.03,148.07,43.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 92065","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",92065,"ORTHOPTIC &/PLEOPTIC TRAINING W/MEDICAL DIRECTJ",null,269,120.69,68.75,344.19,67.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 92065","TUFTS","TUFTS HMO","CPT",92065,"ORTHOPTIC &/PLEOPTIC TRAINING W/MEDICAL DIRECTJ",null,269,202.85,68.75,344.19,67.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 70553","TUFTS","TUFTS POS","CPT",70553,"HC CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL",null,5371,1565.54,664.1,4707.1099999999997,1342.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 71110","BLUE CROSS","BLUE CROSS-PPO","CPT",71110,"HC CHG RADEX RIBS BILATERAL 3 VIEWS",null,387,147.96,72.290000000000006,1274.24,96.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 72080","TUFTS","TUFTS SELECT","CPT",72080,"HC CHG RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS",null,353,124.44,72.290000000000006,801.26,88.25,1]
["OUTPATIENT","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 82164","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT",82164,"HC CHG ANGIOTENSIN I-CONVERTING ENZYME",null,71,20.03,13.32,163.96,17.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 82270","TUFTS","TUFTS PPO","CPT",82270,"HC CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER",null,17,15.11,3.24,42.47,4.25,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 82310","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",82310,"HC CHG CALCIUM TOTAL",null,26,10.42,4.71,57.87,6.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 86638","BLUE CROSS","BLUE CROSS-PPO","CPT",86638,"HC CHG, Q FEVER ANTIBODY",null,63,27.67,11.06,136.13,15.75,1]
["OUTPATIENT","FALLON - FALLON MEDICAID - CPT - 86652","FALLON","FALLON MEDICAID","CPT",86652,"HC CHG, ENCEPHAL ANTIBODY EAST EQU",null,66,12.03,12.03,148.07,16.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 40819","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",40819,"EXC FRENUM LABIAL/BUCCAL",null,1836,2148.08,1098.98,3264.67,459,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 41100","TUFTS","TUFTS PPO","CPT",41100,"BIOPSY TONGUE ANTERIOR TWO-THIRDS",null,852,2058.16,818.07,3264.67,213,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 42100","TUFTS","TUFTS POS","CPT",42100,"BIOPSY PALATE UVULA",null,861,2058.17,1098.98,3264.67,215.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 42415","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",42415,"HC EXC PAROTD,LAT LOBE,DISSECT 5TH NERV",null,7214,7429.92,2531.06,15242.01,1803.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 72197","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",72197,"HC CHG MRI PELVIS W/O & W/CONTRAST MATERIAL",null,5507,664.1,664.1,4707.1099999999997,1376.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 73092","TUFTS","TUFTS SELECT","CPT",73092,"HC CHG RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS",null,267,196.1,72.290000000000006,1262.6600000000001,66.75,1]
["OUTPATIENT","AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 82330","AETNA","AETNA-MEDICARE ADVANTAGE","CPT",82330,"HC CHG CALCIUM IONIZED","QW",69,16.14,12.47,153.49,17.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 82390","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",82390,"HC CHG CERULOPLASMIN",null,52,25.76,9.8000000000000007,120.52,13,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 82436","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",82436,"HC CHG CHLORIDE URINE",null,26,12.41,4.59,56.85,6.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 86698","TUFTS","TUFTS POS","CPT",86698,"HC CHG ANTIBODY HISTOPLASMA",null,28,46.68,11.4,140.32,7,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 86708","TUFTS","TUFTS SELECT","CPT",86708,"HC CHG HEPATITIS A ANTIBODY HAAB",null,58,21.59,11.3,139.02000000000001,14.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA PPO - CPT - 86710","CIGNA HEALTHCARE","CIGNA PPO","CPT",86710,"HC INFLUENZA VIRUS",null,35,26.54,12.36,152.1,8.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 42826","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",42826,"TONSILLECTOMY ONE-HALF AGE 12/>",null,3197,4335.57,2166.09,11845.41,799.25,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 43257","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT",43257,"HC UPR GI NDSC DLVR THERMAL NRG SPHNCTR/CARDIA",null,3148,0,1990.62,7703.8,787,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 73200","TUFTS","TUFTS HMO","CPT",73200,"HC CHG CT UPPER EXTREMITY W/O CONTRAST MATERIAL",null,1991,508.55,193.63,1274.24,497.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 73523","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",73523,"XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; MINIMUM 5 VIEWS",null,519,147.96,144.58000000000001,1677.11,129.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 73610","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",73610,"HC CHG RADEX ANKLE COMPLETE MINIMUM 3 VIEWS",null,319,81.93,72.290000000000006,851.68,79.75,1]
["OUTPATIENT","ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 82533","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT",82533,"HC CHG CORTISOL TOTAL",null,82,16.3,14.87,182.99,20.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 82626","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",82626,"HC CHG DEHYDROEPIANDROSTERONE",null,122,57.32,23.05,283.74,30.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 82657","TUFTS","TUFTS POS","CPT",82657,"HC CHG NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA",null,1263,71.510000000000005,16.47,215.03,315.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 69000","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",69000,"DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE",null,937,972.93,317.70999999999998,1250.8,234.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 69420","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",69420,"MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ",null,955,346.18,346.18,2032.26,238.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 70250","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",70250,"RADIOLOGIC EXAMINATION SKULL 4/> VIEWS",null,355,147.96,72.290000000000006,1103.3900000000001,88.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 93986","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",93986,"DUP-SCAN HEMO COMPL UNI STD",null,168,180.4,180.4,1117.6500000000001,42,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 94250","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",94250,"HC EXPIRED GAS COLLECTION QUANT 1 PROCEDURE SPX",null,143,93.87,71.61,562.35,35.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 11765","BLUE CROSS","BLUE CROSS-PPO","CPT",11765,"WEDGE EXCISION SKIN NAIL FOLD",null,704,527.46,317.70999999999998,1198.25,176,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 12002","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",12002,"SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM",null,454,380.96,296.32,943.8,113.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 37236","TUFTS","TUFTS POS","CPT",37236,"OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL",null,15672,4856.75,1990.62,18787.919999999998,3918,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 38206","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",38206,"HC BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ AUTOL",null,1744,2692.27,1098.98,3264.67,436,1]
["OUTPATIENT","AETNA - AETNA - CPT - 40500","AETNA","AETNA","CPT",40500,"HC LIP SHAVE",null,4030,1500.85,1500.85,7703.8,1007.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 70380","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",70380,"HC X-RAY SALIVARY GLAND",null,392,107.22,72.290000000000006,932.7,98,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 70380","TUFTS","TUFTS SELECT","CPT",70380,"HC X-RAY SALIVARY GLAND",null,392,144.86000000000001,72.290000000000006,932.7,98,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 71101","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",71101,"HC CHG RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS",null,374,193.63,72.290000000000006,1198.1400000000001,93.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 94761","TUFTS","TUFTS POS","CPT",94761,"MEASURE BLOOD OXYGEN LEVEL",null,189,0,11.22,11.22,47.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 95144","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",95144,"PREPJ& ANTIGEN PRV ALLERGEN IMMUNOTHERAPY 1 DO",null,78,81.78,63.62,218.59,19.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 12056","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",12056,"HC LAYR CLOS WND FACE,FACIAL 20.1-30 CM",null,477,527.46,527.46,2032.26,119.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 14060","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",14060,"ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<",null,5231,2601.27,1990.62,11845.41,1307.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 15050","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",15050,"PINCH GRAFT 1/MLT SM ULCER TIP/OTH AREA 2CM",null,3469,810.95,684.11,2032.26,867.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 40831","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",40831,"HC REPAIR MOUTH LACERATION,>2.5 CM",null,691,818.07,818.07,3264.67,172.75,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 41017","TUFTS","TUFTS HMO","CPT",41017,"HC XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB",null,3301,2057.7399999999998,1098.98,4335.57,825.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 42160","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",42160,"HC DESTRUC LESN PALATE/UVULVA",null,3350,3747.12,1098.98,4335.57,837.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 72072","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",72072,"HC CHG RADEX SPINE THORACIC 3 VIEWS",null,353,193.63,72.290000000000006,1274.24,88.25,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 72120","UNICARE","UNICARE","CPT",72120,"HC X-RAY LUMBAR SPINE FLEX/EXTEN",null,169,86.75,72.290000000000006,1102.33,42.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 72141","TUFTS","TUFTS PPO","CPT",72141,"HC CHG MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL",null,3650,944.21,396.79,2653.95,912.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 95811","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",95811,"POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND",null,3214,1970.71,1440.46,9266.61,803.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 95886","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",95886,"NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE",null,436,128.22,128.22,128.22,109,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 15773","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",15773,"GRFG AUTOL FAT LIPO 25 CC/<",null,2060,2611.71,1500.85,7703.8,515,1]
["OUTPATIENT","AETNA - AETNA - CPT - 15936","AETNA","AETNA","CPT",15936,"HC EXC SACR HCESS ULC W MUSC FLAP CLO",null,1858,2166.09,2166.09,11845.41,464.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 17107","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",17107,"DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM",null,2675,810.95,317.70999999999998,1198.25,668.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 42408","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",42408,"HC EXCISION SUBLING SALIVARY CYST",null,3896,3747.12,1990.62,11845.41,974,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 43231","TUFTS","TUFTS SELECT","CPT",43231,"HC ESPHGSC RGD/FLX W/NDSC ULTRASOUND EXAMINATION",null,1471,2593.31,1010.64,7703.8,367.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 43245","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",43245,"HC UPR GI NDSC DILAT GSTR OUTLET FOR OBSTRCJ",null,1449,2491.1,1010.64,7703.8,362.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 73030","TUFTS","TUFTS SELECT","CPT",73030,"HC CHG RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS",null,294,124.44,72.290000000000006,801.26,73.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 73521","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",73521,"XRAY EXAM HIPS BILATERAL W/PELVIS WHEN PERFORMED; 2 VIEWS",null,236,147.96,72.290000000000006,1274.24,59,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 95991","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",95991,"RFL&MAIN IMPLT PMP/RSVR DLVR SPI/BRN PHY/QHP",null,298,1447.83,415.61,1447.83,74.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 96130","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",96130,"HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR",null,341,228.32,71.41,293.52,85.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 96146","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",96146,"HC PSYCL/NRPSYCL TST ELEC PLATFORM AUTO RESULT",null,341,129.58000000000001,36.159999999999997,129.58000000000001,85.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 19125","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",19125,"HC EXCISE BREAST LES W XRAY MARKER",null,4228,5471.79,1990.62,7703.8,1057,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 20103","TUFTS","TUFTS SELECT","CPT",20103,"EXPLORATION PENETRATING WOUND SPX EXTREMITY",null,2701,1098.98,972.93,3264.67,675.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 43257","TUFTS","TUFTS PPO","CPT",43257,"HC UPR GI NDSC DLVR THERMAL NRG SPHNCTR/CARDIA",null,3148,4856.75,1990.62,7703.8,787,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 43275","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",43275,"HC ERCP REMOVE FOREIGN BODY/STENT BILIARY/PANC DUCT",null,2963,4743.7,1990.62,7703.8,740.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 44360","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",44360,"HC ENDOSCOPY UPPER SMALL INTESTINE",null,1211,2882.31,1013.38,7703.8,302.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 73560","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",73560,"HC CHG RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS",null,302,801.26,72.290000000000006,801.26,75.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 74177","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",74177,"HC CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL",null,3344,1105.27,639.20000000000005,4115.74,836,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 74240","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",74240,"HC XRAY UPPER GI TRACT",null,797,347.19,148.44,1899.39,199.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 96372","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",96372,"THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM",null,154,345.64,45.07,345.64,38.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 96409","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",96409,"CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG",null,498,314.33999999999997,314.33999999999997,1868.91,124.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 97033","BLUE CROSS","BLUE CROSS-PPO","CPT",97033,"APPL MODALITY 1/> AREAS IONTOPHORESIS EA 15 MIN",null,162,52.5,35.64,132.72999999999999,40.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 21040","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",21040,"HC EXCISION BENIGN TUMORE MANDIBLE",null,3209,4335.57,1500.85,7703.8,802.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 21079","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",21079,"HC PREP FACE/ORAL PROST TEMP OBTURATOR",null,3209,3747.12,3747.12,17023.61,802.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 44394","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",44394,"HC COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE",null,1971,1645.44,1020.59,7703.8,492.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 45305","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",45305,"HC PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE",null,1341,2115.37,737.96,3264.67,335.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 45382","BLUE CROSS","BLUE CROSS-PPO","CPT",45382,"HC COLSC FLX PROX SPLENIC FLXR CTRL BLD",null,2540,1645.44,1020.59,3264.67,635,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 74420","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",74420,"X-RAY URINARY TRACT EXAM WITH CONTRAST MATERIAL",null,375,507.47,267.85000000000002,4313.6099999999997,93.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 75571","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",75571,"HC CT,HEART;W/OCM;COR CAL",null,153,178.43,32.409999999999997,652.5,38.25,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 97129","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT",97129,"HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES",null,130,0,57.52,57.52,32.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 97761","TUFTS","TUFTS PPO","CPT",97761,"HC PROSTHETIC TRAINING UPPR&/LOWER EXTREM EA 15 M",null,165,164.72,54.69,261.27999999999997,41.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 99157","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",99157,"HC MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS",null,55,156.06,156.06,156.06,13.75,1]
["OUTPATIENT","AETNA - AETNA - CPT - 22510","AETNA","AETNA","CPT",22510,"PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC",null,9073,2397.88,2397.88,7703.8,2268.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 23031","TUFTS","TUFTS SELECT","CPT",23031,"HC DRAIN INFECT SHOULDER BURSA",null,2066,2593.31,1990.62,7703.8,516.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 45915","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",45915,"HC REMV RECTAL OBSTR:FECES/F.B. W ANEST",null,1494,1645.44,1098.98,3264.67,373.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 46900","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",46900,"DSTRJ LESION ANUS SIMPLE CHEMICAL",null,1062,678.1,317.70999999999998,1198.25,265.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 47532","TUFTS","TUFTS SELECT","CPT",47532,"NJX CHOLANGIO PRQ W/IMG GID RS&I NEW ACCESS",null,1510,1098.98,1098.98,6363.26,377.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 75807","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",75807,"HC LYMPH VESSEL X-RAY TRUNK",null,4214,3473.84,321.11,24088.06,1053.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 75891","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",75891,"HC CHG HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I",null,4288,3473.84,827.44,31186.53,1072,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 76390","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",76390,"HC CHG MRI SPECTROSCOPY",null,4489,1660.94,640.69000000000005,4256.72,1122.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 99384","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",99384,"INITIAL PREVENTIVE MEDICINE NEW PT AGE 12-17 YR",null,427,108.49,33.74,286.88,106.75,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN QHP - CPT - 99406","BMC HEALTHNET","BMCHN QHP","CPT",99406,"TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES",null,83,0,50.95,287.77999999999997,20.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 24530","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",24530,"CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ",null,1217,378,378,3264.67,304.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 24670","BLUE CROSS","BLUE CROSS-PPO","CPT",24670,"CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ",null,2004,378,378,3264.67,501,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 25675","TUFTS","TUFTS PPO","CPT",25675,"CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ",null,325,2058.16,378,3264.67,81.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 49440","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",49440,"INSERT GASTROSTOMY TUBE PERCUTANEOUS",null,1695,2491.1,1010.64,3264.67,423.75,1]
["OUTPATIENT","AETNA - AETNA - CPT - 50437","AETNA","AETNA","CPT",50437,"HC DILAT XST TRC NEW ACCESS RCS",null,4504,1500.85,1098.98,5687.17,1126,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 51102","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",51102,"HC ASP BLADDER;W/INS SUPRAPU",null,2441,2921.68,1098.98,3380.52,610.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 76857","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",76857,"US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U",null,919,147.96,98.34,1179.76,229.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 76978","TUFTS","TUFTS SELECT","CPT",76978,"HC US TRGT DYN MBUBB 1ST LES",null,267,375.85,265.3,2420.09,66.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 26236","TUFTS","TUFTS POS","CPT",26236,"HC PR PART REMV BONE,DISTAL PHALANX",null,1975,7467.76,1990.62,11845.41,493.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 26645","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",26645,"CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ",null,2976,2205.59,1098.98,3264.67,744,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 27087","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",27087,"REMOVAL FOREIGN BODY PELVIS/HIP DEEP",null,4826,4405.5600000000004,1990.62,11845.41,1206.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 52332","TUFTS","TUFTS POS","CPT",52332,"HC CYSTOSCOPY, INSERT URETERAL STENT",null,4393,4856.75,1500.85,7703.8,1098.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 54065","AETNA","AETNA","CPT",54065,"DSTRJ LESION PENIS EXTENSIVE",null,2598,1198.25,1198.25,7703.8,649.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 77013","TUFTS","TUFTS POS","CPT",77013,"HC CHG CT GUIDANCE &MONITORING VISC TISS ABLATION",null,1822,0,318.45,962.03,455.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 77066","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",77066,"HC CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",null,1041,1410.44,114.75,1410.44,260.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 77316","TUFTS","TUFTS SELECT","CPT",77316,"BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL",null,909,401.16,160.66,2582.9899999999998,227.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 27252","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",27252,"HC TX HIP DISLOC W/ANESTH",null,2025,2205.59,1500.85,7703.8,506.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 27560","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",27560,"CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA",null,2696,485.97,378,3264.67,674,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 27810","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",27810,"CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ",null,3285,2551.96,1098.98,3264.67,821.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 56440","TUFTS","TUFTS HMO","CPT",56440,"MARSUPIALIZATION BARTHOLINS GLAND CYST",null,2365,4856.75,1500.85,7703.8,591.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 57455","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",57455,"COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX",null,861,589.41,458.47,2032.26,215.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 77371","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",77371,"RADIATION DELIVERY STEREOTACTIC CRANIAL COBALT",null,11275,21995.69,11840.17,88128.37,2818.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 77522","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",77522,"PROTON BEAM DEL,SINGLE, W/COMPENSAT",null,1883,3104.64,925.54,13219.58,470.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 77772","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",77772,"HC HDR RDNCL NTRSTL/12+",null,4931,1212.82,523.85,8624.5,1232.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 78201","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",78201,"HC CHG LIVER IMAGING SPECT",null,1756,1616.75,430.8,11782.07,439,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 28234","TUFTS","TUFTS PPO","CPT",28234,"TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON",null,2895,2058.16,1098.98,3264.67,723.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 28630","TUFTS","TUFTS PPO","CPT",28630,"CLOSED RX MT-PHAL TOE DISLOCATION",null,275,595.01,317.70999999999998,1198.25,68.75,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 58561","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",58561,"HC HYSTEROSCOPY,RMV MYOMA",null,7714,2827.93,1990.62,11845.41,1928.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 59840","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",59840,"INDUCED ABORTION DILATION AND CURETTAGE",null,2365,3965.45,2354.5,11845.41,591.25,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 78278","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",78278,"HC CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING",null,3311,373.93,373.93,4270.45,827.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 78430","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",78430,"HC MYOCRD IMG PET RST/STRS W/CT",null,1832,3961.48,2367.3000000000002,16731.72,458,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 78459","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",78459,"HC CHG MYOCARDIAL IMAGING PET METABOLIC EVALUATION",null,7162,3521.28,1212.54,14762.31,1790.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 78740","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",78740,"HC URETERAL REFLUX",null,2222,464.88,370.89,4270.45,555.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 29445","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",29445,"HC APPLICATION RIGID TOTAL CONTACT LEG CAST",null,357,508.62,395.63,1308.22,89.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 30560","TUFTS","TUFTS POS","CPT",30560,"HC RELEASE OF NASAL ADHESIONS",null,731,4856.75,818.07,7703.8,182.75,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 61651","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT",61651,"ENDOVASCULAR INTRACRANIAL PROLNG ADMN RX AGENT; EACH ADD¿L VASCULAR TERRITORY",null,1590,0,600.36,600.36,397.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 62284","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",62284,"HC INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR",null,645,0,219.52,1198.25,161.25,1]
["OUTPATIENT","AETNA - AETNA - CPT - 62370","AETNA","AETNA","CPT",62370,"ELEC ANLYS IMPLT ITHCL/EDRL PMP W/REPR PHYS/QHP",null,476,1500.85,470.91,3264.67,119,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 78999","TUFTS","TUFTS POS","CPT",78999,"HC FUSE CT & NUC MED IMAGES",null,736,1277.25,167.19,3840.32,184,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 80048","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",80048,"HC CHG BASIC METABOLIC PANEL CALCIUM TOTAL","QW",226,18.27,7.71,94.96,56.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 80069","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT",80069,"HC CHG RENAL FUNCTION PANEL",null,218,18.28,7.92,97.49,54.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 31500","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",31500,"HC INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE",null,840,445.06,346.18,1198.25,210,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 31576","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",31576,"LARYNGOSCOPY FLEXIBLE FIBEROPTIC W/BIOPSY",null,2091,2660.67,1500.85,7703.8,522.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 64462","TUFTS","TUFTS POS","CPT",64462,"HC PVB,THORAC;2ND & ANY ADD¿L INJECT SITE(S) INCLUD IMAGE GUIDE WHEN PERFORMED",null,824,0,124.9,1198.25,206,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 64510","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",64510,"NJX ANES STELLATE GANGLION CRV SYMPATHETIC",null,1071,1610.75,829.82,3264.67,267.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 64635","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",64635,"DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL",null,2471,3092.3,1098.98,3264.67,617.75,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 80169","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT",80169,"DRUG SCREEN QUANTITATIVE EVEROLIMUS",null,310,14.75,10.01,154.22,77.5,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 80169","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT",80169,"DRUG SCREEN QUANTITATIVE EVEROLIMUS",null,310,18.95,10.01,154.22,77.5,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN ACO - CPT - 80197","BMC HEALTHNET","BMCHN ACO","CPT",80197,"HC CHG DRUG SCREEN QUANTITATIVE TACROLIMUS",null,36,27.42,10.01,154.22,9,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 33015","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",33015,"TUBE PERICARDIOSTOMY",null,3850,11845.41,3987.49,11845.41,962.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 33229","AETNA","AETNA","CPT",33229,"HC REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD",null,18441,1990.62,1990.62,62742.78,4610.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 65130","TUFTS","TUFTS HMO","CPT",65130,"HC INSERT OCULAR IMPLANT",null,4867,7467.76,1990.62,11845.41,1216.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 65778","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",65778,"PLACE AMNIOTIC MEMB OCULAR SURFACE SELF RETAIN",null,2051,1355.74,1098.98,3264.67,512.75,1]
["OUTPATIENT","AETNA - AETNA - CPT - 65875","AETNA","AETNA","CPT",65875,"HC SEVERING ADS ANT SEG INCAL SPX POST SYNECHIAE",null,3062,2166.09,2166.09,11845.41,765.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 80201","TUFTS","TUFTS HMO","CPT",80201,"HC CHG DRUG SCREEN QUANTITATIVE TOPIRAMATE",null,46,53.4,10.88,133.80000000000001,11.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 80306","TUFTS","TUFTS PPO","CPT",80306,"HC DRUG TEST PRSMV INSTRMNT",null,192,51.9,11.89,145.87,48,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - U0004","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT","U0004","2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV",null,150,117.7,100,906.74,37.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 33286","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",33286,"HC RMVL SUBQ CAR RHYTHM MNTR",null,892,972.93,972.93,3264.67,223,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 36014","TUFTS","TUFTS HMO","CPT",36014,"HC SLCTV CATHETER PLMT LEFT/RIGHT PULMONARY ARTERY",null,1055,0,373.73,1198.25,263.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 36224","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",36224,"HC SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART",null,7758,7349.8,1990.62,17023.61,1939.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 36430","TUFTS","TUFTS PPO","CPT",36430,"TRANSFUSION BLOOD/BLOOD COMPONENTS",null,928,1406.11,643.03,2230.38,232,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 67108","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",67108,"HC RPR RETINAL DTCHMNT W/VITRECTOMY ANY METH",null,5769,6113.35,2531.06,15242.01,1442.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 67220","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",67220,"DSTRJ LES CHOROID PC 1/> SESS",null,3904,1071.25,684.11,2032.26,976,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 93291","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",93291,"INTERROGATION EVALUATION IN PERSON ILR SYSTEM",null,322,28.83,28.83,237.24,80.5,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 93294","TUFTS","TUFTS HMO","CPT",93294,"INTERROGATION EVAL REMOTE </90 D 1/2/MLT LEAD PM",null,277,106.42,47.21,266.63,69.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 10006","TUFTS","TUFTS POS","CPT",10006,"HC FNA BX W/US GDN EA ADDL",null,435,0,122.2,1198.25,108.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 10180","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",10180,"HC COMPLEX DRAINAGE, WOUND",null,3570,3994.03,1500.85,7703.8,892.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 11057","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",11057,"PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4",null,273,371.6,296.32,1198.25,68.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 36476","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",36476,"HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS",null,2062,0,334.4,1198.25,515.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 36581","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",36581,"RPLCMT COMPL TUN CVC W/O SUBQ PORT/PMP",null,3308,4436.09,1500.85,7703.8,827,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 36595","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",36595,"HC MECH REMOV PERICATH OBSTR CV DEV VIA VEN ACCESS",null,4214,5132.74,2166.09,11845.41,1053.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 67808","AETNA","AETNA","CPT",67808,"HC REMOVE EYELID LESION(S)",null,2949,1500.85,1500.85,7703.8,737.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 67902","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",67902,"HC RPR BLEPHAROPT FRONTALIS MUSC AUTOL FASCAL SLING",null,4867,4996.58,2354.5,15242.01,1216.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 68200","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",68200,"SUBCONJUNCTIVAL INJECTION",null,273,178.83,178.83,624.73,68.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 93572","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",93572,"HC IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL",null,661,0,310.94,716.93,165.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 93653","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",93653,"HC COMPRE EP EVAL TX SVT",null,25096,32266.99,2531.06,62742.78,6274,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 11402","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",11402,"EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM",null,876,972.93,684.11,2032.26,219,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 11441","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",11441,"EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM",null,1009,972.93,684.11,2032.26,252.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 36680","TUFTS","TUFTS PPO","CPT",36680,"HC PLACEMENT NEEDLE INTRAOSSEOUS INFUSION",null,454,595.01,317.70999999999998,1198.25,113.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 37192","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",37192,"HC REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I",null,3752,4436.09,1990.62,11845.41,938,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 37227","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",37227,"HC REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL",null,26649,29835.33,2166.09,62742.78,6662.25,1]
["OUTPATIENT","AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 81288","AETNA","AETNA-MEDICARE ADVANTAGE","CPT",81288,"MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS",null,1882,226.94,142.1,1865.32,470.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 81307","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",81307,"HC PALB2 GENE FULL GENE SEQ",null,223,325.31,282.88,1511.93,55.75,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 81402","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT",81402,"HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 3",null,434,0,150.33000000000001,378.26,108.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 86038","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",86038,"HC CHG ANTINUCLEAR ANTIBODIES ANA",null,175,27.01,11.02,135.68,43.75,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 86146","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT",86146,"HC CRL;BETA-2 GLYCPRTN 1 AB",null,197,35.090000000000003,18.87,285.7,49.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 90791","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",90791,"PSYCHIATRIC DIAGNOSTIC EVALUATION",null,165,214.2,40.369999999999997,214.2,41.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90792","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",90792,"PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES",null,165,214.2,40.369999999999997,214.2,41.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 91110","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",91110,"GI IMAG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R",null,4594,1278.93,1278.93,7945.14,1148.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 81450","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",81450,"HC CHG GENOMIC SEQ ANALYS DNA&RNA ANALYS 5-50 GENE",null,2132,1639.83,561.19000000000005,7366.77,533,1]
["OUTPATIENT","FALLON - FALLON MEDICAID - CPT - 82009","FALLON","FALLON MEDICAID","CPT",82009,"HC CHG KETONE BODIES SERUM QUALITATIVE",null,24,4.12,4.12,50.7,6,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN ACO - CPT - 86308","BMC HEALTHNET","BMCHN ACO","CPT",86308,"HC CHG HETEROPHILE ANTIBODIES SCREEN",null,24,10.33,4.72,58.08,6,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 86316","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT",86316,"HC CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE",null,93,22.41,18.989999999999998,233.69,23.25,1]
["OUTPATIENT","TUFTS - TUFTS SPIRIT - CPT - 86353","TUFTS","TUFTS SPIRIT","CPT",86353,"HC CHG LYMPHOCYTE TRANSFORMATION",null,327,53.93,44.72,550.37,81.75,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 92025","TUFTS","TUFTS HMO","CPT",92025,"COMPUTERIZED CORNEAL TOPOGRAPHY UNI/BI",null,189,187.02,93.87,317.35000000000002,47.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 92136","TUFTS","TUFTS HMO","CPT",92136,"OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL",null,442,358.22,68.75,607.84,110.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 92508","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",92508,"TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV",null,165,59.23,40.21,128.16,41.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 82139","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT",82139,"HC CHG AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE",null,98,35.53,14.65,189.43,24.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 82150","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT",82150,"HC CHG ASSAY OF AMYLASE",null,33,16.3,5.91,72.75,8.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 82247","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",82247,"HC CHG BILIRUBIN TOTAL",null,26,56.28,4.57,56.28,6.5,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 86403","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",86403,"HC CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY",null,269,11.54,9.2899999999999991,114.93,67.25,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 86615","TUFTS","TUFTS MEDICARE SCO","CPT",86615,"HC Q;BORDTLLA AB;IGG,IGA",null,174,19.13,12.03,148.07,43.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 92522","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",92522,"EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE",null,440,570.79,179.09,570.79,110,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 92552","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",92552,"PURE TONE AUDIOMETRY AIR ONLY",null,159,178.83,40.869999999999997,997.99,39.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 92563","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",92563,"TONE DECAY TEST",null,160,67.64,53.94,336.64,40,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 92585","UNICARE","UNICARE","CPT",92585,"AUDITORY EVOKED POTENTIALS COMPREHENSIVE",null,639,392.2,326.83,2582.75,159.75,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN QHP - CPT - 82375","BMC HEALTHNET","BMCHN QHP","CPT",82375,"HC CHG CARBOXYHEMOGLOBIN QUANTITATIVE",null,62,13.49,11.24,138.29,15.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 82436","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",82436,"HC CHG CHLORIDE URINE",null,26,12.41,4.59,56.85,6.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 86631","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",86631,"HC CHG, CHLAMYDIA, ANTIBODY",null,52,25.52,10.79,132.78,13,1]
["OUTPATIENT","TUFTS - TUFTS SPIRIT - CPT - 86654","TUFTS","TUFTS SPIRIT","CPT",86654,"CHG ANTIBODY ENCEPHALITIS WESTRN EQUINE",null,28,14.51,12.03,148.07,7,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 86689","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",86689,"HC HTLV/HIV CONFIRMATORY TEST",null,52,46.44,17.66,217.35,13,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 92602","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",92602,"HC REPROGRAM COCHLEAR IMPLT <7",null,203,228.32,228.32,1412.44,50.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 92627","TUFTS","TUFTS SELECT","CPT",92627,"HC EVAL AUDITORY REHAB STATUS, EA ADD 15",null,208,0,44.13,44.13,52,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 92961","TUFTS","TUFTS POS","CPT",92961,"HC CARDIOVERSION ELECTIVE ARRHYTHMIA INTERNAL SPX",null,792,1817.23,884.17,5464.03,198,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 82540","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT",82540,"HC CHG ASSAY OF CREATINE",null,23,4.99,4.2300000000000004,52,5.75,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MEDICAID - CPT - 82570","BMC HEALTHNET","BMCHN MEDICAID","CPT",82570,"HC CHG CREATININE OTHER SOURCE",null,26,4.72,4.72,58.08,6.5,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 82607","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT",82607,"HC CHG CYANOCOBALAMIN VITAMIN B-12",null,75,16.5,13.75,169.26,18.75,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 86695","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",86695,"HC CHG ANTIBODY HERPES SMPLX TYPE 1",null,66,31.63,12.03,148.07,16.5,1]
["OUTPATIENT","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 86704","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT",86704,"HC CHG HEPATITIS B CORE ANTIBODY HBCAB TOTAL",null,61,14.46,10.99,135.27000000000001,15.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 93271","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",93271,"HC EXT ECG,PT DEMAND EVENT, SYMPT MEMORY LOOP, TRANSMIT",null,170,253.77,126.22,1144.02,42.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 93294","TUFTS","TUFTS SELECT","CPT",93294,"INTERROGATION EVAL REMOTE </90 D 1/2/MLT LEAD PM",null,277,47.21,47.21,266.63,69.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 93318","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",93318,"HC ECHO TRANSEOPHAG MONTR CARDIAC PUMP FUNCTJ",null,1153,1047.71,756.94,5185.51,288.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 93454","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",93454,"HC CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I",null,8485,4719.71,2531.06,7703.8,2121.25,1]
["OUTPATIENT","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 82677","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT",82677,"HC CHG ASSAY OF ESTRIOL",null,90,25.46,22.05,271.39,22.5,1]
["OUTPATIENT","TUFTS - TUFTS SPIRIT - CPT - 82805","TUFTS","TUFTS SPIRIT","CPT",82805,"HC CHG GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY",null,141,86.65,38.92,764.01,35.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 86762","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",86762,"HC CHG ANTIBODY RUBELLA",null,70,33.67,13.13,161.6,17.5,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 86780","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",86780,"HC CHG ANTIBODY TREPONEMA PALLIDUM","QW",61,13.24,12.07,148.63999999999999,15.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 86803","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT",86803,"HC CHG HEPATITIS C ANTIBODY",null,58,30.05,13.01,160.13,14.5,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 93462","TUFTS","TUFTS POS","CPT",93462,"HC LEFT HEART CATH BY TRANSEPTAL PUNCTURE",null,6104,0,524.49,5396.16,1526,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 93619","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",93619,"HC COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION",null,5212,8560.41,2531.06,9904.74,1303,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 93653","TUFTS","TUFTS SELECT","CPT",93653,"HC COMPRE EP EVAL TX SVT",null,25096,21120.9,2531.06,62742.78,6274,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 82951","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",82951,"HC CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS",null,64,27.79,11.74,144.52000000000001,16,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MCO - CPT - 83003","BMC HEALTHNET","BMCHN MCO","CPT",83003,"HC CHG ASSAY OF GROWTH HORMONE HUMAN",null,81,15.21,15.21,187.11,20.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 86813","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",86813,"HC CHG HLA TYPING A/B/C MULTIPLE ANTIGENS",null,266,131.09,52.9,651.04,66.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 86901","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",86901,"HC CHG BLOOD TYPING SEROLOGIC RH (D)",null,87,42.24,2.73,348.71,21.75,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN ACO - CPT - 86999","BMC HEALTHNET","BMCHN ACO","CPT",86999,"HC CHG UNLISTED TRANSFUSION MEDICINE PROCEDURE",null,87,0,31.1,200.27,21.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 93786","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",93786,"BL BLD PRESS W/TAPE&/DISK 24/> HR REC ONL",null,283,178.83,126.22,1077.0999999999999,70.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 94003","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",94003,"HC VENTILATION ASSIST & MGMT INPATIENT EA SBSQ DA",null,602,856.43,300.91000000000003,4796.37,150.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90698","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",90698,"CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,355.01,355.01,160.24,355.01,88.752499999999998,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90714","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",90714,"CR BUILD ONLY - TD VACCINE NO PRSRV >/= 7 YO, IM,DPH",null,63.91,59.44,59.44,63.91,15.977499999999999,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 83014","TUFTS","TUFTS PPO","CPT",83014,"HC H PYLORI DRUG ADMIN",null,40,31.39,7.17,88.24,10,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MEDICAID - CPT - 83036","BMC HEALTHNET","BMCHN MEDICAID","CPT",83036,"HEMOGLOBIN GLYCOSYLATED A1C",null,49,8.86,8.86,109.06,12.25,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 83605","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT",83605,"HC CHG ASSAY OF LACTATE",null,54,11.7,9.75,119.99,13.5,1]
["OUTPATIENT","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 87077","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT",87077,"HC CHG CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL",null,27,17.86,7.18,90.64,6.75,1]
["OUTPATIENT","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 87106","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT",87106,"HC CHG CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST",null,51,10.32,9.41,115.87,12.75,1]
["OUTPATIENT","TUFTS - TUFTS SPIRIT - CPT - 87149","TUFTS","TUFTS SPIRIT","CPT",87149,"HC CHG CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM",null,100,22.06,18.29,225.1,25,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 95115","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",95115,"PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS 1 NJX",null,99,81.78,63.62,218.59,24.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 95708","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",95708,"HC EEG WO VID EA 12-26HR UNMNTR",null,723,982.93,781.56,4577.47,180.75,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 83630","UNICARE","UNICARE","CPT",83630,"HC CHG LACTOFERRIN FECAL QUALITATIVE",null,112,47.64,17.91,220.45,28,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 83735","TUFTS","TUFTS PPO","CPT",83735,"HC CHG ASSAY OF MAGNESIUM",null,34,26.74,6.11,75.150000000000006,8.5,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 83874","TUFTS","TUFTS MEDICARE SCO","CPT",83874,"HC CHG MYOGLOBIN",null,62,18.73,11.78,145.01,15.5,1]
["OUTPATIENT","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 87177","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT",87177,"HC CHG OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID",null,44,15.49,8.1199999999999992,99.89,11,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 87205","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT",87205,"HC CHG SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL",null,23,4.67,3.89,47.89,5.75,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 87210","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",87210,"SMR PRIM SRC WET MOUNT NFCT AGT","QW",23,5.82,4.3,56.49,5.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 95868","TUFTS","TUFTS SELECT","CPT",95868,"NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI",null,648,250.1,228.32,1412.44,162,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 95925","TUFTS","TUFTS PPO","CPT",95925,"HC SOMATOSENSORY TEST,UPPER LIMBS",null,433,918.88,423.72,2582.75,108.25,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90620","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",90620,"HC MENB RECOMBINANT PROT W/OUT MEMBR VESIC VACC IM",null,613.46,613.46,204.03,613.46,153.36500000000001,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MCO - CPT - 90648","BMC HEALTHNET","BMCHN MCO","CPT",90648,"HC HIB VACCINE, PRP-T, IM,DPH",null,355.01,90.91,35.97,355.01,88.752499999999998,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 83918","TUFTS","TUFTS MEDICARE SCO","CPT",83918,"HC CHG ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN",null,62,34.22,17.440000000000001,228.93,15.5,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 84075","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",84075,"HC CHG ASSAY OF PHOSPHATASE ALKALINE","QW",26,6.98,4.72,58.08,6.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 84134","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",84134,"HC CHG PREALBUMIN",null,72,163.76,13.31,163.76,18,1]
["OUTPATIENT","AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 87260","AETNA","AETNA-MEDICARE ADVANTAGE","CPT",87260,"HC CHG IAADI ADENOVIRUS",null,57,17.03,10.94,139.96,14.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 87305","TUFTS","TUFTS POS","CPT",87305,"HC CHG IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS",null,272,44.75,10.94,134.54,68,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 87338","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",87338,"HC CHG IAAD IA HPYLORI STOOL",null,102,19.39,13.12,161.52000000000001,25.5,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 96040","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",96040,"MEDICAL GENETICS COUNSELING EACH 30 MINUTES",null,231,98.67,33.74,122.29,57.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 96136","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",96136,"HC PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN",null,341,28.83,28.83,129.58000000000001,85.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90715","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,149.16999999999999,121.15,163.03,40.7575,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 90734","TUFTS","TUFTS SELECT","CPT",90734,"CR BUILD ONLY - MENINGOCOCCAL VACCINE, IM,TRAVEL",null,464.28,409.13,362.95,464.28,116.07,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 84146","BLUE CROSS","BLUE CROSS-PPO","CPT",84146,"HC CHG ASSAY OF PROLACTIN",null,97,43.48,17.670000000000002,217.56,24.25,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 84163","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",84163,"HC CHG PREGNANCY-ASSOCIATED PLASMA PROTEIN-A",null,72,34.26,13.74,169.1,18,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 84207","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",84207,"HC CHG ASSAY OF PYRIDOXAL PHOSPHATE",null,130,63.24,25.63,315.49,32.5,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 87389","TUFTS","TUFTS PPO","CPT",87389,"HC CHG IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE",null,111,96.16,21.97,270.29000000000002,27.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA PPO - CPT - 87480","CIGNA HEALTHCARE","CIGNA PPO","CPT",87480,"HC CHG IADNA CANDIDA SPECIES DIRECT PROBE TQ",null,157,50.99,18.29,225.1,39.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 96168","TUFTS","TUFTS POS","CPT",96168,"HC HLTH BHV IVNTJ FAM EA ADDL",null,19,0,55.01,55.01,4.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 96168","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",96168,"HC HLTH BHV IVNTJ FAM EA ADDL",null,19,55.01,55.01,55.01,4.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 96411","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",96411,"CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG",null,279,100.35,100.35,612.48,69.75,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 97035","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",97035,"HC APPL MODALITY 1/> AREAS ULTRASOUND EA 15 MIN",null,62,23.37,23.23,86.5,15.5,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 84376","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT",84376,"HC CHG SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC",null,27,7.59,5.0199999999999996,61.7,6.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA PPO - CPT - 84436","CIGNA HEALTHCARE","CIGNA PPO","CPT",84436,"HC CHG ASSAY OF THYROXINE TOTAL",null,35,17.48,6.27,77.11,8.75,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 87496","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",87496,"HC ARUP;CYTOMEG VIR PCR,CSF",null,41,47.31,32.01,393.99,10.25,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 87506","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT",87506,"HC CHG IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11",null,334,381.34,157.59,2550.8000000000002,83.5,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 87532","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",87532,"HC CHG IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ",null,38,75.760000000000005,32.01,393.99,9.5,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 97156","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",97156,"HC FAM ADAPT BHV TX GDN PHY/QHP",null,378,56.05,56.05,129.58000000000001,94.5,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 97605","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",97605,"NEGATIVE PRESSURE WOUND THERAPY </= 50 SQ CM",null,236,296.32,296.32,953.4,59,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 98960","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",98960,"HC EDUCATION&TRAINING SELF-MGMT NONPHYS 1 PT",null,135,72.41,72.41,72.41,33.75,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 90686","TUFTS","TUFTS HMO","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,64.41,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 90691","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",90691,"CR BUILD ONLY - TYPHOID VACCINE, IM,TRAVEL",null,359.7,359.7,359.7,359.7,89.924999999999997,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA PPO - CPT - 84479","CIGNA HEALTHCARE","CIGNA PPO","CPT",84479,"HC CHG THYROID HORM UPTK/THYROID HORMONE BINDING RATIO",null,33,16.47,5.9,72.55,8.25,1]
["OUTPATIENT","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 84484","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT",84484,"HC CHG ASSAY OF TROPONIN QUANTITATIVE",null,49,14.96,9.2100000000000009,120.92,12.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 87591","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",87591,"HC CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ",null,129,75.760000000000005,32.01,393.99,32.25,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 87797","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT",87797,"HC CHG DETECT AGENT NOS, DNA, DIR",null,31,33.549999999999997,22.19,291.27999999999997,7.75,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 99151","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT",99151,"HC MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS",null,110,0,61.58,61.58,27.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 99212","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",99212,"ESTABLISHED PATIENT - PHARM - LEVEL 2",null,113,61.9,33.74,108.49,28.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 99292","TUFTS","TUFTS HMO","CPT",99292,"CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN",null,1377,0,268.83,268.83,344.25,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN ACO - CPT - 99456","BMC HEALTHNET","BMCHN ACO","CPT",99456,"WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS",null,348,0,null,null,87,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 85014","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",85014,"HC CHG BLOOD COUNT HEMATOCRIT",null,12,26.61,2.16,26.61,3,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA PPO - CPT - 85046","CIGNA HEALTHCARE","CIGNA PPO","CPT",85046,"HC CHG BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS",null,141,14.21,5.08,62.56,35.25,1]
["OUTPATIENT","TUFTS - TUFTS SPIRIT - CPT - 87899","TUFTS","TUFTS SPIRIT","CPT",87899,"HC MALARIA ANTIGEN",null,94,17.68,11.87,155.81,23.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 87900","BLUE CROSS","BLUE CROSS-PPO","CPT",87900,"HC CHG NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION",null,600,294.47000000000003,118.9,1463.3,150,1]
["OUTPATIENT","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 88142","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT",88142,"CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN",null,101,44.77,18.48,227.42,25.25,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 81015","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT",81015,"HC CHG URINALYSIS MICROSCOPIC ONLY",null,15,3.28,2.78,34.15,3.75,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 81178","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT",81178,"HC CHG ATXN1 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES",null,175,0,102.3,1328.77,43.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 81220","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",81220,"HC CHG CFTR GENE ANALYSIS COMMON VARIANTS",null,847,1017.12,411.25,1400.52,211.75,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 85210","TUFTS","TUFTS POS","CPT",85210,"HC CHG CLOTTING FACTOR II PROTHROMBIN SPECIFIC",null,65,48.47,11.84,145.74,16.25,1]
["OUTPATIENT","FALLON - FALLON SENIOR PLAN - CPT - 85270","FALLON","FALLON SENIOR PLAN","CPT",85270,"HC CHG CLOTTING FACTOR XI PTA",null,91,17.899999999999999,16.329999999999998,200.93,22.75,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 85366","TUFTS","TUFTS PPO","CPT",85366,"HC CHG FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ",null,38,277.66000000000003,10.33,780.44,9.5,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN ACO - CPT - 88235","BMC HEALTHNET","BMCHN ACO","CPT",88235,"HC CHG TISSUE CULTURE, PLACENTA",null,594,293.91000000000003,120.58,1653.19,148.5,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA - CPT - 88280","CIGNA HEALTHCARE","CIGNA","CPT",88280,"HC CHG CHROMOSOME KARYOTYPE STUDY",null,149,113.06,24.73,324.62,37.25,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN WELL SENSE - CPT - 88312","BMC HEALTHNET","BMCHN WELL SENSE","CPT",88312,"HC CHG SPECIAL STAIN GROUP 1 MICROORGANISMS I&R",null,284,51.52,51.52,557.29999999999995,71,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 81257","TUFTS","TUFTS MEDICARE SCO","CPT",81257,"HC CHG HBA1/HBA2 ANALYSIS FOR COMMON DELETIONS/VARIANT",null,455,148.28,102.26,257.31,113.75,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 81275","TUFTS","TUFTS MEDICARE SCO","CPT",81275,"HC CHG KRAS GENE ANALYSIS VARIANTS IN EXON 2",null,534,280.20999999999998,142.78,1874.37,133.5,1]
["OUTPATIENT","FALLON - FALLON SENIOR PLAN - CPT - 85384","FALLON","FALLON SENIOR PLAN","CPT",85384,"HC CHG FIBRINOGEN ACTIVITY",null,43,9.7200000000000006,7.75,96.06,10.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 85610","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",85610,"POC;INR",null,21,8.57,3.58,44.06,5.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 88346","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",88346,"HC CHG IMMUNOFLUORESCENCE PER SPEC 1ST SINGL ANTB STAIN",null,327,592.04,84.87,2458.16,81.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 88380","TUFTS","TUFTS SELECT","CPT",88380,"HC CHG MICRODISSECTION PREP IDENTIFIED TARGET LASER",null,3123,0,28.59,161.54,780.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90384","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",90384,"HC IG;RHO D HUMAN/300MCG",null,196,99,95.92,288.39,49,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MEDICAID - CPT - 90698","BMC HEALTHNET","BMCHN MEDICAID","CPT",90698,"CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,355.01,355.01,160.24,355.01,88.752499999999998,1]
["OUTPATIENT","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 90715","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,147.87,121.15,163.03,40.7575,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 90716","TUFTS","TUFTS POS","CPT",90716,"CR BUILD ONLY - CHICKEN POX VACCINE,LIVE,SUB-Q,TRAVEL",null,509.67,509.67,509.67,509.67,127.4175,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 90715","TUFTS","TUFTS MEDICARE SCO","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,163.03,121.15,163.03,40.7575,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 90740","TUFTS","TUFTS HMO","CPT",90740,"HC HEP B VACCINE,DIAL/IMMUNOSUP, IM",null,350.28,350.28,0.18,350.28,87.57,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90744","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",90744,"CR BUILD ONLY - HEP B VACCINE,PED/ADOL,IM,DPH",null,87.01,87.01,87.01,87.01,21.752500000000001,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 90670","TUFTS","TUFTS POS","CPT",90670,"CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH",null,749.99,749.99,700.91,749.99,187.4975,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90750","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",90750,"HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX",null,540.45000000000005,540.45000000000005,268.52,540.45000000000005,135.11250000000001,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90746","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",90746,"CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL",null,217.1,175.53,175.53,217.1,54.274999999999999,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 90675","TUFTS","TUFTS MEDICARE SCO","CPT",90675,"CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,1370.91,1370.91,905.04,1370.91,342.72750000000002,1]
["OUTPATIENT","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 90686","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,64.41,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 90700","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT",90700,"CR BUILD ONLY - DTAP IMMUNIZATION, IM, <7 YO,TRAVEL",null,87.75,70.77,70.77,87.75,21.9375,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90620","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",90620,"HC MENB RECOMBINANT PROT W/OUT MEMBR VESIC VACC IM",null,613.46,247.19,204.03,613.46,153.36500000000001,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 90715","TUFTS","TUFTS SELECT","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,144.94,121.15,163.03,40.7575,1]
["OUTPATIENT","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 90740","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT",90740,"HC HEP B VACCINE,DIAL/IMMUNOSUP, IM",null,350.28,84.22,0.18,350.28,87.57,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 90371","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",90371,"HC HEPB IG, IM",null,473.09,473.09,267.44,473.09,118.27249999999999,1]
["OUTPATIENT","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 90670","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT",90670,"CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH",null,749.99,700.91,700.91,749.99,187.4975,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90672","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",90672,"CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST",null,81.53,78.489999999999995,78.489999999999995,81.53,20.3825,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90675","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",90675,"CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,1370.91,905.04,905.04,1370.91,342.72750000000002,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 90686","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,64.41,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90698","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",90698,"CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,355.01,227.17,160.24,355.01,88.752499999999998,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 90691","UNICARE","UNICARE","CPT",90691,"CR BUILD ONLY - TYPHOID VACCINE, IM,TRAVEL",null,359.7,359.7,359.7,359.7,89.924999999999997,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 90700","TUFTS","TUFTS PPO","CPT",90700,"CR BUILD ONLY - DTAP IMMUNIZATION, IM, <7 YO,TRAVEL",null,87.75,85.47,70.77,87.75,21.9375,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90700","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",90700,"CR BUILD ONLY - DTAP IMMUNIZATION, IM, <7 YO,TRAVEL",null,87.75,87.75,70.77,87.75,21.9375,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90715","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,163.03,121.15,163.03,40.7575,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 90734","TUFTS","TUFTS HMO","CPT",90734,"CR BUILD ONLY - MENINGOCOCCAL VACCINE, IM,TRAVEL",null,464.28,362.95,362.95,464.28,116.07,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90740","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",90740,"HC HEP B VACCINE,DIAL/IMMUNOSUP, IM",null,350.28,0.18,0.18,350.28,87.57,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90723","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",90723,"CR BUILD ONLY - DTAP/HEPB/IPV VACCINE,IM,DPH",null,306.57,306.57,306.57,306.57,76.642499999999998,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90746","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",90746,"CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL",null,217.1,175.53,175.53,217.1,54.274999999999999,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 90632","TUFTS","TUFTS PPO","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,248.62,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 90675","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT",90675,"CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,1370.91,905.04,905.04,1370.91,342.72750000000002,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90756","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",90756,"HC CCIIV4 VACCINE ANTIBIOTIC FREE 0.5ML DOS IM USE",null,67.58,67.58,67.58,67.58,16.895,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 90691","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",90691,"CR BUILD ONLY - TYPHOID VACCINE, IM,TRAVEL",null,359.7,359.7,359.7,359.7,89.924999999999997,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN ACO - CPT - 90700","BMC HEALTHNET","BMCHN ACO","CPT",90700,"CR BUILD ONLY - DTAP IMMUNIZATION, IM, <7 YO,TRAVEL",null,87.75,85.47,70.77,87.75,21.9375,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90723","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",90723,"CR BUILD ONLY - DTAP/HEPB/IPV VACCINE,IM,DPH",null,306.57,306.57,306.57,306.57,76.642499999999998,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 90740","TUFTS","TUFTS MEDICARE SCO","CPT",90740,"HC HEP B VACCINE,DIAL/IMMUNOSUP, IM",null,350.28,84.22,0.18,350.28,87.57,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90648","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",90648,"HC HIB VACCINE, PRP-T, IM,DPH",null,355.01,355.01,35.97,355.01,88.752499999999998,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 90746","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",90746,"CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL",null,217.1,205.24,175.53,217.1,54.274999999999999,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90690","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",90690,"CR BUILD ONLY - TYPHOID VACCINE, ORAL,TRAVEL",null,234.33,234.33,234.33,234.33,58.582500000000003,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90698","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",90698,"CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,355.01,160.24,160.24,355.01,88.752499999999998,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90714","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",90714,"CR BUILD ONLY - TD VACCINE NO PRSRV >/= 7 YO, IM,DPH",null,63.91,59.44,59.44,63.91,15.977499999999999,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 90714","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT",90714,"CR BUILD ONLY - TD VACCINE NO PRSRV >/= 7 YO, IM,DPH",null,63.91,63.91,59.44,63.91,15.977499999999999,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 90714","TUFTS","TUFTS POS","CPT",90714,"CR BUILD ONLY - TD VACCINE NO PRSRV >/= 7 YO, IM,DPH",null,63.91,63.91,59.44,63.91,15.977499999999999,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 90714","TUFTS","TUFTS SELECT","CPT",90714,"CR BUILD ONLY - TD VACCINE NO PRSRV >/= 7 YO, IM,DPH",null,63.91,63.91,59.44,63.91,15.977499999999999,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90714","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",90714,"CR BUILD ONLY - TD VACCINE NO PRSRV >/= 7 YO, IM,DPH",null,63.91,63.91,59.44,63.91,15.977499999999999,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90714","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",90714,"CR BUILD ONLY - TD VACCINE NO PRSRV >/= 7 YO, IM,DPH",null,63.91,63.91,59.44,63.91,15.977499999999999,1]
["OUTPATIENT","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 90714","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT",90714,"CR BUILD ONLY - TD VACCINE NO PRSRV >/= 7 YO, IM,DPH",null,63.91,59.44,59.44,63.91,15.977499999999999,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 90715","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,144.94,121.15,163.03,40.7575,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90715","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,121.15,121.15,163.03,40.7575,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90715","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,147.87,121.15,163.03,40.7575,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90715","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,144.94,121.15,163.03,40.7575,1]
["OUTPATIENT","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 90715","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,144.94,121.15,163.03,40.7575,1]
["OUTPATIENT","ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 90715","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,163.03,121.15,163.03,40.7575,1]
["OUTPATIENT","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 90715","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,149.16999999999999,121.15,163.03,40.7575,1]
["OUTPATIENT","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 90715","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,144.94,121.15,163.03,40.7575,1]
["OUTPATIENT","FALLON - FALLON SENIOR PLAN - CPT - 90715","FALLON","FALLON SENIOR PLAN","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,144.94,121.15,163.03,40.7575,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90715","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,144.94,121.15,163.03,40.7575,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90715","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,121.15,121.15,163.03,40.7575,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 90715","TUFTS","TUFTS HMO","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,121.15,121.15,163.03,40.7575,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 90715","TUFTS","TUFTS HMO","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,146.76,121.15,163.03,40.7575,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 90715","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,144.94,121.15,163.03,40.7575,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 90715","TUFTS","TUFTS POS","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,149.16999999999999,121.15,163.03,40.7575,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 90715","TUFTS","TUFTS SELECT","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,144.94,121.15,163.03,40.7575,1]
["OUTPATIENT","TUFTS - TUFTS SPIRIT - CPT - 90715","TUFTS","TUFTS SPIRIT","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,144.94,121.15,163.03,40.7575,1]
["OUTPATIENT","AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 90715","AETNA","AETNA-MEDICARE ADVANTAGE","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,144.94,121.15,163.03,40.7575,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 90715","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,147.87,121.15,163.03,40.7575,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 90715","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,144.94,121.15,163.03,40.7575,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90715","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,163.03,121.15,163.03,40.7575,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90715","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,146.76,121.15,163.03,40.7575,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90715","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,144.94,121.15,163.03,40.7575,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 90715","BLUE CROSS","BLUE CROSS-PPO","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,147.87,121.15,163.03,40.7575,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 90715","BLUE CROSS","BLUE CROSS-PPO","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,163.03,121.15,163.03,40.7575,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 90715","BLUE CROSS","BLUE CROSS-PPO","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,149.16999999999999,121.15,163.03,40.7575,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90715","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,163.03,121.15,163.03,40.7575,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90715","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,149.16999999999999,121.15,163.03,40.7575,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90715","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,146.76,121.15,163.03,40.7575,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 90715","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,146.76,121.15,163.03,40.7575,1]
["OUTPATIENT","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 90715","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT",90715,"CR BUILD ONLY - TDAP VACCINE >7 YO, IM,DPH",null,163.03,121.15,121.15,163.03,40.7575,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 90716","TUFTS","TUFTS HMO","CPT",90716,"CR BUILD ONLY - CHICKEN POX VACCINE,LIVE,SUB-Q,TRAVEL",null,509.67,509.67,509.67,509.67,127.4175,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 90716","TUFTS","TUFTS SELECT","CPT",90716,"CR BUILD ONLY - CHICKEN POX VACCINE,LIVE,SUB-Q,TRAVEL",null,509.67,509.67,509.67,509.67,127.4175,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90717","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",90717,"YELLOW FEVER VACCINE SUBQ",null,578.47,578.47,578.47,578.47,144.61750000000001,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90717","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",90717,"YELLOW FEVER VACCINE SUBQ",null,578.47,578.47,578.47,578.47,144.61750000000001,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 90717","BLUE CROSS","BLUE CROSS-PPO","CPT",90717,"YELLOW FEVER VACCINE SUBQ",null,578.47,578.47,578.47,578.47,144.61750000000001,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 90723","UNICARE","UNICARE","CPT",90723,"CR BUILD ONLY - DTAP/HEPB/IPV VACCINE,IM,DPH",null,306.57,306.57,306.57,306.57,76.642499999999998,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 90723","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT",90723,"CR BUILD ONLY - DTAP/HEPB/IPV VACCINE,IM,DPH",null,306.57,306.57,306.57,306.57,76.642499999999998,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90723","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",90723,"CR BUILD ONLY - DTAP/HEPB/IPV VACCINE,IM,DPH",null,306.57,306.57,306.57,306.57,76.642499999999998,1]
["OUTPATIENT","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 90732","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT",90732,"CR BUILD ONLY - PNEUMOCOCCAL VACCINE,23-VALENT,ADULT,TRAVEL",null,383.29,383.29,257.13,383.29,95.822500000000005,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90732","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",90732,"CR BUILD ONLY - PNEUMOCOCCAL VACCINE,23-VALENT,ADULT,TRAVEL",null,383.29,383.29,257.13,383.29,95.822500000000005,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90732","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",90732,"CR BUILD ONLY - PNEUMOCOCCAL VACCINE,23-VALENT,ADULT,TRAVEL",null,383.29,383.29,257.13,383.29,95.822500000000005,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 90732","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",90732,"CR BUILD ONLY - PNEUMOCOCCAL VACCINE,23-VALENT,ADULT,TRAVEL",null,383.29,257.13,257.13,383.29,95.822500000000005,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 90732","TUFTS","TUFTS POS","CPT",90732,"CR BUILD ONLY - PNEUMOCOCCAL VACCINE,23-VALENT,ADULT,TRAVEL",null,383.29,383.29,257.13,383.29,95.822500000000005,1]
["OUTPATIENT","TUFTS - TUFTS SPIRIT - CPT - 90732","TUFTS","TUFTS SPIRIT","CPT",90732,"CR BUILD ONLY - PNEUMOCOCCAL VACCINE,23-VALENT,ADULT,TRAVEL",null,383.29,383.29,257.13,383.29,95.822500000000005,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90732","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",90732,"CR BUILD ONLY - PNEUMOCOCCAL VACCINE,23-VALENT,ADULT,TRAVEL",null,383.29,257.13,257.13,383.29,95.822500000000005,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90732","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",90732,"CR BUILD ONLY - PNEUMOCOCCAL VACCINE,23-VALENT,ADULT,TRAVEL",null,383.29,257.13,257.13,383.29,95.822500000000005,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90732","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",90732,"CR BUILD ONLY - PNEUMOCOCCAL VACCINE,23-VALENT,ADULT,TRAVEL",null,383.29,383.29,257.13,383.29,95.822500000000005,1]
["OUTPATIENT","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 90732","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT",90732,"CR BUILD ONLY - PNEUMOCOCCAL VACCINE,23-VALENT,ADULT,TRAVEL",null,383.29,257.13,257.13,383.29,95.822500000000005,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90734","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",90734,"CR BUILD ONLY - MENINGOCOCCAL VACCINE, IM,TRAVEL",null,464.28,362.95,362.95,464.28,116.07,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90734","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",90734,"CR BUILD ONLY - MENINGOCOCCAL VACCINE, IM,TRAVEL",null,464.28,362.95,362.95,464.28,116.07,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90734","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",90734,"CR BUILD ONLY - MENINGOCOCCAL VACCINE, IM,TRAVEL",null,464.28,409.13,362.95,464.28,116.07,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 90734","TUFTS","TUFTS POS","CPT",90734,"CR BUILD ONLY - MENINGOCOCCAL VACCINE, IM,TRAVEL",null,464.28,409.13,362.95,464.28,116.07,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 90734","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",90734,"CR BUILD ONLY - MENINGOCOCCAL VACCINE, IM,TRAVEL",null,464.28,362.95,362.95,464.28,116.07,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90734","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",90734,"CR BUILD ONLY - MENINGOCOCCAL VACCINE, IM,TRAVEL",null,464.28,409.13,362.95,464.28,116.07,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90734","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",90734,"CR BUILD ONLY - MENINGOCOCCAL VACCINE, IM,TRAVEL",null,464.28,362.95,362.95,464.28,116.07,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 90734","BLUE CROSS","BLUE CROSS-PPO","CPT",90734,"CR BUILD ONLY - MENINGOCOCCAL VACCINE, IM,TRAVEL",null,464.28,362.95,362.95,464.28,116.07,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90734","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",90734,"CR BUILD ONLY - MENINGOCOCCAL VACCINE, IM,TRAVEL",null,464.28,362.95,362.95,464.28,116.07,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90734","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",90734,"CR BUILD ONLY - MENINGOCOCCAL VACCINE, IM,TRAVEL",null,464.28,409.13,362.95,464.28,116.07,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90739","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",90739,"HC HEPATITIS B VACCINE ADULT 2 DOSE IM",null,411.21,411.21,411.21,411.21,102.80249999999999,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90739","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",90739,"HC HEPATITIS B VACCINE ADULT 2 DOSE IM",null,411.21,136.05000000000001,411.21,411.21,102.80249999999999,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90739","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",90739,"HC HEPATITIS B VACCINE ADULT 2 DOSE IM",null,411.21,411.21,411.21,411.21,102.80249999999999,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 90739","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",90739,"HC HEPATITIS B VACCINE ADULT 2 DOSE IM",null,411.21,131.1,411.21,411.21,102.80249999999999,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90739","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",90739,"HC HEPATITIS B VACCINE ADULT 2 DOSE IM",null,411.21,411.21,411.21,411.21,102.80249999999999,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 90739","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",90739,"HC HEPATITIS B VACCINE ADULT 2 DOSE IM",null,411.21,411.21,411.21,411.21,102.80249999999999,1]
["OUTPATIENT","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 90739","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT",90739,"HC HEPATITIS B VACCINE ADULT 2 DOSE IM",null,411.21,411.21,411.21,411.21,102.80249999999999,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 90739","TUFTS","TUFTS MEDICARE SCO","CPT",90739,"HC HEPATITIS B VACCINE ADULT 2 DOSE IM",null,411.21,190.1,411.21,411.21,102.80249999999999,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 90739","TUFTS","TUFTS POS","CPT",90739,"HC HEPATITIS B VACCINE ADULT 2 DOSE IM",null,411.21,190.1,411.21,411.21,102.80249999999999,1]
["OUTPATIENT","AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 90739","AETNA","AETNA-MEDICARE ADVANTAGE","CPT",90739,"HC HEPATITIS B VACCINE ADULT 2 DOSE IM",null,411.21,154.69999999999999,411.21,411.21,102.80249999999999,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90739","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",90739,"HC HEPATITIS B VACCINE ADULT 2 DOSE IM",null,411.21,411.21,411.21,411.21,102.80249999999999,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90739","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",90739,"HC HEPATITIS B VACCINE ADULT 2 DOSE IM",null,411.21,411.21,411.21,411.21,102.80249999999999,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 90740","UNICARE","UNICARE","CPT",90740,"HC HEP B VACCINE,DIAL/IMMUNOSUP, IM",null,350.28,0.18,0.18,350.28,87.57,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 90371","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT",90371,"HC HEPB IG, IM",null,473.09,267.44,267.44,473.09,118.27249999999999,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 90371","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT",90371,"HC HEPB IG, IM",null,473.09,473.09,267.44,473.09,118.27249999999999,1]
["OUTPATIENT","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 90371","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT",90371,"HC HEPB IG, IM",null,473.09,267.44,267.44,473.09,118.27249999999999,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90371","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",90371,"HC HEPB IG, IM",null,473.09,473.09,267.44,473.09,118.27249999999999,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 90371","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",90371,"HC HEPB IG, IM",null,473.09,473.09,267.44,473.09,118.27249999999999,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 90371","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",90371,"HC HEPB IG, IM",null,473.09,473.09,267.44,473.09,118.27249999999999,1]
["OUTPATIENT","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 90371","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT",90371,"HC HEPB IG, IM",null,473.09,473.09,267.44,473.09,118.27249999999999,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 90371","TUFTS","TUFTS MEDICARE SCO","CPT",90371,"HC HEPB IG, IM",null,473.09,473.09,267.44,473.09,118.27249999999999,1]
["OUTPATIENT","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 90371","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT",90371,"HC HEPB IG, IM",null,473.09,267.44,267.44,473.09,118.27249999999999,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90620","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",90620,"HC MENB RECOMBINANT PROT W/OUT MEMBR VESIC VACC IM",null,613.46,314.44,204.03,613.46,153.36500000000001,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90620","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",90620,"HC MENB RECOMBINANT PROT W/OUT MEMBR VESIC VACC IM",null,613.46,613.46,204.03,613.46,153.36500000000001,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 90620","TUFTS","TUFTS POS","CPT",90620,"HC MENB RECOMBINANT PROT W/OUT MEMBR VESIC VACC IM",null,613.46,204.03,204.03,613.46,153.36500000000001,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90620","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",90620,"HC MENB RECOMBINANT PROT W/OUT MEMBR VESIC VACC IM",null,613.46,247.19,204.03,613.46,153.36500000000001,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90625","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",90625,"HC  CHOLERA VACCINE ADULT 1 DOSE LIVE FOR ORAL USE",null,749.23,749.23,749.23,749.23,187.3075,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90625","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",90625,"HC  CHOLERA VACCINE ADULT 1 DOSE LIVE FOR ORAL USE",null,749.23,749.23,749.23,749.23,187.3075,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 90632","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,266.16000000000003,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 90632","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,259.33999999999997,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 90632","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,244.66,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 90632","UNICARE","UNICARE","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,259.33999999999997,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90632","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,266.16000000000003,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90632","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,248.62,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90632","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,248.62,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 90632","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,259.33999999999997,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 90632","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,266.16000000000003,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 90632","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,248.62,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 90632","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,248.62,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90620","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",90620,"HC MENB RECOMBINANT PROT W/OUT MEMBR VESIC VACC IM",null,613.46,314.44,204.03,613.46,153.36500000000001,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 90620","TUFTS","TUFTS SELECT","CPT",90620,"HC MENB RECOMBINANT PROT W/OUT MEMBR VESIC VACC IM",null,613.46,204.03,204.03,613.46,153.36500000000001,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 90620","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",90620,"HC MENB RECOMBINANT PROT W/OUT MEMBR VESIC VACC IM",null,613.46,247.19,204.03,613.46,153.36500000000001,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 90620","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",90620,"HC MENB RECOMBINANT PROT W/OUT MEMBR VESIC VACC IM",null,613.46,247.19,204.03,613.46,153.36500000000001,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90620","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",90620,"HC MENB RECOMBINANT PROT W/OUT MEMBR VESIC VACC IM",null,613.46,247.19,204.03,613.46,153.36500000000001,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90620","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",90620,"HC MENB RECOMBINANT PROT W/OUT MEMBR VESIC VACC IM",null,613.46,247.19,204.03,613.46,153.36500000000001,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90620","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",90620,"HC MENB RECOMBINANT PROT W/OUT MEMBR VESIC VACC IM",null,613.46,247.19,204.03,613.46,153.36500000000001,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90620","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",90620,"HC MENB RECOMBINANT PROT W/OUT MEMBR VESIC VACC IM",null,613.46,247.19,204.03,613.46,153.36500000000001,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 90632","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,244.66,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 90632","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,248.62,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 90632","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,259.33999999999997,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90632","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,266.16000000000003,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90632","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,244.66,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 90632","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,266.16000000000003,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 90632","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,244.66,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","TUFTS - TUFTS SPIRIT - CPT - 90632","TUFTS","TUFTS SPIRIT","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,259.33999999999997,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","TUFTS - TUFTS SPIRIT - CPT - 90632","TUFTS","TUFTS SPIRIT","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,244.66,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 90632","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,266.16000000000003,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90632","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,248.62,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 90632","BLUE CROSS","BLUE CROSS-PPO","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,266.16000000000003,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90632","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,244.66,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90632","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,244.66,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90633","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",90633,"CR BUILD ONLY - HEPA VACCINE PED/ADOL-2 DOSE,DPH",null,118.96,118.96,118.96,118.96,29.74,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 90633","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",90633,"CR BUILD ONLY - HEPA VACCINE PED/ADOL-2 DOSE,DPH",null,118.96,118.96,118.96,118.96,29.74,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90648","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",90648,"HC HIB VACCINE, PRP-T, IM,DPH",null,355.01,59.97,35.97,355.01,88.752499999999998,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90648","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",90648,"HC HIB VACCINE, PRP-T, IM,DPH",null,355.01,35.97,35.97,355.01,88.752499999999998,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90648","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",90648,"HC HIB VACCINE, PRP-T, IM,DPH",null,355.01,35.97,35.97,355.01,88.752499999999998,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90648","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",90648,"HC HIB VACCINE, PRP-T, IM,DPH",null,355.01,59.97,35.97,355.01,88.752499999999998,1]
["OUTPATIENT","FALLON - FALLON MEDICAID - CPT - 90648","FALLON","FALLON MEDICAID","CPT",90648,"HC HIB VACCINE, PRP-T, IM,DPH",null,355.01,90.91,35.97,355.01,88.752499999999998,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90648","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",90648,"HC HIB VACCINE, PRP-T, IM,DPH",null,355.01,90.91,35.97,355.01,88.752499999999998,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90648","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",90648,"HC HIB VACCINE, PRP-T, IM,DPH",null,355.01,35.97,35.97,355.01,88.752499999999998,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90648","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",90648,"HC HIB VACCINE, PRP-T, IM,DPH",null,355.01,59.97,35.97,355.01,88.752499999999998,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 90648","TUFTS","TUFTS PPO","CPT",90648,"HC HIB VACCINE, PRP-T, IM,DPH",null,355.01,35.97,35.97,355.01,88.752499999999998,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 90648","TUFTS","TUFTS PPO","CPT",90648,"HC HIB VACCINE, PRP-T, IM,DPH",null,355.01,90.91,35.97,355.01,88.752499999999998,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 90648","TUFTS","TUFTS PPO","CPT",90648,"HC HIB VACCINE, PRP-T, IM,DPH",null,355.01,59.97,35.97,355.01,88.752499999999998,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 90648","TUFTS","TUFTS SELECT","CPT",90648,"HC HIB VACCINE, PRP-T, IM,DPH",null,355.01,355.01,35.97,355.01,88.752499999999998,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 90648","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT",90648,"HC HIB VACCINE, PRP-T, IM,DPH",null,355.01,35.97,35.97,355.01,88.752499999999998,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 90648","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT",90648,"HC HIB VACCINE, PRP-T, IM,DPH",null,355.01,35.97,35.97,355.01,88.752499999999998,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH ACO - CPT - 90648","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH ACO","CPT",90648,"HC HIB VACCINE, PRP-T, IM,DPH",null,355.01,59.97,35.97,355.01,88.752499999999998,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90648","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",90648,"HC HIB VACCINE, PRP-T, IM,DPH",null,355.01,59.97,35.97,355.01,88.752499999999998,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MEDICAID - CPT - 90648","BMC HEALTHNET","BMCHN MEDICAID","CPT",90648,"HC HIB VACCINE, PRP-T, IM,DPH",null,355.01,59.97,35.97,355.01,88.752499999999998,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90651","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",90651,"CR BUILD ONLY - HPV 9-VALENT IM, DPH",null,898.26,830.41,830.41,898.26,224.565,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 90651","TUFTS","TUFTS HMO","CPT",90651,"CR BUILD ONLY - HPV 9-VALENT IM, DPH",null,898.26,830.41,830.41,898.26,224.565,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 90651","TUFTS","TUFTS POS","CPT",90651,"CR BUILD ONLY - HPV 9-VALENT IM, DPH",null,898.26,830.41,830.41,898.26,224.565,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 90651","TUFTS","TUFTS PPO","CPT",90651,"CR BUILD ONLY - HPV 9-VALENT IM, DPH",null,898.26,830.41,830.41,898.26,224.565,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 90651","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",90651,"CR BUILD ONLY - HPV 9-VALENT IM, DPH",null,898.26,898.26,830.41,898.26,224.565,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90651","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",90651,"CR BUILD ONLY - HPV 9-VALENT IM, DPH",null,898.26,898.26,830.41,898.26,224.565,1]
["OUTPATIENT","FALLON - FALLON SENIOR PLAN - CPT - 90670","FALLON","FALLON SENIOR PLAN","CPT",90670,"CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH",null,749.99,749.99,700.91,749.99,187.4975,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90670","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",90670,"CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH",null,749.99,749.99,700.91,749.99,187.4975,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 90670","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",90670,"CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH",null,749.99,749.99,700.91,749.99,187.4975,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 90670","TUFTS","TUFTS MEDICARE SCO","CPT",90670,"CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH",null,749.99,749.99,700.91,749.99,187.4975,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90670","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",90670,"CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH",null,749.99,700.91,700.91,749.99,187.4975,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90670","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",90670,"CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH",null,749.99,700.91,700.91,749.99,187.4975,1]
["OUTPATIENT","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 90670","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT",90670,"CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH",null,749.99,749.99,700.91,749.99,187.4975,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 90672","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT",90672,"CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST",null,81.53,81.53,78.489999999999995,81.53,20.3825,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 90672","UNICARE","UNICARE","CPT",90672,"CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST",null,81.53,78.489999999999995,78.489999999999995,81.53,20.3825,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 90672","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT",90672,"CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST",null,81.53,81.53,78.489999999999995,81.53,20.3825,1]
["OUTPATIENT","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 90672","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT",90672,"CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST",null,81.53,81.53,78.489999999999995,81.53,20.3825,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 90672","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",90672,"CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST",null,81.53,78.489999999999995,78.489999999999995,81.53,20.3825,1]
["OUTPATIENT","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 90672","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT",90672,"CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST",null,81.53,81.53,78.489999999999995,81.53,20.3825,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 90672","TUFTS","TUFTS HMO","CPT",90672,"CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST",null,81.53,81.53,78.489999999999995,81.53,20.3825,1]
["OUTPATIENT","AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 90672","AETNA","AETNA-MEDICARE ADVANTAGE","CPT",90672,"CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST",null,81.53,78.489999999999995,78.489999999999995,81.53,20.3825,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90672","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",90672,"CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST",null,81.53,81.53,78.489999999999995,81.53,20.3825,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90672","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",90672,"CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST",null,81.53,78.489999999999995,78.489999999999995,81.53,20.3825,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 90674","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT",90674,"HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",null,72.349999999999994,72.33,72.33,72.349999999999994,18.087499999999999,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90674","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",90674,"HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",null,72.349999999999994,72.33,72.33,72.349999999999994,18.087499999999999,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90674","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",90674,"HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",null,72.349999999999994,72.349999999999994,72.33,72.349999999999994,18.087499999999999,1]
["OUTPATIENT","ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 90740","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT",90740,"HC HEP B VACCINE,DIAL/IMMUNOSUP, IM",null,350.28,350.28,0.18,350.28,87.57,1]
["OUTPATIENT","FALLON - FALLON SENIOR PLAN - CPT - 90740","FALLON","FALLON SENIOR PLAN","CPT",90740,"HC HEP B VACCINE,DIAL/IMMUNOSUP, IM",null,350.28,350.28,0.18,350.28,87.57,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 90740","TUFTS","TUFTS HMO","CPT",90740,"HC HEP B VACCINE,DIAL/IMMUNOSUP, IM",null,350.28,0.18,0.18,350.28,87.57,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 90740","TUFTS","TUFTS PPO","CPT",90740,"HC HEP B VACCINE,DIAL/IMMUNOSUP, IM",null,350.28,350.28,0.18,350.28,87.57,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 90740","TUFTS","TUFTS PPO","CPT",90740,"HC HEP B VACCINE,DIAL/IMMUNOSUP, IM",null,350.28,0.18,0.18,350.28,87.57,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 90740","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",90740,"HC HEP B VACCINE,DIAL/IMMUNOSUP, IM",null,350.28,350.28,0.18,350.28,87.57,1]
["OUTPATIENT","AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 90740","AETNA","AETNA-MEDICARE ADVANTAGE","CPT",90740,"HC HEP B VACCINE,DIAL/IMMUNOSUP, IM",null,350.28,350.28,0.18,350.28,87.57,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 90740","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",90740,"HC HEP B VACCINE,DIAL/IMMUNOSUP, IM",null,350.28,84.22,0.18,350.28,87.57,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90740","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",90740,"HC HEP B VACCINE,DIAL/IMMUNOSUP, IM",null,350.28,0.18,0.18,350.28,87.57,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90740","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",90740,"HC HEP B VACCINE,DIAL/IMMUNOSUP, IM",null,350.28,84.22,0.18,350.28,87.57,1]
["OUTPATIENT","FALLON - FALLON SENIOR PLAN - CPT - 90744","FALLON","FALLON SENIOR PLAN","CPT",90744,"CR BUILD ONLY - HEP B VACCINE,PED/ADOL,IM,DPH",null,87.01,87.01,87.01,87.01,21.752500000000001,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 90744","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT",90744,"CR BUILD ONLY - HEP B VACCINE,PED/ADOL,IM,DPH",null,87.01,87.01,87.01,87.01,21.752500000000001,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90744","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",90744,"CR BUILD ONLY - HEP B VACCINE,PED/ADOL,IM,DPH",null,87.01,87.01,87.01,87.01,21.752500000000001,1]
["OUTPATIENT","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 90744","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT",90744,"CR BUILD ONLY - HEP B VACCINE,PED/ADOL,IM,DPH",null,87.01,87.01,87.01,87.01,21.752500000000001,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 90746","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT",90746,"CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL",null,217.1,205.24,175.53,217.1,54.274999999999999,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 90746","UNICARE","UNICARE","CPT",90746,"CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL",null,217.1,175.53,175.53,217.1,54.274999999999999,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90746","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",90746,"CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL",null,217.1,175.53,175.53,217.1,54.274999999999999,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90746","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",90746,"CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL",null,217.1,205.24,175.53,217.1,54.274999999999999,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90746","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",90746,"CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL",null,217.1,205.24,175.53,217.1,54.274999999999999,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90746","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",90746,"CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL",null,217.1,205.24,175.53,217.1,54.274999999999999,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 90746","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",90746,"CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL",null,217.1,217.1,175.53,217.1,54.274999999999999,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 90746","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT",90746,"CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL",null,217.1,205.24,175.53,217.1,54.274999999999999,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 90746","TUFTS","TUFTS POS","CPT",90746,"CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL",null,217.1,217.1,175.53,217.1,54.274999999999999,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 90746","TUFTS","TUFTS SELECT","CPT",90746,"CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL",null,217.1,205.24,175.53,217.1,54.274999999999999,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 90746","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",90746,"CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL",null,217.1,205.24,175.53,217.1,54.274999999999999,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90746","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",90746,"CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL",null,217.1,205.24,175.53,217.1,54.274999999999999,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 90746","BLUE CROSS","BLUE CROSS-PPO","CPT",90746,"CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL",null,217.1,205.24,175.53,217.1,54.274999999999999,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 90746","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT",90746,"CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL",null,217.1,175.53,175.53,217.1,54.274999999999999,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90746","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",90746,"CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL",null,217.1,175.53,175.53,217.1,54.274999999999999,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90746","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",90746,"CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL",null,217.1,205.24,175.53,217.1,54.274999999999999,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90746","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",90746,"CR BUILD ONLY - HEPATITIS B VACCINE ADULT 3 DOSE IM,TRAVEL",null,217.1,205.24,175.53,217.1,54.274999999999999,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 90750","BLUE CROSS","BLUE CROSS-PPO","CPT",90750,"HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX",null,540.45000000000005,540.45000000000005,268.52,540.45000000000005,135.11250000000001,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90750","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",90750,"HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX",null,540.45000000000005,268.52,268.52,540.45000000000005,135.11250000000001,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 90756","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT",90756,"HC CCIIV4 VACCINE ANTIBIOTIC FREE 0.5ML DOS IM USE",null,67.58,67.58,67.58,67.58,16.895,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90756","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",90756,"HC CCIIV4 VACCINE ANTIBIOTIC FREE 0.5ML DOS IM USE",null,67.58,67.58,67.58,67.58,16.895,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90756","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",90756,"HC CCIIV4 VACCINE ANTIBIOTIC FREE 0.5ML DOS IM USE",null,67.58,67.58,67.58,67.58,16.895,1]
["OUTPATIENT","ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 90756","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT",90756,"HC CCIIV4 VACCINE ANTIBIOTIC FREE 0.5ML DOS IM USE",null,67.58,67.58,67.58,67.58,16.895,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 90756","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",90756,"HC CCIIV4 VACCINE ANTIBIOTIC FREE 0.5ML DOS IM USE",null,67.58,67.58,67.58,67.58,16.895,1]
["OUTPATIENT","FALLON - FALLON SENIOR PLAN - CPT - 90756","FALLON","FALLON SENIOR PLAN","CPT",90756,"HC CCIIV4 VACCINE ANTIBIOTIC FREE 0.5ML DOS IM USE",null,67.58,67.58,67.58,67.58,16.895,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90756","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",90756,"HC CCIIV4 VACCINE ANTIBIOTIC FREE 0.5ML DOS IM USE",null,67.58,67.58,67.58,67.58,16.895,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 90756","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",90756,"HC CCIIV4 VACCINE ANTIBIOTIC FREE 0.5ML DOS IM USE",null,67.58,67.58,67.58,67.58,16.895,1]
["OUTPATIENT","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 90756","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT",90756,"HC CCIIV4 VACCINE ANTIBIOTIC FREE 0.5ML DOS IM USE",null,67.58,67.58,67.58,67.58,16.895,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 90756","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT",90756,"HC CCIIV4 VACCINE ANTIBIOTIC FREE 0.5ML DOS IM USE",null,67.58,67.58,67.58,67.58,16.895,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 90756","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",90756,"HC CCIIV4 VACCINE ANTIBIOTIC FREE 0.5ML DOS IM USE",null,67.58,67.58,67.58,67.58,16.895,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90756","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",90756,"HC CCIIV4 VACCINE ANTIBIOTIC FREE 0.5ML DOS IM USE",null,67.58,67.58,67.58,67.58,16.895,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90756","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",90756,"HC CCIIV4 VACCINE ANTIBIOTIC FREE 0.5ML DOS IM USE",null,67.58,67.58,67.58,67.58,16.895,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90632","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,248.62,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90632","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,244.66,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 90632","TUFTS","TUFTS MEDICARE SCO","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,259.33999999999997,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 90632","TUFTS","TUFTS POS","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,244.66,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 90632","TUFTS","TUFTS SELECT","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,248.62,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","TUFTS - TUFTS SPIRIT - CPT - 90632","TUFTS","TUFTS SPIRIT","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,248.62,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 90632","AETNA","AETNA-MEDICARE ADVANTAGE","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,248.62,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90632","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,266.16000000000003,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90632","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,259.33999999999997,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90632","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,259.33999999999997,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90632","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,266.16000000000003,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90632","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",90632,"CR BUILD ONLY - HEPA VACCINE ADULT IM,TRAVEL",null,266.16000000000003,259.33999999999997,244.66,266.16000000000003,66.540000000000006,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90648","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",90648,"HC HIB VACCINE, PRP-T, IM,DPH",null,355.01,35.97,35.97,355.01,88.752499999999998,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90648","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",90648,"HC HIB VACCINE, PRP-T, IM,DPH",null,355.01,355.01,35.97,355.01,88.752499999999998,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 90648","TUFTS","TUFTS POS","CPT",90648,"HC HIB VACCINE, PRP-T, IM,DPH",null,355.01,35.97,35.97,355.01,88.752499999999998,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 90648","TUFTS","TUFTS POS","CPT",90648,"HC HIB VACCINE, PRP-T, IM,DPH",null,355.01,90.91,35.97,355.01,88.752499999999998,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 90648","TUFTS","TUFTS PPO","CPT",90648,"HC HIB VACCINE, PRP-T, IM,DPH",null,355.01,355.01,35.97,355.01,88.752499999999998,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT - CPT - 90648","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT","CPT",90648,"HC HIB VACCINE, PRP-T, IM,DPH",null,355.01,90.91,35.97,355.01,88.752499999999998,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90648","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",90648,"HC HIB VACCINE, PRP-T, IM,DPH",null,355.01,355.01,35.97,355.01,88.752499999999998,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90648","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",90648,"HC HIB VACCINE, PRP-T, IM,DPH",null,355.01,90.91,35.97,355.01,88.752499999999998,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90648","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",90648,"HC HIB VACCINE, PRP-T, IM,DPH",null,355.01,59.97,35.97,355.01,88.752499999999998,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN ACO - CPT - 90648","BMC HEALTHNET","BMCHN ACO","CPT",90648,"HC HIB VACCINE, PRP-T, IM,DPH",null,355.01,35.97,35.97,355.01,88.752499999999998,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90648","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",90648,"HC HIB VACCINE, PRP-T, IM,DPH",null,355.01,355.01,35.97,355.01,88.752499999999998,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90651","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",90651,"CR BUILD ONLY - HPV 9-VALENT IM, DPH",null,898.26,898.26,830.41,898.26,224.565,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90651","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",90651,"CR BUILD ONLY - HPV 9-VALENT IM, DPH",null,898.26,898.26,830.41,898.26,224.565,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 90670","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT",90670,"CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH",null,749.99,700.91,700.91,749.99,187.4975,1]
["OUTPATIENT","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 90670","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT",90670,"CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH",null,749.99,700.91,700.91,749.99,187.4975,1]
["OUTPATIENT","FALLON - FALLON SENIOR PLAN - CPT - 90670","FALLON","FALLON SENIOR PLAN","CPT",90670,"CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH",null,749.99,700.91,700.91,749.99,187.4975,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90670","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",90670,"CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH",null,749.99,700.91,700.91,749.99,187.4975,1]
["OUTPATIENT","TUFTS - TUFTS SPIRIT - CPT - 90670","TUFTS","TUFTS SPIRIT","CPT",90670,"CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH",null,749.99,749.99,700.91,749.99,187.4975,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 90670","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",90670,"CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH",null,749.99,700.91,700.91,749.99,187.4975,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 90670","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",90670,"CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH",null,749.99,700.91,700.91,749.99,187.4975,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90670","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",90670,"CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH",null,749.99,749.99,700.91,749.99,187.4975,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90670","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",90670,"CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH",null,749.99,700.91,700.91,749.99,187.4975,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 90670","BLUE CROSS","BLUE CROSS-PPO","CPT",90670,"CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH",null,749.99,749.99,700.91,749.99,187.4975,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 90670","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT",90670,"CR BUILD ONLY - PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,DPH",null,749.99,700.91,700.91,749.99,187.4975,1]
["OUTPATIENT","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 90672","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT",90672,"CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST",null,81.53,78.489999999999995,78.489999999999995,81.53,20.3825,1]
["OUTPATIENT","ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 90672","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT",90672,"CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST",null,81.53,78.489999999999995,78.489999999999995,81.53,20.3825,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 90672","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",90672,"CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST",null,81.53,81.53,78.489999999999995,81.53,20.3825,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90672","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",90672,"CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST",null,81.53,78.489999999999995,78.489999999999995,81.53,20.3825,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 90672","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",90672,"CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST",null,81.53,81.53,78.489999999999995,81.53,20.3825,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 90672","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT",90672,"CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST",null,81.53,81.53,78.489999999999995,81.53,20.3825,1]
["OUTPATIENT","TUFTS - TUFTS SPIRIT - CPT - 90672","TUFTS","TUFTS SPIRIT","CPT",90672,"CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST",null,81.53,78.489999999999995,78.489999999999995,81.53,20.3825,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90672","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",90672,"CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST",null,81.53,81.53,78.489999999999995,81.53,20.3825,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90672","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",90672,"CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST",null,81.53,78.489999999999995,78.489999999999995,81.53,20.3825,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 90674","UNICARE","UNICARE","CPT",90674,"HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",null,72.349999999999994,72.33,72.33,72.349999999999994,18.087499999999999,1]
["OUTPATIENT","ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 90674","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT",90674,"HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",null,72.349999999999994,72.33,72.33,72.349999999999994,18.087499999999999,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 90674","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",90674,"HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",null,72.349999999999994,72.33,72.33,72.349999999999994,18.087499999999999,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 90674","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",90674,"HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",null,72.349999999999994,72.349999999999994,72.33,72.349999999999994,18.087499999999999,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 90674","TUFTS","TUFTS POS","CPT",90674,"HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",null,72.349999999999994,72.33,72.33,72.349999999999994,18.087499999999999,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 90674","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",90674,"HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",null,72.349999999999994,72.349999999999994,72.33,72.349999999999994,18.087499999999999,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 90674","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",90674,"HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",null,72.349999999999994,72.33,72.33,72.349999999999994,18.087499999999999,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90674","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",90674,"HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",null,72.349999999999994,72.349999999999994,72.33,72.349999999999994,18.087499999999999,1]
["OUTPATIENT","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 90674","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT",90674,"HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",null,72.349999999999994,72.349999999999994,72.33,72.349999999999994,18.087499999999999,1]
["OUTPATIENT","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 90674","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT",90674,"HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",null,72.349999999999994,72.33,72.33,72.349999999999994,18.087499999999999,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90675","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",90675,"CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,1370.91,1196.6300000000001,905.04,1370.91,342.72750000000002,1]
["OUTPATIENT","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 90675","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT",90675,"CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,1370.91,1370.91,905.04,1370.91,342.72750000000002,1]
["OUTPATIENT","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 90675","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT",90675,"CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,1370.91,1196.6300000000001,905.04,1370.91,342.72750000000002,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 90675","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",90675,"CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,1370.91,1370.91,905.04,1370.91,342.72750000000002,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 90675","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",90675,"CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,1370.91,1196.6300000000001,905.04,1370.91,342.72750000000002,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90675","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",90675,"CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,1370.91,1196.6300000000001,905.04,1370.91,342.72750000000002,1]
["OUTPATIENT","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 90675","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT",90675,"CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,1370.91,1370.91,905.04,1370.91,342.72750000000002,1]
["OUTPATIENT","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 90675","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT",90675,"CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,1370.91,905.04,905.04,1370.91,342.72750000000002,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 90675","TUFTS","TUFTS HMO","CPT",90675,"CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,1370.91,905.04,905.04,1370.91,342.72750000000002,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 90675","TUFTS","TUFTS POS","CPT",90675,"CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,1370.91,1370.91,905.04,1370.91,342.72750000000002,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90675","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",90675,"CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,1370.91,905.04,905.04,1370.91,342.72750000000002,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 90675","BLUE CROSS","BLUE CROSS-PPO","CPT",90675,"CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,1370.91,1196.6300000000001,905.04,1370.91,342.72750000000002,1]
["OUTPATIENT","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 90675","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT",90675,"CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,1370.91,1370.91,905.04,1370.91,342.72750000000002,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90686","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,64.41,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90686","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,62.64,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED HEALTHCARE - CPT - 90686","UNITED HEALTHCARE","UNITED HEALTHCARE","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,60.28,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 90686","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,62.64,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 90686","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,60.28,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 90686","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,59.7,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 90686","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,60.28,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 90674","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT",90674,"HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",null,72.349999999999994,72.349999999999994,72.33,72.349999999999994,18.087499999999999,1]
["OUTPATIENT","FALLON - FALLON SENIOR PLAN - CPT - 90674","FALLON","FALLON SENIOR PLAN","CPT",90674,"HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",null,72.349999999999994,72.33,72.33,72.349999999999994,18.087499999999999,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 90674","TUFTS","TUFTS HMO","CPT",90674,"HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",null,72.349999999999994,72.33,72.33,72.349999999999994,18.087499999999999,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 90674","TUFTS","TUFTS MEDICARE SCO","CPT",90674,"HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",null,72.349999999999994,72.349999999999994,72.33,72.349999999999994,18.087499999999999,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 90674","TUFTS","TUFTS MEDICARE SCO","CPT",90674,"HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",null,72.349999999999994,72.33,72.33,72.349999999999994,18.087499999999999,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 90674","TUFTS","TUFTS PPO","CPT",90674,"HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",null,72.349999999999994,72.33,72.33,72.349999999999994,18.087499999999999,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 90674","TUFTS","TUFTS SELECT","CPT",90674,"HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",null,72.349999999999994,72.349999999999994,72.33,72.349999999999994,18.087499999999999,1]
["OUTPATIENT","AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 90674","AETNA","AETNA-MEDICARE ADVANTAGE","CPT",90674,"HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",null,72.349999999999994,72.349999999999994,72.33,72.349999999999994,18.087499999999999,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90674","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",90674,"HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE",null,72.349999999999994,72.33,72.33,72.349999999999994,18.087499999999999,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 90675","UNICARE","UNICARE","CPT",90675,"CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,1370.91,905.04,905.04,1370.91,342.72750000000002,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90675","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",90675,"CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,1370.91,1370.91,905.04,1370.91,342.72750000000002,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90675","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",90675,"CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,1370.91,1370.91,905.04,1370.91,342.72750000000002,1]
["OUTPATIENT","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 90675","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT",90675,"CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,1370.91,1370.91,905.04,1370.91,342.72750000000002,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90675","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",90675,"CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,1370.91,905.04,905.04,1370.91,342.72750000000002,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 90675","TUFTS","TUFTS HMO","CPT",90675,"CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,1370.91,1370.91,905.04,1370.91,342.72750000000002,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 90675","TUFTS","TUFTS PPO","CPT",90675,"CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,1370.91,1196.6300000000001,905.04,1370.91,342.72750000000002,1]
["OUTPATIENT","TUFTS - TUFTS SPIRIT - CPT - 90675","TUFTS","TUFTS SPIRIT","CPT",90675,"CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,1370.91,1196.6300000000001,905.04,1370.91,342.72750000000002,1]
["OUTPATIENT","AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 90675","AETNA","AETNA-MEDICARE ADVANTAGE","CPT",90675,"CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,1370.91,1370.91,905.04,1370.91,342.72750000000002,1]
["OUTPATIENT","AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 90675","AETNA","AETNA-MEDICARE ADVANTAGE","CPT",90675,"CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,1370.91,905.04,905.04,1370.91,342.72750000000002,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90675","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",90675,"CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,1370.91,1370.91,905.04,1370.91,342.72750000000002,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90675","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",90675,"CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,1370.91,1196.6300000000001,905.04,1370.91,342.72750000000002,1]
["OUTPATIENT","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 90675","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT",90675,"CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,1370.91,905.04,905.04,1370.91,342.72750000000002,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90675","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",90675,"CR BUILD ONLY - RABIES VACCINE, IM,TRAVEL",null,1370.91,1370.91,905.04,1370.91,342.72750000000002,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 90686","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,64.41,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 90686","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,60.28,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 90686","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,59.7,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 90686","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,61.75,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 90686","UNICARE","UNICARE","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,62.64,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90686","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,62.64,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90686","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,60.28,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90686","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,64.41,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90686","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,66.930000000000007,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90686","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,61.75,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90686","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,66.930000000000007,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 90686","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,66.930000000000007,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 90686","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,66.930000000000007,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 90686","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,61.75,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","ELDER SERVICE PLAN - ELEMENT CARE INC - CPT - 90686","ELDER SERVICE PLAN","ELEMENT CARE INC","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,66.930000000000007,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 90686","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,66.930000000000007,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 90686","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,60.28,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90686","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,61.75,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 90686","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,64.41,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 90686","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,59.7,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 90686","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,66.930000000000007,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 90686","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,66.930000000000007,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 90686","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,62.64,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 90686","TUFTS","TUFTS MEDICARE SCO","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,59.7,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 90686","TUFTS","TUFTS POS","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,60.28,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 90686","TUFTS","TUFTS PPO","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,61.75,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 90686","TUFTS","TUFTS SELECT","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,62.64,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 90686","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,64.41,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 90686","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,59.7,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 90686","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,66.930000000000007,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 90686","AETNA","AETNA-MEDICARE ADVANTAGE","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,60.28,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 90686","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,59.7,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90686","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,59.7,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90686","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,66.930000000000007,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90686","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,66.930000000000007,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90686","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,59.7,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90686","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,64.41,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 90686","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,62.64,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90686","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,66.930000000000007,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90690","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",90690,"CR BUILD ONLY - TYPHOID VACCINE, ORAL,TRAVEL",null,234.33,234.33,234.33,234.33,58.582500000000003,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90691","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",90691,"CR BUILD ONLY - TYPHOID VACCINE, IM,TRAVEL",null,359.7,359.7,359.7,359.7,89.924999999999997,1]
["OUTPATIENT","FALLON - FALLON SENIOR PLAN - CPT - 90691","FALLON","FALLON SENIOR PLAN","CPT",90691,"CR BUILD ONLY - TYPHOID VACCINE, IM,TRAVEL",null,359.7,359.7,359.7,359.7,89.924999999999997,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90691","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",90691,"CR BUILD ONLY - TYPHOID VACCINE, IM,TRAVEL",null,359.7,359.7,359.7,359.7,89.924999999999997,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 90691","TUFTS","TUFTS POS","CPT",90691,"CR BUILD ONLY - TYPHOID VACCINE, IM,TRAVEL",null,359.7,359.7,359.7,359.7,89.924999999999997,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 90694","UNICARE","UNICARE","CPT",90694,"HC VACC AIIV4 NO PRSRV 0.5ML IM",null,180.47,180.38,180.38,180.47,45.1175,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90694","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",90694,"HC VACC AIIV4 NO PRSRV 0.5ML IM",null,180.47,180.38,180.38,180.47,45.1175,1]
["OUTPATIENT","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH - CPT - 90694","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH","CPT",90694,"HC VACC AIIV4 NO PRSRV 0.5ML IM",null,180.47,180.38,180.38,180.47,45.1175,1]
["OUTPATIENT","TUFTS - TUFTS SPIRIT - CPT - 90694","TUFTS","TUFTS SPIRIT","CPT",90694,"HC VACC AIIV4 NO PRSRV 0.5ML IM",null,180.47,180.38,180.38,180.47,45.1175,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 90694","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",90694,"HC VACC AIIV4 NO PRSRV 0.5ML IM",null,180.47,180.38,180.38,180.47,45.1175,1]
["OUTPATIENT","AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 90694","AETNA","AETNA-MEDICARE ADVANTAGE","CPT",90694,"HC VACC AIIV4 NO PRSRV 0.5ML IM",null,180.47,180.47,180.38,180.47,45.1175,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 90694","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",90694,"HC VACC AIIV4 NO PRSRV 0.5ML IM",null,180.47,180.38,180.38,180.47,45.1175,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90694","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",90694,"HC VACC AIIV4 NO PRSRV 0.5ML IM",null,180.47,180.47,180.38,180.47,45.1175,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 90694","BLUE CROSS","BLUE CROSS-PPO","CPT",90694,"HC VACC AIIV4 NO PRSRV 0.5ML IM",null,180.47,180.38,180.38,180.47,45.1175,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 90694","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT",90694,"HC VACC AIIV4 NO PRSRV 0.5ML IM",null,180.47,180.47,180.38,180.47,45.1175,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 90698","UNICARE","UNICARE","CPT",90698,"CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,355.01,355.01,160.24,355.01,88.752499999999998,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90698","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",90698,"CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,355.01,355.01,160.24,355.01,88.752499999999998,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90698","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",90698,"CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,355.01,355.01,160.24,355.01,88.752499999999998,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 90698","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",90698,"CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,355.01,355.01,160.24,355.01,88.752499999999998,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 90686","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,59.7,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","ELDER SERVICE PLAN OTHER - ELDER SERVICE PLAN OTHER - CPT - 90686","ELDER SERVICE PLAN OTHER","ELDER SERVICE PLAN OTHER","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,59.7,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","FALLON - FALLON SENIOR PLAN - CPT - 90686","FALLON","FALLON SENIOR PLAN","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,59.7,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90686","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,62.64,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90686","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,59.7,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90686","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,60.28,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 90686","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,62.64,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 90686","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,59.7,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 90686","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,59.7,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE PREFERRED HMO - CPT - 90686","TUFTS","TUFTS MEDICARE PREFERRED HMO","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,59.7,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 90686","TUFTS","TUFTS MEDICARE SCO","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,59.7,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 90686","TUFTS","TUFTS MEDICARE SCO","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,66.930000000000007,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 90686","TUFTS","TUFTS POS","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,66.930000000000007,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 90686","TUFTS","TUFTS PPO","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,66.930000000000007,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 90686","TUFTS","TUFTS SELECT","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,59.7,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","TUFTS - TUFTS SPIRIT - CPT - 90686","TUFTS","TUFTS SPIRIT","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,61.75,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","TUFTS - TUFTS SPIRIT - CPT - 90686","TUFTS","TUFTS SPIRIT","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,60.28,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 90686","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,62.64,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT NON SUBSIDIZ - CPT - 90686","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT NON SUBSIDIZ","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,60.28,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","AETNA - AETNA-MEDICARE ADVANTAGE - CPT - 90686","AETNA","AETNA-MEDICARE ADVANTAGE","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,66.930000000000007,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 90686","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,61.75,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90686","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,60.28,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90686","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,66.930000000000007,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90686","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,66.930000000000007,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 90686","BLUE CROSS","BLUE CROSS-PPO","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,59.7,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90686","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,59.7,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 90686","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,59.7,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90686","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,59.7,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90686","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,61.75,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 90686","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,59.7,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90686","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",90686,"HC FLU VAC NO PRSV 4 VAL 3 YRS+,DPH,FLUZONE",null,66.930000000000007,66.930000000000007,59.7,66.930000000000007,16.732500000000002,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 90690","TUFTS","TUFTS PPO","CPT",90690,"CR BUILD ONLY - TYPHOID VACCINE, ORAL,TRAVEL",null,234.33,234.33,234.33,234.33,58.582500000000003,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 90691","TUFTS","TUFTS MEDICARE SCO","CPT",90691,"CR BUILD ONLY - TYPHOID VACCINE, IM,TRAVEL",null,359.7,359.7,359.7,359.7,89.924999999999997,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 90691","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",90691,"CR BUILD ONLY - TYPHOID VACCINE, IM,TRAVEL",null,359.7,359.7,359.7,359.7,89.924999999999997,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 90694","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT",90694,"HC VACC AIIV4 NO PRSRV 0.5ML IM",null,180.47,180.38,180.38,180.47,45.1175,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC UNIFY - CPT - 90694","TUFTS PUBLIC PLANS","TUFTS PUBLIC UNIFY","CPT",90694,"HC VACC AIIV4 NO PRSRV 0.5ML IM",null,180.47,180.47,180.38,180.47,45.1175,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90694","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",90694,"HC VACC AIIV4 NO PRSRV 0.5ML IM",null,180.47,180.38,180.38,180.47,45.1175,1]
["OUTPATIENT","COMMONWEALTH CARE ALLIANCE - CCA ONE CARE - CPT - 90694","COMMONWEALTH CARE ALLIANCE","CCA ONE CARE","CPT",90694,"HC VACC AIIV4 NO PRSRV 0.5ML IM",null,180.47,180.38,180.38,180.47,45.1175,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90694","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",90694,"HC VACC AIIV4 NO PRSRV 0.5ML IM",null,180.47,180.47,180.38,180.47,45.1175,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90694","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",90694,"HC VACC AIIV4 NO PRSRV 0.5ML IM",null,180.47,180.47,180.38,180.47,45.1175,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM STRIDE - CPT - 90694","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM STRIDE","CPT",90694,"HC VACC AIIV4 NO PRSRV 0.5ML IM",null,180.47,180.38,180.38,180.47,45.1175,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90694","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",90694,"HC VACC AIIV4 NO PRSRV 0.5ML IM",null,180.47,180.38,180.38,180.47,45.1175,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90694","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",90694,"HC VACC AIIV4 NO PRSRV 0.5ML IM",null,180.47,180.47,180.38,180.47,45.1175,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90694","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",90694,"HC VACC AIIV4 NO PRSRV 0.5ML IM",null,180.47,180.47,180.38,180.47,45.1175,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 90698","UNICARE","UNICARE","CPT",90698,"CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,355.01,227.17,160.24,355.01,88.752499999999998,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90698","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",90698,"CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,355.01,227.17,160.24,355.01,88.752499999999998,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 90698","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",90698,"CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,355.01,355.01,160.24,355.01,88.752499999999998,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90698","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",90698,"CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,355.01,355.01,160.24,355.01,88.752499999999998,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90698","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",90698,"CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,355.01,355.01,160.24,355.01,88.752499999999998,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HPI - CPT - 90698","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HPI","CPT",90698,"CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,355.01,160.24,160.24,355.01,88.752499999999998,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 90698","TUFTS","TUFTS HMO","CPT",90698,"CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,355.01,355.01,160.24,355.01,88.752499999999998,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 90698","TUFTS","TUFTS HMO","CPT",90698,"CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,355.01,160.24,160.24,355.01,88.752499999999998,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 90698","TUFTS","TUFTS POS","CPT",90698,"CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,355.01,355.01,160.24,355.01,88.752499999999998,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 90698","TUFTS","TUFTS SELECT","CPT",90698,"CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,355.01,355.01,160.24,355.01,88.752499999999998,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 90698","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT",90698,"CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,355.01,227.17,160.24,355.01,88.752499999999998,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 90698","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT",90698,"CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,355.01,355.01,160.24,355.01,88.752499999999998,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC TOGETHER - CPT - 90698","TUFTS PUBLIC PLANS","TUFTS PUBLIC TOGETHER","CPT",90698,"CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,355.01,355.01,160.24,355.01,88.752499999999998,1]
["OUTPATIENT","ALLWAYS HEALTH PARTNERS - ALLWAYS HLTH COMM SUBSIDIZED - CPT - 90698","ALLWAYS HEALTH PARTNERS","ALLWAYS HLTH COMM SUBSIDIZED","CPT",90698,"CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,355.01,160.24,160.24,355.01,88.752499999999998,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 90698","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",90698,"CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,355.01,227.17,160.24,355.01,88.752499999999998,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 90698","BLUE CROSS","BLUE CROSS-PPO","CPT",90698,"CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,355.01,160.24,160.24,355.01,88.752499999999998,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 90698","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",90698,"CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,355.01,355.01,160.24,355.01,88.752499999999998,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 90698","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",90698,"CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,355.01,227.17,160.24,355.01,88.752499999999998,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MCO - CPT - 90698","BMC HEALTHNET","BMCHN MCO","CPT",90698,"CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,355.01,355.01,160.24,355.01,88.752499999999998,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN MCO - CPT - 90698","BMC HEALTHNET","BMCHN MCO","CPT",90698,"CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,355.01,355.01,160.24,355.01,88.752499999999998,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90698","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",90698,"CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,355.01,227.17,160.24,355.01,88.752499999999998,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90698","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",90698,"CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,355.01,355.01,160.24,355.01,88.752499999999998,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN QHP - CPT - 90698","BMC HEALTHNET","BMCHN QHP","CPT",90698,"CR BUILD ONLY - DTAP-HIB-IP VACCINE, IM,DPH",null,355.01,227.17,160.24,355.01,88.752499999999998,1]
["OUTPATIENT","UNICARE - UNICARE - CPT - 90700","UNICARE","UNICARE","CPT",90700,"CR BUILD ONLY - DTAP IMMUNIZATION, IM, <7 YO,TRAVEL",null,87.75,70.77,70.77,87.75,21.9375,1]
["OUTPATIENT","UNICARE - UNICARE STATE INDEMNITY PLAN - CPT - 90700","UNICARE","UNICARE STATE INDEMNITY PLAN","CPT",90700,"CR BUILD ONLY - DTAP IMMUNIZATION, IM, <7 YO,TRAVEL",null,87.75,85.47,70.77,87.75,21.9375,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 90700","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",90700,"CR BUILD ONLY - DTAP IMMUNIZATION, IM, <7 YO,TRAVEL",null,87.75,85.47,70.77,87.75,21.9375,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 90700","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",90700,"CR BUILD ONLY - DTAP IMMUNIZATION, IM, <7 YO,TRAVEL",null,87.75,85.47,70.77,87.75,21.9375,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 90700","TUFTS","TUFTS HMO","CPT",90700,"CR BUILD ONLY - DTAP IMMUNIZATION, IM, <7 YO,TRAVEL",null,87.75,70.77,70.77,87.75,21.9375,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 90700","TUFTS","TUFTS PPO","CPT",90700,"CR BUILD ONLY - DTAP IMMUNIZATION, IM, <7 YO,TRAVEL",null,87.75,70.77,70.77,87.75,21.9375,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 90700","TUFTS","TUFTS SELECT","CPT",90700,"CR BUILD ONLY - DTAP IMMUNIZATION, IM, <7 YO,TRAVEL",null,87.75,85.47,70.77,87.75,21.9375,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 90700","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",90700,"CR BUILD ONLY - DTAP IMMUNIZATION, IM, <7 YO,TRAVEL",null,87.75,87.75,70.77,87.75,21.9375,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 11720","BLUE CROSS","BLUE CROSS-PPO","CPT",11720,"DEBRIDEMENT NAIL ANY METHOD 1-5",null,165,93.87,93.87,1198.25,41.25,1]
["OUTPATIENT","TUFTS - TUFTS PPO - CPT - 17250","TUFTS","TUFTS PPO","CPT",17250,"CHEMICAL CAUTERIZATION GRANULATION TISSUE",null,328,620.02,296.32,1198.25,82,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 20551","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",20551,"INJECTION SINGLE TENDON ORIGIN/INSERTION",null,324,415.61,317.70999999999998,1198.25,81,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 33249","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",33249,"HC INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR",null,34636,43021.64,2531.06,62742.78,8659,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 38222","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",38222,"HC DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS",null,1103,2309.9699999999998,1098.98,3264.67,275.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 51729","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",51729,"COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL",null,2602,944.22,944.22,3176.09,650.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 62270","AETNA","AETNA","CPT",62270,"SPINAL PUNCTURE LUMBAR DIAGNOSTIC",null,592,1198.25,1005.62,3264.67,148,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 58120","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",58120,"DILATION & CURETTAGE DX&/THER NONOBSTETRIC",null,2365,3965.45,1098.98,4588.18,591.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 10160","TUFTS","TUFTS SELECT","CPT",10160,"PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST",null,729,317.70999999999998,317.70999999999998,1198.25,182.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 58555","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",58555,"HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE",null,3031,4475.54,1098.98,4588.18,757.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 64405","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",64405,"INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV",null,611,415.61,310.58,2032.26,152.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 69220","BLUE CROSS","BLUE CROSS-PPO","CPT",69220,"DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE",null,487,296.32,171.09,508.23,121.75,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-HMO BLUE - CPT - 49083","BLUE CROSS","BLUE CROSS-HMO BLUE","CPT",49083,"ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE",null,818,1278.93,1098.98,3264.67,204.5,1]
["OUTPATIENT","AETNA - AETNA - CPT - 56405","AETNA","AETNA","CPT",56405,"I&D VULVA/PERINEAL ABSCESS",null,840,1500.85,458.47,3264.67,210,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 64425","TUFTS","TUFTS HMO","CPT",64425,"INJECTION ANES ILIOINGUINAL ILIOHYPOGASTRIC NRVS",null,736,1281.21,310.58,2032.26,184,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 12001","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",12001,"SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<",null,343,296.32,296.32,1198.25,85.75,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 69209","TUFTS","TUFTS SELECT","CPT",69209,"RMVL IMPACTED CERUMEN USING IRRIGATION/LAVAGE,UNILATERAL",null,198,171.09,93.87,1198.25,49.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 33286","BLUE CROSS","BLUE CROSS-PPO","CPT",33286,"HC RMVL SUBQ CAR RHYTHM MNTR",null,892,972.93,972.93,3264.67,223,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 10061","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",10061,"INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE",null,1357,943.8,317.70999999999998,1198.25,339.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 36245","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",36245,"HC SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH",null,1858,0,588.04999999999995,1500.85,464.5,1]
["OUTPATIENT","BMC HEALTHNET - BMCHN ACO - CPT - 36592","BMC HEALTHNET","BMCHN ACO","CPT",36592,"COLLECT BLOOD FROM CATHETER VENOUS NOS",null,196,0,178.83,1076.77,49,1]
["OUTPATIENT","UNITED HEALTHCARE - UNITED/HARVARD PILGRIM - CPT - 49465","UNITED HEALTHCARE","UNITED/HARVARD PILGRIM","CPT",49465,"HC CONTRAST INJECTION PERQ RADIOLOGIC EVAL GI TUBE",null,232,497.78,317.70999999999998,1198.25,58,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 51784","TUFTS","TUFTS POS","CPT",51784,"EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL",null,1471,469.76,228.32,797.09,367.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE INDEMNIT - CPT - 57455","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE INDEMNIT","CPT",57455,"COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX",null,861,458.47,458.47,2032.26,215.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 20600","BLUE CROSS","BLUE CROSS-PPO","CPT",20600,"ARTHROCENTESIS ASPIR&/INJECTION SMALL JT/BURSA",null,293,415.61,317.70999999999998,1198.25,73.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-INDEMNITY - CPT - 29075","BLUE CROSS","BLUE CROSS-INDEMNITY","CPT",29075,"APPLICATION CAST ELBOW FINGER SHORT ARM",null,481,395.63,395.63,1308.22,120.25,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS  OUT OF STATE HMO - CPT - 11403","BLUE CROSS OUT OF STATE","BLUE CROSS  OUT OF STATE HMO","CPT",11403,"EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<",null,1130,972.93,972.93,3264.67,282.5,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-PPO - CPT - 40800","BLUE CROSS","BLUE CROSS-PPO","CPT",40800,"HC DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL",null,1027,972.93,317.70999999999998,1250.8,256.75,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 47000","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",47000,"HEARING AID EXAMINATION & SELECTION MONAURAL",null,1304,2672.73,1098.98,3264.67,326,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 58100","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",58100,"ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX",null,683,358.24,278.66000000000003,1198.25,170.75,1]
["OUTPATIENT","BLUE BENEFIT ADMINISTRATORS - BLUE BENEFIT ADMIN-PPO - CPT - 64636","BLUE BENEFIT ADMINISTRATORS","BLUE BENEFIT ADMIN-PPO","CPT",64636,"DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL",null,433,146.83000000000001,146.83000000000001,1198.25,108.25,1]
["OUTPATIENT","TUFTS - TUFTS HMO - CPT - 11983","TUFTS","TUFTS HMO","CPT",11983,"RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT",null,1269,595.01,317.70999999999998,1198.25,317.25,1]
["OUTPATIENT","HARVARD PILGRIM HEALTH CARE - HPHC-HARVARD PILGRIM HEALTHCAR - CPT - 36591","HARVARD PILGRIM HEALTH CARE","HPHC-HARVARD PILGRIM HEALTHCAR","CPT",36591,"COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE",null,192,229.89,178.83,607.66,48,1]
["OUTPATIENT","AETNA - AETNA - CPT - 36901","AETNA","AETNA","CPT",36901,"HC INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR S&I",null,1114,1198.25,1098.98,3264.67,278.5,1]
["OUTPATIENT","TUFTS PUBLIC PLANS - TUFTS PUBLIC DIRECT SUBSIDIZED - CPT - 81000","TUFTS PUBLIC PLANS","TUFTS PUBLIC DIRECT SUBSIDIZED","CPT",81000,"URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY",null,17,4.49,2.97,39.04,4.25,1]
["OUTPATIENT","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 84153","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT",84153,"HC CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL",null,93,22.07,16.78,206.51,23.25,1]
["OUTPATIENT","FALLON - FALLON MEDICAID - CPT - 84153","FALLON","FALLON MEDICAID","CPT",84153,"HC CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL",null,93,16.78,16.78,206.51,23.25,1]
["OUTPATIENT","BLUE CROSS - BLUE CROSS-MEDICARE ADVANTAGE - CPT - 80053","BLUE CROSS","BLUE CROSS-MEDICARE ADVANTAGE","CPT",80053,"HC CHG COMPREHENSIVE METABOLIC PANEL",null,375,26.57,9.6300000000000008,118.56,93.75,1]
["OUTPATIENT","BMC HEALTHNET - BMC SENIOR CARE OPTIONS - CPT - 84443","BMC HEALTHNET","BMC SENIOR CARE OPTIONS","CPT",84443,"HC CHG ASSAY OF THYROID STIMULATING HORMONE TSH","QW",84,37.130000000000003,15.33,188.7,21,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 85027","TUFTS","TUFTS POS","CPT",85027,"HC CHG BLOOD COUNT COMPLETE AUTOMATED",null,33,24.13,5.9,72.55,8.25,1]
["OUTPATIENT","TUFTS - TUFTS SPIRIT - CPT - 85610","TUFTS","TUFTS SPIRIT","CPT",85610,"POC;INR",null,21,4.72,3.58,44.06,5.25,1]
["OUTPATIENT","TUFTS - TUFTS MEDICARE SCO - CPT - 80076","TUFTS","TUFTS MEDICARE SCO","CPT",80076,"HC CHG HEPATIC FUNCTION PANEL",null,224,11.85,7.46,91.78,56,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 70450","TUFTS","TUFTS POS","CPT",70450,"HC CHG CT HEAD/BRAIN W/O CONTRAST MATERIAL",null,1569,423.79,193.63,1274.24,392.25,1]
["OUTPATIENT","TUFTS - TUFTS POS - CPT - 90834","TUFTS","TUFTS POS","CPT",90834,"PSYCHOTHERAPY PATIENT &/ FAMILY 45 MINUTES",null,164,46.18,40.369999999999997,214.2,41,1]
["OUTPATIENT","ELDER SERVICE PLAN - NEIGHBORHOOD PACE (ESP EB) - CPT - 84153","ELDER SERVICE PLAN","NEIGHBORHOOD PACE (ESP EB)","CPT",84153,"HC CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL",null,93,25.23,16.78,206.51,23.25,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 80053","TUFTS","TUFTS SELECT","CPT",80053,"HC CHG COMPREHENSIVE METABOLIC PANEL",null,375,18.420000000000002,9.6300000000000008,118.56,93.75,1]
["OUTPATIENT","CIGNA HEALTHCARE - CIGNA CARELINK - CPT - 72110","CIGNA HEALTHCARE","CIGNA CARELINK","CPT",72110,"HC CHG RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS",null,462,1304.76,125.38,1304.76,115.5,1]
["OUTPATIENT","TUFTS - TUFTS SELECT - CPT - 45385","TUFTS","TUFTS SELECT","CPT",45385,"HC COLSC FLX PROX SPLENIC FLXR RMVL LES SNARE TQ",null,2371,1098.98,1020.59,3264.67,592.75,1]
["OUTPATIENT","UHC COMMUNITY CARE - UHC COMMUNITY CARE (EVERCARE) - CPT - 85730","UHC COMMUNITY CARE","UHC COMMUNITY CARE (EVERCARE)","CPT",85730,"HC CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD",null,31,7.21,5.48,67.41,7.75,1]
["OUTPATIENT","BLUE CROSS OUT OF STATE - BLUE CROSS OUT OF STATE PPO - CPT - 90853","BLUE CROSS OUT OF STATE","BLUE CROSS OUT OF STATE PPO","CPT",90853,"GROUP PSYCHOTHERAPY",null,121,128.29,22.66,128.29,30.25,1]
["OUTPATIENT","UNITED HEALTHCARE - UHC-HPHC STUDENT PLAN - CPT - 84153","UNITED HEALTHCARE","UHC-HPHC STUDENT PLAN","CPT",84153,"HC CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL",null,93,43.05,16.78,206.51,23.25,1]

{"sheet":"CPTPayer&Plans","index":18,"n_rows":12,"n_cols":19,"rows_kept":12,"cut":false,"hidden":true,"merged":[]}
["Select Insurance Carrier","AETNA","ALLWAYS HEALTH PARTNERS","BLUE BENEFIT ADMINISTRATORS","BLUE CROSS","BLUE CROSS OUT OF STATE","BMC HEALTHNET","CIGNA HEALTHCARE","COMMONWEALTH CARE ALLIANCE","ELDER SERVICE PLAN","ELDER SERVICE PLAN OTHER","FALLON","HARVARD PILGRIM HEALTH CARE","SENIOR WHOLE HEALTH","TUFTS","TUFTS PUBLIC PLANS","UHC COMMUNITY CARE","UNICARE","UNITED HEALTHCARE"]
["Select Insurance Plan","Select Insurance Plan","Select Insurance Plan","Select Insurance Plan","Select Insurance Plan","Select Insurance Plan","Select Insurance Plan","Select Insurance Plan","Select Insurance Plan","Select Insurance Plan","Select Insurance Plan","Select Insurance Plan","Select Insurance Plan","Select Insurance Plan","Select Insurance Plan","Select Insurance Plan","Select Insurance Plan","Select Insurance Plan","Select Insurance Plan"]
[null,"AETNA","ALLWAYS HLTH ACO","BLUE BENEFIT ADMIN-PPO","BLUE CROSS-HMO BLUE","BLUE CROSS  OUT OF STATE HMO","BMC SENIOR CARE OPTIONS","CIGNA","CCA ONE CARE","ELEMENT CARE INC","ELDER SERVICE PLAN OTHER","FALLON MEDICAID","HPHC-HARVARD PILGRIM HEALTHCAR","SENIOR WHOLE HEALTH","TUFTS HMO","TUFTS PUBLIC DIRECT","UHC COMMUNITY CARE (EVERCARE)","UNICARE","UHC-HPHC STUDENT PLAN"]
[null,"AETNA-MEDICARE ADVANTAGE","ALLWAYS HLTH COMM SUBSIDIZED",null,"BLUE CROSS-INDEMNITY","BLUE CROSS OUT OF STATE INDEMNIT","BMCHN ACO","CIGNA CARELINK",null,"NEIGHBORHOOD PACE (ESP EB)",null,"FALLON SENIOR PLAN","HPHC-HARVARD PILGRIM HPI",null,"TUFTS MEDICARE PREFERRED HMO","TUFTS PUBLIC DIRECT NON SUBSIDIZ",null,"UNICARE STATE INDEMNITY PLAN","UNITED HEALTHCARE"]
[null,null,null,null,"BLUE CROSS-MEDICARE ADVANTAGE","BLUE CROSS OUT OF STATE PPO","BMCHN MCO","CIGNA PPO",null,null,null,null,"HPHC-HARVARD PILGRIM STRIDE",null,"TUFTS MEDICARE SCO","TUFTS PUBLIC DIRECT SUBSIDIZED",null,null,"UNITED/HARVARD PILGRIM"]
[null,null,null,null,"BLUE CROSS-PPO",null,"BMCHN MEDICAID",null,null,null,null,null,null,null,"TUFTS POS","TUFTS PUBLIC TOGETHER"]
[null,null,null,null,null,null,"BMCHN QHP",null,null,null,null,null,null,null,"TUFTS PPO","TUFTS PUBLIC UNIFY"]
[null,null,null,null,null,null,"BMCHN WELL SENSE",null,null,null,null,null,null,null,"TUFTS SELECT"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"TUFTS SPIRIT"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IFERROR(INDEX(#REF!, SMALL(IF(O$1=#REF!, ROW(#REF!)-ROW(#REF!)+1), ROW(11:11))),\"\" )","v":""}]

{"sheet":"CPTCombo","index":19,"n_rows":3564,"n_cols":16,"rows_kept":3564,"cut":false,"hidden":true,"merged":[]}
[]
[]
[null,null,null,null,null,null,null,null,null,null,"CB Payer Link","Payer Content","CB Plan Link","Plan Content","CB BC Link","BC Content"]
[null,null,null,null,null,null,null,null,null,1,1,{"$f":"TRANSPOSE(CPTPayPln[#Headers])","v":"Select Insurance Carrier"},1,{"$f":"INDEX('CPTPayer&Plans'!A2:S2,,$K$4)","v":"Select Insurance Plan"},1,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2:S2,,$K$4)","v":"Select CPT Code"}]
[null,null,null,null,null,null,null,null,null,2,null,"AETNA",null,{"$f":"INDEX('CPTPayer&Plans'!A3:S3,,$K$4)","v":0},null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3:S3,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,3,null,"ALLWAYS HEALTH PARTNERS",null,{"$f":"INDEX('CPTPayer&Plans'!A4:S4,,$K$4)","v":0},null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A4:S4,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,4,null,"BLUE BENEFIT ADMINISTRATORS",null,{"$f":"INDEX('CPTPayer&Plans'!A5:S5,,$K$4)","v":0},null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A5:S5,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,5,null,"BLUE CROSS",null,{"$f":"INDEX('CPTPayer&Plans'!A6:S6,,$K$4)","v":0},null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A6:S6,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,6,null,"BLUE CROSS OUT OF STATE",null,{"$f":"INDEX('CPTPayer&Plans'!A7:S7,,$K$4)","v":0},null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A7:S7,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,7,null,"BMC HEALTHNET",null,{"$f":"INDEX('CPTPayer&Plans'!A8:S8,,$K$4)","v":0},null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A8:S8,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,8,null,"CIGNA HEALTHCARE",null,{"$f":"INDEX('CPTPayer&Plans'!A9:S9,,$K$4)","v":0},null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A9:S9,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,9,null,"COMMONWEALTH CARE ALLIANCE",null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A10:S10,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,10,null,"ELDER SERVICE PLAN",null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A11:S11,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,11,null,"ELDER SERVICE PLAN OTHER",null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A12:S12,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,12,null,"FALLON",null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A13:S13,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,13,null,"HARVARD PILGRIM HEALTH CARE",null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A14:S14,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,14,null,"SENIOR WHOLE HEALTH",null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A15:S15,,$K$4)","v":0}]
[null,null,"**remember on the CPT payer and plan tables and possible payer and code tables",null,null,null,null,null,null,15,null,"TUFTS",null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A16:S16,,$K$4)","v":0}]
[null,null,"** you want to delete blank rows after they are values",null,null,null,null,null,null,16,null,"TUFTS PUBLIC PLANS",null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A17:S17,,$K$4)","v":0}]
[null,null,"**if you don't there will be extra blank lines on the dropdown",null,null,null,null,null,null,17,null,"UHC COMMUNITY CARE",null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A18:S18,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,18,null,"UNICARE",null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A19:S19,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,19,null,"UNITED HEALTHCARE",null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A20:S20,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A21:S21,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A22:S22,,$K$4)","v":0}]
[null,null,null,null,null,null,{"$f":"CPTCombo!$N$4:INDEX(CPTCombo!$N$4:$N$11,MATCH(\"zzzzzzzz\",CPTCombo!$N$4:$N$11,1))","v":"Select Insurance Plan"},null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A23:S23,,$K$4)","v":0}]
[null,null,null,null,null,null,{"$f":"CPTCombo!$P$4:INDEX(CPTCombo!$P$4:$P$3564,MATCH(\"zzzzzzzz\",CPTCombo!$P$4:$P$3564,1))","v":"Select CPT Code"},null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A24:S24,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A25:S25,,$K$4)","v":0}]
[null,null,null,null,null,null,"CPTCombo!$N$4:INDEX(CPTCombo!$N$4:$N$11,MATCH(\"zzzzzzzz\",CPTCombo!$N$4:$N$11,1))",null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A26:S26,,$K$4)","v":0}]
[null,null,null,null,null,null,"ComboList'!$P$4:INDEX(ComboList'!$P$4:$P$697,MATCH(\"zzzzzzzz\",ComboDeptList'!$P$4:$P$697,1))",null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A27:S27,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A28:S28,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A29:S29,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A30:S30,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A31:S31,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A32:S32,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A33:S33,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A34:S34,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A35:S35,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A36:S36,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A37:S37,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A38:S38,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A39:S39,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A40:S40,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A41:S41,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A42:S42,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A43:S43,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A44:S44,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A45:S45,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A46:S46,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A47:S47,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A48:S48,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A49:S49,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A50:S50,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A51:S51,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A52:S52,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A53:S53,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A54:S54,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A55:S55,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A56:S56,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A57:S57,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A58:S58,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A59:S59,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A60:S60,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A61:S61,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A62:S62,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A63:S63,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A64:S64,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A65:S65,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A66:S66,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A67:S67,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A68:S68,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A69:S69,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A70:S70,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A71:S71,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A72:S72,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A73:S73,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A74:S74,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A75:S75,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A76:S76,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A77:S77,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A78:S78,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A79:S79,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A80:S80,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A81:S81,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A82:S82,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A83:S83,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A84:S84,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A85:S85,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A86:S86,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A87:S87,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A88:S88,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A89:S89,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A90:S90,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A91:S91,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A92:S92,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A93:S93,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A94:S94,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A95:S95,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A96:S96,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A97:S97,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A98:S98,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A99:S99,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A100:S100,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A101:S101,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A102:S102,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A103:S103,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A104:S104,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A105:S105,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A106:S106,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A107:S107,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A108:S108,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A109:S109,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A110:S110,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A111:S111,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A112:S112,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A113:S113,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A114:S114,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A115:S115,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A116:S116,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A117:S117,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A118:S118,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A119:S119,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A120:S120,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A121:S121,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A122:S122,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A123:S123,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A124:S124,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A125:S125,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A126:S126,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A127:S127,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A128:S128,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A129:S129,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A130:S130,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A131:S131,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A132:S132,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A133:S133,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A134:S134,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A135:S135,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A136:S136,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A137:S137,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A138:S138,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A139:S139,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A140:S140,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A141:S141,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A142:S142,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A143:S143,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A144:S144,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A145:S145,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A146:S146,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A147:S147,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A148:S148,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A149:S149,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A150:S150,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A151:S151,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A152:S152,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A153:S153,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A154:S154,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A155:S155,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A156:S156,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A157:S157,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A158:S158,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A159:S159,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A160:S160,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A161:S161,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A162:S162,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A163:S163,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A164:S164,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A165:S165,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A166:S166,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A167:S167,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A168:S168,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A169:S169,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A170:S170,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A171:S171,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A172:S172,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A173:S173,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A174:S174,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A175:S175,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A176:S176,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A177:S177,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A178:S178,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A179:S179,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A180:S180,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A181:S181,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A182:S182,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A183:S183,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A184:S184,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A185:S185,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A186:S186,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A187:S187,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A188:S188,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A189:S189,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A190:S190,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A191:S191,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A192:S192,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A193:S193,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A194:S194,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A195:S195,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A196:S196,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A197:S197,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A198:S198,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A199:S199,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A200:S200,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A201:S201,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A202:S202,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A203:S203,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A204:S204,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A205:S205,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A206:S206,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A207:S207,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A208:S208,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A209:S209,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A210:S210,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A211:S211,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A212:S212,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A213:S213,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A214:S214,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A215:S215,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A216:S216,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A217:S217,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A218:S218,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A219:S219,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A220:S220,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A221:S221,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A222:S222,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A223:S223,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A224:S224,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A225:S225,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A226:S226,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A227:S227,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A228:S228,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A229:S229,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A230:S230,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A231:S231,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A232:S232,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A233:S233,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A234:S234,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A235:S235,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A236:S236,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A237:S237,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A238:S238,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A239:S239,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A240:S240,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A241:S241,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A242:S242,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A243:S243,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A244:S244,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A245:S245,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A246:S246,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A247:S247,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A248:S248,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A249:S249,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A250:S250,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A251:S251,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A252:S252,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A253:S253,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A254:S254,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A255:S255,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A256:S256,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A257:S257,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A258:S258,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A259:S259,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A260:S260,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A261:S261,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A262:S262,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A263:S263,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A264:S264,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A265:S265,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A266:S266,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A267:S267,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A268:S268,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A269:S269,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A270:S270,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A271:S271,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A272:S272,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A273:S273,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A274:S274,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A275:S275,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A276:S276,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A277:S277,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A278:S278,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A279:S279,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A280:S280,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A281:S281,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A282:S282,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A283:S283,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A284:S284,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A285:S285,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A286:S286,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A287:S287,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A288:S288,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A289:S289,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A290:S290,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A291:S291,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A292:S292,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A293:S293,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A294:S294,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A295:S295,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A296:S296,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A297:S297,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A298:S298,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A299:S299,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A300:S300,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A301:S301,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A302:S302,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A303:S303,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A304:S304,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A305:S305,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A306:S306,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A307:S307,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A308:S308,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A309:S309,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A310:S310,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A311:S311,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A312:S312,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A313:S313,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A314:S314,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A315:S315,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A316:S316,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A317:S317,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A318:S318,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A319:S319,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A320:S320,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A321:S321,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A322:S322,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A323:S323,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A324:S324,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A325:S325,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A326:S326,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A327:S327,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A328:S328,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A329:S329,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A330:S330,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A331:S331,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A332:S332,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A333:S333,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A334:S334,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A335:S335,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A336:S336,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A337:S337,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A338:S338,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A339:S339,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A340:S340,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A341:S341,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A342:S342,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A343:S343,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A344:S344,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A345:S345,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A346:S346,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A347:S347,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A348:S348,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A349:S349,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A350:S350,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A351:S351,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A352:S352,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A353:S353,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A354:S354,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A355:S355,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A356:S356,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A357:S357,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A358:S358,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A359:S359,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A360:S360,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A361:S361,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A362:S362,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A363:S363,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A364:S364,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A365:S365,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A366:S366,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A367:S367,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A368:S368,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A369:S369,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A370:S370,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A371:S371,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A372:S372,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A373:S373,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A374:S374,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A375:S375,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A376:S376,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A377:S377,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A378:S378,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A379:S379,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A380:S380,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A381:S381,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A382:S382,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A383:S383,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A384:S384,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A385:S385,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A386:S386,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A387:S387,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A388:S388,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A389:S389,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A390:S390,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A391:S391,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A392:S392,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A393:S393,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A394:S394,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A395:S395,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A396:S396,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A397:S397,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A398:S398,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A399:S399,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A400:S400,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A401:S401,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A402:S402,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A403:S403,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A404:S404,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A405:S405,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A406:S406,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A407:S407,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A408:S408,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A409:S409,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A410:S410,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A411:S411,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A412:S412,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A413:S413,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A414:S414,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A415:S415,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A416:S416,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A417:S417,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A418:S418,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A419:S419,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A420:S420,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A421:S421,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A422:S422,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A423:S423,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A424:S424,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A425:S425,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A426:S426,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A427:S427,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A428:S428,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A429:S429,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A430:S430,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A431:S431,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A432:S432,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A433:S433,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A434:S434,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A435:S435,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A436:S436,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A437:S437,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A438:S438,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A439:S439,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A440:S440,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A441:S441,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A442:S442,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A443:S443,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A444:S444,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A445:S445,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A446:S446,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A447:S447,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A448:S448,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A449:S449,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A450:S450,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A451:S451,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A452:S452,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A453:S453,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A454:S454,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A455:S455,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A456:S456,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A457:S457,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A458:S458,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A459:S459,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A460:S460,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A461:S461,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A462:S462,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A463:S463,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A464:S464,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A465:S465,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A466:S466,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A467:S467,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A468:S468,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A469:S469,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A470:S470,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A471:S471,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A472:S472,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A473:S473,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A474:S474,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A475:S475,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A476:S476,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A477:S477,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A478:S478,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A479:S479,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A480:S480,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A481:S481,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A482:S482,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A483:S483,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A484:S484,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A485:S485,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A486:S486,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A487:S487,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A488:S488,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A489:S489,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A490:S490,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A491:S491,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A492:S492,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A493:S493,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A494:S494,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A495:S495,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A496:S496,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A497:S497,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A498:S498,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A499:S499,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A500:S500,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A501:S501,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A502:S502,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A503:S503,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A504:S504,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A505:S505,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A506:S506,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A507:S507,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A508:S508,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A509:S509,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A510:S510,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A511:S511,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A512:S512,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A513:S513,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A514:S514,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A515:S515,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A516:S516,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A517:S517,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A518:S518,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A519:S519,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A520:S520,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A521:S521,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A522:S522,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A523:S523,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A524:S524,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A525:S525,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A526:S526,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A527:S527,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A528:S528,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A529:S529,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A530:S530,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A531:S531,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A532:S532,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A533:S533,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A534:S534,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A535:S535,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A536:S536,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A537:S537,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A538:S538,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A539:S539,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A540:S540,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A541:S541,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A542:S542,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A543:S543,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A544:S544,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A545:S545,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A546:S546,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A547:S547,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A548:S548,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A549:S549,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A550:S550,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A551:S551,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A552:S552,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A553:S553,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A554:S554,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A555:S555,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A556:S556,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A557:S557,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A558:S558,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A559:S559,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A560:S560,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A561:S561,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A562:S562,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A563:S563,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A564:S564,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A565:S565,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A566:S566,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A567:S567,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A568:S568,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A569:S569,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A570:S570,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A571:S571,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A572:S572,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A573:S573,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A574:S574,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A575:S575,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A576:S576,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A577:S577,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A578:S578,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A579:S579,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A580:S580,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A581:S581,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A582:S582,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A583:S583,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A584:S584,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A585:S585,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A586:S586,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A587:S587,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A588:S588,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A589:S589,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A590:S590,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A591:S591,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A592:S592,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A593:S593,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A594:S594,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A595:S595,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A596:S596,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A597:S597,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A598:S598,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A599:S599,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A600:S600,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A601:S601,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A602:S602,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A603:S603,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A604:S604,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A605:S605,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A606:S606,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A607:S607,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A608:S608,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A609:S609,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A610:S610,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A611:S611,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A612:S612,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A613:S613,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A614:S614,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A615:S615,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A616:S616,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A617:S617,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A618:S618,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A619:S619,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A620:S620,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A621:S621,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A622:S622,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A623:S623,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A624:S624,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A625:S625,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A626:S626,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A627:S627,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A628:S628,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A629:S629,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A630:S630,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A631:S631,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A632:S632,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A633:S633,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A634:S634,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A635:S635,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A636:S636,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A637:S637,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A638:S638,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A639:S639,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A640:S640,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A641:S641,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A642:S642,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A643:S643,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A644:S644,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A645:S645,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A646:S646,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A647:S647,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A648:S648,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A649:S649,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A650:S650,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A651:S651,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A652:S652,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A653:S653,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A654:S654,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A655:S655,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A656:S656,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A657:S657,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A658:S658,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A659:S659,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A660:S660,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A661:S661,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A662:S662,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A663:S663,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A664:S664,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A665:S665,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A666:S666,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A667:S667,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A668:S668,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A669:S669,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A670:S670,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A671:S671,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A672:S672,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A673:S673,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A674:S674,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A675:S675,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A676:S676,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A677:S677,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A678:S678,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A679:S679,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A680:S680,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A681:S681,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A682:S682,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A683:S683,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A684:S684,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A685:S685,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A686:S686,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A687:S687,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A688:S688,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A689:S689,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A690:S690,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A691:S691,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A692:S692,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A693:S693,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A694:S694,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A695:S695,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A696:S696,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A697:S697,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A698:S698,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A699:S699,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A700:S700,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A701:S701,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A702:S702,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A703:S703,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A704:S704,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A705:S705,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A706:S706,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A707:S707,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A708:S708,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A709:S709,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A710:S710,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A711:S711,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A712:S712,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A713:S713,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A714:S714,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A715:S715,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A716:S716,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A717:S717,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A718:S718,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A719:S719,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A720:S720,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A721:S721,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A722:S722,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A723:S723,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A724:S724,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A725:S725,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A726:S726,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A727:S727,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A728:S728,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A729:S729,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A730:S730,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A731:S731,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A732:S732,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A733:S733,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A734:S734,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A735:S735,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A736:S736,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A737:S737,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A738:S738,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A739:S739,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A740:S740,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A741:S741,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A742:S742,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A743:S743,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A744:S744,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A745:S745,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A746:S746,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A747:S747,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A748:S748,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A749:S749,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A750:S750,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A751:S751,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A752:S752,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A753:S753,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A754:S754,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A755:S755,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A756:S756,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A757:S757,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A758:S758,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A759:S759,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A760:S760,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A761:S761,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A762:S762,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A763:S763,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A764:S764,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A765:S765,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A766:S766,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A767:S767,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A768:S768,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A769:S769,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A770:S770,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A771:S771,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A772:S772,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A773:S773,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A774:S774,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A775:S775,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A776:S776,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A777:S777,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A778:S778,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A779:S779,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A780:S780,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A781:S781,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A782:S782,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A783:S783,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A784:S784,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A785:S785,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A786:S786,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A787:S787,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A788:S788,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A789:S789,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A790:S790,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A791:S791,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A792:S792,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A793:S793,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A794:S794,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A795:S795,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A796:S796,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A797:S797,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A798:S798,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A799:S799,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A800:S800,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A801:S801,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A802:S802,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A803:S803,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A804:S804,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A805:S805,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A806:S806,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A807:S807,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A808:S808,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A809:S809,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A810:S810,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A811:S811,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A812:S812,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A813:S813,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A814:S814,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A815:S815,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A816:S816,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A817:S817,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A818:S818,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A819:S819,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A820:S820,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A821:S821,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A822:S822,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A823:S823,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A824:S824,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A825:S825,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A826:S826,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A827:S827,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A828:S828,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A829:S829,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A830:S830,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A831:S831,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A832:S832,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A833:S833,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A834:S834,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A835:S835,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A836:S836,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A837:S837,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A838:S838,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A839:S839,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A840:S840,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A841:S841,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A842:S842,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A843:S843,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A844:S844,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A845:S845,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A846:S846,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A847:S847,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A848:S848,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A849:S849,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A850:S850,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A851:S851,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A852:S852,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A853:S853,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A854:S854,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A855:S855,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A856:S856,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A857:S857,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A858:S858,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A859:S859,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A860:S860,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A861:S861,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A862:S862,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A863:S863,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A864:S864,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A865:S865,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A866:S866,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A867:S867,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A868:S868,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A869:S869,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A870:S870,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A871:S871,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A872:S872,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A873:S873,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A874:S874,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A875:S875,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A876:S876,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A877:S877,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A878:S878,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A879:S879,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A880:S880,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A881:S881,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A882:S882,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A883:S883,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A884:S884,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A885:S885,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A886:S886,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A887:S887,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A888:S888,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A889:S889,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A890:S890,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A891:S891,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A892:S892,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A893:S893,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A894:S894,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A895:S895,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A896:S896,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A897:S897,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A898:S898,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A899:S899,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A900:S900,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A901:S901,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A902:S902,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A903:S903,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A904:S904,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A905:S905,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A906:S906,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A907:S907,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A908:S908,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A909:S909,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A910:S910,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A911:S911,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A912:S912,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A913:S913,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A914:S914,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A915:S915,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A916:S916,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A917:S917,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A918:S918,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A919:S919,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A920:S920,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A921:S921,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A922:S922,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A923:S923,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A924:S924,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A925:S925,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A926:S926,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A927:S927,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A928:S928,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A929:S929,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A930:S930,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A931:S931,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A932:S932,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A933:S933,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A934:S934,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A935:S935,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A936:S936,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A937:S937,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A938:S938,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A939:S939,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A940:S940,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A941:S941,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A942:S942,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A943:S943,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A944:S944,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A945:S945,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A946:S946,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A947:S947,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A948:S948,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A949:S949,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A950:S950,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A951:S951,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A952:S952,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A953:S953,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A954:S954,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A955:S955,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A956:S956,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A957:S957,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A958:S958,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A959:S959,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A960:S960,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A961:S961,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A962:S962,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A963:S963,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A964:S964,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A965:S965,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A966:S966,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A967:S967,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A968:S968,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A969:S969,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A970:S970,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A971:S971,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A972:S972,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A973:S973,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A974:S974,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A975:S975,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A976:S976,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A977:S977,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A978:S978,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A979:S979,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A980:S980,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A981:S981,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A982:S982,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A983:S983,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A984:S984,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A985:S985,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A986:S986,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A987:S987,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A988:S988,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A989:S989,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A990:S990,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A991:S991,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A992:S992,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A993:S993,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A994:S994,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A995:S995,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A996:S996,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A997:S997,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A998:S998,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A999:S999,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1000:S1000,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1001:S1001,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1002:S1002,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1003:S1003,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1004:S1004,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1005:S1005,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1006:S1006,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1007:S1007,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1008:S1008,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1009:S1009,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1010:S1010,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1011:S1011,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1012:S1012,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1013:S1013,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1014:S1014,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1015:S1015,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1016:S1016,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1017:S1017,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1018:S1018,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1019:S1019,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1020:S1020,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1021:S1021,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1022:S1022,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1023:S1023,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1024:S1024,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1025:S1025,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1026:S1026,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1027:S1027,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1028:S1028,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1029:S1029,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1030:S1030,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1031:S1031,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1032:S1032,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1033:S1033,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1034:S1034,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1035:S1035,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1036:S1036,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1037:S1037,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1038:S1038,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1039:S1039,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1040:S1040,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1041:S1041,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1042:S1042,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1043:S1043,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1044:S1044,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1045:S1045,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1046:S1046,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1047:S1047,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1048:S1048,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1049:S1049,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1050:S1050,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1051:S1051,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1052:S1052,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1053:S1053,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1054:S1054,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1055:S1055,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1056:S1056,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1057:S1057,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1058:S1058,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1059:S1059,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1060:S1060,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1061:S1061,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1062:S1062,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1063:S1063,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1064:S1064,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1065:S1065,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1066:S1066,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1067:S1067,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1068:S1068,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1069:S1069,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1070:S1070,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1071:S1071,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1072:S1072,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1073:S1073,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1074:S1074,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1075:S1075,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1076:S1076,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1077:S1077,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1078:S1078,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1079:S1079,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1080:S1080,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1081:S1081,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1082:S1082,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1083:S1083,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1084:S1084,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1085:S1085,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1086:S1086,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1087:S1087,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1088:S1088,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1089:S1089,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1090:S1090,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1091:S1091,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1092:S1092,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1093:S1093,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1094:S1094,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1095:S1095,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1096:S1096,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1097:S1097,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1098:S1098,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1099:S1099,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1100:S1100,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1101:S1101,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1102:S1102,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1103:S1103,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1104:S1104,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1105:S1105,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1106:S1106,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1107:S1107,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1108:S1108,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1109:S1109,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1110:S1110,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1111:S1111,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1112:S1112,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1113:S1113,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1114:S1114,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1115:S1115,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1116:S1116,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1117:S1117,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1118:S1118,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1119:S1119,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1120:S1120,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1121:S1121,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1122:S1122,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1123:S1123,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1124:S1124,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1125:S1125,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1126:S1126,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1127:S1127,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1128:S1128,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1129:S1129,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1130:S1130,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1131:S1131,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1132:S1132,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1133:S1133,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1134:S1134,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1135:S1135,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1136:S1136,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1137:S1137,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1138:S1138,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1139:S1139,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1140:S1140,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1141:S1141,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1142:S1142,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1143:S1143,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1144:S1144,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1145:S1145,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1146:S1146,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1147:S1147,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1148:S1148,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1149:S1149,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1150:S1150,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1151:S1151,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1152:S1152,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1153:S1153,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1154:S1154,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1155:S1155,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1156:S1156,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1157:S1157,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1158:S1158,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1159:S1159,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1160:S1160,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1161:S1161,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1162:S1162,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1163:S1163,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1164:S1164,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1165:S1165,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1166:S1166,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1167:S1167,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1168:S1168,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1169:S1169,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1170:S1170,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1171:S1171,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1172:S1172,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1173:S1173,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1174:S1174,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1175:S1175,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1176:S1176,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1177:S1177,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1178:S1178,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1179:S1179,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1180:S1180,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1181:S1181,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1182:S1182,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1183:S1183,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1184:S1184,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1185:S1185,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1186:S1186,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1187:S1187,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1188:S1188,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1189:S1189,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1190:S1190,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1191:S1191,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1192:S1192,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1193:S1193,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1194:S1194,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1195:S1195,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1196:S1196,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1197:S1197,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1198:S1198,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1199:S1199,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1200:S1200,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1201:S1201,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1202:S1202,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1203:S1203,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1204:S1204,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1205:S1205,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1206:S1206,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1207:S1207,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1208:S1208,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1209:S1209,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1210:S1210,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1211:S1211,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1212:S1212,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1213:S1213,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1214:S1214,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1215:S1215,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1216:S1216,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1217:S1217,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1218:S1218,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1219:S1219,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1220:S1220,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1221:S1221,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1222:S1222,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1223:S1223,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1224:S1224,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1225:S1225,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1226:S1226,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1227:S1227,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1228:S1228,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1229:S1229,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1230:S1230,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1231:S1231,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1232:S1232,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1233:S1233,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1234:S1234,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1235:S1235,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1236:S1236,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1237:S1237,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1238:S1238,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1239:S1239,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1240:S1240,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1241:S1241,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1242:S1242,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1243:S1243,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1244:S1244,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1245:S1245,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1246:S1246,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1247:S1247,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1248:S1248,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1249:S1249,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1250:S1250,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1251:S1251,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1252:S1252,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1253:S1253,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1254:S1254,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1255:S1255,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1256:S1256,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1257:S1257,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1258:S1258,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1259:S1259,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1260:S1260,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1261:S1261,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1262:S1262,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1263:S1263,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1264:S1264,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1265:S1265,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1266:S1266,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1267:S1267,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1268:S1268,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1269:S1269,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1270:S1270,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1271:S1271,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1272:S1272,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1273:S1273,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1274:S1274,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1275:S1275,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1276:S1276,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1277:S1277,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1278:S1278,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1279:S1279,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1280:S1280,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1281:S1281,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1282:S1282,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1283:S1283,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1284:S1284,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1285:S1285,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1286:S1286,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1287:S1287,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1288:S1288,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1289:S1289,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1290:S1290,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1291:S1291,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1292:S1292,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1293:S1293,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1294:S1294,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1295:S1295,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1296:S1296,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1297:S1297,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1298:S1298,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1299:S1299,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1300:S1300,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1301:S1301,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1302:S1302,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1303:S1303,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1304:S1304,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1305:S1305,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1306:S1306,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1307:S1307,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1308:S1308,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1309:S1309,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1310:S1310,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1311:S1311,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1312:S1312,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1313:S1313,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1314:S1314,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1315:S1315,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1316:S1316,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1317:S1317,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1318:S1318,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1319:S1319,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1320:S1320,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1321:S1321,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1322:S1322,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1323:S1323,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1324:S1324,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1325:S1325,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1326:S1326,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1327:S1327,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1328:S1328,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1329:S1329,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1330:S1330,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1331:S1331,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1332:S1332,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1333:S1333,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1334:S1334,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1335:S1335,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1336:S1336,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1337:S1337,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1338:S1338,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1339:S1339,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1340:S1340,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1341:S1341,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1342:S1342,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1343:S1343,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1344:S1344,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1345:S1345,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1346:S1346,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1347:S1347,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1348:S1348,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1349:S1349,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1350:S1350,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1351:S1351,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1352:S1352,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1353:S1353,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1354:S1354,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1355:S1355,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1356:S1356,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1357:S1357,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1358:S1358,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1359:S1359,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1360:S1360,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1361:S1361,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1362:S1362,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1363:S1363,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1364:S1364,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1365:S1365,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1366:S1366,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1367:S1367,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1368:S1368,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1369:S1369,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1370:S1370,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1371:S1371,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1372:S1372,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1373:S1373,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1374:S1374,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1375:S1375,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1376:S1376,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1377:S1377,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1378:S1378,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1379:S1379,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1380:S1380,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1381:S1381,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1382:S1382,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1383:S1383,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1384:S1384,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1385:S1385,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1386:S1386,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1387:S1387,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1388:S1388,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1389:S1389,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1390:S1390,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1391:S1391,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1392:S1392,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1393:S1393,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1394:S1394,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1395:S1395,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1396:S1396,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1397:S1397,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1398:S1398,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1399:S1399,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1400:S1400,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1401:S1401,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1402:S1402,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1403:S1403,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1404:S1404,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1405:S1405,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1406:S1406,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1407:S1407,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1408:S1408,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1409:S1409,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1410:S1410,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1411:S1411,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1412:S1412,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1413:S1413,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1414:S1414,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1415:S1415,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1416:S1416,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1417:S1417,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1418:S1418,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1419:S1419,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1420:S1420,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1421:S1421,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1422:S1422,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1423:S1423,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1424:S1424,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1425:S1425,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1426:S1426,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1427:S1427,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1428:S1428,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1429:S1429,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1430:S1430,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1431:S1431,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1432:S1432,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1433:S1433,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1434:S1434,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1435:S1435,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1436:S1436,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1437:S1437,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1438:S1438,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1439:S1439,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1440:S1440,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1441:S1441,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1442:S1442,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1443:S1443,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1444:S1444,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1445:S1445,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1446:S1446,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1447:S1447,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1448:S1448,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1449:S1449,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1450:S1450,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1451:S1451,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1452:S1452,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1453:S1453,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1454:S1454,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1455:S1455,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1456:S1456,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1457:S1457,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1458:S1458,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1459:S1459,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1460:S1460,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1461:S1461,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1462:S1462,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1463:S1463,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1464:S1464,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1465:S1465,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1466:S1466,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1467:S1467,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1468:S1468,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1469:S1469,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1470:S1470,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1471:S1471,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1472:S1472,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1473:S1473,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1474:S1474,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1475:S1475,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1476:S1476,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1477:S1477,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1478:S1478,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1479:S1479,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1480:S1480,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1481:S1481,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1482:S1482,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1483:S1483,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1484:S1484,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1485:S1485,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1486:S1486,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1487:S1487,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1488:S1488,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1489:S1489,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1490:S1490,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1491:S1491,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1492:S1492,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1493:S1493,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1494:S1494,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1495:S1495,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1496:S1496,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1497:S1497,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1498:S1498,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1499:S1499,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1500:S1500,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1501:S1501,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1502:S1502,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1503:S1503,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1504:S1504,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1505:S1505,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1506:S1506,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1507:S1507,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1508:S1508,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1509:S1509,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1510:S1510,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1511:S1511,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1512:S1512,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1513:S1513,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1514:S1514,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1515:S1515,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1516:S1516,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1517:S1517,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1518:S1518,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1519:S1519,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1520:S1520,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1521:S1521,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1522:S1522,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1523:S1523,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1524:S1524,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1525:S1525,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1526:S1526,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1527:S1527,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1528:S1528,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1529:S1529,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1530:S1530,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1531:S1531,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1532:S1532,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1533:S1533,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1534:S1534,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1535:S1535,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1536:S1536,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1537:S1537,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1538:S1538,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1539:S1539,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1540:S1540,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1541:S1541,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1542:S1542,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1543:S1543,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1544:S1544,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1545:S1545,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1546:S1546,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1547:S1547,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1548:S1548,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1549:S1549,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1550:S1550,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1551:S1551,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1552:S1552,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1553:S1553,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1554:S1554,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1555:S1555,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1556:S1556,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1557:S1557,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1558:S1558,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1559:S1559,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1560:S1560,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1561:S1561,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1562:S1562,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1563:S1563,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1564:S1564,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1565:S1565,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1566:S1566,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1567:S1567,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1568:S1568,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1569:S1569,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1570:S1570,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1571:S1571,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1572:S1572,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1573:S1573,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1574:S1574,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1575:S1575,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1576:S1576,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1577:S1577,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1578:S1578,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1579:S1579,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1580:S1580,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1581:S1581,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1582:S1582,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1583:S1583,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1584:S1584,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1585:S1585,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1586:S1586,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1587:S1587,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1588:S1588,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1589:S1589,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1590:S1590,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1591:S1591,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1592:S1592,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1593:S1593,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1594:S1594,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1595:S1595,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1596:S1596,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1597:S1597,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1598:S1598,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1599:S1599,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1600:S1600,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1601:S1601,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1602:S1602,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1603:S1603,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1604:S1604,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1605:S1605,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1606:S1606,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1607:S1607,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1608:S1608,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1609:S1609,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1610:S1610,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1611:S1611,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1612:S1612,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1613:S1613,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1614:S1614,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1615:S1615,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1616:S1616,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1617:S1617,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1618:S1618,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1619:S1619,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1620:S1620,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1621:S1621,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1622:S1622,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1623:S1623,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1624:S1624,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1625:S1625,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1626:S1626,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1627:S1627,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1628:S1628,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1629:S1629,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1630:S1630,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1631:S1631,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1632:S1632,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1633:S1633,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1634:S1634,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1635:S1635,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1636:S1636,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1637:S1637,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1638:S1638,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1639:S1639,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1640:S1640,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1641:S1641,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1642:S1642,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1643:S1643,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1644:S1644,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1645:S1645,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1646:S1646,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1647:S1647,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1648:S1648,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1649:S1649,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1650:S1650,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1651:S1651,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1652:S1652,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1653:S1653,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1654:S1654,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1655:S1655,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1656:S1656,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1657:S1657,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1658:S1658,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1659:S1659,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1660:S1660,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1661:S1661,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1662:S1662,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1663:S1663,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1664:S1664,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1665:S1665,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1666:S1666,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1667:S1667,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1668:S1668,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1669:S1669,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1670:S1670,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1671:S1671,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1672:S1672,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1673:S1673,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1674:S1674,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1675:S1675,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1676:S1676,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1677:S1677,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1678:S1678,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1679:S1679,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1680:S1680,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1681:S1681,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1682:S1682,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1683:S1683,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1684:S1684,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1685:S1685,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1686:S1686,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1687:S1687,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1688:S1688,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1689:S1689,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1690:S1690,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1691:S1691,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1692:S1692,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1693:S1693,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1694:S1694,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1695:S1695,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1696:S1696,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1697:S1697,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1698:S1698,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1699:S1699,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1700:S1700,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1701:S1701,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1702:S1702,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1703:S1703,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1704:S1704,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1705:S1705,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1706:S1706,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1707:S1707,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1708:S1708,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1709:S1709,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1710:S1710,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1711:S1711,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1712:S1712,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1713:S1713,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1714:S1714,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1715:S1715,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1716:S1716,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1717:S1717,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1718:S1718,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1719:S1719,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1720:S1720,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1721:S1721,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1722:S1722,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1723:S1723,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1724:S1724,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1725:S1725,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1726:S1726,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1727:S1727,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1728:S1728,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1729:S1729,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1730:S1730,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1731:S1731,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1732:S1732,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1733:S1733,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1734:S1734,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1735:S1735,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1736:S1736,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1737:S1737,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1738:S1738,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1739:S1739,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1740:S1740,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1741:S1741,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1742:S1742,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1743:S1743,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1744:S1744,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1745:S1745,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1746:S1746,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1747:S1747,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1748:S1748,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1749:S1749,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1750:S1750,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1751:S1751,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1752:S1752,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1753:S1753,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1754:S1754,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1755:S1755,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1756:S1756,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1757:S1757,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1758:S1758,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1759:S1759,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1760:S1760,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1761:S1761,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1762:S1762,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1763:S1763,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1764:S1764,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1765:S1765,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1766:S1766,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1767:S1767,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1768:S1768,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1769:S1769,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1770:S1770,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1771:S1771,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1772:S1772,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1773:S1773,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1774:S1774,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1775:S1775,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1776:S1776,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1777:S1777,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1778:S1778,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1779:S1779,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1780:S1780,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1781:S1781,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1782:S1782,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1783:S1783,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1784:S1784,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1785:S1785,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1786:S1786,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1787:S1787,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1788:S1788,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1789:S1789,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1790:S1790,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1791:S1791,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1792:S1792,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1793:S1793,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1794:S1794,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1795:S1795,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1796:S1796,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1797:S1797,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1798:S1798,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1799:S1799,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1800:S1800,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1801:S1801,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1802:S1802,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1803:S1803,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1804:S1804,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1805:S1805,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1806:S1806,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1807:S1807,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1808:S1808,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1809:S1809,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1810:S1810,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1811:S1811,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1812:S1812,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1813:S1813,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1814:S1814,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1815:S1815,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1816:S1816,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1817:S1817,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1818:S1818,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1819:S1819,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1820:S1820,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1821:S1821,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1822:S1822,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1823:S1823,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1824:S1824,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1825:S1825,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1826:S1826,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1827:S1827,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1828:S1828,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1829:S1829,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1830:S1830,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1831:S1831,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1832:S1832,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1833:S1833,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1834:S1834,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1835:S1835,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1836:S1836,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1837:S1837,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1838:S1838,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1839:S1839,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1840:S1840,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1841:S1841,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1842:S1842,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1843:S1843,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1844:S1844,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1845:S1845,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1846:S1846,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1847:S1847,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1848:S1848,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1849:S1849,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1850:S1850,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1851:S1851,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1852:S1852,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1853:S1853,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1854:S1854,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1855:S1855,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1856:S1856,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1857:S1857,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1858:S1858,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1859:S1859,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1860:S1860,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1861:S1861,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1862:S1862,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1863:S1863,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1864:S1864,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1865:S1865,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1866:S1866,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1867:S1867,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1868:S1868,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1869:S1869,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1870:S1870,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1871:S1871,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1872:S1872,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1873:S1873,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1874:S1874,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1875:S1875,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1876:S1876,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1877:S1877,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1878:S1878,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1879:S1879,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1880:S1880,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1881:S1881,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1882:S1882,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1883:S1883,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1884:S1884,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1885:S1885,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1886:S1886,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1887:S1887,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1888:S1888,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1889:S1889,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1890:S1890,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1891:S1891,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1892:S1892,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1893:S1893,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1894:S1894,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1895:S1895,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1896:S1896,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1897:S1897,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1898:S1898,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1899:S1899,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1900:S1900,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1901:S1901,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1902:S1902,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1903:S1903,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1904:S1904,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1905:S1905,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1906:S1906,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1907:S1907,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1908:S1908,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1909:S1909,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1910:S1910,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1911:S1911,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1912:S1912,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1913:S1913,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1914:S1914,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1915:S1915,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1916:S1916,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1917:S1917,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1918:S1918,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1919:S1919,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1920:S1920,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1921:S1921,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1922:S1922,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1923:S1923,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1924:S1924,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1925:S1925,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1926:S1926,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1927:S1927,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1928:S1928,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1929:S1929,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1930:S1930,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1931:S1931,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1932:S1932,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1933:S1933,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1934:S1934,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1935:S1935,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1936:S1936,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1937:S1937,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1938:S1938,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1939:S1939,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1940:S1940,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1941:S1941,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1942:S1942,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1943:S1943,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1944:S1944,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1945:S1945,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1946:S1946,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1947:S1947,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1948:S1948,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1949:S1949,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1950:S1950,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1951:S1951,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1952:S1952,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1953:S1953,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1954:S1954,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1955:S1955,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1956:S1956,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1957:S1957,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1958:S1958,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1959:S1959,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1960:S1960,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1961:S1961,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1962:S1962,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1963:S1963,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1964:S1964,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1965:S1965,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1966:S1966,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1967:S1967,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1968:S1968,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1969:S1969,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1970:S1970,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1971:S1971,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1972:S1972,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1973:S1973,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1974:S1974,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1975:S1975,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1976:S1976,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1977:S1977,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1978:S1978,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1979:S1979,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1980:S1980,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1981:S1981,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1982:S1982,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1983:S1983,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1984:S1984,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1985:S1985,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1986:S1986,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1987:S1987,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1988:S1988,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1989:S1989,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1990:S1990,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1991:S1991,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1992:S1992,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1993:S1993,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1994:S1994,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1995:S1995,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1996:S1996,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1997:S1997,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1998:S1998,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A1999:S1999,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2000:S2000,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2001:S2001,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2002:S2002,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2003:S2003,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2004:S2004,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2005:S2005,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2006:S2006,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2007:S2007,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2008:S2008,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2009:S2009,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2010:S2010,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2011:S2011,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2012:S2012,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2013:S2013,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2014:S2014,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2015:S2015,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2016:S2016,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2017:S2017,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2018:S2018,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2019:S2019,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2020:S2020,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2021:S2021,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2022:S2022,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2023:S2023,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2024:S2024,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2025:S2025,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2026:S2026,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2027:S2027,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2028:S2028,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2029:S2029,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2030:S2030,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2031:S2031,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2032:S2032,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2033:S2033,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2034:S2034,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2035:S2035,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2036:S2036,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2037:S2037,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2038:S2038,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2039:S2039,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2040:S2040,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2041:S2041,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2042:S2042,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2043:S2043,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2044:S2044,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2045:S2045,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2046:S2046,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2047:S2047,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2048:S2048,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2049:S2049,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2050:S2050,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2051:S2051,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2052:S2052,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2053:S2053,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2054:S2054,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2055:S2055,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2056:S2056,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2057:S2057,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2058:S2058,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2059:S2059,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2060:S2060,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2061:S2061,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2062:S2062,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2063:S2063,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2064:S2064,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2065:S2065,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2066:S2066,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2067:S2067,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2068:S2068,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2069:S2069,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2070:S2070,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2071:S2071,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2072:S2072,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2073:S2073,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2074:S2074,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2075:S2075,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2076:S2076,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2077:S2077,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2078:S2078,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2079:S2079,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2080:S2080,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2081:S2081,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2082:S2082,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2083:S2083,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2084:S2084,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2085:S2085,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2086:S2086,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2087:S2087,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2088:S2088,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2089:S2089,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2090:S2090,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2091:S2091,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2092:S2092,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2093:S2093,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2094:S2094,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2095:S2095,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2096:S2096,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2097:S2097,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2098:S2098,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2099:S2099,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2100:S2100,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2101:S2101,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2102:S2102,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2103:S2103,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2104:S2104,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2105:S2105,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2106:S2106,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2107:S2107,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2108:S2108,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2109:S2109,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2110:S2110,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2111:S2111,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2112:S2112,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2113:S2113,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2114:S2114,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2115:S2115,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2116:S2116,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2117:S2117,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2118:S2118,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2119:S2119,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2120:S2120,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2121:S2121,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2122:S2122,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2123:S2123,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2124:S2124,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2125:S2125,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2126:S2126,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2127:S2127,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2128:S2128,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2129:S2129,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2130:S2130,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2131:S2131,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2132:S2132,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2133:S2133,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2134:S2134,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2135:S2135,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2136:S2136,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2137:S2137,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2138:S2138,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2139:S2139,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2140:S2140,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2141:S2141,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2142:S2142,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2143:S2143,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2144:S2144,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2145:S2145,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2146:S2146,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2147:S2147,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2148:S2148,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2149:S2149,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2150:S2150,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2151:S2151,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2152:S2152,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2153:S2153,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2154:S2154,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2155:S2155,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2156:S2156,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2157:S2157,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2158:S2158,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2159:S2159,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2160:S2160,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2161:S2161,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2162:S2162,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2163:S2163,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2164:S2164,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2165:S2165,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2166:S2166,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2167:S2167,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2168:S2168,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2169:S2169,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2170:S2170,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2171:S2171,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2172:S2172,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2173:S2173,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2174:S2174,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2175:S2175,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2176:S2176,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2177:S2177,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2178:S2178,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2179:S2179,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2180:S2180,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2181:S2181,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2182:S2182,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2183:S2183,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2184:S2184,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2185:S2185,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2186:S2186,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2187:S2187,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2188:S2188,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2189:S2189,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2190:S2190,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2191:S2191,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2192:S2192,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2193:S2193,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2194:S2194,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2195:S2195,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2196:S2196,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2197:S2197,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2198:S2198,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2199:S2199,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2200:S2200,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2201:S2201,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2202:S2202,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2203:S2203,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2204:S2204,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2205:S2205,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2206:S2206,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2207:S2207,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2208:S2208,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2209:S2209,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2210:S2210,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2211:S2211,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2212:S2212,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2213:S2213,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2214:S2214,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2215:S2215,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2216:S2216,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2217:S2217,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2218:S2218,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2219:S2219,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2220:S2220,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2221:S2221,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2222:S2222,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2223:S2223,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2224:S2224,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2225:S2225,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2226:S2226,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2227:S2227,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2228:S2228,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2229:S2229,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2230:S2230,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2231:S2231,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2232:S2232,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2233:S2233,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2234:S2234,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2235:S2235,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2236:S2236,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2237:S2237,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2238:S2238,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2239:S2239,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2240:S2240,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2241:S2241,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2242:S2242,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2243:S2243,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2244:S2244,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2245:S2245,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2246:S2246,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2247:S2247,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2248:S2248,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2249:S2249,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2250:S2250,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2251:S2251,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2252:S2252,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2253:S2253,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2254:S2254,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2255:S2255,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2256:S2256,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2257:S2257,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2258:S2258,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2259:S2259,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2260:S2260,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2261:S2261,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2262:S2262,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2263:S2263,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2264:S2264,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2265:S2265,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2266:S2266,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2267:S2267,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2268:S2268,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2269:S2269,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2270:S2270,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2271:S2271,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2272:S2272,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2273:S2273,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2274:S2274,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2275:S2275,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2276:S2276,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2277:S2277,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2278:S2278,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2279:S2279,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2280:S2280,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2281:S2281,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2282:S2282,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2283:S2283,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2284:S2284,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2285:S2285,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2286:S2286,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2287:S2287,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2288:S2288,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2289:S2289,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2290:S2290,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2291:S2291,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2292:S2292,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2293:S2293,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2294:S2294,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2295:S2295,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2296:S2296,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2297:S2297,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2298:S2298,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2299:S2299,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2300:S2300,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2301:S2301,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2302:S2302,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2303:S2303,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2304:S2304,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2305:S2305,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2306:S2306,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2307:S2307,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2308:S2308,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2309:S2309,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2310:S2310,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2311:S2311,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2312:S2312,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2313:S2313,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2314:S2314,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2315:S2315,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2316:S2316,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2317:S2317,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2318:S2318,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2319:S2319,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2320:S2320,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2321:S2321,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2322:S2322,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2323:S2323,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2324:S2324,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2325:S2325,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2326:S2326,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2327:S2327,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2328:S2328,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2329:S2329,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2330:S2330,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2331:S2331,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2332:S2332,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2333:S2333,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2334:S2334,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2335:S2335,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2336:S2336,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2337:S2337,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2338:S2338,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2339:S2339,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2340:S2340,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2341:S2341,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2342:S2342,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2343:S2343,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2344:S2344,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2345:S2345,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2346:S2346,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2347:S2347,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2348:S2348,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2349:S2349,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2350:S2350,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2351:S2351,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2352:S2352,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2353:S2353,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2354:S2354,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2355:S2355,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2356:S2356,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2357:S2357,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2358:S2358,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2359:S2359,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2360:S2360,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2361:S2361,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2362:S2362,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2363:S2363,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2364:S2364,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2365:S2365,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2366:S2366,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2367:S2367,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2368:S2368,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2369:S2369,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2370:S2370,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2371:S2371,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2372:S2372,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2373:S2373,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2374:S2374,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2375:S2375,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2376:S2376,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2377:S2377,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2378:S2378,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2379:S2379,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2380:S2380,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2381:S2381,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2382:S2382,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2383:S2383,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2384:S2384,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2385:S2385,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2386:S2386,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2387:S2387,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2388:S2388,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2389:S2389,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2390:S2390,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2391:S2391,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2392:S2392,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2393:S2393,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2394:S2394,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2395:S2395,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2396:S2396,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2397:S2397,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2398:S2398,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2399:S2399,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2400:S2400,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2401:S2401,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2402:S2402,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2403:S2403,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2404:S2404,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2405:S2405,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2406:S2406,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2407:S2407,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2408:S2408,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2409:S2409,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2410:S2410,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2411:S2411,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2412:S2412,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2413:S2413,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2414:S2414,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2415:S2415,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2416:S2416,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2417:S2417,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2418:S2418,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2419:S2419,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2420:S2420,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2421:S2421,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2422:S2422,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2423:S2423,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2424:S2424,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2425:S2425,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2426:S2426,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2427:S2427,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2428:S2428,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2429:S2429,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2430:S2430,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2431:S2431,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2432:S2432,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2433:S2433,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2434:S2434,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2435:S2435,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2436:S2436,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2437:S2437,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2438:S2438,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2439:S2439,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2440:S2440,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2441:S2441,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2442:S2442,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2443:S2443,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2444:S2444,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2445:S2445,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2446:S2446,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2447:S2447,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2448:S2448,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2449:S2449,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2450:S2450,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2451:S2451,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2452:S2452,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2453:S2453,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2454:S2454,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2455:S2455,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2456:S2456,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2457:S2457,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2458:S2458,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2459:S2459,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2460:S2460,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2461:S2461,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2462:S2462,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2463:S2463,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2464:S2464,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2465:S2465,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2466:S2466,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2467:S2467,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2468:S2468,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2469:S2469,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2470:S2470,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2471:S2471,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2472:S2472,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2473:S2473,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2474:S2474,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2475:S2475,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2476:S2476,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2477:S2477,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2478:S2478,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2479:S2479,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2480:S2480,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2481:S2481,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2482:S2482,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2483:S2483,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2484:S2484,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2485:S2485,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2486:S2486,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2487:S2487,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2488:S2488,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2489:S2489,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2490:S2490,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2491:S2491,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2492:S2492,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2493:S2493,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2494:S2494,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2495:S2495,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2496:S2496,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2497:S2497,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2498:S2498,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2499:S2499,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2500:S2500,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2501:S2501,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2502:S2502,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2503:S2503,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2504:S2504,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2505:S2505,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2506:S2506,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2507:S2507,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2508:S2508,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2509:S2509,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2510:S2510,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2511:S2511,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2512:S2512,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2513:S2513,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2514:S2514,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2515:S2515,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2516:S2516,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2517:S2517,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2518:S2518,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2519:S2519,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2520:S2520,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2521:S2521,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2522:S2522,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2523:S2523,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2524:S2524,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2525:S2525,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2526:S2526,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2527:S2527,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2528:S2528,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2529:S2529,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2530:S2530,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2531:S2531,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2532:S2532,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2533:S2533,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2534:S2534,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2535:S2535,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2536:S2536,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2537:S2537,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2538:S2538,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2539:S2539,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2540:S2540,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2541:S2541,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2542:S2542,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2543:S2543,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2544:S2544,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2545:S2545,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2546:S2546,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2547:S2547,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2548:S2548,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2549:S2549,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2550:S2550,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2551:S2551,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2552:S2552,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2553:S2553,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2554:S2554,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2555:S2555,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2556:S2556,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2557:S2557,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2558:S2558,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2559:S2559,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2560:S2560,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2561:S2561,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2562:S2562,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2563:S2563,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2564:S2564,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2565:S2565,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2566:S2566,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2567:S2567,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2568:S2568,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2569:S2569,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2570:S2570,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2571:S2571,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2572:S2572,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2573:S2573,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2574:S2574,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2575:S2575,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2576:S2576,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2577:S2577,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2578:S2578,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2579:S2579,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2580:S2580,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2581:S2581,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2582:S2582,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2583:S2583,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2584:S2584,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2585:S2585,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2586:S2586,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2587:S2587,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2588:S2588,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2589:S2589,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2590:S2590,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2591:S2591,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2592:S2592,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2593:S2593,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2594:S2594,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2595:S2595,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2596:S2596,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2597:S2597,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2598:S2598,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2599:S2599,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2600:S2600,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2601:S2601,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2602:S2602,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2603:S2603,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2604:S2604,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2605:S2605,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2606:S2606,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2607:S2607,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2608:S2608,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2609:S2609,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2610:S2610,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2611:S2611,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2612:S2612,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2613:S2613,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2614:S2614,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2615:S2615,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2616:S2616,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2617:S2617,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2618:S2618,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2619:S2619,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2620:S2620,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2621:S2621,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2622:S2622,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2623:S2623,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2624:S2624,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2625:S2625,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2626:S2626,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2627:S2627,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2628:S2628,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2629:S2629,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2630:S2630,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2631:S2631,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2632:S2632,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2633:S2633,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2634:S2634,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2635:S2635,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2636:S2636,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2637:S2637,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2638:S2638,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2639:S2639,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2640:S2640,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2641:S2641,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2642:S2642,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2643:S2643,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2644:S2644,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2645:S2645,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2646:S2646,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2647:S2647,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2648:S2648,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2649:S2649,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2650:S2650,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2651:S2651,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2652:S2652,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2653:S2653,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2654:S2654,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2655:S2655,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2656:S2656,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2657:S2657,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2658:S2658,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2659:S2659,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2660:S2660,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2661:S2661,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2662:S2662,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2663:S2663,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2664:S2664,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2665:S2665,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2666:S2666,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2667:S2667,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2668:S2668,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2669:S2669,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2670:S2670,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2671:S2671,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2672:S2672,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2673:S2673,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2674:S2674,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2675:S2675,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2676:S2676,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2677:S2677,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2678:S2678,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2679:S2679,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2680:S2680,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2681:S2681,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2682:S2682,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2683:S2683,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2684:S2684,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2685:S2685,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2686:S2686,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2687:S2687,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2688:S2688,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2689:S2689,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2690:S2690,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2691:S2691,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2692:S2692,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2693:S2693,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2694:S2694,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2695:S2695,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2696:S2696,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2697:S2697,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2698:S2698,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2699:S2699,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2700:S2700,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2701:S2701,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2702:S2702,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2703:S2703,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2704:S2704,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2705:S2705,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2706:S2706,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2707:S2707,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2708:S2708,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2709:S2709,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2710:S2710,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2711:S2711,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2712:S2712,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2713:S2713,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2714:S2714,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2715:S2715,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2716:S2716,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2717:S2717,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2718:S2718,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2719:S2719,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2720:S2720,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2721:S2721,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2722:S2722,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2723:S2723,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2724:S2724,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2725:S2725,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2726:S2726,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2727:S2727,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2728:S2728,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2729:S2729,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2730:S2730,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2731:S2731,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2732:S2732,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2733:S2733,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2734:S2734,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2735:S2735,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2736:S2736,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2737:S2737,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2738:S2738,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2739:S2739,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2740:S2740,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2741:S2741,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2742:S2742,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2743:S2743,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2744:S2744,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2745:S2745,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2746:S2746,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2747:S2747,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2748:S2748,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2749:S2749,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2750:S2750,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2751:S2751,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2752:S2752,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2753:S2753,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2754:S2754,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2755:S2755,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2756:S2756,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2757:S2757,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2758:S2758,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2759:S2759,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2760:S2760,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2761:S2761,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2762:S2762,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2763:S2763,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2764:S2764,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2765:S2765,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2766:S2766,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2767:S2767,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2768:S2768,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2769:S2769,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2770:S2770,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2771:S2771,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2772:S2772,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2773:S2773,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2774:S2774,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2775:S2775,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2776:S2776,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2777:S2777,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2778:S2778,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2779:S2779,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2780:S2780,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2781:S2781,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2782:S2782,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2783:S2783,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2784:S2784,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2785:S2785,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2786:S2786,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2787:S2787,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2788:S2788,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2789:S2789,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2790:S2790,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2791:S2791,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2792:S2792,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2793:S2793,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2794:S2794,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2795:S2795,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2796:S2796,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2797:S2797,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2798:S2798,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2799:S2799,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2800:S2800,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2801:S2801,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2802:S2802,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2803:S2803,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2804:S2804,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2805:S2805,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2806:S2806,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2807:S2807,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2808:S2808,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2809:S2809,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2810:S2810,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2811:S2811,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2812:S2812,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2813:S2813,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2814:S2814,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2815:S2815,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2816:S2816,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2817:S2817,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2818:S2818,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2819:S2819,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2820:S2820,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2821:S2821,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2822:S2822,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2823:S2823,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2824:S2824,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2825:S2825,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2826:S2826,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2827:S2827,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2828:S2828,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2829:S2829,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2830:S2830,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2831:S2831,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2832:S2832,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2833:S2833,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2834:S2834,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2835:S2835,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2836:S2836,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2837:S2837,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2838:S2838,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2839:S2839,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2840:S2840,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2841:S2841,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2842:S2842,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2843:S2843,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2844:S2844,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2845:S2845,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2846:S2846,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2847:S2847,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2848:S2848,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2849:S2849,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2850:S2850,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2851:S2851,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2852:S2852,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2853:S2853,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2854:S2854,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2855:S2855,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2856:S2856,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2857:S2857,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2858:S2858,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2859:S2859,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2860:S2860,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2861:S2861,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2862:S2862,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2863:S2863,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2864:S2864,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2865:S2865,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2866:S2866,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2867:S2867,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2868:S2868,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2869:S2869,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2870:S2870,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2871:S2871,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2872:S2872,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2873:S2873,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2874:S2874,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2875:S2875,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2876:S2876,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2877:S2877,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2878:S2878,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2879:S2879,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2880:S2880,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2881:S2881,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2882:S2882,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2883:S2883,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2884:S2884,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2885:S2885,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2886:S2886,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2887:S2887,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2888:S2888,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2889:S2889,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2890:S2890,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2891:S2891,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2892:S2892,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2893:S2893,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2894:S2894,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2895:S2895,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2896:S2896,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2897:S2897,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2898:S2898,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2899:S2899,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2900:S2900,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2901:S2901,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2902:S2902,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2903:S2903,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2904:S2904,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2905:S2905,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2906:S2906,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2907:S2907,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2908:S2908,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2909:S2909,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2910:S2910,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2911:S2911,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2912:S2912,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2913:S2913,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2914:S2914,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2915:S2915,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2916:S2916,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2917:S2917,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2918:S2918,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2919:S2919,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2920:S2920,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2921:S2921,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2922:S2922,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2923:S2923,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2924:S2924,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2925:S2925,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2926:S2926,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2927:S2927,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2928:S2928,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2929:S2929,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2930:S2930,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2931:S2931,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2932:S2932,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2933:S2933,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2934:S2934,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2935:S2935,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2936:S2936,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2937:S2937,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2938:S2938,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2939:S2939,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2940:S2940,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2941:S2941,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2942:S2942,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2943:S2943,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2944:S2944,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2945:S2945,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2946:S2946,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2947:S2947,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2948:S2948,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2949:S2949,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2950:S2950,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2951:S2951,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2952:S2952,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2953:S2953,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2954:S2954,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2955:S2955,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2956:S2956,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2957:S2957,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2958:S2958,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2959:S2959,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2960:S2960,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2961:S2961,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2962:S2962,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2963:S2963,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2964:S2964,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2965:S2965,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2966:S2966,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2967:S2967,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2968:S2968,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2969:S2969,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2970:S2970,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2971:S2971,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2972:S2972,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2973:S2973,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2974:S2974,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2975:S2975,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2976:S2976,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2977:S2977,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2978:S2978,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2979:S2979,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2980:S2980,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2981:S2981,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2982:S2982,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2983:S2983,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2984:S2984,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2985:S2985,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2986:S2986,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2987:S2987,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2988:S2988,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2989:S2989,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2990:S2990,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2991:S2991,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2992:S2992,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2993:S2993,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2994:S2994,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2995:S2995,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2996:S2996,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2997:S2997,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2998:S2998,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A2999:S2999,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3000:S3000,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3001:S3001,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3002:S3002,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3003:S3003,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3004:S3004,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3005:S3005,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3006:S3006,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3007:S3007,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3008:S3008,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3009:S3009,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3010:S3010,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3011:S3011,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3012:S3012,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3013:S3013,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3014:S3014,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3015:S3015,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3016:S3016,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3017:S3017,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3018:S3018,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3019:S3019,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3020:S3020,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3021:S3021,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3022:S3022,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3023:S3023,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3024:S3024,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3025:S3025,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3026:S3026,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3027:S3027,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3028:S3028,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3029:S3029,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3030:S3030,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3031:S3031,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3032:S3032,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3033:S3033,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3034:S3034,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3035:S3035,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3036:S3036,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3037:S3037,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3038:S3038,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3039:S3039,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3040:S3040,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3041:S3041,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3042:S3042,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3043:S3043,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3044:S3044,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3045:S3045,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3046:S3046,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3047:S3047,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3048:S3048,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3049:S3049,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3050:S3050,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3051:S3051,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3052:S3052,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3053:S3053,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3054:S3054,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3055:S3055,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3056:S3056,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3057:S3057,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3058:S3058,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3059:S3059,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3060:S3060,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3061:S3061,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3062:S3062,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3063:S3063,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3064:S3064,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3065:S3065,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3066:S3066,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3067:S3067,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3068:S3068,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3069:S3069,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3070:S3070,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3071:S3071,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3072:S3072,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3073:S3073,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3074:S3074,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3075:S3075,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3076:S3076,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3077:S3077,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3078:S3078,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3079:S3079,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3080:S3080,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3081:S3081,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3082:S3082,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3083:S3083,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3084:S3084,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3085:S3085,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3086:S3086,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3087:S3087,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3088:S3088,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3089:S3089,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3090:S3090,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3091:S3091,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3092:S3092,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3093:S3093,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3094:S3094,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3095:S3095,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3096:S3096,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3097:S3097,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3098:S3098,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3099:S3099,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3100:S3100,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3101:S3101,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3102:S3102,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3103:S3103,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3104:S3104,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3105:S3105,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3106:S3106,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3107:S3107,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3108:S3108,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3109:S3109,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3110:S3110,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3111:S3111,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3112:S3112,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3113:S3113,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3114:S3114,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3115:S3115,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3116:S3116,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3117:S3117,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3118:S3118,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3119:S3119,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3120:S3120,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3121:S3121,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3122:S3122,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3123:S3123,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3124:S3124,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3125:S3125,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3126:S3126,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3127:S3127,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3128:S3128,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3129:S3129,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3130:S3130,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3131:S3131,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3132:S3132,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3133:S3133,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3134:S3134,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3135:S3135,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3136:S3136,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3137:S3137,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3138:S3138,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3139:S3139,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3140:S3140,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3141:S3141,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3142:S3142,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3143:S3143,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3144:S3144,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3145:S3145,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3146:S3146,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3147:S3147,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3148:S3148,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3149:S3149,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3150:S3150,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3151:S3151,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3152:S3152,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3153:S3153,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3154:S3154,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3155:S3155,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3156:S3156,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3157:S3157,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3158:S3158,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3159:S3159,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3160:S3160,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3161:S3161,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3162:S3162,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3163:S3163,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3164:S3164,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3165:S3165,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3166:S3166,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3167:S3167,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3168:S3168,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3169:S3169,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3170:S3170,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3171:S3171,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3172:S3172,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3173:S3173,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3174:S3174,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3175:S3175,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3176:S3176,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3177:S3177,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3178:S3178,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3179:S3179,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3180:S3180,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3181:S3181,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3182:S3182,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3183:S3183,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3184:S3184,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3185:S3185,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3186:S3186,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3187:S3187,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3188:S3188,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3189:S3189,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3190:S3190,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3191:S3191,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3192:S3192,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3193:S3193,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3194:S3194,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3195:S3195,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3196:S3196,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3197:S3197,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3198:S3198,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3199:S3199,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3200:S3200,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3201:S3201,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3202:S3202,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3203:S3203,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3204:S3204,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3205:S3205,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3206:S3206,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3207:S3207,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3208:S3208,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3209:S3209,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3210:S3210,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3211:S3211,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3212:S3212,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3213:S3213,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3214:S3214,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3215:S3215,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3216:S3216,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3217:S3217,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3218:S3218,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3219:S3219,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3220:S3220,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3221:S3221,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3222:S3222,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3223:S3223,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3224:S3224,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3225:S3225,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3226:S3226,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3227:S3227,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3228:S3228,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3229:S3229,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3230:S3230,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3231:S3231,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3232:S3232,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3233:S3233,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3234:S3234,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3235:S3235,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3236:S3236,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3237:S3237,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3238:S3238,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3239:S3239,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3240:S3240,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3241:S3241,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3242:S3242,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3243:S3243,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3244:S3244,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3245:S3245,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3246:S3246,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3247:S3247,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3248:S3248,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3249:S3249,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3250:S3250,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3251:S3251,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3252:S3252,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3253:S3253,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3254:S3254,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3255:S3255,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3256:S3256,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3257:S3257,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3258:S3258,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3259:S3259,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3260:S3260,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3261:S3261,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3262:S3262,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3263:S3263,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3264:S3264,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3265:S3265,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3266:S3266,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3267:S3267,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3268:S3268,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3269:S3269,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3270:S3270,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3271:S3271,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3272:S3272,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3273:S3273,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3274:S3274,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3275:S3275,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3276:S3276,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3277:S3277,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3278:S3278,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3279:S3279,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3280:S3280,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3281:S3281,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3282:S3282,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3283:S3283,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3284:S3284,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3285:S3285,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3286:S3286,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3287:S3287,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3288:S3288,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3289:S3289,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3290:S3290,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3291:S3291,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3292:S3292,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3293:S3293,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3294:S3294,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3295:S3295,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3296:S3296,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3297:S3297,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3298:S3298,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3299:S3299,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3300:S3300,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3301:S3301,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3302:S3302,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3303:S3303,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3304:S3304,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3305:S3305,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3306:S3306,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3307:S3307,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3308:S3308,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3309:S3309,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3310:S3310,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3311:S3311,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3312:S3312,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3313:S3313,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3314:S3314,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3315:S3315,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3316:S3316,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3317:S3317,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3318:S3318,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3319:S3319,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3320:S3320,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3321:S3321,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3322:S3322,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3323:S3323,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3324:S3324,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3325:S3325,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3326:S3326,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3327:S3327,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3328:S3328,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3329:S3329,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3330:S3330,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3331:S3331,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3332:S3332,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3333:S3333,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3334:S3334,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3335:S3335,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3336:S3336,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3337:S3337,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3338:S3338,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3339:S3339,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3340:S3340,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3341:S3341,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3342:S3342,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3343:S3343,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3344:S3344,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3345:S3345,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3346:S3346,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3347:S3347,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3348:S3348,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3349:S3349,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3350:S3350,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3351:S3351,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3352:S3352,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3353:S3353,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3354:S3354,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3355:S3355,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3356:S3356,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3357:S3357,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3358:S3358,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3359:S3359,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3360:S3360,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3361:S3361,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3362:S3362,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3363:S3363,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3364:S3364,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3365:S3365,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3366:S3366,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3367:S3367,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3368:S3368,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3369:S3369,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3370:S3370,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3371:S3371,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3372:S3372,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3373:S3373,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3374:S3374,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3375:S3375,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3376:S3376,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3377:S3377,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3378:S3378,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3379:S3379,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3380:S3380,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3381:S3381,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3382:S3382,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3383:S3383,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3384:S3384,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3385:S3385,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3386:S3386,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3387:S3387,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3388:S3388,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3389:S3389,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3390:S3390,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3391:S3391,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3392:S3392,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3393:S3393,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3394:S3394,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3395:S3395,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3396:S3396,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3397:S3397,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3398:S3398,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3399:S3399,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3400:S3400,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3401:S3401,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3402:S3402,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3403:S3403,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3404:S3404,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3405:S3405,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3406:S3406,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3407:S3407,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3408:S3408,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3409:S3409,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3410:S3410,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3411:S3411,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3412:S3412,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3413:S3413,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3414:S3414,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3415:S3415,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3416:S3416,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3417:S3417,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3418:S3418,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3419:S3419,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3420:S3420,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3421:S3421,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3422:S3422,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3423:S3423,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3424:S3424,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3425:S3425,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3426:S3426,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3427:S3427,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3428:S3428,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3429:S3429,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3430:S3430,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3431:S3431,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3432:S3432,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3433:S3433,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3434:S3434,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3435:S3435,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3436:S3436,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3437:S3437,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3438:S3438,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3439:S3439,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3440:S3440,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3441:S3441,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3442:S3442,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3443:S3443,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3444:S3444,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3445:S3445,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3446:S3446,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3447:S3447,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3448:S3448,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3449:S3449,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3450:S3450,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3451:S3451,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3452:S3452,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3453:S3453,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3454:S3454,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3455:S3455,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3456:S3456,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3457:S3457,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3458:S3458,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3459:S3459,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3460:S3460,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3461:S3461,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3462:S3462,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3463:S3463,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3464:S3464,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3465:S3465,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3466:S3466,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3467:S3467,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3468:S3468,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3469:S3469,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3470:S3470,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3471:S3471,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3472:S3472,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3473:S3473,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3474:S3474,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3475:S3475,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3476:S3476,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3477:S3477,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3478:S3478,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3479:S3479,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3480:S3480,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3481:S3481,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3482:S3482,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3483:S3483,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3484:S3484,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3485:S3485,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3486:S3486,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3487:S3487,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3488:S3488,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3489:S3489,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3490:S3490,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3491:S3491,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3492:S3492,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3493:S3493,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3494:S3494,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3495:S3495,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3496:S3496,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3497:S3497,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3498:S3498,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3499:S3499,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3500:S3500,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3501:S3501,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3502:S3502,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3503:S3503,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3504:S3504,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3505:S3505,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3506:S3506,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3507:S3507,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3508:S3508,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3509:S3509,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3510:S3510,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3511:S3511,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3512:S3512,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3513:S3513,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3514:S3514,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3515:S3515,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3516:S3516,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3517:S3517,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3518:S3518,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3519:S3519,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3520:S3520,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3521:S3521,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3522:S3522,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3523:S3523,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3524:S3524,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3525:S3525,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3526:S3526,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3527:S3527,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3528:S3528,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3529:S3529,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3530:S3530,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3531:S3531,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3532:S3532,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3533:S3533,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3534:S3534,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3535:S3535,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3536:S3536,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3537:S3537,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3538:S3538,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3539:S3539,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3540:S3540,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3541:S3541,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3542:S3542,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3543:S3543,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3544:S3544,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3545:S3545,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3546:S3546,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3547:S3547,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3548:S3548,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3549:S3549,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3550:S3550,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3551:S3551,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3552:S3552,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3553:S3553,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3554:S3554,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3555:S3555,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3556:S3556,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3557:S3557,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3558:S3558,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3559:S3559,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3560:S3560,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3561:S3561,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Codes&Desc'!A3562:S3562,,$K$4)","v":0}]